Sleep respiratory problems in children: Diagnosis and contribution of the orthodontist.

Obstructive sleep apnea/hypopnea syndrome (OSAS) is still not widely diagnosed in children as its clinical signs are extremely variable. The diagnosis is based on recognition of the nocturnal and diurnal clinical symptoms of the syndrome, but above all on analysis of a sleep recording revealing abnormal respiratory phenomena. This recording makes it possible to determine an Apnea/Hypopnea Index (AHI) for each hour of sleep. The abnormality threshold is 1.5AHI/h for children and 5AHI/h for adults. The higher the index, the more severe the OSAS. The consequences of this syndrome are far from negligible, leading possibly to learning difficulties, mood problems, growth abnormalities and delayed neurocognitive development; it may even have an impact on metabolism. The orthodontist, as a health specialist frequently in contact with young patients, needs to be able to detect OSAS by launching a dialogue on the question of sleep so as to refer the patient to a specialist who can confirm the diagnosis. Through observation of the patient, it is possible to identify children at risk. Potential OSAS can then be prevented or cured by increasing the volume of the upper airways thanks to orthodontic treatment. Management of patients suffering from OSAS is multidisciplinary, under the direction of the sleep specialist.

Missed appointment rates in primary care: the importance of site of care.

The objective was to determine whether race, language, or gender concordance between primary care providers (PCPs) and patients is associated with lower missed appointment rates in neighborhood health centers. An additional objective was to determine whether site of care is a determinant of missed appointment rates. In analyses of 74,120 follow-up visits by 13,882 patients, odds ratios for missing an appointment for patients who had language, race or gender concordance with their PCP were 0.90 (95% confidence interval [CI], 0.81-0.99), 0.84 (95% CI, 0.79-0.90) and 1.01 (95% CI, 0.95-1.07) respectively, after adjustment for age, insurance, language, individual PCP open access, sessions per week PCP in practice, and health center. Odds ratios for missing an appointment varied nearly three-fold, depending upon the particular site of care. Race and language concordance between patients and PCPs has only a modest effect on missed appointment rates. Receipt of primary care services at specific neighborhood health centers was the strongest predictor of missed appointment rates in this sample.

European College of Orthodontics: Commission of Affiliation and Titularisation.

Date of birth: 10/12/1993; gender: female. A PRETREATMENT RECORDS: (3/2008; 14.3 yrs). DIAGNOSIS: Class III. B POST-TREATMENT RECORDS: (12/2009; 15.11 yrs). RETENTION: Intercanine wires bonded on both arches. C POST-RETENTION RECORDS: (12/2010; 16.11 yrs).