Oral health care in adult intensive care units: A national point prevalence study.

BACKGROUND: The importance of good oral hygiene for patients in Intensive Care Units (ICUs) is well recognized, however, the most effective way to achieve good oral care in the ICU is unclear. AIM: This study aimed to provide a national picture of oral care practices in adult ICUs in the United Kingdom (UK) to identify areas for improvement. STUDY DESIGN: A national one-day point prevalence study was undertaken in adult ICUs in the UK in the period from 30th September to 14th October 2021. Data were collected on all patients in the ICU on the date of data collection. Using a validated electronic data collection form, anonymised data were collected on methods and frequency of oral care provided, and the use of oral care protocols within the ICU. Data were analysed using descriptive analysis. RESULTS: Data from 195 patients in 15 ICUs in England, Wales and Northern Ireland were collected. Written oral care protocols were available for use in the care of 65% (n = 127) of patients. 73% (n = 142) of patients received oral care within the 24-h period. Oral care methods included toothbrushing 41% (n = 79), foam sticks 3% (n = 5), moisturizing the oral cavity 10% (n = 19) and mouth rinse with chlorhexidine 3% (n = 5) and other oral care methods not specified 12% (n = 23). 44% (n = 85) of patients had an oral assessment within the 24-h period and variable assessment methods were used. CONCLUSION: There is large variability in oral care provision and methods for intubated ICU patients and a lack of consensus was revealed in the study. Oral assessment is conducted less frequently using multiple tools. Optimal oral care standards and further research into oral care provision is pivotal to address this important patient-relevant practice. RELEVANCE TO CLINICAL PRACTICE: Oral care is a fundamental part of care for ICU patients, however, there is a large degree of variability, and oral care is often not based upon oral assessment. The use of an oral care protocol and oral assessments would help to improve patient care, ease of use for staff and provide a tailored oral care plan for patients, improving efficiency and preventing wasted resources.

Evaluating the effectiveness of fluoride varnish in preventing caries amongst Long-Term Care Facility Residents.

OBJECTIVE: To evaluate the effectiveness of professionally applied fluoride varnish on the incidence of dental caries amongst older adults resident in LTCFs in Northern Ireland. BACKGROUND: The oral health status of older adults within Long-Term Care Facilities (LTCFs) is significantly worse than their community living peers. Whilst evidence suggests an important role for fluoride varnish in preventing caries in this population, very few studies have evaluated this intervention. MATERIALS AND METHODS: A quality improvement project was undertaken with dentate residents (n = 190) in nine LTCFs who had fluoride varnish applied by Dental Care Professionals on two separate occasions during a 12-month period (intervention group). Nine LTCFs were chosen as matched controls (control group) with comparable numbers of residents of similar medical status (n = 217). For the intervention group, oral hygiene training was also provided for the care home staff. RESULTS: A total of 407 patients (n = 271 female) were included in the analyses (mean age [SD]: 84.1 [6.6] years). After 12 months, the intervention group recorded a significant reduction in mean number of carious teeth (mean [95% CI]: -0.85 [-1.12, -0.58]; P < .001). Patients in the control group had significant increases in the mean number of carious teeth (mean [95% CI]: 0.21 [0.05, 0.37]; P = .012), mean plaque score (mean [95% CI]: 1.16 [0.28, 2.04]; P = .010) and mean DMFT score (mean [95% CI]: 0.13 [0.04, 0.22]; P = .004). CONCLUSIONS: This study demonstrates the potential role of fluoride varnish in combination with oral hygiene training for staff in the prevention and arrest of carious lesions among older adults in LTCFs.

Are zirconia crowns the superior choice when restoring primary posterior molars?

Data sources Electronic database searches were carried out using predefined search terms using Embase, Google Scholar, Medline, The Cochrane Library, The Cochrane Central Register of Controlled Trials and Latin American and Caribbean Health Sciences Literature. The Trip medical database was also used to identify randomised control trials investigating stainless steel and zirconia crowns. Studies published from 1 January 2000 until 6 June 2021 were included, and reference lists of included studies analysed to ensure data saturation along with grey literature searches.Study selection Inclusion criteria included research published in English only, randomised control trials investigating the clinical and radiographic effectiveness of zirconia crowns compared to stainless steel crowns, the rehabilitation of pulp-treated posterior primary teeth and randomised control trials with children in good health. Expert opinion, case reports and reviews were excluded. Studies with a follow-up period of less than 12 months, studies including children with special care requirements or non-compliant children were also excluded.Data extraction and synthesis Two reviewers (AKP, VKC) were involved with the primary search of abstracts and titles independently; both reviewers were involved in full text assessment. Disagreements were resolved by a third reviewer (NRV). The study characteristics, number of teeth evaluated, follow-up duration, type of zirconia and stainless steel crowns, outcome assessed and outcome results were extracted. Extracted data was analysed using Review Manager, Version 5.3 and dichotomous data was summarised as risk ratios with 95% confidence intervals. Continuous data was summarised as mean difference. Heterogeneity was summarised by I2 scores and a random-effects model and Mantel-Haenszel statistical test was used.Results From the initial 641 studies screened, six studies met the inclusion criteria for the systematic review and were included for analysis. Risk of bias assessment for the included studies was graded as 'low' for three of the six included studies and 'some concern' for the remaining three studies. This was based upon allocation concealment in the randomised control trials. Clinical failures were observed in 63 of 497 events. Rehabilitation with zirconia crowns may result in less clinical failures than stainless steel crowns: risk ratio 0.48; 95% CI (0.15-1.52) p = 0.021. Gingival health was better with zirconia rather than stainless steel crowns: risk ratio 0.32; 95% CI (-0.42-0.23) p <0.001.Conclusions Primary posterior teeth restored with zirconia crowns may have 52% less risk of experiencing clinical failures than teeth with stainless steel crowns and better gingival health than stainless steel crowns, observed after 12 months. However, due to the low quality of included studies and 'very low' grade rating of the evidence provided, further clinical trials are required to provide further evidence on the clinical and radiographic effectiveness of zirconia and stainless steel crowns.

Periodontal status and chronic obstructive pulmonary disease (COPD) exacerbations: a systematic review.

BACKGROUND: A growing body of evidence suggests a role for oral bacteria in lung infections. This systematic review aimed to analyse the association between poor periodontal status and the frequency of chronic obstructive pulmonary disease (COPD) exacerbations. METHODS: PubMed, Embase, Web of Science, CINAHL and Medline were searched for studies published until May 2020, with no language restriction. Studies reporting periodontal condition, or periodontal treatment outcomes, with data on the frequency of exacerbations of COPD, were identified. The primary outcome was the frequency of exacerbations and secondary outcomes included quality of life (QoL) and hospitalisation. Quality and risk of bias assessment were carried out using the Newcastle Ottawa Scale for observational studies, Robins-1 tool for non-randomised intervention studies and Cochrane risk of bias assessment (RoB-2) tool for randomised clinical trials. Studies were assessed for eligibility and quality by two assessors independently. RESULTS: Searches identified 532 records and 8 met the inclusion criteria. Included studies were three clinical trials, one prospective cohort study, one case-control, and three cross-sectional studies. A narrative synthesis was performed. The data from intervention studies showed reduction in the frequency of exacerbations following periodontal treatment. Data from observational studies suggest association of worse plaque scores and fewer teeth with exacerbation, but not pocket depth or clinical attachment loss. Better periodontal health was also associated with reduced frequency of COPD exacerbations, hospitalisations and improved quality of life in COPD patients. Due to the high heterogeneity no meta-analysis was performed. The quality of some of the included studies was low and there was evidence of a high risk of bias. CONCLUSION: The data supports possible association between poor periodontal health, the frequency of exacerbations, hospitalisation and quality of life in COPD patients. The evidence is of moderate to low certainty and is limited by high risk of bias suggesting the need for well-designed and adequately powered randomised controlled trials, to inform future research and clinical practice. The PROSPERO registration number CRD42020180328.

Professional Dental Care May Reduce the Incidence of Non--ventilator-associated Pneumonia in Hospitals and Chronic Care Settings.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Enhanced oral hygiene interventions as a risk mitigation strategy for the prevention of non-ventilator-associated pneumonia: a systematic review and meta-analysis. Satheeshkumar PS, Papatheodorou S, Sonis S. Br Dent J. 2020 Apr; 228(8):615-622. https://doi.org/10.1038/s41415-020-1452-7. PMID: 32332964; PMCID: PMC7223037. SOURCE OF FUNDING: The study was funded by an unrestricted grant from Sunstar to Primary Endpoint Solutions. The authors have no actual or potential conflicts of interest. TYPE OF STUDY/DESIGN: Systematic Review with Meta-Analysis.

Neonatal weight loss and gain patterns in caesarean section born infants: integrative systematic review.

There is evidence that caesarean section delivery can impact on neonatal weight loss and weight gain patterns in the first 5 days of life. We conducted an integrative systematic review to examine the association of mode of delivery on early neonatal weight loss. Pubmed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Excerpta Medica dataBASE, and Medical Literature Analysis and Retrieval System Online were searched for relevant papers published before June 2019. Reference lists from the relevant papers were then backwards and forwards searched. As neonatal weight loss was reported in different formats, a meta-analysis could not be carried out. Most studies did not distinguish between elective and emergency caesarean sections or instrumental and nonassisted vaginal deliveries. Seven papers were included. All papers except one found that caesarean section was associated with higher weight loss in the early days of life. Two papers presented data from studies on babies followed up to 1 month. One study found that on day 25, babies born by caesarean section had significantly higher weight gain than those born vaginally, while another found that by day 28, babies born vaginally gained more weight per day (11.9 g/kg/day) than those born by caesarean section (10.9 g/kg/day; p = .02). Overall, infants born by caesarean section lost more weight than those born vaginally, but due to the small number of studies included, more are needed to look at this difference and why it may occur. This discrepancy in weight between the two groups may be corrected over time, but future studies will need larger sample sizes and longer follow-up periods to examine this.

The benefits of implant-retained overdentures as a treatment modality for patients in primary care settings.

Data sources Data was collected utilising Medline (OVID interface), Google Scholar and Cochrane Library. Systematic reviews with/without meta-analysis were selected which included patient satisfaction and oral health-related quality of life as outcome measures. The literature search performed included systematic reviews with publication dates ranging from 1946 to 2018. PROSPERO was also used to incorporate systematic reviews that had been completed after the last search in August 2018.Study selection Studies were selected using the PICO model, selecting systematic reviews analysing adult edentulous patients with conventional complete dentures and/or implant-retained overdentures. The systematic reviews chosen assessed satisfaction and oral health-related quality of life, while comparing results to adult edentulous patients with no replacement teeth or prosthesis.Data extraction and synthesis All of the articles located from the database searches were uploaded to reference management software. Articles were screened independently by two authors to reduce bias and to assess the articles against the predetermined inclusion criteria. The EndNote filter Service was applied to avoid duplication of articles. Guidance from the Centre for Reviews and Dissemination (University of York) was incorporated to present data narratively, with text and tables. Eight reviews were included in data synthesis.Results Of the eight reviews included, six were systematic reviews without meta-analysis, one systematic review with meta-analysis was included and one was meta-analysis. Conclusions The results of this systematic review highlight the greater benefits of implant retained overdentures compared with conventional complete dentures when assessing patient satisfaction and oral health-related quality of life. The superiority of implant retained overdentures is most evident when patients cannot tolerate conventional complete dentures. However, consideration most be given to the adaptive capabilities of patients and the financial implications of implant-retained overdentures.

Can oral rinses play a role in preventing transmission of Covid 19 infection?

This narrative review describes the existing body of evidence supporting the potential role of oral rinses in preventing the transmission of SARS-CoV2. Multiple sources were searched for evidence including PubMed, Researchgate and Google Scholar. References that were identified were then investigated further to find additional source material and the original primary research. Academic and clinical experts were consulted for additional input on virology, immunology, lipid biochemistry, microbicides as well as dental and clinical practice. The authors also collaborated with a number of commercial companies to acquire information on the specific formulations of oral rinses, information not available within the public domain. There were no restrictions on language for the search strategy.

Periodontitis May Be Associated With Respiratory Diseases Such as Asthma, COPD, and Pneumonia.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Periodontitis and respiratory diseases: A systematic review with meta-analysis. Gomes-Filho IS, Cruz SSD, Trindade SC, et al. Oral Dis. 2020; 26(2):439-446. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic Review with Meta-Analysis.

Short-term and long-term effects of caesarean section on the health of women and children.

A caesarean section (CS) can be a life-saving intervention when medically indicated, but this procedure can also lead to short-term and long-term health effects for women and children. Given the increasing use of CS, particularly without medical indication, an increased understanding of its health effects on women and children has become crucial, which we discuss in this Series paper. The prevalence of maternal mortality and maternal morbidity is higher after CS than after vaginal birth. CS is associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth, and these risks increase in a dose-response manner. There is emerging evidence that babies born by CS have different hormonal, physical, bacterial, and medical exposures, and that these exposures can subtly alter neonatal physiology. Short-term risks of CS include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity. The persistence of these risks into later life is less well investigated, although an association between CS use and greater incidence of late childhood obesity and asthma are frequently reported. There are few studies that focus on the effects of CS on cognitive and educational outcomes. Understanding potential mechanisms that link CS with childhood outcomes, such as the role of the developing neonatal microbiome, has potential to inform novel strategies and research for optimising CS use and promote optimal physiological processes and development.

Soft tissue changes: a comparison between changes caused by the construction bite and by successful treatment with a modified Twin-block appliance.

Background/objectives: Functional appliances are commonly used to correct Class II malocclusion. This study aimed to compare the facial soft tissue changes in Caucasians between pre-treatment and with the construction bite versus pre-treatment and completion of treatment with a modified Twin-block appliance (MTBA). Materials and methods: Fifty-eight Caucasian subjects with Class II division 1 malocclusion had 3D stereophotogrammetric images captured pre-treatment (T1), with the construction bite (T2), and on completion of MTBA treatment (T3). Twenty-six landmarks were located on each image and 10% were re-landmarked 1 month later. Soft-tissue linear and volumetric changes (T1-T2 and T1-T3) were analyzed using linear mixed effect models (SAS® Version 9.4, www.sas.com). Results: Forty-seven subjects [mean age 13.2 (SD 1.7) years] completed treatment [mean duration 9.8 (SD 3.8) months]. Differences between the changes from T1 to T2 versus T1 to T3 for upper facial and upper lip landmarks were insignificant (all P > 0.05) except for nasion, orbitale right, pronasale, and subnasale. For the same comparisons, lower lip and chin landmarks changed significantly (all P < 0.05) as did facial soft tissue volume (P< 0.0001). Limitations: There was no control group. Conclusion: The facial soft tissue changes from pre-treatment to with the construction bite were considerably more than those from pre-treatment to completion of treatment with a MTBA. Implication: With MTBA treatment, the soft tissue changes from pre-treatment to with the construction bite in situ, overestimate those from pre- to post-treatment.

Discharge of Non-Acute Coronary Syndrome Chest Pain Patients From Emergency Care to an Advanced Nurse Practitioner-Led Chest Pain Clinic: A Cross-Sectional Study of Referral Source and Final Diagnosis.

BACKGROUND: Chest pain is a common presentation to emergency departments (EDs). Pathways for patients with non-acute coronary syndrome (ACS) chest pain are not optimal. An advanced cardiology nurse-led chest pain service was commenced to address this. The aim of the study was to assess the outcomes of non-ACS patients discharged from ED to an advanced cardiology nurse-led chest pain clinic and compare by referral type (nurse or ED physician). METHODS: The service consisted of advanced cardiology nurse or ED physician consultation in the ED and discharge to advanced nurse-led chest pain clinic review less than 72 hours after discharge. Referrals were by the advanced nurses during consult hours and out-of-hours were by the ED physicians. Data were extracted from case notes. This was a 1-site cross-sectional study of patients attending the chest pain clinic over 2 years. RESULTS: Confirmed coronary disease was diagnosed in 24% of patients. Of the 1041 patients, 45% were referred by the advanced nurses, who referred significantly more patients who were older (56.5 years/52.3 years), had positive exercise stress test results (21%/12%), and were diagnosed with stable coronary artery disease (19%/11%) and less patients with musculoskeletal diagnosis (5%/13%) and other noncardiac pain (36%/45%). CONCLUSIONS: The study fills a gap in the literature on the follow up of non-ACS patients who present to ED and used advanced cardiology nursing expertise in the ED and chest pain clinic. The advanced nurse referred more patients who were diagnosed with coronary disease, reflecting the expertise, experience, and efficiency of the advanced cardiology nurse-led service.

The Effect of Focus and Phrase Position on East Norwegian Lexical Tonal Accents.

Two experiments examined the acoustic correlates of the disyllabic tonal accent contrast in the Trøndersk dialect of Norwegian, and how narrow focus and phrasal position shape the contrast. Production results showed that both tonal accents have a high-low (HL) pitch contour, with different timing. In narrow focus, the pitch contrast was enlarged through asymmetrical F0 changes. When at the right edge of an accent phrase (AP), the accents were shown to have a higher L, lower AP H% tone, shorter stressed vowel, and longer final vowel. The alignment changes reflected tonal crowding while segmental modifications were due to the phrase-final lengthening in AP-final position. This work contributes to the literature on prosodic typology as well as on the implementation of prosodic focus and sentence intonation in languages with lexical pitch contrasts.

The effect of smiling on facial asymmetry in adults: a 3D evaluation.

BACKGROUND/AIMS: Mild resting facial asymmetry exists in clinically symmetrical faces, but the effect of smiling on the magnitude of overall facial asymmetry in adults has not been assessed. The aim of the present study was to use stereophotogrammetry to quantify the effect of smiling on overall facial asymmetry in Caucasian adults who presented with Class I incisor relationships and no history of orthodontic treatment. METHODS: Twenty male and 20 female Caucasians aged 1 8-30 years with no history of orthodontic treatment, a clinically symmetrical face and a Class I incisor relationship had 3D stereophotogrammetric images captured at rest and on natural and maximal smile (T1). The images were repeated 2-4 weeks later (T2) to assess expression reproducibility. Overall facial asymmetry scores were produced from 27 landmarks using partial Ordinary Procrustes Analysis (OPA) and assessed by an Analysis of Covariance (ANCOVA) model. A random sample of the images was re-examined two months later to calculate intraobserver landmark reproducibility. RESULTS: Mean landmark error was low (0.41 ± 0.07 mm). Mean overall facial asymmetry scores were not significantly gender different (p = 0.5300); therefore, the male and female data were pooled. Mean overall facial asymmetry scores for maximal (0.91 ± 0.16) and natural smile (0.88 ± 0.18) were higher than at rest (0.80 ± 0.17) (p < 0.0001) and were reproducible across (T1-T2) sessions (p = 0.3204). CONCLUSIONS/IMPLICATIONS: Overall 3D facial asymmetry scores for the sampled Caucasian adults with clinically symmetrical faces increased in magnitude from rest to natural and to maximal smile. Clinicians should assess overall facial asymmetry at rest and on natural and maximal smile at baseline, during treatment and as part of a core outcome assessment, particularly for cases with unilateral posterior crossbite, unilateral cleft lip and palate or skeletal asymmetry.

Should suicide risk assessment be embedded in undergraduate dental curricula?

Aims and objectives The aim of this Plan-Do-Study-Act cycle was to establish if undergraduate students believe they have a role to play in suicide risk assessment, and to discuss the implementation of suicide risk prevention into the undergraduate dental curriculum. Data gathered informed development of a subsequent suicide risk assessment educational workshop.Methodology An online questionnaire was disseminated to undergraduate students as part of a quality improvement service evaluation within a UK dental hospital and school. This sought to gain information on attitudes to suicide prevention, previous suicide awareness training, and the appetite and potential barriers to future training.Results A response rate of 23% (n = 30) was achieved. In total, 87% of undergraduate students responding reported having no experience or training in the identification of suicidal patients, 97% of respondents expressed a desire for training, and 80% stated not knowing what to do if a patient disclosed suicidal thoughts during an appointment.Conclusion The dental team have a role to play in suicide risk assessment and the signposting of at-risk patients to appropriate services. To embed this within daily practice, awareness and training must be introduced to undergraduate curricula.

The practices and beliefs of dental professionals regarding the management of patients taking anticoagulant and antiplatelet drugs.

AIM: This study aimed to inform the implementation of the updated Scottish Dental Clinical Effectiveness Programme (SDCEP) guidance, 'Management of Dental Patients taking Anticoagulant or Antiplatelet Drugs', and to determine training needs by investigating dental professionals' current practice and beliefs regarding management of patients taking these medications. METHODS: Dental professionals were recruited via the NHS Education for Scotland Portal. The online questionnaire collected demographic information, data on current practice and information about beliefs regarding behaviours related to the management of patients on anticoagulant or antiplatelet medication. Quantitative data were analysed using SPSS and subjected to frequency calculations, t-tests, one-way ANOVA and linear regression. Qualitative data were collected via free text boxes and analysed using thematic analysis. RESULTS: One hundred and fifty-seven participants responded to the questionnaire. The majority of respondents stated they were aware of the guidance and always based their practice on it. The majority of respondents always assessed the patient's individual bleeding risk prior to dental procedures. Most respondents felt that they did not know how to appropriately manage patients taking low doses of low molecular weight heparins (LMWH), and only 38% of respondents always followed SDCEP guidance about direct oral anticoagulants (DOAC) medication and procedures with a low associated risk of bleeding. DISCUSSION: This study demonstrates a need for further educational support surrounding LMWHs and management of patients on DOAC medication. Time and remuneration represent barriers to guidance implementation in primary care. CONCLUSION: There is good awareness and adherence to the guidance in primary care settings, however training needs were identified to support implementation.

The association of denture wearing with reduced lung function and increased airflow limitation in 58-72 year old men.

OBJECTIVE: To investigate the association between denture wearing and airflow limitation in men in Northern Ireland enrolled in the Prospective Epidemiological Study of Myocardial Infarction (PRIME) study. METHODS: A case-control design was used to study partially dentate men. Cases were men aged 58-72 years who were confirmed as denture wearers. Controls were never denture wearers who were matched by age (± 1 month) and smoking habit to the cases. The men had a periodontal assessment and completed a questionnaire detailing their medical history, dental history and behaviours, social circumstances, demographic background and tobacco use. Physical examination and spirometry measurements of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were also undertaken. Spirometry data for edentulous men who wore complete dentures were compared with that recorded for the partially dentate men studied. RESULTS: There were 353 cases who were partially dentate and were confirmed denture wearers. They were matched for age and smoking habit to never denture wearer controls. The cases had an FEV1 that was on average 140 ml lower than the controls, p = 0.0013 and a 4% reduction in percent predicted FEV1, p = 0.0022. Application of the GOLD criteria indicated that 61 (17.3%) of the cases had moderate to severe airflow limitation compared with 33 (9.3%) of controls, p = 0.0051. Fully adjusted multivariable analysis showed that partially dentate men who were denture wearers were significantly more likely (p = 0.01) to have moderate to severe airflow reduction with an adjusted odds ratio (OR) of 2.37 (95% confidence intervals 1.23-4.55). In the 153 edentulous men studied moderate to severe airflow limitation was recorded in 44 (28.4%), which was significantly higher than in the partially dentate denture wearers (p = 0.017), and the men who had never worn a denture (p<0.0001). CONCLUSION: Denture wearing was associated with an increased risk of moderate to severe airflow limitation in the cohort of middle-aged Western European men studied.

Frankel 2 appliance versus the Modified Twin Block appliance for Phase 1 treatment of Class II division 1 malocclusion in children and adolescents: A randomized clinical trial.

OBJECTIVE: To compare Phase 1 treatment, using the Frankel 2 (FR2) or the modified Twin Block (MTB), for Class II division 1 malocclusion in children and adolescents with respect to: treatment duration, number of appliance breakages, occlusal outcome, and patient and parent perspectives. MATERIALS AND METHODS: Sixty participants with a Class II division 1 malocclusion were randomly assigned to either the FR2 or MTB appliance in a two-armed parallel randomized clinical trial with an allocation ratio of 1 to 1. Time to achieve a Class I incisor relationship was the primary outcome. The number of appliance breakages was recorded. The Peer Assessment Rating (PAR) index was used to evaluate pre- and post-treatment occlusal outcome on study models. Participants completed the child OHRQoL (oral health-related quality of life), Piers-Harris, Standard Continuum of Aesthetic Need (SCAN), and Oral Aesthetic Subjective Impact Score (OASIS) questionnaires pre- and post-treatment; parents completed a SCAN questionnaire. RESULTS: Forty-two participants completed treatment (FR2: 20; MTB: 22). Multiple imputation was used to impute missing data for noncompleters. Mean treatment duration was similar for the two appliances (FR2: 376 days [SD 101]; MTB: 340 days [SD 102]; P = .41). There were no significant differences in mean number of appliance breakages (FR2: 0.3 SD 0.7; MTB: 0.4 SD 0.8; P = .67 or mean PAR score P = .48). Patient and parent perspectives did not differ between appliances (P > .05). CONCLUSIONS: Phase 1 treatment duration, number of appliance breakages, occlusal outcome, and patient and parent perspectives were similar in 11-14 year olds with Class II division 1 malocclusion treated using the FR2 or MTB appliance.

The Effects of Home Language and Bilingualism on the Realization of Lexical Stress in Welsh and Welsh English.

This study investigates effects of long-term language contact and individual linguistic experience on the realization of lexical stress correlates in Welsh and Welsh English. To this end, a production study was carried out in which participants were asked to read out Welsh and English disyllabic words with stress on the penultimate syllable, placed within carrier phrases. Recordings were made of the productions of Welsh and English target words, by two groups of Welsh-English bilinguals differing in home language, as well as the productions of English target words by Welsh English monolinguals and speakers of Southern Standard British English (SSBE). Acoustic measures were taken of fundamental frequency (f0) and intensity ratios of stressed and unstressed vowels, duration of stressed and unstressed vowels, and duration of the post-stress consonant. The results of acoustic comparisons of Welsh English with SSBE and Welsh revealed that SSBE differs from the other groups in all measures of lexical stress. Welsh and Welsh English, however, show considerable phonetic overlap, albeit with language-specific differences in two of the five measures (unstressed vowel duration, intensity ratio). These findings suggest cross-language convergence in the realization of lexical stress in Welsh and Welsh English disyllabic words with penultimate stress. Individual linguistic experience, in turn, did not play a major role in the realization of lexical stress in these words. Bilinguals did not differ from monolinguals when speaking English, and home language also had no effect on any measure. This suggests that other factors must be responsible for the observed patterns. We discuss the possibility that the varieties of Welsh and Welsh English spoken in this community function as a sign of regional or peer group identity, rather than as markers of linguistic experience.

Antenatal breastfeeding self-efficacy and breastfeeding outcomes among mothers participating in a feasibility breastfeeding-support intervention.

BACKGROUND: Breastfeeding rates in Ireland are among the lowest worldwide. A feasibility study of a breastfeeding-support intervention explored maternal characteristics associated with antenatal breastfeeding self-efficacy and with infant-feeding mode at 6 weeks postpartum among women giving birth in Ireland. METHODS: We conducted a prospective study across two sites, urban and rural: The National Maternity Hospital (NMH), Dublin and Wexford General Hospital (WGH), Wexford. Nulliparous, pregnant women were recruited at approximately 32 weeks gestation from the hospitals' antenatal out-patient departments. Participants attended an antenatal class with a support partner, received a one-to-one session with a lactation consultant after delivery and had access to a breastfeeding-support clinic and telephone advice postpartum. Our aim was to understand maternal variables associated with breastfeeding self-efficacy and infant-feeding mode. We explored associations between continuous and categorical variables and any breastfeeding and exclusive breastfeeding using t tests and Chi-squared analyses. RESULTS: One hundred mothers provided baseline data; 64 provided follow-up data. Lower maternal age and non-Irish nationality were associated with higher antenatal breastfeeding self-efficacy. At the rural unit, mothers with tertiary education were more likely to be exclusively breastfeeding than those with secondary education. Though not statistically significant, more normal-weight mothers from the urban unit were exclusively breastfeeding at 6 weeks than overweight/obese mothers. CONCLUSIONS: Breastfeeding outcomes differed by maternal education. Future interventions should target mothers with lower education and possibly also overweight and obese mothers. Increasing breastfeeding self-efficacy, particularly among older and Irish-born mothers, may be a mechanism for improving breastfeeding outcomes.