Adolescents' views on oral health care and promotion in Norway: everyday practices, recommendations, and future visions

Introduction

In this study, we aimed to understand adolescents' perspectives on oral health care and promotion. Our research was conducted in the context of Norway's oral health care system, where societal factors like income and education influence health disparities. Despite free public dental care for all residents younger than 19 years, challenges persist in promoting oral health among adolescents, a group whose oral health behavior and literacy remain largely unexplored.

Materials and methods

A thematic analysis of an anonymized dataset from 80 adolescents aged 12-20 years was conducted.

Results

Five central themes were recognized: (1) Feeling fresh vs. feeling indifferent: A broad spectrum of attitudes; (2) Bridging gaps, building habits: Collaborative efforts in oral care; (3) "Create good experiences at the dentist so people come back again"; (4) Requested qualities in oral health promoting solutions; (5) Reminder tools for everyday use. Taken together, these themes highlight adolescents' oral health practices and resources, recommendations for dental clinics, and visions for future oral health promotion.

Discussion

Based on the results, the discussion highlights a need for tailored oral health promotion and ideas to reach adolescents in meaningful and effective ways. Reflections on the theme of social inequalities are provided.

Is This a Deceased Loved One That I See Before Me or Am I Only Dreaming?

This article makes a case for examining dying person's visions during wakefulness and their dreams during sleep as separate and unique phenomena. The reason being that the mode of experience, for example, being visited by a deceased loved one while awake and conscious vs having a deceased loved one appear in a dream while asleep, may have a different impact on the dying person. A better understanding of the content and impact of waking visions and sleeping dreams, respectively, may be beneficial to both dying persons and their families.

Patients' Dreams and Unreal Experiences During Intensive Care Unit (ICU) Hospitalization

In the intensive care unit (ICU), patients often experience fragmented memories, primarily comprising dreams and illusions. These experiences can impact psychosocial well-being, correlating with post-traumatic stress symptoms and heightened anxiety. Understanding these phenomena is crucial for holistic care. To systematically explore patients' perspectives concerning the recollection of dreams and unreal encounters during their stay in the ICU, considering pertinent clinical conditions and potential influencing factors, we conducted a comprehensive search in the PubMed/MEDLINE, Web of Science, and Scopus databases until November 20, 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From an initial pool of 288 records, a thorough screening for eligibility resulted in the inclusion of nine studies for this systematic review. These selected studies underwent evaluation using either the Critical Appraisal Skills Programme (CASP) Qualitative Checklist or the Newcastle-Ottawa Scale (NOS). All studies categorized dreams into three main types: positive, distressing (including nightmares), and neutral experiences. These were further detailed based on aspects such as time, space, senses, emotions, and distinguishing between reality and unreality. Two studies found associations between dreams and conditions like Guillain-Barré syndrome (GBS), mental abnormalities, and delirium. In one study, GBS patients had more vivid dreams, hallucinations, and delusions compared to ICU control group patients; delirious patients tend to report more frequent frightening dreams. Patients in the ICU who recalled dreams often had more severe illness, longer stays, and higher ventilation frequency. Notably, a prolonged ICU stay significantly predicted the likelihood of dream recall, as consistently observed in three other studies. This suggests that patients with prolonged ICU stays, experiencing higher dream recall, underwent extended treatments. This systematic exploration of patients' perspectives on fragmented memories underscores the connections between these experiences, clinical conditions such as GBS and delirium, and extended ICU stays. Recognizing and attending to these psychological aspects in post-ICU care is critical for alleviating the enduring emotional consequences for patients.

Insights into the daily life of ventricular assist device coordinators: Outcome of an international questionnaire

BACKGROUND

As the incidence of heart failure in developed countries is on the rise, mechanical circulatory support (MCS) often remains the only treatment option for patients with end-stage heart failure and is well established worldwide. Even though VAD coordinators play a key role in VAD programs, their responsibilities and daily duties are not clearly defined and characterized. Recently published data from the first 5-year multicenter clinical trial assessing experience with the HeartMate 3 left ventricular system (Abbott, Abbott Park, IL) show an overall survival of 61% at 5 years. When it comes to possible improvements to these systems, it is necessary for developers not only to know the status quo but also to determine and consider the visions and wishes of those individuals who take care of patients, provide education and deal with possible complications. This would be helpful a meaningful effort towards implementing a standard of care.

METHODS

To fill this knowledge gap, we conducted an online survey using the SurveyMonkey tool, addressing representatives of programs implanting VADs worldwide. Representatives answered a standardized block of 14 questions and were asked to provide responses within 3 months.

RESULTS

A total of 91 VAD coordinators from centers of various regions of the world completed the survey. The majority came from European countries. The numbers of patients followed up by the centers ranged from <20 to 390 patients. The majority of VAD coordinators had a nursing background (68%). Seventy-seven percent of the centers operate a 24-h hotline and 3-monthly visits to the outpatient department are most common. Fifty-nine percent of the centers do not use an infection scoring system for driveline wound care. The majority of the centers indicated that an optimized follow-up concept including wound care, medication, and social care is crucial and the key issue for an improved outcome. Smaller components and intensified psychosocial support ranked highest in questions about how to improve quality of life. Surprisingly, the future prospects of telemetric monitoring were not rated high in significance.

CONCLUSIONS

There is a wide variability in the composition and tasks of VAD programs worldwide. Implementing a standard of care and improving psychosocial care as well as equipment is regarded most important to improve outcomes and quality of life. From the point of view of those responsible, the significance of telemetric monitoring seemed overrated.

Distillation of Regional Activity Reveals Hidden Content of Neural Information in Visual Processing

Multivoxel pattern analysis (MVPA) has become a standard tool for decoding mental states from brain activity patterns. Recent studies have demonstrated that MVPA can be applied to decode activity patterns of a certain region from those of the other regions. By applying a similar region-to-region decoding technique, we examined whether the information represented in the visual areas can be explained by those represented in the other visual areas. We first predicted the brain activity patterns of an area on the visual pathway from the others, then subtracted the predicted patterns from their originals. Subsequently, the visual features were derived from these residuals. During the visual perception task, the elimination of the top-down signals enhanced the simple visual features represented in the early visual cortices. By contrast, the elimination of the bottom-up signals enhanced the complex visual features represented in the higher visual cortices. The directions of such modulation effects varied across visual perception/imagery tasks, indicating that the information flow across the visual cortices is dynamically altered, reflecting the contents of visual processing. These results demonstrated that the distillation approach is a useful tool to estimate the hidden content of information conveyed across brain regions.

Shared Death Experiences: A Little-Known Type of End-of-Life Phenomena Reported by Caregivers and Loved Ones

Anecdotal evidence suggests that some loved ones and caregivers of dying patients undergo a type of end-of-life phenomena known as a shared death experience or SDE, whereby one feels that one has participated in a dying person's transition to a post-mortem existence. Anecdotal evidence also suggests that SDEs can have a range of profound psycho-spiritual-emotional effects. However, SDEs have been all but ignored in hospice and palliative medicine, leaving professional bereavement services uninformed about SDEs and leaving individuals who report SDEs without adequate professional support to process and integrate them. To better understand the features and effects of SDEs, an inductive content analysis was performed on written accounts and transcripts of semi-structured interviews with 107 persons reporting a total of 164 SDEs. Analysis revealed 4 distinct though non-exclusive modes of an SDE: remotely sensing a death, witnessing unusual phenomena, feelings of accompanying the dying, and feelings of assisting the dying. Analysis also revealed 3 major domains of SDE effects: changes in belief, the reconciliation of grief, and the perception of continued relational bonds with the deceased. Interviews highlighted both difficulties and therapeutic value in people openly discussing their experiences with health professionals. We believe that integration of information about SDEs offers an opportunity to add to the breadth and quality of psychological, spiritual, and bereavement care.

Imagining sustainable energy and mobility transitions: Valence, temporality, and radicalism in 38 visions of a low-carbon future

Based on an extensive synthesis of semi-structured interviews, media content analysis, and reviews, this article conducts a qualitative meta-analysis of more than 560 sources of evidence to identify 38 visions associated with seven different low-carbon innovations - automated mobility, electric vehicles, smart meters, nuclear power, shale gas, hydrogen, and the fossil fuel divestment movement - playing a key role in current deliberations about mobility or low-carbon energy supply and use. From this material, it analyzes such visions based on rhetorical features such as common problems and functions, storylines, discursive struggles, and rhetorical effectiveness. It also analyzes visions based on typologies or degrees of valence (utopian vs. dystopian), temporality (proximal vs. distant), and radicalism (incremental vs. transformative). The article is motivated by the premise that tackling climate change via low-carbon energy systems (and practices) is one of the most significant challenges of the twenty-first century, and that effective decarbonization will require not only new energy technologies, but also new ways of understanding language, visions, and discursive politics surrounding emerging innovations and transitions.

On visions and promises - ethical aspects of in vitro meat

Innovators of in vitro meat (IVM) are convinced that this approach is the solution for problems related to current meat production and consumption, especially regarding animal welfare and environmental issues. However, the production conditions have yet to be fully clarified and there is still a lack of ethical discourses and critical debates on IVM. In consequence, discussion about the ethical justifiability and desirability of IVM remains hypothetical and we have to question those promises. This paper addresses the complex ethical aspects associated with IVM and the questions of whether, and under what conditions, the production of IVM represents an ethically justifiable solution for existing problems, especially in view of animal welfare, the environment, and society. There are particular hopes regarding the benefits that IVM could bring to animal welfare and the environment, but there are also strong doubts about their ethical benefits.

End-of-Life Dreams and Visions and Posttraumatic Growth: A Comparison Study

Background: End-of-life dreams and visions (ELDVs) can provide both meaning and comfort to individuals nearing death. While research has examined the prevalence and content of ELDVs, little is known on how dreaming at end of life may affect psychological processes. Objective: This study aimed to explore differences in posttraumatic growth (PTG) between hospice patients who experience ELDVs and hospice patients who do not experience this phenomenon. Design: This is a multimethod cross-sectional comparison study. Settings/Subjects: 70 hospice patients (35 with ELDV experiences and 35 without ELDV experiences) were recruited after being admitted to a hospice inpatient unit. Measurements: PTG was assessed using a modified version of the Posttraumatic Growth Inventory (PTGI). Demographic information, ELDV occurrence, and a brief description of ELDVs were also collected. Results: Significant differences emerged between groups in terms of personal strength (p = 0.012), spiritual change (p = 0.002), and overall PTG (p = 0.019). Patients with ELDV experiences had higher scores on all subscales as well as overall PTG compared to nondreaming patients. Conclusions: Dreams and visions at the end of life affect PTG of dying individuals in hospice care. Further research should be conducted between groups to examine the effects ELDVs may have on other psychological processes.

The Structure and Measurement of Unusual Sensory Experiences in Different Modalities: The Multi-Modality Unusual Sensory Experiences Questionnaire (MUSEQ)

Hallucinations and other unusual sensory experiences (USE) can occur in all modalities in the general population. Yet, the existing literature is dominated by investigations into auditory hallucinations (“voices”), while other modalities remain under-researched. Furthermore, there is a paucity of measures which can systematically assess different modalities, which limits our ability to detect individual and group differences across modalities. The current study explored such differences using a new scale, the Multi-Modality Unusual Sensory Experiences Questionnaire (MUSEQ). The MUSEQ is a 43-item self-report measure which assesses USE in six modalities: auditory, visual, olfactory, gustatory, bodily sensations, and sensed presence. Scale development and validation involved a total of 1,300 participants, which included: 513 students and community members for initial development, 32 individuals with schizophrenia spectrum disorder or bipolar disorder for validation, 659 students for factor replication, and 96 students for test-retest reliability. Confirmatory factor analyses showed that a correlated-factors model and bifactor model yielded acceptable model fit, while a unidimensional model fitted poorly. These findings were confirmed in the replication sample. Results showed contributions from a general common factor, as well as modality-specific factors. The latter accounted for less variance than the general factor, but could still detect theoretically meaningful group differences. The MUSEQ showed good reliability, construct validity, and could discriminate non-clinical and clinical groups. The MUSEQ offers a reliable means of measuring hallucinations and other USE in six different modalities.

Exploring Responsible Neuroimaging Innovation: Visions From a Societal Actor Perspective

Apart from the scientific unknowns and technological barriers that complicate the development of medical neuroimaging applications, various relevant actors might have different ideas on what is considered advancement or progress in this field. We address the challenge of identifying societal actors and their different points of view concerning neuroimaging technologies in an early phase of neuroimaging development. To this end, we conducted 16 semistructured interviews with societal actors, including governmental policy makers, health professionals, and patient representatives, in the Netherlands. We show how the contextual aspects of applications and underlying features of the ideal health system determine the desirability. Neuroimaging developments are perceived as innovations that will optimize the current health system or as opportunities to change existing structures and practices of the current health system more radically. Insights into and understanding of these visions show incongruence between visions regarding desirable medical neuroimaging use and potential conflicting visions regarding the embedding of neuroimaging applications. We conclude that it is possible to prospectively identify incongruent visions and analyze when these visions will most likely come into conflict with each other. Such an analysis might provide a reflective space, beyond personal and political interest, suitable as a starting point for joint reflection and mutual learning in order to manage medical neuroimaging innovations towards more responsible applications.

Experiences of continued presence: On the practical consequences of 'hallucinations' in bereavement

OBJECTIVES

We document the properties of experiences of continued presence (ECPs) helping to resolve controversies about their significance.

METHOD

We used qualitative methods in data collection and analysis. This enabled us to document the properties of ECPs. Narrative biographic interviews were carried out with 17 bereaved informants, and conversation analysis was used to identify the sources of meaning and functions of these experiences.

RESULTS

Our informants heard voices of the deceased, saw their images, felt their touch, and sometimes felt their presence unspecified in any of the senses. Analysis revealed that ECPs were meaningfully connected to the immediate environments in which they happened but also to the personal histories of the bereaved. The narratives reveal helpful and destructive potentials of these experiences. In all cases, the functions relied on the relationship with the deceased.

CONCLUSIONS

The authors warn against oversimplification of ECPs, as significantly contrasting practical consequences commonly occurred within as well as between cases. The findings support the use of talking therapies based on personal meanings to help those disturbed by their experiences of presence.

PRACTITIONER POINTS

Practitioners should not assume that ECPs are signs of pathology - often they have healing consequences. Where ECPs cause distress, the problem is likely to concern relationship difficulties with the deceased. Therapists can help clients with distressing ECPs by working on the relationship with the deceased.

Distressing Visions at the End of Life: Case Report and Review of the Literature

There is a growing body of literature documenting dreams, visions, and other trans-personal communications that occur as part of the dying process, often called end-of-life dreams and visions (ELDVs) or deathbed communications (DBCs). This paper describes a unique case involving distressing visions at the end of life, provides a review of existing literature around ELDVs, and will provide a framework within which to approach the patient experiencing distressing ELDVs.

Hallucinations as a trauma-based memory: implications for psychological interventions

The relationship between hallucinations and life events is a topic of significant clinical importance. This review discusses the extent to which auditory and visual hallucinations may be directly related to traumatic events. Evidence suggests that intrusive images occur frequently within individuals who also report hallucinatory experiences. However, there has been limited research specifically investigating the extent to which hallucinations are the re-experiencing of a traumatic event. Our current theoretical understanding of these relationships, along with methodological difficulties associated with research in this area, are considered. Recent clinical studies, which adopt interventions aimed at the symptoms of posttraumatic stress disorder in people diagnosed with a psychotic disorder, are reviewed. There is a need for the development of evidence-based interventions in this area.