Obesity and thyroid function

A moderate elevation of thyrotropin (TSH) concentrations, which is associated with triiodothyronine (T3) values in or slightly above the upper normal range, is frequently found in obese humans. These alterations seem rather a consequence than a cause of obesity since weight loss leads to a normalization of elevated thyroid hormone levels. Elevated thyroid hormone concentrations increase the resting energy expenditure (REE). The underlying pathways are not fully understood. As a consequence of the increased REE, the availability of accumulated energy for conversion into fat is diminished. In conclusion, the alterations of thyroid hormones in obesity suggest an adaptation process. Since rapid weight loss is associated with a decrease of TSH and T3, the resulting decrease in REE may contribute towards the difficulties maintaining weight loss. Leptin seems to be a promising link between obesity and alterations of thyroid hormones since leptin concentrations influence TSH release.     

我国居民医疗保健消费需求变动对制药产业发展的影响分析

文章采用基于需求变化的动态调整模型,利用1985-2008年数据,分析我国城乡居民医疗保健消费需求变化对中成药和化学药品原药产业发展的影响.分析结果表明,转型时期制药产业的发展一定程度上受居民医疗保健需求变化的影响.城镇居民医疗保健消费需求增长对中成药无论短期影响还是长期影响均大于化学药品原药,农村居民的情况则相反,医疗保健消费需求对化学药品原药无论短期影响还是长期影响均大于中成药.     

The medical insurance system’s weakness to provide economic protection for vulnerable citizens in China: A five-year longitudinal study

ObjectivesLittle is known about the magnitude of catastrophic health expenditure (CHE) attributable to critical disease, especially in the middle-aged and elderly population. This research aimed to exploring the key aspects of how the health insurance fails to protect the middle-aged and elderly against CHE in the past five years. And propose corresponding measures to improve.MethodsData were obtained from the 2011 to 2015 China Health and Retirement Longitudinal Study. The method was adapted from WHO to calculate the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME), and use Generalized Linear Mixed Models (GLMMs) to comprehensively analyze the risk factors that cause middle-aged and elderly people to fall into CHE.ResultsThe incidence of CHE of China’s middle-aged and elderly population has been rose in the five years from 2011 (10.5 %) to 2013 (17.5 %) to 2015 (19.7 %). The CHE of richest families was almost 6 times from 2011 to 2015. Urban Employee Medical Insurance Scheme, the incidence of CHE was up 10 percentage from 2011 to 2015. According to the GLMMs, families have inpatient cares as the most important factor to CHE. The incidence of CHE increased by 2.25 times compared with those who did not use inpatient services.ConclusionsThe health system needs to control the irrational growth of health expenses and reduce residents’ overuse of health services. Government should take supplementary measures to comprehensively strengthen the advantages of health insurance. Raise residents' awareness of health care, enhance citizens' physical fitness, and avoid unnecessary waste of health resources.     

Effect of slope and footwear on running economy and kinematics

Lower energy cost of running (Cr) has been reported when wearing minimal (MS) vs traditional shoes (TS) on level terrain, but the effect of slope on this difference is unknown. The aim of this study was to compare Cr, physiological, and kinematic variables from running in MS and TS on different slope conditions. Fourteen men (23.4 ± 4.4 years; 177.5 ± 5.2 cm; 69.5 ± 5.3 kg) ran 14 5‐min trials in a randomized sequence at 10 km/h on a treadmill. Subjects ran once wearing MS and once wearing TS on seven slopes, from ?8% to +8%. We found that Cr increased with slope gradient (P < 0.01) and was on average 1.3% lower in MS than TS (P < 0.01). However, slope did not influence the Cr difference between MS and TS. In MS, contact times were lower (P < 0.01), flight times (P = 0.01) and step frequencies (P = 0.02) were greater at most slope gradients, and plantar‐foot angles – and often ankle plantar‐flexion (P = 0.01) – were greater (P < 0.01). The 1.3% difference between footwear identified here most likely stemmed from the difference in shoe mass considering that the Cr difference was independent of slope gradient and that the between‐footwear kinematic alterations with slope provided limited explanations.     

MEASURING OVERFITTING IN NONLINEAR MODELS: A NEW METHOD AND AN APPLICATION TO HEALTH EXPENDITURES

When fitting an econometric model, it is well known that we pick up part of the idiosyncratic characteristics of the data along with the systematic relationship between dependent and explanatory variables. This phenomenon is known as overfitting and generally occurs when a model is excessively complex relative to the amount of data available. Overfitting is a major threat to regression analysis in terms of both inference and prediction. We start by showing that the Copas measure becomes confounded by shrinkage or expansion arising from in‐sample bias when applied to the untransformed scale of nonlinear models, which is typically the scale of interest when assessing behaviors or analyzing policies. We then propose a new measure of overfitting that is both expressed on the scale of interest and immune to this problem. We also show how to measure the respective contributions of in‐sample bias and overfitting to the overall predictive bias when applying an estimated model to new data. We finally illustrate the properties of our new measure through both a simulation study and a real‐data illustration based on inpatient healthcare expenditure data, which shows that the distinctions can be important. Copyright © 2013 John Wiley & Sons, Ltd.     

THE MOTIVES OF INTERGENERATIONAL TRANSFER TO THE ELDERLY PARENTS IN CHINA: CONSEQUENCES OF HIGH MEDICAL EXPENDITURE

The support for the elderly is facing big challenges with the problem of population aging. Transfers from adult children could partly insure elderly parents against low income and high medical expenditure. There are two main motives for transfers in the literature, namely altruism and exchange. By using data from a new household survey of people aged 45 years and above in China, we estimate the transfer derivatives with the adjustment of medical expenditure in elderly parents' income. We find a large negative impact of adjusted income on transfers at the lower end of income distribution, which is consistent with the altruistic motive. Evidence on the exchange motive is found only for sons, but not for daughters. In addition, there is evidence on the ‘exchange‐for‐service’ motive, which interprets transfer as a payment to parents' family services, such as taking care of grandchildren. Copyright © 2013 John Wiley & Sons, Ltd.     

Energy expenditure in very low birth weight newborns: a comparison between small and appropriate‐for‐gestational‐age

Aims: To compare resting energy expenditure (REE) in small‐ and appropriate‐for‐gestational‐age very low birth weight newborns after reaching corrected at‐term age. Methods: Observational study that included all clinically stable very low birth weight newborns admitted to a neonatal intensive care unit. The newborns were classified as small‐for‐gestational‐age (SGA) and appropriate‐for‐gestational‐age (AGA). Resting energy expenditure was measured using indirect calorimetry when the newborns reached at‐term age. Results: A total of 51 newborns, of which 23 were SGA and 28 AGA, were included. There was no statistically significant difference in REE between the two groups, although the observed levels were higher than the reference values. Conclusion: There is no statistical difference in resting expenditure energy between SGA and AGA infants when they reached term. The higher energy expenditure found in both groups may be explained by other factors related to prematurity and its complications and requires further investigation.     

发挥自动取单机作用 有效控制财务支出

医院更换新的信息系统之后,为了更大限度的降低成本,有效控制财务支出,为患者提供更好的服务,尤其是在提供检验结果报告单部分,减少因反复翻动检验单引起的交叉感染,保护患者隐私,杜绝错拿检验单,为患者提供24小时自助服务,医院购买引进了先进的检验单自动取单机,即方便患者,又完善了医院信息系统建设,提高竞争力,改善就诊环境。