Wellbeing and mental health outcomes amongst hospital healthcare workers during COVID-19.

BACKGROUND: Global healthcare systems have been particularly impacted by the COVID-19 pandemic. Healthcare workers (HCWs) are widely reported to have experienced increased levels of baseline psychological distress relative to the general population, and the COVID-19 pandemic may have had an additive effect. However, previous studies are typically restricted to physicians and nurses with limited data available on hospital HCWs. We aimed to conduct a cross-sectional, psychological evaluation of Irish HCWs during COVID-19. METHODS: HCWs across five adult acute level-4 Dublin-based hospitals completed an online survey of wellbeing and COVID-19 experience. RESULTS: There were 1898 HCWs who commenced the survey representing 10% of the total employee base. The sample comprised nurses (33%), doctors (21%), Health and Social Care Professionals (HSCPs) (24%) and 'Other' disciplines (22%), and 81% identified as female. Clinical levels of depression, anxiety and PTSD symptoms were endorsed by 31%, 34% and 28% of respondents, respectively. Professional grouping effects included: nurses reporting significantly greater levels of COVID-19 exposure, infection, COVID-fear, moral injury, and post-traumatic distress; HSCPs were significantly less likely to report mood dysfunction. In terms of gender, males were significantly less likely to report negative pandemic experiences, low resilience, and significantly more likely to endorse 'minimal' depression, anxiety, and traumatic distress. Logistic regression modelling revealed mental health outcomes (depression, anxiety and PTSD symptoms) were associated with increased frontline exposure, fewer career years' experience, elevated pre-pandemic stress, and female gender. DISCUSSION: To our knowledge, this is the largest evaluation of psychological wellbeing amongst HCWs in acute hospitals in the Dublin region. Our findings have implications for healthcare workforce wellbeing and future service delivery.

An investigation of the use of standardised leaving certificate performance as a method of estimating pre-morbid intelligence.

BACKGROUND: In cases of brain pathology, current levels of cognition can only be interpreted reliably relative to accurate estimations of pre-morbid functioning. Estimating levels of pre-morbid intelligence is, therefore, a crucial part of neuropsychological evaluation. However, current methods of estimation have proven problematic. OBJECTIVE: To evaluate if standardised leaving certificate (LC) performance can predict intellectual functioning in a healthy cohort. The LC is the senior school examination in the Republic of Ireland, taken by almost 50 000 students annually, with total performance distilled into Central Applications Office points. METHODS: A convenience sample of university students was recruited (n = 51), to provide their LC results and basic demographic information. Participants completed two cognitive tasks assessing current functioning (Vocabulary and Matrix Reasoning (MR) subtests - Wechsler Abbreviated Scale of Intelligence, Second Edition) and a test of pre-morbid intelligence (Spot-the-Word test from the Speed and Capacity of Language Processing). Separately, LC results were standardised relative to the population of test-takers, using a computer application designed specifically for this project. RESULTS: Hierarchical regression analysis revealed that standardised LC performance [F(2,48) = 3.90, p = 0.03] and Spot-the-Word [F(2,47) = 5.88, p = 0.005] significantly predicted current intellect. Crawford & Allen's demographic-based regression formula did not. Furthermore, after controlling for gender, English [F(1,49) = 11.27, p = 0.002] and Irish [F(1,46) = 4.06, p = 0.049) results significantly predicted Vocabulary performance, while Mathematics results significantly predicted MR [F(1,49) = 8.80, p = 0.005]. CONCLUSIONS: These results suggest that standardised LC performance may represent a useful resource for clinicians when estimating pre-morbid intelligence.

Atypical social cognitive processing in premotor Huntington's disease: a single case study.

BACKGROUND: We report the case of a 52-year-old male with pre-motor Huntington's disease (HD) who has undergone detailed clinical and neuropsychological examination. This patient's negative symptomatology and behavioural change are having a detrimental impact on his social, occupational and interpersonal life, in the absence of motor symptoms. METHODS: The patient has undergone repeat neuropsychological testing (T1 aged 50; T2 aged 52) with particular focus on executive function and social cognition on repeat testing. RESULTS: This case details a specific manifestation of HD relating to behavioural, psychiatric and social affective deficits. CONCLUSIONS: This case illustrates how social cognitive changes can occur in HD, months and even years prior to the onset of motor features and how such unrecognized deficits can have a deleterious impact on an individual's functional ability and lifestyle, before the disease is traditionally considered to have become manifest.

The economic cost of nonepileptic attack disorder in Ireland.

The present study endeavored to calculate a conservative estimate of both incidence- and prevalence-based costs of nonepileptic attack disorder (NEAD) in Ireland by applying previously identified prevalence figures to Irish population figures. Variables related to the economic cost of NEAD were identified based on a retrospective chart review of patients diagnosed with NEAD at Beaumont Hospital, Dublin. The annual cost per patient of undiagnosed NEAD was calculated as €20,995.30. The combined cost of diagnosis and psychological treatment of NEAD was estimated at €8728. Although it is difficult to determine precise economic costings, early diagnosis and intervention would result in a significant economic saving to the exchequer, a reduction in hospital waiting-list times, and a better prognosis for patients.

Executive dysfunction is a negative prognostic indicator in patients with ALS without dementia.

BACKGROUND: The prognostic implications of cognitive impairment in amyotrophic lateral sclerosis (ALS) are not established. OBJECTIVES: To investigate the survival effect of the comorbid frontotemporal dementia (FTD) and to determine whether, in the absence of dementia, impairment in different cognitive domains affects outcome. METHODS: A prospective population-based study of incident cases of ALS in the Republic of Ireland included home-based neuropsychological assessments using age-, sex-, and education-matched controls. Four cognitive domains were evaluated: executive function, memory, language, and visuospatial skills. RESULTS: Mean age of the participants (n = 139) was 63.3 years; 61.2% were male and 35.3% had bulbar-onset ALS. Factors associated with shorter survival included age more than 60, severe disability at baseline, shorter delay to diagnosis, and early respiratory involvement. Comorbid FTD was associated with significantly shorter survival time (hazard ratio [HR] 2.67, 95% confidence interval [CI] 1.04-6.85, p = 0.041). In patients with ALS without dementia, the presence of executive dysfunction was significantly associated with shorter survival. This was confirmed in a multivariate model that included age, delay to diagnosis, disease severity at baseline, education, and respiratory status (HR 3.44, 95% CI 1.45-8.18, p = 0.005). In the absence of executive dysfunction, single or multi-domain impairment in other cognitive domains had no significant effect on survival. CONCLUSION: Comorbid frontotemporal dementia is a negative prognostic indicator. In patients with ALS without dementia, executive dysfunction, but not impairment in other cognitive domains, is an important negative prognostic indicator.

The evaluation of a novel method comparing quantitative light-induced fluorescence (QLF) with spectrophotometry to assess staining and bleaching of teeth.

This study reports the development and evaluation of a novel method using quantitative light-induced fluorescence (QLF), which enables its use for quantifying and assessing whole tooth surface staining and tooth whitening. The method was compared with a spectrophotometer to assess reliability. Two experimental phases, intrinsic stain formation and tooth whitening, were conducted in vitro on 16 extracted bovine teeth. Intrinsic stains were developed via access through lingual surfaces and root canals of these teeth using tea solution (2 g/100 ml, Marks and Spencer Extra Strong Tea, Marks and Spencer, London, UK) for 6 days. Stains were removed using 33% hydrogen peroxide (VWR Prolab, Leicestershire, UK) in cycles over 150 min. Stain development/whitening was monitored with QLF (Inspektor Research systems, Amsterdam, Netherlands) and spectrophotometry (Easy shade, Vita Zahnfabrik, Bad Säckingen, Germany). Parameters Delta F for QLF and Delta E for the spectrophotometer were obtained. The progression of stain intensity and removal observed by the methods were tested for correlation using Pearson's correlation coefficient. Intra-examiner reliability for each method was tested. QLF showed a high correlation with spectrophotometry for detecting and monitoring intrinsic tooth stain progression (Pearson coefficient r was -0.987 with correlation significant p < 0.0001). For stain removal, the Pearson coefficient (r) between both methods was -0.906 with no significance p = 0.094. The use of an external reference material in combination with the inner patch QLF analysis technique had the ability to detect and measure whole tooth surface staining and its removal longitudinally. The reliability of the method shows a potential clinical application.

The susceptibility of bleached enamel to staining as measured by Quantitative Light-induced Fluorescence (QLF).

OBJECTIVES: To report the use of Quantitative Light-induced Fluorescence (QLF) to determine if there was a tendency for bleached enamel to take up extrinsic stains more than unbleached enamel. METHODS: Bovine teeth devoid of stains were selected, the roots removed and enamel gently pumiced. Each tooth was sectioned into two and each half randomly assigned to two groups (bleached or unbleached). Windows were created on each half using clear acid resistant varnish. 38% Hydrogen peroxide gel was applied to the exposed windows of the bleached group for 1 hour. The teeth were rinsed and dried. Bleached and unbleached halves of the same teeth were then mounted on glass rods attached to pot lids using green stick. QLF images were taken. The teeth were subjected to a cycle of artificial saliva, chlorhexidine and tea (2 minutes in each solution). This was repeated 5 times. QLF images were taken at the end of each cycle. RESULTS: The uptake and progression of stain was detected in all the sections by QLF. Using paired t- test (SPSS) there was no significant difference between the two groups for the change from baseline to the final stain cycle (p > 0.05), however there was variability in stain uptake within the groups as the cycles progressed. CONCLUSION: Bleaching of enamel in vitro does not appear to increase the susceptibility of enamel to extrinsic staining.

Comparison of quantitative light-induced fluorescence (QLF) and digital imaging applied for the detection and quantification of staining and stain removal on teeth.

OBJECTIVES: This study compares the use of QLF with digital imaging in the detection and quantification of the development and removal of stain on teeth. METHODS: Two experimental phases, tooth staining and tooth whitening, conducted in vitro on labial 12 mm(2) enamel windows made on ten extracted bovine teeth, developed stains in 6-min cycles (2 min in each solution) using artificial saliva, chlorhexidine and tea solutions and removed them using sodium perborate monohydrate in 2-min cycle monitored at the end of each cycle with QLF (Inspektor Research Systems, NL) and digital photography (Fuji, Japan). The stain values were quantified as DeltaQ derived from QLF and DeltaE from digital imaging. This was observed by the two methods correlated with Pearson correlation coefficient (r). Regression equations (R(2)) were also obtained. RESULTS: For both staining and stain removal there was a statistically significant (p<0.01) reverse correlation between DeltaQ values for QLF (r=-0.924, R(2)=85.4%) and DeltaE values for digital imaging (r=-0.994, R(2)=98.8%), respectively. CONCLUSION: QLF showed a high correlation with digital imaging as a technique for detecting and monitoring tooth stains and tooth whitening in vitro. The potential for QLF with further development as a tool for monitoring staining and whitening of teeth may be possible in vivo in addition to the diagnostic ability for caries detection.

An in vitro assessment using transverse microradiography of the effect on mineral loss of etching enamel for in situ studies.

OBJECTIVES: To test the hypothesis that etching enamel with 37% phosphoric acid for 30 s does not lead to detectable mineral loss when measured with transverse microradiography (TMR). DESIGN: An in vitro laboratory investigation. EXPERIMENTAL VARIABLE: Forty bovine incisors were used in the experiment. The crowns of the teeth were covered with acid resistant varnish except for a rectangular area on the labial surface approximately 10 x 12 mm. On the exposed labial surface of 20 teeth an enamel lesion similar to that used in the in situ caries model was induced. Twenty teeth were left without a lesion. The exposed area was divided into three areas of equal size. The control area (C) was covered with acid resistant varnish throughout the experiment. The first experimental area (E1) was etched with 37% phosphoric acid for 30 s and a simulated bracket was bonded to the surface with composite resin. The second experimental area (E2) was left exposed for the remainder of the experiment. The teeth were placed in a demineralizing solution for 24, 48, 72 or 96 h to replicate different cariogenic challenges. OUTCOME MEASURE: Mineral loss as measured with TMR. RESULTS: There were no significant differences in the mineral loss between etched (E1) and etched (C) areas of enamel. There were significant differences in mineral loss between E1 and E2 for the 48 h (p < 0.001) and 72 h (p = 0.001) exposures without a pre-formed enamel lesion. CONCLUSION: There is no detectable mineral loss with TMR when enamel has been etched for 37% phosphoric acid for 30 s. The use of in situ enamel specimens with acid etch retained simulated brackets to investigate demineralization during orthodontics will not significantly affect the outcome compared with unetched specimens.

The in vitro detection of early enamel de- and re-mineralization adjacent to bonded orthodontic cleats using quantitative light-induced fluorescence.

The purpose of this study was to determine whether quantitative light-induced fluorescence (QLF) could detect very early demineralization and remineralization longitudinally adjacent to orthodontic components in an in vitro model. Extracted human premolars (n = 13) were sectioned sagittally to produce two equal halves and an orthodontic cleat was bonded to the buccal surface of each tooth. Transparent nail varnish was placed over the remaining surface, leaving exposed enamel windows adjacent to the cleat on the coronal and gingival aspects. Each half-tooth was placed into the lid of an Eppendorf tube and randomly assigned to either control (distilled water) or experimental (lactic acid demineralizing buffer, pH 4.5) regimes. Digital photographs and QLF baseline images were taken. The tubes were mounted into a rotating holder and left for 24 hours. QLF and digital photographs were taken, the solutions refreshed and the teeth returned. This was continued every 48 hours for 288 hours. At this time the lactic acid buffer was replaced with a remineralizing solution (artificial saliva, fluoride, calcium) and the experiment continued with weekly examinations. QLF images were analysed and deltaQ at the 5 per cent threshold recorded. Analysis of the QLF images showed that both demineralization and remineralization were identified and monitored. Statistical differences between each of the timed examinations were found (P < 0.05). Analysis of the photographs demonstrated that QLF detected subclinical lesions. This initial pilot study has demonstrated the potential for QLF to longitudinally monitor de- and re-mineralization of enamel adjacent to orthodontic cleats in vitro.

Psychometric evaluation of the exercise self-efficacy scale among Korean adults with chronic diseases.

The purpose of this study was to assess the psychometric properties, appropriateness, and demographic response patterns of an exercise self-efficacy scale for Korean adults with chronic diseases. After assessment of face validity by an expert Korean panel, 249 Korean adults with chronic diseases, ages 18-79 years, were recruited from hospitals or health centers in five Korean cities and surrounding rural areas to complete the questionnaire. In a factor analysis the original 18-item exercise self-efficacy scale converged to one factor without rotation and to three subfactors with rotation: situational/interpersonal factor, competing demands factor, and internal feelings factor. Descriptive analysis showed that Korean adults with chronic diseases perceived they had relatively low exercise self-efficacy, with the situational/interpersonal factor as the lowest factor. Exercise self-efficacy was significantly correlated with gender, education, regular exercise, and frequency of exercise. The exercise self-efficacy scale was shown to be a useful measure of exercise beliefs of Korean adults with chronic diseases.

Physical activity research in nursing.

PURPOSE: To present exemplars of physical activity research in nursing, illustrate the importance of physical activity research across the lifespan, and recommend directions for theory development and research. METHODS: Studies of physical activity and exercise currently being conducted by nurse investigators were reported and critiqued by attendees of the Midwest Nursing Research Society 2000 Preconference session entitled "Promoting Physical Activity Among Diverse Groups Across the Health Continuum." Physical activity and exercise literature during the past decade was reviewed. Databases searched included Medline, CINAHL, Wilson, and ERIC. FINDINGS: Investigators have emphasized the need to evaluate the effects of theory-based physical activity interventions designed to alter key correlates of physical activity identified through descriptive research. CONCLUSIONS: Regular physical activity is necessary for health promotion and disease prevention for all populations. Continued research in this important area of health behavior is critical to identify the most effective interventions to increase physical activity among diverse populations.

Enamel demineralisation assessed by computerised image analysis of clinical photographs.

OBJECTIVES: To investigate the use of computerised image analysis to measure the area of demineralisation on the buccal surface of a tooth and to analyse the effect on that measurement of varying the angle at which a photographic image of the buccal surface of a tooth is taken. METHODS: Twenty-two teeth with areas of incremental demineralisation on the buccal surface were photographed perpendicular to the buccal surface and at angles of 20 and 40 degrees, above (Cuspal) and below (Gingival) the perpendicular. The images were captured and analysed using computerised image analysis. RESULTS: The Gingival views showed lower limits of agreement than the Cuspal views, probably due to the positioning of the masking on the lower part of the flash, to reduce reflection. There was a significant difference between the areas of demineralisation measured for the three angles from the Gingival views (p<0.001). The mean differences in areas measured were not linear, but there was a significantly greater reduction in area measured for the 40 degrees views. CONCLUSIONS: Computerised image analysis to measure areas of demineralisation from a captured 35mm slide is reproducible. The position of the masking on the camera flash and the angle of the camera makes a difference to the area measured and the grey scales recorded. Images taken at a larger angle than 20 degrees to the perpendicular will record a significantly reduced area of demineralisation. Standardisation of photographs with the use of calibration markers and manipulation of images is discussed.

Reproducibility of quantitative measurement of white enamel demineralisation by image analysis.

The reproducibility of measuring artificial enamel white spot lesions from captured photographic images using computerised image analysis was assessed. Enamel lesions were induced on the buccal surface of 22 human teeth over periods of 3, 7 and 14 days. Standardised photographs were taken from above and below the occlusal plane. These were repeated after 2 weeks. The photographs were converted into TIFF images and mean grey scale levels of the areas of etched enamel were measured using computerised image analysis. Assessment of repeat readings of the same slide showed good reproducibility for photographs taken below the occlusal plane. The limits of agreement showed reasonable agreement between readings carried out on two slides of the same tooth. Capturing TIFF images via 35-mm film and measuring grey scale levels by computerised image analysis is a useful method of quantitative study of early enamel demineralisation. This may be developed for application in the clinical setting.

Effects on tooth movement of force delivery from nickel-titanium archwires.

The aim of this project was to determine the in vivo effects of tooth movement with nickel-titanium archwires on the periodontium during the early stages of orthodontic treatment. The extent of tooth movement, severity of gingival inflammation, pocket probing depth, gingival crevicular fluid (GCF) flow, and the amount of the chondroitin sulphate (CS) glycosaminoglycan (GAG) component of the GCF of one maxillary canine in each of 33 patients treated with a pre-adjusted appliance were measured before and at four stages during the first 22 weeks of treatment. The methods involved the use of a reflex metrograph to determine the type of tooth movement and electrophoresis to quantitate the CS in the GCF. It was found that GCF flow increased after 4 weeks of tooth movement whereas the increase in the amount of CS in the GCF, which is taken to be indicative of periodontal tissue turnover, occurred at the later stage of 10 weeks. Teeth which showed the greatest amount of tooth movement continued to express large amounts of CS in large volumes of GCF until 22 weeks, whilst the CS levels in those teeth moving to a smaller extent declined. These data suggest that nickel-titanium archwires may produce a super-elastic plateau effect in vivo on canine teeth, which are initially displaced from the arch such that large amounts of tooth movement occur in the first 22 weeks of treatment.

An in situ caries model to study demineralisation during fixed orthodontics.

OBJECTIVES: To investigate de/remineralization of enamel during the early stages of orthodontic treatment using the in situ caries model. DESIGN: A prospective, longitudinal study, using the in situ caries model. SETTING AND SAMPLE POPULATION: The Department of Orthodontics at the University of Liverpool School of Dentistry. Fifteen orthodontic patients undergoing fixed appliance treatment with extraction of premolar teeth. EXPERIMENTAL VARIABLE: Two enamel samples with pre-formed caries-like lesions were placed bilaterally, in specially constructed holders, on an orthodontic fixed appliance. One sample was bonded with a small bracket base. OUTCOME MEASURE: The parameters of the pre-formed carious lesion, expressed as mineral loss (delta Z), lesion depth (ld), lesion width (lw) and ratio (delta Z/ld) were compared between the bracketed, the non-bracketed and a control sample that had not been placed in the mouth. The difference between brackets place on the dominant (toothbrush hand) side and non-dominant side were also investigated. The correlation between mineral loss and length of time the sample was in the mouth was also analysed. RESULTS: There was considerable individual variation; however, a one-factor repeated analysis of variance showed a significant difference in ratio values between the three groups (p = 0.006). A pairwise comparison showed a significant reduction in ratio value for the non-bracketed sample compared with the control, but not the bracketed sample. There was no significant difference in mineral loss between the dominant and non-dominant sides. There was no linear correlation between the length of time the sample was in the mouth. CONCLUSION: An enamel sample with a pre-formed carious lesion, when placed in the mouth of an orthodontic patient, showed reduced remineralization in the presence of a simulated orthodontic bracket. Consistently effective preventive regimes to prevent demineralization in patients with fixed orthodontic appliances need to be developed. The technique described will be a valuable tool in this process.

Clinical use of streptolysin-O to facilitate antisense oligodeoxyribonucleotide delivery for purging autografts in chronic myeloid leukaemia.

Antisense oligodeoxyribonucleotides (ODN) targeted against the breakpoint in BCR-ABL mRNA will specifically decrease BCR-ABL mRNA, provided cells are first permeabilised with streptolysin-O (SL-O). We used 18-mer chimeric methylphosphonodiester: phosphodiester linked (4-9-4) ODN complementary to 9 bases either side of the BCR-ABL junction to purge harvests ex vivo in three CML patients who remained completely Ph positive after multiple chemotherapy courses. After CD34+ cell selection and SL-O permeabilisation, harvests were purged with 20 microM ODN. After purging, all individual CFU-GM colonies grown from the two b3a2 breakpoint cases remained positive for BCR-ABL mRNA. In contrast, all 24 colonies grown from the b2a2 breakpoint case were BCR-ABL mRNA negative. Patients were conditioned with busulphan 16 mg/kg. The initial post-transplant course was uneventful, although the time to return to 0.5 x 10(9)/l neutrophils was slow at 25-51 days. Both chronic phase patients remain in haematological remission at +724 and +610 days, although each has cytogenetic evidence of relapse. The b2a2 accelerated phase patient died of myeloid blast transformation at day +91. The present SL-O-facilitated ODN purging strategy appears to be without significant toxicity, and offers considerable improvements in ODN delivery to the cytosol.

Morphometric assessment of enamel demineralisation from photographs.

OBJECTIVES: To investigate the validity and reproducibility of a method of morphometric assessment of enamel demineralisation. METHODS: An in vitro investigation was carried out on 22 human teeth. One investigator coated the crowns of the teeth with an acid-resistant varnish, leaving a small window on the buccal surface. This was incrementally occluded by varnish over a 14-day period, during which the teeth were placed in a demineralising gel at pH 4.5. After varnish removal, a second investigator blindly quantitated the demineralised area by three methods of examination; direct visual, microscopic and from photographs. The microscopic and photographic measurements were carried out using a morphometric assessment with a 121-dot array. Photographs and assessments were repeated after 1 week. The readings were analysed using the kappa statistic, the limits of agreement and the coefficient of repeatability. RESULTS: Photographic assessments demonstrated excellent agreement for grid positioning (kappa > 0.81) and substantial agreement for reading reproducibility (kappa = 0.61-0.80). The coefficients of repeatability were found to be the same for repeat readings of the same slide and the repeated slides (5.0 mm2). They were higher for the microscopic technique (6.8 mm2) and for the direct visual technique (7.8 mm2). The limits of agreement are presented graphically. CONCLUSIONS: The photographic technique used was a reproducible method of measuring artificial enamel demineralisation. Measurement from photographs was more reproducible than direct measurement with the naked eye. Subjectiveness of the index leads to most variation and more objective means of assessing enamel demineralisation need to be found.

Motivation for physical activity among children and adolescents.

Assisting children and adolescents in adopting physically active lifestyles is an integral part of the health education and health promotion services provide by nurses in school, family, community, and primary care settings. In order to effectively engage in physical activity counseling, the determinants of physical activity must be understood and integrated into effective interventions for youths. This review of research literature includes a critique of intervention studies aimed at helping children and adolescents adopt active lifestyles that will be sustained throughout life. Social cognitive theory provided the theoretical basis for most of the studies reviewed but specification of how theory concepts were operationalized in the interventions was often unclear. Suggestions for increasing the rigor of theoretically based intervention studies aimed at promoting physical activity are proposed. Models and variables are identified that need further testing to determine their relevance to the promotion of physical activity during childhood and adolescence.