Search Results (288)

Background: Neurogenic bowel dysfunction (NBD) is a major chronic sequela of spinal cord injury (SCI) with substantial implications for rehabilitation and long-term management. However, population-level evidence describing how gastrointestinal (GI) diagnostic codes are used following SCI, particularly within administrative healthcare systems, remains limited. Methods: We conducted a nationwide retrospective cohort study using administrative claims data from the Korean National Health Insurance Service (NHIS). A total of 584,266 adults with trauma-related SCI encounters between 2009 and 2019 were identified. GI diagnostic codes—paralytic ileus (K56), irritable bowel syndrome (K58), and functional bowel disorders (K59)—were evaluated as administrative proxies for bowel dysfunction. Demographic characteristics, disability status, regional factors, and health behaviors were analyzed using multivariable logistic regression. Results: GI diagnostic codes were frequently recorded after SCI, most commonly irritable bowel syndrome (approximately 30%) and functional bowel disorders (approximately 37%), whereas paralytic ileus was uncommon. Greater disability severity, female sex, older age, and rural residence were consistently associated with higher odds of GI diagnostic coding. Physical activity showed robust inverse associations across all models. Inverse associations observed with smoking and alcohol consumption were interpreted as reflecting residual confounding or health-related selection, rather than biological protective effects. Conclusions: Patterns of GI diagnostic coding after SCI likely reflect the clinical burden and management needs of neurogenic bowel dysfunction within healthcare systems, rather than the development of new gastrointestinal diseases. These findings underscore the importance of individualized bowel management, incorporation of structured physical activity into rehabilitation programs, and equitable access to SCI rehabilitation services, particularly for individuals with greater disability or those living in rural areas. Full article

Background and Objectives: Despite substantial advances in treatment strategies for patients with type 2 diabetes mellitus (T2DM), its complication, particularly sarcopenia, has emerged as a global healthcare challenge. Pay-for-performance (P4P), an incentive-based payment scheme, has long been used to improve the quality of care; however, few studies have explored its effect on sarcopenia prevention. Therefore, we conducted a nested case–control study to investigate the association between P4P participation and the risk of sarcopenia among patients with T2DM. Materials and Methods: Using a large claims dataset, we identified individuals aged 20–70 years with newly diagnosed T2DM between 2001 and 2010 in Taiwan. All enrollees were followed up until 2013 to determine the occurrence of sarcopenia. For each case, we randomly matched two controls without sarcopenia. The risk of sarcopenia in relation to P4P participation was estimated by fitting conditional logistic regression to yield the adjusted odds ratio (aOR) and corresponding 95% confidence interval (CI). Results: A total of 3475 individuals with sarcopenia and 6948 matched controls were included. Patients enrolled in the P4P program had a lower risk of sarcopenia than their matched counterparts (aOR = 0.66; 95% CI: 0.61–0.74). Earlier P4P enrollment (within 1 year of T2DM diagnosis) and high-intensity P4P participation were associated with additional reductions in sarcopenia risk. Conclusions: Integrating P4P into routine T2DM care may help prevent sarcopenia, highlighting the importance of interdisciplinary collaboration and timely program implementation. Full article

The rapid expansion of mindfulness research has generated both enthusiasm and controversy regarding its actual clinical value. While meditation is often regarded as the central mechanism of mindfulness-based interventions, other components such as psychoeducation and informal practice may play an equally significant role in improving mental health outcomes. This critical review examines the relative contributions of these elements to the therapeutic impact of mindfulness and clarifies the extent to which its effects are comparable to established treatments, particularly Cognitive Behavioral Therapy (CBT). Evidence from meta-analyses and high-quality trials indicates that mindfulness programs achieve moderate efficacy in reducing symptoms of anxiety, depression, and stress, but effect sizes are frequently inflated by methodological limitations. Importantly, cognitive and emotional regulation skills, especially acceptance and non-judgment, appear to sustain long-term benefits more consistently than meditation alone. These findings highlight the need for rigorous longitudinal studies and component-focused designs to identify the mechanisms that drive clinical change. By distinguishing between evidence-based applications and overstated claims, this review contributes to a more balanced understanding of mindfulness and its appropriate integration into healthcare. Full article

Background: Carpal tunnel syndrome (CTS) is a common peripheral neuropathy with increasing prevalence and economic burden. This study aimed to analyze recent trends in CTS treatment patterns, healthcare utilization, and costs within the dualized healthcare system in Korea, using nationwide claim data. Methods: This cross-sectional study used data from the Korean Health Insurance Review and Assessment Service National Patient Sample (HIRA-NPS) between 2010 and 2017. Patients with a primary diagnosis of CTS (KCD-10: G56.0) were included. Descriptive analyses were performed to examine trends in patient characteristics, healthcare utilization, treatment patterns, and medical costs in Western and Korean medicine. Results: A total of 29,112 patients with CTS were analyzed. In Western medicine, diagnostic tests accounted for the highest expenditure, particularly X-ray, nerve conduction studies, and electromyography. Over time, X-ray utilization increased, while nerve conduction and electromyography tests decreased. The proportion of surgical treatment declined from 11.28% in 2010 to 8.55% in 2017, whereas Korean medicine use increased from 9.41% to 15.08%, mainly consisting of acupuncture and related procedures. Conclusions: Korea exhibited a lower CTS surgery rate than other countries, alongside a rising trend in Korean medicine utilization. These findings underscore the distinctive dual healthcare system in Korea and highlight the need for prospective studies to assess the long-term effectiveness of Korean medicine-based conservative treatments. Additionally, the results may inform national health policy decisions, including insurance coverage and resource allocation for CTS management. Full article

As treatments for multiple myeloma (MM) evolve, there is a need for real-world insights into treatment patterns and outcomes. The treatment practices and clinical outcomes in patients with MM (TOTEMM) was a database study (2018–2024) of newly diagnosed transplant-ineligible patients with MM in Argentina (TOTEMM-A) and Brazil (TOTEMM-B) in a private healthcare setting. In TOTEMM-A (n = 72) and TOTEMM-B (n = 892), 37 and 92 different drug regimens were reported, respectively. In each country, treatment duration reduced across lines of therapy (LOT) (TOTEMM-A: range, 6.2–3.4 months; TOTEMM-B: range, 4.4–3.5 months); attrition rates increased across LOT (TOTEMM-A: range, 52.8–86.1%; TOTEMM-B: range, 41.9–88.0%); triplet regimens (mainly bortezomib based) were used most frequently in first-line (1L); >75% relapsed within 12 months, regardless of the drug prescribed; over 90% of relapses occurred between 1L and second-line, and up to half of patients were rechallenged with the same drug; >65% of patients experienced disease progression after 1L; and the 1- to 5-year adjusted cumulative risk of progression or death increased across LOT (TOTEMM-A: range, 47.1–88.5%; TOTEMM-B: range, 40.4–91.7%). The rapid and marked progression underscores the urgent need for novel treatments and regimens. Full article

Background: Social media, especially Instagram, spreads nutrition-related information that often lacks scientific rigor. Many women report feeling inadequately informed about women’s health by healthcare professionals, turning to social media, increasing exposure to misinformation. Objectives: The NutriWomen platform aims to assess the quality, methodological soundness, and credibility of nutritional health claims and dietary recommendations on Instagram targeting women across different life stages. Its goal is to develop a systematic and scientifically grounded evaluation framework to assess Instagram nutrition-related claims and the methodological quality and interpretability of their supporting evidence, and to translate the results into accessible outputs that help women make informed nutrition decisions across life stages. Methods: This study follows a five-stage design Stage 1 involves a retrospective content analysis of Instagram posts containing nutrition-related claims targeted at women, identified through the “Top posts” function and screened using predefined criteria. Stage 2 assesses information quality using a validated 14-item tool. Stage 3 evaluates the scientific accuracy of claims by formulating PI(E)CO(TS) questions, selecting key outcomes, retrieving evidence from PubMed and the Cochrane Database, and appraising systematic reviews with a modified AMSTAR-2 tool incorporating GRADE ratings, when available. Stage 4 develops the NutriWomen website platform to translate assessments into accessible visual summaries. Stage 5 conducts a mixed-methods study with peri-, meno-, and postmenopausal women to explore information needs and evaluate platform usability through focus groups. Conclusions: The NutriWomen platform will be the first website to systematically publish the results of evaluations assessing the scientific quality of nutritional health claims on Instagram targeted at women across different life stages. It will provide a replicable methodology, and a digital tool designed to empower women with trustworthy nutrition information, with the potential to enhance health literacy and promote better health outcomes. Full article

Background: Adolescents and young adults (AYAs) with cancer have unique needs as they transition from childhood to adulthood. This study explored the patterns of health service use and the related costs incurred by the health care system and out-of-pocket (OOP) costs for AYAs diagnosed with cancer in Queensland, Australia. Methods: A linked administrative dataset (CancerCostMod) containing all AYA cancer survivors (n = 871; aged 15–24) diagnosed between July 2011 and June 2015 from the Queensland Cancer Registry (QCR) linked these records to Queensland Health Admitted Patient Data Collection (QHAPDC), Emergency Department Information System (EDIS), Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) records from July 2011 to June 2018. We quantified total and average health service use, associated costs, OOP costs, and costs variations across sociodemographic characteristics. Results: The public hospital costs incurred for AYAs diagnosed with cancer were higher (AUD 33.7 M) compared to private hospitals (AUD 12.6 M). The median cost per person for public admissions (AUD 9759, IQR = AUD 0–37,245). AYAs claimed 215,900 MBS items and 58,321 PBS items over a five-year period. First Nations Australians and individuals living in regional and mostly disadvantaged areas had higher public hospital admissions, associated costs, and ED admissions compared to their counterparts. Conclusions: This study revealed significant variations in healthcare costs for AYAs diagnosed with cancer. Public hospital costs were higher, with notable differences observed across sociodemographic characteristics. Full article

The increasing use of multiple medications among older adults raises concerns about potentially inappropriate medications (PIMs), which are associated with adverse health outcomes and increased healthcare costs. This study aimed to assess the prevalence and types of PIMs dispensed to older adults living in Northwest Italy using real-world pharmacy claims data. An observational, retrospective analysis was conducted on anonymized drug dispensing datasets from two local health authorities, covering individuals aged 65 years or older between 2018 and 2021. PIMs were identified according to the 2019 American Geriatrics Society Beers Criteria, focusing on drugs that are inappropriate or should be used with caution in older adults or have anticholinergic properties. Over half of older adults who received medications during the study period were dispensed at least one PIM, with stable or slight increased prevalence over time with no differences by sex or region. Proton-pump inhibitors used for more than 8 weeks and paroxetine were the most common PIMs, while furosemide and sulfonylureas were also frequently reported PIMs. These findings indicate a persistently high burden of inappropriate prescribing in older adults and highlight the need for coordinated deprescribing interventions and prescriber education to promote safer, evidence-based pharmacotherapy in aging populations. Full article

In fraud detection, centralized approaches often face challenges related to data protection, security, and potential data breaches. Such methods require sensitive healthcare and insurance data to be pooled in one location, which increases vulnerability to misuse. This paper introduces FraudNetX, a privacy-preserving fraud detection framework, by utilizing Vertical Federated Learning (VFL) to address centralized system limitations. VFL enables models to be trained collaboratively while ensuring data privacy and security through quantifiable Differential Privacy (DP) guarantees (ε = 1.0, δ = 1 × 10⁵). FraudNetX implements a noise injection based on Differential Privacy (DP) with Gaussian noise (s = 1.2) in the process of training the model to guarantee confidentiality of the personal data. This research entails two partner organizations, which are a hospital and an insurance company, in an actual VFL configuration. The model is trained on 10 communication rounds in this federated setup, and the local optimization of each client is followed by the global aggregation step. Hospitals and insurers can learn fraud patterns without sharing their data. The proposed FraudNetX is a hybrid architecture which is composed of Feedforward Neural Networks (FFNNs) and transformer encoders. An adaptive weighting strategy has been applied to handle category imbalance concern and enhance recall of a few categories which are hard to detect, especially in fraud involving minorities, balancing the recall performance. The framework also includes a decision model that uses hospital data and claim behavior to classify each claim as legitimate, under review, or fraudulent. The experimental evaluation on the real-world dataset demonstrates that FraudNetX enhances the accuracy and F1-score of fraud detection (accuracy = 99.91%, F1 = 99.94%, ROC-AUC = 0.98) but does not violate data privacy. Full article

Background: Obesity, gastrointestinal disorders, and mental health conditions are major drivers of employer healthcare expenditures, yet nutrition-focused interventions are infrequently reimbursed by health insurance. Precision nutrition, which integrates genetic, gut microbiome, biometric, and behavioral data to guide personalized dietary and lifestyle changes, may offer a scalable approach to reducing costs associated with diet-responsive conditions. Objectives: To evaluate the impact of a precision nutrition digital therapeutic on employer medical spending for diet-responsive conditions in self-insured U.S. health plans. Methods: We conducted a retrospective cohort study of medical claims from January 2022 to December 2024 across seven U.S. self-insured employers. Employees enrolled in a precision nutrition digital therapeutic (n = 258) were compared with never-enrolled peers (n = 8268). We estimated treatment effects using a two-stage difference-in-differences model with member and calendar-month fixed effects and clustered standard errors, focusing on per-member-per-year (PMPY) employer-paid medical spending overall and for predefined diet-responsive condition categories. PMPY estimates were defined conditional on months with positive employer-paid spending and therefore reflect changes in the intensity of spending among members generating claims rather than unconditional per-capita costs. Results: Enrollment in the precision nutrition digital therapeutic was associated with a −$3012 PMPY reduction in diet-responsive medical spending (p = 0.021) relative to non-enrolled peers on this conditional basis. The largest relative reductions were observed for digestive disorders (−$9240 PMPY; p = 0.029) and obesity (−$4884 PMPY; p = 0.007), with a smaller reduction for anxiety-related conditions (−$1356 PMPY; p = 0.043). Total medical spending decreased by −$4044 PMPY but this change did not reach statistical significance (p = 0.09). Conclusions: In this multi-employer claims analysis, participation in a precision nutrition digital therapeutic was associated with lower employer-paid medical expenditures for diet-responsive conditions, particularly digestive disorders and obesity. These findings suggest that precision nutrition digital therapeutics may represent a scalable strategy for employers to address the economic burden of chronic disease within self-insured health plans by reducing the intensity of medical spending among members. Full article

Introduction: Orthodontic practice, though often considered low-risk compared with other dental specialties, is increasingly exposed to medico-legal challenges shaped by the volatile, uncertain, complex, and ambiguous (VUCA) environment of modern healthcare. The aim of this review was to identify the underlying causes and typologies of malpractice claims in orthodontics. Methods: This narrative review synthesizes evidence from 2010–2024 on malpractice allegations and risk management strategies in orthodontics, with attention to the clinical, ethical, and legal dimensions. Results: The analysis of the included articles identified the most common types of malpractice allegations and the share of malpractice allegations of orthodontists in relation to other specialties; the main risks of orthodontic practice were identified, as well as risk management strategies in orthodontics. The findings highlight that most malpractice allegations are not related to medical/clinical errors, but to ethical–legislative, behavioral/relational, and perceptual/aesthetic vulnerabilities. Conclusions: This review highlights the need for physicians to focus on the acquisition of transversal skills, to have the ability to understand, adapt and respond to the rational and emotional needs of patients. This is essential in an ever-changing world, supporting healthcare professionals in maintaining professional safety. This review opens a relevant research direction on the role and impact of digital technology in the orthodontist–patient relationship, having the ability to influence the dynamics of this therapeutic relationship and the perception of the treatment outcome. Full article

This study examines how Israel’s legal and institutional arrangements, including migration policies, health-insurance eligibility rules, and safety enforcement mechanisms, shape health risks for Thai migrant agricultural workers, and identifies policy levers to mitigate preventable harm. Using a legal policy analysis informed by syndemics and labor frameworks, we mapped laws, regulatory oversight, and enforcement chains, and synthesized evidence from worker surveys, affidavits, and civil society reports to link institutional structures with barriers experienced in workplaces and healthcare settings. The findings reveal that health inequalities stem from structural design rather than isolated failures, including exclusion from public insurance, dependence on employer-based plans, employer-tied visas, opaque injury-claim procedures, fragmented oversight, absence of occupational-health surveillance, limited language access, poor housing conditions, and weak inspections. These interlocking features reinforce one another, resulting in under-reporting, delayed medical attention, and cumulative physical and psychological harm. The study concludes that structural legal and administrative reforms—rather than individual adaptation—are required to address these inequities. Policy priorities include integrating migrant workers into public insurance or ensuring equivalent coverage, decoupling residency from single employers, guaranteeing multilingual access, establishing independent health monitoring, and enforcing safety, housing standards and other social determinants of health through transparent inspections, positive incentives and meaningful sanctions. Full article

Background: Gastrointestinal (GI) disorders associated with increased gastric acid secretion, such as gastroesophageal reflux, dyspepsia, bloating, and abdominal pain, significantly impair quality of life and present a substantial healthcare burden. Conventional therapies may have limited efficacy or undesirable side effects, underscoring the need for safe complementary approaches. This study systematically identifies and reviews the medicinal plants used in food supplements (FSs) marketed in Latvia for digestive health, focusing on the conditions linked to excess gastric acid. Methods: A structured literature search was conducted to identify European plant species with proven protective effects on the digestive system or the ability to influence gastric acid levels. A market analysis was performed using the Latvian Food and Veterinary Service FS Register. Results: A total of 218 FS-containing medicinal plants were identified, of which 15 species were included in at least ten products. The most frequently used plants were peppermint (Mentha piperita), artichoke (Cynara cardunculus), fennel (Foeniculum vulgare), Milk thistle (Silybum marianum), dandelion (Taraxacum officinale), chamomile (Matricaria chamomilla), psyllium (Plantago ovata), licorice (Glycyrrhiza glabra), caraway (Carum carvi), lemon balm (Melissa officinalis), and chicory (Cichorium intybus). Label claims most often referred to supporting digestion, relieving bloating, and maintaining normal GI function. However, the majority of claims lacked robust clinical substantiation, and were based primarily on traditional use. Discrepancies between product information and available scientific evidence highlight regulatory and consumer protection challenges. Conclusions: This work contributes to the critical evaluation of plant-based FSs for digestive health, emphasizing the need for standardized preparations, harmonized health claim assessment, and further clinical research to establish efficacy and safety. Full article

Verifiable Credentials (VCs) are a core component of decentralized identity systems, enabling individuals to prove claims without centralized intermediaries. However, managing VC revocation across segregated blockchain networks remains a key interoperability challenge. In this paper, we present a bidirectional blockchain bridge that enables the cross-chain verification of VCs between two Ethereum-compatible private blockchain networks: Geth and Besu. The system allows credentials issued and revoked on one chain to be validated from another without duplicating infrastructure or compromising security. Our architecture combines on-chain smart contracts with an off-chain relay, ensuring auditable, low-latency credential checks across chains. Our proposal is validated through an open-source working prototype. It is particularly relevant for domains where independent organizations must validate shared credentials across segregated blockchain infrastructures, including education, healthcare, and governmental identity services. Full article

Background/Objectives: Cervical dystonia (CD) is the most common focal dystonia, but nationwide evidence on healthcare use is limited. This study assessed trends in utilization and expenditures in Korea. Methods: Using National Health Insurance Service claims (2017–2023), we identified CD patients (ICD-10 G24.3) and analyzed annual patients, visits, and expenditures by demographics, medical system, service type, and specialty. Results: A total of 6614 patients (33,896 claims) were included. Patient numbers declined until 2021 then slightly rebounded, and total expenditures fluctuated. Women were more prevalent, but men incurred higher costs. Western Medicine (WM) expenditures tended to increase while Korean Medicine (KM) tended to decline. Core botulinum toxin costs remained broadly stable; physiotherapy and diagnostic testing increased, particularly WM outpatient testing. Outpatient injection-related and anesthesia expenditures showed decreasing tendencies, while hospitalization and radiology exhibited modest or minimal changes. Neurology managed the most patients, while neurosurgery generated the highest costs. Conclusions: CD care in Korea showed declining patient numbers alongside overall stable total expenditures, with increasing use of rehabilitation and diagnostic services and continued stable use of botulinum toxin as a core therapy. Full article