Optimización de la predicción de problemas financieros en empresas sanitarias privadas españolas aplicando algoritmos genéticos

ObjectiveThis paper presents a methodology to optimize, using Altman's Z-Score for private companies, the prediction of private companies of the Spanish health sector entering a situation of bankruptcy.MethodThe proposed method consists of the application of genetic algorithms (GA) to find the coefficients of the formula of the chain of ratios proposed by Altman in the version of the score for private companies which optimize the prediction for Spanish private health companies, maximizing sensitivity and specificity, and thereby reducing type I and type II errors. For this purpose, a sample of 5,903 companies from the Spanish private health sector obtained from the database of the Iberian Balance Analysis System (SABI) between 2007 and 2015 was used.ResultsThe results show that the predictive model obtained with the AG presents greater accuracy, sensitivity and specificity than that proposed by Altman for private companies with both test data and all sample data.ConclusionsThe most important finding of this study was to establish a methodology that can identify the optimized coefficients for the Altman Z-Score, which allows a more accurate prediction of bankruptcy in Spanish private healthcare companies.     

反复感染手足口病患儿的预防和治疗

目的探讨消毒隔离结合免疫及营养治疗在预防和治疗反复感染手足口病患儿中的作用。 方法收集初次就诊的手足口病患儿共400例，利用随机数字表将患者分为治疗组与对照组各200例，治疗组患儿定期给予消毒隔离健康教育及营养随访，再次患病后给予个体化营养支持治疗。对照组患儿仅在感染手足口病后给予常规治疗。比较两组患儿手足口病再发率和重症率等指标。 结果治疗组患儿平均退热时间为（1.7 ± 1.1）d、皮疹消退时间为（4.0 ± 1.3）d、平均住院天数为（5.6 ± 2.4）d、抗菌药物使用率为19%（38/200）、激素使用率为8%（16/200），均显著低于对照组，差异具有统计学意义（t = 10.028、8.677、8.353、20.650、11.312，P = 0.015、0.032、0.001、0.004、0.011）。治疗组患儿1年内再发率、重症率和并发症发生率分别为12%（24/200）、1%（2/200）和5%（10/200），显著低于对照组患儿，差异均有统计学意义（χ² = 9.21、0.88、7.24，P = 0.010、0.002、0.007）。 结论健康教育、营养随访及个体化营养支持治疗可降低手足口病的再发率及重症率，改善临床结局。     

Comparison of pre-injury recalled Health Status (HS) data of trauma patients and HS of the general population

PurposeSignificant differences exist between retrospectively collected pre-injury Health Status (HS) of trauma patients and the HS of the general population. Compared to the general population, the trauma population includes a larger proportion of individuals with a low level of socio-economic status. The aim was to compare retrospectively collected pre-injury HS with HS of a sample of Dutch individuals not only adjusted for age and gender, but also for educational level.MethodsWithin three months post-trauma, pre-injury HS (n = 2987) was collected by using the EuroQol-five-dimension-3-level (EQ-5D-3L) questionnaire. Data were abstracted from the Brabant Injury Outcome Surveillance. The reference cohort (n = 1839) included a sample of the Dutch general population. Multiple regression was used to compare HS of both cohorts.ResultsA higher recalled pre-injury EQ-5D-3L score of the injury cohort was reported compared to the HS of the reference cohort after adjustment for age (β = 0.014 [95% CI: 0.001,0.027] for males and β = 0.018 [95% CI: −0.001, 0.036] for females). After adjustment for age and educational level, the Beta showed a ≥10% increasement: males; unadjusted β = 0.006 [95% CI: −0.007, 0.019] to β = 0.014 [95% CI: 0.001, 0.027] after age adjustment to β = 0.020 [95% CI: 0.007, 0.033] after adjustment for age and educational level, females; unadjusted β = −0.018 [95% CI: −0.035, −0.001] to β = 0.018 [95% CI: −0.001, 0.036] after age adjustments to β = 0.025 [95% CI: 0.007, 0.043] after adjustments for age and educational level. After adjustment for age, gender and educational level, the injury cohort reported prior to the trauma less problems on the ‘pain/discomfort’ (OR = 0.522 [95% CI: 0.454, 0.602]) and the ‘anxiety/depression’ (OR = 0.745 [95% CI: 0.619, 0.897]) dimensions, as compared to the reference cohort. In contrast, the injury cohort reported significantly more problems on the ‘self-care’ dimension (OR = 1.497 [95% CI: 0.1.112, 2.016]) prior to the trauma.ConclusionsInjured patients report better recalled pre-injury HS compared to the HS of the reference cohort. After adjustment for educational level, the difference in HS between the injury cohort and the reference cohort increases, underlining that other confounders might also influence HS.     

The kynurenine pathway and cognitive performance in community-dwelling older adults. The Hordaland Health Study

IntroductionTryptophan, its downstream metabolites in the kynurenine pathway and neopterin have been associated with inflammation and dementia. We aimed to study the associations between plasma levels of these metabolites and cognitive function in community-dwelling, older adults.MethodsThis cross-sectional study included 2174 participants aged 70–72 years of the community-based Hordaland Health Study. Tryptophan, kynurenine, neopterin and eight downstream kynurenines were measured in plasma. Kendrick Object Learning Test (KOLT), Digit Symbol Test (DST) and the Controlled Oral Word Association Test (COWAT) were all outcomes in standardized Zellner’s regression. The Wald test of a composite linear hypothesis of an association with each metabolite was adjusted by the Bonferroni method. Age, body mass index, C-reactive protein, depressive symptoms, diabetes, education, glomerular filtration rate, hypertension, previous myocardial infarction, prior stroke, pyridoxal 5′phosphate, sex and smoking were considered as potential confounders.ResultsHigher levels of the kynurenine-to-tryptophan ratio (KTR) and neopterin were significantly associated with poorer, overall cognitive performance (p < 0.002). Specifically, KTR was negatively associated with KOLT (β −0.08, p = 0.001) and COWAT (β −0.08, p = 0.001), but not with DST (β −0.03, p = 0.160). This pattern was also seen for neopterin (KOLT: β −0.07; p = 0.001; COWAT: β −0.06, p = 0.010; DST: β −0.01, p = 0.800). The associations were not confounded by the examined variables. No significant associations were found between the eight downstream kynurenines and cognition.ConclusionHigher KTR and neopterin levels, biomarkers of cellular immune activation, were associated with reduced cognitive performance, implying an association between the innate immune system, memory, and language.     

新中国70年卫生投入回顾与展望

本文基于新中国成立以来卫生投入等相关数据，回顾了70年来卫生投入的基本情况。结合文献分析，从卫生投入的规模与结构、世界排位、卫生投入政策的发展变化等方面，系统总结了卫生投入取得的成绩，着重分析了2009年新医改以来政府主导的多元投入机制的突出特点。分析发现，我国在卫生投入结构、政府卫生投入稳定性与可持续性、个人卫生支出占比等方面还存在一定问题。同时，对新时代下面临的新形势新挑战进行了研判。预测显示，为满足人民群众日益增长的需求，推动卫生系统高质量发展，未来一定时期我国卫生投入仍将继续保持增长趋势，到2030年我国卫生投入规模将达到15.3万亿元，占GDP的比重达到9.2%。为此，建议建立以结果为导向的健康投入机制，从"以治疗为中心"向"以人民健康为中心"转变。     

Urinary phthalate metabolites and metabolic syndrome in U.S. adolescents: Cross-sectional results from the National Health and Nutrition Examination Survey (2003–2014) data

Objective

There is limited research on the association between phthalates and metabolic syndrome (MetS). Among adolescents, phthalate exposure, which can occur from multiple sources, has been linked to several risk factors for MetS. The objective was to investigate the association between urinary phthalate metabolite concentrations (i.e., mono-ethyl phthalate (MEP), mono-n-butyl phthalate (MnBP), mono-isobutyl phthalate (MiBP), mono-benzyl phthalate (MBzP), mono-(3-carboxylpropyl) phthalate (MCPP), and di(2-ethylhexyl phthalate (DEHP)) and MetS in adolescents aged 12–19 years using the National Health and Nutrition Examination Survey (NHANES) data (2003–2014). A secondary aim was to assess if observed associations varied by a measure of socioeconomic status, economic adversity, which was defined using parental income and educational attainment as well as household food security.