A randomized controlled add-on trial of fluoxetine and cognitive behavioral therapy for help-seeking men with a sexual interest in children: presentation of the PARACHUTES trial protocol and initial feasibility data.

Background: Sexual Interest in Children (SIC) is a major risk factor for sexual offending, yet clinical trials are sparse. The present protocol outlines a randomized controlled trial (RCT) that aims to investigate the effectiveness of fluoxetine and Cognitive Behavioral Therapy (CBT) in help-seeking men with SIC. Methods: Adult men contacting the Swedish telephone helpline PrevenTell are screened for inclusion and invited to further assessment on site. One hundred and eleven men with SIC (defined as DSM-5 pedophilic disorder or hebephilia) will be randomized (1:1:1 ratio) to receive one of three interventions for 14 weeks: (1) an internet-administered psychoeducational program (iPP), (2) iPP and the addition of fluoxetine 20-40 mg or (3) iPP and the addition of internet-administered CBT (iCBT). Exclusion criteria include severe psychiatric illness, contraindicating treatment and an elevated risk of committing hands-on sexual offences. Symptom intensity is assessed at baseline, pre-treatment, every other week for 12 weeks, and post treatment. The primary outcome measure is the Sexual Interest in Children: Current Assessment Scale (SIC: CAS) that quantifies sexual behaviors associated with SIC as well as perceived distress and impairment. Secondary outcomes include measures of dynamic risk-factors for committing sexual offences. Results: The data collected during the initial 20 months of recruitment were analyzed to predict the required number of individuals to be screened and estimate the probable length of the data collection phase. As of March 2022 to November 2023, 146 men have called PrevenTell and disclosed a sexual interest in minors. Following pre-screening, 110 men were excluded from participation in the trial. Current SSRI therapy was the primary reason for exclusion (n = 24; 22%), followed by an elevated risk of committing hands-on sexual offences (n = 14; 13%). Among the 31 men who underwent the screening procedure on site, 26 were allocated to either iPP, iPP+fluoxetine, or iPP+iCBT. The recruitment rate indicates that the trial will be concluded within the pre-estimated timeframe. Discussion: This is the first RCT of treatment with SSRI and iCBT in a population of help-seeking men with SIC. The significance of this trial and its methodological strengths and limitations are discussed.

Psychiatrists as forensic authorities: evaluation of dangerous habitual offenders in West Germany during the 1960s - the Helmut Hoinka case.

Background: Preventive detention for highly dangerous habitual offenders has been in force in Germany for 90 years. The necessity of this measure is hotly debated from a legal perspective. However, the assignment of preventive detention is largely determined by the opinion of medical experts. This article discusses the role of medical experts and the issues they face in evaluating the dangerousness of habitual offenders using the case of the marriage swindler Helmut Hoinka, prosecuted several times in the Federal Republic of Germany in the 1960s. Methods: Helmut Hoinka's case was chosen for analysis because of the rare opportunity to access detailed materials that allowed us to follow in detail the reasoning of the medical experts who evaluated Hoinka: medical reports stored in the Gerd Huber Archive at the University of Ulm, and Hoinka's court case from the State Archive of North Rhine-Westphalia. To examine these sources, we implemented the historical-critical method. Results: The medical experts who evaluated Hoinka were aware of the defendant's criminal record prior to the evaluation, which was a source of bias. In addition, the criteria for classifying the offender as a dangerous habitual offender were open to a wide range of interpretations. Hoinka's high level of intelligence was negatively emphasized. Some test results were considered unreliable because it was assumed that Hoinka had manipulated his answers. Personal value judgments were allowed in assessing Hoinka's personality. Hoinka's criminal behavior was considered a medical symptom of psychopathy because it violated general moral and social norms. The medical reports of both experts showed that the psychiatrists believed in the genetic nature of psychopathy and criminal behavior. Their criminological prognosis was fully supported by the court in imposing the sentence. Conclusion: Challenges to Hoinka's criminological prognosis were the experts' personal biases, their belief in the theory of genetic predisposition to crime, the lack of clear criteria for antisocial personality disorder, and the absence of forensic recommendations for "psychopathic" criminals. The experts' opinion on Hoinka's criminal predisposition was crucial to the imposition of the sentence.

Knowledge of and Attitude Toward Preventive Care Among Iraqi Dentists and Senior Dental Students: A Cross-Sectional Study.

OBJECTIVES: Acquiring knowledge and maintaining a positive mindset are essential for dental care providers to offer optimal dental services. Dental professionals are expected to follow preventive dentistry principles to ensure the best oral health maintenance for their patients, as prevention is a key component of public health initiatives. This study aims to assess the knowledge and attitudes toward preventive dental care among Iraqi dentists and senior dental students. METHODOLOGY: A cross-sectional study, conducted from June to August 2023, involved 876 Iraqi dentists and 587 senior dental students in Baghdad, utilizing a physically paper-based self-administered questionnaire. Participants' level of knowledge was assessed based on a 5-point Likert scale to 12 statements on preventive dental care. Their attitudes were inquired by selecting one option from a 7-point Likert scale on four pairs of bipolar adjectives describing preventive dentistry. Higher scores were considered more accurate knowledge and more positive attitudes. Statistical evaluation included the Chi-square test and regression analysis. RESULTS: In total, data from 841 dentists and 567 students were analyzed (response rate: 96%). Around 90% of dentists (N=745) and students (N=502) acknowledged the impact of sugar, sealant, and water fluoridation on dental caries, but about 80% of dentists (N=662) and students (N=446) undervalued the role of fluoridated toothpaste. Women (OR=1.4, 95% CI: 1.02-2.1) and dentists, within one year of their graduation (OR=1.9, 95% CI: 1.1-3.5), exhibited higher levels of knowledge. More favorable attitudes towards preventive dentistry were associated with a higher level of knowledge among dentists (OR=1.6, 95% CI: 1.2-2.3). Regarding dental students, those from private dental schools showed higher scores of knowledge than their counterparts from public schools (OR=2.1, 95% CI: 1.3-3.4). The majority of participants held the belief that preventive dentistry is beneficial for the community but just about 60% of dentists (N=477) and students (N=300) exhibited a positive attitude toward the economic advantages of preventive dentistry for dentists, as well as the ease of engaging in preventive dental practices. CONCLUSIONS: The dentists and dental students in this study demonstrated satisfactory knowledge and a favorable attitude toward most aspects of preventive dentistry. However, deficiencies were noted in certain areas, such as the application of topical fluoride for preventing dental caries, as well as a substantial proportion of individuals who lacked a positive perspective on the economic benefits of preventive dentistry. Hence, there is a clear need for educational interventions during their undergraduate training and postgraduate continuing education to enhance their knowledge levels and cultivate a more positive attitude towards preventive dentistry.

Advancing the analysis of water pipe failures: a probabilistic framework for identifying significant factors.

The failure of water pipes in Water Distribution Networks (WDNs) is associated with environmental, economic, and social consequences. It is essential to mitigate these failures by analyzing the historical data of WDNs. The extant literature regarding water pipe failure analysis is limited by the absence of a systematic selection of significant factors influencing water pipe failure and eliminating the bias associated with the frequency distribution of the historical data. Hence, this study presents a new framework to address the existing limitations. The framework consists of two algorithms for categorical and numerical factors influencing pipe failure. The algorithms are employed to check the relevance between the pipe's failure and frequency distributions in order to select the most significant factors. The framework is applied to Hong Kong WDN, selecting 10 out of 21 as significant factors influencing water pipe failure. The likelihood feature method and Bayes' theorem are applied to estimate failure probability due to the pipe materials and the factors. The results indicate that galvanized iron and polyethylene pipes are the most susceptible to failure in the WDN. The proposed framework enables decision-makers in the water infrastructure industry to effectively prioritize their networks' most significant failure factors and allocate resources accordingly.

The environmental microbial retrieving assessment of cell-processing facilities for cell therapy in a hospital laboratory.

Cell therapy represents a promising treatment modality. A critical component in the production of cell therapy products is maintaining the sterility of cell therapy clean rooms (CTCRs). This study aimed to evaluate the environmental microbial load within CTCRs. We systematically monitored microbial load in CTCRs, following established guidelines. Cultured microbial samples underwent metagenomic sequencing, and alpha and beta diversity analyses, functional annotation, and resistance gene profiling were performed using various bioinformatics tools to assess microbial diversity and function. From November 2023 to January 2024, we collected 42 environmental microbial colony samples from various sources within the CTCR and performed metagenomic sequencing on 39 samples. Alpha diversity analysis revealed no significant differences among surface, settle_plate, and airborne categories, but significant disparities within surface subgroups were revealed. Beta diversity analysis showed notable differences between surface and airborne categories and among surface subgroups. Species distribution analysis identified Bacillus as the predominant genus on surfaces. Functional annotation and resistance gene analysis indicated distinct resistance patterns, with significant variations between subgroups, such as microscopes and transfer windows, and hands and other Grade_B environments. Resistance to hydrogen peroxide was notably higher in the transfer window group. These findings highlight the importance of stringent disinfection protocols and enhanced hand hygiene to maintain sterility in CTCRs. These findings provide valuable insights for implementing effective measures to maintain cleanliness throughout CTCRs. The annotation and study of resistance genes can help rapidly identify methods to control cellular contamination under circumstances of environmental microbial pollution.IMPORTANCEMaintaining the sterility of cell therapy clean rooms (CTCRs) is crucial for the production of safe and effective cell therapy products. Our study systematically evaluated the environmental microbial load within CTCRs, revealing significant microbial diversity and distinct resistance patterns to disinfection methods. These findings underscore the need for stringent disinfection protocols and enhanced hand hygiene practices to ensure CTCR sterility. By identifying key microbial species and their resistance genes, our research provides essential insights into controlling contamination and safeguarding the production environment, ultimately contributing to the reliability and success of cell therapy treatments.

Home based cardiac rehabilitation: A retrospective cohort analysis on all-cause mortality and hospital readmission rates across sexes and races.

Objective: Studies have shown that both home-based cardiac rehabilitation (HBCR) and center-based cardiac rehabilitation (CBCR) exhibit comparable efficacy in reducing mortality during short-term follow-up periods of up to 12 months. However, research on sex- and race-specific outcomes associated with HBCR is limited. This study examines all-cause mortality and hospital readmission among patients referred to HBCR, with stratification by sex and race. Methods: This Kaiser Permanente Southern California (KPSC) retrospective cohort study followed 6,868 patients from HBCR referral until death, disenrollment, or December 31, 2021. There were 3,835 HBCR graduates, 722 non-graduates, and 2,311 non-enrolled patients. Cox models were used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) comparing 1) HBCR graduates vs. non-enrolled, and 2) HBCR graduates vs. non-graduates, stratified by sex and race. Differential outcomes among strata were analyzed using Kaplan-Meier curves. Results: Among the 6,868 patients referred to HBCR, 4693 (68.3 %) were male, 2,175 (31.7 %) female, 870 (12.7 %) Asian/Pacific Islander, 731 (10.6 %) African American, 1,612 (23.6 %) Hispanic/Latino, and 3,646 non-Hispanic White (53.1 %). Over a mean follow-up period of 2.28 years, HBCR graduates, compared to patients who did not enroll in HBCR, had overall significantly lower risks of all-cause mortality and hospitalization. These results remained significant with stratification by sex and race. Compared to HBCR non-graduates, HBCR graduates overall had significantly lower risks of all-cause mortality and hospitalization. In the same comparison, mortality risk was significantly reduced for male and White patients; risk of hospital readmission was significantly reduced in both sexes, African American, and White patients. Among HBCR graduates, no significant differences in all-cause mortality or hospital readmission were observed across sexes and races. Conclusion: HBCR participation is associated with reduction of all-cause mortality and hospital readmission rates across sexes and races. Notably, we observed benefits at varying levels of engagement, which suggests that even partial completion of HBCR is associated with risk reduction. Among HBCR graduates, we found similar outcomes across sexes and races, which suggests that the program can be effective among diverse patient groups.

[On certain issues of modern health care system development].

Nowadays, the reforming of health care system in the Russian Federation is the most actual since country survives difficult economic conditions and is in need of development of new enhanced scientific and methodological approaches to various aspects of public health and health care, targeting increase of all types of efficiency in this system (medical, social, economic ones). For proper functioning of health care system, not only physicians, but also such specialists as physicists, engineers, mathematicians, biologists, chemists, lawyers, economists, psychologists, teachers and others are to be involved in process of developing new approaches. The multidisciplinary approach and effective interdisciplinary interaction can input into improvement of health care system based on needs of patients. To achieve the highest benefit for patient, development of comfortable conditions for all participants of diagnostic and treatment process, appropriate quality of medical care and maximal level of satisfaction of subjects in given system, it is necessary to consider segmentation of medical services market i.e. characteristics of consumers and providers. The systematic approach is to be applied to achieve this target, involving organizations of private and public sector of practical health care and scientific and educational organizations. it is needed to develop methods of early diagnostic, disease prevention programs and training of personnel in health care system, taking into account approaches of integrative and preventive medicine.

Use of Patient-Specific Titanium Plates to Prevent Iatrogenic Mandibular Fracture During the Surgical Removal of Dentigerous Cysts: A Two-Case Series.

Dentigerous cysts, if left untreated, can grow significantly and weaken the mandible, posing risks of pathological or iatrogenic fracture. Treatment options may include decompression, marsupialization, and enucleation, which are available, with the choice being multifactorial and tailored to each case. This article describes the management of two complex dentigerous cysts at risk of fracture, one about an 84-year-old woman and the second about a 41-year-old man. The cysts and associated teeth were surgically removed, and simultaneously custom-made titanium osteosynthesis plates were placed to prevent per- and postoperative fracture risks. This approach appears to be indicated in cases where marsupialization or decompression is impossible and when there is a high risk of iatrogenic fracture.

Recent Innovations in Primary Care Cancer Survivorship Roles.

BACKGROUND: Despite 2 decades of cancer survivorship research, policy, and advocacy, primary care in the United States has not fully integrated survivorship care into its generalist role. This manuscript describes innovative roles primary care physicians have adopted in survivorship care and how these roles emerged. METHODS: We conducted qualitative in-depth interviews with a snowball sample of 10 US primary care physician innovators in survivorship care. Interviews were recorded and professionally transcribed. Our team met weekly as interviews were completed to review transcripts and write summaries. We analyzed data using an immersion-crystallization process. RESULTS: Innovators did not receive formal survivorship training but gained knowledge experientially and through self-guided education. All worked in academic primary care and/or cancer centers; context strongly influenced role operationalization. We delineated 4 major role-types along a spectrum, with primary care generalist orientations at one end and cancer generalist orientations at the other. Primary care generalists applied survivorship guidelines during regular visits ("GENERALISTS+") or focused on cancer treatment effects amid other comorbidities during blocked clinic time ("oncoGENERALISTS"). Cancer generalists focused on cancer-related sequalae during and after treatment; some provided continuity care to survivors ("ONCOGENERALISTS"), while others incorporated unmet primary care needs into survivorship consults ("ONCOgeneralists"). CONCLUSIONS: Primary care survivorship innovations are occurring in academic primary care and cancer centers settings in the US. To move beyond the work of individual innovators, systematic investments are needed to support adoption of such innovations. For wider diffusion of survivorship care into community primary care, additional strategies that include primary care survivorship education and workforce development are needed to facilitate risk-stratified and shared-care models.

Social Vulnerability and Compliance With World Health Organization Advice on Protective Behaviors Against COVID-19 in African and Asia Pacific Countries: Factor Analysis to Develop a Social Vulnerability Index.

BACKGROUND: COVID-19 protective behaviors are key interventions advised by the World Health Organization (WHO) to prevent COVID-19 transmission. However, achieving compliance with this advice is often challenging, particularly among socially vulnerable groups. OBJECTIVE: We developed a social vulnerability index (SVI) to predict individuals' propensity to adhere to the WHO advice on protective behaviors against COVID-19 and identify changes in social vulnerability as Omicron evolved in African countries between January 2022 and August 2022 and Asia Pacific countries between August 2021 and June 2022. METHODS: In African countries, baseline data were collected from 14 countries (n=15,375) during the first Omicron wave, and follow-up data were collected from 7 countries (n=7179) after the wave. In Asia Pacific countries, baseline data were collected from 14 countries (n=12,866) before the first Omicron wave, and follow-up data were collected from 9 countries (n=8737) after the wave. Countries' socioeconomic and health profiles were retrieved from relevant databases. To construct the SVI for each of the 4 data sets, variables associated with COVID-19 protective behaviors were included in a factor analysis using polychoric correlation with varimax rotation. Influential factors were adjusted for cardinality, summed, and min-max normalized from 0 to 1 (most to least vulnerable). Scores for compliance with the WHO advice were calculated using individuals' self-reported protective behaviors against COVID-19. Multiple linear regression analyses were used to assess the associations between the SVI and scores for compliance to WHO advice to validate the index. RESULTS: In Africa, factors contributing to social vulnerability included literacy and media use, trust in health care workers and government, and country income and infrastructure. In Asia Pacific, social vulnerability was determined by literacy, country income and infrastructure, and population density. The index was associated with compliance with the WHO advice in both time points in African countries but only during the follow-up period in Asia Pacific countries. At baseline, the index values in African countries ranged from 0.00 to 0.31 in 13 countries, with 1 country having an index value of 1.00. The index values in Asia Pacific countries ranged from 0.00 to 0.23 in 12 countries, with 2 countries having index values of 0.79 and 1.00. During the follow-up phase, the index values decreased in 6 of 7 African countries and the 2 most vulnerable Asia Pacific countries. The index values of the least vulnerable countries remained unchanged in both regions. CONCLUSIONS: In both regions, significant inequalities in social vulnerability to compliance with WHO advice were observed at baseline, and the gaps became larger after the first Omicron wave. Understanding the dimensions that influence social vulnerability to protective behaviors against COVID-19 may underpin targeted interventions to enhance compliance with WHO recommendations and mitigate the impact of future pandemics among vulnerable groups.

Is use of Long-Acting Reversible Contraceptives (LARC) associated with reduced well-woman visits and STI testing? Evidence from female Medicaid clients aged 15-24 in Delaware.

OBJECTIVE: Contraceptive method type matters to sexually transmitted infection (STI) prevention, but contraceptive counseling often emphasizes method efficacy and the benefits of "forgettable" methods, including long-acting reversible contraceptives (LARCs). We aimed to explore associations between prescription method type and annual STI testing and investigated whether these associations relate to annual well-woman visits. METHODS: We constructed a panel of 20,949 young women (<25) enrolled in Delaware's Medicaid program from 2012 through 2019. Conditional logit regressions measured associations between contraceptive method type and annual testing for gonorrhea, chlamydia, or syphilis. We stratified contraceptive methods into LARC, short-acting reversible methods (SARC; pills, patch, ring, and injectable), or no prescription method. We estimated three models examining STI testing in year of method initiation, in years afterwards, and attendance to a well-woman visit as a potential mediator of these associations. RESULTS: STI testing rates did not differ between LARC versus SARC users in the year of method initiation. In the two years after method initiation, LARC versus SARC users were less likely to be tested (OR = 0.73 to OR = 0.87) and less likely to have a well-woman visit (OR = 0.65 to OR = 0.79). In models controlling for attendance to well-woman visits, the decreased likelihood of STI testing in years after initiating LARC versus SARC is largely eliminated, indicating that well-woman visits mediate the relationship between method type and STI testing. CONCLUSIONS: LARC use relates to reduced STI testing in years after method initiation due to reduced attendance to well-women visits. These findings can inform clinical practice and STI prevention.

Factors associated with uptake of isoniazid preventive therapy among children living with HIV in Mwanza region, Tanzania: a cross-sectional study.

BACKGROUND: Tuberculosis (TB) is a leading cause of death among children living with HIV (CLHIV). Isoniazid preventive therapy (IPT) reduces the incidence of TB by 70% and mortality by 50% among CLHIV. However, in most developing countries including Tanzania, the uptake of IPT is suboptimal, below the 90% WHO-global uptake target. We assessed the factors associated with IPT uptake among CLHIV in Mwanza region, Tanzania. METHODS: This was a multicenter facility-based cross-sectional study among CLHIV aged 1 to 10 years in seven districts of Mwanza region, Tanzania from 1st November 2021 to 20th January 2022. Data were collected using a structured interview-administered questionnaire including information on children and caregivers' demographics, caregivers' health related information and children's clinical information. Our outcome variable was uptake of IPT, defined as initiation on IPT either during the time of the study or within past three years before this study We conducted modified Poisson regression to assess the association between IPT uptake and selected exposures in Stata version 15.0. RESULTS: A total of 415 CLHIV were enrolled, the median age of the children was 7 years (Interquartile range: 5-8). The uptake of IPT was 91% (n = 377). The majority of children's caregivers were HIV positive (86%, n = 387) and were aware about IPT (63.6%, n = 264). Factors associated with IPT uptake included; having an employed caregiver [Adjusted Prevalence Ratio (aPR): 1.06 95% Confidence Interval (CI): 1.00-1.13] and attending the ART clinic every month [aPR: 1.00; 95% CI: 0.87-1.00] . CONCLUSIONS: The uptake of IPT uptake among CLHIV in Mwanza, Tanzania exceeds the global WHO-target of ≥ 90%. Monthly ART clinic visits could be essential in promoting IPT uptake among CLHIV.

Taiwan's community health care evolution: Navigating pandemic challenges and shaping the future.

The COVID-19 pandemic has significantly shaped population dynamics and healthcare systems. Primary care clinics in Taiwan demonstrated remarkable resilience in managing the pandemic. This adaptability is reflected in rigorous screening processes, proactive vaccination efforts, and the seamless integration of telehealth services. Noteworthy shifts have been observed in the redistribution of primary care clinics and a decline in preventive healthcare measures. In response to these challenges, Taiwan has embraced a multifaceted approach, with telehealth services, home-based clinical care initiatives, community-based care, and innovative programs, like the Hospital at Home initiative, assuming central roles in mitigating the impact of the pandemic. These strategies underscore a forward-thinking healthcare delivery approach that prioritizes patient well-being. Critical solutions include ongoing reforms in clinical practices, the contingency plans for preventive healthcare, the promotion of telehealth services, the adoption of home-based clinical care, and the enhancement of the integration of practice. Taiwan's visionary initiatives, including digital intelligent healthcare approaches, serve as a robust foundation for building a resilient and patient-centered healthcare system. These concerted efforts and healthcare innovations are necessary for shaping a comprehensive, accessible, and responsive future. Taiwan is setting a noteworthy example for global healthcare systems to follow by prioritizing the well-being of the population.

Regional and socioeconomic disparities in calcium scans.

INTRODUCTION: Disparities in cardiovascular care are well recognized, with socioeconomic status being one of the strongest determinants of cardiovascular disease outcomes. This study evaluates whether these disparities translate to coronary artery calcium (CAC) scan utilization. Specifically, we aim to describe regional variation and socioeconomic variables that impact CAC utilization across the United States relative to the prevalence of coronary artery disease (CAD) and related comorbidities. METHODS: This cross-sectional study integrates county-level CAC utilization with CAD prevalence and publicly available socioeconomic variables including self-identified ethnicity, education, and adjusted gross income. CAC utilization rates were sourced from 2022 hospital commercial claims, outpatient Medicare service claims, and independent imaging center claims. Heart disease prevalence and socioeconomic variables were extracted from the Centers for Disease Control and Prevention and the National Center for Chronic Disease Prevention and Health Promotion. Adjusted gross income per capita was gathered from Internal Revenue Service data. RESULTS: CAC utilization was evaluated across 808 counties within the United States, representing 600,379 claims. Median utilization was 1.62 scans per 1,000 persons with a range of 0.03 to 104.39. The West had the highest CAC scan utilization rate (median 3.09 scans per 1,000 persons) with a CAD prevalence of 548 per 100,000 persons. In contrast, the Midwest had the lowest utilization rate (median 1.24 scans per 1,000 persons) with a CAD prevalence of 635 per 100,000 persons. Socioeconomic factors that favor higher CAC utilization include a larger density of White/Caucasian ethnicity (p = 0.007) and a higher adjusted gross income per capita (p = 0.006). Counties with the lowest rates of CAC utilization have a higher population of African Americans (p <0.001) and a higher proportion of females (p <0.001). CONCLUSION: This analysis highlights regional and socioeconomic differences in CAC utilization in the United States. Under-represented ethnicities such as African Americans have among the lowest rates of CAC utilization despite having a higher burden and mortality from heart disease. Discordance between CAC utilization, heart disease prevalence and socioeconomic status reveals a need for targeted interventions and policies aimed at mitigating structural barriers that perpetuate health inequities.

Examination of the Knowledge Levels of Family Medicine Residents in Turkey about Oral and Dental Health.

PURPOSE: To measure the general oral and dental health knowledge level of family medicine residents who are receiving full-time specialty training in Turkey. Primary care physicians can contribute to improving the oral and dental health of patients during general health services. MATERIALS AND METHODS: The fundamentals of oral and dental health that the family medicine physicians should know about were determined, and questionnaire items on these fundamentals were prepared. The sample size was calculated as 296 individuals. The survey was conducted online. The collected data were analysed employing the following tests: chi-squared, Fisher, Kolmogorov-Smirnov, Spearman, ANOVA, Mann-Whitney U, Kruskal-Wallis, and Bonferroni. RESULTS: 302 family medicine residents in various clinics in Turkey participated in the study. The mean age of the participants was 29.6 ± 5.1. The mean knowledge scores of the resident physicians were calculated as 65.2 ± 10.9 (lowest: 27; highest: 92). The majority of resident physicians stated that they did not receive training on oral and dental health during their residency training, and that they agreed with the idea of integrating it into the residency training curriculum. CONCLUSIONS: The general knowledge level of family medicine residents in Turkey about oral and dental health was found to be moderate.

Effectiveness of preventive intervention programmes aiming to improve oral health in children who have undergone caries-related dental extractions: a rapid review.

OBJECTIVE: To determine the effectiveness of preventive interventions in children who have undergone caries-related dental extractions. METHODS: Rapid review across five databases (CENTRAL, Ovid Medline, Embase, Web of Science and Scopus). Quality was assessed using the Risk of Bias 2 tool. RESULTS: Five studies were included, all randomised controlled trials involving pre-and/or post-extractions activity. Three studies involved oral health education (computer game, motivational interviewing, visual aids), one delivered clinical prevention (fissure sealants), and one an enhanced prevention programme combining additional health education and a clinical intervention (fluoride varnish). Retention was mixed (55%-80% in the intervention groups). Of the three studies measuring caries, all reported less caries development in the test group. However, only a study involving a dental nurse-delivered structured conversation, informed by motivational interviewing, showed an improvement in oral health. Two studies reporting on plaque and gingival bleeding had conflicting results. A study reporting on subsequent dental attendance did not demonstrate a clear improvement. CONCLUSION: Few published studies have explored prevention-based interventions in high caries-risk children requiring dental extractions. Whilst evidence of clinical benefit of preventive interventions in this population is limited, the potential use of contemporary behaviour change techniques appears promising. There is an urgent need for more high-quality longer-term trials using contemporary methodologies.

The preventative effects of Lactococcus Lactis metabolites against LPS-induced sepsis.

Introduction: Sepsis is a syndrome of organ dysfunction caused by a dysregulated host response to infection and septic shock. Currently, antibiotic therapy is the standard treatment for sepsis, but it can lead to drug resistance. The disturbance of the gut microbiota which is affected by sepsis could lead to the development of organ failure. It is reported that probiotics could shape the gut microbiota, potentially controlling a variety of intestinal diseases and promoting whole-body health. Methods: In this study, we evaluated the preventive effects of intra- and extracellular products of probiotics on sepsis. The extracellular products of Lactococcus lactis (L. lactis) were identified through the in vivo cell experiments. The preventive effect and mechanism of L. lactis extracellular products on mouse sepsis were further explored through HE staining, mouse survival rate measurement, chip analysis, etc. Results: L. lactis extracellular products increase cell survival and significantly reduce inflammatory factors secreted in a cellular sepsis model. In in vivo experiments in mice, our samples attenuated sepsis-induced pulmonary edema and inflammatory infiltrates in the lungs of mice, and reduced mortality and inflammatory factor levels within the serum of mice. Finally, the mechanism of sepsis prevention by lactic acid bacteria is suggested. Extracellular products of L. lactis could effectively prevent sepsis episodes. Discussion: In animal experiments, we reported that extracellular products of L. lactis can effectively prevent sepsis, and preliminarily discussed the pathological mechanism, which provides more ideas for the prevention of sepsis. In the future, probiotics may be considered a new way to prevent sepsis.

Comparison of characteristic competencies of public health nurses working at a community general support center and health and welfare in public administration in Japan.

Objectives: To compare the characteristic competencies of public health nurses working for the older adult's health and welfare in public administration ("PA") with those at community general support centers ("CGSC") in Japan. Methods: We conducted a questionnaire survey by mail for PA and CGSC public health nurses. A competency list that was developed to compare three groups (PA, CGSC experts with ≥5 years of experience, and CGSC newcomers with ≤2 years of experience) was used. The following characteristics were examined: (1) competencies acquired early after arriving at the CGSC, (2) competencies acquired through a certain amount of CGSC experience, (3) common competencies, (4) competencies that even experts lacked, and (5) competencies that the newcomers lacked. Results: We examined the responses of 171 PA nurses, 185 CGSC expert public health nurses, and 165 CGSC newcomer public health nurses. The results of comparison of the three groups showed that (1) had no applicable items; (2) had nine items for individual support associated with preventive care management; (3) had 14 items including teamwork among three professionals (social workers, senior care manager, public health nurse)/other professionals and self-improvement; (4) had three items for community development, (5) had two items for individual support and 16 items for community development. Conclusion: Initiatives for preventive care and coordination of care teams should be supported and suggested as characteristic competencies for CGSC public health nurses.

Gerontology in Public Health: A Scoping Review of Current Perspectives and Interventions.

The intersection of gerontology and public health is increasingly vital due to the global aging population and its implications for health systems. This scoping review aims to map existing literature on gerontology within public health, identify current perspectives, and evaluate interventions tailored to the needs of older adults. A systematic search was performed using predefined keywords across multiple databases, including PubMed, Google Scholar, Scopus, and Web of Science. The review included 42 studies that employed various designs, all focusing on public health interventions targeting the aging population.  Key findings indicate a pressing need to integrate gerontological principles into public health practice, recognizing the heterogeneous nature of older adults and the significance of social determinants of health. Interventions ranged from preventive health measures and chronic disease management programs to health promotion activities and caregiver support, including the application of technology to improve health outcomes. However, there was a notable lack of research on diverse populations and mental health interventions. The review also uncovered critical gaps in the literature, such as economic barriers to care access and the necessity for comprehensive policies addressing the aging population's diverse needs. In conclusion, this review emphasizes the importance of a multidimensional approach to effectively addressing older adults' health needs. While several effective interventions exist, there is an urgent need to tackle identified gaps, particularly concerning diverse populations and mental health, to enhance overall health strategies for the aging demographic.

Three-Dimensional Printed Lingual Arch Space Maintainer: A Game Changer in Pediatric Dentistry.

Early loss of deciduous teeth is a challenging situation to handle. In recent years, the loss of deciduous teeth has become very frequent because of the increased risk of caries. Space maintainers play a vital role in preventing space loss. Lingual arch space maintainers are effectively used to maintain space in the lower arch. In order to retain the length of the lower arch and to prevent mesial migration of the mandibular first permanent molar, lingual arch space maintainers are often indicated. Conventional lingual arch fabrication is technique-sensitive and cumbersome. Additionally, it has many documented drawbacks like solder breakage, cement loss, soft tissue lesions, etc. With the advent of newer technology like three-dimensional (3D) printing, the fabrication of appliances and prostheses has become more predictable, accurate, and relatively easier. The present case report highlights the technique and advantages of 3D printing to fabricate lingual arch space maintainers, which has the potential to revolutionize preventive orthodontics in pediatric dentistry.