Challenges in geriatric oral health research methodology concerning caregivers of cognitively impaired elderly adults

Little is known about oral health care behaviors of community-dwelling, cognitively impaired elderly (CIE) persons. Few studies have been conducted regarding the actual provision of oral care for CIE persons or the attitudes and concerns about oral health among their caregivers. The CIE person's ability to perform self-care decreases over time, and the role of the caregiver in daily oral care becomes increasingly important. The purpose of this pilot study was to explore the attitudes toward oral health and identify related concerns among caregivers who care for community-dwelling CIE persons. Caregivers were surveyed by means of a self-administered, mailed questionnaire. To maintain confidentiality, an intermediary was used for recruitment and data collection. Overall, 148 caregivers were invited by an intermediary to participate in the survey; only 21 (14%) consented to participate and returned the questionnaire. This paper discusses some of the numerous methodological challenges identified when an attempt was made to survey caregivers' attitudes toward and barriers to providing oral care for a dependent CIE.     

Urban/Rural Differences in Prosthetic Dental Service Rates

There have been few reports of relative rates of provision of dental health services in rural and urban settings, a comparative measure of access to care in these populations. One part of a statewide survey of active North Carolina general dentists (n=959, response rate=47%) was designed to quantify provision of prosthetic services. To determine contrasting rural and urban rates, responses were analyzed according to dentists'self-report of practice city size using analysis of covariance with percent of insured patients in the practice as the covariate. Mean per-patient-visit rates for crowns, fixed partial dentures, removable partial dentures, and extractions, as well as the distributions of treatment following tooth extraction, differed by city size, with practitioners in the smallest cities reporting treatment distributions reflecting more frequent loss of teeth and less frequent replacement. These differences in patterns of prosthetic care echo the limited existing information describing oral health status, provider supply, and receipt of care, all of which suggest that differential levels of access to care exist and lead to differences in oral health outcomes.     

The Solution Method: 2-year trends in Weight, Blood Pressure, Exercise, Depression, and Functioning of Adults trained in Development Skills

This study describes changes observed during a 2-year period in participants enrolled in The Solution Method, a developmental skills training program for adult weight management. This Intervention is the adult application of a model of treatment previously used only in the management of pediatric obesity (The Shapedown Program). Developmental skills training integrates understandings and methods from developmental, family systems, biomedical, genetic, and behavioral theories of the etiology of obesity. Twenty-two subjects (mean age=43.4±8.5 years and mean body mass index=33.1+5.3) completed a group intervention based on this method, which was conducted by a registered dietitian and a mental health professional. Questionnaire responses indicated the extent to which their weight was a medical and/ or psychosocial risk. Subjects attended 2-hour weekly sessions for an average of 18 weeks during which they were trained in six developmental skills: strong nurturing, effective limits, body pride, good health, balanced eating, and mastery living. Data, which were collected at the beginning of treatment and at 3, 6, 12, and 24 months, included weight, blood pressure, 7-day exercise recalls, and responses to depression and functioning (psychosocial, vocational, and economic) questionnaires. Participants’ weights decreased throughout the 2-year period of the study: mean weight change was −4.2 kg (3 months), −6.0 kg (6 months), −7.0 kg (12 months), and −7.9 kg (24 months). In addition, compared with baseline values, systolic and diastolic blood pressure, exercise, and depression improved throughout the study period. These improvements were statistically significant at 24 months for weight (p<.01), systolic blood pressure (p<.02), diastolic blood pressure (p<.001), and exercise (p<.001); the results were not statistically significant for depression. Most participants reported improvement in a broad range of aspects of functioning. We conclude that this application of developmental skills training for adult weight management may produce significant long-term beneficial effects. J Am Diet Assoc. 1997;97:1133–1138.     

Computer-Assisted Instruction Improves Clinical Reasoning Skills of Dietetics Students

Objective The effects of a computer-assisted instruction (CAI) tutorial program on learning clinical reasoning skills were compared in undergraduate dietetics students.Design A drill-and-practice program to control for time on task, a tutorial program, and a simulation program, as the test vehicle, were developed. The tutorial and simulation programs presented data on a patient with cardiovascular disease.Setting Subjects were tested in 30 undergraduate dietetics programs.Subjects Participants were 413 undergraduate diet therapy students enrolled in a coordinated program in dietetics (CPD) or a didactic program in dietetics (DPD).Intervention After completion of lectures on cardiovascular disease, subjects were given the drill-and-practice program plus a simulation test (group 1), the tutorial plus a simulation test (group 2), or the simulation test only (group 3).Main outcome measures Scores on the simulation test were compared. Variables included type of CAI, dietetics program, year in school, computer experience, and experience using a medical chart. Mastery of objectives related to lower- and higher-level clinical reasoning skills introduced in the tutorial program was compared.Statistical analysis One-way analysis of variance and Student-Newman Keuls tests were conducted to determine any differences among the three groups. Reliability was determined using the Kuder-Richardson Formula 20.Results The reliability coefficient of the simulation test was 0.93. Group 2 scored higher on the simulation test than group 1 or group 3. As a group, the CPD students scored higher than the DPD students. When CPD and DPD students were divided into the three experimental groups, there was no significant difference between the CPD and DPD student simulation scores. Group 2 mastered all objectives for lower-level reasoning skills and the higher-level decision-making objective better than groups 1 and 3.Applications/conclusions A computer tutorial program enhanced clinical reasoning skills in undergraduate dietetics students. This type of program could be used to supplement many topics taught in diet therapy and provide DPD students with experiential learning before their clinical intern practicums. J Am Diet Assoc. 1995; 95:868–873.     

Reaching mothers of preschool-aged children with a targeted quit smoking intervention

Younger women smoke at disproportionately higher rates than other women and their smoking has a major impact on the health of their young children. To address this problem, a smoking cessation intervention combining minimal advice and assistance from a community health nurse and a tailored self-help guide was developed for low-income women with young children. The program evaluation results reported here were gathered from women using publicly funded pediatric services in four agencies with 32 clinic sites in central and eastern Pennsylvania. Unlike volunteers in formal cessation programs, the women varied widely in their readiness to quit smoking. Follow-up data were obtained from 1,230 female smokers, aged 18 to 39, after receiving brief, individualized smoking cessation advice and encouragement to read the self-help guide. One year later, 12.5 percent reported quitting smoking, and 20.2 percent reported having made a serious quit attempt that lasted at least 7 days. These results suggest that, even among smokers with low socioeconomic status and wide variation in their readiness to quit, minimal intervention programs requiring modest resources can promote cessation.This work was funded under contracts from the Cancer Control Program, Pennsylvania Department of Health (SPC-883141 and SPC-979425). The Quitting Times STOP IT quit smoking protocol was adapted from the Smoking Cessation Project, Maternal and Child Health, Massachusetts Department of Public Health. The authors also wish to express appreciation to the staff of the Division of Population Science, Fox Chase Cancer Center for their contributions to this project and especially those of Chris Jepson, Eunice King, C. Tracy Orleans, and Marjorie Utt.     

Comparison of the treadmill exercise score and single-photon emission computed tomographic thallium imaging in risk assessment

Background  

This study compared the prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging with that of treadmill exercise score in medically treated patients with coronary artery disease (CAD)     

Effect of inhaled methanol on pituitary and testicular hormones in chamber acclimated and non-acclimated rats.

Two experiments were conducted in which the acute effects of inhaled methanol on serum hormones associated with reproductive function in the male rat were evaluated. In the first experiment, rats exposed to methanol (0, 200, 5000 and 10,000 ppm) for 6 h were killed at the end of the exposure period (6 h) or the following morning (24 h). Also, because the process of exposure itself could modify neuroendocrine function, the effect of the handling associated with placing the rat in the exposure chamber was evaluated further by dividing the exposed animals into acclimated (2 weeks of prior handling) and non-acclimated groups. At 6 h, an effect of prior handling was noted in the sham-exposed rats, with serum luteinizing hormone (LH) of the non-acclimated group being greater than that of the acclimated group. Serum LH concentrations were altered by methanol exposure, but the direction of change and the exposure level at which an effect was noted differed between the acclimated and non-acclimated rats. Methanol (5000 ppm) reduced serum LH in the non-acclimated animals, while 10,000 ppm increased LH in the acclimated rats. Follicle stimulating hormone (FSH) and testosterone were unchanged by methanol in rats killed at 6 h. Thus, this experiment did not confirm earlier reports that exposure to 200 ppm for 6 h reduced serum testosterone. At 24 h, an effect of prior handling was still present in the hormonal measures, with serum and interstitial fluid testosterone concentrations being greater in the non-acclimated rats. Also, there was a dose x handling interaction with methanol exposure inducing an increase in serum testosterone in the non-acclimated rats (up to 5000 ppm) and a decrease in the acclimated rats (up to 10,000 ppm). In the second experiment, groups of acclimated and non-acclimated rats were exposed to 0 or 5000 ppm methanol for 1, 2 and 6 h and killed immediately after removal from the chamber. Serum LH, testosterone and FSH values were not different in sham- vs methanol-exposed rats at any time point. As in experiment 1, an effect of prior handling was noted. In general, the concentrations of these hormones and serum prolactin in the non-acclimated rats were greater than those observed for acclimated rats. Methanol exposure resulted in increased prolactin concentrations under both handling conditions.(ABSTRACT TRUNCATED AT 400 WORDS)     

Eighteen-month Coronal Caries Incidence in North Carolina Older Adults

In this longitudinal study of a random sample of North Carolinians over the age of 65 and living in their homes, 325 blacks and 280 whites were examined and interviewed 18 months after baseline examinations. Coronal caries incidence was greater among whites than blacks. The increment due to teeth becoming root fragments were similar for both races; however, there were more newly crowned teeth among whites. Newly crowned surfaces were not used as part of the caries increment in logistic regression models to investigate potential risk predictors. For blacks, caries development over the 18-month period was associated with a higher lactobacillus score and more coronal caries at baseline, more previously filled coronal surfaces, and lack of active membership in clubs or other groups. For whites, having no self-reported tooth sensitivity, having a lower socioeconomic index score, taking antihistamine medications at baseline, and having the perception of more problems after the age of 40 than before were all associated with the development of coronal caries.