Educating a New Generation of Doctors to Improve the Health of Populations in Low- and Middle-Income Countries

Francesca Celletti and colleagues from WHO argue that a transformation in the scale-up of medical education in low- and middle-income countries is needed, and detail what this might look like

What influences national and foreign physicians’ geographic distribution? An analysis of medical doctors’ residence location in Portugal

Background The debate over physicians’ geographical distribution has attracted the attention of the economic and public health literature over the last forty years. Nonetheless, it is still to date unclear what influences physicians’ location, and whether foreign physicians contribute to fill the geographical gaps left by national doctors in any given country. The present research sets out to investigate the current distribution of national and international physicians in Portugal, with the objective to understand its determinants and provide an evidence base for policymakers to identify policies to influence it. Methods A cross-sectional study of physicians currently registered in Portugal was conducted to describe the population and explore the association of physician residence patterns with relevant personal and municipality characteristics. Data from the Portuguese Medical Council on physicians’ residence and characteristics were analysed, as well as data from the National Institute of Statistics on municipalities’ population, living standards and health care network. Descriptive statistics, chi-square tests, negative binomial and logistic regression modelling were applied to determine: (a) municipality characteristics predicting Portuguese and International physicians’ geographical distribution, and; (b) doctors’ characteristics that could increase the odds of residing outside the country’s metropolitan areas. Results There were 39,473 physicians in Portugal in 2008, 51.1% of whom male, and 40.2% between 41 and 55 years of age. They were predominantly Portuguese (90.5%), with Spanish, Brazilian and African nationalities also represented. Population, Population’s Purchasing Power, Nurses per capita and Municipality Development Index (MDI) were the municipality characteristics displaying the strongest association with national physicians’ location. For foreign physicians, the MDI was not statistically significant, while municipalities’ foreign population applying for residence appeared to be an additional positive factor in their location decisions. In general, being foreigner and male resulted to be the physician characteristics increasing the odds of residing outside the metropolitan areas. However, among the internationals, older doctors were more likely to reside outside metropolitan areas. Being Spanish or Brazilian (but not of African origin) was found to increase the odds of being based outside the Lisbon and Oporto metropolitan areas. Conclusions The present study showed the relevance of studying one country’s physician population to understand the factors driving national and international doctors’ location decisions. A more nuanced understanding of national and foreign doctors’ location appears to be needed to design more effective policies to reduce the imbalance of medical services across geographical areas.The study was supported by a research grant from the Portuguese High Commission for Health to the International Health Department of the Institute of Hygiene and Tropical. Medicine

Black tiger shrimp (Penaeus monodon) hatchery operations using enhanced biosecurity measures

This manual, titled “Black Tiger Shrimp (Penaeus monodon) Hatchery Operations Using Enhanced Biosecurity Measures,” includes modifications on shrimp hatchery operations done by the Aquaculture Department of the Southeast Asian Fisheries Development Center to provide high- quality postlarvae for shrimp farming. Discussed also in this manual are the necessary protocols and biosecurity measures that shrimp hatchery operators can use as their guide. Main sections included in this manual: 1. Site Selection, 2. Biology, 3. Hatchery Layout, 4. Facilities and Equipment, 5. Biosecurity Standard Operating Procedures, 6. Hatchery Operations, 7. Diseases of Shrimps, and 8. Economic Analysis

Stated preferences of doctors for choosing a job in rural areas of Peru: a discrete choice experiment.

BACKGROUND: Doctors' scarcity in rural areas remains a serious problem in Latin America and Peru. Few studies have explored job preferences of doctors working in underserved areas. We aimed to investigate doctors' stated preferences for rural jobs. METHODS AND FINDINGS: A labelled discrete choice experiment (DCE) was performed in Ayacucho, an underserved department of Peru. Preferences were assessed for three locations: rural community, Ayacucho city (Ayacucho's capital) and other provincial capital city. Policy simulations were run to assess the effect of job attributes on uptake of a rural post. Multiple conditional logistic regressions were used to assess the relative importance of job attributes and of individual characteristics. A total of 102 doctors participated. They were five times more likely to choose a job post in Ayacucho city over a rural community (OR 4.97, 95%CI 1.2; 20.54). Salary increases and bonus points for specialization acted as incentives to choose a rural area, while increase in the number of years needed to get a permanent post acted as a disincentive. Being male and working in a hospital reduced considerably chances of choosing a rural job, while not living with a partner increased them. Policy simulations showed that a package of 75% salary increase, getting a permanent contract after two years in rural settings, and getting bonus points for further specialisation increased rural job uptake from 21% to 77%. A package of 50% salary increase plus bonus points for further specialisation would also increase the rural uptake from 21% to 52%. CONCLUSIONS: Doctors are five times more likely to favour a job in urban areas over rural settings. This strong preference needs to be overcome by future policies aimed at improving the scarcity of rural doctors. Some incentives, alone or combined, seem feasible and sustainable, whilst others may pose a high fiscal burden

Standards for essential composition and quality factors of commercial virgin coconut oil and its differentiation from RBD coconut oil and copra oil

Commercial samples of virgin coconut oil (VCO), refined, bleached and deodorized coconut oil (RBD CNO), and copra oil were analyzed using standard chemical parameters: gas chromatography (GC) of the fatty acid methyl esters (FAME), % moisture by Karl Fischer titration, % volatile matter at 120° C, % free fatty acid, iodine value, peroxide value, and microbial contamination. Principal components analysis (PCA) of the GC-FAME results indicates that the various samples cannot be differentiated by their fatty acid composition, indicating that the fatty acid profile is not affected by the processing method. No trans-fatty acid was detected in all samples down to 0.01% (w/w) detection limit. VCO can be differentiated from RBD CNO and copra oil using the following tests: % moisture by Karl Fischer, % volatile matter volatile at 120° C, and peroxide value

Studies on Standards for Commercial Virgin Coconut Oil

A minimum set of analytical methods is recommended for the differentiation of virgin coconut oil (VCO) from refined, bleached and deodorized coconut oil (RBD CNO): % fatty acid composition,% moisture by Karl Fischer (0.10%), % volatile matter at 120°C (0.10-0.20%), % free fatty acids as lauric acid (0.2%), peroxide value (3 meq/kg), and microbial contamination by colony forming units (\u3c10 cfu/mL). The% fatty acid composition was determined using an internal standard and molecular weight correction from the fatty acid methyl ester to the fatty acid. This method yields absolute amounts of fatty acid in the oil. The absolute amount of oleic acid and linoleic acid can be used to replace the iodine value. Principal components analysis of the fatty acid composition indicates that it is not affected by the processing method

Essential quality parameters of commercial virgin coconut oil

Chemical analyses conducted on commercial samples of virgin coconut oil (VCO) produced by four different methods gave the following ranges of values: % Fatty acid composition: C6: 0.24 to 0.49%; C8: 4.15 to 8.30%; C10: 4.27 to 5.75%; C12: 46.0 to 52.6%; C14: 16.0 to 19.7%; C16: 7.65 to 10.1%; C18: 2.86 to 4.63%; C18:1: 5.93 to 8.53%; C18:2: 1.00 to 2.16%; %moisture by Karl Fischer: 0.05 to 0.12%; %matter volatile at 120 0C: 0.12 to 0.18%; %free fatty acids as lauric acid: 0.042 to 0.329%; and peroxide value: none detected to 1.40. The tests for %moisture by Karl Fischer and %matter volatile at 120 0C can be used to differentiate VCO from and refined, bleached and deodorized coconut oil (RBD CNO). No trans-fatty acid was detected in both VCO and RBD CNO down to 0.01% (w/w) detection limit