Empowering employees with chronic diseases: process evaluation of an intervention aimed at job retention

Purpose Employees with a chronic disease may experience work-related problems that contribute to the risk of job loss. We developed a group-based intervention programme aimed at clarifying problems, making these a subject of discussion at work, and realizing solutions. This process evaluation investigates the intervention's feasibility and the satisfaction of 64 participants in eight groups. Methods Data were collected through process evaluation forms and self-report questionnaires. Results The recruitment of participants was time-consuming. Highly educated women working in the service sector were overrepresented. The programme was administered as planned, although components were sometimes only discussed briefly, due to lack of time. Satisfaction with the overall programme among participants was high; it was perceived as effective and there were only three dropouts. In particular, the focus on feelings and thoughts about having a chronic disease was highly valued, as were the exchange of experiences and role-playing directed at more assertive communication. Conclusions A vocational rehabilitation programme aimed at job retention is feasible and is perceived to be effective. Such a programme should address psychosocial aspects of working with a chronic disease beside practical problems. The recruitment of participants is time-consuming. Cooperation with outpatient clinics is necessary in order to reach all groups of employees with a chronic disease that might benefit from job retention programmes. Trial registration: ISRCTN77240155

The influence of forest reserve protection on the structure, stability, and functioning of dung-associated invertebrate communities

Communities are influenced by many factors, with anthropogenic impacts being one of the strongest. These factors can influence community structure and may cause non-random species loss by filtering certain traits of species, which may also determine how a species contributes to ecosystem functioning. The structure of a community can also be highly variable over short timescales and across seasons, as abiotic factors can alter a resource over the course of days and also alter intensity of competition within a community. These short-timescale influences are most noticeable in an ephemeral resource that is limited in both space and time. Changes in community structure and interactions can be represented as networks of interactions (links) among species (nodes). Interaction networks describe a community and incorporate non-trophic interactions, which can alter their structure. These are generally measured by counting the number of trophic interactions, ignoring non-trophic interactions such as competition. However, competitive interactions may be important for network dynamics, yet the most appropriate way to quantify competition remains unclear. The outcome of a competitive interaction could potentially be predicted by the body size ofcompeting individuals, and this would remove the need to observe individual interactions. These ideas were tested using the dung-associated community in an Afromontane forest reserve in Nigeria across variation in seasons and in areas that were protected from anthropogenic impacts by fencing. Trapping and recording of interactions within the community was used to assess community structure, and experiments were run to test how dung removal and secondary seed dispersal changed across seasons and in protected areas of the forest. The influence of competition was determined by altering the size and number of dung beetles present at the resource. The community structure was influenced by forest protection and varied across seasons. Additionally, the size and number of dung beetles present was higher in protected areas in the wet season, resulting in higher dung removal and secondary seed dispersal and indicating non-random species loss in unprotected areas. The attractiveness of the dung resource changed over short timescales and desiccation occurred rapidly in the dry season, which resulted in decreased insect abundance and diversity over the course of days. Individual dung removal rates were not additive, and could only be used to predict community-level dung removal when taking into account competitive interactions. The body-size ratio between winners and losers of a competition was a good predictor of an interaction outcome. Competition networks were highly connected and nested, with compartmentalisation occurring in the competition network. At the community level, effects of forest protection and changing seasons only altered network nestedness. Therefore, body size can be used to predict species responses to anthropogenic threats and community structure and function when taking into account density-dependent competitive interactions. Furthermore, when determining community responses to anthropogenic threats, sampling across changes in seasons and observing competitive interactions provides more information about a community structure and stability

Patient empowerment in long-term conditions: development and preliminary testing of a new measure

BACKGROUND: Patient empowerment is viewed by policy makers and health care practitioners as a mechanism to help patients with long-term conditions better manage their health and achieve better outcomes. However, assessing the role of empowerment is dependent on effective measures of empowerment. Although many measures of empowerment exist, no measure has been developed specifically for patients with long-term conditions in the primary care setting. This study presents preliminary data on the development and validation of such a measure. METHODS: We conducted two empirical studies. Study one was an interview study to understand empowerment from the perspective of patients living with long-term conditions. Qualitative analysis identified dimensions of empowerment, and the qualitative data were used to generate items relating to these dimensions. Study two was a cross-sectional postal study involving patients with different types of long-term conditions recruited from general practices. The survey was conducted to test and validate our new measure of empowerment. Factor analysis and regression were performed to test scale structure, internal consistency and construct validity. RESULTS: Sixteen predominately elderly patients with different types of long-term conditions described empowerment in terms of 5 dimensions (identity, knowledge and understanding, personal control, personal decision-making, and enabling other patients). One hundred and ninety seven survey responses were received from mainly older white females, with relatively low levels of formal education, with the majority retired from paid work. Almost half of the sample reported cardiovascular, joint or diabetes long-term conditions. Factor analysis identified a three factor solution (positive attitude and sense of control, knowledge and confidence in decision making and enabling others), although the structure lacked clarity. A total empowerment score across all items showed acceptable levels of internal consistency and relationships with other measures were generally supportive of its construct validity. CONCLUSION: Initial analyses suggest that the new empowerment measure meets basic psychometric criteria. Reasons concerning the failure to confirm the hypothesized factor structure are discussed alongside further developments of the scale

Nanofocusing parabolic refractive X-ray lenses

Parabolic refractive x-ray lenses with short focal distance can generate intensive hard x-ray microbeams with lateral extensions in the 100 nm range even at a short distance from a synchrotron radiation source. We have fabricated planar parabolic lenses made of silicon that have a focal distance in the range of a few millimeters at hard x-ray energies. In a crossed geometry, two lenses were used to generate a microbeam with a lateral size of 380 nm by 210 nm at 25 keV in a distance of 42 m from the synchrotron radiation source. Using diamond as the lens material, microbeams with a lateral size down to 20 nm and below are conceivable in the energy range from 10 to 100 keV. (C) 2003 American Institute of Physics