Validation of the Patient Activation Measure in a Multiple Sclerosis Clinic Sample and Implications for Care

Purpose. Patient engagement in multiple sclerosis (MS) care can be challenging at times given the unpredictable disease course, wide range of symptoms, variable therapeutic response to treatment and high rates of patient depression. Patient activation, a model for conceptualising patients’ involvement in their health care, has been found useful for discerning patient differences in chronic illness management. The purpose of this study was to validate the patient activation measure (PAM-13) in an MS clinic sample. Methods. This was a survey study of 199 MS clinic patients. Participants completed the PAM-13 along with measures of MS medication adherence, self-efficacy, depression and quality of life. Results. Results from Rasch and correlation analyses indicate that the PAM-13 is reliable and valid for the MS population. Activation was associated with MS self-efficacy, depression and quality of life but not with self-reported medication adherence. Also, participants with relapse-remitting MS, current employment, or high levels of education were more activated than other subgroups. Conclusions. The PAM-13 is a useful tool for understanding health behaviours in MS. The findings of this study support further clinical consideration and investigation into developing interventions to increase patient activation and improve health outcomes in MS

Forty-Year Analysis of Colonoscopic Surveillance Program for Neoplasia in Ulcerative Colitis: An Updated Overview

C.R.C. was funded by the Derek Willoughby Fund for Inflammatory Research. A.L.H. and T.A.G. were funded by Higher Education Funding Council of England

Poor attention rather than hyperactivity/impulsivity predicts academic achievement in very preterm and full-term adolescents

Background: Very preterm (VP) children are at particular risk for attention deficit/hyperactivity disorder (ADHD) of the inattentive subtype. It is unknown whether the neurodevelopmental pathways to academic underachievement are the same as in the general population. This study investigated whether middle childhood attention or hyperactivity/impulsivity problems are better predictors of VP adolescents' academic achievement. Method: In a geographically defined prospective whole-population sample of VP (<32 weeks gestation) and/or very low birth weight (<1500 g birth weight) (VLBW/VP; n = 281) and full-term control children (n = 286) in South Germany, ADHD subtypes were assessed at 6 years 3 months and 8 years 5 months using multiple data sources. Academic achievement was assessed at 13 years of age. Results: Compared with full-term controls, VLBW/VP children were at higher risk for ADHD inattentive subtype [6 years 3 months: odds ratio (OR) 2.8, p < 0.001; 8 years 5 months: OR 1.7, p = 0.020] but not for ADHD hyperactive-impulsive subtype (6 years 3 months: OR 1.4, p = 0.396; 8 years 5 months: OR 0.9, p = 0.820). Childhood attention measures predicted academic achievement in VLBW/VP and also full-term adolescents, whereas hyperactive/impulsive behaviour did not. Conclusions: Attention is an important prerequisite for learning and predicts long-term academic underachievement. As ADHD inattentive subtype and cognitive impairments are frequent in VLBW/VP children, their study may help to identify the neurofunctional pathways from early brain development and dysfunction to attention problems and academic underachievement

Assessment of the benefits of user involvement in health research from the Warwick Diabetes Care Research User Group : a qualitative case study

Objective  To assess the benefits of involving health-care users in diabetes research. Design and participants  For this qualitative case study, semi-structured interviews were conducted with researchers who had worked extensively with the group. During regular meetings of the Research User Group, members discussed their views of the group's effectiveness as part of the meeting's agenda. Interviews and discussions were transcribed, coded using N-Vivo software and analysed using constant comparative methods. Results  Involvement of users in research was generally seen as contributing to effective and meaningful research. However, the group should not be considered to be representative of the patient population or participants of future trials. An important contributor to the group's success was its longstanding nature, enabling users to gain more insight into research and form constructive working relationships with researchers. The user-led nature of the group asserted itself, especially, in the language used during group meetings. A partial shift of power from researchers to users was generally acknowledged. Users' main contribution was their practical expertise in living with diabetes, but their involvement also helped researchers to remain connected to the `real world' in which research would be applied. While the group's work fulfilled established principles of consumer involvement in research, important contributions relying on personal interaction between users and researchers were hard to evaluate by process measures alone. Conclusions  We demonstrated the feasibility, acceptability and effectiveness of this longstanding, experienced, lay-led research advisory group. Its impact on research stems from the continuing interaction between researchers and users, and the general ethos of learning from each other in an on-going process. Both process measures and qualitative interviews with stakeholders are needed to evaluate the contributions of service users to health research

User guide : Groundwater Vulnerability (Scotland) GIS dataset. Version 2, revised report

This report describes a revised version (Version 2) of the groundwater vulnerability (Scotland) digital dataset produced by the British Geological Survey (BGS). Version 1 of the dataset was produced in 2004 by the British Geological Survey (BGS) and the Macaulay Institute (now the James Hutton Institute) on behalf of the Scottish Environment Protection Agency (SEPA), funded by the Scotland and Northern Ireland Forum for Environmental Research (SNIFFER). Version 2 uses updated input data and a slightly modified methodology. The map shows the relative vulnerability of groundwater to contamination across Scotland. Groundwater vulnerability is the tendency and likelihood for general contaminants to move vertically through the unsaturated zone and reach the water table after introduction at the ground surface. On this map, groundwater vulnerability is described by one of five relative classes ranging from 1 (lowest vulnerability) to 5 (highest vulnerability). The groundwater vulnerability map is a screening tool that can be used to show the relative threat to groundwater quality from contamination across Scotland. It can provide guidance on the vulnerability of groundwater at a regional scale, highlighting areas at comparatively higher risk of groundwater contamination, and can help indicate the degree of specific site investigation required for a new development or activity. It is designed to be used at a scale of 1:100,000 and should be regarded as a tool to aid groundwater risk assessment rather than a complete solution

Why does early childhood deprivation increase the risk for depression and anxiety in adulthood? A developmental cascade model

Abstract Background: Using data from the English & Romanian Adoptees (ERA) study we recently reported that early time-lmited exposure to severe institutional deprivation is associated with early onset and persistent neurodevelopmental problems and later onset emotional problems. Here we examine possible reasons for the late emergence of emotional problems in this cohort. Our main focus is on testing a developmental cascade mediated via the functional impact of early-appearing neurodevelopmental problems on late adolescent functioning. We also explore a second putative pathway via sensitization to stress. Methods: The ERA study includes 165 Romanian individuals who spent their early lives in grossly depriving institutions and were subsequently adopted into UK families, along with 52 UK adoptees with no history of deprivation. Age six years symptoms of neurodevelopmental problems and age 15 anxiety/depression symptoms were assessed via parental reports. Young adult symptoms of depression and anxiety were assessed by both parent and self-reports; young adults also completed measures of stress reactivity , exposure to adverse life events and functioning in work and interpersonal relationships. Results: The path between early institutional deprivation and adult emotional problems was mediated via the impact of early neurodevelopmental problems on unemployment and poor friendship functioning during the transition to adulthood. The findings with regard to early deprivation, later life stress reactivity and emotional problems were inconclusive. Conclusions: Our analysis suggests that the risk for adult depression and anxiety following extreme institutional deprivation is explained through the effects of early neurodevelopmental problems on later social and vocational functioning. Future research should more fully examine the role of stress susceptibility in this model

How young people from culturally and linguistically diverse backgrounds experience mental health: some insights for mental health nurses

This article reports on a part of a study which looked at the mental health of culturally and linguistically diverse (CALD) young people. The research sought to learn from CALD young people, carers, and service providers experiences relevant to the mental health of this group of young people. The ultimate goal was to gain insights that would inform government policy, service providers, ethnic communities and most importantly the young people themselves. To this end, qualitative interviews were undertaken with 123 CALD young people, 41 carers and 14 mental health service providers in Queensland, Western Australia and South Australia. Only one aspect of the study will be dealt with here, namely the views of the young CALD participants, which included risk factors, coping strategies and recommendations about how they could be supported in their struggle to maintain mental health. One of the most important findings of the study relates to the resilience of these young people and an insight into the strategies that they used to cope. The efforts of these young people to assist us in our attempts to understand their situation deserve to be rewarded by improvements in the care that we provide. To this end this article sets out to inform mental health nurses of the results of the study so that they will be in a position to better understand the needs and strengths of their CALD clients and be in a better position to work effectively with them

‘What’s it like to have ME?’ The discursive construction of ME in computer-mediated communication and face-to-face interaction

ME/CFS (chronic fatigue syndrome) is a debilitating illness for which no cause or medical tests have been identified. Debates over its nature have generated interest from qualitative researchers. However, participants are difficult to recruit because of the nature of their condition. Therefore, this study explores the utility of the internet as a means of eliciting accounts. We analyse data from focus groups and the internet in order to ascertain the extent to which previous research findings apply to the internet domain. Interviews were conducted among 49 members of internet (38 chatline, 11 personal) and 7 members of two face-to-face support groups. Discourse analysis of descriptions and accounts of ME/CFS revealed similar devices and interactional concerns in both internet and face-to-face communication. Participants constructed their condition as serious, enigmatic and not psychological. These functioned to deflect problematic assumptions about ME/CFS and to manage their accountability for the illness and its effects