Factors associated with health service utilization in Ulaanbaatar, Mongolia: a population-based survey.

BACKGROUND: Understanding patterns of health service utilization can improve health care and increase use of health services. We examined patterns of health service utilization among residents of Ulaanbaatar, Mongolia. METHODS: A total of 500 adults were surveyed using paper-based questionnaires. The χ(2) test and multiple logistic regression were used to identify associations between factors. RESULTS: 44.1% of respondents had visited a physician during the previous 12 months. After controlling for determinants, the significant predictors of utilization of health service were attention to health examinations (OR = 3.6, CI: 1.93-6.76), being married (OR = 2.7, CI: 1.50-4.72), being satisfied with the overall cleanliness of the hospital (OR = 2.4, CI: 1.12-5.19), being a nonsmoker (OR = 2.2, CI: 1.21-3.98), having periodic physical examinations (OR = 2.2, CI: 1.25-3.71), not being a hospital patient during the previous 3 years (OR = 2.1, CI: 1.22-3.73), having proper documentation (OR = 1.9, CI: 1.10-3.43), having medical insurance (OR = 1.9, CI: 1.96-3.28), not wanting to receive information on food and nutrition (OR = 0.6, CI: 0.36-0.96), having more than 5 household members (OR = 0.5, CI: 0.50-0.85), low income (OR = 0.5, CI: 0.30-0.85), lack of concern for food and nutrition (OR = 0.5, CI: 0.28-0.84), self-medication during the past 12 months (OR = 0.4, CI: 0.24-0.69), and desire for treatment abroad (OR = 0.4, CI: 0.20-0.60). CONCLUSIONS: A number of health-related behaviors and sociodemographic factors were important predictors of health service utilization.

Diffusion-weighted imaging of breast masses: comparison of diagnostic performance using various apparent diffusion coefficient parameters.

OBJECTIVE: The purpose of our study was to assess the utility of the minimum apparent diffusion coefficient (ADC), average ADC, maximum ADC, and ADC difference value and to find optimum ADC parameters for differentiation between benign and malignant lesions in breast diffusion-weighted imaging (DWI). MATERIALS AND METHODS: Sixty-seven women with 75 masslike lesions (27 benign, 48 malignant) were examined with 3-T MRI. To assess heterogeneity within the lesion, the difference between minimum and maximum ADCs was recorded as the ADC difference value. Diagnostic performances of these parameters were compared by receiver operating characteristic (ROC) curve analysis. RESULTS: Each ADC parameter showed significant differences between malignant and benign lesions. The optimal cutoff levels for differentiating benign versus malignant lesions were determined by identifying the points where the sensitivity and specificity were equal on the ROC curves. According to ROC analyses, the following sensitivities and specificities were obtained: average ADC, 75.6% and 75.6%; minimum ADC, 85.5% and 85.5%; maximum ADC, 63.5% and 63.5%; ADC difference value, 70.1% and 70.1%. Minimum ADC had the largest area under the ROC curve (AUC) of 0.93. Minimum ADC combined with the ADC difference value improved the AUC to 0.95, with sensitivity and specificity of 89.1% and 89.1%. CONCLUSION: Minimum ADC may be an optimal DWI single parameter for differentiation between malignant and benign lesions of breast masses. Furthermore, the combination of the minimum ADC and ADC difference value significantly elevated diagnostic performance of breast DWI in comparison with average ADC.

Predictive value for malignancy of suspicious breast masses of BI-RADS categories 4 and 5 using ultrasound elastography and MR diffusion-weighted imaging.

OBJECTIVE: The aim of this study is to evaluate the ability of ultrasound elastography and MR diffusion-weighted imaging (DWI) to predict malignancy of breast masses, with subsequent recommendation for biopsy. MATERIALS AND METHODS: For 115 breast masses classified as BI-RADS category 4 or 5, which were assessed according to combined findings of mammography, B-mode sonography, and dynamic contrast-enhanced MRI, two radiologists retrospectively evaluated the elasticity scores using ultrasound elastography and the apparent diffusion coefficient (ADC) values using MR DWI. The diagnostic abilities of these two techniques were analyzed by using univariate and multivariate logistic regression analysis. RESULTS: In the analysis of all 115 breast masses, the elasticity score was predictive of malignancy, whereas the ADC value was not independently predictive. In an analysis of the 52 masses assessed as BI-RADS category 4, the elasticity score was found to be a significant predictor of malignancy, compared with the ADC value, which was a nonsignificant predictor. In an analysis of the 63 masses assessed as BI-RADS category 5, neither the elasticity score nor the ADC value was a significant predictor of malignancy. CONCLUSION: Our results show that elasticity imaging provides relatively reliable predictions for malignancy, especially in BI-RADS category 4 masses, compared with MR DWI.

The trajectory patterns of parenting and the social competence of toddlers: a longitudinal perspective.

BACKGROUND: Many studies have suggested that the daily emotional interactions between a child and his/her caregiver play a significant role in his/her development. The purpose of this study was to determine whether the trajectory patterns of parenting patterns of caregivers raising toddlers affect the social competence of the toddlers. METHODS: The study participants were 246 dyads of 18-month-old children (baseline) and their caregivers, which was conducted as part of a Japan Science and Technology Agency (JST) project. We used the Interaction Rating Scale (IRS) to evaluate the children's social competence. We assessed the child rearing environments by analyzing the caregivers' responses to the Index of Child Care Environment (ICCE). RESULTS: Multiple logistic regression analysis showed that the children's total score on the IRS was significantly related to how frequently they sang songs together with their caregivers. Their score was also significantly related to how closely their caregiver worked with his/her partner in raising the child. These relationships did not change according to demographic information. CONCLUSIONS: The results confirm previous findings on the relationship between parenting patterns and children's social competence. In particular, the study shows that varied and continual parenting significantly affects a child's social competence.

Interaction Rating Scale (IRS) as an evidence-based practical index of children's social skills and parenting.

BACKGROUND: The purpose of this paper is to describe the features of the Interaction Rating Scale (IRS) as an evidence-based practical index of children's social skills and parenting. METHODS: The participants in our study, which was conducted as part of a Japan Science and Technology Agency (JST) project, were 370 dyads of children (aged 18, 30, and 42 month) and 81 dyads of 7-year-old children with their caregivers. The participants completed the five minute interaction session and were observed using the IRS. RESULTS: The results indicated that the IRS can measure children's social skill development and parenting with high validity. Along with the discriminate validity for pervasive development disorder (PDD), attention-deficit/hyperactivity disorder (ADHD), abuse and maltreatment, a high correlation with the SDQ (Strength and Difficulties Questionnaire), and high reliability, the IRS is effective in describing features of social skill development. CONCLUSIONS: The IRS provides further evidence of the fact that in order to study children's social skill development, it is important to evaluate various features of the caregiver-child interaction as a predictor of social skills.

The trajectory of children's social competence from 18 months to 30 months of age and their mother's attitude towards the praise.

BACKGROUND: Praise from caregivers has been shown as an important influence on the development of social competence in early adolescence. However, the effects of praise in younger children have not been investigated. We examined how the trajectory of children's social competence from 18 months to 30 months of age was related to their caregiver's attitude towards the importance of praise at times when their child was 4 months and 9 months old. METHODS: We studied 155 mother-child dyads, whose interactions during play were observed both when the child was 18 months and 30 months old, which was conducted as part of a Japan Science and Technology Agency (JST) project. The child's social competence was assessed using the Interaction Rating Scale (IRS). Demographic data was obtained when the child was 4 months old, and the caregiver's attitude towards the importance of praise when the child was both 4 months and 9 months old. A logistic regression analysis controlling for the effects of demographic variables was performed. RESULTS: We found that children who had received continuous praise from their mother when they were 4-9 months of age had a decreased risk of low social competence at 18-30 months of age. CONCLUSIONS: A mother's attitude towards the importance of praise at early stages of her child's development has an important influence on the later trajectory of social competence.

A longitudinal study on social competence development and sleeping habits.

BACKGROUND: It is known that sleep problems impact children's health, learning, and school performance. The purpose of this paper is to examine the association between sleeping habits and social competence development. METHODS: Three hundred and nine caregiver-child dyads participated in this study, which was conducted as part of a Japan Science and Technology Agency (JST) project. The caregivers answered some questionnaires about sleeping habits when the child was 9 months and 18 months old. Caregiver-child interaction was observed when the child was 30 months old, and the features of the interaction were examined using the Interaction Rating Scale (IRS) as a measure of social competence. RESULTS: The caregivers' attitude toward sleeping in the 9-month period was found to be significantly correlated with the children's social competence at 30 months. Moreover the caregivers' attitude toward sleeping in the 9-month period significantly correlated with the children's sleeping habits at 9 and 18 months. CONCLUSIONS: These findings show that the caregivers' attitude toward sleeping is an important factor influencing the development of children's social competence.

Implications of social competence among thirty-month-old toddlers: a theory of mind perspective.

BACKGROUND: The purpose of this study was to examine the relations between children's social competence and initial index of theory of mind at 30 months of age. METHODS: The participants of the study were 322 toddlers and parents/caregivers who were registered with the Japan Science and Technology Agency (JST) project. They completed a five-minute interaction session, which was coded using the Interaction Rating Scale (IRS) as an evidence-based practical index of children's social competence. In addition, the children were asked to complete a diverse-desire task as a ToM (theory of mind) index. RESULTS: The results showed that the ToM index was related to the total score and subscales of the IRS, such as Empathy and Emotional regulation. CONCLUSIONS: These findings show that the IRS score was related to ToM task performance at 30 months of age.

The relationship between the development of social competence and sleep in infants: a longitudinal study.

BACKGROUND: Many reports argue that sleep is important for children's health, learning, and academic performance. The purpose of this longitudinal study was to examine the association between sleep and the development of social competence in infants. METHODS: This study was conducted as part of a Japan Science and Technology Agency (JST) project. Caregivers responded to the Japan Children's Study Sleep Questionnaire when children were 18 months old. The interactions of caregivers and children were observed when children were 18, 30, and 42 months old, and rated with the Interaction Rating Scale, which is a measure of social competence. RESULTS: Nocturnal sleep duration of more than 10 h and an earlier bed time than 22:00 were significantly correlated with two trajectory groups (low point and high point transition groups) of children's social competence at 18, 30, and 42 months. Further, total sleep duration of more than 12.25 h and an earlier bed time than 22:00 were significantly correlated with the trajectory of children's social competence at 18, 30, and 42 months. CONCLUSIONS: Sleep duration and sleep onset time are important factors in children's development of social competence.Trial registration The ethics committee of the JST approved this study on March 19, 2001. The registration number is 356-1.

Environmental transition of signal-anchor sequences during membrane insertion via the endoplasmic reticulum translocon.

In biogenesis of membrane proteins on the endoplasmic reticulum, a protein-conducting channel called the translocon functions in both the membrane translocation of lumenal domains and the integration of transmembrane segments. Here we analyzed the environments of polypeptide chains during the processes by water-dependent alkylation of N-ethylmaleimide at site-directed Cys residues. Using the technique, the region embedded in the hydrophobic portion of the membrane within a signal-anchor sequence and its shortening by insertion of a Pro residue could be detected. When translocation of the N-terminal domain of the signal-anchor was arrested by trapping an N-terminally fused affinity tag sequence, the signal-anchor was susceptible to alkylation, indicating that its migration into the hydrophobic environment was also arrested. Furthermore, when the tag sequence was separated from the signal-anchor by insertion of a hydrophilic sequence, the signal-anchor became inaccessible to alkylation even in the N-terminally trapped state. This suggests that membrane integration of the signal-anchor synchronizes with partial translocation of its N-terminal domain. Additionally, in an integration intermediate of a membrane protein, both of the two translocation-arrested hydrophilic chains were in an aqueous environment flanking the translocon, suggesting that the translocon provides the hydrophilic pathway capable of at least two translocating chains.

Localization of ATP-sensitive K+ channel subunits in rat submandibular gland.

ATP-sensitive K(+) (K(ATP)) channel subunits were investigated in rat submandibular gland (SMG). RT-PCR detected the presence of mRNA transcripts of the Kir6.1, Kir6.2, SUR2A, and SUR2B in the SMG, whereas SUR1 mRNA was barely detected. Western blot analysis provided the evidence that these four K(ATP) channel subunits are expressed in rat SMG. Immunostaining detected that these four K(ATP) channel subunits are widely distributed, with different intensities, in myoepithelial cells, epithelial cells of intercalated ducts, granular convoluted tubules, striated ducts, and excretory ducts. Immunofluorescence double staining showed that Kir6.1 and Kir6.2 colocalized with SUR2A in the myoepithelial cells, granular convoluted tubules, striated ducts, and excretory ducts. Kir6.1 and Kir6.2 also colocalized with SUR2B, mainly in the duct system, e.g., the granular convoluted tubules, striated ducts, and excretory ducts. Taken together, these results indicate that the K(ATP) channels in SMG may consist of Kir6.1, Kir6.2, SUR2A, and SUR2B, with various combinations of colocalization with each other, and may play important roles in rat SMG during salivary secretion.

Cholesterol and plant sterol efflux from cultured intestinal epithelial cells is mediated by ATP-binding cassette transporters.

In this study we analyzed functions of ATP-binding cassette (ABC) transporters involved in sterol transport from Caco-2 cells. Treatment with a synthetic liver x receptor ligand elevated both mRNA and protein levels of ABCG5, G8, and ABCA1. The ligand stimulated cholesterol efflux, suggesting that ABC transporters are involved in it. To identify the acceptors of cholesterol, potential molecules such as apolipoprotein A-I, glycocholic acid, phosphatidylcholine, and bile acid micelles were added to the medium. Apo A-I, a known acceptor of cholesterol transported by ABCA1, elevated cholesterol efflux on the basal side, whereas the others raised cholesterol efflux on the apical side. Moreover, bile acid micelles preferentially augmented plant sterol efflux rather than cholesterol. Finally, in HEK293 cells stably expressing ABCG5/G8, bile acid micelle-mediated sterol efflux was significantly accelerated. These results indicate that ABCG5/G8, unlike ABCA1, together with bile acids should participate in sterol efflux on the apical surface of Caco-2 cells.