Experiences of living with Type I diabetes: psychological distress and clinical implications

Living with diabetes can present a number of challenges for individuals concerned. Managing diabetes day to day involves a complex medication and behavioural regime which interrelates with various important psychosocial factors. Previous research suggests that people living with diabetes are as much as two-three times more likely to experience mental health difficulties compared with the general population. However evidence is emerging that many of these difficulties may in fact be a direct result of feeling distressed about living with a complicated and stressful chronic health condition, and not necessarily resultant from co-morbid psychiatric illness. These experiences are known by the term diabetes related distress. To date psychosocial factors related to living with diabetes have mainly been explored quantitatively. However, qualitative approaches have increased in popularity in diabetes research in recent years and can add valuable and rich information to existing data from quantitative research. Extant qualitative research in diabetes has mainly focused on people living with type 2 diabetes or children with type 1 diabetes, leaving adults living with type 1 diabetes as a relatively under researched group. This study aimed to answer the following research questions:Primary: What are the lived experiences of adults with type 1 diabetes? And secondary:What aspects of living with type 1 diabetes are experienced as distressing? ; and What are the potential implications for health services? Eight adults living with type 1 diabetes were interviewed about their experiences. Interviews were transcribed and analysed using interpretative phenomenological analysis. Six major themes emerged from participants' interviews. These were: Experiences of diagnosis, Physical impact of type 1 diabetes, Psychological impact of type 1 diabetes, Social impact of type 1 diabetes, Influence of healthcare teams and Ways of coping. Example subthemes are; Feeling frustrated and restricted by treatment regimes, psychological and emotional distress, constant awareness and worry, impact on development and sense of self, stigma and lack of understanding from others, support from diabetes team and experiences of a simplistic view of diabetes. Participants reported a wide variety of experiences related to the biological, psychological and social components of type 1 diabetes. Some of these were experienced as highly distressing whilst others were more easily managed. This was often dependent on individual differences and was not necessarily static over time. Further awareness of this in practice and a focus on diabetes and its treatment within the context of people’s unique psychosocial circumstances is highly important in supporting people to reduce diabetes related distress, which can improve glycaemic control, health related quality of life and wellbein

A novel peer-support intervention using motivational interviewing for breastfeeding maintenance: a UK feasibility study

Although most UK mothers start breastfeeding, fewer than half breastfeed exclusively for more than 1 week and only one in 100 breastfeed for > 6 months. Most stop breastfeeding before they had planned to. We wanted to see if it was possible to help women breastfeed for longer by using buddies trained in motivational interviewing. This is a form of counselling that motivates people to change their behaviour by exploring their thoughts and worries and helping them to set their own goals. The intervention we studied was called Mam-Kind. Mam-Kind buddies met mothers before their babies were born and provided support for 2 weeks afterwards. Before we embark on an expensive randomised trial of Mam-Kind, we wanted to see if it was acceptable to women and feasible to deliver. Eight buddies delivered Mam-Kind to 70 women from three areas with high levels of social deprivation and teenage pregnancy and low rates of breastfeeding. We interviewed mothers, buddies and health-care professionals to get their views. We found that Mam-Kind was acceptable and feasible to deliver. Mothers reported that buddies provided reassurance, were non-judgemental and were easily contactable. The buddies reported that it was sometimes difficult to use their motivational skills while providing breastfeeding support. It is feasible to design and collect appropriate health economic information. We used this information to refine the training and content of the intervention. The refined Mam-Kind intervention should now be tested in a controlled study to see if it really works to help women continue breastfeeding for longer

ELAIA 2019

DIRECTOR\u27S NOTE Each fall, the Honors Program at Olivet Nazarene University admits a small number of academically gifted students into its freshman class. From the moment they set foot on our campus, these women and men join a community of scholars, and together they read, reflect upon, and discuss the most important ideas of the past and present—all within a Christian fellowship. The first two years of the program involve a series of Honors courses, taught by a team of faculty and modeled on the historic “old-time college,” where small class relationships, interdisciplinary discussion, and debate prevailed. In the junior and senior years, the Honors Program shifts its focus away from the classroom to the laboratory or library. There, students work on a capstone scholarship project within their major that involves original research and writing. Honors students gain experience comparable to what happens at large research institutions as they work one-on-one with a faculty mentor and alongside their classmates in research seminars to conceive and complete their individual projects. For our graduates—many of whom go on to advanced study in medicine, law, or other fields—scholarship becomes a deeply personal, transformative, and spiritually meaningful act. Throughout their four years, Honors students ultimately learn how to love God with their minds, as well as their hearts. Since its establishment in 2007, the program has continued to grow and flourish, and the depth of its research continues to increase. This second volume of ELAIA represents the fruits of that development, containing capstone research projects from the 2019 Honors Program senior class and their faculty mentors. The Table of Contents is diverse, and in that way it is a crystalline reflection of our program’s community of scholars. I, along with the members of the Honors Council, am gratified by the work of each student and faculty mentor printed within these pages. - Stephen Lowe, Honors Program Directo

Performance Analysis For Wireless G (IEEE 802.11 G) And Wireless N (IEEE 802.11 N) In Outdoor Environment

This paper described an analysis the different capabilities and limitation of both IEEE technologies that has been utilized for data transmission directed to mobile device. In this work, we have compared an IEEE 802.11/g/n outdoor environment to know what technology is better. the comparison consider on coverage area (mobility), through put and measuring the interferences. The work presented here is to help the researchers to select the best technology depending of their deploying case, and investigate the best variant for outdoor. The tool used is Iperf software which is to measure the data transmission performance of IEEE 802.11n and IEEE 802.11g

Performance analysis for wireless G (IEEE 802.11G) and wireless N (IEEE 802.11N) in outdoor environment

This paper described an analysis the different capabilities and limitation of both IEEE technologies that has been utilized for data transmission directed to mobile device. In this work, we have compared an IEEE 802.11/g/n outdoor environment to know what technology is better. The comparison consider on coverage area (mobility), throughput and measuring the interferences. The work presented here is to help the researchers to select the best technology depending of their deploying case, and investigate the best variant for outdoor. The tool used is Iperf software which is to measure the data transmission performance of IEEE 802.11n and IEEE 802.11g

A grounded theory analysis of the forms of support on two online anorexia forums

Using Grounded theory this thesis analyses the forms of support that are present on two online anorexia forums. Data was collected through non-participant observation and online interviews with members of two online anorexia forums, one pro-anorexic in orientation, one pro-recovery. Despite the clear differences that exist between the two communities, continuities are strongly apparent, especially when looking at these forums as support environments. This thesis illustrates that support is conditional, that is takes on a variety of forms in any one environment and highlights the role of offline discourses in shaping online support. It also provides an in-depth comparison of two online anorexia forums

An Online Self-Assessment Platform for Community-Dwelling Stroke Survivors: Development and Acceptability

Background: Activity limitation and participation restriction are common in stroke survivors. Digital health technologies are widely utilised to enable self-management. An online platform, specifically developed for stroke survivors can improve the use of electronic Patient-Reported Outcome Measures (ePROM) to enable self-assessment and empower patients to get involved in their care. The overall aim of this PhD was to develop and test the acceptability of an online self-assessment platform, the Stroke Survivors Hub (SSHUB) to support the long-term self-management of stroke survivors. Methods: A systematic review was conducted to explore existing disease-specific PROM to assess daily activity limitations in stroke survivors. This informed the development of the Evaluation of Daily Activity Questionnaire for stroke survivors (EDAQ-SS) with the involvement of 10 stroke survivors and 11 experts. Content validity of the EDAQ-SS was evaluated using the International Classification of Functioning (ICF) Core Set for Stroke. Following this, the EDAQ-SS was digitised as an ePROM and the SSHUB was developed. The SSHUB acceptability was tested with stroke survivors (n=57). Additionally, data collected via the eEDAQ-SS were used to explore patterns of activity limitation and participation restriction in British stroke survivors.Findings: The EDAQ-SS is an appropriate, comprehensive, understandable and relevant PROM to assess the extent of activity limitation and participation restriction in British stroke survivors, and the first stroke specific PROM to differentiate between capacity and performance. The SSHUB is a user-friendly and acceptable online platform to aid self-assessment of stroke survivors’ ability to carry our daily activities and aggregated data provide opportunities to examine the frequency and pattern of these difficulties in community-dwelling stroke-survivors. Conclusion: The EDAQ-SS is an acceptable measure of daily activities for stroke survivors, and freely available on the SSHUB to inform self-management. Future recommendations include the psychometric testing of the EDAQ-SS with a larger sample to establish the measurement validity and reliability, and the strategies to expand the remit of the SSHUB as an online self-management platform

Social research for our times: Thomas Coram Research Unit past, present and future

For 50 years, researchers at UCL’s Thomas Coram Research Unit have been undertaking ground-breaking policy-relevant social research. Their main focus has been social issues affecting children, young people and families, and the services provided for them. Social Research for our Times brings together different generations of researchers from the Unit to share some of the most important results of their studies. Two sections focus on the main findings and conclusions from research into children and children services, and on family life, minoritised groups and gender. A third is then devoted to the innovative methods that have been developed and used to undertake research in these complex areas. Running through the book is a key strategic question: what should be the relationship between research and policy? Or put another way, what does ‘policy relevant research’ mean? This perennial question has gained new importance in the post-Covid, post-Brexit world that we have entered, making this text a timely intervention for sharing decades of experience. Taking a unique opportunity to reflect on research context as well as research findings, this book will be of interest to researchers, teachers, students and those involved in policy making both in and beyond dedicated research units, and can be read as a whole or sampled for individual standalone chapters

Remote self-testing for sexually transmitted infections, within online care pathways: how could this intervention deliver public health benefit? Formative research using chlamydia as an exemplar

Sexually transmitted infections (STIs) remain a public health challenge in England, despite free, confidential testing/treatment services. The eSTI² Research Consortium is developing a diagnostic self-test for STIs, to be deployed within online care-pathways. Should this intervention lead to increased STI detection and prompt effective treatment, it could reduce transmission and morbidity. Through a scoping review and three studies I explored its potential to benefit public health, thus informing the intervention’s ongoing development. The review (2013) found diverse uses of internet/electronic communications in STI care-pathways, but little research was transferable to remote self-testing or management. Current internet-use for sexual health may predict use of the proposed intervention, so I estimated its prevalence, and identified associated factors, using British probability survey data (2010-12). Among sexually-experienced 16-44-year-olds (n=8926), internet-use for STI testing/treatment was rare (<0.5%), but available services were limited. 4.5% women and 4.6% men reported internet-use for information/support with their sex-lives, elevated among the better-educated and some STI risk-groups including young people. In qualitative interviews, 25 young people at risk of STI expressed enthusiasm for a (hypothetical) STI self-test within online care-pathways. Findings informed colleagues’ development of eSTI²’s Online Chlamydia Pathway (OCP). For people requiring chlamydia treatment, this included: online automated medical assessment, a helpline, and community pharmacy treatment collection or facilitated clinic access. I undertook and thematically-analysed 40 qualitative interviews with OCP users, within pilot studies. Participants valued the rapid, convenient and discreet treatment access, increased control over their healthcare, and optional professional support by telephone, enabled by the OCP. Offline parts of the pathway (pharmacy/clinic attendance) risked compromising its perceived advantages, and require further development. Recommendations derived from an iteratively-developed understanding of this complex intervention’s use and appeal, can enhance its potential to enable STI detection and treatment, promptly, effectively and acceptably. Future evaluation must consider impacts on health inequalities

The Legacy for Children™ Program-- A Capstone on Fidelity Monitoring and Certification

INTRODUCTION: Child poverty in the United States results in severe adverse outcomes affecting child health, well-being, and mental and physical development. A burgeoning problem, researchers have sought primary prevention methods such as parent programs that target low income mothers. Legacy for Children™, developed by the Centers for Disease Control and Prevention (CDC), is an evidence-based parent program designed for communities affected by poverty. The evidence-based outcomes of Legacy rely heavily on fidelity monitoring to ensure program efficacy and adherence to the tested model. As an Atlanta Legacy site is implemented, it presents an opportunity to improve the fidelity monitoring processes to ensure program uptake and sustainability. AIM: To examine the existing tools used to measure Legacy fidelity, compile a compendium of tools to inform fidelity processes and recommend ways to improve fidelity monitoring. METHODS: A literature review on fidelity monitoring best practices, implementation science research, and existing evidence-based parent programs was used to gauge ways to improve Legacy. Fidelity monitoring practices from the evidence-based parent programs directly informed Legacy’s fidelity processes and recommendations. A practice fidelity assessment evaluated how fidelity is currently monitored. RESULTS: Recommendations involve three distinct tasks: (1) intense monitoring early on post-workshop training, (2) video monitoring and technical assistance by the IS Supervisor, and (3) establishing a certification process. The practice fidelity assessment revealed that the fidelity assessment form for Miami intervention would work better if shortened and focused on the curricula and procedures versus the lengthy, more group process design. DISCUSSION: Many tools exist to monitor fidelity of evidenced-based parent programs. Although the recommendations proposed compile literature and characteristics from existing parent programs, future research is necessary to determine which elements Legacy should adopt.This document serves to inform the Legacy implementation team and CDC by increasing knowledge and fostering conversations to improve Legacy fidelity monitoring