Parental reports of the oral health-related quality of life of children with cerebral palsy

BACKGROUND The severity of physical and mental impairments and oral problems, as well as socioeconomic factors, may have an impact on quality of life of children with cerebral palsy (CP). The aim of this research was to assess the impact of impairments and oral health conditions, adjusted by socioeconomic factors, on the Oral Health-Related Quality of Life (OHRQoL) of children with CP using their parents as proxies. METHODS Sixty children, between 6-14 years of age were selected. Their parents answered a children's OHRQoL instrument (5 domains) which combines the Parental-Caregivers Perception Questionnaire (P-CPQ) and Family Impact Scale (FIS). The severity of dental caries, type of CP, communication ability, gross motor function, seizures and socioeconomic conditions were assessed. RESULTS Considering the total score of the OHRQoL instrument, only the reduction of communication ability and dental caries severity had a negative impact on the OHRQoL (p < 0.05). Considering each domain of the instrument, the severity of the type of CP and its reduction of communication ability showed a negative impact on oral symptoms and functional limitations domains (p < 0.05). Seizures have a negative impact on oral symptoms domain (p = 0.006). The multivariate fitted model showed that the severity of dental caries, communication ability and low family income were negatively associated with the impact on OHRQoL (p = 0.001). CONCLUSIONS The severity of dental caries, communication ability, and family income are conditions strongly associated with a negative impact on OHRQoL of children with CP.

Tooth Mobility, Periodontal Ligament Space, and the Alveolus During Periodontal Health, Disease, and Disuse

Thesis (Ph.D.)--University of Washington, 2016-07

Perpetual private land conservation: the case for outdoor recreation and functional leisure

As natural areas, agricultural lands, and open spaces continue to be developed at unprecedented rates, it is important for land conservation professionals to understand the individuals who might play a role in permanently protecting these lands and their ecological services. Many factors have been shown to influence land protection decisions among private owners, including land-use activities, demographic characteristics, and environmental intention and behavior. With the hypothesis that individuals already involved in land conservation programs would be candidates for permanent protection, we set out to model conservation easement decisions within a group of participants in southern Indiana’s Classified Forest and Wildlands Program (ICFWP). We used a mailed questionnaire to survey 500 landowners, garnering 308 responses, about their interest in conservation easements. Our results indicated significant positive relationships between interest in conservation easements with variables representing perception of landscape change, outdoor recreation behavior as an adult, and environmental organization membership. By better understanding the ways these factors promote permanent land-use decisions, land conservation professionals can better allocate limited resources through strategic investments in targeting and outreach.

Constructions of Clinical Psychology in Adult Mental Health: A Discursive Thematic Analysis

In face of the current economic-political changes facing the UK and its State institutions and of the new evidence about the impact of social inequality on human distress, this study attempts to understand the increasing practice of delivering psychological therapy by the British clinical psychology profession. A review of the critical histories of the profession in the UK identified the need for a more detailed study of the “history of the present” to reveal the discursive operations that construct professional practice. A discursive thematic analysis (DTA) based on the theoretical concepts of the late post-modern scholar Michel Foucault was used to explore public available documents produced by British clinical psychologists between 2010 and 2014. Two dominant professional discursive themes were identified: alternative and leadership. These themes were found to be supported by the discursive sub-themes of applied science, well-being, Cognitivism and therapy which align the aspiration of the profession with those of the State. The tension between the applied scientist and the therapist role - specifically the need to establish simultaneously the profession’s scientific credibility and its therapeutic abilities in order to respond to market pressures – showed recurrences of the conflicts of the early history of professionalization of clinical psychology. The positioning of clinical psychology against the use of functional psychiatric diagnosis and the challenges and opportunities identified by the opening of the NHS market to ‘any willing provider’ revealed how professional discourses operate to maintain the status quo. This study recommends that the socio-historical construction of the profession should be investigated further, in particular through the subjugated discourse identified here

Does the 6-minute walk test predicts functional capacity in a sample of elderly women? A pilot study

Introduction: Functional capacity is the capacity to conduct daily activities in an independent way. It can be estimated with the 6-minutes’ walk test (6MWT) and other validated functional tests. Objectives: Verify associations between functional capacity measured with two different instruments (6MWT and Composite Physical Function (CPF) scale) and levels of physical activity and between those and characterization variables. Methods: This sample consisted of 30 apparently healthy elderly women from Loures municipality. Essentially they should be independent and community-dwelling. Characterization data were collected, containing characterization of physical activity levels and anthropometric data. Functional capacity was assessed with CPF scale and distance walked by the 6MWT. Results were analysed using a SPSS v21.0 through correlation tests. Results: The walked distance in 6MWT was positively associated with height (r = 0.406; p = 0.026), physical activity level (r = 0.594; p = 0.001) and functional capacity (r = 0.682; p = 0.000). For each point more obtained in CPF, the distance walked increases on average by 7.5 meters. Relatively to sedentary participants, being insufficiently active increases, on average, the distance walked in 85.8 meters; and being active increases, on average, the distance walked in 108.8 meters. No other associations were observed in our sample. Conclusion: Based on the collected sample, walked distance in 6MWT has a high correlation with results in CPF scale, so this test can be used to predict functional capacity. More attention should be taken to promote strategies to increase walking in older adults.

Bioexploration of wild Alaskan berries: From field screening to functional food

Wild berries are fundamental components of traditional diet and medicine for Native American and Alaska Native tribes and contain a diverse array of phytochemicals, including anthocyanins and proanthocyanidins, with known efficacy against metabolic disorders. Bioexploration represents a new paradigm under which bioactive preparations are screened in coordination with indigenous communities, to prepare for subsequent in-depth chemical and biological analysis. The inclusive, participatory philosophical approach utilized in bioexploration has additional benefits that could be realized in seemingly disparate areas, such as education and economics. Five species of wild Alaskan berries (Vaccinium uliginosum, V. ovalifolium, Empetrum nigrum, Rubus chamaemorus, and R. spectabilis) were tested using “Screens-to-Nature” (STN), a community-participatory approach to screen for potential bioactivity, in partnership with tribal members from three geographically distinct Alaskan villages: Akutan, Seldovia, and Point Hope. Berries were subsequently evaluated via HPLC and LC-MS2, yielding significant species and location-based variation in anthocyanins (0.9-438.6 mg eq /100g fw) and proanthocyanins (73.7-625.2 mg eq /100g fw). A-type proanthocyanidin dimers through tetramers were identified in all species tested. Berries were analyzed for in vitro and in vivo activity related to diabetes and obesity. R. spectabilis samples increased preadipocyte-factor-1 levels by 82% over control, and proanthocyanidin-rich fractions from multiple species reduced lipid accumulation in 3T3-L1 adipocytes. Furthermore, extracts of V. uliginosum and E. nigrum (Point Hope) reduced serum glucose levels in C57bl/6j mice up to 45%. The same precepts of bioexploration, especially the inclusion of indigenous community perspectives and knowledge, have relevance in other areas of study, such as education and economics. Studies have established the apathetic, low-motivational environment characteristic of many introductory science laboratory classes is detrimental to student interest, learning, and continuation in scientific education. A primary means of arresting this decline and stimulating the students’ attention and excitement is via engagement in hands-on experimentation and research. Using field workshops, the STN system is investigated as to its potential as a novel participatory educational tool, using assays centered around bioexploration and bioactive plant compounds that hold the potential to offset human health conditions. This evaluation of the STN system provided ample evidence as to its ability to augment and improve science education. Furthermore, Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was employed as a theoretical framework to review the potential benefits and hurdles associated with developing a wild Alaskan berry commodity. Synthesizing various sources of information – including logistics and harvest costs, sources of initial capital, opportunities in the current superfruit industry, and socioeconomic factors – the development of a berry commodity proves to be a complex amalgam of competing factors which would require a delicate balance before proceeding.

Functional studies of lignin biosynthesis genes and putative flowering gene in Miscanthus x giganteus and studies on indolyl glucosinolate biosynthesis and translocation in Brassica oleracea

The first topic area of this thesis involved studies on the accumulation and translocation of glucosinolates (GSs), bioactive secondary plant compounds, in broccoli plants. Changes in GS accumulation and gene expression levels in response to exogeneous methyl jasmonate (MeJA) treatment were analyzed in different tissue types at different developmental stages of broccoli. Greater accumulation of GSs with MeJA treatment was observed in apical leaves of broccoli seedlings and florets of plants at harvest maturity. Increases in indolyl GS in apical leaves of seedlings and florets were coupled with the up-regulation of indolyl GS biosynthesis genes. The accumulation of indolyl GSs appears to be modulated by MeJA treatment in an organ-specific manner for optimal distribution of defense substances in the plant. Metabolic profiling of hydrophilic metabolites using GC-MS demonstrated increased accumulation of various phenolics, ascorbates and amino acids in broccoli tissues after MeJA treatment. Distinct changes in carbohydrate levels observed between different tissues (vegetative leaves and floret tissues) of broccoli plants after treatment suggest that carbon metabolism is differentially modulated by MeJA treatment in different tissue types depending on sink-source relationships. Reduced levels of hexose sugars and tricarboxylic acid intermediates after MeJA treatment may reflect the increased requirement for carbon and energy needed to drive secondary product biosynthesis to accumulate metabolites for defense against insects and other herbivores. Substantial increases of indolyl and aromatic GSs after exogenous treatment with MeJA in stem and petioles of seedlings and the existence of intact indolyl-GS forms in phloem exudates suggest enhanced de novo synthesis in combination with active transport. Indoly GSs share structural similarities with the auxin, IAA, and may interact with components of the auxin transport system for intra- and extra-cellular transport or translocation. Application of the auxin efflux inhibitor, 1-naphthylphthalamic acid (NPA) reduced MeJA-mediated accumulation of indolyl GSs in broccoli florets and seedling tissues. NPA did not inhibit expression of indolyl GS biosynthesis genes shown to be upregulated by MeJA treatment or the accumulation of tryptophan, the amino acid precursor of indolyl GSs. Exogenous application of benzyl GS to Arabidopsis roots induced ectopic expression of the PIN1 protein associated with the auxin transport system similar to treatment with NPA, again suggesting GS interaction with the auxin efflux carrier system. The inhibitory effect of NPA on MeJA-mediated accumulation of GS may be due to competitive binding of NPA to auxin efflux carrier components and that GS transport is mediated by the auxin transport system. The inhibitory effect of NPA on indolyl and aromatic GS accumulation and the bioactivity of exogenous treatment of these GS compounds in PIN1 localization, Arabidopsis root growth, and gravitrophic response suggest that indolyl and aromatic GSs may be antagonistic to IAA transport and biosynthesis. Indolyl and aromatic GSs can also be potentially converted into IAA by hydrolysis. This intrinsic feature of GSs may be the part of a sophisticated regulatory process where the metabolic pathways in the plant shift from active growth to a reversible defense posture in response to biotic or abiotic stress. It seems likely that indolyl and aromatic GSs are important compounds that provide connections between jasmonate and auxin signaling. Further studies are required to reveal the regulatory mechanism for crosstalk between the two hormones. The third part of this research was to investigate effect of selenium fertilization and MeJA treatment on accumulation of GSs in broccoli florets. Increasing dietary intake of the element selenium (Se) has been shown to reduce the risk of cancer. Simultaneous enhancement of both Se and GS concentrations in broccoli floret tissue were conducted through the combined treatment of MeJA with Se fertilization. A low level of Se fertilization (concentration) with MeJA treatment displayed no significant changes in total aliphatic GS concentrations with 90% and 50% increases in indolyl and total GSs concentrations, respectively. This result suggests that Se- and GS-enriched broccoli with improved health-promoting properties can be generated by this combined treatment. The second topic of this thesis was conducted to provide basic information required to improve biomass quality and productivity and develop tools for gene transformation in Miscanthus x giganteus. The perennial rhizomatous grass, Miscanthus x giganteus is an ideal biomass crop due to its rapid vegetative growth and high biomass yield potential. As a naturally occurring sterile hybrid, M. x giganteus must be propagated vegetatively by mechanicalling divided rhizomes or from micropropagated plantlets. The effect of callus type, age and culture methods on regeneration competence was studied to improve regeneration efficiency and shorten the period of tissue culture in M. x giganteus propagation. Seven lignin biosynthesis genes and one putative flowering gene were isolated from M. x giganteus by PCR reactions using maize othologous sequences. Southern hybridization and nuclear DNA content analysis indicated that the genes isolated from M. x giganteus exist in the genome of other Miscanthus species as multiple copies. Analysis of lignin content and histological staining of lignin deposition indicated that higher lignin content is found in mature stem node tissues compared to young leaves and apical stem nodal tissues. Cell wall lignification is associated with increasing tissue maturity in Miscanthus species. RNAi and antisense constructs harboring sequences of these genes were developed to generate Miscanthus transgenic plants with suppressed of lignin biosynthesis and delayed flowering.

ANALYSIS OF FUNCTIONAL STATUS OF ELDERLY RESIDENTS IN LONG-TERM CARE INSTITUTIONS

Objective: To evaluate the functional status of elderly residents in long-term institutions. Methods: Exploratory-descriptive study, developed in two long-term care institutions for the elderly (LTC), in city of Fortaleza, Ceará. The instruments utilized were: 1) Sociodemographic form, 2) Functional Independence Measure (FIM), and 3) International Classification of Functioning (ICF). Data was descriptively analyzed through the calculation of frequency, mean and standard deviation. Results: There was a predominance of males (n=47; 59.49%), with mean age of 74.58 (± 8.89) years, 68.35% (n=54) have been or are married, and 49.37% (n=39) are illiterate. In reference to the FIM, it was observed that the elderly perform the activities in a complete or modified mode and 18.99% (n=15) have difficulty climbing stairs. As to the association between the FIM and the ICF, in relation to self-care, it was seen that 96.20% (n=76) have no difficulty in performing tasks; 92.40% (n=73) move around without difficulty; and 98.73% (n=78) have preserved the cognition. In relation to the capacity of maintaining and controlling social interactions, all exhibit this domain preserved. Conclusion: The surveyed elderly presented good cognitive status and little dependence in activities regarding personal care, mobility and communication. The use of the ICF allows the visualization of the functionality scenario among the elderly, what can facilitate more effective health promotion strategies for this population.

MRI indices of functional recovery following intracerebral implantation of a human neural stem cell line in a pre-clinical model of ischaemic stroke

Stem cell therapy for ischaemic stroke is an emerging field in light of an increasing number of patients surviving with permanent disability. Several allogenic and autologous cells types are now in clinical trials with preliminary evidence of safety. Some clinical studies have reported functional improvements in some patients. After initial safety evaluation in a Phase 1 study, the conditionally immortalised human neural stem cell line CTX0E03 is currently in a Phase 2 clinical trial (PISCES-II). Previous pre-clinical studies conducted by ReNeuron Ltd, showed evidence of functional recovery in the Bilateral Asymmetry test up to 6 weeks following transplantation into rodent brain, 4 weeks after middle cerebral artery occlusion. Resting-state fMRI is increasingly used to investigate brain function in health and disease, and may also act as a predictor of recovery due to known network changes in the post-stroke recovery period. Resting-state methods have also been applied to non-human primates and rodents which have been found to have analogous resting-state networks to humans. The sensorimotor resting-state network of rodents is impaired following experimental focal ischaemia of the middle cerebral artery territory. However, the effects of stem cell implantation on brain functional networks has not previously been investigated. Prior studies assessed sensorimotor function following sub-cortical implantation of CTX0E03 cells in the rodent post-stroke brain but with no MRI assessments of functional improvements. This thesis presents research on the effect of sub-cortical implantation of CTX0E03 cells on the resting- state sensorimotor network and sensorimotor deficits in the rat following experimental stroke, using protocols based on previous work with this cell line. The work in this thesis identified functional tests of appropriate sensitivity for long-term dysfunction suitable for this laboratory, and investigated non-invasive monitoring of physiological variables required to optimize BOLD signal stability within a high-field MRI scanner. Following experimental stroke, rats demonstrated expected sensorimotor dysfunction and changes in the resting-state sensorimotor network. CTX0E03 cells did not improve post-stroke functional outcome (compared to previous studies) and with no changes in resting-state sensorimotor network activity. However, in control animals, we observed changes in functional networks due to the stereotaxic procedure. This illustrates the sensitivity of resting-state fMRI to stereotaxic procedures. We hypothesise that the damage caused by cell or vehicle implantation may have prevented functional and network recovery which has not been previously identified due to the application of different functional tests. The findings in this thesis represent one of few pre-clinical studies in resting-state fMRI network changes post-stroke and the only to date applying this technique to evaluate functional outcomes following a clinically applicable human neural stem cell treatment for ischaemic stroke. It was found that injury caused by stereotaxic injection should be taken into account when assessing the effectiveness of treatment.

Utilization of free and microencapsulated Rosmarinus oficinalis L. extracts as bioactives ingredientes for new functional foods developmen

Currently, many consumers search for food with functional characteristics beyond their nutritional properties. Thus, the concept of functional food becomes a hot topic, allowing the obtaining of health benefits, including disease prevention. In this context, plants are recognized as sources of a wide range of bioactives, mainly phenolic compounds. In particular, the Rosmarinus officina/is L., commonly referred as rosemary, has several phenolic compounds with different bioactive properties such as antioxidant, antiinflammatory and antimicrobial activities, among others [!]. Hence, this plant has great potential for incorporation into foods in order to confer bioactivity to the final products. However, it should be highlighted that the bioactive compounds if exposed to adverse environments, for example: light, moisture, extreme pH, storage, food processing conditions, can be degraded leading to the consequent loss of bioactivity [2]. The microencapsulation is an alternative to overcome this problematic of bioactive compounds, as also to ensure controlled release, or target deliver to a specific site [3]. In this work, lyophilized rosemary aqueous extract prepared by in:'usion was used as a functional ingredient for cottage cheeses, after proving that it possesses, both higher content in phenolic compounds and higher antioxidant activity, comparatively with the corresponding hydroethanolic extract. The rosemary aqueous extract revealed, for example, a DPPH scavenging activity with an EC50 value of 73.44±0.54j!g/mL and presented as main phenolic compound the caffeic acid dimer, commonly named as rosmarinic acid. For the functionalized cottage cheeses, a decrease of bioactivity was observed after seven days under storage in fridge, when the extracts were incorporated in its free form. Therefore, to preserve the antioxidant activity, the rosemary aqueous extract was efficiently microencapsulated by using an atomization/coagulation technique and alginate as the matrix material and thereafter incorporated into the cottage cheeses. The final microspheres showed a size, estimated by OM using a magnification of I OOx, ranging between 51.1 and 122.6 J!m and an encapsulation efficiency, estimated through an indirect method, approaching 100%. Overall, the introduction of both free and microencapsulated extracts did not change the nutritional value of cottage cheeses, providing bioactivity that was more preserved with microencapsulated extracts putting in evidence the importance of using microencapsulation to develop effective functional foods.

Psychometric properties of the oral health impact profile and new methodological approach

Objective: Evaluate the validity, reliability, and factorial invariance of the complete Portuguese version of the Oral Health Impact Profile (OHIP) and its short version (OHIP-14). Methods: A total of 1,162 adults enrolled in the Faculty of Dentistry of Araraquara/UNESP participated in the study; 73.1% were women; and the mean age was 40.7 ± 16.3 yr. We conducted a confirmatory factor analysis, where χ2/df, comparative fit index, goodness of fit index, and root mean square error of approximation were used as indices of goodness of fit. The convergent validity was judged from the average variance extracted and the composite reliability, and the internal consistency was estimated by Cronbach standardized alpha. The stability of the models was evaluated by multigroup analysis in independent samples (test and validation) and between users and nonusers of dental prosthesis. Results: We found best-fitting models for the OHIP-14 and among dental prosthesis users. The convergent validity was below adequate values for the factors “functional limitation” and “physical pain” for the complete version and for the factors “functional limitation” and “psychological discomfort” for the OHIP-14. Values of composite reliability and internal consistency were below adequate in the OHIP-14 for the factors “functional limitation” and “psychological discomfort.” We detected strong invariance between test and validation samples of the full version and weak invariance for OHIP-14. The models for users and nonusers of dental prosthesis were not invariant for both versions. Conclusion: The reduced version of the OHIP was parsimonious, reliable, and valid to capture the construct “impact of oral health on quality of life,” which was more pronounced in prosthesis users.

Basil as functional and preserving ingredient in “Serra da Estrela” cheese

Antitumor, antimicrobial and antioxidant activities of basil were studied, along with its characterization in phenolic compounds, organic acids and soluble sugars. The results placed basil as a valuable candidate for functionalization and conservation of food products, maintaining their nutritional properties, while increasing their shelf life and potential health effects. The basil leaves were then incorporated in "Serra da Estrela Cheese", either in its dehydrated form or as a decoction. The cheeses were then subject to a nutritional evaluation, being characterized for their fatty acids, minerals and CIE color parameters. To assess the combined effects of plant incorporation and storage time, a 2-way ANOVA was used to process the results, further analysed through a linear discriminant analysis. Overall, basil leaves provided antioxidant activity to the cheeses, reduced the moisture, and preserved the unsaturated fatty acids and proteins. Comparing both incorporation types, the decoctions had a higher functionalizing and conservative effect.

Non-use of Formal Health Services in Malawi: Perceptions from Non-users

Background The study upon which this paper is based was undertaken to understand users’ and non-users’ perceptions concerning facilitators and barriers to equitable and universal access to health care in resource-poor countries such as Malawi. In this study, non-users of health services were defined as people who were not in need of health services or those who had stopped using them due to significant barriers. Methods A total of 80 interviews with non-users of health services were conducted in Rumphi, Ntchisi, Phalombe and Blantyre Districts of Malawi. Interviews focused on why informants were not using formal health services at the time of data collection. In order to identify non-users, snowballing was used health surveillance assistants, village headmen and community members also helped. One focus group discussion was also conducted with non-users of health services who were members of the Zion Church. Results Informants described themselves as non-users of health services due to several reasons: cost of health services; long distances to health facilities; poor attitude of health workers; belief in the effectiveness of traditional medicines; old age and their failure to walk. Others were non-users due to their disability; hence they could not walk over long distances or could not communicate effectively with health providers. Some of these non-users were complete non-users, namely members of the Zion Church and those who believed in traditional medicine, and they stated that nothing could be done to transform them into users of health services. Other non-users stated that they could become users if their challenges were addressed e.g. for those who were non-users of health services due to poor attitudes of health workers, they stated that if these health workers were transferred they would be able to access health services. Conclusions Public health education targeting both health workers and non-users, ensuring a functional outreach program and addressing other health system challenges such as shortage of drugs and human resources would assist in transforming non-users into users of health services.

The Role of Existential Beliefs Within the Relation of Centenarians’ Health and Well-Being

The purpose of this study was to explore the role of existential beliefs in mediating the influence of health on centenarians' well-being. A total of 80 centenarians (mean age 101.1; SD = 1.3; 81.3 % women) with no/minor cognitive impairment were included. The OARS questionnaire for diseases and functional capacity (ADL, IADL), the Satisfaction with Life Scale, and the existential beliefs subscale were used for data collection. The findings suggest that existential resources are a crucial element for mitigating the impact of health constraints in subjective well-being in this population. Appropriate models of intervention for very old age that recognize the importance of religion, spirituality, and meaning of life are to be considered.