An exploration of the mechanism by which community health workers bring health gain to service users in England

This thesis presents the findings of a qualitative exploration of how Community Health Workers (CHWs) conceptualise their role in delivering health improvement. The characteristics of CHWs described in the literature, and their role in health improvement, are examined critically. Interview data from 27 CHWs and 15 others across four services is used to explore the health improvement mechanism from the perspective of CHWs. Theory from a range of disciplines is used to explain it. The literature provides incomplete accounts of the mechanism. The empirical work suggests that, in the services sampled, the mechanism may predominantly be one of social support (informational, instrumental, appraisal and emotional support). Three distinct and essential processes emerge (needs assessment, effective service provision, and client engagement). The analysis reports how who CHWs are, and what they do, appear to be important influences on the social support processes, and that CHWs may be better at delivering this kind of support than traditional professional workers, particularly to socially excluded individuals. Overall, this work suggests that CHWs may perform a unique role, as experts in social support. The proposed mechanism can be used to inform service design and evaluation, to maximise CHWs’ potential to deliver effective social support

An assessment of the impacts of pesticide use on the environment and health of rice farmers in Sierra Leone

One of the biggest challenges faced by Sierra Leonean farmers is pest control. Birds, rodents, insects, crustaceans and other organisms can drastically reduce yields. In order to prevent these organisms from destroying their crop, farmers use pesticides. However there are reports that these chemicals are being misused and such misuse is having a negative impact on the environment and the health of the farmers. This research study aimed to investigate the use of pesticides in rice fields and its potential effects on the environment and on the farmers of Sierra Leone. Five hundred farmers and one hundred health workers across the country were interviewed. Fifty focus group discussions were also completed. Field observations were also undertaken to see how farmers apply pesticides to their farms and the possible threats these methods have on human health and the environment. It is clear that a wide range of pesticides are used by rice farmers in Sierra Leone with 60% of the pesticides used entering the country illegally. Most farmers have no knowledge about the safe handling of pesticides as 71% of them have never received any form of training. The pesticides kill both target and non-target organisms some of which enter the food chain. Cases of health problems such as nausea, respiratory disorders and blurred vision investigated in this research are significantly higher among farmers who use pesticides than those who do not use pesticides. Cases of pesticide intoxication are not investigated by health workers but results obtained from interviews with them also indicated that cases of pesticides related symptoms are significantly higher in environments where pesticides are used than those in which pesticides are not used

Innovating for a cause:the work and learning required to create a new approach to healthcare for homeless people

Innovation occupies a pivotal place in our understanding of knowledge-based economies, and this is raising questions about sources of innovation, how it originates, and the role played by employees, work practices and learning. This paper explores these issues through case study research into a new approach to providing healthcare for homeless people in England, and by bringing together conceptual insights from the employee-driven innovation literature, and more broadly from social and practice-based learning theory and organisational theory. Applying these perspectives to our case enables illumination of the innovation as a process – not an event – and as an ongoing set of organisational practices that transcend their origins. Through our analysis we argue that the notion of ‘a cause’ is helpful in elucidating the impetus and the commitment to making the innovation happen (and go on happening). Our findings are presented under three themes: ‘establishing a cause’, ‘organising for innovation’, and ‘innovative capability in practice’. Building on these, we have identified five key inter-related dimensions which help conceptualise the work and learning that it took to create and (re-)enact the innovation and that we suggest may have relevance for understanding and characterising other employee-led innovations in and perhaps beyond healthcare

Is it safe to move away from a full sternotomy for aortic valve replacement?

Minimally invasive surgical approaches have gained popularity among patients and surgeons. The aim of this project was to assess the safety of initiating aortic valve replacement via an anterior right thoracotomy program

An ongoing process of reconnection: A qualitative exploration of mindfulness‐based cognitive therapy for adults in remission from depression

Objectives Mindfulness-based cognitive therapy (MBCT) is an 8-week relapse-prevention intervention designed for people who have experienced multiple episodes of depression and remain vulnerable to relapse. Previous qualitative explorations of the effects of MBCT for people in remission from depression have suggested a number of themes regarding changes arising from participating in MBCT ranging from awareness, agency, perspective, group processes, self-related change, and new ways of understanding depression. We aimed to qualitatively explore how participants in remission from depression experienced MBCT both post-MBCT and during a follow-up period. Methods In a preference-choice trial design, 35 participants took part in qualitative interviews and assessments post-MBCT and at three time points during a 12-month follow-up. Data were analysed using reflexive thematic analysis. Results Two overarching themes were developed as follows: (1) ‘reconnection with experience, self, and others’ and (2) ‘acknowledging an ongoing process of change’. In theme one, sub-themes captured participants’ experiences of increasing levels of awareness of their experience (e.g., thoughts, emotions, sensations, and present moment) from which they described changes in their relationship with experience describing increases in control, choice, acceptance, and calm. Participants described shifts towards reconnection with aspects of the self and relationships with others. In theme two, sub-themes reflected participants’ conflict between avoidance and engagement in mindfulness practices, and the recognition of the gradual change following MBCT and long-term investment needed in mindfulness practices. Conclusions Our findings have clinical implications in terms of facilitating MBCT and point to important themes around recognizing the ongoing process of reconnection with experiences, self, and others

An ongoing process of reconnection: A qualitative exploration of mindfulness‐based cognitive therapy for adults in remission from depression

From Wiley via Jisc Publications RouterHistory: received 2021-03-22, rev-recd 2021-06-27, pub-electronic 2021-07-17Article version: VoRPublication status: PublishedObjectives: Mindfulness‐based cognitive therapy (MBCT) is an 8‐week relapse‐prevention intervention designed for people who have experienced multiple episodes of depression and remain vulnerable to relapse. Previous qualitative explorations of the effects of MBCT for people in remission from depression have suggested a number of themes regarding changes arising from participating in MBCT ranging from awareness, agency, perspective, group processes, self‐related change, and new ways of understanding depression. We aimed to qualitatively explore how participants in remission from depression experienced MBCT both post‐MBCT and during a follow‐up period. Methods: In a preference‐choice trial design, 35 participants took part in qualitative interviews and assessments post‐MBCT and at three time points during a 12‐month follow‐up. Data were analysed using reflexive thematic analysis. Results: Two overarching themes were developed as follows: (1) ‘reconnection with experience, self, and others’ and (2) ‘acknowledging an ongoing process of change’. In theme one, sub‐themes captured participants’ experiences of increasing levels of awareness of their experience (e.g., thoughts, emotions, sensations, and present moment) from which they described changes in their relationship with experience describing increases in control, choice, acceptance, and calm. Participants described shifts towards reconnection with aspects of the self and relationships with others. In theme two, sub‐themes reflected participants’ conflict between avoidance and engagement in mindfulness practices, and the recognition of the gradual change following MBCT and long‐term investment needed in mindfulness practices. Conclusions: Our findings have clinical implications in terms of facilitating MBCT and point to important themes around recognizing the ongoing process of reconnection with experiences, self, and others. Practitioner points: Participants with histories of depression may have experienced disconnection and isolation from internal experiences (e.g., thoughts and emotions), self, and others; MBCT encourages a deliberate shift towards reconnection with these experiences. Practitioners could encourage more psychoeducation and discussions around depression during MBCT to encourage reflections on the process of reconnection. Practitioners should maintain an awareness of the ongoing, gradual processes of change and potential for conflict experienced during MBCT Practitioners could provide a stronger emphasis on building awareness of body sensations during MBCT, with suggestions provided in the discussion section

Mechanisms of action and outcomes for students in Recovery Colleges

Objective\ud Recovery Colleges are widespread, with little empirical research on how they work and outcomes they produce. This study aimed to co-produce a change model characterising mechanisms of action and outcomes for mental health service users attending as students at a Recovery College.\ud Methods\ud A systematised review identified all Recovery College publications. Inductive collaborative data analysis by academic researchers and co-researchers with lived experience of ten key papers informed a theoretical framework for mechanisms and outcome for students, which was refined through deductive analysis of 34 further publications. A change model was co-produced and then refined through stakeholder interviews (n=33).\ud Results\ud Three mechanisms of action for Recovery College students were identified: empowering environment (safety, respect, supporting choices), enabling different relationships (power, peers, working together) and facilitating personal growth (e.g. co-produced learning, strengths, celebrating success). Outcomes were change in the student (e.g. self-understanding, self-confidence) and changes in the student’s life (e.g. occupational, social, service use). A co-produced change model mapping mechanisms of action to outcomes was created.\ud Conclusions\ud The key features identified as differentiating Recovery Colleges from traditional services are an empowering environment, enabling relationships and growth orientation. Recovery Colleges may benefit most attenders, but mental health service users to particularly encourage to enrol may include those who lack confidence, those who services struggle to engage with, those who will benefit from exposure to peer role models, and those lacking social capital. The change model provides the first testable characterisation of mechanisms and outcomes, allowing formal evaluation of Recovery Colleges

Upf1p, a Highly Conserved Protein Required for Nonsense-Mediated mRNA Decay, Interacts with the Nuclear Pore Proteins Nup100p and Nup116p

Saccharomyces cerevisiae Upf1p is a 971-amino-acid protein that is required for the nonsense-mediated mRNA decay (NMD) pathway, a pathway that degrades mRNAs with premature translational termination codons. We have identified a two-hybrid interaction between Upf1p and the nuclear pore (Nup) proteins, Nup100p and Nup116p. Both nucleoporins predominantly localize to the cytoplasmic side of the nuclear pore and participate in mRNA transport. The two-hybrid interaction between Upf1p and the nuclear pore proteins, Nup100p and Nup116p, is dependent on the presence of the C-terminal 158 amino acids of Upf1p. Nup100p and Nup116p can be coimmunoprecipitated from whole-cell extracts with Upf1p, confirming in vitro the interaction identified by the two-hybrid analysis. Finally, we see a genetic interaction between UPF1 and NUP100. The growth of upf1Δ, can1-100 cells is inhibited by canavanine. The deletion of NUP100 allows upf1Δ, can1-100 cells to grow in the presence of canavanine. Physiologically, the interaction between Upf1p and the nuclear pore proteins, Nup100p and Nup116p, is significant because it suggests a mechanism to ensure that Upf1p associates with newly synthesized mRNA as it is transported from the nucleus to the cytoplasm prior to the pioneer round of translation

Protocol update for a multi-centre randomised controlled trial of exercise rehabilitation for people with pulmonary hypertension:the SPHERe trial

Background: The SPHERe (Supervised Pulmonary Hypertension Exercise Rehabilitation) trial is a multi-centre, pragmatic, randomised controlled trial assessing the clinical and cost-effectiveness of supervised exercise rehabilitation with psychosocial and motivational support compared to best-practice usual care for people with pulmonary hypertension (PH). The original protocol was published in BMC Pulmonary Medicine (accessible online). We randomised our first participant in January 2020. In response to the COVID-19 pandemic, the trial was stopped in March 2020. In person delivery of the SPHERe intervention to a vulnerable population was not possible during the COVID-19 pandemic. We describe here how trial procedures and intervention delivery were adapted in response to the COVID-19 pandemic.Methods: Restrictions imposed by the COVID-19 pandemic on the clinically vulnerable PH population meant that trial delivery was changed from a centre-based rehabilitation programme to remotely delivered group online sessions. This led to minor alterations to the eligibility criteria. These changes followed a consultation process with stakeholders and people with PH and were approved by the funder and independent trial committees.Conclusions: We describe the modified SPHERe trial protocol in response to restrictions imposed by the COVID-19 pandemic. SPHERe is the first randomised controlled trial to assess the clinical and cost-effectiveness of an online group rehabilitation programme for people with PH compared to usual care.Trial registration: ISRCTN no. 10608766. Prospectively registered on 18th March 2019, updated 16th August 2023.</p