Predicting discharge to institutional long-term care following acute hospitalisation: a systematic review and meta-analysis.

Background: moving into long-term institutional care is a significant life event for any individual. Predictors of institutional care admission from community-dwellers and people with dementia have been described, but those from the acute hospital setting have not been systematically reviewed. Our aim was to establish predictive factors for discharge to institutional care following acute hospitalisation. Methods: we registered and conducted a systematic review (PROSPERO: CRD42015023497). We searched MEDLINE; EMBASE and CINAHL Plus in September 2015. We included observational studies of patients admitted directly to long-term institutional care following acute hospitalisation where factors associated with institutionalisation were reported. Results: from 9,176 records, we included 23 studies (n = 354,985 participants). Studies were heterogeneous, with the proportions discharged to a care home 3-77% (median 15%). Eleven studies (n = 12,642), of moderate to low quality, were included in the quantitative synthesis. The need for institutional long-term care was associated with age (pooled odds ratio (OR) 1.02, 95% confidence intervals (CI): 1.00-1.04), female sex (pooled OR 1.41, 95% CI: 1.03-1.92), dementia (pooled OR 2.14, 95% CI: 1.24-3.70) and functional dependency (pooled OR 2.06, 95% CI: 1.58-2.69). Conclusions: discharge to long-term institutional care following acute hospitalisation is common, but current data do not allow prediction of who will make this transition. Potentially important predictors evaluated in community cohorts have not been examined in hospitalised cohorts. Understanding these predictors could help identify individuals at risk early in their admission, and support them in this transition or potentially intervene to reduce their risk.

Child and environmental risk factors predicting readiness for learning in children at high risk of dyslexia.

We investigate the role of distal, proximal, and child risk factors as predictors of reading readiness and attention and behavior in children at risk of dyslexia. The parents of a longitudinal sample of 251 preschool children, including children at family risk of dyslexia and children with preschool language difficulties, provided measures of socioeconomic status, home literacy environment, family stresses, and child health via interviews and questionnaires. Assessments of children's reading-related skills, behavior, and attention were used to define their readiness for learning at school entry. Children at family risk of dyslexia and children with preschool language difficulties experienced more environmental adversities and health risks than controls. The risks associated with family risk of dyslexia and with language status were additive. Both home literacy environment and child health predicted reading readiness while home literacy environment and family stresses predicted attention and behavior. Family risk of dyslexia did not predict readiness to learn once other risks were controlled and so seems likely to be best conceptualized as representing gene-environment correlations. Pooling across risks defined a cumulative risk index, which was a significant predictor of reading readiness and, together with nonverbal ability, accounted for 31% of the variance between children.

The Home Literacy Environment Is a Correlate, but Perhaps Not a Cause, of Variations in Children's Language and Literacy Development.

The home literacy environment is a well-established predictor of children's language and literacy development. We investigated whether formal, informal, and indirect measures of the home literacy environment predict children's reading and language skills once maternal language abilities are taken into account. Data come from a longitudinal study of children at high risk of dyslexia (N = 251) followed from preschool years. Latent factors describing maternal language were significant predictors of storybook exposure but not of direct literacy instruction. Maternal language and phonological skills respectively predicted children's language and reading/spelling skills. However, after accounting for variations in maternal language, storybook exposure was not a significant predictor of children's outcomes. In contrast, direct literacy instruction remained a predictor of children's reading/spelling skills. We argue that the relationship between early informal home literacy activities and children's language and reading skills is largely accounted for by maternal skills and may reflect genetic influences.

The Home Literacy Environment as a Predictor of the Early Literacy Development of Children at Family-Risk of Dyslexia.

The home literacy environment (HLE) predicts language and reading development in typically developing children; relatively little is known about its association with literacy development in children at family-risk of dyslexia. We assessed the HLE at age 4 years, precursor literacy skills at age 5, and literacy outcomes at age 6, in a sample of children at family-risk of dyslexia (n = 116) and children with no known risk (n = 72). Developmental relationships between the HLE and literacy were comparable between the groups; an additional effect of storybook exposure on phoneme awareness was observed in the family-risk group only. The effects of socioeconomic status on literacy were partially mediated by variations in the HLE; in turn, effects of the HLE on literacy were mediated by precursor skills (oral language, phoneme awareness, and emergent decoding) in both groups. Findings are discussed in terms of possible gene-environment correlation mechanisms underpinning atypical literacy development.

Compassionate pedagogy for neurodiversity in higher education: A conceptual analysis.

The neurodiversity paradigm challenges pathologising accounts of neurodevelopmental differences, including autism, attention deficit disorder (ADHD), dyslexia, developmental language disorder (DLD) and others. From a neurodiversity perspective, these differences in the way people perceive, learn about and interact with the world are conceptualised as naturally occurring cognitive variation, akin to biodiversity in the natural environment, which may bring unique strengths and challenges for individuals. An implication of this approach is that interventions designed to create contexts in which neurodivergent people can thrive are needed, in addition to those that seek to ameliorate individual-level difficulties. In this conceptual review, we consider how higher education can offer a context in which cognitive diversity can be noticed, welcomed and accepted with warmth. In universities, neurodiversity is one dimension of difference within an increasingly diverse student population, which overlaps - but is not synonymous - with disability. We argue that improving experience and outcomes for neurodivergent students should be a priority for universities aiming to produce graduates equipped to tackle the complex problems of contemporary society. Drawing on the foundational principles of compassion-focused psychological therapies, we consider how compassion can be enacted within interpersonal interaction, curriculum design, and leadership culture in universities. We apply the insights of double empathy theory to the problem of overcoming barriers of difference in the classroom. Finally, we make recommendations for Universal Design for Learning (UDL) and strengths-based pedagogical approaches, which create a fit-for-purpose educational environment for the widest possible range of learners. This realignment with the neurodiversity paradigm offers an antidote to bolt-on provisions for students who differ from the neuro-normative, and might enable neurodivergent thinkers to flourish within and beyond higher education.

Corrigendum: Compassionate pedagogy for neurodiversity in higher education: a conceptual analysis.

[This corrects the article DOI: 10.3389/fpsyg.2023.1093290.].

Shared storybook reading with children at family risk of dyslexia.

Background: Shared storybook reading is an important context for language learning and often constitutes young children's first encounter with the printed word. The quality of early shared reading interactions is a known predictor of language and reading development, but few studies have examined these interactions in children at family risk of dyslexia. Methods: This exploratory study describes the quality of shared storybook reading between mothers and their 3- to 4-year-old children at family risk of dyslexia (FR; n = 18) in comparison with dyads with no known risk (no-FR; n = 13). Mother-child interactions while sharing a familiar and an unfamiliar storybook were coded for type of extra-textual talk (meaning-related talk at the concrete and abstract levels; print-related talk) and affective quality. Maternal and child language and literacy skills were considered as potential correlates of shared reading quality. Results: The linguistic and affective quality of shared reading was broadly comparable across FR and no-FR dyads, particularly when sharing a book they knew well, with large within-group variation. Mothers contributed more concrete meaning-related talk when introducing an unfamiliar book to their children; children contributed more extra-textual talk overall when sharing a familiar book. Maternal language, but not reading, skills were related to the linguistic quality of shared reading. The affective quality of reading interactions was rated more highly in dyads where mothers and children had stronger language skills. Conclusions: These results suggest that the quality of shared reading does not vary systematically as a function of children's risk of dyslexia but is related to maternal language skills. This finding needs to be replicated in a larger sample in order to better understand the risk and protective factors associated with dyslexia. Highlights: What is already known about this topic The quality of extra-textual talk during shared reading between parents and preschoolers predicts later language and literacy outcomes in typically developing children.The affective quality of early shared reading predicts children's motivation to read independently in later childhood.Children at family risk of dyslexia are more likely than their peers with no family risk to have difficulty learning to read and may show weaknesses in oral language skills. What this paper adds The linguistic and affective quality of shared reading between mothers and preschool children is broadly similar when children are at family risk of dyslexia compared with no family risk.The type and quantity of extra-textual talk contributed by mothers and children appears to differ according to the familiarity of the storybook, but replication of the findings in a larger sample is required.The linguistic and affective quality of shared reading is related to maternal language skills. Implications for theory, policy or practice Shared storybook reading offers rich language learning opportunities for children at family risk of dyslexia.Maternal language skills may be an important determinant of the interactional quality of shared reading.The linguistic and affective quality of shared reading is not clearly associated with maternal reading difficulties.

Discussing Weight Management With Type 2 Diabetes Patients in Primary Care Using the Small Talk Big Difference Intervention: Protocol for a Randomized Controlled Trial.

BACKGROUND: Guidelines for the management of type 2 diabetes universally recommend that adults with type 2 diabetes and obesity be offered individualized interventions to encourage weight loss. Yet despite the existing recommendations, provision of weight management services is currently patchy around the United Kingdom and where services are available, high attrition rates are often reported. In addition, individuals often fail to take up services, that is, after discussion with a general practitioner or practice nurse, individuals are referred to the service but do not attend for an appointment. Qualitative research has identified that the initial discussion raising the issue of weight, motivating the patient, and referring to services is crucial to a successful outcome from weight management. OBJECTIVE: Our aim was to evaluate the effectiveness of an Internet-based training program and practice implementation toolkit with or without face-to-face training for primary care staff. The primary outcome is the change in referral rate of patients with type 2 diabetes to National Health Service adult weight management programs, 3 months pre- and postintervention. METHODS: We used the Behavior Change Wheel to develop an intervention for staff in primary care consisting of a 1-hour Internet-based eLearning package covering the links between obesity, type 2 diabetes, and the benefits of weight management, the treatment of diabetes in patients with obesity, specific training in raising the issue of weight, local services and referral pathways, overview of weight management components/ evidence base, and the role of the referrer. The package also includes a patient pamphlet, a discussion tool, a practice implementation checklist, and an optional 2.5-hour face-to-face training session. We have randomly assigned 100 practices in a 1:1 ratio to either have immediate access to all the resources or have access delayed for 4 months. An intention-to-treat statistical analysis will be performed. RESULTS: Recruitment to the study is now complete. We will finalize follow-up in 2018 and publish in early 2019. CONCLUSIONS: This protocol describes the development and randomized evaluation of the effectiveness of an intervention to improve referral and uptake rates of weight management programs for adults with type 2 diabetes. At a time when many new dietary and pharmacological weight management interventions are showing large clinical benefits for people with type 2 diabetes, it is vital that primary care practitioners are willing, skilled, and able to discuss weight and make appropriate referrals to services. TRIAL REGISTRATION: ClinicalTrials.gov NCT03360058; https://clinicaltrials.gov/ct2/show/NCT03360058 (Archived by WebCite at http://www.webcitation.org/74HI8ULfn). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12162.

Navigating the self in maternity care: how Chinese midwives work on their professional identity in hospital setting.

OBJECTIVE: to explore the strategies Chinese midwives employed to work on their professional identity in hospital setting and the consequence of such identity work. DESIGN AND METHODS: this paper draws upon findings from a Constructivist Grounded Theory study that explored the professional identity construction of 15 Chinese midwives with a mixture of midwifery experiences, practising in three different types of hospital settings in a capital city in Southeast China. The accounts from participants in the form of in-depth individual interviews were collected. Work journals voluntarily provided by three participants were also included. FINDINGS: in everyday practice, hospital midwives in China were working on their professional identity in relation to two definitions of the midwife: the external definition ('obstetric nurse'), bound up in the idea of risk management under the medical model of their work organisations; and the internal definition ('professional midwife'), associated with the philosophy of normal birth advocacy in the professional discourse. Six strategies for identity work were identified and grouped into two principle categories: 'compromise' and 'engagement'. The adoption of each strategy involved a constant negotiation between the external and internal definitions of the midwife, being influenced by midwifery experiences, relationships with women, opportunities for professional development and the definition of the situation. A 'hybrid identity', which demonstrated the dynamic nature of midwifery professional identity, was constructed as a result. KEY CONCLUSIONS AND IMPLICATIONS: this paper explored the dynamic nature of midwifery professional identity. This exploration contributes to the body of knowledge regarding understanding the professional identity of hospital midwives in China, while also extending the current theoretical knowledge of identity work by elaborating on the various strategies individuals use to work on their professional identity in the workplace.

A randomized, double-blind, 24-week study comparing the efficacy and tolerability of mirtazapine and paroxetine in depressed patients in primary care.

Primary care patients with a major depressive disorder and 17-item Hamilton Rating Scale for Depression (17-HAM-D) score >18 were randomized to 24 weeks of treatment with mirtazapine 30-45 mg/day (n=99) or paroxetine 20-30 mg/day (n=98). Both treatments were efficacious in improving depressive symptomatology, as assessed by group mean 17-HAM-D scores, percentages of HAM-D responders and remitters and Clinical Global Improvement responders. The mirtazapine group showed statistically significantly larger decreases from baseline in group mean 17-HAM-D scores at weeks 1, 2 and 4, and the difference with the paroxetine group reached the level of clinical relevance at weeks 2 and 4. Antidepressant efficacy was maintained throughout both the acute and continuation phase of treatment. Both treatments were well tolerated. The only adverse event with a statistically significantly higher incidence in the mirtazapine group was fatigue. Statistically significantly more paroxetine-treated patients complained of increased sweating, headache and nausea. The results demonstrate that both mirtazapine and paroxetine were efficacious and well tolerated when used for 24 weeks in depressed patients treated in primary care. An observed difference in efficacy favouring mirtazapine between weeks 1 and 4 indicates that mirtazapine patients had improved earlier compared to those on paroxetine, and corroborates similar findings in other comparisons of mirtazapine versus selective serotonin reuptake inhibitors.

Early exposure to storybooks in the home: Validation of title/author checklist measures in a sample of children at elevated risk of reading difficulty.

Title/author checklists are a reliable and valid method of measuring young children's exposure to storybooks. Early storybook exposure is robustly associated with concurrent oral language; a correlation between storybook exposure and concurrent pre-literacy skills was observed for typically developing children, but not for children at elevated risk of reading difficulty.