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Background. The study was planned to assess the prevalence of dental caries among tribal, suburban and urban children of Tiruchengode and Erode of Tamil Nadu state, India. The objective of the study was to assess the association of dental caries with family background, dental service availability, transportation and knowledge on preventive dental measures among these three groups. Design and methods. Cross-sectional study. A total of 1028 school children in the age range of 9-12 years from various government schools located in Palamalai and Kolli Hills (tribal), Tiruchengode (suburban) and Erode (urban), Tamil Nadu, were included in the study. Decayed, filled, and missing teeth (DMFT), decayed and filled teeth (dft) and Significant Caries Index were recorded. A specially prepared questionnaire was used to record all the data regarding oral hygiene practices, socioeconomic background, dental treatment availability, parent's education level were used for the study. ANOVA t-test and post hoc test were used for comparing quantitative variables between the 3 subgroups. Results. The tribal school children had 89.3% caries prevalence, where as it was 77% in suburban and 55% in urban school children. The mean DMFT score among tribal, suburban and urban school children were statistically significant different (P=0.001) between the three groups. There was a highly significant difference (P=0.001) in the mean DMFT score based on brushing frequency. There was a statistically significant difference (P=0.018) in the mean DMFT scores in the urban group based on the mothers education status. There were no statistically significant differences in the mean DMFT scores based on the presence or absence of television in their house and the parents' income. Conclusions. Oral hygiene practices, dietary habits and access to dental care services played an important role in prevalence of dental caries. It was observed that the socioeconomic status, parents' educational status and mass media influenced the oral health of these children but without a significant contribution.

In many countries around the world sex work is criminalised and its regulatory control is therefore often in the hands of the police. In addition to the impact of this criminalised legal environment, much literature describes the negative impact that certain police practices can have on the ability of sex workers and the programs that work with sex workers to access essential HIV prevention, treatment, care and support services. This situation has resulted in persistent concentrated HIV epidemics among sex workers in many countries of the world. The need for multi-sector partnerships between police and HIV programs is increasingly recognised in various UN declarations and resolutions yet descriptions of the process or key ingredients required to actually establish and sustain these necessary partnerships between police and sex workers [or the programs that provide essential services to sex workers] are sparse. The paper seeks to establish key considerations and critical processes that are required to foster partnerships that if further investigated and scaled up, could result in an enhanced enabling environment for the provision of essential HIV services for sex workers around the globe. This paper is based on a realist review that investigated isolated examples of partnership formation between law enforcement and HIV programs working with sex workers. This methodology research is designed to work with complex social interventions and is based on the emerging 'realist' approach to evaluation. A realist review methodology was chosen given the paucity of relevant literature in this vein and the authors' familiarity with the grey literature and relationships with experts who work in this sphere. The review found that political and police leadership, civil society strengthening and police reform in relation to HIV, are critical factors and key ingredients in changing the enabling environment in which sex work takes place to ensure that HIV prevention, individual and public health as well as HIV prevention and the ...

Murtala Muhammad Umar,1 Nasiru Muhammad,2 Mahmoud B Alhassan3 1Zamfara State Eye Care Programme, King Fahad IBN Abdul-Azeez Women and Children Hospital, Zamfara State, Nigeria; 2Ophthalmology Unit, Surgery Department, College of Health Sciences Usmanu Danfodiyo University, Sokoto, Nigeria; 3Department of Vitreoretina, National Eye Centre, Kaduna, Nigeria Purpose: To determine the prevalence of presbyopia, and near vision spectacle coverage in a rural population of Northwestern Nigeria. Study design: Cross sectional prevalence study. Subjects and methods: Six hundred and fifty people of at least 40 years of age, in 13 clusters (50 per cluster) were examined using a multi-stage random sampling with probability proportional to size. The survey was conducted from April 7 to 28, 2012 at Bungudu Local Government Area of Zamfara State, Nigeria. Presbyopia was defined as the inability to read N8 at 40 cm. Presbyopic Spectacle Correction Coverage (PSCC) was calculated, and information on barriers to using near vision spectacles identified. Results: The crude prevalence of presbyopia was 30.4%, 95% CI: (26.8%–34.1%). The prevalence was significantly higher in females (P=0.0005) and individuals with at least secondary education (P=0.022). The age specific prevalence of presbyopia was three times (63.5%) more among those aged 70 years and above, as compared to those within 40–49 years age group (19.3%). The met need was 0.2%, the unmet need 30.2%, and a PSCC of 0.7%. The major barriers reported as reasons for not obtaining near vision spectacles were unawareness and lack of felt need. Conclusion: The prevalence of presbyopia in Bungudu is relatively low compared to other reports with major risk factors being increasing age, female sex and attainment of higher education. The presbyopic spectacles correction coverage is very low with high unmet need thus there is a need to create awareness, and provide affordable and accessible optical services in the affected population. Keywords: presbyopia, spectacle coverage, Nigeria

International audience ; BACKGROUND:The provision of informed consent is a prerequisite for inclusion of a patient in a clinical research project. In some countries, the legislation on clinical research authorizes a third person to provide informed consent if the patient is unable to do so directly (i.e. surrogate consent). This is the case during acute stroke, when the symptoms may prevent the patient from providing informed consent and thus require a third party to be approached. Identification of factors associated with the medical team's decision to resort to surrogate consent may (i) help the care team during the inclusion process and (ii) enable the patient's family circle to be better informed (and thus feel less guilty) about providing surrogate consent.METHODS:Patients included in the BIOSTROKE cohort (initially dedicated to the analysis of factors influencing stroke severity) were divided into two groups: those having provided informed consent directly and those for whom a third party (such as a family member) had provided surrogate consent. We compared the groups in terms of the initial clinical characteristics (age, gender, type of stroke, severity on the National Institutes of Health Stroke Scale (NIHSS), pre-stroke cognitive status according to the Informant Questionnaire on Cognitive Decline in the Elderly, and the stroke's aetiology) and the functional and cognitive impairments (according to the NIHSS, the modified Rankin score (mRS) and the Mini Mental State Examination) on post-stroke days 8 and 90.RESULTS:Three hundred and ninety five patients were included (mean ± SD age: 67 ± 15 years; 53% males). Surrogate consent had been obtained in 228 cases, and 167 patients had provided consent themselves. The patients included with surrogate consent were likely to be older and more aphasic, with a pre-existing cognitive disorder and more severe stroke (relative to the patients having provided consent). In terms of recovery, the patients included with surrogate consent had a worse functional prognosis ...

Each day there are more children being born and raised in low-income, single-parent homes, a condition being associated to a greater bonding vulnerability between mothers and young children, and to a negative effect on children's mental health. This background information promoted a series of transversal and comparative studies on low-income, mother-child dyads. The global investigation includes two previous studies and two main studies, the first ones evaluating maternal stress and interaction quality, in single-parent and nuclear families. The results show a greater stress level and lower interactional quality in single-parent families. The two main studies evaluated mother-child dyads of single-parent families. The first one considered Chilean families with children attending and not attending public day nurseries, and the second one, Chilean and German families. Both of them evaluated infant psychomotor development, stress levels, maternal depressive symptomatology and mother-child interaction quality with the CARE-Index instrument. In the intercultural study were also evaluated interdependence and independence in the construction of self, ideology of sexual roles and tightness or looseness of social and family norms. The results of the first study show a positive effect by attending public day nurseries on infant psychomotor development, but a negative effect on mother-infant bonding quality. The negative effect on bonding quality increases when attendance to a day nursery starts before the child is 6 months old, just like the positive effect diminishes on infant psychomotor development, with the early start. The results of the second study show interactions of higher quality in Chilean dyads, and greater psychomotor development in German children, and higher scores on interdependence and tightness of family norms in Chilean mothers. There is an opportunity for reflection on the support strategies for early infancy in Chile, on vulnerable families, and the parenting models considering cultural contexts to interpret the results.

IntroductionMen who have sex with men (MSM) are at increased risk of HIV and other STI infections in Nigeria. This is because MSM are afraid to seek medical help because the healthcare workers in various facilities are afraid of the consequences if they provide services for MSM citing the law as a reason not to intervene. MSM in northern states of Nigeria are facing double‐jeopardy because the few international partners working in MSM in Nigeria are pulling out of these volatile areas because of the fear of attacks by the Boko Haram and the Nigerian law enforcement agencies.ObjectivesThe intervention was conducted to promote affordable and sustainable HIV care and treatment for MSM in Nigeria.MethodsThis intervention was conducted in the Boko Haram ravaged cities of Kano and Maiduguri (North‐East Nigeria). Twenty MSM‐key influencers from the two cities were identified and trained on HIV counselling and testing, caregivers, case managers and on initiation process for ARV treatment for new HIV+MSM as well as ethical considerations.ResultsThe mean age of the key influencers was 24 years +/−SD. Each of the trained 20 key influencers reached 20 MSM‐peer with condom promotion, HCT, referral to identified MSM‐community health centers and follow‐up/caregiving within the space of one month. The project was able to reach 400 MSM in the two cities. 89% of the peers consented to HCT. HIV prevalence among the participants was at 18%. The project recorded ARV‐successful referral to healthcare facilities for the respondents that tested positive. The key influencers have been following up for ARV‐adherence.ConclusionsUse of community members should be promoted for sustainability and ownership. It also helps in eradicating socio‐cultural barrier to HIV intervention for MSM. Moreover, this proves to be one of the safest and affordable methods of reaching MSM in Nigeria in this ugly time of legalization of homophobia in the country's constitution.

Repair, Maintenance, Alteration and Addition (RMAA) works are playing an increasingly important role in developing countries. The accidents and fatalities records of RMAA sector in Gaza Strip have been alarmingly high; however, research in the RMAA sector remains limited. Safety of RMAA works has long been neglected because the project sizes of RMAA are small and only last for a short period of time, which make the working environment of RMAA works more difficult to control than new building works. The aim of this paper is to identify, valuate and rank the most important factors that affect safety performance and the most important causes of fatal accidents in RMAA projects. A questionnaire survey was used in this study. The results revealed that poor safety awareness of managers in maintenance firms and lack of training of RMAA workers for handling multi-tasks were the most important factors that affecting safety performance of RMAA works. The results showed that ineffectiveness of lack of training and certification of competence; immature corporate systems of firms which does not care with safety and health through RMAA works, and lack of leadership from government as a key client are the most significant causes of construction fatal accidents of RMAA projects. The results also indicated that the macro level factor is the most important category that causes fatal accidents in RMAA works. It is recommended to enhance the awareness of construction firms, project managers and workers regarding the importance of safety performance in repair and maintenance works and strengthen site monitoring and supervision system in construction firms. Safety training courses should be organized for workers and project managers in order to improve their safety culture and competence regarding safety performance through repair and maintenance works. Furthermore the RMAA subcontractors should be selected according to their good records of safety performance.

The Anaphase-promoting complex/cyclosome (APC/C) cofactor Cdh1 modulates cell proliferation by targeting multiple cell-cycle regulators for ubiquitin-dependent degradation. Lack of Cdh1 results in structural and numerical chromosome aberrations, a hallmark of genomic instability. By using a proteomic approach in Cdh1-null cells and mouse tissues, we have identified kinesin Eg5 and topoisomerase 2α as Cdh1 targets involved in the maintenance of genomic stability. These proteins are ubiquitinated and degraded through specific KEN and D boxes in a Cdh1-dependent manner. Whereas Cdh1-null cells display partial resistance to Eg5 inhibitors such as monastrol, lack of Cdh1 results in a dramatic sensitivity to Top2α poisons as a consequence of increased levels of trapped Top2α-DNA complexes. Chemical inhibition of the APC/C in cancer cells results in increased sensitivity to Top2α poisons. This work identifies in vivo targets of the mammalian APC/C-Cdh1 complex and reveals synthetic lethal interactions of relevance in anticancer treatments. ; We thank Angeles Almeida, Thomas U. Mayer, William T. Beck, Anthony A. Hyman, Jan-Michael Peters, Eusebio Manchado, and Scott Lowe for reagents. M. E., A.J.L.-C., and M.A.-F. were supported by the Spanish Ministry of Education, Culture and Sports, the AECC Scientific Foundation, and the EU-PEOPLE programme, respectively. Work in the O.F.-C. laboratory was supported by grants from the Spanish Ministry of Economy and Competitiveness (MINECO; SAF2011-23753), the Association for International Cancer Research (120229), the Howard Hughes Medical Institute, and the European Research Council (ERC-210520). Work in the H.Y. laboratory was funded by grants from Marie Curie Cancer Care and Cancer Research UK. Work in M.M.'s laboratory was funded by grants from the Foundation Ramon Areces, MINECO (SAF2012-38215), the OncoCycle Programme (S2010/BMD-2470) from the Comunidad de Madrid, and the European Union Seventh Framework Programme (MitoSys project; HEALTH-F5-2010-241548). ; Sí

OBJECTIVE: The 2010 healthcare reform in England introduced primary care-led commissioning in the National Health Service (NHS) by establishing clinical commissioning groups (CCGs). A key factor for the success of the reform is the provision of excellent commissioning support services to CCGs. The Government's aim is to create a vibrant market of competing providers of such services (from both for-profit and not-for-profit sectors). Until this market develops, however, commissioning support units (CSUs) have been created from which CCGs are buying commissioning support functions. This study explored the attitudes of CCGs towards outsourcing commissioning support functions during the initial stage of the reform. DESIGN: The research took place between September 2011 and June 2012. We used a case study research design in eight CCGs, conducting in-depth interviews, observation of meetings and analysis of policy documents. SETTING/PARTICIPANTS: We conducted 96 interviews and observed 146 meetings (a total of approximately 439 h). RESULTS: Many CCGs were reluctant to outsource core commissioning support functions (such as contracting) for fear of losing local knowledge and trusted relationships. Others were disappointed by the absence of choice and saw CSUs as monopolies and a recreation of the abolished PCTs. Many expressed doubts about the expectation that outsourcing of commissioning support functions will result in lower administrative costs. CONCLUSIONS: Given the nature of healthcare commissioning, outsourcing vital commissioning support functions may not be the preferred option of CCGs. Considerations of high transaction costs, and the risk of fragmentation of services and loss of trusted relationships involved in short-term contracting, may lead most CCGs to decide to form long-term partnerships with commissioning support suppliers in the future. This option, however, limits competition by creating 'network closure' and calls into question the Government's intention to create a vibrant market of commissioning support provision.

My dissertation examines the "mi-yi" (secret doctors) as a threshold figure within twentieth-century Taiwanese society. The threshold figure is employed in my study to identify the "mi-yi" as a fugitive subject shuttling between secrecy and publicity, absence and presence, as well as legality and illegality. The dissertation pursues genealogies of "mi-yi" by examining the various treatments of the "mi-yi" during different eras of Taiwan modernity: by Japanese colonial medicine, during the Chinese nationalist regime, and by the U.S. Cold War development in Asia. My project focuses on the transnational history of medical knowledge production and practices that came to define the hierarchies of life and labor in the modern juridical and political senses of the terms. I pursue the genealogies of "secret doctors" in Taiwan to explore how the scientific discourse of medical modernity converges with state politics that redefined the legality and illegality of medical knowledge and practices, thereby further subjugating non-normative medical subjects and practices to the margins of society and humanity. Offering a critical examination of the regime of an administrative and bureaucratic legality along with analyses of medical public cultures, literary representations, and anthropological narratives, this research shows how the scientific notion of medical modernization gets codified into the law as the governance of the body, labor, and affect, and how the state cumulatively extends its power over the domain of medical care and public health. In tracing the genealogies of the "mi-yi" figure in Taiwanese society and its transnational politics of knowledge production, I explain how the illegality of medical practices and the hierarchical structure of production and reproduction of labor became central to Taiwan's modernization, a process that transformed perceptions and practices about the globalized medical cultures and politics

During the First World War the French army drafted 1,880,000 horses and mules, and lost 1,140,000 of them. Direct causes are succinctly recalled: contagious, internal and external diseases of war-horses. The use of horses unfit or little fit for war service, insufficient feeding, neglected protection against bad weather, misuse or delayed withdrawals aggravated the equids' health status and jeopardized the action of the 2,794 veterinarians present in the French armies. The veterinary support, headed by remounting service, failed during a large part of the war, and was only improved in 1917, to be finally optimized in November 1918. We suggest that the short war concept, the late implication of the military command in the equids' care, and the technical veterinary hierarchy kept out of the way, are the basic causes of this hecatomb. ; Pendant la première guerre mondiale l'armée française incorpora 1.880.000 chevaux et mulets et en perdit 1.140.000. Les causes immédiates de ces pertes sont succinctement rappelées : pathologie contagieuse, interne et externe du cheval de guerre. La recherche de causes plus profondes conduit à s'interroger sur le respect des règles fondamentales de l'hippologie ou de la bientraitance des animaux ainsi que sur la qualité des soins vétérinaires. Chevaux intrinsèquement inaptes ou peu aptes au service de guerre, alimentation et protection contre les intempéries insuffisantes, abus d'emploi ou évacuations tardives aggravent l'état de santé des animaux et compromettent l'action des 2.794 vétérinaires présents dans les armées françaises. Dirigé par le service des remontes le soutien vétérinaire se révèle défaillant pendant une grande partie de la guerre. Il est amélioré en 1917, pour n'être optimisé qu'en novembre 1918. Le concept de guerre courte, l'intérêt tardif du commandement pour le potentiel équin des armées, et la tenue à l'écart de la hiérarchie technique vétérinaire sont proposés comme causes fondamentales à cette hécatombe.

Disability rights activists have been trailblazers in the public debate about prenatal genetic testing. They provide meaningful critique about whether such testing should be offered and, more importantly, guidance about adequately and appropriately informing decision-makers. This paper illuminates the rhetorical devices that the disability and medical communities use in policy statements to frame the issues surrounding prenatal genetic screening and testing. The qualitative analysis focuses on how these stakeholder groups imitate and engage the abortion conversation in both form and content, particularly in their use of the language of choice. As medical communities begin to create practice guidelines surrounding emerging genetic technologies and their implementation into prenatal care, disability rights organizations have a timely opportunity to re-engage these conversations. Policy statements may help to rally allies and to make Disability Studies and disability rights perspectives active in the public sphere. Keywords: prenatal diagnosis; Down syndrome; health policy; personal autonomy; choice behaviour Les militantes en droits des personnes ayant un handicap ont fait preuves de pionier-ères dans les débats publics à propos des tests génétiques prénataux. Ils ont formé une critique utile quant à savoir si de tels tests devraient être offerts ou non; ce qui est plus important encore, ils ont offert des directives pour informer de manière adéquate et appropriée ceux et celles qui doivent prendre cette décision. Cet article clarifie les procédés de rhétoriques utilisée dans leurs énoncés de politiques, d'une part par les communautés de personnes handicapées, et d'autre part par la communauté médicale, afin de structurer la discussion à propos du dépistage et des tests génétiques prénataux. L'analyse qualitative qui est employée ici permet de concentrer notre attention sur la façon qu'on ces parties prenantes d'imiter et d'interagir avec les débats sur l'avortement, tout ...

Abstract: Tooth extraction is one of the best solution to prevent the occurrence of abnormalities in the oral cavity. Tooth extraction often experience barriers, obstacles commonly occur in efforts dental care due to lack of knowledge of the people against the tooth extraction. The purpose of this study to describe the level of students' knowledge of tooth extraction in SMP Negeri 2 Langowan. This is a descriptive study with a total sample of 198 students taken by Slovin formula. The results showed that the students' knowledge of tooth extraction in SMP Negeri 2 Langowan in say less because of the students who answered correctly from the scoring just get a score of 822, or by 46.1%, while the students who answered incorrectly by 53.9%. It takes the role of the government, schools and parents to improve the students' knowledge of oral health. Keywords: knowledge, tooth extraction. Abstrak: Pencabutan gigi merupakan salah satu solusi terbaik untuk mencegah terjadinya kelainan-kelainan dalam rongga mulut. Pencabutan gigi kadang mengalami hambatan, umumnya hambatan yang terjadi pada upaya pelayanan kesehatan gigi akibat dari kurangnya pengetahuan masyarakat terhadap pencabutan gigi tersebut. Tujuan penelitian ini untuk mengetahui gambaran tingkat pengetahuan siswa tentang pencabutan gigi di SMP Negeri 2 Langowan. Penelitian ini bersifat deskriptif dengan jumlah sampel sebanyak 198 siswa yang diambil dengan rumus slovin. Hasil penelitian menunjukkan bahwa pengetahuan siswa tentang pencabutan gigi di SMP Negeri 2 Langowan di katakan kurang oleh karena siswa yang menjawab dengan benar dari hasil skoring hanya mendapatkan skor 822 atau sebesar 46,1 % sedangkan siswa yang menjawab salah sebesar 53,9%. Persentase pengetahuan siswa tentang indikasi pencabutan gigi sebesar 50%, Persentase pengetahuan siswa tentang kontra indikasi pencabutan gigi sebesar 47,2%. Persentase pengetahuan siswa tentang manfaat pencabutan gigi sebesar 38,9%. Persentase pengetahuan siswa tentang efek samping gigi yang merupakan indikasi tetapi tidak dicabut sebesar 46,6%. Kata kunci: pengetahuan, pencabutan gigi.

In England at both strategic and operational levels, policy-makers in the public sector have undertaken considerable work on implementing the findings of the Every Child Matters report and subsequently through the Children's Act 2004. Legislation has resulted in many local authorities seeking to implement more holistic approaches to the delivery of children's services. At a strategic level this is demonstrated by the creation of integrated directorate structures providing for a range of services, from education to children's social care. Such services were generally under the management of the Director of Children's Services, holding statutory responsibilities for the delivery of services formally divided into the three sectors of education, health and social services. At a national level, more fundamental policy developments have sought to establish a framework through which policy-makers can address the underlying causes of deprivation, vulnerability and inequality. The Child Poverty Act, 2010, which gained Royal Assent in 2010, provides for a clear intention to reduce the number of children in poverty, acknowledging that 'the best way to eradicate child poverty is to address the causes of poverty, rather than only treat the symptoms'. However, whilst the policy objectives of both pieces of legislation hold positive aspirations for children and young people, a change of policy direction through a change of government in May 2010 seems to be in direct contrast to the intended focus of these aims. This paper explores the impact of new government policy on the future direction of children's services both at the national and local levels. At the national level, we question the ability of the government to deliver the aspirations of the Child Poverty Act, 2010, given the broad range of influences and factors that can determine the circumstances in which a child may experience poverty. We argue that poverty is not simply an issue of the pressure of financial deprivation, but that economic recession and cuts in ...

Sepsis is a potentially life-threatening systemic inflammatory response in the presence of infection, most commonly due to bacterial infection. It occurs predominantly among vulnerable patients, such as elderly, immunocompromised or patients with multiple comorbidities. Pulmonary, gastrointestinal, genitourinary, and primary bloodstream infections account for the majority of infectious sources in septic patients. The term "systemic inflammatory response" (SIRS) is used in cases of an evident systemic response in the absence of infection. Severe sepsis is sepsis with dysfunction of a least one organ, and septic shock is defined as severe sepsis with hypotension. With rising hospitalization rates sepsis clearly became a problem and has up to this time been underestimated by the global health community. A sepsis campaign was founded by the non-profit organization Global Sepsis Alliance to increase public and professional awareness of sepsis. A higher incidence is particularly due to more resistant bacteria, demographic shifting and more surgical procedures amongst others. On the 2nd October 2002 in Barcelona, intensive care professionals from around the globe joined to reduce the number of deaths from sepsis. Since then unfortunately the Global Burden of Disease Report (GBDR) and the WHO website still only list "maternal sepsis" and "sepsis in new-borns", despite the effort of the surviving sepsis campaign. This may partly explain why most non-professionals, journalists and politicians do not know the term "sepsis". Successful early diagnosis and treatment remains difficult and is one of the key features of reducing sepsis incidence. In the pathogenesis of sepsis a central mediator does not seem to exist, although TNFα has been commonly proposed for this role. Diagnosing sepsis includes two or more of these conditions: temperature > 38 ° C or 90 beats/min, respiratory rate > 20 breaths/min or PaCO2 12 000 cells/mm3 or < 10% immature ...