The accessibility and acceptability of self-management support interventions for men with long term conditions: a systematic review and meta-synthesis of qualitative studies

Background: Self-management support interventions can improve health outcomes, but their impact is limited by the numbers of people able or willing to access them. Men’s attendance at existing self-management support services appears suboptimal despite their increased risk of developing many of the most serious long term conditions. The aim of this review was to determine whether current self-management support interventions are acceptable and accessible to men with long term conditions, and explore what may act as facilitators and barriers to access of interventions and support activities. Methods: A systematic search for qualitative research was undertaken on CINAHL, EMBASE, MEDLINE, PsycINFO and Social Science Citation Index, in July 2013. Reference lists of relevant articles were also examined. Studies that used a qualitative design to explore men’s experiences of, or perceptions towards, self-management support for one or more long term condition were included. Studies which focused on experiences of living with a long term condition without consideration of self-management support were excluded. Thirty-eight studies met the inclusion criteria. A meta-ethnography approach was employed to synthesise the findings. Results: Four constructs associated with men’s experience of, and perceptions towards, self management support were identified: 1) need for purpose; 2) trusted environments; 3) value of peers; and 4) becoming an expert. The synthesis showed that men may feel less comfortable participating in self-management support if it is viewed as incongruous with valued aspects of their identity, particularly when activities are perceived to challenge masculine ideals associated with independence, stoicism, and control. Men may find self-management support more attractive when it is perceived as action-oriented, having a clear purpose, and offering personally meaningful information and practical strategies that can be integrated into daily life. Conclusions: Self-management support is most likely to be successful in engaging men when it is congruent with key aspects of their masculine identity. In order to overcome barriers to access and fully engage with interventions, some men may need self-management support interventions to be delivered in an environment that offers a sense of shared understanding, connectedness, and normality, and involves and/or is facilitated by men with a shared illness experience

Protein quality control: the who’s who, the where’s and therapeutic escapes

In cells the quality of newly synthesized proteins is monitored in regard to proper folding and correct assembly in the early secretory pathway, the cytosol and the nucleoplasm. Proteins recognized as non-native in the ER will be removed and degraded by a process termed ERAD. ERAD of aberrant proteins is accompanied by various changes of cellular organelles and results in protein folding diseases. This review focuses on how the immunocytochemical labeling and electron microscopic analyses have helped to disclose the in situ subcellular distribution pattern of some of the key machinery proteins of the cellular protein quality control, the organelle changes due to the presence of misfolded proteins, and the efficiency of synthetic chaperones to rescue disease-causing trafficking defects of aberrant proteins

Parental and peer influences on emerging adult problem gambling: Does exposure to problem gambling reduce stigmatizing perceptions and increase vulnerability?

Research has identified 18 to 30 years olds as the biggest spenders on gambling activities, with significantly higher prevalence of gambling problems than other age groups. Identifying the factors that influence the development of gambling problems in young people is important for guiding prevention strategies. This study aimed to analyse how emerging adult problem gambling is influenced by the people around them. In particular, we explored whether perceived parental and peer problem gambling predicted emerging adult problem gambling, and whether reduced gambling self-stigma mediated these relationships. A community sample of 188. Australian gamblers aged 18 to 29 (M = 21.41, SD = 2.99) completed three versions of the Problem Gambling Severity Index (PGSI) and the Gambling Perception Scale. Results indicated that perceived parental and peer gambling were positively related to emerging adult problem gambling. While reduced gambling helping stigma was related to higher problem gambling, stigma did not mediate the links between significant others’ gambling and emerging adult problem gambling. We conclude that social influences are important in the development of problem gambling for young people, and that older male emerging adults who have a gambling mother are at most risk of problem gambling. © 2016, Centre for Addiction and Mental Health. All rights reserved

Implementing an intervention to promote normal labour and birth: a study of clinicians’ perceptions

Background: Confronted with an increasing caesarean section rate, a regional Victorian hospital has introduced an intervention to support safe, normal labour and birth for low risk primigravidas, consisting of a change in protocol and practice, supported by education. Prior to implementation of the Normal Labour and Birth Bundle (NLBB), this study aimed to identify any clinician factors that may have influenced the uptake, acceptance and of use of the intervention. Method: The Theory of Planned Behaviour (TPB) provided the framework for the conduct and analysis of the staff survey and focus groups. Descriptive and inferential statistics where used to anlayse the survey and findings from the focus groups were derived from thematic analysis. Results: Seventy-six clinicians (88.8%) responded to the survey. Mean scores for TPB constructs were well above the mid-scale score of 4, indicating strong positive attitudes, high levels of self-efficacy and positive social pressure to use the (NLBB) and strong intentions to use it in the future. Self-efficacy was the strongest independent predictor (β =0.48, p<.05) of intention to use the NLBB. The themes identified from the two focus groups were philosophy of care, effective collaboration, clinical decision making during labour and the regional health environment. Conclusions: Understanding staff perceptions allowed for specific strategies to be employed to implement and sustain the intervention

Strategy for Detecting Neuronal Fibers at Risk for Neurodegeneration In Earliest MS by Streamtube Tractography at 3T

Background: While demyelination is central to the onset of MS, focal inflammatory MS lesions are also characterized by axonal injury, including transections[1]. As a result, the study of axonal injury has become an important new area of MS research, and axonal injury is now considered an important contributor to irreversible injury, disability and possibly conversion to progressive stages of disease. In advanced stages of MS, there is direct evidence for significant neuronal loss for example in corpus callosum [2]. In early MS, there is circumstantial evidence for neuronal tract injury due to focal, inflammatory demyelinating lesions associated with a clinically isolated syndrome (CIS) based on neuronal tract (Wallerian) degeneration patterns in corticospinal tract [3] and across the corpus callosum (transcallosal bands) [4]. The presence of such axonal injury is supported by an informative case study where confocal microscopy revealed empty myelin cylinders in spinal cord of an MS patient with a distant subacute brainstem lesion [5]. Purpose: We report an MRI strategy to detect “at-risk ” neuronal fibers in the corpus callosum related to distant focal demyelinating lesions. This strategy is necessary since a priori assumptions about the anatomical location of lesions relative to fiber tracts is often misleading. Methods: We conducted a prospective longitudinal study including 18 CIS patients with an MRI (at least 2 characteristic T2-lesions) placing them at high risk for the development of MS [6]. MRI acquisition was at 3T and included 3mm thick non-gapped proton density/T2 series and sagittal fast spin echo (FSE) T2-weighted imaging with 3mm non-gapped slices. A diffusion tensor imaging sequence is run in the axial plane with sets of diffusion tensor images acquired by echo-plana

Identification of Fibers at Risk for Degeneration By Diffusion Tractography in Patients at

inflammation; Wallerian degeneratio