BACKGROUND: This study investigates the impact of weekend admission with a patient safety indicator (PSI) on 30-day mortality among long-term insurance beneficiaries. METHODS: Data were obtained from the National Health Insurance Service-Senior claim database from 2002 to 2013. To obtain unbiased estimates of odds ratio, we used a nested case-control study design. The cases were individuals who had a 30-day mortality event after their last medical utilization, while controls were selected by incidence density sampling based on age and sex. We examined the interaction between the main independent variables of weekend admission and PSI by categorizing cases into four groups: weekend admission/PSI, weekend admission/non-PSI, weekday admission/PSI, and weekday admission/non-PSI. RESULTS: Of the 83,400 individuals in the database, there were 20,854 cases (25.0%) and 62,546 controls (75.0%). After adjusting for socioeconomic, health status, seasonality, and hospital-level factors, the odds ratios (ORs) of 30-day mortality for weekend admission/PSI (OR, 1.484; 95% confidence interval [CI], 1.371–1.606) and weekday admission/PSI (OR, 1.357; 95% CI, 1.298–1.419) were greater than for patients with weekday admission/non-PSI. CONCLUSION: This study indicated that there is an increased risk of mortality after weekend admission among patients with PSI as compared with patients admitted during the weekday without a PSI. Therefore, our findings suggest that recognizing these different patterns is important to identify at-risk diagnosis to minimize the excess mortality associated with weekend admission in those with PSI.
Case-Control Studies ; Diagnosis ; Humans ; Incidence ; Insurance Benefits ; Insurance, Long-Term Care ; Long-Term Care ; Mortality ; National Health Programs ; Odds Ratio ; Patient Safety ; Seasons

Purpose: This study aimed to identify the relationship between workplace violence and turnover intention, and the mediation effect of resilience on the relationship in hospital nurses. Methods: This was a cross-sectional study. A total of 237 registered nurses were recruited from three hospitals in South Korea from April to May 2019. Participants were invited to complete self-reported questionnaires that measure workplace violence, turnover intention, resilience, and demographic information. The data obtained were analyzed using multiple regression and a simple mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval (5,000 bootstrap resampling). Results After controlling demographic covariates, workplace violence significantly accounted for the variance of turnover intention. It was also demonstrated that resilience partially mediated the relationship between workplace violence and turnover intention in hospital nurses. A 73.8% of nurses had experienced workplace violence (such as attack on personality, attack on professional status, isolation from work, or direct attack). Conclusion: Workplace violence directly influences turnover intention of nurses and indirectly influences it through resilience. Therefore, hospital administrators need to develop and provide a workplace violence preventive program and resilience enhancement program to decrease nurses’ turnover intention, and leaving.

Lung cancer is the leading cause of cancer death worldwide, with an overall 5 year survival rate of 15%. Most patients present with advanced disease that requires systemic chemotherapy, which merely confers several months of survival benefit. Recent advances in understanding the molecular mechanisms underlying lung cancer have led to molecular targeted therapy in this field. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are the first successful personalized therapy for non-small cell lung cancer (NSCLC), with about 30 months of median overall survival in patients with sensitive EGFR mutations. In addition, monoclonal antibodies against vascular endothelial growth factor (VEGF) or EGFR are also in current clinical use. Resistance to EGFR-TKIs has emerged as a major limitation of these agents and become challenge clinically. A number of novel targeted agents have been developed and investigated in clinical trials to overcome the limitation of agents currently available. Recently, echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene (EML4-ALK), as a novel molecular target of NSCLC, has been identified, and its inhibitor is under rapid clinical development. We herein review the molecular targeted therapies currently available for NSCLC and discuss the clinical data of novel agents under clinical development.
Antibodies, Monoclonal ; Carcinoma, Non-Small-Cell Lung ; Humans ; Precision Medicine ; Lung ; Lung Neoplasms ; Lymphoma ; Molecular Targeted Therapy ; Phosphotransferases ; Protein-Tyrosine Kinases ; Receptor, Epidermal Growth Factor ; Survival Rate ; Vascular Endothelial Growth Factor A

Background: With the recent aging of the population, the transition to a disease structure centered on chronic diseases is accelerating. Moreover, the socio-economic gap and the polarization of the health gap between regions further increase the burden of disease on the country. Accordingly, this study calculated the disease cost of hypertension, diabetes, and hyperlipidemia, which are the three major chronic diseases, to establish an effective health promotion policy strategy for each region, and analyzed the gap in disease cost within the region to determine health determinants at the individual as well as the regional level. Methods: This study utilized data from the 2015 sample cohort of the National Health Insurance Service and calculated the disease cost of patients (diabetes: I10–I15, hypertension: E10–E14, hyperlipidemia: E78) based on the main diagnosis. Results: Based on our analysis, the case of medical use in cities and provinces was higher than in metropolitan cities, with relatively small medical use in Seoul and Gangwon-do. In terms of the disease cost, the cost of chronic diseases in Seoul and Jeju was the highest, but the difference in disease cost between patients in each region was the largest in Seoul and Gangwon-do. Conclusion The results of this study provide meaningful data for implementing efficient health promotion policies by analyzing the differences in disease cost and identifying health determinants in different regions. Furthermore, in Korea, where socioeconomic differences are clearly revealed, it can be used as a basis for preparing a strategic plan, from a long-term perspective, to improve the health of patients with chronic diseases in the future.

Background: With the recent aging of the population, the transition to a disease structure centered on chronic diseases is accelerating. Moreover, the socio-economic gap and the polarization of the health gap between regions further increase the burden of disease on the country. Accordingly, this study calculated the disease cost of hypertension, diabetes, and hyperlipidemia, which are the three major chronic diseases, to establish an effective health promotion policy strategy for each region, and analyzed the gap in disease cost within the region to determine health determinants at the individual as well as the regional level. Methods: This study utilized data from the 2015 sample cohort of the National Health Insurance Service and calculated the disease cost of patients (diabetes: I10–I15, hypertension: E10–E14, hyperlipidemia: E78) based on the main diagnosis. Results: Based on our analysis, the case of medical use in cities and provinces was higher than in metropolitan cities, with relatively small medical use in Seoul and Gangwon-do. In terms of the disease cost, the cost of chronic diseases in Seoul and Jeju was the highest, but the difference in disease cost between patients in each region was the largest in Seoul and Gangwon-do. Conclusion The results of this study provide meaningful data for implementing efficient health promotion policies by analyzing the differences in disease cost and identifying health determinants in different regions. Furthermore, in Korea, where socioeconomic differences are clearly revealed, it can be used as a basis for preparing a strategic plan, from a long-term perspective, to improve the health of patients with chronic diseases in the future.

Purpose: This article aimed to investigate 1) whether electronic cigarette (EC) users are more likely to experience asthma attacks or emergency room (ER) visits due to asthma than non-users and 2) how age and smoking behaviors moderate the effect size of the association. Materials and Methods: We used National Health Interview Survey data from 2016–2019. Multiple logistic regression analysis was performed to identify the association between current EC use and having an asthma attack and ER visitation due to asthma. Interaction terms were included to explore the moderation effects of age and cigarette smoking status. Subgroup analysis was conducted according to age group. Results: Of the 218911 participants, 2.0% of them experienced an asthma attack, and 0.5% visited the ER due to asthma. Current EC use was associated with higher odds of having an asthma attack. In interaction analysis, age and smoking status were identified as a moderator in the relationship between EC use and asthma attacks. Participants in their 20s or 30s showed the highest interaction effect. Conclusion Our analysis indicates the potential impact of EC use on public health and the moderating effects of smoking behavior.

Background: The global disease burden of infertility is rising and accessibility to infertility treatments and assisted reproduction is a challenging issue. Therefore, we investigated characteristics of successful delivery after an infertility diagnosis among infertile women. Methods: We designed a retrospective cohort study with the main outcome measure of a delivery medical record after the initial diagnosis of infertility. A total of 10,108 women patients who were diagnosed with infertility between 2005 to 2013 in the National Health Insurance Cooperation Cohort Database of Korea were enrolled. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for subsequent delivery were estimated by applying a Cox proportional-hazard regression model. Results: Approximately 55% of infertile women who reported infertility had a delivery eventually. Infertile women who are aged between 30 to 39 (HR, 0.80; 95% CI, 0.75–0.84), in low income level (HR, 0.77; 95% CI, 0.71–0.84), or diagnosed with diabetes (HR, 0.76; 95% CI, 0.60–0.96) were less likely to report a delivery. Conclusion These findings highlight demographic, socioeconomic, and medical characteristics of reporting a consequent delivery. Although many previous articles reported an association between socioeconomic status and receiving medical evaluation, there were few studies regarding successful delivery after an infertility diagnosis across socioeconomic status. Thus, the maintaining of support for low socioeconomic status infertile women and their family should be considered after the infertility diagnosis in aspects of financial and social approaches.

Suicide is a leading cause of death among adolescents globally, and body weight is also a recognized reason for adolescent suicide. Therefore, we investigated the association between weight control behaviors (WCB) and suicide ideation and attempt, focusing on inappropriate weight control measures. We used data from the 2014 Korea Youth Risk Behavior Web-based Survey, representing a total of 35,224 boys and 34,361 girls aged 12 to 18 years. Adolescents were classified into groups based on WCB: appropriate WCB, inappropriate WCB, and no WCB. We performed logistic regression models to examine associations between WCB and suicide ideation and attempt, controlling for covariates. Both boys and girls with inappropriate WCB were more likely to report suicide ideation and attempt. Underweight and normal weight boys with inappropriate WCB were more likely to think or attempt suicide, and underweight girls with inappropriate WCB were also more likely to attempt suicide. Among five common WCB combinations, the combination of "regular exercise, fasting, eating less" was highly associated with suicide ideation and attempt. We confirmed that inappropriate WCB is associated with suicide ideation and attempt among Korean adolescents. Given the high incidence rate of suicide among adolescents and the adverse effect of inappropriate WCB, encouraging adolescents to control their weight in healthy ways is imperative.
Adolescent* ; Body Weight ; Body Weight Changes ; Cause of Death ; Eating ; Fasting ; Female ; Humans ; Incidence ; Korea ; Logistic Models ; Risk-Taking ; Suicide* ; Thinness ; Weight Perception

OBJECTIVES: To examine the sex-specific factors associated with being unaware of one's hepatitis B virus surface antigen (HBsAg) seropositivity status in a large, HBsAg-positive population of Koreans. METHODS: In total, 1197 subjects aged 19 years or older who were HBsAg-positive according to data from the 2007-2012 Korea National Health and Nutrition Examination Survey were included. Subjects were considered unaware of their HBsAg seropositivity status if they answered that they had no knowledge of being previously infected by the hepatitis B virus (HBV) or diagnosed with HBV hepatitis. Multivariate Poisson regression models with robust variance estimate were used to assess the significance of the variables using weighted frequencies. RESULTS: The majority (77.8%) of HbsAg-positive Korean adults (females, 81.9%; males, 74.6%) were unaware of their HBsAg seropositivity status. We found that sex (female: prevalence ratio [PR] 1.19), household income (low: PR, 1.15), marital status (never married: PR, 1.18), self-rated health (moderate: PR, 1.14; good: PR, 1.12), and alcohol use (at least 2-3 times/wk: PR, 1.21) were associated with being unaware. In females, age (50 to 59 years: PR, 1.29; > or =70 years: PR, 1.30), household income (low: PR, 1.37; middle-low: PR, 1.24), and marital status (never married: PR, 1.33) were associated with being unaware. In males, self-rated health (moderate: PR, 1.14; good: PR, 1.21) and alcohol use (at least 2-3 times/wk: PR, 1.21) were associated with being unaware. CONCLUSIONS: Factors related to the socioeconomic status of females and the health-related behaviors of males were found to be associated with being unaware of one's HBsAg seropositivity status.
Adult ; Aged ; Alcohol Drinking ; Asian Continental Ancestry Group ; Awareness/*physiology ; Body Mass Index ; Female ; Health Status ; Hepatitis B/*diagnosis/epidemiology/virology ; Hepatitis B Surface Antigens/*blood ; Hepatitis B virus/*metabolism ; Humans ; Income ; Male ; Middle Aged ; Nutrition Surveys ; Poisson Distribution ; Prevalence ; Republic of Korea/epidemiology ; Sex Factors ; Young Adult

BACKGROUND: Weekend admission is known for having association with increased mortality attributed by poor quality of care and severe patients. We investigated the association between hospital admission on weekends and the in-hospital mortality rates of patients with cardiovascular disease. Furthermore, we examined this association stratified by admission via emergency room or not. METHODS: We analyzed claim data provided by the Health Insurance Review & Assessment in 2013. In total, 80,817 cardiovascular patients were included in this study, which treated in-hospital mortality (early and during total length of stay) as a dependent variable. A generalized linear mixed effects model was used. We conducted subgroup analyses stratified by admission via emergency room or not. RESULTS: Patients who admitted on weekend showed higher in-hospital mortality both early (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.23–1.78) and during total length of stay (OR, 1.17; 95% CI, 1.02–1.33) compared to those admitted on weekdays. Patients who were admitted to the hospital on a weekend by emergency room were more likely to experience early in-hospital mortality compared to those admitted on weekdays. Furthermore, we found that patients not admitted to the hospital through the emergency department were more likely to experience both early and total length of stay in-hospital mortality. CONCLUSION: Our study shows higher in-hospital mortality rates for cardiovascular patients admitted on weekends. Efforts to improve the quality of care on weekend are important to mitigate the ‘weekend effect’ and improve patient outcomes.
Cardiovascular Diseases ; Emergency Service, Hospital ; Hospital Mortality ; Hospitalization ; Humans ; Insurance, Health ; Korea ; Length of Stay ; Mortality ; Quality of Health Care