Development of a condition-specific measure of quality of life for children with cerebral palsy: empirical thematic data reported by parents and children

Background: Although there is increasing recognition that quality of life (QOL) and health-related quality of life (HRQOL) are important outcome variables in clinical trials for children with cerebral palsy, there are substantial limitations in existing measures of QOL. This study identify themes of QOL for children with cerebral palsy and their parents to guide the development of a new condition-specific QOL scale. Methods: A qualitative study of parent and child views on QOL composition was conducted, using a grounded theory framework. Families participated in semistructured interviews on QOL until thematic saturation was reached (n = 28 families). Results: Overall, 13 themes emerged from the interviews: physical health, body pain and discomfort, daily living tasks, participation in regular physical and social activities, emotional well-being and self-esteem, interaction with the community, communication, family health, supportive physical environment, future QOL, provision of, and access to services, financial stability, and social well-being. Conclusions: Research with parents and children with cerebral palsy, representative of severity across the disease spectrum and socio-economic status, reinforced and expanded on the traditional themes that have underpinned QOL measurement development. This has implications not only for the development of a new QOL scale for children with cerebral palsy, but also for clinical interventions and community care management.

Where do children usually play? A qualitative study of parents' perceptions of influences on children's active free-play

This study explored the perceptions of 78 parents from low, mid and high socio-economic areas in Melbourne, Australia to increase understanding of where children play and why. Using an ecological model interviews with parents revealed that safety and social factors emerged as key social themes, facilities at parks and playgrounds, and urban design factors emerged as important physical environment themes. The children's level of independence and attitudes to active free-play were considered to be important individual level influences on active free-play. The study findings have important implications for future urban planning and children's opportunities for active free-play.

Neighborhood walkability and the walking behavior of Australian adults

Background
The physical attributes of residential neighborhoods, particularly the connectedness of streets and the proximity of destinations, can influence walking behaviors. To provide the evidence for public health advocacy on activity-friendly environments, large-scale studies in different countries are needed. Associations of neighborhood physical environments with adults’ walking for transport and walking for recreation must be better understood.

Method
Walking for transport and walking for recreation were assessed with a validated survey among 2650 adults recruited from neighborhoods in an Australian city between July 2003 and June 2004, with neighborhoods selected to have either high or low walkability, based on objective measures of connectedness and proximity derived from geographic information systems (GIS) databases. The study design was stratified by area-level socioeconomic status, while analyses controlled for participant age, gender, individual-level socioeconomic status, and reasons for neighborhood self-selection.

Results
A strong independent positive association was found between weekly frequency of walking for transport and the objectively derived neighborhood walkability index. Preference for walkable neighborhoods moderated the relationship of walkability with weekly minutes, but not the frequency of walking for transport—walkability was related to higher frequency of transport walking, irrespective of neighborhood self-selection. There were no significant associations between environmental factors and walking for recreation.

Conclusions
Associations of neighborhood walkability attributes with walking for transport were confirmed in Australia. They accounted for a modest but statistically significant proportion of the total variation of the relevant walking behavior. The physical environment attributes that make up the walkability index are potentially important candidate factors for future environmental and policy initiatives designed to increase physical activity.

School and anaemia prevention: current reality and opportunities - a Tanzanian case study

Iron deficiency anaemia is highly endemic in rural areas of Tanzania and in many developing countries. Its prevention among school children requires greater dissemination of knowledge of anaemia among children, teachers, parents and the general community. Associated improvements in the hygienic status of domestic and school environments are also often required. One-hundred-and-thirty-one anaemic children, 90 parents and 76 teachers were interviewed to ascertain their understanding of anaemia. Most children and parents had little knowledge of the symptoms, causes and prevention of anaemia. In addition to their iron-deficient diets, more than half of the children went to school without something to eat at breakfast and during school hours. However, parents and teachers were willing to work together to provide meals for the children. Poor sanitation in the children's homes and in schools was a little recognized factor which could pose a serious risk of anaemia. In addition, inadequate sanitation facilities and poor quality of physical environment prevailed both in the children's homes and in schools. The findings suggest the need for the establishment of a health-promoting schools network to provide a comprehensive framework for health promotion in schools as well as in homes in Tanzania and in other developing countries. Schools can be an ideal setting to positively influence a community's health status. Partnerships among teachers, parents and the wider community are required to identify, prioritize and ameliorate health problems.

Measuring the walkability of local communities using geographic information systems data

Researchers are working to identify and promote environment and policy initiatives to encourage more active and healthy communities. Measuring environmental attributes through objective means can verify which physical environment factors are most important. We describe how Geographic Information Systems (GIS) may be used to measure objectively, the features of the built environment that may influence walking. We show how four key attributes currently believed to be of most relevance to walking for transport may be used to create a ‘walkability’ index. These are dwelling density (higher-density neighbourhoods support greater retail and service variety, resulting in shorter, walkable distances between facilities; driving and parking are more difficult); street connectivity (higher intersection density provides people with a greater choice of potential routes, easier access to major roads where public transport is available and shorter times to get to destinations); land use mix (the more varied the land use mix and built form, the more conducive it is to walk to various destinations); and net retail area (people who live near multiple and diverse retail opportunities are able to make more frequent and shorter shopping trips by walking and can walk to more local employment opportunities). The potential relationships between each of the objective environmental-attribute measures and walking behaviours is discussed, together with suggestions as to how such measures might be used to guide community infrastructure planning. GIS mapping can assist decision makers in where to focus transportation investments and where to guide future growth. Readily accessible GIS data can be used to guide and support urban planning and infrastructure investment decisions in both the private and public sectors, to increase walking in communities.

Associations of perceived community environmental attributes with walking in a population-based sample of adults with type 2 diabetes.

Background: No studies have yet examined the associations of physical environmental attributes specifically with walking in adults with type 2 diabetes.

Purpose: The purpose of this study was to examine associations of perceived community physical environmental attributes with walking for transport and for recreation among adults living with type 2 diabetes.

Methods: Participants were 771 adults with type 2 diabetes who completed a self-administered survey on perceived community physical environmental attributes and walking behaviors.

Results: Based on a criterion of a minimum of 120-min/week, some 29% were sufficiently active through walking for transport and 33% through walking for recreation. Significantly higher proportions of those actively walking for transport and for recreation had shops or places to buy things close by (67.8% and 60.9%); lived within a 15-min walk to a transit stop (70.6% and 71.0%); did not have dead-end streets close by (77.7% and 79.8%); reported interesting things to look at (84.8% and 84.4%); and lived close to low-cost recreation facilities (81.3% and 78.8%). In addition, those actively walking for transport reported living in a community with intersections close to each other (75.6%) and with sidewalks on their streets (88.1%). When these variables were entered simultaneously into logistic regression models, living close by to shops was positively related to walking for transport (OR= 1.92, 99% CI=1.11–3.32).

Conclusions: Consistent with findings from studies of healthy adult populations, positive perceptions of community environmental attributes are associated with walking for transport among adults with type 2 diabetes. The now-strong public health case for environmental innovations to promote more walking for transport is further reinforced by the potential to benefit those living with diabetes.

Walking and cycling to school : predictors of increases among children and adolescents

Background
Little is known about what happens to active commuting as children get older, and less is known about influences on changes in this behavior. This study examined predictors of increases in children's and adolescents' active commuting (walking or cycling) to/from school over a 2-year period.
Methods
Participants were initially recruited and assessed in 2001. Follow-up data were collected in 2004 and 2006 and analyzed in 2008. Participants were 121 children (aged 9.1±0.34 years in 2004) and 188 adolescents (aged 14.5±0.65 years in 2004) from Melbourne, Australia. Parents and adolescents reported their perceptions of individual-level factors and of the neighborhood social and physical environment. Weekly active commuting (walking or cycling) to/from school, ranging from 0 to 10 trips/week was also proxy- or self-reported at the initial measurement and again 2 years later. Logistic regression analyses examined predictors of increases in active commuting over time.
Results
Children whose parents knew many people in their neighborhood were more likely to increase their active commuting (OR=2.6; CI=1.2, 5.9; p=0.02) compared with other children. Adolescents whose parents perceived there to be insufficient traffic lights and pedestrian crossings in their neighborhood were less likely to increase their active commuting over 2 years (OR=0.4; CI=0.2, 0.8; p=0.01), whereas adolescents of parents who were satisfied with the number of pedestrian crossings were more likely to increase their active commuting (OR=2.4; CI=1.1, 5.4; p=0.03) compared with other adolescents.
Conclusions
Social factors and physical environmental characteristics were the most important predictors of active commuting in children and adolescents, respectively.

The competing discourses of workplace health

This article presents an analysis of workplace health programme discourses within an international information technology company. Discourse refers to a system of statements that share a common force and coherence and which are socially constitutive. The representation of entities such as workplace health can be subject to competition between discourses. A critical discourse analysis was undertaken on semi-structured interviews, participant observation and workplace health programme documents. Two competing discourses were identified: health as safety and health as lifestyle. Each discourse is described and shown to both implicitly and explicitly define health within this particular workplace. Lifestyle discourse encouraged moves towards linking of the employees' working and private lives while safety discourse defined health in the relationship between workers and their physical environment. Competition between discourses both constricts and opens spaces for alternative understandings of health in the workplace. The implications of this competition for workplace health policy and practice are discussed.

Influence operations and behavioural change

The intended outcome of Information Operations appears to be a favourable change (to the instigator) in attitudes or belief systems of the target, however, the relationship between attitude and behaviour is tenuous. Propaganda and other methods of ‘influence’ are difficult to assess as the cause and effect relationship is complicated. The short term effects of psychological warfare where force is used in conjunction with influence techniques can be easily assessed; at least at a superficial level. Even in the latter case, the actual causes and effects could be solely the force used or some other factors rather than the psychological techniques per se. Influence Operations attempt to win the hearts and minds of the target audience but, even if successful, the lasting effects of a campaign are problematic. It is further complicated because if a person has a particular view, it does not mean that the ensuing behaviours will reflect that view. Also, there is evidence that the use of force on one set of people produces attitudes and behaviours that instigate radical beliefs and behaviours in another set. So psychological warfare techniques on one group that may or may not produce compliant behaviour stimulates another group to empathise with the victims thus producing an overall practical negative influence. Influence campaigns cannot be separated from the physical environment in which they are executed. If good politics requires good influence campaigns then good influence campaigns require good politics to back them up. This paper will examine the relationships between short term influence campaigns and compare them with the more long term socialising effects such as early education, family and physical attributes that have on attitudes and beliefs which result in the development of such behaviours as terrorism.

Playground design suggestions for downtown communities : with a case study of Hepanxincheng in Hunnanxinqu, Shenyang

Outdoor playgrounds in downtown communities play an important role in children's healthy development. They could provide places for children's outdoor play activities, enhance opportunities for peer interactions, add to community dynamic, and improve urban environment. The literature of three aspects is reviewed first, including (1) the impact of the physical environment on children's development, (2) the benefits of outdoor play environments, and (3) the importance of outdoor play environments in downtown communities. After this literature review, suggestions on outdoor playground design in downtown communities are given, based on a case study of the playground design in Hepanxincheng located in Hunnanxinqu, Shenyang, Liaoning Province.

An integrated theory of sexual offending

This paper represents a first attempt to provide an integrated framework to explain the onset, development, and maintenance of sexual offending. According to the Integrated Theory of Sexual Offending (ITSO), sexual abuse occurs as a consequence of a number of interacting causal variables. We examine the factors that affect brain development (evolution, genetic variations and neurobiology) and ecological factors (social and cultural environment, personal circumstances, physical environment) and discuss how they impact upon core neuropsychological functions underpinning human action. The ITSO then explains how clinical symptoms arise from the interaction between these neurological systems and ecological factors. The capacity of the ITSO to incorporate competing theories of sexual offending is considered, and we end the paper by critically evaluating its usefulness in stimulating research and further theory development.

Mapping landscape features and values in coastal Australia

Places encompass the physical setting, as well as human experience and interpretation. Although sense of place definition nominally includes the physical environment, most research has emphasized the social construction of sense of place and neglect the important contribution of the physical environment to place meanings and attachment. On the other side, theoretical and technological developments during the past decades resulted in significant sophistication and power of analysis, display, and interpretation of spatial information applied in landscape analysis. This development, however, remains disconnected from the socio-political realities of the communities and regions which are the subject of these studies. There is a research need to integrate public perceptions and attitudes with the type of information typically found in a landscape assessment. A challenge of GIS is whether or not Cartesian space can be adapted to incorporate a more humanistic sense and understanding of distance, direction, and position.

Neighbourhood environments and children's social capital : investigating the pattern of relationships

The main purpose of this work was to investigate the pattern of relationships among three constructs: neighbourhood socio-physical environment, children's social interactions and their social capital. This work was designed as a two-phase mixed-methods research. Phase I included several qualitative studies to develop a scale of neighbourhood socio-physical environment, a scale of children's social interactions and a scale of children's social capital. Phase II was a cross-national survey that used these three scales to collect information from high school students in Beijing and Sydney. The main finding of this work was that there were strong and significant correlations among the three constructs. Children's assessment of their neighbourhood socio-physical environment was positively correlated with their social interactions and social capital, which indicated that children who lived in better neighbourhoods had more social interactions and larger volumes of social capital. Strong positive relationship was also found between children's social interactions and social capital, which implied that better-connected children interacted with their friends more.

Contribution of climate and air pollution to variation in coronary heart disease mortality rates in England

There are substantial geographic variations in coronary heart disease (CHD) mortality rates in England that may in part be due to differences in climate and air pollution. An ecological cross-sectional multi-level analysis of male and female CHD mortality rates in all wards in England (1999–2004) was conducted to estimate the relative strength of the association between CHD mortality rates and three aspects of the physical environment - temperature, hours of sunshine and air quality. Models were adjusted for deprivation, an index measuring the healthiness of the lifestyle of populations, and urbanicity. In the fully adjusted model, air quality was not significantly associated with CHD mortality rates, but temperature and sunshine were both significantly negatively associated (p<0.05), suggesting that CHD mortality rates were higher in areas with lower average temperature and hours of sunshine. After adjustment for the unhealthy lifestyle of populations and deprivation, the climate variables explained at least 15% of large scale variation in CHD mortality rates. The results suggest that the climate has a small but significant independent association with CHD mortality rates in England.

Fire and its interaction with ecological processes in box-ironbark forests

Box-Ironbark forests extend across a swathe of northern Victoria on the inland side of the Great Dividing Range. Although extensively cleared and modified, they support a distinctive suite of plants and animals. Historical fire regimes in this ecosystem are largely unknown, as are the effects of fire on most of the biota. However, knowledge of the ecological attributes of plant species has been used to determine minimum and maximum tolerable fire intervals for this ecosystem to guide current fire management. Here, we consider the potential effects of planned fire in the context of major ecological drivers of the current box-ironbark forests: namely, the climate and physical environment; historical land clearing and fragmentation; and extractive land uses. We outline an experimental management and research project based on application of planned burns in different seasons (autumn, spring) and at different levels of burn cover (patchy, extensive). A range of ecological attributes will be monitored before and after burns to provide better understanding of the landscape-scale effects of fire in box-ironbark forests. Such integration of management and research is essential to address the many knowledge gaps in fire ecology, particularly in the context of massively increased levels of planned burning currently being implemented in Victoria.