Advancing Universal Oral Health Coverage via Person-Centred Outcomes.

The World Health Organization member states proposed a comprehensive "Global Strategy on Oral Health," which includes achieving universal oral health coverage by 2030. Challenges and barriers, including persistent inequalities, will hamper the achievement of universal oral health coverage. In low- and middle-income countries, the oral health of a large proportion of the population has been neglected, increasing oral health inequalities. In high-income countries, some receive excessive dental treatment, whilst particularly those with higher needs receive too little dental care. Therefore, an analysis of individual countries' needs, encompassing the training of oral health professionals in a new philosophy of care and attention and the optimisation of the existing resources, is necessary. Distancing from a person-centred focus has prompted individual and societal issues, including under-/overdiagnosis and under-/overtreatment. The person-centred approach considers the perceptions, needs, preferences, and circumstances of individuals and populations. Patient-reported outcome measures, such as self-rated and -reported health, reflect an individual's overall perception of health and are designed to mediate human biology (ie, the disease) and psychology. The usage of patient-reported outcome measures in dentistry to place the individual at the centre of treatment is delayed compared to other areas. This paper discusses some challenges and potential solutions of patient-reported outcome measures in dentistry for achieving universal oral health coverage.

Preclinical dental students self-assessment of an improved operative dentistry virtual reality simulator with haptic feedback.

To test and evaluate the second installment of DENTIFY, a virtual reality haptic simulator for Operative Dentistry (OD), on preclinical dental students, by focusing on user performance and self-assessment. Twenty voluntary unpaid preclinical dental students, with different background experience, were enrolled for this study. After the completion of an informed consent, a demographic questionnaire, and being introduced to the prototype (on the first testing session), three testing sessions followed (S1, S2, S3). Each session involved the following steps: (I) free experimentation; (II) task execution; S3 also included (III) completion of questionnaires associated with the experiment (total of 8 Self-Assessment Questions (SAQ)); and (IV) guided interview. As expected, drill time decreased steadily for all tasks when increasing prototype use, verified by RM ANOVA. Regarding performance metrics (Comparisons by Student's t-test and ANOVA) recorded at S3, in overall, a higher performance was verified for participants with the following characteristics: female, non-gamer, no previous VR experience and with over 2 semesters of previous experience of working on phantom models. The correlation between the participants' performance (drill time), for the four tasks, and user self-assessment evaluation, verified by Spearman's rho analysis, allowed to conclude that a higher performance was observed in students who responded that DENTIFY improved their self perception of manual force applied. Regarding the questionnaires, Spearman's rho analysis showed a positive correlation between the improvement DENTIFY inputs on conventional teaching sensed by students, also enhancing their interest in learning OD, their desire to have more simulator hours and the improvement sensed on manual dexterity. All participating students adhered well to the DENTIFY experimentation. DENTIFY allows for student self-assessment and contributes to improving student performance. Simulators with VR and haptic pens for teaching in OD should be designed as a consistent and gradual teaching strategy, allowing multiplicity of simulated scenarios, bimanual manipulation, and the possibility of real-time feedback to allow for the student's immediate self-assessment. Additionally, they should create performance reports per student to ensure self-perception/criticism of their evolution over longer periods of learning time.

Economic burden of periodontitis in the United States and Europe: An updated estimation.

BACKGROUND: The aim of this study is to estimate the direct and indirect economic burdens of periodontal disease in the US and in Europe. METHODS: We used the most recent data available for the US and for Europe (32 European countries) to estimate the cost of periodontal disease. Global health, dental and periodontal expenditures were estimated. We tried to estimate the direct and the indirect costs of periodontitis. Indirect costs, those related to productivity losses, are a consequence of periodontal disease proper, plus edentulism and caries because of periodontal disease. RESULTS: In 2018, the aggregate cost in the US was estimated at $3.49B and €2.52B in Europe. Indirect costs because of periodontal disease amounted to $150.57B (95% confidence interval [CI]: 103.32-189.87) in the US countries and €156.12B (95% CI: 123.72-221.86) in Europe. The majority of the projected indirect costs were because of edentulism related to periodontal disease and periodontal disease. Indirect costs were the majority of the estimated economic impact with an average of 0.73% (95% CI: 0.50%-0.93%) of annual gross domestic product in the US and 0.99% (95% CI: 0.78%-1.40%) in Europe. CONCLUSIONS: Periodontal disease caused an estimated loss of $154.06B in the US and €158.64B in Europe, in 2018. These results show that the economic burden of periodontal disease is significant and its indirect costs are impactful.

Early Tooth Loss after Periodontal Diagnosis: Development and Validation of a Clinical Decision Model.

The aim of this study was to develop and validate a predictive early tooth loss multivariable model for periodontitis patients before periodontal treatment. A total of 544 patients seeking periodontal care at the university dental hospital were enrolled in the study. Teeth extracted after periodontal diagnosis and due to periodontal reasons were recorded. Clinical and sociodemographic variables were analyzed, considering the risk of short-term tooth loss. This study followed the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guidelines for development and validation, with two cohorts considered as follows: 455 patients in the development phase and 99 in the validation phase. As a result, it was possible to compute a predictive model based on tooth type and clinical attachment loss. The model explained 25.3% of the total variability and correctly ranked 98.9% of the cases. The final reduced model area under the curve (AUC) was 0.809 (95% confidence interval (95% CI): 0.629-0.989) for the validation sample and 0.920 (95% CI: 0.891-0.950) for the development cohort. The established model presented adequate prediction potential of early tooth loss due to periodontitis. This model may have clinical and epidemiologic relevance towards the prediction of tooth loss burden.

A large self-transmissible resistance plasmid from Nigeria contains genes that ameliorate a carrying cost.

Antimicrobial resistance is rapidly expanding, in a large part due to mobile genetic elements. We screened 94 fecal fluoroquinolone-resistant Escherichia coli isolates from Nigeria for six plasmid-mediated quinolone resistance (PMQR) genes. Sixteen isolates harbored at least one of the PMQR genes and four were positive for aac-6-Ib-cr. In one strain, aac-6-Ib-cr was mapped to a 125 Kb self-transmissible IncFII plasmid, pMB2, which also bears blaCTX-M-15, seven other functional resistance genes and multiple resistance pseudogenes. Laboratory strains carrying pMB2 grew faster than isogenic strains lacking the plasmid in both rich and minimal media. We excised a 32 Kb fragment containing transporter genes and several open-reading frames of unknown function. The resulting 93 Kb mini-plasmid conferred slower growth rates and lower fitness than wildtype pMB2. Trans-complementing the deletion with the cloned sitABCD genes confirmed that they accounted for the growth advantage conferred by pMB2 in iron-depleted media. pMB2 is a large plasmid with a flexible resistance region that contains loci that can account for evolutionary success in the absence of antimicrobials. Ancillary functions conferred by resistance plasmids can mediate their retention and transmissibility, worsening the trajectory for antimicrobial resistance and potentially circumventing efforts to contain resistance through restricted use.

[History of medicine in the Amazon region. Disappearance of the shaman and Christianization of healing rituals among the tariano Indians, at the urban outskirts of Manaus]. / Histoire de la médecine en Amazonas. Disparition du chamane et christianisation des rites de guérison chez les indiens tariano, a la périphérie urbaine de Manaus.

A brief history of medicine in Amazonas: the end of shamanism and the progressive Christianisation of therapeutical rites among the Tarianos, in the suburbs of Manaus.

Comunidade sateré-mawé Y'Apyrehyt: ritual e saúde na periferia urbana de Manaus / The Sateré-Mawé community of Y'Apyrehyt: ritual and health on the urban outskirts of Manaus

A comunidade Y'Apyrehyt, uma das três comunidades da etnia Sateré-mawé, na periferia de Manaus, está assentada no antigo Parque das Seringueiras. A comunidade é composta por 67 pessoas, entre adultos e crianças, que sobrevivem dos rendimentos advindos dos turistas que pagam para ver o Ritual da Tucandeira e da venda de artesanato. Mesmo com o puratin ou poratig, o Remo Mágico fincado na entrada da comunidade, somente o Ritual da Tucandeira mantém-se vivo. O processo de ressignificação desse ritual assumiu também caráter estético de coreografia artística e objeto para troca econômica.

The Y'Apyrehyt community, one of three belonging to the Sateré-Mawé indigenous people found on the outskirts of Manaus, is located in a former nature reserve, the Parque das Seringueiras. The community comprises 67 people, adults and children, who live from the income obtained from tourists paying to see the Tucandeira Ant Ritual and from the sale of craftwork. Even with the Magic Oar - the puratin or poratig - displayed at the entrance to the community, only the Tucandeira Ant Ritual remains alive today. The process of attributing new meanings to this ritual has involved both an aesthetic dimension, evinced in its artistic choreography, and its commercialization.

Pajé: reconstrução e sobrevivência / Pajé: reconstruction and survival

Entre os séculos XVI e XVIII assinalou-se, no litoral brasileiro e na Amazônia, a presença dos pajés na solução dos problemas, nos quais a cura das doenças era apenas um dos itens. As leis coloniais foram feitas para que a conquista fosse legalizada, e desde os primeiros contatos mais duradouros, missionários e colonos identificaram o pajé como importante empecilho às mudanças propostas. Assim, os poderes eclesiástico e laico investiram, tanto na Colônia como no Império e na República, para a destruição física e moral dos pajés. As transformações étnicas e lingüísticas que determinaram o desaparecimento de centenas de línguas continuam dificultando uma melhor caracterização do pajé. Sob a influência dos especialistas europeus, ele tem sido confundido com o xamã asiático. Mas o pajé se reconstruiu e sobreviveu. Especificamente no alto rio Negro, apesar de a presença dos missionários salesianos ter provocado violentas transformações, ainda hoje os pajés continuam exercendo os seus poderes.

On the Brazilian coast and in the Amazon, pajés played a role in the resolution of problems from the sixteenth through eighteenth centuries, although curing diseases was only one of their functions. Colonial laws were designed to ensure the legitimacy of the conquest, and right from their earliest long-term contacts with the natives, missionaries and settlers saw the pajés as major roadblocks to proposed changes. Therefore, from the times of the colony through the empire and the republic, ecclesiastic and lay leaders worked together to bring about the physical and moral downfall of the pajés. The ethnic and linguistic changes that wiped out hundreds of languages have always hampered efforts to characterize the figure of the pajé in clear terms. With European specialists making their influence felt, pajés have been confused with Asian shamans. But the pajé has reconstructed himself and survived. Despite the violent transformations caused by Salesian missionaries in the upper Negro River area, pajés there continue exercising their powers even today.