Willingness to Pay for Preventive Dental Care Amongst Older Adults

ObjectiveThe aims of this study were (1) to investigate willingness to pay (WTP) for preventive and curative dental care procedures and (2) to determine the factors that influence older adults’ WTP for dental care.MethodologyOlder, independently living adults from Singapore aged 60 years and older and eligible for government-subsidised dental care were nonrandomly recruited for this study. Data were collected using questionnaires and a clinical examination which recorded details of caries experience, number and distribution of posterior occluding contacts, prosthodontic status, and periodontal status. Using a contingent valuation method, participants were asked to rate WTP in Singapore dollars [SGD$] for 4 aspects of care: dental fillings, dental scaling, dental extraction, and disease prevention advice. Negative binomial regression was used to assess the relationship between the predictor variables associated with WTP for dental fillings, scaling, extraction, and preventive advice.ResultsThe mean value of WTP for a dental filling was SGD$30.23 (SGD$31.05), for scaling was SGD$30.28 (SGD$29.46), for dental extraction was SGD$35.08 (SGD$58.54). In a multivariate model, factors associated with higher WTPfees were as follows: (1) dental filling: age (younger), level of education (higher), and frequency of dental visits (regular); (2) scaling: level of education (higher), agree that dental problems affect overall health, and frequency of dental visits (regular); (3) dental extractions: age (younger), level of education (higher), frequency of dental visits (regular), and prosthodontic status (not wearing); (4) preventive advice: age (younger), gender (male), ethnicity (Chinese), level of education (higher), marital status (married), self-perceived oral health (good), and dental visits (regular).ConclusionsThe findings of our study suggest that older adults are willing to pay most for extraction and least for preventive advice.Key words: Geriatric, Oral health, Health economics, Health attitudes     

Pregnenolone and its sulphate modulate GABAA-receptor-mediated contractile responses in the guinea-pig isolated ileum

Pregnenolone and its sulphate had concentration-dependent dual actions on gamma-aminobutyric acid (GABAA)-receptor-mediated ileal contractile responses, enhancing at 0.001-1 microM but inhibiting at 10 microM. There was a sinistral shift of the GABA dose-response curve in the presence of 0.01 microM pregnenolone, with a significant potentiation over the lower concentration range of GABA (3-30 microM), whilst 10 microM pregnenolone depressed the curve by 50% without a significant change in the EC50, in a manner resembling non-competitive inhibition with picrotoxin. Pregnenolone and its sulphate evidently have modulatory actions at ileal GABAA-receptor complexes in keeping with those seen using neurochemical studies in the central nervous system.     

Mu rhythm suppression over sensorimotor regions is associated with greater empathic accuracy

When people encounter others’ emotions, they engage multiple brain systems, including parts of the sensorimotor cortex associated with motor simulation. Simulation-related brain activity is commonly described as a ‘low-level’ component of empathy and social cognition. It remains unclear whether and how sensorimotor simulation contributes to complex empathic judgments. Here, we combine a naturalistic social paradigm with a reliable index of sensorimotor cortex-based simulation: electroencephalography suppression of oscillatory activity in the mu frequency band. We recruited participants to watch naturalistic video clips of people (‘targets’) describing emotional life events. In two experiments, participants viewed these clips (i) with video and sound, (ii) with only video or (iii) with only sound and provided continuous ratings of how they believed the target felt. We operationalized ‘empathic accuracy’ as the correlation between participants’ inferences and targets’ self-report. In Experiment 1 (US sample), across all conditions, right-lateralized mu suppression tracked empathic accuracy. In Experiment 2 (Israeli sample), this replicated only when using individualized frequency-bands and only for the visual stimuli. Our results provide novel evidence that sensorimotor representations—as measured through mu suppression—play a role not only in low-level motor simulation, but also in higher-level inferences about others’ emotions, especially when visual cues are crucial for accuracy.     

Two-year clinical outcomes following lower limb endovascular revascularisation for chronic limb-threatening ischaemia at a tertiary Asian vascular centre in Singapore

INTRODUCTIONPercutaneous transluminal angioplasty (PTA) is commonly used to treat patients with chronic limb-threatening ischaemia (CLTI). This study aimed to examine the mortality and functional outcomes of patients with CLTI who predominantly had diabetes mellitus in a multi-ethnic Asian population in Singapore.METHODSPatients with CLTI who underwent PTA between January 2015 and March 2017 at the Vascular Unit at Singapore General Hospital, Singapore, were studied. Primary outcome measures were 30-day unplanned readmission, two-year major lower extremity amputation (LEA), mortality rates, and ambulation status at one, six and 12 months.RESULTSA total of 221 procedures were performed on 207 patients, of whom 184 (88.9%) were diabetics. The one-, six- and 12-month mortality rate was 7.7%, 16.4% and 21.7%, respectively. The two-year LEA rate was 30.0%. At six and 12 months, only 96 (46.4%) and 93 (44.9%) patients were ambulant, respectively. Multivariate analysis revealed that preoperative ambulatory status, haemoglobin, Wound Ischaemia and foot Infection (WIfI) score, and end-stage renal failure (ESRF) were independent predictors of one-year ambulatory status. Predictors of mortality at one, six and 12 months were ESRF, preoperative albumin level, impaired functional status and employment status.CONCLUSIONPTA for CLTI was associated with low one-year mortality and two-year LEA rates but did not significantly improve ambulation status. ESRF and hypoalbuminaemia were independent predictors of mortality. ESRF/CKD and WIfI score were independent predictors of loss of ambulation at six months and one year. We need better risk stratification for patients with CLTI to decide between initial revascularisation and an immediate LEA policy.     

Bond strength,compositional, and structural properties of hydroxyapatite coating on Ti,ZrO2-coated Ti,and TPS-coated Ti substrate

The effect of titanium plasma-sprayed (TPS) and zirconia (ZrO(2))-coated titanium (Ti) substrates on the adhesive, compositional, and structural properties of plasma-sprayed hydroxyapatite (HA) coatings were evaluated. X-ray diffraction, Fourier transform infrared (FTIR) spectroscopy, scanning electron microscopy, energy dispersive spectroscopy, surface roughness, and adhesive strength were used to characterize the coatings. Apatite-type and alpha-tricalcium phosphate phases were observed for all HA coatings. A structural change due to the absence of a 960 cm(-1) peak during FTIR analysis was observed for all HA coatings. The coating surfaces appeared rough and melted, with surface roughness correlating to the size of the starting powder. No significant difference in the Ca/P ratio of HA on Ti and TPS-coated Ti substrates was observed. However, the Ca/P ratio of HA on ZrO(2)-coated Ti substrate was significantly increased. Interfaces between all coatings and substrates were observed to be dense and tightly bound, except for HA coatings on TPS-coated Ti substrate interface. However, an intermediate TPS or ZrO(2) layer between the HA and Ti substrate resulted in a lower adhesive strength as compared to HA on Ti substrate.