Household expenditure for dental care in low and middle income countries.

This study assessed the extent of household catastrophic expenditure in dental health care and its possible determinants in 41 low and middle income countries. Data from 182,007 respondents aged 18 years and over (69,315 in 18 low income countries, 59,645 in 15 lower middle income countries and 53,047 in 8 upper middle income countries) who participated in the WHO World Health Survey (WHS) were analyzed. Expenditure in dental health care was defined as catastrophic if it was equal to or higher than 40% of the household capacity to pay. A number of individual and country-level factors were assessed as potential determinants of catastrophic dental health expenditure (CDHE) in multilevel logistic regression with individuals nested within countries. Up to 7% of households in low and middle income countries faced CDHE in the last 4 weeks. This proportion rose up to 35% among households that incurred some dental health expenditure within the same period. The multilevel model showed that wealthier, urban and larger households and more economically developed countries had higher odds of facing CDHE. The results of this study show that payments for dental health care can be a considerable burden on households, to the extent of preventing expenditure on basic necessities. They also help characterize households more likely to incur catastrophic expenditure on dental health care. Alternative health care financing strategies and policies targeted to improve fairness in financial contribution are urgently required in low and middle income countries

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Allostatic load and depressive symptoms in older adults: An analysis of 12-year panel data

BACKGROUND: Whether changes in allostatic load (AL) and depressive symptoms relate over time has not been yet fully explored. This study evaluated the association between AL and depressive symptoms over 12 years among community-dwelling older adults. METHODS: Panel data from 8291 participants in the English Longitudinal Study of Ageing were analysed. Depressive symptoms were assessed with the 8-item Centre for Epidemiologic Studies Depression Scale (CES-D). The AL score was derived from nine metabolic, cardiovascular and immune biomarkers. The association between AL and depressive symptoms was modelled in a linear hybrid model adjusting for time-invariant (sex, ethnicity) and time-variant confounders (age, marital status, education, wealth, physical activity, smoking status, alcohol intake, limitations in daily living, comorbidities). RESULTS: The mean AL score was 3.1 (SD: 2.1), 3.5 (2.3), 3.2 (2.3) and 3.3 (2.5) whereas the mean CES-D score was 1.4 (SD: 1.8), 1.2 (1.8), 1.2 (1.8) and 1.2 (1.7) in waves 2, 4, 6 and 8, respectively. In the adjusted model, the between-person differences (coefficient: 0.02, 95% CI: 0.01, 0.04) but not the within-individual differences (0.01; 95% CI: −0.01, 0.03) in the AL score were associated with CES-D score. The between-person coefficient indicates that participants with greater AL scores also had slightly higher CES-D scores. The within-person coefficient indicates that changes in the AL score were not associated with changes in the CES-D score. CONCLUSION: AL was associated with depressive symptoms. However, most of the association was driven by differences in AL between individuals rather than changes in AL over time

Factors affecting energy-efficiency investment in the hotel industry: survey results from Spain

Increasing energy efficiency is a major way of saving energy and thus reducing energy expenses. However, adoption of energy efficiency is generally low, as demonstrated by the energy efficiency gap. To understand that gap, this paper analyses the factors that affect how the energy efficiency attribute is rated in investment in heating, ventilation and air conditioning (HVAC) systems in the hotel industry in Spain. A survey conducted on two hundred owners of hotels, hostels and holiday cottages (referred to jointly here for the sake of convenience as the hotel industry ) shows that the value placed on energy efficiency is influenced not just by climate conditions, environmental concern and type of hotel but also by other attributes of the HVAC system such as brand reliability, price and performance. The hotel industry may also be identifying EE as a proxy for quality rather than savings. Designing the right energy-efficiency policy entails accounting for potential responses by agents, and this analysis helps identify those drivers to which they may or may not respond. © 2021, The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature.This study was undertaken as a part of the CONSumer Energy Efficiency Decision making (CONSEED) project, an EU-funded H2020 research project under grant agreement number 723741. This research is also supported by the Spanish State Research Agency through María de Maeztu Excellence Unit accreditation 2018-2022 (Ref. MDM-2017- 0714) and the Basque Government BERC programme. Financial support from the Government of Spain and the European Regional Development Fund through grants RTI2018-093692-B-I00, RTC2019- 007315-3 and RED2018-102794-T is gratefully acknowledged

Microplastics in the Antarctic marine system: An emerging area of research

It was thought that the Southern Ocean was relatively free of microplastic contamination; however, recent studies and citizen science projects in the Southern Ocean have reported microplastics in deep-sea sediments and surface waters. Here we reviewed available information on microplastics (including macroplastics as a source of microplastics) in the Southern Ocean. We estimated primary microplastic concentrations from personal care products and laundry, and identified potential sources and routes of transmission into the region. Estimates showed the levels of microplastic pollution released into the region from ships and scientific research stations were likely to be negligible at the scale of the Southern Ocean, but may be significant on a local scale. This was demonstrated by the detection of the first microplastics in shallow benthic sediments close to a number of research stations on King George Island. Furthermore, our predictions of primary microplastic concentrations from local sources were five orders of magnitude lower than levels reported in published sampling surveys (assuming an even dispersal at the ocean surface). Sea surface transfer from lower latitudes may contribute, at an as yet unknown level, to Southern Ocean plastic concentrations. Acknowledging the lack of data describing microplastic origins, concentrations, distribution and impacts in the Southern Ocean, we highlight the urgent need for research, and call for routine, standardised monitoring in the Antarctic marine system

Tooth loss in the United Kingdom--trends in social inequalities: an age-period-and-cohort analysis

This study assessed trends in social inequalities in tooth loss in the United Kingdom between 1988 and 2009. Data from 20,126 adults who participated in the latest three national Adult Dental Health Surveys in England, Wales and Northern Ireland were used. Social class was determined using the 6-point Registrar General's Social Class. Three indicators of tooth loss were analysed; the proportion of edentate people among all adults and the number of teeth and the proportion with functional dentition (defined as having 20+ teeth) among dentate adults. Trends were modelled within an age, period and cohort framework using partial least squares regression (PLSR). Confidence intervals for PLSR estimates were obtained using non-parametric bootstrapping. The Slope and Relative Index of Inequality (SII and RII) were used to quantify social inequalities in tooth loss. Between 1988 and 2009, absolute inequalities in total tooth loss narrowed (SII changed from -28.4% to -15.3%) while relative inequalities widened (RII from 6.21 to 20.9) in the whole population. On the other hand, absolute and relative social inequality in tooth loss remained fairly stable over time among dentate adults. There was an absolute difference of 2.5-2.9 in number of teeth and 22-26% in the proportion with functional dentition between the lowest and highest social classes. In relative terms, the highest social class had 10-11% more teeth and 25-28% higher probability of having functional dentition than the lowest social class. The findings show pervasive inequalities in tooth loss by social class among British adults despite marked improvements in tooth retention in recent years and generations. In the whole adult population, absolute inequalities in tooth loss have narrowed while relative inequalities have increased steadily. Among dentate adults, absolute and relative inequalities in number of teeth and proportion of people with functional dentition have remained significant but unchanged over time

Consumers’ preferences regarding energy efficiency: a qualitative analysis based on the household and services sectors in Spain

Informational failures frequently lead consumers to make non-optimal energy-efficient purchasing decisions. Energy efficiency labels seek to influence consumer behaviour at the point of sale by reducing informational failures regarding energy efficiency. However, several informational and behavioural factors contribute to the energy efficiency gap and could render label-oriented policies useless. The purchasing decision model of Allcott and Greenstone (The Journal of Economic Perspectives, 26, 3 28, 2012) is used here to explore the different factors that influence purchasing decisions and understand (i) the importance of energy consumption compared to other attributes; (ii) how consumers weight energy savings and (iii) what other benefits and costs influence the purchase of energy-efficient goods. The analysis reported here is based on qualitative research methods and is conducted in the household and service sectors (the accommodation sector and private service companies), for appliances, heating and cooling systems and cars in Spain. Results show that (i) there is still an informational gap regarding energy labels and (ii) bounded rationality and end-user behaviour are important limiting factors for the purchase of energy-efficient goods in Spain. © 2020, The Author(s).This work was undertaken as a part of the CONSumer Energy Efficiency Decision making (CONSEED) project, an EU-funded H2020 research project under grant agreement number 723741. This research is also supported by the Spanish State Research Agency through María de Maeztu Excellence Unit accreditation 2018-2022 (Ref. MDM-2017-0714). Amaia de Ayala would like to thank the financial support of Fundación Ramón Areces under the project entitled “La toma de decisiones de los hogares en eficiencia energética: determinantes y diseño de políticas”