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- Uvnäs-Moberg, Kerstin
(författare)
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A comparison of equine-assisted intervention and conventional play-based early intervention for mother-child dyads with insecure attachment
- 2015
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Ingår i: Journal of Occupational Therapy, Schools, & Early Intervention. - : Informa UK Limited. - 1941-1243 .- 1941-1251. ; 8, s. 17-39
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Tidskriftsartikel (refereegranskat)abstract
- Early interventions aim at promoting a good mother–child relationship as basis for a good socio-emotional development, especially in high-risk populations, and at correcting already unfavorable patterns of interaction and are common today. Insecure attachment, both of the child and of the mother, has been identified as a risk factor for early regulation disorders and further child development. Based on accumulating evidence of effectiveness of animal-assisted interventions, we implemented an Equine-Assisted Intervention (EAI) as an early intervention approach for mother–child-dyads and investigated its effects in comparison to a conventional play-based early intervention (PBI) in a randomized controlled trial. Both interventions took place once a week for 45 minutes over a period of 8 weeks and aimed at improving maternal caregiving and security in the mother–child relationship. Twenty mother–child dyads (children aged 12 to 24 months) from a high-risk background, in some of which the child already displayed dysregulation symptoms, were investigated. Attachment of mother and child, maternal caregiving, and interaction within the dyad were assessed before and after the intervention. There was not statistically significant difference (p < 0.05) between intervention groups with regard to changes from insecure to secure attachment or from disorganized to organized attachment, assessed via the Ainsworth Strange Situation Test. The only significant group-difference with regard to self-reported caregiving, was found for proximity maintenance in mothers without previous therapy experience (n = 8), those in the EAI reaching higher scores (p = 0.064). Play interaction, assessed via the CARE-Index, showed that mothers and children in PBI improved significantly more in their interaction behavior on several scales, while child’s difficultness only significantly improved in EAI.Overall both approaches led to significant improvements in mother–child relationship and interaction, both having specific advantages over the other. When given the choice, the majority of mothers would prefer EAI, which points to a potential motivational effect.
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| 2. |
- Okumura, N., et al.
(författare)
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Effects of sacubitril/valsartan in the PARADIGM-HF trial (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) according to background therapy
- 2016
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Ingår i: Circulation Heart Failure. - 1941-3289 .- 1941-3297. ; 9:9
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Tidskriftsartikel (refereegranskat)abstract
- Background - In the PARADIGM-HF trial (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure), the angiotensin receptor neprilysin inhibitor sacubitril/valsartan was more effective than the angiotensin-converting enzyme inhibitor enalapril in patients with heart failure and reduced ejection fraction. We examined whether this benefit was consistent irrespective of background therapy. Methods and Results - We examined the effect of study treatment in the following subgroups: diuretics (yes/no), digitalis glycoside (yes/no), mineralocorticoid receptor antagonist (yes/no), and defibrillating device (implanted defibrillating device, yes/no). We also examined the effect of study drug according to β-blocker dose (≥50% and <50% of target dose) and according to whether patients had undergone previous coronary revascularization. We analyzed the primary composite end point of cardiovascular death or heart failure hospitalization, as well as cardiovascular death. Most randomized patients (n=8399) were treated with a diuretic (80%) and β-blocker (93%); 47% of those taking a β-blocker were treated with ≥50% of the recommended dose. In addition, 4671 (56%) were treated with a mineralocorticoid receptor antagonist, 2539 (30%) with digoxin, and 1243 (15%) had a defibrillating device; 2640 (31%) had undergone coronary revascularization. Overall, the sacubitril/valsartan versus enalapril hazard ratio for the primary composite end point was 0.80 (95% confidence interval, 0.73-0.87; P<0.001) and for cardiovascular death was 0.80 (0.71-0.89; P<0.001). The effect of sacubitril/valsartan was consistent across all subgroups examined. The hazard ratio for primary end point ranged from 0.74 to 0.85 and for cardiovascular death ranged from 0.75 to 0.89, with no treatment-by-subgroup interaction. Conclusions - The benefit of sacubitril/valsartan, over an angiotensin-converting enzyme inhibitor, was consistent regardless of background therapy and irrespective of previous coronary revascularization or β-blocker dose. © 2016 American Heart Association, Inc.
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