"I Like the Feeling of Connecting With People": A Mixed-Methods Study of Nursing Assistants Experiences Across the Care Continuum

Nursing assistants (NAs) are critical professionals across the long-term care continuum. Despite the demands of NAs, these frontline personnel experience workplace challenges and turnover at a disproportionate rate compared to other professionals. Much research has explored the experiences of nursing assistants using federal survey data and national datasets. Guided by a socio-ecological model and the job-demands resource model, this study utilized a sequential mixed-methods approach to uncover a more nuanced understanding of NA workplace experience. Results from this combined qualitative (N = 17) and quantitative (N = 354) study found that there are several workplace aspects, such as organizational culture and supervisor relationships, that contribute to NA experiences across system levels. Further exploration of direct care tasks directly from nursing assistants is necessary to understand full intentions.

"Knowing when it's time to take a break": Nursing home social workers' coping during COVID-19

Background

Nursing home (NH) social workers face many challenges in meeting the psychosocial needs of residents while balancing their own well-being needs.

Methods

This study employed a cross-sectional survey of NH social workers via social media and professional networks about their coping strategies during COVID-19. Open-ended responses were analyzed qualitatively using the rigorous and accelerated data reduction technique (RADaR).

Results

The study included a sample of 63 (N = 63) NH social workers. Four themes defined ways the in which NH social workers coped with stress during COVID-19, including relying on friends and family, mindfulness and spirituality/religion, self-care strategies, and setting boundaries at work.

Conclusion

These techniques appear to be effective; however there remains a need for institutional programs and policies to provide the time and space to holistically support coping in NH social workers and to prevent burnout and turnover, particularly during times of crisis.

Nursing assistant turnover in nursing homes: A scoping review of the literature

BACKGROUND

Nurse aide turnover in long-term care is projected to increase in the coming years. Guided by a social ecological framework, this scoping review systematically searched for peer-reviewed journal articles on nursing assistant or nurse aide turnover in nursing homes.

METHODS

Using the PICO and PRISMA guidelines, 8 university-based library databases via EBSCOhost were searched to source peer-reviewed journal articles published between 2002 and 2022 on nurse aide turnover in nursing homes.

RESULTS

The initial article search revealed 997 articles. After a three-stage article screening and removal process, a final sample of 43 articles (N = 43) remained. Guided by levels of influence, nurse aide turnover is found to be influenced by intrapersonal, interpersonal, institutional, community, and public policy level factors.

CONCLUSION

Findings highlight the need for further research with nursing facility administrators and nurse aides to evaluate the complex interactions within long-term care nursing homes.

Family member roles in long term care: Lessons for the future from COVID-19

This study investigates nursing home residents' and care partners' experiences during COVID-19 visitation restrictions. A nonprobability purposive sample of care partners was recruited via social media and email listservs. Care partners completed surveys (N = 30) and follow-up interviews (n = 17). Before COVID-19, care partners visited residents 3+ times per week for socialization and care. After restrictions, communication between care partners and nursing homes deteriorated. Families experienced reduced communication about residents' health statuses and little COVID-19 case information. Care partners expanded their advocacy roles, proposing policies to protect residents' rights. Care partners reported losing irreplaceable time with residents during restrictions. In future emergencies, we must balance the value of family visits with public health protection such as personal protective equipment (PPE).

Older immigrant adults experiences with social isolation: a qualitative interpretive meta synthesis

Objectives: Older immigrants totaled 7.3 million in 2018, representing 13.9 percent of the population of seniors in the U.S. While this population is found to contribute significantly to society, along with new opportunities comes circumstantial challenges. Of these, one of the most salient issues for foreign-born older adults is social isolation. Additionally, this population may be at an increased risk for social isolation with poor mental health because migrating to a new country might result in resettlement challenges. Despite these concerns, less is known about the consequences of social isolation among older immigrant adults. Hence, this study seeks to explore consequences of social isolation among older immigrants, as well as interventions to combat isolation.Methods: Guided by the Population Interest Context (PICO) framework and the Qualitative Interpretive Meta-Synthesis (QIMS) guidelines.Results: The final sample of seven full text articles were published between 2011 and 2021, totaling 286 participants with ages ranging from 61 to 93 years old. Findings from the study indicated that older immigrants are at risk of social isolation and loneliness because they have fewer social connections due to leaving behind their familiar social group in the home country, encounter linguistic challenges that negatively contribute to greater social isolation and poor mental health. Despite these difficulties older immigrants reported various social interventions, access to senior centers, community programs and services to be of greater importance in building social networks.Conclusion: Authors discuss opportunities for future research, such as exploring evidence-based studies on interventions for social isolation and loneliness of older immigrant populations.

"Please Don't Let Academia Forget about Us:" An Exploration of Nursing Home Social Work Experiences during COVID-19

Nursing home social workers are on the frontlines during COVID-19 responding to individual resident needs, the needs of staff, and larger health needs of the nursing home. However, it is unclear whether nursing home social workers feel adequately trained and prepared in responding to disasters, such as COVID-19. To explore this, we used a study cross-sectional survey distributed via social media focusing on 1) prior training on disaster preparedness, 2) any content social workers wish had been a part of their education, and 3) suggestions for educators/academics to serve social workers on the frontlines. Data in this study are based on a sample of 63 (N=63) nursing home social workers. Demographic data were analyzed using SPSS and qualitative data were analyzed using the RaDar (rigorous and accelerated data reduction) technique. Findings revealed that most social workers had little to no training in disaster preparedness, and shared areas of future education initiatives. Participants also shared the need for bridging the research to practice gap through open access articles and support from academics. Findings from the present study reveal areas social work programs can expand gerontology-focused course offerings. Additionally, developments promoting practitioner support from academics is worth consideration.

"They Just Took Him Out of My Life": Nursing Home Care Partner Experiences During the COVID-19 Pandemic

The current study describes the impact of visitation restrictions on nursing home residents and their family caregivers from caregivers' perspectives during the coronavirus disease 2019 (COVID-19) pandemic. Family caregivers (N = 31) were recruited via social media and email listservs to complete an online survey. Researchers also completed semi-structured, one-on-one interviews with interested participants (n = 17). Caregivers reported experiencing disconnect from residents, confusion on the part of residents, and sadness. All caregivers were of the opinion that residents with dementia declined during lockdown and that they and their residents experienced irreparable harm from the prolonged separation. Providers, policymakers, and researchers must use the lessons learned from the COVID-19 pandemic in future situations. Protecting residents from a deadly disease is important, but long-term separation from family caregivers cannot be condoned again. [Journal of Gerontological Nursing, 48(2), 7-11.].

Dismantling Systemic Racism in Long-Term Services and Supports: A Call to Action for Social Workers

Given the rapidly changing Long-Term Services and Supports (LTSS) system in the United States, it is essential for social workers and other health professionals to critically examine how this evolving landscape continues to shape racial inequities in formal LTSS and subsequent health outcomes. This commentary seeks to inform social work education, research, and practice by describing how systemic racism impacts the use and quality of formal LTSS. We present a call to action for social workers to dismantle systemic racism in LTSS that perpetuates ongoing racial inequities.

Empirically Evaluated Suicide Prevention Program Approaches for Older Adults: A Review of the Literature from 2009-2021

Mental health in later life and suicide risk among older adults are important topics for social work. There is evidence-based research to support the use selective and indicated strategies for suicide prevention, yet, universal prevention approaches are also needed. However, the extent to which the broader contexts of suicide have been examined remains largely absent from the literature. This article presents findings from a systematic review of articles published between 2009 and 2021, focusing what types of empirically evaluated suicide prevention programs effectively prevent and reduce suicidality in older adults. Using the PICO and PRISMA guidelines, a final sample of 8 articles were reviewed in this systematic review. The articles were categorized into three types of programs: 1) primary and home health care, 2) community-based outreach, and 3) counseling. The articles also examined the involvement of social workers in these programs. Following a description of the articles, the authors assess each study using the GRADE rating system. Lastly, the authors discuss the role of the social worker in mental health promotion and prevention strategies.

Nursing home social services: A systematic review of the literature from 2010 to 2020

Nursing home (NH) social workers carry out person-centered care, guided by the 1987 Nursing Home Reform Act. As the projected population of individuals requiring NH care is expected to grow and become more racially and ethnically diverse, the social worker in this setting becomes increasingly important. The aims of this study are to: (1) identify existing research that discusses the role of social work and nursing facilities, (2) synthesize findings to determine what is most often reported in the literature, and (3) present recommendations for practice, research, and policy. This study used the PICO framework and PRISMA guidelines to systematically search for articles published in English between 2010 and 2020 across 11 databases. A final sample of 23 articles discussed social work in the NH organized into three categories: (1) qualifications of the NH social worker (n = 5), (2) social worker responsibilities (n = 11), and (3) policy dictates practice (n = 7). Future research ought to include primary data collection methods with NH social workers, as well as NH residents and family, as residents must be at the center of their care. Considering policy modifications to further enhance the social work role of the interdisciplinary team is warranted.

Nursing Home Social Workers Perceptions of Preparedness and Coping for COVID-19

OBJECTIVES

Social work has a long history of responding to the needs of vulnerable populations during times of crisis and disaster. Social workers are working at the front lines responding to the current COVID-19 pandemic in a variety of health care practice settings, including nursing homes; however, it is unclear how social workers perceive their preparedness during this time.

METHODS

This study employed a cross-sectional survey to nursing home social workers via social media on feelings of preparedness for COVID-19, what has been most professionally helpful for social workers during these times in their role in COVID-19, as well as demographic questions. Demographic data were analyzed using SPSS and qualitative data were analyzed using the rigorous and accelerated data reduction technique.

RESULTS

Data are based on a sample of 63 (N = 63) nursing home social workers. Findings revealed that while some social workers felt prepared for the coronavirus, many respondents stated that they were unprepared to meet the demands and challenges they were facing. Moreover, participants shared that professional support was critically important to get through COVID-19.

DISCUSSION

These findings are important, as social workers are tasked with ensuring each resident attains their highest level of psychosocial well-being, which can be achieved only when nursing home staff are supported. Findings from the present study suggest that additional support for nursing home staff ought to include peer mentoring and mutual support. Additionally, improved leadership across health care settings is worth assessing.

The experience of transportation to visit a nursing home resident: A case study

Maintaining social connections in the community can be accomplished through transportation access and opportunities. This includes relationships between family and residents in nursing homes. Previous research supports the relationship between transportation, social support, and visitation of residents in nursing homes (NHs), however no empirical research to date explores this relationship of family member transportation as a means to visit their loved one in this setting. Guided by a case study approach, a sample of 11 (N = 11) family members of residents in nursing homes across North Central Texas were selected to develop an in-depth understanding of transportation access and mobility, as it relates to visitation of residents in nursing facilities. Analyses revealed the following seven themes: Car access, Alternative modes, Flexibility, Travel time, Actual cost, Collateral cost, and Health and Mobility. Findings from this study uncover how cost, both actual cost and collateral cost, are greatly linked to car access, transportation access, and opportunities to visit, as well as the impact each of these features, and emergent themes, related to transportation have on maintained or fractured relationships of family and residents in nursing homes. This article concludes with implications for future research and social work practice.

Caregiver identity theory and predictors of burden and depression: Findings from the REACH II study

Objective: To examine the relationship between care recipient (person with Alzheimer's disease) ability to perform daily tasks and caregivers' (CG) perceived burden and depression, guided by the caregiver identity theory. We also examine the mediating effect of CG abilities to meet their basic needs.Methods: This study utilizes the baseline data of the REACH II study. Spearman's rho (ρ) was used to test for relationships between burden, reported depression, and each ADLs and IADLs. To further explore the relationship between burden and each ADLs and IADLs, structural equation modeling was conducted using Mplus 8.0.Results: Reported CG total scores indicated increased perceived CG burden with greater number of assisted daily activities. CG depression scores were significantly predicted by reported burden scores and caregiver's ability to pay for basic needs. Importantly, 34.6% of variation in CG reported depressions scores were explained by reported burden scores. A multivariate regression model with reported burden scores, controlling for caregiver's ability to pay for basic needs, explained 36.6% of the variance in CG depression scores. Burden scores and CG ability to pay for basic needs significantly predicted depression scores. Results from the three models indicated that CG burden fully mediated the relationship between daily living skill scores and CG depression.Conclusion: Our study findings suggest the need to more closely examine the link between AD caregiving, financial instability, and mental health and bolster support for policies and programs that offer tangible supports and services to offset the costs of informal AD CG.

Caregiver Burden and Desire for Institutional Placement-The Roles of Positive Aspects of Caregiving and Religious Coping

Based on stress coping theory, this study investigated whether and how positive aspects of caregiving (PAC) and religiosity buffered the association between caregiving burden and desire to institutionalize (DTI). Secondary data (N = 637) were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II project. Descriptive analysis, bivariate correlation, and multiple linear regressions were conducted. The results indicated that higher levels of caregiver burden, daily care bother, and Revised Memory and Behavioral Problem Checklist bother were all significantly associated with higher level of DTI. Both PAC and religious coping were negatively associated with DTI; however, only PAC was significant. Only the interaction between daily care bother and religious coping was significant, which indicated that the harmful effect of daily care bother on DTI was significantly buffered among those who have religiosity. Study findings have important implications for policy makers and for providers who serve dementia family caregivers.

A value-critical policy analysis of the nursing home reform act: a focus on care of African American and Latino residents

Improving nursing home care has been a central legislative focus since the 1980s; The major response effort to address these reports of poor-quality care was first met with a federal rule in 1987, the Nursing Home Reform Act (NHRA). Since enactment of the NHRA in 1987, and despite an increasing utilization of nursing home care by aging minorities, the standardization of care practice, or quality indicators (e.g., structural, process, and outcome measures), within long-term nursing home care have remained relatively unchanged. This paper reports a value-critical policy analysis of the most recent final action rule, effective on November 28 of 2016 by the Centers for Medicare and Medicaid Services (CMS) with a particular focus on its impact on African-American and Latino older adults. This paper presents results of two policy analyses. Taken together, this merged analysis focuses on an overview of the problem, the groups most affected by the problem, current program goals and objectives, forms of benefits and services, and a current state of the social problem. Following the analysis, we present changes and improvements to be made, as well as proposals for reform and recommendations for policy changes.

Investigating Barriers to Family Visitation of Nursing Home Residents: A Systematic Review

Families are integral in helping nursing home residents maintain feelings of social inclusion and an overall sense of belonging, thus reducing consequences of social exclusion. Preliminary research, particularly of the culture change movement in long-term care, shows there are barriers to family engagement and visitation of residents. The objective of this study is to: (1) identify and summarize the barriers most reported to family visitation and (2) synthesize the findings to determine which barriers are most often reported in literature, and which may pose the greatest challenges to family involvement. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a final sample of 15 articles across 11 databases report seven barriers to visitation: psychological, health, staff to family member relationship, employment/finances, travel time, access to transportation, and other. Findings suggest barriers to family visitation and point toward a need for further research as relationships between resident and family member is complex and warrants attention across professions. Interprofessional efforts between social work, allied professionals, and transportation planners are necessary to address this pressing concern experienced by residents in nursing homes, with the ultimate goal of lessening such barriers.

Chronic Kidney Disease and Older African American Adults: How Embodiment Influences Self-Management

Patients living with chronic kidney disease (CKD) must balance the medical management of their kidney disease and other chronic conditions with their daily lives, including managing the emotional and psychosocial consequences of living with a chronic disease. Self-management is critical to managing chronic kidney disease, as treatment consists of a complex regimen of medications, dosages, and treatments. This is a particularly important issue for older African American adults who will comprise a significant portion of the older adult population in the coming years. Yet current conceptualizations of self-management behaviors cannot adequately address the needs of this population. Embodiment theory provides a novel perspective that considers how social factors and experiences are embodied within decision-making processes regarding self-management care among older African Americans. This paper will explore how embodiment theory can aid in shifting the conceptualization of self-management from a model of individual choice, to a framework that cannot separate lived experiences of social, political, and racial factors from clinical understandings of self-management behaviors. This shift in the conceptualization of self-management is particularly important to consider for CKD management because the profound illness burdens require significant self-management and care coordination skills.

Using the Eco-Map and Ecosystems Perspective to Guide Skilled Nursing Facility Discharge Planning

Growing numbers of seniors across the United States require skilled nursing facility care after an inpatient hospital stay. Previous studies indicate that roughly 20 percent of all hospitalized Medicare beneficiaries are admitted to a skilled nursing facility following a qualifying hospital stay. Social workers address psychosocial problems, social support, networks, and healthcare needs during transitions in care, particularly discharge planning. Ecosystems perspective and the eco-map as a discharge planning tool is presented. Social workers can use these tools to examine the patient with respect to their transactional relationships with systems. This will further will facilitate provision of wrap-around services upon discharge.

The health-care experiences of families given the prenatal diagnosis of trisomy 18

OBJECTIVE

The objective of this study was to examine parent-reported experiences in the health care system after receiving the prenatal diagnosis of trisomy 18 and to identify factors that contribute to satisfaction with care.

STUDY DESIGN

Nineteen families who received the diagnosis between 2002 and 2005 were given semistructured telephone interviews. Of the 19 families, 11 continued the pregnancy while the remaining 8 chose induced abortion. Classical content analysis was utilized to identify themes among subject responses.

RESULT

We identified several specific aspects of care as key in either being highly satisfied or dissatisfied: expressions of empathy from provider, continuity of care, communication, valuing the fetus and participation in medical decision-making.

CONCLUSIONS

Aspects of care that were identified as reasons for dissatisfaction are potentially modifiable by training, education or team-based approaches. Further studies are necessary to determine how we can improve the quality of services during prenatal diagnosis.

The effect of the gonial angle, ramus length, age and gender on the temporomandibular opening index

Linear mouth opening is often used to assess the limitation of mandibular movement. However, this has a number of limitations. It is dependent on variables such as age, gender and ramus length. A new measure of movement has been developed previously, called the temporomandibular opening index (TOI). Forty-two subjects who did not exhibit signs and symptoms of temporomandibular disorder (TMD) were recruited to this study. The relationship of age, gender, gonial angle, ramus length and the TOI was studied. Linear regression analysis showed that the TOI was not dependent on gender (P > 0.644), gonial angle (P > 0.327), ramus length (P > 0.248) and age (P > 0.690). The index may therefore be a better measure of mandibular movement.

Following treatment of myogenous TMD patients with the temporomandibular opening index: an initial report

Limitation of mandibular movement is one of the cardinal signs of temporomandibular disorders (TMD), usually assessed by measurement of maximum voluntary mouth opening. A new measure of assessing mandibular mobility, the temporomandibular opening index (TOI), is less dependent on variables such as age, gender and ramus length. It has also been found to be useful to categorize patients. This study examined changes in TOI as treatment progressed in a group of myogenous TMD patients. Seven patients with myogenous TMD were included in the study and the TOI determined at 0 and 2 weeks, 1 and 6 months after initiation of treatment. Treatment outcome was assessed on a 4 point scale, 0=none, 1=mild, 2=moderate, and 3=severe. Headache, neckache, pain (joints and muscles) and joint sounds were assessed. Nine patients with no signs or symptoms of TMD were included to obtain a normal TOI. The mean TOI of the patient group was 16.4% (s.d.=11.2%) initially and 3.95% (s.d.=1.0%) at 6 months, while mean treatment scores changed from 12.57 (s.d.=3.05) to 1.43 (s.d.=1.90). The mean TOI of the control group was 3.63 (s.d.=0.74). A paired t-test showed that the TOI decreased significantly with time (P=0.02) while there was a concomitant decrease in treatment score (P=0.0003) over the same period. The TOI may be a useful method of following treatment of this group of myogenous TMD patients.

Federalism, entitlements, and discretionary grants: the fiscal context of national support for immunization programs

This paper defines the appropriation and resource allocation structure of federal government programs that deliver vaccines to the public through state and local governments, with a special focus on the Centers for Disease Control and Prevention (CDC) Section 317 program. The paper places these programs in the context of the overall intergovernmental finance system of the United States, and the manner in which that system has responded to societal changes in other areas, such as unemployment insurance and environmental protection. The paper concludes that a changing environment for vaccine financing, and uncertain appropriations for state government immunization infrastructure, may have made the current CDC Section 317 program inadequate. Increased entitlement resources for federally funded vaccines have not been matched with increased and stable resources for the balance of program costs. To the contrary, funding provided to the Section 317 program has proven unstable, and its discretionary appropriations have proven vulnerable to both executive and legislative branch earmarking for such activities as overseas disease eradication or home state earmarking by congressional appropriations subcommittee members. In addition, the rigidity of some CDC program requirements makes it difficult for states to effectively use program funds. Consideration should be given to strengthening the Section 317 program and its relationships to other federal aid programs to ensure that adequate immunization protections are provided in all states to adequately protect all citizens.

The temporomandibular opening index (TOI) in patients with closed lock and a control group with no temporomandibular disorders (TMD): an initial study

Mandibular movement may be assessed by measuring maximum mouth opening. This is a linear measurement from the maxillary to the mandibular incisal edge and is affected by gender, age and ramus length. It cannot be used to classify patients. The temporomandibular opening index (TOI) appears to be independent of these variables and has been shown to differ for different categories of patients with temporomandibular disorders (TMD). This study examined the TOI in a group of 11 patients with closed lock and a control group of 11 individuals with no signs or symptoms of TMD. The group with closed lock had a significantly different TOI from that of the control group (P < 0.001) according to the Mann-Whitney U-test. This suggests that the TOI may have greater diagnostic value than linear mouth opening.

Myogenous temporomandibular disorder patients and the temporomandibular opening index

Limited mandibular movement is one of the cardinal signs of temporomandibular disorders, and is usually assessed by measurement of mouth opening. Linear measurement of mouth opening does not discriminate between diagnostic groups and has been shown to be influenced by gender, age and ramus length. A new temporomandibular opening index, however, can differentiate between diagnostic groups and is not influenced by the above variables. When patients with a myogenous temporomandibular disorder were examined, the temporomandibular opening index distinguished two subgroups, the first with values about the lower quartile and the second with values about the upper quartile. A similar identification of two subgroups was seen in electromyographic studies of myogenous temporomandibular disorder patients.

The long-term effect of oromaxillofacial trauma on the function of the temporomandibular joint

Thirty patients with temporomandibular disorders (TMD) after trauma to the orofacial region were followed for 6 months. They were assessed at 10 days, 1 month, and 6 months. It was found that patients with combined fractures of the mandible and condyle showed more effects on function of the temporomandibular joint after 1 month than patients with condylar fracture only. This difference was not so apparent after 6 months. Patients with trauma but no fracture showed similar effects to those with non-condylar fractures. There was a tendency for arthrogenous patients to develop myogenous problems with time. A group of patients with TMD but no trauma, showed more favourable long-term response to conservative treatment. Long-term follow-up of these patients for TMD problems is recommended.

Comparison of a short examination procedure with an extensive diagnostic protocol for the diagnosis of temporomandibular disorders

Eighty-nine patients who complained of temporomandibular disorders were examined using a short and long examination procedure. Seventy were females and 19 males. Mean age of the group was 31.53 years, with a range from 11 to 73 years. The agreement between the two examination procedures was tested using the Kappa statistic. This gave a value of 0.876 (P<0.001). This allowed rejection of the hypothesis that the agreement found between the two procedures was due to chance alone.

A mouth opening index for patients with temporomandibular disorders

Limitation of mouth opening is an important sign of temporomandibular disorders. It is usually measured linearly from the incisal edge of the maxillary incisors to the incisal edge of the mandibular incisors. This measurement has been queried. A new measure of mouth opening, the opening index is suggested. It was shown that the mean opening index differs for groups of patients with a myogenous or arthrogenous temporomandibular joint problem.

The effect of parafunction on condylar asymmetry in patients with temporomandibular disorders

This study was undertaken to examine the relationship between condylar asymmetry and parafunction in patients with temporomandibular disorders (TMD). Twenty-eight patients with TMD and parafunction and 30 patients with TMD but no parafunction were examined. A panoramic radiograph was obtained for each patient and from this the condylar asymmetry determined. The group with parafunction showed a significantly (P < 0.005) higher asymmetry index than did the group with no noticeable parafunction. Patients were grouped into the following age ranges: 10-19 years, 20-29 years, 30-39 years, and 40 + years. The mean asymmetry index was determined for each age range for both groups of patients. The group of patients with TMD and parafunction had a higher mean asymmetry index in all the age ranges studied. This suggests that muscle hyperactivity may be a factor in the increased asymmetry found in patients with TMD.

Temporomandibular joint dysfunction in children: evaluation of treatment

Thirty-eight pediatric patients with temporomandibular joint (TMJ) dysfunction were diagnosed and treated. The etiology for the TMJ dysfunction was trauma in 30 (79%) patients, degenerative joint disease in two (5%) patients, growth disturbances in two (5%) patients and tumor in one (3%) patient. In three (8%) patients the etiology was unclear. The treatment modalities were: non-invasive therapy in 19 (50%) patients, occlusal therapy in 10 (26%) patients and surgical treatment in nine (24%) patients. The reported symptoms of temporomandibular joint dysfunction using the Helkino anamnestic index revealed that, at the initial examination, eight (21%) reported mild symptoms and 30 (79%) severe symptoms. One year later, 33 (87%) reported no symptoms, four (10%) mild symptoms and one (3%) severe symptoms. These differences were significant (P < 0.05-0.01). Maximum mouth opening 1 year after treatment as compared to the initial examination increased (P < 0.05) in all three treatment modalities. Deviation of the mandible on opening, 1 year after treatment as compared to the initial examination, decreased (P < 0.05) in all three treatment modalities. No differences were found between the modalities in both the maximum mouth opening or deviation of the mandible. TMJ dysfunction in children can be effectively treated by non-surgical treatment modalities. Surgery should be considered only when the non-surgical therapies were ineffective.

Condylar asymmetry and handedness in patients with temporomandibular disorders

The relationship between condylar asymmetry and handedness of dentate patients with temporomandibular disorders was investigated. A group of 28 patients (22 females and 6 males) was studied. The mean age was 28.29 years, with a range from 10 to 54 years. The association between handedness and the sign of the condylar asymmetry index was examined using Fisher's exact test. No difference was found between sign and handedness (P > 0.05). This suggests that handedness does not affect the asymmetry index in this group of patients.

Ehlers-Danlos syndrome, fibromyalgia and temporomandibular disorder: report of an unusual combination

An unusual case of temporomandibular disorder in the presence of both fibromyalgia and Ehlers-Danlos syndrome is presented. Some of the problems in treating these patients are discussed. It is suggested that early conservative treatment of the temporomandibular disorder with a stabilization splint and physical therapy is effective, and this approach should be attempted before any surgical intervention is chosen.

Condylar asymmetry measurements in patients with an Angle's Class III malocclusion

Condylar asymmetry/age relationships were investigated in a group of 23 dentate patients with an Angle's Class III malocclusion and no signs or symptoms of temporomandibular disorders and no prior orthodontic treatment. Condylar asymmetry was determined from panoramic radiographs. A graph of age versus asymmetry index was then plotted. There was no significant correlation between age and the asymmetry index in these patients (R2 = 0.019). This is similar to results obtained for a group of patients with a Class I occlusion who were included as controls, and similar to a group of patients with an Angle's Class II division 2 malocclusion investigated previously.

Temporomandibular joint dysfunction in children

Sixteen pediatric patients with temporomandibular joint (TMJ) dysfunction were successfully diagnosed following appropriately selected imaging methods. The role of radiography in diagnosis of TMJ dysfunction is essential in distinguishing between the osteogenic and non-osteogenic etiologies. Computed tomography (CT) was found to be a valuable imaging method, with advantages over plain film radiography. The treatment modalities considered were: non-invasive therapy, occlusal therapy and surgical treatment. The treatment of choice was dependent on the osteogenic or non-osteogenic etiology. Surgery was considered only when the non-invasive or occlusal therapies were ineffective.

Condylar asymmetry and age in patients with an Angle's Class II division 2 malocclusion

The relationship of age to condylar asymmetry varies for different groups of patients with temporomandibular disorders. Those with a problem of myogenous origin show a parabolic curve, while those with an arthrogenous problem show a linear relation. A group of control subjects with no signs or symptoms of temporomandibular disorders showed no correlation between age and asymmetry index. A group of 17 patients with no signs or symptoms of temporomandibular disorders but with Angle's Class II Division 2 malocclusions and deep overbite, was studied for an age-condylar asymmetry relationship. Only patients with a maximum of one missing tooth, other than third molars, were included. As a control, a group of 22 individuals with an Angle's Class I occlusion was considered. The same exclusion criteria as above was applied to this group. Age-asymmetry indicies were plotted for both groups. No correlation between age and asymmetry index was found in either group (coefficients of determination 0.054 and 0.002, respectively). This may support the conclusion that Angle's Class II Division 2 malocclusion with deep overbite is not a major factor in the aetiology of these disorders.

The condylar asymmetry-age relationship in determining myogenous or arthrogenous origin of pain in patients with temporomandibular disorders

The relation of age to asymmetry index of the condyles of the temporomandibular joint differs for groups of patients with a myogenous and arthrogenous origin of pain. It was decided to investigate if this has clinical diagnostic significance. Twenty-eight patients complaining of temporomandibular disorders (TMD) were included in this study. All were dentate with a maximum of five missing teeth including third molars allowed. Condylar asymmetry was measured according to the method of Habets, and this was used to compute the expected patient age for both curves. The patient was assigned to the group with computed age closest to true age. The association between category derived from graphs and that from clinical diagnosis was studied. There was agreement clinically and graphically in 25 of 28 patients. The Kappa statistic to explore the agreement between the two methods gave a value of 0.78, which allows rejection of the hypothesis that agreement was based on chance alone.

The relation of age and handedness to condylar asymmetry in a group of edentulous patients with a temporomandibular disorder of arthrogenous origin

A group of edentulous patients with a temporomandibular disorder of arthrogenous origin was found to have a mean asymmetry index of 7.38%. This was lower than a group with a disorder of myogenous origin, but higher than a control group of non-patients. A graph of age vs. asymmetry index showed no correlation, in keeping with similar results found in a group of patients with a disorder of myogenous origin.

Condylar asymmetry and its relation to age in a group of patients with a craniomandibular disorder of myogenous origin

A group of patients with a myogenous origin of craniomandibular disorders was found to show a variation of condylar asymmetry with age. The curve obtained by plotting patient age against their asymmetry index was parabolic in nature. This differed from a group of patients with an arthrogenous origin of pain, where a linear correlation with age, with a negative slope, had previously been found. The mean asymmetry index for this group of patients was found to be 23.77%. This is higher than that reported for a group of patients with a craniomandibular disorder of arthrogenous origin, namely 18.76%. It appears that these two groups differ in the variation of condylar asymmetry with age..

Variation of condylar asymmetry with age in edentulous patients with a craniomandibular disorder of myogenous origin

The effect of age on condylar asymmetry in dentate patients has already been investigated and a clear relationship between these two variables was established both for a group with an arthrogenous origin and with myogenous origin of pain. In this study, the mean asymmetry index for an edentulous group of patients with a craniomandibular disorder of myogenous origin was found to be 12.55%, less than that for both dentate groups. There appeared to be no correlation between age and the asymmetry index in this group, suggesting that different mechanisms may be at work in the development of these disorders.

The effect of age on condylar asymmetry in patients with craniomandibular disorders of arthrogenous origin

A group of patients with a craniomandibular disorder of arthrogenous origin demonstrated an age-related variation of condylar asymmetry with age. This may reflect a greater depletion of the mesenchymal cell layer, which is responsible for adaptation of the articular surface as age increases. This would then result in greater deterioration of the articular surfaces and a consequent decrease in condylar asymmetry.