Barriers and facilitators in the provision of post-abortion care at district level in central Uganda : a qualitative study focusing on task sharing between physicians and midwives

Background: Abortion is restricted in Uganda, and poor access to contraceptive methods result in unwanted pregnancies. This leaves women no other choice than unsafe abortion, thus placing a great burden on the Ugandan health system and making unsafe abortion one of the major contributors to maternal mortality and morbidity in Uganda. The existing sexual and reproductive health policy in Uganda supports the sharing of tasks in post-abortion care. This task sharing is taking place as a pragmatic response to the increased workload. This study aims to explore physicians' and midwives' perception of post-abortion care with regard to professional competences, methods, contraceptive counselling and task shifting/sharing in post-abortion care. Methods: In-depth interviews (n = 27) with health care providers of post-abortion care were conducted in seven health facilities in the Central Region of Uganda. The data were organized using thematic analysis with an inductive approach. Results: Post-abortion care was perceived as necessary, albeit controversial and sometimes difficult to provide. Together with poor conditions post-abortion care provoked frustration especially among midwives. Task sharing was generally taking place and midwives were identified as the main providers, although they would rarely have the proper training in post-abortion care. Additionally, midwives were sometimes forced to provide services outside their defined task area, due to the absence of doctors. Different uterine evacuation skills were recognized although few providers knew of misoprostol as a method for post-abortion care. An overall need for further training in post-abortion care was identified. Conclusions: Task sharing is taking place, but providers lack the relevant skills for the provision of quality care. For post-abortion care to improve, task sharing needs to be scaled up and in-service training for both doctors and midwives needs to be provided. Post-abortion care should further be included in the educational curricula of nurses and midwives. Scaled-up task sharing in post-abortion care, along with misoprostol use for uterine evacuation would provide a systematic approach to improving the quality of care and accessibility of services, with the aim of reducing abortion-related mortality and morbidity in Uganda.

Mathematics teacher education and technology

Various applications of electronic technology have contributed to the field of mathematics teacher education, but the array of tools now' available to teacher educators in developed countries can be somewhat daunting. In this chapter, the authors present an overview of some of these tools and the ways that they are being used. In addition, they address issues surrounding the development and applications of digital technology in teacher education programs in a number of countries. In particular, they present recent applications of videotapes, multimedia resources, internet-based communities, and tutorial conferencing facilities in pre-service and in-service education of mathematics teachers. As professionals who have used technology in teacher education, the authors blend their own insights into this review of technological tools and relevant issues.

Relationship between body mass index and the use of healthcare services in Australia

Objective: To examine the relationship between body mass index (BMI) and the use of medical and preventive health services. Research Methods and Procedures: This study involved secondary analysis of weighted data from the Australian 1995 National Health Survey. The study was a population survey designed to obtain national benchmark information about a range of health-related issues. Data were available from 17,033 men and 17,174 women, 20 years or age. BMI, based on self-reported weight and height, was analyzed in relation to the use of medical services and preventive health services. Results: A positive relationship was found between BMI and medical service use, such as medication use, visits to hospital accident and emergency departments (for women only); doctor visits, visits to a hospital outpatient clinics; and visits to other health professionals (for women only). A negative relationship was found in women between BMI and preventive health services. Underweight women were found to be significantly less likely to have Papanicolaou smear tests, breast examinations, and mammograms. Discussion: This research shows that people who fall outside the healthy weight range are more likely to use a range of medical services. Given that the BMI of industrialized populations appears to be increasing, this has important ramifications for health service planning and reinforces the need for obesity prevention strategies at a population level.

Globalisation and manufacturing strategy in the TCF industry

Purpose – The textiles, clothing, and footwear (TCF) industry has struggled in Australia since the government commenced dismantling tariffs. By sourcing from Asia, middlemen undercut established suppliers, and retail chains set benchmark low prices with their imported “house” labels. The policy-makers predicted that local producers would become more efficient, and export to make up for lost sales, but the media paints a picture of rising imports, retrenchments, and factory closures. The research objective was to discover what strategies the survivors (actually) employ in adapting to the pressures of globalisation.

Design/methodology/approach – More than 30 companies were involved in the study, ranging from small family businesses to subsidiaries of big multinationals. Each case study was based on an interview with a senior executive, normally followed by a plant tour. This methodology suits a fresh topic, as it avoids preconceptions and imposes no bounds.

Findings – Results show that the policy change was based on “pie in the sky” forecasts. Increasingly, TCF production is transferred to cheap offshore locations, generally via subcontracting plus the “badging” of foreign designs. To survive, local factories should focus on quality and customer service, preferably in niche markets (like uniforms), or for specific customer groups, and develop technologically advanced products. A move down the supply chain into retailing can also assist. Large multinational corporations that engage in foreign direct investment dominate the management literature.

Originality/value – This paper presents a different perspective, neglected in international operations management, whereby domestically oriented businesses attempt to defend themselves against the adverse consequences of globalisation.

How acceptable is a referral and telephone-based outcall programme for men diagnosed with cancer? A feasibility study

The objective of this study was to determine the feasibility and acceptability of a referral and outcall programme from a telephone-based information and support service, for men newly diagnosed with colorectal or prostate cancer. A block randomized controlled trial was performed involving 100 newly diagnosed colorectal and prostate cancer patients. Patients were referred to the Cancer Information Support Service (CISS) through clinicians at diagnosis. Clinicians were randomized into one of three conditions. Active referral 1: specialist referral with four CISS outcalls: (1) ≤1 week of diagnosis; (2) at 6 weeks; (3) 3 months; and (4) 6 months post diagnosis. Active referral 2: specialist referral with one CISS outcall ≤1 week of diagnosis. Passive referral: specialist recommended patient contacts CISS, but contact at the patient's initiative. Patients completed research questionnaires at study entry (before CISS contact), then 4 and 7 months post diagnosis. Overall, 96% of participants reported a positive experience with the referral process; 87% reported they were not concerned about receiving the calls; and 84% indicated the timing of the calls was helpful. In conclusion, the referral and outcall programme was achievable and acceptable for men newly diagnosed with colorectal or prostate cancer.

Issues in IT service-oriented requirements engineering

Corporate information technology (IT) management is increasingly service-oriented, offering continuous evaluation and improvement of application, communication, delivery and support services to internal and external customers. Service-oriented requirements engineering (SoRE) plays a significant role in identifying and specifying service requirements, formally defined through service-level agreements (SLAs). However, the new frameworks and approaches emerging to guide these developments have not yet addressed how requirements for such services can be effectively developed, nor identified the diverse issues involved. We report a case study of a web services team development of requirements for an internal Service Desk service. The study revealed five main issues of concern when developing service provider requirements: service roles, responsibilities and accountability; service performance metrics; resolution of conflicting stakeholder service requirements; customer acceptance of service change; and service provider team structure. This study suggests that in the new IT services era, new techniques and approaches are needed for eliciting and determining provider and customer requirements that involve key stakeholder groups equitably and more closely negotiate the sometimes-conflicting provider and customer needs.

Re-envisioning teacher education in the new media age: multiliteracies, multimodality and internet communication technologies

Multiliteracies pedagogy and research (New London Group, 1996) addresses the range of literacies needed by diverse students to effectively negotiate the increasing multimodality of texts, both inside and outside of schools. Yet, few university teachers understand how youth are able to express themselves, their experiences and lives, in new, empowering and perception-shifting ways as designers in the 21st century. Several theorists (Bruce, 2000; Lemke, 1998; Luke, 2000; Bolter, 1998; Glister, 1997) argue literacy education must be reconceptualised to recognize the importance of teaching and supporting multimedia literacy in a world where internet communication technologies (ICTs) incorporate all semiotic resources. Expression through multiple media and more recently hypermedia—is common to youth—but has often been demonized by historically logocentric approaches to teaching and assessment by privileging print, over all other forms of expression (Albright & Walsh, 2003; Lemke, 1998; McCloud, 1993). As digital media becomes more pervasive in a post-typographic world, tertiary education will need to engage with its representational resources for acquiring traditional school literacy and knowledge. This paper reports on initiatives in Multiliteracies instruction for both pre-service and in-service teachers to more adequately attend to the multisemiotic landscapes of students’ changing worlds in New Times (Hall, 1996).

Do socioeconomic gradients in women's health widen over time and with age?

A population-based study was conducted to investigate changes over time in women's well-being and health service use by socio-economic status and whether these varied by age. Data from 12,328 mid-age women (aged 45–50 years in 1996) and 10,430 older women (aged 70–75 years) from the Australian Longitudinal Study on Women's Health were analysed. The main outcome measures were changes in the eight dimensions of the Short Form General Health Survey (SF-36) adjusted for baseline scores, lifestyle and behavioural factors; health care utilisation at Survey 2; and rate of deaths (older cohort only). Cross-sectional analyses showed clear socioeconomic differentials in well-being for both cohorts. Differential changes in health across tertiles of socioeconomic status (SES) were more evident in the mid-age cohort than in the older cohort. For the mid-aged women in the low SES tertile, declines in physical functioning (adjusted mean change of –2.4, standard error (SE) 1.1) and general health perceptions (−1.5, SE 1.1) were larger than the high SES group (physical functioning –0.8 SE 1.1, general health perceptions –0.8 SE 1.2). In the older cohort, changes in SF-36 scores over time were similar for all SES groups but women in the high SES group had lower death rates than women in the low SES group (relative risk: 0.79, 95% confidence interval 0.64–0.98). Findings suggest that SES differentials in physical health seem to widen during women's mid-adult years but narrow in older age. Nevertheless, SES remains an important predictor of health, health service use and mortality in older Australian women.

Cervical cancer services for Indigenous Women: Advocacy, Community-Based Research and Policy Change in Australia

Collaborative research undertaken in the state of Queensland, Australia, resulted in major changes in cervical cancer screening and treatment for Indigenous women. Guided by an Indigenous statewide reference group and with an Indigenous researcher playing a lead role, qualitative data were collected using interviews, focus groups, and larger community meetings; and case studies were conducted with health workers and community members from diverse rural, remote and urban communities, to explore the different cultural and structural factors affecting understanding and awareness of cervical cancer and Indigenous women's use of and access to health services for screening, diagnosis and treatment. These data were supplemented by an analysis of clinical data and health service checklists. We discuss the methodology and summarize the key social and structural factors that discourage women from presenting for screening or returning for follow-up. These include women's misunderstanding of cervical cancer screening, fear of cancer, distrust of health services, poor recall and follow-up systems, and the economic and social burden to women presenting for treatment. We describe how the research process and subsequent activities provided Indigenous women with a vehicle for their own advocacy, resulting in important policy and program changes.

A construct of sequential service quality in service encounter chains

Studies of the construct of service quality have traditionally been undertaken from the perspective of the service receiver. More recently, research has focused on both the service provider's perspective and the service receiver's perspective. In addition, there have also been some triadic network approaches to the study of service quality. However, there has been very little research into sequential service quality in service-encounter chains (that is, consecutive service performances in a series of service encounters). The incorporation of connected service encounters in services management can improve understanding of sequential service quality in service-encounter chains. This paper provides a customized construct of sequential service quality and  highlights the importance of time, context, and performance threshold in service-encounter chains. Furthermore, the paper presents a customized six-dimensional construct of sequential service quality.

Pathway planning and 'becoming somebody' : Exploring the tensions between wellbeing and credentialism with students at (educational) risk

This paper maps the policy shifts around the education and training of youth that frame how schools respond to issues of youth' at risk'. These shifts have occurred with the move from the self managing schools marked by market discourses of competition, autonomy and image management that supplanted earlier discourses of welfare and community, through to recent policies in Victoria arising from the Kirby Review of Post compulsory Education and Public Education, the Next Generation undertaken by the Labor government. These reports, and the policies emerging out of them, are producing new discourses about youth and schooling focusing on wellbeing, learning networks and more systemic support for schools at the same time as there is increased accountability and expectations of schools. Drawing on the school exclusion literature from the U.K, and using Bourdieu's notion of habitus, we examine the findings from a recent study undertaken on the Geelong Pathways Planning project, funded through a Victorian government strategy, to discuss how schools respond to such initiatives. The project explored the ways in which students in the Geelong region understood and worked with the job planning pathways program, and how service providers (schools, community education facilities, job networks etc) coordinated to meet the needs of individual youth. There was a disjuncture in the participating schools between the discourses of care and welfare for students at risk, and the actual practices and policies that ignored or excluded such students. This paper concludes with a discussion of what might be required systemically, in schools and in their relations to other education providers, to build the capacity to respond more effectively to all students.

Identifying the barriers to implementing the Victorian Department of Education and Training guidelines regarding the provisions of nutrient dense food options in school canteens

Aims & rationale/Objectives : To identify barriers to the full implementation of new guidelines regarding school canteen menus launched by The Victorian Education Department in May 2004.
Methods : A self-administered questionnaire was sent to principals, business mangers and canteen managers of 13 secondary schools in South West Victoria covered by The Greater Green Triangle area (response rate 59%). The questions explored the canteen's role, operation, staffing and profits; existence and content of canteen policy; enablers and barriers to the sale of healthier foods; introduction and promotion of healthier foods; and perceived implications of banning less healthy foods.
Principal findings : The study identified several barriers to implementing healthy menus in school canteens, these being largely consistent with those found in other studies. The majority of schools reported they were making attempts to follow the guidelines for school food services, but were experiencing difficulty in proceeding to full implementation. The barriers identified through the study were student preference for less healthy options, concerns about profitability, lack of policy or its active communication and promotion at the school level and competition from other food outlets.
Discussion : There was evidence that healthy foods had not been actively promoted, suggesting that identification of student preferences as a barrier was based on perception rather than observation. The Victorian guidelines are effectively voluntary, with no accountability measures in place.
Implications : Research needs to be conducted to provide reliable and tested information about factors which impact on student choice. Schools would benefit from specialised assistance to formulate business plans for contemporary canteens selling healthy food and a clarification of government policy.
Presentation type : Poster

Opportunities and challenges for global education in social education curriculum

This paper will explore understandings about global education as expressed in national and local curriculum statements. Despite curriculum statements in Studies of Society and Environment area including ‘global’ in their rationale, slippage occurs between policy documents and the translation to standards statements. The curriculum area - Studies of Society and Environment is - changing as new titles describe the field and a more integrated approach is being developed in some states – Tasmania and Victoria, this presents challenges for global education.

My work in global education is a result of many years as a Geography teacher, nine years at the Asia Education Foundation, a leader of teacher study tours to Asia and pre-service teacher education students to Canada and Northern Territory. I am a passionate believer in the power of travel to unsettle, to educate, and to be reminded of all I have, and to be thankful.

Informing decision-making in libraries: informetric research as input to LIS education and practice.(Library and Information Science).

Findings from informetric research represent an important background resource to add to the mix of information useful for resolving difficult and ongoing problems in specific library environments or information service settings. This paper provides examples of informetric research that can be useful input to decision-making in the field of library management and information service provision. This overview takes four of the challenges that Michael Buckland outlined for library research as a way of guiding the discussion of ways that informetric work can be used to inform library decision-making. (1) References are made to relevant informetric work undertaken or conducted in Australia, by Australian researchers, or with Australian data.

Informetrics includes both quantitative and qualitative methods, which when used in combination can provide a rounded set of findings that has great validity for management, policy and service applications. Quantitative methodologies are generally based on bibliometric techniques, such as mining and analysis of data from various bibliographic and textual databases. Qualitative methods include survey, case study and historical approaches. Used in combination, each set of findings adds richness and other perspectives to an analysis.