RESUMEN
OBJECTIVES: To study the distribution of disease-associated prion protein (PrP) in oral and dental tissues in variant CJD. DESIGN: Prospective single centre autopsy based study. SETTING: Within the National CJD Surveillance Unit, UK, 2000-2002. MATERIALS AND METHODS: Patients with suspected variant CJD undergoing autopsy where permission to remove tissues for research purposes had been obtained from the relatives. Fixed and frozen autopsy tissues from the brain, trigeminal ganglion, alveolar nerve, dental pulp, gingiva, salivary gland, tongue and tonsils were studied by Western blot, PET blot and immunocytochemistry to detect disease-associated PrP. RESULTS: Disease-associated PrP was only detected in the brain, trigeminal ganglia and tonsils. CONCLUSIONS: The failure to detect disease-associated PrP in most dental and oral tissues will help inform ongoing risk assessments for dental surgery in relation to the possible iatrogenic transmission of variant CJD via dental instruments.
Asunto(s)
Síndrome de Creutzfeldt-Jakob/transmisión , Atención Dental para Enfermos Crónicos , Proteínas PrPSc/análisis , Adulto , Anciano , Química Encefálica , Síndrome de Creutzfeldt-Jakob/prevención & control , Instrumentos Dentales , Contaminación de Equipos , Femenino , Humanos , Immunoblotting , Técnicas para Inmunoenzimas , Masculino , Persona de Mediana Edad , Tonsila Palatina/química , Estudios Prospectivos , Distribución Tisular , Ganglio del Trigémino/químicaRESUMEN
The scope and scale of problems in the quality of health service provision have been increasingly recognised in recent years. Policy and planning for financing are usually concerned with how funding is made available and allocated, rather than with what is being achieved, including the quality of health services delivered. A fundamental challenge is how to improve the delivery of health services to achieve improved patient outcomes and to optimize financial outcomes. To accomplish this it is essential that the debates on quality of care and financing are aligned. Approaches to improving the quality of care are drawn from Australia, the US, and the UK. Financing arrangements for care at a national level have a bearing on how payment incentives can be used to promote or impede quality. The level of overall expenditure is obviously important, as are the mechanisms for payment. Long term programs to build knowledge, standardise processes, provide credible performance data and foster accountability are required to ensure that further investments lead to improvement in care.