Coronas cementadas comparado con coronas atornilladas para pacientes con restauraciones fijas implantosoportadas / Cement-retained versus screw-retained crowns in patients with implant rehabilitation

RESUMEN: Introducción: Los implantes dentales se han transformado en una opción de tratamiento de suma relevancia para pacientes parcial o totalmente desdentados. El éxito del tratamiento puede verse afectado por la elección del tipo de retención de estos (cementada o atornillada). A pesar que ambas presentan ventajas, aún no existe consenso sobre el mejor tipo de retención para restauraciones fijas implantosoportadas. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 14 revisiones sistemáticas que en conjunto incluyeron 43 estudios primarios, de los cuales cinco corresponden a ensayos aleatorizados. De estos, solamente dos ensayos responden a la pregunta de interés de manera directa. Concluimos que las coronas atornilladas podrían aumentar levemente el riesgo de pérdida de implante a largo plazo, podrían resultar en nula o poca diferencia en el riesgo de pérdida de implante a mediano plazo, reabsorción ósea y periimplantitis, pero la certeza de evidencia ha sido evaluada como baja. Por otro lado, no es posible establecer con claridad si las coronas cementadas disminuyen el riesgo de complicaciones estéticas y protésicas, ya que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: Dental implants have become a highly relevant treatment option for partially or totally edentulous patients. Implant retention systems (cemented or screwed) can influence the treatment success. Although both have advantages, there is still no consensus on the best type of retention for implant-supported fixed restorations. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified 14 systematic reviews including 43 primary studies overall, of which five were randomized trials. Of these, only two trials answer the question of interest. We concluded that screw-retained crowns may increase long-term implant loss, may make little or no difference in the risk of medium-term implant loss, bone resorption, and peri-implantitis, but the certainty of the evidence has been assessed as low. On the other hand, it is not possible to clearly establish whether cemented crowns reduce the risk of cosmetic and prosthetic complications, since the certainty of the evidence has been assessed as very low.

Cervical cancer screening and adherence to follow-up among Hispanic women study protocol: a randomized controlled trial to increase the uptake of cervical cancer screening in Hispanic women.

BACKGROUND: In the US, Hispanic women have a higher incidence of, and mortality from, cervical cancer than non-Hispanic white women. The reason for this disparity may be attributable to both low rates of screening and poor adherence to recommended diagnostic follow-up after an abnormal Pap test. The 'Cervical Cancer Screening and Adherence to Follow-up Among Hispanic Women' study is a collaboration between a research institution and community partners made up of members from community based organizations, the Yakima Valley Farm Workers Clinic and the Breast, Cervical, and Colon Health Program of the Yakima District . The study will assess the efficacy of two culturally-appropriate, tailored educational programs designed to increase cervical cancer screening among Hispanic women, based in the Yakima Valley, Washington, US. METHODS/DESIGN: A parallel randomized-controlled trial of 600 Hispanic women aged 21-64, who are non-compliant with Papanicolau (Pap) test screening guidelines. Participants will be randomized using block randomization to (1) a control arm (usual care); (2) a low-intensity information program, consisting of a Spanish-language video that educates women on the importance of cervical cancer screening; or (3) a high-intensity program consisting of the video plus a 'promotora' or lay-community health educator-led, home based intervention to encourage cervical cancer screening. Participants who attend cervical cancer screening, and receive a diagnosis of an abnormal Pap test will be assigned to a patient navigator who will provide support and information to promote adherence to follow-up tests, and any necessary surgery or treatment. Primary endpoint: Participants will be tracked via medical record review at community-based clinics, to identify women who have had a Pap test within 7 months of baseline assessment. Medical record reviewers will be blinded to randomization arm. Secondary endpoint: An evaluation of the patient navigator program as a method to improve adherence and reduce time to follow-up among participants who receive an abnormal Pap test result. An additional secondary endpoint is the cost-effectiveness of the two different intensity intervention programs. DISCUSSION: This culturally sensitive intervention aims to increase compliance and adherence to cervical screening in a Hispanic population. If effective, such interventions may reduce incidence of cervical cancer. TRIAL REGISTRATION: NCT01525433.

Strategies for increasing mammography screening in primary care in Chile: results of a randomized clinical trial.

BACKGROUND: Breast cancer is the cancer with the highest incidence among women in Chile and in many Latin American countries. Breast cancer screening has very low compliance among Chilean women. METHODS: We compared the effects on mammography screening rates of standard care, of a low-intensity intervention based on mail contact, and of a high-intensity intervention based on mail plus telephone or personal contact. A random sample of 500 women with the age of 50 to 70 years registered at a community clinic in Santiago who had not had a mammogram in the past 2 years were randomly assigned to one of the three intervention groups. Six months after randomization, participants were re-evaluated for their compliance with mammography screening. The outcome was measured by self-report and by electronic clinical records. An intention to treat model was used to analyze the results. RESULTS: Between 92% and 93% of participants completed the study. Based on electronic records, mammography screening rates increased significantly from 6% in the control group to 51.8% in the low-intensity group and 70.1% in the high-intensity group. About 14% of participants in each group received opportunistic advice, 100% of participants in the low- and high-intensity groups received the mail contact, and 50% in the high-intensity group received a telephone or personal contact. CONCLUSION: A primary care intervention based on mail or brief personal contact could significantly improve mammogram screening rates. IMPACT: A relatively simple intervention could have a strong impact in breast cancer prevention in underserved communities.

[Skin prick test of immediate hypersensitivity in a selected Chilean pediatric population sample]. / Pruebas cutáneas de hipersensibilidad inmediata en una población pediátrica seleccionada.

BACKGROUND: Skin prick test (SPT) of immediate hypersensitivity is a main instrument in the diagnosis of allergy. AIM: To demonstrate the applicability of skin prick test in different age groups. PATIENTS AND METHODS: We studied children and adolescents with the diagnosis of allergy in the Pediatric Respiratory Laboratory of the Catholic University of Chile, from January 2001 to March 2002. The SPT was performed using a standardized technique. The allergens were applied on the volar surface of the forearm in children older than 4 years of age and in younger children it was applied on their back. For study purposes we separated them into three age groups: GI < or =2 years and 11 months, GII from 3 to 4 years and 11 months, GIII > or =5 years. RESULTS: We studied 408 children, aged between 8 months and 15 years. The SPT was applied to all patients with no adverse effects of any kind. There was a positive reaction in 57.7% of children. The reaction was positive in 37% in G1, 39% in GII and 65% in GIII (p <0.001). The predominant allergens for each group were dust mites (Dermatophagoides pteronissinus and farinae). CONCLUSIONS: SPT was useful when used on a selected pediatric population. The frequency of sensitization increased significantly with age. However, more than one third of children between 2 and 4 years of age tested positive to one or more allergen, demonstrating its applicability in this age group.

[Health care resource allocation in Chile. Ethical considerations in decision making]. / Asignación de recursos en salud en Chile. Consideraciones éticas en la toma de decisión.

BACKGROUND: The inclusion of ethical aspects in the world health care reform is currently being discussed. AIM: To analyze the ethical component of health care decision making in Chile. MATERIAL AND METHODS: A qualitative analysis of interviews with 4 health service directors, 4 public hospital directors and 1 sub director. Inquiries to 16 public hospital ethics committees, about importance of ethical components in decision making, role of ethics committees in financial issues and the feasibility of incorporation explicit ethical considerations in decision making. RESULTS: There is an absence of explicit ethical criteria in decision making. There is little participation of directors in these issues and lack of information. Although ethical aspects are considered relevant, they are not taken into account. Ethics committees are mostly dedicated to evaluate research protocols. The community is not mentioned as a relevant actor in decision making about resource allocation. CONCLUSIONS: Health service directors and all health care personnel should be trained in bioethics. These aspects should be incorporated to their daily work.