Health workforce in the Eastern Mediterranean Region: From COVID-19 lessons to actions

The COVID-19 pandemic has had a devastating and unprecedented impact on health and health systems globally leaving an indelible mark on health system infrastructures. The pandemic also clearly demonstrated the critical role of health workers for well-performing health systems, in particular during emergencies and have prompted the need to undergo a critical re-evaluation of health systems and health workforce design and implementation. As the year 2023 marks the halfway point of the 2030 Agenda for Sustainable development, the time is pertinent for action by governments and partners to scale up the health workforce to advance towards sustainable developement goal (SDG) 3 on health and well-being and other health-related SDGs, building on the lessons from COVID-19. Therefore, at the 70th session of World Health Organization Regional Committee for Eastern Mediterranean, Member States unanimously adopted a resolution to call for accelerated actions to address health workforce challenges through solidarity, alignment, and synergy of efforts in order to rebuild resilient health systems after the COVID-19 pandemic.

Call to Action: Investigating Interaction Delay in Smartphone Notifications

Notifications are an essential part of the user experience on smart mobile devices. While some apps have to notify users immediately after an event occurs, others can schedule notifications strategically to notify them only on opportune moments. This tailoring allows apps to shorten the users' interaction delay. In this paper, we present the results of a comprehensive study that identified the factors that influence users' interaction delay to their smartphone notifications. We analyzed almost 10 million notifications collected in-the-wild from 922 users and computed their response times with regard to their demographics, their Big Five personality trait scores and the device's charging state. Depending on the app category, the following tendencies can be identified over the course of the day: Most notifications were logged in late morning and late afternoon. This number decreases in the evening, between 8 p.m. and 11 p.m., and at the same time exhibits the lowest average interaction delays at daytime. We also found that the user's sex and age is significantly associated with the response time. Based on the results of our study, we encourage developers to incorporate more information on the user and the executing device in their notification strategy to notify users more effectively.

On Putting an End to the Backlash Against Electrophysical Agents

Electrophysical agents (EPAs) are core therapeutic interventions in academic physical therapy curricula around the world. They are used concomitantly with several other therapeutic interventions such as exercise, manual therapy techniques, medications, and surgery for the management of a wide variety of soft tissue disorders. Over the past decade, the practice of EPAs has been the subject of intense scrutiny in the U.S. This has been colored by some physical therapists publicly engaging in bashing rhetoric that has yet to be officially and publicly addressed by the guiding organizations which, together, regulate the practice of physical therapy in this country. Published in world renowned public media are unsubstantiated mocking remarks against the practice of EPAs and unethical allegations against its stakeholders. This rhetoric suggests that EPA interventions are "magical" treatments and that those practitioners who include them in their plans of care may be committing fraud. Such bashing rhetoric is in striking contradiction to the APTA's Guide to Physical Therapist Practice 4.0, which lists EPAs as one of its categories of interventions, the CAPTE's program accreditation policy, and the FSBPT's national licensing exam. The purpose of this commentary is to expose the extent of this discourse and to call to action the APTA, CAPTE, and FSBPT organizations, as well as physical therapists, with the aim at putting an end to this rhetoric.

The Importance of Gender-Neutral Terminology in Risk Evaluation and Mitigation Strategy Programs: A Call to Action

The use of risk evaluation and mitigation strategy (REMS) programs is frequently required for prescriptions with potentially teratogenic effects, especially in the field of dermatology. Among these REMS programs, the most well-known example is isotretinoin, an oral retinoid that uses the iPLEDGE system. iPLEDGE has strict regulations and a lengthy approval process, and until recently, patients were grouped into 3 categories: male, female, or female of reproductive potential. This strict grouping has posed problems in the medical community, especially for gender-diverse individuals where their perceived gender conflates with their assigned grouping causing patient-specific distress. The distinction between gender-a multifactorial perception of identity-and biological sex is addressed under new iPLEDGE guidelines. Dermatologists now register patients under one of 2 categories: patients who can become pregnant and those who cannot become pregnant. This change simultaneously improves the accessibility to isotretinoin among gender-diverse individuals, while limiting prescription barriers. Despite initial success being limited due to lengthy system conversions, a registration process based on reproductive potential ultimately enhances iPLEDGE's goal to prevent potential birth defects. We propose that other REMS programs follow the standard set by the iPLEDGE system, including those for the medications thalidomide, acitretin, and mycophenolate mofetil, all of which currently have a similar taxonomy to that of the old iPLEDGE system. Implementing the standardization of gender-neutral terminology can maximize enrollment and minimize distress. Current and ongoing refinement of iPLEDGE and other REMS is needed to build protocols solely around the prevention of birth defects without regard to sex or gender.

Perpetuating Victimization with Efforts to Reduce Human Trafficking: a Call to Action for Massage Therapist Protection

Human trafficking guised as massage therapy businesses is a highly successful business model that creates independent but related victims beyond the women and girls forced into sex work. Massage clinicians and the massage therapy profession are also negatively impacted by the trafficking massage business model with over 9,000 established illicit massage businesses marketing services alongside professional therapeutic massage businesses. Credential regulation efforts advocated for by various massage-related professional organizations and regulating agencies have fallen short in their purported intentions to protect massage therapists and trafficking victims. Massage industry advocates continue endorsing massage therapy as a branch of health care although health-care workers are not generally considered or treated as sex workers. Sexual harassment research in direct patient care disciplines, such as physical therapy and nursing, points to a high patient initiated incident rate and transdisciplinary, detrimental mental health outcomes for clinicians. Reporting and debriefing instances of sexual harassment inside of health-care organizations, covered by The Civil Rights Act of 1964, promotes a victim-centered perspective to support the well-being of past, current, and pending victims. The massage therapy workforce is comprised of mainly female sole proprietors, creating a double vulnerability in their potential to experience sexual harassment. This threat is compounded by little-to-no protective or supporting systems or networks for massage clinicians. The priorities of professional massage organizations to depend on credentialing and licensing as their primary efforts to fight human trafficking, seems more to perpetuate the current system/expectations, leaving individual massage therapists responsible for fighting or reeducation deviant sexualized behaviors. This critical commentary closes with a call to action aimed at professional massage organizations, regulators, and corporations to protect massage therapists through a unified position, supported in word, policy, and action, against sexual harassment, and unequivocally condemns professional massage devaluation and sexualization in all forms.

The role of mental health professionals in the climate crisis: an urgent call to action

The climate and ecological crisis will constitute the defining public health challenge of the twenty-first century, posing an unprecedented global threat to all determinants of health, and to healthcare delivery systems. We believe that mental health professionals have a crucial role to play in responding to this crisis. Whilst responding to the mental health consequences of the climate crisis will remain a key role for us as mental health professionals, we argue that our remit goes beyond this, and should include advancing public understanding of the climate crisis, highlighting its impact on physical and mental wellbeing, and advocating for systemic changes to limit its impending harms. This paper is an urgent call to action for all mental health professionals to take up a role in the context of the climate and ecological crisis. This paper will describe the relationship between mental health and climate change, and frame it within wider systemic and conceptual frameworks. It will demonstrate that as mental health professionals we are well placed to act as leaders of change-arguing that we have a duty to do so-and suggest actions that can be implemented depending on interests, skill sets and opportunities.

Disparities in pancreatic cancer care and research in Native Americans: Righting a history of wrongs

Disparities in pancreatic cancer incidence and outcomes exist in Native American populations. These disparities are multifactorial, difficult to quantify, and are influenced by historical, socioeconomic, and health care structural factors. The objective of this article was to assess these factors and offer a call to action to overcome them. The authors reviewed published data on pancreatic cancer in Native American populations with a focus on disparities in incidence, outcomes, and research efforts. The historical context of the interactions between Native Americans and the United States health care system was also analyzed to form actionable items to build trust and collaboration. The incidence of pancreatic cancer in Native Americans is higher than that in the general US population and has the worst survival of any major racial or ethnic group. These outcomes are influenced by a patient population with often poor access to high-quality cancer care, historical trauma potentially leading to reduced care utilization, and a lack of research focused on etiologies and comorbid conditions that contribute to these disparities. A collaborative effort between nontribal and tribal leaders and cancer centers is key to addressing disparities in pancreatic cancer outcomes and research. More population-level studies are needed to better understand the incidence, etiologies, and comorbid conditions of pancreatic cancer in Native Americans. Finally, a concerted, focused effort should be undertaken between nontribal and tribal entities to increase the access of Native Americans to high-quality care for pancreatic cancer and other lethal malignancies.

Accountability in promoting representation of historically marginalized racial and ethnic populations in the eating disorders field: A call to action

Promoting representation of historically marginalized racial and ethnic populations in the eating disorders (EDs) field among professionals and the populations studied and served has long been discussed, with limited progress. This may be due to a reinforcing feedback loop in which individuals from dominant cultures conduct research and deliver treatment, participate in research, and receive diagnoses and treatment. This insularity maintains underrepresentation: EDs in historically marginalized populations are understudied, undetected, and undertreated. An Early Career Investigators Workshop generated recommendations for change that were not inherently novel but made apparent that accountability is missing. This paper serves as a call to action to spearhead a paradigm shift from equality to equity in the ED field. We provide a theoretical framework, suggest ways to disrupt the feedback loop, and summarize actionable steps to increase accountability in ED leadership and research toward enhancing racial/ethnic justice, equity, diversity, and inclusion (JEDI). These actionable steps are outlined in the service of challenging our field to reflect the diversity of our global community. We must develop and implement measurable metrics to assess our progress toward increasing diversity of underrepresented racial/ethnic groups and to address JEDI issues in our providers, patients, and research participants.

Ophthalmologists and climate change

It is indisputable that human activities have caused climate change and that, if left unchecked, these activities will lead to worsening of weather extremes including fire, drought, and flood with all their attendant human suffering. Reducing future climate change requires limiting cumulative emissions of CO₂ and other greenhouse gases including methane. We have written this evidence-based perspective to highlight interventions with the largest effect to help the average ophthalmologist make the changes with the highest impact in their day-to-day lives.

Digital Health Management During and Beyond the COVID-19 Pandemic: Opportunities, Barriers, and Recommendations

During the coronavirus disease (COVID-19) crisis, digital technologies have become a major route for accessing remote care. Therefore, the need to ensure that these tools are safe and effective has never been greater. We raise five calls to action to ensure the safety, availability, and long-term sustainability of these technologies: (1) due diligence: remove harmful health apps from app stores; (2) data insights: use relevant health data insights from high-quality digital tools to inform the greater response to COVID-19; (3) freely available resources: make high-quality digital health tools available without charge, where possible, and for as long as possible, especially to those who are most vulnerable; (4) digital transitioning: transform conventional offline mental health services to make them digitally available; and (5) population self-management: encourage governments and insurers to work with developers to look at how digital health management could be subsidized or funded. We believe this should be carried out at the population level, rather than at a prescription level.

Determined Action to Tackle Health Determinants: A Collaborative Response to the Challenge of Climate Change Mitigation in Practice Settings

The physical environment has long been understood as a major determinant of health and well-being. In recent years, the relationship between health and the environment has become particularly pronounced, with the impacts of climate change identified as having the potential to reverse the last 50 years of public health advancement (Watts et al., 2015). Increasingly, professional bodies within health care are called upon to frame climate change as a health issue. Despite this, studies have found that nurses report feeling ill-equipped to respond to environmental changes and the resulting health impacts (Anåker, Nilsson, Holmner, & Elf, 2015; Lewis, 2018; Polivka, Chaudry, & Mac Crawford, 2011). This article recognizes some of the barriers facing concerned health-care professionals who wish to introduce climate mitigation activities within their sphere of professional operation. The Australian Nursing and Midwifery Federation (Victorian Branch) was approached by nurses, midwives, and carers, to become more involved in policy debates surrounding climate change and to provide stronger support to members in responding to environmental issues. The result is top-down and bottom-up responses working in synergy for climate change mitigation, by empowering nurses to make changes to their professional practice.