Tissue response during Piezocision-assisted tooth movement: a histological study in rats.

OBJECTIVES: Piezocision is a novel, minimally invasive technique combining micro-incisions and decortications made by a piezotome in order to enhance the rate of orthodontic tooth movement. The combined technique allows simultaneous hard and/or soft tissue grafting via selective tunnelling to correct gingival recessions or bone deficiencies. The present study was designed to evaluate the effects of Piezocision on bone with or without tooth movement on a rat model. MATERIALS AND METHODS: Ninety-four Sprague-Dawley rats were divided into four groups: no treatment (n = 3), TM (tooth movement alone; n = 21), PS (Piezocision alone; n = 35), and PS + TM (Piezocision and tooth movement; n = 35). In each group, seven time points were studied: 1, 3, 7, 14, 28, 42, and 56 days. After sacrifice, the maxillae were removed, defleshed, stained with haematoxylin and eosin for morphometric analyses and tartrate-resistant acid phosphatase for osteoclastic activity. RESULTS: Three days after the surgery, the bone content decreased significantly in the PS and PS + TM groups compared to baseline (P < 0.01) and the TM group (P < 0.05). This trend continued until Day 28 and was particularly evident in the PS + TM group. At Day 56, alveolar bone returned to its baseline levels in all groups. Osteoclastic activity followed similar change pattern found in the amount of bone, suggesting a strong role for the coupling of the resorptive and formative turnover of the bone. Osteoclastic activity increased as soon as Day 1 in the PS (29.0±3.0, P < 0.05) and PS + TM groups (39.0±6.0, P < 0.01) compared to baseline (22.0±4.0). The highest level of osteoclastic activity in TM group was observed at 3 days (64.3±8.0, P < 0.01) with a steady decrease thereafter. The Piezocision-induced osteoclastic activity showed a steady increase up to 7 days in both PS (39.0±7.0, P < 0.01) and PS + TM (51.8±7.0, P < 0.01) groups and decreased thereafter until Day 56. CONCLUSIONS: Within the limitations of our study (number of animals, duration in time, and limited data on the anabolic activity), our preliminary results suggest that Piezocision-facilitated orthodontic tooth movement increases the rate of movement of the teeth undergoing orthodontic treatment through the coupled remodelling of the alveolar bone. This process is initiated by the osteoclastic activity following surgery and extended via the synergistic relationship between Piezocision and tooth movement.

The devil's in the details: Variation in estimates of late-life activity limitations across national cohort studies.

BACKGROUND: Assessing activity limitations is central to aging research. However, assessments of activity limitations vary, and this may have implications for the populations identified. We aim to compare measures of activities of daily living (ADLs) and their resulting prevalence and mortality across three nationally-representative cohort studies: the National Health and Aging Trends Study (NHATS), the Health and Retirement Survey (HRS), and the Medicare Current Beneficiary Survey (MCBS). METHODS: We compared the phrasing and context of questions around help and difficulty with six self-care activities: eating, bathing, toileting, dressing, walking inside, and transferring. We then compared the prevalence and 1-year mortality for difficulty and help with eating and dressing. RESULTS: NHATS, HRS, and MCBS varied widely in phrasing and framing of questions around activity limitations, impacting the proportion of the population found to experience difficulty or receive help. For example, in NHATS 12.4% [95% confidence interval (CI) 11.5%-13.4%] of the cohort received help with dressing, while in HRS this figure was 6.4% [95% CI 5.7%-7.2%] and MCBS 5.3% [95% CI 4.7%-5.8%]. When combined with variation in sampling frame and survey approach of each survey, such differences resulted in large variation in estimates of the older population of older adults with ADL disability. CONCLUSIONS: In order to take late-life activity limitations seriously, we must clearly define the measures we use. Further, researchers and clinicians seeking to understand the experience of older adults with activity limitations should be careful to interpret findings in light of the framing of the question asked.

"I Depend on Her for Everything": A Retrospective Chart Review of Home Care Worker Service Disruptions for Homebound Older Adults During the COVID-19 Pandemic.

Home care workers played critical roles in meeting the complex medical and social needs of homebound adults during COVID-19, yet their contributions remain underappreciated. This study characterizes home care workers' roles during COVID-19 and examines how home care disruptions impacted homebound individuals and caregivers. Using a qualitative analysis of electronic medical records among a randomly sampled subset of homebound patients in a home-based primary care practice, we found that home care workers were essential in meeting existing and new needs of homebound individuals. Insufficient home care worker services, including unstable schedules and inadequate hours of paid care, became particularly disruptive, leading to risks for patients and their caregivers. Given their integral role on care teams, home care workers must be a policy focus to prepare for emergent situations and ensure that homebound individuals have access to high quality, stable home care.

Home, but Not Homebound: A Prospective Analysis of Persons Living With Dementia.

OBJECTIVES: Homebound persons living with dementia may have increased difficulty accessing needed care in the community. This study identifies factors associated with becoming homebound among a national sample of Medicare beneficiaries with newly identified dementia. DESIGN: Prospective cohort analysis. SETTING AND PARTICIPANTS: We used the National Health and Aging Trends Study (NHATS) 2011-2018 to identify community-dwelling older adults at the time of a new dementia diagnosis (n = 939). Dementia status was determined based on cognitive testing and self and proxy reporting. METHODS: We compared characteristics of homebound (ie, those who never or rarely left home) and non-homebound participants at the time of dementia identification. Among non-homebound participants, we used a Fine-Gray subdistribution hazard model to identify factors associated with becoming homebound over follow-up (median follow-up 4 years), accounting for competing risks of death and moving to a nursing home. RESULTS: 20% of individuals with newly identified dementia were homebound and this group was more functionally impaired, medically complex, and socioeconomically disadvantaged as compared to the non-homebound. Over time, depression [subhazard ratio (SHR) 2.19, 95% CI 1.36, 3.54], living in an assisted living facility (SHR 2.60, 95% CI 1.35, 4.97), and Hispanic ethnicity (SHR 1.91, 95% CI 1.05, 3.47) were associated with becoming homebound. CONCLUSIONS AND IMPLICATIONS: Most adults are not homebound at the time of dementia diagnosis. Identifying and addressing modifiable factors like depression may slow progression to homebound status and enable persons living with dementia to access needed care in the community. In order to accommodate diverse individual and family preferences for long-term care, robust systems of home-based clinical and long-term care are necessary for those who do become homebound.

Caring Together: Trajectories of Paid and Family Caregiving Support to Those Living in the Community With Dementia.

OBJECTIVES: Paid caregivers (e.g., home health aides) often work with family caregivers to support persons living with dementia at home. We identify (a) unique trajectories of paid and family caregiving support among persons living with dementia with high care needs and (b) factors associated with these trajectories. METHODS: We used group-based multiple trajectory modeling to identify distinct trajectories of paid and family caregiving hours among National Health and Aging Trends Study respondents with dementia who died or moved to a nursing home (n = 334, mean follow-up 5.5 years). We examined differences between trajectory groups and identified factors associated with group membership using generalized estimating equation modeling. RESULTS: A 3-group model best fit our data: (a) "low/stable care" (61.3% of respondents) with stable, low/no paid care and moderate family care, (b) "increasing paid care" with increasing, moderate paid and family care, and (c) "high family care" with increasing, high family care and stable, low paid care. While both the "increasing paid care" and "high family care" groups were more functionally impaired than the "low/stable care" group, the "high family care" group was also more likely to be non-White and experience multiple medical comorbidities, depression, and social isolation. DISCUSSION: Study findings highlight the importance of considering unique arrangements in dementia care. Receipt of paid care was not only determined by patient care needs. Creating equitable access to paid care may be a particularly important way to support both persons living with dementia and their family caregivers as care needs grow.

Tobacco control in pediatric dental practices: a survey of practitioners.

PURPOSE: The study purpose was to determine tobacco-related knowledge, attitudes, and practice behaviors of American Academy of Pediatric Dentistry (AAPD) members. METHODS: A 26-item survey was distributed to a national, random sample of 1,700 AAPD members. Frequencies, odds ratios and 95% confidence intervals assessed factors related to tobacco control behaviors. RESULTS: Of 1,700 questionnaires, 1,292 (82%) were returned and usable. Over 75% of respondents agreed that it is a pediatric dentist's responsibility to help patients who wish to stop using tobacco; only 142 (11%) had prior tobacco prevention/cessation training. Of those untrained, 905 (70%) were willing to be trained. Not knowing where to send patients for counseling and feeling ineffective with helping patients to stop their tobacco use were significant barriers reported by nearly half the respondents. Two hundred forty-five (19%) reported always/often asking their adolescent patients about tobacco use; 491 (38%) reported always/often advising known tobacco users to quit; and 284 (22%) reported always/often assisting with stopping tobacco use. Feeling well prepared to ask about tobacco was significantly associated with assisting tobacco users (odds ratio=8.9; 95% confidence interval=6.6-12). CONCLUSION: Continuing education programs are needed to enhance the knowledge and skills of pediatric dentists to promote tobacco control behaviors.