The Impact of Long-term Care Insurance on Medical Utilization and Medical Cost in South Korea / 보건행정학회지

Background@#This study aimed to analyze changes in medical utilization and cost before and after long-term care (LTC) implementation. @*Methods@#We used the National Health Information Database from National Health Insurance Service. The participants were selected who had a new LTC grade (grade 1–5) for 2015. Medical utilization was analyzed before and after LTC implementation. Segmented regression analysis of interrupted time series was conducted to evaluate the overall effect of the LTC implementation on medical costs. @*Results@#The total number of participants was 41,726. A major reason for hospitalization in grade 1 was cerebrovascular diseases, and dementia was the top priority in grade 5. The proportion of hospitalization in grade 1 increased sharply before LTC implementation and then decreased. In grade 5, it increased before LTC implementation, but there was no significant difference after LTC implementation. As for medical cost, in grades 1 to 4, the total cost increased sharply before the LTC implementation, but thereafter, changes in level and trend tended to decrease statistically, and for grade 5, immediately after LTC implementation, the level change was decreasing, but thereafter, the trend change was increasing. @*Conclusion@#Long-term care grades showed different medical utilization and cost changes. Long-term care beneficiaries would improve their quality of life by adequately resolving their medical needs by their grades.

Trends in Korean parents' perceptions on food additives during the period 2014–2018

BACKGROUND/OBJECTIVES@#While the use of food additives in food processing has become a common practice worldwide, consumers' worry about potential hazards has not diminished.The purpose of this study was to identify trends in South Korean parents' perceptions about food additives by analyzing the results of surveys conducted from 2014 to 2018. @*SUBJECTS/METHODS@#We conducted an off-line survey in Korea annually between 2014 and 2018 on perceptions about food additives. The numbers of survey respondents in each year from 2014 to 2018 were 381, 426, 301, 519, and 369, respectively. Our consumer respondents were parents of elementary-school-aged children. @*RESULTS@#The ratios of respondents perceiving “food safety” as the most important factor in purchasing processed foods and “food additives” as the biggest threat to food safety have decreased over the years. However, most consumers still have negative perceptions of food additives. Additionally, among consumers lower confidence in or trust of the Korean government continued throughout the study period and appeared to be the main problem that needs to be overcome. @*CONCLUSIONS@#This study found that Korean parents are still troubled by food additives.Consumers' confidence in the government needs to be increased through public communications. More multifaceted educational programs communicating scientific knowledge of food additives are needed in order to correct consumers' misperceptions.

Trends in Korean parents' perceptions on food additives during the period 2014–2018

BACKGROUND/OBJECTIVES@#While the use of food additives in food processing has become a common practice worldwide, consumers' worry about potential hazards has not diminished.The purpose of this study was to identify trends in South Korean parents' perceptions about food additives by analyzing the results of surveys conducted from 2014 to 2018. @*SUBJECTS/METHODS@#We conducted an off-line survey in Korea annually between 2014 and 2018 on perceptions about food additives. The numbers of survey respondents in each year from 2014 to 2018 were 381, 426, 301, 519, and 369, respectively. Our consumer respondents were parents of elementary-school-aged children. @*RESULTS@#The ratios of respondents perceiving “food safety” as the most important factor in purchasing processed foods and “food additives” as the biggest threat to food safety have decreased over the years. However, most consumers still have negative perceptions of food additives. Additionally, among consumers lower confidence in or trust of the Korean government continued throughout the study period and appeared to be the main problem that needs to be overcome. @*CONCLUSIONS@#This study found that Korean parents are still troubled by food additives.Consumers' confidence in the government needs to be increased through public communications. More multifaceted educational programs communicating scientific knowledge of food additives are needed in order to correct consumers' misperceptions.

Interactions of Behavioral Changes in Smoking, High-risk Drinking, and Weight Gain in a Population of 7.2 Million in Korea / 예방의학회지

OBJECTIVES: To identify simultaneous behavioral changes in alcohol consumption, smoking, and weight using a fixed-effect model and to characterize their associations with disease status. METHODS: This study included 7 000 529 individuals who participated in the national biennial health-screening program every 2 years from 2009 to 2016 and were aged 40 or more. We reconstructed the data into an individual-level panel dataset with 4 waves. We used a fixed-effect model for smoking, heavy alcohol drinking, and overweight. The independent variables were sex, age, lifestyle factors, insurance contribution, employment status, and disease status. RESULTS: Becoming a high-risk drinker and losing weight were associated with initiation or resumption of smoking. Initiation or resumption of smoking and weight gain were associated with non-high-risk drinkers becoming high-risk drinkers. Smoking cessation and becoming a high-risk drinker were associated with normal-weight participants becoming overweight. Participants with newly acquired diabetes mellitus, ischemic heart disease, stroke, and cancer tended to stop smoking, discontinue high-risk drinking, and return to a normal weight. CONCLUSIONS: These results obtained using a large-scale population-based database documented interactions among lifestyle factors over time.

Effects of living in the same region as one's workplace on the total fertility rate of working women in Korea / 한국역학회지

OBJECTIVES: The lowest-low fertility status of Korea has continued for the past 17 years despite governmental efforts to encourage childbirth. As the number of working women has increased, their residence patterns have changed; however, the impact of this factor has yet to be explored. Therefore, this study was conducted to investigate the effects of residence patterns relative to the workplace on the total fertility rate of working women.METHODS: Information on eligibility and healthcare utilization was obtained from the National Health Information Database between 2011 and 2015. The study participants were working women aged 15-49 years. We classified their residence relative to their workplace into 3 patterns: same municipality, same province, and different province. The total fertility rate was calculated and logistic regression was performed of childbirth according to residence pattern, adjusting for age, insurance contribution quartile, size of the workplace, year of birth, and province of residence.RESULTS: The total fertility rates of working women from 2011 to 2015 were 1.091, 1.139, 1.048, 1.073, and 1.103, respectively. The total fertility rate by residence pattern was highest in women residing in the same municipality as their workplace. After adjustment, the odds of childbirth in women from the same municipality and the same province were 21.6% and 16.0% higher than those of women residing in a different province, respectively.CONCLUSIONS: The total fertility rate was higher among women living near their workplace. Therefore, effective policy measures should be taken to promote the proximity of working women's workplace and residence.

Interactions of Behavioral Changes in Smoking, High-risk Drinking, and Weight Gain in a Population of 7.2 Million in Korea / 예방의학회지

OBJECTIVES@#To identify simultaneous behavioral changes in alcohol consumption, smoking, and weight using a fixed-effect model and to characterize their associations with disease status.@*METHODS@#This study included 7 000 529 individuals who participated in the national biennial health-screening program every 2 years from 2009 to 2016 and were aged 40 or more. We reconstructed the data into an individual-level panel dataset with 4 waves. We used a fixed-effect model for smoking, heavy alcohol drinking, and overweight. The independent variables were sex, age, lifestyle factors, insurance contribution, employment status, and disease status.@*RESULTS@#Becoming a high-risk drinker and losing weight were associated with initiation or resumption of smoking. Initiation or resumption of smoking and weight gain were associated with non-high-risk drinkers becoming high-risk drinkers. Smoking cessation and becoming a high-risk drinker were associated with normal-weight participants becoming overweight. Participants with newly acquired diabetes mellitus, ischemic heart disease, stroke, and cancer tended to stop smoking, discontinue high-risk drinking, and return to a normal weight.@*CONCLUSIONS@#These results obtained using a large-scale population-based database documented interactions among lifestyle factors over time.

Effects of living in the same region as one's workplace on the total fertility rate of working women in Korea / 한국역학회지

OBJECTIVES@#The lowest-low fertility status of Korea has continued for the past 17 years despite governmental efforts to encourage childbirth. As the number of working women has increased, their residence patterns have changed; however, the impact of this factor has yet to be explored. Therefore, this study was conducted to investigate the effects of residence patterns relative to the workplace on the total fertility rate of working women.@*METHODS@#Information on eligibility and healthcare utilization was obtained from the National Health Information Database between 2011 and 2015. The study participants were working women aged 15-49 years. We classified their residence relative to their workplace into 3 patterns: same municipality, same province, and different province. The total fertility rate was calculated and logistic regression was performed of childbirth according to residence pattern, adjusting for age, insurance contribution quartile, size of the workplace, year of birth, and province of residence.@*RESULTS@#The total fertility rates of working women from 2011 to 2015 were 1.091, 1.139, 1.048, 1.073, and 1.103, respectively. The total fertility rate by residence pattern was highest in women residing in the same municipality as their workplace. After adjustment, the odds of childbirth in women from the same municipality and the same province were 21.6% and 16.0% higher than those of women residing in a different province, respectively.@*CONCLUSIONS@#The total fertility rate was higher among women living near their workplace. Therefore, effective policy measures should be taken to promote the proximity of working women's workplace and residence.

Age-Specific Cutoff Scores on a T1-Weighted Axial Medial Temporal-Lobe Atrophy Visual Rating Scale in Alzheimer's Disease Using Clinical Research Center for Dementia of South Korea Data

BACKGROUND AND PURPOSE: Visual assessment of medial temporal-lobe atrophy (MTA) has been quick, reliable, and easy to apply in routine clinical practice. However, one of the limitations in visual assessments of MTA is the lack of widely accepted age-adjusted norms and cutoff scores for MTA for a diagnosis of Alzheimer's disease (AD). This study aimed to determine the optimal cutoff score on a T1-weighted axial MTA Visual Rating Scale (VRS) for differentiating patients with AD from cognitively normal elderly people. METHODS: The 3,430 recruited subjects comprising 1,427 with no cognitive impairment (NC) and 2003 AD patients were divided into age ranges of 50–59, 60–69, 70–79, and 80–89 years. Of these, 446 participants (218 in the NC group and 228 in the AD group) were chosen by random sampling for inclusion in this study. Each decade age group included 57 individuals, with the exception of 47 subjects being included in the 80- to 89-year NC group. The scores on the T1-weighted axial MTA VRS were graded by two neurologists. The cutoff values were evaluated from the area under the receiver operating characteristic curve. RESULTS: The optimal axial MTA VRS cutoff score from discriminating AD from NC increased with age: it was ≥as ≥1, ≥2, and ≥3 in subjects aged 50–59, 60–69, 70–79, and 80–89 years, respectively (all p < 0.001). CONCLUSIONS: These results show that the optimal cutoff score on the axial MTA VRS for diagnosing of AD differed according to the decade age group. This information could be of practical usefulness in the clinical setting.

Level of Agreement and Factors Associated With Discrepancies Between Nationwide Medical History Questionnaires and Hospital Claims Data / 예방의학회지

OBJECTIVES: The objectives of this study were to investigate the agreement between medical history questionnaire data and claims data and to identify the factors that were associated with discrepancies between these data types. METHODS: Data from self-reported questionnaires that assessed an individual's history of hypertension, diabetes mellitus, dyslipidemia, stroke, heart disease, and pulmonary tuberculosis were collected from a general health screening database for 2014. Data for these diseases were collected from a healthcare utilization claims database between 2009 and 2014. Overall agreement, sensitivity, specificity, and kappa values were calculated. Multiple logistic regression analysis was performed to identify factors associated with discrepancies and was adjusted for age, gender, insurance type, insurance contribution, residential area, and comorbidities. RESULTS: Agreement was highest between questionnaire data and claims data based on primary codes up to 1 year before the completion of self-reported questionnaires and was lowest for claims data based on primary and secondary codes up to 5 years before the completion of self-reported questionnaires. When comparing data based on primary codes up to 1 year before the completion of self-reported questionnaires, the overall agreement, sensitivity, specificity, and kappa values ranged from 93.2 to 98.8%, 26.2 to 84.3%, 95.7 to 99.6%, and 0.09 to 0.78, respectively. Agreement was excellent for hypertension and diabetes, fair to good for stroke and heart disease, and poor for pulmonary tuberculosis and dyslipidemia. Women, younger individuals, and employed individuals were most likely to under-report disease. CONCLUSIONS: Detailed patient characteristics that had an impact on information bias were identified through the differing levels of agreement.

Peripheral Biomarker Candidates of Posttraumatic Stress Disorder

There is high variability in the manifestation of physical and mental health problems following exposure to trauma and disaster. Although most people may show a range of acute symptoms in the aftermath of traumatic events, chronic and persistent mental disorders may not be developed in all individuals who were exposed to traumatic events. The most common long-term pathological consequence after trauma exposure is posttraumatic stress disorder (PTSD). However, comorbid conditions including depression, anxiety disorder, substance use-related problems, and a variety of other symptoms may frequently be observed in individuals with trauma exposure. Post-traumatic syndrome (PTS) is defined collectively as vast psychosocial problems that could be experienced in response to traumatic events. It is important to predict who will continue to suffer from physical and mental health problems and who will recover following trauma exposure. However, given the heterogeneity and variability in symptom manifestations, it is difficult to find identify biomarkers which predict the development of PTSD. In this review, we will summarize the results of recent studies with regard to putative biomarkers of PTSD and suggest future research directions for biomarker discovery for PTSD.

Impact of Vascular Risk Factors, Axial Medial Temporal Atrophy, White Matter Hyperintensity on Cognitive Outcome in Alzheimer's Diseases

BACKGROUND: There is epidemiologic evidence to support vascular disease as a possible cause of Alzheimer's dementia (AD). The primary aim of this study was to determine the prevalence of vascular risk factors (vRFs) with respect to various clinical measures, such as axial-rated medial temporal lobe atrophy (MTA), ischemic white-matter changes, and cognition. The secondary aim was to determine the most significant clinical measure associated with cognitive outcome. METHODS: The study subjects comprised 198 probable AD and 38 subjective memory impairment-no cognitive impairment controls (SMI-NCI), for whom medical data including history vRF-related blood tests, clinical dementia evaluation, cognitive assessment, and brain MRI, were available. The grading of white-matter hyperintensities (WMHs) was achieved using Fazekas' method. MTA was graded by two neurologists independently based on axial T1-weighted MRI images. The prevalence of risk factors for Koreans aged > or =65 years was reviewed for comparison. RESULTS: All vRFs except smoking were more severe in the AD group than in both the SMI-NCI group and Koreans aged > or =65 years, but the high prevalence of vRFs had no impact on WMH lesions, axial MTA, or cognitive outcome. Both white-matter changes and MTA were significantly worse in AD than in SMI-NCI (p<0.001). The degree of MTA was negatively correlated with WMH grade (p<0.001), but the severity of clinical dementia was correlated only with increased axial MTA in AD (Instrumental Activities of Daily Living and Clinical Dementia Rating scores, p<0.001; Clinical Dementia Rating-Sum of Boxes score, p<0.005). CONCLUSIONS: WMHs and axial MTA were significantly more severe in the AD group than in the SMI-NCI subjects. The findings of this study indicate that worsening of cognitive dysfunction in AD appears to be driven by MTA, which is evident even in axial MTA visual grading, irrespective of WMH severity and the presence of vRFs.

Predictive Factors for Decline in Activities of Daily Living in Alzheimer's Disease Dementia with More than 2 Follow-up

BACKGROUND: Impairment in activities of daily living (ADL) is a major problem in Alzheimer's disease (AD), and is related to increased caregiver burden.The present study evaluated whether there are any components of initial dementia evaluation that could predict ADL decline in years follow-up. METHODS: The 32 subjects underwent more than two consecutive neuropsychological evaluation and maintained anti-dementia medication from the Ewha Dementia Cohort. The first clinical, neuropsychological test results, medial temporal atrophy rating and white matter ratings were correlated with the final ADL scores. The subjects were further divided into ADL-preserved and declined groups for the comparison depending on final ADL scores. RESULTS: The annual decline of the Korean Mini-mental status examination (K-MMSE) score was 1.5+/-1.2 and of the Seoul-instrumental ADL score was 6.1+/-4.6. The Factors correlated with the ADL at baseline were the clinical dementia rating, K-MMSE, memory function score and the total neuropsychological test score, left medial temporal lobe atrophy rating, and the neuropsychiatric total score. Only the neuropsychological component including total test, frontal and visuospatial function scores were statistically different between the two groups in the baseline evaluation. CONCLUSIONS: The result of our preliminary study emphasize the other study results that the initial cognitive and dementia status are the strong predictive factors not only for the initial ADL dysfunction but also for the ADL decline in years followed-up dementia cohort.

A Family Harboring CMT1A Duplication and HNPP Deletion

Charcot-Marie-Tooth disease type 1A (CMT1A) is associated with duplication of chromosome 17p11.2-p12, whereas hereditary neuropathy with liability to pressure palsies (HNPP), which is an autosomal dominant neuropathy showing characteristics of recurrent pressure palsies, is associated with 17p11.2-p12 deletion. An altered gene dosage of PMP22 is believed to the main cause underlying the CMT1A and HNPP phenotypes. Although CMT1A and HNPP are associated with the same locus, there has been no report of these two mutations within a single family. We report a rare family harboring CMT1A duplication and HNPP deletion.

Dynamic Changes of MRI Findings after Seizures / 대한간질학회지

INTRODUCTION: Magnetic resonance imaging has demonstrated reversible peri-ictal MRI changes suggestive of hemodynamic changes or cytotoxic edema. We were to investigate the dynamic peri-ictal MRI changes in patients with seizures. METHODS: We retrospectively reviewed the medical records, electroencephalography, and initial and follow-up MRI of 5 patients with single seizure or status epilepticus. We analyzed the patterns and locations of MRI abnormalities and their relationship with characteristics of seizures. RESULTS: Two patients with complex partial seizures (CPS) and versive or unilateral tonic seizures showed high signal changes in frontal cortex on T2-weighted (T2WI), fluid attenuated inversion recovery (FLAIR) and DWI. Three patients had MRI changes in mesial temporal structures including hippocampus after single generalized tonic-clinic seizure without encephalitic features clinically. One patient had multiple signal abnormalities in the left temporo-parietal, mesial temporal, insular cortices and thalamus on T2WI and FLAIR after frequent CPS. All of the lesions disappeared or resolved partially on the follow-up MRI. CONCLUSION: Our results showed that variable MRI changes in peri-ictal phase are possible at cortical as well as at subcortical areas. The dynamic MRI changes can be associated even in patients with single clinical seizure, suggesting that these changes are not related to the seizure frequency.

The Quality of Life of Children and Adolescents with Epilepsy and Their Families / 대한간질학회지

PURPOSE: Children with epilepsy tend to experience more emotional problems compared with healthy controls. The objective of this study was to elucidate the clinical factors influencing the quality of life in children and adolescents with epilepsy. We also evaluated preliminary findings concerning relationships between family factors and child emotional problems. METHODS: Subjects were 90 epilepsy patients aged between 6 and 17 years (mean 12.2+/-3.3 years) and their parents. Parents filled up the Impact of Childhood Illness Scale (ICIS). We compared the differences across patient groups according to the clinical factors such as seizure frequency, epilepsy types and duration, mono- or polytherapy, etc. RESULTS: ICIS subscore for treatment was higher when patients took more than one antiepileptic drugs (p=0.032), and when they still had poor seizure control (p=0.054) by regression analysis. Subscores for treatment, children, parents, and family were analyzed in each clinical factor. CONCLUSION: Epilepsy patients in childhood and adolescent ages have significant impacts on their quality of life and as well as on the family if they are on polytherapy or have poorly controlled seizures.

The Clinical Characteristics and the Prognosis of Poststroke Seizures after Ischemic Cerebral Infarction / 대한간질학회지

BACKGROUND: Although stroke is one of the most frequent causes of seizures in adulthood, there has been constant controversy concerning risk factors and prognosis of poststroke seizures. This study was performed to investigate clinical manifestations, risk factors and prognosis in patients with poststroke seizures (PSS). METHODS: A total of 2048 patients with cerebral infarction were recruited for this study. Patients with PSS were reviewed retrospectively regarding stroke subtype, etiology, lesion location, and functional disability of the stroke as well as seizure types, treatment and recurrence rate. Patients with traumatic or hemorrhagic brain lesion or a history of previous seizures were excluded. RESULTS: PSS developed in 4.2% of ischemic stroke patients (85/2048; 46 men and 39 women, mean age 65.4 years). PSS developed within one week of stroke onset in 18.8% (16/85) whereas after one week in 81.2% (69/85). PSS was more common in patients with cortical lesions than subcortical lesions (15.1% and 0.8%; p=0.076). Status epilepticus more frequently manifested in early onset seizures compared to late onset seizures (31.3% and 10.1%; p=0.029). Seizure recurrence was observed in 44.3% of PSS patients, mostly due to poor compliance to treatment or due to inadequate drug treatment. Only 7.1% of PSS patients were drug resistant and all of these patients had late onset seizures. CONCLUSION: Seizures after ischemic infarction developed more commonly after one week of stroke onset, and in patients with cortical lesions. Seizure recurrence occurred in about half of the patients, and the rate of drug resistance was higher in late onset seizures.

The Effect of L-Carnitine Supplementation on the Dystrophic Muscle and Exercise Tolerance of Muscular Dystrophy (mdx) Mice

BACKGROUND: Duchenne muscular dystrophy is an X-linked recessive disorder leading to death in the late teens or early twenties. There is no effective pharmacological therapy for now. L-carnitine (LCAR), a naturally occurring compound facilitating the transport of fatty acid into mitochondria for -oxidation, has been getting an attention for its antiapoptotic and osmoprotective effect. The aim of this study is to evaluate if LCAR administration reduces dystrophic progression and enhances exercise tolerance in dystrophin deficient (mdx) mice. METHODS: Mdx mice (n=5) and wild type mice (n=5), aged 3 weeks were treated with oral LCAR (75mg/kg/day) for 6 weeks. Five each mdx and wild type mice were recruited for their counter-control. The animals underwent a 30-minute run on a horizontal treadmill for evaluating their exercise endurance. After 6-week training, baseline and post exercise serum CK of each group were analyzed. We examined sarcolemma integrity and muscle histology after exercise. Immunofluorescent stain and Western blot analysis for dystrophin-dystroglycan complex were also performed. RESULTS: LCAR-treated mdx mice showed higher exercise tolerance and lower serum CK value compared with those of control mice. The area of Evans blue dye uptake in LCAR-treated mdx mice was much smaller than that of control mdx mice. There was no remarkable difference in dystrophin-dystroglycan complex expression between treated and control mdx mice. CONCLUSIONS: LCAR seems to enhance exercise tolerance and decrease the breakdown of sarcolemma during strenuous exercise. Our study suggests the possibility of adjunctive therapeutic use of L-carnitine to the patients with Duchenne muscular dystrophy.