In Situ Study to Confirm the Anticaries Potential of a Sodium Monofluorophosphate Dentifrice Containing Calcium Sodium Phosphosilicate

OBJECTIVES

A randomized, investigator-blind, five-treatment, crossover, non-inferiority study was conducted to investigate the effect of the addition of calcium sodium phosphosilicate (CSPS), an agent known to relieve dentin hypersensitivity, to a sodium monofluorophosphate (SMFP)-containing dentifrice on the enamel remineralization potential of fluoride (F), as assessed by percentage surface microhardness recovery (%SMHR) and enamel fluoride uptake (EFU) using a standard in situ caries model.

METHODS

Seventy-seven subjects wearing bilateral mandibular partial dentures holding partially demineralized bovine enamel specimens 24 hours/day brushed their teeth with their assigned randomized dentifrice containing either 1500 or 0 ppm F with 5% CSPS or 1500, 500, or 0 ppm F with 0% CSPS twice daily for 21 days. The success criterion was to observe a difference in % SMHR between dentifrices containing 1500 ppm F of six units or less in the upper bound of the two-sided 95% confidence interval (CI).

RESULTS

Following 21 days of treatment, the upper bound CI of the %SMHR difference between the dentifrices containing 1500 ppm F was 1.66, thus within the non-inferiority limit. No statistically significant differences for %SMHR (p = 0.2601) and EFU (p = 0.2984) were noted between these two dentifrices.

CONCLUSIONS

The present in situ caries study provides evidence demonstrating that the addition of the calcium-containing compound CSPS to a 1500 ppm F dentifrice does not interfere with the ability of fluoride to remineralize surface-softened enamel; i.e., CSPS neither impairs nor improves the potential cariostatic value of SMFP dentifrice.

Examining the sources of occupational stress in an emergency department

BACKGROUND

Previous work has established that health care staff, in particular emergency department (ED) personnel, experience significant occupational stress but the underlying stressors have not been well quantified. Such data inform interventions that can reduce cases of occupational mental illness, burnout, staff turnover and early retirement associated with cumulative stress.

AIMS

To develop, implement and evaluate a questionnaire examining the origins of occupational stress in the ED.

METHODS

A questionnaire co-designed by an occupational health practitioner and ED management administered to nursing, medical and support staff in the ED of a large English teaching hospital in 2015. The questionnaire assessed participants' demographic characteristics and perceptions of stress across three dimensions (demand-control-support, effort-reward and organizational justice). Work-related stressors in ED staff were compared with those of an unmatched control group from the acute ear, nose and throat (ENT) and neurology directorate.

RESULTS

A total of 104 (59%) ED staff returned questionnaires compared to 72 staff (67%) from the acute ENT/neurology directorate. The ED respondents indicated lower levels of job autonomy, management support and involvement in organizational change, but not work demand. High levels of effort-reward imbalance and organizational injustice were reported by both groups.

CONCLUSIONS

Our findings suggest that internal ED interventions to improve workers' job control, increase support from management and involvement in organizational change may reduce work stress. The high levels of effort-reward imbalance and organizational injustice reported by both groups may indicate that wider interventions beyond the ED are also needed to address these issues.

Prevalence and distribution of foot lesions in dairy cattle in Alberta, Canada

The objectives of this cross-sectional study were to determine the prevalence and distribution of foot lesions and associated cow- and herd-level risk factors in dairy cows in Alberta, Canada. Foot lesion data were recorded electronically by 7 hoof trimmers on 28,607 cows in 156 dairy farms from June 2009 to November 2012. Foot lesion prevalence estimates differed between farms that had the whole herd trimmed at once (≥80% of lactating cows were trimmed; n=69 farms and 8,020 cows) and farms on which part of the herd was trimmed (selection of cows was determined by farmer and <80% of lactating cows were trimmed; n=87 and 20,587 cows). Estimates were consistently higher for the latter likely because farmers presumably prioritized lame cows in partial-herd trims. On farms with whole-herd trims, digital dermatitis was the most common lesion among all housing types, present in 15% of cows and 94% of herds. Sole ulcers and white line disease were detected in 6 and 4% of the cows and 92 and 93% of herds, respectively. Other infectious and claw horn lesions each affected 1 to 2% of cows and 62 to 78% of herds. Intraclass correlation coefficients for hoof trimmers ranged from 0.01 to 0.20 for all lesions, indicating some clustering of recorded lesions by trimmer. Multilevel mixed logistic regression models were constructed (including hoof trimmer as fixed and farm as random effects) for the 3 most frequently identified lesions. Prevalence of digital dermatitis decreased with increasing parity, but this effect interacted with days in milk (DIM); primiparous cows had higher odds of digital dermatitis in mid lactation (100-199 DIM) and late lactation (≥200 DIM) compared with cows at other stages of lactation. In contrast, prevalence of sole ulcers and white line disease increased with increasing parity; compared with cows in parity 1, those in parity 4 had 5 or 7 times higher odds of having these lesions, respectively. Cows in mid lactation and late lactation had higher odds of sole ulcers and white line disease than cows at other stages of lactation, regardless of parity. Digital dermatitis prevalence was 2 times higher in herds housed in barns with access to an exercise area. The odds of sole ulcers and white line disease were ≥2 times higher in cows housed in freestalls than those housed in deep-bedded packs. Therefore, preventive measures for control of digital dermatitis merit emphasis, especially in primiparous cows and on farms with exercise areas. In addition, improving housing environment by providing a deep-bedded area for older cows in mid lactation or late lactation could reduce prevalence of claw horn lesions. We inferred that foot lesion data recorded by hoof trimmers can provide useful information not only to develop effective foot health programs at herd level, but also for disease surveillance and genetic improvement at regional and national levels.

Associations between lying behavior and lameness in Canadian Holstein-Friesian cows housed in freestall barns

Lying behavior is an important measure of comfort and well-being in dairy cattle, and changes in lying behavior are potential indicators and predictors of lameness. Our objectives were to determine individual and herd-level risk factors associated with measures of lying behavior, and to evaluate whether automated measures of lying behavior can be used to detect lameness. A purposive sample of 40 Holstein cows was selected from each of 141 dairy farms in Alberta, Ontario, and Québec. Lying behavior of 5,135 cows between 10 and 120 d in milk was automatically and continuously recorded using accelerometers over 4 d. Data on factors hypothesized to influence lying behavior were collected, including information on individual cows, management practices, and facility design. Associations between predictor variables and measures of lying behavior were assessed using generalized linear mixed models, including farm and province as random and fixed effects, respectively. Logistic regression models were used to determine whether lying behavior was associated with lameness. At the cow-level, daily lying time increased with increasing days in milk, but this effect interacted with parity; primiparous cows had more frequent but shorter lying bouts in early lactation, changing to mature-cow patterns of lying behavior (fewer and longer lying bouts) in late lactation. In barns with stall curbs >22 cm high, the use of sand or >2 cm of bedding was associated with an increased average daily lying time of 1.44 and 0.06 h/d, respectively. Feed alleys ≥ 350 cm wide or stalls ≥ 114 cm wide were associated with increased daily lying time of 0.39 and 0.33 h/d, respectively, whereas rubber flooring in the feed alley was associated with 0.47 h/d lower average lying time. Lame cows had longer lying times, with fewer, longer, and more variable duration of bouts compared with nonlame cows. In that regard, cows with lying time ≥ 14 h/d, ≤ 5 lying bouts per day, bout duration ≥ 110 min/bout, or standard deviations of bout duration over 4 d ≥ 70 min had 3.7, 1.7, 2.5, and 3.0 higher odds of being lame, respectively. Factors related to comfort of lying and standing surfaces significantly affected lying behavior. Finally, we inferred that automated measures of lying behavior could contribute to lameness detection, especially when interpreted in the context of other factors known to affect lying behavior, including those associated with the individual cow (e.g., parity and stage of lactation) or environment (e.g., stall surface).

Prevalence of lameness and associated risk factors in Canadian Holstein-Friesian cows housed in freestall barns

Lameness is a severe welfare problem and a production-limiting disease in dairy farming. The objectives of this study were to determine prevalence of lameness and investigate cow- and herd-level factors associated with lameness in dairy cows housed in freestall barns in 3 Canadian provinces. A purposive sample of 40 Holstein-Friesian cows was selected from each of 141 dairy farms in Québec, Ontario, and Alberta. In total, 5,637 cows were scored once for lameness (presence of limping when walking). Data collected included information on individual cows (hock lesions, claw length, body condition score, parity, days in milk, and milk production), management practices (floor and stall cleaning routine, bedding routine, and footbath practices), and facility design (stall dimensions, stall base and bedding type, width of feed alley, flooring type, and slipperiness) hypothesized to be risk factors for lameness. Multilevel mixed logistic regression models were constructed (including farm as a random effect and province as a fixed effect). Herd-level lameness prevalence ranged from 0 to 69% (mean = 21%). Lameness prevalence increased with increasing parity; compared with first parity, cows in parity 2, 3, and ≥ 4 had 1.6, 3.3, and 4 times, respectively, higher odds of being lame. Furthermore, the odds of lameness were 1.6 times greater in cows with low body condition score (≤ 2.5) than in cows with a higher body condition score. In addition, injured hocks and overgrown claws were associated with 1.4- and 1.7-fold increased odds of being lame, respectively, whereas every 1 kg increase in daily milk production was associated with a 3% decrease in the odds of being lame. Lameness prevalence was higher in herds with ≤ 100 cows, but lower in barns with a sand or dirt stall base, or with bedding ≥ 2 cm deep. Cows exposed to very slippery floors had 2 times the odds of being lame compared with cows exposed to nonslippery floors. We attributed the wide range of lameness prevalence to the great variability in facilities and management practices among farms. Finally, we inferred that the prevalence of lameness could be decreased by improving management of multiparous, thin, or injured cows and by adopting management practices intended to improve cow comfort, namely the floor's slip resistance and the stall's lying surface.

PA3 Using the lived experience of volunteers to enhance the care of dying patients and their families

BACKGROUND

In the UK, the majority of people die in hospital.(1) Community presence is considered to be a significant component to achieving a "good death",(2,3) however many patients die with no/few visitors, spending their last weeks of life isolated or alone.

AIM

To establish a Volunteer Service and offer: A presence to dying patients. A connexion to the community outside the Hospital. Support to families, unable to visit or emotionally exhausted from their bedside vigil.

METHODS

The Service was piloted on 6 wards (October 2012-March 2013) within a large NHS Trust, in the North of England. This was followed by a comprehensive evaluation, according to MRC guidance.

RESULTS

Analysis of the service evaluation indicated that the service was extremely beneficial, meeting its aims in providing an emotional support and spiritual presence to dying patients, and their families.

CONCLUSION

The Service provides a model of best practice that could be replicated in other Trusts and within other care settings. There are plans to further develop and expand service provision across the Trust.

REFERENCES

National End of Life Care Intelligence Network. What we know now. 2013. http://www.endoflifecare-intelligence.org.uk/resources/publications/what_we_know_now_2013 Department of Health. End of Life Care Strategy. 2008. https://www.gov.uk/government/publications/end-of-life-care-strategy-promoting-high-quality-care-for-adults-at-the-end-of-their-life Kellehear A. The end of death in late modernity, an emerging public health challenge. Crit Public Health 2007;17(1):71-79.