Outcomes of a multidisciplinary Diabetic Foot Day Unit.

OBJECTIVE: To analyse the main characteristics of patients and the health outcomes obtained and to evaluate the impact of peripheral artery disease (PAD) in patients treated in our multidisciplinary Diabetic Foot Unit. RESEARCH DESIGN AND METHODS: Observational prospective study. 273 patients from two different populations (with and without PAD - classified according to the presence of distal pulses) treated over a 14-month period in the multidisciplinary Diabetic Foot Unit were included. The data on patient characteristics and outcomes were analysed for the purpose of comparison. For the inference study, a comparison of medians with the non-parametric test for independent samples for the quantitative variables and a χ2 test for the comparison of proportions in qualitative variables were performed. RESULTS: Patients with PAD ulcers were older (60 (54-67) vs. 64 (75-81), p=0.000) and had a higher macrovascular burden (8.1% vs. 29% for ischaemic heart disease history, p=0.000; 6.7% vs. 18.1% for cerebrovascular disease history, p=0.004). Their Texas Score was higher (p=0.000) and their major amputation rate was higher (1.4% vs. 12.3%, p=0.001). They had less background of previous ulcers (52.6% vs. 26.8%, p=0.000), their episode duration was shorter (4 (0-10) vs. 0 (0-3) weeks, p=0.000), and their proportional need for antibiotic therapy was lower (64.4% vs. 51.4%, p=0.03). CONCLUSIONS: The differences found between ulcers with and without vascular involvement support the need for a different approach and for the inclusion of vascular surgeons on the team. The multidisciplinary care model for diabetic foot patients could be effective and improve health outcomes.

Are infections in children with juvenile idiopathic arthritis more frequent than in healthy children? A prospective multicenter observational study.

Background: Children with juvenile idiopathic arthritis (JIA) might be at a higher risk of infection. Our objectives are to describe and compare infection rates in patients with JIA vs. healthy patients. Methods: A prospective, multicenter observational study was performed in Spain from January 2017 to June 2019. Patients with JIA from 7 participating hospitals and children without JIA (siblings of patients with JIA, and non-JIA children from primary health centers) were followed up with quarterly questionnaires to record infection episodes. Tuberculosis, herpes zoster, and infections requiring hospital admission were considered severe infections. Rates of infection (episodes/patient/year) were compared using a generalized estimating equations model. Results: A total of 371 children (181 with and 190 without JIA) were included. The median age was 8.8 years (IQR 5.5-11.3); 75% of the patients with JIA received immunosuppressive treatment (24% methotrexate, 22% biologic, 26% both). A total of 667 infections were recorded; 15 (2.2%) were considered severe. The infection rate was 1.31 (95%CI 1.1-1.5) in JIA and 1.12 (95%CI 0.9-1.3) in non-JIA participants (p = 0.19). Age <4 years increased the infection rate by 2.5 times (2.72 vs. 1.12, p < 0.001) in both groups. The most frequent infection sites were upper respiratory (62.6% vs. 74.5%) and gastrointestinal (18.8% vs. 11.4%). There were no differences in severe infections (2.5% vs. 2%, p = 0.65) between the groups. In children with JIA, younger age and higher disease activity (JADAS71) were associated with a higher infection rate. Conclusion: We found no differences in the infection rate or infection severity between patients with and without JIA. Most infections were mild. An age younger than 4 years increased the infection risk in both groups. Higher disease activity was associated with a higher infection rate.

Validation of an instrument to determine oral health knowledge, attitudes, and practices during pregnancy.

BACKGROUND: Oral health of the mother-infant dyad is important to preserve general health. However, there are few instruments in Spanish for the evaluation of knowledge, attitudes and practices that determine this construct. Therefore, this research aimed to develop and evaluate the psychometric properties of the Maternal Oral Health Knowledge, Attitudes and Practices Questionnaire (CAPSOM in Spanish). METHODS: In this instrument development study that carried out in 2018-2019, involving pregnant women between the ages of 18 and 45 in the city of Leon, Guanajuato, Mexico. The sample size was calculated based on 10 women per questionnaire item (n = 10 k). The study used Cronbach's alpha, the modified Lawshe test of validity criteria, factor analysis, and the level of difficulty and discrimination of the items. RESULTS: 207 women took part with their signed, informed consent (25 ± 6 years). The internal consistency of the instrument, both total and by dimension was α = 0.70, α = 0.66 knowledge, α = 0.74 attitudes, and α = 0.66 practices. Values of Content Validity Ratio' ≥ 0.60 were obtained for the final 10 items and Content Validity Index' = 0.90. The average difficulty index of items was 0.40, and there were significant differences (Kruskall-Wallis, p < 0.001) in the discrimination test. Factor analysis demonstrated three main components. CONCLUSIONS: A valid and reliable 10-item Spanish questionnaire was designed to measure pregnant women's oral health knowledge, attitudes, and practices.

Conocimientos y prácticas de odontología preventiva en odontólogos en México.

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COVID-19 Lockdown: Key Factors in Citizens' Stress.

Background: Confinement due to COVID-19 can have a short- and long-term impact on mental health (increased levels of stress and anxiety and emotional upheaval) and on people's quality of life. Knowing what factors are behind the stress can benefit the development of strategies and resources for future situations of a similar nature. The purpose of this study is to examine the incidence of a series of sociodemographic factors, confinement conditions, and work situation on the stress reported by confined citizens. Method: The sample is made up of 2008 citizens (19.9% men), the Perceived Stress Scale of 14 items (PSS-14) was used to assess the stress level of the population, as well as a sociodemographic questionnaire and different questions aimed at obtain information about the characteristics of the confinement and the employment situation. Data were collected using exponential snowball-type non-probability sampling. Results: The results suggest that sociodemographic factors such as age, gender, and income level could be good predictors of confinement stress. Post-confinement work expectancy along with pre-confinement working conditions can be key to protecting the well-being of confined populations. Limitations: This is a transversal study that forces us to be cautious with causal interpretations. The questionnaire was administered online, which means it excluded a good proportion of the population. Conclusion: The perception of stress being higher in women than men, with the lowest stress in older people and those with higher reported incomes. Stress levels increase as populations spend more weeks in confinement and the pre-confinement work situation seems key to protecting the well-being of the population. A lower stress is observed among stable couples without children confined in residential or suburban areas. Low income or economic instability is associated with a higher rate of stress and anxiety. The results can contribute to prioritizing actions and aid by contributing to the formation of teams and the design of tools for work in the current pandemic situation.

Rasch model of the child perceptions questionnaire in multi-country data.

OBJECTIVE: To be fit-for-purpose, oral health-related quality of life instruments must possess a range of psychometric properties which had not been fully examined in the 16-item Short Form Child Perceptions Questionnaire for children aged 11 to 14 years (CPQ11-14 ISF-16). We used advanced statistical approaches to determine the CPQ's measurement accuracy, precision, invariance and dimensionality and analyzed whether age range could be extended from 8 to 15 years. METHODS: Fit to the Rasch model was examined in 6648 8-to-15-year-olds from Australia, New Zealand, Brunei, Cambodia, Hong Kong, Malaysia, Thailand, Germany, United Kingdom, Brazil and Mexico. RESULTS: In all but two items, the initial five answer options were reduced to three or four, to increase precision of the children's selection. Items 10 (Shy/embarrassed) and 11 (Concerned what others think) showed an 'extra' dependency between item scores beyond the relationship related to the underlying latent construct represented by the instrument, and so were deleted. Without these two items, the CPQ was unidimensional. The three oral symptoms items (4 Food stuck in teeth, 3 Bad breath and 1 Pain) were required for a sufficient person-item coverage. In three out of 14 items (21 %), Europe and South America showed regional differences in the patterns of how the answer options were selected. No differential item functioning was detected for age. CONCLUSION: Except for a few modifications, the present analysis supports the combination of items, the cross-cultural validity of the CPQ with 14 items and the extension of the age range from 8 to 15 years. CLINICAL SIGNIFICANCE: The valid, reliable, shortened and age-extended version of the CPQ resulting from this study should be used in routine care and clinical research. Less items and a wider age range increase its usability. Symptoms items are needed to precisely differentiate between children with higher and lower quality of life.

Evaluation of a fluorosis prevention educational program: A randomized field trial.

BACKGROUND: A 2-group randomized field trial was conducted to evaluate the impact of a fluorosis educational preventive program in mother´s knowledge and practices, and on the urine fluoride concentration of their preschool children. MATERIAL AND METHODS: A group of 139 mother-child pairs participated in the study. Randomly, children were assigned to an intervention group, their mothers were participants of an educational program, or a control group (CG); including 69 and 70 child-mother pairs, respectively, the follow-up period was six months. Mother´s knowledge and practices were evaluated and children´s first urine sample was used to measure fluoride concentration at the beginning of the study and at the end of the follow-up period. RESULTS: The mean age of the children was 4.18 (sd 0.62) years-old at baseline. Mothers in the IG improved their knowledge and practices associated with fluorosis risk factors. Adequate knowledge about the amount of toothpaste to use for brushing improved in the IG (p=0.006). In 82.1% of the children in the IG showed decrease in urine fluoride concentration was observed (p< 0.001), no significant differences were shown in the CG. CONCLUSIONS: Mothers participating in an education program improved their knowledge and practices, reducing the risk of dental fluorosis in their children who showed a decreased on their urine F concentration. Key words:Knowledge, practices, urinary fluoride, water fluoride, preschool children, mothers.

Prevalence of dental fluorosis in Mexico 2005-2015: a literature review.

OBJECTIVE:: To perform a literature review regarding current dental fluorosis prevalence in Mexico reported from 2005 to 2015. MATERIALS AND METHODS:: A comprehensive scientific literature review, in both English and Spanish, was performed in four databases up to June 2015. Search terms: fluorosis or dental fluorosis (mesh), prevalence (mesh), distribution (mesh), cases (mesh), epidemiology (mesh), Mexico. RESULTS:: 17 publications were included. Reported prevalence of dental fluorosis in Mexico ranged from 15.5 to 100%. Most of the studies were conducted in areas where water fluoride levels are low or optimal (≤1.5ppmF) and in which a prevalence of 15.5 to 81.7% was observed. In areas with higher levels of naturally fluoridated water (>1.5ppmF), prevalence ranged from 92 to 100%. Fluorosis severity ranged from questionable to severe. CONCLUSION:: High prevalence of dental fluorosis was observed even in areas where fluoride concentration in water was low or optimal. In addition to fluoride in groundwater, there are multiple risk factors that should be controlled.

Prevalence of dental fluorosis in Mexico 2005-2015: a literature review / Prevalencia de fluorosis dental reportada en México 2005-2015: revisión de la literatura

Abstract: Objective: To perform a literature review regarding current dental fluorosis prevalence in Mexico reported from 2005 to 2015. Materials and methods: A comprehensive scientific literature review, in both English and Spanish, was performed in four databases up to June 2015. Search terms: fluorosis or dental fluorosis (mesh), prevalence (mesh), distribution (mesh), cases (mesh), epidemiology (mesh), Mexico. Results: 17 publications were included. Reported prevalence of dental fluorosis in Mexico ranged from 15.5 to 100%. Most of the studies were conducted in areas where water fluoride levels are low or optimal (≤1.5ppmF) and in which a prevalence of 15.5 to 81.7% was observed. In areas with higher levels of naturally fluoridated water (>1.5ppmF), prevalence ranged from 92 to 100%. Fluorosis severity ranged from questionable to severe. Conclusion: High prevalence of dental fluorosis was observed even in areas where fluoride concentration in water was low or optimal. In addition to fluoride in groundwater, there are multiple risk factors that should be controlled.

Resumen: Objetivo: Realizar una revisión de la literatura sobre la prevalencia de fluorosis dental en México reportada durante 2005-2015. Material y métodos: Se realizó una revisión exhaustiva hasta junio de 2015 en cuatro bases de datos de literatura científica en inglés y español. Términos de búsqueda: fluorosis o fluorosis dental (mesh), prevalencia (mesh), distribución (mesh), casos (mesh), epidemiología (mesh), México. Resultados: Se incluyeron 17 publicaciones. La prevalencia reportada en México fue de 15.5 a 100%. La mayoría de los estudios se realizaron en áreas donde el nivel de flúor en agua es bajo u óptimo (≤1.5ppmF), en las cuales se observó una prevalencia de 15.5 a 81.7%. En las zonas con mayor nivel de flúor (>1.5ppmF) en agua natural fue de 92 a 100%. La gravedad de fluorosis varió de dudosa a severa. Conclusión: Existe una alta prevalencia de fluorosis dental incluso en zonas donde la concentración de fluoruro en el agua es baja u óptima. Además de fluoruro en el agua, existen múltiples factores de riesgo que deben ser controlados.

Dental fluorosis, fluoride in urine, and nutritional status in adolescent students living in the rural areas of Guanajuato, Mexico.

OBJECTIVE: The aim of this study was to assess urine fluoride concentration, nutritional status, and dental fluorosis in adolescent students living in the rural areas of Guanajuato, Mexico. MATERIALS AND METHODS: A cross-sectional study was conducted including participants aged 11-20 years. The presence and severity of dental fluorosis was registered according to the Thylstrup and Fejerskov index (TFI) criteria. Anthropometric measures were also recorded. Urine sample of the first morning spot was recollected to assess urine fluoride concentration by using the potentiometric method with an ion-selective electrode. Water samples were also recollected and analyzed. Bivariate tests were performed to compare urine fluoride concentration according to different variables such as sex, body mass index, and TFI. Nonparametric tests were used. A logistic regression model was performed (SPSS® 21.0). RESULTS: This study included 307 participants with a mean age of 15.6 ± 1.6; 62.5% of the participants showed normal weight. A total of 91.9% of the participants had dental fluorosis, and 61.6% had TFI > 4. Mean fluoride content in urine ranged between 0.5 and 6.65 mg/L, with a mean of 1.27 ± 1.2 mg/L. Underweight children showed greater urine fluoride concentration. The increment of urine fluoride was a related (OR = 1.40) to having severe dental fluorosis. CONCLUSIONS: Most of the studied population had moderate or severe dental fluorosis. Urine fluoride concentration was related to fluorosis severity and nutritional status. Underweight children showed greater urine fluoride concentration as well as severe dental fluorosis.

Instrumentos validados para medir la salud bucal en los niños / Validated instruments for measuring the oral health in children

Existe un creciente interés en reconocer la salud bucal como un componente de la calidad de vida, por lo cual actualmente los esfuerzos en la investigación del sector odontológico no sólo se enfocan en rehabilitar padecimientos bucodentales, sino en explorar la relación existente entre el estado de salud bucal y la calidad de vida, para poder evaluarla, mejorarla y mantenerla. Las enfermedades bucales son las más comunes entre las enfermedades crónicas, y son un importante problema de salud pública debido a su prevalencia y al impacto que tienen sobre las personas y sobre la sociedad. Es por esto que han sido desarrollados cuestionarios dirigidos a la población infantil y a sus padres o cuidadores para medir el impacto de las afecciones bucales en la calidad de vida; estos indicadores comprenden diferentes dominios como el dolor y la incapacidad para realizar las funciones normales de la boca, trastornos del sueño, pérdida de días escolares, grado de bienestar emocional, bienestar social y el impacto que generan estas afecciones en la vida familiar. Es por esto que el objetivo de la presente revisión sistemática es mostrar un panorama actual sobre el concepto de calidad de vida relacionada con la salud bucal en los niños y los diferentes instrumentos que existen a nivel mundial para evaluarla.

There is a growing interest in recognizing oral health as a component of quality of life. The dentistry is not only focusing on research for rehabilitating oral-dental diseases, but also in exploring the relation-ship between oral health status and quality of life, in order to evaluate, improve and maintain it. Oral diseases are the most common chronic diseases and remain a major public health problem. This is be-cause of its prevalence and, the impact on individuals and society. For this reason have been developed questionnaires for children and their parents or caregivers to measure the impact of oral conditions on quality of life, with different domains including: pain and inability to perform normal functions of the mouth, sleep disturbances, loss of school days, degree of emotional, social well-being and the impact generated by these conditions in family life. Therefore, the aim of the present systematic review is to show a current overview of the concept of oral health-related quality of life in children and the different instruments that exist around the world for evaluate it.

Consentimiento en investigación en la normativa española. Referencia a la normativa andaluza / Consent in research within the Spanish legislation. Reference to Andalusian rules

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Differential item functioning of the Spanish version of the Child Perceptions Questionnaire.

AIM: Owing to the greater use of translated and adapted instruments for measuring oral health on children's quality of life, there is a need to ensure that such scales (and then items) function in the same way, irrespective of age, sex, socioeconomic status, language, or ethnicity, so they can be used validly and reliably in cross-cultural research. The aim of the present study was to identify whether the Spanish version of the Child Perceptions Questionnaire 11-14 presents differential item functioning. METHODS: Child Perceptions Questionnaire 11-14 data from New Zealand (n = 322) and Mexican (n = 335) school-based surveys were compared. Ordinal logistic regression was undertaken in order to identify uniform or non-uniform differential item functioning. RESULTS: Eleven items showed moderate-to-large uniform differential item functioning in the Spanish version of the Child Perceptions Questionnaire 11-14. Non-uniform differential item functioning was not detected. The psychometric properties of the questionnaire, when removing items showing differential item functioning, showed that the free differential item functioning version was good to excellent. CONCLUSIONS: The Child Perceptions Questionnaire 11-14 Spanish version showed moderate-to-large uniform differential item functioning; however, further research is needed to identify the causes of differential item functioning.

Conocimientos, actitudes y prácticas sobre la influenza A(H1N1) 2009 y la vacunación contra influenza pandémica: resultados de una encuesta poblacional / Knowledge, attitudes and practices about influenza A(H1N1) 2009, and influenza vaccine in Mexico: results of a population survey

OBJETIVO: Evaluar conocimientos, actitudes y prácticas respecto a la pandemia de influenza, con especial énfasis en la vacuna contra influenza estacional y pandémica. MATERIAL Y MÉTODOS: Estudio transversal con muestreo polietápico probabilístico, realizado durante diciembre de 2009 en residentes mayores de 18 años de la Ciudad de México (y área metropolitana), Monterrey, Guadalajara y Mérida. RESULTADOS: Se incluyeron 1 600 sujetos (48.9% masculino); 34% había recibido vacuna contra influenza estacional en años pasados, 90.6% estaba dispuesto a recibir la vacuna contra A(H1N1). La principal causa de rechazo a la vacunación fue no confiar en la vacuna (46.5%). Principales medidas preventivas identificadas por los encuestados: lavado de manos (47.5%), vacuna contra A(H1N1) (28%) y etiqueta respiratoria (19.4%). El nivel escolar (1.7, p=0.006) y edad (1.02, p<0.001) influyeron en el rechazo a la vacuna. El 82.9% de los encuestados calificó el manejo de la situación por el Gobierno Federal como bueno o muy bueno. CONCLUSIONES: La población refirió un alto porcentaje de aceptación para la vacuna de influenza pandémica durante el inicio de la campaña de vacunación en México, comparado con la reportada en otros países. La principal razón de aquéllos que la rechazan es la desconfianza hacia la vacuna.

OBJECTIVE: To assess knowledge, attitudes and practices regarding influenza pandemic, with special emphasis on issues related to influenza vaccine, seasonal and pandemic. MATERIALS AND METHODS: Cross-sectional study, probabilistic multistage sampling in patients over 18 years, residents of Mexico City (and metropolitan area), Monterrey, Guadalajara and Merida in December 2009. RESULTS: A total of 1.600 subjects (48.9% male) were interviewed, 34% had previously received seasonal flu vaccine, 90.6% were willing to be vaccinated against A(H1N1), 46.5% of those who would not receive the vaccine was because they did not trust A (H1N1), 68% considered influenza A (H1N1) as a risk for their family. Hand washing was the preventive measure most commonly reported (47.5%), secondly influenza vaccine (28%). Schooling (1.7, p=0.006) and age (1.02, p<0.001) influence rejection to get vaccine. 82.9% of respondents rate the federal government's management as good or very good. CONCLUSIONS: There was a high acceptance rate for the pandemic influenza vaccine in Mexico when compared to similar studies in other countries, the main reason for those who reject the vaccine was distrust in it.

[Knowledge, attitudes and practices about influenza A(H1N1) 2009, and influenza vaccine in Mexico: results of a population survey]. / Conocimientos, actitudes y prácticas sobre la influenza A(H1N1) 2009 y la vacunación contra influenza pandémica: resultados de una encuesta poblacional.

OBJECTIVE: To assess knowledge, attitudes and practices regarding influenza pandemic, with special emphasis on issues related to influenza vaccine, seasonal and pandemic. MATERIALS AND METHODS: Cross-sectional study, probabilistic multistage sampling in patients over 18 years, residents of Mexico City (and metropolitan area), Monterrey, Guadalajara and Merida in December 2009. RESULTS: A total of 1.600 subjects (48.9% male) were interviewed, 34% had previously received seasonal flu vaccine, 90.6% were willing to be vaccinated against A(H1N1), 46.5% of those who would not receive the vaccine was because they did not trust A (H1N1), 68% considered influenza A (H1N1) as a risk for their family. Hand washing was the preventive measure most commonly reported (47.5%), secondly influenza vaccine (28%). Schooling (1.7, p=0.006) and age (1.02, p<0.001) influence rejection to get vaccine. 82.9% of respondents rate the federal government's management as good or very good. CONCLUSIONS: There was a high acceptance rate for the pandemic influenza vaccine in Mexico when compared to similar studies in other countries, the main reason for those who reject the vaccine was distrust in it.

Validation of the CPQ 8-10ESP in Mexican School children in urban areas

The current indicators used to gather information on oral health in children are basically clinical indexes thatregister mainly dental caries, periodontal disease, and malocclusion. These indexes should be complemented withemotional and social aspects related to the individual experience and perception of oral health status. In orderto obtain this information, valid instruments capable of evaluating the impact of oral health as it relates to thequality of life (OHRQoL) are required. The objective of the Child Perceptions Questionnaire (CPQ8-10) is to assessOHRQoL in children aged eight to ten years. CPQ8-10 consists of 25 questions divided into four domains: oralsymptoms, functional limitation, emotional well-being, and social well-being.Objective: The aim of this study was to validate the translated Spanish version of the Child PerceptionsQuestionnaire (CPQ8-10ESP) in use with Mexican urban children.Material and Methods: Three hundred fifteen students in Mexico City aged eight- to ten-years-old participatedin this study. The CPQ8-10ESP questionnaire was self-administered in the classroom. Clinical data about caries andmalocclusion were obtained. To assess test-retest reliability, the questionnaire was reapplied to a subgroup ofchildren.Results: Cronbach’s alpha reliability coefficient was 0.89 for the total CPQ8-10ESP scale. The intraclass correlationcoefficient was 0.67; a statistically significant difference was found in the CPQ8-10ESP mean score between childrenwith caries and malocclusion; a significant correlation between general well-being ratings with all domainswas found (p<0.001). General perception of oral health was associated with both oral symptoms (p=0.049) andemotional well-being (p=0.022) domains, as well as with the total scale (p=0.015).Conclusions: The CPQ8-10ESP version showed good validity and reliability for use with Mexican schoolchildrenfrom urban areas (AU)

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