Development of Youth-Centered Health Messaging Posters for High School-Based Health Clinics in Hawaii.

BACKGROUND: Youth may be reluctant to seek health care from school health providers due to feeling embarrassed or stigmatized in the health office environment or worried about their confidentiality. The purpose of this project was to create a set of youth-centered health posters that promote youth engagement with nursing staff and to standardize health messaging across high schools in Hawaii school-based clinics. METHODS: Two community advisory boards, 1 composed of 10 youth stakeholders (mean age 17 years) and the other of 7 adult stakeholders, informed poster development utilizing web-based discussion groups. The discussions were transcribed, and additional data was collected using field notes and anonymous digital messages. Adult advisory board members also provided feedback on suggested poster text through an online survey. RESULTS: Youth and adult advisory board participants identified 4 key health concerns facing youth: confidentiality, sexual health, relationships, and mental health. Based on input from the 2 advisory boards, 4 posters were developed, each centered on 1 key health issue. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: School-based posters can convey important messages to help youth understand their health care rights and responsibilities, as well as identify important issues open for discussion with nurses. CONCLUSION: Posters are an underutilized tool for school health providers to create welcoming, inclusive health care environments and facilitate health-related conversations with youth. This paper describes participant feedback about the characteristics of a memorable poster and briefly outlines current knowledge and recommendations for school health providers regarding each of the 4 health issues.

Understanding the difference, makes the difference: perceptions of Black and Minoritised ethnic occupational therapists on mentoring.

INTRODUCTION: Black and Minoritised Ethnicity (BME) occupational therapists face lower career progression opportunities and mentoring is one possible intervention that may offer support. BME persons may have different expectations and experiences from their mentor, and research exploring their perceptions of mentoring is important. In Occupational Therapy there is a growing awareness of the need to be true to the values of social justice. The aim of this research is to learn about BME occupational therapists' experiences and perceptions of mentoring for career progression. METHODS: Four online focus groups involving 19 participants from the UK were held, discussions were facilitated by researchers using a topic guide. Participants responses were analysed, and codes were brought together to create Themes including career progression and role models, mentoring relationship, similarity with the mentor and outcomes from mentoring. RESULTS: The study highlighted that trust is integral to effective mentoring relationships and BME occupational therapists want mentors who they can trust with their experiences and stories. Compatibility between mentors and mentees in terms of personality, values, and working styles is crucial for effective mentoring relationships. Providing opportunities for networking, acknowledging good work and giving permission were all seen as outcomes from good mentoring. The absence of BME role models and ingroup bias were also reported as issues to be addressed. CONCLUSION: This study explores the perception of mentorship as a mechanism for career advancement in occupational therapists from BME backgrounds, with these results transferable to other health and care professional groups. We recommend the creation of a mentoring charter for BME healthcare workers in the United Kingdom to ensure that those from BME backgrounds feel supported, mentored, and provided with equitable access to resources, including adequate mentoring and networking opportunities.

Mentoring for Black and Minoritized Allied Health Professionals in Health and Social Care: A Scoping Review.

Introduction: Diversity, equality and belonging are important aspects within Allied Health Professional (AHP) groups. Mentoring is considered as a solution to improve career progression. To date, there is no consensus on what good mentoring looks like and whether current models are fit for purpose for Black and Minoritised Ethnicity AHPs. Methods: Scoping review to understand mentoring among Black and Minoritised Ethnicity (BME) AHPs through searches in four electronic databases using pre-defined criteria. Results: From 1440 studies screened, 2 studies were included in this review that researched mentoring for BME AHPs in a health and/or social care setting. Themes that emerged from the literature were related to access and amount of mentoring for BME AHPs, psychosocial mentoring may influence cross-race mentorship outcomes and organisational issues related to workforce pressures and management support. There is uncertainty around the importance of same race relationships in mentoring but there is some evidence that within cross-race mentoring this could influence outcomes. Conclusion: It is unknown if mentoring enables career success in BME AHPs. There is emerging evidence on the importance of psychosocial mentoring within cross-race relationships. Careful reflection and further research is needed on how current mentoring models work and ensure fair access to mentorship and support for BME AHPs.

Wheelchair and seating assistive technology provision: a gateway to freedom.

AIM: The meaning of wheelchair and seating assistive technology and the impact inappropriate provision has on people's lives from a service user's perspective within an Irish context is highlighted. There is a dearth in evidence examining the process of wheelchair and seating provision and the interconnectedness between satisfaction, performance and participation from an equality and human rights perspective. The purpose if the study is to investigate wheelchair service users' perspectives of wheelchair and seating provision in Ireland. METHOD: This is a mixed-methods study with an exploratory sequential design that includes two phases. During phase one, wheelchair service users were invited to take part in qualitative in-depth semi-structured interviews, which were thematically analysed and formed part of a larger ethnographic study involving multiple stakeholders in sustainable wheelchair and seating provision strategy development. In phase two, an online Survey Monkey questionnaire was distributed to obtain a wider overview of wheelchair service provision from a wheelchair service users perspective. Data obtained from the closed questions and content analysis for open comments was analysed descriptively for this phase. RESULTS: Eight wheelchair service users agreed to participate in the interviews and 273 responded to the online survey. Thematic analysis and questionnaire frequency and content analysis revealed the vital meaning of wheelchair and seating assistive technology provision. However, bottlenecks within the system affect daily living, with qualitative data highlighting the obstruction to experiences of independent living from initial appointment to wheelchair breakdowns during daily life. CONCLUSION: Appropriate wheelchair and seating assistive technology provision is a basic human right, supported by the essential and embodied nature of the wheelchair as demonstrated through the wheelchair service users' perspective throughout this study. These findings highlight the impact of ad-hoc services on individual freedoms and how the overall pace of the system affects a person's ability to organise their time as an equal member of the community across the lifespan. A national review of wheelchair and seating assistive technology provision services is called for, giving consideration to access to services, assessment and delivery, follow up and management, education and training.IMPLICATIONS FOR REHABILITATIONWheelchair and seating assistive technology provision as a basic human right is misunderstood.Appropriate wheelchair and seating assistive technology provision should be provided to meet this primary need as a pre-requisite for survival.Every aspect of the wheelchair and seating provision process impacts on occupational performance, equality of opportunity and community mobility. Wheelchair and seating assistive technology professionals and providers have a responsibility to review their practice and service provision systems.

Developing an Intervention to Improve Occupational Participation for Justice-Involved People with a Personality Disorder: Defining and Describing Intervention Components.

Occupational participation is undertaking personally meaningful and socially valued activities and roles. It is an important outcome for health and justice interventions, as it is integral to health and desistance. We report the third of a four-stage research project to develop an intervention to improve occupational participation for justice-involved people with a personality disorder in the community. We completed a Delphi survey to produce expert consensus on intervention components and their content, ascertain participant ratings of 28 factors for their level of influence on occupational participation, and the modifiability of the factors with this population. Thirty multi-disciplinary participants completed three survey rounds. Most factors were rated very influential, but few were considered easily modifiable. Participants agreed 121 statements describing intervention components and content. Twenty-seven statements did not reach consensus. In targeting specific factors in intervention, practitioners must balance their degree of influence with potential modifiability. The results will inform intervention manualization and modeling.

Dystrophic muscle distribution in late-stage muscular dystrophy.

There is scant information about the comprehensive distribution of dystrophic muscles in muscular dystrophy. Despite different clinical presentations of muscular dystrophy, a recent multi-center study concluded that phenotypic distribution of dystrophic muscles is independent of clinical phenotype and suggested that there is a common pattern of involved muscles. To evaluate this possibility, the present case report used cadaveric dissection to determine the whole-body distribution of fat-infiltrated, dystrophic muscles from a 72-year-old white male cadaver with adult-onset, late-stage muscular dystrophy. Severely dystrophic muscles occupied the pectoral, gluteal and pelvic regions, as well as the arm, thigh and posterior leg. In contrast, muscles of the head, neck, hands and feet largely appeared unaffected. Histopathology and a CT-scan supported these observations. This pattern of dystrophic muscles generally conformed with that described in the multi-center study, and provides prognostic insight for patients and the physicians treating them.

Parent-Adolescent Sex Communication with Sexual and Gender Minority Youth: An Integrated Review.

INTRODUCTION: Sexual and gender minority (SGM) youth experience adverse sexual health outcomes at higher rates than their heterosexual and cisgender peers. Although parent-adolescent sex communication (PASC) is associated with improved sexual health outcomes among heterosexual youth, less is known about PASC with SGM youth. METHODS: Studies describing experiences of SGM youth and parents during PASC and/or health outcomes of PASC were reviewed. RESULTS: Eleven studies met inclusion criteria, and six themes emerged. These included: (1) limited communication and barriers to communication, (2) impact of SGM disclosure on communication, (3) HIV and/or sexually transmitted disease-focused communication, (4) heteronormative communication, (5) outcomes of communication, and (6) youth preferences for PASC. DISCUSSION: Parent-adolescent sex communication was complicated by barriers to communication and was limited, heteronormative, and influenced by SGM disclosure. Parent-adolescent sex communication may improve sexual health outcomes, but adequate parental education and guidance is lacking. This review identifies ways that health providers can foster positive and inclusive PASC.

Perinatal Anxiety and Depression in Minority Women.

Depression and anxiety are common during pregnancy and are experienced at higher rates among women who are racial and ethnic minorities. Because depression and anxiety influence maternal and infant outcomes, intervening to improve perinatal mental health should be a priority for all healthcare providers. However, in the United States, a number of barriers including lack of mental health providers, lack of perinatal behavioral health systems, and stigma, limit access to care. Universal screening has been recommended and here we examine how universal screening can help nurses improve the mental health of childbearing women. Interventions that are currently in use to improve perinatal anxiety and depression are reviewed and include: psychopharmacology, cognitive behavioral therapy, interpersonal psychotherapy, and mindfulness. Recommendations for future research and healthcare system changes are made.

Dystrophic muscle distribution in late-stage muscular dystrophy

There is scant information about the comprehensive distribution of dystrophic muscles in muscular dystrophy. Despite different clinical presentations of muscular dystrophy, a recent multi-center study concluded that phenotypic distribution of dystrophic muscles is independent of clinical phenotype and suggested that there is a common pattern of involved muscles. To evaluate this possibility, the present case report used cadaveric dissection to determine the whole-body distribution of fat-infiltrated, dystrophic muscles from a 72-year-old white male cadaver with adult-onset, late-stage muscular dystrophy. Severely dystrophic muscles occupied the pectoral, gluteal and pelvic regions, as well as the arm, thigh and posterior leg. In contrast, muscles of the head, neck, hands and feet largely appeared unaffected. Histopathology and a CT-scan supported these observations. This pattern of dystrophic muscles generally conformed with that described in the multi-center study, and provides prognostic insight for patients and the physicians treating them.

People with severe problematic personality traits and offending histories: What influences occupational participation?

BACKGROUND: Occupational participation is important for personality disordered offenders (PDOs) because it is integral to health and desistance from offending. What influences occupational participation is unknown for PDOs in the community, limiting effective intervention to affect change. In England and Wales, the Offender Personality Disorder Pathway aims to improve outcomes for people considered highly likely to have a severe personality disorder and who present a high risk of reoffending, who are determined to be PDOs on the basis of a structured assessment. This study identified the influencers of occupational participation for the population who receive this service. METHOD: In this critical realist, qualitative study, narrative interviews were conducted with 18 PDOs supervised by probation in England. Transcripts were analyzed using a grounded theory approach to establish influencers of occupational participation. RESULTS: Four themes describe influencers of occupational participation: function of occupations; influence of the past; external forces; and learning and adaptation. The latter theme reflected understandings of occupational adaptation described by the Model of Human Occupation. CONCLUSIONS: An intervention to increase prosocial occupational participation should be developed and evaluated for PDOs in the community, taking account of occupational participation over the life course.

What influences social outcomes among offenders with personality disorder: A systematic review.

BACKGROUND: Personality disorder is highly prevalent in offender populations and is associated with poor health, criminal justice, and social outcomes. Research has been conducted into factors that influence offending and health, but, in order to improve (re)habilitation, service providers must also be able to identify the variables associated with social outcomes and the mechanisms by which they operate. AIM: To establish what is known about what influences social outcomes among offenders with personality disorder. METHOD: A systematic review was completed using Cochrane methods, expanded to include nonrandomised trials. Anticipated high heterogeneity informed a narrative synthesis. RESULTS: Three studies met inclusion criteria. Two were qualitative studies including only 13 cases between them. All studies were low quality. CONCLUSIONS: There is insufficient evidence to determine what influences good social outcomes among offenders with personality disorder. Research is required to identify associated variables, to inform the development of effective interventions.

How effective are interventions to improve social outcomes among offenders with personality disorder: a systematic review.

BACKGROUND: Offenders with personality disorder are supported by health, criminal justice, social care and third sector services. These services are tasked with reducing risk, improving health and improving social outcomes. Research has been conducted into interventions that reduce risk or improve health. However, interventions to improve social outcomes are less clearly defined. METHODS: To review the effectiveness of interventions to improve social outcomes we conducted a systematic review using Cochrane methodology, expanded to include non-randomised trials. Anticipated high heterogeneity of the studies informed narrative synthesis. RESULTS: Eleven studies met inclusion criteria. Five contained extractable data. No high-quality studies were identified. Outcomes measured clustered around employment and social functioning. Interventions vary and their mechanisms for influencing social outcomes are poorly operationalised. Although change was observed in employment rates, there was no evidence for the effectiveness of these interventions. CONCLUSIONS: There is a lack of evidence for effective interventions that improve social outcomes. Further research is recommended to reach consensus on the outcomes of importance, identify the factors that influence these and design theoretically-informed and evidence-based interventions.

What can be learned from adolescent time diary research.

Time use is increasingly being recognized as a determinant and indicator of adolescent well-being internationally. Three existing literature reviews of time-use research with children and adolescents have identified time-use diaries as the preferred data collection method. Furthermore, they have encouraged researchers to examine multidimensional patterns of overall time use in large-sample whole child populations to better understand the health, well-being, and quality of life of children and young people. However, these three existing reviews differ in the time frames covered; the age ranges targeted; the categories of time use examined; and the time-use data collection and analysis methods used. This study aimed to map the extent and nature of time diary studies with well adolescents (aged 10-19 years) and the use of person-centered data analysis of overall time use as a multidimensional unit. Finally, it explores whether and how the included studies analyzed the relationship between time use and health, well-being, and quality of life. A scoping review method was employed using Arksey and O'Malley's five-step framework. Thirty-three studies met the inclusion criteria. Most studies were secondary analyses of cross-sectional population-level time-use or lifestyle survey data. One-third of studies (n = 11) captured data representing 24 hours of the day. Two studies (6%) used person-centered analyses, while six studies (18%) empirically examined time use in relation to health and well-being. No studies examined adolescent 24-hour time use and quality of life. Adolescent time-use researchers are encouraged to be explicit in identifying the stage of adolescence to which their studies relate; capture 24-hour time-use data; analyze overall activity patterns as multidimensional units using person-centered methods; and use robust, reliable, valid, sensitive, and age-appropriate instruments to empirically examine time use and health, well-being, and quality of life. Through this, healthy patterns of everyday activity for adolescents can be illuminated.

A person-centred analysis of the time-use, daily activities and health-related quality of life of Irish school-going late adolescents.

PURPOSE: The health, well-being and quality of life of the world's 1.2 billion adolescents are global priorities. A focus on their patterns or profiles of time-use and how these relate to health-related quality of life (HRQoL) may help to enhance their well-being and address the increasing burden of non-communicable diseases in adulthood. This study sought to establish whether distinct profiles of adolescent 24-h time-use exist and to examine the relationship of any identified profiles to self-reported HRQoL. METHOD: This cross-sectional study gathered data from a random sample of 731 adolescents (response rate 52%) from 28 schools (response rate 76%) across Cork city and county. A person-centred approach, latent profile analysis, was used to examine adolescent 24-h time-use and relate the identified profiles to HRQoL. RESULTS: Three male profiles emerged, namely productive, high leisure and all-rounder. Two female profiles, higher study/lower leisure and moderate study/higher leisure, were identified. The quantitative and qualitative differences in male and female profiles support the gendered nature of adolescent time-use. No unifying trends emerged in the analysis of probable responses in the HRQoL domains across profiles. Females in the moderate study/higher leisure group were twice as likely to have above-average global HRQoL. CONCLUSION: Distinct time-use profiles can be identified amongst adolescents, but their relationship with HRQoL is complex. Rich mixed-method research is required to illuminate our understanding of how quantities and qualities of time-use shape lifestyle patterns and how these can enhance the HRQoL of adolescents in the twenty-first century.

A scoping review of time-use research in occupational therapy and occupational science.

BACKGROUND: Time use is a defining interest within occupational therapy and occupational science. This is evident through the range of contributions to the disciplinary knowledge base. Indeed it has been suggested that time-use methods are amongst the most established research techniques used to explore aspects of human occupation. However, the extent and nature of such activity in occupational therapy and occupational science has not been examined to date. AIM: This study sought to map the extent and nature of time-use research in occupational therapy and occupational science journals and the extent to which studies explored the relationship between time-use and health. METHOD: A scoping review method was used. RESULTS: Sixty-one studies were included. Scandinavian countries contributed the largest number of studies (n = 16, 26%). While time-use diaries were used most frequently (n = 30, 49%) occupational therapists and occupational scientists have developed a range of data-collection instruments. Forty-nine studies (80%) focused on time-use in clinical or defined population sub-groups. Ten studies (16%) included an empirical examination of the relationship between time-use and health. CONCLUSION: Future research should examine time-use and health amongst well populations across the lifespan and in different parts of the world.

Learning experiences on role-emerging placements: an exploration from the students' perspective.

BACKGROUND/AIM: Occupational therapy educators are challenged to provide students with practical experiences which prepare them for ever changing health-care contexts on graduation. Role-emerging placements have been widely used internationally to help meet this challenge, but research into the learning experiences of students during these innovative placements is limited. This research investigated the enablers and barriers to learning from the perspectives of students on such placements from two European universities. METHODS: Two separate qualitative studies tracked 10 final year students. Interviews explored their learning experiences prior to, during and after an eight- or 10-week role-emerging placement in a range of settings. RESULTS: Four themes emerged, which were (1) adapting to less doing, more thinking and planning; (2) understanding the complexity of collaboration and making it work; (3) emotional extremes; and (4) realising and using the occupational therapy perspective. CONCLUSIONS: These placements presented a 'roller coaster' of authentic learning experiences which created the opportunity for students to use occupation in practice and develop skills for collaborative working in an interprofessional environment. Whereas students viewed their role-emerging placement experiences positively, challenges included the emotional responses of students and placement pace. Findings suggest the need for supportive student placement experiences in both established and role-emerging areas to prepare students for a range of opportunities in an uncertain future.

Teriparatide and denosumab, alone or combined, in women with postmenopausal osteoporosis: the DATA study randomised trial.

BACKGROUND: Osteoporosis medications increase bone-mineral density (BMD) and lower but do not eliminate fracture risk. The combining of anabolic agents with bisphosphonates has not improved efficacy. We compared combined teriparatide and denosumab with both agents alone. METHODS: From September, 2009, to January, 2011, we enrolled postmenopausal women with osteoporosis into this randomised, controlled trial. Patients were assigned in a 1:1:1 ratio to receive 20 µg teriparatide daily, 60 mg denosumab every 6 months, or both. BMD was measured at 0, 3, 6, and 12 months. Women who completed at least one study visit after baseline were assessed in a modified intention-to-treat analysis. This trial is registered with ClinicalTrials.gov, number NCT00926380. FINDINGS: 94 (94%) of 100 eligible women completed at least one study visit after baseline. At 12 months, posterior-anterior lumbar spine BMD increased more in the combination group (9·1%, [SD 3·9]) than in the teriparatide (6·2% [4·6], p=0·0139) or denosumab (5·5% [3·3], p=0·0005) groups. Femoral-neck BMD also increased more in the combination group (4·2% [3·0]) than in the teriparatide (0·8% [4·1], p=0·0007) and denosumab (2·1% [3·8], p=0·0238) groups, as did total-hip BMD (combination, 4·9% [2·9]; teriparatide, 0·7% [2·7], p<0·0001; denosumab 2·5% [2·6], p=0·0011). INTERPRETATION: Combined teriparatide and denosumab increased BMD more than either agent alone and more than has been reported with approved therapies. Combination treatment might, therefore, be useful to treat patients at high risk of fracture. FUNDING: Amgen, Eli Lilly, National Center for Research Resources.

"What she told us made the world of difference": carers' perspectives on a hospice at home service.

UNLABELLED: This paper explores the expectations and needs of current and bereaved carers whose relatives received care at home from a palliative care team. AIM: A hospice at home service was established in 2006 to provide patients with care in their own homes. We examined whether this model of care was helpful in mitigating carers' burden and in enabling terminally ill patients to be cared for and die at home. METHODS: This study utilized a survey and interviews. Participants were carers in the midwest of Ireland. Survey responses from 122 carers were analyzed using SPSS 18.0 (SPSS Inc., 2009); interviews with 15 carers were also conducted. RESULTS: Carers' expectations of the service were often exceeded, and quality of care dimensions were rated highly. Future improvements could include facilitating discussions on place of death and offering bereavement support. CONCLUSION: The service is supporting carers in facilitating their relatives' choice to die at home.

Revisiting 1:1 and 2:1 clinical placement models: student and clinical educator perspectives.

AIM: A recent systematic review suggests that more comparative research is required on the effectiveness of clinical placement models. This study explored perspectives of clinical educators and students who had participated in both the 1:1 (one student supervised by one clinical educator) and 2:1 (two students supervised by one clinical educator) models of clinical education across occupational therapy and physiotherapy programmes in Ireland. METHODS: Qualitative data using a descriptive approach were gathered through individual semi-structured interviews with a convenience sample of 12 students and eight clinical educators. Transcripts were analysed using thematic content analysis. RESULTS: Three main themes emerged: learning opportunities and experiences; organisation and planning; relationships. Although clinical educators felt that the 2:1 model offered greater learning experiences than the 1:1 model, it presented organisational challenges. Students preferred the 2:1 model earlier in their clinical experience due to the benefits of peer learning, whereas the 1:1 model was favoured in the latter stages to demonstrate individual autonomy. Relationships forged during placement were significant, from the student's perspectives, but differed between models. Clinical educator and student perspectives indicated that learning from other members of the multidisciplinary team had a positive effect on learning within both models. CONCLUSION: Each clinical placement model requires specific organisational and planning skills to be effective. An awareness of individual student learning is essential to avoid dissatisfaction with the learning and assessment process on a 2:1 model. Recently established clinical education teams in Ireland may have a role to play in developing effective clinical learning.

Directions for advancing the study of work transitions in the 21st century.

OBJECTIVES: The purpose of this article is to share the details, outcomes and deliverables from an international workshop on work transitions in London, Ontario, Canada. PARTICIPANTS: Researchers, graduate students, and community group members met to identity ways to advance the knowledge base of strategies to enhance work participation for those in the most disadvantaged groups within society. METHODS: A participatory approach was used in this workshop with presentations by researchers and graduate students. This approach included dialogue and discussion with community members. In addition, small group dialogue and debate, world cafe discussions, written summaries of group discussion and reflection boards were used to bring new ideas to the discussion and to build upon what we know. FINDINGS: Two research imperatives and six research recommendations were identified to advance global dialogue on work transitions and to advance the knowledge base. Occupational justice can be used to support future research directions in the study of work transitions. CONCLUSIONS: Moving forward requires a commitment of community of researchers, clinicians and stakeholders to address work disparities and implement solutions to promote participation in work.