Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Samoocena kompetentnosti hrvaskih vzgojiteljev za spoprijem z neželenim vedenjem otrok

Managing behaviour is a complex component of the teaching process and one that teachers consistently identify as an area of great concern. This study aimed to examine teachers’ perceptions regarding their competence for managing the challenging behaviour of young children and to identify the factors that affect these beliefs. A total of 204 preschool teachers working in Kindergarten Rijeka, Croatia participated. Teachers completed an exploratory survey of self-perceptions of competence in managing the challenging behaviours encountered in their classrooms. Factor analysis revealed a one-factor structure for self-perceived competence, and all scales showed good psychometric properties. Preschool teachers’ assessment of their own competence in managing challenging behaviour was explained by the level of support they received from other professionals when faced with children’s challenging behaviour and prior coursework in classroom management. Participants with higher levels of professional support and more coursework in classroom management estimated themselves to be more competent in managing challenging behaviour. The results suggest that Croatian preschool teachers need training in classroom management and greater access to professional support personnel when working with students with challenging behaviours. (DIPF/Orig.

Epistemic reasoning and adolescent egocentrism among adolescent boys with behavioral disorders and their peers without behavioral disorders

A number of investigations have been conducted to examine social cognition and psychopathology among adolescents, yet little is known about the social cognitive reasoning of adolescents identified as having severe behavioral disorders. The purpose of the present study was to explore the social cognitive reasoning of adolescent boys with behavioral disorders in comparison to their peers without behavioral disorders. Group differences were examined with respect to epistemic reasoning and the dimensions of adolescent egocentrism. In addition, the relation between social cognition and social relationships was investigated. Finally, the relation between social cognition and psychopathology was explored. Thirty-one adolescent boys with behavioral disorders and 32 of their peers without behavioral disorders (matched forage, race, and SES) participated in the study. All participants were individually administered measures designed to assess epistemic reasoning, imaginary audience and personal fable ideation (i.e., invulnerability, omnipotence, personal uniqueness), and personal-intimacy and groupintegration with peers and family. In addition, boys with behavioral disorders completed a measure of internalizing, externalizing, and total problem behaviors. Teacher-ratings of problem behaviors were also completed for each participant in the study. Results revealed that adolescent boys with behavioral disorders were lower in epistemic reasoning than were adolescent boys without behavioral disorders. Groups were not found to differ with respect to imaginary audience or personal fable ideation. For boys with behavioral disorders, no relation was found between social cognition and social relationships. In contrast, for boys without behavioral disorders, personal uniqueness was negatively related to group-integration with peers and omnipotence was positively related to group-integration with family. Social cognitive reasoning was found to predict self-reported problem behaviors for boys with behavioral disorders and teacher-re ported problem behaviors for boys without behavioral disorders. Overall, these results suggest the importance of epistemic reasoning in understanding the relation between social cognition and psychopathology.Education, Faculty ofEducational and Counselling Psychology, and Special Education (ECPS), Department ofGraduat

Croatian Preschool Teachers’ Self-Perceived Competence in Managing the Challenging Behaviour of Children

Managing behaviour is a complex component of the teaching process and one that teachers consistently identify as an area of great concern. This study aimed to examine teachers’ perceptions regarding their competence for managing the challenging behaviour of young children and to identify the factors that affect these beliefs. A total of 204 preschool teachers working in Kindergarten Rijeka, Croatia participated. Teachers completed an exploratory survey of self-perceptions of competence in managing the challenging behaviours encountered in their classrooms. Factor analysis revealed a one-factor structure for self-perceived competence, and all scales showed good psychometric properties. Preschool teachers’ assessment of their own competence in managing challenging behaviour was explained by the level of support they received from other professionals when faced with children’s challenging behaviour and prior coursework in classroom management. Participants with higher levels of professional support and more coursework in classroom management estimated themselves to be more competent in managing challenging behaviour. The results suggest that Croatian preschool teachers need training in classroom management and greater access to professional support personnel when working with students with challenging behaviours. © 2018, University of Ljubljana. All rights reserved

Epistemic Reasoning and Adolescent Egocentrism: Relations to Internalizing and Externalizing Symptoms in Problem Youth

This investigation addressed the question of how two forms of social cognitive reasoning - epistemic reasoning and adolescent egocentrism - interface with externalizing and internalizing forms of psychopathology during adolescence. Adolescents\u27 epistemic reasoning (i.e., types of belief entitlement, or degree of doubt, held by an individual when confronted with contradictory sides of an issue), and imaginary audience and personal fable ideation, were assessed in a sample of 29 adolescent boys with behavioral problems and 30 of their peers without behavioral problems. To assess internalizing and externalizing symptomatology, teachers completed the Child Behavior Checklist (CBCL-TRF). Results revealed that, compared to those without behavior problems, boys with behavioral problems were lower in epistemic reasoning. Further analyses revealed consistent relations between dimensions of social cognitive reasoning to specific forms of psychopathology. These findings suggest that social cognitive reasoning, particularly epistemic doubt, is important in understanding problem behaviors among typical and atypical adolescents