Dental Benefits of Limited Exposure to Fluoridated Water in Childhood

The effect of limited exposure to fluoridated water in childhood is of potential importance in highly-mobile modern society, but the subject has not been well-studied. This longitudinal study assessed caries experience and S. mutans proportions from fissure plaque in school-children who lived for at least the three years of the study in a non-fluoridated community (0.2 mg/L). Residence histories permitted division of the cohort into those who had lived all their lives in non-fluoridated communities, and those who had lived for some time previously in a fluoridated community. The children were aged 6-7 years at the beginning of the three-year study. Children with previous residence in the fluoridated communities developed 26.8% less caries in their permanent teeth during the study than did the children who had lived in non-fluoridated communities all their lives (p = 0.04), and had 29.8% less caries after three years (p = 0.02). Differences between the groups in S. mutans proportions from fissure plaque, sampled at six-monthly intervals throughout the study, could not be demonstrated. The dental benefits observed could not be attributed to socio-economic differences between the groups. Despite evidence that the benefits of limited ingestion of fluoridated water are topical in nature, the fact that many of the affected teeth in this study were unerupted at the time of the fluoride exposure means that pre-eruptive benefits cannot be ruled out.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66708/2/10.1177_00220345860650110801.pd

Does interhospital transfer improve outcome of acute myocardial infarction? A propensity score analysis from the Cardiovascular Cooperative Project

<p>Abstract</p> <p>Background</p> <p>Many patients suffering acute myocardial infarction (AMI) are transferred from one hospital to another during their hospitalization. There is little information about the outcomes related to interhospital transfer. The purpose of this study was to compare processes and outcomes of AMI care among patients undergoing interhospital transfer with special attention to the impact on mortality in rural hospitals.</p> <p>Methods</p> <p>National sample of Medicare patients in the Cooperative Cardiovascular Study (n = 184,295). Retrospective structured medical record review of AMI hospitalizations. Descriptive study using a retrospective propensity score analysis of clinical and administrative data for 184,295 Medicare patients admitted with clinically confirmed AMI to 4,765 hospitals between February 1994 and July 1995. Main outcome measure included: 30-day mortality, administration of aspirin, beta-blockers, ACE-inhibitors, and thrombolytic therapy.</p> <p>Results</p> <p>Overall, 51,530 (28%) patients underwent interhospital transfer. Transferred patients were significantly younger, less critically ill, and had lower comorbidity than non-transferred patients. After propensity-matching, patients who underwent interhospital transfer had better quality of care anlower mortality than non-transferred patients. Patients cared for in a rural hospital had similar mortality as patients cared for in an urban hospital.</p> <p>Conclusion</p> <p>Transferred patients were vastly different than non-transferred patients. However, even after a rigorous propensity-score analysis, transferred patients had lower mortality than non-transferred patients. Mortality was similar in rural and urban hospitals. Identifying patients who derive the greatest benefit from transfer may help physicians faced with the complex decision of whether to transfer a patient suffering an acute MI.</p

Perinatal HIV transmission and the cost-effectiveness of screening at 14 weeks gestation, at the onset of labour and the rapid testing of infants

<p>Abstract</p> <p>Background</p> <p>Preventing HIV transmission is a worldwide public health issue. Vertical transmission of HIV from a mother can be prevented with diagnosis and treatment, but screening incurs cost. The U.S. Virgin Islands follows the mainland policy on antenatal screening for HIV even though HIV prevalence is higher and rates of antenatal care are lower. This leads to many cases of vertically transmitted HIV. A better policy is required for the U.S. Virgin Islands.</p> <p>Methods</p> <p>The objective of this research was to estimate the cost-effectiveness of relevant HIV screening strategies for the antenatal population in the U.S. Virgin Islands. An economic model was used to evaluate the incremental costs and incremental health benefits of nine different combinations of perinatal HIV screening strategies as compared to existing practice from a societal perspective. Three opportunities for screening were considered in isolation and in combination: by 14 weeks gestation, at the onset of labor, or of the infant after birth. The main outcome measure was the cost per life year gained (LYG).</p> <p>Results</p> <p>Results indicate that all strategies would produce benefits and save costs. Universal screening by 14 weeks gestation and screening the infant after birth is the recommended strategy, with cost savings of $1,122,787 and health benefits of 310 LYG. Limitations include the limited research on the variations in screening acceptance of screening based on specimen sample, race and economic status. The benefits of screening after 14 weeks gestation but before the onset of labor were also not addressed.</p> <p>Conclusion</p> <p>This study highlights the benefits of offering screening at different opportunities and repeat screening and raises the question of generalizing these results to other countries with similar characteristics.</p

Idaho health profile.

Description based on: 1996.Mode of access: Internet.Issued by: Centers for Disease Control, ; by Centers for Disease Control and Prevention, <2000-