Young people’s aspirations for education, work, family and leisure

Young people are arguably facing more ‘complex and contested’ transitions to adulthood and an increasing array of ‘non-linear’ paths. Education and training have been extended, identity is increasingly shaped through leisure and consumerism and youth must navigate their life trajectories in highly individualised ways. The study utilises 819 short essays compiled by students aged 14–16 years from 19 schools in Australia. It examines how young people understand their own unique positions and the possibilities open to them through their aspirations and future orientations to employment and family life. These young people do not anticipate postponing work identities, but rather embrace post-school options such as gaining qualifications, work experience and achieving financial security. Boys expected a distant involvement in family life secondary to participation in paid work. In contrast, around half the girls simultaneously expected a future involving primary care-giving and an autonomous, independent career, suggesting attempts to remake gendered inequalities

Contributors to life satisfaction in parents of an adult child with Down syndrome

Aim: This study investigated: (1) concurrent relationships between measures of family life and parental satisfaction with life in parents of an adult with Down syndrome and (2) influence of early family functioning on current parental satisfaction. Method: Sixty-two families were interviewed using a semi-structured interview, and responded to a series of questionnaires related to family functioning when their child with Down syndrome was between 7 and 15 years. Fifteen years later parents were asked to provide data on their current situation, including mental health, and satisfaction and difficulties with respect to care-giving in relation to their adult child. Results: Over half the families provided data to the second phase of the study. Life circumstances were appreciably worse for a small group of families than had been the case 15 years previously; however, these changes were generally unrelated to their parenting role. Overall, parents reported experiencing satisfaction from their care-giving role and did not report high levels of difficulties emanating from this role. Conclusions: Most parents demonstrated good levels of personal functioning, although there was a small group for whom this was not the case. Earlier functioning did not make a strong contribution to current levels of life satisfaction.

The legitimation and reproduction of discourse-practice gaps in work-life balance

Purpose - Critical scholarship on work-life balance (WLB) and its associated practices maintains that workplace flexibility is more than a quasi-functionalist response to contemporary problems faced by individuals, families or organisations. Beginning with Fleetwood’s contention that WLB discourses have become "detached" from their associated practices, this paper explores how workplace practices support or challenge dominant WLB discourses evident in socio-cultural, political and organisational sources. Design/methodology/approach - We analyse individual and group interview transcripts derived from 122 white-collar employees in two different organisational contexts (one public, one private) in the construction industry in Australia. Findings - Four major themes were identified in the data which illustrate discourse practice gaps. First, the demands facing this particular industry/ sector were framed as heightened and unique. Second, productivity was prioritised, dominating employees’ care-giving and lifestyle concerns. Third, employees’ caring responsibilities were communicated as personal and individual choices. Fourth, commitment and efficiency were judged on the basis of presence in the workplace. Research limitations/implications - Even in industries that have embraced WLB, workplace practices legitimate and reinforce the status quo, and maintain a gap between the promises of WLB and its potential to ameliorate conflict and assist workers to span the boundaries of paid work and other life domains. Originality/value - While the practices demonstrated in the research are focused on one industry, the study provides a critical analysis of how the contextually-influenced meaning of WLB is constructed, created and contested in these workplaces and the effects it produces.

A longitudinal study of grieving in family caregivers of people with dementia

A longitudinal study of grieving in family caregivers of people with dementia Recent research into dementia has identified the long term impact that the role of care giving for a relative with dementia has on family members This is largely due to the cognitive decline that characterises dementia and the losses that can be directly attributed to this. These losses include loss of memories, relationships and intimacy, and are often ambiguous so that the grief that accompanies them is commonly not recognised or acknowledged. The role and impact of pre-death or anticipatory grief has not previously been widely considered as a factor influencing health and well-being of family caregivers. Studies of grief in caregivers of a relative with dementia have concluded that grief is one of the greatest barriers to care giving and is a primary determinant of caregiver well-being. The accumulation of losses, in conjunction with experiences unique to dementia care giving, place family caregivers at risk of complicated grief. This occurs when integration of the death does not take place following bereavement and has been associated with a range of negative health outcomes. The aim of this research was to determine the influence of grief, in addition to other factors representing both positive and negative aspects of the role, on the health related quality of life of family caregivers of people with dementia, prior to and following the death of their relative with dementia. An exploratory research project underpinned by a conceptual framework of caregivers’ adaptation in the context of subjective appraisal of the strains and gains in their role was undertaken. The research comprised three studies. Study 1 was a scoping study that involved a series of semi-structured interviews with thirteen participants who were family caregivers of people with severe dementia or whose relative with dementia had died in the previous twelve months. The results of this study in conjunction with factors identified in the literature informed data collection for the further studies. Study 2 was a cross sectional survey of fifty caregivers recruited when their relative was in the moderate to severe stage of dementia. This study provided the baseline data for Study 3, a prospective cohort follow up study. Study 3 consisted of seventeen participants followed up at two time points after the death of their relative with dementia: six weeks and then six months following the death of the relative with dementia. The scoping study indicated that differences in appraisal of the care giving role and encounters with health professionals were related to levels of grief of caregivers prior to and following the death of the relative with dementia. This was supported in the baseline and follow up studies. In the baseline study, after adjusting for all variables in multivariate regression models, subjective appraisal of burden was found to make a significant contribution (p<.05) to mental health related quality of life. The two dependent variables, anticipatory grief and mental health related quality of life, were significantly (p<.01) correlated at a bivariate level. In the follow up study, linear mixed modelling and multiple regression analysis of data found that subjective appraisal of burden and resilience were significantly associated (p<.05 and p<.01, respectively) with mental health related quality of life over time. In addition, bereavement and complicated grief were significantly associated (p<.05) with mental health following the death of the relative. In this study social support and satisfaction with end of life care were found to be statistically associated (p<.05) with physical health related quality of life over time. The strong relationship between grief of caregivers and their health related quality of life over the entire care giving trajectory and period following the death of their relative highlights the urgent need for further research and interventions in this area. Overall results indicate that addressing the risk and protective factors including subjective appraisal of their care giving role, resilience, social support and satisfaction with end of life care of their relative, has the potential to both ameliorate negative health outcomes and to promote improved health for these caregivers. This research provides important information for development of targeted and appropriate interventions that aim to promote resilience and reduce the personal burden on caregivers of people with dementia.

Are mothers of young children really inactive?

Australian surveys have found that only 43% of women meet the current recommendation for regular moderate physical activity, and that women who are mothers of young children are even less likely to be adequately active for health benefit. These women spend a significant proportion of their day in occupational, household and care-giving activities, which may not be ‘captured’ in conventional physical activity surveys. The purpose of this study was to compare physical activity in young mothers and age-matched controls using three different measures of physical activity. 35 women (16 mothers of young children, M) and 19 age-matched comparison women (NM) completed a survey which asked about walking to and from places, and about moderate and vigorous activity in leisure time and at work (paid and unpaid). They also kept a detailed diary of all their activities for two week-days and two week-end days, and wore a pedometer (Yamax digiwalker) on these days. Each activity in the diary was assigned an energy expenditure (EE) score based on it's intensity (Compendium of Physical Activity) and time spent in that activity. There were no differences between M and NM for pedometer steps (M: 9270 sd 2947; NM: 9768 sd 3051) or for daily energy expenditure (EE) calculated from the diaries (M: 2029 sd 189; NM: 2015 sd 169 METS.mins) or survey (M: 2079 sd 448; NM: 1495 sd 325). There was a significant correlation between pedometer steps and daily METs.mins estimated from the diaries (r = 0.35, p = 0.04); however no relationship was observed between pedometer steps and EE from the survey (r = .09, p = .56). Further analysis of the individual survey items found pedometer steps to be related to EE from walking to and from places (r = .34) and leisure time (r = .31), but not work related activity (r = -.08). There were no significant relationships between EE computed from the diaries and any of the survey questions. The three activity measures indicate that the physical activity levels of the young mothers in our sample were comparable to age-matched non-mothers. The results of the correlation analyses highlight the difficulty of assessing low-intensity work-related physical activity via self-report. Supported by Australian Commonwealth Department of Health and Aged Care.

Integrated versus non-integrated management and care for clients with co-occurring mental health and substance use disorders : a qualitative systematic review of randomised controlled trials

The purpose of this paper is to conduct a qualitative review of randomised controlled trials in relation to the treatment of adults with co-occurring mental health and substance use disorder (MH/SUD). In particular, integrated approaches are compared with non-integrated approaches to treatment. Ten articles were identified for inclusion in the review. The findings are equivocal with regard to the superior efficacy of integrated approaches to treatment, although the many limitations of the studies need to be considered in our understanding of this finding. Clearly, this is an extremely challenging client group to engage and maintain in intervention research, and the complexity and variability of the problems render control particularly difficult. The lack of available evidence to support the superiority of integration is discussed in relation to these challenges. Much remains to be investigated with regard to integrated management and care for people with co-occurring and MH/SUD, particularly for specific combinations of dual diagnosis and giving consideration to the level of inter-relatedness between the disorders.

The experiences of African women giving birth in Brisbane, Australia

Our purpose in this research was to uncover first-person descriptions of the birth experiences of African refugee women in Brisbane, Australia, and to explore the common themes that emerged from their experiences. We conducted semistructured interviews with 10 African refugees who had given birth in Brisbane. Essences universal to childbirth such as pain, control, and experiences of caregivers featured prominently in participants’ descriptions of their experiences. Their experiences, however, were further overshadowed by issues such as language barriers, the refugee experience, female genital mutilation (FGM), and encounters with health services with limited cultural competence.

Motives and barriers to bequest giving

Much is known about motivations for giving to charities generally. However, much less has been identified about bequestors as a unique type of charitable donor. This paper explores the motives and barriers for charitable bequest giving. Hypotheses are drawn from the general philanthropic literature and tested using survey data from Australia, a nation distinguished by very high lifetime (inter vivos) giving but low estate (post mortem) giving. The results show that belief in the efficacy of charitable organizations is requisite for leaving a bequest, as the deceased donor has no control over the enactment of the gift. This effect is mediated by the perceived difficulty of making a charitable bequest, which forms an important barrier for leaving such a legacy. Having family whose financial needs are perceived as not taken care of and the perception of financial inability to make a difference also form barriers for bequest giving. The results confirm that bequests constitute a distinctive charitable behaviour, with unique motives and barriers compared to other types of inter vivos giving. While charitable behaviour in general is driven by altruistic attitudes and political and religious values, as well as social reputation, these factors do not affect charitable bequest making as expected. Surprisingly, we find a negative relationship between financial resources and the inclination to leave a charitable bequest. The article ends with suggestions for ways charities might connect more meaningfully with their bequestors or with donors who might consider bequeathing to them.

Preliminary evaluation of a primary care intervention for cry-fuss behaviours in the first 3-4 months of life (‘The Possums Approach’) : effects on cry-fuss behaviours and maternal mood

Problem crying in the first few months of life is both common and complex, arising out of multiple interacting and co-evolving factors. Parents whose babies cry and fuss a lot receive conflicting advice as they seek help from multiple health providers and emergency departments, and may be admitted into tertiary residential services. Conflicting advice is costly, and arises out of discipline-specific interpretations of evidence. An integrated, interdisciplinary primary care intervention (‘The Possums Approach’) for cry-fuss problems in the first months of life was developed from available peer-reviewed evidence. This study reports on preliminary evaluation of delivery of the intervention. A total of 20 mothers who had crying babies under 16 weeks of age (average age 6.15 weeks) completed questionnaires, including the Crying Patterns Questionnaire and the Edinburgh Postnatal Depression Scale, before and 3-4 weeks after their first consultation with trained primary care practitioners. Preliminary evaluation is promising. The Crying Patterns Questionnaire showed a significant decrease in crying and fussing duration, by 1 h in the evening (P = 0.001) and 30 min at night (P = 0.009). The median total amount of crying and fussing in a 24-h period was reduced from 6.12 to 3 h. The Edinburgh Postnatal Depression Scale showed a significant improvement in depressive symptoms, with the median score decreasing from 11 to 6 (P = 0.005). These findings are corroborated by an analysis of results for the subset of 16 participants whose babies were under 12 weeks of age (average age 4.71 weeks). These preliminary results demonstrate significantly decreased infant crying in the evening and during the night and improved maternal mood, validating an innovative interdisciplinary clinical intervention for cry-fuss problems in the first few months of life. This intervention, delivered by trained health professionals, has the potential to mitigate the costly problem of health professionals giving discipline-specific and conflicting advice post-birth.

Improving psychosocial care: a professional development programme

Despite the numerous reports of difficulties experienced by health care providers in providing psychosocial care to terminally ill patients and their families, few studies have yet been undertaken to examine the effectiveness of different educational approaches to addressing these issues. The aim of this paper is to describe a programme of professional development for palliative care nurses, which is currently being offered to 181 registered nurses in Queensland, Australia. The programme is based on an action learning model and is designed to facilitate processes of reflection and peer consultation. In Part One of this paper, a review of this literature is presented to provide the background and rationale for the programme design. Details of the research programme developed to evaluate the programme will be presented in Part Two of this paper, which is to be published in the next issue of this Journal. Surveys of health professionals suggest that the demands of working with terminally ill patients are associated with a great deal of stress (Beaton and Degner 1990, Seale 1992, Vachon 1995), and emotional burden, as they are confronted with their patients' physical and emotional suffering over extended periods of time (Ullrich and Fitzgerald 1990). Key areas of concern (Lyons 1988, Bramwell 1989, Seale 1992, Copp and Dunn 1993, Wilkinson 1995) include: * Handling questions and conversations with dying patients. * Dealing with ethical and moral issues. * Handling emotions. * Giving hope. * Providing spiritual care and bereavement support. * Confronting team communication problems.

Improved rural health through a collaborative model of care – qualitative findings

INTRODUCTION Health disparity between urban and rural regions in Australia is well-documented. In the Wheatbelt catchments of Western Australia there is higher incidence and rate of avoidable hospitalisation for chronic diseases. Structured care approach to chronic illnesses is not new but the focus has been on single disease state. A recent ARC Discovery Project on general practice nurse-led chronic disease management of diabetes, hypertension and stable ischaemic heart disease reported improved communication and better medical administration.[1] In our study we investigated the sustainability of such a multi-morbidities general practice –led collaborative model of care in rural Australia. METHODS A QUAN(qual) design was utilised. Eight pairs of rural general practices were matched. Inclusion criteria used were >18 years and capable of giving informed consent, at least one identified risk factor or diagnosed with chronic conditions. Patients were excluded if deemed medically unsuitable. A comprehensive care plan was formulated by the respective general practice nurse in consultation with the treating General Practitioner (GP) and patient based on the individual’s readiness to change, and was informed by available local resource. A case management approach was utilised. Shediaz-Rizkallah and Lee’s conceptual framework on sustainability informed our evaluation.[2] Our primary outcome on measures of sustainability was reduction in avoidable hospitalisation. Secondary outcomes were patients and practitioners acceptance and satisfaction, and changes to pre-determined interim clinical and process outcomes. RESULTS The qualitative interviews highlighted the community preference for a ‘sustainable’ local hospital in addition to general practice. Costs, ease of access, low prioritisation of self chronic care, workforce turnover and perception of losing another local resource if underutilised influenced the respondents’ decision to present at local hospital for avoidable chronic diseases regardless. CONCLUSIONS Despite the pragmatic nature of rural general practice in Australia, the sustainability of chronic multi-morbidities management in general practice require efficient integration of primary-secondary health care and consideration of other social determinants of health. What this study adds: What is already known on this subject: Structured approach to chronic disease management is not new and has been shown to be effective for reducing hospitalisation. However, the focus has been on single disease state. What does this study add: Sustainability of collaborative model of multi-morbidities care require better primary-secondary integration and consideration of social determinants of health.

Saudi Arabian adult intensive care unit pressure ulcer incidence and risk factors: A prospective cohort study

The purpose of this study was to identify pressure ulcer (PU) incidence and risk factors that are associated with PU development in patients in two adult intensive care units (ICU) in Saudi Arabia. A prospective cohort study design was used. A total of 84 participants were screened second daily basis until discharge or death, over a consecutive 30-day period, out of which 33 participants with new PUs were identified giving a cumulative hospital-acquired PU incidence of 39·3% (33/84 participants). The incidence of medical devices-related PUs was 8·3% (7/84). Age, length of stay in the ICU, history of cardiovascular disease and kidney disease, infrequent repositioning, time of operation, emergency admission, mechanical ventilation and lower Braden Scale scores independently predicted the development of a PU. According to binary logistic regression analyses, age, longer stay in ICU and infrequent repositioning were significant predictors of all stages of PUs, while the length of stay in the ICU and infrequent repositioning were associated with the development of stages II-IV PUs. In conclusion, PU incidence rate was higher than that reported in other international studies. This indicates that urgent attention is required for PU prevention strategies in this setting.

Do Students Not Care about Extra Credit Opportunities? Investigating Student Perceptions of Extra Credit Value vs. Effort

Giving “extra credit” work to students has been a controversial and hotly debated pedagogical issue for the last 20 years (Blood et al. 1993; Groves 2000; Muztaba Fuad and Jones 2012; Norcross et al. 1989; Weimer 2011). Previous work has focused on the faculty perspective discussing benefits and drawbacks associated with extra credit work (e.g. Hill et al. 1993; Norcross et al. 1989). Other scholars have investigated the use and effects of pop quizzes and other extra credit assignments on students’ final grades (Thorne 2000; Oley 1993). Some authors have criticized that the empirical exploration of understanding students’ motivational and performance efforts remains scarce and “rarely appears in the literature” (Mays and Bower 2005, p. 1). Besides a gap of empirical work it further appears that most existing studies stem from Psychology or Information Science. Yet it is surprising that, even though the topic of extra credit is considered a common practice in marketing education (Ackerman and Kiesler 2007), there is a wide gap within the marketing education literature. For example, a quick search in the Journal of Marketing Education for the keyword “extra credit” shows only 25 search results; yet none of those papers address motivational or performance effects of extra credit. A further search in Marketing Education Review yielded no results at all. To the authors’ knowledge, the topic has only been addressed once by Ackerman and Kiesler in the 2007 MEA Proceedings who conclude that for “such a common part of the marketing education curriculum, we know surprisingly little about its impact on students” (p. 123).