Suchergebnisse

FOR THE VAST MAJORITY OF PEOPLE AROUND THE WORLD, CENTRAL AMERICA IS A SMALL GROUP OF COUNTRIES BRIDGING THE GAP BETWEEN THE MAYAN RUINS OF GUATEMALA AND THE PANAMA CANAL. THE NAMES OF THOSE COUNTRIES ARE ONLY RECOGNIZED WHEN THE MAJOR CONTENDING IDEOLOGIES OF CAPITALISM AND COMMUNISM CLASH IN ONE OF THEM, OR WHEN AN INTERNATIONAL FIGURE OF ILL OR GOOD REPUTE ESTABLISHES SOME SORT OF LINK WITH THEM. A FOOTBALL GAME THAT LEADS TO WAR ALSO CATCHES THE EYE OF THE MEDIA. AN EXAMPLE OF THE FIRST SITUATION WOULD BE THE OUSTING OF THE COMMUNIST REGIME OF JACOBO ARBENZ IN GUATEMALA BY HONDURAN TROOPS BACKED BY THE UNITED FRIUT COMPANY AND THE CIA IN 1954; ANOTHER WOULD BE THE RISE OF THE MARXIST REGIME IN NICARAGUA IN 1979. THE SECOND IS EVIDENT IN THE ESTABLISHMENT IN COSTA RICA OF THE INTERNATIONAL FUGITIVE ROBERT VESCO AROUND 1970, AS WELL AS IN THE VISIT OF POPE JOHN PAUL II TO EACH OF THE FIVE NATIONS IN 1983.

INTRODUCTION: A European Union amalgam phase-down has recently been implemented. Publicly funded health care predominates in the United Kingdom with the system favoring amalgam use. The current use of amalgam and its alternatives has not been fully investigated in the United Kingdom. OBJECTIVES: The study aimed to identify direct posterior restorative techniques, material use, and reported postoperative complication incidence experienced by primary care clinicians and differences between clinician groups. METHODS: A cross-sectional survey was distributed to primary care clinicians through British dentist and therapist associations (11,092 invitations). The questionnaire sought information on current provision of direct posterior restorations and perceived issues with the different materials. Descriptive statistical and hypothesis testing was performed. RESULTS: Dentists' response rate was 14% and therapists' estimated minimum response rate was 6% (total N = 1,513). The most commonly used restorative material was amalgam in molar teeth and composite in premolars. When placing a direct posterior mesio-occluso-distal restoration, clinicians booked on average 45% more time and charged 45% more when placing composite compared to amalgam (P < 0.0001). The reported incidences of food packing and sensitivity following the placement of direct restorations were much higher with composite than amalgam (P < 0.0001). Widely recommended techniques, such as sectional metal matrix use for posterior composites, were associated with reduced food packing (P < 0.0001) but increased time booked (P = 0.002). CONCLUSION: Amalgam use is currently high in the publicly funded sector of UK primary care. Composite is the most used alternative, but it takes longer to place and is more costly. Composite also has a higher reported incidence of postoperative complications than amalgam, but time-consuming techniques, such as sectional matrix use, can mitigate against food packing, but their use is low. Therefore, major changes in ...

Background: Across a range of policy areas and geographies, governments and philanthropists are increasingly looking to adopt a social outcomes contracting (SOC) approach. Under this model, an agreement is made that a provider of services must achieve specific, measurable social and/or environmental outcomes and payments are only made when these outcomes have been achieved. Despite this growing interest, there is currently a paucity of evidence in relation to the tangible improvement in outcomes associated with the implementation of these approaches. Although promising, evidence suggests that there are risks (especially around managing perverse incentives).[1] The growing interest in SOC has been accompanied by research of specific programmes, policy domains or geographies, but there has not been a systematic attempt to synthetise this emerging evidence. To address this gap, this systematic review aims to surface the best evidence on when and where effects have been associated with SOC. Methods: This mixed-methods systematic review protocol has been prepared using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines (Additional File 2) (Shamseer et al., 2010). The review aims to consult policymakers throughout the evidence synthesis process, by adopting a user-involved research process. This will include the establishment and involvement of a Policy Advisory Group (PAG). The PAG will consist of a large, diverse, international group of policy makers who are or have been actively involved in funding and shaping social outcomes contracts (Additional File 3). The following electronic databases will be searched: ABI/INFORM Global, Applied Social Sciences Index & Abstracts (ASSIA), Scopus, International Bibliography of the Social Sciences (IBSS), PAIS Index, PolicyFile Index, Proquest Dissertations and Theses, ProQuest Social Science, Social Services Abstracts, Web of Science, Worldwide Political Science Abstracts and PsycINFO. We will also conduct a comprehensive ...

In 2011 a surveillance study for the susceptibility to fidaxomicin and epidemiology of Clostridium difficile isolates in the United States was undertaken in seven geographically dispersed medical centers. This report encompasses baseline surveillance in 2011 and 2012 on 925 isolates. A convenience sample of C. difficile isolates or toxin positive stools from patients were referred to a central laboratory. Antimicrobial susceptibility was determined by agar dilution (CLSI M11-A8). Clinical and Laboratory Standards Institute (CLSI), Food and Drug Administration, or European Union of Clinical Antimicrobial Susceptibility Testing (EUCAST) breakpoints were applied where applicable. Toxin gene profiles were characterized by multiplex PCR on each isolate. A random sample of 322 strains, stratified by institution, underwent restriction endonuclease analysis (REA). The fidaxomicin MIC90 was 0.5 μg/ml for all isolates regardless of REA type or toxin gene profile, and all isolates were inhibited at ≤1.0 μg/ml. By REA typing, BI strains represented 25.5% of the isolates. The toxin gene profile of tcdA, tcdB, and cdtA/B positive with a tcdC 18-bp deletion correlated with BI REA group. Moxifloxacin and clindamycin resistance was increased among either BI or binary toxin-positive isolates. Metronidazole and vancomycin showed reduced susceptibility (EUCAST criteria) in these isolates. Geographic variations in susceptibility, REA group and binary toxin gene presence were observed. Fidaxomicin activity against C. difficile isolated in a national surveillance study did not change more than 1 year after licensure. This analysis provides baseline results for future comparisons.

An estimated one billion children experience child abuse each year, with the highest rates in low- and middle-income countries. The Sinovuyo Teen programme is part of Parenting for Lifelong Health, a WHO/UNICEF initiative to develop and test violence-prevention programmes for implementation in low-resource contexts. The objectives of this parenting support programme are to prevent the abuse of adolescents, improve parenting and reduce adolescent behavioural problems. This trial aims to evaluate the effectiveness of Sinovuyo Teen compared to an attention-control group of a water hygiene programme.This is a pragmatic cluster randomised controlled trial, with stratified randomisation of 37 settlements (rural and peri-urban) with 40 study clusters in the Eastern Cape of South Africa. Settlements receive either a 14-session parenting support programme or a 1-day water hygiene programme. The primary outcomes are child abuse and parenting practices, and secondary outcomes include adolescent behavioural problems, mental health and social support. Concurrent process evaluation and qualitative research are conducted. Outcomes are reported by both primary caregivers and adolescents. Brief follow-up measures are collected immediately after the intervention, and full follow-up measures collected at 3-8 months post-intervention. A 15-24-month follow-up is planned, but this will depend on the financial and practical feasibility given delays related to high levels of ongoing civil and political violence in the research sites.This is the first known trial of a parenting programme to prevent abuse of adolescents in a low- or middle-income country. The study will also examine potential mediating pathways and moderating factors. Pan-African Clinical Trials Registry PACTR201507001119966.