The Relation of Neighborhood Racial and Income Polarity to Preterm Birth Rates in Chicago.

OBJECTIVES: To investigate the extent to which spatial social polarization is associated with preterm birth among urban African-American and non-Latinx white women, and whether prenatal care modifies this relationship. METHODS: We performed multilevel logistic regression analyses on a 2013-2017 dataset of Chicago vital records (N = 29,179) with appended Index of Concentration at the Extremes (ICE) values for race and income. RESULTS: Women who resided in the bottom ICE quintile neighborhoods had a preterm birth rate of 11.5%, compared to 7.3% for those who live in the top ICE quintile areas; adjusted odds ratio (aOR) equaled 1.72 (95% confidence interval [CI] = 1.39, 2.12). This disparity widened for early (< 34 weeks) preterm birth rates, aOR = 2.60 (1.77, 3.81). These associations persisted among women with adequate prenatal care utilization. CONCLUSIONS FOR PRACTICE: Spatial polarization of race and income in urban African-American and non-Latinx white women's residential environment is strongly associated with preterm birth rates, even among those who receive adequate prenatal care. These findings highlight the benefit of using ICE to contextualize the impact of urban neighborhood-level characteristics on preterm birth rates.

Neighborhood Gun Violence and Birth Outcomes in Chicago.

OBJECTIVES: To examine the association between gun violence and birth outcomes among women in Chicago. METHODS: Using a 5-year set of birth files (2011-2015) merged with census and police data, birth outcomes including low birth weight (LBW, BW < 2500 g), preterm birth (PTB, < 37 weeks gestation), and small-for-gestational-age (SGA, BW < 10th percentile) were examined among non-Hispanic (NH) white, NH black, and Hispanic women in Chicago. Gun violence rates were categorized into tertiles. Multilevel, multiple logistic regression examined the effects of gun violence and race/ethnicity on birth outcomes. RESULTS: Of 175,065 births, 10.6% of LBW, 10.6% of PTB, and 9.1% of SGA occurred in high violence tertile. Using white women in low violence tertile as reference, the OR for LBW among black women ranged 1.9-2.1 across all tertiles, and 0.8-1.2 among Hispanic women. OR for PTB for black women were 1.6-1.7 and 1.0-1.2 for Hispanic women, and OR for SGA for black women were 1.6-1.7 and for Hispanic women 0.9-1.0. CONCLUSIONS FOR PRACTICE: In Chicago, race/ethnicity was associated with birth outcomes, regardless of the level of exposure to gun violence, in 2011-2015. The differences in racial/ethnic composition across the violence exposure levels suggest that, rather than gun violence alone, residential segregation and the geographic inequities likely contribute to disparate birth outcomes.

Manejo de quiste periapical incorporando tomografía computarizada de Haz cónico y biopsia. Reporte de caso / Control of a periapical cyst incorporation of cone brean computedtomography and biopsy. case report

El quiste periapical se deriva del epitelio de revestimiento por una proliferación de pequeños residuos epiteliales de Malassez, el presente reporte señala características clínico-patológicas de un quiste periapical y la incorporación del uso de la tomografía computarizada de haz cónico (CBCT) como método de diagnóstico y el procedimiento de biopsia para descartar malignidad. Por lo general, en el protocolo de intervención, el odontólogo no emplea la realización de biopsia ni estudios histopatológicos a lesio-nes que aparentan ser benignas, con base en la literatura y experiencia del caso clíni-co, se pretende que el estudiante de pregra-do, odontólogo general y especialista incor-pore la CBCT y biopsia en el diagnóstico. Paciente femenina de 45 años, acudió a las clínicas estomatológicas de la Carrera de Odontología de la Universidad Nacional Autónoma de Honduras en el Valle de Sula (UNAH-VS). En el exámen intraoral se observó fracturas de coronas fijas de cerá-mica en el incisivo central e incisivo lateral superior izquierdo, presencia de tumefac-ción fluctuante en el rafe palatino medio, dolor a la palpación y presencia de fístula activa. Se realizó una CBCT para elabora-ción del plan de tratamiento; el abordaje clínico fue terapia endodóntica convencio-nal, apicectomía con obturación retrógrada en los dientes involucrados, remoción del quiste, realización de biopsia y estudiosanatomopatológicos que corroboran el diag-nóstico presuntivo de epitelio escamoso típico densamente infiltrado de linfocitos, el corion muestra infiltrados linfoplasmocitarios de un quiste periapical. La paciente evolu-cionó sin complicaciones permaneciendo asintomática; en 12 meses radiografía peria-pical evidenció formación de tejido óseo en el área tratada...(AU)

Estudio comparativo in-vitro del selldo apical de tres cementos endodónticos / Comparative in-vitro study of apical sealing of three endodontic sealers

Una de las bases del éxito en el tratamiento de endo - doncia es realizar un buen sellado apical mediante la obturación hermética tridimensional del sistema de conductos radiculares. Objetivo: Evaluar si existe diferencia significativa en los resultados alcanzados en el sellado apical según el tipo de cemento utiliza - do Materiales y Métodos: Estudio cuasi-experimental, treinta dientes unirradiculares fueron instrumentados y obturados, se dividieron en tres grupos de diez, grupo I: resina epóxica, grupo II: hidróxido de cal- cio y grupo III: óxido de zinc y eugenol. Cada diente fue sellado coronalmente con ionómero de vidrio y se colocaron en suero fisiológico por 4 días; se im - permeabilizaron con 3 capas de esmalte de uñas sumergiéndolos en tinta china a 37ºC por 48 horas. Se realizó el proceso de diafanización para evaluar el nivel de filtración de la tinta china a nivel apical. El análisis inferencial fue realizado con ANOVA unifac- torial, y la prueba post hoc de Games- Howell para evaluar entre que cementos utilizados existían dife- rencias significativas. Resultados: La media de filtra - ción apical fue: 0.1mm utilizando cementos a base de resina epóxica, 0.4mm con el cemento a base de hidróxido de calcio y 1.5mm con el cemento de óxi- do de zinc y eugenol. La prueba de ANOVA unifac- torial, indica que hay diferencias significativas en la filtración de los dientes, según el cemento utilizado (p < 0.1) Conclusión: El cemento a base de resi- na epóxica presenta mejores propiedades de sella - do apical en comparación a los cementos a base de óxido de zinc y eugenol e hidróxido de calcio...(AU)

Preanalytical errors: a preliminary approach to the point of view of primary health care givers.

BACKGROUND: The presence of errors in the preanalytical phase is a widely studied topic. However, information regarding the perspective of those professionals involved is rather scant. METHODS: Two focus groups of professionals from Primary Care involved in the preanalytical phase (general practitioners [GP], community nurses [CN], and other auxiliary health workers, including administrative personnel [AHW]) were convened. A qualitative analysis with a phenomenological approach was performed by using the structure of SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis as a guide, and results were categorized by grouping the resultant dimensions according to this structure. RESULTS: Overall, 12 professionals (3 GP, 6 CN, and 3 AHW) were distributed in two groups. Age and gender distribution were similar between groups. The most commented strengths were organizational capability and teamwork. The main weakness was the workload increase (compared to the short time spent on sample collection). Opportunities were related to workload optimization through on-line analytical requests. Threats were related to the long time elapsed between sample drawing at Primary Care and delivery to the Central Laboratory. CONCLUSIONS: The phenomenological approach allows revealing those aspects that cannot be entirely elucidated by objective data measurement. Attitudes considered as positive can be exploited by the institution, whereas those considered as negative alert us to possible future problems. Primary Care professionals offered a different point of view to laboratory staff, but both recognized high workload as the main threat and on-line analytical request as the best opportunity. These perspectives may help to improve detection and decrease the number of errors.

Occupational exposure to asbestos and ovarian cancer: a meta-analysis.

OBJECTIVE: A recent Monographs Working Group of the International Agency for Research on Cancer (IARC) concluded that there is sufficient evidence for a causal association between exposure to asbestos and ovarian cancer. We performed a meta-analysis to quantitatively evaluate this association. DATA SOURCES: Searches of PubMed and unpublished data yielded a total of 18 cohort studies of women occupationally exposed to asbestos. DATA EXTRACTION: Two authors independently abstracted data; any disagreement was resolved by consulting a third reviewer. DATA SYNTHESIS: All but one study reported standardized mortality ratios (SMRs) comparing observed numbers of deaths with expected numbers for the general population; the exception was a study that reported standardized incidence ratios. For simplicity, we refer to all effect estimates as SMRs. The overall pooled SMR estimate for ovarian cancer was 1.77 (95% confidence interval, 1.37-2.28), with a moderate degree of heterogeneity among the studies (I2 = 35.3%, p = 0.061). Effect estimates were stronger for cohorts compensated for asbestosis, cohorts with estimated lung cancer SMRs > 2.0, and studies conducted in Europe compared with other geographic regions. Effect estimates were similar for studies with and without pathologic confirmation, and we found no evidence of publication bias (Egger's test p-value = 0.162). CONCLUSIONS: Our study supports the IARC conclusion that exposure to asbestos is associated with increased risk of ovarian cancer.

Biopsia por aspiración con aguja fina en nódulo tiroideo. Apoyo del citopatólogo en la obtención de la muestra / Fine needle aspiration of thyroid nodule. The support of the citopathologyst on the sample obtention

Introducción: La biopsia por aspiración con aguja fina (BAAF) es un método simple, rápido y económico, evalúa la naturaleza de un nódulo tiroideo, eliminando la necesidad de remoción quirúrgica al establecer un diagnóstico citológico. Objetivo: Determinar si la presencia del citopatólogo en la obtención de la BAAF disminuye el número de muestras inadecuadas y si esto influye sobre la decisión terapéutica. Pacientes y métodos: Se realizaron 151 BAAF en nódulo tiroideo. Los pacientes fueron distribuidos en dos grupos: Grupo I biopsias practicadas sin la intervención del citopatólogo y el grupo II con la intervención de un citopatólogo. Resultados: Grupo I: 75 pacientes (88 por ciento mujeres) con edad promedio 45.3 años. Diecisiete biopsias fueron inadecuadas. El 77.3 por ciento de las BAAF con diagnóstico inicial benigno, 56.9 por ciento fueron correctos. En cáncer, la BAAF detectó el 63.6 por ciento de los casos. El tiempo promedio de diagnóstico fue de 14 días. Grupo II: 76 pacientes (84.2 por ciento mujeres), edad promedio 41.9 años. Siete biopsias fueron inadecuadas. El 90.8 por ciento de las BAAF con diagnóstico inicial benigno, 68.1 por ciento fueron correctos. En cáncer, la BAAF detectó 55.5 por ciento de los casos. El tiempo promedio de diagnóstico fue de tres días. Conclusiones: La evaluación inmediata del material obtenido en la BAAF disminuye el número de muestras inadecuadas, lo cual mejora la certeza diagnóstica y la decisión terapéutica.