'I just wanted someone to tell me it wasn't all in my mind and do something for me': Qualitative exploration of acceptability of a CBT based intervention to manage chronic orofacial pain.

Introduction Evidence suggests that psychosocial management may produce improved outcomes for patients suffering from chronic orofacial pain (COFP), when symptoms cannot be attributed to pathology. A complex intervention, based on cognitive behavioural therapy (CBT) was developed by a multi-disciplinary team, using evidence synthesis. An important element of developing and evaluating complex interventions is to establish acceptability to stakeholders; therefore qualitative interviews with patients were carried out.Objectives To explore levels of acceptability of a complex intervention to manage COFP.Method Semi-structured interviews were carried out with 17 participants who had been referred to the intervention. Thematic analysis was used to identify emerging issues and themes from the data.Results Themes relating to processes of engagement with the intervention emerged. Important processes were: identification with the intervention; feeling believed and understood; obtaining a plausible explanation for symptoms; degree of perceived effort required to engage; acceptance of having a long-term condition; and receiving demonstrative, positive feedback.Conclusion Patients presenting with unexplained COFP in a secondary care setting are able to accept a CBT based intervention to manage their condition. Findings may offer guidance for dentists who are not used to referring patients to psychosocial interventions and inform the way dentists communicate the nature of unexplained symptoms to patients.

Class inequality and meritocracy: a critique of Saunders and an alternative analysis.

Saunders' recent work claiming that contemporary British society is to a large extent 'meritocratic' is criticized on conceptual and technical grounds. A reanalysis of the National Child Development Study data-set, used by Saunders, is presented. This reveals that while merit, defined in terms of ability and effort, does play a part in determining individuals' class destinations, the effect of class origins remains strong. Children of less advantaged class origins need to show substantially more merit than children from more advantaged origins in order to gain similar class positions. These differences in findings to some extent arise from the correction of biases introduced by Saunders; but there are also features of his own results, consistent with those reported in the reanalysis, which he appears not to have fully appreciated.

Leadership issues: health care in the year 2004.

The intent of this article is to develop a plausible scenario for health care in the year 2004. We hope to engage the reader in a process that will help discern the exogenous forces that are currently impacting the way that health care organizations do business. By identifying these forces, we can track their development and learn to adapt and change proactively as may be necessary. We also discuss the current and projected trends that are shaping health care delivery. Our theme is that the future of health care is continually being reinvented and that the potential for dealing effectively with the dramatic change that the future is bringing already exists in most health care organizations. The future is only waiting to be reinvented.

[Social mobility in France, 1953-1970: a new look]. / La mobilite sociale en France, 1953-1970: nouvel examen

The authors attempt to extend Thelot's analysis of social mobility in France between 1953 and 1970. In particular, they examine "whether observed changes in mobility rates are entirely attributable to 'structural' influences. [They conclude] that while (as Thelot has suggested) the evolution of the occupational structure has been of major importance in altering the amount and pattern of mobility, changes of a systematic kind are none the less still evident when mobility is assessed independently of all structural effects." Data are from two surveys conducted by the National Institute of Statistics and Economic Studies (SUMMARY IN ENG, GER, RUS,)