How does climate change risk affect energy poverty? International evidence.

Based on cross-country data from 2002 to 2019, we explore the impact of climate change risk (CCR) on energy poverty (EP), and the moderating role in the CCR-EP nexus is also discussed. The empirical results suggest that CCR can exacerbate EP, especially for rural areas. Moderating effect analysis shows that financial development, technological innovation, and adaptation readiness can modify the negative impacts of CCR on EP to some extent. Moreover, the impact of CCR on EP is heterogeneous, demonstrating that CCR is more likely to exacerbate EP in countries with low economic development, low economic freedom, high carbon intensity, and the Africa region. Our findings emphasize the challenge of balancing EP alleviation with climate change response and provide the policy guidance to promote coordinated development of CCR management and energy supply security.

The cost of "snubbing": the effect of parental phubbing on filial piety behavior in children and adolescents.

Background: Although numerous studies have used Chinese samples to examine the consequences of parental phubbing, these studies focused on children's mental health and peer interaction. No research to date has directly explored the association between parental phubbing and child-parent interaction. Since parental phubbing is a way how parents interact with their children (parent-child), it might be associated with the way how children interact with their parents (child-parent), such as filial piety behavior, which prescribes how children behave toward their parents and remains one of the goals of parents in educating their children in modern Chinese society. Based on social exchange theory and social gender theory, this study investigated the impact of parental phubbing on filial piety behavior and tested its mediation of perceived parental rejection, its moderation of gender among children and adolescents. Methods: This study was conducted using a questionnaire method. A total of 753 students from Grade 4 to 9 (Mage = 12.28 years, SD = 1.81 years) was surveyed using the Parental Phubbing Scale, Perceived Parental Rejection Questionnaire, and the revised Dual Filial Piety Scale. Results: First, parental phubbing was negatively correlated with reciprocal filial piety (RFP) behavior, but not correlated with authoritarian filial piety (AFP) behavior. Second, perceived parental rejection played a mediating role between parental phubbing and RFP behavior. Third, this direct effect was moderated by gender, in that it was stronger for boys than for girls. Conclusion: These findings suggest that there are intergenerational costs of phubbing, such as reducing children and adolescents' RFP behavior. The present study is the first to combine parent-child interaction in the digital media era (parental phubbing) with traditional Chinese child-parent interaction (RFP behavior), which expands the research topic on the influence of parental phubbing on children and adolescents' psychological development.

Assessment of physiological posterior-tooth displacement under habitual occlusal force by intraoral scanning using implant-supported crowns as the reference.

STATEMENT OF PROBLEM: Studies that have used digital methods to quantitatively evaluate physiological tooth displacement under occlusal force are sparse. PURPOSE: The purpose of this clinical study was to measure physiological posterior tooth displacement under occlusal force by intraoral scanning and reverse engineering technology by using implants as the reference. MATERIAL AND METHODS: A total of 14 participants received 15 implant-supported single mandibular first molar crowns. The surface data of maxillary and mandibular posterior teeth (U1 and L1) and the buccal occlusal data in the maximum intercuspal position (MIP) with habitual occlusal force were obtained by using an intraoral scanner (TRIOS 3, v20.1.2). The U1 and L1 data were segmented into single teeth, which were then aligned to the buccal occlusal data by using the "best-fit alignment" command to build the data under occlusal force (U2 and L2). U1 and L1 data were compared with U2 and L2 data to calculate the centroid and functional cusp vertex displacements and the long axis deflections of the second premolars and second molars, taking the first molar as the reference. The medians, and first quartile (Q1), third quartile (Q3) of the above data were reported, and the Shapiro-Wilk and Wilcoxon tests were used to analyze the differences (α=.05). RESULTS: Under occlusal force, the median (Q1, Q3) centroid displacements of posterior teeth ranged from 61 (52, 101) µm to 146 (80, 186) µm; the functional cusp vertex displacements ranged from 82 (62, 117) µm to 146 (98, 189) µm, and the long axis deflections ranged from 0.45 (0.25, 0.87) degrees to 1.03 (0.52, 1.41) degrees. Mandibular second premolars displaced lingually, mesially, and apically; mandibular second molars displaced distally and apically; and maxillary second premolars and second molars displaced lingually and apically. CONCLUSIONS: A digital method taking implant-supported single crowns as the reference was used to demonstrate physiological posterior-tooth displacement under habitual occlusal force.

Distribution, risk assessment of heavy metals in sediments, and their potential risk on water supply safety of a drinking water reservoir, middle China.

Heavy metals in reservoir sediments were analyzed to assess the pollution level and to understand the potential risk on water supply safety. Heavy metals in sediments will enter the biological chain through bio-enrichment and bio-amplification in water and eventually pose a threat to the safety of drinking water supply. Analysis of eight sampling sites in JG (Jian gang) drinking water reservoir of the sediments showed that from Feb 2018 to Aug 2019 heavy metals including Pb, Ni, Cu, Zn, Mo, and Cr increased by 1.09-17.2%. Vertical distributions of heavy metals indicated that the concentrations increased gradually by 9.6-35.8%. Risk assessment code analysis indicated that Pb, Zn, and Mo were of high risk in the main reservoir area. What is more, enrichment factors of Ni and Mo were 2.76-3.81 and 5.86-9.41, respectively, showing the characteristics of exogenous input. The continuous monitoring results of the bottom water showed that the concentration of heavy metals in the bottom water exceeded the environmental quality standard value of surface water in China, and exceeded the standard by 1.76 times (Pb), 1.43 times (Zn), and 2.04 times (Mo), respectively. Heavy metals in the sediments of JG Reservoir, especially in the main reservoir area, have a potential risk of release from the sediment to the overlying water. Water supply reservoir as a source of drinking water, its quality is directly related to human health and production activities. Therefore, this first study on JG Reservoir is of great significance for the protection of drinking water safety and human health.

Association of Autoimmune Disorders and Disease-modifying Antirheumatic Drugs: (DMARDs) with the Risk of Alzheimer's and/or Dementia: A Population Study Using Medicare Beneficiary Data.

OBJECTIVES: Alzheimer's disease (AD) and/or dementia is a prevalent neurocognitive disorder primarily affecting individuals over the age of 65. Identifying specific causes of AD and/or dementia can be challenging, with emerging evidence suggesting a potential association with autoimmune inflammatory conditions such as rheumatoid arthritis (RA). This study aimed to assess the prevalence rate of AD and/or dementia among Medicare beneficiaries reporting an autoimmune disorder. Additionally, this study sought to identify the comparative prevalence of AD and/or dementia in patients with an autoimmune disorder who were using disease-modifying antirheumatic drugs (DMARDs) compared to those not using DMARDs. METHODS: Cross-sectional secondary data analyses were conducted on Medicare Current Beneficiary Survey (MCBS) data from 2017 and 2018. The MCBS data consists of a nationally representative sample of the Medicare population, a population that is largely 65 and older, and provides de-identified patient information. Patients from this dataset with a self-reported autoimmune disorder were included in the analyses. Descriptive analyses were conducted on demographic variables, chronic conditions, and medication use. The prevalence of AD and/or dementia was compared between patients with and without an autoimmune disorder. A backward stepwise selection regression was used to identify the risk factors associated with the prevalence of AD and/or dementia. RESULTS: The study included 18,929 Medicare beneficiaries, with 4,405 identified as having one autoimmune disorder. The prevalence of AD and/or dementia was significantly higher in patients with an autoimmune disorder. The multivariate regression showed that RA was significantly associated with a higher risk of AD and/or dementia. Other demographic factors, including advanced age, African-American or Hispanic ethnicity, low body mass index, and chronic conditions of ischemic heart disease, history of myocardial infarction, history of stroke, depression, mental health disorder(s), and traumatic brain injury also showed statistically significant associations with AD and/or dementia. Patients using DMARDs demonstrated a reduced likelihood of having AD and/or dementia, compared to patients not using DMARDs. CONCLUSION: This study provides evidence of an association between RA and increased risk of AD and/or dementia. The findings suggest that DMARD use may have a protective effect against the development of AD and/or dementia in patients with an autoimmune disorder.

The economic burden of biologic disease-modifying antirheumatic drugs in rheumatoid arthritis patients in the United States.

BACKGROUND: Previous U.S. economic burden estimates for rheumatoid arthritis (RA) varied from $85.6 to $148.1 billion annually. However, these estimates do not reflect comparative amounts spent on RA treatment options in addition to other medical expenditures. Therefore, this study's goal was to comparatively analyze the overall economic burden of U.S. patients treated for RA using conventional disease-modifying antirheumatic drugs (DMARDs) versus TNF alpha biologic DMARDs. RESEARCH DESIGN AND METHODS: This retrospective observational study analyzed Medical Expenditure Panel Survey Household Component data from 2016 to 2018. Healthcare utilization, total medical expenditures, and out-of-pocket expenditures were compared between RA medication groups. RESULTS: Three hundred twenty-five adult RA patients experiencing 603 RA-related events, including at least one medical visit, were identified. Rheumatic arthritis-attributable medical expenditures among patients prescribed DMARDs were $11.4 billion. Average total medical expenditures were significantly higher for the TNF alpha biologic group $26,216.67 (95% CI: $19,502.84-$32,930.5) versus $5,388.52 (95% CI: $2,768.25-$8,008.79) for the conventional DMARD group (p < 0.001). CONCLUSIONS: RA patients receiving TNF alpha biologics experienced significantly higher total medical and out-of-pocket expenditures; however, they experienced fewer or no occurrences of high-cost drivers of healthcare utilization compared to patients receiving conventional DMARDs.

This study shows that rheumatoid arthritis (RA) patients with biologic-containing disease-modifying antirheumatic drugs (DMARDs) encountered significantly higher total medical expenditures as well as out-of-pocket (OOP) expenditures versus those with conventional DMARDs. The average total medical expenditures were $26,216.67 in the tumor necrosis factor (TNF) alpha biologic group and $5,388.52 in the conventional DMARD group. However, even with higher total medical expenditures, data suggests the TNF alpha biologic group experienced fewer emergency room visits, less home health services, and no hospitalizations compared to the conventional DMARD group.

Do Proposed Quality Measures for Carpal Tunnel Release Reveal Important Quality Gaps and Are They Reliable?

BACKGROUND: The American Academy of Orthopaedic Surgeons recently proposed quality measures for the initial surgical treatment of carpal tunnel syndrome (CTS). One measure addressed avoidance of adjunctive surgical procedures during carpal tunnel release; and a second measure addressed avoidance of routine use of clinic-based occupational and/or physical therapy (OT/PT) after carpal tunnel release. However, for quality measures to serve their intended purposes, they must be tested in real-world data to establish that gaps in quality exist and that the measures yield reliable performance information. QUESTIONS/PURPOSES: (1) Is there an important quality gap in clinical practice for avoidance of adjunctive surgical procedures during carpal tunnel release? (2) Is there an important quality gap in avoiding routine use of clinic-based occupational and/or physical therapy after carpal tunnel release? (3) Do these two quality measures have adequate beta-binomial signal-to-noise ratio (SNR) and split-sample reliability (SSR)? METHODS: This retrospective comparative study used a large national private insurance claims database, the 2018 Optum Clinformatics® Data Mart. Ideally, healthcare quality measures are tested within data reflective of the providers and payors to which the measures will be applied. We previously tested these measures in a large public healthcare system and a single academic medical center. In this study, we sought to test the measures in the broader context of patients and providers using private insurance. For both measures, we included the first carpal tunnel release from 28,083 patients performed by one of 7236 surgeons, irrespective of surgical specialty (including, orthopaedic, plastic, neuro-, and general surgery). To calculate surgeon-level descriptive and reliability statistics, analyses were focused on the 66% (18,622 of 28,083) of patients who received their procedure from one of the 24% (1740 of 7236) of surgeons with at least five carpal tunnel releases in the database. No other inclusion/exclusion criteria were applied. To determine whether the measures reveal important gaps in treatment quality (avoidance of adjunctive procedures and routine therapy), we calculated descriptive statistics (median and interquartile range) of the performance distribution stratified by surgeon-level annual volume of carpal tunnel releases in the database (5+, 10+, 15+, 20+, 25+, and 30+). Like the Centers for Medicare & Medicaid Services (CMS), we considered a measure "topped out" if median performance was greater than 95%, meaning the opportunity for further quality improvement is low. We calculated the surgeon-level beta-binomial SNR and SSR for each measure, each stratified by the number of carpal tunnel releases performed by each surgeon in the database. These are standard measures of reliability in health care quality measurement science. The SNR quantifies the proportion of variance that is between rather than within surgeons, and the SSR is the correlation of performance scores when each surgeons' patients are split into two random samples and then corrected for sample size. RESULTS: We found that 2% (308 of 18,622) of carpal tunnel releases involved an adjunctive procedure. The results showed that avoidance of adjunctive surgical procedures during carpal tunnel release had a median (IQR) performance of 100% (100% to 100%) at all case volumes. Only 8% (144 of 1740) of surgeons with at least five cases in the database had less than 100% performance, and only 5% (84 of 1740) had less than 90% performance. This means adjunctive procedures were rarely performed and an important quality gap does not exist based on the CMS criterion. Regarding the avoidance of routine therapy, there was a larger quality gap: For surgeons with at least five cases in the database, median performance was 89% (75% to 100%), and 25% (435 of 1740) of these surgeons had less than 75% performance. This signifies that the measure is not topped out and may reveal an important quality gap. Most patients receiving clinic-based OT/PT had only one visit in the 6 weeks after surgery. Median (IQR) SNRs of the first measure, which addressed avoidance of adjunctive surgical procedures, and the second measure, which addresses avoidance of routine use clinic-based OT/PT, were 1.00 (1.00 to 1.00) and 0.86 (0.67 to 1.00), respectively. The SSR for these measures were 0.87 (95% CI 0.85 to 0.88) and 0.75 (95% CI 0.73 to 0.77), respectively. All of these reliability statistics exceed National Quality Forum's emerging minimum standard of 0.60. CONCLUSION: The first measure, the avoidance of adjunctive surgical procedures during carpal tunnel release, lacked an important quality gap suggesting it is unlikely to be useful in driving improvements. The second measure, avoidance of routine use of clinic-based OT/PT, revealed a larger quality gap and had very good reliability, suggesting it may be useful for quality monitoring and improvement purposes. CLINICAL RELEVANCE: As healthcare systems and payors use the second measure, avoidance of routine use of clinic-based OT/PT, to encourage adherence to clinical practice guidelines (such as provider profiling, public reporting, and payment policies), it will be critically important to consider what proportion of patients receiving OT/PT should be considered routine practice and therefore inconsistent with guidelines. The value or potential harm of this measure depends on this judgement.

Occlusal Assessment of Zirconia Crowns Designed with the Digital Articulator and Traditional Methods.

PURPOSE: To evaluate and compare the occlusal fit of zirconia crowns designed using a digital articulator method and the traditional method in a self-controlled clinical trial. MATERIALS AND METHODS: Two zirconia crowns each were prepared for 12 patients with a single posterior tooth defect using two different methods: a digital articulator method and the traditional method. In the traditional method, casts were scanned using a model scanner, and the relative positions of the maxillary and mandibular arches were determined by the intercuspal occlusion of the casts. In the digital articulator method, casts were mounted on a mechanical articulator and scanned, and the relative positions were determined by their respective positions in the articulator. Additional dynamic occlusal adjustments of the digital articulator crowns were performed. Both groups of zirconia crowns were milled in a five-axis milling machine. The time required for occlusal adjustments, the occlusal contacts, the occlusal contact distributions, the number of occlusal contacts, the relative occlusal forces, and patient satisfaction (visual analog scale score) were evaluated. Wilcoxon test, McNemar test, and paired t test were used to compare the parameters between the two methods. RESULTS: The occlusal adjustment times for the digital articulator and traditional method crowns were 327 ± 226 seconds and 395 ± 338 seconds, respectively (P > .05). There were no significant differences in occlusal contacts, occlusal contact distributions, number of occlusal contacts, relative occlusal forces, or VAS scores between the two methods (P > .05). CONCLUSION: A digital articulator method for single-crown restoration was applied successfully. Crowns fabricated using a digital articulator or the traditional method can achieve acceptable occlusal fit for single-crown restorations.

Translation and cross-cultural adaption of the Chinese version of the Vanderbilt Head and Neck Symptom Survey version 2.0: a tool for oral symptom assessment in head and neck cancer patients.

BACKGROUND: Patients with head and neck cancer (HNC) who are receiving radiotherapy commonly face detrimental complications, including oral issues. However, oral symptoms are not well understood given the lack of available specific assessment instruments. The Vanderbilt Head and Neck Symptom Survey version (VHNSS) 2.0 is an instrument specifically developed to identify oral symptoms in HNC patients receiving radiotherapy in the United States. OBJECTIVE: To perform the translation and cross-cultural adaptation of the original English version of VHNSS 2.0 into a Chinese version (Mainland China). METHODS: The translation and cultural adaptation process involved translation by independent translators, construction of a consensus version, back translation into the original English version, analysis by the expert committee and a pretest. The pretest was administered to 90 patients with HNC to assess the feasibility and practicality of the tool. RESULTS: The final Chinese version approved by the expert committee was well understood by all participants in the study. The instrument had satisfactory content validity, with indexes of 0.83 for semantic and idiomatic equivalence, 0.90 for cultural equivalence, and 0.91 for conceptual equivalence. Furthermore, this version had good internal consistency, with Cronbach's alpha coefficients ranging from 0.74 to 0.95. CONCLUSION: The Chinese version of VHNSS 2.0 was translated and cross-culturally adapted for use in China. This translation is a feasible instrument to assess oral health-related quality of life in HNC patients undergoing radiotherapy and will be useful for symptom management by clinicians and researchers in China.

The gender gap and healthcare: associations between gender roles and factors affecting healthcare access in Central Malawi, June-August 2017.

BACKGROUND: Women in low and middle-income countries (LMICs) do not have equal access to resources, such as education, employment, or healthcare compared to men. We sought to explore health disparities and associations between gender prioritization, sociocultural factors, and household decision-making in Central Malawi. METHODS: From June-August 2017, a cross-sectional study with 200 participants was conducted in Central Malawi. We evaluated respondents' access to care, prioritization within households, decision-making power, and gender equity which was measured using the Gender-Equitable Men (GEM) scale. Relationships between these outcomes and sociodemographic factors were analyzed using multivariable mixed-effect logistic regression. RESULTS: We found that women were less likely than men to secure community-sourced healthcare financial aid (68.6% vs. 88.8%, p < 0.001) and more likely to underutilize necessary healthcare (37.2% vs. 22.4%, p = 0.02). Both men and women revealed low GEM scores, indicating adherence to traditional gender norms, though women were significantly less equitable (W:16.77 vs. M:17.65, p = 0.03). Being a woman (Odds Ratio (OR) 0.41, 95% confidence interval (CI) 0.21-0.78) and prioritizing a woman as a decision-maker for large purchases (OR 0.38, CI 0.15-0.93) were independently associated with a lower likelihood of prioritizing women for medical treatment and being a member of the Chewa tribal group (OR 3.87, CI 1.83-8.18) and prioritizing women for education (OR 4.13, CI 2.13-8.01) was associated with a higher odds. CONCLUSION: Women report greater barriers to healthcare and adhere to more traditional gender roles than men in this Central Malawian population. Women contribute to their own gender's barriers to care and economic empowerment alone is not enough to correct for these socially constructed roles. We found that education and matriarchal societies may protect against gender disparities. Overall, internal and external gender discrimination contribute to a woman's disproportionate lack of access to care.

An integrated system for rapid assessment of ecological quality based on remote sensing data.

Ecological quality assessment (EQA) is important for regional socio-economic development and its sustainability. To assess the status of land ecological quality more precisely, an ecological quality assessment system with 11 indicators of ecological stability, ecosystem service function, and habitat stress was established using the analytic hierarchy process for Guangdong Province, a highly urbanized region of China. Remotely sensed data were mainly used to quantify the 11 indicators and acquire regional EQA graphs at high spatial resolution. In addition, we used the spatial autocorrelation measure Moran's I to capture dynamic signatures of spatial organization of ecological quality in the study area. The results show that the ecological quality of the study area is heterogeneous spatially but relatively consistent in different regions. Significant positive spatial autocorrelation for EQI in Guangdong was revealed by global Moran's I. Potential ecological hot spot or cold spot were detected based on the spatial clustering patterns that were obtained by local Moran's I. Lands with low ecological quality is mainly distributed in economically developed areas such as the Pearl River Delta and coastal cities in eastern and western Guangdong, while those with high ecological quality are mostly situated in northern mountainous areas that have lush vegetation. The low assessment scores for Guangdong, especially for the Pearl River Delta, are highly correlated with large populations and degrees of industrial agglomeration; this is mainly because urbanization and economic development jeopardize the environment. The presented case study can facilitate information provision and targeted strategy making for environmental protection. This study provides a helpful approach to assess and to analyze the ecological status in the future research. In contrast with methods that employ a single metric and limited data, the assessment system proposed in this study expands the potential application of the remotely sensed data and enriches the methodological system for EQAs.

How Accurate Are the Surgical Risk Preoperative Assessment System (SURPAS) Universal Calculators in Total Joint Arthroplasty?

BACKGROUND: Surgical outcome prediction models are useful for many purposes, including informed consent, shared decision making, preoperative mitigation of modifiable risk, and risk-adjusted quality measures. The recently reported Surgical Risk Preoperative Assessment System (SURPAS) universal risk calculators were developed using 2005-2012 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), and they demonstrated excellent overall and specialty-specific performance. However, surgeons must assess whether universal calculators are accurate for the small subset of procedures they perform. To our knowledge, SURPAS has not been tested in a subset of patients undergoing lower-extremity total joint arthroplasty (TJA). QUESTIONS/PURPOSES: How accurate are SURPAS models' predictions for patients undergoing TJA? METHODS: We identified an internal subset of patients undergoing non-emergency THA or TKA from the 2012 ACS-NSQIP, the most recent year of the SURPAS development dataset. To assess the accuracy of SURPAS prediction models, 30-day postoperative outcomes were defined as in the original SURPAS study: mortality, overall morbidity, and six complication clusters-pulmonary, infectious, cardiac or transfusion, renal, venous thromboembolic, and neurologic. We calculated predicted outcome probabilities by applying coefficients from the published SURPAS logistic regression models to the TJA cohort. Discrimination was assessed with C-indexes, and calibration was assessed with Hosmer-Lemeshow 10-group chi-square tests and decile plots. RESULTS: The 30-day postoperative mortality rate for TJA was 0.1%, substantially lower than the 1% mortality rate in the SURPAS development dataset. The most common postoperative complications for TJA were intraoperative or postoperative transfusion (16%), urinary tract infection (5%), and vein thrombosis (3%). The C-indexes for joint arthroplasty ranged from 0.56 for venous thromboembolism (95% CI 0.53 to 0.59 versus SURPAS C-index 0.78) to 0.82 for mortality (95% CI 0.76 to 0.88 versus SURPAS C-index 0.94). All joint arthroplasty C-index estimates, including CIs, were lower than those reported in the original SURPAS development study. Decile plots and Hosmer-Lemeshow tests indicated poor calibration. Observed mortality rates were lower than expected for patients in all risk deciles (lowest decile: no observed deaths, 0.0% versus expected 0.1%; highest decile: observed mortality 0.7% versus expected 2%; p < 0.001). Conversely, observed morbidity rates were higher than expected across all risk deciles (lowest decile: observed 12% versus expected 8%; highest decile: observed morbidity 32% versus expected 25%; p < 0.001) CONCLUSIONS: The universal SURPAS risk models have lower accuracy for TJA procedures than they do for the wider range of procedures in which the SURPAS models were originally developed. CLINICAL RELEVANCE: These results suggest that SURPAS model estimates must be evaluated for individual surgical procedures or within restricted groups of related procedures such as joint arthroplasty. Given substantial variation in patient populations and outcomes across numerous surgical procedures, universal perioperative risk calculators may not produce accurate and reliable results for specific procedures. Surgeons and healthcare administrators should use risk calculators developed and validated for specific procedures most relevant to each decision. Continued work is needed to assess the accuracy of universal risk calculators in more narrow procedural categories based on similarity of outcome event rates and prevalence of predictive variables across procedures.

Assessment of CAD-CAM zirconia crowns designed with 2 different methods: A self-controlled clinical trial.

STATEMENT OF PROBLEM: In computer-aided design and computer-aided manufacturing (CAD-CAM) dentistry, the correlation method is an efficient way to design complete crowns. However, the occlusal relationship and patient satisfaction with prostheses fabricated using this method remain unclear. PURPOSE: The purpose of this clinical trial was to compare the occlusion of monolithic zirconia crowns designed using the correlation and library methods. MATERIAL AND METHODS: Twenty-three teeth of 21 participants received 2 monolithic zirconia crowns designed by using the correlation or the library method. Defective teeth were scanned using an intraoral scanner to obtain references and working casts from before and after the preparation. Before cementation, the occlusal relationship of both crowns and patient satisfaction were evaluated, and the occlusal adjustment time was recorded. RESULTS: The correlation method resulted in less lateral occlusal interference of the crowns than the library method (P<.01). The occlusal adjustment times of the correlation and library conditions were 455.8 ±357.1 seconds and 575.3 ±488.0 seconds, respectively (P>.05). Relative occlusal force was significantly higher in the correlation than in the library condition and was related to before preparation relative occlusal force (r=0.706, P<.01). The visual analog score before occlusal adjustment was higher in the correlation than in the library condition (P<.05). The occlusal contacts, occlusal contact distributions, and number of occlusal contacts did not differ between conditions (P>.05). CONCLUSIONS: Better eccentric occlusion and reduced lateral occlusal interference were obtained when the correlation method was used to design crowns. The correlation method yielded higher relative occlusal force, which helped to restore the original occlusal force.

White, affluent, educated parents are least likely to choose HPV vaccination for their children: a cross-sectional study of the National Immunization Study - teen.

BACKGROUND: Human Papillomavirus (HPV) vaccination coverage is below national goals in the United States. Research is needed to inform strategically designed interventions that target sociodemographic groups with underutilization of HPV vaccination. METHODS: Secondary data analysis of the National Immunization Survey-Teen 2013 measured association of sociodemographic factors (e.g., ethnicity/race, insurance) with HPV vaccination among females and males ages 13-17 (N = 18,959). Chi-square and multivariable Poisson regressions were conducted using survey-weighted statistics. RESULTS: Having a mother ≥35 years, a mother with some college, being of "Other" ethnicity/race, and having no providers who order vaccines from health departments was negatively associated with females initiating HPV vaccination. Having a mother with some college, being of Non-Hispanic White or "Other" ethnicity/race, and having some or no providers who order vaccines from health departments was negatively associated with males initiating HPV vaccination. These same factors were negatively associated with males completing HPV vaccination with the exception of "Other" ethnicity/race. In contrast, having an unmarried mother, being ages 15-17, having a hospital based provider, and receiving other adolescent vaccinations were positively associated with females initiating and completing HPV vaccination. Having an unmarried mother, health insurance that is not employer or union sponsored, and influenza and meningitis vaccinations was positively associated with male's initiating HPV vaccination. For males, being 15 or 17 years old and having other adolescent vaccinations was positively associated with vaccine completion. All findings p ≤ 0.05. CONCLUSIONS: Future HPV vaccination interventions may benefit from targeting certain sociodemographic groups that were negatively associated with HPV vaccination in this study.

Sub-Regional Assessment of HPV Vaccination Among Female Adolescents in the Intermountain West and Implications for Intervention Opportunities.

Objectives We investigated the similarities and differences in the factors related to human papillomavirus (HPV) vaccination of female adolescents in three sub-regions of the Intermountain West (IW). Methods We analyzed 2011-2012 National Immunization Survey-Teen data. Respondents (parents) who were living in the IW and who had daughters aged 13-17 years old with provider-verified immunization records were included in our analyses. East, Central, and West sub-regions were defined based on geographic contiguity and similarity in HPV vaccination rates and sociodemographic characteristics. Survey-weighted Chi square tests and multivariable Poisson regressions were performed. Results In all three sub-regions, older teen age and receipt of other recommended adolescent vaccinations were significantly associated with HPV vaccination. In the East sub-region, providers' facility type and source of vaccines were significantly related to HPV vaccination. In the Central sub-region, teens with married parents were significantly less likely to be vaccinated than were those with unmarried parents. In the West sub-region, non-Hispanic teens were significantly less likely to be vaccinated than were Hispanic teens. Conclusions for Practice In order to improve HPV vaccine coverage in the IW, region-wide efforts to target younger teens and to promote the HPV vaccine with other recommended adolescent vaccinations should be supplemented with sub-regional attention to the health care system (East sub-region), to married parents (Central sub-region), and to non-Hispanic teens (West sub-region).

Treatment persistence among patients with immune-mediated rheumatic disease newly treated with subcutaneous TNF-alpha inhibitors and costs associated with non-persistence.

The main objective of this study was to describe real-world treatment persistence with subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFi) in patients with ankylosing spondylitis, psoriatic arthritis, or rheumatoid arthritis [collectively immune-mediated rheumatic disease, (IMRD)] in Sweden. A secondary objective was to describe potential effects on health care resource utilization (HCRU) cost from non-persistence. Patients were identified through filled prescriptions for adalimumab (ADA), etanercept (ETA), certolizumab pegol (CZP), and golimumab (GLM) between 5/6/2010 and 12/31/2012 from the Swedish Prescribed Drug Register. Persistence was estimated using survival analysis. Costs were derived from HCRU and comprised specialized outpatient care, inpatient care and non-disease-modifying antirheumatic drug medications. A total of 4903 patients were identified (ADA: 1823, ETA: 1704, CZP: 622, GLM: 754). Comparisons over 3 years showed that GLM had significantly higher persistence than ADA (p = 0.022) and ETA (p = 0.004). The mean difference in non-biologic HCRU costs between persistent and non-persistent patients was higher after compared to before the start of biologic therapy. SC-TNFi-naïve IMRD patients initiating treatment with GLM had significantly higher persistence rates than patients initiating treatment with ADA or ETA in Sweden. Furthermore, persistence rates observed in the study were lower than those observed in clinical trials, highlighting the need for an all-party (provider-patient-payer-drug manufacturer) engagement and development of programs to increase persistence rates in clinical practice, thus leading to improved clinical outcomes. In addition, the results of this study indicate that persistence to treatment with SC-TNFi may be associated with cost offsets in terms of non-biologic costs.

Significant reduction of antibiotic consumption and patients' costs after an action plan in China, 2010-2014.

INTRODUCTION: On July 1, 2011, the Chinese government launched a national Action Plan for antibiotic stewardship targeting antibiotic misuse in public hospitals. The aim of this study was to evaluate the impacts of the Action Plan in terms of frequency and intensity of antibiotic utilization and patients costs in public general hospitals. METHODS: Administrative pharmacy data from July 2010 to June 2014 were sampled from 65 public general hospitals and divided into three segments: (1) July 2010 to June 2011 as the preparation period; (2) July 2011 to June 2012 as the intervention period; and (3) July 2012 to June 2014 as the assessment period. The outcome measures included (1) antibiotic prescribing rates; (2) intensity of antibiotic consumption; (3) patients costs; and (4) duration of peri-operative antibiotic treatment in clean surgeries of thyroidectomy, breast, hernia, and orthopedic procedures. Longitudinal and cross-sectional analyses were conducted. RESULTS: Longitudinal analyses showed significant trend changes in the frequency and intensity of antibiotic consumption, the patients' costs on antibiotics, and the duration of antibiotic treatment received by surgical patients undergoing the 4 clean procedures during the intervention period. Cross-sectional analyses showed that the antibiotic prescribing rates were reduced to 35.3% and 12.9% in inpatient and outpatient settings, that the intensity of antibiotic consumption was reduced to 35.9 DDD/100 bed-days, that patients' costs on antibiotics were reduced significantly, and that the duration of peri-operative antibiotic treatment received by surgical patients undergoing the 4 types of clean procedures decreased to less than 24 hour during the assessment period. CONCLUSION: The Action Plan, as a combination of managerial and professional strategies, was effective in reducing the frequency and intensity of antibiotic consumption, patients' costs on antibiotics, and the duration of peri-operative antibiotic treatment in the 4 clean surgeries.

Geography and the burden of care in pediatric cancers.

BACKGROUND: Childhood cancers typically require rigorous treatment at specialized centers in urban areas, which can create substantial challenges for families residing in remote communities. We evaluated the impact of residence and travel time on the burden of care for families of childhood cancer patients. PROCEDURE: We conducted a cross-sectional, self-administered survey of 354 caregivers of pediatric cancer patients at a children's hospital serving a seven state area. Measures included the impact of cancer treatment on relocation, employment, schooling, and finances. We evaluated these domains by rural/urban residence and travel time (>1 hour and >2 hours) to the hospital in multivariable regression models. RESULTS: Of the 29% of caregivers who reported moving residences as their child was diagnosed, 33% reported that the move was due to their child's cancer. Rural and remote (e.g., >1 hour travel time) caregivers missed more days of work during the first month after diagnosis than did urban and local caregivers, however, these differences did not persist over the first 6 months of therapy. One-third of caregivers reported quitting or changing jobs as a direct result of their child being diagnosed with cancer. Rural respondents had greater out-of-pocket travel expenses and reported a significantly greater perceived financial burden. Rural patients missed more school days and were at an increased risk of having to repeat a grade. CONCLUSIONS: Childhood cancer has an appreciable impact on the lives of patients and caregivers. The burden is greater for those living far from a treatment center.