Trajectories of Preventive Health Care Utilization Among Older Koreans: The Role of Social Relationships.

BACKGROUND: Receiving timely health screening is associated with important public health benefits among older adults. By focusing on the role of social relationships, the present study was aimed at examining longitudinal trajectories of health screening use among older adults in Korea, whose universal health care system provides free-of-charge health screening. METHODS: A nationally representative sample of 3,575 individuals aged 65 or older from wave one of the Korean Longitudinal Study of Aging (2006) was followed for 10 years (up to Wave 6, 2016). Mixed-effect logit models were used to investigate how an older adult's social relationship characteristics (i.e., household composition, financial support from family, social group participation, and the frequency of contact with friends or relatives) were associated with their trajectories of participation in the national health screening program. RESULTS: Despite the low financial burden, only 49.7% of older adults in Korea reported receiving the recommended health screening at the baseline. Although the probability of receiving recommended health screening increased over the 10-year study period, the trajectories were significantly different by an older adult's social relationship characteristics. All four social relationship characteristics were significantly associated with receiving health screening. However, those with more frequent social contacts and those who participated in social groups showed steeper increases in the probability of receiving health screening (i.e., significant interaction with time). CONCLUSIONS: This study highlights the importance of social relationships and intervention approaches that accommodate socially isolated older adults to facilitate their timely receipt of recommended preventive care.

Multi-group frailty trajectories among older Koreans: Results from the Korean Longitudinal Study of Aging.

BACKGROUND: Studies that examined changes in frailty in older populations have been increasing. However, frailty patterns are often portrayed as having single trajectories corresponding to age, and different courses of change in frailty and related factors remain unexplored. OBJECTIVES: We aimed to identify distinct frailty trajectories over time and examine the relationship of frailty trajectories with the sociodemographic and lifestyle-related factors among older Koreans. METHODS: We used data of 3160 community-dwelling Korean adults aged ≥65 years from the Korean Longitudinal Study of Aging (2006-2016). We conducted the analyses using group-based trajectory modeling, analysis of variance or chi-square tests, and multinomial logistic regression. RESULTS: We identified three frailty trajectory groups among older Koreans: no frailty, increasing frailty, and high frailty based on a deficit-related frailty measure. Each frailty trajectory group showed unique sociodemographic and lifestyle characteristics. Compared to individuals in the no frailty group, those in the increasing frailty group were more likely to be older, less educated, unemployed, current smokers, and current drinkers. Compared to those in the no frailty group, individuals in the high frailty group were more likely to be older, unemployed, current drinkers, and without regular exercise. CONCLUSIONS: Using longitudinal data over a 10-year period, we identified multiple frailty trajectories in a cohort of older Koreans, which highlights a significant heterogeneity in frailty development. Our findings suggest the importance of socioeconomic status in determining different patterns of frailty change and the role of lifestyle factors in delaying frailty.

Role of economic evidence in coverage decision-making in South Korea.

OBJECTIVES: The South Korean government required the submission of economic evidence when it implemented the Positive-List System in December 2006. This study investigates the key factors that influenced actual public insurance reimbursement decisions, including the role of economic evidence, after 10 years of decision practice under compulsory health technology assessment (HTA) for new drugs. METHOD: Logistic regression analysis was used to estimate the impact of the variables involved, including cost-effectiveness ratio as a key variable, on reimbursement decisions. The latter were defined as "yes" or "no" at a submitted price and indication. Only cases (n = 91) that present a cost-effectiveness ratio, and that have been reviewed based on this ratio from January 2007 to December 2016, were included in the analysis. RESULTS: Cases with higher cost-effectiveness ratios were less likely to be accepted. In addition, drugs that were used to treat severe diseases and drugs with no substitute were more likely to be recommended. The probability of acceptance declined along with the level of uncertainty in the submitted evidence. The acceptance rate for severe-disease drugs has increased since 2013, when the government introduced several policies that lowered the existing barriers to positive reimbursement. However, such an increase was not statistically significant. CONCLUSIONS: Cost-effectiveness is one of the most influential factors in drug-reimbursement decisions. However, inclusion of other explanatory variables, in addition to the cost-effectiveness ratio, predicted the results of decisions more accurately.

Older Korean American men's prostate cancer screening behavior: the prime role of culture.

East and South Asian male immigrants show markedly low odds of prostate cancer screening as compared to U.S.-born men. However, knowledge about these immigrants' culture-based screening behavior and barriers to screening is extremely limited. This study investigates factors influencing receipt of prostate cancer screening among Korean American immigrant men, particularly investigating culture's impact on screening behaviors. Data were collected through a convenience and purposive sampling technique from 134 Korean American males aged 50 and older recruited in New York City. A structured questionnaire was used and cultural variables were measured by adopting items from Tang and colleagues' work. Approximately 60 % of the sample had received a prostate-specific antigen (PSA) test in their lifetime, and of these, about 66 % reported having done so in the previous 12 months. Logistic regression analysis revealed that a crisis-oriented intervention approach was associated with a substantially reduced likelihood of screening. A positive correlation was noted between the use of Eastern medicine and PSA test receipt. Further analysis revealed a significant interaction effect between use of Eastern medicine and age in predicting PSA test uptake. Culture-specific intervention strategies for increasing prostate cancer screening in this group are discussed, with particular attention to increasing pertinent health literacy. Health professionals should consider the cultural domain when working with Korean immigrant men in order to provide culturally competent care.

1,4-dihydropyrazolo[4,3-d]imidazole phenyl derivatives: a novel type II Raf kinase inhibitors.

The synthesis of a novel series of 1,4-dihydropyrazolo[4,3-d]imidazole phenyl derivatives 1a-b, 2a-v and their antiproliferative activities against A375P and WM3629 human melanoma cell line were described. Most compounds showed competitive antiproliferative activities to sorafenib, the reference standard. Among them, pyrazoloimidazole phenyl urea compounds 2a, 2d, 2g, 2i, 2t exhibited potent activities on WM3629 cell lines (IC(50)=0.56-0.86 microM). Especially, 2t was found to be a potent and selective C-Raf inhibitor, showing a possibility as melanoma therapeutics.

Productive activities and development of frailty in older adults.

OBJECTIVE: Our aim was to examine whether engagement in productive activities, including volunteering, paid work, and childcare, protects older adults against the development of geriatric frailty. METHODS: Data from the first (1988) and second (1991) waves of the MacArthur Study of Successful Aging, a prospective cohort study of high-functioning older adults aged 70-79 years (n = 1,072), was used to examine the hypothesis that engagement in productive activities is associated with lower levels of frailty 3 years later. RESULTS: Engagement in productive activities at baseline was associated with a lower cumulative odds of frailty 3 years later in unadjusted models (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.58-0.96) but not after adjusting for age, disability, and cognitive function (adjusted OR = 0.78, 95% CI = 0.60-1.01). Examination of productive activity domains showed that volunteering (but neither paid work nor childcare) was associated with a lower cumulative odds of frailty after adjusting for age, disability, and cognitive function. This relationship diminished and was no longer statistically significant after adjusting for personal mastery and religious service attendance. DISCUSSION: Though high-functioning older adults who participate in productive activities are less likely to become frail, after adjusting for age, disability, and cognitive function, only volunteering is associated with a lower cumulative odds of frailty.