How does the social “get under the gums”? The role of socio-economic position in the oral-systemic health link

OBJECTIVES: To evaluate the extent of association between systemic inflammation and periodontal disease in American adults, and to assess whether socio-economic position mediated this relationship. METHODS: We used data from the National Health and Nutrition Examination Survey (NHANES IV) (2001-2010). Systemic inflammation was defined by individual and aggregate (cumulative inflammatory load) biomarkers (C-reactive protein, white blood cell counts, neutrophil counts, and neutrophil: lymphocyte ratio). Loss of attachment and bleeding on probing were used to define periodontal disease. Poverty:income ratio and education were indicators of socio-economic position. Covariates included age, sex, ethnicity, smoking, alcohol, and attendance for dental treatment. Univariate and multivariable logistic regressions were constructed to assess the relationships of interest. RESULTS: In a total of 2296 respondents, biomarkers of systemic inflammation and cumulative inflammatory load were significantly associated with periodontal disease after adjusting for age, sex, and behavioural factors. Socio-economic position attenuated the association between markers of systemic inflammation and periodontal disease in the fully adjusted model. CONCLUSION: Socio-economic position partly explains how systemic inflammation and periodontal disease are coupled, and may thus have a significant role in the mechanisms linking oral and non-oral health conditions. It is of critical importance that the social and living conditions are taken into account when considering prevention and treatment strategies for inflammatory diseases, given what appears to be their impactful effect on disease processes

The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers

INTRODUCTION: Appraising the quality of studies included in systematic reviews combining qualitative and quantitative evidence is challenging. To address this challenge, a critical appraisal tool was developed: the Mixed Methods Appraisal Tool (MMAT). The aim of this paper is to present the enhancements made to the MMAT. DEVELOPMENT: The MMAT was initially developed in 2006 based on a literature review on systematic reviews combining qualitative and quantitative evidence. It was subject to pilot and interrater reliability testing. A revised version of the MMAT was developed in 2018 based on the results from usefulness testing, a literature review on critical appraisal tools and a modified e-Delphi study with methodological experts to identify core criteria. TOOL DESCRIPTION: The MMAT assesses the quality of qualitative, quantitative, and mixed methods studies. It focuses on methodological criteria and includes five core quality criteria for each of the following five categories of study designs: (a) qualitative, (b) randomized controlled, (c) nonrandomized, (d) quantitative descriptive, and (e) mixed methods. CONCLUSION: The MMAT is a unique tool that can be used to appraise the quality of different study designs. Also, by limiting to core criteria, the MMAT can provide a more efficient appraisal

Uncovering the impact of COVID-19 on the place of death of cancer patients in South America

Abstract: The COVID-19 pandemic has significantly impacted healthcare systems worldwide, especially on the management of chronic diseases such as cancer. This study explores the effects of COVID-19 on cancer mortality trends in Brazil, Chile, and Peru. The monthly age-standardized mortality rates in different places of death (hospital/clinic or home) were estimated using vital statistics and death certificate databases. An interrupted time series analysis was performed for each country, using the date of lockdown implementation as the intervention point. Overall cancer mortality rates reduced after the implementation of pandemic restrictions, with a significant decrease in Brazil. In total, 75.3%, 55.4%, and 45.7% of deaths in Brazil, Peru, and Chile, respectively, occurred in hospitals. After lockdowns were implemented, at-home deaths increased in all countries, and in-hospital deaths correspondingly decreased only in Chile. Our results suggest that COVID-19 has significantly affected rates of cancer mortality and place of death in Latin America

Acetylcholinesterase inhibitors and risk of bleeding and acute ischemic events in non-hypertensive Alzheimer’s patients

Introduction: Acetylcholinesterase inhibitors (AChEIs) are commonly used to treat mild to moderate cases of Alzheimer disease (AD). To the best of our knowledge, there has been no study estimating the risk of bleeding and cardiovascular events in patients with non-hypertensive AD. Therefore, this study aimed to estimate the association between AChEIs and the risk of bleeding and cardiovascular ischemic events in patients with non-hypertensive AD. Methods: A nested case-control study was conducted to estimate the risk of bleeding and ischemic events (angina, myocardial infarction [MI], and stroke) in patients with AD. This study was conducted using the UK Clinical Practice Research Datalink and Hospital Episode Statistics (HES) databases. The study cohort consisted of AD patients ≥65 years of age. The case groups included all AD subjects in the database who had a bleeding or ischemic event during the cohort follow-up. Four controls were selected for each case. Patients were classified as current users or past users based on a 60-day threshold of consuming the drug. Simple and multivariable conditional logistic regression analyses were used to calculate the adjusted odds ratio for bleeding events and cardiovascular events. Results: We identified 507 cases and selected 2028 controls for the bleeding event cohort and 555 cases and 2220 controls for the ischemic event cohort. The adjusted odds ratio (OR) (95% confidence interval [CI]) for the association of AChEI use was 0.93 (0.75 to 1.16) for bleeding events, 2.58 (1.01 to 6.59) for angina, and 1.89 (1.07 to 3.33) for MI. Past users of AChEIs were also at increased risk of stroke (1.51 [1.00 to 2.27]). Discussion: This is the first study assessing the risk of bleeding and cardiovascular events in patients with non-hypertensive AD. Our findings could be of great interest for clinicians and researchers working on AD

Chronotherapy in dentistry: A scoping review

The circadian clock modulates almost all vital aspects of our physiology and metabolism, including processes relevant to dentistry, such as healing, inflammation and nociception. Chronotherapy is an emerging field aiming to improve therapeutic efficacy and decrease adverse effects on health outcomes. This scoping review aimed to systematically map the evidence underpinning chronotherapy in dentistry and to identify gaps in knowledge. We conducted a systematic scoping search using four databases (Medline, Scopus, CINAHL and Embase). We identified 3908 target articles screened by two blinded reviewers, and only original animal and human studies investigating the chronotherapeutic use of drugs or interventions in dentistry were included. Of the 24 studies included, 19 were human studies and five were animal studies. Chrono-radiotherapy and chrono-chemotherapy reduced treatment side effects and improved therapeutic response, leading to higher survival rates in cancer patients. Animal studies reported that tooth movement and periodontal tissue response to orthodontic forces follow a diurnal rhythm that might influence bone metabolism. Profound and prolonged local anesthesia could be achieved when injected in the evening. Although the overall quality of the included studies was low, chronotherapy applications in dentistry seem to have favourable outcomes, especially in head and neck cancer treatments

“When a Tihik drinks kaxmuk he neither has a father, nor a mother, or a brother” : perceptions of Maxakali on the effects of sugarcane liquor consumption

Este artigo explora um dos aspectos mais interessantes e menos estudados no Brasil: as consequências das experiências complexas e contraditórias da substituição total de bebidas tradicionais indígenas pela cachaça, introduzida pelo contato interétnico. Contribui com a carência de ampliação de estudos na temática, analisando as consequências negativas do uso de álcool Maxakali. Enquanto estudos antropológicos enfatizam funções do beber tradicional e contemporâneo como “lubrificantes” sociais, as percepções sociais Maxakali ressaltam consequências negativas do uso da cachaça vendida ou trocada no contato interétnico. Interpretou-se no cotidiano, símbolos e significados dessas consequências, narradas por 21 lideranças em grupos focais. Com a substituição da Kaxmuk pelos Maxakali, ocorreram adaptações surgidas pelo contato interétnico, com relações negativas para quem bebe, suas família, aldeia e comunidade. No mundo-da-vida, as consequências negativas apresentaram-se em forma de acidentes, desarmonias conjugais, negligências, além de comportamentos violentos, doenças e mortes. Este estudo reforça a importância de produção de conhecimentos aprofundados e abrangentes visando a identificação de grupos vulneráveis em busca de soluções participantes.This study explores one of the most interesting and least studied issues in Brazil: the consequences of complex and contradictory experiences by replacing the traditional drinks by cachaça, introduced through interethnic contact. Given the rarity of the study of Maxakali alcohol consumption in research, this study aims to understand, from the native’s point of view, the negative aftereffect of alcohol consumption. Although anthropological studies emphasize functions of traditional and contemporary drinking as social “lubricants”, social perceptions of the Maxakali highlight the problems of cachaça bought through interethnic contact. Symbols and meanings of these consequences were interpreted through their daily life histories, recorded by 21 leaders in focus group. Through the interethnic contact, some adaptations have occurred in the Maxakali alcohol use, with negative consequences for those who drink, their families, their villages and their community. In the world-of-life, these changes these changes can be seen through accidents, insults, marital disharmony, neglects, violent behavior, illness and death. This study’s findings highlight the importance of producing comprehensive and in-depth knowledge in search of to identify vulnerable groups and to develop participatory solutions

Association between periodontitis and severity of COVID-19 infection: A case–control study

Aim: COVID-19 is associated with an exacerbated inflammatory response that can result in fatal outcomes. Systemic inflammation is also a main characteristic of periodontitis. Therefore, we investigated the association of periodontitis with COVID-19 complications. Materials and Methods: A case–control study was performed using the national electronic health records of the State of Qatar between February and July 2020. Cases were defined as patients who suffered COVID-19 complications (death, ICU admissions or assisted ventilation), and controls were COVID-19 patients discharged without major complications. Periodontal conditions were assessed using dental radiographs from the same database. Associations between periodontitis and COVID 19 complications were analysed using logistic regression models adjusted for demographic, medical and behaviour factors. Results: In total, 568 patients were included. After adjusting for potential confounders, periodontitis was associated with COVID-19 complication including death (OR = 8.81, 95% CI 1.00–77.7), ICU admission (OR = 3.54, 95% CI 1.39–9.05) and need for assisted ventilation (OR = 4.57, 95% CI 1.19–17.4). Similarly, blood levels of white blood cells, D-dimer and C Reactive Protein were significantly higher in COVID-19 patients with periodontitis. Conclusion: Periodontitis was associated with higher risk of ICU admission, need for assisted ventilation and death of COVID-19 patients, and with increased blood levels of biomarkers linked to worse disease outcomes

Depopulation impacts on ecosystem services in Mediterranean rural areas

Despite the exponential increase in human population at global scale, some rural areas have experienced a progressive abandonment over the last decades. Under particular socioecological and policy contexts, changes in demography may promote land-use changes and, consequently, alter ecosystem services (ES) supply. However, most studies on this topic have targeted urban population increase, whereas depopulation has been rarely addressed. Here, we examined how shifts in demographic variables (human population, population density, and number of villages) affect provisioning (water supply, food and biomass production) and regulating (soil retention, water and nutrient regulation) ES in Mediterranean rural areas with contrasting environmental, so-cioeconomic and land-use contexts. When depopulation results in underuse of socio-ecological systems, we ex-pected a decrease of provisioning and an increase of regulating ES, whereas we expected the opposite pattern when it results in land-use intensification. To test this hypothesis, we compared demographic data and ES estimated with Soil and Water Assessment Tool (SWAT) linked to land-use changes between the 1950s and 2000s in three rural areas of Arag ́on (NE Spain). Generalized Additive Mixed Models and Linear Mixed-Effect Models were used to analyze demographic trends, ES changes and the relationship between them. We found severe depopulation (− 42% inhabitants) and associated land-use changes in the three areas, which was particularly evident in isolated mountainous zones (− 63% inhabitants). Depopulation trends significantly affected land use and, consequently, all of the ES evaluated. In mountainous depopulated areas, land abandonment and rewilding resulted in the increase in water regulation (>1000%) and soil retention (>400%). In contrast, agriculture was intensified in more fertile and easy-to-access lowland areas, boosting the food production service (>600%). Accordingly, the interactions among depopulation, crop production and regulating ES should be considered in the management schemes and policies targeting rural areas for a balanced and sustainable supply of ES in the long term

Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs

The Global Alliance for Infections in Surgery : defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p <0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Peer reviewe