An app to support oral hygiene care: Increasing attitudes, knowledge, and confidence in identifying oral health problems among caregivers of persons living with dementia.

PURPOSE: To develop and pilot test an App to help family and paid caregivers perform high quality oral hygiene care. METHODS: A prototype of the App was refined based on stakeholder feedback (e.g., dental care professionals, direct care providers, nursing home administrator, family caregivers). The refined App was pilot tested with 16 family caregivers and 15 paid care providers of persons living with dementia (PLWD). Participants completed a pre-test, watched an App demonstration, used it for 2 weeks, and completed a post-test. Surveys included both structured and open-ended questions. RESULTS: Phase 1 data informed the refinement of the App that led to high acceptability and usability by the Phase 2 participants. Both family and paid caregivers reported a significant increase in attitudes toward providing oral hygiene care to frail older adults (p = .05 and p = .02 for family and paid providers, respectively), knowledge about oral health and care (p = .01 and p = .02), and ability to identify oral health problems (p = .005 and p = .01). Additionally, paid caregivers reported increase in perceived support available in providing oral hygiene care (p < .001). CONCLUSION: Stakeholder engaged approach helped increase the acceptability and usability of the App that successfully increase caregivers' attitude, knowledge, and abilities in oral hygiene care provision.

Post-metamorphic development of skin glands in a true toad: Parotoids versus dorsal skin.

Chemical defenses in amphibians are a common antipredatory and antimicrobial strategy related to the presence of dermal glands that synthesize and store toxic or unpalatable substances. Glands are either distributed throughout the skin or aggregated in multiglandular structures, being the parotoids the most ubiquitous macrogland in toads of Bufonidae. Even though dermal glands begin to develop during late-larval stages, many species, including Rhinella arenarum, have immature glands by the end of metamorphosis, and their post-metamorphic growth is unknown. Herein, we compared the post-metamorphic development of parotoids and dorsal glands by histological and allometric studies in a size series of R. arenarum. Histological and histochemical studies to detect proteins, acidic glycoconjugates, and catecholamines, showed that both, parotoids and dorsal glands, acquire characteristics of adults in individuals larger than 50 mm; that is, a moment in which the cryptic coloration disappears. Parotoid height increased allometrically as a function of body size, whereas the size of small dorsal glands decreased with body size. The number of glands in the dorsum was not linearly related to body size, appearing to be an individual characteristic. Only adult specimens had intraepithelial granular glands in the duct of the largest glands of the parotoids. Since toxic secretions accumulate in the central glands of parotoids, allometric growth of parotoids may translate into greater protection from predators in the largest animals. Conversely, large glands in the dorsum, which produce a proteinaceous secretion of unknown function, grow isometrically to body size. Some characteristics, like intraepithelial glands in the ducts and basophilic glands in the dorsum, are limited to adults.