Yoga has been studied extensively in school settings, including many randomized controlled trials that suggest a range of benefits for healthy adolescents. Yet these studies face practical methodological challenges, including how to randomly assign children in school. The purpose of this study was to conduct a methodologically rigorous systematic review of school-based yoga interventions with random assignment of healthy adolescents. We incorporated a risk of bias measure to consider the trustworthiness of each study, with a detailed focus on the risk of bias in five domains and an overall classification of risk (high, medium, or low). An electronic database search was conducted for studies published between 2014 and 2024, including CINAHL, PsychNet, PubMed, Science Direct, and Scopus. Randomized trials that provided yoga-based interventions for 10–18-year-old individuals in a school-based setting were included. The search identified 1018 studies, of which 20 met the inclusion criteria and were reviewed. All 20 studies were deemed to entail a high overall risk of bias. Common methodological problems included randomizing by classroom but with a small number of groups, measuring multiple outcomes with limited details about whether the measures would be sensitive to intervention effects, and reporting incomplete or selected results that favored yoga. Better study designs are discussed, focusing on study designs that are feasible with limited budgets. Until well-designed yoga programs are implemented in school settings, it continues to be difficult to find statistically significant results that do not also entail a high risk of bias that impairs the study’s trustworthiness.

Department of Occupational Therapy, Clarkson University, Potsdam, NY, United States Corresponding author. Address: Department of Occupational Therapy, Clarkson University, 8 Clarkson Ave, Potsdam, NY 13699, United States. Tel.: 315-268-4436; fax: 315-268-7743. E-mail address: [email protected] (D. Schelly). Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Received June 10, 2021 Received in revised form October 29, 2021 Accepted November 30, 2021

Purpose: The purpose of this study was to explore the impact of food allergy (FA) on the daily lives of young adults who recently transitioned to attending college away from home. Design and Methods: We conducted in-depth qualitative interviews using a grounded theory approach to data collection, data analysis, and theory development. For recruitment, we posted a flier on a FA Facebook group and reposted approximately monthly for one year. We completed and recorded 16 interviews that ranged in duration from 30 to 90 min. The interviews were transcribed, coded, and analyzed with the intention of developing mid-range theory. Results: Several interrelated themes were identified during the analytical process, including hypervigilance, misunderstood risk, and stigma management. Notably, a series of cascading effects eventually lead to what we call “disclosure fatigue,” where students with FA tire of talking about their invisible disability with people who misunderstand it, and they eventually develop strategies to avoid conversations. The consequences include a narrowing of social networks and activities and even risky food behaviors. Conclusions: Research is needed in other settings, for other conditions, to consider and ameliorate the negative health consequences associated with disclosure fatigue. Practice Implications: In addition to focusing on physical aspects of FA, including avoiding exposure, healthcare practitioners in pediatric settings should emphasize social aspects of FA that gain influence during the transition out of high school and away from home. Disclosure fatigue provides one explanation for why individuals with FA may choose to ignore best practices and engage in risky food behaviors.

It is still possible that “Lifestyle Redesign” prevents agerelated declines, but Well Elderly studies have traditionally relied on a crossover design, where the control group receives treatment after the treatment group’s treatment has ended. Thus, there is no way to continue comparing the two groups over time. Of course, it is difficult to recruit participants if they have a 50% chance of receiving no treatment (as opposed to receiving it later). Future research should randomise participants into two treatments: one-on-one occupational therapy treatment in one group, and group sessions and community outings in the other, with objective measures of health repeated over many years. References

Introduction This report uses a present day global pandemic as a case study of health inequities that are best understood by considering the role of time and place. Method I provide a historical overview of Milwaukee, Wisconsin-one of the most segregated cities in the U.S.-to consider prior health disparities and social conditions. I then focus on COVID-19, tracking the monthly census tract distribution of cases for 6 months, including case and mortality data by race and class. Results As expected, Black and Hispanic majority census tracts are the most affected by COVID-19, with some communities experiencing nearly 1 positive case per 10 residents. In previous years, Blacks and Hispanics provided approximately 27% and 3% of the shares of "natural" deaths, respectively; their shares of COVID-19 deaths in the first 6 months of the pandemic were approximately 35% and 13%. On the contrary, the share of natural deaths for whites was approximately 65% in previous years and dropped to 47% for COVID-19 deaths. The average ages of COVID-19 deaths were 72.5 for Blacks, 61.3 for Hispanics, and 79.9 for whites. Conclusion The disparities in COVID-19 outcomes in Milwaukee cannot be separated from historical forces, including race-based politics that intensified during the Great Migration of African Americans from the Jim Crow South. The paper concludes by returning to the turn of the 19th century with a historical snapshot of Jane Addams, who lived a short distance south, in a time with conspicuous parallels to the COVID-19 crisis.

The Beery Visual-Motor Integration (VMI) battery of tests are some of the most commonly used assessments in pediatric occupational therapy, often used to measure change over time. However, the minimal clinically important difference (MCID) has not been estimated for interpreting change scores. We estimated the MCID for the Beery VMI battery of tests in children with autism spectrum disorder (ASD). Four occupational therapists collected data in a public elementary school on 64 children with ASD. The Beery VMI battery was administered to children with ASD twice, approximately 11 months apart. To estimate MCID values, Beery VMI battery scores were anchored to 15-point Likert questions measuring occupational therapists’ ratings of functional change over three domains: fine motor skills, handwriting, and activities of daily living (ADLs). Using this anchor-based method, we were unable to estimate MCID values for the Beery VMI battery. Children’s Beery VMI battery scores did not change significantly over the course of the school year, and there was only one weak correlation between VMI battery change scores and therapists’ ratings of change. The inability to estimate Beery VMI battery MCID values for children with ASD adds further support for research cautioning the use of the Beery VMI as an outcome measure.

Objectives: Behavioral interventions with community dwelling older adults often utilize multiple modes of treatment, which contributes to variation in participation and high rates of nonadherence. The objective of this report was to assess the treatment efficacy of one such study. Methods: We conducted an as-treated analysis of the Well Elderly II trial, where 322 individuals underwent 6 months of individual and group treatment and participated in community outings. We utilized inferential and graphical methods to assess the relationship between treatment received and depression change. Results: Individual treatment and community outings had similar small indirect effects on depressive symptoms, but a selection effect was present for individual treatment, where individuals with high baseline depression scores were the most likely to participate. Discussion: The results provide nuance that is unavailable using intent-to-treat. Future research should expand on our methods for as-treated analyses after intent-to-treat has shown aggregate improvements.

INTRODUCTIONLife review writing can be used to improve depressive symptoms in well older adults, but it is unclear whether the reminiscing, writing, or socialising is associated with the improvements. This study assessed the feasibility of a controlled trial comparing life review writing with two active control groups designed to isolate the acts of (a) engaging in a meaningful leisure activity and (b) socialising.METHODSTwenty-four participants from a 100-bed assisted living facility were enrolled in the study. Participants ranged in age from 70 to 98 years (M = 83.9, SD = 7.6). Eight 1-hour weekly sessions were held, with participants assigned to one of three groups: (a) life review writing, (b) painting, or (c) coffee from around the world. At baseline, participants completed a demographic and health questionnaire, the Mini-Cog, and the Geriatric Depression Scale Short Form (GDS-15). The GDS-15 was administered again at weeks 4 and 8, along with the health questionnaire at post-test.RESULTSNearly 25% (N = 24) of the facility's residents attended at least one session, with an average attendance rate of 66.4%, or 5.3 sessions. However, to achieve this participation rate, our original plan to employ random assignment had to be abandoned. The groups were a partial success insofar as we successfully isolated engaging in a meaningful activity in the painting group, but the writing group engaged in less reminiscing than hoped. At post-test, seven participants reported health, mood, and social life benefits. GDS-15 scores fluctuated over time, with no significant improvement from pre- to post-test.CONCLUSIONThe residents' low willingness to be randomised creates a serious selection bias, but randomising volunteers into different activities runs counter to client-centred therapy. To scrutinise the mechanisms of change of life review writing, we recommend comparing two writing groups: one that reminisces and one that does not.

Importance: The educational landscape is continually changing in response to legislation and the adoption of new standards, such as the Common Core. Currently, little is known about how these changes have influenced the school day. Objective: To examine the motor and technology requirements of kindergarten, second-, and fourth-grade general education classrooms. Design: For 6 full school days, we made unobtrusive observations of and took notes that described classroom activities throughout the day. Data were coded by a committee, allocating each minute of the day into 1 of 10 activity categories. Setting: Kindergarten, second-, and fourth-grade classrooms. Participants: Three general education classrooms with approximately 20 students in each class. Results: Students spent between 37.1% and 60.2% of the school day performing fine motor activities, with handwriting accounting for 3.4%-18.0% of the day. Time spent using technology was relatively sparse in kindergarten (4.8%) and second grade (3.1%) compared with fourth grade (14.3%). Transitions between activities (18.9%-23.4% of time spent) exceeded time spent handwriting. Conclusion and Relevance: This article provides an updated estimate of motor demands throughout the school day. Estimates of fine motor activities were consistent with previous research, but the focus on handwriting appears to have substantially diminished. What This Article Adds: Within the context of their own school, occupational therapists may find transitions to be a good opportunity for providing services within the classroom. In addition, handwriting practice outside of school may be more necessary in the current educational climate than in previous years.

Background: We examined the services provided to adults with autism spectrum disorder (ASD) by occupational therapists across the United States. Method: This cross-sectional study used an online survey, with a combination of structured and open-ended questions, to collect data from a nonprobability sample. Descriptive, inferential, and nonparametric statistics were used to analyze data. Results: In our sample (N= 57), the majority of the participants spent less than half of their workweek intervening with the adult ASD population. Caregivers were instrumental in both referral and discharge, and Medicaid was the most common payer source. The Adult Sensory Profile was used by more than half of the participants and sensory integration was the most influential model underlying practice (77%). The participants advised new occupational therapists to pursue high quality continuing education courses and formal mentorship from senior colleagues. Conclusion: This study suggests that working with adults with ASD remains a niche area of practice. Further research is needed to examine the pathways to receiving occupational therapy for the adult ASD population.

We examined sleep behaviors in allied health students (N = 77) with the following questionnaires: Caffeine Consumption, Pittsburgh Sleep Quality Index (PSQI), Profile of Mood States, and Mental and Physical State and Trait Energy and Fatigue Scales. Students averaged 6.56hr of sleep per night. More than half of the students received borderline or poor sleep quality scores on the PSQI. Students with poor sleep quality had a significantly higher proportion of mood disturbances than students with optimal sleep quality. These results highlight the need for educational programs to emphasize the sleep hygiene practices of their students.

We examined transitions occurring throughout the school day in an elementary school, sampling from kindergarten, second grade, and fourth grade classrooms. Unobtrusive observations and descriptive notetaking were used to gather data during six typical school days in the second half of the school year. Data were coded by committee to categorize the types of transition occurring throughout the day and to calculate the average time between transitions. Results indicate that students experience a transition approximately every 14 minutes of the school day, and the majority of these transitions involve physical movement around the classroom and larger school environment.

Date Presented 04/05/19 This research considered attendance in the Well Elderly II intervention to determine the dosage effect on depression scores. In particular, how many hours of OT sessions are necessary to produce meaningful reductions in depressive symptoms? Our analysis suggests that the small improvements in depression scores do not appear to be associated with the dosage of the intervention received; therefore, any preventative effects of the intervention need to be reconsidered. Primary Author and Speaker: David Schelly Additional Authors and Speakers: Ramona Nadres, Alisha Ohl

OBJECTIVE:Randomized controlled trial (RCT) interventions often rely on p values, where statistical significance is assumed to provide evidence of an intervention effect. This study provides a secondary data analysis of the Well Elderly II RCT using multiple approaches that examine clinical meaningfulness. METHOD:We reanalyzed the Well Elderly II RCT using effect size, standard deviation, standard error of measurement, minimal difference, a fragility index, an assessment of poor scores at baseline, and an analysis with a small subgroup of participants removed. RESULTS:Although some participants improved on several scales, most stayed the same, and a small subset declined. Omitting a small subgroup of participants led to nonsignificant p values. CONCLUSION:There is evidence that disparities in baseline scores and regression to the mean may have created the appearance of an intervention effect. Our methods of considering clinical meaningfulness suggest improved approaches to analyzing RCT data.

Objectives: Autism spectrum disorder (ASD) is underdiagnosed in children from minority and low socioeconomic status families, and reports indicate that parental "lack of awareness" of symptoms is a factor, which implicates the adoption of the category globally. However, parental knowledge of ASD has failed to explain emerging clusters of cases. The objective of the present research was to identify and describe barriers to an "information effect" in diagnosis. Methods: Interviews were conducted with the parents of 54 children with ASD in Costa Rica, many living within clusters that appeared after a genetic study conducted an information campaign for recruitment. The interviews explored factors influencing symptom recognition and help-seeking behaviors. Several barriers were identified that prevent information about ASD or exposure to diagnosed cases from influencing parents' help-seeking behaviors. Results: Early symptoms in most children gave parents no reason to suspect ASD. Later, parents' understanding of ASD depended on caricatures of the disorder. Parents often received unsolicited advice from strangers, although rarely from family, and it was always seen as critical of their parenting; furthermore, the advice was too late to influence the referral process, which was well underway by the time classical symptoms of ASD appeared, if they did at all. Postdiagnosis, the interviewees occasionally gave advice to other parents, mostly strangers, but none had apparently been diagnosed. Conclusions: The results implicate efforts to educate parents about symptoms of ASD, where a focus on generic developmental delays and neurodevelopmental disorders in general may be more effective than ASD-specific information.

Date Presented 4/19/2018 We present methods used to examine clinical relevance, illustrated by reexamining the findings of a popular occupational therapy intervention study, the Well Elderly II randomized controlled trial. Primary Author and Speaker: David Schelly Additional Authors and Speakers: Alisha Ohl

Sociodemographic factors have long been associated with disparities in autism spectrum disorder (ASD) diagnosis. Studies that identified spatial clustering of cases have suggested the importance of information about ASD moving through social networks of parents. Yet there is no direct evidence of this mechanism. This study explores the help-seeking behaviors and referral pathways of parents of diagnosed children in Costa Rica, one of two countries in which spatial clusters of cases have been identified. We interviewed the parents of 54 diagnosed children and focused on social network connections that influenced parents’ help seeking and referral pathways that led to assessment. Spatial clusters of cases appear to be a result of seeking private rather than public care, and private clinics are more likely to refer cases to the diagnosing hospital. The referring clinic rather than information spread appears to explain the disparities.

AIMS:Graduate education in the healthcare professions can be stressful and mentally taxing. The objective of this study was to identify differences in health and health-related behaviors among graduate allied health students based on sex and curriculum stage (i.e., didactic or clinical education).METHODS:Participants (n=77) were assessed for body fat, BMI, resting metabolic rate (RMR), and peripheral arterial-venous O2 (AVO2), as well as a series of cognitive tasks and self-reported health and health-related behaviors. Independent sample t-tests and tests of proportions were used to assess differences between groups.RESULTS:There was no evidence that the didactic and clinical students were meaningfully different upon entering their programs. Didactic students reported significantly higher tension/anxiety, depression, anger, confusion, fatigue, total mood disturbance, trait mental fatigue, total intensity of mental work performed, and time spent sitting (p<0.05). Didactic students also reported significantly lower RMR (p=0.033), but not after normalizing for fat-free mass. Males reported lower intensity of mental work performed on non-work days compared to females (p=0.009).CONCLUSIONS:Findings indicate students in didactic stages have worse mood and decreased health relative to their counterparts in clinical stages. Opportunities exist to integrate physical and mental health-related education, resources, and self-management programming into graduate allied health curricula to improve wellness among students.