Impact of socioeconomic inequalities on dental caries in deprived children: a multilevel analysis.

OBJECTIVES: Inequalities have been reported between high, middle and low socioeconomic position (SEP) children. However, the effect of contextual and individual SEP on existing inequalities among socioeconomically deprived children varies between local contexts. The aim of this study was to assess the impact of contextual and individual SEP on individual caries experience among socioeconomically deprived children in Chile. METHODS: Cross-sectional multilevel analysis of data from the 2015 electronic register of the National Board of School Aid and Scholarships (JUNAEB) of Chile. The contextual variables were the municipality Human Development Index (HDI) and rurality index. Individual variables included gender, living in extreme poverty and school grade. Multilevel negative binomial models assessed their impact on DMFT/dmft. RESULTS: 112,429 children in 255 municipalities were included. Overall, contextual SEP (HDI) was not associated with caries experience in the primary or permanent dentition. Individual SEP (living in extreme poverty) was associated with caries experience in both dentitions. The proportion of children living in extreme poverty with caries experience in the primary teeth was 17% higher than children not living in extreme poverty (PR 1.17; 95% CI 1.15-1.19), while for children with permanent teeth it was 9% higher (PR 1.09; 95% CI 1.08-1.11). CONCLUSION: These findings could support the development of health strategies focused on individual SEP to efficiently reduce oral health inequalities among socioeconomically deprived children.

Transvenous approach to intracranial dural arteriovenous fistula (Cognard v): a treatment option. A case report.

The endovascular technique is the gold standard treatment in dural arteriovenous fistulas. Due to the limited number of series published it is difficult to create rigid guidelines in terms of the best endovascular treatment approach. Treatment must be tailored to each particular case, but it is important to keep in mind that the possibility of treating a type V dAVF by the transvenous approach should not be discarded. In selected cases the transvenous approach may be helpful to increase the chance of success in the endovascular treatment of type V dAVF. We describe a patient in whom the first arterial treatment failed to achieve occlusion of the fistulous point with the glue. Clinical symptoms improved due to the diminished flow at the fistula after the first embolization but as soon as collateral arteries were recruited by the fistula, spinal cord venous drainage impairment led to symptoms recurrence. Transvenous access allowed us to close the fistula completely in one only session with a complete disappearance of the pathologically inverted perimedullary venous flow.

Interphase gap decreases electrical stimulation threshold of retinal ganglion cells.

The most common electrical stimulation pulse used in retinal implants is a symmetric biphasic current pulse. Prior electrophysiological studies in peripheral nerve have shown that adding an interphase gap (IPG) between the two phases makes stimulation more efficient. We investigated the effect of IPG duration on retinal ganglion cell (RGC) electrical threshold. We used calcium imaging to measure the activity of RGCs in isolated retina in response to electrical stimulation. By varying IPG duration, we were able to examine the effect of duration on threshold. We further studied this effect by simulating RGC behavior with a Hodgkin-Huxley-type model. Our results indicate that the threshold for electrical activation of RGCs can be reduced by increasing the length of the IPG.

Secuestro pulmonar intralobar / Intralobar pulmonary sequestration

No disponible

Meeting the challenges of the Ottawa Charter: comparing South African responses to AIDS and tobacco control.

The paper compares the response of the South African Government to HIV and AIDS with the government's policy development concerning the use of tobacco. The high burden of disease from HIV and AIDS in South Africa and the morbidity and mortality from the use of tobacco are outlined. Using the framework of the Ottawa Charter for Health Promotion, the paper reviews and critiques the Government's different stance to building public policy, creating supportive environments, engaging community participation, developing personal skills and re-orienting the health services, for HIV/AIDS and tobacco. The result of these policy choices is described. The lack of adequate implementation of the key elements of the Ottawa Charter has resulted in high morbidity and mortality due to the spread of HIV infection in South Africa. This has also influenced the resurgence of tuberculosis, and the accompanying MDR and XDR TB epidemics. The high prevalence of HIV infection has also meant that the health system is unable to cope with the large numbers of patients requiring anti-retroviral treatment, and the early morbidity and mortality of young economically active people has had devastating social consequences, resulting in the large numbers of orphans. In contrast, South Africa is a signatory to the World Health Organizations' Framework Convention on Tobacco Control, and has successfully implemented many of the policies.

Reduction of caries in rural school-children exposed to fluoride through a milk-fluoridation programme in Araucania, Chile.

OBJECTIVE: To assess the effectiveness of a dental caries prevention programme on the permanent dentition of Chilean rural schoolchildren using fluoridated powdered milk and milk derivatives. BASIC RESEARCH DESIGN: The fluoridated products were delivered to 35,000 schoolchildren in the rural areas of the Ninth Region in Chile using the standard School Feeding Programme (PAE). The daily fluoride dose from milk fluoridated products was estimated at 0.65 mg/day, during approximately 200 schooldays/year. Cross-sectional samples of schoolchildren aged 6, 9 and 12 years from study communities and from positive control communities (ongoing APF-gel programme) were examined at the start of the study in November 1999 and after 36 months. RESULTS: No significant differences were found for the DMFT and dmft indices among 6-year-olds in the study and positive control groups either at baseline or 36 months later. Significant reductions (range 24-27%) were observed in the DMFT index in 9 and 12-years-olds of the study communities when clinical data at baseline, in the absence of a fluoridated preventive programme, were compared to those obtained after 36 months of receiving fluoridated milk products. Upon the follow-up examination, the DMFT indices of schoolchildren aged 9 and 12 years old receiving fluoridated milk were not significantly different from those of the positive control comparison group of the APF-Gel programme. CONCLUSIONS: Considering the relative costs and technical difficulties involved in both caries preventive programmes, it appears that in rural Chilean communities, fluoridation of powdered milk and milk derivatives is an effective alternative caries prevention programme in areas where either water fluoridation or other community delivered programmes are difficult to apply.

The cost-effectiveness of adding fluorides to milk-products distributed by the National Food Supplement Programme (PNAC) in rural areas of Chile.

OBJECTIVE: This paper assesses the cost-effectiveness of a community dental caries prevention programme, targeting pre-school children living in non-fluoridated rural areas of Chile. BASIC RESEARCH DESIGN: The results of a community trial to measure the effects of using fluoridated powdered milk and milk-cereal to prevent dental caries, together with the cost of running the programmeme, were used to determine its cost-effectiveness when compared to the status-quo alternative. In the experimental community, fluoridated milk products were given to approximately 1,000 children aged between six months and six years, using the standard National Complementary Feeding Programme available in Chile. The control group received the milk products only. Dental caries status was recorded at the beginning and end of the programme in both communities using WHO criteria. The costs that would be incurred by such a programme, using a societal perspective, were identified and measured. RESULTS: Children who received fluoridated products had significantly lower mean levels of dental caries than those who had not. This improvement was achieved with a yearly cost of RCH (1999) $1,839.75 per child (1 US$ = RCH (1999) $527.70). On average, this programme resulted in a net societal savings of RCH (1999) $2,695.61 per diseased tooth averted after four years when compared to the control group. CONCLUSIONS: While the analysis has inherent limitations as a result of its reliance on a range of assumptions, the findings suggest that there are important health and economic benefits to be gained from the use of fluoridated milk products in non-fluoridated rural communities in Chile.

Determinants of communication between partners about STD symptoms: implications for partner referral in South Africa

"Background: STDs as preventable diseases are a major public health problem in South Africa; both in terms of their effect on quality of life; their economic costs and the fact that STDs as co-factors drive the HIV epidemic. Their widespread occurrence and high prevalence rates are cause for concern. It is argued that the duration of infection increases the probability of harmful sequelae and STD transmission; including HIV; to others. The promotion of seeking health care for STD symptoms at an early stage and partner referral for STD treatment are important strategies in preventing STD transmission to others and re-infection of partners. The cost implications of contact tracing by healthcare workers has resulted in patients being encouraged to refer their partners for STD treatment. This has not always been effective; despite efforts to improve partner referral rates by improved ""contact cards"" (i.e. a card with a code representing the STD that the patient has been treated for to be given to sexual partners as a way to speed up treatment) and more accessible healthcare services. Other studies have found that the proportion of clients who present with contact cards at STD services ranged from about 2 to 39 ; while the proportion of partners who were referred for treatment range from 16 to 30 . Mathews et al. argue that returning contact cards might not be a sensitive enough proxy indicator for partner referral rates.Partner referrals have been found to be seriously compromised by patients' causal explanations for STDs; as well as by the unequal power of the genders in sexual relationships; which impacts on the patients' ability to communicate about sexual matters. Patients often lack an understanding of the importance of referring their asymptomatic partners for treatment. Women's inability to discuss sexual issues due to their unequal status in sexual relationships might impact on partner referral behaviour. Men have been found to blame the STD on the ""outside women"" (sexual partners outside the primary relationship) and are therefore less likely to refer these partners. The conflict that could arise from informing a partner about an STD was viewed by men as a reason not to communicate about having a STD.While the ability to communicate about STDs with sexual partners is an essential prerequisite for referring them for medical treatment; little attention has been paid to understanding this process. This study is aimed at gaining some understanding of the determinants of communication between partners about STD symptoms. In this study; ""talking with a partner about STD symptoms"" before seeking medical treatment was viewed as an indication of the likelihood of future partner referral behaviour. Methods A randomly selected sample of 1 477 patients with STD symptoms was interviewed using a structured questionnaire. Logistic regression analysis was used to identify the determinants of talking to a partner about the present STD.ResultsIt was found that patients who had talked with their partner about their current STD symptoms were more likely to be female; be employed; have a tertiary level of education; have had only one sexual partner in the preceding six months; have used condoms; albeit inconsistently during the last six months; and to have thought about abstaining from sex while infected. Those who talked were also more likely to have good knowledge about the effects of STDs and the transmission of STDs in the absence of symptoms; had positive attitudes towards condoms and perceived social support for partner referral. Conclusion: Improved partner referral through health education interventions needs to focus specifically on a subgroup of patients; e.g. men and the unemployed; and on the improvement of knowledge regarding the consequences of STDs and asymptomatic transmission. Social and partner support for partner referral and perceived self-efficacy in this regard should be encouraged and maintained. In the absence of skills and counselling services to manage the consequences of STD partner referral; this prevention strategy will remain vulnerable."