They Go the Extra Mile, the Extra Ten Miles...”: Examining Canadian Medical Yourists’ Interactions with Health Care Workers Abroad

Developing an understanding of medical tourists\u27 interactions with their health care workers while abroad is important for a number of reasons. Social support has been linked to improved health outcomes for patients (Berkman et al., 2000; Lee and Rotheram-Borus, 2001; Uchino, 2004, 2006), while a lack of social support has been found to lead to higher mortality rates (Brummett et al., 2001; Rutledge et al., 2004). While abroad, medical tourists are not in a position to draw on their usual social support networks as they are away from home. It could be the case that workers in medical tourism facilities are aware of this and work to form a supportive and trusting bond with the patients given that they are away from home and unable to draw on their usual support networks. Furthermore, when patients perceive their relationship with their health care workers as positive, they have been shown to have a higher chance of improved health outcomes (Stewart et al., 2000; Arora, 2003; Beach et al., 2006; Street et al., 2009). There is no reason to think this would be any different for medical tourists. The patient-health care worker relationship can have important implications for patient health and therefore we believe that research into this topic using medical tourists\u27 own experiential accounts can help to identify strategies that can be used to secure and improve this relationship

Long COVID in long-term care: a rapid realist review

Objectives The goals of this rapid realist review were to ask: (a) what are the key mechanisms that drive successful interventions for long COVID in long-term care (LTC) and (b) what are the critical contexts that determine whether the mechanisms produce the intended outcomes? Design Rapid realist review. Data sources Medline, CINAHL, Embase, PsycINFO and Web of Science for peer-reviewed literature and Google for grey literature were searched up to 23 February 2023. Eligibility criteria We included sources focused on interventions, persons in LTC, long COVID or post-acute phase at least 4 weeks following initial COVID-19 infection and ones that had a connection with source materials. Data extraction and synthesis Three independent reviewers searched, screened and coded studies. Two independent moderators resolved conflicts. A data extraction tool organised relevant data into context-mechanism-outcome configurations using realist methodology. Twenty-one sources provided 51 intervention data excerpts used to develop our programme theory. Synthesised findings were presented to a reference group and expert panel for confirmatory purposes. Results Fifteen peer-reviewed articles and six grey literature sources were eligible for inclusion. Eleven context-mechanism-outcome configurations identify those contextual factors and underlying mechanisms associated with desired outcomes, such as clinical care processes and policies that ensure timely access to requisite resources for quality care delivery, and resident-centred assessments and care planning to address resident preferences and needs. The underlying mechanisms associated with enhanced outcomes for LTC long COVID survivors were: awareness, accountability, vigilance and empathetic listening. Conclusions Although the LTC sector struggles with organisational capacity issues, they should be aware that comprehensively assessing and monitoring COVID-19 survivors and providing timely interventions to those with long COVID is imperative. This is due to the greater care needs of residents with long COVID, and coordinated efficient care is required to optimise their quality of life

"Female Newcomers’ Adjustment to Life in Toronto, Canada: Sources of Stress and Their Implications for Delivering Primary Mental Health Care"

Stress disorders and other mental ill health may be brought on by the disruption caused by resettlement. We examine female newcomers' experiences of adjusting to a new place, metropolitan Toronto, Canada and a new health care system. We consider sources of mental stress experienced during adjustment. We frame this adjustment as a process that happens over place and through time. Thematic findings of interviews (n = 35) with female newcomers from five cultural-linguistic groups are reported. Sources of stress in adjusting to life in Toronto include: navigating a new place, personal safety concerns, adapting to a new lifestyle, and finding employment. Sources of stress in adjusting to a new health care system include: learning how to access care, not having access to specialists, and adapting to a new culture of care. We conclude by considering the implications of what newcomers report for the delivery of primary mental health care (i.e. 'first contact' care).The Lupina Foundatio

A hydrological perspective on UK evaporation: historical trends and future projections

1. Evaporation is an important component of the hydrological cycle. This document presents a review of historical trends and future projections for evaporation in the UK, from a hydrological perspective. 2. Potential evaporation (PE) is generally considered to represent the amount of water that would be lost to the atmosphere if there were no limits to supply. Actual evaporation (AE) can be estimated as a fraction of PE dependent on soil wetness. 3. There are many formulae for estimating PE from meteorological data, of varying complexity, from simple empirical formulae to data-intensive physically-based formulae (like Penman-Monteith). 4. PE is usually required, along with rainfall, as an input for hydrological modelling. MORECS PE, based on Penman-Monteith, is often used in the UK. 5. PE accuracy is generally considered less important than rainfall accuracy for hydrological model performance, as PE is less spatially and temporally variable than rainfall and has a well-defined seasonal pattern. 6. There is relatively little information on historical trends in AE or PE in the UK, or indeed globally. The few UK studies generally indicate increases in PE, and one recent study has shown an increase in national average AE. 7. There is little consensus on the best formulae to derive future PE projections from climate model data. The choice is further complicated when considering possible changes in plant behaviour under higher CO2 concentrations. 8. Most studies presenting future PE projections for the UK indicate increases in annual PE totals, although some studies suggest small decreases in PE for one or two months of the year. 9. The approach used to estimate PE could be particularly important in regions where precipitation and PE are in close balance with each other, but PE uncertainty could be less important than climate model uncertainty for hydrological impacts. 10. Further investigation is needed into which PE formulae are likely to be more (or less) reliable when applied with climate model data, and into the feedbacks between climate change and plant transpiration, plant growth and land-cover