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

Antimicrobial Challenge in Acute Care Surgery

The burden of infections in acute care surgery (ACS) is huge. Surgical emergencies alone account for three million admissions per year in the United States (US) with estimated financial costs of USD 28 billion per year. Acute care facilities and ACS patients represent boost sanctuaries for the emergence, development and transmission of infections and multi-resistant organisms. According to the World Health Organization, healthcare-associated infections affected around 4 million cases in Europe and 1.7 million in the US alone in 2011 with 39,000 and 99,000 directly attributable deaths, respectively. In this scenario, antimicrobial resistance arose as a public-health emergency that worsens patients’ morbidity and mortality and increases healthcare costs. The optimal patient care requires the application of comprehensive evidence-based policies and strategies aiming at minimizing the impact of healthcare associated infections and antimicrobial resistance, while optimizing the treatment of intra-abdominal infections. The present review provides a snapshot of two hot topics, such as antimicrobial resistance and systemic inflammatory response, and three milestones of infection management, such as source control, infection prevention, and control and antimicrobial stewardship

Avaliação da toxicidade da sulfametazina em organismos aquáticos.

Resumo: Dentre os fármacos, o grupo dos antibióticos, entre eles as sulfonamidas, é considerado um dos mais importantes. Estes compostos são extensivamente utilizados na medicina humana, veterinária e na aquicultura, com o propósito de prevenir ou tratar infecções microbianas. Essas substâncias podem acumular-se no solo, sofrer lixiviação ou, ainda, ser transportada via escoamento superficial para os corpos hídricos. A fim de alcançar um maior entendimento sobre os efeitos das sulfonamidas, avaliou-se a toxicidade aguda da sulfametazina utilizando-se duas espécies de invertebrados aquáticos (Daphnia similis e Artemia salina) e o peixe (Piaractus mesopotamicus). Foram determinados os valores de concentração efetiva media (CE50-48h), relacionada à imobilidade dos microcrustáceos equivalente a 77,5-48h e >1000 mg L-¹ para D. similis e A. salina, respectivamente. Para o peixe P. mesopotamicus, não houve efeito letal. Considerando-se que estes compostos são administrados em doses elevadas, a avaliação do seu impacto em toda biota aquática parece aconselhável. Os valores, portanto auxiliam para o estabelecimento de concentrações máximas permissíveis de sulfametazina nos corpos de água. Abstract: Among the drugs, the group of antibiotics, including sulfonamides, is considered one of the most important. These compounds are extensively used in human, veterinary medicine and aquaculture, with the purpose of preventing or treating microbial infections. These substances can build up in the soil, leachate or even be transported via superficial runoff to water bodies. In order to achieve a better understanding of the effects of sulfonamides, the acute toxicity of sulfamethazine was evolved using two species of aquatic invertebrates (Daphnia similis and artemia salina) and fish (Piaractus mesopotamicus). Determined the average effective concentration values were (EC50-48h), related to immobility of microcrustaceans equivalent to 77.5-48h and>1000 mg L -1 for D. similis and A. salina, respectively. For the fish P. mesopotamicus not lethal effect was found. Considering that these compounds are administered in high doses, to assess their impact on aquatic biota all seems advisable. values thus help to establish allowable maximum concentrations of sulfamethazine in water bodies

Periodontitis assessed with a new screening tool and oral health-related quality of life: cross-sectional findings among general-population adults

Introduction: Periodontitis, as a chronic, multifactorial inflammatory disease, has complex relationships with other diseases and ultimately with well-being. The aim of this cross-sectional study was to investigate the association between self-report periodontitis, as measured with the recently developed and validated modified Periodontal Screening Score (mPESS), and oral health-related quality of life (OHRQol) in a large population-based sample derived from the French NutriNet-Santé e-cohort. Methods: The sample was composed of 32,714 adults (75.5% women) with a mean age of 48.8 ± 13.9 years. Periodontitis was assessed based on age, smoking, and oral health status data obtained in 2011–2012, which allowed calculating the mPESS. An mPESS ≥ 5 was used to identify individuals at risk of severe periodontitis (main exposure). OHRQoL was measured with the Oral Health Impact Profile (OHIP-14) (main outcome) and the total score was dichotomized for analysis. Multivariable logistic regression analyses, considering physical health status, dietary and lifestyle confounding variables, were performed. Results: Overall, 6407 participants (19.6%) were at a high risk of severe periodontitis. A total of 7383 participants (22.6%) presented a relatively poor OHRQoL (OHIP-14 > 8, highest quartile). In the multivariable model, each of the following variables was independently and significantly associated with lower OHRQoL: older age (50–64 years), female sex, obesity, snacking between meals, frequent consumption of soft drinks and sweets/chocolate, risk of severe periodontitis, and having < 20 natural teeth were significantly. An mPESS ≥ 5 showed the highest odds for relatively poor OHRQoL (OR = 3.45; 95% CI 3.21–3.72). Conclusion: The results support the association between periodontitis and OHRQoL in non-clinical samples. The use of mPESS could be tested in future prevention programs aiming at improving OHRQoL