Micro-needling versus acellular dermal matrix in RT1 gingival recession coverage: A randomized clinical trial

AIMS

This randomized trial assessed for the first time the efficacy of coronally advanced flap (CAF) followed by micro-needling (MN) in contrast to CAF with acellular dermal matrix (ADM) on gingival thickness (GT, primary outcome), keratinized tissue width (KTW), clinical attachment level (CAL), probing depth (PD), recession depth (RD), recession width (RW), recession reduction (Rec-Red), complete root coverage (CRC) and percentage of root coverage (all secondary outcomes) in management of RT1 gingival recession in patients with thin gingival phenotype.

METHODS

A total of 24 patients (n = 24) with a thin gingival phenotype and single RT1 gingival recession in the aesthetic zone were randomly allocated to test- (CAF + MN; n = 12) or control group (CAF + ADM; n = 12). All clinical parameters were evaluated at baseline, 3 and 6 months.

RESULTS

Both groups independently demonstrated significant gain in GT, RW, RD, CAL, PD, Rec-Red, CRC and percentage of root coverage, with reduced PI and BOP (p < .05) at 3 and 6 months, without intergroup differences (p > .05). At 6 months, KTW gain was significantly higher in CAF + MN (5.08 ± 0.9 mm) than in CAF + ADM-group (4.25 ± 1.06 mm; p < .05). Stepwise linear regression model with GT as dependent variable showed that base-line GT was the only statistically significant predictor for GT with a direct correlation between base-line GT and GT after 6 months.

CONCLUSION

CAF followed by MN could represent a promising graft-less approach for increasing gingival thickness, comparable to CAF with ADM, with superior keratinized tissue width improvement, in the treatment of RT1 recession defects in patients with thin gingival phenotype.

Management of interdental papillary defects using subperiosteal hyaluronic acid injection overlay technique: a prospective longitudinal clinical study

OBJECTIVE

Currently, there is no established treatment protocol to treat interdental papillary loss. This research aimed to evaluate the outcomes of interdental papillary reconstruction using minimally invasive surgery, with injectable hyaluronic acid gel.

METHOD AND MATERIALS

Seventeen patients were included, each with five sites of class 1 papillary recession (40 sites in the maxilla and 45 sites in the mandible). Subperiosteal tunneling was performed through a horizontal incision made apical to the base of the papilla without penetrating it. The free gingival sulcus was sealed by 000 retraction cord. A total of 0.2 to 0.6 mL hyaluronic acid was injected gradually. The incision was sutured with polyglycolic sutures. Treated sites underwent clinical and digital evaluation at three follow-up time points (1 month, 3 months, and 6 months).

RESULTS

The interdental papillary defect height in the maxillary sites significantly reduced by 60%, 66%, and 42% at 1, 3, and 6 months, respectively. In mandibular sites, the reduction was 54%, 55%, and 40% at the same follow-up time points. Regarding interdental papillary defect surface area in the maxilla, the reduction was 65%, 71%, and 45% at 1, 3, and 6 months. In the mandible, a reduction of 60%, 64%, and 48% was noticed at the same time points. Regarding patients' pain level score, during the day of surgery, 16 patients reported pain; the average pain score out of 10 was 3.94, and 11 patients (64.7%) needed to take analgesics. The pain generally subsided in the following days. At the day of treatment, 12 out of the 17 patients (70.6%) reported mild difficulty in speaking and eating. No complication, hypersensitivity, or allergy was noted in any patient.

CONCLUSION

Subperiosteal tunneling with hyaluronic acid injection demonstrates clinical improvements in papilla height and papillary recession surface area reduction after 3 months of follow-up, with reduction in improvement after 6 months.

CLINICAL SIGNIFICANCE

Adjunctive use of hyaluronic acid injection with minimally invasive surgery in interdental papillary management may improve clinical and esthetic outcomes.

Orthodontic retention: Rationale and periodontal implications

Post-treatment change in the form of true relapse and physiological and maturational effects is common following orthodontics. The unpredictable nature of these manifestations dictates a conservative, near-universal approach to retention. Both fixed and removable forms of retention are popular with the latter constrained by variable levels of adherence particularly in the medium- to long-term. Fixed retention may offer a more predictable means of preservation of orthodontic outcomes; however, this advantage is offset by the requirement for prolonged supervision and the potential for adverse changes including periodontal breakdown. Nevertheless, while examples of severe complications are common, a clear causal relationship between intact, passive retainers and periodontal issues does not appear to exist. Nevertheless, the importance of diligent maintenance and careful supervision during fixed retention, in particular, cannot be disregarded.

Effectiveness of Strabismus Surgery in Intermittent Exotropia and Factors Influencing Outcome

Intermittent exotropia (IXT) is known to relapse after surgery. No factors to predict or prevent recurrence are known with certainty. This study investigated surgical outcome, potential influencing factors, and reoperation rate in patients with IXT. Medical records of 537 patients who underwent surgery for IXT from 2000 to 2022 with preoperative angles of exodeviation of 6 to 50 prism diopters (PD) were retrospectively studied. Multivariate regression analyses of factors influencing surgical outcome on postoperative day 1 (POD1) and reoperation rate were performed. A Kaplan-Meier analysis was performed to illustrate the reoperation rate. After the first surgery, 83.8% of patients had a successful surgical outcome on POD1 (esodeviation ≤ 5 PD or exodeviation ≤ 10 PD). Logistic regression analysis revealed that small preoperative angles of exodeviation increased the probability for surgical success. Follow-up data at different times (4 days-20 years) after surgery were available for 176 patients: 40 patients were still in the range of surgical success, 133 patients had exotropia > 10 PD. Of the follow-up patients, 65 (12.1%) underwent reoperation. A total of 8.5% had their reoperation within one year after the first surgery, 52.9% within five years. Cox regression analysis revealed that large preoperative angles of exodeviation, far/near incomitance and alphabet pattern strabismus increased the risk of reoperation. Most patients achieved surgical success on POD1, yet the squint angles often increased after surgery, resulting in reoperation in some patients. Prospective studies are needed for a better assessment of pre-, peri- and postoperative factors for surgical success in IXT.

Corneal tomography changes following major (6 mm) medial rectus muscle recession: a prospective cohort study using Pentacam®

INTRODUCTION

The aim of this study is to evaluate changes in corneal astigmatism, axial anterior corneal curvature, as well as changes in the anterior chamber depth and central corneal thickness, 2 months following the unilateral recession of medial rectus muscle in children.

METHODS

Thirty-three children with esotropia were prospectively evaluated following unilateral medial rectus muscle recession, using Pentacam®. Comparisons were made between the operated and fellow unoperated eyes, pre, and postoperatively. The assessment was made for changes in the radius of axial curvature on major meridians at 3 and 3.5 mm from the optical corneal center in the mid-peripheral zone. Astigmatism changes of the anterior and posterior corneal surface were calculated using vector analysis software (astigMATIC®). ANOVA model was used to examine the interaction between age or central corneal thickness and postoperative changes in anterior and posterior surface corneal astigmatism.

RESULTS

In the intervention group, changes in anterior and posterior corneal surface astigmatism were statistically significant, with a mean increase of 0.59Dx92 and 0.08Dx91, respectively. In the mid-peripheral corneal zone, there is an increase in the radius of anterior corneal axial curvature more evident nasally 3.5 mm from the corneal center on the horizontal meridian, with corresponding decrease superiorly and inferiorly at 3 and 3.5 mm from the corneal center on the vertical meridian.

DISCUSSION

The changes in total astigmatism of the operated eyes are mainly attributed to the anterior corneal surface. These changes are associated with flattening in the 180 meridian of the cornea, leading to a shift to "with-the-rule" astigmatism.

A comparison of alveolar ridge mucosa thickness in completely edentulous patients

PURPOSE

The purpose of this cross-sectional clinical study was to determine and compare alveolar ridge mucosa thickness at crestal, buccal, and lingual locations of the maxillary and mandibular arches in completely edentulous patients using a dedicated, ultrasonic gingival scanner.

MATERIALS AND METHODS

Thirty-eight completely edentulous subjects were included in the study. In each subject, soft tissue thickness was measured at 28 sites of the edentulous ridge by a single calibrated examiner. Intra-observer reliability was calculated with Intraclass Correlation Coefficients by measuring 10 subjects twice, after 1 week. Measurements (mm) were taken at the buccal, lingual, and crestal aspects of the ridge with a dedicated ultrasonic scanner. Repeated measures ANOVA and paired t-tests were used to compare the mean buccal, lingual, and crestal soft tissue thicknesses at each site. The Generalized Estimating Equations model was used to study the effects of age, sex, and race. Confidence level was set to 95%.

RESULTS

Mean tissue thickness ranged from 0.96  to 1.98 mm with a mean of 1.63 ± 0.25 mm. Intraclass Correlation Coefficients were > 0.97. No significant differences between buccal, crestal, and lingual sites were noted for the mandibular arch as well as at 4 sites on the maxillary arch (maxillary right second molar, maxillary right canine, maxillary left first premolar, maxillary left second molar). However, significant differences in soft tissue thickness were noted for all remaining maxillary sites. Race was found to be positively correlated with tissue thickness, with Black individuals showing a significantly greater thickness than White individuals at 4 sites (maxillary right first molar, maxillary left canine, mandibular right second premolar, mandibular right first molar). Age was found to be positively correlated with tissue thickness at 4 sites (maxillary left central incisor, maxillary left first molar, maxillary left second molar, mandibular left second premolar) and negatively correlated at 2 sites (mandibular right canine, mandibular right second molar). Female sex was positively (maxillary left second premolar, maxillary left second molar) and negatively (mandibular right canine) correlated, respectively, with tissue thickness at 3 sites. When data for anterior and posterior sites were respectively pooled, tissue thickness was significantly less at anterior sextant lingual and crestal sites, while no difference was seen for buccal sites.

CONCLUSION

Statistically significant differences for alveolar ridge mucosa thickness were found at several sites in the maxilla and between anterior and posterior sextants for lingual and crestal sites in the maxillary and mandibular arches. Tissue thickness differences were also noted for race with Black individuals showing greater tissue thickness at some sites. Age and sex did not show a clear effect on tissue thickness. Recorded differences in tissue thickness were however small and appear of uncertain clinical significance.

Impact of the Great Recession on Adults With Autism and Their Mothers

Autistic individuals and their families are at risk for poor outcomes in employment and mental health and may be vulnerable to long-term effects of broader societal conditions. The aim of the current longitudinal study was to understand the impact of the Great Recession of 2007-2009 on autistic individuals and their mothers (N = 392). Hierarchical linear modeling (HLM) results indicated that problem behavior of autistic adults increased in the years following the recession. The rate at which autistic individuals moved away and lived separately from their mothers also slowed during the recession. Mothers experienced significantly higher levels of depressive symptoms postrecession, compared to prerecession. In many other respects, the autistic individuals and their mothers did not experience negative outcomes, suggesting resilience and a strong safety net. These included the physical health and vocational/employment status of the autistic adults and their mothers. Results point to specific areas of vulnerability of autistic individuals and their mothers during the economic downturn, as well as a broad pattern of resilience in these families.

A review of the impact of social disruptions on food security and food choice

At times of severe social disruption, be that war, conflict, pandemic, or economic downturn, both the availability and consumption of healthy dietary patterns can be adversely affected with any effects often outlasting the initial social disruption. For instance, when the COVID-19 pandemic hit and lockdown restrictions followed, households were reported to consume unhealthy diets. In some cases, this seemed to be a response to the situation and a coping mechanism. In contrast, in other cases, it was a consequence of limited food availability or access, with some communities finding that fresh foods became difficult to source due to the disruption in global supply chains. The example presented by the impact of conflict in Ukraine, which has also disrupted global food supply chains, at a macrolevel, food systems and at a microlevel, individual and community shows that food choices may respond to different global events in similar ways. Therefore, in this review, a range of events/disruptions are considered, beyond pandemics and wars, including climate disasters (e.g., fire, famine, and floods) that have been shown to impact food supply and consequently, food security. The importance of this can be seen as inadequate and nutritionally poor diets have a concomitant effect on health, which extends beyond the initial period of societal stress and disruption of food supply chains. Hence, the impact of such disruptions on consumer behavior which includes food choice needs to be corroborated. Therefore, this review aims to discuss the impact of such disruptions on consumer behavior and food choices. Additionally, this review provides some practical strategies that can be used to ensure the availability of healthy diets.

Economic effects of the war in Ukraine and recession

BACKGROUND

The economic effects of wars and recessions can have significant impacts on consumer attitudes and behaviors. Understanding how these attitudes and behaviors change impacts during challenging economic times is crucial for financial education and management.

METHODS

A survey was conducted to investigate the financial attitudes and behaviors of individuals during a recessionary period. The survey was distributed from January 15th to February 28th, 2023 and included questions about age, financial education level, savings behavior, attitudes towards debt, gender and financial management behavior, age and financial education, and income and savings behavior. Data were analyzed using t-tests and ANOVA.

RESULTS

Participants with higher income levels had higher levels of savings and investing behaviors than those with lower income levels. Participants with a higher level of formal education in finance had higher levels of budgeting and investing behaviors than those with a lower level of formal education in finance. Additionally, participants who reported higher levels of self-rated financial knowledge had higher levels of all financial management behaviors (budgeting, saving, investing, and debt management) compared to those with lower self-rated financial knowledge.

CONCLUSIONS

The findings suggest that financial education and management programs should target individuals with lower income levels and less formal education in finance. Additionally, promoting self-rated financial knowledge may be a useful strategy for improving financial management behaviors. Future research could explore the effectiveness of different financial education and management programs on improving financial attitudes and behaviors during recessionary periods.

Racial and Educational Disparities in Cumulative Exposure to Hardships of the 2008 Great Recession and Inflammation

OBJECTIVE

This cross-sectional analysis examined self-reported economic hardships of the 2008 Great Recession, race/ethnicity, educational attainment, and psychological well-being (PWB) as predictors of systemic inflammatory physiology at midlife. We also tested for differential vulnerability in the relationship between recession hardship and inflammatory physiology by race/ethnicity, education, and PWB.

METHODS

Adults from the Midlife in the United States Refresher sample completed a survey and biomedical assessments after the recession ( n = 592 non-Hispanic White respondents, n = 158 Black/African American respondents, n = 108 respondents with other race/ethnicity). Cumulative recession hardship was the sum of financial, housing, and employment-related events. Outcomes included circulating levels of interleukin 6 and C-reactive protein. General linear regression models tested main effects interactions between primary predictor variables.

RESULTS

Educational attainment was inversely associated with recession hardships ( b = -0.18, 95% confidence interval = -0.26 to -0.11, p < .001). Black/African American respondents reported more recession hardships than White respondents ( b = 1.17, 95% confidence interval = 0.67 to 1.68, p < .001). More recession hardships predicted higher levels of interleukin 6 ( b = 0.06, p < .001) and C-reactive protein ( b = 0.04, p = .004). Analyses did not support race/ethnicity, education, and PWB as moderators of the association between recession hardship and inflammatory markers.

CONCLUSIONS

Race/ethnicity and education independently predicted disparities in cumulative recession hardship exposure. Recession hardship predicted higher blood levels of inflammatory proteins associated with long-term health. The lack of findings for differential vulnerability in the relationship between recession hardship and inflammatory markers by race/ethnicity, education, or PWB was possibly due to the limited sample size.

Modified Free Gingival Autograft: A Case Report

The purpose of this case study was to introduce an innovative method utilizing a modified free gingival graft technique, with the goal of accomplishing vertical and horizontal augmentation of soft tissue in the mandibular anterior region. A 35-year-old female patient underwent the modified free gingival graft technique in the anterior mandibular area. Remarkably, after a span of nine months, an increase was noted in both horizontal and vertical dimensions of the gingival tissue. This transformation was met with satisfaction from the patient. Following the successful graft procedure, a vertical gain of 3 mm was observed in the keratinized gingiva.

Determinants of the mental health status of university students in Japan: comparison between pandemic and recession periods during the 7th wave of COVID-19

Introduction

Although the number of identified coronavirus disease 2019 (COVID-19) cases and deaths has decreased, the repetitive crest-trough pattern of the spread of COVID-19 has yet to cease. The current situation may affect the mental health status of university students who are distracted in their academic and daily lives by the pandemic. This cross-sectional study aimed to identify the determinant factors of the mental health status of Japanese university students before and in the middle of the 7th wave of the pandemic, one of the largest waves to be experienced in Japan.

Method

A survey was administered to two groups of students during the recession period between the 6th and 7th waves (n = 156) and during the 7th wave of the pandemic (n = 97).

Results

T-tests showed no statistically significant differences between the two groups in Perceived Stress Scale (PSS) scores, while the COVID-19 anxiety scores (p < 0.001) and General Health Questionnaire (GHQ) scores were significantly higher in the Pandemic period group (p = 0.011). The multiple regression model indicated that PSS scores were the only determinant of GHQ scores in the Pandemic period group.

Discussion

The results indicate that stressful life events, such as the COVID-19 pandemic and daily hassles, which are measured by the PSS, affect students' mental health differently. Therefore, the author submits that school counselors should provide counseling to students to reduce anxiety caused by daily hassles, during recession and pandemic periods. Students also require assistance with the reduction of stress and anxiety caused by daily hassles, regardless of the pandemic situation.

Coronally advanced flap versus tunnel technique for the treatment of peri-implant soft tissue dehiscences with the connective tissue graft: A randomized, controlled clinical trial

AIM

To evaluate the efficacy of coronally advanced flap (CAF) versus tunnel technique (TUN) in covering isolated mid-facial peri-implant soft tissue dehiscences (PSTDs).

MATERIALS AND METHODS

Twenty-eight participants presenting with isolated non-molar implants exhibiting PSTDs were enrolled and randomized to receive either CAF or TUN, both with a connective tissue graft (CTG). The primary outcome of the study was the percentage of mean PSTD coverage at 12 months. Secondary endpoints included the frequency of complete PSTD coverage, changes in keratinized mucosa width (KMW) and horizontal mucosal thickness (MT), as assessed with transgingival probing, 3D optical scanning and ultrasonography, professional aesthetic evaluation and patient-reported outcome measures (PROMs).

RESULTS

At 12 months, the mean PSTD coverage of the CAF and TUN groups was 90.23% and 59.76%, respectively (p = .03). CAF-treated sites showed a substantially higher frequency of complete PSTD coverage (p = .07), together with significantly greater gain of KMW (p = .01), increase in MT (p = .02), volumetric gain (p < .01) and professional aesthetic outcomes (p = .01). Both interventions showed an improvement in patient-reported aesthetics and a reduction of the anxiety related to the appearance of the implant compared to baseline, with the CAF group obtaining significantly higher scores (p = .03 for both PROMs).

CONCLUSIONS

CAF + CTG resulted in superior PSTD coverage outcomes, greater gain in KMW and MT, and better PROMs than TUN + CTG for the treatment of isolated PSTDs (ClinicalTrials.gov NCT03498911).

The Great Recession and Physical Activity of Young Adults

Objective. Since physical inactivity has been identified as a pandemic and a public health priority, it is crucial to understand the role of adverse economic shocks on physical activity. In this study, we examine the impact of job losses during the U.S. Great Recession from January 2008 to June 2009 on the likelihood of physical activities of young adults. Methods. We use individual fixed effects estimation on a nationally representative longitudinal data from 2005 to 2015, the Panel Study of Income Dynamics (PSID), to examine the impact of job losses of young adults, their spouses, and their parents on physical exercise of young adults aged 18 to 27 years. Results. Own job losses during the Great Recession led to a decrease in the likelihood of physical exercise among young adults. However, job losses of parents and partners had no effect on the likelihood of young adults' physical exercise. Conclusion. Our findings indicate a negative impact of the recession on physical activity of young adults and highlights the need for policymakers to consider the impact of major economic downturns on the physical activity of young adults.

How Does Consistency of Food and Nutrition Support Effect Daily Food Consumption among Children Living in Poverty? Recession-Era Implications

Underutilization of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and the Supplemental Nutrition Assistance (SNAP) food safety net programs may compromise child nutritional benefits for families with limited incomes. Using a sample of children surveyed before (2003−2006) and after the Great Recession (2007−2009), we examine whether consistent access to WIC and SNAP during times of increased economic stress moderated the association between poverty level (i.e., income-needs ratio [INR]) and fruits and vegetables (FV) or foods high in saturated fats and added sugars (SFAS). Fragile Families and Child Wellbeing Study income-eligible mothers/children (≤185% of poverty) with available FV and SFAS data at the 5- (2003−2006) and 9-year (2007−2010) waves (n = 733) were included. Main effects of INR and interaction effects of consistency of WIC, SNAP, and dual WIC and SNAP support from birth through age 5 were examined. INR was associated with decreased FV consumption frequency from age 5 to 9, conditional upon consistency of dual WIC/SNAP enrollment. FV declined when there was low consistency (<1 year) of dual support. FV consumption was stable across INR when combined WIC/SNAP support lasted at least 2 years. Results can inform strategies for optimizing the nutritional impact of WIC and SNAP by focusing on those most at risk for underutilization of multiple benefits.

Long-Term Clinical Assessment of Two Modifications of Tunnel Technique in Treatment of Cairo Recession Type 1 in Lower Jaw

AIM

The aim of this study is to compare long-term results after using an MCAT (Modified Coronally Advanced Tunnel) with an SCTG (Subepithelial Connective Tissue Graft) or an MCAT with CM (Collagen Matrices) in the treatment of Cairo recession Type 1 in mandibular single-rooted teeth.

MATERIAL AND METHOD

The study encompassed 80 recessions in 18 patients for whom an MCAT was combined with CM on one side of the mandible and with an SCTG on the contralateral one. The following clinical parameters were measured: gingival recession height (GR) and width (RW), probing depth (PD), clinical attachment level (CAL), width of keratinized tissue (KT), gingival thickness (GT), and mean (MRC).

RESULTS

The MRC on the CM- and SCTG-treated sides was 55.25% and 82.35%, respectively. The SCTG side had a significantly greater improvement in MRC, GR, RW, KT, and GT compared to the CM side. The five-year results were stable relative to one-year observations.

CONCLUSIONS

Both methods of treatment enable the achievement of stable long-term clinical results. Application of subepithelial connective tissue grafts is more effective relative to clinical parameters.

Long-term astigmatism changes following horizontal muscle recession: a prospective cohort study

Strabismus surgery may cause refractive changes, particularly in astigmatism. The aim of this study is to evaluate those changes in astigmatism two and 12 months following unilateral recession of horizontal rectus muscles in children. The authors prospectively evaluated 66 children with esotropia or exotropia, that would undergo a unilateral recession strabismus surgery. Comparisons were made between the 66 eyes that would undergo strabismus surgery and the fellow unoperated 66 eyes of the same children. The 66 eyes that would undergo strabismus surgery were divided into medial (38 eyes) and lateral (28 eyes) rectus muscle subgroups, and further, into subgroups based on the astigmatism axis preoperatively (with-the-rule astigmatism: 35 eyes, no astigmatism: 20 eyes, oblique astigmatism: 10 eyes, against-the-rule astigmatism: 1 eye). All patients were examined one day preoperatively, and then, two and 12 months postoperatively. Paired tests were conducted, and the significant level was set to 0.05 or was adjusted for subgroups. Mean age of children included was 6.73 years (SD = 3.19). Mean astigmatism values preoperatively, 2 and 12 months postoperatively were 0.92D (SD = 0.95), 1.45D (SD = 1.04) and 1.50D (SD = 1.10), respectively, for the eyes that underwent strabismus surgery. A statistically significant mean increase of 0.58D in astigmatism values in the eyes that underwent strabismus surgery was observed 12 months postoperatively (p < .005). Astigmatism values in the eyes that did not undergo strabismus surgery did not statistically significantly change during the observation period. The increase of the absolute values of astigmatism in medial and lateral rectus muscle subgroups was similar, 0.59D (SD = 0.10) and 0.57D (SD = 0.11), respectively. For the eyes that had with-the-rule astigmatism and no astigmatism preoperatively, a statistically significant increase was shown 12 months postoperatively (0.64D and 0.66D respectively) (p < .005). Changes in astigmatism were observed in the eyes which underwent recession of horizontal rectus muscles compared to the fellow eyes, which did not undergo any intervention. An increase in cylindrical power was noted in the eyes that had with-the-rule and no astigmatism prior to surgery. This increase may be interpreted by the decreased tension of the recessed rectus muscle following strabismus surgery. Decreased forces, caused by the recessed horizontal rectus muscle, acting on the sclera on 180-degree meridian may lead to corneal flattening on this particular meridian and consequently, a corneal steepening on the 90-degree meridian. These changes seem to be stable during the first 12 postoperative months.

Innovation to Immune: Empirical Evidence From COVID-19 Focused Enterprise Surveys

The recent COVID-19 crisis caught many by surprise. Yet some firms were better prepared to weather the downturn than others. Using a comprehensive data set that observes over 15,000 firms in 27 countries, including several developing countries, shortly before and after the pandemic, we document that pre-crisis innovation affected firm’s survival odds and performance thereafter. The results show that innovative firms are less likely to close and perform better than non-innovators during the pandemic crisis. Innovative firms are also more optimistic about the future than non-innovators. Our results further indicate that firm’s adaptability mediates the relationship between innovation and survival outcomes. The study finding shows that innovative firms are more likely to introduce new products, remote work arrangements, increase delivery, pivoting, and online activities than non-innovators during the pandemic crisis.

Employment Pathways during Economic Recession and Recovery and Adult Health

Our study bridges literatures on the health effects of job loss and life course employment trajectories to evaluate the selection into employment pathways and their associations with health in the short and medium terms. We apply sequence analysis to monthly employment calendars from a population-based sample of working-age women and men observed from 2009 to 2013 (N = 737). We identify six distinct employment status clusters: stable full-time employment, stable part-time employment, stably being out of the labor force, long-term unemployment, transition out of the labor force, and unstable full-time employment. After adjustment for sociodemographic characteristics and health at baseline, those who transitioned out of the labor force showed significantly poorer self-rated health at follow-up, whereas steadily part-time employed respondents still showed a greater risk of meeting criteria for major or minor depression. The findings have important implications for how social scientists conceptualize and model the relationship between employment status and health.

Extra Ocular Muscle Fenestration as a Weakening Maneuver for Surgical Management of Strabismus: A Randomized Pilot Clinical Trial

Purpose

This study aimed to evaluate the efficacy and safety of fenestration in comparison to the classic muscle recession as a weakening maneuver to horizontal and vertical extra ocular muscles in the surgical management of strabismus.

Patients and Methods

This is a pilot single blind parallel group randomized controlled trial with 1:1 allocation ratio. Male or female patients aged 1- to 60-years-old who were admitted to the Pediatric Ophthalmology and Strabismus Department for surgical correction of horizontal or vertical strabismus. Patients were randomly allocated by the envelop method to either group 1 (muscle fenestration, N=9) or group 2 (classic muscle recession, N=9). All participants were assessed at the first post operative day, at one week, and one month after the surgery for the outcomes.

Results

Postoperative ocular alignment evaluated at the first day, one week, and one month following the operation showed comparable results with no significant differences between both groups (p>0.05). The median postoperative pain score evaluated at the first day following the operation was significantly higher in fenestration group than recession group (the medians were 2.0 and 1.0, respectively, p=0.014). Alternatively, the medians of the pain score were equal in both groups at one week and one month postoperatively (p>0.999). One patient in the fenestration group developed progressive subconjunctival hemorrhage. In contrast, there was no postoperative complications in the recession group (p>0.999).

Conclusion

Efficacy and safety of muscle fenestration for correcting horizontal or vertical strabismus was comparable to the classic muscle recession.

Macroeconomic conditions and health-related outcomes in the United States: A metropolitan and micropolitan statistical area-level analysis between 2004 and 2017

We study the relationship between macroeconomic conditions and health in the United States using data from the Behavioral Risk Factor Surveillance System between 2004 and 2017. Unlike many existing studies that use state or county as the level of aggregation, our analysis uses a sample of metropolitan and micropolitan statistical areas. Our results suggest strong associations between worsening macroeconomic conditions and reduced access to care and health insurance coverage. While we do not detect any robust relationships between business cycles and health outcomes in the general population, we do find consistent evidence of worse self-reported health during economic downturns among minorities and less-educated individuals. In addition, there is some suggestive evidence of countercyclicality of healthier lifestyle choices. However, the findings for health behavior outcomes are not robust to adjusting for multiple hypothesis testing.

Inequality in Life and Death

We argue that the COVID epidemic disproportionately affected the economic well-being and health of poor people. To disentangle the forces that generated this outcome, we construct a model that is consistent with the heterogeneous impact of the COVID recession on low- and high-income people. According to our model, two-thirds of the inequality in COVID deaths reflect preexisting inequality in comorbidity rates and access to quality health care. The remaining third stems from the fact that low-income people work in occupations where the risk of infection is high. Our model also implies that the rise in income inequality generated by the COVID epidemic reflects the nature of the goods that low-income people produce. Finally, we assess the health–income trade-offs associated with fiscal transfers to the poor and mandatory containment policies.

Drinking during downturn: New evidence from the housing market fluctuations in the United States during the Great Recession

We investigate how the decline in home prices over the Great Recession in the U.S. impacted drinking behavior. We match data on actual and shadow home prices (from Zillow Research) to individuals' drinking behavior from the Behavioral Risk Factor Surveillance System (BRFSS) by county of residence and year/month of the interview. We improve upon the existing literature by using new measures of exogenous macroeconomic shocks captured by fluctuations in home prices and finding heterogeneous impacts of the downturn based on homeownership. We find that decline in home prices is commonly associated with increases in alcohol consumption, both on extensive and intensive margins. Additionally, we find that the effects are more consistent among homeowners compared to renters. Given that alcohol consumption is one of the leading causes of death in the U.S. and that the COVID-19 pandemic has triggered an economic crisis in many societies, the results have important public health implications.

Economic cycles and inequalities in alcohol-related mortality in the Baltic countries and Finland in 2000-2015: a register-based study

AIM

To estimate whether large macroeconomic fluctuations in the 2000s affected inequalities in alcohol-related mortality in the Baltic countries and Finland.

DESIGN

Longitudinal register-based follow-up study.

SETTING

Estonia, Latvia, Lithuania and Finland.

PARTICIPANTS

General population in the 35-74 age group.

MEASUREMENTS

Socioeconomic status was measured by the highest achieved educational level and was categorised using the International Standard Classification of Education 2011 as low (included categories 0-2), middle (3-4), and high (5-8). Educational inequalities in alcohol-related mortality in 2000-2003, 2004-2007, 2008-2011 and 2012-2015 were examined using census-linked longitudinal mortality data. We estimated age-standardised mortality rates and the relative and slope index of inequality.

FINDINGS

Alcohol-related mortality increased in all countries in 2004-2007 except among Estonian women and decreased/remained the same from 2008 onward except among Latvian men. By 2012-2015 alcohol-related mortality was still higher than in 2000-2003 in Finland, Latvia and Lithuania (women only). Relative inequalities increased across the study period in all countries (significantly in Lithuania and Latvia). The 2004-2007 increase in relative inequalities was mostly driven by a larger mortality increase among the low educated, whereas in 2008-2011 and in 2012-2015 inequalities often increased because of a larger relative mortality decline among the high educated. However, these period changes in relative inequalities and between educational groups were often not statistically significant. Absolute inequalities were larger in 2012-2015 versus 2000-2003 in all countries except Estonia (decrease).

CONCLUSION

In the Baltic countries and Finland, alcohol-related mortality tended to increase faster among the low educated during a period of economic expansion (2004-2007) and decrease more among the high educated during a period of economic recession (2008-2011).

Functionally graded membrane: A novel approach in the treatment of gingival recession defects

Background:

Guided tissue regeneration has recently been advocated in re-constructing soft-tissue dimensions in recession defects. Advancement in nanotechnology has led to increased zest for approaches such as electrospinning of biologically active; nanofibrous functionally graded regenerative membranes for periodontal tissue engineering. A functionally graded membrane (FGM) had been tailored by incorporating chitosan and nano-hydroxyapatite over Amnion membrane and used in gingival recession defects.

Study Design:

It was single-blind, randomized controlled study. Split-mouth study was conducted in nine patients and 22 sites with recession defects were selected. Sites were divided into Group A (Amnion membrane with coronal advanced flap) and Group B (FGM with coronal advanced flap).

Materials and Methods:

Sites were assessed clinically by recording plaque index (PI), gingival index (GI), vertical recession defect depth (VRDD), relative clinical attachment level (CAL), and width of keratinized tissue at baseline, 3–6 months; and radiographically by recording linear bone growth by dentascan at baseline and 6 months.

Result:

Both groups showed statistically significant reduction in PI, GI and VRDD, and CAL and nonsignificant reduction in width of keratinized tissue at 3 and 6 months postoperatively. Group A showed statistically significant linear bone growth at 6 months. Group B also showed gain in linear bone growth at 6 months; however, result was statistically nonsignificant.

Conclusion:

FGM had shown favorable results by enhancing bone growth while preventing the gingival tissue downgrowth.

Changes in peri-implant soft tissue levels following surgical treatment of peri-implantitis: A systematic review and meta-analysis

AIM

To assess the changes in peri-implant soft tissue levels after the surgical treatment of peri-implantitis.

METHODS

Randomized controlled trials, controlled clinical trials, cohort studies and case series, evaluating the changes in the position of the mucosal margin before and after surgical treatment of peri-implantitis, were searched. Secondary outcomes were changes in keratinized mucosa (KM), radiographic bone levels, probing depths (PD), plaque indices, bleeding on probing and patient perception. Meta-analyses were performed to determine weighted mean differences (WMD) or effects (WME).

RESULTS

Twenty-six articles, reporting 20 investigations, were included. Reconstructive approaches yielded significantly less increase in mucosal recession, when compared to access flaps (n = 3, WMD = -1.35 mm, 95% confidence interval [CI] [-2.62; -0.07], p = .038). When comparing among reconstructive surgical interventions similar outcomes were observed irrespective of the use of a barrier membrane (n = 3, WMD = -0.01 mm, 95% CI [-0.15; 0.13], p = .917). When considering the effects over time, limited mucosal recession was observed after reconstructive procedures (n = 23, WME = 0.389 mm, 95% CI [0.204; 0.574]), p = .001), while increased recession was reported with either resective or access flap surgery (n = 6, WME = 1.21 mm, 95% CI [0.70; 1.72], p = <.001; and n = 3, WME = 0.95 mm, 95% CI [0.20; 2.10], p = .106; respectively). When resective and reconstructive approaches were combined the highest values on peri-implant recession were reported (n = 2, WME = 1.97 mm, 95% CI [0.81; 3.14], p < .001). Reconstructive surgical interventions were associated with greater radiographic bone level gains, while similar values were reported for PD reduction when comparing reconstructive, access and resective procedures.

CONCLUSIONS

Resective surgical procedures were associated with significant post-surgical recession while minimal recession was observed in regenerative interventions.

The impacts of COVID-19 containment on the Australian economy and its agricultural and mining industries

We simulate the economic impacts of the COVID-19 pandemic on the Australian economy using VURM, a detailed computable general equilibrium model for Australia. We identify five sources of economic perturbations: changes to productivity due to changing work practices, changes in household demand imposed by voluntary and mandated social distancing behaviour, changes in international trade due to a weakened world economy and severe curtailment of international travel, reduced population growth due to lower net migration and large debt-financed fiscal stimulus. Variants of these shocks and associated recovery paths are simulated in VURM, with three scenarios describing potential recovery arcs. The macroeconomic and industry impacts are reported for each scenario. Ultimately, our focus is on the impact on output and employment in the agriculture and mining sectors, and on their likely recovery prospects. At the peak of economic impacts, output in these sectors declines by about 6 per cent relative to a no-COVID baseline. Compared to the economy-wide average, the decline in agriculture and mining output is small. This can be explained by relatively minor impacts on work practices, relatively low negative impacts on demand for intensive agriculture (helped by fiscal supports for households) and relatively low disruption to export demand.

Rolling back the prison estate: the pervasive impact of macroeconomic austerity on prisoner health in England

Prisons offer policymakers an opportunity to address the pre-existing high prevalence of physical and mental health issues among prisoners. This notion has been widely integrated into international and national prison health policies, including the Healthy Prisons Agenda, which calls for governments to address the health needs of prisoners and safeguard their health entitlement during imprisonment, and the Sustainable Development Goals 2030 concerning reducing inequality among disadvantaged populations.

However, the implementation of the austerity policy in the United Kingdom since the re-emergence of the global financial crisis in 2008 has impeded this aspiration. This interdisciplinary paper critically evaluates the impact of austerity on prison health. The aforementioned policy has obstructed prisoners’ access to healthcare, exacerbated the degradation of their living conditions, impeded their purposeful activities and subjected them to an increasing level of violence.

This paper calls for alternatives to imprisonment, initiating a more informed economic recovery policy, and relying on transnational and national organizations to scrutinize prisoners’ entitlement to health. These systemic solutions could act as a springboard for political and policy discussions at national and international forums with regard to improving prisoners’ health and simultaneously meeting the aspirations of the Healthy Prisons Agenda and the Sustainable Development Goals.

Predicted Earnings Losses from Graduating during COVID-19

Poor labour market conditions at the start of a worker's career can result in earnings losses for many years. The 2021 cohort of Canadian high school and post-secondary students have seen employment prospects diminish amid economic lockdowns to contain the spread of coronavirus disease 2019 (COVID-19). The goal of this article is to predict earnings losses for this cohort. We use Census of Population data to show that a 1 percent increase in unemployment at the time of graduation leads to a 1.5-4 percent average decrease in earnings. Then, using unemployment rate forecasts from various sources, we predict how this year's graduating class is expected to fare. Our approach assumes previous recessions are informative about the effects of the current recession. We estimate that a typical 2021 graduate loses 5-12 percent of the amount they would have earned over the first few years if the pandemic had not occurred.

Recession and risk of suicide in Denmark during the 2009 global financial crisis: an ecological register-based study

AIM

The aim of this study is to analyse the potential impact from the financial crisis (onset in 2009) on suicide rates in Denmark. The hypothesis is that the global financial crisis raised unemployment which leads to raising the suicide rate in Denmark and that the impact is most prominent in men.

METHOD

This study used an ecological study design, including register data from 2001 until 2016 on unemployment, suicide, gender and calendar time which was analysed using Poisson regression models and interrupted time series analysis.

RESULTS

The correlation between unemployment and suicide rates was positive in the period and statistically significant for all, but at a moderate level. A dichotomised version of time (calendar year) showed a significant reduction in the suicide rate for women (incidence rate ratio 0.87, P=0.002). Interrupted time series analysis showed a significant decreasing trend for the overall suicide rate and for men in the pre-recession period, which in both cases stagnated after the onset of recession in 2009. The difference between the genders' suicide rate changed significantly at the onset of recession, as the rate for men increased and the rate for women decreased.

DISCUSSION

The Danish social welfare model might have prevented social disintegration and suicide among unemployed, and suicide prevention programmes might have prevented deaths among unemployed and mentally ill individuals.

CONCLUSIONS

We found some indications for gender-specific differences from the impact of the financial crises on the suicide rate. We recommend that men should be specifically targeted for appropriate prevention programmes during periods of economic downturn.

Private coverage mandates, business cycles, and provider treatment intensity

The Affordable Care Act (ACA) is the source of multiple large-scale health insurance expansions affecting various segments of the US population. Although much has been done to quantify the first-order effects of these policies, less empirical investigation has been devoted to the effects on the supply-side of health care. We focus on a well-known ACA initiative (the young adult dependent coverage mandate) to offer novel evidence on two fronts: the policy's heterogeneous effect across different labor markets and the potential for the policy-induced shift in payer mix to influence provider treatment decisions. First, we show that the federal mandate's direct effect on young adult private insurance take-up is strongly mitigated by the Great Recession. Second, we demonstrate that providers do not treat young adults more aggressively when more of them hold private coverage. Policymakers should keep these broader considerations and more diffuse risk protection implications in mind when contemplating changes to the law.

Do root coverage procedures affect the longevity of teeth? A systematic review

OBJECTIVE

The objective of this study was to systematically review the literature regarding the effect of root coverage procedures on tooth survival and periodontal outcomes.

DATA SOURCES

A systematic search of the literature was performed according to the PRISMA guidelines. A PICO-based search strategy was performed in six databases. Eligibility criteria included studies comparing tooth survival and periodontal outcomes of teeth treated with root coverage procedures versus teeth that had no treatment. The search resulted in 3,646 articles; 212 articles were downloaded for review, and six articles (three studies) were included. Only a single study reported on tooth survival and found no difference between teeth that underwent root coverage procedures versus those that did not. Although the surgeries described in each study were mostly successful in reducing recession and increasing keratinized gingiva, teeth which did not undergo surgery did not seem to have a clinically significant change in recession. The study with the longest follow-up (18 to 35 years) showed an average increase in recession of 0.5 ± 0.9 mm and a decrease in keratinized tissue of 0.3 ± 0.8 mm in the control group.

CONCLUSION

This systematic review highlights the need for randomized controlled trials to assess the influence of root coverage surgeries on tooth longevity in order to better inform evidence-based practice. When compared to no surgical intervention, there is presently no evidence to suggest that root coverage surgeries increase tooth longevity. Furthermore, the amount of recession does not appear to increase a clinically significant amount over time without surgical intervention in the presence of proper maintenance and home care.

Quality of Life, Health and the Great Recession in Spain: Why Older People Matter?

The financial crisis of 2008 precipitated the “Great Recession”. In this scenario, we took Spain as a country of study, because although it experienced significant negative shocks associated with macroeconomic variables (GDP or unemployment), its welfare indicators have been marked by limited changes. This study used data from waves 2 and 4 (years 2006–2007 and 2010–2012, respectively) of the Survey on Health, Aging and Retirement in Europe (SHARE). Specifically, through logistic regressions we have analysed the effects of socioeconomic, demographic, health and “Great Recession” factors on the quality of life (QoL) of elders in Spain. Although QoL did not change too much during the “Great Recession”, the results confirmed the importance of several factors (such as chronicity) that affect the satisfaction with the QoL among the older people. In this regard, statistically significant effects were obtained for individual exposure to recession. Therefore, a decrease in household income in the crisis period with respect to the pre-crisis period would increase by 44% the probability of reporting a low QoL (OR = 1.44; 95% CI: 1.00–2.07). Furthermore, gender differences were observed. Health and socioeconomic variables are the most significant when determining individual QoL. Therefore, when creating policies, establishing multidisciplinary collaborations is essential.

Impact of economic crisis on mental health: a 10-year challenge

The worldwide economic crisis of the last decade, and still unresolved, led to a great recession involving all major economies. Since economic factors may influence mental wellbeing, not surprisingly a rise in poor mental health was observed in different countries, while representing a great challenge to psychiatric interventions. This paper aims at reviewing the available English literature focusing on the impact of the current economic crisis on mental health, with a special focus on depression and suicide. Available studies indicate that consequences of economic crisis, such as unemployment, increased workload or work reorganization, and reduced staff and wages, may constitute important stressing factors with a negative impact on mental health. Although data are not easily comparable in different countries, depression seems to be the most common psychiatric disorders especially in middle-aged men. Even suicide rates seem to be increased in men, mainly in countries with no public welfare or poor family relationships. All these findings require a careful attention from both governments that cut resources on public health instead of investing in it, and psychiatric associations that should implement appropriate strategies to face and to manage this sort of depression epidemic driven by economic crisis. Again, as available data suggest that the impact of the crisis might have been attenuated in countries with higher spending in social protection, they clearly urge policy makers to take into account possible health externalities associated to inadequate social protection systems.

Erratum: Acceleration of Anxiety, Depression, and Suicide: Secondary Effects of Economic Disruption Related to COVID-19

[This corrects the article DOI: 10.3389/fpsyt.2020.592467.].

Acceleration of Anxiety, Depression, and Suicide: Secondary Effects of Economic Disruption Related to COVID-19

The SARS-CoV-2 (COVID-19) pandemic has contributed to increasing levels of anxiety, depression and other symptoms of stress around the globe. Reasons for this increase are understandable in the context of individual level factors such as self-isolation, lockdown, grief, survivor guilt, and other factors but also broader social and economic factors such as unemployment, insecure employment and resulting poverty, especially as the impacts of 2008 recession are still being felt in many countries further accompanied by social isolation. For those who are actively employed a fear of job and income loss and those who have actually become ill and recovered or those who have lost family and friends to illness, it is not surprising that they are stressed and feeling the psychological impact. Furthermore, multiple uncertainties contribute to this sense of anxiety. These fears and losses are major immediate stresses and undoubtedly can have long-term implications on mental health. Economic uncertainty combined with a sense of feeling trapped and resulting lack of control can contribute to helplessness and hopelessness where people may see suicide as a way out. Taking a macro view, we present a statistical model of the impact of unemployment, and national income declines, on suicide, separately for males and females over the life cycle in developed countries. This impact may reflect a potent combination of social changes and economic factors resulting in anomie. The governments and policymakers have a moral and ethical obligation to ensure the physical health and well-being of their populations. While setting in place preventive measures to avoid infections and then subsequent mortality, the focus on economic and social recovery is crucial. A global pandemic requires a global response with a clear inter-linked strategy for health as well as economic solutions. The models we have constructed represent predictions of suicide rates among the 38 highly industrialized OECD countries over a period of 18 years (2000-2017). Unemployment has a major effect on increasing suicide, especially in middle-aged groups. However, the impact of economic decline through losses of national income (GDP per capita) are substantially greater than those of unemployment and influence suicide throughout the life course, especially at the oldest ages.

Laser-Assisted Adjustable Suture Technique in Strabismus Surgery

Purpose

The aim of this study was to assess the efficacy and safety of a new technique (argon laser-assisted lysis of the adjustable suture) in strabismus surgery.

Patients and Methods

Recession of lateral rectus muscle was done and was secured to the sclera at the predetermined recession position after suspending it 1.5–2.5 mm farther. A 10-0 nylon suture was placed at the original insertion site, passed under the previously tied muscle suture knot, and tied, advancing the muscle to the new scleral insertion. Postoperatively in the same day of surgery, if the targeted slight overcorrection was not achieved, a topical anesthetic was given, and argon laser was used to cut the nylon suture providing additional muscle recession.

Results

Forty-two patients with exotropia were included: 11 children and 31 adults. Eleven (26.2%) patients became orthophoric immediately following muscle recession. Thirty-one (73.8%) patients were undercorrected with a mean residual angle of 8.2±3.3 pd. After laser-assisted release of the suture, 12 (28.6%) patients were orthophoric, with 4 (9.5%) patients still undercorrected and 26 (61.9%) patients overcorrected. By the end of 6 months postoperatively, the overall success rate of the procedure was 88.1%, with only 5 (11.9%) patients with exotropia.

Conclusion

The laser-assisted adjustable suture technique had an overall success rate of 88.1% with only 11.9% of the patients showing exotropia. The technique can help achieve successful alignment.

Economic hardship and mental health complaints during COVID-19

The COVID-19 economic crash is idiosyncratic because of its virtual standstill of economic activity. We therefore ask how individual labor market experiences are related to the development of mental health complaints in the spring of 2020. As clinical data collection was compromised during the lockdowns, standardized surveys of the European labor force provide an opportunity to observe mental health complaints as the crisis unfolded. Data are representative of active members of the labor force of six European nations that contained varying levels of COVID-19 burdens in terms of mortality and lockdown measures. We document a steep occupational prestige level gradient on the probability of facing economic hardship during the lockdowns-looming job loss, income loss, and workload decline-which evidently exacerbate socioeconomic inequalities. Analyses indicate a striking positive relationship between instantaneous economic hardships during the COVID-19 lockdown and expressing feelings of depression and health anxiety. Importantly, the magnitude of the association between such hardships and indicators of mental health deterioration is highly dependent on workers' occupational standing, revealing a second layer of exacerbating inequality.

Households Health Expenditure in Interannual Correlation With Public Health Expenditure in Greece

The aim of this article is to investigate the relationship between the public and the private health expenditure (macroeconomic and microeconomic approach) over time and within the recession and austerity period in Greece, in order to find out whether the strict Memorandum health policies pass, influence, or go along with the health expenditure to the final consumer, i.e., the health services user. In this context, by using econometric tools, such as multiple regression and cointegration analysis on the raw microdata of Household Budget Surveys from 1987/88 up to 2018, as well as by using data of public expenditure of Organization for Economic Co-operation and Development-Health Statistics 2019 in the Stata version 13, the study compares the variation of household and public health expenditures before and after the financial crisis in Greece and also examines the correlation between the two variables. The analysis demonstrated that the Greek household health expenditure (HHE) was rapidly increasing during the period 1988-2008, and afterward, it started decreasing. Moreover, the total private and the total public health expenditures seem to have a bidirectional long-run relationship and significant cointegration. The same was observed regarding the public expenditure and household medical services expenditure, as well as pharmaceuticals. Furthermore, the results indicate that over the years of recession, the monthly HHE decreases, due to the confiscation of middle-class income, which led to consumerism restrictions. However, as households are now spending a bigger portion of their shrunken income for health (as health is an inelastic commodity), HHE, as a proportion of total private expenditure, has eventually risen.

A risk balancing act - Tourism competition using health leverage in the COVID-19 era

The world is currently in the throes of the COVID-19 pandemic which has halted the tourism sector and created an unprecedented global economic crisis. This paper will outline economics pertaining to COVID-19 lockdown, recovery and the inevitable competition that will occur between countries for tourists who will be scarcer and therefore more valuable. Countries are competing with a variety of incentives in order to lure visitors. However, persistent first waves that extend into July will put off tourists, further reducing tourism revenues and accelerate job losses and bankruptcies in affected countries. The example of Sweden's response to COVID-19 in this regard will be described. Countries that have COVID-19 relatively under control but experience second waves will also manifest negative tourism effects. Governments and public health must act in unison so as to exit lockdown as speedily and as safely as feasible, with COVID-19 rises that are as low and brief as possible in order to better compete in the tourism sector with other countries. Websites are already online comparing not only safety for travellers vis-à-vis COVID-19 but also the incentives offered by different countries in their attempts to woo tourists in this difficult market.

Furloughing

Over nine million jobs were furloughed in the United Kingdom during the coronavirus pandemic. Using real-time survey evidence from the UK in April and May 2020, we document which workers were most likely to be furloughed and we analyse variation in the terms on which they furloughed. We find that women were significantly more likely to be furloughed. Inequality in care responsibilities seems to have played a key role: mothers were 10 percentage points more likely than fathers to initiate the decision to be furloughed (as opposed to it being fully or mostly the employer's decision) but we find no such gender gap amongst childless workers. The prohibition of working whilst furloughed was routinely ignored, especially by men who can do a large percentage of their work tasks from home. Women were less likely to have their salary topped up beyond the 80 per cent subsidy paid for by the government. Considering the future, furloughed workers without employer-provided sick pay have a lower willingness to pay to return to work, as do those in sales and food preparation occupations. Compared with non-furloughed employees, furloughed workers are more pessimistic about keeping their job in the short to medium run and are more likely to be actively searching for a new job, even when controlling for detailed job characteristics. These results have important implications for the design of short-time work schemes and the strategy for effectively reopening the economy.

Re-invigoration of Pink Esthetics by a Novel Minimally Invasive Technique: A Report of Two Cases

The importance of pink esthetics as well as increased patient comfort has been gaining its pace in dentistry. Moreover, when it comes to the treatment of gingival recession, the ideologies of the periodontists have changed over time, i.e., from “extension to prevention;” it has now become “conserve to preserve.” Utilizing this same principle, pinhole technique was introduced comprising sutureless surgery with minimal surgical intervention, thus providing maximum comfort to the patient while undergoing treatment and postoperatively. This article presents a case report of two cases who were treated with a minimally invasive pinhole surgical technique, with complete root coverage and minimal complications.

Ecological social capital does not predict geographical variance in increases in depression following the 2008 financial crisis

Research suggests that the financial crisis of 2008 and its aftermath were associated with an increase in mental health problems, but there has been little research into potential protective factors. Ecological social capital is a plausible candidate given evidence of its protective status following natural disasters. Pre-crisis area-level estimates of generalized trust and sense of belonging were computed from the 2004 to 2006 waves of the Living in Wales survey (N = 43,473) for 413 neighbourhoods in Wales, using multilevel regression with post-stratification, a technique for disaggregating survey data into small area estimates. Area estimates and the planned analysis were preregistered using Open Science Framework. Data (N = 180,462) from the Welsh Health Survey (2003-2015) were then used to model whether social capital was protective against depression in general and whether it moderated the increase in depression prevalence, associated with the financial crisis. Depression rates increased post-crisis (odds ratio [OR] = 1.271), and trust was a protective factor against depression (OR = 0.775). The hypothesized interaction, however, was not significant (OR = 1.033), nor was sense of belonging (OR = 0.934) or its interaction with the crisis (OR = 1.024). Although ecological generalized trust appears to be a protective factor against depression, it did not buffer against the mental health impact of the financial crisis.

Physical Activity and Sedentary Behaviors of Young Children: Trends from 2009 to 2018

Over the last decade, the lives of children in several countries, including Greece, have been affected by recession. The aim of the present study was (a) to examine time trends in physical activity (PA) and screen time (ST) of Greek preschool children, together with their family affluence (FA), from 2009 until 2018, and to explore the associations among them; and (b) to investigate the connections of parental educational level and children's BMIs to their achieving ST (<1h/day) and PA (11,500 steps/day) guidelines. A total of 652 children from four cross-sectional cohorts participated. PA was recorded with Omron HJ-720IT-E2 pedometers, whereas ST, family affluence (FA) and parental educational level were reported by participants' parents. The results of the one-way ANOVAs that were computed revealed statistically significant differences among cohorts, albeit of no practical importance, in PA, ST and FA. According to the regressions calculated, neither BMI nor the educational level was related to membership in ST and PA guidelines groups. ST was a significant predictor of children's PA in all week periods (school-time, leisure-time, weekend), whereas FA was not such a strong predictor. Multilevel interventions aiming at both ST and PA seem to be imperative for the benefit of young children's health.

Organizational Downsizing, Work Conditions, and Employee Outcomes: Identifying Targets for Workplace Intervention among Survivors

This study broadly assesses the association of organizational downsizing to work conditions and employee outcomes, and the extent to which work conditions mediate the association of downsizing to employee outcomes, thereby serving as targets for workplace intervention to reduce the harmful effects of downsizing on surviving workers. The cross-sectional data came from a national probability sample of 2297 U.S. workers. A parallel multiple-mediator model with multiple outcomes was estimated, adjusting for personal, occupational, geographic, and temporal covariates. Exposure to downsizing was the predictor. A set of 12 work conditions, representing four dimensions of the work environment, served as simultaneous mediators (Work Role: work demands, role conflict, role ambiguity, and work autonomy; Interpersonal Relationships: supervisor aggression, coworker aggression, friendship formation, and dysfunctional leadership; Rewards: distributive justice and promotion opportunities; Security: job insecurity and employment insecurity). A set of 16 employee consequences, representing five categories of outcomes, served as simultaneous outcomes (Inability to Detach from Work: negative work rumination and inability to unwind after work; Energetic Resource Depletion: physical, mental, and emotional work fatigue; Negative Affect: depression, anxiety, and anger; Positive Affect: happiness, confidence, and vigor; Health: physical and mental health; Work Attitudes: job satisfaction, organizational commitment, and turnover intentions). The results indicated that downsizing had an adverse association with nine of the 12 work conditions (higher levels of work demands, role conflict, supervisor aggression, dysfunctional leadership, job insecurity, and employment insecurity, and lower levels of friendship formation, distributive justice, and promotion opportunities) and all 16 employee outcomes. Moreover, the associations of downsizing to the employee outcomes were indirect, collectively mediated by the nine work conditions. This study provides the broadest evaluation of the deleterious effects of downsizing on U.S. workers surviving a downsizing, identifies affected work conditions that can serve as targets for workplace interventions, and provides insight into why organizational downsizing often fails to deliver anticipated financial and performance benefits to organizations. In terms of serving as targets for workplace intervention, some work conditions meditated the associations of downsizing to a broad set of employee outcomes, whereas other work conditions were specific to certain outcomes. The broad mediators should be targets of any intervention aimed at reducing the adverse effects of downsizing, with additional workplace targets depending on the class of outcomes to be addressed by the intervention.

Correlation between Buccal Bone Thickness at Implant Placement in Healed Sites and Buccal Soft Tissue Maturation Pattern: A Prospective Three-Year Study

Background: Optimal aesthetic implant restoration is a combination of a visually pleasing prosthesis and adequate surrounding peri-implant soft tissue architecture. This study describes the influence of the residual buccal bone thickness (BBT), measured at the time of implant placement, on the soft tissue maturation during three years of follow-up. Methods: Seventy-eight implants were enrolled in the present study. The BBT was assessed at the surgical stage and each case assigned to Group 1 (BBT values ≤0.5 mm), Group 2 (BBT values >0.5 and <1.5 mm), or Group 3 (BBT values ≥1.5 mm). Only native bone and healed sites were included. The tooth height (TH), based on the distance between the buccal free gingival margin at the zenith level and the crown incisal edge, according to the main axis of the tooth, was monitored at one, two, and three years from the final prosthodontic rehabilitation to determine any occurrence of recession or coronal repositioning of the gums over time. A Pearson Two-Tailed test was applied and the significance level set at p ≤ 0.05. Results: For BBT values ≤0.5 mm, the buccal gum at three years showed an average recession of 1.22 ± 0.41 mm. For BBT values >0.5 and <1.5 mm, the buccal gum also showed recession of 0.64 ± 0.29 mm. In contrast, for BBT values ≥1.5 mm, the buccal gum showed coronal growth of 0.77 ± 0.22 mm. The differences between the groups were significant (p ≤ 0.01) at all times. Conclusion: The BBT at the time of implant placement was found to affect the buccal gingival margin stability over three years of observation.

The Effect of the Economic Crisis on Adolescents' Perceived Health and Risk Behaviors: A Multilevel Analysis

Background: Previous studies have analyzed the impact of economic crises on adult’s health and lifestyles, but evidence among children and adolescents is limited. The objective of this study was to analyze the impact of the economic crisis on self-perceived health and some risk behaviors in the Spanish adolescent population. Methods: We used data from four waves (2002, 2006, 2010, 2014) of the Health Behavior in School-Aged Children (HBSC) survey in Spain. Separate multilevel logistic and linear regression models were applied for health complaints, self-rated health, life satisfaction, smoking, alcohol consumption, and breakfast skipping. Annual change in Spanish regional unemployment rates was used as a proxy of the economic crisis. An increasing set of control variables were included, consisting of individual, socioeconomic, and family and peer relationships indicators. Median odds ratios were estimated to quantify the cross-region and cross-school variation. Results: Increases in unemployment rates were linked to a higher risk of poorer health and bad habits in the simplest models. The effect was no longer statistically significant when indicators of family and peer relationships were included, suggesting a protective effect against the impact of the economic crisis. Our findings also show that schools had a larger effect on health and lifestyles than regions. Conclusion: The child’s social context—family, peers, school, and region—play an important role on the effects of the economic crisis on health and risk behaviors.

Vital COVID-19 Economic Stimulus Packages Pose a Challenge for Long-Term Environmental Sustainability

With the coronavirus (COVID-19) grappling the world and forcing global economic engines to a standstill, numerous sectors are impacted. As a response plan, numerous governments are turning toward economic mechanisms to support both local and national economies. While those are hailed, as the number for unemployment rises, economic stimulus packages are in essence a short-term solution but with the potential to impact on the long-term socioeconomic fabric. In this respect, if not carefully crafted, those emergency economic packages can bailout heavy and polluting industries, hence posing a long-term problem for the actualization of sustainability agendas and commitments. This chapter explores this scenario, supported by trends from past recessions, and further outlines the need for short-term economic emergency response plans while keeping in line with long-term sustainability needs.