¿Una intervención educativa en niños de doce años de Madrid modifica sus conocimientos y hábitos de higine buco-dental?

Una adecuada educación en higiene buco-dental en niños es deseable para que estos adquieran desde la infancia unos hábitos saludables que prevengan posibles enfermedades odontológicas en el futuro. En este estudio nos hemos propuesto valorar la eficacia de un programa de intervención en escolares que les proporcione unos conocimientos básicos sobre este aspecto sanitario. Para ello hemos impartido a sesenta niños y niñas de sexto de primaria (de doce años) del colegio Berriz VEracruz una charla educativa, distribuyéndoles dos encuestas, una antes y otra cuatro semanas después del programa educativo, y hemos estudiado los conocimietnos y hábitos que sobre salud e higiene buco-dental presentaron antes de la intervención, así como las modificaciones que sufrieron tras la misma. Observamos cambios significativos tanto en la frecuencia como en la técnica de cepillado, en la actitud a tomar ante el sangrado de encías y en el abandono de hábito nocivos. Por todo ellos concluímos que los programas educativos sobre higiene y salud buco-dental son eficaces para modificar positivamente las conductas de niños de esta edad, subrayando el interés que tienen la implantación de los mismos en el ámbito escolar

Cost-effectiveness analysis of timely dialysis referral after renal transplant failure in Spain

<p>Abstract</p> <p>Background</p> <p>A cost-effectiveness analysis of timely dialysis referral after renal transplant failure was undertaken from the perspective of the Public Administration. The current Spanish situation, where all the patients undergoing graft function loss are referred back to dialysis in a late manner, was compared to an ideal scenario where all the patients are timely referred.</p> <p>Methods</p> <p>A Markov model was developed in which six health states were defined: hemodialysis, peritoneal dialysis, kidney transplantation, late referral hemodialysis, late referral peritoneal dialysis and death. The model carried out a simulation of the progression of renal disease for a hypothetical cohort of 1,000 patients aged 40, who were observed in a lifetime temporal horizon of 45 years. In depth sensitivity analyses were performed in order to ensure the robustness of the results obtained.</p> <p>Results</p> <p>Considering a discount rate of 3 %, timely referral showed an incremental cost of 211 €, compared to late referral. This cost increase was however a consequence of the incremental survival observed. The incremental effectiveness was 0.0087 quality-adjusted life years (QALY). When comparing both scenarios, an incremental cost-effectiveness ratio of 24,390 €/QALY was obtained, meaning that timely dialysis referral might be an efficient alternative if a willingness-to-pay threshold of 45,000 €/QALY is considered. This result proved to be independent of the proportion of late referral patients observed. The acceptance probability of timely referral was 61.90 %, while late referral was acceptable in 38.10 % of the simulations. If we however restrict the analysis to those situations not involving any loss of effectiveness, the acceptance probability of timely referral was 70.10 %, increasing twofold that of late referral (29.90 %).</p> <p>Conclusions</p> <p>Timely dialysis referral after graft function loss might be an efficient alternative in Spain, improving both patients’ survival rates and health-related quality of life at an affordable cost. Spanish Public Health authorities might therefore promote the inclusion of specific recommendations for this group of patients within the existing clinical guidelines.</p