Knowledge of emergency dental management among a localized sample of athletic trainers

BACKGROUND/AIMS

Athletic trainers are often the point person when sports-related traumatic dental injuries (TDIs) occur. The aim of this study was to assess knowledge levels of the management of TDIs among athletic trainers in the Midwest United States, as well as evaluate variables that may influence knowledge levels.

MATERIAL AND METHODS

A survey was sent to athletic trainers licensed in Minnesota, Nebraska, and Iowa. The survey included 28 multiple-choice and fill in the blank questions split into three sections. The three sections included background, emergency management of TDIs, and opinion questions.

RESULTS

Of the participants, 100% recalled receiving medical first aid training. However, only 71% recalled receiving formal training on emergency management of dental injuries. Although 75% were confident in managing a dental injury, over 63% of participants scored less than 70% in the knowledge score section. Majority of the participants (98.4%) reported that they believe training on the management of TDIs is important. Athletic trainers working with contact sports were more likely to have experienced managing TDIs more recently than those working in noncontact sports.

CONCLUSIONS

This study shows the gaps in knowledge among athletic trainers pertaining to management of TDIs and emphasizes the importance of sports community having adequate education on emergency management of such dental injuries.

What Matters to Aboriginal and Torres Strait Islander Youth (WM2Y): a study protocol to develop a national youth well-being measure

INTRODUCTION

Adolescents face challenges associated with unprecedented environmental, social and technological changes. The impacts of colonisation, intergenerational trauma, racism and socioeconomic disadvantage intensify these challenges for many Aboriginal and Torres Strait Islander adolescents. However, Aboriginal and Torres Strait Islander adolescents also have cultural, spiritual, family and community capital that fosters their well-being.To date, little research has focused on understanding and appropriately measuring the well-being of Aboriginal and Torres Strait Islander adolescents, a pivotal factor in informing and guiding programmes and interventions that support them. This study will identify the domains of well-being and develop a new preference-based well-being measure based on the values and preferences of Aboriginal and Torres Strait Islander youth (aged 12-17 years).

METHODS AND ANALYSIS

This project will be conducted across three research phases: (1) qualitative exploration of well-being using PhotoYarning and yarns with adult mentors to develop candidate items; (2) Think Aloud study, quantitative survey, psychometric analysis, validity testing of candidate items and finalisation of the descriptive system; and (3) scoring development using a quantitative preference-based approach. A multinomial (conditional) logit framework will be used to analyse responses and generate a scoring algorithm for the new preference-based well-being measure.

ETHICS AND DISSEMINATION

Ethics approvals have been obtained from: the Human Research Ethics Committees for each state and territory where data are being collected, the institutions where the research is being conducted and from the relevant Departments of Education. The new well-being measure will have wide applicability and can be used in assessing the effectiveness of programmes and services. This new national measure will ensure benefit and positive impact through the ability to identify and measure the aspects of well-being important to and valued by Aboriginal and Torres Strait Islander youth. Results will be published in international peer-reviewed journals and presented at conferences, and summaries will be provided to the study partner organisations and other relevant organisations.

A systematic review of the role of penicillin versus penicillin plus metronidazole in the management of peritonsillar abscess

BACKGROUND

Peritonsillar abscess is a localised infection in the peritonsillar space. Pus from the abscess can contain anaerobes. Many clinicians prescribe metronidazole in addition to penicillin, but evidence to support this is limited. This review assessed the evidence of benefit of metronidazole for the treatment of peritonsillar abscess.

METHODS

A systematic review was conducted of the literature and databases including Ovid Medline, Ovid Embase, PubMed and Cochrane library. Search terms included all variations of peritonsillar abscess, penicillin and metronidazole.

RESULTS

Three randomised, control trials were included. All studies assessed the clinical outcomes after treatment for peritonsillar abscess, including recurrence rate, length of hospital stay and symptom improvement. There was no evidence to suggest additional benefit with metronidazole, with studies suggesting increased side effects.

CONCLUSION

Evidence does not support the addition of metronidazole in first-line management of peritonsillar abscess. Further trials to establish optimum dose and duration schedules of oral phenoxymethylpenicillin would benefit clinical practice.

0512 Concurrent and longitudinal linkages between bedtime routines and social-emotional development in toddlers

Introduction

Sleep is important for optimal development in early childhood. Instituting a consistent bedtime routine is an empirically supported behavioral intervention to promote early childhood sleep health. However, prior work has focused on the benefits of a bedtime routine for sleep outcomes, with little research on its potential benefits to social-emotional development. Thus, the current study examined concurrent and longitudinal associations between a consistent bedtime routine (defined as 5 or more nights per week) and social-emotional development in toddlers (ages 12.0 to 19.9 months).

Methods

Caregivers of 32 infants (M = 12.5mos, 59.4% female) completed baseline questionnaires about the frequency of their child’s bedtime routine and other evening activities at their scheduled 12-month well-child visit. At their child’s 15-month well visit, caregivers completed questionnaires including items on bedtime routine frequency, the communication and personal-social subscales of the Ages and Stages Questionnaire (ASQ), and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA).

Results

Over half (59.4%) of caregivers reported a consistent child bedtime routine at 12 months and nearly three quarters (71.9%) reported a consistent bedtime routine at 15 months. Linear regression showed that having a consistent bedtime routine at 15 months was significantly associated with fewer concurrent social-emotional problems on the BITSEA, B = -2.40, p = .009, 95% CI [-3.86, -.94]. Toddlers who scored above the BITSEA cutoff for social-emotional concerns (31.3%) were engaged in a consistent bedtime routine less frequently (M = 4.50 nights/week) than those below the cutoff (M = 6.18 nights/week), p = .004, η2 = .24. However, bedtime routine frequency at 12 months did not predict 15-month BITSEA concerns, p>.05. No associations emerged between bedtime routine frequency at 12 or 15 months and the communication and personal-social ASQ scores.

Conclusion

A consistent bedtime routine is concurrently, but not longitudinally, associated with positive social-emotional development, including less frequent clinically significant concerns, in toddlers at 15 months of age. Bedtime routine frequency was not linked to communication or personal-social interactions. Implementing a consistent bedtime routine may be a feasible method to promote toddlers’ social-emotional development within the context of concerns.

Support (If Any)

This study was partially funded by the Simms/Mann Institute

0513 Sleep in Children in Need of a Bed and Living in Poverty

Introduction

Healthy sleep is important for child development, with youth living in poverty and especially those who do not have a bed at greater risk for sleep issues. This study assessed sleep in school-aged children identified by social services as needing a bed and living in poverty.

Methods

Fifty-two families (100% living ≤ 100% of the US poverty line) of children ages 8-12 years (M= 9.65; 55.8% girls; 61.5% non-Latinx Black) referred to a non-profit bed provision program completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures of child sleep disturbances, sleep-related impairment, and sleep practices prior to bed provision. Comparisons were made to normative data for each measure based on converted T-scores/means.

Results

T-scores (M = 50; SD = 10) for caregiver and child reported child sleep disturbances (M= 46.81 and 47.22, respectively) and sleep-related impairment (M= 56.82 and 53.33, respectively) fell within the normal range. Although few caregiver-child dyads reported clinically significant (> 1 SD above the mean) child sleep disturbances (7.7% and 10.8%, respectively), 30.7% of caregivers and 27.4% of children reported clinically significant child sleep impairment scores compared to an expected rate of 15.9% from normative data. Regarding sleep practices, few caregiver (11.5%) and child (9.8%) reports of problematic sleep timing and caregiver-rated child bedtime routine inconsistency (13.5%) were > 1 SD above the normative mean. However, 25.5% of youth reported inconsistent bedtime routine scores > 1 SD above the normative mean, while 25.0% of caregivers and 31.4% of youth reported scores > 1 SD above the normative mean for child difficulty falling asleep without caregiver presence at bedtime. The prevalence of these elevated scores were greater than the expected prevalence of 15.9% in normative data.

Conclusion

Overall, children living in poverty and without an individual bed score similar to normative samples on sleep measures. However, a greater proportion of youth in this sample showed clinically significant sleep impairments and poor sleep practices compared to normative data. Future studies are needed to understand and promote healthy sleep among youth living in poverty.

Support (If Any)

American Academy of Sleep Medicine Foundation

Weak legs

A 48 year old lady presented with a 7-week history of progressive generalised myalgia and muscle weakness resulting in recurrent falls. Her past medical history included bipolar affective disorder and a previous stroke. Her medications included clopidogrel 75mg, atorvastatin 80mg, and quetiapine 400mg twice daily.

MC3R links nutritional state to childhood growth and the timing of puberty

The state of somatic energy stores in metazoans is communicated to the brain, which regulates key aspects of behaviour, growth, nutrient partitioning and development1. The central melanocortin system acts through melanocortin 4 receptor (MC4R) to control appetite, food intake and energy expenditure2. Here we present evidence that MC3R regulates the timing of sexual maturation, the rate of linear growth and the accrual of lean mass, which are all energy-sensitive processes. We found that humans who carry loss-of-function mutations in MC3R, including a rare homozygote individual, have a later onset of puberty. Consistent with previous findings in mice, they also had reduced linear growth, lean mass and circulating levels of IGF1. Mice lacking Mc3r had delayed sexual maturation and an insensitivity of reproductive cycle length to nutritional perturbation. The expression of Mc3r is enriched in hypothalamic neurons that control reproduction and growth, and expression increases during postnatal development in a manner that is consistent with a role in the regulation of sexual maturation. These findings suggest a bifurcating model of nutrient sensing by the central melanocortin pathway with signalling through MC4R controlling the acquisition and retention of calories, whereas signalling through MC3R primarily regulates the disposition of calories into growth, lean mass and the timing of sexual maturation.

894 An Audit of Venous Thromboembolism Prophylaxis in A Busy ENT Department

Aim

Venous thromboembolisms (VTEs) are a common and preventable cause of in-hospital morbidity and mortality. Assessment of risk factors (RFs) on admission and appropriate prescription of mechanical (e.g., TEDS) and/or pharmacological prophylaxis (e.g., low-molecular-weight heparin (LMWH)) is crucial. This is especially true in ENT where the variety of patient cohorts make a one-size-fits-all approach unsatisfactory. Guidelines from ENT UK reflect this.

Method

Electronic medical records were retrospectively reviewed for all emergency and pre-operative admissions (n = 173) to an adult ENT ward over 8 weeks. Adherence to the ENT UK guideline was assessed.

Results

58% of patients had VTE RFs, 27% had bleeding RFs, 2% had mechanical thromboprophylaxis contraindications. VTE risk assessment was clearly carried out for 39% of admissions. 63 patients (36%) met the criteria for LMWH prescription. 22 (35%) received it. 5 received LMWH without meeting the criteria. 96 patients (55%) met the criteria for TEDS prescription. 5 (5%) received it. 1 received TEDS without meeting the criteria. Overall, 45% of admissions had both prescribed according to the guideline. Using a pro-forma (n = 148) significantly improved risk assessment rates (43% vs. 12%), but not correct prescription rates (45% vs 40%) compared to freehand clerking (n = 25). No patients developed a VTE or unexpected bleeding.

Conclusions

Risk assessment and prescription of pharmacological and, especially, mechanical thromboprophylaxis for those who met the relevant criteria has significant room for improvement. However, no apparent harm occurred because of this. Further work will focus on developing a departmental policy and educating staff on its application.

883 A Closed-Loop Audit to Improve Admissions Documentation in A Busy ENT Department

Aim

Accurate and thorough admissions documentation is crucial for patient safety and effective care. We amended the admissions pro-forma used on a busy adult ENT ward to improve adherence to a modified version of Royal College of Surgeons of England guidelines.

Method

Baseline documentation of the 25 parameters of interest was assessed using electronic medical records for all emergency and pre-operative admissions over a 4-week period (n = 75). A new pro-forma was introduced, and the documentation over the following 4 weeks (n = 75) was assessed in the same way. Statistical analysis was done using Excel and RStudio (z-test for two proportions, p-value ≤ 0.05).

Results

The two groups were similar in age, gender, length of stay, and presenting complaint. The new pro-forma was completed for more admissions than the prior version (91% vs 77%) and resulted in documentation improvements in 19 out of 25 parameters. 9 of these were statistically significant, including initial vital signs and differential diagnosis. Parameters that improved, but not significantly, include admission source, medication history, and cognitive assessment. Across the 8 weeks, using a pro-forma (n = 126) significantly improved documentation of 11 parameters compared to freehand clerking (n = 24).

Conclusions

Adequate documentation at admission can help with immediate patient care, and act as a point of reference during extended stays. We were able to increase use of a pro-forma and produce meaningful documentation improvements quickly. Further work is required to assess why certain parameters are infrequently completed, and how future pro-forma iterations can become more user-friendly.

Studies of multifunctional DNA polymerase I from the extremely radiation resistant Deinococcus radiodurans: Recombinant expression, purification and characterization of the full-length protein and its large fragment

Deinococcus radiodurans is a bacterium with extreme resistance to desiccation and radiation. Although the origins of this extreme resistance have not been fully elucidated, an efficient DNA repair machinery that includes the enzyme DNA polymerase I, is potentially crucial as part of a protection mechanism. Here we have cloned and performed small, medium, and large-scale expression of full-length D. radiodurans DNA polymerase I (DrPolI) as well as the large/Klenow fragment (DrKlenow). We then carried out functional characterization of 5' exonuclease, DNA strand displacement and polymerase activities of these proteins using gel-based and molecular beacon-based biochemical assays. With the same expression and purification strategy, we got higher yield in the production of DrKlenow than of the full-length protein, approximately 2.5 mg per liter of culture. Moreover, we detected a prominent 5' exonuclease activity of DrPolI in vitro. This activity and, DrKlenow strand displacement and DNA polymerase activities are preferentially stimulated at pH 8.0-8.5 and are reduced by addition of NaCl. Interestingly, both protein variants are more thermostable at pH 6.0-6.5. The characterization of DrPolI's multiple functions provides new insights into the enzyme's role in DNA repair pathways, and how the modulation of these functions is potentially used by D. radiodurans as a survival strategy.

592 Objective vs. Subjective Sleep Data in Early Childhood: Implications for Health Disparities Research

Introduction

Given limited psychometric research with families of lower socioeconomic status (SES) and/or non-White backgrounds, this study explored the feasibility of and discrepancies between actigraphy and maternal-reported nightly child sleep in preschoolers of lower-SES and primarily Black backgrounds.

Methods

Twenty-seven children (Mage=3.3 years, SD = 1.2 years; 59.3% girls; 85.2% Black; 100% family income <125% of the US poverty level) were asked to wear an actigraph for 14 days while mothers completed telephone-based sleep diaries. Bedtime, wake time, nighttime sleep duration, nap duration, and 24-hour sleep duration were collected by both measures. Paired t-tests examined actigraphic versus mother-reported child sleep.

Results

Twenty-six percent of dyads (n=7) were excluded due to insufficient data (1-hour difference between measures on >50% of nights). There were no significant demographic differences between dyads with and without discrepant data. Diary-derived sleep onset was calculated by adding caregiver-reported bedtime and caregiver-reported sleep onset latency. There was no significant difference between actigraphy-derived sleep onset (M=10:20PM, SD=69min) and diary-derived sleep onset (M=9:59PM, SD=51min). Average actigraphy sleep offset (M=7:27 AM, SD=62 min) was 42 minutes earlier than diary-derived wake time (M=8:09 AM, SD=84 min), p<.05. Actigraphy-estimated nighttime (M=8.38 hours, SD=.80) and 24-hour sleep duration (M=9.31 hours, SD=1.13) were 0.92 and 0.85 hours shorter, respectively, than diary-derived nighttime (M=9.30 hours, SD=1.07) and total sleep duration (M=10.16 hours, SD=1.17), p<.005. There were no significant differences in average nap duration. The primary mother-reported barrier in completing diaries was limited awareness of child sleep due to work schedules.

Conclusion

Study results highlight some of the challenges of collecting and scoring actigraphy and diary data in preschoolers of lower-income backgrounds, in particular missing diary data and discrepancies between actigraphy and diaries. These findings suggest a need to incorporate both subjective parental report and objective measurement of child sleep in clinical and research contexts, as well determine ways to enhance feasibility and scoring procedures.

Support (if any)

K23HD094905 (AAW)

670 Changes in Childhood Sleep Patterns in an Intervention Study Prior to and During COVID19 Restrictions

Introduction

We conducted a childhood sleep promotion study between March 2019 and December 2020 in Philadelphia. COVID19 was first detected in Pennsylvania in March 2020 and non-essential services were strictly curtailed (including school closures), with easing of curtailments by the fall 2020 (including hybrid schooling in some districts). We determined if changes in sleep duration were consistent during pre-, earlier, and later COVID19 periods.

Methods

Typically developing children (9-12y) with sleep duration <8.5 hours per weeknight were enrolled. Sleep was measured using Fitbit devices during a baseline week and a 7-week intervention period. A factorial design was used to test five candidate intervention components: 1) sleep goal; 2) electronic device reduction messaging; 3) daily routine messaging; 4) child-directed financial incentive; and 5) parent-directed financial incentive. Sleep data were transmitted to a mobile health platform that automated delivery of the intervention components. We categorized participants when they completed the study: 1) Spring-Fall 2019 semesters (pre-COVID19); 2) Spring 2020 semester (started pre-COVID19, with strict restrictions impacting intervention periods); or 3) Fall 2020 semester (easing of COVID19 restrictions). Mixed effect modelling determined sleep changes.

Results

Mean age of participants was 11.6y (51% female and 29% Black participants). Pre-COVID19 (N=59), average sleep duration increased from baseline by 21 (95% CI: 10, 30) minutes per weeknight during the intervention. In spring 2020 (N=18), the average sleep duration increase was two times larger in magnitude at 41 (95% CI: 25, 59) minutes per weeknight. For fall 2020 (N=20), the average sleep duration increase was 24 (95% CI: 7, 40) minutes per weeknight. Changes in sleep timing from baseline during the intervention were consistent pre-COVID19 and in the fall 2020 (e.g., ≈15 minutes earlier sleep onset throughout the intervention period), whereas sleep timing changes were dynamic in the spring 2020 (e.g., 41 minutes earlier for week 1, and 44 minutes later for week 7).

Conclusion

This sleep intervention demonstrated increases in sleep duration pre-COVID19, with marked duration increases and dynamic timing changes coinciding with COVID19 restrictions during earlier (Spring 2020), but not later (Fall 2020), weeks of the COVID19 pandemic in Pennsylvania.

Support (if any)

K0 1 HL1 2 3 6 1 2 and CHOP

613 Variation in Sleep Beliefs and Behaviors Among Caregiver-Child Dyads Participating in a Sleep Extension Intervention

Introduction

Given the high prevalence and poor outcomes of insufficient child sleep, effective interventions for the pediatric primary care setting are needed. Collecting family perspectives on intervention strategies is critical to understand and enhance outcomes, particularly among children who do not experience improvements. This study examined variation in qualitative family sleep beliefs and behaviors by quantitative child sleep outcomes of a sleep extension intervention.

Methods

A total of 24 caregiver-child dyads (child age 9–12 years, M age 11.3 (SD:1.0) years; 46% male; 50% non-Latinx White; 29% Black) participated in a mobile health sleep extension intervention, between March-December 2019, and completed post-intervention semi-structured telephone interviews to solicit intervention perceptions. The intervention used a 25 factorial design consisting of sleep duration goals and weekly performance feedback, with random assignment to sleep health promotion messaging and financial incentive conditions. Sleep duration was assessed via Fitbit Flex 2 devices during 2-week baseline and 7-week intervention periods. We developed a codebook using a grounded theory approach and conducted coding in NVivo. We compared preliminary qualitative themes among children who showed a >=30-minute improvement in sleep duration (‘responders’) versus those who did not (‘non-responders’).

Results

Of the 24 dyads, 38% (N=9 dyads) were classified as non-responders. Preliminary qualitative themes included: family beliefs about sleep and electronics usage; the study impact on sleep behaviors; and an enhanced awareness of child sleep. Intervention responder and non-responder dyads similarly described family restrictions on evening electronics usage (e.g., electronic parental controls; physical removal of devices) to benefit child sleep. However, more children classified as intervention responders described the benefits of these restrictions and expressed beliefs about the negative impacts of electronics on sleep. Whereas caregivers of both responders and non-responders described efforts to remind their child to go to bed earlier during the intervention, caregivers in the responder group described being more focused on and active in child sleep extension strategies. These included setting bedtime reminders and adjusting family activities to ensure an extended sleep schedule.

Conclusion

Addressing caregiver-child beliefs about sleep behaviors and engagement in sleep extension strategies could augment sleep extension intervention outcomes in future research.

Support (if any)

K01HL123612 (JAM), CHOP (JAM), K23HD094905 (AAW)

603 Socioeconomic Status and Caregiver Perception of Young Children’s Sleep

Introduction

Socioeconomic status (SES) has been associated with variation in child sleep problems, but few studies have examined variation by SES in caregiver-reported early childhood sleep problems, patterns, and health behaviors. We hypothesized that, compared to higher-SES caregivers, lower-SES caregivers would report poorer sleep outcomes and sleep health behaviors, but lower rates of caregiver-perceived sleep problems.

Methods

A total of 309 caregivers (97% parents) of young children (M child age=3.59 years; 53.1% girls; 15% non-Hispanic/Latinx White, 57% non-Hispanic/Latinx Black, 20% Hispanic/Latinx White, 8% Hispanic/Latinx Black) completed the Brief Child Sleep Questionnaire. SES was measured via income level (lowest=$0-$20,000; middle= $20,001-$50,000; highest= $50,001 or greater).

Results

The prevalence of a caregiver-reported child sleep problem was similar across SES (17.6% of lowest SES group, 8.8% of middle, and 15.5% of highest, p>.05). However, ANCOVA models covarying for child race/ethnicity, age, caregiver age and education indicated sleep outcomes varied by SES. Caregivers in the lowest SES group reported significantly longer child sleep onset latency (SOL) than the middle or highest groups (p=.008), more frequent night wakings than those of middle SES (p=.009), and longer night waking duration than those of the highest SES, (p=.047). There were no significant differences by SES for child bedtime, total nighttime sleep, and total (24-hour) sleep duration. Logistic regression models with the same covariates showed no variation by SES for sleep behaviors, including caffeine consumption, presence of bedroom electronics, and bedtime resistance. Within each SES group, logistic regression models indicated that increased night wakings were uniquely associated with greater likelihood of endorsing a child sleep problem in the middle SES (p=.045) and highest SES groups (p=.040), but not in the lowest SES group.

Conclusion

Although caregiver-reported child sleep problems did not significantly differ across SES, lower-SES caregivers reported longer child sleep onset latency and increased number and duration of night wakings. Furthermore, night wakings were associated with perceived sleep problems, but only in middle and highest SES families. Clinicians should consider specific sleep parameters, such as SOL and night wakings, in addition to caregiver-reported child sleep problems when assessing and addressing child sleep problems, especially in lower-SES families.

Support (if any)

Funding: NIH K23HD094905 (AAW)