Recruitment and retention of general practitioners in European medical deserts: a systematic review.

EARLY ABSTRACT: ntroduction Despite policies aiming at universal health coverage by ensuring availability and accessibility of general practitioners (GPs), medically underserved areas are still present in Europe. This systematic review aims to summarize and compare literature on interventions and their potential effectiveness of GP recruitment and retention in these underserved areas (i.e., ‘medical deserts’) from 2011 onwards. Method: We used PubMed and Embase to identify publications applying a two-stage selection process. All types of study designs, published in the past 10 years, were included if they discussed a possible intervention for GP recruitment or retention covering an underserved area in an EU-27/EEA/EFTA country. Exclusion criteria were the non-availability of abstracts or full-text, conference abstracts, poster presentations, books or overlapping secondary literature. Identified interventions were classified into four categories: ‘education’, ‘professional and personal support’, ‘financial incentives’ and ‘regulation’. Eligible articles were critically appraisal by two authors (JB, LF), independently, by using the Joanna Briggs Institute checklist. Results Of the 294 publications initially retrieved, 25 publications were included. Of them, 14 (56%) described educational interventions, 13 (52%) professional and personal support, and 11 (40%) financial or regulatory interventions. Overlapping categories were often described (56%). The effectiveness of educational or supportive interventions has mainly been evaluated cross-sectionally, whereby causal inference on future GP availability remains a white spot. We found little and mixed results for the effectiveness of financial and regulatory interventions, as during the study period co-interventions were not taken into account. Conclusion In the past 10 years, educational and supportive interventions to improve GP recruitment and retention are most frequently reported, but often overlapping strategies are seen. While multiple strategies have potential to be effective, the limited evaluation make it difficult to provide suggestions for policymakers to adapt their GP recruitment and retention strategies aiming at a best-practice approach in European medical deserts

PLASMA DEPOSITION OF SILICON NITRIDE

This paper reports on the preparation and characterization of thin films of silicon nitride deposited on heated silicon substrates from Si (CH3)4-NH3-H2 mixtures activated at room temperature by an a.c. discharge at low frequency. The films were deposited at 800°C. Deposition rate as well as refractive index were measured and several parameters were systematically varied, including deposition time (1-3 h), total gas flow rate, chamber pressure (20-45 kPa), peak driving voltage (8-12 kV) and frequency (400-600Hz). The composition of the films was studied using transmission electron microscopy (106 V), Auger spectroscopy and infrared spectroscopy

Pompes à chaleur chimiques applicables à l'habitat: acquisition de données thermodynamiques et cinétiques

Cet article traite de l’étude des pompes à chaleur chimiques basées sur la réaction entre un gaz (ammoniac ou méthylamine) et des chlorures métalliques ou alcalino-terreux, en suspension dans l'heptanol ou en lit fixe. Les conditions de fonctionnement dépendent des caractéristiques thermodynamiques et cinétiques qui sont données ici

Characteristics of medical deserts and approaches to mitigate them: a scoping review

ABSTRACT: Introduction Medical deserts are increasingly considered problematic and many countries employ a multitude of actions and initiatives to achieve a better distribution of the health workforce (HWF). This study systematically maps research and provides an overview of the definitions/characteristics of medical deserts. It also identifies contributing factors and approaches to mitigate medical deserts. Methods Embase, MEDLINE, CINAHL, Web of Science Core Collection, Google Scholar and The Cochrane Library were searched from inception to May 2021. Studies reporting primary research on definitions, characteristics, contributing factors and approaches to mitigate medical deserts were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies. Results Two-hundred and forty studies were included (49% Australia/New Zealand, 43% North America, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n=160), characteristics (n=71), contributing/associated factors (n=113), and approaches to mitigate medical deserts (n=94). Most medical deserts were defined by the density of the population in an area. Contributing/associated factors consisted in sociodemographic/characteristics of HWF (n=70), work-related factors (n=43) and lifestyle conditions (n=34). Approaches focused on training adapted to the scope of rural practice (n=79), HWF distribution (n=3), support and infrastructure (n=6) and innovative models of care (n=7). Discussion Our study provides the first scoping review on definitions, characteristics, contributing/associated factors and approaches to mitigate medical deserts. We identified gaps such as the scarcity of longitudinal studies to investigate factors contributing to medical deserts, and interventional studies to evaluate the effectiveness of approaches to mitigate medical deserts