Search Results (414)

Background: Men who have sex with men (MSM) using HIV pre-exposure prophylaxis (PrEP) experience a high burden of human papillomavirus (HPV) infection and related diseases, yet data on HPV vaccination among this group in Brazil remain limited. Aims: The aims of this study were to estimate the prevalence of complete HPV vaccination and to identify factors associated with vaccination completion among MSM using PrEP in Brazil. Methods: We conducted a cross-sectional online survey between May and September 2025 among MSM aged ≥18 years, residing in Brazil and currently using oral PrEP. Participants were recruited through virtual snowball sampling and targeted advertisements on social media and a gay geosocial networking application. Data were collected using a structured, self-administered questionnaire hosted on REDCap^®. Complete HPV vaccination was defined as self-reported receipt of all doses recommended according to the participant’s age and clinical condition. Sociodemographic characteristics, relationship patterns, sexual behaviors, lubricant use during sexual activity, and history of sexually transmitted infections (STIs) were assessed. Adjusted prevalence ratios (aPRs) and 95% confidence intervals (95% CIs) were estimated using Poisson regression with robust (sandwich) variance. Results: A total of 872 MSM using PrEP were included, of whom 59.4% reported complete HPV vaccination. In adjusted analyses, complete vaccination was more frequent among participants reporting both steady and casual partners (aPR = 1.90; 95% CI: 1.36–2.65) or only casual partners (aPR = 1.72; 95% CI: 1.24–2.39), those reporting lubricant use during sexual activity (aPR = 1.41; 95% CI: 1.23–1.61), and those with a diagnosis of chlamydia and/or gonorrhea in the previous 12 months (aPR = 1.22; 95% CI: 1.08–1.36). Conclusions: Although HPV vaccination coverage among MSM using PrEP in Brazil is higher than that reported for MSM in general, it remains incomplete in a population with regular contact with specialized health services. Integrating systematic assessment and delivery of HPV vaccination into PrEP care may help increase vaccination completion and reduce missed opportunities for prevention. Full article

Aim of the study: Anxiety about dental treatment is one of the main barriers to accessing dental services and, at the same time, a well-known problem for dentists. The main objective of this observational pilot study was to assess the prevalence and determinants of dental anxiety and severe forms compatible with dental phobia among adult dental patients and to explore their association with psychological distress, as well as patients’ preferences for methods to reduce pain and anxiety during dental treatment. Materials and Methods: We carried out a pilot observational study using two well-established questionnaires, namely the BSI-18 (Brief Symptom Inventory-18), which assesses the psychological distress of patients visiting the dentist, and the DAS (Dental Anxiety Scale), which evaluates dental anxiety toward dental treatment. The questionnaires were administered in independent dental practices in Timisoara, and the study was conducted between August 2024 and January 2025 on a sample of 231 persons. Results: The results of our study revealed a clear link between sources of oral health information, the high prevalence of anxiety as a personality trait, anxiety towards the dentist, and referral to dental services. Conclusions: The intensity of dental anxiety is higher before the therapeutic manoeuvre. It has been found, however, that people who are more educated experience lower levels of anxiety in specific situations. Full article

Background: Despite its crucial role in overall health, oral health is frequently overlooked within healthcare systems, partly due to the misconception that oral diseases are neither life-threatening nor directly disabling. This perception has led to an underestimation of the psychological, social, and economic burden associated with oral diseases. Τhe present study aimed to assess oral health status and oral health-related quality of life among dental patients attending a public Special Care Center in Greece. Methods: A cross-sectional study was conducted among 400 dental patients aged 18 years and older who visited a public Special Care Center for a routine check-up or a dental problem between September and October 2024. Data was collected through personal interviews and clinical examinations after informed consent was obtained. Oral health-related quality of life was evaluated using the Oral Health Impact Profile-14 (OHIP-14) and the Oral Impacts on Daily Performance (OIDP) questionnaires. Categorical variables were presented as absolute and relative frequencies, while quantitative variables were summarized as mean, standard deviation, median, minimum, and maximum. Normality was assessed using the Kolmogorov–Smirnov test. Bivariate analyses and multivariate linear regression models were performed, with statistical significance set at p < 0.05. Statistical analyses were conducted using IBM SPSS 23.0. Results: The majority of participants were female (56.3%) with a mean age of 50.4 years (SD = 14.9). Overall oral health-related quality of life was moderate (OHIP-14: Mean = 21.0, SD = 14.8; OIDP: Mean = 14.0, SD = 12.8). Patients who attended the center due to a dental problem reported significantly poorer oral health outcomes than those attending routine check-ups (p < 0.001). Poorer self-rated oral health, having ≥12 missing teeth, prosthetic restoration, and foreign nationality were significantly associated with worse oral health-related quality of life. Conclusions: Dental patients attending the Special Care Center demonstrated moderate oral health status, which was associated with psychological distress, physical disability, and social limitations. These findings underline the need for targeted public oral health interventions, especially for vulnerable population groups. Full article

The global population aged 65 and older is expected to double from 761 million in 2021 to 1.6 billion by 2050. Despite often being treated separately in clinical practice and policy, oral health and mental health are fundamentally interconnected in older adulthood, forming a bidirectional relationship that exacerbates disability, social inequity, and systemic healthcare challenges. This narrative review aims to summarize the two-way relationship between mental and oral health and emphasize their combined impact on systemic health, social engagement, and independence among ageing populations. The bidirectional relationship has profound clinical significance. Untreated oral diseases induce chronic pain and cause social embarrassment, aggravating pre-existing depression and anxiety. Periodontal disease can worsen systemic conditions such as diabetes, cardiovascular disease, and dementia via a shared inflammatory pathway. Conversely, mental health issues—including depression, anxiety, cognitive decline, and the use of psychotropic medications—reduce motivation for oral care, prompt dental neglect, and affect salivary function, deteriorating oral health. Despite clear connections, systemic gaps persist, including fragmented healthcare systems, financial barriers, stigma, lack of awareness, and caregiver burnout. To address these challenges, strategies such as developing integrated care models to unify dental and mental health services, reforming policies to prioritize oral and mental health parity, advocating anti-stigma campaigns to clear the misconceptions, and implementing community-based healthcare programmes to reach underserved older adults are essential. By recognizing oral health as a vital component of mental resilience, societies can transform ageing into an era of empowered well-being, where the mouth–mind connection promotes holistic health rather than functional decline. Full article

Background: Women’s empowerment has been significantly associated with improved child health outcomes. Cambodia, amid a rapid socioeconomic transition, offers a critical setting to examine how advancements in women’s empowerment over the past decade have influenced child immunization completion within the first two years of life. Methods: Data from the Cambodia Demographic and Health Surveys conducted in 2010, 2014, and 2021–22, encompassing 9222 women with recent births, were analyzed. Empowerment was measured across literacy and information access, employment, and decision-making domains. Multinomial logistic regression assessed associations between empowerment factors and completion of oral polio (OPV), diphtheria–tetanus–pertussis (DTP), pneumococcal conjugate (PCV), and measles–rubella (MR) vaccines, adjusting for demographic and socioeconomic variables. Results: Between 2010 and 2022, women’s empowerment in Cambodia improved significantly, marked by higher literacy rates, nearly half of women completing primary education, and expanded digital access, with 82.4% owning mobile phones and approximately 50% using the internet daily. While non-working women slightly increased, agricultural employment declined by 20%, and cash earnings rose from 48.7% to 82.5%. Most women participated in major household decision-making, either independently or jointly. Completion rates for OPV, DTP, and PCV ranged from 79% to 83%, while just over half of children were fully vaccinated against measles. Higher maternal education and cash earnings were positively associated with OPV, DTP, and PCV completion but negatively associated with measles vaccination. Women in agricultural work were less likely to complete measles vaccination for their children than non-working women. Joint decision-making regarding the use of respondents’ income was associated with a higher likelihood of measles non-completion (OR = 2.26, 95% CI: 1.13–4.51), whereas joint decision-making about respondents’ health care was associated with a higher likelihood of measles completion (OR = 0.42, 95% CI: 0.21–0.83). Conclusions: Women’s empowerment remains a key determinant of vaccination outcomes in Cambodia. The distinct pattern observed for measles suggests that vaccines scheduled for older ages encounter greater structural and behavioral barriers. To overcome these challenges, strategies should focus on enhancing defaulter tracking, implementing reminder systems, expanding outreach and catch-up programs, and improving the convenience of vaccination services. Full article

Background: Periprosthetic joint infections (PJI) represent a serious complication following joint arthroplasty and require, in addition to surgical intervention, a targeted antibiotic therapy. The aim of this study was to compare microbiological recommendations for the antibiotic treatment of fictitious PJI patients generated by an artificial intelligence (AI) system with those of an interdisciplinary team (IT) consisting of microbiologists and orthopedic surgeons. The differences between the recommendations suggested by AI and the IT were analyzed with regard to the suggested agents and duration of antibiotic therapy. Methods: Based on meta-analyses, a cohort of 100 fictitious patients with acute early- and acute late-onset PJI was created, reflecting the typical demographic data, comorbidities and pathogen profiles of such a population. This information was input into the AI system ChatGPT (OpenAI, GPT-5 “Thinking mode” accessed via ChatGPT Plus, San Francisco, CA, USA) to generate corresponding recommendations. The objective was to use these profiles to obtain recommendations for definitive antibiotic therapy, including daily dosage, intravenous and oral treatment durations. Simultaneously, the same fictitious patient data were reviewed by the IT to produce their own recommendations. Results: The results revealed both concordances and discrepancies in the selection of antibiotics. Notably, in cases involving multidrug-resistant organisms and more complex clinical scenarios, the AI-generated recommendations were incongruent with those of the IT, with estimated percentage agreement ranging from 0–33%. In straightforward clinical scenarios with monomicrobial infections, AI reached an estimated percentage agreement of up to 57% (95%-CI [0.47–0.67]). Furthermore, AI consistently recommended 12 weeks of therapy duration vs. six weeks usually recommended by the IT. Conclusions: The study provides important insights into the potential and limitations of AI-assisted decision-making models in orthopedic infection treatments. Consultation of AI is universally accessible at all times of day, which may offer a significant advantage in the future for the treatment of PJI. This kind of application will be of particular interest for institutions without in-house microbiology services. However, from our perspective, the current level of incongruence between the AI-generated recommendations and those of an experienced interdisciplinary team remains too high for this approach to be clinically implemented at this time. Furthermore, AI lacks transparency regarding the sources it uses to inform about its decision-making and therapeutic recommendations, currently carries no legal weight and clinical implementation is severely hindered by restrictive privacy laws regarding health care data. Full article

Background: Optimal nutritional care is essential to improving outcomes in hemodialysis, yet translation of evidence into routine practice remains uneven across settings. To inform health system planning and implementation priorities, we mapped global research on hemodialysis-related nutrition. Methods: We searched the Web of Science Core Collection for English-language original articles on nutrition and hemodialysis from 1 January 2006 to 13 October 2025. Publication trends, productivity by country and institution, influential journals and authors, citation impact, and conceptual structure via Keyword Plus co-occurrence, trend, and thematic evolution analyses were assessed using the bibliometrix package (version 5.0) in R. Results: A total of 332 articles from 115 journals were identified, with substantial growth and multidisciplinary authorship, though international collaboration remains limited. The United States contributed 21.4% of publications and achieved the highest citation impact, while China, Japan, Iran, and Brazil formed the next tier of contributors. The Journal of Renal Nutrition accounted for 16.6% of papers. Highly cited studies established links between dietary intake, mineral and electrolyte management, and survival, while supporting the use of intradialytic oral nutritional supplements. Thematic evolution showed a shift from biochemical markers toward patient-centered priorities, including diet quality, adherence, body composition, mental health, and quality of life. Emerging directions point to whole-diet approaches and microbiome-modulating strategies. Conclusions: Global research on diet and hemodialysis has progressed from foundational nutrient studies to multidimensional, patient-focused approaches. Our findings suggest opportunities for health systems to strengthen dietitian-led models of care, integrate patient-reported outcomes, and prioritize scalable nutrition interventions within routine dialysis services. Full article

Background/Objectives: Oral health is a critical component of public health, yet disparities in access and financing remain significant. In Bulgaria, dental services are financed through the National Health Insurance Fund and patient co-payments, with coverage differing between children and adults. The aim of this study was to analyze the dynamics of health insurance payments and expenditures for dental care in Bulgaria over the period 2019–2025, with a focus on differences between age groups and the balance between public funding and patient contributions. Methods: A retrospective descriptive–analytical study was conducted using aggregated data from NHIF annual reports, national legislation, and secondary literature. Absolute expenditures (BGN) and relative shares (%) of dental services within total health insurance payments were examined for the period 2019–2025 (actual data). Key dental procedures analyzed included examinations, restorations, extractions, and treatment of pulpitis/periodontitis in children, as well as prosthetic rehabilitation in older adults. Descriptive statistics, trend analysis, and simple linear regression were applied to assess expenditure growth and predictability. Results: Total health insurance payments in Bulgaria nearly doubled between 2019 and 2025, increasing from 4.12 to 8.87 million BGN. Dental expenditures rose from 167,000 to 416,000 BGN, with the share of dental care rising modestly from 4.05% to 4.69%. For children, NHIF covered nearly all costs, with minimal or absent co-payments. Among adults, a co-financing model prevailed, with fixed patient contributions for basic services but full NHIF coverage for prosthetic rehabilitation in edentulous patients aged 65–69 years. Conclusions: Bulgaria’s dental care financing reflects a socially oriented model, with full coverage for children and mixed financing for adults. Strategic policy adjustments are needed to ensure sustainability, equity, and alignment with universal health coverage goals. Full article

The World Health Organization’s Bangkok Declaration, ‘No health without oral health,’ recognizes oral health as a global public health priority. Despite being largely preventable, oral diseases affect nearly half of the global population, and India mirrors this crisis while facing persistent systemic challenges. This qualitative study explores India’s oral healthcare landscape from the perspective of public health dentists to inform context-sensitive reforms. Thirty-one in-depth interviews were conducted with public health dentists from dental colleges registered with the Dental Council of India, recruited across six regions. Interviews were conducted online via MS Teams using a piloted interview guide and video-recorded with consent. Subsequently, the interviews were transcribed verbatim, anonymized, and qualitative data was analyzed using Atlas.ti, following reflexive thematic analysis. Analysis yielded four main themes: facets of oral health inequalities, dental public health initiatives, strategies to mobilize and optimize dental workforce in rural areas, and recommendations to optimize oral healthcare. This study offers contextually grounded yet globally relevant perspectives on oral health reform. By bridging local insights with international priorities, this study proposes a sustainable, equity-driven framework for transforming oral health systems while laying the foundation for future research and policy action aimed at achieving universal oral health coverage. Full article

Background: Elderly individuals living in Romanian long-term care facilities encounter substantial challenges in accessing oral healthcare, despite the high prevalence of dental disease and prosthetic needs. This study aimed to evaluate the oral health status, treatment needs, and access barriers among elderly residents in a long-term care facility in Timișoara, Romania, while also analyzing the current legislative framework and public funding mechanisms for geriatric dental care. Methods: A cross-sectional clinical and interview-based study was conducted among 70 residents aged 65–89 years from a residential center. Data collection included intraoral examinations, caregiver-assisted surveys, and individual interviews. Outcomes included oral health status (edentulism, caries, prosthetic use), service utilization, perceived barriers, and quality of life impact. The results were compared to existing literature and analyzed within the framework of Romanian and European healthcare legislation. Results: Total edentulism was found in 66.6% of participants, with only 28% having functional dentures. Caries and periodontal disease were prevalent, and 84% of residents lacked financial resources for dental care. Only 17% had accessed any dental services in the past year. Structural limitations, including the absence of mobile dental services and the lack of institutional protocols, further restricted access. Romanian Law no. 17/2000 guarantees healthcare in residential settings, but oral health is not explicitly included. Conclusions: The study highlights a critical gap in the provision of oral healthcare to institutionalized elderly in Romania. Neglect compromises nutrition, autonomy, and psychosocial well-being, underscoring the urgent need for legislative clarity, dedicated funding, mobile dental services, and integration into geriatric care. Full article

Background/Objectives: Dental anxiety has been demonstrated to exert a significant influence on the frequency of treatment, the degree of patient compliance, and the long-term implications for oral health. The objective of this study was to evaluate the extent of dental anxiety experienced by patients attending an oral surgery practice in Germany. In addition, the study sought to assess their preventive dental behaviour and to explore any potential associations between anxiety levels and the utilisation of preventive care services. Methods: The present study comprised 102 consecutive adult outpatients from a private oral surgery practice. The assessment of dental anxiety was conducted using the Corah’s Dental Anxiety Scale (DAS). The behaviour of the subjects in relation to preventative dental care was measured using a series of six standardised items, including the frequency of tooth brushing, tartar removal, and professional tooth cleaning. The data analysis comprised descriptive statistics, chi-square (χ²) tests, multiple linear regression, and one-way analysis of variance (ANOVA). Results: The mean DAS score was 12.69 (SD = 3.36). According to the DAS classification system, 28.4% of patients reported low anxiety, 50.0% moderate anxiety, and 21.6% high dental anxiety. Regression analysis explained 10% of the variance in DAS scores (R² = 0.128, adj. R² = 0.100). The analysis revealed that age (β = −0.218, p = 0.035) and lower educational level (β = −0.357, p < 0.001) were associated with higher anxiety scores, whereas sex was not a significant predictor. Preventive dental behaviour, encompassing practices such as tooth brushing, professional tooth cleaning, and tartar removal, did not exhibit significant disparities across anxiety groups (all p > 0.05). Conclusions: While dental anxiety was prevalent among the patient sample, it did not exert a significant influence on preventive dental behaviours. However, patients with lower levels of education and younger age exhibited higher dental anxiety scores. These findings underscore the necessity for targeted educational and preventive strategies in patients with elevated dental anxiety. Full article

Background/Objectives: Patients that undergo percutaneous coronary intervention (PCI) require effective antiplatelet therapies to minimize the risk of thrombotic cardiovascular events. Oral P2Y12 inhibitors are often utilized, however co-administered opioids may lead to gastric absorption issues in these patients, affecting the efficacy of oral inhibitors. Cangrelor is an intravenous, direct-acting, reversible P2Y12 inhibitor that could be explored as a potential treatment option for patients with gastric absorption issues during ST-elevation myocardial infarction. The objective was to estimate the UK budget impact of introducing cangrelor for ST-elevation myocardial infarction (STEMI) patients with gastric absorption issues undergoing PCI. Methods: A budget impact model was developed to calculate the impact of introducing cangrelor to treat STEMI patients with gastric absorption issues undergoing PCI, to the UK National Health Service and personal social services, over 5 years. Oral P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor), glycoprotein IIb/IIIa inhibitors (eptifibatide and tirofiban), and aspirin and heparin alone were included as base case comparators. Cangrelor uptake ranged from 10% to 30% in years 1–5. The cangrelor-eligible population was estimated at 10,903 patients per year. Results: Over 5 years, cangrelor leads to a small cost saving (0.29%), varying from −GBP 261,989 in year 1 to GBP 174,778 in year 5. The introduction of cangrelor is estimated to lead to 314 fewer hospital days and 190 clinical events avoided over 5 years. Conclusions: Introducing cangrelor to STEMI patients with gastric absorption issues undergoing PCI in the UK is estimated to generate a small cost saving and reduced length of stay for some patients. Full article

Background: The COVID-19 pandemic significantly disrupted various aspects of daily life, including hygiene routines, dietary habits, and access to dental care. This study aimed to evaluate the impact of the pandemic on the oral health-related and dietary behaviors and dietary pattern of patients from the West Pomeranian region of Poland. Methods: A cross-sectional survey was conducted among 100 healthy adult participants from the West Pomeranian region, including patients from the Pomeranian Medical University and private dental practices. A self-administered questionnaire consisting of 43 items was used to assess changes in hygiene, dietary behaviors, and the frequency of dental visits during the pandemic. Results: The majority of respondents were under 30 years of age, with women representing 56% of the sample. Most participants resided in large urban areas with populations exceeding 300,000. During the pandemic, 41% of participants maintained regular dental visits, while 37% reported experiencing dental problems; all those who sought care received appropriate treatment. Nearly half of the respondents had undergone quarantine due to SARS-CoV-2 exposure, and 38% expressed fear of infection. The results revealed a notable decline in preventive dental care during the pandemic: only 41% of participants reported maintaining regular dental check-ups. Additionally, 34% reported increased consumption of snacks, while 25% indicated more frequent alcohol intake. 22% of respondents experienced involuntary teeth clenching during the day, and 13% reported teeth grinding, These findings reflect a negative shift in health behaviors during the COVID-19 period. Conclusions: The pandemic had a substantial adverse effect on oral health behaviors, dietary choices, and the use of dental services. Nevertheless, participants demonstrated awareness of these changes and, following the pandemic, expressed an increased understanding of the importance of regular dental visits. It is necessary to implement preventive measures that increase awareness of the health consequences (such as dental caries and periodontal diseases) in order to reduce the neglect of routine dental check-ups. Full article

Background/Objectives: As the aging population is growing globally, oral health has become integral to ensuring healthy aging and quality of life. This study assessed the oral health status of older adults in a Malaysian long-term care facility and explored caregiver-reported challenges in providing oral care. Methods: A convergent mixed-methods design was applied, involving 115 residents aged ≥60 years and 16 caregivers in a public facility. The residents’ oral health was assessed using interviewer-assisted questionnaires (demography, dependency level, Oral Frailty Five-item Checklist), clinical examinations (dental caries status, number of remaining teeth, oral and denture hygiene), and the Decayed, Missing, and Filled Teeth (DMFT) index. Focus group discussions with caregivers were conducted, transcribed, and thematically analyzed. Quantitative data were descriptively analyzed using SPSS version 29.0. Results: Over one-third of the residents (39%) were moderately to highly dependent on caregivers. All had experienced dental caries, with most having fewer than 20 teeth (92.9%) and requiring dentures (81.7%). Overall, both oral and denture hygiene were poor. Assessment of oral frailty indicated that the majority of residents (94.8%) were at risk of impaired oral function. A thematic analysis identified four key themes influencing oral health: (1) health and oral health conditions of residents; (2) variety in oral care practices; (3) older adults’ attitudes and behaviors; and (4) system factors. These themes were mapped in a conceptual framework demonstrating multilevel influences on oral care. Conclusions: Despite the single-center design, these findings provide actionable insights for improving geriatric oral health policies in Malaysia. Practical recommendations include integrating oral health into aged-care standards, expanding mobile dental services, and establishing oral care champions within facilities. Addressing these challenges is critical to improving quality of life and aligning long-term care practices with the WHO’s healthy aging priorities. Full article

Background/Objectives: This study aimed to examine the utilization of dental care services according to the health information literacy among Korean adults. Methods: This study used secondary raw data from the 9th National Health and Nutrition Examination Survey (2023), which included 3356 adults aged 20 years and older. Frequency analysis, cross-analysis, and logistic regression were performed (p < 0.05). Data were analyzed using IBM SPSS software (ver. 22.0). Results: Using cross-analysis to identify the relationship between health information understanding and oral examinations within the last year, statistically significant differences were confirmed for all questions (p < 0.05). A statistically significant association was identified between individuals’ level of health information literacy and their engagement in preventive dental care, particularly the utilization of scaling procedures (p < 0.05). The higher their understanding of health information, the more likely they were to have undergone an oral examination in the previous year (nearly twice as likely higher; p = 0.003). The higher the understanding of health information regarding preventive treatment (scaling), the more likely the participant was to receive it (i.e., 2.2 times higher; p < 0.001). Conclusions: Educational interventions and policy support to improve the ability to understand health information can be important strategies for promoting the practice of preventive oral health and improving oral health level in people. Full article