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ORIGINAL ARTICLE
Year : 2015  |  Volume : 13  |  Issue : 4  |  Page : 502-508

Knowledge and awareness of stem cells among expectant mothers and parents of elementary school children in Bareilly and Delhi cities


Department of Public Health Dentistry, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India

Date of Web Publication7-Dec-2015

Correspondence Address:
Mayank Kumar Saran
Department of Public Health Dentistry, Institute of Dental Sciences, Bareilly, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.171195

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  Abstract 

Introduction: Stem cells are clonogenic cells capable of both self-renewal and multi-lineage differentiation. Stem cells have been isolated from various tissues, including umbilical cord blood, bone marrow, neural tissue, skin, retina, and dental pulp tissue. Objectives: To assess the knowledge and awareness about stem cells and dental stem cells among expectant mothers and parents of elementary school children in Bareilly and Delhi cities. Materials and Methods: A cross-sectional survey was conducted in which a close-ended questionnaire proforma was given to a sample of 1009 subjects who are parents of elementary school children and expectant mothers from Bareilly and Delhi cities. After 1-week, the filled questionnaire proforma was collected back from the school children and expectant mothers. The results were analyzed using Chi-square test. Results: Out of a sample of 1009 subjects, 809 were from Bareilly (401 expectant mothers and 408 parents of elementary school children) and remaining 200 from Delhi (104 were expectant mothers and 96 parents of elementary school children). The awareness about stem cells was 25% from Delhi and 18% from Bareilly and this difference was statistically significant. Conclusion: The awareness regarding stem cells and dental stem cells was generally poor among the parents of elementary school children and the expectant mothers. It is time to develop and cater programs to improve the awareness related to stem cells as stem cell therapy is said to have immense potential.

Keywords: Expectant mothers, knowledge, parents, stem cells


How to cite this article:
Saran MK, Lakshminarayan N, Kumar M, Shanmukha G. Knowledge and awareness of stem cells among expectant mothers and parents of elementary school children in Bareilly and Delhi cities. J Indian Assoc Public Health Dent 2015;13:502-8

How to cite this URL:
Saran MK, Lakshminarayan N, Kumar M, Shanmukha G. Knowledge and awareness of stem cells among expectant mothers and parents of elementary school children in Bareilly and Delhi cities. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Jul 4];13:502-8. Available from: http://www.jiaphd.org/text.asp?2015/13/4/502/171195


  Introduction Top


Stem cells are pluripotent cells that continuously divide, have the ability of self-renewal, and are capable of generating complex tissues and organs. Stem cells are generally defined as clonogenic cells capable of both self-renewal and multi-lineage differentiation. Postnatal stem cells have been isolated from various tissues, including umbilical cord, bone marrow, neural tissue, skin, retina, and dental epithelium.[1] In general, there are two broad types of stem cells which are: Embryonic stem cells and adult stem cells.[2] Embryonic stem cells are found in the inner cell mass of the blastocyst during the early stages of embryo development. Their self-renewal potential and unrestricted ability to generate new tissues and organs (totipotency) make these cells an attractive cellular source for cell-based regenerative therapies.[3]

The term stem cell was proposed for scientific use by Russian histologist Alexander Maksimov in 1908, while research on stem cells grew out of findings by Canadian scientists in the 1960s. Until recently, the cord blood that remains in the placenta and umbilical cord after birth was considered medical waste. In 1988, first cord blood cell transplant took place to treat a child with Fanconi's Anemia. Approximately, 6000 individuals worldwide have received medical treatment consisting of the infusion of human umbilical cord blood hematopoietic stem cells for the treatment of more than 70 life-threatening malignant and nonmalignant diseases.[4]

In 2003, National Institute of Health, US, announced the discovery of Dental Pulp Stem Cells (DPSCs) by Dr. Songtao Shi. In 2006, Kerkis reported the discovery of Immature DPSCs, "a pluripotent sub-population of DPSCs" using dental pulp organ culture. In 2007, DPSC was used in the first animal studies on bone regeneration and dental end uses. Later, in 2008, DPSC was used in the first animal studies on heart therapies, for muscular dystrophy therapies, for regenerating brain tissue, for bone grafting, and reconstruction of large size cranial bone defects in rats.[2] Striking feature of DPSCs is their ability to regenerate a dentin-pulp-like complex that is composed of mineralized matrix with tubules lined with odontoblasts, and fibrous tissue containing blood vessels in an arrangement similar to the dentin-pulp complex found in normal human teeth,[2] with emphasis on retaining natural teeth and so much potential of DPSC, dental stem cell bank has also been started in many countries including India.

Dentistry is no exception to the advent made by stem cell research.[5] There are several applications in dentistry, especially so in reconstructive surgery. With today's 21st century technological advancements, it is expected that individuals will either retain their natural teeth or obtain functional tooth replacements throughout their entire life. As adult tissue-derived cell sources are anticipated to be useful in clinical applications for tooth regeneration, several stem cells/progenitor cells have been found, which were isolated from adult dental/nondental tissues.[6] However, the knowledge and awareness about stem cells seems to be poor among Indians.[2] Hence, this study was conducted to assess the awareness about stem cells and dental stem cells among expectant mothers and parents of elementary school children in Bareilly and Delhi cities.


  Materials and Methods Top


A cross-sectional survey was conducted during September month of 2014 among expectant mothers and parents of elementary school children from Bareilly city and Delhi. Ethical clearance was obtained from the Institutional Ethic Committee and informed consent was obtained from participants. A close-ended questionnaire was specially prepared for the purpose of collecting data that was first designed in English and then translated into Hindi. It was back translated to check the language validity.

The sample size was estimated using the prevalence of subjects who are aware of stem cells and calculated from a pilot study conducted on 10 subjects. The prevalence was 30%.

Sample size calculation was done by the formula: 4PQ/L 2

Where P = Prevalence; Q = 1−P; L = Allowable error

After calculation, the sample size came out to be 933 and it was rounded off to 1000. It was a convenience sample as there was no sampling frame available or accessible for enrolling expectant mothers. Bareilly and Delhi were divided roughly into four zones, that is, East, West, South, and North. In Bareilly, out of each zone, 10 schools and 10 antenatal clinics from 10 hospitals were selected. Only 10 participants were selected from each sampling site in each zone randomly. This was assumed to provide 400 expectant mothers and 400 parents accounting for a total of 800 subjects from Bareilly for our study. In Delhi, one school and one hospital were selected from each zone and 25 participants were selected from each sampling site. This was assumed to provide 100 expectant mothers and 100 parents. Thus, we assumed to enroll a total of 200 subjects from Delhi. A total of 401 expectant mothers and 408 parents of elementary school children were selected from 40 antenatal clinics and 40 schools in Bareilly, respectively. In Delhi, 104 expectant mothers were selected from antenatal clinics of four nursing homes and 96 parents were selected from four schools. Hence, the final sample included 1009 subjects.

The questionnaire was distributed to the selected participants after visiting the sampling sites on prescheduled days and the completed proformas were collected after 7 days. It was self-administered by the participants. It contained provision for recording sociodemographic data of the participants and 15 questions to gather the awareness about stem cells and dental stem cells among participants. Thirteen out of fifteen questions were measured on dichotomous scale, "Yes" and "No" [Annexure 1 [Additional file 1]].

The collected data were compiled, entered into excel sheets, and transferred to SPSS software (IBM, Chiago), Version 21 for analyses. Chi-square test was applied to find out whether the differences between the groups were statistically significant. A significance level of 5% was fixed.


  Results Top


There were 1009 (809 from Bareilly and 200 from Delhi) participants. Out of 809 subjects from Bareilly, 302 (37.3%) were males and 507 (62.7%) were females, among 200 subjects of Delhi, 89 (44.5%) were males and 111 (55.5%) were females [Table 1].
Table 1: Gender distribution of the subjects

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In the present study, 401 expectant mothers and 408 parents were selected from Bareilly and 104 expectant mothers and 96 parents from Delhi [Table 2].
Table 2: Distribution of expectant mothers and parents

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The term stem cell was unheard by many subjects, 81.7% from Bareilly and 75% from Delhi had never heard of stem cells. More number of Bareillians was unheard of stem cells than Delhites, difference was found to be statistically significant. When the participants were asked whether they know about stem cells, 82.2% from Bareilly and 75.5% from Delhi did not know and the difference was statistically significant.

After obtaining the answer for the first and second question, only those respondents who had heard and knew about stem cells (144 from Bareilly and 49 from Delhi) were considered for further survey. In the sample, 91.7% from Bareilly and 93.9% from Delhi had a clear knowledge that stem cells are beneficial for health. This difference was not statistically significant [Table 3].
Table 3: Awareness and knowledge related to stem cells among subjects

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Regarding the source of information about stem cells, majority said that they got the information from internet (41% from Bareilly and 44.9% from Delhi), which was followed by family doctors (13.9% from Bareilly and 16.3% from Delhi) and relatives (13.2% from Bareilly and 18.4% from Delhi). These differences were not statistically significant [Table 4].
Table 4: Knowledge about source of information regarding stem cells

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The respondents were assessed for their knowledge regarding the source and timing of stem cell collection from umbilical cord and deciduous teeth. Majority (83.3% from Bareilly and 81.6% from Delhi) of the respondents said that umbilical cord should be used for extracting stem cells, immediately after delivery of the child. Majority (66.1% from Bareilly and 61.2% from Delhi) did not know that deciduous teeth can be a source for stem cells [Table 5].
Table 5: Knowledge about source and timing of stem cell collection

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Around 54% of the subjects from Bareilly and around 57% from Delhi did know about the cost of stem cell culture. Awareness about dental stem cell banking was found among 40% of the Bareilly subjects when compared to around 39% of the Delhi subjects. Around 29% from Bareilly and 26% from Delhi knew the nearby place where stem cell banking was available. None of these differences was found to be statistically significant. In Bareilly, only 79.2% of the subjects were aware of at least one benefit of stem cells when compared to nearly 92% in Delhi. This difference was statistically significant [Table 6].
Table 6: Awareness and knowledge related to stem cell culture and banking

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Almost 94% of the subjects from Delhi and 79% of the subjects from Bareilly were aware that they can get more information about stem cells from Gynecologists and their Obstetricians. Higher proportion of subjects from Delhi had this knowledge when compared to Bareilly, this difference was statistically significant. About 53% of Bareilly subjects knew that tooth can be regenerated using stem cells, as compared to 57% from Delhi. Only 37% of Bareillians and 39% of Delhites thought that tooth is a good source of stem cells. Around 23% of Bareillians knew that stem cells from pulpal tissue are used to treat other diseases as compared to 25% from Delhi. About 19% of Bareillians think stem cell collection is invasive when compared to 23% in Delhi. Finally, around 40% of Bareillians think that the regenerated tissues out of stem cells are permanent as against 39% of Delhites. None of these differences was statistically significant [Table 6].

Around 17.3% expectant mothers and 18.3% parents in Bareilly had knowledge of stem cells (P = 0.68), whereas in Delhi, 28.9% expectant mothers and 19.8% parents were having knowledge of stem cells (P = 0.13) [Table 7].
Table 7: Intra group comparison of knowledge about stem cells between expectant mothers and parents in Bareilly and Delhi

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  Discussion Top


Stem cells are the pluripotential cells having self-renewal, multilineage differentiation capacity, and clonogenic efficiency. Umbilical cord blood at the time of delivery is a rich source of stem cells. It can be banked for future use. It is the best gift parents can offer to their children. Bone marrow, neural tissue, skin, and retina are the other sources of stem cells. Dental pulp can be a source for stem cells. Deciduous teeth which exfoliate and wisdom teeth can be potential sources of stem cells. Dental caries and periodontal disease majorly contribute to tooth loss. At present, lost teeth are replaced with artificial removable or fixed prostheses. Stem cells offer hope of regenerating the tooth.[7] Tooth mortality is a public health problem in the urban and rural population.[8]

We included samples from two cities because Delhi is the national capital and Metropolitan city, whereas Bareilly city is just a district headquarters. The intention was to compare the knowledge and awareness regarding stem cells between Bareillians and Delhites. Rural population was not included because our unsystematic observations revealed that more than 90–95% of them had not even heard the term stem cells.

In the current study, 18.3% of subjects from Bareilly and 25% from Delhi had heard of the term stem cells, this difference was significant. This may be because Delhi is a Metropolitan city with subjects having higher literacy, more exposure to media, having varied backgrounds, and better socioeconomic status. In our study, a majority of the subjects had neither heard nor knew anything about stem cells, unlike in the study of Goomer et al.[9] where 62% of the patients had heard and also knew about stem cells. This difference may be because our study included patients from private maternity centers and also government hospitals in contrast to Goomer et al.[9] study in which patients only in private dental practice, majorly belonging to higher socioeconomic strata were studied.

In this study, internet was the source of information about stem cells for more than 40% the subjects, this was followed by family doctors. Dentists hardly contributed as a source of information about stem cells. Dentists played a negligible role in this respect. Dentists need to be trained and motivated to educate people about stem cells. The local Dental Association and Dental Colleges should take lead in creating awareness among dentists by conducting CDE programs and Faculty development programs.

Nearly, 99% of the subjects agreed umbilical cord as a source of stem cells. More than 80% considered that stem cells should be collected immediately after delivery from the umbilical cord. It is ideal to collect immediately after delivery because to prevent platelet aggregation in blood. Only 35.2% of the subjects knew that deciduous tooth can be used as a source of stem cells. It reflects poor degree of awareness and knowledge of subjects about DPSCs. Dentists need to engage in improving the awareness of people.

Around 55% of the subjects had an idea about the cost for stem cell culturing. In India, according to a rough estimate, it costs 9–15 lakhs [10] and in the west, it costs $1 lakhs to $2 lakhs.[11] It is highly expensive and a majority of population is not able to afford for such therapy. Only 40% of the population was aware of stem cells bank. In India, very few stem cells banks are present.

A majority of the subjects were aware of at least one benefit of stem cells banking, although this knowledge was found to be in higher proportion among Delhites than compared to Bareillians. Only 29% of the subjects were aware about nearby place where stem cells banking facility is available. In the current study, 18.3% of people from Bareilly and 25% people from Delhi had heard of the term stem cells, this difference was significant.

Nearly, 83% of the subjects knew that they could get more information on stem cell banking from gynecologist, family doctor, and dentist and 55% believed that a tooth can be regenerated using stem cells. Only 37% of the subjects opined that tooth pulp is a good source of stem cells and 23% of the subjects were of the view that stem cells from dental tissues can be used to treat various others diseases and disorders. Only 20% of subjects opined that regenerated tissue using stem cells is as permanent as a natural tissue or organ.

The study throws light on less than desirable knowledge (knowledge deficit) in the subjects who claimed to have heard about stem cells and knew about stem cells. It is high time that the message needs to be passed for the benefit of larger population and larger good. A concerted effort can take this issue forward. In future, we may see a day when noncommunicable diseases are tackled effectively and efficiently with stem cells research and application.

Limitations

  1. 1. To the best of our knowledge, there is hardly any study done in this regards except for a study.[9]
  2. 2. The sample used in the study is deliberately selected which might account for bias.


Recommendations

  1. 1. Stem cells and dental stem cells offer a bright future for various ailments, common man should be educated about the numerous possibilities that stem cells unfold. They can be motivated to store their children stem cell and that can be the best gift they can offer to their children.



  Conclusions Top


The knowledge about stem cells was very low in the subjects and a major segment of sample had never heard or knew about stem cells. Internet was the most common source of knowledge. Umbilical cord blood was considered the major source of stem cells. More than 50% of subjects knew about the cost of stem cell culturing and location of stem cells bank. Only few people knew that deciduous tooth is a good source of stem cells and opined that tissue regeneration can be performed using stem cells.

Acknowledgments

Authors are thankful to the gynecologists and school administration for their cooperation in this study. The authors are also thankful to the statistician Dr. Shyam for the statistical analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Gronthos S, Brahim J, Li W, Fisher LW, Cherman N, Boyde A, et al. Stem cell properties of human dental pulp stem cells. J Dent Res 2002;81:531-5.  Back to cited text no. 1
    
2.
Vanishree N, Chaithra V, Pabbia A. A tooth for a tooth: Dental stem cell banking in India. Ann Essences Dent 2011;3:90-3.  Back to cited text no. 2
    
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Casagrande L, Cordeiro MM, Nör SA, Nör JE. Dental pulp stem cells in regenerative dentistry. Odontology 2011;99:1-7.  Back to cited text no. 3
    
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Perlow JH. Patients' knowledge of umbilical cord blood banking. J Reprod Med 2006;51:642-8.  Back to cited text no. 4
    
5.
Saxena S, Lakshminarayan N, Kumar M. Challenges in stem cell-based research output to practice – Public health perspectives: A narrative review. J Dent Sci Oral Rehabil 2014;5:14-6.  Back to cited text no. 5
    
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Sahana NS, Srinath SK, Hemavathy S, Vishwanath SK. Missing tooth tissue replacement – The milestones – A review. AOSR 2012;2:47-52.  Back to cited text no. 6
    
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Zhang Y, Chen Y. Bioengineering of a human whole tooth: progress and challenge. Cell Regen (Lond) 2014;3:8.  Back to cited text no. 7
    
8.
Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2005;33:81-92.  Back to cited text no. 8
    
9.
Goomer P, Sidhu AK, Tuli P, Kansal S, Bansal K, Thakre GR. Awareness of stem cells & health implications of SHED found in pediatric dentition among Indian Population. J Int Oral Health 2014;6:44-7.  Back to cited text no. 9
[PUBMED]    
10.
Chandy M. Stem cell transplantation in India. Bone Marrow Transplant 2008;42 Suppl 1:S81-4.  Back to cited text no. 10
    
11.
Stem Cell Transplant (Peripheral Blood, Bone Marrow, and Cord Blood Transplants). Available from: http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/bonemarrowandperipheralbloodstemcelltransplant/stem-cell-transplant-other-transplant-issues. [Last accessed and retrieved on 2014 Nov 15 at 10: 00 pm].  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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