Search

Background: In the demyelinating disease multiple sclerosis (MS), chronic-active brain inflammation, remyelination failure and neurodegeneration remain major issues despite immunotherapy. While B cell depletion and blockade/sequestration of T and B cells potently reduces episodic relapses, they act peripherally to allow persistence of chronic-active brain inflammation and progressive neurological dysfunction. N-acetyglucosamine (GlcNAc) is a triple modulator of inflammation, myelination and neurodegeneration. GlcNAc promotes biosynthesis of Asn (N)-linked-glycans, which interact with galectins to co-regulate the clustering/signaling/endocytosis of multiple glycoproteins simultaneously. In mice, GlcNAc crosses the blood brain barrier to raise N-glycan branching, suppress inflammatory demyelination by T and B cells and trigger stem/progenitor cell mediated myelin repair. MS clinical severity, demyelination lesion size and neurodegeneration inversely associate with a marker of endogenous GlcNAc, while in healthy humans, age-associated increases in endogenous GlcNAc promote T cell senescence. Objectives and methods: An open label dose-escalation mechanistic trial of oral GlcNAc at 6 g (n = 18) and 12 g (n = 16) for 4 weeks was performed in MS patients on glatiramer acetate and not in relapse from March 2016 to December 2019 to assess changes in serum GlcNAc, lymphocyte N-glycosylation and inflammatory markers. Post-hoc analysis examined changes in serum neurofilament light chain (sNfL) as well as neurological disability via the Expanded Disability Status Scale (EDSS). Results: Prior to GlcNAc therapy, high serum levels of the inflammatory cytokines IFNγ, IL-17 and IL-6 associated with reduced baseline levels of a marker of endogenous serum GlcNAc. Oral GlcNAc therapy was safe, raised serum levels and modulated N-glycan branching in lymphocytes. Glatiramer acetate reduces TH1, TH17 and B cell activity as well as sNfL, yet the addition of oral GlcNAc dose-dependently lowered serum IFNγ, IL-17, IL-6 and NfL. Oral GlcANc also dose-dependently reduced serum levels of the anti-inflammatory cytokine IL-10, which is increased in the brain of MS patients. 30% of treated patients displayed confirmed improvement in neurological disability, with an average EDSS score decrease of 0.52 points. Conclusions: Oral GlcNAc inhibits inflammation and neurodegeneration markers in MS patients despite concurrent immunomodulation by glatiramer acetate. Blinded studies are required to investigate GlcNAc's potential to control residual brain inflammation, myelin repair and neurodegeneration in MS. [ABSTRACT FROM AUTHOR]

Urban planning for age-friendly environments is an important issue, and occupational therapists and occupational scientists could contribute to planning such environments; however, knowledge of the potential roles of occupational therapists is limited. To explore the potential roles of occupational therapists in urban planning for age-friendly environments in Japan from the perspectives of occupational therapists and stakeholders. A Q-methodology study was conducted to gain viewpoints from occupational therapists and stakeholders regarding their roles in the urban planning of age-friendly environments for older people in Japan. Participants included eight occupational therapists and seven stakeholders who completed the Q-sorting process. Three viewpoints emerged which are interpreted as roles of occupational therapists: (1) Promote older people's participation in everyday activities in their communities, (2) Advocate for older people towards policy-making to reflect their occupational needs or perspectives, and (3) Arrange neighbourhood environments towards enhancing participation in occupation through adjustments to compensate for functional limitations. Results reveal the potential roles of occupational therapists in urban planning for age-friendly environments in Japan. These roles can be a guide in the continuing professional development of occupational therapists in the fields of urban planning for older people. [ABSTRACT FROM AUTHOR]

The thrust of interprofessional education is to prepare health professions students to deliberately learn and work together with a common goal of providing better and safer care for service users. This study sought to describe the attitudes of health profession students toward interprofessional education and to identify which among the variables (i.e., sex, programme, year level, prior clinical and interprofessional education experiences, and level of moral development) are determinants of their attitudes toward interprofessional education. A total of 485 participants were surveyed using a validated, three-part Interprofessional Education-Attitude Scale (IPE-AS). No statistically significant difference was found between the attitudes toward interprofessional education and variables such as sex, prior clinical and interprofessional education experiences among medical, nursing, and pharmacy students. Our findings found that those with more agreeable attitudes toward interprofessional education were students in the medical programme, those from the lower year levels and those with higher stages of morality (based on Kohlberg's stages of moral development). This suggests that IPE must be introduced across health science curricula with an intentional profiling of students about their experiences related to learning and working with students from different programmes. Moral development, as a variable in the study, also provides information as to how it can improve IPE programmes, competencies, and experiences of students in the fields of health sciences. [ABSTRACT FROM AUTHOR]

This is the third in a series of articles exploring experiences of engaging with interprofessional education during the COVID-19 pandemic. This article focuses on experiences of emergency remote teaching from the student perspective, considering the enablers and barriers to effective learning and taking into account the logistical, technological and theoretical considerations for facilitating an authentic learning experience in line with professional standards. A global perspective of interprofessional education during lockdown is provided through case studies, providing an opportunity to benchmark against examples of best practice to ensure online interprofessional education is successful in preparing students to work within a multiprofessional, multi-agency team to provide high-quality care through effective team working. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has had a significant impact on the learning experiences of students undertaking health and social care programmes across the globe. In the UK, the Nursing and Midwifery Council introduced emergency standards for undergraduate programmes in 2020, making significant short-term changes to programme delivery. However, the mandate for all students to undertake interprofessional education remained. Interprofessional education is key to preparing students on health and social care programmes, as it enables students to work as effective members of multi-agency/multi-professional teams on qualification. It is an important element of training, as it has a direct impact on quality of care and service user experience. This series of articles will explore the experiences of 'lockdown learning' from the perspective of academics, students and service users from a global perspective in relation to the delivery of interprofessional education during the pandemic, which necessitated a wholesale move from face-to-face, blended and online learning to include emergency remote teaching. The series was written by members of the Centre for the Advancement of Interprofessional Education Research Subgroup (Interprofessional Education Experiences) and aims to identify barriers and facilitators to successful shared learning and provide suggestions for how lessons learned can be taken forward to further enhance this important element of pre-registration education. The perceptions and attitudes of academics and students on such comprehensive changes are a unique and rich data source to explore and inform future provision. [ABSTRACT FROM AUTHOR]

The drug using crisis entails participation and justice issues making it a pressing health and social concern in the Philippines today. This study explored the lived experiences of Filipinos recovering from drug addiction and sought to understand the occupational justice determinants of drug addiction to better develop substance addiction rehabilitation programs in the Philippines. Using a qualitative approach, we conducted in-depth interviews guided by the Occupational Justice Health Questionnaire to 24 participants. Data were analyzed using interpretative phenomenological analysis. We found four emerging themes: living with drugs, living around rules, living for the future, and living amidst the war on drugs. Each theme represented a "period of participation" exposing occupational injustices that activated the first enablement skill "raise consciousness of occupational injustice" from the Participatory Occupational Justice Framework. Understanding the participants' lived experiences raised consciousness of the injustices that exist before and during rehabilitation which uncovered pointers to improve local substance addiction rehabilitation programs: use of occupation-based social participation interventions, limitation of occupational therapy services due to lack of human resources reinforcing interprofessional collaboration, a participatory approach is essential in discussing and addressing injustices, and deliberate use of political activities of daily living. [ABSTRACT FROM AUTHOR]

Myelination plays an important role in cognitive development and in demyelinating diseases like multiple sclerosis (MS), where failure of remyelination promotes permanent neuro-axonal damage. Modification of cell surface receptors with branched N-glycans coordinates cell growth and differentiation by controlling glycoprotein clustering, signaling, and endocytosis. GlcNAc is a rate-limiting metabolite for N-glycan branching. Here we report that GlcNAc and N-glycan branching trigger oligodendrogenesis from precursor cells by inhibiting platelet-derived growth factor receptor-a cell endocytosis. Supplying oral GlcNAc to lactating mice drives primarymyelination in newborn pups via secretion in breast milk, whereas genetically blocking N-glycan branching markedly inhibits primary myelination. In adult mice with toxin (cuprizone)-induced demyelination, oral GlcNAc prevents neuroaxonal damage by driving myelin repair. In MS patients, endogenous serumGlcNAc levels inversely correlated with imagingmeasures of demyelination and microstructural damage. Our data identify N-glycan branching and GlcNAc as critical regulators of primary myelination and myelin repair and suggest that oral GlcNAcmay be neuroprotective in demyelinating diseases likeMS. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic, and ensuing physical distancing measures, poses challenges for researchers in the field of interprofessional care. Pandemic management has highlighted the centrality of interprofessional working to effective healthcare delivery during crises. It is essential to find ways to maintain interprofessional research that has commenced, while also designing research to capture important learning from pandemic management and response. However, it also creates opportunities for new research projects and novel research designs. This discussion paper explores ways of adapting existing research methodologies and outlines potential avenues for new research. Specifically, considerations to bear in mind when designing interprofessional research during the pandemic include research ethics and integrity, research design, data collection methods, research opportunities, implications and limitations. Interprofessional research can continue to make a valuable contribution in informing global responses to COVID-19 and in planning for future global health crises. We call for, insofar as possible, for interprofessional research to continue to be developed during this time. [ABSTRACT FROM AUTHOR]

More than the shortage of manpower, occupational therapists (OTs) in substance addiction and rehabilitation (SAR) practice have remained underused and misunderstood in the Philippines. This study aimed to identify the role of Filipino OTs in people with SUD based on the perspectives of OTs, mental health professionals, and former service users and carers in the community. Using Q-Methodology (QM), this research revealed a tripartite role for Filipino OTs in SAR: (a) "Promoter of occupational participation," (b) "Collaborator to enhance participation and well-being," and (c) "Facilitator of environmental supports for occupational participation." [ABSTRACT FROM AUTHOR]

For the past more than 50 years, the World Health Organisation has acknowledged through empirical findings that health workers that learn together work together effectively to provide the best care for their patients. This study aimed to: (1) describe the perceived extent of interprofessional education (IPE) experience among Filipino occupational therapists (OTs), physical therapists (PTs), and speech-language-pathologists (SLPs); (2) identify their attitudes towards interprofessional collaboration (IPC); and (3) compare their attitudes towards IPC according to: prior IPE experience, classification of IPE experience, profession, years of practice, and practice setting. Using a cross-sectional survey design, a two-part questionnaire was sent to Filipino OTs, PTs, and SLPs working in the Philippines via an online survey application. The first part of the survey contained eight items of demographic information and the second part contained the 14-item Attitudes Towards Health Care Teams Scale (ATHCTS). Findings revealed that among the Filipino OT, PT and SLP respondents (n = 189), 70.9% had prior experience on IPE. Moreover, the three most commonly used IPE teaching-learning strategies were case discussion (clinical setting), small group discussion, didactics, and case discussion (community setting), while the use of didactics and case discussion (community setting) yielded more agreeable attitudes towards IPC. Among the 14 items in the ATHCTS, 11 were rated with agreeability and three items with neutrality. For professional variables, only the practice setting variable yielded a statistically significant finding confirming those working in the academia to be more agreeable towards IPC compared to other settings. However, years of practice and professional background variables both yielded no statistically significant difference implying no association between years of practice and attitude towards IPC and a homogenous composition among respondents, respectively. The results of this research are to springboard IPE initiatives within Philippine higher education institutions to enable evidence-based IPC approaches in clinical practice. [ABSTRACT FROM PUBLISHER]

Patients, service users and carers are now expected to contribute to teaching health and social care students in all professions. This follows policy directives driven by a review of failings in NHS standards for patient involvement in all aspects of health and social care. Patient and carer contributions to interprofessional education hold fast to values for patient/carer-centred care. This article discusses the context to service user and carer involvement in health professions education, drawing on current evidence and with considerations for midwifery students. A case study of a well-established carer's session is presented, drawing on the input of a mother, which was continued online during the pandemic. It was ensured that this important learning was not lost when teaching became remote, relying on technology-enhanced learning methods. These adaptations depend on long-standing patient partnerships between faculty in higher education institutions and patients/carers who must feel safe and trust the teaching context where they contribute to student learning. Effective learning can be maintained in online environments to ensure the patient voice remains central to health professions training. [ABSTRACT FROM AUTHOR]

We identified evidence from item response theory (IRT) to examine a German translation of the Interprofessional Facilitation Scale (IPFS). The IPFS was administered to n = 130 mixed-health profession participants in a post-interprofessional education practicum questionnaire. We used IRT analyses to examine the following three aspects of the IPFS: (a) general factor strength, (b) subscale usability, and (c) item bias. First, findings indicate a strong, general factor underlying the IPFS that supports unidimensional interpretations. Second, findings supported IPFS overall reliability, but failed to support subscale reliabilities. Third, item bias assessment using a comparator-French sample (n = 89) indicated insubstantial differences across German and French samples. Taken together, we find sufficient evidence to support the IPFS-German translation's application in IPE contexts and unidimensional interpretations. Subscores are not advisable for interpretation, and future researchers should aim to further inspect potential item bias. [ABSTRACT FROM AUTHOR]

Interprofessional research within the contexts of education and health and social care practice has grown exponentially within the past three decades. To maintain the momentum of high-quality research, it is important that early career researchers embarking on their first research journey and new to interprofessional education or interprofessional collaborative practice feel supported in making their contribution to the field. This guide, developed by the Center for the Advancement of Interprofessional Education (CAIPE) Research Group, has been written with these groups in mind who are embarking on their first research journey, and new to the interprofessional field. It aims to raise awareness of academic resources and share practical advice from those who have previously experienced problems when undertaking interprofessional research in education or health and social care practice. [ABSTRACT FROM AUTHOR]

Assistive technology (AT) is often required to facilitate the performance of occupations and promote inclusion and reduction of dependency among persons with spinal cord injury (SCI). However, only 5-15% of individuals in developing countries have access to AT. This study is aimed at exploring the experience of Filipinos with SCI as they use AT and understand these from an occupational justice (OJ) perspective. This study utilised a hermeneutic phenomenological approach to explore the participants' experiences with AT usage. Ten participants were recruited from a hospital and communities within Metro Manila, Philippines, and interviewed last January 2020. Hermeneutic analysis was done to interpret the shared meaning embedded within their experiences and was informed by an occupational justice perspective. Exploring the experience of the participants in using AT yielded four themes, namely, (1) engaging in occupations despite limited opportunities, (2) going to various locations amidst an inaccessible environment, (3) striving towards inclusion in spite of attitudinal barriers, and (4) securing needs in light of unfavourable life conditions. Filipinos with SCI deal with numerous structural and contextual factors in daily life. There has been partial enablement of OJ as they incorporate AT in their daily lives as occupational rights are far from being recognised and respected. In infusing an OJ perspective to understanding AT use, OT practitioners are bound to identify problems and courses of action that go beyond traditional service delivery. [ABSTRACT FROM AUTHOR]

This article concludes the interprofessional education series published by the Centre for the Advancement of Interprofessional Education Research Subgroup, and considers the lessons that can be learned from experiences of emergency remote teaching during the COVID-19 pandemic. Consideration is given to the practicalities of emergency remote teaching, including its preparation, delivery and proposed outcomes of using online platforms for interprofessional education. The article is written as a guide for others to draw on and includes considerations for future delivery and sustainability of interprofessional education in midwifery practice and other fields of health and social care. [ABSTRACT FROM AUTHOR]

Therapeutic craft is a meaningful occupation used in occupational therapy. This study investigated the lived experience of clients with schizophrenia who engaged in craft activities. This qualitative study was conducted at a mental health hospital where seven participants were recruited through purposive sampling to participate in semi-structured interviews. A thematic analysis was used to process the data. Four themes emerged from the analysis: (i) sense of self and value, (ii) facilitators to occupational engagement, (iii) barriers to occupational engagement, and (iv) future hope. Experiences of clients with schizophrenia provide insight and perhaps a road map for developing holistic rehabilitation and the transition to the future. [ABSTRACT FROM AUTHOR]

This is the fourth article in a series exploring experiences of engaging with interprofessional education during the COVID-19 pandemic. Alongside students and practitioners, academics have had significant learning opportunities during the pandemic through reflecting on experiences of developing and delivering interprofessional education using emergency remote teaching. This article presents reflective accounts from academics across the UK, revealing their authentic experiences of maintaining interprofessional education within health and social care programmes during the pandemic. Personal reflective accounts provide case studies that lead to shared learning and suggestions for future interprofessional education provision. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of cholecalciferol (vitamin D3) supplementation on peripheral immune cell frequency and N‐glycan branching in patients with relapsing‐remitting multiple sclerosis (RRMS). Methods: Exploratory analysis of high‐dose (20 400 IU) and low‐dose (400 IU) vitamin D3 supplementation taken every other day of an 18‐month randomized controlled clinical trial including 38 RRMS patients on stable immunomodulatory therapy (NCT01440062). We investigated cholecalciferol treatment effects on N‐glycan branching using L‐PHA stain (phaseolus vulgaris leukoagglutinin) at 6 months and frequencies of T‐, B‐, and NK‐cell subpopulations at 12 months with flow cytometry. Results: High‐dose supplementation did not change CD3+ T cell subsets, CD19+ B cells subsets, and NK cells frequencies, except for CD8+ T regulatory cells, which were reduced in the low‐dose arm compared to the high‐dose arm at 12 months. High‐dose supplementation decreased N‐glycan branching on T and NK cells, measured as L‐PHA mean fluorescence intensity (MFI). A reduction of N‐glycan branching in B cells was not significant. In contrast, low‐dose supplementation did not affect N‐glycan branching. Changes in N‐glycan branching did not correlate with cell frequencies. Interpretation: Immunomodulatory effect of vitamin D may involve regulation of N‐glycan branching in vivo. Vitamin D3 supplementation did at large not affect the frequencies of peripheral immune cells. [ABSTRACT FROM AUTHOR]

Hashimoto’s encephalopathy (HE) is a presumed autoimmune disorder associated with anti-thyroid autoantibodies and signs and symptoms of encephalopathy. A sub-type of HE is associated with cerebellar dysfunction and ataxia. Immunosuppressive therapy, particularly corticosteroid treatment, is utilized in the majority of cases. Short-term apheresis has been reported with variable patient responses. Here we report the case of a 72 year-old female with an ∼15 year history of cerebellar type HE that had profound improvement in symptoms after long-term apheresis treatment over an ∼2 year period. Following an induction phase, twice-weekly maintenance apheresis of 1 plasma volume reversed long-standing severe gait ataxia that had required a walker, as well as mild cognitive symptoms. This paralleled reductions in anti-thyroid antibody levels. Holidays from apheresis lasting several weeks and/or reductions in maintenance apheresis frequency to once per-week resulted in re-expression of ataxia and cognitive impairments along with a rise in anti-thyroid antibody levels. An apheresis dose-effect was observed whereby parallel rise and fall in both symptomatology and antibody levels would mirror duration between apheresis intervals. To our knowledge, this is the first report of profound therapeutic benefit and a dose-response relationship to long-term apheresis in cerebellar-type HE. This case suggests that maintenance apheresis be considered in responsive patients, particularly in those with contraindications to medical immunosuppression. [ABSTRACT FROM AUTHOR]