Lipids in preventive dentistry.

OBJECTIVES: There is still a great demand for the improvement of oral prophylaxis methods. One repeatedly described approach is rinsing with edible oils. The aim of the present review paper was to analyze the role of lipids in bioadhesion and preventive dentistry. MATERIALS AND METHODS: Despite limited sound scientific data, extensive literature search was performed to illustrate possible effects of lipids in the oral cavity. RESULTS: It is to be assumed that lipophilic components modulate the process of bioadhesion to the oral hard tissues as well as the composition and ultrastructure of the initial oral biofilm or the pellicle, respectively. Thereby, lipids could add hydrophobic characteristics to the tooth surface hampering bacterial colonization and eventually decreasing caries susceptibility. Also, a lipid-enriched pellicle might be more resistant in case of acid exposure and could therefore reduce the erosive mineral loss. Furthermore, anti-inflammatory effects on the oral soft tissues were described. However, there is only limited evidence for these beneficial impacts. Neither the lipid composition of saliva and pellicle nor the interactions of lipids with the initial oral biofilm and the pellicle layer have been investigated adequately until now. CONCLUSION: Edible oils might qualify as mild supplements to conventional strategies for the prevention of caries, erosion, and periodontal diseases but further research is necessary. CLINICAL RELEVANCE: Against the background of current scientific and empirical knowledge, edible oils might be used as oral hygiene supplements but a decisive benefit for the oral health status is questionable.

Recycling of wastewater-derived phosphorus in Swedish agriculture--a proposal.

In 2001 the Swedish Government commissioned the Swedish Environmental Protection Agency (Swedish EPA) (i) to examine the need for stricter human health and environmental regulations governing the agricultural use of sewage sludge and (ii) to propose national targets for the agricultural recycling of phosphorus (P) originating from wastewater. The Swedish EPA may propose: (i) stricter regulations on sludge treatment to limit the risk of spreading pathogens in the environment and transmission of infectious diseases; (ii) recycling of 20-30% of wastewater-P to agriculture by 2015 and recycling of 35-50% of wastewater-P to agriculture by 2025.

Dose schedule of recombinant murine thrombopoietin prior to myelosuppressive and myeloablative therapy in mice.

PURPOSE: Thrombopoietin is being investigated as a therapeutic agent for platelet recovery following myelosuppressive therapy. Little information is available, however, on the optimal dose of this drug or the timing of its administration. To develop these data, a series of studies were conducted to examine the effects that time of dosing has on the efficacy and safety of recombinant full-length murine thrombopoietin in murine myelosuppression and murine myeloablation models. METHODS: For the myelosuppression model, mice were exposed to 500 rad whole-body irradiation in a cesium irradiator and received an intraperitoneal dose of 1.2 mg carboplatin at time 0. For the myeloablation model, mice were exposed to 900 to 950 rad of whole-body irradiation at time 0. RESULTS: Significant increases in the number of platelets and red and white blood cells were observed by day 10 in mice that had received a single intravenous bolus dose of recombinant murine thrombopoietin from 2 h before until 4 h after myelosuppressive therapy compared to those had received myelosuppressive therapy alone. In the myeloablation studies, mice treated with 900 rad of whole-body irradiation alone had a mortality rate of 50% compared to 0% for mice that had received recombinant murine thrombopoietin 2 h prior to whole-body irradiation. When the whole-body irradiation dose was increased to 950 rad, the mortality rate of the control mice was 83% compared to 25% for mice that had received recombinant murine thrombopoietin 2 h prior to whole-body irradiation. Dosing with recombinant murine thrombopoietin 7 days prior to whole-body irradiation resulted in a mortality rate greater than or equal to that of control mice. CONCLUSIONS: These data suggest that pretreatment with thrombopoietin can dramatically affect recovery from myelosuppressive and myeloablative therapy. Therefore, the timing of thrombopoietin administration in relation to the therapy may be critical to the drug's safety and efficacy.

Health reform for children: the Egyptian experience with school health insurance.

In June 1992, the People's Assembly of Egypt passed Law 99 expanding health insurance to cover all school children. This was one of the most important initiatives undertaken in recent years by the Ministry of Health, and it effectively increased the number of beneficiaries covered by the Health Insurance Organization (HIO) from 3.75 million in 1988 to about 14 million in 1993. This paper first examines the policy processes for the introduction of this innovation in Egypt's health system. Next, the paper discusses the implementation and consequences of the new policy in terms of coverage, financing, benefits, and delivery of services, along with data on utilization and expenditures. Several important lessons derive from this analysis. First, major reform efforts are possible when there is a strong political commitment and the proposed program and solutions are acceptable to the key stakeholders. Second, compromises and trade-offs are essential to construct a politically feasible and ethically acceptable reform initiative. Third, while these trade-offs might yield short-term gains, the trade-offs in the long term may undermine the reform's capacity to achieve the anticipated equity enhancements and can potentially undermine the financial sustainability of the reform.

Health reform for children in Japan's aging society: a paradigm shift for pediatricians.

Japan confronts a dilemma in reshaping its health care for children: the low birth rate is reducing the proportion of children in the overall population, while the health issues for children are becoming increasingly complex and connected to social behavior. The present paper reviews Japan's changing demographics and the declining proportion of children in the population structure. This change has important implications for how the government sets priorities in the health sector. Next, the paper considers how 'problems' are defined for health policy in society and how the agenda for health reform is determined. Attention is directed to the political dimensions of these two processes of problem definition and agenda setting. Two examples of health reform for children, in other countries, are discussed to show how these two processes have worked in practice. In the next section, the paper explores new health issues for children in Japan and the challenges to Japanese pediatricians in shaping the agenda for health reform.

Health care financing for the elderly in Japan.

This paper examines the financing of elderly health care in Japan for medical institutions, nursing homes, and at home. The analysis demonstrates that the conventional figures for elderly health expenditures in Japan systematically underestimate the real costs by excluding the costs of uninsured services, nursing homes, and home health care. The paper estimates these costs and shows that they add about 10% to the conventional figure for elderly health care costs in Japan. This inquiry also shows how government policy for health care financing shaped distinctive Japanese patterns of elderly care provision. The financing system provided a hidden subsidy--through national health insurance coverage of long-term hospitalization--that encouraged high institutionalization rates of elderly in medical facilities. Public financing for long-term elderly hospitalization, however, has not been matched by government attention to quality of care, resulting in serious quality problems and reflecting a social trade-off between cost and quality. Also, until recently the financing system rarely reimbursed home health care, thereby creating strong disincentives to the development of formal home health care services. This analysis has important implications for reforms now being considered by the Japanese government in the financing and provision of health care for the elderly, especially the limitations of relying on reimbursement price policy. The reforms could have unintended negative consequences for equity, efficiency, and quality of care.