重大突发公共卫生事件一级响应下口腔疾病临床研究工作指导建议

新型冠状病毒肺炎(corona virus disease 2019,COVID-19)疫情发展迅速,各地相继启动突发公共卫生事件一级响应。新型冠状病毒肺炎的爆发,对包括口腔疾病在内的临床研究的开展带来了巨大挑战。鉴于口腔疾病专业特点与诊疗操作的特殊性,保障临床研究受试者和相关从业人员的健康与权益、规范临床研究的实施尤为必要。结合国家卫生健康委员会颁发的相关规范标准,并参考部分临床研究相关组织发布的临床试验管理共识和中华口腔医学会制定的疫情期间口腔疾病治疗规范,特制订口腔疾病临床研究工作指导建议,为重大突发公共卫生事件一级响应下口腔疾病临床研究的开展提供参考。     

口腔医生对门诊突发医疗事件及处理认知水平的调查

目的了解北京地区口腔医生对门诊突发医疗事件及处理的认知水平,探讨提高口腔医生急救处理能力的方式。方法采用自行设计调查问卷,对北京696名口腔医生进行常见门诊突发医疗事件及紧急处理能力的调查,对数据进行描述和统计分析。结果口腔医生门诊常遇到的13项突发医疗事件中,晕厥、低血糖、轻度过敏反应、体位性低血压发生频率位居前4位,分别为65.92%、51.27%、34.53%、21.08%。不足30%的口腔医生充分了解基础生命支持-心肺复苏(BLS-CPR)的相关知识。非营利性、二或三级医疗机构的口腔医生急救能力高于在营利性、规模小的医疗机构的口腔医生。结论应提高口腔医生应对突发医疗事件的认识和预防意识,加强基本急救能力的培养,口腔医学院应开展急救实践操作训练以提高口腔医生综合执业能力。     

口腔急诊的应急管理与感染防控

当前严重急性呼吸系统综合征冠状病毒2（severe acute respiratory syndrome coronavirus 2,SARS-CoV-2,简称“新冠病毒”）已在全世界流行。该病毒传染性强并呈现传播速度快、隐匿性高等特点,为口腔急诊诊疗工作带来潜在的感染风险。文章根据国家和地方政府发布的疫情防控文件,结合目前上海交通大学医学院附属第九人民医院口腔急诊临床实践,总结口腔急诊应急管理与感染防控经验,供国内口腔同行参考。      

国家口腔公共卫生项目对促进我国口腔卫生事业发展的作用及思考

公共卫生的概念最早由美国学者Winslow提出, 核心是保障和促进公众健康。口腔疾病被公认为公共卫生问题, 龋病是最常见、多发的口腔疾病, 因其可防可治, 一直被世界卫生组织列为可由公共卫生有效干预的疾病。我国政府也将其纳入重点防治的主要慢性病。2008年, 由原卫生部启动的"中西部地区儿童口腔疾病综合干预试点项目", 主要针对学龄儿童的第一恒磨牙施行窝沟封闭和口腔健康教育。覆盖国务院划归的中西部22个省、自治区、直辖市以及新疆生产建设兵团。这是我国首个以中央财政专项经费设置的口腔公共卫生项目, 委托中华口腔医学会管理并组织实施。经过6年的探索和经验积累, 原国家卫生计生委将该项目推广至全国31个省(区、市)和新疆生产建设兵团, 更名为"全国儿童口腔疾病综合干预项目"。项目运行10余年来, 对我国口腔公共卫生事业的发展和全国儿童口腔健康促进产生了重要影响。本文通过回顾项目设立的背景, 梳理项目涵盖内容、实施情况和取得的成效, 总结项目管理的经验, 分析我国口腔公共卫生工作在政策保障、经费保障、防治体系、人员能力、技术措施等方面面临的挑战, 提出未来口腔公共卫生事业发展的对策。     

口腔正畸医疗行为与侵权责任相关的法律问题

一个世纪前,世界著名护理学家、英国皇家功绩勋章获得者F．Nightingale说了这样一句名言：“最重要的是医院不能给病人带来伤害（Aboveall,hospitalshoulddothepatientsnoharm）。”这句名言指导了国际上众多名医名家的行医理念,     

Quality evaluation of young adults' radiographs in Finnish public oral health service

Objective: To evaluate the quality of young adults' radiographs exposed and processed under everyday clinical conditions.

Setting: One administrative unit of the Finnish public oral health service.

Design: Two reviewers independently evaluated the radiographs by the same written criteria that were designed as a checklist for on-site evaluations, without any further calibration.

Sample: In total, 312 radiographs (178 bitewing, 88 periapical and 46 panoramic) from 1990 to 1996, collected from patient documents of a randomly selected sample of young adults born in 1966–1971.

Outcome measures: Radiographs were assessed by quality indicators pertinent to the clinical utility as acceptable or unacceptable. If erroneous by some indicator(s) but still contributing to the diagnostic information, a radiograph was rated as diagnostically acceptable. A score of quality points was calculated for each radiograph.

Results: The overall kappa statistics for intra-examiner reliability was 0.63, the proportional agreement 83%. For inter-examiner reliability, 0.42 and 71%, respectively. Although the evaluation criteria took the clinical utility of the radiographs into consideration, only 15% of bite-wings, 13% of periapicals, and 2% of panoramics received the maximum quality points. Erroneous film positioning was the most common fault on intraoral radiographs. On panoramics, the most frequent faults were in density and contrast and in patient positioning. The radiological evaluation had only been recorded for less than one fifth of the films.

Conclusions: A proportion of radiographs fell short of the ideal. There is room for improvement in the quality of radiography in order to obtain the greatest possible diagnostic yield from the exposed radiographs.     

A needs assessment survey of dental public health graduate education in Saudi Arabia

Objectives

The Faculty of Dentistry at King Abdulaziz University (KAU) is planning to develop a master’s program in dental public health (DPH). To develop a curriculum for this program, a needs assessment was conducted in order to identify the level of DPH expertise that currently exists in Saudi Arabia, to identify gaps in knowledge, and to explore current perceptions regarding this type of program.

Methods

A competency-based survey instrument was administered to private and government affiliated dental practitioners in Jeddah, Saudi Arabia. Participants’ knowledge, attitudes, and competencies in DPH were assessed. In addition, questions were submitted that addressed preferred strategies of teaching, curriculum delivery methods, course content, and prerequisites for DPH. These data were combined with data previously collected from dentists holding academic positions at KAU (n = 146) and were analyzed using Statistical Analysis System version 9.3 software. Mean values and frequencies were calculated for the study variables. Proportional odds ratios and 95% confidence intervals were estimated to assess differences in educational preferences and DPH competencies according to age, gender, and qualification.

Results

Most of the participants (95%) reported a need for a DPH graduate program. The respondents had a basic knowledge of DPH and moderate experience in DPH competencies. A variety of preferred educational strategies and methods were identified and differences in educational preferences according to age, gender, and qualification of the respondents were identified. The responses obtained also acknowledged skills and competencies that the participants considered most important for a DPH practice and that would be important for students accepted into a DPH graduate program.

Conclusions

This needs assessment survey represents a preliminary step in establishing a DPH graduate program that addresses current gaps in knowledge and in the practice of public health dentistry. This survey also provided valuable feedback regarding the development of course content for a graduate education program in DPH.     

新型冠状病毒肺炎疫情期口腔专科感染防控的应急管理

本文根据国家有关新型冠状病毒感染防控要求和突发公共卫生事件应急条例,以及口腔专科的临床诊疗特点,参考国内外口腔诊疗中感染防控相关指南和文献,结合医院疫情期口腔诊疗中感染防控的应急管理工作举措,提出应对此次新型冠状病毒肺炎疫情期医院感染防控的建议,重点聚焦疫情期医务人员防护培训及医院感染防控落实等方面,旨在为口腔专科在疫情发生期快速应对新型冠状病毒感染防控的应急管理提供参考。     

Patterns of access to public oral health care in Queensland by gender, indigenous status and rurality

Data were collected on courses of care from all attendances at public sector dental clinics between July 1994 and June 1996 and examined by gender, rurality and indigenous status. Males and indigenous people were more likely to attend dental clinics when a problem with pain existed, resulting in a high need for emergency services, more diagnoses of dental caries, and treatment more often involving oral surgery, including extractions. Similarly, remote area dwellers had more diagnoses of dental caries and oral surgery, although their attendance at clinics was complicated by access.     

Outbreak of bacterial endocarditis associated with an oral surgery practice: New Jersey public health surveillance, 2013 to 2014

Background

In October and November 2014, the New Jersey Department of Health received reports of 3 patients who developed Enterococcus faecalis endocarditis after undergoing surgical procedures at the same oral surgery practice in New Jersey. Bacterial endocarditis is an uncommon but life-threatening condition; 3 patients with enterococcal endocarditis associated with a single oral surgery practice is unusual. An investigation was initiated because of the potential ongoing public health risk.

An epidemiologic investigation of occupational transmission of Mycobacterium tuberculosis infection to dental health care personnel: Infection prevention and control implications

BackgroundThe authors describe an investigation of a dental hygienist who developed active pulmonary tuberculosis (TB), worked for several months while infectious and likely transmitted Mycobacterium tuberculosis in a dental setting in Washington state.MethodsClark County Public Health (CCPH) conducted an epidemiologic investigation of 20 potentially exposed close contacts and 734 direct-care dental patients in 2010.ResultsOf 20 close contacts, one family member and two coworkers, all of whom were from countries in which TB is endemic, had latent TB infection (LTBI). One U.S.-born coworker experienced a tuberculin skin test (TST) conversion from 0 to 8 millimeters. Of the 305 of 731 (41.7 percent) potentially exposed patients who received a single TST, 23 (7.5 percent) had a positive TST result of at least 5 mm. Among the subset of 157 patients tested by CCPH staff, 16 (10.2 percent) had a positive TST result. The dental office did not have infection prevention and control policies related to TB identification, prevention or education.ConclusionsThe coworker's TST conversion indicated a recent infection, likely owed to occupational transmission. The proportion of dental patients with positive TST results was greater than the 1999-2000 National Health and Nutrition Examination Survey prevalence estimate in the general population, and it may reflect transmission from the hygienist with active TB or a prevalence of LTBI in the community.Practical ImplicationsAll dental practices should implement administrative procedures for TB identification and control as described in this article, even if none of their patients are known to have TB.     

Racial and ethnic disparities in nontraumatic dental-condition visits to emergency departments and physician offices: A study of the Wisconsin Medicaid program

BackgroundNontraumatic dental condition (NTDC) visits occur in emergency departments (EDs) and physician offices (POs), but little is known about factors associated with NTDC visit rates to EDs and POs.MethodsThe authors analyzed all Medicaid dental claims in Wisconsin from 2001 through 2003 to examine factors associated with NTDC visits to EDs and POs. They performed bivariate and multivariable analyses. The independent variables they examined included race/ethnicity, age, sex, dental health professional shortage area (DHPSA) designation and urban influence code for county of residence.ResultsThe authors evaluated 956,774 NTDC visits made during 1,718,006 person-years; 4.3 percent of visits occurred in EDs or POs. Native Americans, African-Americans and enrollees of unknown race/ethnicity had the highest unadjusted ED and PO visit rates for NTDCs. African-Americans, Native Americans, adults and residents in partial or entire DHPSAs had significantly higher adjusted rates of NTDC visits to EDs. The authors observed significantly higher adjusted NTDC visit rates to POs for Native Americans, adults and enrollees residing in entire DHPSAs, and a significantly lower adjusted rate among African-Americans.ConclusionsNative Americans, those residing in entire DHPSAs and adults have significantly higher risks of NTDC visits to EDs and POs. African-Americans are at increased risk of making visits to EDs for NTDCs but at decreased risk of making visits to POs for NTDCs.Clinical ImplicationsReductions in Medicaid visits to EDs and POs and the associated costs might be achieved by improving dental care access and targeted educational strategies among minorities, DHPSA residents and adults.