International Standards for Dementia Workforce Education and Training: A Scoping Review.

BACKGROUND AND OBJECTIVES: The increasing number of people with dementia requires transparency and quality dementia education, training, and care. This scoping review aimed to determine the key elements of national or state-wide standards on dementia education and training that could underpin the development of international standards for dementia workforce training and education. RESEARCH DESIGN AND METHODS: The English-language peer-reviewed and gray literature were searched (2010-20). Key search domains were training, workforce, standards/frameworks, and dementia. RESULTS: Thirteen standards were identified from the United Kingdom (n = 5), the United States (n = 4), Australia (n = 3), and Ireland (n = 1). Most standards focused on training health care professionals with some including people in customer-centric settings, people living with dementia, and informal carers or the general community. Seventeen training topics were identified in 10 or more of the 13 standards. Cultural safety, rural issues, health care professional self-care, digital literacy, and health promotion topics were less commonly reported. The barriers to standards implementation were lack of organizational support, lack of access to relevant training, low staff literacy, lack of funding, high staff turnover, ineffective past program cycles, and inconsistent service delivery. Enablers included a strong implementation plan, funding, strength of partnerships, and building on previous work. DISCUSSION AND IMPLICATIONS: The U.K. Dementia Skills and Core Training Standard, the Irish Department of Health Dementia Together, and the National Health Services Scotland Standard are the recommended strongest standards for underpinning the development of international standards. It is essential that training standards are tailored to the needs of the consumer, worker, and regions.

Strategic Guidance and Technological Solutions for Human Resources Management to Sustain an Aging Workforce: Review of International Standards, Research, and Use Cases.

BACKGROUND: New technologies offer opportunities to create a healthy, productive, and capable aging workforce. There is little research from an organizational perspective about how technology can help create a sustainable aging workforce. OBJECTIVE: This study aims to (1) explore how technological solutions in organizations can help create and maintain a healthy, productive, and capable aging workforce; and (2) provide recommendations and strategic guidance that benefit both the aging worker and the organization. METHODS: International standardization practices, ethical frameworks, collaborative research, and use cases are used to demonstrate how technological solutions can be translated into practice and formed the basis for the development of a set of recommendations to create and maintain a sustainable aging workforce. RESULTS: Organizations need to look at aging through different lenses to optimize an age-inclusive workforce rather than viewing it by chronological age alone. International standards in technology, human resources management, and aging societies can form part of the solution to improve aging workforces. Digitalization of workplaces, digital literacy, innovation, intergenerational collaboration, and knowledge management form important elements of the international standard on age-inclusive workforce. Using internationally agreed ethical frameworks that consider age bias when designing artificial intelligence-related products and services can help organizations in their approach. Age bias in artificial intelligence development in the workplace can be avoided through inclusive practices. No blockchain application was found yet to improve the aging workforce. Barriers to blockchain adoption include fear of layoffs, worker resistance and lack of blockchain competence, worldwide adoption, support, and funding. Integrating blockchain into the internet of things may allow for improved efficiencies, reduce cost, and resolve workforce capacity problems. Organizations could benefit from implementing or funding wearable technologies for their workers. Recent tools such as the Ageing@Work toolkit consisting of virtual user models and virtual workplace models allow for the adaptation of the work processes and the ergonomics of workplaces to the evolving needs of aging workers. Lastly, selected use cases that may contribute to sustaining an aging workforce are explored (eg, the Exposure-Documentation-System, wireless biomedical sensors, and digital voice notes). CONCLUSIONS: The synergy of international standardization and ethical framework tools with research can advance information and communication technology solutions in improving aging workforces. There appears to be a momentum that technological solutions to achieve an age-inclusive workforce will undoubtedly find a stronger place within the global context and is most likely to have increased acceptance of technological applications among aging workers as well as organizations and governments. International standardization, cross-country research, and learning from use cases play an important role to ensure practical, efficient, and ethical implementation of technological solutions to contribute to a sustainable aging workforce.

Persuasive Design Solutions for a Sustainable Workforce: Review of Persuasive Apps for Real-Time Capability Support for Rural Health Care Professionals.

BACKGROUND: There is a need to further investigate how persuasive design principles can change rural health professionals' behaviors to look after their own health workforce capability. Several theories are used when developing apps to persuade people to change behavior, including the Persuasive System Design Model, consisting of primary task, dialogue, system credibility, and social support categories, and Cialdini's principles of persuasion. These have not been analyzed yet in the field of health workforce capability. OBJECTIVE: This study aims to determine the persuasive design techniques used in capability building-related apps and to provide recommendations for designing a health workforce app to increase their persuasiveness. METHODS: A Python script was used to extract a total of 3060 apps from Google Play. Keywords centered around health workforce capability elements. App inclusion criteria were as follows: been updated since 2019, rated by users on average 4 and above, and more than 100,000 downloads. Next, 2 experts reviewed whether 32 persuasive strategies were used in the selected apps, and these were further analyzed by capability categories: competencies and skills, health and personal qualities, values and attitudes, and work organization. RESULTS: In all, 53 mobile apps were systematically reviewed to identify the persuasive design techniques. The most common were surface credibility (n=48, 90.6%) and liking (n=48), followed by trustworthiness (n=43, 81.1%), reminders (n=38, 71.7%), and suggestion (n=30, 56.6%). The techniques in the social support domain were the least used across the different apps analyzed for health workforce capability, whereas those in the primary task support domain were used most frequently. The recommendations reflect learnings from our analysis. These findings provided insight into mobile app design principles relevant to apps used in improving health workforce capability. CONCLUSIONS: Our review showed that there are many persuasive design techniques that can assist in building health workforce capability. Additionally, several apps are available in the market that can assist in improving health workforce capability. There is, however, a specific lack of digital, real-time support to improve health workforce capability. Social support strategies through using social support persuasive design techniques will need to be integrated more prominently into a health workforce capability app. An app to measure and monitor health workforce capability scores can be used in conjunction with direct real-world person and real-time support to discuss and identify solutions to improve health workforce capability for rural and remote health professionals who are at high risk of burnout or leaving the rural health workforce.

Changes in antidepressant medication use in the workplace and sustainable employability: a qualitative study of experiences, strategies and solutions.

This study explores patients' experiences of how antidepressant medication transition events (ceasing, changing or reducing) affect employment and workplace functioning. An anonymous online survey was conducted with adults who had experienced antidepressant medication transition events (AMTEs). Data were analyzed using a hybrid inductive and deductive thematic analysis approach. While a majority of participants perceived many positive impacts of antidepressant medication on their workplace functioning, considerable negative effects during AMTEs were reported. Participants provided practical solutions to assist employers, policy and clinicians. Significant and detrimental impact of antidepressant medication changes occurred in the workplace. There is an urgent need to raise awareness of the vulnerability of people during AMTEs and to develop educational and supportive resources to assist clinicians and practitioners to support people during this vulnerable time.

Patterns of ecstasy use amongst live music event attendees and their opinions on pill testing: a cross sectional study.

BACKGROUND: Pill testing services could potentially be used to reduce drug-related harm. This study aims to identify patterns of ecstasy use among live music event attendees; explore the opinions and potential usage of illicit pill testing programs and examine factors associated with the likelihood of still taking a pill containing a potential harmful substance. METHODS: A cross-sectional survey was completed by 760 people attending a major Australian live music event in 2017. RESULTS: The most commonly used drug in the last 12 months was ecstasy (73.9%). About 5% of people who use drugs had sought medical attention due to consumption of ecstasy. People who use drugs agreed "a lot" that pill testing should be provided for free at live music events (82.2%) and that it should be combined with harm reduction advice (62.9%). Additionally, 32% of all participants agreed 'a lot' that they would be more likely to take illicit drugs at a music festival if pill-testing services were present. However, if people perceived that a harmful substance was detected in their drugs after using a pill testing service, 52.3% of people who have used illicit drugs reported that they would 'not at all' be likely to still consume the drug. They also reported that they would still take a pill if testing demonstrated the presence of unintended MDMA-type substances (70.3%), amphetamines (31.2%) or ketamine (27.8%). Multivariate analyses demonstrated that only increased frequency of ecstasy use was significantly associated with taking a pill despite pill testing services detecting a harmful substance. Gender, age, alcohol and previously seeking ecstasy-related medical attention were not associated in the multivariate analyses. CONCLUSIONS: A high proportion of live music attendees consume alcohol and ecstasy. Both people who have and who have not used illicit drugs support the implementation of pill testing services. People reported they would change their consumption patterns according to the results given by pill testing services. The findings may be used to stimulate public debate, and assist drug and alcohol policy makers in the implementation of harm minimisation strategies such as combining pill testing services with harm reduction advice.

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.

Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom, and the United States.

BACKGROUND: On March 12, 2020, the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic. On that date, there were 134,576 reported cases and 4981 deaths worldwide. By March 26, 2020, just 2 weeks later, reported cases had increased four-fold to 531,865, and deaths increased five-fold to 24,073. Older people are both major users of telehealth services and are more likely to die as a result of COVID-19. OBJECTIVE: This paper examines the extent that Australia, the United Kingdom, and the United States, during the 2 weeks following the pandemic announcement, sought to promote telehealth as a tool that could help identify COVID-19 among older people who may live alone, be frail, or be self-isolating, and give support to or facilitate the treatment of people who are or may be infected. METHODS: This paper reports, for the 2-week period previously mentioned and immediately prior, on activities and initiatives in the three countries taken by governments or their agencies (at national or state levels) together with publications or guidance issued by professional, trade, and charitable bodies. Different sources of information are drawn upon that point to the perceived likely benefits of telehealth in fighting the pandemic. It is not the purpose of this paper to draw together or analyze information that reflects growing knowledge about COVID-19, except where telehealth is seen as a component. RESULTS: The picture that emerges for the three countries, based on the sources identified, shows a number of differences. These differences center on the nature of their health services, the extent of attention given to older people (and the circumstances that can relate to them), the different geographies (notably concerned with rurality), and the changes to funding frameworks that could impact these. Common to all three countries is the value attributed to maintaining quality safeguards in the wider context of their health services but where such services are noted as sometimes having precluded significant telehealth use. CONCLUSIONS: The COVID-19 pandemic is forcing changes and may help to establish telehealth more firmly in its aftermath. Some of the changes may not be long-lasting. However, the momentum is such that telehealth will almost certainly find a stronger place within health service frameworks for each of the three countries and is likely to have increased acceptance among both patients and health care providers.

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.

Medical student well-being during rural clinical placement: A cross-sectional national survey.

CONTEXT: Understanding rural student well-being is essential to inform the development and training of the future rural medical workforce so as to ensure a pipeline of rural doctors to meet rural communities' needs. However, little is known about the well-being of students who are on rural placement. This study aims to identify the predictors of well-being amongst a national sample of medical students on rural clinical placement. METHODS: The Federation of Rural Australian Medical Educators (FRAME) 2015 national exit survey of medical students, completed at the end of rural terms, was used (n = 644) to test the associations between well-being and demographic, financial, academic, supervisor, placement and clinical skills factors, and attitude to future rural work. Univariate and logistic regression were used. RESULTS: Students aged 18-24 years (odds ratio [OR], 8.07 [95% confidence interval {CI}, 2.07-31.46]) and 25-34 years (OR, 4.06 [95% CI, 1.35-12.18]) reported higher levels of well-being compared to students aged over 35 years. Academic support from the rural clinical school (OR, 5.74 [95% CI, 2.59-12.73]), perceived respect from supervisors (OR, 3.13 [95% CI, 1.23-7.99]), not feeling socially isolated (OR, 2.7 [95% CI, 1.40-5.20]), access to counselling services (OR, 2.05 [95% CI, 1.10-3.83]), rural placement being a first choice (OR, 3.04 [95% CI, 1.58-5.86]) and positive attitudes to being part of a rural workforce in the future (OR, 4.0 [95% CI, 2.0-8.3]) were associated with higher odds of well-being compared to students who felt the opposite. Gender, rural background, financial support, clinical skills and role clarity were not found to be associated with well-being (P > .5). CONCLUSIONS: This study may provide guidance to rural clinical schools, policymakers and medical educators in developing rural placement programmes that enhance student well-being so we can address workforce shortages in rural areas.

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-by-step 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. TRIAL REGISTRATION: ACTRN12616001456448 registered: www.anzctr.org.au. Trial site: http://emergencyprotocols.org.au/.

Effect of Serial Anthropometric Measurements and Motivational Text Messages on Weight Reduction Among Workers: Pilot Randomized Controlled Trial.

BACKGROUND: Obesity is an endemic problem with significant health and financial consequences. Text messaging has been shown to be a simple and effective method of facilitating weight reduction. In addition, waist-to-hip ratio (WHR) has emerged as a significant anthropometric measure. However, few studies have examined the effect of serial anthropometric self-measurement combined with text messaging. OBJECTIVE: The primary aim of this study was to assess whether an 8-week program, consisting of weekly serial self-measurements of waist and hip circumference, combined with motivational text messages, could reduce WHR among Australian workers. METHODS: This was a community-based, participant-blinded, staggered-entry, parallel group study. Adult workers with access to mobile phones were eligible and recruited through an open access Web-based survey. Participants were randomly allocated to receive intervention or control messages for 8 weeks. Outcome data were self-assessed through a Web-based survey. RESULTS: A total of 60 participants were randomized with 30 participants each allocated to a control and an intervention group. There was no significant change in WHR (P=.43), and all secondary outcome measures did not differ between the intervention group and the control group at the end of the 8-week intervention. Both groups, however, showed a significant decrease in burnout over time (mean [SE]: pre 4.80 [0.39] vs post 3.36 [0.46]; P=.004). The intervention uptake followed a downward trend. Peak participant replies to weekly self-measurements were received in week 3 (14/23, 61%) and the least in week 8 (8/23, 35%). No harm was found to result from this study. CONCLUSIONS: This study is an innovative pilot trial using text messaging and serial anthropometric measurements in weight management. No change was detected in WHRs in Australian workers over 8 weeks; therefore, it could not be concluded whether the intervention affected the primary outcome. However, these results should be interpreted in the context of limited sample size and decreasing intervention uptake over the course of the study. This pilot trial is useful for informing and contributing to the design of future studies and the growing body of literature on serial self-measurements combined with text messaging. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616001496404; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371696&isReview=true (Archived by WebCite at http://www.webcitation.org/73UkKFjSw).

Qualitative exploration of the impact of employment and volunteering upon the health and wellbeing of African refugees settled in regional Australia: a refugee perspective.

BACKGROUND: People from refugee backgrounds face various challenges after moving to a new country. Successfully securing employment has been linked to positive health outcomes in refugee populations; there is less research into the impact of volunteering on health outcomes in refugees, or the role of employment and volunteering in regional or rural communities. This study aims to explore how employment and volunteering influences the health and wellbeing of refugees settled in regional Australia, and identify areas for appropriate service provision. METHODS: Nine adults of refugee background in regional Australia were purposively sampled through community organisations using word-of-mouth referrals for semi-structured interviews. Interviews were transcribed. Thematic analysis was used to uncover emergent themes and identify relationships between themes. A strengths-based theoretical framework was adopted to inform further analysis. RESULTS: Paid work and volunteering engenders a sense of self-fulfillment and sense of belonging, facilitating successful integration into a new community. Employment further allows maintenance of an adequate standard of living, thus improving healthcare access and promoting healthy lifestyle behaviours. Adverse effects from employment include difficulties managing work-life balance, disconnect with family and loss of traditional heritage, but these were significantly outweighed by the positive effects. Volunteering provides no financial incentive, but similarly promotes community connections and positive self-worth, preparing refugees for the workforce. Both employment and volunteering held direct positive benefits for their physical and mental health, improved healthcare access and promoted cultural and social integration. These factors enabled successful settlement and subsequently improved overall wellbeing of participants. A strengths-based approach demonstrated how participants used employment as a tool for seeking purpose and ongoing self-development. CONCLUSION: Unique experiences with employment and volunteering in a regional area amongst a refugee community were explored. Our results describe various ways in which meaningful employment and volunteering can facilitate positive health and wellbeing outcomes of refugees, and thus reinforces the importance of providing such opportunities to ensure successful settlement. The benefits of volunteering in this community have not been previously explored. Additionally, concerns expressed and recommendations suggested by participants could be used to inform future research, policy, interventions and health and employment service provision for refugee populations.

Completion rates and psychosocial intervention effectiveness in an Australian substance use therapeutic community.

BACKGROUND: Program attrition is a major problem in substance use treatment. It is not clear which client and treatment variables are related to successful completion. This study aimed to identify client variables associated with Therapeutic Community (TC) completion. A secondary aim was to investigate changes in entry and exit scores on psychosocial outcome measures. METHODS: Retrospective quantitative analysis of data collected from 193 Australian TC residents, over 3.5 years. Variables measured included: demographics; Depression, Anxiety, Stress Score (DASS-21) and World Health Organisation Quality of Life 8 questions (WHOQOL-8). RESULTS: Completion rates were 30.6%. High Money WHOQOL-8 scores, suggestive of minimal financial stressors, positively predicted completion. Multivariate analyses showed that negative predictors of completion were: amphetamine being primary substance of concern, aggression, high Relationship WHOQOL-8 scores, suggestive of positive relationships, and younger or older age. Those in the program demonstrated clinically significant psychological improvement and significant improvement in all quality of life scores over time. The degree of psychometric improvement was most pronounced in those who completed the course, with the exception of depression, stress, and money problems. CONCLUSION: The findings provide an understanding of specific predictors of program completion which may help to identify high-risk clients and inform program improvement. Early attrition rates may be reduced by monitoring and supporting high-risk clients. Overall, psychometric improvement occurred amongst both completers and non-completers overtime but is most prominent amongst course completers, with the exception of depression, stress, and money problems. Future research could potentially focus on amphetamine users and shortened TC programs, focusing on acute psychosocial intervention.

Factors influencing early withdrawal from a drug and alcohol treatment program and client perceptions of successful recovery and employment: a qualitative study.

BACKGROUND: Substance use disorders are a major contributor to the economic and healthcare burden in Australia. Therapeutic communities (TCs) are utilised treatment methods globally, though low program completion rates continue to represent a major obstacle in effective and sustainable drug and alcohol treatment. The aim of this study was to explore reasons for early withdrawal from TC programs and perceptions of successful recovery. This study also aimed to explore how employment and volunteering related to early exit and perceptions of successful recovery. METHODS: Semi-structured qualitative interviews were conducted with 13 ex-residents from a long-term TC program at a community-based rehab organisation in regional Australia. RESULTS: Thematic analysis revealed a complex interplay of factors contributing to early TC withdrawal, and perceptions of successful recovery from a lived experience perspective and how this was shaped by employment and volunteering. Eleven themes were identified. Three relating to reasons for joining the program, which connected with ultimate withdrawal from the program: Pre-program existing relationships, pre-program employment situation and needing a 'circuit breaker' in their life. Three relating to reasons for early withdrawal: TC program characteristics, relationships during the program and planning future employment. Five relating to perceptions of successful recovery: Improved understanding of their addiction, reduced substance use, improved physical and psychological health, relationship success and employment success. CONCLUSIONS: Reasons for leaving treatment early are multi-faceted and revolve around relationships, planning future employment and program characteristics. The influence that each plays on their decision to leave early is varied and determined by the value they assign it. Perceived success extends far beyond achieving and maintaining abstinence to encompass improved relationships, psychological and physical wellbeing, understanding of addiction and employment, studying or volunteering. Self-worth and feeling able to contribute to society through employment, study and volunteering were perceived to be essential elements of successful recovery. Clinicians, policy makers and program developers should use the extended definition of successful recovery from the ex-clients perspective when determining the clinical and economic effectiveness of TC programs.

Can the work ability model provide a useful explanatory framework to understand sustainable employability amongst general practitioners: a qualitative study.

BACKGROUND: Work ability (WA) is an indication of how well someone's health, skills and experience match current job demands. The aim of this study was to ascertain whether the work ability model can provide a useful explanatory framework to understand some elements of sustainable employability (SE) amongst GPs. METHODS: A thematic analysis of 19 in-depth interviews with GPs in the Northern Rivers region of NSW, Australia, was conducted and formed the basis for a qualitative validation of the work ability model. RESULTS: In order to provide a more comprehensive reflection on the factors and dynamics found to underpin work ability amongst ageing GPs required the creation of specific subcategories within the WA model. Additionally, new themes relevant to general practice also emerged from the data. The analyses revealed a set of important, new factors and relationships that required additions and refinements to the original model, in order to fully explain sustainable employability in this GP sample. These new emerging themes that required model extension were 'Work-life balance and lifestyle', 'Extended social community' and 'Impact of gender'. CONCLUSION: While the WA model provides a basic explanatory framework for understanding some elements of sustainable employability amongst GPs, a revision of the current model has been proposed to sufficiently describe the factors impinging on sustainable employability in this group. The extended model can potentially be used for addressing workforce planning issues and to assist in programme design to promote sustainable employability amongst GPs and could potentially be translated to other health professional groups.

Perceived driving safety and estimated blood alcohol concentration (BAC) the morning after drinking amongst young Australians attending a music festival: a cross-sectional survey.

BACKGROUND: Alcohol-related motor vehicle crashes remain a significant and costly public health issue globally. Particularly young people are over-represented in these incidents. This study set out to explore the factors that influence individuals' perceptions of their safety to drive, and the factors related to a change in intention to drive. METHODS: Four hundred nine young people aged 18-40 attending an Australian multi-day music festival completed a survey measuring demographics, alcohol use, amount of sleep obtained the previous night, intention to drive, number of passengers, perceived safety to drive, estimated BAC (measured in g/210 L) and change in intention to drive following a BAC measurement via breathalysers. Statistical analyses involved univariate tests of association and multivariate logistic regression. RESULTS: Only one in five participants felt they were completely safe to drive. Males self-rated as less safe to drive than females. Multivariate analyses showed that licence class, sleep hours, units of alcohol consumed in the past 24 h and estimated BAC had statistically significant associations with driving safety perception. Participants who slept for greater than seven hours the previous night were three times more likely to feel safe to drive than those who had less than five hours of sleep (OR 3.05 (95% CI 1.25, 7.45)). Forty-one percent of participants changed their intended time of driving after having their BAC measured with a breathalyser. There was a statistically significant association between changing the intention to drive to a later time with an increase in each extra passenger in a participant's vehicle (OR 1.53 (95% CI 1.02, 2.30)). CONCLUSIONS: Whilst concerning behaviours relating to high-risk alcohol consumption were found, the study uncovered promising findings about young peoples' perceptions of their safety to drive, and their propensity to change their driving intention. The strong correlation between hours of sleep, estimated BAC, units of alcohol consumed and license class with perception of driving safety suggests an increased awareness among young people and promotion of these factors may potentially improve actual driver safety. The influence of number of passengers on intention to drive later is another important consideration for future road safety research or promotion.

Self-efficacy reduces the impact of social isolation on medical student's rural career intent.

BACKGROUND: Social isolation in medical students is a subjective experience that may influence medical career decision making. Rural self-efficacy has been shown to influence rural career intentions following a rural clinical placement, however its impact on social isolation during a rural clinical placement has not been previously modeled. The objective of this study is to explore whether self-perception of social isolation is associated with rural career intent in rural medical students. Secondly, to determine whether self-efficacy influences the association between social isolation and rural career intent. METHODS: 2015 data, from a cross-sectional survey of the National Federation of Rural Australian Medical Educators (FRAME) study. Among 619 medical students attending rural clinical schools (RCS), rural career intent was assessed. This included intended rural location for either postgraduate medical specialist or generalist training or completion of that training. Self-efficacy beliefs in rural medical practice were based on a validated scale consisting of six questions. Social isolation was measured asking students whether they felt socially isolated during their RCS placement. RESULTS: 31.3% of surveyed students self-reported feeling socially isolated during their rural placement. Social isolation was associated with reduced rural career intent after controlling for gender, rural background, RCS preference, RCS support and wellbeing. In step-wise logistic regression the association between social isolation and rural intent disappeared with the inclusion of rural self-efficacy. CONCLUSIONS: Social isolation during a rural clinical placement is commonly reported and is shown to reduce rural career intent. High levels of rural clinical self-efficacy reduce the effects of social isolation on future rural workforce intentions.

Integrated solutions for sustainable fall prevention in primary care, the iSOLVE project: a type 2 hybrid effectiveness-implementation design.

BACKGROUND: Despite strong evidence giving guidance for effective fall prevention interventions in community-residing older people, there is currently no clear model for engaging general medical practitioners in fall prevention and routine use of allied health professionals in fall prevention has been slow, limiting widespread dissemination. This protocol paper outlines an implementation-effectiveness study of the Integrated Solutions for Sustainable Fall Prevention (iSOLVE) intervention which has developed integrated processes and pathways to identify older people at risk of falls and engage a whole of primary care approach to fall prevention. METHODS/DESIGN: This protocol paper presents the iSOLVE implementation processes and change strategies and outlines the study design of a blended type 2 hybrid design. The study consists of a two-arm cluster randomized controlled trial in 28 general practices and recruiting 560 patients in Sydney, Australia, to evaluate effectiveness of the iSOLVE intervention in changing general practitioner fall management practices and reducing patient falls and the cost effectiveness from a healthcare funder perspective. Secondary outcomes include change in medications known to increase fall risk. We will simultaneously conduct a multi-methodology evaluation to investigate the workability and utility of the implementation intervention. The implementation evaluation includes in-depth interviews and surveys with general practitioners and allied health professionals to explore acceptability and uptake of the intervention, the coherence of the proposed changes for those in the work setting, and how to facilitate the collective action needed to implement changes in practice; social network mapping will explore professional relationships and influences on referral patterns; and, a survey of GPs in the geographical intervention zone will test diffusion of evidence-based fall prevention practices. The project works in partnership with a primary care health network, state fall prevention leaders, and a community of practice of fall prevention advocates. DISCUSSION: The design is aimed at providing clear direction for sustainability and informing decisions about generalization of the iSOLVE intervention processes and change strategies. While challenges exist in hybrid designs, there is a potential for significant outcomes as the iSOLVE pathways project brings together practice and research to collectively solve a major national problem with implications for policy service delivery. TRIAL REGISTRATION: Australian New Zealand Clinial Trials Registry ACTRN12615000401550.

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.

The effectiveness of recruitment strategies on general practitioner's survey response rates - a systematic review.

BACKGROUND: Low survey response rates in general practice are common and lead to loss of power, selection bias, unexpected budgetary constraints and time delays in research projects. OBJECTIVE: To assess the effectiveness of recruitment strategies aimed at increasing survey response rates among GPs. DESIGN: Systematic review. SEARCH METHODS: MEDLINE (OVIDSP, 1948-2012), EMBASE (OVIDSP, 1980-2012), Evidence Based Medicine Reviews (OVIDSP, 2012) and references of included papers were searched. Major search terms included GPs, recruitment strategies, response rates, and randomised controlled trials (RCT). SELECTION CRITERIA: Cluster RCTs, RCTs and factorial trial designs that evaluate recruitment strategies aimed at increasing GP survey response rates. DATA COLLECTION AND ANALYSIS: Abstracts identified by the search strategy were reviewed and relevant articles were retrieved. Each full-text publication was examined to determine whether it met the predetermined inclusion criteria. Data extraction and study quality was assessed by using predetermined checklists. RESULTS: Monetary and nonmonetary incentives were more effective than no incentive with monetary incentives having a slightly bigger effect than nonmonetary incentives. Large incentives were more effective than small incentives, as were upfront monetary incentives compared to promised monetary incentives. Postal surveys were more effective than telephone or email surveys. One study demonstrated that sequentially mixed mode (online survey followed by a paper survey with a reminder) was more effective than an online survey or the combination of an online and paper survey sent similtaneously in the first mail out. Pre-contact with a phonecall from a peer, personalised packages, sending mail on Friday, and using registered mail also increased response rates in single studies. Pre-contact by letter or postcard almost reached statistical signficance. CONCLUSIONS: GP survey response rates may improve by using the following strategies: monetary and nonmonetary incentives, larger incentives, upfront monetary incentives, postal surveys, pre-contact with a phonecall from a peer, personalised packages, sending mail on Friday, and using registered mail. Mail pre-contact may also improve response rates and have low costs. Improved reporting and further trials, including sequential mixed mode trials and social media, are required to determine the effectiveness of recruitment strategies on GPs' response rates to surveys.