Parenting in African American families: Profiles of general and culturally specific dimensions of parent-adolescent relationships during late adolescence

Developmental and parenting frameworks suggest that factors at the individual-level and multiple levels of adolescents' contexts are important determinants of how African American parents prepare their children to live in a racially stratified society. Using a person-centered approach, this study explored heterogeneity in profiles of African American parent-adolescent relationships (PARs) using indicators of parent-reported ethnic-racial socialization (cultural socialization, preparation for bias), general parenting practices (autonomy support, monitoring, behavioral control), and relationship quality (warmth, communication, conflict). We also examined how adolescents' characteristics, parents' personal and psychological resources, and contextual sources of stress and support contributed to profile membership. Data were from the Maryland Adolescent Development in Context Study (1991-2000) and consisted of 589 African American caregiver-adolescent dyads (caregivers: 89% female; 57.2% married; adolescents: 50.7% female; Mage = 17, SD = 0.64, range = 15-19 years old). Latent profile analysis revealed four profiles: (a) No-Nonsense High Socializers, (b) Indulgent Average Socializers, (c) Unengaged Silent Socializers, and (d) Authoritative Cultural Socializers. Adolescent characteristics (gender, depression, and problem behavior), parents' personal and psychological resources (parenting self-efficacy, centrality, private regard, and depression), and contextual sources of stress and support (stress: economic hardship, family stress, neighborhood disadvantage and support: marital status, family cohesion, family organization) were correlated with profile membership. Findings suggest that variability in African American PARs is shaped by an extensive set of individual and contextual factors related to adolescents and the family and neighborhood context. These findings have important implications for future research and how to target multiple potential levers for change in African American parenting practice.

A Development and Implementation of a Preconception Counseling Program for Black Women and Men in the Southeastern United States: A Pilot Protocol

Introduction

Racial/ethnic disparities in maternal mortality rates represent one of the most significant areas of disparities amongst all conventional population perinatal health measures in the U.S. The alarming trends and persistent disparities of outcomes by race/ethnicity and geographic location reinforce the need to focus on ensuring quality and safety of maternity care for all women. Despite complex multilevel factors impacting maternal mortality and morbidity, there are evidence-based interventions that, when facilitated consistently and properly, are known to improve the health of mothers before, during and after pregnancy. The objective of this project is to test implementation of pre-conception counseling with father involvement in community-based settings to improve cardiovascular health outcomes before and during pregnancy in southeastern United States.

Methods and Analysis

This study has two components: a comprehensive needs and assets assessment and a small-scale pilot study. We will conduct a community informed needs and assets assessment with our diverse stakeholders to identify opportunities and barriers to preconception counseling as well as develop a stakeholder-informed implementation plan. Next, we will use the implementation plan to pilot preconception counseling with father involvement in community-based settings. Finally, we will critically assess the context, identify potential barriers and facilitators, and iteratively adapt the way preconception counseling can be implemented in diverse settings. Results of this research will support future research focused on identifying barriers and opportunities for scalable and sustainable public health approaches to implementing evidence-based strategies that reduce maternal morbidity and mortality in the southeastern United States' vulnerable communities.

Discussion

Findings will demonstrate that preconception counseling can be implemented in community health settings in the southeastern United States. Furthermore, this study will build the capacity of community-based organizations in addressing the preconception health of their clients. We plan for this pilot to inform a larger scaled-up clinical trial across community health settings in multiple southeastern states.

The bifurcation and topography of the posterior tibial artery within the tarsal tunnel

PURPOSE

The tarsal tunnel (TT) is a fibro-osseous anatomical space coursing from the medial ankle to the medial midfoot. This tunnel acts as a passage for both tendinous and neurovascular structures, including the neurovascular bundle containing the posterior tibial artery (PTA), posterior tibial veins (PTVs) and tibial nerve (TN). Tarsal tunnel syndrome (TTS) is the entrapment neuropathy that describes the compression and irritation of the TN within this space. Iatrogenic injury to the PTA plays a significant role in both the onset and exacerbation of TTS symptoms. The current study aims to produce a method to allow clinicians and surgeons to easily and accurately predict the bifurcation of the PTA, to avoid iatrogenic injury during treatment of TTS.

METHODS

Fifteen embalmed cadaveric lower limbs were dissected at the medial ankle region to expose the TT. Various measurements regarding the location of the PTA within the TT were recorded and multiple linear regression analysis performed using RStudio.

RESULTS

Analysis provided a clear correlation (p < 0.05) between the length of the foot (MH), length of hind-foot (MC) and location of bifurcation of the PTA (MB). Using these measurements, this study developed an equation (MB = 0.3*MH + 0.37*MC - 28.24 mm) to predict the location of bifurcation of the PTA within a 23° arc inferior to the medial malleolus.

CONCLUSIONS

This study successfully developed a method whereby clinicians and surgeons can easily and accurately predict the bifurcation of the PTA, to avoid iatrogenic injury that would previously lead to an exacerbation of TTS symptoms.

Embracing Race, Resisting Oppression: African American Parents as Experienced Guides for Navigating Racial Oppression: Dismantling Systems of Racism and Oppression during Adolescence

This study examined how discrimination experiences, beliefs, and coping in middle adolescence contributed to heterogeneity in African American parent-adolescent relationship (PAR) profiles three years later. Data were from the Maryland Adolescent Development in Context Study in which 589 African American caregivers (92% female; M_age  = 39.15, SD = 6.72; range = 27-74 years old) were interviewed when youth were in 8th and 11th grades. We used previously identified profiles of ethnic-racial socialization, general parenting practices, and relationship quality: No-nonsense High Socializers, Indulgent Average Socializers, Unengaged Silent Socializers, and Authoritative Cultural Socializers. Results indicated that parents' discrimination experiences, racial coping self-efficacy, and racial coping socialization when youth were in the 8th grade predicted membership in PAR profiles three years later controlling for youth gender, parent marital status, and family socioeconomic status.

Exact Solutions of Interacting Dissipative Systems via Weak Symmetries

We demonstrate how the presence of continuous weak symmetry can be used to analytically diagonalize the Liouvillian of a class of Markovian dissipative systems with strong interactions or nonlinearity. This enables an exact description of the full dynamics and dissipative spectrum. Our method can be viewed as implementing an exact, sector-dependent mean-field decoupling, or alternatively, as a kind of quantum-to-classical mapping. We focus on two canonical examples: a nonlinear bosonic mode subject to incoherent loss and pumping, and an inhomogeneous quantum Ising model with arbitrary connectivity and local dissipation. In both cases, we calculate and analyze the full dissipation spectrum. Our method is applicable to a variety of other systems, and could provide a powerful new tool for the study of complex driven-dissipative quantum systems.

Metallization of Porous Polyethylene Using a Wire-Arc Spray Process for Heat Transfer Applications

Metallization of polyethylene (PE) using thermal spray techniques has proved difficult due to its low melting point and softness. In this study, metallic coatings were applied on porous polyethylene substrates using a twin wire-arc spray process. Commercially available polyethylene sheets, 3 mm in thickness, were used as substrates. Copper (Cu), aluminum (Al), and zinc (Zn) were successfully deposited on the porous polymer, without prior surface preparation, to form coatings with thickness of about 400 µm. Coating surface morphology and cross-sections were examined using a scanning electron microscope. Individual metal splats on the porous and non-porous substrates were observed to study the differences in the bonding mechanisms. The adhesion strength and electrical resistivity of the coatings on porous PE were evaluated. It was found that the bond strength of all three metallic coatings was found to be higher than the ultimate fracture strength of the porous. These results suggest that porosity in the polymer helps to overcome the challenges of metallizing polyethylene and provides a significant reduction in the weight of the polymer. Therefore, all these properties aided in fabricating an extremely lightweight, composite material with potential use in thermal management applications.

The protective roles of ethnic identity, social support, and coping on depression in low-income parents: A test of the adaptation to poverty-related stress model

OBJECTIVE

This study tested the Adaptation to Poverty-Related Stress (APRS) model's proposed relationships between poverty-related stress (PRS), ethnic identity affirmation (EI), social support, engagement coping, and depression in a racial/ethnically diverse sample of low-income parents.

METHOD

Path analysis was used to test the APRS model in a sample of 602 parents living at or below 200% of the federal poverty line (50% male, mean age = 32.55 years, SD = 8.78, 34.8% White). Multigroup path analysis tested moderation by gender and race/ethnicity.

RESULTS

Path analysis revealed that PRS was indirectly associated with higher depressive symptoms through less social support and less use of engagement coping operating in parallel and sequentially in a three-path mediated sequence. Conversely, EI was indirectly associated with lower depressive symptoms through greater social support and greater use of engagement coping operating in parallel and sequentially. However, PRS remained a direct predictor of higher depressive symptoms. Moderation by gender and race/ethnicity was not found.

CONCLUSION

Overall, the findings provide empirical support for the APRS model. This study suggests that clinical and preventive interventions targeting depression in low-income parents could benefit from focusing on improving low-income parent's use of engagement coping and perceived social support. Ethnic identity is a promising target as it to protects against PRS' negative impact on coping and social support. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Influence of Systemic Inflammation on Treatment Response and Survival in Anal Squamous Cell Cancer

AIMS

The incidence of anal squamous cell cancer (SCCA) is rising. Although chemoradiotherapy (CRT) provides a chance of cure, a proportion of patients have an incomplete response or develop recurrence. This study assessed the value of inflammation-based prognostic indicators, including the modified Glasgow Prognostic Score (mGPS) and neutrophil:lymphocyte ratio (NLR), in patients with SCCA treated by CRT with curative intent.

MATERIAL AND METHODS

Patients with histologically confirmed SCCA were identified from pathology records. Medical records were retrospectively reviewed and clinical, pathological and treatment characteristics were abstracted. The mGPS (0 = normal C-reactive protein [CRP] and albumin, 1 = CRP >10 mg/l and 2 = CRP >10 mg/l and albumin <35 mg/l) and NLR were calculated from routine blood tests obtained prior to CRT.

RESULTS

In total, 118 patients underwent CRT for SCCA between December 2007 and February 2018. Of these, 99 patients had appropriate pretreatment blood results available. Systemic inflammation as indicated by NLR >3 and mGPS >0 was present in 41% and 39% of patients, respectively. Most patients had T2 or larger tumours (n = 85, 86%) without nodal involvement (n = 64, 65%). An elevated mGPS was associated with more advanced T-stage (56% versus 35%, P = 0.036). NLR >5 was associated with nodal positivity (56% versus 31%, P = 0.047). On multivariate analysis, more advanced T-stage (odds ratio 7.49, 95% confidence interval 1.51-37.20, P = 0.014) and a raised mGPS (odds ratio 5.13, 95% confidence interval 1.25-21.14, P = 0.024) were independently related to incomplete CRT response. An elevated mGPS was prognostic of inferior survival (hazard ratio 3.09, 95% confidence interval 1.47-6.50, P = 0.003) and cancer-specific survival (hazard ratio 4.32, 95% confidence interval 1.54-12.15, P = 0.006), independent of TNM stage.

CONCLUSION

Systemic inflammation, as measured by the mGPS, is associated with an incomplete CRT response and is independently prognostic of inferior survival in patients with SCCA. The mGPS may offer a simple marker of inferior outcome that could be used to identify high-risk patients.

Reducing the Biological and Psychological Toxicity of Poverty-related Stress: Initial Efficacy of the BaSICS Intervention for Early Adolescents

This proof-of-concept study tests the initial efficacy of the Building a Strong Identity and Coping Skills (BaSICS) intervention, a selective prevention of internalizing problems program for early adolescents exposed to high levels of poverty-related stress. Eighty-four early adolescents (M_age  = 11.36 years) residing in very low-income neighborhoods were randomized to receive the 16-session intervention (n = 44) or to an assessment-only control condition (n = 40). BaSICS teaches coping skills, social identity development, and collective social action to empower youth with the ability to connect with members of their communities and cope with poverty-related stress in positive and collaborative ways. Pretest-posttest analyses showed that intervention adolescents acquired problem-solving and cognitive-restructuring skills and reduced their reliance on avoidant coping. In addition, HPA reactivity was significantly reduced in the intervention youth, but not controls. Finally, intervention youth's internalizing and somatic symptoms as reported by both youth and their parents, showed significant reductions over time, whereas control youth had no such changes. Results provide strong support for this approach to strength-building and symptom reduction in a population of early adolescents exposed to poverty-related stress.

Temporal changes in soil microbial properties and nutrient dynamics under climate smart agriculture practices

Climate smart agriculture (CSA) practices are emerging as sustainable alternative to conventional rice-wheat system to pull up natural resources degradation across south Asia. After five years of continuous CSA based experiment, a two years study was conducted to evaluate changes in microbial biomasses (microbial biomass carbon and nitrogen), enzyme activities (alkaline phosphatase, dehydrogenase and β-glucosidase), nutrient release and uptake (N, P and K) at different wheat crop growth stages. Effect of CSA practices was also studied for carbon mineralization in an incubation experiment. Four scenarios (Sc) were included in this study- conventional tillage (CT) based rice-wheat system (Sc1), partial CSA based rice-wheat-mungbean system (Sc2), full CSA based rice-wheat-mungbean system (Sc3), and full CSA based maize-wheat-mungbean system (Sc4). Soil samples were collected from scenarios at 0-15 and 15-30 cm depth at different growth stages of wheat crop namely sowing, crown root initiation (CRI), active tillering, panicle initiation, and harvesting. Analysis of soil was done for chemical properties viz. pH, electrical conductivity, available N, P, K, NPK uptake and mineralizable carbon and biological properties viz., microbial biomass carbon (MBC), microbial biomass nitrogen (MBN), dehydrogenase activity (DHA), alkaline phosphatase activity (APA) and β-glucosidase. Significantly higher microbial biomass carbon (42 %) and nitrogen (79 %) were found in surface soil (0-15 cm depth) under CSA based scenarios (Sc2, Sc3 and Sc4) at harvest stage of wheat over CT based/ conventional scenario (Sc1). At surface soil, alkaline phosphatase, dehydrogenase and β-glucosidase activity was 58, 14 and 13 % higher in CSA based scenarios, respectively than CT based scenario. CSA based scenarios showed significantly higher C mineralization after 3 days of the incubation experiment at harvest. An increase of respectively 15, 48 and 17 % of N, P and K uptake was observed with CSA based scenarios than CT based scenario. At harvest stage, 7 % higher amount of dry matter was reported with full CSA based scenarios (mean of Sc2 to Sc4) compared to Sc1. Higher wheat grain yield of ∼10 % was recorded with CSA based scenarios over CT based scenario. Therefore, CSA based scenarios with improved biological properties and nutrient availability and uptake at different wheat growth stages resulted in higher yields and hence need to be popularized among the farmers.

Mesh inlay, mesh kit or native tissue repair for women having repeat anterior or posterior prolapse surgery: randomised controlled trial (PROSPECT)

OBJECTIVE

To compare standard (native tissue) repair with synthetic mesh inlays or mesh kits.

DESIGN

Randomised controlled trial.

SETTING

Thirty-three UK hospitals.

POPULATION

Women having surgery for recurrent prolapse.

METHODS

Women recruited using remote randomisation.

MAIN OUTCOME MEASURES

Prolapse symptoms, condition-specific quality-of-life and serious adverse effects.

RESULTS

A Mean Pelvic Organ Prolapse Symptom Score at 1 year was similar for each comparison (standard 6.6 versus mesh inlay 6.1, mean difference [MD] -0.41, 95% CI -2.92 to 2.11: standard 6.6 versus mesh kit 5.9, MD -1.21 , 95% CI -4.13 to 1.72) but the confidence intervals did not exclude a minimally important clinical difference. There was no evidence of difference in any other outcome measure at 1 or 2 years. Serious adverse events, excluding mesh exposure, were similar at 1 year (standard 7/55 [13%] versus mesh inlay 5/52 [10%], risk ratio [RR] 1.05 [0.66-1.68]: standard 3/25 [12%] versus mesh kit 3/46 [7%], RR 0.49 [0.11-2.16]). Cumulative mesh exposure rates over 2 years were 7/52 (13%) in the mesh inlay arm, of whom four women required surgical revision; and 4/46 in the mesh kit arm (9%), of whom two required surgical revision.

CONCLUSIONS

We did not find evidence of a difference in terms of prolapse symptoms from the use of mesh inlays or mesh kits in women undergoing repeat prolapse surgery. Although the sample size was too small to be conclusive, the results provide a substantive contribution to future meta-analysis.

TWEETABLE ABSTRACT

There is not enough evidence to support use of synthetic mesh inlay or mesh kits for repeat prolapse surgery.

Extending the toxic stress model into adolescence: Profiles of cortisol reactivity

The toxic stress model posits that extended activation of stress response systems in the absence of a supportive relationship with an adult may over time lead to physiological alterations to these same systems, and ultimately to poorer physical and mental health outcomes. However, empirical tests of model hypotheses in adolescence, a critical period of development, are lacking. This study expands the toxic stress model to include more developmentally-appropriate risk and protective factors for adolescents experiencing overwhelming and uncontrollable stressors. Data were collected for a study of early adolescents from urban low-income households (N = 101; 10-12 years old; 59% female). Participants and a caregiver completed questionnaires; youths completed the modified Trier Social Stress Task alone and provided six saliva samples. Using latent profile analysis, three profiles of cortisol reactivity were identified in early adolescents exposed to chronic environmental stress: Elevated and Reactive (11%), Moderate and Non-Reactive (26%), and Blunted and Non-Reactive (63%). In accordance with the toxic stress model, exposure to more community violence and less family support were associated with blunted cortisol reactivity, and Reactive profile membership was associated with fewer trauma symptoms. Overall, the findings provide empirical support for the extension of the toxic stress model in early adolescence through the application of developmentally-sensitive measures and provide implications for future interventions.

'We've made the best of it. But we do not have a normal life': families' experiences of tuberous sclerosis complex and seizure management

BACKGROUND

Tuberous sclerosis complex (TSC) is a complex multisystem genetic disorder. Approximately 84% of people with TSC have epilepsy. However, there is little literature available regarding families' experiences with TSC and seizure management. Therefore, the aim of the current study was to explore families' positive and negative experiences, and attitudes towards TSC, epilepsy and medical management of seizures.

METHODS

Framework analysis informed an open exploration of families' experiences with TSC, epilepsy and medical management of seizures. Using structured interviews, 11 parents of people with TSC and 2 people with TSC were interviewed, providing the data set for transcription and thematic analysis.

RESULTS

'TSC rules our life' overarched three subordinate themes: 'Our normal', 'Burnout' and 'Seizure management has given us our life back'. Families had to adapt to the normality of needing to constantly supervise their child even as they become an adult. They express a feeling of fear particularly of seizures, and this has impact throughout the family. There are frequent expressions of exhaustion and struggling to fight for access and support. There are some positives and cautious hope with the gaining of control from seizures as being able to predict or plan improves activity and participation. These interviews provided a rich insight into the lives of those with TSC and their families.

CONCLUSION

There are exciting developments with respect to scientific understanding of the pathophysiology of TSC, which opens opportunity for new treatments. Holistic family centred health care and practical support (e.g. opportunities for parental respite) is as important as medical intervention. As TSC is such a complex condition, there is a need for specialist clinics and TSC-specific research.

Parenting within residential neighborhoods: A pluralistic approach with African American and Latino families at the center

The intersection of SES and race-ethnicity impact youth development at the family and neighborhood levels. The confluence of neighborhood structural and social characteristics intersects to impact parenting multiple ways. Within lower-income neighborhoods, there is variability in economic and racial-ethnic demographics and social characteristics and a multitude of different lived experiences. We use a person-centered approach to understand how a plurality of neighborhood social characteristics shape parents' ethnic-racial socialization and monitoring strategies, normative parenting practices for diverse families. With 144 African American and Latino families in a new destination context-areas lacking an enduring historical and economic presence of same-ethnic populations-we examined whether we could replicate neighborhood profiles found in other neighborhood contexts using four neighborhood social process indicators (i.e., connectedness, cohesion and trust, informal social control, and problems), identified family- and neighborhood-level predictors of profiles, and explored differences in ethnic-racial socialization and parental monitoring knowledge by profile. We replicated three neighborhood profiles-integral (high on all positive social dynamics and low problems), anomic (low on all positive social dynamics and high problems), and high problems/positive relationships. Caregivers in these profiles differed in family SES and neighborhood disadvantage such that those in anomic neighborhoods had the lowest income-to-needs ratio whereas those in integral neighborhoods experienced the highest neighborhood disadvantage and lowest proportion of Hispanic residents. Egalitarianism, an ethnic-racial socialization message, and parental monitoring levels differed by neighborhood. Findings suggest African American and Latino families' unique experiences in a new destination context, signaling a complex interplay between race-ethnicity, SES, and place.

Effects of tillage, crop establishment and diversification on soil organic carbon, aggregation, aggregate associated carbon and productivity in cereal systems of semi-arid Northwest India

Intensive tillage based management practices are threatening soil quality and systems sustainability in the rice-wheat belt of Northwest India. Furthermore, it is accentuated with puddling of soil, which disrupts soil aggregates. Conservation agriculture (CA) practices involving zero tillage, crop residue management and suitable crop rotation can serve as better alternative to conventional agriculture for maintaining soil quality. Soil organic carbon is an important determinant of soil quality, playing critical role in food production, mitigation and adaptation to climate change as well as performs many ecosystem functions. To understand the turnover of soil carbon in different forms (Total organic carbon-TOC; aggregate associated carbon-AAC; particulate organic carbon- POC), soil aggregation and crop productivity with different management practices, one conventional agriculture based scenario and three CA based crop management scenarios namely conventional rice-wheat system (Sc1), partial CA based rice-wheat-mungbean system (Sc2), full CA-based rice-wheat-mungbean system (Sc3) and maize-wheat-mungbean system (Sc4) were evaluated. TOC was increased by 71%, 68% and 25% after 4 years of the experiment and 75%, 80% and 38% after 6 years of the experiment in Sc4, Sc3 and Sc2, respectively, over Sc1 at 0-15 cm soil depth. After 4 years of the experiment, 38.5% and 5.0% and after 6 years 50.8% and 24.4% improvement in total water stable aggregates at 0-15 and 15-30 cm soil depth, respectively was observed in CA-based scenarios over Sc1. Higher aggregate indices were associated with Sc3 at 0-15 cm soil depth than others. Among the size classes of aggregates, highest aggregate associated C (8.94 g kg^-1) was retained in the 1-0.5 mm size class under CA-based scenarios. After 6 years, higher POC was associated with Sc4 (116%). CA-based rice/maize system (Sc3 and Sc4) showed higher productivity than Sc1. Therefore, CA could be a potential management practice in rice-wheat cropping system of Northwest India to improve the soil carbon pools through maintaining soil aggregation and productivity.

Achieving Self-Directed Integrated Cancer Aftercare (ASICA) in melanoma: protocol for a randomised patient-focused pilot trial of delivering the ASICA intervention as a means to earlier detection of recurrent and second primary melanoma

BACKGROUND

Melanoma is common; 15,906 people in the UK were diagnosed with melanoma in 2015 and incidence has increased fivefold in 30 years. Melanoma affects old and young people, with poor prognosis once metastatic. UK guidelines recommend people treated for cutaneous melanoma receive extended outpatient, hospital follow up to detect recurrence or new primaries. Such follow up of the growing population of melanoma survivors is burdensome for both individuals and health services. Follow up is important since approximately 20% of patients with early-stage melanoma experience a recurrence and 4-8% develop a new primary; the risk of either is highest in the first 5 years. Achieving Self-directed Integrated Cancer Aftercare (ASICA) is a digital intervention to increase total-skin-self-examination (TSSE) by people treated for melanoma, with usual follow up.

METHODS

We aim to recruit 240 adults with a previous first-stage 0-2C primary cutaneous melanoma, from secondary care in North-East Scotland and the East of England. Participants will be randomised to receive the ASICA intervention (a tablet-based digital intervention to prompt and support TSSE) or control group (treatment as usual). Patient-reported and clinical data will be collected at baseline, including the modified Melanoma Worry Scale (MWS), the Hospital Anxiety and Depression Scale (HADs), the EuroQoL 5-dimension 5-level questionnaire (EQ-5D-5 L), and questions about TSSE practice, intentions, self-efficacy and planning. Participants will be followed up by postal questionnaire at 3, 6 and 12 months following randomization, along with a 12-month review of clinical data. The primary timepoint for outcome analyses will be12 months after randomisation.

DISCUSSION

If the ASICA intervention improves the practice of TSSE in those affected by melanoma, this may lead to improved psychological well-being and earlier detection of recurrent and new primary melanoma. This could impact both patients and National Health Service (NHS) resources. This study will determine if a full-scale randomised controlled trial can be undertaken in the UK NHS to provide the high-quality evidence needed to determine the effectiveness of the intervention. ASICA is a pilot study evaluating the effectiveness of the practice of digitally supported TSSE in those affected by melanoma.

TRIAL REGISTRATION

Clinical Trials.gov, NCT03328247 . Registered on 1 November 2017.

Protocol for a Randomised controlled trial to Evaluate the effectiveness and cost benefit of prescribing high dose FLuoride toothpaste in preventing and treating dEntal Caries in high-risk older adulTs (reflect trial)

BACKGROUND

Dental caries in the expanding elderly, predominantly-dentate population is an emerging public health concern. Elderly individuals with heavily restored dentitions represent a clinical challenge and significant financial burden for healthcare systems, especially when their physical and cognitive abilities are in decline. Prescription of higher concentration fluoride toothpaste to prevent caries in older populations is expanding in the UK, significantly increasing costs for the National Health Services (NHS) but the effectiveness and cost benefit of this intervention are uncertain. The Reflect trial will evaluate the effectiveness and cost benefit of General Dental Practitioner (GDP) prescribing of 5000 ppm fluoride toothpaste and usual care compared to usual care alone in individuals 50 years and over with high-risk of caries.

METHODS/DESIGN

A pragmatic, open-label, randomised controlled trial involving adults aged 50 years and above attending NHS dental practices identified by their dentist as having high risk of dental caries. Participants will be randomised to prescription of 5000 ppm fluoride toothpaste (frequency, amount and duration decided by GDP) and usual care only. 1200 participants will be recruited from approximately 60 dental practices in England, Scotland and Northern Ireland and followed up for 3 years. The primary outcome will be the proportion of participants receiving any dental treatment due to caries. Secondary outcomes will include coronal and root caries increments measured by independent, blinded examiners, patient reported quality of life measures, and economic outcomes; NHS and patient perspective costs, willingness to pay, net benefit (analysed over the trial follow-up period and modelled lifetime horizon). A parallel qualitative study will investigate GDPs' practises of and beliefs about prescribing the toothpaste and patients' beliefs and experiences of the toothpaste and perceived impacts on their oral health-related behaviours.

DISCUSSION

The Reflect trial will provide valuable information to patients, policy makers and clinicians on the costs and benefits of an expensive, but evidence-deficient caries prevention intervention delivered to older adults in general dental practice.

TRIAL REGISTRATION

ISRCTN: 2017-002402-13 registered 02/06/2017, first participant recruited 03/05/2018. Ethics Reference No: 17/NE/0329/233335. Funding Body: Health Technology Assessment funding stream of National Institute for Health Research. Funder number: HTA project 16/23/01. Trial Sponsor: Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL. The Trial was prospectively registered.

Co-activation of SAM and HPA responses to acute stress: A review of the literature and test of differential associations with preadolescents' internalizing and externalizing

Understanding co-activation patterns of the hypothalamic-pituitary-adrenal axis (HPA) and sympathetic adrenal medullary (SAM) during early adolescence may illuminate risk for development of internalizing and externalizing problems. The present study advances empirical work on the topic by examining SAM-HPA co-activation during both the reactivity and recovery phases of the stress response following acute stress exposure. Fourth and fifth grade boys and girls (N = 149) provided cortisol and alpha-amylase via saliva at seven times throughout a 95-min assessment in which they were administered the modified Trier Social Stress Test. Parents reported on adolescents' life stress, pubertal development, medication use, and externalizing problems. Adolescents reported their own internalizing symptoms. Multiple linear regressions tested both direct and interactive effects of SAM and HPA reactivity and recovery on internalizing and externalizing problems. Results from these analyses showed that whereas SAM and HPA reactivity interacted to predict internalizing symptoms, it was their interaction during the recovery phase that predicted externalizing. Concurrent high SAM and HPA reactivity scores predicted high levels of internalizing and concurrently low SAM and HPA recovery scores predicted high levels of externalizing. Implications of the findings for further study and clinical application are discussed.

Impact of Carbamide Peroxide Whitening Agent on Dentinal Collagen

Carbamide peroxide (CP) is widely used as a tooth-whitening agent in self-administered tooth-bleaching products. In this study, the effects of 5% and 10% CP on dentinal collagen structure and chemical properties were evaluated in vitro. Thirty-five intact teeth were exposed to 2 whitening protocols (2 or 4 h daily) with either 5% or 10% CP gel for 1 wk. Shade changes before and after the whitening protocol were captured colorimetrically using a spectroshade. Collagen scaffold models and demineralized dentine disc samples were prepared and exposed to CP droplets (5% or 10%). Structural changes were investigated using electron microscopy. Finally, mineralized dentine disc samples were prepared postbleaching to assess chemical changes resulting from CP exposure in dentinal collagen using Raman spectroscopy. Results showed a difference in tooth shade when exposed to 5% and 10% CP whitening protocols, with a significantly ( P ≤ 0.01) greater change reported for the 10% CP/4-h group. Imaging of the collagen scaffold model following exposure to CP showed a gelatinization process indicating that the free radical by-products from CP are able to disrupt the quaternary structure of noncrosslinked collagen. The most significant damage on the collagen scaffold was seen for the 10% CP exposure for 4 h. Imaging of the demineralized discs displayed the same glassy amorphous layer appearance as found in the collagen scaffold. Raman spectra of the mineralized dentine discs showed a significant decrease ( P ≤ 0.01) in the integrated area of amide I and amide III values in the 4 test groups following CP application. Amide I was more affected as both the exposure time and concentration of CP increased. Despite the claimed safety of whitening agents, this in vitro study concludes that even low concentrations of CP result in a deleterious change in dentinal collagen.