Associations between primary healthcare and infant health outcomes: a cohort analysis of low-income mothers in Rio de Janeiro, Brazil

Background Expanding primary healthcare to urban poor populations is a priority in many low-and middle-income countries and is essential to achieve universal health coverage (UHC). Between 2008 and 2016 the city of Rio de Janeiro undertook an ambitious programme to rapidly expand primary care to low-income areas through the family health strategy (FHS). Infant health impacts of this roll out are unknown. This study examines associations between maternal FHS utilisation and birth outcomes, neonatal and infant mortality. Methods A cohort of 75,339 live births (January 2009–December 2014) to low-income mothers in Rio de Janeiro was linked to primary care, birth, hospital and death records. The relationship between maternal FHS use and infant health outcomes was assessed through logistic regression with inverse probability treatment weighting and regression adjustment. Socioeconomic inequalities in the associations between FHS use and outcomes were explored through interactions. Primary outcomes were neonatal and infant death. Thirteen secondary outcomes were also examined to explore other important health outcomes and potential mechanisms. Results A total of 9002 (12.0%) infants were born to mothers in the cohort who used FHS services either before pregnancy or in the first two trimesters. There was a total of 527 neonatal and 893 infant deaths. Maternal FHS usage during the first two trimesters was associated with substantial reductions in neonatal [adjusted odds ratio (aOR): 0.527, 95% confidence interval (95% CI): 0.345; 0.806] and infant mortality (aOR: 0.672, 95% CI: 0.48; 0.924). Infants born to lower-income mothers and those without formal employment had larger reductions in neonatal and infant mortality associated with FHS use. Maternal FHS in the first two trimesters use was also associated with more antenatal care consultations and a lower risk of low birth weight and preterm birth. Interpretation Expanding primary care to low-income populations in Rio de Janeiro was associated with improved infant health and health equity benefits. Funding DFID/MRC/Wellcome Trust/ESRC

Fluorides, orthodontics and demineralization: a systematic review

Objectives: To evaluate the effectiveness of fluoride in preventing white spot lesion (WSL) demineralization during orthodontic treatment and compare all modes of fluoride delivery. Data sources: The search strategy for the review was carried out according to the standard Cochrane systematic review methodology. The following databases were searched for RCTs or CCTs: Cochrane Clinical Trials Register, Cochrane Oral Health Group Specialized Trials Register, MEDLINE and EMBASE. Inclusion and exclusion criteria were applied when considering studies to be included. Authors of trials were contacted for further data. Data selection: The primary outcome of the review was the presence or absence of WSL by patient at the end of treatment. Secondary outcomes included any quantitative assessment of enamel mineral loss or lesion depth. Data extraction: Six reviewers independently, in duplicate, extracted data, including an assessment of the methodological quality of each trial. Data synthesis: Fifteen trials provided data for this review, although none fulfilled all the methodological quality assessment criteria. One study found that a daily NaF mouthrinse reduced the severity of demineralization surrounding an orthodontic appliance (lesion depth difference –70.0 µm; 95% CI –118.2 to –21.8 µm). One study found that use of a glass ionomer cement (GIC) for bracket bonding reduced the prevalence of WSL (Peto OR 0.35; 95% CI 0.15–0.84) compared with a composite resin. None of the studies fulfilled all of the methodological quality assessment criteria. Conclusions: There is some evidence that the use of a daily NaF mouthrinse or a GIC for bonding brackets might reduce the occurrence and severity of WSL during orthodontic treatment. More high quality, clinical research is required into the different modes of delivering fluoride to the orthodontic patient

The ball mill as a means of investigating the mechanical failure of dental materials

Objective: The main purpose of this paper is to present a new method of predicting clinical performance using mechanical loading in a ball mill. Methods: A series of four experiments (two involving a hybrid composite and one each on orthodontic brackets and bands) is described in which the ball mill was used to subject specimens to mechanical fatigue. Results: A reproducibility study using composite beam specimens showed no significant difference between the Mean Survival Time (MST) in all the three experimental runs (P = 0.42). When subjected to thermal cycling, the MST of the cycled group was 155.0 min compared to 247.0 min fur the control group (P < 0.01). The MST of untreated and sandblasted brackets was 7.9 h and 14 h respectively (P < 0.01). There is also a significant difference (P < 0.001) in the MST of sandblasted bands when compared to the untreated bands. Conclusions: The ball mill proved to be a convenient and reproducible means of producing mechanical fatigue and may be useful in predicting the clinical performance of dental materials. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down

Research Qestions and Data Resource Needs For Examining Student Access to Higher Education

This paper examines some of the important policy issues pertaining to student access to higher education and raises evaluation questions for which evaluation research is needed. For illustrative purposes, the paper presents data that show the progress the nation has made in expanding access persistence and degree completion for various segments of the population at different levels, types and qualities of colleges and universitie

Associations of public transportation use with cardiometabolic health: a systematic review and meta-analysis

Public transport provides an opportunity to incorporate physical activity into journeys, but potential health impacts have not been systematically examined. Literature searches were carried out up to December 2017 using Medline, Embase, Transport Database, Scopus, Cochrane Library, opengrey.eu and Google. We identified longitudinal studies which examined associations between public transport and cardio-metabolic health including: adiposity, type II diabetes, and cardiovascular disease. We assessed study quality using the Newcastle-Ottawa Scale for cohort studies and performed meta-analyses where possible. Ten studies were identified, seven investigating use of public transport and three examining proximity to public transport. Seven studies used individual level data on changes in BMI with objective outcomes measured in six studies. Study follow-up ranged from one to ten years with three studies adjusting for non-transport physical activity. We found a consistent association between public transport use and lower BMI. Meta-analysis of data from five comparable studies found that switching from car to public transport was associated with lower BMI: −0.30 kg/m2 (−0.47, −0.14). Few studies have investigated associations between public transport use and non-adiposity outcomes. These findings suggest that sustainable urban design which promotes public transport use may produce modest reductions in population BMI

The relationship between tooth size discrepancy and archform classification in orthodontic patients

Background: To determine the relationship between clinically significant tooth size discrepancies (TSD) and archform classification in orthodontic patients. Material and Methods: Two hundred and forty consecutive sets of pre-treatment orthodontic study models were scanned and landmarked. All models had permanent teeth erupted from first molar to first molar in both arches. Sixty sets of images were classified into two groups of 30 according to the presence (group 1) or absence (group 2) of a clinically significant overall or anterior TSD (>2 SD from Bolton’s original means). Mean upper and lower archforms were created for each group using a fourth degree polynomial curve. Upper and lower archforms in each group were classified as square, tapering or ovoid; their distribution was analysed using the Fisher test with a 5% level of significance. To evaluate the intra-operator error when determining archform type, the 60 archforms were re-classified by the same operator two weeks later. The unweighted Kappa statistic at 95% confidence intervals was used to determine the similarity of the classification on the two occasions. Results: Reproducibility of the classification of archform was very good (unweighted Kappa statistic of 0.83 with a 95% confidence interval of 0.73, 0.93). There was no statistically significant difference in the distribution of archform type between group 1 and group 2 for the upper ( p =0.3305) or lower ( p =0.6310) arches. Conclusions: The presence of a clinically significant TSD and archform classification do not appear to be related

Global inequalities in the double burden of malnutrition and associations with globalisation: a multilevel analysis of Demographic and Health Surveys from 55 low-income and middle-income countries, 1992-2018

BACKGROUND: Low-income and middle-income countries (LMICs) face a double burden of malnutrition (DBM), whereby overnutrition and undernutrition coexist within the same individual, household, or population. This analysis investigates global inequalities in household-level DBM, expressed as a stunted child with an overweight mother, and its association with economic, social, and political globalisation across country income and household wealth. METHODS: We pooled anthropometric and demographic data for 1 132 069 children (aged <5 years) and their mothers (aged 15-49 years) from 189 Demographic and Health Surveys in 55 LMICs between 1992 and 2018. These data were combined with country-level data on economic, social, and political globalisation from the Konjunkturforschungsstelle Globalisation Index and gross national income (GNI) from the World Bank. Multivariate associations between DBM and household wealth, GNI, and globalisation and their interactions were tested using multilevel logistic regression models with country and year fixed-effects and robust standard errors clustered by country. FINDINGS: The probability of DBM was higher among richer households in poorer LMICs and poorer households in richer LMICs. Economic globalisation was associated with higher odds of DBM among the poorest households (odds ratio 1·49, 95% CI 1·20-1·86) compared with the richest households. These associations attenuated as GNI increased. Social globalisation was associated with higher odds of DBM (1·39, 95% CI 1·16-1·65), independently of household wealth or country income. No associations were identified between political globalisation and DBM. INTERPRETATION: Increases in economic and social globalisation were associated with higher DBM, although the impacts of economic globalisation were mostly realised by the world's poorest. The economic patterning of DBM observed in this study calls for subpopulation-specific double-duty actions, which should further aim to mitigate the potential negative and unequal impacts of globalisation. FUNDING: UK Biotechnology and Biological Sciences Research Council. TRANSLATIONS: For the Spanish and Portuguese translations of the abstract see Supplementary Materials section

The Relationship Between Tooth Size Discrepancy and Archform Classification in Orthodontic Patients

Background To determine the relationship between clinically significant tooth size discrepancies (TSD) and archform classification in orthodontic patients. Material and Methods Eighty teeth with artificial white spot lesions were randomly divided into four groups: (A) distilled and deionized water, (B) Nd:YAG laser, (C) CPP-ACP crème, & (D) CPP-ACP plus laser. SMH was measured using Vickers diamond indenter in Vickers Hardness Number (VHN). Two samples of each group were analyzed using scanning electron microscope (SEM). The results were analyzed with the SPSS 17/win. Results Reproducibility of the classification of archform was very good (unweighted Kappa statistic of 0.83 with a 95% confidence interval of 0.73, 0.93). There was no statistically significant difference in the distribution of archform type between group 1 and group 2 for the upper (p=0.3305) or lower (p=0.6310) arches. Conclusions The presence of a clinically significant TSD and archform classification do not appear to be related