Persistence of gender biases in Europe.

Prior work suggests that modern gender bias might have historical roots but has not been able to demonstrate long-term persistence of this bias due to a lack of historical data. We follow archaeological research and employ skeletal records of women's and men's health from 139 archaeological sites in Europe dating back, on average, to about 1200 AD to construct a site-level indicator of historical bias in favor of one gender over the other using dental linear enamel hypoplasias. This historical measure of gender bias significantly predicts contemporary gender attitudes, despite the monumental socioeconomic and political changes that have taken place since. We also show that this persistence is most likely due to the intergenerational transmission of gender norms, which can be disrupted by significant population replacement. Our results demonstrate the resilience of gender norms and highlight the importance of cultural legacies in sustaining and perpetuating gender (in)equality today.

Explaining citizens' plastic reduction behavior with an extended theory of planned behavior model: An empirical study in Switzerland.

The growing volume of plastic waste resulting from human activities is suffocating our planet. To combat this escalating issue, this study delves into the formation of plastic reduction behavior among Swiss citizens using an extended theory of planned behavior model. Through an online survey, the study obtained 149 valid responses, which were analyzed using partial least squares-based structural equation modeling. The results indicate a significant and strong relationship between plastic risk perception and attitudes towards plastic reduction and environmental protection. Notably, the cognitive dimension (ß = 0.802, p = 0.000) of plastic risk perception exhibits a tighter and stronger association with attitude compared to the emotional dimension (ß = 0.406, p = 0.000). Among the three variables in the theory of planned behavior model, perceived behavioral control (ß = 0.384, p = 0.000) emerges as the strongest determinant of behavioral willingness for plastic reduction. It is followed by attitude (ß = 0.214, p = 0.030). However, no significant relationship is observed between subjective norm and behavioral willingness for plastic reduction (ß = 0.07, p = 0.292). Finally, attitude fully mediates the relationship between plastic risk perception and behavioral willingness for plastic reduction. Theoretical and managerial implications are discussed.

Implementation of a communication curriculum in undergraduate dental education-students' opinions during a 5-year development phase.

INTRODUCTION: Communication training has become an essential part of the dental curriculum. The aim of this study was to evaluate the communication curriculum developed and introduced 2016-2021 at the University of Bern, School of Dental Medicine (SDM), Switzerland. MATERIALS AND METHODS: The curriculum was implemented cumulatively in three phases: (1) lectures and accompanying role plays, (2) forum theatre and trainer-based communication training and (3) self-assessment. Students were surveyed 2016-2021 at the end of each semester using anonymous online questionnaires with five-point Likert scales (0-4). RESULTS: A total of 191 fourth- and fifth-year students were surveyed, and 165 (86.4%) questionnaires were analysed. The mean age of the participants was 24.2 ± 1.4 and 45.5% were female. While students' opinions about the need to communicate increased during weekly lectures in phase 1, their opinions about their ability to communicate simultaneously decreased. During phase 2, fourth-year students' opinions on the need to communicate with dental patients increased from 3.22 ± 0.61 to 3.73 ± 0.45 (p = .001), anticipated benefits for dentists increased from 2.78 ± 0.71 to 3.43 ± 0.57 (p = .001) and for patients from 3.00 ± 0.76 to 3.47 ± 0.63 (p = .022). Only in phase 3, opinions on the ability to communicate statistically significantly increased for both fourth- (2.34 ± 0.71 to 2.72 ± 0.60, p = .033) and fifth-year (2.20 ± 0.63 to 2.86 ± 0.59, p = .001) students. Preferred teaching and assessment methods were trainer-based communication trainings (73.1%), lectures (67.3%) and self-assessments in the student clinic (59.6%). CONCLUSION: Communication curricula in dental education using methods such as lectures and trainer-based communication trainings may additionally need to include self-assessments to be effective from the students' perspective.

Correlation between attitude towards dental care for older adults and ageism in dental students and clinical trainees: Cross-sectional study.

INTRODUCTION: Since the needs for dental care among older adults in Japan are expected to increase in the future, this study aimed to examine the influence of ageism among dental students and clinical trainees on the attitude towards the older adults in dental care. MATERIALS AND METHODS: In 2022, we conducted a questionnaire survey of 9th-, 11th-semester dental students and first-year clinical trainees enrolled at Kyushu Dental University, using the Japanese version of Ageism Scale for Dental Students (ASDS-J), Japanese version of Fraboni Scale of Ageism (FSA-J). Questions on intention to provide dental care to the older adults, relationships with the older adults and living with the older adults were also surveyed. RESULTS: There were 162 participants (84 males and 78 females), and the response rate was 71.7%. The participants were divided into the positive group for dental care to older adults (68 respondents) and the negative group (94 respondents). The ASDS-J score of the negative group was significantly higher than that of the positive group [49 (36-66) vs. 52 (34-88), p < .001]. The binomial logistic regression analysis revealed that the odds ratio of being negative attitude was 1.1 per one point of ASDS-J (95% confidence interval: 1.0-1.2) in the model adjusted for student grade, interaction with the older adults, gender, experience living with the older adults and FSA-J. CONCLUSION: These findings suggest that ageism specific to dental students and clinical trainees (as assessed using the ASDS-J) was independently correlated with negative attitudes towards dental care for older adults.

An educational game for teaching osmolarity and tonicity: opinions of dental and medical students.

In health courses, the students must be familiar with the effects of intravenous solutions on cell volume and function, a topic where there can be learning difficulties and misunderstandings. Since educational games can assist in understanding complex concepts, we created a game relating solution osmolarity and tonicity to red blood cell volume that was used in undergraduate Dentistry and Medicine courses. The students, working in groups, completed the game board by indicating the effect of the solutions on the red blood cell volume and classifying the solutions in terms of tonicity and osmolarity. The student indicated that the use of the educational game contributed to their understanding of osmolarity and tonicity.NEW & NOTEWORTHY This study describes an educational game for teaching osmolarity and tonicity, using classical red blood cell experiment results. The game was used during dialogic teaching, which was interrupted three times so that the student groups could answer questions about the experiments by completing a table describing the effects of different solutions on cell volume. According to the students' perception, the game contributed to their understanding of osmolarity and tonicity as related to human cells.

Service-learning's impact on dental students' attitude to community service.

BACKGROUND: This study aimed to observe the impact of service learning on the attitude of senior dental students toward community service. METHODS: A cross-sectional survey-based was conducted and recruited a total of 120 senior students of Dentistry Taibah University that were enrolled in a clinical service-learning course using convenience sampling. The attitude of dental college students toward community service based on the model of helping behavior by Schwartz was evaluated through Community Service Attitude Scale (CSAS). The data was collected using the same questionnaires for the pre-test and post-test. Data were analyzed by using SPSS 25. A repeated-measures mixed-model ANOVA was used to test the changes across pre-and post-test. RESULTS: A total of 96 students completed the first survey, making a response rate of 80%, and 78 among them completed the second survey as well, making a response rate of 81%. Significant change (P < 0.0001) in ANOVA indicated that there was an overall change in attitude.  CONCLUSIONS: It can be concluded that community-based service-learning positively impacts the attitude of last year's dental students toward understanding needs at the community level and the attitude to help in providing dental care at the community level.

The influence of different dimensions of oral health literacy on parental attitudes and comprehension of an information leaflet about permanent tooth avulsion.

BACKGROUND/AIM: Permanent tooth avulsion requires proper management at the time of the accident and parental oral health literacy (OHL) may influence decision-making with regards to dental trauma. The aim of this study was to investigate the influence of OHL on: (1) self-rated comprehension of an information leaflet (IL), (2) self-rated capacity to execute the tasks proposed on the IL, and (3) attitudes regarding the avulsion of a permanent tooth in children. MATERIAL AND METHODS: A longitudinal study was conducted involving the reading of an IL by 466 parents/caregivers. Evaluations were performed prior to the IL (Phase I), immediately after the application of the IL (Phase II) and 60 days after the application of the IL (Phase III). Self-rated comprehension and capacity to execute the proposed tasks were analyzed in Phase II. Attitude was evaluated in all three phases. Functional OHL was measured using the BREALD-30 and interactive OHL was measured using HeLD-14. RESULTS: Correlations were found between self-rated comprehension and both the OHL/BREALD-30 score (rs = 0.179; p = .012) and OHL/HeLD-14 score (r = 0.258; p < .001). Correlations were also found between the self-rated capacity to execute the proposed tasks and both the OHL/BREALD-30 score (rs = 0.133; p = .047) and the OHL/HeLD-14 score (rs = 0.225; p < .001). Higher BREALD-30 and HeLD-14 scores were associated with a better performance regarding parental attitudes toward permanent tooth avulsion comparing Phases I and II and Phases II and III (p < .05). CONCLUSIONS: Higher levels of OHL were associated with better parental self-rated comprehension of the IL and the capacity to execute the tasks proposed therein as well as more adequate attitudes regarding the avulsion of a permanent tooth.

Attitude and practice of regenerative endodontic procedures among endodontists and paediatric dentists: A multinational survey from 13 countries.

BACKGROUND: Regenerative endodontics (RET) refers to biologically based procedures that aim to restore damaged tooth structures and reinstate the pulp-dentine complex to its normal physiological state. AIM: The purpose of this study was to examine the attitudes and practices of endodontists and paediatric dentists regarding RET. DESIGN: A survey was conducted among endodontists and paediatric dentists from 13 countries. A number of factors were evaluated, including frequency of RET application, followed guidelines, disinfection techniques, intracanal medication type, scaffold type, preferred coronal seal material, and follow-up period. RESULTS: Among the 1394 respondents, 853 (61.2%) and 541 (38.8%) were endodontists and paediatric dentists, respectively. Almost half (43%) of participants have not performed RET yet. The American Association of Endodontics guideline (47.3%) was selected as the primary source for the clinical protocol. The most frequently selected irrigant solution was 1.5%-3% NaOCl at the first (26.1%) and second (13.6%) sessions. A blood clot (68.7%) and MTA (61.9%) were the most frequently selected scaffold type and coronal barrier. Most participants preferred a 6-month follow-up period. CONCLUSION: According to this survey, deviations exist from current RET guidelines regarding all aspects evaluated. Standardizing clinical protocols and adhering to available guidelines would help to ensure more predictable outcomes.

A qualitative evaluation of attitudes toward extractions among primary care orthodontists in Great Britain.

INTRODUCTION: The need to extract permanent teeth as part of orthodontic treatment has been keenly debated over many decades. Changes in the frequency of extraction have been well documented; however, we continue to lack an understanding of what influences clinicians' decisions regarding extracting permanent teeth. METHODS: Purposive sampling was undertaken to obtain representative views from primary care practitioners across Great Britain with a range of experience representing genders and wide geographic distribution. Twenty participants (9 female, 11 male) took part in in-depth, qualitative, 1-to-1 interviews based on a piloted topic guide. Interviews were conducted via video conferencing software with audio recording and verbatim transcription. Thematic analysis was performed with discussion and agreement to identify the main themes. RESULTS: Five main themes were identified: (1) patient-related factors, such as age and features of the malocclusion, (2) operator factors, including the level of experience, (3) setting, with regard to geographic location and method of remuneration, (4) mechanical approaches, including variations in appliance systems; and (5) self-directed ongoing education, including both formal continuing professional development and informal learning from peers. These factors acted as barriers, enablers, or both in relation to nonextraction treatment. CONCLUSIONS: Five key influences on extraction decisions among orthodontists in Great Britain were identified. Extraction choices appear to be influenced by various interrelated factors, evolving over time and with increased experience.

Professional assessment compared to patients' attitudes toward tooth replacement: a cross-sectional study.

BACKGROUND: There is a difference between patient self-assessment and professional assessment of oral health needs; therefore, the aim of the study was to investigate patients' individual needs and awareness of replacing missing teeth with prostheses and then to compare this information with professionally assessed clinical prosthetic needs in the Eastern Province of Saudi Arabia. METHODS: This was a cross-sectional study conducted in the Eastern Province of Saudi Arabia. The study subjects were recruited from Imam Abdulrahman bin Faisal University in Dammam City, Primary Health Care Centers in Alhasa City and from health education campaigns in the same area. All the patients were provided with a questionnaire related to the effect of missing teeth and replacement options, then underwent a clinical examination performed by a well-trained investigator. Statistical analyses were performed using JMP data analysis software (JMP®, Version 16. SAS Institute Inc., Cary, NC, 1989-2021.) RESULTS: A total of 102 participants were included. Most of the participants (94.2%) reported their need to replace missing teeth. Most of the participants stated that losing teeth (teeth) affected their ability to chew food and their appearance (82.6% and 61.6%, respectively). Dental caries was the main reason behind teeth extraction in 77.9% of the study sample. Fixed partial prosthesis was the first treatment option preferred by 33.7%, followed by implant-supported prosthesis with 25.6% to replace the missing teeth. Only 3.5% of participants preferred not to restore the missing teeth. Professional screening showed that 48.8% of the participants had one missing anterior tooth or more, which dictates the need for esthetic restoration, and 58.1% of the participants had three missing posterior teeth or more, which dictates the need for functional restoration. CONCLUSIONS: Patient knowledge and attitudes toward replacing missing teeth in terms of their functional and esthetic needs were variable among the population in comparison to the professional assessment of patient needs. Dentists plays a major role in raising the level of awareness about missing teeth replacement. The results of this study serve as baseline data for any related future studies.

Knowledge and attitudes toward evidence-based cariology and restorative dentistry among Egyptian dental practitioners: a cross-sectional survey.

BACKGROUND: This is the first study to assess Egyptian dental practitioners' knowledge about conservative caries management approaches and investigate whether this knowledge transfers into clinical practice and the barriers to translating research into evidence-based practice. METHODS: A sample of dental practitioners was surveyed using an online questionnaire. Convenience and snowball sampling were used to collect data from February to June 2022. We included graduated dentists from Egyptian universities who practiced in Egypt. Data were analyzed with descriptive statistics, and the associations between variables were checked using Kruskal Wallis and Chi-Square tests. RESULTS: This study included 396 participants from throughout Egypt. There were significant correlations between specialty and participants' knowledge and behaviors toward evidence-based caries management (p = 0.002) and between specialization and tools used to detect carious lesions (p < 0.001). Most participants (59.1%) used G.V Black's classification, and (80.8%) removed caries based on the feature of dentin hardness and color, whereas (67%) removed caries until hard dentine remained. The participants' primary hurdle to staying up-to-date was their belief that the newly gained information would not be clinically applicable due to a lack of equipment or working in low-economic areas. Patient-related barriers were the major obstacles for participants in implementing evidence-based practice. CONCLUSION: Egyptian dentists did not fully embrace minimal invasive approaches for caries management, and practitioners' experiences continue to shape decision-making. It emphasizes the imperative to practically educate dentists using effective knowledge translation dissemination to promote evidence adoption in daily practice and advocate value-based dental care to address the economic crisis's impact on Egypt's healthcare.

A homemade simulation model improves the impact of e-learning for the practical administration of dental anaesthesia.

INTRODUCTION: A simulation model improves the learning of dental anaesthesia in dental students. This study explored first, the making at home of a dental anaesthesia simulation model by dental students, and second, the impact of that simulation model on the learning of dental students following an online course. We compared the level of knowledge, the level of perception of confidence to perform the basic injection technique (BIT) of dental anaesthesia, and the level of attitude towards e-learning of the BIT between a group of dental students who had an online course with a home-made dental anaesthesia simulation model (HMDASM) and a group of dental students who did not use that model. MATERIALS AND METHODS: A group of participants (n = 28) used the HMDASM to learn the BIT with an e-learning course. Another group of participants (n = 28) followed the same e-learning course, but that group used a lemon to practise the BIT. The two groups answered questionnaires that explored the level of theoretical knowledge on the BIT, the level of perception of confidence to perform the BIT, and the level of attitude towards e-learning of the BIT. Questionnaire scores from each group were compared by a Student's t-test (p ≤ .05). RESULTS: The group that used the HMDASM had a level of knowledge similar to that of the other group (p > .05). The group that used the HMDASM had a level of perception of confidence to perform the BIT and a level of attitude towards online learning of the BIT higher than those of the group that did not use the simulation model (p < .05). CONCLUSION: The use of a HMDASM had a positive effect on dental students following an online course to learn the BIT.

An exploration of the impact of working in pairs on the dental clinical learning environment: Students' views.

INTRODUCTION: The aims of this study were to explore the undergraduate dental clinical students' experiences and perspectives of paired working in the clinical learning environment. MATERIALS AND METHODS: An interpretivist methodological approach with a socio-cultural lens was used. A stratified purposeful sampling strategy was chosen. Students digitally recorded three audio-diaries using Gibbs' cycle to guide reflection on collaborating clinically with a peer. 1:1 semi-structured interviews were held using a topic guide. Inductive thematic data analysis was undertaken. RESULTS: Eight participants were recruited. Main themes related to individual characteristics (motivation, professionalism, knowledge and experience) and relational features (feeling safe, attaching value, positive working relationships) that contributed to effective collaborative partnerships. The social setting is important for learning in the dental clinical environment. Benchmarking is used by students to motivate and reassure. Students learnt from their peers, particularly when they felt safe and supported and had developed good relationships. A lesser quality learning experience was highlighted in the assistant role. CONCLUSION: Paired working for clinical training was viewed mostly positively. Working with a variety of peers was beneficial and enabled development of interpersonal skills and professionalism. More effective collaborative learning partnerships were described when students felt they belonged and had affective support. Disadvantages of paired working were noted as reduced hands-on experience, particularly for senior students and when working in the assistant role. Ground rules and setting learning goals to change the mind-set about the assistant role were recommended. Emotional and practical support of students is needed in the clinical setting.

Programmatic Assessment Prototype Design Using Integrated System Thinking And Design Thinking Framework.

Objective: To design a prototype programmatic assessment model using integration of system thinking and design thinking frameworks, and to explore barriers in the way of its implementation in medical education. METHODS: The qualitative case-study was conducted at Bahria University Medical and Dental College, Karachi from September to December 2022. Methodological approaches used were systems thinking and design thinking. Philosophical paradigm used was critical realism. Maximum variation purposive sampling technique was used for selecting faculty members and medical students. Data was collected in two sets of semi-structured interviews. The initial interviews were at the levels of empathise, define and ideate. After that low-fidelity prototype programmatic assessment design was created and presented to the participants. The second set of interviews were focussed on feedback on prototype of programmatic assessment design. Pattern matching method was used for data analysis. RESULTS: Of the 65 subjects, 20(30.7%) were faculty members; 5(25%) lecturers and 5(25%) professors each from basic and clinical sciences. The remaining 45(69.2%) were students; 5(11.1%)from each year of medical and dental streams. Initial interviews revealed that after failure, students struggle to understand the cause of failure as assessment system lacked narrative feedback mechanism and numbers or pass/fail decisions were not self-explanatory. Students lacked attitude towards continued improvement, formative assessment were not taken seriously as they carried only 10% weightage. After the programmatic assessment design was presented to the participants, faculty members voiced concerns regarding faculty training, shortage of resources and legal issues related to its implementation. Students supported the design, especially continued narrative feedback for their academic improvement. Portfolio development was considered a time-consuming task and they had reservations regarding their ability to make quality assessment portfolio. Conclusion: Implementation of programmatic assessment required faculty development and was resource-intensive, but stakeholders, especially students, were found interested in its implementation in medical education.

Orthodontic clinicians' attitudes and knowledge of dentogingival aesthetics: A cross-sectional survey of BOS members.

OBJECTIVE: To assess orthodontic clinicians' knowledge and attitudes towards dentogingival aesthetics and to explore characteristics that predict the knowledge of dentogingival aesthetics. DESIGN: Cross-sectional questionnaire. SETTING: On-line survey of members of the British Orthdontic Society. MATERIALS AND METHODS: An 11-item online questionnaire was sent to orthodontic practitioners for completion. The questionnaire covered respondent demographics and questions relating to both knowledge and attitudes towards dentogingival aesthetics (six parameters). Descriptive statistics were calculated for study characteristics and summary values for the survey items. Responses to the eight knowledge-based questions were converted to a binary outcome (correct and incorrect answer). The maximum score that could be achieved was eight. Multivariable modelling was used in order to examine associations between the study characteristics and the aggregate score. RESULTS: A total of 252 responses were obtained resulting in a response rate of 17%. Within this cohort, the respondents were primarily women (52.8%) and aged 30-40 years (35.7%). The mean score for the eight knowledge-based questions was 3.8 ± 1.8 (range = 0-8). Knowledge of the ideal gingival margin position of the anterior teeth was high (92.4%). Knowledge of the other five dentogingival aesthetic parameters was variable. In the multivariable analysis, lower knowledge scores were predicated by respondents who did not have a special interest in dental aesthetics (-0.54; 95% confidence interval [CI] = -1.01 to -0.07; P = 0.02), who could not recall attending courses, lectures or seminars on dental aesthetics in the past five years (-0.80; 95% CI = -1.43 to -0.17; P = 0.01) and with increasing age (-0.43; 95% CI = -0.62 to -0.23; P < 0.001). CONCLUSION: Knowledge of ideal dentogingival parameters is generally suboptimal among orthodontists in the UK. The reported lack of knowledge of the ideal dentogingival parameters may also influence respondents' attitudes towards the importance of dentogingival aesthetics. Further teaching or courses related to dentogingival aesthetics is desired by orthodontic clinicians.

An assessment of knowledge, attitude, and practice regarding organ donation among students and physicians.

OBJECTIVE: To assess the knowledge, attitude and practice of students and physicians regarding tissue and organ donation at a teaching hospital. Methods: The cross-sectional study was conducted at the Dow University of Health Sciences, Karachi, in 2019, and comprised physicians and students of ether gender. Data was collected using a 43-item self-administered questionnaire. Dichotomous questions were scored as 1 or 0, while multiple-option questions were scored as 2, 1 or 0. Data was analysed using SPSS 25. RESULTS: Of the 859 subjects, 761(88.6%) were students with a mean age of 20.3±1.5 years and 98(11.4%) were physicians with a mean age of 30.6±9.4. Among the students, 630(82.8%) were medical students, while 131(17.2%) were dental. The largest group among the students was of those in the second year of their studies 271(35.6%). Besides, 531(69.8%) and 64(65.3%) physicians were females. Compared to males, female students reported better mean scores in terms of attitude, while higher practice scores were obtained by both male students and physicians (p=0.021). Muslim subjects scored comparatively lower in knowledge, attitude and practice terms than non-Muslims (p<0.05). CONCLUSIONS: There were high knowledge and attitude scores, while scores reflecting practice were low. Effective measures should be taken to encourage medical professionals to donate organs and promote organ donation.

Do hypomineralized teeth affect parents' emotional states and attitudes more than other discoloration conditions?

Discoloration poses a significant esthetic issue, and parents' opinions and emotional states may vary regarding different types of discoloration, such as molar incisor hypomineralization, caries or chromogenic bacteria. This study aimed to assess parent's emotional state and attitudes towards discoloration in primary and permanent teeth. A two-part questionnaire was designed, consisting of questions about demographic data and simulated visuals of different primary and permanent teeth discoloration conditions. The Visual Analog Scale (VAS) was used to determine the emotional state, while parents' attitudes towards dental consultation for each simulated visual were determined using statements such as "Absolutely yes"; "Yes"; "I don't have an idea"; "No"; "Absolutely no". The simulated visuals included cases of "caries with cavitation", "yellow-brown hypomineralized area", "white hypomineralized area" and "chromogenic bacteria". The questionnaire was distributed to 300 parents through online communication channels. Categorical variables were analyzed using Pearson chi-square, with statistical significance set as p < 0.05. A total of 230 parents completed the questionnaire. The highest VAS scores and the highest percentage of "Absolutely yes" responses were observed for "caries with cavitation" in both primary (77.8%, 81.7%) and permanent (60.4%, 94.3%) teeth. Additionally, statistically significant differences were found in the VAS scores for chromogenic bacteria (p = 0.04), caries with cavitation (p = 0.005), white hypomineralized area (p = 0.01) and yellow-brown hypomineralized area (p = 0.02). Comparatively, parental preferences showed statistically significant differences for chromogenic bacteria (p = 0.01), caries with cavitation (p = 0.01), yellow-brown hypomineralized area (p = 0.01) and white hypomineralized area (p = 0.004). Parents displayed stronger emotional responses towards "caries with cavitation" compared to hypomineralization and chromogenic bacteria discolorations and expressed a positive attitude towards seeking dental consultation.

Contemporary Provider Management Practices and Attitudes Toward Referral for Advanced Heart Failure Therapies in Fontan Patients Across North America.

BACKGROUND: To date, no reports have described clinicians' management practices for patients with Fontan circulatory failure or their understanding of risk factors for mortality and transplant outcomes in these patients. METHODS AND RESULTS: A cross-sectional survey of caregivers across North America was conducted from February to September 2020. Responses were compared by primary specialty (heart failure/transplant vs non-heart failure/transplant), years of experience (early, mid, and late career), and Fontan center volume (low, medium, and high). Of 400 responses, the majority were from general cardiologists (111, 28%) followed by heart failure/transplant specialists (93, 23%). Although most agreed that patients with Fontan physiology will have signs/symptoms of heart failure (369 [93%]) and eventuate in heart transplant (286 [72%]), many disagreed (180 [45%]) that routine evaluation by a transplant cardiologist is needed without symptoms. Transplant providers were more likely than non-transplant providers to suggest referral for manifestations of Fontan circulatory failure such as protein-losing enteropathy, plastic bronchitis, liver fibrosis/cirrhosis, and worsening valve regurgitation. Non-transplant providers were more likely to suggest that protein-losing enteropathy, plastic bronchitis, and Fontan-associated liver disease lead to inferior outcomes after transplantation. Early career and transplant providers more favorably viewed ventricular assist device use for Fontan patients failing traditional heart failure therapy (P < .05 for all). CONCLUSIONS: There is significant variation in the management of Fontan patients, including heterogeneous timing of referral of such patients to the heart failure/transplant team, which may have implications for future outcomes.

Cleft Care in a Developing Country: An Assessment of Knowledge and Attitudes of Patients/Parents of Children With an Orofacial Cleft to Orthodontic Treatment.

OBJECTIVE: To assess the knowledge, awareness and attitude to orthodontic treatment of patients and parents of children with orofacial clefts, receiving comprehensive cleft care treatment. DESIGN: Cross-sectional survey. SETTING: A major tertiary health care facility in Nigeria, the Lagos University Teaching Hospital, Idi-araba, Lagos. PARTICIPANTS: Patients and parents of children with orofacial clefts receiving comprehnsive cleft care. INTERVENTION: Patients and parents of children with orofacial clefts were asked to complete the survey. Interviewer-administered questionnaires were used. RESULTS: A total of 123 patients participated in the study, 55.3% (68) were females and 44.7% (55) were males. The majority (85.3%, 114) of patients were children aged between 0 and 5 years, while only 7.3% (9) were adults, aged 18 years and above. About one-third (41) of the respondents indicated that they felt "their teeth was not straight." Although 43.9% (54) reported that they knew that braces could be used to straighten teeth, only 13.8% of the respondents knew who an orthodontist was. Eighty percent (99) indicated that they would be willing to undergo treatment to straighten their teeth or their children/wards' teeth. CONCLUSION: The majority of parents of children with clefts and adult patients attending the institution's cleft clinic had limited knowledge of orthodontics and the orthodontic care required for patients with clefts, although they had a positive attitude toward orthodontic treatment. These findings will guide the center in planning patient-centered orthodontic care for patients with clefts while also highlighting areas of importance for patient counseling and education in the orthodontic care for these patients.

Knowledge, perceptions, attitudes, and clinical experiences on molar incisor hypomineralization among Syrian pediatric dentists and general dental practitioners: a cross-sectional study.

BACKGROUND: Molar incisor hypomineralization (MIH) is a widespread oral health problem. Dentists encounter several challenges regarding MIH management worldwide. The aim of this study was to evaluate and compare the knowledge, perceptions, attitudes, and clinical experiences on MIH among general dental practitioners and pediatric dentists in Syria. METHODS: All general dental practitioners and pediatric dentists belonging to the Syrian Dental Syndicate of Damascus were invited to complete a cross-sectional structured questionnaire (n = 1936). The questionnaire consisted of four sections and required responses regarding demographic data, knowledge, perceptions, attitudes, and experiences on MIH. Data were analyzed with Pearson's chi-square test and multivariate regression models using SPSS Ver. 23.0. RESULTS: The overall response rate was 36.31% (703/1936). Pediatric dentists were significantly more familiar with MIH (p < 0.001) and more confident when diagnosing it (p < 0.001). Most participants (43.95%) perceived an increase in MIH prevalence in Syria. Stainless steel crowns were the most favorable restorative material for molars with post-eruptive breakdown (51.38%). As for molars and incisors with opacities, composite resin was preferred with (41.82%), and (67.51%) respectively. General dental practitioners requested further training regarding MIH treatment (p < 0.001). CONCLUSIONS: Pediatric dentists were equipped with further knowledge regarding MIH, and were more confident when diagnosing it. There is a need for additional training and education for general dental practitioners. Most respondents perceived an increase in the prevalence of MIH. There is a dearth of data regarding MIH prevalence in Syria. The materials of choice for restoring teeth with MIH were stainless steel crowns and composite resin.