A new diagnosis-related group (DRG) based payment system has been implemented in most public hospitals in Korea. We investigated the effects of the new DRG system and its incentive policy on the utilization rate of diagnostic laboratory tests. Three groups were categorized; 36 hospitals under the new DRG system (participant group), 72 hospitals (control-1) matching with 36 participants according to the number of beds, and 42 tertiary hospitals (control-2). The patients of acute myocardial infarction, cerebral infarction, type 2 diabetes mellitus, and gonarthrosis receiving total arthroplasty were included. We analyzed the mean length of stay and the number of diagnostic laboratory tests conducted during hospitalization of the three groups according to the new DRG system and the incentive policy rates under the new DRG system. Before participating in the new DRG system, the number of diagnostic laboratory tests in the participant group was less than that in the two control groups for all four diseases. However, although the participant group’s length of stay decreased under the new DRG system, the number of diagnostic laboratory tests increased as the maximum incentive policy rate increased. The increment of the number of diagnostic laboratory tests was prominent in the period of a maximum of 35% incentive policy rates. Finally, the number of diagnostic laboratory tests of the participant group was similar to or exceeded that of the control-2 group. The new DRG system’s incentive policy rates played a driving force on the increased utilization rate of the diagnostic laboratory test. For preparing in advance for the change in incentive policy rates, monitoring and guidelines for the utilization of diagnostic laboratory tests are necessary.

BACKGROUND/AIMS: We explored Korean physicians’ policies for surveillance of colorectal cancer (CRC) after curative surgery. METHODS: Web-based self-report questionnaires were developed. Invitations to participate were emailed to physicians who diagnosed and treated CRC from October 1 to November 15, 2015. The questionnaire consisted of the role doctors played in the surveillance, examination of surveillance, and duration of postoperative surveillance according to CRC stage or primary site of the cancer. RESULTS: Ninety-one physicians participated in the online survey, and 78 completed the survey. Sixty-seven participants (13%) answered “up to 5 years” for stage I surveillance duration; and 11 (13%) responded with a duration of > 5 years for stage I. A total of 61 (75%) responded with a surveillance duration of up to 5 years for stage II; and 19 (24%) responded with a duration of > 5 years for stage II. Sixty-seven (97%) and 61 (91%) physicians monitored patients with stage II/III every 3 or 6 months by laboratory examination and by abdominopelvic computed tomography scan for the first year, respectively. A total of 43 (53%) responded with a surveillance duration of up to 5 years for stage IV; and 46 (46%) responded with a duration of > 5 years for stage IV after curative resection. CONCLUSIONS: Korean physicians mostly followed up CRC using intensive postoperative surveillance. In preference to monitoring over a comparatively shorter period of time, the physicians tended to prefer monitoring patients post-operatively over a > 5 year period, particularly in cases of advanced-stage CRC.
Colorectal Neoplasms* ; Electronic Mail ; Follow-Up Studies ; Humans ; Surveys and Questionnaires

BACKGROUND: The purpose of this study was to assess the effect of our new video-assisted asthma education program on patients' knowledge regarding asthma and asthma control. METHODS: Adult asthmatics who were diagnosed by primary care physicians and followed for at least 1 year were educated via smart devices and pamphlets. The education sessions were carried out three times at 2-week intervals. Each education period lasted at most 5 minutes. The effectiveness was then evaluated using questionnaires and an asthma control test (ACT). RESULTS: The study enrolled 144 patients (mean age, 56.7±16.7 years). Half of the patients had not been taught how to use their inhalers. After participating in the education program, the participants' understanding of asthma improved significantly across all six items of a questionnaire assessing their general knowledge of asthma. The proportion of patients who made errors while manipulating their inhalers was reduced to less than 10%. The ACT score increased from 16.6±4.6 to 20.0±3.9 (p<0.001). The number of asthmatics whose ACT score was at least 20 increased from 45 (33.3%) to 93 (65.3%) (p<0.001). The magnitude of improvement in the ACT score did not differ between patients who received an education session at least three times within 1 year and those who had not. The majority of patients agreed to the need for an education program (95.8%) and showed a willingness to pay an additional cost for the education (81.9%). CONCLUSION: This study indicated that our newly developed education program would become an effective component of asthma management in primary care clinics.
Adult ; Asthma* ; Education* ; Humans ; Nebulizers and Vaporizers ; Pamphlets ; Physicians, Primary Care ; Primary Health Care*

BACKGROUND: Low levels of physical activity can cause various physical symptoms or illness. However, few studies on this association have been conducted in young adults. The aim of this study was to investigate the association between physical activity levels and physical symptoms or illness in young adults. METHODS: Subjects were university students who participated in a web-based self-administered questionnaire in a university in Seoul in 2013. We obtained information on physical activities and physical symptoms or illness in the past year. Independent variables were defined as symptoms or illness which were associated with decreased academic performance. Logistic regression was performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of each physical symptom or illness with adjustment for covariables. RESULTS: A total of 2,201 participants were included in the study. The main physical symptoms or illness among participants were severe fatigue (64.2%), muscle or joint pain (46.3%), gastrointestinal problems (43.1%), headache or dizziness (38.6%), frequent colds (35.1%), and sleep problems (33.3%). Low physical activity levels were significantly associated with high ORs of physical symptoms or illness. Multivariable-adjusted ORs (95% CIs) in the lowest vs. highest tertile of physical activity were 1.45 (1.14–1.83) for severe fatigue, 1.35 (1.07–1.70) for frequent colds, and 1.29 (1.02–1.63) for headaches or dizziness. We also found that lower levels of physical activity were associated with more physical symptoms or bouts of illness. CONCLUSION: Low physical activity levels were significantly associated with various physical symptoms or illness among university students. Also, individuals in the lower levels of physical activity were more likely to experience more physical symptoms or bouts of illness than those in the highest tertile of physical activity.
Arthralgia ; Common Cold ; Dizziness ; Fatigue ; Gastrointestinal Diseases ; Headache ; Humans ; Korea* ; Logistic Models ; Motor Activity* ; Myalgia ; Odds Ratio ; Seoul ; Young Adult

BACKGROUND: Enquiry into smoking status and recommendations for smoking cessation is an essential preventive service. However, there are few studies comparing self-reported (SR) and cotinine-verified (CV) smoking statuses, using medical check-up data. The rates of discrepancy and under-reporting are unknown. METHODS: We performed a cross-sectional study using health examination data from Healthcare System Gangnam Center, Seoul National University Hospital in 2013. We analyzed SR and CV smoking statuses and discrepancies between the two in relation to sociodemographic variables. We also attempted to ascertain the factors associated with a discrepant smoking status among current smokers. RESULTS: In the sample of 3,477 men, CV smoking rate was 11.1% higher than the SR rate. About 1 in 3 participants either omitted the smoking questionnaire or gave a false reply. The ratio of CV to SR smoking rates was 1.49 (95% confidence interval [CI], 1.38-1.61). After adjusting for confounding factors, older adults (≥60 years) showed an increased adjusted odds ratio (aOR) for discrepancy between SR and CV when compared to those in their twenties and thirties (aOR, 5.43; 95% CI, 2.69-10.96). Educational levels of high school graduation or lower (aOR, 2.33; 95% CI, 1.36-4.01), repeated health check-ups (aOR, 1.45; 95% CI, 1.03-2.06), and low cotinine levels of <500 ng/mL (aOR, 2.03; 95% CI, 1.33-3.09), were also associated with discordance between SR and CV smoking status. CONCLUSION: Omissions and false responses impede the accurate assessment of smoking status in health check-up participants. In order to improve accuracy, it is suggested that researcher pay attention to participants with greater discrepancy between SR and CV smoking status, and formulate interventions to improve response rates.
Adult* ; Cotinine ; Cross-Sectional Studies ; Delivery of Health Care ; Hospitals, Private* ; Humans ; Male* ; Mass Screening ; Odds Ratio ; Self Report ; Seoul ; Smoke* ; Smoking Cessation ; Smoking* ; Surveys and Questionnaires

BACKGROUND: The effect of dietary fat intake on the risk of cardiovascular disease remains unclear. We investigated the association between dietary fat and specific types of fat intake and the risk of metabolic syndrome. METHODS: The study population included 1,662 healthy adults who were 50.2 years of age and had no known hypertension, diabetes, hyperlipidemia, or metabolic syndrome at the initial visit. Dietary intake was obtained from a 1-day food record. During 20.7 months of follow-up, we documented 147 cases of metabolic syndrome confirmed by self-report, anthropometric data, and blood test results. The intakes of total fat, vegetable fat, animal fat, saturated fatty acid (SFA), polyunsaturated fatty acid (PUFA), monounsaturated fatty acid (MUFA), and cholesterol level divided by quintile. Multivariate analyses included age, sex, body mass index, smoking status, alcohol intake, physical activity, total calorie, and protein intake. RESULTS: Vegetable fat intake was inversely associated with metabolic syndrome risk (odds ratio for the highest vs. the lowest quintile, 0.33; 95% confidence interval, 0.14 to 0.76). Total fat, animal fat, SFA, PUFA, MUFA, and cholesterol intakes showed no association with metabolic syndrome. Vegetable fat intake was inversely associated with the risk of hypertriglyceridemia among the components of metabolic syndrome. CONCLUSION: These data support an inverse association between vegetable fat and the risk of metabolic syndrome.
Adult* ; Animals ; Body Mass Index ; Cardiovascular Diseases ; Cholesterol ; Dietary Fats* ; Follow-Up Studies ; Hematologic Tests ; Humans ; Hyperlipidemias ; Hypertension ; Hypertriglyceridemia ; Motor Activity ; Multivariate Analysis ; Smoke ; Smoking ; Vegetables

BACKGROUND: Postmenopausal osteoporosis is a common disease which can cause various morbidity and economic burden. Lactation is known to cause a decline in bone mineral density (BMD), but there are controversies on whether decreased BMD is fully recovered after lactation and whether lactation duration has an influence on postmenopausal BMD. This study was conducted to see whether breastfeeding is associated with postmenopausal bone loss using a highly representative sample of Korean population. METHODS: Retrospective cross sectional study was done using data collected from Korea National Health and Nutrition Examination Survey V. The study outcome was BMD measured with dual-energy X-ray absorptiometry and divided into 2 groups: normal or low BMD (T score<-1), and breastfeeding duration was categorized into 4 groups (never, 1st, 2nd, and 3rd tertile). Logistic regression analysis was done to examine the association between lactation duration and BMD. RESULTS: Among 1,694 postmenopausal women (mean age, 63.5+/-9.1), 85.71% were in low BMD group. Compared to never breastfeeding group, postmenopausal women with longer than 79 months of breastfeeding duration are more likely to have low BMD (adjusted risk ratio [ARR]=1.24; 95% confidence interval, 1.17 to 1.32). As the duration of breastfeeding increases, ARR and risk difference for low BMD also increases (P for trend=0.008). CONCLUSION: The study results showed that total breastfeeding duration was associated with postmenopausal low BMD. All women planning on breastfeeding should be aware of its risks and should take adequate dietary calcium and vitamin D before, during, and after breastfeeding.
Absorptiometry, Photon ; Bone Density ; Breast Feeding* ; Breast* ; Calcium, Dietary ; Female ; Humans ; Korea* ; Lactation ; Logistic Models ; Nutrition Surveys* ; Odds Ratio ; Osteoporosis, Postmenopausal* ; Retrospective Studies ; Vitamin D

BACKGROUND: Nutrition labels provide various information on the nutrient contents of food. However, despite the recent increase in the interest in dietary intake and expansion of related policies, studies on the association between nutrition label reading and dietary intake are lacking in Korea. METHODS: This study analyzed the 2007-2009 KNHANES (Korean National Health and Nutrition Examination Survey) data. To examine macronutrients and micronutrients intake according to nutrition label reading, analysis of covariance was used. Multiple logistic regression analysis was also used to examine the association between adherence to dietary reference intake and nutrition label reading. RESULTS: Nutrition label reading was significantly high among women, youth, and those with high education and high household income. Nutrition label reading was associated with higher intake of calcium and vitamin C in men and the lower intake of calorie, carbohydrates and higher energy ratio of protein in women. Additionally, male nutrition label readers were associated with adherence to dietary reference intake of fiber (odds ratio [OR], 2.00; 95% confidence interval [CI], 1.23 to 3.26) and calcium (OR, 1.26; 95% CI, 1.03 to 1.54). In women, there were no significant differences in the adherence to the dietary reference intake in fat, fiber, sodium, potassium, and calcium according to the nutrition label reading. CONCLUSION: In men, nutrition label reading was associated with healthier intake of several micronutrients, although this was not observed in women. Consideration for clearly reporting vulnerable micronutrients in nutrition labels is necessary.
Adolescent ; Adult* ; Ascorbic Acid ; Calcium ; Carbohydrates ; Education ; Family Characteristics ; Female ; Food Habits ; Food Labeling ; Humans ; Korea ; Logistic Models ; Male ; Micronutrients ; Potassium ; Recommended Dietary Allowances ; Sodium

It has been suggested that Helicobacter pylori eradication may influence production of some peptides in the stomach, which can affect appetite. This hypothesis is controversial. To verify the hypothesis, we conducted this randomized controlled trial using H. pylori infected subjects without any gastrointestinal symptoms. The treatment group received triple H. pylori eradication therapy for 7 days and the control group received no medication. We measured ghrelin, obestatin and the tumor necrosis factor-alpha (TNF-alpha) mRNA levels in endoscopic biopsy specimens and the changes from baseline to follow-up. The plasma active n-octanoyl ghrelin and obestatin levels were measured in both groups. The ghrelin/obestatin ratios in plasma and gastric mRNA expression were calculated at baseline and follow-up. Ghrelin mRNA expression in the fundic mucosa after H. pylori eradication increased significantly compared to the control group (4.47+/-2.14 vs. 1.79+/-0.96, P=0.009), independent of inflammatory changes. However, obestatin mRNA expression decreased in the antral mucosa (-0.57+/-1.06 vs. 0.41+/-0.72, P=0.028). The treatment group showed a marginal increase (P=0.060) in plasma ghrelin/obestatin ratio. The TNF-alpha mRNA expression also decreased significantly with treatment. This randomized controlled trial demonstrates that H. pylori eradication increases ghrelin mRNA expression, independent of inflammatory cell changes.
Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Female ; Gastric Mucosa/*metabolism/microbiology ; Gastroscopy ; Ghrelin/blood/genetics/*metabolism ; Helicobacter Infections/drug therapy/genetics/*metabolism ; *Helicobacter pylori ; Humans ; Male ; RNA, Messenger/metabolism ; Tumor Necrosis Factor-alpha/genetics/metabolism

PURPOSE: As a common and dangerous disease, an abdominal aortic aneurysm (AAA) occurs in approximately 2-4% of the general population and recently the incidence of AAA has been gradually increasing in Korea. Since rupture of an AAA is recognized as a lethal event, a more aggressive policy of early diagnosis and of an elective repair of the AAA are that can be performed with a mortality rate of less than 5 percent is the approach of choice for treating an AAA nowadays. METHODS: This retrospective study reports our experience managing forty-two patients with an AAA who had been operated on between January 1993 and December 1999 at Korea University hospitals. RESULTS: Thirty- seven of the patients were male, and five were female. The mean age was 67.1 years. The most common clinical manifestation was abdominal pain in 26 cases (61.9%), followed by abdominal pulsatile mass in 20 cases (47.6%), and back pain in 12 cases (28.5%). The most common associated disease was hypertension in 24 cases (57.1%). An abdominal CT scan was performed in 26 cases (61.9%) and was the most commonly used method for diagnosis. Emergency repair of the AAA was performed in 10 cases; the repair was performed electively in the other cases. Among the 42 aortic grafts implanted for AAA repair, 37 were bifurcated Y grafts and 4 were straight tube grafts. Axillobifemoral bypass surgery was performed in the case of one infected aneurysm. Among the 42 cases, 10 cases (23.8%) experienced ruptures, requiring 4 urgent operation and 6 emergency procedures. Among the 42 cases, 6 patients (14.2%) expired. In the elective cases, one (3.1%) expired. In the urgent cases, one (25.0%) expired, and in the emergency cases, four (66.6%) expired. CONCLUSION: This study showed that an AAA should be considered as a possible cause of unexplained abdominal pain in aged patients. In such patients, various diagnostic tools must be used to eliminate the possibility of an abdominal aortic aneurysm. Early diagnosis and elective surgery are crucial for a better outcome in the management of patients with an abdominal aortic aneurysm.
Abdominal Pain ; Aneurysm, Infected ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Aortic Rupture ; Back Pain ; Diagnosis ; Early Diagnosis ; Emergencies ; Female ; Hospitals, University ; Humans ; Hypertension ; Incidence ; Korea ; Male ; Mortality ; Retrospective Studies ; Rupture ; Tomography, X-Ray Computed ; Transplants