Postmortem minimally invasive tissue sampling in communities: exploring perceptions of families, funeral workers, religious and community leaders and healthcare providers from Pakistan.

BACKGROUND: Minimally invasive tissue sampling (MITS) has increasingly been used to improve the diagnosis of disease and identification of the cause of death, particularly in underserved areas. However, there are multiple barriers to accessing those who die within the community, our study aimed to explore the perceptions and insights of community members and healthcare providers regarding the feasibility of implementing MITS in community settings. METHODS: A qualitative exploratory study was conducted. A total of twenty one in-depth interviews were conducted with deceased infants' parents, elders of the family, religious leaders, community leaders, and funeral workers. Focus group discussions were conducted with health care providers (n = 14) in two peri-urban slum areas of Karachi, Pakistan. The duration of this study was from August to October 2020. Data was analyzed using thematic analysis and was coded and merged into categories forming eight major themes. RESULTS: In general, participants viewed minimally invasive tissue sampling (MITS) as beneficial for improving child health, though some had concerns about disrespecting the deceased during sample collection. Misinformation, fear of needles, and medical procedures were major barriers to MITS implementation. To enhance acceptance, community and religious leaders suggested using religious rulings, obtaining parental consent, ensuring confidentiality, and increasing efforts of community engagement. Community healthcare providers, along with funeral workers, recommended providing community members with grief counseling to increase study participation. Besides concerns about sampling interfering with respect for the decease, community members also raised concerns about misinformation. Further, participants provided feedback on the design and appearance of the mobile van used to collect MITS samples from children under the age of five. CONCLUSION: This study is critical for understanding the challenges associated with implementation of community-based MITS sampling in Pakistan. Integrating the use of a mobile van for sample collection, grief counseling along with community engagement sessions and advocacy will help address community-based misinformation and develop community trust.

Breaking Down Barriers and Paving the Way for Blockchain Adoption in Dentistry.

Blockchain technology can potentially transform the dentistry sector by facilitating safe communication between dental practitioners and offering secure and efficient administration of patient information. Nevertheless, using this technology in dentistry confronts various barriers, including regulatory and legal obstacles, a lack of technical skills, and a lack of standardization. To overcome these challenges, dental practitioners, industry stakeholders, and regulators must work together to develop a legislative framework that encourages the use of blockchain technology in dentistry. Moreover, education and training programs must equip dental practitioners with the skills and expertise to properly incorporate and use blockchain technology. The use of blockchain technology in dentistry has the potential to greatly improve patient outcomes while also increasing the efficiency and security of the dental business.

Monkeypox resurgence and its implications for Dentistry - A scoping review.

INTRODUCTION: Monkeypox caused by the Monkeypox virus, a member of the Orthopoxvirus genus, is currently considered a major concern among healthcare authorities due to its high transmissibility rate. Currently, no specific treatment is available for this disease, due to which healthcare professionals, specifically Dentists, are required to look out for symptoms at early stages to prevent its spread. OBJECTIVE: To analyze the role of dentists in identifying Monkeypox cases and limiting its spread. METHODS: We conducted a scoping review on monkeypox and its oral manifestation. PRISMA protocols were observed in data collection. The relevant literature search was conducted in relevant databases like PubMed, Scopus, Web of Science, Embase, CINAHL, and Google Scholar. Relevant articles related to Monkeypox, and Dentistry were included in the final review. Articles published from March 2022- September 2022 were included in the review. Keywords and Mesh words related to monkeypox, and dentistry were used as part of the search strategy. RESULTS: A total of 1881 articles were reviewed, among which 7 articles were included. Dentists were strongly advised to be on high alert for Monkeypox symptoms due to their close contact with patients. Around 70% of Monkeypox cases reported oral lesions at early stages, which requires a differential diagnosis from other oral lesions. Considering this, dentists should be well-versed in this new and emerging threat. CONCLUSION: Although dentists have been shown to play an important role in the treatment of monkeypox, there is insufficient data available. More research on dentistry and monkeypox will be needed in the near future.

Systematic review on the current state of disaster preparation Simulation Exercises (SimEx).

INTRODUCTION: The simulation exercise (SimEx) simulates an emergency in which an elaboration or description of the response is applied. The purpose of these exercises is to validate and improve plans, procedures, and systems for responding to all hazards. The purpose of this study was to review disaster preparation exercises conducted by various national, non-government, and academic institutions. METHODOLOGY: Several databases, including PubMed (Medline), Cumulative Index to Nursing and Allied Health Literature (CINAHL), BioMed Central, and Google Scholar, were used to review the literature. Information was retrieved using Medical Subject Headings (MeSH) and documents were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). To assess the quality of the selected articles, the Newcastle-Ottawa Scale (NOS) technique was utilized. RESULTS: A total of 29 papers were selected for final review based on PRISMA guidelines and the NOS quality assessment. Studies have shown that many forms of SimEx commonly used in disaster management including tabletop exercises, functional exercises, and full-scale exercises have their benefits and limitations. There is no doubt that SimEx is an excellent tool for improving disaster planning and response. It is still necessary to give SimEx programs a more rigorous evaluation and to standardize the processes more thoroughly. CONCLUSIONS: Drills and training can be improved for disaster management, which will enable medical professionals to face the challenges of disaster management in the 21st century.

Pivoting Covid-19 Vaccination Through Mvax: A Perspective From An Lmic Setup.

Several countries including Pakistan have already started deploying booster vaccinations owing to the COVID-19 pandemic yet in Pakistan populace is not fully vaccinated yet and currently Pakistan has bracied for another potential Covid-19 surge, as the number of cases in the nation has been escalating, driving the positive rate even higher. Vaccine inequity and acceptance has been an issue in Pakistan owing to lack of knowledge, lack of proximity to healthcare facilities, poor socio-economic status, etc. Also, the behaviour of the populace in Pakistan varies from that of other countries in that when COVID-19 cases declined, individuals thought the virus has been abolished and they stopped following standard operating procedures (SOPs). In this context, this article introduces the notion of mobile vaccination for everyone, which may be implemented to improve vaccination coverage.

The promise of telemedicine in Pakistan: A systematic review.

BACKGROUND: Telemedicine offers the possibility of provision of medical assistance to remote patients, and it has great potential in developing countries like Pakistan. Telemedicine solves logistical barriers, gives support to weak health systems, and helps to establish worldwide networks of healthcare professionals. Because of the high implementation costs, it is not possible yet to adopt telehealth systems for low- and middle-income nations. OBJECTIVE: To present a revision of region-based telemedical services in Pakistan. METHODS: Libraries such as PubMed (Medline), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus (EMBASE), and Google Scholar were used for document search. Newcastle-Ottawa Scale (NOS) was adopted to conduct study quality. Many of the studies (n-8) included in the review were of high quality as assessed through the Newcastle-Ottawa scale. Selected study characteristics were further analyzed based on different parameters such as publication year, sample size, study design, methods, motivation, and outcomes. RESULTS: Search produced 955 articles and 11 items were ultimately selected to conduct the review. These studies were further characterized as region-based telemedicine implementation. Out of 11, eight studies were conducted in the urban region and three studies were conducted in the rural areas of Pakistan. Many studies produced evidence on telehealth interventions by smartphone services such as SMS, apps, and web-based telemedicine. CONCLUSIONS: Telehealth interventions such as mHealth, eHealth, telemedicine, and telepharmacy in Pakistan were introduced starting from the last two decades. For obtaining the full benefits of these technologies, it is necessary that they but certainly need to become an integral part of Pakistan's current health infrastructure.

Characteristics of mobile phone access and usage among caregivers in Pakistan - A mHealth survey of urban and rural population.

INTRODUCTION: Globally mobile ownership and access is becoming very common, and breakthroughs in mobile technology have shaped digital communication, with 7 billion mobile phone users globally. Developing countries account for 80% of newly purchased mobile phone devices with majority of such countries having low Routine Immunization coverage and a high risk of vaccine preventable diseases. The use of mobile phones provides a tremendous potential for public health involvement. OBJECTIVE: The aim of this study is to assess the acceptability and usability of mobile phones among infant caregivers in a LMIC setup and to explore the role of mHealth to improve immunization uptake and coverage. METHODS: This is a cross-sectional survey exploring the regional differences in mobile phone ownership, usability and preferences, along with level of trust with others while sharing a mobile phone. The study was conducted with caregivers of infants in an urban and rural sites of Pakistan. RESULTS: A total of 4472 households were approached, of which 3337 participants were eligible for the study (74.61 %). The reasons for not participating in the study (n = 1135) included (i) household locked or refusal to participate for 594 families (52%), (ii) child older than 14 days of life in 409 cases (36%), (iii) 80 (7%) families did not have access to a functional mobile phone, (iv) 36 (3%)families did not provide a mobile phone number, and (v) 14 (1%) could not stay within the HDSS for 6 months. Access to mobile phone with SMS features was considerably high at both sites: 99.1% in Matiari (rural site) and 96.7% in Karachi (urban). In Matiari 96.6% of the respondents reported having daily access to the phone, contrasting with only 51.4% in Karachi. In Karachi, the predominant spoken language was Urdu, whereas majority of the respondents in Matiari spoke Sindhi (34.6% vs. 70.9%). CONCLUSION: Our study indicates high access to mobile phone in both urban and rural setup, However access to smart phone is still limited, urban and rural setup. Further, the acceptance of overall health- and barrier-based child immunization messages through mobile phone were quite high in both settings. Lastly automated calls were preferred over SMS due to literacy and local settings. This bears important implications for improving child immunization uptake through mobile phones in developing regions such as Pakistan.

Usability and Acceptability of a Mobile App for Behavior Change and to Improve Immunization Coverage among Children in Pakistan: A Mixed-Methods Study.

BACKGROUND: Pakistan's immunization uptake rates are still significantly lower than anticipated despite several initiatives. Lack of awareness, forgetting about vaccination schedule, and vaccine misconception/misinformation are a few of the major drivers that mitigate the rates of immunization. The current COVID-19 pandemic emphasizes the importance of immunization. The significant reductions in regular childhood vaccination during pandemic have increased the risk of outbreaks of vaccine-preventable diseases. Concerns among parents over possibly exposing their children to COVID-19 during child visits may have contributed to the reported declines. Innovative and cost-effective mHealth interventions must be implemented in order to address the problem of inadequate immunization rates. In addition, it is also critical to understand the end user needs in order to reflect on the highly relevant essence of the customized healthcare experience. OBJECTIVE: The aim of this study was to learn about caregivers' attitudes toward the usability and acceptability of behavior-change smartphone applications (mobile phones) for improving immunization coverage in Pakistan. METHODS: A mixed-method design was employed for this study. The study was conducted at Aga Khan University, Hospital. Parents visiting the Community Health Center for 6-week vaccination of their children were recruited. The study was conducted in two stages. Stage 1 consisted of qualitative interviews that grasped the parent's attitudes and challenges to immunization, as well as their acceptability and accessibility of the smartphone-based behavior-change application to increase vaccine uptake. Stage 1 was followed by stage 2, in which data were collected through a questionnaire designed by using data from qualitative interviews. RESULTS: The majority of participants agreed that immunization serves an important role in protecting their child from illnesses that cause morbidity and mortality. Almost all of them emphasized the importance of using a pre-appointment method at vaccination center in order to reduce the waiting time. Furthermore, participants were also interested in AI-based behavior modification applications related to immunization. They also wanted to have applications in their native language for better understanding and communication of related information. In our study, approximately 95.2 percent of participants agreed to accept SMS immunization updates, which was also reasonably high. Lastly, the majority of them identified forgetfulness as a significant contributor to regular immunization. CONCLUSION: To enhance the uptake of childhood vaccines, overall vaccination rates, and overcome barriers related to vaccination coverage, cost-effective and user-friendly mHealth AI-based smart phone applications are required to raise awareness regarding the continuation of vaccination service and the importance of timely vaccination. Parents' experiences and attitudes must be considered while designing and evaluating the efficacy of mHealth-based interventions.

Knowledge, Attitudes, and Perceptions of Dental Assistants regarding Dental Asepsis and Sterilization in the Dental Workplace.

MATERIALS AND METHODS: A cross-sectional study was carried out. A 27-item prepilot tested close-ended questionnaire was designed and administered online to collect data on knowledge of asepsis, sterilization, instrument handling, disinfection, hand-hygiene practices, dental practice, age, education, and experience level from March 2020 to June 2020. RESULTS: Out of 70 dental assistants, the majority were aged between 21 and 29 years (44.30%), more than two-thirds (85.41%) of the dental assistants were working in a hospital, while 14.29% were working in private clinics, only 7.1% had a diploma in the dental assistant program, and 74% had more than 2 years of experience in practice. Dental assistants working in private practice (76.30) had a higher mean knowledge scores compared to those working in hospital (74.25), while those with less than 2 years of experience (75.61) had a higher scores compared to those with 2-5 years of experience (73.96). CONCLUSION: Better compliance with recommended infection control and waste management practices is needed for all dental assistants. Continuing education programs targeting such awareness are vital to improve the management of hazardous waste practices among dental assistants.

Teledentistry-based Program to Improve Oral Hygiene Indicators in Rural Pakistan-A Protocol.

AIM: The primary aim of this research protocol is to secure funding to initiate a teledentistry pilot project in order to improve the oral hygiene conditions of the most vulnerable population of rural Sindh in Pakistan, through hands-on training of 1,000 lady health workers by dentists and community dentistry specialists of other colleges led by Jinnah Medical and Dental College. MATERIALS AND METHODS: Training courses on digital health consultation would be given to participating healthcare workers. The trainees would be trained on all aspects of dental hygiene including precautions, tooth brushing techniques, and oral care. During the 2-day-long course, lady health workers will be taught various tooth brushing techniques, as well as basic instructions about oral hygiene and how to address queries of people regarding oral health. They will also get guidance about the various multimedia softwares in the phone and how to use them. The study would also include teledentistry consultation as a real-time patient learning tool for patients, healthcare workers, and trainees. RESULTS: Results will be made available when the trial has been completed in 2021. The program will be evaluated by assessing its usability, acceptability, knowledge, and satisfaction of users. CONCLUSION: The protocol is designed to illustrate the underlying concept that a more reliable and robust model can be built through creating interactive communities of practice for consumers of telehealth in dental education. The Telehealth Skills Coaching and Delivery Initiative would incorporate and test a technically oriented paradigm of Internet-based medical education for vertically incorporated, community-based learning environments. CLINICAL SIGNIFICANCE: Teledentistry has the ability to expand access to oral health care, increase the provision of oral health care, and decrease costs. In view of the immense advances made in this field, teledentistry can continue to promote specialized health care in the remotest corners of the world. Many countries have already embraced virtual health care (telemedicine) in the face of an increase in cases of COVID-19; however, teledentistry has yet to play its role in this pandemic by enhancing the accuracy and efficiency of dental treatment. In the case of LMICs such as Pakistan, which lack advanced technologies such as teledentistry within their national healthcare network, the COVID-19 pandemic is a challenge to introduce the requisite legislative changes to promote the widespread use of teledentistry.

Oral Manifestations of Rett Syndrome-A Systematic Review.

Rett Syndrome is an x linked developmental disorder which becomes apparent in females after 6 to 18 months of age. It leads to severe impairments including loss of speech, loss of hand movements/manual dexterity, characteristic hand movements such as hang wringing and intellectual disability/learning problems. This systematic review was carried out to identify the dental manifestation of Rett syndrome and to shed light on treatment options available for oral health problems associated with Rett syndrome. A systematic literature search was conducted on the PubMed, Scopus, Biomed, Web of Science, Embase, Google Scholars, Cochrane and CINAHL using the following entries: Rett syndrome (n = 3790), Oral health and Rett syndrome (n = 17), dental health of Rett syndrome patients (n = 13), and the MeSH terms listed below: Rett syndrome and Oral Health (n = 17), Rett syndrome and dentistry (n = 29). The final review included 22 search articles. The most common oral findings was bruxism. Masseteric hypertrophy was also reported. Anterior open bite and non-physiological tooth wear was observed. Other oral manifestations of Rett syndrome included mouth breathing, tongue thrusting, digit/thumb sucking, high arch palate. Increased awareness and dental education amongst dentists and assistants regarding the dental manifestations of Rett syndrome and similar neurodevelopmental disorders is required to improve the level of care and empathy they can provide to these differently able patients. Research on dental aspects of Rett is scarce and this remains a neglected topic.

Relationship between Socioeconomic Inequalities and Oral Hygiene Indicators in Private and Public Schools in Karachi: An Observational Study.

BACKGROUND: The study investigated the relationship between socioeconomic status and oral hygiene indicators in two schools located in Karachi, Pakistan. Oral hygiene indicators of public and private school children were compared. Private schools cater to children of relatively wealthier families compared to public school, whose attendees are generally children from less affluent backgrounds. The aim of this study was to determine whether socio-economic differences and inequalities have an impact on key oral hygiene indicators. METHODOLOGY: Primary data for this research was collected from community school visits conducted by the community dentistry department of Jinnah Medical and Dental and Medical College from January to September 2019. A convenience sample of the two schools, comprising 300 school students was selected. Data was collected using modified World Health Organization (WHO) oral health care forms. A pre-tested/customized dental hygiene form based on WHO forms was created by the research team. This form was used to measure DMFT/dmft scores and key oral hygiene indicators in the sample. RESULTS: A total sample size of 300 school-children affiliated with public and private schools was selected. The children's age ranged from 2 to 18 years. The mean DMFT scores of private and public-school children were not significantly different (private (1.82) vs. public (1.48)). (p = 0.257). The mean of carious teeth was 1.69 in private school children compared to 1.34 in government school children, whereas the mean values of other key indicators of oral hygiene including plaque deposition (p = 0.001), dental stains (p < 0.001) and bleeding gums/gingivitis (p < 0.001), were statistically significant between public and private school children. CONCLUSION: Oral health inequalities can be reduced with increased awareness and public funding to cater for the oral health needs of children of less affluent families. A dynamic and practical community-oriented program is fundamental for enhancing pediatric oral hygiene status, particularly for children attending government schools.

Pivoting Dental Practice Management during the COVID-19 Pandemic-A Systematic Review.

Background and Objectives: The aims of this systematic review were to identify additional infection control measures implemented in dental practice globally to prevent cross-infection and evaluate the psychological impacts of the pandemic among dental professionals. Materials and Methods: A sequential systematic literature search was conducted from December 2019 to 30 April 2020 through PubMed, CINAHL, Scopus, Google Scholar, Embase, and Web of Science databases. The search yielded the following results: "COVID-19" (n = 12,137), "Novel corona virus" (n = 63), "COVID-19 and dentistry" (n = 46), "COVID-19 and oral health" (n = 41), "Novel Corona virus and Dentistry" (n = 0), "dental health and Novel Coronavirus" (n = 26), and "dental practice and Novel Coronavirus" (n = 6). Results: After a careful review and eliminating articles based on inclusion and exclusion criteria, the final review included 13 articles. Management of infection control is discussed extensively in the literature and remains the main theme of many Coronavirus Disease 2019 (COVID-19) articles on dentistry. Telephone triage using a questionnaire, hand hygiene, personal protective equipment (PPE) for clinical and nonclinical staff, a preprocedural mouth rinse, and aerosol management have been discussed and implemented in few countries. Three studies recommended that elective treatments for patients with a temperature of >100.4 F or 38 °C should be postponed or performed in an airborne infection isolation room (AIIR) or negative-pressure room. Limiting the number of patients in the waiting area, the removal of shared objects, proper ventilation, and physical distancing were highly recommended. Psychological distress among dental professionals in relation to existing medical conditions and self-efficacy has been discussed. Conclusions: Although the COVID-19 pandemic has had a substantial impact on the dental profession worldwide, our review highlights many practice management approaches to adopt the new norm. More research highlighting evidence-based safety practices and multisectoral collaboration is required to help dental professionals make informed decisions and make the profession safe, both for the patient and dental professionals.

Emerging Challenges and Threats for Dental Health Care Sector Attributable to COVID-19: Tale of a Developing Country.

Prevention and control of infection in dentistry is an essential matter that has gained immense attention in recent years. There exist a lack of scientific data about the cross-transmission and its associated risk, especially in the dental health care setting of Pakistan. This article will evaluate the emerging challenges and threats for the dental community in Pakistan attributable to the COVID-19 outbreak. There is a significant knowledge gap regarding the state- and institutional-level of infection prevention and control (IPC) policies and practices. In addition, not much is known about the development, implementation, and monitoring of IPC policies and its challenges.