Promoting behavioural changes to improve oral hygiene in patients with periodontal diseases: a systematic review

Aim: This systematic review investigates the impact of specific interventions aiming at promoting behavioural changes to improve oral hygiene (OH) in patients with periodontal diseases. Methods: A literature search was performed on different databases up to March 2019. Randomized and non-randomized controlled trials evaluating the effects of behavioural interventions on plaque and bleeding scores in patients with gingivitis or periodontitis were considered. Pooled data analysis was conducted by estimating standardized mean difference between groups. Results: Of 288 articles screened, 14 were included as follows: 4 studies evaluated the effect of motivational interviewing (MI) associated with OH instructions, 7 the impact of oral health educational programmes based on cognitive behavioural therapies, and 3 the use of self-inspections/videotapes. Studies were heterogeneous and reported contrasting results. Meta-analyses for psychological interventions showed no significant group difference for both plaque and bleeding scores. No effect was observed in studies applying self-inspection/videotapes. Conclusions: Within the limitations of the current evidence, OH may be reinforced in patients with periodontal diseases by psychological interventions based on cognitive constructs and MI principles provided by oral health professionals. However, no conclusion can be drawn on their specific clinical efficacy as measured by reduction of plaque and bleeding scores over time

Impact of risk factor control interventions for smoking cessation and promotion of healthy lifestyles in patients with periodontitis: a systematic review

Aim: The aim of this systematic review was to identify the most recent widely accepted guidelines for risk factor control interventions and to assess their impact in patients with periodontitis. Materials and methods: The electronic search strategy included a first systematic search to identify guidelines for interventions for smoking cessation, diabetes control, physical exercise (activity), change of diet, carbohydrate (dietary sugar) reduction and weight loss in the general population and a second systematic search to identify the studies evaluating these interventions in periodontitis patients. Results: A total of 13 guidelines and 25 studies were selected. Most guidelines included recommendations for all healthcare providers to provide interventions and follow-up counselling with the risk factors considered in the present review. In patients with periodontitis, interventions for smoking cessation and diabetes control were shown to improve periodontal health while the impact of dietary interventions and the promotion of other healthy lifestyles were moderate or limited. Conclusions: While aiming to improve treatment outcomes and the maintenance of periodontal health, current evidence suggests that interventions for smoking cessation and diabetes control are effective, thus emphasizing the need of behavioural support in periodontal care

Collaboration entre médecins généralistes et psychologues en libéral

Psychologists and general practitioners (GPs) are the stakeholders most consulted by patients with psychological difficulties. They each have their own professional identity, their own working framework, references, and language. In France, interactions between them seem limited in private practice. The importance of developing collaboration between GPs and psychologists is supported by data from collaborative mental health practices developed in various countries. Such practices have shown significant improvement in health care, and benefits for patients’ health, as well as for GPs’ and psychologists'practices, and for the community. In 2018, the French National Authority for Health published an overview of the situation and recommendations to improve the coordination between GPs and other healthcare actors concerning adult patients with mental health disorders. The review invites healthcare actors to work with better conviction, involvement, and shared culture, as well as to recognize each other's roles and competences. The professionals interviewed in this article, three psychologists and three GPs, outline the current state of collaboration between psychologists and GPs in France and in Belgium, reviewing professional identities, barriers to interactions and organizations. Interprofessional collaboration in mental health involving these actors is formalized and developed in several countries, unlike in France where work and experimentation are rare. The role of each is not well known, and few opportunities are offered for interprofessional practice and education. The authors report on their experience in the field, and on initiatives that have been implemented in a Southern France region. Several actions are reported: joint professional training evenings, “public cross-consultations” and “joint case studies” (with patients’ agreement), working group between faculties leading to a joint Study Day, programming paired cross-consultations in the practice of each, as well as exchanging medical and psychology students. This experience allowed for constructive meetings, exchanges within “professional couples” on common patients, and opportunities to expose medical and psychological views. It also enabled the authors to observe their different professional language and tools used, to break the isolation of mental health care actors, to accelerate the understanding of patients’ situations, and to mutually enrich professional knowledge and practices. This feedback from field experience, which is not representative or generalizable, shows that it is possible to take advantage of interprofessionality in the field. When the actors know each other, working together in the interest of the professionals and of the patients shows better results. Finally, the authors question what desirable directions should be adopted–particularly concerning the institutional frameworks recently implemented in France, and the need for share

On hypercharge flux and exotics in F-theory GUTs

We study SU(5) Grand Unified Theories within a local framework in F-theory with multiple extra U(1) symmetries arising from a small monodromy group. The use of hypercharge flux for doublet-triplet splitting implies massless exotics in the spectrum that are protected from obtaining a mass by the U(1) symmetries. We find that lifting the exotics by giving vacuum expectation values to some GUT singlets spontaneously breaks all the U(1) symmetries which implies that proton decay operators are induced. If we impose an additional R-parity symmetry by hand we find all the exotics can be lifted while proton decay operators are still forbidden. These models can retain the gauge coupling unification accuracy of the MSSM at 1-loop. For models where the generations are distributed across multiple curves we also present a motivation for the quark-lepton mass splittings at the GUT scale based on a Froggatt-Nielsen approach to flavour.Comment: 38 pages; v2: emphasised possibility of avoiding exotics in models without a global E8 structure, added ref, journal versio

Compact F-theory GUTs with U(1)_PQ

We construct semi-local and global realizations of SU(5) GUTs in F-theory that utilize a U(1)_PQ symmetry to protect against dimension four proton decay. Symmetries of this type, which assign charges to H_u and H_d that forbid a tree level \mu term, play an important role in scenarios for neutrino physics and gauge mediation that have been proposed in local F-theory model building. As demonstrated in arXiv:0906.4672, the presence of such a symmetry implies the existence of non-GUT exotics in the spectrum, when hypercharge flux is used to break the GUT group and to give rise to doublet-triplet splitting. These exotics are of precisely the right type to solve the unification problem in such F-theory models and might also comprise a non-standard messenger sector for gauge mediation. We present a detailed description of models with U(1)_PQ in the semi-local regime, which does not depend on details of any specific Calabi-Yau four-fold, and then specialize to the geometry of arXiv:0904.3932 to construct three-generation examples with the minimal allowed number of non-GUT exotics. Among these, we find a handful of models in which the D3-tadpole constraint can be satisfied without requiring the introduction of anti-D3-branes. Finally, because SU(5) singlets that carry U(1)_PQ charge may serve as candidate right-handed neutrinos or can be used to lift the exotics, we study their origin in compact models and motivate a conjecture for how to count their zero modes in a semi-local setting.Comment: 73 pages, 5 figures, v2: minor corrections to 4.3 and 6.3.1, reference adde

F-Theory GUT Vacua on Compact Calabi-Yau Fourfolds

We present compact three-generation F-theory GUT models meeting in particular the constraints of D3-tadpole cancellation and D-term supersymmetry. To this end we explicitly construct elliptically fibered Calabi-Yau fourfolds as complete intersections in a toric ambient space. Toric methods enable us to control the singular geometry of the SU(5) GUT model. The GUT brane wraps a non-generic del Pezzo surface admitting GUT symmetry breaking via hypercharge flux. It is contractible to a curve and we demonstrate the existence of a consistent decoupling limit. We compute the Euler characteristic of the singular Calabi-Yau fourfold to show that our three-generation flux solutions obtained via the spectral cover construction are consistent with D3-tadpole cancellation.Comment: 22+12 pages; v2: minor clarifications on decoupling limi

G-structures and Domain Walls in Heterotic Theories

We consider heterotic string solutions based on a warped product of a four-dimensional domain wall and a six-dimensional internal manifold, preserving two supercharges. The constraints on the internal manifolds with SU(3) structure are derived. They are found to be generalized half-flat manifolds with a particular pattern of torsion classes and they include half-flat manifolds and Strominger's complex non-Kahler manifolds as special cases. We also verify that previous heterotic compactifications on half-flat mirror manifolds are based on this class of solutions.Comment: 29 pages, reference added, typos correcte

On Global Flipped SU(5) GUTs in F-theory

We construct an SU(4) spectral divisor and its factorization of types (3,1) and (2,2) based on the construction proposed in [1]. We calculate the chiral spectra of flipped SU(5) GUTs by using the spectral divisor construction. The results agree with those from the analysis of semi-local spectral covers. Our computations provide an example for the validity of the spectral divisor construction and suggest that the standard heterotic formulae are applicable to the case of F-theory on an elliptically fibered Calabi-Yau fourfold with no heterotic dual.Comment: 45 pages, 12 tables, 1 figure; typos corrected, footnotes added, and a reference adde

Flipped SU(5) GUTs from E_8 Singularities in F-theory

In this paper we construct supersymmetric flipped SU(5) GUTs from E_8 singularities in F-theory. We start from an SO(10) singularity unfolded from an E_8 singularity by using an SU(4) spectral cover. To obtain realistic models, we consider (3,1) and (2,2) factorizations of the SU(4) cover. After turning on the massless U(1)_X gauge flux, we obtain the SU(5) X U(1)_X gauge group. Based on the well-studied geometric backgrounds in the literature, we demonstrate several models and discuss their phenomenology.Comment: 46 pages, 23 tables, 1 figure, typos corrected, references added, and new examples presente