Autismiopetuksen henkilöstön kokemuksia puhetta tukevien ja korvaavien keinojen käytöstä

Autism spectrum disorder (ASD) is a condition that affects social interaction, communication and behavior. Since effective communication and interaction is a prerequisite for learning, the use of augmentative and alternative communication (AAC) methods has been considered necessary in study environments. The education professionals' perspectives and attitudes towards the use of AAC methods have been linked to the extent to which they support the development of communication skills of their pupils using communication aids. The purpose of this study is to describe the experiences of autism classroom teachers and classroom assistants in the use of AAC methods. This topic is examined based on the benefits and challenges that autism education professionals associate with the use of communication aids, the number of factors contributing to the successful use of the AAC methods as well as the development of the students' communication skills. In this study nine education professionals who worked in autism education classrooms and school's afternoon activities in Helsinki were interviewed. The interviews were conducted as semi-structured individual interviews, which discussed the use of AAC methods for students with ASD. The interviews were recorded, transcribed and analyzed by using inductive thematic analysis approach. Finally, the themes of each research question were compared with each other. Based on the results of this study, AAC methods are particularly useful not only for communication between students and education professionals, but also for the students' ability to express themselves, to develop better social skills and to become more independent in their everyday lives. The challenges of using AAC methods related to usability factors, students' developmental abnormalities, education professionals' practices and various resource issues. Professional co-operation, motivation, favorable usability factors of the AAC methods, and factors related to the activities and roles of education professionals were seen to influence the successful use of the AAC methods and to improve the students' communication skills. In addition, the interviewees strongly emphasized the importance of students' spontaneous communication and speech development in the motivation and work satisfaction of education professionals. The autism classroom teachers' and classroom assistants' experiences in the use of AAC methods emphasize the importance of training and multiprofessional co-operation in support of the use of communication aids and development of students' communication skills. Based on the results of this study, the speech therapists' counseling activities can be regarded as significant for the development and maintenance of the education professionals' AAC skills and for constituting positive attitudes related to the use of AAC methods. This study highlights the importance of further research focusing particularly on more specific identification of challenges related to the use of AAC methods in autism classroom education.Autismin kirjon häiriöillä viitataan eritasoisiin sosiaalisen vuorovaikutuksen, viestinnän ja käyttäytymisen poikkeavuuksiin. Koska tehokkaan viestinnän ja vuorovaikutuksen toteutumista pidetään oppimisen edellytyksenä, voidaan myös puhetta tukevien ja korvaavien keinojen hyödyntäminen opiskeluympäristöissä nähdä tarkoituksenmukaisena. Opetushenkilöstön työntekijöiden puhetta tukevien ja korvaavien keinojen käyttöön liittyvien kokemusten ja asenteiden on nähty olevan yhteydessä siihen, miten hyvin he tukevat viestinnän apuvälineitä käyttävien oppilaidensa viestintätaitojen kehitystä. Tämän tutkimuksen tarkoituksena on kuvata autismiopetuksen henkilöstön kokemuksia puhetta tukevien ja korvaavien keinojen käytöstä. Aihetta tarkastellaan opetushenkilöstön keinojen käyttöön liittämien hyötyjen ja haasteiden pohjalta sekä kuvataan erilaisia keinojen onnistuneen käytön ja oppilaiden viestintätaitojen kehityksen taustalla olevia tekijöitä. Tutkimuksessa haastateltiin yhdeksää eri opetusalan ammattilaista, jotka työskentelivät helsinkiläisten peruskoulujen autismiopetuksen luokissa ja iltapäivätoiminnassa. Haastattelut toteutettiin puolistrukturoituina yksilöhaastatteluina, joissa keskusteltiin puhetta tukevien ja korvaavien keinojen käytöstä autismin kirjon häiriöiden oppilaiden parissa. Haastattelut nauhoitettiin, litteroitiin ja analysoitiin aineistolähtöisesti teemoitellen. Lopuksi kunkin tutkimuskysymyksen teemoja verrattiin toisiinsa. Tutkimuksen tulosten perusteella puhetta tukevat ja korvaavat keinot koetaan erityisen hyödyllisiksi paitsi oppilaiden ja opetushenkilöstön välisen viestinnän myös oppilaiden ilmaisumahdollisuuksien, sosiaalisten taitojen ja itsenäistymiseen liittyvien taitojen lisääntymisen kannalta. Keinojen käytön haasteet käsitettiin usein keinojen käytettävyyteen, oppilaiden kehityksen poikkeavuuteen, opetushenkilöstön toimintatapoihin sekä erilaisiin resurssitekijöihin liittyviksi. Keinojen onnistuneen käytön ja oppilaiden viestintätaitojen kehityksen taustalla tärkeimmiksi vaikuttimiksi nähtiin ammatillisen yhteistyön toteutuminen, motivaatio, keinojen myönteiset käyttöominaisuudet ja –tavat sekä opetushenkilöstön toimintaan ja rooleihin liittyvät tekijät. Lisäksi haastateltavat nostivat vahvasti esille oppilaidensa spontaanin viestinnän ja puheilmaisun kehityksen merkityksen opetushenkilöstön motivaation ja työn palkitsevuuden kannalta. Autismiopetuksen henkilöstön kokemukset puhetta tukevien ja korvaavien keinojen käytöstä korostavat viestinnän apuvälineiden käytön ja viestintätaitojen kehityksen tukemiseen liittyvien koulutusten ja moniammatillisen yhteistyön merkitystä. Tämän tutkimuksen havaintojen perusteella erityisesti puheterapeuttien ohjaustoimintaa voidaan pitää autismiopetuksen henkilöstön puhetta tukevan ja korvaavan viestinnän taitojen kehittämisen ja ylläpitämisen sekä keinojen käyttöön liittyvien myönteisten asenteiden syntymisen kannalta tärkeänä. Jatkotutkimusten tulisi tämän tutkimuksen valossa kohdentua entistä tarkemmin erityisesti autismiopetuksen puhetta tukevan ja korvaavan viestinnän haasteisiin

Nurse educators’ perceptions of factors related to the competence of graduating nursing students

Background: Clinical practice, clinical nursing teaching, curricula, working experience and previous healthcare degrees are factors related to the competence of graduating nursing students from the points of view of nursing students and clinical mentors. However, nurse educators’ perceptions of these factors are lacking in previous studies, despite the fact that assessing student performance and competence is a core competence and one of the main duties of nurse educators.Objectives: The aim of this study was to describe nurse educators’ perceptions of factors related to graduating nursing students’ competence.Design: The study was conducted using a descriptive qualitative approach utilising focus group interviews in data collection.Participants: A purposive sample consisting of 23 volunteer nurse educators from five Finnish universities of applied sciences took part in seven group interviews.Methods: Data was collected in guided, semi-structured interviews, based on a literature review of previous studies. The data was analysed using a deductive- inductive content analysis.Results: According to nurse educators, six main categories describing factors related to graduating nursing students’ competence were found: (1) commitment to the nursing profession, (2) experiences in healthcare, (3) learning abilities, (4) learning environments, (5) student characteristics and (6) the nurse educator’s role. Conclusions: To ensure the adequate competence of the graduating nursing students, students’ commitment to the nursing profession and their learning abilities and should be supported, and the quality of the learning environments, especially those of study groups and successful clinical practices, should be ensured during the education. </p

Left ventricular non-compaction as a potential source for cryptogenic ischemic stroke in the young : A case-control study

Background Up to 50% of ischemic strokes in the young after thorough diagnostic work-up remain cryptogenic or associated with low-risk sources of cardioembolism such as patent foramen ovale (PFO). We studied with cardiac magnetic resonance (CMR) imaging, whether left ventricular (LV) non-compaction-a possible source for embolic stroke due to sluggish blood flow in deep intertrabecular recesses-is associated with cryptogenic strokes in the young. Methods Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725) is an international prospective multicenter case-control study of young adults (aged 18-49 years) presenting with an imaging-positive first-ever ischemic stroke of undetermined etiology. In this pilot substudy, 30 cases and 30 age- and sex-matched stroke-free controls were examined with CMR. Transcranial Doppler (TCD) bubble test was performed to evaluate the presence and magnitude of right-to-left shunt (RLS). Results There were no significant differences in LV volumes, masses or systolic function between cases and controls; none of the participants had non-compaction cardiomyopathy. Semi-automated assessment of LV non-compaction was highly reproducible. Non-compacted LV mass (median 14.0 [interquartile range 12.6-16.0] g/m(2)vs. 12.7 [10.4-16.6] g/m(2), p = 0.045), the ratio of non-compacted to compacted LV mass (mean 25.6 +/- 4.2% vs. 22.8 +/- 6.0%, p = 0.015) and the percentage of non-compacted LV volume (mean 17.6 +/- 2.9% vs. 15.7 +/- 3.8%, p = 0.004) were higher in cases compared to controls. In a multivariate conditional logistic regression model including non-compacted LV volume, RLS and body mass index, the percentage of non-compacted LV volume (odds ratio [OR] 1.55, 95% confidence interval [CI] 1.10-2.18, p = 0.011) and the presence of RLS (OR 11.94, 95% CI 1.14-124.94, p = 0.038) were independently associated with cryptogenic ischemic stroke. Conclusions LV non-compaction is associated with a heightened risk of cryptogenic ischemic stroke in young adults, independent of concomitant RLS and in the absence of cardiomyopathy.Peer reviewe

Right atrium and cryptogenic ischaemic stroke in the young : A case-control study

Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved.Background Recent studies suggest left atrial (LA) dysfunction in cryptogenic stroke. We studied the dynamics of right atrium (RA) and right atrial appendage (RAA) in young adults with cryptogenic stroke. We hypothesised that bi-atrial dysfunction and blood stagnation might contribute to thrombosis formation in patients with patent foramen ovale (PFO), as deep venous thrombosis is detected only in the minority of patients. Methods Thirty patients (aged 18-49) with a first-ever cryptogenic stroke and 30 age-matched and sex-matched stroke-free controls underwent cardiac magnetic resonance (CMR) imaging. An approach to estimate the RAA volume was developed, using crista terminalis and pectinate muscles as anatomical landmarks. Atrial expansion indices were calculated as (maximal volume - minimal volume) ×100%/minimal volume. Total pulmonary to systemic blood flow ratio (Qp/Qs) was based on phase contrast CMR. Right-to-left shunt (RLS) was evaluated with transoesophageal echocardiography in 29 patients and transcranial Doppler in 30 controls, moderate-to-severe RLS considered as clinically significant. Results We found that RA and RAA volumes were similar between patients and controls. Also, RA expansion index was similar, but RAA (95.6%±21.6% vs 108.7%±25.8%, p=0.026) and LA (126.2%±28% vs 144.9%±36.3%, p=0.023) expansion indices were lower in patients compared with controls. Seven (24%) of 29 patients had an RLS compared with 1 (3%) of 30 controls (p=0.012). Among 59 study subjects, RLS was associated with lower RA (81.9%±15.9% vs 98.5%±29.5%, p=0.030), RAA (84.7%±18% vs 105.6%±24.1%, p=0.022), LA (109.8%±18.6% vs 140.1%±33.7%, p=0.017) and LAA (median 102.9% (IQR 65.6%-121.7%) vs 229.1% (151.8%-337.5%], p=0.002) expansion indices and lower Qp/Qs ratio (0.91±0.06 vs 0.98±0.07, p=0.027). Conclusions This study suggests bi-atrial dysfunction in young adults with cryptogenic stroke, associated with moderate-to-severe RLS. Dysfunction of the atria and atrial appendages may be an additional mechanism for PFO-related stroke. Trial registration number NCT01934725.Peer reviewe

Revisiting left atrial volumetry by magnetic resonance imaging : the role of atrial shape and 3D angle between left ventricular and left atrial axis

Background Accurate measurement of left atrial (LA) volumes is needed in cardiac diagnostics and the follow up of heart and valvular diseases. Geometrical assumptions with 2D methods for LA volume estimation contribute to volume misestimation. In this study, we test agreement of 3D and 2D methods of LA volume detection and explore contribution of 3D LA axis orientation and LA shape in introducing error in 2D methods by cardiovascular magnetic resonance imaging. Methods 30 patients with prior first-ever ischemic stroke and no known heart disease, and 30 healthy controls were enrolled (age 18-49) in a substudy of a prospective case-control study. All study subjects underwent cardiac magnetic resonance imaging and were pooled for this methodological study. LA volumes were calculated by biplane area-length method from both conventional long axis (LAV(AL-LV)) and LA long axis-oriented images (LAV(AL-LA)) and were compared to 3D segmented LA volume (LAV(SAX)) to assess accuracy of volume detection. 3D orientation of LA long axis to left ventricular (LV) long axis and to four-chamber plane were determined, and LA 3D sphericity indices were calculated to assess sources of error in LA volume calculation. Shapiro-Wilk test, Bland-Altman analysis, intraclass and Pearson correlation, and Spearman's rho were used for statistical analysis. Results Biases were - 9.9 mL (- 12.5 to - 7.2) for LAV(AL-LV) and 13.4 (10.0-16.9) for LAV(AL-LA) [mean difference to LAV(SAX) (95% confidence interval)]. End-diastolic LA long axis 3D deviation angle to LV long axis was 28.3 +/- 6.2 degrees [mean +/- SD] and LA long axis 3D rotation angle to four-chamber plane 20.5 +/- 18.0 degrees. 3D orientation of LA axis or 3D sphericity were not correlated to error in LA volume calculation. Conclusions Calculated LA volume accuracy did not improve by using LA long axis-oriented images for volume calculation in comparison to conventional method. We present novel data on LA axis orientation and a novel metric of LA sphericity and conclude that these measures cannot be utilized to assess error in LA volume calculation.Peer reviewe

Association between first language and SARS-CoV-2 infection rates, hospitalization, intensive care admissions and death in Finland : a population-based observational cohort study

Funding Information: VH has received a grant from Finska L?kares?llskapet. AJ has received a grant from Wilhelm och Else Stockmanns stiftelse and speaker honoraria from Astellas, GlaxoSmithKline, Sanofi, Thermo Fisher, MSD, OrionPharma and UnimedicPharma. JH has recieved grants from NordForsk, Government research funding and Kirsti och Tor Johansson's hj?rt och cancerstiftelse. The authors declare that they have no other conflicts of interest in relation to this work. This work was supported by a research grant from Finska L?kares?llskapet. Funding Information: VH has received a grant from Finska Läkaresällskapet . AJ has received a grant from Wilhelm och Else Stockmanns stiftelse and speaker honoraria from Astellas , GlaxoSmithKline , Sanofi , Thermo Fisher , MSD , OrionPharma and UnimedicPharma . JH has recieved grants from NordForsk , Government research funding and Kirsti och Tor Johansson’s hjärt och cancerstiftelse . The authors declare that they have no other conflicts of interest in relation to this work. This work was supported by a research grant from Finska Läkaresällskapet . Publisher Copyright: © 2021 The AuthorsObjectives: Motivated by reports of increased risk of coronavirus disease 2019 (COVID-19) in ethnic minorities of high-income countries, we explored whether patients with a foreign first language are at an increased risk of COVID-19 infections, more serious presentations, or worse outcomes. Methods: In a retrospective observational population-based quality registry study covering a population of 1.7 million, we studied the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), admissions to specialist healthcare and the intensive care unit (ICU), and all-cause case fatality in different language groups between 27th February and 3rd August 2020 in Southern Finland. A first language other than Finnish, Swedish or Sami served as a surrogate marker for a foreign ethnic background. Results: In total, 124 240 individuals were tested, and among the 118 300 (95%) whose first language could be determined, 4005 (3.4%) were COVID-19-positive, 623 (0.5%) were admitted to specialized hospitals, and 147 (0.1%) were admitted to the ICU; 254 (0.2%) died. Those with a foreign first language had lower testing rates (348, 95%CI 340-355 versus 758, 95%CI 753-762 per 10 000, p < 0.0001), higher incidence (36, 95%CI 33-38 versus 22, 95%CI 21-23 per 10 000, p < 0.0001), and higher positivity rates (103, 95%CI 96-109 versus 29, 95%CI 28-30 per 1000, p < 0.0001). There was no significant difference in ICU admissions, disease severity at ICU admission, or ICU outcomes. Case fatality by 90 days was 7.7% in domestic cases and 1.2% in those with a foreign first language, explained by demographics (age-and sex adjusted HR 0.49, 95%CI 0.21-1.15). Conclusions: The population with a foreign first language was at an increased risk for testing positive for SARS-CoV-2, but when hospitalized they had outcomes similar to those in the native, domestic language population. This suggests that special attention should be paid to the prevention and control of infectious diseases among language minorities. (C) 2021 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.Peer reviewe

Soluble triggering receptor expressed on myeloid cells-1 is a marker of organ injuries in cardiogenic shock : results from the CardShock Study

Aims Optimal outcome after cardiogenic shock (CS) depends on a coordinated healing response in which both debris removal and extracellular matrix tissue repair play a crucial role. Excessive inflammation can perpetuate a vicious circle, positioning leucocytes as central protagonists and potential therapeutic targets. High levels of circulating Triggering Receptor Expressed on Myeloid cells-1 (TREM-1), were associated with death in acute myocardial infarction confirming excessive inflammation as determinant of bad outcome. The present study aims to describe the association of soluble TREM-1 with 90-day mortality and with various organ injuries in patients with CS. Methods and results This is a post-hoc study of CardShock, a prospective, multicenter study assessing the clinical presentation and management in patients with CS. At the time of this study, 87 patients had available plasma samples at either baseline, and/or 48 h and/or 96-120 h for soluble TREM-1 (sTREM-1) measurements. Plasma concentration of sTREM-1 was higher in 90-day non-survivors than survivors at baseline [median: 1392 IQR: (724-2128) vs. 621 (525-1233) pg/mL, p = 0.008), 48 h (p = 0.019) and 96-120 h (p = 0.029). The highest tertile of sTREM-1 at baseline (threshold: 1347 pg/mL) was associated with 90-day mortality with an unadjusted HR 3.08 CI 95% (1.48-6.42). sTREM-1 at baseline was not associated to hemodynamic parameters (heart rate, blood pressure, use of vasopressors or inotropes) but rather with organ injury markers: renal (estimated glomerular filtration rate, p = 0.0002), endothelial (bio-adrenomedullin, p = 0.018), myocardial (Suppression of Tumourigenicity 2, p = 0.002) or hepatic (bilirubin, p = 0.008). Conclusion In CS patients TREM-1 pathway is highly activated and gives an early prediction of vital organ injuries and outcome. [GRAPHICS] .Peer reviewe