Health professionals' attitudes and practices in relation to Functional Capacity Evaluations

Functional Capacity Evaluations (FCE's) are part of practice in work injury prevention and rehabilitation, and are designed to define an individual's functional abilities or limitations in the context of safe, productive work tasks. Qualitative research methodology was used to investigate the attitudes and behaviours of health professionals in relation to FCE use. The study aimed to identify why health professionals chose a particular FCE, and to identify what factors influence health professionals' clinical judgements when providing results and recommendations for the individual being assessed. Five health professionals from the Hunter Region of New South Wales, Australia, participated in semi-structured, individual interviews using a phenomenological approach. Following inductive analysis of the data, four themes reflecting participants' attitudes and behaviours of FCE use emerged: i) referrals and expectations, including why and when the assessment is completed ii) outcomes, -- what the results aim to provide iii) workplace/practice/usage issues and iv) skills of the assessor. The results indicate the need for further research on the clinical utility of FCE's. A large scale quantitative study would allow results to be generalised to a wider community of FCE users.     

From Health Crisis to Rights Advocacy? HIV/AIDS and Gay Activism in China and Singapore

The relationship between HIV/AIDS and gay activism has been primarily informed by the American experience and understudied in nondemocratic contexts. Drawing upon qualitative research on China and Singapore, we refine understanding of HIV/AIDS’ influence on the development of gay activism under authoritarian conditions, by examining the processes through which activist organizations interact with laws and regulations, political norms, HIV/AIDS funding, and government responses to both HIV/AIDS and collective organizing. We show how HIV/AIDS’ influence plays out in multiple patterns, depending on the strategic responses that gay activists select from a constrained range of options to shape their organizations’ destinies. Therefore, we provide insights for development agencies and international donors into whether and how international assistance intended to encourage activism and wider social change are mediated by political and legal controls on local activism.     

WOMEN AND THE INTERNET The natural history of a research project

This article represents a narrative, 'women and the internet', as a women and technology origin story with a fixed beginning, a contested centre, and an open ending. This article analyses our engagement with this narrative as a pilot study was conducted to look at women's perceptions of, and relationships to, the internet. Although this story felt like a coherent and persuasive narrative, this was questioned as the outcomes of the pilot study were reflected upon. Women coming to the 'net' led to a reconstruction of the questions that need to be addressed in researching gender and information technology. This article begins by describing and deconstructing the motivating story which was brought to this research project. Three genres are introduced-'the webbed utopia', 'flamed out' and 'locked into locality'-which are seen as forming the contested centre of this narrative. While each genre has its own narrative logic, all of them draw on a common tale of historical origins. From each of these perspectives 'Women and the internet' has an ending which is still open, but is rapidly closing. Three questions are then identified which have been raised by analysis: what do we mean by 'access'?; what do we mean by 'the internet'? and 'which women'? The seeming simplicity of these questions disguises serious difficulties which research in this area must address.     

Dissemination to research subjects: operationalizing investigator accountability

Recent articles have argued from principles of bioethics for the right of research subjects to receive the results of the studies in which they have participated. We argue that accountability is a powerful tool of meso-level analysis appropriate to reasoning about answerability in research ethics, and that it captures the responsibility of researchers to disseminate study results to research subjects. We offer the following features of the research situation as relevant to the manner of dissemination to study subject, in addition to factors already proposed in the literature (risk and impact on health outcome): (a) features of the research subject in relation to identity, personal investment, disease, and community; (b) characteristics of the research study and field of inquiry in relation to certainty and significance; and (c) relationships among the research subjects and the healthcare workers involved in their care and in the research.     

Fishing in Urban New Jersey: Ethnicity Affects Information Sources,Perception, and Compliance

Recreational and subsistence angling are important aspects of urban culture for much of North America where people are concentrated near the coasts or major rivers. Yet there are fish and shellfish advisories for many estuaries, rivers, and lakes, and these are not always heeded. This paper examines fishing behavior, sources of information, perceptions, and compliance with fishing advisories as a function of ethnicity for people fishing in the Newark Bay Complex of the New York–New Jersey Harbor. We test the null hypothesis that there were no ethnic differences in sources of information, perceptions of the safety of fish consumption, and compliance with advisories. There were ethnic differences in consumption rates, sources of information about fishing, knowledge about the safety of the fish, awareness of fishing advisories or of the correct advisories, and knowledge about risks for increased cancer and to unborn and young children. In general, the knowledge base was much lower for Hispanics, was intermediate for blacks, and was greatest for whites. When presented with a statement about the potential risks from eating fish, there were no differences in their willingness to stop eating fish or to encourage pregnant women to stop. These results indicate a willingness to comply with advisories regardless of ethnicity, but a vast difference in the base knowledge necessary to make informed risk decisions about the safety of fish and shellfish. Although the overall median income level of the population was in the $25,000–34,999 income category, for Hispanics it was on the border between $15,000–24,999 and $25,000–34,999.     

Principals' perceptions of benefits and barriers to school-based suicide prevention programs

Suicidal behavior among children and adolescents is a national problem and schools can be an effective context for suicide prevention and intervention efforts. School-wide screening programs are viewed as most effective from a public health standpoint, although they garner the least support from school administrators. The purpose of this article is to examine administrators' perceptions of three school-based suicide prevention models while also capturing opinions on barriers and benefits to implementation. Data were gathered through interviews with seven principals from one Midwestern state. Findings reveal agreement among principals that schools play a key role in suicide prevention, but they differ on which type of prevention approach is most appropriate. School principals believed the school-wide screening program included more barriers to implementation than either the in-service or the curriculum-based program, largely due to the likelihood of parental disapproval. Limitations of the study and implications for improving suicide prevention efforts are discussed.     

“Unexpected and Distressing”: Understanding and Improving the Experience of Transferring Palliative Care Inpatients to Residential Care

The survival of patients with advanced cancer, coupled with the increased presence of end-stage chronic illnesses in an aging population, is leading to a demand in palliative care. Due to the ongoing need for acute-pain and symptom control in hospice/palliative care units, few are able to offer long-stay admission for those whose symptoms have stabilized. When a patient no longer requires specialist palliative care services, transfer from an inpatient palliative care facility may then be necessary. A core component of the role of palliative-care social workers involves working with patients and their families/carers when the care pathway shifts and the option of residential aged care facility (RACF) needs to be considered. This research explored several issues, including the impact of this transition on the patient and their families and on the interdisciplinary health care team treating the patient. An investigation was undertaken to identify concerns and barriers regarding the transition from hospice care to RACF and opportunities were highlighted to improve clinical practice in this area. A tripartite approach was adopted conducting face-to-face interviews with patients, their families/carers, and health care professionals. Members of the interdisciplinary team were interviewed and social workers working in similar inpatient palliative-care facilities undertook telephone interviews to gauge their experiences. A thematic analysis discerned a number of themes highlighting the impact of this transition on key stakeholders and incorporated recommendations to improve or best manage this process. The research has highlighted the difficulties that patients/families encounter in this transition, as well as the emphases of protecting the integrity of the patient and family. This is achieved by holding open and ongoing dialogue, particularly through family meetings and working in collaboration with the patient, the family, and the team. Understanding the experience and impact of this transition on key stakeholders is helpful in building up a knowledge base and to ensure a more effective relationship occurs. This research incorporated the voices of terminally ill patients, families, and members of the health care team in order to understand their views and recommendations for best managing the transition from a hospice/inpatient palliative-care facility to a RACF. This enables their input to have some real impetus in clinical practice and service delivery.     

The protective function of meaning of life on life satisfaction among Chinese students in Australia and Hong Kong: a cross-cultural comparative study

OBJECTIVE: The authors compared the predictive effects of acculturative stressors and meaning of life on life satisfaction between Chinese students in Australia and in Hong Kong. PARTICIPANTS: In 2006, the researchers recruited 606 Chinese students studying abroad at the University of Melbourne in Australia and at 6 universities in Hong Kong. METHODS: Participants completed a questionnaire that included measures of acculturative stressors, meaning of life, life satisfaction, and demographic information. RESULTS: The Australian sample experienced a significantly higher level of acculturative stressors than did the Hong Kong sample, but life satisfaction did not differ significantly between the 2 samples. Meaning of life had a strong positive contribution and acculturative stressors had a negative contribution in predicting life satisfaction in both samples. Meaning of life partially mediated the relationship between acculturative stressors and life satisfaction in both samples. CONCLUSIONS: The authors discuss the theoretical and practical implications for Chinese students studying abroad.