Changes in neighborhood walking are related to changes in perceptions of environmental attributes

Background: Several studies have found significant cross-sectional associations of perceived environmental attributes with physical activity behaviors. Prospective relations with environmental factors have been examined for vigorous activity, but not for the moderate-intensity activities that environmental and policy initiatives are being designed to influence. Purpose: To examine prospective associations of changes in perceptions of local environmental attributes with changes in neighborhood walking. Methods: Baseline and 10-week follow-up telephone interviews with 512 adults (49% men). Results: Men who reported positive changes in aesthetics and convenience were twice as likely to increase their walking. Women who reported positive changes in convenience were more than twice as likely to have increased their walking. There were contrasting findings for men and women who reported traffic as less of a problem: Men were 61% less likely to have increased walking; however women were 76% more likely to have done so. Conclusions: Further studies are needed to determine the possibly causal nature of such environment-behavior relations and to elucidate relevant gender differences. Such evidence will provide underpinnings for public health initiatives to increase participation in physical activity.

Staff and patient perceptions of seclusion: Has anything changed?

Background Seclusion continues to be widely used in the management of disturbed behaviour in hospitalized patients. While early research on the topic highlighted significant differences in staff and patient perceptions, there are few recent data to indicate if these differences still exist. Aim This paper reports a study exploring the perceptions of both nursing staff and patients towards the reasons for seclusion; its effects; patients' feelings during seclusion; and possible changes to the practice. Methods Sixty nursing staff and 29 patients who had experienced seclusion at three inpatient units in Queensland, Australia completed Heyman's Attitudes to Seclusion Survey. Results The findings indicate that the two groups differed significantly on a number of the dimensions assessed. Nurses believed seclusion to be very necessary, not very punitive and a highly therapeutic practice that assisted patients to calm down and feel better. Patients, on the other hand, believed that seclusion was used frequently for minor disturbances and as a means of staff exerting power and control. Patients also believed that seclusion resulted in them feeling punished, and had little therapeutic value. Conclusion The disagreement between staff and patients highlights the need for greater dialogue between these groups. While nursing staff require greater understanding of how patients feel about seclusion, patients require information on why and how seclusion is implemented.

Parents' and staff's perceptions of parental needs during a child's admission to hospital: an English perspective

The aim of this research was to compare perceptions of parental needs held by parents of hospitalized children and the staff caring for them, so that potential communication breakdown could be avoided. A well-trialled tool was used with a convenience sample in paediatric facilities in a National Health Service trust in north-east England. Some differences were found between parents and staff for scores for perceived importance of the 51 needs that were included in the questionnaire, and whether or not they were being satisfactorily met during the child’s hospital admission, but there were no consistent patterns, so it is difficult to draw conclusions. Parents declared themselves more independent than the staff perceived them to be. Such findings facilitate improvements in communication between parents and staff and can be included in education programmes for both.

Perceptions of organisational subculture and their significance for organisational commitment

This paper investigates the relationship between perceptions of organisational culture, organisational subculture, leadership style, and commitment. The impact of culture and leadership style on commitment has been previously noted, but there is a lack of detail regarding how different types of culture and leadership styles relate to commitment. The paper particularly addresses the notion of organisational subcultures and how the perception of those cultures relates to commitment, subculture being a neglected variable in the commitment literature. These issues were addressed in a survey of 258 nurses drawn from a range of hospital settings and wards within the Sydney metropolitan region. Results indicate that perceived organisational subculture has a strong relationship with commitment. Furthermore, the results identify the relative strength of specific types of leadership style and specific types of subculture with commitment. Both innovative and supportive subcultures have a clear positive relationship, while bureaucratic subcultures have a negative relationship. In terms of leadership style, a consideration style had a stronger relationship with commitment than a structuring style. Regression analysis was used to investigate the possible role of subculture as a mediator for the influence of leadership on commitment. Both direct and indirect effects of leadership on commitment were found. Implications for practice and for further research are discussed.

Community perceptions of adequate levels and reasons for skin protection

In this study the authors addressed whether or not community members use relevant risk factors to determine an appropriate level of skin protection behavior in the prevention of skin cancer. The authors conducted a postal survey with a community sample of 3,600 Queensland residents that they randomly selected from the Commonwealth electoral roll. The predictors of perceptions of doing enough skin protection included intrapersonal, social, and attitudinal influences. People protected themselves from the sun primarily out of a desire for future good health and on other occasions did not protect themselves from the sun because they were not out there long enough to get burnt. The predictors of perceptions of doing enough skin protection indicated that participants were aware of relevant risk factors. The main reasons that people protect themselves from the sun suggest that they are acting on many health promotion messages. However, skin cancer prevention programs need to move beyond increasing awareness and knowledge of the disease to providing a supportive environment and enhancing individual skills. Health promotion campaigns could reinforce appropriate risk assessment and shape an individual's decision about how much sun protection is needed.

Residents' perceptions of walkability attributes in objectively different neighbourhoods: a pilot study

Physical attributes of local environments may influence walking. We used a modified version of the Neighbourhood Environment Walkability Scale to compare residents' perceptions of the attributes of two neighbourhoods that differed on measures derived from Geographic Information System databases. Residents of the high-walkable neighbourhood rated relevant attributes of residential density, land-use mix (access and diversity) and street connectivity, consistently higher than did residents of the low-walkable neighbourhood. Traffic safety and safety from crime attributes did not differ. Perceived neighbourhood environment characteristics had moderate to high test retest reliabilities. Neighbourhood environment attribute ratings may be used in population surveys and other studies. (c) 2004 Elsevier Ltd. All rights reserved.

Perceptions of the influence of prescription medicine samples on prescribing by family physicians

Background: The provision of free prescription medicine samples is a common and traditional marketing strategy used by pharmaceutical companies, but concerns have been raised about their influence on physician prescribing behavior and patient safety. Objective: We sought to investigate the knowledge, attitudes, and behaviors of Australian family physicians regarding the use of sample prescription medications. Methods: Qualitative and quantitative techniques were used, including (1) mailed questionnaires to family physicians, (2) semistructured interviews with family physicians, and (3) sample cupboard inventories. Results: A number of issues about samples were identified by the questionnaires (208) and interviews (17 doctors), including insufficient labeling, poor record keeping, diversion of stock (personal use by doctors.. their families, practice staff and pharmaceutical representatives), and wasting of expired stock. Prescription medicine samples also influenced prescribing behavior. Australian doctors were less likely to provide samples to patients on financial grounds compared with a previous study in the United States on medical residents. Six sample cupboards were inventoried. Median wholesale value of sample cupboards was AUD $4959 (range $2395-$8709), with 6% of stock expired. Very little generic medicine was included in the sample cupboards. Conclusions: Better methods are needed to meet legislative requirements and to ensure quality use of medicines (and optimal public health) with respect to prescription medicine samples. Doctors and practice staff require training on the appropriate handling and storage of prescription medications. Alternative ways for distribution of sample medications need to be investigated.

Obesity in pre-school children: Issues and challenges for community based child health nurses

Childhood obesity is becoming a topical issue in both the health literature and the popular media and increasingly child health nurses are observing preschool children who appear to be disproportionately heavy for their height when plotted on standardised growth charts. In this paper literature related to childhood obesity in New Zealand and internationally is explored to identify current issues, and the implications of these issues for nurses in community based child health practice are discussed. Themes that emerged from the literature relate to the measurement of obesity, links between childhood and adult obesity and issues for families. A theme in the literature around maternal perception was of particular interest. Studies that investigated maternal perceptions of childhood obesity found that mothers identified their child as being overweight or obese only when it imposed limitations on physical activity or when the children were teased rather than by referring to individual growth graphs. The implications for nursing in the area of child health practice is discussed as nurses working in this area need an understanding of the complex and often emotive issues surrounding childhood obesity and an awareness of the reality of people's lives when devising health promotion strategies.

Aggressive behaviour in the high-secure forensic setting: the perceptions of patients

Twenty-seven patients undergoing treatment in a high-secure forensic facility participated in focus group interviews to elicit their perceptions of (1) the factors leading to aggressive behaviour; and (2) strategies to reduce the risk of such behaviour. The focus group interviews were audiotaped, transcribed and analysed using content analysis. The participants identified that a combination of patient, staff and environmental factors contributed to violence in the study wards. The cause of aggressive behaviour centred around five major themes: the environment; empty days; staff interactions; medication issues; and patient-centred factors. Potential strategies identified by patients to reduce aggressive behaviour included: early intervention; the provision of meaningful activities to reduce boredom; separation of acutely disturbed patients; improved staff attitudes; implementation of effective justice procedures; and a patient advocate to mediate during times of conflict. Findings suggested that social and organizational factors need to be addressed to change the punitive subculture inherent in forensic psychiatric facilities, and to ensure a balance between security and effective therapy.