Effect of flapless piezopuncture on maxillary canine distalization. A preliminary randomized controlled trial

Several methods have been described to shorten orthodontic treatments, but the main disadvantage is their invasiveness. Animal studies have shown that piezopuncture can accelerate the rate of tooth movement without causing collateral damage. Objective: To evaluate the clinical outcome, in terms of safety and efficacy, of a flapless piezopuncture on maxillary canine distalization. Methods: A split-mouth randomized clinical trial was carried out on five patients. Piezopuncture was performed on a random side of the maxillary arch to assess the rate of canine movement on the stimulated side, compared to the non-stimulated control side after 15 (T1), 30 (T2), and 60 (T3) days. Also, immediate side effects and changes in buccal bone thickness after one year were assessed. Results: Distalization on the intervention versus control side at T1 was 1.24±0.21mm versus 0.64±0.33mm (p=0.005); at T2 it was 2.00±0.28mm versus 1.36±0.49mm (p=0.046); and at T3 it was 4.28±0.66mm versus 3.65±0.88mm (p=0.102). No adverse effects related to the surgical procedure were observed or reported by patients. The thickness of the buccal bone plate showed no significant changes. Conclusions: Flapless piezopuncture accelerates the rate of tooth movement in orthodontic patients over the first 15 days and its effect declines over the next 45 days.

Students' perception of instructors and burnout levels in chilean dental students

The educational environment affects dental students' well-being and academic achievement, with unclear impact from clinical instructors on burnout levels. This study is aimed to determine the impact of students' perception about their clinical instructors in its burnout levels in a sample of Chilean dental students. Methods: A cross-sectional study was conducted among fourth and fifth-year dental students at the University of Concepción (Chile), collecting data on various variables including demographics, effective teaching hours, instructor treatment, knowledge delivery, student appreciation, and burnout assessed using Maslach's Burnout Inventory (MBI). Data were gathered through a self-administered survey and analyzed using STATA 10/SE software (p<0.05). Results: One-hundred and seventy students participated, high levels of emotional exhaustion (51.76%), depersonalization (56.47%), and personal accomplishment (60.59%) were found. Female students (p=0.0008), those who perceive inadequate treatment from instructors towards patients (p=0.0496), and those who rate the instructor as obstructionist (p=0.0208) reported higher levels of emotional exhaustion. 5th year students (p=0.0142), students who perceive indifferent treatment from instructors towards students (p=0.0002), and those who rate the instructor as obstructionist (p=0.0026) exhibited higher levels of depersonalization. 4th year students (p=0.0475) and those who perceive indifferent treatment from instructors towards students (p=0.0221) showed lower levels of personal accomplishment. There was a correlation between depersonalization and effective teaching hours (rho=-0.2166, p=0.0046). Conclusion: Students' perception about their clinical instructors as indifferent towards the students, obstructionist in the teaching process, with inadequate treatment towards the patients, and less effective teaching hours is associated with higher students' burnout levels.

Adecuaciones para la atención de personas con discapacidad sensorial en los CESFAM del Servicio de Salud Concepción / Adjustments for the care of people with sensory disabilities in primary health centers

BACKGROUND: People with Sensory Disabilities (PcDS) face barriers for equal access to health care. Thus, health centers require adjustments to comply with equal access that allows an universal coverage of care. AIM: To characterize the adjustments for the care of PcDS in primary health centers in Concepción, Chile. Material and Methods: Cross-sectional study using data obtained through a questionnaire to key informants or via Transparency Law, and direct observation. The variables were subdivided into four categories, namely infrastructure, communication, skills, and environment. RESULTS: The analyzed health centers have a high proportion of general adjustments of their physical settings. However, there is a lack of specific adjustments for deaf and blind people, especially communicational ones. Conclusions: There is a paucity of adjustments for the health care of PcDS in the analyzed health centers. This deficiency underscores the barriers faced by PcDS for receiving care in the Chilean public health system.

Factors Associated with Oral Health-Related Quality of Life in Preschoolers of Concepción, Chile: A Cross-Sectional Study

Abstract Objective: To identify the factors associated with Oral Health-Related Quality of Life (OHRQoL) in preschool children of Concepción, Chile. Material and Methods: A cross-sectional study was conducted in a sample of enrolled preschoolers who attend public schools in Concepción, Chile. To measure OHRQoL, the chilean version of the Early Childhood Oral Health Impact Scale (ECOHIS) was used; sociodemographic variables of the children and their parents were also recorded, as well as variables regarding the last visit to the dentist. To determine differences in the ECOHIS score for categorical variables, ANOVA and t-test were used, while Pearson's r was used to correlate ECOHIS with quantitative variables (p<0.05). Results: A total of 175 children were surveyed, with a distribution of 89 boys and 86 girls aged 56-to-79 months. The total score of the ECOHIS had a mean of 4.48 ±5.96, with a score between 0-38. Statistically significant associations were with parent's educational attainment (r=−0.159), dmft (r=0.380), OHI-S debris (r=0.174) and reason for the last visit to the dentist, the highest average in the ECOHIS scores was registered in the urgency reason. Conclusion: Oral health status, dental service utilization and educational level are associated with the OHRQoL of preschoolers of Concepción (AU).

Association of social factors and health conditions with capacity and performance

ABSTRACT OBJECTIVE Determine and measure the association of social factors and health conditions with worse capacity and performance levels. METHODS Dependent variables consisted of performance and capacity; independent variables comprised age, gender, level of education, personal income, and health conditions. Means (95%CI) of performance and capacity were presented according to the independent variables. Generalized linear models, using a mutual adjustment for all variables considered statistically significant (p < 0.05), measured the associations between each exposure and outcomes. Study population included 12,265 individuals. RESULTS Older women with lower education and income levels and with some health condition showed the worst performance and capacity. CONCLUSION Results showed that the capacity and performance levels of the Chilean population changed according to social demographic characteristics and health conditions.

Factor analysis of the cross-cultural adaptation of the multidimensional attitudes scale towards deaf persons in Chilean dental students

There are various instruments to measure attitudes toward persons with disabilities (PwD). The Multidimensional Attitudes Scale (MAS) toward PwD is a three-dimension scale with good psychometric properties; the Spanish version has been validated with a four-factor structure. Aim: To examine the factor structure of a cross-cultural adapted version of the Spanish MAS towards deaf persons in a sample of Chilean dental students. Methods: This cross-sectional study involved five Chilean public health experts that reviewed the scale for obtaining a preliminary version of a 30-item modified MAS towards deaf persons; a pilot with 15 dental students was performed, and a final sample composed of 311 students was included. For the exploratory factor analysis (EFA), maximum likelihood estimation (ML) for determining the number of factors and parallel analysis (PA) was used, with Oblimin for the rotation method. Cronbach's alpha was used to assess reliability. The root mean square error of approximation (RMSEA), comparative fit index (CFI), incremental fit index (IFI), goodness of fit index (GFI), Tucker-Lewis fit index (TLI-NNF) and root mean square of residuals (RMSR) were used to assess model fit. Results: All items had a normal distribution with the exception of items 7 and 10. The four-factor structure without item 10 in this EFA presented an adequate Cronbach's alpha (>0.83), suggesting acceptable reliability. RMSEA, TLI-NNFI, RMSR, GFI and CFI indices suggested a good fit of the model and were consistent with the literature. Conclusion: The Spanish modified version of the MAS towards deaf persons has a four-factor structure, which in consistent with a previous version of the MAS

Uso de técnicas de impresión 3D en la reconstrucción mandibular. Una revisión breve / Use of 3D printing techniques in mandibular reconstruction. A brief review / Uso de técnicas de impressão 3D na reconstrução mandibular. Uma breve revisão

Resumen En los últimos años, la tecnología y la medicina han podido complementarse para la optimización de tiempo, conocimientos y recursos, aumentando la posibilidad de tratamientos personalizados en más pacientes. A nivel maxilofacial, la reconstrucción de defectos mandibulares se ha visto en la necesidad de progresar sus técnicas debido a la serie de orígenes que afectan el hueso mandibular de manera drástica, como lesiones traumáticas, cáncer, infecciones, enfermedad congénita u otros, y las innumerables consecuencias tanto estéticas como funcionales, restringiendo significativamente la calidad de vida. El objetivo de este artículo es revisar conceptos básicos del uso de tecnologías de impresión 3D en la reconstrucción mandibular. La impresión 3D ha aparecido en diversos ámbitos, siendo en el área de la medicina, un aporte fundamental para la creación de formas anatómicas de alta precisión con el que se pueden diseñar objetos con reproducción de detalles de manera rápida, luego de una serie de pasos que incluyen la obtención de una imagen radiográfica, uso de software y reparación de archivos, y la obtención de un modelo tridimensional. Los últimos estudios han validado el uso de impresiones 3D para una reconstrucción mandibular, con claros beneficios de costos y calidad de detalles. Es necesario crear un enfoque en las técnicas quirúrgicas utilizadas con un objeto impreso tridimensionalmente y un análisis post operatorio de los pacientes sometidos a estos procedimientos más allá de los detalles técnicos.

Abstract In recent years, technology and medicine have been able to complement each other to optimize time, knowledge and resources, increasing the possibility of personalized treatments in more patients. At the maxillofacial level, the reconstruction of mandibular defects has seen the need to progress its techniques due to the series of origins that drastically affect the mandibular bone, such as traumatic injuries, cancer, infections, congenital disease or others, and the innumerable both aesthetic and functional consequences, significantly restricting the quality of life. The objective of this article is to review basic concepts of the use of 3D printing technologies in mandibular reconstruction. 3D printing has appeared in various fields, being in the area of medicine, a fundamental contribution to the creation of high-precision anatomical shapes with which objects with reproduction of details can be designed quickly, after a series of steps which include obtaining a radiographic image, use of software and file repair, and obtaining a three-dimensional model. The latest studies have validated the use of 3D impressions for mandibular reconstruction, with clear benefits in cost and quality of details. It is necessary to create a focus on the surgical techniques used with a three-dimensional printed object and a post-operative analysis of the patients undergoing these procedures beyond the technical details.

Resumo Nos últimos anos, tecnologia e medicina têm se complementado para otimizar tempo, conhecimento e recursos, aumentando a possibilidade de tratamentos personalizados em mais pacientes. No nível maxilofacial, a reconstrução dos defeitos mandibulares tem visto a necessidade de progredir em suas técnicas devido à série de origens que afetam drasticamente o osso mandibular, como lesões traumáticas, câncer, infecções, doenças congênitas ou outras, e as inúmeras ambas estéticas. e consequências funcionais, restringindo significativamente a qualidade de vida. O objetivo deste artigo é revisar os conceitos básicos do uso das tecnologias de impressão 3D na reconstrução mandibular. A impressão 3D tem surgido em vários campos, sendo na área da medicina uma contribuição fundamental para a criação de formas anatômicas de alta precisão com as quais objetos com reprodução de detalhes podem ser desenhados rapidamente, após uma série de etapas que incluem a obtenção de uma imagem radiográfica, uso de software e reparo de arquivos e obtenção de um modelo tridimensional. Os estudos mais recentes têm validado o uso de impressões 3D para reconstruções mandibulares, com claros benefícios em custo e qualidade de detalhes. É necessário criar um foco nas técnicas cirúrgicas utilizadas com um objeto impresso tridimensional e uma análise pós-operatória dos pacientes submetidos a esses procedimentos para além dos detalhes técnicos.

Evaluation of a telemedicine program in oral pathology and preventive oral examination in Hualqui Municipality, Chile

ABSTRACT: Introduction: A telemedicine program in oral pathology (TOP) and a preventive oral examination (POE) to identify oral lesions was implemented in Hualqui, Chile. The objective of this study is to describe the results of the TOP plus POE strategy at CESFAM Hualqui, Chile, during the period of 2016 to 2019. Materials and methods: A prospective cohort study was conducted with 152 Hualqui patients between 2016 and 2019. The following variables were recorded: diagnosis; injury diagnosis dates; date of teleconsultation; date and response of the specialist and subsequent control; waiting time for response (WTR) and waiting time for attention (WTA). Results: The WTR was 19.7 ± 12.8 days and WTA presented a median of 20 days (1−125) days. A total of 45 different oral pathologies were identified, the most frequent being stomatitis 8.6% (13), fibroma 8.6% (13) and mucocele 7.9% (12), and among the least frequent highlights three cases of oral cancer. Conclusions: The waiting periods until a response from the specialist and then until the face-to-face control were around 3 weeks each, most of the cases were identified through POE and correspond mostly to benign pathologies.

Protocolo de atención a usuarios/as/es trans del Servicio de Salud Talcahuano: características y relevancia / Attention Protocol for Trans Users of Talcahuano's Health Service: Characteristics and Relevance / Protocolos de atenção a usuários/as trans do Serviço de Saúde Talcahuano: características e relevância

Resumen Introducción: en Chile, la legislación existente asegura la atención médica en el sistema de salud público para las personas trans; sin embargo, esto no se cumple en todos los servicios de salud. El objetivo de este trabajo es describir las características y relevancia del Protocolo de Atención de Personas Trans, implementado por el Servicio de Salud Talcahuano. Se realizó una investigación cualitativa, con recolección de datos a través de entrevistas semiestructuradas y grupo focal. La información se analizó a través de teoría fundamentada y una matriz FODA. Desarrollo: desde la teoría fundamentada se desprenden dos categorías principales, correspondientes a la "necesidad de despatologización y buen trato" y el "protocolo" como tal, que se articulan desde la comunidad trans y la institucionalidad. El protocolo se caracteriza por ser pionero, participativo, vinculante y reconocido. Desde la matriz FODA, se observa que las fortalezas principales corresponden al diálogo entre comunidad y profesionales, y la apertura del equipo profesional a actualizar sus conocimientos en atención en salud a personas trans. Las debilidades principales refieren a la discriminación pasiva hacia personas trans de parte de algunos profesionales, la falta de algunas prestaciones específicas en el protocolo y las pocas horas disponibles para los especialistas que son parte del programa. Conclusiones: el Protocolo de Atención de Personas Trans es considerado pionero en el país y es valorado positivamente por la comunidad trans nacional, lo cual la valida. Por lo mismo, deben buscarse formas de replicar el trabajo en otros servicios de salud.

Abstract Introduction: In Chile, current legislation ensures medical care for trans people in the national public health system. However, this does not apply to all of the national health services. This paper aims to describe the features and relevance of the Attention Protocol implemented by the Talcahuano's Health Service. A qualitative research study was conducted, and data was collected through semi-structured interviews and focus groups. The information was analyzed with Grounded Theory and a SWOT Matrix. Development: From the Grounded Theory, two main categories were obtained, which were "Need for despathologization and good treatment" and "Protocol" as such, categories that are articulated through the trans community and the institution. The Protocol's main features include its pioneering work, participatory specifications, binding for healthcare personnel and patients, and recognized. From the SWOT Matrix, it is noted that the main strengths of the Protocol include the dialog between professionals and the trans community, and the openness of the professional team in learning about improving health care for trans people. The main weaknesses include a passive discrimination toward trans people from some health professionals, the lack of certain specific services in the Protocol, and the few hours available for professionals from the Program. Conclusions: The Attention Protocol implemented by the Talcahuano's Health Service experience is acknowledged as pioneering work in Chile, and it is both valued positively and validated by the national trans community. Hence, the search for a means to replicate this work in other health services is necessary.

Resumo Introdução: no Chile, a legislação existente assegura a atenção médica no sistema de saúde público para as pessoas trans. Entretanto, isso não está sendo cumprido em todos os serviços de saúde. O objetivo deste trabalho é descrever as características e relevância do Protocolo de Atenção de pessoas trans implementado pelo Serviço de Saúde Talcahuano. Realizou-se uma investigação qualitativa, com coleta de dados através de entrevistas semiestruturadas e grupo focal. A informação foi analisada através da Teoria Fundamentada e uma matriz FODA. Desenvolvimento: a partir da Teoria Fundamentada obtivemos duas categorias principais, correspondentes à "Necessidade de despatologização e bom tratamento" e o "Protocolo" como tal, que se articulam com a comunidade trans e a institucionalidade. O Protocolo se caracteriza por ser pioneiro, participativo, vinculador, e reconhecido. A partir da matriz FODA observa-se que os principais pontos fortes correspondem ao diálogo entre a comunidade e os profissionais, e a abertura da equipe profissional em atualizar seus conhecimentos no que diz respeito a atenção à saúde de pessoas trans. As principais debilidades se referem a discriminação passiva com as pessoas trans por parte de alguns profissionais, a falta de alguns serviços específicos no Protocolo, e as poucas horas disponíveis para os especialistas que fazem parte do programa. Conclusões: o Protocolo de Atenção de pessoas trans implementado pelo Serviço de Saúde Talcahuano é considerado pioneiro no país, e é positivamente valorizado pela comunidade trans nacional, fato que o torna válido. Por esse motivo, deve-se buscar formas de reproduzir este trabalho em outros serviços de saúde.

Salud bucal en Chile, situación actual y desafíos futuros / Oral health in Chile, current situation and future challenges

Chile ha visto una mejora en sus indicadores de morbilidad bucal en las últimas décadas, esto ha ido de la mano con la ampliación de las coberturas en promoción, prevención y tratamiento odontológico, priorizando los grupos infantiles, embarazadas y adultos mayores. A pesar de esto, persiste una morbilidad bucal muy alta, especialmente en la po-blación de 20 a 60 años, que tienen escaso acceso a atención odontológica restauradora. El Ministerio de Salud ha propuesto un ambicioso Plan Nacional de Salud Bucal 2018-2030 que busca mejorar el estado de salud bucal y reducir las desigualdades, esto se basa en los conceptos de equidad, intersectorialidad, participación ciudadana e inclusión y no discriminación, y materializa en cuatro ejes estratégicos: promoción de salud y preven-ción de enfermedades bucales; provisión de servicios odontológicos de calidad; desarrollo del recurso humano; e investigación, monitoreo y evaluación.

In recent decades, Chile has seen an improvement in its indicators of oral morbidity; that has gone hand in hand with the expansion of coverage in promotion, prevention and dental treatment, prioritizing children, pregnant women and the elderly. Albeit this effort, a very high oral morbidity persists, especially in the population aged 20 to 60 years old, whom have little access to restorative dental care. The Ministry of Health has proposed an ambitious 2018-2030 National Oral Health Plan that pursues the improve-ment of oral health as well as to reduce inequalities, based on the concepts of equity, intersectionality, citizen participation and inclusion and non-discrimination, thus it ma-terializes in four strategic axes: health promotion and prevention of oral diseases; delivery of quality dental services; human resources development; and research, monitoring and evaluation.

Improving Dental Service Utilization Rate Using a Proactive Telephone-Based Scheduling Strategy in Primary Healthcare

Abstract Objective: To determine the effect of a proactive telephone-based scheduling strategy to improve dental service utilization rate in primary healthcare. Material and Methods: A retrospective study was carried out based on the dental appointments' records of a primary healthcare center before-strategy and after-strategy periods. The variables studied for both periods were the number of dental appointments requested, dental appointments undergone, no-shows, and available quotas. Data collection was performed by two researchers between May and June 2018. Descriptive statistics were used to calculate the absolute and relative frequencies. Results: A total of 10,193 records of dental appointments were registered within the two periods. After-strategy period, dental appointments undergone increased by 16,7%, no-shows decreased by 3%, and available quotas decreased by 21.3%. Conclusion: A proactive telephone-based scheduling strategy increased the dental service utilization rate in primary healthcare.

Ausencia de perspectiva de género en la educación médica. Implicaciones en pacientes mujeres y LGBT+, estudiantes y profesores / Absence of gender perspective in medical education. Implications in female and LGBT+ patients, students and professionals

RESUMEN La Salud corresponde a un estado de bienestar completo, donde interactúan factores biológicos, socioculturales y psicosociales. El género es uno de ellos. Actualmente está demostrado que las diferencias entre sexos y géneros tienen efectos en múltiples enfermedades, diferencias que tienden a omitirse en la educación médica. Entre las principales consecuencias a dicha omisión se encuentra la atención inadecuada a pacientes y la existencia de distintas discriminaciones dentro de la enseñanza médica. La siguiente revisión bibliográfica abordará cómo la ausencia de perspectiva de género en la educación en la salud afecta a los pacientes y estudiantes de medicina, sean femeninas o LGBT+. Se concluye que han existido mejoras tanto en la atención como en la enseñanza, pero debe continuarse el trabajo, en particular, en la formación inicial de los profesionales de la medicina.

SUMMARY Health is a state of complete well-being, where biological, sociocultural and psychosocial factors interact with each other; gender is one of them. Nowadays, it has been proven that differences between sexes and genders have effects on many diseases; these differences are not usually addressed in medical education. Some of the main consequences are the inadequate attention of patients and the existence of various types of discrimination within medical education. The following review will examine how the absence of gender perspective in health education has effects on female patients and medical students, and on LGBT+ patients and medical students. In conclusion, there have been improvements, both in the attention of patients as well as in medical education, but the efforts on the subject must continue, especially in initial training of medical professionals.

Chilean Health Professionals Attitudes Towards Deafness: A Cross-Sectional Study

Abstract Objective: To assess the attitudes of health professionals towards Deafness and its association with sociodemographic and Deaf contact experience. Material and Methods: A cross-sectional study was carried out in Concepcion, Chile. The sample size was estimated in 171 health professionals. The following variables were considered: sociodemographics, Deaf contact experience, and attitudes to deafness scale (ADS scale). To evaluate the association between the variables, t-test and Spearman correlation test were used (p<0.05). Results: People who had taken a LSCh course had significant more positive attitudes towards item 1 "Deaf people should learn to lipread", with a 2 points difference and in persons who do not know a Deaf person, with 1-point difference. Also, persons who have received some kind of formation in Deafness have a better attitude in item 3 "I would like to have more Deaf friends" with 1-point difference. An inverse correlation was observed within age (rho = -0.237; p=0.0014), years of academic service (rho = -0.323; p<0.0001) or PHC service (rho = -0.1085; p=0,364). Conclusion: The attitude of health professionals towards Deafness was neutral. This attitude is not modulated by sex, type of profession, type of relationship with Deaf people, type of training in hearing disability, Chilean Sign Language Courses or degree of frequency of healthcare delivery to Deaf patients. However, it is modulated by age and years of service.