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OBJECTIVE: This study determines the magnitude and pattern of animal-related injury mortalities and morbidities in rural Bangladesh. DESIGN AND SETTING: A cross-sectional survey was conducted in 51 Unions of 7 subdistricts of Bangladesh from June 2013 to September 2013. PARTICIPANTS: A total of approximately 1.17 million individuals across all age and gender profiles were included in the survey. The participants had to be residents of the seven subdistricts and have provided consent to participate in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: Animal-related injury characteristics and demographic information was collected in the study. Frequency, proportion and 95% CIs of variables such as type of animal, type of animal attack, activity of the person prior to attack and the seasonality of the injury were reported. Data was then statistically analysed for associations between injury and sociodemographic characteristics. RESULTS: The incidence rate of fatal and non-fatal animal-related injuries across all ages were 0.7 (95% CI 0.4 to 1.4) and 1635.3 (95% CI 1612.0 to 1658.0) per 100 000 populations, respectively. Non-fatal animal-related injury rates were highest among adults 18 years and older (1820.6 per 100 000 population (1777.2 to 1865.1)), and in males across all age groups. The most common animal injury was wasp/hornet/bee sting (49%), followed by cow/buffalo (25%), dog bite (9%) and snake bites (9%). CONCLUSIONS: Animal-related injuries are an important public health issue in rural Bangladesh. The incidence of animal-related morbidities was found high in the study area. Males, school-going and productive age groups were at high risk. Immediate attention should be given to prevent these events.

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Background: There is an increasing recognition that community resilience plays a significant role in addressing health shocks like the Ebola virus disease (EVD) epidemic. However, the factors that constitute community resilience, and how these operate dynamically with other health system factors are less understood. Objective: This paper seeks to understand key factors that constitute community resilience and their role in responding to the EVD outbreak in Liberia. Methods: Key informant interviews were conducted between November 2017 and April 2018 with community representatives in Bomi, Margibi and Montserrado counties, and other national stakeholders involved in the EVD response in Liberia from 2014 to 2016. A national stakeholder meeting was conducted to verify and interpret information emerging from the interviews. Results: Factors that were critical for addressing the EVD epidemic in Liberia were identified as: strong leadership, tight bonds and sense of kinship at the community level; trusted communication channels; and trust among various health system stakeholders. These factors facilitated collective actions within communities and helped to direct response initiatives from other levels of the health system to the community. Foreign assistance was seen as crucial for recovery and revitalization of affected communities. However, such aid is often not targeted at addressing critical challenges in a sustainable way, especially when the assistance is highly restricted to specific activities, and those activities are determined without consultation with local actors and community groups. Conclusion: Efforts to systematically build responsible leadership and social capital at community level, including those that strengthen bonds in communities and trust across key actors in the health system, are needed to address health shocks like EVD outbreaks. Without building such capabilities in community resilience, it will be difficult to reap the expected gains from investments focusing on building physical capital and technical capabilities in health services and emergency preparedness.

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System dynamics methods were used to explore effective implementation pathways for improving health systems performance through pay-for-performance (P4P) schemes. A causal loop diagram was developed to delineate primary causal relationships for service delivery within primary health facilities. A quantitative stock-and-flow model was developed next. The stock-and-flow model was then used to simulate the impact of various P4P implementation scenarios on quality and volume of services. Data from the Afghanistan national facility survey in 2012 was used to calibrate the model. The models show that P4P bonuses could increase health workers' motivation leading to higher levels of quality and volume of services. Gaming could reduce or even reverse this desired effect, leading to levels of quality and volume of services that are below baseline levels. Implementation issues, such as delays in the disbursement of P4P bonuses and low levels of P4P bonuses, also reduce the desired effect of P4P on quality and volume, but they do not cause the outputs to fall below baseline levels. Optimal effect of P4P on quality and volume of services is obtained when P4P bonuses are distributed per the health workers' contributions to the services that triggered the payments. Other distribution algorithms such as equal allocation or allocations proportionate to salaries resulted in quality and volume levels that were substantially lower, sometimes below baseline. The system dynamics models served to inform, with quantitative results, the theory of change underlying P4P intervention. Specific implementation strategies, such as prompt disbursement of adequate levels of performance bonus distributed per health workers' contribution to service, increase the likelihood of P4P success. Poorly designed P4P schemes, such as those without an optimal algorithm for distributing performance bonuses and adequate safeguards for gaming, can have a negative overall impact on health service delivery systems.

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OBJECTIVES: To compare the morphological changes and quantitative distribution of lamellar bodies (Lb) (membrane coating granules) in the hamster cheek pouch epithelium with smokeless tobacco (ST). MATERIALS AND METHODS: Archives of experimental material from previously published studies [S. Ashrafi, A. Das, R. Worawongvasu, B. Mehdinejad and J. Waterhouse (1992) Scanning Microscopy6: 183] were utilized. Animals in experimental group received most ST (snuff) in their right pouch, 5 days weekly, for 24 months, while no snuff was given to control group. After 24 months, the epithelial tissues were processed for electron microscopic study. Volume densities of Lb were assessed by morphometry. MAIN OUTCOME MEASURES: Densities of Lb in the two groups, experimental vs control. RESULTS: In the control, Lb extruded their contents into the intercellular spaces of upper granular layers and in between the last granular cell layers and keratin layers to form a permeability barrier. Conversely, in the smokeless tobacco-treated epithelium, the majority of the Lb that were formed remained inside and accumulated within the granular cells, without extruding their contents into the intercellular spaces to form a lipid compound permeability barrier. CONCLUSIONS: Commercial alkaline ST may have contributed to the abnormal accumulation of Lb in the granular cell layer and affected the extrusion process of Lb to form an incomplete permeability barrier in the oral epithelium.

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OBJECTIVES: To compare the morphological changes and quantitative distribution of mitochondria in the hamster cheek pouch (HCP) epithelium treated with smokeless tobacco (ST). MATERIALS AND METHODS: Archives of experimental material from previously published studies (Ashrafi et al., 1992) were utilized. Animals in experimental group received moist ST (snuff) in their right pouch, 5 days weekly for 24 months, while no snuff was given to control group. After 24 months, the epithelial tissues were processed for electron microscopy study. Volume densities of mitochondria were assessed by morphometry. MAIN OUTCOME MEASURES: Mitochondrial volume densities in the two groups, experimental vs control. RESULTS: In both control and experimental groups mitochondria were concentrated between the nucleus and basal cell plasma membrane. A decrease in the mean mitochondrial volume density (Vvmit) was observed from the basal layer to the more superficial layers in both groups. The experimental HCP displayed more mitochondria than control, and the granular epithelial cell layer in experimental group showed significantly a higher mean Vvmit than the control group (P = 0.03). It was concluded that greater numbers of mitochondria were retained in ST-treated granular cells of the hyperplastic epithelia than in the normal epithelium.

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OBJECTIVES: The purpose of this study was to assess dentists' opinions about oral cancer (OC) prevention and early detection. METHODS: Data were collected by a self-administered mail questionnaire sent to all 398 registered dentists practising along the Texas-Mexico border. RESULTS: The effective response rate to the survey was 40%. While 90% of respondents agreed that oral cancer examinations (OCE) should be provided annually for patients 40 years of age and older, only 59% of respondents believed their OC knowledge was current. While 99% agreed that dentists were qualified to perform OCE, only 54 and 68% respectively, agreed that dental hygienists and physicians were similarly qualified. Dentists who rated their undergraduate OC training favorably (OR = 2.68, 1.23-5.81, P = 0.011), had attended their last oral cancer continuing education (OCCE) course within the past 5 years (OR = 2.46, 1.25-4.86, P = 0.009), and those who performed OCE on all patients 40 years and older (OR = 2.64, 1.32-5.26, P = 0.005), were more likely to agree their OC knowledge was current. CONCLUSIONS: Respondents expressed diverse opinions about OC prevention and early detection. Positive opinion on currency of OC knowledge was associated with performance of OCE. Results indicate a need for OCCE targeting the study population as well as increased emphasis on OC curriculum in dental schools.

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Trauma to the teeth is a common reason for emergency room visits among children, with the maxillary anterior teeth being mostly affected. The consequences of dental trauma include disfigurement, speech defects and psychological effects. This is a cross-sectional study comprising 1039 students, with 47% being males and 53% females. Teeth were examined for physical evidence of trauma. The prevalence of incisal fracture was 2.4% with no significant gender difference (2.9% and 2.0% among males and females, respectively). The male to female prevalence ratio was 1.45 to 1.0. The maxillary incisors accounted for 96% of fractured teeth. Among children with traumatized incisors, 86% had one tooth affected, while 14% had two traumatized teeth. The prevalence of incisal trauma was significantly higher among children of low socioeconomic status (chi2=5.86, P=0.02, df=1). Though African American and Hispanic children had higher prevalence than White children, the differences were not statistically significant. The study reports a low prevalence of incisal trauma among Harris County children and a socioeconomic difference. This study recommends further investigation of incisal trauma in this region as well as educational programs to prevent dental trauma.

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OBJECTIVE: To determine the prevalence and severity of dental caries among school children of St. Vincent and The Grenadines. Also, to establish baseline data on dental caries and determine the extent to which the present oral health care system is meeting dental needs. BASIC RESEARCH DESIGN: National cross-sectional survey utilising the World Health Organization's pathfinder methods. Dental examinations were conducted from October to November 1991 by three trained examiners. PARTICIPANTS: A total of 1648 students, 21% of school children in St. Vincent and The Grenadines, were sampled through multistage systematic sampling. OUTCOME MEASURES: Dental caries was diagnosed clinically according to the World Health Organization's diagnostic criteria. RESULTS: Caries prevalence in the permanent dentition was 69.4%, ranging from 68 to 73% according to gender and geographic location. In the primary dentition caries prevalence was 76.6%. Mean DMFT for the survey population was 2.69, dmft was 3.25, while the DMFT scores for gender and location types varied from 2.39 to 3.25. DMFT at 12 years was 3.25. No difference in caries prevalence was observed between gender in the permanent dentition but prevalence was significantly different in the primary dentition being higher among boys. Prevalence was significantly higher in the urban population relative to the rural population. The decayed component constituted 92% of DMFT and 91% of dmft. CONCLUSION: Moderate caries severity and high levels of untreated decay were found in both primary and permanent teeth. The results emphasise the need for continuous surveillance and for appropriate intervention and prevention programmes.

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A national oral health survey of school children was conducted in October through November 1991. The objective was to determine the periodontal status of school children in St. Vincent and The Grenadines (SVG), the pattern and severity of periodontal disease, estimate treatment needs and provide information for health planners. The study had a cross-sectional design, and 1646 schoolchildren representing all school districts were selected via multistage, systematic sampling. Examinations were conducted by three examiners using CPITN probe. Periodontal indicators and treatment needs were determined using the CPITN index. Calculus was the most prevalent condition with values ranging from 26 to 83 percent, bleeding was the least prevalent condition, while children with healthy indicator were intermediate in prevalence. Subjects with healthy indicators ranged from a low of 12 percent among 15-19 year olds, to a high of 51 percent among seven-year-olds. The mean number of healthy sextants varied from three to five, and mean number of sextants with bleeding or calculus varied from one to three. Oral hygiene instruction (OHI) was the most common treatment need, ranging from 49 to 88 percent. The need for prophylaxis was associated with increase in age, with the highest prophylaxis treatment needs of 83 percent, among 15-19 year olds. No significant differences were observed in periodontal status between gender, and also between urban and rural children. A high prevalence of calculus and bleeding was observed among SVG school children. Study recommends initiation of primary prevention programs in form of health promotion and health education.

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