Linda Jones

A 30-year follow-up of residual effects on New Zealand School Dental Nurses, from occupational mercury exposure:

This paper reports possible residual adverse effects from occupational mercury exposure in dentistry, Thirty years ago, the all-women exposed group worked with both silver and copper amalgam filling material without protective gloves or a ventilation system, resulting in chronic mercury exposure. The aim of the study was to test the null hypothesis in a survey of general and reproductive health, and a battery of nine neurobehavioral tests. The population was the 115 graduates of one school for dental nurses from 1968 to 1971. The sample was 43 mercury-exposed women and 32 matched controls. Statistical comparisons revealed that the two groups were equivalent on cognitive tasks and four of the six mood subscales. Significant between-group differences were found in current health symptom experience and reproductive health, especially early hysterectomy experience. Reporting of Occupational Overuse Syndrome was strongly positively correlated with years of work. In general, the study suggests that acute symptoms from mercury exposure may be reversible, while some residual health effects may be becoming more of a concern with the womens increasing age. Human & Experimental Toxicology (2007) 26, 367—374

Understanding the sleep problems of people with dementia and their family caregivers

Sleep disturbances are common with dementia and can adversely affect waking function. However, the perspectives of people with dementia and their family caregivers concerning their sleep are under-researched. We conducted three focus groups with 12 community-dwelling pairs (a person with dementia and their family caregiver). Discussions addressed sleep disturbances, coping strategies, and beliefs and attitudes surrounding sleep. Thematic analysis indicated that dementia-related sleep disturbances were common, including confused awakenings and dementia-related behaviors at night, changes to sleep timing, and nightmares. Common issues for caregivers included being woken at night, having problems getting back to sleep, trips to the bathroom, and daytime sleepiness. Participants often normalized their sleeping problems and had developed a number of coping strategies. These findings highlight the impact that sleep disturbances can have on people living with dementia. Their experiences and beliefs need to be considered for developing effective interventions to improve sleep, waking function, and wellbeing.

The rationale and pilot study of a new paediatric dental patient request form to improve communication and outcomes of dental appointments

BACKGROUND Childrens unhappy visits to the dentist can negatively impact lifelong oral health. A possible intervention is to enhance empathy in the child patient-dental practitioner relationship through communication. The present paper presents a new instrument, the Survey of Anxiety and Information for Dentists (SAID), which targets childrens dental anxiety, coping preferences and dental neglect, and offers children a change to request information and engage in treatment planning. METHOD Five childrens focus groups pilot tested the content, wording and response format of a prototype patient request form, the SAID. Participants were 34 10- to 13-year-old children who individually completed the form then discussed it item by item in their small groups. RESULTS Children had no difficulty completing most items. They identified ambiguities, and items that were meaningless to them, and proposed a new item asking the dentist about their job. Children were polarized over the response format, but they were emphatic about passing the form directly to the dentist, and not to a receptionist or assistant, stressing the importance of having a conversation with their dentist. CONCLUSIONS Before the pilot, dentists had expressed concerns about the potential for words in the SAID-provoking negative feelings. Children, however, wanted and needed facts, so requested that dentists use plain language, not euphemisms, to describe problems and treatment options. We report their selected practical suggestions. SAID-informed negotiated care may promote more patient cooperation and satisfaction at appointments, and more attention to oral hygiene between appointments.

Validating a measure of children's monitoring-blunting coping styles in dental situations

The monitoring-blunting theory of coping suggests that when faced with a threatening situation, individuals can respond by either monitoring or avoiding (blunting) threatening information. The current study sought to validate a scale of childrens preferences for monitoring or blunting in dental situations (the Monitoring Blunting Dental Scale or MBDS). The psychometric characteristics of the scale were assessed in a sample of 240 New Zealand children aged 11–13. Reliability was adequate for both monitoring (α = 0.74) and blunting (α = 0.76) subscale scores. Convergent validity was indicated by strong correlations (>0.6) between the measures subscales and those of a related scale, although discriminant validity with respect to dental anxiety was problematic for the blunting subscale. Exploratory factor analysis supported a two-factor monitoring-blunting model, although confirmatory factor analysis indicated reasonable but imperfect fit for this model, SBχ2(251) = 510.7, p < 0.001, RMSEA = 0.066. We reflect on conceptual issues which may underlie the difficulties experienced here and elsewhere in developing psychometrically sound measures of Millers blunting construct and suggest that the monitoring subscale of the study scale may be most useful to other researchers.

Non-pharmacological interventions for managing dementia-related sleep problems within community dwelling pairs: A mixed-method approach

Dementia-related sleep problems can be complex and challenging. Environmental interventions which resynchronise the sleep/wake cycle have been trialled with promising results for people with dementia in institutionalised settings. However, there is less research concerning community-dwelling people with dementia and their family carers. This study involved a five-week feasibility study including timed light therapy, exercise and sleep education. Sleep and physical and mental functioning were measured at the beginning and end of the trial using objective measures, standardised questionnaires and structured participant feedback. Of 15 community-dwelling pairs who participated, nine completed the trial. The case studies presented here reveal that it is feasible for this population to use non-pharmacological interventions, with positive outcomes. However, there are also issues that can mask benefits or prevent compliance. The options for treating dementia are limited. Environmental interventions may help manage dementia-related sleep problems and further trials would be worthwhile to improve compliance and evaluate effectiveness.

From Policy to Practice: Reflections on working across cultural borders in tertiary education

This paper describes the processes and challenges presented when Pākehā lecturers supervised a research project undertaken by Māori and Pacific nursing students in a New Zealand Bachelor of Nursing programme. It reflects on the reality of translating institutional policies from paper to practice and is situated in the framework of the Treaty of Waitangi and cultural safety. Cultural safety is a nursing concept that focuses on power in health-care relationships. People involved in the project experienced degrees of vulnerability in different cultural contexts, in terms of cultural identity, personal, professional and cultural values and beliefs, nursing and psychology knowledge and academic and institutional policies and practices. Culture is used in a broad sense and not confined to ethnicity. Various issues encountered during the project are identified, and examples of difficult experiences discussed. The paper concludes that working across broad cultural borders requires working with the complexities of multiple realities and discourses.

A Qualitative Investigation of the Application of Behaviour Modification to Group-Quitting for Māori and Pacific Smokers

Hauora Pacific (HP), a research group for Maori and Pacific nursing students, explored the adaptation of a behaviour modification programme as a health promotion strategy and smoking cessation resource for Maori and Pacific people. Each of seven HP members, supported by a mentor from their family or church, conducted a focus group with about six participants of their own ethnicity. The focus groups met twice. Data were collected on smoking beliefs, and what might aid smoking cessation. In the second meeting, themes common to the seven focus groups from the first meetings were validated, and a draft behaviour modification workbook for “quitting in groups” was discussed and edited. The initial surprise for HP members was that their participants did not share the dominant discourse on health risks from smoking; nor did they want to be told they should quit. Participants framed smoking as a positive activity. Discussion highlighted the common belief that “quitting in groups” would not be a preferred way to stop smoking, linked to personal shame from an inability to stop smoking; and the potential for a group to be too judgmental or pressuring. Although some work on the adaptation of a behaviour modification resource for “quitting in groups” did occur, participants felt that much more Maori or Pacific input would be required to shift an essentially western approach to behaviour change, into something another culture could feel ownership of. Addiction was seen as the issue that had been least well addressed in the past, and participants believed that having more trained-andavailable people would be their preferred health resource.