[Impact of health literacy on patient experience of outpatients in China and its mechanism].

OBJECTIVE: To understand the relationship between health literacy and patient experience of outpatients in China, and to explore its mechanism. METHODS: The conceptual framework was developed based on Andersen's behavioral model of health services use and health literacy skills framework. An online cross-sectional survey was conducted with snowball sampling method, while the health literacy was measured by self-designed patient health literacy scale, and the patient experience was measured by the Chinese patient experience questionnaire for ambulatory care developed by Peking Union Medical College. And a structural equation model was built to explore the relationship between them and test the mechanism of health literacy influencing patient experience. RESULTS: A total of 2 773 subjects were investigated. The average score of health literacy was (90.72±12.90) points, accounting for 78.89% of the full score, and the dimension of seeking social support had the lowest score. The average score of overall rating of patient experience was (3.71±0.74) points, and the scores of each dimension of patient experience were between 3.56 and 3.80. The model fit indices of structural equation model for overall rating of patient experience among the outpatients were χ2/df=9.29 (χ2=4 107.27, df=442), root mean square error of approximation (RMSEA)=0.055 (< 0.06), comparative fit index (CFI)=0.926 (>0.90), Tucker-Lewis index (TLI)=0.918 (>0.90), standardized root mean square residual (SRMR)=0.061 (< 0.08), the model was acceptable. The variance in patient experience explained by the model was 0.108. The structural equation model analysis results showed that the overall rating of outpatient experience was directly affected by health literacy (ß=0.263, P < 0.001), also indirectly affected by health literacy (ß=0.012, P < 0.001). In other words, the overall rating increased by 0.275 units for each standard deviation increase of health literacy. Self-evaluated health status mediated the relationship between health literacy and the overall rating of outpatient experience. In terms of diffe-rent dimensions of patient experience, the standardized path coefficient of the total effect of health literacy on patient experience was as follows: Information guidance 0.337, humanistic care 0.319, communication with doctors 0.294, service efficiency 0.240, and hospital environment 0.173. CONCLUSION: The patients with higher level of health literacy were more likely to have a better outpatient experience in China, and the information guidance experience and humanistic care experience were most affected by health literacy. And the communication and information utilization ability had the greatest influence on patient experience.

Morphological and physiological characteristics of transgenic cherry tomato mutant with HBsAg gene.

HBsAg gene was previously introduced into cherry tomato (Lycopersicum esculentum var. cerasiforme) by Agrobacterium-mediated transformation. To investigate the side effect of HBsAg gene in cherry tomato, we analyzed morphological and physiological characteristics of the transgenic mutant N244. The process was performed under field conditions. The results suggested that the mutant N244 exhibited morphological, cytological and physiological variation. First of all, compared with the wild plants NK, N244 had fleshy and dark green leaves, the fewer notches of leaf edge, more adventitious roots and barren seeds. Moreover, the chromosome of N244 were found to be triploid (n = 36) by flow cytometric analysis. Furthermore, N244 has obvious physiological alterations, as compared to NK. It was speculated that transformation of the genes probably led to ploidy variation, and further caused phenotype and physiological changes of plants. Our study will reveal side effects of the mutants, and promote cultivation of transgenic plants in the field.

Bronchial Rn dose survey for residences.

The bronchial dosimeter for Rn progeny proposed by Yu and Guan in 1998 was employed to survey the bronchial dose from Rn progeny in 30 residences in Hong Kong. An average bronchial deposition fraction of Rn progeny was obtained as 0.0334, which gave an average dose conversion factor (DCF) of 8.5 mSv WLM-1. The mean values of potential alpha energy concentration (PAEC) deposited in the tracheobronchial region (PAECT-B), total PAEC in air (PAECT), annual effective dose (E), concentration of Rn gas (RC) and annual dose conversion factor (ADCF) for all the residential sites combined were 0.11 +/- 0.05, 3.1 +/- 1.4 mWL, 1.2 +/- 0.5 mSv yr-1, 23 +/- 10 Bq m-3 and 0.055 +/- 0.020 (mSv yr-1 per Bqm-3), respectively, with air-conditioned sites (AC sites) and non-AC sites having significantly different mean ADCF values. The indoor relative humidity affected PAECT and RC with high confidence levels (> 95%).

[Experimental study on seal treatment of early root-surface caries in senile patients after irradiated by Nd:YAG laser].

OBJECTIVE: To study the curative effect of pulsed Nd:YAG laser on early root-surface caries in senile patients. METHODS: Teeth with early root-surface caries removed from patients aged over 60 were irradiated with different energy output and sealant and observed under scanning electron microscope. RESULTS: Surface layer on early root-face caries were seen to be honeycomb or nibbled before irradiation, melted after irradiated by Nd:YAG laser,and with a smooth surface of the lesion after sealed. CONCLUSION: Early root-surface caries sealed with light-cured sealant after pulsed Nd:YAG laser irradiation is a safe and effective therapy.

Inhibitory effect of recombinant TGF alpha-PE40 on vascular smooth muscle cell proliferation.

AIM: To study inhibitory effect of recombinant transforming growth factor alpha-Pseudomonas exotoxin fusion protein (TP40) on proliferation of the cultured vascular smooth muscle cells (SMC). METHODS: Expression of epidermal growth factor receptor (EGFR) mRNA and EGFR in cultured proliferating and quiescent SMC was analyzed with Northern blot and immunohistochemistry. Inhibitory effects of TP40 on SMC proliferation and protein synthesis were analyzed with crystal violet staining and [3H]leucine incorporation. Competition assays were performed by the addition of 100-fold excess of EGF. RESULTS: Expression of EGFR mRNA and EGFR in rapidly proliferating SMC increased than that in quiescent SMC. When the concentration of TP40 was 10 or 100 micrograms.L-1, inhibitory effects of TP40 on rapidly proliferating SMC proliferation and protein synthesis were much higher than that on quiescent SMC (P < 0.01), and the IC50 of [3H]leucine incorporation against rapidly proliferating and quiescent SMC were 8.01 (5.05-12.69) and 121.95 (90.98-163.47) micrograms.L-1. Excess EGF completely blocked inhibitory effects of TP40. CONCLUSION: The rapidly proliferating SMC express EGFR at a high level. TP40 selectively inhibited the proliferation of rapidly proliferating SMC. The cytotoxic effects of TP40 were specifically mediated by EGFR.

Active measurements of indoor concentrations of radon and thoron gas using charcoal canisters.

Standardized charcoal canisters with diameters of 4 inch, of a type recommended by the USEPA for passive measurement of radon gas concentrations, have been modified for active air sampling. Simultaneous measurement of the concentrations of radon (Rn) and thoron (Tn) in air can be obtained by counting the areas under gamma-ray peaks. Sample results obtained in a laboratory and in a residence with different conditions are also given. The largest uncertainties are about 2% and 3% for Rn and Tn respectively. The minimum detection limits are around 2.0 Bq/m3 for both gases. If only Rn concentration is required, the measurement time can be significantly shortened.

A portable bronchial dosimeter for radon progenies.

A dosimeter for radon progeny has been proposed consisting of a single sampler with one 400-mesh wire screen and one filter, which is considered as a model for a portable bronchial dosimeter. During the sampling, air is drawn through the screen and the filter at a face velocity of 12.0 cm s(-1). After sampling, measurements of the screen and the filter are made at the same time through gross alpha counting. The annual effective dose (E, in mSv y(-1)) is calculated employing the exposure to radon progenies in the tracheobronchial (T-B) region. The dosimeter can be used in conjunction with an activated charcoal canister for the measurement of the radon gas concentration to yield the effective dose conversion factor (DCF, in mSv y(-1) per Bq m(-3)). These have laid the foundation to the design of a portable bronchial dosimeter. The validity of the dosimeter has been tested through measurements of annual effective dose and the effective dose conversion factor in different environments.

Measurement of tracheobronchial dose from simultaneous exposure to environmental radon and thoron progeny.

According to the theory and idea of Hopke et al., a bronchial dosimeter consisting of multiple metal screens has been developed to measure the deposition fractions of radon and thoron progeny in the nasal (N) and tracheobronchial (T-B) regions of the human respiratory tract and to give the dose conversion factors in the T-B region in units of mGy WLM(-1) and mSv y(-1) per Bq m(-3). Different air treatments have been performed in a closed laboratory, which include the use of air conditioning and the application of positive and negative ions for the investigation of the change of the dose conversion factors. At the same time, the radon and thoron gas concentrations have also been measured in the laboratory by active sampling using newly designed activated charcoal canisters connected in series with the bronchial dosimeter for the calculation of the resulted annual effective dose under different air treatments. It is observed that the calculated dose conversion factors derived from the bronchial dosimeter have large discrepancies with those computed using existing lung models. It has also been found that the application of negative ions cannot reduce the annual effective dose in the T-B region; the application of positive ions can lead to a reduction, but not as much as the use of air conditioning. The mitigation of radon effects by air conditioning demonstrated using the bronchial dosimeter is more prominent than that shown by using lung models.

A survey of radon and thoron progeny for dwellings in Hong Kong.

The potential alpha energy concentrations of radon and thoron progeny have been surveyed for dwellings in Hong Kong and the mean values are obtained as 3.58 and 2.29 mWL, respectively. The relative importance of the value for thoron is unexpectedly high, which is attributed to the high 232Th content of the building materials used in Hong Kong. It has also been found that the potential alpha energy concentration values for radon progeny changed dramatically with the season due to the different aerosol contents in the air in different seasons. The factors affecting the potential alpha energy concentration values have also been studied. These factors fall into three categories, namely (1) the building characteristics including age of the buildings, wall coverings and floor coverings; (2) the location of sites including nearby environments and the elevation of the sites; and (3) the meteorological parameters including wind speed, atmospheric pressure, air temperature and relative humidity. For categories (1) and (2), all factors seem to affect the potential alpha energy concentration values, although the effects may be different for radon and thoron progeny, which may be due to the very much different half lives of radon and thoron gas and to the different behavior of radon and thoron progeny in the attachment to aerosols. For category (3), only wind speed has been found to have effects.

A preliminary study on the radon concentrations in water in Hong Kong and the associated health effects.

Tap water, flushing water and drinking water including natural mineral water, artificial mineral water and distilled water have been investigated for their radon concentrations. It has been found that the radon concentration in natural mineral water samples is the highest and that in tap water is the second highest, while other categories have values very near to the detection limit. From these the corresponding annual effective doses for the stomach and the lung are determined. It is found that annual effective dose due to direct consumption of water (mineral and tap water) is far greater than that due to inhalation of radon emanated from tap water and flushing water. Moreover, it is also shown that the annual effective doses due to inhalation of radon emanated from tap water and flushing water is negligible when compared to the total annual effective dose for indoor radon in Hong Kong.