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Exploration of Learning Preferences for Parents of Children with Sensory Over-Responsivity: A Mixed-Methods Study
No full textImportance: Parent education is essential to pediatric occupational therapy (OT), yet there is a paucity of research regarding how to best support parents as adult learners.
Objective: To explore the learning experiences of parents of children with sensory over-responsivity (SOR).
Methods: An embedded mixed-methods design was used. Sixteen parents of children with SOR, aged 3–8 years, were recruited using purposive sampling. All parents participated in group trainings; of these, nine participated in one-on-one interviews. Quantitative data included pre-intervention parenting self-efficacy (PSE) scores and post-intervention learner satisfaction measures. Semi-structured interviews were used to explore parents’ learning experiences during group trainings.
Intervention: Group trainings included varied learning opportunities focused on a problem-solving tool, A SECRET, to help parents support their children in varied contexts.
Results: Five themes were extracted from interview data: 1) Learning process, 2) Learning challenges, 3) Fluctuating PSE, 4) Peer support, and 5) Future training suggestions. Quantitative analysis indicated no correlation between PSE and learning satisfaction. Mixing of methods provided support for understanding fluctuating PSE.
Conclusions and Relevance: This study provides insight into parents\u27 learning preferences and suggests A SECRET may enhance parent training. Findings indicate PSE may fluctuate for parents of children with SOR, warranting further investigation into both A SECRET\u27s effectiveness and PSE\u27s potential impact on parent learning.
Plain Language Summary:
In this study, authors explored parents’ learning needs and their sense of confidence in parenting skills. Parents participated in workshops focused on using a problem-solving tool (A SECRET) that is used to organize supports and strategies for their children with sensory over-responsivity. Parents took part in interviews, providing insights into their learning experiences. Results indicated that parents benefitted from having a structured framework (A SECRET) to organize information from the workshops. While some parents felt overwhelmed by the amount of information presented, they agreed that they appreciated different types of learning opportunities. Most parents reported their confidence in parenting fluctuated depending on their child’s behavior at any given moment. While this study was limited by its small size and lack of diversity, the findings suggest that therapists should consider using varied teaching methods and structured tools when educating parents. This information can help improve how therapists teach parents to support their children with sensory challenges
Prebiotics to Augment the Gut Microbiome for Patients with Lymphoma or Multiple Myeloma Undergoing Autologous Hematopoietic Stem Cell Transplantation: The Primal Trial
No full textIn autologous hematopoietic stem cell transplantation (ASCT), post-transplant loss of microbiota taxa and diversity has been associated with adverse outcomes. We hypothesized that administration of resistant starch, a prebiotic, pre- and post-ASCT would prime the gut microbiome to preferentially support key microbiota members, maintain diversity, and reduce antibiotic exposure. We conducted the PRIMAL trial as a randomized, placebo-controlled, double-blind pilot study comparing resistant potato starch (RS) with a placebo (maltodextrin). The primary endpoints were feasibility and impact on gut microbiome diversity. RS was well tolerated at all time points, meeting the prespecified feasibility cutoffs: over 70% of subjects received 80% of the intended doses pre-transplant, and over 70% completed RS doses on over 50% of post-transplant days. Differential abundance calculations identified statistically significant improvements in known RS-degraders and short-chain fatty acid producers, including Ruminococcus and Bifidobacterium. IV antibiotic exposure was lower in the RS cohort than in the placebo (43% vs 58%), but the difference was not statistically significant (p = 0.33). There were no significant improvements in alpha diversity at the tested pre- and post-transplant time points compared with placebo. A comparison of IV antibiotic exposure between the RS cohort and a historical cohort of lymphoma patients undergoing ASCT between 2012 and 2022 showed a statistically significant reduction (43% vs 82%, p \u3c 0.001). We conclude that RS is feasible, well-tolerated, and produces significant increases in short-chain fatty acid producers post-transplant, with the potential to reduce IV antibiotic exposure. These findings support continued development of prebiotic approaches to target the gut microbiome as a therapeutic strategy to improve outcomes in patients with hematologic malignancies receiving cellular therapy
Occupational Therapy Interventions for Health, Safety, & Wellbeing In Farmers and Ranchers with Disabilities: A Systematized Review
No full textObjective: This systematized review synthesizes evidence on occupational therapy (OT) interventions that enhance health, safety, and participation of agriculture workers with disabilities, advancing evidence-based, context-specific approaches in OT practice.
Abstract: Background: Farmers and ranchers have higher rates of injury, disability, and chronic conditions than the general population. These challenge their health and lifestyle (National Institute for Occupational Safety and Health, 2024; Miller & Aherin, 2018; Desai et al., 2022).
Purpose: To determine the effectiveness of interventions within the scope of OT at improving safety, health, and well-being amongst agricultural workers with disabilities.
Design: We performed a systematized review of peer-reviewed literature on OT interventions for injury prevention, health, and well-being in farmers and ranchers with disabilities. Inclusion criteria included English-written quantitative studies.
Method: A medical librarian conducted Medline, Scopus, and CINAHL searches yielding 535 titles and abstracts. Of these, 98 full texts were reviewed, and 7 articles met inclusion criteria. Strength of evidence was based on U.S. Preventive Services Task Force definitions (2018).
Results: 5 themes emerged: Mindfulness training, ergonomic education with exercise, self-management strategies, AgrAbility participation, and population-level safety/adaptive equipment. A IB randomized control trial (RCT) found moderate evidence for acceptance and commitment therapy. A 1B RCT found moderate evidence for ergonomics with exercise. A 2B and 3B study found moderate evidence in self-management. 2 3B studies found moderate evidence for AgrAbility. 1 3B study found low evidence for population-level adaptive equipment.
Conclusion: To improve health, safety, and well-being among farmers with disabilities, OTs should routinely consider mindfulness, ergonomic, and AgrAbility interventions. Tier 1 safety device interventions may be used case-by-case. An interdisciplinary, client-centered, and context-specific approach is most effective. Further controlled studies are needed. The proposal is relevant to practice by outlining evidenced OT interventions for improved wellbeing in farmers with disabilities.
References:
Desai, B., Sahni, S., Jordan, H., Sahni, R., Reinbeau, R., Nguyen, A., & Babalola, O. (2022). Risk of cardiovascular disease in male farmers over the age of 45: A review of literature. Cureus, 14(5), Article e24642. 10.7759/cureus.24642
Miller, C. D., & Aherin, R. A. (2018). The prevalence of disabilities in the U.S. farm population. Journal of Agricultural Safety and Health, 24(4), 243–260. https://doi.org/10.13031/jash.12934
National Institute for Occupational Safety and Health. (2024). Agriculture worker safety and health. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/niosh/agriculture/about/index.html
U.S. Preventive Services Task Force. (2018). Grade definitions. https:// www.uspreventiveservicestaskforce.org/Page/Name/grade-definitionshttps://digitalcommons.unmc.edu/cahp_ot_sysrev/1030/thumbnail.jp
Wildfire Smoke and Public Health: Comparing 2023 Canadian Wildfire Events with Hospital Admissions in Douglas County, Nebraska
No full textWildfires are becoming increasingly common in Canada and the United States. Smoke produced from these fires creates a multitude of air pollution constituents that can cause breathing and other health issues for humans, particularly those with asthma and other respiratory conditions. Of these pollutants, PM2.5 (particulate matter that is 2.5 microns or smaller) is particularly problematic as these particles are inhaled deep into lung tissue, where they create inflammation and oxidative stress. Poor air quality can also trigger asthma and respiratory issues, leading to an increase in emergency department admissions for breathing treatments. The goal of this study is to examine the effects of a Canadian wildfire event in September of 2023 on hospital admissions in Douglas County, Nebraska. Local hospital admission data for Douglas County, Nebraska was used to determine asthma-related emergency department visits along with local air quality data from the Douglas County Health Department that includes PM2.5 air quality data. These data sets will be used to determine if poor air quality can negatively impact individuals and whether it increases emergency department admissions. This study can help provide advanced public health communications and assist hospital teams for a potential increase in patients following a wildfire event. In addition, the information can be used to help the public prepare for these events in advance
Influence of Food Insecurity on Adolescent Mental Health: A Comprehensive Literature Review
No full textFood insecurity is a growing public health concern with significant implications for adolescent mental health. This literature review provides an overview of current research on the relationship between food insecurity and adolescents’ mental health in the United States. A literature review was completed to identify studies examining the association between food insecurity and anxiety, depression, or attention deficit disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD). Evidence shows that the experience of food insecurity in adolescence is associated with a higher risk of developing or experiencing an exacerbation of anxiety, depression, or ADD/ ADHD. This review utilizes the socioecological model to explain the different levels of societal influence. By using the socioecological framework, this review highlights how individual, interpersonal dynamics, institutions, organizations, communities, systems, and structures interact to protect from or worsen adolescents’ experience of food insecurity and mental health conditions. By sharing findings from all levels of influence, this review aims to identify how a multi-level public health approach would help reduce the incidence and prevalence of food insecurity during adolescence
Pregnancy Outcomes after Exposure to Tuberculosis Treatment in Phase 3 Clinical Trial, 2016-2020
No full textA previous study demonstrated noninferior efficacy of 4-month rifapentine/moxifloxacin regimen for tuberculosis (TB) treatment compared with the standard regimen. We analyzed pregnancy outcomes of women who became pregnant during the study. Among 740 women, 97 (13.1%) became pregnant. Of 102 pregnancies (in 97 participants), 30 (29.4%) participants were exposed to study drugs. Fetal loss was reported for 3/13 (23.1%) in the control regimen, 1/9 (11.1%) in the rifapentine/moxifloxacin regimen, and 1/8 (12.5%) in the rifapentine regimen. Among 21 live births in exposed pregnancies (7 in each arm), 1 infant with a congenital anomaly was reported in a participant on the rifapentine regimen. Among women receiving a short rifapentine/moxifloxacin regimen for tuberculosis who became pregnant, we observed no elevated rates of fetal losses or congenital anomalies
Individualized Care Plans for High Utilizers
Full text linkFrequently admitted patients (i.e., ‘high utilizers’) comprise a small percentage of all patients yet consume a relatively large proportion of hospital resources. This quality improvement project aimed to reduce hospital resource utilization by implementing individualized care plans (ICPs) for high utilizers. An electronic health record (EHR) report identified high utilizers. A hospitalist workgroup then selected patients who were relatively young with frequent low-risk admissions. The workgroup created and documented ICPs in the EHR, then linked to the ICPs from numerous locations. For the selected patients, total admissions per year were reduced from 125 to 41 (-67%) and days per year in hospital from 497 to 219 (-56%), while length of stay was increased from 4 to 5.4 (+26%) days. Implementation of ICPs can allow high utilizers to spend more time at home, while simultaneously freeing up valuable hospital resources for the community. Making ICPs easily accessible is key to success
Schistosoma haematobium Infection and Associated Risk Factors Among Pre-school Age Children in Gambella, Ethiopia
Full text linkBackground Schistosoma haematobium can infect and cause morbidity in pre-school age children (PSAC) and due to its gradual nature, often goes unnoticed in its early stages and can result in long-term irreversible consequences during their most productive years. This study aimed to determine the prevalence, intensity, and associated risk factors of S. haematobium infection among PSAC in Gambella, Ethiopia. Method A cross-sectional study was conducted from July to August 2024 among 390 PSAC in four localities in Gambella, Ethiopia. Urine specimens were examined microscopically and with urinalysis reagent strips. Data on associated factors and socio-demographic characteristics were collected from the PSAC mothers/caregivers using a structured questionnaire. Result The overall prevalence of S. haematobium infection was 16.7 %, of which 20 % (13/65) had heavy-intensity of infection. The prevalence of macro and microhematuria were 7.9 %, and 26.2 %, respectively. The prevalence of infection was significantly higher among PSAC who visited open water sources (90.8 %, P \u3c 0.001), bathed in open water (89.2 %, P = 0.004), and urinated in open water (89.2 %, P = 0.004), as well as among residents of Abaro and Tagni villages (72.3 %, P \u3c 0.001) and who had mothers with no formal education (81.5 %, P = 0.006). The odds of infection were higher among children who played or bathed in infested water (AOR: 2.9, CI: 1.0–8.1) and those living in Abaro village (AOR: 4.3, CI: 1.6–11.9) compared to those who did not engage in these behaviors or lived in other villages, respectively. Conclusion The study showed that S. haematobium infection is prevalent among PSAC in Gambella region in Ethiopia, and contact with an open water while playing, bathing or urinating may increase the risk of acquiring infection with the parasite in this population group. These findings will contribute to a better understanding of the epidemiology of the disease among PSAC
Development of an Occupational Therapy-Specific Clinical Guide for Use of Electrical Stimulation with Spinal Cord Injury: A Modified Delphi Approach Protocol
Full text linkObjective: To establish a method for the development and validation of a clinical guide for the use of electrical stimulation (ES) in occupational therapy for individuals with spinal cord injuries (SCI).
Design: A modified Delphi Approach
Participants: 5 geographically dispersed occupational therapists with advanced expertise in use of ES with SCI.
Outcome Measures: Participants rated sections of a draft guide across three rounds, focusing on clarity, accuracy, and clinical relevance. Additionally, p Participants provided suggestions regarding specific revisions to content that were incorporated in subsequent iterations of the guide across all three rounds. Additionally, post-Delphi process participants completed a survey gathering preliminary validity, utility, and acceptability.
Results: The iterative process resulted in a refined guide with high approval ratings from participants, averaging 88% across all sections by the final round. Participants deemed the guide necessary, implementable, and able to be integrated into clinical practice.
Conclusion: The validated content and relevance of the ES for SCI clinical guide aims to enhance OT practitioners\u27 competence in using it, promoting better patient outcomes
Transcriptomic and Epigenomic Profiling of Immune Cells Responses to Simian Immunodeficiency Virus Infection in the Brain
Full text linkHuman immunodeficiency virus type 1 (HIV-1) is an enveloped retrovirus that significantly impairs the human immune system. A common complication of HIV-1 infection is HIV-associated neurocognitive disorder (HAND), which, prior to the introduction of antiretroviral therapy (ART), led to considerable morbidity and mortality due to untreated neuropsychiatric manifestations. Although ART has substantially reduced the incidence of HIV-associated dementia (HAD), approximately 50% of people living with HIV (PLWH) continue to experience milder forms of HAND. The CNS is seeded by HIV during the acute phase of infection. Once in the brain, HIV targets and activates resident immune cells, primarily microglia and CNS-associated macrophages (CAMs), leading to sustained neuroinflammation and neuronal damage. These myeloid cells also act as viral reservoirs, contributing to the persistence of infection. Despite decades of research, the mechanisms of immune activation within the brain across different stages of HIV infection remain incompletely understood.
This dissertation addresses these knowledge gaps by delineating transcriptomic and epigenomic alterations in brain immune cells during the course of infection, utilizing next-generation sequencing (NGS) technologies in a simian immunodeficiency virus (SIV) infected rhesus macaque model.
Chapter 1 provides a comprehensive introduction, covering the epidemiology and cellular mechanisms of HIV and HAND, the clinical landscape of HAND under cART and in the context of drug abuse, animal models for HAND research, and the application of NGS technologies to study HAND at the transcriptomic and epigenomic levels.
Chapter 2 employs single-cell RNA sequencing (scRNA-seq) to characterize brain myeloid cell responses during acute SIV infection. The key phenotypes that exhibited transcriptional signatures linked to neurodegenerative disorders were identified and validated through IHC staining. Additional genes that were globally upregulated in brain myeloid cells in acute SIV infection have been associated with inflammatory signaling and cellular senescence.
Chapter 3 focuses on lymphocyte dynamics in the brain during acute SIV infection. Significant shifts in T cell phenotypes were observed, notably the loss of CD4+ memory T cells and expansion of proliferating cytotoxic CD4+ T cells, which expressed high levels of viral entry receptors (CD4, CCR5) and adhesion molecules (LFA-1, VLA-4). The cytotoxic CD4+ T cells harbored the highest SIV infection burden in the brain, implicating them as Trojan horse vectors for CNS infection. Collectively, this chapter offers a detailed transcriptomic landscape of lymphocytes and identifies phenotypes that may facilitate early viral dissemination into the CNS.
Chapter 4 characterizes brain myeloid cell phenotypes in chronic SIV infection and encephalitis (SIVE) using multiomic sequencing that integrates single-nucleus RNA-seq (snRNA-seq) and ATAC-seq (snATAC-seq). Two distinct myeloid phenotypes were identified in SIVE brains. Detection of a substantial number of SIV-positive cells and SIV DNA fragments helped the understanding of virus reservoir in brain myeloid cells. More SIV DNA at the long terminal repeat (LTR) regions was enriched near the FSTL5 gene of the host genome. The LTR region was also found to be enriched with host transcription factor (e.g. Sp1, NF-κB, NFAT) binding motifs, which further highlight virus-host interactions.
Chapter 5 explores the combined impact of SIV infection, morphine use, and cART on brain myeloid cells using multiomic approaches. Results show that cART restores myeloid cell homeostasis during infection, consistent with observations in HIV-infected individuals. However, integrative analyses of human and macaque data revealed a higher prevalence of activated/inflammatory phenotypes in human samples under cART. Morphine use was found to be associated with immunosuppressive effects in brain myeloid cells, including decreased expression of MHC class II and interferon-inducible genes. These findings enhance the understanding of the complex interactions between HIV/SIV infection, opioid exposure, and ART in shaping CNS immunity