Mutual support: an exploration of peer support for people with learning difficulties

Mutual Support is an in depth exploration of the role and impact of peer support by people with learning difficulties. Built on one of the seven aims of Centres for Independent Living, the project has constructed a model of peer support based on accounts of direct experiences from people with learning difficulties. The overall aim of the research was to construct and critique the Mutual Support model of peer support and people with learning difficulties. This thesis reflects the process of that construction. The overall aim was met through a research situation in which knowledge was constructed in the interaction between the researcher and participants. This provided an opportunity for people with learning difficulties to reflect upon their relationships with one another, and the emancipatory potential of that support. The focus of the research was two pre-existing settings involving people with learning difficulties supporting one another: a Theatre Company using Forum Drama to facilitate changes in attitudes and policy, and a course facilitated by people with learning difficulties who mentored small groups. Methods used within the research were based on an Inclusive Research process which prioritises meaningful research interaction that is accessible and guided by participants. The research process intertwined meetings with advisory groups, and contact with other local groups of people with learning difficulties, with formal data collection within the two main settings. One to one experienced-based narrative interviews with people from the two main settings provided multiple opportunities for participants to speak about their experiences of peer support. These interviews formed the data used in formal analysis, which was a continual process, with subsequent interviews being based on views previously expressed. A further comprehensive descriptive content analysis of data, using the tools of Nvivo8 and mind-mapping, took place prior to the outputs of the whole project being evaluated during group sessions with those who had taken part. The emerging model is one of collective support which challenges assumptions about the role and impact of people with learning difficulties supporting one another and their capacity to engage in insightful interpersonal interaction. Mutual Support has the potential to break down barriers to inclusion. Mutual Support also demonstrates the value that people with learning difficulties place on giving and receiving support from one another. The outputs of Mutual Support include contribution to current debate in the areas of service user involvement, inclusive research, and the academic field of Disability Studies

Relational care and co-operative endeavour:Reshaping dementia care through participatory secondary data analysis

Dementia is emerging from the shadows of societal exclusion and stigma. The engagement within society for people who are marginalised is coconstructed through the everyday practices that take place between them and those around them. However, this is inherently political, positioning people as active and activist in the relationship of their lives with their communities. The research aimed to interrogate an existing qualitative dataset in partnership with people living with dementia to inform the development of a way of working with people with dementia that is empowering. In this qualitative secondary data analysis project, we (1) analysed data through two theoretical lenses: Douglas’ cultural theory of risk and Tronto’s Ethic of Care, and (2) co-analysed the data together with people living with dementia during 14 workshops. The design involved cycles of presenting, interpreting, representing and reinterpreting the data and findings between multiple stakeholders. We identified a granular understanding of the way relationships change for people with dementia and how subtle factors and nuanced behaviour contribute to social exclusion, or support social inclusion. The results support relational care through the co-operative endeavour (of co-operative communication, cooperative action and co-operative care) in promoting the inclusion of people living with dementia

Stigma as a fundamental hindrance to the United States opioid overdose crisis response.

Alexander Tsai and co-authors discuss the role of stigma in responses to the US opioid crisis

Physician Assistant Students’ Perceptions of the Fitness Industry and Lifestyle Medicine

With nearly two-thirds of all chronic disease having a lifestyle cause, there is spurred interest in curricular changes for Physician Assistants (PA) and other medical providers to learn Lifestyle Medicine (LM) - the therapeutic use of lifestyle changes to prevent, treat and reverse disease. A key competency in LM practice involves an interdisciplinary approach, including aid from fitness professionals. Yet, perceptions of the fitness industry might hinder such a relationship. PURPOSE: To assess PA students\u27 knowledge of LM and perceptions of the fitness industry, to guide curriculum implementation efforts. METHODS: An online survey was advertised to all PA students at Baylor College of Medicine. Students’ competence in assessing and prescribing physical activity and diet, knowledge of LM, current curriculum time spent on LM, and desire to learn more about LM were assessed. Students were also asked to share their attitude of both health clubs and personal trainers, alongside referral perceptions. RESULTS: 76 (84%) of students (25.57 ± 4.86 years; 22.77 ± 4.20 kg/m2) completed the survey, self-reporting moderate competence (range: 1-6) in conducting a physical exam to approve an exercise program (4.22 ± 1.22), determining caloric and nutritional needs (3.80 ± 1.34), and designing an exercise prescription (3.57 ± 1.35). However, only 18%, 6%, and 6% self-rated full competence in each, respectively. 31% of students had heard of the discipline of LM, with 43% self-reporting inadequate or poor knowledge. 0% felt they spent enough time on LM in their program, and 78% rated their time spent on LM was either poor or inadequate. Yet, 100% wanted to learn more. Perceptions of health clubs and personal trainers were positive (8.16 ± 1.68; range: 1-10), with them being appropriate exercise venues for patients (7.78 ± 1.76). However, only 6% - 16% believed that health clubs and personal trainers were fully qualified, effective, smart, and concerned about patient health. CONCLUSIONS: Despite the role of lifestyle on chronic disease, PA students had limited competence and knowledge in LM, but held a unanimous desire for more in their educational training. Perceptions of the fitness industry were generally positive; yet educational efforts might be needed to encourage a team-approach to chronic disease care

“No powers, man!”: A student perspective on designing university smart building interactions

Smart buildings offer an opportunity for better performance and enhanced experience by contextualising services and interactions to the needs and practices of occupants. Yet, this vision is limited by established approaches to building management, delivered top-down through professional facilities management teams, opening up an interaction-gap between occupants and the spaces they inhabit. To address the challenge of how smart buildings might be more inclusively managed, we present the results of a qualitative study with student occupants of a smart building, with design workshops including building walks and speculative futuring. We develop new understandings of how student occupants conceptualise and evaluate spaces as they experience them, and of how building management practices might evolve with new sociotechnical systems that better leverage occupant agency. Our findings point to important directions for HCI research in this nascent area, including the need for HBI (Human-Building Interaction) design to challenge entrenched roles in building management

Adiposity, Cardiometabolic Risk, and Vitamin D Status: The Framingham Heart Study

OBJECTIVE: Because vitamin D deficiency is associated with a variety of chronic diseases, understanding the characteristics that promote vitamin D deficiency in otherwise healthy adults could have important clinical implications. Few studies relating vitamin D deficiency to obesity have included direct measures of adiposity. Furthermore, the degree to which vitamin D is associated with metabolic traits after adjusting for adiposity measures is unclear. RESEARCH DESIGN AND METHODS: We investigated the relations of serum 25-hydroxyvitamin D (25[OH]D) concentrations with indexes of cardiometabolic risk in 3,890 nondiabetic individuals; 1,882 had subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) volumes measured by multidetector computed tomography (CT). RESULTS: In multivariable-adjusted regression models, 25(OH)D was inversely associated with winter season, waist circumference, and serum insulin (P < 0.005 for all). In models further adjusted for CT measures, 25(OH)D was inversely related to SAT (−1.1 ng/ml per SD increment in SAT, P = 0.016) and VAT (−2.3 ng/ml per SD, P < 0.0001). The association of 25(OH)D with insulin resistance measures became nonsignificant after adjustment for VAT. Higher adiposity volumes were correlated with lower 25(OH)D across different categories of BMI, including in lean individuals (BMI <25 kg/m2). The prevalence of vitamin D deficiency (25[OH]D <20 ng/ml) was threefold higher in those with high SAT and high VAT than in those with low SAT and low VAT (P < 0.0001). CONCLUSIONS: Vitamin D status is strongly associated with variation in subcutaneous and especially visceral adiposity. The mechanisms by which adiposity promotes vitamin D deficiency warrant further study.National Institutes of Health's National Heart, Lung, and Blood Institute (N01-HC-25195, R01-DK-80739): American Heart Associatio