An Analysis of the Medical Costs of and Factors Affecting Diabetes Using the Medical Checkup and Payment Dataset in Japan: Can We Reduce the Prevalence of Diabetes?

Background: The cost and economic burden of diabetes are a serious worldwide issue. In this study, we evaluated medical payments for persons diagnosed with diabetes and the factors that led to a person having diabetes to reduce its prevalence. Methods: A dataset containing 113,979 medical checkups and 3,671,783 monthly medical, dental, care-giving and pharmacy payment records of one health insurance society was used. The dataset contains information of normal and healthy persons. The sample period ran from April, 2013 to March, 2016. The medical payments for persons diagnosed with diabetes were calculated. The regression analysis was used to remove the effects of age and gender. The probit analysis was used to analyze the factors that led to a person having diabetes. Results: In 2.9% of cases, the person undergoing the checkup was diagnosed with diabetes, and the medical payments for these patients were 2.7 times as much as the average medical payment per person. This result did not change significantly even if age and gender were considered. The results of the probit analysis suggested that body mass index, high systolic blood pressure, low diastolic blood pressure, eating habits, physical activities, smoking, drinking alcohol and sleeping were important factors for diabetes. Conclusion: The diabetes might be a costlier disease than previously thought in Japan. By the estimation, 8% of all medical payments were made for these persons with diabetes, which is much higher than the result shown by national survey data. However, overall prevalence could be recused by efforts such as prevention of overweight and obesity.

Evaluation of Medical Costs of Kidney Diseases and Risk Factors in Japan

Background: Kidney (renal) diseases and dialysis are among the most costly disorders and represent a worldwide burden. In this study, we evaluate the medical costs for individuals with kidney diseases and risk factors for the diseases in Japan. Data and Methods: The dataset used contained 113,979 medical checkups and 3,172,066 medical cost records obtained from 48,022 individuals in one health insurance society. The sample period was April 2013 to March 2016. We evaluated the distribution of all medical costs, and those of kidney diseases specifically. Then the power transformation Tobit model was used to remove the effects of other variables. Finally, a probit analysis was used to analyze the risk factors. Results: In 0.25% of all cases, individuals were diagnosed with kidney diseases. An individual with kidney disease cost 14.5 times more than those without kidney disease. If the diseases progressed into chronic kidney disease (CKD), the medical costs increased substantially. Even disregarding various characteristics of individuals, this conclusion did not vary. We found important risk factors included diabetes and blood pressure problems. In particular, an individual with both factors had a high probability of developing kidney disease. Conclusion: Kidney diseases are much costlier than other diseases. Screening high-risk individuals, educating patients, and ensuring that treatment begins at an early stage are critically important to controlling medical costs. Limitations: The dataset was observatory, and the sample period was only 3 years.

Risk factors for cost-related medication non-adherence among older patients with diabetes

AIM: To assess the risk factors for cost-related medication non-adherence(CRN) among older patients with diabetes in the United States. METHODS: We used data from the 2010 Health and Retirement Study to assess risk factors for CRN including age, drug insurance coverage, nursing home residence, functional limitations, and frequency of hospitalization. CRN was self-reported. We conducted multivariate regression analysis to assess the effect of each risk factor. RESULTS: Eight hundred and seventy-five(18%) of 4880 diabetes patients reported CRN. Age less than 65 years, lack of drug insurance coverage, and frequent hospitalization significantly increased risk for CRN. Limitation in both activities of daily living and instrumental activities of daily living were also generally associated with increased risk of CRN. Residence in a nursing home and Medicaid coverage significantly reduced risk.CONCLUSION: These results suggest that expandingprescription coverage to uninsured, sicker, and community-dwelling individuals is likely to produce the largest decreases in CRN.

Investigation into the Computational Costs of Using Genetic Algorithm and Simulated Annealing for the Optimization of Explicit Friction Factor Models

Research reports show that the accuracies of many explicit friction factor models, having different levels of accuracies and complexities, have been improved using genetic algorithm (GA), a global optimization approach. However, the computational cost associated with the use of GA has yet to be discussed. In this study, the parameters of sixteen explicit models for the estimation of friction factor in the turbulent flow regime were optimized using two popular global search methods namely genetic algorithm (GA) and simulated annealing (SA). Based on 1000 interval values of Reynolds number (Re) in the range of and 100 interval values of relative roughness () in the range of , corresponding friction factor (f) data were obtained by solving Colebrook-White equation using Microsoft Excel spreadsheet. These data were then used to modify the parameters of the selected explicit models. Although both GA and SA led to either moderate or significant improvements in the accuracies of the existing friction factor models, SA outperforms the GA. Moreover, the SA requires far less computational time than the GA to complete the corresponding optimization process. It can therefore be concluded that SA is a better global optimizer than GA in the process of finding an improved explicit friction factor model as an alternative to the implicit Colebrook-White equation in the turbulent flow regime.

Study of Factors Causing Time and Cost Overrun in Pre-Construction Project (A Case Study of Malaysia)

Cost and time overrun are the key troubles of any improvement ventures. These troubles are inflicting the terrible end result in the development of kingdom monetary improvement and thriving. To overcome these problems, the?paper examines predominant impact on elements causing the mission postponement and cost. A poll review was led for the situation study embracing various information-gathering procedures. The discoveries from the contextual investigation uncovered that the most persuasive factors in Malaysia:?1) contractor’s inappropriate arranging, 2) poor site the board, 3) deficient contractual worker experience,?are the most powerful factors. This paper has likewise broken down the normal and least effective of the postpone variables causing task deferral and cost overrun in Malaysia. It likewise infers that there are various measures as per the idea of deferring components to decrease the effect on task postponement and cost overruns in the development industry.?There are significant factors in the control of time overrun that would be actual thought related to know and tackle in great impact to improvement rate which may additionally no capacity that be recovered. Thirty (30) massive development extensions in Malaysia were exceptional coping with time overrun at some stage in development. Out of 30 undertakings, 17 (56.67%) ventures had been introduced by using 1100 days’ time overrun, 5 (16.67%) extensions in the middle of a hundred and one to 200 days, 5 (16.67%) ventures?201 to 300 days while three (10%) ventures have been deferred for timeframe over 300 days.

临床科室运用成本因素分析法开展医用低值易耗品节流管理实践

目的探讨临床科室运用成本因素分析法开展医用低值易耗品节流管理的效果。方法2022年8月—12月,科室运用成本因素分析法开展低值易耗品节流管理,2023年1月—6月持续观察和评估应用效果。统计一次性注射器(2mL、5mL、20mL)、PVC手套、一次性静脉输液针、一次性止血带及输液胶贴等低值易耗品管理数据,计算人员成本分摊、成本消耗量,统计合理成本结余量。结果运用成本因素分析法实施低值易耗品管理后,价格相同医用低值易耗品合理结余成本共677.22元人民币,价格不同医用低值易耗品合理结余成本共2015元人民币。结论临床科室运用成本因素分析法开展医用低值易耗品节流管理,可减少消耗量,增加合理成本结余,减少科室成本消耗,合理节约医疗资源,强化医务人员节流管理意识,推动科室精细化管理。

广州市某医院脑梗死患者疾病经济负担研究

目的分析脑梗死患者次均住院费用,特别是次均住院自负费用的结构以及影响因素,为缓解患者疾病经济负担提供参考依据。方法运用描述性统计分析对广州市某三甲医院2015—2022年脑梗死出院患者的次均费用及费用结构进行比较分析,并采用多重线性分析法研究影响患者次均住院自负费用的因素。结果脑梗死患者次均住院费用增长放缓,年均增长率为2.86%;费用结构逐步优化,2022年次均技术劳务费占比47.41%;脑梗死患者次均住院自负费用呈增长趋势,年均增长率5.96%,且受住院时间、病例分型、付费方式以及患者来源等因素共同影响。结论脑梗死患者的疾病经济负担仍然较重,医疗机构应不断规范诊疗行为,加强临床路径管理,政府应该不断完善社会保障体系,降低患者的疾病经济负担。

基于AHP的装配式建筑工程造价影响因素研究

装配式建筑造价普遍高于传统现浇建筑,严重制约了装配式建筑的推广应用。以装配式建筑工程造价为研究对象,结合已有文献研究成果,进行装配式建筑工程造价影响因素分析与研究。通过层次分析法,对各影响因素的综合权重比进行计算,确定影响因素的重要性,据此提出装配式建筑工程造价改进措施,可为装配式建筑项目增值提供参考。

三种干预方法在急性淋巴细胞白血病大剂量甲氨蝶呤化疗性口腔黏膜炎中的应用及临床经济学评价

目的 探讨蜂蜜、低温氧气雾化及常规漱口水对急性淋巴细胞白血病(ALL)患者化疗性口腔黏膜炎(CIOM)的临床效果和成本效益。方法 选取2023年2—5月宁夏银川市某三甲医院血液内科住院治疗且符合纳入排除标准的129例ALL患者,随机分为蜂蜜组、低温氧气雾化组和常规漱口水组,每组43例。化学治疗期间,蜂蜜组用蜂蜜涂抹于口腔黏膜表面;低温氧气雾化组以粒细胞刺激因子为雾化液,经低温氧气雾化吸入;常规漱口水组用医嘱漱口水漱口。结果 蜂蜜组、低温氧气雾化组和常规漱口水组分别有7例(16.28%)、9例(20.93%)和20例(46.51%)患者发生CIOM,三组患者CIOM发生率及严重程度比较,差异具有统计学意义(H=11.598,P=0.003)。蜂蜜与低温氧气雾化对ALL患者CIOM的预防与治疗效果均优于常规漱口水(均P<0.05),但蜂蜜与低温氧气的预防与治疗效果比较,差异无统计学意义(P>0.05)。蜂蜜组的成本低于低温氧气雾化组及常规漱口水组(均P<0.05),低温氧气雾化组虽有一定治疗效果,但成本远高于蜂蜜组与常规漱口水组(均P<0.05)。结论 蜂蜜对ALL患者CIOM具有较好的防治效果,同时可以降低患者的医疗费用。

基于网络分析的水网可达性评估

【目的】为探究水资源可达性的空间格局,促进优化水资源配置,科学规划水系布局,【方法】提出一种基于网络特性和取水成本的水网可达性计算方法。运用网络分析工具sDNA计算网络可达性指标,以CRITIC法计算网络分析指标权重,加权求和得到水网网络可达性,然后通过核密度估计进行空间拓展;综合考虑地形、土地利用、道路因素,制作研究区的成本阻力栅格数据,水网网络可达性减去累计成本阻力,以此评估水网的可达性。【结果】研究区的平均可达性为0.31,标准差为0.04,变异系数为0.13。当河网是偏自然状态水系时,可达性呈现出树枝状分布,从主河道到支流逐渐减弱,且随着远离河道而减弱。在地形较为平坦、人类活动频繁、人工渠道发达的区域,一些江河交汇处将出现水网可达性较高的密集区域,例如汉江中游、长江中游、太湖流域、里下河流域、黄淮海平原、渭河平原。【结论】结果表明,从网络分析的角度出发,将水网视为一个拓扑网络来计算水网的可达性,实现了在大尺度区域的应用。同时考虑了取水成本和阻力对局部可达性的影响,从而增加了可达性结果的准确性,为实现精细化的水资源管理提供了重要的依据。

技术融合与企业出口产品质量--来自中国工业企业的经验证据

技术融合是提高科技成果转化和产业化水平、实现经济高质量发展取得新突破的关键。推动中国迈向贸易强国的背景下,研究技术融合究竟如何影响中国企业出口产品质量的问题尤为重要。使用2000—2013年中国工业企业数据作为研究样本,构建固定效应模型,系统考察技术融合对企业出口产品质量的影响及作用机制。研究发现,技术融合的深化显著提升了企业出口产品质量。异质性分析表明,技术融合对企业出口产品质量的提升作用在非国有企业、非外资企业以及沿海企业中表现更为突出。机制检验发现,技术融合深化能够提升企业全要素生产率以及固定成本投入效率,最终实现企业出口产品质量升级;市场化程度以及政府支持力度会在技术融合提升企业出口产品质量过程中发挥正向调节作用。因此,应进一步深化技术融合,搭建高效的交流合作平台,加速优质要素资源流动,重点培育本土企业自主创新能力,实现出口产品质量升级。

技术进步、反鲍莫尔成本病与制造业占比

根据鲍莫尔的非均衡增长理论,技术进步会导致服务业占比上升,制造业占比下降,这就使得我国既要坚持创新驱动,又要保持制造业占比基本稳定面临理论上的悖论。本文立足我国服务业全要素生产率增速已经高于制造业全要素生产率增速的新变化,指出我国存在着反鲍莫尔成本病现象,即制造业领域而不是服务业领域存在鲍莫尔成本病,这修正了鲍莫尔理论模型,从技术进步角度找到了我国制造业占比下降的根本原因,为创新驱动和保持制造业占比基本稳定同步实现提出了逻辑一致的理论解释。此外,论文借助WIOD数据库2000—2014年17个制造业细分行业数据进行实证研究,结果显示,2011年起制造业TFP增速每提高1%,制造业占比将提高2.3%,TFP水平提升会增强制造业国际竞争力。

山西省医院骨科手术患者药品费用的特征与影响因素研究

目的分析山西省骨科手术患者药品费用的特征和影响因素,为合理管控骨科手术患者的药品费用提供参考。方法回顾性收集山西省2016-2021年584204例骨科手术患者的病例信息。按照不同年份、地区、医院级别、手术类型和手术切口类型进行分类,对药品费用进行分析。采用单因素分析和广义线性回归模型对药品总费用的影响因素进行分析,并采用结构方程模型进行验证。结果关节置换术(占42.61%)和骨折后外固定术(占12.60%)是最常见的手术类型。不同手术类型药品总费用在不同地区和不同等级医疗机构之间的差异均有统计学意义(P<0.05),晋中地区的骨折后外固定术药品总费用最高[(11719.97±4374.73)元],三级甲等医院的骨折后外固定术药品总费用最高[(13584.71±4531.82)元]。Ⅰ类切口手术中骨折后外固定术的抗菌药物费用最高[(1176.25±341.42)元]。广义线性回归模型显示,医院所属地、医院级别、性别、付款方式、住院天数和手术类型是药品总费用的独立影响因素(P<0.05)。结构方程模型进一步揭示,医院级别、付款方式和手术类型对药品总费用有显著影响(P<0.05)。结论需关注Ⅰ类切口手术抗菌药物费用高的情况,进一步研究其合理使用方案。

康复患者次均住院费用影响因素的分析:基于分位数回归模型

目的分析甘肃省二级、三级医院康复住院患者次均住院费用的分布特点及其影响因素。方法分层抽取2017年1月1日至2023年6月30日甘肃省59家二级、三级医院康复住院患者病历6950份,收录电子病历管理系统住院病案首页信息数据。描述康复患者次均住院费用的分布及特点,并运用分位数回归模型分析次均住院费用的影响因素。结果纳入患者次均住院费用为6282.65(4095.39,11829.36)元。多因素分析结果显示,康复患者的年龄(β>21.509)、住院时间(β>166.320)、医院级别(β>1096.971)、医院类别(|β|>969.080)、入院途径(β>307.731)、是否转科(β>732.289)和是否用药(β>737.109)对次均住院费用3个分位数点(P10,P50,P90)均有影响(P<0.05),均呈现对高分位点影响最强。2017年至2019年入院的康复患者较2020年至2023年的康复患者在第10分位点次均住院费用较低(β=-732.341),在第90分位点费用较高(β=846.445)(P<0.05)。以自费为对照,医保支付的次均住院费用在第10分位点更高(β_(职工医保)=450.606,β_(居民医保)=478.421),在第90分位点上费用更低(β_(职工医保)=-2517.823,β_(居民医保)=-1283.355)(P<0.05),在第90分位点影响更大。以其他类型疾病为对照,精神与行为障碍、神经系统疾病费用更低(β<-569.500),循环系统疾病在第10分位点上费用更高(β=457.393),肌肉骨骼和结缔组织疾病在第50(β=-1106.791)、第90分位点上费用(β=-3072.947)更低(P<0.05)。结论康复患者次均住院费用差异大,影响因素复杂,医保相比自费在次均住院费用的高分位点有保护作用。

基于AdaCostBoost算法的网络钓鱼检测

针对日益严重的网络钓鱼攻击,提出机器学习的方法进行钓鱼网站的检测和判断.首先,根据URL提取敏感特征,然后,采用AdaBoost算法进行训练出分类器,再用训练好的分类器对未知URL检测识别.最后,针对非平衡代价问题,采用了改进后的AdaBoost算法--AdaCostBoost,加入代价因子的计算.实验结果表明,文中提出的网络钓鱼检测方法,具有较优的检测性能.

基于成本感知的边缘服务器部署方法

针对移动边缘计算(mobile edge computing,MEC)中边缘服务器(edge server,ES)供应商的成本预算问题,建立一种以最小化时延和部署成本为目标的数学模型。通过归一化方法将其转化为单目标优化问题,提出一种基于交叉算法的鲸鱼优化算法的边缘服务器部署方法;采用精英反向学习策略构造新种群,提高种群的多样性和全局收敛速度;采用改进的非线性收敛因子平衡算法的整体开发能力和局部探索能力;利用纵横交叉策略提高算法跳出局部最优的能力。使用上海电信基站的真实数据集进行仿真,其结果表明,与其它4种算法相比,该算法在时延和部署成本方面的表现均优于其它算法,系统成本下降了42.1%。

数字化与对外直接投资新优势——基于我国A股上市工业企业的分析

随着数字技术与实体经济深度融合,数字化已成为企业发展的新优势。本文基于2009—2021年我国A股上市工业企业样本,并匹配具有代表性的对外直接投资(OFDI)数据,研究数字化优势对我国企业OFDI的影响及其作用机制。研究发现,数字化能够显著且稳健地提高我国企业OFDI的可能性、投资广度和投资深度,进而提升我国OFDI的活力和韧性,并且解释力度高达企业OFDI传统优势研发密度的48.3%~53.8%。全要素生产率提升和海外经营成本降低是数字化优势促进企业OFDI的两条潜在机制。异质性分析表明,数字化优势的OFDI促进效应在绿地投资、传统行业和高竞争性行业中表现更加突出。此外,我国OFDI“走进东道国”过程中,跨国公司数字化优势与东道国数字化优势间的竞争效应大于互补效应,因而数字化优势对我国企业OFDI的正向作用在高数字化水平东道国的样本中受到抑制。本文研究结论对新形势下我国如何利用数字化优势推动高水平对外开放,构建以国内大循环为主体、国内国际双循环相互促进的新发展格局具有启示意义。

我国少子化现状及原因分析

近年来,我国人口少子化问题愈来愈严重,主要表现在2016年到2021年期间出生人口数量的快速下降,2021年达到1978年以来最低点(1062万人)。根据第七次人口普查数据,0—14岁人口占比达到了17.95%,达到了严重少子化的程度。造成人口少子化趋势的原因有四个方面:计划生育政策对少子化的影响,主要表现为政策的实施过于简单、僵硬,经济社会因素对少子化的影响,一是年轻人面临房子、子女教育、赡养老人等生活成本的压力;二是城市化的发展降低了生育率。文化观念因素表现在传统观念的淡泊、男女平等的深入,同居者、丁克家庭和同性恋群体规模的扩大;自身因素表现在避孕水平的提高和人工流产等方面。