Vaihtoehtoisia korvausmalleja hammashoidon sairausvakuutusjärjestelmän kehittämiseksi

Tässä tutkimuksessa tavoitteena oli tarjota vaihtoehtoja keskusteluun hammashoidon sairausvakuutuskorvausjärjestelmän uudistamiseksi. Vaihtoehtoisten korvausmallien, porrasmallin ja tilimallin, korvauksia verrattiin vuonna 2009 voimassa olleen taksamallin korvauksiin. Laskelmien avulla arvioitiin, ketkä korvausta saaneet hyötyisivät ja ketkä häviäisivät. Tutkimuksen aineistona oli otos henkilöistä, jotka saivat sairausvakuutuksen sairaanhoitokorvausta yksityisen hammashoidon kustannuksista vuonna 2009. Otoksen koko oli 100 000 henkilöä, joilla oli yhteensä 503 093 toimenpidettä. Aineistossa oli tiedot henkilöille tehdyistä toimenpiteistä, toimenpiteistä maksetuista palkkioista ja saaduista korvauksista. Taustamuuttujia aineistossa olivat sukupuoli, ikä, kotikunta ja valtionveronalaiset vuositulot. Laskelmissa käytettiin kahta vaihtoehtoista korvausmallia: porrasmallia ja tilimallia. Porrasmallissa korvaus nousi, kun asiakkaan kustannukset nousivat. Tilimallissa kaikilla oli käytössään vuosittain samansuuruinen korvaussumma. Tutkimusaineiston todellisille toimenpiteille laskettiin vaihtoehtoisten mallien mukaiset korvaukset. Laskelmissa oletettiin, että henkilöiden toimenpiteet ja toimenpiteiden palkkiot säilyvät ennallaan. Korvausmallit pidettiin kustannusneutraaleina, joten niiden korvaussumma oli korkeintaan vuoden 2009 tasolla. Laskelmat osoittivat, että tilimallista hyötyisi kolme neljästä korvauksen saajasta. Korvausprosentti oli taksamallia korkeampi, kun vuosikustannus eivät ylittäneet 500 euroa. Porrasmallin käyttöönotosta hyötyisi yksi kymmenestä korvauksen saajasta. Korvausprosentti kasvoi, jos vuosikustannus ylitti 800 euroa. Sitä pienemmällä vuosikustannuksella korvausprosentti pieneni taksamalliin verrattuna. Jos sairausvakuutuksen korvausjärjestelmää halutaan uudistaa kustannusneutraalisti ja samalla parantaa edellytyksiä käyttää yksityisiä hammashoitopalveluja, tulisi soveltaa tilimallia porrasmallin asemesta

Hepatic Ultrasonography Compared with Computed Tomography and Magnetic Resonance Imaging at Diagnosis of Metastatic Uveal Melanoma

Purpose To evaluate the consistency of hepatic ultrasonography (US) with staging computed tomography (CT) and magnetic resonance imaging (MRI), to analyze why US was inconsistent with CT/MRI, and to compare CT/MRI. DESIGN Reliability analysis. METHODS Two hundred fifteen patients whose primary uveal melanoma was managed in the Helsinki University Hospital and who were diagnosed with hepatic metastases by US within 60 days of staging CT/MRI from January 1999 to December 2016, were included. Patients attended a real-life follow-up schedule including hepatic US, liver function tests (LFT), and a confirmatory CT/MRI. We evaluated the consistency of US with staging CT/MRI regarding the presence and number of metastases. RESULTS The enrolled patients underwent 215 US, 167 CT, and 69 MRI examinations, and 67% of them had biopsy-confirmed metastases. Screening was regular for 98% of the patients, and 66% were asymptomatic. US was fully consistent with CT/MRI in detecting metastases in 113 (53%) patients, in 63 (29%) CT/MRI showed more metastases, and in 16 (7%) less metastases than US. CT/MRI was inconsistent with US in 23 (11%) patients. The sensitivity of US in detecting metastases was 96% (95% confidence interval, 92-98). US failed to suggest metastases in 10 patients. LFT were abnormal in six of them, and a newly-detected hepatic lesion was present by US in four. CONCLUSIONS Hepatic US is a sensitive screening modality in detecting metastases in patients with primary uveal melanoma, if combined with LFT and in case of any new detected lesion, a confirmatory MRI.Peer reviewe

Meson exchange and nucleon polarizabilities in the quark model

Modifications to the nucleon electric polarizability induced by pion and sigma exchange in the q-q potentials are studied by means of sum rule techniques within a non-relativistic quark model. Contributions from meson exchange interactions are found to be small and in general reduce the quark core polarizability for a number of hybrid and one-boson-exchange q-q models. These results can be explained by the constraints that the baryonic spectrum impose on the short range behavior of the mesonic interactions.Comment: 11 pages, 1 figure added, expanded discussio

Electromagnetic Form Factors of the Nucleon in a Relativistic Quark Pair Creation Model

We study the effects of the | qqq q\bar{q} > component of the hadronic wave function on the description of the electromagnetic structure of the nucleon. Starting with a qqq baryonic wave function which describes the baryonic and mesonic low energy spectrum, the extra q\bar{q} pair is generated through a relativistic version of the 3P_0 model. It is shown that this model leads to a renormalization of the quark mass that allows one to construct a conserved electromagnetic current. We conclude that these dynamical relativistic corrections play an important role in reproducing the Q2 dependence of the electromagnetic form factors at low Q^2.Comment: 15 pages, 3 figures. Minor change

Decline after immobilisation and recovery after remobilisation of synovial fluid IL1, TIMP, and chondroitin sulphate levels in young beagle dogs

OBJECTIVE: To monitor the concentration of markers of cartilage and synovium metabolism in the knee (stifle) joint synovial fluid of young beagles subjected to immobilisation and subsequent remobilisation.METHODS: The right hind limb of 17 dogs was immobilised in flexion for 11 weeks. Simultaneously, the contralateral left knee was exposed to increased weight bearing. The remobilisation period lasted 50 weeks. Litter mates served as controls. The concentration in joint lavage fluid of interleukin 1 (IL1) was measured by immunoassay, the activity of phospholipase A2 (PLA2) was determined by an extraction method, chondroitin sulphate (CS) concentration by precipitation with Alcian blue, hyaluronan (HA) by an ELISA-like assay using biotinylated HA-binding complexes, matrix metalloproteinase 3 (MMP-3), and tissue inhibitor of metalloproteinases 1 (TIMP-1) by sandwich ELISA, and synovitis was scored by light microscopy.RESULTS: Synovitis or effusion was absent in all experimental and control groups. Immobilisation decreased the joint lavage fluid levels of IL1 (p<0.05), TIMP (p< 0.05), and the concentration of CS down to 38 (p<0.05) in comparison with untreated litter mates with normal weight bearing. Immobilisation did not affect the activity of PLA2, or the concentration of MMP-3 or HA in synovial fluid. Joint remobilisation restored the decreased concentrations of markers to control levels. Increased weight bearing did not change the concentrations of markers in comparison with the control joints with normal weight bearing.CONCLUSIONS: 11 weeks joint immobilisation decreased the concentration of markers of cartilage and synovium metabolism in the synovial fluid, and remobilisation restored the concentrations to control levels. The changes in joint metabolism induced by immobilisation, as reflected by the markers, are thus different from those found in osteoarthritis, where increased levels of these markers are associated with enhanced degradation and synthesis. These findings suggest that the change induced in joint metabolism by immobilisation is reversible in its early stages

The π−\pi-Gluon Exchange Interaction Between Constituent Quarks

The interaction mediated by irreducible pion and gluon exchange between constituent quarks is calculated and shown to have a strong tensor component, which tends to cancel the pion exchange tensor interaction between quarks. Its spin-spin component is somewhat weaker than the pion exchange spin-spin interaction, while its central and spin-orbit components are small in comparison to the corresponding single gluon exchange interactions. The combination of the $\pi-$gluon exchange interaction with the single pion exchange interaction and a weak gluon exchange interaction between constituent quarks has the qualitative features required for understanding the hyperfine splittings of the spectra of the nucleon and the $\Delta$ resonances.Comment: LaTeX, 17 pages, 5 Postscript figure

Sustainability of cellulose dissolution and regeneration in 1,5-diazabicyclo[4.3.0]non-5-enium acetate : a batch simulation of the IONCELL-F process

The recyclability of 1,5-diazabicyclo[4.3.0] non-5-enium acetate ([DBNH][OAc]), as a direct dissolution solvent for cellulose, was evaluated during laboratory scale recycling trials. The main objective was to simulate the conditions of a spinning bath from a Lyocell-type air-gap spinning process, called the IONCELL-F process. The saline solution was then concentrated, recycled and reused as many times as possible before cellulose dissolution was no longer possible. The chemical compositions of the ionic liquid and pulp were recorded throughout the experiments. The results of the experiments showed that [DBNH][OAc] can be recycled from aqueous media with an average recovery rate of 95.6 wt% using basic laboratory equipment, without any further process intensification or optimisation. The recycling of the ionic liquid did not change the chemical composition or degree of polymerisation of the recovered pulp but the colour of the regenerated pulps gradually darkened as the recycling times increased. The ionic liquid was found to hydrolyse 6.0-13.6 mol% per cycle, under these conditions. The build-up of the hydrolysis product, 3-( aminopropyl)-2-pyrrolidonium acetate, killed the dissolution feature at between 30.6-45.6 wt% hydrolysis product. The enzymatic digestibility of the regenerated pulp samples was studied with both a monocomponent endoglucanase and a cellulase mixture. The amount of residual [DBNH][OAc] in the regenerated pulps was determined, by both NMR and capillary electrophoresis. Although hydrolysis of the ionic liquid occurs, this study clearly shows potential for industrial application, with appropriate process equipment and recycling conditions.Peer reviewe

Penta-quark states with hidden charm and beauty

More and more hadron states are found to be difficult to be accommodated by the quenched quark models which describe baryons as 3-quark states and mesons as antiquark-quark states. Dragging out an antiquark-quark pair from the gluon field in hadrons should be an important excitation mechanism for hadron spectroscopy. Our recent progress on the penta-quark states with hidden charm and beauty is reviewed.Comment: Plenary talk at the 5th Asia-Pacific Conference on Few-Body Problems in Physics 2011 (APFB2011), 22-26 Aug., 2011, Seoul, Kore

Dairy Intake and Body Composition and Cardiometabolic Traits among Adults : Mendelian Randomization Analysis of 182041 Individuals from 18 Studies

BACKGROUND: Associations between dairy intake and body composition and cardiometabolic traits have been inconsistently observed in epidemiological studies, and the causal relationship remains ill-defined. METHODS: We performed Mendelian randomization analysis using an established genetic variant located upstream of the lactase gene (LCT- 13910 C/T, rs4988235) associated with dairy intake as an instrumental variable (IV). The causal effects of dairy intake on body composition and cardiometabolic traits (lipids, glycemic traits, and inflammatory factors) were quantified by IV estimators among 182041 participants from 18 studies. RESULTS: Each 1 serving/day higher dairy intake was associated with higher lean mass [beta (SE) = 0.117 kg (0.035); P = 0.001], higher hemoglobin A(1c) [0.009% (0.002); P <0.001], lower LDL [-0.014 mmol/L (0.006); P = 0.013], total cholesterol (TC) [-0.012 mmol/L (0.005); P = 0.023], and non-HDL [- 0.012 mmol/L (0.005); P = 0.028]. The LCT- 13910 C/T CT + TT genotype was associated with 0.214 more dairy servings/day (SE = 0.047; P = 0.001), 0.284 cm higher waist circumference (SE = 0.118; P = 0.017), 0.112 kg higher lean mass (SE = 0.027; P = 3.8 X 10(-5)), 0.032 mmol/L lower LDL (SE = 0.009; P = 0.001), and 0.032 mmol/L lower TC (SE = 0.010; P = 0.001). Genetically higher dairy intake was associated with increased lean mass [0.523 kg per serving/day (0.170); P = 0.002] after correction for multiple testing (0.05/18). However, we find that genetically higher dairy intake was not associated with lipids and glycemic traits. CONCLUSIONS: The present study provides evidence to support a potential causal effect of higher dairy intake on increased lean mass among adults. Our findings suggest that the observational associations of dairy intake with lipids and glycemic traits may be the result of confounding. (C) 2019 American Association for Clinical ChemistryPeer reviewe