An individualized psychosocial approach for "treatment resistant" behavioral symptoms of dementia among aged care residents

Background: Behavioral symptoms of dementia are common among residents in mainstream aged care settings, and have a substantial impact on residents and professional caregivers. This study evaluated the impact of individualized psychosocial interventions for behavioral symptoms through a small preliminary study.
Method: Interventions were delivered to a patient group of 31 psychogeriatric aged care residents who presented with behavioral symptoms of dementia that had failed to respond to pharmacological treatment approaches. Outcome data on severity of behaviors, health service utilization and staff burden of care were collected.
Results: A modest but significant reduction in staff ratings of the severity of aggressive and verbally agitated behavioral symptoms was found, with an associated reduction in their perceptions of the burden of caring for these patients. Reduced behavioral disturbance was associated with a reduction in the requirement for primary care consultations, and all participants were able to continue to reside in mainstream aged care facilities, despite an increase in the severity of dementia.
Conclusions: This study supported the use of individualized psychological strategies for behavioral symptoms at all stages of dementia. Methodological limitations of this preliminary study are discussed.

Perceived quality and availability of fruit and vegetables are associated with perceptions of fruit and vegetable affordability among socio-economically disadvantaged women

Objective Perceptions that fruit and vegetables are expensive have been found to be associated with lower consumption of fruit and vegetables among disadvantaged women; however, the determinants of these perceptions are relatively unknown. The purpose of the current paper is to examine whether perceived availability and quality of fruit and vegetables, and social support for healthy eating, are associated with perceptions of fruit and vegetable affordability among women residing in disadvantaged neighbourhoods.

Design Cross-sectional self-report survey.

Setting The study was conducted in Melbourne, Australia.

Subjects An Australian sample of 4131 women, aged 18–45 years, residing in neighbourhoods ranked in the lowest Victorian tertile of relative disadvantage by the Australian Bureau of Statistics, an index that considers aspects of disadvantage such as residents’ income, education, motor vehicle access and employment.

Results Results showed that irrespective of education, income and other key covariates, women who perceived poor availability and quality of fruit and vegetables in their local neighbourhood were more likely to perceive fruit and vegetables as expensive.

Conclusions Our results suggest that perceptions of fruit and vegetable affordability are not driven exclusively by lack of financial or knowledge-related resources, but also by women's psychological response and interpretation of their local nutrition environment.

Using strategic philanthropy to improve heritage tourist sites on the Gallipoli Peninsula, Turkey : community perceptions of changing quality of life and of the sponsoring organization

This paper examines the “Respect for History” project on Turkey's Gallipoli Peninsula sponsored by a Turkish oil company, OPET. The project sought to enhance and protect the cultural and historical experiences of tourists visiting Gallipoli, and to bring direct and indirect benefits to local communities through enhancing tourism-related business opportunities and improving community infrastructure. This research investigates the project's impact on residents’ perceived social and economic wellbeing, using a quality of life framework, and also ascertains residents’ views of the sponsoring firm. The context illustrates key differences between pure philanthropy and strategic philanthropy; the latter defined as doing good by purposefully achieving corporate and civic benefits. The role of strategic philanthropy as a sustainable tourism development tool, and its impact on tourism governance, are considered. Data were collected from 674 residents on the Turkish Gallipoli Peninsula in areas impacted by OPET's investment program. The results, using structural equation modelling (SEM), identify that respondents generally believe that both their economic and social quality of life have improved. This, in turn, has positively influenced respondents’ views of the sponsoring organization. The concept of strategic philanthropy appears valuable as a private sector, non-tourism, sustainable tourism development tool in some circumstances.

Migration and the right to social security: perceptions of off-farm migrants' rights to social insurance in China's Jiangsu Province

In 2001 China ratified the International Covenant on Economic, Social and Cultural Rights. By so doing the national government became legally bound, "to the maximum of its available resources", to achieve "progressively" full realization of the rights specified in the Covenant. Included amongst these entitlements is the "right of everyone to social security, including social insurance". This paper uses data from Jiangsu to examine the extent to which urbanites agree that previously disenfranchised migrants have the same right to social insurance as the urban population. Many urbanites fear that their existing entitlements to social protection will be diluted if social insurance coverage is extended to include new populations. Accordingly, state agencies and the media have sought to promote acceptance of a more positive view of migrant workers than has traditionally prevailed within towns and cities. We find that younger urban residents, urban residents who already have social insurance and urban residents working in the state-owned sector are more likely to agree that migrants have the same right to social insurance as the urban population. © 2007 Institute of World Economics and Politics, Chinese Academy of Social Sciences.

Public values and perceptions of industrial heritage in the Keweenaw Peninsula, Michigan

The purpose of this research is to assess public values and perceptions concerning industrial heritage in the Keweenaw by studying visitors at an endangered mining site tour. This research presents and analyzes feedback collected directly from participants in the Cliff Mine (Michigan) archaeological field school public tour surveys in June 2011, gathers semi-structured interview data from survey participants and local experts, and synthesizes and collates both survey and interview data. As those who study heritage site visitors have found, in all outreach there is a necessity for deeper understanding of visitors for the outreach to be effective. An appropriate metric for collecting public values and opinions was created and used at the Cliff Mine archaeological field school public tours. To accomplish research goals, an opinion survey was created to collect demographic information and qualitative feedback from visitors at the Cliff Mine field school. The survey, a pre-tour and post-tour question list, found that all visitors who filled out a survey supported preservation and most were adults over 46 years of age. Most visitors were white-collar professionals, identified as local residents, and found out about the tour through the newspaper. Interview questions were constructed to supplement and expand on the visitor survey results. In addition, local experts involved in Keweenaw heritage were interviewed. All interviewees supported heritage preservation but often had conflicting views when activities such as mineral collecting were factored into the preservation question. By analyzing responses to the survey and interviews, improvements to outreach efforts at the Cliff Mine are recommended. Future research should further explore perceptions of social class and identity, and should seek out stakeholders not contacted through this research, in order to improve outreach and include all community groups.

A Su Salud Injury Prevention expansion: Analysis of injury prevention perceptions in a Hispanic community

Unintentional injury is the leading cause of death for American ages one to 44 and is ranked in the top ten causes of death for all age groups (CDC, 2006a). A Su Salud Injury Prevention was developed to address injury prevention awareness and education. The program is a mass media education campaign that uses role models, mass media, and community outreach to prevent injury. In 2009, University Health System (UHS) expanded the program. Baseline data were collected from 426 residents in targeted neighborhoods northwest of downtown San Antonio to support the expansion. The purpose of this study was to explore injury perceptions, knowledge, and behaviors of adults living in the expansion area, and define the predominant factors associated with these perceptions. A secondary aim was to assess community awareness and willingness to participate in the program.^ Survey results showed motor vehicle crashes (MVC), falls, drinking and driving, and guns and assaults were considered the most serious injures for adults. The most serious child injuries were MVC, abuse and neglect, falls, and head injuries. Residents were knowledgeable of state seatbelt policy, and over 90% responded as compliant for seatbelt and child car seat use. Most were knowledgeable about drinking and driving state policy and negative outcomes. However, 70% of those reporting driving under the influence of alcohol within the last year engaged in repeat high risk behavior. Men and residents under the age of 55 were more likely to engage in repeat drinking and driving (OR= 3.6, 7.0 respectively). Residents consider injury prevention an important issue, and have interest in a local injury prevention program. Younger women are the most likely to participate in a local program as potential role models and volunteers.^ Results from the study are summarized into an injury prevention and demographic profile of the community that will be used to develop tailored injury prevention messages to create a more effective program, and support program coordinators in effective community engagement. Results will also be used as a comparative basis for future evaluation of a behavioral injury prevention program focused on a predominantly Mexican-American community.^

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.

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.

The drivers of perception: Identifying the driving factors of resident perceptions of municipal service quality in cities of South Florida

The idea of comparative performance assessment is crucial. Recent study findings show that in South Florida the use by most municipalities of external benchmarks for performance comparison is virtually non-existent. On one level this study sought to identify the factors impacting resident perceptions of municipal service quality. On a different and more practical level, this study sought to identify a core set of measures that could serve for multi jurisdictional comparisons of performance. ^ This study empirically tested three groups of hypotheses. Data were collected via custom designed survey instruments from multiple jurisdictions, representing diverse socioeconomic backgrounds, and across two counties. A second layer of analysis was conducted on municipal budget documents for the presence of performance measures. A third layer of analysis was conducted via face-to-face interviews with residents at the point of service delivery. Research questions were analyzed using descriptive and inferential statistic methodologies. ^ Results of survey data yielded inconsistent findings. In absolute aggregated terms, the use of sociological determinants to guide inquiry failed to yield conclusive answers regarding the factors impacting resident perceptions of municipal service quality. At disaggregated community levels, however, definite differences emerged but these had weak predictive ability. More useful were the findings of performance measures reporting via municipal budget documents and analyses of interviews with residents at the point of service delivery. Regardless of socio-economic profile, neighborhood characteristics, level of civic engagement or type of community, the same aspects were important to citizens when making assessments of service quality. For parks and recreation, respondents most frequently cited maintenance, facility amenities, and program offerings as important while for garbage collection services timely and consistent service delivery mattered most. Surprisingly municipalities participating in the study track performance data on items indicated as important by citizen assessments but regular feed back from residents or reporting to the same is rarely done. ^ The implications of these findings suggest that endeavors, such as the one undertaken in this study, can assist in determining a core set of measures for cross jurisdictional comparisons of municipal service quality, improving municipal delivery of services, and to communicate with the public. ^

Perceptions of the Beach Users: A Case Study of the Coastal Areas of North Cyprus Towards Establishment of a "Carrying Capacity"

Within the main elements of economic sustainability, socio-cultural sustainability, and environmental sustainability, the criteria of 'carrying capacity’ have ben emphasized through residents’ perception analysis to explore practical methods towards the application and implementation of such criteria. As data analysis revealed, the main tourist resources in the case of North Cyprus –the coast and the beach- have a certain capacity to sustain the impact and pressure of tourism. Despite the significance of the indigenous environment and with respect to the residents’ perception of optimum carrying capacity levels, this issue has not been given a due consideration. This has resulted in a process of coastal development which bypasses any measure ore application of a standard to harmonize the degree of physical development and the capacity of the beach. The main objective of this paper is to establish the concept of ‘carrying capacity’ as the means to achieve the reconciliation of environmental impacts with tourism development. The study concludes that, if carrying capacity measurement and its implementation are not incorporated into the planning decision as a clear policy, there will be grave negative consequences for those resources attracting visitors.

Motivating residents to combat invasive species on private lands: social norms and community reciprocity

Invasive species (IS) threaten biodiversity and ecosystem functioning. To achieve landscape-scale reductions in IS and the associated gains for biodiversity, IS control efforts must be expanded across private lands. Enhancing IS control across private lands requires an understanding of the factors that motivate residents to engage or prohibit residents from engaging in efforts to control IS. Drawing from the collective interest model and literature, we sought to understand how a wide range of interpersonal, intrapersonal, and contextual factors might influence resident action around combating the invasive tree albizia (Falcataria moluccana), in the Puna District of Hawaiʻi. To do so, we used a cross-sectional survey of 243 residents and elastic net regression techniques. We found that residents’ actions related to IS control were related to their perceptions of social norms and community reciprocity regarding albizia control, as well as their knowledge of effective control strategies and their risk perceptions regarding albizia. These findings suggest that, although common intervention approaches that focus on providing education or subsidies are important, they may be more effective at reducing the spread of IS if coupled with approaches that build community reciprocity and norms.

Resident perceptions of natural resources between cities and across scales in the Pacific Northwest

As the global population becomes increasingly urban, research is needed to explore how local culture, land use, and policy will influence urban natural resource management. We used a broad-scale comparative approach and survey of residents within the Portland (Oregon)-Vancouver (Washington) metropolitan areas, USA, two states with similar geographical and ecological characteristics, but different approaches to land-use planning, to explore resident perceptions about natural resources at three scales of analysis: property level (“at or near my house”), neighborhood (“within a 20-minute walk from my house”), and metro level (“across the metro area”). At the metro-level scale, nonmetric multidimensional scaling revealed that the two cities were quite similar. However, affinity for particular landscape characteristics existed within each city with the greatest difference generally at the property-level scale. Portland respondents expressed affinity for large mature trees, tree-lined streets, public transportation, and proximity to stores and services. Vancouver respondents expressed affinity for plentiful accessible parking. We suggest three explanations that likely are not mutually exclusive. First, respondents are segmented based on preferences for particular amenities, such as convenience versus commuter needs. Second, historical land-use and tax policy legacies may influence individual decisions. Third, more environmentally attuned worldviews may influence an individual’s desire to produce environmentally friendly outcomes. Our findings highlight the importance of acknowledging variations in residents’ affinities for landscape characteristics across different scales and locations because these differences may influence future land-use policies about urban natural resources.

Stakeholder perceptions of ecosystem services of the Wami River and Estuary

Management of riverine and coastal ecosystems warrants enhanced understanding of how different stakeholders perceive and depend upon different kinds of ecosystem services. Employing a mixed methods approach, this study compares and contrasts the use and perceptions of upstream residents, downstream residents, tourism officials, and conservation organizations regarding the value of 30 ecosystem services provided by the Wami River and its estuary in Tanzania, and investigates their perceptions of the main threats to this system. Our findings reveal that all of the stakeholder groups place a high value on the provision of domestic water, habitat for wild plants and animals, tourism, and erosion control, and a relatively low value on the prevention of saltwater intrusion, refuge from predators, spiritual fulfillment, nonrecreational hunting, and the provision of traditional medications and inorganic materials for construction. Differences emerge, however, between the groups in the value assigned to the conservation of riverine and estuarine fauna and the provision of raw materials for building and handicrafts. Declining fish populations and an increasing human population are identified by the residents and conservation employees, respectively, as their prime concerns regarding the future conditions of the Wami River and its estuary. These groups also acknowledge increasing salinity levels and the loss of mangroves as other key concerns. The identification of these mutual interests and shared concerns can help build common ground among stakeholders while the recognition of potential tensions can assist managers in balancing and reconciling the multiple needs and values of these different groups.

Community perceptions of collaborative processes for managing freshwater resources

Six of New Zealand’s 16 regional councils are trialling collaborative planning as a means of addressing complex challenges in freshwater management. Although some work has been undertaken to evaluate similarities and differences across those processes, the success or failure rests with the public’s acceptance of the processes and their outcomes. This is the first study to evaluate public perceptions of freshwater management in regions with collaborative processes. We surveyed 450 respondents in Hawke’s Bay, Northland, and Waikato, some of whom live in catchments in which collaborative processes are under way and some of whom do not. In addition to assessing awareness of the collaborative planning processes, the survey measured perceptions regarding the regional council’s management of freshwater resources, the extent of agreement regarding freshwater management among various interests, the fairness of freshwater management, and the extent to which respondents believe that their interests and concerns are included in freshwater management. We hypothesized that relative to respondents in parts of the region in which traditional processes are in places, respondents in catchments with collaborative management of freshwater resources would have more positive perceptions of management, agreement, fairness, and interests, even if there is low awareness that a collaborative planning process is under way. Survey results indicate that knowledge of collaborative processes is generally low and that living in catchments with collaborative processes does not impact respondents’ perceptions of management, agreement, fairness, or interests in Northland or Waikato. However, relative to Hawke’s Bay respondents living outside of the collaborative catchment, respondents living inside the collaborative catchment believe that the regional council’s freshwater management is better and fairer. Moreover, Hawke’s Bay residents living inside the collaborative catchment perceive less conflict over freshwater management than Hawke’s Bay respondents living outside the collaborative catchment. Further research is needed to identify the reasons for this regional variation.

Government management of tourism in fostering residents support for sustainable tourism development: Evidence from a Portuguese historic town

This study proposes a conceptual framework that explores the correlations between economic dependence (ED), local government management of tourism (GMT), perceived tourism benefits and costs, and support for sustainable tourism development (STD). A quantitative research design was adopted. Data collection was carried out by personal survey applied to 300 residents of the small historic town of Lamego, located within the Douro Valley World Heritage Site. Structural equation modelling methods were employed to analyse the proposed model. Results suggest that GMT has a significant effect on the perceived impacts of tourism, both in the positive and in the negative. The effect of GMT in fostering residents’ support to STD was also empirically supported. Additionally, it was also determined that positive perceptions of the impacts of tourism directly influence support to STD. Nevertheless, ED does not have a significant effect either on perceivedbenefits, nor on perceived costs or on residents’ support to STD. Likewise, perceptions of the negative impacts do not predict residents’ support to STD.