Childhood disability in rural Niger: a population-based assessment using the Key Informant Method.

BACKGROUND: Data on childhood disability is essential for planning health, education and other services. However, information is lacking in many low- and middle-income countries, including Niger. This study uses the Key Informant Method, an innovative and cost-effective strategy for generating population-based estimates of childhood disability, to estimate the prevalence and causes of moderate/severe impairments and disabling health conditions in children of school-going age (7-16 years) in the Kollo department of western Niger. METHODS: Community-based key informants were trained to identify children who were suspected of having the impairment types/health conditions included in this study. Children identified by key informants were visited by paediatricians and underwent an assessment for moderate/severe vision, hearing, physical and intellectual impairments, as well as epilepsy, albinism and emotional distress. RESULTS: Two thousand, five hundred sixty-one children were identified by key informants, of whom 2191 were visited by paediatricians (response rate = 85.6%). Overall, 597 children were determined to have an impairment/health condition, giving a prevalence of disability of 11.4 per 1000 children (10.6- 12.2). Intellectual impairment was most common (6.5 per 1000), followed by physical (4.9 per 1000) and hearing impairments (4.7 per 1000). Many children had never sought medical attention for their impairment/health condition, with health seeking ranging from 40.0% of children with visual impairment to 67.2% for children with physical impairments. CONCLUSION: The Key Informant Method enabled the identification of a large number of children with disabling impairments and health conditions in rural Niger, many of whom have unmet needs for health and other services.

"Until people start dying in droves, no actions will be taken": perception and experience of HIV-preventive measures among people who inject drugs in northwestern Russia.

BACKGROUND: The HIV epidemic among people who inject drugs (PWID) in Russia continues to spread. This exploratory study examines how HIV-prevention measures are perceived and experienced by PWID in the northwestern region of Russia. METHODS: Purposive sampling was used to obtain a variety of cases that could reflect possible differences in perception and experience of HIV-prevention efforts. We conducted 22 semi-structured interviews with PWID residing in the Arkhangelsk and St. Petersburg regions. RESULTS: The main sources of prevention information on HIV for PWID were media campaigns directed to the general population. These campaigns were effective with regard to communicating general knowledge on HIV but were ineffective in terms of risk behavior change. The subjects generally had trust in medical professionals and their advice but did not follow prevention recommendations. Most informants had no or very little prior contact with harm reduction services. On the level of attitudes towards HIV prevention efforts, we discovered three types of fatalism among PWID: "personal fatalism" - uselessness of HIV prevention efforts, if one uses drugs; "prevention-related fatalism" - prevention programs are low effective, because people do not pay attention to them before they get infected; "state-related fatalism" - the lack of belief that the state is concerned with HIV prevention issues. Despite this fatalism the participants opined that NGOs would do a better job than the state as they are "really working" with risk groups. CONCLUSIONS: As HIV prevention campaigns targeted at the general population and prevention advice received from medical professionals are not sufficiently effective for PWID in terms of risk behavior change, prevention programs, such as community-based and peer-based interventions specifically tailored to the needs of PWID are needed, which can be achieved by a large expansion of harm reduction services in the region. Personal communication should be a crucial element in such interventions in addition to harm reduction materials provision. Training programs, peer outreach, and culture-change interventions which try to alter widespread fatalistic norms or attitudes towards their health are especially needed, since this study indicates that fatalism is a major barrier for behavior change.

Four-Millimeter-Long Posterior-Mandible Implants: 5-Year Outcomes of a Prospective Multicenter Study.

BACKGROUND: There is lack of evidence on long-term success of short dental implants in reduced alveolar bone. PURPOSE: In this prospective 5-year study, survival and marginal bone loss of 4-mm implants, which supported fixed dental prostheses (FDPs) in severely resorbed posterior mandibles, were evaluated. MATERIAL AND METHODS: In 28 patients, evaluation of 86 osseointegrated 4-mm-long implants, which supported a 3- or a 4-unit FDP by crown splinting without the use of pontics or cantilevers, was performed over a 5-year period. RESULTS: Three subjects dropped out for non-study reasons: one subject had her three implants removed after 1 year and two subjects died (six implants). Five implants in three subjects were lost between 3 and 5 years. Twenty-four subjects and 71 implants were active at the 5-year follow-up (92.2% survival). After 1 year, significant (p < .001) mean (standard error of the mean [SEM]) 0.44-mm (0.05) marginal bone loss occurred. At 2, 3, and 5 years, mean (SEM) bone loss of 0.57 mm (0.06), 0.55 mm (0.07), and 0.53 mm (0.08) occurred, respectively (no significant change after 1 year). At 5 years, average plaque levels were 13.3%; 69% of the implants were plaque free. On average, mucosal bleeding occurred at 8.1% of the implants. During 5 years, two subjects experienced uncomplicated bridge loosening. No other complications occurred during the study. CONCLUSION: Four-millimeter implants can support FDPs in severely resorbed posterior mandibles for 5 years with healthy peri-implant conditions.

The influence of relining or implant retaining existing mandibular dentures on health-related quality of life: a 2-year randomized study of dissatisfied edentulous patients.

PURPOSE: The purpose was to assess and compare self-reported oral health and oral and general health related quality of life (OHRQoL and HRQoL) in two groups of edentulous adults who reported dissatisfaction with their mandibular dentures, and who were treated with a conventional relining of this denture or by having it converted into an implant-retained one. MATERIALS AND METHODS: Sixty subjects were randomly allocated into two equal groups, a relined conventional denture (RCD) group and an implant-retained overdenture (IOD) group. Data on demographics, oral health, OHRQoL, and HRQoL were recorded by means of a self-administered questionnaire at baseline, 3 months, and 2 years. RESULTS: Fifty-four subjects completed the protocol, 28 in the IOD-group and 26 in the RCD-group. The IOD group reported significant improvement in oral health and Oral Health Impact Profile (OHIP-20) sum score and all its domains after 3 months. The improvements remained stable at the 2-year control. The RCD group reported almost no significant improvements. Neither group reported improved HRQoL. CONCLUSION: The results of this study support the findings from other RCT studies that to implant-retain the mandibular denture significantly improves self-reported oral health and OHRQoL. This treatment modality should be a minimum standard of care in complete denture wearers dissatisfied with their mandibular denture.

The ARV roll out and the disability grant: a South African dilemma?

BACKGROUND: Prior to the antiretroviral (ARV) drug roll out in 2004, people living with HIV (PLHIV) in South Africa received disability grants when they were defined as "AIDS-sick". In the absence of available and effective medication, a diagnosis of AIDS portended disability. The disability grant is a critical component of South Africa's social security system, and plays an important role in addressing poverty among PLHIV. Given the prevalence of unemployment and poverty, disability grants ensure access to essential resources, like food, for PLHIV. Following the ARV roll out in South Africa, PLHIV experienced improved health that, in turn, affected their grant eligibility. Our aim is to explore whether PLHIV reduced or stopped treatment to remain eligible for the disability grant from the perspectives of both PLHIV and their doctors. METHODS: A mixed-methods design with concurrent triangulation was applied. We conducted: (1) in-depth semi-structured interviews with 29 PLHIV; (2) in-depth semi-structured interviews with eight medical doctors working in the public sector throughout the Cape Peninsula; (3) three focus group discussions with programme managers, stakeholders and community workers; and (4) a panel survey of 216 PLHIV receiving ARVs. RESULTS: Unemployment and poverty were the primary concerns for PLHIV and the disability grant was viewed as a temporary way out of this vicious cycle. Although loss of the disability grant significantly affected the well-being of PLHIV, they did not discontinue ARVs. However, in a number of subtle ways, PLHIV "tipped the scales" to lower the CD4 count without stopping ARVs completely. Grant criteria were deemed ad hoc, and doctors struggled to balance economic and physical welfare when assessing eligibility. CONCLUSIONS: It is crucial to provide sustainable economic support in conjunction with ARVs in order to make "positive living" a reality for PLHIV. A chronic illness grant, a basic income grant or an unemployment grant could provide viable alternatives when the PLHIV are no longer eligible for a disability grant.

Four-millimeter implants supporting fixed partial dental prostheses in the severely resorbed posterior mandible: two-year results.

BACKGROUND: Reduced alveolar bone volume complicates implant dentistry. PURPOSE: In this prospective multicenter study, a new, 4-mm long Straumann SLActive implant (Ø 4.1 mm) supporting a fixed dental prosthesis (FDP) in the severely resorbed posterior mandible was evaluated for two years. MATERIAL AND METHODS: Thirty-two patients (11 men, 21 women; mean age 64.1 years) participated. Ten to 12 weeks after single-stage surgery, a screw-retained FDP was attached to three or four 4-mm implants. RESULTS AND DISCUSSION: One hundred implants were inserted. Three failed at surgery and four were lost before loading. Twenty-eight patients received FDPs (93 implants). Two patients were discontinued because of secondary exclusion criteria; therefore, 26 patients were followed up from baseline (BL). After 1 year, one patient insisted on removal of all implants and one patient died because of nonstudy-related complications. Twenty-four patients (87 implants) were eligible for examination 2 years post-loading. All implants were found to be stable [survival rate 95.7% (confidence interval, CI 88.8-98.3) after 1 year and 92.3% (CI 84.5-96.2) after 2 years]. The mean change from BL to 12 months was - 0.43 mm (CI 0.31-0.59; p < .001) and from 12 to 24 months - 0.11 mm (CI -0.01-0.23; p = .056). The survival rate is only slightly lower than in similar studies on 6 to 8.5 mm implants. This may be related to high initial stability and effective use of the residual bone volume with high primary bone-to-implant contact in dense bone structures. The surgical handling of the tested implant was found to be similar to that of implants of common length. However, the preparation procedure must be done with great care to avoid overdrilling. Careful planning and design of the prosthetic construction is mandatory to prevent unfavorable occlusion and avoid harmful shear forces. CONCLUSION: This study showed that 4 mm implants can support an FDP in severely resorbed posterior mandibles for at least 2 years and with healthy peri-implant conditions.

Host response to titanium dental implant placement evaluated in a human oral model.

BACKGROUND: Recent reports have questioned if metal sensitivity may arise from exposure to titanium. The objective of this study was to histologically evaluate non-perforated mucosa covering submerged maxillary titanium implants with regard to induced tissue reactions. METHODS: Thirteen patients, 21 to 69 years of age, without previous implants were included. After initial examination, the bone crest areas destined for dental implant placement were exposed, and threaded external hex dental implants were inserted. Prior to wound closure, a full mucosal tissue slice was biopsied from the edge of the mucoperiosteal flap (baseline). The patients were monitored monthly for 6 months. At the abutment connection, biopsies were taken by a 6-mm punch, altogether yielding 26 specimens. Tissue reactions were analyzed by coded histometric analysis at four defined areas at increasing distance from the oral epithelium, including ratios of inflammatory cells (IC)/epithelial cells, IC/fibroblasts, and number of dense particles. RESULTS: The stained sections portrayed gingival tissue with intact oral epithelium and connective tissue with variable accumulation of IC. Experimental biopsies demonstrated mineralized areas and dense particles of different sizes. Analysis of variance revealed a higher IC/fibroblast ratio for level 3 at baseline compared to level 3 at 6 months (P<0.01). Furthermore, a significant decrease in IC/fibroblast ratio was observed between levels 2 and 3 and 2 and 4 at 6 months (P<0.001). The connective tissue level facing the cover screw contained the highest number of dense particles (P<0.01). CONCLUSIONS: Tissue sensitivity reactions to titanium implants were not disclosed. All 6-month biopsies contained dense particles that were most likely metals.

Four years of clinical experience with an adverse reaction unit for dental biomaterials.

OBJECTIVES: We describe the function of, and results from, the Norwegian National Dental Biomaterials Adverse Reaction Unit after 4 years of activity from 1993 to 1997. METHODS: During this period of time, 296 patients were examined at the unit, which is located at the Dental School, University of Bergen. The most prevalent age group was 40-49 years, and 70% were women. Dental amalgam was the primary reason for referral to the unit for nearly 85% of the patients, followed by metals in crowns and bridges (11%). Materials in removable dentures, resin-based filling materials and cements, endodontic materials, and others, including temporary materials, were also involved. Nearly all (96%) patients reported general subjective symptoms, such as muscle and joint pain, fatigue, and memory problems. Complaints involving the orofacial region (lips, face, temporomandibular joint) and intraoral subjective symptoms were also common. RESULTS: Of the patients who were patch tested with substances in dental materials, 23% were positive to gold, 28% to nickel, 14% to cobalt, 9% to palladium, 6% to mercury, and 8% to one or more components of resin-based materials. Mercury concentrations in blood and urine were statistically higher in the patients with amalgam fillings compared with those without. CONCLUSIONS: Generally, we could not establish a straightforward cause-and-effect relationship between the presence of dental biomaterials and general symptoms. Twenty patients were advised to replace restorative materials because of contact lesions. Another 20 patients were recommended replacement of materials because of allergy verified with positive patch tests. The complex nature of most of the reactions requires a multidisciplinary approach to the care taking of patients who are concerned about reactions from dental materials, particularly amalgam.

Reporting on adverse reactions to dental materials--intraoral observations at a clinical follow-up.

OBJECTIVES: A national reporting system designed to monitor adverse reactions to dental materials was established in Norway in 1993. The activities have also included clinical examination of patients with suspected reactions to dental materials. The ongoing activities are coordinated by the Dental Biomaterials Adverse Reaction Unit at the University of Bergen. The reporting procedure is based on voluntary spontaneous reporting by dentists and physicians. The reports could be based on subjective symptoms or objective findings, or both. The aim of the present study was to compare reported objective intraoral findings with those found during examination at the unit. METHODS: Reported reactions were compared with clinical findings obtained following dental and medical examination at the unit. From 1993 to 1999, a total of 899 reports were received while 253 patients were referred and examined at the unit. RESULTS: The reports on patients who were examined at the unit involved mainly reactions related to amalgam fillings (84%), metals in fixed dentures (11%), resin-based materials and cements (4%), materials used in removable dentures (2%), and endodontic materials (2%). Edema, lichenoid reactions, ulcers/vesicles, erythema, and atrophy were found in 80 patients during the examination at the unit. For 35 of these patients, the intraoral findings at the unit were also given in the reports. For another 45 patients, objective intraoral signs of reactions were found upon examination at the unit, but these findings had not been reported. CONCLUSION: A spontaneous reporting system is a cost-effective method for monitoring intraoral reactions associated with dental materials. Considering the increasing number and complexity of these materials, there appears to be a need for continuous validation of reports by a speciality unit. In order to receive more accurate information about the adverse reactions, it would be advisable that the reporting forms include more detailed guidance regarding signs of reactions that practitioners should be on the look out for and consider.

Fixed partial dentures supported by natural teeth and Brånemark system implants: a 3-year report.

PURPOSE: To evaluate fixed partial dentures (FPDs) supported by a combination of natural teeth and implants in a variety of clinical situations. MATERIALS AND METHODS: In 30 patients, 86 teeth and 85 implants were used as supports for 30 FPDs of varying extension (mean = 8.6 units); 23 in the maxilla and 7 in the mandible. The prostheses had a removable section fastened with screws to both the implants and to a section cemented on the supporting teeth, and were thus functioning as rigid, fixed partial dentures. RESULTS: Five implants were lost prior to the placement of prostheses, 2 were lost after loading, giving survival rates of 91.0% in the maxilla and 95.5% in the mandible. Complications were predominantly soft tissue-related and were all amenable to treatments. One patient was lost to follow-up. The remaining 29 FPDs remained stable throughout the 3-year observation period. DISCUSSION: Changes in plaque accumulated, bleeding on probing, pocket depths, and marginal bone level were acceptable. The survival rate of implants was comparable to that of similar studies. Further investigations are needed with regard to design for such FPDs. CONCLUSION: These findings, together with the patient satisfaction experienced, indicated that the combined support of implants and teeth for fixed prostheses may be appropriate treatment for patients.