Vietnamese-born health professionals : negotiating work and life in rural Australia

Introduction: Australia is a culturally diverse nation due to migrants from a wide variety of countries creating a multicultural society. The health professions are highly valued by the younger generation of overseas-born migrants who have acculturated into Australian society; many have chosen health care as their profession in Australia. However, most migrants settle in metropolitan areas and young health professionals may find working in rural or remote Australia culturally and professionally highly challenging. The present study of migrant health professionals examined the life experiences and acculturation strategies of Vietnamese-born health professionals working and living in rural Australia. Objectives: The two main study objectives were to: (1) examine aspects of the acculturation of overseas-born and Australian-trained health professionals in the Australian health discourse; and (2) identify key coping strategies used by them when in working in the rural context.

Methods: Six overseas-born, Australian-trained health professionals were invited to participate in this qualitative study using a snowball sampling technique. The participants were all born in Vietnam and had experienced working in rural Australia. They included three medical doctors, a dentist, a physiotherapist and a nurse. The interviews were recorded and four participants also provided additional written responses to some of the open-ended interview questions. The interview data were transcribed and later coded for thematic analysis. Topics and themes that emerged focused on the issues and strategies of acculturation to the rural health context.

Results: The study showed that the acculturation process was affected by the participants’ views about and attitudes towards working in an Australian rural context. The study identified these essential strategies used by the participants in adapting to a new workplace: collaborating, distancing, adjusting, repairing, and accommodating.

Conclusion: The study provides insights into the lives of these health professionals in a rural context, and particularly their experience of cultural shock and the coping strategies they may use. A need is identified for a larger study to inform recruitment and retention of these health professionals to rural Australia, and to assist universities to prepare such students and their clinical supervisors for rural placements.

Event that never happened : the history and politics of decentralisation in Victoria and New South Wales 1885-1985

The thesis is an account of movements and policies for decentralisation of population and economic activity away from metropolitan to non-metropolitan areas in Victoria and N.S.W. in the period 1885-1985. It examines the pull from the country and the push from the capitals for decentralisation. Ballarat (Victoria) and Bathurst (N.S.W.) are used as case studies. Introductory chapters describe the historic pattern of population distribution in the two Colonies/States and discuss theories about the spatial distribution of population and industry. Chapters recounting and discussing the history and politics of decentralisation in Victoria and N.S.W. are organised in three periods: 1885-1940; 1940-1965; 1965-1985. A more decentralised distribution of population in Victoria and N.S.W. was almost always widely accepted as being in the public interest. Decentralisation rose and fell recurrently on the issue attention cycle. The pull from the country was fragmented and locally self-interested. The push from the capitals occurred only when life or its quality was perceived as threatened because of factors related to city size. Governments in both States introduced micro policies ostensibly to counter formidable centralising forces. In the 1970s there was an abortive attempt to implement a selective decentralisation policy in N.S.W. The thesis argues that decentralisation did not happen because: (1) there was not a consistent set of values and goals underlying the pull and push; (2) there was never a sustained, unified constituency for decentralisation, even in the country; (3) the power to influence, subvert or obstruct decentralisation policies was too widely diffused; (4) insufficient account was taken in decentralisation policymaking of the underlying economic, social and political dynamics.

The TrueBlue study : is practice nurse-led collaborative care effective in the management of depression for patients with heart disease or diabetes?

Background: In the presence of type 2 diabetes (T2DM) or coronary heart disease (CHD), depression is under diagnosed and under treated despite being associated with worse clinical outcomes. Our earlier pilot study demonstrated that it was feasible, acceptable and affordable for practice nurses to extend their role to include screening for and monitoring of depression alongside biological and lifestyle risk factors. The current study will compare the clinical outcomes of our model of practice nurse-led collaborative care with usual care for patients with depression and T2DM or CHD.

Methods: This is a cluster-randomised intervention trial. Eighteen general practices from regional and metropolitan areas agreed to join this study, and were allocated randomly to an intervention or control group. We aim to recruit 50 patients with co-morbid depression and diabetes or heart disease from each of these practices. In the intervention group, practice nurses (PNs) will be trained for their enhanced roles in this nurse-led collaborative care study. Patients will be invited to attend a practice nurse consultation every 3 months prior to seeing their usual general practitioner. The PN will assess psychological, physiological and lifestyle parameters then work with the patient to set management goals. The outcome of this assessment will form the basis of a GP Management Plan document. In the control group, the patients will continue to receive their usual care for the first six months of the study before the PNs undergo the training and switch to the intervention protocol. The primary clinical outcome will be a reduction in the depression score. The study will also measure the impact on physiological measures, quality of life and on patient attitude to health care delivered by practice nurses.

Conclusion: The strength of this programme is that it provides a sustainable model of chronic disease management with monitoring and self-management assistance for physiological, lifestyle and psychological risk factors for high-risk patients with co-morbid depression, diabetes or heart disease. The study will demonstrate whether nurse-led collaborative care achieves better outcomes than usual care.

Diabetes MILES - Australia (Management and Impact for Long-Term Empowerment and Success) : methods and sample characteristics of a national survey of the psychological aspects of living with type 1 or type 2 diabetes in Australian adults

Background Successful management of diabetes requires attention to the behavioural, psychological and social aspects of this progressive condition. The Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Study is an international collaborative. Diabetes MILES-Australia, the first Diabetes MILES initiative to be undertaken, was a national survey of adults living with type 1 or type 2 diabetes in Australia. The aim of this study was to gather data that will provide insights into how Australians manage their diabetes, the support they receive and the impact of diabetes on their lives, as well as to use the data to validate new diabetes outcome measures.

Methods The survey was designed to include a core set of self-report measures, as well as modules specific to diabetes type or management regimens. Other measures or items were included in only half of the surveys. Cognitive debriefing interviews with 20 participants ensured the survey content was relevant and easily understood. In July 2011, the survey was posted to 15,000 adults (aged 18-70 years) with type 1 or type 2 diabetes selected randomly from the National Diabetes Services Scheme (NDSS) database. An online version of the survey was advertised nationally. A total of 3,338 eligible Australians took part; most (70.4%) completed the postal survey. Respondents of both diabetes types and genders, and of all ages, were adequately represented in both the postal and online survey sub-samples. More people with type 2 diabetes than type 1 diabetes took part in Diabetes MILES-Australia (58.8% versus 41.2%). Most respondents spoke English as their main language, were married/in a de facto relationship, had at least a high school education, were occupied in paid work, had an annual household income > $AUS40,000, and lived in metropolitan areas.

Discussion A potential limitation of the study is the under-representation of respondents from culturally and linguistically diverse backgrounds (including Aboriginal and Torres Strait Islander origin). Diabetes MILES-Australia represents a major achievement in the study of diabetes in Australia, where for the first time, the focus is on psychosocial and behavioural aspects of this condition at a national level.

The role of Australia's public broadcasters in development and democracy

In this article I investigate the ways in which the ABC and SBS use the internet. I predominantly focus on how the public broadcasters’ promote an informed citizenry though participation online. Such online participation further develops a second vital role of public broadcasting which is to develop a sense of nationhood—through Australian content (which can include information and communication in languages other than English) and which provides for local and international communities in rural and metropolitan areas to engage with each other. In order to understand the capacity for the public broadcasters to enhance online public communication and democratic participation, I firstly examine general internet theory and evaluate how liberating the internet has been for those living in countries where the state and political alliances control traditional broadcast and print media. For this analysis, the key aspects of virtual communication and cyber-democracy are explored as they are relevant to the services the public broadcasters could provide. Furthermore, case examples of current practical work undertaken in these areas are examined. The framework of the ‘virtual agora’ is considered because it represents the ideals of a public sphere in cyberspace where people are currently able to discuss and debate key issues. The theory is then related to activities undertaken through the ‘vortals’ of the ABC and SBS. Finally, the extent of political intervention and commercial influence is evaluated.

Family support and ease of access link socio-economic status and sports club membership in adolescent girls : a mediation study

Background Much research has been conducted into the determinants of physical activity (PA) participation among adolescent girls. However, the more specific question of what are the determinants of particular forms of PA participation, such as the link between participation through a sports club, has not been investigated. Accordingly, the aim of this study was to investigate the relationships between participation in a sports club and socio-economic status (SES), access to facilities, and family and peer support, for female adolescents.

Methods A survey of 732 female adolescent school students (521 metropolitan, 211 non-metropolitan; 489 Year 7, 243 Year 11) was conducted. The survey included demographic information (living arrangements, ethnicity indicators, and indicators of SES such as parental education and employment status and locality); access to facilities; and family and peer support (travel, encouragement, watching, praise, joint participation). For each characteristic, sports club participants and non-participants were compared using chi-square tests. Multiple mediation analyses were used to investigate the role of access, family and peer support in the link between SES and sport participation.

Results There were significant associations (p<0.05) between sports club participation and: all demographic characteristics; all measures of family and peer support; and access to sport-related facilities. Highest levels of participation were associated with monolingual Australian-born families, with two parents, at least one of whom was well-educated, with both parents employed, and high levels of parental assistance, engagement and support. Participation in club sport among both younger and older adolescent girls was significantly positively associated with the SES of both their neighbourhoods and their households, particularly in metropolitan areas. These associations were most strongly mediated by family support and by access to facilities.

Conclusions To facilitate and promote greater participation in club sport among adolescent girls from low SES neighbourhoods and households, strategies should target modifiable determinants such as facility access and parental support. This will involve improving access to sports facilities and promoting, encouraging and assisting parents to provide support for their daughters’ participation in sport clubs.

Does the shortage of diabetes specialists in regional and rural Australia matter? Results from Diabetes MILES – Australia.

Aim: To investigate differences in access to services and health outcomes between people living with Type 1 (T1DM) and Type 2 (T2DM) diabetes in rural/regional and metropolitan areas.

Methods: Diabetes MILES—Australia was a national postal/online survey of persons registered with the National Diabetes Services Scheme. Selected variables, including utilisation of health care services and self-care indicators, were analysed for 3338 respondents with T1DM (41%) or T2DM (59%).

Results: Respondents from rural/regional (n=1574, 48%) and metropolitan areas were represented equally (n=1700, 52%). After adjusting for diabetes duration, demographic and socioeconomic variables, rural/regional respondents with T1DM (RR 0.90, 95% CI 0.83–0.97) and T2DM (RR 0.69, 95% CI 0.59–0.81) were less likely to report consulting an endocrinologist during the past 12 months. Rural/regional respondents with T1DM were more than twice as likely to have accessed a community/practice nurse for diabetes care (RR 2.22, 95% CI 1.25–3.93) while those with T2DM were more likely to have accessed a diabetes educator (RR 1.21, 95% CI 1.07–1.36) or dietician (RR 1.17, 95% CI 1.07–1.36). For the T1DM and T2DM groups were no differences between rural/regional and metropolitan respondents in self-reported hypoglycaemic events during past week and the majority of self-care indicators.

Conclusions: Despite a lack of access to medical specialists, respondents with T1DM and T2DM living in rural/regional areas did not report worse health or self-care indicators. The results suggest that multidisciplinary primary services in rural areas may be providing additional care for people with diabetes, compensating for poor access to specialists.

A systematic approach to chronic heart failure care : a consensus statement

The National Heart Foundation of Australia assembled an expert panel to provide guidance on policy and system changes to improve the quality of care for people with chronic heart failure (CHF). The recommendations have the potential to reduce emergency presentations, hospitalisations and premature death among patients with CHF. Best-practice management of CHF involves evidencebased, multidisciplinary, patient-centred care, which leads to better health outcomes. A CHF care model is required to achieve this. Although CHF management programs exist, ensuring access for everyone remains a challenge. This is particularly so for Aboriginal and Torres Strait Islander peoples, those from non-metropolitan areas and lower socioeconomic backgrounds, and culturally and linguistically diverse populations. Lack of data and inadequate identifi cation of people with CHF prevents effi cient patient monitoring, limiting information to improve or optimise care. This leads to ineff ectiveness in measuring outcomes and evaluating the CHF care provided. Expanding current cardiac registries to include patients with CHF and developing mechanisms to promote data linkage across care transitions are essential. As the prevalence of CHF rises, the demand for multidisciplinary workforce support will increase. Workforce planning should provide access to services outside of large cities, one of the main challenges it is currently facing. To enhance community-based management of CHF, general practitioners should be empowered to lead care. Incentive arrangements should favour provision of care for Aboriginal and Torres Strait Islander peoples, those from lower socioeconomic backgrounds and rural areas, and culturally and linguistically diverse populations. Ongoing research is vital to improving systems of care for people with CHF. Future research activity needs to ensure the translation of valuable knowledge and high quality evidence into practice.

An examination of the prevalence, consumer profiles, and patterns of energy drink use, with and without alcohol, in Australia

BACKGROUND: There has been a significant growth in the energy drink (ED) market in Australia and around the world; however, most research investigating the popularity of ED and alcohol and energy drink (AED) use has focused on specific subpopulations such as university students. The aim of this study was to estimate the prevalence, consumption patterns, and sociodemographic correlates of ED and combined AED use among a representative Australian population sample. METHODS: A computer-assisted telephone interview survey (n = 2,000) was undertaken in March-April 2013 of persons aged 18 years and over. Half of the interviews were obtained through randomly generated landline telephone numbers and half through mobile phones. Approximately half of the sample was female (55.5%; n = 1,110) and the mean age of participants was 45.9 (range 18 to 95, SD 20.0). RESULTS: Less than 1 in 6 Australians reported ED use (13.4%, n = 268) and 4.6% (n = 91) reported AED use in the past 3 months. Majority of ED and AED users consumed these beverages monthly or less. ED and AED users are more likely to be aged 18 to 24 years, live in a metropolitan area, and be moderate risk or problem gamblers. AED consumers are more likely to report moderate levels of psychological distress. CONCLUSIONS: Our findings in relation to problem gambling and psychological distress are novel and require further targeted investigation. Health promotion strategies directed toward reducing ED and AED use should focus on young people living in metropolitan areas and potentially be disseminated through locations where gambling takes place.

Student preferences for bachelor degrees at TAFE: the socio-spatial influence of schools

This report on Student Preferences for Bachelor Degrees at TAFE (Technical and Further Education) institutions is derived from research commissioned by Australia’s National Centre for Student Equity in Higher Education (NCSEHE) hosted at Curtin University and conducted by researchers at Deakin University’s Strategic Centre for Research in Educational Futures and Innovation (CREFI). The report focuses on the influence of schools on their students’ higher education (HE) preferences – particularly their preferences for TAFE bachelor degrees – as recorded by the Victorian and South Australian Tertiary Admissions Centres (VTAC and SATAC). Influence is researched in terms of a school’s socioeconomic status, geographical location and sector. The SATAC data set is considerably smaller, at around 8 per cent of the VTAC data set.Bachelor degrees offered by TAFEs are relatively small in number but a growing higher education option for students in Australia (Gale et al. 2013). The Australian Government’s proposal to extend Commonwealth Supported Places (CSPs) to include Australian higher education not delivered by the nation’s public universities (Department of Education 2014b), is likely to fuel further growth in TAFE bachelor degree offerings. The recent Report of the Review of the Demand Driven Funding System in Australian higher education (Kemp & Norton 2014), which recommended this change, also makes special mention of non-university degree options as something that would be of particular benefit to students from low socioeconomic status backgrounds.The research reported herein is informed by a review of the international research literature, which indicates three main influences on students’ HE preferences: (1) students’ families and communities; (2) the socio-spatial location of their schools; and (3) school practices. This report contributes to understandings on the second of these: the influence of school context (their socio-spatial location) on students’ preferences for TAFE bachelor degrees.The research found that the annual rate of student preferences for TAFE bachelor degrees was relatively stable (at around 1,500 per annum) from 2009 to 2012 but rose significantly (by 30%) in 2013. Students from high socioeconomic status schools (and with an average ATAR of 56.9) were the group that registered the largest number of preferences. The number of preferences for TAFE bachelor degrees lodged by students from metropolitan schools exceeded the preferences of students from schools located in all other regions combined. This might reflect the fact that TAFE institutions offering bachelor degrees tend to be located in metropolitan areas.The research also found that students’ preferences for TAFE bachelor degrees increased after announcement of their Australian Tertiary Admission Rank (ATAR), by between 25 and 30 per cent each year. The post-ATAR increase was most noticeable in the Health and Education fields of study and among students from high socioeconomic status schools. The report concludes that while the public perception of TAFE is that it is a sector primarily for students from low SES backgrounds, this is not reflected in students’ preferences for TAFE bachelor degrees. Instead, the preferences of students from high socioeconomic schools outnumber other SES groups in almost every TAFE-degree field of study. This includes the fields of Health and Education, which are often seen to be typical low SES student choices in universities (Gale & Parker 2013).

Using care plans to better manage multimorbidity

BACKGROUND: The health care for patients having two or more long-term medical conditions is fragmented between specialists, allied health professionals, and general practitioners (GPs), each keeping separate medical records. There are separate guidelines for each disease, making it difficult for the GP to coordinate care. The TrueBlue model of collaborative care to address key problems in managing patients with multimorbidity in general practice previously reported outcomes on the management of multimorbidities. We report on the care plan for patients with depression, diabetes, and/or coronary heart disease that was embedded in the TrueBlue study. METHODS: A care plan was designed around diabetes, coronary heart disease, and depression management guidelines to prompt implementation of best practices and to provide a single document for information from multiple sources. It was used in the TrueBlue trial undertaken by 400 patients (206 intervention and 194 control) from 11 Australian general practices in regional and metropolitan areas. RESULTS: Practice nurses and GPs successfully used the care plan to achieve the guideline-recommended checks for almost all patients, and successfully monitored depression scores and risk factors, kept pathology results up to date, and identified patient priorities and goals. Clinical outcomes improved compared with usual care. CONCLUSION: The care plan was used successfully to manage and prioritise multimorbidity. Downstream implications include improving efficiency in patient management, and better health outcomes for patients with complex multimorbidities.

The relationship between exposure to violence and anger in Thai adolescents

Youth violence is a serious public health problem in Thailand, and yet is poorly understood and is thought to vary considerably between metropolitan and rural areas. This article reports the findings of a cross-sectional study involving 1,170 technical college students who completed self-report questionnaires assessing the frequency of violent acts, antisocial behavior, and angry emotion. There were no differences in self-reported violent activities between metropolitan and rural participants, but those attending colleges in the metropolitan areas reported more acts involving weapons. Scores on the measure of anger expression predicted physical and verbal assault, specifically punching and name calling, suggesting that the implementation of interventions which help students to improve control over anger may be a useful violence prevention approach.

Responsabilidade social das empresas e valores humanos: um estudo sobre a atitude dos gestores brasileiros

In the last decades of the 21st century, Corporate Social Responsibility (CSR) has become one of the most widely debated issues in business management, concerning researchers, politicians, managers and society at large. With multilateral implications in economic and social life, CSR refers, essentially, to the discussion about the boundaries of business intervention in society and the ethical limits that should regulate that intervention. It questions the impact of business practices in social well-being, the role left for corporations and for the State in attending to community needs, and which are, at last, the responsibilities that tie enterprises to society. In this research, CSR is approached from the perspective of its ethical foundations, based on the moral reasoning of the business manager, as a key organizational leader with relevant decision power. Specifically, the research aims to understand how the personal human value system and the ethical orientation of managers influence their attitude towards CSR, considering this attitude as an indicator of managerial behavior that translates into corporate performance. Theoretically, CSR concept is discussed and presented as a set of social commitments, based on a strict interpretation of its meaning. As to human values, its philosophical roots are briefly analyzed and Schwartz modern motivational theory is addressed as main reference for studying the personal value system of managers in this research. Concerning ethics, based on classical theory from moral philosophy, references are seek in John Stuart Mill¿s utilitarianism, Immanuel Kant¿s deontological absolutism, John Rawls¿s theory of justice and the ethics of virtue inspired by Aristotle¿s moral thoughts. Based on an extended literature review, research hypothesis are proposed as part of a theoretical model of analysis named Individual Attitude Towards Social Responsibility Model. In order to test the theory¿s empirical validity, it was conducted a field study with 252 Brazilian managers, mainly from the metropolitan areas of São Paulo and Rio de Janeiro. Results show that managerial attitude aligned with CSR principles is favored by conservative personal values, protectors of stability and centered on collective will, and by an ethical orientation based on egalitarianism as postulated by distributive justice principles. However, results also show that the influence of values and personal ethics on managerial attitude towards CSR only occur in managers younger than 30 years old. Findings and their meanings are discussed, as well as summarized in the Axiological and Ethical Determinants of Managers¿ Social Commitment Model. Finally, methodological limitations are evaluated and clues for further research are suggested.

Análise das estratégias de entrada de mercado adotadas por uma organização privada de saúde: o caso Fleury S.A.

Esta dissertação analisa como as estratégias de entrada de mercado adotadas por uma organização privada de saúde contribuíram para a formação dos recursos e capacidades dos seus novos empreendimentos e para o desempenho desses negócios. Para tanto, este trabalho recorre a revisão bibliográfica sobre Entrada de Mercado e Teoria dos Recursos da Firma (RBV) e aplica um estudo de caso no Fleury S.A., apoiado em entrevistas semi-estruturadas com os altos executivos da organização. Os empreendimentos Check-up, Hospital-Dia e a Holding NKB são estudados em profundidade e evidenciam características distintas de entrada, que variam conforme os laços de ligação com o Fleury: por meio do crescimento interno, da formação de uma Joint Venture e da criação de uma Spin-off. Como resultados, verifica-se a convergência da literatura de Entrada de Mercado e RBV, em que os recursos e capacidades do potencial entrante têm um importante impacto no modo de entrada, bem como em sua performance pós-entrada de mercado. Por outro lado, a inexperiência no novo mercado e as analogias equivocadas foram observadas como as principais responsáveis pela entrada inapropriada em um novo mercado.

Microeconomic instability and children's human capital accumulation: the effects of idiosyncratic shocks to father's income on child labor, school drop-outs and repetition rates in Brazil

This paper evaluates the long-run effects of economic instability. In particular, we study the impact of idiosyncratic shocks to father’s income on children’s human capital accumulation variables such as school drop-outs, repetition rates and domestic and non-domestic labor. Although, the problem of child labor in Brazil has declined greatly during the last decade, the number of children working is still substantial. The low levels of educational attainment in Brazil are also a main cause for concern. The large rotating panel data set used allows for the estimation of the impacts of changes in occupational and income status of fathers on changes in his child’s time allocation circumstances. The empirical analysis is restricted to families with fathers, mothers and at least one child between 10 and 15 years of age in the main Brazilian metropolitan areas during the 1982-1999 period. We perform logistic regressions controlling for child characteristics (gender, age, if he/she is behind in school for age), parents characteristics (grade attainment and income) and time and location variables. The main variables analyzed are dynamic proxies of impulses and responses, namely: shocks to household head’s income and unemployment status, on the one hand and child’s probability of dropping out of school, of repeating a grade and of start working, on the other. The findings suggest that father’s income has a significant positive correlation with child’s dropping out of school and of repeating a grade. The findings do not suggest a significant relationship between a father’s becoming unemployed and a child entering the non-domestic labor market. However, the results demonstrate a significant positive relationship between a father becoming unemployed and a child beginning to work in domestic labor. There was also a positive correlation between father becoming unemployed and a child dropping out and repeating a grade. Both gender and age were highly significant with boys and older children being more likely to work, drop-out and repeat grades.