The increasing cost of infrastructure development risks stifling national investment plans.Many projects in Uganda have suffered because of the frequency and magnitude of claims made by parties involved especially the...The increasing cost of infrastructure development risks stifling national investment plans.Many projects in Uganda have suffered because of the frequency and magnitude of claims made by parties involved especially the contractors.As a result,the construction industry is plagued with claims which quite often lead to adversarial relationships.The major grounds for claims were identified through studying the contract documents where claims had been made.Increase in scope;change orders;errors in contract documents;inclement weather;inflation;delay in possessing the site;and change in the tax policy were the most prevalent grounds for making claims.Problems identified in claiming process include delays in getting approval;information on claims not reliable;hostility from the parties involved;pricing of claims;delays in effecting payment when approved;and overzealous contract interpretation leading to misunderstanding and delays Using a survey on project managers for 64 contractors and their corresponding clients or their representatives,the major ways in which it can be reduced were identified as being thoroughness during the design phase;providing for inflation;proper planning of works;using prequalified contractors;and proper documentation of records.Clients have a big role to play in reducing claims.展开更多
Objective:With the continuous changes in social production,the consumption th inking of the masses obviously cannot keep up with the speed of social developmen t,and insurance disputes are increasingly emerging.Among ...Objective:With the continuous changes in social production,the consumption th inking of the masses obviously cannot keep up with the speed of social developmen t,and insurance disputes are increasingly emerging.Among them,the shortcomings of personal injury claims are not prominent,and the theoretical knowledge is not co mplete.In order to improve the quality of professional talents and reduce claims dis putes,the feasibility of integrating forensic medicine into personal injury claims is ex plored.Methods:The professional attributes,subject attributes,knowledge system an d employment data of forensic medicine are analyzed and compared with the actual work of personal injury claims.Main results:Forensic medicine has its uniqueness i n on-site investigation,injury-disease relationship analysis,and resolution of doubts.I t is irreplaceable by other subjects.The subject attributes are consistent with the pe rsonal injury claims major,and personal injury claims itself has basic medical courses,so it is easier to accept forensic medicine.Conclusion:Under the current social bac kground,through the study of the forensic medicine system in the personal injury cl aims major,it has positive practical significance for its professional construction and talent training.展开更多
In this paper, a compound binomial model with a constant dividend barrier and random income is considered. Two types of individual claims, main claims and by-claims, are defined, where every by-claim is induced by the...In this paper, a compound binomial model with a constant dividend barrier and random income is considered. Two types of individual claims, main claims and by-claims, are defined, where every by-claim is induced by the main claim and may be delayed for one time period with a certain probability. The premium income is assumed to another binomial process to capture the uncertainty of the customer＇s arrivals and payments. A system of difference equations with certain boundary conditions for the expected present value of total dividend payments prior to ruin is derived and solved. Explicit results are obtained when the claim sizes are Kn distributed or the claim size distributions have finite support. Numerical results are also provided to illustrate the impact of the delay of by-claims on the expected present value of dividends.展开更多
Claim是英语中常见的言语行为动词,但其用法特征颇为复杂。即使是英语为本族语言者,其使用得体与否也常受质疑。Brysoon(2002)把Claim一词列入Dictionary of Troublesome Words也是事出有因。本文拟从语言学的角度对该词及相关词项作用...Claim是英语中常见的言语行为动词,但其用法特征颇为复杂。即使是英语为本族语言者,其使用得体与否也常受质疑。Brysoon(2002)把Claim一词列入Dictionary of Troublesome Words也是事出有因。本文拟从语言学的角度对该词及相关词项作用法译评。展开更多
Based on the context theory within the framework of the metafunction,the paper analyses the English claim letters in terms of field,tenor and mode.The result of the paper shows the features of the claim letters which ...Based on the context theory within the framework of the metafunction,the paper analyses the English claim letters in terms of field,tenor and mode.The result of the paper shows the features of the claim letters which will help the English claim letter writing.展开更多
In this paper we examine the large deviations principle (LDP) for sequences of classic Cramér-Lundberg risk processes under suitable time and scale modifications, and also for a wide class of claim distributions ...In this paper we examine the large deviations principle (LDP) for sequences of classic Cramér-Lundberg risk processes under suitable time and scale modifications, and also for a wide class of claim distributions including (the non-super- exponential) exponential claims. We prove two large deviations principles: first, we obtain the LDP for risk processes on D∈[0,1] with the Skorohod topology. In this case, we provide an explicit form for the rate function, in which the safety loading condition appears naturally. The second theorem allows us to obtain the LDP for Aggregate Claims processes on D∈[0,∞) with a different time-scale modification. As an application of the first result we estimate the ruin probability, and for the second result we work explicit calculations for the case of exponential claims.展开更多
Modem enterprise theory defines onterprise＇s ownership through the concepts of residual rights of control and claim to residue. It also believes that when they are in homologous, the ownership of enterprise can be ar...Modem enterprise theory defines onterprise＇s ownership through the concepts of residual rights of control and claim to residue. It also believes that when they are in homologous, the ownership of enterprise can be arranged in the best place. When the enterprise is under normal run, shareholders are its owner, but when it goes into bankruptcy, claimers should take place of shareholders becoming the owner of the enterprise. But in China, the ownership of state-owned enterprise （SEE） goes into double misplaces. Management controls the enterprise under the normal run, which leads salaries to seize the earnings and share equities. The state who acts as the shareholder not only lessens investments but also fixes its earnings as much as possible. It gives up the claim to residue, which leads claimers to bear the enterprise＇s residual risks （when the residual income is negative）. When the enterprise goes into bankruptcy, as the shareholder, the state determines whether it can exist or not in order to maximize its own utility. Rights of claimer are being seriously damaged as they can be manipulated freely in the enterprise. Banks＇ bad debts are also in an extremely high level. In this article, the author will establish a model and use the relative data to do technical analysis.展开更多
Claims in international civil engineering projects sometimes will have impact on implementing the contract successfully. in order to observe and evaluate the contract claim situation and give guideline to all the cont...Claims in international civil engineering projects sometimes will have impact on implementing the contract successfully. in order to observe and evaluate the contract claim situation and give guideline to all the contractual roles to settle the claims comfortably, this paper devote the research and literate review to find the key problems in contract claim management and give recommendation accordingly. With this focused objective, this paper presents a research analysis based on randomly selected data from international construction organization. The contract claim case studies analyzed by sampling survey scientific research method that follows a research strategy of specific to general. In the beginning, the paper analyzes the elements of contract claim administration,and then provides the general overview of the contract claim. Finally, it numerates the claim causes usage through cases studies under different contract condition of FIDIC. In addition to these discussions, analysis of other secondary data and recommendations forwarded to explain how claims should handle properly. During the thesis research period,there were 14 simple random selected projects have been studied as a case studies. From studied projects,the time extension in average, exceed 117.7% of its original contract completion time and the cost compensation increase 34.8% comparing to its initial contract value. Thus, the main causes of the majority contract claim problem lies on the failure in contract claim management and on unforeseen circumstance like variation, adverse climate, right of way problems, etc. Finally this thesis contributes to the improvement of contract claim management construction industry and open ways for further researches related to claim management.展开更多
This article considers a risk model as in Yuen et al. （2002）. Under this model the two claim number processes are correlated. Claim occurrence of both classes relate to Poisson and Erlang processes. The formulae is ...This article considers a risk model as in Yuen et al. （2002）. Under this model the two claim number processes are correlated. Claim occurrence of both classes relate to Poisson and Erlang processes. The formulae is derived for the distribution of the surplus immediately before ruin, for the distribution of the surplus immediately after ruin and the joint distribution of the surplus immediately before and after ruin. The asymptotic property of these ruin functions is also investigated.展开更多
Objective: To evaluate the accuracy of identifying cancer patients by use of medical claims data in a health insurance system in China, and provide the basis for establishing the claims-based cancer surveillance syste...Objective: To evaluate the accuracy of identifying cancer patients by use of medical claims data in a health insurance system in China, and provide the basis for establishing the claims-based cancer surveillance system in China.Methods: We chose Hua County, Henan Province as the study site, and randomly selected 300 and 1,200 qualified inpatient electronic medical records(EMRs) as well as the New Rural Cooperative Medical Scheme(NCMS) claims records for cancer patients in Hua County People’s Hospital(HCPH) and Anyang Cancer Hospital(ACH) in 2017. Diagnostic information for NCMS claims was evaluated on an individual level, and sensitivity and positive predictive value(PPV) were calculated taking the EMRs as the gold standard.Results: The sensitivity of NCMS was 95.2%(93.8%-96.3%) and 92.0%(88.3%-94.8%) in ACH and HCPH,respectively. The PPV of the NCMS was 97.8%(96.7%-98.5%) in ACH and 89.0%(84.9%-92.3%) in HCPH.Overall, the weighted and combined sensitivity and PPV of NCMS in Hua County was 93.1% and 92.1%,respectively. Significantly higher sensitivity and PPV in identifying patients with common cancers than noncommon cancers were detected in HCPH and ACH separately(P<0.01).Conclusions: Identification of cancer patients by use of the NCMS is accurate on individual level, and it is therefore feasible to conduct claims-based cancer surveillance in areas not covered by cancer registries in China.展开更多
The objective of this paper was to project possible impacts of climate change on heavy rainfall-related water damage insurance claims and incurred losses for four selected cites (Kitchener-Waterloo, London, Ottawa, an...The objective of this paper was to project possible impacts of climate change on heavy rainfall-related water damage insurance claims and incurred losses for four selected cites (Kitchener-Waterloo, London, Ottawa, and Toronto) located at Ontario, Canada. To achieve this goal, the future climate change scenarios and rainfall simulations, at local scale, were needed. A statistical downscaling method was used to downscale five global climate model (GCM) scenarios to selected weather stations. The downscaled meteorological variables included surface and upper-air hourly temperature, dew point, west-east and south-north winds, air pressure, and total cloud cover. These variables are necessary to project future daily rainfall quantities using within-weather-type rainfall simulation models. A model result verification process has been built into the whole exercise, including rainfall simulation modeling and the development of downscaling transfer functions. The results of the verification, based on historical observations of the outcome variables simulated by the models, showed a very good agreement. To effectively evaluate heavy rainfall-related water damage insurance claims and incurred losses, a rainfall index was developed considering rainfall intensity and duration. The index was evaluated to link with insurance data as to determination of a critical threshold of the rainfall index for triggering high numbers of rainfall-related water damage insurance claims and incurred losses. The relationship between rainfall index and insurance data was used with future rainfall simulations to project changes in future heavy rainfall-related sewer flood risks in terms of water damage insurance claims and incurred losses. The modeled results showed that, averaged over the five GCM scenarios and across the study area, both the monthly total number of rainfall-related water damage claims and incurred losses could increase by about 13%, 20% and 30% for the periods 2016-2035, 2046-2065, and 2081-2100, respectively (from the four-city seasonal average of 12 ± 1.7 thousand claims and $88 ± $21 million during April-September 1992-2002). Within the context of this study, increases in the future number of insurance claims and incurred losses in the study area are driven by only increases in future heavy rainfall events.展开更多
BACKGROUND Helicobacter pylori(H.pylori)infection is a risk factor for many diseases,including peptic ulcer disease and gastric cancer.While H.pylori eradication therapy can prevent these diseases,potentially unfavora...BACKGROUND Helicobacter pylori(H.pylori)infection is a risk factor for many diseases,including peptic ulcer disease and gastric cancer.While H.pylori eradication therapy can prevent these diseases,potentially unfavorable effects of eradication therapy have also been reported in some diseases,such as gastroesophageal reflux disease(GERD),Barrett’s esophagus(BE),inflammatory bowel disease(IBD),allergic diseases,and metabolic diseases.Consequently,both positive and negative impacts should be considered when assessing the effects of H.pylori eradication therapy.AIM To compare the incidence of these diseases before and after H.pylori eradication and to comprehensively assess its effects.METHODS This retrospective cohort study used a Japanese nationwide health claims database(April 2009-March 2020),developed by the Japanese Ministry of Health,Labour and Welfare.The database contained almost all health insurance claims data issued in Japan,and specific health check-up data for individuals who took the check-ups.Descriptive statistics were used for the analyses.Patients who received primary eradication therapy were defined as those prescribed medication for H.pylori eradication.New diagnoses,defined as incidence of upper gastrointestinal diseases and IBD,and prevalence of allergic diseases were compared before and after eradication.The incidence and prevalence of each disease were also compared between the 3-year period before eradication(from the 4th to the 2nd year prior to the year of eradication)and the 3-year period after eradication(from the 1st to the 3rd year after the year of eradication)based on the age category and calendar year and month.Changes in body mass index and proportion of patients with metabolic syndrome(MS)were examined before and after eradication.RESULTS We identified 5219731 patients who received primary eradication therapy.The 65-69 years age group had the greatest number of patients in both sexes.There was no significant increase in the incidence of GERD after eradication when considering the effects of aging and reporting period.However,the incidence of BE was higher in the 3-year period after eradication than in the 3-year period before eradication for all age categories(0.02%-0.10%vs<0.01%-0.05%).The incidence of IBD and prevalence of allergic disease were also higher after eradication.In contrast,the incidence of gastric and duodenal ulcers and gastritis was reduced after eradication.In patients with at least one entry of health check-up data(1701111 patients),the percentage of patients with MS showed a slight increase following eradication(11.0%in the year of eradication and 12.2%after 5 years).CONCLUSION The results suggest that H.pylori eradication therapy reduces peptic ulcers and gastritis;however,it is associated with increased incidence of several other chronic diseases.展开更多
AIM To describe real-world treatment patterns of gastrointestinal neuroendocrine tumors(GI NET).METHODS In this retrospective cohort study,we used 2009-2014 data from 2 United States commercial claims databases to exa...AIM To describe real-world treatment patterns of gastrointestinal neuroendocrine tumors(GI NET).METHODS In this retrospective cohort study,we used 2009-2014 data from 2 United States commercial claims databases to examine newly pharmacologically treated patients using tabular and graphical techniques.Treatments included somatostatin analogues(SSA),cytotoxic chemotherapy(CC),targeted therapy(TT),interferon(IF)and combinations.We identified patients at least 18 years of age,with≥1 inpatient or≥2 outpatient claims for GI NET who initiated pharmacologic treatment from 7/1/09-6/30/14.A 6 mo clean period prior to first treatment ensured patients were newly treated.Patients were followed until end of enrollment or the study end date,whichever was first.RESULTS We identified 2258 newly treated GI NET patients:mean(SD)age was 55.6 years(SD=9.7),47.2%of the patients were between 55 and 64 years,and 48.8%were female.All regions of the United States were represented.59.6%started first-line therapy with SSA monotherapy(964 with octreotide LAR,380 with octreotide SA,and 1 with lanreotide),33.3%CC,3.6%TT,and 0.5%IF.The remainder received combinations.Mean follow up was 576 d.Overall mean first-line therapy duration was 361 d(449 d for SSA,215 for CC,267 for TT).58.9%of patients had no pharmacological treatment beyond first line.The most common secondline was combination therapy with SSA.In graphical pattern analysis,there was no clear pattern visible after first line therapy.CONCLUSION In this study,60%of patients initiated treatment with SSA alone or in combination.The relatively long time to discontinuation suggests possible sustained effectiveness and tolerability.展开更多
文摘The increasing cost of infrastructure development risks stifling national investment plans.Many projects in Uganda have suffered because of the frequency and magnitude of claims made by parties involved especially the contractors.As a result,the construction industry is plagued with claims which quite often lead to adversarial relationships.The major grounds for claims were identified through studying the contract documents where claims had been made.Increase in scope;change orders;errors in contract documents;inclement weather;inflation;delay in possessing the site;and change in the tax policy were the most prevalent grounds for making claims.Problems identified in claiming process include delays in getting approval;information on claims not reliable;hostility from the parties involved;pricing of claims;delays in effecting payment when approved;and overzealous contract interpretation leading to misunderstanding and delays Using a survey on project managers for 64 contractors and their corresponding clients or their representatives,the major ways in which it can be reduced were identified as being thoroughness during the design phase;providing for inflation;proper planning of works;using prequalified contractors;and proper documentation of records.Clients have a big role to play in reducing claims.
文摘Objective:With the continuous changes in social production,the consumption th inking of the masses obviously cannot keep up with the speed of social developmen t,and insurance disputes are increasingly emerging.Among them,the shortcomings of personal injury claims are not prominent,and the theoretical knowledge is not co mplete.In order to improve the quality of professional talents and reduce claims dis putes,the feasibility of integrating forensic medicine into personal injury claims is ex plored.Methods:The professional attributes,subject attributes,knowledge system an d employment data of forensic medicine are analyzed and compared with the actual work of personal injury claims.Main results:Forensic medicine has its uniqueness i n on-site investigation,injury-disease relationship analysis,and resolution of doubts.I t is irreplaceable by other subjects.The subject attributes are consistent with the pe rsonal injury claims major,and personal injury claims itself has basic medical courses,so it is easier to accept forensic medicine.Conclusion:Under the current social bac kground,through the study of the forensic medicine system in the personal injury cl aims major,it has positive practical significance for its professional construction and talent training.
基金supported by the NSFC(11171101)Doctoral Fund of Education Ministry of China(20104306110001)the Graduate Research and Innovation Fund of Hunan Province(CX2011B197)
文摘In this paper, a compound binomial model with a constant dividend barrier and random income is considered. Two types of individual claims, main claims and by-claims, are defined, where every by-claim is induced by the main claim and may be delayed for one time period with a certain probability. The premium income is assumed to another binomial process to capture the uncertainty of the customer＇s arrivals and payments. A system of difference equations with certain boundary conditions for the expected present value of total dividend payments prior to ruin is derived and solved. Explicit results are obtained when the claim sizes are Kn distributed or the claim size distributions have finite support. Numerical results are also provided to illustrate the impact of the delay of by-claims on the expected present value of dividends.
文摘Based on the context theory within the framework of the metafunction,the paper analyses the English claim letters in terms of field,tenor and mode.The result of the paper shows the features of the claim letters which will help the English claim letter writing.
文摘In this paper we examine the large deviations principle (LDP) for sequences of classic Cramér-Lundberg risk processes under suitable time and scale modifications, and also for a wide class of claim distributions including (the non-super- exponential) exponential claims. We prove two large deviations principles: first, we obtain the LDP for risk processes on D∈[0,1] with the Skorohod topology. In this case, we provide an explicit form for the rate function, in which the safety loading condition appears naturally. The second theorem allows us to obtain the LDP for Aggregate Claims processes on D∈[0,∞) with a different time-scale modification. As an application of the first result we estimate the ruin probability, and for the second result we work explicit calculations for the case of exponential claims.
文摘Modem enterprise theory defines onterprise＇s ownership through the concepts of residual rights of control and claim to residue. It also believes that when they are in homologous, the ownership of enterprise can be arranged in the best place. When the enterprise is under normal run, shareholders are its owner, but when it goes into bankruptcy, claimers should take place of shareholders becoming the owner of the enterprise. But in China, the ownership of state-owned enterprise （SEE） goes into double misplaces. Management controls the enterprise under the normal run, which leads salaries to seize the earnings and share equities. The state who acts as the shareholder not only lessens investments but also fixes its earnings as much as possible. It gives up the claim to residue, which leads claimers to bear the enterprise＇s residual risks （when the residual income is negative）. When the enterprise goes into bankruptcy, as the shareholder, the state determines whether it can exist or not in order to maximize its own utility. Rights of claimer are being seriously damaged as they can be manipulated freely in the enterprise. Banks＇ bad debts are also in an extremely high level. In this article, the author will establish a model and use the relative data to do technical analysis.
文摘Claims in international civil engineering projects sometimes will have impact on implementing the contract successfully. in order to observe and evaluate the contract claim situation and give guideline to all the contractual roles to settle the claims comfortably, this paper devote the research and literate review to find the key problems in contract claim management and give recommendation accordingly. With this focused objective, this paper presents a research analysis based on randomly selected data from international construction organization. The contract claim case studies analyzed by sampling survey scientific research method that follows a research strategy of specific to general. In the beginning, the paper analyzes the elements of contract claim administration,and then provides the general overview of the contract claim. Finally, it numerates the claim causes usage through cases studies under different contract condition of FIDIC. In addition to these discussions, analysis of other secondary data and recommendations forwarded to explain how claims should handle properly. During the thesis research period,there were 14 simple random selected projects have been studied as a case studies. From studied projects,the time extension in average, exceed 117.7% of its original contract completion time and the cost compensation increase 34.8% comparing to its initial contract value. Thus, the main causes of the majority contract claim problem lies on the failure in contract claim management and on unforeseen circumstance like variation, adverse climate, right of way problems, etc. Finally this thesis contributes to the improvement of contract claim management construction industry and open ways for further researches related to claim management.
基金This work was supported in part by the National Natural Science Foundation of China (10071058, 70273029) the Ministry of Education of China.
文摘This article considers a risk model as in Yuen et al. （2002）. Under this model the two claim number processes are correlated. Claim occurrence of both classes relate to Poisson and Erlang processes. The formulae is derived for the distribution of the surplus immediately before ruin, for the distribution of the surplus immediately after ruin and the joint distribution of the surplus immediately before and after ruin. The asymptotic property of these ruin functions is also investigated.
基金supported by the National Natural Science Foundation of China (No. 30930102, 81473033)the National Key R&D Program of China (No. 2016YFC0901404)+2 种基金the Digestive Medical Coordinated Development Center of Beijing Hospitals Authority (No. XXZ0204)the Science Foundation of Peking University Cancer Hospital (No. 2017-4)the Open Project funded by the Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing (No. 2017-10)
文摘Objective: To evaluate the accuracy of identifying cancer patients by use of medical claims data in a health insurance system in China, and provide the basis for establishing the claims-based cancer surveillance system in China.Methods: We chose Hua County, Henan Province as the study site, and randomly selected 300 and 1,200 qualified inpatient electronic medical records(EMRs) as well as the New Rural Cooperative Medical Scheme(NCMS) claims records for cancer patients in Hua County People’s Hospital(HCPH) and Anyang Cancer Hospital(ACH) in 2017. Diagnostic information for NCMS claims was evaluated on an individual level, and sensitivity and positive predictive value(PPV) were calculated taking the EMRs as the gold standard.Results: The sensitivity of NCMS was 95.2%(93.8%-96.3%) and 92.0%(88.3%-94.8%) in ACH and HCPH,respectively. The PPV of the NCMS was 97.8%(96.7%-98.5%) in ACH and 89.0%(84.9%-92.3%) in HCPH.Overall, the weighted and combined sensitivity and PPV of NCMS in Hua County was 93.1% and 92.1%,respectively. Significantly higher sensitivity and PPV in identifying patients with common cancers than noncommon cancers were detected in HCPH and ACH separately(P<0.01).Conclusions: Identification of cancer patients by use of the NCMS is accurate on individual level, and it is therefore feasible to conduct claims-based cancer surveillance in areas not covered by cancer registries in China.
文摘The objective of this paper was to project possible impacts of climate change on heavy rainfall-related water damage insurance claims and incurred losses for four selected cites (Kitchener-Waterloo, London, Ottawa, and Toronto) located at Ontario, Canada. To achieve this goal, the future climate change scenarios and rainfall simulations, at local scale, were needed. A statistical downscaling method was used to downscale five global climate model (GCM) scenarios to selected weather stations. The downscaled meteorological variables included surface and upper-air hourly temperature, dew point, west-east and south-north winds, air pressure, and total cloud cover. These variables are necessary to project future daily rainfall quantities using within-weather-type rainfall simulation models. A model result verification process has been built into the whole exercise, including rainfall simulation modeling and the development of downscaling transfer functions. The results of the verification, based on historical observations of the outcome variables simulated by the models, showed a very good agreement. To effectively evaluate heavy rainfall-related water damage insurance claims and incurred losses, a rainfall index was developed considering rainfall intensity and duration. The index was evaluated to link with insurance data as to determination of a critical threshold of the rainfall index for triggering high numbers of rainfall-related water damage insurance claims and incurred losses. The relationship between rainfall index and insurance data was used with future rainfall simulations to project changes in future heavy rainfall-related sewer flood risks in terms of water damage insurance claims and incurred losses. The modeled results showed that, averaged over the five GCM scenarios and across the study area, both the monthly total number of rainfall-related water damage claims and incurred losses could increase by about 13%, 20% and 30% for the periods 2016-2035, 2046-2065, and 2081-2100, respectively (from the four-city seasonal average of 12 ± 1.7 thousand claims and $88 ± $21 million during April-September 1992-2002). Within the context of this study, increases in the future number of insurance claims and incurred losses in the study area are driven by only increases in future heavy rainfall events.
基金The study was reviewed and approved for publication by the Ethics Committee of Oita University,Faculty of Medicine(No.1692).
文摘BACKGROUND Helicobacter pylori(H.pylori)infection is a risk factor for many diseases,including peptic ulcer disease and gastric cancer.While H.pylori eradication therapy can prevent these diseases,potentially unfavorable effects of eradication therapy have also been reported in some diseases,such as gastroesophageal reflux disease(GERD),Barrett’s esophagus(BE),inflammatory bowel disease(IBD),allergic diseases,and metabolic diseases.Consequently,both positive and negative impacts should be considered when assessing the effects of H.pylori eradication therapy.AIM To compare the incidence of these diseases before and after H.pylori eradication and to comprehensively assess its effects.METHODS This retrospective cohort study used a Japanese nationwide health claims database(April 2009-March 2020),developed by the Japanese Ministry of Health,Labour and Welfare.The database contained almost all health insurance claims data issued in Japan,and specific health check-up data for individuals who took the check-ups.Descriptive statistics were used for the analyses.Patients who received primary eradication therapy were defined as those prescribed medication for H.pylori eradication.New diagnoses,defined as incidence of upper gastrointestinal diseases and IBD,and prevalence of allergic diseases were compared before and after eradication.The incidence and prevalence of each disease were also compared between the 3-year period before eradication(from the 4th to the 2nd year prior to the year of eradication)and the 3-year period after eradication(from the 1st to the 3rd year after the year of eradication)based on the age category and calendar year and month.Changes in body mass index and proportion of patients with metabolic syndrome(MS)were examined before and after eradication.RESULTS We identified 5219731 patients who received primary eradication therapy.The 65-69 years age group had the greatest number of patients in both sexes.There was no significant increase in the incidence of GERD after eradication when considering the effects of aging and reporting period.However,the incidence of BE was higher in the 3-year period after eradication than in the 3-year period before eradication for all age categories(0.02%-0.10%vs<0.01%-0.05%).The incidence of IBD and prevalence of allergic disease were also higher after eradication.In contrast,the incidence of gastric and duodenal ulcers and gastritis was reduced after eradication.In patients with at least one entry of health check-up data(1701111 patients),the percentage of patients with MS showed a slight increase following eradication(11.0%in the year of eradication and 12.2%after 5 years).CONCLUSION The results suggest that H.pylori eradication therapy reduces peptic ulcers and gastritis;however,it is associated with increased incidence of several other chronic diseases.
基金Supported by Novartis Pharmaceuticals,One Health Plaza,East Hanover,No.NJ 07936-1080,United State
文摘AIM To describe real-world treatment patterns of gastrointestinal neuroendocrine tumors(GI NET).METHODS In this retrospective cohort study,we used 2009-2014 data from 2 United States commercial claims databases to examine newly pharmacologically treated patients using tabular and graphical techniques.Treatments included somatostatin analogues(SSA),cytotoxic chemotherapy(CC),targeted therapy(TT),interferon(IF)and combinations.We identified patients at least 18 years of age,with≥1 inpatient or≥2 outpatient claims for GI NET who initiated pharmacologic treatment from 7/1/09-6/30/14.A 6 mo clean period prior to first treatment ensured patients were newly treated.Patients were followed until end of enrollment or the study end date,whichever was first.RESULTS We identified 2258 newly treated GI NET patients:mean(SD)age was 55.6 years(SD=9.7),47.2%of the patients were between 55 and 64 years,and 48.8%were female.All regions of the United States were represented.59.6%started first-line therapy with SSA monotherapy(964 with octreotide LAR,380 with octreotide SA,and 1 with lanreotide),33.3%CC,3.6%TT,and 0.5%IF.The remainder received combinations.Mean follow up was 576 d.Overall mean first-line therapy duration was 361 d(449 d for SSA,215 for CC,267 for TT).58.9%of patients had no pharmacological treatment beyond first line.The most common secondline was combination therapy with SSA.In graphical pattern analysis,there was no clear pattern visible after first line therapy.CONCLUSION In this study,60%of patients initiated treatment with SSA alone or in combination.The relatively long time to discontinuation suggests possible sustained effectiveness and tolerability.
