A service evaluation specifying the active components of a functional restorative programme to promote management of persistent non-specific low back pain

BACKGROUND

Functional Restorative Programmes (FRP) for persistent non-specific lower back pain have been shown to be effective, but they often lack sufficient detailed reporting of the intervention components to allow for accurate replication.

OBJECTIVES

This study used the Behaviour Change Technique Taxonomy (v1) (BCTi) ^[1] to identify the main components of one such programme and interviewed patients to identify the most effective programme components and areas for improvement.

DESIGN

A mixed methods design was used.

METHODS

Intervention data were coded using the BCT Taxonomy (v1) to identify the BCTs utilised. Following this, semi-structured interviews with nine patients evaluated the BCTs included using thematic analysis and identified possible techniques for inclusion in future developments of the programme.

RESULTS

Forty-one different BCTs were identified in the coding phase with frequency of occurrence in the programme ranging from forty-nine to one. Four main themes emerged from the interviews: Social Support, Shaping Knowledge, Repetition and Substitution and Changes in Mindset.

CONCLUSION

The results of this study identify the key ingredients in a programme for persistent, non-specific lower back pain, which facilitates the replication of this intervention and identified areas patients appreciated most as well as areas for improvement.

Identifying management practices that drive production-line workers' engagement through qualitative analysis

INTRODUCTION

Engagement research - most often defined by a worker's psychological state of vigor, dedication, and absorption - pays little attention to production-line workers. This study therefore explores factors that drive workers' engagement with health and safety (H&S) in a production-line context as well as their perception of managerial influence Furthermore, the study adds to the body of research by exploring H&S engagement concepts through the use of qualitative research methods.

METHOD

38 semi-structured interviews were conducted and analyzed through template analysis to identify themes that promote and hinder engagement.

RESULTS

The main engagement drivers were found to be: (a) the displayed safety focus of the company in organizational and social aspects; (b) the quality of the communication approach with respect to quality, consistency and direction; and (c) the environment encompassing the relationship between workers and supervisors and peers as well as the psychological environment. Notably, a trusting relationship between supervisors and workers appeared to be the most influential driver in determining engaged H&S behavior. Discussion and impact in industry: The study highlights factors that could be adapted to improve engagement and consequently enhance H&S approaches. Originality: The study reported in this paper offers a unique insight into individual production workers' perceived drivers of H&S engagement using Qualitative Analysis. Practical applications: The study identified the important role that supervisors play in workers' H&S engagement levels and what skills they need to employ to enhance workers' engagement in general and in the context of H&S behavior and performance. Furthermore, the importance of psychological and sociological factors in safety approaches are highlighted and were found to be key for creating safer workplaces.

Investigating Treatment Adherence of British and Greek Patients With Type 2 Diabetes Mellitus

Abstract. Background: Treatment adherence is associated with a number of personal characteristics (e.g., self-esteem, self-efficacy, locus of control) and illness perceptions. However, there is a lack of studies for Type 2 Diabetes Mellitus (T2DM). Aims: The aim of this study was to compare adherence behavior of British and Greek people with T2DM and examine the association between personal characteristics, illness perceptions, and adherence. Method: This was a cross-cultural, cross-sectional study. Five hundred eighty participants completed questionnaires, 208 males (35.9%) and 372 females (64.1%) with a mean age of 49 years. Regression analyses and t-tests were used. Results: Personal characteristics and illness perceptions predicted adherence and British patients reported better exercise adherence while Greek patients reported better diet and medication adherence; both groups reported suboptimal adherence. Self-efficacy, Health Locus of Control (HLoC), and illness perceptions were the main adherence determinants. Limitations: The use of self-reports and the convenience sampling method are the main limitations of this study. Conclusion: The findings address a significant gap in research and can inform future adherence-enhancing interventions to promote the well-being of people with T2DM.

Positive Influence of Role Ambiguity on JD-R Motivational Process: The Moderating Effect of Performance Recognition

Most previous research has shown the negative influence of role ambiguity on employes’ motivational process. This has led to role ambiguity being perceived as a main hindrance demand in the workplace, with a negative effect on the Job Demands Resources (JD-R) model’s motivational process. Recent theories propose that job demands can be perceived by employes as a challenge, rather than a hindrance. However, there is little evidence on which elements of the organizational context shape this perception. The objective of this study is to elucidate the possible effect of performance recognition from the team leader on employes’ interpretation of role ambiguity as a hindrance or a challenge. Data were obtained from 706 employes of a multinational company headquartered in Almería, Spain. Results confirmed that performance recognition moderates the effects of role ambiguity: specifically, performance recognition changes the effect of role ambiguity on engagement from negative to positive and reduces role ambiguity’s negative influence on extra-role behaviors.

Perceived barriers to, and benefits of physical activity among British military veterans that are wounded, injured, and/or sick: a Behaviour Change Wheel perspective

Purpose: Many British military veterans that are wounded, injured, and/or sick (WIS) face significant physical, psychological and social challenges following discharge from the military. There is increasing evidence to support the application and benefit of physical activity for veterans that are WIS. Understanding engagement in physical activity is therefore imperative so that physical activity interventions and initiatives can be designed effectively, and their benefits optimised. Therefore, the aim of this study is to identify the perceived barriers to, and benefits of physical activity among veterans that are WIS.Materials and methods: Nine semi-structured interviews were conducted to explore perceived barriers to, and benefits of physical activity amongst veterans that are WIS. A thematic analysis was conducted, and themes mapped to the Behaviour Change Wheel's capability, opportunity, motivation-behaviour (COM-B) model.Results: Perceptions related to physical capability, psychological capability, physical opportunity and reflective motivation were predominant barriers to engagement in physical activity. As well providing opportunities to socialise, the perceived benefits of engagement in physical activity seemed to mirror the perceived barriers, suggesting a reciprocal relationship.Conclusions: Using the Behaviour Change Wheel, incentivisation, education, persuasion, enablement and environmental restructuring were identified as potentially beneficial intervention functions when seeking to increase levels of physical activity among veterans that are WIS living within the United Kingdom.IMPLICATIONS FOR REHABILITATIONUK-based veterans that are wounded, injured, and/or sick (WIS) often face significant challenges with respect to physical, mental, and social well-being.Perceived barriers, in the form of limited opportunities and a self-perceived lack of capability impact on levels of motivation and are viewed as obstacles to becoming physically active by veterans that are WIS.Providing education and complementary incentives may help reduce the extent of perceived barriers in veterans that are WIS.Approaches that allow veterans that are WIS to socialise while developing self-efficacy will likely increase physical activity engagement.

Telephone helplines as a source of support for eating disorders: Service user, carer, and health professional perspectives

Access to care for eating disorders can be problematic for numerous reasons including lack of understanding and delays with treatment referrals. Previous research has highlighted the benefits of telephone helplines as an accessible source of support for those who may not wish to access face-to-face support or to fill a gap for those waiting for treatment. This study aimed to gain an insight into the perspectives of those who may use or refer others to a telephone helpline in order to identify the requirements of such a service. Triangulation of service user, carer and health professionals' perspectives resulted in identification of themes relating to the type of support, delivery and practicalities of a helpline. The findings indicated that telephone helplines may offer numerous benefits for individuals with an eating disorder, whether accessed as a first step, alongside treatment or as an extension of this support when in recovery. Additionally helplines may provide an opportunity for carers to access information and discuss their own experiences, while supporting their loved one. Raising awareness of these services is important to encourage those affected by an eating disorder to access and make the most of this type of support. These findings offer an insight into the key requirements for new and existing service development with regard to both the type of support and the method of communication required by individuals with eating disorders.

Adolescents' perceptions and experiences of family meals

Benefits of family meals include diet quality, social interaction and wellbeing, yet previous research indicates only one in four adolescents eats a meal with their family every day. This study identified factors relating to the frequency and importance of family meals. A focus group conducted with seven adolescents was analysed thematically. The themes and findings of past research were used to develop a Family Meals Questionnaire (FMQ), completed by 76 adolescents. Regular engagement in healthy family meals eaten around the table was reported, with the majority of participants reporting that their meals included a variety of foods and portions of vegetables. Frequency of family meals was associated with increased family togetherness for both males and females. The nutritional value of meals was found to be most important to females, whereas the impact of family meals on mood was more salient for males. Findings suggest that the views and behaviour of other family members may influence adolescents' enjoyment and perceptions of the importance of family meals, and therefore impact on their frequency. These findings may inform the development of future interventions aimed at increasing adolescent engagement in family meals by adopting a family systems approach to improve the frequency and experience of family meals.

Evaluating a communications campaign to reduce blood clots

Purpose

– “VTE Assess Prevent” is a unique communications campaign designed to educate and remind all front-line staff to risk assess inpatients for venous thromboembolism (VTE) (blood clots) and to provide those at risk with the recommended preventative treatment. The purpose of this paper is to evaluate the VTE communications campaign from the perspective of the front line staff at a UK hospital.

Design/methodology/approach

– A questionnaire implementing both qualitative and quantitative methods was made available to all relevant frontline staff at the hospital via online and paper copies (n=319).

Findings

– Overall positive attitudes towards the design and content of the campaign materials were reported. The campaign had a considerable impact on staff awareness of the importance of risk assessing for VTE and the extent to which risk assessments were carried out. High levels of reported behaviour change were reported as a consequence of the campaign. Recommendations for future communication campaigns included making the communication materials more memorable and enhancing the sense of control that people have over the procedure. Also, improving normative and outcome beliefs, running the communications campaign alongside a programme of education and including monitoring and feedback of performance were recommended.

Originality/value

– Reducing the number of deaths attributable to hospital acquired VTE is a clinical priority within the health services in many countries. The findings from this study highlight the role of the VTE campaign in achieving this goal, provide an insight into the key components of an effective communication campaign and identify recommendations for future campaigns.

Beta-cell replacement and regeneration: Strategies of cell-based therapy for type 1 diabetes mellitus

Pancreatic islet transplantation has demonstrated that long-term insulin independence may be achieved in patients suffering from diabetes mellitus type 1. However, because of limited availability of islet tissue, new sources of insulin producing cells that are responsive to glucose are required. Development of pancreatic beta-cell lines from rodent or human origin has progressed slowly in recent years. Current experiments for ex vivo expansion of beta cells and in vitro differentiation of embryonic and adult stem cells into insulin producing beta-cell phenotypes led to promising results. Nevertheless, the cells generated to date lack important characteristics of mature beta cells and generally display reduced insulin secretion and loss of proliferative capacity. Therefore, much better understanding of the mechanisms that regulate expansion and differentiation of stem/progenitor cells is necessary. Here, we review recent advances in the identification of potential cellular sources, and the development of strategies to regenerate or fabricate insulin producing and glucose sensing cells that might enable future cell-based therapies of diabetes mellitus type 1.

Human Krüppel-like factor 11 inhibits human proinsulin promoter activity in pancreatic beta cells

AIMS/HYPOTHESIS

The Krüppel-like factor 11 (KLF11; TIEG2), a pancreas-enriched Sp1-like transcription factor, is a known negative regulator of pancreatic exocrine cell growth. A recent study indicated KLF11-induced activation of the human proinsulin promoter (hInsP).

MATERIALS AND METHODS

We investigated the functional role of KLF11 in pancreatic beta cells.

RESULTS

Endogenous KLF11 mRNA expression was found in whole rat pancreas, human pancreatic islets and INS-1E beta cells and was profoundly reduced by high glucose in INS-1E. Cotransfections of INS-1E and beta-TC3 beta cells with a human (h)KLF11 expression plasmid and an hInsP-driven reporter plasmid resulted in a substantial dose-dependent and glucose-independent inhibition of proinsulin promoter activity. 5'-deletion of hInsP demonstrated that hKLF11 acts via DNA sequences upstream of -173 and requires the beta cell-specific transcription machinery, since hKLF11-mediated inhibition of promoter activity was abolished in HEK293 cells. Besides a previously described GC box, we further identified a CACCC box within the hInsP, both putative KLF11-binding motifs. Electrophoretic mobility shift analysis (EMSA) verified binding of in vitro translated hKLF11 to the GC box, but neither hKLF11-induced inhibition nor basal hInsP activity was altered by mutation or 5'-deletion of the GC box. In contrast, CACCC box mutation substantially reduced basal promoter activity and partially diminished hKLF11 inhibition, although binding of in vitro translated hKLF11 to the CACCC box could not be verified by EMSA.

CONCLUSIONS/INTERPRETATION

In rodent beta cell lines, we demonstrate hKLF11overexpression-mediated inhibition [corrected] of human proinsulin gene expression and characterise a prominent role for the CACCC box in maintaining basal proinsulin promoter activity.

Improving child protection: a systematic review of training and procedural interventions

AIM

To synthesise published evidence regarding the effectiveness of training and procedural interventions aimed at improving the identification and management of child abuse and neglect by health professionals.

METHODS

Systematic review for the period 1994 to 2005 of studies that evaluated child protection training and procedural interventions. Main outcome measures were learning achievement, attitudinal change, and clinical behaviour.

RESULTS

Seven papers that examined the effectiveness of procedural interventions and 15 papers that evaluated training programmes met the inclusion criteria. Critical appraisal showed that evaluation of interventions was on the whole poor. It was found that certain procedural interventions (such as the use of checklists and structured forms) can result in improved recording of important clinical information and may also alert clinical staff to the possibility of abuse. While a variety of innovative training programmes were identified, there was an absence of rigorous evaluation of their impact. However a small number of one-group pre- and post-studies suggest improvements in a range of attitudes necessary for successful engagement in the child protection process.

CONCLUSION

Current evidence supports the use of procedural changes that improve the documentation of suspected child maltreatment and that enhance professional awareness. The lack of an evidence based approach to the implementation of child protection training may restrict the ability of all health professionals to fulfil their role in the child protection process. Formal evaluation of a variety of models for the delivery of this training is urgently needed with subsequent dissemination of results that highlight those found to be most effective.

Thyroid autoimmunity in children with coexisting type 1 diabetes mellitus and celiac disease: a multicenter study

BACKGROUND

Children with type 1 diabetes mellitus (DM1) are more prone to developing thyroid autoimmunity (TAI); TAI also occurs more frequently in patients with celiac disease (CD).

AIM

To determine whether TAI occurs more frequently in children with coexisting DM1 and CD compared to children with DM1 only, and whether the clinical course of DM1 is influenced by concomitant TAI.

PATIENTS AND METHODS

We performed a multicenter retrospective case-control study comparing data from 84 diabetic children with CD (group 1) to 167 diabetic children without CD (group 2), matched by age at DM1 onset, duration of DM1 and center. Markers of TAI, thyroid function and HbA1c were recorded. The TAI follow-up lasted 4.9 +/- 2.8 years.

RESULTS

TAI was diagnosed in 13% of children in group 1 and 19% of children in group 2 (ns). Diabetes control was not influenced by TAI in either group.

CONCLUSIONS

Occurrence of TAI in diabetic children is not related to coexisting CD. TAI does not lead to worsening of metabolic control in children with DM1.

THE EATING DISORDER INVENTORY: A TEST OF THE FACTOR STRUCTURE AND INTERNAL CONSISTENCY IN A NONCLINICAL SAMPLE

My objective was to investigate the factor structure and internal consistency of the Eating Disorder Inventory (EDI) among a nonclinical sample. Previous research has indicated that although the EDI appears to be psychometrically sound when used with a clinical sample, the relevance of the measure for a nonclinical population is uncertain. Six hundred forty-seven female university students, average age of 23.3 years, completed a questionnaire including the EDI. I found that the factor structure was supported when items from just five subscales of the EDI were included in the analysis, but when items pertaining to all eight subscales were analysed the factor structure was not supported. The current results cast doubt on the factor structure and internal consistency of the EDI when used with a nonclinical sample, unless just five subscales (drive for thinness, perfectionism, bulimia, interpersonal distrust, and maturity fears) are included. More research is needed to clarify the implications of these findings.

Outcomes of pregnancies diagnosed with Klinefelter syndrome: the possible influence of health professionals

OBJECTIVE

To describe the association between the outcomes of pregnancies diagnosed with Klinefelter syndrome (KS) and the specialty of the health professional providing pre- and post-diagnostic counselling.

METHOD

Data were extracted from the case notes of the 111 cases of KS diagnosed prenatally between 1986 and 1997 in eight geographical regions in five European countries. The data extracted included: outcome of pregnancy, maternal age, social class, parity, gestational age at diagnosis, year of diagnosis and specialties of the health professionals conducting pre- and post-diagnosis consultations.

RESULTS

The overall termination rate was 44% (49/111: 95% confidence interval: 35 to 54). Using multivariable logistic regression analysis, the only significant predictor of continuation of the pregnancy was the specialties of the health professionals conducting post-diagnosis counselling: the affected pregnancy was more likely to continue when post-diagnosis counselling involved only a genetics specialist (relative risk: 2.42 (1.14 to 5.92)).

CONCLUSION

There is an association between whether or not a woman terminates a pregnancy affected by an unfamiliar fetal anomaly and the professional background of the health professional providing post-diagnostic counselling. The causal nature of this association remains to be determined.

Counselling following the Prenatal Diagnosis of Klinefelter Syndrome: Comparisons between Geneticists and Obstetricians in Five European Countries

Objective: To describe and compare the information obstetricians and geneticists in five European countries report they would give following the prenatal diagnosis of Klinefelter syndrome. Methods: 388 obstetricians and 269 geneticists from Germany, the Netherlands, Portugal, Spain and the UK completed a brief questionnaire assessing two variables: the information they reported providing to parents following the prenatal diagnosis of Klinefelter syndrome (categorized as positive or negative); and their perceptions of the quality of life with the condition. Results: Geneticists were more likely than obstetricians to report providing more positive than negative information about Klinefelter syndrome than equal amounts of positive and negative information or more negative than positive information about the condition (excess positive information). Regardless of specialty, the information that health professionals reported providing was predicted by their perceptions of the quality of life with the condition, and the country from which they came. Those perceiving quality of life as greater were more likely to provide an excess positive information, as were health professionals from Germany and the UK. Conclusions: These results suggest that the information parents across Europe receive after the prenatal diagnosis of Klinefelter syndrome varies according to the specialty and country of the health professionals consulted, and their perceptions of quality of life with the condition. This variation seems to reflect personal, cultural and professional differences between health professionals. Copyright 2002 S. Karger AG, Basel

Structure quality management in pediatric diabetes care

The aim of all diabetes treatment in childhood and adolescence is to counteract the development of complications (acute as well as late), to achieve normal growth and development, and to provide the patients with as good as possible a quality of life. Many studies have confirmed the benefits of intensified medical management regarding the prevalence and/or the progression of diabetic microvascular complications. Intensified medical management means of course much more than intensified insulin substitution; diabetes care includes diet, physical exercise, diabetes education, continuous monitoring, and psychosocial support. To improve the outcome of patients with diabetes mellitus, optimizing structure quality is one of the goals. A number of prerequisites (regarding the social-socioeconomic-health care system) are not yet fulfilled everywhere; structures necessary to provide qualified diabetes care (e.g. pediatric diabetes center, team of experts, outpatient care) are not yet sufficiently available in some areas. According to both the declarations of St. Vincent and of Kos, every effort should be made to enhance structure quality in an attempt to improve the situation and the outcome of our young patients with diabetes.

Severe hypoglycemia in children and adolescents with IDDM: frequency and associated factors

Severe hypoglycemia is a very common complication in youths with insulin-dependent diabetes mellitus (IDDM). Seventy four children and adolescents were surveyed for a 1-year period to evaluate the frequency and associated factors of severe hypoglycemia. Patients or their parents completed a standardized questionnaire which inquired about severe and mild episodes, treatment, and prevention of hypoglycemia. Forty-four percent of the patients experienced at least one severe hypoglycemic episode [need for assistance (grade III), loss of consciousness with or without convulsions (grade IV)] during the survey period. The event rate was 0.77 episodes (grade III and IV) per patient-year. The group with severe hypoglycemic episodes was significantly older (mean age, 16.3 years; SD, 3.6 years versus mean age 13.7 years; SD, 4.9 years; p = 0.01) and had significantly longer duration of diabetes (mean, 8.2 years; SD, 4.3 years versus mean, 6.1 years; SD, 4.0 years; p = 0.04) than the group without severe hypoglycemic episodes. There were no significant differences in mean glycosylated hemoglobin (HbA1c), daily doses of insulin, type of insulin regimen, gender, and age at diagnosis between patients who reported severe episodes and those who did not. Mild hypoglycemia was reported by 72 patients. Fifty percent of the patients recognized potential precipitating factors. Older age and longer duration of diabetes seem to predispose the patient to severe hypoglycemia. This may be the result of a diminution of the counterregulation system including lower neuroadrenergic reaction, or the still unphysiologic treatment of diabetes. Continued vigilance and education is important in older adolescents with longer duration of diabetes.