Background Knee pain and related disability are important public health problems worldwide. In a systematic review, the prevalence of knee pain varied between 2.4% to 49.2% worldwide and disabilities were greater in those with knee pain compared to those without. The prevalence of knee pain may be higher in mountainous regions. The research student is from Nepal. He has a clinical interest in musculoskeletal disorders and had found at the time of the thesis that there had been no study undertaken across Nepal. Such a study would inform Nepalese health policy. Objectives To estimate the prevalence of knee pain and knee related disability, overall and in different ecological zones, of one region of Nepal. Methods A cross-sectional multistage cluster survey was undertaken using a questionnaire in Nepali delivered face to face to adults aged over 18 years in seven sites across the three ecological zones (plain, hilly and mountainous) of the Western Development Region of Nepal. Crude weighted and age standardised period and point prevalence rates of knee pain were estimated. The prevalence of disability was compared between those who had knee pain and those who did not have knee pain. Binary logistic regression was used to investigate potential independent risk factors for the prevalence of knee pain and knee pain related disability. Results In total 694 participants were recruited; 52.6% were women, the mean age was 41 years and 14.1% lived in the mountainous zone. The period prevalence of knee pain was 22.3% (95% CI 19.2% - 25.5%) and of chronic knee pain was 12.1% (95% CI 9.5 – 14.7%). The point prevalence was 7.6% (95% CI 5.7%-9.6%). Knee pain was higher in the mountainous zone compared to the plain zone. Overall 25.6% of the 694 participants had disability, as measured by the WHO DAS 2.0, and this was significantly higher in those with knee pain compared to those without (81.2% vs. 9.5%). Disability was highest among those with knee pain in the mountainous zone, with all having disability. Despite this only 54.8% of those with knee pain sought advice for their condition, those in the mountainous zone were less likely to seek advice, access hospital treatment or take oral medications. Conclusion Knee pain is highly prevalent in Nepal. Just under half who suffer do not access services for pain management, even though knee pain is associated with high levels of disability. Rates of knee pain are highest in the mountainous areas where access to services is lowest. This demonstration of unmet need, particularly in the poorest and most remote areas of the country, is of importance to policymakers who should focus on raising awareness and improving access to services.

The study aimed to explore the lived experience of the careers of learning disability nurses in England. The methodology was informed by Hermeneutic Phenomenology, and the study design utilised narrative interviewing techniques based on an adapted model of the Biographic Narrative Interpretive Method (Wengraf 2001) in order to explore the career choices, experiences and beliefs, and values about learning disability nursing. Twenty in-depth qualitative interviews with learning disability nurses, who had been in practice in the 30-year period between 1979 and 2009, were undertaken in 2010 across nine counties in England. The data was interpreted using a narrative analysis approach. Key findings indicated that nurses, working in a diverse range of settings with varying degrees of experience, are motivated by working with people with learning disabilities and narrate their experiences of building relationships with people articulating the meaning of this for them as nurses. The initial reasons for choosing learning disability nursing as a career formed a key theme within the findings, with complex influences on their career choice. Additionally, all participants in this study created a narrative of change, focusing on the ways in which change in policy, practice and in societal views have impacted upon their working lives and their identity. The individual narratives have also been interpreted to form a collective narrative of learning disability nursing to specifically explore the identity of learning disability nurses and nursing in a changing context of health and social care provision.

No / . Challenging behaviours (behaviour difficulties) represent a problem of considerable clinical significance for learning disability nurses, and a source of much human distress. Gentle teaching is a relatively new approach to dealing with behavioural difficulties, and has been received with enthusiasm by clinicians, but has so far received little empirical support. The current study attempted to compare gentle teaching with a well-established alternative (behaviour modification) and a control group. Objectives. To examine the comparative effectiveness of gentle teaching, behaviour modification and control interventions for challenging behaviour amongst children with learning disabilities. Design. Nonrandomized controlled trial. Setting. Service users¿ homes in East Yorkshire. Participants. Seventy-seven children who presented with learning disabilities and challenging behaviour (behaviour difficulties) and their parents. Procedure. One-day workshops in were offered by recognized authorities in either behaviour modification or gentle teaching that were not otherwise involved with the research project. Forty-one participants were recruited to the gentle teaching condition; 36 to behaviour modification; 26 to the control group. Random allocation was not possible, because of the slow uptake by interested parents. Measures was preintervention, and at assessment points up until 12 months following intervention. Analysis. Quantitative analysis of pre¿post differences between the groups, using t-test. Results. In general, no significant differences were found between the treatment groups and controls. Significant improvements were found for both gentle teaching and behaviour modification children over controls on the AAMR ABS XVII (social engagement) subscale. Controls had more contact with medical practitioner (GP) services than behaviour modification children and less than gentle teaching children. Conclusion. Although very few differences were found between the three groups, those that did exist generally favoured behaviour modification. Implications for service provision and learning disability nursing practice are described.