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Purpose@#This study aimed to evaluate the participation and follow-up test compliance rates and key performance indicators of the National Cancer Screening Program (NCSP) for colorectal cancer (CRC) from 2004 to 2017. @*Materials and Methods@#The overall outcomes of the NCSP for CRC were analyzed using the NCSP data collected from 2004 to 2017 and the Korean Central Cancer Registry for CRC from 2005 to 2017. We cross-sectionally analyzed the participation and follow-up test compliance rates and performance indicators for each year. The trend of participation rates as an annual percentage change was assessed, and other statistical analyses were performed. @*Results@#The screening participation rates increased from 7.3% in 2004 to 30.5% in 2017. Additionally, the screening rates were higher among individuals aged 60-69 years and National Health Insurance Service beneficiaries of low-income status. However, the adherence to the follow-up test decreased from 63% in 2004 to 32% in 2017. The follow-up tests using the double-contrast barium enema method decreased from 42.2% in 2004 to 0.3% in 2017. However, follow-up tests by colonoscopy increased from 21.0% in 2004 to 31.8% in 2017. Furthermore, the positivity, false-positive, and interval CRC rates decreased, whereas the specificity increased from 2004 to 2016, indicating improved performance of CRC. @*Conclusion@#The participation rates and performance of the NCSP for CRC have steadily improved, whereas adherence to follow-up tests has decreased. Additionally, there is a rapid growth in colonoscopy volume as a follow-up test. Continued efforts are required to improve the follow-up rates.
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The skin, the largest organ in the body, undergoes age-related changes influenced by both intrinsic and extrinsic factors. The primary external factor is photoaging which causes hyperpigmentation, uneven skin surface, deep wrinkles, and markedly enlarged capillaries. In the human dermis, it decreases fibroblast function, resulting in a lack of collagen structure and also decreases keratinocyte function, which compromises the strength of the protective barrier. In this study, we found that treatment with γ-aminobutyric acid (GABA) had no toxicity to skin fibroblasts and GABA enhanced their migration ability, which can accelerate skin wound healing. UVB radiation was found to significantly induce the production of matrix metalloproteinase 1 (MMP-1), but treatment with GABA resulted in the inhibition of MMP-1 production. We also investigated the enhancement of filaggrin and aquaporin 3 in keratinocytes after treatment with GABA, showing that GABA can effectively improve skin moisturization. In vivo experiments showed that oral administration of GABA significantly improved skin wrinkles and epidermal thickness. After the intake of GABA, there was a significant decrease observed in the increase of skin thickness measured by calipers and erythema. Additionally, the decrease in skin moisture and elasticity in hairless mice exposed to UVB radiation was also significantly restored. Overall, this study demonstrates the potential of GABA as functional food material for improving skin aging and moisturizing.
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Objective@#This study aimed to analyze the trends in cervical cancer screening rates, including organized and opportunistic cancer screening rates, with the Papanicolaou test among Korean women. @*Methods@#Data were collected from a nationwide, cross-sectional, Korean National Cancer Screening Survey. To evaluate the cervical cancer screening rates, we used the screening approach of “cervical cancer screening rate with recommendation,” defined as the proportion of women who underwent the Papanicolaou test during the previous 2 years according to the Protocol of National Cancer Screening Program for Cervical Cancer in Korea. The joinpoint regression analysis, which describes the annual percent change (APC), was performed to detect significant changes in cervical cancer screening rates in women aged 30-74 years during 2005-2020. @*Results@#The cervical cancer screening rate was 56.0% in 2020. From 2005 to 2013, there was a rising trend in cervical cancer screening rates (APC=2.70%, 95% confidence interval [CI]:1.05 to 4.38), followed by a falling trend (APC=−2.67%, 95% CI:−4.3 to −1.01). The falling trend was significantly associated with age (≥40 years), education level (below the 15th grade), household income (below the middle-income level), and residence (all residential areas). @*Conclusion@#The recent falling trend was more common in women with a low socioeconomic status, which suggests that there is a socioeconomic gap in cervical cancer screening. Moreover, young women in their thirties had a low screening rate. Therefore, an active participation strategy for women vulnerable to cervical cancer is required.
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The current multimorbidity correction method in the Global Burden of Disease studies assumes the independent occurrence of diseases. Those studies use Monte-Carlo simulations to adjust for the presence of multiple disease conditions for all diseases. The present study investigated whether the above-mentioned assumption is reasonable based on the prevalence confirmed from actual data. This study compared multimorbidity-adjusted years of lived with disability (YLD) obtained by Monte-Carlo simulations and multimorbidity-adjusted YLD using multimorbidity prevalence derived from National Health Insurance Service data. The 5 most common diseases by sex and age groups were selected as diseases of interest. No significant differences were found between YLD estimations made using actual data and Monte-Carlo simulations, even though assumptions about the independent occurrence of diseases should be carefully applied. The prevalence was not well reflected according to disease characteristics in those under the age of 30, among whom there was a difference in YLD between the 2 methods. Therefore, when calculating the burden of diseases for Koreans over the age of 30, it is possible to calculate the YLD with correction for multimorbidity through Monte-Carlo simulation, but care should be taken with under-30s. It is useful to apply the efficiency and suitability of calibration for multiplicative methods using Monte-Carlo simulations in research on the domestic disease burden, especially in adults in their 30s and older. Further research should be carried out on multimorbidity correction methodology according to the characteristics of multiple diseases by sex and age.
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Objectives@#Cognitive behavioral therapy for insomnia (CBT-I) is the first line treatment for insomnia. However, many patients remain with sleep disturbances even after undergoing CBT-I, and those with short sleep durations have shown fewer gains. Acceptance and commitment therapy (ACT) is one of the third wave of behavioral therapies, and it is useful in helping patients get flexibility of mind. Therefore, we incorporated its components into CBT-I, came up with an advanced CBT-I program that involves cognitive behavior therapy based on ACT, and examined its efficacy in comparison to that of CBT-I. @*Methods@#Patients with chronic primary insomnia were recruited at the memory center of CHA University Hospital from June to August 2020. To examine the efficacy of advanced CBT-I compared to that of CBT-I, the patients (n=16) were assigned to two groups (CBT-I: n=6; advanced CBT-I: n=10). The patients in each group were treated for 4 weeks (8 sessions). The quality of sleep, severity of insomnia, sleepiness, depression, anxiety, acceptance, efforts to sleep, and dysfunctional beliefs concerning sleep were assessed with self-report questionnaires. @*Results@#The severity of insomnia, quality of sleep, depression, anxiety, acceptance, efforts to sleep, and dysfunctional beliefs concerning sleep improved after both CBT-I and advanced CBT-I treatment. @*Conclusions@#This study examined the efficacy of advanced CBT-I in improving the severity of insomnia, sleep quality, and other symptoms related to sleep. The results suggest that components of ACT were useful for insomnia.
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Objectives@#Cognitive behavioral therapy for insomnia (CBT-I) is the first line treatment for insomnia. However, many patients remain with sleep disturbances even after undergoing CBT-I, and those with short sleep durations have shown fewer gains. Acceptance and commitment therapy (ACT) is one of the third wave of behavioral therapies, and it is useful in helping patients get flexibility of mind. Therefore, we incorporated its components into CBT-I, came up with an advanced CBT-I program that involves cognitive behavior therapy based on ACT, and examined its efficacy in comparison to that of CBT-I. @*Methods@#Patients with chronic primary insomnia were recruited at the memory center of CHA University Hospital from June to August 2020. To examine the efficacy of advanced CBT-I compared to that of CBT-I, the patients (n=16) were assigned to two groups (CBT-I: n=6; advanced CBT-I: n=10). The patients in each group were treated for 4 weeks (8 sessions). The quality of sleep, severity of insomnia, sleepiness, depression, anxiety, acceptance, efforts to sleep, and dysfunctional beliefs concerning sleep were assessed with self-report questionnaires. @*Results@#The severity of insomnia, quality of sleep, depression, anxiety, acceptance, efforts to sleep, and dysfunctional beliefs concerning sleep improved after both CBT-I and advanced CBT-I treatment. @*Conclusions@#This study examined the efficacy of advanced CBT-I in improving the severity of insomnia, sleep quality, and other symptoms related to sleep. The results suggest that components of ACT were useful for insomnia.
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BACKGROUND@#Evaluation of mortality and prevalence trends is important for health planning and priority decision-making in health policy. This study was performed to examine disease-specific mortality and prevalence trends for diseases in Korea from 2002 to 2015.@*METHODS@#In this study, 206 mutually exclusive diseases and injuries were classified into 21 cause clusters, which were divided into three cause groups: 1) communicable, maternal, neonatal, and nutritional conditions; 2) non-communicable diseases (NCDs); and 3) injuries. Cause specific trends for age-standardized mortality and prevalence rates were analyzed by the joinpoint regression method.@*RESULTS@#Between 2002 and 2015, the age-standardized mortality declined to about 177 per 100,000 population, while the age-standardized prevalence rate increased to approximately 68,065 per 100,000 population. Among the 21 cause clusters, most of the disease mortality rates showed decreasing trends. However, neurological disorders, self-harm, and interpersonal violence included periods during which the mortality rates increased in 2002–2015. In addition, the trends for prevalence rates of human immunodeficiency virus infection and acquired immune deficiency syndrome, tuberculosis, transport injuries, and self-harm, and interpersonal violence differed from the overall prevalence rates. The annual percent change in prevalence rates for transport injuries increased during 2004–2007, and then decreased. The self-harm and interpersonal violence prevalence rates decreased from 2004 to 2014.@*CONCLUSION@#Between 2002 and 2015, overall decreasing trends in the mortality rate and increasing trends in the prevalence rate were observed for all causes in Korea. Especially, NCDs represented an important part of the increasing trends in Korea. For clusters of diseases with unusual trends, proper management must be considered.
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BACKGROUND@#Evaluation of mortality and prevalence trends is important for health planning and priority decision-making in health policy. This study was performed to examine disease-specific mortality and prevalence trends for diseases in Korea from 2002 to 2015.@*METHODS@#In this study, 206 mutually exclusive diseases and injuries were classified into 21 cause clusters, which were divided into three cause groups: 1) communicable, maternal, neonatal, and nutritional conditions; 2) non-communicable diseases (NCDs); and 3) injuries. Cause specific trends for age-standardized mortality and prevalence rates were analyzed by the joinpoint regression method.@*RESULTS@#Between 2002 and 2015, the age-standardized mortality declined to about 177 per 100,000 population, while the age-standardized prevalence rate increased to approximately 68,065 per 100,000 population. Among the 21 cause clusters, most of the disease mortality rates showed decreasing trends. However, neurological disorders, self-harm, and interpersonal violence included periods during which the mortality rates increased in 2002–2015. In addition, the trends for prevalence rates of human immunodeficiency virus infection and acquired immune deficiency syndrome, tuberculosis, transport injuries, and self-harm, and interpersonal violence differed from the overall prevalence rates. The annual percent change in prevalence rates for transport injuries increased during 2004–2007, and then decreased. The self-harm and interpersonal violence prevalence rates decreased from 2004 to 2014.@*CONCLUSION@#Between 2002 and 2015, overall decreasing trends in the mortality rate and increasing trends in the prevalence rate were observed for all causes in Korea. Especially, NCDs represented an important part of the increasing trends in Korea. For clusters of diseases with unusual trends, proper management must be considered.
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Síndrome da Imunodeficiência Adquirida , Planejamento em Saúde , Política de Saúde , HIV , Coreia (Geográfico) , Métodos , Mortalidade , Doenças do Sistema Nervoso , Prevalência , República da Coreia , Tuberculose , ViolênciaRESUMO
BACKGROUND@#For the Korean Burden of Disease (KBD) 2015 study, we have amended disability weights for causes of disease adapting the methodology of the KBD disability weight 2012 study.@*METHODS@#We conducted a self-administered web-based survey in Korea using ranking five causes of disease. A total of 605 physicians and medical college students who were attending in third or fourth grade of a regular course performed the survey. We converted the ranked data into paired comparison data and ran a probit regression. The predicted probabilities for each cause of disease were calculated from the coefficient estimates of the probit regression. ‘Being dead (1)’ and ‘Full health (0)’ were utilized as anchor points to rescale the predicted probability on a scale from 0 to 1.@*RESULTS@#As a result, disability weights for a total of 289 causes of disease were estimated. In particular, we calculated the disability weights of 60 causes of disease considering severity level. These results show that prejudice about the severity of cause of disease itself can affect the estimation of disability weight, when estimating the disability weight for causes of disease without consideration of severity. Furthermore, we have shown that disability weights can be estimated based on a ranking method which can maximize efficiency of data collection.@*CONCLUSION@#Disability weights from this study can be used to estimate disability adjusted life year and healthy life expectancy. Furthermore, we expected that the use of the ranking method will increase gradually in disability weight studies.
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BACKGROUND@#Injury represents an important aspect of disease that affects everyone at some point in their lives. To better understand and prevent these injuries, various analytical methods have been developed to assess both the magnitude and features of injury burden. In this study, we attempted to estimate the injury burden of Korea in 2014 by comparing the prevalence-based approach used by the Global Burden of Diseases (GBD) team and the World Health Organization against an alternative incidence-based approach, and to assess the different implications of these measurements.@*METHODS@#The 10th Korean National Hospital Discharge survey data and causes of death statistics in 2014 were used as data sources. Years of life lost (YLL), years lived with disability (YLD) and disability-adjusted life years (DALYs) were calculated using both the incidence- and prevalence-based approaches. The Korean Classification of Diseases (KCD) version 5 diagnostic codes were used to classify the mechanism of injury.@*RESULTS@#The prevalence-based injury burden tended to be higher (1,670,229 DALYs) than the incidence-based injury burden (1,544,467 DALYs). The elderly population exhibited a higher prevalence-based YLD and DALY relative to incidence-based outcomes. In order of significance, the three most common causes of injury as calculated using an incidence-based approach were road injury, fall, and self-harm, compared with a prevalence-based method, which identified self-harm, road injury, and falls as the most common injuries.@*CONCLUSION@#An appropriate prevention program is needed for injuries with potential to cause long-lasting morbidity. Accordingly, a tailored injury-prevention strategy should be developed for each high-risk group.
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BACKGROUND@#Projection of future trends in disease burden can facilitate setting of priorities for health policies and resource allocation. We report here projections of disease-specific mortality and the burdens of various diseases in Korea from 2016 to 2030.@*METHODS@#Separate age- and sex-specific projection models for 21 major cause clusters from 2016 to 2030 were developed by applying coherent functional data models based on historical trends from 2002 to 2015. The age- and sex-specific years of life lost (YLL) for each cause cluster were projected based on the projected number of deaths. Years lived with disability (YLD) projections were derived using the 2015 age- and sex-specific YLD to YLL ratio. The disability-adjusted life years (DALYs) was the sum of YLL and YLD.@*RESULTS@#The total number of deaths is projected to increase from 275,777 in 2015 to 421,700 in 2030, while the age-standardized death rate is projected to decrease from 586.9 in 2015 to 447.3 in 2030. The largest number of deaths is projected to be a result of neoplasms (75,758 deaths for males; 44,660 deaths for females), followed by cardiovascular and circulatory diseases (34,795 deaths for males; 48,553 deaths for females). The three leading causes of DALYs for both sexes are projected to be chronic respiratory diseases, musculoskeletal disorders, and other non-communicable diseases (NCDs).@*CONCLUSION@#We demonstrate that NCDs will continue to account for the majority of the disease burden in Korea in the future.
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This notice corrects the grant number in funding information.
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OBJECTIVES: Immunization is considered one of the most successful and cost-effective public health interventions protecting communities from preventable infectious diseases. The Korean government set up a dedicated workforce for national immunization in 2003, and since then has made strides in improving vaccination coverage across the nation. However, some groups remain relatively vulnerable and require intervention, and it is necessary to address unmet needs to prevent outbreaks of communicable diseases. This study was conducted to characterize persistent challenges to vaccination. METHODS: The study adopted a qualitative method in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Three focus group interviews were conducted with 15 professionals in charge of vaccination-related duties. The interviews were conducted according to a semi-structured guideline, and thematic analysis was carried out. Data saturation was confirmed when the researchers agreed that no more new codes could be found. RESULTS: A total of 4 main topics and 11 subtopics were introduced regarding barriers to vaccination. The main topics were vaccine hesitancy, personal circumstances, lack of information, and misclassification. Among them, vaccine hesitancy was confirmed to be the most significant factor impeding vaccination. It was also found that the factors hindering vaccination had changed over time and disproportionately affected certain groups. CONCLUSIONS: The study identified ongoing unmet needs and barriers to vaccination despite the accomplishments of the National Immunization Program. The results have implications for establishing tailored interventions that target context- and group-specific barriers to improve timely and complete vaccination coverage.
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Humanos , Lista de Checagem , Doenças Transmissíveis , Surtos de Doenças , Grupos Focais , Imunização , Programas de Imunização , Coreia (Geográfico) , Métodos , Saúde Pública , Pesquisa Qualitativa , VacinaçãoRESUMO
OBJECTIVES: Due to their developmental characteristics, adolescents have a higher probability than other age groups of experiencing injuries caused by accidents, violence, and intentional self-harm. The severity and characteristics of injuries vary by the intentionality and mechanism of injury; therefore, there is a need for a national-level estimate of the scale and the severity of injuries in adolescents that takes these factors into account. METHODS: By using data from the Emergency Department-based Injury In-depth Surveillance Data, National Emergency Department Information System, the Korean National Hospital Discharge In-depth Injury Survey, and cause of death statistics, we calculated the emergency department (ED) visit rate, hospitalization rate, and death rate of injuries per 100 000 adolescents for each injury mechanism. The calculated rates were used to generate the injury pyramid ratio (ratio of death rate to hospitalization rate to ED visit rate) to visualize the scale and the severity of the injury. RESULTS: The mortality rate in adolescents due to injury was 10/100 000; the corresponding rates for hospitalization and ED visits were 1623 and 4923, respectively, resulting in an injury pyramid ratio with the general pyramid form, with a 1:162:492 ratio of deaths to hospitalizations to ED visits. The mortality rate due to suicide/intentional self-harm was 5/100 000, while 35 were hospitalized for this reason and 74 made ED visits. The pyramid ratio of 1:7:15 for intentional self-harm/suicide showed a steep pyramidal form, indicating considerable lethality. The mortality rate due to motor vehicle collisions (MVCs) was 3/100 000; 586 were hospitalized for this reason, while 1023 made ED visits. The pyramid ratio of 1:195:341 for MVCs showed a gradual pyramid form, indicating that the lethality was low and the scale of injury was high. CONCLUSIONS: The main categories of injuries in adolescents were visualized in pyramid form, contributing to an understanding of the scale of each injury by mechanism in terms of levels of death, hospitalization, and ED visits. These findings will be helpful for understanding how to prioritize injuries in adolescents.
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Adolescente , Humanos , Causas de Morte , Emergências , Serviço Hospitalar de Emergência , Hospitalização , Sistemas de Informação , Intenção , Mortalidade , Veículos Automotores , ViolênciaRESUMO
BACKGROUND: Pregnancy may influence the skin in various ways from physiologic changes to pathologic dermatoses. OBJECTIVE: To analyze and quantify the distribution and clinical features of dermatoses in pregnant patients. METHODS: We retrospectively reviewed medical records of 634 pregnant patients who visited the department of dermatology between May, 2006 and November, 2012. The patients' epidemiologic status and clinical characteristics were analyzed. RESULTS: The mean age of patients was 30.6 and the mean gestational age was 22.3 weeks. They were classified into 3 groups: general dermatoses, pregnancy-specific dermatoses, and physiologic skin change. General dermatoses were observed in 434 patients (68.5%) and infectious disease accounted for 50.0% of them. The most frequent infectious disease was viral infection with herpes zoster (29.5%) and varicella (16.1%). Pregnancy-specific dermatoses were recognized in 177 patients (28.0%). Among them, 96 (54.2%) were diagnosed as atopic eruption of pregnancy and 66 (37.3%) were pruritic urticarial papules and plaques of pregnancy. Primigravida, late onset and abdominal involvement were more frequent in patients with pruritic urticarial papules and plaques of pregnancy. The prognosis of patients with pregnancy specific dermatoses was good without major fetal problems. Pyogenic granuloma was recorded as the most common physiologic changes encountered. We performed examinations and procedures in only 36.3% of pregnant patients. CONCLUSION: We analyzed the distribution and clinical characteristics observed in pregnant patients with dermatological problems. Dermatologists should be aware of the differences to improve the quality of patient care.
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Humanos , Gravidez , Varicela , Doenças Transmissíveis , Dermatologia , Idade Gestacional , Granuloma Piogênico , Herpes Zoster , Prontuários Médicos , Assistência ao Paciente , Complicações na Gravidez , Prognóstico , Prurido , Estudos Retrospectivos , Pele , DermatopatiasRESUMO
We report a 62-year-old woman with multiple myeloma associated with cryoglobulinemia accompanied by gangrene of the digits. She presented with generalized purplish net-like discoloration (livedo reticularis), which was more prominent in the lower extremities. Multiple small shallow ulcers with crusts were found in places. In addition, gangrene was observed in both ear helices, both index fingers, and several toes. The patient had monoclonal gammopathy consisting of IgG and kappa (3.95 g/dL), cryoglobulinemia, and bone marrow plasmacytosis (42%). A biopsy of a discolored skin patch on the lower leg revealed leukocytoclastic vasculitis. She was diagnosed with multiple myeloma associated with cryoglobulinemia. Immediate plasmapheresis halted the progression of the skin lesions and digital gangrene. Two cycles of thalidomide plus dexamethasone therapy led to a partial response. This case highlights the need to search for cryoglobulinemia and multiple myeloma when we see livedo reticularis or multiple skin ulcers with obscure causes.