Shushing the press shortens lives: cross-national evidence of the impact of press freedom on life expectancy.

AIMS: Press freedom around the globe has deteriorated over the past decade, especially during the COVID-19 pandemic. This paper explores the effect of press freedom, as a cornerstone of democracy, on life expectancy. METHODS: Exploring cross-country data, we use the ordinary least square method to estimate the association between press freedom and life expectancy. In addition, we adopt three novel instrumental variables to explore the causal relationship. RESULTS: Our estimations indicate that a freer press leads to higher life expectancy, and the effect exists independently of the level of democracy. In addition, the effect of continuous exposure to press freedom is stronger than sporadic free press status. The results are robust to measurement errors, influential outliers, and country-specific heterogeneity. CONCLUSIONS: This study reveals the fundamental role of press freedom in promoting public health that was previously underexplored. Therefore, enhancing freedom of expression can be an effective tool to address three of the United Nations Millennium Development Goals, that is, reduce under-five mortality, improve maternal health, and combat HIV/AIDS.JEL:I1 H7 D02.

International accreditation, linguistic proximity and trade in medical services.

The recent growth in the globalization of medical services has attracted broad attention from scholars and policymakers. The intimacy and risk associated with many medical services makes these markets especially sensitive to trade barriers, transaction costs and asymmetric information. This paper uses a gravity model to investigate the factors associated with the global pattern of bilateral trade in medical services. Using data from the United Nations International Trade in Services Database, we differentiate between trade flows in which the recipient travels to the service provider, 'medical tourism,' and those trade flows in which the service is delivered to the recipient, 'other health services.' Our findings indicate that, after controlling for various economic, historical and geographic linkages, linguistic proximity and international accreditation are not significant predictors of the bilateral pattern of medical tourism, though they are associated with greater trade in other health services. We argue the key difference is that trade in other health services, including medical transcription, diagnostic analysis and laboratory services, is akin to trade in intermediate inputs. The medical service providers contracting for these services are especially sensitive to risk and have strong incentives to monitor quality. By contrast, medical tourism is a market in which patients do not have strong incentives to engage in costly monitoring or information gathering. Providers seeking to market their services to patients abroad have mitigated the effects of linguistic dissimilarity and asymmetric information by exploiting the strong complementarities between medical and non-medical tourism services.

Bias-corrected estimates of reduction of post-surgery length of stay and corresponding cost savings through the widespread national implementation of fast-tracking after liver transplantation: a quasi-experimental study.

Background: Fast-tracking is an approach adopted by Mayo Clinic in Florida's (MCF) liver transplant (LT) program, which consists of early tracheal extubation and transfer of patients to surgical ward, eliminating a stay in the intensive care unit in select patients. Since adopting this approach in 2002, MCF has successfully fast-tracked 54.3% of patients undergoing LT. Objectives: This study evaluated the reduction in post-operative length of stay (LOS) that resulted from the fast-tracking protocol and assessed the potential cost saving in the case of nationwide implementation. Methods: A propensity score for fast-tracking was generated based on MCF liver transplant databases during 2011-2013. Various propensity score matching algorithms were used to form control groups from the United Network of Organ Sharing Standard Analysis and Research (STAR) file that had comparable demographic characteristics and health status to the treatment group identified in MCF. Multiple regression and matching estimators were employed for evaluation of the post-surgery LOS. The algorithm generated from the analysis was also applied to the STAR data to determine the proportion of patients in the US who could potentially be candidates for fast-tracking, and the potential savings. Results: The effect of the fast-tracking on the post-transplant LOS was estimated at approximately from 2.5 (p-value = 0.001) to 3.2 (p-value < 0.001) days based on various matching algorithms. The cost saving from a nationwide implementation of fast-tracking of liver transplant patients was estimated to be at least $78 million during the 2-year period. Conclusion: The fast-track program was found to be effective in reducing post-transplant LOS, although the reduction appeared to be less than previously reported. Nationwide implementation of fast-tracking could result in substantial cost savings without compromising the patient outcome.

Identification of genes related to floral organ development in pak choi by expression profiling.

Pak choi is a highly nutritious vegetable that is widely grown in China, Southeast Asia, and other parts of the world. Because it reproduces by seed, it is very important to understand the mechanism of floral organ development. Therefore, using the Chinese cabbage genome as a reference, this study analyzed the expression profiles of shoot apex genes at flower bud differentiation stages 1 and 5, in order to identify genes related to floral organ development. The results showed that the proportion of mapped genes was high, with 84.25 and 83.80% of clean reads from the two sample saligned to the reference genome, respectively. A total of 525 differentially expressed genes (DEGs) were identified, 224 of which were upregulated and 301 were downregulated. The expression levels of genes homologous to Chinese cabbage flowering genes were also analyzed at stages 1 and 5; the expression levels of Bra012997 (ap1), Bra000393 (SOC1), and Bra004928 (SOC1) were significantly upregulated at stage 5, suggesting that these three genes positively regulate floral development in pak choi. DEGs involved in floral organ development were analyzed with homologous genes from Arabidopsis thaliana; the homologous genes Bra029281 (AGL42), Bra026577 (ARPN), Bra022954 (SPL3), Bra029293 (ARF2), Bra007978 (AtRLP12), Bra033221 (SPL8), Bra008037 (LOX4), Bra001598 (IAA19), Bra003892 (PATL1), Bra038778 (AT4G21323), Bra025315 (KLCR2), and Bra013906 (DTX35) are directly related to floral organ development in Arabidopsis, suggesting that these genes have corresponding functions during flower organ development in pak choi, and could be candidates for further genetic research. These results provide a foundation for research on the molecular mechanism of flower organ development in pak choi and other Brassica rapa vegetables.

Quality control method of Tibetan medicine Saussureae obvalltae / 中国中药杂志

To control the quality of Tibetan medicine Saussureae obvalltae, the quality control method and standard were established in this study. The water content, total ash, acid-insoluble ash and ethanol-soluble extractives of Saussureae obvalltae were determined according to the methods recorded in appendix of Chinese Pharmacopeia(2010 edition). Microscopical identification was performed for the plant and powder of the leaves. The TLC method was established, with chlorogenic acid and rutin as control substances, and a mixture of acetate-btuanone-formic acid-water (10∶6∶1∶2) as developing solvent and silica gel G as thin layer plate. Agilent ZORBAX Eclipse XDB-C₁₈ (4.6 mm×250 mm, 5 μm) column was adopted and eluted with the mobile phase of acetonitrile-0.1% phosphoric acid (17∶83) in a gradient mode at a flow rate of 1.0 mL•min⁻¹. The column temperature was 40 ℃ and the detection wavelength was 350 nm. As a result, the plant and leaves of Saussureae obvalltae of different origins showed constent microscopic features. Chlorogenic acid, rutin and the other constituents were well separated on TLC detected under the sun light. According to the results of the methodological study, chlorogenic acid and rutin were in good linear correlation in the ranges of 0.119 2-0.715 4 μg(r=0.999 9) and 0.160 7-0.964 4 μg(r=1.000), and the average recoveries were 105.4% (RSD 1.4%) and 99.50% (RSD 0. 91%), respectively. The content of ethanol-soluble extractives, water content, total ash and acid-insoluble ash were 26.01%-31.59%, 7.16%-8.04%, 8.46%-11.14%,0.50%-1.87%, respectively. According to the study, the established method was specific and accurate, which could be used for the quality control of this drug.

Trends and structural shifts in health tourism: evidence from seasonal time-series data on health-related travel spending by Canada during 1970-2010.

There has been a growing interest in better understanding the trends and determinants of health tourism activities. While much of the expanding literature on health tourism offers theoretical or qualitative discussion, empirical evidences has been lacking. This study employs Canada's outbound health tourism activities as an example to examine the trends in health tourism and its association with changing domestic health care market characteristics. A time-series model that accounts for potential structural changes in the trend is employed to analyze the quarterly health-related travel spending series reported in the Balance of Payments Statistics (BOPS) during 1970-2010 (n = 156). We identified a structural shift point which marks the start of an accelerated growth of health tourism and a flattened seasonality in such activities. We found that the health tourism activities of Canadian consumers increase when the private investment in medical facilities declines or when the private MPI increases during the years following the structural-change. We discussed the possible linkage of the structural shift to the General Agreement on Trade in Services (GATS), which went into effect in January, 1995.

[Population characteristics and ecological suitability of Saussureae hieracioides].

OBJECTIVE: To analyze the population characteristics and the appropriate producing area of Saussureae hieracioides in China. METHODS: Chuanxibei plateau, one of the main producing areas of Saussureae hieracioides, was selected as the analytical basal place. Ecological methods were used to investigate the density and biomass of Saussureae hieracioides. Traditional Chinese Medicine Geographic Information System (TCMGIS-II) was used to analyze the appropriate producing area of Saussureae hieracioides. RESULTS: Saussureae hieracioides could form the dominant species in its distribution area. The proper region (with similarity of 90% - 100%) of Saussureae hieracioides accounted for 338 776.89 km2, including 5 provinces/municipalities and 226 counties/cities. The largest area among them was Tibet Autonomous Region with area of 148 175.55 km2, followed by Sichuan Province (110 216.46 km2), Qinghai Province (62 947.61 km2), Gansu Province (16 233.09 km2) and Yunnan Province (1 177.18 km2). CONCLUSION: TCMGIS is much valuable to the recognition of formation of producing area, the division of adaptive area, introduction and acclimatization of medicinal materials, it also provides a scientific reference for the introduction and cultivation of Saussureae hieracioides.

Aging of platelet nitric oxide signaling: pathogenesis, clinical implications, and therapeutics.

The nitric oxide (NO)/soluble guanylate cyclase (sGC) system is fundamental to endothelial control of vascular tone, but also plays a major role in the negative modulation of platelet aggregation. The phenomenon of platelet NO resistance, or decreased antiaggregatory response to NO, occurs increasingly with advanced age, as well as in the context of cardiovascular disease states such as heart failure, ischemic heart disease, and aortic valve disease. The central causes of NO resistance are "scavenging" of NO and dysfunction of sGC. In the current review, we discuss the roles of several modulators of NO synthesis and of the NO/sGC cascade on changes in platelet physiology with aging, together with potential therapeutic options to reduce associated thrombotic risk.

Thioredoxin-interacting protein: pathophysiology and emerging pharmacotherapeutics in cardiovascular disease and diabetes.

The thioredoxin system, which consists of thioredoxin (Trx), nicotinamide adenine dinucleotide phosphate (NADPH) and thioredoxin reductase (TrxR), has emerged as a major anti-oxidant involved in the maintenance of cellular physiology and survival. Dysregulation in this system has been associated with metabolic, cardiovascular, and malignant disorders. Thioredoxin-interacting protein (TXNIP), also known as vitamin D-upregulated protein or thioredoxin-binding-protein-2, functions as a physiological inhibitor of Trx, and pathological suppression of Trx by TXNIP has been demonstrated in diabetes and cardiovascular diseases. Furthermore, TXNIP effects are partially Trx-independent; these include direct activation of inflammation and inhibition of glucose uptake. Many of the effects of TXNIP are initiated by its dissociation from intra-nuclear binding with Trx or other SH-containing proteins: these effects include its migration to cytoplasm, modulating stress responses in mitochondria and endoplasmic reticulum, and also potentially activating apoptotic pathways. TXNIP also interacts with the nitric oxide (NO) signaling system, with apparent suppression of NO effect. TXNIP production is modulated by redox stress, glucose levels, hypoxia and several inflammatory activators. In recent studies, it has been shown that therapeutic agents including insulin, metformin, angiotensin converting enzyme inhibitors and calcium channel blockers reduce TXNIP expression, although it is uncertain to what extent TXNIP suppression contributes to their clinical efficacy. This review addresses the role of TXNIP in health and in cardiovascular and metabolic disorders. Finally, the potential advantages (and disadvantages) of pharmacological suppression of TXNIP in cardiovascular disease and diabetes are summarized.

[Determination of skimmin, scopolin and umbelliferone in Tibetan medicine Saussurea hieracioides by HPLC].

This study is aimed to establish a high-performance liquid chromatography (HPLC) method for simultaneous determination of skimmin, scopolin and umbelliferone in Saussurea hieracioides. Samples were analyzed on a Wondasil C18-WR column (4.6 mm x 250 mm, 5 microm) with methanol (A) and water containing 0.1% phosphate (B) as mobile phases for gradient elution at a flow rate of 1.0 mL x min(-1). The detection wavelength and column temperature were set at 325 nm and 35 degrees C, respectively, and the sample size was 10 microL. The results showed that skimmin, scopolin and umbelliferone were simultaneously achieved within 40 min under the above conditions. A good linearity was observed in the range of 0.18-5.6 microg (r = 1.000 0), 0.060-1.8 microg (r = 0.999 9), 0.032-0.97 microg (r = 0.999 8) for skimmin, scopolin and umbelliferone, respectively, with the average recoveries of 99.16% (RSD = 0.41%), 100.3% (RSD = 0.79%), 102.2% (RSD = 0.87%). The method is simple, accurate and reproducible and can be used for the quality control of S. hieracioides.

Anatomical research on the subacromial interval following implantation of clavicle hook plates.

This article aimed to explore whether hook plate implantation significantly narrowed the subacromial space. 24 shoulder joints were implanted with clavicle hook plates. A Vernier caliper was used to measure the length and thickness of the acromion. In addition, the length and thickness of the hook of the plate were measured. The data from all measurements recorded were divided into 2 groups Group A, the length group: the length of acromion and the hook, and Group B, the thickness group: the thickness of acromion and the depth of hook. There are significant statistical differences when comparing between the subgroups within each group. The depth of the hook exceeds the thickness of the acromion (12.41±2.80 mm vs. 10.44±2.59 mm, respectively), the hook plate implantation significantly narrowed the subacromial space by 1.97±1.19 mm (p<0.01), and the length of the hook was shorter than that of the acromion by 9.75±3.64 mm (p<0.01). Our findings revealed that the hook plate with only 3 depths could not match the acromion satisfactorily and the hook plate implantation significantly narrowed the subacromial space. A hook plate with a variable depth, which can match better with patient's anatomy, is worthy of further investigation in the future.

Health tourism on the rise? Evidence from the Balance of Payments Statistics.

The study assesses the presence and magnitude of global trends in health tourism using health-related travel (HRT) spending reported in the International Monetary Fund's Balance of Payments Statistics database. Linear regression and quantile regression are applied to estimate secular trends of the import and export of HRT based on a sample of countries from 2003 to 2009. The results show that from 2003 to 2009 the import and export of health tourism rose among countries with a high volume of such activities (accounting for the upper 40% of the countries), but not among those with a low volume. The uneven growth in health tourism has generated greater contrast between countries with high and low volumes of health tourism activities. However, the growth in the total import of health tourism did not outpace the population growth, implying that in general the population's tendency to engage in health tourism remained static.

Formation and characteristics of aqueous two-phase systems formed by a cationic surfactant and a series of ionic liquids.

Aqueous two-phase systems (ATPS) were obtained in the aqueous mixtures of a cationic surfactant and a series of ionic liquids (ILs). The effects of IL structure, temperature and additives on the phase separation were systematically investigated. The microstructures of some ATPS were observed by freeze-fracture replication technique. Lyotropic liquid crystal was found in the bottom phase besides micelles under different conditions. Remarkably, both IL structure and additives profoundly affected the formation and properties of the ATPSs. The phase separation can be attributed to the existence of different aggregates and the cation-π interactions of the cationic surfactant with the ILs, which has a significant role in the formation of ATPS. The extraction capacity of the studied ATPS was also evaluated through their application in the extraction of two biosubstances. The results indicate that the ILs with BF4(-) as anion show much better extraction efficiencies than the corresponding ILs with Br(-) as anion do under the same conditions. l-Tryptophan was mainly distributed into the NPTAB-rich phase, while methylene blue and capsochrome were mainly in the IL-rich phase.

The role of financial wellbeing, sociopolitical attitude, self-interest, and lifestyle in one's attitude toward social health insurance.

BACKGROUND: There has been continuous debate in the United States, Germany, and China about their respective healthcare systems. While these three countries are dealing with their own unique problems, the question of how social a healthcare system should be is a topic in this debate. OBJECTIVE: This study examined how strongly college students' attitudes toward a social healthcare system relate to ideological orientation and self-interest. METHODS: We used samples of college students in the People's Republic of China, Germany, and the US, and extracted factors measuring "financial wellbeing," "sociopolitical attitude," "self-interest," and "lifestyle" to explain the "attitude toward social health insurance" (ASHI) construct developed in recent literature (Loh et al. in Eur J Health Econ 13:707-722). RESULTS: The results of regression analysis showed that sociopolitical attitude/progressivism is positively related to the ASHI, but the degree of association varies considerably from country to country. We also found that a self-interest factor, measured by health status, seems to be inversely related to an individual's ASHI in the US, but not in China or Germany. Individuals with relatively healthy lifestyle choices were less likely to have a favorable ASHI in Germany, but no such relationship was found in China and the US. These results indicate that while some commonalities exist, there are also considerable differences in the structure of ASHI across these three countries. CONCLUSION: Ultimately, the results reported here could help to develop a predictive model that can be utilized to forecast a country's ASHI. Such a predictive model could be used by politicians to gauge the popularity of a healthcare plan that is under consideration in a particular country.

Premature aging of cardiovascular/platelet function in polycystic ovarian syndrome.

OBJECTIVE: The objective of this study was to compare the impact of aging on nitric oxide (NO) modulation of platelet and vascular function in healthy women and women with polycystic ovary syndrome. METHODS AND RESULTS: A case-control study of women ages 18 to 60 years, comparing women with polycystic ovarian syndrome against age-matched healthy controls, was performed. A total of 242 women, of whom 109 had polycystic ovarian syndrome (based on Rotterdam criteria), participated in the study. Women who were pregnant or on clopidogrel were excluded from the study. Inhibition of platelet aggregation by nitric oxide (primary outcome measure), vascular endothelial function, plasma concentrations of N(G), N(G)-dimethyl-L-arginine (ADMA), endothelial progenitor cell count, and high-sensitivity C-reactive protein (markers of endothelial dysfunction and inflammation) were assessed. With increasing age in control women, there was progressive attenuation of platelet responses to NO, impairment of endothelial function, and elevation of ADMA levels (P ≤.001). Irrespective of age, women with polycystic ovarian syndrome exhibited greater impairment of all these parameters (all P <.05, 2-way analysis of variance) and demonstrated these anomalies earlier in life. CONCLUSIONS: Normal aging in women is associated with attenuation of NO-based signaling in platelets and blood vessels. In women with polycystic ovarian syndrome, these changes are present from early adult life and may contribute to premature atherogenesis.

Peer effects in adolescent bodyweight: evidence from rural China.

Peer effect is a potential determinant of individual weight gain that has drawn considerable attention recently. The presence of peer effect implies that policies targeted at changing bodyweight can have enhanced effectiveness through a multiplier effect. This study aims to measure the peer effects on adolescent bodyweight in China. Using the small community nature of the rural sample of the wave 2000 of the China Health and Nutrition Survey, we define plausible peer groups and assess the effect of the average BMI of his/her peer group on the BMI of an adolescent. An instrumental variable (IV) approach is applied to control for potential endogeneity of the peer group's BMI. We find evidence supporting peer effect on BMI in general. The peer effect is around 0.3 with slight variation between two alternative peer definitions. Split sample analysis shows that the peer effect is significant for females (0.32-0.37), and insignificant for male adolescents. Furthermore, we find strong influence of same-gender peers (0.34-0.42) for female adolescents. Conditional quantile regressions show that the peer effect in weight gain is mainly present at or below the median in the conditional BMI distribution for girls, and at the higher end of the BMI distribution for boys. Multiple tests show strong identification, and strong instruments in our IV estimation. Placebo tests suggest that our results are reasonably robust to the correlated effect, due to unobserved community- and province-level factors.

[Actuality investigation on general crude drugs and its quality standard of Tibetan medicine].

OBJECTIVE: To provide a reference for the standardization of Tibetan medicine. METHOD: Investigating the hospital preparations , Tibetan formulated products, and the literature recorded preparations in the Tibetan, Qinghai, Gansu, Sichuan and Yunnan Provinces. Moreover, the varieties, original bases and standard conditions of these preparations were analyzed. According to Chinese Pharmacopoeia, Tibetan medicine part of ministerial standard, Tibetan medicine standards and related monographs and literatures of Tibetan medicine. RESULT: About 502 various of herbs were used in 711 hospital preparations from 40 medical institutions, Tibetan formulated products from Tibetan pharmaceutical factories, and 439 literature recorded preparations. About 154 herbs were used in more than 10 preparations, while most of them were Tibetan endemic species. About 416 medicinal varieties have the original documented basis, including 287 botanicals, 78 animal medicines, 51 mineral medicines, involving a total of 94 families, 261 genus and 643 species of botanical origin (including species of the next grade), 35 families, 52 genera and 61 species of the animal origin (including species of the next grade). About 122 varieties of herbs were cross-used in the traditional Chinese medicine and Tibetan medicine, about 80% of Tibetan medicinal varieties are produced in the Tibetan Areas of Tibet Plateau. About 293 medicinal varieties were contained in the above standards. Most of the herb's standards only contains character, indentification, and examination, except for 8 varieties which were recorded in the Chinese Pharmacopoeia (2010) as Tibetan medicine. CONCLUSION: This study of quality standard of Tibetan medicine should have an emphasis on the general varieties, especially the study on the arrangement research and the efficacious material basis of the varieties and the original, as well as term standardization of the National Medicine.

Chemical constituents of Rhododendron lepidotum.

An unusual natural product named 2,4,6-trihydroxacetophenone-3, 5-di-C-beta-D-glucoside (18) were isolated from aerial parts of Rhododendron lepidotum grows in Tibet, along with other 17 known compounds: hopenol-B (1), lupeol (2), ursolic acid (3), avicularin (4), quercetin (5), myricetin (6), hyperoside (7), myricetin-3'-O-beta-D-xyloside (8), (+)-taxifolin-3-O-alpha-L-arabinopyranoside (9), (+)-taxifolin-3-O-beta-D-glucopyranoside (10), lyoniside (11), confluentin (12), 2-(4-hydroxyphenyl)-ethyltriacontanoate (13), 2, 6-dimethoxy-4-hydroxyphenyl-1-O-beta-D-glucopyranoside (14), (-)-2-hydroxy-5-(2-hydroxyethyl) phenyl-O-beta-D-glucopyranoside (15), (-)-isola-riciresinol (16) and isofraxoside (17). All the compounds were firstly isolated from this plant as well as compounds 1, 13-18 were reported occurrence in R. spp. for the first time. The structures were identified based on analyses of spectroscopic data and physico-chemical evidences.

Measuring attitude toward social health insurance.

In order to understand the health care system a country chooses to adopt or the health care reform a country decides to undertake, one must first be able to measure a country's attitude toward social health insurance. Our primary goal was to develop a construct that allows us to measure this "attitude toward social health insurance". Using a sample of 724 students from the People's Republic of China, Germany, and the United States and an initial set of sixteen items, we extract a scale that measures the basic attitude toward social health insurance in the three countries. The scale is internally consistent in each of the three countries. A secondary factor labeled "government responsibility" is marginally consistent for the total sample and for the German sample. German respondents have the most favorable attitude toward social health insurance, followed by China, and then the United States. Chinese respondents have the most favorable attitude toward government responsibility in health insurance. The scale developed here can be used to further investigate and understand which health care system will succeed and which will fail in a given country, which is important from both a political and an economic perspective.