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Context: Active white spot lesions (WSLs) are a great concern to clinicians. Aims: This in vitro experiment analyzed cross-sectional microhardness (CSMH) values of occlusal artificially induced active WSLs (control groups D/A, D/B and D/C) along with experimental groups where these lesions were: Exposed to an artificial high risk cariogenic challenge (HRCC) using pH cycling; treated with a glass ionomer cement (GIC) and then exposed to artificial HRCC; or a fluoride varnish (FV) and afterwards submitted to the same artificial HRCC. Materials and Methods: Sixty unerupted human third molars were sectioned buccolingually on the occlusal surface and demineralized for 42 days. One half of each tooth was allocated to control groups (D/A, D/B, and D/C) and the other were used as test groups: A (pH cycling); B (GIC + pH cycling); and C (FV + pH cycling). CSMH test was performed for sound, demineralized, and treated specimens. Statistical Analysis Used: Different depths for CSMH values did not have a normal distribution (Kolmogrov–Smirnov test) and for that matter Wilcoxon and T Test were applied (significance level of 5%). Results: Mean depth of the lesion was 120 μm. A number of samples both in the test groups (n = 37) as in control groups (n = 47) had a lower Knoo p value (softening) or surface erosion. Comparisons between control and test groups only showed statistical difference at a depth 140 μm (P = 0.010) in control group D/A and for test group B at 20 μm (P = 0.004) and at 40 μm (P = 0.007). Conclusions: This in vitro study demonstrated that the use of GIC over an artificial active WSLs and exposed to an artificially HRCC setting tend to express some effect in increased surface KHN values.

Annelore H van Dalen-Kok,1 Wilco P Achterberg,1 Wieke E Rijkmans,1 Sara A Tukker-van Vuuren,1 Suzanne Delwel,2,3 Henrica CW de Vet,4 Frank Lobbezoo,2,5 Margot WM de Waal1 1Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, 2Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, 3Department of Clinical Neuropsychology, Faculty of Behavioral and Movement Sciences, VU University, 4Department of Epidemiology and Biostatistics, The EMGO Institute for Health and Care Research, VU University Medical Center, 5MOVE Research Institute Amsterdam, VU University, Amsterdam, the Netherlands Objectives: Detection and measurement of pain in persons with dementia by using observational pain measurement tools is essential. However, the evidence for the psychometric properties of existing observational tools remains limited. Therefore, a new meta-tool has been developed: Pain Assessment in Impaired Cognition (PAIC), as a collaborative EU action. The aim is to describe the translation procedure and content validity of the Dutch version of the PAIC.Methods: Translation of the PAIC into Dutch followed the forward-backward approach of the Guidelines for Establishing Cultural Equivalence of Instruments. A questionnaire survey was administered to clinical nursing home experts (20 physicians and 20 nurses) to determine whether the PAIC items are indicative of pain and whether items are specific for pain or for other disorders (anxiety disorder, delirium, dementia, or depression). To quantify content validity, mean scores per item were calculated.Results: Eleven items were indicative of pain, for example, “frowning,” “freezing,” and “groaning.” Fifteen items were considered to be pain-specific, for example, “frowning,” “curling up,” and “complaining.” There were discrepancies between the notion of pain characteristics according to nurses and physicians, especially in the facial expressions domain.Discussion: Within the body movement domain, PAIC items correspond well with the clinical experience of the physicians and nurses. However, items in the facial expressions and vocalizations domains need further study with respect to item reduction. Also, differences were revealed in the notion of pain characteristics between physicians and nurses, suggesting the need for more interdisciplinary education on pain in dementia. Keywords: content validity, dementia, education, nursing home, observational pain measurement tool, pain

Objective: The 5-level EuroQoL (EQ-5D-5L) is a patient-reported outcome measure frequently used in stroke research. However, it does not assess the cognitive problems many patients with stroke experience. The aim of this article is to compare the content validity, internal consistency and discriminative ability of the EQ-5D-5L with and without an additional cognitive domain (EQ-5D-5L+C), administered three months post-stroke. Design: Cross-sectional study. Setting: Six general hospitals in the Netherlands. Subjects: In all, 360 individuals with stroke three months after the event. Interventions: Not applicable. Main measures: The modified Rankin Scale and EQ-5D-5L+C were administered in telephone interviews three months post-stroke. Results: A total of 360 patients with stroke were included. Mean age was 68.8 years (standard deviation (SD) = 11.7), 143 (40%) were female, 334 (93%) had had an ischemic stroke, 165 (46%) had a National Institutes of Health Stroke Scale (NIHSS) score ⩽ 4 at presentation and the Barthel Index was 17.2 (SD = 4) four days post-stroke. Cognitive problems were reported by 199 (55%) patients three months post-stroke. Internal consistencies of the EQ-5D-5L and EQ-5D-5L+C were 0.75 and 0.77, respectively. Adding a cognitive domain resulted in a decrease of the ceiling effect from 22% to 14%. Both EQ-5D-5L and EQ-5D-5L+C showed good discriminative ability, but differences between patients with different modified Rankin Scale scores and with/without reported decrease in health and daily activities were slightly larger with the EQ-5D-5L+C compared to the EQ-5D-5L. Conclusions: The EQ-5D-5L+C, which includes a cognitive domain that is highly significant for stroke patients, showed increased content validity and good discriminative ability, without losing internal consistency. [ABSTRACT FROM AUTHOR]

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Conclusions: Provox Vega prostheses demonstrate good short-term feasibility, and their optimized airflow-resistance design offers laryngectomy patients indwelling voice prostheses with more choices in outer diameters without sacrificing (too) much in voice quality. Objectives: Technological progress enables improvement of in vitro airflow characteristics of voice prostheses and design of voice prostheses with smaller outer diameters. This could potentially improve voice quality in users of Provox2, and avoid diminished voice quality in users of prostheses with smaller outer diameters. Methods: This was a prospective clinical phase I/feasibility study of three newly designed indwelling voice prostheses (Provox Vega 22.5 (Provox2 successor), 20, and 17Fr). Assessments consisted of patients' self-reported voice and speech, perceptual evaluation, acoustic analysis, maximum phonation time, loudness, speech rate, pull-out force and adaptation of the tracheoesophageal (TE) puncture to smaller diameter voice prostheses. Vega 22.5 was assessed in 15 patients (all Provox ActiValve users, observation period 3 weeks), and 16 patients with Vega 20/17 (2 weeks each). Results: No voice prostheses problems were encountered. Half of the patients with Vega 22.5 preferred that for its better voice quality. Voice and speech were considered equal to Provox2 for Vega 20, but slightly less for Vega 17. Most TE punctures adapted well to the smaller diameter voice prostheses. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate the implementation of standardized physical and functional tests to monitor patients with a spinal cord injury (SCI) in eight rehabilitation centers and to analyze the enablers and the barriers of the implementation process. Method. The method involved prospective effect and process evaluation. Team members responded to mailed questionnaires at the start ( n = 115) and end ( n = 82) of the 1-year implementation period. Furthermore, a questionnaire was administered to managers ( n = 8), coordinators ( n = 8), and 32 persons with SCI in four centers. Outcome of the effect evaluation was the phase of implementation of standardized testing in each center. The process evaluation analyzed enablers and barriers of the implementation process. Results. After a year of implementation, half of the centers shifted to higher implementation phases. None of the centers was classified in the highest phase. Enablers were the positive attitude of the team members regarding standardized testing and an encouraging local coordinator. Most important barrier was lack of time to implement the standardized testing. Conclusion. There is a large support for implementing standardized tests to monitor patients with SCI. During the 1-year, a positive shift was visible in the extent of implementation. Successful implementation of patient monitoring requires substantial amounts of time and effort of the rehabilitation centers involved. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The Utrecht Scale for Evaluation of Rehabilitation (USER) is a measure of functional independence that covers physical functioning (mobility, self-care), cognitive functioning and additional domains of pain, fatigue and mood. USER is implemented in the Netherlands as a generic rehabilitation outcome measure. This article reports the development and psychometric characteristics of USER. DESIGN: (1) Inter-rater reliability study and (2) responsiveness study with measurements at admission and at discharge from clinical rehabilitation. SETTING: Three rehabilitation facilities in the Netherlands. PATIENTS: Rehabilitation inpatients (N = 319). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Effect size (ES) and standardized response mean (SRM) of USER scales were compared to those of the Barthel Index, Functional Independence Measure (FIM) and to relevant scales of the SF-36. RESULTS: Inter-rater reliability of USER was satisfactory to good. Strong correlations were found between the physical and cognitive functioning scores of USER, the Barthel Index and FIM (0.84-0.94). Correlations between USER pain, fatigue and mood scores and SF-36 scores were also strong (0.58-0.84). Responsiveness of USER physical functioning (1.0-1.2) was very good and slightly better than responsiveness of the Barthel Index (0.9-1.1) and the FIM motor score (0.8-1.1). Responsiveness of the USER cognitive score was below standard (0.2-0.3), but better than responsiveness of the FIM cognitive scores (0.1-0.2). CONCLUSIONS: USER is a reliable, valid and responsive measure of functional independence that can be used as an alternative for the FIM. The pain, fatigue and mood scores were adapted after this study and need additional validation. [ABSTRACT FROM AUTHOR]

The Malaysian Adults Nutrition Survey (MANS) was carried out between October 2002 and July 2003, involving 6,775 men and 3,441 women aged 18 - 59 years. Anthropometric assessment showed that the overall mean body weight and BMI were 62.65 kg (CI: 62.20, 63.09) and 24.37 kg/m2 (CI: 24.21, 24.53) respectively. Based on the WHO (1998) classification of BMI, 12.15% (CI: 11.26, 13.10) were obese (BMI ⩾ 30 kg/m2), and 26.71% (CI: 25.50, 27.96) overweight (BMI ⩾ 25 - 29.9 kg/m2). Significantly, more women were obese [14.66% (CI: 13.37, 16.04)] while significantly more men were overweight [28.55% (CI: 26.77, 30.40)]. Ethnicitywise, prevalence of obesity was highest among the Malays [15.28% (CI: 13.91, 16.77)] while overweight was highest for the Indians [31.01% (CI: 26.64, 35.76)]. Both obesity and overweight were highest among those aged 40 - 49 years. Obesity was highest for those whose household income was between RM1,500 - 3,500 while overweight was more prevalent for those whose household income exceeded RM3,500. The prevalence of overweight was highest for those with primary education [31.90% (CI: 29.21, 34.72)]. There was no significant urbanrural differential in both obesity and overweight. The study found 9.02% (CI: 8.82, 10.61) with chronic energy deficiency (CED) (BMI < 18.5 kg/m2). The prevalence of CED was relatively higher in the indigenous population (Orang Asli) [14.53% (CI: 5.14, 34.77)], subjects aged 18-19 years [26.24% (CI: 21.12, 32.09)], and with monthly household income of < RM1,500 [10.85% (CI: 9.63, 12.20)]. The prevalence of CED was not significantly different among the geographical zones and educational levels, and between urban/rural areas and sexes. The results call for priority action to address the serious problem of overweight and obesity among Malaysian adults as it poses a grave burden to the country's resources and development. [ABSTRACT FROM AUTHOR]

Purpose. To examine the intra- and inter-rater reliability, criterion validity and responsiveness of the Utrecht Arm/hand Test (UAT), a quick and easy assessment method for upper extremity impairment after stroke. Method. Study 1 (N = 29): Repeated administration of the UAT at admission and discharge; comparison with scores on the Fugl-Meyer test (FM), Action Research Arm test (ARA) and Self-Care scale of the Functional Independence Measure (FIM). Study 2 (N = 192): Admission of the UAT and Frenchay Arm Test at admission (FAT) and discharge. Computation of Spearman correlations between UAT and FAT and comparison of the Effect Size and the Standardised Response Mean of both measures. Results. Study 1: Spearman correlations between UAT and FM were 0.93 at admission and 0.94 at discharge. Correlations with ARA and FIM were also high: 0.90 and 0.76 at admission, and 0.89 and 0.73 at discharge. Inter-rater and intra-rater reliability were excellent (weighted [kappa] 0.98-0.99). Study 2: Correlations between UAT and FAT were 0.93 at admission and 0.90 at discharge. The mean UAT score improved from 3.7 at admission up to 4.6 at discharge (p < 0.001). The Effect Size and Standardised Response Mean of the UAT were better than those of the FAT. Conclusion. The UAT is a simple, valid and reliable bedside test for the evaluation of upper extremity impairment after stroke. [ABSTRACT FROM AUTHOR]

Purpose. To determine participation restrictions of young adults with spina bifida (SB) in relation to health condition and activity limitations. Method. A total of 179 persons aged 16-25 years and born with SB participated in a cross-sectional study. The main outcome on four domains of participation (independent living, employment, education and partner relationships) was assessed using a structured questionnaire. Results. At the mean age of 21 years only 16% were living independently, more than one-third of the participants went to special secondary education, 53% of those who finished education did not have a regular job and 71% did not have a partner. Health condition variables (type of SB, hydrocephalus and level of lesion) and to a lesser extent activity limitations (wheelchair dependence and incontinence) were significant determinants for having participation restrictions. Perceived hindrances in participation included long-distance transportation (19-36%), accessibility (10-42%), physical impairments (22-40%), emotional barriers (20-32%) and financial limits (3-17%). More severe SB, defined as hydrocephalus, high level of lesion and wheelchair dependence, was related with more experienced hindrances due to long-distance transportation accessibility of buildings. Conclusions. Many young adults with spina bifida experience participation restrictions. Severity of SB was negatively related to participation. Social integration should be a major focus in the professional guidance of youngsters with physical disabilities. [ABSTRACT FROM AUTHOR]

Background. The CAMCOG is a valid screening instrument for cognitive dysfunction in stroke patients but too time-consuming to be used by physicians in acute or post-acute care settings. The aim of this study was to identify a shorter cognitive screening test or combination of tests that yields the same results as the CAMCOG. Methods. A total of 169 stroke patients completed the CAMCOG and the abbreviated Rotterdam-CAMCOG (R-CAMCOG), Mini Mental State Examination (MMSE) and the cognitive part of the Functional Independence Measure (FIM cognition) after admission to clinical rehabilitation and 1 year after stroke. The CAMCOG score was used as criterion standard for validity. Results. Spearman correlations with the CAMCOG were very strong for the R-CAMCOG (both 0.92), strong for the MMSE (0.66 and 0.69) and moderate to weak for the FIM cognition (0.35 and 0.27). Stepwise linear regression analyses showed that, at admission, the R-CAMCOG explained 83% of the variance in the CAMCOG. The MMSE and R-CAMCOG together explained 87%. At 1 year after stroke the correlations and explained variances were similar. Conclusion. The recently constructed R-CAMCOG appears an efficient alternative for the CAMCOG as a screening tool for cognitive dysfunction of stroke patients. [ABSTRACT FROM AUTHOR]

Objective: To describe the development of a classification for therapeutic activities in clinical spinal cord injury (SCI) rehabilitation.Design: Descriptive study including a modified Delphi consensus method.Setting: Specialized SCI units of 10 rehabilitation facilities.Participants: Thirty physical therapists, occupational therapists, and sports therapists from 10 Dutch and Flemish SCI centers.Main outcome measures: Identification of the levels, categories, and interventions; level of agreement among experts with (1) definitions, (2) terminology, (3) relevance, and (4) completeness of the classification (consensus considered sufficient if 80% or more agree).Results: The classification comprises three levels of functioning: basic functions, basic activities, and complex activities. The three levels comprise 28 categories within which interventions are listed. Sufficient consensus was obtained for the definitions of the three levels (range, 87%-100%). Percentages of consensus for the terminology used and the completeness of the categories ranged from 75% to 100%. The perceived relevance of the categories for everyday work varied per discipline.Conclusion: A potentially useful classification was developed to record clinical treatment sessions in physical therapy, occupational therapy, and sports therapy for persons with SCI. The classification is currently being tested in ongoing research. [ABSTRACT FROM AUTHOR]

PURPOSE: Currently no well validated instrument exists to assess the quality of the assistive technology delivery from the client's perspective. An instrument was developed called KWAZO, consisting of seven questions related to accessibility, knowledge, coordination, efficiency, flexibility and influence of the user. KWAZO, meaning 'quality of care', can be completed by the clients without any assistance. In this study, the feasibility, internal consistency and convergent validity of KWAZO were examined. METHOD: The data stem from a large monitoring study into non-use of and satisfaction with assistive technology (n = 4637) using a mailed questionnaire. Feasibility was tested by studying the rate of non response for each of the questions. To test convergent validity the KWAZO total score was compared to answers on a question about overall satisfaction with service delivery of D-QUEST. RESULTS: Only few missing values were seen (3.1 - 7.5%). Cronbach's alpha was good (0.89), indicating that KWAZO reliably measures one concept. Convergent validity was shown by a moderately strong correlation between KWAZO and the D-QUEST question (0.54; p < 0.001). A difference of about 2.5 points seems to reflect a relevant difference in user satisfaction. CONCLUSIONS: KWAZO is a new questionnaire to assess the quality of an assistive technology provision process from a client's perspective. KWAZO has decent measurement properties and its self-report format makes it an easy-to-use tool for assessment of the quality of assistive technology provision. [ABSTRACT FROM AUTHOR]