Microbiome of periodontitis and peri-implantitis before and after therapy: Long-read 16S rRNA gene amplicon sequencing.

AIMS: The microbial profiles of peri-implantitis and periodontitis (PT) are inconclusive. The controversies mainly arise from the differences in sampling sites, targeted gene fragment, and microbiome analysis techniques. The objective of this study was to explore the microbiomes of peri-implantitis (PI), control implants (CI), PT and control teeth (CT), and the microbial change of PI after nonsurgical treatment (PIAT). METHODS: Twenty-two patients diagnosed with both PT and peri-implantitis were recruited. Clinical periodontal parameters and radiographic bone levels were recorded. In each patient, the subgingival and submucosal plaque samples were collected from sites with PI, CI, PT, CT, and PIAT. Microbiome diversity was analyzed by high-throughput amplicon sequencing using full-length of 16S rRNA gene by next generation sequencing. RESULTS: The 16S rRNA gene sequencing analysis revealed 512 OTUs in oral microbiome and 377 OTUs reached strain levels. The PI and PT groups possessed their own unique core microbiome. Treponema denticola was predominant in PI with probing depth of 8-10 mm. Interestingly, Thermovirga lienii DSM 17291 and Dialister invisus DSM 15470 were found to associate with PI. Nonsurgical treatment for peri-implantitis did not significantly alter the microbiome, except Rothia aeria. CONCLUSION: Our study suggests Treponemas species may play a pivotal role in peri-implantitis. Nonsurgical treatment did not exert a major influence on the peri-implantitis microbiome in short-term follow-up. PT and peri-implantitis possess the unique microbiome profiles, and different therapeutic strategies may be suggested in the future.

The impact of Lacticaseibacillus paracasei GMNL-143 toothpaste on gingivitis and oral microbiota in adults: a randomized, double-blind, crossover, placebo-controlled trial.

BACKGROUND: This study examines the oral health benefits of heat-killed Lacticaseibacillus paracasei GMNL-143, particularly its potential in oral microbiota alterations and gingivitis improvement. METHODS: We assessed GMNL-143's in vitro interactions with oral pathogens and its ability to prevent pathogen adherence to gingival cells. A randomized, double-blind, crossover clinical trial was performed on gingivitis patients using GMNL-143 toothpaste or placebo for four weeks, followed by a crossover after a washout. RESULTS: GMNL-143 showed coaggregation with oral pathogens in vitro, linked to its surface layer protein. In patients, GMNL-143 toothpaste lowered the gingival index and reduced Streptococcus mutans in crevicular fluid. A positive relationship was found between Aggregatibacter actinomycetemcomitans and gingival index changes, and a negative one between Campylobacter and gingival index changes in plaque. CONCLUSION: GMNL-143 toothpaste may shift oral bacterial composition towards a healthier state, suggesting its potential in managing mild to moderate gingivitis. TRIAL REGISTRATION: ID NCT04190485 ( https://clinicaltrials.gov/ ); 09/12/2019, retrospective registration.

Titanium Surfaces with a Laser-Produced Microchannel Structure Enhance Pre-Osteoblast Proliferation, Maturation, and Extracellular Mineralization In Vitro.

The clinical success of dental titanium implants is profoundly linked to implant stability and osseointegration, which comprises pre-osteoblast proliferation, osteogenic differentiation, and extracellular mineralization. Because of the bio-inert nature of titanium, surface processing using subtractive or additive methods enhances osseointegration ability but limits the benefit due to accompanying surface contamination. By contrast, laser processing methods increase the roughness of the implant surface without contamination. However, the effects of laser-mediated distinct surface structures on the osteointegration level of osteoblasts are controversial. The role of a titanium surface with a laser-mediated microchannel structure in pre-osteoblast maturation remains unclear. This study aimed to elucidate the effect of laser-produced microchannels on pre-osteoblast maturation. Pre-osteoblast human embryonic palatal mesenchymal cells were seeded on a titanium plate treated with grinding (G), sandblasting with large grit and acid etching (SLA), or laser irradiation (L) for 3-18 days. The proliferation and morphology of pre-osteoblasts were evaluated using a Trypan Blue dye exclusion test and fluorescence microscopy. The mRNA expression, protein expression, and protein secretion of osteogenic differentiation markers in pre-osteoblasts were evaluated using reverse transcriptase quantitative polymerase chain reaction, a Western blot assay, and a multiplex assay, respectively. The extracellular calcium precipitation of pre-osteoblast was measured using Alizarin red S staining. Compared to G- and SLA-treated titanium surfaces, the laser-produced microchannel surfaces enhanced pre-osteoblast proliferation, the expression/secretion of osteogenic differentiation markers, and extracellular calcium precipitation. Laser-treated titanium implants may enhance the pre-osteoblast maturation process and provide extra benefits in clinical application.

Convolutional-neural-network-based radiographs evaluation assisting in early diagnosis of the periodontal bone loss via periapical radiograph.

Background/Purpose: The preciseness of detecting periodontal bone loss is examiners dependent, and this leads to low reliability. The need for automated assistance systems on dental radiographic images has been increased. To the best of our knowledge, no studies have quantitatively and automatically staged periodontitis using dental periapical radiographs. The purpose of this study was to evaluate periodontal bone loss and periodontitis stage on dental periapical radiographs using deep convolutional neural networks (CNNs). Materials and methods: 336 periapical radiographic images (teeth: 390) between January 2017 and December 2019 were collected and de-identified. All periapical radiographic image datasets were divided into training dataset (n = 82, teeth: 123) and test dataset (n = 336, teeth: 390). For creating an optimal deep CNN algorithm model, the training datasets were directly used for the segmentation and individual tooth detection. To evaluate the diagnostic power, we calculated the degree of alveolar bone loss deviation between our proposed method and ground truth, the Pearson correlation coefficients (PCC), and the diagnostic accuracy of the proposed method in the test datasets. Results: The periodontal bone loss degree deviation between our proposed method and the ground truth drawn by the three periodontists was 6.5 %. In addition, the overall PCC value of our proposed system and the periodontists' diagnoses was 0.828 (P < 0.01). The total diagnostic accuracy of our proposed method was 72.8 %. The diagnostic accuracy was highest for stage III (97.0 %). Conclusion: This tool helps with diagnosis and prevents omission, and this may be especially helpful for inexperienced younger doctors and doctors in underdeveloped countries. It could also dramatically reduce the workload of clinicians and timely access to periodontist care for people requiring advanced periodontal treatment.

Trends and Age-Period-Cohort Effect on Incidence of Male Breast Cancer from 1980 to 2019 in Taiwan and the USA.

Although male breast cancer (MBC) is globally rare, its incidence significantly increased from 1990 to 2017. The aim of this study was to examine variations in the trends of MBC incidence between populations in Taiwan and the USA from 1980 to 2019. The Taiwan Cancer Registry database and the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute of the USA were used. The age-standardized incidence rate was calculated using the world standard population in 2000. The long-term trends of the age, time period, and birth cohort effect on MBC incidence rates were estimated using the SEER Age-Period-Cohort Web Tool. The results revealed that the incidence of MBC in both countries increased from 2010 to 2019 (Taiwan: average annual percentage change (AAPC) = 2.59%; USA: AAPC = 0.64%). The age and period effects on the incidence rates in both countries strengthened, but the cohort effect was only identified in Taiwan (Rate ratio: 4.03). The identified cohort effect in this study bears resemblance to that noted in a previous investigation on female breast cancer in Taiwan. This suggests the possible presence of common environmental factors influencing breast cancer incidence in both genders, such as a high fat diet and xenoestrogen.

Prevalence, Associated Factors, and Appropriateness of Empirical Treatment of Trichomoniasis, Bacterial Vaginosis, and Vulvovaginal Candidiasis among Women with Vaginitis.

Trichomoniasis (TV), bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC) are the most common causes of vaginitis. This study investigated the prevalence of these diagnoses, their associated factors, and the appropriateness of the empirical treatment. From March 25, 2019, to June 17, 2022, 429 women with symptoms or signs of vaginitis were enrolled in a hospital in northern Taiwan with 438 episodes of vaginitis. Vaginal swabs were collected for Gram's staining, in vitro cultures for Trichomonas vaginalis, bacteria, and yeasts, and multiplex PCR assay for TV, BV, and VVC. Their empirical treatments were recorded. Factors associated with different etiologies of vaginitis were sought in multivariable logistic regression models. The prevalence of TV, BV, and VVC were 2.1%, 22.8%, and 21.7%, respectively, while coinfections of BV and VVC, TV and BV, TV and VVC, and triple infection occurred in 5.0%, 0.2%, 0.2%, and 0.7%, respectively. Multivariable analyses revealed that having multiple sexual partners was associated with TV and BV (adjusted odds ratio [aOR] 9.756 and 3.246, respectively), while menopausal women were less likely to have VVC (aOR 0.184). Moreover, dysuria was associated with TV (aOR 4.981), vaginal itch and pelvic pain with VVC (aOR 3.223 and 0.425, respectively), and discharge pH > 4.5 with BV (aOR 1.767). Other clinical symptoms and pelvic examination features had limited value for differential diagnosis. Among the 78 empirical antifungal and metronidazole prescriptions, 55.2% were ineffective or unnecessary. Our study highlights the importance to integrate appropriate diagnostic tools into the clinical care of women with vaginitis. IMPORTANCE Vaginal complaints are widespread among women and are associated with emotional, physical, and economic burdens with challenges in their diagnosis and management. In this survey, we identified that 40% of vaginitis in Taiwan was caused by either trichomoniasis, bacterial vaginosis, vulvovaginal candidiasis, or a combination of these infections. Our data suggested that typical physical findings appeared infrequently among women with these infections and their empirical treatments were frequently inappropriate. Our findings highlighted the importance of integrating proper diagnostic tools into clinical practice to improve the diagnosis and management of vaginitis, as recommended by national and international guidelines.

Vapor-Induced Pore-Forming Atmospheric-Plasma-Sprayed Zinc-, Strontium-, and Magnesium-Doped Hydroxyapatite Coatings on Titanium Implants Enhance New Bone Formation-An In Vivo and In Vitro Investigation.

OBJECTIVES: Titanium implants are regarded as a promising treatment modality for replacing missing teeth. Osteointegration and antibacterial properties are both desirable characteristics for titanium dental implants. The aim of this study was to create zinc (Zn)-, strontium (Sr)-, and magnesium (Mg)-multidoped hydroxyapatite (HAp) porous coatings, including HAp, Zn-doped HAp, and Zn-Sr-Mg-doped HAp, on titanium discs and implants using the vapor-induced pore-forming atmospheric plasma spraying (VIPF-APS) technique. METHODS: The mRNA and protein levels of osteogenesis-associated genes such as collagen type I alpha 1 chain (COL1A1), decorin (DCN), osteoprotegerin (TNFRSF11B), and osteopontin (SPP1) were examined in human embryonic palatal mesenchymal cells. The antibacterial effects against periodontal bacteria, including Porphyromonas gingivalis and Prevotella nigrescens, were investigated. In addition, a rat animal model was used to evaluate new bone formation via histologic examination and micro-computed tomography (CT). RESULTS: The ZnSrMg-HAp group was the most effective at inducing mRNA and protein expression of TNFRSF11B and SPP1 after 7 days of incubation, and TNFRSF11B and DCN after 11 days of incubation. In addition, both the ZnSrMg-HAp and Zn-HAp groups were effective against P. gingivalis and P. nigrescens. Furthermore, according to both in vitro studies and histologic findings, the ZnSrMg-HAp group exhibited the most prominent osteogenesis and concentrated bone growth along implant threads. SIGNIFICANCE: A porous ZnSrMg-HAp coating using VIPF-APS could serve as a novel technique for coating titanium implant surfaces and preventing further bacterial infection.

Acupressure Improves Cognition and Quality of Life Among Older Adults with Cognitive Disorders in Long-Term Care Settings: A Clustered Randomized Controlled Trial.

OBJECTIVE: To examine the effectiveness of acupressure on cognition and quality of life (QoL) among older adults with cognitive disorders residing in long-term care (LTC) settings. DESIGN: A clustered, randomized, assessor-blinded, controlled trial with a repeated measures design. SETTING AND PARTICIPANTS: Participants were recruited from residential care facilities in Taiwan from August 2020 to February 2021. Ninety-two older residents in 18 facilities were randomized to either the intervention arm (9 facilities, n = 46) or the control arm (9 facilities, n = 46). METHODS: Acupressure was performed at Baihui (GV20), Sishencong (EX-HN1), Shenting (GV24), Fengchi (GB20), Shuigou (GV26), Neiguan (PC6), Shenmen (HT7), and Zusanli (ST36). The duration for pressing each acupoint was 3 minutes. The acupressure force was maintained at 3 kg. Acupressure was performed once a day 5 times a week for 12 weeks. The primary outcome measure was the Cognitive Abilities Screening Instrument (CASI). Secondary outcomes included the digit span backward test, the Wisconsin Card Sorting Test (perseverative responses, perseverative errors, and categories completed), semantic fluency tests of categories of animals, fruits, and vegetables, and the Quality of Life-Alzheimer's Disease (QoL-AD). Data were collected at preintervention and postintervention. Three-level mixed effects models were performed. This study complied with the CONSORT checklist. RESULTS: After adjusting for covariates, there was a significant increase in CASI scores, the digit span backward test, perseverative responses, perseverative errors, categories completed, semantic fluency tests of categories, and QoL-AD scores in the intervention versus control arm at 3 months. CONCLUSIONS AND IMPLICATIONS: This study provides support for the use of acupressure to improve cognition and QoL during care among older residents with cognitive disorders in LTC settings. Acupressure can be integrated into aged care practice to improve cognition and QoL of older residents with cognitive disorders in LTC settings.

Effect of dietary patterns on cognitive functions of older adults: A systematic review and meta-analysis of randomized controlled trials: Dietary Patterns on Cognition of Older Adults.

BACKGROUND: Dietary patterns are associated with cognitive benefits, but inconsistent findings have been reported concerning this association. This study aims to provide a more comprehensive review and higher evidence level by evaluating evidence from randomized controlled trials (RCTs) exploring effects of various dietary patterns on cognitive function outcomes in older adults. METHODS: This systematic review and meta-analysis study followed the PRISMA guidelines. Twelves search engines and databases were searched for papers published up until March 2022. Random-effects models were used to calculate effect size (ES). RESULTS: Twenty-two RCTs met our inclusion criteria. A wide range of cognitive measures were used across the included studies. To reduce heterogeneity and to ensure a sufficient number of studies for meaningful interpretation, we utilized global cognition as the outcome measure. Only nine studies used global cognition measures, including the Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), Cognitive Abilities Screening Instrument (CASI), or neuropsychological test battery. Additionally, seven dietary patterns were identified in these studies. The results demonstrated that dietary patterns achieved a significant improvement on cognitive function outcomes including the MMSE/CASI (ES = 0.303; 95% CI [0.045, 0.560]), the ADAS-Cog (ES = -0.277; 95% CI [-0.515, -0.039]), and the cognitive battery (ES = 0.132; 95% CI [0.010, 0.255]). CONCLUSIONS: Multidisciplinary health-care professionals may use this information as a reference when planning elder care. More large-scale, high-quality studies are required to explore the long-term effects of healthy dietary patterns on global cognition, other cognitive domains, and life quality among older adults.

Efficacy of auricular acupuncture in improving dry mouth among an institutionalised older population: A randomised controlled study.

AIMS: To investigate the efficacy of applying auricular acupuncture (AA) treatment in improving dry mouth in institution-dwelling older adults. BACKGROUND: Dry mouth (xerostomia) is a common distressing problem in older populations, especially for institution-dwelling older adults that can affect oral health and quality of life. DESIGN: A randomised controlled trial was conducted from December 2020 to March 2021 and performed according to STRICTA guidelines extended from the CONSORT statement. METHODS: Older adults aged more than 65 years were randomly allocated to an AA group (n = 37) with an 8-week actual auricular points treatment or a control group (n = 38) receiving sham auricular point acupuncture. Measurements comprised a subjective assessment of the level of dry mouth as assessed by a visual analogue scale in a xerostomia questionnaire, and an objective assessment of the physiological wetness of the lingual mucosa measured with a moisture-checking device. A generalised estimating equation model was used for data analyses. RESULTS: After completing an 8-week AA intervention stimulating the Shenmen, Point Zero and Salivary Gland 2-prime points, the AA group exhibited significantly improved subjective symptoms of dry mouth comprised of difficulty speaking (B = -6.47, p < .001), difficulty swallowing (B = -6.73, p < .001), the amount of oral saliva (B = -5.38, p < .001), a dry throat (B = -7.53, p < .001) and thirst (B = -8.06, p < .001) compared with the control group. Moreover, the AA group had higher objective oral saliva flow than the control group (B = 4.73, p < .001). CONCLUSION: AA is an effective non-pharmacological method for improving subjective symptoms of dry mouth and objective saliva secretion in older populations living in nursing homes. RELEVANT TO CLINICAL PRACTICE: Performing regular AA on the Shenmen, Point Zero and Salivary Gland 2-prime auricular points can be considered an alternative treatment approach to improve dry mouth in institution-dwelling older adults.

Mediating effect of job performance between emotional intelligence and turnover intentions among hospital nurses during the COVID-19 pandemic: A path analysis.

Background: Nursing shortages are a persistent and concerning problem for the nursing workforce worldwide. However, the COVID-19 pandemic has brought additional stressors and workloads and has worsened nursing shortages. Aim: To investigate interrelationships among emotional intelligence, job performance, and turnover intentions of nurses during the coronavirus disease 2019 (COVID-19) pandemic, and explore the mediating effect of job performance between emotional intelligence and turnover intentions. Methods: A cross-sectional survey was conducted. In total, 673 nurses working in a medical centre hospital in northern Taiwan were recruited from November 2020 to April 2021. An anonymous questionnaire was used in this survey. Data were collected using a seven-item turnover intention scale, a 16-item emotional intelligence scale, a 24-item job performance scale, and demographic questions. A path analysis was performed. This study was based on STROBE guidelines. Findings: Statistically significant correlations between turnover intentions and emotional intelligence (r = -0.10, p = 0.012), between turnover intentions and job performance (r = -0.13, p = 0.002), and between emotional intelligence and job performance (r = 0.54, p < 0.001) were detected. Model fit indices were adequate. Job performance had a significant indirect effect between emotional intelligence and turnover intentions (ß = -0.16, p = 0.011). Discussion: It was found that job performance was a mediator between emotional intelligence and turnover intentions during the pandemic. The study results support the need to continue to create healthy work environments. Conclusion: These results can assist hospitals in developing specific evidence-based interventions such as showing appreciation and providing acknowledgments to reduce turnover of their nurses during the COVID-19 pandemic.

Factors associated with nurses' willingness to handle abuse of older people.

AIM: The aim of this study was to explore predictors of nurses' willingness to handle abuse of older people. BACKGROUND: Abuse of older people is a long-discussed healthcare issue worldwide. Although nurses are considered capable of identifying and reporting cases of abuse of older people, no study has been conducted in Taiwan on nurses' willingness to handle abuse of older people. DESIGN: A cross-sectional design was used. METHODS: The study was conducted from May to June 2019. A convenience sampling was adopted to survey 555 nurses from a medical center in Taiwan. Data were collected using the Knowledge of Abuse of Older People Scale, Attitudes Towards Older People Scale, Attitudes Towards Handling Abuse of Older People Scale, Willingness to Handle Abuse of Older People Scale, and personal characteristics. Pearson correlation coefficient analysis, independent sample t-test, one-way analysis of variance, and multiple linear regression were performed. RESULTS: Participants scored an average of 2.98 out of 4 on the Willingness to Handle Abuse of Older People Scale, indicating that they were inclined to do so. Attitudes towards older people, knowledge, attitudes towards handling abuse of older people, awareness of the hospital's reporting procedure and dissemination of information related to abuse of older people, sex, age, and clinical work experience explained 41.4% of the variance of willingness. Participants' attitudes toward handling abuse of older people was the most important predictor of their willingness to do so. CONCLUSIONS: To improve nurses' willingness to handle cases of abuse of older people, particularly that of male nurses, hospital authorities should provide in-service training and education and disseminate information on the subject matter. Nursing schools should prioritize offering gerontological nursing courses to foster nursing students' positive attitudes toward older adults and handling abuse of older people. TWEETABLE ABSTRACT: Nurses' attitudes toward handling abuse of older people were the most important predictor of their willingness to handle abuse of older people.

Television watching, reading, cognition, depression and life satisfaction among middle-aged and older populations: A group-based trajectory modelling analysis of national data.

This retrospective cohort study aimed to identify heterogeneous cognition, depression, and life satisfaction trajectory groups, and to examine the independent contributions of watching television and reading to these trajectories among middle-aged and older adults. A sample was taken from the Taiwan Longitudinal Study on Aging (TLSA) with measures of cognition, depression, life satisfaction, watching television, and reading during 12 years of follow-up (N = 4440). Group-based trajectory models and multinomial logistic regressions were used. The findings showed that the cohort was separated into three global cognition groups of low-cognition (n = 376), declining-cognition (n = 805), and maintained-cognition (n = 2718); three episodic memory groups of high-declining (n = 540), middle-stable (n = 2066), and improving groups (n = 1293); three depression groups of low-to-low (n = 2571), median-to-high (n = 960), and high-to-high groups (n = 368); and three life satisfaction groups of low- (n = 1133), middle- (n = 977), and high-level groups (n = 1789). Also, the findings demonstrated that after adjusting for covariates, those who did not watch television or read at the baseline had independently significantly increased odds of having lower global cognitive function, higher depression, and lower life satisfaction over time versus those who watched television or read almost every day. Based on the findings obtained, group-based trajectories of cognition, depression, and life satisfaction scores identified distinct subgroups among TLSA participants. Moreover, the findings suggest that healthcare providers need to develop more targeted population interventions to ensure successful aging. Healthcare providers can encourage older adults, particularly new retirees, to participate in leisure activities (i.e., watching television and reading) to reduce prevalence rates of cognitive impairment and depression.

Efficacy of Er:YAG laser for the peri-implantitis treatment and microbiological changes: a randomized controlled trial.

The aims of this study were to identify the microbiological changes in the periodontal pockets following an Er:YAG laser (ERL) irradiation and mechanical debridement to compare the effectiveness of ERL irradiation to mechanical debridement for peri-implantitis treatment through randomized controlled trials. Twenty-three patients with peri-implantitis lesions were treated in either a test group, ERL set at energy level of 100 mJ/pulse, frequency of 10 Hz, pulse duration was 100 µs, and irradiated by three passages, or a control group, with mechanical debridement using an ultrasonic scaler. An examiner measured the following clinical parameters at different stages (a baseline and at 3- and 6-month post-treatment): probing depth (PD), bleeding on probing (BOP), marginal bone loss (MBL), and anaerobic bacteria counts. Linear regression, with generalized estimation equations, was used to compare the clinical parameters and anaerobic bacterial counts at different stages and between groups. The anaerobic bacterial counts significantly decreased within the control group during the follow-ups. At the 6-month follow-up, both groups showed a significant reduction in PD (test group: mean difference of 0.84 mm; control group: mean difference of 0.41 mm), and the test group showed a significantly higher PD reduction on the buccal site (1.31 mm) compared to that of the control group (0.25 mm). Both ERL and mechanical debridement treatments led to significant improvements in PD. When mechanical debridement therapy was used, significant anaerobic bacterial count reductions were observed. Future treatment of peri-implantitis should involve a combination of both of these therapies.

Psychological distress among immigrant women who divorced: Resilience as a mediator.

PURPOSE: The purpose of this study was to investigate relationships among the demands of immigration, resilience, and psychological distress in divorced immigrant women, and determine the mediating effects of resilience on the relationship between demands of immigration and psychological distress. DESIGN: The cross-sectional study included 117 women who had immigrated and married Taiwanese men but later got divorced. METHODS: The Chinese health questionnaire-12 scale, the resilience scale-Chinese version, and the demands of immigration (DI) scale were used to measure in this study. A multiple regression and Sobel test were used to examine whether resilience mediated the relationship between demands of immigration and psychological distress. FINDINGS: In this study, 47% of the divorced immigrant women were experiencing psychological distress, and 25.6% exhibited high levels of demands of immigration. Women with psychological distress had higher demand scores (t = 2.592, p = 0.011) and lower resilience scores (t = -3.965, p < 0.001) compared to women without psychological distress. The demands of immigration negatively predicted resilience (t = -3.050, p = 0.003). Finally, resilience mediated the association of demands of immigration with psychological distress (z = 2.497, p = 0.0125). CONCLUSIONS: Relationships among the demands of immigration, resilience, and psychological distress in divorced immigrant women were demonstrated in this study. Resilience played an important role in the relationship between demands of immigration and psychological distress. CLINICAL RELEVANCE: Tailored programs that foster resilience to reduce risks of demands of immigration and psychological distress in this vulnerable population should be developed.

Assessment of dental personal protective equipment (PPE) and the relationship between manual dexterity and dissemination of aerosol and splatter during the COVID-19 pandemic.

Background/purpose: Asymptomatic COVID-19 patients visit the dental clinic for routine treatment, during which, high-speed handpieces, and third-use sprayers can produce aerosols. We focused on the effect and possible inadequacy of personal protective equipment (PPE) while cleaning teeth and assessed whether doctors' proficiency was related to the range of spraying droplets. Materials and methods: Doctors were divided into three different groups: attending physicians, residents, and intern respectively. Each doctor treated 15 patients; each group comprised 30 patients. The dentists wore leg covers, shoe covers, medical masks, haircaps, full masks, waterproof barrier gowns, and gloves. Each patient was covered with a waterproof hole towel, and the upper edge was fixed to the patient's nose with a medical tape. After cleaning the teeth with water contained red pigment, the spattering distance and range of droplets were calculated. Concurrently, we examined whether there was any droplet contamination on the PPE. Results: With the exception of shoe covers, haircaps, and medical surgical masks, pigment splash marks were found on both the dentist and assistant's PPE. The interns performed cleaning for a significantly longer time than the residents and attending physicians, with a significant statistical difference (P < 0.05). The spatter distance for the interns was significantly larger than the residents (P < 0.05). Conclusion: It is recommended that the hole towel be centered on the patient's nose tip, at least larger than a radius of 54.9-64.5 cm. The dentist's proficiency did cause differences in the duration of teeth cleaning, which further affects the spatter distance.

Knowledge of and Barriers to Palliative Care Perceived by Healthcare Providers before and after Promotion of the Patient Autonomy Act: A Cross-Sectional Study.

This study was designed to investigate healthcare providers' knowledge of palliative care and perceptions of palliative care barriers before and after promoting the Patient Autonomy Act (PAA). A convenience sample was recruited, including 277 healthcare providers in 2013 and 222 healthcare providers in 2018. Multivariate linear regression analyses were used to identify predictors of knowledge of and perceived barriers to palliative care. A principal component analysis was carried out to identify the most appropriate factorial structure for the contents of knowledge and perceived barriers to palliative care. Three factors related to knowledge of palliative care were identified in both 2013 and 2018 data: 'policy, regulation, and promotion', 'philosophy and treatments', and 'myths and misunderstandings'. Study findings for the two periods were similar. As for barriers to providing palliative care, three factors were identified for 2013: 'quality care', 'difficulties' and 'communication', and for 2018, 'information', 'attitudes' and 'quality care' were identified. Study findings differed between the two periods. Policies can better reinforce mitigating strategies-including opportunities for education, shared decision making, and changes in institutions and care systems. Additionally, assessing barriers creates important opportunities for further research to address the most critical aspects in improving end-of-life care for patients and their families.

Exercise for Trismus Prevention in Patients with Head and Neck Cancer: A Network Meta-Analysis of Randomized Controlled Trials.

A common side effect of managing head and neck cancer is trismus, which devastates patients' quality of life. The purpose of this study was to investigate prophylactic exercise interventions for preventing trismus and difficulty in mouth opening in head and neck cancer. Five databases were searched for randomized controlled trials. Network meta-analysis was performed with risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). This study finally included 11 randomized controlled trials (n = 805). Trismus risk in patients who received exercise with phone call follow up (E + P) was significantly lower than those received usual care (RR = 0.42; 95% CI: 0.29 to 0.61) and exercise alone (RR = 0.33; 95% CI: 0.18 to 6.22). Mouth opening in usual care was significantly lower than in the tri-integrated strategy group (MD = 15.22; 95% CI: 8.88 to 21.56). Exercise is recommended for preserving mouth opening distance in patients with head and neck cancer. Tri-integrated strategies could be an effective method for preventing trismus.

Effectiveness of a musical fitness programme for older adults with cognitive impairment in long-term care facilities: A quasi-experimental study.

OBJECTIVE: To investigate the effectiveness of a musical fitness programme (MFP) intervention in improving neuropsychiatric symptoms, depression, upper-limb muscle strength and cognition of older adults with cognitive impairment in long-term care (LTC) facilities. BACKGROUND: Because of population ageing, the number of older adults with cognitive impairment has been increasing. The effectiveness of medications in treating cognitive impairment is limited; therefore, the global trend has been for non-pharmacological treatments. However, intervention studies of MFPs on older LTC residents with cognitive impairment are scant. DESIGN: This study adopted a quasi-experimental design in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) checklist. In total, 84 older adults with cognitive impairment were recruited from seven LTC facilities. The MFP was implemented from July-November 2019. METHODS: The intervention group received the MFP, which was 50 min per session, twice a week for 12 weeks, whereas the comparison group received usual care. Neuropsychiatric inventory nursing home version, the Cornell scale for depression in dementia Chinese version, 30-s arm curl test and Mini-Mental State Examination were the outcome measures. Data were analysed using Chi-square test, t test and repeated measure analysis of variance. RESULTS: After the intervention, the scores of neuropsychiatric inventory and the Cornell depression exhibited significant differences over time between two groups (F = 3.6, p = .029; F = 5.96, p = .003, respectively). Nevertheless, 30-s arm curl test and Mini-Mental State Examination demonstrated non-significant between-group differences. CONCLUSION: The MFP can effectively reduce neuropsychiatric symptoms and depression in older adults with cognitive impairment in LTC facilities. To ensure a more robust evidence base, more research is warranted. RELEVANCE TO CLINICAL PRACTICE: The MFP is a non-pharmacological treatment that can be implemented to promote psychological well-being among older adults with cognitive impairment in LTC facilities, and to indirectly reduce nursing staff burden. To assist nursing staff in providing this intervention, on-the-job training is needed.

The Effect of Paternal Skin-to-Skin Care: A Systematic Review and Meta-analysis of Randomized Control Trials.

BACKGROUND: Research about skin-to-skin care (SSC) experiences in early period after birth has focused on mothers and infants. PURPOSE: The purpose of this study was to determine the outcomes of paternal skin-to-skin care (P-SSC) in both fathers and infants. METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, Embase, CINAHL, PsycInfo, Airiti Library, and Google Scholar were searched for randomized controlled trials (RCTs) that reported outcomes of P-SSC in both fathers and infants. We calculated pooled mean differences (MDs) and 95% confidence intervals (CIs) using RevMan 5.3 for the meta-analysis [PROSPERO: CRD42018106790]. RESULTS: Seven RCTs including a total of 552 participants were eligible for inclusion. Compared to the maternal skin-to-skin care (M-SSC), fathers in the P-SSC exhibited no significant differences in salivary oxytocin levels (MD: -0.35 pg/mL; 95% CI: -0.75, 0.05), salivary cortisol levels (MD: 0.25 µg/dL; 95% CI: -0.82, 1.33), or anxiety scores (MD: -0.17; 95% CI: -0.57, 0.22) during the period of SSC. Similarly, there were no significant differences in the salivary cortisol levels (MD: -0.11 µg/dL; 95% CI: -0.05, 0.28) among preterm infants between the 2 groups. However, the crying time was less among full-term infants in the P-SSC group compared with infants in the incubator care or cot care groups. IMPLICATIONS FOR PRACTICE AND RESEARCH: P-SSC had similar effects as M-SSC on stress-related outcomes during and after SSC among fathers and infants in the early stages after birth. We recommend that P-SSC be implemented in the early stages after birth. Further RCTs with a longitudinal design and large samples are needed to better understand the long-term effects of P-SSC on fathers and infants.