Riascos-Ochoa J, Tocaruncho-Ariza L. H, Jimenez-Barbosa W. G
Introduction Health systems worldwide are struggling to ensure the affordability of medicines. Prescription, dispensing, and pharmaceutical expenditures are key variables that highlight the need to understand how global scientific evidence is generated against factors (implicit and non-explicit) that influence these variables. Objectives Explore and provide a detailed description of the characteristics of the global scientific production of Open Access articles related to the prescription, dispensing and pharmaceutical expenditure faced by health systems worldwide. Methods A five-stage scientometric mapping was performed based on a systematic search of 8 databases. The five stages are: i) retrieval, ii) migration, iii) analysis, iv) visualization and v) interpretation. Results A corpus of evidence from 103 systematic literature reviews was obtained, screened and sifted, visualizing the countries, authors, databases, journals, institutions and time periods that contributed most to evidence generation. Central research themes are identified and phenomena related to article publication are discussed. Conclusions The analysis reveals a clear leadership of the United Kingdom and the United States in scientific production on prescribing, dispensing and pharmaceutical expenditure in health systems worldwide. This scientific production is mainly focused on financing policies, pharmaceutical incentives and interventions, and rational use of medicines. There is also evidence of the scarcity of scientific production in Latin American publications and authors, which could generate interest for future research.
Benedetta Gottardelli, Roberto Gatta, Leonardo Nucciarelli
et al.
Abstract Background Artificial intelligence (AI) has become a pivotal tool in advancing contemporary personalised medicine, with the goal of tailoring treatments to individual patient conditions. This has heightened the demand for access to diverse data from clinical practice and daily life for research, posing challenges due to the sensitive nature of medical information, including genetics and health conditions. Regulations like the Health Insurance Portability and Accountability Act (HIPAA) in the U.S. and the General Data Protection Regulation (GDPR) in Europe aim to strike a balance between data security, privacy, and the imperative for access. Results We present the Gemelli Generator - Real World Data (GEN-RWD) Sandbox, a modular multi-agent platform designed for distributed analytics in healthcare. Its primary objective is to empower external researchers to leverage hospital data while upholding privacy and ownership, obviating the need for direct data sharing. Docker compatibility adds an extra layer of flexibility, and scalability is assured through modular design, facilitating combinations of Proxy and Processor modules with various graphical interfaces. Security and reliability are reinforced through components like Identity and Access Management (IAM) agent, and a Blockchain-based notarisation module. Certification processes verify the identities of information senders and receivers. Conclusions The GEN-RWD Sandbox architecture achieves a good level of usability while ensuring a blend of flexibility, scalability, and security. Featuring a user-friendly graphical interface catering to diverse technical expertise, its external accessibility enables personnel outside the hospital to use the platform. Overall, the GEN-RWD Sandbox emerges as a comprehensive solution for healthcare distributed analytics, maintaining a delicate equilibrium between accessibility, scalability, and security.
Computer applications to medicine. Medical informatics
Olena Zarutska, Roman Pavlov, Tetiana Pavlova
et al.
This article examines the peculiarities of the management of assets and liabilities of Ukrainian banks in the conditions of significant structural transformations of the resource base during the period of martial law. The analysis is carried out at the level of homogeneous structural and functional groups of banks (SFGBs), which are formed using published reporting data and the application of Kohonen's self-organizing map (SOM). Accumulation of statistical data has been carried out for 5 years, special attention is paid to structural changes in the resource base and directions of placement of bank assets over the past two years.
Over the past two years, the bank has been under the influence of shock factors affecting assets and liabilities. At the beginning of 2022, there was an outflow of funds from bank accounts, which was gradually compensated by the inflow of current funds from corporations and the population of individuals. In 2023, the National Bank of Ukraine actively stimulated the development of the term resource base, the basis for ensuring the growth of credit operations. Transactions with state securities continue to grow in the structure of bank assets. The priority task of the banking system remains the financial support of business, but in the conditions of a full-scale war, such development of credit operations is limited. It is expedient to study the strategy of banks by combining the structure of assets and liabilities according to similar characteristics and analyzing the dynamics of groups. Observation of homogeneous groups confirms their stable nature, features of strategy, risk profile and development priorities. It has been proven that banks within homogeneous SFGBs demonstrate similar behaviour in the formation of management strategies and reactions to internal and external shocks. At the macro level, the SOM structure allows you to quantitatively assess the main processes taking place in the banking system, conduct comparisons with maps, and identify problems and priorities in the management of bank assets and liabilities. The SFGB method allows you to evaluate the trajectory of individual banks on the map and develop recommendations for improving the strategy of managing assets and liabilities.
Bekelu Negash, Alan Katz, Christine J. Neilson
et al.
Introduction
Using data in research often requires that the data first be de-identified, particularly in the case of health data, which often include Personal Identifiable Information (PII) and/or Personal Health Identifying Information (PHII). There are established procedures for de-identifying structured data, but de-identifying clinical notes, electronic health records, and other records that include free text data is more complex. Several different ways to achieve this are documented in the literature. This scoping review identifies categories of de-identification methods that can be used for free text data.
Methods
We adopted an established scoping review methodology to examine review articles published up to May 9, 2022, in Ovid MEDLINE; Ovid Embase; Scopus; the ACM Digital Library; IEEE Explore; and Compendex. Our research question was: What methods are used to de-identify free text data? Two independent reviewers conducted title and abstract screening and full-text article screening using the online review management tool Covidence.
Results
The initial literature search retrieved 3,312 articles, most of which focused primarily on structured data. Eighteen publications describing methods of de-identification of free text data met the inclusion criteria for our review. The majority of the included articles focused on removing categories of personal health information identified by the Health Insurance Portability and Accountability Act (HIPAA). The de-identification methods they described combined rule-based methods or machine learning with other strategies such as deep learning.
Conclusion
Our review identifies and categorises de-identification methods for free text data as rule-based methods, machine learning, deep learning and a combination of these and other approaches. Most of the articles we found in our search refer to de-identification methods that target some or all categories of PHII. Our review also highlights how de-identification systems for free text data have evolved over time and points to hybrid approaches as the most promising approach for the future.
Objective: Tumor necrosis factor alpha inhibitors (TNFi) have shown substantial efficacy in alleviating and treating ankylosing spondylitis (AS). However, the heightened interest is accompanied by concerns over adverse events. In this meta-analysis, we analyzed both serious and common adverse events in patients treated with tumor necrosis factor alpha inhibitors compared with those in the placebo group.Methods: We searched for clinical trials in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data, and VIP Data. Studies were selected based on strict inclusion and exclusion criteria. Only randomized, placebo-controlled trials were included in the final analysis. RevMan 5.4 software was used for performing meta-analyses.Results: A total of 18 randomized controlled trials recruiting 3,564 patients with ankylosing spondylitis were included, with overall moderate to high methodological quality. Compared with the placebo group, the incidences showed no difference and were only slightly increased numerically for serious adverse events, serious infections, upper respiratory tract infection, and malignancies in patients treated with tumor necrosis factor alpha inhibitors. However, tumor necrosis factor alpha inhibitor treatment significantly increased the incidence of overall adverse events, nasopharyngitis, headache, and injection-site reactions in ankylosing spondylitis patients when compared with placebo.Conclusion: The available data indicated that ankylosing spondylitis patients who received tumor necrosis factor alpha inhibitors had no significantly increased risks of serious adverse events when compared with the placebo group. However, tumor necrosis factor alpha inhibitors significantly increased the incidence rate of common adverse events, including nasopharyngitis, headache, and injection-site reactions. Large-scale and long-term follow-up clinical trials are still necessary to further investigate the safety of tumor necrosis factor alpha inhibitors in ankylosing spondylitis treatment.
Seon Cheol Park,1,2 Narongkorn Saiphoklang,1,3 Jonathan Phillips,4 May-Lin Wilgus,1 Russell G Buhr,1 Donald P Tashkin,1 Christopher B Cooper,1,5 Igor Barjaktarevic1 1Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; 2Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; 3Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Thammasat University, Pathum Thani, Thailand; 4Inflammation Discovery Research, Amgen, Thousand Oaks, CA, USA; 5Exercise Physiology Research Laboratory, Department of Physiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USACorrespondence: Igor Barjaktarevic, Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA, Email IBarjaktarevic@mednet.ucla.eduIntroduction: Clinical decisions in chronic obstructive pulmonary disease (COPD) treatment often utilize serially assessed physiologic parameters and biomarkers. To better understand the reliability of these tests, we evaluated changes in commonly assessed biomarkers over 3 months in patients with clinically stable COPD.Methods: We performed an observational prospective cohort study of 89 individuals with clinically stable COPD, defined as no exacerbation history within 3 months of enrollment. Biomarkers included lung function and functional performance status, patient-reported outcomes of symptoms and health status, and blood markers of inflammation. The correlation between testing at baseline and at 3-month follow-up was reported as the intraclass correlation coefficient (ICC). “Outliers” had significant variability between tests, defined as > 1.645 standard deviations between the two measurements. Differences in clinical features between outliers and others were compared.Results: Participants with COPD (n = 89) were 70.5 ± 6.7 years old, 54 (61%) male, had a 40 pack-year smoking history with 24.7% being current smokers, and postbronchodilator forced expiratory volume in one second (FEV1) 62.3 ± 22.7% predicted. The biomarkers with excellent agreement between the initial and the follow-up measurements were FEV1 (ICC = 0.96), Saint George’s Respiratory Questionnaire (SGRQ) (ICC = 0.98), COPD Assessment Test (CAT) (ICC = 0.93) and C-reactive protein (CRP) (ICC = 0.90). By contrast, parameters showing less robust agreement were 6-minute walking distance (ICC = 0.75), eosinophil count (ICC = 0.77), erythrocyte sedimentation rate (ICC = 0.75) and white blood cell count (ICC = 0.48). Individuals with greater variability in biomarkers reported chronic bronchitis more often and had higher baseline SGRQ and CAT scores.Conclusion: Our study evaluated the stability of commonly assessed biomarkers in clinically stable COPD and showed excellent agreement between baseline and three-month follow-up values for FEV1, SGRQ, CAT and CRP. Individuals with chronic bronchitis and more symptomatic disease at baseline demonstrated greater variability in 3-month interval biomarkers.Keywords: COPD, biomarkers, stability, repeatability, variability
ZHAO Linlin, SHAO Shuang, LUO Qi, CHEN Xiaolei, DU Juan
The integration mechanism of medical treatment and prevention based on family doctor teams is a key way to break down the barrier between "medical" and "prevention". In this paper, we explain the definition and connotation of treatment-prevention integration, review the development history of family doctor teams, systematically review the typical practice strategies and the shortcomings of treatment-prevention integrationon family doctor teams in China. Measures should be taken to promote the treatment-prevention integration, including improve the talent training system, change views of "attaching importance to treatment and neglecting prevention", strengthen the organization and management, innovate the assessment and incentive mechanism, reform the medical insurance payment method, encourage diversified forms of services, etc. The study aims to provide reference for improving the quality of services and developing treatment-prevention integration in the future.
Purpose: Socioeconomic inequality may contribute to different risk factors for cancers. This study aims to analyze the socioeconomic patterns of urological cancer incidence and mortality in Taiwan. Materials and Methods: Using data from the National Health Insurance, we designed a retrospective longitudinal cohort study of 3686 subjects who were newly diagnosed with bladder cancer (BC), kidney cancer (KC), and upper urinary tract cancer (UTUC) between 2000 and 2010. We analyzed patients' characteristics and mortality among the three cancers. Results: The average age of KC diagnosis was the youngest among the cancers. Moreover, KC tends to occur in patients with higher-income occupations who reside in urban areas. Both BC and UTUC were much more prevalent in patients with less socioeconomic means and those living in rural areas. Varied comorbidities showed different distributions among urological cancers. Although the extent was most prominent in KC, both overall mortality and cancer-specific mortality of the three cancers increased every year during the follow-up period. Conclusion: Our results demonstrate different patient characteristics and mortality among BC, KC, and UTUC in Taiwan.
Introduction
The goal of this study was to evaluate the differences in urine cotinine
(UC) concentration based on the use of conventional cigarettes, e-cigarettes
(ECs), and dual product use, and determine the use of ECs in the real world.
Methods
In total, 15099 subjects were classified into non-smokers, cigarette
smokers (c-smokers), e-cigarette smokers (e-smokers), and dual users, and
their UC (a classical biomarker of smoking) values were compared. Analysis of
covariance (ANCOVA) was performed after adjusting for age, sex and job status
to analyze the differences in UC concentration in relation to type of smoking.
The reasons for using ECs and the experience of cigarette use before using ECs
were analyzed.
Results
Of the 15099 people, 76.4% were non-smokers, 20.9% c-smokers, 2.3%
dual users, and 0.4% were e-smokers. There were significant differences in UC
concentration among the groups (p<0.001). The geometric mean (GM) UC
concentration was 4.45 ng/mL. UC concentration was the highest among dual
users (GM: 1030.5, median: 1258.9 ng/mL), followed by c-smokers (GM: 842.5,
median: 1163.0 ng/mL), e-smokers (GM: 119.5, median: 309.7 ng/mL), and
non-smokers (GM: 0.8, median: 0.8 ng/mL). Among the EC users, the rate of
using ECs for health or social convenience was 81.9%. Among e-smokers, 11.4%
had never smoked previously.
Conclusions
The UC concentration was the highest among dual users. However, for
the female population, the UC concentration was the highest among e-smokers.
The vast majority of EC users were dual users. In addition, there were no
differences in the frequency of cigarette smoking between the dual user and
c-smoker groups. Consequently, EC use did not lead to a decrease in cigarette use,
but did lead to an increase in UC concentration. Therefore, in the real world, dual
users have higher cotinine levels than the other groups, which could indicate that
they take more nicotine by cigarettes or ECs, or are more addicted than others.
Diseases of the respiratory system, Neoplasms. Tumors. Oncology. Including cancer and carcinogens
In this study, we propose an efficient approach to the calculation of risk measures for an insurer's liability from writing a variable annuity with guaranteed benefits. Our approach is based on a novel application of the Hermite series expansions on the transition density of a diffusion process to the insurance setting. We compare our method with existing methods in the literature, including the analytical method, spectral method and Green's function method, and illustrate its substantial advantages in calculating risk measures for variable annuities with different guarantee structures. The improved efficiency makes our method flexible to practical implementation in reporting risk measures on a daily basis. We also conduct a sensitivity analysis of the risk measures with respect to key parameters. Keywords: Variable annuity, Guaranteed minimum maturity benefit, Guaranteed minimum death benefit, Value-at-Risk, Conditional-tail-expectation, JEL classification: G22, G32
Objectives: This study aimed to determine the patient characteristics, treatment procedures, and medical costs of methicillin-resistant Staphylococcus aureus infections in clinical practice in Japan. Methods: Using the MinaCare database of healthcare information covering nearly 3 million individuals, of which 90% were aged 20–59 years, we extracted and analyzed data of patients who were aged ⩾15 years and diagnosed with methicillin-resistant S. aureus during hospitalization between April 2010 and August 2015. Results: A total of 684 patients with methicillin-resistant S. aureus infection were listed in the database, of which 365 were eligible to be included in this study. Mean patient age was 52.9 years, and 31.5% of the patients were females. Methicillin-resistant S. aureus bacteremia was the most common methicillin-resistant S. aureus infection (32.9%) with a mean age of 48.5 years, followed by pneumonia (24.1%) with a mean age of 61.0 years and methicillin-resistant S. aureus surgical site infection (6.3%) with a mean age of 49.7 years. Vancomycin was the most frequently prescribed anti–methicillin-resistant S. aureus drug used as the first-line therapy (68.5%), followed by teicoplanin (14.2%), linezolid (7.9%), arbekacin (5.8%), and daptomycin (3.6%). The mortality rate was 11.0%, and the mean treatment duration was 13.3 days. The median total medical cost per patient was US$5083. The median treatment cost for methicillin-resistant S. aureus bacteremia was the highest among the methicillin-resistant S. aureus infections at US$9099, followed by methicillin-resistant S. aureus pneumonia at US$3676 and surgery site infections at US$2084. Conclusion: Although the proportion of patients with methicillin-resistant S. aureus is very small in the employment-based health insurance database, methicillin-resistant S. aureus bacteremia is the most common methicillin-resistant S. aureus infection in the working-age population and requires the highest medical cost. Methicillin-resistant S. aureus pneumonia is more common in the elderly and is a cause of high mortality.
[full article, abstract in English; abstract in Lithuanian]
The aim of this article is to assess the consequences of the interpretation of the terms ‘vehicle’ and ‘use of a vehicle’ in the light of the case of Damijan Vnuk v Zavarovalnica Trigalev (C-162/13) the Court of Justice of the European Union (CJEU) in accordance with the objectives set out in the Motor Insurance Directive.
Abstract Background Ghana’s National Health Insurance Scheme (NHIS) has achieved varying levels of enrolment within the regions with different rural-urban populations with associated income inequalities. This study sought to investigate the differences in the determinants of enrolment between the Greater Accra (GAR) and Western (WR) regions of Ghana to inform the NHIS reforms. Method Data from 4214 adults, 18 years and above from a household survey conducted in the two regions was analyzed. Bivariate analysis (t-test for continuous and Pearson chi-square for categorical) was performed to examine differences in respondents characteristics (socio-economic and insurance enrolment) between the two regions for the total, urban and rural samples. Logistic regression estimation was performed to establish differences in determinant of enrolment between the regions. Results Age, sex, educational level, marital status, health status and travel time to nearest health facility were identified as determinants of enrolment in both regions and among the rural and urban residents within the regions. Although the rich and richest in both regions are more likely to enroll than the poor and poorest, the odds of enrolment for the urban richest in the WR is about twice that of GAR whiles the odds of enrolment for the rural richest in the GAR is also about twice that of the WR. Those who visit public facilities in the GAR are more likely to enroll than those in WR for the total and urban samples. However, those who visit private facilities in rural communities in both regions are more likely to enroll. Conclusion Differences in the NHIS enrolment between the regions is as a result of differences in socio-economic factors that are intrinsic in the regions and impact on the inhabitants’ ability to afford insurance premium. Policymakers should determine NHIS premium differently at the district level based on socio-economic activities and income levels within the districts.
In this paper we develop a well-established financial model to investigate whether bubbles were present in opinion polls and betting markets prior to the UK’s vote on EU membership on 23 June 2016. The importance of our contribution is threefold. Firstly, our continuous-time model allows for irregularly spaced time series—a common feature of polling data. Secondly, we build on qualitative comparisons that are often made between market cycles and voting patterns. Thirdly, our approach is theoretically elegant. Thus, where bubbles are found we suggest a suitable adjustment. We find evidence of bubbles in polling data. This suggests they systematically over-estimate the proportion voting for remain. In contrast, bookmakers’ odds appear to show none of this bubble-like over-confidence. However, implied probabilities from bookmakers’ odds appear remarkably unresponsive to polling data that nonetheless indicates a close-fought vote.
The objective of this paper is to present the importance of information and communication technologies (ICT) for the development of insurance companies business, and in particular distribution of insurance products that relies on ICT, primarily the Internet. The special place here is reserved for internet marketing, which is most commonly used in insurance companies. Mobile communications introduce the biggest changes in e-commerce. Nowadays their distribution among consumers offers great opportunities for service providers. Currently, insurance companies in our country do not offer their services through this specific communication channel. However, in the very near future changes can be expected in this sphere because preconditions for such activity already exist in Serbia today. This is supported by the information that certain insurance companies in the countries in the region have already activated their first applications for smartphones, and similar applications for banking already function in Serbia.
Masoome Gholami, Amir Ashkan Nasiripoor, Mohammad Reza Maleki
<p><strong>Background and Objective:</strong> Today health perpectives has been changing widly. Now social determinants of health are more influence in disease rather than biological causes. If these determinants being ignored, achievement to health Golas would be impossible. This study was conducted to determine the relationship between Social determinants of health and access to health care in GonbadKavoos.</p><p><strong>Materials and Methods</strong>: This study was a correlation and cross-sectional. The populations were urban residents of GonbadKavoos, and the sample size was four hundred households, and the data collection tool was a questionnaire. For statistical analyze between variables these tests were used: independent sample test, Pearson correlation and ANOVA.</p><p><strong>Results</strong>: Among determinants of health, the variables like: socio-economic status of household (P<0.0001), educational level of household breadwinner (P<0.0001), family dimension (P<0.018), employment (P<0.003), residential area (P<0.001), access to internet (P<0.0001), doing exercise (P<0.0001), and having insurance (P<0.0001), had significant relationship with access to health care, spatially dental services and periodical checkup.</p><p><strong>Conclusion</strong>: Social determinants of health have very important relationship with access to health care. Then to decline these inequities in access to health care, development of social and economic equality for all people is so crucial.</p>
Using modern wound care dressings began to flourish in Indonesia. The change can be seen from the previous majority of caregivers believe the best make up wound healing environment remains dry wound began to turn into wound care with moisture balance method. This activity aims to share knowledge with the nurses in Surgical department Dr. M. Djamil Hospital Padang on the basis of modern wound care and everyday applications. This activity lasted for one day in the form of seminars and workshops attended by 60 people a surgical nurse. Materials provided not only on the basis of modern wound care, but also about the hospital regulation and health insurance (BPJS) regulations governing the use of the dressing method. Discussion and demontsrasi method used, so that nurses can better understand about modern wound care applications. In the future, need to be arranged procedural clear and an agreement from the medical and hospital pharmacy to use this method in treating injured patients, so the quality of service can be better.
Beverley M Essue, Merel Kimman, Nina Svenstrup
et al.
Objective To determine the nature, scope and effectiveness of interventions to reduce the household economic burden of illness or injury. Methods We systematically reviewed reports published on or before 31 January 2014 that we found in the CENTRAL, CINAHL, Econlit, Embase, MEDLINE, PreMEDLINE and PsycINFO databases. We extracted data from prospective controlled trials and assessed the risk of bias. We narratively synthesized evidence. Findings Nine of the 4330 studies checked met our inclusion criteria – seven had evaluated changes to existing health-insurance programmes and two had evaluated different modes of delivering information. The only interventions found to reduce out-of-pocket expenditure significantly were those that eliminated or substantially reduced co-payments for a given patient population. However, the reductions only represented marginal changes in the total expenditures of patients. We found no studies that had been effective in addressing broader household economic impacts – such as catastrophic health expenditure – in the disease populations investigated. Conclusion In general, interventions designed to reduce the complex household economic burden of illness and injury appear to have had little impact on household economies. We only found a few relevant studies using rigorous study designs that were conducted in defined patient populations. The studies were limited in the range of interventions tested and they evaluated only a narrow range of household economic outcomes. There is a need for method development to advance the measurement of the household economic consequences of illness and injury and facilitate the development of innovative interventions to supplement the strategies based on health insurance.