Global life expectancy has increased with the development of medicine, and better nutrition, hygiene, and health care. However, as the elderly population increases, the number of people who are immunocompromised and who have chronic diseases has also increased. New infectious diseases have also become a significant threat to public health. In particular, pathogens can have fatal consequences in the elderly and people with underlying diseases. Vaccination is an effective and safe means of preventing infectious diseases, and adult vaccination has gained increasing interest in recent years. The increased number of people with chronic diseases and underlying health conditions is a consequence of the aging population. Furthermore, the decline in immunity after immunization in childhood and adolescence, emergence of novel infectious diseases, change in epidemiology due to mutant microorganisms, and increased infectious diseases from overseas have all increased the need for adult vaccination.

Background: In addition to its antidiabetic effects, metformin has pleiotropic effects, such as the inhibition of carcinogenesis. This study aimed to investigate the association between metformin use and pancreatic cancer risk in the Korean National Health Insurance Service (NHIS)-National Health Screening Cohort (HEALS). Methods: Of the individuals in the Korean NHIS-HEALS, 29,271 men and 19,091 women were included in the final analysis after propensity score matching based on age, body mass index, and smoking status. The study population was categorized into three groups: metformin non-users with diabetes mellitus (DM), metformin users with DM, and non-diabetic users. A Cox proportional hazards regression model was used to examine the association between metformin use and pancreatic cancer. Results: The median follow-up period was 12.9 years. The estimated pancreatic cancer incidence was highest in metformin users with DM, regardless of sex (P<0.001), and lowest in non-diabetic men and female metformin non-users (P=0.053). The hazard ratios (95% confidence interval) for pancreatic cancer incidence in metformin users and non-diabetic individuals were 1.116 (0.648–1.923) and 0.447 (0.259–0.771) in men and 2.769 (1.003–7.642) and 1.451 (0.529–3.984) in women, respectively, after full adjustment. Conclusion Women with diabetes using metformin are at a higher risk of pancreatic cancer than women with diabetes not using metformin. Meanwhile, men with DM using metformin have a similar risk of pancreatic cancer as men with DM not using metformin.

A health check-up is one of the best ways to prevent diseases and maintain health by screening for risk factors and diagnosing diseases early. As the burden of illness shifts from infectious to chronic diseases, the importance of health check-ups is emphasized. Korean health authorities began the National Health Screening Programs (NHSPs) for public servants and private school staff in 1980. The NHSP is composed of the National Cancer Screening Programs (NCSPs) and general health checkups. NCSPs, started in 1999, included screenings for stomach, liver, colorectal, breast, and uterine cervical cancers, and they may have contributed to the improved cancer survival rate from 42.9% in 1993–1995 to 77.5% in 2013–2017 in Korea. General health check-ups included lifestyle questionnaires, anthropometric measurements; blood pressure measurement; visual acuity test; hearing test; laboratory tests including fasting glucose, lipid profile, liver function tests, creatinine, and urinalysis; and, chest radiography. Additionally, bone density, cognitive function, and depression were assessed. Testing for non-communicable diseases has improved the control rates of chronic diseases such as hypertension and diabetes mellitus. Favorable changes in the risk factors for cardio-cerebrovascular diseases may lead to a decline in age-standardized mortality and heart disease over several decades. However, many areas of the programs need to be improved. NHSPs should be designed on the basis of individual health conditions, medical needs, and scientific evidence. Greater opportunities to receive NHSPs should be provided to socioeconomically vulnerable individuals. In addition, stricter quality control of NHSPs is required. Follow-up management after the NHSPs should be systematized. In conclusion, NHSPs have contributed to the improvement of public health; however, several aspects of these programs must be addressed.

BACKGROUND: We investigated the association between socioeconomic status (SES) and cancer screening in a Korean population aged 40 years or older. METHODS: This cross-sectional study included 12,303 participants (5,284 men and 7,019 women) who participated in the 2010–2012 Korean National Health and Nutrition Examination Survey. Self-reported questionnaires were used to assess participant's SES (household income, occupational, and educational status) and cancer screening behavior. RESULTS: Compared to the lowest household income group, the odds ratios (ORs) (95% confidence intervals [CIs]) for overall cancer screening of the highest income group were 2.113 (1.606–2.781) in men and 1.476 (1.157–1.883) in women; those for private cancer screening of the highest income group were 2.446 (1.800–3.324) in men and 2.630 (2.050–3.373) in women, while those for National Cancer Screening Programs (NCSP) in the highest income group were 1.076 (0.805–1.439) in men and 0.492 (0.388–0.623) in women. Compared to manual workers, ORs (95% CIs) for private cancer screening of office workers were 1.300 (1.018–1.660) in men and 0.822 (0.616–1.098) in women. In comparison to the least educated men, OR (95% CI) for private cancer screening of the most educated men was statistically significant (1.530 [1.117–2.095]). CONCLUSION: Higher economic status was associated with higher rates of overall and private cancer screening in both sexes and a lower rate of NCSP in women. Male office workers and more educated individuals underwent private cancer screening at a higher rate than manual workers and less educated individuals, respectively.
Cross-Sectional Studies ; Early Detection of Cancer* ; Education ; Family Characteristics ; Female ; Humans ; Male ; Nutrition Surveys* ; Occupations ; Odds Ratio ; Social Class*

BACKGROUND: We investigated the association between socioeconomic status and adherence to health check-ups in a Korean population aged 40 years or older. METHODS: This cross-sectional study included 12,311 participants who participated in the 2010–2012 Korean National Health and Nutrition Examination Survey. Self-reported questionnaires were used to assess each participant's socioeconomic status (household income, occupation, and education) and adherence to health check-ups. RESULTS: Men with a higher income (highest vs. lowest: odds ratio [OR], 1.799; 95% confidence interval [CI], 1.296–2.497) and men with a higher education level (≥12 vs. < 6 years: OR, 1.488; 95% CI, 1.078–2.054) and office workers compared with manual workers (men: OR, 1.431; 95% CI, 1.077–1.902; women: OR, 1.783; 95% CI, 1.256–2.532) appeared to undergo more health check-ups. In particular, men and women with a higher income and education appeared more likely to undergo opportunistic health check-ups (men: highest vs. lowest income: OR, 2.380; 95% CI, 1.218–4.653; ≥12 vs. < 6 years education: OR, 2.121; 95% CI, 1.142–3.936; women: highest vs. lowest income: OR, 4.042; 95% CI, 2.239–7.297; ≥12 vs. < 6 years education: OR, 2.475; 95% CI, 1.283–4.775). CONCLUSION: A higher socioeconomic status was associated with a higher rate of participation in health check-ups. More efforts are needed to identify the factors associated with disparity in adherence to health check-ups.
Adult* ; Cross-Sectional Studies ; Education ; Female ; Health Promotion ; Humans ; Male ; Nutrition Surveys* ; Occupations ; Odds Ratio ; Public Health ; Social Class*

BACKGROUND: Cancer survivors are at a higher risk of primary cancer recurrence and development of second primary cancer. In both cases, early disease detection is crucial. This cross-sectional study assessed cancer screening participation rates according to cancer history. METHODS: Data were obtained from the 2010–2012 Korea National Health and Nutrition Examination Survey for 12,500 participants. Of these, 624 cancer survivors were enrolled in this study. Sampling weights were applied to maintain the representativeness of the Korean adult population. RESULTS: Overall 2-year cancer screening rates prior to the survey in male and female cancer survivors were 59.9% and 73.7%, respectively, while opportunistic cancer screening rates were 33.5% and 52.1%, respectively. The odds ratios (95% confidence interval) of the overall cancer screening among the cancer survivors, compared to others, were 1.16 (0.79–1.72) in male and 1.78 (1.20–2.63) in female participants, after the adjustment for confounding variables. The odds ratios (95% confidence interval) for opportunistic cancer screening and National Cancer Screening Program among cancer survivors were 1.56 (1.07–2.27) and 0.80 (0.53–1.21) in males and 2.05 (1.46–2.88) and 0.66 (0.46–0.95) in females. CONCLUSION: Female cancer survivors showed a higher rate of overall and opportunistic cancer screening than did the male cancer survivors. Further efforts are required to improve cancer screening among male cancer survivors.
Adult ; Confounding Factors (Epidemiology) ; Cross-Sectional Studies ; Diagnosis ; Early Detection of Cancer ; Female ; Humans ; Korea ; Male ; Mass Screening ; Neoplasms, Second Primary ; Nutrition Surveys ; Odds Ratio ; Recurrence ; Survivors ; Weights and Measures

Purpose: We compared cost-effectiveness parameters between inpatient and homebased hospice-palliative care services for terminal cancer patients in Korea. Methods: A decision-analytic Markov model was used to compare the cost-effectiveness of hospicepalliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW).Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice-palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Results: Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Conclusion Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.

Intramural pregnancy is an unusual ectopic gestation located within the uterine wall, completely surrounded by myometrium and separate from the uterine cavity, fallopian tube, or round ligament. It is known to be difficult to diagnose, and associated with a high rate of uterine rupture. We report a case of intramural pregnancy in which early diagnosis was made and successful treatment was done by dilatation and curettage. Diagnostic laparoscopy confirmed the absence of uterine rupture during the procedure. Therefore, conservation of fertility can be possible with early diagnosis of intramural pregnancy. To our knowledge, this is the first case report of intramural pregnancy following IVF-ET in Korea.
Animals ; Dilatation and Curettage ; Early Diagnosis ; Embryo Transfer* ; Embryonic Structures* ; Fallopian Tubes ; Female ; Fertility ; Fertilization in Vitro* ; Korea ; Laparoscopy ; Mice ; Myometrium ; Pregnancy* ; Round Ligaments ; Uterine Rupture

BACKGROUND: The purpose of this study was to investigate the differences in health behaviors and dietary habits between the metabolically healthy group and the metabolically abnormal group in overweight and obese subjects based on the data of National Health and Nutrition Survey (NHANES). METHODS: Using the NHANES data (2007–2010), a total of 18,188 subjects were grouped into the metabolically healthy group and the abnormal group using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) definition. Then we compared their health behaviors, dietary behaviors and nutrient intakes after adjustment for variables in overweight and obese groups. RESULTS: The proportion of metabolic abnormalities tended to increase with increasing age in both overweight and obesity groups.(P for trend <0.001) After adjusting various confounding variables, the odds ratio (95% confidence interval) of skipping any meal and breakfast for metabolically abnormality were 1.318 (1.066–1.631) and 1.354 (1.076–1.705) in male obese group and those of skipping breakfast and carbonated drink intake were 1.578 (1.168–2.133) and 1.540 (1.188–2.492) in female obese group. Daily potassium intake (P=0.032) and daily vitamin C intake (P=0.048) in the male overweight group and daily water intake (P=0.046) and daily carbohydrate intake (P=0.038) in the female overweight group were associated with metabolically abnormality. CONCLUSIONS: There were differences in health behaviors and nutrient intake according to metabolically abnormality in overweight and obese groups.
Adenosine Triphosphate ; Adult ; Ascorbic Acid ; Breakfast ; Carbonated Beverages ; Cholesterol ; Confounding Factors (Epidemiology) ; Drinking ; Education ; Female ; Food Habits ; Health Behavior* ; Humans ; Male ; Meals ; Nutrition Surveys ; Obesity* ; Odds Ratio ; Overweight* ; Potassium

BACKGROUND: The prevalence of metabolic syndrome (MetS) has risen rapidly worldwide, including in South Korea. Factors related to lifestyle are closely associated with the development of MetS. The aim of this study was to investigate the association between MetS and a number of factors positively influencing health, namely non-smoking, low-risk drinking, sufficient sleep, regular exercise, and the habit of reading food labels, among Korean men. METHODS: This cross-sectional study included 3,869 men from the 2007–2009 Korean National Health and Nutrition Examination Survey. Information on five factors positively influencing their health was obtained using a self-reported questionnaire. We categorized subjects into four groups, depending on the number of positive factors reported (group I, 0–1 factor; group II, 2 factors; group III, 3 factors; group IV, 4–5 factors). RESULTS: Men who reported a greater number of positive health factors had better laboratory and anthropometric values than men who reported fewer positive health factors. The prevalence of MetS was 29.1, 27.2, 20.7, and 14.6% in groups I to IV, respectively. Compared to group I, odds ratios (95% confidence intervals) for MetS were 0.96 (0.78–1.19) in group II, 0.67 (0.52–0.87) in group III, and 0.52 (0.35–0.76) in group IV, after adjusting for confounding factors. Odds ratios for abdominal obesity, glucose intolerance, and hypertriglyceridemia were statistically significant. CONCLUSION: A greater number of positive lifestyle factors influencing health were associated with a lower risk of developing MetS, in a nationally representative sample of Korean men.
Alcohol Drinking ; Cross-Sectional Studies ; Drinking ; Glucose Intolerance ; Humans ; Hypertriglyceridemia ; Korea ; Life Style ; Male ; Metabolic Syndrome X ; Nutrition Surveys* ; Obesity, Abdominal ; Odds Ratio ; Prevalence ; Smoking