This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discourag - ing the use of to Vii; ry care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131(3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care uti lization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from. that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.
Health Expenditures ; Humans ; Insurance Coverage ; Insurance* ; Markov Chains ; Medical Assistance ; Outpatients ; Patient Care ; Referral and Consultation* ; Tertiary Healthcare

Aberrant DNA methylation, as an epigenetic marker of cancer, influences tumor development and progression. We downloaded publicly available DNA methylation and gene expression datasets of matched cancer and normal pairs from the Cancer Genome Atlas Data Portal and performed a systematic computational analysis. This study has three aims to screen genes that show hypermethylation and downregulated patterns in colorectal cancers, to identify differentially methylated regions in one of these genes, SFRP1, and to test whether the SFRP genes affect survival or not. Our results show that 31 hypermethylated genes had a negative correlation with gene expression. Among them, SFRP1 had a differentially methylated pattern at each methylation site. We also show that SFRP1 may be a potential biomarker for colorectal cancer survival.
Colorectal Neoplasms* ; Computer Simulation* ; Dataset ; DNA Methylation ; Epigenomics ; Gene Expression ; Genome ; Methylation ; Survival Analysis

Single-cell RNA sequencing (scRNA-seq) has been widely applied to provide insights into the cell-by-cell expression difference in a given bulk sample. Accordingly, numerous analysis methods have been developed. As it involves simultaneous analyses of many cell and genes, efficiency of the methods is crucial. The conventional cell type annotation method is laborious and subjective. Here we propose a semi-automatic method that calculates a normalized score for each cell type based on user-supplied cell type–specific marker gene list. The method was applied to a publicly available scRNA-seq data of mouse cardiac non-myocyte cell pool. Annotating the 35 t-stochastic neighbor embedding clusters into 12 cell types was straightforward, and its accuracy was evaluated by constructing co-expression network for each cell type. Gene Ontology analysis was congruent with the annotated cell type and the corollary regulatory network analysis showed upstream transcription factors that have well supported literature evidences. The source code is available as an R script upon request.

Single-cell RNA sequencing (scRNA-seq) has been widely applied to provide insights into the cell-by-cell expression difference in a given bulk sample. Accordingly, numerous analysis methods have been developed. As it involves simultaneous analyses of many cell and genes, efficiency of the methods is crucial. The conventional cell type annotation method is laborious and subjective. Here we propose a semi-automatic method that calculates a normalized score for each cell type based on user-supplied cell type–specific marker gene list. The method was applied to a publicly available scRNA-seq data of mouse cardiac non-myocyte cell pool. Annotating the 35 t-stochastic neighbor embedding clusters into 12 cell types was straightforward, and its accuracy was evaluated by constructing co-expression network for each cell type. Gene Ontology analysis was congruent with the annotated cell type and the corollary regulatory network analysis showed upstream transcription factors that have well supported literature evidences. The source code is available as an R script upon request.

Background: Concern regarding physical and mental burden of young carers is increasing. This study aimed to determine the physical, mental, and social difficulties of young adults living with dementia patients. Methods: The analysis was based on the 2019 community health survey of Korea. Adults under 30 years living with dementia patients were compared with those having a dementia family member, but not living with them. Suspected difficulties were analyzed using multivariate logistic regression. Results: Objective short sleep duration (OSSD) was higher in those living with dementia patients (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.12–2.40). There was no significant difference in lack of physical activity between the two groups for men, however, for women, lack of physical activity was higher in those living with dementia patients (OR, 2.23; 95% CI, 1.31–3.68). Social activity was slightly lower among those living with dementia patients compared to those not living with dementia patients, with borderline significance (OR, 0.75; 95% CI, 0.55–1.02). Conclusion Results suggest that young carers may have certain difficulties such as OSSD, and lack of physical activity. Further studies are required to specify young carer’s physical, mental, and social profile to provide proper support for them.

Background: Concern regarding physical and mental burden of young carers is increasing. This study aimed to determine the physical, mental, and social difficulties of young adults living with dementia patients. Methods: The analysis was based on the 2019 community health survey of Korea. Adults under 30 years living with dementia patients were compared with those having a dementia family member, but not living with them. Suspected difficulties were analyzed using multivariate logistic regression. Results: Objective short sleep duration (OSSD) was higher in those living with dementia patients (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.12–2.40). There was no significant difference in lack of physical activity between the two groups for men, however, for women, lack of physical activity was higher in those living with dementia patients (OR, 2.23; 95% CI, 1.31–3.68). Social activity was slightly lower among those living with dementia patients compared to those not living with dementia patients, with borderline significance (OR, 0.75; 95% CI, 0.55–1.02). Conclusion Results suggest that young carers may have certain difficulties such as OSSD, and lack of physical activity. Further studies are required to specify young carer’s physical, mental, and social profile to provide proper support for them.

Background: Concern regarding physical and mental burden of young carers is increasing. This study aimed to determine the physical, mental, and social difficulties of young adults living with dementia patients. Methods: The analysis was based on the 2019 community health survey of Korea. Adults under 30 years living with dementia patients were compared with those having a dementia family member, but not living with them. Suspected difficulties were analyzed using multivariate logistic regression. Results: Objective short sleep duration (OSSD) was higher in those living with dementia patients (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.12–2.40). There was no significant difference in lack of physical activity between the two groups for men, however, for women, lack of physical activity was higher in those living with dementia patients (OR, 2.23; 95% CI, 1.31–3.68). Social activity was slightly lower among those living with dementia patients compared to those not living with dementia patients, with borderline significance (OR, 0.75; 95% CI, 0.55–1.02). Conclusion Results suggest that young carers may have certain difficulties such as OSSD, and lack of physical activity. Further studies are required to specify young carer’s physical, mental, and social profile to provide proper support for them.

Background: Concern regarding physical and mental burden of young carers is increasing. This study aimed to determine the physical, mental, and social difficulties of young adults living with dementia patients. Methods: The analysis was based on the 2019 community health survey of Korea. Adults under 30 years living with dementia patients were compared with those having a dementia family member, but not living with them. Suspected difficulties were analyzed using multivariate logistic regression. Results: Objective short sleep duration (OSSD) was higher in those living with dementia patients (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.12–2.40). There was no significant difference in lack of physical activity between the two groups for men, however, for women, lack of physical activity was higher in those living with dementia patients (OR, 2.23; 95% CI, 1.31–3.68). Social activity was slightly lower among those living with dementia patients compared to those not living with dementia patients, with borderline significance (OR, 0.75; 95% CI, 0.55–1.02). Conclusion Results suggest that young carers may have certain difficulties such as OSSD, and lack of physical activity. Further studies are required to specify young carer’s physical, mental, and social profile to provide proper support for them.

No abstract available.

No abstract available.