Neurodivergent occupations are ways of living and embodying life that speaks true for their neurotype. Examples include autistic play, ADHDer concepts of attention, and sensory processing differences. Though the neurodiversity movement is beginning to infiltrate health care services, neurodiversity-affirming practices within occupational therapy remains lacking. Neurodivergent occupations continue to be pathologized within occupational therapy, evident within the profession’s education, and all aspects of the occupational therapy process, such as assessment, treatment, and outcomes. Neurotypicality remains to be the benchmark for functioning within occupational therapy, much of which is secondary to the dominating medical model of disability and ableism proliferating the profession. These factors lead to OTPs creating occupational marginalization when attempting to support neurodivergent individuals, with neurodivergent OTPs pleading for the profession to reflect and modify current conceptualizations of occupational therapy. The proposed program, Embracing Neurodivergent Occupations, aims to answer this call. Embracing Neurodivergent Occupations is a knowledge translation tool incorporating tenets of disability justice, community-defined evidence practice, and lived-experience informed practice. The program intends to be an example of community-based participatory research (CBPR), with the program’s creation incorporating neurodivergent OTPs, scholars, and advocates from around the world for a holistic view on neurodivergent ways of living. Components of the Embracing Neurodivergent Occupations will include: (a) the first neurodiversity-affirming occupational therapy model (EMPOWER Model), (b) conversations on models of disablement and rehabilitation, (c) health and well-being priorities designated by autistic individuals, (d) steps for completing neurodiversity-affirming evaluations, (e) neurodiversity-affirming service and practitioner characteristics, and (f) a grading of commonly utilized occupational therapy programs and resources and their level of being neurodiversity-affirming. Embracing Neurodivergent Occupations has three phases: (1) an introductory workshop with OTPs within this author’s current work setting, (2) a website translating the program into a multimedia resource hub, and (3) morphing the introductory workshop into online modules. Embracing Neurodivergent Occupations aspires to support the profession’s ability to be anti-ableist, provide neurodiversity-affirming services through all aspects of the occupational therapy process, and ultimately empower neurodivergent occupational participation and well-being.

<p>  </p> <p>Maternal and infant health continues to be a compelling and urgent topic in the United States with prenatal care at its forefront for prevention of adverse outcomes. This study explored differences in adverse infant birth outcomes (i.e., preterm birth, low birthweight, and NICU stays) and postpartum maternal wellbeing outcomes (i.e., social support, depression, and confidence) related to the sociodemographic and baseline factors of mothers and their prenatal care experiences. </p> <p>Data was analyzed from the publicly available <em>Listening to Mothers III </em>dataset. Comprised of 2400 online-survey participants who gave birth to singleton infants in U.S. hospitals between 2011 and 2012. Structural equation modeling was employed with FIML to account for missing data. The model examined mediators of prenatal care (i.e., responsive provider behavior, week of first visit, duration of visits, group prenatal care; GPC) between maternal predictors and outcomes.</p> <p>Of infants in the sample, 8% were born preterm, 8% were born low birthweight, and 18% were admitted into the NICU. Depression and smoking during pregnancy, as well as participating in GPC, resulted in 15%, 20% and 18% greater proportions of infant NICU stays, respectively. For postpartum maternal wellbeing, participating in GPC increased the proportion of maternal confidence by 18%. Mothers who received responsive provider behavior had higher rates of social support (<em>b </em>= 0.28, <em>p </em>< .001), reported less depression (<em>b </em>= -0.19, <em>p </em>< .001), and felt more confident (<em>b </em>= 0.07, <em>p </em>= .02). </p> <p>Findings from this study suggest that the most impactful actions for prenatal care providers to take would be to provide increased support to mothers who identify as needing treatment for depression or smoking during pregnancy to best improve infant health through fewer admissions into the NICU, and to continue to bolster the responsiveness in which providers interact with patients to improve overall postpartum maternal wellbeing. </p>

Yes / Digital health twins (DHTs) have been evolving with their diverse applications in medicine, specifically in older care settings, with the increasing demands of older adults. DHTs have already contributed to improving the quality of dementia and trauma care, cardiac treatment, and health care services for older individuals. Despite its many benefits, the optimum implementation of DHTs has faced several challenges associated with ethical issues, quality of care, management and leadership, and design considerations in older care settings. Since the need for such care is continuously rising and there is evident potential for DHTs to meet those needs, this review aims to map key concepts to address the gaps in the research knowledge to improve DHT implementation. The review aims to compile and synthesize the best available evidence regarding the problems encountered by older adults and care providers associated with the application of DHTs. The synthesis will collate the evidence of the issues associated with quality of care, the ethical implications of DHTs, and the strategies undertaken to overcome those challenges in older care settings. The review will follow the Joanna Briggs Institute (JBI) methodology. The published studies will be searched through CINAHL, MEDLINE, JBI, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. Studies published in English from 2002 will be considered. This review will include studies of older individuals (aged 65 years or older) undergoing care delivery associated with DHTs and their respective care providers. The concept will include the application of the technology, and the context will involve studies based on the older care setting. A broad scope of evidence, including quantitative, qualitative, text and opinion studies, will be considered. A total of 2 independent reviewers will screen the titles and abstracts and then review the full text. Data will be extracted from the included studies using a data extraction tool developed for this study. The results will be presented in a PRISMA-ScR (Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews) flow diagram. A draft charting table will be developed as a data extraction tool. The results will be presented as a "map" of the data in a logical, diagrammatic, or tabular form in a descriptive format. The evidence synthesis is expected to uncover the shreds of evidence required to address the ethical and care quality-related challenges associated with applying DHTs. A synthesis of various strategies used to overcome identified challenges will provide more prospects for adopting them elsewhere and create a resource allocation model for older individuals. DERR1-10.2196/51153. / A publishing grant has been received from Linnaeus University as part of the University Library’s research support.

Yes / Laying claim to highest attainable standard of health is a human right. Support for this right is provided by the United Nations Declaration of Human Rights (United Nations [UN], 1948) and a small number of legally binding international treaties. Among the most important of these for health are the International Covenant on Economic, Social, and Cultural Rights (ICESCR) (UN, 1966a) and the Convention on the Rights of the Child (CRC) (UN, 1989). Both these human rights treaties are legally binding for those countries that have ratified them. The ICESCR, in particular, articulates a comprehensive view of the obligations of state members of the United Nations (UN) to respect, protect and fulfil the right to the enjoyment of the highest attainable standard of physical and mental health – known as ‘the right to health’. It provides for both freedoms, such as the right to be free from non-consensual and uninformed medical treatment, medical experimentation, or forced HIV testing, as well as entitlements. These entitlements include the right to a system of protection on an equal basis for all, a system of prevention, treatments and control of disease, access to essential medicines, and services for sexual and reproductive health; and access to information and education about health for everyone. The Committee on Economic, Social, and Cultural Rights (ECSCR) monitors compliance with these provisions. Most states have ratified the ICESCR, and all but two (Somalia and the US) have ratified the CRC.

Counselors are called to address barriers to human growth and development through advocacy (ACA, 2014), such as those posed by inequitable health care access for socially disadvantaged groups (CDC, 2013; IOM, 2011). Health care contributes to positive health outcomes (Healthy People 2020) and is therefore an important component of advancing health equity among marginalized populations, such as older sexual minority women (SMW) with disabilities. Despite evidence of disparate health care access and health outcomes, no research to date has explored the health needs or health care experiences of disabled older SMW. This study therefore sought to address this gap in the literature by: identifying current levels of health care access and barriers among older SMW with disabilities; exploring predictors of health care access among older SMW with disabilities; and identifying protective factors, such as social support and resilience, that moderate the relationship between health care access barriers and health outcomes. Results obtained from a sample of 208 respondents provided baseline data about health care access and barriers among older SMW with disabilities. Generally, respondents had a place to receive health care, but few had access LGBTQIA+-specific health services despite indicating that this type of health care was important to them. Only about half had accessed mental health services in the last six months, and people who had accessed mental health care perceived it to be easier to access than people who had not. Respondents most highly endorsed external barriers related to cost of health care, and they reported higher health care stereotype threat related to age and disability compared to gender and sexuality. External barriers to health care were predictive of most health care access indicators (e.g., utilization of general and specific health services, as well as health outcomes). Among internal barriers, sexuality- and disability-related health care stereotype threat emerged as predictors of health care access and health outcomes respectively. Similarly, acceptability of health services, accessibility of health services, and affordability of health services were specific external barrier categories that appeared to influence health care access and outcomes among older SMW with disabilities. Neither resilience nor social support moderated the relationship of external access barriers to physical or mental health outcomes. However, resilience had a significant independent relationship with physical health outcomes, and both resilience and social support had significant independent relationships with mental health outcomes. These findings illustrate the structural factors related to health care access and outcomes for older SMW with disabilities, as posited by health equity frameworks (Braveman, 2014). The most influential internal barriers related to health care stereotype threat, which may develop in response to minority stressors specific to health care settings. The findings of this study support lifespan perspectives on LGBTQIA+ health (Fredriksen-Goldsen, Simoni et al., 2014), as well as minority stress processes (Meyer, 2003), as frameworks for understanding LGBTQIA+ health in later life. Implications for counselors, counselor educators, community organizations, and policies are discussed. / Doctor of Philosophy / LGBTQIA+ older adults are at increased risk of negative health outcomes, but helping professions have limited resources for understanding their health care needs at present. Because nearly half of older sexual minority women (SMW) have disabilities, this study examined health care access and outcomes among older SMW with disabilities. This is relevant to counseling given the field's focus on social justice, advocacy, and equity, as well as the interconnected nature of physical and mental health. Across different ways of measuring health care access, external barriers related to health care systems and societal injustice were related to whether older SMW with disabilities could access health care. Health care stereotype threat, or internalized stigma related to experiences in health care, predicted health care access and health among disabled older SMW as well. These findings suggest that poor health care utilization and poorer health outcomes among older SMW with disabilities are the result of structural oppression rather than individual choices, which requires systemic interventions to correct. More research is needed to determine how counselors and other helping professionals can enhance strengths to support health among older SMW with disabilities.

Bakgrund: Folkhälsan i Sverige blir allt bättre men trots detta ökar skillnaderna i hälsa mellan olika grupper. En individs hälsa i ungdomsåren påverkar hälsan resten av livet och detta är en av anledningarna att folkhälsoinsatser är prioriterade till barn och ungdomar. En individs livskvalitet förändras beroende på olika faktorer runtomkring. För att undersöka ungdomars livskvalitet krävs det att mätinstrumenten som används är validerade till målgruppen. Syfte: Studien syftar dels till att psykometriskt utvärdera och anpassa mätinstrumentet Minneapolis-Manchester Quality of Life Instrument – Adolescent Form (MMQL) till en svensk ungdomspopulation, dels till att beskriva livskvaliteten bland unga och analysera ojämlikheter utifrån klassiska bakgrundsfaktorer. Metod: En kvantitativ ansats med tvärsnittsdesign användes i studien. Datamaterial från Liv och Hälsa Ung 2014 användes och avgränsades till årskurs 9 på grundskolan och årskurs 2 på gymnasiet i Västerås. Resultat: Faktoranalysen resulterade i en modell av mätinstrumentet MMQL bestående av sju faktorer innehållande 33 frågor. Den interna reliabiliteten av instrumentet undersöktes genom Cronbach’s Alpha vilket visade goda resultat. Ungdomarnas hälsorelaterade livskvalitet är generellt sett god och i nivå med vad andra internationella studier visat. Dock finns det betydande skillnader mellan grupper; tjejer har sämre livskvalitet än killar, de äldre ungdomarna sämre än de yngre och de med låg familjeekonomi har sämre livskvalitet än de med hög familjeekonomi. Slutsats: Den anpassade versionen av MMQL visade goda psykometriska egenskaper i en svensk ungdomskontext. Ungdomarnas livskvalitet är god och i nivå med andra internationella studier men fördelningen av livskvalitet är inte jämlik. / Background: Public health in Sweden is getting better, however, there are increasing differences in health between different groups of society. An individual’s health during adolescence continuously affects the health for life and is one reason why public health interventions are prioritized among children and adolescents. An individual’s quality of life change depending on various factors, which contributes to a better or worse quality of life. To examine young people’s quality of life it requires that the instrument that is being used is validated to the targets group. Aim: The study aims to both evaluate the psychometric properties and adapt the Minneapolis-Manchester Quality of Life Instrument – Adolescent Form (MMQL) instrument to a Swedish youth population, as well as to describe the quality of life amongst young people and analyzes inequalities based on classical background factors. Method: A quantitative approach to the cross-sectional design was used in the study. Data and material from Liv och Hälsa Ung 2014 was used but restricted to the 9th grade in elementary school and grade 2 in upper secondary schools in Västerås. Results: The factor analysis resulted in a 7-factor model of the measure instrument MMQL containing 33 questions. The internal reliability of the instrument was assessed by Cronbach’s Alpha, which showed good results. In regards to the distribution of health-related quality of life statistically significant differences were found between genders as well as between age groups. Conclusion: The customized version of MMQL showed good psychometric properties in the context of Swedish youth. Young people’s quality of life in Västerås is good and on par with other international studies, however, the distribution of quality of life is not equal.

Objetivo: Descrever o comportamento da tuberculose (TB) na comunidade boliviana residente em quatro distritos do município de São Paulo (MSP), Belém, Bom Retiro, Brás e Pari, no período de 1998 a 2008, analisar seu possível impacto na tendência dessa doença e investigar possíveis disparidades em relação ao acesso aos serviços e na qualidade do atendimento entre bolivianos e brasileiros. Metodologia: Estudo descritivo de casos notificados de TB entre migrantes bolivianos. Os dados foram obtidos junto à vigilância da TB do MSP. As variáveis de interesse foram: características sócio-demográficas, aspectos diagnósticos, clínicos e terapêuticos, comportamentais, co-morbidades e indicadores de acesso aos serviços e de qualidade do atendimento. A análise foi efetuada comparando a as variáveis de interesse entre pacientes de nacionalidade boliviana e brasileira residentes nos mesmos distritos. Para a comparação de proporções aplicamos o teste do qui-quadrado ou teste exato de Fisher e para médias o teste de Kruskal-Wallis. Resultados: Foram notificados 2434 casos de TB nos distritos estudados, dos quais 67,5 %, 30,4% e 2,1% eram, respectivamente de nacionalidade brasileira, boliviana e outras; a participação boliviana foi crescente no período, elevando-se de 15% para 53% dos casos; observando-se uma queda de 43,5% no número absoluto de casos entre os brasileiros e um incremento de 250% entre bolivianos. A incidência na área de estudo em 2008 era 3,5 vezes maior do que a verificada, em média, no MSP. Comparados aos brasileiros os bolivianos eram mais jovens (média: 26 versus 39 anos; p<=0,0001) e a prevalência de desemprego entre eles era mais baixa (2,4% versus 10,4%; p<0,0001). Para o período de 2006 a 2008, os bolivianos apresentam taxas mais elevada de cura (70,9% versus 62,1%; p<0,001) e de tratamento supervisionado (81,9% versus 62,2%; p<0,001) e menores de história de TB no passado (6,9% versus 16,9%; p<0,0001), abandono de tratamento (16,9% versus 22,4%; p<0,001), de letalidade por TB (1,6% versus 4,8%; p<0,001) e de recidiva (4,9% versus 9,2%; p<0,001). A prevalência de co-morbidades era mais baixa entre bolivianos. Em torno de 88% dos casos de ambas as nacionalidades o diagnóstico e o tratamento foi efetuado em serviços públicos de saúde. Conclusão: A TB mostrou-se um relevante problema entre bolivianos, contribuído para a manutenção de elevada incidência na área de estudo, justificando estratégias específicas de intervenção. Os resultados sugerem que o cumprimento das diretrizes do Sistema Único de Saúde, de acesso universal aos serviços constitui instrumento efetivo de promoção da equidade em saúde. / Objective: Describing the tuberculosis in the bolivian community resident in the districts of Belém, Bom Retiro, Bras and Pari, located in the municipality of São Paulo (MSP), in the period 1998 to 2008, analyze its possible difference in relation to access services and quality of health care among bolivians and brazilians. Methods: Descriptive study of notified cases of TB among bolivian immigrants. The data are obtained from the TB surveillance of the MSP. The variables of interest were socio-demographic characteristics, diagnostic aspects, clinical and therapeutical, behavioral, comorbidities and indicators of access to services and quality of care. The analysis was performed comparing the variables between bolivians and brazilians patients residing in the same districts. For comparison of proportion was applied the chi-square test or Fisher exact test and for means the Kruskal-Wallis test. Results: Were reported 2434 TB cases in districts studied, whom 67,5%, 30,4% e 2,1% were respectively brazilians, bolivians and others nationalities; the bolivian participation increased in the period, rise from 15% to 53% of all cases, observing a drop of 43,5% in the absolute numbers of cases among the brazilians and a increase of 250% among bolivians. The incidence in study area in 2008 was 3,5 times greater than that seen on average in MSP. Compared to brazilians, bolivians were younger (mean: 26 versus 39 years, p=0.0001 and the prevalence of unemployment was lowest (2,4% versus 10,4%, p<0,0001. In 2006 to 2008, bolivians have higher rates of cure (70,9 versus 62,1%, p<0,001) and supervised treatment (81,9% versus 62,2%), and lower rates of TB in past (6,9% versus 16,9%, p<0,0001), neglect (16,9 % versus 22,4%, p<0,001), TB mortality (1,6% versus 4,8%, p<0,001) and relapse (4,9% versus 9,2%, p<0,001). The prevalence of comorbidities was lower among bolivians. Around 88% of cases of both nationalities the diagnosis and treatement was done in public health services. Conclusions: The TB is significant problem among bolivians, contributing to the maintenance of high incidence in the study area, justifying specific strategies of intervention. The results suggest that compliance with the guidelines of Sistema Único de Saude of universal access to services is an effective instrument for promoting equity in health.

Despite increased access to care and interventions aimed to change health behavior, socioeconomic health disparities have remained unchanged, even for preventable illness and disease. Health behavior theories and interventions heavily rely on perceptions of control over one's fate and thus ignore populations with low perceptions of personal control. Poverty is associated with an external locus of control (LOC), while both poverty and external LOC are associated with less health protective behavior. The purpose of this quantitative study was to explore the role of LOC as an adaptive response to poverty and to discover the risks and benefits to physical and psychological health associated with LOC orientation. Using cross-sectional survey methodology, 136 adult participants from the United States were recruited through snowball sampling to anonymously complete measures of the Multidimensional Locus of Control (MLOC), the Health Promoting Lifestyles II (LPII), the Kessler Psychological Distress Scale (KP10), and a demographic questionnaire. Hierarchical regression and bivariate analyses were used to test the hypotheses. According to the study findings, chance LOC mediated the relationship between socioeconomics and health lifestyles, while external-chance was associated with less healthy lifestyle choices than external-powerful others. Internality did not offer any psychological protections from anxiety and depression for low socioeconomic populations. Implications for social change are to further the understanding of the role of perceived control on health beliefs, behavior and psychological well-being for marginalized populations to promote the development of appropriately targeted, culturally sensitive health interventions.

No description available.

Objetivo: Descrever o comportamento da tuberculose (TB) na comunidade boliviana residente em quatro distritos do município de São Paulo (MSP), Belém, Bom Retiro, Brás e Pari, no período de 1998 a 2008, analisar seu possível impacto na tendência dessa doença e investigar possíveis disparidades em relação ao acesso aos serviços e na qualidade do atendimento entre bolivianos e brasileiros. Metodologia: Estudo descritivo de casos notificados de TB entre migrantes bolivianos. Os dados foram obtidos junto à vigilância da TB do MSP. As variáveis de interesse foram: características sócio-demográficas, aspectos diagnósticos, clínicos e terapêuticos, comportamentais, co-morbidades e indicadores de acesso aos serviços e de qualidade do atendimento. A análise foi efetuada comparando a as variáveis de interesse entre pacientes de nacionalidade boliviana e brasileira residentes nos mesmos distritos. Para a comparação de proporções aplicamos o teste do qui-quadrado ou teste exato de Fisher e para médias o teste de Kruskal-Wallis. Resultados: Foram notificados 2434 casos de TB nos distritos estudados, dos quais 67,5 %, 30,4% e 2,1% eram, respectivamente de nacionalidade brasileira, boliviana e outras; a participação boliviana foi crescente no período, elevando-se de 15% para 53% dos casos; observando-se uma queda de 43,5% no número absoluto de casos entre os brasileiros e um incremento de 250% entre bolivianos. A incidência na área de estudo em 2008 era 3,5 vezes maior do que a verificada, em média, no MSP. Comparados aos brasileiros os bolivianos eram mais jovens (média: 26 versus 39 anos; p<=0,0001) e a prevalência de desemprego entre eles era mais baixa (2,4% versus 10,4%; p<0,0001). Para o período de 2006 a 2008, os bolivianos apresentam taxas mais elevada de cura (70,9% versus 62,1%; p<0,001) e de tratamento supervisionado (81,9% versus 62,2%; p<0,001) e menores de história de TB no passado (6,9% versus 16,9%; p<0,0001), abandono de tratamento (16,9% versus 22,4%; p<0,001), de letalidade por TB (1,6% versus 4,8%; p<0,001) e de recidiva (4,9% versus 9,2%; p<0,001). A prevalência de co-morbidades era mais baixa entre bolivianos. Em torno de 88% dos casos de ambas as nacionalidades o diagnóstico e o tratamento foi efetuado em serviços públicos de saúde. Conclusão: A TB mostrou-se um relevante problema entre bolivianos, contribuído para a manutenção de elevada incidência na área de estudo, justificando estratégias específicas de intervenção. Os resultados sugerem que o cumprimento das diretrizes do Sistema Único de Saúde, de acesso universal aos serviços constitui instrumento efetivo de promoção da equidade em saúde. / Objective: Describing the tuberculosis in the bolivian community resident in the districts of Belém, Bom Retiro, Bras and Pari, located in the municipality of São Paulo (MSP), in the period 1998 to 2008, analyze its possible difference in relation to access services and quality of health care among bolivians and brazilians. Methods: Descriptive study of notified cases of TB among bolivian immigrants. The data are obtained from the TB surveillance of the MSP. The variables of interest were socio-demographic characteristics, diagnostic aspects, clinical and therapeutical, behavioral, comorbidities and indicators of access to services and quality of care. The analysis was performed comparing the variables between bolivians and brazilians patients residing in the same districts. For comparison of proportion was applied the chi-square test or Fisher exact test and for means the Kruskal-Wallis test. Results: Were reported 2434 TB cases in districts studied, whom 67,5%, 30,4% e 2,1% were respectively brazilians, bolivians and others nationalities; the bolivian participation increased in the period, rise from 15% to 53% of all cases, observing a drop of 43,5% in the absolute numbers of cases among the brazilians and a increase of 250% among bolivians. The incidence in study area in 2008 was 3,5 times greater than that seen on average in MSP. Compared to brazilians, bolivians were younger (mean: 26 versus 39 years, p=0.0001 and the prevalence of unemployment was lowest (2,4% versus 10,4%, p<0,0001. In 2006 to 2008, bolivians have higher rates of cure (70,9 versus 62,1%, p<0,001) and supervised treatment (81,9% versus 62,2%), and lower rates of TB in past (6,9% versus 16,9%, p<0,0001), neglect (16,9 % versus 22,4%, p<0,001), TB mortality (1,6% versus 4,8%, p<0,001) and relapse (4,9% versus 9,2%, p<0,001). The prevalence of comorbidities was lower among bolivians. Around 88% of cases of both nationalities the diagnosis and treatement was done in public health services. Conclusions: The TB is significant problem among bolivians, contributing to the maintenance of high incidence in the study area, justifying specific strategies of intervention. The results suggest that compliance with the guidelines of Sistema Único de Saude of universal access to services is an effective instrument for promoting equity in health.