Northern Lights: the positive policy example of Sweden, Finland, Denmark and Norway

The nations of Scandinavia and Finland, or Nordic Europe, continue to provide living proof that economic prosperity can be combined with social equality and environmental responsibility. This book, written from an Australian perspective, explores previous outside policy interest in the Nordic nations and outlines some lessons which the English-speaking world, in particular, can learn now from the achievements of the four main Nordic European nations. In terms of income distribution these countries are still much more equal than Australia, Britain, New Zealand and Canada – and nearly twice as equal as the United States. Workforce participation rates are high in the Nordic nations but working hours remain within reasonable limits, enabling genuine work–life balance. Sweden has played a leading role in improving wellbeing, and lowering poverty, among children. Finland has achieved stunning success in schools since the 1990s. Denmark invests in comprehensive skills training as part of providing security, as well as flexibility, in people’s employment lives. Norway’s taxation approach and other measures ensure that its natural resources are used sustainably for the entire nation’s long-term wealth. All of these achievements are relevant to the policy choices for the future which Australia, and other English-speaking countries, can now make.

Individualised, flexible postnatal care: a feasibility study for a randomised controlled trial

Abstract
Background:
Postnatal care in hospital is often provided using defined care pathways, with limited opportunity for more refined and individualised care. We explored whether a tertiary maternity service could provide flexible, individualised early postnatal care for women in a dynamic and timely manner, and if this approach was acceptable to women.
Methods: A feasibility study was designed to inform a future randomised controlled trial to evaluate an alternative approach to postnatal care. English-speaking women at low risk of medical complications were recruited around 26 weeks gestation to explore their willingness to participate in a study of a new, flexible model of care that involved antenatal planning for early postpartum discharge with additional home-based postnatal care. The earlier women were discharged from hospital, the more home-based visits they were eligible to receive. Program uptake was measured, women’s views obtained by a postal survey sent at eight weeks postpartum and clinical data collected from medical records.
Results: Study uptake was 39% (109/277 approached). Most women (n=103) completed a postnatal care plan during pregnancy; 17% planned to leave hospital within 12 hours of giving birth and 36% planned to stay 48 hours. At eight weeks postpartum most women (90%) were positive about the concept and 88% would opt for the same program again. Of the 28% who stayed in hospital for the length they had planned, less than half (43%) received the appropriate number of home visits, and only 41% were given an option for the timing of the visit. Most (62%) stayed in hospital longer than planned (probably due to clinical complications); 11% stayed shorter than planned.
Conclusions: Women were very positive about individualised postnatal care planning that commenced during pregnancy. Given the hospital stay may be impacted by clinical factors, individualised care planning needs to continue into the postnatal period to take into account circumstances which cannot be planned for during pregnancy. However, individualised care planning during the postnatal period which incorporates a high level of flexibility may be challenging for organisations to manage and implement, and a randomised controlled trial of such an approach may not be feasible.

Skills training to avoid inadvertent plagiarism: results from a randomised control study

Plagiarism continues to be a concern within academic institutions. The current study utilised a randomised control trial of 137 new entry tertiary students to assess the efficacy of a scalable short training session on paraphrasing, patch writing and plagiarism. The results indicate that the training significantly enhanced students' overall knowledge about in-text referencing protocols. Importantly, this knowledge was found to translate into applied skills, with the intervention group performing significantly better in a practical skills application task. Moreover, the findings suggest that it is confidence in writing in English, not language background per se, which plays a significant role in students' practical skills in referencing and their confidence in performing assignment preparation tasks that can help them avoid claims of inadvertent plagiarism.

Motivational interviewing to explore culturally and linguistically diverse people's comorbidity medication self-efficacy

Aims and objectives: To examine the perceptions of a group of culturally and linguistically diverse participants with the comorbidities of diabetes, chronic kidney disease and cardiovascular disease to determine factors that influence their medication self-efficacy through the use of motivational interviewing. Background: These comorbidities are a global public health problem and their self-management is more difficult for culturally and linguistically diverse populations living in English-speaking communities. Few interventions have been tested in culturally and linguistically diverse people to improve their medication self-efficacy. Design: A series of motivational interviewing telephone calls were conducted in the intervention arm of a randomised controlled trial using interpreter services. Methods: Patients with these comorbidities aged ≥18 years of age whose preference it was to speak Greek, Italian or Vietnamese were recruited from nephrology outpatient clinics of two Australian metropolitan hospitals in 2009. Results: The average age of the 26 participants was 73·5 years. The fortnightly calls averaged 9·5 minutes. Thematic analysis revealed three core themes which were attitudes towards medication, having to take medication and impediments to chronic illness medication self-efficacy. A lack of knowledge about medications impeded confidence necessary for optimal disease self-management. Participants had limited access to resources to help them understand their medications. Conclusion: This work has highlighted communication gaps and barriers affecting medication self-efficacy in this group. Culturally sensitive interventions are required to ensure people of culturally and linguistically diverse backgrounds have the appropriate skills to self-manage their complex medical conditions. Relevance to clinical practice: Helping people to take their medications as prescribed is a key role for nurses to serve and protect the well-being of our increasingly multicultural communities. The use of interpreters in motivational interviewing requires careful planning and adequate resources for optimal outcomes.

First aid for depression: a Delphi consensus study with consumers, carers and clinicians.

BACKGROUND: It is unclear how members of the public can best support individuals who are developing a depressive episode before appropriate professional help is received. METHODS: To assess expert consensus, we used the Delphi Method. An expert panel consisting of 167 mental health consumers, carers and clinicians was recruited from developed English-speaking countries. A 99-item questionnaire about how to help someone with depression was developed from a variety of resources. The panel members rated each item according to whether they believed the statement should be included in the first aid recommendations. The results were analysed by comparing consensus rates across the three groups. Three rounds were required to consolidate consensus levels. RESULTS: Sixty-four items were endorsed by > or =80% of panel members from all three groups as essential or important. These items were grouped under the following headings: recognising and acknowledging depression; approaching someone who may be depressed; how to be supportive; what is not helpful for a person who may have depression; whether to encourage the person to seek professional help; whether to encourage the person to use self-help strategies; what to do if the person does not want help. LIMITATIONS: These recommendations may not be applicable outside developed English-speaking countries. CONCLUSIONS: By informing the content of training courses, these recommendations will improve the provision of first aid to individuals who are developing a depressive episode and facilitate the uptake of appropriate professional help.

How important is young children's actual and perceived movement skill competence to their physical activity?

OBJECTIVES: To determine the associations between young children's actual and perceived object control and locomotor skills and physical activity and whether associations differ by sex. DESIGN: Cross sectional study. METHODS: A total of 136 children consented. Children had actual skill (Test of Gross Motor Development-2), perceived skill (Pictorial Scale of Perceived Movement Skill Competence for Young Children), and moderate- to vigorous-intensity physical activity (MVPA) (accelerometers) assessed. Independent t-tests assessed sex differences. A regression (with MVPA as the outcome) was performed with all predictor variables (i.e. Actual Object Control, Actual Locomotor, Perceived Object Control, and Perceived Locomotor). Model 2 also adjusted for age, sex, accelerometer wear time and whether the child was from an English speaking background. Interaction terms between the respective actual or perceived skill factor and sex were added to assess sex differences. RESULTS: Analyses were conducted on 109 children (59 boys, 50 girls; mean age=6.5 years, SD=1.0). Boys had higher actual and perceived object control skill and were more active by an average of 19min per day. There were no sex differences in locomotor skills. There were no associations between skill factors and MVPA, except for girls, where locomotor skill was a significant predictor of MVPA (B=3.66, p=0.016). CONCLUSIONS: Actual rather than perceived skill competence was more important to MVPA in this sample. Locomotor skill competence may be more important than object control skill competence for girls as they may engage in types of physical activity that do not require object control mastery.

Negotiating and creating intercultural relations: Chinese immigrant children in New Zealand early childhood education centres

A multiple-case study investigation of the experiences of eight Chinese immigrant children in New Zealand early childhood centres suggested that the immigrant children’s learning experiences in their first centre can be understood as a process of negotiating and creating intercultural relations. The children’s use of family cultural tools, such as the Chinese language, was a distinctive feature of their learning experiences, simultaneously revealing and extending their exploration of the intercultural practices and their establishment of a sense of belonging. In the presence of Chinese-speaking peers who acted as ‘bridges’ and ‘boundary objects’, the Chinese language was actively used by the immigrant children in English-speaking early childhood centres and, as a result, they created intercultural relations which: (i) bridged the two cultures; (ii) brought the cultures into convergence; (iii) enabled the children to claim group identity; and (iv) battled intercultural constraints. The absence of Chinese speakers, on the other hand, constrained possibilities for intercultural relations. The focus on intercultural relations in this study is expected to lead to educational initiatives to support the incorporation of diverse cultures in early childhood services.

The role of positive and negative affectivity on job satisfaction and life satisfaction

This study examines the relationship between positive affectivity, negative affectivity, job satisfaction, and life satisfaction using a sample of 558 urban employees from Dalian. Positive and negative affectivity were measured with Watson's PANAS scale, job satisfaction was measured with Spector's JSS scale, and life satisfaction was measured with the International Wellbeing Group's PWI scale. All the scales are well established multi-item scales that have been validated both in English speaking populations and in China. The statistical analysis found that affectivity is a source of both job satisfaction and life satisfaction. Job satisfaction is positively related to life satisfaction, supporting the spillover theory. Job satisfaction partly mediates the relationship between affectivity and life satisfaction. The practical implications for managers is that because of the dispositional source of job and life satisfaction, managers need to put more emphasis on improving job satisfaction and subjective quality of life by improving the workplace environment. ©2009 IEEE.

Uptake of a newly implemented advance care planning program in a dementia diagnostic service

BACKGROUND: advance care planning (ACP) provides a framework for discussion and documentation of future care preferences when a person loses cognitive capacity. It can assist people in the early stages of dementia to document their preferences for care at later stages of the illness. METHOD: a three-stage project introduced ACP to clients with mild cognitive impairment (MCI) or recently diagnosed dementia and their families through a specialist memory clinic. Over 8 months, all English-speaking clients (n = 97) and carers (n = 92) were mailed a survey assessing completed documentation for future care; understanding of the principles of ACP and willingness to get further information about ACP (Stage 1). Participants wanting more information were invited to a seminar introducing the ACP program and service (Stage 2). Participants wanting to complete ACP documentation could make an appointment with the ACP clinicians (Stage 3). RESULTS: forty-eight (52.2%) carers and 34 clients (35.1%) responded to the survey. Most clients (62.1%) and carers (79.1%) expressed interest in ACP, and 78.6% of clients and 63.6% of carers believed that clients should be involved in their future medical decisions. Nine clients (26.5%; diagnoses: MCI = 5; AD = 3; mixed dementia = 1) and 9 carers (18.8%) attended the seminars, and 2/48 (4%) carers and 3/34 (8.8%) clients (diagnoses: MCI = 2; AD = 1) completed ACP. CONCLUSION: despite initial interest, ACP completion was low. The reasons for this need to be determined. Approaches that may better meet the needs of people newly diagnosed with MCI and dementia are discussed.

Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies

Background

Previous reviews on risk and protective factors for violence in psychosis have produced contrasting findings. There is therefore a need to clarify the direction and strength of association of risk and protective factors for violent outcomes in individuals with psychosis.

Method

We conducted a systematic review and meta-analysis using 6 electronic databases (CINAHL, EBSCO, EMBASE, Global Health, PsycINFO, PUBMED) and Google Scholar. Studies were identified that reported factors associated with violence in adults diagnosed, using DSM or ICD criteria, with schizophrenia and other psychoses. We considered non-English language studies and dissertations. Risk and protective factors were meta-analysed if reported in three or more primary studies. Meta-regression examined sources of heterogeneity. A novel meta-epidemiological approach was used to group similar risk factors into one of 10 domains. Sub-group analyses were then used to investigate whether risk domains differed for studies reporting severe violence (rather than aggression or hostility) and studies based in inpatient (rather than outpatient) settings.

Findings

There were 110 eligible studies reporting on 45,533 individuals, 8,439 (18.5%) of whom were violent. A total of 39,995 (87.8%) were diagnosed with schizophrenia, 209 (0.4%) were diagnosed with bipolar disorder, and 5,329 (11.8%) were diagnosed with other psychoses. Dynamic (or modifiable) risk factors included hostile behaviour, recent drug misuse, non-adherence with psychological therapies (p values<0.001), higher poor impulse control scores, recent substance misuse, recent alcohol misuse (p values<0.01), and non-adherence with medication (p value <0.05). We also examined a number of static factors, the strongest of which were criminal history factors. When restricting outcomes to severe violence, these associations did not change materially. In studies investigating inpatient violence, associations differed in strength but not direction.

Conclusion

Certain dynamic risk factors are strongly associated with increased violence risk in individuals with psychosis and their role in risk assessment and management warrants further examination.

Reliability of a food frequency questionnaire to assess dietary antioxidant intake

OBJECTIVE: Epidemiologic evidence of a role for antioxidants in the prevention of chronic disease has been inconclusive, in part due to the difficulty of measuring past diets of free-living populations. The purpose of the current study was to examine the reliability of a 19-item, self-administered, semiquantitative, food frequency questionnaire to assess intake of the major dietary antioxidants. METHODS: Reliability was established by administering the food frequency questionnaire a second time by telephone. The subjects comprised 151 participants in the Melbourne Visual Impairment Project, a study of the distribution and determinants of eye disease in Melbourne residents aged 40 and over. RESULTS: Spearman correlation coefficients ranged from 0.39 for spinach to 0.76 for yoghurt, and all were highly significant (all p = 0.001). The reliability of the instrument was not influenced by gender, English speaking ability, or the number of days between the first and second administration of the questionnaire. CONCLUSION: In conclusion, we have shown this 19-item food frequency questionnaire to be highly reliable. It should be useful for anyone involved in the study of the relationship of dietary antioxidant intake to health outcomes in large populations where limitations of time and money prohibit the collection of more detailed dietary intake information.

Leptin in bipolar disorder: a systematic review and meta-analysis

BACKGROUND: Bipolar disorder (BD) is a psychiatric disorder associated with increased rates of obesity and inflammation. Leptin is an adipokine that is mainly produced by the white adipose tissue in response to insulin. It stimulates the immune system, increasing the production of pro-inflammatory cytokines. There is currently uncertainty regarding possible alterations in peripheral leptin levels across the mood states in BD. METHODS: This study comprises a between-group meta-analysis comparing serum and plasma leptin levels in people with BD in mania, depression or euthymia and healthy controls. We conducted a systematic search for all possibly eligible-English and non-English peer-reviewed articles. We calculated the effect size (ES) utilizing Hedges' adjusted g using random effects. RESULTS: Eleven studies were included in the meta-analyses, providing data on 1118 participants. Serum and plasma leptin levels were not altered in subjects with BD when compared to healthy controls in mania (g=-0.99, 95% CI -2.43 to 0.43, P=0.171), in depression (g=0.17, 95% CI -0.45 to 0.79, P=0.584), or in euthymia (g=0.03, 95% CI -0.39 to 0.46, P=0.882). However, we did observe a stronger association between leptin levels and both age and BMI in patients with BD in euthymia compared to healthy controls, such that the greater the age of the individuals, the greater the difference in leptin levels between BD and controls; and the higher the BMI, the greater the difference in leptin levels between BD and controls. CONCLUSIONS: Our meta-analysis provides evidence that leptin levels are not altered in BD across the mood spectrum compared to healthy controls. The disproportionate increase of leptin levels with increase in BMI in BD speaks in favour of a potential inflammatory role of white adipose tissue in BD and a disproportionate increase of leptin levels with increase in age.

Putting grammar in its place: interactions and identity in a Master of TESOL course

This chapter reports on the development of language awareness and second language identities of a cohort of Chinese TESOL teachers that arose as a result of incidental classroom interactions during a TESOL Masters course in Australia. The experiences of such interactions appeared to help the Chinese teachers make stronger connections between form and meaning, and, while they also reflected deeply on the pedagogies of grammar, they gained a wider view of language teaching and learning that included pragmatic and sociolinguistic awareness. The impact of cultural and educational exchanges and the resulting formations of second language identities is an emerging focus of research (Benson, Barkhuizen, Bodycott and Brown, 2013). In the field of TESOL, such movements and exchanges are creating opportunities to develop a richer discourse, by drawing on diverse traditions of professionalism in different communities and contexts, and calls are increasingly being made for a plural professional knowledge and more inclusive relationships (Canagarajah, 2005; Holliday, 2005; Widdowson, 2004). The People’s Republic of China has been one of the major contributors to student and teacher mobility in recent years; English language is now a priority subject in China, and all students entering university must take the English college test whether they intend to major in English or not, and therefore there has been much interest in upskilling cohorts of Chinese teachers of English to meet this demand. An increasingly typical initiative is to award scholarships to gain professional qualifications in English-speaking countries. A cohort of English teachers from Jiangsu province, China, is the focus of the present study. During their Masters in TESOL course in Queensland, Australia, they experienced interactions with native speakers inside and outside of the classroom. As their course lecturer for several TESOL units, I was interested in the nature of the incidental language awareness arising from course activities with their native-speaking peers. I was also interested in whether they felt that these experiences had implications for their sense of identity in a second language. The following sections therefore discuss the key themes: interaction in higher education contexts, language awareness, and second language identities.

Gender issues in elementary mathematics teaching materials: a comparative study between China and Australia

International Association for the Evaluation of Educational Achievement (IEA) cross-national studies (FIMS, SIMS and TIMSS) show that gender differences in mathematical achievements and attitudes have decreased considerably over thirty years (Hanna, 2000), however, mathematics is still historically stereotyped as a male domain with crucial evidence supporting this belief (Forgasz, Leder, & Kloosterman, 2009). Previous research showed that gender differences in mathematics participation,performance and achievement existed widely in the majority of English speaking countries, specifically favouring boys (Forgasz, 1992; Hyde, Fennema, & Lamon, 1990; Tiedemann, 2000). Hyde, Lindberg, Linn, Ellis and Williams (2008) pointed out that the stereotype that females lack mathematical ability persists and is widely held by parents and teachers.Mathematics teaching materials play an important role in mathematics teaching and learning. The contents within mathematical teaching materials are rational, and deliver both explicit and implicit information. The explicit information refers to mathematics knowledge that students can learn from textbooks, while the latter one, also named as hidden curriculum, contains social and cultural messages. Hidden curriculum is a side effect of education. It has deep and long-term influences on students’ construction of math-gender stereotype that impact their future mathematicallearning (Zhang & Zhou, 2008). Therefore, this study will investigate Chinese andAustralian elementary mathematics teaching materials to explore the messages of gender equity and inequity delivered through hidden curriculum including names, images and problem-solving contexts. Based on the findings, practical implications concerning the promotion of equitable gender environments within elementary mathematics teaching materials from a cross-cultural perspective will be discussed.

The medical ethics curriculum in medical schools: present and future

In this review article we describe the current scope, methods, and contents of medical ethics education in medical schools in Western English speaking countries (mainly the United Kingdom, the United States, and Australia). We assess the strengths and weaknesses of current medical ethics curricula, and students' levels of satisfaction with different teaching approaches and their reported difficulties in learning medical ethics concepts and applying them in clinical practice. We identify three main challenges for medical ethics education: counteracting the bad effects of the "hidden curriculum," teaching students how to apply ethical knowledge and critical thinking to real cases in clinical practice, and shaping future doctors' right character through ethics education. We suggest ways in which these challenges could be addressed. On the basis of this analysis, we propose practical guidelines for designing, implementing, teaching, and assessing a medical ethics program within a four-year medical course.