Cultural competency in dental education: developing a tool for assessment and inclusion.

PURPOSE/OBJECTIVES: This study aimed to assess the cultural competency content in selected Doctor of Dental Surgery (DDS) courses and to explore the use of an assessment tool that may be used to standardize the integration of cultural competency in the dental school curriculum. METHODS: A survey was sent to course directors to determine the inclusion of four topics related to cultural competence, the mechanisms of inclusion, and their comfort level in teaching the topics in their courses.  A scan of the same courses was conducted with the use of a tool developed from an Expert Panel's recommendations for knowledge, skills, and attitudes (KSA) to be included in curricula for teaching cultural competence. RESULTS: Twenty-one course directors responded.  Fifteen reported they include social determinants of health and twelve include health inequities in their courses. Faculty reported an average of 8.67 comfort level in teaching these topics but there was less comfort level in teaching cultural humility and implicit bias.  Course directors used assignments, case studies, lectures, quizzes, and patient care (clinical courses) to include the topics. The scan of courses showed that the use of the Competencies for General Dentists in course syllabi covered the recommended knowledge, skills, and attitudes for cultural competence. CONCLUSIONS: The rubric was suitable for assessing cultural competency content.  The Competencies for General Dentists in course syllabi will allow the integration of the recommended KSA in dental courses to teach cultural competence.  However, dental faculty may need training in the integration of KSA items in course objectives and content.

Determination of Cardiovascular Risk in 56,262 Spanish Construction Workers: Cardiovascular Risk in Construction Workers.

OBJECTIVE: To evaluate different cardiovascular risk scales in construction workers. METHODS: A descriptive, cross-sectional study was carried out in 56,262 Spanish construction workers. Scales of obesity and fatty liver, metabolic syndrome, atherogenic indices, and cardiovascular risk scales, among others, were assessed. RESULTS: In women, 19.6% were obese, 18.2% hypertensive, 12.6% had metabolic syndrome, 12% were at high risk of non-alcoholic fatty liver disease, and 4.3% were at moderate or high risk on the SCORE scale. In men, 20.1% were obese, 30.1% hypertensive, 17.5% had metabolic syndrome, and 27.6% had high or moderate risk on the SCORE scale. CONCLUSIONS: Knowing the cardiovascular risk of a large number of construction workers by means of a large number of scales may be of great interest to occupational health professionals, as it may enable them to establish prevention strategies.

Quiste epidermoide cutáneo con células sombra: a la búsqueda de un síndrome polipósico / Shadow cells in a cutaneous epidermoid cyst: searching for a polyposis syndrome

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Primary Neuroendocrine Tumor of the Parotid Gland: A Case Report and a Comprehensive Review of a Rare Entity.

Neuroendocrine tumors (NETs) comprise a heterogeneous group of malignancies from cells derived from the neural crest with neuroendocrine differentiation. Despite the differences in the site of origin, nomenclature, biological behavior, and functional status, NETs share certain ultrastructural and immunohistochemical features. NETs are relative rare tumors with an annual incidence of 5.76 new cases per 100.000 inhabitants and they usually appear in the gastrointestinal tract or in the pulmonary system. Head and neck NETs are uncommon with limited information regarding frequency, most of them showing small cell carcinoma features. NETs that arise from the salivary glands are exceedingly rare. Regardless of their low frequency, it is imperative to accurately differentiate these tumors from the much more common squamous cell carcinomas and from metastasis from another primary tumor due to the completely different therapeutic approaches and prognosis. The diagnosis is based on the recognition of the typical neuroendocrine architecture and immunohistochemical staining and on an exhaustive work-up. Hereby, we report a case of a moderately differentiated NET of the parotid gland that was treated with a complete parotidectomy. We summarize the clues that led to the final diagnosis and major strategies that were employed to manage the patient. We also perform a comprehensive review of the scarce available literature on this topic.

Osteonecrosis of the jaws in 194 patients who have undergone intravenous bisphosphonate therapy in Spain

BACKGROUND: Osteonecrosis of the jaw (ONJ) is a destructive bone process in patients undergoing bisphosphonate therapy and it is modulated by local and systemic factors. The purpose of this article is to determine the prevalence of ONJ in patients who have undergone intravenous bisphosphonate therapy, and relate the risk factors described to establish a protocol to reduce the risk of developing ONJ.MATERIAL AND METHODS: We performed a retrospective study on 194 patients treated with IV bisphosponates, analyzing clinical and pathological variables. RESULTS: The prevalence of ONJ was 12.9 %. The most remarkable complication was pain, which was reported by 80% of patients. The average age of the patients undergoing bisphosphonate therapy was 68.91 years. Most of non-diabetic patients did not develop ONJ (92.3%) (p=0.048). During bisphosphonate therapy, 3.1% of patients underwent extractions in the same percentage in the maxilla and in the mandible; all of which, except for one patient, developed ONJ (p<0.001). In regards to the periodontal state, 94.3% of patients without periodontal problems did not develop ONJ (p=0.001). Almost 50% of the necrosis were located unifocally on the mandible (p<0.001). The number of affected patients and the aggressiveness of the disease increased significantly three years after starting treatment (p<0.001). CONCLUSIONS: Etiology still is a controversial issue and we should focus on known risk factors, such as the as the devel-opment of surgical procedures in patients undergoing bisphosphonate therapy, especially in patients who have already started their treatment, a group in which ONJ prevalence increases. Moreover, a bad periodontal state in these patients is also an important risk factor, and the control of diabetes reduces it. Due to the above, all patients should be diagnosed and educated in oral hygiene prior to treatment, performing periodical maintenance, to detect possible traumatisms and periodontal infection as soon as possible

Osteonecrosis of the jaws in 194 patients who have undergone intravenous bisphosphonate therapy in Spain.

BACKGROUND: Osteonecrosis of the jaw (ONJ) is a destructive bone process in patients undergoing bisphosphonate therapy and it is modulated by local and systemic factors. The purpose of this article is to determine the prevalence of ONJ in patients who have undergone intravenous bisphosphonate therapy, and relate the risk factors described to establish a protocol to reduce the risk of developing ONJ. MATERIAL AND METHODS: We performed a retrospective study on 194 patients treated with IV bisphosponates, analyzing clinical and pathological variables. RESULTS: The prevalence of ONJ was 12.9 %. The most remarkable complication was pain, which was reported by 80% of patients. The average age of the patients undergoing bisphosphonate therapy was 68.91 years. Most of non-diabetic patients did not develop ONJ (92.3%) (p=0.048). During bisphosphonate therapy, 3.1% of patients underwent extractions in the same percentage in the maxilla and in the mandible; all of which, except for one patient, developed ONJ (p<0.001). In regards to the periodontal state, 94.3% of patients without periodontal problems did not develop ONJ (p=0.001). Almost 50% of the necrosis were located unifocally on the mandible (p<0.001). The number of affected patients and the aggressiveness of the disease increased significantly three years after starting treatment (p<0.001). CONCLUSIONS: Etiology still is a controversial issue and we should focus on known risk factors, such as the development of surgical procedures in patients undergoing bisphosphonate therapy, especially in patients who have already started their treatment, a group in which ONJ prevalence increases. Moreover, a bad periodontal state in these patients is also an important risk factor, and the control of diabetes reduces it. Due to the above, all patients should be diagnosed and educated in oral hygiene prior to treatment, performing periodical maintenance, to detect possible traumatisms and periodontal infection as soon as possible.

Letter: Recurrence of periumbilical Paget disease after fresh Mohs treated with slow Mohs with CK-7.

Extrammamary Paget disease (EMPD) is an uncommon neoplasm that often involves the skin of the genital or perianal regions. There are no clearly established guidelines for treatment, but surgical excision with wide margins (3-5 cm) or Mohs micrographic surgery (MMS) are the techniques of choice when there is no association with an underlying neoplasm. We present a case of EMPD in an unusual location (periumbilical skin). This was treated with fresh MMS, but reappeared, necessitating a second MMS (slow).