Community interventions and strategies for caries control in Latin American and Caribbean countries

Abstract Dental caries remains highly prevalent in Latin American and Caribbean countries (LACC). However, this disease can be controlled through interventions that implement evidence-based strategies in an affordable manner and that target all population groups instead of the most affluent only. Therefore, the aim of this report was to summarize the main scientifically documented community interventions and strategies based on restriction of sugars consumption, use of fluoride, and the use of occlusal sealants for caries control in LACC. A critical literature review was carried out in a systematic manner that included defined search strategies, independent review of the identified publications, and compilation of results in this report. Three systematic searches were conducted using the PubMed, LILACS, and SciELO databases to identify studies related to community interventions and strategies for caries control in LACC. Of the 37 publications identified, twenty-six focused on fluoride use, eight on occlusal sealant use, and three on the restriction of sugar consumption. Documented community interventions for sugars restriction were scarce in the region and were based on food supplementation, sugar replacement, and education. Thus, local and/or national policies should prioritize investment in upstream, coherent, and integrated population-wide policies such as taxes on sugary drinks and stronger regulation of advertising and promotion of sugary foods and drinks mainly targeting children. The main fluoride-based strategies used drinking water, refined domestic salt, cow milk, toothpaste and, to a lesser extent, mouth-rinses, acidulated phosphate fluoride (APF) gels, and varnishes to deliver fluoride to the population. Evidence of fluoride use was seen in Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and Venezuela. Studies reporting the use of occlusal sealants were mainly located in Brazil, Chile, Colombia, Costa Rica, Peru, Mexico, and Venezuela. Community interventions restricting sugar consumption should be implemented at the individual level and through public policies. The use of fluoride must be monitored at the local, regional, and national levels so as to achieve maximum anti-caries effect while also minimizing the risk of dental fluorosis. Moreover, fluoridated water and salt programs, used as a mutually exclusive community level strategy for caries control, should expand their benefits to reach non-covered areas of the LACC while also simultaneously providing adequate surveillance of the fluoride concentration delivered to the population. Regulating the concentration of soluble fluoride (for anti-caries effect) in dentifrice formulations is also necessary in order to provide the population with an effective strategy for disease control. Targeting culturally appropriate, economically sustainable caries control interventions to rural populations and native ethnic groups such as indigenous people, quilombolas (African-origin), and riverside Amazonian people remains a crucial challenge.

Fatores associados ao início da prática do aleitamento em uma maternidade de Lima, Peru / Factors associated with the initiation of breastfeeding in a maternity hospital in Lima, Peru

RESUMO Objetivo Verificar os fatores anatomofisiológicos, psicológicos, socioculturais do binômio mãe neonato e sua associação com o início da prática do aleitamento materno. Método Estudo transversal realizado em uma Maternidade de Lima Peru. A amostra foi de 304 neonatos sadios e suas respectivas mães. O desempenho na amamentação foi estimado por avaliação clínica utilizando-se a escala de Avaliação Clínica da Eficácia da Amamentação e a autopercepção materna pela Escala de Autoeficácia da Amamentação. Razões de Prevalência (RP) multivariadas foram estimadas pela Regressão de Poisson com Variância Robusta e intervalos de confiança (IC) de 95%. Resultados A prevalência de baixo desempenho clínico na amamentação foi de 27,6%. Primíparas associarem-se a maior prevalência de baixo desempenho quando não confiavam em ter sucesso [RP:2,02(IC95%:1,18-3,44)] e menor prevalência em ter boa pega [RP:0,52(IC95%:0,29-0,95)], assim como em enfrentar com êxito [RP:0,59(IC95%:0,37-0,91)]. As multíparas, apresentaram maior prevalência quando não confiavam em manter-se motivadas [RP:3,47(IC95%:1,67-7,22)] e em acalmar o neonato [RP:4,07(IC95%:1,83-9,95)]. Houve menor prevalência em manter o neonato acordado [RP:0,32(IC95%:0,14-0,75)] e quando não se sentiam confiantes na presença de seus familiares [RP:0,29(IC95%:0,13-0,64)]. Conclusão É importante que profissionais da saúde estejam atentos às questões emocionais, sociais e culturais para a promoção de um aleitamento materno com qualidade.

ABSTRACT Purpose To verify the anatomophysiological, psychological, and sociocultural factors of the mother-newborn binomial, as well as their association with the initiation of breastfeeding. Methods Cross-sectional study conducted in a maternity hospital in Lima, Peru. The sample consisted of 304 healthy neonates and their mothers. Breastfeeding performance was estimated by clinical assessment using the Clinical Evaluation of Breastfeeding Efficacy scale and maternal self-perception by the Breastfeeding Self-Efficacy Scale. Multivariate Prevalence Ratios (PR) were estimated by Poisson Regression with Robust Variance and 95% confidence intervals (CI). Results The prevalence of clinical low breastfeeding performance was 27.6%. Primiparous women were associated with higher prevalence of low performance when they did not trust to succeed [PR:2.02(95%CI:1.18-3.44)] and lower prevalence in having a good latch [PR:0.52(95%CI:0.29-0.95)], as well as in coping successfully [PR:0.59(95%CI:0.37-0.91)]. Multiparous women showed higher prevalence when they were not confident in staying motivated [PR:3.47(95%CI:1.67-7.22)] and in calming the neonate [PR:4.07(95%CI:1.83-9.95)]. There was lower prevalence in keeping the neonate awake [PR:0.32(95%CI:0.14-0.75)] and when they did not feel confident in the presence of their family [PR:0.29(95%CI:0.13-0.64)]. Conclusion It is important that health professionals be aware of emotional, social, and cultural issues to promote quality breastfeeding.

Heterogeneidad bioquímica y endocrina en la forma completa del síndrome de feminización testicular / Biochemical and endocrine heterogeneity in the complete form of the testicular feminization syndrome

Se estudió una variante familiar de pseudohermafroditismo masculino endocrinológicamente diferente al de la forma clásica del síndrome de feminización testicular completa (STFC). Los tres sujetos afectados, con complemento cromosómico 46 XY y edades de 16, 18 y 20 años, presentaban un fenotipo femenino idéntico al de un paciente de 17 años de edad con la forma clásica del SFTC incluido en el estudio con fines comparativos. Las mayores diferencias endocrinas y bioquímicas encontradas en esta familia, comparadas con la forma clásica fueron: a. elevadas concentraciones de gonadotropinas en el suero sanguíneo; b. testosterona en suero en límites inferiores; c. pobre respuesta testicular a la administración de gonadotropina coriónica; d. relación testosterona: androstendiona anormalmente disminuida; e. leve respuesta hipotálamo-hipofisiaria a la administración de andrógenos; f. existencia de capacidad residual para captar y retener andrógenos en forma intracelular. Estas diferencias, con excepción de la e, fueron más evidentes en los pacientes de 18 y 20 años. Todos los sujetos fueron incapaces de retener nitrógeno en forma significativa durante la administración de testosterona. Las relaciones testosterona: androstendiona anormales sugieren disminución parcial secundaria de la enzima 17-hidroxiesteroide deshidrogenasa, tal y como ha sido demostrado en los modelos del SFTC del roedor. Los resultados en conjunto son indicativos de la existencia de variabilidad en la expresión de la insensibilidad a los andrógenos dependiente de la edad, así como de una amplia heterogeneidad bioquímica y endocrinológica en este síndrome

Diagnóstico clínico erróneo de síndrome de feminización testicular incompleto en un paciente con síndrome de Rokitansky / Clinical diagnosis of incomplete testicular feminization syndrome in a patient with Rokitansky syndrome

Se reporta el estudio clínico, endocrinológico y de receptores intracelulares en una paciente de 45 años de edad con cariotipo 46XX, en la cual el diagnóstico clínico inicial fue de pseudohermafroditismo masculino por deficiencia en la acción de andrógenos en órganos periféricos (síndromes de feminización incompleto) y que resultó corresponder a un síndrome de Rokitansky. Se hace además una revisión comparativa de ambas entidades de acuerdo a los conceptos actuales de dinámica endocrinológica del eje hipotálamo-hipófisis-gónada, así como el mecanismo de acción hormonal a nivel celular. Consideramos de interés esta comunicación en virtud de que no obstante que estas dos entidades presentan complemento cromosómico, perfil endocrino y mecanismo de acción a nivel celular completamente diferente, clínicamente pueden ser confundidos