缺失数据的多重估算

目的 探讨多重估算方法在缺失数据分析中的应用。方法 利用Bayesian理论与MCMC方法，在NORM软件中模拟得到m个完整数据集。结果 对m个重复测量数据集用SAS软件分析，合并m个分析结果可见，由NORM软件合并数据集的标准差比缺失数据集更稳定。结论 多重估算法既能反映缺失数据的不确定性，又可充分利用资料信息，对模型估计结果更可信。     

Informal out-of-pocket payments for healthcare services in Greece

BackgroundInformal out-of-pocket (OOP) payments for healthcare services are not unusual in Greece.AimThis study estimates the association between respondent and incident-level characteristics and informal payments.MethodsA survey of 4218 households was conducted from November 2016 to February 2017. We analyzed healthcare incidents by all household members within the past four months. Multivariate negative binomial regression analysis was used to estimate the association between respondents and incident-level characteristics and informal OOP payments to providers.ResultsA total of 3494 healthcare incidents were reported by 3183 household-representatives. More-than-half (63 %) of all incidents involved informal activity (median=€150). About 30 % of those were related to provider requested payments. Using hospital, dental, diagnostic/screening, and emergency department services compared to primary care services and having oncological and surgical conditions were among the strongest predictors of higher rates for informal payments. The use of specific providers for reasons related to trust, reputation, referral, and lack of alternatives was also associated with higher rates of informal payments. Provider requested and skip the line payments were associated with larger OOP amounts compared to gratitude payments.ConclusionThis survey reveals that informal payments occur for higher-need and less cost-responsive healthcare services particularly in areas where patients lack alternatives. Health policy and regulatory interventions, including stricter control of the financial reporting system are essential to limit informal payments.     

三种膳食油脂对人血清补体、细胞炎性反应因子和趋化因子及其相关蛋白水平的调节作用及机制初探

目的 观察膳食油脂棕榈液油（palm oil,PO）、可可脂（cocoa butter,CO）、大豆油（soybean oil,SO）对人血清补体成分C3、C4、肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、白细胞介素-10（interleukin-10,IL-10）、正常T细胞表达和分泌的活性调节蛋白（secreted regulatory proteins,RANTES）水平的影响。方法 以符合纳入和排除标准的健康青年大学生作为受试者,按体质量指数（body mass index,BMI）采用数字表法随机分为3组,分别是棕榈液油组、可可脂组、大豆油组,每组31名,共93名,分别摄入受试油脂12周,分别在实验开始的第0周和实验结束的第12周检测受试者血清补体成分C3、C4、细胞炎性反应相关因子包括TNF-α、IL-10、趋化因子及RANTES水平。结果 各组受试者实验前后比较,受试者血清补体C3、C4水平均降低,差异有统计学意义（P<0.05）;棕榈液油组和大豆油组受试者血清TNF-α水平显著性降低（P<0.05）;大豆油组受试者血清IL-10水平显著性升高（P<0.05）;3组实验前后受试者血清RANTES水平差异无统计学意义（P>0.05）。与实验前比较,实验后,3组油脂血清补体成分、细胞炎性反应因子和活性调节蛋白水平的差异均无统计学意义（P>0.05）。结论 棕榈液油、可可脂和大豆油这3种膳食油脂均可能降低人体炎性反应状态,尤其是大豆油的效果更加显著。     

Sources of free radicals and oxidative stress in the oral cavity

ObjectiveAn oral cavity is a place especially susceptible to oxidative damage. It is subjected to many environmental pro-oxidative factors or factors that have the ability to generate reactive oxygen species (ROS). The aim of this article is to present the main sources of ROS and oxidative stress in the oral environment.DesignA literature search was performed using the PubMed and Google Scholar databases.ResultsOne of the most important ROS sources in the oral cavity is periodontal inflammation. Other sources of ROS include: xenobiotics (ethanol, cigarette smoke, drugs), food (high-fat diet, high-protein diet, acrolein), dental treatment (ozone, ultrasound, non-thermal plasma, laser light, ultraviolet light), and dental materials (fluorides, dental composites, fixed orthodontic appliances, and titanium fixations). It has been shown that excessive production of ROS in the oral cavity may cause oxidative stress and oxidative damage to cellular DNA, lipids, and proteins, thus predisposing to many oral and systemic diseases.ConclusionsRecognition of the exogenous sources of ROS and limitation of exposure to the ROS generating factors can be one of the prophylactic measures preventing oral and systemic diseases. It is suggested that antioxidant supplementation may be helpful in people exposed to excessive production of ROS in the oral cavity system.     

Quantitative assessment of salivary oral bacteria according to the severity of dental caries in childhood

This study aimed to assess differences in selected oral bacteria in children according to the severity of dental caries. One hundred and thirty-six children, 36–60 months old were divided into three groups according to caries status: caries-free (CF) (n = 47), early childhood caries (ECC) (n = 40) and severe-early childhood caries (S-ECC) (n = 49). Saliva was collected for detection and quantification of selected oral streptococci, Actinomyces naeslundii, Lactobacillus spp., Bifidobacterium spp., and Scardovia wiggsiae by quantitative-polymerase chain reaction. The results showed that the detection and quantitative levels of S. mutans, S. sobrinus, Bifidobacterium spp. and S. wiggsiae were significantly higher in S-ECC children compared to CF and ECC children, while for S. salivarius were significantly higher in CF compared to ECC and S-ECC children. There was no statistical difference among the clinical groups for S. mitis, S. oralis, A. naeslundii and Lactobacillus spp. levels and detection. S-ECC children had a lower monthly family income, started tooth brushing later and were breastfeed for a longer duration compared to CF children. S. mutans levels were positively correlated with S. wiggsiae and Bifidobacterium spp. levels, lower mother’s education and child bottle-feeding before sleeping and negatively correlated with S. salivarius. It was concluded that in addition to S. mutans, other bacterial species, including bifidobacteria, Scardovia wiggsiae and S. sobrinus, are associated with severity of early childhood caries, although their role in the progress of dental caries remains unclear.     

Increased activity of the antioxidants systems modulate the oxidative stress in saliva of toddlers with early childhood caries

ObjectiveThis study aimed to evaluate the oxidative stress levels and the enzymatic and non-enzymatic antioxidant systems in saliva of toddlers with severe early childhood caries (S-ECC).DesignUnstimulated saliva samples were collected at the morning from 0 to 3 year-old S-ECC (n = 30) or caries-free (CF) children (n = 30/group) for evaluation of oxidative stress (OS) and total antioxidant capacity (TAC), which were measured by the ferric reducing antioxidant power (FRAP) assay, as well as to assess the activity of enzymatic (superoxide dismutase, SOD) and non-enzymatic (uric acid, UA) antioxidant systems, respectively. Data were analyzed by Student’s t-test (p < 0.05).ResultsSignificantly higher protein levels were observed in saliva of S-ECC children (0.083 mg/mL) than in the CF group (0.070 mg/mL). Oxidative damage was significantly lower in saliva of S-ECC children (0.0019 μmol/L/mg protein) than in CF children (0.0039 μmol/L/mg protein), while salivary TAC (61.5 μmol/L), SOD activity (36.6 UE/mL) and uric acid (7.05 mg/mL) were significantly higher in saliva of S-ECC when compared to the CF group (49.1 μmol/L, 26.8 UE/mL and 5.02 mg/mL, respectively for TAC, SOD and UA).ConclusionOxidative stress levels were significantly lower in saliva of S-ECC children, what might be associated with the increased activity of salivary enzymatic (SOD) and non-enzymatic (uric acid) antioxidant systems.     

Insights from the design and implementation of a single-entry model of referral for total joint replacement surgery: Critical success factors and unanticipated consequences

BackgroundSingle-entry models (SEMs) in healthcare allow patients to see the next-available provider and have been shown to improve waiting times, access and patient flow for preference-sensitive, scheduled services. The Winnipeg Central Intake Service (WCIS) for hip and knee replacement surgery was implemented to improve access in the Winnipeg Regional Health Authority. This paper describes the system’s design/implementation; successes, challenges, and unanticipated consequences.MethodsOn two occasions, during and following implementation, we interviewed all members of the WCIS project team, including processing engineers, waiting list coordinators, administrators and policy-makers regarding their experiences. We used semi-structured telephone interviews to collect data and qualitative thematic analysis to analyze and interpret the findings.ResultsRespondents indicated that the overarching objectives of the WCIS were being met. Benefits included streamlined processes, greater patient access, improved measurement and monitoring of outcomes. Challenges included low awareness, change readiness, and initial participation among stakeholders. Unanticipated consequences included workload increases, confusion around stakeholder expectations and under-reporting of data by surgeons’ offices. Critical success factors for implementation included a requirement for clear communication, robust data collection, physician leadership and patience by all, especially implementation teams.ConclusionsAlthough successfully implemented, key lessons and critical success factors were learned related to change management, which if considered and applied, can reduce unanticipated consequences, improve uptake and benefit new models of care.