The aesthetic and cultural pursuits of patients with stroke

peer-reviewedTables to accompany this article on second fileGOAL: There has been an increasing interest in the arts in healthcare, with a suggestion that the arts and aesthetics can augment patient outcomes in stroke and other illnesses. Designing such programmes requires better knowledge of the artistic, aesthetic and cultural pursuits of people affected by stroke. The aim of this study was to obtain the insights of this group about the profile of arts and aesthetics activities in their lives as well as the influence of stroke on these aspects. MATERIALS AND METHODS: Patients attending a stroke service were administered questions adapted from the Irish Arts Council’s 2006 questionnaire on participation in aesthetics and cultural pursuits, Information was also collected on stroke type and present functional and cognitive status. Thirty-eight patients were interviewed. Of these, twenty were inpatients in hospital at the time of the interview and eighteen were interviewed in an outpatient setting. FINDINGS: Popular activities included mainstream cinema, listening to music, dancing, attending plays or musicals and being outdoors. Many patients ceased these activities after their stroke, mostly due to health issues and inaccessibility. The majority of patients valued the importance of the arts in the healthcare setting. CONCLUSION: This study gives a perspective for the first time on the aesthetic and cultural pursuits of stroke patients prior to their stroke. It portrays a wide variety of cultural and leisure activities, and the cessation of these post-stroke. It revealed the restrictions patients felt on gaining access to leisure pursuits both while in hospital and following discharge.Acceptedpeer-reviewe

Prenatal nutrition, stimulation, and exposure to punishment are associated with early child motor, cognitive, language, and socioemotional development in Dar es Salaam, Tanzania

© 2018 John Wiley & Sons Ltd Background: Despite growing evidence that early life experiences and exposures can impact child development, there is limited research on how prenatal and early life nutrition and early life parenting practices predict specific domains of child development in resource-limited settings. This study examines the association between prenatal factors, birth outcomes, and early life characteristics with motor, cognitive/language, and socioemotional development in Tanzania. Methods: We assessed motor, cognitive/language, and socioemotional development among a cohort of 198 children aged 20–39 months in Dar es Salaam, Tanzania, whose mothers were previously enrolled in a randomized, placebo-controlled trial of prenatal vitamin A and zinc supplementation. Linear regression models were used to assess standardized mean differences in child development scores for randomized prenatal regimen and pregnancy, delivery, and early childhood factors. Results: Children born to mothers randomized to prenatal vitamin A had significantly lower reported motor scores in minimally adjusted and multivariate analyses, −0.29 SD, 95% CI [−0.54, −0.04], p = 0.03, as compared with children whose mothers did not receive vitamin A. There was no significant effect of randomized prenatal zinc on any development domain. Greater caregiver–child stimulation was associated with 0.38 SD, 95% CI [0.14, 0.63], p \u3c 0.01, better cognitive/language scores, whereas children who experienced both verbal and physical punishment had 0.29 SD, 95% CI [−0.52, −0.05], p = 0.02, lower scores in socioemotional development. Maternal completion of primary school was associated with higher reported motor and cognitive/language development. Further, children of mothers who were \u3c155 cm tall had lower cognitive and language scores. Conclusion: Prenatal vitamin A supplements in a setting with low levels of vitamin A deficiency may not provide child development benefits. However, integrated environmental, educational, parenting, and stimulation interventions may have large positive effects across child development domains in resource-limited settings

Antenatal psychosocial assessment for reducing perinatal mental health morbidity

Background: Mental health conditions arising in the perinatal period, including depression, have the potential to impact negatively on not only the woman but also her partner, infant, and family. The capacity for routine, universal antenatal psychosocial assessment, and thus the potential for reduction of morbidity, is very significant. Objectives: To evaluate the impact of antenatal psychosocial assessment on perinatal mental health morbidity. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register, the Cochrane Depression, Anxiety and Neurosis Group’s Trials Register (CCDANTR-Studies), HSRProj in theNational Library ofMedicine (USA), and the Current Controlled Trials website: http://www.controlled trials.com/ and the UK National Research Register (last searched March 2008). Selection criteria: Randomised and quasi-randomised controlled trials. Data collection and analysis: At least two review authors independently assessed trials for eligibility; they also extracted data from included trials and assessed the trials for potential bias. Main results: Two trials met criteria for an RCT of antenatal psychosocial assessment.One trial examined the impact of an antenatal tool (ALPHA) on clinician awareness of psychosocial risk, and the capacity of the antenatal ALPHA to predict women with elevated postnatal Edinburgh Depression Scale (EDS) scores, finding a trend towards increased clinician awareness of ’high level’ psychosocial risk where the ALPHA were seen for numbers of women with antenatal EDS scores, a score of greater than 9 being identified by ALPHA as of concern for depression (RR 0.69 95% CI 0.35 to 1.38); 139 providers. The other trial reported no differences in EPS scores greater than 12 at 16 weeks postpartum between the intervention (communication about the EDS scores with the woman and her healthcare providers plus a patient information booklet) and the standard care groups (RR 0.86 95% CI 0.61 to 1.21; 371 women). Authors’ conclusions: While the use of an antenatal psychosocial assessment may increase the clinician’s awareness of psychosocial risk, neither of these small studies provides sufficient evidence that routine antenatal psychosocial assessment by itself leads to improved perinatal mental health outcomes. Further studies with better sample size and statistical power are required to further explore this important public health issue. It will also be important to examine outcomes up to one year postpartum not only for mother, but also infant and family