Developing a Training in Motivational Counselling to Promote Return to Work: An Intervention Mapping Approach.

PURPOSE: Due to the Belgian health insurance system's controlling nature, work-disabled claimants can feel forced to return to work (RTW), increasing their risk of relapse. RTW out of interest or importance is considered more sustainable. Such autonomous motivation for RTW can be promoted through 'motivational counselling', an integration of self-determination theory and motivational interviewing. To adopt this, health insurance practitioners need training, which can be designed through intervention mapping as an evidence-based planning tool. This paper reports on the development of a motivational counselling training for health insurance practitioners. METHODS: Intervention mapping's six steps guided the formulation of programme goals and learning outcomes, matching the context. We then identified change methods which were translated into practical components. Together with the health insurances' input, this resulted in a concrete training programme with an implementation and evaluation plan. RESULTS: The training was designed to increase practitioners' knowledge, skills, and beliefs relevant for learning motivational counselling, which also requires solution-focused strategies. Methods like guided practice were translated into built-in exercises, feedback, and information, which were implemented through an online training format of five sessions including one follow-up. CONCLUSION: Reporting about training development increases understanding of its effectiveness and implementation, which will be evaluated via pre- and post-training data collection amongst practitioners. Future trainings can benefit from this by accounting for health insurances' organizational barriers or building on the training's evidence-based backbone whilst only requiring specific adaptations for other stakeholders and contexts. Further research should evaluate motivational counselling's impact on claimants' RTW trajectories.

Line Managers' Perspectives and Responses when Employees Burn Out.

PURPOSE: Little is known about whether burnout can be stopped at an emerging stage. To develop this knowledge, we focus on line managers' perspectives and responses when an employee who seems to be heading for burnout is still at work. METHODS: We interviewed 17 line managers working in the educational and health care sectors, who had been confronted with the sickness absence of at least one employee due to burnout in the past. Interviews were transcribed, coded, and analyzed thematically. RESULTS: During the period that the employee seemed to be developing burnout while still at work, line managers experienced three different, successive phases: picking up signals, role-taking, and re-evaluation. Line managers' personal frame of reference (e.g., having experience with burnout) seemed to influence whether and how they picked up signals of burnout. Line managers not picking up signals, did not take any action. When picking up the signals, the managers however generally took an active role: they started a conversation, changed work tasks, and - at a later stage - adapted the employee's job description, sometimes without consulting the employee. The managers felt powerless yet learned from the experience when subsequently re-evaluating the period during which employees developed symptoms of burnout. These re-evaluations resulted in an adapted personal frame of reference. CONCLUSION: This study shows that improving line managers' frame of reference, e.g., by organizing meetings and/or training, may help them to detect early signals of burnout and take action. This is a first step to prevent the further development of early burnout symptoms.

Process Evaluation of a Motivational Interviewing Intervention in a Social Security Setting: A Qualitative Study among Work-Disabled Patients.

Purpose Return to work (RTW) may be facilitated by motivational interviewing (MI), a counseling style designed to increase motivation towards behavior change. MI's relevance in a RTW context remains however unclear. Exploring how, for whom and in what circumstances MI works is therefore necessary. Methods Eighteen people (29-60 years; sick leave > 12 weeks) with low back pain (LBP) or medically unexplained symptoms (MUS) participated in a semi-structured interview after one MI consultation. We conducted a realist-informed process evaluation to explore MI's mechanisms of impact, its outcomes and how external factors may influence these. Data were coded using thematic analysis. Results Main mechanisms were supporting autonomy, communicating with empathy and respect, facilitating feelings of competence and focusing on RTW solutions instead of hindrances. Competence support was more salient among LBP patients, whereas MUS patients benefited more from empathy and understanding. External factors were mentioned to have impacted MI's effectiveness and/or the further RTW process, being personal (e.g. acceptance of the condition), work-related (e.g. supervisor support) and societal (e.g. possibility of gradual RTW). Conclusions These results stress the importance of self-determination theory's support for autonomy, relatedness and competence, together with a solution-focused approach when stimulating patients' engagement regarding RTW. These mechanisms' instalment during RTW counseling and their long-term impact depends on both personal and system-like external factors. Belgium's social security system's premise, based on control, might actually hinder RTW instead of facilitating it. Further longitudinal research could explore MI's long-term effects as well as its complex interaction with external factors.

Employers' Experience on Involvement in Sickness Absence/Return to Work Support for Employees with Cancer in Small Enterprises.

PURPOSE: Return to work (RTW) is important for employees who have survived cancer, yet it is challenging for employers. Small enterprises (< 100 employees) might have limited resources to facilitate RTW of cancer survivors. The purpose of this article is to examine how such employers engage in the support of RTW and to uncover their needs. METHODS: Eleven owners and one HR manager representing 12 small enterprises (various sectors) were interviewed regarding their experience with RTW of employees surviving cancer. We conducted a thematic analysis with aspects of Grounded Theory. RESULTS: The characteristics of being a small enterprise (i.e. informal practical arrangements, working as a family, working with limited resources and people) related to four concerns experienced by these employers (concerns about the employer's enterprise; the employee's cancer and recovery; RTW and work adjustments; and about communication). In line with these concerns, employers need information on rights and obligations, RTW arrangements and communication skills during RTW guidance. CONCLUSIONS: In small enterprises, employers have generally close relationships with their employees, which means that support is gladly provided when employees are diagnosed with cancer. They do however have limited financial means to facilitate RTW and workplace adjustments. They therefore perceive long-term sickness and RTW as a major financial risk for the company.

Juniperus communis: victim of the combined action of climate warming and nitrogen deposition?

Research on the combined effects of climate change and nitrogen deposition on reproductive traits, and especially on the production of viable seeds, is still scarce despite their importance for population persistence and expansion. Hence, in this study we set out to investigate the direct and indirect effects of the above-mentioned global change drivers on seed viability in the coniferous shrub Juniperus communis L. In many parts of its European range, juniper is increasingly threatened, partly because of a lack of sexual reproduction. We hypothesised that this regeneration failure is partly due to poor seed viability. Using data from 39 populations throughout Europe, we were able to demonstrate that a strong, triangular-shaped relationship exists between the percentage of viable seeds produced and the percentage of juniper seedlings occurring in a population, which indicates that the species is indeed partly seed limited. Furthermore, based on an extended dataset of 42 populations, we found that seed viability was negatively affected by temperature, measured as mean annual growing degree-days, and nitrogen deposition (but not by drought). Suggestions are made about the processes behind the observed patterns, but more research is required. Nevertheless, our results do raise serious concerns for the conservation of juniper in light of the predicted rise in temperature and global nitrogen emissions. Furthermore, it is likely that similar patterns can also be observed for other species.

Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma.

AIMS: Despite curative surgery for pancreatic ductal adenocarcinoma (PDAC), most patients develop cancer recurrence and die from metastatic disease. Understanding of the patterns of failure after surgery can lead to new insights for novel therapeutic modalities. The aim of the present study is to describe the patterns of recurrence after curative resection of PDAC. METHODS: A retrospective analysis was performed of 145 consecutive resections for PDAC between 1998 and 2005 (M/F 75/70; median (range) age 67 years (32-85 y)). The location of the first and consecutive recurrences, and the time interval to cancer recurrence after surgical resection was studied. The magnitude of tumour-free margin was less than a millimetre in 48 patients, whereas a positive surgical margin was observed in 27 patients. The median duration of follow-up was 18.5 (range 0.3-116.8) months. RESULTS: Cancer recurrence was observed in 110 patients. The first location of recurrence was locoregional in 19, extra-pancreatic in 66, and combined locoregional and extra-pancreatic in 25 patients. Extra-pancreatic recurrence developed in the liver in 57, peritoneal in 35, pulmonary in 15, and retroperitoneal in 5 patients. The median (95% CI) overall (OS) and disease-free (DFS) survival was 18.7 (15.7-23.5) and 9.8 (7.5-12.4) months, respectively. The type of cancer recurrence did not significantly influence OS, while the resection margin status had a prognostic effect. CONCLUSION: The vast majority of patients who undergo potentially curative surgery for PDAC develop cancer recurrence located in the abdominal cavity. Surgical resection margins with tumour involvement and tumour-free margins of less then 1mm are negative prognostic factors. Further research on better local surgical control, peri-operative locoregional treatment, and more effective adjuvant systemic therapy is necessary to improve long-term survival of patients with curable PDAC.

E2F1 controls alternative splicing pattern of genes involved in apoptosis through upregulation of the splicing factor SC35.

The transcription factor E2F1 has a key function during S phase progression and apoptosis. It has been well-demonstrated that the apoptotic function of E2F1 involves its ability to transactivate pro-apoptotic target genes. Alternative splicing of pre-mRNAs also has an important function in the regulation of apoptosis. In this study, we identify the splicing factor SC35, a member of the Ser-Rich Arg (SR) proteins family, as a new transcriptional target of E2F1. We demonstrate that E2F1 requires SC35 to switch the alternative splicing profile of various apoptotic genes such as c-flip, caspases-8 and -9 and Bcl-x, towards the expression of pro-apoptotic splice variants. Finally, we provide evidence that E2F1 upregulates SC35 in response to DNA-damaging agents and show that SC35 is required for apoptosis in response to these drugs. Taken together, these results demonstrate that E2F1 controls pre-mRNA processing events to induce apoptosis and identify the SC35 SR protein as a key direct E2F1-target in this setting.

How relevant are exercise capacity measures for evaluating treatment effects in chronic fatigue syndrome? Results from a prospective, multidisciplinary outcome study.

OBJECTIVE: To evaluate the outcome of a multidisciplinary treatment programme for patients with chronic fatigue syndrome, including health-related quality of life (HRQoL) and psychosocial variables, and exercise capacity measures. DESIGN: A six-month prospective outcome study. SETTING: University outpatient rehabilitation clinic; group setting. SUBJECTS: One hundred and sixteen women fulfilling chronic fatigue syndrome criteria. INTERVENTIONS: Cognitive behaviourally and graded exercise-based strategies; emphasis on adaptive lifestyle changes. MEASURES: Short Form General Health Survey (SF-36); Symptom Checklist (SCL-90); Causal Attribution List (CAL); Self-Efficacy Scale (SE); maximum progressive bicycle ergometer test with respiratory gas analysis; and isokinetic leg strength test, before and after treatment. RESULTS: The total group significantly improved on nearly all reported HRQoL/psychosocial variables. Changes in exercise capacity measures were rather modest and did not correlate or only weakly correlated with HRQoL/psychosocial variables. Subgroup analyses indicated that less fit patients improved significantly more on exercise capacity measures than their more fit counterparts. Patients who were fitter at baseline scored better on pretreatment HRQoL/psychosocial variables, but both subgroups improved similarly on these variables. CONCLUSIONS: Health-related quality of life and psychosocial functioning in patients with chronic fatigue syndrome improves after a six-month cognitive behaviourally and graded exercise-based multidisciplinary treatment programme. Increase in exercise capacity measures is not a necessary condition for reported improvements, except for less fit patients.

The effects of catastrophic thinking about pain on attentional interference by pain: no mediation of negative affectivity in healthy volunteers and in patients with low back pain.

BACKGROUND: Previous studies have shown that catastrophic thinking about pain enhances attentional interference in healthy volunteers. OBJECTIVE: To investigate whether the attentional effects of pain catastrophizing can be accounted for by the more general predisposition of negative affectivity. METHODS: Sixty-seven pain-free students participated in the first experiment, and 33 patients with chronic low back pain participated in the second experiment. In both experiments, participants performed an auditory reaction time task while being exposed to a series of threatening electrocutaneous stimuli. Retardation in reaction times to auditory probes during pain was taken as an index of the attentional interruption by pain. Participants also completed self-report instruments of negative affectivity and pain catastrophizing. RESULTS: In both experiments, pain catastrophizing enhanced attentional interference by pain. This effect was most pronounced immediately after the onset of the electrocutaneous stimulus. The effect remained after controlling for the effects of negative affectivity. CONCLUSIONS: Catastrophic thinking about pain enhances attentional interruption by pain in normal samples, as well as in clinical samples of patients with chronic back pain. This effect is specific to pain catastrophizing and cannot be explained by the more general disposition of negative affectivity.

Attention to chronic pain is dependent upon pain-related fear.

Pain interrupts, distracts, and is difficult to disengage from. In this study, the role of pain-related fear in moderating attentional interference produced by chronic pain was investigated. Forty chronic pain patients completed a list of questionnaires assessing pain severity, pain-related fear (Tampa Scale for Kinesiophobia), and negative affect (Negative Emotionality scale). Attentional interference was measured by a numerical interference test. Multiple regression analysis revealed that the attentional interference was best predicted by the interaction between pain severity and pain-related fear. These results are discussed in terms of how pain-related fear creates a hypervigilance to pain.

Affective priming using a color-naming task: a test of an affective-motivational account of affective priming effects.

The affective priming effect, i.e. shorter response latencies for affectively congruent as compared to affectively incongruent prime-target pairs, is now a well-documented phenomenon. Nevertheless, little is known about the specific processes that underlie the affective priming effect. Several mechanisms have been put forward by different authors, but these theoretical accounts only apply to specific types of tasks (e.g. evaluation lexical decisions) or are rather unparsimonious. Hermans, De Houwer, and Eelen (1996) recently proposed a model of the affective priming effect that is based on the idea of the activation of corresponding or conflicting affective-motivational action tendencies. According to this model, affectively incongruent prime-target pairs should not only lead to relatively longer response latencies on tasks that concern the target word itself (target-specific tasks, e.g. evaluation pronunciation), but also on tasks that are unrelated to the actual identity of the specific target word. This hypothesis was tested in a series of four experiments in which participants had to name the color in which the target word was printed. In spite of procedural variations, results showed that the congruence between the valence of prime and target did not influence the color-naming times. The present results therefore provide no direct support for the affective-motivational account of the affective priming effect. Suggestions for future research are provided.

Arginine residues as stabilizing elements in proteins.

Site-specific substitutions of arginine for lysine in the thermostable D-xylose isomerase (XI) from Actinoplanes missouriensis are shown to impart significant heat stability enhancement in the presence of sugar substrates most probably by interfering with nonenzymatic glycation. The same substitutions are also found to increase heat stability in the absence of any sugar derivatives, where a mechanism based on prevention of glycation can no longer be invoked. This rather conservative substitution is moreover shown to improve thermostability in two other structurally unrelated proteins, human copper, zinc-superoxide dismutase (CuZnSOD) and D-glyceraldehyde-3-phosphate dehydrogenase (GAPDH) from Bacillus subtilis. The stabilizing effect of Lys----Arg substitutions is rationalized on the basis of a detailed analysis of the crystal structures of wild-type XI and of engineered variants with Lys----Arg substitution at four distinct locations, residues 253, 309, 319, and 323. Molecular model building analysis of the structures of wild-type and mutant CuZnSOD (K9R) and GAPDH (G281K and G281R) is used to explain the observed stability enhancement in these proteins. In addition to demonstrating that even thermostable proteins can lend themselves to further stability improvement, our findings provide direct evidence that arginine residues are important stabilizing elements in proteins. Moreover, the stabilizing role of electrostatic interactions, particularly between subunits in oligomeric proteins, is documented.