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As routine care was suspended in most countries, one could anticipate progression of undiagnosed and managed oral disease. Patients are usually unaware of the development of oral disease as it is not visible to them and largely asymptomatic, especially in its early stages. The natural progression of conditions such as caries and periodontitis is inevitable without diagnosis and management. The full extent of patient harm because of the suspension of routine dental care can only be estimated when routine oral examinations are fully re-established, and even then, we will probably never know the number of individuals impacted or the extent of disease progression and harm. In first-world countries, there has always been a back-up emergency treatment system for dental problems. For example, in the UK, the safety net for life-threatening swellings and for acute pain relief is the accident and emergency services. This system remained in place during the COVID-19 pandemic. Courts could be expected to understand the coronavirus context and would take this into account should there be a complaint against the clinician about access to care. The suspension of routine dental care to save lives will lead to the closure of many dental practices due to substantial financial impact. The return to routine care will be slow, with prioritisation of non-aerosol generating procedures while we look to further understand methods to mitigate transmission risk via infected aerosol and spatter. Inevitably, the cost of personal protective equipment and the lower volume of patients pose a continued threat to businesses., Key points Natural history of oral disease progression if not managed is described.Concerns about the medico-legal consequences of reduced access to dental care are discussed.The economic repercussions of the COVID-19 need for suspension of routine care and the future increased costs of practice are presented.

Background: Cooking practice has transitioned from use of solid fuels to use of clean fuels, with addition of better ventilation facilities. However, the change in mortality risk associated with such a transition remains unclear. Methods: The China Kadoorie Biobank (CKB) Study enrolled participants (aged 30–79 years) from ten areas across China; we chose to study participants from five urban areas where transition from use of solid fuels to clean fuels for cooking was prevalent. Participants who reported regular cooking (weekly or more frequently) at baseline were categorised as persistent clean fuel users, previous solid fuel users, or persistent solid fuel users, according to self-reported fuel use histories. All-cause and cardiopulmonary mortality were identified through linkage to China's Disease Surveillance Point system and local mortality records. Findings: Between June 24, 2004, and July 15, 2008, 226 186 participants living in five urban areas of China were enrolled in the CKB Study. Among 171 677 participants who reported cooking regularly (weekly or more frequently), 75 785 (44%) were persistent clean fuel users, 80 511 (47%) were previous solid fuel users, and 15 381 (9%) were persistent solid fuel users. During a mean of 9·8 (SD 1·7) years of follow-up, 10 831 deaths were documented, including 3819 cardiovascular deaths and 761 respiratory deaths. Compared with persistent clean fuel users, persistent solid fuel users had significantly higher risks of all-cause mortality (hazard ratio [HR] 1·19, 95% CI 1·10–1·28), cardiovascular mortality (1·24, 1·10–1·39), and respiratory mortality (1·43, 1·10–1·85). The excess risk of all-cause and cardiopulmonary mortality fell by more than 60% in 5 years after cessation of solid fuel use and continued to decrease afterwards. Use of ventilation was associated with lower all-cause mortality risk, even among persistent clean fuel users (HR 0·78, 0·69–0·89). Interpretation: Solid fuel use for cooking is associated with a higher risk of mortality, and cessation of solid fuel use cuts excess mortality risks swiftly and substantially within 5 years. Ventilation use also lowers the risk of mortality, even among people who persistently use clean fuels. It is of prime importance for both policy makers and the public to accelerate the transition from solid fuels to clean fuels and promote efficient ventilation to minimise further adverse health effects.

Background and aims Observational studies have associated resting heart rate with incident diabetes. Whether the associations are causal remains unclear. We aimed to examine the shape and strength of the associations and assessed the causal relevance of such associations in Chinese adults. Methods and results The China Kadoorie Biobank enrolled 512,891 adults in China. Cox proportional hazard regression models was conducted to estimate hazard ratios (HRs) for the associations of resting heart rate with type 2 diabetes and total diabetes. Among 92,724 participants, 36 single-nucleotide polymorphisms (SNPs) related to resting heart rate were used to construct genetic risk score. We used Mendelian randomization analyses to make the causal inferences. During a median follow-up of 9 years, 7872 incident type 2 diabetes and 13,349 incident total diabetes were documented. After regression dilution bias adjustment, each 10 bpm higher heart rate was associated with about a 26% higher risk of type 2 diabetes (HR, 1.26 [95% CI, 1.23, 1.29]) and 23% higher risk of total diabetes (HR, 1.23 [95% CI, 1.20, 1.26]). Instrumental variable analyses showed participants at top quintile compared with those at bottom quintile had 30% higher risk for type 2 diabetes (HR, 1.30 [95% CI, 1.17, 1.43]), and 10% higher risk for total diabetes (HR, 1.10 [95% CI, 1.02, 1.20]). Conclusions This study provides evidence that resting heart rate is an important risk factor for diabetes risk. The results suggest that novel treatment approaches targeting reduction of high heart rate for incidence of diabetes may be worth further investigation.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus which causes COVID-19, is highly contagious. Dentistry is a high-risk profession for occupational virus transmission because of the close proximity of the operator to the patient during treatment and the procedural generation of aerosols. The impact on the provision of dental care has been profound, with routine care restricted or paused for a period around the world. There have been adverse consequences for dental education and clinical research. Emergency and urgent care provisions have generally proceeded. However, even when a patient's condition is deemed urgent, access to the appropriate care may not have been possible due to lack of the recommended personal protective equipment. The common dental diseases of caries and periodontitis usually present with signs and symptoms after some advancement, hence the recommended regular dental examination so that these may be diagnosed early by a professional with suitable lighting, instruments and radiography. Conditions such as oral cancer similarly present in their early stages without symptoms. Many countries introduced telephone and video consultations for patients with symptoms but much disease has gone undiagnosed and without management. It is difficult to ascertain the full effect of the disruption to dental services, education and research but it is likely to be substantial. The immediate future will focus on return to routine care provision with likely longer-term permanent changes., Key points Emergency and urgent care descriptions are presented.The need for the UK to pause routine dental care due to COVID-19 is discussed and compared with Hong Kong.Planning for a safe return to routine dental care and associated dental education is discussed.

Background Self‐rated health ( SRH ) is a strong predictor of mortality in different populations. However, the associations between SRH measures and risk of ischemic heart disease ( IHD ) have not been extensively explored, especially in a Chinese population. Methods and Results More than 500 000 adults from 10 cities in China were followed from baseline (2004–2008) through December 31, 2013. Global and age‐comparative SRH were reported from baseline questionnaires. Incident IHD cases were identified through links to well‐established disease registry systems and the national health insurance system. During 3 423 542 person‐years of follow‐up, we identified 24 705 incident cases of IHD . In multivariable‐adjusted models, both global and age‐comparative SRH was significantly associated with incident IHD . Compared with excellent SRH , the hazard ratios for good, fair, and poor SRH were 1.02 (95% confidence interval [CI], 0.98–1.07), 1.32 (95% CI, 1.27–1.37), and 1.76 (95% CI, 1.68–1.85), respectively. Compared with better age‐comparative SRH , the hazard ratios for same and worse age‐comparative SRH were 1.23 (95% CI, 1.19–1.27) and 1.78 (95% CI, 1.70–1.86), respectively. The associations persisted in all subgroup analyses, although they were slightly modified by study location, education, and income levels. Conclusions A simple questionnaire for self‐assessment of health status was significantly associated with incident IHD in Chinese adults. Individuals and healthcare providers can use SRH measures as a convenient tool for assessing future IHD risk.

Clinical depression is a common medical condition that has pro-found economic implications for individuals, their employers andsociety at large [1].Among others, the Canadian PsychiatricAsso-ciation has fostered research into lowering the work impact ofmental disorders [2]. To reduce the impact of depression onworking Canadians, the Canadian Network for Mood and AnxietyTreatments (CANMAT) has produced a modular continuinghealth education (CHE) programme for family doctors called

The endemic Seychelles Scops-owl Otus insularis is a Critically Endangered restricted range species currently only recorded in the upland forest of Mahé, the largest (152 km2) and highest (903 m) island in the granitic Seychelles. We studied the response of colour-ringed individuals to playback of conspecific calls, to determine factors affecting playback reaction, to monitor behaviour and to assess the reliability of current monitoring techniques. Playback of the territorial waugh call was conducted at fixed points (c. 200 m apart) every month along a total transect length of 8.4 km between April 1999 and May 2001. On the basis of responses and movements of marked individuals we identified 12 territories and noted their boundaries. Mean territory length was 2.92 points (approximately 400 m), equivalent to a conservative estimated territory size of c. 12–16 ha. Males were more frequently detected than females/pairs. The probability of detection (males vs. females/pairs) was 0.87 vs. 0.50 on territory; 0.65 vs. 0.26 at fixed points within territories; and 0.58 vs. 0.22 at fixed points along the transect. There was some significant seasonal variation in detection rates at fixed points within territories for both males and pairs, and in general there was a low probability of detecting individuals around June-August and a high probability of detection around April and, to a lesser degree, October. Response times and owl-recorder distances were not influenced by moon phase or time of playback. This study provides the first baseline data on individual responses to the systematic repeated use of playback in Seychelles Scops-owl. We discuss the implications for current monitoring and its application to other similar Otus species.

The purpose of this study was to determine the attitudes of Mexican-American (MA) parents of children toward school health education programs in South Texas. The Parent Attitude Scale (PAS) was developed and validated by American Cancer Society (ACS) staff and volunteer health educators. The validated survey was used to question randomly selected parents in the McAllen, Texas, school district regarding their attitudes toward school health education. Of 253 parents contacted, 235 (92.9%) parents were interviewed. Mann-Whitney U-Tests indicated that Mexican-American (MA) parents consider school health education to be more important than non-Mexican-American parents do. MA parents, overall, felt that it was more important that their child has good health habits and more important that their child's teacher provide support to them by teaching good health habits than non-MA parents. MA parents also felt that health was more important relative to other subjects at school than non-MA parents. The data indicate strong support for school health education efforts among MA parents in southern Texas. Such support may grow stronger with appropriate parent-recruitment efforts, including those by the ACS. Mexican-American parents may also represent an untapped resource for social and political support for school health programming.

This chapter addresses the problem of adherence to smoking cessation. Several types of interventions targeting smokers have been successful at promoting cessation. In this review, we will provide examples of successful interventions for primary and secondary prevention and provide recommendations to improve adherence to smoking cessation among patients in their clinical practice.

Background High default rates have been reported from the Fife colposcopy clinic in recent years. However, it was felt that this rate was misleading, as many patients who defaulted initially attended subsequent appointments. It was therefore decided to determine the default rate of a cohort of new patients given appointments at the clinic. The objective of the study was to determine the attendance rates for these new patients, between the dates they were first invited to their various appointments and the dates that their notes were subsequently examined as part of this study in September 1992. Methods A retrospective cohort study of new patients invited to the Fife colposcopy clinic was undertaken. The notes of 200 new patients who had been invited during the eight-month period January-August 1991 were selected by systematic sampling. The dates that they had attended for their new patient assessment/treatment, first follow-up and second follow-up appointments were recorded. Attendance rates were then calculated using an incomplete life-table method. Patients were censored if they failed to attend their assessment/treatment or review appointments by 1 October 1992. Results The study demonstrated that 96 per cent of patients attended their first treatment appointment within six months of their appointment date, 91 per cent of first review patients attended within six months, and 88 per cent of second review patients attended within four months. Conclusions These findings suggest that there are two distinct groups of defaulters: those who default initially but subsequently re-attend, and those who default completely. We have named these type A and type B defaulters, respectively. This means that attendance within a certain period of time should also be used to monitor clinic attendance in addition to simple mean attendance rates. As patients who default completely may be more likely to have a severe histological lesion, further work is required to identify factors associated with this type of patient.

Mike Hill has represented Wales on the Faculty of Dental Surgery (FDS) Board for the last five years. He is also chair of the Academy of Medical Royal Colleges in Wales. Here, he writes about some of his experiences in moving to a foreign land…

DESIGN This was a randomised controlled trial in a hospital environment. INTERVENTION After surgical removal of third molars postoperative treatment was with oral amoxicillin-clavulanic acid (AC) or clindamycin (CL) or no antibiotics (C). The surgical technique was the same in all cases, and the follow-up period was 4 weeks. OUTCOME MEASURE Parameters evaluated were pain, differences in mouth opening, infection, the occurrence of dry socket, and adverse postoperative side effects. RESULTS A total of 528 lower third molars were surgically removed in 288 patients during a period of 30 months. The patients' mean age was 20.7 years (age range, 14-61 years). No severe complications such as perimandibular abscess or cellulitis occurred in any patient in any group. There was no significant difference between the groups in the overall occurrence of local infection symptoms after surgery (range, 3.4-4.4%; mean, 3.98%), nor for other parameters. Interestingly, 69.6% of the patients with dry sockets had partially erupted third molars. This rate was the same in each group (62.5% versus 75%) and did not vary significantly. Reported adverse effects were similar in each group (15.3% for AC, 12.2% for CL, 13.9% for C). CONCLUSIONS The results show that specific postoperative oral prophylactic antibiotic treatment after the removal of lower third molars does not contribute to better wound healing, less pain nor increased mouth opening, and could not prevent the cases of inflammatory problems after surgery, respectively. It is therefore not recommended for routine use.