Fluoride varnish or fluoride mouth rinse? A comparative study of two school-based programs.

OBJECTIVE: In many Danish communities, school-based fluoride programs are offered to children with high caries risk in adjunct to tooth brushing. The purpose of this field trial was to compare the caries-preventive effectiveness of two different fluoride programs in 6-12 year olds. BASIC RESEARCH DESIGN: Clinical controlled trial. CLINICAL SETTING: The 2-year study was conducted in Public Dental Clinics in a multicultural low-socioeconomic suburban area of Odense, Denmark with an elevated prevalence of caries compared to the city average. PARTICIPANTS: 1,018 children (aged 6-12 years) from 9 different schools were enrolled after informed consent and their class unit was randomly allocated to one of two fluoride programs. INTERVENTIONS: One group received a semi-annual fluoride varnish applications (FV) and the other group continued with an existing program with fluoride mouth rinses once per week (FMR). All children received oral hygiene instructions and comprehensive dental care at the local Public Dental Clinics throughout the study period. MAIN OUTCOME MEASURES: Increment of caries lesions in permanent teeth at both cavitated and initial caries levels. RESULTS: The groups were balanced at baseline. After two years, 961 children (94.4%) were reexamined. The FV group showed a mean DMFS increment of 0.36 compared to 0.41 in the FMR group. The corresponding values for initial caries lesions were 0.83 and 0.91 respectively. CONCLUSION: There were no statistically significant differences in caries development over two years among children participating in a school-based fluoride varnish or mouth rinse program.

Alternative careers in pediatric dentistry: a survey of pediatric dental residents.

Pediatric dentistry has enjoyed growing popularity in recent years, yet there remains a need for leadership in academe, research, and public health. In November 2008, the first Maternal and Child Health Bureau-sponsored regional Leadership in Pediatric Dentistry convocation was held at the Columbia University College of Dental Medicine. Seventy-two pediatric dentistry trainees from thirteen programs in the New York City area participated in interactive presentations and exercises. Of the sixty- seven participants who completed a pre-event survey, 93 percent stated they would likely or very likely pursue careers that involved, at least in part, private practice, 55 percent in care of children in Medicaid, 51 percent academics, 36 percent dental public health, and 12 percent research. Barriers related to finances, competence, or work environment/location were perceived by 83 percent for careers involving research, 73 percent for dental public health, 66 percent for providing care to children in Medicaid, 46 percent for academics, and 9 percent for private practice. Results of a pair of pre-event and post-event surveys completed by sixty-three attendees showed no change in reported likelihood to pursue a career alternative except for an increase in the likelihood of working in a practice that accepts Medicaid. The challenge before dental educators is to provide consistent and meaningful opportunities throughout training that encourage residents to consider all career options and to discover how their individual interests mesh with their clinical learning.

The medical care of patients with primary care home nursing is complex and influenced by non-medical factors: a comprehensive retrospective study from a suburban area in Sweden.

BACKGROUND: The reduced number of hospital beds and an ageing population have resulted in growing demands for home nursing. We know very little about the comprehensive care of these patients. The objectives were to identify the care, in addition to primary health care, of patients with primary-care home nursing to give a comprehensive view of their care and to investigate how personal, social and functional factors influence the use of specialised medical care. METHODS: One-third (158) of all patients receiving primary-care home nursing in an area were sampled, and 73 % (116) were included. Their care from October 1995 until October 1996 was investigated by sending questionnaires to district nurses and home-help providers and by collecting retrospective data from primary-care records and official statistics. We used non-parametric statistical methods, i.e. medians and minimum - maximum, chi2, and the Mann-Whitney test, since the data were not normally distributed. Conditional logistic regression was used to study whether personal, social or functional factors influenced the chance (expressed as odds ratio) that study patients had made visits to or had received inpatient care from specialised medical care during the study year. RESULTS: 56 % of the patients had been hospitalised. 73 % had made outpatient visits to specialised medical care. The care took place at 14 different hospitals, and more than 22 specialities were involved, but local care predominated. Almost all patients visited doctors, usually in both primary and specialised medical care. Patients who saw doctors in specialised care had more help from all other categories of care. Patients who received help from their families made more visits to specialised medical care and patients with severe ADL dependence made fewer visits. CONCLUSIONS: The care of patients with primary-care home nursing is complex. Apart from home nursing, all patients also made outpatient visits to doctors, usually in both primary and specialised medical care. Many different caregivers and professions were involved. Reduced functional capacity decreased and help from family members increased the chance of having received outpatient specialised medical care. This raises questions concerning the medical care for patients with both medical and functional problems.

The pathways to primary mental health care in high-density suburbs in Harare, Zimbabwe.

The pathways to care for mental illness are diverse and are dependent on sociocultural and economic factors. The objective of this study was to describe the pathways to primary care for patients with common mental disorders in Harare. One hundred and nine consecutive patients with conspicuous psychiatric morbidity identified by general nurses in three primary health care clinics (PHC) and by four traditional medical practitioners were interviewed with the Pathways to Care Schedule. Other than those patients with an acute illness, most patients consulted more than one care provider; three-quarters of those with a history of prior consultations had consulted both traditional and biomedical care providers. Biomedical care providers were the most common first care provider consulted; if this treatment failed, then patients tried other biomedical or traditional care providers. Different factors operated in the decision-making process in choosing between consulting biomedical and traditional care providers. Traditional care providers provided explanations more often than biomedical care providers; explanations given were most often spiritual. Injectable treatments were often prescribed for mental illness, especially by private general practitioners (GPs). Such treatments, and many oral treatments, were non-specific. Dissatisfaction with consultations was most commonly due to lack of symptomatic improvement. The costs of consultation were highest for private GPs, general hospitals and traditional healers; faith-healers, PHCs and hospital psychiatric departments were the cheapest.

A community survey of traditional medical practitioners in high density suburbs of Harare.

Traditional medical practitioners (TMP) are an important part of the health system in Zimbabwe. The objective of this study was to determine, in the study area, their numbers, sociodemographic characteristics and clinical practice. A cross sectional community survey was conducted in two high density suburbs in Harare, Zimbabwe. A sampling frame of TMP was defined by means of a three stage community census (n = 189). A random stratified sample (n = 110) was interviewed with a semi-structured interview. Nearly half the TMP were not registered with formal organizations. Prophets were more likely to be Zimbabwean, Shona speaking, better educated, to have entered practice at a younger age, had fewer years of experience and charged less for consultations. Many TMP reported busy attendance at their clinics in the evenings or on weekends, but on average, most TMP see few patients. Few TMP specialised in physical disorders. Almost two thirds referred patients to formal medical services and most TMP wished to have greater collaboration with biomedical services.