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Biomedical subjects

J J Warren

Publications and source records attributed to J J Warren.

At least 73 records · Page 4Linked to original sources
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Axes: focus of taxonomy II.

A number of persistent issues in the nursing diagnosis community have challenged the ability of one nursing diagnosis taxonomy to account for nursing's practice. The North American Nursing Diagnosis Association (NANDA) Taxonomy Committee, charged with the preparation of one taxonomy for all, has struggled with some of these issues and has initiated development of axes. The issues, figuratively speaking, become the axes. The axes are intended to describe the dimensions of the human condition. This article, third in a series of four, describes the process and development of the proposed axes.

Age Factors↗
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Taxonomic validation: an overview.

A valid taxonomy legitimizes the elements that make up the taxonomy and increases trust in its generalizability and predictability. There is a concern that the NANDA Taxonomy is not a valid taxonomic structure. Despite on-going work to validate individual nursing diagnoses, there is little research that focuses on validation of groups of diagnoses (taxons) within the NANDA taxonomy. This last article in a series of four will familiarize the readers with why, what, and how a taxonomy of nursing diagnoses can be validated. This article highlights assessment of the validity and reliability of a taxonomy, compares the process of taxonomic validation to the research process, and explores examples of validation design.

Cluster Analysis↗
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Family member and guardian acceptance of dental services for nursing home residents.

The decision to utilize dental treatment often rests with a nursing home resident's family member or guardian, and factors associated with family member/guardian acceptance of dental services for residents have not been identified. This paper reports the results of a study which found that nearly 66% of nursing home residents' next of kin identified themselves as being primarily responsible for making health care decisions for the residents. Among these 109 resident/next of kin pairs, utilization of dental services by the residents was associated with younger next of kin, next of kin with higher levels of education, and next of kin who perceived dental need for the resident. In addition, residents who were female, physically mobile, not mentally alert, dentate, and had fewer years of education had dental services accepted for them at a higher rate than did residents who were male, physically immobile, alert, edentulous, or had more years of education. Findings suggest that more effort should be directed at educating the next of kin of nursing home residents in the value of dental care among the elderly.

Age Factors↗
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Factors related to acceptance of dental treatment services in a nursing home population.

This study reports on factors related to acceptance of restorative, oral surgery, and prosthodontic dental treatment services by a population of nursing home residents. Lower cost treatment plans and eligibility for Medicaid benefits were associated with acceptance of all treatment, and for the categories of oral surgery and prosthodontic services. Acceptance of routine restorative procedures was more strongly associated with female residents. It is concluded that financial concerns appear to pose the greatest barrier in providing dental treatment services to nursing home residents.

Aged↗
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Medical and functional status changes among nursing facility residents: implications for dentistry.

This paper reports the results of a study that investigated changes in the medical and functional status of nursing facility residents over a 2.9 year period. Sixty-seven residents from 10 nursing facilities were included in the study, which demonstrated that the resident's medical and functional status deteriorated during this period. These changes adversely affected the residents' ability to receive recommended dental treatment, suggesting that early, definitive, and often aggressive treatment approaches be used in providing services to these individuals.

Aged↗
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Oral health of persons with and without dementia attending a geriatric clinic.

This study of 230 hospital geriatric clinic patients compared the oral health of individuals with dementias with that of persons with no dementing illnesses. Data collected included dental examinations, subject questionnaires and review of hospital records. There were few differences among groups of patients based on categorization into groups of those diagnosed with (1) no dementia, (2) dementia of the Alzheimer's type, and (3) other dementias. However, there were significant differences based on degree of cognitive impairment regardless of dementia diagnosis. Those with severe dementia had poorer gingival health and oral hygiene, but better self-perceived mouth health. There are numerous limitations and inherent difficulties in studies involving persons with dementia, and overcoming these in the future will likely require long-term, interdisciplinary approaches.

Aged↗
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Dental treatment outcomes among dentate nursing facility residents: an initial study.

This investigation used retrospective methodology to examine the outcomes of previous dental treatment and the incidence of developing restorative and extraction needs, including dental caries, among nursing facility residents. Data were taken from treatment records of 48 dentate residents in 10 nursing facilities who received comprehensive dental treatment delivered through the Geriatric Mobile Unit (GMU) program operated by the University of Iowa College of Dentistry and were examined an average of 2.9 years after initial examination. Residents had a mean age of 84 years at the second exam, and 90% were female. About 18% of all previously placed restorations needed to be replaced, and an additional 11% of teeth that received a restoration needed to be extracted at follow-up. At follow-up, nearly 70% (33/48) of residents needed restorative care, while 44% (21/48) needed extractions. The mean incidence of teeth developing new treatment needs between the two visits was 2.7 teeth/person (14.9% of teeth) for restorative need and 1.1 teeth/person (6.6% of teeth) for extraction need. Results suggest that successful treatment outcomes can be achieved for nursing facility residents, but that dental disease and treatment needs develop at a high rate among these residents.

Aged↗
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The accuracy of tooth loss data collected by nurses.

This paper reports on the accuracy of tooth counts conducted in 22 subjects by 10 trained nurses as part of a large longitudinal study of a pharmacological agent. These nurses participated in a training course consisting of seminars, discussion, demonstrations, and practice examinations. Each of the nurses then counted the teeth of 22 subjects and recorded their findings independently. The counts of the nurses were compared with those of the dentists to assess the accuracy of the nurses' counts. We found that nurses and dentists were in perfect agreement for 86% of the patient counts conducted. Individual nurses' levels of agreement with dentists ranged from 73% to 100%, with pairwise kappa statistic values ranging from 0.70 to 1.00. In addition, both Pearson correlation and interclass correlation measures exceeded 0.98 for every comparison of dentist and nurse counts. The results of this study suggest that training nondental health care workers may be an accurate and low-cost way of obtaining tooth loss data and other oral health measures, particularly when oral health data are collected as part of larger, multi-disciplinary studies.

Aged↗
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A review of major nursing vocabularies and the extent to which they have the characteristics required for implementation in computer-based systems.

Building on the work of previous authors, the Computer-based Patient Record Institute (CPRI) Work Group on Codes and Structures has described features of a classification scheme for implementation within a computer-based patient record. The authors of the current study reviewed the evaluation literature related to six major nursing vocabularies (the North American Nursing Diagnosis Association Taxonomy 1, the Nursing Interventions Classification, the Nursing Outcomes Classification, the Home Health Care Classification, the Omaha System, and the International Classification for Nursing Practice) to determine the extent to which the vocabularies include the CPRI features. None of the vocabularies met all criteria. The Omaha System, Home Health Care Classification, and International Classification for Nursing Practice each included five features. Criteria not fully met by any systems were clear and non-redundant representation of concepts, administrative cross-references, syntax and grammar, synonyms, uncertainty, context-free identifiers, and language independence.

Evaluation Studies as Topic↗
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International classification for nursing practice (ICNP): most-frequently asked questions.

The International Classification for Nursing Practice (ICNP) is a collaborative project under the auspices of the International Council of Nurses. The alpha version is available online for comment in preparation for the release of the beta version in 1999. The authors answer the most-frequently asked questions about the ICNP and encourage nurses in the United States to participate in the revision by sending comments and suggestions to the American Nurses Association.

International Cooperation↗
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Fluoride, beverages and dental caries in the primary dentition.

Knowledge concerning risk factors for primary dentition caries in young children is incomplete. Models are presented for caries development using longitudinally gathered fluoride exposure and dietary intake data in the Iowa Fluoride Study. Primary tooth caries examinations were conducted at age 5. Dietary (beverage) and fluoride exposure data were gathered longitudinally from age 6 weeks through 4 years (n = 291); 23% had decayed or filled surfaces. Logistic regression revealed that beverage components and toothbrushing made unique contributions to caries experience. Water consumption (36-48 months), milk consumption (24-36 months), and fluoridated toothpaste brushings (36-48 months) were negatively associated with caries; sugared beverages and milk (6 weeks to 12 months) were positively associated. Although fluoride exposure is important, sugared beverages contribute substantially to caries risk, while water and milk consumption and frequent toothbrushing early can have protective effects.

Animals↗
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Phosphorus runoff: effect of tillage and soil phosphorus levels.

Continued inputs of fertilizer and manure in excess of crop requirements have led to a build-up of soil phosphorus (P) levels and increased P runoff from agricultural soils. The objectives of this study were to determine the effects of two tillage practices (no-till and chisel plow) and a range of soil P levels on the concentration and loads of dissolved reactive phosphorus (DRP), algal-available phosphorus (AAP), and total phosphorus (TP) losses in runoff, and to evaluate the P loss immediately following tillage in the fall, and after six months, in the spring. Rain simulations were conducted on a Typic Argiudoll under a corn (Zea mays L.)-soybean [Glycine max (L.) Merr.] rotation. Elapsed time after tillage (fall vs. spring) was not related to any form of P in runoff. No-till runoff averaged 0.40 mg L(-1) and 0.05 kg ha(-1) DRP and chisel-plow plots averaged 0.24 mg L(-1) and 0.02 kg ha(-1) DRP concentration and loads, respectively. The relationship between DRP and Bray P1 extraction values was approximated by a logistic function (S-shaped curve) for no-till plots and by a linear function for tilled plots. No significant differences were observed between tillage systems for TP and AAP in runoff. Bray P1 soil extraction values and sediment concentration in runoff were significantly related to the concentrations and amounts of AAP and TP in runoff. These results suggest that soil Bray P1 extraction values and runoff sediment concentration are two easily measured variables for adequate prediction of P runoff from agricultural fields.

Agriculture↗
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Phosphorus runoff from incorporated and surface-applied liquid swine manure and phosphorus fertilizer.

Excessive fertilization with organic and/or inorganic P amendments to cropland increases the potential risk of P loss to surface waters. The objective of this study was to evaluate the effects of soil test P level, source, and application method of P amendments on P in runoff following soybean [Glycine max (L.) Merr.]. The treatments consisted of two rates of swine (Sus scrofa domestica) liquid manure surface-applied and injected, 54 kg P ha(-1) triple superphosphate (TSP) surface-applied and incorporated, and a control with and without chisel-plowing. Rainfall simulations were conducted one month (1MO) and six months (6MO) after P amendment application for 2 yr. Soil injection of swine manure compared with surface application resulted in runoff P concentration decreases of 93, 82, and 94%, and P load decreases of 99, 94, and 99% for dissolved reactive phosphorus (DRP), total phosphorus (TP), and algal-available phosphorus (AAP), respectively. Incorporation of TSP also reduced P concentration in runoff significantly. Runoff P concentration and load from incorporated amendments did not differ from the control. Factors most strongly related to P in runoff from the incorporated treatments included Bray P1 soil extraction value for DRP concentration, and Bray P1 and sediment content in runoff for AAP and TP concentration and load. Injecting manure and chisel-plowing inorganic fertilizer reduced runoff P losses, decreased runoff volumes, and increased the time to runoff, thus minimizing the potential risk of surface water contamination. After incorporating the P amendments, controlling erosion is the main target to minimize TP losses from agricultural soils.

Animals↗
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Protein engineering strategies for designing more stable hemoglobin-based blood substitutes.

Over the past five years our laboratory has been using rational, comparative, and random combinatorial mutagenesis strategies to optimize the alpha and beta subunits of recombinant human hemoglobin (Hb) for efficient O2 transport, greater stability, and minimum interference with vascular activity. In each approach, mammalian myoglobin (Mb) has been used as a prototype to develop experimental methodologies and to study the stereochemical mechanisms that govern O2 affinity, discrimination against CO, rates of ligand binding, auto- and chemically induced oxidation, resistance to hemin loss, and stability to globin denaturation. Multiple replacements in the distal portion of the heme pocket have been designed rationally to lower oxygen affinity and at the same time inhibit oxidative side reactions. The P50 values are adjusted by altering electrostatic and steric interactions between the bound ligand and residues at the Leu(B10), His(E7), and Va(E11) positions. Large apolar residues (Leu, Phe, Trp) at the B10 and E11 positions inhibit NO-induced and autooxidation in both myoglobin and hemoglobin by excluding oxidants and proton donors from the immediate vicinity of the bound ligand. Similar strategies appear to have evolved in a number of animal myoglobins and hemoglobins which have unusual amino acids at the E7, B10, and E11 positions. Random combinatorial mutagenesis techniques have been developed to insert new amino acid combinations near the bound ligand in sperm whale Mb. The objective is to obtain "unnatural" distal pocket structures that enhance O2 transport and resistance to oxidation by alternative mechanisms.

Blood Substitutes↗
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A review of fluoride dentifrice related to dental fluorosis.

Introduced to the commercial market 40 years ago, fluoride dentifrice now accounts for nearly all dentifrice purchased in the United States. During this same time, the prevalence and severity of dental caries has declined while dental fluorosis prevalence has increased. While the caries decline can be largely attributed to widespread fluoride dentifrice use, as well as many other sources of fluoride, several recent studies have attributed much of the increase in fluorosis prevalence to early use of fluoride dentifrice. This paper reviews these studies, as well as the efficacy of fluoride dentifrices with lower fluoride concentrations. Finally, recommendations regarding fluoride dentifrice to maintain caries prevention and reduce the risk of dental fluorosis are presented.

Adolescent↗
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Non-nutritive sucking behaviors in preschool children: a longitudinal study.

PURPOSE: Prolonged duration of non-nutritive sucking behaviors may have consequences in regard to the developing orofacial structures and occlusion. Little is known as to why some children have prolonged sucking habits beyond the first 2 to 3 years of life. This paper reports on non-nutritive sucking patterns among a large cohort of healthy children from birth to 36 months of age and older, and identifies factors predictive of prolonged non-nutritive sucking habits. METHODS: Over 600 children were followed from birth to at least 36 months of age using mailed questionnaires sent when children reached the ages of 6 weeks, and 3, 6, 9, 12, 16, and 24 months, and then yearly thereafter. Parents answered questions concerning non-nutritive sucking behaviors including use of pacifier and digit sucking. The study categorized children who maintained habits to 36 months of age or older as having prolonged habits, and using multivariate analyses, compared them to children without prolonged habits on various sociodemographic variables. RESULTS: The study found that for over 20% of the children, a non-nutritive sucking habit was prolonged to 36 months of age or older. Factors associated with prolonged sucking habits included older maternal age, higher maternal education level, and having no older siblings. CONCLUSIONS: Identifying factors related to prolonged non-nutritive sucking habits may be important in developing and targeting recommendations regarding such behaviors in an effort to prevent malocclusions that result from prolonged sucking habits.

Chi-Square Distribution↗
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Factors affecting dentifrice use and ingestion among a sample of U.S. preschoolers.

PURPOSE: This study was performed to assess the actual amount of dentifrice used and ingested and factors associated with use/ingestion among 28 U.S. preschoolers aged 40 to 48 months. METHODS: Using their regular dentifrice brands/flavors and small child-sized toothbrushes (Oral -B 5), the participants or their parents placed dentifrice on toothbrushes three times to assess the quantity used and its consistency. Their brushing behaviors were observed and the amounts of dentifrice ingested were indirectly measured. Afterward, the parents and children placed a "pea-sized" amount of dentifrice on their toothbrushes. RESULTS: The participants were generally consistent in quantity applied, averaging 0.256 g (range 0.035 g-0.620 g; standard deviation 0.177 g) of dentifrice per brushing. Children, either alone or with parental assistance, placed more dentifrice than either mother or father alone (P = 0.007). The estimated mean ingested fluoride was 0.17 mg F per brushing, an average of 62% of the amount of dentifrice used (range up to 98%). Amount of ingested fluoride was positively associated (P < 0.05) with the amount of dentifrice used, and negatively associated with parental assistance in brushing. When asked to apply a pea-sized quantity, the mean quantity applied was 0.314 g (range 0.064 g-0.521 g). CONCLUSIONS: This study further supports the use of small amounts of dentifrice in young children, because they ingest substantial proportions of dentifrice.

Child, Preschool↗