Facilitating conditions for staff’s confidence to enforce school tobacco policies:qualitative analysis from seven European cities

Background: School staff members’ consistent enforcement of school tobacco policies (STPs) is needed to decrease adolescent smoking and exposure to tobacco smoke. Staff’s confidence, indicating their perceived ability to cope with students’ negative responses, explains variations in staff’s STPs enforcement, yet understanding of the determinants for confidence is lacking. We analyzed the conditions in which the staff feel confident in addressing students who violate STPs to support staff’s enforcement. Methods: Data consists of 81 semi-structured interviews with the staff members from 26 secondary schools in seven European cities in Belgium, Finland, Germany, Ireland, Italy, The Netherlands, and Portugal. In every city, 3–4 staff members (senior management, teachers, supportive staff) in 3–4 schools (academic–vocational, high–low SES area) were interviewed. Transcripts were analyzed with thematic analysis. Results: When staff felt confident in their ability to prevent, diminish, or handle students’ negative responses, they were more likely to address students on STP violations. The staff was more confident (1) when consistent policy enforcement within school and regarding the wider society ensured staff legitimacy for STPs enforcement, (2) when dialog and mutual familiarity with students allowed the staff to facilitate constructive interaction with STP violators, and (3) when organizational backup structures provided staff collegial support to overcome challenges in the enforcement. These conditions would support consistent enforcement, especially with persistent misbehavers and among the more uncertain staff members.Conclusions: Our study stresses the need to implement strategies at multiple levels to strengthen staff’s confidence for STP enforcement. To support staff’s legitimacy for enforcement, we suggest reinforcing structures and practices that facilitate consistency in STP enforcement; to support staff’s ability for constructive interaction with STP violators, we suggest strengthening staff’s social and emotional learning; and to support staff’s experience of collegial support, we suggest reinforcing staff’s collective ability to cope with students’ negative responses.</p

Got a friend in me? Mapping the neural mechanisms underlying social motivations of adolescents and adults

Humans have a strong need for social connections, which provide social security and a feeling of social acceptance. Across adolescence, peers emerge as important social interaction partners to fulfill the need for social connections. In her dissertation, Elisabeth Schreuders highlights adolescence as a sensitive period for pursuing personal goals and social development through interactions with different familiar peers, particularly friends.Neural reward-related processes and neural processes underlying prosocial behavior were examined using longitudinal and ecologically valid research designs. The findings show involvement of changes in ventral striatum reward sensitivity from early to mid-adolescence in the motivation to pursue personally valued goals, including stable friendships. It was furthermore found that adults who to a lesser extent adhered to the social norm of behaving in a prosocial manner toward friends yielded greater activity in the supplementary motor area and anterior insula. Additionally, exploratory analyses showed that mid-adolescents with greater social competence yielded greater activity in several brain areas implicated in prosocial decision-making involving friends, including the putamen and superior parietal lobule. Together, these findings highlight adolescence as a sensitive period for self and social development, in which social motivations are reflected in interactions with different types of peers.Pathways through Adolescenc

Using linked hospitalisation data to detect nursing sensitive outcomes: A retrospective cohort study

Background: Nursing sensitive outcomes are adverse patient health outcomes that have been shown to be associated with nursing care. Researchers have developed specific algorithms to identify nursing sensitive outcomes using administrative data sources, although contention still surrounds the ability to adjust for pre-existing conditions. Existing nursing sensitive outcome detection methods could be improved by using look-back periods that incorporate relevant health information from patient’s previous hospitalisations. Design and setting: Retrospective cohort study at three tertiary metropolitan hospitals in Perth, Western Australia.Objectives: The objective of this research was to explore the effect of using linked hospitalisation data on estimated incidence rates of eleven adverse nursing sensitive outcomes by retrospectively extending the timeframe during which relevant patient disease information may be identified. The research also explored whether patient demographics and/or the characteristics of their hospitalisations were associated with nursing sensitive outcomes.Results: During the 5 year study period there were 356,948 hospitalisation episodes involving 189,240 patients for a total of 2,493,654 inpatient days at the three tertiary metropolitan hospitals. There was a reduction in estimated rates for all nursing sensitive outcomes when a look-back period was applied to identify relevant health information from earlier hospitalisations within the preceding 2 years. Survival analysis demonstrates that the majority of relevant patient disease information is identified within approximately 2 years of the baseline nursing sensitive outcomes hospitalisation. Compared to patients without, patients with nursing sensitive outcomes were significantly more likely to be older (70 versus 58 years), female, have Charleson comorbidities, be direct transfers from another hospital, have a longer inpatient stay and spend time in intensive care units (p 0.001).Conclusions: The results of this research suggest that nursing sensitive outcome rates maybe over-estimated using current detection methods. Linked hospitalisation data enables the use of look-back periods to identify clinically relevant diagnosis codes recorded prior to the hospitalisation in which a nursing sensitive outcome is detected. Using linked hospitalisation data to incorporate look-back periods offers an opportunity to increase the accuracy of nursing sensitive outcome detection when using administrative data sources

Friendship stability in adolescence is associated with ventral striatum responses to vicarious rewards

An important task for adolescents is to form and maintain friendships. In this three-wave biannual study, we used a longitudinal neuroscience perspective to examine the dynamics of friendship stability. Relative to childhood and adulthood, adolescence is marked by elevated ventral striatum activity when gaining self-serving rewards. Using a sample of participants between the ages of eight and twenty-eight, we tested age-related changes in ventral striatum response to gaining for stable (n = 48) versus unstable best friends (n = 75) (and self). In participants with stable friendships, we observed a quadratic developmental trajectory of ventral striatum responses to winning versus losing rewards for friends, whereas participants with unstable best friends showed no age-related changes. Ventral striatum activity in response to winning versus losing for friends further varied with friendship closeness for participants with unstable friendships. We suggest that these findings may reflect changing social motivations related to formation and maintenance of friendships across adolescence.Pathways through Adolescenc

Does a reduction in alcohol use by Dutch high school students relate to higher use of tobacco and cannabis?

Background: Substance use of adolescents was investigated in a region around Amsterdam, the Netherlands, in the period 2005-2009. The study was intended to find out to what extent behaviour related to different substances are interrelated and how trends develop in different subgroups. Methods: Two cross-sectional surveys were conducted among Dutch students in the second and fourth year of secondary school, aged 13-16 [n = 1,854 in 2005; n = 2,088 in 2009] by making use of an online questionnaire including questions about alcohol consumption, tobacco use (smoking behaviour) and cannabis use. Two educational levels were included. Results: Decreases in alcohol consumption, tobacco and cannabis use were found between 2005 and 2009. The strongest decline was seen in alcohol consumption. Last month drinking decreased from 61.8 % in 2005 to 36.5 % in 2009. Last month binge drinking decreased from 38.7 % in 2005 to 24.0 % in 2009. Reduced alcohol consumption was found among boys and girls, for all ages and in both educational levels. Changes were strongest among 13-year-olds. Weekly or daily smoking declined between 2005 and 2009 among 13-year-olds, girls and students in the lower schooling level. Last month cannabis use decreased among girls and students in the higher schooling level. In both 2005 and 2009 clustering with alcohol consumption was found for the use of other substances. Conclusions: Between 2005 and 2009 alcohol consumption strongly decreased among high school students. This may be due to the national prevention campaign which in the same period highlighted the importance of not drinking before the age of 16. The decrease in smoking and cannabis use between 2005 and 2009 may be due to clustering with alcohol consumption. A reduction in the use of alcohol in adolescence did not lead to replacement by tobacco or cannabis use

Early Active Motion versus Immobilization after Tendon Transfer for Foot Drop Deformity: A Randomized Clinical Trial

Background: Immobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout. Questions/purposes: To confirm those studies we determined whether when compared with immobilization early active mobilization after a tendon transfer for foot-drop correction would (1) have a similar low rate of tendon insertion pullout, (2) reduce rehabilitation time, and (3) result in similar functional outcomes (active ankle dorsiflexion, plantar flexion, ROM, walking ability, Stanmore score, and resolution of functional problems. Methods: We randomized 24 patients with surgically corrected foot-drop deformities to postoperative treatment with early mobilization with active motion at 5 days (n = 13) or 4 weeks of immobilization with active motion at 29 days (n = 11). In both groups, the tibialis posterior tendon was transferred to the extensor hallucis longus and extensors digitorum communis for foot-drop correction. Rehabilitation time was defined as the time from surgery until discharge from rehabilitation with independent walking. The minimum followup was 16 months (mean, 19 months; range, 16-38 months) in both groups. Results: We observed no case of tendon pullout in either group. Rehabilitation time in the mobilized group was reduced by an average of 15 days. The various functional outcomes were similar in the two groups. Conclusion: In patients with Hansen's disease, an early active mobilization protocol for foot-drop correction has no added risk of tendon pullout and provides similar functional outcomes compared with immobilization. Early mobilization had the advantage of earlier restoration of independent walking. Level of Evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidenc

Increased ventromedial prefrontal cortex activity in adolescence benefits prosocial reinforcement learning

Learning which of our behaviors benefit others contributes to forming social relationships. An important period for the development of (pro)social behavior is adolescence, which is characterized by transitions in social connections. It is, however, unknown how learning to benefit others develops across adolescence and what the underlying cognitive and neural mechanisms are. In this functional neuroimaging study, we assessed learning for self and others (i.e., prosocial learning) and the concurring neural tracking of prediction errors across adolescence (ages 9-21, N = 74). Participants performed a two-choice probabilistic reinforcement learning task in which outcomes resulted in monetary consequences for themselves, an unknown other, or no one. Participants from all ages were able to learn for themselves and others, but learning for others showed a more protracted developmental trajectory. Prediction errors for self were observed in the ventral striatum and showed no age-related differences. However, prediction error coding for others showed an age-related increase in the ventromedial prefrontal cortex. These results reveal insights into the computational mechanisms of learning for others across adolescence, and highlight that learning for self and others show different age-related patterns.Pathways through Adolescenc

Friendship stability in adolescence is associated with ventral striatum responses to vicarious rewards

An important task for adolescents is to form and maintain friendships. In this three-wave biannual study, we used a longitudinal neuroscience perspective to examine the dynamics of friendship stability. Relative to childhood and adulthood, adolescence is marked by elevated ventral striatum activity when gaining self-serving rewards. Using a sample of participants between the ages of eight and twenty-eight, we tested age-related changes in ventral striatum response to gaining for stable (n = 48) versus unstable best friends (n = 75) (and self). In participants with stable friendships, we observed a quadratic developmental trajectory of ventral striatum responses to winning versus losing rewards for friends, whereas participants with unstable best friends showed no age-related changes. Ventral striatum activity in response to winning versus losing for friends further varied with friendship closeness for participants with unstable friendships. We suggest that these findings may reflect changing social motivati