Beyond land use planning and ecosystem services assessment with the conservation use potential framework: A study in the Upper Rio das Velhas basin, Brazil.

Human actions can damage the ecosystems and affect the services depending on them, with ample detrimental consequences. In earlier studies, the Conservation Use Potential (PCU) framework proved useful in assessing the capacity for aquifer recharge, suitable land uses and resistance to erosion at the river basin scale. On the other hand, the joint analysis of PCU and land uses allowed identifying the adequacy of current uses in relation to suitability (natural uses) in various basins. This was especially useful from the management perspective in basins with environmental conflicts, where current uses differed from suitability, because the PCU indicated how and where the conflicts should be mitigated. Besides the use as management tool, the PCU has potential to shed light over environmental issues such as ecosystem services, but that was not tempted so far. The aim of this work was therefore to bridge that knowledge gap and frame the PCU's application from the standpoint of Ecosystem Services (ES) assessment. We demonstrated how the PCU could be used to improve provision (recharge), support (sustainable agriculture) and regulation (resistance to erosion) services in a specific basin with land use conflicts (the Upper Rio das Velhas basin, located in Minas Gerais, Brazil), through the planning of suitable uses. It was noted that the studied basin is mostly composed of Very Low, Low and Medium potentials. These classes occur because steep slopes, fragile soils and lithologies with high denudation potential and low nutrient supply dominate in the basin. On the other hand, urban sprawl has a negative impact on all ES, while maintaining agricultural areas with appropriate management can effectively regulate erosion. As per the current results, the premise of using the PCU as joint management-environmental tool was fully accomplished, and is recommended a basis for public policy design and implementation in Brazil and elsewhere.

Access to dental care for patients with inherited bleeding and hemoglobin disorders.

AIM: To identify the main barriers to dental care access for patients with inherited bleeding (IBD) and hemoglobin disorders (HbD). METHODS: Patients with IBD and HbD were invited to participate in this study between August 2019 and March 2020. Data were collected through a questionnaire consisting of socioeconomic and demographic items and questions about access to dental services and history of dental treatment. Univariate and multiple Poisson regression model was used to determine associations between professional refusal of dental care and other co-variables (p < .05). RESULTS: The participants (29.1%) have already had professional refusal of dental care and participants with IBD (53.2%) did not feel confident with their local dentist due to their bleeding tendency. Most (64.6%) felt apprehensive about visiting the local dentist and high prevalence of refusal to provide dental care was associated with age (prevalence ratio [PR] = 1.021; 95% confidence interval [CI] = 1.010-1.032). Individuals with low bleeding risk were less likely to be denied dental care by a professional compared to those with high bleeding risk (PR = 0.536; 95%CI = 0.291-0.990). CONCLUSION: Professional refusal of dental care was high among patients with IBD, particularly older adults and with an increased risk of bleeding.

Telediagnosis of oral lesions using smartphone photography.

OBJECTIVE: The objective of this observational study was to evaluate telediagnosis of oral lesions using smartphone photography. MATERIALS AND METHODS: Individuals with visible oral lesions composed a convenience sample. The lesions were photographed using a smartphone camera and emailed along with clinical information to three evaluators, who formulated up to two diagnostic hypotheses for each case. A total of 235 photographs from 113 clinical cases were obtained. The evaluators answered questions regarding referral decisions, requests for additional tests, diagnostic difficulties, and image quality. The diagnostic hypotheses were compared to the gold standard by means of percent agreement and kappa coefficient. Consensual face-to-face diagnoses of three specialists-when only a clinical diagnosis was necessary-or histopathological results-when a biopsy was necessary-were considered the gold standard. RESULTS: The telediagnosis was similar to the gold standard in 76% of the cases, and kappa coefficients showed almost perfect agreement (k = 0.817-0.903). The evaluators considered that referrals could have been avoided on an average of 35,4% of the cases. CONCLUSION: Diagnosis of oral lesions using images taken with a smartphone showed almost perfect agreement and diagnostic accuracy comparable to face-to-face diagnosis.