Quality of life for caregivers of a child aged 6-16 years with Autistic Spectrum Disorder and/or an intellectual disability : a comparative study : a thesis presented in fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Turitea, New Zealand

Quality of life for caregivers of children with autistic spectrum disorder and/or an intellectual disability was compared to quality of life for those caring for a normally developing child. Participants were caregivers of children between 6 - 16 years of age who were divided into two groups: Caregivers of disabled children (Group 1, n = 60) and caregivers of normally developing children (Group 2, n = 13). The research investigated differences of overall quality of life between groups. Within Group One the influence on quality of life for caregivers was investigated in relation to the child's behaviour, level of support the child requires to complete activities of daily living, caregivers marital status, caregivers socio-economic level, and caregivers satisfaction with perceived supports. The Quality of Life Index and the Nisonger Child Behavior Rating Form were used to determine quality of life and problem behaviours. Results showed a difference in overall quality of life between groups. Child's behaviour was found to have a significant relationship with caregiver‘s quality of life. Satisfaction with perceived supports had a weak relationship to caregiver‘s quality of life. No statistically significant relationship was found between caregiver‘s quality of life and the child's activities of daily living requirements, caregiver‘s marital status or caregiver‘s socio-economic status. Quality of life for caregivers of developmentally disabled children was shown to be lower than the general population. New Zealand is currently in a state of flux in regards to addressing and refining disability support services. Research that further investigates these results may enhance service delivery and result in better outcomes for those supporting children with a disability

Lameness and pain management on Irish dairy farms

Lameness is a major concern for animal welfare due to the associated pain, and has significant negative economic and environmental consequences. Irish dairying differs from most other systems, whereby cows are out to grass for the majority of the year and housed over the winter months; therefore, research from other system types can be hard to apply to Irish dairy farms. Reducing lameness on Irish dairy farms is vitally important, as the welfare-friendly credentials of Irish dairy products are key to positioning Ireland as a leading supplier of dairy products internationally. In order to reduce lameness, further work is required on the prevalence, causes and risk factors for lameness in Irish dairy cows. The Irish dairy industry would also benefit from knowing what lameness management practices are currently in place on Irish dairy farms. The aim of this thesis was to gain knowledge on lameness and pain management in an Irish pasture-based dairy system. The first study (Papers 1-3) involved lameness scoring cows from 99 pasture-based dairy herds in Ireland during the grazing period, and from 85 of these herds during the housing period. At each visit, infrastructure measurements were taken (housing facilities, milking facilities and cow tracks) and a questionnaire was undertaken with the farmer to identify background information and farm management practices. Cow-level data was also collected (e.g. breed, parity and milk yield). For 98 of the farms visited during the grazing period and for 74 of the farms visited during the housing period, the hind hooves of up to a maximum of 20 lame cows were examined and hoof lesions were recorded. The second study (Paper 4) involved sending a questionnaire on attitudes to pain and the use of non-steroidal anti-inflammatory drugs (NSAIDs) on Irish dairy farms, to both dairy farmers and veterinarians that work with dairy cows in Ireland. Over 1000 questionnaires were returned by dairy farmers and 116 by veterinarians. Paper 1 determined the most important cow-level and herd-level risk factors for lameness in Irish pasture-based dairy herds, based on both the grazing and housing period. Triangulation of elastic net regression and logistic regression using modified Bayesian information criterion, with bootstrapping, were used to obtain a robust set of risk factors. Cow-level risk factors included age and genetic predicted transmitting ability for lameness, and herd-level risk factors included herd and farm size, the distance cows had to turn at the milking parlour exit, stones in paddock gateways, and slats on the cow track near the collecting yard; farmer’s perception of lameness and digital dermatitis in their herd was also associated with lameness outcomes. Paper 2 reported the lameness prevalence during both the grazing and housing periods, and identified lameness management practices that are currently in place on Irish dairy farms. This paper also described current infrastructure and general farm management that may relate to lameness. The median herd lameness prevalence was 7.9% during grazing and 9.1% during housing. This study identified many potential areas of lameness management that could be improved upon on Irish farms; for example, only one farmer carried out lameness scoring, 6% routine trimming and 31% regular footbathing. The majority of farms also had rough (uneven, larger stones, bumps and holes are common, signs of wear or erosion) cow tracks present, and had less than 1.1 cubicles per cow in all pens. Paper 3 identified the prevalence of hoof lesions in lame dairy cows, correlations between lesions, the lesions that were associated with more severe lameness, and risk factors for digital dermatitis. The most prevalent lesions were white line separation, sole haemorrhage and overgrown claws. Digit amputation, foul of the foot, sole ulcer, white line abscess and toe necrosis were associated with more severe lameness. Overgrown claws and penetration of a foreign body were more common during grazing than housing. The strongest correlation at herd-level was between toe necrosis and digital dermatitis, and between overgrown claws and corkscrew claws at cow-level. Cow track characteristics, as well as the farmer’s perception of lameness and digital dermatitis in the herd were associated with digital dermatitis risk. Paper 4 reported attitudes to pain and pain relief by dairy farmers and veterinarians in Ireland, and the use of NSAIDs for various dairy cow and calf conditions and procedures, including those related to lameness. This study showed that veterinarians and farmers are potentially becoming habituated to pain; they scored the conditions and procedures they saw most regularly as less painful than those less commonly seen. Higher pain scores were also associated with higher NSAID use; however, for some conditions and procedures NSAID use was low despite the pain score given. The cost of NSAIDs was also considered less of an issue to farmers than veterinarians thought. This thesis provides valuable insights into dairy cow health and welfare, with a particular focus on lameness. Compared to other countries, a relatively low lameness prevalence was reported during both the grazing and housing period; however, approximately one in ten lame cows is still arguably too high. Farmers should strive for the lowest lameness prevalence possible for welfare and economic reasons. This thesis also showed that there are many areas of lameness management that could be improved upon. Knowledge gained from this thesis will provide guidance for future research and allow information to be disseminated to farmers and veterinarians, thus further decreasing lameness and improving pain management on Irish dairy farms

Lameness and pain management on Irish dairy farms

Lameness is a major concern for animal welfare due to the associated pain, and has significant negative economic and environmental consequences. Irish dairying differs from most other systems, whereby cows are out to grass for the majority of the year and housed over the winter months; therefore, research from other system types can be hard to apply to Irish dairy farms. Reducing lameness on Irish dairy farms is vitally important, as the welfare-friendly credentials of Irish dairy products are key to positioning Ireland as a leading supplier of dairy products internationally. In order to reduce lameness, further work is required on the prevalence, causes and risk factors for lameness in Irish dairy cows. The Irish dairy industry would also benefit from knowing what lameness management practices are currently in place on Irish dairy farms. The aim of this thesis was to gain knowledge on lameness and pain management in an Irish pasture-based dairy system. The first study (Papers 1-3) involved lameness scoring cows from 99 pasture-based dairy herds in Ireland during the grazing period, and from 85 of these herds during the housing period. At each visit, infrastructure measurements were taken (housing facilities, milking facilities and cow tracks) and a questionnaire was undertaken with the farmer to identify background information and farm management practices. Cow-level data was also collected (e.g. breed, parity and milk yield). For 98 of the farms visited during the grazing period and for 74 of the farms visited during the housing period, the hind hooves of up to a maximum of 20 lame cows were examined and hoof lesions were recorded. The second study (Paper 4) involved sending a questionnaire on attitudes to pain and the use of non-steroidal anti-inflammatory drugs (NSAIDs) on Irish dairy farms, to both dairy farmers and veterinarians that work with dairy cows in Ireland. Over 1000 questionnaires were returned by dairy farmers and 116 by veterinarians. Paper 1 determined the most important cow-level and herd-level risk factors for lameness in Irish pasture-based dairy herds, based on both the grazing and housing period. Triangulation of elastic net regression and logistic regression using modified Bayesian information criterion, with bootstrapping, were used to obtain a robust set of risk factors. Cow-level risk factors included age and genetic predicted transmitting ability for lameness, and herd-level risk factors included herd and farm size, the distance cows had to turn at the milking parlour exit, stones in paddock gateways, and slats on the cow track near the collecting yard; farmer’s perception of lameness and digital dermatitis in their herd was also associated with lameness outcomes. Paper 2 reported the lameness prevalence during both the grazing and housing periods, and identified lameness management practices that are currently in place on Irish dairy farms. This paper also described current infrastructure and general farm management that may relate to lameness. The median herd lameness prevalence was 7.9% during grazing and 9.1% during housing. This study identified many potential areas of lameness management that could be improved upon on Irish farms; for example, only one farmer carried out lameness scoring, 6% routine trimming and 31% regular footbathing. The majority of farms also had rough (uneven, larger stones, bumps and holes are common, signs of wear or erosion) cow tracks present, and had less than 1.1 cubicles per cow in all pens. Paper 3 identified the prevalence of hoof lesions in lame dairy cows, correlations between lesions, the lesions that were associated with more severe lameness, and risk factors for digital dermatitis. The most prevalent lesions were white line separation, sole haemorrhage and overgrown claws. Digit amputation, foul of the foot, sole ulcer, white line abscess and toe necrosis were associated with more severe lameness. Overgrown claws and penetration of a foreign body were more common during grazing than housing. The strongest correlation at herd-level was between toe necrosis and digital dermatitis, and between overgrown claws and corkscrew claws at cow-level. Cow track characteristics, as well as the farmer’s perception of lameness and digital dermatitis in the herd were associated with digital dermatitis risk. Paper 4 reported attitudes to pain and pain relief by dairy farmers and veterinarians in Ireland, and the use of NSAIDs for various dairy cow and calf conditions and procedures, including those related to lameness. This study showed that veterinarians and farmers are potentially becoming habituated to pain; they scored the conditions and procedures they saw most regularly as less painful than those less commonly seen. Higher pain scores were also associated with higher NSAID use; however, for some conditions and procedures NSAID use was low despite the pain score given. The cost of NSAIDs was also considered less of an issue to farmers than veterinarians thought. This thesis provides valuable insights into dairy cow health and welfare, with a particular focus on lameness. Compared to other countries, a relatively low lameness prevalence was reported during both the grazing and housing period; however, approximately one in ten lame cows is still arguably too high. Farmers should strive for the lowest lameness prevalence possible for welfare and economic reasons. This thesis also showed that there are many areas of lameness management that could be improved upon. Knowledge gained from this thesis will provide guidance for future research and allow information to be disseminated to farmers and veterinarians, thus further decreasing lameness and improving pain management on Irish dairy farms

Use of Non-Steroidal Anti-Inflammatory Drugs and Attitudes to Pain in Pasture-Based Dairy Cows: A Comparative Study of Farmers and Veterinarians

Pain is a significant welfare concern within the dairy industry. Recognizing and managing pain are important factors for safeguarding animal welfare. A questionnaire was sent via post to Irish dairy farmers and large animal veterinarians to assess attitudes to pain and the use of non-steroidal anti-inflammatory drugs (NSAIDs) in pasture-based dairy cows. The questionnaire could also be completed online. A total of 1,002 surveys were received from dairy farmers and 116 from livestock veterinarians. Veterinarians and farmers generally perceived the same conditions and procedures as the most painful. However, farmers scored surgical procedures significantly higher than veterinarians, and veterinarians scored lameness-related conditions, mastitis (clots in milk only) and hock hair loss significantly higher than farmers. Higher pain scores for conditions and procedures given by dairy farmers and veterinarians were associated with increased NSAID use. However, the use of NSAIDs was low, relative to the pain score, for Burdizzo castration (farmers and veterinarians), white line separation (farmers and veterinarians) and abscess (veterinarians), mastitis with clots in milk only (farmers) and calving with no assistance (farmers). Veterinarians who graduated less recently had significantly lower odds of using NSAIDs, and farmers that completed the survey online, had a larger herd size, completed education up to level four or five (as opposed to level three) and those who seemed to have less knowledge on analgesics, had significantly lower odds of using NSAIDs. Empathy was not found to be associated with NSAID use and no correlation was found between pain and empathy scores. Veterinarians perceived cost as more of a barrier than farmers did; therefore, NSAIDs should be offered more readily. For those working with dairy cows, there is a need to continue education on the benefits of analgesia, especially for conditions and procedures that have low NSAID use relative to pain score. The habituation of humans to pain in animals needs to be prevented to enable pain to be recognized and managed appropriately. Pain scores can be used as a benchmark for veterinarians and farmers to determine how their perception of pain compares to others, and see how this may influence their NSAID use

Palliative wound care: optimising the use of classification systems

Systemy klasyfikacyjne stanowią użyteczne narzędzie pozwalające na sprowadzenie złożonego stanu/choroby do możliwych do określenia elementów oraz ułatwiające komunikację pomiędzy profesjonalistami. Systemy te mogą służyć do definiowania, zazwyczaj w aspekcie nasilenia, poszczególnych objawów chorób i stanów. Mogą również być stosowane przy klasyfikowaniu predyspozycji do pewnych stanów, np. ryzyka powstania odleżyny. Uzyskane informacje wykorzystuje się przy planowaniu leczenia i opieki oraz do prognozowania przebiegu. Systemy klasyfikacyjne mogą być obszerne i złożone, jeśli dotyczą złożonych procesów lub stanów chorobowych, lub mogą być uproszczone. Oba te ograniczenia są szczególnie istotne w medycynie paliatywnej, w której poważny stan pacjentów wiąże się z współwystępowaniem licznych schorzeń i wymaga stosowania wielu metod leczenia oraz uwzględnienia indywidualnych cech chorego. Skuteczne stosowanie systemów klasyfikacyjnych przy podejmowaniu decyzji klinicznych wymaga, oprócz rozległej wiedzy klinicznej, stosowania obowiązujących i praktycznych systemów. System kliniczny TELER®, oparty na sporządzaniu notatek, jest nowoczesnym sposobem oceny, łączącym w sobie klasyfikację, planowanie opieki oraz ocenę wyników leczenia. System ten uwzględnia cele pacjenta, wiedzę teoretyczną i kliniczną oraz w unikalny sposób ocenia, jak zmieniają się dolegliwości pacjenta pod wpływem leczenia i pielęgnacji. Do tego systemu można włączyć uznane systemy klasyfikacyjne, np. drabinę analgetyczną Światowej Organizacji Zdrowia, stosowaną przy łagodzeniu bólu nowotworowego. Niniejsza praca przedstawia system TELER® jako narzędzie wykorzystywane przy podejmowaniu decyzji i szczegółowej ocenie leczenia paliatywnego ran, w kontekście całościowej opieki nad chorym.Classification systems can be useful tools for reducing a complex disease/condition into identifiable elements, and a means to communicate these between professionals. These systems may be used to define, usually in terms of severity, specific aspects of diseases and conditions. They may also be used to classify predisposition to specific conditions, for example the risk of pressure ulceration. Information generated is used to guide treatment and care planning, and to predict outcomes. Classification systems can become lengthy and complicated in the process of trying to represent the complex disease process/condition, or they are a simplification. Both these limitations may be particularly important in the specialty of palliative care where the advanced nature of patients’ conditions often results in multiple overlapping disease, treatment and individual variables. The successful use of classification systems in clinical decision-making requires valid and practical systems to be used alongside sound clinical knowledge. A novel approach that combines classification, care planning and treatment evaluation is a clinical note-making system, TELER®. This system includes patients’ goals, theoretical and clinical knowledge, and uniquely measures how patients’ problems change with treatment and care. The system can incorporate validated classification systems, for example the World Health Organisation analgesic ladder for cancer pain relief. In this paper the system is presented as a tool that has been applied to decision-making and evaluation in relation to the discrete elements of palliating wounds, in the context of total patient care

Prevention and Screening for Cardiometabolic Disease Following Hypertensive Disorders in Pregnancy in Low-Resource Settings:A Systematic Review and Delphi Study

Hypertensive disorders in pregnancy (HDP) and cardiometabolic and kidney diseases are rising in low- and middle-income countries (LMICs). While HDP are risk factors for cardiometabolic and kidney diseases, cost-effective, scalable strategies for screening and prevention in women with a history of HDP are lacking. Existing guidelines and recommendations require adaptation to LMIC settings. This article aims to generate consensus-based recommendations for the prevention and screening of cardiometabolic and kidney diseases tailored for implementation in LMICs. We conducted a systematic review of guidelines and recommendations for prevention and screening strategies for cardiometabolic and chronic kidney diseases following HDP. We searched PubMed/Medline, Embase and Cochrane Library for relevant articles and guidelines published from 2010 to 2021 from both high-income countries (HICs) and LMICs. No other filters were applied. References of included articles were also assessed for eligibility. Findings were synthesized narratively. The summary of guiding recommendations was subjected to two rounds of Delphi consensus surveys with experts experienced in LMIC settings. Fifty-four articles and 9 guidelines were identified, of which 25 were included. Thirty-five clinical recommendations were synthesized from these and classified into six domains: identification of women with HDP (4 recommendations), timing of first counseling and provision of health education (2 recommendations), structure and care setting (12 recommendations), information and communication needs (5 recommendations), cardiometabolic biomarkers (8 recommendations) and biomarkers thresholds (4 recommendations). The Delphi panel reached consensus on 33 final recommendations. These recommendations for health workers in LMICs provide practical and scalable approaches for effective screening and prevention of cardiometabolic disease following HDP. Monitoring and evaluation of implementation of these recommendations provide opportunities for reducing the escalating burden of noncommunicable diseases in LMICs

Histone mRNA is subject to 3’ uridylation and re-adenylation in Aspergillus nidulans

The role of post‐transcriptional RNA modification is of growing interest. One example is the addition of non‐templated uridine residues to the 3′ end of transcripts. In mammalian systems, uridylation is integral to cell cycle control of histone mRNA levels. This regulatory mechanism is dependent on the nonsense‐mediated decay (NMD) component, Upf1, which promotes histone mRNA uridylation and degradation in response to the arrest of DNA synthesis. We have identified a similar system in Aspergillus nidulans, where Upf1 is required for the regulation of histone mRNA levels. However, other NMD components are also implicated, distinguishing it from the mammalian system. As in human cells, 3′ uridylation of histone mRNA is induced upon replication arrest. Disruption of this 3′ tagging has a significant but limited effect on histone transcript regulation, consistent with multiple mechanisms acting to regulate mRNA levels. Interestingly, 3′ end degraded transcripts are also subject to re‐adenylation. Both mRNA pyrimidine tagging and re‐adenylation are dependent on the same terminal‐nucleotidyltransferases, CutA, and CutB, and we show this is consistent with the in vitro activities of both enzymes. Based on these data we argue that mRNA 3′ tagging has diverse and distinct roles associated with transcript degradation, functionality and regulation.publishe

Predicting fitness-to-drive following stroke using the Occupational Therapy – Driver Off Road Assessment Battery

Introduction: It is difficult to determine if, or when, individuals with stroke are ready to undergo on-road fitness-to-drive assessment. The Occupational Therapy - Driver Off Road Assessment Battery was developed to determine client suitability to resume driving. The predictive validity of the Battery needs to be verified for people with stroke. Aim: Examine the predictive validity of the Occupational Therapy - Driver Off Road Assessment Battery for on-road performance among people with stroke. Method: Off-road data were collected from 148 people post stroke on the Battery and the outcome of their on-road assessment was recorded as: fit-to-drive or not fit-to-drive. Results: The majority of participants (76%) were able to resume driving. A classification and regression tree (CART) analysis using four subtests (three cognitive and one physical) from the Battery demonstrated an area under the curve (AUC) of 0.8311. Using a threshold of 0.5, the model correctly predicted 98/112 fit-to-drive (87.5%) and 26/36 people not fit-to-drive (72.2%). Conclusion: The three cognitive subtests from the Occupational Therapy - Driver Off Road Assessment Battery and potentially one of the physical tests have good predictive validity for client fitness-to-drive. These tests can be used to screen client suitability for proceeding to an on-road test following stroke. Implications for Rehabilitation: Following stroke, drivers should be counseled (including consideration of local legislation) concerning return to driving. The Occupational Therapy - Driver Off Road Assessment Battery can be used in the clinic to screen people for suitability to undertake on road assessment. Scores on four of the Occupational Therapy - Driver Off Road Assessment Battery subtests are predictive of resumption of driving following stroke