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    Health inequalities in the geographic distribution of dental practitioners in Costa Rica: an ecological study
    (Community Dentistry and Oral Epidemiology, Early view, 2023) Barboza Solís, Cristina; Barahona Cubillo, Juan; Fantin, Romain Clement
    Results: Mean national LPA was 6.5 full-time equivalents per 10 000 inhabitants, 3.4% of the Costa Rican population had no access to dentist; 12.9% had very low accessibil- ity, 22.7% had low accessibility, 35.0% had good accessibility, 16.2% had high accessi- bility, and 9.8% had very high accessibility. Overall, 39% of the population has a rather low accessibility. LPA was higher in urban districts compared to rural districts and in wealthiest districts compared to most disadvantaged districts. Within districts, after adjustment for district's characteristics, LPA was higher in urban MGU compared to rural MGU and in wealthiest MGU compared to most disadvantaged MGU. Conclusions: This study found that despite having a high number of dentists, their numbers are small in many areas, increasing inequalities in access to health care. The dentist's free establishment, where they can decide to provide private services within a community, creates zones with very high densities, in particular in the wealthiest urban areas, and others with very low densities, in particular the poorest rural areas. The lack of territorial planning has been one of the reasons that has encouraged an imbalance in the availability of dental human resources. To achieve effective universal
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    Derivation, internal validation, and recalibration of a cardiovascular risk score for Latin America and the Caribbean (Globorisk-LAC): A pooled analysis of cohort studies
    (The Lancet Regional Health - Americas, 9, 2022) Stern, Dalia; Hambleton, Ian R.; Lotufo, Paulo Andrade; Di Cesare, Mariachiara; Hennis, Anselm; Ferreccio, Catterina; Irazola, Vilma; Perel, Pablo; Gregg, Edward W.; Aguilar Salinas, Carlos Alberto; Álvarez Vaz, Ramón; Amadio, Marselle Bevilacqua; Baccino, Cecilia; Bambs S., Claudia; Bastos, João Luiz Dornelles; Beckles, Gloria; Bernabé Ortiz, Antonio; Bernardo, Carla; Bloch, Katia Vergetti; Blümel, Juan Enrique; Boggia, José G.; Borges, Pollyana Kássia de Oliveira; Bravo, Miguel; Brenes Camacho, Gilbert; Carbajal, Horacio A.; Casas Vásquez, Paola; Castillo Rascón, María Susana; Ceballos, Blanca H.; Colpani, Verônica; Cooper, Jackie A.; Cortés, Sandra; Cortés Valencia, Adrián; de Sá Cunha, Roberto; d'Orsi, Eleonora; Dow, William H.; Espeche, Walter G.; Fuchs, Flavio Danni; Pereira Costa Fuchs, Sandra Cristina; Godoy Agostinho Gimeno, Suely; Gómez Velasco, Donaji Verónica; González Chica, David Alejandro; González Villalpando, Clicerio; González Villalpando, María Elena; Grazioli, Gonzalo; Guerra, Ricardo Oliveira; Gutierrez, Laura E.; Herkenhoff Vieira, Fernando Luiz; Horimoto, Andrea Roseli Vancan Russo; Huidobro Muñoz, Laura Andrea; Koch, Elard S.; Lajous Loaeza, Martin; Furtado de Lima e Costa, Maria Fernanda; López Ridaura, Ruy; Campos Cavalcanti Maciel, Álvaro; Maestre, Gladys Elena; Manrique Espinoza, Betty Soledad; Marques, Larissa Pruner; Melgarejo Arias, Jesus David; Mena Camaré, Luis Javier; Mill, Jose Gerardo; Moreira, Leila Beltrami; Muñoz Velandia, Oscar Mauricio; Ono, Lariane Mortean; Oppermann, Karen; Ortiz Saavedra, Pedro José; de Paiva, Karina Mary; Viana Peixoto, Sérgio William; da Costa Pereira, Alexandre; Peres, Karen G.; de Anselmo Peres, Marco Aurelio; Ramírez Palacios, Paula; Rech, Cassiano Ricardo; Rivera Paredez, Berenice; Rodríguez Guerrero, Nohora Inés; Rojas Martínez, Maria Rosalba; Rosero Bixby, Luis; Rubinstein, Adolfo; Ruiz Morales, Álvaro de Jesus; Salazar, Martin R.; Salinas Rodríguez, Aarón; Nájera Salmerón, Jorge Alberto; Sánchez, Ramón Augusto; de Souza e Silva, Nelson Albuquerque; Nogueira da Silva, Thiago Luiz; Smeeth, Liam; Spritzer, Poli Mara; Tartaglione, Fiorella; Tartaglione, Jorge; Tello Rodríguez, Tania; Velázquez Cruz, Rafael; Cohorts Consortium of Latin America and the Caribbean (CC-LAC); Carrillo Larco, Rodrigo Martín; Miranda Montero, Juan J.; Ezzati, Majid; Danaei, Goodarz
    Background: Risk stratification is a cornerstone of cardiovascular disease (CVD) prevention and a main strategy proposed to achieve global goals of reducing premature CVD deaths. There are no cardiovascular risk scores based on data from Latin America and the Caribbean (LAC) and it is unknown how well risk scores based on European and North American cohorts represent true risk among LAC populations. Methods: We developed a CVD (including coronary heart disease and stroke) risk score for fatal/non-fatal events using pooled data from 9 prospective cohorts with 21,378 participants and 1,202 events. We developed laboratory based (systolic blood pressure, total cholesterol, diabetes, and smoking), and office-based (body mass index replaced total cholesterol and diabetes) models. We used Cox proportional hazards and held back a subset of participants to internally validate our models by estimating Harrell’s C-statistic and calibration slopes. Findings: The C-statistic for the laboratory-based model was 72% (70−74%), the calibration slope was 0.994 (0.934−1.055) among men and 0.852 (0.761−0.942) among women; for the office-based model the C-statistic was 71% (69−72%) and the calibration slope was 1.028 (0.980−1.076) among men and 0.811 (0.663−0.958) among women. In the pooled sample, using a 20% risk threshold, the laboratory-based model had sensitivity of 21.9% and specificity of 94.2%. Lowering the threshold to 10% increased sensitivity to 52.3% and reduced specificity to 78.7%. Interpretation: The cardiovascular risk score herein developed had adequate discrimination and calibration. The Globorisk-LAC would be more appropriate for LAC than the current global or regional risk scores. This work provides a tool to strengthen risk-based cardiovascular prevention in LAC.

SIBDI, UCR - San José, Costa Rica.

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