A Global Overview of the Geographical Distribution of Dentists: A Scoping Review.

The objective of this study was to identify and analyze the geographic distribution of dentists, in the global context, through available scientific evidence, highlighting the following aspects: 1) the determinants of the geographic distribution of dentists, 2) corrective intervention implemented, and 3) their monitoring and evaluation. A scoping review of the published and gray literature was carried out in scientific databases and in relevant websites. We used an adaptation of a World Health Organization framework to study the distribution of human resources in health to analyze selected publications. After applying the eligibility criteria, 53 publications were included in the review; 10 related to the determinants of geographical distribution, 5 to interventions implemented, and 38 to the monitoring and evaluation process. More studies are needed to identify local determinants of the geographical distribution of dentists and to define adapted intervention strategies to make it more equitable. Knowledge Transfer Statement: The geographic inequality of dentists is a problem for health systems because it has a direct impact on access to services and the oral health conditions of a population. Our study was based on a theoretical conceptual framework formulated in 3 components: 1) determinants of the geographical distribution, 2) strategies implemented to correct the problem, and 3) monitoring and evaluation. It can assist in designing oral health policy and guide decisions by policy makers.

Ten Years of a National Oral Health Policy in Brazil: Innovation, Boldness, and Numerous Challenges.

Brazil is the only country in the world to propose a universal health care system with the aim of guaranteeing delivery of all levels of health care, free of charge, to a population of over 200 million inhabitants by means of a unified health system ("Sistema Único de Saúde" [SUS]). The national policy of oral health, also known as Smiling Brazil ("Brasil Sorridente"), was implemented in 2004. Oral health was designated as 1 of the 4 priority areas of the SUS, transforming oral health care in Brazil, with the objective that the SUS achieve the integrality of care envisaged at its creation. The aim of this article is to share part of this experience in order to prompt reflection about the inclusion of oral health care in other health care systems around the world. The most significant results of Smiling Brazil can be seen in 3 areas: (1) oral health epidemiological indicators, (2) financial investment and professional development, and (3) the building of an oral health care network throughout the 10 y of the policy. The "Discovery!" article presented here portrays 10 y of evolution; however, it is important to point out that this is a process undergoing construction and that the oral health care network needs to be further expanded, refined, and solidified so that over time and through changes in the political parties in power, Smiling Brazil prevails as a perennial policy and not merely an action by a single government.

Markers of the progression of complications in patients with type 2 diabetes: a one-year longitudinal study.

Hyperglycemia induces tissue damage and complications by mechanisms that produce advanced glycation end-products (AGEs) and inflammation.To investigate the factors associated with the progression of complications in Type 2 diabetes patients.We recruited 157 patients (110 women and 47 men) with diabetes for more than 5 years who were non-smokers and did not have current infections or chronic diseases. Patients were grouped according to neuropathy, nephropathy, and retinopathy status: without (I), slight or moderate (II), and severe complications (III). We measured glucose, lipids and HbA1c, low molecular weight AGEs (LMW AGEs), high sensitivity C-reactive protein (CRP), TNF-α, IL-6, and malondialdehyde (MDA). Patients were re-evaluated 1 year later.Patients were 52.2±6.8 years old with 11.0±4.9 years since diagnosis. After 1 year, circulating AGEs increased (p<0.0001) and eGFR decreased (p<0.0007) in groups II and III. IL-6 and MDA decreased in groups I and II. CRP (p<0.029) and AGEs (p<0.0001) increased in group II. At baseline in group I, TNF-α levels were higher (p<0.002) in patients who later developed complications. In group II, TNF-α levels (p<0.015) and microalbuminuria (p<0.00004) were higher in patients whose complications progressed. Logistic regression analysis showed that complication progress was significantly associated with log(albuminuria) (p<0.004) and log(TNF-α) (p<0.008). In the total group, AGEs were associated with age (p<0.024) and HbA1c (p<0.026).Our results suggest that baseline TNF-α is an important predictor of complication progression in Type 2 diabetes patients. AGEs also increased during the deterioration of renal function after 1 year of follow-up observation.

Toxicity of ionic liquids prepared from biomaterials.

In search of environmentally-friendly ionic liquids (ILs), 14 were prepared based on the imidazolium, pyridinium and choline cations, with bromide and several amino acids as anions. Good yields were obtained in the synthesis of pyridinium ILs and those prepared from choline and amino acids. Four of the ILs synthesized from choline and the amino acids arginine, glutamine, glutamic acid and cystine are described here for the first time. The toxicity of the synthesized ILs was checked against organisms of various levels of organization: the crustacean Artemia salina; Human cell HeLa (cervical carcinoma); and bacteria with different types of cell wall, Bacillus subtilis and Escherichia coli. The toxicity was observed to depend on both the cation and anion. Choline-amino acid ILs showed a remarkable low toxicity to A. salina and HeLa cell culture, ten times less than imidazolium and pyridinium ILs. None of ionic liquids exhibited marked toxicity to bacteria, and the effect was 2-3 orders of magnitude smaller than that of the antibiotic chloramphenicol.

Facile synthesis of oxo-/thioxopyrimidines and tetrazoles C-C linked to sugars as novel non-toxic antioxidant acetylcholinesterase inhibitors.

Microwave-assisted synthesis of oxo-/thioxopyrimidines and tetrazoles linked to furanoses with D-xylo and D-ribo configuration, and to a D-galacto pyranose is reported and compared to conventional methods. Reaction of dialdofuranoses and dialdopyranoses with a ß-keto ester and urea or thiourea under microwave irradiation at 300 W gave in 10 min the target molecules containing the 2-oxo- or 2-thioxo-pyrimidine ring in high yield. The tetrazole-derived compounds were obtained in two steps by reaction of the formyl group with hydroxylamine hydrochloride, copper sulfate, triethylamine and dicyclohexylcarbodiimide to give an intermediate nitrile, which was then treated with sodium azide. The use of microwave irradiation in the latter step also resulted in a considerably shorter reaction time (10 min) compared to hours under conventional heating to obtain a complete starting materials conversion. Acetylcholinesterase inhibition ranged from 20% to 80% for compounds concentration of 100 µg/mL, demonstrating the potential of this family of compounds for the control of Alzheimer's disease symptoms. Most of the compounds showed antioxidant activity in the ß-carotene/linoleic acid assay, some of them exhibiting IC(50) values in the same order of magnitude as those of gallic acid. The bioactive compounds did not show cytotoxic effects to human lymphocytes using the MTT method adapted for non-adherent cells, nor genotoxicity determined by the short-term in vitro chromosomal aberration assay.

The in vitro screening for acetylcholinesterase inhibition and antioxidant activity of medicinal plants from Portugal.

Essential oil, ethanolic extract and decoction of 10 plant species from interior Portugal were analyzed for their activity towards acetylcholinesterase (AChE) enzyme and their antioxidant activity. Of these, Melissa officinalis, Paronychia argentea, Sanguisorba minor, Hypericum undulatum and Malva silvestris are used in herbal medicine, Laurus nobilis and Mentha suaveolens as condiments, and Salvia officinalis, Lavandula angustifolia and Lavandula pedunculata also as aromatics. Melissa officinalis and Mentha suaveolens showed AChE inhibitory capacity higher then 50% in the essential oil fraction. Laurus nobilis, Hypericum undulatum, and Sanguisorba minor showed a high inhibition value of AChE in the ethanolic fraction, 64% (1 mg ml(-1)) 68% (0.5 mg ml(-1)), and 78% (1 mg ml(-1)), respectively. Higher values of AChE inhibitory activity were found using decoctions of Lavandula pedunculata, Mentha suaveolens and Hypericum undulatum, 68, 69 and 82% (at a concentration of 5mg dry plant ml(-1) of assay), respectively. The free radical scavenger activity was higher for the polar extracts. In the water extracts most of the plants showed values around 90%. When antioxidant activity was measured with the beta-carotene-linoleic acid assay high activity (65-95%) was also found in the water extracts. Hypericum undulatum, Melissa officinalis and Laurus nobilis showed both high AChE inhibitory capacity and antioxidant activity.

A molecular method for a qualitative analysis of potentially coding sequences of DNA.

Total sequence phylogenies have low information content. Ordinary misconceptions are that character quality can be ignored and that relying on computer algorithms is enough. Despite widespread preference for a posteriori methods of character evaluation, a priori methods are necessary to produce transformation series that are independent of tree topologies. We propose a stepwise qualitative method for analyzing protein sequences. Informative codons are selected, alternative amino acid transformation series are analyzed, and most parsimonious transformations are hypothesized. We conduct four phylogenetic analyses of philodryanine snakes. The tree based on all nucleotides produces least resolution. Trees based on the exclusion of third positions, on an asymmetric step matrix, and on our protocol, produce similar results. Our method eliminates noise by hypothesizing explicit transformation series for each informative protein-coding amino acid. This approaches qualitative methods for morphological data, in which only characters successfully interpreted in a phylogenetic context are used in cladistic analyses. The method allows utilizing character information contained in the original sequence alignment and, therefore, has higher resolution in inferring a phylogenetic tree than some traditional methods (such as distance methods).

A molecular method for a qualitative analysis of potentially coding sequences of DNA

Filogenias baseadas em seqüências totais têm baixo conteúdo informativo. Erros comuns são acreditar que a qualidade dos caracteres pode ser ignorada e que é suficiente confiar nos algoritmos computacionais. Apesar de ampla preferência por métodos a posteriori para a avaliação de caracteres, métodos a priori tornam-se necessários para produzir séries de transformação independentes das topologias das árvores. Propomos um método qualitativo passo a passo para analisar seqüências de proteínas. Codons informativos são selecionados, séries de transformação alternativas de aminoácidos são analisadas e as transformações mais parcimoniosas são hipotetizadas. Conduzimos quatro análises filogenéticas em cobras Phylodrininae. A árvore baseada em todos os nucleotídeos produz a menor resolução. Arvores baseadas na exclusão das terceiras posições, numa matriz de passos assimétrica, e em nosso protocolo de análise produzem resultados similares. Nosso método elimina ruído ao hipotetizar séries de transformação explícitas para cada aminoácido informativo para a codificação de proteínas. Essa abordagem se aproxima de métodos qualitativos para dados morfológicos, nos quais apenas caracteres interpretados com sucesso num contexto filogenético são usados em análises cladísticas. O método permite utilizar informação de caracteres contidos no alinhamento original da seqüência e, portanto, tem maior poder de resolução para inferir árvores filogenéticas que alguns métodos tradicionais (como métodos de distância).

Trends and spatial distribution of oral cancer mortality in São Paulo, Brazil, 1980-1998.

We assessed oral cancer mortality data in São Paulo to study trends of the disease and its distribution by areas of the city. We standardized death rates by gender and age group, and also supplied complementary information regarding oral cancer incidence. Oral cancer mortality remained stationary at high levels during the study period. Site-specific death rates revealed high figures for two categories of site: tongue and unspecified parts of mouth. Gum cancer death rates--the most easily diagnosed site-specific oral cancer at a routine dental examination--fell sharply, possibly as a consequence of the recent expansion in community dental health services in the city. In spite of this observation, the increase of death rates related to unspecified parts of the mouth points to the deficiencies of health services in detecting most of oral cancer cases early. Spatial data analysis enabled indication of areas and socio-economic factors associated with poorer profile in oral cancer mortality, important information for the targeting of health resources directed to the screening, prevention and education in oral cancer.

Usefulness of IS6110-restriction fragment length polymorphism typing of Brazilian strains of Mycobacterium tuberculosis and comparison with an international fingerprint database.

Strains of Mycobacterium tuberculosis isolated from 219 different tuberculosis patients, 115 from patients residing in Rio de Janeiro, 79 from Rio Grande do Sul and the remaining from other regions of the country, were analyzed by IS6110-restriction fragment length polymorphism fingerprinting. The IS6110-DNA patterns from these strains were highly polymorphic: 174 different patterns were observed and 25 patterns were shared by 70 isolates (32%). Most strains (93.4%) had multicopy patterns and only 17% of clustered strains had less than six IS6110 copies. Strain clustering was significantly higher for isolates from Rio Grande do Sul (36.7%) in comparison with strains from Rio de Janeiro (22.6%), but only when using high stringency during cluster analysis. Upon screening of an international database containing 3,970 fingerprints of M. tuberculosis strains, 15% of the patterns of Brazilian strains (21% of the strains) were identical to a fingerprint of an isolate from another country and one particular eight-band pattern forming the largest Brazilian cluster was detected in seven additional countries, suggesting that international transmission of tuberculosis from and to Brazil could be occurring frequently. Alternatively,preferential use of certain IS6110 integration sites could also be important in high-copy number strains, having important consequences for the use of databases for epidemiological studies on a large scale.

DNA fingerprinting of Mycobacterium tuberculosis from patients with and without AIDS in Rio de Janeiro.

Isolates of Mycobacterium tuberculosis derived from patients with AIDS from a single hospital in Rio de Janeiro were typed using a standardized RFLP technique detecting IS6110 polymorphism. Nineteen isolates were obtained from 15 different patients. Eleven distinct IS6110 patterns were found, with 4 banding patterns shared by 2 patients. The clustering value of 53% was much higher in comparison with clustering of M. tuberculosis strains from TB patients without clinical signs for HIV infection from randomly selected health centers. We present these results as preliminary data on M. tuberculosis strain polymorphism in Brazil and on the higher risk for recent transmission amongst patients with AIDS.

DNA fingerprinting of mycobacterium tuberculis from patients with and without AIDS in Rio de Janeiro

Isolates of Mycobacterium tuberculosis derived from patients with AIDS from a single hospital in Rio de Janeiro were typed using a standardized RFLP technique detecting IS6110 polymorphism. Nineteen isolates were obtained from 15 different patients. Eleven distinct IS6110 patterns were found, with 4 banding patterns shared by 2 patients. The clustering value of 53 percent was much higher in comparison with clustering of M. tuberculosis strains from TB patients without clinical signs for HIV infection from randomly selected health centers. We present these results as preliminary data on M. tuberculosis strain polymorphism in Brazil and on the higher risk for recent transmission amongst patients with AIDS.

Cases of human envenoming caused by Philodryas olfersii and Philodryas patagoniensis (Serpentes: Colubridae)

O presente trabalho é um relato de dois casos de acidentes com colubrídeos (Philodryas olfersii e P. patagoniensis) considerados não peçonhentos, que destaca as manifestações clínicas e as suas evoluções. A semelhança de tais acidentes com aqueles causados por serpentes Bothrops indica a necessidade de uma melhor avaliação dos pacientes quanto à terapêutica a ser adotada.

The present paper reports two cases of human envenoming by colubrid snakes of Philodryas, considered as not poisonous, showing evidence of the clinical aspects and the evolution of the symptoms of envenoming. The similarity of these cases with those caused by Bothrops suggests a more careful evaluation on the victims considering the medical treatment to be adopted.

The changing face of the epidemiology of tuberculosis due to molecular strain typing--a review.

About one third of the world population is infected with tubercle bacilli, causing eight million new cases of tuberculosis (TB) and three million deaths each year. After years of lack of interest in the disease, World Health Organization recently declared TB a global emergency and it is clear that there is need for more efficient national TB programs and newly defined research priorities. A more complete epidemiology of tuberculosis will lead to a better identification of index cases and to a more efficient treatment of the disease. Recently, new molecular tools became available for the identification of strains of Mycobacterium tuberculosis (M. tuberculosis), allowing a better recognition of transmission routes of defined strains. Both a standardized restriction-fragment-length-polymorphism-based methodology for epidemiological studies on a large scale and deoxyribonucleic acids (DNA) amplification-based methods that allow rapid detection of outbreaks with multidrug-resistant (MDR) strains, often characterized by high mortality rates, have been developed. This review comments on the existing methods of DNA-based recognition of M. tuberculosis strains and their peculiarities. It also summarizes literature data on the application of molecular fingerprinting for detection of outbreaks of M. tuberculosis, for identification of index cases, for study of interaction between TB and infection with the human immuno-deficiency virus, for analysis of the behavior of MDR strains, for a better understanding of risk factors for transmission of TB within communities and for population-based studies of TB transmission within and between countries.

Cases of human envenoming caused by Philodryas olfersii and Philodryas patagoniensis (Serpentes: Colubridae).

The present paper reports two cases of human envenoming by colubrid snakes of Philodryas, considered as not poisonous, showing evidence of the clinical aspects and the evolution of the symptoms of envenoming. The similarity of these cases with those caused by Bothrops suggests a more careful evaluation on the victims considering the medical treatment to be adopted.