Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 58-62).

Introduction and Rationale: Bicycle riding is popular among the pediatric population, but with popularity comes a significant increase in morbidity and mortality. Cycling injuries occur in one-fifth of children aged 15 years and younger. Most life-threatening injuries among bicycle riders occur when the head is involved in bodily injury. Traumatic brain injury (TBI) related to bicycle accidents accounts for three-fourths of deaths. Despite the risk, many bicycle riders go without wearing helmets, largely due to lack of ownership. Purpose and Objective: The purpose of this Doctor of Nursing Practice (DNP) project was to develop and implement a pilot bicycle helmet program for a pediatric population, ages 5-13, from a pediatric emergency department (PED) perspective. The project objective was to increase bicycle helmet use among participants' children by providing the child with a free bicycle helmet, and also providing the parent with education specifically related to the importance of bicycle helmet safety. The project was driven through the Health Belief Model, and utilized the Teachable Moment of a PED encounter to influence risk-reducing behavior. Methods: This DNP project utilized a quasi-experimental, one group, pre- and post-test design. Participants were recruited from an urban PED, and identified at triage as being involved in a bicycle accident. Eligible children were fitted for a free bicycle helmet, and the parent was provided with an educational session coupled with a handout for home. A one-month follow-up phone call was conducted to assess bicycle helmet use and education retainment following the intervention. Results: All participants reported an increase in bicycle helmet use by their children. This study was able to show statistical significance related to bicycle helmet use, thus the null hypothesis was fairly confidently rejected. However, there were only five participants in this study, which makes generalization of results to a larger population difficult. Conclusions: This study showed that a bicycle helmet program is feasible in a PED, and could increase bicycle helmet use in a pediatric population. A DNP is an excellent candidate to run such a program as it focuses on positively impacting injury-prevention and dissemination of good practice for a larger community.

Currently, there is a dearth of knowledge regarding pediatric Complex Regional pain syndrome (CRPS), whether it is in regards to its pathophysiological mechanisms, pediatric-specific diagnostic criteria, validated diagnostic tests, conclusive treatment regimens, or validation of invasive and noninvasive treatment protocols in the pediatric CRPS population. It is imperative to first explore and establish a pediatric CRPS diagnostic criteria in order to optimize diagnostic accuracy for clinical and research purposes. This study first examined the efficacy of the Budapest criteria, a validated diagnostic instrument for adult CRPS, in the pediatric population. The test was administered to 221 pediatric patients at the Pediatric Pain Rehabilitation Center (PPRC), an intensive day treatment program at Boston Children’s Hospital for youth with chronic pain, and included both CRPS and non-CRPS chronic pain patients. Utilizing the Budapest criteria, secondary analyses were performed to determine whether the pediatric CRPS patients had an alleviation of their diagnosis from admission to discharge from the program. The Budapest clinical decision rule (to satisfy at least 2 signs categories and 3 symptoms categories) was utilized in examining the data. The sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) of the Budapest criteria in the pediatric sample were 0.56, 0.95, 10.39, and 0.47, respectively. The low sensitivity and high specificity was in contrast to the adult findings, and suggests that the Budapest criteria would be appropriate when the primary purpose is to identify stringent research samples as opposed to maximizing clinical diagnoses of CRPS. The likelihood ratios indicated that while satisfying the Budapest clinical decision rule may conclusively increase the probability of the pediatric patient actually having CRPS, a negative test does not significantly decrease the probability of the patient having CRPS. Therefore, modifications that appropriately increase the sensitivity while maintaining the high specificity of the Budapest Criteria are recommended. Repeated measures ANOVA resulted in a significant decrease of the Budapest signs and symptoms score in the 94 pediatric CRPS patients in the sample, both in the Clinician + Budapest (satisfied the Budapest clinical decision rule) and Clinician Diagnosed (did not satisfy the Budapest clinical decision rule) CRPS cohorts (p < 0.001). This further authenticated the use of a multidisciplinary treatment approach in managing pediatric CRPS, as the program was successful in alleviating the patients’ signs and symptoms. Further research must be conducted to explore the improvements that can be made to the Budapest Criteria for its use in pediatric CRPS so as to maximize its diagnostic accuracy. Overall, this study corroborated the use of interdisciplinary treatment regimens for pediatric CRPS, but further rigorous investigation is necessary to elucidate the mechanisms behind pediatric CRPS and the rehabilitation programs’ success in managing CRPS.

(Thesis: M.A.) / In 2000, US Surgeon General David Satcher released a report on the severity of oral health disease in the high risk demographic. His grave report ushered in an era of oral health prevention programs utilizing a combination of education, mouth rinses, fluoride varnishes, dental sealants, and more invasive procedures. Given this wide range of acceptable treatment interventions available, the aim of this paper is to evaluate the effectiveness of certain treatments both by themselves and in tandem with one another on target high risk school age children. The first program we analyzed was a fluoride mouth rinse program based in North Carolina. While we found that although this program may have positive impacts on school age children in the future, it did not currently provide statistically significant benefits to these children. Access to Baby and Child Dentistry, a program in Washington State that used a multi-pronged prevention program involving education, fluoride varnishes, and glass ionomer sealants provided a much clearer benefit to reducing the overall dental caries experience in target school age children. Lastly, the ForsythKids Program, based in Massachusetts which utilized a comprehensive care model of caries prevention was shown to be effective in reducing the number of new caries in school age children. Their comprehensive care model consisted of providing the children with fluoride toothpaste, applying fluoride varnish, fitting glass ionomer sealants and temporary restorations. Armed with this information and based on a model involving four steps and two factors crucial in the successful implementation of an oral health prevention program, we hope to offer a foundation for future forays into both installing and maintaining an oral health prevention program.

OBJECTIVE: Nuclear medicine provides important clinical information for diagnostic and therapeutic purposes. Use of medical imaging has gradually increased in the United States and this has raised health concerns about the potential future risks associated with radiation exposure in children. While studies have evaluated the adverse effects of imaging procedures, there is insufficient evidence about communicating radiation risks. The overall purpose of this paper is to review radiation risks in pediatric imaging using published evidence by the World Health Organization and to evaluate the knowledge and attitude of caregivers towards radiation risks in pediatric imaging. Specifically, we aim to determine whether an educational brochure improves parental knowledge of radiation and/or changes in attitude and perception to allow their children to undergo dental radiographs. METHODS: A prospective sample survey was performed of caregivers who presented with their child to the Boston University Pediatric Oral Healthcare Center. Parents or legal guardians (18 years or older) who accompanied a child were eligible for inclusion and approached for enrollment. Pre- and post-survey questionnaires were used to evaluate parents’ or guardians’ level of knowledge and attitude about the risks and benefits of dental radiographs. Parents were also asked their comfort level to allow their child to undergo dental radiographs. After completing the pre-survey questionnaire, parents were asked to read the English-language informational handout. Statistical analysis was performed through Microsoft Excel 2013. Descriptive analysis was conducted to summarize the survey responses. RESULTS: Among 30 parents who were surveyed, a small proportion (30%) of parents were very comfortable with dentist using dental radiographs on their child, versus 57% after reading the handout. Results showed that the informational handout improved the parental knowledge of risks and benefits of ionizing radiation. Most parents indicated that the handout was helpful and they reported increased level of comfort and willingness in their children receiving radiation imaging during dental treatment procedures. DISCUSSION: Educating parents or caregivers through an informational handout is a helpful resource in improving their knowledge and in relieving their concerns. Informing parents about the risks of ionizing radiation does not change parental willingness for their children to undergo dental radiographs.

Thesis (M.S.)--Boston University

Thesis (MTech (Radiography))--Peninsula Technikon, 2004 / The radiation risks associated with children are higher than the risk for adults. Children have growing organs and they have a longer life expectancy than that of adults. As a consequence the effects of damage from radiation could be greater than in adults. Children who receive radiation damage may pass genetic damage onto future generations. This study was carried out to investigate the optimal effective x-ray dose young children need to receive who have radiographic examination to the chest at Tygerberg Hospital, South Africa. Chest radiographs are documented as being the most common radiographic examination done on children. The age groups of children participating in this study were 0-1 year, 1-5 years and 5-10 years. A total of 67 children were involved and the absorbed doses for 134 views of the anterior-posteria (AP) chest and lateral chest were measured. Entrance surface dose (ESD) values were determined, and measured mean ESD (mGy) and the ESD range was reported for each age group. This was done by attaching thermolurninescent dosirneters (TLD pellets) to the patients skin at the entrance point of the x-ray beam. The results were compared to similar studies done in Ireland and Nigeria From the ESD values obtained the absorbed doses ofthe eyes, heart, liver, thyroid and genitals could be calculated by using the "Childdose" programme ofthe NRPB. The ESD dose levels for South Africa compare favourably with Ireland. However the Nigerian values differed greatly from those of Ireland and South Africa It was very encouraging to note the comparative results achieved at Tygerberg Hospital especially due to the fact that this was the first time such study had been conducted in the Tygerberg Hospital Radiology Department. The results also compare favourable with that achieved by a group working in the United Kingdom. This group does similar surveys every five years as part of their radiation protection programme. The results were also in line with the UNSCEAR document of2000. v This study could serve as a valuable source of reference to radiographers and radiologists when performing paediatric radiology especially as the radiation absorbed dose could be used as a baseline to create awareness of size of dose received, and to limit deleterious radiation doses to patients and to prevent unnecessary exposures. A second significant outcome of the study was the effect that added filters had on the x-ray beam generated. Experiments were done in which the filtration filters were added sequentially. It was found that if the filtration was increased to 2mmAl the dose to the patient decreased by more than 20%. At 50 and 60 kV the density of the x-ray image on film only increased by 2%. From these results it may be concluded that an increase in filtration thickness used for paediatric chest x-rays should be giVIng reduced dose readings and assisting with radiation protection ofthe patient.

O medo e a ansiedade durante os tratamentos odontolÃgicos estÃo na maioria das vezes relacionados à dor do procedimento da anestesia local odontolÃgica. Considerando que existem muitos estudos sobre a atuaÃÃo da vibraÃÃo na analgesia, esta dissertaÃÃo teve por objetivo comparar as reaÃÃes apresentadas por crianÃas ao serem anestesiadas com um dispositivo de anestesia local odontolÃgica que produzia microvibraÃÃes durante o procedimento anestÃsico. Trinta crianÃas, sendo 15 do sexo feminino e 15 do sexo masculino, com idade entre sete e 12 anos submeteram-se a duas sessÃes anestÃsicas, e cada paciente recebeu dois tipos de anestesia: com e sem vibraÃÃo. Um sà pesquisador, odontopediatra, realizou os procedimentos anestÃsicos, que foram filmados e consistiram de anestesias terminais infiltrativas, na regiÃo posterior da maxila. Em razÃo do carÃter multidimensional do medo, ansiedade e dor, utilizou-se uma combinaÃÃo de testes avaliÃ-los, como: O Teste do Medo da CrianÃa (Child Fear Survey Schedule â Dental Subscale â CFSS-DS), Escala de Ansiedade Facial (Facial Anxiety Scale â FAS), Escala Som, Olhos e Movimento (Sound, Eyes and Motor â SEM), Escala Visual AnalÃga â Visual Analogue Scale (VAS) e Escala Frankl. Aplicou-se as escalas em momentos prederteminados, os quais ocorreram antes e apÃs o procedimento anestÃsico. ApÃs a segunda sessÃo anestÃsica, buscou-se saber a preferÃncia das crianÃas quanto ao uso ou nÃo de vibraÃÃo e verificou-se que 90% das crianÃas preferiram a anestesia utilizando-se vibraÃÃo. Houve diferenÃa estatisticamente significante na Escala Visual AnÃloga â Visual Analogue Scale (VAS) na comparaÃÃo das mÃdias (p = 0,04) para um critÃrio de seleÃÃo a um nÃvel de significÃncia de 5%. Dessa forma, conclui-se que o uso da vibraÃÃo pareceu exercer influÃncia positiva sobre a percepÃÃo das crianÃas durante o procedimento de anestesia local, pois a maioria dos participantes da pesquisa optou pelo dispositivo com emprego da vibraÃÃo, atrelando ao fato de que foi verificado que a anestesia local com vibraÃÃo provoca menos dor, segundo a diferenÃa estatisticamente significante da Escala Visual AnÃloga. / The fear and anxiety during dental treatments are often related to pain regarding local dental anesthetic procedures. As there are many studies about the effect of vibration on pain analgesia, this thesis aimed to compare whether children anesthetized with a dental anesthetic device that produced micro-vibrations during the anesthetic procedure would behave differently when compared to the regular procedure. Thirty children, aged between 7 and 12 years underwent two sessions of local dental anesthesia each, with and without the vibration device. A single researcher, pediatric dentist, managed the anesthetic procedures that consisted of maxillary infiltration anesthesia and which were recorded on video. Due to the multidimensional nature of fear, anxiety and pain, multiple tests were used to evaluate them, such as Child Fear Survey Schedule â Dental Subscale â CFSS-DS, Facial Anxiety Scale â FAS , the SEM Scale Sound, Eyes and Motor, the Visual Analogue Scale (VAS) and the Frankl Scale. The scales were applied twice, before and after anesthesia. After the second anesthetic session, the preference of the children regarding the use or not of vibration was assessed and it was found that 90% of children preferred anesthesia using vibration. There was a statistically significant difference considering the Visual Analogue Scale (VAS) in the comparison of means (p = 0,04) considering a significance level of 5%. As a result, we concluded that the use of vibration seemed to result in a positive influence on the perception of the children regarding the anesthetic procedure, as almost the totality opted by the device with vibration, which lead us to the conclusion that the use of vibration resulted in a less painful local dental anesthesia.

Orientador: Antonio Bento Alves de Moraes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T23:22:36Z (GMT). No. of bitstreams: 1 Silva_LeatricePalieraquiPereirada_M.pdf: 1242355 bytes, checksum: ef5187a958c854e72119f0dfed7aab24 (MD5) Previous issue date: 2007 / Resumo: Há um consenso de que tratamentos odontológicos são eventos potencialmente estressantes para crianças, principalmente quando envolvem procedimentos invasivos. O objetivo deste trabalho foi avaliar se um procedimento de distração não contingente, concomitante ao atendimento, facilitaria o manejo de comportamentos, aumentando a colaboração das crianças. Neste estudo, avaliou-se 03 crianças de 04 anos (PI, PII, PIII), caracterizadas como não colaboradoras, a partir da classificação proposta por Stark et al. (1989). A estratégia de distração realizada na cadeira odontológica ocorreu em sistema de perguntas e respostas, baseadas em figuras, ao longo das sessões. As respostas corretas eram reforçadas socialmente, com entrega de fichas a cada resposta certa e entrega de prêmios ao final de cada sessão. As dezenove sessões foram filmadas e os comportamentos das crianças registrados a cada 15 segundos. Os dados mostraram redução dos comportamentos não colaborativos, por meio da diminuição da freqüência de emissão de comportamentos de protesto, manifestados pela alta freqüência de choro (PI: 1ª sessão:74%, 7ª sessão:35%, PII: 1ª sessão:94%, 6ª sessão:40%, PIII: 1ª sessão:17%, 6ª sessão:18%), sugerindo a eficácia da estratégia de distração não contingente, da forma como foi empregada. Além disso, foi observada uma melhoro no desempenho da criança frente à tarefa distrativa no decorrer das sessões (PI: 2ª sessão:29% e 7ª sessão:100% de acerto, PII: 2ª sessão:25% e 6ª sessão:100% de acerto, PIII: 2ª sessão:20%, 6ª sessão:100% de acerto). Pode-se considerar a técnica de distração como promissora em odontopediatria, pois através dela, mesmo em situações potencialmente aversivas, eliciadoras de respostas de medo, as crianças adquirem novas formas de aprendizagem e enfrentamento, que se deu por meio do desvio da atenção da criança para o estímulo do pôster, a realização de perguntas, a entrega de fichas e brindes ao final de cada sessão / Abstract: It's known that dentistry treatment in children is potentially stressful, especially when invasive procedures are involved. The aim of the study was to investigate if a non-contingent distraction procedure, during the treatment, would facilitate behavior management increasing the children¿s cooperation. In the present study 03 four-year old children were evaluated (PI, PII, PIII), presenting non-compliance to the treatment, according to Stark¿s et al. (1989) categorization. The distraction technique carried out in dental chair, during the sessions, involved questions and answers based in pictures. Correct answers were socially reinforced through chips and prizes at the end of the appointment. Nineteen sessions were recorded and the behaviors analyzed in each 15 seconds intervals. It was observed indicative uncooperative behaviors expressed through the high crying frequency (PI: 1st session: 74% and 7th session:35%, PII: 1st session:94% and 6th session:40%, PIII: 1st session:17% and 6th session:18%) pointing that this non-contingent distraction was not effective in reducing children¿s uncooperative behaviors. However, children¿s distraction task was improved during the treatment (PI: 2nd session:29% and 7th session:100% of correct answers, PII: 2nd session:25% and 6th session:100% of correct answers, PIII: 2nd session:20% and 6th session:100% of correct answers). Distraction is considered a promising technique in pediatric dentistry, because, through this strategy, even in potential stressful situations, that elicit fear, children are able to learn and cope. In the present study the coping strategy acquired by the children was to focus in the stimulus of the poster, questions, chips and prizes / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

O objetivo deste estudo foi comparar o preparo de canais radiculares de dentes decíduos artificiais com o uso dos sistemas manual, rotatório e de rotação recíproca, no que diz respeito ao desgaste promovido após a instrumentação dos canais radiculares e o tempo necessário para a realização da instrumentação. Os fatores em estudo foram técnica de instrumentação em três níveis e área de avaliação no canal radicular em três níveis. Foram utilizados apenas os dentes multiradiculares (primeiro molar superior, segundo molar superior, primeiro molar inferior e segundo molar inferior), compondo 24 dentes os quais foram aleatoriamente divididos entre as três técnicas de instrumentação em estudo: manual, Sistema rotatório Mtwo e Sistema de rotação recíproca Reciproc. A unidade amostral foi conduto radicular (n=20). Os condutos radiculares foram escaneados no tomógrafo de TCFC (Accuitomo). Após a instrumentação dos dentes novas imagens foram realizadas, avaliações quantitativas foram feitas medindo-se nas imagens axiais dos canais radiculares, a espessura das paredes em três diferentes regiões: terços apical, médio e cervical. As variáveis de resposta analisadas foram cálculo do transporte do canal, cálculo da descentralização e tempo de instrumentação. Tanto para a avalição da descentralização, quanto para a avaliação do transporte, os dados foram transformados e analisados por ANOVA a 2 critérios e Teste de Tukey, para os dados da comparação dos tempos foi utilizado o teste de Kruskal-Wallis e Teste de Tukey (p<0,05). Para a avaliação do transporte do canal e da descentralização não foi encontrada diferença estatística significativa entre os tipos de instrumentação e terços radiculares (p>0,05). Na avaliação do tempo de preparo, o grupo do sistema reciprocante apresentou menor tempo de preparo em comparação com o sistema manual e rotatório (p<0,05). Desta forma conclui-se que os tipos de instrumentação avaliados promoveram um preparo similar dos canais, sem diferença entre os terços cervical, médio e apical, sendo que o sistema de rotação recíproca resultou em um menor tempo de instrumentação. / The objective of this study was to compare the preparation of root canals of artificial deciduous teeth with the use of the manual systems, rotational and reciprocal rotation, with regard the detrition promoted after instrumentation of root canals and the time necessary for the realization of instrumentation. The factors in study were the techniques of instrumentation in tree levels and the area of root canal in tree levels. Have been used only teeth multirooted (first molar, second molar, lower first molar and second molar), composing 24 teeth which were randomly divided among the three instrumentation techniques under study: manual, rotational system Mtwo and reciprocal rotation system Reciproc. The sample unit was root canal (n = 20). The root canals were scanned in tomographer CBCT (Accuitomo). After instrumentation of new images teeth were conducted quantitative evaluations were made by measuring the axial images of the root canals, the wall thickness at three different regions: apex, middle and cervical thirds. Response variables analyzed were calculating the channel transport, decentralization and calculation time instrumentation. Both for the evaluation of decentralization, as for the evaluation of transportation, data were processed and analyzed by ANOVA and Tukey 2 criteria test to the data comparing the times we used the Kruskal-Wallis test and Tukey test (p <0.05). For the evaluation of the channel transport and decentralization was no statistically significant difference between the types of instrumentation and root thirds (p> 0.05). In assessing the preparation time, the reciprocating system group showed less preparation time compared to the manual system and rotary (p <0.05). Thus it is concluded that the types of instrument reviews promoted a similar preparation of channels, no difference between the cervical, middle and apical thirds, and the reciprocal rotation resulted in a shorter time instrumentation.