Socioeconomic Inequality in Professionally Administered Topical Fluoride among Mexican Schoolchildren

Objective: To identify and characterize socio-economic inequalities in professionally administered topical fluoride treatment to schoolchildren. Methods: One thousand six hundred and forty-four schoolchildren [6 to 13 years of age, mean 9.06 ± 2.02; years 50.9% boys] were included in a cross-sectional study. Using questionnaires directed to mothers/guardians, we collected sociodemographic, socio-economic and dental variables. The dependent variable was at least one professional application of topical fluoride by a dentist in the previous year. Dentists in Mexico carry out the scope of clinical care traditionally assigned to dental hygienists in the United States of America (USA) and Canada. A multivariate logistic regression model was generated. Results: The prevalence of fluoride application was 11.5 % (95% CI = 9.9, 13.0). In the multivariate model, the odds of having a topical fluoride application was higher in children who reported brushing teeth more often (OR = 1.62, 95% CI = 1.22, 2.15) and in children from families with better socio-economic position (OR = 1.26, 95% CI = 1.06, 1.50). Conclusions: The experience of having fluoride administered by a dentist in the previous year was low overall in this sample of Mexican children. The results of the study suggest certain socio-economic inequalities. Strategies aimed at eliminating such inequalities across the socioeconomic spectrum are necessary if this population group is to follow recommended frequency schedules for topical fluoride applications

Overview of progress in European medium sized tokamaks towards an integrated plasma-edge/wall solution

\u3cp\u3eIntegrating the plasma core performance with an edge and scrape-off layer (SOL) that leads to tolerable heat and particle loads on the wall is a major challenge. The new European medium size tokamak task force (EU-MST) coordinates research on ASDEX Upgrade (AUG), MAST and TCV. This multi-machine approach within EU-MST, covering a wide parameter range, is instrumental to progress in the field, as ITER and DEMO core/pedestal and SOL parameters are not achievable simultaneously in present day devices. A two prong approach is adopted. On the one hand, scenarios with tolerable transient heat and particle loads, including active edge localised mode (ELM) control are developed. On the other hand, divertor solutions including advanced magnetic configurations are studied. Considerable progress has been made on both approaches, in particular in the fields of: ELM control with resonant magnetic perturbations (RMP), small ELM regimes, detachment onset and control, as well as filamentary scrape-off-layer transport. For example full ELM suppression has now been achieved on AUG at low collisionality with n = 2 RMP maintaining good confinement . Advances have been made with respect to detachment onset and control. Studies in advanced divertor configurations (Snowflake, Super-X and X-point target divertor) shed new light on SOL physics. Cross field filamentary transport has been characterised in a wide parameter regime on AUG, MAST and TCV progressing the theoretical and experimental understanding crucial for predicting first wall loads in ITER and DEMO. Conditions in the SOL also play a crucial role for ELM stability and access to small ELM regimes.\u3c/p\u3

The Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) Study Rationale, Design, and Baseline Characteristics

Background: People with diabetes and kidney disease have a high risk of cardiovascular events and progression of kidney disease. Sodium glucose co-transporter 2 inhibitors lower plasma glucose by reducing the uptake of filtered glucose in the kidney tubule, leading to increased urinary glucose excretion. They have been repeatedly shown to induce modest natriuresis and reduce HbA1c, blood pressure, weight, and albuminuria in patients with type 2 diabetes. However, the effects of these agents on kidney and cardiovascular events have not been extensively studied in patients with type 2 diabetes and established kidney disease. Methods: The Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) trial aims to compare the efficacy and safety of canagliflozin ­versus placebo at preventing clinically important kidney and cardiovascular outcomes in patients with diabetes and established kidney disease. CREDENCE is a randomized, double-blind, event-driven, placebo-controlled trial set in in 34 countries with a projected duration of â\u88¼5.5 years and enrolling 4,401 adults with type 2 diabetes, estimated glomerular filtration rate â\u89¥30 to 300 to â\u89¤5,000 mg/g). The study has 90% power to detect a 20% reduction in the risk of the primary outcome (α = 0.05), the composite of end-stage kidney disease, doubling of serum creatinine, and renal or cardiovascular death. Conclusion: CREDENCE will provide definitive evidence about the effects of canagliflozin on renal (and cardiovascular) outcomes in patients with type 2 diabetes and established kidney disease. Trial Registration: EudraCT number: 2013-004494-28; ClinicalTrials.gov identifier: NCT02065791