Help needed in medication self-management for people with visual impairment: case-control study

Background: Visual impairment (VI) is rising in prevalence and contributing to increasing morbidity, particularly among older people. Understanding patients' problems is fundamental to achieving optimal health outcomes but little is known about how VI impacts on self-management of medication.

Aim: To compare issues relating to medication self-management between older people with and without VI.

Design and setting: Case-control study with participants aged =65 years, prescribed at least two long-term oral medications daily, living within the community.

Method: The study recruited 156 patients with VI (best corrected visual acuity [BCVA] 6/18 to 3/60) at low-vision clinics; community optometrists identified 158 controls (BCVA 6/9 or better). Researchers visited participants in their homes, administered two validated questionnaires to assess medication adherence (Morisky; Medication Adherence Report Scale [MARS]), and asked questions about medication self-management, beliefs, and support.

Results: Approximately half of the participants in both groups reported perfect adherence on both questionnaires (52.5% Morisky; 43.3%, MARS). Despite using optical aids, few (3%) with VI could read medication information clearly; 24% had difficulty distinguishing different tablets. More people with VI (29%) than controls (13%) (odds ratio [OR] = 2.8; 95% confidence interval [CI] = 1.6 to 5.0) needed help managing their medication, from friends (19% versus 10%) or pharmacists (10% versus 2.5%; OR = 4.4, 95% CI = 1.4 to 13.5); more received social service support (OR = 7.1; 95% CI = 3.9 to 12.9).

Conclusion: Compared to their peers without VI, older people with VI are more than twice as likely to need help in managing medication. In clinical practice in primary care, patients' needs for practical support in taking prescribed treatment must be recognised. Strategies for effective medication self-management should be explored.

Strategy in a religious network: A bourdieuian critique of the sociology of spirituality

Within the sociology of religion there has emerged a discourse on spirituality that views contemporary developments as involving the assertion of individuals’ self-authority. This perspective’s theoretical roots have been persistently criticised for their conceptualisation of agency; in contrast, this paper draws upon Bourdieu’s concept of strategy to examine action in an English religious network of the sort often classified ‘New Age’. In particular, one informant is discussed in order to provide focus for an understanding of what Lahire calls sociology at the level of the individual. Her actions, better explained as strategic improvisations than as choices made on the basis of self-authority, help to illuminate the peculiarities of this religious setting, which is characterised in terms of ‘nonformativeness’. By emphasising social contextualisation, this approach addresses people’s meaningful actions in a way that may be applied not only more widely within the religious field but also in other fields of action.

Organisational Self-Evaluation and Teacher Education for Community Relations in a Transforming Society?

During 2004, the School of Education at the University of Ulster embarked on an innovative three-year project designed to embed community relations objectives within initial teacher education. With the advent of more peaceful times in Northern Ireland, this was a precipitous time for initial teacher educators to review the preparation given to beginner teachers for teaching in an increasingly pluralist society emerging from conflict. The present paper reports on one very specific and time-limited element of the broader project. That is, development work designed to investigate the possibilities of using processes of self-review and evaluation as a lever for improvements in initial teacher education for community relations. Following a brief contextualisation, the background to, and the development of, a set of materials designed to support rigorous and systematic self-review of all aspects of provision in a university-based initial teacher education department is described. The Community Relations Index for Initial Teacher Education (Cr-ITE) was envisaged as being of use to initial teacher education establishments in order to help teacher educators take responsibility for rigorous learning from their practice, whilst placing inclusive values at the centre of organisational development. The final section includes further critical reflection on the role of organisational self-review in transforming teacher education for inclusion in a society emerging from longstanding communal conflict.

Discharging not-for-profit accountability: UK charities and public discourse

Purpose: This paper aims to examine the accountability practices of large United Kingdom (UK) charities through public discourse.
Design/methodology/approach: Based on the ethical model of stakeholder theory, the paper develops a framework for classifying not-for-profit (NFP) accountability and analyzes the content of the annual reports and annual reviews of a sample of large UK charities using this framework.
Findings: The results suggest that contrary to the ethical model of stakeholder theory, the sample charities’ accountability practices are motivated by a desire to legitimize their activities and present their organizations’ activities in a positive light. These results contradict the raison d’eˆ tre of NFP organizations (NFPOs) and the values that they espouse. Research limitations/implications: Understanding the nature of accountability reporting in NFPOs has important implications for preparers and policy makers involved in furthering the NFP agenda. New research needs to examine shifts in accountability practices over time and assess the impact of the recent self-regulation developed to enhance sector accountability.
Originality/value: This paper contributes to the NFP accountability literature by: first, developing a framework of NFP accountability through public discourse using the ethical model of stakeholder theory; and second, advancing the understanding of the accountability practices of large UK charities.

“That’s not Ironic, that’s just Stupid!": Towards an Eclectic Account of the Discourse of Irony

This article draws on a range of models from language studies, particularly from linguistic pragmatics, in order to elucidate patterns in the production and reception of irony in its social and cultural context. An expanded view of the concept of irony, it is suggested, allows for better modelling of the creative mechanisms which underpin it, and in doing so can open the way for a fuller understanding of humour production and reception. A consequence of this broader (five-fold) typology of irony is that it can help shed light on the cultural dynamic of irony. The article uses a range of examples from different media and the lay definitions and interpretations that ordinary (non-academic) users of the language use in the comprehension of irony. Insofar as it seeks to develop an overarching model of irony, this paper draws on a variety of textual examples from a variety of sources, ranging from corpus evidence, through a stand-up comedy routine, to political wall murals and their discursive re-conformation as humour in present-day Northern Ireland. Although the central discussion is supported by insights from other linguistic, cognitive and socio-cultural approaches, the theoretical framework which emerges, with its focus on language and communication in context, is situated squarely within contemporary linguistic pragmatics.

Telling stories of 21st Century welfare: the UK Coalition Government and the neo-liberal discourse of worklessness and dependency’ Critical Social Policy

Policy documents are a useful source for understanding the privileging of particular ideological and policy preferences (Scrase and Ockwell, 2010) and how the language and imagery may help to construct society’s assumptions, values and beliefs. This article examines how the UK Coalition government’s 2010 Green Paper, 21st Century Welfare, and the White Paper, Universal Credit: Welfare that Works, assist in constructing a discourse about social security that favours a renewal and deepening of neo-liberalization in the context of threats to its hegemony. The documents marginalize the structural aspects of persistent unemployment and poverty by transforming these into individual pathologies of benefit dependency and worklessness. The consequence is that familiar neo-liberal policy measures favouring the intensification of punitive conditionality and economic rationality can be portrayed as new and innovative solutions to address Britain’s supposedly broken society and restore economic competitiveness.

Explaining the relationship between ingroup identification and intergroup bias following recategorization: A self-regulation theory analysis

We tested the hypothesis that regulation of discrepancies between perceived actual and ideal differentiation between the ingroup and outgroup could help to explain the relationship between ingroup identification and intergroup bias when participants are recategorized into a superordinate group. Replicating previous findings, we found that following recategorization, identification was positively related to intergroup bias. No such differences emerged in a control condition. However, we also, in the recategorization condition only, observed a positive association between ingroup identification and the perceived discrepancy between actual and ideal degree of differentiation from the outgroup: at higher levels of identification, participants increasingly perceived the ingroup to be less differentiated from the outgroup than they would ideally like. This tendency mediated the relationship between identification and bias. We discuss the theoretical, methodological and practical implications of these findings.

A randomized controlled trial of a self-management psychosocial intervention for men with prostate cancer and their partners: a study protocol.

Background
Little is known about interventions to help men and their partners cope with the after effects of prostate cancer treatment. The lack of in-depth descriptions of the intervention content is hindering the identification of which intervention (or component of an intervention) works.

Aim
To describe the development and evaluation of the content of a self-management psychosocial intervention for men with prostate cancer and their partners.

Design
A feasibility randomized controlled trial including structure, process, and outcome analysis.

Methods
This 9-week intervention commences on completion of treatment and consists of three group and two telephone sessions. The intervention focuses on symptom management, sexual dysfunction, uncertainty management, positive thinking and couple communication. Forty-eight couples will be assigned to either the intervention or a control group receiving usual care. Participants will be assessed at baseline, immediately postintervention and at 1 and 6 months postintervention. Outcome measures for patients and caregivers include self-efficacy, quality of life, symptom distress, uncertainty, benefits of illness, health behaviour, and measures of couple communication and support. An additional caregiver assessment will be completed by the partner.

Discussion
The main purpose of this feasibility study is to investigate the acceptability of the CONNECT programme to men with prostate cancer and their partners and to gain feedback from the participants and facilitators to make changes to and enhance the programme. Reasons why men do not want to participate will be collated to enhance recruitment in the future. We will also test recruitment strategies, randomization procedures, and the acceptability of the questionnaires. Ethical approval granted December 2010.

Multimedia psycho-educational interventions to support patient self-care in degenerative conditions: a realist review

Objective: Multimedia interventions are increasingly used to deliver information in order to promote self-care among patients with degenerative conditions. We carried out a realist review of the literature to investigate how the characteristics of multimedia psychoeducational interventions combine with the contexts in which they are introduced to help or hinder their effectiveness in supporting self-care for patients with degenerative conditions.

Method: Electronic databases (Medline, Science Direct, PSYCHinfo, EBSCO, and Embase) were searched in order to identify papers containing information on multimedia psychoeducational interventions. Using a realist review approach, we reviewed all relevant studies to identify theories that explained how the interventions work.

Results: Ten papers were included in the review. All interventions sought to promote self-care behaviors among participants. We examined the development and content of the multimedia interventions and the impact of patient motivation and of the organizational context of implementation. We judged seven studies to be methodologically weak. All completed studies showed small effects in favor of the intervention.

Significance of Results: Multimedia interventions may provide high-quality information in an accessible format, with the potential to promote self-care among patients with degenerative conditions, if the patient perceives the information as important and develops confidence about self-care. The evidence base is weak, so that research is needed to investigate effective modes of delivery at different resource levels. We recommend that developers consider how an intervention will reduce uncertainty and increase confidence in self-care, as well as the impact of the context in which it will be employed.

'You' and 'I' in university seminars and spoken learner discourse

You and I may be little words but they do a great deal. In spoken discourse they reference shared knowledge and mark stance. In pedagogical contexts, they maintain relations in teacher-student discourse. However, language classrooms may rarely explore this array of pragmatic meanings. A lack of awareness of the variety of these functions may be problematic for learners when seeking to construct interpersonal relations and operate successfully in particular spoken contexts. This paper presents a study of you and I in two spoken corpora: a corpus of English language learner task talk and a corpus of university seminar talk. Findings illustrate different patterns of I and you between the two corpora: I and you have a higher rate of occurrence in learner discourse, and pronoun repetition is more frequent in learner discourse, though it does not account for the higher rate of you and I. These findings suggest that language learner task talk displays more features tied to speech production and self-regulation and fewer features associated with attempting to point to the informational space of others, a key feature of university classroom talk. This paper concludes by outlining pedagogical applications to overcome features perceived as disfluent.

Let's talk about health: shoppers' discourse regarding health while food shopping

Objective: The present study aimed to examine the role of health in consumers’ food purchasing decisions through investigating the nature of people’s discourse regarding health while conducting their food shopping.

Design: The study employed the think-aloud technique as part of an accompanied shop. All mentions of health and terms relating to health were identified from the data set. Inductive thematic analysis was conducted to examine how health was talked about in relation to people’s food choice decisions.

Setting: Supermarkets in Dublin, Republic of Ireland and Belfast, Northern Ireland.

Subjects Participants: (n 50) were aged over 18 years and represented the main household shopper.

Results: Responsibility for others and the perceived need to illicit strict control to avoid ‘unhealthy’ food selections played a dominant role in how health was talked about during the accompanied shop. Consequently healthy shopping was viewed as difficult and effort was required to make the healthy choice, with shoppers relating to product-based inferences to support their decisions.

Conclusions: This qualitative exploration has provided evidence of a number of factors influencing the consideration of health during consumers’ food shopping. These results highlight opportunities for stakeholders such as public health bodies and the food industry to explore further ways to help enable consumers make healthy food choices.

Following instructions from working memory: Why does action at encoding and recall help?

Two experiments investigated the consequences of action at encoding and recall on the ability to follow sequences of instructions. Children aged 7–9 years recalled sequences of spoken action commands under presentation and recall conditions that either did or did not involve their physical performance. In both experiments, recall was enhanced by carrying out the instructions as they were being initially presented and also by performing them at recall. In contrast, the accuracy of instruction-following did not improve above spoken presentation alone, either when the instructions were silently read or heard by the child (Experiment 1), or when the child repeated the spoken instructions as they were presented (Experiment 2). These findings suggest that the enactment advantage at presentation does not simply reflect a general benefit of a dual exposure to instructions, and that it is not a result of their self-production at presentation. The benefits of action-based recall were reduced following enactment during presentation, suggesting that the positive effects of action at encoding and recall may have a common origin. It is proposed that the benefits of physical movement arise from the existence of a short-term motor store that maintains the temporal, spatial, and motoric features of either planned or already executed actions.