Affiliated People Research Articles

Dual-modal radiomics for predicting cervical lymph node metastasis in papillary thyroid carcinoma.

Preoperative prediction of cervical lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC) is significant for surgical decision-making. This study aims to develop a dual-modal radiomics (DMR) model based on grayscale ultrasound (GSUS) and dual-energy computed tomography (DECT) for non-invasive CLNM in PTC. In this study, 348 patients with pathologically confirmed PTC at Jiangsu University Affiliated People's Hospital who completed preoperative ultrasound (US) and DECT examinations were enrolled and randomly assigned to training (n = 261) and test (n = 87) cohorts. The enrolled patients were divided into two groups based on pathology findings namely, CLNM (n = 179) and CLNM-Free (n = 169). Radiomics features were extracted from GSUS images (464 features) and DECT images (960 features), respectively. Pearson correlation coefficient (PCC) and the least absolute shrinkage and selection operator (LASSO) regression with 10-fold cross-validation were then used to select CLNM-related features. Based on the selected features, GSUS, DECT, and GSUS combined DECT radiomics models were constructed by using a Support Vector Machine (SVM) classifier. Three predictive models based on GSUS, DECT, and a combination of GSUS and DECT, yielded performance of areas under the curve (AUC) = 0.700 [95% confidence interval (CI), 0.662-0.706], 0.721 [95% CI, 0.683-0.727], and 0.760 [95% CI, 0.728-0.762] in the training dataset, and AUC = 0.643 [95% CI, 0.582-0.734], 0.680 [95% CI, 0.623-0.772], and 0.744 [95% CI, 0.686-0.784] in the test dataset, respectively. It shows that the predictive model combined GSUS and DECT outperforms both models using GSUS and DECT only. The newly developed combined radiomics model could more accurately predict CLNM in PTC patients and aid in better surgical planning.

A mucosal recovery software tool for endoscopic submucosal dissection in early gastric cancer.

Due to the limited diagnostic ability, the low detection rate of early gastric cancer (EGC) is a serious health threat. The establishment of the mapping between endoscopic images and pathological images can rapidly improve the diagnostic ability to detect EGC. To expedite the learning process of EGC diagnosis, a mucosal recovery map for the mapping between ESD mucosa specimen and pathological images should be performed in collaboration with endoscopists and pathologists, which is a time-consuming and laborious work. 20 patients at the Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College from March 2020 to July 2020 were enrolled in this study. We proposed the improved U-Net to obtain WSI-level segmentation results, and the WSI-level results can be mapped to the macroscopic image of the specimen. For the convenient use, a software pipeline named as "Pathology Helper" for integration the workflow of the construction of mucosal recovery maps was developed. The MIoU and Dice of our model can achieve 0.955 ± 0.0936 and 0.961 ± 0.0874 for WSI-level segmentation, respectively. With the help of "Pathology Helper", we can construct the high-quality mucosal recovery maps to reduce the workload of endoscopists and pathologists. "Pathology Helper" will accelerate the learning of endoscopists and pathologists, and rapidly improve their abilities to detect EGC. Our work can also improve the detection rate of early gastric cancer, so that more patients with gastric cancer will be treated in a timely manner.

SUICIDE CASES IN HIGHER EDUCATION INSTITUTIONS OF PAKISTAN; FACTORS AND SAFETY IMPLICATIONS

Pakistan is an Islamic Country. Suicide and attempt of suicide are against the Islamic teachings and laws of the country. The reported cases are rare, but the actual scenario of unreported incidents may be different. Reasons for suicide may be variable but lead towards exclusion from the educational stream, creating a threatening environment, thereby leaving its impact on fellow students and faculty. Suicides are not confined to only students but also have ingress in faculty. This paper is a cross-case analysis of three suicide cases with students and faculty related to higher education institutions. A qualitative research paradigm is used with a mix of secondary data available through print and electronic media and primary data of self-interaction of researcher with affiliated people of surroundings. Data were analyzed using three-stage thematic analysis, i.e. coding, clustering, pattern recognition and final write-up. The paper endeavours to understand the reasons, complex risk factors and their implications on the overall functioning of the educational process in higher educational institutions. Significant findings included but were not restricted to the relation of suicides with ethnicity, societal acceptability, harassment, and gender discrimination. Factors in these findings may contribute to students' overall safety and security in attaining educational objectives

Histiocyte-rich rhabdomyoblastic tumor: a clinicopathological and molecular genetic analysis

Objective: To investigate the clinicopathologic and molecular genetic characteristics, diagnosis, differential diagnosis, treatment and prognosis of histiocyte-rich rhabdomyoblastic tumor (HRRMT). Methods: The clinical data of two cases of HRRMT diagnosed in Fujian Provincial Hospital and Fujian University of Traditional Chinese Medicine Affiliated People's Hospital from 2020 to 2021 were collected. Histopathology and immunohistochemical (IHC) staining were used to assess morphological changes; the genetic changes were analyzed with next-generation sequencing. The relevant literature was reviewed. Results: Both cases showed well-defined solid nodules and soft masses. Microscopically, the tumors had a fibrous pseudocapsule with lymphocytic aggregation, and locally invaded the surrounding skeletal muscle tissue, and the tumor cells were fusiform to epithelioid with an intensive foamy histiocytic infiltrate. No necrosis or mitosis was observed. Immunophenotyping showed the tumor cells were positive for desmin, either one or both skeletal muscle markers (myogenin or MyoD1), and negative for h-caldesmon, ALK and SMA. The Ki-67 index was<5%. Using next-generation sequencing, one case was found to harbour KRAS (G12D) and MSH3 (Q470*) mutations. Conclusions: HRRMT is a newly described skeletal muscle tumor with uncertain malignant potential. Its diagnosis and differential diagnosis depend on morphologic and IHC staining. No specific molecular genetics changes have been identified so far.

Phosphoinositide-3-kinase regulatory subunit 4 participates in the occurrence and development of amyotrophic lateral sclerosis by regulating autophagy.

The development of amyotrophic lateral sclerosis (ALS) may be related to the abnormal alterations of multiple proteins. Our previous study revealed that the expression of phosphoinositide-3-kinase regulatory subunit 4 (PIK3R4) was decreased in ALS. However, the role of PIK3R4 in ALS pathogenesis remains unknown. This study was the first to find that transfection of PC12 cells with small interfering RNA against the PIK3R4 gene significantly decreased the expression levels of PIK3R4 and the autophagy-related proteins p62 and LC3. Additionally, in vivo experiments revealed that the PIK3R4 protein was extensively expressed in the anterior horn, posterior horn, central canal, and areas surrounding the central canal in cervical, thoracic, and lumbar segments of the spinal cord in adult mice. PIK3R4 protein was mainly expressed in the neurons within the spinal lumbar segments. PIK3R4 and p62 expression levels were significantly decreased at both the pre-onset and onset stages of ALS disease in Tg(SOD1*G93A)1Gur mice compared with control mice, but these proteins were markedly increased at the progression stage. LC3 protein expression did not change during progression of ALS. These findings suggest that PIK3R4 likely participates in the prevention of ALS progression. This study was approved by the Ethics Committee for Animal Care and Use of Jiangxi Provincial People's Hospital, Affiliated People's Hospital of Nanchang University (approval No. 2020025) on March 26, 2020.

Vitamin D status and vitamin D deficiency risk factors among pregnancy of Shanghai in China

BackgroundThere is increasing awareness that vitamin D deficiency in pregnant women may be associated with several adverse effects for the mother and newborn. The risks for vitamin D deficiency are unclear. This study was to assess vitamin D nutritional status and vitamin D deficiency risk factors among pregnant women in Shanghai in China.MethodsThis study is a cross-sectional study conducted in the Sixth Affiliated People’s Hospital of Shanghai Jiao Tong University. A total of 953 healthy pregnant women participated, serological examinations and other variables included serum 25-hydroxyvitamin D [25(OH)D], total blood cholesterol (TCh), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very-low-density lipoprotein (VLDL) cholesterol, triglycerides at the first antenatal visit (12–14 weeks) pregnancy parity and age, body mass index (BMI) before pregnancy, and completed OGTTs test. Associations between vitamin D deficiency and possible predictors (age group, pre-pregnancy BMI, parity, and gestational hyperlipemia) were assessed with a multinomial logistic regression analysis. And also used to investigate the effects of 25(OH)D and the other variables on the occurrence of gestational diabetes mellitus.ResultsThe mean vitamin D level of pregnancy was 16 (a range from 11 to 21) ng/ml, and severe vitamin D deficiency was 31.8% (303); vitamin D deficiency was 40.7% (388); vitamin D insufficiency was 25.1% (239); normal vitamin D was 2.4%(23). Vitamin D deficiency risk factors were age over 30, parity over 2, overweight, obese, and hyperlipemia. The increasing level of vitamin D nutritional status in pregnancy is significantly related to reducing gestational diabetes mellitus. Vitamin D deficiency is a risk factor for gestational diabetes mellitus.ConclusionsIt is a high prevalence of vitamin D deficiency in Chinese pregnancy in Shanghai. Aging more than 30 years, the parity of more than 2, overweight and obesity, and hyperlipemia are risk factors for vitamin D deficiency. Vitamin D deficiency is a risk factor for gestational diabetes mellitus. Public health strategies to prevent vitamin D deficiency should focus on those risks to promote health pregnancy of Shanghai in China.

Clinical Efficacy of Different Bone Cement Distribution Patterns in Percutaneous Kyphoplasty: A Retrospective Study

Bone cement distribution patterns in percutaneous kyphoplasty (PKP) is the key factor in keeping the vertebral stabilization and curative effect. However, the same cement volume can result in different bone cement distribution patterns and can thereby lead to different clinical outcomes. Therefore we investigated associations between cement distribution patterns and the occurrence rates of recompression in cemented vertebrae after PKP for patients with osteoporotic vertebral compression fractures (OVCFs). The study focuses attention on the influence of compact and dispersive cement distribution patterns in PKP for patients with OVCFs. A retrospective cohort study. An affiliated people's hospital of a university. According to different cement distribution patterns, patients were assigned to 4 groups. The demographic data, radiographic data, and clinical outcomes were compared between the 4 groups. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were evaluated before and 2 days after PKP. Moreover, the relationships between bone cement and clinical outcomes were analyzed. The epidemiologic data, clinical outcomes, and complications of the 4 groups were assessed. Comparisons of the radiologic and clinical results of the 4 groups were made pre- and postoperatively. Anterior height of fractured vertebrae (AH), the kyphotic Cobb angle, and the volumetric cubage index of the fractured vertebrae were measured. A total of 104 subjects were retrospectively analyzed and followed up (median age, 75.01 ± 8.42 years; age range, 56-94 years). The mean procedure duration was 61.26 ± 23.05 minutes (range, 30-140 minutes). The mean follow-up was 12.1 ± 2.2 months (range, 2-15 months). Statistically, there was no significant difference in terms of gender, age, body mass index, and bone mineral density (P > 0.05). The incidence of cement leakage was significantly lower in group A than those in the other groups. The total amount of bone cement injected into 104 cases (104 vertebral bodies in total) was 848.5 mL, and the amount of bone cement injected into a single vertebral body was 7.94 ± 1.38 mL. The amount of bone cement injection in each group was the lowest (6.80 ± 1.66 mL) in group D, followed by (7.94 ± 1.38 mL) group B, and the highest (8.96 ± 1.68 mL) in group A, with a statistically significant difference between the 4 groups (P < 0.05). No serious complications were observed during the follow-up periods. The AH and Cobb angle improved significantly for the 4 groups (P < 0.05). The VAS score decreased from 3.55 ± 0.54, 3.53 ± 0.65, 3.40 ± 0.58, and 3.40 ± 0.66 preoperatively to 0.18 ± 0.39, 0.23 ± 0.41, 0.20 ± 0.40, and 0.15 ± 0.36 at 48 hours postoperatively. The ODI score dropped from 35.65 ± 4.54, 36.45 ± 4.72, 34.12 ± 4.86, and 35.65 ± 4.34 preoperatively to 15.47 ± 1.32, 15.32 ± 1.34, 15.23 ± 1.26, and 15.73 ± 1.17 at 48 hours postoperatively. Our estimation of the vertebral body volume is imprecise. In addition, the number of subjects with OVCFs was small in this retrospective study. The volume of the fractured vertebra was not calculated accurately. Significant associations between cement distribution patterns and bone cement leakage affected the clinical outcome in patients after PKP. A higher incidence of bone cement leakage was observed in patients with treated vertebrae exhibiting a single-dispersive or single-compact pattern. Percutaneous kyphoplasty, osteoporotic vertebral compression fracture, bone cement distribution patterns.

Attitudes of the Nonreligious toward Abortion, Contraceptives, and Homosexuality: Comparing the Far East and Western Europe

Abstract Numerous studies have shown that the number of nonreligious people in the World is increasing and that people without religious affiliation demonstrate more liberal attitudes on controversial issues than affiliated people. Research suggests these differences may arise from the higher education level of the nonreligious and/or cultural context. To further explore the effects of culture on the attitudes of nonreligious, I analyze data from The Global Attitudes Project-Spring (2013). The data were downloaded from the Association of Religion Data Archives, www.TheARDA.com and were collected by Pew Research Center. When the data were analyzed, 6746 of the participants (18.2%) were found to be nonreligious. Three of the countries with the highest rate of nonreligious are from Western Europe (Czechia=69.5%, Britain=44.4%, Germany=35.3%) and three of them are from Far East (China=83.4%, Japan=45.4%, South Korea=42.6%). I compared attitudes of nonreligious from these countries (N=4581) towards abortion, contraception use, and homosexuality. The results indicate that nonreligious people living in the Far East find abortion, contraceptive use, and homosexuality more “morally unacceptable” than Western Europeans. This suggests that attitudes among the nonreligious are not homogenous, and that cultural factors are important variables to consider in future research.

Clinical analysis of laparoscopic cholecystectomy in 216 elderly patients with gallbladder stones

Objective To investigate the clinical characteristics and perioperative management of 1aparoscopic cholecystectomy(LC) in the elderly with gallbladder diseases. Methods From January 2006 to December 2016, the clinical data of two hundred and sixteen elderly patients with LC in the Sixth Affiliated People's Hospital of Jinshan Branch were analysed retrospectively. Results The operations of LC were successfully done in 206 patients(95.8%) and 9 cases (4.2%, 9/216) underwent conversion to open cholecystectomy for various reasons.Postoperative complications occurred in 22 cases (10.2%, 22/216).2 cases died within 1 weeks after the operation, and the remaining patients recovered from the hospital. Conclusion Adequate perioperative management, strict surgical indications and operative skills are the necessary conditions for the successful implementation of LC in the elderly. Key words: Cholecystectomy; laparoscopic; elderly

Instructions to mimic improve facial emotion recognition in people with sub-clinical autism traits.

People tend to mimic the facial expression of others. It has been suggested that this helps provide social glue between affiliated people but it could also aid recognition of emotions through embodied cognition. The degree of facial mimicry, however, varies between individuals and is limited in people with autism spectrum conditions (ASC). The present study sought to investigate the effect of promoting facial mimicry during a facial-emotion-recognition test. In two experiments, participants without an ASC diagnosis had their autism quotient (AQ) measured. Following a baseline test, they did an emotion-recognition test again but half of the participants were asked to mimic the target face they saw prior to making their responses. Mimicry improved emotion recognition, and further analysis revealed that the largest improvement was for participants who had higher scores on the autism traits. In fact, recognition performance was best overall for people who had high AQ scores but also received the instruction to mimic. Implications for people with ASC are explored.

肢端肥大症患者生长激素水平及其与临床资料、生化指标及甲状腺激素水平的关系分析

目的：探讨肢端肥大症患者生长激素水平及其与临床资料、生化指标及甲状腺激素水平之间的关系。方法：回顾性分析2012年1月~2016年12月在山西医科大学附属人民医院神经外科就诊65例肢端肥大症患者的一般临床资料、肝肾功能等生化指标及甲状腺功能。结果：肢端肥大症患者生长激素水平与临床资料、肝肾功能无相关性(r = −0.057~−0.104，P均 > 0.05)；与总胆固醇(TC)呈正相关(r = 0.279, P 0.05)；与TSH呈负相关(r = −0.402, P 0.05)。结论：肢端肥大症型垂体腺瘤的血清生长激素水平与肿瘤体积、肝功、肾功无相关性。血脂方面，其与TC水平正相关，与LDL、HDL、TG无相关性。甲状腺激素方面，其与TSH水平呈负相关，与TT4水平呈正相关，与FT3、TT3、FT4之间无相关性。 Objective: To explore the growth hormone (GH) level in the patients with acromegaly and its re-lationship with clinical data, biochemical indexes and thyroid hormone levels. Methods: The clinical data, biochemical indicators such as liver and kidney function and thyroid function of 65 acromegaly patients with pituitary adenomas, who visited Shanxi Medical University Affiliated People’s Hospital from January 2012 to December 2016, were analyzed retrospectively. Results: There was no significant correlation among serum GH, clinical data, liver and kidney function in the patients with acromegaly (r = −0.057 - −0.104, P > 0.05). Serum GH has positive correlation with TC (r = 0.279, P 0.05). Serum GH has negative correlation with TSH (r = −0.402, P 0.05). Conclusions: The serum GH level in the patients with acromegaly is insignificantly related to the adenomas volume, liver function and renal function. In the aspect of blood lipid, , the serum GH level was positively correlated with TC level, and had no correlation with LDL, HDL, TG. In the aspect of thyroid function, the serum GH level was negatively correlated with TSH level and positively correlated with TT4 level, and no correlation with FT3, TT3, FT4.

The analysis of death risk factors for peritoneal dialysis patients and nursing countermeasures

Objective To induce and analysis the death relative factors of peritoneal dialysis patients over the past five years in fourth ward of qiandongnan from guizhou province guiyang medical college affiliated people's hospital in endocrinology and to improve the effect of nursing intervention. Methods 492 peritoneal dialysis patients were retrospective analyzed from Mar 2009 to Mar 2014, in order to conclude the causes of the patients that ending with death (n =89) and to formulate targeted nursing measures. Results The primary disease for death of maintained peritoneal patients was cardiovascular events [41.6%(37/89)], and the second factor was infection [32.6%(29/89)]. The risk factors for mortality were age (≥70 years old), diabetes, endogenous creinine clearance rate declined [<50 L·week-1·m-2 ],change of hemodialysis to peritoneal dialysis and higher peritoneal transport status. Conclusions It's important to strengthen the nursing intervention for the peritoneal dialysis patients with coronary heart disease, and to formulate targeted nursing measures for risk factors, so as to avoid the death. Key words: Peritoneal dialysis; Risk factors; Nursing; Disease outcome

Automatic Segmentation and Quantitative Analysis of White Matter Hyperintensities on FLAIR Images Using Trimmed-Likelihood Estimator

Quantitative analysis of white matter hyperintensities (WMHs) on fluid-attenuated inversion recovery (FLAIR) images provides information for disease tracking, therapeutic efficacy assessment, and cognitive science research. This study developed an automatic segmentation method to detect and quantify WMHs on FLAIR images. This study aims to assess the accuracy and reproducibility of the proposed method. The FLAIR images of 82 patients (58-84years) with different WMH burdens were acquired with the same 3T scanner (Intera-achieva SMI-2.1; Philip Medical System, Sixth Affiliated People's Hospital, Shanghai, China). The FLAIR images were preprocessed through brain extraction and intensity inhomogeneity correction. An anatomy atlas built from a set of 20 patients with different WMH burdens (mild, 11 patients; moderate, 6 patients; and severe, 3 patients) was used to estimate a control parameter in the framework of segmentation. The general flow for WMH segmentation included classification of foreground and background regions, detection of abnormally high signals, and WMH refinement. The performance of automatic segmentation was evaluated by a volumetric comparison with manual segmentation on patients with different WMH burdens. Similarity index values for the accuracy of automatic segmentation compared to manual segmentation were consistently high for patients with different WMH burdens (mild, 0.78±0.08; moderate, 0.83±0.06; severe, 0.84±0.08; and total, 0.80±0.08). Linear regression demonstrated a strong correlation between the WMH volumes measured by the two methods in all patients (r=0.98, P=.006). Small average differences were detected between the WMH volumes obtained through manual and automatic segmentations (mild, 4.76%; moderate, 6.84%; and severe, 7.59%). The results of Bland-Altman analysis show a system bias of 0.68cm(3) and a standard deviation of 2.10cm(3) over the range of 2.58-53.9cm(3). The developed method is accurate and efficient in detecting and quantifying differently sized WMHs on FLAIR images. Automatic segmentation is a promising computer-aided diagnostic tool to study WMHs in aging and dementia in basic research and even in clinical trials.

CT and enhanced CT in diagnosis of gastrointestinal neuroendocrine carcinomas

To enhance diagnosis of gastrointestinal neuroendocrine carcinomas using CT and contrast-enhanced CT images. A total of 44 patients with gastrointestinal neuroendocrine carcinomas, as confirmed by clinical pathology and immunohistochemistry in the Sixth Affiliated People's Hospital of Shanghai Jiao Tong University Shanghai China, were included in the study. CT and enhanced CT scanning were performed, and the resulting images were reviewed and analyzed. Twenty-seven males and 17 females were enrolled. Gastrointestinal involvement included the following: 5 cases located in the middle or inferior segment of the esophagus; 5 in the gastric cardia, 15 in the body of stomach, 6 located in the gastric antrum; 5 located in the Vater papilla of the duodenum; and 8 located in the colon. Among the 44 cases 80%-90% of the lesions had homogeneous density. Totally 81.8% (36/44) cases demonstrated homogeneous enhancement in arterial phases, most of the cases (n = 33) moderately or obviously enhanced. Only 17.2% (8/44) cases appeared as heterogeneous enhancement. And 86.4% cases (n = 38) were further enhanced in the venous phase. The CT images also revealed some of the metastases. Some liver metastasis cases have obvious homogeneous enhancement. CT and enhanced CT provide useful information regarding gastrointestinal neuroendocrine carcinomas' location, density, enhancement pattern, and some metastasis. These features are helpful to increase the diagnostic accuracy.

Enhanced CT and CT virtual endoscopy in diagnosis of heterotopic pancreas

To improve the diagnosis of heterotopic pancreas by the use of contrast-enhanced computed tomography (CT) imaging and CT virtual endoscopy (CTVE). A total of six patients with heterotopic pancreas, as confirmed by clinical pathology and immunohistochemistry in the Sixth Affiliated People's Hospital of Shanghai Jiao Tong University, Shanghai, China, were included. Non-enhanced CT and enhanced CT scanning were performed, and the resulting images were reviewed and analyzed using three-dimensional post-processing software, including CTVE. Four males and two females were enrolled. Several heterotopic pancreas sites were involved; three occurred in the stomach, including the gastric antrum (n = 2) and lesser curvature (n = 1), and two were in the duodenal bulb. Only one case of heterotopic pancreas lesion occurred in the mesentery. Four cases had a solid yet soft tissue density that had a homogeneous pattern when viewed by enhanced CT. Additionally, their CT values were similar to that of the pancreas. The ducts of the heterotopic pancreas tissue, one of the characteristic CT features of heterotopic pancreas tissue, were detected in the CT images of two patients. CTVE images showed normal mucosa around the tissue, which is also an important indicator of a heterotopic pancreas. However, none of the CTVE images showed the typical signs of central dimpling or umbilication. CT, enhanced CT and CTVE techniques provide useful information about the location, growth pattern, vascularity, and condition of the gastrointestinal wall around heterotopic pancreatic tissue.

Subjective and objective fit in religious congregations: Implications for well-being

For most religiously affiliated people, the context of the religious group is a central element of the religious experience, but it is also one that has been relatively neglected in the study of the impact of religion on well-being. This study used social attraction as a framework to examine the role of individual—group fit in three congregations, with respect to four outcomes with implications for overall well-being. Structural equation modeling of survey data indicated that subjective fit with the congregation’s prototype was associated with greater life satisfaction and better self-reported health. Objective fit with observed congregational norms was associated only with greater life satisfaction. These effects were not mediated by existential certainty or by social support.

Evaluación Inicial del Seguro Popular sobre el Gasto Catastrófico en Salud en México

Estimating Seguro Popular de Salud's (SPS) initial outcome regarding households' catastrophic health spending (CHS). The relationship of other important factors to the CE was also estimated. A cross-sectional study, based on evaluating Seguro Popular's survey, was carried out in the Mexican states of Colima and Campeche during 2002; it was carried out during the first semester of 2005. SPS and other co-variables' relationship with CHS was estimated by using the probit model. Such relationship was then estimated again using the bi-probit model, but taking endogeneity between CHS and SPS affiliation into consideration. Some simulations led to a detailed analysis of the influence of the use by type of service on the CHS. The probability of SPS-affiliated households incurring CHS was about 8% less than un-affiliated households (controlled for other co-variables and corrected for endogeneity). The probability of incurring CHS was always less for affiliated people, independently of the income bracket which they belonged to and the kind of services used. The results suggested that SPS is financially protecting households; nevertheless, the goal of a 75 % reduction in CHS has still to be achieved.

Health insurance in the contributive and subsidized regimes and its impact on the service providers

The performance of 18 private Health-promoting (EPS) and Family Compensation (CCF) entities, as well as their general balances for 1997, 1998 and 1999, were studied to determine the profit margins achieved by EPS's in their work of administering health insurance. The average behavior of each EPS balance sheet was analyzed to reduce the effect produced by extreme cases; each EPS's value was thus weighted by the number of its affiliated people. The expected behavior of the costs and expenses of companies whose main business is providing health insurance could thus become determined. The main source of operational income for a private EPS is the contributive regime's per capita unit of payment (UPC). Subsidized regime participation and that of other sources of income has decreased year by year. By contrast, public EPS's have shown decreasing participation in income obtained from UPC (contributive and subsidized) and growing dependence on other sources of income; this can be interpreted as being a symptom of weak commercial management. According to the balance sheets provided by the SNS, the EPS (public, private and Family Compensation entities), including the Social Security Institute (ISS), together obtained a total of 4.18 billion pesos operational income in 1999, an increase of 21.7% as compared to 1998. Income received from the ISS amounted to 1.93 billion dollars in 1999 (46% of the total). At 2000 prices, the total amount of operational income was 4.54 billion pesos in 1999 (15.6% real increase). Taking the behavior of 4 EPS's as our reference point (Sanitas, Humana Vivir, Coomeva and Famisanar), it can be concluded that an EPS whose main business is health insurance needs a 17.2% gross margin to cover its operational and non-operational costs and a 1.1% margin before tax.