The association between dual sensory loss and healthcare expenditure: Mediating effect of depression.

BACKGROUND: Previous studies have suggested the dual sensory loss (DSL) is linked to depression, and that they are associated with higher healthcare expenditures, respectively. However, the association between DSL, depression and healthcare expenditures remains ambiguous. OBJECTIVES: The current study aims to examine the association between DSL, depression and healthcare expenditures as well as catastrophic health expenditures (CHE) among Chinese people aged 45 and above. METHODS: We first utilized the China Health and Retirement Longitudinal Survey (CHARLS) 2018 to obtain data from a total of 13,412 Chinese individuals aged 45 and above to conduct a cross-sectional study. DSL was defined as a combined variable of self-reported vision loss and hearing loss. Depression was measured using The Center for Epidemiologic Studies Depression Scale (CESD-10). The healthcare expenditures, including outpatient out-of-pocket cost and inpatient out-of-pocket cost, were obtained from the Harmonized CHARLS section. CHE were defined as out-of-pocket (OOP) health spending equal to or higher than 40 % of a household's capacity to pay. A Tobit linear regression with three models and a path analysis were conducted to estimate the association between DSL, depression and healthcare expenditures and CHE. Then we utilized 2011CHARLS and 2018CHARLS to present a longitudinal analysis. A path analysis was conducted to estimate the association between 2011DSL, 2018depression and 2018healthcare expenditures and CHE. RESULTS: Depression has a significant mediating effect between DSL and healthcare expenditures. (For outpatient OOP cost: a = 0.453, b = 23.559, c = 25.257, the proportion of mediating effect in total effect = 29.71 %; for inpatient OOP cost: a = 0.453, b = 13.606, c = 15.463, the proportion of mediating effect in total effect = 28.50 %; all P < 0.05). The mediating effect of depression also exists in the association between DSL and CHE (a = 0.453, b = 0.018, c = 0.043, the proportion of mediating effect in total effect = 15.90 %; P < 0.05). The mediation effect of depression on healthcare expenditures and CHE also exists in the longitudinal analysis using CHARLS 2011 and CHARLS 2018 (all P < 0.05). LIMITATIONS: The DSL status were based on self-report and we used 2018CHARLS to conduct the study, which may cause some bias. CONCLUSION: Significant mediating effect of depression exists between DSL and higher healthcare expenditures and CHE. The mental health of elder people with DSL should be focused on, and we should have an overall viewpoint on the topic of healthcare expenditures and CHE.

Impact of changes to invite methodology on equality of access to the National Breast Screening Programme in the South of England.

In response to the COVID-19 pandemic, a temporary change in policy was implemented in 2020. Breast screening services in England were advised to change from timed appointments to an open invitation for invitees to contact the service and arrange an appointment. This change to invitation methodology had potential benefits and risks including impacting inequalities in uptake. Qualitative data were collected by online questionnaire from 23 service providers and routinely collected quantitative uptake data were analysed to investigate the impact of open invitations on the National Programme in the South of England. Office for National Statistics and general practitioner (GP) practice profile data enabled the modelling of sociodemographic characteristics of breast screening invitees at each GP practice. Most services changed to open invitations (17/23), 82% of which altered administrative capacity and/or procedures to accommodate this change. Logistic benefits were reported including a more consistent flow of participants, fewer long gaps and fewer wasted slots. The change to open invitations was associated with a 7.2% reduction in the percentage of participants screened, accounting for participant sociodemographics and historical screening provider uptake. The inequality in screening uptake experienced by participants of minority ethnic background was exacerbated by the change to open invitations. Open invitations, whilst affording logistic benefits in an unprecedented pandemic era, were associated with reduced overall uptake and exacerbation of existing health inequality experienced by women of minority ethnic background. The broader impact on services highlighted the need for sustainability of measures taken to accommodate such operational changes.

Assessment of the influence on left ventricle by potassium oxonate and hypoxanthine-induced chronic hyperuricemia.

Cellular cytoplasmic xanthine oxidase (XO)-mediated uric acid synthesis and extracellular excess uric acid exposure are both causes of cardiomyocytic injury under the condition of hyperuricemia (HUA). Potassium oxonate suppresses uric acid degradation to increase extracellular concentration, while hypoxanthine is the catalytic substrate of XO. We aimed to observe cardiac damage in a chronic HUA mouse model induced by potassium oxonate and hypoxanthine. The mouse model was established by the co-administration of potassium oxonate and hypoxanthine for eight weeks. Then, left ventricular parameters were examined by echocardiographic evaluation, and the heart tissues were harvested for further histopathological analysis. The results showed that plasma uric acid was persistently elevated in the model mice, which demonstrated the stable establishment of chronic HUA. The left ventricular anterior wall was significantly thickened in the model group compared with the blank control group. After the end of modeling, the left ventricular anterior wall thickness of the hyperuricemic mice increased compared with that of blank group. The histological analysis showed and myocardial structure disorganization in the model group compared with the blank control. The above cardiac impairment changes could be attenuated by allopurinol pretreatment. This study systematically assessed cardiac damage in a chronic HUA mouse model. In addition, it provides useful information for future HUA-associated heart injury mechanism investigation and therapeutic treatment evaluation.

Association amongst social support inside or outside the family and depression symptoms: longitudinal study of urban-rural differences in China.

PURPOSE: The purpose is to analyze the longitudinal association between social support inside and outside the family and depression and the differences between urban and rural areas. METHODS: A total of 11,150 respondents were included from Harmonized China Health and Retirement Longitudinal Study (Harmonized CHARLS). The baseline data and the subsequent two surveys were used to describe the basic characteristics and social support in the urban and rural. The growth curve model was used to analyse the longitudinal association between social support inside and outside the family and depression. RESULTS: People participating in social activities were less likely to suffer from depression while those who had public transfer were more likely to suffer from depression. Respondents who had weekly contact with their children were less likely to suffer from depression. Respondents with larger families were also less likely to suffer from depression, but this effect was significant in rural. As time changes, the association between social activities and depression does not change significantly, only public transfer and family size show a gradually weakening impact on depression in rural areas. The association between the contact with children and depression scores weakens in rural areas but increases in urban areas. CONCLUSIONS: Future dynamic intervention for depression can include holding various beneficial social activities, carrying forward the filial piety culture and improving the level of rural social welfare, protecting the excellent traditional culture, and providing public services for rural special families.

Association Between Dynamic Trends of Functional Disability and Poverty Among People Aged 45 and Over.

BACKGROUND: The disability problem has become prominent with the acceleration of the global aging process. Individual disability is associated with economic conditions and contributes to family poverty. As disability will change over a long period of time and may even show distinct dynamic trends, we aimed to focus on activities of daily living (ADL) and classify functional disability trends. Moreover, we aimed to highlight and analyze the association between functional disability trends and economic conditions and explore the influencing factors. MATERIALS AND METHODS: A total of 11,222 individuals who were 45 years old or older were included in four surveys conducted by the China Health and Retirement Longitudinal Study in 2011, 2013, 2015, and 2018. Samples were analyzed after excluding those with missing key variables. The latent class growth model was used to classify the ADL trends. Two binary logistic regressions were established to observe the association between the ADL trends and follow-up economic conditions or catastrophic health expenditure trends. RESULTS: ADL trends of older adults were classified into improving (25.4%), stabilizing (57.0%), and weakening ADL (17.6%). ADL trend was associated with follow-up poverty (p = 0.002) and catastrophic health expenditure trends (p < 0.001). Compared with the improving ADL trend, the stabilizing ADL may have a negative influence on individuals' economic conditions (OR = 1.175, 95%CI = 1.060-1.303). However, a stabilizing ADL trend was less likely to bring about catastrophic health expenditures (OR = 0.746, 95%CI = 0.678-0.820) compared with an improving ADL trend. CONCLUSION: The improvement of functional disability would make the medical expense burden heavier but would still be beneficial for the prevention of poverty. A significant association was found between socioeconomic factors and poverty. Preventing the older adults from developing disability and illness, improving the compensation level of medical insurance, and optimizing the long-term care insurance and the primary healthcare system can potentially contribute to the prevention of poverty. Meanwhile, focusing on people who are poor at early stages, women, middle-aged, low-educated, and in rural areas is important.

Dissipation and dietary risk assessment of kasugamycin and saisentong in Chinese cabbage.

A quick, easy, cheap, effective, rugged, and safe pretreatment method using dispersive solid-phase extraction was developed to quantify kasugamycin in Chinese cabbage samples by using ultra-performance liquid chromatography/tandem mass spectrometry. A pretreatment method involving precolumn transformation was utilized to determine the residue of saisentong in Chinese cabbage through high-performance liquid chromatography/ultraviolet detection. These methods were successfully applied through field trials to determine the contents of kasugamycin and saisentong in Chinese cabbage. The dissipation of kasugamycin and saisentong in Chinese cabbage followed first-order kinetics with a linear correlation coefficient of 0.9066-0.9731 at the 95% confidence level. The half-lives of kasugamycin and saisentong in Chinese cabbage were 1.8-2.0 and 2.2-3.8 days, respectively. Terminal residual levels of kasugamycin in Chinese cabbage were not detected 14 days after application. The dietary risk assessment of kasugamycin and saisentong in Chinese cabbage showed that their risk quotients were 0.93 and 2.58%, respectively, in the preharvest interval (PHI) of 14 days. Kasugamycin and saisentong in Chinese cabbage did not pose potential health hazards at PHI of 14 days. The maximum residue limits of kasugamycin and saisentong in Chinese cabbage were 0.02 and 0.36 mg/kg, respectively, and 14 days was the safe PHI.

Usefulness of overnight pulse oximeter as the sleep assessment tool to assess the 6-year risk of road traffic collision: evidence from the Taiwan Bus Driver Cohort Study.

Background: In order to support health service organizations in arranging a system for prevention of road traffic collisions (RTC), it is important to study the usefulness of sleep assessment tools. A cohort study was used to evaluate the effectiveness of subjective and objective sleep assessment tools to assess for the 6-year risk of both first RTC event only and recurrent RTC events. Methods: The Taiwan Bus Driver Cohort Study (TBDCS) recruited 1650 professional drivers from a large bus company in Taiwan in 2005. The subjects were interviewed in person, completed the sleep assessment questionnaires and had an overnight pulse oximeter survey. Moreover, this cohort of drivers was linked to the National Traffic Accident Database (NTAD) and researchers found 139 new RTC events from 2005 to 2010. Primary outcomes were traffic collisions from NTAD, nocturnal oxygen desaturation index (ODI) from pulse oximeter, Pittsburg sleeping quality score, Epworth daytime sleepiness score, Snore Outcomes Survey score and working patterns from questionnaires. A Cox proportional hazards model and an extended Cox regression model for repeated events were performed to estimate the hazard ratio for RTC. Results: The RTC drivers had increased ODI4 levels (5.77 ± 4.72 vs 4.99 ± 6.68 events/h; P = 0.008) and ODI3 levels (8.68 ± 6.79 vs 7.42 ± 7.94 events/h; P = 0.007) in comparison with non-RTC drivers. These results were consistent regardless of whether ODI was evaluated as a continuous or a categorical variable. ODI4 and ODI3 levels increased the 6-year RTC risks among professional drivers even after adjusting for age, education, history of cardiovascular disease, caffeine intake, sleeping pills used, bus driving experience and shift modes. Moreover, there was an increased trend for ODI between the stratification of the number of RTCs in comparison with the non-RTC group. In the extended Cox regression models for repeated RTC events with the Anderson and Gill intensity model and Prentice-Williams-Petersen model, measurement of ODI increased hazards of the subsequent RTC events. Conclusion: This study showed that an increase in the 6-year risk of RTC was associated with objective measurement of ODI for a sign of sleep-disordered breathing (SDB), but was not associated with self-reported sleeping quality or daytime sleepiness. Therefore, the overnight pulse oximeter is an effective sleep assessment tool for assessing the risk of RTC. Further research should be conducted regarding measures to prevent against SDB among professional drivers.

Comparative assessment of therapeutic safety of norcantharidin, N-farnesyloxy-norcantharimide, and N-farnesyl-norcantharimide against Jurkat T cells relative to human normal lymphoblast: A quantitative pilot study.

The therapeutic safety of an anticancer drug is one of the most important concerns of the physician treating the cancer patient. Half maximal inhibitory concentration (IC50) and hillslope are usually used to represent the strength and sensitivity of an anticancer drug on cancer cells. The therapeutic safety of the anticancer drug can be assessed by comparing the IC50 and hillslope of anticancer drugs on cancer cells relative to normal cells. Since there are situations where "more anticancer activity" implies "more toxicity," the safety of an anticancer drug in these situations is hard to evaluate by using IC50 and hillslope alone. In a previous study, the "net effect" index was devised to represent the net therapeutic effects of one anticancer drug relative to the other. However, the therapeutic safety of one specific anticancer drug alone was not defined in the "net effect" index. This study introduced the "safety index (SI)" to quantify the degree of safety of an anticancer drug by using 4-parameter logistic model on cancer cells relative to normal cells. The therapeutic safety of norcantharidin (NCTD), N-farnesyloxy-norcantharimide (NOC15), and N-farnesyl-norcantharimide (NC15) in the treatment of Jurkat T cells relative to human normal lymphoblast was compared using the newly defined SI. We found that the SI of NOC15 and NC15 was significantly higher than that of NCTD, suggesting that both NOC15 and NC15 can damage more cancer cells and less normal cells than NCTD. We conclude that both NOC15 and NC15 are safer anticancer drugs than NCTD in the treatment of Jurkat T cells relative to human normal lymphoblast. The SI can be further applied to the screening, developments, and applications of anticancer drugs in the future.

Factors influencing the intention to utilize out-of-pocket health checkup services: A sample of citizens from 12 townships of Taichung County in Taiwan.

BACKGROUND: Taiwan started its National Health Insurance (NHI) system in 1995. However, until now, most cancer screening tests and preventive care have been out-of-pocket (OOP) medical items excluded from the coverage of NHI. The aim of this study was to explore the factors influencing an individual's intention to utilize OOP health checkups. METHODS: A cross-sectional research method was adopted in this study. Based on the theory of planned behavior, a questionnaire was developed and used to survey purposively sampled residents (n = 940) from 12 randomly selected townships in Taichung County, Taiwan, from August to September 2006. Descriptive statics and linear regression were conducted to analyze the collected data. RESULTS: Our results showed that result evaluation (beta = 0.092), behavioral beliefs (beta = 0.088), behavioral norms of people with experience in utilizing OOP health checkups (beta = 0.116), perceived convenience (beta = 0.273), and worry about illness and perceived health (beta = 0.110) were important factors influencing the intention to utilize OOP health checkups. Age, education and acceptable health checkup charges were also related. CONCLUSION: Reinforcing disease- and health checkup-related knowledge may positively influence an individual's intention to utilize OOP health checkups. In addition, improving perceived convenience and reducing disease-screening barriers can intensify the individual's intention to use OOP health checkups. The influence of age, education level and OOP checkup charges should also be taken into consideration when related policies are formulated.

The Chinese version of the Facts on Aging Quiz scale: reliability and validity assessment.

BACKGROUND: The use of health care services by older adults is increasing with the aging of the population. It is therefore essential that health care workers are current in their knowledge about gerontology; thus, educational programs regarding the care of elders are essential. Chinese-language assessments to measure knowledge about gerontology and aging and attitudes toward older adults are lacking. OBJECTIVE: This study was designed to measure the reliability and validity of a Chinese-language version of Palmore's facts on aging quiz (FAQ 1). METHOD: Cronbach's alpha, construct validity, content validity and convergent validity of the Chinese version of the FAQ 1 were assessed. A sample of 220 student nurses was recruited. Part of the sample (n=125; Group A) was comprised of experienced nurses who had returned to school for advanced degrees. The remaining 95 participants were first-year undergraduate students without prior work experience (Group B). The FAQ 1 was administered to all participants. The Chinese-language version of Kogan's Attitudes toward Older People (KAOP) was also administered to assess convergent validity of the FAQ 1. RESULTS: Cronbach's alpha of the FAQ was 0.68, content validity was 0.82, and construct validity and convergent validity were acceptable. Group A had more correct answers on each item than Group B, indicating that students with prior work experience with the elderly were more knowledgeable regarding older people and aging. CONCLUSIONS: Based on the results of the assessment, the Chinese version of FAQ 1 is a valid and reliable instrument for measuring students' or health care providers' knowledge about older people.

Factors influencing the purchasing behavior of TCM outpatients in Taiwan.

OBJECTIVES: To test the factors that influence Chinese medicine outpatients' behavior patterns in purchasing Traditional Chinese Medicine (TCM) under the National Health Insurance (NHI) system in Taiwan. METHODS: A structural questionnaire was developed and administered to randomly selected outpatients waiting for Chinese Medicine at pharmacies in two academic hospitals that offered Chinese Medicine services in central Taiwan. A total of 641 effective questionnaires were collected. SPSS 10.0 (Statistical Package for Social Sciences, SPSS Inc., Chicago, IL) was used to run descriptive analysis and one-way analysis of variance (ANOVA). In addition, LISREL 8.30 (Analytical Package, Scientific Software International, Inc., Chicago, IL) was used to modify and analyze the relationship between the variables of the hypothetical pathway model. RESULTS: Path analysis showed that "behavioral intention" and "suffering from disease" had positive and direct influences on the outpatients' patterns of purchasing TCM. Furthermore, "usable resources" was an important factor with direct influence on behavioral intention. When there were more usable resources, the behavioral intention became stronger and indirectly influenced the purchasing behavior of TCM outpatients. In addition, one-way ANOVA showed that the purchasing behavior was significantly influenced by the number of diseases that an individual suffered. The results of the pathway model showed that "behavioral intention" and "suffering from disease" had positive and direct influence on the TCM purchasing behavior of Chinese Medicine outpatients. However, "usable resources" was an important factor with direct influence on behavioral intention. When there were more usable resources, the behavioral intention became stronger and indirectly had influence on the TCM purchasing behavior. Furthermore, the analysis result of one-way ANOVA showed that the more chronic diseases the surveyed subject suffered, the more significant the influence on purchasing behavior became. CONCLUSIONS: Under the current NHI system, patients with multiple chronic diseases are the major purchasers of TCM products not covered by NHI. Therefore, increasing the usable resources of TCM products for the patients with chronic diseases will help hospitals in developing TCM services under the current NHI system.

Do it right this time: the role of employee service recovery performance in customer-perceived justice and customer loyalty after service failures.

Integrating justice and customer service literatures, this research examines the role of customer service employees' behaviors of handling customer complaints, or service recovery performance (SRP), in conveying a just image of service organizations and achieving desirable customer outcomes. Results from a field study and a laboratory study demonstrate that the dimensions of SRP--making an apology, problem solving, being courteous, and prompt handling--positively influenced customer satisfaction and then customer repurchase intent through the mediation of customer-perceived justice. In addition, service failure severity and repeated failures reduced the positive impact of some dimensions of SRP on customer satisfaction, and customer-perceived justice again mediated these moderated effects.

The impact of justice climate and justice orientation on work outcomes: a cross-level multifoci framework.

In this article, which takes a person-situation approach, the authors propose and test a cross-level multifoci model of workplace justice. They crossed 3 types of justice (procedural, informational, and interpersonal) with 2 foci (organization and supervisor) and aggregated to the group level to create 6 distinct justice climate variables. They then tested for the effects of these variables on either organization-directed or supervisor-directed commitment, satisfaction, and citizenship behavior. The authors also tested justice orientation as a moderator of these relationships. The results, based on 231 employees constituting 44 work groups representing multiple organizations and occupations, revealed that 4 forms of justice climate (organization-focused procedural and informational justice climate and supervisor-focused procedural and interpersonal justice climate) were significantly related to various work outcomes after controlling for corresponding individual-level justice perceptions. In addition, some moderation effects were found. Implications for organizations and future research are discussed.

Job performance failure and occupational carpal tunnel claims.

Using a sample of one job type from one firm (to hold job tasks and sick leave/disability policy constant), we estimate the effect of demographic variables, job performance warnings, and workers' compensation benefits on the propensity to file a carpal tunnel syndrome (CTS) loss work-time claim. We find that disciplinary notices increase the employees' propensity to file a CTS claim. State maximum workers' compensation benefits are also positively related to CTS claim frequency, however, the relationship is not statistically significant. CTS claimants respond differently than other sprain/strain claimants to benefits and to gender. In particularly, women have relatively more CTS claims, while men have relatively more other sprain/strain claims in our sample. The estimates here underscore the importance of psychosocial factors in the filing of occupational CTS and sprain injuries claims.