Astley Ainslie Hospital

Birth defects are emerging as the one of the leading causes of infant death worldwide. Their epidemiological investigation was prompted by the recognition of congenital rubella syndrome and of thalidomide-related phocomelia. Pediatric surgeons require sound data on birth defects as a baseline for reporting their own outcomes. Hence, birth defects data are the foundation for quality control and improvement in neonatal surgery. However, meaningful epidemiological studies of birth defects are often challenged practically by limited resources and dispersed populations, as well as scientifically by prioritization of reductionist genetic investigations. Instead, it may be more helpful to see birth defects as complex systems problems, similar to surgical errors. Accordingly, a better understanding of birth defects may require pediatric surgeons equipped with training in statistics, modeling and complex dynamic systems, rather than the current popularity for molecular biology approaches. Finally, birth defects are sensitive to widely different influences ranging from assisted reproduction technology to climate change. Thus, for a greater number of population health issues, birth defects may provide an early warning signal that can only be tracked with appropriate epidemiological measurements. The COVID-19 pandemic only emphasizes this need for investment in public health and the science of populations.

BackgroundPeople with functional neurological disorder (FND) are commonly seen by occupational therapists; however, there are limited descriptions in the literature about the type of interventions that are likely to be helpful. This document aims to address this issue by providing consensus recommendations for occupational therapy assessment and intervention.MethodsThe recommendations were developed in four stages. Stage 1: an invitation was sent to occupational therapists with expertise in FND in different countries to complete two surveys exploring their opinions regarding best practice for assessment and interventions for FND. Stage 2: a face-to-face meeting of multidisciplinary clinical experts in FND discussed and debated the data from stage 1, aiming to achieve consensus on each issue. Stage 3: recommendations based on the meeting were drafted. Stage 4: successive drafts of recommendations were circulated among the multidisciplinary group until consensus was achieved.ResultsWe recommend that occupational therapy treatment for FND is based on a biopsychosocial aetiological framework. Education, rehabilitation within functional activity and the use of taught self-management strategies are central to occupational therapy intervention for FND. Several aspects of occupational therapy for FND are distinct from therapy for other neurological conditions. Examples to illustrate the recommendations are included within this document.ConclusionsOccupational therapists have an integral role in the multidisciplinary management of people with FND. This document forms a starting point for research aiming to develop evidence-based occupational therapy interventions for people with FND.

Purpose: To profile and compare the seating and powered characteristics and functions of electrically powered wheelchairs (EPWs) in a general user population including equipment costs.Method: Case notes of adult EPW users of a regional NHS service were reviewed retrospectively. Seating equipment complexity and type were categorized using the Edinburgh classification. Powered characteristics and functions, including control device type, were recorded.Results: 482 cases were included; 53.9% female; mean duration EPW use 8.1 years (SD 7.4); rear wheel drive 88.0%; hand joystick 94.8%. Seating complexity: low 73.2%, medium 18.0%, high 8.7%. Most prevalent diagnoses: multiple sclerosis (MS) 25.3%, cerebral palsy (CP) 18.7%, muscular dystrophy (8.5%). Compared to CP users, MS users were significantly older at first use, less experienced, more likely to have mid-wheel drive and less complex seating. Additional costs for muscular dystrophy and spinal cord injury users were 3–4 times stroke users.Conclusions: This is the first large study of a general EPW user population using a seating classification. Significant differences were found between diagnostic groups; nevertheless, there was also high diversity within each group. The differences in provision and the equipment costs across diagnostic groups can be used to improve service planning.Implications for RehabilitationAt a service planning level, knowledge of a population’s diagnostic group and age distribution can be used to inform decisions about the number of required EPWs and equipment costs.At a user level, purchasing decisions about powered characteristics and functions of EPWs and specialised seating equipment need to be taken on a case by case basis because of the diversity of users’ needs within diagnostic groups.The additional equipment costs for SCI and MD users are several times those of stroke users and add between 60 and 70% of the cost of basic provision.

Levels of physical activity after stroke are low, despite multiple health benefits. We explored stroke survivors' perceived barriers, motivators, self-efficacy and intention to physical activity. Fifty independently mobile stroke survivors were recruited prior to hospital discharge. Participants rated nine possible motivators and four possible barriers based on the Mutrie Scale, as having 'no influence', 'some influence' or 'a major influence' on physical activity. Participants also rated their self-efficacy and intention to increasing walking. The most common motivator was 'physical activity is good for health' [34 (68%)]. The most common barrier was 'feeling too tired' [24 (48%)]. Intention and self-efficacy were high. Self-efficacy was graded as either 4 or 5 (highly confident) on a five-point scale by [34 (68%)] participants, while 42 (84%) 'strongly agreed' or 'agreed' that they intended to increase their walking. Participants felt capable of increasing physical activity but fatigue was often perceived as a barrier to physical activity. This needs to be considered when encouraging stroke survivors to be more active.

The Heart Manual (HM) NHS Lothian, UK’s leading home-based cardiac rehabilitation programme. In collaboration with e-health experts, patients and health professionals an innovative digital version of the original programme was developed and further refined using input and expertise of cardiac rehabilitation patient graduates and health professionals. Usage was monitored, and usability and accessibility assessed. Participants fed back over a number of iterations of the resource. The evaluation has highlighted the perceived user-friendliness of the HM digital format and its effectiveness in delivering the key messages of the programme. It also flagged several areas for further modification of the resource. Our pilot project has emphasised the value of employing a user-centred approach when developing and improving web based interventions. Such approach should result in better matched interventions which will maximise patients’ engagement and received benefits.

Research indicates that service utilization rates in migrant groups are low, although levels of distress appear high when compared with host populations. This paper systematically reviews quantitative and qualitative literature on factors associated with attitudes toward seeking psychological help among working age migrants. Data were extracted from MEDLINE, EMBASE, PsycINFO, Science Direct and SAGE databases. Eight quantitative studies and 16 qualitative studies met the inclusion and exclusion criteria. The majority of studies were conducted in North America (67%). Although results of quantitative studies were heterogeneous, stronger identification with host than heritage culture, fluency in host country language, psychological attributions of distress, higher educational levels, higher socioeconomic status, female gender, and older age were associated with more favourable attitudes toward help-seeking in some migrant groups. Three major themes emerged from the qualitative literature: logistical barriers, cultural mismatch between service providers and participants, and preferences for other sources of assistance.