THE DEMAND FOR PREVENTIVE AND RESTORATIVE DENTAL SERVICES

Chronic tooth decay is the most common chronic condition in the United States among children ages 5–17 and also affects a large percentage of adults. Oral health conditions are preventable, but less than half of the US population uses dental services annually. We seek to examine the extent to which limited dental coverage and high out‐of‐pocket costs reduce dental service use by the nonelderly privately insured and uninsured. Using data from the 2001–2006 Medical Expenditure Panel Survey and an American Dental Association survey of dental procedure prices, we jointly estimate the probability of using preventive and both basic and major restorative services through a correlated random effects specification that controls for endogeneity. We found that dental coverage increased the probability of preventive care use by 19% and the use of restorative services 11% to 16%. Both conditional and unconditional on dental coverage, the use of dental services was not sensitive to out‐of‐pocket costs. We conclude that dental coverage is an important determinant of preventive dental service use, but other nonprice factors related to consumer preferences, especially education, are equal if not stronger determinants. Copyright © 2013 John Wiley & Sons, Ltd.     

社区老年人自助养老现状与需求调查

目的：了解社区老年人自助养老现状及需求,为推进多元化养老模式的改革和发展提供依据。方法：自行设计调查问卷,随机对社区60岁及以上老年人152人进行调查。结果：从未接受其他老年人无偿和有偿照顾者分别为73.7%和82.9%;从未为其他老年人提供无偿和有偿照顾者分别为73.7%和90.8%;有接受其他老年人无偿和有偿照顾意愿者分别为73.7%和55.3%;有承担其他老年人无偿和有偿照顾意愿者分别为73.7%和51.3%。结论：社区老年人自助养老意识较薄弱,但有较高的自助养老意愿,应积极倡导自助养老理念,促进多元化养老模式的开展,努力实现“积极老龄化”。     

Supplier-induced demand for newborn treatment: Evidence from Japan

We estimate the degree of supplier-induced demand for newborn treatment by exploiting changes in reimbursement arising from the introduction of the partial prospective payment system (PPS) in Japan. Under the partial PPS, neonatal intensive care unit (NICU) utilization became relatively more profitable than other procedures, since it was excluded from prospective payments. We find that hospitals have responded to PPS adoption by increasing NICU utilization and by more frequently manipulating infants’ reported birth weights which in large part determine their maximum allowable stay in the NICU. This induced demand substantially increases the reimbursements received by hospitals.     

Site‐Specific Labeling of Proteins and Peptides with Trans‐cyclooctene Containing Handles Capable of Tetrazine Ligation

There is a growing library of functionalized non‐natural substrates for the enzyme protein farnesyltransferase (PFTase). PFTase covalently attaches these functionalized non‐natural substrates to proteins ending in the sequence CAAX, where C is a cysteine that becomes alkylated, A represents an aliphatic amino acid, and X is Ser, Met, Ala, or Gln. Reported substrates include a variety of functionalities that allow modified proteins to undergo subsequent bioconjugation reactions. To date the most common strategy used in this approach has been copper catalyzed azide‐alkyne cycloaddition (CuAAC). While being fast and bioorthogonal CuAAC has limited use in live cell experiments due to copper's toxicity.¹ Here, we report the synthesis of trans‐cyclooctene geranyl diphosphate. This substrate can be synthesized from geraniol in six steps and be enzymatically transferred to peptides and proteins that end in a CAAX sequence. Proteins and peptides site‐specially modified with trans‐cyclooctene geranyl diphosphate were subsequently targeted for further modification via tetrazine ligation. As tetrazine ligation is bioorthogonal, fast, and is contingent on ring strain rather than the addition of a copper catalyst, this labeling strategy should prove useful for labeling proteins where the presence of copper may hinder solubility or biological reactivity.     

Application of Hydrogen Peroxide to the Control of Eutrophic Lake Systems in Laboratory Assays

We exposed water samples from a recreational lake dominated by the cyanobacterium Planktothrix agardhii to different concentrations of hydrogen peroxide (H₂O₂). An addition of 0.33 mg·L⁻¹ of H₂O₂ was the lowest effective dose for the decay of chlorophyll-a concentration to half of the original in 14 h with light and 17 h in experiments without light. With 3.33 mg·L⁻¹ of H₂O₂, the values of the chemical oxygen demand (COD) decreased to half at 36 and 126 h in experiments performed with and without light, respectively. With increasing H₂O₂, there is a decrease in the total and faecal coliform, and this effect was made more pronounced by light. Total and faecal coliform were inhibited completely 48 h after addition of 3.33 mg·L⁻¹ H₂O₂. Although the densities of cyanobacterial cells exposed to H₂O₂ did not decrease, transmission electron microscope observation of the trichomes showed several stages of degeneration, and the cells were collapsed after 48 h of 3.33 mg·L⁻¹ of H₂O₂ addition in the presence of light. Our results demonstrate that H₂O₂ could be potentially used in hypertrophic systems because it not only collapses cyanobacterial cells and coliform bacteria but may also reduce chlorophyll-a content and chemical oxygen demand.     

The needs of patients with post–intensive care syndrome: A prospective,observational study

BackgroundThe needs of critical illness survivors and how best to address these are unclear.ObjectivesThe objective of this study was to identify critical illness survivors who had developed post–intensive care syndrome and to explore their use of community healthcare resources, the socioeconomic impact of their illness, and their self-reported unmet healthcare needs.MethodsPatients from two intensive care units (ICUs) in Western Australia who were mechanically ventilated for 5 days or more and/or had a prolonged ICU admission were included in this prospective, observational study. Questionnaires were used to assess participants' baseline health and function before admission, which were then repeated at 1 and 3 months after ICU discharge.ResultsFifty participants were enrolled. Mean Functional Activities Questionnaire scores increased from 1.8 out of 30 at baseline (95% confidence interval [CI]: 0–3.5) to 8.9 at 1 month after ICU discharge (95% CI: 6.5–11.4; P = <0.001) and 7.0 at 3 months after ICU discharge (95% CI: 4.9–9.1; P = < 0.001). Scores indicating functional dependence increased from 8% at baseline to 54% and 33% at 1 and 3 months after ICU discharge, respectively. Statistically significant declines in health-related quality of life were identified in the domains of Mobility, Personal Care, Usual Activities, and Pain/Discomfort at 1 month after ICU discharge and in Mobility, Personal Care, Usual Activities, and Anxiety/Depression at 3 months after ICU discharge. An increase in healthcare service use was identified after ICU discharge. Participants primarily identified mental health services as the service that they felt they would benefit from but were not accessing. Very low rates of return to work were observed, with 35% of respondents at 3 months, indicating they were experiencing financial difficulty as a result of their critical illness.ConclusionsStudy participants developed impairments consistent with post–intensive care syndrome, with associated negative socioeconomic ramifications, and identified mental health as an area they need more support in.     

山东省临床护士移动护理类APP功能需求及使用意愿的现状调查

[目的]调查山东省医院护士移动护理类应用程序(APP)功能需求及使用意愿的现状,为进一步开展移动护理类APP临床使用提供依据。[方法]采用方便抽样,对山东省1207名护士进行问卷调查,问卷内容包括一般资料、移动护理类APP知晓情况调查表、移动护理类APP功能需求调查表、移动护理类APP使用意愿调查表。[结果]参与调查的护士群体中,有289名(23.94%)护士使用过移动护理类APP,769名(63.71%)护士知晓移动护理类APP;护士对移动护理类APP的“病人端口药物提醒”及“护士端口健康护理”功能需求最高;护士对移动护理类APP使用意愿平均分为(4.16±0.69)分。[结论]护士对移动护理类APP的知晓度好、功能需求高,同时有较强的使用意愿。护理管理者应重视护士及病人双方对移动护理类APP的软件功能需求及使用心理,以期促进移动护理类APP更好地满足于护理服务。     

医养结合机构失能老人服务供需匹配问卷的研制

目的编制医养结合机构失能老人服务供需匹配问卷。方法于2019年4—5月,在文献研究、半结构访谈和专家咨询的基础上拟定问卷初稿,通过德尔菲法对14名专家进行2轮函询。根据专家函询结果对问卷进行修改和完善,形成最终版问卷。计算专家积极系数、专家权威系数、专家意见集中程度、专家意见协调系数。结果2轮专家函询问卷的有效回收率分别为93.3%和100.0%,专家权威系数为0.92。第2轮函询中,维度及条目的专家意见协调系数分别为0.638和0.407(P<0.001),变异系数均<20%。最终确立的医养结合机构失能老人服务供需匹配问卷包括5个维度,30个条目。结论医养结合机构失能老人服务供需匹配问卷的科学性和可靠性较好,内容全面,可作为有利的调查工具进行失能老人服务供需匹配研究,为制订医养结合照护服务供给方案提供参考依据。