Brighter Smiles Africa--translation of a Canadian community-based health-promoting school program to Uganda.

PROJECT GOAL: To adapt a successful Canadian health-promoting school initiative to a Ugandan context through international partnership. RATIONALE: Rural children face many health challenges worldwide; health professionals in training understand these better through community-based learning. Aboriginal leaders in a Canadian First-Nations community identified poor oral health as a child health issue with major long-term societal impact and intervened successfully with university partners through a school-based program called "Brighter Smiles". Makerere University, Kampala, Uganda (MUK) sought to implement this delivery model for both the benefit of communities and the dental students. KEY STEPS/HURDLES ADDRESSED: MUK identified rural communities where hospitals could provide dental students with community-based learning and recruited four local schools. A joint Ugandan and Canadian team of both trainees and faculty planned the program, obtained ethics consent and baseline data, initiated the Brighter Smiles intervention model (daily at-school tooth-brushing; in-class education), and recruited a cohort to receive additional bi-annual topical fluoride. Hurdles included: challenging international communication and planning due to inconsistent internet connections; discrepancies between Canadian and developing world concepts of research ethics and informed consent; complex dynamics for community engagement and steep learning curve for accurate data collection; an itinerant population at one school; and difficulties coordinating Canadian and Ugandan university schedules. ACCOMPLISHMENTS: Four health-promoting schools were established; teachers, children, and families were engaged in the initiative; community-based learning was adopted for the university students; quarterly team education/evaluation/service delivery visits to schools were initiated; oral health improved, and new knowledge and practices were evident; an effective international partnership was formed providing global health education, research and health care delivery.

3-year results of a collaborative school-based oral health program in a remote First Nations community.

INTRODUCTION: Surveys of dental health among Aboriginal children in Canada, using scales such as the Decayed, Missing, and Filled Teeth (DMFT) score, indicate that Aboriginal children have 2 to 3 times poorer oral health compared with other populations. A remote First Nations community approached requested assistance in addressing the health of their children. The objective was to work with the community to improve oral health and knowledge among school children. The hypothesis formulated was that after 3 years of the program there would be a significant decrease in dmft/DMFT (primary/permanent) score. METHODS: This was a cross-sectional study of all school-aged children in a small, remote First Nations community. Pre- and post- intervention evaluation of oral health was conducted by a dentist not involved in the study. The intervention consisted of a school-based program with daily brush-ins, fluoride application, educational presentations, and a recognition/incentive scheme. RESULTS: Twenty-six children were assessed prior to the intervention, representing 45% of the 58 children then in the community. All 40 children in the community were assessed following the intervention. Prior to the intervention, 8% of children were cavity free. Following 3 years of the intervention, 32% were cavity free. Among the 13 children assessed both pre- and post-intervention, dmft/DMFT score improved significantly (p <0.005). The visiting hygienist noted increased knowledge about oral health. CONCLUSION: A community- and university-supported, school-based, collaborative oral health program improved oral health and knowledge among children in a remote First Nations community.

Effect of helmet wear on the incidence of head/face and cervical spine injuries in young skiers and snowboarders.

PURPOSE: To evaluate whether helmets increase the incidence and/or severity of cervical spine injury; decrease the incidence of head injury; and/or increase the incidence of collisions (as a reflection of adverse effects on peripheral vision and/or auditory acuity) among young skiers and snowboarders. METHODS: During one ski season (1998-99) at a world class ski resort, all young skiers and snowboarders (<13 years of age) presenting with head, face, or neck injury to the one central medical facility at the base of the mountain were identified. On presentation to the clinic, subjects or their parents completed a questionnaire reviewing their use of helmets and circumstances surrounding the injury event. Physicians documented the site and severity of injury, investigations, and disposition of each patient. Concurrently, counts were made at the entry to the ski area of the number of skiers and snowboarders wearing helmets. RESULTS: Seventy children were evaluated at the clinic following ski/snowboard related head, neck, and face injuries. Fourteen did not require investigation or treatment. Of the remaining 56, 17 (30%) were wearing helmets and 39 (70%) were not. No serious neck injury occurred in either group. Using helmet-use data from the hill, among those under 13 years of age, failure to wear a helmet increased the risk of head, neck, or face injury (relative risk (RR) 2.24, 95% confidence interval (CI) 1.23 to 4.12). When corrected for activity, RR was 1.77 and 95% CI 0.98 to 3.19. There was no significant difference in the odds ratio for collisions. The two groups may have been different in terms of various relevant characteristics not evaluated. No separate analysis of catastrophic injuries was possible. CONCLUSION: This study suggests that, in skiers and snowboarders under 13 years of age, helmet use does not increase the incidence of cervical spine injury and does reduce the incidence of head injury requiring investigation and/or treatment.

A quantitative ranking of Canada's research output of original human studies for the decade 1989 to 1998.

BACKGROUND: Since 1987 research articles have been catalogued with the author's affiliation address in the 40 databases of the Medical Literature Analysis and Retrieval System (MEDLARS) of the National Library of Medicine, Bethesda, Md. The present study was conducted to examine the Canadian entries in MEDLARS to interpret past and future trends and to combine the MEDLARS demographic data with data from other sources to rank Canadian research output of human studies both nationally and internationally. METHODS: The PubMed Web site of the National Library of Medicine was used to count medical articles archived in MEDLARS and published from Jan. 1, 1989, through Dec. 31, 1998. The articles attributed to Canadian authors were compared by country, province, city, medical school, hospital, article type, journal and medical specialty. RESULTS: During the study period Canadian authors contributed on average 3% (standard deviation [SD] 0.2%) of the worldwide MEDLARS content each year, which translated to a mean of 11,067 (SD 1037) articles per year; 49% were human studies, of which 13% were clinical or controlled trials, and 55% involved people aged 18 years or less. In total, 68% of the articles were by authors affiliated with Canadian medical schools; those affiliated with the University of Toronto accounted for the greatest number (8604), whereas authors affiliated with McGill University had the greatest rate of annual increase in the quantity published (8%). Over one-third (38%) of the articles appeared in Canadian journals. When counted by specialty, 17% of the articles were by authors with clinical specialties, 5% by those with surgical specialties and 3% by those with laboratory specialties. INTERPRETATION: The annual rate of increase in research output for Canada was more than 3 times higher than that seen world wide. Canada is now ranked seventh among countries contributing human studies to MEDLARS. The increase indicates that Canada's medical schools are productive, competitive in making contributions to medical science and are supporting Canadian journals.

The cost-benefit of pulse-oximeter use in the prehospital environment.

INTRODUCTION: Pulse-oximetry has proven clinical value in Emergency Departments and Intensive Care Units. In the prehospital environment, oxygen is given routinely in many situations. It was hypothesized that the use of pulse oximeters in the prehospital setting would provide a measurable cost-benefit by reducing the amount of oxygen used. METHODS: This was a prospective study conducted at 12 ambulance stations (average transport times > 20 minutes). Standard care protocols and paramedic assessments were used to determine which patients received oxygen and the initial flow rate used. Pulse-oximetry measurements (SpO2) were then taken. If SpO2 fell below 92% or rose above 96% (except in patients with chest pain), oxygen (O2) flow rates were adjusted. Costs of oxygen use were calculated: volume that would have been used based on initial flow rate; and volume actually used based on actual flow rates and transport time. RESULTS: A total of 1,907 patients were recruited. Oximetry and complete data were obtained on 1,787 (94%). Of these, 1,329 (74%) received O2 by standard protocol: 389 (27.5%) had the O2 flow decreased; 52 had it discontinued. Eighty-seven patients (6%) not requiring O2 standard protocol were hypoxemic (SpO2 < 92%) by oximetry, and 71 patients (5%) receiving oxygen required flow rate increases. Overall, O2 consumption was reduced by 26% resulting in a cost-savings of $0.20/patient. Prehospital pulse-oximetry allows unnecessary or excessive oxygen therapy to be avoided in up to 55% of patients transported by ambulance and can help to identify suboptimally oxygenated patients (11%). CONCLUSIONS: Rationalizing the O2 administration using pulse-oximetry reduced O2 consumption. Other health care savings likely would result from a reduced incidence of suboptimal oxygenation. Oxygen cost-saving justifies oximeter purchase for each ambulance annually where patient volume exceeds 1,750, less frequently for lower call volumes, or in those services where the mean transport time is less than the 23 minute average noted in this study.

Ultrasound fetal biometry charts for a North American Caucasian population.

PURPOSE: This study was done to produce enhanced fetal biometry charts and graphs presenting percentile values as a function of fetal age. METHODS: The relationships between the ultrasound measurements of 10 fetal parameters and menstrual age were determined by a cross-sectional study. Data were obtained from 508 to 790 fetuses. Anatomic structures were scanned and measured 3 times during 1 routine sonographic examination. The study group consisted of 1,396 Caucasian women who had normal singleton fetuses with confirmation of menstrual dates by sonography before 14 weeks and for whom complete pregnancy outcome information was available. For each of the 10 parameters, percentile curves were derived for the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles. RESULTS: Ready-to-use fetal measurement charts and graphs are presented in a format giving the percentile values as a function of fetal age. There were no significant differences between male and female fetuses. CONCLUSIONS: These fetal biometry charts and graphs, obtained from a North American Caucasian population, enhance previously published data.

Unresolved instrumentation problems following clinical trials using near infrared spectroscopy.

Near infrared spectroscopy (NIRS) clinical trials conducted over a seven year period have identified instrument engineering problems related to fiber optic failure, electromagnetic interference, chromophore algorithms, and computational software. These problems have caused confusion amongst clinicians at the bedside, rejection of large volumes of data, repeated reanalysis of data, and a significant diversion of project resources away from clinical studies and into engineering solutions. This article summarizes previously published studies and presents new data which, together, emphasize the need for improvements in NIRS technology. Instrument designers need to be aware of the need for these improvements if NIRS is to serve clinicians better during research designed to rationally define clinical management protocols. © 1998 Society of Photo-Optical Instrumentation Engineers.

Diurnal changes in lumbar intervertebral distance, measured using ultrasound.

STUDY DESIGN: This study measured the distances between the tips of the transverse processes of adjacent lumbar vertebrae (L1-L4) in the same subjects after 1 day of normal activities and again the next morning. OBJECTIVES: To determine the feasibility of directly measuring the lumbar intervertebral distance using ultrasound and to determine the magnitude of the diurnal change in the intervertebral distance. SUMMARY OF BACKGROUND DATA: A diurnal variation in height results from, in part, a decrease in height of the intervertebral discs with loading of the spine during the day. Previous estimates of the diurnal changes in disc height have used radiologic, stereophotographic, and magnetic resonance imaging techniques. No previous study has used ultrasound imaging. METHODS: Ultrasound was used to measure the distance between the tips of adjacent lumbar vertebral transverse processes. Measurements were made on six occasions in each of seven subjects after 6:00 PM in the evening and again the following morning before rising. RESULTS: The distance between the tips of adjacent transverse processes could be measured, within an individual, with a reproducibility of better than +/- 7.5% coefficient of variation. Reproducibility of the measurement of the total distance between L1 and L4 was better than +/- 4%. The intervertebral distances between L1 and L4 were significantly greater in the morning than in the evening. The average diurnal change in the total intervertebral distance L1-L4 was 5.3 mm. CONCLUSIONS: The study confirms the feasibility of using ultrasound to directly measure changes in the distances between the lumbar vertebrae.

Comparison of 13 published cytochrome c oxidase near-infrared spectroscopy algorithms.

Conflicting patterns of change in cytochrome c oxidase (Cyt a,a3) redox status have been obtained between different near-infrared spectrophotometers when making measurements during tissue ischaemia. This study identifies possible sources of error that could be the cause of the discrepancy. A single set of optical density data was repeatedly analysed using each of the absorption spectra from 13 publications. In addition, changes in Cyt a,a3 redox status were calculated from the data set using three numerical methods, five computer software routines, eight displacements in wavelength, and ten incremental changes in the value of absorption or concentration coefficients. All Cyt a,a3 absorption spectra resulted in algorithms yielding similar patterns of change, regardless of the numerical method or computer process employed (0.9996 average r2, coefficient of correlation). However, a significantly different pattern of change in Cyt a,a3 redox status, resembling that reported by Piantadosi [Piantadosi CA (1993) Methods Toxicol. 2:107-126], was obtained when either the wavelengths, and/or the absorption values were altered to simulate erroneous values. This implies that all of the present algorithms are valid (including those of Piantadosi), but that microchip encoding errors may exist in the instrument used by Piantadosi.

Study design for microgravity human physiology experiments.

In some areas of research, such as microgravity life sciences, both the number of subjects and the opportunity for repeated observation under experimental conditions are limited. Small N study designs are appropriate for these situations since they require few subjects and few observations in the experimental condition. Small N studies compare treatment conditions separately for each subject so that between-subject variability does not obscure treatment effects. Multiple observations are collected for each individual in the baseline condition to ensure a stable reference point for comparison with the smaller number of observations collected under the experimental conditions. Individual differences can be overlooked in large N studies, but in small N studies the focus is on the individual, and differences observed between particular individuals can be suggestive of underlying causal processes. We present a step-by-step approach to designing and conducting a small N study.