Screening Program for Imported Diseases in Immigrant Women: Analysis and Implications from a Gender-Oriented Perspective.

The female immigrant population is especially vulnerable to imported diseases. We describe the results of a prospective screening program for imported diseases performed in immigrant female patients. The protocol included tests for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), Treponema pallidum, Trypanosoma cruzi, Strongyloides stercoralis and Schistosoma spp., intestinal parasites, malaria, and the detection of microfilaremia, according to the patient's origin. Six hundred eleven patients were studied. The most frequent imported diseases were intestinal parasitosis (39.4%), followed by syphilis (14.6%), HIV infection (9%), chronic HCV (5%), and HBV (3.3%). Most of the cases of HIV (78%) and HBV (85%) were diagnosed in patients aged between 16 and 45 years. Hepatitis C virus appeared mostly in patients in the 46- to 65-year range (P = 0.001; odds ratio [OD]: 3.667 [1.741-7.724]) or older than 65 years (P = 0.0001; OR: 26.350 [7.509-92.463]). Syphilis was diagnosed more frequently in patients older than 46 years (P = 0.0001; OR: 4.273 [2.649-6.893]). Multivariate analysis confirmed a greater presence of HCV infection (P = 0.049) and syphilis (P = 0.0001) in patients aged between 46 and 65 years. In 15.4% of patients, screening did not find any pathology. These data show a high prevalence of imported diseases in the female immigrant population, which may have serious consequences in terms of morbimortality and vertical transmission. Our results encourage the establishment of policies of active screening both in women of childbearing age and within the specific pregnancy screening programs.

Microbiological effects of an antiseptic mouthrinsein irradiated cancer patients

Objective: To assess the microbiological effects of an antiseptic, non-alcohol based mouth-rinse containing chlorhexidineand cetylpyridinium chloride, in patients undergoing radiation therapy for head-and-neck cancer.Study Design: This was a parallel, double-blind, prospective, randomized clinical trial, including patients irradiatedas part of the therapy of head-and-neck cancer, aged 18-75, with at least 10 teeth, and willing to sign an informed consent. Cancer patients were randomly assigned to one of the two treatments (test mouth-rinse or a placebo).Three visits were scheduled (baseline, 14 and 28 days). Microbiological findings were evaluated in tongue,mucosa and subgingival samples, by means of culture. Microbiological variables were assessed by means of theMann-Whitney, Wilcoxon and chi-square tests.Results: 70 patients were screened and 36 were included. The detection of Candida species in mucosa and tonguesamples showed significant reductions in the test group. Total bacterial counts decreased in both groups frombaseline to the 2-week visit, while minor changes occurred between 2 and 4 weeks (effects on P. gingivalis, P.intermedia, C. rectus, E. corrodens).Conclusions: Within the limitations of the small sample size, this study suggests that the use of the tested mouthrinsemay lead to improvements in microbiological parameters in patients irradiated for head-and-neck cancer (AU)

Microbiological effects of an antiseptic mouthrinse in irradiated cancer patients.

OBJECTIVE: To assess the microbiological effects of an antiseptic, non-alcohol based mouth-rinse containing chlorhexidine and cetylpyridinium chloride, in patients undergoing radiation therapy for head-and-neck cancer. STUDY DESIGN: This was a parallel, double-blind, prospective, randomized clinical trial, including patients irradiated as part of the therapy of head-and-neck cancer, aged 18-75, with at least 10 teeth, and willing to sign an informed consent. Cancer patients were randomly assigned to one of the two treatments (test mouth-rinse or a placebo). Three visits were scheduled (baseline, 14 and 28 days). Microbiological findings were evaluated in tongue, mucosa and subgingival samples, by means of culture. Microbiological variables were assessed by means of the Mann-Whitney, Wilcoxon and chi-square tests. RESULTS: 70 patients were screened and 36 were included. The detection of Candida species in mucosa and tongue samples showed significant reductions in the test group. Total bacterial counts decreased in both groups from baseline to the 2-week visit, while minor changes occurred between 2 and 4 weeks (effects on P. gingivalis, P. intermedia, C. rectus, E. corrodens). CONCLUSIONS: Within the limitations of the small sample size, this study suggests that the use of the tested mouth-rinse may lead to improvements in microbiological parameters in patients irradiated for head-and-neck cancer.

Mucositis in irradiated cancer patients: Effects of an antiseptic mouthrinse

Objective: To assess the effects of an antiseptic, non-alcohol based mouth-rinse containing chlorhexidine and cetylpyridinium chloride, in preventing the oral complications associated to radiation therapy in head-and-neckcancer patients.Study design: This was a parallel, double blind, prospective, randomized clinical trial. Cancer patients were randomly assigned to one of the two treatments (test mouth-rinse or a placebo). Three visits were scheduled (baseline,14 and 28 days). Different outcome variables were evaluated: mucositis, plaque and gingival indices, stimulated saliva and salivary pH.Results: 70 patients were screened and 36 were included. The presence and the degree of mucositis significantly increased in both groups and no significant differences were detected between groups, although the median increase in the placebo group (1.81) at 2 weeks was higher than in the test group (1.20).Conclusions: Within the limitations of the small sample size, this study suggests that the use of the tested mouthrinsemay lead to some improvements in clinical parameters in patients irradiated for head-and-neck cancer (AU)

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Mucositis in irradiated cancer patients: effects of an antiseptic mouthrinse.

OBJECTIVE: To assess the effects of an antiseptic, non-alcohol based mouth-rinse containing chlorhexidine and cetylpyridinium chloride, in preventing the oral complications associated to radiation therapy in head-and-neck cancer patients. STUDY DESIGN: This was a parallel, double blind, prospective, randomized clinical trial. Cancer patients were randomly assigned to one of the two treatments (test mouth-rinse or a placebo). Three visits were scheduled (baseline, 14 and 28 days). Different outcome variables were evaluated: mucositis, plaque and gingival indices, stimulated saliva and salivary pH. RESULTS: 70 patients were screened and 36 were included. The presence and the degree of mucositis significantly increased in both groups and no significant differences were detected between groups, although the median increase in the placebo group (1.81) at 2 weeks was higher than in the test group (1.20). CONCLUSIONS: Within the limitations of the small sample size, this study suggests that the use of the tested mouth-rinse may lead to some improvements in clinical parameters in patients irradiated for head-and-neck cancer.

Tasa de derivación y factores asociados a la calidad de la hoja de derivación en Atención Primaria / Influence of the primary care physician in the quantity and quality of referrals to Specialist Services

Objetivo. 1) Analizar la relación entre la cantidad y calidad de las hojas de interconsulta (IC) y los factores relacionados con el médico de familia (MF). 2) Conocer su distribución por especialidades.Diseño. Estudio descriptivo, transversal.Emplazamiento. Centro de salud urbano de la ciudad de Cuenca.Sujetos. Analizamos un total de 1.214 derivaciones realizadas a través del programa informático de explotación de datos (TURRIANO) por 7 MF, durante el último trimestre del año 2005.Mediciones principales. Se han analizado retrospectivamente las hojas de IC. Recogimos variables asociadas al MF y asociadas a la propia IC (especialidad a la que va dirigida, fecha y calidad). Se establecieron 3 categorías para valorar la calidad de las IC: “mala” (cumplía al menos uno de los criterios “ausencia de motivo de consulta y/o anamnesis de la enfermedad actual” y “ausencia de exploración física y/o exploraciones complementarias”), “aceptable” (presencia simultánea de los dos criterios anteriores) y “buena” (cumplía criterios de “aceptable” más la presencia de al menos uno de los siguientes: antecedentes familiares, antecedentes personales, tratamiento habitual, diagnóstico de sospecha).Resultados. La calidad de las derivaciones fue defi ciente en un 68,2%, aceptable en un 11,4%, y buena en un20,3%. Los servicios a los que más se derivó fueron Traumatología 14,7%, Oftalmología 11,8%, Ginecología11% y Dermatología 10,1%.La proporción de derivaciones buena/aceptable en las especialidades más demandadas fue: Dermatología66,7%, Traumatología 29,1%, Otorrinolaringología 23,3%, Ginecología 19,5% y Oftalmología 16,8%. En cuantoa la calidad aceptable/buena de la interconsulta, la variable formación MIR presentó una diferencia estadísticamente significativa (p = 0,03). El 28,6% tenía formación MIR, el 57,1% eran tutores y el 57,1% hombres.Conclusiones. El número de IC realizadas por un equipo de Atención Primaria (EAP) a Atención Especializada(AE) es una referencia de su correcto funcionamiento y de su capacidad de resolución. Encontramos una granvariabilidad en el número de las IC entre los distintos médicos, que no parece justifi carse por el número detarjetas y el volumen de trabajo. Disponer de formación especializada y tutorizar residentes parece relacionarsecon mayor capacidad de cumplimentación y calidad de las interconsultas

Objective. To analyze the relationship between the quantity and quality of referrals and factors related to the family physician (FP). To determine their distribution by specialities.Design. Descriptive, cross study.Setting. Primary care centre in Cuenca city.Subjects. We analyzed a total of 1,214 referrals, using the software package (TURRIANO), made by 7 familyphysicians during the last quarter of 2005.Main measurements. Referral forms were analysed retrospectively. We compiled variables associated with the family physician (fi gure 1) and with the referral itself (speciality to which it is addressed, date and quality).Three categories were established to assess the quality of referrals. Poor quality referrals met at least one ofthe 2 following criteria “lack of consultation reason (MC) and/or current history of the disease (AD)” and “lack of physical (PE) and/or complementary tests (CT)”. In acceptable referrals, the two previous criteria were present simultaneously. Finally, a referral was evaluated as good if it fulfi lled all the criteria for being acceptable plus thepresence of at least one of the following: Family history, personal history, routine treatment, diagnosis.Results. We analyzed 1,214 referrals. The quality of the referrals was poor in 68.2%, acceptable in 11.4% andgood in 20.3%. The services that most referrals were made to were Traumatology 14.7%, Ophthalmology 11.8%,Gyneacology 11%, and Dermatology 10.1%. The proportion of good/acceptable referrals in the most popularspecialities were: Dermatology 66.7%, Traumatology 29.1%, Otolaryngology 23.3%, Gyneacology 19.5% andOphthalmology 16, 8%.With regard to the acceptable /good quality of the referral only the variable training (MIR) presented a statisticallysignifi cant difference (p = 0, 03). Of the doctors considered, 28. 6% had MIR training, 57.1% were tutors and 57.1% were male.Conclusions. The number of referrals made by a Primary Health Care team (PC) to Specialist care (SC) is relatedto correct performance of this team and their ability to solve problems in their daily work.In our study there was a great variability in the number of referrals made by different doctors, which does notappear to be justifi ed by the number of cards and workload. Having specialist training and tutoring residents appears to be associated with a greater capacity and quality completion of referrals

Efficacy of a 0.15% benzydamine hydrochloride and 0.05% cetylpyridinium chloride mouth rinse on 4-day de novo plaque formation.

OBJECTIVE: To evaluate the effect of a mouth-rinse formulation combining benzydamine hydrochloride and cetylpyridinium chloride (BNZ+CPC) in preventing de novo plaque formation, in comparison with CPC and placebo mouth rinses. PATIENTS AND METHODS: This was a controlled, observer-blind, cross-over study. In this model of plaque re-growth, subjects received a session of oral prophylaxis and were directed to withdraw oral hygiene measures for the next 4 days, using only the mouth rinse assigned. The outcome parameters were the plaque index (PlI) and gingival index (GI). In addition, microbiological evaluation of the subgingival microflora, by means of culture, was performed, as well as patient-based variables. Data analysis was carried out using anova for Latin-square design. RESULTS: The analysis of variance showed a significant statistical difference between the BNZ+CPC association and placebo (p<0.0001). No differences between CPC and placebo were detected considering multiple comparisons between treatments. The 90% confidence interval of the differences between BNZ+CPC and CPC showed no equivalence between treatments, being the PlI lower in the BNZ+CPC group. No significant difference between groups in GI was observed. Mean anaerobic colony-forming units (CFU) demonstrated a significant increase between visits in all groups (p<0.001) and differences among groups were not significant. Subjects treated with BNZ+CPC frequently reported "tingling mouth" and "numbness mouth". CONCLUSION: Within the limitations of the study model, the BNZ+CPC combination showed a statistically significant plaque-inhibitory capacity, as compared with the placebo mouth rinse, and an additive effect as compared with CPC. No relevant clinical or microbiological adverse effects were detected.

A randomized clinical trial on the short-term clinical and microbiological effects of the adjunctive use of a 0.05% chlorhexidine mouth rinse for patients in supportive periodontal care.

OBJECTIVE: To evaluate the clinical and microbiological activity of a new mouth rinse formulation, used as an adjunct to oral hygiene, for patients in supportive periodontal care. PATIENTS AND METHODS: This was a randomized, placebo-controlled clinical trial with two groups: test group, rinsing twice per day with the test product (with 0.05% chlorhexidine and 0.05% cetylpyridinium chloride); and control group, rinsing with a placebo. Treated chronic periodontitis patients were included, and two visits were rendered, baseline, and after 15 days. Clinical outcome variables included plaque and gingival indices, and probing pocket depth. Subgingival samples were processed by culturing. Patient-based variables and adverse effects were also assessed. Outcome variables were compared by t-test, chi2, and Mann-Whitney test. RESULTS: The results belonged to 33 patients. Plaque and gingival indices, and the log of bacterial total counts were reduced in the test group (p < or = 0.01), but differences between groups were only statistically significant (p < 0.05) for plaque and bacterial counts. A significant reduction in the proportions of flora (p < 0.05) and frequency of detection (p = 0.01) of Porphyromonas gingivalis was observed in the test group. CONCLUSIONS: The newly formulated mouth rinse demonstrated short-term plaque-inhibitory activity. This was associated with a reduction in the total load of anaerobic subgingival microflora.

Differences in antimicrobial activity of four commercial 0.12% chlorhexidine mouthrinse formulations: an in vitro contact test and salivary bacterial counts study.

AIM: To evaluate the in vitro and in vivo antimicrobial activity of four commercial 0.12% chlorhexidine mouthrinses. MATERIAL AND METHODS: The in vitro antimicrobial activity test consisted in a modified contact test where 20 selected bacterial species were tested during 1 min with each test product. After the contact, the inoculum was cultured, and the results were expressed in terms of survival/resistance and the percentage of survival as compared to a saline control. The in vivo test consisted of a double-blind, randomized, crossover salivary bacterial counts study. 10 volunteers rinsed during 1 min with each tested product. Saliva samples were obtained before rinsing, and after 5 min, and 1, 3, 5 and 7 h. These samples were cultured both aerobically and anaerobically. Percentages of survival, in regard to baseline, were calculated for each time point. Comparisons among products were tested using anova and selected paired t-test. RESULTS: The in vitro contact test showed no survival in any tested species with CHX+CPC, while three species (Lactobacillus casei, Streptococcus mitis and Peptostreptococcus micros) were resistant to the other three products. CHX and CHX+NaF demonstrated additional resistant species (three and four species, respectively). The in vivo salivary bacterial counts test showed higher reductions of CHX+CPC and CHX+ALC in aerobic and anaerobic bacteria, lasting for 5 h. Significant differences were detected at multiple time points, when these two products were compared both with the control and the other tested products. CONCLUSION: Important differences in activity, among 0.12% CHX products, were detected by both in vitro and in vivo tests. The formulation with alcohol was more active than those without alcohol, excepting the formulation with CHX+CPC, in which the reformulation and addition of CPC not only compensate but rather increase the antimicrobial activity.