Search Results (2,831)

Objectives: Patients with rare diseases in China face extremely high medical expenses. The current coverage framework remains inadequate in terms of coverage depth and proactive risk control, underscoring an urgent need for institutional reform. Methods: This study employs a policy content analysis approach to review the current landscape of rare disease protection in China. Drawing on risk management theory and the health capital model, it constructs an analytical framework to examine potential institutional reforms through the lens of risk response pathways and the efficiency of health investment. Results: The findings reveal that basic medical insurance (BMI) provides limited financial protection for patients with rare diseases. Among China’s 31 provincial-level administrative centers, 24 have set general outpatient reimbursement ceilings under the urban and rural resident basic medical insurance (URRBMI) at 1000 RMB or less. In comparison, 24 cities have set outpatient reimbursement limits under the urban employee basic medical insurance (UEBMI) at 6000 RMB or less. The security system relies predominantly on the BMI, while supplementary mechanisms have failed to provide effective support or continuity in coverage. Current policies are generally reactive, with coverage typically triggered only after a confirmed diagnosis and often lacking early intervention or preventive strategies. Conclusions: China’s rare disease security system urgently requires structural improvements in coverage depth and proactive risk management. The proposed Dedicated Insurance Scheme for Rare Diseases (DISRD) presents a feasible and sustainable model for China’s multi-tiered system of securing rare diseases. It provides valuable institutional insights for other countries and regions seeking to build public health systems with proactive risk control capabilities. Full article

Objective: The objective of this retrospective cross-sectional study is to explore how caregiver social determinants of health, appraisal of healthcare provider effectiveness, and insurance coverage influence caregiver ability to have their adolescent child access vision care, including completion of annual vision screening, visiting an ophthalmologist or optometrist, and completion of recommended additional screenings. Study Design: We used National Survey of Children’s Health (NSCH) data for 12–17-year-old adolescents for the years 2022 and 2023 (n = 37,425). Summary statistics for the selected sample were generated and binary logistic regressions were conducted. Outcome variables were the type of vision screening that occurred or not. Covariates were socioeconomic and demographic data of the adolescent’s primary caregiver. Independent variables were insurance coverage and healthcare provider’s skill and effectiveness. Results: Significant associations were reported between visiting an ophthalmologist or optometrist and each of spending enough time with patients; listening carefully to patients; and making patients feel like care is a partnership. Additionally, significant associations were reported between insurance coverage and both successful completion of vision screening and visiting an eye doctor. Conclusions: This study underscores the substantial impact of effectiveness of eye doctors in delivering annual vision exams and insurance adequacy on adolescent vision care engagement. Our results will inform the development of future evidence-based educational interventions to raise awareness on the importance of annual vision screenings in US adolescents and emphasize the need for screening mandates to advocate for this important public health issue. Full article

Background/Objectives: Psychosocial factors are not routinely screened for during the perioperative period, even though they significantly influence overall health. This study aimed to inventory the psychosocial vulnerabilities among patients undergoing cancer surgery. Methods: We conducted a cross-sectional analysis of a researcher-administered psychosocial screener implemented within a statewide health system between July 2023 and August 2025. A 45 min screener was offered to consecutive adult patients within two weeks before their major elective cancer surgery. Residential addresses were geocoded to assign neighborhood deprivation percentiles for the Area Deprivation Index (ADI) and the Social Vulnerability Index (SVI). Elevated psychosocial vulnerability was determined based on a model-based clustering approach, and a high deprivation index was defined as ≥75th percentile. Results: A total of 383 patients (37% response rate) completed the screener, including colorectal (40%), thoracic (36%), and surgical oncology (24%) patients, with a median age of 66 years (IQR, 57–73). Over half (52.0%, n = 199) reported ≥2 psychological and ≥2 social vulnerabilities. Younger patients (p = 0.021), non-white patients (p < 0.001), patients identifying as non-heterosexual (p = 0.014), without a partner (p < 0.001) or private insurance (p = 0.040), and those with lower household income (p < 0.001) were more likely to report elevated psychosocial vulnerability. Patients with elevated psychosocial vulnerability were more likely to reside in deprived neighborhoods (ADI: 34.0 vs. 29.0, p = 0.035; SVI: 0.35 vs. 0.27, p = 0.005). Conclusions: Patients undergoing major cancer surgery experience substantial psychosocial vulnerabilities, particularly those from socioeconomically disadvantaged neighborhoods. Future work should identify the psychosocial factors most predictive of poor surgical outcomes to guide targeted preoperative interventions. Full article

Spherical Adsorptive Carbon (SAC), a type of oral sorbent, is prescribed to chronic kidney disease (CKD) patients to remove uremic toxins. However, evidence regarding its effectiveness in delaying chronic kidney disease (CKD) progression remains insufficient. We aimed to evaluate the impact of SAC on CKD progression in patients with CKD stage 3 or higher using nationwide data. In this retrospective cohort study, we included patients diagnosed with CKD stage ≥3 from the Korea National Health Insurance System database between January 2020 and December 2022. Outcomes were compared between SAC users (N = 1289) and non-users (N = 1289) after 1:1 propensity score matching (PSM). After PSM, the time from index date to end-stage kidney disease (ESKD) was significantly longer in the SAC user group compared to the non-user group (246.8 days vs. 118.6 days, p < 0.001). In Cox regression analysis, the risk of ESKD was significantly lower in the SAC group (HR = 0.37, 95% CI: 0.29–0.48). However, the risk of dialysis initiation did not show a significant difference between the two groups (HR = 0.83, 95% CI: 0.27–2.59). This nationwide cohort study suggests that SAC treatment may delay progression from CKD stage 3 to ESKD, although it did not significantly reduce the risk of dialysis initiation. Full article

Occupational burnout is ubiquitous yet still debated as a disease entity. Previous reviews surveyed multiple biomarkers but left their neural substrate unclear. We therefore asked: What, if any, reproducible magnetic-resonance signature characterises burnout? Following PRISMA principles adapted for mechanistic synthesis, two reviewers searched PubMed, Scopus, Google Scholar, ResearchGate and Cochrane from January 2000 to May 2025 using “MRI/fMRI” AND “burnout”. After duplicate removal and multi-stage screening, 17 clinical studies met predefined inclusion criteria (English language, MRI outcomes, validated burnout diagnosis). In total, ≈1365 participants were scanned, 880 with clinically significant burnout and 470 controls. Uniform Maslach Burnout Inventory thresholds defined cases; most studies matched age and sex, and all excluded primary neurological disease. Structural morphometry (8/17 studies) revealed consistent amygdala enlargement—predominantly in women—and grey-matter loss in dorsolateral/ventromedial prefrontal cortex and striatal caudate–putamen, while hippocampal volume remained unaffected, distinguishing burnout from PTSD or depression. Resting-state and task fMRI (9/17 studies) showed fronto-cortical hyper-activation, weakened amygdala–ACC coupling, and progressive fragmentation of rich-club networks, collectively indicating compensatory executive overdrive and global inefficiency. Two longitudinal cohorts and several intervention sub-studies demonstrated partial reversal of cortical thinning and limbic hyper-reactivity after mindfulness, exercise, cognitive-behavioural therapy, neurofeedback, or rTMS, underscoring plasticity. Across heterogeneous paradigms and populations, MRI converges on a coherent, sex-modulated but reversible brain-networkopathy that satisfies objective disease criteria. These findings justify early neuro-imaging-based triage, circuit-targeted therapy, and formal nosological recognition of burnout as a mental disorder, with policy ramifications for occupational health and insurance parity. Full article

Background: Although several epidemiological studies have suggested a potential association between infections and Parkinson’s disease (PD), relatively few have specifically examined the relationship between upper respiratory tract infections (URIs) and PD, apart from coronavirus disease 2019 (COVID-19). Objectives: We investigated whether a history of URI was associated with the diagnosis of PD among Korean individuals aged ≥40 years, using data from the Korean National Health Insurance Service–Health Screening Cohort. Methods: A total of 5844 patients newly diagnosed with PD were identified and matched with 23,376 control participants at a 1:4 ratio based on age, sex, income, and geographical region. Conditional logistic regression analyses were performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for PD, adjusting for potential confounders including smoking, alcohol consumption, body mass index, blood pressure, comorbidity scores, blood glucose, and serum cholesterol levels. Results: Overall, no significant association was found between a history of URI and PD when considering a two-year exposure window. However, in the one-year window analysis, individuals with a history of URI had a modestly reduced odds of PD (≥1, ≥2, or ≥3 episodes: (adjusted OR: 0.93, 95% CI: 0.88–0.97, aOR: 0.91, 95% CI: 0.87–0.96 and aOR: 0.92, 95% CI: 0.87–0.98, respectively). Subgroup analyses revealed that the inverse association was more pronounced among women, older adults (≥65 years), and those with higher comorbidity scores. No clear dose–response trend was observed across increasing frequencies of URI diagnoses. Conclusions: Our findings suggest that the apparent protective association between recent URI history and PD is unlikely to be causal and may instead reflect confounding by medication use or reverse causation related to the prodromal phase of PD. These results should therefore be interpreted with caution and regarded as hypothesis-generating. Further prospective studies incorporating detailed prescription data and long-term follow-up are warranted to clarify the role of infections and anti-inflammatory medications in the pathogenesis of PD. Full article

Introduction: Central line-associated bloodstream infections (CLABSIs) are a major cause of morbidity and mortality, yet health disparities in CLABSI incidence and outcomes remain understudied. This study evaluates these disparities and their impact on CLABSI rates, in-hospital mortality, hospital length of stay (LOS), and costs using the National Inpatient Sample (NIS) from 2016 to 2022. Methods: We conducted a retrospective analysis of adult hospitalizations using the NIS database that included central venous catheter placement and identified CLABSI using AHRQ’s Patient Safety Indicator 07. Primary outcomes included CLABSI incidence and in-hospital mortality; secondary outcomes were LOS and inflation-adjusted hospital costs. Outcomes were analyzed using logistic and lognormal regression models, focusing on demographic and clinical variables that included sex, race, socioeconomic status, and insurance type. Results: Among 11.5 million CVCs placed between 2016 and 2022, 6.56 million met CLABSI eligibility criteria, with 1 in 400 (0.25%) complicated by CLABSI. Blacks had 29.8% higher adjusted odds of CLABSI than Whites (p < 0.001), whereas Medicaid beneficiaries had 18.4% higher odds compared to those privately insured (p = 0.002). CLABSI was associated with a 97% increase in LOS and an 82% increase in hospital costs (both p < 0.001). In-hospital mortality was 13.3% and did not differ significantly by CLABSI status after adjustment. Discussion: Racial and socioeconomic disparities persist in CLABSI incidence and healthcare resource utilization, with Blacks and Medicaid beneficiaries at the highest risk. Although CLABSI rates returned to pre-pandemic levels in 2022, associated costs and LOS remained elevated. Further research and targeted prevention strategies are needed to reduce health disparities and improve patient outcomes. Full article

Background/Objectives: Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders and is characterized by transient but very severe vertigo, increasing fall risk, especially in older people. While many risk factors have been reported, there are still contradicting papers and evidence from large-scale studies remains limited. Methods: This nationwide, nested case–control study utilized Korean National Health Insurance Service-Health Screening Cohort data to investigate possible risk factors for BPPV. In particular, it examined the association between prior head trauma and BPPV, proposing prior head trauma as a plausible and clinically relevant risk factor. From an initial cohort of 514,866 participants, 29,467 BPPV cases were matched 1:4 with 117,868 controls based on age, sex, income, region, and index date. Conditional logistic regression, with overlap weighting, assessed the risk of BPPV associated with head trauma and other potential factors. Results: Head trauma was modestly more prevalent in the BPPV group (2.29% vs. 1.83%) and was significantly associated with BPPV (adjusted OR 1.28, 95% CI 1.17–1.40, p < 0.001). The corresponding Absolute Risk Increase (ARI) was 0.82 percentage points over the entire follow-up and 0.66 percentage points within 1 year. The association persisted across most subgroups including both demographic and clinical factors except underweight individuals and those with high comorbidity scores. Conclusions: This large-scale analysis reinforces head trauma as a significant risk factor for BPPV, providing population-level evidence that may guide clinical assessment and prevention strategies. Full article

Background: Migraine and chronic periodontitis are prevalent conditions that may share common inflammatory and neurovascular pathways. Growing evidence suggests an association between periodontal inflammation and migraine, yet large-scale population-based studies are limited. Objective: To investigate the association between chronic periodontitis and the occurrence of migraine using a nested case-control design in a nationally representative Korean adult cohort. Methods: This study utilized data from the Korean National Health Insurance Service-Health Screening Cohort (2002–2019). A total of 43,359 individuals diagnosed with migraine (ICD-10: G43) were matched 1:4 by age, sex, income, and residence with 173,436 controls. Chronic periodontitis was identified using ICD-10 code K053. Conditional logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for demographic, behavioral, and clinical covariates. Results: A significant association was observed between chronic periodontitis and migraine. Individuals with at least one diagnosis of periodontitis within one year prior to migraine onset had increased odds of migraine (adjusted OR = 1.10, 95% CI: 1.08–1.13). Similar associations were observed for two diagnoses within one year (OR = 1.05; 95% CI: 1.01–1.09) and one diagnosis within two years (OR = 1.10; 95% CI: 1.08–1.13). No association was found with three or more diagnoses in one year. Subgroup analyses confirmed consistent associations across migraine subtypes and demographic strata. Conclusions: This study demonstrated a statistically significant association between chronic periodontitis and migraine, suggesting a potential shared inflammatory or neurovascular mechanism. Recognizing periodontal disease as a modifiable factor may offer new insights into migraine prevention and management. Further longitudinal and interventional studies are warranted to establish causality. Full article

The coronavirus disease 2019 (COVID-19) pandemic has put a renewed focus on the value of vaccines in combatting potentially life-threatening diseases. The primary aim was to conduct a longitudinal study on the dispensing patterns of vaccines (from 2017 to 2021) in a section of the private healthcare sector in South Africa. A descriptive cross-sectional pharmacoepidemiological study on health insurance data covering 5 years was conducted. The study included all vaccines available on the South African market (childhood, adult, travel, and other vaccines). The study population consisted of 3.8 million individuals. The descriptive statistics were calculated. The vaccine-dispensing patterns were distinctly different in 2021 compared to the preceding four years. The COVID-19 vaccine was introduced in 2021 in South Africa. Although the total number of medical insurance scheme members stayed relatively constant, the number of vaccine claims increased approximately seven-fold in 2021 compared to the average for the preceding four years (2017 to 2020). The tetanus and pneumococcal vaccines were the most dispensed bacterial vaccines, whilst the influenza and COVID-19 vaccines were the most dispensed viral vaccines. COVID-19 vaccines accounted for 55.74% of all vaccines dispensed over the 5 years, and for 85.70% of the vaccines dispensed in 2021. An increase in the number of bacterial vaccines dispensed was observed towards the middle of 2020, which was attributed to the pneumococcal vaccine. Pneumococcal vaccines were administered during the COVID-19 pandemic to prevent morbidity and mortality from co-/secondary infections and superinfections. Similar ongoing studies on vaccine-dispensing patterns in the post-COVID-19 era are necessary, especially since the outbreak of various vaccine-preventable diseases has recently been observed. Full article

This study aims to reconstruct NDI45 missing values due to cloud cover while outlining the importance of vegetation health for the climate–carbon cycle and the benefits of the NDI45 index for high canopy area indices. The methods include a novel hybrid framework that combines a deterministic Kalman filter (KF) and a clustering-based LSTM network to generate gap-free NDI45 series with 20 m spatial and 5-day temporal resolution. The innovation of the applied method relies on achieving a single-sensor workflow, provides a pixel-level uncertainty map, and minimizes LSTM overfitting through clustering based on a correlation threshold. In the northern Pampas (South America), this hybrid approach reduces the MAE by 22–35% on average and narrows the 95% confidence interval by 25–40% compared to the Kalman filter or LSTM alone. The three-dimensional spatio-temporal analysis demonstrates that the KF–LSTM hybrid provides better spatial homogeneity and reliability across the entire study area. The proposed framework can generate gap-free, high-resolution NDI45 time series with quantified uncertainties, enabling more reliable detection of vegetation stress, yield fluctuations, and long-term resilience trends. These capabilities make the method directly applicable to operational drought monitoring, crop insurance modeling, and climate risk assessment in agricultural systems, particularly in regions prone to frequent cloud cover. The framework can be further extended by including radar backscatter and multi-model ensembles, thus providing a promising basis for the reconstruction of global, high-resolution vegetation time series. Full article

Relevance: Obstructive sleep apnea (OSA) is a major public health problem with significant social and economic consequences. With increasing prevalence associated with urbanization and aging, untreated OSA is a considerable burden to the healthcare system, work productivity, and accident costs. Objectives: To analyze the global socioeconomic burden of OSA and evaluate epidemiological, economic, and healthcare policy perspectives across different regions and income levels. Materials and Methods: We conducted a narrative comprehensive review of published studies and WHO reports, covering direct medical costs, indirect social costs, and the cost-effectiveness of both existing and emerging diagnostic and therapeutic techniques. Results: OSA is estimated to afflict some 936 million adults around the world, and if it remains untreated, OSA results in 2.5 times higher healthcare costs compared to non-OSA individuals. The annual societal cost of untreated OSA in the U.S. now exceeds USD 150 billion, when considering direct medical expenses, productivity losses, and accident-related costs. Recent studies also highlight significant global costs, with annual per-patient estimates up to EUR 28,000 in the U.S. and EUR 1700–5000 in Europe. The inequality of treatment access continues between the affluent and the poor regions. Novel approaches as AI diagnostics and telemedicine, hold promise for reducing costs and improving treatment adherence among underserved populations with limited access to conventional care. Discussion: This review underscores the importance of uniform care throughout the world, timely diagnosis initiatives using portable technology, and scalable technological solutions to help reduce the social toll of OSA. Policymaker support, public education campaigns, and insurance changes are necessary to optimize both the cost and effectiveness of OSA management worldwide. Full article

Background/Objectives: Later-stage melanoma at diagnosis is associated with increased mortality. Health care access, socioeconomic status, and neighborhood-level factors likely influence stage at presentation. This study aimed to examine whether neighborhood disadvantage, as measured by the Area Deprivation Index (ADI), is associated with later-stage melanoma diagnosis. Methods: We conducted a cross-sectional analysis of a retrospective cohort of 941 patients diagnosed with melanoma at a large academic medical center between 2010 and 2019. Residential addresses were geocoded and linked to ADI and rurality data. Covariates included race, ethnicity, age, gender, and insurance status. Multivariable logistic regression models with robust standard errors clustered at the census tract level were used to assess associations with melanoma stage at diagnosis. Results: Of 941 patients (63% male, 92.8% non-Hispanic White, mean age 64 years), 432 (46%) were diagnosed with late-stage melanoma. Mean ADI was higher among late-stage cases (5.4) compared to early-stage cases (3.3) (p < 0.001), even after adjustment for covariates. Non-Hispanic White race, private insurance, older age, and urban residences were associated with earlier stage at diagnosis. Racial disparities were attenuated after adjusting for ADI, with no significant interaction between race and ADI. Conclusions: Neighborhood disadvantage is significantly associated with later-stage melanoma diagnosis and contributes to observed racial and socioeconomic disparities. These findings highlight the need for targeted educational interventions and health policy initiatives to reduce late-stage melanoma diagnoses in vulnerable populations. Full article

Designing fair and sustainable pricing mechanisms for health insurance requires accurate risk assessment and the formulation of incentive-compatible strategies among stakeholders. This study proposes a hybrid framework that integrates machine learning with game theory to determine optimal, risk-based premium rates. Using a comprehensive dataset of insured individuals, the XGBoost algorithm is employed to predict medical claim costs and calculate corresponding premiums. To enhance transparency and explainability, SHAP analysis is conducted across four risk-based groups, revealing key drivers, including healthcare utilization and demographic features. The strategic interactions among the insurer, insured, and employer are modeled as a repeated game. Using the Folk Theorem, the conditions under which long-term cooperation becomes a sustainable Nash equilibrium are explored. The results demonstrate that XGBoost achieves high predictive accuracy (R² ≈ 0.787) along with strong performance in error measures (RMSE ≈ 1.64 × 10⁷ IRR, MAE ≈ 1.08 × 10⁶ IRR), while SHAP analysis offers interpretable insights into the most influential predictors. Game-theoretic analysis further reveals that under appropriate discount rates, stable cooperation between stakeholders is achievable. These findings support the development of equitable, transparent, and data-driven health insurance systems that effectively align the incentives of all stakeholders. Full article

Background: The present study aims to evaluate the effectiveness of ESYSTA^® (Emperra GmbH E-Health Technologies, Germany), a CE-certified digital health application made to support insulin-treated diabetes patients to improve their disease management through better self-empowerment. Methods: To evaluate the effectiveness of ESYSTA^®, data from patients who used ESYSTA^® for at least 12 months and participated in an originally prospective one-arm study were evaluated. This study was conducted in cooperation with the German health insurance company AOK Nordost (2012–2015). From a real-world data pool of insured AOK Nordost patients, a control group was matched to mimic a controlled trial that allows the use of ESYSTA^® to be compared with standard care in the context of a disease management program (DMP). Results: The study results show significant and clinically relevant reductions in HbA1c values of at least 0.4% in ESYSTA^® users after 6 months. After 12 months, users achieved, on average, an HbA1c reduction of approximately 0.7%. These reductions are more pronounced compared to the matched control group. Conclusions: The present study shows the effectiveness of the digital health application ESYSTA^®. Using a matched control group further increased the internal and external validity of the study results. Full article