Effects of dog-assisted intervention on quality of life in nursing home residents with dementia

Background: People with dementia often have a poor quality of life. Therefore, methods that can improve their life situation must be identified. One promising method is dog-assisted intervention.

Aim: This study aimed to investigate the effects of dog-assisted intervention on quality of life in nursing home residents with dementia.

Materials and methods: A one-group, pretest post-test study design was used. Quality of life was measured using the QUALID in 59 nursing home residents prior to and after a dog-assisted intervention. Non-parametric tests were used to analyze the data, and effect sizes were calculated.

Results: The participants’ total scores improved significantly between baseline and post-test 1 (p?=?<?0.001) and worsened significantly at post-test 2 (p?=?0.025). The largest effect size was found for the item ‘Verbalization suggests discomfort’ (p?=?0.001).

Conclusion: The results indicate that dog-assisted interventions can have positive effects on quality of life in nursing home residents with moderate to severe dementia.

Significance: The results contribute to a growing knowledge base about non-pharmacological methods that can be used in dementia care. Occupational therapists should consider dog-assisted interventions when planning activities that can reduce the illness burden and improve the quality of life for people with dementia.     

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.     

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.     

Enteral Nutrition Support Does Not Improve PNI in Radiotherapy Patients with Locally Advanced Esophageal Cancer

Objective: The assessment of prognostic nutritional index (PNI) before and during radiotherapy is an important parameter for the prognosis in patients with cancer. In this study, enteral tube feeding (ETF) was used during radiotherapy in patients with EC. Dynamic changes of various nutritional indicators (including PNI) were monitored.

Methods: Patients with EC who underwent radiotherapy between June 2016 and July 2017 were enrolled. ETF was performing with the energy of 25?kcal?×?kg/d. Nutritional status were evaluated. Least significant difference (LSD) was used for multiple comparisons between groups.

Results: A total of 148 patients were admitted, including 51 patients fed via ETF. For patients who were not scheduled to nutritional support, significant difference were observed in albumin (ALB) (P?<?0.001), prealbimnin (PA) (P?=?0.05) and PNI (P?<?0.001) compared to levels before radiotherapy. In the patients fed via enteral tube, no significant difference were found in weight, BMI, ALB, retinol binding protein (RBP) and PA before and after radiotherapy, while PNI significantly decreased (P?<?0.001).

Conclusion: After preforming ETF with the energy of 25?kcal?×?kg/d in patients with EC during radiotherapy, PNI, the key nutritional index reflecting prognosis, significantly decreased.     

Inter-rater and test-retest reliability of the Danish version of the everyday technology use questionnaire

Background: Everyday technologies are naturally integrated in people’s daily life. For older adults and adults living with a chronic disease like chronic obstructive pulmonary disease (COPD), the ability to use technologies for health management has become increasingly important. The aim of this study was to investigate inter-rater and test-retest reliability of the Danish version of the Everyday Technology Use Questionnaire (ETUQ) in a sample of older adults with (n?=?23) and without (n?=?24) COPD.

Material and method: The ETUQ was initially translated in accordance with the dual panel approach and then administered to a sample of 47 participants. Svensson’s method for paired ordinal data was utilized to calculate and analyze reliability.

Results: Overall, inter-rater and test-retest reliability of the Danish version of the ETUQ demonstrated excellent percentage agreement (PA) (>75%), although for test-retest reliability, nine items demonstrated fair (53%) to good (73%) agreement.

Conclusion: This study supports the use of the Danish version of the ETUQ in a sample of older adults with or without COPD.

Application to practice: The Danish version of the ETUQ is an evidence-based evaluation that can reliably contribute to clinical occupational therapy and research in Denmark focusing on everyday technology use.     

The Norwegian Occupational Balance Questionnaire (OBQ11-N) – development and pilot study

Background: The concept occupational balance has been linked with health and well-being, and it is therefore viewed as an important concept for occupational therapy practice, theory and research. To operationalize and measure occupational balance, the Occupational Balance Questionnaire (OBQ) was developed in Sweden. To date, no Norwegian translations of the OBQ exists.

Aim: To describe the process of developing a Norwegian version of the 11-items Occupational Balance Questionnaire (OBQ11-N) and to evaluate its feasibility and face validity.

Methods: The development process followed a predetermined series of steps, including forward and back translation and cognitive interviews with a pilot sample.

Results: The pilot study sample (n?=?8) varied with respect to age, gender and education level. There was high level of agreement between the participants with regard to their understanding of the content of the items. Three of the items were slightly modified in terms of words and phrasing.

Conclusion: The OBQ11-N was developed according to established translation guidelines and appears to be feasible and have good face validity.

Significance: The OBQ11-N may prove useful for assessing occupational balance and associated factors in Norwegian population groups. However, more research is needed to establish the Norwegian version of the questionnaire as psychometrically valid.     

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.     

Open defecation explains differences in nutritional status between Bengali and tribal children in the Chittagong Hill Tracts of Bangladesh

Objective: We describe differences in linear growth as measured by height-for-age z-score (HAZ) between children from Bengali and tribal populations in the Chittagong Hill Tracts of Bangladesh and examine factors associated with HAZ in both groups.

Design: We used nutritional surveillance data collected in Bangladesh from 2003 to 2006 to analyze HAZ among 12,006 children aged 6–23 months and conducted multivariate linear regression and Blinder-Oaxaca decomposition to quantify the relative contribution of independent variables to differences in HAZ between Bengali and tribal children.

Results: Mean HAZ was stable for Bengali children (?1.88 in 2003 to ?1.90 in 2006) but improved for tribal children (?1.87 in 2003 to ?1.68 in 2006). The difference between groups was significant across the study period (p?=?0.008). Among Bengali children, HAZ was positively associated with father’s schooling (β?=?0.221; 95% CI: 0.079–0.363). Among tribal children, HAZ was positively associated with consumption of animal source foods (β?=?0.073; 95% CI: 0.051–0.096) and goat ownership (β?=?0.240; 95% CI: 0.025–0.454). Results of a likelihood ratio test indicated that distance to a health center was inversely associated with HAZ among tribal children (p?<?0.001). Blinder-Oaxaca decomposition demonstrated a difference in pooled coefficients between groups (p?=?0.004), explained primarily by differences in coefficients for paternal education (p?=?0.001) and village-level prevalence of open defecation (p?=?0.004).

Conclusions: Different responses among Bengali and tribal children to village-level open defecation are an explanatory factor for the difference in HAZ between Bengali and tribal populations. Open defecation may also act a proxy for unmeasured factors such as household environmental conditions and food hygiene.

Abbreviations: Chittagong Hill Tracts (CHT); height-for-age z-scores (HAZ); Nutrition Surveillance Project (NSP); World Health Organization (WHO)     

Ethnic differences in the cardiac responses to aerobic exercise

Background: Cardiovascular disease disproportionately affects North American Indigenous populations. Ethnic differences in cardiac responses to exercise are known, though Indigenous populations response is unknown. To evaluate cardiac responses to aerobic exercise among Canadian Indigenous and European adults.

Methods: Indigenous (N?=?12, 4 females, 1 male incomplete) and European (N?=?12, all completed) Canadian age and sex-matched adults 19–40 years and free of cardiovascular disease or diabetes completed a cycle ergometer maximal aerobic power test and 30?min at 60% maximal aerobic capacity on two separate days. Echocardiographic assessments preceded and immediately followed exercise.

Results: Responses to maximal exercise were similar among ethnicities including decreases in stroke volume index, cardiac output index and ejection fraction, and increases in arterial-ventricular coupling. However, following submaximal exercise, only Indigenous adults demonstrated reductions in end systolic volume, end diastolic volume (154.8?±?40.6?mL to 136.5?±?33.0?mL, p?=?0.01, vs. 149.4?±?22.4?mL to 147.1?±?27.0?mL; p?=?0.81), stroke volume index (44.9?±?8.7?mL?m^?2 to 38.0?±?6.5?mL?m^?2, p?=?0.002, vs. 46.4?±?7.1?mL?m^?2 to 44.0?±?6.5?mL?m^?2; p?=?0.28) and arterial compliance.

Conclusion: Indigenous and European adults demonstrated similar cardiac responses to maximal exercise, though only Indigenous adults demonstrated cardiac responses to submaximal exercise.     

Milk and Plasma Lutein and Zeaxanthin Concentrations in Chinese Breast-Feeding Mother–Infant Dyads With Healthy Maternal Fruit and Vegetable Intake*

Objectives: While others have reported that milk from coastal Chinese women contains high levels of lutein and zeaxanthin, no research has determined the corresponding infant plasma response. Whether infant plasma levels increase commensurately provides important guidance for supplementation of these increasingly intriguing carotenoids in breast-feeding mothers and formula-fed infants.

Methods: Fifty-six mother–infant pairs with a maternal diet rich in eggs, green leafy vegetables, and fruit were enrolled between 6 and 16 weeks of lactation. Milk samples and blood samples from both the mother and infant were collected at entry. Maternal 3-day dietary records and a second milk sample were collected 1 to 3 weeks later.

Results: Mean milk lutein concentrations in samples 1 and 2 were 6.5 and 7.7?μg/dL (range 1–22.5?μg/dL), and for zeaxanthin, 1.6 and 1.7?μg/dL (range 1–5.9?μg/dL). Lutein concentrations in infant plasma (18.2?μg/dL) were similar to those in maternal plasma (21.6?μg/dL); zeaxanthin was lower than lutein in both maternal (3.1?μg/dL) and infant (2.9?μg/dL) plasma. Infant and maternal mean plasma lutein and zeaxanthin concentrations were higher than those in both milk samples 1 and 2 (lutein, 6.9 and 8.2?μg/dL; zeaxanthin, 1.9 and 2.0?μg/dL). Infant plasma lutein and zeaxanthin concentrations positively correlated with those in milk sample 1 (lutein, r²?=?0.15, p?=?0.004; zeaxanthin, r²?=?0.21, p?<?0.001).

Conclusions: Together, these results reveal that high milk concentrations of lutein and zeaxanthin driven by healthy maternal intakes of xanthophyll rich foods are associated with high infant plasma concentrations. These findings will be useful for determining appropriate lutein fortification strategies.

Clinical Study.gov registration number: NCT01669655.     

Viewpoints on how students with autism can best navigate university

Background: Despite recognition of the challenges faced by students with autism spectrum disorders (ASD) there is limited understanding of the barriers and facilitators to participation in major life areas, such as being a university student.

Aim/Objective: This research aimed to examine viewpoints on what affects the success of Australian university students with ASD.

Material and Method: Q-methodology was used to describe the viewpoints of university students with ASD, their parents and their mentors, on success at university for students with ASD. A total of 57 participants completed the Q-sort.

Results/Findings: Three viewpoints emerged; Individualised Support, Contextual Support and Social Support.

Conclusions: This study highlighted that supports need to be individualized to the barriers and facilitators faced by Australian students with ASD. Supports also need to be contextualized to the built and social environments of universities.

Significance: This study supports the premise that environmental interventions can be effective in facilitating participation in major life areas, such as university education. Peer mentoring for students with ASD may have utility for this group, but should be extended to include social, emotional and psychological support.     

Factors associated with participation by African Americans in a study of the genetics of glaucoma

Objective: African Americans have been historically underrepresented in research studies. Our aim was to evaluate factors influencing enrollment in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study.

Design: Patients approached to enroll in the POAAGG study were asked to complete a 15-item survey addressing demographic characteristics, knowledge of genetics and glaucoma, and opinions on human research. Survey responses were compared between subjects who enrolled (Enrollers) and did not enroll (Decliners) in the POAAGG study.

Results: Enrollers (N?=?190) were 3.7 years younger (P?=?0.007) and had similar gender, education, and income level to Decliners (N?=?117). Knowledge about genetics and glaucoma was similar between groups. Enrollers were more comfortable providing DNA for research studies (93.1% vs 54.1%; P?<?0.001) and more likely to have participated in prior studies (P?=?0.003) and consider participating in future studies (P?<?0.001). Among Decliners, lack of time was the primary reason given for not enrolling.

Conclusion: To increase participation of African Americans in genetic research studies, efforts should be made to raise comfort with DNA donation.     

Defining sensory modulation: A review of the concept and a contemporary definition for application by occupational therapists

Background: Sensory interventions are prevalent amongst adult mental health practitioners and are supported by major stakeholders and policy makers across the world. The term commonly used by occupational therapists applying sensory practices is sensory modulation, however this term has evolved.

Aims: This paper aims to investigate and clarify the definition of ‘sensory modulation’ for application by occupational therapists.

Method: A framework guided this concept analysis on sensory modulation. A summative content analysis approach was employed to code results.

Results: Six conceptual themes for sensory modulation were identified. 81% of authors defined sensory modulation as consisting of more than one of these themes. 18% of authors defined sensory modulation as both a neurophysiological process and means to regulate behaviour.

Conclusion: The concept of sensory modulation has evolved in occupational therapy practice. The authors summarise with the following proposed definition of sensory modulation for contemporary occupational therapy practice: ‘Sensory modulation is considered a twofold process. It originates in the central nervous system as the neurological ability to regulate and process sensory stimuli; this subsequently offers the individual an opportunity to respond behaviourally to the stimulus’.

Significance: A contemporary definition of ‘sensory modulation’ has been identified for occupational therapy practice.     

Child and parent perspectives of life quality of children with physical impairments compared with non-disabled peers

Background: Life quality has become a widely used concept within rehabilitation and occupational therapy practice.

Aim: This study explored child and parent perspectives of life quality of children with physical impairments compared with a group of non-disabled children.

Method: Data were collected with the Icelandic self- and proxy-reported versions of the KIDSCREEN-27. For children with physical impairments, reports from 34 children and 40 parents were included in the analyses, and in control group reports from 429 children and 450 parents were included.

Results: Children with physical impairments evaluated their life quality within the average range on four out of five life quality dimensions. The lowest scores were within the physical well-being dimension. Self-reported scores of children with physical impairments were higher than those of their parents on all dimensions except autonomy and parent relations. Thus, the parents considered more environmental and personal factors to negatively influence their child’s life quality than children did themselves.

Conclusion: Children with physical impairments experience their life quality similarly to non-disabled children.

Significance: Focus on life quality can help occupational therapists to identify what circumstances positively or negatively influence client well-being and to focus more on contextual factors that contribute to disablement.     

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.     

Effect of Soy Milk on Metabolic Status of Patients with Nonalcoholic Fatty Liver Disease: A Randomized Clinical Trial

Objective: Studies in experimental models of nonalcoholic fatty liver disease (NAFLD) have reported positive effects of soy components in improving metabolic parameters. Whether such effects could be achieved through consumption of whole soy foods in patients with NAFLD is still unclear. Therefore, this trial was conducted to assess the effects of soy milk on metabolic parameters of patients with NAFLD.

Methods: This parallel randomized clinical trial was conducted on 70 patients with NAFLD. Patients in the soy milk group consumed 240?ml of soy milk daily as a part of low-calorie diet (i.e., 500-deficit calorie diet) for 8?weeks. Patients in the control group just followed the low-calorie diet. Grade of fatty liver, liver enzymes, lipid profile, serum high-sensitivity C-reactive protein (hs-CRP), and anthropometric indices were measured at baseline and the end of the trial.

Results: At the end of the trial, the soy milk group had significantly higher reduction in serum alanine aminotransferase (ALT) (–12.06?±?17.61?IU/L in the soy milk group versus –5?±?8.58?IU/L in the control group, p?=?0.04) and hs-CRP (–1.32?±?1.60?mg/L in the soy milk group versus –0.36?±?1.54?mg/L in the control group, p?=?0.01) compared to the control group. However, changes in fatty liver grade and other liver enzymes, including aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase, as well as lipid profile and anthropometric indices were not significantly different between the treatment groups.

Conclusion: Consumption of soy milk in the context of a restricted-calorie diet for 8?weeks had favorable effects on serum ALT and hs-CRP in patients with NAFLD.     

Association Between Magnesium Status,Dietary Magnesium Intake,and Metabolic Control in Patients with Type 2 Diabetes Mellitus

Background: Hypomagnesemia could worsen glycemic control by impairing insulin release and promoting insulin resistance. On the contrary, type 2 diabetes mellitus (T2DM) may induce and/or exacerbate low serum magnesium levels, and this could, in turn, worsen glycemic control of diabetes.

Objective: The aim of this study was to investigate the relationship between serum magnesium level, dietary magnesium intake, and metabolic control parameters in patients with T2DM.

Methods: The study included 119 patients with T2DM (26 male, 93 female; mean age 54.7?±?8.4 years). Serum magnesium level was measured by spectrophotometric method. Magnesium intake was assessed by food frequency questionnaire. Anthropometric measurements were taken. The General Linear Model procedure was applied to determine the relationship of serum magnesium with quantitative variables.

Results: Of the 119 patients, 23.5% of the patients had inadequate magnesium intake (lower than 67% of the recommended daily allowance), and 18.5% had hypomagnesemia. In patients with hypomagnesemia (< 0.75?mmol/l), serum levels of fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and serum glycosylated hemoglobin (HbA1c) were higher compared to patients with normomagnesemia. FPG levels were significantly higher in patients with hypomagnesemia in Model 1 (179.0?±?64.9 vs. 148.7?±?52.0?mg/dl, p?=?0.009) but the significance disappeared in other models. PPG levels were significantly higher in patients with hypomagnesemia in all models (287.9?±?108.4 vs. 226.8?±?89.4?mg/dl, p?=?0.006 for Model 1, p?=?0.027 for Model 2, p?=?0.016 for Model 3). Serum HbA1c levels were significantly higher in patients with hypomagnesemia, and this significance proceeded (8.0?±?1.9% vs. 6.5?±?1.2%, p?=?0.000 for all models). Body fat mass was significantly higher in patients with hypomagnesemia as compared to patients with normomagnesemia in model 3 (35.4?±?9.4?kg, 34.6?±?10.2?kg; p?=?0.034). Dietary magnesium intake was not significantly associated with either metabolic parameters or anthropometric measurements.

Conclusion: Hypomagnesemia in T2DM is directly associated with poor metabolic control. Clinical assessment should, therefore, focus on augmentation of magnesium status and adequate magnesium intake in patients with T2DM.     

Higher Waist Circumference Is Related to Lower Plasma Polyunsaturated Fatty Acids in Healthy Participants: Metabolic Implications

Objective: We evaluated whether the relationship between waist circumference (WC) and cardiometabolic risk is related to usual diet and plasma fatty acid composition.

Methods: This cross-sectional study included 226 health professionals from 20 to 59?years old. Anthropometric features, oxidative stress, inflammatory markers, and plasma fatty acid profile were assessed. Dietary intake was evaluated with a semi-quantitative food frequency questionnaire, the quality of dietary habits by Healthy Eating Index, and insulin resistance by homeostasis model assessment–insulin resistance and triglyceride-glucose index.

Results: Higher WC was associated with lower concentrations of high-density lipoprotein cholesterol (p?=?0.000) and adiponectin (p?=?0.000) and higher uric acid levels (p?=?0.011). Plasma polyunsaturated fatty acid (PUFA) levels were negatively associated with weight (p?=?0.046), systolic blood pressure (p?=?0.035), fasting glucose (p?=?0.000), triglyceride-glucose index (p?=?0.023), and IL-1β (p?=?0.037). Individuals with elevated WC consumed more calories (p?=?0.002), niacin (p?=?0.002), and pyridoxine (p?=?0.017), but less calcium (p?=?0.001), phosphorus (p?=?0.016), and vitamin B2 (p?=?0.011). In addition, individuals with higher WC denoted lower PUFA concentrations (p?=?0.036).

Conclusion: The results suggest that participants with higher WC have lower plasma PUFA concentrations and higher levels of saturated fatty acids. This could be related to metabolic and inflammatory changes that could trigger increased risk of metabolic syndrome and cardiovascular disease.     

Meaningful engagement and person-centered residential dementia care: A critical interpretive synthesis

Background: People with moderate to advanced dementia living in residential care are at risk of occupational deprivation. Person-centered care has been adopted as a guiding principle in the provision of residential care for older adults with dementia. In this context, there has been shift in occupational therapy practice from addressing occupational performance towards focusing on meaningful engagement. While both meaningful engagement and person-centered care have been well researched the relationship between the two concepts is poorly understood.

Aim: A critical interpretative synthesis was conducted to determine how principles of person-centered care inform occupational therapy practice in relation to promotion of meaningful engagement among residents with moderate to advanced dementia.

Methods: A systematic search of research addressing meaningful engagement of people with moderate to advanced dementia identified 26 papers.

Results: Papers were classified as theoretical papers and empirical research. Two overarching constructs emerged, namely promoting a culture of collaborative care and understanding the resident as a person with a past, present and future.

Conclusions: Occupational deprivation prevails and person-centered care is not fully addressed if opportunities for growth and engagement for residents with moderate to advanced dementia is not extended beyond their life history.

Significance: Creating continued opportunities for building agency of residents with dementia could promote occupational justice in residential care.     

Effects of Protein Versus Carbohydrate Supplementation on Markers of Immune Response in Master Triathletes: A Randomized Controlled Trial

Objective: This study examines the long-term effects of ingesting hydrolyzed beef protein versus carbohydrate on indirect markers of immunity during 10 weeks of endurance training in master-aged triathletes (n?=?16, age 35–60?years).

Methods: Participants were randomly assigned to either a hydrolyzed beef protein (PRO, n?=?8) or nonprotein isoenergetic carbohydrate (CHO, n?=?8) condition, which consisted of ingesting 20?g of each supplement, mixed with water, once a day immediately post workout, or before breakfast on nontraining days. Salivary human neutrophil peptides (HNP1–3) were measured before and after performing an incremental endurance test to volitional exhaustion at both pre and post intervention. Additionally, baseline levels of platelets, neutrophils, eosinophil basophils, monocytes, and lymphocytes were determined at pre and post intervention.

Results: No significant changes in baseline concentration and secretion rate of salivary HNP1–3 were observed for either treatment. The CHO group showed a nonsignificant decrease in resting HNP1–3 concentrations following the intervention (p?=?0.052, effect size d?=?0.53). Protein supplementation demonstrated a significant reduction in lymphocyte counts pre to post intervention (mean [SD]: 2.30 [0.57] vs. 1.93 [0.45] 10³/mm³, p?=?0.046, d?=?0.77), along with a moderate but not statistically significant increase (d?=?0.75, p?=?0.051) of the neutrophil-to-lymphocyte ratio.

Conclusions: In master-aged triathletes, postworkout ingestion of only protein, with no carbohydrate, may not be as effective as carbohydrate alone to attenuate negative long-term changes of some salivary and cellular immunological markers. Future studies should consider the co-ingestion of both macronutrients.