BACKGROUND/AIMS: The introduction of direct-acting antivirals (DAA) in 2013 revolutionized hepatitis C virus (HCV) treatment, offering a cure rate >90%. However, this therapy is expensive, and estimations of the number of chronic HCV-infected (CHC) patients and their treatment costs pre-2013 are therefore essential for creating policies and expanding drug access. Herein, we aimed to investigate the number of HCV-related liver disease patients, their healthcare utilization, their annual direct medical costs, and the interferon-based antiviral treatment rates and costs from 2009 to 2013 in South Korea. METHODS: The National Health Insurance database was reviewed, and patients diagnosed with CHC from 2009 to 2013 were extracted. Data regarding detailed healthcare utilization, prescribed drugs, and direct medical costs were obtained. For annual direct healthcare cost calculations, a prevalence-based approach was used. RESULTS: Overall, 181,768 CHC patients were identified. In 2013, the annual per-patient costs for chronic hepatitis, liver cirrhosis, hepatocellular carcinoma, and the first year post-liver transplant were 895, 1,873, 6,945, and 67,359 United States dollars, respectively. Interferon-based antiviral therapeutics were prescribed to 25,223 patients (13.9%). CONCLUSIONS: Healthcare costs have increased remarkably with increasing liver disease severity. Thus, efforts to stop disease progression are needed. Moreover, the low rate of interferon-based therapy indicates an unmet need for DAA.
Antiviral Agents ; Carcinoma, Hepatocellular ; Costs and Cost Analysis ; Delivery of Health Care* ; Disease Progression ; Health Care Costs* ; Hepacivirus ; Hepatitis C ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Korea* ; Liver Cirrhosis ; Liver Diseases ; National Health Programs* ; Ribavirin ; United States

STUDY DESIGN: Retrospective clinical analysis. PURPOSE: To delineate the clinical presentation of melioidosis in the spine and to create awareness among healthcare professionals, particularly spine surgeons, regarding the diagnosis and treatment of melioidotic spondylitis. OVERVIEW OF LITERATURE: Melioidosis is an emerging disease, particularly in developing countries, associated with a high mortality rate. Its causative pathogen, Burkholderia pseudomallei, has been labeled as a bio-terrorism agent. METHODS: We performed a retrospective analysis of patients who were culture positive for B. pseudomallei. Assessment of patients was performed using clinical, radiological, and blood parameters. Clinical measures included pain, neurological deficit, and return to work. Radiological measures included plain radiography of the spine and magnetic resonance imaging. Blood tests included erythrocyte sedimentation rate and C-reactive protein levels. RESULTS: Four patients having melioidosis with spondylitis were evaluated. All of them had diabetes mellitus; three had multiple abscesses which required incision and drainage. Their clinical spectrum was similar to that of tuberculous spondylitis; all had back pain and radiology revealed infective spondylodiscitis with prevertebral and paravertebral collections with psoas abscess. Three patients underwent ultrasound-guided drainage of the psoas abscess and one had aspiration of the subcutaneous abscess. Bacteriological cultures showed presence of B. pseudomallei, and histopathology showed non-caseating granulomatous inflammation. All patients were treated with intravenous Ceftazidime for 2 weeks, followed by oral bactrim double strength and Doxycycline for 20 weeks. All patients improved with treatment and were healed at follow up. CONCLUSIONS: Melioidosis presents with a clinical spectrum similar to that of tuberculosis. A diagnosis of melioidotic spondylitis should be considered, particularly in patients with diabetes with neutrophilic leukocytosis and clinical-radiological features suggestive of infective spondylodiscitis. Bacteriological culture and histopathology helps in differentiating the two conditions. Health education for healthcare professionals is important for correctly diagnosing this disease.
Abscess ; Anti-Bacterial Agents ; Back Pain ; Blood Sedimentation ; Burkholderia pseudomallei ; C-Reactive Protein ; Ceftazidime ; Delivery of Health Care ; Developing Countries ; Diabetes Mellitus ; Diagnosis ; Discitis ; Doxycycline ; Drainage ; Follow-Up Studies ; Health Education ; Hematologic Tests ; Humans ; Inflammation ; Leukocytosis ; Magnetic Resonance Imaging ; Melioidosis ; Mortality ; Neutrophils ; Psoas Abscess ; Radiography ; Retrospective Studies ; Return to Work ; Spine ; Spondylitis* ; Surgeons ; Trimethoprim, Sulfamethoxazole Drug Combination ; Tuberculosis

The 20th National Assembly of Korea was called to order on April 13, 2016. The National Assembly is invested with the authority to play a significant role in influencing healthcare policy. There are many pending issues in healthcare policy that the Assembly needs to address in this term. The low fertility rate and population aging that Korea faces can exert a major impact on the healthcare system, as aging will lead to an expansion of non-communicable diseases, which can place a high burden on society. This requires strengthening the social security system, including National Health Insurance. A paradigm shift is necessary, in which healthcare providers are organized in the National Health Insurance using approaches such as the Accountable Care Organization (ACO) and Patient_Centered Medical Home (PCMH), and people are offered choices similar to the US Medicare Advantage Program. Additionally, it is essential that healthcare accessibility is enhanced by covering catastrophic medical costs and guaranteeing patient safety through quality improvement so that healthcare costs are kept within an affordable range. Therefore, the 20th National Assembly must overcome differences in ideology to improve the healthcare system with the aim of promoting national health.
Accountable Care Organizations ; Aging ; Birth Rate ; Delivery of Health Care ; Health Care Costs ; Health Personnel ; Health Policy* ; Humans ; Korea ; Medicare Part C ; National Health Programs ; Patient Safety ; Patient-Centered Care ; Quality Improvement ; Social Security

Hepatitis C virus (HCV) is one of the major causes of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. In South Korea, the prevalence of HCV infection in adults is 0.78%. Recent outbreaks of HCV infection in Korea were associated with unsafe injection practices such as syringe reuse, contaminated multi-dose vials, and unsanitary medical procedures. The findings emphasize the role of unsafe injection practices in the community outbreak of hepatitis C, as well as the need to establish a routine surveillance system and increase awareness among health care workers regarding safe injection practices. In response to the HCV outbreaks, the Korean government and Korean Medical Association announced a strategy for prevention and control of HCV infection. It should encompass health care institutions as well as non-medical facilities providing invasive procedures carrying the risk of HCV transmission. Furthermore, the government needs to consider including an anti-HCV test in national health screening and broaden financial support for expensive novel oral anti-HCV drugs for early detection and eradication of HCV infection.
Adult ; Carcinoma, Hepatocellular ; Delivery of Health Care ; Disease Outbreaks* ; Financial Support ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Hepatitis, Chronic ; Humans ; Korea* ; Liver Cirrhosis ; Mass Screening ; Prevalence ; Syringes

A hemangioma is the most common benign hepatic tumor. Many hepatic hemangioma tend to be found incidentally, but should be differentiated from malignant tumors, especially in patients with a high risk for malignancy. We presented a 52-year-old woman who diagnosed as hepatic hemangioma. The patient was a chronic alcohol abuser and diagnosed as a hepatic C virus carrier for the first time. Contrast enhanced abdominal computed tomography (CT) revealed a 4cm sized hepatic mass involving both segment 5 and 6. Abdominal CT finding suggested hepatic hemangioma, but could not rule out the malignancy. Because the patient had risk factors for hepatocellular carcinoma, abdominal ultrasonography (US) was performed for further evaluation. But abdominal US also showed atypical finding. For the confirmative diagnosis, dynamic magnetic resonance imaging using gadoxetate disodium (primovist(R), Bayer HealthCare, Berlin, Germany) which is the innovative liver cell-specific contrast medium was done, and the patient was diagnosed as hepatic hemangioma.
Berlin ; Carcinoma, Hepatocellular ; Delivery of Health Care ; Diagnosis ; Female ; Hemangioma* ; Hepatitis C ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Liver ; Magnetic Resonance Imaging* ; Middle Aged ; Risk Factors ; Tomography, X-Ray Computed ; Ultrasonography

BACKGROUND: The purpose of this study was to assess the quality of long-term-stored leftover blood samples, and to evaluate the long-term stability of selected serum biomarkers such as proteins, enzymes, electrolytes, and tumour markers. METHODS: Stored blood samples were transferred to our biobank after being used to conduct tests for routine medical examinations in one health care institution, and were preserved at or below -70degrees C for 4 years. We analysed 24 biomarkers whose levels had been reported 4 years ago and tested them using the same analyser, reagents, and methods by utilizing an ADVIA Centaur Immunoassay System (Siemens Healthcare Diagnostics, USA) or an ADVIA 2400 Chemistry System (Siemens, USA). RESULTS: A total of 15 out of the 24 tested biomarkers showed significant differences in paired Student t-tests (P<0.01). Among them, 5 biomarkers (free T3, free T4, thyroid stimulating hormone, carcino-embryonic antigen, and alpha feto-protein) showed significant differences and high correlation coefficients (R2>0.975). Two biomarkers, creatinine and rheumatoid arthritis factor, showed no significant differences but were poorly correlated with previously analysed data. Aspartate aminotransferase, alanine aminotransferase, hepatitis B virus (HBV) surface antigen, and insulin levels were discordant according to their reference ranges. A total of 3 biomarkers, C-reactive protein, cancer antigen 125, and HBV surface antibody, showed no significant differences and good correlations without discordant data. CONCLUSIONS: Our findings showed that long-term storage for more than 4 years can result in a considerable bias for variable biomarkers. Only 3 of the 24 biomarkers evaluated were found to be stable biomarkers. Long-term storage of leftover samples is not recommended for most chemical analyses.
Alanine Transaminase ; Antigens, Surface ; Arthritis, Rheumatoid ; Aspartate Aminotransferases ; Bias (Epidemiology) ; Biomarkers* ; C-Reactive Protein ; Chemistry ; Creatinine ; Delivery of Health Care ; Electrolytes ; Enzyme Stability ; Hepatitis B virus ; Humans ; Immunoassay ; Indicators and Reagents ; Insulin ; Methods ; Protein Stability ; Reference Values ; Serum ; Thyrotropin

BACKGROUND/AIMS: The aim of this study was to investigate outcomes and current status of the National Liver Cancer Screening Program in a single healthcare center. METHODS: Subjects received abdominal ultrasonography (US) and/or serum alpha-fetoprotein (AFP) testing from January 2011 to December 2012. The clinical characteristics of the subjects, detection rate of liver cancer, and direct medical costs were investigated. RESULTS: Among 621 subjects, five (0.8%) were newly detected with hepatocellular carcinoma. Four underwent curative treatment, and all were detected by US (two surgical resections and two radiofrequency ablations). The remaining patient, whose disease was detected by an elevated AFP level, was infiltrative type with a poor prognosis. Of 492 subjects whose medical history was revealed, 45% had hepatitis B, 5% had hepatitis C, 1% had both, and 3% had other liver cirrhosis including alcoholic cirrhosis. The remaining 46% of subjects had no risk factors for liver cancer. Direct medical costs were estimated at 8,420,000 Won for detecting a single case of liver cancer, which was much lower than that of stomach cancer at 45,060,000 Won. If the non-high risk subjects were excluded, the cost for a single case of liver cancer decreased to 5,560,000 Won. CONCLUSIONS: The high-risk group should be more accurately defined by appropriate screening tests to optimize liver cancer surveillance. The detection rate by the liver cancer surveillance program was about 1%, and most tumors could be detected at the early stage by US. The role of AFP seemed to be small for early defection of liver cancer.
alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Delivery of Health Care ; Hepatitis B ; Hepatitis C ; Humans ; Liver ; Liver Cirrhosis ; Liver Cirrhosis, Alcoholic ; Liver Neoplasms ; Mass Screening ; Prognosis ; Risk Factors ; Stomach Neoplasms

The healthcare industry employs over one million workers in Korea and encompasses a usually broad spectrum of occupations and related exposures. There are so many biological exposures in healthcare settings, including blood-borne pathogens, HIV, hepatitis B and hepatitis C, air-borne pathogens such as tuberculosis, and a wide variety of respiratory viruses. The World Health Organization (WHO) estimates the global burden of disease (GBD) from occupational exposure to be 40% of Hepatitis B and C infections and 2.5% of the human Immunodeficiency virus (HIV) infections among Healthcare workers (HCWs). Some countries have used surveillance systems to monitor national trends and incidence rates of occupational infections among HCWs; identify newly emerging hazards for HCWs; assess the risk of occupational exposures and infections; and evaluate preventive measures including engineering controls, work practices, protective equipment, and post-exposure prophylaxis to prevent occupational infections. Infection control programs such as engineering control in medical facilities, immunization, post exposure prophylaxis, and use of personal protective equipment (PPE) have been widely introduced to reduce occupational infectious disease among HCWs. Thus some developed countries which have actively introduced infection control program have decreased incidences of occupational infectious diseases among HCWs. This study describes the epidemiologic characteristics of occupational infectious diseases among HCWs, the kinds of surveillance system to monitor infectious diseases among HCWs, and infection control measures that apply to healthcare settings.
Blood-Borne Pathogens ; Communicable Diseases ; Delivery of Health Care ; Developed Countries ; Health Care Sector ; Hepatitis ; Hepatitis B ; Hepatitis C ; HIV ; Humans ; Immunization ; Incidence ; Infection Control ; Korea ; Occupational Exposure ; Occupations ; Organothiophosphorus Compounds ; Post-Exposure Prophylaxis ; Tuberculosis ; World Health Organization

Health care is a labour intensive industry and, in most countries, health care workers (HCWs) are fast growing sector of the workforce. Variety of occupational hazard, such as biological, ergonomical, chemical, physical and psychological factors, have been reported in HCWs. Major occupational infectious diseases in HCWs are blood-borne pathogens such as HIV, hepatitis B and hepatitis C, and airborne pathogens such as tuberculosis, and a wide variety of respiratory viruses. Most common occupational musculoskeletal disorder (MSD) in HCWs are low back pain and related diseases. One of the most prevalent ergonomical risk factor of low back pain is moving the patients or changing the patients' position. Important carcinogenic chemicals in HCWs are formaldehyde, ethylene oxide and anticancer drugs, which have been reported reported to be cause of occupational lymphohematopoietic cancer. Glutaraldehyde and latex glove can cause allergic asthma and contact dermatitis. Physical hazard such as ionizing radiation and noise also should be considered for HCWs's occupational health. Because, HCWs comprise a wide range of professional, technical and support personnel, the organizational factor might affect to job stress. In addition to organizational factors, the shift work and night work is serious health problem of HCWs. Theses risk factors can affect to chronic underlying disorder.
Asthma ; Blood-Borne Pathogens ; Communicable Diseases ; Delivery of Health Care ; Dermatitis, Contact ; Ethylene Oxide ; Ethylenes ; Formaldehyde ; Glutaral ; Hepatitis B ; Hepatitis C ; HIV ; Humans ; Latex ; Low Back Pain ; Noise ; Occupational Diseases ; Occupational Health ; Radiation, Ionizing ; Risk Factors ; Tuberculosis

BACKGROUND/AIMS: Medical students face the threat of acquiring blood-borne infections such as HIV, Hepatitis B and Hepatitis C during their clinical activities in clerkship. This study determined the frequency of exposure and the risks of exposure to blood and body fluids among medical students. METHODS: An anonymous questionnaire was administrated to the 4th year medical students in a tertiary academy university hospital. RESULTS: The surveys were completed by 124 students (100% of the students). Seventy-one percent (88 cases) reported more than one time of exposure to blood or body fluids during the consecutive 2 years of clinical rotation. Single needle stick injury occurred for 19.3% of the students, both exposure to needle stick and splash occurred for 40.9% and single splash occurred for 39.8% of the 88 cases. Venipucture was the highest exposure event (50%), and the other causes were scrub (35.2%), bedside procedures (35.2%), arterial puncture (22.7%), lancet (13.6%), suture (5.7%) and others (8%). The emergency department had the highest exposures rate (80.7%), and this was followed by general surgery (33%), neurosurgery (8%), orthopedic surgery (8%), plastic surgery (6.8%), obstetrics-gynecology (5.7%) and others (10.1%). The major exposure sites in the hospital were the emergency room (81.8%), operation room (38.6%), intensive care unit (8%), general ward (6.8%) and others (2.3%). Only nineteen cases (21.6%) of hospital exposure were reported to the appropriate medical personnel. CONCLUSIONS: This study shows medical students have the potential risk of health care related infection when they are exposed to many patients in the emergency department without a supervisor being present. To avoid the occurrence of these problems, preventive education, and particularly the practice of universal precaution, should be taken by the medical students before beginning their clinical activity.
Anonyms and Pseudonyms ; Body Fluids ; Collodion ; Delivery of Health Care ; Emergencies ; Hepatitis B ; Hepatitis C ; HIV ; Humans ; Intensive Care Units ; Needles ; Needlestick Injuries ; Neurosurgery ; Orthopedics ; Patients' Rooms ; Punctures ; Students, Medical ; Surgery, Plastic ; Sutures ; Universal Precautions ; Surveys and Questionnaires