Reabilitação de dente com hipoplasia de Turner: relato de caso / Rehabilitation of tooth with Turner's hypoplasia: case report

Os defeitos de esmalte são alterações qualitativas ou quantitativas na estrutura dentária, que originam-se de fatores sistêmicos, locais ou genéticos. A hipoplasia de Turner é um defeito na espessura do esmalte localizado cuja etiologia decorre de um traumatismo ou infecção periapical presente no dente decíduo predecessor, afetando o desenvolvimento do dente permanente. O objetivo do presente estudo foi apresentar um caso clínico de paciente infantil com dente hipoplásico de Turner em pré-molar, que tornou-se não vital sem que houvesse lesão de cárie ou trauma adicional. Em razão das características clínicas e radiográficas do dente afetado, bem como do risco de cárie e do comportamento cooperador da paciente, optou-se pela reabilitação do elemento afetado por meio de tratamento endodôntico e de restauração semidireta em resina composta. Torna-se de fundamental importância o conhecimento da etiologia e a realização de um exame clínico e radiográfico minucioso visando ao diagnóstico precoce e à elaboração de um plano de tratamento adequado para todos os defeitos de desenvolvimento do esmalte, incluindo-se a hipoplasia de Turner, cujo tratamento dependerá da severidade da alteração, do comportamento do paciente e do risco de cárie. Sugere-se a realização de estudos que associem a microestrutura do esmalte hipoplásico com a ausência de vitalidade pulpar.

Enamel defects are qualitative or quantitative changes in the tooth structure originating from systemic, local, or genetic factors. Turner's hypoplasia is a defect in the thickness of the localized enamel whose etiology arises from trauma or periapical infection in the predecessor deciduous tooth, affecting the permanent tooth's development. The objective of the present study was to present a clinical case of a child patient with a hypoplastic Turner premolar tooth, which became non-vital without the occurrence of caries, or additional trauma. Due to the affected tooth's clinical and radiographic characteristics, the risk of cavities, and the patient's cooperative behavior, it was decided to rehabilitate the affected element through endodontic treatment and semidirect restoration in composite resin. It is of fundamental importance to know the etiology and carry out a thorough clinical and radiographic examination aiming at early diagnosis and the development of an adequate treatment plan for all enamel developmental defects, including Turner's hypoplasia, whose treatment will depend on the severity of the change, the patient's behavior and the risk of caries. Studies are suggested to be carried out that associate the microstructure of hypoplastic enamel with the absence of pulp vitality.

Calidad de vida relacionada con la salud y los estados de ánimo en estudiantes de instituciones educativas de Antioquia, Colombia / Quality of life related to the health and mood states of students in educational institutions from Antioquia, Colombia / Qualidade de vida relacionada à saúde e ao humor em estudantes de instituições de ensino em Antioquia, Colômbia

Introducción: La calidad de vida relacionada con la salud (CVRS) y los estados de ánimo son indicadores cruciales del bienestar en adolescentes, pero su relación con estudiantes de Antioquia, Colombia, no ha sido ampliamente estudiada. Objetivo: Determinar la CVRS y los estados de ánimo en escolares de Antioquia-Colombia. Materiales y métodos: Estudio transversal con 1957 escolares de 9 a 20 años. Se aplicaron mediciones de CVRS, ansiedad, depresión, hostilidad y alegría, actividad física, comportamiento sedentario, apoyo social de padres y nivel socioeconómico. Resultados: La calidad de vida alta (CVA) es más elevada en hombres, personas con alegría, estudiantes con apoyo de padres, activos físicamente y personas de nivel socioeconómico alto y medio. AL aumentar un año de edad, disminuye en un 15 % la CVA, y al aumentar la depresión, la ansiedad y el comportamiento sedentario disminuye la CVA. Además, los niveles de depresión y ansiedad son mayores en mujeres, estudiantes mayores, sin apoyo de los padres y personas sedentarias. Conclusiones: La CVRS se asocia con estados de ánimo, actividad física, comportamiento sedentario y apoyo de los padres; mientras que los estados de ánimo se asocian con el sexo, el apoyo de los padres, la CVS y el sedentarismo.

Introduction: Even though health-related quality of life (HRQL) and mood states are key indicators of the well-being of adolescents, their relationship has not been analyzed in students from Antioquia, Colombia. Objective: To determine HRQL and mood states in schoolchildren from Antioquia. Materials and methods: A cross-sectional study was conducted on 1,957 schoolchildren and adolescents aged between 9 and 20 years. Measurements of HRQL, anxiety, depression, hostility and happiness, physical activity, sedentary behavior, parental social support, and socioeconomic status were applied. Results: A high quality of life (HQL) was observed more frequently in male participants, students with parental support, physically active, and those belonging to medium and high socioeconomic status. HQL decreased 15% as their age increased by one year. Also, HQL was reduced when depression, anxiety, and sedentary behavior increased. Furthermore, depression and anxiety levels were higher in women, older students, as well as in those without parental control and with sedentary behavior. Conclusions: HRQL is associated with mood states, physical activity, sedentary behavior, and parental support. In contrast, mood states are related to gender, parental support, HQL, and sedentary lifestyle.

Introdução: A qualidade de vida relacionada à saúde (CVRS) e os estados de humor são indicadores cruciais de bem-estar em adolescentes, mas sua relação com estudantes de Antioquia, Colômbia, não foi amplamente estudada. Objetivo: Determinar a CVRS e os estados de humor em escolares de Antioquia-Colômbia. Materiais e métodos: Estudo transversal com 1.957 escolares de 9 a 20 anos. Foram aplicadas medidas de QVRS, ansiedade, depressão, hostilidade e felicidade, atividade física, comportamento sedentário, apoio social dos pais e nível socioeconômico. Resultados: A alta qualidade de vida (CVA) é maior em homens, pessoas com alegria, estudantes com apoio parental, fisicamente ativos e pessoas de nível socioeconômico alto e médio. À medida que a idade aumenta em um ano, diminui em 15% o CVA, e ao aumentar a depressão, a ansiedade e o comportamento sedentário aumentam, o CVA diminui. Além disso, os níveis de depressão e ansiedade são mais elevados nas mulheres, nos estudantes mais velhos, sem apoio dos pais e nas pessoas sedentárias. Conclusões: A QVRS está associada a estados de humor, atividade física, comportamento sedentário e apoio parental; enquanto os estados de humor estão associados ao sexo, apoio parental, CVS e estilo de vida sedentário.

Deep Learning-Based SD-OCT Layer Segmentation Quantifies Outer Retina Changes in Patients With Biallelic RPE65 Mutations Undergoing Gene Therapy.

Purpose: To quantify outer retina structural changes and define novel biomarkers of inherited retinal degeneration associated with biallelic mutations in RPE65 (RPE65-IRD) in patients before and after subretinal gene augmentation therapy with voretigene neparvovec (Luxturna). Methods: Application of advanced deep learning for automated retinal layer segmentation, specifically tailored for RPE65-IRD. Quantification of five novel biomarkers for the ellipsoid zone (EZ): thickness, granularity, reflectivity, and intensity. Estimation of the EZarea in single and volume scans was performed with optimized segmentation boundaries. The control group was age similar and without significant refractive error. Spherical equivalent refraction and ocular length were evaluated in all patients. Results: We observed significant differences in the structural analysis of EZ biomarkers in 22 patients with RPE65-IRD compared with 94 healthy controls. Relative EZ intensities were already reduced in pediatric eyes. Reductions of EZ local granularity and EZ thickness were only significant in adult eyes. Distances of the outer plexiform layer, external limiting membrane, and Bruch's membrane to EZ were reduced at all ages. EZ diameter and area were better preserved in pediatric eyes undergoing therapy with voretigene neparvovec and in patients with a milder phenotype. Conclusions: Automated quantitative analysis of biomarkers within EZ visualizes distinct structural differences in the outer retina of patients including treatment-related effects. The automated approach using deep learning strategies allows big data analysis for distinct forms of inherited retinal degeneration. Limitations include a small dataset and potential effects on OCT scans from myopia at least -5 diopters, the latter considered nonsignificant for outer retinal layers.

Transition clinics in pediatric rheumatology in Colombia: reflection on a necessary shortcomings.

INTRODUCTION: Transition clinics are conceived as programs dedicated to the active, multidimensional development of a process that addresses the medical, psychosocial, educational, and vocational needs of pediatric patients suffering from a chronic disease that will persist into adulthood. Their understanding is justified in physiological, psychological, and sociocultural terms on the basis of the differential morbidity and mortality associated with a chronic disease that begins in childhood and prevails into adulthood. MATERIALS AND METHODS: Here, we reflect on the history, structure, and impact of transition clinics in pediatrics, with an emphasis on pediatric rheumatologic diseases. Additionally, we propose comprehensive reflection as an alternative for the patient, their family, and the medical team, outlining guidelines for development, implementation, and evaluation. RESULTS: The transition of care should commence in early adolescence, considering each patient's cognitive ability as a condition for the initiation of an educational process involving introspection into the disease. Interdisciplinarity is defined as a team that addresses the clinical, physical, emotional, and social dimensions of each patient and their interaction with the environment within the framework of individualized care and family support. Despite this, the lack of evidence supporting standardized guidelines for the implementation and overall effectiveness evaluation of these interventions was highlighted. CONCLUSIONS: The transition process is considered successful when the patient is adherent and has a positive and informed perception of their health‒disease journey. We urge the generation of evidence documenting the comprehensiveness of processes inherent to transition clinics as the foundation of necessity.

Impact of Exon 1 polymorphism in the MBL2 gene on MBL serum levels and infection susceptibility in acute lymphoid leukemia.

Polymorphisms in the MBL2 gene exon 1 can decrease serum levels of mannose-binding lectin (MBL), increasing the risk of infection in immunocompromised individuals. This study evaluated the association between the polymorphism in exon 1 of the MBL2 gene, genotypes, serum MBL levels, and infection in 122 patients with acute lymphoid leukemia (ALL). The MBL*A allele exhibited the highest frequency (0.37) within the study population. The MBL*D (0.32) was the predominant variant. The combined frequency of O polymorphic alleles (either B or D) was 0.63. The frequencies of the A/A, A/O and O/O genotypes were 0.13, 0.49 and 0.38, respectively. All patients exhibited consistently low levels of serum MBL, irrespective of their exon 1 genotype. Parasitic infections (n = 103), bacterial (n = 69) and viral (n = 48). A/O genotype (0.49) had higher infection rates, A/A (0.13) had lower rates, and O/O showed increased viral susceptibility (OR: 0.37; 95% CI 0.13-1.06; p = 0.05). Our findings demonstrated that the study population were MBL-deficient, regardless of their MLB2 genotype. Individuals with the A/O genotype had more infections, while those with the O/O genotype appeared more susceptible to viral infections. These findings highlight the impact of MBL levels and genetic variants on infection susceptibility in ALL patients.

Validity and reliability of the step test to estimate maximal oxygen consumption in pediatric population.

Cardiorespiratory fitness is the most important variable related to health and a strong predictor of mortality. However, it is rarely used in clinics due to costs, specialized equipment, space needs, and the requirements of expert staff such as an exercise physiologist, physician, or other health professional. This work aims to validate and test the reliability of a submaximal step test to estimate VO2max of 8-to 16-year-old pediatric populations as a simple and low-cost tool for clinical practice. A cross-sectional study included 242 children and adolescents (42.1% girls) aged 8-16. Cardiorespiratory fitness was determined by a maximal incremental test on a treadmill until exhaustion. The step test entailed maintaining a steady pace of 22 steps per minute for 3 min (60 bpm), with the heart rate being recorded at the end of the test. Nutritional status was computed through BMI z-score. A multiple linear regression model validated the step test and developed a new equation to predict VO2max, including the third-minute heart rate, weight, and height. The reliability among predicted and measured VO2max was assessed by Bland-Altman analysis. The mean age was 12.5 ± 2.6; 51.6% were overweight or obese. The cardiorespiratory fitness measured as VO2max was 35.01 ± 0.58 ml·min-1·kg-1. A robust correlation was observed between the predicted VO2max from the step test and the measured VO2max (r = 0.86, p < 0.001). Bland-Altman analysis indicated statistical concordance between predicted and measured VO2max. Our findings indicate that the step test protocol is valid and reliable for estimating VO2max in children and adolescents. Furthermore, the predictive equation is suitable for application among children aged 8-16.

Cluster analysis of symptoms and assessment of caregiver reports in pediatric foreign bodies.

Foreign body (FB) ingestion and aspiration are frequent causes of pediatric emergency room visits, with significant morbidity and mortality risks. This cross-sectional study analyzed 1,052 pediatric patients admitted for suspected FB events at a single institution between 2008 and 2015, including 886 cases of suspected ingestion and 166 cases of suspected aspiration. Cluster analysis identified three distinct clusters for both groups, with respiratory symptoms being predominant in clusters with worse outcomes. The respiratory clusters were associated with increased complication rates (13.0% for aspiration, 3.6% for ingestion) and all mortalities (three in aspiration and two in ingestion). In ingestion cases, Respiratory Cluster patients showed increased complications, prolonged hospital stays (mean 55.1 h), and accounted for all mortalities, a relationship not previously reported. Caregiver-reported certainty of event occurrence showed moderate sensitivity (72.5%) and low specificity (45.4%) for aspiration, and higher sensitivity (86.8%) with lower specificity (19.8%) for ingestion. Decision Curve Analysis revealed a net benefit in utilizing caregiver certainty for clinical decision-making. Confirmatory radiographic findings were commonly observed in ingestion cases (84.2%) than in aspiration cases (37.7%), likely due to the higher incidence of metal ingestions compared to mostly organic aspirations. Endoscopic management had high success rates (97.6%), and low mortality, highlighting its central role in FB treatment. These findings underscore the importance of assessing respiratory symptom severity within the broad clinical spectrum of FBs to identify patients at risk of worse clinical outcomes, which helps prioritize resources when necessary. Caregiver-reported information has been shown to be valuable in guiding diagnostic decisions.

Secular Trends in Physical Growth Among Peruvian Children and Adolescents Living at High Altitudes.

OBJECTIVE: We aim (1) to examine secular trends in height, weight, and waist circumference (WC) among Peruvian children and adolescents living in the city of Junín and (2) to compare their growth status with the World Health Organization (WHO) and US Centers for Disease Control and Prevention (CDC) reference data. METHODS: The sample included 2874 Peruvians (n = 1681 in the 2009 cohort and n = 1193 in the 2019 cohort) aged 6-16 years from the district of Junín (4107 m of altitude). Height, weight, and WC were measured using standardized protocols. Within each sex, a two-way between-subjects analysis of variance-age, and cohort as main factors and age-by-cohort as the interaction-was used to test for differences in height, weight, and WC. STATA 17 software was used in all statistical analyses. RESULTS: Height revealed a positive secular trend among girls, aged 6-11 years, and among boys up to 14 years of age. Similar positive secular trends in weight and WC were found across all age groups in both boys and girls. Compared to North American peers, children in the 2009 cohort were shorter, lighter, and had a smaller WC. For weight and WC, the 2019 cohort overlapped the 50th percentile across all age groups (except for 16-year-old girls). CONCLUSIONS: Both boys' and girls' height, weight, and WC showed positive secular trends between 2009 and 2019, with statistically significant differences varying across age groups. Peruvian youth of both sexes were shorter and lighter than their North American peers.

Results From the First Para Report Card on Physical Activity for Children and Adolescents With Disabilities in Chile.

BACKGROUND: Global initiatives have been put in place to attain a thorough understanding of worldwide variations in physical activity (PA) among children and adolescents. Yet, there is limited knowledge about PA-related indicators, specifically for children and adolescents with disabilities (CAWD). To bridge this data gap, the Global Matrix of Para Report Cards (PRCs) of CAWD initiative was established to address the scarcity of information on PA for this population globally. The purpose of this manuscript is to summarize the results of Chile's First PRC on PA for CAWD. METHODS: Chile's PRC included 10 core PA indicators common to the Global Matrix of PRCs. Evidence from scientific articles, reports, and databases available or released from 2018 to January 2022 was included for each indicator. A scientific committee collected and analyzed the data, assigning letter grades (A-F) based on benchmarks. RESULTS: The grades assigned were as follows: Overall PA, D-; Organized Sports and Physical Activity Participation, C-; Active Play, INCOMPLETE; Active Transportation, D-; Sedentary Behavior, F; Physical Fitness, INCOMPLETE; Family and Peers, D+; School, C+; Community and Environment, D+; Government, B-. CONCLUSIONS: Chile scored low in most indicators. Although some efforts have been made in the last decade in terms of policies, these have not been reflected in PA and related behaviors in CAWD. The results underscore that maintaining the current situation is inadequate for addressing the widespread problem of physical inactivity among CAWD in Chile, emphasizing the urgency for substantial changes and a comprehensive approach to effectively combat this crisis.

Argentina's Global Matrix 4.0 Report Card Results on Physical Activity for Children and Adolescents.

BACKGROUND: The objective of the Argentine Global Matrix 4.0 Report Card was to synthesize the available national evidence on topics related to physical activity and health of children and adolescents and, based on that evidence, to assign a grade to some related indicators. METHODS: The Report Card working group reviewed and compiled the best available evidence on the indicators developed by Active Healthy Kids Global Alliance. Each of the 12 grades (for 10 core and 2 optional indicators) were based on the percentage of children and adolescents meeting a benchmark established in the Global Matrix grading rubric: These grades could range from A+ (best) to F (worst), or an incomplete was assigned when evidence was insufficient or inadequate for grading. The grades were subsequently reviewed and harmonized by 2 independent Active Healthy Kids Global Alliance reviewers. RESULTS: Overall Physical Activity, Sedentary Behavior, and Government, all received a grade of D+. Organized Sport and Physical Activity and Community and Environment each received a grade of C-. Obesity received a grade of C+. Active Play, Active Transportation, Physical Fitness, Family and Peers, School, and Sleep were graded as incomplete. CONCLUSIONS: Only half of the indicators were able to be graded, as the other half were inconclusive due to lack of evidence. This leaves a gap and thus a challenge at the national level to improve research, surveillance systems, and policies to promote physical activity during childhood and adolescence.

Peruvian Adolescent Mental Health Across Two Years of the COVID-19 Pandemic: A Four Time-Point Longitudinal Study.

PURPOSE: This study investigated symptoms of anxiety and depression, feelings of loneliness, and life satisfaction among low-to-middle income Peruvian adolescents during 2 years of remote schooling due to the COVID-19 lockdown. METHODS: We used a four-wave longitudinal observational approach. Data were collected in April 2020, October 2020, June 2021, and November 2021 in Perú. A total of 2,392 adolescents (ages 10-15; 57% female) participated in the study. We described longitudinal changes in symptoms of anxiety and depression, feelings of loneliness, and life satisfaction across the four time points and investigated sex and school grade differences. RESULTS: Symptoms of anxiety, depression, and loneliness increased, and life satisfaction decreased over the course of 2 years of remote education. The rate of change was different for each outcome of well-being. We found robust sex differences for all outcomes. In addition, we found school grade differences for anxiety and depression. DISCUSSION: The mental health and well-being of Peruvian adolescents, particularly female adolescents, declined during 2 years of remote education, despite loosening of other pandemic restrictions. Depression appears to have the earliest impacts, with anxiety levels showing even some improvement for male adolescents. School grade differences in levels of anxiety and depression for seventh and eighth graders in 2020 and 2021 provide initial evidence to disentangle pandemic from developmental effects.

Do binge drinking adolescents have a greater number of traumatised teeth? A longitudinal study with 12-year-olds in Brazil.

BACKGROUND: Binge drinking has been linked to traumatic dental injury (TDI). Once drunk, adolescents are more prone to accidents, which may result in orofacial injury. AIM: This study evaluated the possible association of binge drinking with a number of traumatised teeth in a population of 12-year-old Brazilian adolescents in 2013 and 2015. DESIGN: This study was longitudinal, carried out with 588 adolescents at two moments, 2013 and 2015. TDI, overjet and lip protection were assessed by calibrated examiners. Binge drinking data were collected through the Alcohol Use Disorders Identification Test. Sociodemographic indicators were obtained through a questionnaire answered by the parents/guardians. The Poisson regression model with a random effects intercept was estimated. RESULTS: A higher prevalence of traumatised teeth was observed among adolescents who binge drink (IRR = 1.37; 95% CI: 1.05-1.80; p < .05). The prevalence was also significantly higher among adolescents in this age range with a ≥ 3-mm overjet and those with inadequate lip protection (IRR = 1.99; 95% CI: 1.44-2.76; p < .001 and IRR = 3.41; 95% CI: 2.57-4.53; p < .001, respectively). CONCLUSION: A greater number of traumatised teeth were found among adolescents who reported binge drinking and had severe overjet and inadequate lip coverage.

Relationship among different levels of individual and community social capital with oral health related-quality of life among adolescents.

AIM: To evaluate the relationship of different levels of social capital with oral health-related adolescents' quality of life (OHRQoL). METHODS: This is a cross-sectional study nested in a cohort study started in 2010 with a sample of children 1 to 5 years old from Brazil. Individuals were followed after 10 years, data which was considered in this study (11 to 15 years old). OHRQoL was evaluated by the short version of CPQ11-14. Individual social capital (ISC) was assessed through the presence of individual social networks and social trust. Community social capital (CSC) was assessed through the presence of voluntary institutions, community cultural centers or residents' associations. For both ISC and CSC, the participants were classified as with high social capital (at least one source) or low social capital (absence of any source). Adjusted Poisson Regression analysis was performed to verify the interaction of different levels of social capital and OHRQoL. Results are present in Rate Ratio (RR) and 95 % confidence interval (95 % CI). RESULTS: A total of 429 adolescents were evaluated. Adolescents with low CSC and low ISC presented CPQ11-14 scores 36 % higher (RR 1.36 95 %CI 1.15-1.62) than counterparts who presented higher social capital levels. The interaction among high and low levels of social capital was not associated with CPQ11-14 scores, indicating that no level stands out over the other. CONCLUSION: Only the total absence of both levels of social capital negatively related with OHRQoL, indicating the importance of the presence of at least one source of social capital. CLINICAL RELEVANCE: The findings show that social capital affects OHRQoL, a crucial psychosocial aspect considering the clinical practice.

Perpetration of Adolescent Dating Violence: Child Abuse, Attitudes, Impulsivity, Reactive and Proactive Aggression; Automatic or Complex Processes?

Adolescent dating violence (ADV) research has neglected the environmental factors at play in contexts of perpetration. This study, conducted in Chile, investigated the socio-cognitive processes inherent to the relationship between child abuse and ADV perpetration by examining the association between child abuse, impulsivity, reactive aggression, proactive aggression, attitudes that rationalize or justify ADV, and actual ADV perpetration. Data were collected from 655 adolescents using self-reported measures of child abuse, impulsivity, reactive and proactive aggression, attitudes justifying ADV, and ADV perpetration using structural equation modeling. Having experienced child abuse predicted higher levels of impulsivity, which in turn predicted higher levels of aggressive traits, both for reactive and proactive aggression. Proactive aggression predicted higher levels of ADV perpetration, whereas reactive aggression did not. While we did not find that child abuse predicted a greater propensity for ADV, nor that such a disposition indicated a higher level of proactive aggression by influencing ADV perpetration, we did find that a positive attitude toward ADV predicted a higher frequency of ADV perpetration. Our results suggest that the socio-cognitive process underlying ADV involves automatic and complex processes stemming from child abuse, thus linking environmental and individual factors.

Resilience in Families of Autistic Children and Children With Intellectual Disability During the COVID-19 Pandemic.

Resilience in families of autistic children and children with intellectual disability is associated with factors such as family functioning, social support, and financial strain. Little is known about family resilience during the COVID-19 pandemic when many resources were limited. This study examined the association of family resilience with child characteristics, family resources, and socioecological factors during the pandemic. Data collected during the COVID-19 pandemic from 734 United Kingdom parents/caregivers of children who are autistic and/or have intellectual disability were analyzed using path analysis. Greater family resilience was significantly associated with fewer child behavior problems, absence of intellectual disability, higher financial status, and greater family functioning, though not school support. These factors might guide future research and practices to support vulnerable families at risk of low resilience.

Acceptability and feasibility of minimally invasive restorative procedures for patients with disability. A cohort study.

BACKGROUND: Unmet caries treatment needs are prevalent among people with disability, partly due to difficulties of cooperation during conventional dental treatment. This cohort study compared atraumatic restorative treatment (ART), silver modified atraumatic restorative treatment (SMART), and conventional restorative treatment (CRT), in terms of feasibility and acceptability in patients referred for special care dentistry in a specialized university clinic. METHODS: Patients referred for dental restorative care were treated using either ART, SMART, or CRT approach. Acceptance, feasibility, and complexity for the provision of care according to the BDA Case Mix Tool were assessed. ANOVA with Bonferroni correction and Chi-square tests investigated differences in age, gender, and BDA scores. Spearman Logistic Regression was used to correlate treatment selection with BDA scores. RESULTS: From a total of 150 patients, 74 were included (20.6 ± 11.2 years of age) 26 chose ART, 35 SMART, 11 CRT and 2 were referred for sedation/GA. ART, SMART, and CRT were feasible for all patients who had selected these options, with optimal placement of restorations for all patients receiving ART, 95.8% of patients receiving SMART, and all patients receiving CRT. Local anesthesia was required for 4 of the 26 patients receiving ART and for the 11 patients receiving CRT, but not required for any of the patients receiving SMART (p = .001). BDA-complexity scores were significantly higher for patients receiving SMART (OR 3.730, 95% CI 0.0∼1.82, p ≤ .001). CONCLUSIONS: ART and SMART are feasible and acceptable approaches to restorative dental treatment in patients with a disability who have difficulty coping with conventional treatment. CRT is more likely to be selected by patients with lower BDA-scores. The survival of the restorations should be assessed to determine the effectiveness of these options and further research is required to confirm the results of this pilot study in a larger population.

Disparities among Different Countries in Access for Diagnosis and Treatment of Pediatric Sensorineural Hearing Loss.

OBJECTIVE: Timely diagnosis and management of pediatric sensorineural hearing loss (SNHL) is essential for best outcomes. This study evaluated the differences of health access among cochlear implant (CI) centers of countries with different health care systems. STUDY DESIGN: Retrospective. SETTING: Multicenter, tertiary pediatric CI referral center in four different countries: United States (USA), France (FR), Australia (AUS), and Brazil (BR). PATIENTS: Pediatric (age 0-21 years (0-16 years AUS)) patients receiving CI between January 2017 and December 2019. INTERVENTIONS: CI. MAIN OUTCOME MEASURES: Primary outcome measures included age at milestones in CI process and age at implantation. RESULTS: There were 1,673 patients who underwent CI surgery at four multinational designated institutions were identified (n = 143 AUS; 153 BRA; 1,158 FR; and 219 USA). Median age at time of hearing loss diagnosis ( p < 0.0001), median age at hearing aid (HA) fitting ( p < 0.0001), and CI evaluation ( p < 0.0001) differed between countries. However, age at CI surgery was not significantly different between countries. Time from diagnosis to HA fitting was impacted by country ( p < 0.0001) and language ( p = 0.01) but not by private compared with public insurance. There were 512 children with available data regarding onset of hearing loss as prelingual n = 358 (70%) and postlingual n = 154 (30%). In patients with prelingual severe to profound hearing loss, country and race/ethnic origin affected age at diagnosis ( p < 0.0001, p = 0.001), HA fitting ( p < 0.0001, p < 0.001), candidacy evaluation ( p = 0.0001, p = 0.02), and CI surgery ( p = 0.0027, p = 0.001). CONCLUSIONS: Age at pediatric CI was comparable across the CI centers compared in the four countries. This is encouraging given the effect of neuroplasticity on pediatric CI outcomes, despite different health care expenditures and delivery systems in the four countries. Improvement in care access for certain populations may decrease disparities in pediatric CI access worldwide.

Health Risk Assessment for Ingestion of Edible Mushrooms Contaminated by Chromium.

A health risk assessment was carried out to determine the probability of damage and carcinogenic effects from consumption of five mushroom species (Boletus edulis, Cantharellus cibarius, Lactarius indigo, Ramaria flava, and Sarcodon calvatus) potentially contaminated by chromium (Cr), based on data reported by López-Vázquez and Prieto-García (2016) in Hidalgo state [López-Vázquez E, Prieto-García F. Minerals and toxic elements in wild mushrooms species from regions of Hidalgo state in Mexico. Asian J Chem. 2016;28(12):2725-30]. The evaluation was carried out based on an environmental risk indicator: potential ecological risk; and two health risk indicators: the hazard quotient, non-cancer damage and the risk of increase of individual cancer. The results showed that there is a high probability of carcinogenic damage for the three regions where older adults and pregnant are the most vulnerable sectors. Due to the traditional use of edible mushrooms in Mexico, the evidence of bioaccumulation of heavy metals of toxicological interest in mushroom species, as well as the notable damage to health due to the consumption of contaminated species; the monitoring and implementation of standards that regulate their consumption and ensuring their food safety is essential. More research is required to support the use of these evaluations.

Aquatic Compared With Land-Based Exercises on Gross Motor Function of Children/Adolescents With Cerebral Palsy: A Systematic Review With Meta-Analysis.

AIM: This study aimed to compare gross motor function between aquatic- and land-based exercises in children and adolescents with cerebral palsy (CP). METHODS: The authors conducted an electronic search of nine databases from their inception to 21 November 2024 (PROSPERO registration: CRD42020194121). Inclusion criteria were randomized controlled trials involving aquatic-based exercises for children and adolescents with CP, assessing gross motor function using standardized scales or tests. Three authors independently extracted data using a predetermined Excel form. The risk of bias was assessed with the PEDro scale. The body of evidence was synthesized using the GRADE approach. Meta-analysis was conducted using the Revman 5.3 program. RESULTS: A total of 369 children aged 2-18 years from 15 studies were included. Most participants were ambulatory and classified as having spastic hemiparetic or diparetic CP. The majority of studies had a high risk of bias and small sample sizes. Aquatic-based exercises were categorized as aquatic physical therapy, Halliwick, swimming exercises, gait training and exercises. Low-quality evidence indicated that aquatic physical therapy resulted in higher gross motor function than land-based exercises (SMD = 0.47, n = 93, 4 trials, I2 = 5%, p = 0.03), with a small effect size. No significant differences were found for Halliwick or swimming exercises. INTERPRETATION: There is low-quality evidence, because of high risk of bias, imprecision and inconsistency, suggesting that aquatic-based exercises are comparable with land-based exercises. Future research should focus on well-designed interventions with adequate sample sizes to compare the combination of aquatic- and land-based therapies with land-based therapy alone.

The association of personal, parental, school and community factors with depressive symptoms among a sample of Colombian students of ages 9 to 12 years.

Few studies have examined how the personal characteristics of students, together with factors from their local social environments and communities, affect students living in generally high levels of social disruption. We examined the influence that personal characteristics as well as factors from the local social environments and communities may have on Colombian students' levels of depressive symptoms shortly after the end of the of armed conflict. Data were collected from 710 students attending the fifth grade in a random sample of elementary schools in the province of Sucre in Colombia. Information was gathered on the students' ages and gender as well as characteristics of their parents, school factors, and community factors. A five-level hierarchical regression model was used to determine the extent to which all these variables predicted depression scores, as measured by the Adolescent Depression Rating Scale. While personal, parental, school and community factors were all found to predict depression scores, the category, parental factors had the most impact. That was followed by school factors, community factors and finally personal characteristics. Multiple social and environmental factors were associated with the level of depression experienced by Colombian students.

Few studies have examined how the characteristics of students, together with their local social environments and communities, affect students living in generally high levels of social disruption. We examined the influence that personal characteristics as well as factors from the local social environments and communities may have on Colombian students' levels of depressive symptoms shortly after the end of the of armed conflict. Data were collected from 710 students attending the fifth grade in a sample of Colombian, elementary schools. Information was gathered on the students' ages and gender as well as characteristics of their parents, schools, and communites. We used regression analyses to determine the extent to which all these variables predicted students' levels of depression. While the personal, parental, school and community characteristics of students were all found to predict depression scores, how students were parented had the most impact. That was followed by characteristics of their schools, communities and their personal characteristics. We concluded that multiple social and environmental factors were associated with the level of depression experienced by Colombian students.