Rural Zambian Oral Health Transition: A Long-Term Retrospective Examination of an Outreach Program's Progress and Impact.

Objective: This study aimed to (a) describe an annual prevention-focused, community-based oral health outreach program in rural Zambia, (b) assess its oral health outcomes using demographic and oral health variables, and c) identify milestones resulting from program activities. Methods: A retrospective analysis of demographic and oral health data from a single site between 2007-2014 and 2018-2019 was conducted. Demographic variables included sex and age, while clinical outcomes encompassed pain, untreated caries, and treatment urgency. Bivariate and multivariable analyses were performed, adjusting for sex and age categories. Information on community development was obtained from the Ministry of Health and local community representatives. Results: Data from 5,791 subjects were analyzed. The prevalence of pain, untreated caries, and highest treatment urgency category decreased consistently across year categories. Both bivariate and multivariable analyses showed statistically significant differences in clinical outcomes between year categories (p < 0.001). In addition, the percentage of male participants and younger age categories increased during the study period. Key program milestones included the installation of two boreholes for clean water, the development of a local community oral health volunteer program, the establishment of an educational pipeline by the Dental Training School for residents, and the construction of a maternal/oral health center with district and ministry oversight. Conclusion: The observed decrease in treatment urgency scores, presence of pain, and untreated caries are consistent with the prevention-seeking behavior of program participants. The increasing participation and changing demographic patterns over time suggest a growing demand for oral health services among males and younger individuals. The positive oral health outcomes and development of a maternal child/oral health facility exemplify a program design aligned with community needs and appropriate care delivery.

Oral health conditions and correlates: a National Oral Health Survey of Rwanda.

Background: Dental diseases are chronic, lifelong and preventable yet affect over half the world's population. Personal oral hygiene practices and socio-economic factors contribute to oral health outcomes affecting oral health quality of life. Integrating basic oral care within community level health systems increases accessibility and availability of oral health resources.Objective: National Oral Health Survey of Rwanda (NOHSR) data were investigated for associations of socio-demographic characteristics, personal oral hygiene practices, oral health outcomes, and oral health quality of life indicators.Methods: Data were analyzed and descriptive statistics calculated. Multivariable logistic regression models were developed to assess associations between untreated caries, calculus, and pain with various independent variables (demographics and personal oral hygiene practices). Additional logistic regression models examined associations between quality of life indicators and the aforementioned independent variables as well as untreated caries and pain.Results: Those who did not use a toothbrush (62.7%), or toothpaste (70.0%), and cleaned their teeth less than once per day (55.3%) had a higher prevalence of untreated caries. Approximately one-third of those in rural areas cleaned their teeth once per day or more compared to two-thirds of those in urban areas (35.4% vs. 71.2%). Those cleaning their teeth less than once daily were estimated to have 56.0% higher odds of caries than those who cleaned their teeth once a day or more (OR = 1.56, [95% CI 1.25-1.95]). Those with secondary education or higher and those with skilled jobs demonstrated more frequent teeth cleaning and higher toothbrush and toothpaste use. Quality-of-life indicators varied significantly with untreated caries and pain.Conclusion: Socio-economic, individual, and workforce characteristics are important considerations when assessing oral health outcomes. This study investigated social demographic disparities in relation to oral health related behaviors and outcomes. This information can help guide oral health care programming in Rwanda.

Dental fluorosis among people and livestock living on Gihaya Island in Lake Kivu, Rwanda.

BACKGROUND: Dental fluorosis is caused by prolonged exposure to excessive fluoride during the period of permanent tooth formation and is characterized by tooth discoloration, pitting, and loss of shape. Communities living near Lake Kivu in Western Rwanda exhibit a high prevalence of dental fluorosis; however, data on prevalence and risk factors are scarce. METHODS: This cross sectional, quantitative study used a One Health approach to investigate dental fluorosis prevalence among people and livestock and to measure fluoride content in the environment. In 2018, oral health examinations were conducted to assess the prevalence of fluorosis in children (aged 9 to 15 years), cattle and goats residing on Gihaya Island (Rwanda, East Africa). All children and cattle/goats meeting basic eligibility criteria (e.g., island residence) were invited to participate. Presence and severity of dental fluorosis was categorized according to the Dean's Fluorosis Index. Samples of local foods, water, soil and grass were collected from communal sources and individual households and analyzed for fluoride content using standard laboratory techniques. Descriptive and binomial analyses (Fisher Exact Test) were used to assess this dataset. RESULTS: Overall, 186 children and 85 livestock owners (providing data of 125 livestock -23 cattle and 102 goats) participated. Dental fluorosis was recorded in 90.7% of children and 76% of livestock. Moderate to severe fluorosis was observed in 77% children while goats and cattle most often exhibited mild or absent/questionable severity, respectively. Water from Lake Kivu (used primarily for human cooking water and livestock drinking water) contained fluoride levels that were consistently higher than the maximum threshold (1.5 mg/L) recommended by the World Health Organization. Other sources (borehole and rainwater) were within safe limits. All food, soil and grass samples contained fluoride. The highest levels were observed in porridge (0.5 mg/g) and small fishes (1.05 mg/g). CONCLUSIONS: Altogether, dental fluorosis was highly prevalent among children and goats on Gihaya Island with various food and water sources contributing a cumulative exposure to fluoride. An immediate and coordinated response across human, animal and water professionals is needed to reduce fluoride exposure within safe limits for island residents.

Correlation between muscle morphology of the transverse carpal ligament and branching pattern of the motor branch of median nerve.

PURPOSE: This was an intraoperative anatomical study to identify the prevalence of variations in the motor branch of median nerve and to correlate these with the presence of a transverse carpal ligament (TCL) with superficial or interposed muscle. METHODS: Over a period of 12 years in 1400 consecutive patients in whom the carpal tunnel was opened for any reason, observations were made in each hand to (1) determine the presence or absence of muscle fibers lying superficial to or within the TCL and (2) identify the anatomic branching patterns of the motor branch of median nerve. The primary objective was to ascertain whether the appearance of the TCL could be used to predict the anatomy of the motor branch. RESULTS: A normal motor branch arising beneath a purely ligamentous TCL was found in 1011 hands (72%). The focus of this paper is on the remaining 386 hands (28%), in which muscle fibers were found lying superficial to or within the TCL; in this group, only 29 hands (8%) had a normal motor branch. An anomalous motor branch was found in 93% of hands with a TCL with superficial or interposed muscle fibers and in less than 1% of hands with a purely ligamentous TCL. CONCLUSIONS: In exposing the carpal tunnel, special care should be taken by the surgeon to identify and protect the motor branch when muscle fibers are encountered superficial to or within the TCL.

Building oral health research infrastructure: the first national oral health survey of Rwanda.

BACKGROUND: Oral health affects quality of life and is linked to overall health. Enhanced oral health research is needed in low- and middle-income countries to develop strategies that reduce the burden of oral disease, improve oral health and inform oral health workforce and infrastructure development decisions. OBJECTIVE: To implement the first National Oral Health Survey of Rwanda to assess the oral disease burden and inform oral health promotion strategies. METHODS: In this cross-sectional study, sample size and site selection were based on the World Health Organization (WHO) Oral Health Surveys Pathfinder stratified cluster methodologies. Randomly selected 15 sites included 2 in the capital city, 2 other urban centers and 11 rural locations representing all provinces and rural/urban population distribution. A minimum of 125 individuals from each of 5 age groups were included at each site. A Computer Assisted Personal Instrument (CAPI) was developed to administer the study instrument. RESULTS: Nearly two-thirds (64.9%) of the 2097 participants had caries experience and 54.3% had untreated caries. Among adults 20 years of age and older, 32.4% had substantial oral debris and 60.0% had calculus. A majority (70.6%) had never visited an oral health provider. Quality-of-life challenges due to oral diseases/conditions including pain, difficulty chewing, self-consciousness, and difficulty participating in usual activities was reported at 63.9%, 42.2% 36.2%, 35.4% respectively. CONCLUSION: The first National Oral Health Survey of Rwanda was a collaboration of the Ministry of Health of Rwanda, the University of Rwanda Schools of Dentistry and Public Health, the Rwanda Dental Surgeons and Dental (Therapists) Associations, and Tufts University and Harvard University Schools of Dental Medicine. The international effort contributed to building oral health research capacity and resulted in a national oral health database of oral disease burden. This information is essential for developing oral disease prevention and management strategies as well as oral health workforce and infrastructure.

A readily prepared neutral heterobimetallic titanium(IV)-rhodium(I) catalyst for intramolecular hydroacylation.

The combination of HOCMe2CH2PPh2, Ti(OiPr)4, and [Rh(cod)Cl]2 (3:1:1) in either benzene or dichloromethane produces a discrete species (tentatively formulated as complex) that is an active catalyst for intramolecular hydroacylation reactions of 3-substituted pentenals.

Selective ring opening cross metathesis of cyclooctadiene and trisubstituted cycloolefins.

[reaction: see text] The selective ring opening cross metathesis of 1,5-cyclooctadiene and trisubstituted cycloolefins with acroyl species is described. The ring-opened products contain electronically differentiated olefins suitable for additional metathesis reactions. Trisubstituted cycloolefins open regioselectively, placing the acroyl cap on the less-substituted terminus.

Relationship between duration of treatment and oral health in adults with intellectual and developmental disabilities.

The purpose of this study was to evaluate how dental outcomes changed over time among subjects with intellectual and developmental disabilities (IDD) who were under treatment. This retrospective study included 107 subjects who were treated at a Tufts Dental Facilities clinic. Data from each subject were collected at three time points: initial visit, midpoint visit, and most recent visit. Generalized estimating equations were used to assess the relationship between time in treatment and several outcome variables (cooperation level, hygiene rating, presence of caries, periodontitis, dental pain, and infection). Statistically significant decreases in caries (p < .001) and increases in periodontitis (p = .002) were found over time. Associations between time and other outcome variables were not statistically significant. The prevalence of caries decreased and the prevalence of periodontitis increased over time among patients with IDDs receiving regular comprehensive dental care. Even among patients under routine maintenance, significant oral health problems remain.

Saudi and U.S. dental student attitudes toward treating individuals with developmental disabilities.

This study was conducted to compare the attitudes of senior dental students at the Faculty of Dentistry at King Abdulaziz University (KAU) in Jeddah, Saudi Arabia, and at Tufts University School of Dental Medicine (TUSDM) in Boston, Massachusetts, about providing dental care to individuals with developmental disabilities (DD). Two subsequent classes of senior dental students at both universities were surveyed using a pretested, validated, online questionnaire. The students' demographic and educational data were collected, along with information about their experience, training, and attitudes toward this population. Two hundred and fourteen students responded to the online survey, for a response rate of 35 percent (51 percent for KAU students and 21 percent for TUSDM students). Students at TUSDM had more training, more experience, and more positive attitudes toward individuals with DD compared to KAU students (p<0.05). Students who reported having previous experience with individuals with DD had more positive attitudes than students who reported no experience with these individuals (p<0.05). Students who reported being prepared to treat individuals with DD had more positive attitudes than students who reported not being prepared (p<0.05). These findings suggest an association between predoctoral education in the treatment of individuals with special needs and having positive attitudes toward providing oral health care to individuals with DD.

At-home oral care for adults with developmental disabilities: a survey of caregivers.

BACKGROUND: Little is known about effective at-home oral care methods for people with developmental disabilities (DDs) who are unable to perform personal preventive practices themselves and rely on caregivers for assistance. METHODS: A convenience sample of 808 caregivers (84.5 percent paid, 15.5 percent family members) who accompanied adults with DDs (20 years or older) to appointments at a specialized statewide dental care system completed computer-assisted personal interview surveys. The authors used these data to investigate caregivers' at-home oral care experiences and to explore differences between caregivers who were paid and those who were family members. RESULTS: Caregivers reported that a high proportion (85 percent) of dentate adults with DDs received assistance with tooth cleaning. They also reported a high prevalence of dental problems, and low adherence to brushing (79 percent) and flossing (22 percent) recommendations. More caregivers reported that they felt confident assisting with brushing than with flossing (85 percent versus 54 percent). Family members and paid caregivers differed with respect to confidence and training. CONCLUSIONS: At-home oral care, particularly flossing, presents substantial challenges for adults with DDs. Solutions must be tailored to address the different experiences and distinct needs of the family members and paid caregivers who assist these adults. PRACTICAL IMPLICATIONS: Caregivers play an important role in providing at-home oral care, and they must be included in efforts to improve oral health outcomes for people with DDs.

Formation of microvascular networks in vitro.

This protocol describes how to form a 3D cell culture with explicit, endothelialized microvessels. The approach leads to fully enclosed, perfusable vessels in a bioremodelable hydrogel (type I collagen). The protocol uses microfabrication to enable user-defined geometries of the vascular network and microfluidic perfusion to control mass transfer and hemodynamic forces. These microvascular networks (µVNs) allow for multiweek cultures of endothelial cells or cocultures with parenchymal or tissue cells in the extra-lumen space. The platform enables real-time fluorescence imaging of living engineered tissues, in situ confocal fluorescence of fixed cultures and transmission electron microscopy (TEM) imaging of histological sections. This protocol enables studies of basic vascular and blood biology, provides a model for diseases such as tumor angiogenesis or thrombosis and serves as a starting point for constructing prevascularized tissues for regenerative medicine. After one-time microfabrication steps, the system can be assembled in less than 1 d and experiments can run for weeks.

The oral health status of 4,732 adults with intellectual and developmental disabilities.

BACKGROUND: Two reports by the U.S. surgeon general noted the disproportionate impact of oral disease on and lack of oral health information regarding people with disabilities. METHODS: In this retrospective study, the authors used clinical and demographic data (from April 1, 2009, through March 31, 2010) from electronic dental records of 4,732 adults with intellectual and developmental disabilities (IDDs) who were receiving dental care through a state-supported system of dental clinics. The authors used these data to investigate the oral health status of, and associated risk factors for, adults with IDD. RESULTS: The prevalence of untreated caries in the study population was 32.2 percent, of periodontitis was 80.3 percent and of edentulism was 10.9 percent. The mean (standard deviation) numbers of decayed teeth; missing teeth; and decayed, missing and filled teeth were 1.0 (2.2), 6.7 (7.0) and 13.9 (7.7), respectively. CONCLUSIONS: Management of oral health presents significant challenges in adults with IDD. Age, ability to cooperate with dental treatment and type of residence are important considerations in identifying preventive strategies. CLINICAL IMPLICATIONS: The study population demonstrated a high burden of dental disease. Further research is required to identify effective interventions to improve oral health in adults with IDD.

"Matched/mismatched" diastereomeric dirhodium(II) carboxamidate catalyst pairs. Structure-selectivity correlations in diazo decomposition and hetero-Diels-Alder reactions.

Homo-ligated dirhodium(II) carboxamidates provide well-defined structural frameworks with which to investigate catalyst-controlled multiple asymmetric induction ("match/mismatch" effects). Diastereomeric pairs of methyl 2-oxoimidazolidine-4(S)-carboxylate ligands containing 2-phenylcyclopropane (4S,2'S,3'S-HMCPIM and 4S,2'R,3'R-HMCPIM) and N-benzenesulfonylproline (4S,2'S-HBSPIM and 4S,2'R-HBSPIM) attachments at the 1-N-acyl site have been prepared; the resulting (cis-2,2)-Rh(2)L(4) compounds have been produced in good yields, and the X-ray crystal structure of each dirhodium(II) compound has been obtained. The incorporation of additional stereocenters into the dirhodium(II) ligands leads to recognizable levels of double asymmetric induction for C-H insertion, cyclopropanation, and hetero-Diels-Alder cycloaddition applications. The configurationally "matched" cases provide modest increases in enantioselectivity for intramolecular C-H insertion reactions relative to the model catalyst Rh(2)(MPPIM)(4), but applications of the configurationally mismatched catalysts result in significant lowering of enantioselectivity. The Rh(2)(BSPIM)(4) catalysts show the highest degree of differential selectivity. Hetero-Diels-Alder reactions show inverse behavior from the configurationally matched and mismatched Rh(2)L(4) catalysts to that found in the metal carbene transformations.

Synthesis and activity of ruthenium alkylidene complexes coordinated with phosphine and N-heterocyclic carbene ligands.

This paper reports the synthesis and characterization of a variety of ruthenium complexes coordinated with phosphine and N-heterocyclic carbene (NHC) ligands. These complexes include several alkylidene derivatives of the general formula (NHC)(PR(3))(Cl)(2)Ru=CHR', which are highly active olefin metathesis catalysts. Although these catalysts can be prepared adequately by the reaction of bis(phosphine) ruthenium alkylidene precursors with free NHCs, we have developed an alternative route that employs NHC-alcohol or -chloroform adducts as "protected" forms of the NHC ligands. This route is advantageous because NHC adducts are easier to handle than their free carbene counterparts. We also demonstrate that sterically bulky bis(NHC) complexes can be made by reaction of the pyridine-coordinated precursor (NHC)(py)(2)(Cl)(2)Ru=CHPh with free NHCs or NHC adducts. Two crystal structures are presented, one of the mixed bis(NHC) derivative (H(2)IMes)(IMes)(Cl)(2)Ru=CHPh, and the other of (PCy(3))(Cl)(CO)Ru[eta(2)-(CH(2)-C(6)H(2)Me(2))(N(2)C(3)H(4))(C(6)H(2)Me(3))], the product of ortho methyl C-H bond activation. Other side reactions encountered during the synthesis of new ruthenium alkylidene complexes include the formation of hydrido-carbonyl-chloride derivatives in the presence of primary alcohols and the deprotonation of ruthenium vinylcarbene ligands by KOBu(t). We also evaluate the olefin metathesis activity of NHC-coordinated complexes in representative RCM and ROMP reactions.