ABSTRACT
Background@#Continuity of care in primary care settings is crucial for managing diabetes. We aimed to statistically define and analyze continuity factors associated with demographics, clinical workforce, and geographical relationships. @*Methods@#We used 2014–2015 National Health Insurance Service claims data from the Korean registry, with 39,096 eligible outpatient attendance. We applied multivariable logistic regression to analyze factors that may affect the continuity of care indices for each patient: the most frequent provider continuity index (MFPCI), modified-modified continuity index (MMCI), and continuity of care index (COCI). @*Results@#The mean continuity of care indices were 0.90, 0.96, and 0.85 for MFPCI, MMCI and COCI, respectively. Among patient factors, old age >80 years (MFPCI: odds ratio [OR], 0.81; 95% confidence interval [CI], 0.74–0.89; MMCI: OR, 0.84; 95% CI, 0.76–0.92; and COCI: OR, 0.81; 95% CI, 0.74–0.89) and mild disability were strongly associated with lower continuity of care. Another significant factor was the residential area: the farther the patients lived from their primary care clinic, the lower the continuity of diabetes care (MFPCI: OR, 0.74; 95% CI, 0.70–0.78; MMCI: OR, 0.70; 95% CI, 0.66–0.73; and COCI: OR, 0.74; 95% CI, 0.70–0.78). @*Conclusion@#The geographical proximity of patients’ residential areas and clinic locations showed the strongest correlation as a continuity factor. Further efforts are needed to improve continuity of care to address the geographical imbalance in diabetic care.
ABSTRACT
Background@#The rapid rise in coronavirus disease worldwide has drastically limited the availability of hospital facilities for patients. Residential treatment centers were opened in South Korea for the admission of asymptomatic or patients with mild symptoms. This study discusses the appropriateness of the admission criteria set by the centers in a pandemic situation, the prioritization of patients for admission, and ways to minimize the risk of self-isolation. @*Methods@#A total of 217 low-risk patients (n=217) were admitted to the Nowon Residential Treatment Center between August 22 and October 14, 2020. The following criteria were met at the time of admission: patients (1) were asymptomatic or had mild symptoms, (2) had either a controlled or no underlying chronic disease, and (3) did not need oxygen treatment. Among them, 202 patients who were eligible for inclusion in the study were retrospectively investigated through periodic interviews. @*Results@#Of the 202 patients, 153 satisfied the criteria for symptomatic isolation standards, and 25 for asymptomatic isolation standards. The clinical conditions of 24 patients were aggravated, and these patients were transferred to other hospitals, among which 12 had persistent fever and 13 were suffering dyspnea with oxygen saturation (SpO2) <95%. @*Conclusion@#In the event of another large-scale epidemic, it would be appropriate to prioritize accommodating patients who are elderly or have underlying diseases and self-isolate young patients with no underlying diseases and provide them with SpO2 meters and thermometers to self-measure SpO2 and body temperature.
ABSTRACT
Objectives@#This study aimed to assess the effectiveness of relapse prevention interventions involving behavioral and pharmacological treatment among abstinent smokers. @*Methods@#This rapid review was conducted using MEDLINE, Cochrane CENTRAL, CINAHL, Embase, KMbase, and KoreaMed to identify studies published until June 20, 2020. The participants were abstinent smokers who quit smoking on their own, due to pregnancy, hospitalization, or by participating in a smoking cessation program. We found a systematic review that fit the objective of this study and included 81 randomized controlled trials (RCTs). Studies that did not present information on smoking cessation status, had no control group, or used reward-based interventions were excluded. Random effect and fixed effect meta-analyses were used to estimate the relative risk (RR) and 95% confidence interval (CI). In subgroup analyses, differences between subgroups were verified based on the participant setting, characteristics, intervention type, and intensity. @*Results@#Following screening, 44 RCTs were included in the meta-analysis. The review reported no differences in the success rate of relapse prevention between the behavioral interventions. Pharmacotherapy interventions showed higher success rates (RR, 1.15; 95% CI, 1.05−1.26; I2=40.71%), depending on prior abstinence duration and the drug type. Conclusions: The results indicated that pharmacotherapy has a significant effect on preventing relapse among abstinent smokers.
ABSTRACT
Background@#In the Republic of Korea, which medical specialties should take the responsibility for primary care and what the role of primary care should be are still unclear. In this study, we focused on the comprehensiveness of primary care to identify related factors. @*Methods@#The National Health Insurance Service (NHIS)-National Sample Cohort is a population-based cohort, sampled in the 2002 NHIS database and followed up until 2015. We used data collected from January 2014 to December 2015, including 20,423,832 outpatient visits in 19,557 office-based clinics. The Korean government has designated 52 simple or minor disease groups (SMDGs) to enhance the experience of patients who attend primary care for managing those diseases. We assessed comprehensiveness for each clinic as the number of SMDGs treated in each clinic for 2 years. We also identified the factors related to higher comprehensiveness, using logistic regression for analysis. @*Results@#The clinics included in the study had provided treatment for an average of 14 SMDGs during a 2-year period. Compared to general practitioners, internal medicine physicians presented higher comprehensiveness with an odds ratio (OR) of 2.29 (95% confidence interval [CI], 2.03–2.59), and family medicine physicians illustrated higher comprehensiveness (OR, 4.96; 95% CI, 3.59–6.83). Other specialties showed lower comprehensiveness than general practitioners. Clinics located in the capital city and metropolitan area tended to have lower comprehensiveness. Clinics hiring more doctors and having hospitalization facility showed higher comprehensiveness. @*Conclusion@#General physician, internal medicine, and family medicine are the fields providing comprehensive medical care in Korea. Clinics located in metropolitan area and capital city show lower comprehensiveness. The number of physicians is related to higher comprehensiveness of clinics.
ABSTRACT
Objectives@#This study aimed to assess the effectiveness of relapse prevention interventions involving behavioral and pharmacological treatment among abstinent smokers. @*Methods@#This rapid review was conducted using MEDLINE, Cochrane CENTRAL, CINAHL, Embase, KMbase, and KoreaMed to identify studies published until June 20, 2020. The participants were abstinent smokers who quit smoking on their own, due to pregnancy, hospitalization, or by participating in a smoking cessation program. We found a systematic review that fit the objective of this study and included 81 randomized controlled trials (RCTs). Studies that did not present information on smoking cessation status, had no control group, or used reward-based interventions were excluded. Random effect and fixed effect meta-analyses were used to estimate the relative risk (RR) and 95% confidence interval (CI). In subgroup analyses, differences between subgroups were verified based on the participant setting, characteristics, intervention type, and intensity. @*Results@#Following screening, 44 RCTs were included in the meta-analysis. The review reported no differences in the success rate of relapse prevention between the behavioral interventions. Pharmacotherapy interventions showed higher success rates (RR, 1.15; 95% CI, 1.05−1.26; I2=40.71%), depending on prior abstinence duration and the drug type. Conclusions: The results indicated that pharmacotherapy has a significant effect on preventing relapse among abstinent smokers.
ABSTRACT
Background@#In the Republic of Korea, which medical specialties should take the responsibility for primary care and what the role of primary care should be are still unclear. In this study, we focused on the comprehensiveness of primary care to identify related factors. @*Methods@#The National Health Insurance Service (NHIS)-National Sample Cohort is a population-based cohort, sampled in the 2002 NHIS database and followed up until 2015. We used data collected from January 2014 to December 2015, including 20,423,832 outpatient visits in 19,557 office-based clinics. The Korean government has designated 52 simple or minor disease groups (SMDGs) to enhance the experience of patients who attend primary care for managing those diseases. We assessed comprehensiveness for each clinic as the number of SMDGs treated in each clinic for 2 years. We also identified the factors related to higher comprehensiveness, using logistic regression for analysis. @*Results@#The clinics included in the study had provided treatment for an average of 14 SMDGs during a 2-year period. Compared to general practitioners, internal medicine physicians presented higher comprehensiveness with an odds ratio (OR) of 2.29 (95% confidence interval [CI], 2.03–2.59), and family medicine physicians illustrated higher comprehensiveness (OR, 4.96; 95% CI, 3.59–6.83). Other specialties showed lower comprehensiveness than general practitioners. Clinics located in the capital city and metropolitan area tended to have lower comprehensiveness. Clinics hiring more doctors and having hospitalization facility showed higher comprehensiveness. @*Conclusion@#General physician, internal medicine, and family medicine are the fields providing comprehensive medical care in Korea. Clinics located in metropolitan area and capital city show lower comprehensiveness. The number of physicians is related to higher comprehensiveness of clinics.
ABSTRACT
Migration presents a substantial social and public health issue. However, it is unclear whether diabetes is worse among Asian migrants than natives of South Korea over time. This longitudinal study investigated the nationwide population, including 2,680,495adults aged 20 years and older (987,214 Asian migrants and 1,693,281 natives), who received health check-ups, using the Korean National Health Insurance Service data (2009-2015). Joinpoint regression was used to estimate the annual percentage change of diabetes, and multivariable logistic regression was used to examine differences in incident type 2 diabetes between Asian mi-grants and natives adjusting for age, sex, economic status, body mass index, smoking status, any alcohol use, and physical activity. The age-adjusted prevalence of diabetes increased among native men (from 8.8% in 2009 to 9.7% in 2015, APC=1.64, p<0.05) compared to Asian migrant men, and the age-adjusted prevalence of diabetes increased among native women (from 6.0% in 2009 to 6.7% in 2015, APC=1.88, p<0.05) compared to Asian migrant women. In the multivariate analyses, Asian migrants wereless likely to get type 2 diabetes than natives (odds ratio, 0.82; 95% CI, 0.78 to 0.86) between the first and last health check-ups. However, the odds ratio for developing type 2 diabetes was 1.15 (95% CI, 1.10 to 1.20) among low-income levels compared to high-income levels, regardless of whether they were Asian migrants or natives. The results could help to establish a new strategy for prevention, treatment, and management of diabetes among the Asian population.
ABSTRACT
Background@#Previous studies suggested the correlation between thyroid and kidney functions, especially the high prevalence of hypothyroidism in chronic kidney disease. This study aimed to evaluate the influence of hypothyroidism on kidney function in Korean adults by using data from a representative nationwide survey. @*Methods@#This was a cross-sectional study composed of 5,250 individuals aged ≥19 years who were enrolled in the sixth Korea National Health and Nutrition Examination Survey. The participants were classified into three groups of patients with euthyroidism, subclinical hypothyroidism, and overt hypothyroidism according to thyroid function. Chronic kidney disease was defined as having a decreased estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Univariate and multivariate logistic regression analyses were used to evaluate the prevalence and adjusted odds ratio (aOR) of chronic kidney disease. @*Results@#Compared with the euthyroidism group, the subclinical and overt hypothyroidism groups showed higher prevalence rates of chronic kidney disease in both sexes. This tendency was significant in the elderly people aged ≥65 years. In the multivariate logistic regression analysis, the subclinical hypothyroidism group did not show a significant difference (adjusted odds ratio [aOR], 1.78; 95% confidence interval [CI], 0.82–3.87) from the euthyroidism group. In the overt hypothyroidism group, the aOR of chronic kidney disease was significantly higher (aOR, 5.90; 95% CI, 1.73– 20.15) than that in the euthyroidism group. @*Conclusion@#Overt hypothyroidism was associated with decreased eGFR and may be considered as an independent risk factor of chronic kidney disease.
ABSTRACT
Muscle strength and physical function decrease in older men, as do testosterone levels. Nonetheless, the effects of testosterone replacement therapy on muscle strength and physical function remain inconclusive and equivocal. We conducted a rapid systematic review, the results of which showed that testosterone replacement does not affect muscle strength (measured by hand grip strength and leg muscle strength), although it may increase physical function (measured by the 6-minute walk test, Physical Activity Scale for the Elderly score, and other physical performance tests). However, most of the studies were conducted in the United States or Europe and did not include participants from Asian or other ethnic backgrounds; therefore, further studies are needed to evaluate the effects of testosterone replacement in a broader population.
Subject(s)
Aged , Humans , Male , Asian People , Europe , Hand , Hand Strength , Leg , Motor Activity , Muscle Strength , Testosterone , United StatesABSTRACT
BACKGROUND: Non-communicable diseases (NCDs) are an important issue worldwide. Obesity has a close relationship with NCDs. Various age-related changes should be considered when evaluating obesity. METHODS: National representative cohort data from the National Health Insurance Service National Sample Cohort from 2012 to 2013 were used. Sex-specific and age group-specific (10-year intervals) means for body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WtHR) were calculated. Optimal cut-points for obesity parameters were defined as the value predicting two or more components of metabolic syndrome (except WC). RESULTS: The mean value and optimal cut-point for BMI decreased with age for men. The mean BMI value for women increased with age, but optimal cut-points showed no remarkable difference. The mean WC of men increased with age, but the optimal cut-points were similar for age groups. For women, the mean value and optimal cut-point for WC increased with age. Regarding WtHR, the mean value and optimal cut-point increased with age for men and women. Differences across age groups were larger for women. CONCLUSION: The mean values of the obesity indices and the optimal cut-points were changed according to age groups. This study supports the necessity of applying age group-specific cut-points for the various obesity parameters.
Subject(s)
Female , Humans , Male , Body Mass Index , Cohort Studies , National Health Programs , Obesity , Waist CircumferenceABSTRACT
OBJECTIVES: This pilot study aimed to obtain preliminary data on the associations between atherosclerosisand periodontitis, physical health status, and general and oral health behaviors. METHODS: Thirty-three subjects were recruited from among those who underwent carotid computed tomography (CT) angiography and general health check-up at the Seoul National University Hospital Health Examination Center (SNUHHEC). Two trained dentists conducted a periodontal examination to evaluate probing pocket depth and clinical attachment loss. A self-administered questionnaire was completed by study subjects, following informed consent. Data on physical health status were collected through review of medical records from the SNUHHEC. Information on general health behavior was obtainedfrom the self-reported questionnaire. Descriptive and comparative analyses were performed using IBM SPSS Statistics 21.0®. Statistical significance was set at P<0.05. RESULTS: A marginal, but non-significant association was noted between atherosclerosis and periodontitis(P=0.373). Flossing habit showed a significant association with periodontitis (P=0.007) and obesity (P=0.033). A possible association was noted between daily exercise and flossing (P=0.073). The habitual use of interdental brush also showed borderline association with smoking (P=0.098) and a stronger associationwith previous periodontal treatment (P=0.067); however, these associations were not statisticallysignificant. CONCLUSIONS: Our pilot study did not show an association between arteriosclerosis and periodontal disease.However, positive oral health care behavior, especially flossing, seems to alleviate arteriosclerosis. In other words, in this pilot survey, we confirmed the possibility that healthy oral care behavior can help to alleviate arteriosclerosis. Future large-scale studies are needed to confirm whether positive oral health care behaviors improve overall health.
Subject(s)
Humans , Angiography , Arteriosclerosis , Atherosclerosis , Dental Care , Dentists , Health Behavior , Informed Consent , Medical Records , Obesity , Oral Health , Overweight , Periodontitis , Pilot Projects , Seoul , Smoke , SmokingABSTRACT
The association between vitamin D levels and nonalcoholic fatty liver disease (NAFLD) has been recognized. However, few studies showed independent associations between vitamin D deficiency and NAFLD after a sex-related adjustment for metabolic factors. We aimed to study whether vitamin D deficiency is an independent risk factor of NAFLD even after controlling for metabolic syndrome and visceral fat in both sexes. In this cross-sectional study, 7,514 Korean adults (5,278 men, 2,236 women) participated in a health check-up program. They underwent blood tests, abdominal computed tomography (CT) of the visceral fat area, and ultrasonography for NAFLD screening. Multiple logistic regression analysis was used to investigate the association of vitamin D deficiency with NAFLD according to the sex differences. Vitamin D deficiency is associated with NAFLD. The adjusted odds ratio (aOR) for NAFLD increased sequentially with decreasing vitamin D level, even after adjusting for metabolic syndrome and visceral fat. The subjects in the vitamin D sufficiency group (20–30 ng/mL) had an aOR for NAFLD of 1.18 (95% CI, 1.00–1.39), whereas the deficiency group (< 20 ng/mL) had an aOR of 1.29 (95% CI, 1.10–1.52). However, we have detected a significant sex-related interaction when analyzing the results. A significant relationship between vitamin D deficiency and NAFLD was found in men (aOR, 1.33; 95% CI, 1.11–1.60) but not in women.
Subject(s)
Adult , Female , Humans , Male , Cross-Sectional Studies , Hematologic Tests , Intra-Abdominal Fat , Logistic Models , Mass Screening , Metabolic Syndrome , Non-alcoholic Fatty Liver Disease , Odds Ratio , Risk Factors , Sex Characteristics , Ultrasonography , Vitamin D Deficiency , Vitamin D , VitaminsABSTRACT
Health risk appraisal (HRA) is a systematic approach for collecting information regarding individual risk factors, predicting the probability of disease occurrence and death, and linking patients with interventions to promote health and prevent disease. Because the risk factors of cardiovascular disease are well established, several cardiovascular disease risk prediction models have been developed over multiple decades. The health risk appraisal prediction model of the Korean national health screening program will be revised and updated using the latest well-validated studies to reflect the current characteristics of the Korean population and to improve the effectiveness of education and behavioral modifications. It is necessary to provide various tools such as a web page and smartphone application to increase the utility of this program in the future.
Subject(s)
Humans , Behavior Control , Cardiovascular Diseases , Education , Health Status Indicators , Mass Screening , Risk Factors , SmartphoneABSTRACT
BACKGROUND: Cardiovascular disease (CVD) has become the most common cause of mortality and morbidity worldwide. Health screening is associated with higher outpatient visits for detection and treatment of CVD-related diseases (diabetes mellitus, hypertension, and dyslipidemia). We examined the association between health screening, health utilization, and economic status. METHODS: A sampled cohort database from the National Health Insurance Corporation was used. We included 306,206 participants, aged over 40 years, without CVD (myocardial infarction, stroke, and cerebral hemorrhage), CVD-related disease, cancer, and chronic renal disease. The follow-up period was from January 1, 2003 through December 31, 2005. RESULTS: Totally, 104,584 participants received at least one health screening in 2003–2004. The odds ratio of the health screening attendance rate for the five economic status categories was 1.27 (95% confidence interval [CI], 1.24 to 1.31), 1.05 (95% CI, 1.02 to 1.08), 1, 1.16 (95% CI, 1.13 to 1.19) and 1.50 (95% CI, 1.46 to 1.53), respectively. For economic status 1, 3, and 5, respectively, the diagnostic rate after health screening was as follows: diabetes mellitus: 5.94%, 5.36%, and 3.77%; hypertension: 32.75%, 30.16%, and 25.23%; and dyslipidemia: 13.43%, 12.69%, and 12.20%. The outpatient visit rate for attendees diagnosed with CVD-related disease was as follows for economic status 1, 3, and 5, respectively: diabetes mellitus: 37.69%, 37.30%, and 43.70%; hypertension: 34.44%, 30.09%, and 32.31%; and dyslipidemia: 18.83%, 20.35%, and 23.48%. CONCLUSION: Thus, higher or lower economic status groups had a higher health screening attendance rate than the middle economic status group. The lower economic status group showed lower outpatient visits after screening, although it had a higher rate of CVD diagnosis.
Subject(s)
Humans , Cardiovascular Diseases , Cohort Studies , Diabetes Mellitus , Diagnosis , Dyslipidemias , Follow-Up Studies , Hypertension , Infarction , Mass Screening , Mortality , National Health Programs , Odds Ratio , Outpatients , Renal Insufficiency, Chronic , StrokeABSTRACT
BACKGROUND: Cigarette smoking is a risk factor for cardiovascular disease (CVD) and has both beneficial and harmful effects in CVD. We hypothesized that weight gain following smoking cessation does not attenuate the CVD mortality of smoking cessation in the general Korean population. METHODS: Study subjects comprised 2.2% randomly selected patients from the Korean National Health Insurance Corporation, between 2002 and 2013. We identified 61,055 subjects who were classified as current smokers in 2003–2004. After excluding 21,956 subjects for missing data, we studied 30,004 subjects. We divided the 9,095 ex-smokers into two groups: those who gained over 2 kg (2,714), and those who did not gain over 2 kg (6,381, including weight loss), after smoking cessation. Cox proportional hazards regression models were used to estimate the association between weight gain following smoking cessation and CVD mortality. RESULTS: In the primary analysis, the hazard ratios of all-cause deaths and CVD deaths were assessed in the three groups. The CVD risk factors and Charlson comorbidity index adjusted hazard ratios (aHRs) for CVD deaths were 0.80 (95% confidence interval [CI], 0.37 to 1.75) for ex-smokers with weight gain and 0.80 (95% CI, 0.50 to 1.27) for ex-smokers with no weight gain, compared to one for sustained smokers. The associations were stronger for events other than mortality. The aHRs for CVD events were 0.69 (95% CI, 0.54 to 0.88) and 0.81 (95% CI, 0.70 to 0.94) for the ex-smokers with and without weight gain, respectively. CONCLUSION: Although smoking cessation leads to weight gain, it does not increase the risk of CVD death.
Subject(s)
Humans , Cardiovascular Diseases , Comorbidity , Mortality , National Health Programs , Risk Factors , Smoke , Smoking Cessation , Smoking , Weight GainABSTRACT
Osteoporosis is a medical condition of global concern, with increasing incidence in both sexes. Bone mineral density (BMD), a highly heritable trait, has been proven a useful diagnostic factor in predicting fracture. Because medical information is lacking about male osteoporotic genetics, we conducted a genome-wide association study of BMD in Korean men. With 1,176 participants, we analyzed 4,414,664 single nucleotide polymorphisms (SNPs) after genomic imputation, and identified five SNPs and three loci correlated with bone density and strength. Multivariate linear regression models were applied to adjust for age and body mass index interference. Rs17124500 (p = 6.42 × 10⁻⁷), rs34594869 (p = 6.53 × 10⁻⁷) and rs17124504 (p = 6.53 × 10⁻⁷) in 14q31.3 and rs140155614 (p = 8.64 × 10⁻⁷) in 15q25.1 were significantly associated with lumbar spine BMD (LS-BMD), while rs111822233 (p = 6.35 × 10⁻⁷) was linked with the femur total BMD (FT-BMD). Additionally, we analyzed the relationship between BMD and five genes previously identified in Korean men. Rs61382873 (p = 0.0009) in LRP5, rs9567003 (p = 0.0033) in TNFSF11 and rs9935828 (p = 0.0248) in FOXL1 were observed for LS-BMD. Furthermore, rs33997547 (p = 0.0057) in ZBTB and rs1664496 (p = 0.0012) in MEF2C were found to influence FT-BMD and rs61769193 (p = 0.0114) in ZBTB to influence femur neck BMD. We identified five SNPs and three genomic regions, associated with BMD. The significance of our results lies in the discovery of new loci, while also affirming a previously significant locus, as potential osteoporotic factors in the Korean male population.
Subject(s)
Humans , Male , Asian People , Body Mass Index , Bone Density , Femur , Femur Neck , Genetics , Genome-Wide Association Study , Incidence , Linear Models , Osteoporosis , Polymorphism, Single Nucleotide , SpineABSTRACT
In order to increase inhaled corticosteroid (ICS) use and to reduce hospitalization, emergency department visits and ultimately the economic burden of asthma, "Korean Asthma Management Guideline for Adults 2007" was developed. To assess the guideline effects on physician's ICS prescription for asthma, we conducted segmented regression and multilevel logistic regression using National Health Insurance claims database of outpatient visits from 2003 to 2010. We set each quarter of a year as a time unit and compared ICS prescription between before and after guideline dissemination. A total of 624,309 quarterly visits for asthma was observed. The ICS prescription rate before and after guideline dissemination was 13.3% and 16.4% respectively (P < 0.001). In the segmented regression, there was no significant guideline effect on overall ICS prescription rate. In multilevel logistic regression analyses, the effect of guideline on overall ICS prescription was not significant (odds ratio, 1.03; 95% CI, 1.00-1.06). In subgroup analysis, ICS prescription increased in secondary care hospitals (odds ratio, 1.15; 95% CI, 1.02-1.30) and in general hospitals (odds ratio, 1.10; 95% CI, 1.04-1.16). However, in primary clinics, which covered 81.7% of asthma cases, there was no significant change (odds ratio, 0.98; 95% CI, 0.94-1.02). From the in-depth interview, we could identify that the reimbursement criteria of the Health Insurance Review and Assessment Service and patient's preference for oral drug were barriers for the ICS prescription. The domestic asthma clinical guideline have no significant effect on ICS prescription, especially in primary clinics.
Subject(s)
Humans , Administration, Inhalation , Adrenal Cortex Hormones/administration & dosage , Allergy and Immunology/standards , Anti-Inflammatory Agents/administration & dosage , Asthma/drug therapy , Drug Prescriptions/statistics & numerical data , Guideline Adherence/statistics & numerical data , Practice Guidelines as Topic , Prevalence , Pulmonary Medicine/standards , Republic of Korea/epidemiology , Treatment OutcomeABSTRACT
BACKGROUND: Small vessel disease is an important cause of cerebrovascular diseases and cognitive impairment in the elderly. There have been conflicting results regarding the relationship between Helicobacter pylori infection and ischemic stroke. This study aimed to examine the association between H. pylori infection and cerebral small vessel disease. METHODS: The study included 1,117 patients who underwent brain magnetic resonance imaging and H. pylori identification between 2005 and 2013 at Health Promotion Center, Seoul National University Hospital. Multivariable logistic regression analysis was used to assess the association between H. pylori infection and small vessel disease with adjustment for age, sex, hypertension, diabetes mellitus, dyslipidemia, body mass index, smoking status, problem drinking, and antiplatelet use. RESULTS: The adjusted odds ratios (aORs) for the association between H. pylori infection and silent brain infarction and cerebral microbleeds were 1.03 (95% confidence interval [CI], 0.66-1.61) and 0.70 (95% CI, 0.38-1.28), respectively. The aORs for silent brain infarction and cerebral microbleeds were 0.81 (95% CI, 0.44-1.44) and 0.59 (95% CI, 0.30-1.18) in patients aged 65 years, respectively. Moreover, the aORs for silent brain infarction and cerebral microbleeds were 0.96 (95% CI, 0.54-1.71) and 0.74 (95% CI, 0.33-1.69) in H. pylori-infected patients without atrophic gastritis and 0.89 (95% CI, 0.48-1.62) and 0.99 (95% CI, 0.43-2.27) in those with atrophic gastritis, respectively. CONCLUSION: No association between H. pylori infection and small vessel disease was observed. H. pylori-induced inflammation may not be a risk factor for microcirculatory damage in the brain.
Subject(s)
Aged , Humans , Body Mass Index , Brain , Brain Infarction , Cerebral Small Vessel Diseases , Diabetes Mellitus , Drinking , Dyslipidemias , Gastritis, Atrophic , Health Promotion , Helicobacter pylori , Helicobacter , Hypertension , Inflammation , Logistic Models , Magnetic Resonance Imaging , Odds Ratio , Risk Factors , Seoul , Smoke , Smoking , StrokeABSTRACT
Participation in a screening program by itself may not improve clinical outcomes. Treatment gaps in the program may limit its full benefit. We evaluated statin prescription rates for subjects with sustained hypercholesterolemia to assess the treatment gaps in the National Health Screening Program (NHSP) in Korea. A retrospective, random cohort was established among National Health Insurance Corporation (NHIC) members. Finally, we examined 465,499 individuals who attended the NHSP from 2003 to 2010 without any history of dyslipidemia, statin prescription, or hospitalization for cardiovascular events until the end of 2002. The subsequent statin prescription rates were identified from the NHIC medical service claim database from 2003 to 2011. Descriptive data and odds ratio from multivariate logistic analyses on statin prescription rates and the corresponding correlations were evaluated. The NHSP detected 114,085 (24.5%) cases of newly diagnosed hypercholesterolemia. However, only 8.6% of these received statin prescription within 6 months of diagnosis. For cases of sustained hypercholesterolemia determined in the next screening visit by the NHSP, the statin prescription rate increased, but only to 12.2%. Statin prescriptions were more common among females, older individuals, and hypertension or diabetes patients. Furthermore, the statin prescription rates had increased over the study period. The NHSP exhibited low statin prescription rate which has been improving. For the NHSP to be effective, it would be worthwhile to decrease the gap between the diagnosis of hypercholesterolemia and the following treatment.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Chronic Disease , Drug Prescriptions/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hypercholesterolemia/diagnosis , Insurance Claim Reporting/statistics & numerical data , Mass Screening/statistics & numerical data , National Health Programs/statistics & numerical data , Prevalence , Republic of Korea/epidemiology , Risk Assessment , Treatment OutcomeABSTRACT
BACKGROUND: Migrant health is becoming public health issues, as the migrant populations are increasing and their length of stay is prolonged. This study aims to analyze the differences in prevalence of chronic diseases among migrants according to length of stay and residential status. METHODS: An initial population pool were 3,024 who were assessed with health screening programs by Migrant Health Association. 2,459 migrants were selected for final analysis. Via Stata 10 we conducted univariate logistic regression analysis to examine the effects of their length of stay and residential status on the prevalence of hypertension, diabetes, dyslipidemia, and obesity. In the final analysis, the result of each sex was adjusted for age, nationality, length of stay, and residential status via multiple logistic regression analysis. RESULTS: Longer length of stay tends to increase the prevalence of hypertension in male; 4-6 year stay-duration group demonstrated statistically significant excess compared to 1 year or less stay-duration group (adjusted odds ratio [OR], 1.39; confidence interval [CI], 1.01 to 1.92). After adjustment, male migrants stayed more than 7 year showed considerably higher dyslipidemia than male migrants stayed less than 1 year (adjusted OR, 1.95; CI, 1.05 to 3.64). Compared to the group with 1 year or less stay-duration, the prevalence of obesity in male was significantly higher among 4-6 year (adjusted OR, 1.65; CI, 1.17 to 2.32) and 7 year or more stay-duration group (adjusted OR, 1.65; CI, 1.11 to 2.45). CONCLUSION: Longer length of stay correlated to higher prevalence of hypertension, dyslipidemia, and obesity among some population of migrants. So more researches and new developing policies are needed for this problem.