The preponderance of evidence shows that dental treatment, especially high-cost technologically advanced care, will not bring oral health to the masses. There are calls to action and proposed solutions, and to tackle this issue there is much work to be done. Our challenge is how to frame the multiple issues on treatment and health into 1 coherent agenda intellectually and culturally that will stimulate action to bring better health to all.
In the United States, we spend approximately $4.5 trillion, or roughly 18% of the gross domestic product, on health care.4 A graphic adapted from Roser5 (Figure) presenting life expectancy vs per capita cost for health care shows the United States with both the lowest life expectancy and the highest per capita cost for health care among 21 countries. The US oral health care expenditure is approximately 4% of the total health care cost at $165 billion.4 Of this, less than 3% is spent on public health, and only approximately 2% is directed toward prevention.6 Let us ask the difficult question that the dental community should be engaging collectively: Does this approach to health care bring health? Some relevant groups with messages to consider include the National Institutes of Health, whose 2021 Oral Health in America report describes groups with long-standing elevated levels of oral disease and provides several calls to action.7 The report shows gains in reducing untreated disease in children when insurance coverage has increased. In contrast, there was essentially no gain toward oral health in the adult population, with resources having remained flat.7 A report in The Lancet calls for more inclusion of upstream social determinants to bring about greater dental health.8 The report states the need to reorient the oral health agenda toward public health, recognizing the broader determinants of oral health and challenging the dominant approach focused on individual behavior and technology-focused clinical care.8 A group led by Christopher Murray described a growing shift in the burden of disease to people with disabilities, with little baseline disease data and no proven interventions to bring health.9 How do we move toward a society that supports the goal of oral health for all? Calls to action have included having the oral health care community move toward an integrated primary care health system with a focus on prevention. Actions directed at economic, trade, social, and welfare policies are needed. Increasing the number of people with oral health insurance that access the system is known to have a positive impact.10 Support to improve Medicaid coverage for adults is 1 example of moving in this direction. Additional recommendations include having patients engage with primary care providers on a routine basis to provide ongoing preventive services in addition to disease mitigation and emergency therapies. National and state-level policies need to recognize and support the value of upstream interventions that can help reduce the need for disease mitigation and move people toward a health trajectory. The dental education system must inculcate graduates with the need for and complexity of providing preventive health care to the diverse populations we serve. Students need to understand there will be successes and failures and that helping people stay or move toward being healthy is a dynamic and iterative process.
For people at high disease risk, especially those with recurring disease, we do not have interventions proven to bring sustained health. Due to the many social determinants associated with oral diseases, we continue to see disproportionate disease levels residing in specific segments of the population. People with increased risk and prevalence of developing oral diseases include those with upstream factors associated with low income (eg, dietary issues, access to care, and medication use), underrepresented minorities, those with special health care needs, and the young and older people. People with elevated oral disease risk often have multiple upstream risk factors, thereby compounding the challenge of applying effective interventions that result in health vs disease. If we are to achieve our goal of oral health for all, what approaches are needed by the oral health care workforce? For people with high disease risk, care models focused on the mitigation of disease morbidities increase the challenge of bringing an appropriate arsenal of tools directed at preventing disease. Interventions targeted at upstream determinants need to be an integral component of health care and not an afterthought. The concept of oral health care coalitions and integration of providers is not a novel concept but increasingly is being proposed as a necessary action to increase the number of patient contact points and types of care delivered and to achieve oral health for all.2 ,3 Some examples include behavior modification, empathy projection, nutrition and dietary counseling, social work support, public health measures, interprofessional practice, ethics, and informative risk assessment or prognosis prediction. Evidence-based dentistry is more prevalent today, but is it being used more for treatment technologies and managing the disease rather than bringing a person to health?
David C. Johnsen, DDS, MS J. Tim Wright, DDS, MS Globally, oral diseases are the most prevalent of all noncommunicable diseases.1 Conventional wisdom typically equates dentistry and the provision of oral health care to good oral health. Like much of health care, treatment directed at achieving oral health frequently is focused on managing and treating the symptoms of chronic diseases such as caries and periodontal disease. The health care system in the United States, and in most countries, is largely driven financially by treatment of existing disease more than focusing resources directed at achieving health. For many diseases, including caries and periodontitis, the balance between health and disease depends on a plethora of diverse factors including biological, psychological, social, and environmental determinants. For people with lower disease risk, treatment directed at prevention indeed can bring health. For the masses that develop oral disease, the road to health can be challenging at best and unobtainable at worst. Although understanding of the pathogenesis and underlying mechanisms for diseases has advanced, identifying a person’s risk of developing an oral disease remains a challenge. Implementing effective interventions is an even greater conundrum.
The Ohstat Statement: Explanations And Elaborations Identifying information The primary purpose of identifying information—the title and abstract—is to help readers make an informed choice about whether to read an article. Not so obvious is that this information should also help readers decide not to read an article. Thus, titles should identify the relationship that was studied. The title should not attempt to “capture the reader’s attention” with anything other than an accurate description of the research. Abstracts should not “highlight the research” but, again, should summarize it accurately so readers will know what to expect if they read the article.17
1. Title: Space permitting, identify the research design in the title.
The strength of evidence for health care interventions is limited by the study design. Including this information in the title helps with critical appraisal by assisting readers decide whether to read the article. Character limits notwithstanding, try to include as many of the SPICED-T elements as possible: Setting, Patients, Intervention, Comparator, Endpoint, Design, and sometimes Time frame.18 A title can easily be shortened by removing the least important element. If applicable, some key elements must always be included in the title and abstract (e.g., single-sex studies).
2. Abstract: Provide a structured abstract, as specified by the journal.
The International Committee of Medical Journal Editors (ICMJE) recommends including a structured abstract when reporting original research.19 Such abstracts have 5 or more headings, and journals may specify which headings to use. Usually, only the results and conclusions require complete sentences. However, the form of the abstract will be specified by the individual journal.
3. Consistency: Confirm that all information in the abstract is identical to that in the article, especially the conclusions.
Many studies have found important discrepancies between the abstract and the full article.20 Because abstracts are often separated from the full article, the information they contain needs to be identical to that in the full article. The conclusions, results, and objectives all need to be consistent throughout the manuscript. The classic IMRaD structure of scientific articles (Introduction, Methods, Results, and Discussion) is well known, and the OHStat Guidelines emphasize the reasons for this organization. In 1965, Sir Austin Bradford Hill stated in an editorial board meeting of the BMJ that the structure of a scientific paper is built around the answers to 4 questions: “Why did you start, what did you do, what did you find, and what does it mean?”21 Introduction: Why Did You Start?21 After the title, the introduction is the most important and least-appreciated part of the scientific article. A good introduction can be enormously useful because it prepares readers to understand the paper, orients them to the research by establishing the need and importance of the study, indicates in general how the need was addressed, and tells readers what to expect if they continue to read the article.
4. Problem: Describe the background, nature, scope, and importance of the problem addressed by the research.
Describe the historical, social, medical, ideological, or public health contexts of the problem. Indicate how serious and prevalent it is, as well as its consequences, implications, and whom it affects. “Little is known about . . .” is rarely a good justification for doing research. A simple lack of knowledge is not sufficient to explain why a relationship needs to be studied or why a research report should be taken seriously.22 Novice readers may need the background to understand the problem; experts expect a compelling justification of the research. The background in the Introduction should support a problem statement—the gap in knowledge or an untapped potential—that stimulated the research.
5. Objectives: State the specific research objectives, including any prespecified hypotheses, in terms of a clinically important outcome measure or measures.
The problem statement in the Introduction should support the choice of the primary outcome—the variable whose change in value is of interest and why it is clinically or practically important. The specific and measurable objectives should determine the methods of the research. Methods: What Did You Do? The purpose of the Methods section is to tell how the research question was addressed. The thought that a clear and transparent Methods section would allow someone to replicate the study is laudable but often not realistic, given the word limitations of a typical journal article, even with supplemental information. Instead, it may be better to tell readers where to obtain copies of the protocol, the statistical analysis plan, and the original data set. In an article, a more reasonable goal is to provide enough information to establish the adequacy of the methods and, in so doing, establish the credibility of the authors as careful and thoughtful researchers.
6. Design: Describe the overall study design and any variant (e.g., split-mouth, crossover, equivalence) and planned subgroup analyses.
To understand the essential aspects of the study, its design should be described in the Methods. The hierarchy of evidence for clinical studies (both observational studies and clinical trials) arranges sources of information and research designs from those with the most control over error, confounding, and bias to those with the least control. We encourage researchers to aim for the highest appropriate level of evidence.23 ,24 The hierarchy listed below is one of many versions, although all include essentially the same designs in the same order:25
▪ Meta-analysis of RCTs ▪ Systematic reviews ▪ RCTs ▪ Cohort studies ▪ Case-control studies ▪ Cross-sectional studies ▪ Case series ▪ Case reports
Publishing/∗standards research design/standards statistical data interpretation comparative studies retrospective studies
“Large proportions of articles contain errors in the application, analysis, interpretation, or reporting of statistics or in the design or conduct of research.”1 Oral health research is not immune to this criticism. For example, a 2009 review of 95 randomized controlled trials (RCTs) published in the leading journal in each of 6 dental specialties found generally suboptimal reporting of key Consolidated Standards for Reporting Trials (CONSORT) guidelines.2 In another review, “spin”—nonstatistically significant results reported as “clinically important”—was assessed in the abstracts of 75 RCTs published in 10 leading dental journals. Of the 75 trials, 17 incorrectly presented a “statistically nonsignificant result for the primary outcome as showing treatment equivalence or comparable effectiveness” and 2 emphasized the conclusions of a secondary outcome when the primary outcome was not statistically significant.3 Additionally, a report of quality and spin in RCT abstracts in the periodontal-cardiovascular field found poor adherence to CONSORT guidelines, with 87% of trials not reporting on the primary outcome and 86% of trials showing at least 1 form of spin in the results and/or conclusions.4 Thus, “overall, dental journals show low reporting of quality-related characteristics with high variation that is journal-dependent.”5 Although oral health research is similar to clinical research in other fields, many dental studies have design characteristics that can confound analysis. For example, the unit of analysis can be a single tooth, multiple teeth, individual tooth sites, or a single patient. In longitudinal studies, teeth can be lost without disqualifying the participant from the study, and perhaps uniquely in human research, observational units may be added through the primary and permanent dentition process. Another unusual study design in oral health research is the split-mouth study.6 A review of 119 such studies found improved reporting across 2 decades, but overall quality “was still below the acceptable level”: 85% did not provide a sample size calculation, 76% did not identify a primary outcome, 61% used inappropriate statistical methods that did not consider the correlated data, and 38% did not justify the design.7 A common approach to improving reports of biomedical research is to use a checklist of reporting guidelines. Checklists can remind authors to report key elements of a study and help reviewers find where each guideline is addressed when evaluating a manuscript. Most such guidelines are modeled after the CONSORT Statement for reporting randomized trials, first published in 19968 and most recently updated in 2010.9 Also of interest to this document is the STROBE Statement for reporting observational studies.10 Use of the CONSORT Statement has been associated with improved reporting of RCTs.11 ,12 However, the EQUATOR Network website lists over 550 checklists.13 Thus, there appeared to be a need for a consolidated guideline that could address the main issues in the most common study designs in oral health. Accordingly, members of the Task Force on Design and Analysis in Oral Health Research14 began to develop guidelines for reporting clinical studies in oral health in 2019. The process of development is described in the OHStat Statement.15 Drafts were circulated to editors of 85 oral health journals and to Task Force members and sponsors. The draft was discussed at a December 2020 workshop, attended by 49 researchers. The revision was circulated to the writing group and approved by the Task Force. As with other guidelines, the recommendations for reporting oral health research should 1) inform authors of the information needed to document and publish their research, 2) allow readers to assess the validity of the research or at least the credibility of the authors, 3) make the research process transparent, and 4) ideally, provide links to the information needed to replicate the study. The target audiences for the OHStat Guidelines are authors, reviewers, and journal editors. Authors are advised to include the completed OHStat checklist when submitting a manuscript for publication. Journal editors and reviewers may also wish to consult these and other guidelines when evaluating a manuscript and should insist on complete adherence to the guidelines within journal page limits, word limits, or in supplemental information. Critical appraisal and interpretation of observational studies and clinical trials in oral health will improve with an understanding of the details that support study validity. The purpose of this article is to provide the rationale and scientific background for each item. The terminology used is that provided in the original CONSORT Explanation and Elaboration document.16
Abstract Adequate and transparent reporting is necessary for critically appraising research. Yet, evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research—statisticians and trialists from academia and industry—empaneled a group of authors to develop methodological and statistical reporting guidelines identifying the minimum information needed to document and evaluate observational studies and clinical trials in oral health: the OHstat Guidelines. Drafts were circulated to the editors of 85 oral health journals and to Task Force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The final version was subsequently approved by the Task Force in September 2021, submitted for journal review in 2022, and revised in 2023. The checklist consists of 48 guidelines: 5 for introductory information, 17 for methods, 13 for statistical analysis, 6 for results, and 7 for interpretation; 7 are specific to clinical trials. Each of these guidelines identifies relevant information, explains its importance, and often describes best practices. The checklist was published in multiple journals. The article was published simultaneously in JDR Clinical and Translational Research, the Journal of the American Dental Association, and the Journal of Oral and Maxillofacial Surgery. Completed checklists should accompany manuscripts submitted for publication to these and other oral health journals to help authors, journal editors, and reviewers verify that the manuscript provides the information necessary to adequately document and evaluate the research.
Ist dies der Sommer, in dem sich mehr und mehr Menschen von den Dating-Apps abwenden und ihr Glück wieder im Analogen suchen? Meet statt swipe, Kneipe statt Cyberspace. Von MIT Technology Review Online
Und wie gehe ich mit weiblichem Narzissmus um? Laut Dr. Wardetzki ist der Umgang mit narzisstischen Verhaltensweisen aus zwei Gründen kompliziert: Entweder die Menschen geben einem das Gefühl nicht gut genug zu sein oder stellen einen buchstäblich auf ein Podest, um einen zu idealisieren. Die Balance des Selbstwertgefühles des Gegenübers ist demnach sehr wankelmütig. Man sollte deshalb laut Dr. Wardetzki weder die Idealisierung noch die Abwertung annehmen. Je stabiler das eigene Selbstbewusstsein, desto leichter fällt der Kontakt.
„Jeder Mensch hat narzisstische Anteile“, so der Psychologe und Therapeut Dr. Simon Mota von der Universität Münster gegenüber Planet Wissen. Wenn sich das ein oder andere aufgezählte Anzeichen von uns für dich also normal anfühlt, brauchst du dir keine Sorgen zu machen. Laut Mota ist Narzissmus ein Spektrum mit unterschiedlichen Ausprägungen. Ein Stück weit gesunder Narzissmus ist also nicht schädlich und ein gesundes Selbstbewusstsein hilft uns, leichter durchs Leben zu kommen.
Weiblicher Narzissmus wird oft in Verbindung mit einem starken Perfektionismus gesehen. Denn je perfekter wir sind, desto wertvoller sind wir laut narzisstischem Denken.
2. Auffällig gepflegtes Aussehen Weibliche Narzisstinnen sind absolute Expertinnen darin, ihr Inneres zu verstecken. Das gelingt zum Beispiel auch durch ein perfekt gepflegtes Auftreten, für das Narzisstinnen versuchen so viel Anerkennung zu erhalten wie nur möglich.
3. Scheinbar sicheres Auftreten Mit einem starken Auftreten verstecken sowohl weibliche als auch männliche Narzisst:innen ihre Unsicherheiten perfekt.
4. Extrem hohe Ansprüche
Damit einher geht nicht nur ein starker Perfektionismus, sondern auch eine Erwartung von Höchstleistung. Der Durchschnitt ist demnach nie genug.
5. Bescheidenheit
Bescheidenheit würden wir zunächst vielleicht keinem narzisstischen Menschen zuordnen. Doch weiblicher Narzissmus geht oft mit einem großen Minderwertigkeitsgefühl einher, welches
6. Fehlerfreiheit
Laut einer Studie der Oregon State University, lernen Narzissten selten dazu, da sie glauben, keine Fehler zu machen. So verhält es sich auch bei den weiblichen Narzissten. So machen diese in der Regel nie Fehler und schieben die Schuld gerne von sich.
Männlichen Personen wird häufig nachgesagt, dass sie diese Ursachen meist versuchen zu überspielen. Weibliche Personen hingegen sollen eher nach Anerkennung und positivem Feedback suchen. So gibt es zwei völlig unterschiedliche Reaktionen auf dieselben Symptome. Weiblicher Narzissmus: So erkennst du ihn Das Auffällige an weiblichem Narzissmus ist: Er ist unglaublich schwer zu erkennen! So kann es durchaus sein, dass uns nahestehende Personen diese Anzeichen zeigen und wir es nicht einmal bemerkt haben. Wichtig ist dabei allerdings, dass narzisstische Verhaltensweisen oder Strukturen menschlich sind und auch wichtig, um unseren Selbstwert anzuerkennen.
Doch mit den weiblichen Narzissten verhält es sich noch einmal anders als beim generellen Narzissmus. So kann man beispielsweise weiblichen Narzissmus gut von männlichem Narzissmus abgrenzen. Die Ursachen für Narzissmus sind allerdings häufig dieselben:
Ein mangelndes Selbstwertgefühl Das Gefühl von Minderwertigkeit Starke Selbstzweifel Ein großes Maß an Selbstkritik Eine traumatische Kindheit Extremer Leistungsdruck Fixierung auf Status und Materielles
Wie stellst du dir einen typischen Narzissten vor? Wahrscheinlich kommen dir direkt Begriffe wie: egoistisch, rücksichtslos und selbstverliebt in den Kopf. Doch was viele vergessen: Narzissmus ist laut Definition eine Persönlichkeitsstörung, die von schweren Minderwertigkeitskomplexen und einem drastischen Mangel an Selbstbewusstsein ausgelöst wird. Genau dieser Aspekt tritt speziell beim weiblichen Narzissmus stark in den Vordergrund.
Von Narzissmus haben die meisten von uns schon einmal etwas gehört. Aber was genau hat es eigentlich mit weiblichem Narzissmus auf sich? Eines ist klar: narzisstische Züge haben wir alle, so kann es sein, dass du in deinem Umfeld öfter darauf triffst.
Lügen von Narzissten: Das einzige Ziel ist Macht & Kontrolle
Eine Beziehung mit einem narzisstischen Menschen kann sogar so weit gehen, dass du gesundheitliche Folgen davonträgst. Neben Selbstzweifel können das auch Depressionen, Angststörungen sowie chronische Erkrankungen sein. Daher ist es umso wichtiger, die Warnsignale so schnell wie möglich erkennen, um dich aus dieser Verbindung zu lösen. Wenn du es allein nicht schaffst, solltest du Menschen, denen du vertraust, um Hilfe bitten.
Menschen, die mit einer narzisstischen Person eine Beziehung eingehen, werden früher oder später mit viel Schmerz und Leid konfrontiert. Denn aufgrund der psychischen Erkrankung ist es Narzissten nicht möglich, eine gesunde und glückliche Beziehung zu führen. Doch nicht immer ist es leicht, einen Narzissten auf den ersten Blick zu erkennen. So verhalten sie sich, besonders in den Anfangsphasen einer Beziehung, immer sehr charmant und hilfsbereit. Doch Menschen mit einer narzisstischen Persönlichkeitsstörung können sich nicht langfristig verstellen und so kommt es meist schon nach wenigen Monaten zu Warnsignalen.
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