A portfolio of academic, therapeutic practice and research work : including an investigation of the construction of care and care receivers on internet support sites

Many care receivers feel like a burden and this perception is socially constructed (Gorvin & Brown, 2012). To explore why care receivers may feel this way, the research uses a critical discourse analysis, as suggested by Edley (2001), to examine caregivers' posts on publically accessible internet support sites, specifically exploring how caregivers construct care receivers. Two interpretative repertoires that caregivers' used widely to account for their tasks are presented. These are: care is a family responsibility and caring is harmful. When used together, these position care receivers as a burden and caregivers as burdened. Within care as a family responsibility, there is an ideological dilemma for caregivers as they address the question: when 1 care, who am I? Here, they debate who they are in relation to the person they care for: a caregiver, a family member, or both. Most caregivers constructed care as something additional to normal relating, allowing them to speak of their suffering. Caregi vers constructed care receivers as frustrated and with diminished autonomy. The implications of these constructions for care receivers and counselling psychologists are discussed.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Inflammation Dynamically Regulates Steroid Hormone Metabolism and Action within Macrophages in Rheumatoid Arthritis

Rationale: In inflammatory diseases such as rheumatoid arthritis (RA), steroid metabolism is a central component mediating the actions of immuno-modulatory glucocorticoids and sex steroids. However, the regulation and function of cellular steroid metabolism within key leukocyte populations such as macrophages remain poorly defined. In this study, the inflammatory regulation of global steroid metabolism was assessed in RA macrophages. Methods: Bulk RNA-seq data from RA synovial macrophages was used to assess transcripts encoding key enzymes in steroid metabolism and signalling. Changes in metabolism were assessed in synovial fluids, correlated to measures of disease activity and functionally validated in primary macrophage cultures. Results: RNA-seq revealed a unique pattern of differentially expressed genes, including changes in genes encoding the enzymes 11β-HSD1, SRD5A1, AKR1C2 and AKR1C3. These correlated with disease activity, favouring increased glucocorticoid and androgen levels. Synovial fluid 11β-HSD1 activity correlated with local inflammatory mediators (TNFα, IL-6, IL-17,), whilst 11β-HSD1, SRD5A1 and AKR1C3 activity correlated with systemic measures of disease and patient pain (ESR, DAS28 ESR, global disease activity). Changes in enzyme activity were evident in inflammatory activated macrophages in vitro and revealed a novel androgen activating role for 11β-HSD1. Together, increased glucocorticoids and androgens were able to suppress inflammation in macrophages and fibroblast-like-synoviocytes. Conclusions: This study underscores the significant increase in androgen and glucocorticoid activation within inflammatory polarized macrophages of the synovium, contributing to local suppression of inflammation. The diminished profile of inactive steroid precursors in postmenopausal women may contribute to disturbances in this process, leading to increased disease incidence and severity.<br/