Integration of oral health into primary care: a scoping review protocol.

INTRODUCTION: Integrated care has been introduced as a means of improving health outcomes and access to care, and reducing the cost of healthcare. Despite its importance, the integration of oral health into primary care is still an emerging healthcare pathway. This scoping review protocol has been developed and funded by the Canadian Institutes of Health Research to provide an evidence-based synthesis on a primary oral healthcare approach and its effectiveness in improving oral health outcomes. METHODS AND ANALYSIS: The 6-stage framework developed by Levac et al underpins this scoping review. We will identify relevant existing theories, programmes and original research through a comprehensive and systematic search of electronic databases such as OVID (MEDLINE, EMBASE, Cochrane databases), NCBI (PubMed), EBSCOhost (CINAHL), ProQuest, Databases in Public Health, Databases of the National Institutes of Health (health management and health technology) and relevant organisational websites and other sources of grey literature. All types of studies from 1978 to May 2016 in the French and English languages will be included. Using the Rainbow conceptual model of integrative primary care, a qualitative descriptive approach and thematic analysis will be used to synthesise the literature. Implementing novel healthcare models necessitates identifying barriers, sharing knowledge and delivering information. The integration of oral healthcare into primary care is an approach that promotes breaking the boundaries separating oral healthcare professionals and primary care. It creates opportunities for the dental workforce to become more involved in community-based practice and to assume shared responsibility with healthcare professionals to address the unmet oral health needs of those experiencing vulnerability and marginalisation. ETHICS AND DISSEMINATION: The scoping study has received approval from the Université de Montréal's Institutional Review Board (#14-097-CERES-D). The findings will be disseminated through publications and presentations in provincial, national and international research symposiums and professional meetings.

DENTAL STUDENTS' PERSPECTIVES ON RURAL DENTAL PRACTICE: A QUALITATIVE STUDY.

INTRODUCTION: The chronic shortage of dentists in rural communities may affect the quality of care provided to these communities. The aim of this study was to explore the knowledge and perspectives of Quebec's future dentists regarding rural dental practice and their career intentions. METHODS: We conducted a qualitative study at 2 major dental faculties using the interpretive description method. Purposeful maximum variation sampling and snowball techniques were used to recruit 4th-year dental students and specialty residents as study participants. Face-to-face, semi-structured, 60-90-minute interviews were conducted and audio-recorded. Qualitative data were analyzed using a thematic approach including interview debriefing, transcript coding, data display and interpretation. RESULTS: Of the 17 interviews, 10 were with women and 7 with men; the age range of participants was 22-39 years. Five major themes emerged from the interviews: awareness of access to oral health care in rural areas, image of rurality, image of rural dental practice, perceived barriers to and perceived enablers of rural dental practice. Students said that undergraduate dental education, financial rewards, professionalism, professional support and social media may positively affect their perspective on rural dental practice. CONCLUSIONS: There is a need to implement and support strategies known to increase dental students' knowledge of rural practice and their motivation to choose rural practice. Dental educators have an essential role to play in shaping professional character and encouraging apprenticeship to meet these goals.

Oral health and access to dental care: a qualitative exploration in rural Quebec.

INTRODUCTION: We sought to explore how rural residents perceive their oral health and their access to dental care. METHODS: We conducted a qualitative research study in rural Quebec. We used purposeful sampling to recruit study participants. A trained interviewer conducted audio-recorded, semistructured interviews until saturation was reached. We conducted thematic analysis to identify themes. This included interview debriefing, transcript coding, data display and interpretation. RESULTS: Saturation was reached after 15 interviews. Five main themes emerged from the interviews: rural idyll, perceived oral health, access to oral health care, cues to action and access to dental information. Most participants noted that they were satisfied with the rural lifestyle, and that rurality per se was not a threat to their oral health. However, they criticized the limited access to dental care in rural communities and voiced concerns about the impact on their oral health. Participants noted that motivation to seek dental care came mainly from family and friends rather than from dental care professionals. They highlighted the need for better education about oral health in rural communities. CONCLUSION: Residents' satisfaction with the rural lifestyle may be affected by unsatisfactory oral health care. Health care providers in rural communities should be engaged in tailoring strategies to improve access to oral health care.

INTRODUCTION: Nous avons voulu vérifier comment les résidents des milieux ruraux perçoivent leur santé buccale et leur accès aux soins dentaires. MÉTHODES: Nous avons effectué une étude de recherche qualitative dans le Québec rural. Nous avons utilisé un échantillonnage déterministe pour recruter les participants à l'étude. Des enregistrements sonores d'entrevues semi-structurées, effectuées par une personne dûment formée, ont été colligés jusqu'à atteinte de la saturation. Nous avons procédé à une analyse thématique pour dégager les enjeux. Cela a inclus un compterendu des entrevues, l'encodage des transcriptions, la présentation des données et leur interprétation. RÉSULTATS: La saturation a été atteinte après 15 entrevues. Cinq grands thèmes ont émergé des entrevues : idylle rurale, perception de la santé buccale, accès aux soins dentaires, déclencheurs de l'action et accès aux renseignements dentaires. La plupart des participants se sont dits satisfaits du mode de vie rural et à leur avis, la ruralité en soi ne menaçait pas leur santé buccale. Toutefois, ils se sont plaints d'un accès limité aux soins dentaires dans les communautés rurales et se sont dits inquiets de l'impact sur leur santé buccale. Les participants ont noté que la motivation à chercher des soins dentaires venait principalement de la famille et des amis plutôt que des professionnels des soins dentaires. Ils ont rappelé la nécessité d'une meilleure sensibilisation à la santé buccale dans les communautés rurales. CONCLUSION: La satisfaction des résidents à l'endroit d'un mode de vie rural peut être affectée par des soins de santé buccale insatisfaisants. Les professionnels de la santé des communautés rurales devraient participer à des stratégies adaptées pour améliorer l'accès aux soins dentaires.

Linkage maps from multiple genetic crosses and loci linked to growth-related virulent phenotype in Plasmodium yoelii.

Plasmodium yoelii is an excellent model for studying malaria pathogenesis that is often intractable to investigate using human parasites; however, genetic studies of the parasite have been hindered by lack of genome-wide linkage resources. Here, we performed 14 genetic crosses between three pairs of P. yoelii clones/subspecies, isolated 75 independent recombinant progeny from the crosses, and constructed a high-resolution linkage map for this parasite. Microsatellite genotypes from the progeny formed 14 linkage groups belonging to the 14 parasite chromosomes, allowing assignment of sequence contigs to chromosomes. Growth-related virulent phenotypes from 25 progeny of one of the crosses were significantly associated with a major locus on chromosome 13 and with two secondary loci on chromosomes 7 and 10. The chromosome 10 and 13 loci are both linked to day 5 parasitemia, and their effects on parasite growth rate are independent but additive. The locus on chromosome 7 is associated with day 10 parasitemia. The chromosome 13 locus spans ~220 kb of DNA containing 51 predicted genes, including the P. yoelii erythrocyte binding ligand, in which a C741Y substitution in the R6 domain is implicated in the change of growth rate. Similarly, the chromosome 10 locus spans ~234 kb with 71 candidate genes, containing a member of the 235-kDa rhoptry proteins (Py235) that can bind to the erythrocyte surface membrane. Atypical virulent phenotypes among the progeny were also observed. This study provides critical tools and information for genetic investigations of virulence and biology of P. yoelii.

Virulence differences in Toxoplasma mediated by amplification of a family of polymorphic pseudokinases.

The population structure of Toxoplasma gondii includes three highly prevalent clonal lineages referred to as types I, II, and III, which differ greatly in virulence in the mouse model. Previous studies have implicated a family of serine/threonine protein kinases found in rhoptries (ROPs) as important in mediating virulence differences between strain types. Here, we explored the genetic basis of differences in virulence between the highly virulent type I lineage and moderately virulent type II based on successful genetic cross between these lineages. Genome-wide association revealed that a single quantitative trait locus controls the dramatic difference in lethality between these strain types. Neither ROP16 nor ROP18, previously implicated in virulence of T. gondii, was found to contribute to differences between types I and II. Instead, the major virulence locus contained a tandem cluster of polymorphic alleles of ROP5, which showed similar protein expression between strains. ROP5 contains a conserved serine/threonine protein kinase domain that includes only part of the catalytic triad, and hence, all members are considered to be pseudokinases. Genetic disruption of the entire ROP5 locus in the type I lineage led to complete attenuation of acute virulence, and complementation with ROP5 restored lethality to WT levels. These findings reveal that a locus of polymorphic pseudokinases plays an important role in pathogenesis of toxoplasmosis in the mouse model.

Coordinated progression through two subtranscriptomes underlies the tachyzoite cycle of Toxoplasma gondii.

BACKGROUND: Apicomplexan parasites replicate by varied and unusual processes where the typically eukaryotic expansion of cellular components and chromosome cycle are coordinated with the biosynthesis of parasite-specific structures essential for transmission. METHODOLOGY/PRINCIPAL FINDINGS: Here we describe the global cell cycle transcriptome of the tachyzoite stage of Toxoplasma gondii. In dividing tachyzoites, more than a third of the mRNAs exhibit significant cyclical profiles whose timing correlates with biosynthetic events that unfold during daughter parasite formation. These 2,833 mRNAs have a bimodal organization with peak expression occurring in one of two transcriptional waves that are bounded by the transition into S phase and cell cycle exit following cytokinesis. The G1-subtranscriptome is enriched for genes required for basal biosynthetic and metabolic functions, similar to most eukaryotes, while the S/M-subtranscriptome is characterized by the uniquely apicomplexan requirements of parasite maturation, development of specialized organelles, and egress of infectious daughter cells. Two dozen AP2 transcription factors form a series through the tachyzoite cycle with successive sharp peaks of protein expression in the same timeframes as their mRNA patterns, indicating that the mechanisms responsible for the timing of protein delivery might be mediated by AP2 domains with different promoter recognition specificities. CONCLUSION/SIGNIFICANCE: Underlying each of the major events in apicomplexan cell cycles, and many more subordinate actions, are dynamic changes in parasite gene expression. The mechanisms responsible for cyclical gene expression timing are likely crucial to the efficiency of parasite replication and may provide new avenues for interfering with parasite growth.

The construction and use of log-odds substitution scores for multiple sequence alignment.

Most pairwise and multiple sequence alignment programs seek alignments with optimal scores. Central to defining such scores is selecting a set of substitution scores for aligned amino acids or nucleotides. For local pairwise alignment, substitution scores are implicitly of log-odds form. We now extend the log-odds formalism to multiple alignments, using Bayesian methods to construct "BILD" ("Bayesian Integral Log-odds") substitution scores from prior distributions describing columns of related letters. This approach has been used previously only to define scores for aligning individual sequences to sequence profiles, but it has much broader applicability. We describe how to calculate BILD scores efficiently, and illustrate their uses in Gibbs sampling optimization procedures, gapped alignment, and the construction of hidden Markov model profiles. BILD scores enable automated selection of optimal motif and domain model widths, and can inform the decision of whether to include a sequence in a multiple alignment, and the selection of insertion and deletion locations. Other applications include the classification of related sequences into subfamilies, and the definition of profile-profile alignment scores. Although a fully realized multiple alignment program must rely upon more than substitution scores, many existing multiple alignment programs can be modified to employ BILD scores. We illustrate how simple BILD score based strategies can enhance the recognition of DNA binding domains, including the Api-AP2 domain in Toxoplasma gondii and Plasmodium falciparum.