Fatherhood among adolescents in conflict with the law: A family systemic approach / Paternidad en adolescente en conflicto con la ley: una perspectiva desde la terapia familiar sistémica / Paternidade em adolescentes em conflito com a lei: uma perspectiva da terapia familiar sistêmica

Resumen (analítico) The objective of this paper was to analyze the construction of father-hood in adolescents who are in conflict with the law through an exploratory and qualitative study. Life stories were developed using the in-depth interview technique. The sample consisted of four adolescents in conflict with the law. Through interpretative content analysis, we obtained seven categories, including: emotional context of family origin, family functioning, witnessing family violence and the expression of masculinity by transgressing the law and using drugs. Paternity allows these young fathers to reflect on their own experiences during childhood and develop a paternal role during their transition process out of detention. The main role they assume in their paternity is that of provider, but they also make space to satisfy the affective needs of their children.

Abstract (analytical) El objetivo fue analizar la construcción de la paternidad en adolescentes en conflicto con la ley. Se llevó a cabo un estudio exploratorio y cualitativo, se construyeron historias de vida a través de la técnica de entrevista a profundidad. La muestra se conformó por cuatro adolescentes en conflicto con la ley. Se hizo un análisis de contenido interpretativo y se obtuvieron siete categorías: contexto emocional de la familia de origen, el funcionamiento familiar, ser testigo de violencia familiar y la expresión de masculinidad al transgredir la ley y usar drogas. La paternidad permite reflexionar acerca de sus experiencias en la infancia, desarrollar un rol paternal en transición, en el que asumen como principal función el proveer, pero dando espacio a satisfacer las necesidades afectivas de sus hijos.

Resumo (analítico) O objetivo foi analisar a construção da paternidade em adolescentes em conflito com a lei. Realizou-se um estudo exploratório e qualitativo, as histórias de vida foram construídas por meio da técnica de entrevista em profundidade. A mostra foi composta por quatro adolescentes em conflito com a lei. Por meio da análise de conteúdo interpretativa, obtivemos sete categorias: contexto emocional de origem familiar, funcionamento familiar, testemunho de violência familiar, expressão da masculinidade pela transgressão da lei e uso de drogas. A paternidade permite que reflitam sobre suas vivências na infância, desenvolvam um papel paternal em transição, em que assumem a função principal de prover, mas dando espaço para a satisfação das necessidades afetivas de seus filhos.

Global application of oral disease prevention and health promotion as measured 10 years after the 2007 World Health Assembly statement on oral health.

OBJECTIVES: The WHO World Health Assembly established in 2007 a Resolution (WHA60.17) on oral health, which called upon countries to ensure that public health actions for disease prevention and health promotion are established. The objective of the present survey undertaken 10 years later (2017-2018) was to measure the application of such programmes for key population age groups in low-, middle- and high-income countries. METHODS: Oral health focal points of ministries of health worldwide (n = 101) answered a structured questionnaire on existing national oral health systems and the actual public health activities. The response rate was 58.4%. The questionnaire was used to collect information about structural factors, country workforce, financial models, provision of preventive services and promotion for oral health, school health programmes, administration of fluoride, national oral health targets and oral health surveillance. The countries were classified by national income for analysis of data. RESULTS: Coverage of population groups by primary oral health care and emergency care varied by national income. The gap between countries in delivery of preventive care was strong since low-income countries less often reported preventive activities than middle-income countries and particularly when compared to high-income countries. School oral health programmes were less frequent in low-income than other countries. Moreover, population methods of fluoridation and use of fluoridated toothpaste were unusual in low-income countries. Health education, mass communication and community events were often essential elements in health promotion. In disease prevention, many countries considered the link between oral health and general health conditions and intervention towards shared risk factors of NCDs. The health concern for the consumption of tobacco, unhealthy diet and sugars was particularly emphasized by high-income countries but less highlighted by low-income countries. Finally, while national oral health targets for children and surveillance systems were frequently reported by countries, similar systems for adolescents, adults and older people were rare. CONCLUSIONS: The inequities between countries in oral disease prevention and health promotion were substantial. Limited financial resources for preventive care and health promotion; inadequate workforce for oral health, and insufficient coverage in primary health care were observed in low-resource countries. The results of the survey demonstrate the need for building effective oral health systems oriented towards oral disease prevention and health promotion.

Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective.

BACKGROUND: This paper is a summary of the proceedings of the International Association of Paediatric Dentistry Bangkok Conference on early childhood caries (ECC) held in 3-4 November 2018. AIM: The paper aims to convey a global perspective of ECC definitions, aetiology, risk factors, societal costs, management, educational curriculum, and policy. DESIGN: This global perspective on ECC is the compilation of the state of science, current concepts, and literature regarding ECC from worldwide experts on ECC. RESULTS: Early childhood caries is related to frequent sugar consumption in an environment of enamel adherent, acid-producing bacteria in a complex biofilm, as well as developmental defects of enamel. The seriousness, societal costs, and impact on quality of life of dental caries in pre-school children are enormous. Worldwide data show that ECC continues to be highly prevalent, yet infrequently treated. Approaches to reduce the prevalence include interventions that start in the first year of a child's life, evidence-based and risk-based management, and reimbursement systems that foster preventive care. CONCLUSIONS: This global perspective on ECC epidemiology, aetiology, risk assessment, global impact, and management is aimed to foster improved worldwide understanding and management of ECC.

WHO Global Consultation on Public Health Intervention against Early Childhood Caries.

Early Childhood Caries (ECC) is prevalent around the world, but in particular the disease is growing rapidly in low- and middle-income countries in parallel with changing diet and lifestyles. In many countries, ECC is often left untreated, a condition which leads to pain and adversely affects general health, growth and development, and quality of life of children, their families and their communities. Importantly, ECC is also a global public health burden, medically, socially and economically. In many countries, a substantial number of children require general anaesthesia for the treatment of caries in their primary teeth (usually extractions), and this has considerable cost and social implications. A WHO Global Consultation with oral health experts on "Public Health Intervention against Early Childhood Caries" was held on 26-28 January 2016 in Bangkok (Thailand) to identify public health solutions and to highlight their applicability to low- and middle-income countries. After a 3-day consultation, participants agreed on specific recommendations for further action. National health authorities should develop strategies and implement interventions aimed at preventing and controlling ECC. These should align with existing international initiatives such as the Sixtieth World Health Assembly Resolution WHA 60.17 Oral health: action plan for promotion and integrated disease prevention, WHO Guideline on Sugars and WHO breastfeeding recommendation. ECC prevention and control interventions should be integrated into existing primary healthcare systems. WHO public health principles must be considered when tackling the effect of social determinants in ECC. Initiatives aimed at modifying behaviour should focus on families and communities. The involvement of communities in health promotion, and population-directed and individual fluoride administration for the prevention and control of ECC is essential. Surveillance and research, including cost-effectiveness studies, should be conducted to evaluate interventions aimed at preventing ECC in different population groups.

Oral Health Surveys: basic methods

Las Encuestas de Salud Oral y los manuales de la OMS que son los Métodos básicos que han animado los países para llevar a cabo encuestas de salud oral estandarizada que es comparable internacionalmente. El Banco de Datos de Salud Oral de la OMS Global recopila los datos obtenidos a través de encuestas nacionales sobre la carga de enfermedades bucodentales y el análisis estadístico recomendada por la OMS en los grupos de edades como indicador clave en los niños y los adultos. Conducta regular de encuestas de salud bucal en un número de países tiene revelada tendencias importantes en el estado de salud bucal, en particular entre los niños. Por un lado, en varios países de ingresos altos, la salud bucal de los niños es mejores tras la introducción y consolidación de la prevención de enfermedades orales según los programas. El rápido aumento de los niveles de la enfermedad oral, por otra parte, se han observado en una serie de países de bajos y medianos ingresos en paralelo con los cambios en las condiciones de vida y la creciente adopción de estilos de vida poco saludables.

Oral health care systems in developing and developed countries.

Health care systems are essential for promoting, improving and maintaining health of the population. Through an efficient health service, patients can be advised of disease that may be present and so facilitate treatment; risks factors whose modification could reduce the incidence of disease and illness in the future can be identified, and further, how controlling such factors can contribute to maintain a good quality of life. In developed countries, clinics or hospitals may be supported by health professionals from various specialties that allow their cooperation to benefit the patient; these institutions or clinics may be equipped with the latest technical facilities. In developing countries, health services are mostly directed to provide emergency care only or interventions towards certain age group population. The most common diseases are dental caries and periodontal disease and frequently intervention procedures aim, at treating existing problems and restore teeth and related structure to normal function. It is unfortunate that the low priority given to oral health hinders acquisition of data and establishment of effective periodontal care programmes in developing countries but also in some developed countries where the periodontal profile is also less than satisfactory. Despite the fact that in several developed countries there are advanced programmes oriented to periodontal disease treatments, the concern is related to the lack of preventive oriented treatments. According to data available on periodontal status of populations from developed countries, despite the number of dentists and trained specialists, dental health professionals do not presently meet adequately the need for prevention, focusing mainly on curative care. The need for strengthening disease prevention and health promotion programmes in order to improve oral health conditions and particularly periodontal status in the majority of countries around the world is evident. Unfortunately, in many countries, the human, financial and material resources are still insufficient to meet the need for oral health care services and to provide universal access, especially in disadvantaged communities, in both developing and developed countries. Moreover, even though the most widespread illnesses are avoidable, not all population groups are well informed about or able to take advantage of the proper measures for oral health promotion. In addition, in many countries, oral health care needs to be fully integrated into national or community health programmes. Improving oral health is a very challenging objective in developing countries, but also in developed countries, especially with the accelerated aging of the population now underway and intensifying over the coming years.

Urinary fluoride levels in Jamaican children in 2008, after 21 years of salt fluoridation.

RATIONALE: In 1984, the DMFT12 in Jamaican children was 6.7 (very severe). In 1987, national salt fluoridation was implemented (250 mg F-/kg salt). In 1995, a national survey showed a substantial decrease of caries severity (DMFT12 of 1.8). OBJECTIVES: To see whether the favorable exposure of fluoride was continued. METHODS: Assessment of urinary fluoride parameters based on WHO guidelines. Children were sampled in two urban and two rural sites. Valid nocturnal and daytime urinary collections were obtained from 128 children (mean age 4.7 y). A questionnaire administered to parents provided information on oral hygiene practice, and use of fluoride via salt, dentifrices or supplements. RESULTS: Excretion rate values extrapolated to 24 h were 271 in urban and 330 microgF/24 h in rural, F-concentrations were in the range of 1.13 and 1.30. Almost all children were reported to use toothpaste, most with 600 to 1000 ppm F; 65% of children use more than the recommended amount of toothpaste. Fluoridated salt was consumed by 98% of the children. There was no other apparent usage of fluorides. CONCLUSIONS: Urinary excretion results point to a suboptimal exposure of fluoride, whereas concentrations would suggest an optimal or slightly higher intake. Dentifrices with 500 ppm F should be made available in order to minimize the risk of enamel fluorosis.

Development of salt fluoridation in the Americas.

Fluoridation of water supplies has proven to be an effective preventive measure for dental caries. Many developing countries in the Americas have multiple water systems and economies that do not permit the viable application of this approach. Some of the highest dental caries prevalence in the world was evident in the Americas. Fluoridated salt was considered as a potential solution on account of the urgent need for dental caries prevention to millions of people with limited access to routine dental services. A fluoridated salt trial was initiated in Colombia (1963) and upon successful completion with preventive results comparable to water fluoridation, the approach was introduced to other countries and was supported by resolutions of WHO, PAHO, regional health groups and the FDI. The procedures for addition of fluoride were comparable to those for iodization and the two elements were compatible. In the period 1972-2004, ten countries introduced national or localized programmes and five more initiated programmes. Results, based on addition of F ion at 200-250 mg/kg salt, indicated caries prevalence reductions in 12 year olds ranging from 84% in Jamaica, 73% in Costa Rica to 40% in Uruguay at an average cost of 0.06 U.S. dollars /capita/year. This paper provides a background to the situation in the Americas, illustrates the approaches and feasibility of implementing viable fluoridated salt programmes in countries, and demonstrates the results obtainable at minimum cost.

Methodological and biological factors explaining the reduction in dental caries in Jamaican school children between 1984 and 1995

Most of the reductions in dental caries between 1984 and 1995 is attributable to the introduction, in 1987, of salt fluoridation. While the 1995 survey included fewer rural areas than the 1984 survey did, that does not invalidate the observed reduction in dental caries. The use of fluoride toothpaste and dietary fluoride supplements as well as access to dental health promotion and preventative and curative services do not seem to be major contributors to the reductions observed (AU)

Methodological and biological factors explaining the reduction in dental caries in Jamaican school children between 1984 and 1995

OBJECTIVE: To assess the methods used and results found in two surveys, one conducted in 1984 and the other in 1995, that indicated a large reduction in the prevalane and severity of dental caries among children in Jamaica, with special attention focused on methodological differences between the two surveys and the biological factors that may explain the large reduction in caries. METHODS: In 1984 a modified "pathfinder" methodology was used to measure the prevalence and severity of dental caries in 6-, 12-, and 25-year-old children in Jamaica. A similar survey was conducted in 1995. A comparison of the two surveys showed an 84 percent reduction in the severity of dental caries at age 12. Both surveys used the same diagnostic criteria and clincal procedures, but the 1984 survey included a higher proprtion of rural residents than did the 1995 one. RESULTS: The data show an epidemiological transition between 1984, when dental caries was highly prevalent and severe, and 1995, when the disease was less prevalent and was concentrated in a smaller proportion of the population. CONCLUSIONS: Most of the reduction in dental caries between 1984 and 1995 is attributable to the introduction, in 1987, of salt flouridation. While the 1995 survey included fewer rural areas than the 1984 survey did, that does not invalidate the observed reduction in dental caries. The use of flouride toothpaste and dietary flouride supplements as well as access to dental health promotion and preventive and curative services do not seem to be major contributors to the reductions observed. (AU)

Urinary fluoride excretion by children 4-6 years old in a south Texas community

This study evaluated urinary fluoride excretion by school children 4-6 years old who were living in a south Texas rural community that had concentrations of fluoride in drinking water supplies generally around the optimal level. We took supervised collections of urine samples in the morning and afternoon at school, and parents of the participating students collected nocturnal samples. We recorded the beginning and end times of the three collection periods and then determined the urinary volume and urinary flow for each of the periods. We measured urinary fluoride concentrations and calculated the urinary excretion rate per hour. The children had breakfast and lunch provided at the school, where the drinking water contained 1.0-1.3 milligrams/liter (mg/L) fluoride. Fluoride concentrations in the tested household water supplies, from wells, ranged from 0.1 to 3.2 mg/L fluoride. The children's average urinary fluoride concentrations found for the day were similar to those for the night, with means ranging from 1.26 mg/L to 1.42 mg/L. Average excretion was 36.4 mg/h in the morning, 45.6 mg/h in the afternoon, and 17.5 mg/h at night. The lower nocturnal excretion rates are easily explained by low urinary flow at night. Based on the 15 hours of urine collected, the extrapolated 24-hour fluoride excretion was 749 µg. In conjunction with similar studies, the data from this study will help in developing upper limits for urinary fluoride excretion that are appropriate for avoiding unsightly fluorosis while providing optimal protection against dental decay