OTs Delivering Culturally Sensitive Care for Dementia Family Caregivers From Diverse Backgrounds

As occupational therapists, addressing key cultural barriers that may obstruct access to dementia care and education for individuals with dementia and their caregivers from diverse backgrounds is a priority for client-centered care. Stress, racial discrimination, and distrust may exacerbate symptoms and prevalence of dementia in certain populations, such as Chinese- Americans and Latinx (Quinones et al. 2020). Immigrants’ experiences of aging and health are diverse due to belonging to different socioeconomic, ethnic, cultural, and linguistic groups and having varying levels of education and work experience (R. S. 2020). There are existing cultural differences regarding caregiving and family networks, perception and recognition of dementia and associated symptoms, negative experiences with health and care services, and language barriers. Examining how individuals from diverse cultural backgrounds understand dementia and experience the caregiving role can provide occupational therapists (OTs) with an understanding of the importance of cultural sensitivity. We aim to establish educational resources for OT Practitioners (OTPs) on how to be culturally sensitive when supporting caregivers from diverse backgrounds and individuals living with dementia (ILwD) and their particular needs. Providing educational resources to OTPs will contribute to fostering collaborative relationships between OTPs and dementia family caregivers from diverse backgrounds

Chemoresistant MyoD+/Nog+ cells restore tumor heterogeneity in rhabdomyosarcoma following initial chemotherapy

Rhabdomyosarcoma (RMS) is the most common soft tissue malignancy in childhood and adolescence. RMS rarely occurs in adults, but the outcome is significantly worse. Most adult patients with advanced RMS die because their cancer exhibits or develops resistance to available therapies. Chemotherapy treatment for RMS includes Doxorubicin, a DNA intercalating agent and topoisomerase II inhibitor, and Vincristine, a mitosis inhibitor. Histologically, RMS is classified into two main subtypes, embryonal (ERMS) and alveolar (ARMS). ARMS tumors typically harbor chromosomal translocations resulting in the expression of PAX3- or PAX7-FOXO1 fusion proteins. ERMS tumors exhibit a much wider range of genetic abnormalities. The fact that RMS of the same subtype may have significant difference in clinical behavior has been well recognized. Previously, we have shown that RMS cell lines propagated in vitro are heterogeneous with respect to expression of Myoblast determination protein 1 (MyoD1) and Noggin (Nog). Importantly, MyoD+/Nog+ cells have shown higher levels of chemoresistance to Vincristine and Doxorubicin than MyoD negative cells in part to upregulation of anti-apoptotic genes Gli-1 and BcL2 (Dawson et al 2020)

Hearing the voices of students with autism. What is the lived experience of students in an ASD class?

The education of students with Autism Spectrum Disorder (ASD) has been subject to debate for a number of years, particularly following the international commitment to inclusive education. In Ireland students with ASD have access to a continuum of provision which affords them the opportunity to attend a mainstream school, a special school or a special class within a mainstream school. This study sought to obtain the voices of students with ASD in order to gain a more in depth understanding of their experiences in an ASD class within a mainstream school. Four students with ASD took part in this qualitative study, sharing their experiences through drawings, semi-structured interviews and photo-elicitation interviews. Interpretive phenomenological analysis was used to examine the data and the findings demonstrate their experiences are predominantly positive, furthermore it became apparent the participants viewed the school as a whole as having a positive influence on their experiences

Military veteran engagement with mental health and well-being services: a qualitative study of the role of the peer support worker

Background: Many UK military veterans experiencing mental health and well-being difficulties do not engage with support services to get the help they need. Some mental health clinics employ Peer Support Workers (PSWs) to help veteran patients engage, however it is not known how the role influences UK veteran engagement. Aims: To gain insight into the role of peer support in UK veteran engagement with mental health and well-being services. Method: A qualitative study based on 18 semi-structured interviews with veterans, PSWs and mental health clinicians at a specialist veteran mental health and well-being clinic in Scotland. Results: Four themes of the PSW role as positive first impression, understanding professional friend, helpful and supportive connector, and an open door were identified across all participants. The PSWs’ military connection, social and well-being support and role in providing veterans with an easily accessible route to dis-engage and re-engage with the service over multiple engagement attempts were particularly crucial. Conclusions: The Peer Support role enhanced veteran engagement in the majority of instances. Study findings mirrored existing peer support literature, provided new evidence in relation to engaging UK veterans, and made recommendations for future veteran research and service provision

Comparing the Fiscal Consequences of Controlled and Uncontrolled Osteoarthritis Pain Applying a UK Public Economic Perspective

**Background:** Individuals experiencing osteoarthritis (OA) pain can pose significant costs for governments due to reduced work activity in these individuals and increasing reliance on public support benefits. In this analysis we capture the broader economic impact of OA pain by applying a government perspective, public economic framework to assess controlled and uncontrolled pain. **Methods:** We used a Markov model to compare labour market participation in people with uncontrolled OA hip or knee pain compared to a cohort with controlled OA pain. The likelihood of employment, long-term sickness, disability, and early retirement in those with controlled pain used publicly available UK data. The relative effect of uncontrolled OA pain on fiscal outcomes is drawn from peer reviewed publications reporting reduced work activity and reliance on public benefits for people with uncontrolled OA pain. Lost tax revenue was derived using UK tax rates and national insurance contributions applied to annual earnings. Social benefit rules were applied to calculate government financial support to individuals. Health-care costs were calculated based on estimates from an UK observational study. The base case analysis compared the projected lost tax revenue and transfer payments for a 50-year-old cohort with severe OA pain, retiring at age 65. **Results:** For a 50-year-old individual with moderate uncontrolled OA pain with 15-years remaining work expectancy, the model estimated a £62 383 reduction in employment earnings, a £24 307 reduction in tax contributions and a need for £16 034 in government benefits, compared to a person with controlled OA pain. In people with severe uncontrolled OA pain incremental foregone earnings were estimated to be £126 384, £44 925 were not paid through taxation and £25 829 were received in public benefits, compared to the controlled pain cohort. Health-care costs represented 13% and 12% of all OA-related fiscal cost in the moderate uncontrolled OA pain and severe uncontrolled OA pain comparison, respectively. **Conclusions:** For governments, maintaining an active workforce is paramount to maintaining economic growth and reducing spending on government programs. The approach described here can be used to augment cost-effectiveness models to inform a range of stakeholders of benefits attributed to controlled OA pain

A qualitative study of the views and experiences of those working in residential children's homes

Young people in residential children's homes have typically experienced significant child maltreatment and will have likely experienced multiple placement moves; both are associated with a range of poor outcomes and impact on wellbeing. Whilst much is understood about the impact of child maltreatment, little is known about how residential health care workers experience and understand the potential difficulties the children they look after experience. Our study aimed to gain an insight into the views of residential workers, how they understand their role, and what barriers they experience in their work, as well as supportive factors. We used a qualitative design to understand residential workers' perspectives of supporting their young people. Five focus groups were run with a total of 22 participants. Participants were predominantly female and ranged in age and years of experience within the sector. Participants worked in five residential care homes across England and Wales. Three core themes were identified using thematic analysis. Firstly, residential workers feel this is a rewarding profession but not one that is well understood and valued by society. Secondly, factors such as shift demands and managing challenging behaviour can be barriers to residential workers being emotionally available to the children in their care, but factors such as being part of a cohesive team and access to reflective spaces help promote resilience. Thirdly, workers recognise that confidence and skill impact their ability to successfully manage challenging behaviours. The implications of the findings can be used within children's services to promote workers' wellbeing, to reduce staff burnout and secondary trauma, and to improve retention, which can increase positive outcomes for young people in their care and can guide practice within the residential care sector

Impact of Electronic Chronic Pain Questions on patient-reported outcomes and healthcare utilization, and attitudes toward eCPQ use among patients and physicians: prospective pragmatic study in a US general practice setting

OBJECTIVE: The Electronic Chronic Pain Questions (eCPQ) has been developed to help healthcare providers systematically capture chronic pain data. This study evaluated the impact of using the eCPQ on patient-reported outcomes (PROs) and healthcare resource utilization (HCRU) in a primary care setting, and patient and physician perceptions regarding use of, and satisfaction with, the eCPQ. METHODS: This was a prospective pragmatic study conducted at the Internal Medicine clinic within the Henry Ford Health (HFH) Detroit campus between June 2017 and April 2020. Patients (aged ≥18 years) attending the clinic for chronic pain were allocated to an Intervention Group to complete the eCPQ in addition to regular care, or a control group to receive regular care only. The Patient Health Questionnaire-2 and a Patient Global Assessment were assessed at baseline, 6-months, and 12-months study visits. HCRU data were extracted from the HFH database. Telephone qualitative interviews were conducted with randomly selected patients and physicians who used the eCPQ. RESULTS: Two hundred patients were enrolled, 79 in each treatment group completed all 3 study visits. No significant differences (p \u3e 0.05) were found in PROs and HCRU between the 2 groups. In qualitative interviews, physicians and patients reported the eCPQ as useful, and using the eCPQ improved patient-clinician interactions. CONCLUSION: Adding the eCPQ to regular care for patients with chronic pain did not significantly impact the PROs assessed in this study. However, qualitative interviews suggested that the eCPQ was a well-accepted and potentially useful tool from a patient and physician perspective. By using the eCPQ, patients were better prepared when they attended a primary care visit for their chronic pain and the quality of patient-physician communication was increased