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

Uima-allas tarhaminkille (Mustela vison) – hyvinvointia vai ei?

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Lipoproteiini (a):n suurentunut pitoisuus on ateroskleroottisen valtimotaudin riskitekijä, jonka tehokas hoito mahdollistuu uusilla täsmälääkkeillä

Vertaisarvioitu. English abstract.Lipoproteiini (a) [Lp(a)] on LDL:n kaltainen kolesterolia kuljettava aterotromboottinen seerumin lipoproteiini ja ateroskleroottisen valtimotaudin itsenäinen riskitekijä. Ihmisten Lp(a)-pitoisuudet vaihtelevat suuresti ja määräytyvät pääosin perinnöllisesti. Suurentunut Lp(a)-pitoisuus liittyy sepelvaltimotautiin, sydän- ja aivoinfarktiin, perifeeriseen valtimotautiin ja aorttaläpän ahtaumaan. Seerumin Lp(a)-pitoisuuden mittaamista suositellaan erityisesti familiaalisen hyperkolesterolemian (FH) yhteydessä sekä silloin, kun potilaan suvussa on varhaisia valtimotautitapauksia tai potilaan valtimotautien kokonaisriski on suuri tai erittäin suuri. Statiinilääkitys ei pienennä Lp(a)-pitoisuutta. Sen sijaan LDL-kolesterolipitoisuutta voimakkaasti pienentävät PCSK9:n estäjät pienentävät Lp(a)-pitoisuutta noin 30 % ja näyttävät pienentävän valtimotautiriskiä myös tätä kautta. Lähivuosina markkinoille on tulossa seerumin Lp(a)-pitoisuutta erittäin tehokkaasti pienentäviä RNA:han kohdentuvia täsmälääkkeitä.Peer reviewe

Cholesterol loading suppresses the atheroinflammatory gene polarization of human macrophages induced by colony stimulating factors

In atherosclerotic lesions, blood-derived monocytes differentiate into distinct macrophage subpopulations, and further into cholesterol-filled foam cells under a complex milieu of cytokines, which also contains macrophage-colony stimulating factor (M-CSF) and granulocyte-macrophage-colony stimulating factor (GM-CSF). Here we generated human macrophages in the presence of either M-CSF or GM-CSF to obtain M-MO and GM-MO, respectively. The macrophages were converted into cholesterol-loaded foam cells by incubating them with acetyl-LDL, and their atheroinflammatory gene expression profiles were then assessed. Compared with GM-MO, the M-MO expressed higher levels of CD36, SRA1, and ACAT1, and also exhibited a greater ability to take up acetyl-LDL, esterify cholesterol, and become converted to foam cells. M-MO foam cells expressed higher levels of ABCA1 and ABCG1, and, correspondingly, exhibited higher rates of cholesterol efflux to apoA-I and HDL2. Cholesterol loading of M-MO strongly suppressed the high baseline expression of CCL2, whereas in GM-MO the low baseline expression CCL2 remained unchanged during cholesterol loading. The expression of TNFA, IL1B, and CXCL8 were reduced in LPS-activated macrophage foam cells of either subtype. In summary, cholesterol loading converged the CSF-dependent expression of key genes related to intracellular cholesterol balance and inflammation. These findings suggest that transformation of CSF-polarized macrophages into foam cells may reduce their atheroinflammatory potential in atherogenesis.Peer reviewe

High heterotrophic CO2 emissions from a Malaysian oil palm plantations during dry-season

Background Tropical peatlands are currently being rapidly cleared and drained for the establishment of oil palm plantations, which threatens their globally significant carbon sequestration capacity. Large-scale land conversion of tropical peatlands is important in the context of greenhouse gas emission factors and sustainable land management. At present, quantification of carbon dioxide losses from tropical peatlands is limited by our understanding of the relative contribution of heterotrophic and autotrophic respiration to net peat surface CO2 emissions. Methods In this study we separated heterotrophic and autotrophic components of peat CO2 losses from two oil palm plantations (one established in ‘2000’ and the other in 1978, then replanted in ‘2006’) using chamber-based emissions sampling along a transect from the rooting to non-rooting zones on a peatland in Selangor, Peninsular Malaysia over the course of three months (June-August, 2014). Collar CO2 measurements were compared with soil temperature and moisture at site and also accompanied by depth profiles assessing peat C and bulk density. Results The soil respiration decreased exponentially with distance from the palm trunks with the sharpest decline found for the plantation with the younger palms. The mean heterotrophic flux was 1244.7 ± SE 149.2 mg m-2h-1 and 663.8 ± SE 102.2 mg m-2h-1 at the 2000 and 2006 plantations, respectively. Autotrophic emissions adjacent to the palm trunks were 944 ± SE 99.7 mg m-2h-1 and 1962 ± SE 246 mg m-2h-1 at the 2000 and 2006 plantations, respectively. Heterotrophic CO2 flux was positively related to peat soil moisture, but not temperature. Total peat C stocks were 60 kg m-2 (down to 1 m depth) and did not vary among plantations of different ages but SOC concentrations declined significantly with depth at both plantations but the decline was sharper in the second generation 2006 plantation. Conclusions The CO2 flux values reported in this study suggest a potential for very high carbon (C) loss from drained tropical peats during the dry season. This is particularly concerning given that more intense dry periods related to climate change are predicted for SE Asia. Taken together, this study highlights the need for careful management of tropical peatlands, and the vulnerability of their carbon storage capability under conditions of drainage

Milk and milk-derived peptides combat against hypertension and vascular dysfunction : a review

Epidemiological studies have revealed that consumption of milk and fermented dairy products is inversely associated with elevated blood pressure and with many of the risk factors of the metabolic syndrome. Previously, calcium was thought to be behind this phenomenon, but during the last 20 years, convincing evidence emerging from experimental, epidemiological and intervention studies has highlighted the important role of the small peptides formed during fermentation processes. This review provides an overview of the potential blood pressure lowering components present in dairy products with a special focus on casein-derived tripeptides.Peer reviewe

Sensitivity of barley varieties to weather in Finland

Global climate change is predicted to shift seasonal temperature and precipitation patterns. An increasing frequency of extreme weather events such as heat waves and prolonged droughts is predicted, but there are high levels of uncertainty about the nature of local changes. Crop adaptation will be important in reducing potential damage to agriculture. Crop diversity may enhance resilience to climate variability and changes that are difficult to predict. Therefore, there has to be sufficient diversity within the set of available cultivars in response to weather parameters critical for yield formation. To determine the scale of such ‘weather response diversity’ within barley (Hordeum vulgare L.), an important crop in northern conditions, the yield responses of a wide range of modern and historical varieties were analysed according to a well-defined set of critical agro-meteorological variables. The Finnish long-term dataset of MTT Official Variety Trials was used together with historical weather records of the Finnish Meteorological Institute. The foci of the analysis were firstly to describe the general response of barley to different weather conditions and secondly to reveal the diversity among varieties in the sensitivity to each weather variable. It was established that barley yields were frequently reduced by drought or excessive rain early in the season, by high temperatures at around heading, and by accelerated temperature sum accumulation rates during periods 2 weeks before heading and between heading and yellow ripeness. Low temperatures early in the season increased yields, but frost during the first 4 weeks after sowing had no effect. After canopy establishment, higher precipitation on average resulted in higher yields. In a cultivar-specific analysis, it was found that there were differences in responses to all but three of the studied climatic variables: waterlogging and drought early in the season and temperature sum accumulation rate before heading. The results suggest that low temperatures early in the season, delayed sowing, rain 3–7 weeks after sowing, a temperature change 3–4 weeks after sowing, a high temperature sum accumulation rate from heading to yellow ripeness and high temperatures (⩾25°C) at around heading could mostly be addressed by exploiting the traits found in the range of varieties included in the present study. However, new technology and novel genetic material are needed to enable crops to withstand periods of excessive rain or drought early in the season and to enhance performance under increased temperature sum accumulation rates prior to heading

Carboxyl-Terminal Cleavage of Apolipoprotein A-I by Human Mast Cell Chymase Impairs Its Anti-Inflammatory Properties

Objective Apolipoprotein A-I (apoA-I) has been shown to possess several atheroprotective functions, including inhibition of inflammation. Protease-secreting activated mast cells reside in human atherosclerotic lesions. Here we investigated the effects of the neutral proteases released by activated mast cells on the anti-inflammatory properties of apoA-I. Approach and Results Activation of human mast cells triggered the release of granule-associated proteases chymase, tryptase, cathepsin G, carboxypeptidase A, and granzyme B. Among them, chymase cleaved apoA-I with the greatest efficiency and generated C-terminally truncated apoA-I, which failed to bind with high affinity to human coronary artery endothelial cells. In tumor necrosis factor--activated human coronary artery endothelial cells, the chymase-cleaved apoA-I was unable to suppress nuclear factor-B-dependent upregulation of vascular cell adhesion molecule-1 (VCAM-1) and to block THP-1 cells from adhering to and transmigrating across the human coronary artery endothelial cells. Chymase-cleaved apoA-I also had an impaired ability to downregulate the expression of tumor necrosis factor-, interleukin-1, interleukin-6, and interleukin-8 in lipopolysaccharide-activated GM-CSF (granulocyte-macrophage colony-stimulating factor)- and M-CSF (macrophage colony-stimulating factor)-differentiated human macrophage foam cells and to inhibit reactive oxygen species formation in PMA (phorbol 12-myristate 13-acetate)-activated human neutrophils. Importantly, chymase-cleaved apoA-I showed reduced ability to inhibit lipopolysaccharide-induced inflammation in vivo in mice. Treatment with chymase blocked the ability of the apoA-I mimetic peptide L-4F, but not of the protease-resistant D-4F, to inhibit proinflammatory gene expression in activated human coronary artery endothelial cells and macrophage foam cells and to prevent reactive oxygen species formation in activated neutrophils. Conclusions The findings identify C-terminal cleavage of apoA-I by human mast cell chymase as a novel mechanism leading to loss of its anti-inflammatory functions. When targeting inflamed protease-rich atherosclerotic lesions with apoA-I, infusions of protease-resistant apoA-I might be the appropriate approach.Peer reviewe