Feminization of Sri Lankan Doctors and Key Specialties: 2000 to 2020

The study focused on the feminization of Sri Lankan generalist doctors in all major and selected minor specialties between 2000 and 2020. The study analyzed all relevant documents by exploring Sri Lanka's male-to-female doctor and specialist ratio over 20 years. This was determined by analyzing state medical faculty records from 1990 to 2020. For better clarity, the researchers analyzed the gender ratio changes in every five-year block from 1990 to 2020. Focus groups filled PGIM's gender data fields. Five-year medical students surged from 43% to 63% between 1990 and 2020. Linear trend analysis predicts 68% of female medical students by 2025 and 72% by 2030. This study simulated generalist doctors with medical students. Until recently, men dominated medicine, surgery, obstetrics, and pediatrics. Female specialists have increased in all fields over the past 20 years. The feminization of medical doctors challenges national human resource policies and health sector reforms. They emphasize gender-sensitive health workforce planning that considers a country's economic development and healthcare system. Sri Lankan health policymakers should consider gender dynamics in national health HR planning for the next decade

Utilising surface-level data to explore surface, tooth, individual and family influence on the aetiology of hypomineralised second primary molars

OBJECTIVES: Hypomineralised second primary molars (HSPM) are common developmental enamel defects. The aims of this study were to use surface-level data to explore the clustering of HSPM at four levels (family, child, tooth, surface). METHODS: This study of 172 twin pairs was nested within the Peri/postnatal Epigenetic Twin Study. HSPM was measured by standardised oral examinations at age 6 years. Multilevel logistic regression models were fitted to assess the correlation structure of surface level data and variation in HSPM. The associations between surface level risk factors and HSPM were then explored using the multilevel logistic regression model using the best fitting correlation structure. RESULTS: The prevalence of HSPM was 68 (19.8%) children, with a total of 141 (10.3%) teeth and 264 tooth surfaces (6.3%) affected. Multilevel models revealed that a hierarchical structure accounting for correlation at the family, child and tooth level best accounted for the variation in HSPM. The estimated variances from the best fitting model (Model 3) were largest at the family level (12.27, 95% CI 6.68, 22.51) compared with 5.23 at the child level and 1.93 at the tooth level. Application of regression analysis utilising this three-level correlation structure identified tooth/surface level factors in addition to the previously identified familial and individual risk factors for HSPM. CONCLUSION: In addition to familial (environmental and genetic) and unique child-level factors, the aetiology of HSPM is likely to be influenced by local tooth-level factors

Prevention of incipient carious lesions with various interventions during fixed and removable orthodontic treatment. A systematic review and meta-analysis

Objective: To systematically review and quantify the effectiveness of interventions in reducing caries development during orthodontic treatment and evaluate the quality of evidence for the development of clinical guidelines. Materials and methods: A comprehensive literature search of the Cochrane, EMBASE and MEDLINE databases was conducted to identify eligible randomised controlled trials (RCTs). The risk of bias was assessed using the Cochrane risk of bias (RoB 2) tool. In order to facilitate the development of clinical guidelines, the quality of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Results: A total of 18 RCTs were included in the qualitative synthesis, of which 10 had a high risk of bias, and eight had minor concerns. Three RCTs that investigated the efficacy of fluoride interventions during fixed orthodontic treatment were included in the quantitative synthesis. The pooled effect size resulted in a risk reduction of 0.23 (95% CI:-0.35,-0.11, p < 0.001) in the intervention group compared to controls. The GRADE evaluation identified the evidence as moderate due to the limited number of RCTs and moderate heterogeneity (I-squared statistic of 49.3%). Conclusions: Although fluoride is the most effective evidence-based preventive intervention during orthodontic treatment, large RCTs are required to provide high quality evidence. Further studies are needed to evaluate the caries preventive effects of oral hygiene programs, chlorhexidine, CPP-ACP and other interventions

Genetic and early-life environmental influences on dental health in childhood: a study of twins

© 2018 Dr. Mihiri Jacintha SilvaThrough toothache, infection and tooth loss, dental diseases have a major impact on the health and well-being of children. Dental caries and hypomineralised second primary molars (HSPM) are two common diseases of childhood. Both are complex conditions, which are likely to be influenced by genetic and environmental factors. Although the cause of dental caries is generally well understood, persistently high rates in childhood suggests that more effective preventive strategies are needed. Targeting upstream factors, from early in life, before clinical signs occur and before caries risk is programmed may provide a novel target for caries prevention. In contrast, HSPM is a relatively poorly understood condition of unknown aetiology that is thought to be triggered during tooth formation, in the prenatal and early life period. Understanding prenatal and early life influences on dental health is hampered by a lack of prospective longitudinal studies. The aim of this project was to use a prospective longitudinal study of twin children to (1) investigate the contribution of genetics, shared and non-shared environment to the variation in risk of dental caries and HSPM; (2) to identify specific shared and non-shared factors from the pre- and perinatal period that are likely to be associated with disease; and (3) apply twin statistical methods to explore a potentially causal relationship between body mass index (BMI) and dental caries. Data collected from questionnaires, medical records, biosamples and dental examinations through the course of the study were used in this thesis. In order to evaluate the relative contribution of genetic and environmental factors to the variation in risk of the binary outcomes, dental caries and HSPM, case-wise concordances were derived and compared in monozygotic (MZ) and dizygotic (DZ) twins. Various general and twin specific regression based statistical methods (including within/between analyses) were applied to evaluate the association between the outcomes and a range of exposures. Finally, within/between pair analysis was applied to determine the strength and direction of a potential causal relationship between dental caries and BMI. As detailed in Chapter Four of this thesis, HSPM was found to be common, affecting 19.8% of the children in study, and the variation in risk was predominantly due to environmental factors. Dizygosity, infantile eczema, vitamin D levels at birth, in vitro fertilization, maternal smoking beyond the first trimester of pregnancy and higher socioeconomic status were risk factors for HSPM. As detailed in Chapter Five, dental caries affected 32.2% of children, with 24.1% of children showing signs of advanced dental caries. Environmental factors predominated over genetics in determining variation in dental caries risk. Water fluoridation, maternal obesity and HSPM were important risk factors for dental caries. Analysis of BMI and dental caries at six years of age revealed that although the relationship is heavily influenced by confounders, an inverse causal relationship is likely. However, due to the cross-sectional nature of the study, it was not possible to determine which is the determinant and which is the outcome. The findings of this thesis suggest that dental caries and HSPM risk are heavily influenced by environmental factors, some of which are modifiable and arise as early as the prenatal period. With replication in other longitudinal cohorts, these findings may provide novel targets for population-based preventive strategies to improve the oral health of children

Oral health in nursing homes: resident oral health and carer knowledge

© 2012 Mihiri Jacintha SilvaThe oral health of nursing home residents is poor, characterised by high levels of dental caries and poor oral hygiene. Affecting mostly older populations, salivary gland hypofunction and xerostomia is also likely to be common among nursing home residents. A lack of oral health care by nursing home staff is a major factor contributing to the high levels of oral disease among residents. As the Australian population ages and edentulism rates decline, the picture of oral health will change. Without appropriate strategies to improve the oral health of nursing home residents and the care they receive, the future is bleak. The impact of poor oral health extends beyond the mouth, and can affect general health of residents and impair quality of life. In order to develop programs and policies to overcome the forecast problems in oral health among nursing home residents, the current picture of oral health in nursing homes needs to be investigated fully. The aim of this study was to provide a comprehensive assessment of the state of oral health in nursing homes by examining the knowledge and attitudes of nursing home staff in addition to resident oral health outcomes. A total of 221 dentate residents and 346 nursing home staff, including Personal Care Assistants (PCAs), division one (Div 1) and two (Div 2) nurses and Directors of Nursing (DON) participated in the study. Residents’ assessments included a detailed medical history, comprehensive dental examination, and questionnaires to assess oral health related quality of life and xerostomia and saliva testing. Nursing home staff completed a questionnaire regarding their training, dental habits and oral health knowledge and attitudes. Nursing home residents were elderly and medically compromised, with high levels of functional impairment. Most residents required assistance with oral hygiene and did not regularly utilise professional dental care. There were high levels of untreated coronal and root decay, particularly among residents with functional impairment and those who had irregular professional dental care. There were no significant associations with medical conditions or the number of medications taken. The prevalence of salivary disease was high with over a half of the residents having salivary gland hypofunction and a third having xerostomia. Consistent with the current understanding, the two conditions were found to be independent. Unexpectedly, medical conditions and the number of medications taken were not associated with either of the two conditions. In regards to quality of life, the most commonly reported oral impacts were difficulty eating certain foods, feeling embarrassed or self-conscious about problems with the mouth and painful aching from the mouth. Dental caries was generally not associated with quality of life, except for a significantly higher caries rate among those who reported feeling self-conscious. Xerostomia was significantly associated with most aspects of quality if life. The findings of this study confirm the worsening oral health of nursing home residents and the wide prevalence of xerostomia and salivary gland hypofunction. It highlights the impact of these conditions on quality of life. Improving the knowledge of nursing home staff, and providing them with practical skills in oral hygiene provision, particularly of functionally impaired residents, may help improve the oral health of nursing home populations

The Impact of Molar Incisor Hypomineralisation on Children and Adolescents:A Narrative Review

Molar incisor hypomineralisation (MIH) is a qualitative developmental enamel defect with a prevalence of 13% worldwide. This review aims to outline the current evidence regarding the impact of MIH on children’s oral health and, more broadly, their day-to-day activities. MIH is associated with negative sequelae, including hypersensitivity, post-eruptive breakdown, the rapid development of carious lesions and poor aesthetics. Other concerns pertain to the clinical management of MIH and include difficulty in achieving local anaesthesia, increased dental fear and anxiety (DFA) and increased behaviour management problems. Oral health-related quality of life (OHRQoL) is the most standardised measure of patient impact; however, no instruments have been validated for use in MIH populations. The few existing observational studies investigating the impact of MIH on OHRQoL in children have produced conflicting results. Interventions to alleviate hypersensitivity and improve aesthetics had a positive impact on the OHRQoL of MIH-affected children. Multiple methodological issues make it difficult to measure the impact of MIH, including heterogeneity in the MIH severity classification, an overlap in the indices used to diagnose dental caries and MIH as well as the subjectivity of outcome measures for hypersensitivity and DFA

The Impact of Molar Incisor Hypomineralisation on Children and Adolescents:A Narrative Review

Molar incisor hypomineralisation (MIH) is a qualitative developmental enamel defect with a prevalence of 13% worldwide. This review aims to outline the current evidence regarding the impact of MIH on children’s oral health and, more broadly, their day-to-day activities. MIH is associated with negative sequelae, including hypersensitivity, post-eruptive breakdown, the rapid development of carious lesions and poor aesthetics. Other concerns pertain to the clinical management of MIH and include difficulty in achieving local anaesthesia, increased dental fear and anxiety (DFA) and increased behaviour management problems. Oral health-related quality of life (OHRQoL) is the most standardised measure of patient impact; however, no instruments have been validated for use in MIH populations. The few existing observational studies investigating the impact of MIH on OHRQoL in children have produced conflicting results. Interventions to alleviate hypersensitivity and improve aesthetics had a positive impact on the OHRQoL of MIH-affected children. Multiple methodological issues make it difficult to measure the impact of MIH, including heterogeneity in the MIH severity classification, an overlap in the indices used to diagnose dental caries and MIH as well as the subjectivity of outcome measures for hypersensitivity and DFA

Cloned Human TCR from Patients with Autoimmune Disease Can Respond to Two Structurally Distinct Autoantigens

There is increasing evidence that the TCR can have significant plasticity in the range of Ags that a single receptor can recognize. Although it has been proposed that such TCR plasticity might contribute to autoimmunity, there have been few studies examining this possibility in either animal models or human disease. In the present study, we examined human T cell clones that were generated against two structurally dissimilar proteins, U1-70 kDa and Smith-B, that are physically associated in the U1-small nuclear ribonucleoprotein complex and that are frequent targets of autoantibodies and T cells in the same lupus patient. We found that the TCR from all clones isolated had substantial sequence homology within their complementarity-determining region 3. We molecularly cloned and expressed individual TCR/A and TCR/B genes in a TCR-negative human cell line J.RT3-T3.5. We then examined the interaction between the TCR and U1-70 kDa and Smith-B antigenic peptides. We found that there was plasticity or degeneracy of the TCR reactive with these lupus autoantigens in that two structurally dissimilar lupus autoantigenic peptides could stimulate a single TCR. These studies support an important role of plasticity of the TCR in the development of human autoimmunity