Complex social gradient in life expectancy in Costa Rica: an ecological study with 24-Million person-years follow-up / Complejo gradiente socioeconómico en esperanza de vida en Costa Rica: un estudio ecológico con seguimiento de 24 millones de personas-año

ABSTRACT: The knowledge of Costa Rica's situation regarding the social gradient in mortality is still incomplete. National Electoral Rolls, which included all adult Costa Rican citizens were used. The event was death between 2010 and 2018. The exhaustive final sample included 2,747,616 people for 23,985,602 person-years of follow-up. An ecological study at the electoral district level was performed. A negative social gradient was observed in men and in women, in particular in urban area. A protective effect of rural areas compared to urban areas was revealed in men, but not in women. As a result, in men, the poorest districts of mixed/rural areas had similar life expectancy than the richest districts in urban areas. These results partially contradicted the international literature on socioeconomic inequalities. It demonstrates the importance of studying contexts other than high-income countries to better understand the social inequalities in health worldwide.

RESUMEN: El conocimiento sobre la distribución del gradiente social de la mortalidad en Costa Rica aún no ha sido totalmente comprendido y nuevos estudios pueden confirmar o refutar lo que anteriormente se ha observado. Se utilizaron las listas electorales nacionales, que incluían a todos los ciudadanos costarricenses adultos. El evento fue la muerte entre 2010 y 2018. Siendo la muestra exhaustiva final de 2.747.616 personas para 23.985.602 personas-año de seguimiento. Se realizó un estudio ecológico a nivel de distrito electoral, para caracterizar la situación socioeconómica de cada uno. Se observó un gradiente social negativo en hombres y mujeres, en particular en el área urbana. Se observó un efecto protector de las áreas rurales en comparación con las áreas urbanas en los hombres, pero no en las mujeres. Como resultado, en los hombres, los distritos más pobres de las áreas mixtas/rurales tenían una esperanza de vida similar a la de los distritos más ricos de las áreas urbanas. Estos resultados contradicen parcialmente la literatura internacional sobre las inequidades socioeconómicas en mortalidad. Demuestra la importancia de estudiar contextos distintos a los de los países de ingresos altos para comprender mejor las desigualdades sociales en salud en todo el mundo.

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.

A broad-spectrum beta-lactam-sparing stewardship program in a middle-income country public hospital: antibiotic use and expenditure outcomes and antimicrobial susceptibility profiles

ABSTRACT Background: Antimicrobial stewardship programs are an efficient way to reduce inappropriate use of antimicrobials and costs; however, supporting data are scarce in middle-income countries. The aim of this study was to evaluate antibiotic use, bacterial susceptibility profiles, and the economic impact following implementation of a broad-spectrum beta-lactam-sparing antimicrobial stewardship program. Methods: An interrupted time-series analysis was performed to evaluate antibiotic use and expenditure over a 24-month period (12 months before the antimicrobial stewardship program and in the 12 months after implementation of the antimicrobial stewardship program). Antibiotics were classified into one of two groups: beta-lactam antibiotics and beta-lactam-sparing antibiotics. We also compared the antimicrobial susceptibility profiles of key pathogens in each period. Results: Beta-lactam antibiotics use decreased by 43.04 days of therapy/1000 patient-days (p = 0.04) immediately following antimicrobial stewardship program implementation, whereas beta-lacta-sparing antibiotics use increased during the intervention period (slope change 6.17 days of therapy/1000 patient-days, p < 0.001). Expenditure decreased by $2089.99 (p < 0.001) immediately after intervention and was maintained at this level over the intervention period ($−38.45; p = 0.24). We also observed that a greater proportion of pathogens were susceptible to cephalosporins and aminoglycosides after the antimicrobial stewardship program. Conclusions: The antimicrobial stewardship program significantly reduced the use of broad-spectrum beta-lactam-antibiotics associated with a decrease in expenditure and maintenance of the susceptibility profile in Gram-negative bacteria.

Surgical practices during cholecystectomy in Algeria: results of a survey

Background: The cholecystectomy is one of the most practiced surgeries; the learned societies published guidelines to improve surgical practices. Guidelines are sometimes not followed, either by negligence, by lack of means or adequate professional environment. So, to know the real practices of surgeons, a survey was conducted.Methods: An anonymous national survey involving all practicing Algerian surgeons was conducted. At the end of the survey, all data were captured and processed using the SPSS v20 software; χ2 tests were used to compare different groups of surgeons.Results: Only 122 responses were retained, twenty-two percent of surgeons perform open cholecystectomy. No surgeon performed routinely cholangiography, 43% extracted the gallbladder using extraction disposal, 18% performed systematic abdominal cavity drainage, all surgeons send the gallbladder to histology for examination and postoperative antibiotic prophylaxis was routinely prescribed by 69% of surgeons. The average postoperative hospitalisation recommended by surgeons was 1.65 days (0-5) days. The experience of the surgeon or his position was associated with lower rates of systematic prescription of antibiotic prophylaxis, and with a lower duration of postoperative hospitalisation.Conclusions: We recommend publication of guidelines of good practices adapted to the socio-professional and economic context of countries.

Patterns of failure for early-stage glottic carcinoma: 10 years' experience in conformal radiotherapy era

Purpose: Larynx cancer is the most common head-and-neck cancer in Turkey. Vocal cords are involved nearly 70%–80% of laryngeal carcinomas. We aim to present our 10 years' experience and failure patterns of the patients with T1 and T2 glottic laryngeal carcinoma by same manner, technique, doses, and physician in conformal radiotherapy (RT) era. Methods: Between January 2005 and December 2015, a total of 143 patients treated with definitive RT for early-stage glottis laryngeal cancer were selected. The total dose was 65.25 Gy in 29 fractions. Results: The median follow-up time was 64 (range: 12–150) months. All of the patients had a complete clinical response to the treatment. A 5-year local control (LC) rates were 84.5%, 91.8%, 74%, and 56% for overall, T1a, T1b, and T2, respectively. Ultimate LC rates (after salvage treatment) for 5 years were 90%, 95%, 92%, and 75% for overall, T1a, T1b, and T2, respectively. Regional neck control for the whole group was 92% for 5 years. After the initial RT, a total of 22 (15.4%) patients had disease recurrence at any site of the neck or larynx. Median time to disease recurrence was 59.5 months (range: 5–150). Conclusion: This study represents a large and long-term analysis of early-stage glottic carcinoma treated by same manner, technique, doses, and physician in conformal RT era. Definitive RT provides a high LC rate, tolerable toxicity, and favorable voice quality. Extension beyond the vocal cords and T2 stage are the most important unfavorable prognostic factors regarding LC

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.