Life Priorities Research Articles

“In my age, we didn’t have the computers”: Using a complexity lens to understand uptake of diabetes eHealth innovations into primary care—A qualitative study

BackgroundShared decision-making is a central component of person-centred care and can be facilitated with the use of patient decision aids (PtDA). Barriers and facilitators to shared decision-making and PtDA use have been identified, yet integration of PtDAs into clinical care is limited. We sought to understand why, using the concepts of complexity science.MethodsWe conducted 60-minute in-depth interviews with patients with diabetes, primary care physicians, nurses and dietitians who had participated in a randomized controlled trial examining the impact of MyDiabetesPlan (an online goal-setting PtDA). Relying on a qualitative description approach, we used a semi-structured interview guide to explore participants’ experiences with using MyDiabetesPlan and how it was integrated into the clinical encounter and clinical care. Audiotapes were transcribed verbatim, then coded independently by two analysts.Findings17 interviews were conducted (5 physicians, 3 nurses, 2 dietitians, 7 patients). Two themes were developed: (1) MyDiabetesPlan appeared to empower patients by providing tailored patient-important information which engaged them in decision-making and self-care. Patients’ use of MyDiabetesPlan was however impacted by their competing medical conditions, other life priorities and socioeconomic context. (2) MyDiabetesPlan emphasized to clinicians a patient-centred approach that helped patients assume greater ownership for their care. Clinicians’ use of MyDiabetesPlan was impacted by pre-existing clinical tools/workplans, workflow, technical issues, clinic administrative logistics and support, and time. How clinicians adapted to these barriers influenced the degree to which MyDiabetesPlan was integrated into care.ConclusionsA complexity lens (that considers relationships between multiple components of a complex system) may yield additional insights to optimize integration of PtDA into clinical care. A complexity lens recognizes that shared decision-making does not occur in the vacuum of a clinical dyad (patient and clinician), and will enable us to develop a family of interventions that address the whole process, rather than individual components.Trial registrationClinicalTrials.gov NCT02379078.

СУЧАСНІ ТЕНДЕНЦІЇ РОЗВИТКУ ТЕОРІЇ ТА ПРАКТИКИ СОЦІАЛЬНОГО ВИХОВАННЯ

The formation of the foundations of moral, social formation and development of personality is an extremely important area of social pedagogy. Social education plays an important role in the process of socialization of the individual, the development of norms and habits of behavior, the formation of socially significant personality traits. The current state of development of the theory and practice of social education is characterized by increased attention to self-realization of the individual, ensuring the spiritual unity of generations, the education of patriotic feelings. In the process of development of the younger generation, it is important to prepare young people for the process of adaptation in society, to strengthen the mental and spiritual health of children. The article considers modern views on the understanding of the concept of social education, trends in this category in scientific and legal positions. Attention is paid to the current aspects of the process of social education and its role in the socialization of the individual. The tasks performed by social education in the formation of a spiritual, creative personality are outlined. Separate normative-legal documents that influence the content of social education in modern conditions are noted. It is emphasized that social education has a purposeful nature, affects the development of civil society, the formation of Ukrainian national identity. The formation of the current foundations of the theory and practice of social education can not take place without taking into account previous experience and taking into account the historically formed vision of the process of social education in the context of the formation of a harmonious personality. The development of the theory of social pedagogy and the solution of socio-pedagogical problems is directly connected with the possibility of social education to develop the necessary intellectual, moral and spiritual qualities of the individual in the educational environment. Effective social education enriches and develops key social institutions, allows to grow a conscious generation of young people, to form a civil society on the basis of morality, honesty, responsibility and mutual respect. It should be noted that social pedagogy plays an important role in educating social and cultural values that shape the personality. The educational center purposefully provides the necessary guidelines, in the process of studying which forms the worldview, beliefs, views and life priorities of the younger generation.

Ecoturism as a Means of Formation of Ecological Consciousness and Culture of Personality

In the conditions of the global ecological crisis the problem of physical habitation of people as a biological species objectively arises in the foreground. The main reasons for the negative impact of human activities and society on the natural environment, which caused such a crisis, are revealed. Emphasis is placed on the fact that the reduction in society of the technocratic worldview in the life of mankind eventually led to such a negative situation. Emphasis is placed on the fact that in order to overcome it, firstly, it is necessary to rethink the relationship in the system «human — nature» at the global level and, accordingly, to form in the individual and society the need to replace the technological worldview with ecological. It turns out that a system-forming element in the system of ecological worldview is ecological consciousness which is ultimately managed to provide a spiritual basis for a set of environmental factors in human life and society. As a result, they become priorities in human life. Moreover, they can even become a meaning of human life. The content of the basic levels of ecological consciousness formation is revealed: national-realistic, everyday-empirical and conscious-theoretical. It is proved that the carriers of the national-realistic level are characterized by an intuitive approach to understanding the existing environmental problems. As for the everyday-empirical level of ecological consciousness, such people are interested in the practical solution of the problem in the field of ecology, which is directly related to them. And only the carriers of the conscious-theoretical level of ecological consciousness are characterized by a conscious and stable attitude towards environmental problems in all their manifestations. They are characterized by the active life position of protection and conservation of nature, which is realized in active environmental activities. It is proved that ecotourism serves as an effective means of forming and affirming the ecological consciousness and ecological culture of the individual and society, due to the fact that in the process of human interaction with the natural environment the need for care is formed. The content and correlation of the concepts «ecotourism», «biotourism», «natural tourism», «agritourism», «green tourism» are revealed. It turns out that ecotourism necessarily supports the «greening» of other types of tourism, which in their activities are beginning to teach not only the risks of negative impact of such activities on the environment, but also create efforts to ensure its preservation. The significant ecological potential of Khmelnytskyi region is revealed.

TRUST AND MUTUAL ASSISTANCE AS MORAL AND ETHICAL VALUES IN MAINTAINING MENTAL HEALTH UNDER THE CONDITIONS OF PANDEMIC

The article reveals trust and mutual assistance as moral and ethical factors in mental health maintaining in a pandemic. Humanization of social relations, new ethics, development of moral and ethical values is the guarantee and necessary condition for the survival of mankind under conditions of planetary instability and proneness to conflict. These values help a person to overcome the limits of individual existence, help him to maintain harmony with the world around him and with himself, to foster tolerance and flexibility in relations with other people, to focus upon an adequate understanding of slings and arrows of life in the COVID-19 pandemic. The moral and ethical values of trust and mutual assistance contribute to a person’s ability to mutual tolerance and empathy in accepting the Other, cultivating spiritual flexibility and willingness to compromise, focusing upon understanding life values and priorities other than usual, recognising social equality, because all people are equally valuable.

Global Values — The Basis for the Life Support Paradigm Development

The article is devoted to the study of the accounting paradigm, which is based on global values, priorities of companiesstakeholders and individuals. To comprehend the task, the key values of the global community aimed at its sustainable development are identified and compared with a similar resource of companies and individuals. In the recent years, the significant economic, technological, social and environmental changes have a significant impact on the revision of life priorities at all levels: person — company — global community. The dramatic transformation of global life values that took place in 2020 (and is still ongoing) under the influence of the COVID‑19 pandemic has profoundly and seriously affected the entire life support system of physical and economic entities. All this together determined the need to develop a new value-oriented foundation for building an accounting paradigm. In the course of the study, the authors used methods and techniques of comparative, logical and expert analysis. The authors studied a chronology of the emergence of modern accounting models which is based of generalization of the works of modern scientists in this field. The main purpose of the study was to substantiate the global initial grounds for constructing an accounting paradigm based on a common value characteristic of life support for interested users and economic entities in conditions of uncertainty as well as risks and new opportunities associated with environmental and social changes. Thus, its results caused the justification of the commonality and interdependence of the life activity of an individual, company and society; the necessity and possibility of developing a new value-based view of life support for the accounting sphere. The proposed methods are aimed to improve the life quality in general. They are recommended for the accounting and reporting theory development, as well as to be a basis for improving the quality of the information space of the economy and society.

Care Disparities Across the Health Care Continuum for Older Adults: Lessons From Multidisciplinary Perspectives.

Older adults comprise a considerable proportion of patients with cancer in the world. Across multiple cancer types, cancer treatment outcomes among older age groups are often inferior to those among younger adults. Cancer care for older individuals is complicated by the need to adapt treatment to baseline health, fitness, and frailty, all of which vary widely within this age group. Rates of social deprivation and socioeconomic disparities are also higher in older adults, with many living on reduced incomes, further compounding health inequality. It is important to recognize and avoid undertreatment and overtreatment of cancer in this age group; however, simply addressing this problem by mandating standard treatment of all would lead to harms resulting from treatment toxicity and futility. However, there is little high-quality evidence on which to base these decisions, because older adults are poorly represented in clinical trials. Clinicians must recognize that simple extrapolation of outcomes from younger age cohorts may not be appropriate because of variance in disease stage and biology, variation in fitness and treatment tolerance, and reduced life expectancy. Older patients may also have different life goals and priorities, with a greater focus on quality of life and less on length of life at any cost. Health care professionals struggle with treatment of older adults with cancer, with high rates of variability in practice between and within countries. This suggests that better national and international recommendations that more fully address the needs of this special patient population are required and that primary research focused on the older age group is urgently required to inform these guidelines.

P129 IBD care in the UK: A comprehensive, novel service assessment with feedback from 10,222 patients and 166 NHS organisations to inform a vision for quality improvement

Abstract Background The IBD Benchmarking Tool, comprising an online Service Self-Assessment and Patient Survey, has provided a unique and comprehensive picture of Inflammatory Bowel Disease (IBD) care across the UK. The aim was to evaluate current local service performance to facilitate future quality improvement. Methods The IBD Patient Survey (PS) ran from July to November 2019 and the Service Self-Assessment (SSA) from October 2019 to January 2020. Detailed views were collected of the quality of IBD care from patient and clinician perspectives, measured against the UK IBD Standards 2019.1 The IBD UK National Report will be published in April 2021. Results 10,222 patients completed the PS. 89% (9,100/10,222) had found it hard to cope with having Crohn’s or Colitis over the previous year. 72% (6,954/9,640) rated the quality of their care as excellent, very good or good and 28% (2,686/9,640) rated the quality of their care as fair or poor. The top three factors that predicted how highly people with IBD rated their quality of care were: feeling supported by a team of specialists; having regular reviews; and discussing wider life goals and priorities, as part of planning their care. 26% (535/2,089) had waited more than a year for their diagnosis. 41% (849/2,087) had visited Accident & Emergency at least once before being diagnosed. 32% (656/2,057) were not offered any information about their condition when diagnosed. 91% (8,284/9,099) did not have a personalised care plan. Over the previous 12 months, 70% (6,732/9,574) had one or more flares and 72% (1,622/2,250) of inpatient admissions were unplanned. A key finding from the SSA (166 centres: 134 adult, 32 paediatric) was that no adult IBD services reported meeting the IBD Standards’ recommendation for whole time equivalent (WTE) staffing across the IBD team. Where services reported meeting the WTE for IBD nurse specialists, patients were more likely to rate the quality of their care highly and to have regular clinical review of their Crohn’s or Colitis. Conclusion The results highlight four key areas for change: improvements in diagnosis and information provision; personalised care and support for self-management; faster access to specialist advice and treatment; and effective multidisciplinary team (MDT) working. The Report sets out recommendations for action in each of these areas. To our knowledge, this is the first time that healthcare professionals and patients have assessed care against a common set of standards. The IBD Benchmarking Tool provides location-matched service performance and patient experience as an exemplar for others to follow. Reference

Reduced quality of life in ICU survivors - the story behind the numbers: A mixed methods study

To gain insight into the daily functioning of ICU survivors who reported a reduced quality of life (QoL) one year after ICU admission. A two-phase mixed method study design. QoL was assessed using the SF-36 questionnaire before admission and after one year (Phase 1). Participants reporting a reduced QoL were invited for an in-depth interview (Phase 2). Interview data were coded thematically using the PROMIS framework. Of the 797 participants, 173 (22%) reported a reduced QoL, of which 19 purposively selected patients were interviewed. In line with their questionnaire scores, most participants described their QoL as reduced. They suffered from physical, mental and/or cognitive problems, impacting their daily life, restricting hobbies, work, and social activities. A new balance in life, including relationships, had to be found. Some interviewees experienced no changes in their QoL; they were grateful for being alive, set new life priorities, and were able to accept their life with its limitations. Reduction in QoL is due to physical, mental, and cognitive health problems, restricting participants what they want to do. However, QoL was not only affected by the critical illness, but also by factors including independency, comorbidity, and life events. Registration: NCT03246334 (clinical trials.gov).

Post-Traumatic Growth Experiences among COVID-19 Confirmed Cases in China: A Qualitative Study.

COVID-19 infection can cause psychological distress and profoundly impact patients' lives, but it can also lead to positive changes and post-traumatic growth (PTG), or positive psychological change in response to challenging life circumstances. Current research on the influence of COVID-19 infection has mainly focused on its negative effects. Therefore, the aim of this study was to investigate whether patients with COVID-19 in China experienced PTG and, if so, what changed for them during the process of PTG. We used a qualitative descriptive approach to conduct this study. Using the purposive sampling recruitment method, patients with a confirmed COVID-19 diagnosis were recruited from a COVID-19 designated hospital in Shanghai, China, from April to July 2020. Data were collected using semi-structured, in-depth interviews conducted via cell phone or in person while social distancing to prevent the spread of COVID-19. Forty confirmed COVID-19 patients (19-68 years old) were recruited. Several prominent themes and subthemes were extracted from the interview responses regarding participants' experiences of PTG. The following are among the positive changesthat occurred for these participants after their diagnosis of COVID-19: (1) Reevaluation of their life priorities, which included a greater appreciation of being alive and re-evaluating their values and goals, (2) Improved relationships within their social circles, which included establishing or maintaining closer relationships with family and friends and a greater willingness to help others, and (3) Perceived changes regarding themselves, which included personal growth and increased awareness of the importance of their health. The study identified potential positive impacts of COVID-19 on patients, which could be helpful in the implementation of interventions to facilitate PTG among COVID-19 survivors.

Legal Regulation of GMO Turnover and Health Protection in Russia

The article considersboth advantages and disadvantages of the widespread use of genetically modified foodsamong the population. Special attention is drawn to insufficient arguments of their supporters and opponents. The authors of the article propose to focus on the possible advances and risks of genetically modified foodsfor public health. A state policy of approving or prohibiting the use of genetically modified foods, including the relevant bio-policy, should be based on the priority of human life and health and the interests of consumers of food products. Other arguments are secondary and subsidiary for making the most important political decisions affecting the foundations of human life and the environment. Methods: The research was carried out from the standpoint of theoretical analysis,general (sociological, systemic, structural, functional) and specialscientific methods (comparative jurisprudence, technical and legal analysis, specification, interpretation). The methodological basis of this study was the theory of knowledge.Objective: The article aims at studying the possibility of GMO turnover in Russia, as well as determining the purposes of their use and legal regulation.Results:It was concluded that the market authorization of genetically modified products and the issuance of appropriate permissions to use them as food products, whoseingredients contain a modified gene, make states answer the following question: “Do these genetically modified products preservepublic health and the health of a particular individual?”.If such a goal is not pursued, there is no social need (at least, in Russia) to introduce such products into civil circulation. Supporting this conclusion, the authors of the article provideseveralarguments

Exploring How Postmillennial Pharmacy Students Balance Life Priorities and Avoid Situations Known to Deplete Resilience

Objective. Students are facing increasing academic pressures that can contribute to poor wellbeing. Evidence to inform the development of better student support services is weak. This study aimed to explore Bachelor of Pharmacy students' self-reported life priorities and ways they strategize to avoid resilience-depleting events on a day-to-day basis.Methods. Postmillennial (those born after 1996) pharmacy students enrolled in their final year of pharmacy school were introduced to the coaching concepts of the Wheel of Life and anti-goals. Students' top eight life priorities were collected and categorized. Students were asked to submit one anti-goal targeting a strategy used to avoid resilience depletion. Anti-goals were coded according to student priority areas and overarching themes were interpreted.Results. The top priorities of 110 final-year pharmacy students were: family, finance, health, friends/relationships, study, career prospects, fitness, personal growth, travel, and mental health/wellbeing. Priorities were both similar and dissimilar to traditional coaching priorities. Sixty-eight anti-goals were coded. The themes "being prepared" and "being present" were used to summarize strategies that students employed to avoid resilience depletion.Conclusion. The life priorities of newer student generations may be changing to be more individualistic and include a greater focus on self-help, while maintaining the core priorities of family, health, and finance. These findings uphold the notion that student support mechanisms must be modernized to accommodate students' needs.

Correlation between hand functioning, cognition and quality of life of CP children: 2-year prospective randomized study

IntroductionFor treatment of CP patients multidisciplinary approach is often promoted. But it is not cost-efficient to involve all medical staff and variety of diagnostic/intervention tools for every patient.ObjectivesHaving knowledge on pivotal manifestations of CP and what are they related to would ease multidirectional approach in practice. It will shorten a search of pathologies only to those related to main manifestations related to quality of life.Methods611 children aged 2 to 18 years (mean age–6y5m) with CP(G80.0-G80.9): examined by 3 independent doctors. 56%males, 44%females. Randomized blinded assessment. Fine hand function assessed by “9-hole peg”,“Box and Blocks” tests, dynamometry. Intellectual functioning assessment was done using Raven Matrices. Quality of Life(QoL) assessment according to Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). The intraclass correlation coefficient(ICC) was used for finding out discrepancies between observers. Inferencial statistics including 95%CI and P-value.ResultsICC coefficient between observers was highly reliable–0.93(95%CI:0.89–0.95). The mean QoL score for children GMFCS levels I and II was 58.5(SD 16.6), for GMFCS III, IV and V children–22.4(SD13.4). QoL was more related to fine hand functioning(r=0,344) than to cognition(r=0,295). There was a strong correlation bond between fine hand functioning and cognition (r=0,663). In case fine hand function improved positive changes in cognition were observed in 74% of subjects(p<0,05). Correlation between grasp power and IQ was weak(r=0,184). Grasp power improvement was slightly related to QoL(r=0,102).ConclusionsFine hand functioning improves QoL even more that cognition.So training of fine motor skills should be given a priority in case of limited rehabilitation resources.DisclosureNo significant relationships.

ЦЕННОСТИ ПЕРСОНАЛА СОВРЕМЕННОЙ НАУЧНО-МЕДИЦИНСКОЙ ОРГАНИЗАЦИИ

Background. Priorities in life and professional values are the socio-psychological guidelines for the professional development of a specialist. The value environment in each organization is unique, it depends on many factors and is a component of the organizational culture, for the effective management and development of which it is necessary to study and take into account both individual life values of employees and the values of different categories of personnel and the organization as a whole. Aim. To study the peculiarities of the life values of employees of medical-scientific institution and assess their compliance with the values of the organization. Materials and Methods. Sociological survey, statistical analysis. The object of the research was the personnel of a modern scientific and medical organization, and the life values of employees and the values of the organization. The work was performed on the base of Research Institute for Complex Problems of Cardiovascular Diseases. The survey covered 74.8% of the basic personnel (doctors, research personnel, nurses, administrative and management personnel, servicing personnel). Results. The first three leading life values of all the personnel were health, happy family life and material well-being. More than half the respondents consider the most important values for the organization to be professionalism and responsible attitude to work, correct and respectful attitude to colleagues, correct and respectful attitude to patients, discipline and order in work, strict observance of laws and normative requirements, aspiration to professional perfection. In the personnel, the priority values for the organization do not depend on age. 73.7% of employees have a personal system of values that coincides with the values of the organization. Conclusions. In the opinion of the personnel, most important values of a medical and scientific institution are socio-normative values with a strong emphasis on the priority of personal professionalism. The majority of respondents believe that their personal values correspond to the values important for the organization, which is an indicator of the social and psychological congruence of employees, but is also a sign of the culture of conformism in the institution, which would more likely be a limiting factor in a research organization.

THE INFLUENCE OF ADVERTISING ON THE FORMATION OF VALUE ORIENTATIONS OF YOUNG PEOPLE

The article analyzes the issues of value orientations of young people under the influence of advertising and advertising images. The definition of "advertising", "value orientations" is revealed. Research on this problem is analyzed, which can be divided into three areas: the study of the genesis of advertising, the study of advertising theory, as well as consumer behavior and the influence of psychological factors on product choice and perception of advertising. Features of an age category (youth) which are subject to influence of advertising, owing to the psychological features, emotional instability are revealed. The role of advertising, both positive and negative, in the choice of values, formation of motives, lifestyle, model of youth behavior is revealed. The research was conducted on the basis of the Faculty of Social and Psychological Education of the Uman State Pedagogical University named after Pavlo Tychyna. The sample was 50 students aged 18 to 22 years. The gender aspect did not take into account. The survey (survey) of student youth made it possible to determine the opinion of respondents who believe that advertising dictates a particular lifestyle, at the same time it helps to learn about products and navigate when buying, and a large percentage of respondents believe that advertising is depressing. A significant number of respondents admitted that they made purchases under the influence of advertising. Young people also point out that family, health and love are important values, although they do not put these values ​​first. Problems such as aimless leisure time on the Internet and in front of the TV, increased value of money and career in the life priorities of young people were revealed. The author concludes that the impact of advertising on the formation of value orientations has been confirmed, but is not critical, and there is a need to develop measures to reduce the impact of commercial advertising to correct the negative effect and create a basis for traditional values ​​and behaviors.

Globalization, Sharia law, and cultural hybridity: A case of marriage preferences of young Bangladeshis

This contribution is one of the few psychological studies analyzing the marriage preferences of Bangladeshi urban youths. Our goal was to demonstrate that the line between traditional and “modern” marriage is no longer clear-cut and document the importance of social status and religion in shaping the life priorities of young, educated Bangladeshis. The sample (N = 205) consisted of unmarried university undergraduates aged 19-26. Participants were presented with three marriage scenarios: a traditional marriage arrangement, a hybrid model based on mutual attraction and family support, and finally, a Western-style love marriage. Generally, the Western marriage arrangements were rated more positively than the other models. Surprisingly, there were no significant differences between preferences for a hybrid and a traditional model. Additionally, participants from a higher social milieu with lower levels of religiosity accepted love marriages more eagerly than middle-class students.

Participation in social and leisure activities while re-constructing the self: understanding strategies used by stroke survivors from a long-term perspective

Purpose To further understand social and leisure (SL) participation after stroke and how it can be supported in a long-term perspective, this study aims to deepen the understanding of strategies used by long-term stroke survivors in relation to SL activities. Materials and methods The study has a qualitative design, using a grounded theory approach, and is based on in-depth interviews with 10 persons who had a stroke 15 years ago and four of their family members. Results The findings comprise nine different strategies used by the participants. These had two overarching purposes; to protect and re-construct the post-stroke self and to enable participation in valued SL activities despite challenges. The findings are summarized in one overarching theme: “Employing different strategies to balance costs and rewards of engagement in social and leisure activities”. Conclusions Strategies for SL participation involves balancing different priorities in life and can change over time as they are continuously influenced by various personal and environmental conditions. These findings contribute to an improved understanding of why and how people hold on to activities, give up activities and find new activities after a stroke. It also highlights the need for a long-term perspective on stroke rehabilitation and support. IMPLICATIONS FOR REHABILITATION Re-engagement in social and leisure activities after stroke is a long-term process and various types of support may be needed during different stages of recovery and adaptation. Successful rehabilitation interventions build on an understanding of each individual’s priorities, goals and strategies and how these may change or manifest over time. Special attention should be given to the individual’s perception of costs and benefits in relation to engagement in activities, and the role that it has for the person’s identity. By providing knowledge and supporting the use of adequate coping strategies, rehabilitation professionals can help patients find a new and accepted post-stroke identity.

Conditions of effective self-management. “Manage yourself, be creative, achieve goals”

The article addresses what seems to be the critical aspects related to the most important competence of a human being in the 21st century – the competence to manage oneself. Nowadays, when life and civilization and technological development have accelerated unbelievably, people find it increasingly challenging to fulfill the social roles entrusted to them. That applies to everyone, but especially to those who have to manage (lead) other people or even entire teams, often forgetting about themselves, their needs, life priorities, and personal development. One should be able to wisely and rationally plan professional development in his/her personal life so as not to lose himself/herself entirely in the surrounding reality, being absorbed only in professional matters and others’ problems. This article indicates the most critical aspects that should be taken into account when planning personal and socio-professional development since only in this way can one feel the fulfillment of both in personal (family) and social and professional life.

Parents and Caregivers Satisfaction After Palliative Treatment of Spastic Hip Dislocation in Cerebral Palsy.

Objectives: Pain appearance is one the most common complication of spastic hip disease in children with cerebral palsy (CP). It determines child and caregiver quality of life and life priorities. Reconstruction hip surgery should be considered as a treatment of choice. Some clinical conditions give the inability to perform such a procedure. In our paper, we would like to present four palliative methods of spastic hip dislocation treatment in children with CP.Material: We analyzed four groups of patients treated because of hip pain. Inclusion criteria were pain appearance (visual analog scale-11 or numeric rating scale-11) and hip joint dislocation (migration percentage >80%). All patients were admitted to our department between 2008 and 2018. In the first group, patients were treated only by steroid injections to hip joints; in the second group, patients were recruits after hip interposition arthroplasty with shoulder spacer; in the third group, they were patients after valgus subtrochanteric osteotomy (Schanz); and in the fourth group, these were patients after proximal femoral resection (Castle procedure). The minimal follow-up time was 2 years. The first group consisted of 15 patients (15 hips) with a mean age of 15.5 (8–17) years; the second group, 20 patients (24 hips) with a mean age of 14.2 (9–22.6) years; the third group, 22 patients (24 hips) with a mean age of 13.5 (7–20.5) years; and the fourth group, 10 patients (15 hips) with a mean age of 12.9 (7–17.6) years.Methods: Radiological evaluation was based on a standardized anteroposterior X-ray of the hip joints. Pain severity before surgery and at the last follow-up time was measured by visual analog scale-11. Parents or caregivers were asked about their child's pain during sitting, perineal care, and rest. During the visit, all caregivers were asked about treatment satisfaction (no 0 to max 10) and if they would decide again for the same surgery.Results: In all groups of patients, we observed a decrease in pain complaints. The observed reduction of pain in the first group was from 7.88 (4–10) to 3.08 (0–8) (p = 0.05), but results of injection were observed only for 4 months (2–8), and it has to be repeated (average: two times). In the second group, level of pain was reduced from 4.93 (1–10) to 0.93 (0–5) (p < 0.001); in the third group, from 6.22 (3–10) to 0.59 (0–6) (p < 0.001); and in the fourth group, pain reduces from 5.43 (2–10) to 2.13 (0–5) (p < 0.001). Observed changes concerned mostly sitting position and perineal care. The complication rate was in the second group, 6 of 24 cases of extraarticular ossification; in the third group, 2 of 24 cases with extraarticular ossification, two cases of revision surgery. In the fourth group, two cases needed another femoral resection. In the first group, five patients died during follow-up time, so they were excluded from the study. In the steroid injection group, parents' treatment evaluation was 6.83 (0–10), and only in three cases that they would resign from the treatment. In the hip interposition arthroplasty group, caregivers' evaluation was 7.41 (0–10), and in five cases, parents did not accept the surgery. In the Schanz osteotomy group, parents' evaluation was 5.9 (0–10), and in eight cases, caregivers would not repeat surgery. In the proximal femoral resection group, satisfaction was the highest, 8.3 (3–10), and only two parents would not decide for surgery again.Conclusion: All procedures can be considered as palliative treatment options for pain complain in a spastic hip joint dislocation in children with CP. Steroid injections to the hip joint need to be repeated, and with the follow-up time, it becomes less effective. Steroid injection seems to be the treatment of choice for patients with general anesthesia contraindications. Interposition arthroplasty of the hip joint seems to give better final results, but the highest parents' satisfaction surprisingly was observed in the proximal femoral resection group, but differences were not statistically significant.

Rethinking family (dis)engagement with augmentative &amp; alternative communication

AbstractAugmentative and Alternative Communication (AAC) is a core component of special education for many children with learning disabilities and/or autism who have minimal or no speech. Much literature focuses on implementation of AAC in the classroom or therapy setting, but less is known about how AAC is used in the family home. Few studies are authored by an AAC parent/researcher with reflection on positionality, power and the advantages conferred by ‘insider’ status. This paper addresses this gap by exploring the perspectives of five families of minimally verbal children on the place of AAC in their child’s home communication. Semi‐structured family interviews were transcribed and subjected to Thematic Analysis. Formal AAC practices such as Picture Exchange Communication System (PECS) and Makaton were found to play a limited role in the children’s home communication. Findings indicate three possible explanations: the emotional and relationship‐building dimensions of family communication; the competing priorities of family life with a disabled child; and the child’s existing multimodal communication strategies including the use of household objects. These findings offer a preliminary starting point for understanding the emic perspectives of AAC families and reasons for their convergence/divergence with professional attitudes to AAC, and warrant further investigation in larger‐scale studies.

Сhange in figurative ideas of women’s quality of life depending on age

Objective. To assess the quality of life of refugee women.&#x0D; Material and methods. 149 refugee women, who are close relatives in three generations, were examined and divided into 3 groups depending on their age: Group I 51 women aged 1835 years, group II 61 women aged 3654 and group III 34 women aged 55 and over. The quality of life was assessed in two main ways: by self-assessment (subjective method) and by doctors (objective approach). The studies regarding the quality of life were carried out in accordance with the general principles of sociological research. The assessment was realized in points for each criterion. The maximum scale corresponds to 100 points. Along with this program, the international standardized questionnaire SF-36 was used in addition.&#x0D; Results. The data we obtained in the course of the study, first of all indicate the importance of the life priorities of the subjects examined and must be taken into account when planning measures to improve the quality of health.&#x0D; Conclusions. Comparative analysis of health-related quality of life indicators showed that among women parameters of physical functioning significantly decrease with age, regardless of the hierarchy of life priorities. Psychological components increase in middle-aged women with the life priority work.