Australian doctors’ non-clinical activities: results from the MABEL survey of doctors

Objective. The aim of the present study was to investigate non-clinical work conducted by Australian doctors.
Methods. This study was an exploratory descriptive study using data from Wave 5 of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey, collected in 2012 from Australian medical practitioners (2200 general practitioners (GPs), 3455 specialists, 1270 specialists in training and 1656 hospital non-specialists). The main outcome measure was the number of hours worked per week in non-clinical work. Regression analysis was used to determine associations between non-clinical activities (i.e. education-related, management and administration and other) and personal and professional characteristics, including age, gender, job and life satisfaction, total clinical working hours, sector of practice
(public or private) and doctor type.
Results. Australian doctors spend an average of just under 7 h per week, or 16% of their working time, on non-clinical activities. Doctors who worked more hours on non-clinical activities overall, and in education-related and management and
administration specifically, were male, younger, had lower life satisfaction and generally spent fewer hours on clinical work. Lower job satisfaction was associated with longer management and administration hours, but not with time spent in
education-related activities. Specialists were more likely to work long non-clinical hours, whereas GPs were more likely to report none. Hospital non-specialists reported relatively high management and administration hours.
Conclusions. Further work is required to better understand the full range of non-clinical activities doctors are involved in and how this may impact future workforce projections.

Educational and mental health implications of the multidimensional model of the self-concept for adolescent girls : comparison of clinical and non-clinical samples

The importance of a positive self-concept as an educational outcome and a facilitator of other desirable outcomes are well established within the education research field. Although the multidimensional and hierarchical model of the self-concept is widely accepted within the educational psychology, this perspective is not widely used within the mental health research. Hence, the purpose of the present investigation is to compare the psychometric properties of the short version of the Self-Description Questionnaire (SDQII-S) based on responses by a large sample of female adolescent high school students (N= 829) and a clinical sample of adolescent girls who have been diagnosed with anorexia nervosa (N= 75). The well-established psychometric properties of the longer version of the SDQII generalise well to both samples of adolescent girls, and analyses provided good support for the invariance of the factor structure across the two samples. Furthermore, analyses employing new structural equation modelling approaches to comparing the latent mean differences indicated that there were differences (although surprisingly small) between the two groups that were generally consistent with a priori predictions. The important educational and clinical implications of these results are discussed.

The relationship between personality traits and psychotic like experiences in a large non-clinical adolescent sample

Objective: The relationship between personality and psychosis is well established. It has been suggested that this relationship may be partly accounted for by higher levels of depression in individuals with certain personality traits. We explored whether the link between personality and psychotic symptoms is already apparent in adolescence, and if this association would still hold when depression was controlled for. Method: 654 secondary school students were surveyed via self-report questionnaires measuring the Five-Factor model of personality (NEO-FFI), depression (CES-D) and psychotic-like experiences (CAPE). Results: Positive associations were found between Neuroticism and all CAPE-subscales except Magical Thinking, which was in turn associated with all other personality traits when at high levels. Agreeableness was negatively associated with all CAPE-subscales, while Openness to Experience was only positively associated with Persecutory Ideas and Magical Thinking. After controlling for depression, many of the significant associations remained. Conclusion: Our findings suggest that the chance of having psychotic like experiences is more likely for adolescents with certain personality traits. These associations are not fully explained by depression, especially when psychotic experiences are at higher levels. Future research is needed to investigate if these personality traits might put a person at risk for the development of full-blown psychosis.

Shaping pathways to gambling consumption? An analysis of the promotion of gambling and non-gambling activities from gambling venues

Background: In Australia, venues which provide gambling activities also provide activities that are utilised by families and children. However, there has been limited theoretical or empirical discussion about whether engagement with non-gambling activities may play a role in shaping pathways to current or future engagement in gambling within these environments. We examined marketing tactics for non-gambling and gambling activities in Clubs. Using this data, we propose a conceptual model to test the role of non-gambling activities within gambling environments in shaping gambling attitudes and consumption intentions.

Methods: This study used a mixed method interpretive content analysis to review the marketing activities on the websites of a sample of 65 registered Clubs in New South Wales, Australia. We identified the extent and nature of techniques used to market gambling and non-gambling activities, particularly non-gambling activities directed towards families and children.

Results: Clubs use various marketing tactics to appeal to families and encourage parents to bring their children into venues. We hypothesise that marketing aimed at bringing children and families into gambling environments may play a role in shaping children’s and adults perceptions of these environments and may be influential in the development of a pathway that increases the likelihood that children will continue to visit these environments as adults, and subsequently the extent to which they engage in gambling later in life.

Conclusions: Future research should explore how the presence of family-friendly activities in Clubs and other venues with gambling activities may play a role in shaping future gambling attitudes and behaviours.

Characteristics of doctors transitioning to a non-clinical role in the MABEL study

Objective: To investigate the characteristics and satisfaction of medical doctors transitioning from a clinical into an entirely non-clinical role.

Design and setting: Wave 1 to Wave 5 data from 2008- 2012 in the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal, populationbased survey were analysed.

Participants: Medical doctors including general practitioners (GPs), specialists, specialists in training (SIT) and hospital non-specialists (HNS). Hospital nonspecialists represent doctors working in a hospital who were not enrolled in a specialty training program. The total number of participants surveyed across the 5 waves was 15,195 doctors.

Main outcome measures: The number of medical doctors making the transition from a clinical role to a nonclinical role from one wave of data to the subsequent wave of data. Individuals who responded 'Yes' to the question 'Are you currently doing any clinical medical work in Australia?' were defined as working in a clinical role. Individuals who stated that they were 'Doing medical work in Australia that is non-clinical' were defined as working in a completely non-clinical role. Each doctor's characteristics while partaking in clinical work prior to making the change to a non-clinical role were noted.

Results: Over 5 years, there were a total of 498 individuals who made the transition from a clinical role to a completely non-clinical role out of a possible 15,195 doctors. Increasing age was the strongest predictor for transition to a non-clinical role. With regards to doctor type, specialists, hospital non-specialists and specialists-in- training were more likely to make the transition to a totally non-clinical role compared to GPs. There was minimal evidence of a relationship between lower job satisfaction and making a transition, and also between higher life satisfaction and making a transition.

Conclusions: Understanding the characteristics of, and reasons for non-clinical career transition are important for workforce training, planning and development.

Rules and resources: a structuration approach to understanding the coordination of childrens`s inpatient health care

Aim. This paper presents findings from a multi-method study exploring the process of care coordination in children's inpatient health care.

Background. Existing work on care coordination is typified by 'black-box' type studies that measure inputs to and outcomes of care coordination roles and practices, without addressing the process of coordination.

Method. Using questionnaires, interviews and observation to collect data in multiple sites in the United Kingdom and Denmark between 1999 and 2005, the study gathered the perceptions of staff and compared these with observed practice. Giddens' structuration theory was used to provide an analytical and explanatory framework.

Findings. Current care coordination practice is diverse and inconsistent. It involves a wide range of clinical and non-clinical staff, many of whom perceive a lack of clarity about who should perform specific coordination activities. Staff draw upon a wide range of different material and non-material resources in coordinating care, the use of which is governed by largely tacit and informal rules.

Conclusions. Care coordination can be usefully conceptualized as a 'structurated' process – one that is continually produced and reproduced by staff using rules and resources to 'instantiate' or bring about care coordination through action. Potentially negative implications of this are manifested in diversity and inconsistency in care coordination practice. However, positive aspects such as the opportunity this provides to tailor care to the needs of the individual patient can be realized.

Devil's in the detail : non-commercial business losses

When the theme for the 2008 Australasian Tax Teachers’ Conference was announced (The Devil’s in the Detail), the author immediately thought of the non-commercial losses provisions. These provisions are contained in Division 35 of the Income Tax Assessment Act 1997 (Cth) (‘ITAA 1997’) and restrict individuals from offsetting losses from non-commercial activities against other income.

Clinical pharmacy input for hospital inpatients according to disease state

This study measured the clinical activities performed and times taken by hospital pharmacists to provide medication monitoring services to individual medical and surgical patients. Linking these data to hospital Patient Administration Systems showed how clinical pharmacy manpower needs are guided by patient partition, disease complexity and Diagnosis Related Group classification.

Reliability of the mood disorder questionnaire : comparison with the structured clinical interview for the DSM-IV-TR in a population sample

Objective: The Mood Disorder Questionnaire (MDQ) is a widely used self-report screening instrument for the detection of bipolar disorder in clinical populations. The aim of the present study was therefore to investigate the reliability of this instrument.

Methods: Screening results using the MDQ were compared with results obtained using the Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition (SCID) in a community-based sample of 1066 women. Trained personnel, who were blind to the results of the MDQ screen, conducted clinical interviews.

Results: Using the MDQ, 21 women screened positive for bipolar disorder, and using the SCID diagnoses, 24 women were confirmed with a diagnosis of bipolar disorder. Six women were detected on both instruments. Compared to the SCID, the sensitivity for the MDQ was 25%, specificity 99%, positive predictive value 28%, negative predictive value 98%, and a demonstrated kappa of 0.25. The MDQ failed to detect any of the 11 participants in the study with bipolar II disorder and missed seven of 13 participants with bipolar I disorder or bipolar not otherwise specified. Of the 21 women who screened positive using the MDQ, 19 had current or past psychopathologies other than bipolar disorder.

Conclusion: The MDQ has substantial limitations for detection of bipolar disorder, in particular bipolar II disorder, in non-clinical populations.

Ocupação, bem-estar e satisfação de vida: a experiência de um modelo alternativo de estágio em terapia ocupacional na Austrália

An alternative training model within occupational therapy developed at Deakin University, in Australia, named Occupation, Wellness and Life-Satisfaction (OWLS) is presented. OWLS provides students with opportunities to practice in nontraditional settings, thus enabling strategic learning in non-clinical settings, including working with professionals who are not occupational therapists and with different work cultures and practices, in response to gaps identified within the community. It promotes opportunities for developing skills such as health promotion, health education and assessment and interventions in schools, thus improving the health and wellbeing of the community. The program has contributed towards development of new projects, with positive results achieved by students, thereby representing an important educational strategy for professional occupational therapy training and expanding the field of activities.

Cloud-based non-invasive tele-rehabilitation exercise monitoring

Exercise based rehabilitation plays a vital role in the recovery of various conditions, such as stroke, Parkinson’s disease (PD), chronic pain, and so on. Recently, telerehabilitation has become increasingly popular quantitative nature in assessments particularly for systematic monitoring of progress as well as cost saving for the patients as well as for the health care sector at large. However, challenges do exist in implementing a distributed bio-feedback in a cost-effective and efficient way. In this paper, we present the associated conceptual framework of cloud-based tele-rehabilitation system employing affordable non-invasive Microsoft Kinect® allowing patients to perform rehabilitation exercises in non-clinical setting such as home environments without loosing the quality of patients care. More importantly, different from existing tele-rehabilitation systems, our system not only measures whether patients can perform rehabilitation tasks, but also how well they can finish the tasks. Preliminary experiments validate its potential in training healthy subject to perform exercise motions emulating the physical rehabilitation process.

Measuring health in a vacuum: examining the disability weight of the DALY

The Disability Adjusted Life Year (DALY) is a widely used summary measure of population health combining years of life lost due to mortality and years of healthy life lost due to disability. A feature of the DALY is that, in the assessment of morbidity, each health condition is associated with a disability weight. The disability weight lies on a scale between 0 (indicating the health condition is equivalent to full health) and 1 (indicating the health condition is equivalent to death). The disability weight associated with each health condition is currently fixed across all social, cultural and environmental contexts. Thus blindness in the United Kingdom has the same disability weight as blindness in Niger in spite of structural interventions in the UK that make the disability less severe than in Niger. Although the fixed disability weight is defended on grounds that it supports a strongly egalitarian flavour in the DALY, we argue that the lack of consideration of realistic contexts results in a measure that will underestimate the burden associated with morbidity in disadvantaged populations and overestimate the burden in advantaged populations. There is, consequently, a loss of information on possible non-clinical points of intervention. Disaggregated estimates of the burden of disease such as those in the World Health Report 2000 should be interpreted with caution.

Outsourcing and benchmarking in a rural public hospital : does economic theory provide the complete answer?

INTRODUCTION: The ideology and pronouncements of the Australian Government in introducing 'competitive neutrality' to the public sector has improved efficiency and resource usage. In the health sector, the Human Services Department directed that non-clinical and clinical areas be market tested through benchmarking services against the private sector, with the possibility of outsourcing. These services included car parking, computing, laundry, engineering, cleaning, catering, medical imaging (radiology), pathology, pharmacy, allied health and general practice. Managers, when they choose between outsourcing, and internal servicing and production, would thus ideally base their decision on economic principles. Williamson's transaction cost theory studies the governance mechanisms that can be used to achieve economic efficiency and proposes that the optimal organisation structure is that which minimises transaction costs or the costs of exchange. Williamson proposes that four variables will affect such costs, namely: (i) frequency of exchange; (ii) asset specificity; (iii) environmental uncertainty; and (iv) threat of opportunism. This paper provides evidence from a rural public hospital and examines whether Williamson's transaction cost theory is applicable. d into an analysis that relies solely on transaction

Australian women`s experiences of living with hepatitis C virus: results from a cross-sectional survey

Background: Of the estimated 160 000 Australians currently infected with the hepatitis C virus (HCV), over one-third are women and very few have received clinical treatment, with most managing their illness in non-specialist settings. Little is known about the experiences of women living with HCV in the general community. The present study provides the results from the first comprehensive social survey of Australian women's experiences of living with HCV.

Methods: In 2000, a questionnaire was administered to a largely non-clinical sample of women with HCV (n = 462) living in the state of Victoria and the Australian Capital Territory, Australia. The questionnaire was self-administered with a return rate of 75%. The mean age was 35 years and 83% were 'current' or 'past' injecting drug users. The mean time since diagnosis was 4.6 years (SD = 4.0) and the mean time since infection was 10.5 years (SD = 8.2).

Results: Fifty-eight percent of women reported experiencing symptoms related to their HCV, the most common being tiredness (78%) and nausea (44%). Of the sample, 56% currently saw a doctor for their HCV, and while 52% had ever been referred to a specialist, only 17% of the total sample had ever begun interferon-based combination or monotherapy. Forty-eight percent of women reported experiencing less favorable treatment by a health professional because of their HCV. Age-related self-assessed health status was significantly lower than Australian norms, as were SF-12 physical and mental health scores. The SF-12 physical and mental health scores were highly correlated, indicating a significant physical and mental health burden associated with HCV.

Conclusion: The social, physical and mental health needs of women living with HCV are considerable. Most women had not accessed specialist treatment and the response of the primary health care system to HCV-related women's health issues requires improvement.