OBJECTIVES: To investigate trends in the prevalence of allergic disease over a 9-year period. METHODS: Using National Health Insurance Service (NHIS) data, the annual number of patients with allergic disease was obtained for each regional subdivisions (small cities, counties, and districts) from 2003 to 2011. Annual populations for each sub-region were obtained and used to calculate the standardized prevalence. To compare prevalence within the study period, data was standardized spatially and temporally. For standardization, demographic data was used to obtain the registered population and demographic structure for 2010, which was used to perform direct standardization of previous years. In addition, a geographic information system (GIS) was used to visualize prevalence for individual sub-regions, and allergic diseases were categorized into five groups according to prevalence. RESULTS: The nationwide outpatient prevalence of allergic rhinitis increased approximately 2.3-fold, from 1.27% in 2003 to 2.97% in 2013, while inpatient prevalence also increased approximately 2.4-fold,. The outpatient prevalence of asthma increased 1.2-fold, and inpatient prevalence increased 1.3-fold. The outpatient prevalence of atopic dermatitis decreased approximately 12%, and inpatient prevalence decreased 5%. CONCLUSIONS: There was a large difference between prevalence estimated from actual treatment data and prevalence based on patients' self-reported data, particularly for allergic rhinitis. Prevalence must continually be calculated and trends should be analyzed for the efficient management of allergic diseases. To this end, prevalence studies using NHIS claims data may be useful.
Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; Asthma/epidemiology ; Child ; Child, Preschool ; Databases, Factual ; Dermatitis, Atopic/epidemiology ; Female ; Geographic Information Systems ; Humans ; Hypersensitivity/*epidemiology ; Infant ; Infant, Newborn ; Middle Aged ; National Health Programs ; Prevalence ; Republic of Korea/epidemiology ; Rhinitis, Allergic/epidemiology ; Young Adult

Background: Although cardiovascular outcome trials using sodium-glucose cotransporter-2 inhibitors (SGLT-2i) showed a reduction in risk of 3-point major adverse cardiovascular events (MACE), they did not demonstrate beneficial effects on stroke risk. Additionally, meta-analysis showed SGLT-2i potentially had an adverse effect on stroke risk. Contrarily, pioglitazone, a type of thiazolidinedione (TZD), has been shown to reduce recurrent stroke risk. Thus, we aimed to compare the effect of SGLT-2i and TZD on the risk of stroke in type 2 diabetes mellitus (T2DM) patients. Methods: Using the Korean National Health Insurance Service data, we compared a 1:1 propensity score-matched cohort of patients who used SGLT-2i or TZD from January 2014 to December 2018. The primary outcome was stroke. The secondary outcomes were myocardial infarction (MI), cardiovascular death, 3-point MACE, and heart failure (HF). Results: After propensity-matching, each group included 56,794 patients. Baseline characteristics were well balanced. During the follow-up, 862 patients were newly hospitalized for stroke. The incidence rate of stroke was 4.11 and 4.22 per 1,000 person-years for the TZD and SGLT-2i groups respectively. The hazard ratio (HR) of stroke was 1.054 (95% confidence interval [CI], 0.904 to 1.229) in the SGLT-2i group compared to the TZD group. There was no difference in the risk of MI, cardiovascular death, 3-point MACE between groups. Hospitalization for HF was significantly decreased in SGLT-2i-treated patients (HR, 0.645; 95% CI, 0.466 to 0.893). Results were consistent regardless of prior cardiovascular disease. Conclusion In this real-world data, the risk of stroke was comparable in T2DM patients treated with SGLT-2i or TZD.

Lead, one of the most toxic heavy metals, takes longer time to be excreted from the body than other heavy metals. The purpose of this study is, by measuring lead excretion via urine and feces, to find out the effect of vitamin C in lead chelation. Thirty-six rats were randomly assorted into four groups. All 33 rats except for the control group were administered with lead, before orally administered with different doses of vitamin C per kilogram of body weight. The lead excretion levels in urine and feces as well as the survival rate were then measured for each group. The rats with lead administrations (10/13, 76.9%) with lead administrations only, 10/11 rats (90.9%) with lead administrations and low dose of vitamin C, 9/9 rats (100%) with lead administrations and high dose of vitamin C survived. Among the 29 surviving rats, low vitamin C intake group exhibited higher urinary excretion than the lead only group. The urinary excretion level in high dose vitamin C intakegroup was significantly higher than the lead only group. In addition, fecal lead excretion seemed to be increased in the high dose vitamin C intake group, compared to the group with lead administrations only with statistical significance. Through animal experiment, it was found out that administrating high dose of vitamin C accelerated the excretion of lead in body compared to low dose of vitamin C.
Animal Experimentation ; Animals ; Ascorbic Acid* ; Body Weight ; Feces ; Metals, Heavy ; Rats* ; Survival Rate ; Vitamins*

PURPOSE: High-quality hospice and palliative medicine curricula are necessary in Korean medical schools. This study evaluated changes in students' knowledge and attitudes toward both hospice and palliative care following the completion of a course on these topics, as well as the course's overall role in the basic medical education curriculum.METHODS: Questionnaires measuring knowledge and attitudes were collected before and after the course from 76 fourth-year medical students, who had received instructions integrating both hospice and palliative care in 2016.RESULTS: The questionnaire item “Select the correct answer on the use of opioid pain control in hospice and palliative care” changed the most in terms of number of correct answers pre- and post-course (3.50 and 5.32, respectively; P<0.001). Pre- and post-course, the numbers of students who answered “Strongly Agree” and “Agree” to questions concerning their attitudes toward hospice and palliative care (“I know the purposes and roles of hospice and palliative care”) were 17 (22.4%) and 65 (85.6%), respectively (P≤0.001). Affirmative responses also increased for “As a pre-physician, I know when to describe and advise hospice and palliative care to patients”, from 22 (28.9%) to 65 (85.6%; P≤0.001).CONCLUSION: This study showed that comprehensive hospice education in the form of an integrated educational course might promote changes in medical students' knowledge and attitudes toward hospice and palliative medicine.
Curriculum ; Education ; Education, Medical ; Hospice Care ; Hospices ; Humans ; Palliative Care ; Palliative Medicine ; Schools, Medical ; Students, Medical

Background: Vulvar cancer is one of the rare gynecologic malignancies. Despite the recent increasing trend of vulvar cancer in western countries due to the increased infection of human papillomavirus, there has been no study for population-based incidence of vulvar cancer in Korea. We aimed to investigate the prevalence and treatment of vulvar cancer in South Korea between 2014 and 2018. Methods: Data from patients diagnosed and treated with vulvar cancer between 2014 and 2018 were obtained from the Health Insurance Review and Assessment Service/National Inpatient Sample (National In-Patient Sample) in South Korea. Results: A total of 4,636,542 women were identified through the HIRA-NIS database from 2014 to 2018, of which 259 patients were diagnosed and treated for vulvar cancer. The mean age diagnosed with vulvar cancer was 62.82 (± 14.30) years in 2014, 64.19 (± 16.79) years in 2015, and 67.40 (± 14.41) years in 2016. In terms of treatment modalities, the most frequent treatment was surgery only without chemotherapy or radiation therapy. In the age-specific prevalence analysis, vulvar cancer was the most prevalent among those over 70 years old. According to multiple regression analysis, patients’ age was significantly associated with the prevalence of vulvar cancer. Vulvar cancer was more prevalent in women with low socioeconomic status (SES) compared to those with high SES in 2018 (OR, 4.242; P < 0.001). Conclusion Considering the high prevalence of vulvar cancer in the elderly, it is necessary to establish a new strategy for early screening and treatment.

Purpose: Though the socioeconomic burden of cancer on patients is increasing in South Korea, there is little research regarding the type of cancer that incurs the highest costs. This study analyzed the socioeconomic burden on cancer patients from 2011 to 2015 according to sex and age. Materials and Methods: A prevalence-based approach was applied utilizing claim data of the National Health Insurance Service in Korea to estimate the socioeconomic burden of cancer on patients. Patients who received treatment for cancer from 2011 to 2015 were the study subjects. The total socioeconomic burden of their disease and treatment was divided into direct and indirect costs. Results: There was an increase of 50.7% for 5 years, from 821,525 to 1,237,739 cancer patients. The cancer costs for men and women increased $8,268.4 million to $9,469.7 million and $3,626.5 million to $4,475.6 million, respectively. Furthermore, the 50-59-year-old age group accounted for a large portion of the total disease cost. Liver, lung, stomach, and colorectal cancers created the heaviest economic burdens on patients. Conclusion Overall, this study indicates new policies for cancer prevention, early detection, and postcancer treatment management are necessary to help limit the costs associatedwith cancer, especially in the elderly, and provides a foundation for establishing cancer-related health care policies, particularly by defining those cancers with heavier disease burdens.

Purpose: To investigate the long-term effects of taking 5-alpha reductase inhibitors (5ARIs) on the development of bladder cancer (BC) and the implementation of radical cystectomy (RC), a standard procedure for advanced BC. Materials and Methods: From the National Health Insurance Sharing Service database, males aged over 40 years who underwent serum prostate-specific antigen testing from 2006 through 2017 were identified, which is required for the prescription of 5ARIs. The association between the administration duration of 5ARIs and the practice for BC was analyzed. Results: Of the 3,843,968 subjects, 1,514,713 (39.4%) took 5ARIs for an average of 1.53 years, remaining 2,329,255 (60.6%) as non-5ARI counterparts. The incidence of BC was higher in the non-5ARI than in the 5ARI group (1.25% vs. 0.87%, p<0.001), as was the implementation rate of RC (11.1% vs. 10.4%, p=0.037). In a multivariate analysis, the non-5ARI group had a significant risk of BC (hazard ratio [HR]=2.289, 95% confidence interval [CI]=2.241–2.338) and RC (HR=2.199, 95% CI=2.061–2.348) than the 5ARI group. Among the 5ARIs group, though the incidence of BC was maintained (slope=-0.002 per year, p=0.79) after an initial increase for two years, the rate of RC decreased (slope=-1.1, p<0.001) consistently for ten years during the administration. Conclusions Compared to the untreated group, 5ARIs use was associated with lower rates of BC and RC. In contrast to the increase in BC seen with short-term use of less than two years, long-term use of 5ARIs decreased the rate of RC in a duration-dependent manner for ten years, suggesting a strategy to prevent disease progression.