Virtual fracture liaison clinics in the COVID era: an initiative to maintain fracture prevention services during the pandemic associated with positive patient experience.

We introduced virtual fracture liaison clinics during the COVID-19 pandemic in order to support clinical care while DXA services were down-turned. We observed that virtual FLS clinics are effective in delivering fracture risk assessment, health promotion, and clinical management and are well received by patients with positive patient experience. INTRODUCTION: We examined the impact of virtual FLS telephone clinics, as an alternative to face-to-face clinics during the COVID-19 lockdown. METHODS: Patients presenting with low trauma fracture were recruited according to standard criteria. A structured telephone clinic appointment was offered, which included fracture risk and health promotion assessment and a treatment plan. Risk factors, demographics, fracture type, FRAX scores, and outcomes were analysed. We assessed patient experience with an anonymised patient survey. RESULTS: Clinical outcomes from virtual clinics were assessed (77F/33M; mean age 65.7 years). The mean 10-year observed fracture risk for major osteoporotic fracture was 18.2% and 7.0% for hip fracture. We observed high 'attendance' rates at 79%; however, a significant number were still not available for telephone review (11%) or cancelled their appointment (10%). A recommendation for bisphosphonate treatment was made in 54% of the cohort based on National Osteoporosis Guidelines Group (NOGG) criteria. Follow-up DXA assessment is planned for 64%, according to fracture risk and NOGG guidance. We received 60 responses from the initial patient survey. Ninety percent rated their overall experience of service at 4 or 5 (very good to excellent). Ninety-eight indicated they would recommend the service to others. CONCLUSIONS: Virtual clinics are effective in delivery of fracture risk assessment and clinical management with positive patient experience. While a significant proportion will require DXA follow-up to complete the clinical assessment, virtual clinics have mitigated delays in fracture prevention interventions during the COVID-19 pandemic.

Who is more susceptible to Covid-19 infection and mortality in the States?

BackgroundA novel coronavirus was detected in Wuhan, China and reported to WHO on 31 December 2019. WHO declared a global pandemic on 11 March 2020. The first case in the US was reported in January 2020. Since mid-March 2020, the number of confirmed cases has increased exponentially in the States, with 1.1 million confirmed cases, and 57.4 thousand deaths as of 30 April 2020. Even though some believe that this new lethal coronavirus does not show any partiality to the rich, previous epidemiological studies find that the poor in the US are more susceptible to the epidemics due to their limited access to preventive measures and crowded living conditions. In this study, we postulate that the rich is more susceptible to Covid-19 infection during the early stage before social distancing measures have been introduced. This may be attributed to the higher mobility (both inter- and intra-city), given their higher tendency to travel for business/education, and to more social interactions. However, we postulate after the lockdown/social distancing has been imposed, the infection among the rich may be reduced due to better living conditions. Further, the rich may be able to afford better medical treatment once infected, hence a relatively lower mortality. In contrast, without proper medical insurance coverage, the poor may be prevented from receiving timely and proper medical treatment, hence a higher mortality. MethodWe will collect the number of confirmed Covid-19 cases in the US during the period of Jan 2020 to Apr 2020 from Johns Hopkins University, also the number of Covid-19 tests in the US from the health departments across the States. County-level socio-economic status (SES) including age, sex, race/ethnicity, income, education, occupation, employment status, immigration status, and housing price, will be collected from the US Census Bureau. State/county-level health conditions including the prevalence of chronic diseases will be collected from the US CDC. State/county-level movement data including international and domestic flights will be collected from the US Bureau of Transportation Statistics. We will also collect the periods of lockdown/social distancing. Regression models are constructed to examine the relationship between SES, and Covid-19 infection and mortality at the state/county-level before and after lockdown/social distancing, while accounting for Covid-19 testing capacities and co-morbidities. Expected FindingsWe expect that there is a positive correlation between Covid-19 infection and SES at the state/county-level in the US before social distancing. In addition, we expect a negative correlation between Covid-19 mortality and SES.

Dental caries and periodontal disease in Brazilian children and adolescents with cerebral palsy.

The aim of the present study was determine the prevalence and factors associated with dental caries and periodontal disease in Brazilian children and adolescents with cerebral palsy (CP). This is a cross-sectional study conducted with 80 patients ranging in age from 2 to 18 years old. Oral exams were conducted by an examiner with records of DMFT, dmft, Gingival Bleeding Index (GBI) and Community Periodontal Index (CPI). The statistical analysis used Poisson Regression with robust variance estimation (α = 0.05). The prevalence of dental caries was 59.3%, with DMFT and mean dmft of 1.71 ± 2.42 and 2.22 ± 3.23, respectively. The mean GBI was 22.44%, and in the CPI, the prevalence of gingival bleeding, calculus, shallow and deep pockets were 94.73%, 79.62%, 12.90% and 3.22%, respectively. The caregiver's educational level of less than eight years were associated with the dental caries experience (PR = 1.439; 95%CI = 1.09-1.89). The periodontal alterations were associated with female sex (PR = 0.82; 95%CI = 0.69-0.97), caregiver's educational level of less than eight years (PR = 1.15; 95%CI = 1.03-1.29), poor oral perception (PR = 0.89; 95%CI = 0.80-0.98), serious communication problem (PR = 0.87; 95%CI = 0.76-0.99) and athetoid type of CP (PR = 0.85; 95%CI = 0.75-0.97). The patients with CP presented high dental caries experience and periodontal alterations, which were associated with their demographic, socioeconomic, oral health perception and systemic information.

Indicadores socioeconômicos e desigualdades em saúde bucal no Brasil / Socioeconomic indicators and inequalities in oral health in Brazil

Objetivo: relacionar indicadores socioeconômicos com a oferta de cobertura na Atenção Básica e de recursos humanos em saúde bucal no Brasil. Metodologia: realizou-se um estudo ecológico com a utilização dos seguintes dados secundários, coletados por unidade federativa (n=27): Produto Interno Bruto per capita (PIB), analfabetismo acima de 15 anos (ANALF), Número de Cirurgiões-Dentistas (NCD) e População Coberta na Atenção Básica (PCAB); a partir das bases eletrônicas do Instituto Brasileiro de Geografia e Estatística; Conselho Federal de Odontologia; e Departamento de Informática do Sistema Único de Saúde. Utilizaram-se Testes de Correlação de Pearson e Exato de Fisher para análise. Resultados: evidenciou-se associação significante (p<0,01) entre: PIB/ANALF; PIB/NCD; PIB/PCAB; ANALF/NCD, ANALF/PCAB. Detectou-se correlação entre os dados: PIB/ANALF; PIB/PCAB; e ANALF/PCAB (p<0,01); ANALF/NCD (p<0,05), sendo correlações negativas: PIB/ANALF; PIB/PCAB; ANALF/NCD. Os estados, em que o valor do PIB foi baixo, caracterizaram-se por baixo NCD e altos ANALF e PCAB. Onde o ANALF foi baixo, a PCAB foi reduzida. Conclusão: os indicadores analisados podem contribuir na elaboração de modelos de decisão em saúde, na explicação dos processos organizativos e da desigualdade na oferta de serviços e recursos humanos em saúde bucal no Brasil.

Objective: to relate socioeconomic indicators with the offer coverage in primary health care and human resource in oral health in Brazil. Methods: an ecological survey was performed using the following secondary data, collected by state (n= 27): Gross Domestic Product per capita (PIB); illiteracy over 15 years (Analf), Number of Dentists (NCD) and Population Covered in Primary Health Care (PCAB); from the electronic database of the Brazilian Institute of Geography and Statistics, Federal Council of Dentistry, and Department of the Unified Health System. It has used Pearson?s correlation tests and Fisher Exact test for analysis. Results: associations were significant (p<0.01) between: GDP/Analf; GDP/NCD; GDP/PCAB; Analf/NCD; Analf/PCAB. It has detected a correlation between the data: GDP/PCAB, and Analf/PCAB (p<0.01); Analf/NCD (p<0.05), and negative correlations: GDP/Analf; GDP/PCAB; Analf/NCD. The states where the value of GDP was low, characterized by low and high NCD Analf and PCAB. Where Analf was low, the PCAB was reduced. Conclusion: the analyzaded indicators could contribute to the development of decision models in health, to the explanation of organizational processes and of inequality in the provision of services and human resources for oral health in Brazil.

Atividade antifúngica de três óleos essenciais sobre cepas de candida / Antifungal activity of three essential oils on candida strains

Objetivou-se avaliar a atividade antifúngica dos óleos essenciais de Melaleuca alternifólia (melaleuca), Cymbopogon winterianus (citronela), e Rosmarinus officinalis (alecrim) sobre Candida albicans (ATCC289065), C. albicans (ATCC40227), C. krusei (ATCC40147), C. tropicalis (ATCC40042) e C. tropicalis (ATCC13803). Determinou-se a atividade antifúngica pela Concentração Inibitória Mínima (CIM) e Concentração Fungicida Mínima (CFM), obtidas através das técnicas de microdiluição e de esgotamento, respectivamente. Em microplacas de 96 poços foram inseridos 100?L de caldo Sabouraud-Dextrose duplamente concentrado, 100?L da diluição dos óleos essenciais e 10?L do inoculo fúngico (1,5x106 microrganismos/mL). Realizou-se diluição seriada dos produtos partindo-se da concentração inicial de 8% até 0,0625%. A CIM correspondeu a menor diluição na qual se verificou ausência de crescimento fúngico visível. Realizou-se a semeadura, em Ágar Sabouraud-Dextrose, de 10?L das diluições correspondentes a CIM e duas imediatamente anteriores. Os testes foram realizados em triplicata e a Nistatina (100.000UI/mL) serviu de controle. Procedeu-se análise estatística pelos testes Kruskal-Wallis e Dunn. Para R. officinalis, observou-se melhor desempenho frente C. albicans (ATCC289065) e C. tropicalis (ATCC40042), com CIM e CFM iguais a 0,5626mg/ mL. M. alternifólia e C. winterianus apresentaram melhor desempenho frente C. tropicalis (ATCC40042), com CIM e CFM iguais a 0,5626mg/mL. O óleo essencial de R. officinalis apresentou atividade antifúngica estatisticamente diferente (p<0,05), com menores valores de CIM e CFM. Não se observou diferença estatística (p>0,05) para a ação de M. alternifólia e C. winterianus. Concluiu-se que os produtos avaliados exerceram atividade antifúngica sobre Candida, destacando-se o óleo essencial de R. officinalis, com menores CIM e CFM.

The aim was to evaluate the antifungal activity of essential oils from Melaleuca alternifólia (tea tree), Cymbopogon winterianus (citronella), and Rosmarinus officinalis (rosemary) on Candida albicans (ATCC289065), C. albicans (ATCC40227), C. krusei (ATCC40147), C. tropicalis (ATCC40042) and C. tropicalis (ATCC13803). The antifungal activity was determined by Minimum Inhibitory Concentration (MIC) and Minimal Fungicidal Concentration (MFC), obtained through the microdilution and exhaustion techniques, respectively. In 96-well microplates were inserted 100?L of Sabouraud-Dextrose broth doubly concentrated, 100?L of the dilution of essential oils and 10?L of fungal inoculums (1.5x106 microorganisms/mL). The products were diluted from initial concentration of 8% until 0.0625%. The MIC corresponded to the lowest dilution at which there was no visible fungal growth. Aliquots of 10?L of dilutions corresponding to the MIC and two immediately preceding were sown on Sabouraud-Dextrose agar. The tests were performed in triplicate and nystatin (100,000UI/mL) served as control. Statistical analysis was conducted by Kruskal-Wallis and Dunn tests. For R. officinalis, better performance was observed on C. albicans (ATCC289065) and on C. tropicalis (ATCC40042), with MIC and MFC at 0.5625mg/mL. M. alternifólia and C. winterianus presented better performance on C. tropicalis (ATCC40042), with MIC and MFC at 0.5625mg/mL. The essential oil from R. officinalis presented antifungal activity statistically different (p<0.05), with lower MIC and MFC. No statistical difference (p>0.05) was observed for the antifungal activity of M. alternifólia and C. winterianus. It was concluded that the evaluated products exerted antifungal activity against Candida, highlighting the essential oil from R. officinalis, with lower MIC and MFC.

Prevalência presumível de hepatites virais e cobertura vacinal para hepatite do tipo b entre estudantes de odontologia da UFPB (Paraíba, Brasil) / Probable prevalence of viral hepatitis and its vaccinal coverage among dental students of the paraíba federal university (Paraíba, Brazil)

O cirurgião dentista está potencialmente exposto à transmissão vertical e horizontal de várias doenças contagiosas, em especial a hepatite viral, por meio de contato com sangue, mucosa e secreções bucais de pacientes, muitos dos quais podem estar assintomáticos. Pesquisa que envolveu 154 estudantes de Odontologia da Universidade Federal da Paraíba (UFPB), com o objetivo de verificar a prevalência presumível de hepatites virais e seu perfil de proteção, constatou que, dos 154 estudantes entrevistados, 131 deles (85,1 por cento) afirmaram não ter tido hepatite, enquanto 21 (13,6 por cento) afirmaram ter tido hepatite, sendo que 2 estudantes não se lembravam se tiveram ou não hepatite. Quanto à cobertura vacinal, 85 (55,2 por cento) entrevistados disseram ter tomado vacina e 37 (24 por cento) afirmaram não ter tomado vacina. Dentre aqueles que foram vacinados, 37 (43,5 por cento) disseram ter tomado as três doses. A conscientização do profissional para a ocorrência do risco de transmissão de doenças, desde o período de formação acadêmica, oferece maior segurança não só a ele, mas também a seus pacientes e familiares.