Nurturing attachments in looked after children: a feasibility study of a group-based programme for carers

Introduction: The attachment related difficulties of Looked after Children are well recognised in literature with difficulties linked to early experiences hypothesised to be perpetuated by experiences of the care system itself. Recent policy guidelines have emphasised the importance of relationships for children in care, one of the most important being with their primary carer. Golding (2014) published a group format training resource entitled ‘Nurturing Attachments’ which aims to promote ‘therapeutic parenting’; however there is limited knowledge on the feasibility of this intensive approach.
Aims: To assess the feasibility of Nurturing Attachments through exploring (i.) recruitment, retention and attrition, (ii.) initial outcomes, (iii.) acceptability and (iv.) ability of the programme to be delivered in line with the manual content and structure.
Method Two Health and Social Care Trusts in NI participated in the study by facilitating a Nurturing Attachments group in each site with adoptive parents, foster carers and kinship carers (N = 26). Carers completed pre and post measures to explore initial outcome, completing an evaluation questionnaire to explore acceptability. Acceptability was also explored with Trust stakeholders and group facilitators through focus group and interview. To explore if the manual can be delivered as intended, each group completed debrief tools.
Results: The overall response rate for uptake was 13.9%, which impacted on engagement for a ‘treatment as usual’ group. Once engaged in the programme, attrition was low and attendance was high. Initial outcomes have shown positive effects for both young person and carers. Feedback suggests a positive response regarding acceptability with limited expressed concern. The manual can be delivered in a standardised way; however can be flexible enough to allow for group processes.
Conclusions: Further research is needed to continue to explore efficacy, however the current study has provided supporting evidence that Nurturing Attachments as an intervention has positively impacted on many levels of the LAAC system.

Substance Use and Misuse : Adolescent Substance Use in the context of the family ; a qualitative study of young people's views on parent child attachments , parenting style and parental substance use

Introduction and Aims. While the role of the family in adolescent substance use has been well documented, few studies have attempted to explore in-depth youth perceptions of how these familial processes/dynamics influence teenage substance use. This paper reports the findings from a study exploring risk and protective factors for teenage substance use within the context of the family as perceived by young people with a view to informing current and future family based prevention and education interventions.
Design and Methods. Data collection took place in nine post-primary schools across Northern Ireland. Nine focus groups using participatory techniques were facilitated with a purposive sample of sixty-two young people (age 13-17 years). Data were transcribed verbatim and analysed using a content/thematic analysis.
Results. Three broad themes/aspects of the family emerged from the data, which may serve to protect or attenuate the risk of substance use among young people. Parent-child attachment was a major theme identified in protecting adolescents from substance use in addition to effective parenting particularly an authoritative style of parenting supplemented by parental monitoring and good parent-child communication to encourage child disclosure. Family substance use was deemed to impact on children’s substance use if exposed at an early age and the harms associated with PSM were discussed in detail.
Discussion and Conclusions. The qualitative approach provides insight into current understanding of youth perceptions of substance use in the context of family dynamics. A number of recommendations are outlined. Family based (preventive) interventions/parenting programmes may benefit from components on effective parenting including authoritative styles, parental monitoring, effective communication, spending time together (building attachments), parent-child conflict, adolescent development and factors which impact on parenting. Parenting programmes tailored to mothers and fathers may be beneficial. School based interventions targeting children/adolescents may be best placed to target children living with parental substance misuse.
Keywords: substance/substance related disorders, focus groups, young people/adolescent,

Wear of Ball Attachments After 1 to 8 Years of Clinical Use: A Qualitative Analysis

The purpose of this study was to analyze and compare scanning electron microscopy (SEM) observations of ball attachments that had been worn by patients during three periods of clinical use. One hundred forty-four specimens of ball anchor attachments (gold alloy matrix and titanium patrix) were studied by SEM after periods of approximately 1, 3.5, and 8 years of clinical use. Twenty new attachment components were examined as controls. SEM images revealed signs of mechanical wear for the ball attachments studied. The surfaces of the titanium patrix were associated primarily with roughening after short-term use, whereas surfaces of the gold alloy matrix showed wear, roughening, and loss of microscopic material in the form of flakes. Severe mechanical wear on both surfaces was noted after longer periods of use. The mechanical changes were not correlated with patient-mediated observations regarding the time-dependent retentive efficacy of the attachments. One year of clinical wear appeared to have limited effect on the ball attachment tested. Conversely, longer periods of use led to marked modifications in shape of the matrix and patrix components. Int J Prosthodont 2011;24:270-272.

Maxillary Rehabilitation Using Fixed and Removable Partial Dentures with Attachments: A Clinical Report

Despite requiring dental crown preparation and possible root canal treatment, besides the difficulty of clinical and laboratory repairs, and financial burden, the association between fixed (FPD) and removable partial dentures (RPD) by means of attachments is an important alternative for oral rehabilitation, particularly when the use of dental implants and FPDs is limited or not indicated. Among the advantages of attachment-retained RPDs are the improvements in esthetics and biomechanics, as well as correction of the buccal arrangement of anterior teeth in Kennedy Class III partially edentulous arches. This article describes the treatment sequence and technique for the use of attachments in therapy combining FPD/RPD. © 2013 by the American College of Prosthodontists.

WEAR OF MATRIX OVERDENTURE ATTACHMENTS AFTER ONE TO EIGHT YEARS OF CLINICAL USE

Statement of problem. Matrices of unsplinted attachment systems are generally reported to be the weak component of implant overdentures, often requiring frequent maintenance. Clinical wear results in reduced retention of the prosthesis, requiring activation or renewal of the matrix to restore the initial level of retention. Purpose. The purpose of this retrospective study was to measure the wear of the matrix of a ball attachment after various periods of clinical wear. Material and methods. Seventy specimens of 3 groups of matrices of ball attachments that had been in use for mean periods of 12.3 months (1Y group, n=26), 39.0 months (3Y group, n=28) and 95.6 months (8Y group, n=16) were retrieved from 35 patients (2 specimens per patient) and measured on a coordinate measuring machine equipped with a touch trigger probe. Ten unused matrices were used as controls (CTRL group). The external and internal matrix diameters and deviations from circularity were measured. For the various time periods, the decreases in matrix thickness were calculated and compared with controls. Kruskal-Wallis 1-way ANOVA by ranks, followed by the Mann-Whitney post hoc tests, were conducted to test for differences in median values among groups (alpha=.05). Results. For the internal upper diameter of the matrices tested, the Kruskal-Wallis and Mann-Whitney tests revealed significant differences for the 3 groups compared to the controls. For group 1Y, a significant difference (P<.001) of the internal upper diameter was found compared to the CTRL group. Compared to the controls, the nonparametric analyses for groups 3Y and 8Y showed significant differences for the internal upper diameter (P<.001) and deviations from circularity (P<.001). For groups 1Y, 3Y and 8Y, matrix thickness losses were 07, 47 and 70 pm, respectively. Conclusions. Within the limitations of this study, it was observed that one year of clinical wear had limited effect on the ball attachment matrices. Three to 8 years of clinical use resulted in a significant decrease of matrix thickness, especially at the tip of the retentive lamellae. (J Prosthet Dent 2012;107:191-198)

Influence of the lubricant and the alloy on the wear behaviour of attachments

Wear of attachments leads to a loss of retention and reduces the function of overdentures. This study evaluated the retention force changes of an attachment system for overdentures. The influence of the lubricant and the alloy on wear constancy was examined.

Impact of measurement errors on the determination of the linear modulus of human meniscal attachments

For the development of meniscal substitutes and related finite element models it is necessary to know the mechanical properties of the meniscus and its attachments. Measurement errors can falsify the determination of material properties. Therefore the impact of metrological and geometrical measurement errors on the determination of the linear modulus of human meniscal attachments was investigated. After total differentiation the error of the force (+0.10%), attachment deformation (−0.16%), and fibre length (+0.11%) measurements almost annulled each other. The error of the cross-sectional area determination ranged from 0.00%, gathered from histological slides, up to 14.22%, obtained from digital calliper measurements. Hence, total measurement error ranged from +0.05% to −14.17%, predominantly affected by the cross-sectional area determination error. Further investigations revealed that the entire cross-section was significantly larger compared to the load-carrying collagen fibre area. This overestimation of the cross-section area led to an underestimation of the linear modulus of up to −36.7%. Additionally, the cross-sections of the collagen-fibre area of the attachments significantly varied up to +90% along their longitudinal axis. The resultant ratio between the collagen fibre area and the histologically determined cross-sectional area ranged between 0.61 for the posterolateral and 0.69 for the posteromedial ligament. The linear modulus of human meniscal attachments can be significantly underestimated due to the use of different methods and locations of cross-sectional area determination. Hence, it is suggested to assess the load carrying collagen fibre area histologically, or, alternatively, to use the correction factors proposed in this study.

Biomechanics of meniscal horn attachments

Menisci are anchored to the tibia by means of ligament-like structures called meniscal attachments. Failure material properties of bovine meniscal attachments were obtained. There were no significant differences in the structural properties or ultimate stress between the meniscal attachments (p>0.05). Furthermore, Glycosaminoglycan (GAG) fraction and crimping frequency was obtained for each attachment using histology and differential interference contrast (DIC) respectively. Results showed that the anterior attachment’s insertion had the greatest GAG fraction when compared to the posterior attachment’s insertion. Crimp frequency of the collagen fibrils was homogeneous along the length. Moreover, Scanning Electron Microscopy (SEM) technique was used to reveal the morphology of collagen in human meniscal attachments. Its midsubstance was composed of collagen fascicles running parallel to the longitudinal axis, with a few fibrils running obliquely, and others transversely. There were no differences between attachments for crimping angle or length. Since ligamentous-type tissues are comprised mainly of water, the fluid pressure within meniscal horn attachments was measured using a Fiber Optic Microsensor (FOM). Four cadaveric human joints were subjected to 2BW compressive load (ramp) at 0-, 15-, and 30-degrees of flexion for a minute and then the load was hold for 20 minutes (equilibrium). There were significant differences between 0- and 15- (p1– c5) were obtained. Significant differences were found on the straightened collagen fibers coefficient (c5) between MP and LA attachments (p