A qualitative study into the perspectives of clients on shared decision-making as a method to support return to work.

BACKGROUND: Being able to participate in work is an important determinant of health. Therefore, reintegration professionals provide support to clients to return to work (RTW). Since RTW has a significant impact on a client's life, it is preferred that clients are involved in the decision-making process of RTW. A method to do so, is shared decision-making (SDM), involving the following steps: collaborating as a team, explaining to clients that they can be part of the decision-making process, setting a shared goal, presenting and discussing choice options, and making a shared decision. OBJECTIVE: We explored how clients experience and prefer these SDM steps in their current and ideal interaction with professionals. METHODS: We performed semi-structured interviews with fourteen clients receiving support in their RTW process from four different municipalities. RESULTS: Clients emphasised the importance of collaborating as team. None of the clients reported having been told that they could be part of the decision-making process, or discussed a shared goal with a professional, which they would prefer. Some clients were presented choice options. When choice options were discussed, frequently only the negative aspects of choice options were explained by the professional. A great number of clients experienced that shared decisions were made, but based this on the shared effort made by the client and professional to RTW. CONCLUSIONS: Clients generally wish to cooperate and participate in the decision-making process, but their ability to do so is limited due to not being fully involved in the SDM steps.

Availability and implementation of guidelines in European child primary health care: how can we improve?

BACKGROUND: Clinical guidelines are important for providing high-quality child primary health care. We aimed to assess the availability, use and achieved delivery of guidelines in the European Union (EU). METHODS: We used a case study design to ascertain expert views on guidelines in six countries representing the EU. The experts completed an online questionnaire (response 49%), asking about their perception of guideline availability and implementation regarding three topics that represent prevention and care, i.e. vaccination, assessment of mental health and asthma care. RESULTS: According to the respondents all countries had guidelines available for asthma care. For vaccination and mental health assessment respondents agreed to a lesser degree that guidelines were available. Implementation of guidelines for vaccination was mostly perceived as intended, but implementation of the guidelines for mental health assessment and asthma care was limited. Notable barriers were complexity of performance, and lack of training of professionals and of financial resources. Important facilitators for guideline implementation were the fit with routine practice, knowledge and skills of professionals and policy support. We found no clear relationship of guideline availability and implementation with type of child primary health care system of countries, but strong governance and sufficient financial resources seemed important for guideline availability. CONCLUSIONS: Availability and implementation of clinical guidelines in child primary health care vary between EU countries. Implementation conditions can be strongly improved by adequate training of professionals, stronger governance and sufficient financial resources as facilitating factors. This can yield major gains in child health across Europe.

Shared decision making from reintegration professionals' perspectives to support return to work: a qualitative study.

BACKGROUND: Work participation is an important determinant of public health; being unemployed leads to a decrease in an individual's health. In the Netherlands, people with a work disability can apply for disability benefits, in which people also receive support to return to work (RTW). A method, currently used in the medical sector, that can include both the perspective of the reintegration professional and of the individual in the process of RTW, is shared decision making (SDM). In this article we explore to what extent reintegration professionals currently use SDM, and to what extent they prefer to use SDM in their ideal interaction with clients. METHODS: We performed semi-structured interviews with fourteen reintegration professionals from four different municipalities. The transcripts were coded according to content analysis, applying open and axial coding. RESULTS: Reintegration professionals emphasised the importance of having a good relationship with clients, of building trust and collaborating as a team. They did not inform their clients that they could be part of the decision-making process, or discussed a shared goal. Although professionals did emphasise the importance of aligning their approach with the preferences of the client and though they tried to offer some choice options, they did not mention available options, discussed the pros and cons of these options or evaluated decisions with their clients. Furthermore, they did not mention any of these aspects in their ideal interaction with clients. CONCLUSIONS: SDM has a potential value, because all professionals underline the importance of having an alliance with clients, collaborating as a team, and striving to align their approach with the preferences of the client. However, professionals currently perform a limited set of SDM steps. Additional knowledge and skills are needed for both reintegration professionals and municipalities so that professionals can consider and reflect on the value of using SDM, or SDM steps, in supporting RTW. Providing clients with knowledge and skills seems necessary to facilitate both self-management and SDM.

Usefulness of Image Theater Workshops for Exploring Dilemmas in Diabetes Self-Management Among Adolescents.

Diabetes treatment involves a demanding self-management regime that is particularly challenging to adolescents. There is a need for qualitative research into the specific contexts in which adolescents attempt to balance self-management demands with the needs and desires of adolescent life. This study investigates the usefulness of image theater, a participatory form of theater using the body as an expressive tool, to articulate these dilemmas in daily life contexts. We performed a qualitative analysis of two image theater workshops with 12- to 18-year-old adolescents living with diabetes. Our results show three areas of application: (a) unraveling the contextual complexity of lived experience, (b) the articulation of implicit understandings and underlying motives, and (c) the playful exploration of new behavior. We conclude that image theater is a promising method, especially with respect to the opportunities of a more contextual and action-oriented understanding of the trade-offs made in self-management provide for diabetes education and counseling.

Students' beliefs and behaviour regarding low-calorie beverages, sweets or snacks: are they affected by lessons on healthy food and by changes to school vending machines?

OBJECTIVE: To study the effects of school lessons about healthy food on adolescents' self-reported beliefs and behaviour regarding the purchase and consumption of soft drinks, water and extra foods, including sweets and snacks. The lessons were combined with the introduction of lower-calorie foods, food labelling and price reductions in school vending machines. DESIGN: A cluster-randomized controlled design was used to allocate schools to an experimental group (i.e. lessons and changes to school vending machines) and a control group (i.e. 'care as usual'). Questionnaires were used pre-test and post-test to assess students' self-reported purchase of extra products and their knowledge and beliefs regarding the consumption of low-calorie products. SETTING: Secondary schools in the Netherlands. SUBJECTS: Twelve schools participated in the experimental group (303 students) and fourteen in the control group (311 students). The students' mean age was 13.6 years, 71.5% were of native Dutch origin and mean BMI was 18.9 kg/m(2). RESULTS: At post-test, the experimental group knew significantly more about healthy food than the control group. Fewer students in the experimental group (43%) than in the control group (56%) reported bringing soft drinks from home. There was no significant effect on attitude, social norm, perceived behavioural control and intention regarding the consumption of low-calorie extra products. CONCLUSIONS: The intervention had limited effects on students' knowledge and self-reported behaviour, and no effect on their beliefs regarding low-calorie beverages, sweets or snacks. We recommend a combined educational and environmental intervention of longer duration and engaging parents. More research into the effects of such interventions is needed.

How adolescents with diabetes experience social support from friends: two qualitative studies.

Self-management of diabetes is challenging, especially for adolescents who face multiple changes, including closer peer relationships. Few studies have explored how friends can provide constructive support in this effort. The present research investigated, in two qualitative studies, the perceptions of adolescents with diabetes and their friends with respect to the positive social support that friends can offer. In study 1, 28 adolescents aged 12-15 with type 1 diabetes participated in online focus groups. In study 2, 11 of these adolescents were interviewed in person together with their best friends. The data were analysed by means of content analysis. In study 1, the adolescents with diabetes identified various supportive behaviours of friends, particularly concerning emotional support: treating them normally, showing interest, having fun, providing a distraction, and taking their diabetes into account. They differed in their attitude towards support, and this influenced which behaviours they perceived as supportive. Study 2 showed that the adolescents with diabetes and their friends often had similar opinions on the desired degree of support. Fear of stigmatization and sense of autonomy withheld some adolescents with diabetes from soliciting more support. These insights can be useful in patient education aiming to promote social support.

The attitudes and intention to participate in hemoglobinopathy carrier screening in The Netherlands among individuals from Turkish, Moroccan, and Surinamese descent.

OBJECTIVE: To explore factors that influence intention to participate in hemoglobinopathy (HbP) carrier screening under Dutch subjects at risk, since HbP became more common in The Netherlands. METHOD: Structured interviews with 301 subjects from Turkish, Moroccan, or Surinamese ethnicity. RESULTS: Half of the participants were familiar with HbP, 27% with carrier screening. Only 55% correctly answered basic knowledge items. After balanced information, 83% percent of subjects express intention to participate in HbP carrier screening. Intention to participate was correlated with (1) anticipated negative feelings, (2) valuing a physician's advice, and (3) beliefs on significance of carrier screening. Risk perception was a significant determinant, while respondents were unaware of HbP as endemic in their country of birth. Respondents preferred screening before pregnancy and at cost < 50€. CONCLUSION: These findings show the importance of informing those at risk by tailored health education. We propose easy access at no costs for those willing to participate in HbP carrier screening.

Changes in self-reported energy balance behaviours and body mass index during a mass media campaign.

BACKGROUND: Prevention of (serious) overweight can be achieved by means of small behaviour changes in physical activity and/or diet. OBJECTIVE: To evaluate a mass media campaign promoting energy balance behaviours in a Dutch population. Effects were examined for body mass index (BMI) and five energy balance behaviours. METHODS: A representative cohort study of 1200 Dutch adults was employed. Data were collected at four moments. Two campaign waves were launched, following T1 (targeting the general adult population) and T2 [targeting low socio-economic status (SES) men], respectively. Regression analyses were performed to estimate the short-term and long-term effects of campaign exposure. RESULTS: In total, data of 1030 participants (86%) were available. Time trends showed unfavourable changes in most but not all energy balances behaviour for the total sample. No differences were found for BMI. No differences in the outcome measures were found as a result of exposure to the first campaign (19%). A short-term effect of exposure to the second campaign (29% exposure) was found (T2-T3), but only for low SES respondents, with increases in the attention being paid towards food choice (P = 0.02). At long term, BMI was less likely to increase among exposed people with a non-Dutch ethnicity (P = 0.01, T2-T4). CONCLUSIONS: Exposure to the campaign was low. The first campaign wave had no effects on BMI and energy balance behaviours. Small but favourable changes in attention towards food choice and BMI for at-risk populations were observed among those exposed to the second campaign wave.

Promoting the purchase of low-calorie foods from school vending machines: a cluster-randomized controlled study.

BACKGROUND: Vending machines account for food sales and revenue in schools. We examined 3 strategies for promoting the sale of lower-calorie food products from vending machines in high schools in the Netherlands. METHODS: A school-based randomized controlled trial was conducted in 13 experimental schools and 15 control schools. Three strategies were tested within each experimental school: increasing the availability of lower-calorie products in vending machines, labeling products, and reducing the price of lower-calorie products. The experimental schools introduced the strategies in 3 consecutive phases, with phase 3 incorporating all 3 strategies. The control schools remained the same. The sales volumes from the vending machines were registered. Products were grouped into (1) extra foods containing empty calories, for example, candies and potato chips, (2) nutrient-rich basic foods, and (3) beverages. They were also divided into favorable, moderately unfavorable, and unfavorable products. RESULTS: Total sales volumes for experimental and control schools did not differ significantly for the extra and beverage products. Proportionally, the higher availability of lower-calorie extra products in the experimental schools led to higher sales of moderately unfavorable extra products than in the control schools, and to higher sales of favorable extra products in experimental schools where students have to stay during breaks. Together, availability, labeling, and price reduction raised the proportional sales of favorable beverages. CONCLUSION: Results indicate that when the availability of lower-calorie foods is increased and is also combined with labeling and reduced prices, students make healthier choices without buying more or fewer products from school vending machines. Changes to school vending machines help to create a healthy school environment.

Wolf-Hirschhorn syndrome due to pure and translocation forms of monosomy 4p16.1 → pter.

The aim of this study was to obtain a quantitative definition of Wolf-Hirschhorn syndrome (WHS) through systematic phenotypic analyses in a group of six children with 4p15.32 → pter, 4p15.33 → pter, or 4p16.1 → pter monosomy (considered together as M4p16.1). These results were used for evaluation of the phenotypic effects of a double chromosome imbalance in one child with 4p16.1 → pter monosomy and additional 11q23.3 → qter trisomy. Children with pure M4p16.1 presented with a total of 227 clinical and morphological traits, of which 119 were positive in at least two of them. These traits overlap to a great extent with clinical criteria defining the WHS phenotype. Among the 103 traits identified in the child with unbalanced translocation der(4)t(4;11)(p16.1;q23.3), most clinical and developmental traits (but only 11 morphological) were found to be shared by WHS children with pure M4p16.1 and at least one reported patient with pure 11q trisomy. Forty-six traits of this child corresponded solely to those identified in at least one child with pure M4p16.1. Only five traits of the hybrid phenotype were present in at least one child with pure distal 11q trisomy but in none of the present children with pure M4p16.1. In conclusion, most of the morphological traits of the hybrid phenotype in the child with der(4)t(4;11)(p16.1;q23.3) can be attributed to the M4p16.1, whereas their overlap with those associated with pure distal 11q trisomy is less evident. Phenotype analyses based on the same systematic data acquisition may be useful in understanding the phenotypic effects of different chromosome regions in complex rearrangements. © 2011 Wiley-Liss, Inc.

Molecular and histochemical characterisation of two distinct poplar Melampsora leaf rust pathosystems.

In this study, we compared interactions of two Melampsora foliar rust species with poplar, which resulted in either limited or abundant pathogen proliferation. In the pathosystem exhibiting limited pathogen growth, a defence response was observed after invasion of poplar leaf tissues by the biotroph, with late and clear production of reactive oxygen species (ROS) and other products. Characterisation of the histological, biochemical and transcriptional events occurring in both pathosystems showed striking similarity with components of plant defence reactions observed during qualitative resistance. Key components associated with development of an active defence response, such as up-regulation of pathogenesis-related (PR) genes, were observed during infection. Moreover, the time course and strength of gene induction appear to be critical determinants for the outcome of the tree-pathogen interaction. This work provides basic biochemical characterisation and expression data for the study of so-called partial resistance in the poplar-rust pathosystem, which is also applicable to other plant-pathogen interactions resulting in quantitative disease resistance.

The C20orf133 gene is disrupted in a patient with Kabuki syndrome.

Kabuki syndrome (KS) is a rare, congenital mental retardation syndrome. The aetiology of KS remains unknown. Four carefully selected patients with KS were screened for chromosomal imbalances using array comparative genomic hybridisation at 1 Mb resolution. In one patient, a 250 kb de novo microdeletion at 20p12.1 was detected, deleting exon 5 of C20orf133. The function of this gene is unknown. In situ hybridisation with the mouse orthologue of C20orf133 showed expression mainly in brain. The de novo nature of the deletion, the expression data and the fact that C20orf133 carries a macro domain, suggesting a role for the gene in chromatin biology, make the gene a likely candidate to cause the phenotype in this patient with KS. Both the finding of different of chromosomal rearrangements in patients with KS features and the absence of C20orf133 mutations in 19 additional patients with KS suggest that KS is genetically heterogeneous.

The C20orf133 gene is disrupted in a patient with Kabuki syndrome.

BACKGROUND: Kabuki syndrome (KS) is a rare, clinically recognisable, congenital mental retardation syndrome. The aetiology of KS remains unknown. METHODS: Four carefully selected patients with KS were screened for chromosomal imbalances using array comparative genomic hybridisation at 1 Mb resolution. RESULTS: In one patient, a 250 kb de novo microdeletion at 20p12.1 was detected, deleting exon 5 of C20orf133. The function of this gene is unknown. In situ hybridisation with the mouse orthologue of C20orf133 showed expression mainly in brain, but also in kidney, eye, inner ear, ganglia of the peripheral nervous system and lung. CONCLUSION: The de novo nature of the deletion, the expression data and the fact that C20orf133 carries a macro domain, suggesting a role for the gene in chromatin biology, make the gene a likely candidate to cause the phenotype in this patient with KS. Both the finding of different of chromosomal rearrangements in patients with KS features and the absence of C20orf133 mutations in 19 additional patients with KS suggest that KS is genetically heterogeneous.

Sexual decision-making in HIV-positive men who have sex with men: how moral concerns and sexual motives guide intended condom use with steady and casual sex partners.

Determinants of intended condom use with steady and casual sex partners were examined among Dutch HIV-positive men who have sex with men (MSM) (N = 296). Given the proposition that safer sex behavior among HIV-positive people is a form of prosocial behavior, the present study extended the general framework of the Theory of Planned Behavior with Schwartz's norm-activation theory and tested the assumption that personal norms would mediate the effects of other psychosocial factors on intended condom use for anal sex. In addition, it was hypothesized that, depending on the context in which sex occurs, specific motives for unprotected anal sex may have a negative influence on intended condom use and, as such, undermine a prosocial tendency to practice safer sex. Therefore, we also investigated the influence of sexual motives for unprotected anal sex on intended condom use with steady and casual sex partners. Results indicated that the Theory of Planned Behavior adequately predicted condom use intentions (for casual sex partners and steady sex partners, the explained variance was 52% and 53%, respectively). However, our proposed model of sexual decision-making significantly improved the prediction of behavioral intentions. For steady and casual sex partners, the assumption of the mediating role of personal norms on condom use intention was confirmed empirically. Additionally, sexual motives for unprotected anal sex exerted, as expected, a direct, negative effect on condom use intention with casual sex partners. The implications of the findings for future research and the development of HIV-prevention programs for HIV-positive MSM are discussed.

Sexual risk behavior among HIV-positive men who have sex with men: a literature review.

OBJECTIVE: To review research on sexual risk behavior among HIV-positive men who have sex with men (MSM) after the year 2000. METHOD: The review included 53 published studies that reported on unprotected anal intercourse (UAI) in cross-sectional and longitudinal surveys of HIV-positive MSM and MSM of mixed HIV status. RESULTS: The findings indicate high levels of UAI among HIV-positive MSM, particularly with HIV-negative or HIV status unknown partners. In studies of MSM of mixed HIV status, we found that the rate of UAI among HIV-positive MSM was much higher than that of HIV-negative MSM. Furthermore, the prevalence of UAI among HIV-positive MSM has increased in recent years. CONCLUSION: Although studies indicate that HIV-positive MSM have adopted risk reduction strategies, roughly two in five HIV-positive MSM continue to engage in UAI, which represents a risk for continued HIV and STI (sexually transmitted infection) transmission. PRACTICE IMPLICATIONS: Prevention efforts targeting HIV-positive MSM to assist them in adopting and maintaining safer sexual behaviors need to be intensified.

Systematic development of a self-help and motivational enhancement intervention to promote sexual health in HIV-positive men who have sex with men.

The objective of this study was to describe the application of a systematic process-Intervention Mapping-to developing a theory- and evidence-based intervention to promote sexual health in HIV-positive men who have sex with men (MSM). Intervention Mapping provides a framework that gives program planners a systematic method for decision-making in each phase of intervention development. In Step 1, we focused on the improvement of two health-promoting behaviors: satisfactory sexual functioning and safer sexual behavior. These behaviors were then linked with selected personal and external determinants, such as attitudes and social support, to produce a set of proximal program objectives. In Step 2, theoretical methods were identified to influence the proximal program objectives and were translated into practical strategies. Although theoretical methods were derived from various theories, self-regulation theory and a cognitive model of behavior change provided the main framework for selecting the intervention methods. The main strategies chosen were bibliotherapy (i.e., the use of written material to help people solve problems or change behavior) and motivational interviewing. In Step 3, the theoretical methods and practical strategies were applied in a program that comprised a self-help guide, a motivational interviewing session and a motivational interviewing telephone call, both delivered by specialist nurses in HIV treatment centers. In Step 4, implementation was anticipated by developing a linkage group to ensure involvement of program users in the planning process and conducting additional research to understand how to implement our program better. In Step 5, program evaluation was anticipated based on the planning process from the previous Intervention Mapping steps.

White pine weevil (Pissodes strobi) biological performance is unaffected by the jasmonic acid or wound-induced defense response in Norway spruce (Picea abies).

In eastern Canada, the white pine weevil (Pissodes strobi Peck) is a pest of several native pine and spruce species and of the introduced species, Norway spruce (Picea abies Karst). We evaluated the feeding activities, oviposition and rate of adult emergence of white pine weevil on field-grown Norway spruce subjected to jasmonic acid or wounding pretreatments. We also monitored the host-plant reaction to white pine weevil attack, jasmonic acid and wounding treatments by quantifying several mono- and sesquiterpenes in bark and characterizing some molecular aspects of the terpenoid response. Two cDNA sequences were identified that had a high percentage of identity with genes encoding monoterpene or sesquiterpene synthases. Both putative terpene synthase genes showed distinctive profiles in Norway spruce bark and needles following all treatments. Although the Norway spruce trees showed different physiological responses to mechanical wounding and white pine weevil attack, transcript activity of the gene encoding terpenoid synthase and consequent accumulation of terpenoid resin did not significantly affect the weevils' feeding activities, oviposition or rate of adult emergence.

Molecular epidemiology of white pine blister rust: recombination and spatial distribution.

ABSTRACT Multilocus haplotypes (MLHs) were derived for the spermogonial (monokaryotic haploid) stage of Cronartium ribicola, the causal agent of white pine blister rust. Six random amplified polymorphic DNA loci and three single-strand conformational polymorphism markers were analyzed for 246 rust samples collected from two heavily infected white pine plantations. All cankers sampled were spatially located within the plantations. The hypothesis that spores are not locally disseminated was supported by the absence of any spatial clustering in the distribution of the MLHs. A large number of MLHs was found at both sites and the haplotypic diversity was close to the maximum (one) in both populations. All measures of recombination were not different from expectations under a scenario of sexual recombination. Genetic differentiation between the two sites was very low (theta = 0.023), yet it was significantly different from zero (P < 0.01). This analysis is in agreement with a scenario of extensive sexual recombination followed by some long-distance dispersal.

Sexuality and sexual risk behavior in HIV-positive men who have sex with men.

The purpose of this study was to examine the psychological processes pertaining to sexuality and sexual risk behavior among HIV-positive men who have sex with men (MSM). The authors analyzed transcripts of 30 semistructured interviews. Findings suggest that sexual problems in HIV-positive MSM might be primarily caused by the perceived risk of transmitting HIV to others. Furthermore, safer sexual behavior seems to be related to feelings of personal responsibility for safer sex. This study illustrates that although some men might have a clear notion of personal responsibility for safer sex, contextual factors can influence whether behavior is consistent with their norms of personal responsibility. The implications of the study are discussed for the practice of HIV prevention for HIV-positive MSM.