Association between one-carbon metabolism indices and DNA methylation status in maternal and cord blood.

One-carbon metabolism is essential for multiple cellular processes and can be assessed by the concentration of folate metabolites in the blood. One-carbon metabolites serve as methyl donors that are required for epigenetic regulation. Deficiencies in these metabolites are associated with a variety of poor health outcomes, including adverse pregnancy complications. DNA methylation is known to vary with one-carbon metabolite concentration, and therefore may modulate the risk of adverse pregnancy outcomes. This study addresses changes in one-carbon indices over pregnancy and the relationship between maternal and child DNA methylation and metabolite concentrations by leveraging data from 24 mother-infant dyads. Five of the 13 metabolites measured from maternal blood and methylation levels of 993 CpG sites changed over the course of pregnancy. In dyads, maternal and fetal one-carbon concentrations were highly correlated, both early in pregnancy and at delivery. The 993 CpG sites whose methylation levels changed over pregnancy in maternal blood were also investigated for associations with metabolite concentrations in infant blood at delivery, where five CpG sites were associated with the concentration of at least one metabolite. Identification of CpG sites that change over pregnancy may result in better characterization of genes and pathways involved in maintaining a healthy, term pregnancy.

The impact of STRENGTH on the expected and actual transition to home experience.

PURPOSE: The purpose of this study was to investigate the experiences and expectations of people with stroke, during their transition from hospital to home, after participating in a novel inpatient outreach program, entitled STRENGTH. METHODS: A qualitative study was conducted using semi-structured interviews, which were undertaken at discharge and 4-6 weeks post discharge. Thematic analysis was used to code the interview transcripts. RESULTS: The study incorporated data from seven people with stroke, who had a mean age of 61 years. Thematic analysis derived two themes, each with two sub-themes. The first theme was "Hospital and home" and described clients' experiences of therapy and the hospital environment. The second theme was "Life will never be what it was before" and elaborated on the adaptations and changing expectations that clients had before and after discharge. CONCLUSIONS: People with stroke described the therapy they received in both the hospital and home as beneficial. The results support the addition of the home-based inpatient program, STRENGTH, to the current rehabilitation system, as it appeared to realign the expectations of people with stroke and better prepare them for their discharge home.

Identifying age-friendly behaviours for bus driver age-awareness training.

BACKGROUND: Occupational therapists may be involved in advocating for age-friendly bus systems and training bus drivers in age-awareness. In order to develop evidence-based bus driver age-awareness training programs, the specific required bus driver behaviours should be explicated. PURPOSE: This study aims to define, clarify, and illustrate behaviours associated with bus driver friendliness and helpfulness. METHODS: Forty older people (aged 60 and over) in Queensland, Australia, completed a round trip bus journey and subsequent interview. Qualitative content analysis of participant observations with stimulated recall interviews was used to identify categories and themes around friendly and helpful bus drivers. FINDINGS: General professional behaviours included making older people feel safe, courtesy, friendliness, helpfulness and being aware of invisible disabilities and specific professional behaviours included giving time, pulling in close to the curb, communication, and information. IMPLICATIONS: The findings are incorporated into suggestions for a bus driver age-awareness training program.

Self-identified goals and the ability to set realistic goals following acquired brain injury: a classification framework.

OBJECTIVE: To develop a framework for classifying the nature of goals identified by people with acquired brain injury (ABI) and explore the extent to which goals and the ability to set realistic goals vary over time and according to stage of recovery. METHODS: Participants included 60 people with ABI comprising two subgroups: a post-acute subgroup (n = 28, mean time since injury = 1.1 years, SD = 0.5) and a long-term subgroup (n = 32, mean time since injury = 4.9 years, SD = 3.0). Participants completed the Self-Awareness of Deficits Interview, which includes a goal-setting component, at an initial assessment and at 12-month follow-up assessment. Data generated from the interviewing process were analysed using a combination of qualitative and quantitative methods. RESULTS: Through an inductive analysis, a classification framework was developed consisting of the following goal categories: 'relationships', 'work and education', 'injury/rehabilitation', 'health and leisure', 'daily life management' and 'general life/personal goals'. Each of these categories comprised several subcategories of goals. Overall, the post-acute subgroup identified more goals in the improve function/rehabilitation subcategory than the long-term subgroup (P = 0.002), whereas the nature of other life goals remained consistent over time. The ability to set realistic goals improved over time for the entire sample (P = 0.013). CONCLUSION: The findings provide therapists with greater insight into the goals most commonly identified by individuals with ABI. The classification framework may assist therapists to elicit client goals and tailor rehabilitation accordingly.

The transition from hospital to home for individuals with acquired brain injury: a literature review and research recommendations.

PURPOSE: To review the literature relating to the transition from hospital to home for individuals with acquired brain injury (ABI) and make recommendations concerning the future direction of transition-specific research. METHOD: Relevant research articles were identified through searching existing database systems and by reviewing the reference lists of identified articles. Only articles in which the results directly related to individuals with ABI from the time of discharge to 1 year post-discharge were included in the review. RESULTS/DISCUSSION: A total of 50 articles were identified as meeting the criteria for inclusion in the review. The methodological quality of included articles was evaluated using a set of specific criteria. The articles were classified into the following categories: (i) The perspectives of individuals with ABI and their caregivers; (ii) outcomes for individuals with ABI following transition; (iii) post-discharge services; and (iv) transitional living services/programmes. The majority of articles were based on samples of individuals with stroke, typically aged over 65 years. A common theme identified in the review was that the transition from hospital to home is typically perceived as an exciting yet difficult period for individuals and their families and as such, post-discharge support is critical. CONCLUSION: Further ABI transition-specific research is necessary in order to: (i) Develop a comprehensive theoretical framework of the transition phase; and (ii) facilitate both the validation of current intervention strategies and the development of innovative/tailored intervention approaches.

Prospective memory in adults with traumatic brain injury: an analysis of perceived reasons for remembering and forgetting.

Reasons for prospective remembering and forgetting after traumatic brain injury (TBI) were investigated using Ellis' (1996) five phases of prospective memory as a framework. Participants were 38 individuals with severe TBI and 34 controls. Participants self-rated their perceived reasons for prospective remembering and forgetting using section C of the Comprehensive Assessment of Prospective Memory (CAPM). Significant others also rated participants using the same scale. Analyses were conducted to examine the effect of group membership (TBI or control) on reported reasons for prospective remembering and forgetting. Findings highlighted the TBI group's difficulties with encoding, performance interval, and execution phases of prospective remembering.

Objective and behavioural assessment of the emergence from post-traumatic amnesia (PTA).

PRIMARY OBJECTIVE: To determine the profile of resolution of typical PTA behaviours and describe new learning and improvements in self-care during PTA. RESEARCH DESIGN: Prospective longitudinal study monitoring PTA status, functional learning and behaviours on a daily basis. METHODS AND PROCEDURES: Participants were 69 inpatients with traumatic brain injury who were in PTA. PTA was assessed using the Westmead or Oxford PTA assessments. Functional learning capability was assessed using a routine set of daily tasks and behaviour was assessed using an observational checklist. Data was analysed using descriptive statistics. MAIN OUTCOMES AND RESULTS: Challenging behaviours that are typically associated with PTA, such as agitation, aggression and wandering resolved in the early stages of PTA and incidence rates of these behaviours were less than 20%. Independence in self-care and bowel and bladder continence emerged later during resolution of PTA. New learning in functional situations was demonstrated by patients in PTA. CONCLUSIONS: It is feasible to begin active rehabilitation focused on functional skills-based learning with patients in the later stages of PTA. Formal assessment of typically observed behaviours during PTA may complement memory-based PTA assessments in determining emergence from PTA.

Using occupation to facilitate self-awareness in people who have acquired brain injury: a pilot study.

BACKGROUND: Impaired self-awareness in people who have had an acquired brain injury (ABI) is a complex phenomenon that impedes rehabilitation progress and outcome. PURPOSE: This pilot study investigated the effect of an occupation-based intervention program on the self-awareness and emotional status of people after ABI. Four male adults with impaired self-awareness following ABI participated in this study. Each received a 10-week individualized program that focused on the performance of three occupations for 1 to 2 hours per week. A facilitative approach was taken, using techniques to improve self-awareness described in the literature. Repeated measures of participants'self-awareness and emotional status were taken pre- and post-intervention, and analyzed descriptively. RESULTS: Results indicated preliminary support for the effectiveness of the program in facilitating participants' self-awareness. However, consideration of baseline and follow-up data indicated a complex picture. Increased anxiety was found to accompany improvements in participants' self-awareness in all four cases. PRACTICE IMPLICATIONS: This study will assist occupational therapists with program development for clients who have had an acquired brain injury.

Prospective memory rehabilitation for adults with traumatic brain injury: a compensatory training programme.

PRIMARY OBJECTIVE: To describe a prospective memory rehabilitation programme based on a compensatory training approach and report the results of three case studies. RESEARCH DESIGN: Programme evaluation using pre- and post-intervention assessments and telephone follow-up. METHODS AND PROCEDURES: Three participants with traumatic brain injury completed 8 weeks of training with 1-2 hour individual sessions. Assessments were formal prospective memory assessment, self-report and measures of diary use. EXPERIMENTAL INTERVENTIONS: Intervention aimed to identify potential barriers, establish self-awareness of memory deficits, introduce a customized compensatory tool, a cueing system and organizational strategies. A significant other was involved in training to assist generalization. MAIN OUTCOMES AND RESULTS: All three participants improved on formal prospective memory assessment and demonstrated successful diary use after the programme. Self-report of prospective memory failure fluctuated and may reflect increased self-awareness. CONCLUSION: A compensatory approach may be useful in improving prospective memory performance following TBI.

Behavioral responses to tactile stimuli in children with cerebral palsy.

Children with cerebral palsy often have difficulty processing tactile information. Assessment of tactile processing in children with cerebral palsy frequently relies on the use of informal clinical observations, checklists, and sensory histories without established psychometric properties. It is proposed that a formal approach to the assessment of behavioral responses to tactile stimuli will provide a better understanding of the tactile processing of children with cerebral palsy. This approach also has potential to assist with the development of intervention strategies and the evaluation of progress. The purposes of this article are to review the literature on the tactile processing difficulties of children with cerebral palsy, examine the suitability of existing assessments of tactile processing for children with cerebral palsy, and provide a rationale for a new assessment tool being developed by the authors.

Self-awareness of prospective memory failure in adults with traumatic brain injury.

The frequency of prospective memory failure in individuals with severe traumatic brain injury (TBI) was investigated by comparison with a non-brain-injured control group. Self-awareness of prospective memory function was also assessed by comparing self-ratings with ratings by significant others. Study participants included 33 individuals with severe TBI and 29 non-brain-injured persons. Each participant nominated a close friend or relative who completed the informant's version of the questionnaire. Participants and their significant others both rated the participants' frequency of prospective memory lapses using the Comprehensive Assessment of Prospective Memory (CAPM). An independent groups design was adopted to compare the TBI and control groups. No significant difference was found between the TBI and control participants' self-ratings of frequency of prospective memory failure, but ratings by significant others were significantly different. The TBI group demonstrated less self-awareness (i.e. underestimated the frequency of prospective memory failure compared to significant others) than the control group.