Regulation of host metabolic health by parasitic helminths.

Obesity is a worldwide pandemic and major risk factor for the development of metabolic syndrome (MetS) and type 2 diabetes (T2D). T2D requires lifelong medical support to limit complications and is defined by impaired glucose tolerance, insulin resistance (IR), and chronic low-level systemic inflammation initiating from adipose tissue. The current preventative strategies include a healthy diet, controlled physical activity, and medication targeting hyperglycemia, with underexplored underlying inflammation. Studies suggest a protective role for helminth infection in the prevention of T2D. The mechanisms may involve induction of modified type 2 and regulatory immune responses that suppress inflammation and promote insulin sensitivity. In this review, the roles of helminths in counteracting MetS, and prospects for harnessing these protective mechanisms for the development of novel anti-diabetes drugs are discussed.

Effect of experimental hookworm infection on insulin resistance in people at risk of type 2 diabetes.

The reduced prevalence of insulin resistance and type 2 diabetes in countries with endemic parasitic worm infections suggests a protective role for worms against metabolic disorders, however clinical evidence has been non-existent. This 2-year randomised, double-blinded clinical trial in Australia of hookworm infection in 40 male and female adults at risk of type 2 diabetes assessed the safety and potential metabolic benefits of treatment with either 20 (n = 14) or 40 (n = 13) Necator americanus larvae (L3) or Placebo (n = 13) (Registration ACTRN12617000818336). Primary outcome was safety defined by adverse events and completion rate. Homoeostatic model assessment of insulin resistance, fasting blood glucose and body mass were key secondary outcomes. Adverse events were more frequent in hookworm-treated participants, where 44% experienced expected gastrointestinal symptoms, but completion rates were comparable to Placebo. Fasting glucose and insulin resistance were lowered in both hookworm-treated groups at 1 year, and body mass was reduced after L3-20 treatment at 2 years. This study suggests hookworm infection is safe in people at risk of type 2 diabetes and associated with improved insulin resistance, warranting further exploration of the benefits of hookworms on metabolic health.

Occupational Science Concepts Essential to Occupation-Based Practice: Development of Expert Consensus.

IMPORTANCE: What occupational science (OS) knowledge may be essential to occupational therapy practice has not been systematically explored. OBJECTIVE: To identify and gain expert consensus on OS concepts viewed as essential to occupational therapy practice. DESIGN: A complex, convergent mixed-methods Delphi design with an international panel of OS experts randomly assigned to two parallel groups. In Round 1, each group generated OS concepts; in Rounds 2 and 3, they rated the degree to which each concept was essential to occupational therapy. Data were analyzed separately for each group. A fourth round combined the two groups and used carefully merged concept definitions from both groups to validate consensus on essential concepts arising from the prior rounds. PARTICIPANTS: Fifty-two nominated experts from 22 countries who met a priori criteria participated in the 14-mo study. RESULTS: Of 62 experts invited, 52 (Group A = 24, Group B = 28) participated in the first round, and 42 (81%) completed the full-group final round. Eleven concepts met the consensus threshold (≥70%) established for the study. Additional analysis compared parallel- and full-group results to carefully discern conceptual similarities and differences, especially with near-consensus concepts. CONCLUSIONS AND RELEVANCE: Substantial expert agreement was established for several OS concepts viewed as essential, providing a basis for future studies to refine the concepts for occupational therapy education and practice. What This Article Adds: The results of this research provide a systematically derived preliminary basis for selecting OS content for occupational therapy educational programs and preliminary concepts for organizing OS knowledge germane to occupational therapy practice.

Effectiveness of Transition Readiness Interventions by School-Based Occupational Therapy Personnel.

Despite federal mandates to transition students with disabilities to successful adulthood, outcomes have been poor. Although areas of occupational therapy expertise, such as life and work skills, are effective in improving transition outcomes, occupational therapy personnel rarely provide transition services. The purpose of this study was to examine the effectiveness of occupational therapy transition readiness services for students with disabilities, 14 to 16 years of age, over two academic years of intervention. Forty-two students and 14 occupational therapy personnel from 10 school districts participated. Assessments were provided to transition teams. Peer groups explored work and life skills and completed long-term student-led projects. Pre-post scores of functional behavior were analyzed using a proportional change index. Students receiving occupational therapy transition readiness services demonstrated statistically significant gains. Occupational therapy holds potential to increase the functional readiness of students with disabilities for transition to a successful and productive adult life.

Safety and tolerability of experimental hookworm infection in humans with metabolic disease: study protocol for a phase 1b randomised controlled clinical trial.

BACKGROUND: Abdominal obesity and presence of the metabolic syndrome (MetS) significantly increase the risk of developing diseases such as Type 2 diabetes mellitus (T2DM) with escalating emergence of MetS and T2DM constituting a significant public health crisis worldwide. Lower prevalence of inflammatory and metabolic diseases such as T2DM in countries with higher incidences of helminth infections suggested a potential role for these parasites in the prevention and management of certain diseases. Recent studies confirmed the potential protective nature of helminth infection against MetS and T2DM via immunomodulation or, potentially, alteration of the intestinal microbiota. This Phase 1b safety and tolerability trial aims to assess the effect of inoculation with helminths on physical and metabolic parameters, immune responses, and the microbiome in otherwise healthy women and men. METHODS: Participants eligible for inclusion are adults aged 18-50 with central obesity and a minimum of one additional feature of MetS recruited from the local community with a recruitment target of 54. In a randomised, double-blind, placebo-controlled design, three groups will receive either 20 or 40 stage three larvae of the human hookworm Necator americanus or a placebo. Eligible participants will provide blood and faecal samples at their baseline and 6-monthly assessment visits for a total of 24 months with an optional extension to 36 months. During each scheduled visit, participants will also undergo a full physical examination and complete diet (PREDIMED), physical activity, and patient health (PHQ-9) questionnaires. Outcome measurements include tolerability and safety of infection with Necator americanus, changes in metabolic and immunological parameters, and changes in the composition of the faecal microbiome. DISCUSSION: Rising cost of healthcare associated with obesity-induced metabolic diseases urgently calls for new approaches in disease prevention. Findings from this trial will provide valuable information regarding the potential mechanisms by which hookworms, potentially via alterations in the microbiota, may positively influence metabolic health. TRIAL REGISTRATION: The protocol was registered on ANZCTR.org.au on 05 June 2017 with identifier ACTRN12617000818336. Alternatively, a Google search using the above trial registration number will yield a direct link to the trial protocol within the ANZCTR website.

Association of Sleep and Hand Function in People With Carpal Tunnel Syndrome.

This study examined whether sleep quality is associated with hand function above and beyond what can be explained by the effect of pain and carpal tunnel syndrome (CTS) severity on hand function in clients with CTS. The sample included 53 adults ages 30-86 yr. The Manual Ability Measure-20, Pittsburgh Sleep Quality Index, visual analog scale for pain, and electromyography for CTS diagnosis and severity level were used to measure outcomes. Sleep quality was significantly associated with manual ability after controlling for CTS severity and pain. In CTS care, attention to sleep is significant because it may promote hand function.

Influence of Exercise Mode on Post-exercise Arterial Stiffness and Pressure Wave Measures in Healthy Adult Males.

Background: Exercise mode has been reported to be an important determinant of arterial stiffness and wave reflection changes following a brief bout of exercise with inconsistent results to date. This study examined the impact of exercise mode on arterial stiffness and pressure wave measures following acute aerobic exercise (AER), resistance exercise (RES), and a control (CON) condition with no exercise. Methods: In a randomized, cross-over, repeated measures design, 21 healthy adult males (26.7 ± 7.2 years) undertook three experimental intervention sessions: AER (30-min cycle ergometry at 70-75% maximum heart rate), RES (3 × 10 repetitions of six upper and lower body exercises at 80-90% of 10-repetition maximum) and CON (30-min seated rest). Measures of arterial stiffness and pressure waves, such as carotid-femoral pulse wave velocity (cf-PWV), augmentation index (AIx), AIx corrected for heart rate of 75 (AIx75), and forward wave (Pf), backward wave (Pb) and reflection magnitude, were assessed at Rest and at 10-min intervals for 60 min after the intervention sessions. Comparisons between interventions and over time were assessed via repeated measures ANOVA and post-hoc Tukey's tests. Results: No significant differences in cf-PWV were noted between the three interventions at rest or post-intervention. However, RES led to significantly greater post-intervention AIx, AIx75, Pf, and Pb compared to AER and CON with AIx75 also remaining significantly elevated throughout the post-intervention period. In contrast, AER resulted in a brief, significant elevation of AIx75 and no change in cf-PWV, Pf, Pb, and reflection magnitude. Conclusions: Exercise mode, specifically RES and AER, significantly influenced the time course of pressure wave reflection responses following a brief bout of exercise in healthy adult males. Distinct adjustments during exercise including changes in blood pressure and vasomotor tone may be key modulators of post-exercise arterial function. Identification of modal differences may assist in understanding the impact of exercise on cardiovascular function and the mechanisms by which exercise benefits vascular health.

Acute Effects of Exercise Mode on Arterial Stiffness and Wave Reflection in Healthy Young Adults: A Systematic Review and Meta-Analysis.

Background: This systematic review and meta-analysis quantified the effect of acute exercise mode on arterial stiffness and wave reflection measures including carotid-femoral pulse wave velocity (cf-PWV), augmentation index (AIx), and heart rate corrected AIx (AIx75). Methods: Using standardized terms, database searches from inception until 2017 identified 45 studies. Eligible studies included acute aerobic and/or resistance exercise in healthy adults, pre- and post-intervention measurements or change values, and described their study design. Data from included studies were analyzed and reported in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. Meta-analytical data were reported via forest plots using absolute differences with 95% confidence intervals with the random effects model accounting for between-study heterogeneity. Reporting bias was assessed via funnel plots and, individual studies were evaluated for bias using the Cochrane Collaboration's tool for assessing risk of bias. A modified PEDro Scale was applied to appraise methodological concerns inherent to included studies. Results: Acute aerobic exercise failed to change cf-PWV (mean difference: 0.00 ms-1 [95% confidence interval: -0.11, 0.11], p = 0.96), significantly reduced AIx (-4.54% [-7.05, -2.04], p = 0.0004) and significantly increased AIx75 (3.58% [0.56, 6.61], p = 0.02). Contrastingly, acute resistance exercise significantly increased cf-PWV (0.42 ms-1 [0.17, 0.66], p = 0.0008), did not change AIx (1.63% [-3.83, 7.09], p = 0.56), and significantly increased AIx75 (15.02% [8.71, 21.33], p < 0.00001). Significant heterogeneity was evident within all comparisons except cf-PWV following resistance exercise, and several methodological concerns including low applicability of exercise protocols and lack of control intervention were identified. Conclusions: Distinct arterial stiffness and wave reflection responses were identified following acute exercise with overall increases in both cf-PWV and AIx75 following resistance exercise potentially arising fromcardiovascular and non-cardiovascular factors that likely differ from those following aerobic exercise. Future studies should address identified methodological limitations to enhance interpretation and applicability of arterial stiffness and wave reflection indices to exercise and health.

A Century of Therapeutic Use of the Physical Environment.

In this article, we describe the use of the objects and spaces of the physical environment by occupational therapy practitioners in the United States over the profession's first 100 years. Using professional literature selected by decade from the years 1917 through 2016 to obtain data, we applied grounded theory methods to complete a detailed description. Team-based analysis over four coding schemes yielded a theoretical description of the profession's therapeutic use of the physical environment. Study findings included descriptions across occupational therapy's history of (1) treatment spaces, (2) the concepts of adapting and grading, and (3) a typology of constructive and nonconstructive applications of objects and activities by occupational therapy clients and practitioners. This extended historical perspective on trajectories of change in intervention space, the role of physical products in intervention, therapist repertoire, and the enduring role of adaptation suggests how the physical environment may be used in future practice.

Cross-cultural understandings of festival food-related activities for older women in Chiang Mai, Thailand, Eastern Kentucky, USA and Auckland, New Zealand.

This cross-country, cross-cultural study explored the meaning of older women's food-related activities for the annual festivals of Songkran (Thai New Year) in Chiang Mai, Thailand; and Christmas in Richmond, Kentucky, USA; and Auckland, New Zealand. A derived etic method was used. The community-dwelling participants were 33 Thai women, aged 60 and older, and 16 New Zealand and 23 eastern Kentucky women, aged 65 and older. This article focuses on the final cross-cultural analysis of the data. Emic, or within-country, findings are presented, followed by the derived etic, or cross-cultural, interpretations for two themes of meaning; older women's 'protecting what matters' and 'leading the way'. Applying derived etic methods helped reveal how, despite the highly different food-related practices, preparing and sharing celebratory foods at Songkran or Christmas held related meanings for older women in Thailand, Kentucky USA, and New Zealand.

Youth and administrator perspectives on transition in Kentucky's state agency schools.

Students, a large percentage with disabilities, are at high risk for poor post-secondary outcomes in state agency education programs. This mixed-methods study describes the understandings of student transitions in state agency education programs from the perspectives of youth and administrators. Results indicated that: transition is more narrowly defined within alternative education programs; key strengths of transition practice are present in nontraditional schools; and the coordination barriers within this fluid inter-agency transition system are most apparent in students' frequent inter-setting transitions between nontraditional and home schools.

Pediatric therapists' perspectives on occupation-based practice.

AIMS: The aim of this study was to describe the perspectives on occupation-based practice of 22 pediatric occupational therapists in a medical facility in the Midwestern United States. METHODS: The study used a grounded theory approach to analyze the individual, semi-structured interviews of 22 pediatric occupational therapists. Transcripts were initially coded using Ethnograph™ 5.0 software and analysis continued using constant comparison techniques and memo writing to produce emergent themes of meaning. FINDINGS: The doing of occupation-based practice was based in personal identity and influenced by professional education. Occupation-based practice was more satisfying and rewarding for therapists, and they found it more effective and individualized. Patients and families were perceived by therapists to find occupation-based practice more motivating, understandable, valuable, and easily generalized to everyday life. However, occupation-based practice was seen as more difficult in a medical-based facility because pragmatic factors and contextual forces exerted strong influences. CONCLUSIONS: Therapists used specific creative strategies to negotiate between competing paradigms to maximize occupation-based practice within constraints.

Informing early intervention through an occupational science description of infant-toddler interactions with home space.

OBJECTIVE: The study provides a substantive description of infant and toddler play with everyday objects and independent negotiation of home space. METHOD: A grounded theory approach was used to study 18 typically developing children longitudinally from ages 1 to 18 months. Data from 133 home visits included videotaped self-directed play sessions with usual objects, maternal interviews, and observation records. RESULTS: Infant Space Theory is a substantive theory of infant-toddler interactions with the spaces and objects of the home. This contextualized view of the infant-toddler describes progressions in gaze and visual play, in mapping and ranging home space, in stationary object play, and in the little-described development of mobile object play. CONCLUSION: Therapists providing early intervention services within the home environment may benefit from the theory in their creation and modeling of naturalistic interventions with infants and families.

Responsible decision-making through measured criteria for faculty time use.

The demands upon faculty's time use within the three missions of universities have always created shared tensions in many academic settings. However, the move to post-baccalaureate entry in occupational therapy education has added complexity to this mix, with increasing expectations of graduate education and scholarship both for faculty and students. This article will present the development of the EKU-OT Faculty Work Profile, a model for categorizing faculty's time use during an academic year. The model provides a mechanism for faculty exploration of occupational patterns in an academic setting. The need for increased scholarship in occupational therapy education is addressed as an outcome measure for strategic planning. Potential use and implications will be presented as they relate to the complexities of faculty work inherent in higher education settings.

Occupational Therapy Alone Has Looked Upon Occupation: Future Applications of Occupational Science to Pediatric Occupational Therapy.

Occupational therapy has been an invisible profession, largely because the public has had difficulty grasping the concept of occupation. The emergence of occupational science has the potential of improving this situation. Occupational science is firmly rooted in the founding ideas of occupational therapy. In the future, the nature of human occupation will be illuminated by the development of a basic theory of occupational science. Occupational science, through research and theory development, will guide the practice of occupational therapy. Applications of occupational science to the practice of pediatric occupational therapy are presented. Ultimately, occupational science will prepare pediatric occupational therapists to better meet the needs of parents and their children.