Economic Burden of Atopic Dermatitis in Taiwan.

Atopic dermatitis is a prevalent inflammatory skin disease that manifests clinically as pruritus and eczema. Severe forms of atopic dermatitis can be chronic and relapsing or associated with other dermatological complications and comorbidities, resulting in lifelong impacts across multiple aspects for patients. This study was conducted to calculate the atopic dermatitis-related economic burden in Taiwan. First, the out-of- pocket costs incurred by 200 patients with atopic dermatitis were estimated using a specifically designed questionnaire. Secondly, work impairment was converted into quantifiable costs. The costs reimbursed by the Taiwan National Health Insurance (NHI), which were estimated in our previous work, were included in the final calculation. The atopic dermatitis-related economic burden for patients in Taiwan in 2018 was estimated as (2018 New Taiwan dollars; NT$) 37.90 billion, which is 0.207% of Taiwan's gross domestic product. This substantial economic burden suggests an existing need for more effective and equitable treatment for atopic dermatitis.

Healthcare utilization and costs of atopic dermatitis in Taiwan.

BACKGROUND: Atopic dermatitis (AD) is a common chronic skin disease. Only relatively scant studies from Asian countries have attempted to quantify AD-associated healthcare utilization and costs by using population-based databases. This study aims to evaluate the AD-associated annual healthcare utilization and costs in Taiwan. METHODS: A retrospective matched-cohort study was conducted by matching the AD cases with controls at a 1:4 (cases:controls) ratio, with the data for both the cases and controls being sourced from the 2017 National Health Insurance Research Database (NHIRD). The AD patients were stratified by disease severity based on their treatments. Differences in the regression-adjusted frequency of care and costs between the cases and controls were compared using t-tests by the severity level of AD. RESULTS: The incremental frequency of outpatient visits per year increased with AD severity (9.60, 11.28, and 16.23 for mild, moderate, and severe cases, respectively). However, the frequency of inpatient care and emergency room visits per year showed no consistent pattern associated with disease severity. The incremental total costs per year were NT$9,511.64, NT$9,705.20, and NT$15,762.09 for mild, moderate, and severe cases, respectively, and the outpatient and drug costs accounted for 46.65%-54.82% and 17.01%-31.20% of the total costs, respectively. CONCLUSION: AD was found to impose significant healthcare costs, with estimated total cost burdens of NT$3.61 billion in 2017, which is 0.314% of Taiwan's national health expenditure and 0.020% of Taiwan's gross domestic product.

Extreme rituals in a BDSM context: the physiological and psychological effects of the 'Dance of Souls'.

Participation in extreme rituals (e.g., fire-walking, body-piercing) has been documented throughout history. Motivations for such physically intense activities include religious devotion, sensation-seeking and social bonding. The present study aims to explore an extreme ritual within the context of bondage/discipline, dominance/submission and sadism/masochism (BDSM): the 'Dance of Souls', a 160-person ritual involving temporary piercings with weights or hooks attached and dancing to music provided by drummers. Through hormonal assays, behavioural observations and questionnaires administered before, during and after the Dance, we examine the physiological and psychological effects of the Dance, and the themes of spirituality, connectedness, transformation, release and community reported by dancers. From before to during the Dance, participants showed increases in physiological stress (measured by the hormone cortisol), self-reported sexual arousal, self-other overlap and decreases in psychological stress and negative affect. Results suggest that this group of BDSM practitioners engage in the Dance for a variety of reasons, including experiencing spirituality, deepening interpersonal connections, reducing stress and achieving altered states of consciousness.

Participating in a Culture of Consent May Be Associated With Lower Rape-Supportive Beliefs.

With the recent national focus on rates of sexual violence, many interventions have been proposed, including those that focus on affirmative consent (e.g., "Yes Means Yes" campaign). The goal of the present study was to test whether individuals within a subculture with long-standing norms of affirmative consent-the bondage and discipline/dominance and submission/sadism and masochism (BDSM) community-report lower rape-supportive attitudes compared to individuals not from within this subculture. BDSM practitioner participants, adult participants from Amazon's Mechanical Turk (MTurk), and college student participants completed measures of hostile sexism, benevolent sexism, rape myth acceptance, victim blaming, expectation of sexual aggression, and acceptance of sexual aggression. BDSM practitioners reported significantly lower levels of benevolent sexism, rape myth acceptance, and victim blaming than did college undergraduates and adult MTurk workers. BDSM practitioners did not differ significantly from college undergraduates or adult MTurk workers on measures of hostile sexism, expectations of sexual aggression, or acceptance of sexual aggression. Limitations and implications are discussed.

Altered States of Consciousness during an Extreme Ritual.

Extreme rituals (body-piercing, fire-walking, etc.) are anecdotally associated with altered states of consciousness-subjective alterations of ordinary mental functioning (Ward, 1984)-but empirical evidence of altered states using both direct and indirect measures during extreme rituals in naturalistic settings is limited. Participants in the "Dance of Souls", a 3.5-hour event during which participants received temporary piercings with hooks or weights attached to the piercings and danced to music provided by drummers, responded to measures of two altered states of consciousness. Participants also completed measures of positive and negative affect, salivary cortisol (a hormone associated with stress), self-reported stress, sexual arousal, and intimacy. Both pierced participants (pierced dancers) and non-pierced participants (piercers, piercing assistants, observers, drummers, and event leaders) showed evidence of altered states aligned with transient hypofrontality (Dietrich, 2003; measured with a Stroop test) and flow (Csikszentmihalyi, 1990; Csikszentmihalyi & Csikszentmihalyi, 1990; measured with the Flow State Scale). Both pierced and non-pierced participants also reported decreases in negative affect and psychological stress and increases in intimacy from before to after the ritual. Pierced and non-pierced participants showed different physiological reactions, however, with pierced participants showing increases in cortisol and non-pierced participants showing decreases from before to during the ritual. Overall, the ritual appeared to induce different physiological effects but similar psychological effects in focal ritual participants (i.e., pierced dancers) and in participants adopting other roles.

Effects of subjective sexual arousal on sexual, pathogen, and moral disgust sensitivity in women and men.

The present experiment tested a novel method of manipulating subjective sexual arousal to examine the effects of sexual arousal on disgust sensitivity. Participants were instructed to employ their own preferred methods of achieving sexual or physiological arousal in the privacy of their own home to reach a target state of arousal. Participants then completed the Three-Domain Disgust Scale (Tybur, Lieberman, & Griskevicius, 2009), which measures sensitivity to sexual, pathogen, and moral disgust. The sexual arousal manipulation caused large, homogenous increases in sexual arousal in women and men. In women, sexual arousal (but not physiological arousal) significantly reduced sensitivity to sexual disgust and marginally increased sensitivity to pathogen disgust. In men, sexual arousal did not decrease disgust sensitivity in any domain. Findings support the evolutionary hypothesis that sexual arousal inhibits sexual disgust, which facilitates an organism's willingness to engage in high-risk, but evolutionarily necessary, reproductive behaviors, an effect that could be particularly important for women.

An Ethical Approach to Peeking at Data.

When data analyses produce encouraging but nonsignificant results, researchers often respond by collecting more data. This may transform a disappointing dataset into a publishable study, but it does so at the cost of increasing the Type I error rate. How big of a problem is this, and what can we do about it? To answer the first question, we estimate the Type I error inflation based on the initial sample size, the number of participants used to augment the dataset, the critical value for determining significance (typically .05), and the maximum p value within the initial sample such that the dataset would be augmented. With one round of augmentation, Type I error inflation maximizes at .0975 with typical values from .0564 to .0883. To answer the second question, we review methods of adjusting the critical value to allow augmentation while maintaining p < .05, but we note that such methods must be applied a priori. For the common occurrence of post-hoc dataset augmentation, we develop a new statistic, paugmented , that represents the magnitude of the resulting Type I error inflation. We argue that the disclosure of post-hoc dataset augmentation via paugmented elevates such augmentation from a questionable research practice to an ethical research decision.