Severe obesity and diabetes self-care attitudes, behaviours and burden: implications for weight management from a matched case-controlled study.

Aims
To investigate whether diabetes self-care attitudes, behaviours and perceived burden, particularly related to weight management, diet and physical activity, differ between adults with Type 2 diabetes who are severely obese and matched non-severely obese control subjects.

Methods
The 1795 respondents to the Diabetes MILES—Australia national survey had Type 2 diabetes and reported height and weight data, enabling BMI calculation: 530 (30%) were severely obese (BMI ≥ 35 kg/m2; median BMI = 41.6 kg/m2) and these were matched with 530 control subjects (BMI < 35 kg/m2; median BMI = 28.2 kg/m2). Diabetes self-care behaviours, attitudes and burden were measured with the Diabetes Self-Care Inventory—Revised. Within-group and between-group trends were examined.

Results
The group with BMI ≥ 35 kg/m2 was less likely to achieve healthy diet and exercise targets, placed less importance on diet and exercise recommendations, and found the burden of diet and exercise recommendations to be greater than the group with BMI < 35 kg/m2. The group with BMI ≥ 35 kg/m2 was more likely to be actively trying to lose weight, but found weight control a greater burden. These issues accentuated with increasing obesity and were greatest in those with BMI > 45 kg/m2. There were no between-group differences in other aspects of diabetes self-care: self-monitoring of blood glucose, use of medications and smoking. Moderate-to-severe symptoms of depression were independently associated with reduced likelihood of healthy diet and physical activity, and with greater burden associated with diet, physical activity and weight management.

Conclusions
Severely obese people with diabetes demonstrated self-care attitudes, behaviours and burdens that infer barriers to weight loss. However, other important diabetes self-care behaviours are supported equally by severely obese and non-severely obese individuals.

A prospective analysis of pain experience, beliefs and attitudes, and pain management in a cohort of Danish surgical patients.

Background: 

Management of obesity: attitudes and practices of Australian dietitians

OBJECTIVE: To document attitudes and current practices of Australian dietitians in the management of overweight and obesity, and to examine their training needs.

DESIGN: Cross-sectional postal survey of a randomly selected sample of members of the Dietitians Association of Australia.

SUBJECTS: 400 dietitians (66% of those surveyed).

MEASURES: Questionnaire-based measures of dietitian's views of obesity, education and training in weight management, definitions and perceptions of success, professional preparedness, approaches to weight management, strategies recommended for weight management, and problems and frustrations experienced.

RESULTS: Dietitians viewed themselves as potential leaders in the field of weight management, and saw this area as an important part of their role. While they considered themselves to be the best-trained professionals in this area, many felt that their training was poor and many were pessimistic about intervention outcomes. Despite this, most dietitians held views that were current, and regularly employed many of the elements of known best practice in management. However, important areas of weakness included: providing opportunities for long-term follow-up; providing a range of management interventions; promoting self-monitoring of diet and exercise; and promoting opportunities for social support.

CONCLUSIONS: This study suggests that training in and advocacy for the management and prevention of overweight and obesity are priority areas for dietitians, and that formal studies to evaluate dietitians' effectiveness in management should be undertaken.

Obesity management: Australian general practitioners' attitudes and practices

Objectives: To document general practitioners’ (GPs) attitudes and practices regarding the prevention and management of overweight and obesity.

Research Methods and Procedures: A cross-sectional survey of a randomly selected sample of 1500 Australian GPs was conducted, of which 752 questionnaires were returned. The measures included views on weight management, definitions of success, views regarding the usefulness of drugs, approaches to and strategies recommended for weight management, and problems and frustrations in managing overweight and obesity.

Results: GPs view weight management as important and feel they have an important role to play. Although they consider themselves to be well prepared to treat overweight patients, they believe that they have limited efficacy in weight management and find it professionally unrewarding. GPs view the assessment of a patient's dietary and physical activity habits and the provision of dietary and physical activity advice as very important. The approaches least likely to be considered important and/or least likely to be practiced were those that would support the patient in achieving and maintaining lifestyle change.

Discussion: There remains considerable opportunity to improve the practice of GPs in their management of overweight and obesity. Although education is fundamental, it is important to acknowledge the constraints of the GPs’ existing working environment.

Should I and Can I?: a mixed methods study of clinician beliefs and attitudes in the management of lifestyle risk factors in primary health care

Background
Primary health care (PHC) clinicians have an important role to play in addressing lifestyle risk factors for chronic diseases. However they intervene only rarely, despite the opportunities that arise within their routine clinical practice. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about this for PHC clinicians working outside general practice. The aim of this study was to explore the beliefs and attitudes of PHC clinicians about incorporating lifestyle risk factor management into their routine care and to examine whether these varied according to their self reported level of risk factor management.

Methods
A cross sectional survey was undertaken with PHC clinicians (n = 59) in three community health teams. Clinicians' beliefs and attitudes were also explored through qualitative interviews with a purposeful sample of 22 clinicians from the teams. Mixed methods analysis was used to compare beliefs and attitudes for those with high and low levels of self reported risk factor management.

Results
Role congruence, perceived client acceptability, beliefs about capabilities, perceived effectiveness and clinicians' own lifestyle were key themes related to risk factor management practices. Those reporting high levels of risk factor screening and intervention had different beliefs and attitudes to those PHC clinicians who reported lower levels.

Conclusion
PHC clinicians' level of involvement in risk factor management reflects their beliefs and attitudes about it. This provides insights into ways of intervening to improve the integration of behavioural risk factor management into routine practice.

On land management: landowners' attitudes to land and farming in Valdera, Tuscany

This thesis aims at explaining the intersecting dynamics of structural changes in agriculture and urbanisation, which involves changes in urban-rural relationships. The research questions are: how and why do landowners differ in their attitudes to land and farming? what are the main implications on rural landscapes and the policy implications? Relationships between urbanisation and agriculture are firstly analysed through a critical literature review; the analysis focuses on the 'landowner' as the key actor who actively takes decisions on the rural landscape From the empirical study – which is based on a Tuscan area (Valdera), and addressed through qualitative methods – a great diversity of landowners' attitudes to land and farming emerge, thus contributing to the agricultural restructuring, such as: 1) the emphasis on recreational function of the countryside for urban people 2) contracting out of land management, especially when landowners live or/and have 'urban' employment 3) the active role of hobby farmers in land management 4) agricultural operations simplification and lack of investments (especially in case of property rights expropriation). The thesis is framed in three papers, with the same methods and research questions. It seems evident that rural landscapes is subjected to functional changes (e.g. residential) and structural changes (landscape polarisation), which requires the need 1) to consider that rural landscape management is increasingly less connected to agricultural production as economic activity; 2) to give a coherence to the range of policy interventions (physical planning, landscape, sectoral).

Understanding Michigan nonindustrial private forest landowners attitudes and knowledge about forest management

Approximately one-fourth of the non-industrial private forestland (NIPF) owners in the state of Michigan, who collectively own approximately 50% of the private forested land, have conducted commercial timber harvest in recent years. Previous studies indicated that NIPFs preferred to manage their forest for a sustained yield of high-quality timber, but were limited to even-aged regeneration treatments or conversion for uneven-aged silviculture due to previous cuttings. Improved knowledge about NIPF’s intentions and forest management behavior could be useful for successful implementation of sustained yield management. This study’s objective was to identify more active NIPF’s attitudes towards timber management, their forest management practices and whether their forest management behavior leads or leads not to q management for sustained yield. Active NIPF’s intentions to harvest timber for biofuels and its suitability with NIPF’s forest management behavior will be discussed. Phone interviews of 30 NIPFs who have experience with commercial timber harvests were conducted between August and October 2011. All interviews were recorded, transcribed, and analyzed for identifying NIPF’s motivations, attitudes, forest management behavior and forestry related knowledge. Interviewees, whether consciously or not, tended to manage their land for a sustained yield and they would be willing to harvest timber for biofuels facility as long as it benefits landowners management goals.

Teachers' Acculturation Attitudes and their Classroom Management: an empirical study among fifth-grade primary school teachers in Switzerland

This article investigates the influence of attitudes towards acculturation of 180 primary school teachers on their classroom management. The results indicate that teachers with integrative attitudes towards immigrant students' acculturation have a high propensity to punish students for disruptive behaviour, but they also demonstrate high levels of diagnostic expertise in social areas. Teachers with assimilative attitudes are also likely to punish students for misbehaviour, but tend to have a deficiency in the ability to diagnose social tensions among students. Teachers with assimilative attitudes who report high levels of disruptive behaviour in their classroom have the strongest tendency to punish and the lowest level of diagnostic expertise in social areas.

Attitudes and management of alcohol problems in general practice: Descriptive analysis based on findings of a world health organization international collaborative survey

Aims: To determine if general practitioners' (GPs) experience of education on alcohol, support in their working environment for intervening with alcohol problems, and their attitudes have an impact on the number of patients they manage with alcohol problems. Methods: 1300 GPs from nine countries were surveyed with a postal questionnaire as part of a World Health Organization (WHO) collaborative study. Results: GPs who received more education on alcohol (OR = 1.5; 95% CI, 1.3-1.7), who perceived that they were working in a supportive environment (OR = 1.6; 95% CI, 1.4-1.9), who expressed higher role security in working with alcohol problems (OR = 2.0; 95% CI, 1.5-2.5) and who reported greater therapeutic commitment to working with alcohol problems (OR = 1.4: 95% CI, 1.1-1.7) were more likely to manage patients with alcohol-related harm. Conclusion: Both education and support in the working environment need to be provided to enhance the involvement of GPs in the management of alcohol problems.

Factors affecting student attitudes toward flexible online learning in management education

In response to recent technological advances and the trend toward flexible learning in education, the authors examined the factors affecting student satisfaction with flexible online learning. The authors identified 2 key student attributes of student satisfaction: (a) positive perceptions of technology in terms of ease of access and use of online flexible learning material and (b) autonomous and innovative learning styles. The authors derived measures of perceptions of technology from research on the Technology Acceptance Model and used locus of control and innovative attitude as indicators of an autonomous and innovative learning mode. First-year students undertaking an introductory management course completed surveys at the beginning (n = 248) and at the end (n = 256) of course work. The authors analyzed the data by using structural equation modeling. Results suggest that student satisfaction is influenced by positive perceptions toward technology and an autonomous learning mode.