Developing an analytical tool of the processes of justificational mediation

Within the Instrumental Approach (IA) the newly developed notion of justificational mediation (JM) describes mediations that aim at establishing truth of mathematical statements in the context of CAS-assisted proofs in textbooks. Here we study JM with the intent to broaden the notion to the context of informal justification processes of early secondary students interacting with GeoGebra. Seeing JM as a process that has the objective of changing the status of a claim, we use Toulmin’s model and combine it with the IA to unravel the structure of the process through an analytical tool. The study is part of a broader project on the interplay between reasoning competency and GeoGebra with lower secondary students

A Smile can Hide a Thousand Tears

Bacheloroppgave sykepleie, 2014I 2011 ble det begått 598 selvmord i Norge, 78 av disse var unge jenter og gutter i alderen 15- 24 år. Dette er et økende antall unge fra året før (Statistisk Sentralbyrå, 2013). Erfaringer fra psykiatripraksis og personlige erfaringer med selvmord hos unge er bakgrunnen for oppgaven vår: ”Et smil kan skjule tusen tårer”. Vi har erfart at å kommunisere med selvmordstruede mennesker, og særlig de unge skaper usikkerhet hos sykepleieren og krever noe av oss som menneske å håndtere. Oppgaven tar for seg faglitteratur og forskning om selvmord, og det å fremme håp hos den selvmordstruede pasienten. Vi har valgt å benytte litteratur som har fokus på det å fremme håp hos den unge voksne som ikke lenger ønsker å leve. Vi ønsker å definere hva det vil si å være suicidal og hvordan man kan kommunisere med unge, for å skape relasjon og hvordan dette igjen bidrar til å hjelpe den unge i en vanskelig livssituasjon. Begreper som vil være sentrale i oppgaven er respekt, åpenhet, tillit og relasjon. Dette fordi det er svært relevant for å være en støttende og hjelpende sykepleier og at man utviser respekt for pasienten og har en åpen dialog for å skape en tillitsfull relasjon. Oppgaven er basert på litteratur og forskning som allerede foreligger om temaet, og er satt opp mot våre egne erfaringer i en drøftingsdel. Vi ønsker å belyse et fenomen, som vi selv ønsker å forstå bedre

SGLT2 inhibitor treatment is not associated with an increased risk of osteoporotic fractures when compared to GLP-1 receptor agonists:A nationwide cohort study

BACKGROUND: Type 2 diabetes mellitus (T2D) is associated with an increased fracture risk. It is debated whether sodium-glucose cotransporter 2 (SGLT2) inhibitors influence fracture risk in T2D. We aimed to investigate the risk of major osteoporotic fractures (MOF) with SGLT2 inhibitors compared to glucagon-like peptide 1 (GLP-1) receptor agonists when used as add-on therapies to metformin. METHODS: We conducted a population-based cohort study using Danish national health registries. Diagnoses were obtained from discharge diagnosis codes (ICD-10 and ICD-8-system) from the Danish National Patient Registry, and all redeemed drug prescriptions were obtained from the Danish National Prescription Registry (ATC classification system). Subjects treated with metformin in combination with either SGLT2 inhibitors or GLP-1 receptor agonists were identified and enrolled from 2012 to 2018. Subjects were then propensity-score matched 1:1 based on age, sex, and index date. Major osteoporotic fractures (MOF) were defined as hip, vertebral, humerus, or forearm fractures. A Cox proportional hazards model was utilized to estimate hazard rate ratios (HR) for MOF, and survival curves were plotted using the Kaplan-Meier estimator. RESULTS: In total, 27,543 individuals treated with either combination were identified and included. After matching, 18,390 individuals were included in the main analysis (9,190 in each group). Median follow-up times were 355 [interquartile range (IQR) 126-780] and 372 [IQR 136-766] days in the SGLT2 inhibitor and GLP-1 receptor agonist group, respectively. We found a crude HR of 0.77 [95% CI 0.56-1.04] for MOF with SGLT2 inhibitors compared to GLP-1 receptor agonists. In the fully adjusted model, we obtained an unaltered HR of 0.77 [95% CI 0.56-1.05]. Results were similar across subgroup- and sensitivity analyses. CONCLUSION: These results suggest that SGLT2 inhibitors have no effect on fracture risk when compared to GLP-1 receptor agonists. This is in line with results from previous studies

What causes grief in dementia caregivers?

[Abstract] Alzheimer’s disease (AD) is the most prevalent neurodegenerative disease in the world. Most AD patients become dependent on their relatives, i.e. family caregivers. Providing care to a person with AD influences caregiver’s life and leads to feelings of grief, which often precede caregiver depression. The purpose of the article was to evaluate the Meuser and Marwit Caregiver Grief Inventory (MM-CGI-50) for use in Polish family caregivers and to find out determinants of grief of family caregivers of AD individuals living in Poland. A sample of 151 spouse and adult child caregivers of community-dwelling AD patients (95 females and 56 males) was interviewed to determine the influence of such factors as caregiver’s age, gender, family relation to the care recipient (CR) and caregiving-related changes in caregiver’s working time, leisure time and material status to find out the impact of caregiving role on intensity of caregiver grief. Caregiver grief was measured by means of MM-CGI-50. Additionally, carers were administered a questionnaire including patient’s and caregiver’s demographics. Also, CR’s dementia assessment was informant-based and determined with investigator-administered clinical dementia rating (CDR) scale. Of all analyzed factors, only caregiver’s informant dementia rating significantly influenced caregiver grief. To conclude, the effect of caregiver’s age, gender, family relation to the CR and caregiving-related changes in caregiver’s working time; leisure time and material status could not be found. To add, MM- CGI-50 can be effectively used to assess grief in Polish family caregivers of AD patients

The project “understAID”, a platform that helps informal caregivers to understand and aid their demented relatives

[Abstract] “UnderstAID” is a platform that helps informal caregivers to understand and aid their demented relatives. It is an international project initiated by Denmark, Poland and Spain. The aim of the project is to design, and implement the multimedia platform “understAID” to support informal caregivers of dementia patients. The project was launched in April 2013 and is expected to end 36 months later. The project is divided into five tasks concerning the final aim. The aim of task 1 is the management of the project, as well as the exploitation and dissemination of gathered information. Task 2 is meant to define the contents and solutions of the CarePlatform based on the knowledge gained from real-case studies. Demented elderlies from each country (n = 40) suffering from different degrees of dementia were evaluated by formal caregivers and dementia professionals. The aim of task 3 is the development of the social learning interface. Task 4 focuses on the CarePlatform development and system integration. Finally, task 5 assumes testing and validation of the platform. The platform is devised to be available in two versions, namely the light one for mobile appliance and the premium version. Also different activities leading to the popularization of the platform are planned

The risk of major osteoporotic fractures with GLP-1 receptor agonists when compared to DPP-4 inhibitors:A Danish nationwide cohort study

BACKGROUND: Type 2 diabetes mellitus (T2D) is associated with an increased fracture risk. There is little evidence for the effects of glucagon-like peptide 1 receptor agonists (GLP-1RA) on fracture risk in T2D. We aimed to investigate the risk of major osteoporotic fractures (MOF) for treatment with GLP-1RA compared to dipeptidyl peptidase 4 inhibitors (DPP-4i) as add-on therapies to metformin. METHODS: We conducted a population-based cohort study using Danish national health registries. Diagnoses were obtained from discharge diagnosis codes (ICD-10 and ICD-8-system) from the Danish National Patient Registry, and all redeemed drug prescriptions were obtained from the Danish National Prescription Registry (ATC classification system). Subjects treated with metformin in combination with either GLP-1RA or DPP-4i were enrolled from 2007 to 2018. Subjects were propensity-score matched 1:1 based on age, sex, and index date. MOF were defined as hip, vertebral, humerus, or forearm fractures. A Cox proportional hazards model was utilized to estimate hazard rate ratios (HR) for MOF, and survival curves were plotted using the Kaplan-Meier estimator. In addition, Aalen’s Additive Hazards model was applied to examine additive rather than relative hazard effects while allowing time-varying effects. RESULTS: In total, 42,816 individuals treated with either combination were identified and included. After matching, 32,266 individuals were included in the main analysis (16,133 in each group). Median follow-up times were 642 days and 529 days in the GLP-1RA and DPP-4i group, respectively. We found a crude HR of 0.89 [0.76–1.05] for MOF with GLP-1RA compared to DPP-4i. In the fully adjusted model, we obtained an unaltered HR of 0.86 [0.73–1.03]. For the case of hip fracture, we found a crude HR of 0.68 [0.49–0.96] and a similar adjusted HR. Fracture risk was lower in the GLP-1RA group when examining higher daily doses of the medications, when allowing follow-up to continue after medication change, and when examining hip fractures, specifically. Additional subgroup- and sensitivity analyses yielded results similar to the main analysis. CONCLUSION: In our primary analysis, we did not observe a significantly different risk of MOF between treatment with GLP-1RA and DPP-4i. We conclude that GLP-1RA are safe in terms of fracture

RECOMMENDATIONS OF THE ALZHEIMER'S DISEASE INTERNATIONAL CONCERNING THE CARE OF PATIENTS WITH DEMENTIAAND THE SITUATION IN POLAND

According to data of WHO research, there are an estimated 36,5 million people with dementia worldwide. They need long-term care. The nature of this care depends on economic situation of the country - the higher developed it is, the bigger participation of institutions specialized in long-term care and smaller participation of home care. In high income countries around one-third to one-half of people with dementia are cared for in care homes. Alzheimer's Disease International (ADI) predicts that by 2030 number of patients with dementia will double and triple by 2050. This prognosis requires advanced planning, monitoring and coordination actions to improve system of long-term care. To achieve this goal, ADI recommends: promoting broad public awareness of dementia and combating stigma, identifying dementia capable support services at all stages of the disease, assessing and improving the quality of health care, social care and long-term care support and services, assessing availability and access to diagnostic services, promotion of brain health. Caregivers should be valued by society for they demanding and difficult work. Also patients should keep their autonomy and choice. 92% of suffering from dementia patents in Poland are cared at home since beginning of disease until their death. Other 8% stays at different types of home cares. There are also short-term care, daily care and ambulatory care available. The reasons of small participation of those institutions are: maladjusted to growing number of patients with dementia system of care, complicated administrative procedures, lack of money to cover up costs of care and lack of knowledge about dementia in society

UnderstAID, an ICT platform to help informal caregivers of people with dementia: a pilot randomized controlled study

[Abstract] Information and communications technology (ICT) could support ambient assisted living (AAL) based interventions to provide support to informal caregivers of people with dementia, especially when they need to cope with their feelings of overburden or isolation. An e-learning platform (understAID application) was tested by informal caregivers from Denmark, Poland, and Spain to explore the technical and the pedagogical specifications, as well as evaluating the impact of its use on the psychological status of the participants. 61 informal caregivers completed the study taking part in the experimental (n=30) or control (n=31) groups. 33.3% of the caregivers were satisfied with the application and around 50% of the participants assessed it as technically and pedagogically acceptable. After using understAID the caregivers in the experimental group significantly decreased their depressive symptomatology according to the Center for Epidemiologic Studies Depression scale, but a possible benefit on their feelings of competence and satisfaction with the caring experience was also observed. The low scores obtained for satisfaction were highlighting issues that need to be modified to meet the informal caregivers’ needs in national, social, and cultural context. Some possible biases are also considered and discussed to be taken into account in future improvements of understAID application.European Commission; AAL-2012-5-10