Proteomic analysis reveals a potential role for extracellular vesicles within the erythroblastic island niche.

Introduction: Erythroblastic island (EBI) macrophages play an essential role in the production and maturation of the vast numbers of red blood cells (RBCs) that are produced throughout life. Their location within the bone marrow makes it difficult to study the cellular and molecular interactions associated with their action so we have used an in vitro model of the EBI niche using macrophages derived from human induced pluripotent stem cells (hiPSCs). We previously demonstrated that the activation of the transcription factor KLF1 enhanced the activity of hiPSC-derived EBI macrophages. Methods: To elucidate the mechanisms associated with EBI-like activity we carried out a quantitative proteomic analysis and assessed the role of extracellular vesicles using Nanosight Tracking analyses and media filtration. Results and Discussion: Gene ontology analysis showed that many of the proteins upregulated by KLF1 were protein-binding factors, some of which were associated with the cell membrane or extracellular vesicles We demonstrated that filtration of macrophage-conditioned media resulted in a reduction in the supportive effects on erythroid cell viability and maturation implying a role for extracellular vesicles but this was not KLF1 dependent. Pathway analyses of the proteomic data revealed that proteins upregulated by KLF1 were associated with the citric acid cycle, pyruvate metabolism and ATP synthesis indicating that KLF1-activated macrophages had a metabolic profile comparable to a pro-reparative phenotype. This study has generated a proteomic dataset that could provide new insights into the role of macrophages within the EBI niche and has indicated a potential role for extracellular vesicles in the differentiation and maturation of RBCs in vitro. Further research will aid in the production of RBCs in vitro for use in disease modelling and cell therapy.

Simultaneous Focal Boost With Stereotactic Radiation Therapy for Localized Intermediate- to High-Risk Prostate Cancer: Primary Outcomes of the SPARC Phase 2 Trial.

PURPOSE: Dose-escalated radiation therapy is associated with better biochemical control at the expense of toxicity. Stereotactic body radiation therapy (SBRT) with dose escalation to the dominant intraprostatic lesion (DIL) provides a logical approach to improve outcomes in high-risk disease while limiting toxicity. This study evaluated the toxicity and quality of life (QoL) with CyberKnife-based SBRT and simultaneous integrated boost in localized prostate cancer. METHODS AND MATERIALS: Eligible participants included newly diagnosed, biopsy-proven unfavorable intermediate- to high-risk localized prostate cancer (at least 1 of the following: Gleason ≥4+3, magnetic resonance imaging(MRI)-defined T3a N0, prostate-specific antigen ≥20) with up to 2 MRI-identified DILs. Participants received 36.25 Gy in 5 fractions on alternative days with a simultaneous boost to DIL up to 47.5 Gy as allowed by organ-at-risk constraints delivered by CyberKnife. All participants received androgen deprivation therapy. The primary outcome measure was acute grade 2+ genitourinary toxicity. Acute and late genitourinary and gastrointestinal toxicity using Radiation Therapy Oncology Group scoring, biochemical parameters, International Prostate Symptom Score, International Index of Erectile Function 5, and EQ-5D QoL outcomes were assessed. RESULTS: Between 2013 and 2023, 20 participants were enrolled with a median follow-up of 30 months. The median D95 dose to DIL was 47.43 Gy. Cumulative acute grade 2+ genitourinary and gastrointestinal toxicity were 25% and 30%, respectively. One patient developed acute grade 3 genitourinary toxicity (5%). There is no late grade 3 genitourinary or gastrointestinal toxicity to date. International Prostate Symptom Score and urinary QoL scores recovered to baseline by 6 months. Patient-reported outcomes showed no significant change in EQ-5D QoL scores at 12 weeks and 1 year. There are no cases of biochemical relapse reported to date. CONCLUSIONS: CyberKnife SBRT-delivered dose of 36.25 Gy to the prostate with a simultaneous integrated boost up to 47.5 Gy is well tolerated. Acute and late genitourinary and gastrointestinal toxicity rates are comparable to other contemporary SBRT trials and series with focal boost.

Health, Wellbeing and Empowerment E-workshops for Mothers of Children with Disabilities: A Non-randomised Comparison Study.

Mothers of children with disabilities can experience compromised health. Targeted interventions require investigation to determine effectiveness. Healthy Mothers Healthy Families (HMHF) is a health, wellbeing and empowerment program that addresses mothers need to protect, and or, recover their own health due to caregiving impacts. This study compared the effectiveness of HMHF e-workshops online compared to no intervention. The HMHF e-workshops were delivered to 290 mothers across the 2020-2022 Covid-19 pandemic and 172 participated in research. The HMHF e-workshops included 3 online 2- hour workshops facilitated by credentialled peer-facilitators, closed online group chat, e-workbook and online learning package. Participants in both groups completed surveys pre and post the workshops (or control) over 8-10 weeks. Mothers who participated in HMHF significantly increased health help seeking behaviours (p < .001), and improved mental health and health behaviors over time: health behavior (p < .001), positive wellbeing (p < .004) and depression (p < .001) and stress symptoms (p = .005). Compared to controls, HMHF e-workshop participants significantly improved health behaviours (p < .001) and self-reported symptoms of depression (p = .002) and stress (p = .005) over 8-10 weeks. E-workshops were accessible and effective for mothers of children with high care needs and family responsibilities across the COVID-19 pandemic. Compared to no intervention, the HMHF intervention was more effective for improving healthy behaviours and mental health.

The genetic legacy of the first successful reintroduction of a mammal to Britain: Founder events and attempted genetic rescue in Scotland's beaver population.

Conservation translocations often inherently involve a risk of genetic diversity loss, and thus loss of adaptive potential, but this risk is rarely quantified or monitored through time. The reintroduction of beavers to Scotland, via the Scottish Beaver Trial in Knapdale, is an example of a translocation that took place in the absence of genetic data for the founder individuals and resulted in a small and suspected to be genetically depauperate population. In this study we use a high-density SNP panel to assess the genetic impact of that initial translocation and the effect of subsequent reinforcement translocations using animals from a different genetic source to the original founders. We demonstrate that the initial translocation did, indeed, lead to low genetic diversity (H o = 0.052) and high mean kinship (KING-robust = 0.159) in the Knapdale population compared to other beaver populations. We also show that the reinforcement translocations have succeeded in increasing genetic diversity (H o = 0.196) and reducing kinship (KING robust = 0.028) in Knapdale. As yet, there is no evidence of admixture between the two genetic lineages that are now present in Knapdale and such admixture is necessary to realise the full genetic benefits of the reinforcement and for genetic reinforcement and then rescue to occur; future genetic monitoring will be required to assess whether this has happened. We note that, should admixture occur, the Knapdale population will harbour combinations of genetic diversity not currently seen elsewhere in Eurasian beavers, posing important considerations for the future management of this population. We consider our results in the wider context of beaver conservation throughout Scotland and the rest of Britain, and advocate for more proactive genetic sampling of all founders to allow the full integration of genetic data into translocation planning in general.

Genomics and conservation: Guidance from training to analyses and applications.

Environmental change is intensifying the biodiversity crisis and threatening species across the tree of life. Conservation genomics can help inform conservation actions and slow biodiversity loss. However, more training, appropriate use of novel genomic methods and communication with managers are needed. Here, we review practical guidance to improve applied conservation genomics. We share insights aimed at ensuring effectiveness of conservation actions around three themes: (1) improving pedagogy and training in conservation genomics including for online global audiences, (2) conducting rigorous population genomic analyses properly considering theory, marker types and data interpretation and (3) facilitating communication and collaboration between managers and researchers. We aim to update students and professionals and expand their conservation toolkit with genomic principles and recent approaches for conserving and managing biodiversity. The biodiversity crisis is a global problem and, as such, requires international involvement, training, collaboration and frequent reviews of the literature and workshops as we do here.

Occupational Therapy Observation Tool-Adjustment Support Details for autistic children: Investigation of content validity and clinical utility.

INTRODUCTION: Standardised testing is crucial for autistic children to receive appropriate interventions, necessary services, and funding. Behaviours associated with autism can hinder children's test performance and participation. The 18-item, two-page Occupational Therapy Observation Tool-Adjustment Support Details (OTOT-ASD) is used in conjunction with standardised assessments. The OTOT-ASD enables the recording of autism-related behaviours and the reasonable assessment accommodations made to support participation in testing. The current study aims to investigate the content validity and clinical utility of the OTOT-ASD from occupational therapists' perspectives. METHOD: A specifically designed online questionnaire was distributed Victoria-wide to occupational therapists with clinical experience with autistic children. The questionnaire was designed in line with the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN), including relevance, comprehensiveness, and comprehensibility of items evaluated for content validity. Applicability and clinical usefulness were also investigated. Quantitative data were analysed using descriptive statistics. RESULTS: Seventy-one occupational therapists responded to the questionnaire and 46 provided a full dataset. Over 96% of the respondents considered documenting behaviours and testing accommodations as important, yet less than 45% reported having resources to record this information. Ninety-five percent of the respondents perceived the OTOT-ASD to be useful in clinical practice. Over 70% agreed that OTOT-ASD items were significantly relevant to practice and comprehensive. To improve comprehensibility, identified items were altered following feedback. CONCLUSION: The findings suggest that the OTOT-ASD is clinically useful and content validity is sound. Further research on other psychometric properties of the OTOT-ASD and users' qualitative experiences in utilising the tool is recommended.

Marginalising dyslexic researchers is bad for science.

Communication in the sciences is often based on text, which places researchers with dyslexia at a disadvantage. However, this means that science is missing out on the original insights and specific strengths in exploration that dyslexic researchers bring to their disciplines. Here we discuss how the scientific community can address the challenges that dyslexic researchers face, and how science stands to benefit as a result. We discuss this in the context of a new theoretical framework proposing the existence of complementary learning strategies that could play a key role in scientific progress, particularly with regard to accelerating innovation.

Feasibility of Health Promoting Activity Coaching for Mothers of Children With Disabilities: Pilot Nonrandomized Controlled Trial.

IMPORTANCE: Mothers of children with disabilities experience health disparity. Interventions targeting maternal mental health need to be developed. OBJECTIVE: To determine the feasibility and preliminary effectiveness of the Healthy Mothers Healthy Families-Health Promoting Activities Coaching (HMHF-HPAC) intervention for mothers to improve participation in healthy activities and mental health and to evaluate outcome measures. DESIGN: Nonrandomized controlled pilot feasibility study with one group who received HMHF-HPAC and a control group. SETTING: Pediatric occupational therapy service; on site or telehealth. PARTICIPANTS: Twenty-three mothers completed prequestionnaires; of those, 11 mothers participated in the intervention, and 5 did not (7 withdrew). INTERVENTION: Eleven pediatric occupational therapists were trained to deliver six 10-min sessions of HMHF-HPAC to mothers, integrated into their child's therapy session or separately via telehealth. OUTCOMES AND MEASURES: Mixed-design analysis of variance explored changes in scores on the Depression Anxiety Stress Scale-21 Items and the Health Promoting Activities Scale. RESULTS: The intervention group reported, on average, significant reductions in depressive symptoms and stress symptoms and significant increases in participation in health-promoting activity. No significant main effect of time was found for these variables in the control group. CONCLUSIONS AND RELEVANCE: The HMHF-HPAC program is a viable occupational therapy coaching intervention that can be embedded in existing services for families of children with disabilities. Future trials that evaluate the effectiveness of the HMHF-HPAC intervention for mothers of children with disabilities are warranted. What This Article Adds: This article provides support for the feasibility of appropriate and sensitive outcome measures and program content and delivery to implement the novel HMHF-HPAC intervention in further research. Mothers of children with disabilities benefited from integrated HMHF-HPAC delivered by pediatric occupational therapists within the family's existing services.

Modelling the erythroblastic island niche of dyserythropoietic anaemia type IV patients using induced pluripotent stem cells.

Introduction: Congenital dyserythropoietic anaemia (CDA) type IV has been associated with an amino acid substitution, Glu325Lys (E325K), in the transcription factor KLF1. These patients present with a range of symptoms, including the persistence of nucleated red blood cells (RBCs) in the peripheral blood which reflects the known role for KLF1 within the erythroid cell lineage. The final stages of RBCs maturation and enucleation take place within the erythroblastic island (EBI) niche in close association with EBI macrophages. It is not known whether the detrimental effects of the E325K mutation in KLF1 are restricted to the erythroid lineage or whether deficiencies in macrophages associated with their niche also contribute to the disease pathology. Methods: To address this question, we generated an in vitro model of the human EBI niche using induced pluripotent stem cells (iPSCs) derived from one CDA type IV patient as well as two iPSC lines genetically modified to express an KLF1-E325K-ERT2 protein that could be activated with 4OH-tamoxifen. The one patient iPSC line was compared to control lines from two healthy donors and the KLF1-E325K-ERT2 iPSC line to one inducible KLF1-ERT2 line generated from the same parental iPSCS. Results: The CDA patient-derived iPSCs and iPSCs expressing the activated KLF1-E325K-ERT2 protein showed significant deficiencies in the production of erythroid cells with associated disruption of some known KLF1 target genes. Macrophages could be generated from all iPSC lines but when the E325K-ERT2 fusion protein was activated, we noted the generation of a slightly less mature macrophage population marked by CD93. A subtle trend in their reduced ability to support RBC enucleation was also associated with macrophages carrying the E325K-ERT2 transgene. Discussion: Taken together these data support the notion that the clinically significant effects of the KLF1-E325K mutation are primarily associated with deficiencies in the erythroid lineage but it is possible that deficiencies in the niche might have the potential to exacerbate the condition. The strategy we describe provides a powerful approach to assess the effects of other mutations in KLF1 as well as other factors associated with the EBI niche.

Co-design of an NHS primary care health check for autistic adults.

LAY ABSTRACT: Autistic people are on average more likely to experience poor health than people who are not autistic. Health checks have been shown to improve access to effective healthcare. This study investigated people's views about a primary care health check for autistic adults. We held discussion groups and interviewed autistic adults, adults with intellectual disabilities, supporters and health professionals. People wanted the health check to look at a person's physical and mental health, and how they were doing socially. They thought people should be able to share information about their needs and the reasonable adjustments they would like before the health check. They wanted healthcare services to change the way they communicate with autistic people, such as being able to book appointments online rather than by telephone. They wanted a choice in how the health check was completed, with video call or email offered as well as face-to-face appointments. People thought further training of primary care staff on autism was needed, to increase awareness of the diversity of experiences of autistic people and ways in which difficulties, such as pain, may present differently to non-autistic people. Clinicians raised questions about whether mental health and social care services could meet the additional needs that might be identified through the health check. We used this information to design an NHS primary care health check for autistic people in collaboration with autistic people, supporters and health professionals.

Cross-Cultural Validation of the Chinese Version of the Health Promoting Activities Scale.

IMPORTANCE: The Health Promoting Activities Scale (HPAS) measures the frequency of participation in health-promoting activities of mothers of children with disabilities. Translation of the HPAS into Chinese and validation of the Chinese version will enable its use with Chinese-speaking mothers of children with disabilities. OBJECTIVE: To translate the HPAS into Chinese and assess its construct validity in relation to measures of well-being, mental health, and activity satisfaction. DESIGN: Cross-cultural validation. SETTING: Community. PARTICIPANTS: Eight bilingual Chinese speakers were involved in the translation. Ethnic Chinese mothers of children with disabilities living in Australia, Singapore, or Taiwan (N = 89) were recruited via purposive snowball sampling. Participants self-selected to complete the Chinese e-survey. OUTCOMES AND MEASURES: Translation was guided by recommended frameworks. The Chinese versions of the Warwick-Edinburgh Mental Well-being Scale (WEMWS), Personal Well-being Index (PWI), and Kessler Psychological Distress Scale-10 (K10) were used to determine construct validity. Internal reliability was investigated. RESULTS: The Chinese version of the HPAS correlated significantly with satisfaction ratings (r = .45, p < .001; n = 87), WEMWS Total score (r = .61, p < .001; n = 85), PWI mean score (r = .44, p < .001; n = 84), and K10 total score (r = -.33, p = .002; n = 81). Internal reliability was moderate (Cronbach's α = .74). CONCLUSIONS AND RELEVANCE: The Chinese version of the HPAS was found to be cross-culturally equivalent to the original HPAS and psychometrically sound for use with Chinese-speaking mothers of children with disabilities. What This Article Adds: This study provides an example of the cross-cultural validation process. The Chinese version of the HPAS is psychometrically sound and could be used as an outcome measure of Chinese mothers' participation in health-promoting activities.

"People say you're going home, but I don't have a home": Housing After Prison.

Recidivism in Australia is high, especially in the Australian Capital Territory (ACT). While high-quality stable housing has been shown to reduce recidivism, people released from prison face many barriers in obtaining housing. This paper reports on a qualitative study exploring the housing experiences of 11 people released from prison in the ACT. Participants felt the importance of housing for reintegration and avoiding recidivism, but reported many challenges, including issues relating to lack of pre-release planning, income and employment, drug use, difficulties and delays with accessing social housing, and complying with parole or bail conditions. We recommend increased investment in services to assist people in prison with organizing housing before release. Furthermore, as housing is a foundational need for reintegration and drug use is high among the prison population in the ACT, Housing First initiatives may be the most appropriate model for providing accommodation and reducing recidivism.

Developing the FEEDS toolkit of parent-delivered interventions for eating, drinking and swallowing difficulties in young children with neurodisability: findings from a Delphi survey and stakeholder consultation workshops.

BACKGROUND: Young children with neurodisability commonly experience eating, drinking and swallowing difficulties (EDSD). Little is documented about which interventions and outcomes are most appropriate for such children. We aimed to seek consensus between parents of children with neurodisability and health professionals on the appropriate interventions and outcomes to inform future clinical developments and research studies. METHODS: Two populations were sampled: parents of children aged up to 12 years with neurodisability who experienced EDSD; health professionals working with children and young people (aged 0-18 years) with neurodisability with experience of EDSD. Participants had taken part in a previous national survey and were invited to take part in a Delphi survey and/or consultation workshops. Two rounds of this Delphi survey sought agreement on the appropriate interventions and outcomes for use with children with neurodisability and EDSD. Two stakeholder consultation workshops were iterative, with the findings of the first discussed at the second, and conclusions reached. RESULTS: A total of 105 parents and 105 health professionals took part. Parents and health professionals viewed 19 interventions and 10 outcomes as essential. Interventions related to improvement in the physical aspects of a child's EDSD, behavioural changes of the child or parent, and changes in the child or family's well-being. Both parents and health professionals supported a 'toolkit' of interventions that they could use together in shared decision making to prioritise and implement timely interventions appropriate to the child. CONCLUSIONS: This study identified interventions viewed as essential to consider for improving EDSD in children with neurodisability. It also identified several key outcomes that are valued by parents and health professionals. The Focus on Early Eating, Drinking and Swallowing (FEEDS) Toolkit of interventions to improve EDSD in children with neurodisability has been developed and now requires evaluation regarding its use and effectiveness.

Developmental Dyslexia: Disorder or Specialization in Exploration?

We raise the new possibility that people diagnosed with developmental dyslexia (DD) are specialized in explorative cognitive search, and rather than having a neurocognitive disorder, play an essential role in human adaptation. Most DD research has studied educational difficulties, with theories framing differences in neurocognitive processes as deficits. However, people with DD are also often proposed to have certain strengths - particularly in realms like discovery, invention, and creativity - that deficit-centered theories cannot explain. We investigate whether these strengths reflect an underlying explorative specialization. We re-examine experimental studies in psychology and neuroscience using the framework of cognitive search, whereby many psychological processes involve a trade-off between exploration and exploitation. We report evidence of an explorative bias in DD-associated cognitive strategies. High DD prevalence and an attendant explorative bias across multiple areas of cognition suggest the existence of explorative specialization. An evolutionary perspective explains the combination of findings and challenges the view that individuals with DD have a disorder. In cooperating groups, individual specialization is favored when features that confer fitness benefits are functionally incompatible. Evidence for search specialization suggests that, as with some other social organisms, humans mediate the exploration-exploitation trade-off by specializing in complementary strategies. The existence of a system of collective cognitive search that emerges through collaboration would help to explain our species' exceptional adaptiveness. It also aligns with evidence for substantial variability during our evolutionary history and the notion that humans are adapted not to a particular habitat but to variability itself. Specialization creates interdependence and necessitates balancing complementary strategies. Reframing DD therefore underscores the urgency of changing certain cultural practices to ensure we do not inhibit adaptation. Key improvements would remove cultural barriers to exploration and nurture explorative learning in education, academia, and the workplace, as well as emphasize collaboration over competition. Specialization in complementary search abilities represents a meta-adaptation; through collaboration, this likely enables human groups (as a species and as cultural systems) to successfully adapt. Cultural change to support this system of collaborative search may therefore be essential in confronting the challenges humanity now faces.

Carers' Health-Related Quality of Life in Global Health Technology Assessment: Guidance, Case Studies and Recommendations.

Including health outcomes for carers as well as patients in economic evaluations can change the results and conclusions of the analysis. Whilst in many disease areas there can be clear justification for including carers' health-related quality of life (HRQL) in health technology assessments (HTAs), we believe that, in general, the perspective of carers is under-represented in HTA. We were interested in the extent, and methods by which, HTA bodies include carers' HRQL in economic evaluation. We reviewed guidance from 13 HTA bodies across the world regarding carers' HRQL. We examined five interventions, as case studies, assessed by different HTA bodies, and extracted information on whether carers' HRQL was included by the manufacturers or assessors in their dossiers of evidence, the data and methods used, and the impact on the results. We developed recommendations to guide analysts on including carers' HRQL in economic evaluations. When reviewing the methods guides: two bodies recommend including carers' HRQL in the base case, two referred to outcomes for all individuals, two preferred to exclude carers, three said it depended on other conditions, and it was unclear for four. Across the five case studies: five source studies for carers' HRQL and two different modelling approaches were used. Including carers' HRQL increased incremental quality-adjusted life-years (QALYs) in 19/23 analyses (decreased it in two); there was substantial variation in the magnitude of change. We recommend: (1) the inclusion of carers is clearly justified, (2) the use of HRQL data from the population under comparison where possible, (3) the use of data from another disease area or country is clearly justified (and transferability/applicability issues are discussed), (4) the use of external data to derive comparisons for cross-sectional data is justified, (5) assumptions and implications of the modelling approach are explicit, and (6) disaggregated results for patients and carers are presented.

Evaluating the feasibility, fidelity, and preliminary effectiveness of a school-based intervention to improve the school participation and feelings of connectedness of elementary school students on the autism spectrum.

In My Shoes is a peer supported, teacher-led, school-based intervention that aims to improve the school participation and connectedness of students on the autism spectrum. The aim of this study was to explore the feasibility, fidelity, and preliminary effectiveness of In My Shoes in mainstream elementary schools. Ten Grade 3 and 4 students on the autism spectrum and 200 of their typically developing peers across eight classrooms and six schools participated. The following aspects of feasibility were explored: recruitment capability and sample characteristics, data collection procedures and outcome measures, appropriateness, implementation, and practicality of the intervention. Fidelity was explored by evaluating the delivery of intervention components against set criteria. Preliminary effectiveness was investigated by evaluating changes in intervention outcomes pre-post intervention using a range of outcome measures. Study findings are encouraging, suggesting In My Shoes is a feasible and appropriate intervention, and shows promise in improving the self-report school engagement of all student participants, as well the classroom participation and subjective school experiences of students on the autism spectrum. Useful insights into ways the intervention and the design of future research can be improved are discussed.

Initial Development and Evaluation of the My Family's Accessibility and Community Engagement (MyFACE) Tool for Families of Children With Disabilities.

IMPORTANCE: Parental perceptions and experiences of community inclusion influence the community participation of families and children with a disability, although no measurement tools exist. OBJECTIVE: To describe the initial development of the My Family's Accessibility and Community Engagement (MyFACE) tool. DESIGN: MyFACE measures parental perceptions of community accessibility and engagement of families raising a child with a disability. Items represent common community activities rated on a 5-point Likert scale. COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guided content validity, construct validity, and internal reliability testing. SETTING: Australia. PARTICIPANTS: Seventy-seven mothers of children with a disability provided data, with 69 complete data sets. RESULTS: The nine-item MyFACE had excellent content and construct validity and good internal reliability (Cronbach's α = .85). Hypothesis testing correlated MyFACE with maternal factors (mental health and healthy behavior) and child factors (psychosocial issues). Three predictors together explained 27% of the variance in a significant model, F(3, 61) = 7.09, p < .001. The most important predictor was maternal depressive symptoms. CONCLUSIONS AND RELEVANCE: Initial evaluation of the MyFACE tool suggests sound psychometric properties warranting further development. What This Article Adds: The MyFACE tool provides clinicians and researchers with a way to measure parental perceptions of community inclusion. Maternal depressive symptoms were predictive of MyFACE scores, indicating that to be effective, family participation may require clinicians to address maternal mental health and children's participation restrictions.

Healthy Mothers Healthy Families, Health Promoting Activity Coaching for mothers of children with a disability: Exploring mothers' perspectives of programme feasibility.

BACKGROUND: Health Promoting Activity Coaching, an intervention within the Healthy Mothers Healthy Families programme (HMHF-HPAC), was delivered by occupational therapists in a project that assessed feasibility of this new intervention. The HMHF-HPAC promotes the health and well-being of mothers of children with disabilities and is a six-session programme with website, workbook, and one-on-one coaching. Consumer experiences of this novel health-promoting intervention were sought to enable consumer-informed feedback for future modifications and improvements prior to further development. METHODS: This qualitative study explored the experiences of mothers who participated in the HMHF-HPAC and their perspectives on the service delivery, content and impact. This study was embedded within an overarching feasibility study and was conducted parallel to a quantitative component. Seven mothers who completed the HMHF-HPAC participated in semi-structured interviews. Data were analysed thematically using a six-stage thematic approach. FINDINGS: Four key themes emerged: Recognising Mothers; From Vulnerability to Empowerment; A Goal for Me; and Perspectives on Content and Delivery. Mothers reported increased participation in health-promoting activities over the duration of HMHF-HPAC, reflective of their individual needs. Mothers described improved mood and energy levels, reduced stress and anxiety, greater self-awareness, and increased engagement in leisure activities with their children. Health-promoting goals identified by mothers' pertained to improving physical activity levels, healthy dietary changes, sleep quality and duration, community engagement, and mindfulness activities. Mothers reported that their child's occupational therapists, the website, and workbook were acceptable and viable. CONCLUSIONS: Mothers' experiences support the feasibility of embedding the HMHF-HPAC programme into occupational therapy services directed towards child and family-focused interventions. Mothers found occupational therapists to be acceptable facilitators of the HMHF-HPAC, given the frequent interactions and rapport with mothers and the occupational underpinnings of the programme. The HMHF-HPAC is an accessible intervention that promotes family-oriented practice.

Views about primary care health checks for autistic adults: UK survey findings.

BACKGROUND: Compared with the general population, autistic adults experience higher rates of physical and mental health conditions, premature morbidity and mortality, and barriers to health care. A health check for autistic people may improve their health outcomes. AIM: To establish the views of autistic people towards a primary care health check for autistic people. DESIGN & SETTING: Cross-sectional questionnaire study in England and Wales. METHOD: A questionnaire was sent to autistic adults with physical health conditions in England and Wales. A total of 458 people (441 autistic adults and 17 proxy responders) completed the questionnaire. RESULTS: Most responders (73.4%, n = 336) thought a health check is needed for all autistic people. Around half of the participants thought a health check should be offered from childhood and the health check appointment should last between 15 and 30 minutes. Autistic people were positive about providing primary care staff with contextual information regarding their health and the reasonable adjustments they would like before their health check appointment. Training about autism and the health check was considered important, alongside adequate time for discussions in the health check appointment (all by over 70% of responders). The clinician's autism knowledge, seeing a familiar clinician, environmental adaptations, appropriate information, and accessible appointments were considered particularly important in making a health check accessible. CONCLUSION: Autistic people and relatives were supportive of a primary care health check for autistic people. Information gathered was used to support the design of a primary care health check for autistic adults.

Healthy ageing through participation in community situated activities: A scoping review of assessment instruments to support occupational therapy practice.

INTRODUCTION: The occupational therapy profession has an essential role to play in healthy ageing that includes enabling participation, a construct that according to The International Classification of Functioning, Disability and Health (ICF), incorporates an environmental context. Environmental barriers and enablers of participation in community-situated activities for people over the age of 65 have been identified. To support practice, occupational therapists require assessments with demonstrated content validity including comprehensive coverage of the construct. The purpose of this scoping review study was to investigate what instruments are available to assess community participation for people over the age of 65 that included environmental factors. METHODS: A scoping review of the literature was conducted, utilising the Joanna Briggs Institute (JBI) scoping review methodology. The evidence source was review articles and inclusion criteria were that they reviewed instruments to assess participation that could be used for people over the age of 65. Items extracted from included instruments were evaluated against a preset list of community-participation and environment categories that had been developed from the ICF. RESULTS: Twenty-three review studies met inclusion criteria and from these 240 instruments were extracted. Twenty instruments were retained after exclusions and from these, 540 instrument items were extracted. Of these, 280 (47%) were coded as community-participation, and only 20 (3.4%) as environment items. Fourteen of the instruments included no environment items. CONCLUSIONS: No instrument was identified that comprehensively assessed community participation including the related environmental factors. Such an instrument is required to enable occupational therapy practitioners to support healthy ageing. The development of such an instrument will strengthen the profession's capacity to develop new ways of delivering services to older adults in line with emerging ways that aged care will be delivered and to advance its essential role in healthy ageing.