Immigrants and the utilization of hospital emergency departments

BACKGROUND: Immigrants with language barriers are at high risk of having poor access to health care services. However, several studies have indicated that immigrants tend to use emergency departments (EDs) as their primary source of care at the expense of primary care. This may place an additional burden on already overcrowded EDs and lead to a low level of patient satisfaction with ED care. The study was to review if immigrants utilize ED care differently from host populations and to assess immigrants’ satisfaction with ED care. DATA SOURCES: Studies about immigrants' utilization of EDs in Australia and worldwide were reviewed. RESULTS: There are confl icting results in the literature about the pattern of ED care use among immigrants. Some studies have shown higher utilization by immigrants compared to host populations and others have shown lower utilization. Overall, immigrants use ED care heavily, make inappropriate visits to EDs, have a longer length of stay in EDs, and are less satisfi ed with ED care as compared to host populations. CONCLUSIONS: Immigrants might use ED care differently from host populations due to language and cultural barriers. There is sparse Australian literature regarding immigrants' access to health care including ED care. To ensure equity, further research is needed to inform policy when planning health care provision to immigrants. KEY WORDS: Emergency department; Health service; Immigrants; Language; Utilization

Overdue choices : how information and role in decision-making influence women's preferences for induction for prolonged pregnancy

Background: Enabling women to make informed decisions is a crucial component of consumer-focused maternity care. Current evidence suggests that health care practitioners’ communication of care options may not facilitate patient involvement in decision-making. The aim of this study was to investigate the effect of specific variations in health caregiver communication on women’s preferences for induction of labor for prolonged pregnancy. Methods: A convenience sample of 595 female participants read a hypothetical scenario in which an obstetrician discusses induction of labor with a pregnant woman. Information provided on induction and the degree of encouragement for the woman’s involvement in decision-making was manipulated to create four experimental conditions. Participants indicated preference with respect to induction, their perceptions of the quality of information received, and other potential moderating factors. Results: Participants who received information that was directive in favor of medical intervention were significantly more likely to prefer induction than those given nondirective information. No effect of level of involvement in decision-making was found. Participants’ general trust in doctors moderated the relationship between health caregiver communication and preferences for induction, such that the influence of information provided on preferences for induction differed across levels of involvement in decision-making for women with a low trust in doctors, but not for those with high trust. Many women were not aware of the level of information required to make an informed decision. Conclusions: Our findings highlight the potential value of strategies such as patient decision aids and health care professional education to improve the quality of information available to women and their capacity for informed decision-making during pregnancy and birth. (BIRTH 39:3 September 2012)

Welfare-to-work and the experience of single mothers in Australia : where are the benefits?

In July 2006 ‘welfare-to-work’ policies were introduced for single parents in Australia. These policies require most single parents with school aged children to be employed or seeking employment of 15-25 hours per week in return for their income support payment. The changes represented a sharp increase in the obligations applying to single parents on income support. This paper is concerned with how the well-being of single mothers who are combining income support and paid employment is being influenced by these stepped up activity requirements. The paper draws on data from semi-structured interviews with 21 Brisbane single mothers. The analysis explores participants’ experiences in the new policy environment utilizing the theoretical framework of ‘relational autonomy’. Relational approaches to autonomy emphasize the importance of relations of dependency and interdependency to the development of autonomy and well-being. The findings indicate that in their dealings with the welfare bureaucracy participants experienced a lack of recognition of their identities as mothers, paid workers and competent decision makers. These experiences have negative consequences for self worth, relational autonomy and ultimately the well-being of single parent families.

Intraurban rail access : Policy implications of five revealed perspectives from a Q-sorting exercise in three Australian cities

This project advances current understanding of intra-urban rail passengers and their travel experiences in order to help rail industry leaders tailor policy approaches to fit specific, relevant segments of their target population. Using a Q sorting technique and cluster analysis, our preliminary research identified five perspectives occurring in a small sample of rail passengers, who varied in their frequency and location of rail travel as well as certain socio-demographic characteristics. Revealed perspectives (named to capture the gist of their content) included: ‘Rail Travel is About the Destination, Not the Journey’; ‘Despite Challenges, Public Transport is Still the Best Option’; ‘Rail Travel is Fine’; ‘Rail Travel? So Far, So Good’; and ‘Bad Taste for Rail Travel’. This paper discusses each of the perspectives in detail, and considers them in terms of tailored policy implications. An overarching finding from this study is that improving railway travel ‘access’ requires attention to physical, psychological, financial, and social facets of accessibility. For example, designing waiting areas to be more socially functional and comfortable has the potential to increase ridership by addressing social forms of access, decreasing perceived wait times, and making time at the station feel like time well spent. Even at this preliminary stage, the Q sorting technique promises to provide a valuable, holistic albeit fine-grained analysis of passenger attitudes and experiences that will assist industry efforts to increase ridership.

Transforming mobile personal life log into autobiographical multimedia eChronicles

Mobile devices are becoming indispensable personal assistants in people's daily life as these devices support work, study, play and socializing activities. The multi-modal sensors and rich features of smartphones can capture abundant information about users' life experience, such as taking photos or videos on what they see and hear, and organizing their tasks and activities using calendar, to-do lists, and notes. Such vast information can become useful to help users recalling episodic memories and reminisce about meaningful experiences. In this paper, we propose to apply autobiographical memory framework to provide an effective mechanism to structure mobile life-log data. The proposed model is an attempt towards a more complete personal life-log indexing model, which will support long term capture, organization, and retrieval. To demonstrate the benefits of the proposed model, we propose some design solutions for enabling users-driven capture, annotation, and retrieval of autobiographical multimedia chronicles tools.

Cellular model systems to study the tumor biological role of kallikrein-related peptidases in ovarian and prostate cancer

Since the identification of the gene family of kallikrein related peptidases (KLKs), their function has been robustly studied at the biochemical level. In vitro biochemical studies have shown that KLK proteases are involved in a number of extracellular processes that initiate intracellular signaling pathways by hydrolysis, as reviewed in Chapters 8, 9, and 15, Volume 1. These events have been associated with more invasive phenotypes of ovarian, prostate, and other cancers. Concomitantly, aberrant expression of KLKs has been associated with poor prognosis of patients with ovarian and prostate cancer (Borgoño and Diamandis, 2004; Clements et al., 2004; Yousef and Diamandis, 2009), with prostate-specific antigen (PSA, KLK3) being a long standing, clinically employed biomarker for prostate cancer (Lilja et al., 2008). Data generated from patient samples in clinical studies, alongwith biochemical activity, suggests that KLKs function in the development and progression of these diseases. To bridge the gap between their function at the molecular level and the clinical need for efficacious treatment and prognostic biomarkers, functional assessment at the in vitro cellular level, using various culture models, is increasing, particularly in a three-dimensional (3D) context (Abbott, 2003; Bissell and Radisky, 2001; Pampaloni et al., 2007; Yamada and Cukierman, 2007).

Indian students at QUT : expectations and experiences

India currently ranks among the top source countries for the Australian education industry and therefore, a better understanding of the concerns and challenges confronted by Indian students is essential. This study was undertaken to assess the needs and expectations of Indian students enrolled at Queensland University of Technology (QUT) that would inform the formulation of strategies to provide superior service to the current and future cohorts of students coming from India. Data collection was undertaken through surveys and focus group meetings. The findings reveal the acute need for more effective dissemination of information prior to the students commencing their programs on both academic and non-academic aspects of university life as well as the resources and support available at QUT. Usage of English in an academic setting, career related services, accommodation, and networking opportunities were identified as some of the key areas of concern by the participants.

Preparing high achieving English teachers to work in disadvantaged schools : 'I'll teach Shakespeare when I'm 60'

The recent release of the Gonski Review recognises the decline in Australia’s schooling performances over the last decade, noting in particular a distressing increase in the ‘achievement gap’ affecting students from low SES backgrounds (Gonski, 2012). The report details the need for more quality in teachers throughout the schooling system, particularly within the schools with the greatest academic needs. This paper specifically focuses on a group of high-achieving pre-service English teachers. In their last two years of university study, they participated in a program called Exceptional Teachers for Disadvantaged Schools (ETDS), designed to prepare them to work in disadvantaged or low SES schools. We wanted to capture their experiences of teaching in challenging settings during their practicum, and as they prepared to graduate, we wondered what they now felt about teaching English in low SES schools. Using narrative inquiry, we analysed a range of reflective data to gain insight into such things as their initial motivations for entering the teaching profession and how their preconceived expectations may or may not have shifted after practicum experiences in low SES schools. We encouraged open reflection about how they perceived themselves as English teachers.

Nurse staffing levels and the incidence of mortality and morbidity in the adult intensive care unit : a literature review

BACKGROUND: Studies have shown that nurse staffing levels, among many other factors in the hospital setting, contribute to adverse patient outcomes. Concerns about patient safety and quality of care have resulted in numerous studies being conducted to examine the relationship between nurse staffing levels and the incidence of adverse patient events in both general wards and intensive care units. AIM: The aim of this paper is to review literature published in the previous 10 years which examines the relationship between nurse staffing levels and the incidence of mortality and morbidity in adult intensive care unit patients. METHODS: A literature search from 2002 to 2011 using the MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Australian digital thesis databases was undertaken. The keywords used were: intensive care; critical care; staffing; nurse staffing; understaffing; nurse-patient ratios; adverse outcomes; mortality; ventilator-associated pneumonia; ventilator-acquired pneumonia; infection; length of stay; pressure ulcer/injury; unplanned extubation; medication error; readmission; myocardial infarction; and renal failure. A total of 19 articles were included in the review. Outcomes of interest are patient mortality and morbidity, particularly infection and pressure ulcers. RESULTS: Most of the studies were observational in nature with variables obtained retrospectively from large hospital databases. Nurse staffing measures and patient outcomes varied widely across the studies. While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies concluded that a trend exists between increased nurse staffing levels and decreased adverse events. CONCLUSION: While an overall statistical association between increased nurse staffing levels and decreased adverse patient outcomes was not found in this review, most studies demonstrated a trend between increased nurse staffing levels and decreased adverse patient outcomes in the intensive care unit which is consistent with previous literature. While further more robust research methodologies need to be tested in order to more confidently demonstrate this association and decrease the influence of the many other confounders to patient outcomes; this would be difficult to achieve in this field of research.

Epistemic beliefs and beliefs about teaching practices for moral learning in the early years of school : relationships and complexities

While investment in young children is recognised as important for the development of moral values for a cohesive society, little is known about early years teaching practices that promote learning of moral values. This paper reports on observations and interviews with 11 Australian teachers, focusing on their epistemic beliefs and beliefs about teaching practices for moral education with children aged 5 to 8 years. The analysis revealed three main patterns of thinking about moral education: following others, reflecting on points of view, and informing reflection for action. These patterns suggest a relationship between epistemic beliefs and beliefs about teaching practices for moral learning which have implications for teacher professional development concerning experiences in moral education.

What are the health needs, familial and social problems of Thai migrants in a local community in Australia? A focus group study

This study explored the health needs, familial and social problems of Thai migrants in a local community in Brisbane, Australia. Five focus groups with Thai migrants were conducted. The qualitative data were examined using thematic content analysis that is specifically designed for focus group analysis. Four themes were identified: (1) positive experiences in Australia, (2) physical health problems, (3) mental health problems, and (4) familial and social health problems. This study revealed key health needs related to chronic disease and mental health, major barriers to health service use, such as language skills, and facilitating factors, such as the Thai Temple. We concluded that because the health needs, familial and social problems of Thai migrants were complex and culture bound, the development of health and community services for Thai migrants needs to take account of the ways in which Thai culture both negatively impacts health and offer positive solutions to problems.

Desperately seeking Asia through China: Reading ‘China’ in the Australian Curriculum: History through children’s literature

This paper considers how Asia can be meaningfully studied and understood in the first national history curriculum to be implemented in Australia. Its focus is on how empathy might be conceptualised as part of the process of becoming ‘Asia literate’ and the ways in which an empathetic understanding can be developed in the Australian Curriculum: History by engaging students with children’s literature. We argue that stories about Chinese experiences in Australia from particular episodes in the nation’s past can be utilised for their potential to prompt historical inquiry and empathetic engagement in the classroom.

Challenging TEFL trainees' professional beliefs: unexpected encounters in international practicum

This study explores the impact of an international school-based experience on the professional beliefs and practices of TEFL trainees. Through their experiences in an Australian primary classroom, 17 Hong Kong TEFL trainees found their professional beliefs challenged in unexpected ways. A combination of stimulated recall and guided reflection encouraged participants to develop new understandings from these intercultural encounters.

‘Working with the team’ : an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care

This study aimed to explore how a new model of integrated primary/secondary care for type 2 diabetes management, the Brisbane South Complex Diabetes Service (BSCDS), related to improved diabetes management in a selected group of patients. We used a qualitative research design to obtain detailed accounts from the BSCDS via semi-structured interviews with 10 patients. The interviews were fully transcribed and systematically coded using a form of thematic analysis. Participants’ responses were grouped in relation to: (1) Patient-centred care; (2) Effective multiprofessional teamwork; and (3) Empowering patients. The key features of this integrated primary/secondary care model were accessibility and its delivery within a positive health care environment, clear and supportive interpersonal communication between patients and health care providers, and patients seeing themselves as being part of the team-based care. The BSCDS delivered patient-centred care and achieved patient engagement in ways that may have contributed to improved type 2 diabetes management in these participants.