Search Results (1,666)

Background/Objectives: On 1 November 2023, the Medicare Benefits Schedule (MBS) introduced major reforms to prostate-specific antigen (PSA) testing in Australia, extending the minimum re-test interval for average-risk men (item 66655) from 12 to 23 months and introducing a new annual high-risk item (66654). These changes were aimed at reducing overscreening, aligning practice with national guidelines, and improving cost efficiency; however, their real-world impact on PSA utilisation, downstream diagnostic activity, and health-system costs has not been evaluated. Methods: We performed a national, population-level analysis of all reimbursed PSA tests (items 66655 and 66654) and prostate magnetic resonance imaging (MRI) scans (item 63541) from November 2021 to October 2025 using MBS claims data. Monthly utilisation trends were examined descriptively and modelled using interrupted time-series segmented regression with Newey–West heteroscedasticity- and autocorrelation-consistent standard errors. Economic impacts were estimated using schedule fees. MRI trends were assessed to explore early signals of downstream diagnostic change. Results: Prior to the reform, average-risk PSA testing (item 66655) averaged 61,704 claims per month (median 62,526). After November 2023, utilisation fell immediately to 49,620 and stabilised at a lower mean of 44,702 claims per month (median 43,495), representing a sustained 27.6 percent reduction. High-risk PSA testing (item 66654) accounted for 130,739 claims post-reform (10.9 percent of monthly post-reform PSA activity), but the increase in high-risk testing did not offset the reduction in average-risk claims; total PSA claims fell from 61,704 to 50,149 per month (−18.7 percent). Interrupted time-series modelling confirmed a large, significant step decrease for item 66655 (−23,191 claims, 95% confidence interval (CI) −31,215 to −15,167; p < 0.001) and for total PSA testing (−16,876 claims, 95% CI −25,899 to −7853; p < 0.001). In contrast, prostate MRI utilisation increased from 3854 to 4454 monthly scans (+15.6 percent) with no significant step-change at the time of the reform (p = 0.74) but a significant acceleration in post-reform growth (+49 scans/month, p = 0.0095). The reform resulted in an estimated net saving of $2.8 million in annual PSA expenditure. Conclusions: The November 2023 MBS reforms led to a large, immediate, and durable reduction in reimbursed PSA screening among average-risk men, while high-risk testing increased modestly but remained proportionally small. Total PSA testing declined meaningfully, producing substantial cost savings for Medicare. Rising MRI utilisation indicates that downstream diagnostic activity did not fall in parallel with reimbursed PSA claims, though this trend may reflect independent drivers of MRI growth rather than preserved screening vigilance. Reductions varied by jurisdiction, with two smaller jurisdictions showing net increases over the study window, underscoring that the national pattern was not uniform. Full article

Background/Objectives: Obesity is associated with respiratory infection risk, but its relationship with post-discharge healthcare burden remains unclear. This study examined the associations of body mass index (BMI) and waist circumference (WC), evaluated separately, with hospitalization and post-discharge outcomes in analyses stratified by sex among South Korean adults with claims-defined hospitalizations involving influenza or pneumonia. Methods: This retrospective cohort study used the 2018 National Health Insurance Service (NHIS) Customized Research Database linked to health-screening data. Adults aged 20–89 years with claims-defined hospitalizations involving influenza or pneumonia were included if BMI and WC measurements were available from the most recent NHIS health-screening examination conducted within two years before the index admission. Length of stay and index hospitalization costs were summarized descriptively. Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause and pneumonia-related readmission within two years after discharge, and two-part models were used to estimate readmission-related costs, expressed in US dollars (USD). Results: The cohort included 175,774 patients, of whom 80,257 (45.7%) were male. Category-specific associations varied according to the anthropometric measure, outcome, and sex stratum. In female patients, the highest WC category had the largest estimated all-cause readmission HR (HR 1.195, 95% confidence interval 1.157–1.235), and the highest model-based mean cost of the first all-cause readmission was also observed in this category (USD 1407.4). In male patients, several higher BMI categories had lower estimated readmission HRs than the reference category; however, these estimates should not be interpreted as protective effects because competing mortality was not accounted for using competing-risk methods. Patterns for pneumonia-related readmission and costs were less consistent. Conclusions: BMI and WC showed category-specific associations with readmission, while model-based mean readmission costs varied across anthropometric categories and sex strata. Higher WC categories were associated with higher all-cause readmission HRs in the female stratum; however, the independent or incremental prognostic value of BMI and WC was not evaluated. Full article

Background/Objectives: Melioidosis is an environmentally acquired infection caused by Burkholderia pseudomallei (B. pseudomallei). Although historically framed as a tropical disease, evidence indicates that recognized risk can extend beyond classical endemic regions. This narrative review synthesized Digital Object Identifier (DOI)-verified evidence on environmental persistence, climate-sensitive risk, geographic emergence, and One Health preparedness. Methods: Structured narrative searches of PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Europe PubMed Central (Europe PMC), Crossref, and publisher records were conducted for literature available up to 19 June 2026. Forty-four DOI-verified sources were retained. Evidence categories were derived inductively by inferential function during thematic synthesis and used as a qualitative interpretive framework, not as a validated quantitative risk score. Results: B. pseudomallei persists in soil and water, survives nutrient limitation, and clusters in environmental microfoci, but the interpretive value of detection depends on viability, exposure context, and diagnostic endpoint. Rainfall, humidity, flooding, and cyclones are associated with incidence, severity, or mobilization in several settings, supporting climate-sensitive risk rather than uniform geographic spread. Case-based evidence is strongest when it separates importation, local acquisition, environmental establishment, source attribution, and animal sentinel signals. Human risk depends on exposure route, host susceptibility, diagnostic recognition, and access to prolonged antimicrobial management, whereas animal evidence is best interpreted as sentinel or common-exposure evidence unless reservoir or direct-transmission data are available. Conclusions: Melioidosis beyond the tropics requires graded evidence interpretation because environmental detection, modeled suitability, animal signals, and human cases support different levels of geographic and One Health inference; this approach links early signals to surveillance while reserving higher-confidence claims for convergent evidence. Full article

Rumors, misleading claims, and other factually risky information units may gain visibility during crises before verification processes are complete. Existing detection systems often address factual status or diffusion separately, whereas operational monitoring requires identifying units that are both factually risky and highly amplified by a forecast horizon. This paper proposes the Disinformation Diffusion Virality Risk Index (DDVRI), an explainable early-warning framework for estimating this joint risk from evidence observed during a prespecified early window. The formulation defines early histories, adjudicated factual labels, fold-specific amplification thresholds estimated without test outcomes, optional absolute amplification floors, block-structured early representations, calibrated risk scores, and capacity-constrained alerting rules. The proposed framework is evaluated using two open datasets, one focused on crisis rumors and another focused on COVID-19 health misinformation with social engagement information. The results support DDVRI as a probabilistic early-warning and prioritization methodology for rare cases that combine factual risk and high-amplification, rather than as a general fake-news classifier or an automatic moderation system. Full article

Background and Objectives: Pain has been proposed as a pathway linking chronic disease to healthcare spending, but existing estimates measure exposure, pain and cost in the same period and combine coefficients on incompatible scales. We asked how much of the disease–expenditure association runs through pain when exposure, pain and cost are separated in time. Materials and Methods: In the Korea Health Panel Survey (2019–2023; 54,845 adult person-years), chronic disease at year t, EQ-5D pain/discomfort at t + 1 and out-of-pocket payments during t + 2 were linked, conditioning on pain and payments at t. Direct and indirect effects were estimated by parametric g-computation (randomised-interventional analogues, two-part outcome model, exposure-specific adjustment sets, survey and censoring weights, false discovery rate control). Results: Among 25,692 triplets, pain/discomfort predicted the amount spent among healthcare users (cost ratio, CR 1.099, 95% confidence interval, CI 1.023–1.180) but showed no detectable association with whether care was used (odds ratio, OR 1.136, 0.918–1.406); the contemporaneous cost ratio was substantially larger (1.296), inflated by simultaneity. Three musculoskeletal conditions prospectively predicted pain (false discovery rate q < 0.001). Six conditions had indirect-effect intervals excluding zero, but none survived false discovery rate correction (minimum q = 0.19); where estimable, the proportion mediated was small (2.8% to 4.8%). Conclusions: The disease → pain and pain → payment associations are each established, but the disease-specific mediated amount is not confirmed after multiplicity correction. Contemporaneous designs overstate the indirect association; claims that pain causes a specified share of chronic disease expenditure are not supported. Full article

In May 2025, a new and welcome Pandemic Treaty was signed. The success of this treaty for the management of future pandemics depends on a re-evaluation of the importance of previous well-established treaty-based international human rights norms in controlling health crises. During the COVID-19 pandemic, public health responses globally were characterised by poor preparation, uncertainty, and hasty and sometimes perverse decisions. International human rights norms, especially health rights, and other treaty obligations were honoured more in their breach than their observance. The lessons learned from public health strategies that had integrated international human rights norms into the control and management of the HIV/AIDS pandemic were either ignored or forgotten. Early public health attempts to control the HIV/AIDs pandemic were hobbled by data breaches, travel restrictions, compulsory reporting, stigma, and misinformation about how the virus spread. This was replaced by a more successful human rights-based approach (HRBA) that used health rights indicators to identify groups susceptible to the disease but difficult to reach with conventional public health policies. The efficacy of health rights indicators and HRB methodology to remove barriers to treatment and suppress pandemics should have been seriously considered in strategies to control COVID-19. The article claims that failure to do this meant that more lives were lost than necessary and more people were left with serious long-term health effects. This article explores the practical significance of the international human rights legal framework, especially health rights, as trialled during the HIV/AIDS pandemic, for the management of COVID-19 and other pandemics. Full article

Background: Foodborne illness surveillance commonly focuses on reported outbreaks and laboratory-confirmed infections. Nationwide information on foodborne illness-related diagnoses recorded during routine healthcare encounters remains limited in South Korea. This study described the volume and distribution of claims-defined foodborne illness-related episodes and associated diagnostic category records documented in the 2023 HIRA database. Methods: This nationwide retrospective descriptive study used administrative reimbursement claims data from the Health Insurance Review and Assessment Service in 2023. Repeated qualifying encounters for the same patient were grouped into episodes using a 30-day gap rule. For the monthly analysis, each episode was counted once and assigned to the diagnostic category first recorded during the episode; other category-specific analyses used non-mutually exclusive diagnostic category records. Unique episodes were summarized by calendar month, whereas diagnostic category records were summarized by demographic characteristics, selected underlying diseases, healthcare institution type, and region. Results: A total of 6,829,577 unique claims-defined episodes generated 7,754,215 diagnostic category records because an episode could contribute to more than one diagnostic category. Unspecified records accounted for 79.3%, followed by bacterial records (12.1%), viral records (8.6%), and protozoal/other-cause records (<0.1%). Viral and unspecified records were more frequently observed in younger age groups, whereas bacterial records were concentrated among adults aged 19–64 years. Most records were associated with clinic visits (80.3%). Monthly episode counts showed variation, with the highest count observed in July and relatively high counts also observed in January, August, and September. Crude record rates based on healthcare institution location varied across regions. Conclusions: Foodborne illness-related diagnostic records were predominantly unspecified and were most frequently documented in clinics, suggesting limited etiologic specificity in routine diagnostic coding. Claims-based findings may complement existing surveillance but should not be interpreted as confirmed disease incidence or etiologic distribution. Full article

Matcha tea, a powdered green tea produced from shade-grown Camellia sinensis leaves, has gained increasing attention as both a traditional beverage and a functional food ingredient. While previous reviews have focused on its phytochemical profile and biological activities, less attention has been given to the effects of food processing and matrix interactions on matcha bioactives. This review critically synthesizes current evidence on the processing-induced transformation, stability, and digestive bioaccessibility of key matcha compounds in real food systems. The production methods, phytochemical compositions, and reported health effects are summarized, with a particular emphasis on matrix-dependent changes during processing, including catechin degradation and epimerization, caffeine retention, L-theanine stability, and chlorophyll loss. The implications of these alterations for sensory quality, safety, and gastrointestinal release are discussed. Emerging findings on gut microbiota modulation and omics-based approaches are also highlighted. Collectively, the available evidence indicates that the functional value of matcha in foods is strongly influenced by processing–matrix interactions rather than native composition alone, leading to trade-offs among health functionality, consumer acceptance, and safety. By integrating food chemistry, processing, and nutritional perspectives, this review proposes a framework to guide the rational formulation of matcha-enriched foods and align health claims with realistic processing outcomes. Full article

Background: Artificial intelligence has significantly improved the diagnosis of retinal diseases using fundus and optical coherence tomography. However, the pathway between the accuracy of the models and their clinical application is still unclear. Objective: The objective of this systematic review is to overcome this gap by correlating the quality of methodology with clinical preparation in the current studies and to critically examine the translation readiness possibility. Methods: The PRISMA-based review clearly addresses the six research questions in an organized manner. A comprehensive search is conducted across six electronic databases, resulting in a total of 883 records. After rigorous screening, a final set of 43 fundus- and OCT-based articles published between 2020 and August 2025 that passed a comprehensive eligibility criterion was selected. The selected studies are assessed using the custom AI-specific risk-of-bias assessment tool and the CLAIM checklist to measure the quality of technical reporting. The reviewer’s agreement is calculated using Cohen’s kappa, interrater reliability, and the intraclass correlation coefficient. Results: Although convolutional and hybrid deep-learning-based studies are often reported to have an accuracy of more than 95.0%, only 14.3% are truly clinically validated, and 23.1% do not include code or implementation data details. Reviewers’ agreement scores are from moderate to high (fundus-based ICC(2, 1) = 0.911, CI = [0.896, 0.923]) and (OCT based ICC(2, 1) = 0.643, CI = [0.422, 0.792]), supporting the reliability of the quality assessments. In order to combine these dimensions, we come up with a composite Technical-Clinical Integrity Index, which measures data transparency, rigor of validation, and reporting of performance. Conclusions: Retinal disease diagnosis has achieved high performance with low clinical transfer. This review provides the guidelines of a Translational Readiness Framework that can be used by researchers, clinicians, and health analytics teams to assess and implement credible artificial intelligence systems in ophthalmology. Full article

Natural mineral water standards use compositional criteria to define product identity and distinguish natural mineral water from other drinking water categories. China’s National Food Safety Standard—Drinking Natural Mineral Water (GB 8537) specifies seven alternative minimum threshold parameters for this purpose. This study assessed how these parameters function in four dimensions: regulatory identity, hydrogeological resource recognition, health-related interpretation, and label-based market communication. We compared major international regulatory frameworks, qualitatively synthesized health-related evidence, reviewed representative source-scale hydrogeological evidence from China, and analyzed label information from 150 commercial products. China’s system differs from the Codex and European Union frameworks, which emphasize source authenticity, compositional stability, permitted treatment, and disclosure, and from the United States system, which primarily defines mineral water by total dissolved solids. Regional studies showed that mineral water composition reflects site-specific combinations of lithology, geological structure, recharge, groundwater circulation, and water–rock interaction. The same parameter may occur in more than one hydrogeological setting, whereas different parameters within one groundwater system may arise through distinct geochemical processes. Health-related evidence varies substantially and should not be interpreted as establishing consumer health claims. In the label survey, metasilicic acid, TDS, and strontium were the most frequently declared parameters, while zinc and free carbon dioxide were less frequently declared. We propose a functional framework that distinguishes statutory identity, hydrogeological resource, health/safety, sensory/technical, and consumer-communication roles. This framework clarifies why the seven parameters should not be treated as functionally equivalent and provides a basis for refining natural mineral water standards and label communication. Full article

Antimicrobial resistance (AMR) is a major One Health challenge driven by antimicrobial misuse in human medicine, veterinary practice, animal production, and polluted environments. Migratory birds move among wetlands, farms, wastewater-affected habitats, landfills, and coastal ecosystems and may acquire and redistribute antimicrobial-resistant bacteria (ARB) and antimicrobial resistance genes (ARGs) across ecological and political boundaries. This perspective synthesizes evidence on exposure sources, bacterial reservoirs, resistance determinants, cross-species interfaces, and surveillance priorities while explicitly distinguishing four claims: detection or carriage, persistence in individual birds, redistribution along migratory routes, and onward transmission to recipient hosts or environments. Published studies report multidrug-resistant Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Enterococcus spp., and Campylobacter spp., with determinants including blaCTX-M, blaTEM, blaNDM, mcr, tet, sul, and qnr genes. The eight evidence groups summarized here constitute an illustrative, non-comprehensive selection; they are predominantly observational surveys or screenings, and none reconstructs a complete source–bird–destination–recipient transmission chain. Taxon-specific ecology modifies exposure: gulls and storks frequently exploit refuse and wastewater, waterfowl and shorebirds connect aquatic habitats, whereas passerines often reflect more local point-source contamination. Current evidence therefore supports migratory birds primarily as mobile sentinels and opportunistic carriers of anthropogenic AMR, while acknowledging possible natural or ancestral resistance in avian-associated microbiota. Future surveillance should combine longitudinal sampling, baseline cohorts such as pre-migratory nestlings, paired bird–water–soil–sediment sampling, whole-genome sequencing, plasmid profiling, telemetry, environmental DNA, wastewater-based epidemiology, and interoperable veterinary reporting. Practical mitigation requires antimicrobial stewardship, wastewater and landfill control, farm biosecurity, and coordinated veterinary, environmental, and public-health action. Full article

Real-world fault data for hydrogen-cooled turbogenerators are scarce and largely proprietary, which hinders data-driven health assessment aligned with severity standards. This paper proposes a standards-aligned, multi-source ordinal fusion framework and demonstrates it, as a proof of concept, on a reproducible four-domain surrogate collection. The collection combines public industrial datasets—SKAB (cooling loop), UCI-WWT (water chemistry), CARE Wind Farm A (electrical and thermal conditions)—and a physics-informed hydrogen-side stream derived from Henry’s law and a continuously stirred tank reactor (CSTR) mass balance, joined by paired sampling. The collection is a methodological benchmark, not a validated diagnostic for any specific machine. A dual-head classifier supervised by a hybrid CORN + EMD ordinal loss, a multi-stream fusion backbone, and a calibrated ensemble with per-model temperature scaling are aligned with the four-level GB/T 43188-2023 scheme (Normal/Attention/Abnormal/Serious). All methods are evaluated under a unified protocol (mean ± standard deviation over three seeds; the deterministic calibrated ensemble is reported as a single value). On 600 fused test samples, the ensemble reaches F1-macro 0.5349, Accuracy 0.6717, Cohen’s κ = 0.4713, and quadratic-weighted kappa (QWK) 0.5948, improving F1-macro by +22.4 pp over the strongest full-scale single-source baseline (InceptionTime on CARE, trained under the identical protocol), with larger rank-aware gains (+30.4 pp on κ, +36.2 pp on QWK). It further improves by +8.9 pp over the strongest cross-entropy fusion baseline retrained under the identical protocol. The results support the methodological claim that fusing four heterogeneous monitoring domains under rank-aware ordinal supervision yields coherent, standards-aligned severity grades, offering a reproducible benchmark and methodology whose transfer to real hydrogen-cooled turbogenerators remains to be validated on co-recorded plant data. Full article

Background: Dental insurance claims data are vital for research in oral health, epidemiology, and policy. However, issues like data quality, coding standards, validity, interoperability, and analytical approaches hinder their use. This review outlines these challenges. Methods: Following PRISMA-ScR and Arksey-O’Malley, we searched Web of Science, Scopus, and PubMed through April 2026 for peer-reviewed studies on dental insurance data issues. Two reviewers screened and extracted data, identifying key challenges and implications. Results: Out of 563 records, 389 remained after deduplication; 45 studies met criteria. Data sources included Medicaid, Medicare, insurers, and national systems from various countries. Six main challenges emerged: (1) coding errors and lack of standardization; (2) data validity and quality concerns; (3) interoperability and linkage barriers; (4) fraud detection issues; (5) analytical limitations; (6) policy insights on disparities. Validation showed variable accuracy, with diagnosis codes more reliable than procedure codes. Conclusions: Challenges limit data use in research and policy. Standardized coding, validation, interoperability, transparency, and causal inference are essential for leveraging these data to improve oral health research and policies. Full article

Functional fresh cheeses can serve as effective carriers of bioactive compounds and probiotic cultures. This study developed a Casu Axedu cheese fortified with olive leaf phenolics and a probiotic-candidate Lactiplantibacillus plantarum (LP) strain. Three formulations were produced from thermised sheep milk: a control (CA-I), a cheese with LP (CA-IL) and a cheese combining olive leaf extract (OLE; 20 mg GAE 100 g⁻¹ milk) and LP (CA-IOL). In all experimental cheeses, inulin was included as a dietary fibre, and lactose hydrolysis was performed to improve product accessibility for lactose-intolerant consumers. Cheeses were stored at 3 ± 1 °C for 30 days and analysed for polyphenol profile, antioxidant capacity, physicochemical and nutritional characteristics, microbiological quality, sensory properties and consumer acceptance. OLE fortification approximately doubled the total polyphenols and produced a more than threefold increase in FRAP antioxidant capacity in CA-IOL, with a high percentage of the main olive leaf phenolics retained after 30 days. Composition, fatty acid profile, vitamin A/E and cholesterol contents were unaffected by OLE and LP addition; all formulations met “high in protein” and lactose-free label criteria (according to the guidelines issued by the Italian Ministry of Health DGISAN Communication No. 27673 of 7 July 2015), and the inulin-based “source of fibre” claim was supported by formulation and mass-balance calculation. Presumptive lactobacilli remained at high counts throughout storage in the LP-containing cheeses, and OLE neither impaired the lactic microflora nor promoted coliform growth. OLE addition increased perceived bitterness, astringency and olive-like notes in CA-IOL, moderately reducing liking scores relative to those of the control among the tested consumer panel (5.25 ± 1.7 at 30 d); mean liking nonetheless remained above the neutral point of the 9-point hedonic scale. Overall, combining inulin, olive leaf extract and a probiotic-candidate L. plantarum strain enabled the production of a Casu Axedu cheese with enhanced antioxidant properties and improved nutritional features while retaining acceptable sensory quality. This approach represents a promising strategy for the valorisation of olive by-products and the development of innovative sheep milk dairy products consistent with circular economy principles. Full article

Background: Definitions of BCG-unresponsive non-muscle-invasive bladder cancer (NMIBC) have become central to therapeutic decision making and clinical trial eligibility. This perspective synthesizes regulatory frameworks with real-world observations to examine how structural conditions shape the applicability of current definitions. These definitions rely on structural prerequisites—adequate BCG exposure, routine maintenance therapy, standardized surveillance, timely access to early radical cystectomy, and complete tumour-level documentation—that are not consistently achievable across diverse health-care environments. This study examines the structural and operational factors that limit the applicability of current BCG-unresponsive criteria in real-world NMIBC care. Methods: A multilevel analysis was performed and integrated four complementary sources of evidence—regulatory frameworks, national claims datasets, multicenter clinical studies, and real-world practice observation—selected for their ability to capture distinct structural dimensions of NMIBC care. Operational assumptions embedded in contemporary definitions were compared with real-world treatment patterns. Structural barriers were categorized across macro-level system constraints, meso-level institutional practices, and micro-level clinical workflows. Results: As a result, a substantial proportion of patients cannot be classified under existing criteria because the exposure-based and time-dependent conditions required by regulatory definitions are not met in routine practice. Maintenance BCG is infrequently delivered, surveillance intervals vary widely, early radical cystectomy is limited by system-level and institutional factors, and key tumour-level variables required for classification are often missing in large-scale datasets. As a result, many patients cannot be reliably classified using existing criteria—not because of tumour biology or clinician behavior, but because the structural assumptions underlying the definitions are unmet. Conclusions: Current BCG-unresponsive criteria rely on structural conditions that are not universally present in real-world NMIBC care. These findings suggest that context-specific operational definitions, together with complementary strategies such as improving guideline implementation, enhancing data completeness, standardizing surveillance practices, and strengthening healthcare infrastructure, may help align regulatory expectations with real-world practice and support equitable access to bladder-sparing therapies. Full article