Recommendations by the Spanish Society of Epidemiology and Oral Public Health (SESPO) for the healthcare adaptation of public health dental clinics in Spain during the COVID-19 pandemic.

BACKGROUND: In March 2020, the World Health Organization (WHO) declared the COVID-19 pandemic and, a few days later, the Spanish Government declared a State of Emergency and the population lockdown. This crisis situation crisis forced deep changes in health care. At dental care level, it became necessary for both public health services and private consultations to plan changes to enable them to face this healthcare challenge. MATERIAL AND METHODS: SESPO and the General Council of Dentists of Spain (CGDE) appointed a Working Group to prepare a protocol for dental clinics after the lockdown stage. Continuing with this teamwork task, a series of recommendations addressed to public health managers and the dental workforce were agreed, according to the COVID-19 protection protocols, with the evidence available at the time of their preparation. RESULTS: The SESPO Working Group prepared a schedule with recommendations to be taken. The CGDE presented this document to the Ministry of Health, Consumption and Social Welfare, and SESPO emailed it to all the Health Councils of the autonomous regions. The document was also uploaded to the CGDE and SESPO websites and was emailed to all SESPO associated members. CONCLUSIONS: Keeping in mind the existing territorial variation, both at the organization level of dental public health services, and at the care level (especially in child preventive programs and care for pregnant women), this health crisis has highlighted the importance of teamwork. It is necessary to unify the standards for all dental health care units in the national territory in challenging times. Key words:COVID-19, Dental public health, dental care, dentistry, primary care, infection, SARS-CoV-2.

Real-time three-dimensional transoesophageal echocardiography in the assessment of aortic valve stenosis.

AIMS: To determine the feasibility of real-time three-dimensional transoesophageal echocardiography (3D-TOE) in the evaluation of aortic valve stenosis, to study its reliability, and to test the concordance of this new method when compared with transthoracic two-dimensional echocardiography (2D-TTE) as the diagnostic standard. METHODS AND RESULTS: Fifty-nine consecutive patients with moderate-to-severe aortic valve stenosis were assessed by means of 2D-TTE and 3D-TOE by independent blinded observers. Aortic valve planimetry was possible in 94.9% of patients. Inter-observer intraclass correlation coefficients (ICC) were 0.892 (CI 95% 0.818-0.936; P < 0.001), and 0.871 (CI 95% 0.780-0.925; P < 0.001) for 2D-TTE and 3D-TOE, respectively. Bland-Altman plot showed a mean difference in aortic valve area (AVA) of 0.040 cm(2), with 2D-TTE yielding larger values than 3D-TOE. ICC of both methods was 0.724 (CI 95% 0.530-0.839; P < 0.001). CONCLUSION: Assessment of AVA by means of 3D-TOE is feasible in most patients with aortic valve stenosis. Reliability of the measurement is good. However, there is some disagreement with standard 2D-TTE that needs further investigation.