Benefit Claims Research Articles

Evaluating the scientific evidence to support mental health and well-being claims made on probiotic products.

Increasing interest in probiotics for mental health has led to products marketed to consumers claiming psychological benefits. This study aimed to identify mental health claims on probiotic supplements and to provide a narrative review of the scientific evidence to support these claims. Probiotic supplements with mental health claims on the product label were identified. A search of the scientific literature was performed using Google Scholar, PubMed and Cochrane Central Register of Controlled Trials. Studies were included if the primary outcome was mental health or a biomarker of mental health, if they investigated the exact probiotic strain or combination of strains as present in the product, and if the study was a trial of probiotics conducted in either humans or animals. Included studies were assessed for risk of bias. Fourteen probiotic products with mental health claims were identified containing five different strains or strain combinations. Eighteen studies relevant to the products and investigating mental health outcomes met inclusion criteria. Ten studies investigated the same combination of probiotics and provided evidence to support the claims made. Statistically significant results were not universally present for all products. The amount and quality of evidence to support claims of mental health benefits made on probiotic products is variable. The results support the need for a grading system to facilitate informed consumer decision-making when choosing a probiotic supplement to support mental health.

Impact of eliminating retirement earnings test on labor supply and pension benefit claims

Impact of eliminating retirement earnings test on labor supply and pension benefit claims

Degenerative Shoulder Diseases: Shoulder Injuries, Epidemiology, ICD10, Coding.

Despite the increasing number of cases in recent years, there are currently no data available on the disease and care situation for degenerative shoulder diseases and shoulder injuries, as well as on the ICD-10 coding behaviour of the treating physicians. This paper presents, for the first time, a descriptive analysis based on billing data from 2022 of coded shoulder diseases affecting 4.9 million insured individuals of a statutory health insurance in Baden-Württemberg. The study distinguishes between accident-related shoulder injuries and diseases caused by degenerative changes in the shoulder. In ICD-10 coding, a distinction is made between specific codes (using key numbers of the underlying disease) and non-specific codes that only encode the symptom. According to billing data, women were slightly more affected by shoulder diseases than men (7.3% vs. 6.9%), with women being significantly older on average at the time of diagnosis. For fractures, the gender difference averaged 20 years. The analysis of coding behaviour revealed that general practitioners coded non-specific shoulder diseases, such as joint pain or impingement syndrome, more frequently than other specialist groups. The analysis of the claiming of benefits showed that only one-third of the evaluated patients received imaging, and only 40% received a prescription for physiotherapy due to a shoulder diagnosis. The investigation of comorbidities found that patients with degenerative shoulder diseases were more frequently affected by metabolic diseases and hypertension than those without shoulder diseases. These results regarding the frequency of coded shoulder diseases in various health sectors demonstrate their importance in the Federal Republic of Germany for both men and women. In summary, the evaluations-despite methodological limitations-suggest that there may be potential for more specific coding in the diagnosis and prescription of therapeutic measures. A more precise understanding of the actual cause of claiming health services can be helpful for the provider to initiate specific diagnostic and therapeutic measures and identify a potentially increased need for care within the health system in the Federal Republic of Germany.

Concentration and Stability of Fluoride Chemically Available in Charcoal-Containing Toothpastes

Plain Language SummaryActivated charcoal toothpastes have become popular, with claims of multiple benefits. Although most are fluoride free, others incorporate fluoride (F) into their formulations, yet the chemical availability and stability of F in these products remain unclear. Our study aimed to assess the chemical availability and stability of F in commercially fluoridated toothpastes formulated with activated charcoal. We purchased duplicate samples with different lot numbers of different brands containing F and activated charcoal (n = 20) in the USA and Chile. Three toothpastes, one non-fluoridated, one containing sodium fluoride (NaF), and another with sodium monofluorophosphate (Na2FPO3), were used as controls. Toothpastes were tested both when fresh and after their expiration date. We measured the total amount of F and available total soluble F using a F-specific ion electrode. Most toothpastes contained either NaF (70%) or Na2FPO3 (30%), and all included silica. The amount of available F in fresh toothpastes ranged between 952.6 and 1,438.1 ppm and between 925.7 and 1,493.7 ppm in expired samples. The available F stayed close to the amount listed on the labels, and most toothpastes did not form insoluble F after expiration, except the Na2FPO3-/CaCO3-based control. In conclusion, the tested toothpastes with activated charcoal present F potentially bioavailable and chemically stable to control caries. However, concerns regarding abrasiveness, as raised by other researchers, cast doubt on the suitability of these toothpastes for widespread use.

Public vs Private Bodies: Who Should Run Advanced AI Evaluations and Audits? A Three-Step Logic Based on Case Studies of High-Risk Industries

Artificial Intelligence (AI) Safety Institutes and governments worldwide are deciding whether they evaluate and audit advanced AI themselves, support a private auditor ecosystem or do both. Auditing regimes have been established in a wide range of industry contexts to monitor and evaluate firms’ compliance with regulation. Auditing is a necessary governance tool to understand and manage the risks of a technology. This paper draws from nine such regimes to inform (i) who should audit which parts of advanced AI; and (ii) how much resources, competence and access public bodies may need to audit advanced AI effectively. First, the effective responsibility distribution between public and private auditors depends heavily on specific industry and audit conditions. On the basis of advanced AI’s risk profile, the sensitivity of information involved in the auditing process, and the high costs of verifying safety and benefit claims of AI Labs, we recommend that public bodies become directly involved in safety critical, especially gray- and white-box, AI model audits. Governance and security audits, which are well-established in other industry contexts, as well as black-box model audits, may be more efficiently provided by a private market of auditors under public oversight. Secondly, to effectively fulfill their role in advanced AI audits, public bodies need extensive access to models and facilities. Public bodies’ capacity should scale with the industry's risk level, size and market concentration, potentially requiring 100s of employees for auditing in large jurisdictions like the EU or US, like in nuclear safety and life sciences.

Rejected sickness cash benefit claims after 180 days of sick leave in the Swedish rehabilitation chain: A nationwide register-based study.

Since a lack of financial security among vulnerable groups could further hamper health and well-being, this study scrutinises factors predicting rejected prolonged sickness cash benefit claims among people on compensated sick leave of more than 180 days with a rejection between days 181 and 365. All 246,872 claims for employed people on sick leave recorded in the Swedish official statistics register between January 2018 and June 2021 were analysed. Claim outcome was evaluated using logistic regression with odds ratios recalculated to relative risks (RR) with 95% confidence intervals (CI), mutually adjusted for sociodemographic, work and health-related factors. Overall, 46,611 (19%) of the claims were rejected, with slightly lower rates among women (RR=0.97; 95% CI 0.95-0.99). Musculoskeletal diseases had the highest rejection rates (RR=1.84; 95% CI 1.75-1.94) followed by injuries (RR=1.57; 95% CI 1.50-1.64) and symptoms (RR=1.51; 95% CI 1.46-1.56). Mental disorders also had above-average rates (RR=1.14; 95% CI 1.09-1.19), whereas the lowest rates were found among pregnancy-related diagnoses (RR=0.13; 95% CI 0.12-0.14) and neoplasms (RR=0.18; 95% CI 0.18-0.18). Higher rates were found among immigrants (RR=1.37; 95% CI 1.34-1.40), those with only primary education (RR=1.09; 95% CI 1.06-1.12) and among blue-collar workers. The regional variation was substantial (RR range 0.41-1.72). High rejection rates were found for complex diagnoses and diagnoses with presupposed work ability in physically lighter occupations and among groups with assumed precarious positions at the labour market. Systematic differences in rates were identified between geographic regions. More studies are warranted to conclude if the differences found could be justified by other factors.

Health Claims, Product Features and Instructions for Use on the Labels of Potassium-enriched Salt Products: A Content Analysis

BackgroundPotassium-enriched salt is a proven dietary intervention for reducing risk of stroke, cardiovascular disease, and premature mortality when used instead of regular table salt. Potassium-enriched salt products are available globally, but the on-pack health claims, product features, and instructions for use are diverse. ObjectivesThe objective of this study was to summarize the label features of potassium-enriched salt products available worldwide. MethodsA content analysis was conducted on the labels of potassium-enriched salt products available for sale in May 2023. Potassium-enriched salt products were identified through a systematic search of literature, major online shopping websites, and Google using similar keywords such as “salt substitute” or “low sodium salt.” Information on product labels was coded relating to health claims, product features, and instructions for use, and were quantitatively summarized. ResultsA total of 117 potential potassium-enriched salt products were identified, with 83 included in the final analysis after excluding products containing no sodium (n = 15), no potassium (n = 5), or that were duplicates (n = 14). There were 23 (28%) products with on-pack claims for health benefits and 36 (43%) with health warnings. Twenty-five (30%) of product labels included descriptions of other product features such as taste and potassium content, and 36 (43%) had instructions for use. ConclusionsThere was large variability in the label features of potassium-enriched salt products identified in this study. Most product labels made no health-related statements, but among those that did, warnings occurred more frequently than statements of health benefits. The diversity in labeling may cause confusion among consumers, and standardized, evidence-based labeling should be developed.

Unemployment insurance for the self-employed: A conceptual way forward

In this contribution we give common guidelines on how unemployment schemes for the self-employed could be developed in practice. These guidelines have been derived from national descriptions contained in this special edition on unemployment protection for the self-employed, or in other recent comparative contributions on the matter. Our reference framework is the EU Council Recommendation (2019) on Access to Social Protection, and more in particular the overall objective that social protection should be designed in a labour status neutral manner and, where necessary, adapted to the specific work situation of the professional groups covered. Applied to unemployment, the design of the scheme should be as similar as possible to that of unemployment insurance for wage earners. However, it is crucial to adapt the rules as specifically as necessary to the nature of self-employed work, such as, for example, the fact that the self-employed do not work for an employer. Starting from this basis, we developed key rules with regard to unemployment schemes for the self-employed. We did so by addressing the essential components of unemployment schemes: the definition of the unemployment risk, financing, access and entitlement conditions, and re-eligibility in case of repeated claims for unemployment benefits. We also address recent evolutions in the labour market, such as coverage when multiple activities are performed (combining activities as an employee and as a self-employed person), and elaborate on situations involving temporary closure of the self-employed activity (e.g. due to Covid-19) and partial unemployment. In conclusion, we provide some reflections on the apparent ongoing evolution of the risk of unemployment towards a broader income protection scheme, which not only provides income replacement in case of a final loss of professional activity or self-employed business, but also gives structural income support if the person loses income partially due to external economic and/or social reasons.

Evidence from an Applied Research Health Question (AHRQ): Physician-prescribed medications to children for oral health issues

ObjectivesTo understand changes in prescription patterns over time, and support dental and oral health program planning, Toronto Public Health issued an AHRQ request to collect information on physician-prescribed medications following an oral health-related incident. ApproachAn algorithm was created to identify oral health-related incidents among children and youth aged up to 17 years old in Ontario and Toronto during fiscal years 2013 to 2022. The algorithm used provincial data on physician visits, emergency department visits, inpatient hospitalizations, or day surgeries to define ‘dental-related incidents’. Physician-prescribed medications (e.g., chlorhexidine, opioids, benzodiazepines, antibiotics, NSAIDs and others) within seven days of a dental-related incident were recorded using Ontario Drug Benefit Claims and the Narcotics Monitoring System. ResultsOf 522,674 dental-related incidents in Ontario between 1 April 2013 and 31 March 2023, 9.2% had physician-prescribed medications (versus 8.6% of 90,810 dental-related incidents in Toronto). The proportion of incidents with prescriptions increased from 6.4% in 2013 to 10.7% in 2022 in Ontario, and from 5.9% to 10.3% in Toronto. The most prescribed medication was antibiotics, followed by immediate-release combination medications and non-long-acting medications. Conclusions/ImplicationsOver the 10-year period examined, an increasing proportion of dental-related incidents had physician-prescribed medications, which may be attributed to the implementation of Ontario’s pharmacare program (OHIP+) in 2018. Early access to routine and preventative dental care could become more accessible as part of Canada’s new federal dental program. Results from this AHRQ will inform better resource allocation in dental and oral health program planning, potentially reducing avoidable healthcare costs.

The welfare costs of misinformation

Social Security (SS) benefits, with an average replacement rate of around 40 percent, serve as an important source of retirement income for older Americans. Yet, the size of lifetime benefits a household receives depends on many factors, including the age of benefit claim and life-cycle labor supply decisions. Given the complexity of the associated rules, many households may lack understanding of one or more aspects of the system. In this work, we use a life-cycle model of consumption, savings, labor supply, and Social Security application decisions to study the welfare impact of such misinformation. Our findings indicate significant welfare losses stemming from misinformation, especially when it causes individuals to strongly over-estimate the value of future entitlements. Additionally, we show that the Social Security Statement program, a large public information campaign, must inform only 20.1 percent of misinformed individuals in order for aggregate benefits of information to outweigh aggregate costs.

Can infrared light really be doing what we claim it is doing? Infrared light penetration principles, practices, and limitations.

Near infrared (NIR) light has been shown to provide beneficial treatment of traumatic brain injury (TBI) and other neurological problems. This concept has spawned a plethora of commercial entities and practitioners utilizing panels of light emitting diodes (LEDs) and promising to treat patients with TBI and other disorders, who are desperate for some treatment for their untreatable conditions. Unfortunately, an LED intended to deliver photonic energy to the human brain does not necessarily do what an LED pointed at a mouse brain does. There is a problem of scale. Extensive prior research has shown that infrared light from a 0.5-watt LED will not penetrate the scalp and skull of a human. Both the properties of NIR light and the manner in which it interacts with tissue are examined. Based on these principles, the shortcomings of current approaches to treating neurological disorders with NIR light are explored. Claims of clinical benefit from low-level LED-based devices are explored and the proof of concept challenged. To date, that proof is thin with marginal benefits which are largely transient. Extensive research has shown fluence at the level of the target tissue which falls within the range of 0.9 J/cm2 to 15 J/cm2 is most effective in activating the biological processes at the cellular level which underlie direct photobiomodulation. If low-level infrared light from LED devices is not penetrating the scalp and skull, then these devices certainly are not delivering that level of fluence to the neurons of the subjacent brain. Alternative mechanisms, such as remote photobiomodulation, which may underlie the small and transient benefits for TBI symptoms reported for low-power LED-based NIR studies are presented. Actionable recommendations for the field are offered.

Genotoxicity of selected cannabinoids in human lymphoblastoid TK6 cells

Natural non-psychoactive cannabinoids such as cannabigerol (CBG), cannabidiol (CBD), cannabichromene (CBC), cannabidivarin (CBDV), and cannabinol (CBN) are increasingly consumed as constituents of dietary products because of the health benefits claims. Cannabinoids may reduce certain types of pain, nausea, and anxiety. Anti-inflammatory and even anti-carcinogenic properties have been discussed. However, there are insufficient data available regarding their potential (geno-)toxic effects. Therefore, we tested CBG, CBD, CBC, CBDV, and CBN for their genotoxic potential and effects on mitosis and cell cycle in human lymphoblastoid TK6 cells. The selected cannabinoids (except CBDV) induced increased micronuclei formation, which was reduced with the addition of a metabolic activation system (S9 mix). CBDV induced micronuclei only after metabolic activation. Mitotic disturbances were observed with all tested cannabinoids, while G1 phase accumulation of cells was observed for CBG, CBD and CBDV. The genotoxic effects occurred at about 1000-fold higher concentrations than are reported as blood levels from human consumption. However, the results clearly indicate a need for further research into the genotoxic effects of cannabinoids. The mechanism of the mitotic disturbance, the shape of the dose–response curves and the possible effects of mixtures of cannabinoids are aspects which need clarification.

Long-term impacts of COVID-19 in patients with prior heart failure in Korea: A nationwide cohort study using the common data model.

Limited data are available on the long-term prognosis and monitoring period after coronavirus disease 2019 (COVID-19) infection in the population with prior heart failure (HF). We aimed to exam the association of COVID-19 with clinical prognosis in populations with prior HF and evaluate prognosis within 30 days and 30 days to 1 year after infection. Based on insurance benefit claims sent to the Health Insurance Review and Assessment Service of Korea from January 2018 to April 2022, 9,822,577 patients were selected and converted to the Observational Medical Outcomes Partnership-common data model by the Big Data Department of Health Insurance Review and Assessment Service of Korea. In the dataset, 1,565,274 patients exhibited diagnosis of HF based on the International Statistical Classification of Diseases and Related Health Problems 10 codes. They were divided into 2 groups according to COVID-19 infection, and propensity-score-matching analysis was performed. The clinical outcome was all-cause mortality. Among the 1,565,274 patients with an HF diagnosis, 1,152,975 patients were classified into the HF with the COVID-19 group and 412,299 patients in the HF without COVID-19 group. We created 200,780 matched pairs by propensity-score-matching analysis. Within 30 days of COVID-19, the HF with COVID-19 group had a higher risk of all-cause death compared with the HF without COVID-19 group (hazard ratio [HR]: 2.19, 95% confidence interval [CI]: 2.04-2.36, P < .01). Thirty days to 1 year after COVID-19 infection, the HF with COVID-19 group exhibited a higher risk of all-cause death (HR: 2.04, 95% CI: 1.83-2.27, P < .01). In populations with prior HF, COVID-19 is associated with a higher risk of all-cause mortality within 30 days and this risk remains augmented up to 1 year after the acute phase of COVID-19. Our findings suggest that greater attention may be crucial in populations with prior HF for a prolonged period after COVID-19 infection.

Caitlin Clark's surprising economic impact

Increases in attendance for University of Iowa's women's basketball games caused by star player Caitlin Clark have led to claims of large economic benefits for Iowa City. This paper uses daily hotel occupancy data to analyze the visitor inflow arising from Clark's stardom. The findings show a surprising pattern: hotel occupancy did increase substantially during Clark's junior season but showed a much smaller increase during her senior season, even with considerably higher game attendance. Local fans substituting from men's games to women's games, thereby leaving fewer women's basketball seats available for out-of-town visitors, appears to explain at least some of the smaller hotel occupancy effect in Clark's senior season.

Detoxification: The science behind social media claims of detox health benefits

Detoxification: The science behind social media claims of detox health benefits Jessie R. Badley and Pamela J. Lein from the University of California, Davis, explain the science behind detoxification and the claims of detox health benefits in social media and the deception associated with it. A variety of “detoxification” therapies, supplements, and diets are being pushed on social media platforms like TikTok and Instagram as “natural” approaches for removing toxic substances from your body to promote weight loss and/or improve health and wellness.

An ‘interface first’ bureaucracy: Interface design, universal credit and the digital welfare state

AbstractThe front‐line of the welfare state is increasingly not a letter, phone call or face‐to‐face visit, but an online user‐interface. This ‘interface first’ bureaucracy is a fundamental reshaping of social security administration, but the design and operation of these interfaces is poorly understood. Drawing on interview data from senior civil servants, welfare benefits advisors and claimants on the UK's flagship Universal Credit working‐age benefit, this paper is a detailed analysis of the role played by interfaces in the modern welfare state. Providing examples from across the Universal Credit system, it sets out a five‐fold typology of user‐interface design elements in the social security context: (i) structuring data input, (ii) interaction architecture, (iii) operative controls, (iv) prompting and priming, and (v) integrations. The paper concludes by considering the implications of an ‘interface first’ welfare bureaucracy for future research.

Bonsai's Marketing Strategy Centers on Creating Customer Value

This paper contributes to a different marketing approach on how to describe value from the customer's perspective. This research examines value-based pricing by highlighting a customer-centric approach with a focus on customer value creation to explore what this literature can convey in achieving success. The research locus is the research object of the Jombang Bonsai Community FB community which has 16,645 members. with consideration: Members of the Jombang Bonsai Facebook Community Trust; Own a bonsai plant business; Join the community for at least 2 years. The qualitative approach carried out through the data analysis technique used is the Manual Data Analysis Procedure (MDAP), from the results of interviews accompanied by triangulation of sources and theories to produce findings on customer-centred approach marketing strategies including Price Formation: Product and Services, Authorization Use, Resource Access, Benefit Claim Rights, Buyer Type, Availability, Use, Results, Economic Success. As well as Mechanism Policies: Quantity, Price Formation, Price Conditions, Price Discrimination, Product Characteristics, Customer Identity, Transaction Forms, Market Laws.

Long COVID and financial outcomes: evidence from four longitudinal population surveys

BackgroundLong-term sequelae of COVID-19 (long COVID) include muscle weakness, fatigue, breathing difficulties and sleep disturbance over weeks or months. Using UK longitudinal data, we assessed the relationship between long COVID...

Viability and Diversity of the Microbial Cultures Available in Retail Kombucha Beverages in the USA.

Kombucha is a two-stage fermented sweetened tea beverage that uses yeast and lactic acid bacteria (LAB) to convert sugars into ethanol and lactate and acetic acid bacteria (AAB) to oxidize ethanol to acetate. Its popularity as a beverage grew from claims of health benefits derived from this vibrant microbial bioconversion. While recent studies have shed light on the diversity of cultures in Kombucha fermentation, there is limited information on the diversity, and especially viability, of cultures in retail beverages that advertise the presence of Kombucha and probiotic cultures. In this study, 12 Kombucha beverages produced by different manufacturers throughout the US were purchased and microbially characterized. Eight of the beverages contained viable Kombucha cultures, while 3 of the remaining 4 had viable Bacillus cultures as added probiotics. Amplicon profiling revealed that all contained Kombucha yeast and bacteria cells. The dominant yeasts detected were Lachancea cidri (10/12), Brettanomyces (9/12), Malassezia (6/12), and Saccharomyces (5/12). Dominant LAB included Liquorilactobacillus and Oenococcus oeni, and AAB were Komagataeibacter, Gluconobacter, and Acetobacter. One beverage had a significant amount of Zymomonas mobilis, an ethanol-producing bacterium from Agave cactus. While Kombucha beverages differ in the types and viability of cultures, all except one beverage contained detectable viable cells.

THINKING THROUGH THE DEBATE ABOUT CAESAREAN SECTION “ON DEMAND” PART I: THINKING ABOUT CHOICE PART II: THINKING ABOUT RISK

The debate about choosing Caesarean section when there is no medical indication raises many questions for midwives and other maternity care providers about choice, risk, normal birth and our role in a society where attitudes towards technology are changing. Both the popular and professional literature about this debate and the claims of benefit to fetus and mother need to be examined in a social and political context. Midwives have an important role to play in emphasizing that the safest system of care would support low intervention approaches to vaginal birth for the majority of women. The overwhelming reason women choose Caesarean section is fear and anxiety about birth. The request for Caesarean surgery “on demand” can be seen, in part, as a call to improve care for pregnant women and vaginal birth.