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The objective of this study was to examine the acceptance and awareness of mothers with children with special needs regarding their children's special situation. A qualitative exploratory approach was employed in this study. Between November 2023 and January 2024, in-depth individual interviews were conducted with 22 mothers of children with special needsFour primary themes emerged from the mothers included in the study regarding their acceptance and awareness of their children's special situation: Challenges, Transformation, Adaptation, and Mistakes. The Challenges theme encompasses the child who deviates from expectations, lack of information, stigma, lack of support, burden of care, inadequacy, and guilt. The Transformation theme encompasses the concept of the special child, increased responsibilities, attitude toward the social environment, and normal means of blessing. The Adaptation theme encompasses the sub-themes of treatment and care, family dynamics, spirituality, and social. The Mistakes theme encompasses the sub-themes of dependency on the child, dependency of the child, and allowing secondary gain. The parents demonstrated a willingness to accept and be aware of their children's special condition, which facilitated the process of transformation and adaptation. In order for parents to undergo the transformation process more expeditiously, it is necessary to enhance their acceptance and awareness. [ABSTRACT FROM AUTHOR]

Aims: The oral health needs of frail older adults are increasing with an aging population in Canada. The objective of this study was to explore the perceptions of dentists in British Columbia regarding their view of geriatric dentistry as a distinct scope of practice and in relation to special needs dentistry. Methods and results: Qualitative data were gathered thorough semi guided interviews of a purposeful sample of dental clinicians, educators and members of organized dentistry with specialized knowledge of oral health for frail older adults. Interviews were transcribed, coded, and analyzed using a thematic approach. Thematic saturation was reached with the 10 participants in this study. Through the method of interpretative description, patient, dentist, and systemic factors that shaped scope of practice for geriatric dentistry were identified as well as the broader skill sets required for geriatric dentistry. Conclusion: The study found that participants perceived geriatric dentistry as unique scope of practice from general dentistry requiring special knowledge in the management of challenges associated with aging with frailty as well as the ability to work in long‐term care. Similar to special needs dentistry, geriatric dentistry requires person‐centered care and emphasized the need for interprofessional collaboration in alternative care settings. [ABSTRACT FROM AUTHOR]

Aim(s): To identify, synthesise and map systematic reviews of the effectiveness of nursing interventions undertaken in a neonatal intensive care unit or special care nursery. Design: This scoping review was conducted according to the JBI scoping review framework. Methods: Review included systematic reviews that evaluated any nurse‐initiated interventions that were undertaken in an NICU or SCN setting. Studies that reported one or more positive outcomes related to the nursing interventions were only considered for this review. Each outcome for nursing interventions was rated a 'certainty (quality) of evidence' according to the Grading of Recommendations, Assessment, Development and Evaluations criteria. Data Sources: Systematic reviews were sourced from the Cochrane Database of Systematic Reviews and Joanna Briggs Institute Evidence Synthesis for reviews published until February 2023. Results: A total of 428 articles were identified; following screening, 81 reviews underwent full‐text screening, and 34 articles met the inclusion criteria and were included in this review. Multiple nursing interventions reporting positive outcomes were identified and were grouped into seven categories. Respiratory 7/34 (20%) and Nutrition 8/34 (23%) outcomes were the most reported categories. Developmental care was the next most reported category 5/34 (15%) followed by Thermoregulation, 5/34 (15%) Jaundice 4/34 (12%), Pain 4/34 (12%) and Infection 1/34 (3%). Conclusions: This review has identified nursing interventions that have a direct positive impact on neonatal outcomes. However, further applied research is needed to transfer this empirical knowledge into clinical practice. Implications for the profession and/or patient care: Implementing up‐to‐date evidence on effective nursing interventions has the potential to significantly improving neonatal outcomes. Patient or public contribution: No patient or public involvement in this scoping review. [ABSTRACT FROM AUTHOR]

Introduction: Treating anterior restorations is a real challenge for a dentist and conventional protocols are not always applicable. The aim of this study is to determine different therapeutic to conducting anterior restorations in disabled people. Case report: We begin by presenting the case of a 23‐year‐old, handicapped man, who was brought in consultation to compensate for the loss of the left upper central incisor (#21). Materials and methods: We then performed a systematic literature review in December 2022, in accordance with the PRISMA guidelines. The publications, on three databases, dealing with dental treatments on disabled people were selected whether they were clinical studies or case reports. Results: In the end, 14 publications were included. Most of the treatments described in the studies (n = 10; 71.43%) concern people aged under 19. The patients present different types of handicaps with various degrees of severity and the oral diseases described are as heterogeneous as the handicaps retrieved. Discussion: It is therefore difficult to make common treatment recommendations for all these variable profiles and situations. Most of patients in this study are very young, so there is a need for preventive and therapeutic care as earlier as possible, to preserve the vitality of their teeth and dental occlusion. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pain is one of the most common symptoms in the patients hospitalized in intensive care units, and its correct and timely diagnosis is important. Identifying tools that accurately assess pain in a shorter time will help patients better manage pain. The aim of this study was to compare the accuracy and the duration of response to behavioral pain scales (BPS and CPOT) during painful procedures in the intensive care unit. MATERIALS AND METHODS: The descriptive-comparative study was conducted in two groups, each including 16 nurses, in the intensive care unit of Besat Hospital in Hamadan in 2022. Each group separately evaluated the patients’ pain during position change and secretion suction based on BPS and CPOT scales along with an evaluator. At the same time, the accuracy of the scores given by each nurse and the duration of pain diagnosis were compared using the determined evaluator, and the results were analysed. RESULTS: Comparing the durations of response to the scales, the average duration of response for BPS and CPOT tools were 13.21 and 13.63, respectively; in general, their difference was significant (P < 0.001). Examining the accuracy of the nurses and the evaluators in pain evaluation revealed a significant difference between the two tools, and the results of adaptability were higher for CPOT, in all cases, in comparison with BPS (P = 0.024). CONCLUSIONS: The results showed that CPOT assesses the pain more accurately compared to BPS, but the duration of pain evaluation is a little longer via CPOT. The results of the study can help the nurses working in ICUs by choosing more accurate tools with shorter evaluation duration.

Introduction: There is no agreed taxonomy of the techniques used to support patients to receive professional oral healthcare. This lack of specification leads to imprecision in describing, understanding, teaching and implementing behaviour support techniques in dentistry (DBS). Methods: This review aims to identify the labels and associated descriptors used by practitioners to describe DBS techniques, as a first step in developing a shared terminology for DBS techniques. Following registration of a protocol, a scoping review limited to Clinical Practice Guidelines only was undertaken to identify the labels and descriptors used to refer to DBS techniques. Results: From 5317 screened records, 30 were included, generating a list of 51 distinct DBS techniques. General anaesthesia was the most commonly reported DBS (n = 21). This review also explores what term is given to DBS techniques as a group (Behaviour management was most commonly used (n = 8)) and how these techniques were categorized (mainly distinguishing between pharmacological and non‐pharmacological). Conclusions: This is the first attempt to generate a list of techniques that can be selected for patients and marks an initial step in future efforts at agreeing and categorizing these techniques into an accepted taxonomy, with all the benefits this brings to research, education, practice and patients. [ABSTRACT FROM AUTHOR]

Aim: Transfer from a wheelchair and discomfort in dental chair are two important barriers for access to dental care among wheelchair-bound patients. The authors have devised an automated wheelchair recliner that helps to mimic the dental chair functioning at wheelchair itself. The aim of this study was to analyze the performance and acceptability of wheelchair recliner among wheelchair-bound patients. Settings and Design: Tertiary care settings, cross-sectional design. Materials and Methods: A total of 100 wheelchair-bound adult patients (aged >21 years) were evaluated for acceptability of the recliner. The patients were assessed using eight-item covering patient comfort/acceptability related to positioning, reclining, repositioning, fear of falls, joy, discomfort, perception regarding dentist's discomfort, and use in future on a scale of 0-4 with 0 indicating least satisfying and four indicating most satisfying experience. Overall, patient experience was graded as poor, fair, good, very good, and excellent. The Chi-square test was used to compare the results. Statistical Analysis Used: IBM Stats package 21.0 was used. Mean ± standard deviation, Numbers/percentages and Chi-square test were used to compare results. The confidence level of the study was 95%. Results: The age of patients ranged from 22 to 83 years (mean age 52.26 ± 18.58 years). Majority were males (58%) and had temporary (60%) disability. On a 4-point scale, the mean scores of patients ranged from 2.47 ± 1.23 (positioning) to 3.40 ± 0.74 (intent to use in future). Overall experience was rated as good to very good by 77% of patients. No significant association of age, sex, or type of disability was seen with overall patient experience. Conclusion: The acceptability rates were good to very good among wheelchair-bound patients and were unaffected by their age, sex, and type of disability. [ABSTRACT FROM AUTHOR]

Purpose: To compile the literature available about the oral health and dental care of the deaf and hard of hearing (DHH) population.Materials and Methods: The study question of this scoping review was 'What are the main findings reported in the literature about oral health and dental care of the DHH population?' The following databases were included: Web of Science, LILACS, SciELO, MEDLINE, Scopus, EMBASE, GoogleScholar and Redalyc. Full-text articles published in peer-reviewed journals, in Spanish, Portuguese, and English, from the January 2000 to January 2018 were selected with qualitative and quantitative methods. All study designs were included in the review with the exception of letters to the editor and case reports.Results: A total of fifty articles were selected for analysis. DHH population has poorer oral hygiene and a higher prevalence of caries than their non DHH peers. DHH also report significant struggles with oral health and dental access. Most dentists experienced difficulties communicating with their DHH patients.Conclusions: This scoping review is the first known that centers on DHH oral health and their dental care. Efforts to develop accessible dental health programmes are needed to address apparent oral health inequities in the DHH population. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics of oral health interventions implemented in prison settings and explore the barriers and facilitators towards implementation. Methods: Following Joanna Briggs Institute scoping review methodology, six databases were searched including Medline (R), Emcare, Embase, AMED, Cochrane and PsycINFO. A total of 978 studies were returned and screened. The inclusion criteria were those studies conducted in a prison population, with an intervention to address oral health and published since 2000. Results: Ten studies published between 2008 and 2021 were included. All were conducted in high‐income countries. Three intervention types were identified: health education (n = 5), teledentistry (n = 3) and screening or triaging (n = 2). The barriers and facilitators to successful implementation were grouped into a framework of four overarching concepts. These included prison environment, population makeup, compliance and staffing. Clinical Significance: Evidence suggests that oral health interventions in prisons are focused on improving access to services and oral health messages. A range of drivers including the prison environment, staffing levels, recruitment and intervention compliance influence implementation and the success of interventions. [ABSTRACT FROM AUTHOR]

The occurrence of acute leukemia during pregnancy is a rare pathologic situation and requires a multidisciplinary approach that includes at least a hematologist, gynecologist, neurologist, or psychotherapist and sometimes even intensive care unit care. The difficulties in caring for such a patient are many, from determining the risk associated with continuing the pregnancy, to choosing diagnostic tools and therapy appropriate for such a situation, to considering the patient's wishes and preferences. Below, we present the approach for cases of acute leukemia in pregnancy diagnosed and treated at the Emergency University Hospital of Bucharest (SUUB), Hematology Department, between January 1, 2017 and December 31, 2022, during a 6-year period. [ABSTRACT FROM AUTHOR]

Dental general anesthesia (GA) is a day-stay procedure and is a suitable choice for complicated cases. It is undertaken in a controlled hospital setting that ensures the quality, safety, efficacy, and efficiency of dental treatment. The purpose of this study is to determine the prevalence, severity, duration, and factors related to the occurrence of postoperative discomfort in young children following GA in a general hospital. This study includes a minimum sample size of 23 children that were undergoing GA over a 1-month period. Informed consent was obtained from the parent prior to the treatment. A preoperative questionnaire via the Survey Monkey program was used for the purposes of recording the responses of the survey population. All data related to the immediate postoperative period while the child was in the post-anesthetic recovery room (PAR) was collected and assessed by one of the investigators using the Face, Legs, Activity, Cry, and Consolability (FLACC) pain assessment scale. Postoperative data was gathered using the Dental Discomfort Questionnaire (DDQ-8) and was performed by phone 3 days after the GA procedure. The participating 23 children ranged from 4 to 9 years old (mean 5.43 ± 1.53). A total of 65.2% were girls and 34.8% were boys, with 30.4% experiencing a recent history of pain. [ABSTRACT FROM AUTHOR]

Abstract Patients with intellectual disabilities often fail to follow traditional tongue position instructions for panoramic radiographs resulting in missed pathology or unnecessary further radiation. This simple breathing technique is a new clinical instruction method for panoramic radiography developed to reduce the most common patient position error: patient failure to hold the tongue to the roof of the mouth. The technique is suitable for all patients including young patients and those with intellectual disabilities. The simple breathing technique uses ‘tell‐show‐do’ communication methods and does not mention the tongue but utilises the known tongue positions that occur during breathing and swallowing. This simple breathing technique instruction for panoramic radiography uses a demonstration of ‘breathe‐in, breathe‐out, swallow, lips closed and hold still’ to reduce the intensity of both the palatoglossal and pharyngeal airspaces on panoramic radiographs. This method, referred in this article as the simple breathing technique, can improve the diagnostic potential of panoramic radiographs and can be used with young children and patients with intellectual disabilities, and this slow breathing technique can help them further relax.

Abstract Background This study aimed to explore the challenges experienced in dental health care by professionals and caregivers of persons with special needs in Trinidad and Tobago. This research presented results from the first qualitative study which gained insight into the service component of dental care for people with special needs in this country. Methods This qualitative study was conducted between March and June 2021. Recruitment of participants used both purposive and snowball sampling. A semi-structured interview schedule was used in the interviews of dentists, (a dental assistant), physicians and caregivers of people with special needs. Narrative inquiry was used in data analysis. The transcripts were individually coded and a follow-up peer debriefing session to cross reference responses and increase the validity of the analysis was performed. Results Barriers related to the provision of dental care included readiness of health care professionals, the level of specialized care and the resources required for patient treatment. Caregivers encountered barriers such as cost and lack of accessible dental care for persons with special needs. Possible solutions were education of key stakeholders, policy intervention, advocacy and prevention strategies. Conclusions Caregivers and allied health care professions experience multiple barriers when treating patients with special needs. Study participants indicated a need change in the provision and access of dental services for people with special needs. Education of healthcare professionals, improved social policies and health promotion is warranted.

This paper addresses general aspects of burn-out and coping mechanisms in the context of the professional activity of workers in Social care (Child Protection). According to the National Authority for the Rights of Persons with Disabilities, Children and Adoptions (ANDPDCA, 2021), the main responsibilities of Child Protection are the evaluation and monitoring of the special protection measure for children and families. The evaluation and monitoring process involves all the workers in the multidisciplinary team, namely: social workers, psychologists, educators, nurses, etc. and also administrative support staff. [ABSTRACT FROM AUTHOR]

Patients with intellectual disabilities often fail to follow traditional tongue position instructions for panoramic radiographs resulting in missed pathology or unnecessary further radiation. This simple breathing technique is a new clinical instruction method for panoramic radiography developed to reduce the most common patient position error: patient failure to hold the tongue to the roof of the mouth. The technique is suitable for all patients including young patients and those with intellectual disabilities. The simple breathing technique uses 'tell‐show‐do' communication methods and does not mention the tongue but utilises the known tongue positions that occur during breathing and swallowing. This simple breathing technique instruction for panoramic radiography uses a demonstration of 'breathe‐in, breathe‐out, swallow, lips closed and hold still' to reduce the intensity of both the palatoglossal and pharyngeal airspaces on panoramic radiographs. This method, referred in this article as the simple breathing technique, can improve the diagnostic potential of panoramic radiographs and can be used with young children and patients with intellectual disabilities, and this slow breathing technique can help them further relax. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the challenges experienced in dental health care by professionals and caregivers of persons with special needs in Trinidad and Tobago. This research presented results from the first qualitative study which gained insight into the service component of dental care for people with special needs in this country. Methods: This qualitative study was conducted between March and June 2021. Recruitment of participants used both purposive and snowball sampling. A semi-structured interview schedule was used in the interviews of dentists, (a dental assistant), physicians and caregivers of people with special needs. Narrative inquiry was used in data analysis. The transcripts were individually coded and a follow-up peer debriefing session to cross reference responses and increase the validity of the analysis was performed. Results: Barriers related to the provision of dental care included readiness of health care professionals, the level of specialized care and the resources required for patient treatment. Caregivers encountered barriers such as cost and lack of accessible dental care for persons with special needs. Possible solutions were education of key stakeholders, policy intervention, advocacy and prevention strategies. Conclusions: Caregivers and allied health care professions experience multiple barriers when treating patients with special needs. Study participants indicated a need change in the provision and access of dental services for people with special needs. Education of healthcare professionals, improved social policies and health promotion is warranted. [ABSTRACT FROM AUTHOR]

Late preterm infants (LPIs) represent a significant percentage of all neonates (6-8%), but there are limited published data on their postnatal management. Our aim was to compare the frequency of neonatal intensive care unit (NICU) admission and the breastfeeding rate of LPIs born at 35+0-36+6 weeks of gestation who were cared for by initial rooming in strategy rather than directly admitted to the special care unit (SCU) and, eventually, to the NICU. We carried out a retrospective study in the perinatal centers of Careggi University Hospital (CUH) and San Giovanni di Dio Hospital in Florence, Italy, where the first and second strategies were applied, respectively. Main outcomes were LPIs admission rate at SCU/NICU and breastfeeding rate at discharge. We studied 190 LPIs born at SGDH and 240 born at CUH. The admission rate in SCU (81 vs. 43%; P < 0.001) and NICU (20 vs. 10%; P = 0.008) was higher in SGDH than in CUH, as was the exclusive breastfeeding rate (36 vs. 22%; P < 0.001). However, infants who were assisted in rooming-in at CUH and infants with similar clinical characteristics at SGDH had similar mixed (60 vs. 69%) and exclusive (35 vs. 31%) breastfeeding rates.  Conclusion: Postnatal assistance of LPIs in rooming-in, eventually followed by admission in SCU/NICU based on their clinical conditions, allowed to safely halve their hospitalization. The assistance of infants in rooming-in did not negatively affect their breastfeeding rate. These results support the possibility of assisting LPIs in rooming-in. What is Known: • Late preterm infants represent a significant percentage of all neonates. • Early rooming-in and breastfeeding is recommended for late preterm infants. What is New: • Postnatal assistance of late preterm infants in rooming-in, followed when necessary by admission in neonatal units based on clinical conditions, allowed to safely avoid about half the number of hospitalizations in comparison with direct admission in neonatal units. • This strategy did not affect breastfeeding rate. Infants who were admitted to SCU/NICU after initial rooming-in had worst breastfeeding rate. [ABSTRACT FROM AUTHOR]

Aims: Previous research has demonstrated that autistic individuals often experience difficulties accessing dental care, both as a result of autism specific difficulties and practitioners' attitudes towards autism. However, very little research exists that explores dental professionals' experiences of providing care to their autistic patients. The aim of this study was to investigate the strategies UK‐based dental professionals' use when working with autistic patients Methods and Results: In this study, dental professionals (n = 16) from a variety of specialty roles (special care, paediatrics, orthodontics) were interviewed. We asked participants to talk through, in depth, specific cases they had encountered in their practice, what sorts of accommodations they had provided, and what concerns had arisen during appointments. Thematic analysis was used to analyses the data and revealed four main themes: the unique dental needs associated with being autistic, effective adaptations to practice, the crucial role of the caregiver, and the importance of specialist knowledge Conclusion: Recommendations for how dentists can improve the dental experiences of autistic patients can be drawn from the specialist dentists' responses in this study. These include involving autistic patients in decisions about their treatment and being flexible and willing to work with autistic patients and their caregivers. [ABSTRACT FROM AUTHOR]

School-age children are not immune to COVID-19 or the pronounced and persistent symptoms associated with a long-COVID diagnosis. Students may present with a variety of symptoms affecting their physical, cognitive, and mental health. The school community should be educated on the school-based interventions and recommendations for creating an individualized safe and successful return to school plan. As we await approval for vaccinations in school-age children younger than 12 years and continue to reposition ourselves to the waves of this pandemic and new variants of the virus, understanding the medical and educational long-term effects on our students may be a long-term need. [ABSTRACT FROM AUTHOR]

Dental general anesthesia (GA) is a day-stay procedure and is a suitable choice for complicated cases. It is undertaken in a controlled hospital setting that ensures the quality, safety, efficacy, and efficiency of dental treatment. The purpose of this study is to determine the prevalence, severity, duration, and factors related to the occurrence of postoperative discomfort in young children following GA in a general hospital. This study includes a minimum sample size of 23 children that were undergoing GA over a 1-month period. Informed consent was obtained from the parent prior to the treatment. A preoperative questionnaire via the Survey Monkey program was used for the purposes of recording the responses of the survey population. All data related to the immediate postoperative period while the child was in the post-anesthetic recovery room (PAR) was collected and assessed by one of the investigators using the Face, Legs, Activity, Cry, and Consolability (FLACC) pain assessment scale. Postoperative data was gathered using the Dental Discomfort Questionnaire (DDQ-8) and was performed by phone 3 days after the GA procedure. The participating 23 children ranged from 4 to 9 years old (mean 5.43 ± 1.53). A total of 65.2% were girls and 34.8% were boys, with 30.4% experiencing a recent history of pain.

Aims: Disability is a key social determinant of health. The objective of this study was to test the association between disability status and irregular dental attendance among the Australian population, and to examine whether the observed association varied among adolescents. Methods: Data on 17 501 participants from The Household, Income and Labour Dynamics in Australia (HILDA) were analysed. The main outcome examined was irregular dental attendance (two or more years since last dental visit) with disability as the primary exposure. Multivariable logistic regression models were fitted to test the associations between disability and dental attendance pattern. Models were adjusted for age, gender, country of birth, region of residence, education and income. Analysis was repeated among adolescents (15‐ to 24‐year‐old) to examine for variations in observed association. Results: One in four participants reported having a disability. Unadjusted model showed that the odds for irregular dental attendance were 1.40 times greater (95%; CI, 1.30‐1.51) in those with disability than those without disability. After adjusting for all covariates, participants with disability had 1.20 times higher odds (95%; CI 1.10‐1.30) of irregular dental attendance than those without disability. Irregular dental attendance was 1.41 times greater (95%; CI 1.10‐1.80) in those with disability aged 15‐24 years than those without disability. Conclusions: Australian individuals with disability are more likely to have irregular dental attendance than those without. [ABSTRACT FROM AUTHOR]

Objectives: To undertake a realist review of carer‐led oral hygiene interventions for people with intellectual disabilities. This was run parallel with a Cochrane Review. Methods: Realist review methods were followed. This was characterized by an iterative process of developing and refining theories of how interventions might work, expressed as context‐mechanism‐outcome configurations. The steps included identifying candidate theories with local and international expert consultation before applying an iterative search strategy. Selection criteria were applied for screening of the abstracts and 10% of the included full texts were screened by the three review members, independently, to ensure adherence to the criteria. Data were extracted in NVivo and synthesized qualitatively to confirm, refute or refine theories about what works, why, in what circumstances and for whom. Results: Of the 697 potential sources, 112 studies progressed to full‐text screening, and 58 of those were included in the review. These 58 studies found evidence to support six theories about carer‐led oral hygiene interventions for people with intellectual disabilities, from a starting point of ten candidate theories. This realist review found evidence to support the contention that, in order for carer‐led oral hygiene interventions for people with ID to succeed, there is a need for adequate resources and a system‐level approach; involving carers in design and implementation; tailoring of training to suit carers' needs and work environments; clearly stating how interventions are expected to work; specifying goals with achievable steps for carers to follow; providing carers with support and feedback on their efforts; acknowledging the physical and emotional toll caring for people with intellectual disabilities has on the well‐being of carers; and repeating training. Conclusions: The theories from this realist review will direct future interventions by suggesting the mechanisms and contexts that are important to achieve the intended outcome of improved oral health for people with intellectual disabilities. These are, of course, propositions intended for testing, rather than proven. The parallel use of Cochrane and realist methods provides a unique richness to our hypothesis of what works, for whom, when and how. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the efficacy of the social story‐based intervention in promoting the oral health status among preschool children with special healthcare needs. Methods: The 24‐month randomized controlled trial recruited 306 children from centres that provided educational training for 2‐ to 6‐year‐old children who had special healthcare needs. The participants received standardized toothbrushing training and oral health education materials. The education materials for children in the test group were validated social stories, while materials for children in the control group were standard leaflets. Those materials were introduced in each training session and used at home by parents. Children's oral health status and oral health‐related behaviours were assessed before and after interventions. Data were analysed via generalized estimating equations, negative binomial regression and binary logistic regression. Results: There was no significant difference in caries experience among children in both groups after 24 months. However, children in the test group showed better oral hygiene status and better toothbrushing performance, and they were more likely to visit a dentist (OR = 2.00, 95% CI:1.15,3.49) than their peers in the control group. Caries progression was more likely to be observed among children who had low social skills or whose parents were not working full‐time. Children from high‐income families showed better oral hygiene status than their peers (Estimate = −0.11, 95%CI: −0.20,−0.01). Conclusion: Social stories could be used to improve oral health‐related behaviours among young children with SHCN. The efficacy of the intervention might be associated with children's adaptive skills and family socio‐demographic status. [ABSTRACT FROM AUTHOR]

Objectives: Psychiatric inpatients suffer from poorer oral health than the general population, and difficulties in accessing necessary dental treatment remain even when a dedicated dental service is available within the psychiatric hospital. The aim of this study was to identify barriers to access dental care from the point of view of dentists working within French psychiatric hospitals. Methods: The relatively small number of dentists working in psychiatric hospitals necessitated a qualitative approach. Semi‐structured interviews were conducted, recorded, transcribed and coded in a conventional content analysis approach. Results: Eight interviews were conducted. Six of the dentists interviewed were men, and two were women. Three of them worked full‐time in a psychiatric facility, while the other five worked partly in the hospital and partly in private practice. The average duration for interviews was 54 minutes (minimum 24 min, maximum 89 min). The interviews highlighted three dimensions of barriers to access to dental care. The first dimension was directly related to the patient. This may be linked to the patient's psychiatric disorder but not necessarily. This also encompasses refusal of care. A second dimension regrouped events related to the organization of the hospital (locally), such as communication issues between staff members within the dental office, and with other staff members from the psychiatric ward. A third dimension included difficulties related to the overall organization of the healthcare system, including financial issues and deinstitutionalization. Conclusions: In‐site dental consultations appear as an interesting tool to enhance access to oral care for psychiatric inpatients. However, difficulties remain from the dentists' perspective. [ABSTRACT FROM AUTHOR]

A presented paper is reviewed for the Special Care Dentistry (SCD) teaching of dental undergraduates from different continents and compared it to the current SCD education scene in Malaysia. Related literature were reviewed together with the current updates of SCD in Malaysia as an overview to bridge the gap for SCD teaching, planning the learning outcomes, and the curriculum guidelines. It highlights the barriers, similarities, and the different approaches applied in Malaysia. Constructing the SCD curriculum and adhering to it is a challenge. Most countries will be bound to the local expectations and needs to be able to construct their national guidelines. The literature shows the difference in approach of teaching SCD globally. Different factors such as lack of SCD expertise, lack of disabled-friendly facilities, overloaded curriculum, and lack of educational resources were highlighted in the literature as factors that can halt the SCD education. Educators need to incorporate the learning outcomes, the local needs, and/or curriculum guidelines within their institutions to design the content of their own programs. The Malaysian experience can be an example of a southeast Asian approach in SCD education. [ABSTRACT FROM AUTHOR]

Background: Providing oral hygiene in patients with a tracheal tube in the mouth is one of the most important tasks of nurses. This study has been conducted with the aim of comparing the effects of two mouthwash solutions (chlorhexidine and orthodentol) on the oral hygiene of patients with respiratory ventilation device and hospitalized in intensive care units. Methods: This is a clinical trial in which 90 patients with oral tracheal tube entered the study through simple sampling method. Inclusion criteria were being insensitive to herbal compounds and aged 15-85 years. They were divided randomly into two intervention (orthodentol) and control (chlorhexidine) groups. Each group had 45 subjects. The Beck Oral Hygiene Checklist was used to collect data (before and after intervention). Data were analyzed using SPSS software. Results: Patients in intervention and control groups were similar in terms of demographic characteristics, oral hygiene, and other characteristics. Oral hygiene in patients in both orthodentol and chlorhexidine groups had a significant improvement after intervention. Conclusion: The comparison of orthodentol and chlorhexidine oral mucosal effects showed that oral hygiene of patients hospitalized in intensive care units was improved to a certain extent. Considering the benefits of herbal compounds, orthodentol mouthwash can be mentioned as an appropriate alternative for chlorhexidine.

Aims and Objectives: This study was undertaken to investigate the referral patterns and treatment needs of patients managed by the special care dentistry (SCD) clinic specialists at a Malaysian teaching dental hospital, in preparation for improved oral health services for this patient population. Materials and Methods: The dental records of patients who attended the SCD clinic between January and December 2017, were reviewed for information, including sociodemographic characteristics, sources and reasons for referral, dental treatment needs, and medical profile. Quantitative data were analyzed via the Statistical Package for the Social Sciences version (chi-squared test, P < 0.01). Results: A total of 182 patients were managed in 2017, consisting mostly of Malays (89.6%) and with a majority being males (63.2%) in the 0-20 years age group (69.8%). A slight prevalence of adolescent/adult patients (52.2%) was reported as compared with that of pediatric patients (47.8%), with no significant difference between the genders. Many of the patients were encountered within the mobile dental service program (53.8%) and mostly first presented for routine checkups (66.5%). Treatment needs included periodontal therapy (76.9%), restoration (47.3%), exodontia (28.0%), and dentures (12.1%). The patient study sample additionally boasted physical impairments (58.8%), complex medical conditions (32.4%), psychiatric disorders (8.8%), and intellectual disabilities (8.2%). Systemic health issues included cardiovascular (18.7%), respiratory (9.9%), and endocrine (7.7%) disorders. Significant differences in the numbers of patients with physical disabilities and complex medical conditions were observed across age groups. Conclusion: This study provides important information for the future development of SCD services at the institutional and national levels. [ABSTRACT FROM AUTHOR]

Aim: Dental treatment is necessary in oncology patients since pre-existing oro-dental disease may influence cancer treatment and prognosis. This study investigated the applicability of two indices in reflecting the actual oral health status of 100 non-cancer patients who were admitted for dental complaints/routine controls.

Introduction: Complete edentulism is an eventual oral health outcome and results from the combined pathology of dental caries, periodontal disease, or faulty method of rehabilitation due to reduced cost. Complete edentulism has a significant concern and leads to reduced quality of life (QoL) along with impact on general health. However, it has been observed that due to wider and better oral health services globally, edentulism rate is decreasing every decade. Edentulism is directly related to masticatory and nutritional problems, and some authors regard it as a good mortality indicator. Methodology: The sample population consisted of 100 individuals comprising 63 males and 37 females who fulfilled the inclusion criteria. Geriatric oral health assessment index (GOHAI) was administered by a single investigator at baseline (preinsertion) and also 6 and 12 months postdenture insertion. Sociodemographic data, including age and gender, were also collected. Results: It was observed that the overall oral health-related QoL (OHRQoL) scores of the sample improved significantly at 6 and 12 months postinsertion (P < 0.001) when compared to baseline scores. When GOHAI scores were compared individually for males and females (pre- and post-insertion), it was observed that there was statistically significant improvement in OHRQoL (male - pre = 25.02 ± 1.34 and post-12 months = 8.84 ± 1.26, P < 0.001, female - pre = 25.19 ± 0.88 and post-12 months = 9.05 ± 1.20, P < 0.001) postinsertion of denture in both the groups. Conclusion: OHRQoL in patients improved after complete denture rehabilitation. There was an upward shift in score for each item in GOHAI from preinsertion to 6 and 12 months postinsertion of dentures, reflecting improvement in OHRQoL of the sample. [ABSTRACT FROM AUTHOR]

Aims Whilst there is a considerable body of literature examining the pharmacology of conscious sedation, the social tasks required to successfully provide conscious sedation have not been reported. This paper discusses data regarding the interpersonal work integral to effective conscious sedation provision, from a larger qualitative study exploring how patients and clinicians engage with secondary care conscious sedation provided within the UK. Method Semi-structured interviews were conducted with 13 conscious sedation providers and nine patients within UK-based secondary care sedation settings. Digital audio-recordings were transcribed verbatim and subsequently analysed using a constant comparative method within NVivo Data Analysis Software. Results Four main themes of interpersonal work were reported by participants: displaying care, containing emotions, demonstrating competence and maximizing the effect. Conclusion This study shows that performing conscious sedation requires more than technical delivery, and involves the projection of attributes in a literal 'performance.' The importance of managing outward emotional appearance reflects previous dental research. The need to manage outward appearance, and the emotional impact this has, is of relevance to all clinicians. [ABSTRACT FROM AUTHOR]

Background: Quality of life in elderly is a very sensitive issue. It is important to know if the dental problems, general health and dental treatment have an impact on the quality of life in elderly. The elderly population has a typical set of mind regarding their oral health. This study examines the trends in patients’ behavioral patterns due to tooth loss, suggestive of some change in quality of life. Aims: The purpose of this study was to identify and acknowledge the problems of completely edentulous patients and their relationship to the Quality of Life (QOL). Also, the study was aimed at exploring the changes in global self–rated general health between the pre and post–treatment scores. Settings and Design: This is a randomized controlled clinical trial study which is done to evaluate the problems in the elderly and quality of life as long as their oral health is concerned. It is conducted on a group of people representing the elderly population with complete edentulism. Material and Methods: Sixty three patients with mean age 69.41 who needed dentures were investigated before and after 6 months of their treatment by administration of GOHAI (Geriatric Oral Health Assessment Index) scale. Comparison between Pre & Post–treatment values of various scores were done with McNemar–Bowker Test. Quantitative data was represented using Mean ± SD and Median, IQR (Interquartile range). Analysis of Pre & Post–treatment quantitative data was done using Wilcoxon Signed Rank Test. Results: The results of the present study showed GOHAI scores increased from 28.90 + 7.28 to 42.19 + 7.60 (p=highly significant). There was a significant change in the quality of life in elderly after their prosthodontic rehabilitation, though the self rated general health did not show any significant improvement. Conclusion: It is the responsibility of the entire dental fraternity to understand the needs of elderly associated to their oral health. It is important to evaluate and assess the psychological effects of tooth loss on their quality of life. A thorough investigation is necessary before and after the dental/prosthodontic care.

BACKGROUND: A wide range of oral health conditions has been studies in disabled populations. Many studies showedthat the oral health of individuals who were disabled was poor and their oral treatment needs were greater than those ofthe general population. This study aimed to determine caries experience, levels of oral hygiene, periodontal health andprevalence of malocclusion in a sample of disabled subjects.METHODS: Five special care needs schools were randomly selected from the list of schools in Kerman and all attendantswere examined for dental status on the basis of WHO criteria, gingival health and oral hygiene behaviors. Data wereanalyzed by ANOVA and chi-square tests.RESULTS: There were 297 participants in the study. The most frequent group of disability was mental retard. The meandecayed, missing and filled teeth (DMFT) score was 5.14. Ninety percent of subjects had gingival inflammation. Therewas no significant (P = 0.34) difference between caries experiences of different disable groups.CONCLUSIONS: Oral hygiene of disabled groups was poor and their caries experience rate was very high. Special oralhealth care program for them is recommended

Objectives: The aim of this study was to evaluate efficacy in children affected by Down syndrome of "Digital Brush" in terms of Plaque Index reduction added to the daily oral hygiene procedures.Methods: A total of 56 patients with Down syndrome were recruited and randomly assigned in two groups: both control and test groups underwent standard hygiene procedures of tooth brushing twice a day followed by the intervention of Digital Brush, TNT gauze impregnated with chlorhexidine 0.12%, for the test group and by sterile gauze soaked in water for the control group. Initial plaque index was measured for all patients (T0), subsequently were instructed to use either Digital Brush or gauze soaked with water for 2 weeks. At last, patients were reevaluated (T1) and the plaque index measured.Results: Plaque index improvement from T0 to T1 in control group was 11.7%, while in test group was 24.1%. The mean differences between test and control group was statistically significant (p < 0.001).Conclusions: This study demonstrates how the Digital Brush, added to the daily oral hygiene procedures, obtains significant improvements in supragingival plaque control in children with Down syndrome. [ABSTRACT FROM AUTHOR]

Background: Special Olympics Special Smiles (SOSS) is an initiative created for oral health data collection and education in oral hygiene for athletes with an intellectual disability. The aims of this study were to evaluate treatment needs of participants of Special Olympics in Belgium 2013 in comparison with those from 2008 and to assess the impact of screening and referral within the SOSS in a group of athletes who participated in two consecutive events, 2012 and 2013. Methods: Data were collected following a standardized protocol developed by the U.S. Centres for Disease Control and Prevention, Division of Oral Health. Oral hygiene habits, treatment urgency and reports of oral pain, gingival signs, sealants, untreated caries, missing and filled teeth were recorded. Data analysis of data from 2013 consisted in descriptive statistics followed by the analysis of the data by univariable and multivariable logistic regression. This data was compared with data from 2008 published by Leroy et al., 2012 using Chi square tests. Data from athletes who participated in both Special Olympics events (2012 and 2013) were compared using Exact McNemar's test and Chi-square test for homogeneity of proportions. The level of significance for all tests was set at a p-value < 0.05. Results: A total of 627 athletes with intellectual disability participated to the SOSS program in 2013, while 132 athletes met the inclusion criteria of being a participant at both SO Belgium 2012 and 2013. The prevalence of gingival signs was 44.3 % in 2013, slightly higher than in 2008 (42.4 %). The burden of untreated decay affected 27.1 % of the population showing a net increase in comparison to 2008 (20.9 %). McNemar's test and Chi-square test revealed that there were no statistically significant differences in the proportions of all compared parameters between 2012 and 2013. Conclusion: Special Olympics results from 2013 indicate a considerable unmet treatment need among Belgian Special Olympics Athletes, persistent from 2008 to 2013. Moreover, SO intervention had no impact in the oral health of athletes who participated in 2012 and 2013 events. Continuous efforts for preventive and restorative oral health care are needed for this population. [ABSTRACT FROM AUTHOR]

A foreign service clinic in Guatemala caring for patients with special needs was initiated by joining SCDA efforts with the Open Wide Foundation. The trip included five SCDA members: two AEGD residents and three support staff. Open Wide participants included the Executive Director, the Clinical Director in Guatemala, as well as two dentists, dental support staff, and Guatemalan dental students. Two physician anesthesiologists provided general anesthesia. Care adjuncts included general anesthesia, oral sedation, and medical stabilization.Lessons Learned: (1) Conducting a dental clinic for patients with special needs is possible and relatively easy to accomplish, given a partnership with a foundation that agrees with and facilitates this service; (2) advance planning is required to maximize the service provided; (3) committed and flexible team members can accomplish a significant amount of care in a short period of time; and (4) limited but invaluable training of in-country healthcare providers is possible. The Special Care Dentistry Association is long known for service and care delivery to patients with special needs by its members, and for its advocacy and organizational support for these activities. A foreign service opportunity in Guatemala, Central America, was sought out by members of the SCDA to further the outreach efforts of the organization, give members clinical experience in a foreign setting, and train in-country providers to deliver care to patients with special needs. This was the first effort by SCDA members to host a clinic to deliver care specifically to patients with special needs outside of North America. [ABSTRACT FROM AUTHOR]

ABSTRACT The aim of this study was to evaluate the clinical effectiveness of .12% chlorhexidine applied via spray and the acceptance. A total of 26 individuals with mental health issues, aged 7-14, were included into two groups: placebo (control, n = 13) and chlorhexidine (experimental, n = 13). Both groups received two daily applications of spray during 2 months. The periodontal conditions were evaluated by the simplified oral hygiene index (OHI-S) and gingival index (GI). The evaluation of acceptance of the application method (spray) was assessed by questionnaire. Data were analyzed with nonparametric tests, with a significance level of 5%. Regarding the OHI-S index, only the experimental group showed significant change during the evaluations ( p < 0.001). Regarding the GI, both groups showed significant changes during the evaluations. The method of application was well accepted by patients and caregivers, and .12% chlorhexidine solution applied via spray significantly reduced the rates of dental and gingival biofilm. [ABSTRACT FROM AUTHOR]

Various studies have indicated that persons with special needs may face several barriers to dental treatment, which increases the prevalence of oral diseases in this population. Moreover, these studies suggested that Saudis with special needs have a higher prevalence of oral diseases, such as dental caries and periodontal disease. The aim of this review is to synthesize evidence regarding the current status, trends in oral health behaviors, and oral health care utilization among these individuals, as well as to assess the quality of the literature. Furthermore, this review seeks to recommend directions for future research and oral health care policymaking. An electronic search was conducted using the following databases and registers: PubMed/Medline, Embase, ISI Web of Science, Scopus, ClinicalTrials.gov, and CENTRAL. Gray literature, which included conference proceedings and unpublished literature, was searched via the library services and Google/Google Scholar, and the quality of studies was assessed using the AXIS scale for cross-sectional studies. A total of 38 studies were included in this review, with the majority of the studies graded as 'low'. Within the limitations of this study, it can be concluded that individuals with special needs have limited access to oral health care, poor oral health status, and a general lack of awareness in regard to oral health. Therefore, nationwide surveys should be carried out to ascertain the actual extent of the oral inequities among individuals with special needs.

Objectives: The present study explored the objective and subjective oral health care needs and the association between both among Belgian adults with disabilities. Materials and methods: A two-stage sampling methodology was used to select a sample of adults (22-65 years old) with disabilities, from various types of residential settings, day care centers, and sheltered workplaces and spread over the ten provinces. Oral screenings were performed by 28 trained dentists; subjective oral health care needs were collected through questionnaires. Results: Seven hundred seven adults with disabilities were recruited; from 656 (93 %), permission was obtained for an oral examination. In 467 (78 %) and 407 (68 %) participants, dental plaque and calculus, respectively, were observed. In 343 (56 %) participants, untreated caries lesions (into dentine) were recorded; 203 (33 %) participants had 20 or less teeth. The prosthetic replacement of missing teeth was poor. Exactly 228 (40 %) participants stated that they had a problem in the oral region, and 264 (48 %) indicated that they were in need of an appointment with a dentist. Barriers to consult a dentist were reported by 244 (42 %); fear ( n = 87; 37 %), followed by financial and transportation problems (both, n = 68; 29 %), was the most frequently reported barrier. Conclusions: The preventive as well as curative oral care needs in Belgian adults with various forms of disabilities are very high. Clinical relevance: Efforts to tackle these vast oral health care needs should take into account the differences in needs and demands between subgroups and should comprise the improvement of access to proper care. [ABSTRACT FROM AUTHOR]

Background: Quality of life in elderly is a very sensitive issue. It is important to know if the dental problems, general health and dental treatment have an impact on the quality of life in elderly. The elderly population has a typical set of mind regarding their oral health. This study examines the trends in patients' behavioral patterns due to tooth loss, suggestive of some change in quality of life. Aims: The purpose of this study was to identify and acknowledge the problems of completely edentulous patients and their relationship to the Quality of Life (QOL). Also, the study was aimed at exploring the changes in global self-rated general health between the pre and post-treatment scores. Settings and Design: This is a randomized controlled clinical trial study which is done to evaluate the problems in the elderly and quality of life as long as their oral health is concerned. It is conducted on a group of people representing the elderly population with complete edentulism. Material and Methods: Sixty three patients with mean age 69.41 who needed dentures were investigated before and after 6 months of their treatment by administration of GOHAI (Geriatric Oral Health Assessment Index) scale. Comparison between Pre & Post-treatment values of various scores were done with McNemar-Bowker Test. Quantitative data was represented using Mean ± SD and Median, IQR (Interquartile range). Analysis of Pre & Post-treatment quantitative data was done using Wilcoxon Signed Rank Test. Results: The results of the present study showed GOHAI scores increased from 28.90 + 7.28 to 42.19 + 7.60 (p=highly significant). There was a significant change in the quality of life in elderly after their prosthodontic rehabilitation, though the self rated general health did not show any significant improvement. Conclusion: It is the responsibility of the entire dental fraternity to understand the needs of elderly associated to their oral health. It is important to evaluate and assess the psychological effects of tooth loss on their quality of life. A thorough investigation is necessary before and after the dental/prosthodontic care. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: The American Academy of Pediatrics recommends all preterm infants receive human milk. The objective of this study was to describe the use of human milk in advanced care neonatal units of US maternity hospitals. METHODS: We used Centers for Disease Control and Prevention's national Maternity Practices in Infant Nutrition and Care survey from 2007, 2009, and 2011 to analyze 2 questions to describe the prevalence of US advanced care (special/level 2 or intensive/level 3) neonatal units routinely providing human milk to infants, and the use of any donor milk in these units. RESULTS: In 2011, 30.8% of maternity hospitals reported that most infants (≥90%) were routinely provided human milk in advanced care units, compared with 26.7% in 2009 and 21.2% in 2007 (trend P < .001). States in the Northwest and Northeast had a higher prevalence of hospitals routinely providing human milk to >90% of infants in advanced care units. In 2011, 22.0% of maternity hospitals providing advanced care used banked donor milk, compared with 14.4% in 2009 and 11.5% in 2007 (trend P< .001). Most of this increase occurred in intensive care units (25.1% 2007 vs 45.2% 2011; trend P< .001). There was substantial geographic variation in the prevalence of advanced care units using donor milk; generally the prevalence was higher in the West and in states with a milk bank in the state or a neighboring state. CONCLUSIONS: The use of human milk in US advanced care neonatal units is increasing; however, only one-third of these units are routinely providing human milk to most infants. [ABSTRACT FROM AUTHOR]

Objectives To assess the impact of a multi-tiered oral health education programme on care staff caring for people with intellectual disability ( ID). Methods Postal questionnaires were sent to all care staff of a community-based residential care service for adults, randomly assigned to control and intervention groups. A specifically developed training programme was delivered to residential staff nominees, who then trained all staff within the intervention group. The control group received no training. Post-test questionnaires were sent to both groups. Paired-samples t-test was used to compare oral health-related knowledge ( K) and behaviour, attitude and self-efficacy ( BAS) scores. Results Of the initial 219 respondents, 154 (response rate between 40% and 35.8%, with attrition rate of 29.7% from baseline to repeat) returned completed questionnaires at post-test ( M = 8.5 months, range = 6.5-11 months). Control and intervention groups were comparable for general training, employment and demographic variables. In the intervention group, mean Knowledge Index score rose from K = 7.2 to K = 7.9 ( P < 0.001) and mean BAS scale score rose from BAS = 4.7 to BAS = 5.4 ( P < 0.001). There was no statistically significant increase in mean scores from test ( K = 7.0, BAS = 4.7) to post-test ( K = 7.2, BAS = 4.9) for the control group. Conclusions Mean scores regarding knowledge, attitude, self-efficacy and reported behaviour increased significantly at 8.5 months in staff where training was provided. The results indicate that a multi-tiered training programme improved knowledge, attitude, self-efficacy and reported behaviour amongst staff caring for people with ID. [ABSTRACT FROM AUTHOR]

Leroy R, Declerck D. Oral health-care utilization in adults with disabilities in Belgium. Eur J Oral Sci 2013; 121: 36-42. © 2012 Eur J Oral Sci Reports on oral health-service utilization among individuals with disabilities are very sparse. Nevertheless, such data are a prerequisite for the provision of proper care and for the development of optimal reimbursement schemes and may ultimately lead to better access to care. The objective of the present study was to provide data on oral health-care utilization in Belgian residents with disabilities and to compare these data with the utilization pattern of their peers without special needs. Data from the Permanent Sample of Socially Insured Persons, an anonymous representative sample of Belgian residents, were used. The database contained prospective data on oral and general health-care utilization and socio-demographic variables from 1,221 individuals with disabilities and from 131,877 individuals without disabilities, collected from 2002 to 2008. Overall, annual dental-attendance rates were very low and in those who attended, professional debridements, a cornerstone in preventive oral health care, were infrequently recorded. In adults with disabilities, significantly fewer radiographs, restorations, and endodontic treatments were recorded, whereas significantly more emergency visits were charged. Further research is indicated to evaluate whether this outcome points to high unmet oral-treatment needs. [ABSTRACT FROM AUTHOR]

Modelling patient flow in health care systems is considered to be vital in understanding the operational and clinical functions of the system and may therefore prove to be useful in improving the functionality of the health care system, and most importantly provide an evidence based approach for decision making, particularly in the management of the system. In this paper, we introduce a nonproportional cumulative odds random effects model for patient pathways by violating the proportional assumption of the cumulative odds model. Using the probability integral transform, we have extended this to cases where the random effects are not normal, specifically gamma and exponentially distributions. Some of the advantages of this is that these models depict changes in wellbeing (frailties) of patients as they move from one stage of care to the other in time. This is an hybrid extension of our earlier work by jointly including pathways and covariates to explain probability of transition and discharge, which could easily be used to predict the outcome of the treatment. The models here show that the inclusion of pathways render patients characteristics as insignificant. Thus, pathways provide a source of useful information about transition and discharge than patient characteristics, especially when the model is applied to a London University Neonatal Unit dataset. Bootstrapping was then used to investigate the stability, consistency and generalizability of estimated parameters from the models. [ABSTRACT FROM AUTHOR]

The article studies the practice of one special form of closed accommodation: special care. The term suggests that this is a welfare-oriented response to norm-breaking behaviour of young people. The empirical example comes from Finland, where special care is defined as restrictive activity under the Child Welfare Act and aimed at, among other things, interrupting a vicious circle of crime in young people for the best interests of the child. A contradictory picture is drawn of special care. The article suggests that the contradictions should be understood — but not necessarily accepted — within the social context in which the institutional placements take place. [ABSTRACT FROM AUTHOR]

A systematic review of original studies was conducted to determine if differences in oral health exist between adults who have intellectual disabilities (ID) and the general population. Electronic searching identified 27 studies that met the inclusion criteria. These studies were assessed for strength of evidence. People with ID have poorer oral hygiene and higher prevalence and greater severity of periodontal disease. Caries rates in people with ID are the same as or lower than the general population. However, the rates of untreated caries are consistently higher in people with ID. Two subgroups at especially high risk for oral health problems are people with Down syndrome and people unable to cooperate for routine dental care. Evidence supports the need to develop strategies to increase patient acceptance for routine care, additional training for dentists to provide this care, and the development of more effective preventive strategies to minimize the need for this care. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the mechanical and chemical control of dental biofilm in patients with Down syndrome, using different experimental dentifrices. Material and Methods: Forty institutionalized children between ages 7 and 13 years in the mixed dentition phase participated in this study. An experimental cross-over, blind clinical trial was used, having the following protocols: fluoridated dentifrice (protocol G1); fluoridated dentifrice + chlorhexidine (protocol G2); fluoridated dentifrice + chlorhexidine + plaque-disclosing agent (protocol G3); and fluoridated dentifrice + plaque-disclosing agent (protocol G4). Each experimental stage lasted 10 days with a 15-day washout. The evaluated parameters were Plaque Index and gingival bleeding. Results: The initial clinical conditions between each stage were similar. Statistical differences were observed ( P < 0.001) for the clinical conditions evaluated before and after the treatments. The dentifrices containing plaque-disclosing agent, irrespective of their association with chlorhexidine, produced a greater reduction in the final plaque index. As for gingival bleeding, the dentifrice containing erythrosine and the one containing chlorhexidine produced similar results. The dentifrice containing an association of chlorhexidine and erythrosine gave the best results. Conclusion: With the methodology employed, it was possible to conclude that the combination of drugs (chlorhexidine, fluorine and erythrosine) within one dentifrice can be useful in controlling dental biofilm and in the reduction of gingival bleeding. [ABSTRACT FROM AUTHOR]

In Spain, the wet nurse had a prominent place in the Court of Philip II (1540–1580), suckling princes. The aim of this review is to identify the role of wet nurses in the Spanish monarchy and the survival of the infants, who were children of Philip II (16th century). A scoping review is presented, studying documents on wet nurses in the Spanish monarchy. The dialectical structural model of care (DSMC) is applied, and three thematic blocks are used to make up the historical-cultural model. Books, chapters and databases were analysed from Cuiden, Pubmed, Scopus, Science Direct and Google Scholar, from January–September 2021. These wet nurses were treated as ladies, as they came from wealthy families related to royalty. The services of wet nurses from neighbouring localities to the court were used. They had to be of good appearance and in excellent health. They were hired because of the need for survival of the infants, children of Philip II. The functions of the four wives of Philip II were relegated to reproduction, childcare, family and monarchical duties. They used empirical medicine in the form of prescriptions for beauty, hygiene and feminine care. The wet nurses were the driving force that promoted the health of babies through breastfeeding. [ABSTRACT FROM AUTHOR]

Like the general population, nurses become patients within the health care services available to them. They write anecdotal accounts of their experience and research the experience of their colleagues. This paper reports a small descriptive study of how the positions of senior nurses who experienced a life threatening condition influenced their illness trajectories. Eleven nurses in both New Zealand and Australia told stories of their experiences which focussed on intercessions/intervention by themselves, their family and the health care team. Themes identified were: looking after our own, the gaze of family and friends in advocacy and intercession, stereotypes of nurses as patients, senior nurses as vulnerable patients - existential healing through the small things, and senior nurses as knowledgeable people. Within these themes were narratives of special and meagre care. The authors conclude that all senior nurses should receive care that is regardful of who they are as senior nurses and vulnerable patients. [ABSTRACT FROM AUTHOR]

Scleroderma, the general name of a group of progressive diseases affecting the connective tissues is the most deadly of the varying connective tissue disorders. Characterized by abnormal thickening of the skin, this collagen-vascular disease is associated with immune dysfunction. Hallmark signs of scleroderma include fibrosis, vascular instability and initial inflammation resulting from excessive collagen deposition. Oral facial involvement is considerable, necessitating adaptations in patient oral self-care and influencing oral hygiene. Appropriate dental hygiene management of patients with this autoimmune disorder requires an understanding of clinical characteristics, the recognition of oral facial involvement, treatment considerations and pharmacological interventions. With this information, dental hygienists will be better prepared to provide compassionate, safe and effective dental hygiene management and care to patients with scleroderma. [ABSTRACT FROM AUTHOR]

Objective: To assess prevalence figures for psychiatric disorders among institutionalized adolescents due to behavioural problems and/or delinquency. Method: Participants were recruited from consecutive referrals to/or treated at two Swedish adolescent units, SIS1 (n = 60) and SIS2 (n = 70) with ranging age of 12-20.3 years (mean age = 16.2; SD = 1.8) during 1 year. Clinical and diagnostic information was used to generate DSM-IV diagnoses. Results: One or several neuropsychiatric disorders were diagnosed in 53% of all subjects: 39% met DSM-IV diagnostic criteria for attention deficit/hyperactivity disorder (AD/HD), 15% for a pervasive developmental disorder (referred to as autism spectrum disorders, ASDs) and 8% had a mental retardation (referred to as a learning disability, LD). The collapsed prevalence for psychiatric disorders requiring specialist attention was 66%, counting severe depression and psychotic disorders but not substance use. About one in three of all adolescents in the study were given psychopharmacological treatment. Conclusion: Published studies and this clinical survey clearly indicate that systematic studies of mental health needs among institutionalized adolescents are warranted to form the basis of adequate treatment and support measures. [ABSTRACT FROM AUTHOR]