Aging Society Research Articles

Digital forgotten people?: decomposing digital divide in urban China

The digital divide among senior citizens is a significant challenge in the information era, particularly during the COVID-19 pandemic when elderly individuals’ difficulties with technology negatively impacted their quality of life. This paper analyzes the digital divide by breaking it down into three aspects: ownership, competence, and learning. Using a novel and representative dataset from Shanghai, the study highlights a significant digital divide among the elderly, characterized by lower device ownership, limited digital competence, and restricted learning channels, despite many seniors showing interest in digital skills. This divide is exacerbated by internal disparities tied to age, education, and family support. It highlights the need for targeted policies to enhance digital inclusion for the aging population. Overall, this research contributes conceptual innovation to enhance our understanding of the digital divide and addresses the challenges faced by the ‘digitally forgotten’ in China. Given China’s blend of technological advancement and demographic shifts, the findings of this research have broader implications for global efforts to navigate the complexities of digital transformation in aging societies.

Reflections on the Challenges of Old-age Security and Policy Options for an Ageing Population

The global phenomenon of population aging is advancing at an unprecedented pace, particularly in China, where the accelerating aging process poses substantial challenges to the existing pension security system. The issue of elderly care has emerged as a critical topic in the realms of society, economy, and politics, impacting national sustainability and social stability. The challenges brought about by an aging society extend beyond the pressures of pension payments and insufficient elderly care services, encompassing risks related to funding sources and management, as well as concerns over the fairness of the security system. In the face of these challenges, there is an urgent need to optimize pension policies, advance pension system reforms, enhance the elderly care service system, and strengthen the coordination between social and medical security to construct a more equitable and sustainable pension security framework. Measures must be collaboratively advanced through top-level institutional design, policy execution efficiency, and societal involvement to provide robust support in addressing the challenges of aging. This paper will delve into the impact of population aging on the pension security system, analyze the current state and shortcomings of policies, and propose strategies to enhance the system's resilience, offering insights and recommendations for strengthening the pension security framework.

Effect of recombinant irisin on recombinant human bone morphogenetic protein-2 induced osteogenesis and osteoblast differentiation

Osteoporotic fragility fractures substantially impact aging societies, necessitating long-term care and increasing healthcare costs. Myokine irisin, secreted by skeletal muscle, influences bone metabolism; however, a comprehensive understanding of the mechanisms by which irisin affects bone metabolism is still lacking. Therefore, this study aimed to explore the effects of irisin on osteogenesis and osteoblast differentiation triggered by bone morphogenetic protein-2 (BMP-2). We used 4-week-old male ICR mice and implanted polyethylene glycol pellets containing recombinant human BMP-2 (rh-BMP-2) into the left dorsal muscle pouch. Mice received weekly intraperitoneal injections of either phosphate-buffered saline or recombinant irisin (re-irisin). Ectopic bone formation was evaluated 3 weeks post-surgery using micro-computed tomography (μ-CT) and histological analysis. In vitro experiments, C2C12 cells were treated with or without rh-BMP-2 and re-irisin, and we assessed osteoblast differentiation markers, e.g., runt-related transcription factor 2, alkaline phosphatase, osteocalcin, and osteopontin, using real-time reverse transcription-polymerase chain reaction. The μ-CT analyses showed that re-irisin significantly increased bone mineral content and bone volume of ectopic bones newly formed by rh-BMP-2. The gene expressions of the osteoblast markers were significantly increased by rh-BMP-2 and further upregulated by re-irisin. The treatment of cyclic AMP response element-binding protein (CREB) small interfering RNA attenuated these effects, suggesting that CREB signaling pathway was involved in rh-BMP-2/re-irisin-induced osteoblastic differentiation. This study demonstrates the potential of irisin to enhance osteogenesis through BMP signaling, offering insights for osteoporosis treatment and highlighting irisin as a promising therapeutic target for improving bone health and extending a healthy lifespan.

Oxidation of a zirconium nitride multilayer-covered knee implant after two years in clinical use

The surface composition and microstructure of an up to 5 µm thick multilayer on a knee implant were investigated. When the implant was explanted after approximately two years of clinical use due to failure from aseptic loosening, the topmost ZrN layer was found to be oxidized. Interestingly, only the non-articulating area was visibly oxidized (color change).Up until then, the formation and characteristics of the oxide and its influence on the tribological performance remained uncertain. The oxide was thoroughly analyzed using transmission electron microscopy (TEM) and atom probe tomography (APT). The articulating and non-articulating areas were compared with an as-fabricated implant, which served as a reference. The results show that a thin oxide was also present on the articulating surface. All measured oxides were thicker than expected from native oxidation. The oxygen content of the majority of the oxide, measured with energy dispersive X-ray spectroscopy (EDS) and APT, was lower than required for the stable ZrO2 form. Underneath the oxide, the ZrN layer remained unaffected, demonstrating the oxide's effective passivating behavior against further oxidation. No cobalt from the substrate was detected within the ZrN layer, proving the multilayer's excellent barrier function against ion release from the base metal. Statement of significanceIn our aging society, the use of artificial knee implants is widespread. Implant failure is not only costly, but often connected with pain for the patient and inevitably involves the implantation of a new joint. Hence, understanding the origin of joint failure is of high importance to extend the lifetime of the implant. In this research, we investigate the influence of a surface oxide, formed on an explant which failed after ∼ 2 years, on the multilayer stability. As a novelty, we focus not on the wear of the polyethylene gliding surface but on the formed oxide. The use of high-resolution analysis techniques allowed us to get a glimpse on the ongoing mechanisms at the explants surface.

Retirement consumption puzzle in Japan: Insights from pension and senior worker employment policy changes

Previous studies in Japan have examined the retirement consumption puzzle (RCP) when mandatory retirement was prevalent. However, the retirement landscape has significantly evolved due to rising public pension ages and enhanced policies promoting employment among senior workers. This study explores household consumption behavior as a result of these recent shifts, particularly focusing on the increasingly common practice of partial retirement. We investigate household consumption during retirement, considering partial retirement enabled by policies allowing continued part-time work or self-employment beyond the mandatory retirement age, and address endogeneity issues between retirement and consumption. Our findings reveal that non-durable and food expenditures increase during partial retirement, driven by liquidity effects from substantial retirement lump-sum payments. These results challenge the traditional understanding of consumption patterns in an aging society, highlighting the impact of changes in work environments.

Legal and Economic Conditions for Running a Care Farm: A Polish Case Study

The purpose of this paper is to present the situation of Polish care farms in the context of legal and economic conditions. The need to analyze this topic arises from the current lack of literature that has synthetically addressed the challenges posed by the ageing population in the European Union, including in Poland. The research gap revealed by the authors is especially prominent when it comes to aspects related to the setting up and running of care farms in Poland. Therefore, this paper analyzes the legal forms of establishing a care farm. Next, it discusses the economic aspects of how care farms operate. Based on research materials, especially including those retrieved through the use of the formal dogmatic approach, the authors determined the formal conditions for the setting up and successive running of care farms. The authors have analyzed with the help of formal dogma the forms of running care farms in Poland referring to the current legislation, as well as the position presented in the literature. Also, due to the method used in analyzing the materials collected in this study, the authors have presented their views on how to finance such facilities. Findings from this research confirm that Polish care farms have promising outlooks as they respond to the changing needs of an ageing society. Moreover, as a result of the formal dogmatics method used, it was found that in Poland the most common form of running a care farm is an association. This is because the establishment of an association does not require the fulfillment of many legal criteria as is the case with a sole proprietorship. For this reason, those interested in starting a care farm may opt for the association form.

Willingness analysis of middle-aged and older people’s participation in reverse mortgage schemes

Enabling older adults to age at home is an urgent issue. This study focuses on the attitudes of middle-aged and older people (MAOP) in the capital cities of Taiwan, which are characterised by expensive housing prices and living costs, to examine their preferences for reverse mortgage (RM) schemes. The stated preference method and conditional multinomial logit model are utilised for analysis. The study simulates the total payment duration (TPD) and monthly payment amounts (MPA) to determine the market share of MAOPs’ choices regarding terms. The results indicate that MAOPs tend to opt for RM schemes when they have children, partly enhancing the preference toward the long-term alternative (AL). Increasing the MPA has a positive effect on the market share of the AL scheme, but the amount must be increased to 90% to replace the market share of non-participation schemes significantly. The experimental design of this study could serve as a reference for future RM scheme designs. The findings suggest that there should be more alternative funding sources in an ageing society, particularly through revitalising housing assets, to promote ageing in place.

Unexpected Journeys: Investigating Urgent and Emergency Care Trends of Patients Attending a Community Specialist Team for Older Adults

Abstract Background Transitions of care for older people via ICPOP and Urgent and Emergency Care (UEC) pathways are becoming more complex. Demand for unscheduled care for older adults with complex care needs will increase with an ageing society, requiring proactive case management and practical realisation of integrated care pathways. Methods Retrospective analysis of UEC presentations of older patients attending a community specialist team (CST) who underwent Comprehensive Geriatric Assessment (CGA) between January-July 2023. Demographics and functional status [Clinical Frailty Score (CFS), Barthel Index (BI), Lawton-Brody Score (IADL), Montreal Cognitive Assessment (MOCA)] were extracted, along with UEC presentations post-CGA until March 2024. Results 356 patients underwent CGA and 42% (n=148) had subsequent unscheduled care attendance(s). Of those with an UEC attendance 36% (n=54) lived alone. Median functional scores were: CFS 5, BI 17, IADL 3, MOCA 17. Median time to UEC presentation was 100 days since CGA. There were 283 UEC interactions in total. 39% (n=58) had >1 interaction. 73% (n=206) of interactions resulted in acute hospital admissions, 21% (n=58) were ED visits, and 6% (n=19) were Pathfinder interactions. Falls (31%) and infection (19%) were the leading causes for presentation. Of 206 admissions, 61% were admitted under medical specialties, 26% under Geriatric Medicine, and 13% under Surgery. Average hospital stay was 13 days. 65% (n=134), were discharged home, 11% (n=22) to transitional care beds, 7% (n=15) to rehabilitation, 7% (n=14) to nursing home, 3% (n=5) transferred to other hospitals, 7%(n=15) died. Conclusion Over half of patients attending a CST had an UEC presentation, reflecting the complexity of this cohort and their level of healthcare utilisation. Case management roles that complement and pull together existing elements of the older persons pathway are lacking across healthcare settings and are fundamental to successful implementation of a patient-centred age friendly health system.

Lab study on the physiological thermoregulatory abilities of older people with different frailty levels

The advent of an aging society has increased the need for a better understanding of thermal comfort requirements, especially for older people's health. Differences in thermal comfort needs among older individuals with varying frailty levels are noted, but the impact of health on physiological thermoregulation is underexplored. This study, based on the frailty classification method characterized by Fried, selected 12 non-frail (age:71.00 ± 5.41) and 12 pre-frail (age:72.68 ± 5.7) older individuals for laboratory experiments. This experiment set sudden temperature change experiments to illustrate differences in subjective perceptions and physiological changes between non-frail and pre-frail older people. Results show that non-frail individuals are more likely to complain in warmer environments. Significant differences in perception only emerged when the temperature differential between neutral and warm conditions exceeded 5 °C. Pre-frail individuals exhibited slower skin temperature changes and required more time to stabilize with the environment, particularly in the foot. Pre-frail individuals tend to sweat less in changing environments and require more time to reach stable sweating. There is positive evidence indicating that heart rate of pre-frail individuals is higher than non-frail individuals, with different changing trends observed between the two groups. When the temperature difference exceeds 5 °C, the pulse intensity trend in pre-frail individuals diverges from that of non-frail individuals. In controlling indoor environments for older people, it is essential to consider both subjective comfort and physiological thermoregulation capabilities. For older adults with frailty characteristics, applying localized warming, using small temperature differences, gradually adjusting the environment may better meet their comfort needs.

Unlocking the night: Exploring the health impacts of night-time walking environments on health outcomes of older adults

Walking remains the primary form of physical activity for many older adults in China, and the quality of the walking environment at night may determine the frequency and duration of evening outings. This study reveals how night-time environmental features influence the health outcomes of older adults. Using the medical check-up records of 87,578 older adults from a public health service in the Beilin district of Xi'an city, China, the role of the night-time walking environment in managing chronic conditions was examined. A favorable night-time walking environment reduced the prevalence of chronic conditions and comorbidities among older adults. However, the health effects stemming from the night-time walking environment exhibited heterogeneity, with significant impacts only on metabolic conditions, such as hypertension and diabetes, while the effects on other conditions were not significant. Our findings supplement the theory of healthy aging by highlighting the potential value of the environment in managing chronic conditions, which may serve as a cost-effective health intervention for aging societies.

Infrastructure distribution in cities and the improvement of the well-being of citizens in Japan: evidence from the quantile regression

ABSTRACT Urban construction under the aging society needs to provide efficient services for residents. We investigated the heterogenous relationship between various types of municipality-level critical infrastructure and park construction and the subjective well-being of citizens based on quantile regression using original survey data and the Japanese government statistics bureau of 2015-2017. Positive relationships were found in the low-and middle-level life satisfaction regions owing to the construction of museums or libraries, government branches, government services, health centers, police stations, fire stations, schools, hospitals, post offices, disabled and senior centers, and parks. Moreover, citizens were more likely to feel safe if the living community had comprehensive government-related institutions, including government offices, police stations, fire stations, schools, and post offices, among others. Our results indicated that the number of favorable infrastructures should be increased in areas with low levels of life satisfaction and less-safe communities to improve the citizens’ overall well-being.

Social influences on the psychological well-being of elderly individuals

PurposeThis research aims to analyze the primary social factors influencing the mental health and happiness of older adults. Specifically, the paper identifies the elements of social influences on the psychological well-being of elderly individuals.Design/methodology/approachEmploying a quantitative research methodology, survey data were collected to examine the psychological well-being of older adults, utilizing SPSS software version 28.0 for data analysis.FindingsPsychological well-being in the elderly is intricately linked to personal, cognitive, emotional and social aspects. Seniors experiencing reduced loneliness, ample communication opportunities, active social engagement and living with family members demonstrate higher levels of psychological well-being. Surprisingly, details of daily activities in senior age showed little impact on psychological well-being.Research limitations/implicationsThe research results may lack generalizability due to the chosen approach, prompting a need for further testing of proposed propositions.Originality/valueThis study fulfills an identified need to explore how psychological well-being is established in an elderly society, shedding light on critical social determinants.

Bevaikystė ir požiūris į rūpinimąsi vyresnio amžiaus tėvais Lietuvoje

In rapidly ageing societies, caring and responsibilities for parents in old age is a widely discussed topic. This is particularly relevant in societies with low fertility and high rates of childlessness. Lithuania is one of the countries where demographic ageing rates have risen sharply in a short period of time. This process has been driven not only by low fertility but also by emigration of middle-aged and young people and increasing life expectancy. There is no lack of research on demographic changes in ageing societies in the country, but very little is known about the attitudes of childless men and women towards caring for their parents in old age. The aim of the study is to determine the attitudes of childless and child-bearing individuals towards parental responsibilities in Lithuania. Our analysis is based on the 2018-2019 ‘Families and Inequality Survey’ dataset collected in Lithuania. The data covers 3,005 individuals aged 34-48 at the time of the survey. The representative sample was obtained by using a stratified sampling method. Face-to-face interviews were carried out with respondents in their homes by using a standardized questionnaire. The data were analysed using descriptive statistics and chi-square methods. We found that the proportion of men (12.0%) who do not want to have children is statistically significantly higher (p=0.003) than the proportion of women (7.6%). We found that childless people were less likely than those with children to agree with the statement that children should look after their parents. In addition, women were more likely than men to agree with these statements. Our findings are important from a practical point of view – when considering social care and pronatalist policy measures. Research project is financially supported by the Research Council of Lithuania (LMTLT), agreement No. P-MIP-22-24.

Blood loss during three column osteotomies: influence on outcomes and mitigation strategies.

Three column osteotomies (3CO) are a powerful tool for the correction of rigid sagittal spinal deformities. However, 3CO surgeries are technically demanding procedures that are associated with prolonged operative times, large amounts of intraoperative blood loss, and high rates of post-operative neurological and medical complications. The purpose of this retrospective cross-sectional study is to delineate the effects of blood loss, blood transfusion, and tranexamic acid use on perioperative outcomes following 3CO. Patients undergoing 3CO between 2014 and 2021 were identified using current procedural terminology (CPT) codes, and charts were reviewed for demographics, surgical characteristics, and post-operative length of stay (LOS). Statistical analysis included T-tests for continuous characteristics and χ2 testing for categorical characteristics. Regression models were used to further investigate relationships between outcomes and variables of interest. Forty-two patients met inclusion criteria. Increased intensive care unit (ICU) LOS was positively correlated with increased operative length (P=0.02), percent estimated blood volume (EBV) lost (P=0.02), and number of units of red blood cell transfusion (P<0.001). Increased hospital LOS was associated with increased number of intraoperative blood transfusions (P=0.01). Linear regression analyses controlling for age, gender, and American Society of Anesthesiologists (ASA) class showed that each 21% increase in EBV loss was associated with a one day increase in ICU LOS (P=0.01). Similarly, each additional unit of packed red blood cells transfused was associated with 0.728 day increase in hospital LOS. Increased intraoperative blood loss was associated with longer ICU stays. Red blood cell transfusions were also associated with increased hospital and ICU LOS. No variables of interest related to intraoperative blood loss or blood transfusion were associated with readmission or reoperation at any time point. These findings highlight the need for continued focus on surgical techniques and adjuncts that can minimize blood loss and transfusion requirements.

Prospective Analysis and Innovative Path Research on Silver Sports Economy in the Context of Aging Society

This study focuses on the prospects and innovative pathways for the development of the silver-haired sports economy in the context of an ageing society. The proportion of the global population over 65 years old is expected to increase from 9% in 2019 to 16% in 2050, highlighting the huge potential of the silver-hair economy. This paper adopts a mixed research methodology, combining spatial econometric modelling and rootedness theory, to explore in depth the current development status, trend forecasts and innovation paths of the silver-haired sports economy. The study constructs a silver-hair sports economy assessment system containing 22 indicators, and uses panel data to analyse the development level of 31 provinces, municipalities and autonomous regions in China from 2010 to 2023, and the results show that the average annual growth rate of silver-hair sports economy reaches 15.7%, but the gap between Beijing, Tianjin, Shanghai and Guangdong and the central and western regions reaches 1.8 times. Analyses based on the Spatial Durbin Model show that every 1 percentage point increase in silver-haired sports consumption can drive 0.3 percentage points of GDP growth in neighbouring regions. Through a Delphi method research of 150 industry experts, it is predicted that the size of China's silver-haired sports market will exceed RMB 3 trillion in 2030, increasing its share of GDP to 2%. The qualitative study reveals three innovative paths: intelligent transformation, ecosystem construction, and cross-border integration, and proposes specific strategies such as "integration of sports and medicine" and "social platform for silver sports". The results of the study provide data support and theoretical basis for the formulation of policies for the development of the silver sports economy, and provide important insights into the industrial transformation of an aging society.

The changing social vulnerability in Shanghai during 2000–2020 and its implications for risk management

Risk dynamics are driven not only by changes in hazard and exposure, but also the changing social vulnerability along with urban development, aging, renewal, and adaptation planning. However, there has been limited research on the spatial and temporal changes in social vulnerability, particularly at a fine scale in urban settings. To bridge this gap, our study developed a framework to consistently evaluate social vulnerability. Using Shanghai as a case study, the framework was applied to assess the social vulnerability at a township level for the years 2000, 2010, and 2020. The results revealed that the social vulnerability index decreased in 99.56 % of the townships in Shanghai from 2000 to 2020. However, there were notable variations among the four primary sub-indexes as demographic sub-index, particularly regarding an aging population, displayed a strong increase aggravating social vulnerability, in contrast to an overall decline trend of the other three sub-indexes of educational, residential, and economic. Therefore, the social vulnerability reduced along with socioeconomic development while an aging society posed a new challenge. Furthermore, 32 townships were identified with a notable rising demographic sub-index, a high flood hazard, and a low capability of disaster reliefs, demonstrating social vulnerability should be comprehensively addressed aligning with other challenges. The study highlighted the need to consider the dynamics of social vulnerability in disaster risk reduction strategies and the importance of addressing emerging challenges, such as an aging population, in urban vulnerability.

Perceptions and Satisfaction With the Use of Digital Medical Services in Urban Older Adults of China: Mixed Methods Study.

In an aging and information-driven society, older adults have distinct perceptions of and specific demands for digital medical services. It is essential for society to understand these needs and develop a more thoughtful approach to digital health care. This study aims to evaluate the behavioral intention and satisfaction of older adults with digital medical services by identifying the perceived factors and the pathways through which these factors influence their behavior. This study used a mixed methods approach, combining qualitative and quantitative analyses. A focus group interview was conducted with 30 randomly selected older adults, and the interviews were transcribed verbatim and coded using grounded theory. In addition, 876 valid questionnaires were collected to describe older adults' perceptions of and satisfaction with digital medical care. Then, t tests and ANOVA were used to explore differences among various demographic groups, while hierarchical multiple regression was conducted to identify the factors most closely related to satisfaction. Structural equation modeling was used to identify multiple mediating effects. The qualitative study identified the core category of "medical service relief and transformation paths for older adults in the context of digital reform." Quantitative analysis revealed that more than half of the older adults were satisfied with digital medical services, and behavioral intentions were higher among those with higher incomes and education levels. Structural equation modeling confirmed that external variables, such as digital skills training, positively influenced perceived ease of use (β=.594, P<.001), perceived usefulness (β=.544, P<.001), and promoted digital medical behavioral intentions (β=.256, P<.001), while also reducing perceived risk (β=-.295, P<.001). Additionally, perceived ease of use (β=.168, P<.001) and perceived usefulness (β=.508, P<.001) positively impacted behavioral intention, whereas perceived risk (β=-.05, P=.037) exerted a negative influence. Furthermore, behavioral intention (β=.641, P<.001) significantly and positively affected older adults' satisfaction with digital medical care. The mediation test identified 4 significant paths: (1) external variables → perceived ease of use → behavioral intention (effect size of 13.9%); (2) external variables → perceived usefulness → behavioral intention (effect size of 38.4%); (3) external variables → perceived ease of use → perceived usefulness → behavioral intention (effect size of 10.1%); and (4) a direct effect (35.5%) from external variables to behavioral intention. Based on the study's findings, addressing the needs of older adults and enhancing perceived usefulness are the most effective ways to encourage the use of digital health care devices. Community support plays a crucial role in helping older adults integrate into digital health care, and adapting the design of services and products to suit their needs improves their perceptions of digital health care. This, in turn, promotes usage behavior and satisfaction, while the negative impact of perceived risk remains minimal.

Mining, farming, and diplomacy. Understanding the human landscape of Bronze Age Sardinia (Italy) through geospatial analysis

Human agency on landscape modification and land use is often seen in terms of socio-economic opportunities vs. natural constraints. In the study of prehistoric cultures this is both a strong source of information about sustenance strategies and community behaviours, and a subject potentially easy to analyse within a limited set of physical and social parameters. The recent advancements in the use of spatial analysis tools in landscape archaeology allow to obtain ever more precise models. However, studies that compare at the same time the geological landscape and social elements are very scarce. We used Point Pattern Analysis and Modelling to investigate megalithic structures (nuraghes) in Bronze Age southwestern Sardinia (Italy) and identify correlations between their spatial patterns and a set of covariates encompassing both environmental (i.e. topography and geological resources) and cultural factors. The models which best represent pattern distribution come from the combination of covariates from both groups.The models highlight a close distance from known ore deposits and show a clear dependence of Nuragic populations to ore extraction and metallurgy. The availability of fertile soils with moderate permeability and moderately low pH is also significant, as well as a preference to prominent locations with a positive correlation with the Topographic Position Index and the Convexity Index. From a cultural standpoint, we observed a consistent aggregation of simple nuraghes around complex nuraghes at mid-short distances. The occurrence of polycentric patterns can be explained either by the former emerging from the presence of the latter or vice versa, and is typically associated with a loosely stratified social structure devoid of strong hierarchies. These results underscore the efficacy of spatial analysis in disentangling and juxtaposing the physical and social factors influencing the distribution of past culture, and offer new insight on the development of Bronze Age societies in their geographical context.

Hagfish-inspired hydrogel for root caries: A multifunctional approach including immediate protection, antimicrobial phototherapy, and remineralization

Root caries is the main cause of oral pain and tooth loss in the elderly. Protecting root lesions from environmental disturbances, resisting pathogens, and facilitating remineralization over time are essential for addressing root caries, but are challenging due to the irregular root surface and the complex oral environment. Hagfish secretes slime when facing danger, which converts into gels upon contact with seawater, suffocating the predators. Inspired by hagfish's defense mechanism, a fluid-hydrogel conversion strategy is proposed to establish a mechanical self-regulating multifunctional platform for root caries treatment. The fluid system (silk fibroin-tannic acid-black phosphorene-urea, ST-BP-U), in which urea disrupts the hydrogen bonds between silk fibroin and tannic acid, can easily spread on the irregular root surface and permeate into dentinal tubules. Upon contact with the surrounding water, urea diffuses, prompting the hydrogel re-formation and creating intimate attachments with micromechanical inlay locks. Meanwhile, BP increases the crosslinking of the re-formed hydrogel network, resulting in reinforced cohesion for robust wet adhesion to the tooth root. This process establishes a structured platform for effective antimicrobial phototherapy and dentin remineralization promotion. This water-responsive fluid-hydrogel conversion system adapts to the irregular root surface in the dynamic wet environment, holding promise for addressing root caries. Statement of significanceRoot caries bring a heavy burden to the aging society, but the irregular root surface and dynamic moist oral environment always hinder non-surgical therapeutic effects. Here, we propose a water-responsive fluid-hydrogel conversion strategy aimed at mechanical self-regulation on the irregular and wet root interface to construct a functional structural platform. The liquid system (ST-BP-U) that prebreak intermolecular hydrogen bonds can easily spread on irregular surfaces and dentin tubules. When encountering water, hydrogen bonds re-form, and BP increases the crosslinking of the hydrogel formed in situ. Based on this firm wet-adhesion platform, it provides powerful phototherapy effects and promotes dentin remineralization. This fluid-hydrogel conversion system turns the disadvantages of wet environment into advantages, offering a promising strategy for root caries.

Research on the Planning and Design of Med–Small-Sized Hospitals in China Based on Patient Perceived Value in the Context of Healthcare Model Transformation

China’s aging society has led to a major transformation of the healthcare model from traditional therapeutic medical care to life support healthcare. Med–small-sized hospitals (with 20–299 beds) are expected to play a major role in this transition compared to large hospitals. However, hospitals often take 3–5 years or more from design to construction. In order to guide architects in planning and designing for future needs, this study aims to identify the key points of planning and design that can enhance the value of med–small-sized hospitals in terms of functional configuration, spatial environment, etc. In this study, a questionnaire survey was conducted on the perceived value of 600 patients in Nanjing, China. The data were used to construct a structural equation model (SEM) of perceived value for med–small-sized hospitals in China. There are 24 observed variables in six dimensions, including cost value, functional value, social value, cognitive value, patient satisfaction, and patient loyalty. The final SEM indicates that optimizing functional configurations and spatial environment design can significantly increase the value of hospitals, while patients’ willingness to go to the inpatient department is quite low. Finally, based on the survey findings from Nanjing, we proposed four optimization strategies: (1) promoting diversified development and collaboration based on regional characteristics, (2) optimizing functional configurations, (3) maintaining an efficient and concise patient experience, and (4) optimizing the inpatient department.