Patient-centered care factors and access to care: a path analysis using the Andersen behavior model.

OBJECTIVES: Using the Andersen behavioral model, we examined the complex relationships among geographic access to care, financial disadvantage, patient-centered care factors, and access to care outcomes. STUDY DESIGN: This was a retrospective, cross-sectional study of the US civilian non-institutionalized population. METHODS: Our analytic sample included 15,787 US adults aged 18 years or older who had health insurance coverage for a full year in Medical Expenditure Panel Survey 2014-2015. Structural equation modeling was used to determine the associations among usual source of care, travel time to provider, financial disadvantage, patient-centered care factors (perceived interaction with health provider, shared decision-making, and value of health care), and access to care (perceived access to care and unmet need of health services). RESULTS: Our analysis showed that patient-centered care factors were associated with improved perceived access to care (ß = 0.03 to 0.56, P = .002) and reduced unmet needs of health care (ß = -0.03 to -0.17, P = .03 to < .001). Although longer travel time to provider and having financial disadvantage of paying medical bills had negative effects on access to care outcomes, these associations were mediated by patient-centered care quality factors. CONCLUSIONS: Our findings suggest that better patient-centered care factors are associated with enhanced patient access to care. Efforts that focus on improving patient experience could be an effective approach along with coverage expansion to enhance access to quality care.

[Advances in application of clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated 9 system in stem cells research].

Gene engineering has attracted worldwide attention because of its ability of precise location of disease mutations in genome. As a new gene editing technology, clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated 9 (Cas9) system is simple, fast, and accurate to operate at a specific gene site. It overcomes the long-standing problem of conventional operation. At the same time, stem cells are a good foundation for establishing disease model in vitro. Therefore, it has great significance to combine stem cells with the rapidly developing gene manipulation techniques. In this review, we mainly focus on the mechanism of CRISPR/Cas9 technology and its application in stem cell genomic editing, so as to pave the way for promoting rapid application and development of CRISPR/Cas9 technology.

Population phylogenomic analysis and origin of mitochondrial DNA in Chinese domestic pig.

The genetic diversity of eight domestic pigs was analyzed using a hypervariable fragment in the mitochondrial (mt) DNA control region; a portion of the hypervariable control region (515 bp) was sequenced from 153 samples. Haplotype diversity and nucleotide diversity in Yushan black pig populations were significantly higher than other populations (p < 0.01). A neighbor-joining tree was constructed from domestic pig mtDNA and five wild pigs. The results indicate that there are only small differences among individual pigs from different regions. Networks of the domestic pigs were constructed to better visualize the relationships between sequences. Each core haplotype was surrounded by a star-like pattern, consistent with recent population expansion.

Phylogeography and origin of Chinese domestic chicken.

The loss of local chicken breeds as result of replacement with cosmopolitan breeds indicates the need for conservation measures to protect the future of local genetic stocks. The aim of this study is to describe the patterns of polymorphism of the hypervariable control region of mitochondrial DNA (HVR1) in domestic chicken in China's Jiangxi province to investigate genetic diversity, genetic structure and phylo-dynamics. To this end, we sequenced the mtDNA HVR1 in 231 chickens including 22 individuals which belonged to previously published sequences. A neighbor-joining tree revealed that these samples clustered into five lineages (Lineages A, B, C, E and G). The highest haplotype diversity and nucleotide diversity were both found in Anyi tile-liked gray breed. We estimated that the most recent common ancestor of the local chicken existed approximately 16 million years ago. The mismatch distribution analysis showed two major peaks at positions 4 and 9, while the neutrality test (Tajima's D = -2.19, p < 0.05) and Fu's F-statistics (-8.59, p < 0.05) revealed a significant departure from the neutrality assumption. These results support the idea that domestication of chickens facilitated population increases. Results of a global AMOVA indicated that there was no obvious geographic structure among the local chicken breeds analyzed in this study. The data obtained in this study will assist future conservation management of local breeds and also reveals intriguing implications for the history of human population movements and commerce.

Expression and genomic imprinting of DCN, PON2 and PEG3 genes in porcine placenta.

Imprinted genes play vital roles in the placental development and fetal growth in eutherian mammals. DCN (decorin), PON2 (paraoxonase 2) and PEG3 (paternally expressed 3) genes have been identified as imprinted genes in the mouse. Here, we detected the imprinting status of three genes in the porcine placenta on DG90 (day 90 of gestation) and the expression differences in Yorkshire and Meishan placenta on DG26, DG55 and DG90. The results indicated that the DCN and PON2 genes were not imprinted genes, while the PEG3 gene showed paternal monoallelic expression in porcine placenta. The expression of the DCN gene increased from DG26 to DG90 in both Yorkshire and Meishan pig placenta. However, this gene expression was greater in Yorkshire than Meishan pig on DG55. The expression of the PON2 gene was greater in Meishan pig than that in Yorkshire on DG26 and DG90. The PEG3 gene expression was not affected by day of pregnancy or breed. Data from the present study contribute to function genomic of porcine placental development.