Exploring activity-induced dental modifications in medieval Pieve di Pava (central Italy, 10th-12th centuries AD).

OBJECTIVE: This study aims to investigate the following aspects: i) presence of activity-induced dental modifications (AIDMs) in a medieval population from Pieve di Pava (Siena, central Italy); ii) sex-specific and age-specific distribution of AIDMs in the sample; iii) potential correlations between AIDMs and the tradi tional activities and cultural habits of rural communities in medieval Italy. DESIGN: The permanent teeth of 204 individuals buried at Pieve di Pava (10th-12th centuries AD) were systematically examined in order to assess the distribution of five types of AIDM, i.e. lingual surface attrition of the maxillary anterior teeth (LSAMAT), excessive occlusal load, grooving, notching, and chipping. RESULTS: Prevalence rates of LSAMAT, excessive occlusal load and grooving were low, whereas higher frequencies were recorded for the other types of AIDMs. Prevalence was higher in the male subsample for all the modifications recorded. Overall, the frequencies of AIDMs increased with age. CONCLUSIONS: The very low prevalence of LSAMAT was thought to be connected to leatherworking in the sample under study, while excessive occlusal load was interpreted as evidence that hard materials requiring preliminary chewing and softening were not regularly processed with teeth. The unique case of interproximal grooving in an old male individual may reflect the use of a toothpick for therapeutic purpose. Conversely, the very high prevalence of notching and chipping was taken as indicative of the processing of wool fibers. The sex-specific distribution of these AIDMs suggests that males performed activities involving the use of teeth more frequently than females.

Direct oral anticoagulants and therapeutic adherence: do not let your guard down.

BACKGROUND: Direct oral anticoagulants (DOAC) and vitamin K antagonist drugs (VKA) are recommended for stroke prevention in atrial fibrillation and for treatment of venous thromboembolism. Undoubtedly, DOAC have contributed to improve quality of life of these patients, but unfortunately, available 'real world' data show a very high variable compliance to DOAC. AIMS AND OBJECTIVES: to evaluate predictors that adversely affect therapeutic adherence in patients naive naïve  to DOAC. METHODS AND POPULATION: this study was conducted on an outpatient population in oral anticoagulant therapy in a period between January 2019 and February 2020. Patients naiveto DOAC and treated for at least 6 months were enrolled. Non-Italian-speaking patients, cognitive or psychiatric disorders, refusal to participate or non-consent to the interview were exclusion criteria. A socio-demographic scale and the 8-item Morisky scale (MMAS-8) questionnaire assessed therapeutic adherence. RESULTS: One hundred two DOAC-naïve patients were selected from a population of 407 patients on the first visit at our centre. The population was homogeneously represented for gender (males 48%). The mean age was 79.5 years. Atrial fibrillation (65.7%) resulted the main reason for DOAC prescription and a polypharmacy was detected in 47.1% of the patients. Moreover, an optimal adherence to DOAC therapy was assessed in less than 30% of patients. CONCLUSIONS: Polypharmacy, patient's isolation, such as a low education level were statistically associated with a low therapeutic adherence. Therapeutic adherence remains an unsolved problem for anticoagulated patient. To identify patients at higher risk of poor compliance and therapeutic failure and establish targeted care pathways is a priority.