Treatment Fees Research Articles

Analysis of the changing trend of economic burden of patients with chronic diseases under the Integrated Medical and Health Service System

BackgroundIntegrating medical resources is one of the explorations of medical mechanism reform to meet the needs of whole-cycle health management and is an important initiative in the current round of China's healthcare system reform. 2015 saw the construction of county medical communities to promote the balanced layout of medical resources, which opened a new exploration of the construction of an integrated healthcare service system in China. 2017 saw the promotion of the pilot construction of compact county medical communities in Zhejiang Province, China.ObjectiveFrom the perspective of alleviating the financial burden on those in need of health services, the characteristics of chronic disease patients' access to health care and the composition and changing curve of the medical cost burden are analyzed to provide a basis for the construction path of an integrated health care service system.MethodsA retrospective cohort study was conducted to select 5739 permanent residents who met the inclusion and exclusion criteria in Z town, H city, Zhejiang province. This population's health insurance utilization data from 2015 to 2018 were retrieved, and their average annual costs, cost composition, and health insurance payments were analyzed.ResultsThe average annual growth rates of medical insurance and out-of-pocket costs before and after the implementation of the Medical Community were 12.85% and 9.72%, respectively. The increase narrowed significantly after the construction of the Medical Community, with the ringgit growth rate dropping to 2.73% in 2018. The top three medical expenses that accounted for the highest percentage were drug, consultation, and treatment fees. The frequency of visits to primary health care consulting hospitals has increased yearly.ConclusionsBy implementing various measures to strengthen the grassroots level, patients' choice of primary care has increased year by year in the early stages of the construction of the Medical Community. From the perspective of cost control, strengthening the regulation of drugs and tests and restricting the use of high-value consumables can further reduce medical costs and ease their financial burden.

Analysis of the patient’s experiences on the related instagram posts about the orthodontic treatment

Objectives: The study aimed to comparatively evaluate the patients’ experiences with these treatments by analyzing the contents of the posts shared by the patients with clear aligner and fixed orthodontic treatment (FOT). Material and Methods: To reach the treatment methods, the hashtags “braces” for FOT and “aligner” for clear aligner treatment (CAT) were used in the Instagram search engine. To reach objective patient evaluations, clinicians’ posts, company posts, and influencers’ posts containing advertisements and collaborations were eliminated and direct patient posts were considered. Seventy-nine posts were included in the FOT group and 52 posts in the CAT group. The posts were evaluated comparatively in terms of the number of likes, followers of the profiles, comments and content, the gender of the patients, and the treatment stage. Results: According to the results of the analysis, although the number of followers, likes, comments, and positive and neutral comments were higher in favor of the aligner group between the FOT and CAT groups, the rate of likes/followers was found to be higher in favor of the fixed treatment group (P < 0.05). Conclusion: Considering the literature, although studies on CATs on social media are limited, this media is seen as an effective factor in the treatment decision-making process of patients. While the most negative comments of individuals in fixed treatment were psychological effects, the most criticized issue in CAT was treatment fees.

Near-Suicide Phenomenon: An Investigation into the Psychology of Patients with Serious Illnesses Withdrawing from Treatment

Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon "near-suicide". This study attempted to explore this phenomenon by examining how the seriousness of the patient's illness or injury and the subjective evaluation of the patient's and family's financial situation after paying treatment fees affect the final decision on the treatment process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families' financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost-benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients' likelihood of making "near-suicide" decisions and improve social equality in the healthcare system.

Effectiveness of Audiovisual Animation Education as an Effort to Increase Knowledge To Prevent the Risk of Falling Patients in Hospital

Background: The risk of falling is one aspect that needs to be studied in patient safety, especially for patients who have a risk of falling due to weakness or the effects of therapy. It can cause injury, increasing the patient’s long of stay, and patient’s treatment fees. The other effects of this are physical injury including scratch, torn, bruised even it can cause fracture, bleeding and head injury. The purpose of this study was to determine the effectiveness of providing audiovisual animation education as an increase in knowledge of efforts to prevent falls in patients in hospitals.Methods: This study uses a quasi-experimental research design with a one group pretest posttest approach without a control group. The research was conducted at Gambiran Hospital. The sampling technique used a purposive sample technique, namely by determining certain criteria. Data were collected using a questionnaire sheet, bivariate analysis using the Paired Sample T-Test with the help of SPSS.Results: Based on the results of statistical tests, it is known that the value of sig. (2-tailed) of 0.000 <0.05, meaning that H1 is accepted, it can be concluded that audiovisual animation education is effective as an effort to prevent the risk of falling in patients in the hospital.Conclusion: Animated audiovisual education is very effective to increase respondent’s knowledge in preventing patient fall. With the guaranteed patient safety it will affect patient’s recovery. The guaranteed patient safety can not be separated from the hospital monitoring and family caring to avoid from various risks than can be occured, one of this risk is risk of patient fall. This audiovisual methods is a good method to increase knowledge, because this method involve more sense in learning process, both sense of sight and sense of hearing.

Optimization and transformation of water treatment technology for surface water reinjection into geothermal reservoir in Dongli Lake area of Tianjin

Tianjin is one of the areas with higher geothermal resources development and utilization in China. In 2013, the first surface water reinjection test base in China was established in Dongli Lake area. However, some problems had occurred during the operation of surface water reinjection, which affected the effect of surface water reinjection. Aiming at the problems during operation, we optimized and transformed the water treatment process of surface water reinjection, so that the reinjection system could operate stably. This will supply the thermal reservoir effectively and alleviate the decline of thermal reservoir pressure, and then geothermal resources will be developed and utilized sustainably. After the transformation and upgrading of surface water treatment process, the maximum reinjection volume was 150 m3/h, it could increase the production of geothermal resources to 200000 m3/a, and increased the heating area of geothermal to 150000 m2/a. The surface water treatment process will reduce the emission of carbon dioxide, sulfur dioxide, nitrogen oxides, coal ash and other pollutants, saving 879100 yuan of environmental treatment fee (environmental protection tax) and 2.6 million yuan of resource tax every year. And the calculated operation cost was about 1.80 ∼ 2.26 yuan/m3. It will play an exemplary role in the stable operation of surface water reinjection, provide new ideas for surface water reinjection and the protection of geothermal resources, and provide technical support for the realization of the double carbon goal.

Study on forest ecosystem damage assessment system and management system

Ecological environment damage events will destroy or damage the balance between animal and plant habitats and ecosystems, and even pose a threat to China’s ecological security. However, at present, there are some problems in the identification and evaluation of forest ecosystem damage, such as imperfect evaluation system, insufficient quantitative evaluation methods, imperfect damage compensation management system, and lack of analysis of the overall damage of the interaction between human activities and forest ecosystem. Based on the damaged object, the system involves a total of four first-class indicators, including physical damage, mental damage, economic forest fruit loss, forest by-products loss, processing and manufacturing loss, forest tourism loss, scientific research literature and history loss, soil conservation loss, water conservation loss, wind prevention and sand fixation loss, carbon fixation and oxygen release loss, atmospheric purification loss. There are 14 secondary indicators of emergency treatment fee and investigation and evaluation fee, as well as 22 tertiary indicators, and the value quantification method of each indicator is clarified by using market value method, alternative cost method, shadow engineering method, recovery cost method and other methods. The article also discusses the management system of forest ecosystem damage from the two aspects of forestry technology department and judicial administration department. The purpose is to provide reference for the quantification and standardization of forest ecosystem damage assessment technology and the improvement of management system.

North Korean arrivals' medical service usage in South Korea, 2015-2019.

This study retrospectively reviews the medical service usage data of North Korean arrivals collected from 2015 to 2019. The purpose of this study is to understand the medical use status of North Korean arrivals and to design health policies for them. We reviewed 32,653 medical records of North Korean arrivals who visited the National Medical Center as outpatients and inpatients during a 5-year period. Among 1453 patients with an average age of 46.7years, we found that among the treated patients, there were many women in their 40s and 50s who complained of psychiatric disorders. The most frequently visited department was psychiatry. The most frequently diagnosed disorder was unspecified depression. 88% of patients utilized Medical Care assistance type 1, which means that they are medical aid beneficiaries because they are usually in difficult economic circumstances. Medical examination and treatment fees of North Korean arrivals increased in general, and older patients paid more. Among North Korean arrivals, middle-aged women and mentally ill patients showed high medical needs. This study recommends that the government provide policy support to North Korean arrivals for professional psychiatric treatment and improvement of medical access. We also expect these results to be applied to the health problems of other refugees.

Process design and techno-economic analysis of fuel ethanol production from food waste by enzymatic hydrolysis and fermentation

In this study, fuel ethanol production from food waste using enzymatic hydrolysis and fermentation was evaluated from techno-economic viewpoint. The plant was designed with a capacity of 10 t/d food waste and a lifetime of 15-year. The total capital cost, annual operation cost and annual net profits of the plant were US$ 367,552, US$ 155,959 and US$ 74,995.57, respectively. The plant was economically viable as long as the internal rate of return remained below 29.8%. The shortest payback time was 5 years with discount rate of 5%. The price of fuel ethanol and food waste treatment fee were the most important variables for the economic performance of the plant by sensitivity analysis. This work could provide the basic knowledge for techno-economic analysis of food waste treatment and promote the industrial production of fuel ethanol.

Performance comparison of sewage treatment plants before and after their upgradation using emergy evaluation combined with economic analysis: A case from Southwest China

Upgradation of sewage treatment plants has been greatly promoted in China, but few studies investigate impact of this practice on synergetic relationship between environmental performance and economic performance of those systems. This study aims to investigate environmental sustainability, economic benefit and greenhouse gasses emission intensity of different sewage treatment schemes and then identify the best one as well as related negative factors needed to be addressed in the future. A comprehensive performance index-Synergetic effect index (SEI), derived from integration of Improved emergy sustainability index (IESI), Net economic benefit ratio (NEBR) and Carbon emission per unit sewage treatment (CEUS), is proposed to address this issue. Firstly, to investigate environmental sustainability of sewage treatment more completely, this approach improved the classic emergy analysis through integrating emissions’ impacts into related classic emergy yield ratio and environmental loading ratio respectively and then built the comprehensive index IESI. Next the indicator NEBR and CEUS were proposed to assess economic benefit and greenhouse gasses emission intensity, respectively. Finally, the three indicators, i.e. IESI and NEBR as well as CEUS, are merged into the index SEI to evaluate comprehensive performance of sewage treatment. A sewage treatment plant, located in Southwest China, as a research case, was investigated using the presented approach from its construction stage to its operation stage. It is found that, after the upgradation, total emergy input increases by 11.96% mainly from extra thermal electricity power consumption, total emission's’ impact decreases by 39.92% mainly from raised removal rate of total phosphorus, emergy yield rate is slightly improved and environmental load rate descends greatly, and thus the sustainability level clearly rises. Meanwhile, environmental emissions significantly affect the environmental load and then the sustainable level. This upgradation improves its economic benefit because rising sewage treatment fee slightly exceeds its added treatment cost. Thermal electricity power consumption in operation stage is the main contributor to total carbon emission. Sensitivity analyses shows that changes of main input categories have not altered the research results. Generally, the upgradation promotes the synergetic relationship between its environmental performance and economic performance by 95.65%. However, indirect environmental emissions from the upgradation should be emphasized. This enterprise should further improve energy performance, optimize the existing processes and promote its circular economy in the future.

Two Semiconductor Companies' Financial Support Compensation (FSC) Programs for Semiconductor Workers with Suspected Work-Related Diseases (WRDs).

This study described two companies’ financial compensation programs for semiconductor workers with suspected work-related diseases (WRDs) and discussed the major related issues. The key contents of the programs found on the websites opened by two semiconductor companies (Samsung and SK Hynix) were cited. In order to select the suspected WRDs for the FSC, all available epidemiologic studies related to health problems conducted in the semiconductor industry were reviewed. Most program contents are similar, although the amount of financial compensation and a few types of disease available for compensation differ between the companies. The group of cancer, rare disease, childhood rare disease among children born to semiconductor workers (hereafter selected diseases among offspring), and fetal loss, including spontaneous abortion (SAB) and stillbirth, were considered for compensation. An employment duration of longer than one year on a semiconductor production line is required for FSC for cancer or rare disease. The FSC for SAB and offspring disease require a period of employment longer than one month, either before three months prior to conception or between conception and childbirth. The maximum amount of compensation per type of cancer and rare disease was fixed based on the medical treatment fee. The FSC programs of the two companies have been operated successfully to date. These programs are arguably considered to contribute to resolving the conflict between companies and workers with WRDs.

Incidence, characteristics, and treatments of traumatic open fractures in children and adolescents: A retrospective observational study.

We aimed to investigate the incidence, characteristics, and treatments of open fractures in children and adolescents (≤18 years old).We retrospectively reviewed the records of 2418 children and adolescents who presented with traumatic fractures and were admitted to our university-affiliated hospitals, among which 206 patients (8.5%) presented with open fractures. The patients’ clinical and radiographic records were reviewed, and the age, gender, cause of injury, injury season, injury week, associated injuries and complications were collected.This study enrolled 1789 males (74.0%) and 629 females (26.0%) with an average age of 11.2 ± 5.0 years. The patients were divided into an open fracture group (OF group, n = 206) and a group with no open fracture (No-OF group, n = 2212). There were 206 patients (8.5%) who presented with open fractures and the most common fracture sites were the tibia (31.1%, 64/206) and fibula (20.9%, 43/206). The patients in the OF group presented with higher frequency of emergency admission (P < 0.001), self-supporting medical insurance (P < 0.001), MVCs (P < 0.001), wounded by machine (P < 0.001), struck by object (P < 0.001), hurt/cut by others (P < 0.001), lower limb fractures (P < 0.001), multiple fractures (P = 0.010), associated injuries (P < 0.001) and wound infection (P = 0.003) then the patients in the No-OF group. The most common complication were wound infection (5.8%) and pneumonia (1.0%) in the OF group, wound infection (2.1%) and pressure sores (2.0%) in the No- OF group. Multivariate logistic regression analysis indicated that mechanical trauma (OR = 64.229, P < 0.001), being hurt/cut by others (OR = 26.757, P < 0.001), and being struck by an object (OR = 15.345, P < 0.001) were stronger risk factors for open fracture than were low falls; additionally, lower limb fractures (OR = 5.970, P < 0.001), upper limb fractures (OR = 5.865, P < 0.001) and multiple fractures (OR = 5.414, P < 0.001) were stronger risk factors than craniofacial fractures for open fractures. The frequency of surgical treatment for the patients with traumatic open fractures (87.9%, 181/206) was significantly higher than those without open fractures (72.2%, 1596/2212) (P < 0.001). The hospital stays and fees for surgical treatment for the patients with traumatic open fractures were significantly higher than those without open fractures (P < 0.001).Etiology (especially being injured by a machine or being hurt/cut by others) and the fracture site (including lower limb fractures and upper limb fractures) were independent risk factors for open fractures. Traumatic open fractures presented with higher surgical treatment rate, hospital stays and fees.

An overview study on management and implementation of WEEE in China.

Waste electrical and electronic equipment (WEEE) which contains various valuable and harmful materials is an inevitable waste in modern society. In order to resolve the pollution problems associated with WEEE treatment, a WEEE management system has been established in China. The main role of importers and manufacturers of electrical and electronic equipment (EEE) is to pay the treatment fees to facilitate the WEEE recycling in China. The announced treatment and subsidy fee is given by set, not by the weight of WEEE. There is no lesser green treatment fee for the producers which can produce environmentally friendly EEE in China. Also, the recovery of refrigerants from the foaming agent of refrigerators is not required in China. In total, 45 million sets of recycled WEEE were certified in 2020, a year that contains the most updated data. Among them, 48%, 14%, 20%, 10% and 8% are for TV, refrigerator, washing machine, computer and air conditioners, respectively. The spatial analysis indicates that the WEEE recycling activities are mainly concentrated on the mid-east and east regions of China. It also can be concluded that the certified amount of each province has higher positive correlation with provincial population than provincial GDP per capita and green recovery rate. It also clearly notes that the amount of recycled air conditioner is the lowest for each province. Thus, more effort should be conducted to increase the recycling of scrapped air conditioner in China.

Research on the Current Situation and Countermeasures of Inpatient Cost and Medical Insurance Payment Method for Rehabilitation Services in City S.

ObjectiveThis study aimed to introduce bed-day payment for rehabilitation services in City S, China, and analyze the cost of inpatient rehabilitation services. Key issues were defined and relevant countermeasures were discussed.MethodsThe data about the rehabilitation cost of 3,828 inpatient patients from June 2018 to December 2019 was used. Descriptive statistics and the Kruskal–Wallis test were employed to describe sample characteristics and clarify the comparity of cost and length of stay (LOS) across different groups. After normalizing the distribution of cost and LOS by Box–Cox transformation, multiple linear regression was used to explore the factors influencing cost and LOS by calculating the variance inflation factor (VIF) to identify multicollinearity. Finally, 20 senior and middle management personnel of the hospitals were interviewed through a semi-structured interview method to further figure out the existing problems and countermeasures.Results(1) During 2015–2019: both discharges and the cost of rehabilitation hospitalization in City S rose rapidly. (2) The highest number of discharges were for circulatory system diseases (57.65%). Endocrine, nutritional, and metabolic diseases were noted to have the longest average length of stay (ALOS) reaching 105.8 days. The shortest ALOS was found to be 24.2 days from the diseases of the musculoskeletal system and connective tissue. Neurological, circulatory, urological, psychiatric, infectious, and parasitic diseases were observed to be generally more costly. (3) The cost of rehabilitation was determined to mainly consist of the rehabilitation fee (23.63%), comprehensive medical service fee (22.61%), and treatment fee (19.03%). (4) Type of disease, age, nature of the hospital, and grade of the hospital have significant influences both on cost and LOS (P < 0.05). The most critical factor affecting the cost was found to be the length of stay (standardized coefficient = 0.777). (5) The key issues of City S's rehabilitative services system were identified to be the incomplete criteria, imperfections in the payment system, and the fragmentation of services.ConclusionsBed-day payment is the main payment method for rehabilitation services, but there is a conflict between rapidly rising costs and increasing demand for rehabilitation. The main factors affecting the cost include the length of stay, type of disease, the grade of the hospital, etc. Lack of criteria, imperfections in the payment system, and the fragmentation of services limit sustainability. The core approach is to establish a three-tier rehabilitative network and innovate the current payment system.

Surgeons, Hernia Surgery and Informed Consent in the Seventeenth Century Ottoman Istanbul.

In the seventeenth century Ottoman Istanbul, especially Greek surgeons specialized in hernia surgery. Both Muslim and non-Muslim patients had signed contracts with surgeons in sharia courts before undergoing a surgery. In this study, we analyze these documents, which serve as informed consent in the Ottoman period, in detail. We used Istanbul Sharia Court Registers (Istanbul Sicils) as the primary information source. We scanned a total of twenty nine registers dating back to the seventeenth century. In six of these registers, we determined a total of twenty one informed consents (known as rıza senedi in Turkish literature) regarding hernia surgery and surgeons. Based on these data, we examined the surgeons and hernia surgeries, the fees received by surgeons, and the informed consent documents of the seventeenth-century Istanbul. In the scanned informed consents, we identified five male surgeons and twenty one patients. While four of the surgeons were Greek, one of them was Muslim. The contracts show that the patients were informed about possible complications before operations, and their permissions were obtained accordingly. The contracts also clearly state that a blood-money from the surgeons would not be requested if a patient dies during or after an operation. The cost of operations ranged between 500 and 2100aḳče. The patient-physician relationship in Ottomans was seen as a business relationship. Medical processes were recorded in courts before treatment fees were paid. These court records had been a practice that protected the patients and the physicians in terms of criminal liability.

Views and practices on medical cannabis of unlicensed providers in Thailand: a qualitative study

Background: Despite the legalization of cannabis use for medical purposes in Thailand in February 2019, illicit providers are still widespread and accessible. This study aimed to understand why people still chose to receive medical cannabis treatment or products from unlicensed or illegal providers. The practices of unlicensed or illegal providers in provision of medical cannabis products or treatment services were also examined. Methods: Qualitative in-depth interviews were conducted among medical cannabis providers and users, including 36 unlicensed and 7 licensed providers and 25 users in 2019-2021. Snowball sampling was used to recruit participants until saturation of data was achieved. Interviews included open-ended questions about the providers’ practices and attitudes towards medical cannabis. Interviews were recorded and transcribed, and thematic analysis was performed. Results: Overall, six reasons were identified to answer why unlicensed/illicit providers were still popular, including: 1) easy accessibility; 2) familiarity with the unlicensed providers before the legal scheme became available; 3) favorable characters (kind, supportive, non-judgmental) of unlicensed providers; 4) affordable treatment fees; 5) trust in the quality of the medicines; and 6) lack of knowledge and negative attitudes towards cannabis from healthcare professionals. Most providers started their career as medical cannabis providers by using it themselves or with their relatives and being satisfied with the results. They used cannabis products to treat all diseases, including skin, eyes, HIV/AIDS, non-communicable diseases and all kinds of cancers. Additionally, they believed that it was effective, with no or minimal adverse effects. Conclusions: This study suggests that some patients will continue receiving medical cannabis treatment and products from unlicensed or illegal providers. More attention should be paid on increasing the capacity of medical cannabis service systems within public health hospitals, and the certification of unlicensed providers, so as to integrate them into a regulated system.

Forest Fire, Destruction, and Sanction: The Perspectives of Health and Law

Introduction: The search for the ideal concept to eradicate crimes of forest fire and destruction cannot be separated from the sanctions for individual or corporate perpetrators, who fund and order for the forest to be burned and destroyed. It must also consider the health rights of the victims. Methods: This study uses the normative legal research method. Results and Discussion: There needs to be a clear concept in punishing corporations so that they refrain from undergoing similar criminal actions in the future. The court that handles the forest fire cases may and has the right to improvise by burdening the health treatment fees of those who suffer due to the forest fires to the perpetrators. Conclusion: The forest fire law enforcement system is not yet ideal as it cannot yet maximally punish corporations that burn forests. Neither has it considered the victims' health rights and their recovery

Dental technology of Taiwan during the Japanese colonial period

Background/purposeDuring the Japanese colonial period, the Taipei Hospital had already provided complete dental services with a fixed price per treatment. This study tried to compare the differences in the prices of various dental treatments between the Japanese colonial period and today. Materials and methodsThis study used the “Dental Treatment Fees in the 27th Annual Report of Taipei Hospital (Taisho 12)” as the study materials to compare the differences in the prices of various dental treatments between the Japanese colonial period and today using the monthly salary of a novice elementary school teacher as an income benchmark. ResultsA hundred years ago, the Taipei Hospital had already provided the dental treatments such as scaling and endodontic, operative dentistry, prosthodontic, and orthodontic treatments. Of these treatment items, the prices for prosthodontic and orthodontic treatments were more expensive. After a century of development, the costs of scaling and operative dentistry treatments dropped, while the costs of endodontic, prosthodontic, and orthodontic treatments increased. ConclusionDuring the Japanese colonial period, Taiwan's dental treatment technology had already had the forms of modern dentistry with several dental specialties. At that time, the costs of dental treatments are quite expensive. Today's dental treatment items are more detailed and diverse. The health insurance system provides Taiwanese people with convenient and cheap general dental treatments such as scaling and treatments related to operative dentistry, endodontics, periodontics, and oral surgery. However, the costs of prosthodontic and orthodontic treatments increase and have to be paid by the patients themselves.

EVALUATION OF THE PATIENTS' SATISFACTION WITH PRIVATE DENTAL CLINICS SERVICES: A QUESTIONNAIRE-BASED STUDY.

The aim: To evaluate patient satisfaction with dental care services at Iraqi private dental units. Materials and methods: Online questionnaires were sent to 1600 Iraqi people. The questionnaires were composed of four sections: the first section was involved with gathering the demographic information of the participants, and the remaining three sections consisted of twenty-one questions to evaluate the responders' satisfaction with regard to the dentist, treatment, and the dental clinic. Results: The final total of responses was 427 after using the inclusion and exclusion criteria. The distribution of the participants according to the obtained demographic data was as follows: (male 45.4% and female 54.6%), (above 40y 41.7% and less or equal to 40y 58.3%), (employed 52.9% and not employed 47.1%), (postgraduate 29.3%, college graduate 55.7%, and undergraduate 15%), and (enough and exceeding income 4.9%, enough income 51.8%, and less than enough income 43.3%). Only the educational level and the income level appeared to have an effect on the degree of patient satisfaction. Most of the participants complained about the high treatment fees and the long wait in the clinic before receiving treatment. Conclusions: The current study is the first conducted in Iraq to assess dental patient satisfaction. The satisfaction levels differed among the participants, which indicates the need to benefit from the evaluation of patients to improve the quality of treatment service in dental clinics. Future research should be conducted to precisely identify the factors that lead to increased satisfaction of dental patients with their treatment experiences.

Factors Related to Oncologists' Use of the Disease Treatment and Employment Support Guidance Fee.

The purpose of this study is to examine the factors related to oncologists' use of the disease treatment and employment support guidance fee in Japan. A cross-sectional online survey was conducted in January 2021 among all the diplomates of the subspecialty board of medical oncology in the Japanese Society of Medical Oncology (n = 1,452), using the official mailing list. Logistic regression analysis was used to investigate the association between demographic and other factors and use of the disease treatment and employment support guidance fee. In total, 146 individuals participated in the study (response rate 10.0%). Experience of using the fee was associated with medical specialty and knowledge of the Guideline for Workplace Patient Coordination and Disease Treatment. It may be possible to increase the use of the disease treatment and employment support guidance fee among oncologists by raising awareness of the Guideline for Workplace Patient Coordination and Disease Treatment.

The Renewable Energy Sources for Municipal Wastewater Processes in Thailand: A Case Study of the Nonthaburi Wastewater Treatment Plant

Abstract There are 101 municipal wastewater treatment plants in Thailand supplied with electricity and cannot collect wastewater treatment fees. Alternative sources of energy for municipal wastewater treatment would reduce the electricity costs and future fossil energy uses. The Nonthaburi wastewater treatment plant (WWTP) is located in the Northwest of Bangkok and selected due to its available data. The solar energy source is applied to the Nonthaburi WWTP due to the light intensity and the area to install. By comparing to the wind and the biogas sources, the wind speed and the sludge production are not sufficient, respectively. Besides the estimated installation cost of the solar-cell panels among three companies, the NPV of 25 years and the IRR of three percent rate, the area required for installation is an affecting factor for the plant consideration.