Medical emergencies in dental practice: A nationwide web-based survey of Italian dentists.

Objective: Dentists must be prepared to manage medical emergencies, which are arisen during dental practice together with the increase of age population and medically compromised patients. This study aims at assessing the occurrence of medical emergencies in a cohort of Italian dentists, to ascertain their level of confidence in the management of these conditions, also based on their educational training and type of medical graduation, and, finally, to know their educational needs, in order to plan appropriate institutional interventions for specific training. Methods: A national-based cross-sectional study was carried out by means of an online survey sent to all dentists working in Italy. Results: The survey included 6818 questionnaires. Most of the respondents (n = 4443; 65.2%) reported the occurrence of at least one medical emergency during their professional life. The events rarely resulted in death as declared by only 62 (0.9%) of respondents. The commonest medical emergency was the vasovagal syndrome. Most medical emergencies occurred during the dental procedure (n = 4883; 71.6%). An average degree of satisfaction about the ability to diagnose and manage medical emergencies was reported by most of respondents, with high level of confidence in treating vasovagal syndrome, while a lack in preparedness about the management of myocardial infarction or transient ischemic attack (TIA) and stroke. Medical doctors were more confident in managing the emergencies than dentistry graduates (p < .01). Considering the educational needs, almost all of participants (n = 6721; 98.6%) declared the need to improve their training and expressed their interest in theoretical-practical institutional courses as well as in the establishment of an official national register for medical emergencies occurred in dental practice. Conclusions: Medical emergencies are not negligible and the dentist should receive adequate training and continuing education to be updated and ready for their correct management. Clinical significance: The dentist should be ready to deal with medical emergencies and provide first aid to the patient. The dentist is not always prepared to manage the most complex emergencies; therefore, there is the need to organize post-graduate courses and to set up an emergency register.

Factors associated with a positive childbirth experience in Brazilian women: A cross-sectional study.

BACKGROUND: Having a positive childbirth experience is an increasingly valued outcome. Few studies evaluated the women's satisfaction with childbirth through face-to-face interviews out of the health service environment. The objective of this study was to identify factors associated with a higher level of satisfaction with the childbirth experience among Brazilian women. METHODS: This cross-sectional study involved 287 women giving birth in two hospitals in southern Brazil. Women who gave birth to healthy newborns at term were randomly selected. Face-to-face interviews were conducted 31-37 days after delivery, at the mothers' homes, using a structured questionnaire. Satisfaction with the childbirth experience was measured using a Likert-type scale ranging from very satisfied to very dissatisfied. Prevalence ratios (PR) were estimated using Poisson regression with robust variance. RESULTS: Following hierarchical multivariate analysis, the following factors remained associated with a higher level of satisfaction with the childbirth experience: being satisfied with antenatal care (PR=1.30; 95% confidence interval [95%CI]=1.06-1.59), understanding the information provided by health professionals during labor and delivery (PR=1.40; 95%CI=1.01-1.95), not having reported disrespect and abuse (PR=1.53; 95%CI=1.01-2.31), and having had the baby put to the breast within the first hour of life (PR=1.63; 95%CI=1.26-2.11). No association was observed with type of delivery or hospital status (public or private). CONCLUSIONS: A higher level of satisfaction with the childbirth experience is related to satisfactory antenatal care, a non-abusive, respectful, and informative environment during childbirth, and to the opportunity to breastfeed the baby within the first hour of life. In clinical practice, greater attention to these basic principles of care during pregnancy and delivery could provide more positive experiences during birth.

Association between maternal satisfaction with breastfeeding and postpartum depression symptoms.

BACKGROUND: Due to the multiple health benefits of breastfeeding, it is essential to identify factors that may negatively interfere with this healthy practice. Among such factors are postpartum depression (PPD) and maternal satisfaction with breastfeeding. The objective of this study was to evaluate the association between maternal satisfaction with breastfeeding and symptoms of PPD in the first month after childbirth. METHODS: This cross-sectional study nested in a cohort study was conducted in Porto Alegre, Brazil, with 287 puerperal women selected at two maternity hospitals, one public and one private. Women were interviewed at their homes the week after the infant completed 30 days of life. A structured questionnaire was applied, as well as instruments to evaluate maternal satisfaction with breastfeeding (Maternal Breastfeeding Evaluation Scale) and to screen for PPD (Edinburgh Postnatal Depression Scale). The association between higher satisfaction with breastfeeding (outcome) and negative PPD screening test was assessed using Poisson regression with robust variance, adjusting for specific covariables. Adjusted prevalence ratios (aPR) and respective 95% confidence intervals (95%CI) were estimated. RESULTS: The prevalence of increased satisfaction with breastfeeding (defined as women with scores above the median) was 47% higher among women who screened negative for PPD when compared to those with a positive result (aPR 1.47; 95%CI 1.01-2.16). This result was adjusted for maternal age and skin color, cohabitation with the infant's father, planned pregnancy, type of delivery, exclusive breastfeeding, and occurrence of breastfeeding problems. CONCLUSIONS: The findings of this study showed an association between higher maternal satisfaction with breastfeeding and absence of PPD symptoms, reinforcing the importance of caring for the mental health of pregnant and puerperal women and paying attention to their satisfaction with breastfeeding.

Maternal satisfaction with breastfeeding in the first month postpartum and associated factors.

BACKGROUND: Breastfeeding success has been measured based on its duration, disregarding satisfaction with the maternal experience. Studies to investigate maternal satisfaction with breastfeeding are rare, especially in Brazil, and little is known about their determinants. The aim of this study was to measure the level of satisfaction with breastfeeding in a group of women in the first month of their child's life, and to identify factors associated with higher maternal satisfaction. METHODS: A cross-sectional study nested within a cohort was conducted with 287 women recruited at two (one public, one private) maternity services in the city of Porto Alegre, southern Brazil, from January to July 2016. Women residing in the municipality who had given birth to a healthy singleton born at term, were rooming in, and had initiated breastfeeding were randomly included. During the week after the child was 30 days old, women were interviewed at their homes to measure the level of maternal satisfaction with breastfeeding, using the Maternal Breastfeeding Evaluation Scale (MBFES), validated for use in the Brazilian population. Associations between maternal satisfaction and explanatory variables were estimated using multivariate Poisson regression with robust variance in a four-level hierarchical approach. Satisfaction level was categorized using as cutoff point the median score obtained with the MBFES. Women with scores equal to or above the median were considered to have higher levels of satisfaction, whereas those scoring below the median were considered to be less satisfied. RESULTS: Maternal satisfaction with breastfeeding in the first month postpartum was high, with a median score of 124 on MBFES, close to the maximum score (145 points). The prevalence of more elevated levels of satisfaction with breastfeeding was higher among women with brown (pardo) and black skin color (prevalence ratio [PR] 1.33, 95%CI 1.05;1.69), those who lived with the partner (PR 1.75, 95%CI 1.05;2.94), who planned to breastfeed for 12 months or more (PR 1.48, 95%CI 1.02;2.17), and who did not report low milk supply (PR 1.47, 95%CI 1.03;2.10) or cracked nipples (PR 1.29, 95%CI 1.01;1.65). CONCLUSIONS: The factors associated with maternal satisfaction with breastfeeding in the first month postpartum include individual factors and maternal expectations, family constitution, as well as breastfeeding-related problems.

COVID-19 Outbreak in North Italy: An Overview on Dentistry. A Questionnaire Survey.

This survey assessed the symptoms/signs, protective measures, awareness, and perception levels regarding COVID-19 among dentists in Lombardy, Italy. Moreover, an analysis of the answers gathered in areas with different prevalence of the disease was carried out. All Lombardy's dentists were sent an online ad hoc questionnaire. The questionnaire was divided into four domains: personal data, precautionary measures (before patient arrival; in the waiting room; in the operating room), awareness, and perception. Three thousand five hundred ninety-nine questionnaires were analyzed. Five hundred two (14.43%) participants had suffered one or more symptoms referable to COVID-19. Thirty-one subjects were positive to the virus SARS-CoV-2 and 16 subjects developed the disease. Only a small number of dentists (n = 72, 2.00%) were confident of avoiding infection; dentists working in low COVID-19 prevalence areas were more confident than those working in the Milan area and high prevalence area (61.24%, 61.23%, and 64.29%, p < 0.01 respectively). The level of awareness was statistically significantly higher (p < 0.01) in the Milan area (71.82%) than in the other areas. This survey demonstrated that dentists in the COVID-19 highest prevalence area, albeit reported to have more symptoms/signs than the rest of the sample, were the ones who adopted several precautionary measures less frequently and were the more confident of avoiding infection.

Validation of a tool to evaluate women's satisfaction with breastfeeding for the Brazilian population / Validação de instrumento para avaliação da satisfação da mulher com a amamentaçãopara a população brasileira

Abstract Objective To perform the construct validity and the internal consistency of the Maternal Breastfeeding Evaluation Scale tool, aiming at its application in the Brazilian population. Methods Cross-sectional study that applied the tool to 287 Brazilian women 30 days after childbirth. Main component analysis with varimax rotation was used for the factor analysis, verifying the number of subscales and the maintenance or extraction of the components. Four hypotheses were tested using the unpaired Student's t-test for construct validation. The reliability analysis was performed using Cronbach's alpha coefficient. Results The exploratory factor analysis identified the need to exclude an item and to reformulate the subscales. The results of the construct validity showed that all hypotheses proposed were confirmed: women who were breastfeeding, those who were exclusively breastfeeding, those who did not have problems related to breastfeeding, and those who intended to breastfeed for at least 12 months achieved significantly higher mean values in the scale. The tool showed adequate internal consistency (Cronbach's alpha = 0.88, 95% CI: 0.86-0.90), as did the pleasure and fulfillment of the maternal role subscales (0.92, 95% CI: 0.91-0.93%); child growth, development, and satisfaction (0.70; 95% CI: 0.65-0.75); and maternal physical, social, and emotional aspects (0.75, 95% CI: 0.70-0.79). Conclusions The validation process of the Brazilian version of the Maternal Breastfeeding Evaluation Scale tool showed that it is valid and reliable tool to be applied to the Brazilian population.

Resumo Objetivo Realizar a validação de constructo e avaliar a consistência interna do instrumento Maternal Breastfeeding Evaluation Scale, visando à sua aplicação na população brasileira. Métodos Estudo transversal com aplicação do instrumento a 287 mulheres brasileiras após 30 dias do nascimento da criança. Para a análise fatorial utilizou-se a análise de componentes principais com rotação varimax, verificando o número de subescalas e a manutenção ou extração dos componentes. Para a validação de constructo quatro hipóteses foram testadas pelo teste T-student não pareado. A análise de confiabilidade foi realizada utilizando o coeficiente de alfa de Cronbach. Resultados A análise fatorial exploratória identificou a necessidade de exclusão de um item e a reformulação das subescalas. Os resultados da validade de constructo mostraram que todas as hipóteses propostas foram confirmadas: as mulheres que estavam amamentando, as que estavam em amamentação exclusiva, as que não apresentavam problemas relacionados à amamentação e aquelas com intenção de amamentar por pelo menos 12 meses apresentaram valores médios significativamente superiores na escala. O instrumento apresentou consistência interna adequada (alfa de Cronbach = 0,88; IC95%: 0,86-0,90), assim como as subescalas prazer e realização do papel materno (0,92; IC95%: 0,91-0,93), crescimento, desenvolvimento e satisfação infantil (0,70; IC95%: 0,65-0,75) e aspectos físico, social e emocional materno (0,75; IC95%: 0,70-0,79). Conclusões O processo de validação do instrumento Maternal Breastfeeding Evaluation Scale/BRASIL constatou que ele é válido e confiável para ser aplicado à população brasileira.

Validation of a tool to evaluate women's satisfaction with breastfeeding for the Brazilian population.

OBJECTIVE: To perform the construct validity and the internal consistency of the Maternal Breastfeeding Evaluation Scale tool, aiming at its application in the Brazilian population. METHODS: Cross-sectional study that applied the tool to 287 Brazilian women 30 days after childbirth. Main component analysis with varimax rotation was used for the factor analysis, verifying the number of subscales and the maintenance or extraction of the components. Four hypotheses were tested using the unpaired Student's t-test for construct validation. The reliability analysis was performed using Cronbach's alpha coefficient. RESULTS: The exploratory factor analysis identified the need to exclude an item and to reformulate the subscales. The results of the construct validity showed that all hypotheses proposed were confirmed: women who were breastfeeding, those who were exclusively breastfeeding, those who did not have problems related to breastfeeding, and those who intended to breastfeed for at least 12 months achieved significantly higher mean values in the scale. The tool showed adequate internal consistency (Cronbach's alpha=0.88, 95% CI: 0.86-0.90), as did the pleasure and fulfillment of the maternal role subscales (0.92, 95% CI: 0.91-0.93%); child growth, development, and satisfaction (0.70; 95% CI: 0.65-0.75); and maternal physical, social, and emotional aspects (0.75, 95% CI: 0.70-0.79). CONCLUSIONS: The validation process of the Brazilian version of the Maternal Breastfeeding Evaluation Scale tool showed that it is valid and reliable tool to be applied to the Brazilian population.

Combined pro-breastfeeding practices are advantageous in facilities providing maternity and newborn services.

This study aimed to evaluate the association between a set of pro-breastfeeding practices in facilities providing maternity and newborn services and the prevalence of exclusive breastfeeding at 30 days postpartum, considering the contribution of each practice. A cross-sectional study nested within a cohort study was conducted with 287 women who delivered healthy term infants in two hospitals in southern Brazil. They were interviewed at home at 30 days postpartum. The following practices were evaluated: skin-to-skin contact soon after birth, breastfeeding in the first hour, uninterrupted rooming-in, professional support with breastfeeding, breastfeeding guidance, encouragement to breastfeed on demand, no supplementation with infant formula, and no pacifier use. A score of pro-breastfeeding practices was calculated using a logistic model, which allowed each practice to have its discriminatory capacity and difficulty estimated individually. Poisson regression was used to estimate the association between exclusive breastfeeding at 30 days and the pro-breastfeeding practice score. The prevalence of exclusive breastfeeding at 30 days was 61.7%. The practices with greatest discriminatory capacity, that is, those that contributed most to the score estimates, were professional support with breastfeeding, breastfeeding guidance, and encouragement to breastfeed on demand. The most difficult ones were breastfeeding in the first hour, encouragement to breastfeed on demand, and non-utilization of infant formula. For each unit (standard deviation) of increase in the score, there was an increase of 20% in the prevalence of exclusive breastfeeding at 30 days. We conclude that the set of pro-breastfeeding practices assessed here increased the effect of these practices on exclusive breastfeeding rates at 30 days.

Nutritional status of HIV-positive patients in Niterói, Rio de Janeiro, Brazil.

The objective of this cross-sectional study was to assess the nutritional status of HIV-positive patients in a hospital in the city of Niteroi, Rio de Janeiro, Brazil. We studied 235 patients (130 men and 105 women) from May 2009 to June 2010. The frequency of undernourishment among women was 7.6%; 26.7% of the women were overweight, and 16.2% were obese. Among men, the frequency of undernourishment was 3.8%; 25.4% of the men were overweight, and 6.9% were obese. A logistic regression was done to investigate the relationship between nutritional status and potential predisposing factors. Women were more frequently affected by obesity and undernourishment than men. However, only the difference in obesity was significant, and women had almost three times higher odds of being obese (OR 2.6; 95% CI 1.03-6.65). According to a nationwide survey done in Brazil during 2008-2009, 50.1% of the Brazilian healthy males were overweight, and 12.5% were obese; 48% of healthy females were overweight, and 16.9% were obese. Although the prevalence of undernourishment in HIV-positive patients is now lower than that observed in the beginning of the AIDS epidemic and excess weight is increasingly common among people living with HIV/AIDS, the proportion of excess weight was found lower and of undernourishment was higher in the present study than that found in the Brazilian population.

Perfil nutricional e bioquímico dos pacientes HIV positivos em atendimento no ambulatório de infectologia do Hospital Universitário Antonio Pedro em Niterói - RJ / Biochemical and nutritional profile of HIV-positive patients in the outpatient clinic of infectious diseases at the University Hospital Antonio Pedro in Niterói - RJ

Desde 1980, ano da identificação do primeiro caso de aids no Brasil, mais de meio milhão de novos casos foram notificados no país. A região Sudeste foi a mais atingida com mais de 300 mil casos. No estado do Rio de Janeiro foram identificados 81.606 casos da doença, 48.061 dos quais na capital apenas...Este estudo foi aprovado pelo Comitê de Ética em Pesquisa do HUAP. Num período de 13 meses, foram estudados 235 pacientes, sendo a maioria do sexo masculino(55,3%). A média de idade dos pacientes foi de 43,1 anos, com o predomínio de raça não branca (50,6%). Em relação ao estado nutricional 5,5% da população estudada apresentava baixo peso , 54,4% apresentavam classificação normal, 26% sobrepeso e 11,1% obesidade. Os exames de glicemia de jejum estavam alteradas em 13,7% dos indivíduos, o colesterol total em 40,8%, o LDL em 33,5% e o HDL em 47,9% deles. Este estudo mostra elevado sobrepeso e obesidade na população com HIV/aids, identificando a necessidade em se conhecer o perfil nutricional desses pacientes e tomando as medidas necessárias para o seu controle precoce.

Differences in oral health among Italian adolescents related to the type of secondary school attended.

PURPOSE: The aim of the present study was to evaluate the possible interaction between the type of secondary school attended, oral clinical data and self-perceived oral health (SPOH) behaviour among Italian adolescents. MATERIALS AND METHODS: A total of 913 adolescents living in Milan (Italy), attending two different types of secondary schools, grammar and technical secondary schools, were examined regarding dental caries and gingival conditions. Oral health behaviour data were collected using an anonymous questionnaire. The presence of caries was recorded using the decayed missed filled tooth (DMFT) index, gingival conditions with community periodontal index (CPI) following World Health Organization recommendations. Stepwise logistic regression was applied to determine whether the type of school attended was associated with the clinical outcome variables and subjects' SPOH and with oral health or lifestyle behaviour. RESULTS: The prevalence of caries was 59.8% (95% CI = 41.3 to 76.8); a third of participants showed a CPI = 0, whereas 34.9% had bleeding at probing and 37.9% had calculus. Caries distribution was significantly related to the type of school attended in each score of the DMFT categorisation (P < 0.01). Experience of tooth discomfort was claimed by 23.6% of subjects from grammar schools and 35.3% from technical schools (P < 0.01). In males, CPI > or = 1 was associated with the type of school, OR = 1.6 (95% CI = 1.1 to 2.5), the highest DMFT score and experience of self-perceived tooth discomfort, OR = 1.6 (95% CI = 1.2 to 2.0) and OR = 1.2 (95% CI = 1.4 to 2.6), respectively. In females, only CPI > or = 1 and highest DMFT score were associated with the type of school, OR = 2.1 (95% CI = 1.3 to 3.3) and OR = 1.6 (95% CI = 1.2 to 2.0), respectively. CONCLUSIONS: The type of school is a sensitive indicator of oral health status among adolescents.

The relationship between facial skeletal class and expert-rated interpersonal skill: an epidemiological survey on young Italian adults.

BACKGROUND: The facial region plays a major role in determining physical attractiveness, so we assessed the hypothesis that the capability of successfully managing interpersonal relationships in young adults might be related to the facial skeletal class. METHODS: 1,014 young subjects applying to the Military Academy of Pozzuoli, Italy, were enrolled and the cephalometric evaluation was performed by calculating the angular relationships between skeletal points localized by the lateral cephalogram of the face, sorting the subjects in three groups corresponding to each major facial skeletal class. Concurrently, the subjects were evaluated by a team of psychiatrists administering the MMPI-2 test followed by a brief colloquium with each candidate, in order to identify those subjects characterized by low skills for managing interpersonal relationships. RESULTS: According to the psychiatric evaluation about 20% of the subjects were considered potentially unable to manage successfully interpersonal relationships (NS). Males displayed an about two-fold increased risk of being NS. No differences were shown in the distribution of the NS male subjects among the three different facial skeletal classes. On the other hand, NS females displayed a different distribution among the three facial skeletal classes, with a trend of about two-fold and four-fold, respectively, for those subjects belonging to classes II and III, respect to those belonging to class I. CONCLUSION: Females may be more sensitive to physical factors determining beauty, such as the facial morphology certainly is. This finding appears to be interesting especially when thinking about possible orthodontic interventions, although further study is certainly needed to confirm these results.

Caries experience and status in school-age children residing in four North Italian communities.

PURPOSE: The aim of this paper was to describe the caries experience in four North Italian areas. The areas selected were four North Italian medium-sized cities: San Remo located in western Liguria, Ferrara in Emilia, and Varese and Melegnano (Milan suburbs). MATERIALS AND METHODS: 1104 subjects (560 males and 544 females) were examined. Several dental outcomes were used: DMFT Index and SiC index following WHO recommendations; and the caries experience ratio; the percentage of children with high caries disease and with rampant caries was calculated as the percentage of subjects with DMFT > 0, DMFT > or = 4 and DMFT > or = 7. RESULTS: Mean DMFT ranged from 1.21 +/- 1.65 in the Ferrara group to 1.83 +/- 2.49 in San Remo. Among the groups, statistically significant differences were observed for DT and DMFT (p = 0.04 and p = 0.01 respectively). The SiC index was 3.75 +/- 1.87, 3 (2-5) in all samples, with significant differences among the four areas (p = 0.04). No statistical differences were observed among the four areas regarding caries experience and the proportion of children with high and rampant caries. An elevated proportion of subjects with high caries (DMFT > or = 4) was noted in the San Remo group (22.9%). The distribution of children by gender according to DMFT levels was not statistically significant either. The F/DMFT ratio was similar in the survey areas, from 0.30 in San Remo, 0.38 in Varese and Ferrara, to 0.40 in the Milan suburbs. CONCLUSION: Information drawn from this study can be helpful to describe and plan future dental prevention programmes aimed at reducing caries experience and promoting better oral health level.

Socio-economic influence on caries experience and CPITN values among a group of Italian call-up soldiers and cadets.

PURPOSE: Dental care in Italy is carried out mainly by private professionals and therefore the collection of epidemiological data on dental health is not often possible. Thus, the aim of this study was to collect the DMFT and CPITN values in a population of young Italian male subjects, namely call-up soldiers and cadets, and relate them to the socio-economic status of the subjects. MATERIAL AND METHODS: The sample was made up of two groups from different Italian academies: call-up soldiers: 1184 male call-up soldiers aged from 19 to 25; cadets: 2477 cadets aged from 19 to 25. The level of education was evaluated by means of a questionnaire which the soldiers had to fill in before being examined. Two trained dentists carried out the epidemiological survey following WHO guidelines. Data elaboration was carried out at the 'WHO Collaboration Centre of Milan for Epidemiologist and Community Dentistry'. Data on DMFT were compared by ANOVA. A p value < 0.01 was considered as statistically significant. RESULTS: The mean DMFT value observed was 3.69 +/- 3.31. The differences between the two groups were statistically significant for D e F components (p < 0.05). The caries-free rate is lower in the call-up soldiers group (12.57%) than that reported for the cadets group (25.26%) and the difference was statistically significant (p < 0.01). Statistically significant differences were observed in DMFT values between the two groups stratified by educational level. A healthy periodontium was observed in more than 50% of the sample. In the call-up soldiers group, 40.95% had healthy periodontal conditions; 40.25% of the subjects showed bleeding on probing; 19.03% presented with calculus; and 2.77% presented periodontal pockets 4-5 mm deep. In the cadets group, 57.95% had healthy periodontal conditions; 38.18% of the subjects showed bleeding on probing; 3.52% presented with calculus; and 0.35% presented periodontal pockets 4-5 mm deep. The differences in proportion between the two groups were always statistically significant except for the bleeding score where an almost similar percentage for both groups was recorded. CONCLUSION: The results showed that call-up soldiers have a higher DMFT index and the D value is higher in less educated subjects. Bleeding on probing did not vary either between call-up soldiers and cadets or among socio-economic subgroups. Such results have underlined the need of a systematical information campaign on oral hygiene in Italian schools.