Comprehensive Health Insurance and access to maternal healthcare services among Peruvian women: a cross-sectional study using the 2021 national demographic survey.

BACKGROUND: The government-subsidized health insurance scheme Seguro Integral de Salud ("SIS") was introduced in Peru initially to provide coverage to uninsured and poor pregnant women and children under five years old and was later extended to cover all uninsured members of the population following the Peruvian Plan Esencial de Aseguramiento Universal - "PEAS" (Essential UHC Package). Our study aimed to analyze the extent to which the introduction of SIS has increased equity in access and quality by comparing the utilization of maternal healthcare services among women with different insurance coverages. METHODS: Relying on the 2021 round of the nationally-representative survey "ENDES" (Encuesta Nacional Demográfica y de Salud Familiar), we analyzed data for 19,181 women aged 15-49 with a history of pregnancy in the five years preceding the survey date. We used a series of logistic regressions to explore the association between health insurance coverage (defined as No Insurance, SIS, or Standard Insurance) and a series of outcome variables measuring access to and quality of all services along the available maternal healthcare continuum. RESULTS: Only 46.5% of women across all insurance schemes reported having accessed effective ANC prevention. Findings from the adjusted logistic regression confirmed that insured women were more likely to have accessed ANC services compared with uninsured women. Our findings indicate that women in the "SIS" group were more likely to have accessed six ANC visits (aOR = 1.40; 95% CI 1.14-1.73) as well as effective ANC prevention (aOR = 1.32; 95% CI 1.17-1.48), ANC education (aOR = 1.59; 95% CI 1.41-1.80) and ANC screening (aOR = 1.46; 95% CI 1.27-1.69) during pregnancy, compared with women in the "Standard Insurance" group [aOR = 1.35 (95% CI 1.13-1.62), 1.22 (95% CI 1.04-1.42), 1.34 (95% CI 1.18-1.51) and 1.31(95% CI 1.15-1.49)] respectively. In addition, women in the "Standard Insurance" group were more likely to have received skilled attendance at birth (aOR = 2.17, 95% CI 1.33-3.55) compared with the women in the "SIS" insurance group (aOR = 2.12; 95% CI 1.41-3.17). CONCLUSIONS: Our findings indicate the persistence of inequities in access to maternal healthcare services that manifest themselves not only in the reduced utilization among the uninsured, but also in the lower quality of service coverage that uninsured women received compared with women insured under "Standard Insurance" or "SIS". Further policy reforms are needed both to expand insurance coverage and to ensure that all women receive the same access to care irrespective of their specific insurance coverage.

Simultaneous Implant Placement and Sinus Lift Using Leukocyte-Platelet Rich Fibrin: A Retrospective 40-Month Study.

ABSTRACT: The aim of this study was to report the 40-month clinical radiographical outcomes of maxillary sinus floor augmentation using leukocyte-platelet rich fibrin (L-PRF) as a single graft in combination with immediately placed implants. Twenty partially edentulous individuals with missing teeth in the region associated to maxillary sinus were included in this retrospective study. A lateral sinus floor elevation was performed considering a complete wear of the bone wall of the maxillary sinus and immediately placing the implant and filled the maxillary sinus with L-PRF clots as a single graft. After 5 months, all the implants received single screwed implant-supported prostheses. Subsequent evaluation was every 4 months assessing the success rate and biological complications. Two maxillary sinus membrane were perforated and covered with L-PRF clots. The mean bone height gain was 62.6%, observing a 100% of success and that in all the cases achieved at least the implant height. In conclusion, the use of platelet-rich fibrin clot as a single graft biomaterial during the maxillary sinus lift procedure combined with immediate implant placement may be a reliable clinical alternative, even to repair the sinus membrane.

Identifying the determinants of health insurance coverage among Peruvian women of reproductive age: an assessment based on the national Peruvian demographic survey of 2017.

BACKGROUND: Like many other Latin America- and Caribbean countries, Peru has introduced a tax-financed health insurance scheme called "Sistema Integral de Salud (SIS)" to foster progress towards Universal Health Coverage. The scheme explicitly targets the poorest sections of the population. Our study explores levels of health insurance coverage and their determinants among Peruvian women following the introduction of SIS. We wish to determine the extent to which the introduction of SIS has effectively closed gaps in insurance coverage and for whom. METHODS: Relying on the 2017 round of ENDES (Encuesta Nacional Demográfica y de Salud Familiar) survey, we analyzed data for 33,168 women aged 15-49. We used multinomial logistic regression to explore the association between health insurance coverage (defined as No Insurance, SIS, Standard Insurance) and women's socio-demographic and economic characteristics. RESULTS: Out of the 33,168 women, 25.3% did not have any insurance coverage, 45.5% were covered by SIS and 29.2% were covered by a Standard Insurance scheme. Women in the SIS group were found to have lower educational levels, live in rural areas and more likely to be poorer. Women in the Standard insurance group were found to be more educated, more likely to be "Spanish", and to be wealthier. Most uninsured women appeared to belong to a middle class, not poor enough to be eligible for SIS, but also not eligible for standard insurance. CONCLUSIONS: Our study confirms that SIS has been effective in increasing coverage among vulnerable women, with coverage rates comparable with those observed among men. Nevertheless, on its own, it has proven to be insufficient to ensure universal coverage among women. Further reforms are needed to ensure that coverage is extended to all population groups.

Autologous Fibrin Glue With Collagen Carrier During Maxillary Sinus Lift Procedure.

This study aimed to describe the use of autologous fibrin glue (AFG) with a collagen carrier during maxillary sinus lift procedures with immediate implants during 3 years of follow-up. Twelve patients who had lost their teeth in the region associated to maxillary sinus, with a bone remnant 3 to 5 mm in height, were selected to perform a maxillary sinus augmentation with AFG and collagen membrane, placing the implant immediately. After 5 months, the implants were connected and rehabilitated. The patients were followed-up for a 3-year period, being evaluated every 6 months. At the end of the 3-year follow-up period, 100% implant success was observed, with a mean of bone augmentation of 7.75 mm. Three maxillary sinus membranes were perforated and healed by using AFG and collagen membrane without identify any complication during the follow-up period. Finally, the use of collagen carrier combined with AFG as a filling material during the maxillary sinus lift procedure may be a low-cost and reliable alternative that allows bone formation.

Using an Attachment System with PEEK Matrices for Single-Implant Overdentures: In Vitro Retention Force.

Single-implant overdentures (SIOs) represent a major biomechanical challenge in terms of prosthetic retention. The Novaloc attachment system has the potential to overcome those challenges when used for SIOs, due to the use of PEEK matrices. This study compared the retentive force of the Novaloc attachment to the traditional Locator system, before and after cyclic insertion-removal cycles. Three Novaloc matrices (white, yellow, and green, corresponding to low, medium, and high retention, respectively) and Locator (medium retention) were tested, totalling four groups. Retentive force was measured using an Imada force gauge before and after 1095 insertion-removal cycles, corresponding to a year of SIO wearing. Retention was tested with the implants angulated at 0, 10, and 20°. Data for the different groups, angles, and cycling periods were tested via linear regression analysis and two-way ANOVA (α = 0.05). Although the Locator system yielded higher retention forces in general, it lost a much higher percentage of retention with cycling. This trend was similar with the three angles, with forces being inversely proportional to the implant angulation. The authors conclude that Novaloc may provide more reliable retention for SIOs due to their higher resistance to insertion-removal cycling.

Ozone for the treatment of temporomandibular joint disorders: a systematic review and meta-analysis.

Temporomandibular joint disorders (TMD) generate pain and difficulties for mouth opening affecting the patients' quality of life. Ozone is an emerging therapy that has been proposed as a potential treatment, due to that, the evidence about its efficacy should be reviewed. Therefore, this work aimed to conduct a comprehensive systematic review to address the efficacy of ozone therapy for the treatment of pain and limited mouth opening in patients with TMD. The design of the included studies was clinical trials and observational studies, whereas, a series of cases, in vivo, and in vitro studies were excluded. The search was performed in PubMed, ClinicalTrials, Web of Science, and Scopus. Gray literature was searched at Google Scholar. Relevant data of all included studies were recorded. The risk of bias (using RoB 2) and the quality (using Grading of Recommendations Assessment, Development, and Evaluation) assessments were carried out. Meta-analyses using random-effects models of pain and maximal mouth opening data were performed. This review included 8 studies with 404 participants suffering limited function and pain related to TMD. At the overall bias of the studies, 25% exhibited some concerns and 75% had high risk; and the quality of the studies was low. The analysis of the included studies suggests that ozone therapy can diminish pain and improve the maximal mouth opening in TMD patients. However, there is no conclusive evidence of ozone therapy as a superior treatment for TMD compared with occlusal splint and pharmacotherapy.

Molecular survey and genetic characterization of tick-borne pathogens in dogs in metropolitan Recife (north-eastern Brazil).

To identify DNA of the main tick-borne pathogens in dogs from Recife (Brazil), polymerase chain reactions were carried out on blood samples of dogs treated at the Veterinary Hospital of the Universidade Federal Rural de Pernambuco from March 2007 to June 2008. The detection of DNA was performed using specific primers. Amplicons were analyzed through electrophoresis and sequencing. A phylogenetic tree was constructed using the UPGMA method, revealing that the sequences were closely related to those of strains from other geographic regions. Among the 205 blood samples analyzed, 48.78% was positive for Anaplasma platys; 38.04% was positive for Ehrlichia canis; 7.31% was positive for Babesia canis vogeli; and 0.49% was positive for Hepatozoon canis and Mycoplasma haemocanis. Coinfection of two or three pathogens was found in 23.9% (49/205) of the dogs. The subspecies B. canis vogeli was identified. Infection by H. canis and M. haemocanis is reported for the first time in dogs in the state of Pernambuco (Brazil). The data indicate that the main tick-borne pathogens in dogs in this region are E. canis and/or A. platys, followed by B. canis vogeli.

Oral Applications of Cyanoacrylate Adhesives: A Literature Review.

Cyanoacrylate adhesives have been used in medicine and dentistry with some controversial opinions. The aim of this review was to summarize the relevant literature regarding the use of cyanoacrylate adhesives for oral wounds during dental and surgical procedures, with focus on the applications, indications, advantages, and disadvantages. In conclusion, in vivo and clinical studies have demonstrated in the last few years convincing results regarding the safety, efficacy, ease of application, and feasibility of all types of cyanoacrylate adhesives used in intra- and extraoral procedures.

Ultra-Thin Veneers: A Current State-of-the-Art

ABSTRACT: Currently, the aesthetic requirements of patients are increasing and they have begun to request more conservative treatments. One alternative to achieve harmonious results is through the indication of ultra-thin veneers. This is considered a conservative technique but the evidence basis for it seems to be limited. The following review attempts to summarize the relevant literature to establish guidelines for clinicians based on scientific evidence regarding the use of ultra-thin veneers. Ultra-thin veneers seem to be a reliable alternative to achieve aesthetic and harmonious results; however, many factors must be considered to ensure correct diagnosis and treatment plan. In addition, the literature is scarce in relation to a consensus on tooth preparation and long-term studies evaluating the success of this type of treatment over time do not exist.

RESUMEN: Actualmente, los requisitos estéticos de los pacientes han aumentando y solicitan tratamientos más conservadores. Una alternativa para lograr resultados armónicos es mediante la indicación de carillas o laminados ultrafinos. Esta se considera una técnica conservadora, pero la base teórica parece ser limitada. La siguiente revisión intenta resumir la literatura relevante para establecer pautas para clínicas basadas en evidencia científica sobre el uso de carillas ultrafinas. Las carillas ultrafinas parecen ser una alternativa confiable para lograr resultados estéticos y armónicos; sin embargo, se deben considerar muchos factores para asegurar un diagnóstico y plan de tratamiento correcto. Además, la literatura es escasa en relación a un consenso sobre la preparación dental y no existen estudios a largo plazo que evalúen el éxito de este tipo de tratamiento a lo largo del tiempo.

[Comparison of nested-PCR with blood smear examination in detection of Ehrlichia canis and Anaplasma platys in dogs]. / Comparação de nested-PCR com o diagnóstico direto na detecçáo de Ehrlichia canis e Anaplasma platys em cães.

The clinical signs of Ehrlichia canis and Anaplasma platys infection are similar, and the diagnosis of these pathogens made by stained blood smears is poor due sensibility and specificity. On the other hand, the molecular diagnosis is highly sensitive and specific and nested-PCR have been optimized for accurate diagnosis these pathogens in dogs. At the veterinary teaching hospital, whole-blood samples with EDTA were obtained from 100 dogs and smears were made from blood samples for evaluation for intracellular parasites. For each sample, DNA was extracted and submitted to nPCR analysis for detection of E. canis and A. platys. The results of stained blood smears showed 9% of the animals were positive for E. canis and 21% for A. platys. Regarding of nPCR analysis, 57 and 55% of dogs were positive for E. canis and A. platys respectively. As compared to a nested PCR, the stained blood smears revealed false-negative results for both E. canis and A. platys. The results indicate that the nPCR is highly sensitive and specific for detection of both pathogens and the molecular diagnosis could be more useful at veterinary hospital.

Comparação de nested-PCR com o diagnóstico direto na detecção de Ehrlichia canis e Anaplasma platys em cães / Comparison of nested-PCR with blood smear examination in detection of Ehrlichia canis and Anaplasma platys in dogs

Os sinais clínicos das infecções por Ehrlichia canis e Anaplasma platys são similares, e o diagnóstico desses patógenos feito por esfregaços sanguíneos corados é difícil devido à sensibilidade e especificidade. Por outro lado, os diagnósticos moleculares são altamente sensíveis e específicos, e nested-PCRs têm sido otimizadas para o diagnóstico preciso desses patógenos em cães. Em um Hospital Veterinário Escola, amostras de sangue total com EDTA foram obtidas de 100 cães, e esfregaços foram feitos das amostras de sangue para busca dos parasitos intracelulares. Para cada amostra, DNA foi extraído e submetido à nPCR para detecção de E. canis e A. platys. Os resultados dos esfregaços sanguíneos mostraram que 9% dos animais foram positivos para E. canis e 21% para A. platys. Com relação à nPCR, 57 e 55% dos cães foram positivos para E. canis e A. platys, respectivamente. Quando comparados com a nPCR, os esfregaços sanguíneos corados revelaram resultados falso-negativos para E. canis e A. platys. Os resultados indicam que a nPCR é altamente sensível e específica para detecção de ambos os patógenos, e os diagnósticos moleculares podem ser mais úteis nos Hospitais Veterinários.

The clinical signs of Ehrlichia canis and Anaplasma platys infection are similar, and the diagnosis of these pathogens made by stained blood smears is poor due sensibility and specificity. On the other hand, the molecular diagnosis is highly sensitive and specific and nested-PCR have been optimized for accurate diagnosis these pathogens in dogs. At the veterinary teaching hospital, whole-blood samples with EDTA were obtained from 100 dogs and smears were made from blood samples for evaluation for intracellular parasites. For each sample, DNA was extracted and submitted to nPCR analysis for detection of E. canis and A. platys. The results of stained blood smears showed 9% of the animals were positive for E. canis and 21% for A. platys. Regarding of nPCR analysis, 57 and 55% of dogs were positive for E. canis and A. platys respectively. As compared to a nested PCR, the stained blood smears revealed false-negative results for both E. canis and A. platys. The results indicate that the nPCR is highly sensitive and specific for detectionof both pathogens and the molecular diagnosis could be more useful at veterinary hospital.

Comparação de nested-PCR com o diagnóstico direto na detecção de Ehrlichia canis e Anaplasma platys em cães

The clinical signs of Ehrlichia canis and Anaplasma platys infection are similar, and the diagnosis of these pathogens made by stained blood smears is poor due sensibility and specificity. On the other hand, the molecular diagnosis is highly sensitive and specific and nested-PCR have been optimized for accurate diagnosis these pathogens in dogs. At the veterinary teaching hospital, whole-blood samples with EDTA were obtained from 100 dogs and smears were made from blood samples for evaluation for intracellular parasites. For each sample, DNA was extracted and submitted to nPCR analysis for detection of E. canis and A. platys. The results of stained blood smears showed 9% of the animals were positive for E. canis and 21% for A. platys. Regarding of nPCR analysis, 57 and 55% of dogs were positive for E. canis and A. platys respectively. As compared to a nested PCR, the stained blood smears revealed false-negative results for both E. canis and A. platys. The results indicate that the nPCR is highly sensitive and specific for detection of both pathogens and the molecular diagnosis could be more useful at veterinary hospital.

Os sinais clínicos das infecções por Ehrlichia canis e Anaplasma platys são similares, e o diagnóstico desses patógenos feito por esfregaços sanguíneos corados é difícil devido à sensibilidade e especificidade. Por outro lado, os diagnósticos moleculares são altamente sensíveis e específicos, e nested-PCRs têm sido otimizadas para o diagnóstico preciso desses patógenos em cães. Em um Hospital Veterinário Escola, amostras de sangue total com EDTA foram obtidas de 100 cães, e esfregaços foram feitos das amostras de sangue para busca dos parasitos intracelulares. Para cada amostra, DNA foi extraído e submetido à nPCR para detecção de E. canis e A. platys. Os resultados dos esfregaços sanguíneos mostraram que 9% dos animais foram positivos para E. canis e 21% para A. platys. Com relação à nPCR, 57 e 55% dos cães foram positivos para E. canis e A. platys, respectivamente. Quando comparados com a nPCR, os esfregaços sanguíneos corados revelaram resultados falso-negativos para E. canis e A. platys. Os resultados indicam que a nPCR é altamente sensível e específica para detecção de ambos os patógenos, e os diagnósticos moleculares podem ser mais úteis nos Hospitais Veterinários.

Comparação de nested-PCR com o diagnóstico direto na detecção de Ehrlichia canis e Anaplasma platys em cães / Comparison of nested-PCR with blood smear examination in detection of Ehrlichia canis and Anaplasma platys in dogs

Os sinais clínicos das infecções por Ehrlichia canis e Anaplasma platys são similares, e o diagnóstico desses patógenos feito por esfregaços sanguíneos corados é difícil devido à sensibilidade e especificidade. Por outro lado, os diagnósticos moleculares são altamente sensíveis e específicos, e nested-PCRs têm sido otimizadas para o diagnóstico preciso desses patógenos em cães. Em um Hospital Veterinário Escola, amostras de sangue total com EDTA foram obtidas de 100 cães, e esfregaços foram feitos das amostras de sangue para busca dos parasitos intracelulares. Para cada amostra, DNA foi extraído e submetido à nPCR para detecção de E. canis e A. platys. Os resultados dos esfregaços sanguíneos mostraram que 9% dos animais foram positivos para E. canis e 21% para A. platys. Com relação à nPCR, 57 e 55% dos cães foram positivos para E. canis e A. platys, respectivamente. Quando comparados com a nPCR, os esfregaços sanguíneos corados revelaram resultados falso-negativos para E. canis e A. platys. Os resultados indicam que a nPCR é altamente sensível e específica para detecção de ambos os patógenos, e os diagnósticos moleculares podem ser mais úteis nos Hospitais Veterinários.

The clinical signs of Ehrlichia canis and Anaplasma platys infection are similar, and the diagnosis of these pathogens made by stained blood smears is poor due sensibility and specificity. On the other hand, the molecular diagnosis is highly sensitive and specific and nested-PCR have been optimized for accurate diagnosis these pathogens in dogs. At the veterinary teaching hospital, whole-blood samples with EDTA were obtained from 100 dogs and smears were made from blood samples for evaluation for intracellular parasites. For each sample, DNA was extracted and submitted to nPCR analysis for detection of E. canis and A. platys. The results of stained blood smears showed 9% of the animals were positive for E. canis and 21% for A. platys. Regarding of nPCR analysis, 57 and 55% of dogs were positive for E. canis and A. platys respectively. As compared to a nested PCR, the stained blood smears revealed false-negative results for both E. canis and A. platys. The results indicate that the nPCR is highly sensitive and specific for detection of both pathogens and the molecular diagnosis could be more useful at veterinary hospital.