Application of chronic disease management model in early childhood caries / 口腔疾病防治

@#Early childhood caries (ECC) is not only harmful to children's oral cavity and even the whole body, the government and relevant health departments pay more and more attention to the prevention and treatment of early childhood caries. However, at present, the primary treatment for ECC is the traditional filling therapy. The chronic disease management model can conduct regular testing of chronic non-communicable diseases and their risk factors, and provide long-term and effective professional management to patients by supervision and advice by doctors, nurses and pharmacists. This model has a good effect on slowing down the development of the disease, improving the quality of life of patients and saving public health resources. As a common chronic non-communicable disease, ECC is very suitable for prevention and treatment through chronic disease management. In recent years, chronic disease management models have also been increasingly used in the management of caries. The current common chronic disease management models include the chronic care model, innovative care for chronic condition, and British chronic disease management system models. And above models have certain applications in the management of ECC. How to establish the caries risk assessment system suitable for the diagnosis and treatment model of our country, and how to screen the children with high risk of caries by step-by-step prevention and control network for personalized prevention needed to be further studied in the future.

Manejo e integración estomatológica del paciente pediátrico con trastorno de Asperger / Management and dental integration of the pediatric patient with Asperger disorder

Trastorno neurológico enmarcado dentro de los trastornos de espectro autista (TEA) cuyas manifestaciones se reflejan en los ámbitos de la comunicación, interacción e imaginación social. Se clasifica en el manual diagnóstico y estadístico de trastornos mentales (DSM IV), se caracteriza por un mayor o menor grado de deterioro en las habilidades de lenguaje y comunicación, así como patrones repetitivos o restrictivos de pensamiento y comportamiento. El síntoma más distintivo es el interés obsesivo en un solo objeto o tema y la exclusión de cualquier otro pero siempre conservando habilidades de lenguaje. El pronóstico es bueno, debido a la compensación cognitiva, el enfoque repetitivo y restrictivo a actividades humanas productivas o generadoras de deferencias particulares, aunque no hay tratamiento específico, sino más bien interdisciplinario e individualizado, éste consiste en manejar los síntomas conductuales y la comorbilidad de forma independiente ya sea farmacológica o intervencionista. Paciente masculino de cinco años de edad, con un peso de 26 kg, cuadro de inmunizaciones completas, previamente diagnosticado con trastorno de Asperger (2015); caries dental de diversos grados, manejo estomatológico para su rehabilitación. El objetivo de este reporte es dar a conocer los cuidados para el tratamiento dental en pacientes con este trastorno (AU)

Neurological disorder known as autism spectrum disorders (ASD) whose main manifestations are reflected in the areas of communication, interaction and social imagination. It was first classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM lV), characterized by a greater or lesser degree of deterioration in language and communication skills, as well as repetitive patterns or restrictive of thought and behavior. The most distinctive symptom is obsessive interest in a single object or topic and the exclusion of any other, but always retaining language skills. The prognosis is good in most of the cases, due to the cognitive compensation, the repetitive and restrictive approach to productive or deferential human activities, although there is no specific treatment, but rather interdisciplinary and individualized, this consists of managing behavioral symptoms and comorbidity independently either pharmacologically or interventionally. Male patient with five years old and weight of 26 kg, complete immunization chart, previously diagnosed with Asperger's disorder (2015); with dental caries of various degrees implementing dental management. The objective of this report is to make aware of the care and behavior management for dental treatment in patients with this Disorder (AU)

Análisis conductual de niños brasileños que participan del "Programa boquita del bebé" ­ Gurupi/Tocantins / Behavioral analysis of Brazilian children participating in the "Baby's Little Mouth Program" at Gurupi-Tocantins / Análise comportamental de crianças brasileiras participantes do "Programa Bo-quinha do Bebê" ­ Gurupi/Tocantins

La respuesta del comportamiento del niño ha sido estudiada en algunas investigaciones y es útil para predecir cómo el niño reacciona al tratamiento odontológico, especialmente los bebés y los niños más pequeños, que es donde se encuentra uno de los mayores desafíos de la odontopediatría. Objetivo: Evaluar el patrón de comportamiento de niños de 3 a 5 años de edad, en un programa preventivo de la municipalidad de Gurupi/Tocantins, Brasil. Materiales y métodos: Este estudio fue evaluado y aprobado por el comité de ética e investigación. Un total de 60 niños, con diferentes perfiles de participación del programa "boquita del bebé" fueron analizadas. Entre ellos, 20 frecuentaban el programa, 20 habían desistido y 20 nunca participaron anteriormente. El perfil de comportamiento fue analizado por un examinador externo en el momento de la higiene bucal (profilaxis) por medio de la escala de comportamiento de Venham. Los datos fueron analizados mediante la regresión de Poisson (α=5%). Resultados: Los niños que presentaron peor comportamiento fueron aquellas que nunca participaron del programa "boquita del bebé" (OR: 3.80 / p=0.008), así como, los niños que no permitían el cepillado en casa (OR: 4.17 / p=0.001) y aquellos que sólo permitían el cepillado en ocasiones (OR: 3.07 / p=0.010). Conclusión: Existe una influencia positiva del programa en el condicionamiento psicológico, en la ansiedad de los niños y en la adopción de hábitos correctos en sus rutinas diarias.

The behavioral response of the child has been studied in some researches and is useful to predict how the child reacts to dental treatment, especially infants and young children, which is one of the greatest challenges of pediatric dentistry. Ob-jective: To evaluate the behavioral pattern of children from 3 to 5 years of age in a preventive program in the municipality of Gurupi /Tocantins, Brazil. Materials and methods: This study was evaluated and approved by the Ethics and Research Committee. A total of 60 children, with different participation profiles of the program "Baby's Little Mouth" were analyzed. Of these, 20 were frequent program participants, 20 were dropouts and 20 had never participated in the program before. The behavioral profile was analyzed by an external examiner, at the time of oral hygiene (prophylaxis), through the behavioral scale of Venham. Data were analyzed using Poisson regression analysis (α = 5%). Results: The children who presented the worst behavior were those who had never participated in the "Baby's Little Mouth" program (OR=3.80; p=0.008), as well as children who did not allow brushing at home (OR=4.17; p=0.001) and those that only allowed brushing someti-mes (OR=3.07; p=0.010). Conclusion: There is a positive influence of the program on psychological conditioning, on the anxiety of children and on the adoption of correct daily habits in their routines.

A resposta comportamental da criança tem sido estudada em algumas pesquisas e sendo útil para prever como a criança reage ao tratamento odontológico, especialmente os bebês e as crianças mais novas, que é onde se encontra um dos maiores desafios da odontopediatria. Objetivo: Avaliar o padrão comportamental de crianças de 3 a 5 anos de idade, em um programa preventi-vo do município de Gurupi/Tocantins, Brasil. Materiais e métodos: Este estudo foi avaliado e aprovado pelo Comitê de ética e pesquisa. Um total de 60 crianças, com diferentes perfis de participação do programa "Boquinha do bebê" foram analisadas. Dentre elas, 20 eram frequentadoras assíduas do programa, 20 eram desistentes e 20 nunca participaram anteriormente. O perfil comportamental foi analisado por um examinador externo no momento da higienização bucal (profilaxia) por meio da escala comportamental de Venham. Os dados foram analisados mediante a Regressão de Poisson (α=5%). Resultados: As crianças que apresentaram pior comportamento foram aquelas que nunca participaram do programa "Boquinha do bebê" (OR: 3,80 / p=0,008), assim como, as crianças que não permitiram escovação em casa (OR: 4,17 / p=0,001) e aquelas que só permi-tiam a escovação às vezes (OR: 3,07 / p=0,010). Conclusão: Existe uma influência positiva do programa no condicionamento psicológico, na ansiedade das crianças e na adoção de corretos hábitos em suas rotinas.

The effect of a preoperative informative video on the perception of pain in youths undergoing third molar extraction: a randomized clinical trial / O efeito de vídeo informativo pré-operatório na percepção de dor em jovens submetidos à exodontia de terceiros molares: estudo randomizado

BACKGROUND AND OBJECTIVES: The extraction of the third molar is an invasive procedure and is potentially traumatic for the patient. Preparatory procedures may be used for the management of pain and emotional responses, resulting in a better recovery process for patients. The aim of the study evaluates the effects of a preparatory procedure using an animated informative video on post-surgical pain responses after third molar extraction on youths during the postoperative follow-up. METHODS: 140 patients undergoing third molar extraction were randomly divided into two groups: control (CG) and experimental (EG). For pain assessment, the short-form McGill pain questionnaire was given once before the procedure and four times after the surgery, and the amount of postoperative analgesic consumption was recorded. The informative video was presented to the EG after the first assessment. For data analysis, ANOVA and Tukey tests (p < 0.05) were used. Data analysis indicated that the EG patients reported reduced pain perception for all pain indexes. RESULTS: Significant between-group differences were observed for Sensory and Affective Rank Pain Indexes (PRI-S and PRI-A, respectively), as well as for Global Assessment, at stages 2, 3 and 4 (p=0.0001; p=0.0027; p=0.0001). For Present Pain Intensity, a significant difference between groups was observed (p=0.0004) at stages 3, 4 and 5. The postoperative consumption of analgesics was lower in the EG (p=0.0001), indicating higher medicine consumption by CG patients. CONCLUSION: The results suggest that the preoperative informative video effectively reduced pain perception and the consumption of analgesics.

JUSTIFICATIVA E OBJETIVOS: A exodontia de terceiros molares é um procedimento invasivo e potencialmente traumático. Procedimentos preparatórios podem ser usados para manuseio da dor e de respostas emocionais, resultando em uma melhor recuperação dos pacientes. O objetivo deste estudo foi avaliar os efeitos de um vídeo de animação informativo em respostas de dor após exodontia de terceiro molar em jovens. MÉTODOS: Neste estudo, 140 pacientes submetidos a exodontia de terceiro molar foram randomizados em dois grupos: controle (GC) e experimental (GE). Para avaliação da dor foi utilizado o Questionário de Dor McGill, forma reduzida. Essa avaliação foi realizada uma vez antes do procedimento cirúrgico e quatro vezes após. Foi também registrada a quantidade de analgésicos consumidos após exodontia. O vídeo informativo foi apresentado ao GE após a primeira avaliação. Foram utilizados os testes ANOVA e Tukey para análise de dados (p<0,05). RESULTADOS: A análise mostrou que o GE relatou diminuição de todos os índices de dor. Diferença significativa entre os grupos foi observada nos Índices de Estimativa de Dor Sensorial e Afetiva (PRI-S e PRI-A), como na Avaliação Global de Experiência de Dor nas fases 2, 3 e 4 (p=0,0001; p=0,0027; p=0,0001). Para a Intensidade de Dor Presente (PPI) foi observada diferença significativa entre os grupos (p=0,0004) nas fases 3, 4 e 5. O consumo pós-operatório de analgésico foi menor no GE (p=0,0001), indicando um maior consumo de medicamento para o GC. CONCLUSÃO: Os resultados sugerem que o vídeo de informação pré-operatório efetivamente reduziu a percepção de dor e o consumo de analgésicos.

Aproximación a la terapia cognitivo conductual como herramienta terapéutica en el Síndrome de Tourette / Approximation to behavioral therapy for Tourette syndrome management

El síndrome de Tourette (ST) es una patología del espectro neuropsiquiátrico que se caracteriza por la presencia de múltiples tics tanto motores como vocales. Su peak ocurre entre los 8 -12 años de edad y tienden a disminuir en la vida adulta. Un 20 por ciento de los pacientes no presentará mejoría de su sintomatología al llegar a la adultez. La constelación de síntomas que se presentan durante el transcurso de la enfermedad, resulta frustrante y poco predecible para los pacientes y sus padres, quienes ya poco entienden de esta patología. Uno de los desafíos que representa el ST para los tratantes es abarcar al paciente en todas sus dimensiones y lograr un tratamiento integral y multidisciplinario. La terapia o intervención conductual (TC) logra centrarse en este aspecto y obtener una mirada global del problema. Dentro de los subgrupos de TC, el “Habit Reversal” plantea que el ST se modula constantemente por el ambiente, lo que clínicamente se traduce en un aumento o disminución de la urgencia por realizar los tics, por lo tanto al manejar el entorno y la urgencia mediante una respuesta competitiva, los tics deberían disminuir. Mediante diferentes estudios se ha demostrado la efectividad de la terapia y su duración en el tiempo, por lo que se la ha validado como una nueva alternativa terapéutica, que puede realizarse o no en conjunto con la terapia farmacológica.

Tourette's syndrome (ST) is a pathology of the neuropsychiatric spectrum characterized by the presence of multiple motor and vocal tics. Its peak occurs between 8 to 12 years old and tend to decrease in adult life. About 20 percent of patients presented no improvement in their symptoms in adulthood. The constellation of symptoms that occur during the course of the disease is unpredictable and frustrating for patients and their parents, who already have little understanding of this pathology. One of the challenges of the ST for caregivers is to embrace the patient in all its dimensions and achieve their treatment in a comprehensive and multidisciplinary way. Therapy or behavioral intervention (TC) does focus on this aspect and get an overall view of the problem. Within subgroups of TC, the "Habit Reversal" suggests that the ST is constantly modulated by the environment, which translates clinically in an increase or decrease in the urge to perform tics. Therefore managing the environment and urgency by a competitive response, tics should decrease. Various studies have demonstrated the effectiveness of the therapy and its duration in time, so that it has been validated as a new therapeutic alternative, which can be done or not in conjunction with drug therapy.

Miedos dentales / Dental fears

El miedo al dentista no es tan infrecuente como la mayoría de la gente puede pensar. Una mala experiencia puede crear una fantasía horrible en la mente de una persona que programó, o debe programar, una visita a una clínica dental. OBJETIVO: describir la actitud de los pacientes en relación a diferentes factores subyacentes a los miedos dentales. MÉTODO: se realiza una encuesta a una muestra de 218 pacientes en el Consultorio 1, Santiago, Chile. Se utiliza un cuestionario con 17 ítem. El tratamiento estadístico se desarrolla con el programa SPSS 12. RESULTADOS: al analizar la estructura factorial de la escala de miedos dentales se encuentran cuatro factores. El principal factor está relacionado con "mala praxis profesional", mientras que los "aspectos inherentes al tratamiento" generan menos miedo. CONCLUSIONES: ha sido posible diferenciar cuatro factores que pueden generar o contribuir al miedo dental. La dimensión más trascendente es la denominada ""aspectos inherentes al tratamiento"", aunque los otros factores explorados pueden generar temor en menor grado. Las técnicas de manejo conductual son métodos para controlar las conductas de pacientes derivadas del miedo. Estas técnicas son necesarias para ayudar a modelar conductas.

Fear of the dentist, isn't as uncommon as most people might think. One bad experience can create a horrific fantasy in the mind of a person who is scheduled, or should be scheduled, to see go to a dental clinic. The aim of the current study is to describe the patient's attitude regarding several factors hidden in dental fears. METHOD: a survey has been performed among 218 patients who visited the Consultorio 1, Santiago, Chile. The questionnaire used included 17 items. The statistical data processing was carried out with the help of software SPSS 12. RESULTS: analyzing the factorial composition of dental fears scale, we detected four factors. The main factor is related to bad professional praxis, while "inherent actions to the treatments" factor generate less fear. CONCLUSION: among dental fears, it has been possible to differentiate four aspects or dimensions that could represent answers to the title: Dental Fears. One of these dimensions, which generate less level fear, is called "treatment inherent aspects". However, the others three dimensions do provoke a certain degree of fear. Behavioral management techniques are methods to control patient's behavior. These techniques are necessary to help modeling behaviors.

Ascertainment on the basic medical postgraduates fostering mode / 中华医学教育探索杂志

The education,as well as the fostering environment,of the basic medical college postgraduates has its strong "local features".Our college exerts the subject advantages,empha-sizes on the feature-fostering mode,and implements level-management(That is: college—teaching office—scientific research office).Management is centered on the daily fostering of the depart-ment,teaching office and scientific research office.With the target management as the guidance,we strengthen process management of different stages including the study of basic knowledge,topic-selection,topic opening,experiment research and thesis-writing while attaching importance to the behavioral management,consciousness of teamwork,spirit of commitment and devotion,foster and improve the comprehensive quality of communication ability,pursuit of truth etc.