This study is aimed at determining whether a commercially available varnish, containing 40% chlorhexidine, is able to reduce the numbers of mutans streptococci and lactobacilli in saliva, in a moderately caries-active population in Surinam. 238 children, ages 13–14 years, were selected from different schools in Paramaribo, Surinam. From these children, total dental status was recorded and saliva samples were taken. At baseline and every 6 months, a 40% chlorhexidine varnish (EC40®) was applied. The control group received a neutral gel that did not contain chlorhexidine. The numbers of salivary mutans streptococci and lactobacilli were calculated by standard methods, and the caries status was recorded every 12 months. The study lasted 30 months. The results indicate that chlorhexidine varnish did not decrease the numbers of cariogenic bacteria, nor did it decrease caries progression. Moreover, in this population with a low dental health care, children with lactobacilli present in the saliva above our detection level, the chlorhexidine varnish even tended to increase caries progression, possibly due to selection of aciduric and acidogenic oral bacterial species. We therefore conclude that 40% chlorhexidine varnish is not likely to decrease caries in children in a high-treatment-need population without treatment of the sources of infection.
ObjectivesTo evaluate the cost-effectiveness of the ST-segment elevation myocardial infarction (STEMI) network of Catalonia (Codi Infart).DesignCost-utility analysis.SettingThe analysis was from the Catalonian Autonomous Community in Spain, with a population of about 7.5 million people.ParticipantsPatients with STEMI treated within the autonomous community of Catalonia (Spain) included in the IAM CAT II-IV and Codi Infart registries.Outcome measuresCosts included hospitalisation, procedures and additional personnel and were obtained according to the reperfusion strategy. Clinical outcomes were defined as 30-day avoided mortality and quality-adjusted life-years (QALYs), before (N=356) and after network implementation (N=2140).ResultsA substitution effect and a technology effect were observed; aggregate costs increased by 2.6%. The substitution effect resulted from increased use of primary coronary angioplasty, a relatively expensive procedure and a decrease in fibrinolysis. Primary coronary angioplasty increased from 31% to 89% with the network, and fibrinolysis decreased from 37% to 3%. Rescue coronary angioplasty declined from 11% to 4%, and no reperfusion from 21% to 4%. The technological effect was related to improvements in the percutaneous coronary intervention procedure that increased efficiency, reducing the average length of the hospital stay. Mean costs per patient decreased from €8306 to €7874 for patients with primary coronary angioplasty. Clinical outcomes in patients treated with primary coronary angioplasty did not change significantly, although 30-day mortality decreased from 7.5% to 5.6%. The incremental cost-effectiveness ratio resulted in an extra cost of €4355 per life saved (30-day mortality) and €495 per QALY. Below a cost threshold of €30 000, results were sensitive to variations in costs and outcomes.ConclusionsThe Catalan STEMI network (Codi Infart) is cost-efficient. Further studies are needed in geopolitical different scenarios.
This study aims to investigate the social importance of sport in L’Hospitalet de Llobregat. As an instrument for social cohesion and integration, sport has become a very important part of municipal activity. We use two surveys: the Baròmetre, which gathers opinion about municipal services; and satisfaction surveys completed by the users of sports facilities. The sports offer (6.5) receives a better rating than overall municipal management (5.9), and counts for 20.4% of the global assessment of the municipal management. Satisfaction with facilities is 7.3 out of 10, while price receives the lowest mark. Detailed analysis of satisfaction surveys conducted among the population can help the municipal management of sports facilities. Policies that focus only on prices are unlikely to be as effective at improving members’ perception of sports facilities as those that also take other aspects into account.
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