Disease trends after Helicobacter pylori eradication based on Japanese nationwide claims and the health check-up database

BACKGROUND Helicobacter pylori(H.pylori)infection is a risk factor for many diseases,including peptic ulcer disease and gastric cancer.While H.pylori eradication therapy can prevent these diseases,potentially unfavorable effects of eradication therapy have also been reported in some diseases,such as gastroesophageal reflux disease(GERD),Barrett’s esophagus(BE),inflammatory bowel disease(IBD),allergic diseases,and metabolic diseases.Consequently,both positive and negative impacts should be considered when assessing the effects of H.pylori eradication therapy.AIM To compare the incidence of these diseases before and after H.pylori eradication and to comprehensively assess its effects.METHODS This retrospective cohort study used a Japanese nationwide health claims database(April 2009-March 2020),developed by the Japanese Ministry of Health,Labour and Welfare.The database contained almost all health insurance claims data issued in Japan,and specific health check-up data for individuals who took the check-ups.Descriptive statistics were used for the analyses.Patients who received primary eradication therapy were defined as those prescribed medication for H.pylori eradication.New diagnoses,defined as incidence of upper gastrointestinal diseases and IBD,and prevalence of allergic diseases were compared before and after eradication.The incidence and prevalence of each disease were also compared between the 3-year period before eradication(from the 4th to the 2nd year prior to the year of eradication)and the 3-year period after eradication(from the 1st to the 3rd year after the year of eradication)based on the age category and calendar year and month.Changes in body mass index and proportion of patients with metabolic syndrome(MS)were examined before and after eradication.RESULTS We identified 5219731 patients who received primary eradication therapy.The 65-69 years age group had the greatest number of patients in both sexes.There was no significant increase in the incidence of GERD after eradication when considering the effects of aging and reporting period.However,the incidence of BE was higher in the 3-year period after eradication than in the 3-year period before eradication for all age categories(0.02%-0.10%vs<0.01%-0.05%).The incidence of IBD and prevalence of allergic disease were also higher after eradication.In contrast,the incidence of gastric and duodenal ulcers and gastritis was reduced after eradication.In patients with at least one entry of health check-up data(1701111 patients),the percentage of patients with MS showed a slight increase following eradication(11.0%in the year of eradication and 12.2%after 5 years).CONCLUSION The results suggest that H.pylori eradication therapy reduces peptic ulcers and gastritis;however,it is associated with increased incidence of several other chronic diseases.

Herbs and management of hypertension:Claims,criticism,and challenges

Hypertension(HTN)is one of the most common chronic diseases affecting over 30%of the adult population globally,with a growing incidence rate.This article aims to identify the commonly used herbs for HTN treatment and examine their claims,criticisms,and challenges.It further aims to provide useful recommendations regarding the use of herbs for HTN treatment.HTN complications,such as coronary heart disease,stroke,peripheral vascular disease,vision impairment,and renal failure can result in morbidity and mortality.The high cost of conventional medications,which sometimes may not even be available or easily accessible with their unfavorable side effects as well as taking more than one pill per day,has led hypertensive patients,particularly those in rural areas,to explore alternative treatments such as herbal therapies.It is crucial to determine the different modes of action,doses,safety,and efficacy of herbal remedies used in combination with conventional medications to improve treatment adherence and enhance patient outcomes.

ON THE RUIN FUNCTIONS FOR A CORRELATED AGGREGATE CLAIMS MODEL WITH POISSON AND ERLANG RISK PROCESSES

This article considers a risk model as in Yuen et al. （2002）. Under this model the two claim number processes are correlated. Claim occurrence of both classes relate to Poisson and Erlang processes. The formulae is derived for the distribution of the surplus immediately before ruin, for the distribution of the surplus immediately after ruin and the joint distribution of the surplus immediately before and after ruin. The asymptotic property of these ruin functions is also investigated.

Identification of cancer patients using claims data from health insurance systems: A real-world comparative study

Objective: To evaluate the accuracy of identifying cancer patients by use of medical claims data in a health insurance system in China, and provide the basis for establishing the claims-based cancer surveillance system in China.Methods: We chose Hua County, Henan Province as the study site, and randomly selected 300 and 1,200 qualified inpatient electronic medical records(EMRs) as well as the New Rural Cooperative Medical Scheme(NCMS) claims records for cancer patients in Hua County People’s Hospital(HCPH) and Anyang Cancer Hospital(ACH) in 2017. Diagnostic information for NCMS claims was evaluated on an individual level, and sensitivity and positive predictive value(PPV) were calculated taking the EMRs as the gold standard.Results: The sensitivity of NCMS was 95.2%(93.8%-96.3%) and 92.0%(88.3%-94.8%) in ACH and HCPH,respectively. The PPV of the NCMS was 97.8%(96.7%-98.5%) in ACH and 89.0%(84.9%-92.3%) in HCPH.Overall, the weighted and combined sensitivity and PPV of NCMS in Hua County was 93.1% and 92.1%,respectively. Significantly higher sensitivity and PPV in identifying patients with common cancers than noncommon cancers were detected in HCPH and ACH separately(P<0.01).Conclusions: Identification of cancer patients by use of the NCMS is accurate on individual level, and it is therefore feasible to conduct claims-based cancer surveillance in areas not covered by cancer registries in China.

Real-world treatment patterns of gastrointestinal neuroendocrine tumors: A claims database analysis

AIM To describe real-world treatment patterns of gastrointestinal neuroendocrine tumors(GI NET).METHODS In this retrospective cohort study,we used 2009-2014 data from 2 United States commercial claims databases to examine newly pharmacologically treated patients using tabular and graphical techniques. Treatments included somatostatin analogues(SSA),cytotoxic chemotherapy(CC),targeted therapy(TT),interferon(IF) and combinations. We identified patients at least 18 years of age,with ≥ 1 inpatient or ≥ 2 outpatient claims for GI NET who initiated pharmacologic treatment from 7/1/09-6/30/14. A 6 mo clean period prior to first treatment ensured patients were newly treated. Patients were followed until end of enrollment or the study end date,whichever was first.RESULTS We identified 2258 newly treated GI NET patients: mean(SD) age was 55.6 years(SD = 9.7),47.2% of the patients were between 55 and 64 years,and 48.8% were female. All regions of the United States were represented. 59.6% started first-line therapy with SSA monotherapy(964 with octreotide LAR,380 with octreotide SA,and 1 with lanreotide),33.3% CC,3.6% TT,and 0.5% IF. The remainder received combinations. Mean follow up was 576 d. Overall mean first-line therapy duration was 361 d(449 d for SSA,215 for CC,267 for TT). 58.9% of patients had no pharmacological treatment beyond first line. The most common secondline was combination therapy with SSA. In graphical pattern analysis,there was no clear pattern visible after first line therapy.CONCLUSION In this study,60% of patients initiated treatment with SSA alone or in combination. The relatively long time to discontinuation suggests possible sustained effectiveness and tolerability.

Climate Change and Heavy Rainfall-Related Water Damage Insurance Claims and Losses in Ontario, Canada

The objective of this paper was to project possible impacts of climate change on heavy rainfall-related water damage insurance claims and incurred losses for four selected cites (Kitchener-Waterloo, London, Ottawa, and Toronto) located at Ontario, Canada. To achieve this goal, the future climate change scenarios and rainfall simulations, at local scale, were needed. A statistical downscaling method was used to downscale five global climate model (GCM) scenarios to selected weather stations. The downscaled meteorological variables included surface and upper-air hourly temperature, dew point, west-east and south-north winds, air pressure, and total cloud cover. These variables are necessary to project future daily rainfall quantities using within-weather-type rainfall simulation models. A model result verification process has been built into the whole exercise, including rainfall simulation modeling and the development of downscaling transfer functions. The results of the verification, based on historical observations of the outcome variables simulated by the models, showed a very good agreement. To effectively evaluate heavy rainfall-related water damage insurance claims and incurred losses, a rainfall index was developed considering rainfall intensity and duration. The index was evaluated to link with insurance data as to determination of a critical threshold of the rainfall index for triggering high numbers of rainfall-related water damage insurance claims and incurred losses. The relationship between rainfall index and insurance data was used with future rainfall simulations to project changes in future heavy rainfall-related sewer flood risks in terms of water damage insurance claims and incurred losses. The modeled results showed that, averaged over the five GCM scenarios and across the study area, both the monthly total number of rainfall-related water damage claims and incurred losses could increase by about 13%, 20% and 30% for the periods 2016-2035, 2046-2065, and 2081-2100, respectively (from the four-city seasonal average of 12 ± 1.7 thousand claims and $88 ± $21 million during April-September 1992-2002). Within the context of this study, increases in the future number of insurance claims and incurred losses in the study area are driven by only increases in future heavy rainfall events.

Shorebirds, Stakeholders, and Competing Claims to the Beach and Intertidal Habitat in Delaware Bay, New Jersey, USA

Birds have specific habitat needs as a function of their life cycle and reproductive stage. Migrant shorebirds that may fly from the Arctic to the southern tip of South America have foraging and habitat requirements at sites where they stop to refuel before continuing their migration north or south. Throughout the world, shorebirds mainly forage on mudflats at low tide. Red knots (Calidris canutus rufa) are threatened in the United States and elsewhere, and it is critical to determine factors that might contribute to their decline. This paper uses Delaware Bay as a case study to examine shorebird (and red knot) use of the intertidal habitat, and competing claims to habitats they require during their northward migration, as well as some of the key stakeholders that play a role in protecting red knots. Shorebirds are drawn to Delaware Bay to feed on the eggs of Horseshoe Crabs (Limulus polyphemus) that are concentrated at the high tide. But they also feed on the intertidal mudflat. We examined intertidal habitat use on 17 beaches in an extensive study in 2015, and 5 key beaches in 2016. Most of the beaches were longitudinal, but four were more complex, and were used extensively for resting as well as foraging;numbers there were higher than on the longitudinal beaches. On foraging beaches, some shorebirds were present on over 85% of the intertidal censuses, and red knots were present on over 48% of the intertidal censuses. Average numbers of red knots on the longitudinal beaches varied from 0 to 354 ± 116 when any shorebirds were present, but averaged up to 1184 ± 634 when knots were present in 2015. Some beaches in 2015 had no knots (a beach with long-term aquaculture). Tide, intertidal location, and beach (name) determined the number of knots (and all shorebirds). Numbers decreased with distance from the mean high tide line. The average number of knots present in the intertidal mudflats two hours before or after low tide when knots were present (e.g. no censuses with zeros) was 2040 (=maximum flock size, in 2015). Major threats to red knots are from recreationists, overfishing of horseshoe crabs (reduction in egg prey base), and use of the intertidal by aquaculture. We discuss the role of stakeholders in conservation and protection of red knots.

Asymptotics of discounted aggregate claims for renewal risk model with risky investment

Under the assumption that the claim size is subexponentially distributed and the insurance surplus is totally invested in risky asset, a simple asymptotic relation of tail probability of discounted aggregate claims for renewal risk model within finite horizon is obtained. The result extends the corresponding conclusions of related references.

Applications of Mogulskii, and Kurtz-Feng Large Deviation Results to Risk Reserve Processes with Aggregate Claims

In this paper we examine the large deviations principle (LDP) for sequences of classic Cramér-Lundberg risk processes under suitable time and scale modifications, and also for a wide class of claim distributions including (the non-super- exponential) exponential claims. We prove two large deviations principles: first, we obtain the LDP for risk processes on D∈[0,1] with the Skorohod topology. In this case, we provide an explicit form for the rate function, in which the safety loading condition appears naturally. The second theorem allows us to obtain the LDP for Aggregate Claims processes on D∈[0,∞) with a different time-scale modification. As an application of the first result we estimate the ruin probability, and for the second result we work explicit calculations for the case of exponential claims.

Anesthesia Related Closed Claims and Litigations at the Detroit Medical Center: Analysis, Lessons Learned, and Conclusions

The analysis of closed claims and litigations can provide an invaluable tool to improve patient safety by minimizing adverse anesthesia-related outcomes. Analysis of collective data describing such claims is integral to develop new guidelines aimed to reduce adverse anesthesia-related events. In this study, we give a descriptive analysis of anesthesia-related claims at the Detroit Medical Center, Detroit, MI, USA. The study analyzed different components in anesthesia-related closed claims and litigations such as medical, demographic and socio-economic factors. From 67,000 procedures in anesthesiology care provider, related cases claims were made in 0.057% (38/67,000) of all cases. The majority of claims involved procedures involving Caucasian females aged 51-55 years. The highest risk periods involved early shift times during Monday and Tuesday, particularly of procedures performed during August. About 33% of all cases in which death occurred involved patients who received an Obstetrics/Gynecology or an Orthopedic procedure under general anesthesia. The majority of closed claims and litigations cases were distributed between procedures treating nerves injuries and anoxic encephalopathy. The OR and PACU at urban hospitals had the highest claim rates. MD anesthesiologists constituted the lowest proportion of all anesthesia providers involved in closed claims incidents. The average compensation paid was predominately in the range of $200,000-$250,000. In addition to reporting anesthesia related factors involved in closed claims and litigations this study also includes a series of recommendations which may work as a framework for improving anesthesia practices.

Impact of relative contraindications on the use, benefits, and risks of anticoagulant prophylaxis in atrial fibrillation: analysis of a claims database

Background: Many individuals with atrial fibrillation (AF) do not receive recommended anticoagulant prophylaxis for stroke prevention. The study investigators attempted to assess whether the presence of relative contraindications (RCIs) to anticoagulation with warfarin might contribute to this, and to assess the risks and benefits of prophylaxis in patients with RCIs. Methods: Study investigators identified patients with established non-valvular AF and flutter in a claims database. Operationally defined RCIs included, in order of clinical severity: (1) prior intracranial hemorrhage;(2) gastrointestinal bleeding or esophageal varices;(3) neurological disorder;and (4) dizziness. Nonfatal events were attributed to warfarin if patients had an appropriate claim in the previous month. Results: A total of 67,082 AF patients were eligible for analysis, including 50,485 (75.3%) in the prevalent cohort. Warfarin exposure during the study period was 68% in the prevalent cohort. At baseline, 50.5% of prevalent cohort patients had one or more RCIs. Patients with RCI had higher prevalence of stroke risk factors (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, and prior stroke or transient ischemic attack) compared to those without RCI. Patients with RCIs often received warfarin and had lower rates of ischemic stroke than those who did not. Conclusions: These results suggest that RCIs do not account for underutilization of anticoagulant prophylaxis in AF patients. Further, the benefit/risk aspects of anticoagulation for stroke prophylaxis may be favorable for many patients with RCIs.

Claims in International Construction Contract: A Case Study

Claims in international civil engineering projects sometimes will have impact on implementing the contract successfully. in order to observe and evaluate the contract claim situation and give guideline to all the contractual roles to settle the claims comfortably, this paper devote the research and literate review to find the key problems in contract claim management and give recommendation accordingly. With this focused objective, this paper presents a research analysis based on randomly selected data from international construction organization. The contract claim case studies analyzed by sampling survey scientific research method that follows a research strategy of specific to general. In the beginning, the paper analyzes the elements of contract claim administration,and then provides the general overview of the contract claim. Finally, it numerates the claim causes usage through cases studies under different contract condition of FIDIC. In addition to these discussions, analysis of other secondary data and recommendations forwarded to explain how claims should handle properly. During the thesis research period,there were 14 simple random selected projects have been studied as a case studies. From studied projects,the time extension in average, exceed 117.7% of its original contract completion time and the cost compensation increase 34.8% comparing to its initial contract value. Thus, the main causes of the majority contract claim problem lies on the failure in contract claim management and on unforeseen circumstance like variation, adverse climate, right of way problems, etc. Finally this thesis contributes to the improvement of contract claim management construction industry and open ways for further researches related to claim management.

The Study of Construction Claims for International Project under FIDIC Conditions of Contract

Claims over contracts in the building,engineering and construction industry are become common issues in business today.The text aims at presenting the key concepts of construction claim,and construction claim management,focusing on the common classifica tion.In addition,it introduces some measures trying to prevent the event of claim.The result from the text can help the contractors im prove their weaknesses and maintain their strengths of their claim management process.Meanwhile,it also gives some measures for owner to prevent the contractor's claim.

The Latest Status and Progress of Domestic and Foreign Regulations on Cosmetic Efficacy Claims

The supervision and administration of cosmetics and its two supporting documents related to efficacy,cosmetics classification rules and classification catalogue and evaluation standard of cosmetic efficacy claims,have been successively introduced and implemented,making China’s cosmetics industry officially enter the era of efficacy evaluation.In the time window when the new era is coming,the definitions of cosmetics in China and other countries are compared.The latest status and progress of regulations on cosmetic efficacy claims in China and other countries are summarized,and the standard methods or guidance of cosmetic efficacy evaluation at home and abroad are introduced.The enlightenment from the supervision systems of cosmetic efficacy in other cosmetic consumer markets around the world are discussed.In addition,the opportunities and challenges for cosmetic enterprises under the background of cosmetic law reform in China are also prospected.

EXPECTED PRESENT VALUE OF TOTAL DIVIDENDS IN THE COMPOUND BINOMIAL MODEL WITH DELAYED CLAIMS AND RANDOM INCOME

In this paper, a compound binomial model with a constant dividend barrier and random income is considered. Two types of individual claims, main claims and by-claims, are defined, where every by-claim is induced by the main claim and may be delayed for one time period with a certain probability. The premium income is assumed to another binomial process to capture the uncertainty of the customer＇s arrivals and payments. A system of difference equations with certain boundary conditions for the expected present value of total dividend payments prior to ruin is derived and solved. Explicit results are obtained when the claim sizes are Kn distributed or the claim size distributions have finite support. Numerical results are also provided to illustrate the impact of the delay of by-claims on the expected present value of dividends.

Arbitrage-free interval of American contingent claims under proportional transaction cost

In a general continuous-time market model with proportional transaction costs, we derive the range of arbitrage-free prices of American contingent claims. Using a martingale approach, we obtain the upper and the lower hedging price of American contingent claims.

On the Expected Present Value of Total Dividends in a Risk Model with Potentially Delayed Claims

In this paper, we consider a risk model in which two types of individual claims, main claims and by-claims, are defined. Every by-claim is induced by the main claim randomly and may be delayed for one time period with a certain probability. The dividend policy that certain amount of dividends will be paid as long as the surplus is greater than a constant dividend barrier is also introduced into this delayed claims risk model. By means of the probability generating functions, formulae for the expected present value of total dividend payments prior to ruin are obtained for discrete-type individual claims. Explicit expressions for the corresponding results are derived for K n claim amount distributions. Numerical illustrations are also given.

Pursuing a smoke-free generation

The United Kingdom may soon become a world leader in forging a smoke-free generation.Last month,the country passed a bill that bans the sale of cigarettes to anyone born in 2009 or later.The prime minister claims the policy will"phase out smoking in young people almost completely as early as 2040."A final vote by Parliament is expected next month.Tobacco claims 8 million lives every year,and could claim a billion lives over this century-mostly in low-and middle-income countries.For every person that dies,at least 30 more suffer from smokingrelated chronic disease.The benefits of a tobacco-free society would be transformational.

A Future Beyond Imagination

The renewal and cultural revival of its two mother rivers has made Shanghai more beautiful,and now,it must acquire new industrial muscle as well.WHEN American historian Jeffrey Wasserstrom came to Shanghai in March 2009,a year before the World Expo 2010,he exclaimed,“Shanghai’s future is beyond imagination.”At that time,Shanghai had carried out riverbank management in some sections of the Huangpu River,one of the two mother rivers of the city,and restored its cultural functions.

LIVING A HAPPY LIFE,ENJOYING THE PRIMARY HUMAN RIGHT

Seventy-five years after the UN proclaimed the Universal Declaration of Human Rights as a common standard of achievements for all people and all nations,China has carved out a unique path of human rights development with historic achievements,lifting hundreds of millions of people out of poverty.In China,human rights are no abstract concept but tangible progress seen in the improvement of people’s life and life expectancy.The development and practice of human rights in China has four distinctive features:it is people-centric,autonomous,comprehensive,and sustainable.In particular,people’s rights to subsistence and development has been guaranteed,their right to be the masters of their country is better reflected,and the rights of all ethnic people and all groups have been more comprehensively fulfilled.