The Rural Clinical Division: a student journey to rural medicine

Background: The University of Queensland has through an Australian Government initiative, established a Rural Clinical Division (RCD) at four regional sites in the southern and central Queensland. Over the fi rst four years of the existence of the RCD, an integrated package of innovative medical education has been developed. Method: The integrated aspects of the RCD program include: The Rural Medical Rotation: Every medical student undertakes an eight week rural rotation in Year 3. Year 3 and 4 MBBS - 100 students are currently spending one to two years in the rural school and demand is increasing. Interprofessional Education - Medical and Allied Health students attend lectures, seminars and workshops together and often share the same rural clinical placement. Rural health projects - allow students to undertake a project of benefi t to the rural community. Information Technology (IT) - the Clinical Discussion Board (CDB) and Personal Digital Assistants (PDA) demonstrate the importance of IT to medical students in the 21st century. Changing the Model of Medical Education - The Leichhardt Community Attachment Placement (LCAP), is a pilot study that resulted in the addition of three interns to the rural workforce. All aspects of the RCD are evaluated with surveys using both qualitative and quantitative free response questions, completed by all students regularly throughout the academic year. Results: Measures of impact include: Student satisfaction and quality of teaching surveys – 86-91% of students improved their clinical skills and understanding across all rotations. Academic results and progress – RCD students out-perform their urban colleagues. Intent to work in rural areas – 90% of students reported a greater interest in rural medicine. Intern numbers – rural / regional intern placements are increasing. Conclusions: The RCD proves to be a site for innovations all designed to help reach our primary goal of fostering increased recruitment of a rural medical workforce.

Appropriate surveying methods in the Philippines: Can modern GPS units help?

An investigation was undertaken to test the effectiveness of two procedures for recording boundaries and plot positions for scientific studies on farms on Leyte Island, the Philippines. The accuracy of a Garmin 76 Global Positioning System (GPS) unit and a compass and chain was checked under the same conditions. Tree canopies interfered with the ability of the satellite signal to reach the GPS and therefore the GPS survey was less accurate than the compass and chain survey. Where a high degree of accuracy is required, a compass and chain survey remains the most effective method of surveying land underneath tree canopies, providing operator error is minimised. For a large number of surveys and thus large amounts of data, a GPS is more appropriate than a compass and chain survey because data are easily up-loaded into a Geographic Information System (GIS). However, under dense canopies where satellite signals cannot reach the GPS, it may be necessary to revert to a compass survey or a combination of both methods.

Compiling a GIS database of tree farms on Leyte Island

As part of ACIAR project ASEM/2003/052, Improving Financial Returns to Smallholder Tree Farmers in the Philippines, plantations of timber trees in Leyte Island, the Philippines were located using a systematic survey of the island. The survey was undertaken in order to compile a database of plantations which could be used to guide the planning of project activities. In addition to recording a range of qualitative and quantitative information for each plantation, the survey spatially referenced each site using a Global Positioning System (GPS) to electronic maps of the island which were held in a Geographical Information System (GIS). Microsoft Excel and Mapsource® software were used as the software links between GPS coordinates and the GIS. Mapping of farm positions was complicated by different datums being used for maps of Leyte Island and this caused GPS positions to be displaced from equivalent positions on the map. Photos of the sites were hyperlinked to their map positions in the GIS in order to assist staff to recall site characteristics.

Challenge or opportunity: can regional training hospitals capitalise on the impending influx of interns?

To the Editor: The increase in medical graduates expected over the next decade presents a huge challenge to the many stakeholders involved in providing their prevocational and vocational medical training. 1 Increased numbers will add significantly to the teaching and supervision workload for registrars and consultants, while specialist training and access to advanced training positions may be compromised. However, this predicament may also provide opportunities for innovation in the way internships are delivered. Although facing these same challenges, regional and rural hospitals could use this situation to enhance their workforce by creating opportunities for interns and junior doctors to acquire valuable experience in non-metropolitan settings. We surveyed a representative sample (n = 147; 52% of total cohort) of Year 3 Bachelor of Medicine and Bachelor of Surgery students at the University of Queensland about their perceptions and expectations of their impending internship and the importance of its location (ie, urban/metropolitan versus regional/rural teaching hospitals) to their future training and career plans. Most students (n = 127; 86%) reported a high degree of contemplation about their internship choice. Issues relating to career progression and support ranked highest in their expectations. Most perceived internships in urban/metropolitan hospitals as more beneficial to their future career prospects compared with regional/rural hospitals, but, interestingly, felt that they would have more patient responsibility and greater contact with and supervision by senior staff in a regional setting (Box). Regional and rural hospitals should try to harness these positive perceptions and act to address any real or perceived shortcomings in order to enhance their future workforce.2 They could look to establish partnerships with rural clinical schools3 to enhance recruitment of interns as early as Year 3. To maximise competitiveness with their urban counterparts, regional and rural hospitals need to offer innovative training and career progression pathways to junior doctors, to combat the perception that internships in urban hospitals are more beneficial to future career prospects. Partnerships between hospitals, medical schools and vocational colleges, with input from postgraduate medical councils, should provide vertical integration4 in the important period between student and doctor. Work is underway to more closely evaluate and compare the intern experience across regional/rural and urban/metropolitan hospitals, and track student experiences and career choices longitudinally. This information may benefit teaching hospitals and help identify the optimal combination of resources necessary to provide quality teaching and a clear career pathway for the expected influx of new interns.

Endangerment and likeability of wildlife species: How important are they for proposed payments for conservation

Examines empirically the relative influence of the degree of endangerment of wildlife species and their stated likeability on individuals’ willingness to pay (WTP) for their conservation. To do this, it utilises data obtained from the IUCN Red List and likeability and WTP data obtained from two serial surveys of a sample of the Australian public who were requested to assess 24 Australian wildlife species in each of three animal classes: mammals, birds and reptiles. Between the first and second survey, respondents were provided with extra information about the focal species. This information resulted in the clear dominance of endangerment as the major influence on the WTP of respondents for the conservation of the focal wildlife species. Our results throw doubts on the proposition in the literature that the likeability of species is the dominant influence on WTP for conservation of wildlife species. Furthermore, our results suggest that the relationship between WTP for the conservation of wildlife in relation to their population levels may be more complex and different to that suggested in some of the literature on ecological economics.

Public support for sustainable commercial harvesting of wildlife: An Australian case study

This paper surveys a sample of 204 members of the Australian public to determine their attitude to the sustainable commercial harvesting of wildlife generally, and considers their specific support for the sustainable commercial harvesting of each of 24 Australian native species. The general attitude of the sample to wildlife harvesting is related to their attitude to nature conservation. The relationship between respondents’ support for the sustainable commercial harvesting of each of the species and their degree of endangerment based on IUCN Red List rankings is established and found to be an inverse one. Support for the commercial sustainable use of each of the species is compared with the willingness of respondents to pay for their conservation. Support for sustainable commercial harvesting of species is found to be inversely related to the willingness of respondents to pay is for a particular species’ conservation. In turn, this willingness to pay is found to rise with the degree of endangerment of species. While the likeability of a species has some influence on whether there is support or not for its commercial harvesting, it does not seem to be the predominant influence— the degree of endangerment of a species appears to be the major influence here. Even so, this does not imply majority support for the harvest of all species that are not threatened; rather, majority support for harvest was observed only for some species known to be abundant. None of the species that appear in the Red List have majority support for harvesting. Implications are outlined of the results for the policy of promoting wildlife conservation by means of sustainable use.

Economic, social and cultural influences on the status and wellbeing of Indian rural wives

Examines the status and well being of wives in rural India using results from interviews. Surveys were conducted in three villages in the southwest of West Bengal and in three villages in the west of Orissa. The survey in West Bengal contained a large proportion of Santal tribals and the Oriyan survey was dominated by Kondh tribals. The relationships between variables representing economic, social and cultural factors are compared with ‘dependent’ variables representing the status of wives within their family and their wellbeing. Wellbeing is indicated by whether the basic needs of wives for food and medical care are met. Status of wives is indicated by their ‘control’ over family resources, whether or not they are restricted in joining social groups and in working outside their home, and the extent of their involvement in family decision-making. Cultural factors are found to be the dominant influence on the status of wives. Family income and other economic factors are found to be associated cross sectionally with greater restrictions on wives within their family. Nevertheless, the higher in the economic status of the household, the more likely are the basic needs of wives to be met.

Knowledge and willingness to pay for the conservation of wildlife species: Experimental results evaluating Australian tropical species

The nature of an experiment involving 204 residents is outlined and the results are reported and analysed. Two consecutive surveys of the respondents provide data about their stated knowledge of 23 wildlife species present in tropical Australia, most of which exclusively occur there. In addition, these surveys provide data about the willingness of respondents to pay for the conservation of those species belonging to three taxa; reptiles, mammals, and birds. Thus it is possible to compare the respondents’ stated knowledge of the species with their willingness to pay for their conservation, and to draw relevant inferences from this. From the initial survey and these associations, interesting relationships can be observed between those variables (knowledge and willingness to pay). The second survey was completed after the respondents’ knowledge of the species was experimentally increased and became more balanced. This is shown to result in increased dispersion (greater discrimination) in willingness to contribute to conservation of the different species in the set of wildlife species considered. Both theoretical and policy conclusions are drawn from the results.

Information and wildlife valuation: Experiments and policy

The authors use experimental surveys to investigate the association between individuals' knowledge of particular wildlife species and their stated willingness to allocate funds to conserve each. The nature of variations in these allocations between species (e.g., their dispersion) as participants' knowledge increases is examined. Factors influencing these changes are suggested. Willingness-to-pay allocations are found not to measure the economic value of species, but are shown to be policy relevant. The results indicate that poorly known species, e.g., in remote areas, may obtain relatively less conservation support than they deserve.

Antarctic tourists: A case study of their evaluation of Antarctic wildlife and environmental issues

Reports the results of surveys of Antarctic cruise ship passengers on the ‘Akademik Ioffe’ who undertook their Antarctic journey in January 2003. The prime purposes of the surveys were to determine the socio-economic profile of these travellers, evaluate the importance of Antarctic wildlife for their travel, their attitude to Antarctic wildlife conservation as well as environmental issues involving Antarctica, both prior to their tourist visit to Antarctica and following it. This paper reports on the socio-economic profile of respondents, their willingness to pay for their Antarctic trip, and their knowledge of Antarctica. The comparative importance of Antarctic wildlife as a factor motivating respondents to undertake their journey is assessed and the evaluation of travellers following their Antarctic visit is considered. The relative importance of different Antarctic wildlife species is taken into account as well as Antarctic attractions other than wildlife. The attitudes of respondents to several environmental issues involving Antarctica, (eg. the commercial use of its natural resources and global environmental change impacting on Antarctica) are canvassed and summarised. In conclusion, the relevance of the survey results for Antarctic conservation are discussed. Particular attention is given to the question of whether Antarctic tourism favours or threatens Antarctic nature conservation.

An initial assessment of policies for saving a rare Australian glider: Experimental results, economics and ecology

Reviews the ecological status of the mahogany glider and describes its distribution, habitat and abundance, life history and threats to it. Three serial surveys of Brisbane residents provide data on the knowledge of respondents about the mahogany glider. The results provide information about the attitudes of respondents to the mahogany glider, to its conservation and relevant public policies and about variations in these factors as the knowledge of participants of the mahogany glider alters. Similarly data is provided and analysed about the willingness to pay of respondents to conserve the mahogany glider. Population viability analysis is applied to estimate the required habitat area for a minimum viable population of the mahogany glider to ensure at least a 95% probability of its survival for 100 years. Places are identified in Queensland where the requisite minimum area of critical habitat can be conserved. Using the survey results as a basis, the likely willingness of groups of Australians to pay for the conservation of the mahogany glider is estimated and consequently their willingness to pay for the minimum required area of its habitat. Methods for estimating the cost of protecting this habitat are outlined. Australia-wide benefits seem to exceed the costs. Establishing a national park containing the minimum viable population of the mahogany glider is an appealing management option. This would also be beneficial in conserving other endangered wildlife species. Therefore, additional economic benefits to those estimated on account of the mahogany glider itself can be obtained.

Development of a dietary supplement database

Data describing the composition of dietary supplements are not readily available to the public health community. As a result, intake from dietary supplements is generally not considered in most dietary surveys and, hence, little is known about the significance of supplement intake in relation to total diet or disease risk. To enable a more comprehensive analysis of dietary data, a database of the composition of various dietary supplements has been compiled. Active ingredients of all dietary supplements sold in Australia are included in the Australian Register of Therapeutic Goods (ARTG), maintained by the Therapeutic Goods Administration. Products included in the database were restricted to those vitamin, mineral and other supplements identified in dietary data collected from studies conducted in southeast Queensland and New South Wales (850 supplements). Conversion factors from ingredients compounds to active elements were compiled from standard sources. No account has been made for bioavailability, consistent with current practice for food composition databases. The database can be queried by ARTG identification number, brand, product title, or a variety of other fields. Expected future developments include development of standard formulations for use when supplements are incompletely specified, and expansion of products included for more widespread use.

New limits on the possible variation of physical constants

Recent detections of high-redshift absorption by both atomic hydrogen and molecular gas in the radio spectra of quasars have provided a powerful tool for measuring possible temporal and spatial variations of physical 'constants' in the Universe. We compare the frequency of high-redshift hydrogen 21-cm absorption with that of associated molecular absorption in two quasars to place new (1 sigma) upper limits on any variation in y = g(p) alpha(2) (where alpha is the fine-structure constant, and g(p) is the proton g-factor) of \Delta y/y\ < 5 x 10(-6) at redshifts z = 0.25 and 0.68. These quasars are separated by a comoving distance of 3000 Mpc (for H-0=75 km s(-1) Mpc(-1) and q(0) = 0). We also derive limits on the time rates of change of \(g) over dot (p)/(g) over dot (p)\ < 1 x 10(-15) yr(-1) and \(alpha) over dot/(a) over dot\ < 5 x 10(-16) yr(-1) between the present epoch and z = 0.68, These limits are more than an order of magnitude smaller than previous results derived from highredshift measurements.

Genetics and race variability of the lucerne - Colletotrichum trifolii pathosystem in Australia

The Australian-bred lucerne cultivars, Trifecta and Sequel, were found to possess useful levels of resistance to both Colletotrichum trifolii races 1 and 2. Race 2 has only been previously observed in the United States and surveys did not reveal its presence in Australia. Multilocus fingerprinting using random amplified polymorphic DNA (RAPDs) analysis revealed low diversity (<10% dissimilarity) within Australian C. trifolii collections, and between the Australian race 1 isolates and a US race 2 isolate. Studies on the inheritance of resistance to C. trifolii race 1 in individual clones from Trifecta and Sequel revealed the presence of 2 different genetic mechanisms. One inheritance was for resistance as a recessive trait, and the other indicated that resistance was dominant. The recessive system has never been previously reported, whereas in the US, 2 completely dominant and independent tetrasomic genes Anl and Ant have been reported to condition C. trifolii resistance. It was not possible to fit the observed segregations from our studies to a single-gene model. In contrast to US studies, clones of cv. Sequel exhibiting the recessive resistance reacted differently to spray and stem injection with C. trifolii inoculum, being resistant to the former and susceptible to the latter, providing additional evidence for the presence of a different genetic mechanism conditioning resistance to those previously reported in the US. As C. trifolii is one of the most serious diseases of lucerne worldwide, the future development of molecular markers closely linked to the dominant and recessive resistances identified in these studies, and the relationships between these resistances and Anl and Ans as determined by genetic mapping, appear to be useful areas of future study.

Changes in estimated coronary risk in the 1980s: data from 38 populations in the WHO MONICA Project

The World Health Organization (WHO) MONICA Project is a 10-year study monitoring trends and determinants of cardiovascular disease in geographically defined populations. Data were collected from over 100 000 randomly selected participants in two risk factor surveys conducted approximately 5 years apart in 38 populations using standardized protocols. The net effects of changes in the risk factor levels were estimated using risk scores derived from longitudinal studies in the Nordic countries. The prevalence of cigarette smoking decreased among men in most populations, but the trends for women varied. The prevalence of hypertension declined in two-thirds of the populations. Changes in the prevalence of raised total cholesterol were small but highly correlated between the genders (r = 0.8). The prevalence of obesity increased in three-quarters of the populations for men and in more than half of the populations for women. In almost half of the populations there were statistically significant declines in the estimated coronary risk for both men and women, although for Beijing the risk score increased significantly for both genders. The net effect of the changes in the risk factor levels in the 1980s in most of the study populations of the WHO MONICA Project is that the rates of coronary disease are predicted to decline in the 1990s.