General practitioners’ management of the long-term sick role

In this paper, we use qualitative research techniques to examine the role of general practitioners in the management of the long-term sickness absence. In order to uncover the perspectives of all the main agents affected by the actions of general practitioners, a case study approach focussing on one particular employment sector, the public health service, is adopted. The role of family physicians is viewed from the perspectives of health service managers, occupational health physicians, employees / patients, and general practitioners. Our argument is theoretically framed by Talcott Parsons’s model of the medical contribution to the sick role, along with subsequent conceptualisations of the social role and position of physicians. Sixty one semi-structured interviews and three focus group interviews were conducted in three Health and Social Care Trusts in Northern Ireland between 2010 and 2012. There was a consensus among respondents that general practitioners put far more weight on the preferences and needs of their patients than they did on the requirements of employing organisations. This was explained by respondents in terms of the propinquity and longevity of relationships between doctors and their patients, and by the ideology of holistic care and patient advocacy that general practitioners viewed as providing the foundations of their approach to patients. The approach of general practitioners was viewed negatively by managers and occupational health physicians, and more positively by general practitioners and patients. However, there is some evidence that general practitioners would be prepared to forfeit their role as validators of sick leave. Given the imperatives of both state and capital to reduce the financial burden of long-term sickness, this preparedness puts into doubt the continued role of general practitioners as gatekeepers to legitimate long-term sickness absence.

Welcome to the Occupation: Patterns in the Management of the Fourteenth-Century English Landscape

Occupation of the landscape took many different forms and is one of the predominant ways of viewing settlement within the medieval world. Buildings are the most effective method of occupying space, both physically and psychologically. This paper will draw on current research into fourteenth century manorial buildings in England and explore how they were used to occupy both the landscape and the communities associated with them.

Research agendas for the sustainable management of tropical peatland in Malaysia

There is a need for coordinated research for the sustainable management of tropical peatland. Malaysia has 6% of global tropical peat by area and peatlands there are subject to land use change at an unprecedented rate. This paper describes a stakeholder engagement exercise that identified 95 priority research questions for peatland in Malaysia, organized into nine themes. Analysis revealed the need for fundamental scientific research, with strong representation across the themes of environmental change, ecosystem services, and conversion, disturbance and degradation. Considerable uncertainty remains about Malaysia's baseline conditions for peatland, including questions over total remaining area of peatland, water table depths, soil characteristics, hydrological function, biogeochemical processes and ecology. More applied and multidisciplinary studies involving researchers from the social sciences are required. The future sustainability of Malaysian peatland relies on coordinating research agendas via a ‘knowledge hub’ of researchers, strengthening the role of peatlands in land-use planning and development processes, stricter policy enforcement, and bridging the divide between national and provincial governance. Integration of the economic value of peatlands into existing planning regimes is also a stakeholder priority. Finally, current research needs to be better communicated for the benefit of the research community, for improved societal understanding and to inform policy processes.

Design, recruitment, logistics, and data management of the GEHA (Genetics of Healthy Ageing) project

In 2004, the integrated European project GEHA (Genetics of Healthy Ageing) was initiated with the aim of identifying genes involved in healthy ageing and longevity. The first step in the project was the recruitment of more than 2500 pairs of siblings aged 90 years or more together with one younger control person from 15 areas in 11 European countries through a coordinated and standardised effort. A biological sample, preferably a blood sample, was collected from each participant, and basic physical and cognitive measures were obtained together with information about health, life style, and family composition. From 2004 to 2008 a total of 2535 families comprising 5319 nonagenarian siblings were identified and included in the project. In addition, 2548 younger control persons aged 50-75 years were recruited. A total of 2249 complete trios with blood samples from at least two old siblings and the younger control were formed and are available for genetic analyses (e.g. linkage studies and genome-wide association studies). Mortality follow-up improves the possibility of identifying families with the most extreme longevity phenotypes. With a mean follow-up time of 3.7 years the number of families with all participating siblings aged 95 years or more has increased by a factor of 5 to 750 families compared to when interviews were conducted. Thus, the GEHA project represents a unique source in the search for genes related to healthy ageing and longevity.

Content validity of the Illness Perception Questionnaire-Revised for people with Type 2 Diabetes: A Think-Aloud study

Objectives: To access the cognitions of adults with type 2 diabetes whilst completing items on the Illness Perceptions Questionnaire – Revised (IPQ-R). To determine whether these cognitions are congruent with the meaning of items and subscales as interpreted by researchers and clinicians using the IPQ-R and to identify the nature and extent of problems that individuals experience when completing the IPQ-R.
Design: Participants (n=36) were recruited from a primary care diabetes clinic and a hospital diabetes clinic. They were asked to complete the IPQ-R using a ‘think-aloud’ methodology.
Main Outcome Measures: Transcripts were analysed to identify instances where participants expressed problems with item completion, or where there was inconsistency between verbal and written responses.
Results: The most problematic subscales were those of ‘personal control’ and ‘consequences’.
Conclusion: Generally, participants found the IPQ-R unproblematic. However, participants had problems with the concept of ‘cure’ and ‘symptoms’ in the context of type 2 diabetes, and with the negative phrasing used in some items. These findings have important implications for the interpretation of IPQ-R scores, particularly when the IPQ-R is used as the basis for individualised interventions among people with type 2 diabetes.

Promoting normality in the management of the perineum during the second stage of labour

The management of the perineum during birth has multiple long-term effects on women and their families. The midwife has a key role to play and often the techniques they employ vary significantly, as does their justification of these practices. This article seeks to examine current evidence to explore what is known to contribute to lower perineal trauma rates and what practices should be avoided to protect childbearing women. The conclusions drawn show that the updating of
practice and antenatal education may be required so that woman are given the information they need to make an informed choice as to what they want for their own body, child and experience.

The management of an ageing workforce: organisational policies in Germany and Britain

Demographic change as well as pressure from the European Union and national government are forcing organisations to change age-discriminatory HRM approaches. Based on a qualitative analysis of eight British and German organisations, we found that commitment, scope, coverage and implementation of age management differ due to country-specific institutions, particularly government, in nudging employers and unions to preferred age practices. This confirms the path dependency concept suggested by institutional theory. Nevertheless, we also found that industry-specific factors mediate the implementation of age management, leading to some convergence across countries. This indicates that organisations deviate from the institutional path to implement practices that they deem important.