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.

Behavior, pain perception, and the extremely low-birth weight survivor

This article explores the literature concerning responses to pain of both premature and term-born newborn infants, the evidence for short-term and long-term effects of pain, and behavioral sequelae in individuals who have experienced repeated early pain in neonatal life as they mature. There is no doubt that pain causes stress in babies and this in turn may adversely affect long-term neurodevelopmental outcome. Although there are methods for assessing dimensions of acute reactivity to pain in an experimental setting, there are no very good measures available at the present time that can be used clinically. In the clinical setting repeated or chronic pain is more likely the norm rather than infrequent discrete noxious stimuli of the sort that can be readily studied. The wind-up phenomenon suggests that, exposed to a cascade of procedures as happens with clustering of care in the clinical setting in an attempt to provide periods of rest for stressed babies, an infant may in fact perceive procedures that are not normally viewed as noxious, as pain. Pain exposure during lifesaving intensive medical care of ELBW neonates may also affect subsequent reactivity to pain in the neonatal period, but behavioral differences are probably not likely to be clinically significant in the long term. Prolonged and repeated untreated pain in the newborn period, however, may produce a relatively permanent shift in basal autonomic arousal related to prior NICU pain experience, which may have long-term sequelae. In the long run, the most significant clinical effects of early pain exposure may be on neurodevelopment, contributing to later attention, learning, and behavior problems in these vulnerable children. Although there is considerable evidence to support a variety of adverse effects of early pain, there is less information about the long-term effects of opiates and benzodiazepines on the developing central nervous system. Current evidence reviewed suggests that judicious use of morphine for adjustment to mechanical ventilation may ameliorate the altered autonomic response. It may be very important, however, to distinguish stress from pain. Animal evidence suggests that the neonatal brain is affected differently when exposed to morphine administered in the absence of pain than in the presence of pain. Pain control may be important for many reasons but overuse of morphine or benzodiazepines may have undesirable long-term effects. This is a rapidly evolving area of knowledge of clear relevance to clinical management likely to affect long-term outcomes of high-risk children.

In Two Minds? Parental Attitudes toward Physical Punishment in the UK

Since the Millennium, the use of physical punishment in the home has been a widely debated topic across the UK. Reliance on public opinion has been an important feature of this debate with a variety of UK surveys showing that many find physical punishment acceptable and do not support a complete ban on smacking. Drawing on the results from a comprehensive review of the literature, this article highlights that public/parental opinion is less than straightforward. Parents are often ambivalent about physical discipline, do not view it as an optimal method of behaviour management and are more prone to smack when stressed or angry. Likewise, a survey of the disciplinary practices and attitudes of 1000 parents in Northern Ireland shows that majority of parents have negative attitudes towards physical discipline. Nonetheless, many parents continue to smack despite the fact they do not believe it to be effective. Lack of parental support for legislative reform should be reconsidered in the light of this ambivalence. Most important, the UK Government needs to reframe the smacking debate in terms of children's rights rather than relying on public opinion if it is to fulfil its commitment to protect children from harm as set out in the United Nations Convention on the Rights of the Child.

Farmer perception of suitable conditions for slurry application compared with decision support system recommendations

The application of slurry nutrients to land can be associated with unintended losses to the environment depending on soil and weather conditions. Correct timing of slurry application, however, can increase plant nutrient uptake and reduce losses. A decision support system (DSS), which predicts optimum conditions for slurry spreading based on the Hybrid Soil Moisture Deficit (HSMD) model, was investigated for use as a policy tool. The DSS recommendations were compared to farmer perception of suitable conditions for slurry spreading for three soil drainage classes (well, moderate and poorly drained) to better understand on farm slurry management practices and to identify potential conflict with farmer opinion. Six farmers participated in a survey over two and a half years, during which they completed a daily diary, and their responses were compared to Soil Moisture Deficit (SMD) calculations and weather data recorded by on farm meteorological stations. The perception of land drainage quality differed between farmers and was related to their local knowledge and experience. It was found that the allocation of grass fields to HSMD drainage classes using a visual assessment method aligned farmer perception of drainage at the national scale. Farmer opinion corresponded to the theoretical understanding that slurry should not be applied when the soil is wetter than field capacity, i.e. when drainage can occur. While weather and soil conditions (especially trafficability) were the principal reasons given by farmers not to spread slurry, farm management practices (grazing and silage) and current Nitrates Directive policies (closed winter period for spreading) combined with limited storage capacities were obstacles to utilisation of slurry nutrients. Despite the slightly more restrictive advice of the DSS regarding the number of suitable spreading opportunities, the system has potential to address an information deficit that would help farmers to reduce nutrient losses and optimise plant nutrient uptake by improved slurry management. The DSS advice was in general agreement with the farmers and, therefore, they should not be resistant to adopting the tool for day to day management.

Parental Disputes, Religious Upbringing and Welfare in English Law and the ECHR

This article assesses the position of English law concerning parental disputes about the religious upbringing of children. Despite the strong emphasis on both parents being able to direct their child’s religious upbringing, courts have interpreted the child’s welfare to restrict the exposure of the child to parental religious beliefs or practices in some circumstances: preserving the child’s future choice of religion, the physical integrity of the child, the child’s contact and relationship with both parents, the child’s educational choices, and the child’s relationship with both parents’ religious community. It is suggested that courts should have a wide understanding of welfare and should be wary to prohibit parents teaching their minority beliefs. This article also compares the position of the European Court of Human Rights (ECtHR) and suggests that, despite the stronger emphasis by the ECtHR on parental rights, English law is generally not that much at odds with the ECtHR.

Parental care influences social immunity in burying beetle larvae

In this study, evidence is provided of social immunity in the offspring of a sub-social species, the burying beetle, Nicrophorus vespilloides. Nicrophorus vespilloides is a carrion breeder and, in a similar fashion to the adult beetles, the offspring produce exudates that exhibit lytic activity, which are used to coat the breeding resource. This strategy defends against the microbial community. The lytic activity in larval exudates declines as the brood develops, perhaps being most beneficial at the start of the breeding bout. Changing levels of parental care through widowing/orphaning affects lytic activity in the larval exudates, with levels decreasing in the absence of both parents.

The influence of parents, older siblings, and non-parental care on infant development at nine months of age

Background: The majority of research examining the influence of social environment on early child development suggests benefits to two-parent households, but contradictory evidence for the effects of siblings. The aims of the present study were to examine the influence of the child's proximal social environment, and the effects of interactions between socioeconomic status and social environment on developmental outcomes.

Methods: Primary caregivers of a representative sample of 10,748 nine-month-old infants in Ireland completed the Ages and Stages Questionnaire and provided information on social environment. Adjustment was made for infant and maternal characteristics, household income, and area where the child was living at the time of the study. Further analyses tested for interactions between social environment and household income.

Results: Binary logistic regressions indicated no effects for number of parents in the household. However, the presence of siblings in the household was a consistent predictor of failing to reach milestones in communication, gross motor, problem-solving, and personal-social development. Furthermore, there was a gradient of increasing likelihood of failing in gross motor, problem-solving, and personal-social development with increasing numbers of siblings. Care by a grandparent decreased the likelihood of failing in communication and personal-social development.

Conclusions:These findings do not support the majority of research that finds positive benefits for two-parent households. Similarly, the findings suggest limited effects for non-parental care. However, the observed negative effects of siblings support both the confluence and resource dilution models of sibling effect. Examination of follow-up data may elucidate current findings.