Bullying Among Adolescents With Autism Spectrum Disorders: Prevalence and Perception

This study examined: (a) the prevalence of bullying and victimization among adolescents with ASD, (b) whether they correctly perceived bullying and victimization, and (c) whether Theory of Mind (ToM) and bullying involvement were related to this perception. Data were collected among 230 adolescents with ASD attending special education schools. We found prevalence rates of bullying and victimization between 6 and 46%, with teachers reporting significantly higher rates than peers. Furthermore, adolescents who scored high on teacher- and self-reported victimization were more likely to misinterpret non-bullying situations as bullying. The more often adolescents bullied, according to teachers and peers, and the less developed their ToM, the more they misinterpreted bullying situations as non-bullying. Implications for clinical practice are discussed

It’s not just the Therapist: Therapist and Country-Wide Experience Predict Therapist Adherence and Adolescent Outcome

Contains fulltext : 173905.pdf (publisher's version ) (Open Access)Objective: Therapist adherence is a quality indicator in routine clinical care when evaluating the success of the implementation of an intervention. The current study investigated whether therapist adherence mediates the association between therapist, team, and country-wide experience (i.e. number of years since implementation in the country) on the one hand, and treatment outcome on the other hand. We replicated and extended a study by Löfholm et al. (2014). Method: Data over a 10-year period were obtained from 4290 adolescents (12-17 years) with antisocial or delinquent problem behavior, who were treated with Multisystemic Therapy (MST) by 222 therapists, working in 27 different teams in the Netherlands. Multilevel structural equation modeling was used to assess the associations between experience, therapist adherence, and post-treatment outcomes. Results: Treatment outcomes were directly predicted by therapist experience, countrywide experience, and therapist adherence, but not by team experience. Moreover, therapist adherence mediated the association between therapist and country-wide experience, and treatment outcomes. The association between therapist experience and therapist adherence was not affected by the number of years of team experience or country-wide experience. Conclusion: The effect of country-wide experience on outcome may reflect increasing experience of training and supporting the therapists. It suggests that nation-wide quality control may relate to better therapist adherence and treatment outcome for adolescents treated with systemic therapy.17 p

Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention - a qualitative study

Background: Older cardiac patients are at high risk of readmission and mortality. Transitional care interventions (TCIs) might contribute to the prevention of adverse outcomes. The Cardiac Care Bridge program was a randomized nurse-coordinated TCI combining case management, disease management and home-based rehabilitation for hospitalized frail older cardiac patients. This qualitative study explored the experiences of patients' participating in this study, as part of a larger process evaluation as this might support interpretation of the neutral study outcomes. In addition, understanding these experiences could contribute to the design and application of future transitional care interventions for frail older cardiac patients. Methods: A generic qualitative approach was used. Semi-structured interviews were performed with 16 patients ≥70 years who participated in the intervention group. Participants were selected by gender, diagnosis, living arrangement and hospital of inclusion. Data were analysed using thematic analysis. In addition, quantitative data about intervention delivery were analysed. Results: Three themes emerged from the data: 1) appreciation of care continuity; 2) varying experiences with recovery and, 3) the influence of an existing care network. Participants felt supported by the transitional care intervention as they experienced post-discharge support and continuity of care. The perceived contribution of the program in participants' recovery varied. Some participants reported physical improvements while others felt impeded by comorbidities or frailty. The home visits by the community nurse were appreciated, although some participants did not recognize the added value. Participants with an existing healthcare provider network preferred to consult these providers instead of the providers who were involved in the transitional care intervention. Conclusion: Our results contribute to an explanation of the neutral study of a nurse-coordinated transitional care intervention. For future purpose, it is important to identify which patients might benefit most from TCIs. Furthermore, the intensity and content of TCIs could be more personalized by tailoring interventions to older cardiac patients' needs, considering their frailty, self-management skills and existing formal and informal caregiver networks. Keywords: Cardiac rehabilitation; Cardiology; Case management; Disease management; Frailty; Nurses; Physical therapists; Qualitative research; Transitional care

The course of readmission in frail older cardiac patients

Aim: The aim of this study is to explore patients' and (in)formal caregivers' perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program. Design: This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles. Methods: Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi-structured interviews were held with patients (n = 4), informal caregivers (n = 5), physical therapists (n = 4), and community nurses (n = 5) between April and June 2019. Patients' medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six-step analysis of Strauss & Corbin have been used. Results: Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients' health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers' perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3). Conclusion: Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients' care needs and expectations should be prioritized to stimulate participation. Impact: (In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients' care needs and expectations

Studies on Leaf Analysis 1. Seasonal variation of carbohydrates in rice plants

葉分析は作物栄養診断上極めて適確なることは, 曩の予備的実験に於て認めた処であるが, 本報文は各肥料条件下に栽培する水稲を供試し, 葉分析により生育中に於ける体内炭水化物の状態を明かにせんとしたものであるその結果得たるもの次の如し。(1)水稲葉中には生育期を通じ, 可溶糖として蔗糖過半を占め, 還元糖少し。(2)葉身及葉鞘共生育進むに従い, 蔗糖含量を増し成熟期に低下す。(3)葉身中蔗糖は開花期に一時的に低下す。此は開花に蔗糖が多量需要されることを暗示する。(4)澱粉は全生育期中葉身には殆んど存在せざるも, 葉鞘には多量蓄積される時期-幼穂形成期-あり。之は水稲の注目すべき生理機能なり。(5)加里缺除及窒素過用の肥料条件は葉鞘中の蓄積澱粉を減少せしめる。即ち之等条件は光合成機能を阻害せしめるのであろう。(6)適当なる生育時期に於ける葉鞘中澱粉含量は水稲体の栄養状態を表示するから, 稲作診断上に一指標を与えるであろう。 / Carbohydrates, that is, sucrose, reducing sugar, and starch in leaf blade, leaf sheath, and top internode of rice plants were determined by photoelectric colorimeter by field experiment grown on varied fertilizer treatments. In complete plot, as normal growth was observed, sucrose content in dry leaf blade ranged from about 1 to 5%, gradually increasing as growth proceeds. At flowering stage, temporary decrease was observed, but in leaf sheath it was no evidence. We assume that at flowering stage ear demands much carbohydrates, so that sucrose are transported from leaf blade to ear. Reducing sugar content in leaf blade and leaf sheath ranged from 0.1∿1%. It is appeared that in leaf sheath maximum value was observed tillering and flowering stage. Starch was scarecely observed in leaf blade, but in leaf sheath contained remarkably, for example in complete plot 15%, at the stage between vegetative and reproductive phase-probably in the ear bud formation stage. This is a notable physiological function of rice plants. On the difference by varied fertilizer treatments, especially in respect to starch content in leaf sheath, NP or N plots reduced starch content, but K plot increased. We consider that K element indicates the rate photosynthesis. For the nutritional diagnosis of rice plants, we propose that starch content in leaf sheath at suitable stage is important index

Toward tailored care for families with multiple problems:A quasi-experimental study on effective elements of care

Several effective interventions have been developed for families with multiple problems (FMP), but knowledge is lacking as to which specific practice and program elements of these interventions deliver positive outcomes. The aim of this study is to assess the degree to which practice and program elements (contents of and structure in which care is provided) contribute to the effectiveness of interventions for FMP in general and for subgroups with child and/or parental psychiatric problems, intellectual disabilities, or substance use. We performed a quasi-experimental study on the effectiveness of practice and program elements provided in attested FMP interventions. Using self-report questionnaires, we measured primary (child's internalizing and externalizing problems) and secondary (parental stress and social contacts) outcomes at the beginning, end, and three months thereafter. By means of Latent Profile Analysis, we identified groups of families receiving similar combinations of practice elements ("profiles"), and we calculated propensity scores. Next, we assessed how practice element profiles and program elements affected improvement in outcomes, and whether these effects were moderated by subgroup characteristics. We found three practice element profiles (explorative/supportive, action-oriented, and their combination), which were equally effective. Regarding program elements, effects were enhanced by more frequent telephone contact between visits and more frequent intervision. Effectiveness of practice and program elements varied for specific FMP subgroups. Variations in the content of care for FMP do not affect its effectiveness, but variations in the structure of the care do. This finding can help to further improve effective interventions

The Cardiac Care Bridge randomized trial in high‐risk older cardiac patients: A mixed‐methods process evaluation

Aim: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse-coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design: A mixed-methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods: Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi-structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data-analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results: The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in-hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion: Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non-significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact: In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients