Smartphone-based combined oral and whole-body exercise programme aimed at improving oral functions: A randomized clinical trial.

OBJECTIVES: To investigate the effects of a smartphone-based oral and whole-body exercise programme on oral function in older adults. METHODS: Individuals aged 65 years or above were randomized into three groups (non-app use, app use and control group), and a combined oral and whole-body exercise programme was conducted for 5 weeks. Oral muscle strength, saliva flow rate, Oral Health Impact Profile-14 (OHIP-14), and Geriatric Oral Health Assessment Index (GOHAI) were measured before and after the intervention. The changes in each group were analysed at the end of the programme using paired sample t-tests, and the differences among the groups were analysed using the chi-square test, Fisher's exact test and ANOVA. RESULTS: The anterior tongue strength increased by 2.80 kPa after the intervention in the non-app use group; however, the change was not statistically significant. In the app use group, the anterior tongue strength significantly increased by 4.48 kPa. The saliva flow rate increased by 0.54 and 0.71 g/min in the non-app and app use groups, respectively, after the intervention (p < 0.05), and the change was greater in the app use group than in the other groups (p < 0.01). There were no significant changes in the posterior tongue strength, cheek strength, OHIP-14 or GOHAI scores over the course of the study. CONCLUSIONS: A smartphone-based combined oral and whole-body exercise programme can improve anterior tongue strength and saliva flow rate in older participants. The programme, however, did not result in significant changes in posterior tongue strength, cheek strength and perceived oral health.

Association Between Subjective Masticatory Function and Mild Cognitive Impairment in Older Adults.

AIM: This study aimed to examine the effect of subjective masticatory function on the occurrence of mild cognitive impairment (MCI) by analysing the Korean Longitudinal Study of Ageing (KLoSA) data. METHODS: The study participants were 2954 KLoSA participants aged 60 years or older in the first wave (2006) who had normal cognitive function. The subjective masticatory function was determined using a survey item, and the responses were grouped into 3 categories, ie, good, moderate, and poor. The occurrence of MCI in the 3 groups was followed up until 2020. Cognitive function was assessed based on the Korean Mini-Mental State Examination score. Age, sex, education level, residence, health insurance type, smoking status, drinking status, and the number of chronic diseases were considered as potential confounders. To examine the occurrence of MCI according to subjective masticatory function, Cox proportional hazard regression analysis was performed. RESULTS: Cox proportional hazard regression models adjusted for confounders yielded the following results: in men, the risk of MCI was higher in those whose subjective masticatory function was moderate and poor, as compared to those with good subjective masticatory function (adjusted hazard ratio [aHR], 1.33; 95% confidence interval [CI], 1.12-1.58; aHR, 1.23; 95% CI, 1.04-1.46). In contrast, in women, subjective masticatory function did not significantly influence the occurrence of MCI (aHR, 1.05; 95% CI, 0.89-1.24; aHR, 1.08; 95% CI, 0.92-1.28). CONCLUSIONS: This study suggests that poor masticatory function may be a risk factor for MCI in older men.

Optimization Method to Predict Optimal Noise Reduction Parameters for the Non-Local Means Algorithm Based on the Scintillator Thickness in Radiography.

The resulting image obtained from an X-ray imaging system depends significantly on the characteristics of the detector. In particular, when an X-ray image is acquired by thinning the detector, a relatively large amount of noise inevitably occurs. In addition, when a thick detector is used to reduce noise in X-ray images, blurring increases and the ability to distinguish target areas deteriorates. In this study, we aimed to derive the optimal X-ray image quality by deriving the optimal noise reduction parameters based on the non-local means (NLM) algorithm. The detectors used were of two thicknesses (96 and 140 µm), and images were acquired based on the IEC 62220-1-1:2015 RQA-5 protocol. The optimal parameters were derived by calculating the edge preservation index and signal-to-noise ratio according to the sigma value of the NLM algorithm. As a result, a sigma value of the optimized NLM algorithm (0.01) was derived, and this algorithm was applied to a relatively thin X-ray detector system to obtain appropriate noise level and spatial resolution data. The no-reference-based blind/referenceless image spatial quality evaluator value, which analyzes the overall image quality, was best when using the proposed method. In conclusion, we propose an optimized NLM algorithm based on a new method that can overcome the noise amplification problem in thin X-ray detector systems and is expected to be applied in various photon imaging fields in the future.

Enhanced Mott cell formation linked with IgM Fc receptor (FcµR) deficiency.

In previous studies, Mott cells, an unusual form of plasma cells containing Ig-inclusion bodies, were frequently observed in peripheral lymphoid tissues in our IgM Fc receptor (FcµR)-deficient (KO) mouse strain. Because of discrepancies in the reported phenotypes of different Fcmr KO mouse strains, we here examined two additional available mutant strains and confirmed that such enhanced Mott-cell formation was a general phenomenon associated with FcµR deficiency. Splenic B cells from Fcmr KO mice clearly generated more Mott cells than those from WT mice when stimulated in vitro with LPS alone or a B-1, but not B-2, activation cocktail. Nucleotide sequence analysis of the Ig variable regions of a single IgMλ+ Mott-hybridoma clone developed from splenic B-1 B cells of Fcmr KO mice revealed the near (VH) or complete (Vλ) identity with the corresponding germline gene segments and the addition of six or five nucleotides at the VH/DH and DH/JH junctions, respectively. Transduction of an FcµR cDNA into the Mott hybridoma significantly reduced cells containing IgM-inclusion bodies with a concomitant increase in IgM secretion, leading to secreted IgM binding to FcµR expressed on Mott transductants. These findings suggest a regulatory role of FcµR in the formation of Mott cells and IgM-inclusion bodies.

Effectiveness of an oral health education programme using a mobile application for older adults: A randomised clinical trial.

OBJECTIVE: To investigate the effectiveness of an oral health education programme using a mobile app for adults aged 65 years or older. METHODS: Participants aged 65 or older were randomly allocated into non-app use (n = 25), app use (n = 22) and control (n = 26) groups. The non-app use group received lecture-based oral health education using PowerPoint presentations and participated in workbook activities twice a week for five weeks, whereas the app use group underwent oral health education using a smartphone app and workbook activities for five weeks. Before and after the intervention, a questionnaire survey and oral health examination were performed to examine changes in oral health-related indices. RESULTS: The non-app use group showed significant changes, with a 2.1 increase in oral health knowledge score, 0.2 decrease in the O'Leary index and 0.6 decrease in tongue coating. The app use group showed significant changes, with a 3.1 increase in oral health knowledge score, a 2.5 increase in oral health perception, a 0.3 decrease in the O'Leary index and a 1.4 decrease in tongue coating. Repeated-measures ANOVA showed that interaction between time and group was significant only in tongue coating variable. CONCLUSION: The smartphone app developed in this study carries the possibility to convey informative content for oral health education among older adults.

Effects of Integrative Cognitive Function Improvement Program on Cognitive Function, Oral Health, and Mental Health in Older People: A Randomized Clinical Trial.

We aimed to investigate the effects of an integrative cognitive function improvement program that combined existing cognitive, emotional, and physical therapies on cognitive function, oral health, and mental health in elder participants. Participants were classified into one of the following groups: cognitively normal (CN; n = 18), mild cognitive impairment (MCI; n = 17), and control (n = 17). An integrative cognitive function improvement program was administered to the CN and MCI groups for six weeks. To measure cognitive function, electroencephalogram (EEG) and cerebral blood flow (CBF) were evaluated, and to measure oral health, the O'Leary index, Löe & Silness index, tongue coating, unstimulated saliva flow rate, and oral muscle strength were measured. To measure mental health status, mental health, happiness and social support were measured. The CN and MCI groups showed a significant change in EEG-based indices for awareness level and physical stress. Regarding oral health, the O'Leary and the Löe & Silness index score decreased significantly in the CN and MCI groups. Saliva flow rate increased significantly in the CN and MCI groups. In regards to mental health, the happiness score increased post-intervention in the CN and MCI groups. In conclusion, the integrative cognitive function improvement program was effective in improving cognitive function, oral health, and mental health of elder people.

The complete chloroplast genome of Ziziphus jujuba cv. Bokjo (Rhamnaceae).

We have sequenced the Ziziphus jujuba cv. Bokjo chloroplast genome by de novo assembly using next-generation sequencing. The complete circular chloroplast genome consisted of 161,714 bp and contained four parts: a large single-copy (LSC) region of 89,323 bp, a small single-copy (SSC) region of 19,361 bp, and two inverted repeat regions (IRa and IRb) of 26,515 bp each. The genome annotation predicted a total of 110 genes, including 76 protein-coding genes, 30 tRNA genes, and four rRNA genes. Phylogenetic analysis demonstrated the close taxonomic relationship between Z. jujuba cv. Bokjo and two other members of the Ziziphus genus, Z. spina-christi and Z. mauritiana. We found 135 polymorphic loci, 63 single nucleotide polymorphism (SNP) and 72 insertion-deletion (InDel), from the comparison of Z. jujuba cultivar Bokjo and Z. jujuba reference (NC_030299). The polymorphic loci could be used for the differentiation of Z. jujuba genetic resources and for breeding in the future.

B cell-mediated regulatory mechanisms control tumor-promoting intestinal inflammation.

Mechanisms underlying tumor-promoting inflammatory processes in colitis-associated colorectal cancer (CAC) remain largely elusive. Here, we provide genetic evidence for distinct B cell-mediated immunoregulatory mechanisms that protect from chronic colitis versus CAC. We demonstrate an inherent capacity of interleukin-10 (IL-10)-producing B cells to differentiate into immunoglobulin A (IgA) plasma cells (PCs) upon Toll-like receptor (TLR) activation. Our data show that B cell-derived IL-10 is essential to limit pathogenic T helper type 1 (Th1)/Th17 T cell responses during chronic colitis, while IgA PCs derived from IL-10+ B cells are being implicated in restraining tumorigenesis during CAC. Formation of a tumor-protective intestinal environment was associated with clonal expansion of specific types of colonic IgA PCs and development of an altered microbiota that attenuated CAC. We thus propose that regulatory B cell-mediated immunomodulation entails temporal release of IL-10, which is superseded by the generation of specific IgA affecting the microbial community, thereby controlling chronic inflammation and tumorigenesis in a distinctive but interrelated manner.

Associations between Mental Health and Oral Health among Korean Adolescents: Analysis of the National Surveys (2008-2017).

We aimed to analyze the trends and associations between the oral and mental health of Korean adolescents using the Korea Youth Risk Behavior Web-based Surveys. In total, 713,713 adolescents who participated in the surveys were included. To examine trends in oral and mental health, Pearson's correlation coefficients were calculated between the weighted percentages and years, and the regression line slope was assessed to estimate annual changes. A complex sample logistic regression analysis was also performed. Experiencing oral symptoms and suicide-related factors both showed a gradually decreasing trend from 2008 and slight increases in 2017 and 2016, respectively. Compared with adolescents who had no oral symptoms, those with all six oral symptoms showed an increase in suicide attempts in the last 12 months, suicide ideation, and feelings of sadness and despair. In conclusion, experiencing more oral symptoms is associated with an increased risk of suicide-related factors.

Periodontitis as a Risk Factor for Rheumatoid Arthritis: a Matched-Cohort Study.

OBJECTIVE: The intent was to analyse the association of periodontitis with the development of rheumatoid arthritis (RA) using a representative population-based cohort and longitudinal matched-cohort design. METHODS: Participants were 40 years of age or older and had not been diagnosed with RA between 2002 and 2006. Among the participants, those who were newly diagnosed with periodontitis between 2004 and 2006 (excluding cases that had already been diagnosed with periodontitis between 2002 and 2003) were allotted to the periodontitis group. Among the participants, those who had never been diagnosed with periodontitis between 2002 and 2006 formed the control group, matched by sex, age, and household income at a 1:1 ratio. From 2007 to 2018, the 2 groups (n = 691,506) were followed to monitor the development of RA. The t-test and χ2 test compared the general characteristics and health-related variables of both groups. The Kaplan-Meier method with a log-rank test was conducted to compare the incidence of RA in both groups. The hazard ratio (HR) and adjusted hazard ratio (aHR) were calculated using a Cox proportional hazard regression analysis to evaluate the risk of subsequent RA. RESULTS: Univariate analysis revealed that the periodontitis group was more likely to develop RA than the control group (hazard ratio 1.10), and multivariate analysis also revealed a higher incidence risk of RA (adjusted hazard ratio 1.09) in the periodontitis group. CONCLUSIONS: Our findings demonstrate that periodontitis is associated with an increased risk of developing RA.

Changes in Antibiotic Prescription After Tooth Extraction: A Population-Based Study from 2002 to 2018.

OBJECTIVE: Microbial resistance due to antibiotic misuse is a worldwide problem. This study aimed to examine the trends in antibiotic prescription after tooth extraction in Korea. METHODS: From the database of National Health Insurance Sharing Service, patients who underwent tooth extraction from 2002 to 2018 were selected as subjects, and 10% of them were selected via stratified sampling based on sex and age. Overall, 15,838,529 cases were observed for annual antibiotic prescription and broad-spectrum antibiotic prescription patterns. Additionally, standardized annual antibiotic use was calculated using a defined daily dose. RESULTS: Prescriptions were issued in 13,429,770 (84.8%) of the tooth extraction cases, of which 12,179,185 (90.7%) included antibiotics. Logistic regression analysis revealed that the likelihood of prescribing antibiotics after tooth extraction decreased in 2003 compared to 2002 (odds ratio, 0.95) but increased from 2004 to 2018. In the case of the broad-spectrum antibiotic prescription rate, there was no clear trend between 2002 and 2012 (odds ratio, 0.89-1.07); however, over the last 5 years, the likelihood of broad-spectrum antibiotic prescription has steadily increased. The value of antibiotics based on the defined daily dose of 1000 patients per day was calculated to be 4.39 in 2002, exhibiting a steady increase later and reaching 6.97 in 2018, whereas that of broad-spectrum antibiotics was 1.68 in 2002 and has since been on the rise; the highest was 3.82 in 2018. CONCLUSIONS: Antibiotic use after tooth extraction increased over the last 17 years; additionally, the rate of prescribing broad-spectrum antibiotics has increased over the last 5 years.

Infection control of operating room and anesthesia for cesarean section during the COVID-19 outbreak in Daegu, the Republic of Korea -a case series.

BACKGROUND: The coronavirus disease-19 (COVID-19) was first reported in Wuhan, China, with Korea being subsequently exposed. In Korea, COVID-19 screening guidelines have been established in every hospital as an attempt to prevent its spread. There has been a previous report of a successful cesarean section of a confirmed mother; however, there remain no guidelines for suspected mothers. Cesarean section is often urgently operated without sufficient infection evaluations. We would like to suggest anesthetic management guidelines for cesarean section patients suspected of COVID-19. CASE: Our hospital, which is located in Daegu, Korea, was designated as a quarantine and delivery facility for suspected mothers. We performed the cesarean section on seven suspected mothers and one confirmed mother. CONCLUSIONS: This case report presents guidelines for infection control during surgery and anesthesia for cesarean section of mothers with suspected COVID-19 involving operating room preparation and protection strategy.

Effects of Professional Oral Health Care Programs for Elderly Residents of Nursing Facilities.

Purpose: The purpose of this study was to investigate the effects of a professional oral health care program on the oral health status and salivary flow of elderly people living in nursing homes.Methods: Elderly residents aged ≥ 65 years, living in a nursing home, were randomly assigned to either a one-week interval, two-week interval, or control group, and received an oral health intervention accordingly over a period of 12 weeks. Plaque index, tongue coating, gingival index, and salivary flow rate were compared before and after the oral health intervention within and between the groups.Results: The plaque, tongue coating, and gingival indices of the participants who received the oral health intervention decreased significantly; while the salivary flow rate significantly increased. Plaque, tongue coating, and gingival indices decreased most significantly in the one-week interval group, followed by the two-week interval group, relative to the control. The salivary flow rate increased most significantly in the one-week interval group, followed by the two-week interval group.Conclusion: A professional oral health care program is effective for improving the oral health and salivation of elderly residents in nursing homes and the effect was found to be greater with interventions provided at one-week intervals. Oral health care professionals, including dentists and dental hygienists, must regularly monitor and manage the oral health of elderly residents.

Effects of lingual exercises on oral muscle strength and salivary flow rate in elderly adults: a randomized clinical trial.

AIM: The present study investigated the effects of two types of lingual exercise (tongue-hold swallowing and tongue-pressure resistance training) on oral muscle strength, salivary flow rate and subjective oral health of the elderly. METHODS: We randomly assigned 74 elderly adults (≥65 years) to three groups (tongue-hold swallowing, tongue-pressure resistance training and control groups). Each group participated in 8 weeks of their appropriately prescribed intervention. We measured anterior tongue strength, posterior tongue strength, lip strength, salivary flow rate and Oral Health Impact Profile-14 score before and after 8 weeks. Differences before and after intervention were observed with a paired sample t-test. Moreover, analyses of covariance and variance were performed to determine the differences in the measured values between the groups. RESULTS: The tongue-hold swallowing group showed improvement in both anterior and posterior tongue strength, while the tongue-pressure resistance training group showed a significant increase in only anterior tongue strength. Both the tongue-hold swallowing and tongue-pressure resistance training groups showed increased salivary secretion, with the tongue-pressure resistance training group showing a higher level of salivary secretion. However, the difference in the subjective oral health scores before and after the intervention was not significant. CONCLUSIONS: The two lingual exercises strengthened some aspects of tongue muscles and increased the salivary flow rate, with more salivary secretion in the tongue-pressure resistance training group than in the tongue-hold swallowing group. Any evidence of the lingual exercises being able to enhance subjective oral health could not be found. Geriatr Gerontol Int 2020; ••: ••-••.

Effectiveness of an oral health education programme for older adults using a workbook.

OBJECTIVE: This study investigated the effects of an oral health education programme utilising a workbook for people aged 65 years or older. MATERIALS AND METHODS: A pre-post quasi-experimental design was used to verify the effectiveness of an oral health education programme using a workbook. Oral health education was provided once a week for 5 weeks from May to June 2019. Intervention group I only received lectures on oral health education, while intervention group II reviewed the content using the workbook immediately after the lecture. Chi-square test, Fisher's exact test and a one-way analysis of variance (ANOVA) were conducted to compare differences among the three groups; a paired t test was also carried out to identify the changes before and after the programme. RESULTS: Intervention group I showed a significant increase of 3.52 on oral health knowledge and 3.47 on oral health recognition, while exhibiting a significant decrease of 0.21 on the O'Leary index and 0.69 on the tongue coating index. Intervention group II depicted a significant increase of 4.48 on oral health knowledge and 3.97 on oral health recognition and a significant decrease of 0.32 on the O'Leary index and 2.10 on the tongue coating index. CONCLUSIONS: The oral health education programme using the workbook increased knowledge and recognition of oral health and lowered the O'Leary and tongue coating indexes. Hence, the use of a workbook may facilitate the effectiveness of oral health education for older people.

Rheumatoid arthritis and periodontitis in adults: Using the Korean National Health Insurance Service-National Sample Cohort.

BACKGROUND: Using the database of the National Health Insurance Service-National Sample Cohort (NHIS-NSC), we aimed to assess the relationship between the prevalence of rheumatoid arthritis (RA) and periodontitis. METHODS: Participants aged ≥19 years with a previous health check-up at the NHIS between 2009 and 2015 were selected. In total, 559,280 participants were included after implementing appropriate exclusion criteria. The Chi-squared test was used to compare the general and health-related characteristics of participants with and without RA or periodontitis. Univariate and multivariate logistic regression analyses with consecutive adjustment for confounders, were used to assess the association between the prevalence of rheumatoid arthritis and periodontitis. RESULTS: The prevalence of rheumatoid arthritis in patients with and without periodontitis was 6.2% and 5.2%, respectively. The prevalence of periodontitis in patients with and without rheumatoid arthritis was 19.6% and 16.6%, respectively. The possibility of having rheumatoid arthritis was greater in patients with periodontitis than in individuals without periodontitis (odds ratio [OR]; 1.22, P <0.001), and remained high (OR; 1.07, P <0.001) after adjusting for confounders. CONCLUSION: Our results revealed a significant association between the prevalence of rheumatoid arthritis and periodontitis.

The impact of infection control cost reimbursement policy on central line-associated bloodstream infections.

BACKGROUND: In September 2016, the Korean National Health Insurance Service began reimbursing infection control (IC) costs on the condition that a certain number of doctors and full-time nurses for IC be allocated to supported hospitals. We analyzed the impact of the IC cost reimbursement policy on central line-associated bloodstream infections (CLABSIs). METHODS: A before-and-after study that analyzed the CLABSI rate trends between preintervention (January 2016 to February 2017) and intervention (March to December 2017) periods using autoregression time series analysis was performed in intensive care units (ICUs) at a 750-bed, secondary care hospital in Daegu, Republic of Korea. The enhanced IC team visited ICUs daily, monitored the implementation of CLABSI prevention bundles, and educated all personnel involved in catheter insertion and maintenance from March 2017. RESULTS: Autoregressive analysis revealed that the CLABSI rates per month in the preintervention and intervention periods were -0.256 (95% confidence interval, -0.613 to 0.101; P = .15) and -0.602 (95% confidence interval, -0.972 to -0.232; P = .008), respectively. The rates of compliance with maximal barrier precautions significantly improved from the preintervention (36.2%) to the intervention (77.9%) period (χ² test, P < .001). CONCLUSIONS: The IC cost reimbursement policy accelerated the decline in CLABSI rates significantly in monitored ICUs. A nationwide study to evaluate the effectiveness of the IC cost reimbursement policy for various health care-associated infections is warranted.

Association between oral health status and chronic obstructive pulmonary disease in Korean adults.

OBJECTIVES: This study aimed to elucidate the association between oral health status and chronic obstructive pulmonary disease (COPD) in Korean adults (≥ 40 years old) using a representative national dataset from the 6th Korea National Health and Nutrition Examination Survey (6th KNHANES, 2013-2015). METHODS: Participants aged ≥ 40 years from the 6th KNHANES who had received an oral and pulmonary function tests (N = 7719) were included in this study. The participant characteristics according to COPD were compared using t-test and chi-squared test. Logistic regression analysis was used to estimate the association between oral health status and COPD. RESULTS: Participants with poor periodontal status exhibited a higher prevalence of COPD. Moreover, patients with COPD had a greater number of missing teeth than those without COPD. The logistic regression model adjusted for demographic, socioeconomic, health- and oral health-related factors showed that the periodontal status was not significantly associated with COPD, while participants with more missing teeth had a significantly increased possibility of having COPD. CONCLUSIONS: This study revealed that loss of teeth in adults aged ≥ 40 years was associated with COPD.

Association of oral health and activities of daily living with cognitive impairment.

OBJECTIVES: This study compared the oral health status between elderly individuals with and without cognitive impairment and explored the association of oral health and activities of daily living (ADL) with cognitive impairment. METHODS: We conducted convenience sampling on patients aged more than 65 years and analysed data from 630 participants. Data were collected and analysed via a survey evaluating general characteristics, oral health behaviour, subjective oral health status, Oral Health Impact Profile (OHIP-14), Geriatric Oral Health Assessment Index (GOHAI) and ADL. RESULTS: The path analysis and regression analysis of the association of oral health and ADL with cognitive impairment showed that the OHIP-14 was not significantly associated with cognitive impairment, whereas the GOHAI and ADL had significant associations with cognitive impairment. A 1-point increase in the GOHAI was associated with a 0.024-point increase in the cognitive impairment score, and a 1-point increase in the ADL was associated with a 0.006-point decrease in the cognitive impairment score (normal = 0, cognitive impairment = 1). CONCLUSIONS: Poor oral health and ADL were associated with cognitive impairment. Therefore, oral hygiene management is important in maintaining oral health in elderly individuals with cognitive impairment.

Association between oral health and dementia in the elderly: a population-based study in Korea.

We have investigated the association of oral health with development of dementia in elderly Koreans. Data for subjects aged ≥65 years who underwent regular National Health Insurance Service check-ups and received dental care in 2017 were analysed. Those treated for dementia in 2017 served as the dementia group and those with no record of dementia in 2002-2017 as the control group. Explanatory variables were sex, age, household income, place of residence, smoking status, alcohol consumption, and presence of diabetes mellitus and hypertension, periodontitis, and removable dentures. Regression analysis showed that dementia was significantly more common in women than in men and in those aged ≥81 years than in those aged 65-70 years. The risk of dementia was highest in the 'upper-middle' income group and in the rural population. Smokers and those who consumed alcohol were less likely to develop dementia. Subjects with diabetes were more likely to have dementia than those without it, as were those with hypertension. Dementia was less likely in subjects with periodontitis and more likely in those with removable dentures. Therefore, loss of teeth may contribute to development of dementia.