ABSTRACT
OBJECTIVES: Children's access to dental general anesthesia (DGA) is limited, with highly variable wait times. Access factors occur at the levels of facility, dental provider, and anesthesia provider. It is unknown if these factors also influence utilization of dental surgery. We characterized patterns in DGA utilization by system, provider, population, and individual disease levels to explain variation. METHODS: We conducted a cross-sectional analysis of Medicaid-enrolled children (≤9 y) who received DGA in Massachusetts, Maryland, Texas, Connecticut, Washington, Illinois, and Florida from 2011 to 2012. DGA events were characterized by the place of service, measures of disease burden, average reimbursements for dental provider and anesthesia provider, and average total expenditures. RESULTS: A total of 10,149,793 children met study eligibility criteria. States with similar patterns of caries-related visits, such as Illinois (16% of Medicaid enrollees had a caries-related claim) and Washington (22%), had different DGA rates (1% and 17%, respectively). Reimbursement rates for dental providers, DGA services, and nonhospital places of services did not consistently align in states with higher DGA rates. Surgical extraction rates, as a proxy for the most severe disease, exceeded 75% in Maryland, which had the lowest DGA rate (0.3%). CONCLUSIONS: Variation in DGA rates across states was not explained by reimbursements rates (provider, DGA services, place of service) or population or individual level of caries burden. Efforts to evaluate and alter utilization of DGA should consider factors such as dental and anesthesia provider capacity, health facility capacity (hospital vs. ambulatory surgery center vs. office), and population- and individual-level disease burden. Our negative findings suggest the presence of other social determinants of oral health that influence utilization of services (e.g., race/ethnicity, language preference, immigration status, policy and budget goals), which should be explored. Our findings also raise the specter that variation in surgical rates may represent instances of unmet needs or overtreatment. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by clinicians and policy makers as they address policy and clinical interventions to influence children with severe caries. Interventions to change utilization of surgical services on a population level may need to include state-specific factors that extend beyond reimbursement, disease burden, anesthesia provider type, or facility type.
Subject(s)
Anesthesia, General , Medicaid , Child , Connecticut , Cross-Sectional Studies , Florida , Humans , Illinois , Maryland , Massachusetts , Texas , United States , WashingtonABSTRACT
Las reacciones adversas a medicamentos (RAM) se encuentranen forma habitual en la práctica clínica, representando hasta el2% del total de consultas dermatológicas. Dentro de las RAM reportadas,hasta el 30% corresponderían a RAM mucocutáneas(RAM- MC). El Programa de Farmacovigilancia se implementó enChile el año 1995. Desde el año 2011 se encuentra normado,siendo de carácter obligatorio la notificación al Subdepartamentode Farmacovigilancia del Instituto de Salud Pública (ISP). El objetivode este trabajo es describir retrospectivamente las notificacionesde sospechas de RAM- MC realizadas al ISP durante el año2013. Se obtuvo un total de 113 notificaciones, la mayoría de ellasen mujeres (59,3%). Las RAM- MC más frecuentemente notificadasfueron erupción eritematosa (47,8%), hiperpigmentación dela piel (23,9%), síndrome de Stevens Johnson (8,8%) y anafilaxia(8,8%). Los fármacos involucrados con mayor frecuencia fueronlos quimioterapéuticos (28,3%), antibióticos (19,5%), otros (15%)y anticonvulsivantes (8%).
Adverse drug reactions (ADRs) are seen routinely in clinicalpractice, representing up to 2% of dermatology consultations.Among the reported ADRS, up to 30% correspond to mucocutaneousADRS-MC. The Pharmacovigilance Programmewas implemented in Chile in 1995. Since 2011 it notificationis mandatory to the Subdepartment of Pharmacovigilance ofthe Public Health Institute (ISP). The aim of this study is todescribe retrospectively the reports of suspected ADRS-MCmade to the ISP during 2013. A total of 113 notifications wereobtained, most of them in women (59.3%). The RAM-MC morefrequently reported were erythematous rash (47.8%), skin hyperpigmentation(23.9%), Stevens Johnson syndrome (8.8%)and anaphylaxis (8.8%).The drugs most often involved were chemotherapeutics(28.3%), antibiotics (19.5%), others (15%) and anticonvulsants(8%).
Subject(s)
Male , Female , Humans , Adolescent , Adult , Infant , Child, Preschool , Child , Young Adult , Middle Aged , Aged , Aged, 80 and over , Drug-Related Side Effects and Adverse Reactions/epidemiology , Drug Eruptions/epidemiology , Skin Diseases/epidemiology , Disease Notification , Retrospective Studies , Age and Sex Distribution , Pharmacovigilance , Chile/epidemiologyABSTRACT
INTRODUCCIÓN: El Carcinoma basocelular (CBC) es la neoplasia más frecuente en la población humana. Se ha observado un aumento de su incidencia en todos los países, incluyendo a Chile. CBC es un tumor heterogéneo clínica e histológicamente. Entre sus factores de riesgo, destaca la exposición a la radiación ultravioleta. En Chile, en la última década se han realizado numerosas campañas de prevención del cáncer cutáneo y de detección precoz de esta neoplasia. El propósito de este trabajo es comparar el comportamiento del CBC en relación a parámetros demográficos, clínicos e histológicos en dos periodos de tiempo, 1995-1999 y 2005-2009 en la población de cuatro hospitales públicos de Santiago de Chile...
INTRODUCTION: Basal cell carcinoma (BCC) is the most common malignancy in the human population. There has been an increased incidence in all countries, including Chile. BCC is a clinically and histologically heterogeneous tumor. The main risk factor of BCC is the ultraviolet radiation exposure. In Chile, in the last decade, there have been numerous campaigns of skin cancer prevention and early detection of this neoplasm. The purpose of this paper is to compare the behavior of BCC in relation to demographic, clinical and histological parameters in two periods, 1995-1999 and 2005-2009 in the population of four hospitals in Santiago de Chile
Subject(s)
Humans , Male , Skin Neoplasms/pathology , Skin Neoplasms/epidemiology , Carcinoma, Basal Cell/pathology , Carcinoma, Basal Cell/epidemiology , Sex Factors , Age Factors , Age and Sex Distribution , Neoplasm InvasivenessABSTRACT
Durante las últimas decadas se han desarrollado múltiples técnicas para el borrado de tatuajes. Los láseres Q-switched Nd:YAG han demostrado ser los más eficaces y con el menor riesgo de efectos adversos por su habilidad de fragmentar selectivamente el pigmento (fototermólisis selectiva). Objetivo: Evaluar la efectividad del tratamiento para el borrado de tatuajes amateur, profesionales, cosméticos y traumáticos con un equipo láser Q-switched Nd:YAG. Materiales y métodos: Se estudiaron cien pacientes con 140 tatuajes entre marzo de 2008 y enero del 2011. Los pacientes fueron tratados mediante un láser Q-switched (QS) Nd:YAG, capaz de producir múltiples longitudes de onda. Los resultados fueron comparados mediante la prueba no paramétrica de Mann Whitney (p <0,05). Resultados: Trece tatuajes (9,2 por ciento) obtuvieron una respuesta completa de aclaramiento y se consideró terminado su tratamiento. Veinticinco tatuajes (17,8 por ciento) lograron una excelente respuesta. Treinta y dos (23 por ciento) tatuajes lograron una respuesta buena. Treinta y dos (22,8 por ciento) tatuajes obtuvieron una respuesta razonable y 38 (27,1 por ciento) obtuvieron una respuesta pobre. Conclusiones: el grupo de pacientes que más se beneficia del tratamiento láser es el amateur negro-azul.
Several techniques for removing tattoos have been developed in recent decades. Q-switched lasers have demonstrated to be most effective with the least risk of adverse effects for its ability to selectively break tattoo pigments into smaller fragments (selective photothermolysis). Objective: Evaluate the effectiveness of treatment for erasing amateur, professional, cosmetic and traumatic tattoos using a Q-switched (QS) Nd: YAG laser. Materials and methods: From March 2008 through January 2011 one hundred patients were studied, altogether they had one hundred and forty tattoos. The patients were treated with a Q-switched Nd: YAG laser device capable of producing multiple wavelengths. The results were compared using the nonparametric Mann Whitney test (p <0.05). Results: 13 tattoos (9.2 percent) had a complete clearance response and the patients were considered to have completed the treatment. Twenty five (17.8 percent) tattoos achieved ann excellent response. Thirty two (23 percent) were considered as good response. Thirty two (23 percent) tattoos accomplished a reasonable response and 38 (27 percent) were considered to achieve a poor response. Conclusions: The patients who benefitted the most from laser treatments are the amateur blue black group.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Young Adult , Middle Aged , Ablation Techniques , Laser Therapy , Lasers, Solid-State , Tattooing , ChileABSTRACT
Existe una gran variedad de lesiones o condiciones que producen un cambio de coloración o discromía en la mucosa oral. Entre éstas se encuentran las pigmentaciones que pueden ser de origen exógeno o endógeno y lesiones tumorales. Los pigmentos endógenos incluyen la melanina, hemoglobina, hemosiderina y caroteno. En cambio, las pigmentaciones exógenas se pueden provocar por tatuajes, intoxicación por metales pesados y tinciones.
There are a variety of injuries or conditions that produce a color change or dyschromia in oral mucosa. These dyschromias include pigmentation, that may be of endogenous or exogenous origin and malignant tumor. Endogenous pigments include melanin, hemoglobin, hemosiderin, and carotene. Instead exogenous pigmentation can result from tattoos, heavy metals and stains.
Subject(s)
Humans , Melanoma , Mouth Neoplasms , Mouth Mucosa/pathology , Pigmentation Disorders , Diagnosis, DifferentialSubject(s)
Humans , Adult , Female , Ichthyosis/pathology , Ichthyosis/therapy , Face , Neck , Radio Waves/therapeutic useABSTRACT
Adverse drug reactions (ADRs) are responsible for up to 10percent of hospital admissions worldwide; within them, that mucocutaneous reactions are the most common represented 30percent of the total. The aim of this study was to analyze 119 reports of ADRs recorded in the Pharmacy Department of University of Chile Clinical Hospital in the period 2004-2010 by gender, age, most frequent clinical presentations, drugs and health personnel linked to the notification. In addition, we tried to quantify the relative importance of mucocutaneous reactions in the total of reported ADRs. ADRs were more common in women (56.3percent). The average age was 52.84 years + / - 7.77, 52.07 + / - 10.6 for women and 53.84 + / - 13.43 for men without significant differences (p = 0.85). According to the clinical presentation, mucocutaneous reactions were the most frequent (31.1percent) followed by hematological (25.2percent). The drugs involved were chemotherapy (68.9percent), antibiotics (5.9percent) and NSAIDs, nonsteroidal anti-inflammatory drugs, (4.2percent). In health personnel linked to the notification, we found the association medical / pharmaceutical chemist was the most frequent (40.3percent), followed by a pharmaceutical chemist (33.6percent). In mucocutaneous ADRs we observed a mean age of 54.65 + / - 9.19 years and female predominance (62.2percent). According to the clinical dermatology, we observed a prevalence of skin rash (35.1percent), mucositis (21.6percent), facial erythema (16.2percent) and pruritus (16.2percent). The drugs involved were chemotherapy (78.4percent), antibiotics (8percent), antiretroviral therapy (5percent) and opioids (5percent). Finally, we found that according to time of onset, delayed reactions were the most frequent (43.2percent).
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Drug Eruptions/epidemiology , Pharmaceutical Preparations/adverse effects , Adverse Drug Reaction Reporting Systems/statistics & numerical data , Chile/epidemiologyABSTRACT
Introducción: Las Reacciones de Hipersensibilidad Medicomentosa (RHM) son un motivo de consulta muy común en Dermatología. Con el objetivo de implementar la farmacovigilancia dentro de la Sociedad Chilena de Dermatología (SOCHIDERM) se creó un Protocolo paro la notificación de RHM de tipo muco-cutáneo. Objetivo: Validar una propuesta de Protocolo de Farmacovigilancia de RHM de tipo mucocutáneo de la SOCHIDERM paro el uso de dermatólogos y médicos de nuestro país. Resultados: En nuestro estudio, la frecuencia de RHM fue 0,3% -0,5% del total de consultas ambulatorias y 5,2% 17,2% de las interconsultas a Dermatología. Los patrones más frecuentes fueron el urticarial, morbiliforme y la reacción medicamentosa fija. Los fármacos imputados con mayor frecuencia fueron los analgésicos/antiinflamatorios, los fármacos con acción en el sistema nervioso central, los antibióticos y los antihipertensivos. Discusión: Es importante tener un Protocolo de Farmacovigilancia. Esto nos permitirá obtener datos a nivel nacional. El desafío a corto plazo paro farmacovigilancia en SOCHIDERM es lograr notificar las RHM de tipo muco-cutáneo graves o con compromiso vital, que sean atendidas por dermatólogos en nuestro país, a través del Protocolo de Farmacovigilancia SOCHIDERM.
Introduction: Drug Hypersensitivity Reactions (DHR) are a common cause of consultation in dermatology. In order to implement fharmacovigilance in the Chilean Society of Dermatology (SOCHIDERM), we created a protocol for the notification of mucocutaneous DHR. Objective: To validate a SOCHIDERM mucocutaneous DHR pharmacovigilance protocol for dermatologists and physicians in our country. Results: In our study. DHR accounted for 0.3-0.5 % of all outpatient consultations, and 5,2-17,2% of interconsultations in dermatology. The most frequent patterns were urticarial, morbilliform and fixed drug reaction. The drugs most frequently involved were analgesics/anti-inflammatory drugs with action in the central nervous system, antibiotics and antihypertensives. Discussion: It is important to have a Pharmacovigilance Protocol since it will allow to obtain nationwide data. The short-term challenge for the SOCHIDERM pharmacovigilance is to notify serious or life-threatening mucocutaneous DHR that have been seen by dermatologists in our country, through this Protocol.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Drug Hypersensitivity/epidemiology , Pharmaceutical Preparations/adverse effects , Adverse Drug Reaction Reporting Systems/organization & administration , Age and Sex Distribution , Clinical Protocols , Chile/epidemiology , Drug Eruptions/epidemiology , Hospitals/statistics & numerical data , Ambulatory Care Facilities/statistics & numerical data , Multicenter Studies as Topic , Disease Notification , Retrospective StudiesABSTRACT
Endothelium controls vascular smooth muscle tone by secreting relaxing and contracting factors. There is a constant release of endothelium derived relaxing factors, mainly nitric oxide, a potent vasodilator, inhibitor of platelet aggregation, monocyte adhesion and smooth muscle proliferation. In addition, the endothelium may increase the release of NO in response to humoral stimulation by vasoactive substances such as acetylcholine, bradykinin or substance P. Although the endothelium releases a number of products, no single blood test has yet proved useful to determine normal endothelial function or as early abnormalities. The most useful test of endothelial function relies on the measurement of endothelium-dependent dilatation in response to pharmacological or physiologic stimuli. The alteration of this response is known as endothelial dysfunction and has been observed in a variety of circumstances related to cardiovascular risk. This review summarizes the evidence that sustains this association and emphasizes the clinical utility of assessing endothelial function presenting two clinical cases of hypercholesterolemia in which a high-resolution vascular ultrasound in the brachial artery was used.
Subject(s)
Cardiovascular Diseases/physiopathology , Endothelium, Vascular/physiopathology , Adult , Brachial Artery/physiopathology , Cardiovascular Diseases/etiology , Child, Preschool , Endothelium, Vascular/physiology , Female , Humans , Male , Muscle Relaxation/physiology , Muscle, Smooth, Vascular/physiology , Risk Factors , Vasodilation/physiologyABSTRACT
El status epiléptico parcial complejo en el niño es un cuadro poco descrito en la literatura médica. En un período de 4 años (1984-1987) hemos observado 6 pacientes menores de 15 años con este diagnóstico. Se describen las características clínicas, electroencefalográficas, tratamiento y evolución de estos casos. Se enfatiza la importancia de recordar este diagnóstico en cuadros que comprometen la conciencia o en casos de conducta psicótica, en los cuales el examen neurológico y electroencefalograma son elementos primordiales para el diagnóstico diferencial. Evidencias clínicas y experimentales en cuanto a secuelas, hacen aconsejable una actitud más activa en el diagnóstico y tratamiento del status epiléptico parcial complejo
Subject(s)
Child , Adolescent , Humans , Male , Female , Status Epilepticus/diagnosis , Carbamazepine/therapeutic use , Diagnosis, Differential , Electroencephalography , Status Epilepticus/drug therapyABSTRACT
Se describe el estudio efectuado en 86 pacientes con trichomoniasis vaginal en las cuales es efectuó vacunación con Solcotrichovac. Las pacientes fueron controladas por un período superior a un año en el 90,7% de los casos. Los resultados muestran desaparición de las trichomonas vaginales en el 87% de los casos, así como una desminución de la sintomatología, y mejoría del grado de pureza vaginal. Se analizan los factores que intervienen en la patogenia de la trichomoniasis y se describe el mecanismos de acción de esta vacuna
