‘Working with the team’ : an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care

This study aimed to explore how a new model of integrated primary/secondary care for type 2 diabetes management, the Brisbane South Complex Diabetes Service (BSCDS), related to improved diabetes management in a selected group of patients. We used a qualitative research design to obtain detailed accounts from the BSCDS via semi-structured interviews with 10 patients. The interviews were fully transcribed and systematically coded using a form of thematic analysis. Participants’ responses were grouped in relation to: (1) Patient-centred care; (2) Effective multiprofessional teamwork; and (3) Empowering patients. The key features of this integrated primary/secondary care model were accessibility and its delivery within a positive health care environment, clear and supportive interpersonal communication between patients and health care providers, and patients seeing themselves as being part of the team-based care. The BSCDS delivered patient-centred care and achieved patient engagement in ways that may have contributed to improved type 2 diabetes management in these participants.

A qualitative analysis of stress, uplifts and coping in the personal and professional lives of Singaporean nurses.

Aim. This paper is a report of a descriptive study of nurses’ experiences of daily stress and coping. Background. Much of the research on stress in nursing is quantitative and has focused on only work stressors. Moreover, few studies have examined the uplifting side of living and the role it may play in moderating stress. A theoretical framework on stress and coping, ‘hassles’ and ‘uplifts’ was used to examine nurses’ experiences across their personal and professional lives from a qualitative perspective. Methods. A purposive sample of Singaporean hospital nurses (n = 23) identified using a snowball sampling technique, participated in two sets of email interviews in 2009. The qualitative data were analysed using thematic analysis. Results. Three themes were identified as constituting daily hassles: (i) time pressures, (ii) nature of nursing work and (iii) multiple roles. Uplifts were expressed in relation to one main theme of feeling good extending across nurses’ personal and professional lives. Three themes were identified as ways of coping: (i) taking time out, (ii) seeking emotional support and (iii) belief systems. Conclusion. The interaction between personal and professional life plays a major role in Singaporean nurses’ experiences of stress and coping. However, stress may be ameliorated through effective management and strong familial support. Nurses and employers are recommended to use uplifts and identify ways of coping to minimize attrition and contribute to the development of a healthy workforce.

The time course of in vivo recovery of transverse strain in high-stress tendons following exercise

Objective To evaluate the time course of the recovery of transverse strain in the Achilles and patellar tendon following a bout of resistance exercise. Methods Seventeen healthy adults underwent sonographic examination of the right patellar (n=9) and Achilles (n=8) tendons immediately prior to and following 90 repetitions of weight-bearing quadriceps and gastrocnemius-resistance exercise performed against an effective resistance of 175% and 250% body weight, respectively. Sagittal tendon thickness was determined 20 mm from the enthesis and transverse strain, as defined by the stretch ratio, was repeatedly monitored over a 24 h recovery period. Results Resistance exercise resulted in an immediate decrease in Achilles (t7=10.6, p<0.01) and patellar (t8=8.9, p<0.01) tendon thickness, resulting in an average transverse stretch ratio of 0.86±0.04 and 0.82±0.05, which was not significantly different between tendons. The magnitude of the immediate transverse strain response, however, was reduced with advancing age (r=0.63, p<0.01). Recovery in transverse strain was prolonged compared with the duration of loading and exponential in nature. The average primary recovery time was not significantly different between the Achilles (6.5±3.2 h) and patellar (7.1±3.2 h) tendons. Body weight accounted for 62% and 64% of the variation in recovery time, respectively. Conclusions Despite structural and biochemical differences between the Achilles and patellar tendon, the mechanisms underlying transverse creep recovery in vivo appear similar and are highly time dependent. These novel findings have important implications concerning the time required for the mechanical recovery of high-stress tendons following an acute bout of exercise.

Transcriptome analysis of neutrophils after endurance exercise reveals novel signaling mechanisms in the immune response to physiological stress

Neutrophils serve as an intriguing model for the study of innate immune cellular activity induced by physiological stress. We measured changes in the transcriptome of circulating neutrophils following an experimental exercise trial (EXTRI) consisting of 1 h of intense cycling immediately followed by 1 h of intense running. Blood samples were taken at baseline, 3 h, 48 h, and 96 h post-EXTRI from eight healthy, endurance-trained, male subjects. RNA was extracted from isolated neutrophils. Differential gene expression was evaluated using Illumina microarrays and validated with quantitative PCR. Gene set enrichment analysis identified enriched molecular signatures chosen from the Molecular Signatures Database. Blood concentrations of muscle damage indexes, neutrophils, interleukin (IL)-6 and IL-10 were increased (P < 0.05) 3 h post-EXTRI. Upregulated groups of functionally related genes 3 h post-EXTRI included gene sets associated with the recognition of tissue damage, the IL-1 receptor, and Toll-like receptor (TLR) pathways (familywise error rate, P value < 0.05). The core enrichment for these pathways included TLRs, low-affinity immunoglobulin receptors, S100 calcium binding protein A12, and negative regulators of innate immunity, e.g., IL-1 receptor antagonist, and IL-1 receptor associated kinase-3. Plasma myoglobin changes correlated with neutrophil TLR4 gene expression (r = 0.74; P < 0.05). Neutrophils had returned to their nonactivated state 48 h post-EXTRI, indicating that their initial proinflammatory response was transient and rapidly counterregulated. This study provides novel insight into the signaling mechanisms underlying the neutrophil responses to endurance exercise, suggesting that their transcriptional activity was particularly induced by damage-associated molecule patterns, hypothetically originating from the leakage of muscle components into the circulation.

Proximal and distal forms of visionary leadership : a stress buffering perspective

Occupational stress research has consistently demonstrated many negative effects of work stressors on employee adjustment (i.e., job-related attitudes and health). Considerable literature also describes potential moderators of this relationship. While research has revealed that leader vision can have significant positive effects on employee adjustment it has neglected investigation of its potential stress buffering effects. Based on leadership and identification theories, it was predicted that stress buffering effects of leader vision would be more evident for distal versus proximal leaders and also when the distal or proximal leader vision was congruent with the employee adjustment outcome type (distal versus proximal). Predictions were tested with an employee sample from one large public sector organization (N = 519). Hierarchical multiple regression analyses revealed that main and moderated effects relating to leader vision supported the notion that occupational stress would be reduced when there was congruence of distal and proximal leader vision and distal and proximal outcome types. However, stress buffering effects were found for high and low perceivers of leader vision that were not in line with hypotheses posing questions for the definitions of distal and proximal identifications. Findings are discussed in terms of theoretical and practical implications.

The Levels of Job Satisfaction, Stress and Burnout In Australian and New Zealand Haemodialysis Nurses

Background: Job dissatisfaction, stress and burnout is linked to high rates of nurses leaving the profession, poor morale, poor patient outcomes and increased financial expenditure. Haemodialysis nurses find their work satisfying although it can be stressful. Little is known, however, about job satisfaction, stress or burnout levels of haemodialysis nurses in Australia and New Zealand. Aims: To assess the current levels of job satisfaction, stress, burnout and nurses’ perception of the haemodialysis work environment. Methods: An observational study involved a cross-sectional sample of 417 registered or enrolled nurses working in Australian or New Zealand haemodialysis units. Data was collected using an on-line questionnaire containing demographic and work characteristics as well as validated measures of job satisfaction, stress, burnout and the work environment Results: 74% of respondents were aged over 40 and 75% had more than six years of haemodialysis nursing experience. Job satisfaction levels were comparable to studies in other practice areas with higher satisfaction derived from professional status and interactions with colleagues. Despite nurses viewing their work environment favourably, moderate levels of burnout were noted with frequent stressors related to workload and patient death and dying. Interestingly there were no differences found between the type or location of dialysis unit. Conclusion: Despite acceptable levels of job satisfaction and burnout, stress with workloads and facets of patient care were found. Understanding the factors that contribute to job satisfaction, stress and burnout can impact the healthcare system through decreased costs by retaining valued staff and through improved patient care.

Internationalising Australian secondary education

This thesis presents the findings of a case study of international students who enrol in Australian secondary schools. Specifically, it focuses on the ways that staff in three schools and two international colleges position Eastern Asian international students through discourses of cultural difference. It draws together the Discourse Historical Approach to Critical Discourse Analysis with the work of Basil Bernstein and Pierre Bourdieu. The study finds that groups of students are positioned positively or negatively depending on their relationship to the dominant discourses of the Australian school. Australian students, while rarely mentioned, were positioned positively. By contrast, the Eastern Asian international students were positioned negatively in relation to the privileged discourses of Australian schooling. These discourses reflected the cultural capital that was valued in the schools. In particular, the cultural capital of active and willing engagement in competitive sports and being rough, rugged and an ‘ocker’ were privileged at the schools. International students from Papua New Guinea, and a few Eastern Asian students who behaved as ockers, were positioned positively because they realised cultural capital that was valued at the schools. By contrast, the students who were unable to be positioned through these discourses, because they did not realise cultural capital that was valued, were not viewed favourably. As a result, the data showed that there was a hierarchy of positions at the schools that were constructed in staff accounts. The analysis of data suggests that only some students are positioned favourably in Australian schools. The students who were already able to construct privileged Australian school discourses were positioned positively. The data suggest that the majority of the Eastern Asian students were represented through negative discourses because they did not realise cultural capital that was valued at the schools. Findings of this study may assist schools to identify international students who may experience their Australian school education negatively. The findings may also contribute to assisting staff to better engage with international students.

Investigation of the chemical and physical basis of oxidative stress generated by particulate matter using the profluorescent probe technique

Following the growing need for adoption of alternative fuels, this project aimed at getting more information on the oxidative potential of biodiesel particulate matter. Within this scope, the physical and chemical characteristics of biodiesel PM were analysed which lead to identification of reactive organic fractions. An in-house developed proflurescent nitroxide probe was used. This project further developed in-depth understanding of the chemical mechanisms following the detection of the oxidative potential of PM. This knowledge made a significant contribution to our understanding of processes behind negative health effects of pollution and enabled us to further develop new techniques to monitor it.

Assessment of the molecular structure of natrodufrénite – NaFe2+Fe3+5(PO4)4(OH)6•2(H2O), a secondary pegmatite phosphate mineral from Minas Gerais, Brazil

The mineral natrodufrénite a secondary pegmatite phosphate mineral from Minas Gerais, Brazil, has been studied by a combination of scanning electron microscopy and vibrational spectroscopic techniques. Electron probe analysis shows the formula of the studied mineral as (Na0.88Ca0.12)∑1.00(Mn0.11Mg0.08Ca0.04Zr0.01Cu0.01)∑0.97(Al0.02)∑4.91(PO4)3.96(OH6.15F0.07)6.22⋅2.05(H2O). Raman spectroscopy identifies an intense peak at 1003 cm−1 assigned to the ν1 symmetric stretching mode. Raman bands are observed at 1059 and 1118 cm−1 and are attributed to the ν3 antisymmetric stretching vibrations. A comparison is made with the spectral data of other hydrate hydroxy phosphate minerals including cyrilovite and wardite. Raman bands at 560, 582, 619 and 668 cm−1 are assigned to the ν4 bending modes and Raman bands at 425, 444, 477 and 507 cm−1 are due to the ν2 bending modes. Raman bands in the 2600–3800 cm−1 spectral range are attributed to water and OH stretching vibrations. Vibrational spectroscopy enables aspects of the molecular structure of natrodufrénite to be assessed.

A case study of pedagogical responses to internationalisation at a faith-based secondary school in Australia

This case study investigated pedagogical responses to internationalisation by a faith-based secondary school in Australia. Using social constructivism as the theoretical framework the study examined teaching and learning for culturally and linguistically diverse students. Data generated through questionnaires, focus groups, individual interviews and document archives were analysed and interpreted using thematic analysis. The findings showed that teachers believed themselves to be ill-equipped to teach international students. Their concerns centred on a lack of explicit pedagogical, cultural and linguistic knowledge to help the students acculturate and learn. Recommendations include the dissemination of school policies to teachers, intentional staff collaboration and professional development to address the teachers’ needs for internationalisation.

Work environment, job satisfaction, stress and burnout among haemodialysis nurses

Aim To examine the relationships among nurse and work characteristics, job satisfaction, stress, burnout and the work environment of haemodialysis nurses. Background Haemodialysis nursing is characterised by frequent and intense contact with patients in a complex and intense environment. Method Cross-sectional online survey of 417 haemodialysis nurses that included nurse and work characteristics, the Brisbane Practice Environment Measure, Index of Work Satisfaction, Nursing Stress Scale and the Maslach Burnout Inventory. Results Haemodialysis nurses reported an acceptable level of job satisfaction and perceived their work environment positively, although high levels of burnout were found. Nurses who were older and had worked in haemodialysis the longest had higher satisfaction levels, experienced less stress and lower levels of burnout than younger nurses. The in-centre type of haemodialysis unit had greater levels of stress and burnout than home training units. Greater satisfaction with the work environment was strongly correlated with job satisfaction, lower job stress and emotional exhaustion. Conclusion Haemodialysis nurses experienced high levels of burnout even though their work environment was favourable and they had acceptable levels of job satisfaction. Implications for Nursing Management: Targeted strategies are required to retain and avoid burnout in younger and less experienced nurses in this highly specialised field of nursing.

Driver perceptions of the benefits of reducing their driving speed on safety, emissions, and stress and road rage

The existing literature shows driving speed significantly affects levels of safety, emissions, and stress in driving. In addition, drivers who feel tense when driving have been found to drive more slowly than others. These findings were mostly obtained from crash data analyses or field studies, and less is known regarding driver perceptions of the extent to which reducing their driving speed would improve road safety, reduce their car’s emissions, and reduce stress and road rage. This paper uses ordered probit regression models to analyse responses from 3538 Queensland drivers who completed an online RACQ survey. Drivers most strongly agreed that reducing their driving speed would improve road safety, less strongly agreed that reducing their driving speed would reduce their car’s emissions and least strongly agreed that reducing their driving speed would reduce stress and road rage. Younger drivers less strongly agreed that these benefits would occur than older drivers. Drivers of automatic cars and those who are bicycle commuters agreed more to these benefits than other drivers. Female drivers agreed more strongly than males on improving safety and reducing stress and road rage. Type of fuel used, engine size, driving experience, and distance driven per week were also found to be associated with driver perceptions, although these were not found to be significant in all of the regression models. The findings from this study may help in developing targeted training or educational measures to improve drivers’ willingness to reduce their driving speed.

Performance of a cognitive, but not visual, secondary task interacts with alcohol-induced balance impairment in novice and experienced motorcycle riders

The appropriateness of applying drink driving legislation to motorcycle riding has been questioned as there may be fundamental differences in the effects of alcohol on driving and motorcycling. It has been suggested that alcohol may redirect riders’ focus from higher-order cognitive skills such as cornering, judgement and hazard perception, to more physical skills such as maintaining balance. To test this hypothesis, the effects of low doses of alcohol on balance ability were investigated in a laboratory setting. The static balance of twenty experienced and twenty novice riders was measured while they performed either no secondary task, a visual (search) task, or a cognitive (arithmetic) task following the administration of alcohol (0%, 0.02%, and 0.05% BAC). Subjective ratings of intoxication and balance impairment increased in a dose-dependent manner in both novice and experienced motorcycle riders, while a BAC of 0.05%, but not 0.02%, was associated with impairments in static balance ability. This balance impairment was exacerbated when riders performed a cognitive, but not a visual, secondary task. Likewise, 0.05% BAC was associated with impairments in novice and experienced riders’ performance of a cognitive, but not a visual, secondary task, suggesting that interactive processes underlie balance and cognitive task performance. There were no observed differences between novice vs. experienced riders on static balance and secondary task performance, either alone or in combination. Implications for road safety and future ‘drink riding’ policy considerations are discussed.

A meta-analytic clarification of the relationship between posttraumatic growth and symptoms of posttraumatic distress disorder

Traumatic experiences can have a powerful impact on individuals and communities but the relationship between perceptions of beneficial and pathological outcomes are not known. Therefore, this meta-analysis examined both the strength and the linearity of the relationship between symptoms of posttraumatic stress disorder (PTSD) and perceptions of posttraumatic growth (PTG) as well as identifying the potential moderating roles of trauma type and age. Literature searches of all languages were conducted using the ProQuest, Wiley Interscience, ScienceDirect, Informaworld and Web of Science databases. Linear and quadratic (curvilinear) rs as well as βs were analysed. Forty-two studies (N=11, 469) that examined both PTG and symptoms of PTSD were included in meta-analytic calculations. The combined studies yielded a significant linear relationship between PTG and PTSD symptoms (r=.315, CI = 0.299, 0.331), but also a significantly stronger (as tested by Fisher’s transformation) curvilinear relationship (r=.372, CI = 0.353, 0.391). The strength and linearity of these relationships differed according to trauma type and age. The results remind those working with traumatised people that positive and negative post-trauma outcomes can co-occur. A focus only on PTSD symptoms only may limit or slow recovery and mask the potential for growth.

Factors influencing the impact of primary and secondary prevention strategies for cervical cancer among Queensland women

Since the introduction of the National Human Papillomavirus Vaccine Program (NHPVP) in 2007, few studies have assessed women's knowledge, beliefs and attitudes towards cervical screening and human papillomavirus (HPV) vaccination in Australia. It is imperative to ascertain this, as substantial changes are anticipated to the National Cervical Screening Program (NCSP) through a process called 'the Renewal', to ensure any changes that are introduced will be acceptable and well understood by women. The objectives of this study were to describe Queensland women's current knowledge of cervical cancer/screening and HPV, their beliefs and attitudes towards Pap smears and the HPV vaccine and seek their advice on effective methods for communicating changes to the NCSP in their communities. This research was a descriptive-exploratory study that incorporated a combination of qualitative and quantitative methods within the context of the Health Belief Model (HBM). A computer-assisted telephone interview (CATI) survey of 1002 Queensland women was conducted in Phase 1 of the study. During Phase 2 of the study, 23 focus groups were conducted throughout Queensland to gather in-depth information about women's knowledge, awareness and acceptance about cervical cancer prevention strategies. This study found high levels of awareness of HPV (over 60%) and the HPV vaccine (over 86%) amongst Queensland women. However, it also identified considerable uncertainty amongst participants about perceived susceptibility to cervical cancer, especially, the link between cervical cancer, HPV and sexual activity. Women also had limited understanding of the benefit of the Pap smear as a preventative strategy, with many women thinking the main purpose of the Pap smear was for the early detection of cancer. Despite high awareness of HPV, women participating in this study also had significant knowledge deficits about their susceptibility to HPV and the severity of HPV infection. Queensland women had high levels of awareness of the HPV vaccine, which was most commonly via the media. High acceptance of the HPV vaccine was found amongst participants although awareness of the full benefits of vaccination was not evident with little acknowledgement that the quadrivalent vaccine used in the NHPVP would also prevent genital warts. Extensive barriers to having Pap smears, including physical and psychological discomfort, were identified and the most common barriers to vaccination were concerns about side effects and a lack of information upon which to make a decision about consent. Women described enablers for screening participation, such as reminder systems and practitioner characteristics, and expressed positive views towards self collected testing as an enabler, particularly for women who did not attend screening. As this study was conducted with Queensland women it may therefore not be representative of women from other parts of Australia and as participants were more likely to report they were regular screeners than Queensland women overall, these results may not be representative of women least likely to participate in cervical screening. The use of self-reported cervical screening history may also have led to over-reporting of screening status and previous abnormalities by participants. This study reveals significant gaps in Queensland women's knowledge that require effective communication strategies to address. Recommendations from this study highlight the need for increased community education to raise awareness about primary and secondary cervical cancer prevention strategies, training of cervical screening providers in sensitive examination techniques, a reduction in costs associated with screening, the exploration of alternative service models and communication plans that incorporate methods women trust and recommend for disseminating information about changes to the NCSP. This study is the first large study to explore women's perceptions of the Pap smear and barriers to screening, their knowledge about HPV and their attitudes towards the HPV vaccine in Queensland, since the introduction of the NHPVP. It highlights considerable uncertainty about many aspects of cervical cancer and primary and secondary prevention strategies available in Australia and identified many barriers to cervical screening and concerns about HPV vaccination. These knowledge gaps and barriers need to be taken into account and addressed within the context of anticipated changes to the NCSP to ensure benefits are maximised for women in future primary and secondary cervical cancer prevention strategies in the Australian context.