Factors affecting cognitive outcome in early pediatric stroke

OBJECTIVE We examined cognitive performance in children after stroke to study the influence of age at stroke, seizures, lesion characteristics, neurologic impairment (NI), and functional outcome on cognitive outcome. METHODS This was a prospectively designed study conducted in 99 children who sustained an arterial ischemic stroke (AIS) between the age of 1 month and 16 years. All children underwent cognitive and neurologic follow-up examination sessions 2 years after the insult. Cognitive development was assessed with age-appropriate instruments. RESULTS Although mean cognitive performance was in the lower normative range, we found poorer results in subtests measuring visuoconstructive skills, short-term memory, and processing speed. Risk factors for negative cognitive outcome were young age at stroke, seizures, combined lesion location (cortical and subcortical), as well as marked NI. CONCLUSIONS We recommend that all children with a history of AIS undergo regularly scheduled neuropsychological assessment to ensure implementation of appropriate interventions and environmental adjustments as early as possible.

Synchronous and Time-Lagged Effects between Occupational Self-Efficacy and Objective and Subjective Career Success: Findings from a Four-Wave and 9-Year Longitudinal Study

We integrated research on the dimensionality of career success into social-cognitive career theory and explored the positive feedback loop between occupational self-efficacy and objective and subjective career success over time (self-efficacy → objective success → subjective success → self-efficacy). Furthermore, we theoretically accounted for synchronous and time-lagged effects, as well as indirect reciprocity between the variables. We tested the proposed model by means of longitudinal structural equation modeling in a 9-year four-wave panel design, by applying a model comparison approach and indirect effect analyses (N = 608 professionals). The findings supported the proposed positive feedback loop between occupational self-efficacy and career success. Supporting our time-based reasoning, the findings showed that unfolding effects between occupational self-efficacy and objective career success take more time (i.e., time-lagged or over time) than unfolding effects between objective and subjective career success, as well as between subjective career success and occupational self-efficacy (i.e., synchronous or concurrently). Indirect effects of past on future occupational self-efficacy via objective and subjective career success were significant, providing support for an indirect reciprocity model. Results are discussed with respect to extensions of social-cognitive career theory and occupational self-efficacy development over time.

Cognitive remediation therapy: Does it generalize to significant outcome areas?

Objective: Cognitive remediation therapy (CRT) approaches have demonstrated to be effective in improving cognitive functions in schizophrenia. However, there is a lack of integrated CR approaches that target multiple neuro- and social-cognitive domains with a special focus on the generalization of therapy effects to functional outcome and negative symptoms. Method: This 8-site randomized controlled trial evaluated the efficacy of a novel cognitive-behavioral group therapy approach called integrated neurocognitive therapy (INT). INT includes manual-based exercises to improve all neuro- and social-cognitive domains as defined by the Measurement And Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative by compensation and restitution. One hundred and fifty-six outpatients with a diagnosis of schizophrenia or schizoaffective disorder accord- ing to DSM-IV-TR were randomly assigned to receive 15 weeks of INT or treatment as usual (TAU). INT patients received 30 bi-weekly therapy sessions. Each session lasted 90min. Mixed models were applied to assess changes in neurocognition, social cognition, symptoms, and functional outcome at post-treatment and at 9-month follow-up. Results: Compared to TAU, INT patients showed significant improvements on multiple neuro- and social-cognitive domains, negative symptoms, and functional outcome after therapy and at 9-month follow-up. Number-needed-to-treat analyses indicate that only five INT patients are necessary to produce durable and meaningful improvements in functional outcome. Conclusions: Integrated interventions on neurocognition and social cognition have the potential to improve not only cognitive performance but also functional outcome and negative symptoms. These findings are important as treatment guidelines for schizophrenia have criticized CRT for their poor generalization effects.

Differential effectiveness of integrated cognitive remediation therapy for schizophrenbia outpatients: The impact oft he duration of illness

Background Nowadays there is extensive evidence available showing the efficacy of cognitive remediation (CR). To date, only limited evidence is available about the impact of the duration of illness on CR effects. The Integrated Neurocognitive Therapy (INT) represents a new developed CR approach. It is a manualized group therapy targeting all 11 NIMH-MATRICS domains. Methods In an international multicenter study, 166 schizophrenia outpatients (DSM-IV-TR) were randomly assigned either to INT or to Treatment-As-Usual (TAU). 60 patients were defined as Early Course group (EC) characterized by less than 5 years of illness, 40 patients were in the Long-Term group (LT) characterized by more than 15 years of illness, and 76 patients were in the Medium-Long-Term group (MLT) characterized by an illness of 5-15 years. Treatment comprised of 15 biweekly sessions. Assessments were conducted before and after treatment and at follow up (1 year). Multivariate General Linear Models (GLM) examined our hypothesis, whether EC, LT, and MLT groups differ under INT and TAU from each other in outcome. Results First of all, the attendance rate of 65% was significantly lower and the drop out rate of 18.5% during therapy was higher in the EC group compared to the other groups. Interaction effects regarding proximal outcome showed that the duration of illness has a strong impact on neurocognitive functioning in speed of processing (F>2.4) and attention (F>2.8). But INT intervention compared to TAU only had a significant effect in more chronically ill patients of MLT and LT, but not in younger patients in EC. In social cognitive domains, only the EC group showed a significant change in attribution (hostility; F>2.5), LT and MLT groups did not. However, no differences between the 3 groups were evident in memory, problem solving, and emotion perception. Regarding more distal outcome, LT patients had more symptoms compared to EC (F>4.4). Finally, EC patients showed higher improvements in psychosocial functioning compared to LT and MLT (F=1.8). Conclusions Against common expectations, long-term, more chronically ill patients showed higher effects in basal cognitive functions compared to younger patients and patients without any active therapy (TAU). On the other hand, early-course patients had a greater potential to change in attribution, symptoms and psychosocial functioning. Consequently, more integrated therapy offers are also recommended for long-term course schizophrenia patients.

Healthcare provider perspectives on parental refusal of medical interventions: A qualitative study

Background. Healthcare providers in pediatrics are faced with parents making medical decisions for their children. Refusal to consent to interventions can have life threatening sequelae, yet healthcare workers are provided little training in handling refusals. The healthcare provider's experience in parental refusal has not been well described, yet is an important first step in addressing this problem. ^ Specific aims. Describe: (1) the decision-making processes made by healthcare providers when parents refuse medical interventions for their children, (2) the source of healthcare workers' skills in handling situations of refusal, and (3) the perspectives of healthcare workers on parental refusals in the inpatient setting. ^ Methods. Nurses, physicians and respiratory therapists (RT) were recruited via e-mail at Texas Children's Hospital (TCH). Interview questions were developed using Social Cognitive Theory constructs and validated. One-on-one in-depth, one hour semi-structured interviews were held at TCH, audio recorded and transcribed. Coding and analysis were done using ATLAS ti. The constant comparative method was applied to describe emergent themes that were reviewed by an independent expert. ^ Results. Interviews have been conducted with nurses (n=6), physicians and practitioners (n=6), social workers (n=3) and RT (n=3) comprising 13 females and 5 males with 3–25 years of experience. Decision-making processes relate to the experience of the caregiver, familiarity with the family, and the acuity of the patient. Healthcare workers' skills were obtained through orientation processes or by trial-and-error. Themes emerged that related to the importance of: (1) Communication, where the initial discussion about a medical procedure should be done with clarity and an understanding of the parents' views; (2) Perceived loss of control by parents, a key factor in their refusal of interventions; and (3) Training, the need for skill development to handle refusals. ^ Conclusions. Effective training involving clarity in communication and a preservation of perceived control by parents is needed to avoid the current trial-and-error experience of healthcare workers in negotiating refusal situations. Such training could lessen the more serious outcomes of parental refusal. ^

Sexual initiation of U.S. Latino and Colombian high school students: Toward a new theory of adolescent sexuality and implications for sexual health prevention and promotion

The general research question for this dissertation was: do the data on adolescent sexual experiences and sexual initiation support the explicit or implicit adolescent sexuality theories informing the sexual health interventions currently designed for youth? To respond to this inquiry, three different studies were conducted. The first study included a conceptual and historical analysis of the notion of adolescence introduced by Stanley Hall, the development of an alternative model based on a positive view of adolescent sexuality, and the rationale for introducing to adolescent sexual health prevention programs the new definitions of sexual health and the social determinants of health approach. The second one was a quantitative study aimed at surveying not only adolescents' risky sexual behaviors but also sexual experiences associated with desire/pleasure which have been systematically neglected when investigating the sexual and reproductive health of the youth. This study was conducted with a representative sample of the adolescents attending public high schools in the State of Caldas in the Republic of Colombia. The third study was a qualitative analysis of 22 interviews conducted with male and female U.S. Latino adolescents on the reasons for having had or having not had vaginal sex. The more relevant results were: most current adolescent sexual health prevention programs are still framed in a negative approach to adolescent sexuality developed a century ago by Stanley Hall and Sigmund Freud which do not accept the adolescent sexual experience and propose its sublimation. In contrast, the Colombian study indicates that, although there are gender differences, adolescence is for males and females a normal period of sexual initiation not limited to coital activity, in which sexual desire/pleasure is strongly associated with sexual behavior. By the same token, the study about the reasons for having had or not had initiated heterosexual intercourse indicated that curiosity, sexual desire/pleasure, and love are basic motivations for deciding to have vaginal sexual intercourse for the first time and that during adolescence, young women and men reach the cognitive development necessary for taking conscious decisions about their sexual acts. The findings underline the importance of asking pertinent questions about desire/pleasure when studying adolescent sexuality and adopting an evidence-based approach to sexual health interventions.^

Effects of a health advocacy program to promote physical activity and nutrition behaviors among adolescents: An evaluation of the Young Leaders for Healthy Change program

Background. This study was designed to evaluate the effects of the Young Leaders for Healthy Change program, an internet-delivered program in the school setting that emphasized health advocacy skills-development, on nutrition and physical activity behaviors among older adolescents (13–18 years). The program consisted of online curricular modules, training modules, social media, peer and parental support, and a community service project. Module content was developed based on Social Cognitive Theory and known determinants of behavior for older adolescents. ^ Methods. Of the 283 students who participated in the fall 2011 YL program, 38 students participated in at least ten of the 12 weeks and were eligible for this study. This study used a single group-only pretest/posttest evaluation design. Participants were 68% female, 58% white/Caucasian, 74% 10th or 11th graders, and 89% mostly A and/or B students. The primary behavioral outcomes for this analysis were participation in 60-minutes of physical activity per day, 20-minutes of vigorous- or moderate- intensity physical activity (MVPA) participation per day, television and computer time, fruit and vegetable (FV) intake, sugar-sweetened beverage intake, and consumption of breakfast, home-cooked meals, and fast food. Other outcomes included knowledge, beliefs, and attitudes related to healthy eating, physical activity, and advocacy skills. ^ Findings. Among the 38 participants, no significant changes in any variables were observed. However, among those who did not previously meet behavioral goals there was an 89% increase in students who participated in more than 20 minutes of MVPA per day and a 58% increase in students who ate home-cooked meals 5–7 days per week. The majority of participants met program goals related to knowledge, beliefs, and attitudes prior to the start of the program. Participants reported either maintaining or improving to the goal at posttest for all items except FV intake knowledge, taste and affordability of healthy foods, interest in teaching others about being healthy, and ease of finding ways to advocate in the community. ^ Conclusions. The results of this evaluation indicated that promoting healthy behaviors requires different strategies than maintaining healthy behaviors among high school students. In the school setting, programs need to target the promotion and maintenance of health behaviors to engage all students who participate in the program as part of a class or club activity. Tailoring the program using screening and modifying strategies to meet the needs of all students may increase the potential reach of the program. The Transtheoretical Model may provide information on how to develop a tailored program. Additional research on how to utilize the constructs of TTM effectively among high school students needs to be conducted. Further evaluation studies should employ a more expansive evaluation to assess the long-term effectiveness of health advocacy programming.^

Something real: A social marketing approach to smoking prevention among Montevideo youth

Uruguay has some of the strictest tobacco-control laws in Latin America. Despite this, youth smoking rates in Uruguay are amongst the highest in South America. Thus, it is important to identify strategies to prevent youth smoking in Uruguay. The current qualitative research study sought to identify intrapersonal and socioenvironmental factors that are associated with smoking among middle school youth in Uruguay. It also sought to develop potential prevention strategies and media messages that would resonate with youth for a social media campaign. The study was grounded in social cognitive theory and the theory of reasoned action/planned behavior, among other behavioral science theories; anthropological perspectives were also considered. To achieve these goals, 29 group and individual structured interviews were conducted in two private middle schools catering to lower and higher SES youth in Montevideo, Uruguay during the summer of 2012. One hundred and three study participants, including students, parents, and teachers, were interviewed. The structured interviews were recorded, transcribed, translated, back translated, coded and analyzed. The study findings show that positive attitudes towards smoking (i.e. to be seen, to increase status, to ensure women's equality, to looking old, and to service as a rite of passage), delinquent behavior (i.e. transgression/deviant behavior), social norms that support smoking (i.e. peer pressure and modeling, group membership/sense of belonging, parental modeling, and family support), easy access and availability to tobacco (i.e. retails stores) were factors associated with youth smoking. Potential protective factors may include parental support, negative attitudes towards smoking, sports/music, and smoke-free environments. Because study participants are accustomed to government-sponsored strong countermarketing graphic imaging, study participants selected even stronger images and messages as the preferred way to receive tobacco prevention messages. Something Real ("Algo Real") was a theme that resonated with the participants and chosen as the name for the proposed campaign. This campaign was designed as a multiple component intervention that included mass, school base, and family based strategies to prevent tobacco use. Some intervention materials specific to these intervention components were developed to target relevant intrapersonal and socioenvironmental factors identified above. These materials will be tested in future pilot studies and larger scale evaluation with this population, outside the scope of this dissertation. ^

Prácticas de lectura en bibliotecas virtuales en contextos didácticos diversos

Este trabajo se propone examinar los procesos cognitivos de alumnos de escuelas primaria en las prácticas de lectura en bibliotecas virtuales en el contexto de dos situaciones didácticas contrastantes. La perspectiva teórica adoptada considera los aportes de la tradición socio-histórica vigotskiana y del constructivismo relacional piagetiano. El diseño metodológico se inscribe en un estudio cualitativo de casos en el que se realiza el seguimiento de las prácticas de lectura de los alumnos mediante observaciones de aula donde se registran minuciosamente las acciones de un grupo frente a la pantalla y los intercambios con sus compañeros y el docente. Estos datos se complementan con encuestas realizadas previamente y entrevistas clínicas individuales, administradas a posteriori de la observación. Los resultados evidencian que los estudiantes parten de ideas provenientes de una historia socio-cognitivo-cultural que guían sus representaciones acerca de las bibliotecas virtuales. Estas ideas entran en constante contradicción con las formas organizativas y los contenidos que las bibliotecas les presentan. Las condiciones e intervenciones didácticas tienen un papel constitutivo en el desarrollo de las prácticas y saberes altamente complejos que requieren las búsquedas. La comparación permite avanzar sobre las situaciones que generan una mayor autonomía de los alumnos.

La complejidad de un campo social específico

El objetivo principal de este texto es exponer los aspectos generales y algunas conclusiones de un proyecto de investigación y desarrollo sobrela Región Rural Periurbana de La Plata. Entendida como un complejo campo social específico en el marco del periurbano. Se desarrollan brevemente: la historia regional, cuestiones de enfoque teórico, la construcción económica y política de la región y el campo de relaciones sociales interculturales

La comprensión infantil de la muerte : Una mirada desde lo real, lo posible y lo necesario

El artículo refiere a una investigación doctoral en curso sobre el desarrollo de la comprensión infantil de la muerte, y se centra en los conceptos de lo real, lo posible y lo necesario de las últimas investigaciones piagetianas. Aunque se trata de una discusión teórica, se mencionan algunos estudios precedentes acerca de la comprensión de la muerte, puntuando algunos de sus problemas metodológicos vinculados con la distinción entre creencias infantiles sugeridas y espontáneas. Se presentan algunos datos de nuestras exploraciones piloto con niños de 5 a 10 años. Ellos se utilizan como ilustración en la discusión sobre la posibilidad de analizar el desarrollo del concepto de muerte desde la hipótesis 'tendiente a precisar los mecanismos productores de novedad' de la diferenciación gradual entre lo real, lo posible y lo necesario. Se señala que la aceptación de la universalidad, la inevitabilidad y la irreversibilidad de la muerte es una constante en todos los niños entrevistados. Asimismo, sus ideas acerca de la 'persistencia de la existencia' luego de la muerte, y de la 'relocalización' post mórtem en otro espacio, sugieren la presencia de mecanismos análogos a los hallados en otros estudios. Finalmente, la co-existencia de racionalidades diferentes en un mismo sujeto, parecen manifestar las complejas relaciones entre representaciones sociales y creencias espontáneas

Prácticas de lectura en bibliotecas virtuales en contextos didácticos diversos

Este trabajo se propone examinar los procesos cognitivos de alumnos de escuelas primaria en las prácticas de lectura en bibliotecas virtuales en el contexto de dos situaciones didácticas contrastantes. La perspectiva teórica adoptada considera los aportes de la tradición socio-histórica vigotskiana y del constructivismo relacional piagetiano. El diseño metodológico se inscribe en un estudio cualitativo de casos en el que se realiza el seguimiento de las prácticas de lectura de los alumnos mediante observaciones de aula donde se registran minuciosamente las acciones de un grupo frente a la pantalla y los intercambios con sus compañeros y el docente. Estos datos se complementan con encuestas realizadas previamente y entrevistas clínicas individuales, administradas a posteriori de la observación. Los resultados evidencian que los estudiantes parten de ideas provenientes de una historia socio-cognitivo-cultural que guían sus representaciones acerca de las bibliotecas virtuales. Estas ideas entran en constante contradicción con las formas organizativas y los contenidos que las bibliotecas les presentan. Las condiciones e intervenciones didácticas tienen un papel constitutivo en el desarrollo de las prácticas y saberes altamente complejos que requieren las búsquedas. La comparación permite avanzar sobre las situaciones que generan una mayor autonomía de los alumnos.

La complejidad de un campo social específico

El objetivo principal de este texto es exponer los aspectos generales y algunas conclusiones de un proyecto de investigación y desarrollo sobrela Región Rural Periurbana de La Plata. Entendida como un complejo campo social específico en el marco del periurbano. Se desarrollan brevemente: la historia regional, cuestiones de enfoque teórico, la construcción económica y política de la región y el campo de relaciones sociales interculturales

La comprensión infantil de la muerte : Una mirada desde lo real, lo posible y lo necesario

El artículo refiere a una investigación doctoral en curso sobre el desarrollo de la comprensión infantil de la muerte, y se centra en los conceptos de lo real, lo posible y lo necesario de las últimas investigaciones piagetianas. Aunque se trata de una discusión teórica, se mencionan algunos estudios precedentes acerca de la comprensión de la muerte, puntuando algunos de sus problemas metodológicos vinculados con la distinción entre creencias infantiles sugeridas y espontáneas. Se presentan algunos datos de nuestras exploraciones piloto con niños de 5 a 10 años. Ellos se utilizan como ilustración en la discusión sobre la posibilidad de analizar el desarrollo del concepto de muerte desde la hipótesis 'tendiente a precisar los mecanismos productores de novedad' de la diferenciación gradual entre lo real, lo posible y lo necesario. Se señala que la aceptación de la universalidad, la inevitabilidad y la irreversibilidad de la muerte es una constante en todos los niños entrevistados. Asimismo, sus ideas acerca de la 'persistencia de la existencia' luego de la muerte, y de la 'relocalización' post mórtem en otro espacio, sugieren la presencia de mecanismos análogos a los hallados en otros estudios. Finalmente, la co-existencia de racionalidades diferentes en un mismo sujeto, parecen manifestar las complejas relaciones entre representaciones sociales y creencias espontáneas