Awareness, Knowledge, Attitude, and Skills (AKAS) of Telemedicine and Its Use by Primary Healthcare Providers.

Background: This study aimed to determine the rate of telemedicine (TM) use and the levels of awareness, knowledge, attitude, and skills of TM among primary healthcare (PHC) providers. Methods: In a cross-sectional study, 104 PHC providers were subjected to a validated AKAS scale via Survey Monkey. The tool consists of 4 parameters that users can respond to using a 4-point Likert scale to assess their awareness (12 statements), knowledge (11 statements), attitude (11 statements), and skills (13 statements) on TM. Total and percentage mean scores (PMS) were calculated for each parameter. Participants were categorized in each parameter into three categories: low (≤ 49% score), average (50-70% score), and high (≥ 71% score) levels. The association of AKAS levels with personal characteristics and TM use was investigated. The significance was set at p<0.05. Results: One-half of participants (51%) reported current use of TM, and two-thirds (63.5%) reported a high level of AKAS, with a PMS of 72.9±14.7, 95% CI: 70.1-75.7. There were significant associations between the following: years of experience and levels of knowledge (Χ2LT = 6.77, p= 0.009) and skills (Χ2LT = 4.85, p = 0.028), respectively; and total household income and levels of skills (Χ2LT = 6.91, p= 0.009). The rate of TM use was significantly associated with awareness levels (Χ2LT = 6.14, p = 0.013). Lack of training ranked as the first barrier (45.5%), followed by connection problems and tools' unavailability (35.1% each). The participants recommended providing TM training (41.1%) and stabilization of connection and networking signals (30.1%). Conclusion: Despite their high level of TM awareness, the rate of TM use by PHC providers is less than satisfactory. Establishing standardized TM training and supporting the network signals are recommended. A large-scale study on the impact of TM integration with PHC services is necessary.

Physicians' Examination and Referral Practices on Orthodontic Problems Among 6-12-Year-Old Children in Saudi Arabia.

Background: Physicians are more likely to examine children than dentists; thus, they may have a significant role in detecting oral and dentofacial problems. This study aimed to determine the rate and comprehensiveness of examinations, the rate and quality of referral practices, and the predictors of referral practice of physicians regarding orthodontic problems among children. Methods: In a multi-center cross-sectional study, a total of 518 physicians in Saudi Arabia were subjected to an e-questionnaire of four sections: (1) Physicians' demographic and work-related characteristics; (2) Physicians' comprehensiveness of oral and orthodontic examinations; (3) Physicians' referral practices to orthodontists and reasons considered for referral; and (4) Physicians' sources of orthodontic education. Logistic regression analysis was applied to identify the significant predictors of referral practice. The significance was set at p < 0.05. Results: Most physicians reported partial oral (78.5%) and orthodontic (72.2%) examinations, while the full examination was reported by only 12% and 2.5% of physicians, respectively. Referral to orthodontists was practiced by most of the physicians (83.8%), yet for the majority of them, the quality of referral was poor (40.3%) or fair (46.1%), with only 13.6% who practiced quality referral. Dental development issues (53.3%) and functional issues (51.5%) were reported as the main reasons for referral, followed by family/patient request (42.9%), dental alignment (42.5%), oral respiratory issues (32.4%), and finally jaw relation (26.1%). Referral practice was predicted by the comprehensive oral (OR = 2.37, p = 0.007) and orthodontic (OR = 4.26, p < 0.001) examinations, number of patients seen by the physician (OR = 1.58, p = 0.007), and level of training (OR = 1.88, p = 0.03). Conclusion: Although most physicians reported high rates of examination and referral practices on orthodontic problems among children in Saudi Arabia, only a small portion showed comprehensive examinations and quality referral practice. Including dental courses in medical curricula and improving oral and orthodontic examination guidelines for physicians are recommended.

Adhesion of microorganisms to bovine submaxillary mucin coatings: effect of coating deposition conditions.

The adhesion of Staphylococcus epidermidis, Escherichia coli, and Candida albicans on mucin coatings was evaluated to explore the feasibility of using the coating to increase the infection resistance of biomaterials. Coatings of bovine submaxillary mucin (BSM) were deposited on a base layer consisting of a poly(acrylic acid-b-methyl methacrylate) (PAA-b-PMMA) diblock copolymer. This bi-layer system exploits the mucoadhesive interactions of the PAA block to aid the adhesion of mucin to the substratum, whereas the PMMA block prevents dissolution of the coating in aqueous environments. The thickness of the mucin coating was adjusted by varying the pH of the solution from which it was deposited. Thin mucin coatings decreased the numbers of bacteria but increased the numbers of C. albicans adhering to the copolymer and control surfaces. Increasing the mucin film thickness resulted in a further lowering of the density of adhering S. epidermidis cells, but it did not affect the density of E. coli. In contrast, the density of C. albicans increased with an increase in mucin thickness.

Spectroscopic ellipsometry of mucin layers on an amphiphilic diblock copolymer surface.

Both visible and infrared (IR) spectroscopic ellipsometry have been employed to study the structure of thin layers of bovine submaxillary mucin (BSM) adsorbed on poly(acrylic acid-block-methyl methacrylate) (PAA-b-PMMA) copolymer and poly(methyl methacrylate) (PMMA) surfaces at three pH values (3, 7, and 10). The adsorbed mucin layer on the copolymer surface had the greatest thickness (17 nm) when adsorbed from a mucin solution at a pH of 3. For the first time, IR ellipsometry was used to identify adhesive interactions and conformational changes in mucin/polymer double layers. After applying the regularized method of deconvolution in the analysis, the formation of hydrogen bonds between the carboxyl groups of the BSM and PAA-b-PMMA copolymer in double layers has been found. The IR ellipsometry data, in agreement with the visible ellipsometry analysis, indicate the pH dependence of adhesion of mucin to the copolymer surface. There is an increase in the amount of hydrogen-bonded carboxyl groups in mucin deposited at a pH of 3. There is no evidence that the amide groups of the mucin participate in this bonding. At the lower pH, the IR ellipsometry spectra after deconvolution reveal an increase in the proportion of beta-sheets in the BSM upon adsorption on the copolymer surface, indicating a more unfolded, aggregated structure. The IR ellipsometry data also indicated some changes in the conformational states of the side groups in the copolymer induced by entanglements and bonding interactions with the mucin macromolecules. Deconvolution provides an unprecedented level of information from the IR ellipsometry spectra and yields important insights.

Absorption of cetylpyridinium chloride into poly(N-isopropylacrylamide)-based microgel particles, in dispersion and as surface-deposited monolayers.

The addition of cetylpyridinium chloride (CPC) to aqueous dispersions of poly(N-isopropylacrylamide) [poly(NIPAM)] and poly(N-isopropylacrylamide-co-acrylic acid) [poly(NIPAM-co-AAc)] microgel particles leads to absorption of the CPC into the particles and to corresponding changes in their hydrodynamic diameter. With the latter set of particles there is a strong pH dependence. The dependence of both hydrodynamic diameter and electrophoretic mobility of the microgel particles on the added CPC concentration show a strong correlation with CPC uptake, as obtained from direct CPC absorption measurements. Various mechanisms for CPC absorption into the microgel particles are postulated, including electrostatic, polar, and hydrophobic interactions. A comparison has also been made between the effect of added CPC on the hydrodynamic diameter of free microgel particles in dispersion, determined by dynamic light scattering, and the thickness of adsorbed monolayers of the same microgel particles deposited on cationically modified, oxidized silicon surfaces, as determined from ellipsometry measurements. The trends observed in both cases are broadly similar. This work opens the way for development of microgel layers for controlled uptake and release applications.

Swelling and deswelling of adsorbed microgel monolayers triggered by changes in temperature, pH, and electrolyte concentration.

The formation and characterization of close-packed monolayers of negative, poly(N-isopropylacrylamide)-based microgel particles onto positively charged silicon wafers is described. The silicon wafers were rendered positive by first oxidizing their surface to silica and then adsorbing a layer of poly(ethyleneimine). The thickness of the deposited microgel monolayers (under aqueous conditions) has been determined by spectroscopic ellipsometry as a function of temperature (20-60 degrees C), pH (3-8), and added NaCl concentration (0-1 M). No actual desorption of the microgel particles was evident on changing the conditions, but a swelling/deswelling transition was observed around 32 degrees C. The thickness of the monolayer has been compared with the hydrodynamic diameter of the free microgel particles, dispersed in aqueous solution. For the poly(N-isopropylacrylamide) microgel particles, without any bulk ionisable comonomer groups present, the temperature dependence of the ellipsometric thickness of the monolayer mirrors closely that of the hydrodynamic diameter of the free particles. When ionizable (-COOH) groups are introduced into the microgel particles, however, this correspondence is largely lost because the microgel particles forming the deposited monolayer now contract strongly onto the oppositely charged substrate surface.