Ingredients and change processes in occupational therapy for children: a grounded theory study

Background: There is limited evidence about the effectiveness of occupational therapy interventions for participation outcomes in children with coordination difficulties. Developing theory about the interventions, i.e. their ingredients and change processes, is the first step to advance the evidence base.

Aim: To develop theory about the key ingredients of occupational therapy interventions for children with coordination difficulties and the processes through which change in participation might happen.

Material and methods: Grounded theory methodology, as described by Kathy Charmaz, was used to develop the theory. Children and parents participated in semi-structured interviews to share their experiences of occupational therapy and processes of change. Data collection and analysis were completed concurrently using constant comparison methods.

Results: Five key ingredients of interventions were described: performing activities and tasks; achieving; carer support; helping and supporting the child; and labelling. Ingredients related to participation by changing children’s mastery experience, increasing capability beliefs and sense of control. Parents’ knowledge, skills, positive emotions, sense of empowerment and capability beliefs also related to children’s participation.

Conclusion and significance: The results identify intervention ingredients and change pathways within occupational therapy to increase participation. It is unclear how explicitly and often therapists consider and make use of these ingredients and pathway.     

Alexithymia is associated with low level of vitamin D in young healthy adults

Objective

Vitamin D plays an important role in brain development and functioning. Low levels of vitamin D have been described in several psychiatric and neurologic conditions including autism spectrum disorder. Alexithymia that shows high comorbidity with autism is also present in the general population as well as hypovitaminosis D.

Methods

Here we assessed the relation between alexithymia as measured by the Toronto Alexithymia Scale-20 and vitamin D level in healthy young adults.

Results

We found an inverse correlation between the levels of alexithymia and vitamin D.

Discussion

These data suggest the association between disturbed emotional processing and low levels of vitamin D to be present in young healthy subjects.     

Book Review

Changing the public health

Rcswch Unit in Health .ad Behaviourd Chutge. University of Edinburgh, John Wdey and Son, London, 1989, ISBN 0 471 91976 4.

The new public health

John Ashtw and RowYd Seymour. Open University Press, 1988. ISBN 0 335 15550 2, £6.95.

Infertility services-a desperate case

N d Pfeilu cmd Allison Qukk. Greater London Association of Community Health Councils, 1988.

A new kind of Doctor

Julian Tudor Hart. Merlin Press, 1988. ISBN 085036 299 7, £11.95 (hardback).     

The plausibility of maternal toxicant exposure and nutritional status as contributing factors to the risk of autism spectrum disorders

Recent research suggests the maternal environment may be especially important for the risk of developing autism spectrum disorders (ASD). In particular maternal infections, micronutrient deficiencies, obesity, and toxicant exposures are likely to interact with genetic risk factors to disrupt fetal brain development.

Objectives: The goal of this paper is to investigate the plausibility of maternal toxicant exposure and nutritional status as causal factors in the development of ASD.

Methods: This paper reviews current research investigating the hypothesis that maternal toxicant exposure and prenatal micronutrient intake are important modifiable risk factors for ASD.

Results: Zinc, copper, iron, and vitamin B9 are identified as specific micronutrients with relevance to the etiology of ASD. Specific toxicants induce a maternal inflammatory response leading to fetal micronutrient deficiencies that disrupt early brain development. Importantly, maternal micronutrient supplementation is associated with reduced risk of ASD. Furthermore, animal studies show that micronutrient supplementation can prevent the teratogenicity and developmental neurotoxicity of specific toxicants.

Discussion: These findings lead to the hypothesis that maternal infection, obesity, and toxicant exposures (e.g. valproic acid, endocrine disrupting plasticizers, ethanol, and heavy metals) are all environmental risk factors for ASD that lead to fetal micronutrient deficiencies resulting from a maternal inflammatory response. It could be possible to use markers of inflammation and micronutrient status to identify women that would benefit from micronutrient supplementation or dietary interventions to reduce the risk of ASD. However, more research is needed to demonstrate a causal role of fetal micronutrient deficiencies and clarify the underlying mechanisms that contribute to ASD.     

Reproductive and maternity health care services in Finland: perceptions and experiences of Somali-born immigrant women

Objective. To explore immigrant Somali women's experiences of reproductive and maternity health care services (RMHCS) and their perceptions about the service providers.

Design. Five focus group discussions were conducted from April 1999 to June 2000 using a purposeful sampling strategy in order to reach multiparous female Somali-born Immigrants with experiences from the maternity health care in Finland.

Participants. A total of 70 married Somali women aged 18–50 and mother of 2–10 children were studied. Among them, 18 came from Kenya, 32 from Mogadishu and 20 from Hargeysa.

Settings. Of the participants, 45 were living in the city of Vantaa, 22 in the city of Helsinki and 13 in the city of Turku.

Results. Participants were satisfied with the RMHCS they received in Finland. Despite their satisfaction, the health care providers' social attitudes towards them were perceived as unfriendly, and communication as poor.

Conclusions. The women's experiences revealed that they have access to good quality RMHCS in Finland. While their experiences are significant, their perceptions are important for physicians, nurses and midwives in order to achieve culturally competent care.     

Rodent control in urban communities in Johannesburg,South Africa: from research to action

Introduction:

Rodents are troublesome urban pests, with potentially serious health implications. Preventive efforts require greater understanding of social contexts in which they are prevalent. This study aimed to determine rodent prevalence and identify factors associated with rodent infestations in urban residential settings.

Methods:

The Health, Environment and Development study is a longitudinal panel study conducted in five settlements across Johannesburg. Data on socio-economic status, domestic behaviour and housing quality are collected annually. Logistic regression revealed risk factors for rodent prevalence at household level.

Results:

Rodents are a major household problem in all study areas (prevalence 54%). Factors associated with increased prevalence of rats included lower income, living in informal areas, overcrowding, cracks in dwelling walls and internal damp.

Conclusion:

Socio-economic status, housing quality, domestic behaviour and environmental health services are associated with exposure to rodents in urban Johannesburg communities. This information served as a platform to launch rodent awareness campaigns at study sites.     

Participation and occupation in occupational therapy models of practice: A discussion of possibilities and challenges

Background: Occupation has been the focus in occupational therapy practice to greater or lesser degrees from a historical viewpoint. This evokes a need to discuss whether concepts that are added to our field will enhance or blur our focus on occupation.

Aim: To explore how the concept of participation in the International Classification of Functioning, Disability and Health (ICF) is related to the concept of occupation by reviewing and comparing its use in three models of practice within occupational therapy. The aim was also to generate discussion on possibilities and challenges concerning the relationship of participation and occupation.

Method: The models reviewed were The Model of Human Occupation (MOHO), the Canadian Model of Occupational Performance and Engagement (CMOP-E) and the Occupational Therapy Intervention Process Model (OTIPM).

Results: The concept of participation was related to occupation in different ways in these models. Based on the review some challenges and considerations for occupational therapy were generated.

Conclusion: Relating the concept of participation from the ICF to the concept of occupation in models of practice can be challenging. At the same time, relating the concepts can be a resource to develop occupational therapy and the understanding of occupational issues in society.     

Postnatal protein malnutrition induces neurochemical alterations leading to behavioral deficits in rats: Prevention by selenium or zinc supplementation

Background/objectives

Protein malnutrition (PM) is a worldwide problem affecting brain development in a large number of children. The present study was aimed at studying the perturbations in antioxidant defense system resulting from protein deficiency and to evaluate the preventive effect of Se and Zn on cortex and cerebellum.

Methods

Well-fed (WF) and PM rats were fed on 16 and 5% protein diet, respectively. After 10 weeks, animals were supplemented with Se and Zn at a concentration of 0.15 and 227 mg/l in drinking water for 3 weeks.

Results

PM rats showed significant increase in lipid peroxidation, nitrite, and protein carbonyl levels. Reduction in the activity of antioxidant enzymes, thiol levels, GSH/GSSG ratio, and neurobehavioral deficits were observed in PM groups. Se and Zn supplementation reduced the levels of lipid peroxidation, nitrite, and protein carbonyl and restored the activity of antioxidant enzymes and thiol levels in the cortex and cerebellum of PM rats along with neurobehavioral deficits.

Discussion

The study showed that Se and Zn supplementation might be beneficial in preventing biochemical alterations and neurobehavioral deficits in PM children.     

Acceleration of reflex maturation and physical development in suckling rats: effects of a maternal diet containing lipids from goat milk

Objective

To investigate the effects of lipids from goat milk containing conjugated linoleic acids on body weight and reflex ontogeny of neonatal rats treated during the prenatal and suckling periods.

Methods

Three groups were studied: soybean oil (S), coconut oil (C), and goat milk lipids (GM). Reflex maturation (palm grasp, righting reflex, cliff avoidance, vibrissae placing, negative geotaxis, auditory startle, and free-fall righting) as well as body weight evolution were recorded during lactation.

Results

Data demonstrated that the lipids from goat milk accelerated body weight evolution as well as all the reflex maturation investigated (P < 0.05).

Discussion

The supply of goat's milk offered to Wistar rats during pregnancy and lactation provided a variety of fatty acids necessary to accelerate the development of offspring.     

Group triple P and child unintentional injury risk: a pilot study

Objective: Given the associations between externalizing behaviors and childhood unintentional injuries (CUI), this pilot study evaluated whether an empirically supported behavioral parent training program, Group Triple P, decreased risk for CUI.

Methods: Parents of 19 children ages 2–8 referred by their child’s primary care physician for child externalizing behavior problems completed measures of child injury risk pre- and post-Triple P.

Results: Child injury risk and disruptive behavior problems decreased significantly.

Conclusions: Overall, our findings indicate that teaching behavior management and parenting skills to parents has the potential to decrease injury risk in their children, despite this not being an explicit target of intervention.     

Impact of occupational,physical, and speech and language therapy in preschoolers with hyperactive/inattentive symptoms: A naturalistic 2-year follow-up study

Objective: Impact of speech and language therapy (ST) and occupational/physical therapy (OT/PT) on language and motor skills was examined in hyperactive/inattentive children.

Methods: Preschoolers were divided into those receiving and not receiving ST or OT/PT.

Results: Children receiving ST showed no gains in language functioning relative to those not receiving ST. OT/PT yielded similar results for motor functions. Hours of a service did not predict improvement. However, children who received ST showed improvement in social skills.

Discussion: The apparent lack of benefit suggests the need for further investigation into efficacy of these treatments in hyperactive/inattentive preschool children.     

Self-rating of daily time management in children: psychometric properties of the Time-S

Background: Impaired ability to manage time has been shown in several diagnoses common in childhood. Impaired ability involves activities and participation domain (daily time management, DTM) and body function and structure domain (time-processing ability, TPA). DTM needs to be evaluated from an individual’s own perspective. To date, there has been a lack of self-rating instruments for children that focus on DTM.

Aim: The aim of this study is to describe psychometric properties of Time-S when used in children aged 10–17 years with a diagnosis of ADHD, Autism, CP or mild ID. Further, to test whether TPA correlates with self-rated DTM.

Material and methods: Eighty-three children aged 10–17 years participated in the study. Rasch analysis was used to assess psychometric properties. Correlation analysis was performed between Time-S and a measure of TPA.

Results: The 21 items of the Time-S questionnaire fit into a unitary construct measuring self-perceived daily management of an individual’s time. A non-significant, small correlation was found between TPA and DTM.

Conclusion and significance: The results indicate good psychometric properties for the questionnaire. The questionnaire is potentially useful in intervention planning and evaluation.     

Synaptophysin and the dopaminergic system in hippocampus are involved in the protective effect of rutin against trimethyltin-induced learning and memory impairment

Objectives

This study aimed to investigate the protective effect of rutin against trimethyltin-induced spatial learning and memory impairment in mice. This study focused on the role of synaptophysin, growth-associated protein 43 and the action of the dopaminergic system in mechanisms associated with rutin protection and trimethyltin-induced spatial learning and memory impairment.

Methods

Cognitive learning and memory was measured by Morris Water Maze. The expression of synaptophysin and growth-associated protein 43 in hippocampus was analyzed by western blot. The concentrations of dopamine, homovanillic acid, and dihyroxyphenylacetic acid in hippocampus were detected using reversed phase high-performance liquid chromatography with electrochemical detection.

Results

Trimethyltin-induced spatial learning impairment showed a dose-dependent mode. Synaptophysin but not growth-associated protein 43 was decreased in the hippocampus after trimethyltin administration. The concentration of dopamine decreased, while homovanillic acid increased in the hippocampus after trimethyltin administration. Mice pretreated with 20 mg/kg of rutin for 7 consecutive days exhibited improved water maze performance. Moreover, rutin pretreatment reversed the decrease of synaptophysin expression and dopamine alteration.

Discussion

These results suggest that rutin may protect against spatial memory impairment induced by trimethyltin. Synaptophysin and the dopaminergic system may be involved in trimethyltin-induced neuronal damage in hippocampus.     

Impaired IQ and academic skills in adults who experienced moderate to severe infantile malnutrition: A 40-year study

Objectives

To evaluate IQ and academic skills in adults who experienced an episode of moderate-to-severe infantile malnutrition and a healthy control group, all followed since childhood in the Barbados Nutrition Study.

Methods

IQ and academic skills were assessed in 77 previously malnourished adults (mean age = 38.4 years; 53% male) and 59 controls (mean age = 38.1 years; 54% male). Group comparisons were carried out by multiple regression and logistic regression, adjusted for childhood socioeconomic factors.

Results

The previously malnourished group showed substantial deficits on all outcomes relative to healthy controls (P < 0.0001). IQ scores in the intellectual disability range (< 70) were nine times more prevalent in the previously malnourished group (odds ratio = 9.18; 95% confidence interval = 3.50–24.13). Group differences in IQ of approximately one standard deviation were stable from adolescence through mid-life.

Discussion

Moderate-to-severe malnutrition during infancy is associated with a significantly elevated incidence of impaired IQ in adulthood, even when physical growth is completely rehabilitated. An episode of malnutrition during the first year of life carries risk for significant lifelong functional morbidity.     

A community-based intervention for low-income families to reduce children’s blood lead levels between 3–9.9 μg/Dl

Introduction: In 2012, the Center for Disease Control announced children’s blood lead levels (BLLs) above 5 μg/dL should be provided assistance, as no level of lead exposure is safe.

Method: A community-based randomized controlled trial targeting children from low-income families (BLLs: 3–9.9 μg/dL) was implemented utilizing educational and environmental tactics.

Results: All groups evidenced a significant decrease in children’s BLLs and a significant increase in lead knowledge, but no main effects based on group assignment. When compared to a post-hoc passive control group, all intervention groups evidenced significant BLL reduction.

Discussion: Findings are discussed in terms of low-cost primary prevention initiatives and mechanisms explaining intervention efficacy.     

Racial discrimination,racial/ethnic segregation,and health behaviors in the CARDIA study

Objective

Racial discrimination has been associated with unhealthy behaviors, but the mechanisms responsible for these associations are not understood and may be related to residential racial segregation. We investigated associations between self-reported racial discrimination and health behaviors before and after controlling for individual- and neighborhood-level characteristics; and potential effect modification of these associations by segregation.

Design

We used data from the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) study for 1169 African-Americans and 1322 whites. To assess racial discrimination, we used a four category variable to capture the extent and persistence of self-reported discrimination between examination at years 7 (1992–1993) and 15 (2000–2001). We assessed smoking status, alcohol consumption, and physical activity at year 20 (2005–2006). Segregation was examined as the racial/ethnic composition at the Census tract level.

Results

Discrimination was more common in African-Americans (89.1%) than in whites (40.0%). Living in areas with high percentage of blacks was associated with less reports of discrimination in African-Americans but more reports in whites. After adjustment for selected characteristics including individual- and neighborhood-level socioeconomic conditions and segregation, we found significant positive associations of discrimination with smoking and alcohol consumption in African-Americans and with smoking in whites. African-Americans experiencing moderate or high discrimination were more physically active than those reporting no discrimination. Whites reporting some discrimination were also more physically active than those reporting no discrimination. We observed no interactions between discrimination and segregation measures in African-Americans or whites for any of the three health behaviors.

Conclusions

Racial discrimination may impact individuals' adoption of healthy and unhealthy behaviors independent of racial/ethnic segregation. These behaviors may help individuals buffer or reduce the stress of discrimination.     

Preventive behaviour at work – A concept analysis

Background: Preventive behaviour is a significant intervention target in order to promote health at work, but has never been discussed in an occupational perspective.

Aim: To clarify the concept of preventive behaviour at work.

Methods: The Walker and Avant (2011) method was used to conduct the study.

Results: The attributes of the concept are: (1) compliance with safety rules and procedures, (2) proactivity, participation, engagement and initiatives related to prevention, (3) maintenance of physical environment, (4) concern for social environment and (5) reflexivity and analytical skills of work situations. The analysis also identified the antecedents and the consequences of the concept that are all related to either the person, the environment or the occupation.

Conclusion: Preventive behaviour occurs when a worker shows an active involvement to comply with safety rules and procedures of his trade, takes initiatives to improve prevention, preserves his physical environment, communicates with his peers and analyses work situations before committing to it.

Significance: Occupational therapists have a central role in primary prevention of work injuries and have the expertise to help develop each of the five attributes of the concept of preventive behaviour.     

How children with cerebral palsy master bimanual activities from a parental perspective

Background: During childhood, children learn the daily life activities they want and need to do. Children with unilateral spastic cerebral palsy often have difficulties performing activities requiring two hands.

Aim: To describe parental reasoning on how children with unilateral spastic cerebral palsy learn to master the performance of bimanual activities in everyday life.

Material and methods: Sixteen parents participated in focus groups, a qualitative research approach with its own methodological criteria and research methods.

Results: One overall theme emerged from the analysis: ‘Finding harmony between pleasure and effort is the key to learning’. This overall theme arose as a synthesis of four themes: ‘awakening of the inner drive’, ‘trying on one’s own’, ‘enabling things to work’ and ‘it must be worth the effort´. The parents described when an activity woke their children´s inner drive to perform. Their children also strived to develop their own way to perform an activity, sometimes with the support of others, still, some activities were not possible to learn.

Conclusions: Occupational therapists and others in the children’s environment have an important mission to support the children to find their own harmony between pleasure and effort and their individual key to success in learning bimanual everyday activities.     

Dietary intake of fruits and beta-carotene is negatively associated with amyotrophic lateral sclerosis risk in Koreans: A case-control study

Objectives

Amyotrophic lateral sclerosis (ALS), a rare progressive neurodegenerative disease, has been suggested to have an association with oxidative stress, and thus antioxidant dietary factors may influence pathophysiological mechanisms or the risk of ALS. The purpose of the present study was to investigate the hypothesis that intake of fruits, rich in antioxidant nutrients, is negatively associated with the risk of ALS.

Methods

Seventy-seven Koreans diagnosed with ALS according to the EI Escorial criteria-revised and the same number of age- and sex-matched healthy controls participated in this study. Dietary intake was estimated using the standardized food frequency questionnaire.

Results

Multivariate logistic regression analysis showed that fruit consumption was negatively associated with the risk of ALS, but intake of beef, fish, and fast food were positively associated with the risk of ALS. In addition, the risk of ALS was negatively associated with intake of plant calcium and beta-carotene, while positively associated with intake of total calcium and animal calcium. Intake of vegetables and other antioxidant nutrients had no effect on the risk of ALS in the present study.

Discussion

The intake of fruits and beta-carotene decreases the risk of sporadic ALS in this present study. However, large prospective and interventional studies are needed to confirm the effect of fruits and beta-carotene intake on the risk of ALS.     

Antinociceptive and antiallodynic effects of Momordica charantia L. in tibial and sural nerve transection-induced neuropathic pain in rats

Objective

This study was designed to investigate the ameliorative potential of Momordica charantia L. (MC) in tibial and sural nerve transection (TST)-induced neuropathic pain in rats.

Materials and methods

TST was performed by sectioning tibial and sural nerve portions (2 mm) of the sciatic nerve, and leaving the common peroneal nerve intact. Acetone drop, pin-prick, hot plate, paint-brush, and walking track tests were performed to assess cold allodynia, mechanical and heat hyperalgesia, and dynamic mechanical allodynia and tibial functional index, respectively. The levels of tumour necrosis factor (TNF)-alpha and thio-barbituric acid reactive substances (TBARS) were measured in the sciatic nerve as an index of inflammation and oxidative stress. MC (all doses, orally, once daily) was administered to the rats for 24 consecutive days.

Results

TST led to significant development of cold allodynia, mechanical and heat hyperalgesia, dynamic mechanical allodynia, and functional deficit in walking along with rise in the levels of TBARS and TNF-alpha. Administration of MC (200, 400, and 800 mg/kg) significantly attenuated TST-induced behavioural and biochemical changes. Furthermore, pretreatment of BADGE (120 mg/kg, intraperitoneally) abolished the protective effect of MC in TST-induced neuropathic pain.

Conclusions

Collectively, it is speculated that PPAR-gamma agonistic activity, anti-inflammatory, and antioxidative potential is critical for antinociceptive effect of MC in neuropathic pain.