Health insurance and education: major contributors to oral health inequalities in Colombia

Background Health inequalities, including inequalities in oral health, are problems of social injustice worldwide. Evidence on this issue from low-income and middle-income countries is still needed. We aimed to examine the relationship between oral health and different dimensions of socioeconomic position (SEP) in Colombia, a very unequal society emerging from a long-lasting internal armed conflict. Methods Using data from the last Colombian Oral Health Survey (2014), we analysed inequalities in severe untreated caries (≥3 teeth), edentulousness (total tooth loss) and number of missing teeth. Inequalities by education, income, area-level SEP and health insurance scheme were estimated by the relative index of inequality and slope index of inequality (RII and SII, respectively). Results A general pattern of social gradients was observed and significant inequalities for all outcomes and SEP indicators were identified with RII and SII. Relative inequalities were larger for decay by health insurance scheme, with worse decay levels among the uninsured (RII: 2.57; 95% CI 2.11 to 3.13), and in edentulousness (RII: 3.23; 95% CI 1.88 to 5.55) and number of missing teeth (RII: 2.08; 95% CI 1.86 to 2.33) by education, with worse levels of these outcomes among the lower educated groups. Absolute inequalities followed the same pattern. Inequalities were larger in urban areas. Conclusion Health insurance and education appear to be the main contributors to oral health inequalities in Colombia, posing challenges for designing public health strategies and social policies. Tackling health inequalities is crucial for a fairer society in a Colombian post-conflict era and our findings highlight the importance of investing in education policies and universal health care coverage

Explaining oral health inequalities in European welfare state regimes: The role of health behaviours

OBJECTIVE: To assess the extent to which behavioural factors, including those related to dental care, account for oral health inequalities in different European welfare state regimes. METHODS: Data from the Eurobarometer 2009 survey were analysed. Nationally representative samples of dentate adults aged ≥45 years (n = 9979) from 21 European countries classified into the five welfare regimes (Scandinavian, Anglo-Saxon, Bismarckian, Southern, Eastern) were considered. Inequalities in no functional dentition (having <20 natural teeth) by education and occupation were identified using the Relative and Slope Indices of Inequality (RII and SII, respectively). The percentage reduction in RII and SII was calculated from regression models before and after adjustment for behaviours, first one at a time and then all together. RESULTS: Behaviours explained 21.0% (95% CI 8.7, 31.4) and 13.1% (95% CI 7.9, 33.2) of educational inequalities in no functional dentition (RII) in the Scandinavian and Eastern regimes, respectively. For occupational inequalities, the attenuations in RII in these welfare regimes were 19.3% (95% CI 7.1, 24.2) and 10.5% (95% CI 3.4, 22.5), respectively. Attenuations were weaker and nonsignificant in the Bismarckian, Anglo-Saxon and Southern regimes. Among the behaviours analysed, alcohol consumption was particularly relevant in explaining inequalities in the Scandinavian regime, and this was confirmed in sensitivity analyses through three-way cross-level interaction terms in multilevel models. Behaviours related to dental care produced similar, consistent attenuations in the Scandinavian and Eastern regimes for both socioeconomic indicators. SII findings showed a similar picture. CONCLUSION: The role of particular behaviours in explaining oral health inequalities could be heterogeneous across European welfare regimes, indicating that their importance might be influenced by the general approach to social policies

A hydrodynamic cavitation prototype reactor evaluation for decreasing cephalexin concentration in aqueous solution

A prototype of a hydrodynamic cavitation reactor was evaluated to determine the effectiveness of this system on the percentage decrease of cephalexin concentration present in an aqueous solution prepared with ultrapure water. The process variables or factors were pH [5 and 9], number of holes in the cavitation plate [5 and 7] and reaction time (30 min and 60 min). The results indicate that the percentage removal of Cephalexin (CFX) and total organic carbon (TOC) depends on the variables studied and the interaction between them. The highest yields were achieved at pH 5, 5 holes in the cavitation plate and 60 min of reaction reaching values of 24.16 % for CFX and 16.8 % for TOC. It was determined that, for the lowest number of holes in the cavitation plate and acid pH, the phenomenon that guides the process is the hydrodynamic cavitation, when increasing the number of holes and therefore decreasing the intensity of cavitation, the pH becomes more relevant and has incidence on the performance of the analyzed process. On the other hand, it was determined that, also in reaction times of 30 min, removal values very close to the maximum values obtained are achieved. The process can be intensified by the simultaneous application of other advanced oxidation processes to increase the effectiveness