PURPOSE: This study was conducted to describe the trends and age-period-cohort effects on the incidence and mortality rate of cervical cancer in Korea. MATERIALS AND METHODS: The incidence and mortality rate of cervical cancer among ≥ 20-year-old women from 1993 to 2012 were obtained from the Korea Central Cancer Registry and the Korean Statistical Information Service. Age-standardized rates were calculated and Joinpoint regression was used to evaluate the trends in the incidence and mortality rate. Age-period-cohort analysis was performed to investigate the independent effects of age, period and cohort. RESULTS: The incidence of cervical cancer decreased from 32.8 per 100,000 in 1993 to 15.9 per 100,000 in 2012 (annual percent change [APC], –3.9%; 95% confidence interval [CI], –4.2% to –3.6%). The mortality rate decreased from 5.2 per 100,000 in 1993 to 2.1 per 100,000 in 2012 (APC, –4.8%; 95% CI, –5.1% to –4.4%); however, the incidence and mortality rates among young women (< 30 years old) increased. An age-period-cohort model of the incidence and mortality rate showed decreasing period effects between 1993 and 2008 and decreasing cohort effects between 1928 and 1973, while birth cohorts after 1973 exhibited slight increases in the incidence and mortality rate of cervical cancer. CONCLUSION: Recent decreases in the incidence and mortality rate of cervical cancer were due to decreases in the period and cohort effects, which reflect the implementation of a cancer screening program and changes in lifestyle. However, our findings also highlighted an increase in cohort effects on the incidence and mortality rate among young women born after 1973.
Cohort Effect ; Cohort Studies ; Early Detection of Cancer ; Female ; Humans ; Incidence* ; Information Services ; Korea* ; Life Style ; Mortality* ; Parturition ; Uterine Cervical Neoplasms* ; Young Adult

OBJECTIVES: As a baseline study to aid in the development of proper policy, we investigated the current condition of unpreparedness of documents required when issuing copies of medical records and related factors. METHODS: The study was comprised of 7,203 cases in which copies of medical records were issued from July 1st, 2007 through June 30th, 2008 to 5 tertiary referral hospitals. Data from these hospitals was collected using their established electronic databases and included study variables such as unpreparedness of the required documents as a dependent variable and putative covariates. RESULTS: The rate of unpreparedness of required documents was 14.9%. Multiple logistic regression analysis revealed the following factors as being related to the high rate of unpreparedness: patient age (older patients had a higher rate), issuance channels (on admission > via out-patient clinic), type of applicant (others such as family members > for oneself > insurers), type of original medical record (utilization records on admission > other records), issuance purpose (for providing insurer > medical use), residential area of applicant (Seoul > Honam province and Jeju), and number of copied documents (more documents gave a lower rate). The rate of unpreparedness differed significantly among the hospitals; suggesting that they may have followed their own conventional protocols rather than legal procedures in some cases. CONCLUSIONS: The study results showed that the level of compliance to the required legal procedure was high, but that problems occurred in assuring the safety of the medical information. A proper legislative approach is therefore required to balance the security of and access to medical information.
Coat Protein Complex I ; Compliance ; Electronics ; Electrons ; Humans ; Insurance Carriers ; Logistic Models ; Medical Records ; Outpatients ; Tertiary Care Centers

OBJECTIVE: The Depression in Old Age Scale (DIA-S) is a new screening tool for assessing depression in the elderly. The primary aims of this study were to describe the validation of the Korean version of the DIA-S (K-DIA-S) and to compare its validity with that of other depression screening questionnaires used in elderly outpatients in medical settings. METHODS: A total of 385 elderly outpatients completed the K-DIA-S and underwent the Mini International Neuropsychiatric Interview to diagnose depressive disorders. Other measures included the 15-item short form of the Geriatric Depression Scale (SGDS), the 9-item depression module of the Patient Health Questionnaire (PHQ-9), and the Montgomery–Asberg Depression Rating Scale (MADRS). Reliability and validity tests, an optimal cutoff point estimate, and receiver operating characteristic curve analysis were performed to investigate the diagnostic validity of the K-DIA-S. Areas under the curves (AUCs) for the K-DIA-S, SGDS, and PHQ-9 were compared statistically. RESULTS: The K-DIA-S showed good internal consistency and strong correlations with the SGDS (r = 0.853), PHQ-9 (r = 0.739), and MADRS (r = 0.772). The cut-off point of the K-DIA-S that can be recommended for screening depressive symptoms was a score of 4. For “any depressive disorder”, the AUC (standard error) for the K-DIA-S was 0.896 (0.015), which was significantly larger than that for the PHQ-9 (p = 0.033). CONCLUSION: The present findings suggest that the K-DIA-S has good psychometric properties and is a valid and reliable tool for assessing depressive symptoms in elderly populations and medically ill patients.
Aged ; Area Under Curve ; Depression ; Depressive Disorder ; Humans ; Mass Screening ; Outpatients ; Psychometrics ; Reproducibility of Results ; ROC Curve

Objective: We revised the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP), first published in 2002 and revised in 2006, 2010, 2014, and 2018, to reflect recent progress in the treatment of bipolar disorder. Methods: The questionnaires consisted of 56 items for adult patients and 7 items for child/adolescent patients, and were used to obtain the consensus of experts regarding pharmacological treatment strategies for various phases of bipolar disorder. The review committee included 87 Korean psychiatrists and 40 child and adolescent psychiatry experts. Results: For treatment of manic episodes, a combination of a mood stabilizer (MS) and atypical antipsychotics (AAP), or monotherapy with MS or AAP were recommended as first-line treatments. Combinations of MS and AAP, or AAP and lamotrigine (LMT) were recommended as first-line treatments for depressive episodes regardless of the severity. Monotherapy with MS, AAP, or LMT were also first-line treatments for mild to moderate depressive episodes. For mixed features, a combination of MS and AAP, or monotherapy with AAP or MS were recommended as first-line treatments, and a combination of AAP and LMT, or MS and LMT were the first-line treatments for depressive mixed state. Conclusion The recommendations of the KMAP-BP 2022 have changed from the previous version, to reflect the evolution of the social culture and healthcare system in Korea and recent evidence regarding pharmacotherapy of bipolar disorder. The KMAP-BP 2022 provides clinicians with a wealth of information regarding appropriate strategies to treat patients with bipolar disorder.

Objectives: This study revised the Korean Medication Algorithm Project for Bipolar Disorder 2018 for rapid cycling. Methods: Questionnaires to survey the expert opinion of medication for rapid cycling were completed by a review committee consisting of 87 Korean expert psychiatrists. The experts’ opinions were classified into three categories based on the lowest category in which the confidence interval fell (6.5≤ for first-line, 3.5≤ for second-line, and 3.5> for third-line treatment). Results: The first-line treatments were a combination of mood stabilizers and atypical antipsychotics, atypical antipsychotics monotherapy, or mood stabilizer monotherapy. Furthermore, a mood stabilizer with lamotrigine therapy and an atypical antipsychotic with lamotrigine combinations was the first-line treatment for a depressive episode. The first-line medications in all episodes were valproate, lithium, quetiapine, olanzapine, and aripiprazole. Risperidone was the first-line medication in manic episodes and mixed states, and lamotrigine was the first-line medication for treating depressive episodes. Conclusion Compared to the surveys in 2018, the preference for atypical antipsychotics and lamotrigine has increased, and the modalities as a second-line treatment are more diversified.

Objectives: The objective of this study was to revise the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2022: children and adolescents. Methods: We performed a survey, using a questionnaire comprising 23 questions according to various situations facing children and adolescents with bipolar disorders. A total of 40 of the 60 experts in child and adolescent psychiatry responded to the survey. Results: The first-line pharmacotherapeutic strategies for manic and depressive episodes in children with bipolar disorders were a combination of mood stabilizer (MS) and atypical antipsychotics (AAP). The first-line medications selected for these children were aripiprazole (treatment of choice, TOC) and risperidone. The first-line pharmacotherapeutic strategies for manic episodes in adolescents were a combination of MS and an AAP (TOC), monotherapy with MS, and monotherapy with an AAP. Lithium, valproate, aripiprazole, risperidone, and quetiapine were selected as first-line medications for these adolescents. First-line pharmacotherapeutic strategies for depressive episodes in adolescents were a combination of MS and an AAP, monotherapy with MS, and monotherapy with an AAP. The first-line pharmacotherapeutic strategies for the depressive episodes in adolescents at high risk for bipolar disorder were a combination of MS and AAP and monotherapy with an AAP. Lithium, valproate, aripiprazole (TOC), quetiapine, and risperidone were selected as first-line medications for the treatment of depressive episodes in adolescents with bipolar disorder. Conclusion It is expected that the present KMAP-BP 2022: children and adolescents will give the direction and be usefully applied by clinicians to treat children and adolescents with bipolar disorders.

Objectives: In this study, we investigated and organized the maintenance-treatment strategies for Bipolar I and II disorders outlined in The Korean Medication Algorithm Project for Bipolar disorder 2022 (KMAP-BP 2022). Methods: The questionnaire sought to survey expert opinion on medication for bipolar disorders and was completed by a review committee consisting of 87 experienced Korean psychiatrists. It comprised 56 questions, and each question included various sub-items. The questionnaire for the maintenance treatments covered overall treatment strategies after acute mood episodes in bipolar I and II disorders, the choice of mood stabilizers and atypical antipsychotics and antidepressants, duration of medication, and treatment strategies for breakthrough symptoms. Results: In the case of bipolar I disorder, mood stabilizer monotherapy, atypical antipsychotics monotherapy, and a combination of mood stabilizers and atypical antipsychotics were selected as the first-line treatments. In maintenance management of bipolar II disorder, mood stabilizer monotherapy, atypical antipsychotics monotherapy, and combinations of mood stabilizers were selected as the preferred first-line treatments. Conclusion There has been a growing body of evidence that atypical antipsychotics have a greater preference than observed in the previous KMAP-BP of 2018. Also, monotherapy of mood stabilizers or atypical antipsychotics was more frequently selected in KMAP-BP 2022 than in the KMAP-BP 2018.

Objectives: The safety and tolerability of drugs are very important to ensure compliance and efficacy in the treatment of bipolar disorders. An expert opinion survey was conducted on treatment strategies in various special clinical situations, such as patients with significant weight gain, reporting characteristic drug side effects, low drug adherence, pregnant and reproductive women, and genetic counseling. Methods: A written survey that addressed treatment strategies related to safety and tolerability was prepared. The survey focused on significant weight gain, characteristic drug side effects, low drug adherence, treatment of pregnant and reproductive women, and genetic counseling. Eighty-seven experts in the review committee completed the survey. Results: In the case of weight gain occurring during drug treatment, it was considered preferable to replace the treatment drug with a drug that caused less weight gain, such as lamotrigine, aripiprazole, or ziprasidone. If there was a significant weight gain due to the treatment drug, it was considered preferable to intervene as soon as possible. In the case of hyperprolactinemia, it was considered preferable to change the drug. It was recommended that the drug beto discontinued in case of a benign rash as seen in patients treated with lamotrigine. For improving drug adherence, there was an increased preference for long-acting injections. It was also opined that antipsychotics should be used with great caution in pregnant or reproductive women. Conclusion Treatment strategies in various clinical situations related to the safety and tolerability of drugs for bipolar disorder have been described. It is hoped that this information would be useful in practical clinical situations.

Objectives: The present study was carried out to revise the guidelines for the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) 2018. The revision was carried out based on expert opinions to facilitate clinical decisions related to the treatment of bipolar disorders in patients with comorbid physical illnesses. Methods: A 56-item questionnaire was developed; a consensus was arrived at by 87 out of 93 experts (93.5%), on the pharmacological treatment strategies to be used in cases of comorbid physical illnesses accompanying bipolar disorders. Results: For patients with bipolar disorder exhibiting comorbid conditions, by consensus, lamotrigine, aripiprazole, and ziprasidone were recommended as the first-line strategies for metabolic syndrome; lamotrigine and aripiprazole were the recommended first-line strategies for cardiovascular problems; lithium and aripiprazole were the recommended first-line strategies for haptic problems; valproate, lamotrigine, aripiprazole, and quetiapine were the recommended first-line strategies for renal problems; and valproate and aripiprazole were the recommended first-line strategies for cerebrovascular problems or cerebral damage. Conclusion The present study is the most recent consensus among experts on recommendations for the treatment of bipolar disorders in patients with comorbid physical illnesses. Aripiprazole was recommended as the first-line pharmacotherapeutic agent in five comorbid physical conditions. This recommendation is similar to KMAP-BP 2018. Additionally, lamotrigine has been added as a first -line pharmacotherapeutic agent in patients with the metabolic syndrome, cardiovascular problems, and renal problems in the current algorithm.

Objectives: The fifth revision of the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was undertaken to provide more precise guidelines for clinicians. In this study, we evaluated treatment strategies recommended by the KMAP-BP 2022 for theelderly patients with bipolar disorder. Methods: The review committee comprised eighty-seven psychiatrists with vast clinical experience in treating bipolar disorders, who completed a survey. An expert consensus was obtained on pharmacological treatment strategies for elderly patients with bipolar disorders. The executive committee analyzed the data and discussed the results to produce the final algorithm. Results: In elderly patients with bipolar disorders, the first-line treatment option for manic episodes is monotherapy, with atypical antipsychotics or mood stabilizers, and a combination of a mood stabilizer and atypical antipsychotics. The first-line treatment option for depressive episodes was a combination of a mood stabilizer and atypical antipsychotics, monotherapy with atypical antipsychotics or a mood stabilizer or lamotrigine, and a combination of atypical antipsychotics or a mood stabilizer with lamotrigine. Conclusion In the KMAP-BP 2022, the recommendation for treatment options for elderly patients with bipolar disorder, has been newly introduced. We expect that this algorithm would provide valuable information for the treatment of elderly patients with bipolar disorder.