Edentulism and quality of life in the Salvadoran population: a cross-sectional study.

INTRODUCTION: Edentulism is the partial or total loss of teeth, it is irreversible and disabling due to its sequelae in the masticatory, phonetic and aesthetic function that affect the quality of life. OBJECTIVE: To establish the impact of edentulism and sociodemographic factors on the quality of life of the Salvadoran population. MATERIALS AND METHODS: Secondary cross-sectional analysis of data in 3322 users of the Public Health System of El Salvador, aged 15 to > 60 years. The variables under study were sociodemographic, edentulismo and quality of life. Edentulism was determined by clinical examination using the Oral Impact on Daily Performance scale. The statistical analysis was performed using χ2, OR, multiple regression analysis and set the significance threshold at p < 0.05. RESULTS: Partial edentulism in the upper jaw was present in 68.24% people, partial edentulism in the lower jaw was present in 72.42% people and complete edentulism was observed in 2.02% people. There were significant sex differences and a relationship between sex and quality of life (p < 0.004); the self-perception of severe/very severe impacts was greater in women. People without education or with primary or secondary education only were the most affected (p < 0.05). Tooth loss increases with age, affecting quality of life in a severe/very severe manner. Complete edentulism had greater impacts on quality of life in terms of eating (25.64%), speaking (21.15%), and socializing/enjoying contact with people (10.90%). A severe/very severe impact on quality of life of teeth lost was reported mainly by those over 60 years of age, with an average of 11 missing posterior teeth, 6 missing anterior teeth and 13 missing teeth per patient. Those missing up to 6 anterior teeth were times more likely to perceive severe/very severe impacts on quality of life than those without any missing teeth (OR:5.788). Edentulism affected the quality of life of those examined, especially the loss of upper anterior teeth.

How to treat subsyndromal anxiety disorder - practical recommendations for implementation in primary care.

BACKGROUND: Anxiety is a common and disabling condition that significantly impacts quality of life. Subsyndromal anxiety (SSA) refers to anxiety symptoms that do not meet the full diagnostic criteria for an anxiety disorder but pose a risk for developing such disorders. We aimed to provide practical recommendations for the treatment of SSA in primary care settings. METHODS: A narrative review was conducted to identify strategies for recognizing and treating patients with SSA. RESULTS: The recommendations for treating SSA include lifestyle modifications such as exercise and stress reduction techniques, psychotherapy, and pharmacological treatments, including natural compounds like the lavender oil extract Silexan. Regular follow-up care is essential to monitor treatment response and address ongoing symptoms. Additionally, the use of the GAD-7 tool is recommended for accurately identifying patients with SSA. CONCLUSION: Implementing these recommendations in primary care can lead to effective treatment of SSA, preventing the development of more severe anxiety disorders. An integrative approach, combining lifestyle modifications, psychotherapy, and pharmacotherapy, including natural compounds, offers significant benefits for managing anxiety.

Anxiety is prevalent and disablingSubsyndromal anxiety is a risk factor for anxiety disordersSubsyndromal anxiety can be assessed with the GAD-7 (Generalised Anxiety Disorder-7 scale)Subsyndromal anxiety can be treated with life-style modification, psychotherapy and pharmacological treatment, including silexan, a natural compound.

Composite Alloplastic Biomaterial vs. Autologous Platelet-Rich Fibrin in Ridge Preservation.

AIM: The aim of this study was to examine the clinical and histological differences of using a combination of alloplastic beta triphasic calcium phosphate (ß-TCP) and a cross-linked collagen membrane versus autologous platelet-rich fibrin (PRF-L) in ridge preservation after dental extraction. MATERIAL AND METHODS: Fifty-one patients were included in this observational case-series study. Dental extractions were performed, after which 25 patients were grafted with ß-TCP and 26 with PRF-L. After four months of healing, clinical, radiological, histomorphometric and histological evaluations were performed. RESULTS: A significantly higher percentage of mineralized tissue was observed in samples from the PRF-L grafted areas. Cellularity was higher in PRF-L grafted areas (osteocytes in newly formed bone per mm² = 123.25 (5.12) vs. 84.02 (26.53) for PRF-L and ß-TCP, respectively, p = 0.01). However, sockets grafted with PRF-L showed a higher reduction in the bucco-lingual dimension after four months of healing (2.19 (0.80) vs. 1.16 (0.55) mm, p < 0.001), as well as a higher alteration in the final position of the mid muco-gingival junction (1.73 (1.34) vs. 0.88 (0.88) mm, p < 0.01). CONCLUSION: PRF-L concentrate accelerates wound healing in post-extraction sockets in terms of new mineralized tissue component. However, the use of ß-TCP biomaterial appears to be superior to maintain bucco-lingual volume and the final position of the muco-gingival junction.

[Fraud in the health systems of Chile: a detection model]. / Fraudes a los sistemas de salud en Chile: un modelo para su detección.

OBJECTIVES: To develop a model for detecting cases of organized fraud in Chile based on data from the legal forms for medically authorized leave (formulario legal de licencia médica curativa-MAL) and to establish the relevance of this data to fraud detection. METHODS: A binomial logistic regression model was employed using four variables from the MAL form, a national requirement for illness-related work absences: the number of legal absences taken by a single person, the number of days authorized by the prescribing doctor, the total cost per illness, and a dichotic variable reflecting whether or not the diagnosis is one that can be proven. The analysis involved 4,079 MAL forms that had been submitted in 2003 to a private health provider and of which 356 were already identified as fraudulent by a panel of medical fraud experts. RESULTS: The model successfully identified 99.71% of the fraudulent medical authorizations and 99.86% of the non-fraudulent, according to the criteria of the panel of fraud experts. Three of the variables employed had statistically-significant independent predictive power. The positive predictive value of the proposed model was 98.59%, while its negative predictive value was 99.97%. CONCLUSIONS: The binomial logistic model that was developed uses four variables that are common to all MAL forms in use by Chile's public as well as private insurers, permitting separation of fraudulent from non-fraudulent requests to be more accurate, more timely, and at a cost lower that of an expert panel.

Fraudes a los sistemas de salud en Chile: un modelo para su detección / Fraud in the health systems of Chile: a detection model

OBJETIVOS: Desarrollar un modelo para detectar casos de fraude planificado en Chile a partir de los datos contenidos en los formularios de licencia médica curativa (LMC) y establecer la contribución relativa de esos datos a su detección. MÉTODOS: SE aplicó un modelo de regresión logística binominal a partir de cuatro variables contenidas en el formulario legal de LMC exigido nacionalmente para justificar las ausencias al trabajo por motivos de enfermedad: el número de licencias médicas asignadas a una misma persona, el número de días de licencia médica otorgados por el médico tratante, el monto total a pagar por la enfermedad y una variable dicotómica que refleja si el diagnóstico es comprobable o no. Se analizaron 4 079 LMC presentadas el año 2003 a una institución privada de salud previsional, de las cuales 356 estaban ya clasificadas como fraudulentas por un panel de médicos expertos en fraude. RESULTADOS: El modelo logró identificar correctamente 99,71 por ciento de las licencias médicas fraudulentas y 99,86 por ciento de las no fraudulentas según el criterio del panel de expertos en fraude. Tres de las variables empleadas presentaron un poder predictivo independiente estadísticamente significativo. El valor predictivo positivo del modelo propuesto fue de 98,59 por ciento, mientras el valor predictivo negativo fue de 99,97 por ciento. CONCLUSIONES: El modelo logístico binomial desarrollado, basado en cuatro variables de uso universal en los formularios de LMC utilizados por todas las entidades aseguradoras de Chile, tanto públicas como privadas, permite discriminar de forma precisa y más rápidamente y con menor costo que los paneles de expertos las solicitudes fraudulentas de las no fraudulentas.

OBJECTIVES: To develop a model for detecting cases of organized fraud in Chile based on data from the legal forms for medically authorized leave (formulario legal de licencia médica curativa-MAL) and to establish the relevance of this data to fraud detection. METHODS: A binomial logistic regression model was employed using four variables from the MAL form, a national requirement for illness-related work absences: the number of legal absences taken by a single person, the number of days authorized by the prescribing doctor, the total cost per illness, and a dichotic variable reflecting whether or not the diagnosis is one that can be proven. The analysis involved 4 079 MAL forms that had been submitted in 2003 to a private health provider and of which 356 were already identified as fraudulent by a panel of medical fraud experts. RESULTS: The model successfully identified 99.71 percent of the fraudulent medical authorizations and 99.86 percent of the non-fraudulent, according to the criteria of the panel of fraud experts. Three of the variables employed had statistically-significant independent predictive power. The positive predictive value of the proposed model was 98.59 percent, while its negative predictive value was 99.97 percent. CONCLUSIONS: The binomial logistic model that was developed uses four variables that are common to all MAL forms in use by Chile's public as well as private insurers, permitting separation of fraudulent from non-fraudulent requests to be more accurate, more timely, and at a cost lower that of an expert panel.

[Work absenteeism in Chile according to the type of work place]. / 30 años de estudio sobre ausentismo laboral en Chile: una perspectiva por tipos de empresas.

BACKGROUND: The issue of medically justified work absenteeism has a great relevance in Chile at the present moment. AIM: To analyze sick leaves among people working in hospitals, mines, automotive industry and universities. MATERIAL AND METHODS: Analysis of 14 thesis and research papers about absenteeism in Chile. The incapacity rate (number of days with sick leave per worker per year, the frequency rate (number of sick leaves per year per worker) and the severity rate (mean duration of sick leaves) were calculated. The diseases causing the highest rates of absenteeism were also recorded. RESULTS: The mean age of the studied populations was 36 years old and the most common diseases causing absenteeism were respiratory, rheumatologic and trauma. Hospital workers had the highest incapacity rate with 14.3 days of sick leave per worker per year, followed by mining industry with 12 days, automotive industry with 7.1 days and universities with 6 days. CONCLUSIONS: In Chile, respiratory diseases are the main cause of sick leaves and hospital workers have the highest incapacity rate.

Neumonía eosinofílica / Eosinophilic pneumonia

Dada la variabilidad en el tiempo de resolución radiológica y clínica de las neumonías, resulta controversial decidir cuando iniciar estudios invasivos para la neumonía de lenta resolución o que no resuelve. En paciente inmunocompetentes que ingresan con características clásicas de neumonía adquirida en la comunidad, la respuesta tórpida al tratamiento instaurado es el principal determinante para estudios adicionales. Se recomiendan como estudios adicionales la tomografía de tórax y el lavado broncoalveolar con cultivos apropiados para bacterias, legionella, hongos y micobacterias; con el fin de ampliar el diagnóstico diferencial. En el caso de las neumonías eosinofílicas el diagnóstico se realiza frecuentemente por exclusión, aunque se debe sospechar en pacientes que presenten infiltrados característicos, con eosinofilia asociados a una lenta resolución clínica y radiológica. Se confirma el diagnóstico mediante lavado broncoalveolar , biopsia transbronquial y la excelente respuesta terapéutica a los esteroida.