Secondary caries adjacent to bulk fill resin composite restorations lined with fluoride agents.

PURPOSE: To evaluate the potential secondary caries reduction of bulk-fill resin composite restorations treated with different fluoride (F)-based agents prior to restoration placement. METHODS: 25 upper extracted molars received Class V cavities on both buccal and lingual surfaces with an enamel margin and root surface margin. The teeth were randomly assigned into five groups with five teeth per group (n=10). The treatment groups were: control group, with no treatment; the other groups received treatment using different F-based agents prior to bonding. All teeth were restored using a selective etch bonding technique and bulk fill resin composite. All teeth received 10,000 thermal cycles followed by immersion in demineralizing solution to produce artificial caries-like lesions. Polarized light microscope evaluation was performed on longitudinal sections (30 enamel lesions and 30 root surface lesions per group). Lesion depth and wall lesions for both enamel and root surface adjacent to the restorations were evaluated. RESULTS: Both lesion depths and frequency of wall lesions in the enamel and root surfaces in all treatment groups were significantly reduced compared with the control group. Among the different F-based agents, no significant difference was seen on the enamel or root surface lesion depth, showing a similar presence of enamel and root cavosurface wall lesions. CLINICAL SIGNIFICANCE: F-based agent treatment of adjacent enamel and root surfaces prior to placement of restorative materials provided resistance to the development of secondary caries during an in vitro caries model.

Experiences and Needs of Children Who Have a Parent with Young Onset Dementia: A Meta-ethnographic Review.

Objectives: The aim of the present review was to critically evaluate empirical evidence regarding the needs and experiences of children who have a parent with young onset dementia (YOD).Methods: A systematic search of five databases was carried out and the resulting 16 studies were reviewed using a meta-ethnographic approach.Results: Three main themes arose from the data: 'Dementia Impact", which describes how the child experiences the deterioration in their parent and changes to relationships; "Psychological Impact", comprising the child's private emotional experiences and the psychological consequences of changes in roles; and "Practical Impact", detailing the ways in which children adapt their lives in response to parental YOD, and children's needs for support.Conclusions: These themes synthesize the existing literature and produce a line of argument explaining the experience of children whose parents have YOD.Clinical Implications: Information and policies regarding YOD should take account of the experiences of patients' children and should include targeted support for children of parents with YOD.

Self-Compassion, Coping Strategies, and Caregiver Burden in Caregivers of People with Dementia.

OBJECTIVE: Caring for someone with dementia can have negative consequences for caregivers, a phenomenon known as caregiver burden. Coping strategies influence the impact of caregiving-related stress. Specifically, using emotion-focused strategies has been associated with lower levels of burden, whereas dysfunctional strategies have been related to increased burden. The concept of self-compassion has been linked to both positive outcomes and the coping strategies that are most advantageous to caregivers. However, as yet, no research has studied self-compassion in caregivers. Therefore, the aim of this study was to explore the relationship between self-compassion, coping strategies and caregiver burden in dementia caregivers. METHOD: Cross-sectional survey data was collected from 73 informal caregivers of people with dementia recruited from post-diagnostic support services and caregiver support groups. RESULTS: Self-compassion was found to be negatively related to caregiver burden and dysfunctional coping strategies and positively related to emotion-focused coping strategies. Dysfunctional strategies mediated the relationship between self-compassion and caregiver burden, whereas emotion-focused strategies did not. CONCLUSION: Caregivers with higher levels of self-compassion report lower levels of burden and this is at least partly due to the use of less dysfunctional coping strategies. CLINICAL IMPLICATIONS: Interventions that develop self-compassion could represent a useful intervention for struggling caregivers.

Staff Factors Contributing to Family Satisfaction with Long-Term Dementia Care: A Systematic Review of the Literature.

OBJECTIVE: The aim of the present review was to critically evaluate empirical evidence regarding staff factors that contribute to families' satisfaction with ongoing care provision for their relatives with dementia in long-term care. METHODS: Four databases were systematically searched using search terms informed by the aim of the present systematic review. The resulting 14 relevant articles comprised both qualitative and quantitative studies. RESULTS: The findings highlighted three broad areas relating to staff factors that appeared to contribute to families' satisfaction with care provision: family related factors, relating to staff interaction with families; staffing related factors, focusing on staffing organization and composition; and client related factors, focusing on staff interaction with clients and the quality of care provided. CONCLUSIONS: The findings have important implications for care staff and managers working in such settings regarding staffing organization, staff training, recruitment and retention. Future research directions are discussed. CLINICAL IMPLICATIONS: Families want consistent, knowledgeable staff that interact well and respond appropriately to the needs of their relative as well as their own needs as family members. Staff training in such settings should therefore focus not only on staff education but also on the importance of establishing effective relationships with both clients and families.

Meditation-based interventions for family caregivers of people with dementia: a review of the empirical literature.

OBJECTIVES: Providing care for a family member with dementia is associated with increased risk of adverse mental health sequelae. Recently, interventions utilising meditation-based techniques have been developed with the aim of reducing psychological distress among dementia caregivers. The present review aimed to critically evaluate the extant empirical literature in order to determine: (1) whether meditation-based interventions can reduce depression among dementia caregivers and (2) whether meditation-based interventions can reduce subjective burden among dementia caregivers. METHOD: After adhering to inclusion and exclusion criteria, a total of eight studies were included in the present review. Methodological quality was assessed using one of two scales dependent on study design. RESULTS: The results provide tentative evidence that meditation-based interventions do indeed improve levels of depression and burden in family dementia caregivers. CONCLUSIONS: The review highlighted the strengths and weakness of the studies' methodological designs. Whilst this novel review offers evidence in support of meditation-based interventions to improve the psychological distress of family dementia caregivers, future research should direct efforts to conduct larger scale, more rigorous studies. Clinical implications of the findings are also discussed.

Staphylococcus, not MRSA? A final report of carriage and conversion rates in nursing students.

OBJECTIVE: To evaluate and characterize staphylococcal carriage, possibly including methicillin-resistant Staphylococcus aureus (MRSA), and conversion rates in nursing students across clinical semester rotations and to describe risk factors. DESIGN: A prospective longitudinal cohort design with six times of measurement. Data collected August 2010 to May 2012. Institutional Review Board approval (2010F5693). SETTING: Texas State University, San Marcos, TX. PARTICIPANTS: Eighty-seven nursing students. INTERVENTIONS: A positive MRSA swab was considered an end point for participation. Intervention offered was bactroban (mupirocin) for nasal decolonization and an oral antibiotic, doxycycline; follow-up post treatment collection sample was done to verify decolonization prior to next clinical rotation. MAIN OUTCOME MEASURES: Screening for Staphylococcus aureus and MRSA identification; confirmation and antibiotic susceptibility by Vitek 2; self-administered questionnaires delineating demographics and risk factors; panel logistic regression models by Stata version 13. RESULTS: MRSA colonization did not increase. S. aureus incidence was 17.7 - 26.4%. Staphylococcal species incidence other than S. aureus increased (9.2 - 82.3%). The following odds ratio (OR) associations were found to be statistically significant: boil or skin infections with S. aureus (OR = 2.94, p < .01), working or volunteering in a healthcare facility odds with species other than S. aureus (OR = 4.41, p < .01) and gym and sports facilities odds with S. other (OR 2.45, p < .01). The most frequently occurring species at Wave 5 was S. hominis (21 isolates) while the most frequently occurring species at Wave 6 was S. epidermidis (25 isolates). CONCLUSIONS: MRSA colonization did not increase during longitudinal study. S. aureus colonization remained fairly stable throughout the study (17 - 26%). Species colonization with non S. aureus species (e.g. S. hominis, S. epidermis, S. haemolyticus) increased significantly (9.2 - 82.3%) during clinical rotations. Knowledge of infection control and compliance may have contributed to an absence of MRSA colonization; however, the colonization by other staphylococci has been shown to be a risk factor for MRSA acquisition.

The prevalence of Helicobacter pylori antibody in different age groups in Central Texas.

OBJECTIVE: The prevalence of exposure to the bacteria Helicobacter pylori in Central Texas is unknown. It has been shown that elderly individuals have a higher rate of infection than younger individuals. Exposure is even higher in the elderly living in long term care facilities. Evidence of exposure can be demonstrated by the presence of antibody to H. pylori. Plasma samples collected from several age groups are tested for the antibody to determine the exposure rate for different age groups. DESIGN: An exemption was granted by the Texas State University Institutional Review Board (IRB) as the plasma samples had been previously collected for other types of laboratory assessments. Samples were tested with the Status H. pylori Immunoassay that identifies anti-H. pylori IgG antibody in plasma samples. SETTING: The research study took place in the Texas State University Clinical Laboratory Science Department. PATIENTS OR OTHER PARTICIPANTS: Blinded in-patient plasma samples were used that had been previously collected for other assays. MAIN SOURCE MEASURE(S): The percentage of positive antibody tests is determined by age group. RESULTS: The chi-squared (chi2) results for each age group expressed a p-value of 0.000. The age group, 41-60, had the highest rate of positive antibody tests at 24%. The second highest age group was the 61 and over age group at 17%. Third highest age group was the 21-40 age group at 16% positive tests. The lowest percentage testing positive was the 0-20 age group at 6%. CONCLUSION: There was a higher prevalence of antibody in patients older than 40 years old than in younger patients. Curiously, the oldest age group (61 years or older) did not have the highest rates of exposure. Exposure rates were much lower than rates seen in other areas.

Methicillin resistant Staphylococcus aureus (MRSA): an interim report of carriage and conversion rates in nursing students.

OBJECTIVE: To evaluate and characterize MRSA and staphylococci carriage and conversion rates in nursing students across clinical semester rotations and to describe risk factors. DESIGN: A prospective, longitudinal cohort design (interim report) with three times of measurement. Data collected between August 2010 and May 2011 (ongoing longitudinal study to May 2012). Institutional Review Board approval (2010F5693). SETTING: Texas State University, San Marcos, TX. PARTICIPANTS: Eighty-seven nursing students. INTERVENTIONS: A positive MRSA swab represented an end-point for a participant. Intervention offered was bactroban (mupirocin) for nasal decolonization and an oral antibiotic, doxycycline; posttreatment collection to verify decolonization prior to next clinical rotation. MAIN OUTCOME MEASURES: Screening for Staphylococcus aureus and MRSA identification; confirmation and antibiotic susceptibility by Vitek 2. Self-administered questionnaires collected demographics and risk factors. Generalized estimating equations calculated population-averaged panel logistic regression models allowing for an AR(1) error by Stata version 12. RESULTS: MRSA colonization did not increase. S. aureus prevalence (20-26%). Species prevalence other than S. aureus increased (9.2% to 80%). The following associations were found to be statistically significant: boil or skin infection odds with S. aureus (OR = 2.43, p < .05), working or volunteering in healthcare facility odds with S. other (OR = 2.72, p < .05) and gym and sports activities odds with S. other (OR = 4.98, p < .001). CONCLUSIONS: MRSA colonization did not increase. Knowledge and understanding of MRSA (risks) may play a role in compliance and barrier precautions. S. aureus colonization remained stable (25-30%). Species colonization other than S. aureus (e.g. S. epidermis, S. haemolyticus) increased to significant levels.

Noise Exposure on the London Underground, an Observational Study over a Decade.

OBJECTIVES: There are no hearing protection regulations in place for passengers using public transport, such as the London Underground. In light of this, we sought to examine sound pressure levels experienced by regular users of the London Underground. METHODS: Sound pressure levels (A-weighted decibels: dBA) were taken on moving London Underground carriages between Euston and South Wimbledon on the Northern Line, and between Euston and Vauxhall on the Victoria Line, during 2006 and 2018. In addition, carriage sound pressure levels travelling within Zone 1 of the London Underground were tested in 2019. Three experimental and three technical repeats were undertaken using a hand-held calibrated multi-function sound level meter. RESULTS: Passengers are routinely and consistently subjected to sound pressure levels exceeding 80 dBA, with levels sometimes reaching over 100 dBA. CONCLUSION: This study is unique within the literature, with no published studies outlining exposure levels for London Underground passengers. It provides evidence of elevated noise exposure to passengers, consistently along large stretches of the London Underground, over a prolonged study period (2006-2019). KEY WORDS: Sensorineural hearing losssound pressureexposureLondonundergroundtube. LEVEL OF EVIDENCE: N/A Laryngoscope, 2020.

Experiences of healthcare assistants working with clients with dementia in residential care homes.

The study aimed to explore the experiences of healthcare assistants working with people with dementia in UK residential care homes. Eight participants completed semi-structured interviews which were analysed by interpretative phenomenological analysis. Data analysis revealed three main themes representing healthcare assistants' experiences: the importance of relationships, which referred to the importance of their relationships with clients, families and colleagues as well as their attachment to clients; something special about the role, which referred to their perception that their role was unique and rewarding as well as their personal commitment to the job; and the other side of caring, which referred to the more difficult aspects of their role, including managing emotions and conflicts within the caring role. The findings indicate that staff should be supported to build strong and supportive relationships within their role and have opportunities to explore their emotional reactions to reduce any adverse impact on care provision. It is possible that this could be facilitated through reflective practice groups or clinical supervision.

The positive aspects of caregiving in dementia: A critical review of the qualitative literature.

Positive aspects of caregiving in dementia have been identified as important in understanding the experiences of carers, yet the research base lacks clear definitions of key concepts. Qualitative research explores carers' experiences of positive aspects of caregiving in rich detail which lends itself to supporting theory development. The aim of the present review was to critically evaluate the empirical findings of qualitative studies that have explored positive aspects of caregiving in dementia. A systematic search of the literature revealed 14 studies that met this aim. Carers described multiple positive dimensions of caregiving and identified several factors that were important in supporting their positive caregiving experience. The present review evidences a solid base of understanding of the positive aspects of caregiving in dementia from which concepts and theories can be further developed. Clinical and research implications are discussed.

What do we know about the attitudes, experiences and needs of Black and minority ethnic carers of people with dementia in the United Kingdom? A systematic review of empirical research findings.

This paper reviews recent literature on the experiences, attitudes and needs of caring for someone with dementia in Black and minority ethnic communities in the United Kingdom. Eight articles, which investigated carer experiences from Black and minority ethnic communities when caring for someone with dementia, were critically appraised. All eight studies used a qualitative methodology. The review identified several themes and issues across the qualitative studies. These included memory loss being viewed as a normal process of ageing, care being perceived as an extension of an existing responsibility, a poor understanding of what support services provide, the influence of migration, the impact of stigma and increased female responsibility. Methodological limitations of the research literature studies are also highlighted and clinically relevant implications are discussed, alongside recommendations for future research in this area.

Validation of a Computerized test of Functional Capacity.

Regulatory guidance for schizophrenia cognition clinical trials requires that the assessment of cognitive change is accompanied by a functionally meaningful endpoint. However, currently available measures are challenged by resistance to change, psychometric weaknesses, and for interview-based assessments, dependence upon the presence of an informant. The aims of the current study were to: 1) assess the validity, sensitivity, and reliability of the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) as a measure of functional capacity; 2) determine the association between performance on the VRFCAT and performance on the MATRICS Consensus Cognitive Battery (MCCB); and 3) compare the metrics of the VRFCAT with the UCSD Performance-based Skills Assessment (UPSA). 167 patients with schizophrenia and 166 healthy controls completed the VRFCAT, UPSA, and the MCCB at baseline. The VRFCAT and UPSA were completed again at follow-up. The VRFCAT, MCCB, and UPSA were very sensitive to impairment in schizophrenia (d=1.16 to 1.22). High test-retest reliability was demonstrated for VRFCAT total completion time and the UPSA total score in patients (ICC=0.81 and 0.78, respectively). The UPSA demonstrated significant practice effects in patients (d=0.35), while the VRFCAT did not (d=-0.04). VRFCAT total completion time was correlated with both UPSA (r=-0.56, p<0.0001 for patients and -0.58, p<0.0001 for controls) and MCCB Composite (r=-0.57, p<0.0001 for patients and -0.68, p<0.0001 for controls). The VRFCAT is a highly reliable and sensitive measure of functional capacity with associations to the UPSA and MCCB. These results provide encouraging support for a computerized functional capacity assessment for use in schizophrenia.