The contribution of qualitative research in designing a complex intervention for secondary prevention of coronary heart disease in two different healthcare systems

Background: Developing complex interventions for testing in randomised controlled trials is of increasing importance in healthcare planning. There is a need for careful design of interventions for secondary prevention of coronary heart disease (CHD). It has been suggested that integrating qualitative research in the development of a complex intervention may contribute to optimising its design but there is limited evidence of this in practice. This study aims to examine the contribution of qualitative research in developing a complex intervention to improve the provision and uptake of secondary prevention of CHD within primary care in two different healthcare systems.

Methods: In four general practices, one rural and one urban, in Northern Ireland and the Republic of Ireland, patients with CHD were purposively selected. Four focus groups with patients (N = 23) and four with staff (N = 29) informed the development of the intervention by exploring how it could be tailored and integrated with current secondary prevention activities for CHD in the two healthcare settings. Following an exploratory trial the acceptability and feasibility of the intervention were discussed in four focus groups (17 patients) and 10 interviews (staff). The data were analysed using thematic analysis.

Results: Integrating qualitative research into the development of the intervention provided depth of information about the varying impact, between the two healthcare systems, of different funding and administrative arrangements, on their provision of secondary prevention and identified similar barriers of time constraints, training needs and poor patient motivation. The findings also highlighted the importance to patients of stress management, the need for which had been underestimated by the researchers. The qualitative evaluation provided depth of detail not found in evaluation questionnaires. It highlighted how the intervention needed to be more practical by minimising administration, integrating role plays into behaviour change training, providing more practical information about stress management and removing self-monitoring of lifestyle change.

Conclusion: Qualitative research is integral to developing the design detail of a complex intervention and tailoring its components to address individuals' needs in different healthcare systems. The findings highlight how qualitative research may be a valuable component of the preparation for complex interventions and their evaluation.

Gender differences in the role of emotional intelligence during the primary-secondary school transition

The relationship between components of emotional intelligence (EI) (interpersonal
ability, intrapersonal ability, adaptability and stress management) and academic
performance in English, maths and science was examined in a sample of 86 children
(49 males and 37 females) aged 11–12 years during the primary–secondary school
transition period. Results indicated that for both males and females, intrapersonal
ability had little relationship with academic achievement, while adaptability had the
strongest relationship with achievement in all subjects. Gender differences were particularly
pronounced for science, for which stronger relationships were observed with all
EI components for males. In addition, apparent only for males was a negative
relationship between stress management and science. These findings offer support for
the current inclusion of a personal and emotional element in the primary school curriculum,
and indicate that such training is likely to help males more than females to make
a successful transition from primary to secondary school.

Occupational stress in the chef profession

Purpose – The purpose of this paper is to consider the occupational stress experienced by chefs and the moderating influence of coping behaviour and locus of control on stress outcomes. Design/methodology/approach – A total of 40 working chefs were surveyed. They were asked to complete an occupational stress questionnaire, the General Health Questionnaire. Differences were
sought between gender and locus of control and stress measures, and correlations were carried out between key variables. Findings – The reported stress was markedly higher than in previous research. Excessive workload,
feeling undervalued and communication issues were common and bullying and threats of violence were present for some. Unexpectedly, locus of control was unable to predict stress experiences. Explanations were offered, such as the possibility that those who perceive they have a strong sense of control may believe that this, paradoxically, affords them the opportunity to engage in unhealthy behaviours. Research limitations/implications – Limitations of the research include the influence of the wider environment, specifically the history of political violence in the province, and its possible effect on stress outcomes. However, this may be negated by the many positive effects peace has brought over the last decade. In drawing conclusions it is important to note the limitations of the sample size and the self-reporting nature of survey responses. Further research could usefully incorporate well-being as well as stress measures, including physiological ones. It would be worth exploring further how one’s sense of control affects perceptions of stress and, in turn, the coping behaviours engaged in. Practical implications – Practical implications include the need for managers and head chefs to provide more feedback to employees, to validate their good work and to foster a supportive working environment. Norms in the working environment endorsing aggressive behaviour must be challenged.
Staff appraisals should consider the need to have work that involves variety and challenge, especially where changes involve increases in workload. Originality/value – This paper identifies some important ingredients to reduce distress and it will be of value to chefs and other kitchen staff and, more broadly, to those involved in people management.

A lethal tetrad in diabetes:hyperglycemia, dyslipidemia, oxidative stress, and endothelial dysfunction

This paper addresses the consequences of diabetes and obesity, diseases that have become epidemic in our society, particularly in the past 20 years. Specifically, it summarizes current knowledge about some of the risk factors and mechanisms for the vascular complications of diabetes. These complications can be broadly divided into microvascular disease, such as diabetic retinopathy and diabetic nephropathy, and macrovascular disease, such as accelerated atherosclerosis, and they are the main cause for morbidity and premature mortality among diabetic patients. The roles of hyperglycemia, dyslipidemia and dyslipoproteinemia, oxidative stress, and endothelial dysfunction will be considered. Finally, the "treatment gap" will be addressed. This gap refers to our failure to achieve currently accepted goals to reduce established risk factors for complications in the clinical management of diabetic patients.

Performance management systems and Public Value Strategy: a case study

Purpose
This article aims to analyze the role of performance management systems (PMS) in supporting public value strategies.

Design/methodology/approach
This article draws on the public value dynamic model by Horner and Hutton (2010). It presents the results of a case study of implementation of a PMS model, the ‘Value Pyramid’ (VP).

Findings
The results stress the need for an improved conceptualization of PMS within public value strategy. Through experimentation using the VP, the case site was able to measure and visualize what it considered public value and reflect on the internal/external causes of both creation and destruction of public value.

Research limitations/implication
This article is limited to just one case study, although in-depth and longitudinal.

Originality/value
This article is one of the first attempting to understand the role of PMS within the public value strategy framework, answering the call of Benington and Moore (2010) to consider public value from an accounting perspective.

Proteomic analysis reveals oxidative stress response as the main adaptative physiological mechanism in cows under different production systems

Three groups of cows representing three ranges of welfare in the production system were included in the study: two groups of Bruna dels Pirineus beef cattle maintained under different management systems (good and semiferal conditions) and a group of Alberes cows, a breed that lives in the mountains (hardest conditions).

In order to identify new stress/welfare biomarkers, serum from Bruna cows living in both environments was subjected to DIGE labelling, two-dimensional electrophoresis and MALDI-MS or ion trap MS. Identification was achieved for 15 proteins, which mainly belonged to three biological functions, the oxidative stress pathway (glutathione peroxidase (GPx) and paraoxonase (PON-1)), the acute phase protein family (Heremans Schmid glycoprotein alpha2 (α2-HSG)) and the complement system.

Biological validation included the Alberes breed. GPx and PON-1 were validated by an enzymatic assay and found to be higher and lower, respectively, in cows living in hard conditions. α2-HSG was validated by ELISA and found to be reduced in hard conditions. Other biomarkers of the redox status were also altered by living conditions: protein carbonyl content, superoxide dismutase (SOD) and glutathione reductase (GR).

Our results show that changes in the redox system are the main adaptation of cows living in challenging environmental conditions. This article is part of a Special Issue entitled: “Farm animal proteomics”.

A systematic review of midwife led interventions to address post traumatic stress syndrome

Objective
to systematically identify interventions that midwives could introduce to address post-traumatic stress in women following childbirth.

Methods
a search strategy was developed and relevant papers were identified from databases including Cinahl, Cochrane Library, EMBASE, Maternity and Infant Care, MEDLINE, PsycINFO, and Web of Science. Key search terms used were post-traumatic stress, post partum, intervention, controlled trial and review. Papers eligible for inclusion were primary studies and reviews of research published from 2002–2012, focusing on interventions which could be implemented by midwives for the prevention and/or management of PTSD. For primary studies, RCTs, controlled clinical trials, and cohort studies with a control group were eligible. Eligible reviews were those with a specified search strategy and inclusion/exclusion criteria. Methodological quality was assessed using recognised frameworks.

Findings
six primary studies and eight reviews were eligible for inclusion. The majority of included studies or reviews focused on debriefing and/or counselling interventions; however the results were not consistent due to significant variation in methodological quality and use of dissimilar interventions. Two of the reviews considered the general management of post partum PTSD and one broadly covered anxiety during pregnancy and the post partum, incorporating a section on PTSD. The majority of women reported that the opportunity to discuss their childbirth experience was subjectively beneficial.

Conclusions and implications for practice
no evidence-based midwifery interventions were identified from this systematic review that can be recommended for introduction into practice to address PTSD. It is recommended that future research in this area should incorporate standardised interventions with similar outcome measures to facilitate synthesis of results. Further research on interventions used in non-maternity populations is needed in order to confirm their usefulness in addressing post partum PTSD.

The effects of transportation stress and barnacle fouling on predation rates of starfish (Asterias rubens) on mussels (Mytilus edulis).

The starfish, Asterias rubens, is widely distributed throughout the northern hemisphere and is an important predator on benthic mussel (Mytilus edulis) beds. Whilst several studies have examined how the size of individuals determines this predator–prey relationship, less is known about how the physiological condition of the prey (mussels) and the extent of their fouling may alter these relationships. Such issues are of particular interest to those working within the benthic mussel cultivation industry to inform best management practice and to help minimise losses during the aquaculture process. The potential role of starfish in the removal of epibiotic barnacles from mussels, the presence of which increases processing costs within the industry, is also of interest. We tested whether stressing mussels by aerial exposure for 48 h and whether the extent of barnacle fouling on mussels affected the feeding rates of three different size classes of starfish feeding on two different size classes of mussels. Feeding rates on stressed and unstressed mussels were similar for each starfish–mussel size combination. Barnacle fouling reduced the feeding rate of medium-sized starfish on larger-sized mussels. We also observed starfish, of all size classes, preying directly on the epibiotic barnacles on mussels, however, feeding rates were low and considered unlikely to reduce the extent of fouling on mussels. Our findings show that the predator–prey relationship between starfish and mussels does not differ between unstressed mussels and those experimentally stressed by aerial exposure for 48 h so that this level of stress is unlikely to affect predation rates by A. rubens following relaying in commercial operations. Whilst barnacle fouling suppressed predation rates in one of our experimental treatments, it does not appear that fouling by barnacles would provide a significant refuge from predation for the majority of mussels in benthic aquaculture stocks. Instead we found the size relationship between starfish and mussels was more important in determining predation rates. Starfish are also unlikely to help reduce barnacle fouling on cultured mussels by preying solely on fouling barnacles and the need to control starfish predation during culture remains.

Silicon, the silver bullet for mitigating biotic and abiotic stress, and improving grain quality, in rice?

Adequate silicon fertilization greatly boosts rice yield and mitigates biotic and abiotic stress, and improves grain quality through lowering the content of cadmium and inorganic arsenic. This review on silicon dynamics in rice considers recent advances in our understanding of the role of silicon in rice, and the challenges of maintaining adequate silicon fertility within rice paddy systems. Silicon is increasingly considered as an element required for optimal plant performance, particularly in rice. Plants can survive with very low silicon under laboratory/glasshouse conditions, but this is highly artificial and, thus, silicon can be considered as essential for proper plant function in its environment. Silicon is incorporated into structural components of rice cell walls were it increases cell and tissue rigidity in the plant. Structural silicon provides physical protection to plants against microbial infection and insect attack as well as reducing the quality of the tissue to the predating organisms. The abiotic benefits are due to silicon's effect on overall organ strength. This helps protect against lodging, drought stress, high temperature (through efficient maintenance of transpiration), and photosynthesis by protecting against high UV. Furthermore, silicon also protects the plant from saline stress and against a range of toxic metal stresses (arsenic, cadmium, chromium, copper, nickel and zinc). Added to this, silicon application decreases grain concentrations of various human carcinogens, in particular arsenic, antimony and cadmium. As rice is efficient at stripping bioavailable silicon from the soil, recycling of silicon rich rice straw biomass or addition of inorganic silicon fertilizer, primarily obtained from iron and steel slag, needs careful management. Silicon in the soil may be lost if the silicon-cycle, traditionally achieved via composting of rice straw and returning it to the land, is being broken. As composting of rice straw and incorporation of composted or non-composted straw back to land are resource intensive activities, these activities are declining due to population shifts from the countryside to cities. Processes that accelerate rice straw composting, therefore, need to be identified to aid more efficient use of this resource. In addition, rice genetics may help address declining available silicon in paddy soils: for example by selecting for characteristics during breeding that lead to an increased ability of roots to access recalcitrant silicon sources from soil and/or via selection for traits that aid the maintenance of a high silicon status in shoots. Recent advances in understanding the genetic regulation of silicon uptake and transport by rice plants will aid these goals.

Associates of an elevated natriuretic peptide level in stable heart failure patients:implications for targeted management

BACKGROUND: Persistently elevated natriuretic peptide (NP) levels in heart failure (HF) patients are associated with impaired prognosis. Recent work suggests that NP-guided therapy can improve outcome, but the mechanisms behind an elevated BNP remain unclear. Among the potential stimuli for NP in clinically stable patients are persistent occult fluid overload, wall stress, inflammation, fibrosis, and ischemia. The purpose of this study was to identify associates of B-type natriuretic peptide (BNP) in a stable HF population.

METHODS: In a prospective observational study of 179 stable HF patients, the association between BNP and markers of collagen metabolism, inflammation, and Doppler-echocardiographic parameters including left ventricular ejection fraction (LVEF), left atrial volume index (LAVI), and E/e prime (E/e') was measured.

RESULTS: Univariable associates of elevated BNP were age, LVEF, LAVI, E/e', creatinine, and markers of collagen turnover. In a multiple linear regression model, age, creatinine, and LVEF remained significant associates of BNP. E/e' and markers of collagen turnover had a persistent impact on BNP independent of these covariates.

CONCLUSION: Multiple variables are associated with persistently elevated BNP levels in stable HF patients. Clarification of the relative importance of NP stimuli may help refine NP-guided therapy, potentially improving outcome for this at-risk population.