Enamel fluorosis related with fluoride-containing water ingestion and urinary excretion in schoolchildren.

Background: Natural water sources are considered as the major environmental exposure of fluoride, resulting in increased prevalence of enamel fluorosis. This type of natural exposure should be permanently monitored to avoid the interactions with other non-natural fluoride sources. We evaluated the prevalence of enamel fluorosis in Colombian schoolchildren and its relationship with fluoride-containing water ingestion exposure dose and urinary fluoride excretion. Material and Methods: We included 923 schoolchildren aged 7-12 years residing in eight municipalities in Colombia. Sampling of consumption water was performed in major aquifers used for daily supply. Samples were collected in 98 polyethylene containers and refrigerated until analysis. Water and urine fluoride concentrations were measured using the fluoride selective electrode method. Enamel fluorosis was evaluated using Thylstrup and Ferjerskov Index (TFI). Demographic and anthropometric characteristics were assessed. Besides, other exposures to non-natural fluoride were also evaluated. Logistic regression was applied for multiple analyses. Results: The median fluoride concentration in water and urine samples was 10.5 mg/L and 0.63 mg/L respectively, with the highest value found in Algarrobo-Magdalena, and the lowest value found in Manzanares-Caldas. The overall prevalence of enamel fluorosis was 86.1%, being more frequent the mild codes with TFI-1 to TFI-2. The highest prevalence was found in Margarita-Bolívar and Manzanares-Caldas, and the most severe codes (TFI-5 to TFI-9) were detected in Manzanares-Caldas. The multiple analysis revealed water ingestion exposure dose, urinary excretion, involuntary intake of toothpaste, amount of table salt consumption and sex as significant factors (p< 0.001). Conclusions: The fluoride ingestion exposure dose and its subsequent urinary excretion could be used as estimators of past fluoride exposure, explaining the current prevalence of enamel fluorosis in Colombian schoolchildren. Key words:Fluoride, groundwater ingestion, enamel fluorosis, prevalence, severity.

An updated examination of the perception of barriers for pharmacogenomics implementation and the usefulness of drug/gene pairs in Latin America and the Caribbean.

Pharmacogenomics (PGx) is considered an emergent field in developing countries. Research on PGx in the Latin American and the Caribbean (LAC) region remains scarce, with limited information in some populations. Thus, extrapolations are complicated, especially in mixed populations. In this paper, we reviewed and analyzed pharmacogenomic knowledge among the LAC scientific and clinical community and examined barriers to clinical application. We performed a search for publications and clinical trials in the field worldwide and evaluated the contribution of LAC. Next, we conducted a regional structured survey that evaluated a list of 14 potential barriers to the clinical implementation of biomarkers based on their importance. In addition, a paired list of 54 genes/drugs was analyzed to determine an association between biomarkers and response to genomic medicine. This survey was compared to a previous survey performed in 2014 to assess progress in the region. The search results indicated that Latin American and Caribbean countries have contributed 3.44% of the total publications and 2.45% of the PGx-related clinical trials worldwide thus far. A total of 106 professionals from 17 countries answered the survey. Six major groups of barriers were identified. Despite the region's continuous efforts in the last decade, the primary barrier to PGx implementation in LAC remains the same, the "need for guidelines, processes, and protocols for the clinical application of pharmacogenetics/pharmacogenomics". Cost-effectiveness issues are considered critical factors in the region. Items related to the reluctance of clinicians are currently less relevant. Based on the survey results, the highest ranked (96%-99%) gene/drug pairs perceived as important were CYP2D6/tamoxifen, CYP3A5/tacrolimus, CYP2D6/opioids, DPYD/fluoropyrimidines, TMPT/thiopurines, CYP2D6/tricyclic antidepressants, CYP2C19/tricyclic antidepressants, NUDT15/thiopurines, CYP2B6/efavirenz, and CYP2C19/clopidogrel. In conclusion, although the global contribution of LAC countries remains low in the PGx field, a relevant improvement has been observed in the region. The perception of the usefulness of PGx tests in biomedical community has drastically changed, raising awareness among physicians, which suggests a promising future in the clinical applications of PGx in LAC.

As3MT and GST Polymorphisms Influencing Arsenic Metabolism in Human Exposure to Drinking Groundwater.

The urinary arsenic metabolites may vary among individuals and the genetic factors have been reported to explain part of the variation. We assessed the influence of polymorphic variants of Arsenic-3-methyl-transferase and Glutathione-S-transferase on urinary arsenic metabolites. Twenty-two groundwater wells for human consumption from municipalities of Colombia were analyzed for assessed the exposure by lifetime average daily dose (LADD) (µg/kg bw/day). Surveys on 151 participants aged between 18 and 81 years old were applied to collect demographic information and other factors. In addition, genetic polymorphisms (GSTO2-rs156697, GSTP1-rs1695, As3MT-rs3740400, GSTT1 and GSTM1) were evaluated by real time and/or conventional PCR. Arsenic metabolites: AsIII, AsV, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) were measured using HPLC-HG-AFS. The influence of polymorphic variants, LADD and other factors were tested using multivariate analyses. The median of total arsenic concentration in groundwater was of 33.3 µg/L and the median of LADD for the high exposure dose was 0.33 µg/kg bw/day. Univariate analyses among arsenic metabolites and genetic polymorphisms showed MMA concentrations higher in heterozygous and/or homozygous genotypes of As3MT compared to the wild-type genotype. Besides, DMA concentrations were lower in heterozygous and/or homozygous genotypes of GSTP1 compared to the wild-type genotype. Both DMA and MMA concentrations were higher in GSTM1-null genotypes compared to the active genotype. Multivariate analyses showed statistically significant association among interactions gene-gene and gene-covariates to modify the MMA and DMA excretion. Interactions between polymorphic variants As3MT*GSTM1 and GSTO2*GSTP1 could be potential modifiers of urinary excretion of arsenic and covariates as age, LADD, and alcohol consumption contribute to largely vary the arsenic individual metabolic capacity in exposed people.

Human papilloma virus genotypes in dysplasia and epithelial hyperplasia of oral cavity using the luminex xmap technology. A multicenter study

BACKGROUND: Oral cancer associated with high risk (HPV-HR) human papilloma virus (HPV) has been increasing. HPV-HR has been associated with epithelial dysplasia, however, little information exists on its frequency in epithelial hyperplasia lesions. The aim of this study is to compare HPV genotypes in dysplastic and hyperplastic lesions of oral cavity. MATERIAL AND METHODS: Two hundred and fifty oral lesions: 131 dysplasia and 119 hyperplasia from two regions of Colombia were evaluated. One hundred seventy-four coming from urban area and 104 from a high risk population to oral cancer from a rural area. HPV was identified by qPCR and Twenty-four HPVs genotypes were evaluated by Luminex(R) technology. Logistic regressions were performed to establish the associations between HPV infections with oral dysplasia. RESULTS: Twenty-eight percent (70/250) of the samples were positives for any HPV and HPV-HRs were more frequently than low risk HPVs. HPV-16 was the most detected genotype (16%) followed by HPV-31, 53, 18 and 45. HPV, HPV-HRs and HPV-16 were only associated with dysplasia in urban area; OR 3.28 (CI 95% 1.49-7.17), OR 7.94 (CI 95% 2.97-21.2) and OR 5.90 (CI 95% 2.05-17). Individuals in rural area showed more HPV and HPV-HRs infection in hyperplasic lesions than urban population. The majority of HPV+ lesions had multi-type of HPV (52/70) and the urban individuals showed more genotypes than rural population. CONCLUSIONS: HPV-.HRs are frequently found in hyperplastic and dysplastic epithelial lesions. HPV-HRs and HPV-16 were associated with dysplasia in urban population. Rural high risk population and urban population differ in the frequency and variety of HPV genotypes

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Factors associated with dental fluorosis in three zones of Ecuador.

BACKGROUND: To determine the prevalence of dental fluorosis in 10-12 year-old school children, in three provinces of the inter-andean Region of Ecuador: Imbabura, Pichincha and Chimborazo, as well as the relationship between certain factors, considering that the latest studies go back to the year 2009. MATERIAL AND METHODS: A cross-sectional and observational study was proposed. A sample of 599 was calculated at 95% of confidence considering population projections for children between 10 and 12 old of three zones of Ecuador. However, 608 school children, who had the acceptance and informed consent of their parents to participate, completed a survey about factors associated with dental fluorosis. Once the survey was completed, the vestibular surfaces of the upper and lower anterior teeth of the infant were photographed, following standardized distance and light procedures. Three evaluators, trained in the detection of fluorosis using the Thylstrup and Fejerskov index, analyzed the photographs. The Stata 13.0 software was used for the statistical analysis, with a level of significance of 5% and with a confidence interval of 95%. To relate the risk factor of fluorosis, a multinomial logistic model was used. RESULTS: The prevalence of dental fluorosis was of 89.96%, with a greater presence of grade 2 TF. A positive statistical relationship and statistical significance was detected between dental fluorosis and consumption of bottled beverages. Also the amount of toothpaste used and its ingestion during brushing (p = 0.000) were analyzed. CONCLUSIONS: The populations evaluated, that are related to the consumption of bottled beverages and involuntary toothpaste ingestion, and have a high prevalence of a mild level of fluorosis. Key words:Fluorosis, dental, risk factors, epidemiology.

Arsenic exposure, profiles of urinary arsenic species, and polymorphism effects of glutathione-s-transferase and metallothioneins.

This study assessed the effects of polymorphic variants of gutathione-S-transferase and metallothioneins on profiles of urinary arsenic species. Drinking groundwater from Margarita and San Fernando, Colombia were analyzed and the lifetime average daily dose (LADD) of arsenic was determined. Specific surveys were applied to collect demographic information and other exposure factors. In addition, GSTT1-null, GSTM1-null, GSTP1-rs1695 and MT-2A-rs28366003 genetic polymorphisms were evaluated, either by direct PCR or PCR-RFLP. Urinary speciated arsenic concentrations were determined by HPLC-HG-AFS for species such as AsIII, AsV, monomethylarsonic acid (MMA), dimethylarsinic acid (DMA), and total urinary As (TuAs). Primary methylation index (PMI) and secondary methylation index (SMI) were also calculated as indicators of the metabolic capacity. Polymorphisms effects were tested using multivariate analysis, adjusted by potential confounders. The As concentrations in groundwater were on average 34.6 ± 24.7 µg/L greater than the WHO guideline for As (10 µg/L). There was a correlation between As concentrations in groundwater and TuAs (r = 0.59; p = 0.000). Urinary inorganic arsenic (%InAs) was associated with GSTP1, LADD, GSTP1*Age, GSTP1*alcohol consumption (r2 = 0.43; likelihood-ratio test, p = 0.000). PMI was associated with sex (r2 = 0.20; likelihood-ratio test, p = 0.007). GSTP1 (AG + GG) homozygotes/heterozygotes could increase urinary %InAs and decrease the PMI ratio in people exposed to low and high As from drinking groundwater. Therefore, the explanatory models showed the participation of some covariates that could influence the effects of the polymorphisms on these exposure biomarkers to As.

Ansiedad y miedo en niños atendidos en consulta odontológica de la Universidad de Cartagena / Fear and anxiety in children treated at the dental surgery of the University of Cartagena

Resumen Objetivo: Determinar los niveles de ansiedad y miedo a la consulta odontológica en niños atendidos en la Universidad de Cartagena. Material y métodos: Mediante un diseño transversal se seleccionaron 284 niños entre tres y ocho años, excluyendo a niños con discapacidades motoras, cognitivas y síndromes. A los niños entre seis a ocho años se les aplicó la escala combinada de miedo y a los de tres a cinco años la escala de Corah modificada dirigida a los padres. Se aplicaron pruebas de estadística descriptiva y para la comparación entre los grupos las pruebas t-Student, ANOVA y Kruskal-Wallis; asumiendo un límite de significancia de 0.05. Resultados: Se encontraron altos niveles de miedo y ansiedad durante la colocación de anestesia, ruido de equipos rotatorios y aislamiento dental. Se observaron diferencias en la edad durante la consulta (p = 0.03) y el aislamiento dental (p = 0.02) y con el sexo en la profilaxis (p = 0.02). Conclusión: Existen altos niveles de miedo y ansiedad ante la consulta odontológica en niños atendidos en la Universidad de Cartagena, se sugiere que estos niveles difieren de acuerdo con la edad, sexo y procedimientos odontológicos.

Abstract Objective: To determine fear and anxiety levels with respect to dental treatment of children treated at the University of Cartagena. Material and methods: By means of a cross-sectioned design, 284 children aged 3-8 years were selected; children with cognitive and motor disabilities as well as syndromes were excluded. Combined fear scale was applied to children ages 6-8 years, children aged 3-5 received modified Corah scale directed to the parents. Descriptive statistical tests were applied; to establish comparison among groups t-Student, ANOVA and Kruskal-Wallis test were applied, assuming 0.05 significance level. Results: High levels of fear and anxiety were found during anesthesia administration, noise elicited by rotary instruments and tooth isolation. Differences were observed related to age during consultation (p = 0.03) and tooth isolation (p = 0.02) and with gender during prophylaxis (p = 0.02). Conclusion: High levels of fear and anxiety when confronted to a dental appointment were observed in children treated at the University of Cartagena. It is suggested these levels differ according to age, gender and dental procedures.

Changes in Empathy Levels on Dentistry's Students of Public University in Cartagena City, Colombia

Objective: To compare levels of empathy in dentistry students in the cohorts of 2013 and 2016 years, in a public university in Cartagena, Colombia. Material and Methods: The sample consists of 332 students from first to fifth academic year. The instrument used was the Jefferson Medical Empathy Scale (EEMJ), Spanish version for medical students (version S), validated in Mexico and Chile and adapted for students of dentistry in Colombia. Implementation was anonymous and confidential and informed consent was used. The scale was judged by judges in order to verify cultural validity and students' understanding of the scale was evaluated. The means and standard deviation were estimated. A bifactorial variance analysis, model III was applied to find differences of means between academic years, the genders and in the interaction of these factors. The comparison between empathic cohort data 2013 and 2016 was performed using the Wilks Lambda Statistician and the M Box test. The level of significance used was α≤0.05 and ß<0.20. Results: The results were significant for the "academic years" factor (p = 0.027), gender (p = 0.782) and interaction (p = 0.364) were not significant. The size of the effect of the statistical differences found is not high. The value of R2 corrected shows that the factors studied explain only 2.9% of all the variation of empathy. Conclusion: The empathy in the study subjects presents some fluctuations; however there are no statistically significant differences for the factors of interest among the cohorts evaluated.

Validity and internal consistency of the Maslach Burnout Inventory in dental students from Cartagena, Colombia / Validez y consistencia interna del Inventario Maslach para burnout en estudiantes de Odontología de Cartagena, Colombia

Abstract Objective: To determine the internal consistency and content validity of the Maslach Burnout Inventory-Student Survey (MBI-SS) in dental students from Cartagena, Colombia. Materials and methods: Scale validation study in 886 dental students from Cartagena, Colombia. Factor structure was determined through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was measured using the Cronbach's alpha coefficient. Analyses were performed using the Stata v.13.2 for Windows (Statacorp., USA) and Mplus v.7.31 for Windows (Muthén & Muthén, USA) software. Results: Internal consistency was α = 0.806. The factor structure showed three that accounted for the 56.6% of the variance. CFA revealed: x 2 = 926.036; df=85; RMSEA = 0.106 (90% CI, 0.100-0.112); CFI = 0.947; TLI = 0.934. Conclusions: The MBI showed an adequate internal consistency and a factor structure being consistent with the original proposed structure with a poor fit, which does not reflect adequate content validity in this sample.

Resumen Objetivo: Determinar la consistencia interna y la validez de contenido del Inventario Maslach para burnout-Encuesta para estudiantes (IMB-EE) en estudiantes de Odontología de Cartagena, Colombia. Material y métodos: Estudio de validación de una escala en 886 estudiantes de Odontología de Cartagena (Colombia). Se determinó la estructura de factores a través de análisis factorial exploratorio y confirmatorio, y la consistencia interna, con el coeficiente alfa de Cronbach. El análisis estadístico se realizó empleando Stata v.13.2 para Windows (StataCorp., Estados Unidos) y Mplus v.7.31 (Muthén & Muthén, Estados Unidos). Resultados: La consistencia interna general fue α = 0,806. La solución factorial mostró tres factores que explican el 56,6% de la varianza. El análisis factorial confirmatorio mostró: X 2 =926,036; gl = 85; RCEMA = 0,106 (intervalo de confianza del 90%, 0,100-0,112); ICA = 0,947; ITL = 0,934. Conclusiones: El IMB muestra adecuada consistencia interna y una estructura factorial coherente con la propuesta original, pero con ajuste pobre, lo cual no refleja adecuada validez de contenido en esta muestra.

El cáncer bucal y su relación con la proteína translocadora mitocondrial de 18kda / Oral cancer and its relation with the 18kda mitochondrial translocator protein

Resumen El cáncer bucal posee una alta incidencia y mortalidad a nivel global. A pesar de los avances en el diagnóstico y el pronóstico de esta enfermedad, aún se mantiene una baja tasa de supervivencia de 5 años, lo cual hace necesario el estudio de métodos diagnósticos que sean capaces de detectar la enfermedad en estadios tempranos. Es por esto que avances en proteómica e inmunohistoquímica, han permitido identificar diversos biomarcadores, entre ellos la proteína translocadora (TSPO) mitocondrial de 18kDa, la cual está involucrada en diversos procesos celulares, como el transporte de colesterol, la proliferación celular y la apoptosis. Se ha reportado la presencia de valores alterados de la TSPO en diversos tipos de cáncer, así como la presencia de la TSPO en saliva y tejido de sujetos con cáncer bucal, lo cual representa una oportunidad para entender el proceso de la carcinogénesis bucal e identificar nuevas alternativas para el diagnóstico de esta enfermedad. La presente revisión de tema tiene como objetivo presentar aspectos teóricos en relación con la TSPO como un biomarcador a estudiar en sujetos con cáncer bucal, considerando su implicación en los procesos de apoptosis celular y participación en el estrés oxidativo.

Abstract Oral cancer has a high incidence and mortality rate globally. Despite the advances in the diagnosis and prognosis of this disease, a 5 years survival rate still remains, which makes it necessary to study diagnostic methods capable to detect the disease in early stages. That is why advances in proteomics and immunohistochemistry had allowed the identification of various biomarkers, including the 18 kDa mitochondrial translocator protein (TSPO), which is involved in some cellular processes, such as cholesterol transport, cellular proliferation and apoptosis. It has been reported the altered TSPO values in various types of cancer, as well as the presence of TSPO in saliva of subjects with oral cancer, which represents an opportunity to understand the oral carcinogenic process and identify new alternatives for the diagnosis of this disease. The objective of this review is to present theoretical aspects related to TSPO as a biomarker to study in subjects with oral cancer, considering its implication in the apoptosis mechanism and participation in oxidative stress.

Resumo O câncer bucal apresenta alta incidência e mortalidade ao nível mundial. Apesar dos avanços no diagnóstico e prognóstico da doença, uma baixa taxa de sobrevivência de 5 anos ainda é mantida, o que requer o estudo de métodos de diagnóstico capazes de detectar a doença nos estágios iniciais. é por isso que os avanços na proteômica e imuno-histoquímica identificaram diversos biomarcadores, incluindo a proteína translocadora (TSPO) 18 kDa mitocondriais, que está envolvida em diversos processos celulares, tais como o transporte de colesterol, a proliferação celular e a apoptose. Tem sido relatada a presença de valores alterados da TSPO em diferentes tipos de câncer, assim como a presença da TSPO em saliva e tecidos de pacientes com câncer bucal, o que representa uma oportunidade para entender o processo da carcinogênese bucal e identificar novas alternativas para o diagnóstico desta doença. A presente revisão de literatura tem como objetivo apresentar aspectos teóricos em relação ao uso da TSPO como um biomarcador a ser estudado em pacientes com câncer bucal, considerando seu envolvimento nos processos de apoptose celular e participação no estresse oxidativo.

[Validity and internal consistency of the Maslach Burnout Inventory in Dental Students from Cartagena, Colombia]. / Validez y consistencia interna del Inventario Maslach para burnout en estudiantes de Odontología de Cartagena, Colombia.

OBJECTIVE: To determine the internal consistency and content validity of the Maslach Burnout Inventory-Student Survey (MBI-SS) in dental students from Cartagena, Colombia. MATERIALS AND METHODS: Scale validation study in 886 dental students from Cartagena, Colombia. Factor structure was determined through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was measured using the Cronbach's alpha coefficient. Analyses were performed using the Stata v.13.2 for Windows (Statacorp., USA) and Mplus v.7.31 for Windows (Muthén & Muthén, USA) software. RESULTS: Internal consistency was α=.806. The factor structure showed three that accounted for the 56.6% of the variance. CFA revealed: χ2=926.036; df=85; RMSEA=.106 (90%CI, .100-.112); CFI=.947; TLI=.934. CONCLUSIONS: The MBI showed an adequate internal consistency and a factor structure being consistent with the original proposed structure with a poor fit, which does not reflect adequate content validity in this sample.

Impacto de salud oral sobre calidad de vida en adultos jóvenes de clínicas odontológicas universitarias / Oral health impact on life quality in young adults at dental university clinics

El objetivo de este estudio es asociar estado de salud oral y calidad de vida en adultos de clínicas odontológicas universitarias de Cartagena, Colombia. Material y Métodos: Estudio analítico, en 400 adultos jóvenes y maduros (20 a 59 años), que asistieron a las clínicas odontológicas de la Universidad de Cartagena y Corporación Universitaria Rafael Núñez, distribuidos equitativamente; se aplicó un instrumento validado para indagar variables sociodemográficas, el General Oral Health Assesment Index (GOHAI) para evaluar impacto calidad de vida relacionada con la salud oral (CVRSB) y examen oral para evaluar número de dientes, presencia de caries dental, placa bacteriana, restos radiculares, cálculo dental y obturaciones. Se analizaron datos a través de frecuencia y proporciones, significancia de relaciones entre variables (c2), estimación del riesgo (OR) y modelo de regresión logística con un intervalo de confianza 95 %. Resultados. 66,7 % de los participantes eran mujeres y se hallaban en adultez madura (54,7 %) edad promedio 44,6 años (DE=13,7). El 33,2 % presentó un impacto negativo de CVRSB (IC 95 %). Se hallaron asociaciones entre bajo nivel de escolaridad (OR=2,4; IC 95 %= 1,6-3,8; p=0,000), ausencia de servicios de salud (OR=1,9; IC 95 %= 1,2-2,8; p=0,002), presencia de menos de 19 dientes (OR=3,6; IC 95 %= 2,3-5,8; p=0,000), restos radiculares (OR=6,5; IC 95 %= 4,1-10; p=0,000) y cálculos (OR=5,3; IC 95 %= 3,3-8,4; p=0,000;) con el impacto negativo de CVRSB. En el modelo multivariado las variables que mejor explican el impacto negativo fueron: ausencia de servicios de salud, contar con menos de 19 dientes, presencia de restos radiculares y cálculos (p<0,05). Conclusión. Adultos jóvenes y maduros presentan un impacto negativo de CVRSB al contar con menos de 19 dientes, presencia de restos radiculares y cálculos dentales y ausencia de servicios de salud.

The aim of this study is to associate oral health status and quality of life in adults treated at university dental clinics in Cartagena, Colombia second semester 2013. Cross-sectional analytical study, in 400 young and mature adults (20-59 years) attending dental clinics University and the University Corporation Cartagena Rafael Nunez and distributed equally between the two institutions; a validated instrument was applied to investigate for sociodemographic variables and the General Oral Health Assessment Index (GOHAI) evaluating the impact of oral health on quality of life (CVRSB); oral exam was performed to evaluate the number of teeth, presence of dental caries and plaque, root fragments, dental calculus and seals. Data were analyzed by frequency and proportion, taking confidence intervals of 95 %, significance of relationships between variables by means of chi-square, risk estimation through OR, and logistic regression model with a confidence level of 95 %. 66.7 % of participants were women and were at the stage of mature adulthood with 54.7 %, with an average age of 44.6 years (SD= 13.7). 60.2 % (95 % CI 55-65) had a low impact of oral health on quality of life, followed by a high impact with 33.2 %. We found associations between low levels of schooling (p=0.000; OR=2.4; IC 95 %= 1.6-3.8), social security (p=0.0.02; OR=1.9; IC 95 %= 1.2-2.8), presence of less than 19 teeth (p=0.000; OR=3.6; IC 95%= 2.3-5.8), root fragments (p=0.000; OR=6.5; IC 95 %= 4.1-10), dental calculus (p=0.000; OR=5.3; IC 95 %= 3.3-8.4) with the negative impact of the CVRSB. In the multivariate model variables that best explain the negative impact of CVSB they were: lack of social security, have fewer than 19 teeth, presence of root fragments and stones (p <0.05). Young and mature adults have a negative impact on CVRSB especially when they have less than 19 teeth, presence of root fragments and dental calculus or when they have no social security arises.

Factores relacionados con la empatía en estudiantes de Enfermería de la Universidad de Cartagena / Empathy-related factors in nursing students of the Cartagena University

OBJETIVO: Determinar los niveles de empatía y su relación con factores sociodemográficos, familiares y académicos en estudiantes de Enfermería. MÉTODO: Estudio de corte transversal en estudiantes de Enfermería de la Universidad de Cartagena, Colombia. Se seleccionaron aleatoriamente 196 participantes, a los cuales se aplicó un cuestionario que indagaba sobre características sociodemográficas, familiares, académicas y la Escala de Empatía Médica de Jefferson-versión S. Se utilizó la prueba de Shapiro-Wilk para evaluar el supuesto de normalidad y las pruebas t Student, ANOVA, índice de correlación de Pearson y regresión lineal simple para establecer relación entre variables (p < 0,05). RESULTADOS: La media de empatía global fue 108,6±14,6 puntos; se encontraron asociaciones estadísticamente significativas entre la empatía global y el curso académico (p = 0,004), y el promedio académico acumulado (p = 0,001; R2=0,058; r=0,240); entre la dimensión «toma de perspectiva» con la procedencia (rural/urbana) (p = 0,010), y la funcionalidad familiar (p = 0,003); entre la dimensión «cuidado con compasión» y el curso académico (p = 0,002); y entre la dimensión «ponerse en el lugar del paciente» y el rendimiento académico (p = 0,034). CONCLUSIÓN: Los niveles de empatía en estudiantes de Enfermería pueden variar dependiendo de diversos factores personales y académicos, estas características deberían tenerse en cuenta en la implementación de estrategias pedagógicas para promover mejores niveles de empatía desde los primeros años de formación

OBJECTIVE: To determine empathy levels and its relationship with sociodemographic, academic and family factors in nursing students. Method: Cross-sectional study, 196 nursing students was randomly selected at the University of Cartagena, Colombia. A questionnaire that asked about sociodemographic, family and academic factors and the Scale of Physician Empathy Jefferson-version S were applied. Shapiro-Wilk test was used to assess the normality assumption. t Student, ANOVA, Pearson test and simple linear regression were used to establish the relationship (p < 0.05). RESULTS: The global empathy score was 108.6±14.6; statistically significant associations between global empathy with the training year (p = 0.004) and grade point average (R2=0.058; p = 0.001; r=0.240) were found. Moreover, the 'perspective taking' dimension with provenance (rural/urban) (p = 0.010) and family functioning (p = 0.003); the 'compassionate care' dimension with the training year (p = 0.002) and the 'putting themselves in the place of the patient' dimension with academic performance (p = 0.034). CONCLUSIONS: The empathy levels in nursing students may vary depending on various personal and academic factors, these characteristics should be taken into account for implementing teaching strategies to promote higher empathy levels since the early training years

[Empathy-related factors in Nursing students of the Cartagena University]. / Factores relacionados con la empatía en estudiantes de Enfermería de la Universidad de Cartagena.

OBJECTIVE: To determine empathy levels and its relationship with sociodemographic, academic and family factors in nursing students. METHOD: Cross-sectional study, 196 nursing students were randomly selected at the University of Cartagena, Colombia. A questionnaire that asked about sociodemographic, family and academic factors and the Scale of Physician Empathy Jefferson-version S were applied. Shapiro-Wilk test was used to assess the normality assumption. t Student, ANOVA, Pearson test and simple linear regression were used to establish the relationship (p<0.05). RESULTS: The global empathy score was 108.6±14.6; statistically significant associations between global empathy with the training year (p=0.004) and grade point average (R(2)=0.058; p=0.001; r=0.240) were found. Moreover, the "perspective taking" dimension with provenance (rural/urban) (p=0.010) and family functioning (p=0.003); the "compassionate care" dimension with the training year (p=0.002) and the "putting themselves in the place of the patient" dimension with academic performance (p=0.034). CONCLUSION: The empathy levels in nursing students may vary depending on various personal and academic factors,these characteristics should be taken into account for implementing teaching strategies to promote higher empathy levels since the early training years.

Expresión génica del factor de crecimiento transformante beta en niños con fisura labio palatina no sindrómica / Gene expression of transforming growth factor bet in children with non-syndromic cleft lip and palate

El objetivo fue determinar la expresión génica del factor de crecimiento transformante beta (TGF-ß) y posibles factores de riesgo en niños con y sin fisuras labio palatina no sindrómicas (FLPNS). Diseño de casos (Niños con fisuras orales; n= 20) y controles (niños no afectados; n= 40). A partir de muestras de saliva se realizó la extracción de mRNA utilizando el RNeasy® Protect Saliva Mini Kit-QIAgen y la expresión génica del TGF-ß mediante la reacción en cadena de la polimerasa en transcriptasa reversa, además se aplicó un cuestionario para registrar características sociodemográficas y posibles factores de riesgo durante el periodo de concepción (medicamentos, enfermedades, alcohol, cigarrillo y edad de los padres).Los datos fueron analizados mediante medidas de tendencia central y dispersión, frecuencias y porcentajes, para establecer asociaciones se utilizaron las prueba T-Student, Chi-cuadrado y Odds ratio, asumiendo un límite de confianza de 0,05. El promedio de edad de los participantes fue de 6,8 (DE= 4,6) años y el 63,3 % eran de sexo masculino. Al evaluar los posibles factores asociados con el desarrollo de FLPNS no se encontraron diferencias significativas, sin embargo el 11,7 % de las madres habían ingerido algún tipo de medicamentos durante el embarazo, el 1,7 % habían fumado algún cigarrillo y el 13,3 % ingerido alcohol. Existieron diferencias significativas en la expresión génica del TGF-ß entre los grupos (p= 0,0205), siendo menor en grupo de casos. Los factores de riesgo evaluados mostraron poca evidencia de asociación con la presencia de FLAPNS, los niños con esta alteración tienen menor expresión génica del TGF-ß, sugiriendo que alteraciones moleculares en la vía de señalización del TGF-ß posiblemente están involucradas en el desarrollo de las fisuras labio palatinas, ya que se pueden afectar procesos de diferenciación, crecimiento y proliferación celular, en donde participan varios genes incluyendo el TGF-ß.

The aim of this study was to determine gene expression of transforming growth factor beta (TGF-ß) and possible risk factors in children with and without non-syndromic oral clefts. Cases (Children with cleft lip and palate; n= 20) and controls (unaffected children; n= 40) study, from saliva samples mRNA extraction was performed using the RNeasy® Protect Saliva Mini Kit-QIAgen and gene expression of TGF-ß by reverse transcriptase polymerase chain reaction, a questionnaire was also applied to record sociodemographic characteristics and possible risk factors. Data were analyzed using measures of central tendency and dispersion, frequencies and percentages. Odds ratio, Chi-square and T-Student tests were used to determine association (p<0.05). The average age of participants was 6.8 (SD= 4.6) years and 63.3 % were male. No statistically significant association was found between any of the possible risk factors examined with the development of oral clefts (p> 0.05), however it was reported that 11.7 % of mothers had ingested some type of drug during pregnancy, 1.7 % reported maternal smoking and 13.3 % reported alcohol consumption. There were significant differences in gene expression levels of TGF-ß between groups (p= 0.0205), being lower in children with oral clefts. Most environmental risk factors evaluated here gave little evidence of association with the presence of oral clefts. Children with oral clefts have lower gene expression of TGF-ß, suggesting that molecular alterations in the signaling pathway of TGF-ß are possibly involved in the development of cleft lip and palate, as they can affect processes of differentiation, growth and proliferation cell, where several genes are involved including TGF-ß.

Social skills and behavior in children during the dental appointment in a school teaching and dental assistance, Cartagena (Colombia) / Habilidades sociales y conducta en niños durante la consulta odontológica en un centro docente-asistencial, Cartagena (Colombia)

ABSTRACT. Introduction: the goal of this study was to describe the social skills, behavior, and related problems of children during dental consultation at a teaching care center in the city of Cartagena, Colombia. Methods: this was a cross sectional study in 205 children aged 5 to 8 years receiving dental treatment in the area of study and evaluated by the Frankl scale, the Preschool and Kindergarten Behavior Scales (PKBS), and a survey about family and socio-demographic factors. The analysis was performed by means of averages (±DE), t-tests, one-way analysis of variance (Anova), and Chi square tests. Results: the Frankl scale showed higher positive behaviors. The findings obtained in the social skills dimension for the "help a friend in trouble" item showed higher averages as age progressed: age 5 (1.46), age 6 (1.57), age 7 (1.74), age 8 (1.77) (p<0.03). There was a difference for the type of clinic where care was provided (p<0.05). Concerning behavioral problems, some items showed differences in terms of age (p<0.05), sex (p<0.05), and type of clinic (p<0.05). Conclusions: some environmental factors and personal relationships influence the social skills, behavior, and related problems in children.

RESUMEN. Introducción: el objetivo del presente trabajo es describir habilidades sociales, conducta y problemas de comportamiento en niños durante la consulta odontológica en un centro docente-asistencial en la ciudad de Cartagena (Colombia). Métodos: estudio transversal realizado en 205 niños entre 5 y 8 años, atendidos en consulta odontológica en el área de estudio y evaluados mediante la escala de Frankl, escala para comportamiento preescolar y jardín infantil (PKBS) y cuestionario para factores socio-demográficos y familiares. Para el análisis se usaron promedios (±DE), pruebas t, Anova de una vía y chi cuadrado. Resultados: según la escala de Frankl, se observó conducta positiva con mayor frecuencia. Con la dimensión de habilidades sociales, para el ítem "ayuda a un amigo en dificultades" se evidenciaron mayores promedios a medida que avanzaba la edad; 5 años (1,46), 6 años (1,57), 7 años (1,74), 8 años (1,77) (p<0,03), y hubo diferencia para el tipo de clínica donde se realizó la atención (p<0,05). De acuerdo a la dimensión de problemas de conducta, en algunos ítems hubo diferencia para edad (p< 0,05), sexo (p<0,05) y tipo de clínica (p<0,05). Conclusiones: en las habilidades sociales, conducta y problemas de comportamiento infantil, influyen algunos factores del entorno y relaciones personales.

Factores relacionados con la empatía en estudiantes de medicina de la Universidad de Cartagena / Factors related to empathy in medical students at the University of Cartagena

Objetivo: Determinar los niveles de empatía y su relación con factores sociodemográficos, familiares y académicos en estudiantes de Medicina. Diseño: Estudio de corte transversal. Emplazamiento: Universidad de Cartagena (Colombia). Participantes: 256 estudiantes de Medicina de la Universidad de Cartagena, seleccionados aleatoriamente. Mediciones Principales: Se aplicó un cuestionario que indagaba sobre características sociodemográficas, familiares, académicas y la Escala de Empatía Médica de Jefferson versión S. Para el análisis se utilizó la prueba de Shapiro-Wilk para evaluar el supuesto de normalidad, las pruebas T Student y Anova para establecer la relación entre variables (p<0,05). Resultados: La media de empatía global fue 114,3 ± 12,8 puntos. Se encontraron diferencias estadísticamente significativas entre la media de empatía global con el sexo (p=0,0033), funcionalidad familiar (p=0,0017), Medicina como primera opción de estudio (p=0,03), rendimiento académico (p=0,0464) y promedio académico acumulado (p=0,003; r=0,19). Conclusiones: Los niveles de empatía en estudiantes de Medicina pueden variar dependiendo del sexo, funcionalidad familiar, primera opción de estudio, promedio y rendimiento académico; lo que hace imperativa la implementación de estrategias pedagógicas en las áreas humanas involucrando a las familias de los educandos, mejorando así los niveles de empatía y la atención en salud (AU)

Objective: To determine empathy levels and its relationship with sociodemographic, academic and family factors in medical students. Design: Cross-sectional study. Location: University of Cartagena (Colombia). Participants: 256 medical students at the University of Cartagena, randomly selected. Main measures: A questionnaire was applied that asked about sociodemographic, family and academic factors and the Jefferson Scale of Physician Empathy version S. Shapiro-Wilk test was used to assess the normality assumption, and T Student and Anova tests were used to establish relationship among variables (p<0.05). Results: The average global empathy was 114.3 ± 12.8 points; we found statistically significant differences between the average global empathy with sex (p=0.0033), family functioning (p=0.0017), Medicine as first choice study (p=0.03), academic performance (p=0.0464) and cumulative grade point average (p=0.003; r = 0.19). Conclusions: The levels of empathy in medical students may vary depending on gender, family functioning, first choice of study, academic average and performance; which makes it imperative to implement pedagogical strategies in human areas involving students’ families, and therefore improving the levels of empathy and health care (AU)

Distribución de la orientación empática en estudiantes de odontología: Cartagena, Colombia / Distribution of empathetic orientation among dentistry students of Cartagena, Colombia

Objetivo Describir el nivel de empatía de los alumnos que cursan el programa de odontología en la Universidad de Cartagena. Métodos Estudio descriptivo cuantitativo realizado en una muestra de 360 estudiantes de 1° a 5° año de odontología Universidad de Cartagena (Colombia), durante el segundo periodo académico de 2012. En quienes se aplicó la Escala de Empatía Médica de Jefferson (EEMJ) en versión español para estudiantes (versión S). El análisis consistió en la estimación de estadígrafos descriptivos; media aritmética y desviación típica en todos los factores y sus niveles correspondientes. La comparación de las medias se realizó mediante un Análisis de Varianza Bifactorial Modelo III, con interacción de primer orden y se aplicó la prueba de comparación múltiple de Duncan. Resultados Se encontraron diferencias estadísticamente significativas para las variables "nivel" (p<0,005) y "sexo" (p<0,001), existiendo menores valores de orientación empática para los estudiantes de 1° nivel y mayores valores para las mujeres. No se encontró significación en la interacción entre estos dos factores (p>0,05). Conclusiones Los valores de orientación empática en los estudiantes de odontología evaluados, fueron diferentes en los niveles de estudio y el sexo, lo que puede influir en la formación profesional integral que propenden las instituciones de educación superior dentro de sus Proyectos Educativos y hace imperativo impulsar el desarrollo de habilidades interpersonales en los educandos desde los primeros años de formación, que contribuya a mejorar la calidad de la atención en salud brindada.(AU)

Objective To describe the level of empathy of dental students at the University of Cartagena. Methods A descriptive, quantitative study on a sample of 360 students from 1st to 5th year of Dentistry at the University of Cartagena (Colombia) during the second academic period of 2012. The Spanish version for students (S version) of the Jefferson Scale of Physician Empathy (JSPE) was administered to them. The analysis consisted of calculating descriptive statistics, the arithmetic mean, and standard deviation of all the factors and their corresponding levels. The comparison of means was performed through bifactorial analysis of variance model III, with first-order interaction and application of the Duncan multiple comparison test. Results Statistically significant differences were found for the "year" variables (p<0.005) and gender (p <0.001). Lower empathic orientation values were found for 1st year students and higher value were found for women. No significance was found in the interaction between these two factors (p>0.05). Conclusions Empathic orientation values in the dental students assessed were different depending on the level or year of study and the student's gender. This may influence the comprehensive training promoted by higher education institutions as part of their educational projects. It also provides an imperative for the promotion of interpersonal skills interpersonal skills among students starting in the first years of their training to help improve the quality of health care provided.(AU)

Violencia intrafamiliar y factores de riesgo en mujeres afrodescendientes de la ciudad de Cartagena / Domestic violence and risk factors in women of African descent of the city of Cartagena

Objetivo: Estimar la asociación entre violencia intrafamiliar y factores de riesgo en mujeres afrodescendientes de la ciudad de Cartagena. Diseño del estudio: Estudio transversal. Emplazamiento: Comunidad Rural de Tierra Baja, Cartagena de Indias, Colombia. Participantes: 220 mujeres, seleccionadas a conveniencia. Métodos: Se indagó por factores sociodemográficos, presencia de violencia y abuso, y su severidad (cuestionario de abuso Norvold [NorAQ]), causas de actos violentos durante el último mes, factores de riesgo relacionados (antecedentes de violencia, roles, consumo de alcohol, falta de recreación, funcionalidad familiar [Apgar Familiar]). Los datos fueron analizados a partir de proporciones y la asociación se obtuvo por razones de disparidad y regresión logística nominal. Resultados: El 20,4% (IC95% 15,1-25,7) de las mujeres manifiestan ser víctimas de violencia, en su mayoría de abuso emocional, siendo el esposo el principal agresor; el 66,4% no denunciaron los casos por miedo y los celos son la principal causa que la desencadenó. En el análisis multivariado, el modelo que mejor explica la presencia de violencia hacia la mujer corresponde a los siguientes factores: estado civil, falta de recreación y consumo de alcohol (p=0,0001). Conclusiones: Las mujeres de Tierra Baja sufren de violencia, posiblemente por falta de oportunidades de recreación y consumo de alcohol de su pareja, lo que no garantiza el bienestar biopsicosocial de sus familias (AU)

Objective: To estimate the association between family violence and risk factors in afro descendent women from the city of Cartagena. Study design: Cross-Sectional Study. Location: Tierra Baja Rural Community, Cartagena de Indias, Colombia. Participants: 220 women selected by convenience sample. Methods: The factors investigated included sociodemographic factors, presence of violence and abuse and its severity (Norvold abuse questionnaire [NorAQ]), causes of violence during the last month, related risk factors (history of violence, roles, alcohol consumption, lack of recreation, family functioning [Family Apgar]). Data were described using proportions, and the association was obtained with odds ratios by nominal logistic regression. Results: 20.4 % (95 % CI 15.1-25.7) of women report being victims of violence, mostly emotional abuse, being the husband the primary aggressor; 66, 4 % did not report cases for fear, and jealousy is the main trigger. In the multivariate analysis, the model that best explains the presence of violence against women corresponds to the following factors: marital status, lack of recreation and alcohol consumption (p = 0.0001). Conclusions: Women from Tierra Baja suffer violence, possibly due to lack of opportunities for recreation and to their partner's alcohol abuse, which does not guarantee the biopsychosocial welfare of their families (AU)

[Distribution of empathetic orientation among dentistry students of Cartagena, Colombia]. / Distribución de la orientación empática en estudiantes de odontología. Cartagena, Colombia.

Objective To describe the level of empathy of dental students at the University of Cartagena. Methods A descriptive, quantitative study on a sample of 360 students from 1st to 5th year of Dentistry at the University of Cartagena (Colombia) during the second academic period of 2012. The Spanish version for students (S version) of the Jefferson Scale of Physician Empathy (JSPE) was administered to them. The analysis consisted of calculating descriptive statistics, the arithmetic mean, and standard deviation of all the factors and their corresponding levels. The comparison of means was performed through bifactorial analysis of variance model III, with first-order interaction and application of the Duncan multiple comparison test. Results Statistically significant differences were found for the "year" variables (p<0.005) and gender (p <0.001). Lower empathic orientation values were found for 1st year students and higher value were found for women. No significance was found in the interaction between these two factors (p>0.05). Conclusions Empathic orientation values in the dental students assessed were different depending on the level or year of study and the student's gender. This may influence the comprehensive training promoted by higher education institutions as part of their educational projects. It also provides an imperative for the promotion of interpersonal skills interpersonal skills among students starting in the first years of their training to help improve the quality of health care provided.