Background: The purpose of this study is to explain the factors influencing the incurrence of catastrophic health expenditure of national health insurance households using panel data observed over a long period. Methods: The study targeted 3,652 households who had no censoring during the 11-year survey period (2007–2017) and householders whose insurance type was consistently maintained as national health insurance. Generalized estimating equations were adopted to identify factors affecting the occurrence of catastrophic health expenditure at 20%, 30%, and 40% threshold levels. A subgroup analysis was conducted by categorizing groups depending on the existence of the elderly in the household. Results: For the last 11 years, the incidence of catastrophic health expenditure in the households without the elderly decreased slightly at all threshold levels, but the households with the elderly seemed to be increased. At baseline, household type showed a statistically significant relationship with all other variables. The results of generalized estimating equations analyses show that household income was not significant at all threshold levels in the households without elderly. On the other hand, in the households with the elderly, the 2nd (odds ratio [OR], 1.33–2.05) and 3rd quintile groups (OR, 1.25–2.55) were more likely to have catastrophic health expenditure compared to the 1st quintile of household income group. Conclusion As the amount of health expenditures relative to the ability to pay is increasing in households with the elderly, the application of an intervention followed by consistent monitoring is needed. This study found that there were differences in influencing factors according to the presence of the elderly in the households. In particular, in households with the elderly, interesting results have been drawn regarding the occurrence of catastrophic health expenditure in the near-poor, so additional research is required.

OBJECTIVES: This study was designed for the evaluation of relationships between PC-Bang (the place where people surf the internet, play computer games and etc) visit and stress in adolescents. METHODS: 66 adolescents in city of Kangnung were interviewed in June, 2000. The independent variables were general characteristics of adolescents, the characteristics related to school activities and the length of time using PC-Bang. The amount of stress was measured by the Korean version BEPSI (Brief Encounter Psychosocial Instrument) scale. RESULTS: The multiple regression analysis shows that the BEPSI score of female was higher than that of male by 0.18 (p<0.05) and the adolescents with more communication with their friends scored lower 4.04 (p<0.001) than others in the BEPSI. As the time used in PC bang increased, the BEPSI score was also increased 0.18 point per hour (p<0.01). CONCLUSION: This result shows that the time of PC-Bang usage is significantly related with the BEPSI score of adolescents.
Adolescent* ; Female ; Friends ; Humans ; Internet ; Male ; Video Games

OBJECTIVES: This study was conducted to elucidate the effects of an air quality warning system (AQWS) implemented in January 2015 in Korea by analyzing changes in the incidence and exacerbation rates of environmental diseases. METHODS: Data from patients with environmental diseases were extracted from the National Health Insurance Service-National Sample Cohort database from 2010 to 2019, and data on environmental risk factors were acquired from the AirKorea database. Patient and meteorological data were linked based on residential area. An interrupted time series analysis with Poisson segmented regression was used to compare the rates before and after AQWS introduction. Adjustment variables included seasonality, air pollutants (carbon monoxide, nitrogen dioxide, sulfur dioxide, particulate matter less than 10 μm in diameter, and ozone), temperature, and humidity. RESULTS: After AQWS implementation, the incidence of asthma gradually decreased by 20.5%. Cardiovascular disease and stroke incidence also significantly decreased (by 34.3 and 43.0%, respectively). However, no immediate or gradual decrease was identified in the exacerbation rate of any environmental disease after AQWS implementation. Sensitivity analyses were performed according to age, disability, and health insurance coverage type. Overall, the AQWS effectively mitigated the occurrence of most environmental diseases in Korea. However, the relationships between alarm system implementation and reduced incidence differed among diseases based on the characteristics of vulnerable and sensitive individuals. CONCLUSIONS Our results suggest that by tailoring the AQWS to demographic and sociological characteristics and providing enhanced education about the warning system, interventions can become an efficient policy tool to decrease air pollution-related health risks.

Background: Using KIDS-KAERS database (KIDS-KD) from 2016 to 2020, the aim is to investigate signals of adverse events of alpha-adrenoceptor antagonists and to present adverse events that are not included in the precautions for use when marketing approval. Methods: This study was conducted by disproportionality analysis. Data mining analysis was performed to detect signals of alpha-adrenoceptor antagonists, such as terazosin, doxazosin, alfuzosin, silodosin, and tamsulosin. The signal was defined by three criteria as proportional reporting ratio (PRR), reporting odds ratio (ROR), and information component (IC). Detected signals were compared with product labeling and the European Medicines Agency-Important Medical Events list. Results: Out of the total number of 408,077 reports for adverse events, 6,750 cases were reported as adverse events of alpha-adrenoceptor antagonists. Dizziness, mouth dryness, hypotension postural, and oedema peripheral are identified as common adverse events of five alphaadrenoceptor antagonists and are typically listed on drug labels. However, new signals were detected for pneumonia, chronic obstructive airway disease, eye diseases such as glaucoma and cataracts, fracture, and ileus of tamsulosin that were not previously listed on the drug labels in Korea. Conclusions This study identified signals related to adverse drug reactions of alpha-adrenoceptor antagonists and presented serious adverse events, suggesting new adverse reactions to be aware of when using alpha-adrenoceptor antagonists.

Background: Low-density lipoprotein cholesterol is an important marker highly associated with cardiovascular disease. Since the direct measurement of it is inefficient in terms of cost and time, it is common to estimate through the Friedewald equation developed about 50 years ago. However, various limitations exist since the Friedewald equation was not designed for Koreans. This study proposes a new low-density lipoprotein cholesterol estimation equation for South Koreans using nationally approved statistical data. Methods: This study used data from the Korean National Health and Nutrition Examination Survey from 2009 to 2019. The 18,837 subjects were used to develop the equation for estimating low-density lipoprotein cholesterol. The subjects included individuals with low-density lipoprotein cholesterol levels directly measured among those with high-density lipoprotein cholesterol, triglycerides, and total cholesterol measured. We compared twelve equations developed in the previous studies and the newly proposed equation (model 1) developed in this study with the actual low-density lipoprotein cholesterol value in various ways. Results: The low-density lipoprotein cholesterol value estimated using the estimation formula and the actual low-density lipoprotein cholesterol value were compared using the root mean squared error. When the triglyceride level was less than 400 mg/dL, the root mean squared of the model 1 was 7.96, the lowest compared to other equations, and the model 2 was 7.82. The degree of misclassification was checked according to the NECP ATP III 6 categories. As a result, the misclassification rate of the model 1 was the lowest at 18.9%, and Weighted Kappa was the highest at 0.919 (0.003), which means it significantly reduced the underestimation rate shown in other existing estimation equations. Root mean square error was also compared according to the change in triglycerides level. As the triglycerides level increased, the root mean square error showed an increasing trend in all equations, but it was confirmed that the model 1 was the lowest compared to other equations. Conclusion The newly proposed low-density lipoprotein cholesterol estimation equation showed significantly improved performance compared to the 12 existing estimation equations. The use of representative samples and external verification is required for more sophisticated estimates in the future.

Background: This study purposed to examine the difference in the prevalence of obesity at each stage among people with and without disabilities considering the severity and type of disability. Methods: The study targeted a total of 1,315,967 people, including 68,418 disabled and 1,247,549 non-disabled, who completed the national health screenings. Logistic analysis and average marginal effect analysis were conducted in three stages (pre-obesity, obesity, severe obesity). Those analyses were conducted considering the severity and type of disabilities. Results: People with disabilities were more likely to be at all stages of obesity than non-disabled people. In severely disabled people, the probability of obesity was higher than non-disabled people at all stages of obesity, but mildly disabled people had a higher only in the severe obesity stage, no difference in obesity stage, and a low in the pre-obesity stage. In physical and mental disabilities, the probability of obesity was higher than non-disabled people at all stages of obesity, but external physical function and internal organs disabled had a lower in the obesity and pre-obesity stage, and no difference in severe obesity stage. Conclusion This study found that people with disabilities had a higher relationship with obesity than people without disabilities. In addition, severity and types of disabilities have different effects on the stage of obesity. Therefore, it is necessary to care about the health inequality and health of disabled people considering their severity and types of disabilities.

BACKGROUND/AIMS: A retrospective analysis was performed to evaluate the safety and effectiveness of extracorporeal shock wave lithotripsy (ESWL) for pancreatolithiasis on successive days under intravenous bolus of pethidine alone. METHODS: Ninety patients with calcified pancreatic stones (> or =5 mm) presenting with abdominal pain were selected for ESWL. ESWL was performed with an electroconductive lithotripter under fluoroscopic target systems. Fragmented calculi after ESWL were removed by endotherapy. RESULTS: A mean of 4.2 ESWL sessions were performed for each patient, with a mean of 2,984 shocks at a mean power setting of 12.8 kV. Eighty-four (89.3%) patients underwent ESWL for three or more days in a row. Fragmentation of the stones were achieved in 83/90 (92.2%) patients. Complete clearance of the main pancreatic duct was achieved in 54/90 (60.0%) patients, and partial clearance was achieved in 27 (30.0%) patients. The mean dose of pethidine used during ESWL was 53.5+/-20.7 mg per session. As ESWL-related complications, four (4.3%) patients developed mild acute pancreatitis. CONCLUSIONS: In case of endoscopically difficult-to-treat pancreatic duct stones, combined therapy with ESWL is an effective method, and treatment with multiple sessions of ESWL on successive days under intravenous bolus of pethidine alone is safe and well tolerated.
Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Calculi/*therapy ; Female ; Fluoroscopy ; Humans ; Injections, Intravenous ; *Lithotripsy ; Male ; Meperidine/*administration & dosage ; Middle Aged ; Pancreatic Ducts ; Pancreatitis/therapy ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome

The efficacy of the sustained release-delivery system was tested in suppressing the development of proliferative vitreoretinopathy(PVR) with intravitreal Fluoropyrimidines(5-Fu: FU, Fluorouridine: FUD, 5-Fluoro-5'-monophosphate: FUMP). PVR was induced in one-hundred-eightyeight eyes of one-hundred-twenty rahbits by intravireal injection of homologous dermal fibroblasts(250.000 cells/0.1 ml). Each drugs were encapsulated with liposome(LFU. LFUD. LFUMP) or polymer(PFU. PFUD) and non-coated drugs wer e used as controls. 3 weeks after injections of fibroblasts, retina detached in 50.0% of control eyes. Among treated eyes, the detachment rates in percentage are as follows; FU 37.5, FUD 50.3, LFU 37.5, LFUD 37.5, PFU 16.7, PFUD 22.2. For the pharmacokinetic study. radiolaveled(-14C) drugs were used in liposome group and frozen vitreouses were measured by scintillatng counter; polymer group was measured by HPLC. The intravitreal half life(hour) of injected drugs were FU 3.2, FUMP 2.9, LFU 7.1, LFUMP 7.6, and PFU was exceptionally long(11.1 days).
Chromatography, High Pressure Liquid ; Fibroblasts ; Fluorouracil ; Liposomes ; Polymers ; Retina ; Vitreoretinopathy, Proliferative*

PURPOSE: In this randomized, double-blind study, we investigated the analgesic efficacy and side effects of continuous constant-dose infusions of remifentanil after total abdominal hysterectomy and compared it to fentanyl. MATERIALS AND METHODS: Fifty-six adult female patients scheduled for elective total abdominal hysterectomy were enrolled in this study. Patients were randomly assigned to two groups according to fentanyl (group F, n=28) or remifentanil (group R, n=28) for postoperative analgesia. Patients in group F were given fentanyl intravenously with an infusion rate of fentanyl 0.5 microgram/kg/hr; group R was given remifentanil with an infusion rate of remifentanil 0.05 microgram/kg/min for 2 days. Pain intensity at rest, occurrence of postoperative nausea and vomiting (PONV), dizziness, pruritus, and respiratory depression were assessed 1 hr after arrival at the post-anesthesia care unit, at 6; 12; 24; and 48 hr post-operation and 6 hr post-infusion of the study drug. Pain was evaluated by using visual analogue scale (VAS; 0-10). The time that patients first requested analgesics was recorded as well as additional analgesics and antiemetics. RESULTS: There were no significant differences in VAS, time to first postoperative analgesics, and additional analgesics between the 2 groups. The incidences and severities of PONV and opioid related side effects were not different between the groups; however, there were 3 episodes (10.7%) of serious respiratory depression in group R. CONCLUSION: Continuous infusion technique of remifentanil did not reveal any benefits compared to fentanyl. Furthermore, it is not safe for postoperative analgesia in the general ward.
Adolescent ; Adult ; Aged ; Analgesics, Opioid/administration & dosage/therapeutic use ; Drug Administration Schedule ; Female ; Fentanyl/administration & dosage/*therapeutic use ; Humans ; Hysterectomy/*adverse effects ; Infusions, Intravenous ; Middle Aged ; Pain, Postoperative/*drug therapy/etiology ; Piperidines/administration & dosage/*therapeutic use ; Treatment Outcome

BACKGROUND: In spite of various types of medical supports, many diabetic patients have not been cared adequately. This study was performed to investigate the clinical characteristics and the patterns of management according to the types of the medical institutions. METHODS: Seven private clinics as primary care institutions, 3 hospitals as secondary care institutions, and 2 medical centers as the tertiary care institutions located in Seoul and Gyeonggi province were the targets of investigation for three months from December 2000 to February 2001. The survey included demographic information, biochemical tests and the pharmacological agents used concomitantly. The subjects who have completed the entire tests were respectively 321, 343 and 1830 patients in the primary, secondary and tertiary care centers. RESULTS: There were no significant differences in age and sex distribution among the study groups. The fasting and postprandial blood glucose levels were highest in secondary and primary institutions, respectively. The glycated hemoglobin levels were higher in primary care institutions than in others. In tertiary care institutions, blood pressure and lipid profile (total cholesterol, triglyceride and HDL-cholesterol) were better controlled compared with the other study groups. CONCLUSIONS: In spite of the limited data from the selected medical institutions, the overall status of the blood glucose, hypertension and hyperlipidemia management for the diabetic patients in Korea were inadequate in all types of medical institutions. For the better management of the diabetic patients, more efforts will be required including the standard management protocol as well as the education program for the primary physicians.
Blood Glucose ; Blood Pressure ; Cholesterol ; Diabetes Mellitus ; Education ; Fasting ; Gyeonggi-do* ; Hemoglobin A, Glycosylated ; Humans ; Hyperlipidemias ; Hypertension ; Korea ; Primary Health Care ; Secondary Care ; Seoul* ; Sex Distribution ; Tertiary Care Centers ; Tertiary Healthcare ; Triglycerides