ECHO ADHD in India: a feasible and acceptable training model for child-care physicians to identify and manage attention deficit hyperactivity disorder

Background: Children with attention deficit hyperactivity disorder (ADHD) have complex unmet needs. Physicians cite lack of knowledge, skills and resources as barriers to meeting these. ECHO (Extension of community health outcomes) ADHD, a case based tele-mentoring model was designed to address gaps in physician knowledge and skills regarding ADHD. A study was conducted to assess 1. Acceptability and feasibility of the program 2. Change in knowledge, self-efficacy and perception about appropriateness and feasibility of role in ADHD diagnosis and management pre and post program. Methods: The 6-month pilot trained pediatricians, developmental pediatricians, psychiatrists, neurologists through 14 sessions comprising lectures, case discussions. Participants completed measures for knowledge (KADDS-knowledge of attention deficit disorders scale), self-efficacy, and acceptability and feasibility of role at baseline and endline. Descriptive and non-parametric analysis assessed acceptability and feasibility of program and change in knowledge, self-efficacy, appropriateness and feasibility of role. De-identified case summaries helped in analysing participant queries.Results: Sixty four percent (57/88) participants completed baseline and endline evaluations and were included. Most were pediatricians and developmental pediatricians who found the model acceptable and feasible. Significant improvement was noted in knowledge about ADHD diagnosis, self-efficacy and perceptions about appropriateness and feasibility of role. Improvement in knowledge about ADHD comorbidities and management was not significant on KADDS. Case summaries, questions to hub team, discussions indicated participant focus on ADHD diagnosis. Conclusions: ECHO ADHD is an acceptable and feasible model in low- and middle-income country (LMIC) setting which improved knowledge and self-efficacy among participants.

Prevalence of Dental Caries Among Costa Rican Male Students Aged 12-22 Years Using ICDAS-II / Prevalencia de caries en varones costarricenses escolarizados de 12 a 22 años utilizando ICDAS-II

ABSTRACT: Objective: Dental decay is a public health challenge in Low- and Middle- Income Countries, particularly for young people, often confronted to healthcare access barriers. The aim of this study was to determine the prevalence and severity of dental caries among young male students in Costa Rica. Study design: A cross-sectional study was performed in 428 Costa Rican male students aged 12-22 years, who attended a nonprofit social welfare boarding school in 2019. A clinical examination was ran by three calibrated examiners following the International Caries Detection and Assessment System (ICDAS-II). Results: Caries prevalence was estimated at 83%, 15% have lost a tooth due to dental decay, 61% have at least one filled tooth, 36% have at least one filled and decayed tooth. The most frequent caries lesions were codes 2-Inactive (46.7%) and code 1-Inactive (23.8%). DMFT indicated a mean index using ICDAS-II 1-6>0 codes of 7.89. Using ICDAS-II 3-6>0 as threshold, the index decreases to 3.94. Finally, the lower and upper first permanent molars were found to be the most affected teeth. Conclusions: Dental caries experience represents a significant public health burden in young people, requiring better access to public dental healthcare.

RESUMEN: Objetivo: La caries dental continúa siendo uno de los grandes desafíos de salud pública en los países de ingresos bajos y medios, en particular para los jóvenes, que a menudo se enfrentan a barreras de acceso a la atención médica y odontológica. El objetivo de este estudio es determinar la prevalencia y severidad de la caries dental entre jóvenes estudiantes varones en Costa Rica. Diseño del estudio: se realizó un estudio transversal con 428 estudiantes varones costarricenses de entre 12 y 22 años, que asistieron a un internado de asistencia social sin fines de lucro llamado Ciudad de los Niños en 2019. Tres examinadores calibrados realizaron un examen clínico siguiendo el Sistema Internacional de Detección y Evaluación de Caries. (ICDAS-II). Resultados: La prevalencia de caries se estimó en 83%, el 15% ha perdido un diente debido a caries dental, el 61% tiene al menos un diente obturado, el 36% tiene al menos un diente obturado y con caries. Las lesiones de caries más frecuentes fueron los códigos 2-Inactivo (46,7%) y el código 1-Inactivo (23,8%). CPOD indicó un índice medio utilizando códigos ICDAS-II 1-6>0 de 7,89. Usando ICDAS-II 3-6>0 como umbral, el índice disminuye a 3,94. Finalmente, los primeros molares permanentes inferiores y superiores resultaron ser los dientes más afectados. Conclusiones: La experiencia de la caries dental representa una carga de salud pública significativa en los jóvenes, que requiere un mejor acceso a la atención médica dental pública.

Current Status and the Future of Occupational Safety and Health Legislation in Low- and Middle-Income Countries

This article addresses three key issues. First, the commonalities, differences, strengths, and limitations of existing occupational safety and health (OSH) legislation of low- and middle-income countries were determined. Second, required revisions were identified and discussed to strengthen the laws in accordance with the best international practice. Finally, proposals for additional OSH laws and interventions were suggested. A literature search of OSH laws of 10 selected low- and middle-income countries was carried out. The laws were subjected to uniform review criteria. Although the agricultural sector employs more than 70% of the population, most of the reviewed countries lack OSH legislation on the sector. Existing OSH laws are gender insensitive, fragmented among various government departments, insufficient, outdated, and nondeterrent to perpetrators and lack incentives for compliance. Conclusively, the legal frameworks require reformation and harmonization for the collective benefit to employees, employers, and regulatory authorities. New OSH legislation for the agricultural sector is required.