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School closures during COVID lockdown impacting student MH

School closures as part of broader social lockdown measures during the COVID‐19 pandemic may be associated with a decline in the health and well‐being of children and adolescents, according to new research published in JAMA Pediatrics. Researchers found that the pandemic caused significant damage to children's mental health.

OTHR-06. NARRATIVE MEDICINE AND THE PRACTICE OF PEDIATRIC NEURO-ONCOLOGY: GRAPPLING WITH THE UNTHINKABLE

Abstract As pediatric neuro-oncology team members work with patients, they engage in life and death struggles on behalf of children. Among patients who survive, many are left with intellectual decline, psychological difficulties, inability to take on daily life skills, and an overall decrease in health-related quality of life (Castellino et al., 2014). Absorbing the weight of these stories of illness and complex survival leads to risk of burnout and moral distress. This research sought to understand how pediatric neuro-oncology team members at a U.S. hospital interact with, interpret, and make meaning of the illnesses, complex recoveries, and deaths of patients as a result of participating in a series of narrative medicine workshops. In the workshops, team members encountered fictional stories of loss and longing for restoration as they engaged in close reading and discussion of a text. Writing about the text after participating in discussion helped members connect more deeply to their own formative stories. Further, it enlarged their capacity to connect to the stories of fellow team members and the narratives of patients and their families. Those who practice narrative medicine seek “to recognize, absorb, interpret, and be moved to action by the stories of others” (Charon et al., 2017, p. 1). Its methods harness creativity and insight to equip those in healthcare not only to diagnose and treat their patients but to bear witness to what patients undergo (Charon et al., 2017). If team members train themselves to see the beauty, pain, complexity, and ambiguity in a work of art, they may in turn see their patients and one another as works of art. The act of engaging in narrative medicine practice as a healthcare team in and of itself alleviates distress and fosters collaborative relationships among team members as they grapple with unthinkable loss in their work.

Effects of Soy-Based Infant Formula on Obesity and Neurodevelopment in an Autism Mouse Model

Abstract Objectives Mice fed soy-based diets exhibit increased weight gain compared to mice fed casein-based diets and the effects are more pronounced in a model of fragile X syndrome (FXS; Fmr1KO). FXS is a neurodevelopmental disability characterized by intellectual impairment, seizures, autistic behavior, anxiety, and obesity. We hypothesize that high consumption of soy protein during postnatal development is a dietary exposure that increases the risk of developing obesity, particularly in vulnerable populations such as FXS. Here, we analyzed body weight as a function of mouse age, diet, and genotype to determine the effect of diet on weight gain. We also assessed plasma protein biomarker expression and behavior in mice in response to diet. Medical record and survey data were employed to identify associations between infant formula, weight gain and neurological development in children. Methods Methods include prospective and retrospective evaluation of weight gain and neurological outcomes in mice and humans, respectively, as a function of postnatal diet. Results Juvenile Fmr1KO mice fed a soy protein-based rodent chow throughout gestation and postnatal development exhibit increased weight gain compared to mice fed casein-based purified ingredient diet or grain-based, low phytoestrogen chow. Adolescent and adult Fmr1KO mice fed a soy-based infant formula diet exhibited increased weight gain compared to reference diets. Increased body mass was due to increased lean mass. Wild type male mice fed soy-based infant formula exhibited increased learning in a passive avoidance paradigm and Fmr1KO male mice had a deficit in nest building. Mice consuming a soy-based infant formula diet exhibited altered expression of numerous plasma proteins including the adipose hormone leptin and the β-amyloid degrading enzyme neprilysin. Consumption of soy-based infant formula was not associated with obesity at 6 years of age in children but was associated with an increased need for support in school. Conclusions In conclusion, single-source, soy-based diets may contribute to the development of obesity and the exacerbation of neurological phenotypes in developmental disabilities through a β-amyloid-mediated pathway. Funding Sources This work was supported by the National Institutes of Health, FRAXA Research Foundation, RayBiotech and the United States Department of Agriculture.

P02-14 KaziBantu ‘healthy schools for healthy communities' - A holistic approach to enhance health literacy and physical activity in primary schools from low-resourced settings in South Africa

Abstract Backgound The disease profile of low- to middle-income countries is moving towards one seen in Westernised countries, where deaths are mainly attributed to chronic diseases. Children develop risk factors at a young age predisposing them to noncommunicable diseases in adulthood. Most of the risk factors are preventable through healthy lifestyles. Results from South Africa (SA) show that many children, particularly from marginalized communities, do not achieve the minimal requirements of physical activity (PA). Thus, more emphasis needs to be placed on primary prevention strategies, such as incorporating health promotion interventions within established educational and workplace structures. Primary schools present unique opportunities for holistic prevention interventions. Methods Using an ecosystem approach, an interprofessional team of PA researchers, public health specialists and digital innovators, together with partners from the ministry of education and ministry of health in SA, was set up to map and tackle the role of physical education (PE) in the SA school system. Experts identified actionable changes at the school, teacher and policy levels. First, a comprehensive health intervention was developed and implemented in primary schools in low resourced settings in the Eastern Cape of SA. The intervention was followed to learn and adapt. Finally, changes in the educational system will be scaled-up and sustained through governmental institutionalization. Results In 1994 PE lost its stand-alone subject status and became part of Life Orientation. Ever since, non-specialist teachers lack the confidence and understanding to adequately teach the subject. The interdisciplinary team developed ‘the KaziBantu model (Healthy Schools for Healthy Communities)’, to promote PA and healthy lifestyles in public primary schools through two complementary programs: KaziKidz, a PE toolkit for schoolchildren, and KaziHealth, a workplace health intervention program for teachers. Furthermore, Short Learning Programs have been developed for continued professional development of life orientation teachers, thereby introducing lasting changes within the educational system. Discussion/Conclusion PE and health literacy are oftentimes neglected in the SA curriculum, especially in marginalized areas. System-wide changes initiated and sustained through local ownership are critical to ensure long-lasting impact. Our multilateral intervention aimed to achieve this to offer children and teachers a quality education.

Arnaiz P, Müller I, Dolley D et al.

Art-therapy focused on stimulating the emotional and expressive skills of children with special educational needs

Introduction The link between school education and art therapy is supported by the fact that it comes to supplement the common school education activities of children with special educational requirements with a dual purpose: to complete and fix their specific content; to train and practice as much as possible the students’ minds and critical thinking through artistic means. Objectives Prevention of absenteeism and school dropout of the child with special educational requirements through art therapy. Methods In art therapy, the most used methods specific to the fields of visual arts are: drawing, painting, icon, modeling on the wheel, but other techniques can be used. Children are the ones who choose their work materials and activities from the offer that the art therapist makes. From the offer of materials, the beneficiary prefers to paint porcelain objects and letters. He was challenged to identify letters after which he painted them. Results Increasing the feeling of social utility, self-confidence. Improving school situation. Reducing school dropout and literacy. The beneficiary has an interest in letters and numbers and their writing. Form words quickly, easily identifying letters. Create your own games by comparing numbers. Make puzzles with letters and numbers. Art education helps the beneficiary to more easily express their emotions, perceptions, desires and way of thinking. Learning numbers and letters becomes a fun activity when using colors. Conclusions The child needs education through art, because without it there is an imbalance in the fundamental purpose of man, that of developing harmoniously and multilaterally. Disclosure No significant relationships.

Lorint L

P06 Working differently – ‘Accepting Me’

Abstract Introduction/Background Management of children with chronic pain predominantly focuses on paced and graded activity to regain functional loss, this case summarises a different approach, resulting in improved patient outcome through use of ‘acceptance’. Early intervention from therapeutic services is integral to patient’s prognosis with attention being given to restoring limb function, improving pain and increased QoL. The majority of people with CRPS will see a reduction in pain within two years. However, evidence supports some people will continue with pain despite treatment and therapy intervention. At which point is a different approach needed, enabling the individual to take control. Description/Method Teenage female originally diagnosed with CRPS with developing chronic pain patten. Admitted for two weeks rehab session following goal setting using the COSA under the occupational therapy service. Initial goals met during inpatient stay; child discharged with advice to continue progress at home. Unfortunately, she regressed and subsequently functional level reduced. During follow up appointments it became clear that she was struggling with her perception of “being different” and not being able to complete the tasks she wanted to do. Using elements from Ten footsteps approach the therapist was able to explore and empower, particularly, using “footstep 2” Acceptance. This enabled to the patient to acknowledge that pain was a present in her life however did not need to stop her living an active life with some adjustments. By spending some time exploring how wheelchair users can achieve and succeed, the patient was able to progress by accepting her limitations due to pain whilst finding ways to do the things that she wants and needs too. For example, she spent time education her school about how the environment and attitudes could be changed to help her be an active member of the school community. Furthermore, she accepted in the short term that using her wheelchair outdoors meant she could spend time with friends and remain independent at home with ADLS, empowering her to be in control of her pain levels. Although other elements of the Ten Footsteps approach where used Acceptance was crucial to compliance with intervention and enable her to feel in control of her therapy input. Therapy remains ongoing, however time between follow ups has increased significantly, with increased patient control of symptoms and their management. Furthermore, she actively participates in school activities and has become an advocate for herself and others in similar situations. Discussion/Results This particular case, highlights the advantage to having Occupational Therapy treating in this area, being able to offer a holistic approach to intervention but also focus meaningful and purposeful occupation. This results in a balance of health and well-being being achieved, regardless of the individual functional deficits. Occupational therapists are best placed to lead with this patient group due to their uniquely training to be able to bridge the gap between physical health and mental health. This highlights how both are intertwined together and neither can be separated when aiming to achieve a meaningful and purposeful life. Furthermore, there is the potential for occupational therapy to bridge the gap between MDT member ensuring continuity for the patient. The Initial treatment programme failed to yield the results and the patient plateaued it was important to explore if this was the right approach always rehab or is there a place for Acceptance - resulting in a fulfilled meaningful and purpose full life. This case also highlights how using the evidence base within Occupational Therapy alternative approach can be used depending on the individual that is being treated. In this case acceptance of a “life with pain” and a life using a wheelchair enable the patient to accept their functional abilities and work with them to achieve a meaningful and purposeful life. Furthermore, this enable the patient to progress physically which with the traditional approach of returning to baseline (pre illness) had been halted. Until OT discussed living life to the full regardless of adaptations and equipment the patient was reluctant to work on graded goals as they wanted to achieve their ultimate goal of walking without an aid. However once focusing on success stories of individuals who live a fulfilled life despite of a disability the patient was able to refocus and achieve. Key learning points/Conclusion Sometimes the well-used approach is the most comfortable for us as therapists however this often results in a one size fits all intervention and will not achieve the best outcome therefore alternatives should always be explored. A holistic approach is needed in order to enable patients to reach their goals. There is not a one size fits all approach and as an Occupational therapist we have a duty to explore and adapt in order to get the best outcomes for our patients. Acceptance was the key for the patient to be able to explore current abilities, identity deficits and work on individual goals within their capabilities. Therefore, what was evident is that by accepting current abilities the patient was able to work on more realistic and grade goals – resulting in progress`. For future practice exploring a holistic and realistic approach need to be embraced from the beginning with a view to be flexible. Standard needs to be widened to ensure that therapist feel comfortable when the “norms” are not working and know how to adapt and negotiate difficult conversations.

P141 Where Do We Go From Here? California Local Health Departments Navigate School-based SNAP-Ed During COVID-19

Background COVID-19 forced California Supplemental Nutrition Assistance Program Education (SNAP-Ed) to suddenly shift planned strategies to meet SNAP-eligible population needs. K-12 schools, important SNAP-Ed partners for reaching children and families, were profoundly affected. Most (77%) local health departments (LHDs) reported they were unable to accomplish previously planned activities at school sites in 2020. Objective To understand pandemic-related changes to school-based SNAP-Ed and identify areas of opportunity. Study Design, Settings, Participants We conducted secondary mixed-methods analyses of California LHDs’ school-based SNAP-Ed activity and needs assessment data from fiscal years 2020-2021. Measurable Outcome/Analysis Outcomes include number and type of SNAP-Ed programs that were halted or newly implemented, number of participants reached, policies, systems, and environmental change strategies (PSEs) adopted, new methods of education delivery, and extent to which schools implemented nutrition and physical activity (Nut-PA) best practices. Qualitative analysis examined COVID-19-related barriers and facilitators to SNAP-Ed implementation. Results In 2020, 270 PSE interventions were initiated in schools; 21% were discontinued and 12% were created in response to COVID. New opportunities included using school meal distributions to provide free groceries, home gardening kits, and brief face-to-face nutrition education. Many LHDs transitioned to virtual Nut-PA education, increasing SNAP-Ed participant reach. In Fall 2020, as schools adjusted to alternative learning models, school-level assessments of Nut-PA practices indicated the most common area of opportunity was nutrition education. Over 75% of schools reported that PSE strategies requiring on-site/in-person implementation, such as improving lunchroom facilities, were not feasible. Facilitators of SNAP-Ed implementation included community support and strong partnerships between schools, community-based organizations, and SNAP-Ed implementing agencies; barriers included regulations and staff turnover. Conclusions SNAP-Ed programs nationwide can continue to serve SNAP-eligible children and families during crises like COVID-19 by partnering with schools and other community organizations. These partners identified the nutrition and physical activity needs of a community and the best practices to address them. Funding Supplemental Nutrition Assistance Program - Education

P68 Identifying the Content and Context of Pain Within Education and Training of General Practitioners

Abstract Introduction/Background Chronic musculoskeletal pain is prevalent in over 33% of children and adolescents. In order to manage this pain appropriately, healthcare professionals need to have the knowledge and skills to do so. Sub-optimal coverage has been reported in undergraduate curricula and even in specialist postgraduate paediatric rheumatology curricula. Pain is a frequent presentation in primary care but the coverage of pain in the core curricula of general practice training is not known. The aim of this study was to identify pain-related content within the curricula and understand the context in which these terms present in. Description/Method A directed search within the Royal College of General Practitioners (RCGP) was executed in April 2022. A systematic hand search was further carried out in early April to identify resources for this article. This was done using leading web search engines in the UK: Google, Microsoft Bing and Yahoo. The keywords for these searches included: ‘GP’, ‘general practitioners’, ‘curriculum’, curricula’, ‘training’ and ‘guidelines’. A number of general practitioners across the UK (N = 3) were also approached to further help with identifying possible documents guiding the training and curricula of general practitioners for analysis. After analyses were done, an informal interview was carried out with a general practitioner in order to ensure the validity of the results and findings. A quantitative summative content analysis was performed on the materials identified. This was done by calculating the frequencies of pre-determined key terms: ‘pain’, ‘pain management’, ‘acute pain’, ‘chronic pain’ and ‘pain relief’. This search was done in such a way that it was able to account for terms that were used separately, such as ‘pain’ and ‘management’, within a sentence to be coded as ‘pain-management’. Additional non pre-determined key terms, such as ‘pains’, ‘painful’, ‘long term pain’, ‘pain perception’ and ‘alleviate pain’, were also identified. After these key terms were identified, the weighted frequencies of terms were calculated. A qualitative summative content analysis was then carried out to arrange key phrases into themes which could describe the context in which key terms were presented. This study used a latent approach where each phrase with pain terms was considered in relation to its salient underlying meaning. NVivo software (QRS International, Warrington, UK) was used to facilitate analysis. Discussion/Results 9 resources were identified but 7 were excluded as they were not part of the core curricula of the specialty. The 2 documents used for analyses were: The RCGP Curriculum Being a General Practitioner (2020) and The RCGP Curriculum The Curriculum Topic Guides (2020). Key terms were only present in the latter document with 113 key terms, accounting for 0.1% of the document in total. Within these 113 pain terms, 7 were part of case discussions, comprising merely 0.06% of the pain terms. 5 of the 113 pain terms (0.04%) were within the phrase ‘chronic pain’. There were no phrases of ‘acute pain’ found within the document. Further qualitative analysis was carried out and identified 7 main themes. (i) Definition of pain: keywords were found to predominantly be in the context of acute presentations. Pain in the context of chronic pain was more often in examples of long-term conditions and/or as part of multimorbidity. (ii) Body systems associated with and/or affected by pain e.g. musculoskeletal, cardiovascular, abdominal, neurological, respiratory, genitourinary and reproductive systems. (iii) The biopsychosocial model of pain: phrases focussed on the appropriate care in order to maximise patients’ psychosocial wellbeing in the context of underlying diagnoses. (iv) Recognition and communication of pain: identifying the cause of pain and how pain is expressed and perceived by both patient and general practitioners. (v) Impact of pain on patients, carers and families. (vi) Pain in age groups: pain within children was mentioned the most, followed by adults, then adolescents more specifically. (vii) Pain management: pain in the context of relief, management, care and alleviation. It was also noted that reference to pain was made in the context of case discussions (reflective learning practice) and formative assessments (Applied Knowledge Test, Clinical Skills and Workplace Based Assessments). Key learning points/Conclusion This research has identified gaps in the content and context of pain within the curricula for general practice postgraduate training in the UK. Currently, there is limited reference to pain in the general practice curricula generally. When compared to the core pain curricula proposed by the International Association for the Study of Pain (IASP), there was limited coverage of general practitioners' understanding of the importance of fundamental concepts of pain, environmental influences, pain assessment and measurement, and pain management, as well as unique pain assessment and management approaches for people with additional needs. IASP describe these core components of pain education as pertinent to all healthcare professionals potentially seeing patients with chronic pain in their clinical practice. In view of the prevalence of chronic pain in the general population (in adults and in children/young people), these discrepancies should be reviewed and addressed, thereby improving the integration of pain education into postgraduate training programmes in the future. This is especially important given that undergraduate training in pain is equally as limited, as identified in others' past research. By improving the knowledge, skills and confidence of general practitioners in pain assessment, communication and management approaches, this will ultimately impact upon the long-term outcomes of individuals living with chronic pain across the life course.

541. In Silico Modeling by Causal Inference for Identifying Biomarkers of Sepsis

Abstract Background “Every 3 seconds, someone in the world dies of sepsis” (https://sepsistrust.org/about/). We used causal inference theory as a in silico method to identify biomarkers of sepsis. Causal Inference is a theory in Machine Learning that seeks for the root causes of an event. Methods In the study it was used transcription profile data downloaded from http://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE12624. This dataset has 70 samples, being 34 sepsis and 36 non-sepsis samples. Data set contains 8,519 attributes: 7,672 genes obtained after preprocessing of the mRNA expression profile data. The method applied in the dataset was a modification in the HEISA, a local learner of two stages algorithm (Figure 1). In the first stage HEISA identifies variables that compounds the set of parents, children, parents of parents and children of children of a target. During the second stage is calculated the causal effect using do-calculus method, of the selected variables of the first stage in the target. At end of the second stage, features with causal effect greater than 0.2 is selected. After selecting the features mRNA expression, it was applied two algorithms of classification, Random Forest and K-means, in order to evaluate the ability of the selected variables of identifying the occurrence of sepsis. Figure 1 - Causal inference HEISA algorithm. Results As shown in Table I, after applying the algorithm, it was select six mRNA expressions that better explains whether sepsis occurs, or not. Analyzing these genes it was possible to observe that three of them are known biomarkers, they are related to sepsis: NM_017526, NM_004649 and NM_006099. It is important to stress that the second one, Homo sapiens leptin receptor overlapping transcript (LEPROT) transcript variant 1 mRNA, is known to be inversely proportional to sepsis (its causal effect is negative). The other three biomarkers, NM_017526, NM_001274, and NM_001071 also are inversely proportional to sepsis. Their relationship with sepsis is still unknown. Regarding the classification task, using only those six mRNA expressions, the accuracy of the task of classification was 100%. Table I - Sepsis biomarkers candidates. Conclusion In a big set of 7,672 genes, only six were returned as sepsis biomarkers candidates. This is a very promising in silico discovery, made by a novel mathematical method, the Causal Inference theory. Disclosures All Authors: No reported disclosures.