Identifying and applying psychological theory to setting and achieving rehabilitation goals: development of a practice framework

Goal setting is considered to be a fundamental part of rehabilitation; however, theories of behaviour change relevant to goal-setting practice have not been comprehensively reviewed. To identify and discuss specific theories of behaviour change relevant to goal-setting practice in the rehabilitation setting. (ii) To identify 'candidate' theories that that offer most potential to inform clinical practice. The rehabilitation and self-management literature was systematically searched to identify review papers or empirical studies that proposed a specific theory of behaviour change relevant to setting and/or achieving goals in a clinical context. Data from included papers were extracted under the headings of: key constructs, clinical application and empirical support. Twenty-four papers were included in the review which proposed a total of five theories: (i) social cognitive theory, (ii) goal setting theory, (iii) health action process approach, (iv) proactive coping theory, and (v) the self-regulatory model of illness behaviour. The first three of these theories demonstrated most potential to inform clinical practice, on the basis of their capacity to inform interventions that resulted in improved patient outcomes. Social cognitive theory, goal setting theory and the health action process approach are theories of behaviour change that can inform clinicians in the process of setting and achieving goals in the rehabilitation setting. Overlapping constructs within these theories have been identified, and can be applied in clinical practice through the development and evaluation of a goal-setting practice framework

The Integrated Neurophysiology of Emotions during Labour and Birth: a Feminist Standpoint Exploration of the Women's Perspectives of Labour Progress

Within childbirth there is a common and widely known explanation of labour and birth which describes and defines the birth process as that of stages and phases. The boundaries between the stages and phases have been determined by cervical dilatation with time parameters set to measure progress. The measurement of cervical dilatation is determined by a health professional and has resulted in an apparent inability of women to determine themselves whether they are in labour and their closeness to the impending birth. The aims of this thesis were threefold; the first was to critically examine the knowledge base of labour progress, so that the influences on knowledge development were fully understood. Through exploring the historical and theoretical development I found that the current knowledge has come from a male understanding of female anatomy and observational data constructed within a discourse of male, medical, scientific superiority. The second aim of the thesis was to explore the perspectives of women who had experienced a spontaneous labour and birth in order to determine whether the discourse of labour as stages and phases resonated with them. This leads to the third aim of providing a description of the women’s voices and perspectives based on their experiential knowledge of spontaneous labour and birth. A critical feminist ontology and feminist standpoint methodology guided the research which used in-depth one-to-one interviews with 18 women who had experienced a spontaneous labour and birth. Early thematic analysis was developed further through feedback from the participants supporting a coconstruction of knowledge. Analysis revealed that women considered the stages and phases of labour to be an abstract concept which did not resonate with their experiences of labour and birth. An important aspect of labour was having support during the process, in terms of both emotional and physical support from midwives, partners, family and friends present during the labour and birth. Women’s perceptions were dominated by their feelings and a linear pattern of feelings was discerned consistently amongst the participants. The emotions of labour were an important finding in this research but during the feedback process the women requested a scientific foundation to support the findings. I therefore explored the recent advances in theoretical understanding of the role of emotion, cognition, physiology and behaviour. Contemporary theories define emotions and neurohormones as bi-directional and intricately linked to behaviour change and physiological adaptations. I argue that the feelings women have described give an indication of an underlying hormonal influence and a directing of behaviour, necessary for labour to move towards birth. The hormones involved in labour also support maternal behaviour and attachment to the baby. I suggest a new conceptual understanding of labour as the integration of the mind, body and behaviour in which the feelings and hormones that initiate and sustain labour to birth also support the necessary adaptation and transition to becoming a mother. This integrated neurophysiologic concept will help midwives and other health professionals involved in maternity to recognise emotions as a key to understanding physiological labour and birth. It has also highlighted the importance of emotional and physical support during labour. Further research is necessary to test the hypothesis that women experience a similar range of emotions at similar times during a spontaneous labour and birth and to what extent the described emotions resonate with other women’s experiences

Implementing a framework for goal setting in community based stroke rehabilitation: a process evaluation

Abstract Background: Goal setting is considered 'best practice' in stroke rehabilitation; however, there is no consensus regarding the key components of goal setting interventions or how they should be optimally delivered in practice. We developed a theory-based goal setting and action planning framework (G-AP) to guide goal setting practice

A survey of engagement and competence levels in interventions and activities in a community mental health workforce in England.

National Health Service (NHS) mental health workforce configuration is at the heart of successful delivery, and providers are advised to produce professional development strategies. Recent policy changes in England have sharpened the focus on competency based role development. We determined levels of intervention activities, engagement and competence and their influencing factors in a community-setting mental health workforce. Using a modified questionnaire based on the Yorkshire Care Pathways Model we investigated 153 mental health staff working in Coventry and Warwickshire NHS Trust. A median score of competence was computed across 10 cluster activities. Low engagement and competence levels were examined in a logistic regression model. In 220 activities, Monitoring risk was the highest rate of engagement (97.6%) and Group psychological therapy/Art/Drama therapy was the lowest engagement (3.6%). The median competence level based on all activities was 3.95 (proficient). There were significant differences in the competence level among professional groups; non-qualified support group (3.00 for competent), Counsellor/Psychologist/Therapist (3.38), Occupational therapists (3.76), Nurses (4.01), Medical staff (4.05), Social workers (4.25) and Psychologists (4.62 for proficient/expert). These levels varied with activity clusters; the lowest level was for Counsellor/Psychologist/Therapist in the accommodation activity (1.44 novice/advance beginner) and the highest for Occupational therapists in personal activity (4.94 expert). In a multivariate analysis, low competence was significantly related to non-qualified community support professions, late time of obtaining first qualification, more frequencies of clinical training, and training of cognitive behavioural therapy. The associations were similar in the analysis for 10 activity clusters respectively. There was a reasonable competence level in the community-setting mental health workforce, but competence varied with professional groups and cluster activities. New staff and other non-qualified support professions need to receive efficient training, and the training content is more important than frequency to increase level of competence

The epidemiology of soil-transmitted helminths in Bihar State, India.

BACKGROUND: Soil-transmitted helminths (STHs) infect over a billion individuals worldwide. In India, 241 million children are estimated to need deworming to avert the negative consequences STH infections can have on child health and development. In February-April 2011, 17 million children in Bihar State were dewormed during a government-led school-based deworming campaign. Prior to programme implementation, a study was conducted to assess STH prevalence in the school-age population to direct the programme. The study also investigated risk factors for STH infections, including caste, literacy, and defecation and hygiene practices, in order to inform the development of complementary interventions. METHODS: A cross-sectional survey was conducted among children in 20 schools in Bihar. In addition to providing stool samples for identification of STH infections, children completed a short questionnaire detailing their usual defecation and hand-hygiene practices. Risk factors for STH infections were explored. RESULTS: In January-February 2011, 1279 school children aged four to seventeen provided stool samples and 1157 children also completed the questionnaire. Overall, 68% of children (10-86% across schools) were infected with one or more soil-transmitted helminth species. The prevalence of ascariasis, hookworm and trichuriasis was 52%, 42% and 5% respectively. The majority of children (95%) practiced open defecation and reported most frequently cleansing hands with soil (61%). Increasing age, lack of maternal literacy and certain castes were independently associated with hookworm infection. Absence of a hand-washing station at the schools was also independently associated with A. lumbricoides infection. CONCLUSIONS: STH prevalence in Bihar is high, and justifies mass deworming in school-aged children. Open defecation is common-place and hands are often cleansed using soil. The findings reported here can be used to help direct messaging appropriate to mothers with low levels of literacy and emphasise the importance of water and sanitation in the control of helminths and other diseases

Integrative analyses identify modulators of response to neoadjuvant aromatase inhibitors in patients with early breast cancer

Introduction Aromatase inhibitors (AIs) are a vital component of estrogen receptor positive (ER+) breast cancer treatment. De novo and acquired resistance, however, is common. The aims of this study were to relate patterns of copy number aberrations to molecular and proliferative response to AIs, to study differences in the patterns of copy number aberrations between breast cancer samples pre- and post-AI neoadjuvant therapy, and to identify putative biomarkers for resistance to neoadjuvant AI therapy using an integrative analysis approach. Methods Samples from 84 patients derived from two neoadjuvant AI therapy trials were subjected to copy number profiling by microarray-based comparative genomic hybridisation (aCGH, n = 84), gene expression profiling (n = 47), matched pre- and post-AI aCGH (n = 19 pairs) and Ki67-based AI-response analysis (n = 39). Results Integrative analysis of these datasets identified a set of nine genes that, when amplified, were associated with a poor response to AIs, and were significantly overexpressed when amplified, including CHKA, LRP5 and SAPS3. Functional validation in vitro, using cell lines with and without amplification of these genes (SUM44, MDA-MB134-VI, T47D and MCF7) and a model of acquired AI-resistance (MCF7-LTED) identified CHKA as a gene that when amplified modulates estrogen receptor (ER)-driven proliferation, ER/estrogen response element (ERE) transactivation, expression of ER-regulated genes and phosphorylation of V-AKT murine thymoma viral oncogene homolog 1 (AKT1). Conclusions These data provide a rationale for investigation of the role of CHKA in further models of de novo and acquired resistance to AIs, and provide proof of concept that integrative genomic analyses can identify biologically relevant modulators of AI response

The Top 100 questions for the sustainable intensification of agriculture in India’s rainfed drylands

India has the largest area of rainfed dryland agriculture globally, with a variety of distinct types of farming systems producing most of its coarse cereals, food legumes, minor millets, and large amounts of livestock. All these are vital for national and regional food and nutritional security. Yet, the rainfed drylands have been relatively neglected in mainstream agricultural and rural development policy. As a result, significant social-ecological challenges overlap in these landscapes: endemic poverty, malnutrition and land degradation. Sustainable intensification of dryland agriculture is essential for helping to address these challenges, particularly in the context of accelerating climate change. In this paper, we present 100 questions that point to the most important knowledge gaps and research priorities. If addressed, these would facilitate and inform sustainable intensification in Indian rainfed drylands, leading to improved agricultural production and enhanced ecosystem services. The horizon scanning method used to produce these questions brought together experts and practitioners involved in a broad range of disciplines and sectors. This exercise resulted in a consolidated set of questions covering the agricultural drylands, organized into 13 themes. Together, these represent a collective programme for new cross- and multi-disciplinary research on sustainable intensification in the Indian rainfed drylands