National Healthcare Insurance Research Articles

Epidemiology of myasthenia gravis in France: Incidence, prevalence, and comorbidities based on national healthcare insurance claims data

BackgroundThe European literature has reported high variability in the incidence and prevalence rates of myasthenia gravis (MG), but no specific epidemiological data for France have been published. This study aimed to assess the incidence and prevalence rates of myasthenia gravis in France based on data extracted from the French National Health Insurance Claims Database (the SNIIRAM database). MethodsWe conducted a retrospective repeated cross-sectional population study from 2008 to 2018 using a representative sample of the French population (Échantillon généraliste des bénéficiaires) covered by health insurance. We calculated the incidence, prevalence, and sex ratio of MG and screened for comorbidities associated with MG (standardized to the general population). ResultsIn total, 331 MG patients were identified between 2008 and 2018. The average incidence of MG in France was 50 per million person-years, while the mean prevalence was 465 per million people. The female-to-male ratio was 1.33. The Incidence of MG gradually increased from 40years of age for women and 60 for men. Thymoma was present for 5.1% of MG patients and a thymectomy was performed for 4.7%. Thyroid disease was the most prevalent autoimmune comorbidity, affecting approximately 8.5% of cases. MG patients had an increased cancer risk, with a standardized rate ratio of 2.38 (95% CI: 1.64–3.46). ConclusionThe incidence and prevalence rates of MG are significantly higher than those previously reported in the literature and the incidence increases with age. The excess risk of cancer raises concerns for MG patients, in particular, concerning the management of immunosuppressive drugs.

Implementing Indicators and Trajectories of Return to Work After Breast Cancer Diagnosis: A Mixed-Methods Study Using the French National Healthcare Insurance Database and Stakeholder Consultation

PurposeReturn to work (RTW) is important for quality of life after breast cancer but its analysis at the population-level remains limited in France. This study aimed to implement Electronic Healthcare Data (EHD)-based indicators and trajectories to measure RTW after breast cancer diagnosis, and to examine stakeholders’ perspectives regarding these indicators. MethodsWe followed a mixed-methods approach that consisted of (i) implementing RTW indicators and identifying clusters of trajectories using state sequence analysis with data from a representative sample of the French National Health Data System and (ii) exploring, through qualitative focus group and interviews, stakeholders’ perceptions on the interpretation, limitations, and utility of these indicators. ResultsWe extracted data from 317 women aged 25-55 years with a first diagnosis of early-stage breast cancer. The median number of sickness absence periods was 2 for a total of 434 days during the 3-year follow-up, and the median time to sustainable RTW was 240 days. Three clusters of RTW trajectories were identified: “early RTW” (49.5% of the population), “RTW after partial resumption” (37.5%) and “continuous compensation” (12.9%). Feedback from stakeholders highlighted the multi-factorial nature of RTW and underscored the added value of EHD for studying RTW, despite certain limitations. ConclusionsWe demonstrated the feasibility of calculating RTW indicators and identifying trajectories using the French National Health Data System. These indicators can serve as outcome measures in RTW promotion and provide a basis for designing targeted interventions for breast cancer survivors.

SOCIAL HEALTH INSURANCE ADMINISTRATION BODY PARTICIPANTS’ SATISFACTION ON DECISION TO USE MOBILE APPLICATION

Mobile JKN is an application developed by Social Health Insurance Administration Body to provide easy access to information about the National Healthcare Insurance Program (JKN Program). The number of participants in the Social Security Agency on Health (BPJS Health) has almost reached 250 million people. The government must manage public services so Social Security Agency on Health participants can access health facilities conveniently. The study aims to analyze the Social Security Agency on Health participants’ satisfaction with the decision to use the Mobile JKN application using the Expectancy Disconfirmation Model (EDM). EDM described how perceived expectations and performance influence public satisfaction. The study method is quantitative, with the study unit being Social Security Agency on Health participants and locus in Bogor. Structural Equation Modeling (SEM), a multivariate data analysis technique, was used in this study to examine the data and assess the intricate relationships between the constructs and indicators. The data processing technique uses SmartPLS. The finding shows that using the mobile JKN application has positively impacted user satisfaction. The Social Security Agency on Health participants were satisfied after utilizing the Mobile JKN application to access healthcare services.

Continuous positive airway pressure treatment for obstructive sleep apnea, hospitalizations, and related costs in the French National Healthcare Insurance database

Continuous positive airway pressure treatment for obstructive sleep apnea, hospitalizations, and related costs in the French National Healthcare Insurance database

National Free Healthcare or National Healthcare Insurance: The Direction and Path of China's Healthcare Reform

As in the current situation, Chinese communism is chasing an equal and fair society. Social equality has become the most essential thing in China. However, as the gap between rich and poor becomes more extensive, the problem becomes severe. The most significant one is that many people are experiencing a lack of money to do medical health care. Rich people have power but eliminate the poor peoples ability. Therefore, this article will investigate the feasibility of free health care for all people by using two examples to compare and contrast to receive an accurate and friendly method on this problem. And also to investigate why these two methods have succeeded or failed. After these, this article will provide evidence and reasons why China is feasible to provide free health care and also give an alternative method for free health care.

Progress report of a cross-organ and biomarker-based basket-type clinical trial: BELIEVE Trial.

Cancer genomic medicine using next-generation sequencers has been developing. However, the number of patients who could receive genomically matched therapy is limited because off-label use or patient-oriented compassionate use was not permitted under National Health Insurance in Japan. To improve patient drug accessibility, we initiated a biomarker-based basket-type clinical trial (NCCH1901) in October 2019 under patient-proposed healthcare services. We listed the drugs that had high medical needs but were not covered by National Healthcare Insurance. Then we included these drugs before patient proposal so that they could access off-label drugs soon after they had the results of CGP tests. All drugs were provided free of charge by pharmaceutical companies. The objective was to administer off-label drugs and to collect efficacy and safety data for these drugs. The primary endpoint was the response rate based on the best overall response for up to 16 weeks. As of January 31, 2022, we included 18 drug cohorts and 295 patients were treated in this study. The most common cancer was brain tumor, followed by carcinoma of endocrine organs and colorectal cancer. BRAF mutations and ERBB2 amplifications were the frequent genomic abnormalities to be enrolled. This study was one way to access off-label drugs, and contributed significantly to providing treatment opportunities for patients in Japan.

Homologous Recombination Repair Gene Alterations Are Associated with Tumor Mutational Burden and Survival of Immunotherapy

Background: Comprehensive genomic profiling (CGP) has become generally accepted practice in cancer care since CGP has become reimbursed by national healthcare insurance in Japan in 2019. However, its usefulness for cancer patients is insufficient for several reasons. Methods: In an observational clinical study of FoundationOne® CDx, potential biomarkers were explored and the cause of testing failure was investigated. A total of 220 cancer patients were enrolled in the study during the period from 2018 to 2019 at Kyushu University Hospital. Results: The primary tumor sites of the 220 cases were breast (115), colon (29), stomach (19), and pancreas (20). The present dataset suggested that homologous recombination repair (HRR) gene alterations were positively associated with tumor mutational burden-high (TMB-high) (p = 0.0099). A public dataset confirmed that patients with HRR gene alterations had a higher TMB and showed significantly longer survival of immunotherapy. In the present study, 18 cases failed sequencing. A lower percentage of tumor cell nuclei was the most common reason for testing failures (p = 0.037). Cases that received neoadjuvant chemotherapy before sampling tended to fail testing. Conclusions: HRR gene alterations can be a potential biomarker predicting TMB-high and a good response to immunotherapy. For successful sequencing, samples with lower percentages of tumor cell nuclei and previous neoadjuvant chemotherapy should be avoided.

The Mediated Impact of Health Care Insurance Inclusion Between Hospital Management and Operation Efficiency in Saudi Arabia

The healthcare scene in Saudi Arabia has been experiencing notable changes, characterised by an increasing focus on enhancing the quality and availability of medical services. Given the significant role that hospitals play in the provision of healthcare services, it is essential to comprehend the interplay between management strategies and operational efficiency. In a country without fixed and implanted national health care insurance program, like KSA, it is a challenge to modify the weak existed program to a big project of national health care insurance program. This inclusion despite making high beneficial for health care of the human but making high challenge for health care management and could affect the Management Efficiency which was almost affected by different variables like Management Staff Satisfaction. Facilities Availability, Management Cost Reduction and Patient Safety Improvement Plan Healthcare providers had to have compensatory shift that healthcare administrator had to provide after healthcare insurance changes. This study will benefits hospital management practises on operational efficiency results, using well-established theories of organisational management and healthcare economics. Furthermore, the research investigates the degree to which the existence of health care insurance coverage acts as a mediator in this association. The presence of health care insurance plays a pivotal role in shaping patients' ability to get medical services and has the potential to influence the efficacy of hospital management approaches. In order to accomplish these aims, quantitative research have been used. Quantitative data is collected by means of surveys and archive hospital performance measures, derived from interviews and focus group discussions conducted with important players within the healthcare sector of Saudi Arabia.

Factors affecting the Health Care Insurance Inclusion and Saudi Hospital Management Operation Efficiency

The Saudi healthcare scene has seen significant changes, with an increased emphasis on improving the quality and availability of medical treatments. Given the critical role that hospitals play in the delivery of healthcare services, it is critical to understand the relationship between management strategies and operational efficiency. It is difficult to transform a weak existing program into a large project of national health care insurance in a country that lacks a stable and implanted national health care insurance program, such as KSA. This inclusion, while highly helpful for human health care, poses a significant challenge for health care management and may have an impact on Management Efficiency, which is heavily influenced by variables such as Management Staff Satisfaction. Plan for Facility Availability, Management Cost Reduction, and Patient Safety Improvement After healthcare insurance reforms, healthcare professionals were required to have compensatory shifts, which healthcare administrators were required to supply. Using well-established theories of organizational management and healthcare economics, this study will enhance hospital management practices in terms of operational efficiency results. Furthermore, the study looks into the extent to which the availability of health insurance functions as a moderator in this relationship. The availability of health care insurance influences patients' ability to obtain medical services and has the potential to influence the efficacy of hospital management practices. Quantitative research was employed to achieve these objectives. Quantitative data is gathered through surveys and historical hospital performance metrics derived from interviews and focus group conversations with key players in Saudi Arabia's healthcare system.

Association between adverse outcomes of hepatitis A and acetaminophen use: A population-based cohort study.

Acetaminophen (APAP) may cause acute liver injury with therapeutic doses in high-risk conditions such as chronic alcohol consumption or malnutrition. In acute hepatitis A (AHA), however, the safety of APAP has not been fully established. This study examined the potential association between APAP use and clinical outcomes of AHA in a nationwide and hospital-based cohort. Adult patients with AHA were identified from claims data of South Korean national healthcare insurance between 2008 and 2016 (n=43,500). Logistic regression models were used to compare the risk of adverse outcomes (renal replacement therapy, hepatic encephalopathy and/or brain edema, mechanical ventilation, and liver transplantation) in patients exposed to APAP against control and patients exposed to NSAIDs. A propensity score (PS)-matched hospital-based AHA cohort (n=146) was assessed for biochemical profiles after exposure to APAP or NSAIDs. AHA patients were exposed to APAP or NSAIDs in 26.4% and 11.5% of cases, respectively. Compared to NSAID treatment, APAP exposure was associated with a higher incidence of hospitalization (98.8% vs. 92.4%; p<0.0001). APAP exposure was independently associated with increased adverse outcomes (odds ratio [OR]=5.66, p<0.0001 against control; OR =1.67, p=0.0015 against NSAIDs). PS-matched hospital cohort showed higher peak serum bilirubin levels (7.0vs. 5.3mg/dL; p=0.03) and a longer time to recovery of jaundice after APAP use than with NSAID use. APAP exposure was associated with increased adverse outcomes in a nationwide AHA cohort.

One-stage laparoscopic cholecystectomy with intraoperative endoscopic retrograde cholangiography bile duct stone extraction is a feasible option in Indonesia within the National Health Insurance System.

Bile duct stones are a widespread condition that can pose a significant risk to life due to the occurrence of complications. In recent years, there has been a growing inclination toward the use of one-stage minimally invasive procedures for the treatment of this condition. However, it is important to note that in developing countries, such as Indonesia, where the National Healthcare Insurance System is established, the implementation of these procedures is still relatively uncommon due to limitations in healthcare facilities. This study presents a case series involving 13 patients who underwent a consecutive initial attempt of one-stage Laparoscopic Cholecystectomy with subsequent Intraoperative Endoscopic Retrograde Cholangiopancreatography (LC-ERCP) for the extraction of bile duct stones. These patients were among the 124 individuals treated for bile duct stones at our hospital for one year (June 2022 to May 2023). All the participants in this study were covered by the National Health Insurance. Among the 124 patients diagnosed with bile duct stones, thirteen (10.5%) were subjected to an initial attempt of one-stage LC-ERCP procedure, which had a success rate of 76.4%. However, three of them experienced difficulties during the cannulation of bile duct, leading to the failure of this approach. The patients included in the study had a mean age of 46.5years, with average serum levels of total bilirubin and direct bilirubin measuring 2.1 and 1.4mg/dL, respectively. The average duration of successful and unsuccessful procedures was 121.5min and 183.3min, respectively. The average length of postoperative hospital stay was 3.5days, and no instances of mortality or complications were recorded during the study. One-stage LC-ERCP procedure offered a promising treatment option for bile duct stones in Indonesia, particularly for patients registered under the National Healthcare Insurance System. This approach could serve as a viable alternative for facilities that lack proficiency in LC-CBDE skills. Furthermore, the ability to perform ERCP in a supine position is crucial in achieving a high success rate. The results of this study showed the need for advancements in Indonesian public healthcare facilities to meet the growing demand for improved treatment modalities.

Semaglutide and cancer: A systematic review and meta-analysis

BackgroundFrench national health care insurance system database has suggested 1–3 years use of glucagon like peptide-1 receptor agonists (GLP1RA) (exenatide, liraglutide and dulaglutide) may be linked with increased occurrence of thyroid cancer. Similar data on semaglutide is not-available. Hence, we undertook this systematic review to look at the safety of semaglutide focussing on different cancers. MethodsDatabases were searched for randomized controlled trials (RCTs) and real-world studies involving patients receiving semaglutide in the intervention-arm. Primary outcome was to evaluate the occurrence of pancreatic and thyroid cancers. Secondary outcomes were to the evaluate occurrence of any other malignancies or severe adverse-events. ResultsData from 37 RCTs and 19 real-world studies having 16,839 patients in placebo-control group, 16,550 patients in active-control group and 13,330 patients in real-world studies were analysed. Compared to placebo, occurrence of pancreatic cancer [OR 0.25 (95%CI: 0.03–2.24); P = 0.21], thyroid cancer [OR 2.04 (95%CI: 0.33–12.61); P = 0.44; I2 = 0%] and all neoplasms (benign, malignant and otherwise unspecified) [OR 0.95 (95%CI:0.62–1.45); P = 0.82; I2 = 0%] was similar in the semaglutide group. Compared to active controls, occurrence of pancreatic cancer [OR 0.40 (95%CI:0.09–1.87); P = 0.26; I2 = 0%], thyroid cancer [OR 1.19 (95%CI:0.15–9.66); P = 0.87; I2 = 0%] and all neoplasms (benign, malignant and otherwise unspecified) [OR 0.91 (95% CI: 0.44–1.89); P = 0.79; I2 = 0%] were similar in the semaglutide group. Real-world data analysis revealed single case each of pancreatic cancer and B-cell lymphoma. ConclusionSemaglutide use in RCTs and real-world studies was not associated with an increased risk of any types of cancer, and this conclusion is supported by a high grade of evidence.

The growing burden of generalized myasthenia gravis: a population-based retrospective cohort study in Taiwan.

The prevalence of myasthenia gravis is increasing in many countries, including Asia. As treatment options expand, population-based information about the disease burden can inform health technology assessments. We conducted a population-based retrospective cohort study using the Taiwan National Healthcare Insurance Research database and Death Registry to describe the epidemiology, disease burden and treatment patterns of generalized myasthenia gravis (gMG) from 2009 to 2019. Episodes of hepatitis B virus (HBV) infection or reactivation were explored. The number of patients with gMG increased from 1,576 in 2009 to 2,638 in 2019 and the mean (standard deviation) age from 51.63 (17.32) to 55.38 (16.29) years. The female:male ratio was 1.3:1. Frequently reported co-morbidities were hypertension (32-34% of patients), diabetes mellitus (16-21%) and malignancies (12-17%). The prevalence of patients with gMG increased annually from 6.83/100,000 population in 2009 to 11.18/100,000 population in 2019 (p < 0.0001). There was no temporal trend in all-cause fatality rates (range 2.76-3.79/100 patients annually) or gMG incidence rates (2.4-3.17/100,000 population annually). First-line treatment was with pyridostigmine (82%), steroids (58%), and azathioprine (11%). There was minimal change in treatment patterns over time. Among 147 new HBV infections, 32 (22%) received ≥4 weeks of antiviral therapy suggesting chronic infection. The HBV reactivation rate was 7.2%. The epidemiology of gMG in Taiwan is evolving rapidly, with higher prevalence rates and increasing involvement of older age-groups suggesting a growing burden of disease and associated healthcare costs. HBV infection or reactivation may pose a previously unrecognized recognized risk for patients with gMG receiving immunosuppressants.

1084-P: The Trend of Korean Diabetes Patients’ Foot EMG Wave Pattern Age over 65

Depending on the healthcare system, ethnicity, and diet, delaying complications related to diabetes differ in each country. Diabetic ulcer accompanied by neuropathy of the foot is the key indicator for the development of complications. Therefore finding the total number of impaired feet with foot muscle dystrophy may understand how the diabetes progression of the patients is controlled by public health organization structures. Korea is one of the nations which adopted a national wide government-organized healthcare insurance system compared with private. In this study, we examined how Korean diabetic feet are controlled by the Korean public health care system. To figure out this, diabetes subjects' foot EMG were examined by STEMG-2 (STUFProject EMG Device-2) by checking 3-second foot up and down movement. Age over 65 who suffered from 50 male and female diabetes patients and 50 male and female nondiabetic patients the foot EMG was tested. After finishing the test results EMG was converted into a digital signal by 1024 arbitrary units and plotted wave pattern with subtracting reference. As a result, 98% of nondiabetics showed constant wave patterns corresponding to muscle relaxation and contraction. Whereas, 86% of diabetes patients have constant EMG wave patterns and only 14% have inconsistent EMG wave patterns. 84% of male and 78% of female diabetes patients have similar wave patterns to nondiabetes individuals Also patients who are BMI less than 23 have 96% of constant patterns. 80% of patients' glucose levels below 180 mg/dl have constant wave patterns. However, 60% of patients over 180mg/dl glucose level have inconsistent patterns. In the conclusion, 86% of Korean diabetes patients are controlling muscle destruction could happen a chronic effect of diabetes. Even 13% of diabetes patients who showed abnormal wave patterns, may have some acute cramp with the foot but visually all toes are intact. This may means the progression of diabetic complications is controlled by the Korean national health system. Disclosure W. Kim: None. M. Park: None. Funding National Research Foundation of Korea (HNU X-Corps)

Looking ahead to potential incretin combination therapies for nonalcoholic steatohepatitis in patients with diabetes

ABSTRACT Introduction There are no drugs approved by regulatory agencies for the treatment of nonalcoholic fatty liver disease (NAFLD); incretin combination therapies are being developed for treatment of type 2 diabetes and research has moved to test their usefulness in NAFLD. Areas covered We reviewed the literature on the effectiveness of dual and triple peptides combining receptor agonists of the glucagon-like peptide 1, the glucose-dependent insulinotropic peptide, and glucagon to treat NAFLD and its associated metabolic diseases, and/or the cardiovascular risk intimately connected with the cluster of the metabolic syndrome. Other combination peptides involved the glucagon-like peptide 2 receptor, the fibroblast growth factor 21, the cholecystokinin receptor 2, and the amylin receptor. Expert opinion Both dual and triple agonists are promising, based on animal, pharmacokinetic and proof-of concept studies, showing effectiveness both in the presence and the absence of diabetes on a few validated surrogate NAFLD biomarkers, but the majority of studies are still in progress. Considering the long natural history of NAFLD, final proof of their efficacy on primary clinical liver outcomes might be also derived from the analysis of large databases of National Healthcare Systems or Insurance companies, when used in diabetes for improving glycemic control, after careful propensity-score matching.

Totally robotic Roux-en-Y gastric bypass in a morbidly obese patient in Korea: a case report

Robotic bariatric surgery renders it unnecessary for surgeons to manually apply torque while simplifying intracorporeal suturing. Surgeons can comfortably manipulate instruments. Also, the three-dimensional operative field is very clear. Unfortunately, robotic bariatric surgery is still not the first choice for morbidly obese patients in Korea because it currently is not covered by the National Healthcare Insurance system. In this video, we show the totally robotic Roux-en-Y gastric bypass conducted using robotic staplers, in a morbidly obese patient with diabetes mellitus and private medical insurance.

P133 Risk Factors for the Occurrence and Severity of Vertebral Fractures in Inflammatory Bowel Disease Patients: A Nationwide Population-Based Cohort Study

Abstract Background The risk of vertebral fractures is increased in inflammatory bowel disease (IBD) patients. However, whether the severity of vertebral fractures differs between IBD patients and the general population, or between patients with Crohn’s disease and ulcerative colitis, is unknown. Methods We investigated risk factors associated with the occurrence and severity of vertebral fractures in IBD patients using The National Healthcare Insurance Service (NHIS) database. Results From 2008 to 2018, there were 33,778 patients with IBD (24,370 UC patients and 9408 CD patients) and 101,265 patients in the reference population. The incidence rate ratio of vertebral fractures in IBD patients was 1.27 per 1000 person-years (95% CI 1.26–1.27). The risk of vertebral fracture was higher in CD and UC patients than in the matched reference group (HR 1.593; 95% CI 1.317–1.927; p &amp;lt; 0.001 and HR 1.269; 95% CI 1.141–1.412; p &amp;lt; 0.01 respectively). The occurrence of vertebral fracture was associated with Crohn’s disease, older age, female sex, high Charlson Comorbidity Index (CCI) score, and long-term steroid use. The severity of vertebral fractures was associated with IBD and older age. Conclusion Vertebral fractures occur frequently and more severely in IBD patients, particularly those with CD. Therefore, we suggest monitoring of bone density, regular vitamin D supply, and reducing the use of corticosteroids to prevent vertebral fractures in IBD patients who are older, female, or have comorbidities.

P885 Does long term corticosteroid use increase the risk of femur fracture in Inflammatory Bowel Disease patients? : A nationwide population-based cohort study

Abstract Background Inflammatory Bowel Disease (IBD) patients have been reported to have a higher frequency of femur fracture than healthy controls. Based on the data femur fractures in IBD patients, not many studies analyzing this correlation have been reported various risk factors, including corticosteroid therapy. Aim of this study was to demonstrate the prevalence of femur fracture in IBD patients with long-term corticosteroids. Methods The National Healthcare Insurance Service (NHIS) database of IBD patients between 2008-2018 was used for this cohort study. We collected the data of ICD-10 code, sex, age, comorbidities, corticosteroid use and IBD-related medications. The sex- and 10-year age matched non-IBD reference population was extracted during the same study period at a matching ratio of 1:3. Results From 2008 to 2018, 33,778 patients with IBD and 101,265 patients in the reference population were followed up for a median 5.0 years. The result showed that the use of corticosteroid more than 1year increased the risk of femur fracture of both Ulcerative Colitis and Crohn's Disease patient ((HR 2.83; 95% CI 1.37-5.84; P&amp;lt;0.01 and HR 2.62; 95% CI 1.00-6.86; p&amp;lt;0.05), respectively. Also, long term use of corticosteroid increased the severity of femur fracture (HR 0.62; 95% CI 0.43-0.90; p&amp;lt;0.05). Conclusion Femur fractures in patients with IBD patients are generally associated with results in hospitalization and related with significant morbidity and mortality. As use of corticosteroid and its duration contributed to femur fracture risk include its severity, prevention of fracture and careful corticosteroid therapy strategy should be considered.

Perception and Behavior of PLWHA towards Out-of-Pocket Costs when Accessing Antiretroviral Treatment

Out-of-pocket costs are defined as direct and indirect costs when accessing antiretroviral (ARV) treatment at healthcare centers that aren’t subsidized by the government. While ARV treatment can be accessed for free, costs for diagnostic tests, consultation, and treatment for opportunistic infections are the main factor behind the low number of People Living with HIV/AIDS (PLWHA) accessing ARV treatment post-diagnosis. This study aims to understand PLWHA’s behaviors that are related to ARV treatment access based on perceived barriers to out-of-pocket costs. This study used a qualitative approach with 8 PLWHA informants and 1 healthcare worker informant that works at a care, support, and treatment (CST) clinic at a private hospital. This study was conducted for four months from August to November 2021. Results found that behaviors in accessing ARV treatment in PLWHA are influenced by their perceived seriousness of HIV, perceived barriers in the national healthcare insurance referral process, and self-efficacy. Perceived out-of-pocket cost barriers were not identified as the informants’ reason for deciding to start ARV treatment or discontinue ARV treatment. This study recommends increasing the availability of clinical psychologists that can provide psychological support for PLWHA, specifically within the first 6 months of diagnosis, supplemented by peer support groups.

Hormone Replacement Therapy and Psoriasis Risk: A Nationwide Population-Based Cohort Study.

Hormone replacement therapy (HRT) is used to relieve menopause symptoms, but has been reported to be associated with coronary heart disease and cancers in women. However, a link between HRT and psoriasis has yet to be established. The aim of this study was to determine the association between HRT and the risk of psoriasis. We executed a nationwide population-based study. A total of 1,130,741 post-menopause women were enrolled in the national health care insurance database based on the enrollment criteria. The study population was classified into four groups based on the duration of the HRT, and the risk of psoriasis was analyzed. The incidence rates of psoriasis per 1,000 person-years were 3.36 and 4.09 in the no history of HRT and ≥ 5 years of HRT, respectively. After adjustment for age, smoking, alcohol intake, regular exercise, body mass index, diabetes mellitus, hypertension, and dyslipidemia, the most prolonged duration of the HRT group (≥ 5 years) exhibited significantly increased risk of developing psoriasis (hazard ratio, 1.22; 95% confidence interval, 1.16-1.29). We propose that HRT in post-menopausal women is associated with an increased likelihood of psoriasis development.