Characteristics and Health Care Spending of Persistently and Transiently High-cost Older Adults in Korea / 예방의학회지

Objectives@#This study examined differences in health care spending and characteristics among older adults in Korea by high-cost status (persistently, transiently, and never high-cost). @*Methods@#We identified 1 364 119 older adults using data from the Korean National Insurance Claims Database for 2017-2019. Outcomes included average annual total health care spending and high-cost status for 2017-2019. Linear regression was used to estimate differences in the outcomes while adjusting for individual-level characteristics. @*Results@#Persistently and transiently high-cost older adults had higher health care spending than never high-cost older adults, but the difference in health care spending was greater among persistently high-cost older adults than among transiently high-cost older adults (US$20 437 vs. 5486). Despite demographic and socioeconomic differences between transiently high-cost and never high-cost older adults, the presence of comorbid conditions remained the most significant factor. However, there were no or small differences in the prevalence of comorbid conditions between persistently high-cost and transiently high-cost older adults. Rather, notable differences were observed in socioeconomic status, including disability and receipt of Medical Aid. @*Conclusions@#Medical risk factors contribute to high health care spending to some extent, but social risk factors may be a source of persistent high-cost status among older adults in Korea.

Correction of Posttraumatic Deviated Finger Deformity Using Preserved Superficial Fat Skin Composite Graft

The electrical burn or amputation of fingers gives damages not only to the soft tissue, but also to the bone, tendon and joint structure and causes severe deformity. To correct severe deformity, surgeons perform osteoplasty, tenolysis, capsulotomy, arthro- plasty, and flap surgery. However, such surgery can not be performed under some circumstances because patients wish to undergo surgery step-by-step, in stead of taking all at once. The deformity would have been more severe if the corrective surgery had been delayed without any treatment. The authors have reconstructed only soft tissue using the preserved superficial fat skin graft taken from the medial side of the foot or great toe. Nine patients who had deviated fingers were corrected from June 2001 to June 2002. Seven patients had deformity due to electrical burn, one due to amputation and the other due to congenital syndactyly. The period of follow-up was from 19 to 31 months. At surgery, a skin incision on the scar vertical to the finger and release of contraction of the deviated finger was performed. The soft tissue defect was reconstructed with a composite graft taken from medial side of the foot or great toe, with a preserved superficial fat layer. To accelerate healing of the grafted tissue, antibiotic ointment was applied to preserve the moisture environment. The composite graft was well taken without complication, and especially, there was no necrosis although the composite tissue was as big as 18x15mm to 33x11mm. The preoperative deformity was corrected better than we expected after surgery. The color and tissue texture were excellent and well harmonized with the surrounding skin, and the donor site healed without complication. We also observed a new bone formation in some cases.

A Standardized Model of Partial Thickness Burn in Domestic Pig

A standardized animal model with an identical burn wound depth is necessary to carry out a study on burn wound healing. It should be easy to operate, reliable and reproducible. The authors used pigs because they histologically resembles human skin most. The method of getting the pigs burned embodied a standardized burn models by using a digitally controlled aluminum thermal block designed by the authors. Nine pigs were burned by maintaining the heat at 70degrees C for 10 seconds, 15 seconds and 20 seconds, respectively, and at 80degrees C, 85degrees C, 90degrees C, 95degrees C and 100degrees C, every 5 seconds, 10 seconds and 15 seconds, for a total of 54 contact burn wounds. And another six pigs were burned at same contact time and temperature (n=3). Another three pigs were burned by maintaining the heat at 80degrees C for 10 seconds to produce 30 more contact burn wounds (n=30). After wounding, the burned skin was biopsied, stained with H&E and observed under microscopy. Two pathologists measured the vertical distance between the basement membrane and dermal tissue of the deepest burned tissue. The depth of burn increased at a regular phase in proportion to the temperature and the time of increasing temperature. The depth of 30 biopsies of the burned tissue at 80degrees C for 10 seconds was similar statistically. Therefore, the standardized burn model of a pig, made by using digitally controlled aluminum thermal block is highly simple, reliable and reproducible for a standardized burn model, and will be very helpful in the study of burn wound healing.