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Background: Since 2006, Taiwan has actively pursued the development of its medical tourism industry. In 2013, the government sought to bolster this sector by integrating medical tourism into the Free Economic Pilot Zones. Despite narrowly missing the mark, the initiative failed to materialize into law. This qualitative study endeavors to discern the pertinent factors influencing the agenda-setting process for incorporating medical tourism into the Free Economic Pilot Zones in Taiwan. Methods: A comprehensive examination of policies concerning the legitimation of medical tourism within the Free Economic Pilot Zones was undertaken through semi-structured interviews and a thorough review of policy documents. Key informants were strategically selected using purposive and snowball sampling techniques. Thematic analysis was applied to scrutinize the amassed data and organize it within the framework of Kingdon's multiple streams. Results: In the problem stream, increasing financial strains and cost containment pressures under the National Health Insurance program have long driven health care providers to seek further opportunities in medical tourism. The existing barriers to expanding medical tourism in Taiwan included diplomatic tensions (specifically cross-strait relations), public concerns about commercialization of medical care and reduced their access to care, and legal and language barriers. Within the policy stream, factors such as franchise fees to support national health insurance, limited number of demonstration medical tourism sites and services allowed, the allowance of foreign medical personnel, regulations governing domestic physicians, the importance of demonstration, regulation, and accreditation, as well as restrictions on investment from China, were emphasized. The politics stream highlights factors such as governmental support, opposition from opposing parties, public concerns and critics from academia and non-governmental organizations, and skepticism from medical faculties. Conclusion: Acknowledging the recognized challenges in enacting the medical tourism provision of the Free Economic Pilot Zones Special Act and emphasizing the political will of leadership, a viable policy solution remained elusive. Although a window of opportunity existed for the passage of the bill, it waned as public concerns sidelined the issue from the national agenda. The Taiwan case underscores the necessity for meticulous consideration of issues, proposed solutions, and political dynamics to achieve successful policy enactment. [ABSTRACT FROM AUTHOR]

The purpose of the article is a comprehensive analysis of the current legislation of Ukraine and the scientific works of Ukrainian and foreign scientists in the field of health care. The study makes it possible to consider the realization of equal opportunities in receiving healthcare services according to the state healthcare policy. In particular, this research ounlines that the state shall ensure the availability of free medical assistance and medical services. The article pays special attention to the problem of financing. It is noted that work in this direction should include two components - internal and external, which affect the factors of improving health care management. In general, due to the modern development of the medical industry of Ukraine being complicated by COVID-19 and military actions, the search for additional sources of funding for health care is becoming especially urgent. The article also analyzes how medical institutions performs their functions under the conditions of COVID-19 and warfare in Ukraine. [ABSTRACT FROM AUTHOR]

Background: Survivors of critical illness experience high rates of serious health-related suffering. The delivery of palliative care may assist in decreasing this burden for survivors and their families. Objectives: To understand beliefs, attitudes, and experiences of post-intensive care unit (ICU) program clinicians regarding palliative care and explore barriers and facilitators to incorporating palliative care into critical illness survivorship care. Design: Qualitative inquiry using semistructured interviews and framework analysis. Results were mapped using the Consolidated Framework for Implementation Research. Setting/Subjects: We interviewed 29 international members (United States, United Kingdom, Canada) of the Critical and Acute Illness Recovery Organization post-ICU clinic collaborative. Results: All interprofessional clinicians described components of palliative care as essential to post-ICU clinic practice, including symptom management, patient/family support, facilitation of goal-concordant care, expectation management and anticipatory guidance, spiritual support, and discussion of future health care wishes and advance care planning. Facilitators promoting palliative care strategies were clinician level, including first-hand experience, perceived value, and a positive attitude regarding palliative care. Clinician-level barriers were reciprocals and included insufficient palliative care knowledge, lack of self-efficacy, and a perceived need to protect ICU survivors from interventions the clinician felt may adversely affect recovery or change the care trajectory. System-level barriers included time constraints, cost, and lack of specialty palliative care services. Conclusion: Palliative care may be an essential element of post-ICU clinic care. Implementation efforts focused on tailoring strategies to improve post-ICU program clinicians' palliative care knowledge and self-efficacy could be a key to enhanced care delivery for survivors of critical illness. [ABSTRACT FROM AUTHOR]

Hiring foreign domestic helpers has been seen as a policy to release females from household responsibilities so they can join the labor market. Surprisingly, few studies explore the relative importance of needs to taking care children and elderly. Employing the 2016 Hong Kong census, we found that the number of elderly persons and the number of young children in the household are positively associated with the decision to hire foreign domestic helpers. Our analysis also demonstrates that members are more likely to choose to work and outsource the care of young children to foreign domestic helpers. However, the findings show that households are more likely to take care of elderly without helpers even when household members are employed. Household members may co-ordinate and allocate time to take care of their elderly instead of outsourcing the care to a foreign domestic helper. [ABSTRACT FROM AUTHOR]

Background Radiofrequency ablation (RFA) is the most effective non-pharmacological approach in the reduction of ventricular tachycardia (VT) recurrence. However, it is crucial to thoroughly screen every patient for contraindications for RFA and provide appropriate pharmacological prophylaxis, if needed, since adverse effects may be fatal. Case summary A 77-year-old male with multi-vessel coronary artery disease, heart failure with reduced ejection fraction (New York Heart Association (NYHA) Class III), with implantable cardioverter-defibrillator was admitted to our clinic due to recurrent life-threatening VT. The patient presented several concomitant diseases: dyslipidaemia, hypertension, and chronic kidney disease in Stage IIIB. He had a history of two myocardial infarctions and coronary artery bypass grafts complicated by mediastinitis and dehiscence of a sternotomy scar (2013). Radiofrequency ablation and pace mapping of VT were performed in sterile conditions, but no pre-operative antibiotic prophylaxis was administered. There were no local or general complications in the post-operative period. The patient was discharged from the clinic in good condition. A week later, the patient suffered from septic shock and infective endocarditis of mitral valve complicated with infiltration of the ventricular septum, wall dissection of the left ventricle (LV), pseudoaneurysm, and abscess of the LV. At the time of the second hospitalization extensive dental carries were found and oral cavity sanitation was performed. Due to the severity of the condition, patient did not survive. Conclusion Oral cavity infections are common but often overlooked, mainly when the RFA procedure is urgent. A thorough physical examination, including a dental check-up, is crucial to minimize the risk of potential infection of the endocardial tissue and maximize the benefits of the therapy. Still, it is possible that the myocardial infection was not a result of oral cavity infection but a result of other undiagnosed and untreated infection. Contamination of the procedure site with patients' own microbiota or foreign microorganisms by the medical personnel is also a likely and unfortunate scenario. The presented case highlights the significance of not only prophylaxis, screening, and treatment of possible inflammation sites before RFA but also the need for sustaining sanitary standards and sterile conditions. [ABSTRACT FROM AUTHOR]

When an increasing number of cases strained the country's healthcare system, the COVID-19 pandemic exposed the Philippines' workforce vulnerabilities even further. The Philippine government responded by imposing a deployment ban for healthcare workers going abroad in 2020, followed by a deployment cap in 2021. This paper focused on the policy development stage, specifically analyzing the factors that influenced the development of the deployment cap to address the Philippines' problem on healthcare worker shortage. Various sources of information were gathered by conducting a literature and document review, including local main news sources, published literature, government records, organizational documents, position statements, and social media posts from key interest groups such as professional groups and civil servants. The 3I+E (Institutions, Interests, Ideas and External Factors) Framework was used to analyze the factors influencing the policy formulation/development process. Although worker migration has long been accepted as a means of economic salvation for families in the Philippine labor culture, during the COVID-19 crisis, it was viewed as a significant factor and controlling it appeared to be a viable solution to keeping an adequate number of healthcare workers in the country. The deployment cap policy can be viewed as a decision to strike a balance between workforce availability and economic disruption. [ABSTRACT FROM AUTHOR]

This article reports on a study that examined the lived experience of 15 foreign-born female university faculty members through the qualitative research methodology called photo elicitation. The article investigates ways in which intersectionality, social marginality, and resilience offer a framework for understanding the participants' lived experiences of being foreign-born, female, and academic in the United States. Findings demonstrate that as non-native-born women, the faculty members faced multi-faceted challenges in both personal and professional realms. Implications for the role of social work advocacy and higher education policy advocacy are discussed. [ABSTRACT FROM AUTHOR]

Reflective practice is an important and influential component of social work and is often perceived as a contributing factor to professional development, experiential learning, and practice growth. However, the relationship between reflective practice and practitioner self-care, resiliency, and well-being is not commonly discussed. Furthermore, reflective practice is also not often examined within international domains of social work practice, and how practitioners who are working abroad and away from their home communities utilize reflective practice. This doctoral research project sought to explore the impact of reflective practice on workers who were practicing social work in a global development capacity. These workers crossed international borders as they practiced in foreign contexts. A meaningful discovery was how reflective practice was discussed as a conduit for self-care as practitioners worked in challenging and complex conditions that often lacked formal supervision and support. Participants spoke of how they coped with challenges by engaging in reflective practice. [ABSTRACT FROM AUTHOR]

Background Many studies report that foreign-born healthcare workers (HCWs) in high-income countries have an elevated risk of COVID-19. However, research has not yet specifically evaluated the distribution of COVID-19 among foreign-born workers in different healthcare work groups. We examined the risk of COVID-19 infection and hospitalization among foreign-born HCWs in different occupational roles in Sweden. Methods We linked occupational data (2019) of 783 950 employed foreign-born workers (20–65 years) to COVID-19 data registered between 1 January 2020 and 30 September 2021. We used Cox proportional hazards regression to estimate the hazard ratio (HR) with 95% confidence intervals (95% CIs) of COVID-19 infection and hospitalization in eight healthcare occupational groups vs. non-HCWs and assessed whether region of birth modified the association between healthcare occupations and COVID-19. Results All HCWs had a higher risk of COVID-19 outcomes than non-HCWs, but the risk differed by occupational role. Hospital-based assistant nurses had the highest risk (infection: HR 1.78; 95% CI 1.72–1.85; hospitalization: HR 1.79; 95% CI 1.52–2.11); allied HCWs had the lowest risk (infection: HR 1.22; 95% CI 1.10–1.35; hospitalization: HR 0.98; 95% CI 0.59–1.63). The relative hazard of the outcomes varied across foreign-born workers from different regions. For example, the relative risk of COVID-19 infection associated with being a physician compared to a non-HCW was 31% higher for African-born than European-born workers. Conclusions The risk of COVID-19 among foreign-born HCWs differed by occupational role and immigrant background. Public health efforts that target occupational exposures as well as incorporate culturally responsive measures may help reduce COVID-19 risk among foreign-born HCWs. [ABSTRACT FROM AUTHOR]

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Aim: To understand the prevalence of depressive symptoms among foreign caregivers and the associated factors. Design: A cross‐sectional study. Methods: Data from 178 Indonesian foreign caregivers, selected based on convenience and snowball sampling in Taiwan, were collected between July 2019 and February 2020 using questionnaires. Stepwise multiple linear regression was used to identify the factors associated with depressive symptoms. Results: Approximately 30.3% of the foreign caregivers displayed depressive symptoms. The symptoms were more prevalent among the participants who were younger; had more social support; shared a bed with others; and experienced higher work‐related stress, more loneliness and physical discomfort. The findings suggest that nurses or nurse practitioners visiting patients at home should not only deliver care for them but also show concern for the psychological well‐being of the foreign caregivers of these patients. Moreover, interventions should be developed to alleviate or prevent the emergence of depressive symptoms among foreign caregivers. [ABSTRACT FROM AUTHOR]

Aim: To explore transition experiences of Middle Eastern qualified midwives into practice in Australia. Design: This was a qualitative study using multiple case narrative approach underpinned by structuration theory. Methods: A total of 19 Middle Eastern qualified midwives from different states of Australia participated in this study. Individual semi‐structured interviews were conducted between November 2020 and September 2021, digitally recorded and then transcribed. Transcriptions were analysed in three stages, with three main categories generated in the second stage and a core category that was developed in third. Results: Entering the Australian workforce, Middle Eastern qualified midwives had to reframe their professional identities to fit the new system by adjusting to three aspects of the practice, including preparation for practice, scope of practice and context of practice. While they were prepared by medically oriented curricula, worked in systems that had limitations for midwives to practise in antenatal and postnatal and lacked regulation standards, they learned to practise autonomously in their full scope in a standardized context in Australia. Conclusion: Middle Eastern qualified midwives in Australia re‐evaluated their practice in their home countries, realized the gaps and adjusted to new ways of practising in Australia. Impact To effectively use the potential of Middle Eastern midwives for workforce sustainability in Australia, support should be available to enable them to develop the necessary competencies for safe practice in Australia including provision of context‐specific transition programmes prior to registration and supporting mentorship after their integration into the Australian healthcare workforce. Patient or public contribution: Patient or public contribution does not apply to this study as its purpose was to explore the transition experiences of Middle Eastern qualified midwives themselves. [ABSTRACT FROM AUTHOR]

Background and Objectives With a growing aging stroke population and the changing structure of the society, the demand for foreign caregivers has rapidly increased in Taiwan and many other developed countries. However, little is known regarding the perception, values, and abilities of foreign caregivers and how those may influence their quality of care. This study aimed to explore and describe the experiences of Indonesian foreign caregivers, the largest migrant working population in Taiwan, who reside with and provide support to older adults with stroke and their families. Research Design and Methods By adopting a descriptive qualitative approach, we conducted semistructured interviews with 22 Indonesian caregivers (mean age: 36 years) who were providing care to community-dwelling older stroke survivors (age ≥ 65 years) in Taiwan. Data were analyzed through thematic analysis. Results Six themes were constructed from the interviews: (a) foreign caregiver's background, (b) foreign caregiver's perception of the health and functional status of stroke survivors, (c) foreign caregiver's values and preferences, (d) consequences of caring for stroke survivors, (e) skills/abilities/knowledge of foreign caregivers to provide stroke survivors with required care, and (f) potential resources that foreign caregivers can use. Discussion and Implications Foreign caregivers described the positive and negative aspects of caring for stroke survivors. Differences in language, religion, culture, values, and expectations between foreign caregivers and stroke survivors influence the caregiving experience. These findings can help Taiwan and other developed countries to better support foreign caregivers providing critical care to older adults with stroke and their families. [ABSTRACT FROM AUTHOR]

"Biculturation": Transnational social workers navigating movement into indigenous space in Aotearoa New Zealand Based on 20 semi-structured interviews, participants identified their learning, including formal learning, learning through practice, and learning by being in relationship with Māori. Challenges identified by participants involved having little structured orientation to a new culture, feeling judged and significant cultural differences. Suggestions from participants to improve the process of transition include having a systemic approach to learning about the bicultural environment, provision of mandatory bicultural work induction and providing cultural supervision once in practice. [ABSTRACT FROM AUTHOR]

Background: There is growing concern about the sustainability and long-term impact of short-term medical missions (STMMs)—an increasingly common form of foreign medical aid—given that brief engagements do little to address the underlying poverty and fragmented healthcare system that plagues many low- and middle-income countries (LMICs). In the absence of formal evaluations, unintended but serious consequences for patients and local communities may arise, including a lack of continuity of patient care, poor alignment with community needs, and cultural and language barriers. Objective: We conducted semi-structured interviews with Honduran healthcare providers (n = 88) in 2015 to explore local providers' perceptions of the impact and sustainability of foreign medical aid on patient needs, community health, and the country's healthcare system. Methods: Respondents represented a random sample of Honduran healthcare providers (physicians, dentists, nurses) who worked for either a government-run rural clinic or non-governmental organization (NGO) in Honduras. Findings: Honduran healthcare providers largely framed foreign medical teams as being assets that help to advance community health through the provision of medical personnel and supplies. Nonetheless, most respondents identified strategies to improve implementation of STMMs and reduce negative impacts. Many respondents emphasized a need for culturally- and linguistically-tailored medical care and health education interventions. Participants also recommended strengthening local partnerships to mitigate the risk of dependence, including on-going training and support of community health workers to promote sustainable change. Conclusions: Guidelines informed by local Honduran expertise are needed to increase accountability for more robust training of foreign physicians in the provision of context-appropriate care. These findings provide valuable local perspectives from Honduran healthcare providers to improve the development and implementation of STMMs, informing strategies that can complement and strengthen healthcare systems in LMICs. [ABSTRACT FROM AUTHOR]

In clinical practice, due to foreign caregivers coming from different countries, when nursing staff teach the chest percussion skills to foreign caregivers, language barriers prevent them from fully understand the purpose and method. This leads to problems in patient's chest percussion care skills and indirectly affects the recovery of the lungs. Reasons that contribute to this issue are: the content of the Chinese health education leaflet is unreadable; the pictures are unclear; general difficulty in communication; lacks of teaching aids and standard procedures for checking and guiding the chest claw skill of foreign caregivers. An improvement project started from May 2019 to Oct 2019, used a strategy that included (I) Holding a course of chest percussion nursing instruction (II) Establishing a standard procedure for thoracic percussions (III) Creating a picture card of "Lung Spur Sputum Shooting and Postural Drainage Care Skills-Easy to Learn_Chinese and Indian Version " (IV) Production and filming of the instructional video of "Chest percussion for foreign caregivers" in Hindi Version". After these interventions, the accuracy rate of foreign caregivers' recognition in thoracic percussion care increased from 41.2% to 85.7%, and the accuracy rate of skills increased from 35.6% to 83.1%. [ABSTRACT FROM AUTHOR]

Objective: To identify facilitators and barriers and derive concrete measures towards better workplace integration of migrants working in the German healthcare sector. Design: Two-centre cross-sectional quantitative online survey of experiences of discrimination among healthcare professionals with a migration history in two large German university hospitals. Participants: 251 participants fully completed the questionnaires. Main outcome measures: Experiences of discrimination and perception of inequality. Results: Fifty-five percent of migrant health workers had had at least some command of German before arriving in Germany. Members of all professional groups surveyed expressed experiences of discrimination related to language, nationality, race/ethnicity, and sex/gender. The proportions of staff with experiences of discrimination by peers differed significantly among occupational roles, with nurses and technologists having the most experiences of discrimination. The perception of inequality was reported more frequently than experiences of discrimination and had a negative impact on workplace satisfaction. Specifically, the compulsion to compete was a frequent feeling stated by participants. Conclusion: The mechanisms of discrimination and structural inequality revealed by our survey could inform specific measures, for example at the management level, to increase workplace satisfaction and attract migrant health workers in the long term. [ABSTRACT FROM AUTHOR]

Aim(s): The main aim of this article is to outline the devastating aftereffects of COVID‐19 in terms of ethical recruitment and the respect of dignity of nurses and health care professionals. Background: Nations experience the ominous impacts of the COVID‐19 pandemic in terms of an exacerbated shortage of nurses worldwide. In this situation, migration flows of nurses are skyrocketing and the respect of the migrant nurses' dignity as human beings should be guaranteed. Evaluation: Data from reports elaborated by the International Centre on Nurse Migration (ICNM) were examined and outlined the central role of the respect of dignity of every nurse to prevent unethical exploitation of them. Key issue(s): The respect of human dignity is a complex concept. Human dignity denotes the inner nature of human beings but also their rights at work. Conclusion(s): In a post‐COVID‐19 world with increased flows of nurse migration, it is crucial to guarantee dignity at work for migrant nurses. Implications for Nursing Management: Nurse leaders should prioritize the ethical recruitment of health care workers and give a prominent role to the WHO 'Code of Practice on the International Recruitment of Health Personnel' which recognizes the ethical bedrocks of employment. [ABSTRACT FROM AUTHOR]

A remarkable rise in outsourcing domestic labor has been well documented, but the scope of the existing studies is limited. This study aims at investigating the factors and duration of using live-in domestic help in Hong Kong. The study also aims at disentangling the cross-sectional patterns in using paid domestic help into two different patterns: differential risks in the transition into the practice and the differential risks in the transition out from the practice. This study analyzes retrospective life-history data from a representative household survey (N = 2003). Discrete-time logit models were employed. The results show that employing live-in helpers is a stable practice that could last for more than a decade. Yet, the factors for using and ending the practice are different. The results show that the flexible outsourcing framework could satisfactorily explain the families employing live-in helpers but is less applicable in explaining the duration of the practice. [ABSTRACT FROM AUTHOR]

The article reports on a new fast-track process introduced by the Medical Board of Australia to expedite the entry of urgently needed internationally trained medical specialists into the Australian healthcare system.

In order to understand the difficulties faced by highly skilled foreign professionals when dealing with the Japanese healthcare system and to identify the support they require therein, university health center staff members of the Okinawa Institute of Science and Technology Graduate University conducted semi-structured interviews with faculty, staff, and students from the Institute. Data from the interviews were analyzed by subject matter analysis using a narrative-oriented approach. In total, 13 participants were interviewed, and five themes and 15 subthemes were generated from the 40 codes extracted. Although participants considered themselves to be accepting of other cultures and made little mention of the need for cultural and religious considerations that previous studies have identified as important, they reported that their experiences receiving healthcare in Japan were fraught with many difficulties. They felt that the capacity to communicate in Japanese was a prerequisite for receiving appropriate healthcare and that hospitals should assume the responsibility of providing language support. While they reported satisfaction with the easy and inexpensive access to advanced medical equipment and specialists in Japan, they also noted challenges in selecting medical institutions and departments, the flow and procedures in the hospital, and building open and direct relationships with doctors. In addition, based on the present study, people with chronic illnesses felt isolated from the community, worried about a lack of privacy, and wanted a primary care physician they could trust. In order to provide appropriate healthcare to foreigners, we require an accurate understanding of their needs, how to address these comprehensively and in a multifaceted manner, and how the communication responsibilities should be shared among the involved parties (i.e., foreign care recipients and Japanese medical professionals). [ABSTRACT FROM AUTHOR]

The demand for social workers in England has been outstripping supply for more than a decade. As a result, social work continues to be on the UK Shortage Occupation List (2021; available online at: https://www.gov.uk/guidance/immigration-rules/immigration-rules-appendix-shortage-occupation-list (accessed May 26, 2021), ensuring the migration of social workers will continue. While several studies have examined the experiences of migrating social workers, these studies largely neglected the impact culture plays in this transition. This article will focus on the experiences of social workers who were trained in India and migrated to England. It is part of a much larger study that used a mixed method approach to explore the migration to England of social workers from eight different countries. Indian social workers highlighted the significant differences between the individualistic character of English culture and the much more collectivist Indian culture. This difference shaped a range of attitudes towards the family and parenting, as well as the distinctions between what is 'public' or 'communal' and what is 'private'. Other differences raised were regarding communication resulting from the more hierarchical tendencies of Indian society. In the final section, implications for practice are discussed and recommendations are made for the induction required to help future migrating social workers make a smoother transition. [ABSTRACT FROM AUTHOR]

Rift Valley fever (RVF) is a zoonotic disease which leads to livestock losses and human fatalities, thus impoverishing pastoralists who largely depend on livestock for their livelihood. These losses lead to both short- and long-term effects that perpetuate poverty and disrupt family order and structure. We used qualitative methods to understand the lived experiences of pastoralists with RVF after a major outbreak in Kenya. Using narratives, we identified the social, economic and psychological effects of this disease, while focus group discussions helped us to understand the experiences of the pastoralists during and after an outbreak. The major impacts were deprivation and impoverishment, abrupt disruption to their way of life and family dynamics and mistrust of the formal healthcare system. The latter was related to the isolation of patients and the presence of foreign medical personnel in the area that fueled mistrust. Efforts need to be made by public health practitioners and policy-makers to enhance dialogue between clinicians and pastoralists and to come up with practical ways of improving local people's livelihoods during and after an RVF epidemic. [ABSTRACT FROM AUTHOR]

Organ donation rates in the United States are lowest among Asians. Physicians are highly respected in Asian communities and may be influential in promoting donor registration, but little is known about their organ donor registration attitudes. We assessed associations between knowledge, attitudes, personal/professional experience, cultural/religious beliefs surrounding organ donation and donor registration status using multivariable logistic regression. We surveyed 121 Asian physicians in Queens, New York; 22% were registered donors. Registered donors were more likely to discuss donation wishes with their family (OR 9.47, 95% CI 2.60–34.51), know that donor human leukocyte antigen does not need to match organ recipients (OR 6.47, 95% CI 1.66–25.28), and have experience advising patients about organ donation (OR 5.35, 95% CI 1.50–19.02). Culturally tailored educational materials providing updated information to promote family discussion about organ donation could potentially increase Asian physicians' level of comfort and expertise in discussing organ donor registration with patients. [ABSTRACT FROM AUTHOR]

The expatriate literature needs to move beyond maladjustment as a primary reason for expatriate failure. This article draws on the psychological contract as a valuable lens to observe changes in expatriate behavior that may determine expatriate success or failure on international assignments. Prior research on the expatriate psychological contract has focused solely on an expatriate's social exchange relationship with the assigning parent company. This article offers a dual-foci perspective of the expatriate psychological contract and suggests that expatriates' perceptions of psychological contract breach arise from two sources-the assigning parent company and the receiving host company. The conceptualization of breach with dual foci forms the basis for the proposed model of expatriate failure. The model proposes that differences in expatriates' contexts will influence their likelihood of perceiving breach and that breach, once perceived, will affect expatriate behavior through its influence on sense-making, affect, conation, and attitudes. The propositions developed in this article provide a foundation for future theorizing and empirical work on expatriate cognitions of psychological contract breach. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

The article offers information on the experiences and considerations of taking an executive clinical leadership post abroad after a career in the NHS. Topics include the impact of working overseas on family dynamics, the complexities of the relocation process, and the adaptation to new professional and cultural environments.

Interest in global health is rising in graduate medical education. Trainees are increasingly seeking high-quality, ethically sound, and educationally robust opportunities for global medical rotations (Int J Gynecol Obstet. 2014;128(2): 148-51). When based on best educational practices, these opportunities can provide a unique learning experience for residents in traditional physical medicine and rehabilitation programs. This article describes the development of an international rotation in physical medicine and rehabilitation including specific competency-based physical medicine and rehabilitation global health learning objectives, predeparture training, rotation structure, and postrotation feedback mechanisms. The aim is to present the development of the program as a resource for both residents and program directors to help create and maximize existing rotations at their own institutions. Learners must complete predeparture requirements that include completion of a musculoskeletal rotation and global health didactics intended to provide foundational knowledge in physiatry and global health. Postrotation requirements include the residency program's standardized evaluation form, resident survey, and self-reflection essay. Experience from a novel 4-wk pilot rotation to Punta Gorda, Belize, is described to exemplify Accreditation Council for Graduate Medical Education-based learning objectives as well as the benefits of a formalized rotation structure. Using this unique set of learning objectives and proposed rotation requirements, the authors believe that physical medicine and rehabilitation residency programs can develop valuable global health learning experiences. [ABSTRACT FROM AUTHOR]

The phenomenon of emerging-market organizations appointing foreign executives from distant cultural contexts to headquarters positions has stirred public and academic interest. Emerging giants, aspiring multinationals, and even local organizations that focus entirely on domestic markets have joined the global hunt for management talent. This article reports why foreign executives from significant cultural distance are appointed to local headquarters positions, what they contribute, and why these positions are not filled with local executives. Data are sourced from in-depth interviews with two sample groups in organizations founded and headquartered in Malaysia (46 foreign executives from 13 countries and 25 host-country peers from three local ethnocultural groups). Triangulation of dyadic data from these two sample groups reveals a dichotomy between the initial reasons for which foreign executives are appointed and the continued reasons why some of these executives remain in their positions. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Identity and representation remain some of the most complex aspects of what it means to practice medicine. These themes' plurality and diverse expressions are particularly challenging in medical school admissions decisions. This article offers a personal viewpoint on intersections among race, class, and culture and key roles each plays in driving equitable, inclusive admissions that motivate diversity in medicine. [ABSTRACT FROM AUTHOR]

Choosing to work abroad without the sponsorship of an organisation is becoming increasingly commonplace, and this is a defining characteristic of self-initiated expatriates (SIE). Previous research suggests that SIEs' willingness to interact and adapt to new cultural occupational settings, and their motivational cultural intelligence or cultural quotient (motivational CQ), are particularly important qualities, and that these qualities are related to their levels of job satisfaction. However, it remains unclear how motivational CQ interacts with specific situational aspects of the workplace, such as role clarity and power distance. This study examines the contributions made by motivational CQ and its interaction with power distance in relation to role clarity to determining subsequent job satisfaction. The results indicate that motivational CQ is positively related to role clarity, which helps to improve job satisfaction, and that this indirect effect is moderated by power distance. Furthermore, this pattern of effects is more apparent for Chinese SIEs than for British SIEs. We discuss the theoretical and practical implications of the findings, as well as the limitations of the study. [ABSTRACT FROM AUTHOR]

The current article focused on examining the potential benefits of the End-of-Life (EoL) informal caregiving, communication, and ritualistic behaviors in adaptation to the conjugal bereavement across two different cultural-background contexts: France and Togo, West Africa. The investigation adopted a transnational approach including a total of 235 bereaved spouses. Despite the variation in the length of time since death, no significant difference was found between the Togolese and French bereaved with respect to the level of complicated grief symptoms. However, the Togolese bereaved perceived a significant postloss growth, fostered by EoL communication with the dying and the performance of ritualistic behaviors. In the French sample, bereaved individuals who had experienced more intimate communication with their dying spouse reported a high level of postloss growth. Moreover, findings showed that EoL caregiving without ritualistic support or communication is associated with poor postbereavement outcomes. These findings suggest a clinical need to promote informal caregiving to the dying, communication with the dying, and ritualistic support during the process of dying as entangled components of EoL care. [ABSTRACT FROM AUTHOR]

BACKGROUND: The World Health Organization (WHO) has declared novel coronavirus (COVID-19) infection a global pandemic due to the fast transmission of this disease worldwide. To prevent and slow the transmission of this contagious illness, the public health officials of many affected countries scrambled to introduce measures aimed at controlling its spread. As a result, unprecedented interventions/measures, including strict contact tracing, quarantine of entire towns/cities, closing of borders and travel restrictions, have been implemented by most of the affected countries including the Kingdom of Saudi Arabia. OBJECTIVES: The aim of this paper is to share health care professionals' perspectives who are experiencing COVID19 firsthand in a foreign land. In addition, the role of the Saudi governance to combat the current situation is also discussed. DISCUSSION: Personal and previous experiences as related to Middle East respiratory syndrome coronavirus (MERS-CoV) by the authors has been compared to the current situation and how it affected our thoughts and management. A review of the evidence-based literature was conducted to investigate the demographics of the region; and to understand the awareness of the various tools that are available and how they were utilized in the present situation of pandemic. CONCLUSIONS: Saudi Arabia has been challenged during the pandemic as are other countries. [ABSTRACT FROM AUTHOR]

Objective. To develop a "knowledge-attitude-practice" questionnaire as an evaluating tool of foreigners' cognition on TCM treatment, so as to promote the internationalization of TCM. Methods. The questionnaire was based on the "knowledge-attitude-practice" model and adjusted by expert consultation using the Delphi method. After conducting a survey among foreigners, Cronbach's α and exploratory factor analysis were used to test the internal consistency reliability and structural validity of the questionnaire, respectively. Results. A total of 10 experts participated in two rounds of expert consultation. The recovery rates of two rounds of expert consultation form were 100.0%. The coefficient authority in two rounds of expert consultation was 0.87 and 0.88, respectively. The concentration of expert opinions in the knowledge, attitude, and practice dimensions was 3.80 to 4.70 points, 3.70 to 4.50 points, and 3.60 to 4.40 points, respectively, in the first round and 4.30 to 4.80 points, 4.10 to 4.60 points, and 4.00 to 4.50 points, respectively, in the second round. The coefficient of variation in the knowledge, attitude, and practice dimensions was 0.10–0.32, 0.16–0.29, and 0.19–0.35, respectively, in the first round and 0.09–0.19, 0.15–0.25, and 0.16–0.31, respectively, in the second round. The W value and significance test x 2 in the first round were 0.657 and 218.620 while those in the second round were 0.671 and 181.181 P < 0.001 . 8 items were deleted and 1 item was added, and other reserved items were modified according to the statistical analysis results of evaluation items and expert suggestions after the first round and there were no changes after the second round. The revised questionnaire includes three dimensions of knowledge, attitude, and practice, with a total of 30 items. After translating the questionnaire into English, it was conducted in 176 foreigners. Cronbach's α coefficient of the total questionnaire, knowledge dimension, attitude dimension, and practice dimension was 0.908, 0.781, 0.823, and 0.918, respectively. Exploratory factor analysis extracted 3 factors with a cumulative contribution of 54.090%. After testing reliability and validity, 1 item was deleted, leaving 29 items. Conclusions. After two rounds of expert consultation based on the Delphi method, the results of expert authority, expert coordination, and expert opinions' concentration were promising, and the expert consultation results were reliable. The "knowledge-attitude-practice" questionnaire of foreigners on TCM treatment in English had good reliability and validity and can evaluate foreigners' cognition on TCM treatment. [ABSTRACT FROM AUTHOR]

Objective. To analyze health practice transformations in health providers in Mexico. Materials and methods. We used qualitative data to explore transnational health practices of men with migration experience to the US, healthcare professionals in Mexico from eight rural communities, and Mexican providers in US. Data used came from a study that explored transnational health practices in the context of migration. Results. Healthcare professionals provided care to migrants through remote consultations or via a family member, and in-person during migrants' visits or by healthcare professionals relocating to migrants' destination communities in the US. The remote consultations mainly caused three changes in the field of medical practice: providing care without a patient review or clinical examination, long-distance prescription of medications, and provision of care mediated by a family member. Conclusions. Changes in their medical practice shifted roles of healthcare professionals and of migrants as patients, transforming the hegemonic biomedical model in Mexico. [ABSTRACT FROM AUTHOR]

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Many doctors work or train in foreign countries and speak with a foreign accent. People sometimes assume that a person who speaks with a foreign accent possesses negative traits and personality characteristics. The purpose of this study is to test if doctors who speak with a foreign accent are perceived as less competent than doctors who speak with a standard accent. Both Caucasian Canadian and Chinese Canadian undergraduates rated the competence of a doctor speaking English with either a standard Canadian accent or a Chinese accent. The doctor was delivering either good or bad news about the patient's cholesterol levels or cancer. Previous research has shown that when reminded of death, participants favor in-group members. We found that the Chinese-accented doctor's competence was judged more negatively than the standard Canadian accented doctor by all participants. Both doctors were deemed less competent when delivering bad news than good news. These results suggest that foreign-accented doctors face biases about their competence from their patients. [ABSTRACT FROM AUTHOR]

Purpose: This paper presents the phenomenon of stigmatisation among injured immigrant and ethnocultural minority workers experiencing a long-standing disability. Stigmatisation was one of the main findings of our study, the aim of which was to gain insight into the work rehabilitation process in the context of intercultural relations in Quebec. Various categories of stakeholders took part in the study, which sought to describe their experiences and perspectives and to identify the constraints, barriers, facilitators, and specific needs they encounter in terms of intercultural competencies. Methods: A purposive sample of 40 individuals was selected and divided into four groups: workers (N = 9), clinicians (N = 15), workers' compensation board rehabilitation experts (N = 14), and workplace representatives (N = 2). Semi-structured interviews were conducted using the critical incident technique, combined with an "explicitation" interviewing technique. Data collection and analysis procedures were based on grounded theory. Results: This study shows that immigrant and ethnocultural minority workers may experience stigmatisation as a cumulative process involving different concomitant parts of their "identity": age, gender, social class, ethnicity, mental health, and occupational injuries. Cumulative stigma may aggravate personal distress and feelings of shame, rejection, and disqualification from full social acceptance. Negative anticipatory judgements made by practitioners may undermine the therapeutic relationship and breach mutual trust and confidence. Conclusions: The phenomenon of stigmatisation is well documented in the sociological and health literature, but studies tend to focus on only one type of stigma at a time. Future research should focus on the cumulative process of stigmatisation specifically affecting immigrant and ethnocultural minority workers and its potentially damaging impact on self-concept, healthcare delivery, rehabilitation interventions, and the return to work. The repetition of certain clinical situations with people from certain groups should not lead practitioners to undue generalizations, even if they may sometimes be accurate; these generalizations must always be verified on a case by case basis. Ethnicity and culture, along with other social attributions, should serve as working hypotheses or support tools in health communication, not as hindrances to clinical reasoning. Practitioners should deepen their understanding of the patient's treatment expectations and the support available for rehabilitation in his family and community. Stigma in the context of care is linked to the idea of conforming to the proposed institutional models of care (including expected beliefs, attitudes, and behaviours). Therefore, practitioners should be aware that alleged differences, misunderstanding or disagreements can highlight an asymmetry in practitioner–patient power relationships. Organisations should also promote exchange and reflection on how to adapt their institutional models to avoid asymmetrical power relations. Intercultural training should be promoted at the various organisational levels so that managers, decision-makers, and practitioners share a common knowledge of the challenges of intervention in multi-ethnic settings. [ABSTRACT FROM AUTHOR]

In this article the author talks about the practices and policies of the recruitment industry for foreign-educated health professionals (FEHPs) which has gradually increased. It mentions that in 2006, Academy Health, a health care think tank, convened a multistake holder task force to research the international nurse recruitment industry.

Cancer is one of Europe's key research missions, with gender equity a major policy pillar. To benchmark how well European countries perform for gender balance in cancer research, high quality intelligence is required. For cancer research papers in Europe (EUR31; the 28 EU Member States plus Iceland, Norway and Switzerland) from two specific years (2009 and 2019), we evaluated the numbers of female authors overall and then the female last-author presence, as a proxy of female cancer research leadership. Overall, female authorship increased from 42% to 49%. In 2009, females represented 50% or more of cancer research authors in only five EUR31 countries. By 2019, that number had risen to 17. In Eastern European (EE) countries, females were more likely to be in the majority. The presence of female cancer research authors in the last (senior) author position increased from 24% to 34%. Five of the top six countries for female authorship in 2019 were from EE, whereas disappointingly four central European countries (Austria (AT), Czechia (CZ), Germany (DE) and Switzerland (CH)) were below the 25th percentile. A number of European powerhouses of cancer research (UK, DE, CH) underperformed in terms of female cancer research leadership. However, when cancer researchers from these countries worked abroad (e.g. Scandinavia, USA) the percentage of females was similar to that of their host countries. A factor potentially influencing female cancer research participation was availability and relative cost of child-care, which is more favourable in Scandinavia and EE than in central/western Europe. Our data show that Horizon Europe's Cancer Mission must ensure gender equity in its future research programmes and support the enhancement of female cancer research leadership opportunities. • First paper of its kind to evaluate gender inequity in cancer research in Europe. • Highlights significant gender bias in female cancer research leadership in Europe. • Gender inequity more pronounced in some of Europe's powerhouses of cancer research. • Female cancer research leadership more favoured in Eastern Europe and Scandinavia. • Cancer research leadership may be influenced by availability and cost of childcare. [ABSTRACT FROM AUTHOR]

The relevance of language for quality healthcare delivery cannot be overemphasised. Within the framework of communication accommodation theory, this paper discusses language barriers in expatriate doctor-patient communication in three state-owned hospitals in Ghana, and the strategies employed by the medical personnel to bridge communication gaps. The study design is qualitative and the data were obtained through semi-structured interviews with 16 expatriate doctors, three nurses and three patients. Furthermore, observation of five patient-doctor interactions was undertaken and notes taken. Both datasets were then analysed using the qualitative conventional content analysis approach. The findings revealed that the expatriate doctors employed convergence strategies such as ad hoc interpreters, gestures, picture charts and electronic dictionaries to deal with language barriers. The study is expected to stimulate further research into innovative ways of dealing with language barriers in expatriate doctor-patient interactions. [ABSTRACT FROM AUTHOR]

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As the US wrestles with immigration policy and caring for an aging population, data on immigrants' role as health care and long-term care workers can inform both debates. Previous studies have examined immigrants' role as health care and direct care workers (nursing, home health, and personal care aides) but not that of immigrants hired by private households or nonmedical facilities such as senior housing to assist elderly and disabled people or unauthorized immigrants' role in providing these services. Using nationally representative data, we found that in 2017 immigrants accounted for 18.2 percent of health care workers and 23.5 percent of formal and nonformal long-term care sector workers. More than one-quarter (27.5 percent) of direct care workers and 30.3 percent of nursing home housekeeping and maintenance workers were immigrants. Although legal noncitizen immigrants accounted for 5.2 percent of the US population, they made up 9.0 percent of direct care workers. Naturalized citizens, 6.8 percent of the US population, accounted for 13.9 percent of direct care workers. In light of the current and projected shortage of health care and direct care workers, our finding that immigrants fill a disproportionate share of such jobs suggests that policies curtailing immigration will likely compromise the availability of care for elderly and disabled Americans. [ABSTRACT FROM AUTHOR]

Background/aim: While internationally educated occupational therapists (IEOTs) may assist Western countries in addressing workforce shortages, their transition to practice can be difficult. Provincial and national levels of government in Canada have funded initiatives to address the barriers experienced by IEOTs. The purpose of this study is to identify the key forces shaping the experiences of IEOTs transitioning to practice in Canada. Methods: An interpretive description approach was taken to interview 11 IEOTs who graduated from the Occupational Therapy Examination and Practice Preparation (OTepp) program. Data analysis was guided by the theoretical scaffolding of the occupational therapy profession. Two team members, who are also occupational therapists, developed codes and categories independently and then through discussion reached a higher level of interpretation. Results: The experiences of IEOTs in Canada were shaped by two key forces: Realising that more than exam preparation is required and the impact of previous person, environment and occupation transactions. Participants underestimated their learning needs related to their transition to Canadian practice. As they engaged in the OTepp program, they realised that their learning extended beyond that required for the national certification exam. Also, the extent to which the participant (person), previous context (environment) and previous practice (occupation) were similar to Canadian therapists, influenced IEOTs' performance in OTepp and their overall transition to practice. The Person‐Environment‐Occupation (PEO) model provided a framework to contextualise this theme. Conclusion: IEOTs will benefit from individualised learning needs assessments and education plans to address their specific needs. At an international level, the occupational therapy profession must engage in dialogue about the differences between education programs and the resulting implications for the profession. More research is also needed to understand the experiences of IEOTs who withdraw from or do not engage in formal supports. [ABSTRACT FROM AUTHOR]

This paper explores how mature female flight attendants [FAs] use Selection, Optimization and Compensation [SOC] strategies to cope with age-related diminishing resources at work. The role of FAs is an age-sensitive occupation, and in some organizations, women are under constant pressure to look young and attractive. This Interpretative Phenomenological Analysis study aims to add depth and nuance to our understanding of SOC strategies qualitatively; most published studies are quantitative. A homogenous sample of 5 mature single Filipina FAs, foreign workers employed by Arabian Gulf-based airlines, were interviewed through a semi-structured protocol. Recruitment was through a snowball process. The study found that FAs use SOC strategies to compensate for age-related decline. Off-duty, their focus is directed to activities that help them to meet the organizations' expectations of youthful appearance and productivity. To achieve this, resources from other life domains are diverted, which leads to negative outcomes from focusing SOC strategies on only one aspect of life. Despite negative personal implications and concerns about the future, the participants still felt attached to their work identities. This shows the importance of understanding the use of SOC strategies within and across life domains, as well as their implications for career sustainability and workability. The use of such strategies at work when detrimental to other life roles is unsustainable. The findings highlight the importance of conducting more qualitative studies on SOC behaviors of specific groups, so the experiences of aging at work can be explored in more depth, allowing areas of concern to be identified. [ABSTRACT FROM AUTHOR]