Assessment of oral health in older adults by non-dental professional caregivers : development and validation of a photograph-supported oral health–related section for the interRAI suite of instruments

Objectives An optimized oral health-related section and a video training were developed and validated for the interRAI suite of instruments. The latter is completed by professional non-dental caregivers and used in more than 40 countries to assess care needs of older adults. Methods The optimized oral health-related section (ohr-interRAI) consists of nine items and a video training that were developed in consecutive phases. To evaluate psychometric properties, a study was conducted in 260 long-term care residents. Each resident was assessed by a dentist and by four caregivers (two who received the video training, two who did not). Results Mean kappa values and percent agreement between caregivers and dentist ranged between kappa = 0.60 (80.2%) for dry mouth and kappa = 0.13 (54.0%) for oral hygiene. The highest inter-caregiver agreement was found for dry mouth with kappa = 0.63 [95% CI: 0.56-0.70] (81.6%), while for the item palate/lips/cheeks only kappa = 0.27 [95% CI: 0.18-0.36] (76.7%) was achieved. Intra-caregiver agreement ranged between kappa = 0.93 [95% CI: 0.79-1.00] (96.4%) for dry mouth and kappa = 0.45 [95% CI: 0.06-0.84] (82.8%) for gums. Logistic regression analysis showed only small differences between caregivers who watched the video training and those who did not. Conclusions Psychometric properties of the optimized ohr-interRAI section were improved compared to previous versions. Nevertheless, particularly the items based on inspection of the mouth require further refinement and caregiver training needs to be improved

SPEKTRALANALYTISCHE AUSWERTUNG SPANNUNGSOPTISCHER BILDER

Two hypotheses have been proposed about the etiology of neurodevelopmental learning disorders, such as dyslexia and dyscalculia: representation impairments and disrupted access to representations. We implemented a multi-method brain imaging approach to directly investigate these representation and access hypotheses in dyscalculia, a highly prevalent but understudied neurodevelopmental disorder in learning to calculate. We combined several magnetic resonance imaging methods and analyses, including univariate and multivariate analyses, functional and structural connectivity. Our sample comprised 24 adults with dyscalculia and 24 carefully matched controls. Results showed a clear deficit in the non-symbolic magnitude representations in parietal, temporal and frontal regions, as well as hyper-connectivity in visual brain regions in adults with dyscalculia. Dyscalculia in adults was thereby related to both impaired number representations and altered connectivity in the brain. We conclude that dyscalculia is related to impaired number representations as well as altered access to these representations.ISSN:1053-8119ISSN:1095-957

An investigation of far and near transfer in a gamified visual learning paradigm.

After training, visual perceptual learning improvements are mostly constrained to the trained stimulus feature and retinal location. The aim of this study is to construct an integrated paradigm where the visual learning happens in a more natural context and in parallel for multiple stimulus types, and to test the generalization of learning-related improvements towards untrained features, locations, and more general cognitive domains. Half the subjects were trained with a gamified perceptual learning paradigm for ten hours, which consisted of an orientation discrimination task and a novel object categorization task embedded in a three-dimensional maze. A second group of subjects, an active control group, played ten hours of Candy Crush Saga. Before and after training, all subjects completed a 'near transfer' orientation discrimination and novel object categorization task, as well as a set of 'far transfer' general cognitive and attentional tasks. During the perceptual learning tasks, two different stimulus features and two retinal location pairs were assessed in each task. For the experimental group, one stimulus feature and retinal location pair was trained, whilst the other one remained untrained. Both features and location pairs were untrained in the control group. Far transfer did occur in some domains across all subjects irrespective of the training regimen (i.e. executive functioning, mental rotation performance, and multitask performance and speed). Near transfer was present in both groups, however only more pronounced for one particular task in the experimental group, namely novel object categorization. To conclude, all but one near transfer task did not generalize more than the control group

An investigation of far and near transfer in a gamified visual learning paradigm

After training, visual perceptual learning improvements are mostly constrained to the trained stimulus feature and retinal location. The aim of this study is to construct an integrated paradigm where the visual learning happens in a more natural context and in parallel for multiple stimulus types, and to test the generalization of learning-related improvements towards untrained features, locations, and more general cognitive domains. Half the subjects were trained with a gamified perceptual learning paradigm for ten hours, which consisted of an orientation discrimination task and a novel object categorization task embedded in a three-dimensional maze. A second group of subjects, an active control group, played ten hours of Candy Crush Saga. Before and after training, all subjects completed a ‘near transfer’ orientation discrimination and novel object categorization task, as well as a set of ‘far transfer’ general cognitive and attentional tasks. During the perceptual learning tasks, two different stimulus features and two retinal location pairs were assessed in each task. For the experimental group, one stimulus feature and retinal location pair was trained, whilst the other one remained untrained. Both features and location pairs were untrained in the control group. Far transfer did occur in some domains across all subjects irrespective of the training regimen (i.e. executive functioning, mental rotation performance, and multitask performance and speed). Near transfer was present in both groups, however only more pronounced for one particular task in the experimental group, namely novel object categorization. To conclude, all but one near transfer task did not generalize more than the control group.status: publishe

“You Don't Have to Be a Drinker to Get Gout, But It Helps”: A Content Analysis of the Depiction of Gout in Popular Newspapers

OBJECTIVE: To analyze the depiction of gout and its management in popular newspapers. METHODS: We conducted a content analysis of popular newspaper articles for reporting about the causes, management, and depictions of gout. The Factiva database was used to identify articles from the 21 highest circulation newspapers in the UK and US from August 2010 to August 2015. Articles with a primary focus on gout were analyzed (n = 114). RESULTS: Overindulgence of certain foods and beverages was most commonly reported as the cause of gout (72 of 114 articles). The range of dietary advice for gout management was extensive, with advice to decrease intake of 44 different food and beverage items and increase intake of 17 different food and beverage items. Strong advice was given for 23 of 40 dietary strategies (58%), 13 of 29 antiinflammatory strategies (45%), and 4 of 42 urate-lowering therapy strategies (10%) (P < 0.0001). Serum urate monitoring or treatment targets were rarely reported. Social embarrassment due to gout was reported in 27 of 114 articles (23.7%). Jokes or humorous references to gout were reported in 30 of 114 articles (26.3%), often highlighting causal beliefs related to lifestyle and drinking alcohol. CONCLUSION: Popular newspaper articles depict gout as a self-inflicted condition that is socially embarrassing and the focus of humor. Dietary solutions are overemphasized compared to effective urate-lowering strategies. Initiatives that challenge popular perceptions of gout may play an important role in changing public understanding about the disease, ultimately increasing the uptake of effective urate-lowering therapy and reducing reliance on unproven strategies.status: publishe

Predictors of patient satisfaction with removable denture renewal: A pilot study

PURPOSE: Conventional removable dentures still play an important role in the treatment of lost teeth. A thorough understanding of the parameters that influence patient satisfaction is useful for deciding whether denture replacement is meaningful. From a clinical perspective, factors that can be measured before starting treatment are relevant. This pilot study investigated whether patient satisfaction after denture renewal was affected by aspects related to the old prostheses, type of jaw, and patient motivation for denture renewal. MATERIALS AND METHODS: Fifty subjects (mean age 68.2 ± 8.4) were provided with 74 removable dentures (partial n = 20, complete n = 54). Satisfaction was assessed before treatment and 3 months after new prosthesis insertion. Total satisfaction 3-month post-insertion (TSP3) merged 6 individual satisfaction items measured after treatment. Change of total satisfaction 3-month post-insertion (CTS3) represented the difference of total satisfaction when old and new prostheses were compared. The effect of the following independent variables was investigated: reason patients requested new dentures (fit, esthetics, broken denture, wear, advice of dentist, extractions), satisfaction with the old prosthesis (general, retention, stability, comfort, pronunciation, chewing, esthetics), and technical quality of the old prostheses as assessed by a dentist (stability, retention, fit, border, wear, esthetics). Gender, age, and a cognitive screening test were included as confounding variables. Mann-Whitney-U tests and linear mixed model analysis were performed. RESULTS: All individual satisfaction items significantly improved with new prostheses for maxillary and mandibular jaws. TSP3 was higher for maxillary prostheses, if retention satisfaction with the old prosthesis was good, and if the dentist assessed the esthetics of the old prosthesis as deficient. CTS3 was associated with male gender, dissatisfaction with chewing before treatment, and dissatisfaction with esthetics before treatment. CONCLUSIONS: This pilot study showed that satisfaction 3 months after new denture insertion was associated with aspects of satisfaction and quality related to the old prosthesis, type of jaw, and gender. These factors may help dentists predict therapeutic benefits when deciding on the need for denture replacement. Further research should be done with a greater number of subjects and should include balanced quantities of the different types of dentures.status: publishe

Impact of Denture Cleaning Method and Overnight Storage Condition on Denture Biofilm Mass and Composition: A Cross-Over Randomized Clinical Trial.

BACKGROUND:Appropriate oral hygiene is required to maintain oral health in denture wearers. This study aims to compare the role of denture cleaning methods in combination with overnight storage conditions on biofilm mass and composition on acrylic removable dentures. METHODS:In a cross-over randomized controlled trial in 13 older people, 4 conditions with 2 different mechanical cleaning methods and 2 overnight storage conditions were considered: (i) brushing and immersion in water without a cleansing tablet, (ii) brushing and immersion in water with a cleansing tablet, (iii) ultrasonic cleaning and immersion in water without a cleansing tablet, and (iv) ultrasonic cleaning and immersion in water with a cleansing tablet. Each test condition was performed for 5 consecutive days, preceded by a 2-days wash-out period. Biofilm samples were taken at baseline (control) and at the end of each test period from a standardized region. Total and individual levels of selected oral bacteria (n = 20), and of Candida albicans were identified using the Polymerase Chain Reaction (PCR) technique. Denture biofilm coverage was scored using an analogue denture plaque score. Paired t-tests and Wilcoxon-signed rank tests were used to compare the test conditions. The level of significance was set at α< 5%. RESULTS:Overnight denture storage in water with a cleansing tablet significantly reduced the total bacterial count (p<0.01). The difference in total bacterial level between the two mechanical cleaning methods was not statistically significant. No significant effect was observed on the amount of Candida albicans nor on the analogue plaque scores. CONCLUSIONS:The use of cleansing tablets during overnight denture storage in addition to mechanical denture cleaning did not affect Candida albicans count, but reduced the total bacterial count on acrylic removable dentures compared to overnight storage in water. This effect was more pronounced when combined with ultrasonic cleaning compared to brushing. TRIAL REGISTRATION:ClinicalTrials.gov NCT02454413

Can the interRAI Home Care instrument be applied to the definition criteria of the Global Leadership Initiative on Malnutrition (GLIM)? A longitudinal study

BACKGROUND & AIMS: As malnutrition is an important modifiable risk factor for poor clinical outcomes, it is important to target malnourished older people and older people at risk of malnourishment. The Global Leadership Initiative on Malnutrition (GLIM) recently reached a consensus for a global definition of malnutrition. The primary aim of this study was to apply the interRAI Home Care (interRAI HC) instrument to fit the GLIM definition criteria of malnutrition to the closest. A second goal was to identify potential risk factors associated with malnutrition using this comprehensive assessment and to quantify their association. METHODS: This is a case control study, which retrospectively determines the exposure to the risk of malnutrition and estimates its potential risk factors. The longitudinal data came from a larger study called Protocol 3. Eligibility criteria were a minimum age of 65 years old, a minimum score of 6 on the Edmonton Frail Scale or at least a moderate level of functional impairment measured by a Belgian version of the Katz scale. Older people with an official dementia diagnosis were also eligible. Bivariate analysis was performed and logistic regression models were developed in order to identify significant determinants of malnutrition. RESULTS: The data consisted of 6334 frail older people (mean age: 80.6 ± 6.9, 70.6% female). About 2.4% became malnourished within a follow-up period of one year after baseline. The adjusted logistic regression yielded significant odds ratios for dysphagia (OR 2.2), loss of appetite (OR 1.8), bladder incontinence (OR 1.5) and low fluid intake (OR 1.5). Diabetes (OR 0.5) and visits to the physician (OR 0.5) had both a significant reverse effect. CONCLUSIONS: This study was the first large longitudinal research to explore the risk factors of malnutrition with a comprehensive assessment instrument as the interRAI HC, applying it to the recent GLIM definition criteria. The worldwide use of the interRAI instruments makes these findings relevant for global clinical practice and research. Adapting the interRAI instruments to the GLIM definition improves accurate detection, prevention and early treatment of malnourishment, avoiding further health deterioration in older people.status: Published onlin