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.     

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.     

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.     

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.     

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.     

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.     

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.     

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 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.     

Behavioral effects of the presence of a dog in a classroom

Abstract

To test the idea that dogs have a positive influence on the social behavior of school children, one of three dogs was introduced alternately into a class at an elementary school in Vienna, attended by 24 children (mean age: 6.7 years). Most of the 14 boys and ten girls came from first-generation immigrant families. With parental consent, their behavior was videotaped for two hours every week, during “open teaching situations,” first during a one-month control period in the absence of dogs, followed by an experimental period of similar duration, when a dog was present in the classroom. Frequency and duration of all observable behaviors of individuals and their interactions were coded from these tapes. Although major individual differences were found in the children's interest in the dog and their behavioral responses, the group became socially more homogenous due to decreased behavioral extremes, such as aggressiveness and hyperactivity; also, formerly withdrawn individuals became socially more integrated. Effects were more pronounced in the boys than the girls. Even though the children spent considerable time watching and making contacting with the dog, they also paid more attention to the teacher. We conclude that the presence of a dog in a classroom could positively stimulate social cohesion in children and provide a relatively cheap and easy means of improving teaching conditions.     

Health care professionals' perspectives on oral care for long-term care residents: nursing staff, speech-language pathologists and dental hygienists

doi: 10.1111/j.1741‐2358.2011.00513.x Health care professionals’ perspectives on oral care for long‐term care residents: Nursing staff, speech–language pathologists and dental hygienists Background: Oral health has been identified as a key factor in general health and systemic disease in long‐term care populations. To optimise oral health of this population, it is important to understand the oral care perspectives held by health care professionals involved in oral care provision. Objectives: To explore perspectives regarding oral care held by nursing staff, speech–language pathologists (SLPs) and dental hygienists (DHs) in long‐term care institutions and to understand how their perspectives impact activities and processes involved in the delivery of oral care. Methods: A focus group methodology was utilised. Separate focus groups for each targeted profession were held. Transcribed data were analysed using constant comparative analysis. Results: Daily oral health maintenance and monitoring was considered a role of nursing staff. SLPs and DHs have roles focusing on advocacy, education and supplemental care. Social factors motivate nursing staff to provide oral care, whereas factors related to the general health consequences of poor oral health underlined the motivations of SLPs and DHs. Conclusions: Education and training initiatives incorporating social aspects of oral health may be more effective for motivating nursing staff than approaches emphasising physical risk factors. Organisations can foster environments that support collaboration and communication amongst the members of multidisciplinary teams in order to promote oral health as a priority.     

Oral hygiene of elderly people in long-term care institutions--a cross-sectional study

Objective: The aim of this cross‐sectional study was to assess the level of oral hygiene in elderly people living in long‐term care institutions and to investigate the relationship between institutional and individual characteristics, and the observed oral cleanliness. Materials and methods: Clinical outcome variables, denture plaque and dental plaque were gathered from 359 older people (14%) living in 19 nursing homes. Additional data were collected by a questionnaire filled out by all health care workers employed in the nursing homes. Results: Only 128 (36%) residents had teeth present in one or both dental arches. About half of the residents (47%) wore complete dentures. The mean dental plaque score was 2.17 (maximum possible score = 3) and the mean denture plaque score was 2.13 (maximum possible score = 4). Significantly more plaque was observed on the mucosal surface of the denture with a mean plaque score of 2.33 vs. 1.93 on the buccal surface (p < 0.001). In the multiple analyses only the degree of dependency on an individual level was found to be significantly correlated with the outcome dental plaque (odds ratio: 3.09) and only the management of the institution with denture plaque (odds ratio: 0.43). Conclusion: Oral hygiene was poor, both for dentures and remaining teeth in residents in long‐term care institutions and only the degree of dependency of the residents and the management of the institutions was associated with the presence of dental plaque and denture plaque respectively.     

Local neighborhood effects on long-term survival of individual trees in a neotropical forest

The survival of approximately 235 000 individual tropical trees and saplings in the 50 ha permanent plot on Barro Colorado Island (BCI), Panama was analyzed over a 13-year interval (1982–1995) as a function of four biotic neighborhood variables: (i) total stem density; (ii) conspecific density; (iii) relative plant size; and (iv) relative species richness. These neighborhood variables were measured in annular rings of width 2.5 m, extending 30 m from a given focal plant, and in one more distant annulus at 47.5–50 m. Because survival was spatially autocorrelated, a Gibbs sampler and a Monte Carlo Markov chain method were used for fitting an autologistic regression model to obtain unbiased estimates of parameter variances for hypothesis testing. After pooling all species at the community level, results showed that all four variables had significant and often strong effects on focal plant survival. Three of the four variables had negative effects on focal plant survival; relative plant size was the only variable with a positive effect (18% increase in the survival odds ratio). The variables with a negative effect on the survival odds ratio, in order of their effect strength in the nearest annulus, were: stem density (a 70% reduction in the survival odds ratio), conspecific density (50% reduction) and species richness (13% reduction). A guild-level analysis revealed considerable heterogeneity among guilds in their responses to these variables. For example, survival of gap species showed a much larger positive response to relative plant size than did survival of shade-tolerant species. Survival of shrub species was positively affected by conspecific density, but canopy tree survival was negatively affected. Conspecific density negatively affected survival of rare species much more strongly than survival of common species. The neighborhood effects of conspecific density disappear within approximately 12–15 m of the focal plant. Although locally strong, the rapid spatial decay of these effects raises unanswered questions about their quantitative contribution to the maintenance of tree diversity on landscape scales in the BCI forest.     

Dogs in child psychotherapy: Effects on state of mind

Abstract

Using a pretest-posttest design, this study investigates possible influences of animal-assisted therapy (AAT), using a dog, on the state of mind of children and adolescents who have undergone inpatient psychiatric treatment. To measure this, the Basler Befindlichkeits-Skala (BBS) was used, which measures general “state of mind” and provides four sub-scale scores: vitality, intra-emotional balance, social extroversion, and alertness. For Group 1 patients (n = 61, with AAT), the results show highly significant increases in all dimensions of the BBS. These changes were not found in a second group (Group 2, n = 39), in which there was no AAT. There was a significant negative correlation between pretest BBS scores and the change in scores that occurred after therapy incorporating AAT. Among seven patients in Group 1, a deterioration in state of mind was recorded. Under our controlled clinical conditions, an effect size of 0.38 was calculated for the therapy using a dog. Incorporating a dog could catalyze psychotherapeutic work with children and adolescents.     

Short and long-term effects of unguided internet-based cognitive behavioral therapy for chronic insomnia in morning and evening persons: a post-hoc analysis

ABSTRACT

A post-hoc analysis comparing morning and evening persons with insomnia on sleep and mental health characteristics was conducted in order to investigate whether an Internet-based cognitive behavioral therapy for insomnia (ICBTi) was effective both for morning and evening persons. Adult patients (N = 178, mean age = 44.8, 67% females) with insomnia were randomized to either ICBTi (N = 92; morning persons = 41; evening persons = 51) or a web-based patient education condition (N = 86; morning persons = 44; evening persons = 42). All patients were assessed with sleep diaries, the Insomnia Severity Index (ISI), the Bergen Insomnia Scale (BIS), the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), the Hospital Anxiety and Depression Scale (HADS) and the Chalder Fatigue Scale (CFQ). Patients were characterized as morning or evening persons based on a median split on the Horne-Östberg Morningness Eveningness Questionnaire. Short and long-term effects of treatment were examined with mixed-model repeated-measures analyses. Morning and evening persons did not differ in terms of age, gender or educational status. At baseline, morning persons had more wake time after sleep onset (d= 0.54, p < .001) and more early morning awakening (d= 0.38, p < .05) compared to evening persons, while evening persons reported longer sleep onset latency (d= 0.60, p < .001), more time in bed (d= 0.56, p < .001), longer total sleep time (d= 0.45, p < .01), more fatigue (d= 0.31, p < .05) and more dysfunctional beliefs and attitudes about sleep (d= 0.47, p < .01). Despite these differences at baseline, both morning and evening persons receiving ICBTi benefitted more across most measures compared to morning and evening persons who received patient education. For morning persons in the ICBTi group, ISI scores were reduced from 17.3 at baseline to 8.8 (d_pre-post = 2.48, p < .001) at post-assessment, and to 10.0 at 18-month follow up (d_pre-post18m = 2.13, p < .001). Comparable results were found for evening persons in the ICBTi group, with a reduction in ISI scores from 17.4 at baseline to 8.6 (d_pre-post = 2.24, p < .001) at post-assessment, and to 8.7 at 18-month follow up (d_pre-post18m = 2.19, p < .001). Similar results were found on the BIS, DBAS, HADS, CFQ and sleep diary data. Despite different insomnia symptomatology between the two groups, the current study suggests that ICBTi is effective across scores on the morningness-eveningness dimension. The study was pre-registered at: ClinicalTrials.gov Identifier: NCT02261272.     

Metabolic effects of anti-angiogenic therapy in tumors

Anti-angiogenic therapy has recently been added to the panel of cancer therapeutics, but predictive biomarkers of response are still not available. In animal models, anti-angiogenic therapy causes tumor starvation by increasing hypoxia and impairing nutrients supply. It is thus conceivable that angiogenesis inhibition causes remarkable metabolic perturbations in tumors, although they remain largely uncharted. We review here recent acquisitions about metabolic effects of angiogenesis blockade in tumors and discuss the possibility that some metabolic features of tumor cells - i.e. their dependency from glucose as primary energy substrate - might affect tumor responses to anti-VEGF treatment.     

Biological and clinical effects of aromatase inhibitors in neoadjuvant therapy

Postmenopausal women with large primary oestrogen receptor-rich (>20 fmol/mg protein or 80 histoscore) breast cancers have been treated neoadjuvantly with either letrozole (2.5 or 10 mg daily n=12 in each case) or anastrozole (1 or 10 mg daily n=12 and 11, respectively). Tumour was available for analysis before treatment (wedge biopsy) and 3 months later at definitive surgery (wide local excision or mastectomy). Clinical response to treatment was assessed by sequential measurements of tumour volume based on caliper assessment, ultrasound and mammography. Results showed that in these selected groups of patients a reduction in tumour volume with treatment was observed in 43 of 47 cases (91%). Pathological responses, i.e. clear decrease in tumour cellularity or increased fibrosis was evident in 32 cases (68%). Furthermore, there was a decrease with therapy in immunohistochemical staining for Ki67 in all tumours. Staining for progesterone receptor (PgR) was reduced in all 21 PgR-positive cancers treated with letrozole and in 16 of 17 positive cancers treated with anastrozole. These effects are at least as great as those seen in a non-randomised group of patients treated with tamoxifen over the same time period (additionally tamoxifen treatment was often associated with an increase in PgR staining). The results suggest that potent specific aromatase inhibitors will be valuable in treating hormone-dependent cancers.