Using the Precede-Proceed Model of Health Program Planning in breast cancer nursing research

Aim: In this paper we discuss the use of the Precede-Proceed model when investigating health promotion options for breast cancer survivors. Background: Adherence to recommended health behaviors can optimize well-being after cancer treatment. Guided by the Precede-Proceed approach, we studied the behaviors of breast cancer survivors in our health service area. Data sources: The interview data from the cohort of breast cancer survivors are used in this paper to illustrate the use of Precede-Proceed in this nursing research context. Interview data were collected from June to December 2009. We also searched Medline, CINAHL, PsychInfo and PsychExtra up to 2010 for relevant literature in English to interrogate the data from other theoretical perspectives. Discussion: The Precede-Proceed model is theoretically-complex. The deductive analytic process guided by the model usefully explained some of the health behaviors of cancer survivors, although it could not explicate many other findings. A complementary inductive approach to the analysis and subsequent interpretation by way of Uncertainty in Illness Theory and other psychosocial perspectives provided a comprehensive account of the qualitative data that resulted in contextually-relevant recommendations for nursing practice. Implications for nursing: Nursing researchers using Precede-Proceed should maintain theoretical flexibility when interpreting qualitative data. Perspectives not embedded in the model might need to be considered to ensure that the data are analyzed in a contextually-relevant way. Conclusion: Precede-Proceed provides a robust framework for nursing researchers investigating health promotion in cancer survivors; however additional theoretical lenses to those embedded in the model can enhance data interpretation.

The association between leisure motivation and recovery: A pilot study

Background and aims: Recovery from mental illness may be facilitated by participation in activities that provide meaning and purpose in the lives of consumers. Leisure participation can be a major source of enjoyment as well as mental and physical well-being. Methods and results: This study examined the association between consumers’ motivation to engage in leisure and their self-reported perception of recovery in a sample of 44 Clubhouse members. The Leisure Motivation Scale and the Recovery Assessment Scale were used to measure the association between leisure motivation and recovery. The results indicated a statistically significant association between leisure motivation and recovery. Conclusion: These findings have implications for service delivery within mental health settings, as occupational therapists may be able to design leisure-based programs more effectively if they can understand the needs and motives for participation. More emphasis should be placed on supporting consumers to re-integrate and be socially included within the community through leisure-based initiatives.

Hormones down under: Hormone therapy use after the Women's Health Initiative

Aims:  The primary objective was to describe the usage pattern of hormone therapy (HT) in a sample of urban Australian women in 2001 and to assess the characteristics of users vs. non-users. The second objective was to determine whether there had been any change in usage since the publication of the results of the combined oestrogen plus progestagen arm of the Women's Health Initiative (WHI) in 2002. Methods:  A cohort of 374 postmenopausal women aged 50–80 years participated in this substudy of the LAW (Longitudinal Assessment of Ageing in Women) project: a 5-year multidisciplinary, observational study. Participants completed an annual medical assessment including details of the use of HT and the reasons for use, as well as demographic and psychosocial data. Results:  In December 2001, 30.8% of the participants were using HT, whereas 55.4% were ever users. The management of vasomotor symptoms and mood disturbance were the primary reasons for use. Of those who had been using HT in December 2001 (24.4%) women ceased using HT in the 3 months following publication of the WHI results. The percentage of women using HT in December 2003 (13.9%) was less than half of that of December 2001. Conclusion:  The rate of HT use and the reasons for use, in 2001 in Brisbane was similar to that of other Australian regions. Usage of HT decreased since the publication of the WHI results in 2002 which may reflect changing attitudes by patients and practitioners regarding HT.

Enhancing employment services for people with severe mental illness: the challenge of the Australian service environment

Objectives:  Comparatively few people with severe mental illness are employed despite evidence that many people within this group wish to obtain, can obtain and sustain employment, and that employment can contribute to recovery. This investigation aimed to: (i) describe the current policy and service environment within which people with severe mental illness receive employment services; (ii) identify evidence-based practices that improve employment outcomes for people with severe mental illness; (iii) determine the extent to which the current Australian policy environment is consistent with the implementation of evidence-based employment services for people with severe mental illness; and (iv) identify methods and priorities for enhancing employment services for Australians with severe mental illness through implementation of evidence-based practices. Method:  Current Australian practices were identified, having reference to policy and legal documents, funding body requirements and anecdotal reports. Evidence-based employment services for people with severe mental illness were identified through examination of published reviews and the results of recent controlled trials. Results:  Current policy settings support the provision of employment services for people with severe mental illness separate from clinical services. Recent studies have identified integration of clinical and employment services as a major factor in the effectiveness of employment services. This is usually achieved through co-location of employment and mental health services. Conclusions:  Optimal evidence-based employment services are needed by Australians with severe mental illness. Providing optimal services is a challenge in the current policy environment. Service integration may be achieved through enhanced intersectoral links between employment and mental health service providers as well as by co-locating employment specialists within a mental health care setting.

Strategic dalliances as an enabler for discontinuous innovation in slow clockspeed industries: evidence from the oil and gas industry

The concept of ‘strategic dalliances’– defined as non-committal relationships that companies can ‘dip in and out of,’ or dally with, while simultaneously maintaining longer-term strategic partnerships with other firms and suppliers – has emerged as a promising strategy by which organizations can create discontinuous innovations. But does this approach work equally well for every sector? Moreover, how can these links be effectively used to foster the process of discontinuous innovation? Toward assessing the role that industry clockspeed plays in the success or failure of strategic dalliances, we provide case study evidence from Twister BV, an upstream oil and gas technology provider, and show that strategic dalliances can be an enabler for the discontinuous innovation process in slow clockspeed industries. Implications for research and practice are discussed, and conclusions from our findings are drawn.

Which older women could benefit from interventions to decrease sitting time and increase physical activity?

In addition to the well-known health risks associated with lack of physical activity (PA), evidence is emerging about the health risks of sedentary behaviour (sitting). Research about patterns and correlates of sitting and PA in older women is scarce. METHODS: Self-report data from 6,116 women aged 76-81 years were collected as part of the Australian Longitudinal Study on Woman’s Health. Linear regression models were computed to examine whether demographic, social and health factors were associated with sitting and PA. RESULTS: Women who did no PA sat more than women who did any PA (p<0.001). Seven correlates were associated with sitting and PA (p<0.05). Five of these were associated with more sitting and less PA: three health-related (BMI, chronic conditions, anxiety/depression) and two social correlates (caring duties, volunteering). One demographic (being from another English-speaking country) and one social correlate (more social interaction) were associated with more sitting and more PA. Four correlates, two demographic (living in a city; post-high school education), one social (being single), and one health-related correlate (dizziness/loss of balance) were associated with more sitting only. Two other health-related correlates (stiff/painful joints; feet problems) were associated with less PA only. CONCLUSION: Sedentary behaviour and PA are distinct behaviours in older Australian women. Information about the correlates of both behaviours can be used to identify population groups who might benefit from interventions to reduce sedentary behaviour and/or increase PA.

Effects of varied ionic calcium and phosphate on the proliferation, osteogenic differentiation and mineralization of human periodontal ligament cells in vitro

Background and Objective: A number of bone filling materials containing calcium (Ca++) and phosphate (P) ions have been used in the repair of periodontal bone defects; however, the effect that local release of Ca++ and P ions have on biological reactions is not fully understood. In this study, we investigated the effects of various levels of Ca++ and P ions on the proliferation, osteogenic differentiation, and mineralization of human periodontal ligament cells (hPDLCs). Materials and Methods: hPDLCs were obtained using an explant culture method. Defined concentrations and ratios of ionic Ca++ to inorganic P were added to standard culture and osteogenic induction media. The ability of hPDLCs to proliferate in these growth media was assayed using the Cell Counting Kit-8 (CCK-8). Cell apoptosis was evaluated by FITC-Annexin V/PI double staining method. Osteogenic differentiation and mineralization were investigated by morphological observations, alkaline phosphatase (ALP) activity, and Alizarin red S/von Kossa staining. The mRNA expression of osteogenic related markers was analyzed using a reverse transcriptase polymerase chain reaction (RT-PCR). Results: Within the ranges of Ca++ and P ions concentrations tested, we observed that increased concentrations of Ca++ and P ions enhanced cell proliferation and formation of mineralized matrix nodules; whereas ALP activity was reduced. The RT-PCR results showed that elevated concentrations of Ca++ and P ions led to a general increase of Runx2 mRNA expression and decreased ALP mRNA expression, but gave no clear trend on OCN mRNA levels. Conclusion: The concentrations and ratios of Ca++ and P ions could significantly influence proliferation, differentiation, and mineralization of hPDLCs. Within the range of concentrations tested, we found that the combination of 9.0 mM Ca++ ions and 4.5 mM P ions were the optimum concentrations for proliferation, differentiation, and mineralization in hPDLCs.

An examination of the predictors of blood donors' intentions to donate during two phases of an avian influenza outbreak

BACKGROUND: Data from prior health scares suggest that an avian influenza outbreak will impact on people’s intention to donate blood; however research exploring this is scarce. Using an augmented theory of planned behavior (TPB), incorporating threat perceptions alongside the rational decision-making components of the TPB, the current study sought to identify predictors of blood donors’ intentions to donate during two phases of an avian influenza outbreak. STUDY DESIGN AND METHODS: Blood donors (N = 172) completed an on-line survey assessing the standard TPB predictors as well as measures of threat perceptions from the health belief model (HBM; i.e., perceived susceptibility and severity). Path analyses examined the utility of the augmented TPB to predict donors’ intentions to donate during a low- and high-risk phase of an avian influenza outbreak. RESULTS: In both phases, the model provided a good fit to the data explaining 69% (low risk) and 72% (high risk) of the variance in intentions. Attitude, subjective norm, and perceived susceptibility significantly predicted donor intentions in both phases. Within the low-risk phase, gender was an additional significant predictor of intention, while in the high-risk phase, perceived behavioral control was significantly related to intentions. CONCLUSION: An augmented TPB model can be used to predict donors’ intentions to donate blood in a low-risk and a high-risk phase of an outbreak of avian influenza. As such, the results provide important insights into donors’ decision-making that can be used by blood agencies to maintain the blood supply in the context of an avian influenza outbreak.

Managing medical advice seeking in calls to Child Health Line

Child Health Line is a 24-hour Australian helpline that offers information and support for parents and families on child development and parenting. The helpline guidelines suggest that nurses should not offer medical advice, however they regularly receive calls seeking such advice. This paper examines how the service guidelines are talked into being through the nurses’ management of caller’s requests for medical advice and information, and shows how nurses orient to the boundaries of their professional role and institutionally regulated authority. Three ways in which the child health nurses manage medical advice and information seeking are discussed: using membership as a nurse to establish boundaries of expertise, privileging parental authority regarding decision making about seeking treatment for their child, and respecifying a ‘medical’ problem as a child development issue. The paper contributes to research on medical authority, and nurse authority in particular, by demonstrating the impact of institutional roles and guidelines on displays of knowledge and expertise. More generally, it contributes to an understanding of the interactional enactment and consequences of service guidelines for telehealth practice, with implications for training, policy and service delivery.

Bullying : the moral and social orders at play

This special issue came about following an international symposium on bullying held in December 2008 at the Department of Child Studies, Linko¨ping University, Sweden, led by Jakob Cromdal and Paul Horton. The articles represent a diverse body of theoretical and empirical work that emphasises children and young people’s views of and participation in everyday experiences. The articles, as a collection, aim to be provocative in terms of challenging some existing dominant understandings about bullying to propose alternate ways to understand this phenomenon.

Does emotion modulate the blink reflex in human conditioning? Startle potentiation during pleasant and unpleasant cues in the picture-picture paradigm

Emotional processes modulate the size of the eyeblink startle reflex in a picture-viewing paradigm, but it is unclear whether emotional processes are responsible for blink modulation in human conditioning. Experiment 1 involved an aversive differential conditioning phase followed by an extinction phase in which acoustic startle probes were presented during CS+, CS-, and intertrial intervals. Valence ratings and affective priming showed the CS+ was unpleasant postacquisition. Blink startle magnitude was larger during CS+ than during CS-. Experiment 2 used the same design in two groups trained with pleasant or unpleasant pictorial USs. Ratings and affective priming indicated that the CS+ had become pleasant or unpleasant in the respective group. Regardless of CS valence, blink startle was larger during CS+ than CS- in both groups. Thus, startle was not modulated by CS valence.

Impact of disability on families : Grandparents’ perspectives

Background Caring for a child with a disability can be a unique and challenging experience, with families often relying on informal networks for support. Often, grandparents are key support resources, yet little is known about their roles and experiences. Reporting on data collected in a larger Australian study, this article explores grandparents' experiences of caring for a child with a disability and the impact on their family relationships and quality of life. Method A qualitative purposive sampling design was utilised; semi-structured interviews were conducted with 22 grandparents (17 women, 5 men) of children with a disability. Grandparents ranged in age from 55 to 75 years old and lived within a 90-min drive of Brisbane, Australia. Interviews were transcribed and responses analysed using a thematic approach, identifying categories, themes and patterns. Findings Four key themes characterised grandparents' views about their role in the family: holding own emotions (decision to be positive), self-sacrifice (decision to put family needs first), maintaining family relationships (being the ‘go-between’) and quality of life for family in the future (concerns about the future). Conclusions Grandparents are central to family functioning and quality of life, but this contribution comes with a significant cost to their own personal well-being. Implications for policy, practice and research are discussed, particularly grandparents' fear that their family could not cope without their support.

Me and my body : the relevance of the difference for the distinction between withdrawing life support and euthanasia

In this paper I discuss David Shaw’s claim that the body of a terminally ill person can be conceived as a kind of life-support, akin to an artificial ventilator. I claim that this position rests upon an untenable dualism between the mind and the body. Given that dualism continues to be attractive to some thinkers, I attempt to diagnose the reasons why it continues to be attractive, as well as to demonstrate its incoherence, drawing on some recent work in the philosophy of psychology. I conclude that, if my criticisms are sound, Shaw’s attempt to deny the distinction between withdrawal and euthanasia fails.

A communitarian theory of the education rights of students with disabilities

There is a lack of writing on the issue of the education rights of people with disabilities by authors of any theoretical persuasion. While the deficiency of theory may be explained by a variety of historical, philosophical and practical considerations, it is a deficiency which must be addressed. Otherwise, any statement of rights rings out as hollow rhetoric unsupported by sound reason and moral rectitude. This paper attempts to address this deficiency in education rights theory by postulating a communitarian theory of the education rights of people with disabilities. The theory is developed from communitarian writings on the role of education in democratic society. The communitarian school, like the community within which it nests, is inclusive. Schools both reflect and model the shape of communitarian society and have primary responsibility for teaching the knowledge and virtues which will allow citizens to belong to and function within society. Communitarians emphasise responsibilities, however, as the corollary of rights and require the individual good to yield to community good when the hard cases arise. The article not only explains the basis of the right to an inclusive education, therefore, but also engages with the difficult issue of when such a right may not be enforceable.