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BACKGROUND: Oral diseases represent a main public health problem worldwide. There is scarce information about oral health indicators in adults in middle-income countries in Latin America and Africa. OBJECTIVES: To identify and describe national health surveys with national representative samples that included oral health assessment for adults in Latin America. METHODS: A systematic review was conducted in scientific and regional bibliographic databases (PubMed, SciELO, Wos and Embase); this was complemented with searchings in grey literature (Google Scholar, Open Grey and government health organization websites), from August 2016 to May 2017 (from 2000 to date). Studies conducted, supervised or funded by Ministries of Health or National Health Institutes were included. Data extracted included country, year, methods, interview and dental examination. Two researchers independently performed search and data extraction. Results were discussed as a group. RESULTS: Only 5 countries in Latin America have developed national health surveys evaluating the dental status in adults, with overall national representative samples during 2000-2015: Brazil, Colombia, Panama, Chile and Uruguay. Main differences were observed in the type of dental indicators selected, measure of dental services access and the professional who performed the dental examination. While some dental surveys were specifically designed as oral health surveys (Brazil, Colombia, Panama and Uruguay) and the examination was performed by dentists, other surveys represent a module within a general health survey (Chile) and the examination was performed by nurses. CONCLUSIONS: There are a small number of Latin American countries that report research about dental status with national representation samples. Most of these studies have been conducted as national oral health surveys, and fieldwork was carried out by dentists. The development of oral health research in this part of the world should be promoted as these surveys provide relevant information to monitor oral health and evaluate the effectiveness of health programmes.

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BACKGROUND: The measurement of health benefits is a key issue in health economic evaluations. There is very scarce empirical literature exploring the differences of using quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) as benefit metrics and their potential impact in decision-making. METHODS: Two previously published models delivering outputs in QALYs, were adapted to estimate DALYs: a Markov model for human papilloma virus (HPV) vaccination, and a pneumococcal vaccination deterministic model (PNEUMO). Argentina, Chile, and the United Kingdom studies were used, where local EQ-5D social value weights were available to provide local QALY weights. A primary study with descriptive vignettes was done (n = 73) to obtain EQ-5D data for all health states included in both models. Several scenario analyses were carried-out to evaluate the relative importance of using different metrics (DALYS or QALYs) to estimate health benefits on these economic evaluations. RESULTS: QALY gains were larger than DALYs avoided in all countries for HPV, leading to more favorable decisions using the former. With discounting and age-weighting - scenario with greatest differences in all countries - incremental DALYs avoided represented the 75%, 68%, and 43% of the QALYs gained in Argentina, Chile, and United Kingdom respectively. Differences using QALYs or DALYs were less consistent and sometimes in the opposite direction for PNEUMO. These differences, similar to other widely used assumptions, could directly influence decision-making using usual gross domestic products (GDPs) per capita per DALY or QALY thresholds. CONCLUSION: We did not find evidence that contradicts current practice of many researchers and decision-makers of using QALYs or DALYs interchangeably. Differences attributed to the choice of metric could influence final decisions, but similarly to other frequently used assumptions.

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Health and environmental problems associated with the presence of toxic aromatic compounds in water from oil spills have motivated research to develop effective and economically viable strategies to remove these pollutants. In this work, coconut shell (endocarp), coconut fiber (mesocarp) and coconut shell with fiber (endocarp and mesocarp) obtained from coconut (Cocos nucifera) waste were evaluated as biosorbents of benzene, toluene and naphthalene from water, considering the effect of the solution pH (6-9) and the presence of dissolved organic matter (DOM) in natural water (14 mg/L). In addition, the heat capacity of saturated biosorbents was determined to evaluate their potential as an alternative power source to conventional fossil fuels. Tests of N2 physisorption, SEM, elemental and fiber analysis, ATR-FTIR and acid-based titrations were performed in order to understand the materials' characteristics, and to elucidate the biosorbents' hydrocarbon adsorption mechanism. Coconut fiber showed the highest adsorption capacities (222, 96 and 5.85 mg/g for benzene, toluene and naphthalene, respectively), which was attributed to its morphologic characteristics and to its high concentration of phenolic groups, associated with the lignin structure. The pH of the solution did not have a significant influence on the removal of the contaminants, and the presence of DOM improved the adsorption capacities of aromatic hydrocarbons. The adsorption studies showed biphasic isotherms, which highlighted the strong affinity between the molecules adsorbed on the biosorbents and the aromatic compounds remaining in the solution. Finally, combustion heat analysis of coconut waste saturated with soluble hydrocarbons showed that the heat capacity increased from 4407.79 cal/g to 5064.43 ±â€¯11.6 cal/g, which is comparable with that of woody biomass (3400-4000 cal/g): this waste biomass with added value could be a promising biofuel.

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Aim of the Study. To compare the effect of glossopharyngeal nerve block with topical anesthesia on the tolerance of patients to upper gastrointestinal endoscopy. Methods. We performed a clinical trial in one hundred patients undergoing upper gastrointestinal endoscopy. Subjects were randomly assigned to one of the following two groups: (1) treatment with bilateral glossopharyngeal nerve block (GFNB) and intravenous midazolam or (2) treatment with topical anesthetic (TASS) and intravenous midazolam. We evaluated sedation, tolerance to the procedure, hemodynamic stability, and adverse symptoms. Results. We studied 46 men and 54 women, from 17 to 78 years of age. The procedure was reported without discomfort in 48 patients (88%) in the GFNB group and 32 (64%) in the TAAS group; 6 patients (12%) in GFNB group and 18 (36%) in TAAS group reported the procedure as little discomfort (χ (2) = 3.95, P = 0.04). There was no difference in frequency of nausea (4% in both groups) and retching, 4% versus 8% for GFNB and TASS group, respectively (P = 0.55). Conclusions. The use of glossopharyngeal nerve block provides greater comfort and tolerance to the patient undergoing upper gastrointestinal endoscopy. It also reduces the need for sedation.

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En el presente artículo invitamos al lector a conocer mejor la Atención Primaria, sus diferencias con la atención especializada y su importancia en los sistemas de salud actuales. Además, hablaremos sobre los cuatro atributos que debe cumplir la Atención Primaria, descritos por Bárbara Starfield: Accesibilidad y primer contacto, donde debe existir un fácil acceso al sistema sanitario; Longitudinalidad, donde se debe establecer una relación personal y continua entre el médico y paciente; Integralidad, que da solución a las necesidades de salud más frecuentes de la comunidad; y Coordinación, que significa un trabajo en conjunto entre los médicos de Atención Primaria y otros especialistas.

In this article we invite our readers to know about primary care,their differences with the secondary care and its importance in the current health systems. We talk about the four attributes of primary care described by Barbara Starfield : Accessibility and first contact where there should be easy access to the health system; Longitudinality, which must establish a personal relationship between the physician and continuous patient .Integrity,which gives solution to the most common health needsof the community and Coordination, where there isa joint effort between primary care physicians and other specialists.

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BACKGROUND: Cost-effectiveness analysis has been recommended by many national agencies around the world as a valid methodology to improve resource allocation within the health-care system. If the preferences of the society are taken into account in such a decision-making process, it is generally recommended that these values should be elicited by using a generic health-related quality-of-life instrument, such as the EuroQol five-dimensional (EQ-5D) questionnaire. OBJECTIVES: To estimate a set of social values for EQ-5D questionnaire based on the time trade-off valuation technique for use in Chile. METHODS: A valuation questionnaire was applied to a probabilistic sample of 2000 individuals, aged 20 years or older, living in the Metropolitan region. The fieldwork took place during October to November 2008. Utility weights for 42 health states were calculated directly by the application of time trade-off. Several random effect and ordinary least-squares regression models were fitted to these valuations to predict the full set of 243 health states generated by the EQ-5D system. The best model was chosen by applying criteria of parsimony, goodness of fit, and prediction capacity. RESULTS: The selected regression model was robust and showed better predictive characteristics than others reported in similar studies conducted elsewhere. The chosen regression model showed a R(2) of 0.34, mean absolute error of 0.017, and high predictive capacity. CONCLUSIONS: This study provides an EQ-5D social value set for domestic use in Chile. Our results differ from those reported in other countries, justifying the need to perform local studies that adequately reflect societal health preferences.

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Phenomena as the progressive increase of health expenditure and the population aging have lead many countries to consider economic methodologies in order to obtain bigger sanitary benefits in contexts of limited resources. This article describes the basic components to consider in a health technology assessment , it analyses the process of decision making with cost-effectiveness analysis and reports how this methodology has been widely implemented in Latin America and the rest of the world.

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Fenómenos como el aumento progresivo del gasto en salud y el envejecimiento poblacional han obligado a los distintos países a considerar metodologías económicas que permitan obtener un mayor beneficio sanitario dentro de un contexto de recursos limitados. El presente artículo describe los componentes básicos a considerar en una evaluación de tecnología sanitaria, analiza el proceso de toma de decisión en un análisis de costo efectividad y reporta como dicha metodología ha sido implementada en América Latina y en el resto de mundo.

Phenomena as the progressive increase of health expenditure and the population aging have lead many countries to consider economic methodologies in order to obtain bigger sanitary benefits in contexts of limited resources. This article describes the basic components to consider in a health technology assessment , it analyses the process of decision making with cost-effectiveness analysis and reports how this methodology has been widely implemented in Latin America and the rest of the world.

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