Browsing by Subject "SUPPORT"

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  • Lönnqvist, Jan-Erik; Szabo, Zsolt Peter; Kelemen, Laszlo (2021)
    The authoritarian personality is characterized by unquestionining obedience and respect to authority. System justification theory (SJT) argues that people are motivated to defend, bolster, and justify aspects of existing social, economic, and political systems. Commitment to the status quo is also a key characteristic of the authoritarian personality. It can be argued that the social context matters for how an underlying latent authoritarian character is expressed. This means that authoritarian regimes could be expected to lead to increased authoritarianism and stronger system-justification. We investigated this hypothesis in two representative samples of Hungarians, collected before (2010) and after (2018) 8 years of Fidesz' rule (N = 1,000 in both samples). Moreover, the strong version of SJT argues that members of disadvantaged groups are likely to experience the most cognitive dissonance and that the need to reduce this dissonance makes them the most supportive of the status quo. This argument dovetails nicely with claims made by the political opposition to Fidesz, according to which Fidesz is especially popular among low-status members of society. We found that measures assessing authoritarian tendencies did not change between 2010 and 2018. However, more specific beliefs and attitudes did change, and these effects were especially pronounced among Fidesz supporters. Their belief in a just world and a just system has grown stronger, while their attitudes toward migrants had hardened. Low status was associated with lower levels of system-justifying ideologies. However, low status Fidesz voters justified the system more than high status opposition voters in 2018, lending some support for the strong version of SJT. Our results suggest that beliefs and attitudes of Hungarians have changed between 2010 and 2018, and that political leadership played a crucial role in this.
  • Tarkiainen, Laura (2020)
    This article provides a rhetorical discourse analysis of constructions of unemployed people’s deservingness. Data consist of transcripts from Finnish parliament members debating the ‘Activation Model for Unemployment Security’, from December 2017. In the analysis, three discursive constructions of unemployed people’s deservingness were identified: an ‘effortful citizen lacking control’, a ‘needy citizen deserving the welfare state’s reciprocal acts’ and an ‘undeserving freeloader in need of an attitude adjustment’. Analysis focuses on how deservingness and undeservingness are rhetorically accomplished and treated as factual in parliament members’ accounts. The analysis pays particular attention to the question of how speakers build factuality through the management of categories, extreme case formulations, ‘truth talk’ and maximisation and minimisation strategies. The results reflect the negotiated nature of deservingness as well as varying constructions of unemployed people’s responsibility in the contemporary Nordic welfare state context.
  • Kellezi, Blerina; Guxholli, Aurora; Stevenson, Clifford; Ruth Helen Wakefield, Juliet; Bowe, Mhairi; Bridger, Kay (2021)
    Although Social Cure research shows the importance of family identification in one's ability to cope with stress, there remains little understanding of family responses to human rights violations. This is the first study to explore the role of family identity in the collective experience of such violations: meanings ascribed to suffering, family coping strategies, and family-based understandings of justice. Semi-structured interviews (N = 27) with Albanian dictatorship survivors were analysed using Social Identity Theory informed thematic analysis. The accounts reveal Social Cure processes at work, whereby family groups facilitated shared meaning-making, uncertainty reduction, continuity, resilience-building, collective self-esteem, and support, enhanced through common fate experiences. As well as being curative, families were contexts for Social Curse processes, as relatives shared suffering and consequences collectively, while also experiencing intergenerational injustice and trauma. Although seeking and achieving justice remain important, the preservation of family identity is one of the triumphs in these stories of suffering.
  • Dimitri, Paul; Fernandez-Luque, Luis; Banerjee, Indraneel; Bergada, Ignacio; Calliari, Luis Eduardo; Dahlgren, Jovanna; de Arriba, Antonio; Lapatto, Risto; Reinehr, Thomas; Senniappan, Senthil; Thomas-Teinturier, Cecile; Tsai, Meng-Che; Zaini, Azriyanti Anuar; Bagha, Merat; Koledova, Ekaterina (2021)
    Background: The use of technology to support health and health care has grown rapidly in the last decade across all ages and medical specialties. Newly developed eHealth tools are being implemented in long-term management of growth failure in children, a low prevalence pediatric endocrine disorder. Objective: Our objective was to create a framework that can guide future implementation and research on the use of eHealth tools to support patients with growth disorders who require growth hormone therapy. Methods: A total of 12 pediatric endocrinologists with experience in eHealth, from a wide geographical distribution, participated in a series of online discussions. We summarized the discussions of 3 workshops, conducted during 2020, on the use of eHealth in the management of growth disorders, which were structured to provide insights on existing challenges, opportunities, and solutions for the implementation of eHealth tools across the patient journey, from referral to the end of pediatric therapy. Results: A total of 815 responses were collected from 2 questionnaire-based activities covering referral and diagnosis of growth disorders, and subsequent growth hormone therapy stages of the patient pathway, relating to physicians, nurses, and patients, parents, or caregivers. We mapped the feedback from those discussions into a framework that we developed as a guide to integration of eHealth tools across the patient journey. Responses focused on improved clinical management, such as growth monitoring and automation of referral for early detection of growth disorders, which could trigger rapid evaluation and diagnosis. Patient support included the use of eHealth for enhanced patient and caregiver communication, better access to educational opportunities, and enhanced medical and psychological support during growth hormone therapy management. Given the potential availability of patient data from connected devices, artificial intelligence can be used to predict adherence and personalize patient support. Providing evidence to demonstrate the value and utility of eHealth tools will ensure that these tools are widely accepted, trusted, and used in clinical practice, but implementation issues (eg, adaptation to specific clinical settings) must be addressed. Conclusions: The use of eHealth in growth hormone therapy has major potential to improve the management of growth disorders along the patient journey. Combining objective clinical information and patient adherence data is vital in supporting decision-making and the development of new eHealth tools. Involvement of clinicians and patients in the process of integrating such technologies into clinical practice is essential for implementation and developing evidence that eHealth tools can provide value across the patient pathway.
  • Sortheix, Florencia M.; Parker, Philip D.; Lechner, Clemens; Schwartz, Shalom (2019)
    We investigate the impact of the global financial crisis (GFC) on the personal values of youth and young adults (age 16-35 years) from 16 European countries. Using time series cross-sectional data from seven waves (2002-2014) of the European Social Survey, we examined (1) whether the GFC led to value shifts between cohorts of young people and (2) whether welfare state provision moderate the expected value shifts. Multilevel analyses showed that, following the GFC, the importance of security, tradition, benevolence, and, to a lesser extent, conformity values increased. In contrast, hedonism, self-direction, and stimulation values decreased. In line with our moderation hypothesis, power, and, to a lesser extent, achievement values increased following the GFC in countries low on welfare expenditures but decreased in countries high on welfare expenditures. Contrary to expectations, increases in tradition and benevolence values were more pronounced in high-welfare countries.
  • Jokela, Markus; García-Velázquez, Regina; Airaksinen, Jaakko; Gluschkoff, Kia; Kivimäki, Mika; Rosenström, Tom (2019)
    Background: Depression is a heterogeneous mental disorder with multiple symptoms, but only few studies have examined whether associations of risk factors with depression are symptom-specific. We examined whether chronic diseases and social risk factors (poverty, divorce, and perceived lack of emotional support) are differently associated with somatic and cognitive/affective symptoms of depression. Methods: Cross-sectional analyses were based on individual-level data from the 31,191 participants of six cross-sectional U.S. National Health and Nutrition Examination Surveys (NHANES) carried out between 2005 and 2016. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire. Information on chronic diseases and social risk factors was self-reported by participants. Results: After adjustment for sex, age, race/ethnicity, and all the of other symptoms besides the outcome symptom, higher number of chronic diseases was independently related to fatigue, psychomotor retardation/agitation, and sleep problems in a dose-response pattern (range of odds ratios: 1.21 to 2.59). Except for concentration problems, social risk factors were associated with almost all of the cognitive/affective symptoms (range of odds ratios: 1.02 to 2.09) but only sporadically with somatic symptoms. Limitations: All measures were self-reported by the participants, which may have introduced bias to the associations. Cross-sectional data did not allow us to study temporal dynamics. Conclusions: Specific symptoms of depression may be useful in characterizing the heterogeneous etiology of depression with respect to somatic versus social risk factors.
  • Islam, Mohammad Mahmudul; Pal, Shuvo; Hossain, Mohammad Mosarof; Mozumder, Mohammad Mojibul Hoque; Schneider, Petra (2020)
    By employing empirical and secondary data (qualitative and quantitative), this study demonstrates how social equity (with its three dimensions) can meaningfully address the conservation of the coastal social-ecological system (SES), without losing diverse ecosystem services (ES) in south-east coastal Bangladesh. Based on this proposition, this study assesses the available ES and identifies the drivers responsible for ES changes, arguing for the application of social equity for resource conservation. The findings show that communities along Bangladesh's south-eastern coast use several ES for food, medicine, income, livelihoods, and cultural heritage. However, this valuable ecosystem is currently experiencing numerous threats and stressors of anthropogenic and natural origin. In particular, large-scale development activities, driven by the blue growth agenda, and neoliberalism policy, pose a risk to the local communities by degrading coastal ecosystem services. Escaping this situation for coastal natural resource-dependent communities in Bangladesh will require a transformation in the governance structure. Implementing the Small-Scale Fisheries (SSF) Guidelines that call for initiating policy change to deliver social justice to small-scale fisheries would help to address coastal ecosystem service conservation in Bangladesh.
  • Selwood, Katherine E.; Wintle, Brendan A.; Kujala, Heini (2019)
    The importance of expert input to spatial conservation prioritization outcomes is poorly understood. We quantified the impacts of refinements made during consultation with experts on spatial conservation prioritization of Christmas Island. There was just 0.57 correlation between the spatial conservation priorities before and after consultation, bottom ranked areas being most sensitive to changes. The inclusion of a landscape condition layer was the most significant individual influence. Changes (addition, removal, modification) to biodiversity layers resulted in a combined 0.2 reduction in correlation between initial and final solutions. Representation of rare species in top ranked areas was much greater after expert consultation; representation of widely distributed species changed relatively little. Our results show how different inputs have notably different impacts on the final plan. Understanding these differences helps plan time and resources for expert consultation.
  • Chen, An; Tenhunen, Henni; Torkki, Paulus; Heinonen, Seppo; Lillrank, Paul; Stefanovic, Vedran (2017)
    Introduction Nowadays, an important decision for pregnant women is whether to undergo prenatal testing for aneuploidies and which tests to uptake. We investigate the factors influencing women's choices between non-invasive prenatal testing (NIPT) and invasive prenatal tests in pregnancies with elevated a priori risk of fetal aneuploidies. Methodology This is a mixed-method study. We used medical data (1st Jan 2015-31st Dec 2015) about women participating in further testing at Fetomaternal Medical Center at Helsinki University Hospital and employed Chi-square tests and ANOVA to compare the groups of women choosing different methods. Multinomial logistic regressions revealed the significant clinical factors influencing women's choice. We explored the underlying values, beliefs, attitudes and other psychosocial factors that affect women's choice by interviewing women with the Theory of Planned Behavior framework. The semi-structured interview data were processed by thematic analysis. Results Statistical data indicated that gestational age and counseling day were strong factors influencing women's choice. Interview data revealed that women's values and moral principles on pregnancy and childbirth chiefly determined the choices. Behavioral beliefs (e.g. safety and accuracy) and perceived choice control (e.g. easiness, rapidness and convenience) were also important and the major trade-offs happened between these constructs. Discussion Values are the determinants of women's choice. Service availability and convenience are strong factors. Medical risk status in this choice context is not highly influential. Choice aids can be developed by helping women to identify their leading values in prenatal testing and by providing lists of value-matching test options and attributes.
  • Sorsa, Minna Anneli; Kylmä, Jari; Bondas, Terese Elisabet (2021)
    Perinatal psychological distress (PPD) may cause delays in help-seeking in the perinatal period, which is crucial for families with small children. Help-seeking theories focus on rational processes of behavior wherein 'help-seeking' is viewed as a decision-making process, in which action is preceded by recognizing a problem. We identified the phase prior to actual help-seeking actions as a life situation and a phenomenon through which to gain a deeper understanding from women's own perspectives. The aim of this study was to integrate and synthesize knowledge of women's experiences of contemplating seeking help for PPD. We chose interpretative meta-ethnography by Noblit and Hare (1988) and implemented eMERGe guidelines in reporting. The search was performed systematically, and the 14 included studies were evaluated with Critical Appraisal Skills Programme checklist (CASP). We identified seven themes and a metaphor in a lines-of-argument synthesis, showing that contemplating help-seeking is a multidimensional phenomenon. We did not observe a straightforward and linear process (as previous research suggests) but instead a complex process of contemplating help-seeking. A clinical implication is that service providers should work with outreach and develop their tools to connect with mothers with PPD. Another suggestion is to improve training in mental health literacy prior to or during pregnancy.
  • Tarvasmäki, Tuukka; Lassus, Johan; Varpula, Marjut; Sionis, Alessandro; Sund, Reijo; Kober, Lars; Spinar, Jindrich; Parissis, John; Banaszewski, Marek; Cardoso, Jose Silva; Carubelli, Valentina; Di Somma, Salvatore; Mebazaa, Alexandre; Harjola, Veli-Pekka; CardShock Study Investigators (2016)
    Background: Vasopressors and inotropes remain a cornerstone in stabilization of the severely impaired hemodynamics and cardiac output in cardiogenic shock (CS). The aim of this study was to analyze current real-life use of these medications, and their impact on outcome and on changes in cardiac and renal biomarkers over time in CS. Methods: The multinational CardShock study prospectively enrolled 219 patients with CS. The use of vasopressors and inotropes was analyzed in relation to the primary outcome, i.e., 90-day mortality, with propensity score methods in 216 patients with follow-up data available. Changes in cardiac and renal biomarkers over time until 96 hours from baseline were analyzed with linear mixed modeling. Results: Patients were 67 (SD 12) years old, 26 % were women, and 28 % had been resuscitated from cardiac arrest prior to inclusion. On average, systolic blood pressure was 78 (14) and mean arterial pressure 57 (11) mmHg at detection of shock. 90-day mortality was 41 %. Vasopressors and/or inotropes were administered to 94 % of patients and initiated principally within the first 24 hours. Noradrenaline and adrenaline were given to 75 % and 21 % of patients, and 30 % received several vasopressors. In multivariable logistic regression, only adrenaline (21 %) was independently associated with increased 90-day mortality (OR 5.2, 95 % CI 1.88, 14.7, p = 0.002). The result was independent of prior cardiac arrest (39 % of patients treated with adrenaline), and the association remained in propensity-score-adjusted analysis among vasopressor-treated patients (OR 3.0, 95 % CI 1.3, 7.2, p = 0.013); this was further confirmed by propensity-score-matched analysis. Adrenaline was also associated, independent of prior cardiac arrest, with marked worsening of cardiac and renal biomarkers during the first days. Dobutamine and levosimendan were the most commonly used inotropes (49 % and 24 %). There were no differences in mortality, whether noradrenaline was combined with dobutamine or levosimendan. Conclusion: Among vasopressors and inotropes, adrenaline was independently associated with 90-day mortality in CS. Moreover, adrenaline use was associated with marked worsening in cardiac and renal biomarkers. The combined use of noradrenaline with either dobutamine or levosimendan appeared prognostically similar.
  • Hansen, Sylvia; Huttunen-Lenz, Maija; Sluik, Diewertje; Brand-Miller, Jennie; Drummen, Mathijs; Fogelholm, Mikael; Handjieva-Darlenska, Teodora; Macdonald, Ian; Martinez, Alfredo J.; Larsen, Thomas Meinert; Poppitt, Sally; Raben, Anne; Schlicht, Wolfgang (2018)
    PurposeWeight loss has been demonstrated to be a successful strategy in diabetes prevention. Although weight loss is greatly influenced by dietary behaviors, social-cognitive factors play an important role in behavioral determination. This study aimed to identify demographic and social-cognitive factors (intention, self-efficacy, outcome expectancies, social support, and motivation with regard to dietary behavior and goal adjustment) associated with weight loss in overweight and obese participants from the PREVIEW study who had pre-diabetes.MethodProspective correlational data from 1973 adult participants were analyzed. The participants completed psychological questionnaires that assessed social-cognitive variables with regard to dietary behavior. Stepwise multiple regression analyses were performed to identify baseline demographic and social-cognitive factors associated with weight loss.ResultsOverall, being male, having a higher baseline BMI, having a higher income, perceiving fewer disadvantages of a healthy diet (outcome expectancies), experiencing less discouragement for healthy eating by family and friends (social support), and lower education were independently linked to greater weight loss. When evaluating females and males separately, education was no longer associated with weight loss.ConclusionThe results indicate that a supportive environment in which family members and friends avoid discouraging healthy eating, with the application of a strategy that uses specific behavior change techniques to emphasize the benefits of outcomes, i.e., the benefits of a healthy diet, may support weight loss efforts. Weight loss programs should therefore always address the social environment of persons who try to lose body weight because family members and friends can be important supporters in reaching a weight loss goal.
  • Cooper, Matthew W.; Di Minin, Enrico; Hausmann, Anna; Qin, Siyu; Schwartz, Aaron J.; Correia, Ricardo A. (2019)
    Due to the importance of public support in fostering positive outcomes for biodiversity, Aichi Biodiversity Target 1 aims to increase public awareness of the value of biodiversity and actions that help to conserve it. However, indicators for this critical target have historically relied on public-opinion surveys that are time-consuming, geographically restricted, and expensive. Here, we present an alternative approach based on tracking the use of biodiversity-related keywords in 31 different languages in online newspapers, social media, and internet searches to monitor Aichi Target 1 in real-time, at a global scale, and at relatively low cost. By implementing the indicator, we show global patterns associated with spatio-temporal variability in public engagement with biodiversity topics, such as a clear drop in conversations around weekends and biodiversity-related topic congruence across culturally similar countries. Highly divergent scores across platforms for each country highlight the importance of sourcing information from multiple data streams. The data behind this global indicator is visualized and publicly available at Biodiversity Engagement Indicator.com and can be used by countries party to the Convention on Biological Diversity (CBD) to report on their progress towards meeting Aichi Target 1 to the' Secretariat. Continued and expanded monitoring using this indicator will provide further insights for better targeting of public awareness campaigns.
  • Korhonen, Jaana; Miettinen, Jenni; Kylkilahti, Eliisa; Tuppura, Anni; Autio, Minna; Lähtinen, Katja; Pätäri, Satu; Pekkanen, Tiia-Lotta; Luhas, Jukka; Mikkilä, Mirja; Linnanen, Lassi; Ollikainen, Markku; Toppinen, Anne (2021)
    It is uncertain how the traditional forest sector can respond to the changing political environment, evolving markets, and global environmental problems. This study focuses on the development of forest-based bioeconomy (BE) in Finland from the perspective of three forest-based value networks (wooden multistory construction, fiber-based packaging, and biorefining) and thus breaks the tendency of siloed discussions. The study of expert opinions applies a collaborative interdisciplinary research method that combines group discussions and follow-up survey data. The results indicate that transformational regulation, proper incentives, and ways of increasing interaction at the business-consumer interface are required to support the creation of new practices and the destruction of old practices in the industry renewal. (C) 2021 The Authors. Published by Elsevier Ltd.
  • Rochfort, Andree; Beirne, Sinead; Doran, Gillian; Patton, Patricia; Gensichen, Jochen; Kunnamo, Ilkka; Smith, Susan; Eriksson, Tina; Collins, Claire (2018)
    Background: Patient self-management support is recognised as a key component of chronic care. Education and training for health professionals has been shown in the literature to be associated with better uptake, implementation and effectiveness of self-management programs, however, there is no clear evidence regarding whether this training results in improved health outcomes for patients with chronic conditions. Methods: A systematic review was undertaken using the PRISMA guidelines using the Cochrane Library, PubMEd, ERIC, EMBASE, CINAHL, PsycINFO, Web searches, Hand searches and Bibliographies. Articles published from inception to September 1st, 2013 were included. Systematic reviews, Meta-analysis, Randomized controlled trials (RCTs), Controlled clinical trials, Interrupted time series and Controlled before and after studies, which reported on primary care health professionals' continuing education or evidence-based medicine/education on patient self-management for any chronic condition, were included. A minimum of two reviewers participated independently at each stage of review. Results: From 7533 abstracts found, only two papers provided evidence on the effectiveness of self-management education for primary healthcare professionals in terms of measured outcomes in patients. These two articles show improvement in patient outcomes for chronic back pain and diabetes based on RCTs. The educational interventions with health professionals spanned a range of techniques and modalities but both RCTs included a motivational interviewing component. Conclusions: Before and up to 2 years after the incorporation of patient empowerment for self-management into the WONCA Europe definition of general practice, there was a scarcity of high quality evidence showing improved outcomes for patients as a result of educating health professionals in patient self-management of chronic conditions.
  • Hakulinen, Christian; Elovainio, Marko; Arffman, Martti; Lumme, Sonja; Suokas, Kimmo; Pirkola, Sami; Keskimäki, Ilmo; Manderbacka, Kristiina; Böckerman, Petri (2020)
    Objective: Individuals with severe mental disorders have an impaired ability to work and are likely to receive income transfer payments as their main source of income. However, the magnitude of this phenomenon remains unclear. Using longitudinal population cohort register data, the authors conducted a case-control study to examine the levels of employment and personal income before and after a first hospitalization for a serious mental disorder. Methods: All individuals (N=50,551) who had been hospitalized for schizophrenia, other nonaffective psychosis, or bipolar disorder in Finland between 1988 and 2015 were identified and matched with five randomly selected participants who were the same sex and who had the same birth year and month. Employment status and earnings, income transfer payments, and total income in euros were measured annually from 1988 to 2015. Results: Individuals with serious mental disorders had notably low levels of employment before, and especially after, the diagnosis of a severe mental disorder. Their total income was mostly constituted of transfer payments, and this was especially true for those diagnosed as having schizophrenia. More than half of all individuals with a serious mental disorder did not have any employment earnings after they received the diagnosis. Conclusions: The current study shows how most individuals in Finland depend solely on income transfer payments after an onset of a severe mental disorder.
  • Tuominen, L; Ritmala-Castren, M; Nikander, P; Makela, S; Vahlberg, T; Leino-Kilpi, H (2021)
    Background: Chemotherapy-induced side effects may have a negative effect on nutrition intake, thus increasing the risk of malnutrition and consequently, other serious complications for patients with cancer. The prevalence of malnutrition is common among patients with colorectal cancer. Nurse-led empowering education may have a positive effect on self-care activity in this patient group. Therefore, our purpose is to develop an empowering educational nursing intervention and test its effect on self-care activation and knowledge level among patients with colorectal cancer during chemotherapy. Secondary outcomes are quality of life and risk of malnutrition. Methods: An interdisciplinary expert group developed a face-to-face empowering educational intervention using teach-back method. A two-arm, single-centre, superiority trial with stratified randomisation (1:1) and pre-post measures will be used to assess the effect of the intervention compared to standard care. Patients (N = 40 + 40) will be recruited in one university hospital outpatient clinic in Finland. Eligibility criteria are adult patients diagnosed with colorectal cancer starting oral fluoropyrimidine or combination chemotherapy treatment. A registered nurse experienced in oncology will deliver the intervention 2 weeks after the first chemotherapy. Outcomes are measured before intervention (M0) and after a two-month follow-up period (M1). Discussion: This study will assess whether nurse-led empowering education using teach-back method is effective on self-care activity among patients with colorectal cancer. If the intervention has a positive effect, it may be implemented into patient education in a corresponding context.
  • Syrjämäki, Marja; Pihlaja, Päivi; Sajaniemi, Nina (2018)
    This article focused on the pedagogy that enhances peer interaction in integrated special groups. In Finland, most children identified as having special educational needs (SEN) attend day-care in mainstream kindergarten groups; the rest are in integrated or segregated early childhood special education (ECSE) groups in public day-care centres [National Institute of Health and Welfare. 2013. "Child Day Care 2013 - Municipal Survey." Accessed March 15, 2016. https://www.julkari.fi/bitstream/handle/10024 /116231/Tr16_14.pdf?sequence=4]. An integrated group, which typically consists of seven children without and five with SEN, is supposed to be an inclusive environment that provides an atmosphere in which every child can feel togetherness and be scaffolded [Pihlaja, P. 2009. "Erityisen tuen kaytannot varhaiskasvatuksessa - nakokulmana inkluusio." [The Special Education Practices in Early Childhood Education - Inclusion as Viewpoint.] Kasvatus 2: 146-156]. Our aim was to examine how ECSE professionals' pedagogical practices were used to enhance peer interaction in interactive play. We analysed 14 videotaped sessions of guided play and conceptualized the studied phenomenon by portraying five guidance types in which the identified pedagogical practices were used in different ways.
  • Syrjämäki, Marja; Pihlaja, Päivi; Sajaniemi, Nina (2019)
    This article focuses on the initiatives taken by children and the responses given by professional adults with regard to the pedagogy of enhancing peer interaction among diverse learners. The study took place in four integrated special groups of public early childhood education. In groups of this kind, typically developing children and those with special educational needs (SEN) spent time together on a daily basis. We analysed 12 videotaped play sessions with 33 (3- to 6-year-old) children and 10 adults to examine the children's initiatives, the adults' responses, and the consequences that ensued. The study revealed verbal and nonverbal initiatives followed by a variety of responses scaffolding the children's interaction and participation. However, the nonverbal or faint initiatives, especially those taken by the children with SEN, were at risk of being unnoticed or ignored. These findings call for professional reflection on pedagogical sensitivity in recognizing and responding to the initiatives of children.
  • Levy, Bruno; Clere-Jehl, Raphael; Legras, Annick; Morichau-Beauchant, Tristan; Leone, Marc; Frederique, Ganster; Quenot, Jean-Pierre; Kimmoun, Antoine; Cariou, Alain; Lassus, Johan; Harjola, Veli-Pekka; Meziani, Ferhat; Louis, Guillaume; Rossignol, Patrick; Duarte, Kevin; Girerd, Nicolas; Mebazaa, Alexandre; Vignon, Philippe (2018)
    BACKGROUND Vasopressor agents could have certain specific effects in patients with cardiogenic shock (CS) after myocardial infarction, which may influence outcome. Although norepinephrine and epinephrine are currently the most commonly used agents, no randomized trial has compared their effects, and intervention data are lacking. OBJECTIVES The goal of this paper was to compare in a prospective, double-blind, multicenter, randomized study, the efficacy and safety of epinephrine and norepinephrine in patients with CS after acute myocardial infarction. METHODS The primary efficacy outcome was cardiac index evolution, and the primary safety outcome was the occurrence of refractory CS. Refractory CS was defined as CS with sustained hypotension, end-organ hypoperfusion and hyperlactatemia, and high inotrope and vasopressor doses. RESULTS Fifty-seven patients were randomized into 2 study arms, epinephrine and norepinephrine. For the primary efficacy endpoint, cardiac index evolution was similar between the 2 groups (p = 0.43) from baseline (H0) to H72. For the main safety endpoint, the observed higher incidence of refractory shock in the epinephrine group (10 of 27 [37%] vs. norepinephrine 2 of 30 [7%]; p = 0.008) led to early termination of the study. Heart rate increased significantly with epinephrine from H2 to H24 while remaining unchanged with norepinephrine (p <0.0001). Several metabolic changes were unfavorable to epinephrine compared with norepinephrine, including an increase in cardiac double product (p = 0.0002) and lactic acidosis from H2 to H24 (p <0.0001). CONCLUSIONS In patients with CS secondary to acute myocardial infarction, the use of epinephrine compared with norepinephrine was associated with similar effects on arterial pressure and cardiac index and a higher incidence of refractory shock. (Study Comparing the Efficacy and Tolerability of Epinephrine and Norepinephrine in Cardiogenic Shock [OptimaCC]; NCT01367743) (J AmColl Cardiol 2018; 72: 173-82) (C) 2018 by the American College of Cardiology Foundation.