An exploratory study of factors influencing pakistani physicians' retention and resettlement career decisions

Background: The recruitment, retention and migration of health workers is a global phenomenon. The literature shows push factors associated with leaving rural areas and developing countries in general are explored in depth. However importantly, some health workers behave differently and decide to stay in or return to a developing country. Less is known about the reasons/ pull factors of this groups' decision making. Methods: This paper aims to explore the perceptions of Pakistani physicians regarding their career decisions to remain in their country, or resettle back after working abroad for some time. Thirteen Pakistani physicians were interviewed via telephones who were working in Pakistan and Australia. Results: The motivation for Pakistani physicians to remain or resettle back into their country stems from the perceived better quality of life in Pakistan compared to the better standard of life overseas. Other reasons include a perceived differentiation between locals and non-locals abroad and the availability of a permanent job in Pakistan. Conclusion: The main factors that contributed to Pakistani physicians' retention and resettlement decisions were mostly personal and family or societal factors and there was a minimal role for professional or health system related factors in their career decisions, except for the availability of permanent jobs in Pakistan

To Remain, Migrate Abroad or Resettle: A complex dynamic process affecting Pakistani physicians’ career decisions

Objective: This study investigated Pakistani physicians’ decision-making concerning their decisions to stay in Pakistan, migrate abroad, or resettle back into their country after working abroad. Methods: This qualitative study employed a phenomenological research design. Thirteen Pakistani physicians characterised as ‘stayers’, ‘leavers’ and ‘resettlers’ were interviewed via telephone to explore their lived experience in 2008-2009. Results: Results show a dynamic nature of the physicians’ career decision-making depending on their constant weighing of complex personal, family, professional and societal factors. Stayers, leavers and resettlers are not mutually exclusive groups but rather individual physicians’ can move between these groups at different stages of career and life. Physicians vary in their decision making. Stayers and resettlers place more emphasis on personal and family reasons and societal factors providing there is a permanent job for them. Leavers focus on health system problems and recent societal problems of personal and societal insecurity. Conclusions: The findings of this study indicates that physician migration, retention and resettlement is a complex issue and there are multiple personal, social, political and economic factors that affect their decisions to stay, move abroad or resettle back into their countries. Therefore, it is recommended that future research focusing on health workers retention, migration and resettlement issues look at it from a holistic perspective rather than focusing only on the economic and professional imperatives. The findings of this study have international implications for health care managers dealing with a highly mobile international medical workforce. Strategies considering different stages of the physician career/ life cycle need to highlight the importance of identity, belonging and place as doctors weigh this with career goals

Regulation of E2F through the DP component

Transcription factor E2F plays an important role in orchestrating early cell cycle progression through its ability to co-ordinate and integrate the cell cycle with the transcriptional apparatus. Physiological E2F arises when members of two distinct families interact as E2F-DP heterodimers, in which the E2F component mediates transcriptional activation and physical interaction with pocket proteins, such as the tumour suppressor protein pRB. However, very little information is available regarding the mechanisms, which control the levels of functional E2F. In this study I have defined the DP component as an integrator of the E2F transcription factor with the nuclear transport pathway and the ubiquitin-proteasome mediated degradation pathway. Specifically, a bipartite nuclear localisation signal in DP is defined and shown to be necessary for nuclear accumulation of a non-NLS-containing heterodimeric partner. Pocket protein association also offers an alternative in trans NLS for translocation of the heterodimer into the nucleus. Surprisingly, the basic region of the NLS is also necessary for efficient nuclear accumulation of NLS-containing E2F heterodimeric partners. The basic region is also instrumental in the association of DP-3 with the epsilon isoform of the 14-3-3 family of signalling molecules. Using a mutant DP that fails to bind 14-3-3 has uncovered a role for 14-3-3 in the E2F pathway. An association targets the E2F heterodimer for ubiquitin-proteasome-mediated degradation to reduce excessive levels of E2F and allow cells to progress into G2 phase of the cell cycle. This study defines new pathways of growth control that are integrated with the E2F pathway through the DP subunit

To Remain, Migrate Abroad or Resettle: An Exploratory Study of Pakistani Physicians' Career Decisions

The recruitment, retention and migration of highly skilled health professionals is of growing global concern because of its impact on health systems in both developing and developed countries. These global changes in the health workforce include physicians moving from rural to urban areas within a country or from one country to another. Pakistan has the leading number of physicians working in the United States, the United Kingdom, Canada and Australia even though it faces a shortage of physicians. The reasons have not been identified and evaluated in-depth within the Pakistani context. To date much of the available health workforce research in South Asia is based on quantitative techniques, with far fewer studies using qualitative methodologies to explore the health workforce. This is one of the first studies in South Asia, and especially in Pakistan, to use a qualitative research design to study the physician workforce. The purpose of this study is to explore the perceptions of Pakistani physicians regarding their career decision to remain in their country, migrate abroad or resettle back into their country after working abroad for some time

The Working World of Nursing Unit Managers

Nursing unit managers (NUMs) occupy a first-line management position in many healthcare services worldwide. In this role, they are responsible for the nursing and administrative operations of a ward. The literature suggests that while the position has evolved into a complex and multifaceted one, the scope and authority of the role are poorly understood. Few studies have explored the working world of NUMs or considered how the well-documented oppression of nurses might impact on them as managers. Using a feminist approach, and individual interviews, this qualitative study, which focused on the construct of power, explored the working world of twenty nursing unit managers employed in the public healthcare system of New South Wales, Australia

Barriers to the early identification and intervention of early psychosis among young rural males

The literature shows that a lengthy duration of untreated psychosis has been recognised amongst young rural males. Early psychosis has been described as a cluster of symptoms marked by: hallucinations and delusions; thought disorder; and cognitive impairment and it is more prevalent amongst young males than young females. A significant discrepancy of duration of the length of untreated psychosis has been identified between rural and urban communities. This discrepancy has far reaching consequences for young rural men at a significant transitional developmental phase in their lives. This study, conducted in rural communities in northern New South Wales, sought to understand the lived experiences of young rural males and their families in regard to emergent mental health problems, in an effort to recognise the barriers to earlier identification of early psychosis, and its timely treatment

Cross-Cultural Parenting: Experiences of Intercultural Parents and Constructions of Culturally Diverse Families

According to U.S. Census Bureau data (2003), intercultural relationships are on the rise, and much has been written on cultural differences in marriage. A significant amount of literature has discussed challenges confronted by couples in these partnerships; however, much less has been written on how couples navigate their cultural diversity which is often amplified after they become parents. The goal of this study is to reveal the personal stories and narratives of intercultural parents who have not been the focus of previous research. To examine their experiences, the following research questions guided the structure of this thesis: "What are the experiences of intercultural couples raising children together? How do they construct family systems within culturally diverse households?" Consistent with humanistic and existential approaches in professional counseling which focus on the relativity of the human experience, this study employed a qualitative research design. A social constructionist theoretical framework and a grounded theory methodology were used to examine the experiences of intercultural parents and how they construct family systems within culturally diverse households. This study incorporated in-depth interviews as a primary technique in data collection to elicit perceptions of intercultural couples, using parenting and childrearing as a lens to explore their lived experiences. Twenty-one participants from fifteen intercultural couples were interviewed in an individual, conjoint, and/or sequential format; ten participated in individual or conjoint follow-up interviews. Using a grounded theory approach for data analysis, four themes emerged that relate to both intercultural parenting and culturally diverse families: (1) the cultural context and constructions of identity for parents and families; (2) cross-cultural challenges and cleavages; (3) negotiating intercultural parenthood and culturally diverse families; and (4) opportunities for parents and children in culturally diverse households. A model of cultural adaptation among intercultural parents is presented as an analytical tool to better understand how parents co-construct culturally diverse family systems based on their conceptualization of their cultural differences and their degree of mutual acculturation. This multi-dimensional model of cultural adaptation illustrates that cultural adaptation among intercultural parents is neither a static nor a symmetrical process. Parents adopt different strategies to reconcile their cultural differences, including assimilation, cultural tourism, cultural transition, cultural amalgamation, and biculturation, at various stages of their relationship and for different purposes. Counselors will gain from understanding these divergent strategies and family systems to better equip couples to benefit from their diversity and differences within their families

Connecting Mental Health Helping Capital in Rural Communities to Young People with Emergent and Early Mental Health Problems

Understanding the mental health help-seeking experiences of young rural people in rural areas is important because most mental health problems emerge during adolescence. In addition, early recognition of emerging mental health problems in adolescents is linked to recovery as it is known to mitigate the long-term consequences of mental health decline. This research study aimed to better understand young people with emergent mental health problems who live in rural areas and to develop an improved theoretical perspective of rural mental health care that draws from the unique mental health helping capital that already exists within rural communities. Relevant literature was reviewed and a mixed methods case study research design selected to answer the research question: What helps young rural people with emergent mental health problems? A rural socio-ecological health theoretical framework was selected to explore the research topic. A cross sectional survey was conducted and data was analysed with descriptive, comparative and content analysis techniques. A pilot study with nine respondents was compared to the actual survey results of 81 respondents to determine the reliability of the survey tool. A strong similarity in responses between the two sets of responses was detected using Pearson’s correlations. The survey sample was inclusive of a broad range of rural participants from relevant backgrounds and across a full range of adult age groups. The results showed that rural people are willing to seek mental health help when it is required, and that the best people to provide mental health advice to young people are health professionals. People prefer to do nothing and hope that a mental health problem will resolve spontaneously prior to actually seeking mental health professional care. Young people prefer to seek help from their parents and friends if their mental health problems do not resolve spontaneously. In addition, the survey results described the rural nursing characteristics that are seen as helpful mental health care contributions towards the mental health care of people in rural communities. In-depth interviews were conducted with 20 participants. Transcribed data were analysed using thematic techniques and four themes emerged. The first theme described the characteristics of the emergence of mental health problems experienced by young rural people. The second theme described the characteristics of helping and how other people help young rural people with mental health problems. The third theme outlined the lack of meaningful connection with mental health services that young people and their families experience. Lastly, the fourth theme described the characteristics of health, welfare and social service providers. The integrated findings of this study identify the importance of: • Providing positive first mental health encounters for young rural people in their rural communities enables successful initial and ongoing mental health helping. • Rural nurses are mental health capital in rural communities. • Barriers to mental health help-seeking for young rural people persist. Implications arising from the findings for clinical practice and interdisciplinary collaboration support the need for an innovative deployment of current health resources to places of greater convenience for young rural people. The new theoretical perspective arising from this research supports a co-location of nursing assets in rural communities to promote the early engagement of young rural people into appropriate mental health care when required. Rural nurses are ideal mental health human resource assets to deploy in co-located rural settings because nurses are able to contribute expertise by paying adequate attention, carefully listening, providing authentic care which is mindfully present and understanding the local context for young rural people. The outcomes of this study provide new insights about the emergent mental health problems of young rural people, and make recommendations to improve rural mental health services for this population

The health that workers want

Employee health has significant social implications for Australia. Prevention strategies and health services for work-related injury and illness are managed by Occupational Health and Safety and Workers' Compensation systems. The extent of human suffering and the costs associated with work-related injury and illness are considerable and arguably these systems do not adequately address employee health. Non work-related injury and illness occurring during the employment period of life are contextually bound to work and are integral to the concept of employee health. This thesis seeks to understand the subjective experience of employee health from the workers' perspective. Because of workers' direct experience of their health problems their accounts are beneficial for improving workplace policies, procedures and practices. A case study approach with both quantitative and qualitative methods is used to access these experiences. The focus of the research is on a population belonging to an industry at risk of occupational stress, in order to prevent further burdens of ill health for the individual, workplace and community. The tertiary sector of the education industry in Australia provides the context for case study for this work

The evolution of lung cancer and impact of subclonal selection in TRACERx

Lung cancer is the leading cause of cancer-associated mortality worldwide. Here we analysed 1,644 tumour regions sampled at surgery or during follow-up from the first 421 patients with non-small cell lung cancer prospectively enrolled into the TRACERx study. This project aims to decipher lung cancer evolution and address the primary study endpoint: determining the relationship between intratumour heterogeneity and clinical outcome. In lung adenocarcinoma, mutations in 22 out of 40 common cancer genes were under significant subclonal selection, including classical tumour initiators such as TP53 and KRAS. We defined evolutionary dependencies between drivers, mutational processes and whole genome doubling (WGD) events. Despite patients having a history of smoking, 8% of lung adenocarcinomas lacked evidence of tobacco-induced mutagenesis. These tumours also had similar detection rates for EGFR mutations and for RET, ROS1, ALK and MET oncogenic isoforms compared with tumours in never-smokers, which suggests that they have a similar aetiology and pathogenesis. Large subclonal expansions were associated with positive subclonal selection. Patients with tumours harbouring recent subclonal expansions, on the terminus of a phylogenetic branch, had significantly shorter disease-free survival. Subclonal WGD was detected in 19% of tumours, and 10% of tumours harboured multiple subclonal WGDs in parallel. Subclonal, but not truncal, WGD was associated with shorter disease-free survival. Copy number heterogeneity was associated with extrathoracic relapse within 1 year after surgery. These data demonstrate the importance of clonal expansion, WGD and copy number instability in determining the timing and patterns of relapse in non-small cell lung cancer and provide a comprehensive clinical cancer evolutionary data resource