Evolution in access to fluoridated water in Sao Paulo State, Brazil, from the 1950s to the early 21st century

Access to fluoridated water is a known protective factor against dental caries. In 1974, fluoridation of the public water supply became mandatory by law in Brazil, resulting in improved coverage, especially in more developed regions of the country. Coverage increased across the country as a priority under the national oral health policy. This article systematizes information on the implementation and expansion of fluoridation in Sao Paulo State from 1956 to 2009, using secondary data from technical reports, official documents, and the Information System for Surveillance of Water Quality for Human Consumption (SISAGUA). In 2009, fluoridation covered 546 of 645 counties in Sao Paulo State (84.7%), reaching 85.1% of the total population and 93.5% of the population with access to the public water supply. The results indicate that fluoridation has been consolidated as part of State health policy. However, the challenge remains to implement and maintain fluoridation in 99 counties, benefiting 6.2 million inhabitants that are still excluded from this service.

Is the food frequency consumption essential as covariate to estimate usual intake of episodically consumed foods?

BACKGROUNDS/OBJECTIVES: The aim of this paper is to verify the performance of the frequency of consumption as variable for prediction of the usual intakes of foods. SUBJECTS/METHODS: In total, 725 individuals who answered two nonconsecutive 24-h recall and one food frequency questionnaire (FFQ) in the 'Healthy Survey-Sao Paulo-Brazil'. An additional indicator variable indicating if one is usual consumer was created before analyzing. The Multiple Source Method and National Cancer Institute method were used to estimate usual intake of selected food considering different models of prediction: with no covariates; with FFQ; with FFQ plus indicator variable; and with only indicator variable. RESULTS: For foods that are consumed every day or almost every day, the inclusion of the FFQ and/or the indicator variable as covariates resulted in similar percentiles of consumption when compared with the model with no covariates. For episodically consumed foods, the models with FFQ plus indicator variable and with only indicator variable estimated similar percentiles of intake. CONCLUSIONS: The use of the indicator variable instead the FFQ appears as a good alternative to estimate usual intake of episodically consumed foods.

Access to healthcare services for tuberculosis: analysis of patient satisfaction

Tuberculosis remains a pubic health challenge. Uncountable efforts are made to control the disease, and patient treatment and accessibility to healthcare can hinder reaching a cure. The objective of this article is to analyze the satisfaction of tuberculosis patients regarding tuberculosis control services. This is an epidemiological, prospective study, using both a quantitative and qualitative approach. Data were collected using a semi-structured questionnaire. Participants included 77 patients. The quantitative data were positively evaluated, and the qualitative data permitted an understanding of the patients' experience regarding their accessibility and treatment. Aspects such as the criteria for performing Directly Observed Treatment and the proximity of the healthcare facility to the patients' residence affected their satisfaction, which implies the need to reorganize healthcare services in order to provide more appropriate care to tuberculosis patients.

Oral health and access to dental care services in relation to the Health Necessities Index. Sao Paulo, Brazil, 2008

The Health Department of Sao Paulo, Brazil, has developed a Health Necessities Index (HNI) to identify priority areas for providing health assistance. In 2008, a survey of the status of oral health was conducted. The objective of this ecological study was to analyze the status of oral health in relation to the HNI. The variables, stratified by the age of 5, 12 and 15 years old were: percentage of individuals with difficulty of access to dental care services; DMFT and DMFS; prevalence of the need for tooth extraction and treatment of dental caries. Data were analyzed for the 25 Health Technical Supervision Units (HTS). The Statistical Covariance Test was used as well as the Pearson correlation coefficient and linear regression model. A positive correlation was observed between high scores of the HNI and difficulty of access to services. In the HTS with high scores of HNI a higher incidence of dental caries was observed, a greater need for tooth extractions and low caries-free incidence. In order to improve health conditions of the population it is mandatory to prioritize actions in areas of social deprivation.

Digital library of historical cartography: open access to cultural heritage and public good

This paper describes the integration of information between Digital Library of Historical Cartography and Bibliographical Database (DEDALUS), both of the University of São Paulo (USP), to guarantee open, public access by Internet to the maps in the collection and make them available to users everywhere. This digital library was designed by Historical Cartography Studies Laboratory team (LECH/USP), and provides maps images on the Web, of high resolution, as well as such information on these maps as technical-scientific data (projection, scale, coordinates), printing techniques and material support that have made their circulation and cultural consumption possible. The Digital Library of Historical Cartography is accessible not only to the historical cartography researchers, but also to students and the general public. Beyond being a source of information about maps, the Digital Library of Historical Cartography seeks to be interactive, exchanging information and seeking dialogue with different branches of knowledge

"Water users must be efficient producers". Women's access to and use of land in Chókwè irrigation scheme, Mozambique

The irrigation scheme Eduardo Mondlane, situated in Chókwè District - in the Southern part of the Gaza province and within the Limpopo River Basin - is the largest in the country, covering approximately 30,000 hectares of land. Built by the Portuguese colonial administration in the 1950s to exploit the agricultural potential of the area through cash-cropping, after Independence it became one of Frelimo’s flagship projects aiming at the “socialization of the countryside” and at agricultural economic development through the creation of a state farm and of several cooperatives. The failure of Frelimo’s economic reforms, several infrastructural constraints and local farmers resistance to collective forms of production led to scheme to a state of severe degradation aggravated by the floods of the year 2000. A project of technical rehabilitation initiated after the floods is currently accompanied by a strong “efficiency” discourse from the managing institution that strongly opposes the use of irrigated land for subsistence agriculture, historically a major livelihood strategy for smallfarmers, particularly for women. In fact, the area has been characterized, since the end of the XIX century, by a stable pattern of male migration towards South African mines, that has resulted in an a steady increase of women-headed households (both de jure and de facto). The relationship between land reform, agricultural development, poverty alleviation and gender equality in Southern Africa is long debated in academic literature. Within this debate, the role of agricultural activities in irrigation schemes is particularly interesting considering that, in a drought-prone area, having access to water for irrigation means increased possibilities of improving food and livelihood security, and income levels. In the case of Chókwè, local governments institutions are endorsing the development of commercial agriculture through initiatives such as partnerships with international cooperation agencies or joint-ventures with private investors. While these business models can sometimes lead to positive outcomes in terms of poverty alleviation, it is important to recognize that decentralization and neoliberal reforms occur in the context of financial and political crisis of the State that lacks the resources to efficiently manage infrastructures such as irrigation systems. This kind of institutional and economic reforms risk accelerating processes of social and economic marginalisation, including landlessness, in particular for poor rural women that mainly use irrigated land for subsistence production. The study combines an analysis of the historical and geographical context with the study of relevant literature and original fieldwork. Fieldwork was conducted between February and June 2007 (where I mainly collected secondary data, maps and statistics and conducted preliminary visit to Chókwè) and from October 2007 to March 2008. Fieldwork methodology was qualitative and used semi-structured interviews with central and local Government officials, technical experts of the irrigation scheme, civil society organisations, international NGOs, rural extensionists, and water users from the irrigation scheme, in particular those women smallfarmers members of local farmers’ associations. Thanks to the collaboration with the Union of Farmers’ Associations of Chókwè, she has been able to participate to members’ meeting, to education and training activities addressed to women farmers members of the Union and to organize a group discussion. In Chókwè irrigation scheme, women account for the 32% of water users of the familiar sector (comprising plot-holders with less than 5 hectares of land) and for just 5% of the private sector. If one considers farmers’ associations of the familiar sector (a legacy of Frelimo’s cooperatives), women are 84% of total members. However, the security given to them by the land title that they have acquired through occupation is severely endangered by the use that they make of land, that is considered as “non efficient” by the irrigation scheme authority. Due to a reduced access to marketing possibilities and to inputs, training, information and credit women, in actual fact, risk to see their right to access land and water revoked because they are not able to sustain the increasing cost of the water fee. The myth of the “efficient producer” does not take into consideration the characteristics of inequality and gender discrimination of the neo-liberal market. Expecting small-farmers, and in particular women, to be able to compete in the globalized agricultural market seems unrealistic, and can perpetuate unequal gendered access to resources such as land and water.

Design and synthesis of multipotent drugs: application to Alzheimer's disease and benign prostatic hyperplasia

The aim of this thesis was to synthesize multipotent drugs for the treatment of Alzheimer’s disease (AD) and for benign prostatic hyperplasia (BPH), two diseases that affect the elderly. AD is a neurodegenerative disorder that is characterized, among other factors, by loss of cholinergic neurons. Selective activation of M1 receptors through an allosteric site could restore the cholinergic hypofunction, improving the cognition in AD patients. We describe here the discovery and SAR of a novel series of quinone derivatives. Among them, 1 was the most interesting, being a high M1 selective positive allosteric modulator. At 100 nM, 1 triplicated the production of cAMP induced by oxotremorine. Moreover, it inhibited AChE and it displayed antioxidant properties. Site-directed mutagenesis experiments indicated that 1 acts at an allosteric site involving residue F77. Thus, 1 is a promising drug because the M1 activation may offer disease-modifying properties that could address and reduce most of AD hallmarks. BPH is an enlargement of the prostate caused by increased cellular growth. Blockade of α1-ARs is the predominant form of medical therapy for the treatment of the symptoms associated with BPH. α1-ARs are classified into three subtypes. The α1A- and α1D-AR subtypes are predominant in the prostate, while α1B-ARs regulate the blood pressure. Herein, we report the synthesis of quinazoline-derivatives obtained replacing the piperazine ring of doxazosin and prazosin with (S)- or (R)-3-aminopiperidine. The presence of a chiral center in the 3-C position of the piperidine ring allowed us to exploit the importance of stereochemistry in the binding at α1-ARs. It turned out that the S configuration at the 3-C position of the piperidine increases the affinity of the compounds at all three α1-AR subtypes, whereas the configuration at the benzodioxole ring of doxazosin derivatives is not critical for the interaction with α1-ARs.

Conflict affected peoples’ access to education: IDP pupils in Georgia

This work seeks to understand what kind of impact educational policies have had on the secondary school students among internally displaced persons (IDPs) and their identity reconstruction in Georgia. The study offers a snapshot of the current situation based on desk study and interviews conducted among a sample of secondary school IDP pupils. In the final chapter, the findings will be reflected against the broader political context in Georgia and beyond. The study is interdisciplinary and its methodology is based on social identity theory. I shall compare two groups of IDPs who were displaced as a result of two separate conflicts. The IDPs displaced as a result of conflict in Abkhazia in 1992–1994 are named as old caseload IDPs. The second group of IDPs were displaced after a conflict in South Ossetia in 2008. Additionally, I shall touch upon the situation of the pupils among the returnees, a group of Georgian old caseload IDPs, who have spontaneously returned to de facto Abkhazia. According to the interviews, the secondary school student IDPs identify themselves strongly with the Georgian state, but their group identities are less prevailing. Particularly the old case load IDP students are fully integrated in local communities. Moreover, there seems not to be any tangible bond between the old and new caseload IDP students. The schools have neither tried nor managed to preserve IDP identities which would, for instance, make political mobilisation likely along these lines. Right to education is a human right enshrined in a number of international conventions to which the IDPs are also entitled. Access to education or its denial has a deep impact on individual and societal development. Furthermore, education has a major role in (re)constructing personal as well as national identity.

Examining the Role of Vocational Rehabilitation on Access to Care and Public Health Outcomes for People Living with HIV/AIDS

The purpose of this study is to examine the role of vocational rehabilitation services in contributing to the goals of the National HIV/AIDS strategy. Three key research questions are addressed: (a) What is the relationship among factors associated with the use of vocational rehabilitation services for people living with HIV/AIDS? (b) Are the factors associated with use of vocational rehabilitation also associated with access to health care, supplemental employment services and reduced risk of HIV transmission? And (c) What unique role does use of vocational rehabilitation services play in access to health care and HIV prevention? Survey research methods were used to collect data from a broad sample of volunteer respondents who represented diverse racial (37% Black, 37% White, 18% Latino, 7% other), gender (65% male, 34% female, 1% transgender) and sexual orientation (48% heterosexual, 44% gay, 8% bisexual) backgrounds. The fit of the final structural equation model was good (root mean square error of approximation = .055, Comparative Fit Index=.953, Tucker Lewis Index=.945). Standardized effects with bootstrap confidence intervals are reported. Overall, the findings support the hypothesis that vocational rehabilitation services can play an important role in health and prevention strategies outlined in the National HIV/AIDS strategy.

The causal effect of switching to second-line ART in programmes without access to routine viral load monitoring

We examined the effect of switching to second-line antiretroviral therapy (ART) on mortality in patients who experienced immunological failure in ART programmes without access to routine viral load monitoring in sub-Saharan Africa.

Agricultural Policymaking: Interest Groups and Access to Governmental Officials

Conservation agriculture that focuses on soil recovery is both economically and environmentally sustainable. This lies in contrast with many of the current agricultural practices, which push for high production, which, in turn lead to over-depletion of the soil. Agricultural interest groups play a role in crafting farming policies with governmental officials. Therefore, my study examined three interest group types agribusinesses, farmer organizations, and environmental NGOs that seek to influence agricultural policy, specifically focusing on the federal farm bill, due to its large impact throughout the nation. The research in which data wasgathered through subject interviews, a literature review, and databases found that access to governmental officials affects the amount of influence a group can have. Access is contingent upon: 1) the number of networks (social, professional, and political), 2) amount of money spent through campaign contributions and lobbying expenditures, and 3) extent of business enterprises and subsidiaries. The evidence shows that there is a correlation between these variables and the extent of access. My research concludes that agribusiness interest groups have the most access to government officials, and thus have the greatest influence on agricultural policies. Because agribusinesses support subsidies of commodity-crops this indirectly impacts conservation agriculture, as the two programs compete in a zero-sum game for funding in the farm bills.