Burden of care and general health in families of patients with schizophrenia

Background: De-institutionalization of psychiatric patients has led to a greater emphasis on family management in the community, and family members are often overwhelmed by the demands that caring for a patient with schizophrenia involves. Most studies of family burden in schizophrenia have taken place in developed countries. The current study examined family burden and its correlates in a regional area of a medium income country in South America. Method: Sixty-five relatives of patients with schizophrenia who were attending a public mental health out-patient service in the province of Arica, Chile, were assessed on Spanish versions of the Zarit Caregiver Burden Scale and SF-36 Health Survey (SF-36). Results: Average levels of burden were very high, particularly for mothers, carers with less education, carers of younger patients and carers of patients with more hospitalisations in the previous 3 years. Kinship and number of recent hospitalisations retained unique predictive variance in a multiple regression. Burden was the strongest predictor of SF-36 subscales, and the prediction from burden remained significant after entry of other potential predictors. Conclusions: In common with families in developed countries, family members of schizophrenia patients in regional Chile reported high levels of burden and related functional and health impact. The study highlighted the support needs of carers in contexts with high rates of poverty and limited health and community resources.

Longitudinal patterns of weight in women diagnosed with breast cancer [Conference Abstract]

Introduction: Weight gain is a common concern following breast cancer and has been associated with negative health outcomes. As such, prevention of weight gain is of clinical interest. This work describes weight change between 6- and 18-months following a breast cancer diagnosis and explores the personal, treatment and behavioural characteristics associated with gains in weight. Methods: Body mass index was objectively assessed, at three-monthly intervals, on a population-based sample of women newly diagnosed with unilateral breast cancer (n=185). Changes in BMI between 6- and 18-months post-diagnosis were calculated, with gains of one or more being considered clinically detrimental to future health. Results: Approximately 60% of participants were overweight or obese at 6-months post-diagnosis. While BMI remained relatively stable across the testing period (range=27.3-27.8), 24% of participants experienced clinically relevant gains in BMI (median gains=1.9). Following adjustment for potential confounders, younger age (<45 years; Odds ratio, OR=9.8), being morbidly obese at baseline (OR=4.6) and receiving hormone therapy (OR=4.8) were characteristics associated with an increased odds (p<0.05) of gaining BMI. Other characteristics associated with gains in BMI were more extensive surgery and having a history of smoking, although these relationships were not supported statistically. In contrast, caring for younger children was associated with reduced risk of gaining BMI (OR=0.3, p=0.20). Conclusions: Clinically relevant weight gain between 6- and 18-months post-breast cancer diagnosis is an issue for one in four women, with certain subgroups being particularly susceptible. However, the majority of women diagnosed with breast cancer are overweight or obese and gains in body weight are common. Thus, interventions that address the importance of achieving and sustaining a healthy body weight, delivered to all women with breast cancer, may have greater public health impact than interventions targeting any specific breast cancer subgroup.

What is the relationship between social governance and schooling?

The most frequently told story charting the rise of mass schooling should be fairly familiar to most of us. This story normally centres around the post-enlightenment social changes of the late 18th and early 19th centuries, and details how society slowly became more caring and more humane, and how we all decided that rather than simply being fodder for the mills, all children – including those from the working-classes - had the right to an education. The more civilised we became, the more we pushed back the school leaving age, until we eventually developed schools which clearly reflected the values and ambitions of the wider community. After all, are school not simply microcosms of society at large? In addition to this, the form that modern schooling takes is regarded as an unproblematic part of the same story. Of course we should organise our learning in the way we do, with the emphasis on formalised learning spaces, graded curricula, timetables of activities, various forms of assessment, and a clear hierarchy of authority. These features of the contemporary education merely reflect the fact that this is self-evidently the best system available. After all, how else could education possibly be organised?

An evaluation of viability of public private partnerships in social infrastructure procurement projects in Queensland, Australia

Public private partnerships (PPP) have been widely used as a method for public infrastructure project delivery not only locally and internationally, however the adoption of PPPs in social infrastructure procurement has still been very limited. The objective of this paper is to investigate the potential of implementation of current PPP framework in social affordable housing projects in South East Queensland. Data were collected from 22 interviewees with rich experiences in the industry. The findings of this study show that affordable housing investment have been considered by the industry practitioners as a risky business in comparison to other private rental housing investment. The main determents of the adoption of PPPs in social infrastructure project are the tenant-related factors, such as the inability of paying rent and the inability of caring the property. The study also suggests the importance of seeking strategic partnership with community-based organisation that has experiences in managing similar tenants’ profiles. Current PPP guideline is also viewed as inappropriate for the affordable housing projects, but the principle of VFM framework and risk allocation in PPPs still be applied to the affordable housing projects. This study helps to understand the viability of PPP in social housing procurement projects, and point out the importance of developing guideline for multi-stakeholder partnership and the expansion of the current VFM and PPPs guidelines.

Community engagement for development and application of 3D visualisation models : a two edged

Background: SEQ Catchments Ltd and QUT are collaborating on groundwater investigations in the SE Qld region, which utilise community engagement and 3D Visualisation methodologies. The projects, which have been funded by the Australian Government’s NHT and Caring for our Country programmes, were initiated from local community concerns regarding groundwater sustainability and quality in areas where little was previously known. ----- Objectives: Engage local and regional stakeholders to tap all available sources of information;•Establish on-going (2 years +) community-based groundwater / surface water monitoring programmes;•Develop 3D Visualisation from all available data; and•Involve, train and inform the local community for improved on-ground land and water use management. ----- Results and findings: Respectful community engagement yielded information, access to numerous monitoring sites and education opportunities at low cost, which would otherwise be unavailable. A Framework for Community-Based Groundwater Monitoring has been documented (Todd, 2008).A 3D visualisation models have been developed for basaltic settings, which relate surface features familiar to the local community with the interpreted sub-surface hydrogeology. Groundwater surface movements have been animated and compared to local rainfall using the time-series monitoring data.An important 3D visualisation feature of particular interest to the community was the interaction between groundwater and surface water. This factor was crucial in raising awareness of potential impacts of land and water use on groundwater and surface water resources.

Settings for mental health care

The quality of the environment is important to client recovery and rehabilitation. • The preferred environment for the care of the mentally ill over time has been the home. • Environmental strategies in the care of the mentally ill became more important in the eighteenth century, when it was noticed that patients were more manageable in a pleasant environment. • Confinement of the mentally ill in large public asylums was largely an innovation of the nineteenth century. • The therapeutic milieu is a consciously organised environment. • Maxwell Jones in the United States and Thomas Main in the United Kingdom pioneered the concept of the hospital and environment as treatment tools. • The goals of the therapeutic milieu are containment, structure, support, involvement, validation, symptom management, and maintaining links with family and the community. • The principles on which the therapeutic milieu is based include: open communication, democratisation, reality confrontation, permissiveness, group cohesion and the multidisciplinary team. • The principle guiding the care of clients in the community is that of the least-restrictive alternative. • The therapeutic community residence is an environment that encourages the development of the client as a person in interaction with others, rather than as someone suffering from a health problem or disability. • The preferred contemporary setting for the provision of mental health care is the community. • The predominant form of service delivery in the community is case management, which has been found to be most effective for people with severe mental illnesses. • The principles of caring in the community are self-determination, normalisation, a focus on client strengths, and the community as a resource

Caregivers' beliefs about practice in infant child care programmes

Infant caregivers in centre-based child care were videotaped as they interacted with the children during routine and non-routine activities. During a subsequent interview, the video provided a stimulus for discussion and reflection on practices. Caregivers were also asked to write about their beliefs on good practice in caring for infants. Transcripts of the interviews and the written statements were then analysed for evidence of nave and informed beliefs about caregiving. Most caregivers held nave beliefs and only one caregiver had an informed understanding of professional practice with infants. The usefulness of the analytical framework used in this research is discussed as a means for understanding caregiving practices. It has important implications for approaches to initial professional education of early childhood teachers and for professional development programmes.

Establishing content validity of a survey research instrument : the older patients in acute care survey - United States

Geriatric nursing competency in the acute care setting is a social mandate for the 21st century. This article reports on the content validation of an Australian research instrument, the Older Patients in Acute Care Survey (OPACS) that examines the attitudes, the knowledge, and the practices of nurses working with acute care patients. The OPACS tool was developed primarily to assist nurse educators to assess attitudes, knowledge, and practices of nursing staff in caring for older patients in the acute care setting; to evaluate the implementation of institution-specific educational interventions; and to improve quality of care given to older patients. An overall content validity index (CVI) for the OPACS was calculated (CVI = .918), revealing high content validity. Opinions (CVI = .92) and practices (CVI = .97) subconstructs revealed high content validity as well. Therefore, results indicate that the OPACS has high content validity in the U.S. acute care setting and could assist nurse educators in establishing and enhancing nurse competency in the care for geriatric patients in the future.

Collaborative voices: Ongoing reflections on cultural competency and the health care of Australian Indigenous people

The issue of cultural competency in health care continues to be a priority in Australia for health and human services professionals. Cultural competence in caring for Aboriginal and Torres Strait Islander peoples is of increasing interest, and is a priority in closing the gap in health disparities between Indigenous and non-Indigenous Australians. Through a collaborative conversation, the authors draw on a case study, personal experience and the literature to highlight some of the issues associated with employing culturally appropriate, culturally safe and culturally competent approaches when caring for Aboriginal and Torres Strait Islander peoples. The intent of this article is to encourage discussion on the topic of cultural competency, and to challenge health professionals and academics to think and act on racism, colonialism, historical circumstances and the political, social, economic, and geographical realms in which we live and work, and which all impact on cultural competency.

Pre-service teacher education and the development of middle school teacher identity : an exploratory study

This research study investigated the factors that influenced the development of teacher identity in a small cohort of mature-aged graduate pre-service teachers over the course of a one-year Graduate Diploma program (Middle Years). It sought to illuminate the social and relational dynamics of these pre-service teachers’ experiences as they began new ways of being and learning during a newly introduced one-year Graduate Diploma program. A relational-ontological perspective underpinned the relational-cultural framework that was applied in a workshop program as an integral part of this research. A relational-ontological perspective suggests that the development of teacher identity is to be construed more as an ontological process than an epistemological one. Its focus is more on questions surrounding the person and their ‘becoming’ a teacher than about the knowledge they have or will come to have. Hence, drawing on work by researchers such as Alsup (2006), Gilligan, (1982), Isaacs, (2007), Miller (1976), Noddings, (2005), Stout (2001), and Taylor, (1989), teacher identity was defined as an individual pre-service teacher’s unique sense of self as a teacher that included his or her beliefs about teaching and learning (Alsup, 2006; Stout, 2001; Walkington, 2005). Case-study was the preferred methodology within which this research project was framed, and narrative research was used as a method to document the way teacher identity was shaped and negotiated in discursive environments such as teacher education programs, prior experiences, classroom settings and the practicum. The data that was collected included student narratives, student email written reflections, and focus group dialogue. The narrative approach applied in this research context provided the depth of data needed to understand the nature of the mature-aged pre-service teachers’ emerging teacher identities and experiences in the graduate diploma program. Findings indicated that most of the mature-aged graduate pre-service teachers came in to the one-year graduate diploma program with a strong sense of personal and professional selves and well-established reasons why they had chosen to teach Middle Years. Their choice of program involved an expectation of support and welcome to a middle-school community and culture. Two critical issues that emerged from the pre-service teachers’ narratives were the importance they placed on the human support including the affirmation of themselves and their emerging teacher identities. Evidence from this study suggests that the lack of recognition of preservice teachers’ personal and professional selves during the graduate diploma program inhibited the development of a positive middle-school teacher identity. However, a workshop program developed for the participants in this research and addressing a range of practical concerns to beginning teachers offered them a space where they felt both a sense of belonging to a community and where their thoughts and beliefs were recognized and valued. Thus, the workshops provided participants with the positive social and relational dynamics necessary to support them in their developing teacher identities. The overall findings of this research study strongly indicate a need for a relational support structure based on a relational-ontological perspective to be built into the overall course structure of Graduate Pre-service Diplomas in Education to support the development of teacher identity. Such a support structure acknowledges that the pre-service teacher’s learning and formation is socially embedded, relational, and a continual, lifelong process.

Moderation or mediation? An examination of the role perceived managerial support has on job satisfaction and psychological strain

Employees are vital assets for an enterprise and therefore need to be valued by their employers. Employers can create a safe and reduced stress environment to work; managers thus provide organizational support through their managerial role by caring for their subordinates’ well-being and by providing work advisory. By providing the managerial support to the employees, organizations can reduce costs and increase productivity. Past research has investigated the role of organizational support on stress as a single model either moderating or mediating role. The previous findings were also inconsistent. The purpose of this study was to test both the mediating and the moderating effect of the perceived managerial support on role stressors and psychological outcomes. This study used 380 participants taken from several small firms in Thailand. The results confirmed the mediation role of perceived managerial support, but not the moderation effect.

A secure framework and related protocols for ubiquitous access to electronic health records using Java sim cards

Ubiquitous access to patient medical records is an important aspect of caring for patient safety. Unavailability of sufficient medical information at the point-ofcare could possibly lead to a fatality. The U.S. Institute of Medicine has reported that between 44,000 and 98,000 people die each year due to medical errors, such as incorrect medication dosages, due to poor legibility in manual records, or delays in consolidating needed information to discern the proper intervention. In this research we propose employing emergent technologies such as Java SIM Cards (JSC), Smart Phones (SP), Next Generation Networks (NGN), Near Field Communications (NFC), Public Key Infrastructure (PKI), and Biometric Identification to develop a secure framework and related protocols for ubiquitous access to Electronic Health Records (EHR). A partial EHR contained within a JSC can be used at the point-of-care in order to help quick diagnosis of a patient’s problems. The full EHR can be accessed from an Electronic Health Records Centre (EHRC) when time and network availability permit. Moreover, this framework and related protocols enable patients to give their explicit consent to a doctor to access their personal medical data, by using their Smart Phone, when the doctor needs to see or update the patient’s medical information during an examination. Also our proposed solution would give the power to patients to modify the Access Control List (ACL) related to their EHRs and view their EHRs through their Smart Phone. Currently, very limited research has been done on using JSCs and similar technologies as a portable repository of EHRs or on the specific security issues that are likely to arise when JSCs are used with ubiquitous access to EHRs. Previous research is concerned with using Medicare cards, a kind of Smart Card, as a repository of medical information at the patient point-of-care. However, this imposes some limitations on the patient’s emergency medical care, including the inability to detect the patient’s location, to call and send information to an emergency room automatically, and to interact with the patient in order to get consent. The aim of our framework and related protocols is to overcome these limitations by taking advantage of the SIM card and the technologies mentioned above. Briefly, our framework and related protocols will offer the full benefits of accessing an up-to-date, precise, and comprehensive medical history of a patient, whilst its mobility will provide ubiquitous access to medical and patient information everywhere it is needed. The objective of our framework and related protocols is to automate interactions between patients, healthcare providers and insurance organisations, increase patient safety, improve quality of care, and reduce the costs.

A secure framework and related protocols for ubiquitous access to electronic health records using Java SIM cards

Ubiquitous access to patient medical records is an important aspect of caring for patient safety. Unavailability of sufficient medical information at the patient point-of-care could possibly lead to a fatality. In this paper we propose employing emergent technologies such as Java SIM Cards (JSC),Smart Phones (SP), Next Generation Networks (NGN), Near Field Communications (NFC), Public Key Infrastructure (PKI), and Biometric Identification to develop a secure framework and related protocols for ubiquitous access to Electronic Health Records (EHRs). A partial EHR contained within a JSC can be used at the patient point-of-care in order to help quick diagnosis of a patient’s problems. The full EHR can be accessed from an Electronic Healthcare Records Centre (EHRC).

Correlates of sitting time in working age Australian women : who should be targeted with interventions to decrease sitting time?

Background: While there is emerging evidence that sedentary behavior is negatively associated with health risk, research on the correlates of sitting time in adults is scarce. Methods: Self-report data from 7,724 women born between 1973-1978 and 8,198 women born between 1946-1951 were collected as part of the Australian Longitudinal Study on Women’s Health. Linear regression models were computed to examine whether demographic, family and caring duties, time use, health and health behavior variables were associated with weekday sitting time. Results: Mean sitting time (SD) was 6.60 (3.32) hours/day for the 1973-1978 cohort and 5.70 (3.04) hours/day for the 1946-1951 cohort. Indicators of socio-economic advantage, such as full11 time work and skilled occupations in both cohorts and university education in the mid-age cohort, were associated with high sitting time. A cluster of ‘healthy behaviours’ was associated with lower sitting time in the mid-aged women (moderate/high physical activity levels, non-smoking, non-drinking). For both cohorts, sitting time was highest in women in full-time work, in skilled occupations and in those who spent the most time in passive leisure. Conclusions: The results suggest that, in young and mid-aged women, interventions for reducing sitting time should focus on both occupational and leisure-time sitting.