Does community-based health insurance affect lifestyle and timing of treatment seeking behavior?Evidence from Ethiopia

Objectives This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance(CBHI)scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms.There is growing concern about the financial sustainability of CBHI schemes in developing countries.However,few empirical studies have identified potential contributors,including ex-ante and ex-post moral hazards.Methods We implement a household fixed-effect panel data regression model,drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia.Results The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals.However,CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms.Particularly,on average,we estimate about 4-6 h delay for malaria symptoms,a little above 4 h for tetanus,and 10-11 h for tuberculosis among the insured households.Conclusions While there is evidence that CBHI improve the utilization of outpatient or primary care services,our study suggests that insured members may wait longer before visiting health facilities.This delay could be partly due to moral hazard problems,as insured households,particularly those from rural areas,may consider the opportunity costs associated with visiting health facilities for minor symptoms.Overall,it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

现场诊断日本血吸虫感染常用方法比较

目的 比较三种常用诊断日本血吸虫感染的方法 ,在日本血吸虫病流行区进行现场诊断时的特性。方法 在湖北省和江西省各选取一个村庄为研究对象 ,各试点每位居民均接受改良加藤法、间凝法和孵化法检测感染 ,湖北试点只收集一次新鲜粪便标本制作 2张加藤涂片 ,江西试点收集连续 7d的新鲜粪便标本 ,每天制涂片 2张。同时收集相关的流行病学基础资料。结果 在两个试点中 ,各年龄组和性别的各种检测方法的阳性率变化趋势相同 ;间凝法和孵化法的检出率随着感染率的增加而上升。江西试点间凝法的敏感度和特异度分别为80 %和 48% ,单次加藤法和孵化法的敏感度分别为 6 8%和 33 % ;而湖北试点的孵化法阳性率却高于单次加藤法。结论 加藤法为现场诊断首选 ;孵化法易受现场条件限制 ,稳定性较差 ;间凝法假阳性率较高 。

中国人群心电图T波参数正常范围的调查

调查和评估中国人群 12导联心电图T波参数的正常范围以及年龄、性别和导联差异。采集 5 36 0例 (男 36 14例、女 174 6例 ,年龄范围 18～ 84岁 )健康人 12导联心电图 ,分别按性别分为 5个年龄组 ,计算男、女各年龄组T波幅度和额面T波电轴的中位数及 96 %范围正常上、下限 ,以及各导联负向T波的发生率。结果 :男性各导联T波幅度随年龄增长而逐渐下降 ,呈现明确的年龄趋势 ,尤其在胸导联 (P <0 .0 0 1) ;而女性的年龄趋势并不十分明确。男、女T波振幅的性别差异主要发生在胸导联 (P <0 .0 0 1) ,且T波幅度的性别差异随年龄增长趋向减小。在肢体导联 ,T波振幅的正常上限值在男性为 0 .5 4mV ,女性为 0 .4 5mV ;而在胸导联 ,男性为 1.4 4mV ,女性为 0 .9mV。绝大多数导联女性负向T波发生率高于男性 ;在Ⅰ、Ⅱ及V4～V6导联 ,负向T波最大发生率不超过 1.6 4 % ;在V1导联 ,男性负向T波发生率为 12 .19% ,而女性为 4 6 .79% ;在V2 导联 ,男、女负向T波发生率分别仅为 0 .33%和 2 .4 %。男、女T波中位数电轴均随年龄增长逐渐向左上偏移 ,6 0岁以后又转向左下 ;各年龄组T波中位数电轴的性别差异几乎相同 ,均约为 6°(P <0 .0 0 1)。结论 :中国人群心电图T波参数存在明确的年龄、性别和导联差异。有必要制定与年龄?

The impact of FinTech start-ups on incumbent retail banks’share prices

Background:This study aims to clarify the role of FinTech digital banking start-ups in the financial industry.We examine the impact of the funding of such start-ups on the stock returns of 47 incumbent US retail banks for 2010 to 2016.Methods:To capture the importance of FinTech start-ups,we use data on both the dollar-volume of funding and number of deals.We relate these to the stock returns with panel data regression methods.Results:Our results indicate a positive relationship exists between the growth in FinTech funding or deals and the contemporaneous stock returns of incumbent retail banks.Conclusions:Although these results suggest complementarity between FinTech and traditional banking,we note that our results at the banking industry level are not statistically significant,and that the coefficient signs for about one-third of the banks are negative,but not statistically significant.Since the FinTech industry is young and our sample period short,we cannot rule out that our findings are spurious.

Aspirin responsive platelet thrombophilia in essential thrombocythemia and polycythemia vera

Essential thrombocythemia(ET) and polycythemia vera(PV) frequently present with erythromelalgia and acrocyanotic complications, migraine-like microvascular cerebral and ocular transient ischemic attacks(MIAs) and/or acute coronary disease. The spectrum of MIAs in ET range from poorly localized symptoms of transient unsteadiness, dysarthria and scintillating scotoma to focal symptoms of transient monocular blindness, transient mono- or hemiparesis or both. The attacks all have a sudden onset, occur sequentially rather than simultaneously, last for a few seconds to several minutes and are usually associated with a dull, pulsatile or migraine-like headache. Increased hematocrit and blood viscosity in PV patients aggravate the microvascular ischemic syndrome of thrombocythemia to major arterial and venous thrombotic complications. Phlebotomy to correct hematocrit to normal in PV significantly reduces major arterial and venous thrombotic complications, but fails to prevent the platelet-mediated erythromelalgia and MIAs. Complete long-term relief of the erythromelalgic microvascular disturbances, MIAs and major thrombosis in ET and PV patients can be obtained with low dose aspirin and platelet reduction to normal, but not with anticoagulation. Skin punch biopsies from the erythromelalgic area show fibromuscular intimal proliferation of arterioles complicated by occlusive plateletrich thrombi leading to acrocyanotic ischemia. Symptomatic ET patients with erythromelalgic microvascular disturbances have shortened platelet survival, increased platelet activation markers β-thromboglobulin(β-TG), platelet factor 4(PF4) and thrombomoduline(TM), increased urinary thromboxane B2(TXB2) excretion, and no activation of the coagulation markers thrombin fragments F1+2 and fibrin degradation products. Inhibition of platelet cyclooxygenase(COX1) by aspirin is followed by the disappearance and no recurrence of microvascular disturbances, increase in platelet number, correction of the shortened platelet survival times to normal, and reduction of increased plasma levels of β-TG, PF4, TM and urinary TXB2 excretion to normal. These results indicate that platelet-mediated fibromuscular intimal proliferation and platelet-rich thrombi in the peripheral, cerebral and coronary end-arterial microvasculature are responsible for the erythromelalgic ischemic complica-tions, MIAs and splanchnic vein thrombosis. Baseline platelet P-selectin levels and arachidonic acid induced COX1 mediated platelet activation showed a highly significant increase of platelet P-selectin expression(not seen in ADP and collagen stimulated platelets), which was significantly higher in JAK2V617 F mutated compared to JAK2 wild type ET.

美国并购交易中CEO留任和薪酬回报问题研究的文献综述及对中国遏制CEO自利行为的建议

通过美国学者对美国并购交易中CEO留任和薪酬回报问题的研究发现,美国CEO利用其决策权接受私有企业支付的低并购溢价来获得并购后的留任或较高的解雇补贴,从而提出应该对我国企业高管并购自利行为进行关注;建议我国企业通过加强对高管层的监控机制、优化薪酬制度、建立完善的经理人竞争机制、提高管理层薪酬披露的透明度及发挥市场监管对高管的约束作用,尽可能遏制高管损害公司利益的自利行为。

计算机技术与临床工作平静地等待戈多

信息技术（information technology，IT）的流程支持已经被人称为改善卫生保健质量和安全性的重要障碍。有2个方面特别引起人们的注意和投资。第一个是临床决策支持系统，亦即为改善临床医生做出决定而设计的信息系统。第二个则是一种为减少用药错误而采用的计算机医嘱输入（Computerized Physician Order Entry，CPOE）系统。该领域的文献以频繁的成功报告为特征，并且经常预言一个光明的新（近期的）未来；然而，这个未来似乎永远不会到来。在统治会议进程的欢呼和高度期望的背后，在自动贩卖信息和大量科学文献的背后，其现实情况是，目前各地所用系统虽然拥有满意的使用者，但是对医疗质量和安全性做出有效贡献者罕见。

荷兰结核病在不同年龄人群间的传染:应用DNA指纹法的分析

背景:1950年至1980年间荷兰结核病感染率的下降比发病率的下降快得多。本研究的目的在于确定这一现象是否能用年龄组内的不同传播所解释。方法:应用RFLP法将荷兰1993～1996年所有菌株进行分型,同一指印的菌株被鉴定为同一来源,由此确定2个荷兰患者年龄上的相关性。结果:两簇人群81对菌株患者年龄的平均差异是13.9岁。而所有可能配对患者资料的年龄平均差异是25.5岁。Fisher氏检验相关系数为0.62 (95%可信区间[CI]值为0.46～0.74)。结论:结核病传染源更易传染给和他们年龄相近的人群。由于在1950～1980年间,病例的平均年龄在增加。传染源可能对过去常观测年感染率的儿童的感染更少。在低结核国家中儿童、青少年结核病的年感染率的资料不适于该人群中的老年者。

Meeting report on the first Sino-Dutch symposium on oncology

On October 31,2015,the first Sino-Dutch symposium on oncology was organized in Guangzhou(China).The symposium revealed similarities between Chinese and Dutch efforts to improve the care of tumor patients and to create enhanced insight into the nature of cancers.In particular,it became evident for some types of cancer that immunotherapy should focus on counteracting interleukin-17-associated immunity and targeting cancer stroma.Targeting specific cancer microenvironment and stroma also opens new therapeutic options,including the use of radio-active theranostics and live tumor imaging-guided surgeries.

Ethane dimethylsulphonate selectively destroys Leydig cells in the adult bonnet monkeys (Macaca radiata)

Aim:To study the effect of intratesticular administration of ethane-1,2-dimethylsulphonate(EDS)which has been exten-sively used to selectively destroy Leydig cells in rats and study the role of gonadotropin in regulation of differentiation ofLeydig cells(LC)in the adult male bonnet monkey.Methods and Results:In vitro studies with cultured interstitialcells isolated from monkey testis revealed an inhibitory effect of EDS on LC as assessed by decrease in testosterone pro-duction.Intratesticular administration of EDS(5,10,20,50 mg/testis)resulted in a dose-dependent rapid decrease inserum testosterone levels,with a 65%decrease with 5 mg of EDS by the 3rd day,which returned to control levels by the45th day.EDS treatment resulted in a significant decrease in testicular testosterone.In addition a significant decrease in[(125)~I]hCG binding and phenylesterase activity in the interstitial cells was noticed.Histological analysis of the testes onthe 5th day after administration of EDS revealed an interstitium devoid of LC indicating the destructive action of EDS.Conclusion:The monkey LC are sensitive to destructive action of EDS.

Studying Design and Use of Healthcare Technologies in Interaction: The Social Learning Perspective in a Dutch Quality Improvement Collaborative Program

Designing technologies is a process that relies on multiple interactions between design and use contexts. These interactions are essential to the development and establishment of technologies. This article seeks to understand the attempts of healthcare organisations to integrate use contexts into the design of healthcare technologies following insights of the theoretical approaches of social learning and user representations. We present a multiple case study of three healthcare technologies involved in improving elderly care practice. These cases were part of a Dutch quality improvement collaborative program, which urged that development of these technologies was not “just” development, but should occur in close collaboration with other parts of the collaborative program, which were more focused on implementation. These cases illustrate different ways to develop technologies in interaction with use contexts and users. Despite the infrastructure of the collaborative program, interactions were not without problems. We conclude by arguing that interactions between design and use are not naturally occurring phenomena, but must be actively organised in order to create effects.

A Model to Estimate the Impact of Thresholds and Caps on Coverage Levels in Community-Based Health Insurance Schemes in Low-Income Countries

Background: Community-based health insurance (CBHI) schemes are increasingly implemented in low-income settings. These schemes limit the coverage they offer both by the types of care considered, and by applying thresholds and/or caps to costs reimbursed. The consequences of these thresholds and/or caps on insurance coverage have hitherto been usually ignored, for lack of data on the distributions of healthcare costs or understanding of their impact on effective coverage levels. This article describes a theoretical model to obtain the distributions even without data collection in the field, and demonstrates the quantitative impact of thresholds and/or caps on claim reimbursements. Methods: This model applies to applications on healthcare expenditures in low-income settings, following research methods examined in the Western world. We looked at hospitalizations and tests;we compared the simulated distributions to empirical data obtained through 11 household surveys conducted between 2008 and 2010 in rural locations (9 in India and 2 in Nepal). Results: We found that the shape of the distributions was very similar in all locations for both benefits, and could be represented by a model based on a lognormal distribution. The agreement between theoretical and empirical results was satisfactory (mostly within 10% difference). Conclusions: The model makes it possible to simulate the expected performance of the CBHI (represented by the percentage of costs or bills covered). The aim is to match costs with local levels of willingness-to-pay for health insurance. This model makes it possible to determine at the stage of package-design the optimal levels of thresholds and/or caps for each benefit-type included.

Primary intramedullary melanocytoma presenting with lower limbs,defecation,and erectile dysfunction:A case report and review of the literature

BACKGROUND Primary intramedullary melanocytoma is an exceedingly rare type of primary melanocytic tumor in the central nervous system.Unfortunately,primary intramedullary melanocytoma lacks specificity in clinical symptoms and imaging features and there is currently no standard strategy for diagnosis or treatment.CASE SUMMARY A 52-year-old male patient suffered from weakness and numbness involving the bilateral lower limbs for 18 mo,and defecation and erectile dysfunction for 6 mo.Furthermore,these symptoms started to worsen for the last 3 mo.Preoperative magnetic resonance imaging(MRI)revealed an intramedullary tumor located at the T9-T10 level.In subsequently surgery,the maximal safe resection extent approached to 98%.The lesion was confirmed to be melanocytoma by pathological examination.In addition,the possibility of original melanocytoma outside the spinal cord was excluded after the examination of the whole body.Therefore,a diagnosis of primary intramedullary melanocytoma was established.The patient refused to accept radiotherapy or Gamma Knife,but MRI examination on July 28,2020 showed no sign of development.In addition,on April 10,2021,the recent review showed that the disorder of defecation and lower limbs improved further but erectile dysfunction benefited a little from the surgery.CONCLUSION After diagnosing intramedullary melanocytoma by postoperative pathology,the inspection of the whole body contributed to excluding the possibility of metastasis from other regions and further suggested a diagnosis of primary intramedullary melanocytoma.Complete resection,adjuvant radiation,and regular review are critical.In addition,maximal safe resection also benefits prognosis while the tumor is difficult to be resected totally.

Supporting smoking cessation in healthcare: obstacles in scientific understanding and tobacco addiction management

Despite ongoing efforts to reduce tobacco smoking, the smoking prevalence in many countries has remained stable for years. This may be a consequence of either lack of knowledge about effective ways to reduce smoking, or failing treatment of tobacco addiction in healthcare. This study explored gaps in the current understanding of smoking cessation and the challenges facing tobacco addiction management in order to formulate recommendations for future research and healthcare practice. A narrative review was written to determine areas in which more research is needed as well as areas in which sufficient knowledge is already available. Recommendations for future research were prioritised using a Delphi-procedure. Recommendations for healthcare practice were confirmed by expert’s assessment. Smoking is not widely acknowledged as an addiction and a relatively small number of smokers ask help from a healthcare professional when trying to stop smoking. Most healthcare professionals recognise the importance of advising patients to stop smoking, but experience certain barriers to actually do this. Overall, healthcare professionals need to be convinced that tobacco smoking is an addiction and should be treated likewise. If all healthcare professionals systematically advise their patients to give up smoking, eventually more smokers will successfully stop smoking.

内在安全的生产,对清洁生产的一种正常的补充

内在的安全性,是一种利用没有毒性、可燃性或不稳定性的工艺与材料的方法,它通常被认为是化工厂设计的一个重要概念.受到清洁生产成功发展的鼓舞,进行了一项类似的有关内在安全生产的发展可行性研究.在1997-1998年进行的初步试验案例中,发展并检验了一个产生内在安全的技术选择的方法论.该研究表明,大部分选择的偿还时间少于两年,而且内在安全的生产是一个可行的概念,有可能同时产生巨大的安全与经济成效的改善,并且可以结合进清洁生产计划.

For CO<SUB>2</SUB>Emission Trading in China, Can the Market Become a National One, Four Years after Creating Seven Local Markets?

In this paper, we assess the existing seven local pilot carbon emission trading schemes in China and analyse the factors determining whether China’s carbon market is successful in terms of handling substantial amounts of CO2 emissions rights, regulating the market and trading them at a reasonable price. The emission trading system is developing slowly in most of the participating provinces and cities. Prices tend to decline, while volumes trading slowly increase. The volatility is partially the result of regulation (the rights need to be renewed before a certain date) and partially due to government interventions in the market. Based on the assessment, recommendations are provided for China implementing a national carbon market, based on the experiences and lessons learnt from the seven local carbon emission trading schemes. Conditions for China to roll out the system and later improve the national emission trading scheme to replace the existing local emission trading schemes are formulated.

Market Capturing and Business Expansion Strategy for Gluten-Free Foods in India and USA Using PESTEL Model

The ultimate goal for any business is to grow vertically and horizontally. Successful business is combination of careful analysis of external and internal factor of business environment and adoption of appropriate business strategy. In this study external factors of gluten-free market are studied in detail through PESTEL model (for external factors). The study would facilitate manufacturers to bring gluten-free foods from niche market to main stream market and to make it more affordable for all the sections of the society. The study focuses on markets of India and USA, since both of these nations have high potential for gluten-free foods and the demand further continues to increase every year.

Modelling Livestock Activities and Environmental Sustainability: The African Case

This paper develops a dynamic model of grazing land degradation. The model illustrates the relationship between live-stock levels and grazing land degradation over time. It identifies the mechanisms by which the factors internal to the livestock local production system and those drawn from the larger economic context of livestock marketing influence livestock-grazing land relationship. The paper shows that overstocking leads to degradation which leads to declining relative prices of livestock as quality declines and mortality increases. As relative price of livestock falls, consumption increases. The increased consumption and mortality ultimately leads to lower livestock population, which leads to de-creased degradation. The model results show that medium term dynamics of grazing land degradation are quite differ-ent from long term dynamics. It is shown that although grazing land sustainability situation is adverse in the medium term, yet it is favourable in the long term. The livestock system is dynamic and can adjust when longer term system dy-namics are allowed to play out. Part of the adjustment mechanism is built in the livestock system and the other part comes from the economic system. The built-in adjustment mechanism works through the two-way relationship between the stock and degradation. The external adjustment mechanism, originating from the economic system, works through economic growth, relative prices and foreign trade. In the medium term, opportunistic management strategy and poli-cies that facilitate access to grazing land and water are crucial for mitigating degradation. The results suggest that the views of the mainstream range management paradigm and the new thinking of range ecology can be reconciled.

The Paradigm of Surgical Ellipse Dimensions: Are the Length-to-Width Ratio of 3 to 4 and a Vertex Angle of 30&ordm;Correct?

Background: It has been postulated that elliptical cutaneous excisions must possess a length-to-width ratio of 3 to 4 and a vertex angle of 30o or less in order to be closed primarily without creating a “dog ear”. These dimensions became axiomatic in cutaneous surgery and have been taught in the apprenticeship model for years. The present article examines the validity of that paradigm. Methods: We collected data from two sources: ellipses described in the literature (57 cases);and elliptical excisions performed at the authors’ outpatient clinic (83 cases). The surgical ellipse lengths, widths, and vertex angles were analyzed, and the data were compared to a mathematical formula used to generate a fusiform ellipse. Results: The length-to-width ratio of 3 - 4 was found to be inconsistent with the recommended vertex angle of 30o. In fact, a length-to-width ratio of 3 - 4 determines a vertex angle of 48o - 63o. A 30o vertex angle is only feasible with long length-to-width ration of about 7.5. Conclusions: The paradigm that surgical ellipses should have a vertex angle of 30o with length-to-width ratio of 3 - 4 is incorrect. Evidence from actual surgical practice and from mathematical formulation shows that either the length-to-width ratio must be larger than 3 - 4 or the vertex angle must be larger than 30 degrees.

Big Data Study for Gluten-Free Foods in India and USA Using Online Reviews and Social Media

Celiac disease, gluten-allergy or gluten-sensitivity is caused due to glutamine protein from the grains like wheat, rye and barley (collectively called gluten). This protein damages the small intestine and causes stomach pain, bloating, weakness etc. Celiac disease, gluten-allergy or gluten-sensitivity has never really been taken seriously in developing countries like India. However, in developed nations like UK, USA, Canada and other parts of Europe, gluten-free foods have become quite popular. With a prevalence rate of about one in 100 - 133 people worldwide, celiac disease is widespread across the globe and life-long consumption of gluten-free food is recommended treatment for this allergy. Apart from celiac-disease patients, gluten-free foods are also consumed by health conscious people for weight management and high protein diet and by the patients for diabetes, autism and food allergies. Apart from gluten-free flour, biscuits, cookies and snacks, product innovations like gluten-free beers are becoming very popular. Big data including online blogs, articles, and reviews have played a major role in increased sales of gluten-free foods. Thus, analysis of editorial and social media content becomes essential to understand the leading trends in gluten-free foods. This study provided deep insights about positive, negative and neutral sentiments related to gluten-free foods using the data from Perspectory Media Insights and Google Trends. This study also revealed that most of the consumers talked and expected product innovation in food sections like snacks, fast food (pizza, pasta and noodles) and desserts through comments on social and editorial media. Searches were divided into developed (e.g., U.S.A.) and developing nations (e.g., India) to get more details about the consumer preferences. This study would help manufacturers of gluten-free foods to develop food products according to the choices and preferences of consumers. The study is very unique in itself since it combines big data to niche food market of gluten-free foods to draw the valuable consumer preferences using online platforms.