The Effect of an Animal-Assisted Intervention on Anxiety and Pain in Hospitalized Children

ABSTRACT

Forty children between the ages of 8 and 18 years, who were admitted to a hospital pediatric unit, were randomly assigned to an animal-assisted intervention (AAI) or an active control condition (working on an age-appropriate jigsaw puzzle). Ratings of pain and anxiety were taken both pre- and post-condition. The attachment Questionnaire and Family Life Space Diagram (FLSD) also were administered, and information on medications taken was recorded. A significant post-condition difference was found between groups for anxiety, with the aaI group having lower anxiety scores. However, no significant within- or between-group pre-post changes in either pain or anxiety were detected. Nearly two-thirds of the children (64%) reporting pain at baseline were receiving some type of analgesic, which may have influenced outcomes. Findings demonstrate some support that attachment may be a moderating variable: children with a secure attachment style reported lower pain and anxiety at baseline, with large effect sizes for differences in both anxiety (g = 1.34) and pain (g = 1.23). Although the aaI did not significantly reduce anxiety and pain in these hospitalized children, further investigation of the influence of analgesic use and the moderating effect of attachment style is indicated.     

The Effect of Dolphin-Assisted Therapy on the Cognitive and Social Development of Children with Down Syndrome

Cognitive and speech development are delayed in children with Down syndrome (DS). We investigated the effect of dolphin-assisted therapy (DAT), a form of animal-assisted intervention, on the development of speech/language and social behavior in children with DS. We hypothesized that DAT would improve the social and cognitive functions with respect to verbalization and thereby promote task performance. A semi-crossover design was used to study 45 children with DS: 18 received a weekly one-hour session of DAT for 6 weeks (group A), 12 children (group B) started with swimming pool sessions (control period of 6 weeks) and thereafter received DAT, and 17 children (group C) were put on a waiting list (control period of 6 weeks) before receiving DAT. The parameters “verbalization,” “impulsiveness,” “proper understanding of rules,” “recognition of persons,” and “establishing contacts” were measured using the Matson Evaluation of Social Skills for Individuals with Severe Retardation (MESSIER) before and after DAT, as well as before and after each of the control periods. Repeated measures ANOVA revealed no significant changes for any of the variables during the control periods (swimming pool, waiting list). Following the period of DAT there was a significant improvement in “verbalization” and “recognition of persons,” while “impulsiveness” decreased. No significant changes were found for the other parameters. “Verbalization” continued to increase during the follow-up period of 6 months, while “recognition of persons” slightly decreased. The results of this study provide support for our hypothesis. Through improvements in verbalization and the recognition of persons, the execution of tasks among children with DS receiving DAT improved. Additional studies are needed to determine if these positive effects of DAT are long-term.     

The Effect of Animal-Assisted Therapy on Pain Medication Use After Joint Replacement

Animal-assisted therapy (AAT) has been used in a variety of healthcare settings and studies to evaluate the potential patient benefits are warranted. This retrospective study measured the impact of AAT on the use of oral pain medications by adults after total joint replacement surgery. One group of patients received care in a hospital with an AAT program and the comparison group was in a hospital without an AAT program. Adult patient cohorts were matched on: age, gender, ethnicity, length of stay, and Diagnosis Related Group code for type of total joint replacement. Pain medication doses, converted into morphine equivalent daily doses (MEDD), were compared. Pain medication use was significantly less in the AAT group: 15.32 mg vs. 21.16 (t₍₁₁₉₎ = 2.72, p = 0.007). The effectiveness of AAT in decreasing the need for pain medication and its effect on patient well-being in the post-operative period and in other settings deserves further study.     

The perceived effectiveness of continuing care and group support in the long-term self-help treatment of obesity

Objective : Obesity is increasingly considered a chronic disease requiring continuing care, but professional long‐term treatment for most patients is not available. This study examined treatment recipients’ perception of the effectiveness of different components of a group self‐help, continuing‐care treatment program for obesity. Research Methods and Procedures : Members (n = 120) and volunteer leaders (n = 66) of a self‐help, continuing‐care treatment program of previously demonstrated effectiveness (mean treatment duration, 40.6 months; mean weight lost, 14.1 kg) rated how helpful and effective they found the various therapeutic strategies used by this program. The strategies examined were continuing care, group support, behavior therapy, motivational enhancement strategies involving positive reinforcement, and motivational enhancement strategies involving punishment. Results : The single most highly valued aspect of treatment was the provision of continuing care, followed by group support. Greater success at achieving one's goal weight was associated with perceptions of greater effectiveness of the program's strategies overall (r = 0.219, p < 0.005), of continuing care (r = 0.225, p < 0.005), and of positive reinforcement strategies (r = 0.223, p < 0.01). Participants who had successfully attained their goal weight perceived behavior therapy strategies as more effective than did participants who had not reached their goal weight [t (170) = 2.93, p < 0.005]. Discussion : The high ratings given to continuing care and group support strategies indicate the acceptability of supportive self‐help treatment for obesity administered over the long term. The findings suggest that continuing care and group support should be made available to participants in the self‐help treatment of obesity.     

The Psychological and Physiological Effects of Using a Therapy Dog in Mindfulness Training

ABSTRACT

The present study was a randomized controlled trial examining the psychological and physiological effects of adding animal-assisted therapy (AAT) to a modified Mindfulness-Based Stress Reduction program (MBSR) for clients experiencing psychological distress. It was hypothesized that AAT would complement mindfulness-based interventions because the therapy dog will provide a focus for attention to the current experience and exemplify acceptance and “being,” enabling the understanding and practice of the main aspects of mindfulness. Participants (n=21) were randomly assigned to an MBSR or MBSR+AAT group and then completed an intervention consisting of six 50-minute individual therapy sessions. Each session included didactic and experiential components modified for delivery with or without a certified therapy dog. State and trait mindfulness, psychological distress measures, blood pressure, and heart rate were assessed at each session. Results indicate that all participants experienced fewer anxiety and depressive symptoms, decreased psychological distress, and increased mindfulness skills from preto post-treatment. Additionally, state anxiety, blood pressure, and heart rate decreased within sessions. No significant difference was found between the control and experimental groups, indicating that interaction with a therapy dog had no impact on symptom reduction, skill acquisition, or client satisfaction in the current study. However, moderate to large effect size estimates indicate clinically significant differences between groups, with higher ratings for the MBSR+AAT group on therapist efficacy, recommending the training, and participating in future treatment. Future studies need to increase methodological rigor by including multiple therapist/dog teams and increasing sample size. Moreover, researchers must more thoroughly examine the role the dog might have in altering the social environment, such as reducing stigma surrounding mental health services and enhancing the therapeutic alliance.     

Behavior of dolphins towards adults and children during swim-with-dolphin programs and towards children with disabilities during therapy sessions

Abstract

In recent years, dolphin-assisted therapy has become very popular and an increasing number of facilities worldwide offer therapy programs with dolphins. In contrast to other animal-assisted therapy programs, dolphins are not domestic animals; they are mostly caught in the wild and there are still no studies on their behavior during these therapies. However, there is speculation that the behavior of dolphins toward people with mental and physical disabilities may play an important role in the success of the therapy. We observed 83 sessions with five untrained dolphins (Tursiops truncatus) at Dolphins Plus, a fenced area with ocean water in the Florida Keys, USA. Our detailed observations of contact and distance behavior between dolphins and different groups of swimmers (adults, children, and children with mental and physical disabilities) show that, in general, dolphins prefer small humans to adults. One dolphin showed a clear preference toward children with mental and physical disabilities, and we conclude that she showed assisting behavior.     

Methodological issues in studying the anxiety-reducing effects of animals: Reflections from a pediatric dental study

Abstract

This article reports observations made during a study investigating the role of a therapy dog in reducing anxiety in urban children visiting the dentist. The design and execution of the study were affected by methodological issues such as the reaction of urban children to the dog in the clinic, the tools used to measure anxiety in the children, the age and pet-ownership status of the children, and the personality of the therapy dog. Suggestions made for researchers designing similar studies include allowing children to become comfortable with the therapy dog before beginning formal data collection, working with younger children who have made fewer visits to the dentist, and using or developing more accurate tools for measuring behavioral and physiological anxiety.     

The effects of the presence of a dog in the classroom

Abstract

This study examined the effects of the presence of a dog in the classroom on field independence, social competence, empathy with animals and social-emotional atmosphere. The participants were 46 first-graders (43 of them immigrants) of two school classes (control and experimental). In the experimental group, a dog was present in the classroom for three months. Multivariate analyses revealed significant enhancement of field independence and empathy with animals in the experimental group in comparison to the control group (no dog). Thus, the presence of the dog fostered the development of autonomous functioning and a better segregation of self/non-self, which is the foundation of sensitivity towards the needs and moods of other people. Moreover, according to the views of the teachers, the children in the experimental group exhibited higher social integration, and there were fewer aggressive children, compared with the children in the control group. In sum, the results indicate that a dog can be an important factor in the social and cognitive development of children.     

A scoping review and research synthesis on financing and regulating oral care in long-term care facilities

doi: 10.1111/j.1741‐2358.2011.00575.x A scoping review and research synthesis on financing and regulating oral care in long‐term care facilities Background: Oral health care for frail elders is grossly inadequate almost everywhere, and our knowledge of regulating and financing oral care in this context is unclear. Objective: This scoping study examined and summarised the published literature available and the gaps in knowledge about regulating and financing oral care in long‐term care (LTC) facilities. Methods: We limited the electronic search to reports on regulating and financing oral care, including reports, commentaries, reviews and policy statements on financing and regulating oral health‐related services. Results: The broad electronic search identified 1168 citations, which produced 42 references, including 26 pieces of grey literature for a total of 68 papers. Specific information was found on public and private funding of care and on difficulties regulating care because of professional segregation, difficulties assessing need for care, uncertainty on appropriateness of treatments and issues around scope of professional practice. A wide range of information along with 19 implications and 18 specific gaps in knowledge emerged relevant to financing and regulating oral healthcare services in LTC facilities. Conclusions: Effort has been given to enhancing oral care for frail elders, but there is little agreement on how the care should be regulated or financed within the LTC sector.     

Oral health care in private and small long-term care facilities: a qualitative study

Objective: Elderly people who are institutionalised receive qualified care. Among the services supplied, oral health care has not always been a priority. The aim of this study was to identify the characteristics of oral health care provided to the elderly residents in long‐term care facilities (LTC) in Porto Alegre/RS city. Methods: Twelve private and small‐size LTCs (less than 20 residents) participated in this study. All supervisors and 36 carers were interviewed. The data obtained were organised according to the offer of oral health under the following categories: responsibility for oral care, oral care routines, difficulties carrying out oral care routines. Results: The procedures used most often in order of frequency were tooth brushing, prostheses cleaning, use of mouthwashes, soaking of prostheses and cleaning of the tongue. Among the difficulties mentioned were the high cost of dental assistance, the lack of co‐operation both by family members and by the elderly themselves, the oral and general health status of the elderly and the limited time available for carers to carry out the tasks. Oral care is conducted empirically, and the responsibility is left to the carers. Conclusions: Analysis of the statements given reveals that oral care does not follow any kind of protocol or standardisation. The persistence of this situation could lead to unsatisfactory oral health care in private and small LTC facilities.     

The Role of Therapy Dogs in Speed and Accuracy to Complete Motor Skills Tasks for Preschool Children

ABSTRACT

The purpose of this study was to determine whether the presence of a therapy dog would affect the performance of a set of gross motor skills tasks for a mixed group of language-impaired and typical preschool children. The 14 children in the group were between four and six years old (four female and ten male); the two dogs were Miniature Poodles. The design was a two-way mixed model factorial, where a series of 10 gross motor skills tasks (e.g., long jump, high jump—labeled Type of Task) performed by the children served as one variable, and the presence or absence of the therapy dog (labeled Dog Presence) served as the other variable. In the dog-present conditions, the dog either performed the task immediately prior to, or at the same time as, the child. Time to complete each task and the accuracy of task performance as determined by a rating scale were determined from a review of experiment videotapes. The main effect of Dog Presence was significant (F_(1,36) = 7.471, p < 0.05, R² = 0.17). As predicted, the children completed the tasks faster when the dog was present (M = 10.88 s,SD = 9.84) than when the dog was absent (M = 13.86 s,SD = 12.64), but this effect was not present in the ratings data. This indicates that the presence of a therapy dog served as an effective motivator for the children, who performed faster, but without compromising accuracy, in all tasks but one. The interaction between dog presence and type of task was also significant (F_(9,71) = 3.67, p < 0.05, R² = 0.32) in the ratings data, indicating that the presence of the dog increased performance accuracy in some types of tasks, while decreasing it in others. Based on these results and the strong connection between motor skills and language development, the authors recommend a role for therapy dogs in speech and language development programs for preschool children.     

Informing the debate on oral health care for older people: a qualitative study of older people’s views on oral health and oral health care

doi: 10.1111/j.1741‐2358.2009.00274.x
Informing the debate on oral health care for older people: a qualitative study of older people’s views on oral health and oral health care Background: Older people represent a growing and diverse section of the population. As age increases, people are more likely to experience health and mobility problems and be at higher risk of developing oral disease. Nevertheless, few older people utilise primary oral healthcare services. It is therefore important to understand the value older people place on oral health and dental services to inform providers and planners of oral health care. This research was conducted as part of a study to identify potential ways of minimising barriers to oral health care in older people. Objectives: To explore perceptions of oral health and oral healthcare services amongst older people living in a socially deprived inner city area and how these are related to service utilisation. Methods: A qualitative approach was utilised to explore the range of issues related to older people’s perceptions of oral health and their views on health care. This involved a combination of focus groups and semi‐structured individual interviews with older people and their carers. Data analysis was conducted using the Framework approach. Results:

• ? Response: Thirty‐nine older people and/or their carers participated in focus groups.
• ? Oral health perception: Oral health was associated with the presence of natural teeth, the absence of pain, practical/social functioning, preferably supported by positive assessment by a dentist.
• ? Oral health life‐course: Older people have a long and complex dental history. Past negative experiences with oral health care, especially in childhood, strongly influenced present attitudes towards dentistry and dental personnel.
• ? Citizenship and right to health care: There was a strong perception that, as ‘British citizens’, older people should have a right to free health care and that the National Health Service (NHS) should support them in this phase of their life.

Conclusions: The oral health life‐course of older people is an important influence on their perceptions of oral health and dental attendance. They consider oral health of importance and place great emphasis on their citizenship and rights of access to state funded oral health care. This raises important issues for the funding and delivery of NHS oral health care for older people.     

Oral health care and aspiration pneumonia in frail older people: a systematic literature review

Objective: To systematically review the literature on oral health care interventions in frail older people and the effect on the incidence of aspiration pneumonia. Background: Oral health care seems to play an important role in the prevention of aspiration pneumonia in frail older people. Methods: Pubmed, Web of Science, Cochrane Library, EMBASE and CINAHL were searched for eligible intervention studies. Only publications with regard to hospitalized or institutionalized older people, who were not dependent on mechanical ventilation were eligible. Two authors independently assessed the publications for their methodological quality. Results: Five publications were included and reviewed. Two studies showed that improvement of oral health care diminished the risk of developing aspiration pneumonia and the risk of dying from aspiration pneumonia directly. The three studies remaining showed that adequate oral health care decreased the amount of potential respiratory pathogens and suggested a reduction in the risk of aspiration pneumonia by improving the swallowing reflex and cough reflex sensitivity. Conclusions: According to the results of the current systematic literature review oral health care, consisting of tooth brushing after each meal, cleaning dentures once a day, and professional oral health care once a week, seems the best intervention to reduce the incidence of aspiration pneumonia.     

A Systematic Review of Research on Pet Ownership and Animal Interactions among Older Adults

ABSTRACT

Research on the impact of companion animals in the lives of older adults is considered from two perspectives: pet ownership and in animal-assisted interventions (AAI). This paper first presents a discussion of potential theoretical explanations of the impact of animals on human health and wellbeing among older adults, and then provides a systematic review and evaluation of existing research on the topics of human–animal interaction (HAI) and physical health and exercise, depression and anxiety, and loneliness and social functioning. Each of the studies in this review (n = 145) are rated according to modified Oxford Center for Evidence Based Medicine (OCEBM) levels and the role of theory, in conceptualizing the study or interpreting outcomes, is discussed. The quality of evidence for each topical area of HAI and aging research is summarized, and recommendations are made for future research directions that will increase our knowledge of the relationship between HAI and health outcomes for older adults in different settings.     

Impact of different groups of swimmers on dolphins in swim-with-the-dolphin programs in two settings

Abstract

In recent years, dolphin-assisted therapy has become very popular, and an increasing number of facilities worldwide are offering therapy programs that incorporate dolphins. We observed 83 sessions with five dolphins at “Dolphins Plus,” USA, and 37 sessions with 13 dolphins at “Dolphin Reef.” Israel, during unstructured swim-with-the-dolphin programs. Both facilities are fenced sea pens with ocean water. Our detailed observations focused on contact and distance behaviors between dolphins and amongst dolphins with different groups of human swimmers: adults, children and children with mental and physical disabilities at “Dolphins Plus,” and adults only at “Dolphin Reef.” The dolphins at “Dolphins Plus” showed some signs of stress such as avoidance, speed increase, higher metabolism and intensification of a subgroup. These signs were most evident when the dolphins were with adult swimmers. In contrast, the dolphins at “Dolphin Reef” seemed to be attracted to adult swimmers. We will discuss these opposing findings with reference to the different housing conditions. Our results indicate that limited space results in a reduction of the dolphins' attraction for swimmers.     

The Effect of a Canine-assisted Activity on College Student Perceptions of Family Supports and Current Stressors

Using data from a previously published study on effects of a canine-assisted activity (CAA) on college student stress the week before final examinations, we examined whether participation in this activity had effects on perceptions of 1) family supports (i.e., emotional distance to family members and pets) and 2) current stressors. A total of 74 students completed the Family Life Space Diagram (FLSD), which uses an individual's structured drawings of distances between symbols of self and living entities, organizations, and stressors to reflect “emotional distances.” Participants were randomly assigned to order of CAA or FLSD, which was the intervention study control condition. Groups completed the FLSD after participating in CAA (Group A, n = 34) or prior to CAA (Group B, n = 40). Participants were primarily white (56.8%) females (75.7%) with a mean age of 19.38 years (SD = 1.75). Significant differences with large effect sizes were found for both groups in distances between 1) self-closest and self-average family member (Group A: t = 7.02, df = 33, p < 0.001, d = 1.205; Group B: t = 6.25, df = 39, p < 0.001, d = 0.987) and 2) self-closest personal stressor (t = 2.93, df = 18, p = 0.009, d = 1.311) and self-average personal stressor (t = 2.54, df = 18. p = 0.020, d = 1.138). In both cases, Group A (FLSD following CAA) placed personal stressors in closer proximity to self. Although CAA did not affect students’ current perceptions of family and pet relationships, the intervention may have increased their abilities to cope with personal stressors. Modified stress theory supports the proposition that positive emotions associated with CAA engage positive coping strategies, resulting in more positive perceptions of stressors.     

The effects of hormone therapy on cognition in breast cancer

The use of hormonal therapies for the treatment of breast cancer is common, yet few studies have examined the possible cognitive effects. Several regions of the brain, important in memory and cognition, are rich in oestrogen receptors. As a result, the long-term use of anti-oestrogens may have potential consequences for cognition. This project aims to establish whether significant cognitive deficit exists in women receiving hormone therapy for breast cancer and to develop a cognitive package that is sensitive to the potential effects of oestrogen deficiency on cognition. Cognitive assessments measured a range of memory and attention functions in patient and control groups to identify whether cognitive impairment, if apparent, occurs at a widespread or function specific level. Ninety-four patients from the anastrozole, tamoxifen and combined (ATAC) trial and 35 non-cancer controls were assessed. Groups did not differ significantly in age or estimated full-scale intelligence. The patient group did not differ from controls on measures of working memory, attention and visual memory but was significantly impaired compared to the control group on measures of verbal memory (P=0.026) and processing speed (P=0.032). Cognitive performance in the patient group was not significantly related to length of time on trial or measures of psychological morbidity. As more and more hormonal agents are used in clinical trials of both adjuvant and preventive settings it is of vital importance that any potentially deleterious effects on cognitive function are measured adequately. Preliminary results from this study suggest that anti-oestrogen therapy may cause a specific deficit in verbal memory that corroborates the links between oestrogen levels and verbal memory often reported in studies of the cognitive benefits of hormone replacement therapy.     

Barriers to provision of dental care in long-term care facilities: the confrontation with ageing and death

Objective: The aim of the study was to reveal barriers to providing dental care for residents in long‐term care (LTC) facilities. Design: Participants were selected randomly from the dentist register in Berlin and Saxony, Germany. The sample consisted of 60 self‐employed and 60 employed dentists, a further 60 dentists worked in their own dental practice but also part‐time in an LTC facility. In semi‐structured interviews a questionnaire with 36 statements concerning working conditions, administration and cost, insecurity concerning treatment decisions as well as confrontation with ageing and death was employed. Subsequently, the study participants were asked to rank the four dimensions concerning their impact on the decision against providing dental care in an LTC facility. Results: The random sample was representative in age and gender for the dental register in Berlin and Saxony. Fifty‐six per cent of the participants (63% of the men and 51% of the women; 52% of the self‐employed, 60% of the employed and 56% of the consultant dentists) indicated unfavourable working conditions as biggest obstacle in providing dental care in an LTC‐facility. Thirty‐two per cent of participants rated administration and cost, 7% the insecurity in treatment decisions as major hindrance. Only 5% of the participants rated the confrontation with age and death as substantial barrier. There were no age and gender differences. Dentists in Berlin seemed more concerned about administration and cost of a consultancy activity and less secure in their therapy decisions than the colleagues from Saxony (p < 0.001). Dentists who work partly in LTC facilities were the least concerned about the confrontation with ageing and death (not significant), employed dentist showed the least secure in their treatment decisions (p > 0.001). Conclusion: It can be concluded that the awareness of infra‐structural and financial aspects in providing dental care in LTC facilities should be raised with health politicians and that these aspects should be considered when inaugurating or re‐structuring the consultancy services to LTC facilities. Further it would be desirable to establish more postgraduate training programmes to increase clinical and ethical competence in the area of gerodontology.     

Impact and control of methicillin-resistant Staphylococcus aureus (MRSA) in long-term care facilities

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are a growing concern in long-term care facilities (LTCF). Epidemiologic studies performed in our area have shown high rates of MRSA colonization in elderly residents, and very high rates in some centres. However, the clinical impact of nasal MRSA colonization is often slight. Prevention of MRSA transmission in LTCF includes the application of simple preventive measures with proven effectiveness, such as hand washing, adequately covering of infected wounds, and proper use of antibiotics, without limiting the activities of colonized residents or carrying out active surveillance.