The effect of quality circles on job satisfaction and quality of work-life of staff in emergency medical services

INTRODUCTION

Quality circles, as a participatory management technique, offer one alternative for dealing with frustration and discontent of today's workers. This study was conducted to investigate the effect of implementation of quality circles on nurses' quality of work-life and job satisfaction.

MATERIALS AND METHODS

In this study, two emergency medical services (EMS) of Hamedan province were selected and randomly assigned as the experimental and control groups. After the experimental group was trained and quality circles were established in this group, the levels of quality of work-life and job satisfaction were measured in the two groups. Then, the statistical analyses were performed using t-test.

RESULTS

After the intervention, the results showed significant differences between the scores of motivational factors (p=0.001), the total scores of job satisfaction (p=0.003), and the scores of some quality of work life (QWL) conceptual categories including the use and development of capacities (p=0.008), the total space of life (p=0.003), and the total scores of QWL (p=0.031) in the experimental group compared to those in the control group.

CONCLUSION

This study confirms the effectiveness of quality circles in improving quality of work-life and job satisfaction of nurses working in EMS, and offers their application as a management method that can be used by EMS managers.

Organizational determinants of interprofessional collaboration in integrative health care: systematic review of qualitative studies

Context

Inteprofessional collaboration (IPC) between biomedically trained doctors (BMD) and traditional, complementary and alternative medicine practitioners (TCAMP) is an essential element in the development of successful integrative healthcare (IHC) services. This systematic review aims to identify organizational strategies that would facilitate this process.

Methods

We searched 4 international databases for qualitative studies on the theme of BMD-TCAMP IPC, supplemented with a purposive search of 31 health services and TCAM journals. Methodological quality of included studies was assessed using published checklist. Results of each included study were synthesized using a framework approach, with reference to the Structuration Model of Collaboration.

Findings

Thirty-seven studies of acceptable quality were included. The main driver for developing integrative healthcare was the demand for holistic care from patients. Integration can best be led by those trained in both paradigms. Bridge-building activities, positive promotion of partnership and co-location of practices are also beneficial for creating bonding between team members. In order to empower the participation of TCAMP, the perceived power differentials need to be reduced. Also, resources should be committed to supporting team building, collaborative initiatives and greater patient access. Leadership and funding from central authorities are needed to promote the use of condition-specific referral protocols and shared electronic health records. More mature IHC programs usually formalize their evaluation process around outcomes that are recognized both by BMD and TCAMP.

Conclusions

The major themes emerging from our review suggest that successful collaborative relationships between BMD and TCAMP are similar to those between other health professionals, and interventions which improve the effectiveness of joint working in other healthcare teams with may well be transferable to promote better partnership between the paradigms. However, striking a balance between the different practices and preserving the epistemological stance of TCAM will remain the greatest challenge in successful integration.

Acceptance of Internet-based health care services among households in Poland: secondary analysis of a population-based survey

BACKGROUND

Polish society is benefiting from growing access to the Internet, but the use of advanced e-services is still limited. The provision of Internet-based health services depends not only on the penetration of the Internet into society, but also on the acceptance of this technology by potential users.

OBJECTIVE

The main objective of this study was focused on the assessment of predictors of acceptance of Internet use for provision of health services (eg, sociodemographic status, the use of information technologies, and consumption of health care services) among households in Poland.

METHODS

The study was based on a secondary analysis of the dataset from the 2011 Social Diagnosis survey (a biannual survey conducted since 2001 about economic and non-economic aspects of household and individual living conditions in Poland). Analysis of the questionnaire results focused on the situations of the households included in the study. The predictors for 2 outcome variables describing the acceptance of households for Internet use for provision of a full health care service, or at least access to information and download of required forms, were assessed using multivariate logistic regression.

RESULTS

After excluding those households that would not consider the use of health care services or for which predictor variables assumed missing values, the final analyses were conducted on data from 8915 households. Acceptance of the use of the Internet for provision of full health care services in Polish households was significantly higher among households in urban locations with ≥ 200,000 inhabitants than among households in rural areas; it was also higher with salaried employment as the source of income than with self-employment in agriculture (odds ratio [OR] = 0.53, 95% CI 0.40 - 0.70), retirement pension (OR = 0.46, 95% CI 0.39 - 0.54), disability pension (OR = 0.48, 95% CI 0.34 - 0.68), or with several simultaneous income sources (OR = 0.66; 95% CI 0.57 - 0.79). Furthermore, acceptance of Internet-based health care was higher in households with a higher monthly net income per capita (OR = 2.11, 95% CI 1.75 - 2.53 for households from the lowest and the highest income interval), among households with > 1 child aged < 15 years (OR = 1.38, 95% CI 1.20 - 1.59), among households with at least some books (with OR = 3.33, 95% CI 2.39 - 4.64 for household with no books and those with over 500 books). Acceptance was also higher in households with a computer (OR = 1.86, 95% CI 1.35 - 2.56), Internet access (OR = 1.95, 95% CI 1.37 - 2.76), and Internet access for a longer duration (OR = 1.36, 95% CI 1.06 - 1.75 and OR = 1.81, 95% CI 1.40 - 2.33 for households with access < 1 year versus those with access for 1-5 years and > 5 years, respectively). Greater self-declared confidence in using technology was also associated with higher acceptance of the Internet for health care services (OR = 2.94, 95% CI 2.21 - 3.91 for the least confident households versus those with the highest confidence). Furthermore, recent use of health care services increased acceptance of using the Internet for at least some health-related services (OR = 1.49, 95% CI 1.16 - 1.91), but not for full provision of online health care services (OR = 1.20, 95% CI 0.92 - 1.55). Neither the hospitalization of a member of a household nor the opinion about satisfying health care needs of a household affected the degree of acceptance.

CONCLUSIONS

The acceptance of health care services through the Internet is higher in households from larger cities, with stable income from an employee salary, as well as with higher income levels per capita. Furthermore, general computer and Internet use in the household influenced the perception of eHealth. Paradoxically, the use of health care services or the level of satisfaction with the coverage of the household's health needs has a limited influence on acceptance of Internet-based health care services.

Is intravenous iron sucrose the treatment of choice for pregnant anemic women?

Anemia during pregnancy remains an important public health problem in developing countries like India. Anemia is the direct cause of 12-15% of maternal deaths. Iron deficiency is the commonest cause for anemia in the Indian subcontinent. Several preventive and therapeutic approaches are in practice. The available routes of iron supplementation are oral and intravenous. In spite of oral iron being least invasive, cheap and safe, the ineffectiveness of oral iron due to dietary inhibitors and poor compliance are well known. Intravenous iron sucrose can be a promising therapy for moderate to severely anemic pregnant women and has been in practice for quite some time in private and public health practices. In this article, we report the current evidence on the safety and efficacy of intravenous iron sucrose in anemic pregnant women on hematological and clinical outcomes. Though the evidence on its efficacy in improving hemoglobin and serum ferritin is convincing, its effect on maternal and fetal outcomes are unclear. This is primarily due to lack of well-designed and larger studies powered to detect difference in clinical outcomes. Hence, there is a need to gather evidence from a well-designed large randomized clinical trial conducted in a developing country. The results of such a study would feed into the national policy and would form the basis to frame guidelines for management of anemia in developing countries.

Discrete choice experiments in pharmacy: a review of the literature

Objective

Discrete choice experiments (DCEs) have been widely used to elicit patient preferences for various healthcare services and interventions. The aim of our study was to conduct an in-depth scoping review of the literature and provide a current overview of the progressive application of DCEs within the field of pharmacy.

Methods

Electronic databases (MEDLINE, EMBASE, SCOPUS, ECONLIT) were searched (January 1990–August 2011) to identify published English language studies using DCEs within the pharmacy context. Data were abstracted with respect to DCE methodology and application to pharmacy.

Key findings

Our search identified 12 studies. The DCE methodology was utilised to elicit preferences for different aspects of pharmacy products, therapy or services. Preferences were elicited from either patients or pharmacists, with just two studies incorporating the views of both. Most reviewed studies examined preferences for process-related or provider-related aspects with a lesser focus on health outcomes. Monetary attributes were considered to be important by most patients and pharmacists in the studies reviewed. Logit, probit or multinomial logit models were most commonly employed for estimation.

Conclusion

Our study showed that the pharmacy profession has adopted the DCE methodology consistent with the general health DCEs although the number of studies is quite limited. Future studies need to examine preferences of both patients and providers for particular products or disease-state management services. Incorporation of health outcome attributes in the design, testing for external validity and the incorporation of DCE results in economic evaluation framework to inform pharmacy policy remain important areas for future research.

Applying a Health Network approach to translate evidence-informed policy into practice: a review and case study on musculoskeletal health

BACKGROUND

While translation of evidence into health policy and practice is recognised as critical to optimising health system performance and health-related outcomes for consumers, mechanisms to effectively achieve these goals are neither well understood, nor widely communicated. Health Networks represent a framework which offers a possible solution to this dilemma, particularly in light of emerging evidence regarding the importance of establishing relationships between stakeholders and identifying clinical leaders to drive evidence integration and translation into policy. This is particularly important for service delivery related to chronic diseases. In Western Australia (WA), disease and population-specific Health Networks are comprised of cross-discipline stakeholders who work collaboratively to develop evidence-informed policies and drive their implementation. Since establishment of the Health Networks in WA, over 50 evidence-informed Models of Care (MoCs) have been produced across 18 condition or population-focused Networks. The aim of this paper is to provide an overview of the Health Network framework in facilitating the translation of evidence into policy and practice with a particular focus on musculoskeletal health.

CASE PRESENTATION

A review of activities of the WA Musculoskeletal Health Network was undertaken, focussing on outcomes and the processes used to achieve them in the context of: development of policy, procurement of funding, stakeholder engagement, publications, and projects undertaken by the Network which aligned to implementation of MoCs.The Musculoskeletal Health Network has developed four MoCs which reflect Australian National Health Priority Areas. Establishment of community-based services for consumers with musculoskeletal health conditions is a key recommendation from these MoCs. Through mapping barriers and enablers to policy implementation, working groups, led by local clinical leaders and supported by the broader Network and government officers, have undertaken a range of integrated projects, such as the establishment of a community-based, multidisciplinary rheumatology service. The success of these projects has been contingent on developing relationships between key stakeholders across the health system.

CONCLUSIONS

In WA, Networks have provided a sustainable mechanism to meaningfully engage consumers, carers, clinicians and other stakeholders; provided a forum to exchange ideas, information and evidence; and collaboratively plan and deliver evidence-based and contextually-appropriate health system improvements for consumers.

Complementary feeding patterns in India

There are far too many children in the world who suffer from under-nutrition and growth faltering, with life time consequences such as reduced work capacity, increased infections, impaired intellectual performance and an increased risk of non communicable diseases later in life. These changes occur early in life, and consequently, complementary feeding has been receiving increased attention in the international nutrition community. In India, common problems relate not only to insufficient breastfeeding, but also to detrimental feeding practices. Only about 20% of children aged 6-23 months were fed according to the three recommended Infant and Child Feeding practices. The most common types of solid or semi-solid foods fed to both breastfeeding and non-breastfeeding children under 3 years of age were foods made from grains and roots. These complementary feeding practices were found to be significantly associated with poor socioeconomic status, undesirable socio-cultural beliefs, maternal illiteracy, and ignorance. Although many initiatives have been carried out in India to promote Infant and Young Child Feeding, the progress in reducing the number of undernourished children in India over the last decade has been slow and modest. Equally, with the growing evidence and interest in the role of infant nutrition in the development of over nutrition and non-communicable disease, it is important to plan appropriate complementary feeding interventions that result in optimal growth. Contact opportunities with parents, specifically mothers, must be used for counseling through multiple communication channels such as local media, in order to constantly educate the population with consistent and simple messages on child feeding.

Are Dutch patients willing to be seen by a physician assistant instead of a medical doctor?

BACKGROUND

The employment of physician assistants (PAs) is a strategy to improve access to care. Since the new millennium, a handful of countries have turned to PAs as a means to bridge the growing gap between the supply and demand of medical services. However, little is known about this new workforce entity from the patient's perspective. The objective of this study was to assess the willingness of Dutch patients to be treated by a PA or a medical doctor (MD) under various time constraints and semi-urgent medical scenarios.

METHODS

A total of 450 Dutch adults were recruited to act as surrogate patients. A convenience sample was drawn from patients in a medical office waiting room in a general hospital awaiting their appointments. Each participant was screened to be naive as to what a PA and a nurse practitioner are and then read a definition of a PA and an MD. One of three medical scenarios was assigned to the participants in a patterned 1-2-3 strategy. Patients were required to make a trade-off decision of being seen after 1 hour by a PA or after 4 hours by a doctor. This forced-choice method continued with the same patient two more times with 30 minutes and 4 hours and another one of 2 hours versus 4 hours for the PA and MD, respectively.

RESULTS

Surrogate patients chose the PA over the MD 96 % to 98 % of the time (depending on the scenario). No differences emerged when analysed by gender, age, or parenthood status.

CONCLUSION

Willingness to be seen by a PA was tested a priori to determine whether surrogate Dutch patients would welcome this new health-care provider. The findings suggest that employing PAs, at least in concept, may be an acceptable strategy for improving access to care with this population.

The alcohol industry lobby and Hong Kong's zero wine and beer tax policy

BACKGROUND

Whereas taxation on alcohol is becoming an increasingly common practice in many countries as part of overall public health measures, the Hong Kong Special Administrative Region Government is bucking the trend and lowered its duties on wine and beer by 50 percent in 2007. In 2008, Hong Kong removed all duties on alcohol except for spirits. The aim of this paper is to examine the case of Hong Kong with its history of changes in alcohol taxation to explore the factors that have driven such an unprecedented policy evolution.

METHODS

The research is based on an analysis of primary documents. Searches of official government documents, alcohol-related industry materials and other media reports on alcohol taxation for the period from 2000 to 2008 were systematically carried out using key terms such as "alcohol tax" and "alcohol industry". Relevant documents (97) were indexed by date and topic to undertake a chronological and thematic analysis using Nvivo8 software.

RESULTS

Our analysis demonstrates that whereas the city's changing financial circumstances and the Hong Kong Special Administrative Region Government's strong propensity towards economic liberalism had, in part, contributed to such dramatic transformation, the alcohol industry's lobbying tactics and influence were clearly the main drivers of the policy decision. The alcohol industry's lobbying tactics were two-fold. The first was to forge a coalition encompassing a range of catering and trade industries related to alcohol as well as industry-friendly lawmakers so that these like-minded actors could find common ground in pursuing changes to the taxation policy. The second was to deliberately promote a blend of ideas to garner support from the general public and to influence the perception of key policy makers.

CONCLUSIONS

Our findings suggest that the success of aggressive industry lobbying coupled with the absence of robust public health advocacy was the main driving force behind the unparalleled abolition of wine and beer duties in Hong Kong. Strong public health alliance and advocacy movement are needed to counteract the industry's continuing aggressive lobby and promotion of alcoholic beverages.

Integrating a pharmacist into the general practice environment: opinions of pharmacist's, general practitioner's, health care consumer's, and practice manager's

Background

Pharmacists are viewed as highly trained yet underutilised and there is growing support to extend the role of the pharmacist within the primary health care sector. The integration of a pharmacist into a general practice medical centre is not a new concept however is a novel approach in Australia and evidence supporting this role is currently limited. This study aimed to describe the opinions of local stakeholders in South-East Queensland on the integration of a pharmacist into the Australian general practice environment.

Methods

A sample of general practitioners, health care consumers, pharmacists and practice managers in South-East Queensland were invited to participate in focus groups or semi-structured interviews. Seeding questions common to all sessions were used to facilitate discussion. Sessions were audio recorded and transcribed verbatim. Leximancer software was used to qualitatively analyse responses.

Results

A total of 58 participants took part in five focus groups and eighteen semi-structured interviews. Concepts relating to six themes based on the seeding questions were identified. These included positively viewed roles such as medication reviews and prescribing, negatively viewed roles such as dispensing and diagnosing, barriers to pharmacist integration such as medical culture and remuneration, facilitators to pharmacist integration such as remuneration and training, benefits of integration such as access to the patient’s medical file, and potential funding models.

Conclusions

These findings and future research may aid the development of a new model of integrated primary health care services involving pharmacist practitioners.

Prevalence of behaviour-related fertility disorders in a clinical sample: results of a pilot study

INTRODUCTION

There is no doubt that lifestyle factors can be detrimental to fertility. The aim of the present pilot study was to identify initial prevalence rates for behaviour-related fertility disorders in a clinical sample of couples wanting a child.

METHODS

Between February 2010 and August 2010, all patients coming for the first time to Heidelberg University's Women's Hospital for consultation on involuntary childlessness were asked to fill out a questionnaire designed by the authors of this article. The questionnaire was based on a review of the relevant literature, with special reference to the latest research findings on behaviour detrimental to fertility. Of the 156 couples addressed, 110 women and 100 men took part in the study.

RESULTS

For behaviour-related infertility, 9 % of the women and 3 % of the men in our sample were classified on the basis of BMI <18.5, sexual disorders, or abuse of anabolic steroids. If we include smokers, these figures increase: 11 % female smokers and 18 % male smokers. A further 19 % of the women practised sport to an excessive degree; and 26 % of the women and 53 % of the men had a BMI ≥25.

DISCUSSION

The prevalence of behaviour-related fertility disorders should not be underestimated. For the prevention of behaviour-related fertility disorders, it is important to inform the population about lifestyle-mediated fertility risks.

A Case Control Study on School Dropouts in Children of Alcohol-Dependent Males Versus that in Abstainers/Social Drinkers' Children

OBJECTIVE

To study and compare in the children of alcohol-dependent males versus those in a socio-demographically similar control group, the occurrence of school dropouts, and to examine the link between certain factors like parental education and socioeconomic status on school dropout.

MATERIALS AND METHODS

This was a community-based case control study. The participants were 107 family units in both study group (alcohol-dependent male, wife, at least one child less than 14 years of age) and control group (abstainer/social drinker, wife, at least one child less than 14 years of age). It was conducted in an urban slum community in Mumbai. Interview technique was used for data collection. The study was conducted for a period of 1 year.

STATISTICAL ANALYSIS

Using software SPSS version 17.0, percentages, Chi-square test.

RESULTS AND CONCLUSION

The number of school dropouts was significantly higher (45.31%, P < 0.001) in the children of alcohol-dependent males as compared to 22.47% in the abstainers/social drinkers' children. In the study group, there was higher number of school dropouts among boys (52.73%, P < 0.05) as compared to girls (35.37%). There was a statistically significant association between parental illiteracy and school dropout in children in both the groups. In the control group, significantly higher number of school dropouts of socioeconomic class IV and V had dropped out as compared to those of socioeconomic class III and II.

Parental involvement and mental well-being of Indian adolescents

This study examined the association between parental involvement and mental well being among the 6721 school going adolescents aged 13 to 15 years who participated in Indias nationally representative Global School based Student Health Survey (GSHS) in 2007. Parental involvement (homework checking, parental understanding of their childrens problems, and parental knowledge of their childrens freetime activities) was reported by students to decrease with age, while poor mental health (loneliness, insomnia due to anxiety, and sadness and hopelessness) increased with age. Age adjusted Logistic regression models showed that high levels of reported parental involvement were significantly associated with a decreased likelihood of poor mental health.

Classification of health structural indicators using scalogram model in golestan province, northern iran

BACKGROUND

One of the main and basic pillars of health system promotion is the equitable distribution of health facilities in order to ensure fair access of people in the community to the health services. The goal of this study was to classify the health structural indicators in Golestan Province using Scalogram analysis model.

METHOD

A descriptive study was conducted in 2010. Data related to indicators in 3 categories of institutional, human resources and rural health and their indicators were collected using statistical yearbook. Data analysis was done using SPSS software and scalogram analysis model.

RESULTS

There is large gap between health structural indicators in cities of Golestan Province. Aq Qala City with 97 score and Azad Shahr City with 41 score were the most and lowest scores respectively from enjoyment of health structural indicators. Generally, 18% of cities were in less developed level and only 27% of cities were developed level.

CONCLUSION

To achieve a fair and balanced healthcare status in different provinces based on their state of development, plans should be arranged in order to reduce the gap in the access to healthcare facilities.

Scale construction utilising the Rasch unidimensional measurement model: A measurement of adolescent attitudes towards abortion

BACKGROUND

Measurement scales seeking to quantify latent traits like attitudes, are often developed using traditional psychometric approaches. Application of the Rasch unidimensional measurement model may complement or replace these techniques, as the model can be used to construct scales and check their psychometric properties. If data fit the model, then a scale with invariant measurement properties, including interval-level scores, will have been developed.

AIMS

This paper highlights the unique properties of the Rasch model. Items developed to measure adolescent attitudes towards abortion are used to exemplify the process.

METHOD

Ten attitude and intention items relating to abortion were answered by 406 adolescents aged 12 to 19 years, as part of the "Teen Relationships Study". The sampling framework captured a range of sexual and pregnancy experiences. Items were assessed for fit to the Rasch model including checks for Differential Item Functioning (DIF) by gender, sexual experience or pregnancy experience.

RESULTS

Rasch analysis of the original dataset initially demonstrated that some items did not fit the model. Rescoring of one item (B5) and removal of another (L31) resulted in fit, as shown by a non-significant item-trait interaction total chi-square and a mean log residual fit statistic for items of -0.05 (SD=1.43). No DIF existed for the revised scale. However, items did not distinguish as well amongst persons with the most intense attitudes as they did for other persons. A person separation index of 0.82 indicated good reliability.

CONCLUSION

Application of the Rasch model produced a valid and reliable scale measuring adolescent attitudes towards abortion, with stable measurement properties. The Rasch process provided an extensive range of diagnostic information concerning item and person fit, enabling changes to be made to scale items. This example shows the value of the Rasch model in developing scales for both social science and health disciplines.

Pharmacists and harm reduction: A review of current practices and attitudes

BACKGROUND

Injection drug use and other high-risk behaviours are the cause of significant morbidity and mortality and thus have been the focus of many health promotion strategies. Community pharmacists are considered underutilized health providers and are often thought to be more accessible than other health professionals. The purpose of this review is to provide an overview of community pharmacists' practices as well as pharmacists' attitudes and identified barriers toward providing harm reduction services. We will highlight the major harm reduction services being offered through community pharmacies, as well as identify barriers to implementing these services.

METHODS

A review of the literature from 1995 to 2011 was conducted using the electronic databases MEDLINE, PubMed and Scopus, encompassing pharmacists' involvement in harm reduction services. Keywords included pharmacist, harm reduction, disease prevention, health promotion, attitudes, competence and barriers. References of included articles were examined to identify further relevant literature.

RESULTS

Pharmacists are primarily involved in providing clean needles to injection drug users, as well as opioid substitution. Pharmacists generally have a positive attitude toward providing health promotion and harm reduction programs and express some interest in increasing their role in this area. Common barriers to expanding harm reduction strategies in community pharmacists' practice include lack of time and training, insufficient remuneration, fear of attracting unruly clientele and inadequate communication between health providers.

CONCLUSION

As one of the most accessible health care providers, community pharmacists are in an ideal position to provide meaningful services to injection drug users. However, in order to do so, pharmacists require additional support in the form of better health team and system integration, as well as remuneration models.

Implementing patient-centred cancer care: using experience-based co-design to improve patient experience in breast and lung cancer services

Purpose

The aim of this paper was to briefly describe how the experience-based co-design (EBCD) approach was used to identify and implement improvements in the experiences of breast and lung cancer patients before (1) comparing the issues identified as shaping patient experiences in the different tumour groups and (2) exploring participants' reflections on the value and key characteristics of this approach to improving patient experiences.

Methods

Fieldwork involved 36 filmed narrative patient interviews, 219 h of ethnographic observation, 63 staff interviews and a facilitated co-design change process involving patient and staff interviewees over a 12-month period. Four of the staff and five patients were interviewed about their views on the value of the approach and its key characteristics. The project setting was a large, inner-city cancer centre in England.

Results

Patients from both tumour groups generally identified similar issues (or 'touchpoints') that shaped their experience of care, although breast cancer patients identified a need for better information about side effects of treatment and end of treatment whereas lung cancer patients expressed a need for more information post-surgery. Although the issues were broadly similar, the particular improvement priorities patients and staff chose to work on together were tumour specific. Interviewees highlighted four characteristics of the EBCD approach as being key to its successful implementation: patient involvement, patient responsibility and empowerment, a sense of community, and a close connection between their experiences and the subsequent improvement priorities.

Conclusion

EBCD positions patients as active partners with staff in quality improvement. Breast and lung cancer patients identified similar touchpoints in their experiences, but these were translated into different improvement priorities for each tumour type. This is an important consideration when developing patient-centred cancer services across different tumour types.

Reviewing the review process: Identifying sources of delay

BACKGROUND

The process of manuscript review is a central part of scientific publishing, but has increasingly become the subject of criticism, particularly for being difficult to manage, slow, and time consuming - all of which contribute to delaying publication.

AIMS

To identify potential sources of delays during manuscript review by examining the review process, and to identify and propose constructive strategies to reduce time spent on the review process without sacrificing journal quality.

METHOD

Sixty-seven manuscripts published in the Australasian Medical Journal (AMJ) were evaluated in terms of duration of peer review, number of times manuscripts were returned to authors, time authors spent on revision per review round, manuscripts containing grammatical errors reviewers deemed as major, papers where instructions to authors were not adhered to, and the number of reviews not submitted on time.

RESULTS

The median duration of the review process was found to be 74 days, and papers were on average returned to authors 1.73 times for revision. In 35.8% of papers, instructions to authors were not adhered to, whilst 29.8% of papers contained major grammatical errors. In 70.1% of papers reviewers did not submit their reviews on time, whilst the median time spent on revision by authors per review round was found to be 22 days.

CONCLUSION

This study highlights the importance of communication before and during review. Reviewers should be thoroughly briefed on their role and what is expected of them, whilst the review process as well as the author's role in preventing delays should be explained to contributors upon submission.

Global health governance and the commercial sector: a documentary analysis of tobacco company strategies to influence the WHO framework convention on tobacco control

BACKGROUND

In successfully negotiating the Framework Convention on Tobacco Control (FCTC), the World Health Organization (WHO) has led a significant innovation in global health governance, helping to transform international tobacco control. This article provides the first comprehensive review of the diverse campaign initiated by transnational tobacco corporations (TTCs) to try to undermine the proposed convention.

METHODS AND FINDINGS

The article is primarily based on an analysis of internal tobacco industry documents made public through litigation, triangulated with data from official documentation relating to the FCTC process and websites of relevant organisations. It is also informed by a comprehensive review of previous studies concerning tobacco industry efforts to influence the FCTC. The findings demonstrate that the industry's strategic response to the proposed WHO convention was two-fold. First, arguments and frames were developed to challenge the FCTC, including: claiming there would be damaging economic consequences; depicting tobacco control as an agenda promoted by high-income countries; alleging the treaty conflicted with trade agreements, "good governance," and national sovereignty; questioning WHO's mandate; claiming the FCTC would set a precedent for issues beyond tobacco; and presenting corporate social responsibility (CSR) as an alternative. Second, multiple tactics were employed to promote and increase the impact of these arguments, including: directly targeting FCTC delegations and relevant political actors, enlisting diverse allies (e.g., mass media outlets and scientists), and using stakeholder consultation to delay decisions and secure industry participation.

CONCLUSIONS

TTCs' efforts to undermine the FCTC were comprehensive, demonstrating the global application of tactics that TTCs have previously been found to have employed nationally and further included arguments against the FCTC as a key initiative in global health governance. Awareness of these strategies can help guard against industry efforts to disrupt the implementation of the FCTC and support the development of future, comparable initiatives in global health.

Determinants of diarrhoea and acute respiratory infection among under-fives in Uganda

BACKGROUND

Diarrhoea and acute respiratory infection (ARI) are leading causes of mortality and morbidity in children under the age of five in developing countries. On the African continent, pneumonia (14%) and diarrhoea (17%) cause more child deaths than Malaria (16%), HIV/AIDS (4%), and measles (1%) combined. This paper set out to investigate the factors associated with the occurrence of diarrhoea and ARI incidence for children under five years in Uganda.

METHOD

We used a nationally representative Uganda Demographic and Health Survey (UDHS) (2006). Sampling was done in two stages. In the first stage 321 clusters were selected from among a list of clusters sampled in the 2005/06 Uganda National Household Survey (UNHS), 17 clusters from the 2002 Census frame from Karamoja, and 30 internally displaced camps (IDPs). In the second stage, households in each cluster were selected as per UNHS listing. In addition 20 households were randomly selected in each cluster. Questionnaires were used during data collection. During the analysis, a maximum likelihood probit model was used in order to ascertain the probability of occurrence of diseases.

RESULTS

On average, 32% and 48% of children in the survey suffered from diarrhoea and ARI in the two weeks prior to the survey date. The occurrence was concentrated amongst children aged 0-24 months. Mother's education, especially at postsecondary level, reduced the probability of diarrhoea occurrence but had no effect on ARI occurrence. First hour initiation and exclusive breastfeeding reduced the probability occurrence of both diarrhoea and ARI. Other significant factors associated with the occurrence of both diseases include: regional and location differentials, wealth status, type of dwelling, mother's occupation, child age, and child nutritional status.

CONCLUSION

Policy interventions should target female education, eliminate location and regional disadvantages, and educate the population to adopt breastfeeding practices recommended by the World Health Organization (WHO). The government should also ensure proper dwelling places for the population that are associated with favourable health outcomes. Other proper feeding practices together with breastfeeding (after six months), should be made known to the masses so as to reduce the number of children that are malnourished and growth retarded.

SPIO-RGD nanoparticles as a molecular targeting probe for imaging tumor angiogenesis using synchrotron radiation

Angiogenesis, new blood vessels sprouting from pre-existing vessels, is essential to tumor growth, invasion and metastasis. It can be used as a biomarker for early stage tumor diagnosis and targeted therapy. To visualize angiogenesis many molecular imaging modalities have been used. In this study a novel X-ray molecular targeting probe using superparamagnetic iron oxide (SPIO) conjugated with arginine-glycine-aspartic acid (SPIO-RGD) has been developed. Based on the extremely high sensitivity to the iron element of synchrotron radiation X-ray fluorescence and the superior spatial resolution of third-generation synchrotron radiation, the feasibility of SPIO-RGD as a promising molecular probe for imaging tumor angiogenesis has been demonstrated.

Developing cessation interventions for the social and community service setting: a qualitative study of barriers to quitting among disadvantaged Australian smokers

Background

Smoking rates remain unacceptably high among individuals who are socially disadvantaged. Social and community service organisations (SCSO) are increasingly interested in providing smoking cessation support to clients, however little is known about the best way to assist disadvantaged smokers to quit in this setting. This study aimed to explore barriers and facilitators to quitting within the conceptual framework of the PRECEDE model to identify possible interventions appropriate to the social and community service setting.

Methods

Semi-structured focus groups were conducted with clients attending five community welfare organisations located in New South Wales, Australia. Thirty-two clients participated in six focus groups. A discussion guide was used to explore the barriers and facilitators to smoking and smoking cessation including: current smoking behaviour, motivation to quit, past quit attempts, barriers to quitting and preferences for cessation support. Focus groups were audio-taped, transcribed and analysed using thematic analysis techniques.

Results

Participants were current smokers and most expressed a desire to quit. Factors predisposing continued smoking included perceived benefits of smoking for stress relief, doubting of ability to quit, fear of gaining weight, and poor knowledge and scepticism about available quit support. The high cost of nicotine replacement therapy was a barrier to its use. Continual exposure to smoking in personal relationships and in the community reinforced smoking. Participants expressed a strong preference for personalised quit support.

Conclusions

Disadvantaged smokers in Australia express a desire to quit smoking, but find quitting difficult for a number of reasons. SCSOs may have a role in providing information about the availability of quit support, engaging disadvantaged smokers with available quit support, and providing personalised, ongoing support.

The importance of resilience and stress to maintaining smoking abstinence and cessation: a qualitative study in Australia with people diagnosed with depression

This study explored stress in relation to smoking and how non-smokers (never-smoked and ex-smokers) are 'resilient' to smoking in a population where there is a high prevalence of smoking (people diagnosed with depression). In-depth oral history interviews were conducted with 34 adult participants from metropolitan Adelaide, and who were medically diagnosed with depression. Participants were recruited according to their smoking status (currently smoking, ex-smoker, and never-smoked). Smoking was taken-up and maintained for a number of reasons that included perceived high levels of stress. Resilience to stress in relation to smoking was also a major theme. Non-smoking participants tended to be more resilient to stress. Ex-smokers were able to quit for a number of varied reasons during critical transition points in their lives. The never-smoked participants reported successful strategies to cope with stress but not all of them were necessarily healthy. There was often interplay between external factors and the individual's internal properties that led to a building or an erosion of resilience. Smokers and ex-smokers have indicated a strong relationship between stress and tobacco use. Ex-smokers and the never-smoked participants have demonstrated how being 'resilient' to stress can be important to smoking abstinence. The finding that external factors can interact with internal properties to build resilience in relation to stress and smoking is important for policy and practice.

The expanding public health threat of obesity and overweight

Obesity and overweight is a continuing public health crisis. This health threat respects no boundaries or economic strata, and is a pervasive universal threat with short- and long-term negative sequelae associated. Pharmacists and other health professionals need to structure interventions from individual patient and population-based standpoints. Documentation of effects of programmes needs to be disseminated and incorporated into educational, research and practice-based efforts.

Additive and subtractive resilience strategies as enablers of biographical reinvention: a qualitative study of ex-smokers and never-smokers

The notion of developing resilience is becoming increasingly important as a way of responding to the social determinants of poor health, particularly in disadvantaged groups. It is hypothesized that resilient individuals and communities are able to 'bounce back' from the adversities they face. This paper explores the processes involved in building resilience as an outcome in relation to both quitting smoking and never smoking. The study involved 93 qualitative, oral-history interviews with participants from population groups with high and enduring smoking rates in Adelaide, Australia, and was essentially interested in how some people in these groups managed to quit or never start smoking in the face of adversities, in comparison to a group of smokers. Our key findings relate to what we call additive and subtractive resilience strategies, which focus on the practices, roles and activities that individuals either 'took on' or 'left behind' in order to quit smoking or remain abstinent. The theoretical lenses we use to understand these resilience strategies relate to biographical reinforcement and biographical reinvention, which situate the resilience strategies in a broader 'project of the self', often in relation to attempting to develop 'healthy bodies' and 'healthy biographies'.

Exploration of the beliefs and experiences of Aboriginal people with cancer in Western Australia: a methodology to acknowledge cultural difference and build understanding

Background

Aboriginal Australians experience poorer outcomes, and are 2.5 times more likely to die from cancer than non-Aboriginal people, even after adjustment for stage of diagnosis, cancer treatment and comorbidities. They are also less likely to present early as a result of symptoms and to access treatment. Psycho-social factors affect Aboriginal people's willingness and ability to participate in cancer-related screening and treatment services, but little exploration of this has occurred within Australia to date. The current research adopted a phenomenological qualitative approach to understand and explore the lived experiences of Aboriginal Australians with cancer and their beliefs and understanding around this disease in Western Australia (WA). This paper details considerations in the design and process of conducting the research.

Methods/Design

The National Health and Medical Research Council (NHMRC) guidelines for ethical conduct of Aboriginal research were followed. Researchers acknowledged the past negative experiences of Aboriginal people with research and were keen to build trust and relationships prior to conducting research with them. Thirty in-depth interviews with Aboriginal people affected by cancer and twenty with health service providers were carried out in urban, rural and remote areas of WA. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. Participants' narratives were divided into broad categories to allow identification of key themes and discussed by the research team.

Discussion and conclusion

Key issues specific to Aboriginal research include the need for the research process to be relationship-based, respectful, culturally appropriate and inclusive of Aboriginal people. Researchers are accountable to both participants and the wider community for reporting their findings and for research translation so that the research outcomes benefit the Aboriginal community. There are a number of factors that influence whether the desired level of engagement can be achieved in practice. These include the level of resourcing for the project and the researchers' efforts to ensure dissemination and research translation; and the capacity of the Aboriginal community to engage with research given other demands upon their time.