Medical students on long-term rural clinical placements and their perceptions of urban and rural internships : a qualitative study

Background: There is some anecdotal evidence that anxiety about the responsibility of an intern influences rural future intentions. Additionally, research has shown that urban interns have reported that they are worried about being 'forced' to work in non-metropolitan hospitals in their first year after graduation. This study sought to explore rural medical students' perceptions and expectations of a rural internship and how local health services and/or their medical school can prepare them best for a rural intern position. Methods: Four focus groups were conducted with 62 final-year medical students upon completion of a 12-month rural clinical school placement. Focus groups were audio-recorded and transcribed verbatim for thematic analysis to identify key themes. Results: Most students have high levels of anxiety around starting work but they acknowledge that this may be exaggerated. They believe that in rural areas they get higher quality supervisory support than in urban hospitals as people know you better, whereas in the city you are more anonymous. However, the level of responsibility placed on rural interns was considered to be a double-edged sword. While rural interns were allowed to do more than be a 'paper-pusher' this level of responsibility means they are more accountable. The majority felt that doing your first training years in a metropolitan hospital can be crucial to getting on a training program in your chosen speciality. Conclusions: There appears to be a relatively high level of anxiety about rural internships amongst final-year medical students. Students need more targeted information around specialisation, particularly around regional training hubs, if we want to achieve higher levels of interns choosing a rural career path

Translating facilitated multimodal online learning into effective person-centred practice for the person living with dementia among health care staff in Australia : an observational study

Background: This paper aims to identify whether health care staff perceive a 12-week online facilitated, multimodal, person-centred care, dementia education program influences their knowledge, skills, behaviour and practice improvement activities in dementia care. In particular it will examine a dementia education program 'Positive Approach to Care of the Older Person with Dementia' (The Program). Methods: Three clusters of online questions were developed. Participants completed the first cluster at course completion (N = 1455;2013-2016). The second cluster was added into the 2015-2016 exit-surveys to measure clinical practice improvement (CPI) activities implementation (N = 520). Thirdly, all participants were invited to a 2018 follow-up survey (N = 343). The Program was also matched with key factors that are likely to result in effective online dementia education programs. Results: The Program had a 78% completion rate. At course completion (2013-2016, N = 1455), 62% felt that the online forums generated useful discussion and 92% thought their work would support implementing their new knowledge and skills. In 2015-16, participants (N = 520) reported that The Program had influenced their practice in terms of new knowledge (87%), understanding (87%), awareness (88%), and new ideas about delivering dementia care (80%). Almost all (95%) participants indicated they had changed 'an aspect of their own professional practice'. Sixty-three percent had planned to develop a CPI activity. Of those (N = 310), 40% developed a new or improved tool and 21% planned to deliver education or create new resources. The most common CPI activities reported in the 2018 follow-up survey (N = 343) included education (49%) and role modelling of new behaviour (47%). Additionally, 75% indicated their CPI influenced their practice and had influenced patients (53%) and colleagues (53%). Fifty-seven percent reported their projects were sustained for 12 months or more. Conclusion: The Positive Approach to Care of the Older Person with Dementia education program can potentially improve training the dementia workforce. Participants perceived that a multimodal online platform facilitated by clinical champions influences knowledge transfer, skills and behaviour, encourages workplace CPI activities. Further effort could be directed towards empowering and supporting care staff on system, procedure and practice change and engaging management to translate training activities into practice

Do cognitive aids reduce error rates in resuscitation team performance? : trial of emergency medicine protocols in simulation training (TEMPIST) in Australia

Background: Resuscitation of patients with time-critical and life-threatening illness represents a cognitive challenge for emergency room (ER) clinicians. We designed a cognitive aid, the Emergency Protocols Handbook, to simplify clinical management and team processes. Resuscitation guidelines were reformatted into simple, single step-bystep pathways. This Australian randomised controlled trial tested the effectiveness of this cognitive aid in a simulated ER environment by observing team error rates when current resuscitation guidelines were followed, with and without the handbook. Methods: Resuscitation teams were randomised to manage two scenarios with the handbook and two without in a high-fidelity simulation centre. Each scenario was video-recorded. The primary outcome measure was error rates (the number of errors made out of 15 key tasks per scenario). Key tasks varied by scenario. Each team completed four scenarios and was measured on 60 key tasks. Participants were surveyed regarding their perception of the usefulness of the handbook. Results: Twenty-one groups performed 84 ER crisis simulations. The unadjusted error rate in the handbook group was 18.8% (121/645) versus 38.9% (239/615) in the non-handbook group. There was a statistically significant reduction of 54.0% (95% CI 49.9–57.9) in the estimated percentage error rate when the handbook was available across all scenarios 17.9% (95% CI 14.4–22.0%) versus 38.9% (95% CI 34.2–43.9%). Almost all (97%) participants said they would want to use this cognitive aid during a real medical crisis situation. Conclusion: This trial showed that by following the step-by-step, linear pathways in the handbook, clinicians more than halved their teams’ rate of error, across four simulated medical crises. The handbook improves team performance and enables healthcare teams to reduce clinical error rates and thus reduce harm for patients

Cross sectional analysis of depression amongst Australian rural business owners following cyclone-related flooding

Background: Flooding is an increasingly prevalent natural hazard worldwide and can have a profound impact on the mental health of those directly and indirectly affected. Little is known about the impact on business owners, who may be particularly vulnerable to the mental health complications of flooding given the additional economic stressors. Methods: A large cross-sectional survey was conducted six months after severe flooding in the rural Northern Rivers region of New South Wales, Australia in 2017. The survey assessed demographics, probable depression (using the Patient Health Questionnaire-2), flood exposure, flood-related financial factors, prior flood exposure and support from various organisations. Logistic regression was used to identify predictors of probable depression in 653 of the 745 participants who identified as business owners. Results: The prevalence of probable depression in our sample was 17.0%. A quarter (25.1%) of business owners whose business was flooded suffered from probable depression, compared to 12.4% of non-flooded business owners. The multivariable model for probable depression demonstrated elevated adjusted odds ratios (AOR) for business owners who had to evacuate their business (AOR = 2.11, 95% Confidence Interval (CI) 1.25–3.57) compared to those who did not evacuate. Insurance disputes/rejections were a strong predictor for probable depression (AOR = 3.76, CI 1.86–7.60). Those whose income was reduced due to the flood and had not returned to normal six months post-flood demonstrated an increased AOR for probable depression (AOR 2.53, CI 1.26–5.07) compared to those whose income had returned to normal. The univariable analysis found elevated crude odds ratios (OR) for the cumulative effect of multiple flood exposures and unmet support needs by the state government (OR = 2.74, CI 1.12–6.68). The majority of business owners felt their needs were not met by most organisations providing flood-related support. Conclusion: The impact of flood exposure and flood-related financial factors on probable depression was highly significant for the business owner population. Furthermore, business owners felt under-supported by flood-related services. These findings highlight the vulnerability of exposed business owners and the need for increased support. Disaster planning programs in conjunction with system level changes such as infrastructure and education are vital for disaster preparedness

Motivations, dating app relationships, unintended consequences and change in sexual behaviour in dating app users at an Australian music festival

Background: Despite the popularity of dating apps, there remain scarce data on the motivations, consequences and their influence on sexual behaviour change in the Australian population. Objective: To explore motivations, dating app relationships, unintended consequences and change in sexual behaviour in dating app users at an Australian music festival. Methods: A cross-sectional study design was used. Festival patrons aged 18–30 at a major Australian music festival completed a paper-based survey. Logistic regression was used to identify which factors were associated with an increase in sexual partners since using dating apps. Results: The primary reasons for dating app use (N=437) were boredom (59.7%), casual sex (45.1%) and casual dating (42.8%). A third of users used them at music festivals (33.8%, n=432). A third of participants had used dating apps for more than 2 years (33.3%) and a third (33.0%) of users claimed to have changed their sexual behaviour after app use, including increased frequency of sexual activity (70.0%), number of sexual partners (57.1%) and sexual experimentation (42.1%). Dating app users tended not to discuss sexually transmitted infections (STI) status with a sexual partner regardless of whether they had met them on an app or not: 38.5% would ‘never’ and 36.9% would ‘sometimes’ have safe sex discussions with partners met via apps. Condoms were ‘always’ used for 36.9% of dating app users when meeting partners via dating apps, compared to 29.9% met by other means. 8.6% of dating app users reported having contracted STIs, and 2.8% had unwanted pregnancies with those met on dating apps. After adjusting for socio-demo graphics, those who had an STI after engaging in sexual activity with a person met via a dating app had 2.4 times the odds of reporting an increase in sexual partners, and those who had used a dating app for over 2 years had twice the odds of reporting an increase in sexual partners. When condom use was entered into the model, those that ‘often’ or ‘sometimes’ used a condom with a new dating app partner were twice as likely to report an increase in sexual partners since using dating apps, compared to those who ‘always’ used a condom with a new dating app partner. Sexual orientation and STI discussions with a new sexual dating app partner were not associated with an increase in dating app partners. Conclusion: Dating app usage is common and users report increased sexual activity, sexual partners and experimentation. STI discussions with potential partners and condom use remained low regardless of how partners were met and despite an increase in sexual partners since using dating apps. Given the high-risk nature of individuals that utilise dating apps, safe sex discussion, including STIs, pregnancies and condom use should be promoted to improve sexual health outcomes

Geosocial networking dating app usage and risky sexual behavior in young adults attending a music festival : cross-sectional questionnaire study

Background: Despite the prevalent use of geosocial networking dating apps (GNDAs), there is limited research on their impact on sexual health outcomes among young music festivals attendees. Objective: This study aims to explore the use of GNDAs and risky sexual behaviors of young adults attending a music festival. Methods: The music festival attendees (N=862) completed a cross-sectional questionnaire study encompassing demographics, dating app use, and risky sexual behaviors in the past year. Associations between these variables were estimated using bivariate and multivariate logistic regression analyses. Results: Of the respondents, 51.9% (448/862) had used GNDAs in the previous year. Compared with people who had 1 partner, people who had 2-5 sexual partners in the previous year had almost 7 times the odds of using dating apps (odds ratio [OR] 6.581, 95% CI 4.643-9.328) and those who had more than 5 partners had 14 times the odds of using dating apps (OR 14.294, 95% CI 8.92-22.906). Condom users were more likely to be app users (P<.001), as were those who relied on emergency Plan B (P=.002), but people using hormonal contraception were less likely to use dating apps (P=.004). After adjusting for sexual orientation and relationship status, those having casual sex had 3.096 (95% CI 2.225-4.307; P<.001) times the odds of using dating apps and those having multiple sexual partners had 3.943 (95% CI 2.782-5.588; P<.001) times the odds of using dating apps. Similarly, after adjusting for sexual orientation, relationship status, and number of sexual partners, people who had no discussions before having sex about sexually transmitted infections (STIs) or boundaries were more likely to use dating apps (OR 1.755, 95% CI 1.232-2.500; P=.002). Those who perceived the risk of having sex without contraception to be very high had 2.486 (95% CI 2.213-5.096; P=.01) times the odds of using dating apps than those who perceived no risk. Compared with those who perceived no risk, people who thought that the risk of having multiple sexual partners was low to high had 1.871 (95% CI 1.024-3.418; P=.04) times the odds of using dating apps. A significant number of app users (389/440, 88.4%) indicated that GNDAs should promote safe sex. Conclusions: This study identified that festival goers engaging in certain high-risk sexual behaviors, including casual sex, having multiple sexual partners, and having sex without discussion about STI status and boundaries, are more likely to use dating apps. Festival goers who perceived sex without any form of contraception, having sex while drunk, and having multiple sexual partners as risky were more likely to be app users. Policy makers and GNDA developers should acknowledge the vulnerability of their users to adverse sexual health outcomes and use GNDAs as a platform to promote risk-reduction practices

Swipe-based dating applications use and its association with mental health outcomes : a cross-sectional study

Background: Swipe-Based Dating Applications (SBDAs) function similarly to other social media and online dating platforms but have the unique feature of “swiping” the screen to either like or dislike another user’s profile. There is a lack of research into the relationship between SBDAs and mental health outcomes. The aim of this study was to study whether adult SBDA users report higher levels of psychological distress, anxiety, depression, and lower self-esteem, compared to people who do not use SBDAs. Methods: A cross-sectional online survey was completed by 437 participants. Mental health (MH) outcomes included the Kessler Psychological Distress Scale, Generalised Anxiety Disorder-2 scale, Patient Health Questionnaire-2, and Rosenberg Self-Esteem Scale. Logistic regressions were used to estimate odds ratios of having a MH condition. A repeated measures analysis of variance was used with an apriori model which considered all four mental health scores together in a single analysis. The apriori model included user status, age and gender. Results: Thirty percent were current SBDA users. The majority of users and past users had met people face-to-face, with 26.1%(60/230) having met > 5 people, and only 22.6%(52/230) having never arranged a meeting. Almost 40%(39.1%; 90/230) had previously entered into a serious relationship with someone they had met on a SBDA. More participants reported a positive impact on self-esteem as a result of SBDA use (40.4%; 93/230), than a negative impact (28.7%;66/230). Being a SBDA user was significantly associated with having psychological distress (OR = 2.51,95%CI (1.32–4.77)), p = 0.001), and depression (OR = 1.91,95%CI (1.04–3.52), p = 0.037) in the multivariable logistic regression models, adjusting for age, gender and sexual orientation. When the four MH scores were analysed together there was a significant difference (p = 0.037) between being a user or non-user, with SDBA users having significantly higher mean scores for distress (p = 0.001), anxiety (p = 0.015) and depression (p = 0.005). Increased frequency of use and longer duration of use were both associated with greater psychological distress and depression (p < 0.05). Conclusion: SBDA use is common and users report higher levels of depression, anxiety and distress compared to those who do not use the applications. Further studies are needed to determine causality and investigate specific patterns of SBDA use that are detrimental to mental health

Retiring to Spain : Women's Narratives of Nostalgia, Belonging and Community

Review of the title Retiring to Spain: Women’s Narratives of Nostalgia, Belonging and Community written by A. Ahmed, Policy Press, 2015

Cancer Information Services : a pre-/post-evaluation of training to promote nationwide consistency of information

The object of this study was to evaluate whether an integrated training package improved the consistency and accuracy of advice about breast cancer to callers of Cancer Information Services (CIS) in Australia. The study followed a pre-/post-evaluation design and the participants were all CIS officers from the state- based CIS. A computerized database was used which contained the current best advice about breast cancer combined with a 1-day interactive training workshop for all officers of participating CIS. The proportion of responses that accorded with predetermined model answers for each of five scenarios employed by simulated callers during normal working hours at pre-and post-evaluation were then calculated. There were 95 simulated calls during pre-evaluation, and 104 calls post-evaluation. In some cases, such as breast reconstruction, accordance with model answers was high at both pre- and post-test. The proportion of responses on an item that related to a description of lymphoedaema differed from pre-to post-test with P = 0.007; while an item on the appropriateness of discussing genetic testing with general practitioners differed from pre-to post-test with P = 0.003. There was less concordance, both pre- and post- test, for issues related to surgery, hospitalization, familial aspects and Tamoxifen. We concluded that the intervention presents a method of disseminating consistent information across a number of independent CIS. Some areas were identified that require more targeted intervention

The relationship between lifestyle, occupational health, and work-related factors with presenteeism amongst general practitioners

There is evidence that general practitioners (GPs) are more likely to exhibit sickness presenteeism than other health professional groups or other high-income earners and less likely to take sick leave. This study aims to examine the relationship between lifestyle, occupational health, and work-related factors with presenteeism amongst GPs. A cross-sectional study was conducted amongst GPs in 2011. Logistic regression was used to determine crude and adjusted odds ratios between lifestyle, occupational health, and work-related factors with presenteeism. Whilst adjusting for age and gender, exercising 1 to 3 times a week (odds ratio [OR] = 4.88), not having a good work-life balance (OR = 4.2), work-related sleep problems (OR = 2.55), moderate psychological distress (OR = 3.94), and poor or fair health (OR = 6.22) were associated with presenteeism. Increased burnout and reduced job satisfaction and workability due to the physical demands of the job were also associated with presenteeism. In conclusion, presenteeism amongst GPs can be addressed by implementing interventions in relation to physical activity, stress reduction, and sleep hygiene and improving work-life balance and the physical demands of the job