Students’ knowledge, attitudes and practices related to infection control in undergraduate dental clinical training during COVID-19 A report from one South African university

The COVID-19 pandemic has highlighted the need for renewed conversations in infection control in the context of dental undergraduate learning. This study set out to examine dental therapy and oral hygiene students’ knowledge, attitudes and practices related to infection control.This quantitative survey was conducted at one dental training site in South Africa. The study population comprised 156 full time enrolled students that was stratified into Year 1 (n=55), Year 2 (n=54) and Year 3 (n=47). An online, self-administered questionnaire with closed and open-ended questions was used to collect information. Data were analyzed using SPSS version 25.0 (IBM Corp., USA) and thematic analysis. The response rate for the study was 70.5% (n=111).Almost all participants (n=104) strongly agreed/agreed that COVID-19 is transmitted mainly through infected droplets. Most participants (Year 1: n=24, 22.5%; Year 2: n=28, 26.2%; Year 3: 22, 31.2%) strongly disagreed / disagreed that younger people were less susceptible to contracting COVID-19 disease. While 23 first (21.5%) and 16 second-year students (14.9%) strongly agreed/agreed that personal protective gear was sufficient protection against COVID-19, about 16 third-year students (14%) were unsure or disagreed. Almost all participants (n=105, 98.1%) strongly agreed/agreed to washing or sanitizing their hands regularly. The emergent themes from qualitative data analysis included: better access to resources and more coordinated planning for clinical and classroom-based learning. There were inconsistencies in participants’ knowledge and attitudes towards infection control. There is a need for ongoing awareness of infection control in both clinical and class-room based learning

Knowledge, attitude and perceptions of dental professionals on patients seeking oral health care from traditional healers in KwaZulu-Natal, South Africa

BackgroundThe general and oral healthcare needs of communities far exceed the capacity of the current public health system of South Africa (SA). This results in patients deferring treatment or seeking alternative measures in the form of the traditional health practice. It is important for dental professionals in the health system to be aware of such oral health care seeking behaviour within rural communities to initiate joint corporate oral health education programmes and referral systems that resonate with these communities. Aims and objectivesThe study aimed to explore the knowledge, attitude and perceptions of dental professionals (16 dentists, 25 dental therapists, 4 oral hygienists and 3 dental assistants) regarding patients seeking oral health care from traditional healers. MethodsThis was an exploratory, cross-sectional study that evaluated dental professionals’ knowledge, attitude and perceptions on patients seeking oral health care from traditional healers. A purposive sampling technique using specific inclusion criteria was used to select 48 qualified dental professionals (oral hygienists, dentists, dental assistants and dental therapists) practising in rural KwaZulu-Natal. A self-administered questionnaire was used for data collection. Data related to sociodemographic variables and knowledge, attitudes and perceptions of dental professionals were recorded. ResultsMost (77.1%) dental professionals were aware that their patients were seeking oral health care from traditional healers. They further maintained that the traditional health practice included ideas and methods from which the oral health fraternity could benefit. ConclusionThis study revealed most of the dental professionals in rural Kwa-Zulu Natal have encountered patients who have consulted traditional health practitioners for oral health care. The dental personnel were accepting of traditional healers and believed that traditional healers could contribute positively to rural oral health care

Knowledge, attitudes and practices of emergency care practitioners in the management of common dental emergencies in the eThekwini District, KwaZulu-Natal.

It is essential to provide timeous and appropriate treatment in cases of dental emergencies. First responders such as Emergency Care Practitioners (ECPs) usually provide this prehospital care. The successful management of casualties experiencing common dental emergencies is dependent on two fundamental factors; the first responder's knowledge and ability to render the appropriate level and standard of medical care, and secondly, the time that expires between the onset of the incident and the initiation of definitive emergency medical treatment. Delayed or inappropriate management can have long term physiological and psychological effects.This was an exploratory and descriptive study, using quantitative and qualitative methods to determine the knowledge and attitudes of Emergency Care Practitioners of the eThekwini District of KwaZulu-Natal, South Africa, in the management of dental emergencies.The results revealed that Emergency Care Practitioners had inadequate knowledge, training, and understanding of the management of common dental emeregncies by ECPs. There was limited initial training, with a significant portion of the participants (44.9%, p 0.233) having not received any training at all in the management of orofacial traumas, and with a significant majority (78.3%, < 0.001) having no further education and training. Most ECPs indicated a desire to receive such training. This study indicated that ECPs lacked confidence in managing dental emergencies, which highlighted a need for specific dental awareness and training programs to further empower ECPs in the management of such emergencies

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.

The Global Burden of Diseases, Injuries and Risk Factors 2017 includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. METHODS: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data.; We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs s1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury

MRI Features and Their Association With Outcomes in Children With Anti-NMDA Receptor Encephalitis

OBJECTIVES: How brain MRI lesions associate with outcomes in pediatric anti-NMDA receptor encephalitis (pNMDARE) is unknown. In this study, we correlate T2-hyperintense MRI brain lesions with clinical outcomes in pNMDARE. METHODS: This was a multicenter retrospective cohort study from 11 institutions. Children younger than 18 years with pNMDARE were included. One-year outcomes were assessed by the modified Rankin Score (mRS) with good (mRS ≤2) and poor (mRS ≥3) outcomes. RESULTS: A total of 175 pNMDARE subjects were included, with 1-year mRS available in 142/175 (81%) and 60/175 (34%) had abnormal brain MRIs. The most common T2-hyperintense lesion locations were frontal, temporal, and parietal. MRI features that predicted poor 1-year outcomes included abnormal MRI, particularly T2 lesions in the frontal and occipital lobes. After adjusting for treatment within 4 weeks of onset, improvement within 4 weeks, and intensive care unit admission, MRI features were no longer associated with poor outcomes, but after multiple imputation for missing data, T2 frontal and occipital lesions associated with poor outcomes. DISCUSSION: Abnormal frontal and occipital lesions on MRI may associate with 1-year mRS in pNMDARE. MRI of the brain may be a helpful prognostication tool that should be examined in future studies

MRI Features and Their Association With Outcomes in Children With Anti-NMDA Receptor Encephalitis.

ObjectivesHow brain MRI lesions associate with outcomes in pediatric anti-NMDA receptor encephalitis (pNMDARE) is unknown. In this study, we correlate T2-hyperintense MRI brain lesions with clinical outcomes in pNMDARE.MethodsThis was a multicenter retrospective cohort study from 11 institutions. Children younger than 18 years with pNMDARE were included. One-year outcomes were assessed by the modified Rankin Score (mRS) with good (mRS ≤2) and poor (mRS ≥3) outcomes.ResultsA total of 175 pNMDARE subjects were included, with 1-year mRS available in 142/175 (81%) and 60/175 (34%) had abnormal brain MRIs. The most common T2-hyperintense lesion locations were frontal, temporal, and parietal. MRI features that predicted poor 1-year outcomes included abnormal MRI, particularly T2 lesions in the frontal and occipital lobes. After adjusting for treatment within 4 weeks of onset, improvement within 4 weeks, and intensive care unit admission, MRI features were no longer associated with poor outcomes, but after multiple imputation for missing data, T2 frontal and occipital lesions associated with poor outcomes.DiscussionAbnormal frontal and occipital lesions on MRI may associate with 1-year mRS in pNMDARE. MRI of the brain may be a helpful prognostication tool that should be examined in future studies

Examining the contributions of environmental quality to pediatric multiple sclerosis

BackgroundMultiple sclerosis (MS) is a presumed autoimmune disease caused by genetic and environmental factors. It is hypothesized that environmental exposures (such as air and water quality) trigger the innate immune response thereby activating a pro-inflammatory cascade.ObjectiveTo examine potential environmental factors in pediatric MS using geographic information systems (GIS).MethodsPediatric MS cases and healthy controls were identified as part of an ongoing multicenter case-control study. Subjects' geographic locations were mapped by county centroid to compare to an Environmental Quality Index (EQI). The EQI examines 5 individual environmental components (air, land, water, social, built factors). A composite EQI score and individual scores were compared between cases and controls, stratified by median proximity to enrollment centers (residence <20 or ≥20 miles from the recruiting center), using logistic regression.ResultsOf the 287 MS cases and 445 controls, 46% and 49% respectively live in areas where the total EQI is the highest (worst environmental quality). Total EQI was not significantly associated with the odds for MS (p = 0.90 < 20 miles from center; p = 0.43 ≥ 20 miles); however, worsening air quality significantly impacted the odds for MS in those living near a referral center (OR = 2.83; 95%CI 1.5, 5.4) and those who reside ≥ 20 miles from a referral center (OR = 1.61; 95%CI 1.2, 2.3).ConclusionAmong environmental factors, air quality may contribute to the odds of developing MS in a pediatric population. Future studies will examine specific air constituents and other location-based air exposures and explore potential mechanisms for immune activation by these exposures