Managing multiple morbidity in mid-life: a qualitative study of attitudes to drug use

OBJECTIVE: To examine attitudes towards drug use among middle aged respondents with high levels of chronic morbidity. DESIGN: Qualitative study with detailed interviews. SETTING: West of Scotland. PARTICIPANTS: 23 men and women aged about 50 years with four or more chronic illnesses. MAIN OUTCOME MEASURE: Participants' feelings about long term use of drugs to manage chronic multiple morbidity. RESULTS: Drugs occupied a central place in the way people managed their comorbidities. Respondents expressed an aversion to taking drugs, despite acknowledging that they depended on drugs to live as "normal" a life as possible. Respondents expressed ambivalence to their drugs in various ways. Firstly, they adopted both regular and more flexible regimens and might adhere to a regular regimen in treating one condition (such as hypertension) while adopting a flexible regimen in relation to others, in response to their experience of symptoms or varying demands of their daily life. Secondly, they expressed reluctance to take drugs, but an inability to be free of them. Thirdly, drugs both facilitated performance of social roles and served as evidence of an inability to perform such roles. CONCLUSIONS: Insight into the considerable tension experienced by people managing complex drug regimens to manage multiple chronic illness may help medical carers to support self care practices among patients and to optimise concordance in their use of prescribed drugs

Identifying and applying psychological theory to setting and achieving rehabilitation goals: development of a practice framework

Goal setting is considered to be a fundamental part of rehabilitation; however, theories of behaviour change relevant to goal-setting practice have not been comprehensively reviewed. To identify and discuss specific theories of behaviour change relevant to goal-setting practice in the rehabilitation setting. (ii) To identify 'candidate' theories that that offer most potential to inform clinical practice. The rehabilitation and self-management literature was systematically searched to identify review papers or empirical studies that proposed a specific theory of behaviour change relevant to setting and/or achieving goals in a clinical context. Data from included papers were extracted under the headings of: key constructs, clinical application and empirical support. Twenty-four papers were included in the review which proposed a total of five theories: (i) social cognitive theory, (ii) goal setting theory, (iii) health action process approach, (iv) proactive coping theory, and (v) the self-regulatory model of illness behaviour. The first three of these theories demonstrated most potential to inform clinical practice, on the basis of their capacity to inform interventions that resulted in improved patient outcomes. Social cognitive theory, goal setting theory and the health action process approach are theories of behaviour change that can inform clinicians in the process of setting and achieving goals in the rehabilitation setting. Overlapping constructs within these theories have been identified, and can be applied in clinical practice through the development and evaluation of a goal-setting practice framework

Improving the health of people with multimorbidity: the need for prospective cohort studies

The dramatic rise in long-term conditions (LTCs) represents a major challenge for individuals, families, and health care systems worldwide. Due to the scale of this rise, the management of patients with LTCs largely falls within the domain of primary rather than secondary care, at least in countries with well-developed primary care systems. For example, in the UK, which has a comprehensive primary care system based around general practice (trained family physicians working in multidisciplinary teams) and funded by the National Health Service (NHS), primary care contacts account for around 90% of the total activity of the NHS, and patients with LTCs account for 80% of general practice consultations. Effective primary care and community-based management of people with LTCs is thus a top priority

Intra-Firm Human Capital Externalities in Tunisia

In this case-study, we use matched worker-firm Tunisian data to elicit the roles of intra-firm human capital and modern firm features in worker remunerations. We show that the estimated return to education in wage equations is not modified when replacing in the list of regressors the firm dummies, representing observed and unobserved firm heterogeneity, by the first three factors of a Principal Component Analysis of the observed firm characteristics. These factors can be interpreted as: the activity sector, the intra-firm human capital density and the modernity of the firm. These results constitute an interesting argument in favour of the presence of intra-firm human capital externalities. Moreover, the estimated education coefficient does not change when the three factors are replaced by three surrogate variables, respectively: the textile industry dummy, the intra-firm mean education, and the firm’s age.economic development, rate of returns, human capital, wage differentials, intra-firm knowledge externalities, Tunisia.

Patient-reported outcome measures for chronic obstructive pulmonary disease: the exclusion of people with low literacy skills and learning disabilities

<p>Background: Patient-reported outcome measures (PROMs) are intended to reflect outcomes relevant to patients. They are increasingly used for healthcare quality improvement. To produce valid measures, patients should be involved in the development process but it is unclear whether this usually includes people with low literacy skills or learning disabilities. This potential exclusion raises concerns about whether these groups will be able to use these measures and participate in quality improvement practices.</p> <p>Methods: Taking PROMs for chronic obstructive pulmonary disease (COPD) as an exemplar condition, our review determined the inclusion of people with low literacy skills and learning disabilities in research developing, validating, and using 12 PROMs for COPD patients. The studies included in our review were based on those identified in two existing systematic reviews and our update of this search. Results People with low literacy skills and/or learning disabilities were excluded from the development of PROMs in two ways: explicitly through the participant eligibility criteria and, more commonly, implicitly through recruitment or administration methods that would require high-level reading and cognitive abilities. None of the studies mentioned efforts to include people with low literacy skills or learning disabilities.</p> <p>Conclusion: Our findings suggest that people with low literacy skills or learning disabilities are left out of the development of PROMs. Given that implicit exclusion was most common, researchers and those who administer PROMs may not even be aware of this problem. Without effort to improve inclusion, unequal quality improvement practices may become embedded in the health system.</p&gt

Neron: spektakle prześladowań i nadmiaru

Publikacja została sfinansowana ze środków Narodowego Programu Rozwoju Humanistyki w ramach projektu nr 12H 11 0004 8

Musculoskeletal Symptom Survey Among Construction Workers in Indonesian: A Case Study in Construction Project

The objective of this study was to find out the prevalence, characteristics, and distribution of musculoskeletal pain among construction workers in Indonesia based on a case-study in a construction project. Construction jobs is closely related to cases of musculoskeletal disorders caused by job characteristics. Musculoskeletal disorders developed after work with awkward positions and high workload. Complaints of the musuculoskeletal in construction workers are in the neck, upper back, lower back, knees, shoulders, elbows, hands / wrists, thighs and ankles. A questionnaire about musculoskeletal pain in different parts of body was completed by 33 construction workers from the construction project in Bandung city. The majority of respondents had elbow pain (60.61%) followed by low back and shoulder pain (54.55%). The implications of this study is developing ergonomics intervention in further research to prevent musculoskeletal disorders in construction job

Projecting the Past: Ancient Rome, Cinema and History

Brought vividly to life on screen, the myth of ancient Rome resonates through modern popular culture. Projecting the Past examines how the cinematic traditions of Hollywood and Italy have resurrected ancient Rome to address the concerns of the present. The book engages contemporary debates about the nature of the classical tradition, definitions of history, and the place of the past in historical film

UMA COVID-19_News_President Updates_A Message from President Wyke: UMA’s Safe Return Plan

Screenshot of University of Maine at Augusta\u27s news webpage with a communication from President Rebecca M. Wyke regarding the return to campus for the 2020 Fall Semester