'I think positivity breeds positivity': a qualitative exploration of the role of family members in supporting those with chronic musculoskeletal pain to stay at work

Background: It is proposed that family members are important sources of support in helping those with chronic musculoskeletal pain to remain at work, but the phenomenon remains largely unexplored. The aim of this study was to examine the extent and nature of support provided by family members in this respect. Methods: Qualitative data were collected from workers and their ‘significant others’ spouses/partners/close family members) in two un-related studies focused on working with pain; one conducted in the United Kingdom (n = 10 dyads) and one in the Netherlands (n = 21 dyads). Thematic analysis techniques were applied to both sets of data independently, and findings were then assimilated to establish common themes. Results: Findings were broadly similar in both studies. Workers acknowledged significant other support in helping them to manage their pain and remain at work, and their descriptions of the type of support provided and required were echoed by their significant others. Three common themes were identified - ‘connectivity’, ‘activity’ and ‘positivity’. Worker and significant other responses were largely congruent, but significant others provided more in-depth information on the nature of their support, their concerns and the impact on their relationship. Conclusions: This research presents novel insights about the specific contribution made by significant others in helping their relatives with chronic musculoskeletal pain to stay at work. These findings add to the under-represented ‘social’ dimension of the biopsychosocial model currently applied to our understanding and treatment of pain, and point to harnessing support from significant others as a potentially effective management strategy

Setting standards for preventative services to reduce child health inequalities in Greater Manchester

Recent policy documents such as Every Child Matters and the National Service Framework for Children, Young People and Maternity Services have indicated a fundamental shift in ways of thinking about child health, emphasising the crucial role of preventative action as well as treatment for ensuring that children have the best possible chance to reach their full potential. This is paramount in deprived areas, where child poverty translates itself into social disadvantage that affects the life chances of children from birth onwards. Whilst the NHS cannot tackle the fundamental drivers of child poverty, it can make a substantial contribution to improving the health and life chances of children living in deprived areas through making sure that parents have access to the services they need and have the information and support to make the best choices about the health and development of their children. The World Health Organisation (WHO) in its strategy on equity in health states that disparities in health status between different groups in the population should be reduced by improving the health of the disadvantaged. Hence, the National Service Framework for Children, Young People and Maternity Services set down 11 standards that define, in general terms, the aims and objectives of services for all children (standards 1-5), services for particular groups of children and young people (standards 6-10) and maternity services (standard 11). These standards underpin a more generic health inequalities target that sets the goal of a reduction of at least 10% in the gap in infant mortality between manual groups and the population as a whole in 2010

The influence of 'significant others' on persistent back pain and work participation: a qualitative exploration of illness perceptions

Background Individual illness perceptions have been highlighted as important influences on clinical outcomes for back pain. However, the illness perceptions of 'significant others' (spouse/partner/close family member) are rarely explored, particularly in relation to persistent back pain and work participation. The aim of this study was to initiate qualitative research in this area in order to further understand these wider influences on outcome. Methods Semi-structured interviews based on the chronic pain version of the Illness Perceptions Questionnaire-Revised were conducted with a convenience sample of UK disability benefit claimants, along with their significant others (n=5 dyads). Data were analysed using template analysis. Results Significant others shared, and perhaps further reinforced, claimants' unhelpful illness beliefs including fear of pain/re-injury associated with certain types of work and activity, and pessimism about the likelihood of return to work. In some cases, significant others appeared more resigned to the permanence and negative inevitable consequences of the claimant's back pain condition on work participation, and were more sceptical about the availability of suitable work and sympathy from employers. In their pursuit of authenticity, claimants were keen to stress their desire to work whilst emphasising how the severity and physical limitations of their condition prevented them from doing so. In this vein, and seemingly based on their perceptions of what makes a 'good' significant other, significant others acted as a 'witness to pain', supporting claimants' self-limiting behaviour and statements of incapacity, often responding with empathy and assistance. The beliefs and responses of significant others may also have been influenced by their own experience of chronic illness, thus participants lives were often intertwined and defined by illness. Conclusions The findings from this exploratory study reveal how others and wider social circumstances might contribute both to the propensity of persistent back pain and to its consequences. This is an area that has received little attention to date, and wider support of these findings may usefully inform the design of future intervention programmes aimed at restoring work participation

Ribosome-Inactivating Proteins: From Plant Defense to Tumor Attack

Ribosome-inactivating proteins (RIPs) are EC3.2.32.22 N-glycosidases that recognize a universally conserved stem-loop structure in 23S/25S/28S rRNA, depurinating a single adenine (A4324 in rat) and irreversibly blocking protein translation, leading finally to cell death of intoxicated mammalian cells. Ricin, the plant RIP prototype that comprises a catalytic A subunit linked to a galactose-binding lectin B subunit to allow cell surface binding and toxin entry in most mammalian cells, shows a potency in the picomolar range. The most promising way to exploit plant RIPs as weapons against cancer cells is either by designing molecules in which the toxic domains are linked to selective tumor targeting domains or directly delivered as suicide genes for cancer gene therapy. Here, we will provide a comprehensive picture of plant RIPs and discuss successful designs and features of chimeric molecules having therapeutic potential

The ‘cognitive apprenticeship’ model and postgraduate research supervision: mind the gap

The ‘cognitive apprenticeship’ is an application of social learning theory, whereby the student models the ‘master’ in order to learn a required set of skills, and is often the dominant approach in postgraduate research supervision practice. The theory proposes that learning which takes place in a ‘real world’ context is the most effective, but it does not offer any guidance on negotiating the tensions which may arise as a result of the contextual differences between the professional and academic backgrounds of supervisor and student. Reflecting on the research supervision of a Professional Doctorate student who then transferred to PhD study, this presentation will illustrate the tensions and challenges relating to teaching, learning and applying academic research skills in clinical practice. During the supervision journey, an in-depth understanding of the different cultures and values within these two disciplines has developed and been successfully negotiated in order to manage both the demands of doctoral research and the post-doctoral career aspirations of the student. The results of this observation have implications for the application of pedagogical theory in teaching research methods

Increasing response rates to lifestyle surveys: a review of methodology and 'good practice'.

Background Lifestyle surveys are traditionally used for collecting detailed population information about individual behaviours that impact on health. However, declining response rates and the under-representation of certain population groups in lifestyle survey data has led to uncertainty over the accuracy of any findings. In order to maximise response rates, a mixed-methods approach is now recommended. This review was carried out in order to examine the methodological literature related to the administration of lifestyle surveys and the implications for response rates. It was envisaged that the results of this review could provide a valuable resource for those involved in undertaking lifestyle surveys. Methods A review of the empirical evidence and published literature on the methodological considerations associated with administration of lifestyle surveys, specifically in relation to maximising response rates, was carried out. A search for ‘grey literature’ was also conducted using the internet, and citation tracking was performed on all retrieved articles. A request for examples of relevant lifestyle survey work, particularly those incorporating mixed-methods designs and/or strategies to increase response rates, was distributed to several Primary Care Trusts (PCTs) across England. The responses are illustrated as ‘good practice’ case studies. Results The postal questionnaire remains an important lifestyle survey tool, but response rates have decreased rapidly in recent years. Interviews and telephone surveys are recommended in order to supplement data from postal questionnaires to overcome any literacy and language barriers. These approaches are advocated to increase response rates in some population groups, but costs may be prohibitive. Electronic surveys are a cheaper alternative, but the evidence seems to suggest that the use of the internet does not appear to increase overall response rates to surveys. Evidence on the use of incentives suggests they can be effective at increasing response rates, but only if their use is tailored to the design of the survey and to the characteristics of target populations. Conclusions The empirical evidence was not robust enough to make definitive recommendations, but information from the published literature, along with examples of ‘good practice’ in lifestyle survey work suggests that supplementing, or offering different survey modes, alongside targeted maximisation strategies can increase coverage and also, with careful planning, can prove to be cost-effective