Search Results (5,190)

Background/Objectives: We wished to determine whether patients of providers subscribing to Health Information Exchange (HIE) services experience a reduction in emergency room visits and inpatient admissions compared to those who do not subscribe and whether the type of HIE service (online access to records via an HIE portal and/or integration with their electronic health record (EHR) and push notifications) a provider uses further impacts utilization. Methods: The research team utilized the Colorado All-Payer Claims Database (CO APCD) from 2017 to 2019, intentionally excluding the impact of COVID-19 on HIE services. A pre–post analysis was conducted 15 months before and after the provider subscribed to HIE solutions to quantify the effects when compared to control clinics. Results: Subscription to HIE solutions was associated with lower inpatient (IP) admissions than those in a control group for all insurance payer types (p = 0.001). The reduction in Medicaid patients was more pronounced when their providers subscribed to either service alone or in combination and was associated with significantly fewer ED and IP admissions than those for control clinics (p = 0.003, p < 0.05 for HIE portal alone and p < 0.0001, p = 0.002 for both HIE portal and integrated EHR solutions). HIEs enable providers to coordinate care and access patients’ previous test results and clinical histories, potentially reducing the need for high-cost emergency department and inpatient services. This, in turn, appears to substantially impact low-resource individuals, who have historically been the highest users of these services. Conclusions: HIE provider subscription is associated with a reduction in patients’ use of inpatient care after enrolling in HIE products across all insurance types. Medicaid patients experienced the most significant decrease in both emergency room (ED) visits and inpatient admissions when compared to control clinics. Full article

This paper investigates a robust optimal reinsurance and investment problem for an insurance company operating in a Markov-modulated financial market. The insurer’s surplus process is modeled by a diffusion process with jumps, which is correlated with financial risky assets through a common shock structure. The economic regime switches according to a continuous-time Markov chain. To address model uncertainty concerning both diffusion and jump components, we formulate the problem within a robust optimal control framework. By applying the Girsanov theorem for semimartingales, we derive the dynamics of the wealth process under an equivalent martingale measure. We then establish the associated Hamilton–Jacobi–Bellman (HJB) equation, which constitutes a coupled system of nonlinear second-order integro-differential equations. An explicit form of the relative entropy penalty function is provided to quantify the cost of deviating from the reference model. The theoretical results furnish a foundation for numerical solutions using actor–critic reinforcement learning algorithms. Full article

Previous studies have found that support that is uplifting in nature (i.e., positive social support) can have a positive influence on the spiritual well-being of individuals with chronic diseases. However, few studies have explored positive and negative social support’s (i.e., the individual receiving the support feeling unsupported) impact. The purpose of this study is to assess the relationship between positive and negative social support and spiritual well-being among individuals of African descent with chronic illnesses. Survey items that focused on positive and negative social support as well as spiritual well-being were obtained from a secondary dataset, the National Survey of American Life. Missing imputation models were adjusted by demographic characteristics (gender, age, income, education, marital status, employment, length of stay in the U.S., insurance, and religious service attendance). Findings from the analysis revealed a positive association between positive social support and spiritual well-being (β: 0.07, SE: 0.01, p < 0.0001). No significant associations were observed between negative social support and spiritual well-being (β: 0.01, SE: 0.01, p = 0.51). Future researchers should continue to explore the impact of social support on the spiritual well-being of individuals of African descent through the implementation of a culturally tailored program designed to reduce chronic diseases within this population. Full article

This study selects Chinese A-listed non-financial and non-insurance enterprises covering the period from 2009 to 2023 as the research sample. Utilizing the green credit interest subsidy policy (GCISP) as a quasi-natural experiment, it employs a multi-period difference-in-differences (DID) model to examine the policy effect and micro-level mechanisms through which GCISP—by coordinating fiscal subsidies with green finance—impacts corporate green innovation. The findings reveal that GCISP significantly promotes corporate green innovation. This enhancing effect is achieved through two pathways: alleviating financing constraints and reducing agency costs. The conclusions of this study provide valuable insights for refining green economic policies that harmonize green finance with fiscal subsidies, and offer reliable empirical evidence and policy implications to support corporate green transformation. Full article

Hepatitis B virus (HBV) infection is a global health concern with an estimated 254 million people with chronic HBV infection. The utilization of immunosuppressive therapies (ISTs) is increasing and expanding continuously with new agents being implemented across multiple medical disciplines. The occurrence of HBV reactivation (HBVr) during or after IST varies from 15% to 50% in HBsAg-positive individuals and can be higher than 75% after stem cell transplantation. HBVr is gaining increasing significance in contemporary clinical practice. The American Gastroenterological Association (AGA) in 2025, the European Association for the Study of the Liver (EASL) in 2025, and the Asian Pacific Association for the Study of the Liver (APASL) in 2021, published their most recent clinical guidelines as major societies in the area, which enables us to better predict and manage HBVr. This narrative review focuses on comparing these three current guidelines, highlighting key similarities and differences to provide valuable guidance for practitioners navigating the complex, sometimes conflicting recommendations, thereby aiding clinicians in their decision-making. The risk of HBVr during IST has been stratified into three categories in all three guidelines: high (>10%), moderate (1–10%), and low (<1%). The effectiveness of prophylaxis scales with baseline risk for HBV reactivation. Prophylaxis is clearly cost-effective for high-risk patients, potentially beneficial for those at moderate risk, and generally may not be justified for low-risk individuals. Entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF) are all highly effective in preventing HBV reactivation during immunosuppression and all are considered to be economically viable options for HBVr high risk patients. When selecting among these agents, safety considerations—particularly renal and bone toxicity—and insurance coverage remain the primary factors directing clinical decision-making. Full article

Background/Objectives: Pacemaker-associated heart failure (PaHF) is a recognized complication of chronic ventricular pacing, yet its long-term incidence and prognostic impact remain incompletely defined. Previous studies on PaHF have been largely limited by small sample sizes, single-center designs, and insufficient long-term or time-dependent analyses. We aimed to evaluate the incidence, clinical predictors, and mortality risk of PaHF in a nationwide real-world cohort. Methods: Using the Korean National Health Insurance Service database, we identified 32,216 patients who underwent de novo pacemaker implantation between 2008 and 2019 without prior heart failure. Results: During a median follow-up of 3.8 years, 4170 patients (12.9%) developed new-onset PaHF and 6184 (19.2%) died. PaHF was independently associated with increased all-cause mortality (adjusted hazard ratio [HR]: 3.11, 95% confidence interval [CI]: 2.93–3.32, p < 0.001), even after accounting for immortal-time bias and relevant covariates. The incidence of PaHF and its associated mortality risk both peaked within the first six months post implantation and remained persistently elevated throughout follow-up; notably, PaHF-associated mortality showed a late resurgence. Sensitivity and subgroup analyses consistently demonstrated higher mortality among patients with PaHF across a wide range of clinical characteristics. Conclusions: In this large, nationwide cohort, the development of PaHF was associated with a substantial and sustained increase in mortality risk following pacemaker implantation. Given the persistent and dynamic nature of this risk, longitudinal monitoring of cardiac function and individualized pacing strategies may be warranted to mitigate long-term adverse outcomes. Additionally, these findings provide real-world benchmarks to guide future pacing strategies and surveillance efforts. Full article

Acne is a multifactorial skin condition characterized by an infection in the pilosebaceous units in the skin. Patients with acne suffer from comedones, papules, pustules and nodules or cysts in severe cases. These clinical features might cause disfigurmentation, depression, anxiety and significantly impact the quality of life of patients. Systemic and continuous exposure of antibiotics put patients at risk of developing systemic toxicity, bacterial resistance and gut dysbiosis. Microneedles offer an innovative approach of providing targeted topical delivery of minocycline while insuring efficient permeation through skin layers. Methods: minocycline microneedles were formulated using casting method and characterized for insertion ability, mechanical strength, drug content, antibacterial activities, deposition and dissolution behavior using ex vivo full-thickness rat skin. Results: Insertion tests confirmed effective skin penetration and mechanical integrity with only 9.5% height reduction. Drug content was 673.06 ± 5.34 µg/array. Dissolution occurred within 2 min in skin, indicating user-friendly wear time. Ex vivo Franz diffusion studies showed 26% of the drug deposited into the skin, significantly higher (p = 0.0068) than the 18.3% that permeated through it. Antibacterial testing revealed strong activity against S. aureus, S. epidermidis, and C. acnes, with MIC values < 0.146 µg/mL and MBC values ranging from 9.375–18.75 µg/mL. Conclusions: The result of this research demonstrate that minocycline microneedles effectively deliver minocycline into the skin highlighting their potential as a safer and more efficient alternative for acne therapy. Full article

Background: Preventing and reducing acute exacerbations is a key objective in chronic obstructive pulmonary disease (COPD) management. Therefore, vaccination against influenza and pneumococcal disease is particularly important for this population. Under self-funded vaccination policies, the coverage rates for both vaccines among COPD patients in China are critically low. Since 2013, Shanghai has implemented a program providing one free dose of the 23-valent pneumococcal polysaccharide vaccine (PPV23) to residents aged 60 and above, whereas influenza vaccination remains self-funded. Few studies have compared influenza and pneumococcal vaccination coverage among COPD patients in China under these distinct funding strategies. Methods: This study used a stratified cluster sampling method to select COPD patients registered in the “Shanghai Community Chronic Disease Health Management System” from both urban (Xuhui) and suburban (Fengxian) districts of Shanghai. Data on demographic characteristics, medical history, physical examination results, behavioral risk factors, and vaccination records were extracted from the system. Vaccination records were verified using the “Shanghai Immunization Information System”. Descriptive analysis was conducted to assess influenza vaccine (self-funded, InfV) coverage during the 2023/2024 influenza season and cumulative PPV23 (government-funded) vaccination coverage among COPD patients. Logistic regression analysis was further employed to identify potential factors associated with InfV and PPV23 vaccination uptake in this population. Results: During the 2023/2024 influenza season, the influenza vaccination coverage under a self-funded policy was 5.87% among 1601 COPD patients in Shanghai, while the cumulative coverage of PPV23 under the government-funded program reached 52.15%. The willingness to receive PPV23 (60.40% vs. 27.55%; χ² = 350.73, p < 0.001) and the uptake among willing individuals (86.35% vs. 21.32%; χ² = 570.69, p < 0.001) were significantly higher under the free strategy compared to the self-funded InfV. For both vaccines, the primary reason for vaccine hesitancy was concern about adverse reactions, cited by over 50% of unwilling COPD patients. Multivariate analysis identified urban residence (aOR = 4.47, 95%CI: 2.86–6.98), prior PPV23 vaccination (aOR = 6.00, 95%CI: 3.43–10.49) and prior COVID-19 vaccination (aOR = 3.18, 95%CI: 1.79–5.66) as positive predictors of self-funded influenza vaccination. For PPV23 vaccination under the government-funded policy, significant factors included prior influenza vaccination (aOR = 6.89, 95%CI: 4.68–10.12), advanced age (aOR = 4.73, 95%CI: 3.68–6.09), and suburban residence (aOR = 0.37, 95%CI: 0.29–0.47). Conclusions: Influenza vaccination coverage among COPD patients in Shanghai remains critically low compared to the government-funded PPV23, highlighting the pivotal role of public funding. To address this disparity, urgent policy measures, including incorporating the influenza vaccine into publicly funded or health insurance reimbursement schemes, are essential. Full article

Background/Objectives: Excessive screen time and inadequate sleep are well-established developmental risk factors, yet limited research has examined the relationship between adherence to national sleep and screen time guidelines and language outcomes in children with mild language delays. This study examined sleep, screen time, and language outcomes in 765 children aged 1–5 with mild language delays enrolled in the Early Discovery Program. Methods: Sleep and screen time were categorized according to American Academy of Pediatrics and Caring for Our Children guidelines. Language outcomes were measured using standardized scores from the Preschool Language Scales–Fifth Edition. Results: Sociodemographic factors, including race, insurance status, and caregiver education, were significantly associated with sleep and screen behaviors. Excessive screen time was negatively associated with expressive language scores, while sleep duration showed no significant relationship. Conclusions: Findings highlight the need for early interventions that promote adherence to national health guidelines and address sociodemographic factors influencing language development in young children. Full article

Background/Objective: Elucidation of prognostic factors is key to personalizing management approach for patients with glioblastoma (GBM). In patients who are treated with conventionally fractionated radiotherapy (cvRT), sex and other demographic variables (e.g., income level) were recently found to predict for treatment outcomes. However, it is unknown whether these factors predict for outcomes in elderly or poor performance status patients who receive hypofractionated RT (hyRT). In this study, we assess the association of clinical and non-clinical factors to outcomes in GBM patients treated with hyRT concurrent with temozolomide (TMZ). Methods: The records of 61 adult patients with newly diagnosed GBM consecutively treated at our institution with post-operative hyRT (4005 cGy in 15 daily fractions) and TMZ were retrospectively analyzed. Established clinical variables as well as key demographic variables were compared using chi-squared tests. Kaplan–Meier analyses were used to compare overall survival (OS) and progression-free survival (PFS) between clinical and demographic subgroups. Multivariate modeling was performed using Cox proportional hazards regression. Results: Female and male patients composed 44.3% and 55.7% of the study population, respectively, and did not differ significantly in their clinical or tumor characteristics. Most patients were 65 years or older (85.2%), and over half resided in middle/high-income regions (55.7%) and were privately insured (55.7%). On an univariate analysis, female sex was associated with shorter OS (median 10.0 months vs. 13.3 months in males, p = 0.0224) and PFS (median 3.00 months vs. 4.60 months in males, p = 0.0134). Female sex remained significantly associated with inferior outcomes on multivariate analysis. Income level, type of insurance and marital status were not significantly associated with treatment outcomes. Conclusion: Our study is the first to report sex differences in GBM outcomes following hyRT-TMZ. Contrary to responses following cvRT-TMZ, females appear to have inferior outcomes after hyRT-TMZ versus males. Further investigation is warranted to define the optimal treatment approach for sex subgroups in GBM. Full article

Disasters caused by natural hazards, including the August 2023 floods in Slovenia and the 2020 earthquakes in Croatia, resulted in a combined damage and loss of about EUR 26 billion. Indemnity insurance covered only a small share, shifting recovery to public budgets. This review examines whether parametric insurance can provide transparent, pre-arranged, and auditable post-event liquidity to smooth public finances and support timely recovery. A structured qualitative review of peer-reviewed studies, supervisory materials, and EU and national law assesses data readiness, enforceability, and consumer protection duties. EU rules address parts of prudential and conduct risk. However, gaps persist in trigger verification, automated execution, and in the treatment of third-party trigger data sources and calculation methodologies documented for supervisory reviews and audits (no published parametric-specific accreditation standards). The core gap reflects the low take-up of catastrophe insurance rather than a low overall insurance penetration. Parametric cover is treated strictly as a complement to indemnity insurance. We outline narrowly scoped pilots using verifiable, publicly sourced triggers, version-controlled calculations, pre-tested basis risk disclosures, and reversible, auditable settlements with human oversight. Parametric designs add value only when verifiable triggers, transparent disclosures, and supervisory audits are embedded ex ante. Full article

Background/Objectives: Cancer remains a major public health concern in India, with the Northeast Region (NER) reporting the country’s highest incidence rates. In Meghalaya, a predominantly tribal state, cultural beliefs, financial hardship, and limited healthcare access significantly affect cancer diagnosis and treatment outcomes. This study explores the experiences and needs of cancer patients in Meghalaya, India, to inform culturally sensitive, patient-centred, and financially inclusive approaches to cancer care among tribal populations. Methods: A qualitative study was conducted among 19 participants (12 patients and 7 caregivers; in cases where patients were unable to communicate effectively due to physical weakness or treatment-related complications, their primary caregivers, those directly linked to the specific patients, were interviewed instead) receiving treatment at Civil Hospital, Shillong, between August and November 2023. In-depth interviews were conducted in Khasi, translated into English, and analysed thematically following COREQ guidelines. Results: Ten key themes emerged. Patients often attributed early symptoms to supernatural causes and sought traditional healers, delaying diagnosis. Many experienced fragmented care pathways, misinformation, and fear of treatment side effects. The financial burden was severe, with high out-of-pocket costs for travel, diagnostics, and medicines, despite partial relief through the Meghalaya Health Insurance Scheme. Communication about costs between patients and providers was limited, leaving families unprepared for the expenses. Emotional distress, loss of livelihood, and dependence on family support were common, while faith and spirituality served as major coping mechanisms. Conclusions: Cancer care in Meghalaya is shaped by intertwined cultural, economic, and systemic barriers. Strengthening culturally tailored health education, decentralised diagnostic services, structured financial counselling, and cost transparency can improve care delivery. Future research should adopt multi-centre, longitudinal approaches to guide equitable, patient-centred cancer policies in tribal and rural settings. Full article

Background and Objectives: Lumbar spinal stenosis (LSS) is a leading cause of disability in older adults, but the role of cigarette smoking in its development remains unclear. This study aimed to clarify the association between smoking and the incidence of LSS, with a focus on dose–response relationships and subgroup variations by age and sex. Methods: We conducted a nationwide, population-based cohort study using the Korean National Health Insurance Service database. A total of 2,123,268 adults aged ≥ 40 years who underwent health screening in 2009 were followed until LSS diagnosis, death, or 2020. Smoking status, duration, daily consumption, and pack-years were assessed. Cox proportional hazards models with progressive adjustment for demographic, lifestyle, and clinical factors were applied. Results: Over a mean follow-up of 8.2 years (17.5 million person-years), 721,909 new cases of LSS were identified. Fully adjusted models showed higher risk in former (HR 1.047; 95% CI, 1.039–1.056) and current smokers (HR 1.052; 95% CI, 1.044–1.060) compared with never smokers. A clear dose–response pattern was observed, with the greatest risk in heavy smokers (≥40 pack-years; HR 1.207; 95% CI, 1.191–1.222). Subgroup analyses indicated stronger associations among adults aged ≥ 65 years and in women. Conclusions: Cigarette smoking was independently associated with an increased risk of LSS, with risk increasing according to lifetime exposure. The findings underscore the importance of smoking cessation strategies to reduce the burden of spinal degeneration, especially in older adults and women. Full article

The purpose of this study was to assess workers’ perceptions, experiences, and strategies related to financial health, with the goal of identifying and validating a model of financial resilience aligned with theoretical and empirical fit criteria. A sequential quantitative approach was employed, combining exploratory factor analysis (EFA) to uncover latent dimensions, followed by confirmatory factor analysis (CFA) to validate the resulting structure. This dual methodology was designed to ensure both empirical robustness and theoretical coherence. The study used a non-experimental, cross-sectional design and drew on survey data from 311 employees of a sugar company in San Juan Bautista Tuxtepec, Oaxaca, selected through a non-probabilistic self-selection sampling method. The instrument, based on existing models was administered electronically. Internal consistency was assessed using Cronbach’s alpha (α), McDonald’s omega (ω), composite reliability (CR), and average variance extracted (AVE), while multivariate normality was also examined. Findings reveal that financial resilience encompasses not only recovery from financial shocks but also proactive financial behaviors such as budgeting, long-term saving, and responsible debt management. Respondents emphasized the role of credit history, insurance access, and perceived financial autonomy in promoting both financial stability and emotional well-being. These results contribute to the theoretical conceptualization of financial resilience and have practical implications for policy and financial education with a preventive and mental health-oriented perspective. Full article

Background/Objectives: Prescribing inhaled corticosteroids (ICS) to patients with bronchiectasis may be controversial. Studies investigating the association between ICS and the risk of lung cancer in patients with bronchiectasis are rare. Methods: Patients with bronchiectasis were enrolled from the National Sample Cohort Data of the National Health Insurance Service (NHIS-NSC) in Korea. Among them, patients with lung cancer were selected as the case group, and the control group was selected by matching the patient group with the propensity score at 1:5 for age, sex, and recruitment year. Kaplan–Meier analysis and Cox proportional hazards model analysis were performed to determine the risk of lung cancer associated with ICS use in patients with bronchiectasis. In addition, ICS dose–response analysis was performed to determine the risk of lung cancer in patients with bronchiectasis. Results: A total of 19,043 patients with bronchiectasis were included in the study. In patients with bronchiectasis, ICS use was associated with an increased risk of lung cancer. After adjusting for age, sex, pack-years of smoking, body mass index (BMI), household income, region of residence, and Charlson comorbidity index (CCI), ICS use was found to be significantly associated with an increased risk of lung cancer (aHR 1.40, 95% CI 1.17 to 1.67). Furthermore, we found that the cumulative incidence of lung cancer increased with the cumulative dose of ICS in patients with bronchiectasis. Subgroup analysis of lung cancer risk in patients with bronchiectasis using ICS showed that the risk of lung cancer was significantly higher in those aged 70 years or older, male, with a BMI of 23 kg/m² or higher, with a history of smoking, with a higher number of pack-years of smoking, and with a higher CCI. Conclusions: In patients with bronchiectasis, the use of ICS is associated with an increased risk of lung cancer, which is affected by the cumulative dose of ICS. Full article