Facilitating joint attention with salient pointing in interactions involving children with autism spectrum disorder

Children with autism spectrum disorder (ASD) reportedly have difficulties in responding to bids for joint attention, notably in following pointing gestures. Previous studies have predominantly built on structured observation measures and predefined coding categories to measure children’s responsiveness to gestures. However, how these gestures are designed and what detailed interactional work they can accomplish have received less attention. In this paper, we use a multimodal approach to conversation analysis (CA) to investigate how educators design their use of pointing in interactions involving school-aged children with ASD or autistic features. The analysis shows that pointing had specific sequential implications for the children beyond mere attention sharing. Occasionally, the co-occurring talk and pointing led to ambiguities when a child was interpreting their interactional connotations, specifically when the pointing gesture lacked salience. The study demonstrates that the CA approach can increase understanding of how to facilitate the establishment of joint attention

Efficacy of high-intensity, low-volume interval training compared to continuous aerobic training on insulin resistance, skeletal muscle structure and function in adults with metabolic syndrome: study protocol for a randomized controlled clinical trial (Intraining-MET)

ABSTRACT: Evidence of the efficacy of high-intensity, low-volume interval training (HIIT-low volume) in treating insulin resistance (IR) in patients with metabolic disorders is contradictory. In addition, it is unknown whether this effect is mediated through muscle endocrine function, which in turn depends on muscle mass and fiber type composition. Our aims were to assess the efficacy of HIIT-low volume compared to continuous aerobic exercise (CAE) in treating IR in adults with metabolic syndrome (MS) and to establish whether musclin, apelin, muscle mass and muscle composition are mediators of the effect. Methods: This is a controlled, randomized, clinical trial using the minimization method, with blinding of those who will evaluate the outcomes and two parallel groups for the purpose of showing superiority. Sixty patients with MS and IR with ages between 40 and 60 years will be included. A clinical evaluation will be carried out, along with laboratory tests to evaluate IR (homeostatic model assessment (HOMA)), muscle endocrine function (serum levels of musclin and apelin), thigh muscle mass (by dual energy x-ray absorptiometry (DXA) and thigh muscle composition (by carnosine measurement with proton magnetic resonance spectroscopy (H–MRS)), before and after 12 weeks of a treadmill exercise program three times a week. Participants assigned to the intervention (n = 30) will receive HIIT-low volume in 22-min sessions that will include six intervals at a load of 90% of maximum oxygen consumption (VO2 max) for 1 min followed by 2 min at 50% of VO2 max. The control group (n = 30) will receive CAE at an intensity of 60% of VO2 max for 36 min. A theoretical model based on structural equations will be proposed to estimate the total, direct and indirect effects of training on IR and the proportion explained by the mediators. Discussion: Compared with CAE, HIIT-low volume can be effective and efficient at improving physical capacity and decreasing cardiovascular risk factors, such as IR, in patients with metabolic disorders. Studies that evaluate mediating variables of the effect of HIIT-low volume on IR, such as endocrine function and skeletal muscle structure, are necessary to understand the role of skeletal muscle in the pathophysiology of MS and their regulation by exercise. Trial registration: NCT03087721. High-intensity Interval, Low Volume Training in Metabolic Syndrome (Intraining-MET). Registered on 22 March 2017, retrospectively registered

Simulated consultations: a sociolinguistic perspective

Background: Assessment of consulting skills using simulated patients is widespread in medical education. Most research into such assessment is sited in a statistical paradigm that focuses on psychometric properties or replicability of such tests. Equally important, but less researched, is the question of how far consultations with simulated patients reflect real clinical encounters – for which sociolinguistics, defined as the study of language in its socio-cultural context, provides a helpful analytic lens. Discussion: In this debate article, we draw on a detailed empirical study of assessed role-plays, involving sociolinguistic analysis of talk in OSCE interactions. We consider critically the evidence for the simulated consultation (a) as a proxy for the real; (b) as performance; (c) as a context for assessing talk; and (d) as potentially disadvantaging candidates trained overseas. Talk is always a performance in context, especially in professional situations (such as the consultation) and institutional ones (the assessment of professional skills and competence). Candidates who can handle the social and linguistic complexities of the artificial context of assessed role-plays score highly – yet what is being assessed is not real professional communication, but the ability to voice a credible appearance of such communication. Summary: Fidelity may not be the primary objective of simulation for medical training, where it enables the practising of skills. However the linguistic problems and differences that arise from interacting in artificial settings are of considerable importance in assessment, where we must be sure that the exam construct adequately embodies the skills expected for real-life practice. The reproducibility of assessed simulations should not be confused with their validity. Sociolinguistic analysis of simulations in various professional contexts has identified evidence for the gap between real interactions and assessed role-plays. The contextual conditions of the simulated consultation both expect and reward a particular interactional style. Whilst simulation undoubtedly has a place in formative learning for professional communication, the simulated consultation may distort assessment of professional communication These sociolinguistic findings contribute to the on-going critique of simulations in high-stakes assessments and indicate that further research, which steps outside psychometric approaches, is necessary

Aikuisten liikuntamotivaatioon vaikuttavat tekijät

Abstract Exercise promotes health, work ability, well-being and prevents diseases, such as type 2 diabetes. This study looks at the factors affecting exercise motivation in adults. Factors affecting exercise motivation refers to factors that either motivate people to exercise or restrict them. The study material was gathered from four different sets of subjects: women attending gymnastics classes arranged by the sports association Oulun Voimisteluseura, parents with young children and persons at high risk of type 2 diabetes taking part in the follow-up of the Finnish Diabetes Prevention Study in Oulu or the Elvira Counseling project. The survey targeted at female gymnasts (n=76) included open-ended questions and 56 statements which were studied using factor analysis. The survey aimed at parents with young children (n=37) consisted of five open-ended questions. The high-risk persons (n=74) who took part in group counseling in the Elvira Counseling project completed questionnaires at the beginning and at the end of the counseling. Twenty-two of them were interviewed. Group counseling sessions (82 h) were videotaped. The surveys yielded information on issues such as exercise activity and pedometer use and respondents’ assessments of how their exercise volume had been affected by pedometer use. Exercise activity was reported as the means of metabolic equivalent (MET) hours and its 95% confidence intervals. The statistical significance of changes in MET hours was measured using pairwise t-test, and differences in MET hours between groups were tested with variance analysis. Surveys targeted at persons from Oulu taking part in the Finnish Diabetes Prevention Study were conducted in 2003 (n=63) and 2008 (n=71). The survey comprised five open-ended questions. Qualitative data were analyzed using inductive content analysis. Exercise motivation consisted of exercise capital, which comprises four sub-areas: exercise activity, exercise as a habit, exercise as a resource and perceiving life situation as conducive to exercise. Factors motivating and restricting exercise came out as physical, mental and social factors. The concept of exercise capital provides a tool for exercise counseling in different life situations. Exercise motivation can be supported by looking at the factors restricting by focusing on their own exercise activity and motivation, by strengthening factors that promote motivation to exercise and by supporting family exercise and the social aspects of exercise.Tiivistelmä Liikunta edistää terveyttä, työkykyä, hyvinvointia ja ehkäisee sairauksia, kuten tyypin 2 diabetesta. Tässä tutkimuksessa selvitetään, millaisia ovat aikuisten liikuntamotivaatioon vaikuttavat tekijät. Liikuntamotivaatioon vaikuttavilla tekijöillä tarkoitetaan liikkumiseen motivoivia ja liikkumista rajoittavia tekijöitä. Tutkimusaineisto kerättiin neljästä osa-aineistosta: Oulun Voimisteluseuran liikuntaryhmissä käyviltä naisilta, pienten lasten vanhemmilta ja tyypin 2 diabeteksen korkean riskin henkilöiltä, jotka osallistuivat Suomalaisen diabeteksen ehkäisytutkimuksen seurantaan Oulussa tai Elvira counseling -hankkeeseen. Kysely naisvoimistelijoille (n=76) sisälsi avoimia kysymyksiä sekä 56 väittämää, joita tarkasteltiin faktorianalyysillä. Pienten lasten vanhempien (n=37) kysely sisälsi viisi avointa kysymystä. Elvira counseling –hankkeessa toteutettuun ryhmäohjaukseen osallistuneet henkilöt (n=74) vastasivat kyselyyn ohjauksen alussa ja lopussa, heistä 22 haastateltiin, ja kaikki ryhmäohjauskerrat videoitiin (82 h). Kyselyt tuottivat tietoa muun muassa liikunta-aktiivisuudesta ja askelmittarin käytöstä sekä vastaajien arvioita askelmittarin käytön vaikutuksesta heidän liikkumisensa määrään. Liikunta-aktiivisuus raportoitiin metabolic equivalent (MET) -tuntien keskiarvoina ja sen 95 % luottamusväleinä. MET-tunneissa tapahtuneiden muutosten tilastollista merkitsevyyttä mitattiin parittaista T-testiä käyttäen, ja ryhmien välisiä MET-tuntieroja testattiin varianssianalyysilla. Suomalaiseen diabeteksen ehkäisytutkimukseen osallistuneille oululaisille toteutettiin kyselytutkimukset vuosina 2003 (n=63) ja 2008 (n=71). Kysely sisälsi viisi avointa kysymystä. Laadulliset aineistot analysoitiin aineistolähtöisellä sisällönanalyysilla. Liikuntamotivaatio muodostui liikunnallisesta pääomasta, jossa on neljä toisiinsa vaikuttavaa osa-aluetta: liikunta-aktiivisuus, liikunta tottumuksena, liikunta voimavarana sekä elämäntilanteen kokeminen liikkumiselle suotuisana. Liikkumiseen motivoivat tekijät ja liikkumista rajoittavat tekijät ilmenivät fyysisinä, psyykkisinä ja sosiaalisina tekijöinä. Liikunnallisen pääoman käsite tarjoaa työvälineen erilaisissa elämäntilanteissa. Liikuntamotivaatiota voidaan tukea pohtimalla liikkumista rajoittavia tekijöitä oman liikunta-aktiivisuuden ja liikuntamotivaation tarkastelun ja ongelmanratkaisun avulla, vahvistamalla liikkumista motivoivia tekijöitä sekä tukemalla perheliikuntaa ja liikunnan sosiaalisia merkityksiä

Factors reducing the use of a persuasive mHealth app and how to mitigate them:thematic analysis

Abstract Background: Studies on which persuasive features may work for different users in health contexts are rare. The participants in this study were microentrepreneurs. We built a persuasive mobile app to help them to recover from work. Representatives of this target group tend to be very busy due to work, which was reflected in their use of the app during the randomized controlled trial intervention. Microentrepreneurs also often have dual roles; they are professionals in their line of work as well as entrepreneurs managing their own business, which may add to their workload. Objective: This study aimed to present users’ views on the factors that hinder their use of the mobile health app that we developed and how these factors could be mitigated. Methods: We interviewed 59 users and conducted both data-driven and theory-driven analyses on the interviews. Results: Factors reducing app use could be divided into 3 categories: use context (problem domain–related issues, eg, the lack of time due to work), user context (user-related issues, eg, concurrent use of other apps), and technology context (technology-related issues, eg, bugs and usability). Due to the nature of the participants’ entrepreneurship, which often interferes with personal life, it became clear that designs targeting similar target groups should avoid steep learning curves and should be easy (quick) to use. Conclusions: Personalized tunneling—guiding the user through a system via personalized solutions—could help similar target groups with similar issues better engage with and keep using health apps because of the easy learning curve. When developing health apps for interventions, background theories should not be interpreted too strictly. Applying theory in practice may require rethinking approaches for adaptation as technology has evolved rapidly and continues to evolve. Trial Registration:: ClinicalTrials.gov NCT03648593; https://clinicaltrials.gov/ct2/show/NCT0364859

Mikroyrittäjien kokemuksia työterveyshuollon palvelujen järjestämisestä ja niiden kehittämistarpeista

Tiivistelmä Tutkimuksen tarkoitus: Kuvailla mikroyrittäjien työterveyshuoltopalveluja sekä kokemuksia niiden järjestämisestä ja kehittämistarpeista. Aineisto ja menetelmät: Kyselyaineistosta ristiintaulukoitiin työterveyshuoltopalvelut taustamuuttujien suhteen sukupuolittain. Tilastollista merkitsevyyttä mitattiin Χ² testillä. Mikroyrittäjien haastatteluaineisto (n=30) analysoitiin aineistolähtöisellä sisällönanalyysilla. Aineistot kerättiin vuonna 2018. Tulokset: Mikroyrittäjistä (N=1245) työterveyshuoltopalvelut itselleen oli järjestänyt 38 % naisista ja 56 % miehistä. Yrittäjien koulutustasolla, iällä tai koetulla terveydentilalla ei ollut tähän vaikutusta. Yrittäjät, jotka eivät pystyneet säännöllisesti maksamaan palkkaa itselleen, olivat harvemmin järjestäneet työterveyshuoltopalvelut. Mikroyrittäjät kokivat työterveyshuollon järjestämisen kalliina tai tarpeettomana. Palvelujen ei koettu huomioivan yrittäjyyden tai työn vaatimuksia. Myönteiset kokemukset liittyivät nopeaan hoitoon pääsyyn, hyvään ohjaukseen ja ennaltaehkäisevään terveydenhuoltoon. Ennaltaehkäisevien, yksilöllisten, yrittäjyyden ja työn vaatimukset huomioivien palvelujen kehittäminen ja tiedottaminen koettiin tärkeiksi. Päätelmät: Mikroyrittäjille suunnatuissa työterveyshuoltopalveluissa tulee kehittää ennaltaehkäiseviä palveluja. Mikroyrittäjyyden vaatimusten ja aikutusten tuntemusta tulee lisätä koulutuksessa. Mikroyrittäjät tarvitsevat lisää tiedottamista työterveyshuoltopalveluista.Abstract Aim: To describe microentrepreneurs’ occupational health services (OHS) and microentrepreneurs’ experiences how OHS need to be developed. Data and methods: The data of questionnaires was analyzed by using crosstabulations of OHS services with background variables separately by gender. Statistical significancy was measured by using Χ²-test. The interviews (n=30) were analyzed by using inductive content analysis. The data was collected in year 2018. Results: Among microentrepreneurs (N=1245), 38 % of women and 56 % of men has OHS services. Education, age or perceived health had not effect on OHS. They who has not possibility to pay salary to themselves, has also more seldom OHS. The microentrepreneurs felt that OHS were expensive, that they had no any need for OHS services, and that OHS did not take into account the nature of entrepreneurship or the demands of entrepreneurs’ work. Positive experiences were related to quick access to OHS, good quality guidance and health promotion services. Development of individual, holistic health promotion services that take into account entrepreneurship and the demands of entrepreneurs’ work were considered important. Conclusions: In microentreprenurs’ OHS, health promotion services need to be developed in future. Knowledge on demands and effects of entrepreneurship and entrepreneurs’ work should be increased in education of occupational health nurses. Microentrepreneurs need more information about OHS in future