Blood donation in a large urban centre of southeast Brazil: a population-based study.

OBJECTIVES: This study aimed to estimate the prevalence and characterise potential blood donors and non-donors in a well-populated and representative urban area of Southeastern Brazil. BACKGROUND: Studies on blood donation usually evaluate individuals who donate. Population-based studies may contribute to characterise those who never reach the blood centre, trying to increase the range of donors. STUDY DESIGN AND METHODS: This was a secondary analysis of a population-based survey and a blood donor motivation study [Recipient Epidemiology and Donor Evaluation study (REDS II) International]. In a cross-sectional study 4047 individuals representing a metropolitan area answered the question 'Have you ever donated blood at least once in your life?'. The profiles ('Yes/No') were compared. Non-donors from this reference population were compared with donors of a local blood center, in a case control analysis. RESULTS: A total of 69·0% of the population had never donated blood and was composed mostly of women, younger than 30 years old, people not contributing to social security and not subscribing to newspapers. In the case-control study, the likelihood of donating was higher for: men, younger than 50 years old, longer time of education, married, participating in political campaigns and with a good self-perception of health. The factors associated with no blood donation were: self-reported mixed or white race/ethnicity, income higher than two minimum wages and belonging to trade union, political, religious/spiritual, or other social group and worse self perception of health. CONCLUSIONS: This population-based study allowed us to characterise a high proportion of people that never reaches the blood centre. The results may be used to diversify the donor profile, creating strategies to target those least likely to donate blood, as women, white people and those with higher income and purchasing power.

Cytokine production associated with periportal fibrosis during chronic schistosomiasis mansoni in humans.

Volunteers living in an area where schistosomiasis mansoni is endemic were subjected to ultrasound examination and classified into groups according to the levels of fibrosis diagnosed, namely, absence of indications of fibrosis (group 0), incipient fibrosis (group 1), and moderate/severe fibrosis (group 2). Peripheral blood mononuclear cells (PBMC) collected from the volunteers were stimulated with soluble antigens from adult schistosomes or from schistosome eggs, and the production of the cytokines gamma interferon, tumor necrosis factor alpha, transforming growth factor beta (TGF-beta), interleukin-4 (IL-4), IL-10, and IL-13 was determined. Potential associations of the level of fibrosis with age, sex, intensity of infection, and cytokine production were investigated between the three groups. Univariate analysis identified associations of age (>50), gender (male), and absence of eggs/g of feces with moderate/severe fibrosis and an association of intensity of infection (>100 eggs) with incipient fibrosis. When cytokine production in PBMC cultures stimulated by soluble egg antigens was categorized as low or high, significant differences in the distribution of IL-13 levels were established between groups 0 and 2. No significant differences were detected between the groups in the cytokines produced by PBMC cultures stimulated with soluble antigens from adult schistosomes. When all variables were tested in multivariate analyses, only IL-13 was strongly associated with fibrosis (odds ratio = 5.8; 95% confidence interval [CI] = 1.1 to 30.5). While high levels of TGF-beta appeared to be associated with protection against fibrosis, the strength of the association was low.

Nested case-control study in a serological survey to evaluate the effectiveness of a Chagas disease control programme in Brazil.

OBJECTIVE: To identify risk factors associated with Trypanosoma cruzi infections in areas under surveillance in the State of Minas Gerais, Brazil. METHODS: A model using a nested case-control design incorporated within a serological survey of schoolchildren which was employed to evaluate the effectiveness of the Chagas disease control programme. FINDINGS: In a sample of 40,374 schoolchildren (aged 7-14 years) surveyed, 16 children tested positive for T. cruzi antibody (by indirect immunofluorescence and indirect haemagglutination). In the case-control study, each case was randomly matched to three seronegative controls (classroom and age +/- 1 year). Compared to controls, T. cruzi-seropositive children were more likely to have a seropositive mother (odds ratio (OR) = 6.8; 95% confidence interval (CI) = 0.71-63.9) or a seropositive family member (OR = 8.6; 95% CI = 1.0-75.5). CONCLUSION: Use of the nested case-control model in a sero-epidemiological survey to evaluate risk factors for T. cruzi transmission was adequate for assessing the effectiveness of a Chagas disease control programme.

[Epidemiological surveillance in the Chagas disease control program in Minas Gerais State, Brazil (1984-1998)]. / Vigilância epidemiológica no Programa de Controle da Doença de Chagas em Minas Gerais, Brasil (1984-1998).

This paper describes the surveillance phase of the Chagas Disease Control Program in Minas Gerais State. Surveillance was conducted by the County Health Services with community participation in the planning, decision-making, and maintenance processes and is intended to be sustainable in the context of Brazil's Unified National Health System (SUS).

Kinetics of enamel demineralization in vitro.

Previously, we reported that the rate (R) of hydroxyapatite dissolution in acetic, lactic, and phosphoric acid solutions is a function of the degree of saturation with respect to the dissolving mineral, DS (defined as the ratio of the mean ionic activity product for hydroxyapatite [Ca5OH(PO4)3] in solution to its solubility product constant), and the sum of the acid activities (sumBiH) in solution: R = K(1-DS)m(sumBiH)n. The present study was undertaken to explore the general validity of this model in describing the kinetics of enamel demineralization. Thin sections of human enamel were exposed to partially saturated 0.1 mol/L lactic acid solutions, at two different DS levels, and at pH values of 4.3 to 6.0. Thin sections of human enamel were also exposed to solutions with four different concentrations of acetic and lactic acids (pH 4.3) with three different DS values and, at one DS value, to solutions of propionic acid. Mineral loss was monitored by quantitative microradiography. In solutions with pH values of 4.3 and 5.0, "lesions" were formed with well-defined surface layers, whereas, in solutions with pH 6.0, "lesions" were produced with no apparent surface layers. The formation of relatively intact surface layers was consistent with predicted phase transformations. Rates of mineral loss were found to be inversely proportional to both the degree of saturation with respect to enamel mineral, DS(En), and the pH of the solution and increased with increased activities of each organic acid, consistent with the proposed model. However, at the same DS(En) and acid activity, rates of demineralization were the same in the acetic and propionic acid solutions, whereas rates of demineralization in lactic acid were greater. It is suggested that specific interactions of acid species with enamel mineral may modify the rate of enamel demineralization. These in vitro findings suggest that relatively small differences in DS(En) values found in plaque fluid may result in very significant differences in the rate of enamel demineralization in vivo.

[Association of the degree of saturation with respect to enamel in plaque fluid with caries activity].

The aim of this study was to investigate changes of the degree of saturation with respect to enamel in plaque fluid by sucrose rinse, and their association with caries activity. Three groups of subjects were selected by their caries status: caries free, caries positive and caries active. Plaque samples were collected before, 3 and 7 minutes after a one-minute 5% sucrose rinse. Plaque fluids were isolated and analyzed for organic acids (capillary electrophoresis), inorganic ions (ion exchange chromatography), calcium activity and pH (selective electrodes). The degrees of saturation (DS) were calculated based on the total composition or calcium activity. The results showed that there were significantly more pH drops, and particularly more DS drops within caries active group after a sucrose rinse, compared with caries free and positive groups. This suggests that the degree of saturation is a much sensitive index to describe the cariogenetic status of individuals.

Molecular cloning and mRNA tissue distribution of a novel matrix metalloproteinase isolated from porcine enamel organ.

A cDNA encoding a novel matrix metalloproteinase (MMP) was isolated from a porcine enamel organ-specific cDNA library. Multiple tissue northern blot analysis revealed the presence of two mRNA transcripts which were expressed only in the enamel organ. The transcripts were 1968 bp or 3420 bp in length and resulted from the utilization of alternative polyadenylation sites. The open reading frame of the cloned mRNA encodes a protein composed of 483 amino acids. The MMP has a predicted molecular mass of 54.1 kDa, which is similar to that of the stromelysins or collagenases, although it is not a member of either of these two classes of MMPs. A motif analysis revealed that the cloned MMP does not contain a consensus hemopexin-like domain because it lacks a critical tryptophan and proline residue at the appropriate positions. Since the cloned MMP is a new member of the MMP gene family and its expression appears limited to the enamel organ, we have named it enamelysin.

Developmental changes in the pH of enamel fluid and its effects on matrix-resident proteinases.

The objectives of this study were to measure pH in developing enamel at progressively older (more mature) stages of amelogenesis in vivo, and then to formulate synthetic enamel fluid mixtures that approximated these pH values for in vitro studies. The ultimate goal was to characterize the molecular weights of proteinases visualized by enzymograms incubated in synthetic enamel fluid using gelatin and casein as substrates. For most experiments, the proteinases were extracted en masse from small freeze-dried enamel strips directly into a non-reducing sample preparation buffer. In some experiments, we pre-treated the enamel strips with acetic acid to determine if this common method for demineralization and protein extraction caused any changes in the activity levels of the enamel proteinases. In other experiments, we first soaked enamel strips in synthetic enamel fluid to determine solubility of the proteinases within an aqueous phase. The results indicated that the pH of developing enamel remained fairly constant near pH 7.23 across the secretory stage, but it was generally more acidic (6.93) and fluctuated in focal areas between mildly acidic (6.2-6.8) and near-neutral (7.2) conditions across the maturation stage. The pH then slowly rose to near 7.35 when the enamel was almost mature (hard). The acidic conditions were generally inhibitory to most enamel proteinases, but there were some caseinase activities in mid-maturation-stage enamel near 23-30 kDa which appeared to be activated by weakly acidic conditions (pH 6.28). Pre-treatment of enamel samples with 0.5 M acetic acid markedly altered the overall profile of enamel proteinases, causing activation of some latent proteinase activities and permanent inhibition of other activities. Most proteinases in whole homogenates were insoluble in synthetic enamel fluid. This suggests that they may be tightly bound, directly or indirectly, to matrix proteins or mineral components in situ.

Composition and cariogenic potential of dental plaque fluid.

Our understanding of the chemical events that take place at the tooth-plaque interface has improved greatly through studies of the chemical composition and properties of dental plaque fluid. In the absence of fermentable carbohydrate, plaque fluid has been found to be supersaturated with respect to tooth mineral and other calcium phosphate phases, thus exhibiting the potential to support calculus formation and the remineralization of incipient carious lesions. Following the exposure to fermentable carbohydrate, the degree of saturation of plaque fluid decreases rapidly, primarily due to lactic acid production and the lowering of plaque fluid pH. The extent of these chemical changes has been shown to be associated with differences in caries history. Such studies have been facilitated by the recent development of microanalytical techniques. Unfortunately, little is known about the relationship between the observed chemical changes in plaque fluid and the microbial composition of plaque. Limited information is also available on the association of immune factors in plaque fluid with dental disease.

Effect of fluoride incorporation into human dental enamel on its demineralization in vitro.

Coronal surfaces of extracted human teeth were ground to a depth of about 1 mm and then cut in half labiolingually. One half was used as a control; the other half was exposed, for 3 days, to a fluoride-enriching buffer (0.1 mol/l lactic acid, 19.7 mmol/l CaCl2, 10.8 mmol/l KH2PO4, 3 mmol/l NaN3; pH adjusted to 4.68 with KOH) having fluoride concentrations from 0.0002 to 2.2 parts/10(6). This exposure resulted in an uptake of fluoride by the enamel to a depth of 2 microns without any apparent demineralization. The fluoride uptake was proportional to the F concentration of the enriching solution, reaching concentrations of about 8000 parts/10(6) within the first micrometre of enamel exposed to the highest F concentration; the controls had uniform F concentrations not exceeding 50 parts/10(6) along the 2.5 microns of enamel depth sampled. Thin sections (140-160 microns) were cut perpendicularly to the lingual surface, coated with protective resin except for a window about 1 mm long on the ground lingual surface, and exposed to a demineralizing buffer. The mineral losses of the sections were followed over 5 days by microradiography and image analysis. Fluoride enrichment resulted in reduced demineralization and the reduction was inversely related to the enamel fluoride content. The controls displayed a uniform erosion of the surface enamel whereas all the treatments below 1.5 parts/10(6) in the enriching solutions developed typical subsurface 'lesions'. The mineral content of the surface layer increased with increasing time of exposure to the demineralizing buffer.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of Ca-P-F in caries prevention: chemical aspects.

The fluoride agents used in caries prevention can be divided into two broad categories: systemic and topical, although this division is not exempt from ambiguities. A review is given of the efficacy of systemic (fluoridated water and supplements) and topical agents. The latter include high concentration (12,000 ppm F) solutions, fluoridated dentifrices and mouthrinses. Emphasis is placed on the concept that there is no unique mode of action of the fluoride agents; their beneficial effects are related to different mechanisms depending on the agent and the mode of usage. Chemical models are advanced to explain the effect of the various agents. Of particular interest is the chemistry involved with dentifrices containing dicalcium phosphate dihydrate. It is shown that the presence of this compound greatly enhances fluoride utilisation in in vitro systems simulating the oral environment.

Cariogenic potential of pooled plaque fluid from exposed root surfaces in humans.

The composition of pooled plaque fluid from exposed root surfaces of five population samples was determined before and at selected times (3, 7 and 15 min) after a 5 and 10% sucrose rinse. Subjects were 45-65 yr old, had exposed, sound root surfaces, and were grouped according to root caries status [caries-free (CF), no root caries history; caries-positive (CP), recorded root caries experience]. Samples were obtained only from the sound surfaces of the CF and CP subjects after overnight fasting. Plaque samples from each subgroup were pooled under mineral oil and maintained on ice. Plaque fluid was then isolated by centrifugation and analysed for organic acids and inorganic ions (ion chromatography), and pH (microelectrodes). From these data, the degree of saturation [DS(TM)] in plaque fluid with respect to tooth mineral (TM) was calculated. Before exposure to sucrose, plaque fluids from the CF and the CP subgroups had similar ionic compositions. These fluids were also found to be supersaturated with respect to tooth mineral. After exposure to sucrose, a rapid decrease in plaque fluid pH was observed, which corresponded primarily to lactic acid production. For all times examined, mean pH and DS(TM) values were lower and lactic acid concentrations were higher in the CP than the CF samples. Lower values of DS(TM) suggest that plaque fluid from CP subjects had a measurably greater cariogenic potential. Calcium concentrations also increased significantly and to comparable levels in all plaque fluid samples after sucrose exposure, despite lower acid production in CF samples.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of sucrose concentration on the cariogenic potential of pooled plaque fluid from caries-free and caries-positive individuals.

Pooled plaque samples were obtained from (1) coronal surfaces of two groups of caries-free (CF) subjects, (2) coronal 'white-spot' surface areas of a group of caries-positive (CP) subjects, and (3) exposed, sound root surfaces of root caries-free (RCF) and root caries-positive (RCP) subjects. The plaque samples were obtained before and 3 min after a 1 min rinse with a 0.5, 1, 2, 5 and 10% sucrose solution. Plaque fluid was then isolated from each plaque sample by centrifugation and analyzed for inorganic ions, organic acids, and pH values. With increasing sucrose concentration: (1) plaque fluid pH and the degree of saturation (DS) with respect to tooth mineral decreased; (2) the pH and DS values of CP and RCP samples were consistently lower than those of CF and RCF samples, respectively; (3) plaque fluid lactic acid concentrations increased and were consistently higher in the CP and RCP samples than in the CF and RCF samples, respectively, and (4) plaque fluid lactic acid concentrations leveled off between 1 and 5% sucrose; this occurred at lower sucrose concentrations with CP and RCP samples than with CF and RCF samples, respectively. RCP samples contained consistently higher levels of mutants streptococci than RCF samples. The chemical composition of plaque fluids, following sucrose exposure, were found to correlate well with caries history. The observed differences in lactic acid concentrations in samples from CF and CP subjects are discussed with regard to differences in microbiological composition and possible differences in plaque permeability to sucrose.

Composition of pooled plaque fluid from caries-free and caries-positive individuals following sucrose exposure.

The composition of pooled plaque fluid from five population samples was determined before and at selected times (7, 15, 30, and 60 min) after a 10% sucrose rinse. Subjects were grouped according to caries status (caries-free, CF, DMFS = 0; caries-positive, CP, DMFS > 10). Samples were also studied from white-spot surfaces and from sound surfaces of the same mouths of two additional CP groups. Plaque fluid was isolated by centrifugation and analyzed for organic acids, inorganic ions (ion chromatography), and pH (microelectrodes). Prior to sucrose exposure, plaque fluids from the CF subgroups and from sound surfaces of the CP subjects had higher pH values than samples from CP subgroups and from white-spot surfaces, respectively; the ionic compositions were otherwise similar. Starved plaque fluids were also found to be supersaturated with respect to enamel and to a significantly greater degree in the CF samples, suggesting that CF plaque fluid may have a greater remineralization potential than CP samples. Following sucrose exposure, a rapid decrease in plaque fluid pH was observed, which corresponded primarily to lactic acid production. For all times examined, mean pH and DS(En) values were lower and lactic acid concentrations were higher in the CP samples than in the CF samples; noted differences were statistically significant at 7 min for pH and DS(En), and at 7, 15, and 30 min for lactic acid. Lower values of DS(En) suggest that plaque fluid from CP subjects had a measurably greater cariogenic potential.(ABSTRACT TRUNCATED AT 250 WORDS)

Labile or surface pools of magnesium, sodium, and potassium in developing porcine enamel mineral.

The present study was undertaken to assess the labile or surface pools of Mg, Na, and K ions in porcine enamel tissues at various developmental stages. The enamel samples, corresponding to the outer and the inner secretory, the early maturing, and the mature hard enamel, were dissected from the labial sides of permanent incisors of 6- to 8-month-old piglets. Each enamel sample was extracted successively with solutions of de-ionized water and 50 mmol/L Tris-4 mol/L guanidine buffer (for removal of organic matrix proteins, mainly amelogenins). The labile (free or organically bound) pools of Mg, Na, and K were assessed by the total amounts of these ionic species extracted by the water and Tris-guanidine buffer. The surface (adsorbed onto enamel mineral) pool of Mg was assessed directly by determination of the adsorption of Mg onto enamel mineral at various developmental stages. The results showed that: (i) 30-40% of the Mg in the secretory and early maturation enamel was in the surface pool (adsorbed onto the enamel mineral); (ii) 25 to 40% of the total sodium in the enamel samples was in labile forms; and (iii) most (around 70-80%) of the total potassium was readily extracted in water and appeared to originate from the enamel fluid; only marginal portions remained in the solids. The present adsorption studies also indicated that the maximum uptake of magnesium in the early maturation enamel was due mostly to an increase of the occupancy by Mg ions of adsorption sites on the crystal surfaces, which become accessible with a massive removal of enamel matrix proteins.(ABSTRACT TRUNCATED AT 250 WORDS)

Competitive adsorption of magnesium and calcium ions onto synthetic and biological apatites.

Magnesium (Mg) is a conspicuous constituent of hard tissues but its possible role in biomineralization is poorly understood. It is possible that Mg2+ adsorbed onto bioapatites may contribute to the modulation of crystal growth as such inhibitory activity has been reported for synthetic apatites. The present study was undertaken to determine the adsorption isotherms of Mg ions onto synthetic apatites and biominerals in tooth and bone tissues in the presence of other ions of natural occurrence. Synthetic crystals used as adsorbents were hydroxyapatite and, as a better prototype for the biomineral, Mg-containing carbonatoapatite. Human enamel and dentin materials were obtained from extracted, caries-free, permanent teeth. Porcine dentin materials at two developmental stages were obtained from erupted deciduous and unerupted permanent teeth of a 6-month-old slaughtered piglet. Porcine bone was obtained from the cortical portion of the mandible of the same animal. All biomineral samples were pulverized and then treated by plasma ashing (deproteination) at about 60 degrees C. Each of the powdered samples was equilibrated in solutions containing various initial concentrations of Mg2+, Ca2+, and Na+ (or K+) as nitrate salts. Following equilibration, concentrations (and activities) of magnesium and calcium ions in the experimental solution were determined. The pH values of the equilibrium solutions were in the range of 6.2-6.5. Experimental data of the Mg adsorption onto hydroxyapatite were interpreted on the basis of a Langmuir-type model for binary systems assuming competition of Mg2+ and Ca2+ for the same adsorption sites on the crystal surfaces of the apatites.(ABSTRACT TRUNCATED AT 250 WORDS)

Changes in the solubility of enamel mineral at various stages of porcine amelogenesis.

The solubility of enamel mineral (a carbonated apatite) formed at various stages of porcine amelogenesis was investigated at controlled partial pressures of CO2. Enamel samples were obtained from the outer (young) secretory, inner (old) secretory, early (soft) and late (hard) mature enamel of the permanent dentition of slaughtered piglets. The dissected enamel was pulverized and subjected to a plasma ashing at low temperature to remove organic matter. The composition (Ca, total P, HPO4, and CO3) of the enamel mineral was determined chemically. The enamel mineral contained significant amounts of carbonate and acid phosphate; the model adopted for its stoichiometry was [Ca]5-x [HPO4]v[CO3]w[PO4]3-x[OH]1-x. Each enamel sample was equilibrated in dilute phosphoric acid solutions (0.01-1.2 mM) under Pco2 = 1.86 and 1.75%. Equilibration of the enamel samples usually took 20-25 days; the solution composition (pH, concentrations of Ca, P, Mg, Na, and K, and activity of Ca2+) was determined periodically. The composition of the solution at equilibrium showed that (1) the outer (younger) secretory mineral was the most soluble and the solubility of enamel mineral decreased with advancing developmental stages; (2) the mean activity product in the saturated solutions for the outer secretory enamel was the same as that calculated on the basis of the reported composition of the enamel fluid; and (3) the solubility data obtained with most of the enamel samples were consistent with a model in which the equilibration includes two processes: dissolution of the original enamel mineral and precipitation of a new carbonatoapatite. Analyses of the equilibrated samples, particularly the mature enamel, by electron microscopy, supported the precipitation of carbonatoapatite.(ABSTRACT TRUNCATED AT 250 WORDS)

Kinetics of hydroxyapatite dissolution in acetic, lactic, and phosphoric acid solutions.

The present study was undertaken in an attempt to relate the kinetics of hydroxyapatite dissolution to solution parameters, under experimental conditions relevant to the dental caries process. Thus, the dissolution of hydroxyapatite was studied in acetic, lactic, and dilute phosphoric acid solutions having initial pH values from 4 to 6. Rates of dissolution and the corresponding degree of saturation with respect to hydroxyapatite were determined at various times throughout the dissolution process. Rates of dissolution of all solutions were found to decrease with increasing degree of solution saturation and were greater in solutions with lower initial values of pH. However, rates of dissolution in partially saturated phosphoric acid solutions (without added organic acid) were at least one order of magnitude lower than those observed in the organic acid buffers with the same initial pH, over the same range of saturation values. The data obtained are consistent with a surface-controlled dissolution model in which the rate of dissolution is dependent upon the degree of saturation and the sum of the activities of the acidic species in solution, i.e., phosphoric and organic acids. These results suggest that in order to assess the cariogenic potential of a given medium (e.g., plaque fluid), one must determine both the degree of saturation with respect to the dissolving mineral and the activities of acidic species in solution.