An accessible method for teaching doctors about death certification

The World Health Organization recommends that data on mortality in its member countries are collected utilising the Medical Certificate of Cause of Death published in the instruction volume of the ICD-10. However, investment in health information processes necessary to promote the use of this certificate and improve mortality information is lacking in many countries. An appeal for support to make improvements has been launched through the Health Metrics Network���s MOVE-IT strategy (Monitoring of Vital Events ��� Information Technology) [World Health Organization, 2011]. Despite this international spotlight on the need for capture of mortality data and in the use of the ICD-10 to code the data reported on such certificates, there is little cohesion in the way that certifiers of deaths receive instruction in how to complete the death certificate, which is the main source document for mortality statistics. Complete and accurate documentation of the immediate, underlying and contributory causes of death of the decedent on the death certificate is a requirement to produce standardised statistical information and to the ability to produce cause-specific mortality statistics that can be compared between populations and across time. This paper reports on a research project conducted to determine the efficacy and accessibility of the certification module of the WHO���s newly-developed web based training tool for coders and certifiers of deaths. Involving a population of medical students from the Fiji School of Medicine and a pre and post research design, the study entailed completion of death certificates based on vignettes before and after access to the training tool. The ability of the participants to complete the death certificates and analysis of the completeness and specificity of the ICD-10 coding of the reported causes of death were used to measure the effect of the students��� learning from the training tool. The quality of death certificate completion was assessed using a Quality Index before and after the participants accessed the training tool. In addition, the views of the participants about accessibility and use of the training tool were elicited using a supplementary questionnaire. The results of the study demonstrated improvement in the ability of the participants to complete death certificates completely and accurately according to best practice. The training tool was viewed very positively and its implementation in the curriculum for medical students was encouraged. Participants also recommended that interactive discussions to examine the certification exercises would be an advantage.

Implementation of ICD-11... perspectives from the Australian Bureau of Statistics

As the development of ICD-11 progresses, the Australian Bureau of Statistics is beginning to consider what will be required to successfully implement the new version of the classification. This paper will present early thoughts on the following: building understanding amongst the user community of upcoming changes and the implications of those changes; the need for training of coders and data users; development of analytical methods and conduct of comparability studies; processes to test, accept and implement new or updated coding software; assessment of coding quality; changes to data analyses and reporting processes; updates to regular publications; and assessing the resources required for successful implementation.

Experiences in training ICD-10 trainers

The National Centre for Health Information Research & Training (formerly NCCH Brisbane) has been conducting an annual introductory ICD-10 coding program in Brisbane for seven years. In 2008, the Centre introduced a new initiative, inviting potential trainers to participate in a one week train the trainer workshop prior to the regular coder training. The new trainers are provided with the opportunity to practice their new skills with the support and assistance of the NCHIRT trainers during the subsequent introductory program. This paper will report on the results of a survey of participants of these programs about their experiences conducting training courses in their own countries. The train the trainer program as a means to create a cadre of trainers to support the implementation of ICD-11 will be explored.

Social and emotional determinants of health

- describe what is meant by socioeconomic differences in health, and the social and emotional determinants of health - understand how health inequalities are affected by the social and economic circumstances that people experience throughout their lives - discuss how factors such as living and working conditions, income, place and education can impact on health - identify actions for public health policy-makers that have the potential to make a difference in improving health outcomes within populations - appreciate the concept of social cohesion and social capital, and their role as potential protective factors in health - understand conceptual models that can assist in analysing these issues.

Exploring Indigenous social attitudes and priorities in Australia

Given significant government attention to, and expenditure on, Indigenous equity in Australia, this article addresses a core problem: the lack of a sound understanding of Indigenous social attitudes and priorities. An account of cultural theory raises the likelihood of difference in outlook between Indigenous and non-Indigenous people, including those making and implementing policy. Yet, years of scholarly research and official statistical collections have overlooked potentially critical aspects of Indigineity. Suggestions of difference emerge from reference to the 2007 Australian Survey of Social Attitudes (AuSSA). If the attitudes recorded a small sample in this instrument manifest in the Indigenous population at large, policy priorities and directions should be reviewed and possibly revised. Despite inherent methodological difficulties, the article calls for targeted social attitude research among Australia's Indigenous peoples so that future policy can be better oriented and calibrated. The national benefits would outweigh the costs via better directed policy making.

The "human factor" in DFM

With a focus on understanding the overall effect of DFM on human factors aspects, DFM/DFA literature was systematically searched, reviewed and critically assessed. The influence of DFM on work organization is analysed using examples from literature, with the aim of quantifying consequences on work performance, job satisfaction and human work load where possible. It is also shown that job enlargement through DFM tasks increases the workload for the Product Designer, who is on the critical path of the engineering process. Without taking measures to counterbalance this higher workload of the Product Designer, DFM projects in complex engineering environments are likely to fail.

Using mobile social media and GIS in health and place research

This paper presents new research methods that combine the use of location-based, social media on mobile phones with geographic information systems (GIS) to explore connections between people, place and health. It discusses the feasibility, limitations, and benefits of using these methods, which enable real-time, location-based, quantitative data to be collected on the recreation, consumption, and physical activity patterns of urban residents in Brisbane, Queensland. The study employs mechanisms already inherent in popular mobile social media applications (Facebook, Twitter and Foursquare) to collect this data. The research methods presented in this paper are innovative and potentially applicable to an increasing number of academic research areas, as well as to a growing range of service providers that benefit from monitoring consumer behaviour, and responding to emerging changes in these patterns and trends. The ability to both collect and map objective, real-time data about the consumption, leisure, recreation, and physical activity patterns amongst urban communities has direct implications for a range of research disciplines including media studies, advertising, health promotion, social marketing, public health inequalities, and urban design.

���We are not here to claim better services than any other��� : Social exclusion among men from refugee backgrounds in urban and regional Australia

This paper reports on a mixed-methods study of social exclusion experiences among 233 resettled refugees living in urban and regional Queensland, Australia. The findings reported here are drawn from the SettleMEN project, a longitudinal investigation of health and settlement experiences among recently arrived adult men from refugee backgrounds conducted between 2008 and 2010. Using questionnaire surveys and semi-structured interviews, we examine four key dimensions of social exclusion: production, consumption, social relations, and services. We show that, overall, participants experienced high levels of social exclusion across all four dimensions. Participants living in regional areas were significantly more likely to be excluded from production, social relations, and services. We argue that there is a pressing need to tackle barriers to economic participation and discrimination in order to promote the social inclusion of men from refugee backgrounds.

Quality of work life and turnover intention in primary healthcare organisations : a cross-sectional study of registered nurses in Saudi Arabia

Purpose: The purpose of this study was to improve the retention of primary healthcare (PHC) nurses through exploring and assessing their quality of work life (QWL) and turnover intention. Design and methods: A cross-sectional survey design was used in this study. Data were collected using a questionnaire comprising four sections (Brooks��� survey of Quality of Nursing Work Life [QNWL], Anticipated Turnover Intention, open-ended questions and demographic characteristics). A convenience sample was recruited from 143 PHC centres in Jazan, Saudi Arabia. A response rate of 87% (n = 508/585) was achieved. The SPSS v17 for Windows and NVivo 8 were used for analysis purposes. Procedures and tests used in this study to analyse the quantitative data were descriptive statistics, t-test, ANOVA, General Linear Model (GLM) univariate analysis, standard multiple regression, and hierarchical multiple regression. Qualitative data obtained from responses to the open-ended questions were analysed using the NVivo 8. Findings: Quantitative findings suggested that PHC nurses were dissatisfied with their work life. Respondents��� scores ranged between 45 and 218 (mean = 139.45), which is lower than the average total score on Brooks��� Survey (147). Major influencing factors were classified under four dimensions. First, work life/home life factors: unsuitable working hours, lack of facilities for nurses, inability to balance work with family needs and inadequacy of vacations��� policy. Second, work design factors: high workload, insufficient workforce numbers, lack of autonomy and undertaking many non-nursing tasks. Third, work context factors: management practices, lack of development opportunities, and inappropriate working environment in terms of the level of security, patient care supplies and unavailability of recreation room. Finally, work world factors: negative public image of nursing, and inadequate payment. More positively, nurses were notably satisfied with their co-workers. Conversely, 40.4% (n = 205) of the respondents indicated that they intended to leave their current employment. The relationships between QWL and demographic variables of gender, age, marital status, dependent children, dependent adults, nationality, ethnicity, nursing tenure, organisational tenure, positional tenure, and payment per month were significant (p < .05). The eta squared test for these demographics indicates a small to medium effect size of the variation in QWL scores. Using the GLM univariate analysis, education level was also significantly related to the QWL (p < .05). The relationships between turnover intention and demographic variables including gender, age, marital status, dependent children, education level, nursing tenure, organisational tenure, positional tenure, and payment per month were significant (p < .05). The eta squared test for these demographics indicates a small to moderate effect size of the variation in the turnover intention scores. Using the GLM univariate analysis, the dependent adults��� variable was also significantly related to turnover intention (p < .05). Turnover intention was significantly related to QWL. Using standard multiple regression, 26% of the variance in turnover intention was explained by the QWL F (4,491), 43.71, p < .001, with R�� = .263. Further analysis using hierarchical multiple regression found that the total variance explained by the model as a whole (demographics and QWL) was 32.1%, F (17.433) = 12.04, p < .001. QWL explained an additional 19% of the variance in turnover intention, after controlling for demographic variables, R squared change =.19, F change (4, 433) = 30.190, p < .001. The work context variable makes the strongest unique contribution (-.387) to explain the turnover intention, followed by the work design dimension (-.112). The qualitative findings reaffirmed the quantitative findings in terms of QWL and turnover intention. However, the home life/work life and work world dimensions were of great important to both QWL and turnover intention. The qualitative findings revealed a number of new factors that were not included in the survey questionnaire. These included being away from family, lack of family support, social and cultural aspects, accommodation facilities, transportation, building and infrastructure of PHC, nature of work, job instability, privacy at work, patients and community, and distance between home and workplace. Conclusion: Creating and maintaining a healthy work life for PHC nurses is very important to improve their work satisfaction, reduce turnover, enhance productivity and improve nursing care outcomes. Improving these factors could lead to a higher QWL and increase retention rates and therefore reinforcing the stabilisation of the nursing workforce. Significance of the research: Many countries are examining strategies to attract and retain the health care workforce, particularly nurses. This study identified factors that influence the QWL of PHC nurses as well as their turnover intention. It also determined the significant relationship between QWL and turnover intention. In addition, the present study tested Brooks��� survey of QNWL on PHC nurses for the first time. The qualitative findings of this study revealed a number of new variables regarding QWL and turnover intention of PHC nurses. These variables could be used to improve current survey instruments or to develop new research surveys. The study findings could be also used to develop and appropriately implement plans to improve QWL. This may help to enhance the home and work environments of PHC nurses, improve individual and organisational performance, and increase nurses��� commitment. This study contributes to the existing body of research knowledge by presenting new data and findings from a different country and healthcare system. It is the first of its kind in Saudi Arabia, especially in the field of PHC. It has examined the relationship between QWL and turnover intention of PHC nurses for the first time using nursing instruments. The study also offers a fresh explanation (new framework) of the relationship between QWL and turnover intention among PHC nurses, which could be used or tested by researchers in other settings. Implications for further research: Review of the extant literature reveals little in-depth research on the PHC workforce, especially in terms of QWL and organisational turnover in developing countries. Further research is required to develop a QWL tool for PHC nurses, taking into consideration the findings of the current study along with the local culture. Moreover, the revised theoretical framework of the current study could be tested in further research in other regions, countries or healthcare systems in order to identify its ability to predict the level of PHC nurses��� QWL and their intention to leave. There is a need to conduct longitudinal research on PHC organisations to gain an in-depth understanding of the determents of and changes in QWL and turnover intention of PHC nurses at various points of time. An intervention study is required to improve QWL and retention among PHC nurses using the findings of the current study. This would help to assess the impact of such strategies on reducing turnover of PHC nurses. Focusing on the location of the current study, it would be valuable to conduct another study in five years��� time to examine the percentage of actual turnover among PHC nurses compared with the reported turnover intention in the current study. Further in-depth research would also be useful to assess the impact of the local culture on the perception of expatriate nurses towards their QWL and their turnover intention. A comparative study is required between PHC centres and hospitals as well as the public and private health sector agencies in terms of QWL and turnover intention of nursing personnel. Findings may differ from sector to sector according to variations in health systems, working environments and the case mix of patients.

Diversity, disruption, continuity: Parenting and social and emotional wellbeing amongst Aboriginal peoples and Torres Strait Islanders

This paper reviews the diversity in parenting values and practices amongst Aboriginal peoples and Torres Strait Islanders. Firstly, issues arising from the historical traumatic disruption of families��� attachments are discussed, Then the contribution Indigenous parenting makes to the development of healthy and vulnerable individuals becomes the central focus. Family therapists can draw from a broad understanding of the diversity of parenting values and practices in the context of a strength-based approach.

Gender differences in recreational and transport cycling : a cross-sectional mixed-methods comparison of cycling patterns, motivators, and constraints

Background: Gender differences in cycling are well-documented. However, most analyses of gender differences make broad comparisons, with few studies modeling male and female cycling patterns separately for recreational and transport cycling. This modeling is important, in order to improve our efforts to promote cycling to women and men in countries like Australia with low rates of transport cycling. The main aim of this study was to examine gender differences in cycling patterns and in motivators and constraints to cycling, separately for recreational and transport cycling. Methods: Adult members of a Queensland, Australia, community bicycling organization completed an online survey about their cycling patterns; cycling purposes; and personal, social and perceived environmental motivators and constraints (47% response rate). Closed and open-end questions were completed. Using the quantitative data, multivariable linear, logistic and ordinal regression models were used to examine associations between gender and cycling patterns, motivators and constraints. The qualitative data were thematically analysed to expand upon the quantitative findings. Results: In this sample of 1862 bicyclists, men were more likely than women to cycle for recreation and for transport, and they cycled for longer. Most transport cycling was for commuting, with men more likely than women to commute by bicycle. Men were more likely to cycle on-road, and women off-road. However, most men and women did not prefer to cycle on-road without designed bicycle lanes, and qualitative data indicated a strong preference by men and women for bicycle-only off-road paths. Both genders reported personal factors (health and enjoyment related) as motivators for cycling, although women were more likely to agree that other personal, social and environmental factors were also motivating. The main constraints for both genders and both cycling purposes were perceived environmental factors related to traffic conditions, motorist aggression and safety. Women, however, reported more constraints, and were more likely to report as constraints other environmental factors and personal factors. Conclusion: Differences found in men���s and women���s cycling patterns, motivators and constraints should be considered in efforts to promote cycling, particularly in efforts to increase cycling for transport.

Joined-up practice : five areas of exemplary practice for social workers and educators to re-engage homeless youth

Young people seen as ���at risk��� are a substantial focus across a wide range of policy and practice fields in national and international contexts. This article addresses two of those fields, youth homelessness and youth failing to obtain a basic education that will give them access to employment and full community participation as active citizens. By comparing solutions to the problems of youth homelessness and youth educationally at risk, the article distils key meta-characteristics useful for both social workers and educators in mutually supporting some of the most at risk young people in our communities today. This is what the authors term ���a joined-up practice���.

Ocularcentric labour : ���you don���t do this for money���

Building on the tradition of emotional labour and aesthetic labour, this study of fitness workers introduces the concept of ���ocularcentric labour��� (the worker seeking the adoring gaze of the client as the primary reward). It is a state in which labour���s quest for the psycho-social rewards gained from their own body image shapes the employment relationship (both the organization of work and the conditions of employment). We argue that for many fitness workers the goal is to gain access to the positional economy of the fitness centre to promote their celebrity. For this they are willing to trade-off standard conditions of employment, and exchange traditional employment rewards for the more intrinsic psycho-social rewards gained through the exposure of their physical capital to the adoration of their gazing clients. Significantly, with ocularcentric labour the worker becomes both the site of production and consumption.