Intercultural sensitivity in Chilean healthcare profession students.

Each culture has unique health care related values, habits, perceptions, expectations, norms, etc., that makes cultural competence an important attribute to be developed by healthcare professionals, to ensure they provide effective treatment. Intercultural sensitivity (IS) is the affective dimension of cultural competence. The objective of this study is to explore the self-perceived level of IS in first and last year students of three health sciences professions (i.e., Dentistry, Medicine, and Nursing) at the Universidad de la Frontera, Temuco, Chile. This study adopted a cross-sectional design and a group comparison (e.g., year of study). 312 students completed the Intercultural Sensitivity Scale (ISS). Findings showed that overall ISS scores ranged from 1.83 to 4.94, with a mean score of 4.11 (s.d. 0.43). Group comparison between first and final year students showed statistically significant differences (4.18 vs. 4.00; p < 0.001). Medical and nursing students had a significantly higher overall mean IS score compared to dental students (4.21 and 4.16, respectively vs. 4.02; p < 0.01). There were also significant differences between three factors (interaction engagement; interaction confidence; and interaction enjoyment) by healthcare profession. These findings allow for discussion of the need for explicit incorporation and development of cultural competence in on health care professional curricula. Longitudinal research is needed to explore how IS changes over time, along with generating qualitative data from the student populations IS experiences and exposure.

Cultural Competence in the nursing, dentistry, and medicine professional curricula: a qualitative review.

BACKGROUND: Cultural competence development in the formative process of healthcare professionals is crucial for the provision of culturally appropriate health care. This educational issue is highly relevant in the growing multicultural composition of southern Chile. The objective of this study was to examine how the healthcare professions curricula at the Universidad de La Frontera, in La Araucanía Region, prepares future professionals to respond to patients' cultural needs. METHOD: A sequential transformative mixed methods design composed of two phases was carried out. Phase 1 reviewed all printed material and documentation to explore content that developed cross-cultural skills and competencies in the curricula. In Phase 2 semi-structured interviews were conducted with academics with responsibilities for the development of the curriculum in each career, to detect how academics envisage the incorporation of cultural competence in the curricula. RESULTS: Regarding curricular contents, findings indicated that the healthcare professions curricula at The Universidad de La Frontera have similar approaches to the inclusion of CCT in subjects' syllabuses, with inclusion of the different CCT, particularly in the Dental and Medical curricula. However, this coverage showed significant variations in the undergraduate healthcare curricula. The analysis revealed that themes around the Ethics and human values for professional practice; the Psychosocial and cultural determinants of health; the Relationship health-family-community, and to a lesser extent, the Clinician-patient relationship were well covered in the courses. On the other hand, Inequalities in health was the theme with the least contact time in all three courses. Academics called for a better organisation of the inclusion of CCT in the curricula. They also highlighted the challenges of maintaining the dominant paradigm underlying healthcare models, practices, and orientations within the academic staff and health discipline. CONCLUSION: Curricula contents findings indicate that the healthcare professions curricula at Universidad de La Frontera have similar approaches to the inclusion of CCT in subjects' syllabuses. However, its depth of coverage allows for improvements. The systematization of CCT and teaching-learning methodologies in healthcare professions curricula is necessary to develop formative processes that allow future professionals to be aware of and respectful with patients' cultural characteristics and needs.

Questions and health outcomes prioritization for the development of a COVID-19 dental clinical practice guideline: A case study.

RATIONALE, AIMS AND OBJECTIVES: In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical. The guideline development process includes prioritization of the guideline topic, questions and health outcomes. This case study describes the application of a new methodology to prioritize questions and rate the importance of health outcomes for a COVID-19 dental guideline. METHODS: Panel members rated the topic and the questions' overall importance, using a 9-point scale (1 = least important; 9 = most important). In addition, they rated six criteria if multiple questions received the same overall importance rating: common in practice, uncertainty in practice, variation in practice, new evidence available, cost consequences, not previously addressed. Panellists also rated the importance of each outcome, defined with health outcome descriptors, using a 9-point scale and the utility of health outcomes on a visual analogue scale. The correlation between each criterion and overall question importance was tested by Spearman correlation coefficient. RESULTS: Of seven topics, four were rated as high priority and three were rated as important, but not of high priority. Thirty-six percent of the questions (18/50) were rated as high priority to address in the guideline and 64% (32/50) were rated as an important question but not of high priority. Of the 11 outcomes, 72.7% were rated as critical for decision making. The mean utility rating was 0.57 (SD 0.32), with a minimum mean rating of 0.16 and a maximum of 0.76 (SD 0.23). CONCLUSION: This case study demonstrated that this approach provides a rigorous and transparent methodology to conduct the prioritizations of guideline topics, questions and health outcomes.

QUALITY APPRAISAL OF CLINICAL PRACTICE GUIDELINES ON PROVISION OF DENTAL SERVICES DURING THE FIRST MONTHS OF THE COVID-19 PANDEMIC.

OBJECTIVES: To evaluate the quality of clinical practice guidelines (CPGs) on dental services provision during the first months of the COVID-19 pandemic. MATERIALS AND METHODS: We systematically searched in MEDLINE, EMBASE, LILACS, Epistemonikos, Trip databases, websites of CPG developers, compilers of CPGs, scientific societies and ministries of health to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. Reviewers independently and in duplicate assessed the included CPGs using the AGREE II instrument. We calculated the standardized scores for the 6 domains and made a final recommendation about each CPG. The inter-appraiser agreement was assessed using the intraclass correlation coefficient (ICC). RESULTS: Twenty-three CPGs published were included. Most of the CPGs were from America (n = 15) and Europe (n = 6). The overall agreement between reviewers was very good (ICC = 0.93; 95%CI 0.87-0.95). The median score for each domain was the following: Scope and purpose 67% (IQR 20%); Stakeholder involvement 33% (IQR 14%); Rigour of development 13% (IQR 13%); Clarity of presentation 64% (IQR 31%); Applicability 19% (IQR 17%) and Editorial independence 8% (IQR 8%). Twenty two guidelines were not recommended by the reviewers. Only one of the CPGs was recommended with modifications. The median overall rate was 3 (IQR 1). All CPGs were classified as low quality. CONCLUSIONS: The overall quality of CPGs on dental services provision during the first months of the COVID-19 pandemic was low, which makes its implementation difficult for clinicians and policy makers. Therefore, it is critical that developers are transparent and forthcoming about the difficulties that have arisen during the CPG development process.

A phylogeny of the genus Limia (Teleostei: Poeciliidae) suggests a single-lake radiation nested in a Caribbean-wide allopatric speciation scenario.

OBJECTIVE: The Caribbean is an important global biodiversity hotspot. Adaptive radiations there lead to many speciation events within a limited period and hence are particularly prominent biodiversity generators. A prime example are freshwater fish of the genus Limia, endemic to the Greater Antilles. Within Hispaniola, nine species have been described from a single isolated site, Lake Miragoâne, pointing towards extraordinary sympatric speciation. This study examines the evolutionary history of the Limia species in Lake Miragoâne, relative to their congeners throughout the Caribbean. RESULTS: For 12 Limia species, we obtained almost complete sequences of the mitochondrial cytochrome b gene, a well-established marker for lower-level taxonomic relationships. We included sequences of six further Limia species from GenBank (total N = 18 species). Our phylogenies are in concordance with other published phylogenies of Limia. There is strong support that the species found in Lake Miragoâne in Haiti are monophyletic, confirming a recent local radiation. Within Lake Miragoâne, speciation is likely extremely recent, leading to incomplete lineage sorting in the mtDNA. Future studies using multiple unlinked genetic markers are needed to disentangle the relationships within the Lake Miragoâne clade.

Recommendations for Safe Dental Care: A Systematic Review of Clinical Practice Guidelines in the First Year of the COVID-19 Pandemic.

In the context of a pandemic, the rapid development of clinical practice guidelines (CPGs) is critical to guide dental staff towards the safe provision of dental care; detailed knowledge of the recommendations will help to achieve the intended results. We carried out a systematic review of the recommendations in clinical practice guidelines (CPGs) on the provision of dental care issued during the first year of the COVID-19 pandemic. A systematic database search was performed in MEDLINE, EMBASE, LILACS, Epistemonikos, and Trip databases to identify documents with recommendations intended to minimize the risk of COVID-19 transmission during dental care. The selection process and data extraction were carried out by two researchers independently. The majority of CPGs recommended the use of rubber dam, high-volume evacuator, mouthwash prior to dental care, four-handed work, and mechanical barriers. The use of aerosol-generating equipment should be avoided whenever possible. In aerosol-generating procedures, the use of a N95 respirator (or similar) is recommended, in addition to a face protector, an impermeable disposable apron/gown, a cap, and gloves. The CPGs developed during the first year of the pandemic offer recommendations which guide dental staff in providing safe dental care, minimizing exposure to SARS-CoV-2 and reducing the risk of COVID-19 infection in the clinical environment. Such recommendations must, however, be updated as new evidence arises.

Prevalencia y Severidad de Caries Dental en los Niños Beneficiarios del Programa de Salud Oral Asociados a Escuelas de Chile

RESUMEN: La caries es la enfermedad crónica más prevalente en niños constituyendo un problema de salud pública a nivel mundial. El objetivo de este estudio fue determinar la prevalencia y severidad de caries en niños y niñas pertenecientes al Programa de Salud Oral asociado a escuelas de la Junta Nacional de Auxilio Escolar y Becas (JUNAEB). Se realizó un estudio de corte trasversal basado en datos del año 2015 del Sistema Informático del Programa de Salud Oral de JUNAEB. Las variables de estudio fueron presencia y severidad de caries (índices ceod y COPD) y las variables de asociación exploratorias fueron zona geográfica, provincias, sexo, tipo de dependencia administrativa del colegio, tipo de enseñanza, sistema de salud, situación de extrema pobreza, tipo de dentición y tipo de atención. La asociación independiente entre las variables se analizó mediante el test de Chi2 y t-test. La muestra quedó constituida por 162.116 individuos, siendo el 50 % mujeres. La población estudiada mostró una prevalencia de 49 % y un índice ceod y COPD de 2,48 y 1,55 respectivamente. La mayor prevalencia (63 %) fue la zona centro sur y la región del Bío-Bío mostró los mayores índices de severidad (p<0,001). Las asociaciones más significativas fueron entre caries y el nivel socioeconómico y zona geográfica (p<0,001). Este estudio evidencia la asociación de la prevalencia/ severidad de caries y el nivel socioeconómico, y la distribución geográfica de la caries; lo cual hace necesario implementar medidas preventivas que compensen la ruralidad o la falta de fluoración del agua en algunas zonas geográficas de pobreza extrema.

ABSTRACT: Caries is the most prevalent chronic disease in children, constituting a worldwide public health problem. The aim of this study was to determine the prevalence and severity of caries in children included in the Oral Health Program associated to schools of the National Board of School Aid and Scholarships (JUNAEB). A cross- sectional study based on data from 2015 electronic register JUNAEB Oral Health Program was carried out. The main variables studied were presence and severity of caries (dmft and DMFT indices) and association variables were geographical area, sex, type of administrative dependency of the school, type of education, health system, and situation of extreme poverty, type of teething and type of care. The independent association between the variables was analyzed using the Chi2 test and the t-test.The sample consisted of 162,116 individuals, 50 % being women. The studied population showed a prevalence of 49 % and a CEOD and COPD index of 2.48 and 1.55, respectively. The highest prevalence (63 %) was the south-central zone and the Bío- Bío region showed the highest severity indices (p <0.001). The most significant associations were between caries and socioeconomic level and geographic area (p <0.001). This study shows the association between caries prevalence / severity and socioeconomic level, and the geographical distribution of caries, which make necessary the implementation of preventive measures that compensate rurality, or the lack of water fluoridation in some areas of extreme poverty.

Limia mandibularis, a new livebearing fish (Cyprinodontiformes: Poeciliidae) from Lake Miragoane, Haiti.

Limia mandibularis, a new livebearing fish of the family Poeciliidae is described from Lake Miragoane in southwestern Haiti on Hispaniola. The new species differs from all other species in the genus Limia by the presence of a well-developed lower jaw, the absence of preorbital and preopercular pores, and preorbital and preopercular canals forming an open groove each. The description of this new Limia species from Lake Miragoane confirms this lake as an important center of endemism for the genus with a total of nine described species so far.

Caracterización de los pacientes con diabetes mellitus tipo II. Hospital Francisco Menéndez, Ahuachapán, El Salvador. Julio - Diciembre 2017 / Characterization of patients with type II diabetes mellitus. Francisco Menéndez Hospital, Ahuachapán, El Salvador. July - December 2017

Este estudio es descriptivo de corte transversal. El universo poblacional para este estudio lo conformaron todas las personas con Diabetes Mellitus tipo II que consultaron de julio a diciembre 2017. Se tomó como unidad de análisis acada paciente con Diabetes Mellitus tipo II mayor de 20 años. De los 281 casos que había se filtró la base se excluyeron 32 casos duplicados, 27 procedentes de Guatemala y 2 menores de 20 años, quedando así un total de 220. La edad mínima de los pacientes con Diabetes Mellitus tipo II es de 20 años y una máxima de 90 años con una desviación estándar de 57 años. El grupo de edad con la mayor cantidad de personas con Diabetes Mellitus tipo II es el de 50 a 59 años (25.9%). El 63.6% de los estudiados pertenece al sexo femenino y el 36.3% al sexo masculino. El 60.9% proceden del área rural. Más de la mitad (62.5%) tienen estudios básicos. Casi el total de pacientes (93.2%) proceden del departamento de Ahuachapán. Más de un tercio (39.5%) tiene 5 años de padecer de Diabetes Mellitus. El 14.5% de los pacientes son Obesos. Casi todos los pacientes (90.5%) tienen antecedentes familiares. Las complicaciones mayormente presentes entre los pacientes son: pie diabético (7.3%), nefropatía diabética (3.6%), neuropatía (2.3%) y retinopatía (0.9%). El 11.8% de los pacientes, son hipertensos. La Diabetes Mellitus tipo II afecta mayormente a mujeres mayores de 50 años provenientes de la zona rural. Los antecedentes familiares parecen predisponer a las personas para la Diabetes Mellitus. El pie diabético es la complicación más frecuente entre las personas diabéticas. La Hipertensión Arterial es una enfermedad concomitante que puede estar presente en una parte de la población con Diabetes Mellitus tipo II

Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery.

The objective of this work is to compare the performances of two electroencephalogram based indices for detecting loss of consciousness and loss of response to nociceptive stimulation. Specifically, their behaviour after drug induction and during recovery of consciousness was pointed out. Data was recorded from 140 patients scheduled for general anaesthesia with a combination of propofol and remifentanil. The qCON 2000 monitor (Quantium Medical, Barcelona, Spain) was used to calculate the qCON and qNOX. Loss of response to verbal command and loss of eye-lash reflex were assessed during the transition from awake to anesthetized, defining the state of loss of consciousness. Movement as a response to laryngeal mask (LMA) insertion was interpreted as the response to the nociceptive stimuli. The patients were classified as movers or non-movers. The values of qCON and qNOX were statistically compared. Their fall times and rise times defined at the start and at the end of the surgery were calculated and compared. The results showed that the qCON was able to predict loss of consciousness such as loss of verbal command and eyelash reflex better than qNOX, while the qNOX has a better predictive value for response to noxious stimulation such as LMA insertion. From the analysis of the fall and rise times, it was found that the qNOX fall time (median: 217 s) was significantly longer (p value <0.05) than the qCON fall time (median: 150 s). At the end of the surgery, the qNOX started to increase in median at 45 s before the first annotation related to response to stimuli or recovery of consciousness, while the qCON at 88 s after the first annotation related to response to stimuli or recovery of consciousness (p value <0.05). The indices qCON and qNOX showed different performances in the detection of loss of consciousness and loss of response to stimuli during induction and recovery of consciousness. Furthermore, the qCON showed faster decrease during induction. This behaviour is associated with the hypothesis that the loss of response to stimuli (analgesic effect) might be reached after the loss of consciousness (hypnotic effect). On the contrary, the qNOX showed a faster increase at the end of the surgery, associated with the hypothesis that a higher probability of response to stimuli might be reached before the recovery of consciousness.

Prevalencia de agenesia dental en niños con dentición mixta de las clínicas odontológicas docente asistencial de la Universidad de La Frontera / Prevalence of dental agenesis in children with mixed dentition of teaching assistant dental clinics at the Universidad de La Frontera

El objetivo de este estudio (corte transversal y descriptivo) es determinar la prevalencia de agenesia (hipodoncia) dental en niños con dentición mixta que asisten a las Clínicas Odontológicas Docente Asistencial de La Universidad de La Frontera, durante el año 2009. Se examinaron 307 niños entre 6 y 11 años, que cumplían con los criterios de inclusión. La prevalencia de agenesia en la población estudiada fue de 4.2 por ciento (13/307), resultando más afectados los individuos de sexo femenino 5,9 por ciento (9/153). De acuerdo al orden de frecuencia, el diente más afectado por agenesia fue el segundo premolar inferior, con un valor de 4,2 por ciento (13/307). Le siguen, el segundo premolar superior, cuyo valor fue de 3,3 por ciento (10/307), 1,3 por ciento (4/307) del incisivo lateral inferior y 0,33 por ciento (1/307) del primer premolar superior. No se encontraron hallazgos radiográficos de agenesia en incisivo lateral superior y primer premolar inferior. Este estudio nos permitió obtener indicadores significativos de la población estudiada, como además señalar la importancia del diagnóstico precoz de esta anomalía, que conlleva a interceptar alteraciones de maloclusión.

The purpose of this study (cross sectional and descriptive) was to determine the prevalence of dental agenesis (hypodontia) in children with mixed dentition attending the teaching assistant dental clinics at the Universidad de La Frontera, 2009. We examined 307 children between 6 and 11 years, who met the inclusion criteria. The prevalence of agenesis in the studied population was 4.2 percent (13/307), with female individuals being the most affected, 5.9 percent (9/153). According to the order of frequency, the most affected by tooth agenesis was the second premolar, with a value of 4.2 percent (13/307). Followed by the second premolar, the value was 3.3 percent (10/307), 1.3 percent (4/307) of the lateral incisor and 0.33 percent (1/307) of the first premolar. There were no radiographic findings of agenesis of upper lateral incisor and first premolar. This study allowed us to obtain significant indicators of the population studied, and also note the importance of early diagnosis of this anomaly, which leads to intercept alterations in the occlusion.

Conservative treatment of an ankylosed tooth after delayed replantation: a case report.

An 8-year-old boy sustained avulsion of his upper right maxillary central incisor and lateral luxation of his upper left maxillary incisors. Subsequently, the upper right maxillary central incisor developed replacement resorption, and both upper left maxillary incisors developed pulpal canal obliteration. In the ankylosed tooth, decoronation procedure was performed, and in the 44-month follow-up period the involved alveolar site showed vertical apposition of bone and continuing replacement resorption. Decoronation is a surgical procedure that allows preservation of the bone volume for the future, avoiding aesthetic disturbances and more aggressive treatments in cases where other therapeutic alternatives are not feasible.