Rationale and Design of an Online Educational Program Using Game-Based Learning to Improve Nutrition and Physical Activity Outcomes Among University Students in the United Kingdom

Objective: To assess the impact of an online game-based educational program on nutrition knowledge and dietary and physical activity habits among university students in the United Kingdom.

Design: Randomized controlled trial with pre- and postintervention comparisons.

Setting: Two higher education settings in London, UK.

Subjects: Current undergraduate and postgraduate students of two universities (n?=?88) aged 18–34 years are randomly allocated to an intervention (n?=?44) or a control group (n?=?44).

Intervention: The intervention group will receive access to an educational website and online quizzes with gamification elements, including information about healthy eating and physical activity. The control group will receive no information. Duration of the intervention will be 10 weeks.

Measures of Outcome: Primary outcome is nutrition knowledge. Secondary outcomes include dietary and activity habits. Nutrition knowledge and dietary and activity habits will be assessed using questionnaires. Weekly steps will be counted using pedometers. Assessment of anthropometric and metabolic risk factors will take place.

Analysis: Quantitative analysis will investigate changes in nutrition knowledge between the two groups of the study population. Linear regression analysis will be used, if the data follow the normal distribution (otherwise binomial regression analysis), to examine whether field of study, residence status, body mass index (BMI), and demographic factors affect nutrition knowledge. Associations between changes in knowledge and dietary and physical activity behavior will be assessed by correlations.

Conclusions/Implications: The study will provide insights with regard to the design and use of online game-playing as a cost-effective approach to improve nutritional knowledge among university students.     

Test-retest and inter-rater reliability of the Danish version of the management of everday technology assessment for use with older adults with and without COPD

Background: The trend towards telemedicine increasingly requires clients to manage everyday technology (ET) to access and use health services. The Management of Everday Technology Assessment (META) is an observation-based instrument developed to evaluate the ability to manage ET.

Aim: To examine test-retest (TRR) and inter-rater reliability (IRR) of the Danish translation of the META for older adults with and without COPD.

Method and Materials: 47 older adults with COPD (n?=?23) and without (n?=?24) were recruited. IRR was examined by four raters paired across 30 participants. TRR was examined for 21 participants by the same rater administering the META twice within four weeks. A rank-based method for paired ordinal data was used to calculate percentage agreement (PA) and measures of systematic disagreement and individual variability. Mann Whitney U tests were used to compare PA to health status (presence/absence of COPD).

Results: Inter-rater PA was acceptable across 10 of 11 items and test-retest PA across 8 of 11 items. Systematic disagreement was present for one item in TRR. No significant differences in PA were found regarding health status.

Conclusion: The Danish META generates reliable scores for this sample. However, conclusive statements cannot be made for all items.     

Vocational support in mental health service delivery in Australia

Background: Individuals experiencing severe and persistent mental illness report a desire to gain and sustain work. Individual Placement and Support (IPS) is an evidence-based approach to vocational rehabilitation to support competitive employment outcomes.

Aim/Objective: This study aimed to evaluate whether a joint-governance management partnership, between a clinical adult mental health and an employment service, could deliver a sustained IPS program in Australia.

Materials and Method: The methodology entailed a Clinical Data Mining approach, to examine records from seven years of implementation of IPS in one setting within an Australian public mental health service context.

Results/Findings: Despite the prevalence of schizophrenia spectrum diagnoses and an older mean age (39 years), indicating that a large proportion of the cohort had experienced serious mental illness for over twenty years, findings were that 46.3% of participants achieved employment.

Conclusions: This is an excellent result and is comparable to the only randomised control trial, with adult services, in the Australian context, which found a 42.5% employment rate possible under IPS compared with just 23.5% with referral to external employment services.

Significance: More extensive trialling of IPS across clinical services is required, in Australia and internationally, including fidelity protocols, for knowledge translation to be achieved.     

Joining,belonging, and re-valuing: A process of meaning-making through group participation in a mental health lifestyle intervention

Background: Balancing Everyday Life (BEL), a new group-based intervention for mental health service users, was implemented in Sweden. Mental health service users often experience group interventions as meaningful, but knowledge of the process of meaning-making in a group is lacking.

Aim: To explore participants’ perceptions of the group in the Balancing Everyday Life (BEL) lifestyle intervention; specifically, personal experiences of what brings meaning when participating in a group.

Methods: This qualitative Grounded Theory study included 26 interviews with 19 BEL participants.

Results: A process of meaning-making in a group was constructed: Joining with others: from feeling alone to connected, A sense of belonging: mutual support and understanding, and Re-valuing Self: respect and self-worth. No longer feeling alone contributed to meaning. Peers and group leaders were considered important parts of the group, and participants appreciated feeling understood, respected, and helping others.

Conclusion: The proposed process of meaning-making, as well as ‘Joining’ as a unique step, seems to be new contributions which could help practitioners when organizing groups. Overcoming fear of joining could break a cycle of isolation and lead to connecting and belonging. The value of participants finding purpose through helping others should be further explored.     

Altering the boundaries of everyday life in a nursing home context

Background: Despite global and local policy frameworks that explicitly aim to privilege participation and active engagement of older adults living in nursing homes, this group often has limited possibilities to engage in occupations and to have influence in their everyday lives.

Aim: To explore how older adults’ engagement and influence in an occupation can emerge in everyday life in a nursing home setting.

Material and methods: A participatory qualitative approach was applied. Older adults living in a nursing home participated in a Book Club that was created collaboratively between researchers, residents, and the nursing home community.

Findings: The analysis identified qualities of altering the boundaries of everyday life and addressing the uncertain conditions for influence and engagement as processes actualized by the residents when engaging in the Book Club. Further analysis identified how these processes involved ordinariness, familiarity, fellowship, and connectedness.

Conclusion and Significance: Engagement and influence in occupation in a nursing home is possible when enabling partnerships and resourcefulness among the residents. However, such enablement is not guaranteed and needs to be actively upheld by the nursing home community in order to build practices aligned with policy frameworks of participation.     

Measuring perceived outcomes from participating at a clubhouse for persons with mental illness: Psychometric properties and associated factors

Background: The clubhouses are part of a growing international movement concerned with providing work-oriented psychosocial rehabilitation for people with a history of mental illness. Instruments used for measuring outcomes from clubhouse participation is in a developing phase.

Aims: This study aimed to assess psychometric properties of an outcome survey tool used at a Norwegian clubhouse, and to explore factors associated with members’ perceived outcomes from participation at the clubhouse.

Methods: A cross-sectional design was used. The instrument’s factor structure was examined with Principal Components Analysis (PCA), and internal consistency was assessed with Cronbach’s α. Associations with the derived outcome scale score were examined with linear regression analysis.

Results: All scale items belonged to the same latent factor, and internal consistency of the items was α?=?0.81. Members, who used the clubhouse more frequently perceived the outcomes from participating to be better, compared to their counterparts.

Conclusion: The outcome scale was unidimensional and the items fit well together. Active members were likely to evaluate outcomes of clubhouse participation as more positive, compared to less active members.

Significance: The scale can be useful for exploring clubhouse members’ perceptions of the outcomes they relate to their participation at the clubhouse.     

Critical dialogical approach: A methodological direction for occupation-based social transformative work

Background: Calls for embracing the potential and responsibility of occupational therapy to address socio-political conditions that perpetuate occupational injustices have materialized in the literature. However, to reach beyond traditional frameworks informing practices, this social agenda requires the incorporation of diverse epistemological and methodological approaches to support action commensurate with social transformative goals.

Aim: Our intent is to present a methodological approach that can help extend the ways of thinking or frameworks used in occupational therapy and science to support the ongoing development of practices with and for individuals and collectives affected by marginalizing conditions.

Method: We describe the epistemological and theoretical underpinnings of a methodological approach drawing on Freire and Bakhtin’s work.

Results: Integrating our shared experience taking part in an example study, we discuss the unique advantages of co-generating data using two methods aligned with this approach; dialogical interviews and critical reflexivity.

Discussion: Key considerations when employing this approach are presented, based on its proposed epistemological and theoretical stance and our shared experiences engaging in it.

Significance: A critical dialogical approach offers one way forward in expanding occupational therapy and science scholarship by promoting collaborative knowledge generation and examination of taken-for-granted understandings that shape individuals assumptions and actions.     

Facilitating open family communication when a parent has chronic pain: A scoping review

Background: When a parent has chronic pain, family communication can become strained. Clinicians are encouraged to identify and support families struggling with open communication. Occupational therapists are commonly involved in the provision of pain management services but their role in facilitating open communication in families affected by this condition has not been clearly articulated.

Objective: To develop a comprehensive understanding of what is being done and/or thought to be helpful for facilitating open communication in families affected by chronic pain, in order to articulate the role of occupational therapy in this area of care.

Methods: A scoping review was conducted and 24 items analyzed using qualitative content analysis.

Results: The facilitation of open communication in families affected by parental chronic pain is dependent on a variety of factors, including the skills that members possess and occupations which they perform individually and together. It can also be prompted by relationship tension or a family accessing professional support. Occupational therapy literature on the matter is currently limited and focused on assertiveness training.

Conclusion and significance: There is scope for occupational therapist to extend their role beyond assertiveness training and use occupation-centered interventions to facilitate communication within families affected by parental chronic pain.     

A survey on client-centered practice among danish occupational therapists

Background: In Denmark, the cost of healthcare services comprise 12% of the gross domestic product. A recommended method for optimizing effectiveness of and enhance client satisfaction with healthcare is client-centred practice (CCP), a central component of occupational therapy ideology. However, Danish occupational therapists’ perceptions of CCP, including the facilitators and barriers that may contribute to CCP, have never been examined.

Aim: To examine Danish occupational therapists’ perceptions of CCP.

Methods: A survey was conducted using an electronic questionnaire in a small, but representative sample of Danish occupational therapists from all regions and practices.

Results: Three hundred and forty-six occupational therapists (5%) responded. Of these, 98% rated CCP as important, 97% considered their work client-centred, and 92% were satisfied with their level of CCP. Having time to conduct self-directed work, using assessments to identify clients’ priorities, and CCP education, but not fixed regimes, were positively correlated with CCP.

Conclusion: Danish occupational therapists perceive to practice CCP and appear to have adopted the beliefs, theory and ideals of CCP, perhaps influenced by the egalitarian Danish culture. Self-directed work, means to identify and evaluate their clients’ wishes, and education facilitated CCP. Possible absence of occupational therapists not compliant with CCP makes further research warranted.     

Are the school version of the assessment of motor and process skills measures valid for German-speaking children?

Background: There are no validated assessment tools for evaluating quality of schoolwork task performance of children living in German-speaking Europe (GSE).

Objective: To determine whether the international age-normative means of the School Version of the Assessment of Motor and Process Skills (School AMPS) are valid for use in GSE.

Methods: The participants were 159 typically-developing children, 3-12 years, from GSE. We examined the proportions of School AMPS measures falling within?±2 standard deviation (SD) of the international age-normative means, and evaluated for significant group differences (p?<?0.05) in mean School AMPS measures between the GSE sample and the international age-normative sample using one-sample Z tests. When significant mean differences were found, we evaluated if the differences were clinically meaningful.

Results: At least 95% of the GSE School AMPS measures fell within?±2 SD of the international age-normative means for the School AMPS. The only significant mean differences were for 6- (p?<?0.01) and 8-year-olds (p?=?0.02), and only the 6-year-old school process mean difference was clinically meaningful.

Conclusions: Because the only identified clinically meaningful difference was associated with likely scoring error of one rater, the international age-normative means of the School AMPS appear to be valid for use with children in GSE.     

Impact factor,eigenfactor, article influence,scopus SNIP,and SCImage journal rank of occupational therapy journals

Background: Journals are currently assessed and ranked using a number of different quantitative performance metrics.

Aim: To compare and correlate the publication metrics of English-language occupational therapy journals published in 2015.

Method: Bibliometric data was sourced for 14 English-language occupational therapy journals including the Journal Citations Report (JCR) 2-year impact factor (IF), Eigenfactor Score (EFS), Article Influence Score (AIS), Scopus Source Normalized Impact per Paper (SNIP), Scopus Citescore, and SCImago Journal Rank (SJR) score. The JCR, Scopus, and SJR 2015 bibliometric data were correlated.

Results: The top six English-language occupational therapy journals in relation to JCR IF, EFS, AIS, SNIP, Citescore, SJR score, and SJR IIF were AJOT, AOTJ, POPT, CJOT, SJOT, and BJOT. JCR IF, EFS, JCR AIS, SNIP, Citescore, SJR score and SJR IIF were all significantly correlated with coefficients ranging from 0.751 to 0.961 (p?<?0.05; p?<?0.01). The calculated SJR IIF was on average 0.335 larger than the JCR IFs reported.

Conclusions: The findings indicate that the range of available bibliometric measures should be used collectively to yield a more comprehensive assessment of journal and article rankings rather than the singular use of IF scores that currently and frequently occurs in many jurisdictions.     

Nutrition and Cancercapsaicin Treatment Reduces Tumor Growth,Tumor Cell Proliferation Ex Vivo and Partially Reverses Cancer Cachexia in Walker 256 Tumor-Bearing Rats

Capsaicin (trans-8-methyl-n-vanillyl-6-nonenamide) is the main pungent component found in hot peppers.

Aim: In this study, we investigated the effect of capsaicin treatment on tumor growth and the metabolic indicators of cachexia in Walker 256 tumor-bearing rats.

Methods: Male Wistar rats were inoculated subcutaneously in the right flank with 1?ml of a sterile suspension of 3?×?10⁷ Walker tumor cells. The treated groups received capsaicin intraperitoneal 5?mg/kg body weight for 13?days.

Results: The tumor weight on Day 14 in the non-treated group was 18?g. The rats also had a body weight loss, hypoglycemia, hyperlactacidemia, hypertriacylglycerolemia, and a depletion in glycogen storage. Treatment with capsaicin decreased tumor growth by 49% and a reversal of triacylglycerol serum. We also found a 32% reduction in tumor cell proliferation ex vivo. Lactate serum concentrations and body weight were lower but did not reach control levels.

Conclusion: The treatment with capsaicin reduces tumor growth and cellular proliferation along with increased apoptosis and partial cachexia reversal.     

Dietary Phosphorus to Protein Ratio for the Mexican Population with Chronic Kidney Disease

Objective: Hyperphosphatemia is a major contributor to poor outcomes among cases of chronic kidney disease. Considering that foods with high protein content are major sources of phosphorus, a more suitable dietary phosphorus measure is the phosphorus to protein ratio. However, Mexican phosphorus to protein ratio tables do not exist. This article aims to estimate the phosphorus to protein ratio in foods commonly used by the Mexican population and to establish its usefulness in the selection of foods for patients with chronic kidney disease.

Methods: Six tables with the phosphorus to protein ratio were developed from different data sources concerning Mexican animal food composition.

Results: Egg whites have the best phosphorus to protein ratio. Partially skimmed milk has the lowest ratio among dairy products. Dairy products have high phosphorus to protein ratio variability. Red meat products have a ratio with an average of 9?mg/g. The phosphorus to protein ratio varies considerably for seafood (1.2–38.3?mg/g).

Conclusions: The phosphorus to protein ratio could be a good strategy to choose each food during chronic kidney disease dietary treatment for the Mexican population.     

HPV Vaccine recommendations: does a health care provider’s gender and ethnicity matter to Unvaccinated Latina college women?

Objectives: There are disparities in the uptake of HPV vaccine among racial/ethnic minority women. The strongest predictor of HPV vaccine uptake among adult women is health care provider (HCP) recommendation; however, it is unclear how issues relating to race/ethnicity may mitigate these recommendations. Research shows that racial/ethnic and gender concordance between a patient and HCP can improve patient satisfaction, access and quality of care. If concordance contributes to improved patient-provider interactions, then it may be a factor in patient decisions regarding HPV vaccination. The objectives of this study were to (1) explore gender and ethnicity HCP preference regarding HPV vaccination among unvaccinated; and (2) understand factors associated with those preferences.

Design: Unvaccinated Latina college students (n?=?187) completed a survey that assessed HCP preferences, medical mistrust, cultural assimilation and HPV vaccine recommendation. Logistic regression models evaluated associations between above variables with HPV knowledge and preference for a female and/or Latina HCP.

Results: Most respondents had health insurance (71%), a regular HCP (64%), were US-born (67%), with foreign-born parents (74%). Thirty-four percent and 18% agreed that they would be more likely to get the HPV vaccine if the recommending HCP was female and Latino, respectively. Latina women reporting higher medical mistrust preferred a HPV vaccine recommendation from a Latino/a provider.

Conclusions: Latinas’ preferences regarding gender and ethnicity of their HCPs may affect patient-provider interactions. Increasing diversity and cultural awareness among HCPs, and providing linguistically and culturally-appropriate information may decrease patient-provider mistrust, increase uptake of the HPV vaccine, and decrease persistent cervical cancer disparities.     

Use of Vitamin D Supplements in Osteoarthritis: An Observational Study in a Tertiary Health Care Facility

Objective: The purpose of the study was to assess impact of vitamin D supplements on the disease progression and overall health of osteoarthritis (OA) patients.

Methodology: A cohort study was carried out for 8?months (August 2017–March 2018) in the Orthopedics Department of Kasturba Hospital, Manipal, India, a tertiary care hospital. One hundred and forty-two patients who were diagnosed with OA (grades 1–3) with low serum 25(OH)D levels (severely deficient, deficient, or insufficient) were selected for the study. These patients were categorized into two cohorts: a control cohort (CC) and a study cohort (SC). CC members were patients (n?=?71) who had not received vitamin D supplements, and SC members were patients (n?=?71) who had received vitamin D supplements. Severity grading of OA, pain score, and health assessment were performed using the Kellgren–Laurence grading score, visual analogue scale (VAS), and WOMAC, respectively, at baseline and after 3?months of follow-up.

Results: Subjects in the both CC and SC reported no statistically significant difference (similar in both group) in severity grade (p?=?0.303), pain score (p?=?0.099), parathyroid hormone (PTH) (p?=?0.083), and health status (p?=?0.76) at baseline. After 3?months of follow-up (post vitamin D supplementation), OA patients have shown statistically significant difference in severity grades, serum 25(OH)D status, PTH level (p?<?0.001), and overall health status (p?=?0.001) in the SC with respect to baseline. Likewise, percentage distribution of positive changes was significantly higher in severity grade, pain score, serum 25(OH)D level, overall health status (p?<?0.001), and PTH (p?=?0.040) of SC as compared to CC at follow-up.

Conclusion: Vitamin D supplements have significantly improved serum 25(OH)D levels, PTH, severity grade, and pain score of OA patients. Most importantly, vitamin D supplements have shown improvement in the overall health of OA patients, emphasizing the place of vitamin D supplements in the management of OA.

Clinical Trial Registry-India (CTRI) registration no: CTRI/2017/12/011031     

Fruit and Vegetable Consumption and Their Association With the Indicators of Iron and Inflammation Status Among Adolescent Girls

Background: The objective of this study was to identify an association among dietary components, iron, and inflammatory status among adolescent girls.

Method: Dietary information for 85 adolescent girls was collected through food frequency questionnaires. Biomarkers of iron and inflammatory status were analyzed.

Results: We found that 28.2% of adolescent girls had anemia and 65.9% girls were iron-deficient. Girls who did not consume guava had 3.8-fold (95% confidence interval =1.1–9.4; p?=?0.020) increased the risk of having low serum iron levels. Girls who consumed amaranth had significantly (p?=?0.024) higher serum hepcidin levels (n?=?44; 129.7?±?81.40?pg/mL vs n?=?41; 94.6?±?55.8?pg/mL) as well as ferritin levels (n?=?44; 19.7?±?16.4?µg/L vs n?=?41; 14.0?±?10.2?µg/L). Overall consumption of fruits and green leafy vegetables among girls significantly affects their iron status.

Conclusions: Regular consumption of vitamin C–rich fruits and green leafy vegetable intake are imperative for improvement of iron status among adolescent girls.     

Differences between Japan and Taiwan in the treatment of pregnant women with depressive symptoms by omega-3 fatty acids: An open-label pilot study

Objectives: Although safe approaches for improving depression in pregnancy are required and the efficacy of omega-3 polyunsaturated fatty acids (PUFAs) has been suggested, the amount of supplemental omega-3 PUFAs has varied among previous studies and adequate amount might be different among countries. The aim of this pilot study is to explore the feasibility of using 1800?mg of omega-3 PUFAs supplementation for our future double-blind, placebo-control trial, and to clarify the clinical difference and the similarity between two sites of Japan and Taiwan.

Methods: Pregnant women between 12 and 24 weeks’ gestation with depressive symptoms were recruited. Participants were supplemented daily with omega-3 PUFAs capsules containing 1206?mg eicosapentaenoic acid and 609?mg docosahexaenoic acid for 12 weeks. The primary outcome was change in total score on the 17-item Hamilton Rating Scale for Depression (HAMD) at 12 weeks after supplementation.

Results: Eight pregnant women in Japan and five in Taiwan participated in the study. A substantial proportion of pregnant women reported high consumption of omega-3 supplements and dietary fish were excluded in Taiwan rather than in Japan sites. The decrease in HAMD score from baseline to 12 weeks after the start of the intervention was significantly larger in Japanese participants than in Taiwanese participants (Wilcoxon rank sum test; P?=?0.045).

Discussion: The improvement of depressive symptoms was smaller at the Taiwan site than at the Japan site. Differences in psychopathology of recruited participants identified by self-rating scales might affect the degree of population heterogeneity and the treatment efficacy. A randomized-controlled trial is needed to confirm these findings.

Trial Registration: ClinicalTrials.gov Identifier: NCT01948596.     

Differences in nativity,age and gender may impact health behavior and perspectives among Asian Indians

Objective: Identify health perspectives among Asian Indians in greater Houston area, to guide a tailored community wide survey.

Design: Four focus groups of different ages, gender, and nativity were conducted at which participants were asked for their opinions about specific health topics. Key informant interviews were conducted with ten community leaders to validate focus group responses. Recordings from focus groups and key informant interviews were transcribed and analyzed.

Results: Diabetes, cancer, and hypertension were primary health concerns. Common themes were sedentary lifestyle and poor health literacy. Older participants were more accepting of having familial hypertension and high cholesterol. Women were more concerned about health of family members and dietary habits. Perspectives differed on eating habits, physical activity, use of Western medicine, and smoking based on nativity. Responses from key informant interviews validated focus group findings.

Conclusion: Perspectives on health may differ among Asian Indians depending on gender, age, and nativity.