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Indianapolis, IN, United States

Pontigo-Loyola A.P.,Autonomous University of the State of Hidalgo | Medina-Solis C.E.,Autonomous University of the State of Hidalgo | Lara-Carrillo E.,National Autonomous University of Mexico | Patino-Marin N.,Autonomous University of San Luis Potosi | And 5 more authors.

The objective of this study is to determine the impact of socio-demographic, socioeconomic, and other risk indicators on dental fluorosis (DF) among Mexican adolescents. A cross-sectional study was carried out in 1,538 adolescents 12 and 15 years of age in semi-rural communities located at high altitude (>2,000 m) and with high concentration of fluoride in water (1.38-3.07 ppm) in Hidalgo, Mexico. DF was determined by means of Dean's Index and all teeth were examined. Remaining variables were collected using a questionnaire. The adjusted final model was performed using ordered logistic regression. After adjusting for sex, the variables associated with DF were (p < 0.05): being 12 years old (OR = 1.10) versus 15 years old; having lived the first 6 years of life in El Llano (3.07 F ppm) (OR = 3.19) or San Marcos (1.38 F ppm) (OR = 1.63) versus Tula (1.42 F ppm); having public (OR = 1.35) or private health insurance (OR = 1.36) versus those without insurance; belonging to the lower quartiles of socioeconomic position (SEP) [1st quartile (OR = 2.48), 2nd quartile (OR = 1.81), 3rd quartile (OR = 1.49)] versus the highest quartile; having drunk tap water (OR = 1.83) or from a well or spring (OR = 2.30) versus those who drank water purchased in large containers or bottles. Demographic and socioeconomic variables were associated with DF. While better SEP appeared to play an important role in DF, a pattern of water intake associated with water purchased in large containers or bottles (which have different connotations to the use of bottled water in industrialized Western countries) did reduce DF risk in these high fluoride content, high altitude communities. © 2012 The Society of The Nippon Dental University. Source

Imperiale T.F.,Indiana University | Imperiale T.F.,The Regenstrief Institute Inc
International Journal of Medical Informatics

Purpose: To assess provider acceptance of recommendations by a decision tool that scans the electronic medical record and determines whether sodium phosphate may be taken. In addition, to determine decision tool effects on a composite outcome of colonoscopies canceled, rescheduled, aborted, or repeated sooner than recommended due to preparation (prep) quality; prep quality; colonoscopy duration; and patient satisfaction with and tolerance of the preparation. Methods: We used 4 alternating 4-week periods to compare the decision tool with usual care for outpatient colonoscopy. All decision tool decisions were reviewed in real-time by gastroenterology nurses and/or physicians. Patients completed a survey about the prep process. Endoscopists blindly rated prep quality. Colonoscopy duration and findings were recorded. Results: Of 354 persons in the decision tool group, 4 prep decisions were overridden because of patient preference or prior prep failure, but none for medical reasons. Sodium phosphate was used more frequently in the decision tool group (73% vs. 41%; P<0.01). There was no difference between the decision tool and usual care groups in the composite outcome (26% vs. 30%, respectively; P=0.29), acceptable prep quality (62% vs. 56%; P=0.22), colonoscopy duration (28 vs. 30. min; P=0.17), patient satisfaction (P=0.38), or preparation tolerance (P=0.37). Conclusions: An electronic medical record-based decision tool can safely and effectively tailor the prep for colonoscopy and may improve colonoscopy efficiency and patient satisfaction. Limitations: This study was performed at a single VA medical center and endoscopy unit, relies on the presence of relevant medical conditions and laboratory data in the electronic medical record, and had a higher than expected use of sodium phosphate during usual care. © 2011 Elsevier Ireland Ltd. Source

Villalobos-Rodelo J.J.,Area de Medicina Preventiva | Villalobos-Rodelo J.J.,Autonomous University of Sinaloa | Medina-Solis C.E.,Autonomous University of the State of Hidalgo | Verdugo-Barraza L.,Area de Medicina Preventiva | And 5 more authors.

Introduction: Dental caries is one of the most common chronic childhood diseases worldwide. In Mexico it is a public health problem. Objective: To identify variables associated with caries occurrence (non-reversible and reversible lesions) in a sample of Mexican schoolchildren. Material and methods: We performed a cross-sectional study in 640 schoolchildren of 11 and 12 years of age. The dependent variable was the D1+2MFT index, comprising reversible and irreversible carious lesions (dental caries) according to the Pitts D1/D2 classification. Clinical examinations were performed by trained and standardized examiners. Using structured questionnaires we collected socio demographic, socio-economic and health-related oral behaviors. Negative binomial regression was used for the analysis. Results: The D1+2MFT index was 5.68±3.47. The schoolchildren characteristics associated with an increase in the expected average rate of dental caries were: being female (27.1%), having 12 years of age (23.2%), consuming larger amounts of sugar (13.9%), having mediocre (31.3%) and poor/very poor oral hygiene (62.3%). Conversely, when the family owned a car the expected mean D1+2MFT decreased 13.5%. Conclusions: When dental caries occurrence (about 6 decayed teeth) is estimated taking into consideration not only cavities (lesions in need of restorative dental treatment) but also incipient carious lesions, the character of this disease as a common clinical problem and as a public health problem are further emphasized. Results revealed the need to establish preventive and curative strategies in the sample. Source

Meslin E.M.,Indiana University | Meslin E.M.,Indiana University - Purdue University Indianapolis | Alpert S.A.,Indiana University | Carroll A.E.,Indiana University | And 5 more authors.
International Journal of Medical Informatics

Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a "Points to Consider" (P2C) document, and convened a national expert panel to review and critique the P2C. Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions ("Points") that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. Discussion: The P2C is intended to clarify what is at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. © 2013 The Authors. Source

Islas-Granillo H.,Autonomous University of the State of Hidalgo | Borges-Yanez S.A.,National Autonomous University of Mexico | Medina-Solis C.E.,Autonomous University of the State of Hidalgo | Casanova-Rosado A.J.,Autonomous University of Campeche | And 5 more authors.
Geriatrics and Gerontology International

Aim: To determine the prevalence of root caries and the root caries index in a population of older Mexicans, and its relationship to socioeconomic, sociodemographic and dental factors. Methods: We carried out a cross-sectional study in 85 persons 60years and older living either in long-term care facilities, or independently and attending an elder day-care group. Each subject underwent an oral examination, performed by a trained and standardized dentist, to determine the root caries index and other clinical variables. Questionnaires were administered to collect socioeconomic, sociodemographic and hygiene data. Statistical analyses were performed using non-parametric tests. Results: The prevalence of root caries was 96.5%. The root caries index was 37.7%±21.7%. Statistically significant differences (P<0.05) of root caries index were observed across residential arrangements and marital statuses, and were higher in publicly funded long-term care and among single subjects (P<0.05). Those who had poor hygiene had more root caries (P<0.05); persons with a low level of schooling and who brushed their teeth less frequently also showed a difference (P<0.05). Conclusions: The prevalence of root caries was very high. The type of long-term care, marital status, schooling and oral hygiene were associated with a higher root caries index. Oral health programs and preventive caries interventions are needed for this age group in general; targeted strategies may be better focused if sociodemographic profiles are used to characterize high need groups. © 2011 Japan Geriatrics Society. Source

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