The feminization of the medical work force, implications for Scottish primary care: a survey of Scottish general practitioners

BACKGROUND: The number of women working in general practice internationally has been steadily rising. In Scotland there have been concerns that such a change may lead to increased part-time working and subsequently to a fall in available general practice manpower despite an apparently rising overall number of general practitioners. However, there is very little information on the actual hours worked by men and women general practitioners or on the types of work they are undertaking. METHODS: Anonymous workload questionnaires of all Scottish general practitioner principals and non-principals RESULTS: Response rates for general practice principals and non-principals were 67.2% and 65.2% respectively. Male principals spent on average 18% more time on general medical services (GMS) and 50% more time on non-GMS activities (such as teaching, specialist sessions, administration and research) than women (both p <0.01). This difference was similar for non-principals. In no age group did the hours worked by women doctors approach that of male doctors. CONCLUSION: Women doctors in primary care in Scotland work fewer hours in all age groups than their male counterparts. The rapidly increasing proportion of women in general practice may lead to an increasing shortfall of medical availability in the future if current work patterns are maintained. Further longitudinal research is required to establish this and man-power planning is required now to address this. More worryingly auxiliary activities such as teaching and administrative duties are not being taken up by women. This may have serious implications for the future development of the specialty in Scotland

Surfaces: An interdisciplinary project to understand and enhance health in the vulnerable rainforests of Papua New Guinea

Background New Guinea has the third largest tropical rainforest on Earth. However, one quarter of the forests of Papua New Guinea (PNG, New Guinea’s eastern half) have been cleared or degraded, nearly half through commercial logging.Sustainable development requires supporting good health (Sustainable Development Goal [SDG] 3) and protecting life on land (SDG 15). To remote communities in PNG with low levels of health provision, these goals can seem in conflict. Logging companies’ offer of roads and income can partly extinguish the remoteness that bars access to health services, making desire for health a driver for forest destruction and erosion of health related ecosystem services. Conservation success thus requires synergies be developed with delivery of other SDGs, particularly those pertaining to health. We aim to provide a model of integrated health and conservation in PNGs rainforests. Methods We are mapping and piloting biological, anthropological, and medical methods to address SDGs on health and biodiversity, focusing first on scabies and fungal diseases. At Wanang, team members have a long term collaboration with nine clans with unmet health needs who collectively chose to preserve their 10,000 hectare forest whilst surrounding communities allowed logging. Similar collaborations are being developed along an altitudinal transect on Mt.Wilheim (4,509m). Stage 1 of Surfaces will (i) systematically map evidence on integrated conservation and health programmes, (ii) conduct clinical examinations and rapid anthropological assessments to understand medical needs, and survey skin disease, and (iii) produce a case study of the Wanang agreement, based on interviews with participants. This will lay the foundation for a multi-year health intervention and interdisciplinary study. Findings We are in the projects’ early stages (so do not yet have findings), and would appreciate advice and suggestions of collaboration from others in the Planetary Health community. Funding Sussex Sustainability Research Programme, University of Sussex, UK. Contributions All authors have commented on multiple drafts and approved the final version of the abstract for publication. Conflicts of interest We declare we have no conflicts of interest. Acknowledgments We thank the projects partner communities; New Guinea Binatang Research Centre; and our advisory group

A Study of the Vocational Placement of Pupils of the Elementary and High Schools

There was a time when people could go West and become empire builders; when there was little competition, but the resources which nature provided so abundantly no longer exist in their vastness. Pioneers and adventurers have skinned the cream of these luxuries. It is necessary now for science and its cohorts to substitute skill, knowledge, and training for the vagrancies of chance and its dependence up- on fate

The missing link: self-assessment and continuing professional development

The purpose of this paper is to review current understanding of the role of self-assessment in continuing education, particularly in the health professions, and to examine how this knowledge can assist in more effective continuing education. The ongoing debate over compulsory continuing professional development (CPD) has seen a variety of approaches proposed. CPD programmes are expected to foster self-assessing and self-directed practitioners, but the common structure is reported to be largely ineffectual in modifying behaviour. If dentistry is to maintain the rights and privileges of a self-regulating profession, then it must ensure that the development and judgement of ongoing competence is meaningful. Improving practitioners’ knowledge of the how and why of effective self-assessment should improve participation in, and outcomes of, CPD. An oft-repeated observation is that the least competent are the most confident. If this is the case, then the idea that dentists should be able, or entitled, to choose the path of their continuing professional development must be open to question. We propose that development of the ability of practitioners to self-assess their ongoing requirements for CPD is essential if all stakeholders are to get the maximum return for effort.C. Redwood, T. Winning, G. Townsen

Exercise in the treatment of youth substance use disorders: Review and recommendations

Substance use disorders among youth represent a significant public health concern. It is well established that regular exercise provides important physical and mental health benefits; however, evidence for the role of exercise as an adjunct component within substance use disorder treatment is scarce. In this review, we identify factors associated with the development and persistence of substance use disorders among youth, identify current treatment modalities, and present evidence to support the efficacy of incorporating exercise participation during rehabilitation. We also provide a series of recommendations for future research that explores the feasibility and effectiveness of exercise participation as a complement to substance use disorder treatment among youth

Exile Vol. XVIII

POETRY The Man And His Table by Al Werder 3 Ours by Debra Tucker 6 Running through rows and pile of leaves by Molly O\u27neill 12 Looking Glass by Alice Colthart 13 16 Years Old by Peter Porteous 14-15 a feather by Judy Meloy 28 I kicked summer\u27s shed garments by Bruce P. Andre 29 Tuesday Afternoon by Juliet Lockwood 30 snuggled deep inside by Judi Hasel 31 Star Spangled Pterdactyl by Peter Porteous 44 Billy\u27s by Suzi Harriss 45 Hong Kong by Peter Porteous 46 Ennui by Debra Tucker 47 pathetic collapse by Bruce P. Andre 48 In place of alphabet by Suzi Harriss 51 Encore by Richard Glaser 58 reflections disrupt by Judi Hasel 60 FICTION Eyes by Clark Blaise 7-11 Characters From New Mexico Life by Ardyth Hilts 16-27 Hospital Scene by Dennis Trudell 34-35 A Late Morning by Peter Porteous 36-42 Accident by Richard Glaser 52-57 ART Cover by Gail Lutsch by Jane Demos 5 by Tom Coulter 10 by Maria Ramoki 13 by Vicki Haskell 11, 15 by Alex Hutton 20 by Pat Menster 31, 59 by Scott Kenan 43 by Ann Merrill 46 by James Lautz PHOTOGRAPHY by Kathy Kerschner 1, 2, 62, 36, 64 by Bruce P. Andre 7, 28, 49 by Bruce Marshall 32, 36, 42, 61 to Paul Bennett, founder of Exile, teacher, 25 years. 2 The following previous graduates of Denison University contributed pieces of fiction to this issue of Exile: Clark Blaise \u2761 (Eyes 7-11) and Dennis Trudell \u2760 (Hospital Scene 34-35

Rationale, experience and ethical considerations underpinning integrated actions to further global goals for health and land biodiversity in Papua New Guinea

The SURFACES project is integrating action on good health and wellbeing (Sustainable Development Goal [SDG] 3) and conservation of life on land (SDG 15) in the threatened rainforests of Papua New Guinea (PNG), and mapping evidence of similar projects worldwide. Our approach is framed by Planetary Health, aiming to safeguard both human health and the natural systems that underpin it. Our rationale is demonstrated through a summary of health needs and forest conservation issues across PNG, and how these play out locally. We outline differing types of integrated conservation and health interventions worldwide, providing examples from Borneo, Uganda, India and elsewhere. We then describe what we are doing on-the-ground in PNG, which includes expansion of a rainforest conservation area alongside the establishment of a nurse-staffed aid post, and an educational intervention conceptually linking forest conservation and health. Importantly, we explore some ethical considerations on the conditionality of medical provision, and identify key challenges to successful implementation of such projects. The latter include: avoiding cross-sectoral blindness and achieving genuine interdisciplinary working; the weak evidence base justifying projects; and temporal-spatial issues. We conclude by suggesting how projects integrating actions on health and conservation SDGs can benefit from (and contribute to) the energy of the emerging Planetary Health movement