COVID-19 related risk factors and their association with non-syndromic orofacial clefts in five Arab countries: a case-control study.

BACKGROUND: The environmental etiology of non-syndromic orofacial clefts (NSOFCs) is still under research. The aim of this case-control study is to assess COVID-19 associated factors that may be related to the risk of NSOFC in five Arab countries. These factors include COVID-19 infection, COVID-19 symptoms, family member or friends infected with COVID-19, stress, smoking, socioeconomic status and fear of COVID-19. METHODS: The study took place in governmental hospitals in five Arab countries from November 2020 to November 2021. Controls are matched in the month of delivery and site of recruitment. A clinical examination was carried out using LASHAL classification. Maternal exposure to medication, illnesses, supplementation, COVID-19 infection during their pregestation and 1st trimester periods were evaluated using a validated questionnaire. Maternal exposure to stress was assessed using the Life Events scale, fear of covid-19 scale, family member or friend affected with covid-19 infection, pregnancy planning and threatened abortion. RESULTS: The study recruited 1135 infants (386 NSOFC and 749 controls). Living in urban areas, maternal exposure to medications 3-months pregestation, maternal exposure to any of the prenatal life events and maternal fear of COVID-19 significantly increased the risk of having a child with NSOFC. On the other hand, mothers exposed to supplementation 3-months pregestation, mothers suspected of having COVID-19 infection, family members or friends testing positive with COVID-19 significantly decreased the risk of having a child with NSOFC. CONCLUSIONS: This study suggests that NSOFC may be associated with maternal exposure to lifetime stress and COVID-19 fear in particular, with no direct effect of the COVID-19 infection itself. This highlights the importance of providing psychological support for expecting mothers during stressful events that affect populations such as the COVID-19 pandemic, in addition to the usual antenatal care.

Children’s access to dental care during the COVID-19 pandemic: a multi-country survey

We assessed the impact of COVID-19 on children’s access to dental care and determine factors associated with problems in accessing dental care. A multi-country cross-sectional survey collected data from caregivers of children from August 2020 to February 2021. The questionnaire was developed guided by the framework of the Andersen’s model of factors (predisposing, enabling and need). Multilevel logistic regression was used to assess the association between access-to-dental care problem and predisposing, enabling and need factors. A total of 4,843 caregivers from 20-countries reported on their children (52.3% males, mean age = 8.4 years) with 29.2% having access to care problem. A significantly greater percentage of caregivers from lower-middle-income countries (LMICs) than low-income countries (LICs), upper-middle-income countries (UMICs) and high-income countries (HICs) reported an access-to-dental care problem (P < .001). Caregivers living in LICS, university-educated caregivers, caregivers with older children and caregivers whose children had more frequent pain during the pandemic had higher odds of reporting an access to dental care problem. The association of the access problem with dental pain and dental insurance was modified by country income, showing a link between macrolevel contextual factors and the utilization of dental care in children that needs to be addressed in future studies. [ FROM AUTHOR] Copyright of Children's Health Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

COVID-19, economic problems, and family relationships in eight Middle East and North African countries.

Objective: The aim was to assess the reported family relationships during the COVID-19 pandemic and the association between these relationships and individual, interpersonal, and country-level income in eight Middle East and North Africa (MENA) countries. Background: COVID-19 causes fear of infection, loss of loved ones, and economic problems that may affect family relationships. Methods: Data were collected from eight MENA countries using an online survey (July-August 2020). The dependent variable was change in family relationship during COVID-19, and the independent variables were individual, interpersonal, and country-level factors represented by sociodemographic factors, COVID-19 status, financial impact (whether participants lost or had reduced wages) and country income. Multilevel logistic regression analysis was conducted. Results: There were 1854 responses, mean (SD) age of 30.6 (9.9) years, 65.8% were female, 3.4% tested COVID-19 positive, and 20.8% reported lost/reduced wages. Family relationships were more likely to improve or remain unchanged (84.3%) for participants who had a history of COVID-19 (adjusted odds ratio [AOR] = 3.54, 95% confidence interval [CI]: [1.25, 10.01]). However, family relationships were more likely to not improve for those who knew someone who died of COVID-19 (AOR = 0.76, 95% CI [0.58, 0.99]) and those with lost/reduced wages (AOR = 0.69, 95% CI [0.52, 0.94]). Conclusion: Family relationship improved or remained unchanged for those who tested positive for COVID-19 and did not improve for those who lost wages or lost someone due to COVID-19. Implications: Policy makers should develop strategies to provide social and financial support to employees to reduce the losses and adverse social impact caused by the pandemic.

Changes in Behavior Management and Treatment Modalities in Pediatric Dentistry during COVID-19 Pandemic.

OBJECTIVE: This study aims to assess the knowledge and confidence of dentists related to behavior management with extra personal protective equipment (PPE), non-aerosol-generating dental procedures in the course of the coronavirus disease-2019 (COVID-19) pandemic. MATERIALS AND METHODS: A cross-sectional online survey was conducted among a sample of dentists who worked in Jordan and India in June 2020 during the COVID-19 pandemic. RESULTS: This study included a total of 177 dentists in Jordan and India that were practicing during the early months of the pandemic. Most dentists were seeing <6 patients per day. The most common emergency treatments during the pandemic by Jordanian dentists were abscesses (51.8%) and cellulitis (44.6%) vs (44.6%) abscesses and (35.5%) pulpitis in India. There was a high adoption of all elements of the PPE protocol. Most participants never or rarely used N2O sedation to manage their patients in Jordan and India (80.4 and 71.1%), respectively. Participants in Jordan and India that considered treatment non-aerosol-generating procedures (non-AGP) were (82.1 vs 97.5%, p = 0.000), respectively. CONCLUSION: Most of the surveyed dentists believe the extra PPE acts as a barrier to patient communication and child behavior management and would consider modifying the PPE to be more child-friendly. Most dentists consider non-AGP procedures and silver diamine fluoride (SDF) to be practical ways to practice safer dentistry, yet more training and information is needed for dentists treating children to provide a more confident safe environment for both dentists and their patients. HOW TO CITE THIS ARTICLE: Alsaleh MM, Sabbarini JM, Al-Batayneh OB, et al. Changes in Behavior Management and Treatment Modalities in Pediatric Dentistry during COVID-19 Pandemic. Int J Clin Pediatr Dent 2020;13(S-1):S125-S131.

Perceived Preparedness of Dental Academic Institutions to Cope with the COVID-19 Pandemic: A Multi-Country Survey.

Dental academic institutions are affected by COVID-19. We assessed the perceived COVID-19 preparedness of these institutions and the characteristics of institutions with greater perceived preparedness. An international cross-sectional survey of dental academics was conducted from March to August 2020 to assess academics' and institutional attributes, perceived preparedness, and availability of infection prevention and control (IPC) equipment. Principal component analysis (PCA) identified perceived preparedness components. Multilevel linear regression analysis assessed the association between perceived preparedness and fixed effect factors (academics' and institutions' attributes) with countries as random effect variable. Of the 1820 dental academics from 28 countries, 78.4% worked in public institutions and 75.2% reported temporary closure. PCA showed five components: clinic apparel, measures before and after patient care, institutional policies, and availability of IPC equipment. Significantly less perceived preparedness was reported in lower-middle income (LMICs) (B = -1.31, p = 0.006) and upper-middle income (UMICs) (B = -0.98, p = 0.02) countries than in high-income countries (HICs), in teaching only (B = -0.55, p < 0.0001) and in research only (B = -1.22, p = 0.003) than teaching and research institutions and in institutions receiving ≤100 patients daily than those receiving >100 patients (B = -0.38, p < 0.0001). More perceived preparedness was reported by academics with administrative roles (B = 0.59, p < 0.0001). Academics from low-income countries (LICs) and LMICs reported less availability of clinic apparel, IPC equipment, measures before patient care, and institutional policies but more measures during patient care. There was greater perceived preparedness in HICs and institutions with greater involvement in teaching, research, and patient care.

Knowledge of dental academics about the COVID-19 pandemic: a multi-country online survey.

BACKGROUND: COVID-19 is a global pandemic affecting all aspects of life in all countries. We assessed COVID-19 knowledge and associated factors among dental academics in 26 countries. METHODS: We invited dental academics to participate in a cross-sectional, multi-country, online survey from March to April 2020. The survey collected data on knowledge of COVID-19 regarding the mode of transmission, symptoms, diagnosis, treatment, protection, and dental treatment precautions as well as participants' background variables. Multilevel linear models were used to assess the association between dental academics' knowledge of COVID-19 and individual level (personal and professional) and country-level (number of COVID-19 cases/ million population) factors accounting for random variation among countries. RESULTS: Two thousand forty-five academics participated in the survey (response rate 14.3%, with 54.7% female and 67% younger than 46 years of age). The mean (SD) knowledge percent score was 73.2 (11.2) %, and the score of knowledge of symptoms was significantly lower than the score of knowledge of diagnostic methods (53.1 and 85.4%, P <  0.0001). Knowledge score was significantly higher among those living with a partner/spouse than among those living alone (regression coefficient (B) = 0.48); higher among those with PhD degrees than among those with Bachelor of Dental Science degrees (B = 0.48); higher among those seeing 21 to 30 patients daily than among those seeing no patients (B = 0.65); and higher among those from countries with a higher number of COVID-19 cases/million population (B = 0.0007). CONCLUSIONS: Dental academics had poorer knowledge of COVID-19 symptoms than of COVID-19 diagnostic methods. Living arrangements, academic degrees, patient load, and magnitude of the epidemic in the country were associated with COVD-19 knowledge among dental academics. Training of dental academics on COVID-19 can be designed using these findings to recruit those with the greatest need.

Behavior change due to COVID-19 among dental academics-The theory of planned behavior: Stresses, worries, training, and pandemic severity.

OBJECTIVE: COVID-19 pandemic led to major life changes. We assessed the psychological impact of COVID-19 on dental academics globally and on changes in their behaviors. METHODS: We invited dental academics to complete a cross-sectional, online survey from March to May 2020. The survey was based on the Theory of Planned Behavior (TPB). The survey collected data on participants' stress levels (using the Impact of Event Scale), attitude (fears, and worries because of COVID-19 extracted by Principal Component Analysis (PCA), perceived control (resulting from training on public health emergencies), norms (country-level COVID-19 fatality rate), and personal and professional backgrounds. We used multilevel regression models to assess the association between the study outcome variables (frequent handwashing and avoidance of crowded places) and explanatory variables (stress, attitude, perceived control and norms). RESULTS: 1862 academics from 28 countries participated in the survey (response rate = 11.3%). Of those, 53.4% were female, 32.9% were <46 years old and 9.9% had severe stress. PCA extracted three main factors: fear of infection, worries because of professional responsibilities, and worries because of restricted mobility. These factors had significant dose-dependent association with stress and were significantly associated with more frequent handwashing by dental academics (B = 0.56, 0.33, and 0.34) and avoiding crowded places (B = 0.55, 0.30, and 0.28). Low country fatality rates were significantly associated with more handwashing (B = -2.82) and avoiding crowded places (B = -6.61). Training on public health emergencies was not significantly associated with behavior change (B = -0.01 and -0.11). CONCLUSIONS: COVID-19 had a considerable psychological impact on dental academics. There was a direct, dose-dependent association between change in behaviors and worries but no association between these changes and training on public health emergencies. More change in behaviors was associated with lower country COVID-19 fatality rates. Fears and stresses were associated with greater adoption of preventive measures against the pandemic.