Pulmonary tuberculosis space-time clustering and spatial variation in temporal trends in Portugal, 2000-2010: an updated analysis.

Portugal, a medium- to low-level endemic country (21·6 cases/100 000 population in 2012), has one of the highest European Union tuberculosis (TB) incidences. Although incidence is declining progressively, the country's heterogeneity in both regional endemics and their evolution suggests the importance of a better understanding of subnational epidemiology to customize TB control efforts. We aimed to update knowledge on municipality-years pulmonary TB incidence clustering, identify areas with different time trends, and show the potential of combining complementary clustering methods in control of infectious diseases. We used national surveillance municipality-level data (mainland Portugal, 2000-2010). Space-time clustering and spatial variation in temporal trends methods were applied. Space-time critical clusters identified (P < 0·001) were still the Lisbon and Oporto regions. The global incidence declined at a 5·81% mean annual percentage change, with high space-time heterogeneity and distinct time trend clusters (P < 0·001). Municipalities with incidences declining more rapidly belonged to critical areas. In particular, the Oporto trend cluster had a consistent -8·98% mean annual percentage change. Large space-time heterogeneities were identified, with critical incidences in the greater Lisbon and Oporto regions, but declining more rapidly in these regions. Oporto showed a consistent, steeper decrease and could represent a good example of local control strategy. Combining results from these approaches gives promise for prospects for infectious disease control and the design of more effective, focused interventions.

Craniofacial features and specific oral characteristics of Down syndrome children.

AIM: This article intends to describe the characteristics of Down syndrome children in order to facilitate their management in the dental office. METHODS: A review of literature was made limited to articles published between 2003 and 2013. The article is based on a literature search in PubMed and the authors' clinical experience with the patient group. DISCUSSION: Individuals with Down syndrome are clinically characterized by generalized hypotonia, neurological, cardiac and respiratory problems and changes in their stomatognathic system. Almost all these patients have an occlusal disharmony, including anterior open bite, anterior and posterior crossbite, anterior proclination and underdevelopment of the maxilla and the midface. Dental anomalies such as hypodontia, peg-shaped teeth and enamel hypocalcification are also found. The dentomaxillofacial features have clinical implications in speech, nutrition, posture, ventilation and aesthetics, with enormous consequences in growth, development and social integration. CONCLUSIONS: When planning the dental treatment of patients with Down syndrome, dental practitioners should always consider their general health, in order to achieve a holistic and interdisciplinary approach.

Does the chemistry in the saliva of Down syndrome children explain their low caries prevalence?

AIM: The present study focuses on the relationship between dental caries and saliva components such as phosphate, calcium, potassium, chloride as well as α-amylase in children with Down syndrome. MATERIALS AND METHODS: Forty-five Caucasian sibling pairs, with the mean age of 13±4 years compose the final sample. Stimulated whole saliva was collected from DS children and their siblings and an automatic analyser quantified the biochemical parameters. RESULTS: Down syndrome children presented lower caries rates. The salivary concentration of calcium, phosphate, potassium and chloride did not differ between DS and sibling children. In respect to α-amylases, the absolute salivary concentration as well as salivary secretion rate was similar between DS and sibling controls. CONCLUSION: In conclusion, no correlation between dental caries and salivary ionic composition as well as α-amylase secretion rate was found in DS children.