Socioeconomic inequalities in healthcare system efficiency in Japan during COVID-19 pandemic: an analysis of the moderating role of vaccination.

Background: In the context of the COVID-19 pandemic, limited research has focused on socioeconomic disparities in Local Healthcare System Efficiency (LHSE) among Japanese prefectures. This study seeks to investigate the moderating impact of vaccination on the relationship between LHSE and socioeconomic characteristics and endowments. Methods: To explore these relationships, we first utilized the Data Envelopment Analysis with Slack-Based Measure to measure the LHSE, based on data from Japanese prefectures during waves 2 to 5 of the pandemic. Then estimating the impact of socioeconomic variables on LHSE. Finally, we assessed the changes in the way socioeconomic variables affect LHSE before and after vaccine deployment using the Seemingly Unrelated Estimation t-test methodology. Results: The research findings suggest an overall reduction in LHSE disparities across various regions due to the utilization of vaccines. Particularly in areas with relatively nsufficient bed resources, a significant improvement in LHSE was observed in most regions. However, there was no evidence supporting the role of vaccine deployment in mitigating socioeconomic inequalities in LHSE. Conversely, the utilization of vaccines showed a positive correlation between the improvement in LHSE and the proportion of older adult population in regions with sufficient bed resources. In regions facing bed shortages, the enhancement of LHSE became more reliant on reducing the occupancy rate of secured beds for severe cases after the introduction of vaccination. Discussion: In regions facing bed shortages, the enhancement of LHSE became more reliant on reducing the occupancy rate of secured beds for severe cases. This underscores the importance for policymakers and implementers to prioritize the treatment of severe cases and ensure an effective supply of medical resources, particularly secured beds for severe cases, in their efforts to improve LHSE, in the post-COVID-19 era with rising vaccine coverage.

Obesity-induced downregulation of miR-192 exacerbates lipopolysaccharide-induced acute lung injury by promoting macrophage activation.

BACKGROUND: Macrophage activation may play a crucial role in the increased susceptibility of obese individuals to acute lung injury (ALI). Dysregulation of miRNA, which is involved in various inflammatory diseases, is often observed in obesity. This study aimed to investigate the role of miR-192 in lipopolysaccharide (LPS)-induced ALI in obese mice and its mechanism of dysregulation in obesity. METHODS: Human lung tissues were obtained from obese patients (BMI ≥ 30.0 kg/m2) and control patients (BMI 18.5-24.9 kg/m2). An obese mouse model was established by feeding a high-fat diet (HFD), followed by intratracheal instillation of LPS to induce ALI. Pulmonary macrophages of obese mice were depleted through intratracheal instillation of clodronate liposomes. The expression of miR-192 was examined in lung tissues, primary alveolar macrophages (AMs), and the mouse alveolar macrophage cell line (MH-S) using RT-qPCR. m6A quantification and RIP assays helped determine the cause of miR-192 dysregulation. miR-192 agomir and antagomir were used to investigate its function in mice and MH-S cells. Bioinformatics and dual-luciferase reporter gene assays were used to explore the downstream targets of miR-192. RESULTS: In obese mice, depletion of macrophages significantly alleviated lung tissue inflammation and injury, regardless of LPS challenge. miR-192 expression in lung tissues and alveolar macrophages was diminished during obesity and further decreased with LPS stimulation. Obesity-induced overexpression of FTO decreased the m6A modification of pri-miR-192, inhibiting the generation of miR-192. In vitro, inhibition of miR-192 enhanced LPS-induced polarization of M1 macrophages and activation of the AKT/ NF-κB inflammatory pathway, while overexpression of miR-192 suppressed these reactions. BIG1 was confirmed as a target gene of miR-192, and its overexpression offset the protective effects of miR-192. In vivo, when miR-192 was overexpressed in obese mice, the activation of pulmonary macrophages and the extent of lung injury were significantly improved upon LPS challenge. CONCLUSIONS: Our study indicates that obesity-induced downregulation of miR-192 expression exacerbates LPS-induced ALI by promoting macrophage activation. Targeting macrophages and miR-192 may provide new therapeutic avenues for obesity-associated ALI.

Global assessment of future sectoral water scarcity under adaptive inner-basin water allocation measures.

Water scarcity has become a major threat to sustainable development under climate change. To reduce the population exposure to water scarcity and improve universal access to safe drinking water are important targets of the Sustainable Development Goal (SDG) 6 in the near future. This study aims to examine the potential of applying adaptive inner-basin water allocation measures (AIWAM), which were not explicitly considered in previous studies, for mitigating water scarcity in the future period (2020-2050). By incorporating AIWAM in water scarcity assessment, nonagricultural water uses are assumed to have high priority over agricultural water use and thus would receive more water supply. Results show that global water deficit is projected to be ~3241.9 km3/yr in 2050, and severe water scarcity is mainly found in arid and semi-arid regions, e.g. Western US, Northern China, and the Middle East. Future warming climate and socioeconomic development tend to aggravate global water scarcity, particularly in Northern Africa, Central Asia, and the Middle East. The application of AIWAM could significantly mitigate water scarcity for nonagricultural sectors by leading to a decrease of global population subject to water scarcity by 12% in 2050 when compared to that without AIWAM. However, this is at the cost of reducing water availability for agricultural sector in the upstream areas, resulting in an increase of global irrigated cropland exposed to water scarcity by 6%. Nevertheless, AIWAM provides a useful scenario that helps design strategies for reducing future population exposure to water scarcity, particularly in densely populated basins and regions. Our findings highlight increasing water use competition across sectors between upstream and downstream areas, and the results provide useful information to develop adaptation strategies towards sustainable water management.

Rapid and highly sensitive visual detection of oxalate for metabolic assessment of urolithiasis via selective recognition reaction of CdTe quantum dots.

Urolithiasis is a common disease that affects 5% to 8.8% of the world population with high recurring frequency. Therefore, there is an urgent need for the rapid and efficient diagnostics of urolithiasis. In this study, we developed a quantum dots (QDs)-based sensor for detecting urolithiasis oxalate. Urolithiasis oxalate was quantified by reducing Cu2+ to Cu+, which can be selectively recognized by CdTe QDs. The homogeneous sensing system shows high sensitivity for oxalate detection in the range of 0.1 µM to 10 mM within 6 min; moreover, the visual detection of 10 µM oxalate could be achieved by the naked eye. Our method was tested on 53 clinical samples; it showed 100% specificity and sensitivity for calcium oxalate urolithiasis compared with clinical diagnosis, even for hematuria samples. Furthermore, this method can be expanded to other wide range of biochemistry applications for medical diagnosis and point-of-care testing.

The validity of caries risk assessment in young adults with past caries experience using a screening Cariogram model without saliva tests.

OBJECTIVE: To evaluate the caries-predictive validity of a screening Cariogram model without saliva tests in Chinese young adults with past caries experience. METHODS: Two-hundred and fifteen Chinese young adults seeking dental care were included in this observational study, with informed consent obtained. All participants were 18-29 years of age and with past caries experience. A caries risk assessment was made at baseline using a full-blown Cariogram model and a screening Cariogram model without saliva tests; this assessment included bacterial count, saliva secretion and buffer capacity. Participants were divided into five risk groups according to 'the chance of avoiding caries' expressed in Cariogram software with two models. Each participant was required to receive re-examination after 2 years and then the actual caries increment (ΔDMFS) was calculated. The correlation between ΔDMFS and the ratings of caries risk was analysed using Spearman rank correlation. Differences between the full-blown and screening models were expressed as area under the receiver-operating characteristics (ROC) curve (AUC). RESULTS: One-hundred and ninety-two participants finished the 2-year follow-up study, after 23 dropped out. The mean 2-year caries increment was 0.67 ± 1.03. Both Cariogram models displayed a statistically significant relationship with caries development (P < 0.001): more new caries was found among those assessed with high risk compared with those assessed with low risk. No statistically significant difference of the AUC was found between the two Cariogram models (P > 0.05). CONCLUSIONS: The Cariogram model without saliva tests does not significantly decrease the caries-predictive ability in young adults with a history of caries. This screening model is a potential tool for rapid caries risk assessment for such populations.

Factors influencing subjective orthodontic treatment need and culture-related differences among Chinese natives and foreign inhabitants.

AIM: The aim of this survey was to compare Chinese natives and foreign inhabitants in Chengdu, China, with respect to: (1) attitudes towards dental appearance, (2) subjective orthodontic treatment need, and (3) the main factors influencing orthodontic treatment need. METHODOLOGY: A total of 522 subjects, including 227 foreign inhabitants and 295 Chinese natives in Chengdu participated in the survey. A simple random sampling method was adopted and a face-to-face interview was conducted at some public sites using a questionnaire. Data was entered by two persons synchronously using Epidata 3.0, and SPSS 13.0 was used to analyze these data. RESULTS: 89.0% of foreign inhabitants were satisfied with their teeth compared to only 46.8% of Chinese natives. Females were more dissatisfied with their teeth than males. Chinese natives put improving appearance as the top priority (55.9%) for seeking orthodontic treatment; however, in foreign inhabitants, the main reason for seeking treatment was to improve masticatory function (44.1%), followed by "to be pretty" (35.2%). The importance of well-aligned teeth and self-perception of psychosocial impact of malocclusion were the same two main factors influencing subjective orthodontic treatment need (P < 0.05) in foreign inhabitants and Chinese natives. Subjective orthodontic treatment need between the two target groups was significantly different (P < 0.05). CONCLUSION: (1) It was very common that Chinese natives were dissatisfied with their dental appearance, and their subjective orthodontic treatment needs were high. (2) There were some differences in orthodontic treatment motives between the two target groups. (3) There were differences in subjective orthodontic treatment needs between foreign inhabitants and Chinese natives. However, the prominent influential factors were almost the same. There may be benefit to understanding subjective orthodontic needs of different races.