Key lifestyles and health outcomes across 16 prevalent chronic diseases: A network analysis of an international observational study.

Background: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements. Methods: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test. Findings: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05). Conclusion: To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies.

Patient safety climate research in primary care dentistry: A systematic scoping review.

BACKGROUND: Patient safety climate constitutes an important element for quality improvement. Its current evidence base has been generated in hospital settings in developed countries. Studies in dentistry are limited. OBJECTIVE: To systematically explore the evidence regarding assessing patient safety climate in dentistry. METHODS: We developed a search strategy to explore MEDLINE, SCOPUS, and Web of Science databases from January 1st, 2002, to December 31st, 2022, to include observational studies on patient safety culture or patient safety climate assessment. Methodological features and item data concerning the dimensions employed for assessment were extracted and thematically analyzed. Reported scores were also collected. RESULTS: Nine articles out of 5584 were included in this study. Most studies were generated from high-income economies. Our analysis revealed methodological variations. Non-randomized samples were employed (ranging from 139 to 656 participants), and response rates varied from 28% to 93.7%. Three types of measurement instruments have been adapted to assess patient safety climate. These mainly consisted of replacing words or rewording sentences. Only one study employed an instrument previously validated through psychometric methods. In general, patient safety climate levels were either low or neutral. Only one study reported scores equal to or greater than 75. DISCUSSION: Despite diverse assessment tools, our two-decade analysis reveals a lag compared with medicine, resulting in methodological variations for assessing patient safety climate. Collaboration is vital to elevate standards, prioritize patient safety across oral healthcare services, and advocate for integrating safety climate into local and national quality and patient safety strategies.

Key lifestyles and interim health outcomes for effective interventions in general populations: A network analysis of a large international observational study.

Background: The interconnected nature of lifestyles and interim health outcomes implies the presence of the central lifestyle, central interim health outcome and bridge lifestyle, which are yet to be determined. Modifying these factors holds immense potential for substantial positive changes across all aspects of health and lifestyles. We aimed to identify these factors from a pool of 18 lifestyle factors and 13 interim health outcomes while investigating potential gender and occupation differences. Methods: An international cross-sectional study was conducted in 30 countries across six World Health Organization regions from July 2020 to August 2021, with 16 512 adults self-reporting changes in 18 lifestyle factors and 13 interim health outcomes since the pandemic. Results: Three networks were computed and tested. The central variables decided by the expected influence centrality were consumption of fruits and vegetables (centrality = 0.98) jointly with less sugary drinks (centrality = 0.93) in the lifestyles network; and quality of life (centrality = 1.00) co-dominant (centrality = 1.00) with less emotional distress in the interim health outcomes network. The overall amount of exercise had the highest bridge expected influence centrality in the bridge network (centrality = 0.51). No significant differences were found in the network global strength or the centrality of the aforementioned key variables within each network between males and females or health workers and non-health workers (all P-values >0.05 after Holm-Bonferroni correction). Conclusions: Consumption of fruits and vegetables, sugary drinks, quality of life, emotional distress, and the overall amount of exercise are key intervention components for improving overall lifestyle, overall health and overall health via lifestyle in the general population, respectively. Although modifications are needed for all aspects of lifestyle and interim health outcomes, a larger allocation of resources and more intensive interventions were recommended for these key variables to produce the most cost-effective improvements in lifestyles and health, regardless of gender or occupation.

Global impacts of COVID-19 on lifestyles and health and preparation preferences: An international survey of 30 countries.

Background: The health area being greatest impacted by coronavirus disease 2019 (COVID-19) and residents' perspective to better prepare for future pandemic remain unknown. We aimed to assess and make cross-country and cross-region comparisons of the global impacts of COVID-19 and preparation preferences of pandemic. Methods: We recruited adults in 30 countries covering all World Health Organization (WHO) regions from July 2020 to August 2021. 5 Likert-point scales were used to measure their perceived change in 32 aspects due to COVID-19 (-2 = substantially reduced to 2 = substantially increased) and perceived importance of 13 preparations (1 = not important to 5 = extremely important). Samples were stratified by age and gender in the corresponding countries. Multidimensional preference analysis displays disparities between 30 countries, WHO regions, economic development levels, and COVID-19 severity levels. Results: 16 512 adults participated, with 10 351 females. Among 32 aspects of impact, the most affected were having a meal at home (mean (m) = 0.84, standard error (SE) = 0.01), cooking at home (m = 0.78, SE = 0.01), social activities (m = -0.68, SE = 0.01), duration of screen time (m = 0.67, SE = 0.01), and duration of sitting (m = 0.59, SE = 0.01). Alcohol (m = -0.36, SE = 0.01) and tobacco (m = -0.38, SE = 0.01) consumption declined moderately. Among 13 preparations, respondents rated medicine delivery (m = 3.50, SE = 0.01), getting prescribed medicine in a hospital visit / follow-up in a community pharmacy (m = 3.37, SE = 0.01), and online shopping (m = 3.33, SE = 0.02) as the most important. The multidimensional preference analysis showed the European Region, Region of the Americas, Western Pacific Region and countries with a high-income level or medium to high COVID-19 severity were more adversely impacted on sitting and screen time duration and social activities, whereas other regions and countries experienced more cooking and eating at home. Countries with a high-income level or medium to high COVID-19 severity reported higher perceived mental burden and emotional distress. Except for low- and lower-middle-income countries, medicine delivery was always prioritised. Conclusions: Global increasing sitting and screen time and limiting social activities deserve as much attention as mental health. Besides, the pandemic has ushered in a notable enhancement in lifestyle of home cooking and eating, while simultaneously reducing the consumption of tobacco and alcohol. A health care system and technological infrastructure that facilitate medicine delivery, medicine prescription, and online shopping are priorities for coping with future pandemics.

Opinión de los estudiantes de odontología de la FES Iztacala UNAM, sobre el proceso de evaluación a distancia antes de la pandemia por COVID-19: estudio transversal / Opinion of dental students at FES Iztacala UNAM on the distance evaluation process before the COVID-19 pandemic: a cross-sectional study

Introducción: El proceso de evaluación a distancia es una modalidad que ha sido utilizada en los últimos años. Sin embargo, la pandemia por COVID-19 ha ocasionado su rápida adaptación. El personal docente ha reportado las ventajas de este modo de evaluación; no obstante, la opinión de los estudiantes de odontología en torno a las ventajas y desventajas de esta modalidad no ha sido explorada. Objetivo: Explorar las ventajas y desventajas de las tecnologías de la información y comunicación (TIC), específicamente en el proceso de evaluación a distancia reportadas por estudiantes de odontología. Material y métodos: Se realizó un estudio transversal retrospectivo, en una muestra no aleatoria de 310 estudiantes de tercer año, distribuidos en cuatro generaciones, adscritos a la Facultad de Odontología de la FES Iztacala. Se administró un cuestionario estructurado para la medición de sus opiniones en torno a las evaluaciones a distancia. Se realizó un análisis descriptivo y bivariado. Resultados: De un total de los 382 estudiantes potencialmente elegibles, 310 aceptaron participar (96%). Conclusiones: La opinión mayoritaria fue la preferencia a los exámenes por Internet y mejor a distancia. Queda pendiente la duda: ¿cuál será el comportamiento cuando los estudios profesionales vuelvan a la normalidad después de la pandemia COVID-19? (AU)

Introduction: The process of distance assessment has been employed in the last years. However, COVID-19 pandemic has accelerated its adoption. Academic personnel have previously reported the benefits of this mode of assessments. Nevertheless, dentistry-students' opinions around the advantages and disadvantages of this mode of assessment has not been explored. Objective: Explore the advantages and disadvantages concerning the ICT skills specifically about the process of distance assessment of dental students. Material and methods: A retrospective cross-sectional study was conducted in a non-randomized sample of 310 of third-year students distributed in four years attending to the School of Dentistry at FES Iztacala. A structured questionnaire was distributed to measure students' opinions around the advantages and disadvantages of distance assessments. A descriptive and bivariate analysis was conducted. Results: Questionnaires were returned by 310 students (96% response rate). Conclusion: Students' perceptions of their ICT skills has increased, matched by better equipment and greater appreciation of e-learning (AU)

Patient Safety Incidents in Primary Care Dentistry in England and Wales: A Mixed-Methods Study.

BACKGROUND: In recent decades, there has been considerable international attention aimed at improving the safety of hospital care, and more recently, this attention has broadened to include primary medical care. In contrast, the safety profile of primary care dentistry remains poorly characterized. OBJECTIVES: We aimed to describe the types of primary care dental patient safety incidents reported within a national incident reporting database and understand their contributory factors and consequences. METHODS: We undertook a cross-sectional mixed-methods study, which involved analysis of a weighted randomized sample of the most severe incident reports from primary care dentistry submitted to England and Wales' National Reporting and Learning System. Drawing on a conceptual literature-derived model of patient safety threats that we previously developed, we developed coding frameworks to describe and conduct thematic analysis of free text incident reports and determine the relationship between incident types, contributory factors, and outcomes. RESULTS: Of 2000 reports sampled, 1456 were eligible for analysis. Sixty types of incidents were identified and organized across preoperative (40.3%, n = 587), intraoperative (56.1%, n = 817), and postoperative (3.6%, n = 52) stages. The main sources of unsafe care were delays in treatment (344/1456, 23.6%), procedural errors (excluding wrong-tooth extraction) (227/1456; 15.6%), medication-related adverse incidents (161/1456, 11.1%), equipment failure (90/1456, 6.2%) and x-ray related errors (87/1456, 6.0%). Of all incidents that resulted in a harmful outcome (n = 77, 5.3%), more than half were due to wrong tooth extractions (37/77, 48.1%) mainly resulting from distraction of the dentist. As a result of this type of incident, 34 of the 37 patients (91.9%) examined required further unnecessary procedures. CONCLUSIONS: Flaws in administrative processes need improvement because they are the main cause for patients experiencing delays in receiving treatment. Checklists and standardization of clinical procedures have the potential to reduce procedural errors and avoid overuse of services. Wrong-tooth extractions should be addressed through focused research initiatives and encouraging policy development to mandate learning from serious dental errors like never events.

Patient Safety Incidents and Adverse Events in Ambulatory Dental Care: A Systematic Scoping Review.

BACKGROUND: There have been efforts to understand the epidemiology of iatrogenic harm in hospitals and primary care and to improve the safety of care provision. There has in contrast been very limited progress in relation to the safety of ambulatory dental care. OBJECTIVES: To provide a comprehensive overview of the range and frequencies of existing evidence on patient safety incidents and adverse events in ambulatory dentistry. METHODS: We searched MEDLINE and EMBASE for articles reporting events that could have or did result in unnecessary harm in ambulatory dental care. We extracted and synthesized data on the types and frequencies of patient safety incidents and adverse events. RESULTS: Forty articles were included. We found that the frequencies varied very widely between studies; this reflected differences in definitions, populations studied, and sampling strategies. The main 5 PSIs we identified were errors in diagnosis and examination, treatment planning, communication, procedural errors, and the accidental ingestion or inhalation of foreign objects. However, little attention was paid to wider organizational issues. CONCLUSIONS: Patient safety research in dentistry is immature because current evidence cannot provide reliable estimates on the frequency of patient safety incidents in ambulatory dental care or the associated disease burden. Well-designed epidemiological investigations are needed that also investigate contributory factors.

Día del Dentista, según la cosmovisión maya / Day of the dentist, according to the Mayan cosmovision

El día del odontólogo tradicionalmente se festeja el 9 de febrero, en conmemoración a Santa Apolonia, quien el 9 de febrero del año 248 d.C., por no renunciar a su fe cristiana, es martirizada quitándole los dientes. Sin embargo, existe una historia de origen maya, escrita en el Popol Vuh, la de Vucub Caquix, ave mítica antropomorfa, a quien se le extraen los dientes. Este hecho acontece antes de la creación del mundo, el 13 de agosto del año 3114 a.C. Este hallazgo surge al relacionar el Popol Vuh con las imágenes representadas en la vasija maya K 1226, la estela 25 de Izapa y las inscripciones de la estela de Cobá, Quintana Roo. Por lo anterior, proponemos que este acontecimiento podría tomarse en cuenta para conmemorar en México el día del dentista el 13 de agosto, puesto que ello sería una forma de revalorar y reafirmar nuestra identidad prehispánica (AU)

The dentist's day is traditionally celebrated on February 9, in commemoration of Santa Apolonia, who on February 9 of the year 248 AD, for not giving up her Christian faith, is martyred by taking her teeth. However, there is a story of Mayan origin, written in Popol Vuh, that of Vucub Caquix, a mythical anthropomorphic bird, whose teeth are extracted. This fact occurs before the creation of the world, on August 13, 3114 BC. This finding arises when the Popol Vuh is related to the images represented in the Mayan vessel K 1226, stela 25 of Izapa and the inscriptions of the stela de Cobá, Quintana Roo. Therefore, we propose that this event could be taken into account to commemorate August 13, as the day of the dentist, as a way to revalue and reaffirm our pre-Hispanic identity (AU)

Ferritin, metabolic syndrome and its components: A systematic review and meta-analysis.

BACKGROUND AND AIMS: Mechanisms for the association between iron stores and risk factors for diabetes and cardiovascular disease, such as metabolic syndrome (MetS) and its components, are still not clear. We evaluated the associations between ferritin levels, MetS and its individual components, and potential role of confounding, in a meta-analysis. METHODS: We searched articles in MEDLINE and EMBASE until February 14th, 2018. There were two approaches: meta-analysis of 1) cross-sectional and longitudinal studies and 2) only cross-sectional studies. Meta-regressions were conducted to identify sources of heterogeneity in the associations of ferritin with MetS and its individual components. RESULTS: Information from 26 studies (5 prospective) was systematically reviewed and 21 studies were meta-analysed. The pooled OR for MetS by increased ferritin was 1.78 (95%CI: 1.60-1.97) in the meta-analysis 1, and 1.70 (95%CI: 1.49-1.95) in the meta-analysis 2. The pooled association was weaker in studies adjusted for hepatic injury markers (meta-regression coefficient (95% CI): -0.34 (-0.60,-0.09) p = 0.008) and body mass index (BMI) (meta-regression coefficient (95% CI): -0.27 (-0.53,-0.01) p = 0.039). Among MetS components, the pooled association with increased ferritin was strongest with high triglycerides [OR (95%CI): 1.96 (1.65-2.32)] and high glucose levels [OR 95%CI: 1.60 (1.40-1.82)]. Higher cut-off points used to define high ferritin concentrations were more strongly associated with high triglycerides [meta-regression coefficient (95% CI): 0.22 (0.03, 0.041), p = 0.023]. CONCLUSIONS: High triglycerides and glucose are the components more strongly associated with ferritin. Hepatic injury and BMI appear to influence the ferritin-MetS association, and a threshold effect of high ferritin concentration on the ferritin-high triglycerides association was observed.

Oral health workforce planning part 2: figures, determinants and trends in a sample of World Dental Federation member countries.

BACKGROUND AND AIM: A range of factors needs to be taken into account for an ideal oral health workforce plan. The figures related to dentists, specialists, auxiliaries, practice patterns, undergraduate and continuing dental education, laws/regulations, the attitudes of oral health-care providers and the general trends affecting the practice patterns, work conditions and preferences of oral health-care providers are among such determinants. Thus, the aim of the present study was to gather such information from a sample of World Dental Federation (FDI) member countries with different characteristics. METHODS: A cross-sectional survey study was carried out among a sample of FDI member countries between March 2, 2012 and March 27, 2012. A questionnaire was developed addressing some main determinants of oral health workforce, such as its structure, involvement of the public/private sector to provide oral health-care services, specialty services, dental schools, trends in workforce and compliance with oral health needs, and a descriptive analysis was performed. The countries were classified as developed and developing countries and Mann-Whitney U-tests and chi-square tests were used to identify potential significant differences (P > 0.05) between developed and developing countries. All data were processed in SPSS v.19. RESULTS: In the18 questionnaires processed, the median number of dentists (P = 0.005), dental practices (P = 0.002), hygienists (P = 0.005), technicians (P = 0.013) and graduates per year (P = 0.037) was higher in developed countries. Only 12.5% of developed and 22.2% of developing countries reported having optimal number of graduates per year. It was noted that 66.7% of developing countries had more regions lacking enough dentists to meet the demand (P = 0.050) and 77.8% lacked the necessary specialist care (P = 0.015). Although developing countries reported mostly an oversupply of dentists, regardless of the level of development most countries did not report an oversupply of specialists. Most developed countries did not feel that their regulations (87.5%) complied with the needs and demands of the population and most developing countries did not feel that their undergraduate dental education (62.5%) complied. Migrating to other countries was a trend seen in developing countries, while, despite increased numbers of dentists, underserved areas and communities were reported. DISCUSSION: The cross-sectional survey study suggests that figures related to optimum or ideal oral health workforce and fair distribution of the available workforce does not seem to be achieved in many parts of the world. Further attention also needs to be dedicated to general trends that have the capacity to affect future oral health workforce.

Oral health workforce planning. Part 1: Data available in a sample of FDI member countries.

BACKGROUND & AIM: Workforce planning is a resource to measure and compare current versus future workforce. Organised dentistry needs to focus on the benefits and the determinants and various systems of workforce planning together with the challenges, new trends and threats. The aim of the study was to identify data sources from countries relating to a selection of oral health indicators in a sample of FDI member countries. The potential for differences between developed and developing countries was also examined. METHODS: A cross-sectional survey study was carried out among FDI member countries classified in developed and developing countries between October 2011 and January/February 2012. A questionnaire was developed addressing the availability of 40 selected indicators distributed in four domains. Mann-Whitney U-tests to identify differences between developed and developing countries and chi-square tests for the degree of information regularly available were carried out. RESULTS: There is an important lack of information about indicators relevant to oral health between FDI participating countries regardless of their level of economic development. Although not significant, the availability of indicators for developing countries showed higher variability and minimum values of zero for all domains. Surveys were the source of information more frequently reported. DISCUSSION: Standardised and reliable methodologies are needed to gather information for successful workforce planning. It is of utmost importance to increase the awareness and understanding of the member National Dental Associations regarding the role, basic elements, benefits, challenges, models and critical elements of an ideal workforce planning system.

Estudio clínico comparativo entre articaína y lidocaína / A clinical comparative study between articaine and lidocaine

El propósito de este estudio fue comparar el efecto anestésico entre la lidocaína y el clorhidrato de articaína. Hipótesis: el clorhidrato de articaína tiene mejor efecto anestésico. Materiales y métodos: cartuchos comerciales de lidocaína (xylocaína) y articaína (medicaína) fueron usados para algunos procedimientos en pacientes sanos. La edad fue de 18 a 30 años, con una media de 26 años. Solamente un cartucho de anestesia fue utilizado por procedimiento por el mismo operador. Fue registrada la información sobre tiempo de latencia, duración de la anestesia, así como el grado de dolor obtenido por el paciente. Resultados: mayor eficacia del clorhidrato de articaína sobre la lidocaína con mayor tiempo de duración, bien tolerada por los pacientes y con reportes al dentista de ausencia de dolor. Conclusión: el clorhidrato de articaína tiene algunas ventajas sobre la lidocaína en relación al control de dolor y menor tiempo operatorio