Collaboration between infection control and occupational health in three continents: a success story with international impact

Globalization has been accompanied by the rapid spread of infectious diseases, and further strain on working conditions for health workers globally. Post-SARS, Canadian occupational health and infection control researchers got together to study how to better protect health workers, and found that training was indeed perceived as key to a positive safety culture. This led to developing information and communication technology (ICT) tools. The research conducted also showed the need for better workplace inspections, so a workplace audit tool was also developed to supplement worker questionnaires and the ICT. When invited to join Ecuadorean colleagues to promote occupational health and infection control, these tools were collectively adapted and improved, including face-to-face as well as on-line problem-based learning scenarios. The South African government then invited the team to work with local colleagues to improve occupational health and infection control, resulting in an improved web-based health information system to track incidents, exposures, and occupational injury and diseases. As the H1N1 pandemic struck, the online infection control course was adapted and translated into Spanish, as was a novel skill-building learning tool that permits health workers to practice selecting personal protective equipment. This tool was originally developed in collaboration with the countries from the Caribbean region and the Pan American Health Organization (PAHO). Research from these experiences led to strengthened focus on building capacity of health and safety committees, and new modules are thus being created, informed by that work. The products developed have been widely heralded as innovative and interactive, leading to their inclusion into “toolkits” used internationally. The tools used in Canada were substantially improved from the collaborative adaptation process for South and Central America and South Africa. This international collaboration between occupational health and infection control researchers led to the improvement of the research framework and development of tools, guidelines and information systems. Furthermore, the research and knowledge-transfer experience highlighted the value of partnership amongst Northern and Southern researchers in terms of sharing resources, experiences and knowledge.

The economic impact of genetically modified cotton on South African smallholders: Yield, profit and health effects

Results of a large-scale survey of resource-poor smallholder cotton farmers in South Africa over three years conclusively show that adopters of Bt cotton have benefited in terms of higher yields, lower pesticide use, less labour for pesticide application and substantially higher gross margins per hectare. These benefits were clearly related to the technology, and not to preferential adoption by farmers who were already highly efficient. The smallest producers are shown to have benefited from adoption of the Bt variety as much as, if not more than, larger producers. Moreover, evidence from hospital records suggests a link between declining pesticide poisonings and adoption of the Bt variety.

Innovative implementation of iLearn e-Portfolio for Personal Development Planning

iLearn is a Web 2.0 tool developed in Blackboard to help students with Personal Development Planning (PDP). This paper describes a case study on how the innovative use of mobile digital technology in iLearn e-Portfolio for developing reflective portfolios for PDP benefits the students. The e-Portfolio tool benefits students as it enables them to create and share portfolios, record achievements and reflections that support future job applications and promotion. Students find it beneficial because they can make use of iLearn e-Portfolio to keep academic records and achievements, activities and interests, work experience, reflective practice, employer information and some other useful resources, and also to tailor their CV and covering letters including evidence to support their CV, transferable skills and selling points. Useful information for preparing for an interview, reflecting after an event and any thoughts and evaluation can be kept in iLearn e-Portfolio. Keeping assessment and feedback records in iLearn e-Portfolio enables students to know their progress, to identify any gaps they need to fill to develop their study practices and areas for development. The key points from the feedback on the assignments and assessments are beneficial for future improvement. The reflections on the assignments and how students make use of the advice are particularly useful to improve their overall performance. In terms of pedagogical benefits, the “Individual Learner Profile” records and reviews evidence in verbal communication, basic and higher academic skills, time management, numeracy skill and IT skills, students become increasingly aware of their own strengths and any weaker areas that may require development. The e-Portfolio also provides opportunity for students to reflect on the experience and skills they have gained whilst participating in activities outside their studies. As the iLearn e-Portfolio is a reflective practice tool, it is consistent with the principle of Schon's reflective practitioner to reframe problems and to explore the consequences of actions. From the students’ feedback, for those who engage regularly in iLearn, they are better able to set agendas for their Personal Tutorial meetings and provide their Personal Tutor with a unique record of their achievements, skills and attributes which help them writing effective references for them. They make the most of their student experience in general. They also enhance their transferable skills and employability overall. The iLearn e-Portfolio prepares for the workplace and life beyond University including continuing professional development. Students are aware of their transferable skills, evidence of the skills and skill level, including award or accreditation, and their personal reflection on their transferable skills. It is beneficial for students to be aware of their transferable skills, to produce evidence of the skills and skills level such as award and accreditation, and to record their personal reflection on their transferable skills. Finally, the innovative use of mobile digital technology in iLearn e-Portfolio for developing reflective portfolios for PDP will improve their employability.

Access, equity and the role of rights in health care

Modern health care rhetoric promotes choice and individual patient rights as dominant values. Yet we also accept that in any regime constrained by finite resources, difficult choices between patients are inevitable. How can we balance rights to liberty, on the one hand, with equity in the allocation of scarce resources on the other? For example, the duty of health authorities to allocate resources is a duty owed to the community as a whole, rather than to specific individuals. Macro-duties of this nature are founded on the notion of equity and fairness amongst individuals rather than personal liberty. They presume that if hard choices have to be made, they will be resolved according to fair and consistent principles which treat equal cases equally, and unequal cases unequally. In this paper, we argue for greater clarity and candour in the health care rights debate. With this in mind, we discuss (1) private and public rights, (2) negative and positive rights, (3) procedural and substantive rights, (4) sustainable health care rights and (5) the New Zealand booking system for prioritising access to elective services. This system aims to consider: individual need and ability to benefit alongside the resources made available to elective health services in an attempt to give the principles of equity practical effect. We describe a continuum on which the merits of those, sometimes competing, values-liberty and equity-can be evaluated and assessed.

Innovative use of e-portfolio for personal development

iLearn is a quasi-Web 2.0 tool developed in Blackboard to help users with Personal Development Planning (PDP). This paper describes a case study on how the innovative use of mobile digital technology in iLearn e-Portfolio for developing reflective portfolios for PDP benefits the users, who are training to be professionals in construction management and surveying, The e-Portfolio tool benefits users as it enables them to create and share portfolios, record achievements and reflections that support future job applications and promotion. Users find it beneficial because they can make use of iLearn e-Portfolio to keep academic records and achievements, activities and interests, work experience, reflective practice, employer information and some other useful resources, and also to tailor their CV and covering letters including evidence to support their CV, transferable skills and selling points. Useful information for preparing for an interview, reflecting after an event and any thoughts and evaluation can be kept in iLearn e-Portfolio. Keeping assessment and feedback records in iLearn e-Portfolio enables learners to know their progress, to identify any gaps they need to fill to develop their study practices and areas for development. The key points from the feedback on the assignments and assessments are beneficial for future improvement. The reflections on the tasks and how they make use of the advice are particularly useful to improve their overall performance. In terms of pedagogical benefits, the “Individual Learner Profile” records and reviews evidence in verbal communication, basic and higher academic skills, time management, numeracy skill and IT skills, learners become increasingly aware of their own strengths and any weaker areas that may require development. The e-Portfolio also provides opportunity for them to reflect on the experience and skills they have gained whilst participating in activities outside their studies. As the iLearn e-Portfolio is a reflective practice tool, it is consistent with the principle of Schon's reflective practitioner to reframe problems and to explore the consequences of actions. From the users’ feedback, for those who engage regularly in iLearn, they are better able to set agendas for their supervision meetings and provide their supervisor with a unique record of their achievements, skills and attributes which help them writing effective references for them. They make the most of their learning experience in general. They also enhance their transferable skills and employability overall. The iLearn e-Portfolio prepares them for the workplace including continuing professional development. Users are aware of their transferable skills, evidence of the skills and skill level, including award or accreditation, and their personal reflection on their transferable skills. It is beneficial for them to be aware of their transferable skills, to produce evidence of the skills and skills level such as award and accreditation, and to record their personal reflection on their transferable skills. Finally, the innovative use of mobile digital technology in iLearn e-Portfolio for developing reflective portfolios for PDP will improve their employability.

The influence of individual characteristics on employee creative participation

In a knowledge-based economy and dynamic work environment retaining competitiveness is increasingly dependent on creativity, skills, individual abilities and appropriate motivation. For instance, the UK government explicitly stated in the recent "Review of Employee Engagement and Investment" report that new ways are required through which British companies could boost employee engagement at work, improving staff commitment and, thereby, increase workplace productivity. Although creativity and innovation have been studied extensively, little is known about employees' intrinsic willingness to contribute novel ideas and solutions (defined here as creative participation). For instance, the same individual can thrive in one organisation but be completely isolated in another and the question is to what extent this depends on individual characteristics and organisational settings. The main aim of this research is, therefore, to provide a conceptual framework for identification of individual characteristics that influence employees' willingness to contribute new ideas. In order to achieve this aim the investigation will be based on a developed psychological experiment, and will include personal-profiling inventory and a questionnaire. Understanding how these parameters influence willingness of an individual to put forward created ideas would offer an opportunity for companies to improve motivation practices and team efficiency, and can consequently lead to better overall performance.

The economic impact of genetically modified cotton on South African smallholders: Yield, profit and health effects

Results of a large-scale survey of resource-poor smallholder cotton farmers in South Africa over three years conclusively show that adopters of Bt cotton have benefited in terms of higher yields, lower pesticide use, less labour for pesticide application and substantially higher gross margins per hectare. These benefits were clearly related to the technology, and not to preferential adoption by farmers who were already highly efficient. The smallest producers are shown to have benefited from adoption of the Bt variety as much as, if not more than, larger producers. Moreover, evidence from hospital records suggests a link between declining pesticide poisonings and adoption of the Bt variety.

Self-exclusion from health care in women at high risk for postpartum depression

Background A significant proportion of women who are vulnerable to postnatal depression refuse to engage in treatment programmes. Little is known about them, other than some general demographic characteristics. In particular, their access to health care and their own and their infants' health outcomes are uncharted. Methods We conducted a nested cohort case-control study, using data from computerized health systems, and general practitioner (GP) and maternity records, to identify the characteristics, health service contacts, and maternal and infant health outcomes for primiparous antenatal clinic attenders at high risk for postnatal depression who either refused (self-exclusion group) or else agreed (take-up group) to receive additional Health Visiting support in pregnancy and the first 2 months postpartum. Results Women excluding themselves from Health Visitor support were younger and less highly educated than women willing to take up the support. They were less likely to attend midwifery, GP and routine Health Visitor appointments, but were more likely to book in late and to attend accident and emergency department (A&E). Their infants had poorer outcome in terms of gestation, birthweight and breastfeeding. Differences between the groups still obtained when age and education were taken into account for midwifery contacts, A&E attendance and gestation;the difference in the initiation of breast feeding was attenuated, but not wholly explained, by age and education. Conclusion A subgroup of psychologically vulnerable childbearing women are at particular risk for poor access to health care and adverse infant outcome. Barriers to take-up of services need to be understood in order better to deliver care.

Communicating information about medication: the benefits of making it personal

Two experiments, using a controlled empirical methodology, investigated the effects of presenting information about medicines using a more personalised style of expression. In both studies, members of the general public were given a hypothetical scenario about visiting the doctor, being diagnosed with a particular illness, and being prescribed a medication. They were also given a written explanation about the medicine and were asked to provide ratings on a number of measures, including satisfaction, perceived risk to health, and intention to comply. In Experiment 1 the explanation focused only on possible side effects of the medicine, whereas in Experiment 2 a fuller explanation was provided, which included information about the illness, prescribed drug, its dosage and contraindications as well as its side effects. In both studies, use of a more personalised style resulted in significantly higher ratings of satisfaction and significantly lower ratings of likelihood of side effects occurring and of perceived risk to health. In Experiment 2 it also led to significantly improved recall for the written information.

Perceptions of psychological content in the GP consultation - the role of practice, personal and prescribing attributes

Objective: The aim of the present study was to determine the relationship between the characteristics of general practices and the perceptions of the psychological content of consultations by GPs in those practices. Methods: A cross-sectional survey was conducted of all GPs (22 GPs based in nine practices) serving a discrete inner city community of 41 000 residents. GPs were asked to complete a log-diary over a period of five working days, rating their perception of the psychological content of each consultation on a 4-point Likert scale, ranging from 0 (no psychological content) to 3 (entirely psychological in content). The influence of GP and practice characteristics on psychological content scores was examined. Results: Data were available for every surgery-based consultation (n = 2206) conducted by all 22 participating GPs over the study period. The mean psychological content score was 0.58 (SD 0.33). Sixty-four percent of consultations were recorded as being without any psychological content; 6% were entirely psychological in content. Higher psychological content scores were significantly associated with younger GPs, training practices (n = 3), group practices (n = 4), the presence of on-site mental health workers (n = 5), higher antidepressant prescribing volumes and the achievement of vaccine and smear targets. Training status had the greatest predictive power, explaining 51% of the variation in psychological content. Neither practice consultation rates, GP list size, annual psychiatric referral rates nor volumes of benzodiazepine prescribing were related to psychological content scores. Conclusion: Increased awareness by GPs of the psychological dimension within a consultation may be a feature of the educational environment of training practices.

Why don’t pesticide applicators protect themselves? Exploring the use of personal protective equipment among Colombian smallholders

The misuse of personal protective equipment (PPE) during pesticide application was investigated among smallholders in Colombia. The integrative agent-centered (IAC) framework and a logistic regression approach were adopted. The results suggest that the descriptive social norm was significantly influencing PPE use. The following were also important: (1) having experienced pesticide-related health problems; (2) age; (3) the share of pesticide application carried out; and (4) the perception of PPE hindering work. Interestingly, the influence of these factors differed for different pieces of PPE. Since conformity to the social norm is a source of rigidity in the system, behavioral change may take the form of a discontinuous transition. In conclusion, five suggestions for triggering a transition towards more sustainable PPE use are formulated: (1) diversifying targets/tools; (2) addressing structural aspects; (3) sustaining interventions in the long-term; (4) targeting farmers’ learning-by-experience; and (5) targeting PPE use on a collective level.

Exploring behavioural change through an agent-oriented system dynamics model: the use of personal protective equipment among pesticide applicators in Colombia

The misuse of Personal Protective Equipment results in health risk among smallholders in developing countries, and education is often proposed to promote safer practices. However, evidence point to limited effects of education. This paper presents a System Dynamics model which allows the identification of risk-minimizing policies for behavioural change. The model is based on the IAC framework and survey data. It represents farmers' decision-making from an agent-oriented standpoint. The most successful intervention strategy was the one which intervened in the long term, targeted key stocks in the systems and was diversified. However, the results suggest that, under these conditions, no policy is able to trigger a self sustaining behavioural change. Two implementation approaches were suggested by experts. One, based on constant social control, corresponds to a change of the current model's parameters. The other, based on participation, would lead farmers to new thinking, i.e. changes in their decision-making structure.