A cost-effectiveness analysis of fluoride varnish application in preventing Root caries in elderly persons: a Markov simulation study.

BACKGROUND: Root caries are prevalent issues that affect dental health, particularly among elderly individuals with exposed root surfaces. Fluoride therapy has shown effectiveness in preventing root caries, but limited studies have addressed its cost-effectiveness in elderly persons population. This study aimed to evaluate the cost-effectiveness of a fluoride treatment program for preventing root caries in elderly persons within the context of Chinese public healthcare. METHODS: A Markov simulation model was adopted for the cost-effectiveness analysis in a hypothetical scenario from a healthcare system perspective. A 60-year-old subject with 23 teeth was simulated for 20 years. A 5% sodium fluoride varnish treatment was compared with no preventive intervention in terms of effectiveness and cost. Tooth years free of root caries were set as the effect. Transition probabilities were estimated from the data of a community-based cohort and published studies, and costs were based on documents published by the government. The incremental cost-effectiveness ratio (ICER) was calculated to evaluate cost-effectiveness. Univariate and probabilistic sensitivity analyses were performed to evaluate the influence of data uncertainty. RESULTS: Fluoride treatment was more effective (with a difference of 10.20 root caries-free tooth years) but also more costly (with a difference of ¥1636.22). The ICER was ¥160.35 per root caries-free tooth year gained. One-way sensitivity analysis showed that the risk ratio of root caries in the fluoride treatment group influenced the result most. In the probabilistic sensitivity analysis, fluoride treatment was cost-effective in 70.5% of the simulated cases. CONCLUSIONS: Regular 5% sodium fluoride varnish application was cost-effective for preventing root caries in the elderly persons in most scenarios with the consideration of data uncertainty, but to a limited extent. Improved public dental health awareness may reduce the incremental cost and make the intervention more cost-effective. Overall, the study shed light on the economic viability and impact of such preventive interventions, providing a scientific basis for dental care policies and healthcare resource allocation.

A systematic review and meta-analysis of factors related to non-suicidal self-injury among Chinese adolescents.

BACKGROUND: Over the past several decades the prevalence of adolescent non-suicidal self-injury (NSSI) has been rising steadily. Understanding the factors associated with NSSI is a critical public health concern. The current study aims to explore the critical factors related to NSSI among Chinese adolescents. METHODS: A systematic literature search was conducted to identify the studies meeting our eligibility criteria (published until June 2022) in PubMed, Web of Science, Science Direct, Springer Link, CNKI, VIP, and Wanfang data. The meta-package of R language was used to perform a meta-analysis to compute the pooled effect (r). RESULTS: A total of 59 studies were included in this analysis, with a sample size of 192,546. Twenty-four democratic, personal, and social factors were examined in current study. The pooled effect value (r) has revealed that 23 factors are associated with NSSI behaviors among Chinese adolescents. The factor, Internet addiction, has demonstrated the greatest association with NSSI compared to other factors. CONCLUSION: Consistent with previous studies on adolescent NSSI, findings have demonstrated that a number of demographic, personal, and social factors significantly contribute to NSSI behaviors among Chinese adolescents. Future research on prevention and intervention for adolescent NSSI may benefit from targeting these factors.

[Heavy Metal Concentration, Source, and Pollution Assessment in Topsoil of Chuzhou City].

In order to understand the pollution level and ecological risk of heavy metals in topsoil of Chuzhou City, a total of 4360 soil samples in Chuzhou City were collected, and the concentrations of eight heavy metals including Cr, Zn, Pb, Cu, Ni, Cd, As, and Hg were measured. Correlation analysis, cluster analysis, and principal component analysis were used to analyze the sources of the heavy metals, and the enrichment factor index, single-factor pollution index, pollution load index, geo-accumulation index method, and potential ecological risk index were selected to assess the environmental risk of the eight heavy metals in the topsoil. The results showed that the average values of Cr, Zn, Pb, Cu, Ni, Cd, As, and Hg contents in the surface soil of Chuzhou City were higher than the background value of that in the soil of Yangtze-Huaihe River Basin of Anhui, and Cd, Ni, As, and Hg were significantly different in space and influenced by external disturbance. The eight types of heavy metals could be divided into four categories based on correlation analysis, cluster analysis, and principal component analysis. Cr, Zn, Cu, and Ni were from natural background sources; As and Hg mainly came from sources of industrial and agricultural pollution; Pb mainly came from the sources of transportation pollution and industrial and agricultural pollution; and Cd came from the sources of transportation pollution, natural background, and industrial and agricultural pollution. The overall pollution degree of Chuzhou City was low, and the ecological risk level was at a slight level based on the pollution load index and the potential ecological risk index; however, the ecological risk of Cd and Hg was generally serious, and these two heavy metals should be taken as the objects of priority control. The results provided a scientific basis for soil safety utilization and classification control in Chuzhou City.

Does information disclosure among public hospitals stimulate medical cost change efforts? A pilot study in Shanghai.

BACKGROUND: In 2013, the Shanghai Hospital Development Center issued a policy to advocate public hospitals to report their information about costs on diseases. The objective was to evaluate the impact of interhospital disclosure of costs on diseases on medical costs and compare costs per case following information disclosure between hospitals of different rankings. METHODS: The study uses the hospital-level performance report issued by Shanghai Hospital Development Center in the fourth quarter of 2013, which covers quarterly aggregated hospital-level discharge data from 14 tertiary public hospitals participating in thyroid malignant tumors and colorectal malignant tumors information disclosure from the first quarter of 2012 to the third quarter of 2020. An interrupted time series model with segmented regression analysis is employed to examine changes in quarterly trends with respect to costs per case and length of stay before and after information disclosure. We identified high- and low-cost hospitals by ranking them on a costs per case basis per disease group. RESULTS: This research identified significant differences in cost changes for thyroid malignant tumors and colorectal malignant tumors between hospitals after disclosing information. A hospital's discharge costs per case for thyroid malignant tumors increased significantly among top-cost hospitals (1629.251 RMB, P = 0.019), while decreased for thyroid and colorectal malignant tumors among low-cost hospitals (-1504.189 RMB, P = 0.003; -6511.650 RMB, P = 0.024, respectively). CONCLUSION: Our findings indicate that information disclosure of costs on diseases results in changes in discharge costs per case. And low-cost hospitals continued to maintain their leading edge, whereas the high-cost hospitals changed their position in the industry by reducing discharge costs per case after information disclosure.

Assessment of In Vitro Digestive Behavior of Lactic-Acid-Bacteria Fermented Soy Proteins: A Study Comparing Colloidal Solutions and Curds.

This study investigated the effect of lactic-acid-bacteria fermentation on the microstructure and gastrointestinal digestibility of soy proteins using a digestomics approach. Fermented soy protein isolates (FSPIs) under varied fermentation-terminal pH demonstrated a colloidal solution (FSPI-7.0/6.0) or yogurt-like curd (FSPI-5.0/4.0) state. Cryo-electron microscopy figures demonstrated the loosely stacked layer of FSPI-7.0/6.0 samples, whereas a denser gel network was observed for FSPI-5.0/4.0 samples. Molecular interactions shifted from dominant ionic bonds to hydrophobic forces and disulfide bonds. The gastric/intestinal digestion demonstrated that the curd samples afforded a significantly low particle size and high-soluble protein and peptide contents in the medium and late digestive phases. A peptidomics study showed that the FSPI-6.0 digestate at early intestinal digestion had a high peptidome abundance, whereas FSPI curd digestates (FSPI-5.0/4.0) elicited a postponed but more extensive promotion during medium and late digestion. Glycinin G2/G4 and ß-conglycinin α/α' subunits were the major subunits promoted by FSPI-curds. The spatial structures of glycinin G2 and ß-conglycinin α subunits demonstrated variations located in seven regions. Glycinin G2 region 6 (A349-K356) and ß-conglycinin α subunit region 7 (E556-E575), which were located at the interior of the 3D structure, were the key regions contributing to discrepancies at the late stage.

[Chinese medicine dispensing granules: history, status quo, and development prospect in "post-pilot era"].

Chinese medicine dispensing granules, the result of the efforts to transform Chinese medicinal decoction pieces in China, features portability and ease of storage. Thus, it is destined to be an indispensible dosage form in the modernization drive of Chinese medicine. The Announcement on Ending the Pilot Project of Chinese Medicine Dispensing Granules was released in February 2021 and relevant regulations went into force in November 2021, which marks the a new journey for the development of Chinese medicine dispensing granules and the beginning of the "post-pilot era". However, it faces the challenges in quality and standard. This study reviewed the history of Chinese medicine dispensing granules, analyzed the technical progress, market, and main problems in development, and proposed suggestions and prospects for its development in the "post-pilot era", which is expected to serve as a reference for its industry development and rational use.

Assessment of the effect of lactic acid fermentation on the gastroduodenal digestibility and immunoglobulin E binding capacity of soy proteins via an in vitro dynamic gastrointestinal digestion model.

Fermentation by lactic acid bacteria is helpful in reducing soy protein immunoreactivity. However, how lactic acid fermentation influences the gastroduodenal digestibility and immunoglobulin E (IgE) binding capacity of soy proteins remains unclear. In this study, the protein digestion of a fermented soybean protein isolate (FSPI) was investigated and compared with that of a soybean protein isolate (SPI). The effect on their respective IgE binding capacities at the gastric and duodenal phases was also explored by using a novel in vitro dynamic gastrointestinal digestion model (Bionic Rat Model II+). Medium pH was measured, microstructural analysis was performed, peptide distribution and free amino acid content were determined, and SDS-PAGE analysis was performed to assess the differences between SPI and FSPI. The results showed that FSPI had lower pH (3.76), larger protein aggregates (>60 µm), and higher low-molecular-weight peptides than SPI. During the first 30 min of gastric and duodenal digestion, the extent of hydrolysis of FSPI was higher than that of SPI, and the gastric transition time of the former was longer than that of the latter. Conversely, differences tended to be narrower in the next 30-180 min of gastric and duodenal digestion. As a result, the IgE binding capacity of FSPI was significantly lower than that of SPI at 30 min of gastric and duodenal digestion. Therefore, fermentation by lactic acid bacteria affected the digestibility rate of soy proteins, especially at the initial phases of gastric and duodenal digestion, thereby reducing the exposure of intact epitopes in the duodenum. This study helped to elucidate how lactic acid fermentation affected the digestive behavior of soy proteins and its implication in IgE immunoreactivity reduction.

[Occurrence and Risk Assessment of Organophosphate Esters in Source Water of the Nanjing Section of the Yangtze River].

We explored the pollution characteristics, spatial and temporal distribution, ecological risk, and human health risk of organophosphate esters (OPEs) in the source water of the Nanjing section of the Yangtze River. Thirteen OPEs were determined by solid phase extraction-high performance liquid chromatography-tandem mass spectrometry. The results showed that twelve OPEs were detected to different extents with total concentrations ranging from 85.21 to 1557.96 ng·L-1[excluding tris (2,3-dibromopropyl) phosphate]. Chloroalkyl phosphate was the main compound and tris(2-chloroethyl) phosphate (TCEP) was the most abundant of the thirteen OPEs, which reached up to 447.08 ng·L-1. Seasonal variation of OPEs showed that the concentrations of OPEs in summer ranged from 220-1557.96 ng·L-1, with the average concentration of 493.78 ng·L-1 being 1.7-2.6 times higher than of that in spring and autumn. An ecological risk assessment showed that tricresyl phosphate and 2-ethylhexyl diphenyl phosphate were associated with moderate or high risks to organisms (algae, crustaceans, and fish). At a high exposure concentration, the total non-carcinogenic risk of OPEs in source water ranged from 4.41×10-3-2.91×10-2, with the highest risk being associated with children aged 0-3 months. The total cancer risk value was 5.88×10-7-3.89×10-6, among which TCEP and Tris(1,3-dichloro-2-propyl) phosphate was associated with a potential risk for children. We conclude that the long-term exposure risk for children of OPEs in the source water of the Nanjing section of the Yangtze River deserve more attention.

[Occurrence Characteristics and Risk Assessment of Antibiotics in Source Water of the Nanjing Reach of the Yangtze River].

Occurrence characteristics of antibiotics in the source water of the Nanjing section of the Yangtze River were analyzed preliminarily by solid-phase extraction and high-performance liquid chromatography-tandem mass spectrometry (SPE-HPLC-MS/MS). The results showed that the cumulative concentration of 16 sampling points ranged from 13.37 ng·L-1 to 780.5 ng·L-1, with an average concentration of 92.95 ng·L-1. Four sulfonamides, three fluoroquinolones, one tetracycline, five macrolides, and one chloramphenicol antibiotic were detected with average concentration ranging from 0.14 ng·L-1 to 49.91 ng·L-1,including enrofloxacin (ERX) and clarithromycin (CLR) with the highest detection rate of 100%, and clindamycin (CLI) with the highest concentration of 739.44 ng·L-1. Overall, the concentration levels of antibiotics in the Nanjing section of the Yangtze River were low compared with other rivers and lakes in China. The risk assessment results showed that the largest cumulative risk of S2 was 0.31, and the environmental risk of sulfamethoxazole (SMX), doxycycline (DOX), and roxithromycin (ROX) had lower risk levels;the health risk indexes of nine antibiotics for different age groups were between 2.22×10-6and 4.86×10-3, while CLI and DOX are the main potential health risk factors for humans.

Occurrence, distribution and risk assessment of suspected endocrine-disrupting chemicals in surface water and suspended particulate matter of Yangtze River (Nanjing section).

The occurrence and distribution of eight selected endocrine-disrupting chemicals were investigated in samples of surface water and suspended particulate matter (SPM) in Nanjing section of Yangtze River over a year (the flow period, the wet period and the dry period). All target compounds were detected at least once in surface water with 4-tert-butylphenol (4-TBP), nonyphenol (NP) and bisphenol A (BPA) as the dominant compounds, with concentrations in the range of 225-1121ng/L, 1.4-858ng/L and 1.7-563ng/L, respectively. Except for December, all selected compounds for the other sampling times were not found in all sampling points. NP (mean concentration 69.8µg/g) and BPA (mean concentration 51.8µg/g) were also the dominant estrogens in SPM. In addition, the highest total compounds concentrations were found in December in both phases, which could be due to the low flow conditions and temperature during this season. Meanwhile, a significant positive correlation was found between the total compounds concentrations in the water phase and those in SPM phase. Risk assessment based on the calculated risk quotients (RQ) showed that low and moderate risk for the aquatic environment from presence of the target compounds at all sampling points with exception of 4-TBP and NP which might pose a high risk to aquatic organisms.