Paws with a Purpose: Evidence Supporting the Use of Animal Assisted Therapy to Improve Quality of Life in Adults with Psychiatric Diagnoses

Approximately 62.7 million Americans have a psychiatric diagnosis, including Alzheimer’s disease and mental disorders1,6. Adults who are diagnosed with these conditions experience a variety of limitations, including decreased quality of life4. Occupational Therapy (OT) has been shown to be an effective treatment to increase quality of life in adults with psychiatric diagnoses3. Occupational therapists working within the mental health field often need to use creative and innovative approaches to motivate their clients, including Animal-assisted therapy (AAT). AAT is a unique intervention approach that has the potential to improve a person’s emotional, physical, cognitive and social functioning5. In order to evaluate the efficacy of AAT to improve quality of life in adults with psychiatric diagnoses, a systematic literature review was conducted. Quality of life was operationally defined as functional ability and physical, emotional, and social well-being2. Electronic databases including CINAHL, Ovid Medline, PsycINFO, and Google Scholar were used to select peer-reviewed articles from 1995 to 2013. Predefined selection criteria were used to identify AAT studies, assessing quality of life for adults with psychiatric diagnoses. All investigators assessed and subsequently agreed on inclusion. A total of 228 publications were found; thirteen studies met the inclusion criteria. The purpose of this session is to present the current evidence supporting AAT and discuss future clinical implications for occupational therapy practice. The review process, definitions, and themes will be presented. The results describe AAT as a promising treatment intervention to improve quality of life in adults with psychiatric diagnoses. Animals have been found to increase social participation, decrease emotional and behavioral symptoms, and influence occupational performance by serving as “role models” for ADLs and related routines. Additionally, it is suggested that animals be used as a modality, with the therapist planning and guiding the treatment session. AAT may also be justified as a supplement to conventional therapy and pharmacological treatment approaches to increase quality of life for individuals with psychiatric diagnoses. To advance the knowledge of AAT in OT practice, continued research is necessary to develop specific, standardized AAT protocols, outline the role of OT in AAT, and establish credible results from high quality studies. References: National Institute of Mental Health. (n.d.). The numbers count: Mental disorders in america. Retrieved from http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america/index.shtml Cella, D. F. (1994). Quality of life: concepts and definition. Journal of pain and symptom management, 9(3), 186-192. Graff, M. J., Vernooij-Dassen, M. J., Thijssen, M., Dekker, J., Hoefnagels, W. H., & OldeRikkert, M. G. (2007). Effects of community occupational therapy on quality of life, mood, and health status in dementia patients and their caregivers: a randomized controlled trial. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 62(9), 1002-1009. Lehman, A. F. (1983). The well-being of chronic mental patients: assessing their quality of life. Archives of General Psychiatry, 40(4), 369. Kanamori, M., Suzuki, M., Yamamoto, K., Kanda, M., Matsui, Y., Kojima, E., ... & Oshiro, H. (2001). A day care program and evaluation of animal-assisted therapy (AAT) for the elderly with senile dementia. American Journal of Alzheimer\u27s disease and other Dementias, 16(4), 234-239. Alzheimer\u27s Association. (2013). Alzheimer\u27s facts and figures. Retrieved from http://www.alz.org/alzheimers_disease_facts_and_figures.as

Person-centered approach to examining emergent literacy risks in children with specific language impairment

Children with specific language impairment (SLI) are at increased risk for reading difficulties, and some studies suggest that these problems are evident even with pre-reading skills, such as alphabet knowledge and phonological awareness. To date, most studies asserting these emergent literacy difficulties have relied on mean score differences between children with SLI and children who are typically developing. However, work concerning children with SLI also reports considerable heterogeneity, such that some children perform as well as typically developing peers. The present study utilizes a person-centered approach to examine whether the actual proportion of preschool children with SLI (n = 62) who might be identified as “at risk” on measures of emergent literacy differs significantly from the proportion of age-matched typically developing peers (n = 40), and whether a subset of children with concomitant speech impairment would exhibit greatest risk. Results showed that a significantly greater percentage of children with SLI were classified as at risk on all three emergent literacy measures, and the percentage of children at risk for each measure was similar. Children with concomitant speech and language impairment performed more poorly on the alphabet knowledge measure, as compared to those with LI-only, but had similar scores on the other two measures (rhyme awareness and print knowledge). Implications of these findings with respect to assessing emergent literacy in children with language disorders are discussed

Xeroderma Pigmentosum Group C Deficiency Alters Cigarette Smoke DNA Damage Cell Fate and Accelerates Emphysema Development

Cigarette smoke (CS) exposure is a major risk factor for the development of emphysema, a common disease characterized by loss of cells comprising the lung parenchyma. The mechanisms of cell injury leading to emphysema are not completely understood but are thought to involve persistent cytotoxic or mutagenic DNA damage induced by CS. Using complementary cell culture and mouse models of CS exposure, we investigated the role of the DNA repair protein, xeroderma pigmentosum group C (XPC), on CS-induced DNA damage repair and emphysema. Expression of XPC was decreased in mouse lungs after chronic CS exposure and XPC knockdown in cultured human lung epithelial cells decreased their survival after CS exposure due to activation of the intrinsic apoptosis pathway. Similarly, cell autophagy and apoptosis were increased in XPC-deficient mouse lungs and were further increased by CS exposure. XPC deficiency was associated with structural and functional changes characteristic of emphysema, which were worsened by age, similar to levels observed with chronic CS exposure. Taken together, these findings suggest that repair of DNA damage by XPC plays an important and previously unrecognized role in the maintenance of alveolar structures. These findings support that loss of XPC, possibly due to chronic CS exposure, promotes emphysema development and further supports a link between DNA damage, impaired DNA repair, and development of emphysema

Inhibition of acid sphingomyelinase disrupts LYNUS signaling and triggers autophagy

Activation of the lysosomal ceramide-producing enzyme, acid sphingomyelinase (ASM), by various stresses is centrally involved in cell death and has been implicated in autophagy. We set out to investigate the role of the baseline ASM activity in maintaining physiological functions of lysosomes, focusing on the lysosomal nutrient-sensing complex (LYNUS), a lysosomal membrane-anchored multiprotein complex that includes mammalian target of rapamycin (mTOR) and transcription factor EB (TFEB). ASM inhibition with imipramine or sphingomyelin phosphodiesterase 1 (SMPD1) siRNA in human lung cells, or by transgenic Smpd1+/- haploinsufficiency of mouse lungs, markedly reduced mTOR- and P70-S6 kinase (Thr 389)-phosphorylation and modified TFEB in a pattern consistent with its activation. Inhibition of baseline ASM activity significantly increased autophagy with preserved degradative potential. Pulse labeling of sphingolipid metabolites revealed that ASM inhibition markedly decreased sphingosine (Sph) and Sph-1-phosphate (S1P) levels at the level of ceramide hydrolysis. These findings suggest that ASM functions to maintain physiological mTOR signaling and inhibit autophagy and implicate Sph and/or S1P in the control of lysosomal function

Washington State Dependency Best Practices Report

The judge\u27s work in child abuse and neglect cases is among the most challenging of any judicial proceeding. The complexities are substantial. Such cases depend upon the exercise of discretion and good judgment together with the application of sound legal principles. The judge must call upon his or her most cherished skills—objectivity, wisdom, patience, and foresight—in circumstances of acute stress. Lives are literally at stake—the lives of the most vulnerable children and youth in our communities and the lives of families wracked by generations of poverty and despair. Families, children, and youth who have experienced intense trauma; who may be mentally ill; where domestic violence may have become a way of life; where substance abuse, alcoholism, and the experience of incarceration have become normal, all rely on the dependency judge for timely and just resolution. The judge is called upon to bring safety, well-being, and permanence to the child. Decisions must be made. Problems must be solved. The stakes are high. What makes this work possible is judicial leadership and system collaboration: the internal system in your courtroom and your courthouse; the external system among the community of stakeholders, service providers, other branches of government, and the like. Embracing these internal and external resources not only makes your job easier but also richer, and good results are more likely to ensue for the troubled children and families we serve. This collection of practices provides options for this important work—options that have been proven to result in better outcomes. They provide real, achievable, cost-effective, and efficient means to improve the process as well. Use them. They will enhance the already extraordinary work you are doing every day.https://digitalcommons.law.uw.edu/faculty-books/1046/thumbnail.jp

The impact of polio eradication on routine immunization and primary health care: A mixed-methods study

Background: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).Methods: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.Results: Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year.Conclusions: Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts

Npas1+ Pallidal Neurons Target Striatal Projection Neurons

Compelling evidence demonstrates the external globus pallidus (GPe) plays a key role in processing sensorimotor information. An anatomical projection from the GPe to the dorsal striatum (dStr) has been described for decades. However, the cellular target and functional impact of this projection remain unknown. Using cell-specific transgenic mice, modern monosynaptic tracing techniques, and optogenetics-based mapping, we discovered that GPe neurons provide inhibitory inputs to direct- and indirect-pathway striatal projection neurons (SPNs). Our results indicate that the GPe input to SPNs arises primarily from Npas1- expressing neurons and is strengthened in a chronic Parkinson’s disease (PD) model. Alterations of the GPe-SPN input in a PD model argue for the critical position of this connection in regulating basal ganglia motor output, arguing that strengthening of GPe-SPN connection is maladaptive and may underlie the hypokinetic symptoms in PD

Early childhood educator's implementation readiness and intervention fidelity: Findings from a person-centered study

Research has indicated that early educators’ intervention fidelity is a significant predictor of children's responsiveness to classroom interventions. To improve understanding of predictors of intervention fidelity in early childhood settings, this study adopted a person-centered approach to identify profiles of “implementation readiness” in 1,192 Danish educators, and to examine relations with implementation fidelity. Multilevel latent profile analyses including setting-level characteristics as well as characteristics particular to the individual educator, showed reliable profiles of general and intervention-specific implementation readiness, which were associated with proportion of fulltime educators, employees with a teaching-related pre-service education, and investment in professional development. Higher and more positive implementation readiness predicted implementation dosage and adherence to early childhood interventions

Development and validation of a 30-day mortality index based on pre-existing medical administrative data from 13,323 COVID-19 patients: The Veterans Health Administration COVID-19 (VACO) Index.

BACKGROUND: Available COVID-19 mortality indices are limited to acute inpatient data. Using nationwide medical administrative data available prior to SARS-CoV-2 infection from the US Veterans Health Administration (VA), we developed the VA COVID-19 (VACO) 30-day mortality index and validated the index in two independent, prospective samples. METHODS AND FINDINGS: We reviewed SARS-CoV-2 testing results within the VA between February 8 and August 18, 2020. The sample was split into a development cohort (test positive between March 2 and April 15, 2020), an early validation cohort (test positive between April 16 and May 18, 2020), and a late validation cohort (test positive between May 19 and July 19, 2020). Our logistic regression model in the development cohort considered demographics (age, sex, race/ethnicity), and pre-existing medical conditions and the Charlson Comorbidity Index (CCI) derived from ICD-10 diagnosis codes. Weights were fixed to create the VACO Index that was then validated by comparing area under receiver operating characteristic curves (AUC) in the early and late validation cohorts and among important validation cohort subgroups defined by sex, race/ethnicity, and geographic region. We also evaluated calibration curves and the range of predictions generated within age categories. 13,323 individuals tested positive for SARS-CoV-2 (median age: 63 years; 91% male; 42% non-Hispanic Black). We observed 480/3,681 (13%) deaths in development, 253/2,151 (12%) deaths in the early validation cohort, and 403/7,491 (5%) deaths in the late validation cohort. Age, multimorbidity described with CCI, and a history of myocardial infarction or peripheral vascular disease were independently associated with mortality-no other individual comorbid diagnosis provided additional information. The VACO Index discriminated mortality in development (AUC = 0.79, 95% CI: 0.77-0.81), and in early (AUC = 0.81 95% CI: 0.78-0.83) and late (AUC = 0.84, 95% CI: 0.78-0.86) validation. The VACO Index allows personalized estimates of 30-day mortality after COVID-19 infection. For example, among those aged 60-64 years, overall mortality was estimated at 9% (95% CI: 6-11%). The Index further discriminated risk in this age stratum from 4% (95% CI: 3-7%) to 21% (95% CI: 12-31%), depending on sex and comorbid disease. CONCLUSION: Prior to infection, demographics and comorbid conditions can discriminate COVID-19 mortality risk overall and within age strata. The VACO Index reproducibly identified individuals at substantial risk of COVID-19 mortality who might consider continuing social distancing, despite relaxed state and local guidelines

Exploring concepts of health with male prisoners in three category-C English prisons

Lay understandings of health and illness have a well established track record and a plethora of research now exists which has examined these issues. However, there is a dearth of research which has examined the perspectives of those who are imprisoned. This paper attempts to address this research gap. The paper is timely given that calls have been made to examine lay perspectives in different geographical locations and a need to re-examine health promotion approaches in prison settings. Qualitative data from thirty-six male sentenced prisoners from three prisons in England were collected. The data was analysed in accordance with Attride-Stirling's (2001) thematic network approach. Although the men's perceptions of health were broadly similar to the general population, some interesting findings emerged which were directly related to prison life and its associated structures. These included access to the outdoors and time out of their prison cell, as well as maintaining relationships with family members through visits. The paper proposes that prisoners' lay views should be given higher priority given that prison health has traditionally been associated with medical treatment and the bio-medical paradigm more generally. It also suggests that in order to fulfil the World Health Organization's (WHO) vision of viewing prisons as health promoting settings, lay views should be recognised to shape future health promotion policy and practice