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.

Treatments for non-small cell lung cancer: a systematic quality assessment of clinical practice guidelines

Aim To evaluate the methodological quality of clinical practice guidelines (CPGs) on treatments for non-small cell lung cancer (NSCLC). Methods We searched MEDLINE, CPG developer websites, lung cancer societies, and oncology organizations to identify CPGs providing recommendations on treatments for NSCLC. The methodological quality for each CPG was determined independently by three appraisers using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument. Results Twenty-two CPGs met the eligibility criteria. The median scores per AGREE II domain were: scope and purpose 90.7% (64.8–100%), stakeholder involvement 76.9% (27.8–96.3%); rigor of development 80.9% (27.1–92.4%); clarity of presentation 89.8% (50–100%); applicability 46.5% (12.5–87.5%); and editorial independence 91.7% (27.8–100%). Most of the CPGs (54.5%) were rated as “recommended with modifications” for clinical use. Conclusions Overall, the methodological quality of CPGs proving recommendations on the management of NSCLC is moderate, but there is still room for improvement in their development and implementation (AU)

Treatments for non-small cell lung cancer: a systematic quality assessment of clinical practice guidelines.

AIM: To evaluate the methodological quality of clinical practice guidelines (CPGs) on treatments for non-small cell lung cancer (NSCLC). METHODS: We searched MEDLINE, CPG developer websites, lung cancer societies, and oncology organizations to identify CPGs providing recommendations on treatments for NSCLC. The methodological quality for each CPG was determined independently by three appraisers using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument. RESULTS: Twenty-two CPGs met the eligibility criteria. The median scores per AGREE II domain were: scope and purpose 90.7% (64.8-100%), stakeholder involvement 76.9% (27.8-96.3%); rigor of development 80.9% (27.1-92.4%); clarity of presentation 89.8% (50-100%); applicability 46.5% (12.5-87.5%); and editorial independence 91.7% (27.8-100%). Most of the CPGs (54.5%) were rated as "recommended with modifications" for clinical use. CONCLUSIONS: Overall, the methodological quality of CPGs proving recommendations on the management of NSCLC is moderate, but there is still room for improvement in their development and implementation.

Estrés académico autopercibido y factores relacionados en una escuela privada de odontología en Cartagena, Colombia / Self-perceived academic stress and related factors in a private dental school from Cartagena, Colombia / Estresse acadêmico auto-percebido e fatores relacionados em uma escola particular de odontologia em Cartagena, Colômbia

Introducción: El estrés académico surge de una interacción entre factores estresantes ambientales y las reacciones de los estudiantes, asociándose con frustración y fracaso académico. Además, algunos factores demográficos y familiares influyen en el estrés. Objetivo: Analizar estrés académico, factores demográficos y familiares en estudiantes de Odontología en Escuela privada de Cartagena. Materiales y métodos: Estudio descriptivo de corte transversal, en 158 estudiantes. Se aplicó cuestionario sociodemográfico, APGAR familiar e inventario SISCO. Se analizó los datos mediante estadística descriptiva y prueba X2. Resultados: Se encontró disfuncionalidad familiar y mal soporte de amigos en casi la mitad de los participantes, niveles de preocupación moderada cercana a 70%, alta frecuencia de demandas del entorno (estresores), reacciones comportamentales y presencia de síntomas ante estímulo estresor. Hubo asociación entre alta frecuencia de inquietud en situaciones cotidianas y pertenecer a semestres básicos, baja frecuencia de uso de estrategias de afrontamiento y sexo femenino, alta frecuencia de reacciones comportamentales y disfunción familiar. Conclusiones: Los principales factores identificados fueron pertenecer a semestres básicos, ser mujer y presencia de disfuncionalidad familiar. Los niveles de estrés y disfuncionalidad familiar sugieren una alerta para intervenir desde bienestar universitario, previniendo condiciones desfavorables en la salud y rendimiento académico de los estudiantes.

Introduction: Academic stress arises from an interaction between environmental stressors and student reactions, which are associated with academic frustration and academic failure. Likewise, there are demographic and family factors that affect stress. Objective: To analyze academic stress, demographic and family factors in Dentistry students at a private school in Cartagena. Materials and methods: A descriptive cross-sectional study with 158 students. The APGAR family sociodemographic questionnaire and SISCO inventory were used. Descriptive statistics and the X2 test were applied to analyze data. Results: Family dysfunction and low friend support were observed in almost half of the participants, 70% displayed moderate anxiety levels. Also, a high frequency of environmental demands (stressors), behavioral reactions, and the presence of symptoms in response to the stressors were found. There were associations between: high frequency of restlessness in everyday situations and belonging to initial semesters; low frequency of using coping strategies and female gender; and high frequency of behavioral reactions and family dysfunction. Conclusions: The main factors identified were belonging to initial semesters, being a woman, and family dysfunction. Levels of stress and family dysfunction can be used as a signal for university welfare services to intervene and prevent unfavorable student health and academic performance conditions.

Introdução: O estresse acadêmico surge de uma interação entre os estressores ambientais e as reações dos alunos, associados à frustração e ao fracasso acadêmico. Além disso, alguns fatores demográficos e familiares influenciam o estresse. Objetivo: Analisar o estresse acadêmico, fatores demográficos e familiares em estudantes de odontologia de uma escola particular de Cartagena. Materiais e métodos: Estudo transversal descritivo, em 158 estudantes. Questionários sociodemográficos, APGAR familiar e inventário SISCO foram aplicados. Os dados foram analisados por meio de estatística descritiva e teste X2. Resultados: Disfunção familiar e pouco apoio dos amigos foram encontrados em quase metade dos participantes, níveis de preocupação moderada próximos a 70 %, alta frequência de demandas do ambiente (estressores), reações comportamentais e presença de sintomas diante de estímulos estressantes. Houve associação entre alta frequência de inquietação em situações cotidianas e pertencimento aos semestres básicos, baixa frequência do uso de estratégias de enfrentamento e sexo feminino, alta frequência de reações comportamentais e disfunção familiar. Conclusões: Os principais fatores identificados foram pertencer aos semestres básicos, ser mulher e a presença de disfunção familiar. Os níveis de estresse e disfuncionalidade familiar sugerem um alerta para intervir da unidade de bem-estar da universidade para prevenir condições desfavoráveis na saúde e desempenho acadêmico dos estudantes.

Therapeutic Options in Unresectable Oral Squamous Cell Carcinoma: A Systematic Review.

PURPOSE: This review describes the current scientific evidence of therapeutic options in unresectable oral squamous cell carcinoma. METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched MEDLINE (Via PubMed) to identify studies assessing treatments for unresectable oral squamous cell carcinoma. The methodological quality assessment of the included studies was performed using the Joanna Briggs Institute (JBI) checklist tool. The evidence was organized and presented using tables and narrative synthesis. RESULTS: Thirty-three studies met the eligibility criteria. Most studies had an observational design. The sample size varied from 16 to 916 participants. The methodology quality of the included studies ranged from 2.5 to 10 using the JBI tool. Overall, the optimal treatment of patients with unresectable oral cancer is challenging, so there is a sprinkling of studies assessing a variety of therapeutic options, such as radiotherapy, chemotherapy, concurrent chemoradiotherapy, immunotherapy, targeted therapy plus chemotherapy or radiotherapy, and gene therapy plus chemotherapy. CONCLUSION: There is lacking evidence about the benefits of some therapeutic options for unresectable oral squamous cell carcinoma. Overall, these patients can be treated using a multimodal approach such as concurrent chemoradiotherapy or induction chemotherapy followed by chemoradiotherapy, which have shown good clinical outcomes. However, other options could be considered depending on the assessment of risk/benefits, tumor extension, and patient values and preferences.

Trastornos mentales comunes y factores asociados en estudiantes de Odontología en Cartagena, Colombia / Common Mental Disorders and Associated Factors in Dental Students From Cartagena, Colombia

RESUMEN Introducción: La valoración de morbilidad psicológica resulta de interés porque la salud mental hace parte de la salud integral de un individuo, y la detección precoz de casos propende al bienestar emocional. Objetivo: Estimar la asociación entre trastornos mentales comunes y factores relacionados en estudiantes de Odontología de Cartagena, Colombia. Métodos: Estudio de corte transversal en 858 estudiantes de Odontología de Cartagena, Colombia, que respondieron a un cuestionario estructurado anónimo autoaplicado para evaluar la presencia de TMC (Cuestionario General de Salud-12), consumo problemático de alcohol (CAGE), variables sociodemográficas y otras relacionadas. Se realizó estadística descriptiva y análisis bivariable con pruebas de la x2. La fuerza de asociación se computó con razones de prevalencia (RP) e intervalos de confianza del 95% (IC95%). Con regresión log-binomial, se obtuvieron RP e IC95% ajustados. El análisis se realizó empleando Stata v.13.2 para Windows (Stata Corp.; College Station, Texas, Estados Unidos). Resultados: El promedio de edad fue 20,8 ± 3,01 arios y más de la mitad eran mujeres. La prevalencia de TMC fue del 30,3% (IC95%, 27,3-33,5). El modelo de regresión indicó como factores asociados: sexo (RP, 1,54; IC95%, 1,21-1,96), cambios económicos recientes (RP, 1,70; IC95%, 1,37-2,12), conflictos familiares (RP, 2,29; IC95%, 1,89-2,77)], abandono (RP, 1,58; IC95%, 1,23-2,03), historia de abuso (RP, 2,05; IC95%, 1,27-3,31) y consumo problemático de alcohol (RP, 1,35; IC95%, 1,02-1,78). Conclusiones: La prevalencia de TMC fue alta. Ser mujer y tener conflictos familiares, historia de abuso y consumo problemático de alcohol son factores de riesgo de TMC y deben ser cuidadosamente evaluados para la predicción del bienestar emocional.

ABSTRACT Introduction: Psychological morbidity assessments are of interest since mental health is part of a person's overall health and early detection promotes emotional well-being. Aim: To determine the association between common mental disorders and related factors in dental students from Cartagena, Colombia. Methods: We conducted a cross-sectional study in 858 dental students from Cartagena, Colombia; who answered a structured anonymous self-report questionnaire to assess the presence of common mental disorders (CMD) (General Health Questionnaire-12), problematic alcohol consumption (CAGE), sociodemographic and other related variables. Data were analyzed using descriptive statistics and bivariate analysis was conducted later using x2 tests. The strength of association was obtained with prevalence ratios (PR) and 95% confidence intervals (95%CI). Finally adjusted PRs, and 95%CIs were obtained using a log-binomial regression model. Statistical analysis was performed using Stata v.13.2 for Windows (Stata Corp.; TX, USA). Results: The average age was 20.8 ± 3.01 years of age, and more than half were females. CMD overall prevalence was 30.3% (95%CI, 27.3-33.5). The regression model suggested as associated factors: sex (PR, 1.54; 95%CI, 1.21-1.96), recent economic changes (PR, 1.70; 95%CI, 1.37-2.12), family conflicts [PR, 2.29; 95%CI, 1.89-2.77), abandonment (PR, 1.58; 95%CI, 1.232.03), history of abuse (PR, 2.05; 95%CI, 1.27-3.31), and problematic alcohol consumption (PR, 1.35; 95%CI, 1.02-1.78). Conclusions: CMD prevalence was high. Being female, family conflicts, history of abuse and problematic alcohol consumption are considered as risk factors for CMD development and should be carefully assessed to predict emotional well-being.

Common Mental Disorders and Associated Factors in Dental Students From Cartagena, Colombia. / Trastornos mentales comunes y factores asociados en estudiantes de Odontología en Cartagena, Colombia.

INTRODUCTION: Psychological morbidity assessments are of interest since mental health is part of a person's overall health and early detection promotes emotional well-being. AIM: To determine the association between common mental disorders and related factors in dental students from Cartagena, Colombia. METHODS: We conducted a cross-sectional study in 858 dental students from Cartagena, Colombia; who answered a structured anonymous self-report questionnaire to assess the presence of common mental disorders (CMD) (General Health Questionnaire-12), problematic alcohol consumption (CAGE), sociodemographic and other related variables. Data were analyzed using descriptive statistics and bivariate analysis was conducted later using χ2 tests. The strength of association was obtained with prevalence ratios (PR) and 95% confidence intervals (95%CI). Finally adjusted PRs, and 95%CIs were obtained using a log-binomial regression model. Statistical analysis was performed using Stata v.13.2 for Windows (Stata Corp.; TX, USA). RESULTS: The average age was 20.8±3.01 years of age, and more than half were females. CMD overall prevalence was 30.3% (95%CI, 27.3-33.5). The regression model suggested as associated factors: sex (PR, 1.54; 95%CI, 1.21-1.96), recent economic changes (PR, 1.70; 95%CI, 1.37-2.12), family conflicts [PR, 2.29; 95%CI, 1.89-2.77), abandonment (PR, 1.58; 95%CI, 1.23-2.03), history of abuse (PR, 2.05; 95%CI, 1.27-3.31), and problematic alcohol consumption (PR, 1.35; 95%CI, 1.02-1.78). CONCLUSIONS: CMD prevalence was high. Being female, family conflicts, history of abuse and problematic alcohol consumption are considered as risk factors for CMD development and should be carefully assessed to predict emotional well-being.

Impacto de la sonrisa sobre calidad de vida relacionada con salud bucal en adultos / Impact of the smile on oral health-related quality of life in adults

RESUMEN: Objetivo. Describir impacto de la sonrisa sobre calidad de vida relacionada con la salud bucal (CVRSB) en pacientes, Facultad de Odontología, Universidad de Cartagena, Colombia. Material y Métodos. Estudio analítico de corte transversal, en 389 adultos seleccionados por muestreo censal. Se indagó: variables sociodemográficas, la sonrisa evaluada de dos formas: Apariencia Clínica: color y tamaño de dientes, encías y labios, número de dientes, presencia de caries, restos radiculares, uso de prótesis dentales y Satisfacción de la Sonrisa: a través del Smile Perception Impact related Quality of Life (SPIRQoL). También se indagó por la CVRSB con el General Oral Health Assesment Index (GOHAI). Fue realizado análisis univariado y multivariado de Regresión de Poisson con varianza robusta y nivel de confianza del 95 %. Resultados. 17,7 % (IC 95%: 7,6-13,8) presentó insatisfacción con su sonrisa (SPIRQoL) y el dominio autoestima fue el más comprometido; en el modelo multivariado la procedencia rural impactó de manera negativa sobre la satisfacción de la sonrisa (SPIRQoL) (RR: 2,27, IC 95 %: 1,4-3,6, p=0,001), igual que el tamaño inadecuado de dientes (RR: 10, IC 95 %: 3,12-32,1, p= 0,000), encías (RR: 2,4, IC 95 %: 1,3-4,3, p=0,004) y labios inadecuados (RR: 2,5, IC 95 %: 1,5-4,4, p=0,001). La insatisfacción de la sonrisa impactó de manera negativa sobre la CVRSB (GOHAI) (RR: 1,19, IC 95%: 1,2-1,4, p= 0,000). Conclusiones. La insatisfacción de la sonrisa genera impacto negativo sobre CVRSB además de la apariencia clínica inadecuada de dientes, encías y labios y ser de procedencia rural.

ABSTRACT: Objective. To assess the impact of the smile on oral health-related quality of life in adults, Faculty of Dentistry, University of Cartagena, Colombia. Material and Methods. Analytic Cross-sectional study in 389 subjects aged between 18 and 81 years using Census sampling. The sociodemographic variables were evaluated and the smile assessed , in two ways: Clinical Appearance: teethcolor and size, gums, lips, number of teeth, presence of caries, root fragments, use of dentures and Smile Satisfaction: through the Smile Perception Impact-related Quality of Life (SPIRQoL). Besides, the Oral health-related quality of life (OHRQoL) was evaluated through the General Oral Health Assessment Index (GOHAI). Univariate statistical analysis and multivariate analysis with Poisson regression models were used to associate the different clinical and sociodemographic factors with the outcome. Results. 17,7% (CI 95% = 7,6 -13,8) showed dissatisfaction with their smile (SPIRQoL); the self-esteem was the most compromised domain; in the multivariate model, the rural origin had a negative impact on the smile perception measured by SPIRQoL (RR: 2,27; CI 95 %= 1,4-3,6; p=0,001), just like inadequate size teeth (RR: 10; CI 95 %= 3,12-32,1, p= 0.000), inadequate gums (RR: 2.4; CI 95 %= 1,3-4,3; p=0,004) and inadequate lips (RR: 2,5; CI 95 %=1,5-4,4; p=0,001). Smile dissatisfaction showed negative impacts on the OHRQoL measured with GOHAI (RR: 1,19; IC 95%= 1,2-1,4; p= 0,000). Conclusion. Smile dissatisfaction showed negative impacts on OHRQoL, in addition to the clinical inadequate appearance of teeth , gums and lips and being from rural origin.

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.

Algunas consideraciones sobre el aislamiento absoluto / Some considerations on absolute isolation

El aislamiento absoluto es un procedimiento clínico que contribuye a mejorar los procederes en la operatoria dental, rehabilitación, odontopediatría y endodoncia, pues propicia un ambiente adecuado para los materiales de restauración, así como en la seguridad del paciente. Con el fin de promover su uso en la práctica se realizó una revisión bibliográfica que incluye la historia, elementos del aislamiento absoluto, recomendaciones y evidencia científica sobre su uso(AU)

Absolute isolation is a clinical procedure that contributes to improve procedures in the dental operative, rehabilitation, Odontopediatrics and Endodontics, because it propitiates an appropriate atmosphere for the restoration materials, as well as in the patient's security. With the purpose of promoting their use in practice a literature review was carried out that includes the history, elements of the absolute isolation, recommendations and scientific evidence on their use(AU)

Validez de constructo y confiabilidad de la APGAR familiar en pacientes odontológicos adultos de Cartagena, Colombia / Construct validity and reliability of the family APGAR in adult dental patients from Cartagena, Colombia

RESUMEN Objetivo: Determinar la validez de constructo y confiabilidad del APGAR familiar en pacientes odontológicos adultos de Cartagena, Colombia. Métodos: Estudio de validación de escalas sin criterio de referencia en 227 pacientes entre 22 y 94 años atendidos en una Clínica Odontológica Universitaria del Norte (Colombia). Los datos del APGAR se extrajeron a partir de la historia clínica de salud familiar. La consistencia interna se estimó con la fórmula de Kuder-Richardson y la validez de constructo, empleando análisis factorial exploratorio (AFE) y confirmatorio (AFC). Los siguientes índices de ajuste se obtuvieron a partir del AFC: χ2, p-valor para χ2, grados de libertad (gl), raíz cuadrada del error medio de aproximación, índice comparativo de ajuste e índice de Tucker-Lewis. El análisis de los datos se hizo a través de Stata v.13.2 para Windows (StataCorp, TX, USA) y Mplus v.7.31 para Windows (Muthén & Muthén, LA, USA). Resultados: El promedio global del APGAR familiar fue 17,07±3,15 y la prevalencia de disfunción familiar fue 44,4 % (IC 95%: 38 - 51 %). La consistencia interna fue 0,90. El AFE reportó un solo factor que explicó el 64,1 % de la varianza total. El AFC mostró como índices de ajuste χ2=702,960; gl=10, p-valor=0.001; RCEMA=0.155 (IC90%: 0.107-0.209); ICA=0.961; ITL=0.922. Conclusiones: En la muestra, APGAR familiar resultó ser un instrumento de tamizaje con alta utilidad clínica, excelente consistencia interna pero cuestionable validez de constructo. Deben realizarse investigaciones adicionales a fin de obtener escalas con adecuadas propiedades psicométricas para la medición de constructos en salud.

ABSTRACT Objective: To determine construct validity and reliability of the family APGAR scale in dental adult patients from Cartagena, Colombia. Methods: Scale validation study without a reference criterion in 227 patients between 22 and 94 years old whom consulted a college-based dental clinic. Family APGAR data was obtained from the family health charts. Internal consistency was calculated with the Kuder-Richardson formula and construct validity, by means of exploratory (EFA) and confirmatory factor analysis (CFA). Fit indexes were obtained from CFA: χ2; p-value for χ2; degrees of freedom (df); root mean square error of approximation (RMSEA); comparative fit index (CFI) and Tucker-Lewis index (TLI). Data analysis was performed using Stata v.13.2 for Windows (StataCorp, TX, US) and Mplus v.7.31 for Windows (Muthén & Muthén, LA, US). Results: Family APGAR overall score was 17,07±3,15 and prevalence of family dysfunction was 44,4% (95% CI: 38 - 51%). Internal consistency was 0,90. EFA showed a single factor that accounted for 64,1% of the total variance. CFA showed as fit indexes: χ2=702,960; df=10, χ2 p-value=0.001; RMSEA=0.155 (90% CI: 0.107-0.209); CFI=0.961; TLI=0.922. Conclusions: Family APGAR in Cartagena dental adult patients seems to be a highly valuable screening instrument with excellent internal consistency but questionable construct validity. Additional studies must be conducted in order to obtain scales with adequate psychometric properties for construct measurement.

Algunas consideraciones sobre el aislamiento absoluto / Some considerations on absolute isolation

El aislamiento absoluto es un procedimiento clínico que contribuye a mejorar los procederes en la operatoria dental, rehabilitación, odontopediatría y endodoncia, pues propicia un ambiente adecuado para los materiales de restauración, así como en la seguridad del paciente. Con el fin de promover su uso en la práctica se realizó una revisión bibliográfica que incluye la historia, elementos del aislamiento absoluto, recomendaciones y evidencia científica sobre su uso.

Absolute isolation is a clinical procedure that contributes to improve procedures in the dental operative, rehabilitation, Odontopediatrics and Endodontics, because it propitiates an appropriate atmosphere for the restoration materials, as well as in the patient's security. With the purpose of promoting their use in practice a literature review was carried out that includes the history, elements of the absolute isolation, recommendations and scientific evidence on their use.

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.

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)

Gingivoplastia y frenillectomía labial con láser de alta intensidad: presentación de caso / Gingivoplasty and labial frenectomy with high intensity laser: presentation of a case

En los últimos años la estética se ha convertido en motivo de consulta odontológica frecuente. Los pacientes creen que la estética de la sonrisa depende de los dientes; sin embargo, al realizar la evaluación clínica, el profesional puede detectar inconformidad estética del paciente condicionada por factores del medio bucal como los tejidos blandos del periodonto de protección, específicamente la encía aumentada o la inserción muy baja de la mucosa de los frenillos labiales, lo que puede ocasionar que los pacientes manifiesten ver sus dientes de tamaño reducido; además al sonreír pueden exponer gran cantidad de encía. A continuación se expone el caso de una paciente mujer que acude a consulta por inconformidad estética en la sonrisa y tamaño dental; tras la valoración intraoral se diagnostica gingivitis localizada asociada a placa bacteriana y presencia de frenillo papilar alargado, provocando apariencia de dientes cortos o pequeños. Se decide realizar procedimiento quirúrgico mínimamente invasivo para reposicionar los tejidos blandos y mejorar la armonía, respetando espacios biológicos, utilizando terapia con láser de alta intensidad considerando las ventajas de su uso como tiempo de intervención menor, no requerir anestesia local, menor sangrado, tiempo de cicatrización más corto y haciendo innecesario el uso de suturas al compararle con la cirugía convencional con bisturí. Al finalizar el procedimiento la paciente manifiesta satisfacción y ausencia de dolor. Tras control posquirúrgico a los 15 días se aprecia ausencia de edema en el tejido gingival, reposicionamiento de la inserción del frenillo labial superior y borde libre de encía marginal en los órganos dentarios anterosuperiores reposicionados en sentido apical.

In recent years, aesthetics has become a common reason for a dental visit. Patients believe that the aesthetics of the smile depends on the teeth. However, when the clinical evaluation is carried out, the professional can also detect aesthetic dissatisfaction of a patient, conditioned by factors of the oral environment, such as periodontium soft tissue, in particular the increased gingiva or low insertion of the mucosa of the labial frenulum. These may cause patients to believe that their teeth are reduced in size, due to much more gum being exposed when they smile. The clinical case is presented of a female patient who made a dental appointment because of aesthetic dissatisfaction with her smile and dental size. After the intraoral assessment was carried out, a diagnosis was made of a localized gingivitis associated with plaque and presence of an elongated papillary frenum, giving the appearance of short or small teeth. It was decided to perform a minimally invasive surgical procedure to generate the reposition of soft tissues and improve harmony, respecting biological spaces. High-power laser therapy was performed, due to the advantages of its use, such as reduced intervention time, no requirement of local anesthesia, less bleeding, shorter healing time, and unnecessary use of sutures, compared with conventional surgery carried out with scalpel. Immediately after the procedure, the patient felt satisfaction and no pain. On day 15 post-surgery it was observed that there was no swelling of gingival tissue, reposition of the insertion of the upper frenum, and free edge of marginal gingiva in anterior-superior teeth in an apical direction.

Salud bucal en escolares con síndrome de Down en Cartagena (Colombia) / Oral health in school children with Down syndrome in Cartagena (Colombia)

Objetivo. Describir el estado de salud bucal en escolares con Síndrome de Down (SD) en Cartagena, Colombia. Diseño del estudio. Estudio descriptivo transversal. Emplazamiento. Instituciones Escolares con niños con SD de Cartagena de Indias. Participantes. 158 estudiantes entre 3 y 41 años Mediciones principales. Se diseñó un instrumento para evaluar variables sociodemográficas e instrumento clínico para evaluar el estado de salud bucal, considerando prevalencia de caries dental (COP), fluorosis dental (índice de Dean), maloclusiones (Clasificación Angle), placa bacteriana (índice de placa comunitario IPC), presencia de enfermedad periodontal, lesiones en tejidos blandos y anomalías dentales (forma, tamaño y número). Los datos fueron analizados a partir de proporciones y se utilizó la prueba chi cuadrado para significancia en las relaciones, asumiendo un límite de 0,05 para la significación. Resultados. La prevalencia de caries dental fue 45 % (IC95 %:37-53), fluorosis dental 45,5 % (IC95 %: 37,7-53,4) y enfermedad periodontal en 58,8 % (IC95 %: 51,1-66,6); relación molar clase III derecha 62 % (IC95 %: 40,2-74,2), clase III izquierda 60,7 % (IC95 %: 49,6-73,5) y mordida abierta 41,8 % (IC95 %: 33,9-49,5). Se encontraron relaciones con significancia estadística entre presencia de caries dental y enfermedad periodontal en escolares adolescentes y aquellos con ausencia de cepillo dental propio; entre uso de crema dental fluorada con menor presencia de caries dental, baja frecuencia de cepillado dental (≤2 veces al día) con menor presencia de fluorosis y mayor presencia de enfermedad periodontal; también entre esta última y el cepillado no supervisado (p<0,05). Conclusiones. Los escolares con SD presentan altas prevalencias de caries dental, fluorosis y enfermedad periodontal que requieren más atención y educación para lograr mejorar su salud bucal (AU)

Objective. To describe the state of oral health in school children with Down Syndrome (DS) in Cartagena, Colombia. Study Design. This was a cross-sectional descriptive study. Participants. 158 students between 3 and 41 years Location. School institutions with children with DS of Cartagena de Indias Main measurements. An instrument was designed to assess sociodemographic variables, as well as a clinical tool to assess the state of oral health considering Dental caries prevalence evaluated by DMFT, dental fluorosis (Dean index), malocclusion (Angle classification), dental plaque (community plaque index CPI), presence of periodontal disease, soft tissue injuries and dental anomalies (shape, size and number). Data were analyzed from proportions and Chi-Square test was used for significance in relationships, assuming a limit of 0.05 for significance Results. Caries prevalence was 45% (37-53 95 %CI), dental fluorosis prevalence 45.5% (37.7 to 53.4 95 %CI) and periodontal disease 58.8% (51.1 to 66.6 95 %CI); Class III molar on the right side 62% (40.2 to 74.2 95 %CI), Class III molar on the left side 60.7% (49.6 to 73.5 95 %CI) and open bite 41.8% (33.9 to 49.5 95 %CI). Bivariate analysis revealed statistical significance between the presence of dental caries and periodontal disease in school adolescents and those that do not have their own toothbrush; in use of fluoride toothpaste with less presence of dental caries, low frequency of tooth brushing (≤2 times a day) with less presence of fluorosis and more presence of periodontal disease; also between periodontal disease and unsupervised brushing (p <0.05). Conclusion. School children with DS presented high prevalence of dental caries, fluorosis and periodontal disease requiring more care and education in order to improve their oral health (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)