Beneficial effects of dark chocolate for episodic memory in healthy young adults: a parallel-groups acute intervention with a white chocolate control

There is good evidence that cocoa flavonoids can acutely improve cognitive function in humans, possibly via mechanisms such as increased cerebral blood flow. To date, much of the evidence is based on measures of executive function with extracts and cocoa-based interventions with a high flavonoid content. The aim of the present study was to explore whether benefits to episodic verbal memory and mood are observed two hours post consumption of a commercially available dark chocolate (DC) bar relative to a 35 g white chocolate bar (WC). Ninety-eight healthy young adults (n = 57 females) aged 18−24 years consumed either a 35 g DC bar or a calorie-matched low flavonoid WC bar. Verbal episodic memory and mood were assessed pre consumption and 2 h post consumption. An ANOVA analysis showed that the DC was associated with better verbal memory performance for several outcome measures of the Rey Auditory Verbal Learning Test relative to the WC, however, there were no effects on mood. These findings lend support to the notion that everyday available portions of dark chocolate can confer benefits to the brain in healthy consumers

A cross-sectional study of explainable machine learning in Alzheimer’s disease: diagnostic classification using MR radiomic features

IntroductionAlzheimer’s disease (AD) even nowadays remains a complex neurodegenerative disease and its diagnosis relies mainly on cognitive tests which have many limitations. On the other hand, qualitative imaging will not provide an early diagnosis because the radiologist will perceive brain atrophy on a late disease stage. Therefore, the main objective of this study is to investigate the necessity of quantitative imaging in the assessment of AD by using machine learning (ML) methods. Nowadays, ML methods are used to address high dimensional data, integrate data from different sources, model the etiological and clinical heterogeneity, and discover new biomarkers in the assessment of AD.MethodsIn this study radiomic features from both entorhinal cortex and hippocampus were extracted from 194 normal controls (NC), 284 mild cognitive impairment (MCI) and 130 AD subjects. Texture analysis evaluates statistical properties of the image intensities which might represent changes in MRI image pixel intensity due to the pathophysiology of a disease. Therefore, this quantitative method could detect smaller-scale changes of neurodegeneration. Then the radiomics signatures extracted by texture analysis and baseline neuropsychological scales, were used to build an XGBoost integrated model which has been trained and integrated.ResultsThe model was explained by using the Shapley values produced by the SHAP (SHapley Additive exPlanations) method. XGBoost produced a f1-score of 0.949, 0.818, and 0.810 between NC vs. AD, MC vs. MCI, and MCI vs. AD, respectively.DiscussionThese directions have the potential to help to the earlier diagnosis and to a better manage of the disease progression and therefore, develop novel treatment strategies. This study clearly showed the importance of explainable ML approach in the assessment of AD

The MEDEA childhood asthma study design for mitigation of desert dust health effects: implementation of novel methods for assessment of air pollution exposure and lessons learned

Background: Desert dust events in Mediterranean countries, originating mostly from the Sahara and Arabian deserts, have been linked to climate change and are associated with significant increase in mortality and hospital admissions from respiratory causes. The MEDEA clinical intervention study in children with asthma is funded by EU LIFE+ program to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related health effects. Methods: This paper describes the design, methods, and challenges of the MEDEA childhood asthma study, which is performed in two highly exposed regions of the Eastern Mediterranean: Cyprus and Greece-Crete. Eligible children are recruited using screening surveys performed at primary schools and are randomized to three parallel intervention groups: a) no intervention for desert dust events, b) interventions for outdoor exposure reduction, and c) interventions for both outdoor and indoor exposure reduction. At baseline visits, participants are enrolled on MEDena® Health-Hub, which communicates, alerts and provides exposure reduction recommendations in anticipation of desert dust events. MEDEA employs novel environmental epidemiology and telemedicine methods including wearable GPS, actigraphy, health parameters sensors as well as indoor and outdoor air pollution samplers to assess study participants’ compliance to recommendations, air pollutant exposures in homes and schools, and disease related clinical outcomes. Discussion: The MEDEA study evaluates, for the first time, interventions aiming to reduce desert dust exposure and implement novel telemedicine methods in assessing clinical outcomes and personal compliance to recommendations. In Cyprus and Crete, during the first study period (February–May 2019), a total of 91 children participated in the trial while for the second study period (February–May 2020), another 120 children completed data collection. Recruitment for the third study period (February–May 2021) is underway. In this paper, we also present the unique challenges faced during the implementation of novel methodologies to reduce air pollution exposure in children. Engagement of families of asthmatic children, schools and local communities, is critical. Successful study completion will provide the knowledge for informed decision-making both at national and international level for mitigating the health effects of desert dust events in South-Eastern Europe. Trial registration: ClinicalTrials.gov: NCT03503812, April 20, 2018

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Removing Fluoride from Drinking Water By Organic Polymers

Fluoride is a substance that can provide beneficial or detrimental effects depending on the total amount ingested. Naturally occurring high fluoride concentrations exist in many drinking water supplies. The fluoride removal methods developed in the past have been found to be either impractical and/or not cost effective. The purpose of this study was to determine whether organic polymers can effectively remove fluoride. The water used in this study contained naturally occurring fluoride concentrations between 4.5 to 5.5 mg/1 and it was collected from the City of Franklin, Virginia, water supply system. Laboratory jar test procedures, which simulated a conventional water treatment plant, were carried out; organic polymers were used as primary coagulants and metal salts and clay were used as coagulant aids. Results indicated that the most effective combination was that of a cationic polymer and alum. At the optimum dosage, the optimum fluoride concentration was achieved without significantly affecting the pH, turbidity, alkalinity, and hardness of the water

Clinical evaluation of protocols in management of incipient caries lesions in adults

Objectives. The principles of modern caries management include detection and long-term monitoring of incipient non cavitated caries lesions; evaluation of patient's caries risk and effort to reduce the risk as well as caries management by applying less invasive treatment options and always according to the caries risk profile of each patient. The treatment of patients should focus mainly on prevention (using high fluoride toothpastes, solutions, patient education, etc) and avoid further invasive treatments, achieving thus the goal of modern dentistry, which follows the philosophy of minimal intervention. The effort of balancing the causative factors of caries with the protective factors in conjunction with caries risk assessment offers the ability to focus on the patient for the prevention and treatment before there is an irreversible lesion on dental tissues. For the application of modern caries management and treatment today, it is necessary to clinically apply a proper cost-effective prevention program on incipient caries lesions, according to minimally invasive principles, which guides the dentist beyond the theory, in the clinical practice.The aim of this study was to investigate the management of incipient carious lesions in adults with two preventive protocols. Different protocols were applied, based on the caries risk of each patient. The protocols for the management of incipient caries lesions evaluated in this clinical study include preventive and minimally invasive methods as published at the most recent studies of incipient lesions treatment. Moreover, the present in vivo study assessed detection ability of the Vista Proof and DIAGNOdent pen device at the incipient occlusal caries lesions of permanent teeth. Methods. A total of 50 adult patients of high, moderate and low caries risk with 516 incipient caries took part in the present study. These patients were assessed for caries with ICDAS criteria and were then divided into 3 groups depending on their caries risk profile: a high risk, a moderate risk and a low caries risk group. Participants in each group were further divided randomly into 2 subgroups (intervention group and control group). In intervention subgroups an intensive preventive protocol was applied while in control subgroups the protocol consisted only of instructions for oral hygiene. The invasive-intensive protocol included the topical application of fluoride, brushing with 5000ppm fluoride toothpaste, use of ACP-CPP, applications of sealants at occlusal lesions ICDAS code 2 and minimal resin restorations at occlusal lesions ICDAS code 3. In the control group and in the intervention group, recalls were performed at time intervals according to the caries risk of each patient. High risk patients were re-examined every 3 months, moderate risk every 6 months and low risk at 1 year. At the recalls, each lesion treated or not, was re-evaluated by the clinical ICDAS criteria (pit and fissures caries, root caries, caries on smooth surfaces, proximal surfaces). Moreover pit and fissures caries were evaluated with diagnostic devices. The treatment and the control groups were compared and the development of lesions was evaluated. Additionally, the diagnostic capacity of Vista Proof ™ and DIAGNOdent pen ™ devices was evaluated in relation to Visual examination with ICDAS II clinical criteria.The percentage and absolute number of incipient lesions in all groups at baseline examination and at the one year recall as well as the DMFS index for each group, were calculated. The changes for each lesion from the baseline examination to the one year recall were recorded. The non-parametric WILCOXON statistic test was applied in the two visits (baseline and one year) in each group for number of lesions comparison. Sensitivity, specificity, area under the ROC curve (Az values) at D1 threshold were calculated for the detection methods (Vistaproof and Diagnodentpen) independently in the annual recall. D1 threshold was used as lesions were incipient and ICDAS measurements were inferior to 4. Finally the agreement (ICC-Intraclass correlation coefficient) was calculated between diagnostic methods.ResultsΤhere was no statistically significant difference in the number of lesions (baseline and after 1 year) within the high-risk and moderate-risk groups that received the intensive protocol, while the control groups were statistically significant different. In patients with moderate caries risk, the intervention group presented lower caries development Rates, lower DMFS index than the control group. In patients with high caries risk the control group presented significant lower DMFS than the intervention group. The control group in patients with high caries risk presented overall better results than the intervention group. In low caries risk group there was no statistically significant difference in the number of lesions. Regarding the caries diagnostic devices at the one year recall, sensitivity and specificity found 0.61 and 0.51 for Diagnodent while sensitivity and specificity of VistaProof device was 0.64 and 0.54, respectively. The different detection methods showed no differences in diagnostic capacity (Az values) and ICC values were found very low.ConclusionsThe two different preventive protocols in high and moderate caries risk groups presented differences in effectiveness. In patients with moderate caries risk oral hygiene instructions given to the control group are not adequate to control caries. In patients with high caries risk, the result of this study is not clear. The control group presented overall better results than the intervention group however some incipient lesions further progressed into dentin in the control group, a fact that did not exist in the intervention group. Thus in high caries risk patients due to the above mentioned result the dentist must choose whether to apply to the patient an intensive protocol, however the risk of some incipient lesions to progress into dentin must be considered. In such cases the final selection should be done in collaboration with the patient and the cost-effectiveness should be taken into account. Regarding the low caries risk patients, both protocols proved to have no difference in results, meaning that in these patients the application only of oral hygiene instructions is adequate for the management of the incipient lesions.Incipient lesions in patients should be monitored regularly as the present study showed that these lesions are possible to advance in less than a year to a “worse” category (as evaluated with ICDAS criteria).Regarding the devices this study showed that they could be used only as an auxiliary tool in the clinical examination for monitoring occlusal lesions.Σκοπός. Ο σκοπός της παρούσας μελέτης ήταν η αξιολόγηση δύο προληπτικών προγραμμάτων για την διαχείριση των αρχόμενων τερηδονικών βλαβών σε ενήλικες. Μέθοδοι. Πενήντα ενήλικες ασθενείς υψηλού, μέσου και χαμηλού τερηδονικού κινδύνου με 516 αρχόμενες τερηδονικές αλλοιώσεις έλαβαν μέρος στην παρούσα μελέτη. Αυτοί οι ασθενείς αξιολογήθηκαν με τα ICDAS κριτήρια και με τις διαγνωστικές συσκευές Vista Proof™ και DIAGNOdent pen™ και στη συνέχεια χωρίστηκαν σε 3 ομάδες ανάλογα με τον τερηδονικό τους κίνδυνο: σε μια ομάδα υψηλού τερηδονικού κινδύνου, μια ομάδα μέσου κινδύνου και μια ομάδα χαμηλού τερηδονικού κινδύνου. Οι συμμετέχοντες σε κάθε ομάδα περαιτέρω χωρίστηκαν τυχαία σε 2 υποομάδες (ομάδα παρέμβασης και ομάδα ελέγχου).Στις υποομάδες παρέμβασης εφαρμόστηκε ένα εντατικό προληπτικό πρωτόκολλο ενώ στις υποομάδες ελέγχου το πρωτόκολλο περιελάμβανε μόνο οδηγίες στοματικής υγιεινής. Το πρωτόκολλο στις ομάδες παρέμβασης περιελάμβανε την τοπική εφαρμογή φθορίου, βούρτσισμα με οδοντόκρεμα 5000ppm φθορίου, χρήση ACP-CPP, εφαρμογές ΚΟΣ-sealants στις μασητικές αλλοιώσεις με κωδικό 2 κατά τα ICDAS II κριτήρια και αποκαταστάσεις με σύνθετη ρητίνη στις μασητικές αλλοιώσεις με κωδικό 3 κατά ICDAS II. Έγινε σύγκριση των 2 ομάδων -της ομάδας θεραπείας και της ομάδας ελέγχου- και αξιολόγηση της εξέλιξης των βλαβών. Επίσης αξιολογήθηκε η ικανότητα διάγνωσης των συσκευών Vista Proof™ και DIAGNOdent pen™ σε σχέση με την οπτική παρατήρηση, με βάση τα ICDAS II κλινικά κριτήρια. Αποτελέσματα. Δεν βρέθηκε στατιστικά σημαντική διαφορά στον αριθμό των βλαβών (στην αρχική εξέταση και μετά από 1 έτος) στις ομάδες υψηλού κινδύνου και μέσου τερηδονικού κινδύνου που εφαρμόστηκαν τα εντατικά πρωτοκόλλα, ενώ στις αντίστοιχες ομάδες ελέγχου βρέθηκαν στατιστικά σημαντικές διαφορές. Στην ομάδα χαμηλού τερηδονικού κινδύνου δεν υπήρχε στατιστικά σημαντική διαφορά στον αριθμό των βλαβών. Όσον αφορά τις διαγνωστικές συσκευές οι διαφορετικοί μέθοδοι ανίχνευσης των τερηδονικών βλαβών δεν παρουσίασαν διαφορές ως προς την ικανότητα διάγνωσης.Συμπεράσματα Τα δύο διαφορετικά προληπτικά πρωτόκολλα παρουσίασαν διαφορές στην αποτελεσματικότητα στις ομάδες υψηλού και μέσου τερηδονικού κινδύνου. Όσον αφορά τους ασθενείς χαμηλού τερηδονικού κινδύνου, η εφαρμογή οδηγιών στοματικής υγιεινής είναι ουσιώδης για τη διαχείριση των αρχόμενων βλαβών. Όσον αφορά τις συσκευές η παρούσα μελέτη έδειξε ότι θα μπορούσαν να χρησιμοποιηθούν μόνο σαν βοηθητικό εργαλείο στην κλινική εξέταση για την παρακολούθηση μασητικών αλλοιώσεων

Κλινική αξιολόγηση πρωτοκόλλων διαχείρισης αρχόμενων τερηδονικών βλαβών σε ενήλικες

Σκοπός Ο σκοπός της παρούσας μελέτης ήταν η αξιολόγηση δύο προληπτικών προγραμμάτων για την διαχείριση των αρχόμενων τερηδονικών βλαβών σε ενήλικες. Μέθοδοι Πενήντα ενήλικες ασθενείς υψηλού, μέσου και χαμηλού τερηδονικού κινδύνου με 516 αρχόμενες τερηδονικές αλλοιώσεις έλαβαν μέρος στην παρούσα μελέτη. Αυτοί οι ασθενείς αξιολογήθηκαν με τα ICDAS κριτήρια και με τις διαγνωστικές συσκευές Vista Proof™ και DIAGNOdent pen™ και στη συνέχεια χωρίστηκαν σε 3 ομάδες ανάλογα με τον τερηδονικό τους κίνδυνο: σε μια ομάδα υψηλού τερηδονικού κινδύνου, μια ομάδα μέσου κινδύνου και μια ομάδα χαμηλού τερηδονικού κινδύνου. Οι συμμετέχοντες σε κάθε ομάδα περαιτέρω χωρίστηκαν τυχαία σε 2 υποομάδες (ομάδα παρέμβασης και ομάδα ελέγχου). Στις υποομάδες παρέμβασης εφαρμόστηκε ένα εντατικό προληπτικό πρωτόκολλο ενώ στις υποομάδες ελέγχου το πρωτόκολλο περιελάμβανε μόνο οδηγίες στοματικής υγιεινής. Το πρωτόκολλο στις ομάδες παρέμβασης περιελάμβανε την τοπική εφαρμογή φθορίου, βούρτσισμα με οδοντόκρεμα 5000ppm φθορίου, χρήση ACP-CPP, εφαρμογές ΚΟΣ-sealants στις μασητικές αλλοιώσεις με κωδικό 2 κατά τα ICDAS II κριτήρια και αποκαταστάσεις με σύνθετη ρητίνη στις μασητικές αλλοιώσεις με κωδικό 3 κατά ICDAS II. Έγινε σύγκριση των 2 ομάδων -της ομάδας θεραπείας και της ομάδας ελέγχου- και αξιολόγηση της εξέλιξης των βλαβών. Επίσης αξιολογήθηκε η ικανότητα διάγνωσης των συσκευών Vista Proof™ και DIAGNOdent pen™ σε σχέση με την οπτική παρατήρηση, με βάση τα ICDAS II κλινικά κριτήρια. Αποτελέσματα Δεν βρέθηκε στατιστικά σημαντική διαφορά στον αριθμό των βλαβών (στην αρχική εξέταση και μετά από 1 έτος) στις ομάδες υψηλού κινδύνου και μέσου τερηδονικού κινδύνου που εφαρμόστηκαν τα εντατικά πρωτοκόλλα, ενώ στις αντίστοιχες ομάδες ελέγχου βρέθηκαν στατιστικά σημαντικές διαφορές. Στην ομάδα χαμηλού τερηδονικού κινδύνου δεν υπήρχε στατιστικά σημαντική διαφορά στον αριθμό των βλαβών. Όσον αφορά τις διαγνωστικές συσκευές οι διαφορετικοί μέθοδοι ανίχνευσης των τερηδονικών βλαβών δεν παρουσίασαν διαφορές ως προς την ικανότητα διάγνωσης. Συμπεράσματα Τα δύο διαφορετικά προληπτικά πρωτόκολλα παρουσίασαν διαφορές στην αποτελεσματικότητα στις ομάδες υψηλού και μέσου τερηδονικού κινδύνου. Όσον αφορά τους ασθενείς χαμηλού τερηδονικού κινδύνου, η εφαρμογή οδηγιών στοματικής υγιεινής είναι ουσιώδης για τη διαχείριση των αρχόμενων βλαβών. Όσον αφορά τις συσκευές η παρούσα μελέτη έδειξε ότι θα μπορούσαν να χρησιμοποιηθούν μόνο σαν βοηθητικό εργαλείο στην κλινική εξέταση για την παρακολούθηση μασητικών αλλοιώσεων.Objectives The principles of modern caries management include detection and long-term monitoring of incipient non cavitated caries lesions; evaluation of patient's caries risk and effort to reduce the risk as well as caries management by applying less invasive treatment options and always according to the caries risk profile of each patient. The treatment of patients should focus mainly on prevention (using high fluoride toothpastes, solutions, patient education, etc) and avoid further invasive treatments, achieving thus the goal of modern dentistry, which follows the philosophy of minimal intervention. The effort of balancing the causative factors of caries with the protective factors in conjunction with caries risk assessment offers the ability to focus on the patient for the prevention and treatment before there is an irreversible lesion on dental tissues. For the application of modern caries management and treatment today, it is necessary to clinically apply a proper cost-effective prevention program on incipient caries lesions, according to minimally invasive principles, which guides the dentist beyond the theory, in the clinical practice. The aim of this study was to investigate the management of incipient carious lesions in adults with two preventive protocols. Different protocols were applied, based on the caries risk of each patient. The protocols for the management of incipient caries lesions evaluated in this clinical study include preventive and minimally invasive methods as published at the most recent studies of incipient lesions treatment. Moreover, the present in vivo study assessed detection ability of the Vista Proof and DIAGNOdent pen device at the incipient occlusal caries lesions of permanent teeth. Methods A total of 50 adult patients of high, moderate and low caries risk with 516 incipient caries took part in the present study. These patients were assessed for caries with ICDAS criteria and were then divided into 3 groups depending on their caries risk profile: a high risk, a moderate risk and a low caries risk group. Participants in each group were further divided randomly into 2 subgroups (intervention group and control group). In intervention subgroups an intensive preventive protocol was applied while in control subgroups the protocol consisted only of instructions for oral hygiene. The invasive-intensive protocol included the topical application of fluoride, brushing with 5000ppm fluoride toothpaste, use of ACP-CPP, applications of sealants at occlusal lesions ICDAS code 2 and minimal resin restorations at occlusal lesions ICDAS code 3. In the control group and in the intervention group, recalls were performed at time intervals according to the caries risk of each patient. High risk patients were re-examined every 3 months, moderate risk every 6 months and low risk at 1 year. At the recalls, each lesion treated or not, was re-evaluated by the clinical ICDAS criteria (pit and fissures caries, root caries, caries on smooth surfaces, proximal surfaces). Moreover pit and fissures caries were evaluated with diagnostic devices. The treatment and the control groups were compared and the development of lesions was evaluated. Additionally, the diagnostic capacity of Vista Proof ™ and DIAGNOdent pen ™ devices was evaluated in relation to Visual examination with ICDAS II clinical criteria. The percentage and absolute number of incipient lesions in all groups at baseline examination and at the one year recall as well as the DMFS index for each group, were calculated. The changes for each lesion from the baseline examination to the one year recall were recorded. The non-parametric WILCOXON statistic test was applied in the two visits (baseline and one year) in each group for number of lesions comparison. Sensitivity, specificity, area under the ROC curve (Az values) at D1 threshold were calculated for the detection methods (Vistaproof and Diagnodentpen) independently in the annual recall. D1 threshold was used as lesions were incipient and ICDAS measurements were inferior to 4. Finally the agreement (ICC-Intraclass correlation coefficient) was calculated between diagnostic methods. Results Τhere was no statistically significant difference in the number of lesions (baseline and after 1 year) within the high-risk and moderate-risk groups that received the intensive protocol, while the control groups were statistically significant different. In patients with moderate caries risk, the intervention group presented lower caries development Rates, lower DMFS index than the control group. In patients with high caries risk the control group presented significant lower DMFS than the intervention group. The control group in patients with high caries risk presented overall better results than the intervention group. In low caries risk group there was no statistically significant difference in the number of lesions. Regarding the caries diagnostic devices at the one year recall, sensitivity and specificity found 0.61 and 0.51 for Diagnodent while sensitivity and specificity of VistaProof device was 0.64 and 0.54, respectively. The different detection methods showed no differences in diagnostic capacity (Az values) and ICC values were found very low. Conclusions The two different preventive protocols in high and moderate caries risk groups presented differences in effectiveness. In patients with moderate caries risk oral hygiene instructions given to the control group are not adequate to control caries. In patients with high caries risk, the result of this study is not clear. The control group presented overall better results than the intervention group however some incipient lesions further progressed into dentin in the control group, a fact that did not exist in the intervention group. Thus in high caries risk patients due to the above mentioned result the dentist must choose whether to apply to the patient an intensive protocol, however the risk of some incipient lesions to progress into dentin must be considered. In such cases the final selection should be done in collaboration with the patient and the cost-effectiveness should be taken into account. Regarding the low caries risk patients, both protocols proved to have no difference in results, meaning that in these patients the application only of oral hygiene instructions is adequate for the management of the incipient lesions. Incipient lesions in patients should be monitored regularly as the present study showed that these lesions are possible to advance in less than a year to a “worse” category (as evaluated with ICDAS criteria). Regarding the devices this study showed that they could be used only as an auxiliary tool in the clinical examination for monitoring occlusal lesions

Pediatric asthma symptom control during lockdown for the COVID-19 pandemic in Spring 2020: A prospective community-based study in Cyprus and Greece

Objectives To prospectively quantify at the community level changes in asthma symptom control and other morbidity indices, among asthmatic schoolchildren in response to coronavirus disease 2019 (COVID-19) lockdown measures. Methods In Spring 2019 and Spring 2020, we prospectively assessed monthly changes in pediatric asthma control test (c-ACT), asthma medication usage, infections and unscheduled visits for asthma among schoolchildren with active asthma in Cyprus and Greece. We compared asthma symptom control and other morbidity indices before and during lockdown measures, while participants’ time spent at home was objectively assessed by wearable sensors. Results A total of 119 asthmatic children participated in the study during Spring 2020. Compared to a mean baseline (pre-COVID-19 lockdown) c-ACT score of 22.70, adjusted mean increases of 2.58 (95% confidence interval [CI]: 1.91, 3.26, p < 0.001) and 3.57 (95% CI: 2.88, 4.27, p < 0.001) in the 2nd and 3rd monthly assessments were observed after implementation of lockdown measures. A mean increase in c-ACT score of 0.32 (95% CI: 0.17, 0.47, p < 0.001) was noted per 10% increase in the time spent at home. Improvement was more profound in children with severe asthma, while significant reductions in infections, asthma medication usage and unscheduled visits for asthma were also observed. During Spring 2019, 39 children participated in the study in the absence of lockdown measures and no changes in c-ACT or other indices of disease severity were observed. Conclusions Clinically meaningful improvements in asthma symptom control, among asthmatic schoolchildren were observed during the COVID-19 lockdown measures in Spring 2020. Improvements were independently associated with time spent at home and were more profound in the children with severe asthma