Challenges and resilience of Taiwan's oral health care system after Covid-19 pandemic.

This paper examines the resilience of Taiwan's oral healthcare system in response to COVID-19, focusing on pre-pandemic conditions, pandemic impacts, and policy recommendations for future resilience. In Taiwan, oral diseases were prevalent, with 80.48% of adults affected by periodontitis in 2016, and 65.43% of 5-year-old children experiencing dental caries. Taiwan's National Health Insurance (NHI) covers over 99% of the population, providing comprehensive dental care. The global budget (GB) payment system, implemented in 1998, ensured financial stability. During the pandemic, dental visits in Taiwan decreased by 5.1% in 2021 compared to 2019. Despite reduced visits, the GB system maintained financial stability, mitigating financial impacts on healthcare institutions. The pandemic generally negatively affected healthcare workers' well-being, increasing resignation intentions. However, the number of practicing dentists in Taiwan remained stable from 2016 to 2022, with slight increases. Urban-rural disparities persisted, and workplace transitions increased, indicating greater mobility among dental professionals. To enhance resilience, the following recommendations are proposed: 1. Strengthen hierarchy of oral healthcare system: Balance dental resources across regions, and improve referrals between hospital and clinics; 2. Provide integrated patient-centered care: Integrate oral health into disease prevention and offer comprehensive services across all stages of life; 3. Integrate digital technology: Promote teledentistry and leverage Taiwan's strengths in information and communication technology (ICT).

Influencing factors of examiner: Examples from certificated orthodontists board examination.

BACKGROUND: The rating result reflects not only the performance of the candidate but some extent of the examiner's preference. Examiner bias could be objective, which means it can't be changed by the examiner like gender, age, race, educational level, or professional experience. No study about examiner bias was performed in the dental education realm, especially in the orthodontic field. Therefore, this study aimed to figure out possible influencing factors in examiners from examples of the Taiwan Board of Orthodontist examination. METHODS: The examiner groups comprised 29 males and 21 females selected from the certificated Taiwan Board of Orthodontists. Every examiner would receive a series of lectures about rating standards before the exam. The score data were collected from 2009 to 2019. RESULTS: As for the univariate regression model of the Taiwan Board of Orthodontist examination, the experienced examiner with a certification of more than 15 years tends to rate more leniently, but female examiners tend to rate harsher. The scores would increase with the examiner's age in both the univariate regression model of self-prepared and assigned cases. CONCLUSION: As for the multivariate model of self-prepared exams, the elder and the examiner who work in private practice clinics tend to rate more leniently. As for the multivariate model of the assigned case exam, the score would be only affected by age. However, further studies are necessary to determine the direct relation among these factors.

DDR1 promotes E-cadherin stability via inhibition of integrin-ß1-Src activation-mediated E-cadherin endocytosis.

Discoidin domain receptor 1 (DDR1), a receptor tyrosine kinase of collagen, is primarily expressed in epithelial cells. Activation of DDR1 stabilises E-cadherin located on the cell membrane; however, the detailed mechanism of DDR1-stabilised E-cadherin remains unclear. We performed DDR1 knockdown (Sh-DDR1) on Mardin-Darby canine kidney cells to investigate the mechanism of DDR1-stabilised E-cadherin. Sh-DDR1 decreased junctional localisation, increased endocytosis of E-cadherin, and increased physical interactions between E-cadherin and clathrin. Treatment of the dynamin inhibitor Dyngo 4a suppressed Sh-DDR1-induced E-cadherin endocytosis. In addition, the phosphorylation level of Src tyrosine 418 was increased in Sh-DDR1 cell junctions, and inhibition of Src activity decreased Sh-DDR1-induced E-cadherin endocytosis. To characterise the molecular mechanisms, blocking integrin ß1 decreased Src activity and E-cadherin junctional localisation in Sh-DDR1 cells. Photoconversion results showed that inhibition of Src activity rescued E-cadherin membrane stability and that inhibition of integrin ß1-Src signalling decreased stress fibres and rescued E-cadherin membrane stability in Sh-DDR1 cells. Taken together, DDR1 stabilised membrane localisation of E-cadherin by inhibiting the integrin ß1-Src-mediated clathrin-dependent endocytosis pathway.