Community Activities in Primary Care: A Literature Review.

Community health promotion activities are a useful tool for a proactive approach to healthy lifestyles. However, the implementation of these types of activities at health centers is not standardized. The aim of this review was to analyse the characteristics of community activities undertaken in the primary care setting and substantiate available evidence on their health impact. We conducted a bibliographic review until November 15th, 2023 in the TRIPDATABASE, MEDLINE, EMBASE, and DIALNET databases. We included original papers on interventions, community activities, and actions and/or social prescriptions which had been implemented in a Primary Care setting, included a group approach in at least one session, and described some type of evaluation of the intervention applied. Studies targeted at professionals and those without involvement of the primary care team were excluded. The search identified 1912 potential studies. We included a total of 30 studies, comprising 11 randomized clinical trials, 14 quasi-experimental studies, 1 cohort study, and 4 qualitative studies. The issues most frequently addressed in community activities were healthy habits, physical activity, cardiovascular diseases and diabetes. Community activities can improve the physical and psychological environment of their participants, as well as their level of knowledge about the issues addressed. That said, however, implementation of these types of interventions is not uniform. The existence of a professional community-activity liaison officer at health centers, who would help integrate the health system with the community sector, could serve to standardize implementation and maximize the health impact of these types of interventions.

Evaluation of Celiac Disease by Minimally Invasive Biomarkers in a Spanish Pediatric Population.

BACKGROUND: The diagnosis of celiac disease (CD) has been substantially improved with the availability of highly sensitive CD-specific IgA-TG2, Ig-GDP, and IgA-EMA. The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) published (2012) and updated (2020) diagnostic criteria for CD in order to simplify CD diagnosis and to avoid biopsies in selected patients. METHODS: A prospective study including 5641 pediatric patients (0-16 years old) from January 2012 to January 2019 was performed. CD diagnosis was made according to the ESPGHAN algorithm. The objective of this study was to evaluate the utility of biomarkers and the relationship between TGA-IgA and EMA titers. RESULTS: CD diagnoses were confirmed in 113 patients, 110 were IgA-TG2-positive and 3 (2.7%) had IgA deficiency. The diagnosis was made by serologic tests in 95 (84.1%) patients. Only 18 (15.9%) patients underwent intestinal biopsy. We obtained 100% concordance between IgA-EMA and positive results for IgA-TG2 ≥ 10 ULN with IgA-EMA antibody titer ≥ 1:80. CONCLUSIONS: This study provides evidence of a positive correlation between IgA-TG2 antibody serum levels and IgA-EMA. The diagnosis could be guaranteed with strict application of IgA-TG2 values ≥ 10 ULN (confirmed by subsequent testing) plus the serological response to the gluten-free diet (GFD).

Red Cell Distribution Width as a Predictive Factor of Celiac Disease in Middle and Late Adulthood and Its Potential Utility as Celiac Disease Screening Criterion.

Red cell distribution width (RDW) could be of interest by its potential use in the assessment of celiac disorder (CD). The main objective of this study was to evaluate the case positive rate of CD and the utility of red cell distribution width (RDW) in the CD diagnosis. This prospective study included 9.066 middle adult (≥45 years old) and elderly patients (≥60 years old) from 2012 to 2021. CD diagnosis was performed by CD antibody tests (serology and Human Leucocyte Antigen genotype (HLA)) and biopsy. Gastrointestinal and extra-intestinal manifestations as well as hematological and biochemical parameters were analyzed. CD diagnoses were confirmed in 101 patients (median (IQR) age = 62 (52.3−73); 68.32% women) by serologic tests (100%) and intestinal biopsy (88.12%), showing mainly marked or complete atrophy (76.24%, MARSH 3a−c). Anemia was the most commonly presenting extra-intestinal manifestation (28.57%). Among 8975 individuals without CD, 168 age and sex matched were included. By comparison of CD and no CD individuals, we observed that high >14.3% RDW was exhibited by 58.40% and 35.2% individuals with CD and without CD, respectively. Furthermore, high RDW is associated with CD and grade III atrophy. We suggest that RDW could be used as a CD screening criterion.

Relevancia clínica del cepillado dental y su relación con la caries / Clinical relevance of tooth brushing in relation to dental caries

ObjetivoDeterminar el impacto clínico del cepillado dental en la salud bucodental.DiseñoEstudio de prevalencia.EmplazamientoCentro de Salud Fontiñas (Santiago de Compostela).ParticipantesSe estudiaron 281 niños de 5–14 años.Mediciones principalesExploración odontológica según la metodología de la OMS. Se determina la frecuencia de cepillado dental, ingesta de dulces y prevalencia de caries. Análisis mediante regresión logística y estimación de relevancia clínica con el cálculo de la diferencia relativa de prevalencias (DRP) y el número necesario de pacientes por tratar (NNT) para prevenir un episodio.ResultadosLos niños que no se cepillan nunca los dientes tienen un 40% (intervalo de confianza [IC] del 95%: 24,3–57,8) de cariados temporales y los que lo hacen varias veces al día tienen un 15,3% (IC del 95%: 9,4–23,7). Al ajustar por edad, ingesta de dulces, cepillado dental y visita al dentista, se observa una asociación entre no cepillado dental y caries en la dentición temporal (odds ratio: 2,3; IC del 95%: 1,05–5,3) y definitiva (odds ratio: 3.9; IC del 95%: 1,4–10,3).ResultadosLa DRP es del 62% (IC del 95%: 30–79), es decir, la prevalencia de caries es un 62% menor en niños que se cepillan varias veces al día en relación con los que no lo hacen nunca. El NNT es de 4 (IC del 95%: 2,4–14), es decir, por cada 4 niños que se cepillan varias veces al día hay un caso menos de caries en comparación con los que no se cepillan nunca. El efecto de la intervención disminuye al bajar la frecuencia de cepillado. El mismo efecto se observa en cariados definitivos (DRP=55% [IC del 95%: 16–76]; NNT=5 [IC del 95%: 2,8–53,3]).ConclusionesEl cepillado dental se asocia a la salud bucodental, con un gran impacto clínico. El efecto positivo del cepillado dental fue superior al de una dieta correcta(AU)

AimTo determine the impact and clinical relevance of tooth brushing on oral health.DesignPrevalence study.LocationFontiñas Health Centre. (Santiago de Compostela, Spain). Prevalence study (n=281 children aged 5–14 years.LocationOdontological examination according to WHO methodology, to determine the frequency of tooth brushing, frequency of sweet consumption and their impact on the prevalence of caries.Statistical analysisLogistic regression and estimation of the relative prevalence difference (RPD) and the Number Needed to Treat in order to prevent one additional bad outcome (NNT).ResultsThe children who never brush their teeth have a 40% (95% CI: 24.3&%#x02013;57.8%) of early caries, while those who brush their teeth several times a day have 15.3% (95% CI: 9.4&%#x02013;23.7%). An association between not brushing the teeth and caries in primary teeth (OR=2.3; 95% CI:1.05–5.3) was observed after adjusting for age, sweet consumption and visits to the dentist. The same occurred with final teeth (OR=3.9; 95% CI:1.4–10.3).ResultsThe RPD was 62%(95% CI: 30&%#x02013;79%), meaning that prevalence of caries is 62% lower in children who brush their teeth several times a day as compared to those who never brush their teeth. The NNT is 4 (95% CI: 2.4–14), so for every 4 children who brush their teeth several times a day, there is one less case of caries, compared to those who never brush their teeth. There is a dose-response relationship between prevalence of caries and brushing frequency. The same effect was observed with definitive caries: RPD=55% (95% CI:16&%#x02013;76%), NNT=5 (95% CI:2.8–53.3).ConclusionsTooth brushing is related to oral health, with a major clinical impact. The positive effect of tooth brushing was superior to that of a correct diet(AU)

[Clinical relevance of tooth brushing in relation to dental caries]. / Relevancia clínica del cepillado dental y su relación con la caries.

AIM: To determine the impact and clinical relevance of tooth brushing on oral health. DESIGN: Prevalence study. LOCATION: Fontiñas Health Centre. (Santiago de Compostela, Spain). Prevalence study (n=281 children aged 5-14 years. Odontological examination according to WHO methodology, to determine the frequency of tooth brushing, frequency of sweet consumption and their impact on the prevalence of caries. STATISTICAL ANALYSIS: Logistic regression and estimation of the relative prevalence difference (RPD) and the Number Needed to Treat in order to prevent one additional bad outcome (NNT). RESULTS: The children who never brush their teeth have a 40% (95% CI: 24.3%-57.8%) of early caries, while those who brush their teeth several times a day have 15.3% (95% CI: 9.4%-23.7%). An association between not brushing the teeth and caries in primary teeth (OR=2.3; 95% CI:1.05-5.3) was observed after adjusting for age, sweet consumption and visits to the dentist. The same occurred with final teeth (OR=3.9; 95% CI:1.4-10.3). The RPD was 62%(95% CI: 30%-79%), meaning that prevalence of caries is 62% lower in children who brush their teeth several times a day as compared to those who never brush their teeth. The NNT is 4 (95% CI: 2.4-14), so for every 4 children who brush their teeth several times a day, there is one less case of caries, compared to those who never brush their teeth. There is a dose-response relationship between prevalence of caries and brushing frequency. The same effect was observed with definitive caries: RPD=55% (95% CI:16%-76%), NNT=5 (95% CI:2.8-53.3). CONCLUSIONS: Tooth brushing is related to oral health, with a major clinical impact. The positive effect of tooth brushing was superior to that of a correct diet.