Red tape, slow emergency, and chronic disease management in post-María Puerto Rico.

This paper draws upon the notion of slow emergency as a framework to interpret ethnographic and qualitative findings on the challenges faced by Puerto Ricans with chronic conditions and health sector representatives throughout the island during and after Hurricane María. We conducted participant observation and qualitative interviews with chronic disease patients (n=20) health care providers and administrators (n=42), and policy makers (n=5) from across the island of Puerto Rico in 2018 and 2019. Many Puerto Ricans coping with chronic diseases during and after María experienced bureaucratic red tape as the manifestation of colonial legacies of disaster management and health care. They describe a precarious existence in perpetual "application pending" status, waiting for services that were not forthcoming. Drawing on ethnographically informed case examples, we discuss the effects of these bureaucratic barriers on persons with three chronic conditions: renal disease, opioid dependency, and HIV/AIDS. We argue that while emergency management approaches often presume a citizen-subject with autonomous capacity to prepare for presumably transient disasters and envision a 'post-disaster future' beyond the immediate crisis, Puerto Rican voices draw attention to the longer, sustained, slow emergency of colonial governance.

Effectiveness of silver diamine fluoride in caries prevention and arrest: a systematic literature review.

This study aimed to evaluate the scientific evidence regarding the effectiveness of silver diamine fluoride (SDF) in preventing and arresting caries in the primary dentition and permanent first molars. A systematic review (SR) was performed by 2 independent reviewers using 3 electronic databases (PubMed, ScienceDirect, and Scopus). The database search employed the following key words: "topical fluorides" AND "children" AND "clinical trials"; "topical fluorides" OR "silver diamine fluoride" AND "randomized controlled trial"; "silver diamine fluoride" AND "children" OR "primary dentition" AND "tooth decay"; "silver diamine fluoride" OR "sodium fluoride varnish" AND "early childhood caries"; and "silver diamine fluoride" AND "children". Inclusion criteria were articles published in English, from 2005 to January 2016, on clinical studies using SDF as a treatment intervention to evaluate caries arrest in children with primary dentition and/or permanent first molars. Database searches provided 821 eligible publications, of which 33 met the inclusion criteria. After the abstracts were prescreened, 25 articles were dismissed based on exclusion criteria. The remaining 8 full-text articles were assessed for eligibility. Of these, 7 publications were included in the SR. These included 1 study assessing the effectiveness of SDF at different concentrations; 3 studies comparing SDF with other interventions; 2 investigations comparing SDF at different application frequencies and with other interventions; and 1 study comparing semiannual SDF applications versus a control group. The literature indicates that SDF is a preventive treatment for dental caries in community settings. At concentrations of 30% and 38%, SDF shows potential as an alternative treatment for caries arrest in the primary dentition and permanent first molars. To establish guidelines, more studies are needed to fully assess the effectiveness of SDF and to determine the appropriate application frequency.

Factores asociados a la consulta odontológica en niños/as y jóvenes de Talca (Chile) e inmigrantes chilenos de Montreal (Canadá) / Factors associated with dental consultation in children in Talca (Chile) and in Chilean immigrants in Montreal (Canada)

Objetivo: Determinar los factores que influyen en la consulta al odontólogo de los/las niños/as de 4 a 7 años y los/las jóvenes de 10-13 años de edad residentes de la ciudad de Talca (Chile) y los/las niños/as y los/las jóvenes inmigrantes chilenos residentes en la ciudad de Montreal (Canadá). Métodos: Estudio transversal no probabilístico, con 147 niños/as en Talca y 94 en Montreal. Entre 2009 y 2011 se midieron variables sociodemográficas, nivel de estudios, percepción de la salud de los/las hijos/as, sexo y edad de los/las niños/as, composición familiar y cercanía al centro de salud. Se hizo análisis exploratorio bivariado con test exacto de Fisher. Para buscar las variables asociadas a la consulta odontológica se utilizó la regresión de Cox robusta con tiempo constante con nivel de significación de 0,05. Resultados: En Talca las variables asociadas a la consulta odontológica de dos o más veces al año fueron el nivel de estudios del/de la tutor/a y su percepción sobre la salud del/de la hijo/a, teniendo los/las niños/as con tutores/as con estudios universitarios 2,20 (intervalo de confianza del 95% [IC95%]: 1,30-3,73) veces más posibilidades de consultar al dentista y los/las tutores/as con percepción positiva consultan 53% menos al dentista (odds ratio: 0,47; IC95%: 0,28-0,77). En Montreal, los/las niños/as con tutores/as con estudios universitarios tenían 2,10 veces más posibilidades (IC95%: 1,17-3,76) de consultar al dentista y 2,11 veces más posibilidades de consultar si tenían entre 10 y 13 años de edad (IC95%: 1,15-3,88). Conclusiones: El nivel de estudios del/de la tutor/a se asoció con las visitas al dentista en ambas muestras, siendo los/las niños/as con tutores/as de mayor nivel de estudios quienes más consultan (AU)

Objective: To identify the factors that influence the use of dental services in 4-7-year-olds and in 10-13-year-olds resident in the cities of Talca (Chile) and Montreal (Canada). Methods: A nonprobabilistic cross-sectional study was carried out in 147 boys and girls in Talca and in 94 boys and girls in Montreal between 2009 and 2011. Sociodemographic variables were recorded in parents and children, including age and sex. Data were also gathered on parental education, family composition, and proximity to health centers within neighborhoods. The data were analyzed with Fisher's exact test and the robust Cox regression model (with constant time) with a significance level of 0,05. Results: In Talca, parental education was significantly associated with dental care visits at least twice a year. The children of parents with university education were 2.20 times more likely to consult a dentist (95% CI: 1.30-3.73). Children whose parents perceived their children's health positively were 53% (OR = 0,47; 95% CI: 0,28-0,77) less likely to consult a dentist. In Montreal, the children of parents with university education were 2.10 times more likely to consult a dentist (95%CI: 1.17-3.76), while older children (10-13 years) were 2.11 (95% CI: 1.15-3.88) times more likely to consult a dentist. Conclusions: In both cities, parental education level was associated with the use of dental services (AU)

[Factors associated with dental consultation in children in Talca (Chile) and in Chilean immigrants in Montreal (Canada)]. / Factores asociados a la consulta odontológica en niños/as y jóvenes de Talca (Chile) e inmigrantes chilenos de Montreal, (Canadá).

OBJECTIVE: To identify the factors that influence the use of dental services in 4-7-year-olds and in 10-13-year-olds resident in the cities of Talca (Chile) and Montreal (Canada). METHODS: A nonprobabilistic cross-sectional study was carried out in 147 boys and girls in Talca and in 94 boys and girls in Montreal between 2009 and 2011. Sociodemographic variables were recorded in parents and children, including age and sex. Data were also gathered on parental education, family composition, and proximity to health centers within neighborhoods. The data were analyzed with Fisher's exact test and the robust Cox regression model (with constant time) with a significance level of 0,05. RESULTS: In Talca, parental education was significantly associated with dental care visits at least twice a year. The children of parents with university education were 2.20 times more likely to consult a dentist (95% CI: 1.30-3.73). Children whose parents perceived their children's health positively were 53% (OR = 0,47; 95% CI: 0,28-0,77) less likely to consult a dentist. In Montreal, the children of parents with university education were 2.10 times more likely to consult a dentist (95%CI: 1.17-3.76), while older children (10-13 years) were 2.11 (95% CI: 1.15-3.88) times more likely to consult a dentist. CONCLUSIONS: In both cities, parental education level was associated with the use of dental services.