The social negotiation of fitness for work: tensions in doctor-patient relationships over medical certification of chronic pain

The UK government is promoting the health benefits of work, in order to change doctors' and patients' behaviour and reduce sickness absence. The rationale is that many people 'off sick' would have better outcomes by staying at work; but reducing the costs of health care and benefits is also an imperative. Replacement of the 'sick note' with the 'fit note' and a national educational programme are intended to reduce sickness-certification rates, but how will these initiatives impact on doctor-patient relationships and the existing tension between the doctor as patient advocate and gate-keeper to services and benefits? This tension is particularly acute for problems like chronic pain where diagnosis, prognosis and work capacity can be unclear. We interviewed 13 doctors and 30 chronic pain patients about their experiences of negotiating medical certification for work absence and their views of the new policies. Our findings highlight the limitations of naïve rationalist approaches to judgements of work absence and fitness for work for people with chronic pain. Moral, socio-cultural and practical factors are invoked by doctors and patients to contest decisions, and although both groups support the fit note's focus on capacity, they doubt it will overcome tensions in the consultation. Doctors value tacit skills of persuasion and negotiation that can change how patients conceptualise their illness and respond to it. Policy-makers increasingly recognise the role of this tacit knowledge and we conclude that sick-listing can be improved by further developing these skills and acknowledging the structural context within which protagonists negotiate sick-listin

Behaviour change interventions for the management of Raynaud's phenomenon : a systematic review protocol

Introduction Raynaud's phenomenon (RP) describes excessive peripheral vasospasm to cold exposure and/or emotional stress. RP episodes are associated with digital colour changes, pain and reduced quality of life. Pharmacological interventions are of low to moderate efficacy and often result in adverse effects such as facial flushing and headaches. Recommended lifestyle and behavioural interventions have not been evaluated. The objectives of the proposed systematic review are to assess the comparative safety and efficacy of behaviour change interventions for RP and identify what we can learn to inform future interventions. Methods and analysis Studies eligible for inclusion include randomised controlled trials testing behaviour change interventions with a control comparator. A comprehensive search strategy will include peer review and grey literature up until 30 April 2017. Search databases will include Medline, Embase, PsychINFO and Cochrane. Initial sifting, eligibility, data extraction, risk of bias and quality assessment will be subject to review by two independent reviewers with a third reviewer resolving discrepancies. Risk of bias assessment will be performed using Cochrane risk of a bias assessment tool with quality of evidence assessed using Grading of Recommendations Assessment, Development and Evaluation(GRADE). A meta-analysis will be performed if there are sufficient data. Two subgroup analyses are planned: primary versus secondary RP outcomes; comparison of theoretically informed interventions with pragmatic interventions. Ethics and dissemination This review does not require ethical approval as it will summarise published studies with non-identifiable data. This protocol complies with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Findings will be disseminated in peer-reviewed articles and reported according to PRISMA. This review will make a significant contribution to the management of RP where no review of behaviour-change interventions currently exist. The synopsis and protocol for the proposed systematic review is registered in the International Prospective Register of Systematic Reviews (registration number CRD42017049643)

Behaviour change interventions for the management of Raynaud's Phenomenon: A systematic review

Objectives Raynaud’s phenomenon (RP) is a significant cause of morbidity. Vasodilator medications cause unwanted adverse effects, with behavioural and lifestyle changes forming the mainstay of self-management; this is difficult to implement successfully. The objectives of this study were to evaluate the efficacy of behaviour change interventions for RP and identify learning points for future treatment development.Design Systematic literature review and narrative synthesis of findings.Data sources EMBASE, MEDLINE, Cochrane and PsycINFO were searched for eligible studies on 22 August 2017.Eligibility criteria Randomised controlled trials (RCTs) of behaviour change interventions with at least one control comparator arm.Data extraction and synthesis Study selection, data extraction and risk of bias were assessed independently by two reviewers, reaching consensus with a third when necessary. Primary outcomes of interest included severity/impact, frequency and duration of RP episodes, pain, disability, adverse events and study withdrawal.Results Of 638 articles retrieved, eight studies fulfilled criteria for inclusion. Biofeedback was the active behaviour change treatment arm for seven studies, with one study reporting a behavioural intervention. Studies were published 1978–2002; six were USA-based studies, one German and one Swedish. Using Cochrane Risk of Bias assessment, studies were assessed to be overall at high risk of bias, with the exception of one large RCT. The total sample included 495 participants (study median=29), with a median age of 39.5 years and preponderance towards females (73%). Five studies reported significant effects in primary outcomes of interest; however, due to missing data, relative efficacy of interventions could not be reliably assessed.Conclusions There is no evidence to support or refute claims of the efficacy of behaviour change interventions for the management of RP. There remains a strong case for developing and testing behaviour change interventions that focus on self-management; however, theoretical development and advancement in trial quality is imperative to underpin future work

The Occurrence of Bioactive Micromonosporae in Aquatic Habitats of the Sunshine Coast in Australia

Screening strategies based on the ecological knowledge of antibiotic producing microorganisms and their roles in the natural environment are being increasingly employed in the search for novel antibiotic agents. Micromonosporae are common inhabitants of aquatic habitats and have proved to be a continuing source of novel bioactive compounds including antibacterial and antitumor agents. The ecological distribution and frequency of bioactive micromonosporae in Sunshine Coast region aquatic habitats were studied through a range of selective isolation procedures designed to negatively select against the isolation of unwanted microbial taxa commonly associated with marine environments. It was revealed that bioactive compound producing species of micromonosporae were present in the aquatic habitats of the Sunshine Coast region in Australia

Pathologies in International Policy Transfer:The Case of the OECD Tax Transparency Initiative

ABSTRACT The importance of international organizations to the development and diffusion of international policy norms is widely recognized but is increasingly tempered by an appreciation of the pathologies of policy transfer. Using a case study of the OECD’s campaign to promote transparency in global tax affairs, this paper identifies a new and relatively distinctive form of dysfunctional policy transfer. Specifically it argues that international organizations face bureaucratic incentives to promote weak or lowest common denominator standards in order to maximize their prospects of brokering successful international agreements. However the paper also notes that while international organizations may have a short-term interest in promoting weak standards, their longer-term legitimacy is often tied to the effectiveness of the standards they promote. It is argued that this dynamic often leads to incremental policy change

Phases of two coupled Luttinger liquids

A model of two interacting one--dimensional fermion systems (``Luttinger liquids'') coupled by single--particle hopping is investigated. Bosonization allows a number of exact statements to be made. In particular, for forward scattering only, the model contains two massless boson sectors and an Ising type critical sector. For general interactions, there is a spin excitation gap and either s-- or d--type pairing fluctuations dominate. It is shown that the same behavior is also found for strong interactions. A possible scenario for the crossover to a Fermi liquid in a many chain system is discussed.Comment: revised version, some changes, 11 pages, no figures, RexTeX3.

Spin Dynamics in the Magnetic Chains Arrays of Sr14Cu24O41: a Neutron Inelastic scattering Investigation

Below about 150 K, the spin arrangement in the chain arrays of Sr14Cu24O41 is shown to develop in two dimensions (2D). Both the correlations and the dispersion of the observed elementary excitations agree well with a model of interacting dimers. Along the chains, the intra- and inter-dimer distances are equal to 2 and about 3 times the distance (c) between neighboring Cu ions. While the intra-dimer coupling is J about 10 meV, the inter-dimer couplings along and between the chains are of comparable strenght, J// about -1.1 meV and Jperp about 1.7 meV, respectively. This remarkable 2D arrangement satisfies the formal Cu valence of the undoped compound. Our data suggest also that it is associated with a relative sliding of one chain with respect to the next one, which, as T decreases, develops in the chain direction. A qualitative analysis shows that nearest inter-dimer spin correlations are ferromagnetic, which, in such a 2D structure, could well result from frustration effects.Comment: 4 pages, 5 figures, submitted to Phys.Rev.B, date of receipt 29 June 199