Two-year survival of ART restorations placed in elderly patients: A randomised controlled clinical trial

OBJECTIVES: Older dentate adults are a high caries risk group who could potentially benefit from the use of the atraumatic restorative treatment (ART). This study aimed to compare the survival of ART and a conventional restorative technique (CT) using rotary instruments and a resin-modified glass-ionomer for restoring carious lesions as part of a preventive and restorative programme for older adults after 2 years.

METHODS: In this randomised controlled clinical trial, 99 independently living adults (65-90 years) with carious lesions were randomly allocated to receive either ART or conventional restorations. The survival of restorations was assessed by an independent and blinded examiner 6 months, 1 year and 2 years after restoration placement.

RESULTS: Ninety-six (67.6%) and 121 (76.6%) restorations were assessed in the ART and CT groups, respectively, after 2 years. The cumulative restoration survival percentages after 2 years were 85.4% in the ART and 90.9% in the CT group. No statistically significant between group differences were detected (p=0.2050, logistic regression analysis).

CONCLUSIONS: In terms of restoration survival, ART was as effective as a conventional restorative approach to treat older adults after 2 years. This technique could be a useful tool to provide dental care for older adults particularly in the non-clinical setting. (Trial Registration number: ISRCTN 76299321).

CLINICAL SIGNIFICANCE: The results of this study show that ART presented survival rates similar to conventional restorations in older adults. ART appears to be a cost-effective way to provide dental care to elderly patients, particularly in out of surgery facilities, such as nursing homes.

Cost-effectiveness of ART restorations in elderly adults: a randomized clinical trial

BACKGROUND: As the world population ages, the requirement for cost-effective methods of treating chronic disease conditions increases. In terms of oral health, there is a rapidly increasing number of dentate elderly with a high burden of maintenance. Population surveys indicate that older individuals are keeping their teeth for longer and are a higher caries risk group. Atraumatic Restorative Treatment (ART) could be suitable for patients in nursing homes or house-bound elderly, but very little research has been done on its use in adults.

OBJECTIVES: To compare the cost-effectiveness of ART and a conventional technique (CT) for restoring carious lesions as part of a preventive and restorative programme for older adults.

METHODS: In this randomized clinical trial, 82 patients with carious lesions were randomly allocated to receive either ART or conventional restorations. Treatment costs were measured based on treatment time, materials and labour. For the ART group, the cost of care provided by a dentist was also compared to the cost of having a hygienist to provide treatment. Effectiveness was measured using percentage of restorations that survived after a year.

RESULTS: Eighty-two patients received 260 restorations, that is, 128 ART and 132 conventional restorations. 91.1% of the restorations were on one surface only. After a year, 252 restorations were assessed in 80 patients. The average cost for ART and conventional restorations was €16.86 and €28.71 respectively; the restoration survival percentages were 91.1% and 97.7%, respectively. This resulted in a cost-effectiveness ratio of 0.18 (ART) and 0.29 (CT). When the cost of a hygienist to provide ART was inserted in the analysis, the resulting ratio was 0.14.

CONCLUSIONS: Atraumatic restorative treatment was found to be a more cost-effective alternative to treat older adults after 1 year, compared to conventional restorations, especially in out of surgery facilities and using alternative workforce such as hygienists. Atraumatic restorative treatment can be a useful tool to provide dental care for frail and fearful individuals who might not access dental treatment routinely.

The Use of ART in Elderly Patients after 2 years

Caries experience is high in the elderly, and barriers to care for older adults include fear and cost. Access to care is especially problematic in the case of frail and homebound elderly. Objective: to compare the survival of restorations placed using Atraumatic Restorative Treatment (ART) and a conventional technique using rotary instruments and a resin-modified glass-ionomer (CT) to treat carious lesions in older patients. Methods: In this randomised clinical trial, 99 independently living adults (65-90 yrs) with carious lesions were recruited from a geriatric day hospital and a community centre and randomly allocated to receive either ART or conventional restorations. They received tailored oral hygiene instructions and scaling and polishing of teeth prior to restoration placement. The survival of restorations was assessed 6, 12 and 24 months after restoration placement by an independent examiner. Results: Ninety-nine patients participated in the trial, 46 males and 53 females, with a mean age of 73.2 (SD: 6.8). In total, 300 restorations were placed, 142 ART in 51 patients and 158 conventional restorations in 48 patients, with an average of 2.8 ART (SD: 1.83) and 3.2 conventional (SD: 2.62) restorations placed per patient. After 2 years, 88 ART and 117 conventional restorations were assessed. The restoration survival percentages were 93.1% and 94%, respectively. Conclusion: ART was found to be as effective as a conventional restorative approach to treat older adults after 2 years and could be a useful tool to provide dental care for older dentate adults.

The Sociology of Children, Childhood and Generation

Outlining sociology’s distinctive contribution to childhood studies and our understanding of contemporary children and childhood, The Sociology of Children provides a thought provoking and comprehensive account of the connections between the macro worlds of childhood and the micro worlds of children’s everyday lives.

Examining children’s involvement in areas such as the labour market, family life, education, play and leisure, the book provides an effective balance between understanding childhood as a structural phenomenon, and recognising children as meaning makers actively involved in constructing, co-constructing and reconstructing their everyday lives.

Through the concept of 'generagency' Madeleine Leonard offers a model for examining and illuminating how structure and agency are activated within interdependent relationships influenced by generational positioning. This framework provides a conceptual tool for thinking about the continuities, challenges and changes that impact on how childhood is lived and experienced.

Belief, Knowledge and Expertise. The emergence of the lay expert in medical sociology

The paper has three main aims. First, to trace – through the pages of the Journal – the changing ways in which lay understandings of health and illness have been represented during the 1979-2002 period. Second, to say something about the limits of lay knowledge (and particularly lay expertise) in matters of health and medicine. Third, to call for a re-assessment of what lay people can offer to a democratised and customer sensitive system of health care and to attempt to draw a boundary around the domain of expertise. In following through on those aims, the author calls upon data derived from three current projects. These latter concern the diagnosis of Alzheimer’s disease in people with Down’s syndrome; the development of an outcome measure for people who have suffered a traumatic brain injury; and a study of why older people might reject annual influenza vaccinations. Key words: Lay health beliefs, lay expertise, Alzheimer’s, Traumatic Brain Injury, Vaccinations

Desire for fertility and associated factors among people living with HIV/AIDS (PLWHA) in selected antiretroviral therapy (ART) clinics of Horro Guduru Wollega Zone, North West Oromia, Ethiopia- A cross sectional study

Background: Most recently fertility issues in HIV positive men and women are becoming increasingly important. Because of ART access and its good life effect, it is expected that the need and desire to get married, to have children and to have sexual partners for PLWHA would change with the regard to reproductive health. In Ethiopia HIV positive individuals may or may not have desire to have children. And the extent of this desire and how it varies by individual, health and demographic characteristics is not well known.

Objective: the aim of the study was to assess desire for fertility and associated factors among PLWHA in selected ART clinics of Horro Guduru Wollega Zone, Oromia National Regional State, Ethiopia.

Methods: A cross-sectional, institutional-based study that employed quantitative and qualitative in-depth interviews was conducted. Three hundred twenty one study subjects were selected using systematic random sampling technique and the data was collected using interviewer administered structured questionnaire. Data entry and analysis were performed using EPI Info version 3.5.1 and SPSS version 16. P-value <0.05 was taken as statistically significant and logistic regression was used to control potential confounding factors.

Results: Seventy three (57.9%) of the males and seventy six (39%) of the females desired to have children, giving a total of 149(46.4%) of all study participants. PLWHA who desired children were younger (AOR:3.3, 95%CI: 1.3-8.9), married (AOR: 5.8, 95%CI: 2.7-12.8), had no children (AOR: 75, 95%CI: 20.1-273.3) and males (AOR; 1.9, 95%CI: 1.02-3.62) compared with their counter parts. The major reason for those people who did not desire children were having desired number of children 80 (46.5%) followed by fear of HIV transmission to child reported by 42 (24.4%) of them.

Conclusion: A considerable number of PLWHA wants to have a child currently or in the near future. Many variables like socio demography, partner related, number of alive children and HIV related disease condition were significantly associated with fertility desire.

Revolting Arts or Spatial Democracy: Performances of popular arts during the Egyptian Revolution?

This paper investigates how spatial practices of Public art performance had transformed public space from being a congested traffic hub into an active and animated space for resistance that was equally accessible to different factions, social strata, media outlets and urban society, determined by popular culture and social responsibility. Tahrir Square was reproduced, in a process of “space adaptation” using Henri Lefebvre’s term, to accommodate forms of social organization and administration.205 Among the spatial patterns of activities detected and analyzed this paper focus on particular forms of mass practices of art and freedom of expression that succeeded to transform Tahrir square into performative space and commemorate its spatial events. It attempts to interrogate how the power of artistic interventions has recalled socio-cultural memory through spatial forms that have negotiated middle grounds between deeply segregated political and social groups in moments of utopian democracy. Through analytical surveys and decoding of media recordings of the events, direct interviews with involved actors and witnesses, this paper offers insight into the ways protesters lent their artistry capacity to the performance of resistance to become an act of spatial festivity or commemoration of events. The paper presents series of analytical maps tracing how the role of art has shifted significantly from traditional freedom of expression modes as narrative of resistance into more sophisticated spatial performative ones that take on a new spatial vibrancy and purpose.

Participatory Sonic Arts: towards a socially engaged art of sound in the everyday (The Som da Maré Project)

Participatory and socially engaged art practices have, for a couple of decades, emerged a myriad of aesthetic and methodological strategies across different media. These are artistic practices that have a primary interest in participation, affecting social dynamics, dialogue and at times political activism. Nato Thompson in “Living Form: Socially Engaged Art from 1991-2011” surveys these
practices, which range from theatre to urban planning, visual art to healthcare. Linked to notions such as relational aesthetics (Bourriaud, 1998), community art and public art, socially engaged art often focuses on the development of a sense of ownership by the part of participants. If an artist is working truly collaboratively with participants and addressing the reality of a particular community, the long-term effect of a project lies in the process of engagement as well as in the artwork itself. Projects by New York based artist Pablo Helguera, for example, use different media to engage with social inequalities through participative action while rejecting the notion of art for art sake.

“Socially engaged art functions by attaching itself to subjects and problems that normally belong to other disciplines, moving them temporarily into a space of ambiguity. It is this temporary snatching away of subjects into the realm of art-making that brings new insights to a particular problem or condition and in turn makes it visible to other disciplines.” (Helguera, 2011)

Socially engaged practices develop the notion of artwork about or by a community, to work of a community. In this chapter we address how socially engaged, participatory approaches can form a context for the sonic arts, arguably less explored than practices such as theatre and performance art. The use of sound is clearly present in a wide range of socially engaged work (e.g. Helguera’s “Aelia Media” enabling a nomadic radio station in Bologna or Maria Andueza “Immigrant Sounds – Res(on)Art (Stockholm)” exploring ways of sonically resonating a city, or Sue MacCauley’s “The Housing Project” addressing ways of representing the views of urban dwellers on public scape through sound art. It is nevertheless rare to encounter projects which take our experience of sound in the everyday as a trigger for community social engagement in a participatory context.
We address concepts and methodologies behind the project Som da Maré, a participatory sonic arts project in the favelas of Maré, Rio de Janeiro.

Constructions of locality and gender and their impact on the educational aspirations of working class children

Over recent years the moral panic that has surrounded 'boys' underachievement' has tended to encourage crude and essentialist comparisons between all boys and all girls and to eclipse the continuing and more profound effects on educational achievement exerted by social class and 'race'/ethnicity. While there are differences in educational achievement between working class boys and girls, these differences are relatively minor when comparing the overall achievement levels of working class children with those from higher, professional social class backgrounds. This paper argues that a need exists therefore for researchers to fully contextualise the gender differences that exist in educational achievement within the over-riding contexts provided by social class and 'race'/ethnicity. The paper provides an example of how this can be done through a case study of 11-year-old children from a Catholic, working class area in Belfast. The paper shows how the children's general educational aspirations are significantly mediated by their experiences of the local area in which they live. However, the way in which the children come to experience and construct a sense of locality differs between the boys and girls and this, it is argued, helps to explain the more positive educational aspirations held by some of the girls compared to the boys. The paper concludes by considering the relevance of locality for understanding its effects on educational aspirations among other working class and/or minority ethnic communities.

Pierre Bourdieu as a Sociologist of the Economy and Critic of 'Globalisation'

This article examines Pierre Bourdieu's sociology of the economy and his more recent politically engaged interventions on 'globalisation'. Many scholars regard these as not being in the same academic league as his classic studies on taste, academia, and state elites, etc., and, instead, dismiss them as a private matter or even, as the spleen of Pierre Bourdieu, the individual. This paper questions this disjunction of the 'academic' and 'politically engaged' sides of Pierre Bourdieu's work. First, it argues that his most recent interventions against a neo-liberal globalisation were the logical result of a particular definition of intellectual practice that had been outlined before in his sociology of the intellectual field. It then demonstrates that Bourdieu's economic sociology and critique of contemporary capitalism not only does not contradict his earlier research, but that it provides valuable and original insights into the current transformation of the political economy of the advanced capitalist countries. The paper concludes with a suggestion of how to strengthen the theoretical foundation of Bourdieu's analysis of contemporary capitalism by relating it to and making it compatible with alternative approaches in the tradition of critical political economy.