Self-management and self-efficacy across the multiple sclerosis journey

Multiple Sclerosis (MS), the most common progressive neurological disease in young adults can take a relapsing remitting (RR) course especially in the early stages. There is a gap in knowledge in the application of self-management and self-efficacy with progressive long-term conditions. This research explored the experience of individuals with RRMS with particular focus on their attitudes to self-management and development of self-efficacy. The research addresses the question about engagement with self-management and self-efficacy influencing the journey of people with RRMS and their formal and informal carers. The research draws on the experiences, perspectives and understanding of the social processes and reality through interaction. Using grounded theory for generation of the themes captured from people with RRMS, their partners/carers and professionals involved in their care. The research design around a conceptual framework, used longitudinal studies capturing the experiences of people with RRMS and their partners/carers, through individual interviews and self-efficacy qualitative questionnaires over eight monthly meetings. The research sample of people with RRMS was three male and three female with an average age of 44.5 years, a mean duration with RRMS for 9.6 years. Professionals shared their perceptions and experiences through a focus group and individual interviews. Personal and reflective diaries kept by the researcher of events throughout the study enabled decision and audit trials to contribute to the rigour of the research. The data analysis has generated a number of themes that have been developed and presented throughout the thesis. The research process has generated new theory around the knowledge of and experiences of the three groups of research participants. Fluctuations of living with RRMS across roller coaster journeys, with transitional processes of daily changes and meanings brought threats and challenges. These highlight the importance of self-efficacy and self-control, of coping with uncertainty and unpredictability, through engaging with self-management behaviours. These enhanced perceptions of self- determination, positiveness, independence, quality of life and well-being. The transformation of uncertainty secured hope, opportunities and embracing RRMS through coping mechanisms and self-confidence. Formal and informal support was required where the People with RRMS deemed appropriate. The epistemological perspective has explored power as a multilayered and dynamic concept with different knowledge bases and issues that need addressing prior to successful partnership working. The research is original in terms of the groupings, the areas reviewed for this RRMS group and the potential for ongoing work, policy and practice changes both locally and nationally. Implications for practice, policy and further research were derived from the conclusions. In practice more empowerment, advice and information are required for people with RRMS to live independently. Policies for skills and knowledge training in these areas are required for shared decision-making and partnership working. Further research is required into utilisation of Integrated Care Management of ways of supporting independence, self-control and personalised plans for people with long- term conditions and their informal carers

Activity and Culture: The Contribution to Health and Well-being in Later Life

A nurse-led multi-agency team worked with older people to develop a model of activity and culture, and evaluate its impact to health and well-being. Underpinned by a needs analysis, the project sought to identify the range of activities that older people used to engage in, currently undertake and what they aspire to engage with both inside their home and in the community. Initial findings revealed that lack of confidence, restricted opportunities and physical barriers such as transport, limited tenants' involvement with physical, social and cultural activities that could improve their health and wellbeing. The project has therefore aimed to develop a more diverse and accessible programme of activities that better reflects individual and collective needs. Following early positive evaluations, the project team are now considering how the centre could be accessed by, and benefit, a wider group of community dwelling older people and would hope to collaborate with other groups to explore how this model can be developed for use with a wider range of older people

Moderate exercise increases affinity of large very low density lipoproteins for hydrolysis by lipoprotein lipase

Context: Postprandial triglyceride (TG) concentration is independently associated with cardiovascular disease risk. Exercise reduces postprandial TG concentrations but the mechanisms responsible are unclear. Objective: To determine the effects of exercise on affinity of chylomicrons, large very low density lipoproteins (VLDL1) and smaller VLDL (VLDL2) for lipoprotein lipase (LPL) mediated TG hydrolysis. Design: Within-participant cross-over study. Setting: A University metabolic investigation unit. Participants: Ten overweight/obese men. Interventions: Participants undertook two oral fat tolerance tests, separated by 7–14 days, in which they had blood taken fasting and for 4 hours after a high-fat mixed meal. On the afternoon before one test, they performed a 90-minute treadmill walk at 50% maximal oxygen uptake (EX); no exercise was performed before the control test (CON). Main outcome measures: Circulating TG-rich lipoprotein concentrations; affinity of chylomicrons, VLDL1, VLDL2 for LPL-mediated TG hydrolysis. Results: Exercise significantly reduced fasting VLDL1-TG concentration (CON: 0.49(0.33–0.72) mmol.l−1, EX: 0.36(0.22–0.59) mmol.l−1, [geometric means (95% confidence interval)]; p=0.04). Time-averaged postprandial chylomicron-TG (CON: 0.55±0.10 mmol.l−1, EX: 0.39±0.08 mmol.l−1, [mean±SEM], p=0.03) and VLDL1-TG (CON: 0.85±0.13 mmol.l−1, EX: 0.66±0.10 mmol.l−1, p=0.01) concentrations were both lower in EX than CON. Affinity of VLDL1 for LPL-mediated TG hydrolysis increased by 2.2(1.3–3.7) fold (geometric mean (95% confidence interval)) (p=0.02) in the fasted state and 2.6(1.8–2.6) fold (p=0.001) postprandially. Affinity of chylomicrons and VLDL2 was not significantly different between trials. Conclusions: Exercise increases affinity of VLDL1 for LPL-mediated TG hydrolysis both fasting and postprandially. This mechanism is likely to contribute to exercise's TG-lowering effect

Measuring success: Program fidelity of Queensland\u27s child health home visiting services. a document analysis

Background: The Family CA.R.E. (Community-based Assistance Resourcing and Education) program was introduced in Queensland two decades ago. It aimed to redress health inequalities for infants from families experiencing specific social stressors. The program has been locally adapted over time and has not been evaluated against the original program. This study assessed the extent to which selected hospital and health services in Queensland, Australia have modified the original Family C.A.R.E. program. Methods: Altheide\u27s model was used to facilitate a critical document analysis of policies and guidelines for adapted Family C.A.R.E. home visiting programs in use by hospital and health services (target n = 7). Results: Five of seven eligible services provided service model documentation. There was low alignment with the original Family C.A.R.E. program across four of the five participating services. While the program delivered within Service 4 was highly aligned to the structure and intent of the original model, variation to the program was still evident. Importantly, four of the five participating programs were not collecting evaluation measures. Conclusions: Health services have adapted the original Family C.A.R.E program format to \u27fit\u27 the local service environment but have largely failed to collect data to facilitate evaluation. Inability to evaluate the program leads to uncertainty about program success and benefits as well as any unintended consequences for families engaging in unevaluated home visiting programs. This study highlights the importance of monitoring program fidelity and evaluating success given the potential ramifications for this vulnerable cohort and for health service delivery

Translation and Validation of an Online Suite of Assessments in American Sign Language

Abstract This article reports on a National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Disability and Rehabilitation Research Project (DRRP; Federal Grant # 90DP0067). The project is being conducted by investigators in the Substance Abuse Resources and Disability Issues (SARDI) Program in the Boonshoft School of Medicine at Wright State University (WSU), in collaboration with nationally recognized experts on Deaf culture and substance abuse/mental health. The goal of this DRRP is to develop and test an online suite of instruments in American Sign Language (ASL), validated for deaf consumers, assessing substance use, mental health, and occupational interests. The translation process used to validate these assessments in ASL is discussed along with the current project status

Feeding ecology of larval Atlantic herring (Clupea harengus): linking main prey availability and recruitment in Trinity Bay, Newfoundland

Newfoundland Atlantic herring (Clupea harengus) populations are composed of spring- and autumn- spawning components, targeted as a mixed fishery. Until the early 2000s, the spring-spawning component accounted for ~90% of the total catch. Within the last decade, the relative abundance of spring-spawning herring has decreased and autumn-spawning herring now dominate the catch in most areas. Year-class strength is largely determined by survival rate during the larval stage. The objective of this study is to identify the main prey of larval herring and explore the link between main prey availability and subsequent recruitment strength. Herring larvae were collected using bongo tows in Trinity Bay, Newfoundland, in the autumns of 2002 (15-52 mm Standard Length), 2006 (5-15 mm SL) and 2013 (5-15 mm SL). Diet composition was identified and otoliths were extracted to estimate age. Nauplius stages of the calanoid copepod Temora longicornis and the cyclopoid copepod Oithona similis dominated the diet during the early larval stage (5-15 mm SL) in 2006 and 2013, respectively. In 2002, the mid-size calanoid copepod Pseudocalanus sp. strongly dominated the diet in the mid-larval stage (15-30 mm SL). In the late larval stage (>30 mm SL) in 2002, larval diet showed a shift to the larger calanoid copepod Calanus sp. The seasonal abundance peak of the main prey during the mid-larval stage, Pseudocalanus sp., shifted from spring to autumn during the mid-2000s, concurrent with the period of changing relative abundance of spawning components. A positive relationship was found between the abundance of Pseudocalanus sp. in October and recruitment of autumn-spawning herring, thereby supporting the idea that survival may be driven by preferred prey availability during the larval stage. We could not reject the hypothesis that the observed shift in herring population dynamics in the mid-2000s resulted from higher survival rates in autumn-hatched larvae through increased availability of their main prey

The High Cost of Opioid Use in Pregnancy

Background: Numerous investigators have highlighted the need to integrate opioid use disorder (OUD) treatment with maternity care. Since data first became available in 2014, Montgomery County (Ohio) has experienced the highest rates of OUD and unintended opioid overdose deaths in the state. This paper examines the demographics and costs of medical treatment for pregnant women with OUD and their newborns with prenatal exposure to opioids (PEO). Methods: The study involved a retrospective records review of all newborns born between May 1, 2016, and April 30, 2017, at a large, urban medical center. Newborns with PEO were matched with a control group by mother's type of insurance, race/ethnicity, method of birth, and maternal parity. Results: Establishing which of the pregnant women should be diagnosed with OUD and be included in the study group was inordinately challenging. Ultimately, of the 3841 infants birthed during the study period, 131 (3.4%) were iden-tified as being born to mothers with OUD. Significantly more mothers with OUD were White and on Medicaid. Only 25 (19.2%) mothers with OUD engaged in treatment for substance use. Compared to the control group, newborns with PEO were much more likely (71.4% versus 25.4%) to be admitted to the NICU and had much longer lengths of stay in both the NICU (mean of 14.4 versus 4.1 days) and hospital (16.9 versus 5.8 days), resulting in dramatic increases in health care cost. Conclusion: These data underscore the need for a comprehensive, systematic approach to OUD and PEO and affirm the government as a major stakeholder in the care of infants born to these women

A research protocol - Indigenous culture, saves lives - Australian Indigenous cultural views and knowledge in health policy: A case study - the National Aboriginal and Torres Strait Islander Health Plan 2013 - 2023

In Australia, an evidence gap exists for governments and policymakers about what it means when the cultures of Aboriginal and Torres Strait Islander people are included in public policies.  Specifically, when the cultures of Indigenous Australians have been incorporated in a public health policy like the Australian Government's National Aboriginal and Torres Strait Islander Health Plan 2013-2023 (Health Plan), how do policymakers implement - enable, embed, and enact - cultures?  More disturbing is the non-recognition of Indigenous culture's innate relationship to the knowledges held by Indigenous Australians.  In recognition of the importance of Indigenous cultures to the health and wellbeing of Indigenous Australians, the centrality of culture in the Health Plan represents the first national Indigenous public policy that reflects its relevance.  This research protocol describes a public policy qualitative research study that aims to address this evidence gap by using the Health Plan as a case study