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Background: Safety in the housing environment is a basic human need and may be a prerequisite for health but studies from the perspective of the residents are limited in the literature. Although historically public health research has recognized the housing environment as an important determinant of health, there is a need for more research on how housing conditions influence residential well-being. Aim: The overall aim of this thesis was to examine factors and conditions associated with residential well-being and perceived safety in different types of housing areas and to compare safety promotion intervention designs based on residents self-expressed safety needs with corresponding designs developed by local government professionals. Materials and methods: A postal survey (response rate 56%, n=2476) and 11 focus groups (57 participants) were conducted among the residents in 3 small-scale housing areas with detached houses and 3 housing areas with blocks of flats in a Swedish municipality. The areas were geographically contiguous as each of the small-scale areas bordered on an area with blocks of flats. The study municipality is a designated member of WHO Safe Community network that have signed up to work in line with the indicators developed by WHO Collaborating Centre on Community Safety Promotion. Narrative data from a postal questionnaire were used to analyze the lay perspective and identify features perceived to be necessary to feel safe by residents in areas with blocks of flats and small-scale housing areas. Quantitative data were used to examine correlates of local safety-related concerns through a factor analysis. Logistic regression analysis examined associations between high-level scores of the safetyrelated dimensions found and area-level crime rate and being a victim of crime, area reputation, gender, age, education, country of birth, household civil status and type of housing. To examine how self-assessed area reputation is associated with social trust and residential well-being, a multilevel logistic regression analysis was performed using quantitative data, controlling for the random effect of neighbourhood- and individual-level socio-demographic factors. Data from focus group interviews were analyzed to identify mechanisms of how neighbourhood reputation was established. The quality function deployment (QFD) technique was used in a case study to integrate residents’ demands into the design of safety promotion interventions in housing areas. The resulting design was then compared with the safety intervention programme designed by professionals at the municipality administrative office. The results from this comparison were then investigated to identify improvements for the indicators for Safe Homes in the Safe Community programme. Results: The residents’ narratives showed that a stable social structure in the housing area was perceived to be the central factor in a safety-supportive residential environment. Whereas maintenance of good and reassuring relations was emphasized in small-scale housing areas, support for management of poor or even fear-provoking neighbour relations was requested from areas with blocks of flats. The crime rates were lower and safety-related concerns were less in small-scale housing areas. Three composite dimensions (CD) of perceived residential safety were identified: structural indicators of social disorder (CD 1); contact with disorderly behaviour (CD 2); and existential insecurity (CD 3). Area-level crime rates and individual-level variables were associated with dimensions (CD 1) and (CD 3), but only individuallevel variables were associated with dimension (CD 2). The level of residential well-being and social trust was higher in small-scale areas. The housing area reputation was found to be strongly associated with safety-related concerns, residential well-being and social trust. The area reputation also seemed to be a determinant of position in the local social structure; residents were found to position themselves in a rank order. The QFD analysis showed that the initiation and maintenance of social integrative processes in housing areas were the most highly prioritized interventions among the residents, but the analysis did not highlight the safety needs of several vulnerable groups. The Safe Community programme designed by professionals did not address the social integrative processes, but did cover the vulnerable groups. Conclusions: Area reputation is an important and probably underestimated dimension in the development of residential well-being and perceived safety. The QFD technique can be added to the methodological toolbox for residential safety promotion. The technique is particular suitable for providing a quality orientation from the lay perspective on safety promotion in local residential areas. The current Safe Homes concept in the Safe Community programme would benefit from being widened to Safe Housing.

This thesis draws upon data gathered during research undertaken with a grant from the Resuscitation Council (UK). It explores the use of Automatic External Defibrillators (AEDs) by laypeople, which is known as Public Access Defibrillation (PAD). Whilst an abundance of research has been undertaken about this phenomenon, it has predominately been conducted using quantitative methods; however the data I am using was collected using a qualitative approach. During the research, fifty-three semi-structured interviews were carried out. Most of these were with laypeople who had been trained to use AEDs, and nine involved those who delivered the training. These interviews were conducted at sites typical of those where these devices have been introduced, such as railway stations and airports. The geographical area of these locations covered the East and West Midlands, South and West Yorkshire, Lincolnshire and Essex. The aims of the research were quite broad and included exploring how to make training more realistic, how debriefing and support for those who had used an AED should be organised and how the interviewees perceived the technology inherent in the AED. This thesis reanalyses the data that was collected during that research and focuses on two themes. Firstly, some of the theories of technologies in transition are used to illustrate how AEDs were developed in a laboratory and progressed from that setting to become commonplace in public locations. The actor-network theory is adopted to argue that these technological devices exert an influence on the human actors in the networks that exist within society. Specifically, my analysis is informed by the work of Timmermans (1998; 1999; 1997) whose theories about external chest compressions I have developed and applied to AEDs. They suggest that these devices achieved universality, in part, through the influence of debates and medical protocols. One significant factor was that AEDs allowed for defibrillation to be redefined from a medical, to a first aid procedure. Eventually, using these devices was included in the protocols for first aid and this legitimised their use by laypeople. These theories are observable in the data through the interviewees’ accounts of how they came to accept being trained to use AEDs. The experiences of those who had used an AED during a resuscitation attempt are provided and suggest that these are distressing and unpleasant events. Consequently, a key component of this thesis is a discussion of the necessity to provide psychological debriefing for those who have been involved in these incidents. The findings of this thesis suggest that laypeople who have used an AED usually have questions about the actions they took during the attempted resuscitation and need to address these with someone soon afterwards. Generally, they prefer to discuss these issues with a person who has experience of resuscitation and using a defibrillator. However, the provision of such support is often not well organised and individuals are sometimes not aware of what is available to them. I conclude by suggesting that it is important that those who are asked to use an AED have a clearly identifiable person to contact should they need to discuss any issues which may arise. I argue that the responsibility for ensuring that such mechanisms are in place lies with those who instigate the schemes which place AEDs in these locations. Public access defibrillation is a relatively new concept in the UK and I believe that this thesis makes an important contribution to the body of knowledge relating to this phenomenon.

This research explores the understanding of psychosocial risks and work-related stress by international multi-disciplinary experts in developing countries. It further explores their views on the perceived health impact of these issues. It identifies preliminary priorities for action while considering similarities and differences in conceptualizing these issues in industrialized and developing countries. Finally, it explores in what ways these issues can enter the policy agenda in developing countries. This research applies a triangular methodological approach where each stage provides the basis for the development of the next. It starts out with 29 semi-structured interviews to explore the views of experts and also to inform two rounds of an online Delphi survey, which then informed four focus group discussions. The total sample amounted to 120 participants (each sampled once). Key findings for developing countries indicate that a) psychosocial hazards need addressing due to an impact on workers' health; b) occupational health and safety priorities have changed during the last decade pointing to the need for monitoring of psychosocial hazards and the need to address work-related stress, violence, harassment and unhealthy behaviours together with other workplace hazards; c) socio-economic conditions and processes of globalization need attention in the study of psychosocial hazards and an extended research paradigm is required; and d) there is an ever present need for capacity building, stakeholder mobilization, infrastructure development and international exchange and collaboration to address all workplace hazards. Developing countries are not spared from the health and economic impact of psychosocial risks and work-related stress, and there will be a need to address these issues through policy development. To pave the way, this dissertation outlines a need for concerted action at different levels.

Introduction Regular cycling has been shown to improve health and well-being and has a role in tackling obesity and inactivity. Cycle collisions, particularly those involving motorised vehicles, can lead to significant mortality and morbidity and are currently a barrier to wider uptake of cycling. There is evidence that the conspicuity of cyclists may be a factor in some injury collisions. Low-cost, easy to use retro-reflective and fluorescent clothing and accessories (’conspicuity aids’) are widely available. Their effectiveness in reducing the risk of cycling collisions is currently unknown. This study was designed to investigate the relationship between the use of conspicuity aids and risk of collision or evasion crashes for utility and commuter cyclists in an urban setting in the UK. Methods A matched case-control study was undertaken. Cases were adult commuter and utility cyclists who were involved in a crash resulting from a collision or attempted evasion of a collision with another road user. Cases were recruited at a large UK emergency department. Controls were commuter and utility cyclists matched by time and day of travel, season and geographical area of cycling. Controls were recruited at public and private cycle parking sites. Data on the use of conspicuity aids, crash circumstances, participant demographics, cycling experience, safety equipment use and journey characteristics including an estimate of the bicycle crash risk for each chosen route (the number of previous crashes per 100 million kilometres travelled by bicycle calculated for each participant route) were collected using self-completed questionnaires and maps. Conditional logistic regression was used to calculate crude and adjusted odds ratios and 95% confidence intervals of the risk of a crash involving a collision or evasion of a collision with another road user when cyclists reported they were using any item of fluorescent or retro-reflective clothing or equipment vs. none. Unconditional logistic regression was used to analyse associations between participant characteristics and conspicuity aid use. Continuous variables were dichotomised where there was a non-linear relationship to the bicycle crash outcome variable or the primary exposure variable. The sensitivity of the study models to selection, recall and information biases and the effect of missing data was assessed using independent records of conspicuity aid use by potential participants during recruitment. Observations of conspicuity aid use within the study source population at sites across the study catchment area were also conducted by the researcher during the recruitment phase. Results There were 76 cases and 272 controls cyclists who were eligible for inclusion in the primary analysis (response rate of 13% and 54% respectively). The proportion of cases who reported using any item of fluorescent or reflective materials on their clothing or equipment (excluding bicycle mounted reflectors) was higher than for matched controls (cases users 69.7%; 95% CI 58.1% to 79.8% vs. control users 65.4%; 95% CI 59.5% to 79.1%). The unadjusted odds ratio for a collision or evasion crash when using conspicuity aids, was 1.2 (95% CI 0.66 to 2.17). Two alternative modelling strategies were employed. After adjustment for confounding from age, gender, socio-economic deprivation, number of years of cycling experience, bicycle crash risk along each route and cycle helmet use the odds ratio was 1.77 (95% CI 0.74 to 4.25). After adjustment for confounding from age, gender, socio-economic deprivation, bicycle crash risk along each route and history of previous cycle crash involvement the odds ratio was 2.4 (95% CI 1.06 to 5.7). The odds ratio was not significantly affected by adjustment for possession of a driving licence, reported bicycle safety training in childhood, psychometric associates of risk taking behaviour, cycle helmet wearing, years of experience of cycling, distance or number of trips cycled in the previous seven days, type of bicycle, the use of bike-mounted lights or reflectors, weather or lighting conditions, familiarity with the route or alcohol consumption within 8 hours prior to the recorded journey. There was a significant difference between the measure of bicycle crash risk along each route for cases and controls with controls reporting travelling on routes with lower objective bicycle crash risk (median (IQR); cases 378.5 (232.4 to 548.3) vs. controls 268.5 (192.6 to 464.5); p= 0.006). There were no significant differences in route risk for users vs. non-users of conspicuity aids (route risk median (IQR) for conspicuity aid users vs. non-users; 308.1 (198.0 to 504.3) vs. 272.3 (203.7 to 413.4; p= 0.22). Conspicuity aid use was associated with increased length of participant route (unadjusted OR 3.25 for reported route greater than median; 95% CI 2.04 to 5.17 p<0.001), higher numbers of police-recorded bicycle crashes (unadjusted OR 2.26 for greater than median; 95% CI 1.43 to 3.55; p<0.001) and lower numbers of observed cyclists on each route (unadjusted OR 0.999; 95% CI 0.998 to 1.000 p=0.015). Route risk data were missing for 50 participants (15 cases and 35 controls). Validation of the primary exposure showed that there was moderate agreement between participants’ self-reports and independently collected data (kappa 0.42; 95% CI 0.32 to 0.51) but independent data were collected on only 4 eligible cases. Self-reported use of conspicuity aids was higher amongst cases and controls in this study than that observed for cyclists in the study area during the recruitment period (23%; 95% CI 22% to 24%). Discussion The results of this study show a non-significant increase in the odds of a crash for users compared to non-users of conspicuity aids whilst cycling. This association was increased after adjustment for confounders but most models generated to adjust for confounding remained insignificant. No reduction in crash risk could be demonstrated. This is not consistent with the large body of evidence suggesting that conspicuity aids increase the distances from which wearers can be detected and recognised by drivers in a variety of settings. There was evidence that cases were cycling along routes with greater exposure to traffic danger than controls although there were many participants with missing data for this variable potentially introducing a further source of bias. The route risk estimates did not vary significantly between conspicuity aid users and non-users. Residual confounding may have occurred if conspicuity aid users were taking more risks when encountering similar traffic conditions to non-users. This could not be measured but may go some way to explaining these results. If cyclists over-estimate the likely effect of their conspicuity aid use this could result in over compensation and a net increase in crash risk. Adjustment for route risk may have introduced bias by the loss of some participants from the analysis or by acting as a positive suppressor variable increasing the influence of uncontrolled confounding if conspicuity aid use were leading to risky riding over and above the objective risk arising from differing road and traffic conditions. The association between the odds of crash and travelling on roads with higher incidences of previous cycle crashes and fewer cyclists provides support for the “safety in numbers” effect reported in other studies. Differential selection and misclassification biases may also have resulted in over representation of conspicuity aid users amongst cases compared to controls. Social expectation from involvement in a collision crash may have resulted in cases who were not using conspicuity aids being less likely to participate than controls who were non-users. For similar reasons cases may have been more inclined to over-estimate their conspicuity aid use than controls.

Whilst the training of healthcare staff is seen as a key element to the prevention and management of violence and aggression, questions remain as to the effectiveness of these programmes in preparing staff to apply this to clinical practice. To date there is a relative paucity of well-designed studies into the effectiveness of the training to prevent and manage violence and aggression in healthcare settings. Within this context a study was conceived to examine the effectiveness of two aggression management training programmes in preparing staff for clinical practice. In order to provide a meaningful and evidence-based evaluation of the two programmes, Pawson and Tilley's Realistic Evaluation model was adopted for use in this study. In keeping with the chosen methodology, data was collected using a combination of methods including surveys, semi-structured interviews, and participant observation of training. A total of 64 participants were eligible for inclusion in the study; which ran over the course of a calendar year. The research highlighted that training should have relevance to the staff group undergoing instruction. That training should be conducted wherever possible in staff groups, tackling real problems, with participants reflecting and learning from their experience and from each other. It should also provide measures of competency that describe both workplace and organisational outcomes and describe the requirements of assessment. That training should be engaging and integrate decision-making, planning, organization and skill building and cover a range of interventions. Most importantly, was the need to help staff transfer what they had learnt as part of training to clinical practice. These factors are brought together in a model of training devised as part of this study called the PROMPTS Aggression Management Training Model ©. As the first study to apply realistic evaluation in aggression management research, it was a good fit, particularly given the growing emphasis on understanding how context influences evidence-based practice. The strengths and limitations of the approach are considered, including how to operationalize it. This approach provided a useful interpretive framework with which to make sense of the multiple factors that were simultaneously at play and being observed through various data sources, and for developing explanatory theory about aggression management training and its implementation in practice.

Clinicians working with women in forensic secure environments will be acutely aware of the diverse risks, complex treatment needs and unique responsivity issues found in this multifaceted marginal group. Women make up 5% of the prison population and approx 20% of the secure forensic psychiatric population (approx 4,500 and 1,085 women respectively). What animates the studies of women is not so much numbers of offenders but the particular circumstances of the women and girls “behind” the numbers. There is a common perception that women make up such a small number of the criminal justice service (CJS) population that devising gender sensitive environments and interventions is unnecessary. However studies of patients detained in high and medium security have identified significant gender differences. Women are more likely to commit minor offenses, be diagnosed with a personality disorder, present with self injurious behavior and have suffered childhood victimization. Thus, women and girls who are caught up in the justice system enter it as a result of circumstances distinctly different from those of men. Up until recently the needs of women were inadequately met in services centered on the needs of men and it is only relatively recently that the need to address these glaring differences has been thrashed out in the public arena. Following a number of high profile reviews and reports mixed sex wards have been become a exceptional, strip searches of women in prison have been abolished and large numbers of women have been reviewed and stepped down to lower levels of security. A less well researched area of women’s secure care centers on the profound impact of adjusting to a new environment which involves coping with severance of social support networks.

<p> Despite the rapidly expanding body of literature relating to electronic nicotine delivery system (ENDS) use, notable gaps in the available literature are apparent. Many different models and types of ENDS are available, such as electronic cigarettes, electronic hookahs, and newer-generation ENDS devices (vapes/mods). Yet, the scientific community has been slow to identify and investigate different ENDS products other than &ldquo;e-cigarettes.&rdquo; The current project serves to bring a level of specificity to ENDS research that has not yet been seen in the published literature. The current study used a multi-site, cross-sectional, experimental design to test 1) whether endorsement of ENDS usage is affected by the language used in measurement, and 2) whether the perceived risk associated with ENDS differs by product type. Lifetime ENDS use was significantly affected by the specific terms used in measurement within a sample of 546 undergraduate students. When presented with response options for multiple ENDS types, lifetime use was 17% greater than when asking about e-cigarettes alone. Significant perceptual differences between ENDS devices were apparent. E-hookahs and vapes/mods were seen as significantly less harmful to use during pregnancy, less harmful to one&rsquo;s health, and less addictive than either cigalike e-cigarettes or conventional tobacco cigarettes. Together, these findings suggest using generic, single-item measures that only ask about e-cigarettes are problematic.</p>

<p>Background:</p><p>Knowing the scope of neurosurgical disease at Mbarara Hospital is critical for infrastructure planning, education and training. In this study, we aim to evaluate the neurosurgical outcomes and identify predictors of mortality in order to potentiate platforms for more effective interventions and inform future research efforts at Mbarara Hospital. </p><p>Methods: </p><p>This is retrospective chart review including patients of all ages with a neurosurgical disease or injury presenting to Mbarara Regional Referral Hospital (MRRH) between January 2012 to September 2015. Descriptive statistics were presented. A univariate analysis was used to obtain the odds ratios of mortality and 95% confidence intervals. Predictors of mortality were determined using multivariate logistic regression model.</p><p>Results:</p><p>A total of 1876 charts were reviewed. Of these, 1854 (had complete data and were?) were included in the analysis. The overall mortality rate was 12.75%; the mortality rates among all persons who underwent a neurosurgical procedure was 9.72%, and was 13.68% among those who did not undergo a neurosurgical procedure. Over 50% of patients were between 19 and 40 years old and the majority of were males (76.10%). The overall median length of stay was 5 days. Of all neurosurgical admissions, 87% were trauma patients. In comparison to mild head injury, closed head injury and intracranial hematoma patients were 5 (95% CI: 3.77, 8.26) and 2.5 times (95% CI: 1.64,3.98) more likely to die respectively. Procedure and diagnostic imaging were independent negative predictors of mortality (P <0.05). While age, ICU admission, admission GCS were positive predictors of mortality (P <0.05). </p><p>Conclusions: </p><p>The majority of hospital admissions were TBI patients, with RTIs being the most common mechanism of injury. Age, ICU admission, admission GCS, diagnostic imaging and undergoing surgery were independent predictors of mortality. Going forward, further exploration of patient characteristics is necessary to fully describe mortality outcomes and implement resource appropriate interventions that ultimately improve morbidity and mortality.</p> / Thesis

<p> The purpose of this project is to create a fun and educational nutrition program for middle school students including sixth, seventh and eighth grade. The nutrition program strives to increase understanding about the benefits of nutrition to encourage middle school students to consume more fruits and vegetables and to decrease the rate of childhood obesity. Based on current research, a curriculum was developed to include lecture, discussion, and activity components to guide in: creating cafeteria posters, responsible use of social media, and empowering other students by sharing their knowledge. Pre- and post-program questionnaires were also included. A committee of nutrition professionals and educators reviewed the curriculum and revisions were made based on their feedback. The program was not pilot-tested for the purposes of this project, but it is encouraged to do so prior to implementation.</p>