When providing services, occupational therapists encounter social inequities that affect the health and well-being of their clients and create ethical tensions.
To develop an understanding of the ...ethical tensions encountered by occupational therapists working with clients experiencing social inequity and how such tensions are navigated.
This qualitative study used an interpretive description methodology.
Community and tertiary health settings.
Fifteen occupational therapists who identified as working with clients experiencing social inequity.
Semistructured interviews were used to explore participants' practice experiences. Data were analyzed using thematic analysis.
Two themes were identified in relation to participants' experiences of ethical tensions: (a) perpetuating inequities and (b) experiencing conflicting values. A further three themes were identified in relation to how participants identified and navigated these tensions: (a) taking action, (b) seeking support, and (c) ensuring integrity and accountability.
Ethical tensions frequently emerged when systemic health contexts were not responsive to social inequities or created barriers to health care access. Occupational therapists felt a sense of responsibility to take action to address inequity, which led them to stretch boundaries and roles. Having informal and formal supports, and confidence in the scope of their practice, helped the occupational therapists to navigate ethical tensions with integrity and accountability. Increased avenues for support that incorporate reflexivity offer an opportunity for occupational therapists to engage in dialogue about social inequities and ethical practice. What This Article Adds: This article explores the types of ethical tensions occupational therapists experience when addressing social inequities and provides insights into how such tensions are managed.
DNA methylation is strongly associated with smoking status at multiple sites across the genome. Studies have largely been restricted to European origin individuals yet the greatest increase in ...smoking is occurring in low income countries, such as the Indian subcontinent. We determined whether there are differences between South Asians and Europeans in smoking related loci, and if a smoking score, combining all smoking related DNA methylation scores, could differentiate smokers from non-smokers.
Illumina HM450k BeadChip arrays were performed on 192 samples from the Southall And Brent REvisited (SABRE) cohort. Differential methylation in smokers was identified in 29 individual CpG sites at 18 unique loci. Interaction between smoking status and ethnic group was identified at the AHRR locus. Ethnic differences in DNA methylation were identified in non-smokers at two further loci, 6p21.33 and GNG12. With the exception of GFI1 and MYO1G these differences were largely unaffected by adjustment for cell composition. A smoking score based on methylation profile was constructed. Current smokers were identified with 100% sensitivity and 97% specificity in Europeans and with 80% sensitivity and 95% specificity in South Asians.
Differences in ethnic groups were identified in both single CpG sites and combined smoking score. The smoking score is a valuable tool for identification of true current smoking behaviour. Explanations for ethnic differences in DNA methylation in association with smoking may provide valuable clues to disease pathways.
Previous studies have reached conflicting conclusions regarding the proportion of Merkel cell carcinomas (MCCs) that contain the Merkel cell polyomavirus (MCPyV) and the clinical significance of ...tumor viral status. To address these controversies, we detected MCPyV large T antigen using immunohistochemistry with two distinct antibodies and MCPyV DNA using quantitative PCR. Tumors were called MCPyV-positive if two or more of these three assays indicated presence of this virus. A total of 53 of 282 (19%) MCC tumors in this cohort were virus-negative using this multimodal system. Immunohistochemistry with the CM2B4 antibody had the best overall performance (sensitivity = 0.882, specificity = 0.943) compared with the multimodal classification. Multivariate analysis including age, sex, and immunosuppression showed that, relative to MCC patients with virus-positive tumors, virus-negative MCC patients had significantly increased risk of disease progression (hazard ratio = 1.77, 95% confidence interval = 1.20–2.62) and death from MCC (hazard ratio = 1.85, 95% confidence interval = 1.19–2.89). We confirm that approximately 20% of MCCs are not driven by MCPyV and that such virus-negative MCCs, which can be quite reliably identified by immunohistochemistry using the CM2B4 antibody alone, represent a more aggressive subtype that warrants closer clinical follow-up.
Objective: To explore the perspectives of student midwives, midwifery educationalists and midwifery clinicians from and connected to one University in order to identify strategies to enhance ...awareness of sexual and gender diversity in a pre- registration midwifery curriculum.
Design: A mixed method study including an online survey and a series of focus groups
Setting: One University in London
Participants: 47 survey respondents and 16 focus group participants
Findings: Two Inductive themes were developed from the data analysis: Practising Open Mindedness and Cultivating Openness and four sub themes; Making Assumptions, Developing self- awareness, Challenge and Discomfort and Safe spaces. Participants proposed learning strategies that they thought would facilitate cultivating openness and open mindedness.
Abstract Purpose Globally, alcohol use is the leading cause of ill health and life years lost in adolescents, although its clinical impact is often overlooked, particularly in England where most ...research is based in schools. This study aims to examine the prevalence of alcohol consumption and the association between alcohol consumption and age of onset with health and social consequences among adolescents presenting to emergency departments (EDs). Methods Consecutive attenders (n = 5,576) aged 10–17 years at 10 EDs were included. Information was collected on general health and functioning, quality of life, alcohol use, and alcohol-related health and social consequences. Results Nearly 40% of adolescents reported the consumption of alcohol that was more than a sip in their lifetime. Age of the first alcohol consumption before the age of 15 years was associated with tobacco use ( p < .001), lower quality of life ( p = .003), and evidence of an alcohol use disorder ( p = .002). It was also associated with general social functioning (problems with conduct p = .001 and hyperactivity p = .001) and alcohol-related health and social consequences (accident p = .046, problems with a parent p = .017, school p = .0117, or police p = .012). Conclusions Rates of alcohol consumption in adolescents presenting to the ED were similar to those reported in schools in England and globally. Associations of alcohol consumption and earlier onset of drinking with poorer health and social functioning were observed. The ED can offer an opportunity for the identification of hazardous alcohol use in adolescents.
Introduction
There is an emerging need for plant-based, vegan options for patients requiring nutritional support.
Methods
Twenty-four adults at risk of malnutrition (age: 59 years (SD 18); Sex: 18 ...female, 6 male; BMI: 19.0 kg/m
2
(SD 3.3); multiple diagnoses) requiring plant-based nutritional support participated in a multi-center, prospective study of a (vegan suitable) multi-nutrient, ready-to-drink, oral nutritional supplement (ONS) 1.5 kcal/mL; 300 kcal, 12 g protein/200 mL bottle, mean prescription 275 mL/day (SD 115) alongside dietary advice for 28 days. Compliance, anthropometry, malnutrition risk, dietary intake, appetite, acceptability, gastrointestinal (GI) tolerance, nutritional goal(s), and safety were assessed.
Results
Patients required a plant-based ONS due to personal preference/variety (33%), religious/cultural reasons (28%), veganism/reduce animal-derived consumption (17%), environmental/sustainability reasons (17%), and health reasons (5%). Compliance was 94% (SD 16). High risk of malnutrition (‘MUST’ score ≥ 2) reduced from 20 to 16 patients (
p
= 0.046). Body weight (+0.6 kg (SD 1.2),
p
= 0.02), BMI (+0.2 kg/m
2
(SD 0.5),
p
= 0.03), total mean energy (+387 kcal/day (SD 416),
p
< 0.0001) and protein intake (+14 g/day (SD 39),
p
= 0.03), and the number of micronutrients meeting the UK reference nutrient intake (RNI) (7 vs. 14,
p
= 0.008) significantly increased. Appetite (Simplified Nutritional Appetite Questionnaire (SNAQ) score;
p
= 0.13) was maintained. Most GI symptoms were stable throughout the study (
p
> 0.06) with no serious adverse events related.
Discussion
This study highlights that plant-based nutrition support using a vegan-suitable plant-based ONS is highly complied with, improving the nutritional outcomes of patients at risk of malnutrition.
Iron deficiency anemia is the most common nutritional disorder in the world. Anemia is especially serious during pregnancy,
with deleterious consequences for both the mother and her developing fetus. ...We have developed a model to investigate the mechanisms
whereby fetal growth and development are affected by maternal anemia. Weanling rats were fed a control or iron-deficient diet
before and throughout pregnancy and were killed at Day 21. Dams on the deficient diet had lower hematocrits, serum iron concentrations,
and liver iron levels. Similar results were recorded in the fetus, except that the degree of deficiency was markedly less,
indicating compensation by the placenta. No effect was observed on maternal weight or the number and viability of fetuses.
The fetuses from iron-deficient dams, however, were smaller than controls, with higher placental:fetal ratios and relatively
smaller livers. Iron deficiency increased levels of tumor necrosis factor α (TNFα) only in the trophoblast giant cells of
the placenta. In contrast, levels of type 1 TNFα receptor increased significantly in giant cells, labyrinth, cytotrophoblast,
and fetal vessels. Leptin levels increased significantly in labyrinth and marginally ( P = 0.054) in trophoblast giant cells. No change was observed in leptin receptor levels in any region of the placentas from
iron-deficient dams. The data show that iron deficiency not only has direct effects on iron levels and metabolism but also
on other regulators of growth and development, such as placental cytokines, and that these changes may, in part at least,
explain the deleterious consequences of maternal iron deficiency during pregnancy.
To estimate and compare the optimal cut-off score of Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C in identifying at-risk alcohol consumption, heavy episodic alcohol use, ICD-10 ...alcohol abuse and alcohol dependence in adolescents attending ED in England.
Opportunistic cross-sectional survey.
10 emergency departments across England.
Adolescents (n = 5377) aged between their 10th and 18th birthday who attended emergency departments between December 2012 and May 2013.
Scores on the AUDIT and AUDIT-C. At-risk alcohol consumption and monthly episodic alcohol consumption in the past 3 months were derived using the time-line follow back method. Alcohol abuse and alcohol dependence was assessed in accordance with ICD-10 criteria using the MINI-KID.
AUDIT-C with a score of 3 was more effective for at-risk alcohol use (AUC 0.81; sensitivity 87%, specificity 97%), heavy episodic use (0.84; 76%, 98%) and alcohol abuse (0.98; 91%, 90%). AUDIT with a score of 7 was more effective in identifying alcohol dependence (0.92; 96%, 94%).
The 3-item AUDIT-C is more effective than AUDIT in screening adolescents for at-risk alcohol use, heavy episodic alcohol use and alcohol abuse. AUDIT is more effective than AUDIT-C for the identification of alcohol dependence.
Iron deficiency anemia is the most common nutritional disorder in the world. Anemia is especially serious during pregnancy, with deleterious consequences for both the mother and her developing fetus. ...We have developed a model to investigate the mechanisms whereby fetal growth and development are affected by maternal anemia. Weanling rats were fed a control or iron-deficient diet before and throughout pregnancy and were killed at Day 21. Dams on the deficient diet had lower hematocrits, serum iron concentrations, and liver iron levels. Similar results were recorded in the fetus, except that the degree of deficiency was markedly less, indicating compensation by the placenta. No effect was observed on maternal weight or the number and viability of fetuses. The fetuses from iron-deficient dams, however, were smaller than controls, with higher placental:fetal ratios and relatively smaller livers. Iron deficiency increased levels of tumor necrosis factor α (TNFα) only in the trophoblast giant cells of the placenta. In contrast, levels of type 1 TNFα receptor increased significantly in giant cells, labyrinth, cytotrophoblast, and fetal vessels. Leptin levels increased significantly in labyrinth and marginally (P = 0.054) in trophoblast giant cells. No change was observed in leptin receptor levels in any region of the placentas from iron-deficient dams. The data show that iron deficiency not only has direct effects on iron levels and metabolism but also on other regulators of growth and development, such as placental cytokines, and that these changes may, in part at least, explain the deleterious consequences of maternal iron deficiency during pregnancy.
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