Panorama OCDE sobre el rol de la salud oral en las estrategias nacionales y politicas para el manejo y control de diabetes mellitus tipo 2: Una revisión sistemática

RESUMEN: Objetivo: Describir el rol de la Salud Oral en las estrategias nacionales y políticas sanitarias para el manejo integral y control de Diabetes Mellitus Tipo 2 (DM2) en los 38 Estados miembros de la Organización para la Cooperación y Desarrollo Económico (OCDE). Materiales y Método: Se realizó una revisión sistemática exploratoria, siguiendo la pauta PRISMA-ScR. Se incluyeron reportes gubernamentales, guías de práctica clínica, documentos oficiales OMS y OCDE, y artículos identificados en PubMED y LiLACS hasta diciembre de 2020. Se sintetizó: 1) Inclusión de la Salud Oral en planes nacionales o guías clínicas de DM2, 2) Prestaciones y cobertura odontológica para DM2 y 3) Indicadores de salud asociados al control de DM2. Resultados: 84 documentos fueron incluidos. 1) La Salud Oral está incorporada en los planes nacionales de 22 países OCDE para el control de DM2. 2) De estos, 8 garantizan la atención odontológica con alta cobertura para DM2. 3) Países OCDE con alta cobertura odontológica presentan los mejores indicadores de control metabólico de DM2. Conclusiones: En el marco de la Salud Global, países que no tienen integrada la salud oral podrían beneficiarse si incorporan la atención odontológica con cobertura universal en el manejo integral y control de la DM2.

ABSTRACT: Aim: To describe the role of Oral Health in national strategies and health policies for the comprehensive management and control of Type 2 Diabetes Mellitus (T2DM) in the 38 member states of the Organization for Economic Cooperation and Development (OECD). Method: A scoping review was carried out, according to the PRISMA-ScR guideline. Government reports, clinical practice guidelines, official WHO and OECD documents, and review articles identified in PubMED and LiLACS were included up to December 2020. The following were synthesized: 1) Inclusion of Oral Health in national plans or clinical guidelines for DM2, 2) Dental benefits and coverage for DM2 and 3) Health indicators associated with the control of DM2. Results: 84 documents were included. 1) Oral Health is incorporated in the national plans of 22 OECD countries for the control of DM2. 2) Of these, 8 provide dental care with high coverage for DM2. 3) OECD countries with high dental coverage have the best indicators of metabolic control of DM2. Conclusions: In the framework of Global Health, countries that do not have Oral Health integrated could benefit if they add dental care in the comprehensive management and control of DM2.

Revisión sistemática exploratoria de los mecanismos de pago en la atención del parto en países pertenecientes y no pertenecientes a la Organización para la Cooperación y el Desarrollo Económico / A scoping review of the payment mechanisms in childbirth of country members and non-members of the Organisation for Economic Co-operation and Development

INTRODUCCIÓN Los mecanismos de pago corresponden a la operacionalización de la función de compra en salud, incentivando comportamientos en los proveedores de servicios sanitarios. Resulta pertinente preguntarse cómo afectan la vía de resolución del parto, considerando el aumento generalizado en índices de cesárea a nivel global. OBJETIVO: Describir los mecanismos de pago existentes para la atención del parto en países miembros y no miembros de la Organización para la Cooperación y el Desarrollo Económico. MÉTODOS: Revisión sistemática exploratoria (scoping review). Se adoptaron los cinco pasos metodológicos del Joanna Briggs Institute. La búsqueda se realizó por las investigadoras de forma independiente, logrando la confiabilidad interevaluador (κ 0,96) en bases de datos electrónicas, otras fuentes de información, sitios web gubernamentales y no gubernamentales. Se tamizó en tres niveles, considerando literatura no mayor a 10 años de antigüedad, idioma inglés y español. Se analizaron los resultados considerando el funcionamiento del mecanismo de pago y sus efectos en prestado-res, seguros y beneficiarias. RESULTADOS: Se obtuvo evidencia de 34 países (50% pertenecientes a la Organización para la Cooperación y el Desarrollo Económico). El 64% con uso de más de un mecanismo de pago para el parto. Entre los mecanismos más utilizados están: grupos relacionados de diagnósticos (47,6%), pago por resultados (23,3%), pago por servicios (16,6%) y pago fijo prospectivo (13,3%). CONCLUSIÓN: Los países recurren a la arquitectura de los mecanismos de pago para mejorar indicadores en salud materno-perinatales. Es necesario explorar cuál sería la mejor combinación de mecanismos que mejora la provisión de atenciones de salud y bienestar de la población, en el campo de la salud sexual y reproductiva.

INTRODUCTION: Payment mechanisms serve to put into operation the function of purchasing in health. Payment mechanisms impact the decisions that healthcare providers make. Given this, we are interested in knowing how they affect the generalized increase of C-section rates globally. OBJECTIVE: The objective of this review is to describe existing payment mechanisms for childbirth in countries members of the Organization for Economic Co-operation and Development (OECD) and non-members. METHODS: We conducted a scoping review following the five methodological steps of the Joanna Briggs Institute. The search was conducted by researchers independently, achieving inter-reliability among raters (kappa index, 0.96). We searched electronic databases, grey literature, and governmental and non-governmental websites. We screened on three levels and included documents published in the last ten years, in English and Spanish. RESULTS: were analyzed considering the function of the reimbursement mechanism and its effects on providers, payers, and beneficiaries. Results Evidence from 34 countries was obtained (50% OECD members). Sixty-four percent of countries report the use of more than one payment mechanism for childbirth. Diagnosis-Related Groups (47.6%), Pay-for-performance (23.3%), Fee-for-service (16.6%) and Fixed-prospective systems (13.3%) are among the most frequently used mechanisms. CONCLUSION: Countries use payment mechanism architecture to improve maternal-perinatal health indicators. Therefore, it is necessary to explore the best combination of mechanisms that improve the provision of health care and welfare of the population in the field of sexual and reproductive health.

A Comparative Study of Suicide Rates among 10–19-Year-Olds in 29 OECD Countries

OBJECTIVE: This study had two main objectives: to compare current suicide rates in OECD countries among 10–19-year-olds and to identify patterns of suicide rates based on age, gender and time. Furthermore we investigated the main dimensions that contributed to the variation in child and adolescent suicide rates across countries. METHODS: We combined the WHO mortality data and the population data released by OECD to calculate the suicide rates in 29 OECD countries. A self-organizing map (SOM), k-means clustering analysis, and multi-dimensional scaling were used to classify countries based on similarities in suicide rate structure and to identify the important dimensions accounting for differences among groups. RESULTS: We identified significant differences in suicide rates depending on age, sex, country, and time period. Late adolescence and male gender were universal risk factors for suicide, and we observed a general trend of declining suicide rates in OECD countries. The SOM analysis yielded eight types of countries. Most countries showed gender gaps in suicide rates of similar magnitudes; however, there were outliers in which the gender gap was particularly large or small. CONCLUSION: Significant variation exists with respect to suicide rates and their associated gender gaps in OECD countries.

Innovation on classification of healthcare systems / 中国卫生政策研究

This article addresses the issue of the classification of healthcare systems, with the intent to take a step further than the previously analysed models of healthcare organisation. As concerns the financing of healthcare services, the standard tripartite classification ( according to which healthcare systems are divided into three groups:voluntary insurance, social health insurance and universal coverage) is enriched with two additionaltypes: compul-sory national health insurance and residual programs. With respect to the provision of services and the relationship between insurers and providers, it is important to distinguish between vertically integrated and separated systems. What differentiates this analysis from the majority of previous studies is its underlying logic. Assuming that all sys-tems are hybrid,the article proposes to put aside the classic logic for classifying healthcare systems ( according to which individual countries are pigeonholed into different classes depending on the prevailing system) in favour of the identikit logic. The concept of segmentation ( of healthcare services or population) proves to be remarkably use-ful to this purpose.

Emerging power for international health development assistance: A case study of the BRIC countries / 中国卫生政策研究

Brazil, Russia, India, China and South Africa are the five BRIC countries which have showed a rapid growth in economic development in recent years especially in international health assistance area, which has gradually become a force that cannot be ignored. This article compares and analyzes the current status and character-istics of the BRIC countries in the field of international health assistance and compares them with the Countries of the Economic Cooperation and Development Organization's Development Assistance Committee ( ECDO-DAC) . It will also summarize the new features, advantages and disadvantages of the health development assistance exerted by the BRICS countries;and ultimately provide suggestions for the future international health development aid policy of China.

How to make the right policy for the medical workforce

What is the most important area to focus on to improve health in Korea? The overall number of doctors is the only indicator of the health care system that is currently emphasized by the government. Instead, we should focus on the number of public hospital beds, which is very low, and health expenditures, which are below average when normalized for gross domestic product. In most Organization for Economic Cooperation and Development countries, the public sector is the main source of health care financing, with approximately three-quarters of health care spending originating from the public sector. In Korea, social health insurance and the government currently finance approximately 55% of all health expenditures. In contrast, Korea has a top ranking in comparison to other countries with regard to the number of private hospital beds. The ratio of medical doctors, dentists, and Korean traditional doctors in the workforce in primary clinics is approximately 2.5:1.3:1. Therefore, the Korean government should decide whether traditional doctors should be included in the health care delivery system. Most medical doctors in primary clinics are specialists who require a corresponding support system. The training of new doctors is too fast, as the overall number of doctors in Korea is sufficient. The government should develop the best possible plan to help doctors be doctors and show their devotion to the community.

A methodology for definition of rural spaces: an implementation in Brazil / Uma metodologia para definição de espaços rurais: uma implementação no Brasil

ABSTRACT: Rural spaces definitions are differentiated in several countries. The Organization for Economic Co-operation and Development (OECD) has standardized a rural definition by regional typology. The OECD regional typology set areas as Predominantly Urban, Intermediate, or Predominantly Rural. This paper analyses the application of OECD regional typology in Brazilian territory. The research used the OECD methodology, with support of GIS software, to define the rural areas in Brazil. The mostly segmented data from Brazilian Census of 2010 are used in contrast to others studies. The paper concludes that Brazil is more urban than official estimates and OECD reports. According to paper results, 87.48% of Brazilian population is urban and only one Territorial Level 3 region was classified as predominantly rural.

RESUMO: As definições de espaços rurais são diferenciadas em vários países. A Organization for Economic Co-operation and Development (OECD) tem padronizado uma definição de rural através da sua tipologia regional. A tipologia regional da OECD define áreas como Predominantemente Urbanas, Intermediárias ou Predominantemente Rurais. O presente artigo analisa a aplicação da tipologia da OECD no território brasileiro. A pesquisa usou a metodologia proposta pela OECD, com o suporte de software GIS, para definir as áreas rurais presentes no Brasil. Utilizando os dados mais desagregados disponíveis dos Censos Brasileiros de 2010, este artigo se diferencia de outros estudos desse âmbito. As conclusões apontam para um Brasil mais urbano do que as estimativas oficiais e os relatórios da OECD. De acordo com os resultados, 87,48% da população brasileira seria urbana e apenas uma mesorregião seria classificada como Predominantemente Rural.

Endocrine disruption of cadmium in rats using the OECD enhanced TG 407 test system / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To evaluate the endocrine disrupting effects of cadmium (Cd) using OECD enhanced TG407 test guideline.</p><p><b>METHODS</b>Sprague-Dawley (SD) rats were randomly divided into six groups and accordingly administered with 0, 1, 2.5, 5, 10, 20 mg/kg•BW/day of Cd by gavage for 28 days. Body weight, food consumption, hematology, biochemistry, sex hormone levels, urinary β2-microglobulin, organ weights and histopathology and estrous cycle were detected.</p><p><b>RESULTS</b>Cd could significantly decrease animals' body weight (P<0.05). Serum luteinizing hormone (LH) at 10-20 mg/kg•BW groups and testosterone (T) at 2.5 and 10 mg/kg•BW groups decreased significantly (P<0.05). However, no statistically significant change was found in urinary β2-microglobulin among Cd-treatment groups (P>0.05). Endpoints related to female reproduction including uterus weight and histopathological change at 10-20 mg/kg•BW groups showed significant increase (P<0.05). While among male rats in 2.5, 10, 20 mg/kg•BW groups, weight of prostate, thyroids, and seminal vesicle glands significantly decreased (P<0.05). Moreover, no histopathological change was observed in kidney.</p><p><b>CONCLUSION</b>Results suggested that Cd can cause endocrine disrupting effects in SD rats. Comparing with possible renal toxicity of Cd, its toxicity on endocrine system was more sensitive.</p>

Genotoxicity and acute and subchronic toxicity studies of a standardized methanolic extract of Ficus deltoidea leaves

OBJECTIVE: Ficus deltoidea leaves have been used in traditional medicine in Southeast Asia to treat diabetes, inflammation, diarrhea, and infections. The present study was conducted to assess the genotoxicity and acute and subchronic toxicity of a standardized methanol extract of F. deltoidea leaves. METHODS: Sprague Dawley rats were orally treated with five different single doses of the extract and screened for signs of toxicity for two weeks after administration. In the subchronic study, three different doses of the extract were administered for 28 days. Mortality, clinical signs, body weight changes, hematological and biochemical parameters, gross findings, organ weights, and histological parameters were monitored during the study. Genotoxicity was assessed using the Ames test with the TA98 and TA100 Salmonella typhimurium strains. Phytochemical standardization was performed using a colorimeter and high-performance liquid chromatography. Heavy metal detection was performed using an atomic absorption spectrometer. RESULTS: The acute toxicity study showed that the LD50 of the extract was greater than 5000 mg/kg. In the subchronic toxicity study, there were no significant adverse effects on food consumption, body weight, organ weights, mortality, clinical chemistry, hematology, gross pathology, or histopathology. However, a dose-dependent increase in the serum urea level was observed. The Ames test revealed that the extract did not have any potential to induce gene mutations in S. typhimurium, either in the presence or absence of S9 activation. Phytochemical analysis of the extract revealed high contents of phenolics, flavonoids, and tannins. High-performance liquid chromatography analysis revealed high levels of vitexin and isovitexin in the extract, and the levels of heavy metals were below the toxic levels. CONCLUSION: The no-observed adverse effect level ...

Pharmacological screening of Dikamaliartane-A, A cycloartane isolated from gum resin, Dikamali.

The biological activitites of Dikamaliartane-A, a cycloartane isolated from gum resin Dikamali of Gardenia gummifera/Gardenia lucida was screened for some pharmacological actions. The study was carried out using albino mice (20-25gr). It reduced locomotor activity and potentiated pentobarbitone-induced sleeping time in mice indicating Central Nervous System depressant activity. It protected mice from strychnine and electro shock–induced convulsions indicating that it has anti-convulsant activity. All these activities were statistically significant. The LD50 (Lethal Dose) was carried out in mice according to Organization for Environmental Cooperation and Development (OECD) Guidelines 423. The LD50 was tested in three mices for each dose with doses from 5mg/kg, 50mg/kg, 300mg/kg and 2000mg/kg. The LD50 was found to be 500mg/kg.

Vediuppu Chendhuram: Oxide form of salt petre and its in vivo toxicological profile.

Background: Vediuppu Chendhuram (VC) is a traditional Siddha mineral formulation applied to treat Urinary tract dysfunction such as burning micturation and retention of urine. It is synthesized through special oxidation of Vediuppu as narrated in the text Anubhoga Vaithiya Navaneetham. Physicochemical characterization of VC has been carried out using qualitative compound analysis and modern techniques such as Fourier transform infra-red spectroscopy, inductively coupled plasma analysis and scanning electron microscopy. Such study reveals the presence of heavy metals like arsenic, cadmium, mercury and lead are present below the detection limit and the presence of sodium, potassium, sulphur, phosphorus and calcium under acceptable limits. The primary objective of this work is to validate the safety of VC through animal model. Methods: The raw Vediuppu are procured from country drug store at Nagercoil, Tamilnadu and purified by the traditional procedure by soaking in Cow’s urine until it dried. The test drug VC is prepared by the process of Pudam (Oxidation) described in Anuboga Vaithiya Navaneetham 3rd part, pg no. 76-77. The safety profile is evaluated by doing acute oral toxicity and repeated oral toxicity studies under OECD guidelines on Albino wistar rats. Results: Animals were found to be safe upto 300mg/kg body weight in acute oral toxicity study. Repeated toxicity study of VC has revealed that upto 200mg/kg body weight; all the treated animals have survived throughout the dosing period of 28 days. But at the dose of 400mg/kg, exhibits mortality on 21st day of treatment. No significant changes in the body weight, food and water intake have been observed. Complete urine, haematology, biochemical analyses, gross necropsy and histopathological examination at the end of treatment did not reveal any abnormalities. Conclusion: Vediuppu Chendhuram is the safest drug under intended human adult dosages (520 mg – 1040 mg) as illustrated in the literature.

In vivo Genotoxicity of Silver Nanoparticles after 90-day Silver Nanoparticle Inhalation Exposure

OBJECTIVES: The antimicrobial activity of silver nanoparticles has resulted in their widespread use in many consumer products. Yet, despite their many advantages, it is also important to determine whether silver nanoparticles may represent a hazard to the environment and human health. METHODS: Thus, to evaluate the genotoxic potential of silver nanoparticles, in vivo genotoxicity testing (OECD 474, in vivo micronuclei test) was conducted after exposing male and female Sprague-Dawley rats to silver nanoparticles by inhalation for 90 days according to OECD test guideline 413 (Subchronic Inhalation Toxicity: 90 Day Study) with a good laboratory practice system. The rats were exposed to silver nanoparticles (18 nm diameter) at concentrations of 0.7 x 10(6) particles/cm3 (low dose), 1.4 x 10(6) particles/cm3 (middle dose), and 2.9 x 10(6) particles/cm3 (high dose) for 6 hr/day in an inhalation chamber for 90 days. The rats were killed 24 hr after the last administration, then the femurs were removed and the bone marrow collected and evaluated for micronucleus induction. RESULTS: There were no statistically significant differences in the micronucleated polychromatic erythrocytes or in the ratio of polychromatic erythrocytes among the total erythrocytes after silver nanoparticle exposure when compared with the control. CONCLUSION: The present results suggest that exposure to silver nanoparticles by inhalation for 90 days does not induce genetic toxicity in male and female rat bone marrow in vivo.

Medical Care Quality Improvement on the Groundwork of National Healthcare Insurance Financial Stability

According to 2005 OECD health data, the total Korean expenditure on health in percentage of GDP is 6%, while other OECD countries spend an average 10% of their GDP. Accordingly, health and medical professionals uniformly point out that the idea of 'proper medical treatment with a reasonable fee' is unfair. Hence, the rationalization of the national health insurance rate is a step toward the financial stability of the national health insurance system and a way to further the realization of proper medical care. The importance of strengthening national health insurance coverage through financial expansion on the national health insurance system should be recognized as an urgent social and political issue.