Implementation of a comprehensive AIDS education programme for schools in Masaka District, Uganda

As part of a large IEC (Information, Education and Communication)/STD intervention trial, a 19-lesson, comprehensive school-based AIDS education programme was implemented and evaluated in 50 primary and 16 secondary schools in 12 parishes of Masaka District, Uganda. A series of three teacher-training and evaluation workshops spread over a year was held in each parish, between which teachers implemented the programme in the classroom. One hundred and forty-eight teachers were trained and about 3,500 students were subsequently exposed to the programme. Both teachers and students responded positively, which suggests that this type of programme has much to offer young people who attend school. However, some problems were encountered: language, programme content, community resistance to teaching about condoms, and several practical issues. Proposed solutions include flexibility with the English language policy, alternative approaches to role play activities, targeting influential individuals with information about the need for young people to learn about safer sex, and a parallel community-based IEC programme to facilitate community acceptance of the need for the programme. In addition, implementation may be incomplete unless comprehensive AIDS education is fully incorporated into the curriculum, and properly examined. These findings are placed in the context of other life skills/AIDS education programmes being introduced both in Uganda and elsewhere in Africa.     

Primary molar pulp therapy--histological evaluation of failure

Objectives. Qualitative comparison of the clinical, radiographic and histological outcomes in a small sample of cariously exposed primary molars, extracted after unsucessful pulp treatment by two vital pulpotomy methods. Subjects and methods. The primary molars were extracted, because of treatment failure, during a longitudinal clinical investigation of the relative efficacy of 20% Buckley’s Formocresol versus calcium hydroxide powder as pulp dressings in vital pulp therapy (in press). Fifty‐two child patients were sequentially enrolled in the longitudinal clinical investigation, 26 boys and 26 girls. Primary molar teeth requiring vital pulp therapy were randomly allocated to either the formocresol group (F) or the calcium hydroxide group (C). Coronal pulp amputation was prescribed only in teeth with vital, cariously‐exposed pulp tissue. All cases were reviewed using predefined clinical and radiological criteria. Seventy‐nine cariously‐exposed primary molars required vital pulp therapy. Forty‐four teeth were included in group F and 35 in group C. Five per cent (n = 2) of teeth in group F and 11 per cent of teeth (n = 4) in group C were terminated from the trial due to clinical and/or radiographic failure. Of the six teeth extracted, five were sufficiently intact to be retained for histological evaluation. Results. Post‐extraction radiographs taken before specimen preparation showed reactionary dentine barrier (bridge) formation in teeth treated with calcium hydroxide. However, the narrowing of root canals, indicative of appositional reactionary dentine deposition, was seen in both groups (F and C). Histological examination confirmed these findings and revealed that pus cells were evident in all specimens examined. There was also histological evidence of resorption of reactionary dentine within the root canal and that forming the calcified barrier (dentine bridge). Conclusion. The clinical and radiographic outcomes for the five teeth correlate well with the reported findings from decalcified histological section. Although numbers are small, the histological findings may indicate possible reasons for treatment failure. There are few reports of this sort in the literature of this under‐researched treatment modality.     

Permanent impairment of embryo development by hydrosalpinges

Recent reports suggest a deleterious effect of hydrosalpinges on pregnancy outcome for in-vitro fertilization (IVF) and improvement following surgical treatment. We compared the effect of hydrosalpinx on pregnancy outcome in 286 patients having 348 IVF cycles and followed the development of untransferred embryos for 7 days to determine if hydrosalpinges affect oocyte quality or embryo development. The delivery rate per retrieval was significantly lower for patients with hydrosalpinx, but was restored by surgical treatment to that of patients without hydrosalpinx. However, the implantation rate per embryo transferred and normal blastulation of untransferred embryos, which were significantly decreased in patients with hydrosalpinx, and growth arrest and degeneration of untransferred embryos, which were significantly increased compared to patients without hydrosalpinx, were not restored by surgical treatment of hydrosalpinges. We conclude that surgical treatment of hydrosalpinges decreases early pregnancy loss and improves pregnancy outcome, possibly by diminishing reversible deleterious effects exerted on the endometrium. As we have seen in our laboratory, hydrosalpinges may have a permanent negative influence on ovarian function, follicular development and oocyte quality since implantation of transferred embryos and normal blastulation of untransferred embryos remain low, and in-vitro growth arrest and degeneration remain high despite surgical treatment of hydrosalpinges.      

Job hazards and respiratory symptoms in Hispanic female domestic cleaners

Abstract

The occupational hazards and respiratory symptoms of domestic cleaners in USA are largely unknown. We conducted a cross-sectional study among 56 Hispanic female domestic cleaner on their health status and frequency of cleaning products used and tasks performed. While women used multi-use products (60.0%) and toilet bowl cleaners (51.8%) most days of the week, many (39.3%) reported not using personal protective equipment while cleaning. Itchy/watery eyes (61.8%) and itchy nose (56.4%) were the most frequently reported symptoms. A history of physician-diagnosed asthma was reported by 14.3% while 33.9% had symptoms of bronchial hyperresponsiveness (BHR). In conclusion, this vulnerable population has high prevalence of physician-diagnosis asthma and BHR symptoms and is potentially exposed to myriad occupational hazards. Further research exploring associations between products use, cleaning tasks and respiratory symptoms is warranted.     

Barriers to improving endodontic care: the views of NHS practitioners.

AIMS: Concerns have been expressed about the technical quality of NHS endodontic treatment. Bringing performance into line with guidelines for good practice needs to be underpinned by an understanding of barriers to compliance. To this end, our research involved an exploratory investigation of the factors influencing the behaviour of general dental practitioners in their practice of endodontics. MATERIALS AND METHODS: Subjects 12 dental practitioners, representative of varying levels of professional experience and status, and of compliance with good practice guidelines. Data collection In-depth interviews, following a topic guide. Analysis Identification, abstraction and charting of major themes. FINDINGS: Informants' responses suggested that general dental practitioners' endodontic practice is influenced by a complex web of factors. A key barrier to high quality treatment is the NHS remuneration scheme. Undergraduate and postgraduate education and training are also highly influential on practice. Dentists reported employing a range of strategies to manage the time-cost tensions imposed by the remuneration system. Perceived deficiencies in the content and delivery of postgraduate training were highlighted by our informants. CONCLUSIONS: There was a perception among our informants that the NHS fee structure needs to be revised. Their views suggest that a system which rewards quality rather than volume may be more appropriate, but, we believe, such a system would need to take into account efficiency as well as effectiveness. Modification of the current system of postgraduate training in endodontics is also indicated by the views expressed in the interviews. From the diversity of views and from a critical review of the literature, we conclude that flexibility is the key note in changing practice, with no single strategy likely to be universally appropriate.     

Serum contamination affects the surface hardness of Portland-type cements

Aim  To compare the surface hardness of cured mineral trioxide aggregates (MTAs), Portland cements (PC) and a dental gypsum product (die stone) after mixing with the recommended solution alone or incorporating serum.
Methodology  Samples ( n  = 3) of white MTAs (ProRoot and Angelus), white PCs (Lafarge) and dental die stone (BPB) were mixed to standard consistency with recommended solution or 50 : 50 (v/v) recommended solution : defibrinated horse serum, packed into 15 mm × 2mm Perspex moulds and stored at 37 °C/100% humidity. Vickers hardness (3/specimen: 200 g at 0.05 mm mm^-1) was determined at 1 or 4 h (depending on setting time), 1, 2, 3, 7, 14, 28 and 56 days. Differences in surface hardness between materials and mixing solutions and changes over time were compared with anova and paired sample t -tests ( P  < 0.05).
Results  Die stone attained full hardness within 1 day and remained constant thereafter. White PC and MTAs became significantly harder with time. Serum contamination greatly reduced the 1-day hardness of white PC and ProRoot MTA, significantly increased the 56-day hardness of PC and all MTAs.
Conclusions  The Vickers hardness of white PC and MTAs increased for extended periods after initial hardening. Portland-type cements appeared to cure in a dissimilar manner to a gypsum-based dental stone. The hardness of white PC was greater than that of white MTAs at all times after initial hardening. Significant serum contamination may retard the early hardening of some Portland-type cements, but uniformly produced a significantly harder material at 56 days. The mechanisms of this action are incompletely understood. Clinically, assessing the set of MTAs at 24 h may not be warranted.