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PubMed2006

The potential impact of neighborhood empowerment on dental caries among adolescents.

OBJECTIVE: Empowerment has been considered a dimension of social capital. It refers to social interaction processes that enable people to enhance their individual and collective skills and to exert greater control over their lives. This relationship has not been explored in relation to dental health. The objective of this study was to investigate the association between neighborhood empowerment and dental caries in adolescents. METHODS: A multilevel study was designed to assess the individual and neighborhood effects on the oral health of adolescents. Four sources of data were used: (a) clinical examinations (WHO), (b) students' questionnaires, (c) parents' questionnaires and (d) census data. The study population was 1302, 14/15-year-old students from 39 public schools of two cities of the Distrito Federal (DF), Brazil. Data analysis used logistic multilevel modeling at two levels: students (sources a and b) and neighborhood as defined by catchment areas of schools (sources c and d). RESULTS: High DMFT (DMFT > median, DMFT > or =3) rates were significantly lower in areas with higher levels of empowerment. This relationship was independent of socioeconomic variables at the individual and area levels and of all other individual risk factor variables such as sex, fluoride, sugar consumption, tooth brushing and dental attendance [OR for low compared with high empowerment was 1.54 (95% CI = 1.09-2.18), P = 0.014]. CONCLUSIONS: Neighborhood empowerment may play an important role in explaining inequalities in the levels of dental caries. New perspectives are needed so that more effective interventions can be implemented using area-based perspectives.

Adolescent↗
PubMed1983

Organ transplantation.

In the report "Pregnancy interception with a combination of prostaglandins: Studies in monkeys: by J. W. Wilks (30 Sept., p. 1407), figures 2 and 3 on page 1408 were interchanged.

Costs and Cost Analysis↗
PubMed1986

Proposal for a future delivery market for transplant organs.

Improvements in surgical procedures and immunosuppressive practices have greatly increased the range and success rate of organ transplants. Unfortunately, supply does not meet demand, and demand is increasing. This paper documents the current level of unsatisfied demand for several transplantable organs, and argues that the extant system of altruistic organ donation is unlikely ever to provide adequate supply because of lack of incentives to donate and the ambiguity surrounding property rights over transplantable organs. A greater reliance on markets would help attenuate these problems. However, unorganized private spot markets for human organs are likely to be both inefficient and inequitable, and are perceived as morally offensive. A feasible alternative is an organized, publicly operated future delivery market, wherein an individual can contract, for valuable consideration, with a government agency for delivery of a specific organ upon death. The implementation of such a market would encounter difficult (but not intractable) problems such as price determination, the selection of a medium of exchange, and contractual issues, particularly the role of minors in such a system. Finally, it is argued that such a market is superior to the much-discussed compulsory expropriation alternative.

Altruism↗
PubMedDate not supplied

Palliative care in Russia.

The article addresses the history of establishing hospices in Russia complying with international WHO documents. The article also presents the ethics of palliative medicine in the Russian Federation with an objective analysis of the diseases affecting patients with special highlights on social problems.

Attitude of Health Personnel↗
PubMed2000

MIB-1 immunohistometry of follicular adenoma and follicular carcinoma of the thyroid gland.

OBJECTIVE: To analyze cellular proliferative activity, MIB-1 immunopositivity of normal tissue (n = 20), follicular adenoma (n = 30) and follicular carcinoma (n = 32) of the thyroid gland was analyzed by means of immunohistometry. STUDY DESIGN: Immunohistochemical reactions were performed on 3-micron sections from routinely formalin fixed and paraffin embedded surgical specimens using an indirect peroxidase method. The rate of immunostained cells was determined using the CM-2 TV image analysis system (Hund, Wetzlar, Federal Republic of Germany). Forty viewing fields (1.94 mm2) were measured with 20:1 objective magnification. An average of 5,965 cells were assessed in each case. RESULTS: Mean MIB-1 immunopositivity was higher in follicular carcinoma (average, 2.30%) and follicular adenoma (0.58%) than in normal thyroid tissue (0.14%). The distribution of single values differed significantly between groups (P < .001). To test the suitability of MIB-1 immunohistometry for the differential diagnosis of follicular adenoma and follicular carcinoma, different four-field tables with varying thresholds were calculated. Using a threshold of 0.9%, follicular carcinoma could be detected with a sensitivity of 75% (24/32) and a specificity of 83% (25/30). If a specificity of 90% is required (27/30), the sensitivity of the test decreases to 69% (22/32), based on a threshold of 1.1%. CONCLUSION: As some overlap of single values has to be considered, MIB-1 immunohistometry, although presenting new insights into the proliferative potential of thyroid lesions, is of only limited value for the differential diagnosis of follicular lesions in routine surgical pathology.

Adenocarcinoma, Follicular↗
PubMed1991

The HIV-infected health care worker: another AIDS policy conundrum.

To ascertain the degree of patient risk for acquiring HIV from an infected health care worker, several key questions have arisen: Beyond a single dental practice, has there been doctor-to-patient HIV transmission; are some procedures inherently more dangerous to patients than others; can HIV be transmitted despite good technique and universal precautions; is hepatitis B virus (HBV) transmission from physician to patient a relevant model for HIV transmission; is operator skill and technique as much or more of a factor in the risk for transmission than the nature of the procedure itself? The Centers for Disease Control (CDC) released recommendations about HIV-infected health care workers last year....The CDC proposed that sufficient data existed to declare that certain procedures were "exposure-prone," that is, that transmission of HIV to a patient could occur despite good technique and proper precautions.... Because of the major concerns expressed by many medical specialty societies, the CDC has indicated plans to review and revise the recommendations.

AIDS Serodiagnosis↗