Intranasal sufentanil/midazolam versus ketamine/midazolam for analgesia/sedation in the pediatric population prior to undergoing multiple dental extractions under general anesthesia: a prospective, double-blind, randomized comparison.

This article details a double-blind, randomized study evaluating the efficacy and safety of intranasal sufentanil and intranasal midazolam (S/M) when compared with intranasal ketamine and intranasal midazolam (K/M) for sedation and analgesia in pediatric patients undergoing dental surgery. Fifty healthy ASA status 1 children aged 5-7 years, weighing 15-20 kg, and having 6 or more teeth extracted, were randomly allocated to 2 groups of 25 patients each (n = 50). In the S/M group, 25 children received intranasal sufentanil 20 microg, and intranasal midazolam 0.3 mg/kg 20 minutes before the induction of anesthesia. In the K/M group, 25 children received intranasal ketamine 5 mg/kg and intranasal midazolam 0.3 mg/kg 20 minutes before the induction of anesthesia. Sevoflurane in nitrous oxide and oxygen was used for induction and maintenance of anesthesia. This study demonstrated the safety and efficacy of both methods with ease of administration, combined with a rapid onset of action. Both groups were equally sedated. A smooth mask induction of anesthesia was experienced in the majority of children. Effective postoperative analgesia for multiple dental extractions was provided. The intranasal administration of drugs for sedation and analgesia has some promising features in preschool children undergoing multiple dental extractions.

An evaluation of analgesic efficacy and clinical acceptability of intravenous tramadol as an adjunct to propofol sedation for third molar surgery.

This article details a double-blind, randomized, placebo-controlled pilot study evaluating the analgesic efficacy and clinical acceptability of intravenous tramadol in patients undergoing surgical removal of an impacted third molar tooth under local anesthesia and intravenous sedation with propofol. Forty-five ASA status 1 dental outpatients were randomly allocated to 2 groups of 22 (group A) and 23 (group B) patients each (n = 45). Group A (T/P) received intravenous tramadol 1.5 mg/kg injected over 2 minutes, followed by a bolus dose of intravenous propofol 0.4 mg/ kg. Maintenance consisted of a continuous infusion of propofol 3 mg/kg/h, with an additional bolus dose of 0.4 mg/kg intravenously 2-3 minutes prior to the infiltration of the local anesthetic solution. Group B (P/P) patients received no tramadol but instead a saline placebo solution and an identical amount of propofol. Overall, in this study, postoperative pain was much better controlled in the group receiving tramadol 1.5 mg/kg intravenously despite there being no significant difference in the dose of propofol administered in both groups. Intravenous tramadol, when given with propofol, did not affect the cardiovascular, respiratory, and sedative effects of propofol. Following tramadol, despite being an opioid, no nausea and vomiting were reported in the early postoperative period, indicating the value of using tramadol with propofol. Thus, this pilot study demonstrated the potential use of intravenous tramadol with propofol in day-case dento-alveolar surgery.

Drinking water in South Africa: implications for fluoride supplementation.

During the extremely heavy rainfall period in the first half of 2000 in certain summer rainfall regions of South Africa a similar investigation as in 1983-1984/1985 was done but on a smaller scale, and compared to the previous results. A greater reduction (P < 0.05) of the fluoride levels in the drinking water than previously recorded has recently been demonstrated, thus strongly accentuating the effect of heavy rains. Presently, for fluoride prescription we recommend that the prescriber should decide whether it is a dry or wet period for his area and then read the fluoride content for that area, from the higher or lower end of the water fluoride content range from the tables published in 1988, 1991 or 1994. When in doubt the higher fluoride level should be used as a measure of safety against overprescribing. If only one value exists it should be used until further notification. An extended study is in process to set a single table for South Africa.

Private medical schemes: dental claims during 1989 and 1990.

In this investigation, claim patterns of members of 6 private medical aid schemes were studied. The number of members per scheme, the maximum benefits per member, the number of members with no claims, the age distribution of members with no dental claims and the percentage of total paid out per discipline are shown. The percentage of principal members who made no dental claims from these 6 medical schemes ranged between 53.6 - 75.5 per cent in 1989 and between 67.1 - 85 per cent in 1990. In this article we seek possible explanations for these unexpected findings.

Effectiveness of two school-based caries preventive programmes.

Although the efficacy of school-based preventive programmes is well established, their effectiveness under conditions prevailing in the community require further exploration. A longitudinal study was conducted to assess the community effectiveness of two school-based caries preventive programmes. A group of 150 primary school pupils, 10-15 years old were randomly selected from each of three primary schools (Dagbreek, Vergesig, De Villiers) in the Boland town of Robertson. The sample comprised 75 10-12 year-olds and 25 in each of the 13, 14 and 15 year age groups. The 75 (10-12 year-olds) constituted the experimental cohort, which was to be followed up over a period of 3 years and compared to the 13-15 year-olds, the control or baseline cohort. The experimental cohort in Vergesig was exposed to a daily toothbrushing programme with a fluoride dentifrice, the Dagbreek children were exposed to the same regimen plus a weekly 0.2 per cent fluoride rinse and the De Villiers cohort acted as a control group for contamination and co-intervention. The DMFT index (WHO, 1987) was used as a caries measure. Dagbreek showed a reduction of 0.96 DMFT (14.2 per cent) and Vergesig of 1.85 DMFT (24.5 per cent). The difference is attributed to a higher baseline DMFT at Vergesig. The weekly fluoride rinse did not confer any additional benefit. Although the caries reduction was lower than that generally found in clinical trials, the two intervention programmes were cost-effective.

Youth attending Cape Peninsula day hospitals. Sexual behaviour and missed opportunities for contraception counselling.

Questionnaires were completed by a sample of youth (aged 15-24 years) attending day hospitals in the Cape Peninsula. Of the total sample of 225, 73.3% indicated that they had experienced sexual intercourse; of these, 27.3% had had 2 or more partners in the previous year, and on their last coital episode 91.0% had known their partner for more than 7 days and 52.8% had used some form of contraception. The criteria of a strict definition of missed opportunity for contraception intervention were fulfilled by 7.6% of the total sample, while 43.6% of those who had experienced sexual intercourse and 43.9% of those who had not did not receive contraception intervention but would have liked to have done so. Those who had had more than one partner in the previous year were more likely to have satisfied the strict definition of missed opportunity, while of those who had not had sexual intercourse, younger respondents and students were more likely not to have received contraception intervention despite wanting such intervention. It is concluded that all youth attending day hospitals should routinely be offered contraception counselling and that the issue of sexually transmitted diseases should be addressed simultaneously.

Levels of care needed by medical inpatients in a teaching hospital.

Medical inpatients in a teaching hospital ward were studied daily for 2 weeks. The registrar responsible for each patient decided each day what level of care would be most appropriate, and what elements of care were needed for the patient on that day. From their documented assessments on 308 of 458 recorded days registrars considered that 54.5% of patient-days (168 of 308 days) could appropriately have been spent at a lower of level of care than the academic hospital, had such beds been available. The assessments of the registrars in the study ward were similar to assessments of all medical registrars in all other general medical wards in the hospital. Professional staff in the study ward recorded task duration each time any work was done for a patient. Nurses spent 23.9% more time per patient on those whom registrars thought could be treated at lower levels. Doctors spent 15.0% more time per patient on those whose presence in the hospital registrars considered appropriate. Health care could be provided more economically if more lower-level facilities were available. This could perhaps also be achieved with reorganisation of care within a teaching hospital but steps would have to be taken to ensure maintenance of continuity of care and staff-patient relationships.

Oral health status and treatment needs of black college students at Khayelitsha.

Descriptive information on the oral health status and treatment needs of black students at a teacher training college in Khayelitsha was collected to facilitate the planning of appropriate preventive and therapeutic programmes. A random sample of 96 subjects was drawn from the college population. The average age of the group was 27.3 years; 83.3 per cent were females and 90.6 per cent had experienced caries. The mean DMFT was high (11.14), the mean score for males was almost half that for females (p = 0.0247). 54.2 per cent needed treatment for caries such as fillings (47.9 per cent) and extractions (25.0 per cent). No students had shallow pocketing and deep pockets were recorded in only 3.4 per cent. However more than 4 segments on average showed signs of bleeding or higher scores for periodontal disease. A significant difference existed between the sexes for the presence of calculus (p less than 0.005). Oral hygiene instruction and prophylaxis were needed by the majority of students namely 92.1 per cent and 70.8 per cent respectively. The high number of students with bleeding and calculus indicates that an intensive program of oral health education is required by this group.

Missed opportunities for measles immunisation in selected western Cape hospitals.

Measles is still a major cause of childhood mortality and morbidity in South Africa. The World Health Organisation (WHO) has recently recommended that greater attention be paid to opportunities for immunisation in the curative sector. This study quantified the extent of missed opportunities for measles immunisation in children attending primary, secondary and tertiary level curative hospitals in the western Cape. Exit interviews of 1,068 carers of children aged between 6 and 59 months inclusive showed that 2.4-40.7% of carers had been requested to produce a Road-to-Health card, and that 4.8-43.1% of carers had a card available. The proportion of children with documented evidence of measles immunisation available ranged from 4.8% to 40.0% between facilities. The study demonstrated that a considerable number of potential opportunities to immunise children against measles are currently being missed in children attending hospitals and day hospitals in the western Cape. The study documents the effect of a fragmented approach to health care, and indicates a need for rapid integration of preventive and curative components of health care into a metropolitan-based primary health care service.

Evaluation of a peri-urban community health worker project in the western Cape.

The South African Christian Leadership Assembly (SACLA) Health Project is a non-governmental organisation that runs a community health worker (CHW) programme in 4 peri-urban townships of Cape Town. A cross-sectional descriptive community survey was conducted in April 1990 to evaluate coverage and health education on oral rehydration solution (ORS) and to plan future preventive, promotive and development programmes. Research concepts and methods were made accessible to the CHWs through a training process designed to facilitate participation in every stage of the research. A multi-stage cluster sampling scheme was used, and the CHWs interviewed 822 residents. Coverage indicators showed that over 80% of all respondents had previously known about or consulted the CHW. The most common community problems related to water, filth and refuse, toilets, housing, unemployment and lack of community facilities. The most common health problems were generalised aches and pains, chest problems, skin problems, worms, and diarrhoea. An index developed to measure knowledge of ORS showed very few respondents had 'complete knowledge'. The community's expectations of the CHW included health education, attending to sanitation problems, providing a clean environment, organising community facilities, and helping with employment.

Sunscreen use and environmental awareness among beach-goers in Cape Town, South Africa.

BACKGROUND: The potential impact on health of increased exposure to sunlight has caused increased concern in recent years. In South Africa little is known of peoples' sunbathing habits, use of sunscreens, and factors influencing these practices. AIMS: The aims of the study were to determine sunscreen usage among the South African beach-going public, to determine sunbathing practices of beach-goers and to determine factors influencing peoples' sunbathing habits. METHODS: Cluster sampling at 3 popular Cape Peninsula beaches was used to select a sample of 231 white adult beach-goers. Questionnaires were administered to obtain information on the use of sunscreens, frequency of use, peoples' sunbathing activities, their susceptibility to sunburn and ability to tan, whether there was a history of severe sunburn, and knowledge and awareness of environmental issues. Information was also obtained on personal characteristics and sociodemographic factors. RESULTS: 50% of respondents were using a sunscreen on the day of the interview. More women than men, and people over 25 years of age relative to younger persons, made frequent use of sunscreen lotions. A sun protection factor (SPF) of 15 or more was being used by 5% of the population. With respect to peoples' knowledge and awareness of the environment, 90% of the population cited skin cancer as a potential consequence of over-exposure to sunlight, although, in general, knowledge of environmental issues was poor. CONCLUSIONS: A major effort is needed to improve attitudes and practices in South Africa with respect to sun-tanning activities.

Measles vaccination coverage and its determinants in a rapidly growing peri-urban area.

A study was undertaken to ascertain the vaccination coverage of children aged 12-23 months living in Khayelitsha, a peri-urban township outside Cape Town, and to identify factors associated with measles vaccination coverage. A stratified proportional cluster sampling technique was used to select 46 clusters of 10 children each. Three strata were defined according to area of residence. The vaccination status of each child was determined from the preschool card. Usable information was obtained for 432 children; in 75.4% of cases the respondent was the child's mother, and 69.4% of children possessed a preschool card. Measles vaccination coverage was 63.5% (95% confidence interval 58-67%). Three factors had a significant association with incomplete measles vaccination: less than 6 months' residence in the area (odds ratio (OR) 3.1), having been born outside Cape Town (OR 2.5), and home delivery (OR 2.0). The mothers' level of education and children's age were not associated with measles vaccination status. Children in the New Shanty area were identified as a high-risk group. Carers of children in the New Shanty area were the least likely to know of the need for measles vaccination and to be visited by a community health worker. Greater efforts are required to identify high-risk children and areas.