The Results of Water Fluoridation in Ireland

The visit of Dr. Trendley Dean to Dublin in the mid-1950s helped accelerate the decision to introduce water fluoridation as a public health measure in the prevention of caries in the Republic of Ireland. A challenge to the constitutional validity of the Health (Fluoridation of Water Supplies) Act 1960 failed and in 1964 the water supplies of Dublin city were fluoridated. Over the next seven to eight years all the major urban communities in the Republic of Ireland were fluoridated. Currently, 67 percent of the 3.5 million people in the country reside in fluoridated communities. Studies conducted over the last 20 years show that residents of fluoridated communities have better dental health than those in nonfluoridated communities—the mean dmft is lower in children and the number of natural teeth present in adults is higher.     

Correlates of suicide in building industry workers.

Suicide within the construction industry in Queensland, Australia was reportedly high in a recent Royal Commission report. The current study examined the incidence and causes of suicide in this industry using psychological autopsy and focus group investigations. A total of 64 male suicides occurred over the seven-year period, representing a crude suicide rate of 40.3 per 100,000, significantly greater than the working age Australian male rate. Young employees were at excessive risk with separation/divorce, relationship problems, and untreated psychiatric conditions the major contributors. Focus groups emphasized the importance of work/home interface factors and industry-specific factors preceding suicide.     

The oral health and treatment needs of community‐dwelling older people in a rural town in Western Australia

Objectives: The aim of this study was to assess, in a sample of older rural community‐dwelling Australians, their: oral health status, dental treatment needs, perceived barriers to access dental services and the prevalence and severity of dental anxiety. Methods: A cross‐sectional study of elderly rural Australians. Results: Eighty participants (mean age of 71.7 years) had a mean number of 0.69 (SD 1.6) decayed teeth, 15.72 (SD 13.3) missing teeth and 3.9 (SD 5.4) filled teeth. Forty‐one per cent were edentulous. Xerostomia was reported by 53% of the edentulous and 43% of the dentate. The average Corah Dental Anxiety Scale score was 8.72 (SD 3.8). Prevalence of dental anxiety was 15.6%. Two‐thirds needed dental treatment. Conclusions: Caries experience was lower than that reported in other studies. Reported barriers to use of dental services were long waiting times, lack of perceived dental need and costs.     

Feeding preferences and attitudes to breastfeeding and its promotion among teenagers in Northern Ireland.

Northern Ireland has one of the lowest breastfeeding initiation rates in the world. Given that attitudes toward infant feeding are formed at an early age and a high rate of teenage pregnancy, it has become necessary to survey attitudes to infant feeding and breastfeeding promotion preferences in teenagers in Northern Ireland. Questionnaires were distributed to teenagers aged 14 to 18 years (n = 419) based in 7 schools selected by type and location throughout Northern Ireland. Attitudes to breastfeeding in public reflected preferred infant-feeding method and were positively influenced by prior exposure to breastfeeding (P = .024). Females were more positive than males both in relation to breastfeeding in public (P = .002) and breastfeeding promotion (P = .003). Recommendations for breastfeeding promotion include specific targeting of young people (both male and female) and enabling contact between teenagers and nursing mothers as much as possible.     

Bladder acellular matrix as a substrate for studying in vitro bladder smooth muscle-urothelial cell interactions

The objective of this study was to evaluate the ability of bladder acellular matrix (BAM) to support the individual and combined growth of primary porcine bladder smooth muscle (SMC) and urothelial (UEC) cells. An in vitro co-culture system was devised to evaluate the effect of UEC on (i) SMC-mediated contraction of BAM discs, and (ii) SMC invasiveness into BAM. Cells were seeded onto BAM discs under 4 different culture conditions. Constructs were incubated for 1, 7, 14 and 28 days. Samples were then harvested for evaluation of matrix contraction. Immunohistochemistry (IHC) was utilized to examine cellular organization within the samples and conditioned media supernatants analyzed for net gelatinase activity. BAM contraction was significantly increased with co-culture. The same side co-culture configuration lead to a greater reduction in surface area than opposite side co-culture. IHC revealed enhanced SMC infiltration into BAM when co-culture was utilized. A significant increase in net gelatinase activity was also observed with the co-culture configuration. Enhanced infiltration and contractile ability of bladder SMCs with UEC co-culture may, in part, be due to an increase in gelatinase activity. The influence of bladder UECs on SMC behaviour in vitro indicates that BAM may contain some key inductive factors that serve to promote important bladder cell-cell and cell-matrix interactions.     

Orders to limit emergency treatment for an ambulance service in a large metropolitan area

We describe a policy allowing paramedics and emergency physicians to honor orders from nursing home records not to perform resuscitation or endotracheal intubation. The policy was adopted by the regional body coordinating emergency medical care and endorsed by the county medical society. The policy establishes community-wide definitions for "do not resuscitate" and "do not intubate" orders. It requires physicians to write such directives in patient's medical records and to update them every two years. It urges long-term care facilities to adopt policies to help ensure good decision-making practices in the formulation of these directives. The policy intends to partially address the unnecessary loss of patient autonomy that occurs when emergency care is administered according to routine orders.     

Capacity and Competence in Child and Adolescent Psychiatry

Capacity and competence in the field of child and adolescent psychiatry are complex issues, because of the many different influences that are involved in how children and adolescents make treatment decisions within the setting of mental health. This article will examine some of the influences which must be considered, namely: developmental aspects, the paradoxical relationship between the need for autonomy and participation and the capacity of children, family psychiatry, and the duty of care towards children and adolescents. The legal frameworks relevant to consideration of consent and competence will be briefly considered, as well as some studies of children's consent, participation and competence. A case vignette will be used as a focus to consider the complexity of the issue of competence in child and adolescent psychiatry, in the particular mental disorder of anorexia nervosa.     

The effectiveness of simulation activities on the cognitive abilities of undergraduate third‐year nursing students: a randomised control trial

Aims and objectives. To provide evidence on the effectiveness of simulation activities on the clinical decision‐making abilities of undergraduate nursing students. Based on previous research, it was hypothesised that the higher the cognitive score, the greater the ability a nursing student would have to make informed valid decisions in their clinical practice. Background. Globally, simulation is being espoused as an education method that increases the competence of health professionals. At present, there is very little evidence to support current investment in time and resources. Methods. Following ethical approval, fifty‐eight third‐year undergraduate nursing students were randomised in a pretest–post‐test group‐parallel controlled trial. The learning environment preferences (LEP) inventory was used to test cognitive abilities in order to refute the null hypothesis that activities in computer‐based simulated learning environments have a negative effect on cognitive abilities when compared with activities in skills laboratory simulated learning environments. Results. There was no significant difference in cognitive development following two cycles of simulation activities. Therefore, it is reasonable to assume that two simulation tasks, either computer‐based or laboratory‐based, have no effect on an undergraduate student’s ability to make clinical decisions in practice. However, there was a significant finding for non‐English first‐language students, which requires further investigation. Conclusions. More longitudinal studies that quantify the education effects of simulation on the cognitive, affective and psychomotor attributes of health science students and professionals from both English‐speaking and non‐English‐speaking backgrounds are urgently required. It is also recommended that to achieve increased participant numbers and prevent non‐participation owing to absenteeism, further studies need to be imbedded directly into curricula. Relevance to clinical practice. This investigation confirms the effect of simulation activities on real‐life clinical practice, and the comparative learning benefits with traditional clinical practice and university education remain unknown.