DISTRACTION: ITS UTILIZATION AND EFFICACY WITH CHILDREN UNDERGOING DENTAL TREATMENT

We investigated the utilization and efficacy of distraction in reducing the anxious and disruptive behavior of 4 children undergoing dental treatment. During the distraction procedure, the children were shown a poster and told a story about it during dental treatment. They earned a prize if they attended to the poster and story and could correctly answer questions about them following each intervention visit. The children's disruptive behavior was assessed via direct observation, and results were analyzed within a multiple baseline design. The children exhibited high levels of anxious and disruptive behavior across baseline visits, regardless of the length of time in treatment or number of visits. Anxious and disruptive behavior decreased upon introduction of the intervention for all children. This was accompanied by the children meeting the criterion for correct answers on the distraction quiz. However, 2 of the children demonstrated an increase in their anxious and disruptive behavior across intervention visits. Results are discussed in terms of the need to evaluate treatment strategies that promote maintenance as well as initial changes.     

USE OF ESCAPE AND REWARD IN THE MANAGEMENT OF YOUNG CHILDREN DURING DENTAL TREATMENT

A reinforced practice procedure was used to facilitate cooperative behavior in five children, aged 3 to 6 years, during dental treatment. In a multiple baseline design across subjects, the children were rewarded with escape, inexpensive stickers, and praise for cooperative behavior in the presence of the sights, sounds, and some sensations of the dental instruments prior to actual dental treatment. Direct observations of disruptive behavior via a 15-s interval recording system indicated baseline levels as high as 90% were reduced to less than 15% by the final treatment visit. In addition, the procedure was effective in reducing overall heart rate and blood pressure reactivity to dental treatment. All children were rated by the involved dental professionals as more cooperative and relaxed following exposure to reinforced practice.     

VISITING THE DENTIST: A BEHAVIORAL COMMUNITY ANALYSIS OF PARTICIPATION IN A DENTAL HEALTH SCREENING AND REFERRAL PROGRAM

One-hundred and twenty-five families in the Medicaid Early Periodic Screening, Diagnosis and Treatment Program were assigned to one of five treatments to encourage parents to obtain health care service following the dental screening of their children: (a) a control procedure, in which parents were given a dentist's name; (b) a multiple contact procedure, in which parents received a postcard and two telephone call reminders; (c) a problem-solve procedure, in which a social worker aide conducted a brief session with the parent; (d) an incentive procedure, in which parents selected among four gifts that were contingent on seeking care; (e) an incentive + problem-solve procedure, in which the latter two treatments were combined. The multiple contact, incentive, and incentive + problem-solve techniques were significantly more effective in initiating dental visits than the control procedures. Families assigned to the intensive strategies were most likely to complete treatment. A cost-efficiency analysis showed the multiple contact technique to be a low-cost and highly effective procedure.     

The Dental Subscale of the Children's Fear Survey Schedule: Predictive Value and Clinical Usefulness

This study reports on the predictive value and clinical usefulness of the Dutch parental version of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Parents of 718 children (4–12 years) completed this CFSS-DS version before or during the child's visit. The dentist rated the child's dental fear during treatment on a 5-point Likert-type Scale from 1 (not afraid at all) to 5 (very afraid). Reliability analysis was performed, and correlation coefficients between the two measures were calculated. The reliability of the scale proved to be high (Cronbach's = .93) and significant correlation coefficients were found (r = .58 and r = .68, p < .01). The negative predictive value of the CFSS-DS was high (.96), whereas its positive predictive value was relatively low (0.41). It was concluded that the CFSS-DS might be of clinical value as a screening device of dental fear, whereas its predictive value of fearful behavior should not be overestimated.     

General self-efficacy,dental anxiety and multiple fears among 20-year-olds in Norway

This paper examines the extent to which low general self-efficacy and painful dental and medical experiences are related to dental anxiety, multiple fears and to avoidance of dental care. A total of 754 20-year-olds completed a series of questionnaires, including the General Self-efficacy Scale (GSE), Geer Fear Scale (GFS) and Dental Fear Survey (DFS). Females had lower self-efficacy, higher dental anxiety and higher scores on the GFS than males. Multivariate analyses (linear stepwise regression) indicated that painful dental experiences, a high score on the GFS and negative opinions about own dental health explained 37% of the variance in DFS scores. Self-efficacy had no predictive power for dental anxiety, and only dental anxiety had predictive power for dental avoidance behavior. Thirty-eight percent of the total variance in GFS scores was explained by the following variables: being a female, high dental anxiety (DFS), low general self-efficacy (GSE) and low educational level of the mother.     

Perceived sources and levels of stress,general self-efficacy and coping strategies in preclinical dental students

Dental education programs are known to be highly stressful and stress can affect general health. The aims were to identify sources of stress among preclinical students and to evaluate their perceived levels of stress, self-efficacy and effective coping strategies in a private dental school. One hundred preclinical students in a Turkish private dental school were surveyed using dental environment stress (DES), perceived stress (PSS), general self-efficacy (G-SES) and brief coping scales (Brief-COPE). Age, gender, history of psychiatric treatment, factors that affected the choice of dentistry, choice rank of dental school, scholarship and income was recorded. ‘Exams and grades’ followed by ‘Fear of failing course or year’ were found to be the most stressprovoking factors. The most and the least stressprovoking DES domains were ‘Workload’ and ‘Social stressors’, respectively. ‘Social stressors’ affected male more than female (p < .05). The most and the least common coping strategies were found to be ‘Planning’, and ‘Drug’, respectively. Female used ‘Instrumental support’ more than male (p < .05). Demographic factors had impact on the perceived stress factors and levels, as well as coping strategies. Unlike previous studies establishing high stress levels in dental students, preclinical students displayed moderate level of stress. Clinical dental education might be more responsible for creating stress.     

The mathematical abilities of children with cochlear implants

Research has shown that cochlear implants give rise to improvements in speech recognition and production in children with profound hearing loss but very few studies have explored mathematical abilities in these children. The current study compared the mathematical abilities of 24 children with cochlear implants (mean age 10 years 1 month) to a control group of 22 hearing children (mean age 9 years 8 months). The math questions were categorized into questions that tapped into arithmetic or geometrical reasoning. It was predicted that the cochlear implant group would perform below the hearing group on the arithmetic questions but not the geometrical reasoning questions. Unexpectedly, the results showed that the cochlear implant group performed significantly below the hearing group on both types of math questions, but that this difference was mediated by language skill as assessed by vocabulary knowledge. The clinical implications of these results and possible future research results are considered.     

Recognition of Affective Speech Prosody and Facial Affect in Deaf Children with Unilateral Right Cochlear Implants

Cochlear implant (CI) devices provide the opportunity for children who are deaf to perceive sound by electrical stimulation of the auditory nerve, with the goal of optimizing oral communication. One part of oral communication concerns meaning, while another part concerns emotion: affective speech prosody, in the auditory domain, and facial affect, in the visual domain. It is not known whether childhood CI users can identify emotion in speech and faces, so we investigated speech prosody and facial affect in children who had been deaf from infancy and experienced CI users. METHOD: Study participants were 18 CI users (ages 7–13 years) who received right unilateral CIs and 18 age- and gender-matched controls. Emotion recognition in speech prosody and faces was measured by the Diagnostic Analysis of Nonverbal Accuracy. RESULTS: Compared to controls, children with right CIs could identify facial affect but not affective speech prosody. Age at test and time since CI activation were uncorrelated with overall outcome measures. CONCLUSION: Children with right CIs recognize emotion in faces but have limited perception of affective speech prosody.     

Assessment of dental anxiety: A facet approach

Dental anxiety is a complicated phenomenon, and its multicomponent nature is often not acknowledged in existing measurement instruments. Using a facet design, a new Dental Anxiety Inventory (DAI) was constructed. Facets chosen were: time (made up of four elements: at home, on your way to the denstist, in the denstist's waiting room, in the dental chair), situation (three elements: introductory aspects, dentist-patient interaction, actual dental treatment), and reaction (three elements: subjective feelings, physical reactions, cognitive reactions). Psychometric qualities of the DAI are good. The internal structure of the DAI was studied by linear and nonlinear techniques, and was partially recovered from the data. The construct and criterion validity of the DAI was supported in several studies.     

光学相干断层扫描观察白内障术后黄斑区病变

通过光学相干断层扫描(optical coherence tomography,OCT)技术来早期明确白内障超声乳化术后视网膜黄斑区病变.采集我院白内障超声乳化术及人工晶状体植入术后视力改善不良的老年性白内障患者,进行OCT检查,观察其图象特征.结果提示术眼黄斑区OCT图像表现为:黄斑区视网膜水肿,视网膜厚度增加;黄斑区增生膜形成,部分伴有黄斑区视网膜水肿;黄斑区神经上皮层变薄;黄斑裂孔形成;老年黄斑变性(萎缩性),表现为视网膜色素上皮层断裂、厚薄不均;部分病例视网膜色素上皮层增殖、断裂,表现为色素上皮损害.OCT由于其独特的横截面成像技术,通过精确测量视网膜厚度及观察视网膜反射性的改变,可以在白内障超声乳化术后早期发现黄斑区视网膜的病变,定量地了解病情的变化,是一种比较理想的检测手段.