[Adjustments for the care of people with sensory disabilities in primary health centers]. / Adecuaciones para la atención de personas con discapacidad sensorial en los CESFAM del Servicio de Salud Concepción.

BACKGROUND: People with Sensory Disabilities (PcDS) face barriers for equal access to health care. Thus, health centers require adjustments to comply with equal access that allows an universal coverage of care. AIM: To characterize the adjustments for the care of PcDS in primary health centers in Concepción, Chile. MATERIAL AND METHODS: Cross-sectional study using data obtained through a questionnaire to key informants or via Transparency Law, and direct observation. The variables were subdivided into four categories, namely infrastructure, communication, skills, and environment. RESULTS: The analyzed health centers have a high proportion of general adjustments of their physical settings. However, there is a lack of specific adjustments for deaf and blind people, especially communicational ones. CONCLUSIONS: There is a paucity of adjustments for the health care of PcDS in the analyzed health centers. This deficiency underscores the barriers faced by PcDS for receiving care in the Chilean public health system.

[Health care of people with visual or hearing disabilities]. / Estado actual de la atención sanitaria de personas con discapacidad auditiva y visual: una revisión breve.

Visual or hearing disabilities account for 20% of people reporting some sort of disability. We performed a literature review about the interaction that people with visual or hearing disabilities have with the health care system. We found that these people report a lower quality of life and have a higher frequency of physical and psychological ailments. They also have difficulties to obtain an adequate health care and report a paucity of trained professionals to take care of them.

Effects of a Nintendo Wii exercise program versus Tai Chi Chuan on standing balance in older adults: a preliminary study.

[Purpose] This study compared the effect of the Nintendo Wii balance board (NWBB) and Tai Chi Chuan (TCC) on the standing balance (SB) of older adults. [Participants and Methods] Twelve older adults (NWBB=7 and TCC=5) completed the intervention and two testing sessions (pre-post). SB was assessed using posturographic measures with the center of pressure (CoP) in five modes: quiet eyes open (QSB-EO) and eyes closed (QSB-EC), on sponge (SBS-EO and SBS-EC), and with optokinetic field (SB-OF). [Results] Both interventions significantly decrease the area of CoP sway (CoPSway) in QSB-EO and SB-OF. The NWBB-group decreased CoPSway in SBS-EC and CoP velocity (Vmean) in QSB-EO, QSB-EC, and SBS-EC. The TCC-group decreased the Vmean in SBS-EO and conversely the Vmean in QSB-EC increased. [Conclusion] Sponge and optokinetic field were the most unstable assessments. These findings reveal the potential benefits for SB of both interventions, however the NWBB improved more variables in the postural control of older adults.

Adaptation and Validation of the Rapid Estimate of Adult Literacy in Dentistry for Chilean Population.

OBJECTIVE: To adapt and validate the Rapid Estimate of Adult Literacy in Dentistry (REALD-30) for the Chilean population. METHODS: REALD-30 was translated to Spanish, piloted, and revised by experts. Demographics, oral health status, oral health-related quality of life, and health literacy were analyzed. Summary measures, internal consistency, reliability, and convergent and predictive validity were calculated. RESULTS: Cronbach's alpha was 0.876, intra-class correlation coefficient was 0.789 for reliability, Pearson´s and Spearman´s correlations were ≥0.693 for convergent validity, and <= *-0.138 for predictive validity. CONCLUSION: REALD-30 is a valid and reliable instrument to measure oral health literacy in the Chilean population.

[Psychosocial impact of type 1 diabetes mellitus in children, adolescents and their families. Literature review]. / Impacto psicosocial de la diabetes mellitus tipo 1 en niños, adolescentes y sus familias. Revisión de la literatura.

Type 1 diabetes mellitus is the most common chronic endocrine pathology among children. Treatment includes diet, physical activity, insulin medication, and proper self-control. This self-control may be difficult, resulting in children, adolescents and their families suffering diverse psychosocial complications. There is an inverse relationship between self-control and psychosocial complications, the main problems being anxiety and depression, where adolescents are 2.3 times more likely to have mental health problems. Families are initially affected, in the debut period by a state of shock, with feelings of distress and anger. The necesary changes in habits and lifestyles can lead to psychosocial problems, including anxiety, depression and eating disorders. Subsequently, the child or adolescent and his or her family group may move into new balance characterized by good self-control and adherence to tratment, or deepen individual and group disorders which may reappear, especially in adolescence. The comprehensive treatment of type 1 diabetes mellitus requires addressing these aspects through multidisciplinary teams which include medical and phychosocial professionals. This review analyses the main aspects related to the psychosocial impact of diabetes mellitus type 1 among children, adolescents and their families.

Impact of proximity of thermoelectric power plants on bronchial obstructive crisis rates.

BACKGROUND: Environmental pollution is a risk factor for cardiorespiratory diseases. Energy generated by thermoelectric power plants (TEPP) represents a relevant source of pollution. The aim of this study was to evaluate the relationship between living near a coal-fired TEPP and the consultation rates for bronchial obstructive crises (BOC) in the province of Concepción, Chile. METHODS: Population-based study. The epidemiological weeks from 2012 to 2014 were analyzed. The dependent variable was the emergency consultation rate for BOC in two health centers within 5 km of a TEPP (Coronel) and two that were more than 40 Km away from a TEPP (Talcahuano). The independent variables were the commune, climatological variables (air temperature and relative atmospheric humidity), environmental pollutants (PM10, PM2.5 and nitrogen oxide), weeks with the highest consultation rate and the years. Rates, Pearson's correlation and gross risk measures were calculated and adjusted for environmental and climatological variables. RESULTS: BOC rates were significantly higher in Coronel (RR = 4.9 95% CI 4.0-5.8; p < 0.05). The PM2.5 it showed the strongest correlation with BOC rates (r = 0.3; p < 0.01) in Coronel, but not Talcahuano. Linear regression modelling indicated that proximity to a TEPP (health center location) and temperature explained 26 and 18% of the variance in BOC rates, respectively. CONCLUSIONS: Rates of emergency consultation for BOC were significantly higher among a population living within 5 km of a coal-fired TEPP than those living 40 km away.

Correlation between center of pressure and functional balance in non-faller elderly practitioners of Tai Chi Chuan.

[Purpose] This study aimed to determine the correlation between center of pressure and functional balance in non-faller elderly practitioners of Tai Chi. [Subjects and Methods] For the study, nine non-faller elderly practitioners of Tai Chi who were able to maintain a standing posture and walk independently were recruited. Timed one-leg standing and timed up-and-go tests were used as functional balance tests and force platform to measure the center of pressure. The Pearson correlation coefficient was calculated for the timed up-and-go/timed one-leg standing test scores and center of pressure parameter values. [Results] None of the correlations was statistically significant, but moderate correlations were observed between the pairs timed one-leg standing/sway area of center of pressure, timed one-leg standing/standard deviation of center of pressure in the mediolateral direction, timed one-leg standing/mean velocity of center of pressure in the anteroposterior direction, and timed up-and-go test sway area of center of pressure. [Conclusion] Timed one-leg standing is more appropriate than timed up-and-go test for the measurement of functional balance in non-faller elderly practitioners of Tai Chi.

Change in functional balance after an exercise program with Nintendo Wii in Latino patients with cerebral palsy: a case series.

[Purpose] This study aimed to explore the possibility of improving functional balance using an exercise program with Nintendo and the Balance Board peripheral in subjects with cerebral palsy. [Subjects and Methods] This study included 4 male outpatients of a neurological center. All participants received an exercise program based on the use of Nintendo with the Balance Board peripheral. Training consisted of three 25-min sessions per week for 6 weeks. Each session was guided by a physical therapist. Timed up-and-go and one-leg standing tests were conducted before and after the intervention. [Results] All subjects showed significant improvements in the results of the timed up-and-go test. However, there were no significant changes in the results of the one-leg standing test. [Conclusion] The exercise protocol involving Nintendo with the Balance Board peripheral appears to improve functional dynamic balance in patients with cerebral palsy. However, static functional balance does not improve after 6 weeks of training.

[Prevalence of metabolic syndrome in Mapuche individuals living in urban and rural environment in Chile]. / Prevalencia de síndrome metabólico en individuos de etnia Mapuche residentes en zonas rurales y urbanas de Chile.

BACKGROUND: Metabolic Syndrome (MS) increases the risk of diabetes and mortality associated with cardiovascular disease. However, the prevalence of MS could differ by ethnicity and lifestyle factors. AIM: To determine the prevalence of MS in Mapuche individuals living in urban and rural environments in Chile and to investigate whether the prevalence and risk of MS in urban and rural environments differs by sex, age and nutritional status. MATERIAL AND METHODS: A total of 1077 Mapuche participants were recruited from urban (MU = 288) and rural (MR = 789) settings. Body mass index, waist circumference and blood pressure were measured. A fasting blood sample was obtained to measure serum glucose, HDL cholesterol and triacylglycerol. The prevalence of MS was determined using the unified IDF and ATP-III criteria. RESULTS: An environment and sex interaction was found for the prevalence of MS (p = 0.042). The prevalence was significantly lower in male MR (13%) compared to other groups (22, 23 and 25% among female MR, female MU and male MU respectively). Also, the prevalence of central obesity and low HDL-cholesterol were significantly lower in male MR. MU are at an increased risk of developing MS compared to MR, with an odds ratio of 1.59 (95% confidence intervals 1.1 to 2.2). This risk increases along with age or body mass index of the population. CONCLUSIONS: The adoption of an urbanized lifestyle increases the risk of developing MS in Mapuche individuals. This risk is enhanced by age and nutritional status.

Motivational interviewing at home: A community trial to improve oral health literacy and reduce morbidity in disadvantaged Chilean families.

BACKGROUND: Limited evidence exists regarding the effects of home-based interventions on oral health outcomes in preschool-aged children or caregivers despite the success of such interventions in other child and pregnancy health outcomes. The aim of this community trial was to assess the impact after 12 months of a home-delivered motivational interviewing (MI) intervention on oral health outcomes in disadvantaged Chilean families. METHODS: This trial was conducted with a community single-blinded design, including preschoolers (aged 2-4 years) and their caregivers from 2 disadvantaged communities who received either the MI intervention or standard oral health interventions at kindergartens. The MI intervention comprised from 4 through 6 tailored home visits by MI-trained dental hygienists. Data on socioeconomic-demographic factors, caries (International Caries Detection and Assessment System [ICDAS]), oral hygiene, and caregivers' oral health literacy (OHL) (assessed with Oral Health Literacy Instrument and Rapid Estimate of Adult Literacy in Dentistry, 30 items) were collected at baseline and 12-month follow-up. RESULTS: Two hundred fifty-two dyads completed baseline measurements, and 212 completed the follow-up (control, n = 104; intervention, n = 108). Weak associations were found between clinical-sociodemographic factors and OHL at baseline (correlations, < 0.3) and follow-up. Analysis of covariance revealed a reduction in caries incidence for lesions with ICDAS scores above 0 (P = .03) but not for ICDAS scores above 2 (P = .47). No reduction in oral hygiene was observed (P = .74). Oral Health Literacy Instrument scores showed no improvement (P = .10), and Rapid Estimate of Adult Literacy in Dentistry, 30 items scores showed a marginal increase (P = .03). CONCLUSIONS: Home-delivered MI intervention had a marginal impact on preschoolers' caries incidence and caregivers' OHL but no effect on preschoolers' oral hygiene, with the primary impact observed at the level of caries ICDAS scores above 0. PRACTICAL IMPLICATIONS: Home-delivered MI interventions by dental hygienists marginally reduce caries incidence in preschoolers from disadvantaged populations. This trial was registered at the Australian and New Zealand Clinical Trials Registry. The registration number is ACTRN12615000450516.

Assessing Personality Risks profile in Prosthodontics Patients: A Delphi-Driven Classification Approach.

PURPOSE: This paper aims to identify specific personality traits that could potentially undermine the overall satisfaction of the patient with the prosthodontic treatment. MATERIALS AND METHODS: A literature review was conducted to identify the personality traits (PT) relevant to patients requiring dental treatment. Later, a Delphi process was employed to classify the selected PT into risk levels to prosthodontic treatment satisfaction, ultimately leading to the development of a personality risk profile (PRP) proposal. The expert panel consisted of specialists with over ten years of practice. The Delphi process involved three rounds of evaluation and consensus building. RESULTS: Twenty-six PT associated with dental treatment satisfaction were identified. Following the three rounds of the Delphi method, a consensus was achieved, resulting in the classification of these PT into three PRP, as follows: Low Risk (cooperative, understanding, compliant, trusting, concerned about their health, willing, thankful, and responsible), Moderate Risk (Insecure, Over-informed, Demanding, Appearance-obsessed, and Pessimistic), and High Risk (mistrustful, skeptical, unwilling, defiant attitude, unrealistic expectations, neglectful, treatment resistant, patient refers negatively about other dentists, violent, irresponsible, idealise the dentist, and controller). CONCLUSIONS: This study identified and categorized PT that have the potential to adversely impact prosthodontics treatment satisfaction. Through this PRP proposal, dental professionals can recognize these patients before initiating prosthodontic interventions.

Metformin Restrains the Proliferation of CD4+ T Lymphocytes by Inducing Cell Cycle Arrest in Normo- and Hyperglycemic Conditions.

CD4+ T lymphocytes play a key role in the modulation of the immune response by orchestrating both effector and regulatory functions. The effect of metformin on the immunometabolism of CD4+ T lymphocytes has been scarcely studied, and its impact under high glucose conditions, particularly concerning effector responses and glucose metabolism, remains unknown. This study aims to evaluate the effect of metformin on the modulation of the effector functions and glucose metabolism of CD4+ T lymphocytes under normo- and hyperglycemic conditions. CD4+ T lymphocytes, obtained from peripheral blood from healthy volunteers, were anti-CD3/CD28-activated and cultured for 4 days with three concentrations of metformin (0.1 mM, 1 mM, and 5 mM) under normoglycemic (5.5 mM) and hyperglycemic (25 mM) conditions. Effector functions such as proliferation, cell count, cell cycle analysis, activation markers and cytokine secretion were analyzed by flow cytometry. Glucose uptake was determined using the 2-NBDG assay, and levels of glucose, lactate, and phosphofructokinase (PFK) activity were assessed by colorimetric assays. Metformin at 5 mM restrained the cell counts and proliferation of CD4+ T lymphocytes by arresting the cell cycle in the S/G2 phase at the beginning of the cell culture, without affecting cell activation, cytokine production, and glucose metabolism. In fact, CD69 expression and IL4 secretion by CD4+ T lymphocytes was higher in the presence of 5 mM than the untreated cells in both glucose conditions. Overall, metformin inhibited proliferation through mechanisms associated with cell cycle arrest, leading to an increase in the S/G2 phases at the expense of G1 in activated CD4+ T lymphocytes in normo- and hyperglycemic conditions. Despite the cell cycle arrest, activated CD4+ T lymphocytes remained metabolically, functionally, and phenotypically activated.

Motivational interviewing for preventing oral morbidities in adults: Systematic review and meta-analysis.

OBJECTIVE: This systematic review with meta-analysis was performed to assess whether motivational interviewing (MI) effectively prevents oral morbidities in adults. METHODS: Studies considered were randomized controlled trials, cluster-randomized controlled trials and community-based randomized trials assessing interventions based on MI or indicating that a counselling technique based on the principles developed by Miller and Rollnick was used. Controls were any type of oral health education or negative controls. Participants were 18-60 years old. The main outcome was any oral morbidity. From 602 studies identified in MEDLINE, Scopus, Web of Science and LILACS databases, seven studies were included in the synthesis. RESULTS: Studies included only evaluated periodontal outcomes, no studies were found for other oral morbidities. Patients' mean age was 43.7 years, and the follow-up time after MI or MI-based intervention varied between 1 month and 1 year. The total study population was 272 people with moderate-to-severe periodontitis; other groups analysed were pregnant women (n = 112) and patients with mental disorders and alcohol problems (n = 60). Meta-analysis for the plaque index (four studies, n = 267), bleeding on probing (two studies, n = 177) and gingival index (two studies, n = 166) were carried out. The summary effects for the random-effects model were estimated respectively as -3.59 percentage points (CI: [-11.44; 4.25] for plaque index, -6.41 percentage points (CI: [-12.18, -0.65]) for bleeding on probing and -0.70 (CI: [-1.87; 0.48]) for gingival index, marginally favouring the MI group. The reduced number of studies, the non-disclosure of some aspects of the data and the heterogeneity among them undermine the precision of the estimates. CONCLUSION: The current evidence available is limited to periodontal outcomes, and it is not possible to determine whether MI effectively prevents oral morbidities in adults.

Telerehabilitation in Low-Resource Settings to Improve Postural Balance in Older Adults: A Non-Inferiority Randomised Controlled Clinical Trial Protocol.

Background: Several exercise methods with virtual reality devices have been used in treatments for older adults and patients with neurodegenerative diseases, although the mechanisms continue to be elucidated. The aim of this study is to establish the feasibility and effectiveness of a rehabilitation programme using low-cost virtual reality aimed at improving postural balance in older adults. It also seeks to compare low-cost virtual reality under two delivery modalities, telerehabilitation (TR) in elderly centres and face-to-face (FtF) in rehabilitation centres. Methods: The study is set up as a non-inferiority two-arm parallel triple-blind randomised controlled clinical trial. Sixteen persons aged 65 to 75-years-old will be included. Eighteen Wii therapy sessions (25-30 min) will be provided through both FtF (control group, n = 8) and TR (exposure group, n = 8), both with a Nintendo Wii balance board. Data will be collected at baseline (week 0), during the Wii therapy sessions (weeks 2, 4, and 6), and during the follow-up (weeks 8 and 10). The primary outcome will be the area of centre-of-pressure (CoP) sway; secondary outcomes will be medial-lateral and anterior-posterior velocity and standard deviation of CoP; and tertiary outcomes will be clinical measures: single-leg stand, timed up-and-go tests, Barthel Index, and Tinetti's scale. Statistical analyses will be performed using SPSS 20.00 for Windows. The trial adheres to the Declaration of Helsinki and the Chilean laws of rights and duties of the patient and research in humans. Ethical approval was obtained from the Ethics Committee of the University of Talca. Written informed consent will be obtained from participants. Discussion: In this trial, older adults from a Chilean city with a large rural and underserved population share will be included to test the feasibility and effectiveness of a rehabilitation programme using low-cost VR aimed at improving postural balance to generate evidence to support decision makers generating public health policy. Trial registration: Australian New Zeeland Clinical Trials Registration (ACTRN12621001380886).

Postural control telerehabilitation with a low-cost virtual reality protocol for children with cerebral palsy: Protocol for a clinical trial.

OBJECTIVE: To establish the feasibility and effectiveness of a rehabilitation programme using low-cost virtual reality aimed at improving postural control in children with cerebral palsy-spastic hemiplegia. It also aims to compare the effectiveness of this programme under two delivery modalities, telerehabilitation (TR) and face-to-face (FtF). METHODS: This is a registered randomized controlled clinical trial protocol (ACTRN12621000117819). Eighteen sessions of low-cost virtual reality therapy will be provided through both, FtF and TR modalities using a Nintendo Wii balance board. Each programme will last for 6 weeks and will consist of 3 sessions per week of 25 minutes each. Twenty patients diagnosed with cerebral palsy-spastic hemiplegia will be recruited for each group: FtF or TR (n = 40). Participants will be assessed at baseline, by the end of weeks 2, 4, and 6, and at weeks 8 and 10 (post-intervention follow-ups). The primary outcome will be the Center of Pressure sway area (CoParea); secondary outcomes will be standard deviation and velocity of the CoP in the mediolateral and anterior-posterior directions; tertiary outcomes will include the Modified-Modified Ashworth Scale for lower limbs, Modified Ashworth Scale for upper limbs, timed up-and-go tests, the timed one-leg standing and 6-minute walk test. RESULTS: This study provides an assessment of the feasibility and effectiveness of an affordable rehabilitation programme using low-cost virtual reality aimed at improving postural control in children with cerebral palsy. CONCLUSION: The designed rehabilitation programme using low-cost virtual reality may improve postural control in children with cerebral palsy-spastic hemiplegia. The TR modality is likely to be as effective as the FtF modality. The TR programme has been designed to overcome access barriers to physiotherapy services for children with cerebral palsy in low-resource settings, remote areas, and in restricted mobility contexts.

Association of social factors and health conditions with capacity and performance.

OBJECTIVE: Determine and measure the association of social factors and health conditions with worse capacity and performance levels. METHODS: Dependent variables consisted of performance and capacity; independent variables comprised age, gender, level of education, personal income, and health conditions. Means (95%CI) of performance and capacity were presented according to the independent variables. Generalized linear models, using a mutual adjustment for all variables considered statistically significant (p < 0.05), measured the associations between each exposure and outcomes. Study population included 12,265 individuals. RESULTS: Older women with lower education and income levels and with some health condition showed the worst performance and capacity. CONCLUSION: Results showed that the capacity and performance levels of the Chilean population changed according to social demographic characteristics and health conditions.

Osteoimmunology drives dental implant osseointegration: A new paradigm for implant dentistry.

There is a complex interaction between titanium dental implants, bone, and the immune system. Among them, specific immune cells, macrophages play a crucial role in the osseointegration dynamics. Infiltrating macrophages and resident macrophages (osteomacs) contribute to achieving an early pro-regenerative peri-implant environment. Also, multinucleated giant cells (MNGCs) in the bone-implant interface and their polarization ability, maintain a peri-implant immunological balance to preserve osseointegration integrity. However, dental implants can display cumulative levels of antigens (ions, nano and microparticles and bacterial antigens) at the implant-tissue interface activating an immune-inflammatory response. If the inflammation is not resolved or reactivated due to the stress signals and the immunogenicity of elements present, this could lead implants to aseptic loosening, infections, and subsequent bone loss. Therefore, to maintain osseointegration and prevent bone loss of implants, a better understanding of the osteoimmunology of the peri-implant environment would lead to the development of new therapeutic approaches. In this line, depicting osteoimmunological mechanisms, we discuss immunomodulatory strategies to improve and preserve a long-term functional integration between dental implants and the human body. Scientific field of dental science: implant dentistry.

Oral Health and Dental Care in Deaf and Hard of Hearing Population: A Scoping Review.

PURPOSE: To compile the literature available about the oral health and dental care of the deaf and hard of hearing (DHH) population. MATERIALS AND METHODS: The study question of this scoping review was 'What are the main findings reported in the literature about oral health and dental care of the DHH population?' The following databases were included: Web of Science, LILACS, SciELO, MEDLINE, Scopus, EMBASE, GoogleScholar and Redalyc. Full-text articles published in peer-reviewed journals, in Spanish, Portuguese, and English, from the January 2000 to January 2018 were selected with qualitative and quantitative methods. All study designs were included in the review with the exception of letters to the editor and case reports. RESULTS: A total of fifty articles were selected for analysis. DHH population has poorer oral hygiene and a higher prevalence of caries than their non DHH peers. DHH also report significant struggles with oral health and dental access. Most dentists experienced difficulties communicating with their DHH patients. CONCLUSIONS: This scoping review is the first known that centers on DHH oral health and their dental care. Efforts to develop accessible dental health programmes are needed to address apparent oral health inequities in the DHH population.

Inasistencia a citas dentales: una revisión breve de las causas y las estrategias para su prevención / Non-attendance at dental appointments: a brief review of causes and strategies for prevention / Não comparência a consultas de medicina dentária: uma breve análise das causas e estratégias de prevenção

RESUMEN La inasistencia a citas dentales es un problema relevante en la atención sanitaria debido a las consecuencias negativas que implica. El presente artículo tiene como objetivo revisar las causas de la inasistencia y las estrategias implementadas para su prevención a nivel internacional. Los factores socioeconómicos, culturales, geográficos y demográficos son identificados como las principales causas del ausentismo. Se ha observado una relación inversamente proporcional entre el nivel socioeconómico y el ausentismo, donde aquellos pacientes con mayores recursos tienden a tener una menor inasistencia. El factor socioeconómico y cultural, junto con la educación en salud oral, influyen en la preocupación y la frecuencia de los controles dentales. Se han propuesto diversas soluciones, como el recordatorio telefónico o mediante mensajes de texto (SMS), aunque su efectividad puede variar debido a la familiaridad y el acceso de los pacientes a la tecnología. Se requiere abordar este problema de manera integral y considerar diferentes enfoques para reducir la inasistencia a citas dentales.

ABSTRACT Non-attendance at dental appointments is a relevant problem in health care due to the negative consequences it entails. This article aims to review the causes of nonattendance and the strategies implemented for its prevention at the international level. Socioeconomic, cultural, geographic, and demographic factors are identified as the main causes of absenteeism. An inversely proportional relationship has been observed between socioeconomic status and absenteeism, with those patients with greater resources tending to have lower absenteeism. Socioeconomic and cultural factors, together with oral health education, influence the concern and frequency of dental checkups. Various solutions have been proposed, such as telephone or SMS reminders, although their effectiveness may vary due to patient familiarity and access to technology. There is a need to address this problem comprehensively and consider different approaches to reduce missed dental appointments.

RESUMO A não comparência às consultas de medicina dentária é um problema relevante nos cuidados de saúde pelas consequências negativas que acarreta. Este artigo tem como objetivo rever as causas do absentismo e as estratégias implementadas para a sua prevenção a nível internacional. Os fatores socioeconómicos, culturais, geográficos e demográficos são identificados como as principais causas do absentismo. Foi observada uma relação inversamente proporcional entre o estatuto socioeconómico e o absentismo, sendo que os doentes com mais recursos tendem a ter menos absentismo. Os fatores socioeconómicos e culturais, juntamente com a educação para a saúde oral, influenciam a preocupação e a frequência das consultas dentárias. Têm sido propostas várias soluções, como lembretes por telefone ou SMS, embora a sua eficácia possa variar devido à familiaridade do paciente e ao acesso à tecnologia. É necessário abordar este problema de forma abrangente e considerar diferentes abordagens para reduzir a não comparência às consultas dentárias.

Coupling between Osseointegration and Mechanotransduction to Maintain Foreign Body Equilibrium in the Long-Term: A Comprehensive Overview.

The permanent interaction between bone tissue and the immune system shows us the complex biology of the tissue in which we insert oral implants. At the same time, new knowledge in relation to the interaction of materials and the host, reveals to us the true nature of osseointegration. So, to achieve clinical success or perhaps most importantly, to understand why we sometimes fail, the study of oral implantology should consider the following advice equally important: a correct clinical protocol, the study of the immunomodulatory capacity of the device and the osteoimmunobiology of the host. Although osseointegration may seem adequate from the clinical point of view, a deeper vision shows us that a Foreign Body Equilibrium could be susceptible to environmental conditions. This is why maintaining this cellular balance should become our therapeutic target and, more specifically, the understanding of the main cell involved, the macrophage. The advent of new information, the development of new implant surfaces and the introduction of new therapeutic proposals such as therapeutic mechanotransduction, will allow us to maintain a healthy host-implant relationship long-term.