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Purpose:To identify academic and demographic variables related to a successful outcome on the national certification exam for occupational therapists (National Board for Certification in Occupational Therapy [NBCOT] exam) at one academic institution with the expectation that it could be replicated with multiple institutions.Method:Binary logistic regression analyses were used to analyze three sets of academic and demographic predictors of the pass/retake outcome on the NBCOT exam.Results:Results of these analyses indicated that overall grade point average (GPA) and outcomes of specific academic coursework that was focused on practice application predicted passing the NBCOT examination on the first attempt.Conclusion:Results from this study illustrate the complexity in predicting performance on the NBCOT examination and the need to expand the predictors included in future analyses.

Neural tube defects (NTD) are potentially preventable in two-thirds of cases by periconceptional maternal Folic Acid (FA) supplementation. A national audit for the years 2009-11 showed no decline in NTD rates over twenty years. The aim of this national audit was to determine trends/rates and inform revision of national FA supplementation and food fortification strategies. Of 274,732 live and stillbirths there were 121(42.0%) cases of anencephaly, 136(47.2%) cases of spina bifida and 31(10.8%) cases of encephalocoele giving a total of 288 and overall rate of 1.05/1000 compared with 1.04/1000 in 2009-11(NS). In the 184 women where the information was available, only 29.9%(n=55) reported starting FA before pregnancy. The number of cases diagnosed antenatally was 91%(n=262) and 53%(n=154) were live-born. This audit confirms that over a generation, healthcare interventions have not succeeded in decreasing the number of pregnancies in Ireland complicated by NTD, and that revised strategies need to be developed and implemented.

Neural tube defects (NTDs) are associated with deficient maternal folic acid peri-conceptionally. In Ireland, there is no mandatory folic acid food fortification, partly due to declining NTD rates in recent years. The aim of this study was to ascertain the incident rate of NTD during the period 2009-11 and describe epidemiologically NTD in Ireland.Cases were ascertained through multiple sources, including three regional congenital anomaly registers, all maternity hospitals nationally and paediatric hospitals providing care for children with spina bifida in the Republic of Ireland during the period 2009-11.From 225 998 total births, 236 NTDs were identified, giving an incidence of 1.04/1 000 births, increasing from 0.92/1 000 in 2009 to 1.17/1 000 in 2011. Of all cases, 45% (n = 106) had anencephaly, 49% (n = 115) had spina bifida and 6% (n = 15) had an encephalocoele; 78% (n = 184) were liveborn or stillborn and 22% (n = 52) were terminations abroad. Peri-conceptional folic acid supplement intake was 13.7% among the 52.5% (n = 124) of cases whose folic acid supplement intake was known.The incidence of NTDs in the Republic of Ireland appears to be increasing. Renewed public health interventions, including mandatory folic acid food fortification, must be considered to reduce the incidence of NTD.

Background Chromosomal trisomies are associated with advancing maternal age. In Ireland, information on the total prevalence and outcome of trisomy affected pregnancies is unavailable. This study aimed to ascertain more precise data on Trisomies 21, 18 and 13 in a large Irish region during the period 2011-2013. Methods Multiple information sources were used in case finding, including a regional congenital anomaly register, all maternity and paediatric hospitals in the region and the regional Department of Clinical Genetics. Results There were 394 trisomy cases from 80 894 total births, of which 289 were Trisomy 21, 75 were Trisomy 18 and 30 were Trisomy 13. The total prevalence rate was 48.9/10 000 births, 35.7, 9.3 and 3.7 for Trisomies 21, 18 and 13, respectively. Over 90% of Trisomies 18/13 and 47% of Trisomy 21 were diagnosed prenatally; 61% of Trisomy 21 cases and nearly 30% of Trisomies 18/13 were live births; 38% all trisomy affected pregnancies ended in a termination. Conclusions This study provides precise data on the total prevalence and outcome of trisomy affected pregnancies in the East of Ireland. Total prevalence rates were higher than previously reported. Prenatal diagnosis had a significant impact on outcome. These data provide a better basis for planning of services for live-born children affected by trisomy.

Objective To determine the survival status of children with Down syndrome (DS), and to document factors influencing survival. Design Follow-up study of cases identified from the Dublin European Register of Congenital Anomalies and Twins (EUROCAT) Register. Follow-up was attempted for each case until death or 1992 or until the date last known to be alive. Setting Eastern Health Board, Dublin. Subjects In all, 389 DS children, born between 1 January 1980 and 31 December 1989 were followed up. Results Survival rates of 88% at one year and 82% at 10 years were found. There was a non-significant improvement in survival between the cohort born in 1980-1984 and that born in 1985-1989. Congenital heart defects reduced survival to 72% and complete atrio-ventricular canal defects (CAVD) had the poorest prognosis (58% survival at 10 years). Cases with CAVD showed a trend towards improved survival when surgically treated. Maternal age mother's county of residence, sex of infant, season of birth and presence of additional non-cardiac congenital anomalies had no impact on survival. Conclusions Four out of five DS children now survive at least 10 years. Adequate educational and health service provision needs to be made for them, especially those with congenital heart defects. The need for studies which compare survival and quality of life in DS children with CAVD who undergo cardiac surgery versus those who do not, taking account of various selection factors, is identified.

Background We conducted a descriptive epidemiological study of Down syndrome (DS) in the four Irish counties (Dublin, Kildare, Wicklow and Galway) covered by EUROCAT registries of congenital malformations for the years 1981-1990. Methods EUROCAT registries, which cover defined populations, use multiple sources for case ascertainment. All DS cases born between 1 January 1981 and 31 December 1990 to mothers resident in the four counties were identified. Crude birth prevalence rates and maternal agestandardized rates (SPRs) were calculated for each county and for each year in the study period. The prevalence of DS by maternal age grouped in five-year periods and the risk for each five-year group were also estimated. Results The crude birth prevalence for the four counties was 18-5/10 000 for all births and 18-3 for live births. There was a fall in the total number of DS births over the decade, but less change in the crude birth prevalence owing to an increase in the proportion of mothers aged 35 + . Galway had the highest crude birth prevalence of DS (23-5/10 000) but the SPR was within average for the four counties as a whole - 110-3, 95 per cent confidence interval (Cl) 86 7139. The risk of having a DS child increased 70-fold from 1:1841 at age 15-19 to 1:26 at 45 years or older. Nearly half of all DS cases (47-4 per cent) had at least one additional anomaly. Conclusions The parts of Ireland covered by EUROCAT have a high birth prevalence of DS births as compared with some other countries, but the maternal age-specific rates are not substantially different from those in large international studies.

AOTA recognizes SI as one of several theories and methods used by occupational therapists and occupational therapy assistants working with children in public and private schools. Regardless of the theories and methods utilized, occupational therapy practitioners work within the framework of occupational therapy toward the desired outcome of health and participation through engagement in occupations that allow participation in a child's daily life (AOTA, 2008). When children demonstrate sensory-related deficits that interfere with their ability to access the general education curriculum, occupational therapy using a sensory integrative approach is appropriate.

These guidelines about supervision, roles, and responsibilities are to assist in the appropriate utilization of occupational therapists, occupational therapy assistants, and occupational therapy aides and in the appropriate and effective provision of occupational therapy services. It is expected that occupational therapy services are delivered in accordance with applicable state and federal regulations, relevant workplace policies, the Occupational Therapy Code of Ethics (AOTA, 2005), and continuing competency and professional development guidelines.

These guidelines about supervision, roles, and responsibilities are to assist in the appropriate utilization of occupational therapy personnel and in the appropriate and effective provision of occupational therapy services. All personnel are expected to meet applicable state and federal regulations, adhere to relevant workplace policies and the Occupational Therapy Code of Ethics (AOTA, 2000), and participate in ongoing professional development activities to maintain continuing competency.

Promotion of folic acid to prevent neural Tube Defects (NTD) has been ongoing for ten years in Ireland, without a concomitant reduction in the total birth prevalence of NTD. The effectiveness of folic acid promotion as the sole means of primary prevention of NTD is therefore questionable. We examined trends in folic acid knowledge and peri-conceptional use from 1996-2002 with the aim of assessing the value of this approach. From 1996-2002, 300 women attending ante-natal clinics in Dublin hospitals annually were surveyed regarding their knowledge and use of folic acid. During the period the proportion who had heard of folic acid rose from 54% to 94% between 1996 and 2002 (c2 test for trend: p0.001). Knowledge that folic acid can prevent NTD also rose from 21% to 66% (c2 test for trend: p0.001). Although the proportion who took folic acid during pregnancy increased from 14% to 83% from 1996 to 2002 (c2 test for trend: p0.001), peri-conceptional intake did not rise above 24% in any year. There is a high awareness of folic acid and its relation to NTD, which is not matched by peri-conceptional uptake. The main barrier to peri-conceptional uptake is the lack of pregnancy planning. To date promotional campaigns appear to have been ineffective in reducing the prevalence of NTD in Ireland. Consequently, fortification of staple foodstuffs is the only practical and reliable means of primary prevention of NTD.

In the past six years, there have been reports from abroad of an unexplained rise in the birth prevalence rate of the congenital abdominal wall defect gastroschisis, while rates for the macroscopically similar anomaly omphalocoele have remained stable. The Dublin EUROCAT Registry of congenital anomalies monitors trends in the birth prevalence of birth defects in the eastern region of Ireland. We analysed births of children with omphalocoele and gastroschisis born in the period 1981-2000, with comparisons of a number of demographic and obstetric variables. During the 20 year period the birth prevalence rate for omphalocoele remained stable at 2.5/10,000 births, whereas the rate for gastroschisis increased significantly during the 1990s from 1.0/10,000 in 1991 to 4.9/10,000 in 2000. Most of the increase occurred among mothers under 25 years of age. Omphalocoele was associated with a relatively high proportion of other major congenital anomalies. This study showed that there has been an unexpected rise in the birth prevalence of gastroschisis in the region, similar to that experienced in other countries in the same time period and likely to have common aetiological features.