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Occupational Therapy Interventions for School-Aged Children to Improve Handwriting Outcomes: A Systematized Review
Get PDFImportance: The development of handwriting skills builds a child’s confidence, self-esteem, fine motor skills, ability to communicate effectively and overall academic success (Feder & Majnemer, 2007).
Objective: The purpose of this systematized review was to determine which occupational therapy interventions are most effective for improving handwriting outcomes for prekindergarten through 3rd grade students.
Data sources: Searches were performed by a medical librarian in PubMed, CINAHL and ERIC including articles from 2014 to 2024.
Design: Studies were included if they were English-language articles with a level of evidence of I, II, or III that focused on occupational therapy interventions with an outcome of improving handwriting for students in prekindergarten through third grade who did not have a specific diagnosis or disability. Included articles were organized into an evidence table and synthesized. Articles were graded with the U.S. Preventative Task Force (2018) grade definitions.
Findings: Twenty articles met inclusion criteria, and four themes emerged: cognitive, sensory-based, motor-based, and multiple components interventions. One IA, five IIB, and four IIIB articles provide moderate evidence for multiple component interventions. Four IIIB and one IIB articles provide moderate evidence for cognitive interventions. Three IIB articles provide moderate evidence for motor interventions. Two IIIB articles provide moderate evidence for sensory interventions.
Conclusions and relevance: Findings suggest that a variety of occupational therapy interventions, including cognitive, sensory-based, motor-based, and multiple component interventions can effectively improve handwriting skills in school-aged students. Improvement was noted in all studies, which used varied measures of handwriting.
What this study adds: This review highlights that a range of interventions within the scope of occupational therapy are effective for improving handwriting among school-aged children. References:
Feder, K. P. & Majnemer, A. (2007). Handwriting development, competency, and intervention. Developmental Medicine & Child Neurology, 49(4), 312-317. https://doi.org/10.1111/j.1469-8749.2007.00312.x
U.S. Preventive Services Task Force. (2018). Grade definitions. https://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitionshttps://digitalcommons.unmc.edu/cahp_ot_sysrev/1019/thumbnail.jp
Involvement of NLRP6-Dependent Pyroptosis in Methamphetamine-Induced Neuroinflammation
No full textMethamphetamine (Meth) is a widely abused drug associated with significant neuroinflammation and neurodegeneration, mainly through the activation of glial cells and neurons in the central nervous system. Though, the etiologies of Meth-induced neurotoxicity are numerous, neuroinflammation is a focal point in mediating this pathology. Mounting evidence implicates inflammasome proteins as critical mediators regulating cellular activation, thereby impacting altered homeostasis of several crucial biological processes. While Meth has been shown to change the gene expression profiles of various CNS cells, there is a knowledge gap in our understanding of how Meth mediates the activation of astrocyte-specific NLRP6 (NOD-Iike receptor family, pyrin domain-containing protein 6) that controls cellular activation. This study investigates the role of the astrocyte-specific NOD-like receptor family pyrin domain-containing protein 6 (NLRP6) inflammasome in Meth-induced astrocytic pyroptosis and neuroinflammation. Our findings demonstrate that Meth exposure induces NLRP6-dependent pyroptosis, astrocyte activation, and the release of proinflammatory cytokines in mouse primary astrocytes. Gene silencing of NLRP6 reduces Meth-induced pyroptosis, and proinflammatory cytokines release. We also identified miR-152 as a critical upstream regulator of NLRP6, which is downregulated in Meth-exposed astrocytes. Overexpression of miR-152 decreases NLRP6 expression, mitigating Meth-induced pyroptosis and inflammation. In vivo and ex vivo studies in Meth-exposed mice confirmed these results and showed that Meth induces anxiety-like, cognitive impairment and depression-like behavior, further linking astrocyte-specific NLRP6 signaling to Meth-induced neuroinflammation. This study highlights the potential of targeting the NLRP6 inflammasome in astrocytes as a therapeutic approach to alleviate Meth-induced CNS pathology. Further research is warranted to explore clinical applications and identify therapeutic targets for Meth-related neurological disorders
Knowledge and Practices of Parents of School Age Children Towards Helminthiasis and Malaria in Northwestern Ethiopia
Get PDFBACKGROUND: Helminthiasis and malaria prevail in developing countries including Ethiopia, where they claim lives, retard physical and mental growth, reduce productivity and contain economic growth. Implementing helminthiasis and malaria control strategies require adequate knowledge and practices of the affected communities. Knowledge and practices of parents of school age children was assessed in relation to risk of child infection with Helminthiasis and malaria.
METHODS: A total of 398 parents of school age children attending Maksegnit Number Two Elementary School from September 2020 to June 2021 were interviewed regarding their sociodemography, knowledge and practice towards Helminthiasis and malaria. The risk of child infection with Helminthiasis and malaria in relation to sociodemography and household practices was tested using multivariable logistic regression model.
RESULTS: Risk of child infection with Helminthiasis was lower when the responding parent was female (OR = 0.54; CI = 0.32-0.92) and monthly household income was ≥ 2001 birr (OR = 0.39; CI = 0.22-0.70). A monthly income of ≥ 2001 birr was associated with a low risk of child infection with malaria (OR = 0.37; CI = 0.21-0.65). Children living with married parents were at higher risk of Helminthiasis (OR = 2.25, CI = 1.33-3.81) and malaria (OR = 2.71, CI = 1.60-4.58) infection. Latrine with wooden floor was correlated with a high risk of child infection with Helminthiasis (OR = 7.2; CI = 2.16-23.95). While washing with soap after toilet (OR = 0.09; CI = 0.03-0.34) and eating washed cabbage/fruit (OR = 0.26; 0.15-0.44) were associated with a lower risk of infection. Parents who participated in environmental management based vector control were less likely to report child infection with malaria (OR = 0.44; 0.20-0.97). A child living in residual insecticide sprayed house was at risk of malaria infection (OR = 3.16; CI = 1.45-6.92).
CONCLUSIONS: In general female responding parent, higher household income, and washing with soap after toilet or eating washed cabbage/fruit were associated with decreased risk of intestinal helminthiasis infection in children. In addition, higher income and participation in enviroinmental management based vector contol were associated with decreased malaria infection risk in children
Hour of Life at Enteral Feeding Initiation and Associated Clinical Morbidity in Extremely Low-Birth-Weight Infants
Get PDFBACKGROUND/OBJECTIVES: Identifying nutritional interventions in extremely low-birth-weight (ELBW) infants (\u3c1000 \u3eg) that are associated with favorable clinical outcomes is important. Delayed enteral feeding initiation (\u3e3 days) has been associated with increased odds of developing morbidity. Therefore, the aim of this study is to evaluate the relationship between hour of life at enteral feeding initiation and associated clinical outcomes.
METHODS: An IRB-approved retrospective chart review evaluated ELBW infants. Birth acuity was evaluated using CRIB II scoring and incidence of various morbidities (bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and spontaneous intestinal perforation (SIP)) and mortality was assessed after adjustment.
RESULTS: A total of 27/61 (44.3%) initiated enteral feedingNEC, SIP, or death between categories of hour of life at enteral feeding initiation. After adjusting for CRIB II scores, enteral feeding initiation ≥12 h of life was associated with more days receiving oxygen \u3e21% inspired air (β = 32.7;
CONCLUSIONS: Timing of enteral feeding initiation may be delayed in ELBW infants with higher clinical acuity, yet later initiation by hour of life is associated with worsened clinical respiratory outcomes. Early initiation within the first 12 h of life is feasible and was not associated with gastrointestinal morbidity in this single-center cohort of ELBW infants
Nanoscale Characterization of Interaction of Nucleosomes with H1 Linker Histone
Get PDFIn eukaryotic nuclei, DNA is wrapped around an octamer of core histones to form nucleosomes. H1 binds to the linker DNA of nucleosome to form the chromatosome, the next structural unit of chromatin. Structural features on individual chromatosomes contribute to chromatin structure, but not fully characterized. In addition to canonical nucleosomes composed of two copies each of histones H2A, H2B, H3, and H4 (H3 nucleosomes), centromeres chromatin contain nucleosomes in which H3 is replaced with its analog CENP-A, changing structural properties of CENP-A nucleosomes. Nothing is known about the interaction of H1 with CENP-A nucleosomes. Here we filled this gap and characterized the interaction of H1 histone with both types of nucleosomes. H1 does bind both types of the nucleosomes forming more compact chromosome particles with elevated affinity to H3 nucleosomes. H1 binding significantly increases the stability of chromatosomes preventing their spontaneous dissociation. In addition to binding to the entry-exit position of the DNA arms identified earlier, H1 is capable of bridging of distant DNA segments. H1 binding leads to the assembly of mononucleosomes in aggregates, stabilized by internucleosome interactions as well as bridging of the DNA arms of chromatosomes. Contribution of these finding to the chromatin structure and functions are discussed
Bio-Preparedness in a Global Context: Multi-Site International Study Investigating Global Health Security Challenges in Egypt, Oman, and the United States
Get PDFThe COVID-19 pandemic exposed myriad vulnerabilities globally within public health systems, from inadequate bio-risk management in laboratories to overwhelming utilization of hospital resources and disparities in vaccine access and uptake. The Global Health Security Index (GHSI), which critically evaluates health security domains including health systems and risk environments, reports serious weaknesses in global health security. This dissertation aims to investigate critical aspects of global health security domains by examining factors impacting biosafety and biosecurity capacities in laboratories in Egypt, healthcare resource utilization in hospitals in Oman relating to acute respiratory infections (ARI), and COVID-19 vaccine uptake in the United States. In the first study, results show that laboratory characteristics, specialization, and employee training are significant predictors of biosafety and biosecurity knowledge and practices. Emphasizing a multidisciplinary approach to biosafety and biosecurity training that incorporates both technical and administrative perspectives leads to improvement in biosafety and biosecurity knowledge and practices. In the second study, results show that oxygen therapy, geographic location and institutional policies are significant predictors of healthcare resource utilization beyond that attributable to disease severity. The development and standardization of policies, resource allocation, and healthcare strategies to manage patients more effectively leads to improvement in health outcomes and reduced burden on healthcare systems. In the third study, results show a novel finding that immigrant populations had higher vaccine uptake than native-born Americans, particularly in the Midwest region. This suggests that further studies of the immigrant population – a supposedly vulnerable population for health care access – are necessary to identify risk environment factors associated with vaccine uptake. To promote vaccination equity, public health interventions will have to go beyond traditional models to utilize novel mechanisms to improve vaccine uptake among vulnerable populations. By developing a more thorough understanding of biosafety and biosecurity knowledge and practices in laboratories in a lower-middle income country, hospital resource utilization and disease severity in a higher-income country, and COVID-19 vaccine uptake among vulnerable populations in a higher-income country, this multi-site international study contributes to the global health security knowledge base that informs more effective public health policies and interventions
Digitally Printed Assessment Tool for Identification of Simulated Tooth Occlusal Interferences
No full textObjectives: Digitally printed casts of dentitions were designed for identifying types of occlusal tooth interferences (premature first contact, left and right working, non-working, protrusive) and 2 occlusal schemes (canine or group guidance). Pre and post assessments were compared including respondents perceived level of confidence understanding occlusal interferences. Method: Lauria Flex® typodont was scanned using Trios® scanner. Five study cast sets, digitally designed with tooth morphology modifications, were printed in SprintRay® resin, mounted on Hanau WideVue® articulators with GC® acrylic resin custom incisal tables to prevent wear during closure, lateral excursive and protrusive movement. Each case illustrated a type of occlusal interference. Dental students(D2) were allowed 1 minute/set to visually inspect and/or use shimstock occlusal foil/hemostat to identify occlusal scheme and tooth interference. Participants indicated response confidence using Likert scale (1-unconfident,2-somewhat unconfident,3-somewhat confident,4-confident). Assessment tool was used prior to and following completion of preclinical fixed prosthodontics course. Results: Pre-assessment frequency of correctly identified occlusal interferences from highest to lowest: Premature initial tooth contact (92%), working side occlusal interference (48%), protrusive movement occlusal interference (38%), working side occlusal interference (14%), non-working side occlusal interferences (12%).Pre-assessment median confidence level for correctly identifying 5 types of occlusal interferences and 2 occlusal schemes was “somewhat unconfident”. Pre-assessment indicated no statistical difference in median confidence levels between respondents who answered correctly compared to incorrectly for each of the five cases. Fisher exact test compared differences in correctly answered case questions between pre(N=50) and post assessments(N=58). Wilcoxon rank sum test compared pre/post median values of specific confidence questions. Identifying non-working side occlusal interferences was significantly improved when comparing median response pre and post assessment scores (p\u3c.05). Confidence increased post assessment (p\u3c.05) for each identified interference type and occlusal scheme. Conclusion: Printed simulated dentitions on a articulator may be beneficial assessing occlusal tooth interference knowledge and a self-reflection tool
Interprofessional Team Performance in Pediatric Settings: Analyzing Reflections from QI-Trained Medical Students
No full textBackground: The aim of this study was to analyze reflections on interprofessional team performance from medical students who received quality improvement (QI) training and consider implications for identifying the facilitators of and barriers to effective team-based care in pediatric settings. Methods: Survey evaluations and narrative reflections were completed by third-year students (M3s) at a single U.S. allopathic medical school during their pediatric clerkship after receiving training in TeamSTEPPS® and Institute for Healthcare Improvement (IHI) Open School, two programs that support QI in healthcare. Descriptive statistical and inductive thematic analyses were conducted on the resulting 183 narratives, along with the development of a valence rating system. Results: Inductive thematic analysis generated 40 themes that were grouped under the five TeamSTEPPS® skill domains into thematic maps. The most common themes were patient care, rounding style, and intra-team communications. High-performing teams demonstrated open communication, role clarity, shared understanding, and organized task delegation. Low-performing teams displayed a lack of information exchange, uncertain team roles, unhealthy power dynamics, and disorganized task delegation. The narrative findings were summarized in an evidence-informed figure that highlighted qualities of high and low-performing teams. Conclusions: After instruction in QI methods, pediatric clerkship students identified consistent drivers of and barriers to effective team performance. The themes within the narrative reflections can provide insights on improving patient care delivery. The evidence-informed figure detailing elements of interprofessional team performance can be used as a framework to inform future QI studies and current team-based, interprofessional care in pediatrics
How to Evacuate When Disaster Strikes: A Literature Review of Hospital Evacuations
Get PDFHospitals are an essential component of any community’s infrastructure, and due to the nature of their services they are vulnerable when a disaster strikes. If a disaster is severe enough to warrant a hospital evacuation, both hospital and community leaders must decide how to proceed with the resources at their disposal. Organizations such as the World Health Organization, the United Nations, and the United States Department of Health and Human Services offer general guidance, but specifics as to how a hospital should proceed with an evacuation are left to individual hospital leaders and emergency management teams. This capstone project will review the existing literature surrounding hospital evacuations as well as recommendations from international authorities, identify gaps in current literature and official recommendations, and pinpoint opportunities for improvement in future hospital evacuations. As an attempt to address gaps in the literature, a four-step framework that can be utilized to provide structure to a hospital undertaking an evacuation will be recommended
Evaluating the Effectiveness of Video Self-Monitoring on Staff Treatment Integrity during Covert and Overt Observations
Get PDFPrevious research has shown low treatment integrity can lead to decreased effectiveness and efficiency of skill acquisition during discrete-trial instruction (DTI; Carroll et al., 2013). Pantermuehl and Lechago (2015) found that during covert observations, treatment integrity ranged from 18.6 to 76% whereas during overt observations, integrity was as high as 100%. This shows reactivity is an obstacle within DTI service delivery. It is important to investigate how reactivity affects staff performance and identify ways to increase and maintain high integrity. Finding a socially acceptable, effective, and efficient method to increase and maintain high levels of staff treatment integrity during covert observations is critical in the clinic setting. The purpose of the current study was to examine the effectiveness of video self-monitoring in increasing and maintaining high treatment integrity for staff implementing DTI during covert and overt observations. Participants included four staff working one-on-one with children with autism spectrum disorder (ASD) implementing DTI with less than 90% integrity during covert or overt observations. Results show video self-monitoring was effective at increasing staff treatment integrity and maintaining high integrity over time