Suchergebnisse

OBJECTIVES: To determine whether experiences of off-the-job training in domestic (DT) and overseas study (OS) settings are associated with work performance and work–family conflict in physicians. DESIGN, SETTING AND PARTICIPANTS: We conducted a national cross-sectional survey in 77 public hospitals across seven provinces in China between July 2014 and April 2015. Participants were 3182 physicians. EXPOSURE: Participants were categorised into four groups: none, DT only, OS only and DT and OS. PRIMARY OUTCOME MEASURES: Work performance was assessed by work engagement, career attrition and patient-centred care. Work–family conflict was assessed by affecting care for family, feeling guilty towards family and receiving complaints from family. RESULTS: A total of 25.89% participants had experienced DT only, 8.71% OS only and 8.47% DT and OS. After adjustment for potential confounders, participants who had experiences of DT and OS compared with those with no training were more likely to report positive work performance (pride in work: OR=2.11, 95% CI: 1.43 to 3.10; enjoyment of work: OR=1.67, 95% CI: 1.11 to 2.51; turnover intention: OR=0.54, 95% CI: 0.38 to 0.77; early retirement: OR=0.63, 95% CI: 0.45 to 0.89; and exhaustion: OR=0.66, 95% CI: 0.45 to 0.98) and less work–family conflicts (feeling guilty towards family: OR=0.51, 95% CI: 0.35 to 0.74; and complaints from family: OR=0.66, 95% CI: 0.47 to 0.91). We found no obvious association between DT/OS experience with patient-centred care. CONCLUSIONS: Physicians with DT and OS experiences are more likely to have better work performance and less work–family conflict than those without such experience. Physicians face increasing pressure to pursue continuing education and experience associated distress. Therefore, hospitals and government policy-makers should promote DT and OS.

Water, in most of the transboundary river basins, is a bone of contention among their riparian states. Taking this into account, this article assessed the monthly impact of upstream water withdrawal on the water security of middle stream and downstream sub-basins at a country-basin mesh spatial resolution. Roughly 2.18 billion people in 442 sub-basin areas experience water stress intensification by less than 1% throughout the year. In addition, 2.12 billion people in 336 sub-basin areas experience water stress level change, from no water stress to one of the water stress categories, for at least one month as the result of upstream withdrawal. Even though there is a clear upstream impact in many of the basins, water disputes with severe social, economic, political, and environmental consequences are nonexistent. This might be an indication that grave water disputes are the result of complex socio-economic and political interactions, not merely because of water deficits due to upstream water withdrawal. Therefore, understanding this relationship is crucial in identifying inflection points for water conflicts within transboundary river basins.