Caries Experience in Preschoolers in Three Ecuadorian Communities.

Dental caries in the preschool population presents a significant challenge in the field of global public health, including Ecuador. Early detection of this disease is crucial for developing effective strategies for prevention and promotion of oral health, which can have a substantial impact on the quality of life of preschool-aged children. This study evaluated 600 children aged 3 to 5 years attending preschool education centers using the ICDAS II diagnostic criteria. The Student's t-test was used to analyze differences between the means of two independent groups. Additionally, an analysis of variance (ANOVA) was conducted to assess differences between the means of three or more groups. The prevalence of caries was 87%, with a dft index of 3.85 in the three provinces studied. A high treatment need was observed in 84.17% of the population. No significant differences in the DFT index were found based on gender, although both groups exhibited elevated values. No significant differences were observed in relation to province and environment. The second molar was the most affected tooth, with a caries prevalence of 58.8%. Despite the lack of significant differences among the evaluated variables, a high prevalence and experience of dental caries were found in the studied population.

Are we well? A post-pandemic snapshot of dental educator wellness, well-being, and fulfillment.

INTRODUCTION: The COVID-19 pandemic brought unprecedented changes to oral care and dental education delivery. To date, the vast majority of studies focus on the impact COVID-19 had on the well-being and wellness of patients, practitioners, and students; however, limited literature addresses the pandemic's impact on dental educators. PURPOSE: The aim of this study was to investigate the wellness, well-being, and fulfillment of dental educators in the years following the onset of the COVID-19 pandemic. METHODS: Following Institutional Review Board approval, an anonymous electronic Qualtrics survey was emailed to full-time and adjunct faculty across five (5) dental education institutions in the US. Faculty self-reported on their wellness, general well-being, physical well-being, mental well-being, fulfillment, and work-life balance. Group differences were examined using analysis of variance and the Tukey-Kramer test for multiple comparisons at the p < 0.05 level. RESULTS: The results revealed females and younger dental faculty members reported statistically significantly lower levels of wellness (F2, 123  = 11.16, p < 0.001, F3, 121  = 8.53, p < 0.001), physical (F2, 123  = 11.53, p < 0.001, F3, 121  = 5.54, p = 0.001) and mental well-being (F2, 123  = 12.49, p < 0.001, F3, 121  = 8.63, p < 0.001), fulfillment (F3, 121  = 5.01, p < 0.003), and higher levels of burnout (F2, 123  = 5.53, p = 0.005, F3, 121  = 4.85, p < 0.003). Those who expressed higher levels of burnout also had statistically lower mean well-being scores (F4, 119  = 10.54, p < 0.001). Females also reported a significantly lower work-life balance score compared to male respondents (F2, 121  = 10.37, p < 0.002). CONCLUSION: Despite the social and environmental challenges faced over the last couple of years post-pandemic, dental educators demonstrate a quick ability to adapt, however, disproportional differences in gender and age groups were identified as being significantly correlated to dental educators' self-reports on wellness, well-being, and fulfillment. Insight into these variables can help inform strategies in the academic setting to help support and strengthen the academic workforce.

Implementation of Virtual Interprofessional Observed Structured Clinical Encounters (OSCEs): A Pilot Study.

This pilot study was designed to investigate the feasibility of incorporating validated McMaster-Ottawa Team Observed Structured Clinical Encounters (TOSCEs) as a behavioral assessment in an interprofessional education (IPE) program using Zoom Communications. First- and second-year students from 11 health professional programs (e.g., audiology, dental hygiene, graduate psychology, healthcare administration and leadership, occupational therapy, pharmacy, physical therapy and athletic training, and physician assistant studies) at a single university participated and were assessed on the four Interprofessional Education Collaborative (IPEC) core competencies. Students completed three McMaster-Ottawa TOSCE stations (20 mins per station), followed by a large group debriefing for all participants to discuss the process and provide feed¬back. A validated, abbreviated version of the McMaster-Ottawa scoring rubric was utilized by faculty observers, and individual student scores were submitted using a Google form. Kruskal Wallis tests were used to analyze student performance related to the IPEC core competencies to deter¬mine whether significant differences existed between mean performance scores as compared by year in program (first year vs. second), and between case types. Kruskal-Wallis tests suggested differences on the collaborative patient performance item between the pediatric and diabetes cases only. There were no significant differences in performance across academic year in health professional programs, p > 0.05. Qualitative feedback highlighted the timely telehealth approach to collaborative practice and effective delivery of the interprofessional (IP) OSCE event across all of the student focus groups. The virtual IP OSCEs were feasible and recommended as a valuable IPE initiative at our institution.

Preferences Toward Attributes of Disease-Modifying Therapies: The Role of Nurses in Multiple Sclerosis Care.

ABSTRACT: BACKGROUND: Nurses play an essential role in coordinating the care of patients with multiple sclerosis (MS) throughout their disease trajectory in a complex treatment landscape. The aim of this study was to assess nurses' preferences toward different disease-modifying therapy attributes. METHODS: We conducted a multicenter, noninterventional, cross-sectional study in collaboration with the Sociedad Española de Enfermería Neurológica. Nurses actively involved in MS care were invited to participate in the study. Prevention of disability progression, preservation of cognitive function, side effect profile and safety monitoring, and method of administration were the treatment attributes tested. Conjoint analysis was used to assess preferences in 8 simulated treatment options and rank them from most to least preferred. RESULTS: A total of 98 nurses were included in the study. The mean (SD) age was 44.7 (9.8) years, and 91.8% were female with a mean (SD) time of experience in MS care of 7.5 (5.4) years. Participants prioritized preservation of cognition (38.6%), followed by preventing disability progression (35.2%) and side effect risk and safety monitoring (13.5%). Route and frequency of administration were the least preferred attributes (7.4% and 5.3%, respectively). Estimated utilities were consistent across the sample according to sociodemographic and professional practice characteristics. CONCLUSIONS: Nurses' preferences toward treatments were mainly driven by efficacy attributes. This information may support the role of nurses in the multidisciplinary management of MS facilitating shared decision making.

Effect of bosentan in pulmonary hypertension development in systemic sclerosis patients with digital ulcers.

Systemic sclerosis is a disease where microcirculation damage is critical in their beginning and vascular complications have similar pathogenic findings. Digital ulcers are a frequent complication in systemic sclerosis patients and pulmonary hypertension is one of the leading causes of death. The use of bosentan has been shown to be useful for the treatment of pulmonary arterial hypertension and to prevent new digital ulcers. However, is unknown if bosentan can prevent pulmonary hypertension. Our objective was to determine if bosentan is useful to prevent pulmonary hypertension in SSc patients. A retrospective study in 237 systemic sclerosis patients with digital ulcers history treated or not with bosentan to prevent it was made. We analyzed the occurrence of pulmonary hypertension defined by an echocardiogram pulmonary arterial pressure > 40 mmHg in the entire cohort. Demographic, clinical, and treatment variables were recorded for all patients. Statistical significance was denoted by p values < 0.05. Fifty-nine patients were treated with bosentan a median of 34 months. 13.8% of treated patients had pulmonary hypertension vs 23.7% of untreated patients (p 0.13) during the follow up. In multivariate analysis patients not treated with bosentan had 3.9fold-increased risk of pulmonary hypertension compared with patients under bosentan treatment (p < 0.02). Moreover the percentage carbon monoxide diffusing capacity (DLCO) in bosentan treated patients did not decrease from baseline to the end of follow-up (61.8±14% vs 57±20.1%, p = 0.89). We concluded that Systemic sclerosis patients with digital ulcers treated with bosentan seems to have less risk to develop pulmonary hypertension and to stabilize DLCO.

Frecuencia de ansiedad y depresión en niñas y adolescentes de la casa de acogida "Miguel León" en el cantón Cuenca, Ecuador / Frequency of anxiety and depression in girls and adolescents from "Miguel León" foster home in Cuenca, Ecuador

INTRODUCCIÓN: La depresión y ansiedad son dos patologías de alto impacto personal, social y económico; su evolución se da en muchos casos desde edades tempranas. La violencia generada dentro del hogar puede provocar la separación de muchos NNA de su núcleo familiar; siendo enviados, la mayoría de las veces, a casas de acogida. Aquellos niños y adolescentes que se encuentran en casas de acogida, tienden a desarrollaron ansiedad, depresión y estrés y estos trastornos desencadenan en dificultades emocionales y mentales a lo largo de su vida. En este contexto, el principal objetivo de este trabajo fue dar a conocer la frecuencia de ansiedad y depresión en niñas y adolescentes de la casa de acogida "Miguel León" del cantón Cuenca, en el 2016, generando estadísticas que permitan sentar las bases para proyectos de protección y estudios futuros. MATERIALES Y MÉTODOS: Estudio de tipo descriptivo, transversal cuantitativo. Con una población de estudio de 35 niñas y adolescentes, en edades de 5 a 18 años, de una casa de acogida. Para la recolección de datos se usaron, la Escala de Ansiedad Infantil de SPENCE y el Inventario CDI. El procesamiento se realizó mediante el programa Microsoft Excel 2010 y el software SPSS 15.0. Los datos se presentan en tablas y gráficos mediante frecuencias y porcentajes. RESULTADOS: La frecuencia de ansiedad fue de 22.86% y la frecuencia de depresión del 17.14%. El rango de edad más prevalente para ambas patologías fue de 10 a 14 años con 62.5% y 50% respectivamente. Tanto en el grupo de NNA con ansiedad como en el grupo con depresión el tiempo de estancia en la casa de acogida fue de 0 a 6 meses para la mayoría (50 y 66.67% respectivamente). CONCLUSIÓN: La frecuencia de depresión en niñas de 5 a 18 años de edad en la casa de acogida fue de 17.14%. La frecuencia de ansiedad en niñas de 5 a 18 años de edad en la casa de acogida fue del 22.86%, valores inferiores a los encontrados en otros estudios. El rango de edad en el que estas enfermedades fueron más prevalentes fue de 10-14 años. Ambos trastornos fueron más prevalentes cuanto menor fue el tiempo de estadía en la casa de acogida.

BACKGROUND: Depression and anxiety are two pathologies of great personal, social and economic impact; in many cases both have an early onset. Domestic violence can separate children and adolescents from their families; being sent, most of the times, to foster homes. Children and adolescents in foster homes tend to develop anxiety, depression and stress triggering lifelong emotional and mental difficulties. In this context, the aim of this study was to determine the frequency of anxiety and depression in girls and female adolescents from "Miguel León" Shelter, Cuenca, during 2016, creating statistical data that will allow setting protection projects and future studies. METHODS: Descriptive, quantitative cross-sectional study. The study population was stablished with 35 girls and adolescents, aged 5 to 18 years, from a foster home. For data collection, the SPENCE Child Anxiety Scale and the CDI Inventory were applied. Data was processed with Microsoft Excel 2010 and SPSS 15.0. Data is presented in charts and graphics using frequencies and percentages. RESULTS: The frequency of anxiety was 22.86% and the frequent of depression was 17.14%. The most prevalent age range for both pathologies was 10 to 14 years old with 62.5% and 50% respectively. In both groups, diagnosed with anxiety and diagnosed with depression, the length of stay in the foster home was 0 to 6 months for the majority of the population ( 50 and 66.67% respectively). CONCLUSIÓN: The frequency of depression in girls aged 5 to 18 years, was 17.14%. The frequency of anxiety in girls aged from 5 to 18 years in the foster home was 22.86%, values lower than those found in other studies. The age range in which both diseases were most prevalent was, 10-14 years old. Both disorders were more prevalent the shorter the time spent in the foster home.

Assessing Pharmacists' Preferences towards Efficacy Attributes of Disease-Modifying Therapies in Relapsing-Remitting Multiple Sclerosis.

Introduction: Hospital pharmacists are increasingly playing a critical role in the care of patients with multiple sclerosis (MS). However, little is known about their preferences and perspectives towards different attributes of disease-modifying therapies (DMTs). The objective of this research was to assess pharmacists´ preferences for DMT efficacy attributes. Methods: A multicenter, non-interventional, cross-sectional, web-based study was conducted. Preventing relapses, delaying disease progression, controlling radiological activity, and preserving health-related quality of life (HRQoL) and cognition were the attributes selected based on a literature review and a focus group with six hospital pharmacists. Conjoint analysis was used to determine preferences in eight hypothetical treatment scenarios, combining different levels of each attribute and ranking them from most to least preferred. Results: Sixty-five hospital pharmacists completed the study (mean age: 43.5 ± 7.8 years, 63.1% female, mean years of professional experience: 16.1 ± 7.4 years). Participants placed the greatest preference on delaying disease progression (35.7%) and preserving HRQoL (21.6%) and cognition (21.6%). Importance was consistent in all groups of pharmacists stratified according to demographic characteristics, experience, research background, and volume of patients seen per year. Conclusions: Understanding which treatment characteristics are meaningful to hospital pharmacists may help to enhance their synergistic role in the multidisciplinary management of patients with MS.

Assessing treatment tolerability for rheumatoid arthritis. Validation and practical applications of the 'TOL-AR-18 questionnaire' / Evaluación de la tolerabilidad al tratamiento de la artritis reumatoide. Validación y aplicaciones prácticas del «cuestionario TOL-AR-18»

INTRODUCTION: Given the lack of standardized tools to assess tolerability from patient's perspective, we carried out the validation of a questionnaire to asses treatment tolerability for rheumatoid arthritis (RA): TOL-AR-18. METHODS: The TOL-AR-18 was validated in the cross-sectional observational study in adult patients with RA. Socio-demographic and clinical variables were collected. Patients completed the TOL-AR-18 and ARTS questionnaires and a question about their general health status. RESULTS: Data of 66 patients with a mean age (standard deviation; SD) of 56.71 (10.50) years were analyzed; 66.7% were women. Mean (SD) time to disease progression was 10.76 (8.23) years, and time from first treatment initiation was 9.24 (7.70) years. Patients did not report other adverse events rather than those included in the TOL-AR-18. The questionnaire was feasible with high internal consistency (Cronbach's Alpha >0.90). Discriminant validity was moderate, with significant differences between patients in remission and all other, and between patients who did not report adverse events and the rest (P<.05). Convergent validity was moderate-low when correlated with the ARTS questionnaire. CONCLUSION: The TOL-AR-18 is valid for use in a clinical setting and useful as an additional tool for all professionals to manage and assess tolerability in RA

INTRODUCCIÓN: La ausencia de herramientas estandarizadas para evaluar la tolerabilidad desde la perspectiva del paciente, planteó la posibilidad de validar el cuestionario TOL-AR-18 de tolerabilidad al tratamiento de la artritis reumatoide (AR) y evaluar su aplicación en la práctica clínica. MÉTODOS: El desarrollo del cuestionario se realizó siguiendo la metodología estandarizada y posteriormente se validó mediante un estudio observacional y transversal con pacientes >18 años diagnosticados de AR, en tratamiento durante al menos 3 meses. Se recogieron variables socio-demográficas y clínicas. Los pacientes completaron los cuestionarios TOL-AR-18, ARTS, y el cuestionario sobre el estado de salud percibida. RESULTADOS: Se analizaron datos de 66 pacientes de edad media (desviación estándar [DE]) de 56,71 (10,50) años; un 66,7% eran mujeres y el 65,1% presentaba remisión/baja actividad por DAS28. La media (DE) del tiempo de evolución y del inicio del primer tratamiento fue de 11,34 (9,41) y 9,24 (7,7) años, respectivamente. Los pacientes no reportaron reacciones adversas adicionales a las incluidas en el TOL-AR-18. El cuestionario resultó factible con una consistencia interna elevada (alfa de Cronbach>0,9). La validez discriminante fue moderada, con diferencias estadísticamente significativas entre pacientes en remisión y el resto, y entre quienes no reportaban reacciones adversas y el resto (p < 0,05). La validez convergente fue moderada-baja al correlacionarse con el cuestionario ARTS. CONCLUSIONES: El cuestionario TOLAR-18 es válido para su uso en la práctica clínica y útil como herramienta complementaria para el manejo y valoración de la tolerabilidad en la AR por parte de todos los profesionales implicados

Assessing treatment tolerability for rheumatoid arthritis. Validation and practical applications of the 'TOL-AR-18 questionnaire'.

INTRODUCTION: Given the lack of standardized tools to assess tolerability from patient's perspective, we carried out the validation of a questionnaire to asses treatment tolerability for rheumatoid arthritis (RA): TOL-AR-18. METHODS: The TOL-AR-18 was validated in the cross-sectional observational study in adult patients with RA. Socio-demographic and clinical variables were collected. Patients completed the TOL-AR-18 and ARTS questionnaires and a question about their general health status. RESULTS: Data of 66 patients with a mean age (standard deviation; SD) of 56.71 (10.50) years were analyzed; 66.7% were women. Mean (SD) time to disease progression was 10.76 (8.23) years, and time from first treatment initiation was 9.24 (7.70) years. Patients did not report other adverse events rather than those included in the TOL-AR-18. The questionnaire was feasible with high internal consistency (Cronbach's α >0.90). Discriminant validity was moderate, with significant differences between patients in remission and all other, and between patients who did not report adverse events and the rest (P<.05). Convergent validity was moderate-low when correlated with the ARTS questionnaire. CONCLUSION: The TOL-AR-18 is valid for use in a clinical setting and useful as an additional tool for all professionals to manage and assess tolerability in RA.

Rituximab levels are associated with the B cell homeostasis but not with the clinical response in patients with rheumatoid arthritis.

OBJECTIVE: To study the levels of rituximab (RTX) and anti-RTX antibodies (ARAs) in patients with rheumatoid arthritis (RA) at 30, 90, and 180 days after the first infusion, in relation to clinical and serological parameters and B cell homeostasis. METHODS: Thirty-four patients with RA who failed to respond to anti-tumor necrosis factor therapy received RTX. At baseline, 4, 12, and 24 weeks after the first infusion of RTX, we performed a clinical assessment and determined the levels of RTX, ARAs, B cells, rheumatoid factors, anti-cyclic citrullinated peptide antibodies, immunoglobulins, and complements. RESULTS: RTX levels varied widely among patients. No ARAs were detected during the follow-up. Patients with lower levels of RTX presented with higher decreases in erythrocyte sedimentation rate, immunoglobulins, and complement 6 months after the first infusion. Patients with higher levels of RTX showed a higher B cell depletion at 90 days but an earlier B cell recovery than those with lower levels of RTX. No differences in clinical response were observed between the two groups at 6 months after starting the treatment. CONCLUSION: Our findings suggest that RTX levels in the serum of patients with RA are related to B cell homeostasis and the severity of immunological parameters but not to the clinical response at 6 months.

Validación facial de la escala Nursing Activities Score en tres unidades de cuidado intensivo en Bogotá, Colombia / Facial validation of Nursing Activities Score in three intensive care units in Bogota, Colombia

Introducción: La medición de cargas de trabajo en enfermería es fundamental para objetivizar la relación enfermera-paciente. Se asume que a mayor complejidad de los pacientes, es mayor el tiempo de dedicación de una enfermera a la provisión de cuidados directos Método: Se usará la adaptación transcultural de la escala Nursing Activities Score (NAS) al español, compuesta por 23 ítems que miden tareas clínicas y administrativas de enfermeras en UCI. Se someterá el instrumento a un juicio de expertos usando el método delphi de dos rondas para corroborar la validez de contenido del instrumento. Se aplicará la razón de validez de contenido (RVC) y el índice de validez de contenido (IVC) para establecer la utilidad de cada uno de los ítems. Posteriormente, se aplicará el instrumento a una muestra de profesionales de enfermería de tres unidades de cuidado intensivo polivalentes, aplicando los mismos estadísticos de prueba. Resultados: Se obtuvieron datos de RVC significativos para la mayoría de los ítems, tanto en la ronda de expertos como en el muestreo con profesionales. Aunque hay algunos ítems que no obtuvieron el puntaje mínimo para que se consideren válidos, el índice global IVC en la muestra de expertos y profesionales se considera satisfactorio, por lo que se considera que la escala puede ser válida con modificaciones (AU)

Introduction: The measurement of workloads in nursing is essential to objectify the nurse-patient relationship. It is assumed that the greater complexity of patients, the greater the time commitment of a nurse providing direct care. Method: Cross-cultural adaptation of the scale Nursing Activities Score (NAS) to Spanish, includes 23 items that measure clinical and administrative tasks of nurses in ICU use. The instrument to an expert opinion be submitted using the Delphi method two rounds to corroborate the content validity of the instrument. The ratio of content validity (RVC) and content validity index (CVI) to establish the usefulness of each item will apply. The ratio of content validity (RVC) and content validity index (CVI) to establish the usefulness of each item will apply. Subsequently, the device should be applied to a sample of nursing professionals three polyvalent intensive care units, applying the same statistical test. Results: significant RVC data were obtained for most items, in the round of experts and professionals sampling. Although there are some items that did not obtain the minimum score to be considered valid, the global index IVC in the sample of experts and professionals is considered satisfactory, so the scale is considered to be valid with amendments (AU)

Association between nailfold capillaroscopy findings and pulmonary function tests in patients with systemic sclerosis.

OBJECTIVE: To determine whether there is an association between different capillaroscopic findings and pulmonary function tests in systemic sclerosis (SSc). METHODS: We did a retrospective observational study in a cohort of patients with SSc and early SSc. Patients with at least 1 nailfold videocapillaroscopy (NVC) magnified 120× were included. Pathological findings were giant capillaries, angiogenesis, and density loss. Findings were compared with lung function values: percent expected value of forced vital capacity (FVC), DLCO, and FVC/DLCO ratio. Other variables collected were sex and SSc type, and the presence of digital ulcers (DU), interstitial lung disease (ILD), scleroderma renal crisis, and/or pulmonary hypertension (PH). RESULTS: Of 136 patients with SSc, 85 had undergone an NVC. The frequency of ILD, DU, and PH was 24.1%, 28.7%, and 17.2%, respectively. Data analysis showed that patients with density loss had worse FVC% (86.91 ± 19.42 vs 101.13 ± 16.06, p < 0.01) and DLCO% (71.43 ± 21.19 vs 85.9 ± 19.81, p < 0.01) compared to those without. CONCLUSION: Patients with loss of density present worse FVC and DLCO values. Prospective studies are warranted to determine whether NVC is useful for studying pulmonary function in SSc.