Financial Knowledge and Private Health Insurance: Does Age Matter?

(1) Background: The paper focuses on the relationship between financial knowledge (FK) and holding private health insurance (PHI), and also focuses on the effect of age on the aforementioned relationship. (2) Method: The study was carried out on a sample of 8055 individuals taken from the 2016 Financial Competences Survey (the only one available), prepared by the Bank of Spain. Unlike previous studies that limited themselves to considering numeracy as a proxy for FK, in this study, two levels of FK-basic and advanced-are considered. (3) Results: The results indicate that a higher level of FK, specifically advanced FK, increases the probability of an individual holding PHI. Regarding age, it has been observed that the relationship between FK and PHI is only relevant in middle and older age, but not in younger and adults. Therefore, it is appropriate to differentiate between basic and advanced FK, and we confirm that age exerts a moderating effect on the influence of FK on PHI. (4) Conclusion: We conclude that FK-specifically, advanced FK for middle-aged and older people-is relevant to the likelihood of an individual holding PHI, which can improve health and financial wellbeing.

Photorespiration: regulation and new insights on the potential role of persulfidation.

Photorespiration has been considered a 'futile' cycle in C3 plants, necessary to detoxify and recycle the metabolites generated by the oxygenating activity of Rubisco. However, several reports indicate that this metabolic route plays a fundamental role in plant metabolism and constitutes a very interesting research topic. Many open questions still remain with regard to photorespiration. One of these questions is how the photorespiratory process is regulated in plants and what factors contribute to this regulation. In this review, we summarize recent advances in the regulation of the photorespiratory pathway with a special focus on the transcriptional and post-translational regulation of photorespiration and the interconnections of this process with nitrogen and sulfur metabolism. Recent findings on sulfide signaling and protein persulfidation are also described.

A phase Ib/II study of galunisertib in combination with nivolumab in solid tumors and non-small cell lung cancer.

BACKGROUND: In this phase Ib/II open-label study, tumor immune suppression was targeted in patients with advanced refractory solid tumors and patients with recurrent/refractory non-small cell lung cancer (NSCLC) using galunisertib with nivolumab. METHODS: Eligible patients were ≥ 18 years old, had an Eastern Cooperative Oncology Group performance status ≤ 1, and were treatment-naive for anti-programmed cell death-1, its ligand, or transforming growth factor ß receptor 1 kinase inhibitors. Phase Ib was an open-label, dose-escalation assessment of the safety and tolerability of galunisertib with nivolumab in patients with advanced refractory solid tumors. Phase II evaluated the safety of galunisertib with nivolumab in NSCLC patients who had received prior platinum-based treatment but were immuno-oncology agent-naive. RESULTS: This trial was conducted between October 2015 and August 2020. No dose-limiting toxicities were observed in phase I. In the phase II NSCLC cohort (n = 25), patients received 150 mg twice daily galunisertib (14 days on/14 days off dosing schedule for all phases) plus nivolumab at 3 mg/kg (intravenously every 2 weeks). In this phase, the most frequent treatment-related adverse events (AEs) were pruritus (n = 9, 36%), fatigue (n = 8, 32%), and decreased appetite (n = 7, 28%). No grade 4 or 5 treatment-related AEs were observed. Six (24%) patients had confirmed partial response (PR) and 4 (16%) had stable disease; 1 additional patient had confirmed PR after initial pseudo-progression. The median duration of response was 7.43 months (95% confidence interval [CI]: 3.75, NR). Among the 7 responders, including the delayed responder, 1 had high PD-L1 expression (≥ 50%). The median progression-free survival was 5.26 months (95% CI: 1.77, 9.20) and the median overall survival was 11.99 months (95% CI: 8.15, NR). Interferon gamma response genes were induced post-treatment and cell adhesion genes were repressed, although the association of these observations with tumor response and clinical outcomes was not statistically powered due to limited samples available. CONCLUSIONS: The study met its primary endpoint as galunisertib combined with nivolumab was well tolerated. Preliminary efficacy was observed in a subset of patients in the Phase 2 NSCLC cohort. TRIAL REGISTRATION: Trial registered with ClinicalTrials.gov (NCT02423343; 22.04.2015).

Little but Intense: Using a HIIT-Based Strategy to Improve Mood and Cognitive Functioning in College Students.

Looking for useful and motivational strategies for promoting healthy habits and improving cognitive functioning in young populations, the aim of the present study was to determine if a single bout of high-intensity interval exercise could stimulate mood and working memory in college students. A total of 25 male subjects (mean ± SD, age: 21.7 ± 2.1 years; height: 1.77 ± 0.06 m; weight: 72.6 ± 8.4 kg; body mass index: 23.1 ± 1.4 kg/m2; VO2peak: 47.1 ± 9.3 mL/kg/min) participated voluntarily in this study. Participants underwent a high-intensity interval exercise consisting of 10 × 1 min of cycling at VO2peak power output. The Profile of Mood States (POMS) questionnaire and Digit Span Test (DST) were administered at three assessment time points: (a) pre-intervention assessment, (b) post-intervention assessment, and (c) 30 min post-intervention. The mood states decreased significantly after exercise; however, a significant increase in mood was found after 30 min of recovery. A significant post-exercise increase in DST performance was observed; moreover, DST scores obtained 30 min after exercise remained higher than those assessed pre-exercise. In conclusion, a single bout of HIIT induces acute positive changes in mood states in male college students and seems to be a powerful stimulus for cognitive functioning.

Optimizing internal biosecurity on pig farms by assessing movements of farm staff.

For internal biosecurity, it is important to separate different age groups in a pig farm and to stick to specific working lines when visiting the barns. Currently, there is no research on the movements of farm staff on pig farms. The objectives of this observational study were to assess movements of farm staff on pig farms, to assess risky movements and to investigate whether movements differ according to time (week of the batch farrowing system (BFS) and weekday vs. weekend) and unit (farrowing, gestation/insemination, nursery, and fattening unit). Five commercial sow farms participated and on each farm, an internal movement monitoring system was installed. Detection points were installed throughout the farm and workers had to wear a personal beacon. Movement data were collected from 1 December 2019 until 30 November 2020. The following sequence of movements was considered as safe: (1) dressing room, (2) farrowing, (3) gestation/insemination, (4) nursery, (5) fattening, (6) quarantine, and (7) cadaver storage. Movements in the opposite direction were considered as risk, unless a dressing room was visited in between. The total number of movements differed according to week of the BFS, and was highest in insemination and farrowing week. The percentage of risky movements was influenced by week of the BFS for two farms, and was highest around weaning. The percentage of risky movements varied between farms and ranged from 9 to 38%. There were more movements on a weekday compared to a weekend day. There were more movements towards the farrowing and gestation/insemination unit in insemination and farrowing week compared to other weeks of the BFS, but week of the BFS had no impact on movements towards nursery and fattening unit. This study showed that there were a lot of (risky) movements on pig farms and that these movements varied according to week of the BFS, day of the week, and unit. This study creates awareness, which could be a first step in optimizing working lines. Future research should focus on why certain risky movements occur and how these can be avoided to achieve better biosecurity and higher health status on farms.

Cross-sectional associations of persistent organic pollutants measured in adipose tissue and metabolic syndrome in clinically diagnosed middle-aged adults.

INTRODUCTION: Although often overlooked in clinical settings, accumulation of persistent organic pollutants (POPs) in visceral adipose tissue (VAT) is thought to be a relevant risk factor for metabolic syndrome (MetS). METHODS: One hundred and seventeen patients undergoing non-oncological surgery were randomly recruited and classified as MetS + if presented 3 out of the 5 MetS components: waist circumference (WC), systolic and diastolic blood pressure (SBP and DBP, respectively), serum glucose, insulin, triglycerides (TG) and high-density lipoprotein (HDL) cholesterol levels, according International Diabetes Federation (IDF) criteria. Seventeen organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) were measured in adipose tissue samples. Linear, logistic and weighted quantile sum (WQS) regression models, adjusted for age and sex, were performed. RESULTS: One third of the participants were males (36.8%) with a median age of 44 years, showing clinical evidences of MetS (35.0%). Adjusted linear regression models showed that WC correlated positively with all OCP concentrations. Higher fasting serum glucose levels were related to higher HCB and γ-HCH concentrations. The remaining OCPs and PCBs were not associated with this MetS component. HCB was inversely associated with HDL cholesterol levels, while PCB-180 was positively associated. HCB and γ-HCH concentrations were also positively correlated with DBP and SBP levels. PCB-138 was also positively associated with SBP. Adjusted logistic models revealed that exposure to HCB and γ-HCH were associated with increased odds of MetS [ORs (95%CI) 1.53 (1.22-1.92) and 1.39 (1.10-1.76) respectively; p < 0.01]. No associations were observed for the remaining POPs. WQS models showed a positive and significant mixture effect of POPs on the odds of MetS (exp [beta] = 2.34; p < 0.001), with γ-HCH (52.9%), o,p'-DDT (26.9%) and HCB (19.7%) driving the association. CONCLUSIONS: Our findings support that POPs accumulated in VAT, specifically HCB and (gamma)-HCH, are associated with both isolated components and clinically diagnosed SMT.

Empirical approach to the gender gap in students' reading consumption in international contexts.

Reading is a very important aspect today, which is why it is a recurring topic in research. This study aims to analyze the gender gap in the reading consumption of adolescents and compare the situation in Spain with that of other countries. It addresses, for the first time, the influence of the gender factor on the reading habits of adolescents who have just begun secondary education. This is an empirical study carried out based on the research projects "Determining factors in the reading habits of secondary education students. A study from the variables of the educational context" and "Reading habits in international contexts of Secondary Education students. A study of educational practices to promote reading." It is based on the hypothesis that reading consumption is conditioned by gender and country-specific educational policies and, therefore, by the place where the study is carried out. To do this, an international sample of students was taken as a reference, made up of a matrix group of Spanish students contrasted with small samples from three different countries that we are interested in comparing with the Spanish context: Portugal, Poland, and Chile. The results have shown that the gender gap in reading is perceived in all the contexts studied and that it increases in contexts with less developed co-education programs; therefore, it is necessary to implement effective policies in the educational field to eliminate the existence of gender stereotypes.

Private Health Insurance and Financial Risk Taking in Spain-The Moderating Effect of Subjective Risk Tolerance.

This study focuses on the effect of private health insurance on financial risk taking in Spanish households. According to the arguments related to the background risk, we propose two hypotheses: the first predicts a positive relationship between health insurance and risk taking and the second asserts that attitude to risk moderates this relationship. Spain is a good laboratory because it has a National Health System (NHS) that offers healthcare coverage to the entire population, which could eliminate the effect of health insurance on risk taking. Based on a sample of 6110 households obtained from the Household Finance Survey (EFF), our results confirm both hypotheses. Specifically, we show that private health insurance significantly increases a household's portfolio risk, especially in households with greater risk aversion. The results are concordant with the scarce amount of previous empirical evidence obtained in other contexts and are robust for different subsamples and estimation methods.

Nursing Homes: Affiliation to Large Chains, Quality and Public-Private Collaboration.

The objective of this paper was to estimate the influence of being affiliated with an NH chain on perceived consumer quality, and whether this relationship is affected by maintaining a collaboration agreement with public administrations. We used a combination of theoretical foundations: (1) From the consumer perspective, we focussed on online reviews of the quality of nursing homes (NHs); (2) from the industrial organisation literature, we proposed arguments regarding the advantages and disadvantages of belonging to a chain; (3) the theory of transaction costs was used to explain public-private collaboration. The study was carried out on a sample of 642 chain-affiliated Spanish NHs, with data from quality scores downloaded from the website topMayores.es. We distinguished between the six largest chains and the rest. We applied linear regression models. The results show that NHs affiliated with one of the largest NH chains obtained worse quality scores in the assessment made by users, although quality scores improved for the largest chains of NHs involved in an agreement with the public administration.

Women and financial literacy in spain. Does marital status matter?

This study focuses on the joint effect of gender and marital status on financial literacy. The study is based on the data of 7,456 adults who responded to the Financial Competencies Survey (2016), conducted by the Bank of Spain. The results revealed that married/couple women have a lower level of financial literacy than married/couple men, perhaps because men often make decisions regarding family finances, while women are often in charge of other homework. This may have important consequences for the financial autonomy of women of all ages, especially as they aging.

High serum angiotensin-converting enzyme 2 activity as a biomarker of frailty in nursing home residents.

Angiotensin-converting enzyme (ACE) and angiotensin-converting enzyme 2 (ACE2) are two of the main components of the renin-angiotensin system (RAS). Imbalanced RAS showing lower ACE2 has been associated with increased cardiovascular risk, muscular pathologies, sarcopenia, frailty, other age-related pathologies and a poorer health status. However, its role in aging remains unclear. Thus, the aim of this work was to analyze the serum enzymatic activity of ACE and ACE2, the ACE/ACE2 ratio and its association with anthropometric parameters, blood pressure, physical function, dependence and frailty in older people living in nursing homes. This study is a secondary analysis of baseline data from two randomized clinical trials in a population of 228 older individuals living in nursing homes (Spain). Serum ACE and ACE2 enzymatic activities were measured by fluorimetry. Variables linked to cardiovascular risk, physical function, dependence and frailty were measured using validated tests, indexes and scales. Association between ACE, ACE2 serum activities, the ACE/ACE2 ratio and the rest of the quantitative variables were assessed by Pearson's correlations and by partial correlations controlled by age and sex. The association between serum ACE and ACE2 activities, the ACE/ACE2 ratio and frailty scores was analyzed by generalized linear models with and without controlling for sex and age. Differences in enzymatic activities between sexes and between frail and non-frail individuals were analyzed using Student's t-test and general linear models to control analysis by age and sex. We found that higher serum ACE2 activity was associated with a higher body mass index, worse physical function, greater dependence and increased frailty. This association is consistent with the elevation of circulating ACE2 in certain pathological conditions and in line with RAS deregulation in muscular dystrophies. Serum ACE2 activity, in combination with other molecules, could be proposed as a biomarker of poor physical function, higher dependence and frailty.

Effect of aflibercept plus FOLFIRI and potential efficacy biomarkers in patients with metastatic colorectal cancer: the POLAF trial.

BACKGROUND: Aflibercept is an antiangiogenic drug against metastatic colorectal cancer (mCRC) combined with 5-fluorouracil/leucovorin/irinotecan (FOLFIRI); however, no antiangiogenic biomarker has yet been validated. We assessed aflibercept plus FOLFIRI, investigating the biomarker role of baseline vascular endothelial growth factor A (VEGF-A) and angiotensin-converting enzyme (ACE). METHODS: Phase II trial in oxaliplatin-treated mCRC patients who received aflibercept plus FOLFIRI. The reported 135 ng/mL ACE cut-off was used and ROC analysis was performed to assess the optimal VEGF-A cut-off for progression-free survival (PFS). Overall survival (OS), time to progression (TTP), time to treatment failure (TTF), overall response rate (ORR) and disease control rate (DCR) were also assessed. RESULTS: In total, 101 patients were followed for a median of 12 (6-17) months. The 1941 pg/mL VEGF-A was an optimal cut-off, with a longer median PFS when VEGF-A was <1941 versus ≥1941 pg/mL (9 versus 4 months). Patients with VEGF-A < 1941 pg/mL showed longer median OS (19 versus 8 months), TTP (9 versus 4 months) and TTF (8 versus 4 months), along with higher ORR (26% versus 9%) and DCR (81% versus 55%). No differences were identified according to ACE levels. CONCLUSIONS: This study supports aflibercept plus FOLFIRI benefits, suggesting VEGF-A as a potential biomarker to predict better outcomes.

Training vs. Competition in Sport: State Anxiety and Response of Stress Hormones in Young Swimmers.

This study was aimed to assess the neuroendocrine response to stress induced by different sports environments (a regular training session and a competitive event), to define the contribution of psychological and physical stress, and to check the possible relationship between state-anxiety and stress hormones responses to competitive and non-competitive sports practices. Twelve young national-level male swimmers participated in this investigation. Endorphins, adrenocorticotropin, and prolactin plasma levels were measured at baseline conditions (t0), before a regular swimming training session (t1), and before and after real swimming competition consisting of 100 m freestyle (t2 and t3, respectively). Moreover, state-anxiety was evaluated in all assessment time-points. The results showed no differences in endorphin, adrenocorticotropin, prolactin and state-anxiety between t0 and t1; however, significant increases in endorphins (142%), prolactin (137%) and state-anxiety (13%) were observed in t2. Huge stress response was observed in t3 (increases of 354%, 387%, and 250% for endorphins, adrenocorticotropin, and prolactin, respectively) although state-anxiety decreased slightly. Lastly, a lack of the relationship between stress hormones and state-anxiety was found in all conditions. Mental and especially physical stress associated with sports competition induces a significant release of stress hormones which is not relevant for the regular training session.

Neurophysiological Stress Response and Mood Changes Induced by High-Intensity Interval Training: A Pilot Study.

This pilot study, conducted in advance of a future definitive randomized controlled trial, aimed to investigate the feasibility of using a HIIT-based intervention to induce neurophysiological stress responses that could be associated with possible changes in mood. Twenty-five active male college students with an average age of 21.7 ± 2.1 years, weight 72.6 ± 8.4 kg, height 177 ± 6.1 cm, and BMI: 23.1 ± 1.4 kg/m2 took part in this quasi-experimental pilot study in which they were evaluated in two different sessions. In the first session, subjects performed a graded exercise test to determine the cycling power output corresponding to VO2peak. The second session consisted of (a) pre-intervention assessment (collection of blood samples for measuring plasma corticotropin and cortisol levels, and application of POMS questionnaire to evaluate mood states); (b) exercise intervention (10 × 1-min of cycling at VO2peak power output); (c) post-intervention assessment, and (d) 30-min post-intervention evaluation. Significant post-exercise increases in corticotropin and cortisol plasma levels were observed whereas mood states decreased significantly at this assessment time-point. However, a significant increase in mood was found 30-min after exercise. Finally, significant relationships between increases in stress hormones concentrations and changes in mood states after intense exercise were observed. In conclusion, our HIIT-based intervention was feasible to deliver and acceptable to participants. A single bout of HIIT induced acute changes in mood states that seems to be associated with hypothalamic-pituitary-adrenal axis activation.

Effects of Padel Competition on Brain Health-Related Myokines.

Padel is becoming one of the most widespread racket sports that may have potential health benefits. Considering that several myokines mediate the cross-talk between skeletal muscles and the brain, exerting positive effects on brain health status, this study was designed to evaluate the responses of brain-derived neurotrophic factor (BDNF), leukemia inhibitory factor (LIF), and irisin (IR) to padel competition in trained players and to determine whether these responses were sex-dependent. Twenty-four trained padel players (14 women and 10 men with a mean age of 27.8 ± 6.3 years) participated voluntarily in this study. Circulating levels of BDNF, LIF, and IR were assessed before and after simulated padel competition (real playing time, 27.8 ± 8.49 min; relative intensity, 75.2 ± 7.9% maximum heart rate). Except for BDNF responses observed in female players (increasing from 1531.12 ± 269.09 to 1768.56 ± 410.75 ng/mL), no significant changes in LIF and IR concentrations were reported after padel competition. In addition, no sex-related differences were found. Moreover, significant associations between IR and BDNF were established at both pre- and post-competition. Our results suggest that while competitive padel practice stimulates BDNF response in female players, padel competition failed to boost the release of LIF and IR. Future studies are needed to further explore the role of these exercise-induced myokines in the regulation of brain functions and to identify the field sports that can contribute to myokine-mediated muscle-brain crosstalk.

Arrangements with the NHS for providing healthcare services: do they improve financial performance of private for-profit hospitals in Spain?

BACKGROUND: In developed countries around the world there is a trend to enhance the public-private collaboration in healthcare. In Spain, a decentralized country with a NHS funded with taxes and universal coverage, commissioning to for-profit private hospitals the production of healthcare services to specific patients that are publicly insured is a traditional practice. Around 43% of the for-profit private hospitals in Spain have a commissioning agreement with the NHS to diagnose or treat patients on public tariffs. These revenues represent 26% of the total revenues of private for-profit hospitals. The research question of this study is if commissioning with the NHS improves the financial performance of private-for-profit hospitals in Spain. METHODS: With a long panel (2000-2017) of for-profit hospitals we estimate a model for the financial performance (return on assets) using commissioning as main explanatory variable and other variables as control (variables financial indicators and structural information). Specific models are estimated for subgroups of hospitals according to size and specialization. The models are estimated by panel regression with fixed effects and GMM as robustness. RESULTS: Private for-profit hospitals that have commissioning with NHS obtain higher financial performance than no-commissioning hospitals. This effect varies depending on hospital size and type (hospital specialization), the advantage being more relevant for general hospitals and particularly for hospital with at least 50 beds. CONCLUSIONS: Commissioning with the NHS is a promising source of financial profitability for general acute private for-profit hospitals. The evidence provided by this study may orientate the NHS in the regulation and negotiation of commissioning contracts in healthcare.

Real-world experience of ocrelizumab in multiple sclerosis in a Spanish population.

OBJECTIVE: Pivotal trial have shown that patients with multiple sclerosis (MS) receiving ocrelizumab had better outcomes. However, data on ocrelizumab in clinical practice are limited. The aim of this study was to evaluate the preliminary safety profile and effectiveness of ocrelizumab treatment for multiple sclerosis (MS) in a real-world clinical setting. METHODS: We conducted a retrospective study including consecutive patients from nine public hospitals in south-eastern Spain who received ocrelizumab after it was approved. RESULTS: A total of 228 MS patients were included (144 with relapsing-remitting MS [RRMS], 25 secondary progressive MS [SPMS], and 59 primary progressive MS [PPMS]). Median follow-up period was 12 months (range, 1-32). No evidence of disease activity (NEDA) status at year 1 was achieved in 91.2% of the relapsing MS (RMS) population, while disability progression was detected in 37.5% of the PPMS patients (median follow-up period, 19 months). The most common adverse events reported were infusion-related reactions and infections, with the most common infections being urinary tract infections followed by upper respiratory infections and COVID-19. INTERPRETATION: The preliminary results in our real-world setting show that ocrelizumab presented excellent results in suppressing disease activity with a favorable and consistent safety profile.