In 2009, the South Korean government expanded universal health insurance to include oral health services. In the present study, we sought to examine whether improved access resulted in a reduction in ...income-based self-reported oral health inequalities.
We analyzed repeated cross-sectional data from the Korea National Health and Nutrition Examination Survey (KNHANES) waves IV through VI (2007-2015). We analyzed self-reported oral health status among 68,431 subjects. Changes in oral health inequalities across four income levels (low, middle-low, middle-high, and high) were assessed with the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII).
The average oral health status of children and adolescents improved the most over the observation period. The absolute magnitude of oral health inequalities (measured by the SII) improved for most groups, with the notable exception of young male adults. By contrast, the ratio of poor oral health between high- and low-income groups (measured by the RII) changed little over time, indicating that relative inequalities remained resistant to change.
The expansion of dental health insurance may not be sufficient to move the needle on self-reported oral health inequalities among adults.
Objectives
This study aimed to evaluate whether Korea's 2012 health insurance expansion of adult dental care coverage reduced income‐based oral health inequalities.
Methods
This study analysed ...nationally representative repeated cross‐sectional data from waves IV to VI (2007‐2015) of the Korean National Health and Nutrition Examination Survey. The main outcome variable is unmet dental needs due to cost, and the independent variable is household income. Further, the slope index of inequality (SII) and the relative index of inequality (RII) were calculated. Calculations were adjusted for income and stratified by age group, gender and survey period. Data from the three waves were pooled to estimate the SII and RII trend coefficients between survey years. These were tested using two‐way interaction terms for each age group and gender.
Results
Some changes in income‐based inequality trends were identified. Relative and absolute inequalities in unmet needs (indicated by the RII and SII) decreased over time for most age groups. However, this trend was not observed for older women.
Conclusions
Income‐based inequalities in unmet dental needs persisted among older women in Korea despite the insurance expansion. By contrast, after the 2012 insurance expansion, the absolute and relative inequality in unmet dental needs decreased for young and middle‐aged as well as older adults.
Tumor recurrence following treatment is the major cause of mortality for glioblastoma multiforme (GBM) patients. Thus, insights on the evolutionary process at recurrence are critical for improved ...patient care. Here, we describe our genomic analyses of the initial and recurrent tumor specimens from each of 38 GBM patients. A substantial divergence in the landscape of driver alterations was associated with distant appearance of a recurrent tumor from the initial tumor, suggesting that the genomic profile of the initial tumor can mislead targeted therapies for the distally recurred tumor. In addition, in contrast to IDH1-mutated gliomas, IDH1-wild-type primary GBMs rarely developed hypermutation following temozolomide (TMZ) treatment, indicating low risk for TMZ-induced hypermutation for these tumors under the standard regimen.
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•Distant recurrence predicts branched evolution of the paired tumors•Distant recurrence frequently involves divergence in key GBM driver alterations•Recurrent GBMs have more aberrations in core GBM driver pathways than initial GBMs•TMZ-induced hypermutation is rare in IDH1-wild-type primary GBMs
Kim et al. find that glioblastomas recurring at distant sites have driver genetic alterations very different from those of matched initial tumors. They also show that, in contrast to IDH1-mutated tumors, IDH1-wild-type primary glioblastomas rarely develop hypermutation following temozolomide treatment.
A new protocol for preparation of acyl fluorides was developed by recognizing activated ketones as starting materials. The method provides a different scope compared with previously reported methods ...that employ carboxylic acids as substrates. A working hypothesis of pull-and-push-driven fluorinative C–C bond cleavage was successfully demonstrated by the simple addition of diethylaminosulfur trifluoride (DAST) derivatives to α-oximinoketones. The designed reaction system led to a highly efficient and chemoselective reaction. The wide availability of the ketones allowed for a range of synthetically useful aryloyl and aliphatic acyl fluorides including those containing chiral skeletons. The method is mild, fast, scalable, and potentially one-pot operative.
Background: In 2012, the Korean government expanded dental insurance for the elderly to promote improved access to dental care. We examined the causal effect of this policy on dental care needs, ...focusing on low-income older adults.Methods: We compared data before and after policy implementation using double difference (DD) and triple difference (DDD) analyses. We used the nationally representative data from the Korea National Health and Nutrition Examination Survey from 2010 and 2016–2018. Individuals aged ≥65 years were included in the treatment group, and individuals aged <65 years were included in the control group.Results: Dental insurance expansion was associated with a paradoxical increase in perceived unmet dental needs among elderly individuals (8.8 percentage points increase, 95% CI: 4.7 to 13.0). However, there were improvements in dental prosthetics outcomes (denture wearing 4.0 percentage points, 95% CI: 0.2 to 7.9 and dental implants 5.0 percentage points, 95% CI: 2.1 to 7.9; P < 0.01). Upon analyzing low-income elderly individuals using DDD analysis, we found that the insurance expansion led to a 21.6% smaller increase in unmet dental needs among low-income adults, compared to high-income adults (95% CI, −35.0 to −8.5; P < 0.01).Conclusion: Dental insurance expansion in South Korea resulted in improvements in access to dental prosthetic services overall. It also led to a smaller increase in unmet dental needs among low-income older adults, compared to high-income adults.
Abstract
There have been marked improvements in oral health in Korea during the past 10 years, including chewing ability. We sought to disentangle age, period, and cohort effects in chewing ability ...between 2007 and 2018. We analyzed data from the Korea National Health and Nutrition Examination Survey. The main variable was chewing difficulty, which was assessed among participants aged 20 years and older. APC analysis revealed three trends in chewing difficulty: (1) there was an increase in chewing difficulty starting at around 60 years of age (age effect), (2) there was a steady decrease in chewing difficulty during the observation period (period effect), and (3) chewing ability improved with each successive generation born after 1951 (cohort effect). Regarding recent improvements in chewing ability, cohort effects were somewhat more important than period effects.
A high-efficiency fuel cell power conditioning system with input current ripple reduction is proposed. The proposed system consists of a high-efficiency high-step-up current-fed resonant push-pull ...converter and a full-bridge inverter. The converter conserves inherent advantages of a conventional current-fed push-pull converter such as low input-current stress and high voltage conversion ratio. Also, a voltage-doubler rectifier is employed in order to remove the reverse-recovery problem of the output rectifying diodes and provide much higher voltage conversion ratio. The current ripple reduction control without an external component is suggested. Therefore, the proposed system operates in a wide input-voltage range with a high efficiency. By using a current-ripple reduction control, the input current ripple is furthermore reduced. A 1.5-kW prototype is implemented with input-voltage range from 30 to 70 V. Experimental results show that minimum efficiency at full load is about 92.5% and that ripple current is less than 2% of the rated input current.
The Korean National Health Insurance expanded the dental insurance in 2012 to cover denture services for older adults. We analyzed whether the new policy improved of chewing ability in the eligible ...population. We used regression discontinuity (RD), a quasi-experimental design, to analyze the effects of the expanded dental insurance. We analyzed data from the Korea National Health and Nutrition Examination Survey conducted in 2010 and 2015. The study population consisted of two groups: the treatment group, aged 65 and above who were eligible; and the control group, under 65 years of age who were not eligible for the dental insurance benefit. The main outcome evaluated was self-reported chewing difficulty. The RD analysis showed that in 2015, the chewing difficulty in aged above 65 was 2.2% lower than in those aged under 65. However, the difference was not statistically significant (P = 0.76). The results from the falsification testing of predetermined covariates, placebo cut-offs, and bandwidths validated our main conclusion. The expansion of dental insurance benefits to include dentures for the older adults did not improve the chewing ability in the eligible population. Future studies should evaluate long-term outcomes of oral health as well as the social impacts on the elderly.
The epithelial-mesenchymal transition (EMT) comprises an essential biological process involving cancer progression as well as initiation. While the EMT has been regarded as a phenotypic conversion ...from epithelial to mesenchymal cells, recent evidence indicates that it plays a critical role in stemness, metabolic reprogramming, immune evasion and therapeutic resistance of cancer cells. Interestingly, several transcriptional repressors including Snail (SNAI1), Slug (SNAI2) and the ZEB family constitute key players for EMT in cancer as well as in the developmental process. Note that the dynamic conversion between EMT and epithelial reversion (mesenchymal-epithelial transition, MET) occurs through variable intermediate-hybrid states rather than being a binary process. Given the close connection between oncogenic signaling and EMT repressors, the EMT has emerged as a therapeutic target or goal (in terms of MET reversion) in cancer therapy. Here we review the critical role of EMT in therapeutic resistance and the importance of EMT as a therapeutic target for human cancer.
Phototoxicity is an acute toxic reaction induced by topical skin exposure to photoreactive chemicals followed by exposure to environmental light and thus chemicals that absorb UV are recommended to ...be evaluated for phototoxic potential. There are currently three internationally harmonized alternative test methods for phototoxicity. One of them is the in vitro Phototoxicity: RhE Phototoxicity test method (OECD TG498).
Korean center for the Validation of Alternative Methods (KoCVAM) developed an in vitro phototoxicity test method using a KeraSkin™ reconstructed human epidermis model (KeraSkin™ Phototoxicity Assay) as a ‘me-too’ test method of OECD TG498.
For the development and optimization of KeraSkin™ Phototoxicity Assay, the following test chemicals were used: 6 proficiency chemicals in OECD TG498 (3 phototoxic and 3 non-phototoxic), 6 reference chemicals in OECD Performance Standard No. 356 (excluding the proficiency test chemicals, 3 phototoxic and 3 non-phototoxic) and 13 additional chemicals (7 phototoxic and 6 non-phototoxic). Based on the test results generated from the test chemicals above, the overall predictive capacity of KeraSkin™ Phototoxicity Assay was calculated. In particular, the assay exhibited 100 % accuracy, 100 % sensitivity, and 100 % specificity. Therefore, it fulfills the requirements to be included as a ‘me-too’ test method in OECD TG498.
•Statistical analysis of 25 chemicals showed KeraSkin™ Phototoxicity Assay with 100% sensitivity, specificity, and accuracy.•Predictive capacity for OECD PS No. 356 reference chemicals 100% sensitivity, specificity, and accuracy.•Based on the ROC curve, phototoxicity prediction cut-off set at ≥ 30% decrease in cell viability, consistent with OECD TG498.•KeraSkin™ Phototoxicity Assay satisfied requirements for inclusion as 'me-too' method in OECD TG498.
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