STATEMENT OF PROBLEM & PURPOSE: To study the effect of different fluoridation methods after in-office bleaching on the color of teeth during severe staining with coffee. MATERIAL AND METHODS: 44 specimens were randomly divided into four groups. Group 1 (no bleaching, no fluoride, coffee) was served as control for the influence of coffee on the color of untreated teeth. Group 2, 3 and 4 were undergone bleaching with 35% H2O2 for 30 minutes a day on 3 consecutive days. Group 2 was remained without fluoridation. Group 3 and 4 were fluoridated for 1 hour with either Cavity shield(R) or pH 7 Gel(R). All of groups were immersed in coffee solution for 7 days. Color determination was accomplished using the spectrophotometer (VITA Easyshade(R)). RESULTS: Delta L and Delta h increased, whereas Delta C decreased in the bleached groups. Pairwise comparisons with Tukey's HSD showed that there were statistically significant differences for Delta L and Delta h between the bleached groups and the non-bleached group (P < .05). Delta L and Delta h decreased continuously, while DeltaC showed an increase after a decrease in all of groups during immersion in coffee solution. After immersion in coffee solution for 7 days there were no statistically significant differences for Delta L, Delta C and Delta h between the groups (P > .05). Also there were no statistically significant differences for Delta L, Delta C and Delta h between the group 3 treated with Cavity shield(R) and the group 4 treated with pH 7 Gel(R) (P > .05). CONCLUSION: It was concluded that fluoridation was not beneficial to the prevention of extrinsic stains after bleaching.
Coffee ; Coloring Agents ; Fluoridation ; Fluorides ; Hydrogen-Ion Concentration ; Immersion ; Tooth

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poor-quality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.
Benchmarking ; Hospitals ; Humans ; *National Health Programs ; Quality Improvement/*economics ; Quality of Health Care/economics ; Reimbursement, Incentive/*organization & administration ; Republic of Korea

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

Background/Aims: This study aimed to evaluate the cost-effectiveness of hepatitis C virus (HCV) screening compared to no screening in the Korean population from societal and healthcare system perspectives. Methods: A published decision-tree plus Markov model was used to compare the expected costs and quality-adjusted life years (QALY) between one-time universal HCV screening and no screening in the population aged 40–65 years using the National Health Examination (NHE) program. Input parameters were obtained from analyses of the National Health Insurance claims data, Korean HCV cohort data, or from the literature review. The population aged 40–65 years was simulated in a model spanning a lifetime from both the healthcare system and societal perspectives, which included the cost of productivity loss due to HCV-related deaths. The incremental cost-effectiveness ratio (ICER) between universal screening and no screening was estimated. Results: The HCV screening strategy had an ICER of $2,666/QALY and $431/QALY from the healthcare system and societal perspectives, respectively. Both ICERs were far less than the willingness-to-pay threshold of $25,000/QALY, showing that universal screening was highly cost-effective compared to no screening. In various sensitivity analyses, the most influential parameters on cost-effectiveness were the antibodies to HCV (anti-HCV) prevalence, screening costs, and treatment acceptance; however, all ICERs were consistently less than the threshold. If the anti-HCV prevalence was over 0.18%, screening could be cost-effective. Conclusions One-time universal HCV screening in the Korean population aged 40–65 years using NHE program would be highly cost-effective from both healthcare system and societal perspectives.

Objectives: This study aimed to evaluate the registered dentists’ program, from the dentist’s perspective, before its nationwide implementation. Methods: In-depth interviews were conducted with 18 dentists who had participated in the registered dentists’ program in G Province. A questionnaire was prepared based on previous research. The data were collected by transcription of interview recordings. Qualitative research methodology was implemented and the data were coded according to the grounded theory. A paradigm model was presented and the core categories were indicated. Results: The findings were organized into 6 categories, 25 subcategories, and 315 codes, based on open coding of the first categorization of collected data. The central phenomenon was found to be the experience of dissatisfaction with the program. The causal conditions were shown as problems of the program, while contextual and intervening conditions were shown as passive participation of dentists and positive effects of the program, respectively. The action/interaction strategies were summarized as an improvement plan and the consequence was an increased intention to participate. Conclusions The study proposes the need to strengthen primary dental care through this registered dentists’ program, by performing continuous evaluations. The standards and guidelines, cooperation of participants, and appropriate compensation should be considered to promote successful implementation.

Objectives: This study aimed to evaluate the registered dentists’ program, from the dentist’s perspective, before its nationwide implementation. Methods: In-depth interviews were conducted with 18 dentists who had participated in the registered dentists’ program in G Province. A questionnaire was prepared based on previous research. The data were collected by transcription of interview recordings. Qualitative research methodology was implemented and the data were coded according to the grounded theory. A paradigm model was presented and the core categories were indicated. Results: The findings were organized into 6 categories, 25 subcategories, and 315 codes, based on open coding of the first categorization of collected data. The central phenomenon was found to be the experience of dissatisfaction with the program. The causal conditions were shown as problems of the program, while contextual and intervening conditions were shown as passive participation of dentists and positive effects of the program, respectively. The action/interaction strategies were summarized as an improvement plan and the consequence was an increased intention to participate. Conclusions The study proposes the need to strengthen primary dental care through this registered dentists’ program, by performing continuous evaluations. The standards and guidelines, cooperation of participants, and appropriate compensation should be considered to promote successful implementation.

BACKGROUND/AIMS: The prevalence of hepatitis C virus (HCV) infection in Korea exhibits significant geographic variation, with it being higher in Busan and Jeonam than in other areas. The reason for this intranational geographic difference was investigated in this study by conducting a comparative analysis of the risk factors related to HCV infection among three geographic areas: the capital (Seoul), Busan, and the province of Jeolla. METHODS: In total, 990 patients with chronic HCV infection were prospectively enrolled at 5 university hospitals located in Seoul (n=374), Busan (n=264), and Jeolla (n=352). A standardized questionnaire survey on the risk factors for HCV infection was administered to these three groups of patients, and a comparative analysis of the findings was performed. RESULTS: The analysis revealed significant regional differences in exposure to the risk factors of HCV infection. By comparison with patients in Seoul as a control group in the multivariate analysis, patients in Busan had significantly more experience of invasive medical procedures, acupuncture, cosmetic procedures, and multiple sex partners. In contrast, patients in Jeolla were significantly older, and they had a higher prevalence of hepatocellular carcinoma, a lower prevalence of multiple sex partners, and had experienced fewer invasive procedures. CONCLUSIONS: There was a significant geographic difference in the exposure to potential risk factors of HCV infection between patients from the three studied regions. This may explain the regional variation of the prevalence of HCV infection in Korea, and should be taken into account when planning strategies for the prevention and management of HCV infection.
Adult ; Aged ; Asian Continental Ancestry Group ; Female ; Hepatitis C/diagnosis/*epidemiology ; Hospitals, University ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Prevalence ; Questionnaires ; Republic of Korea/epidemiology ; Risk Factors

Colorectal cancer developed during pregnancy is extremely rare condition associated with a poor prognosis. Pregnant women usually present with more advanced stage at diagnosis than their non-pregnant counterparts. There are several possible reasons for this disparity as follows. The first one is delay in making the diagnosis due to similarity between the early symptoms of colon cancer and the gastrointestinal complains of pregnancy, the second is proliferation and decreased apoptosis of tumor cells due to the effects of various cytokines and hormonal environmental stimuli related to the state of pregnancy, and the third is an increased opportunity for tumor spread due to the immunosuppressed state of pregnancy and increased perfusion of all the organs. Thus, it is important not to underestimate the patient's symptoms because the early diagnosis is essential for better prognosis. We report a 27-year-old primigravida with advanced stage adenocarcinoma of the left colon diagnosed after cesarean delivery with a brief review of literature.
Adenocarcinoma ; Adult ; Apoptosis ; Colon* ; Colonic Neoplasms* ; Colorectal Neoplasms ; Cytokines ; Diagnosis ; Early Diagnosis ; Female ; Humans ; Perfusion ; Pregnancy* ; Pregnant Women ; Prognosis

BACKGROUND/AIMS: To evaluate the era of direct acting antivirals (DAAs), we must understand the treatment patterns and outcomes of interferon-based therapy for hepatitis C virus (HCV) infection. We aimed to elucidate the treatment rate, factors affecting treatment decisions, and efficacy of interferon-based therapy in a real-world setting. METHODS: This nationwide cohort study included 1,191 newly diagnosed patients with chronic HCV infection at seven tertiary hospitals in South Korea. Subjects were followed retrospectively until March 2015, which was just before the approval of DAA therapy. RESULTS: In total, 48.2% and 49.3% of the patients had HCV genotypes 1 and 2, respectively. Interferon-based therapy was initiated in 541 patients (45.4%). The major reasons for no treatment included ineligibility (18.9%), concern about adverse events (22.3%), cost (21.5%), and an age >75 years (19.5%). Interferon-based therapy was discontinued (18.5%) mainly due to adverse events (n=66). The intent-to-treat analysis found that the sustained virologic response (SVR) rate was 58.3% in genotype 1 patients and 74.7% in non-genotype 1 patients. CONCLUSIONS: Approximately one-third of newly diagnosed HCV patients in South Korea received interferon-based therapy and showed a suboptimal SVR rate. Diagnosis of patients at younger ages and with a less advanced liver status and reducing the DAA therapy cost may fulfill unmet needs.
Antiviral Agents ; Cohort Studies ; Diagnosis ; Genotype ; Hepacivirus ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Humans ; Korea* ; Liver ; Retrospective Studies ; Ribavirin ; Tertiary Care Centers

Background/Aims: The risk factors for the development of primary biliary cholangitis (PBC) is unclear. This study aimed to investigate the risk factors associated with PBC in Korea through a questionnaire survey. Methods: Consecutively enrolled 103 PBC patients from six referral hospitals and 100 age- and sex-matched community controls participated in this study. A standardized questionnaire survey including demographics, lifestyle, individual and familial medical history and reproductive history was prospectively collected and analyzed. Results: The PBC patients had a mean age of 58.3 years and a female proportion of 86.4%. The age- and sex-matched controls had a similar educational level and economic status to the PBC patients. Among the lifestyle factors, the multivariable analysis showed smoking including both first-hand and second-hand (odds ratio [OR], 2.03; 95% confidence interval [CI], 1.06 to 3.93), history of autoimmune diseases (OR, 2.46; 95% CI, 1.06 to 6.35), and family history of PBC (OR, 17.76; 95% CI, 1.77 to 2,418.74) were significantly associated with PBC, whereas alcohol intake was negatively associated with PBC. Among reproductive factors, the number of induced abortions was significantly associated with PBC, while the number of full-term deliveries was negatively associated with PBC. Conclusions A family history of PBC, accompanying autoimmune diseases, and smoking were significantly associated with PBC. More induced abortions and less full-term deliveries were associated with PBC in women. In contrast, mild to moderate alcohol intake was negatively associated with PBC. Further studies are warranted to validate the results of this study and to search for clues about the pathogenesis of PBC.