Parent support programmes and policies in the Caribbean

ABSTRACT

The authors, through a consultancy with the Caribbean Child Development Centre, the University of the West Indies Open Campus, sought to identify comprehensive parent support programmes and policies in the healthcare sector in non-Spanish-speaking Caribbean countries. As mapping researchers, the authors were contracted to map policies and programmes in the healthcare sector whose aims were to support both family wellbeing and children’s healthy development. A review of the existing literature about parenting practices and parenting support programming in the Caribbean was conducted. A catalogue of existing programmes and policies in non-Spanish speaking Caribbean countries was compiled using relevant documents and interviews from primary sources involved in the programmes and the development and implementation of policies. This article outlines the trends identified during the interviews and mapping exercise.     

Immunoglobulins and innate antimicrobial factors in whole saliva of patients with insulin-dependent diabetes mellitus

We analyzed the flow rate and composition of paraffin-stimulated whole saliva samples from 35 adult diabetic patients and their age- and sex-matched, non-diabetic, clinically healthy controls. All patients had insulin-dependent diabetes (IDDM) with a mean (+/- S.D.) duration of 14.0 +/- 9.1 years. The saliva analysis included the quantitation of total protein, amylase, immunoglobulins (isotypes A, G, and M), and the non-antibody, innate antimicrobial factors (lysozyme, lactoferrin, salivary peroxidase, myeloperoxidase, thiocyanate, and hypothiocyanite). The whole saliva samples from diabetic patients had significantly higher amounts of IgA (p less than 0.001) and IgG (p less than 0.05) than did the controls. No differences between the study groups were observed in flow rate, protein content, amylase activity, or IgM. The levels of innate defense factors were similar in both study groups except for salivary peroxidase, which was higher (p less than 0.02) among diabetics than among controls. Our results indicate that the antimicrobial defense capacity of whole saliva is not impaired in diabetic patients.     

Diagnostic quality versus patient exposure with five panoramic screen-film combinations

Five film-screen combinations were used to make five density-matched panoramic radiographs of a tissue-equivalent phantom skull using the Midwest/Morita Panoral x-ray machine. The radiographs were evaluated as to their diagnostic quality by twenty dental radiologists. The results demonstrate that proper screen-film selection can significantly reduce patient exposure without compromising diagnostic quality.     

Postoperative complaints following impacted mandibular third molar surgery in Ile-Ife, Nigeria.

An investigation into the pattern of complaints lodged by patients after impacted mandibular third molar surgery was done in a Nigerian teaching hospital over a period of 3 years. One hundred and twenty seven records were retrieved. Pericoronitis (71.2%), pulpitis (17.6%) and periodontitis (11.2%) were the reasons for surgery. No third molar surgery was done for prophylactic or orthodontic reasons. Sixty-one complaints were lodged by 49 (38.6%) patients on day 1, and 37 complaints by 35 patients on day 7. These complaints were verified by the findings of the examining clinician. Pain, swelling and trismus were the commonest complaints. A significant association (P = 0.042) was found between patients' complaints on the first postoperative day and the drug combination given. Similarly, there was a significant relationship (P = 0.0055) between the type of analgesics prescribed and the presence of postoperative pain. No significant relationship was however found between the complaints and patients' age, indication for extraction, impaction type and method of impacted tooth removal. Although the findings of this retrospective study are limited in their comparability, they suggest the need for an appraisal of pain management in patients undergoing mandibular third molar surgery in our hospital. Consequently, there should be a reduction in complaint rate thereby making selective review appointment on the first postoperative day feasible.     

Changes in properties of nonaqueous elastomeric impression materials after storage of components

STATEMENT OF PROBLEM: Storage stability, or shelf life, is a critical property of perishable dental materials. PURPOSE: The purpose of this investigation was to document changes in the properties of nonaqueous elastomeric impression materials over time and on exposure to various environmental conditions. MATERIAL AND METHODS: Materials investigated included a polyether impression material, a polysulfide material (light, regular, and heavy consistencies), and an addition-reaction silicone material (light, regular, heavy, and putty consistencies). Tests included viscosity of individual pastes, elastic recovery, working and setting times, strain in compression, dimensional change, creep compliance, and tear energy. Means and standard deviations were calculated for each test interval. Statistical analysis included 2-way ANOVA (variables: time and storage condition) and comparison to baseline values using 1-way ANOVA (variable: time) and Scheffe's multiple comparison test (P < or = 0.05) within each material, consistency, and test. RESULTS: Results over 72 months revealed changes in viscosity, working/setting times, elastic recovery, and creep compliance. Separation of components was seen with polysulfide and addition silicone materials. Some batches of polysulfide base paste and polyether reactor paste solidified in the tube. CONCLUSION: Most batches of the materials and consistencies tested remained efficacious well past their designated shelf lives under a variety of storage and use conditions. Data for the addition-reaction silicone impression material changed little during the 72-month testing period; thus, the material may be considered relatively storage stable. Creep compliance was the most precise storage-stability indicator. The storage stability of perishable materials should be addressed in American Dental Association Specifications.     

A randomized clinical trial comparing the efficacy of mandibular implant-supported overdentures and conventional dentures in diabetic patients. Part IV: Comparisons of dietary intake

STATEMENT OF PROBLEM: It is unclear whether the replacement of conventional mandibular dentures with implant-supported overdentures alters the diet and thus improves the nutritional intake of edentulous persons. PURPOSE: The purpose of this study was to compare the pretreatment and posttreatment diets of edentulous diabetic patients who received new dentures with either a conventional complete mandibular denture (CD) or a mandibular implant-supported overdenture (IOD). MATERIAL AND METHODS: New dentures were made for 89 edentulous diabetic patients with acceptable metabolic control without insulin (NIT) or with insulin (IT). A randomized approach was used to assign 37 patients a mandibular CD and 52 patients a mandibular IOD supported by 2 cylindrical implants. Of the 89 patients, 58 submitted a dietary log for 7 consecutive days before treatment (PT) and 6 months after treatment completion (PTC). An average daily intake of 28 essential nutrients was determined for each patient at each time interval. Separate 2 x 2 x 2 repeated analysis of variance (ANOVA) tests were performed for each nutrient to compare the means of the 2 denture groups (CD and IOD), 2 diabetic groups (NIT and IT), and 2 time intervals (PT and PTC). The intakes were also compared with the recommended daily allowance (RDA). RESULTS: ANOVAs for all 28 nutritional variables showed no main effect for either denture type or diabetic treatment. Time effects were seen for magnesium, potassium, copper, and monounsaturated fats. The PTC mean intake of the total sample (N = 58) decreased for all 3 minerals and increased for monounsaturated fats with study dentures. Post hoc tests showed the differences between PT and PTC means to be statistically significant for only magnesium (P=.043) and potassium (P=.015). The percentage of patients with PT intake 25% or more below the RDA ranged from 33% to 85% in the CD group and from 24% to 100% in the IOD group for the same 11 nutrients. PTC fiber intake deficiency was noted in almost all participants. Carbohydrate consumption was markedly lower than that recommended by the American Diabetic Association. CONCLUSION: As is often the case with elderly groups, this group of edentulous diabetic patients showed highly comprised nutritional intakes of fiber, vitamins, and minerals. The replacement of old dentures with new dentures that included either a mandibular CD or IOD did not alter patient diets such that the patients improved their nutritional intakes of essential micronutrients and macronutrients.     

In vitro solubility of human pulp tissue in calcium hydroxide and sodium hypochlorite.

The tissue solvent capacity of a 2% stabilized sodium hypochlorite solution (Milton) and a commercial calcium hydroxide solution (Calasept) was examined under in vitro conditions where autolyzed human pulp fragments weighing approximately 0.0065 g were immersed in these solutions at 37 degrees C for periods of up to 10 days. It appeared that sodium hypochlorite was able to dissolve half the volume of pulp tissue within 1 h and the remaining tissue after 2-2 1/2 h. Calcium hydroxide dissolved half the pulp volume within 2 h, whereas it took 1 week for the remaining tissue to dissolve. These findings support the use of sodium hypochlorite as an irrigation solution during canal preparation and calcium hydroxide as a canal dressing for the purpose of creating a canal free of pulp remnants before root filling.