Selective feeding centres in refugee settings: evaluation framework protocol

Selective feeding programs are centres for the treatment of persons suffering from acute malnutrition. Unlike chronic malnutrition, acute malnutrition reflects recent problems. In a crisis situation, wasting is preferred above other indicators because it is sensitive to rapid change, indicates present change, can be used to monitor the impact of interventions and is a good predictor of immediate mortality risk. This paper reviews the current approach being used in the field to evaluate the effectiveness of feeding programs. There is no comprehensive evaluation framework in place to assess the impact of feeding programs on mortality due to malnutrition. Some loose outcome measures, such as the number of children enrolled in a feeding centre, are being used to determine if a feeding centre should continue. In addition, malnutrition prevalence and crude mortality rates determined through nutritional and mortality surveys are used to assess the impact of feeding programs. This procedure does not take into account potential confounding factors that impact on malnutrition prevalence, including access to non-relief foods and the general food ration. Therefore, one could not confidently say that the reduction of malnutrition prevalence is a result of feeding programs. This paper presents an alternative approach to evaluating feeding centres.

A defection analysis of lapsed members of five sporting clubs : examining motivations and behaviours

The issue of defection has been examined primarily in a transactional context as opposed to subscription markets where the infrequent nature of the purchase or renewal means that retention of subscribers is often both more difficult and more crucial. This paper reports on a survey that aimed to uncover more information about the motivations and future intentions of recently lapsed subscribers. 1,011 lapsed members across four Australian Football League (AFL) clubs and one Australian National Rugby League (NRL) club were surveyed. Analysis of the responses returned suggests that although these lapsed members report that they joined to financially support and feel more involved with the club, they let their membership lapse primarily due to an inability to attend games. Despite joining for intangible, altruistic reasons, it seems that if these members could not get to games, they believed that the membership was not worth maintaining. These members were satisfied with the membership; however measures of overall level of satisfaction had only a weak positive relationship with the likelihood of members rejoining in the future. The inconsistencies in the findings challenge some conventional approaches to both the methods of researching lapsed members and the theories that are frequently used to explain behaviours. We find that simplistic entry or exit surveys are likely to be of limited value in subscription defection research and that satisfaction is unlikely to be a strong predictor of defection behaviour.

Gardner; re BWW: Victorian Supreme Court makes landmark Australian ruling on tube feeding

• The Victorian Supreme Court has decided that artificial nutrition and hydration provided through a percutaneous gastrostomy tube to a woman in a persistent vegetative state may be withdrawn.
• The judge ruled, in line with a substantial body of international medical, ethical and legal opinion, that any form of artificial nutrition and hydration is a medical procedure, not part of palliative care, and that it is a procedure to sustain life, not to manage the dying process.
• Thus, the law does not impose a rigid obligation to administer artificial nutrition or hydration to people who are dying, without due regard to their clinical condition. The definition of key terms such as “medical treatment”, “palliative care”, and “reasonable provision of food and water” in this case will serve as guidance for end-of-life decisions in other states and territories.
• The case also reiterates the right of patients, and, when incompetent, their validly appointed agents or guardians, to refuse medical treatment.
• Where an incompetent patient has not executed a binding advance directive and no agent or guardian has been appointed, physicians, in consultation with the family, may decide to withdraw medical treatment, including artificial nutrition or hydration, on the basis that continuation of treatment is inappropriate and not in the patient’s best interests. However, Victoria and other jurisdictions would benefit from clarification of this area of the law

Applying GIS in physical activity research: community walkability and walking behaviours.

Physical activity provides many health benefits, including reduced risk of cardiovascular disease, Type II diabetes and some cancers. Environmental exposure factors (e.g., the built environment) are now receiving ever-increasing attention. Large-scale interdisciplinary studies on the association between attributes of local community environments and residents’ physical activity are being conducted. We will focus on findings from Australia - the Physical Activity in Localities and Community Environments (PLACE) study. PLACE is examining factors that may influence the prevalence and the social and spatial distribution of walking for transport and walking for recreation. A stratified two-stage cluster sampling strategy was used to select 32 urban communities (154 census collection districts), classified as high and low ‘walkable’ using a GISbased walkability index (dwelling density, intersection density, net retail area and land use mix) and matched for socio-economic status. We report data on a sub-sample of 1,216 residents who provided information on the perceived attributes of their community environments (e.g., dwelling density, access to services, street connectivity) and weekly minutes of walking for transport and for recreation. Moderate to strong associations were found between GIS indicators of walkability and the corresponding self-report measures. The walkability index explained the same amount of neighborhood-level variance in walking for transport as did the complete set of self-report measures. No significant associations were found with walking for recreation. Relevant GIS-based indices of walkability, for purposes other than transport need to be   developed.

The dietary, physical activity and sedentary behaviours of Victorian regional secondary school students

The aim of this study was to investigate the dietary, physical activity and sedentary behaviours of adolescents from four secondary schools in Warrnambool, regional Victoria. In 2004, a random sample of students (n=712), stratified by school year level, was generated from school enrolment databases and 443 students completed a lifestyle questionnaire. Twenty per cent of students were physically active for 60 minutes or more per day; 28 per cent used electronic media in free time for a maximum of two hours per day. Only seven per cent of students met these two Australian physical activity recommendations. Fruit, vegetables and dairy products were consumed every day by 39 per cent, 40 per cent and 71 per cent of students respectively; three serves per day of each of these foods are recommended for Australian adolescents. Compared with boys, girls were less physically active (p<0.001), consumed more fruit (p=0.011) and vegetables (p<0.001), but fewer dairy products (p<0.024). Seventeen per cent of students were overweight or obese; these students were less physically active than normal weight peers (p<0.018). The dietary, physical and sedentary behaviours of regional Victorian secondary school students in this study were inadequate when compared with Australian recommendations. Dietary and physical activity habits are still evolving in adolescence and unhealthy habits can still be changed.

Burnout in the caring nurse: learning resilient behaviours

This paper reviews current literature to offer a discussion related to burnout, an issue that affects the entire healthcare sector, including nurses and patients. Literature suggests a correlation between moral distress and burnout in nurses. These issues are considered to be current and affect recruitment and retention of nurses. The authors propose supporting nurses by using knowledge of resilient behaviours as a means of transcending burnout and workplace stress. The authors believe that this process can be achieved through existing hospital professional development processes, for example supervision, reflective practice, in-service education and other forms of professional development.

Sun exposure and sun protection behaviours among young adult sport competitors

Objective: To explore the relationship between sun protection and physical activity in young adults (18-30 years) involved in four organised sports.

Methods: Participants (n=237) in field hockey, soccer, tennis and surf sports completed a self-administered survey on demographic and sun-protective behaviours while playing sport. Differences in sun-protective behaviour were explored by sport and by gender.

Results: Sunburn during the previous sporting season was high (69%). There were differences between sports for sunburn, sunscreen use and reapplication of sunscreen. Lifesaving had the highest rates compared with the other three sports. Hats and sunglasses worn by participants varied significantly by sports. A greater proportion of soccer and hockey players indicated they were not allowed to wear a hat or sunglasses during competition. For all sports, competition was played mainly in the open with no shade provision for competitors while they were playing. There were some gender differences within each of the sports. Female soccer and tennis players were more likely to wear sunscreen compared with males. Female hockey players were more likely to wear a hat compared with males.

Conclusions: Our findings highlight that there is still room for improvement in sun-protective behaviours among young adult sport competitors. There is a need for a systematic approach to sun protection in the sporting environments of young adults.

Implications: Health promotion efforts to increase physical activity need to be paired with sun protection messages.

Motivational processes associated with unhealthy body change attitudes and behaviours

Objective
The relationship between approach–avoidance motivational processes and unhealthy body change attitudes and behaviours was investigated.
Method
Self-reported sensitivity to rewards (SR) and sensitivity to punishments (SP) were measured for a convenience sample of 130 women, aged 18 to 40 years, along with measures of disordered eating symptomatology and exercise dependence.
Results
Together, SR and SP significantly predicted variance in drive for thinness (21%), bulimia (17%), and obligatory exercise (7%). These relationships were partly mediated by internalization of the thin ideal, body comparison, and subjective importance of achieving one's ‘ideal’ body and of avoiding one's ‘worst possible’ body. Interestingly, body dissatisfaction partly mediated the relationships involving SP but not SR.
Discussion
The results suggest that an underlying sensitivity to punishments, but not rewards, can manifest as a ‘fear of fatness’. Both of these motivational traits can increase the salience of self evaluations, and thus indirectly contribute to unhealthy body change attitudes and behaviours.

Which food-related behaviours are associated with healthier intakes of fruits and vegetables among women?

Objective To examine associations between shopping, food preparation, meal and eating behaviours and fruit and vegetable intake among women.
Design Cross-sectional survey.
Setting Community-based sample from metropolitan Melbourne, Australia.
Subjects A sample of 1136 women aged 18–65 years, randomly selected from the electoral roll.
Results Food-related behaviours reflecting organisation and forward-planning, as well as enjoyment of and high perceived value of meal shopping, preparation and consumption were associated with healthier intakes of fruits and vegetables. For example, women who more frequently planned meals before they went shopping, wrote a shopping list, enjoyed food shopping, planned in the morning what they will eat for dinner that night, planned what they will eat for lunch, reported they enjoy cooking, liked trying new recipes and who reported they sometimes prepare dishes ahead of time were more likely to consume two or more servings of vegetables daily. Conversely, women who frequently found cooking a chore, spent less than 15 minutes preparing dinner, decided on the night what they will eat for dinner, ate in a fast-food restaurant, ate takeaway meals from a fast-food restaurant, ate dinner and snacks while watching television and who frequently ate on the run were less likely to eat two or more servings of vegetables daily.
Conclusions Practical strategies based on these behavioural characteristics could be trialled in interventions aimed at promoting fruit and vegetable consumption among women.

Snacking behaviours of adolescents and their association with skipping meals

Background: Snacking is likely to play an important role in the development of overweight and obesity, yet little is known about the contexts of snacking in adolescents or how snacking may influence other dietary habits, like meal skipping. This study examines the contexts in which adolescents snack and whether these contexts are associated with demographic characteristics of adolescents and with meal skipping.
Methods: A cross-sectional, self-reported online food habits survey was administered to 3,250 secondary students in years seven and nine. The students were drawn from 37 secondary schools in Victoria, Australia during 2004–2005. Frequencies of meal skipping, and snacking in eight contexts, were compared across gender, year level and region of residence. Logistic regressions were performed to examine associations between snacking contexts and meal skipping adjusting for gender and region.
Results: The most common contexts for snacking among adolescents were after school (4.6 times per week), while watching TV (3.5 times per week) and while hanging out with friends (2.4 times per week). Adolescents were least likely to snack all day long (0.8 times per week) or in the middle of the night (0.4 times per week). Snacking contexts were variously associated with gender, year level and region. In contrast, meal skipping was associated with gender and region of residence but not year level. Adolescents who reported more frequent snacking on the run, on the way to or from school, all day long, or in the middle of the night were more likely to skip meals.
Conclusion: These data suggest adolescents snack frequently, especially in their leisure time. In addition, adolescents who snack on the run, on the way to or from school, all day long or in the middle of the night are more likely to skip meals than are adolescents who don't snack at these times. Understanding the contexts in which adolescents snack, and their associations with skipping meals, may assist those involved in the promotion of healthy food habits among adolescents.

Strategies which aim to positively impact on weight, physical activity, diet and sedentary behaviours in children from zero to five years. A systematic review of the literature

Preventing the development of obesity in children is an international health priority. To assess the effectiveness of interventions designed to prevent obesity, promote healthy eating and/or physical activity and/or to reduce sedentary behaviours in 0–5-year-old children, a systematic review of the literature was performed. Literature searches were limited to articles published between January 1995 and June 2006, printed in English and sampling children aged 0–5-years. Searches excluded literature concerned with breastfeeding, eating disorders, and interventions which were school-based or concerned with obesity treatment. Two reviewers independently extracted data and assessed study strengths and weaknesses. Nine included studies were grouped based on the settings in which they were delivered. Most studies involved multi-approach interventions, were conducted in the USA and varied in study designs and quality. All showed some level of effectiveness on at least one obesity-behaviour in young children. These studies support, at a range of levels, the premise that parents are receptive to and capable of some behavioural changes that may promote healthy weight in their young children. The small quantity of research heralds the need, particularly given the potential for early intervention to have long-lasting impacts on individual and population health, to build in a substantial way upon this evidence base.

Dissecting obesogenic behaviours: the development and application of a test battery for targeting prescription for weight loss

There are limited practical tools to help clinicians or public health workers manage obesity in their patients. We have previously developed a scanning technique for diagnosing environments leading to obesity (Analysis Grid for Environments/Elements Leading to Obesity). Here we describe the development of a tool for identifying behaviours in an individual most likely to lead to obesity. A questionnaire battery of five tests called the DAB-Q (Diet, Activity and Behaviour Questionnaire) was developed, piloted and internally validated with overweight women from a commercial weight loss programme. Outcome from the tests, which are available free on the Internet, provides clinicians with a simple, effective and time-saving tool for ranking foods, drinks and activities likely to be most effectively targeted for weight loss in an individual. This is based on total scores derived from measures of frequency, potential for change and potency of each item as a potential contributor to overweight.

Time-budget and feeding behaviour of the squirrel glider (petaurus norfolcensis) in remnant linear habitat

The squirrel glider (Petaurus norfolcensis) occurs in forests and woodlands in eastern Australia. In Victoria it is now largely restricted to small, fragmented areas and is considered endangered. In this study, the time-budget, feeding behaviour and related habitat use of the squirrel glider were investigated in a linear remnant of roadside vegetation near Euroa, Victoria. Timed observations of three males and three females, fitted with radio-collars, were made in each of four seasons. Gliders were observed for a total of 53.2 h, during which they devoted 72% of time to foraging activities. Grooming accounted for 16% of observation time. Exudates associated with homopterous insects were the primary food items consumed throughout the year. Arthropods, nectar and pollen, and Acacia gum formed the remainder of the diet. The proportion of time devoted to harvesting these food items showed marked seasonal variation. The primary dependence on homopterous insect exudates in this study area contrasts with other investigations at sites of greater floristic diversity where nectar and pollen were the most important dietary resources. This highlights the need to obtain ecological information from the range of habitats occupied by a species. Large trees are a vital habitat component of remnant linear vegetation in this study area, providing gliders with critical foraging resources. Retention of such trees is essential for the longevity of glider populations.

A cross-sectional study of weight-and shape-related beliefs, behaviours and concerns of north Queensland adolescents

The purpose of this study was to examine differences in weight- and shape-related beliefs, behaviours and concerns across a high school population. Data were collected by questionnaire from 902 high school students from private schools in Townsville. Concerns about weight and shape were more apparent in students from the higher school years. More girls in higher than lower school years were dissatisfied with their bodies, concerned that many parts of their bodies were too fat and more of them attempted weight loss. More boys in higher than lower school years were satisfied with their bodies but they wanted to 'bulk up'. Societal expectations of weight and shape may adversely affect both males and females but in different ways. Thus, interventions aiming to promote the maintenance of a healthy body weight may need to account for the desire of the majority of young women to be thinner, while the majority of young men would like to be larger.