Pregnancy complications and childhood mental health: is the association modified by sex or adverse social circumstances? Findings from the 'growing up in Ireland' national infant cohort study.

Specific pregnancy complications, socioeconomic position and sex have all been independently associated with child mental health outcomes, but their combined effects remain unclear. We examined whether total number of complications experienced in the pregnancy associated with mental health at 5 and 9-years, and whether this varied by sex or adverse social circumstances. Pregnancy complications were self-reported at 9-months post-natally from a list of 16 complications. Parents completed the Strengths and Difficulties Questionnaire (SDQ) when their child was 5 and 9-years. The primary outcome was the SDQ-total and scoring in the clinical range (> 16) was a secondary outcome. We applied generalized linear mixed models to a large nationally representative Irish cohort (GUI; n = 11,134). Analyses were adjusted for sex, adverse social circumstances (at 9-months), and gestational smoking. We included an interaction term between pregnancy complications and each variable respectively in separate models to examine if associations varied by sex or adverse circumstances.After controlling for covariates, total complications associated with mental health at 5 and 9-years. Each additional pregnancy complication conferred a 10% higher total-SDQ score (exponentiated co-efficient 1.10 [95%CI 1.06-1.14], 1.20 [1.15-1.26], 1.20 [1.12-1.29] and 1.34 [1.21-1.48] for 1, 2, 3 and 4 + complications respectively). For the dichotomised outcome, generally increasing odds for clinical levels of mental health difficulties were observed (OR 1complication = 1.89, 95%CI [1.37-2.59]; OR 2complications = 2.31, 95%CI [1.53-3.50]; OR 3complications = 1.77, 95%CI [0.89-3.52]; OR 4 + complications = 6.88, 95%CI [3.29-14.40]). Females had significantly lower odds of exhibiting clinically significant mental health difficulties than males (OR = 0.43, 95%CI[0.32-0.57]).There was no evidence that the association between pregnancy complications and child's mental health varied by sex or social circumstances at 5 or 9-years. Males exposed to numerous pregnancy complications in the context of adverse social circumstances had the highest predicted probability of having mental health difficulties in middle childhood.

The Impact of Complex Trauma on Occupations and Daily Functioning in Childhood: A Scoping Review.

AIMS: To explore the impact of complex trauma on occupations and daily functioning in childhood through empirical studies and asses the extent and state of available evidence. METHODS: The five-stage scoping review framework by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR: Tricco et al.) were followed. EMBASE, MEDLINE, CINAHL, PsychINFO, and Web of Science databases were systematically searched. Included studies were empirical research published in English up to December 2022, reporting on the impact of complex trauma on daily functioning or occupations in children experiencing such trauma, defined as prolonged exposure to interpersonal trauma arising within the primary caregiving system. RESULTS: Eight studies were included. They reported impacts on personal and instrumental activities of daily living, sleep, education, work, play, leisure, and social participation. Some domains lacked comprehensive investigation, and studies lacked descriptions of specific effects on these areas. CONCLUSIONS: The review reveals a lack of robust empirical evidence on the impact of complex trauma on occupations and daily functioning in childhood, with limited depth for comprehensive analysis on the extent of children's occupational life impact. Further research is warranted to address identified gaps.

Impact of an evidence-based practice course on occupational therapist's confidence levels and goals.

Confidence levels of 136 Irish occupational therapists were measured before and after an evidence based practice training course. Ranked scores on the evidence based practice confidence scale showed statistically significant improvement in all areas between pre and post course. Goals set by therapists to integrate EBP into their practice following the course were analysed and grouped into categories which included: 1) getting ready to use evidence based practice, 2) examining current and best practices, and 3) promoting a culture of evidence based practice in the workplace. Course feedback using Likert scales identified satisfaction with course content and delivery method.

Interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function for children with hemiplegic cerebral palsy.

OBJECTIVE: We examined the interrater reliability of the Melbourne Assessment of Unilateral Upper Limb Function. METHOD: Three occupational therapists independently scored 34 videotaped assessments of children with hemiplegic cerebral palsy aged 6 yr, 1 mo, to 14 yr, 5 mo. Intraclass correlation coefficients (ICCs) at a 95% confidence interval were calculated for total scores, category scores, and item scores. RESULTS: The correlation between raters' total scores was high (ICC = .961). The highest correlation for test components between raters was found for fluency (ICC = .902), followed by range of movement (ICC = .866), and the lowest correlation was found for quality of movement (ICC = .683). The ICCs for individual test item scores varied and ranged from .368 to .899. CONCLUSION: This study demonstrated high interrater reliability for total scores, with scoring of some individual components and items requiring further consideration from both a clinical and a research perspective.

Surgical treatment of swan-neck deformity in hemiplegic cerebral palsy.

PURPOSE: Previously described surgical treatments for dynamic swan-neck deformity in cerebral palsy are technically difficult and time consuming. Typically only a few fingers could be addressed at one sitting, and postoperative swelling and stiffness were often incurred. An easy procedure of central slip tenotomy is described that allows for multiple fingers to be addressed, with minimal postoperative morbidity. METHODS: Fifteen patients (33 fingers) with hemiplegic cerebral palsy and dynamic swan-neck deformities of their fingers were treated. Only swan-neck deformities of greater than 20 degrees were considered for treatment. Pre- and postoperative measurements of swan-neck deformity were recorded. A central slip tenotomy was performed through a transverse incision proximal to the proximal interphalangeal joint. The joint was pinned in 10 degrees of flexion for 4 weeks, and then active extension was allowed to 10 degrees short of full extension and blocked with an oval-8 splint. Average patient age was 16 years (range 5-44 years). All patients had concurrent procedures performed on the extremity. Average follow-up evaluation was 23 months (+/-12 months). RESULTS: Improvement in dynamic swan-neck deformity averaged 32 degrees . Preoperative swan-neck deformity averaged 38 degrees and postoperative swan-neck deformity averaged 6 degrees . No swan-neck deformity was worse than its preoperative state, and no patient developed boutonniere deformity. No patient lost active or passive flexion after the procedure. All patients would repeat the procedure. CONCLUSION: Central slip tenotomy is a reliable treatment for dynamic swan-neck deformity in cerebral palsy in patients without dynamic metacarpophalangeal flexion deformity. Because of the simplicity of the procedure, it can easily be added to the treatment of the entire upper extremity in cerebral palsy.