In an era of low fertility, the maternity infrastructure system has collapsed steeply and the number of obstetrically underserved areas has increased. To improve the maternity infrastructure, the Yoon Suk Yeol administration has announced the introduction of an essential medical support policy centered on introducing an additional delivery medical fee. The core of the essential medical policy for labor and delivery is the addition of regional medical fees, safety policy additional fees, and infectious disease-controll policy additional fees to the existing labor and delivery medical fees. The government's delivery medical additional fees will vary according region, with 200% increase in metropolitan cities, 300% increase in nonmetropolitan cities, and an additional 100% increase in the event of an infectious disease outbreak. After analyzing the government's plan to support additional fees, it is estimated that the total delivery expenses will be increased by Korean won (KRW) 236,619,748,266, and KRW 485,872,173 per maternity hospital. Even though this support plan is expected to help maintain maternity hospitals, this plan has limitations in small maternity hospitals in metropolitan cities and maternity hospitals for high-risk pregnant women. This is because the government's support policy is based on the "medical payment system by action," which is less effective in rural maternity hospitals with fewer deliveries and in training hospitals that mainly treat high-risk pregnant women rather than simple deliveries. Additionally, given the expected decline in the number of births in the future, it is estimated that the total delivery medical fees will steadily decline, as will the income per maternity hospital. To maintain a sustainable maternity infrastructure, it is essential to introduce the medical fees for operating a maternity delivery room that can be maintained, the medical fees for high-risk pregnancies, and various salary and protection support policies for obstetricians and nurses in addition to delivery medical fees.

Background: This study evaluated the relationship between guideline adherence for heart failure (HF) with reduced ejection fraction (HFrEF) at discharge and relevant clinical outcomes in patients with acute HF with preserved ejection fraction (HFpEF) with or without atrial fibrillation (AF). Methods: We analyzed Korean Acute Heart Failure Registry data for 707 patients with HFpEF with documented AF and 687 without AF. Guideline adherence was defined as good or poor according to the prescription of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and mineralocorticoid receptor antagonists. Anticoagulation adherence was also incorporated for the AF group. Results: Among patients with normal sinus rhythm, those with poor guideline adherence had a reduced prevalence of comorbidities and favorable clinical characteristics when compared with those with good guideline adherence. Using inverse probability of treatment weighting (IPTW) to address the bias of nonrandom treatment assignment, good adherence was associated with a poor 60-day composite endpoint in the multivariable Cox model (weighted hazard ratio [wHR], 1.74; 95% confidence interval [CI], 1.01–3.00; P = 0.045). For patients with AF, baseline clinical characteristics were similar according to the degree of adherence. The IPTW-adjusted analysis indicated that good adherence was significantly associated with the 60-day composite endpoint (wHR, 0.47; 95% CI, 0.27–0.79; P = 0.005). In the analysis excluding warfarin, good adherence was associated with 60-day rehospitalization (wHR, 0.60; 95% CI, 0.37–0.98; P = 0.040), 1-year re-hospitalization (wHR, 0.67; 95% CI, 0.48–0.93; P = 0.018), and the composite endpoint (wHR, 0.77; 95% CI, 0.59–0.99; P = 0.041). Conclusion Our findings indicate that good adherence to guidelines for HFrEF is associated with a better 60-day composite endpoint in patients with HFpEF with AF.

Background: This study evaluated the relationship between guideline adherence for heart failure (HF) with reduced ejection fraction (HFrEF) at discharge and relevant clinical outcomes in patients with acute HF with preserved ejection fraction (HFpEF) with or without atrial fibrillation (AF). Methods: We analyzed Korean Acute Heart Failure Registry data for 707 patients with HFpEF with documented AF and 687 without AF. Guideline adherence was defined as good or poor according to the prescription of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and mineralocorticoid receptor antagonists. Anticoagulation adherence was also incorporated for the AF group. Results: Among patients with normal sinus rhythm, those with poor guideline adherence had a reduced prevalence of comorbidities and favorable clinical characteristics when compared with those with good guideline adherence. Using inverse probability of treatment weighting (IPTW) to address the bias of nonrandom treatment assignment, good adherence was associated with a poor 60-day composite endpoint in the multivariable Cox model (weighted hazard ratio [wHR], 1.74; 95% confidence interval [CI], 1.01–3.00; P = 0.045). For patients with AF, baseline clinical characteristics were similar according to the degree of adherence. The IPTW-adjusted analysis indicated that good adherence was significantly associated with the 60-day composite endpoint (wHR, 0.47; 95% CI, 0.27–0.79; P = 0.005). In the analysis excluding warfarin, good adherence was associated with 60-day rehospitalization (wHR, 0.60; 95% CI, 0.37–0.98; P = 0.040), 1-year re-hospitalization (wHR, 0.67; 95% CI, 0.48–0.93; P = 0.018), and the composite endpoint (wHR, 0.77; 95% CI, 0.59–0.99; P = 0.041). Conclusion Our findings indicate that good adherence to guidelines for HFrEF is associated with a better 60-day composite endpoint in patients with HFpEF with AF.

BACKGROUND: Cardiovascular risk remains increased despite optimal low density lipoprotein cholesterol (LDL-C) level induced by intensive statin therapy. Therefore, recent guidelines recommend non-high density lipoprotein cholesterol (non-HDL-C) as a secondary target for preventing cardiovascular events. The aim of this study was to assess the efficacy and tolerability of omega-3 fatty acids (OM3-FAs) in combination with atorvastatin compared to atorvastatin alone in patients with mixed dyslipidemia. METHODS: This randomized, double-blind, placebo-controlled, parallel-group, and phase III multicenter study included adults with fasting triglyceride (TG) levels ≥200 and <500 mg/dL and LDL-C levels <110 mg/dL. Eligible subjects were randomized to ATOMEGA (OM3-FAs 4,000 mg plus atorvastatin calcium 20 mg) or atorvastatin 20 mg plus placebo groups. The primary efficacy endpoints were the percent changes in TG and non-HDL-C levels from baseline at the end of treatment. RESULTS: After 8 weeks of treatment, the percent changes from baseline in TG (−29.8% vs. 3.6%, P<0.001) and non-HDL-C (−10.1% vs. 4.9%, P<0.001) levels were significantly greater in the ATOMEGA group (n=97) than in the atorvastatin group (n=103). Moreover, the proportion of total subjects reaching TG target of <200 mg/dL in the ATOMEGA group was significantly higher than that in the atorvastatin group (62.9% vs. 22.3%, P<0.001). The incidence of adverse events did not differ between the two groups. CONCLUSION The addition of OM3-FAs to atorvastatin improved TG and non-HDL-C levels to a significant extent compared to atorvastatin alone in subjects with residual hypertriglyceridemia.

PURPOSE: Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking. METHODS: Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients' demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected. RESULTS: A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m2. The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; “micronutrient and vitamin deficiency” (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay. CONCLUSION: NT may induce or be associated with several complications, and some of them may seriously affect the patient's outcome. NST personnel in each hospital should be aware of each problem during nutritional support.
Adult ; Body Mass Index ; Demography ; Diarrhea ; Enteral Nutrition ; Hospitalization ; Humans ; Hyperammonemia ; Intensive Care Units ; Korea ; Length of Stay ; Multicenter Studies as Topic ; Nutrition Therapy ; Nutritional Support ; Parenteral Nutrition ; Referral and Consultation ; Retrospective Studies ; Vitamins

No abstract available.
Colitis, Ulcerative* ; Infliximab* ; Ulcer* ; Vitiligo*

No abstract available.
Bacterial Infections* ; Occupational Diseases*

Exophiala species are dark pigmented fungi associated with phaeohyphomycosis that exhibit yeast-like or hyphal forms of the fungus in superficial subcutaneous locations or systemic disease. The incidence of subcutaneous tissue infection of Exophiala species has recently increased, particularly in immunocompromised hosts. In Korea, E. jeanselmei, E. dermatitidis, and E. salmonis were isolated from patients with phaeohyphomycosis. However, there have been no case reports of phaeohyphomycosis caused by E. oligosperma. Here we report the first case of phaeohyphomycosis caused by E. oligosperma in Korea. An 82-year-old female with competent immune function presented with multiple subcutaneous masses on the dorsum of the left hand and wrist. A histopathological examination of the skin specimen revealed granulomatous inflammation with fungal hyphae and yeast. Molecular identification was performed using internal transcribed spacer sequences analysis. The sequence showed 100% identity with the E. oligosperma strains. She was treated with oral itraconazole and showed improvement.
Aged, 80 and over ; Exophiala* ; Female ; Fungi ; Hand ; Humans ; Hyphae ; Immunocompromised Host ; Incidence ; Inflammation ; Itraconazole ; Korea ; Phaeohyphomycosis* ; Skin ; Subcutaneous Tissue ; Wrist ; Yeasts

PURPOSE: To construct new Korean reference curves for birth weight by sex and gestational age using contemporary Korean birth weight data and to compare them with the Lubchenco and the 2010 United States (US) intrauterine growth curves. METHODS: Data of 2,336,727 newborns by the Korean Statistical Information Service (2008-2012) were used. Smoothed percentile curves were created by the Lambda Mu Sigma method using subsample of singleton. The new Korean reference curves were compared with the Lubchenco and the 2010 US intrauterine growth curves. RESULTS: Reference of the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles birth weight by gestational age were made using 2,249,804 (male, 1,159,070) singleton newborns with gestational age 23-43 weeks. Separate birth weight curves were constructed for male and female. The Korean reference curves are similar to the 2010 US intrauterine growth curves. However, the cutoff values for small for gestational age (<10th percentile) of the new Korean curves differed from those of the Lubchenco curves for each gestational age. The Lubchenco curves underestimated the percentage of infants who were born small for gestational age. CONCLUSION: The new Korean reference curves for birth weight show a different pattern from the Lubchenco curves, which were made from white neonates more than 60 years ago. Further research on short-term and long-term health outcomes of small for gestational age babies based on the new Korean reference data is needed.
Asian Continental Ancestry Group ; Birth Weight* ; Female ; Gestational Age* ; Growth Charts ; Humans ; Infant ; Infant, Newborn ; Information Services* ; Male ; United States

BACKGROUND: Atherosclerotic plaques in the carotid artery have been considered a potential source of cerebrovas- cular events. Carotid plaques are associated with an increased risk of ischemic stroke. We performed this study to evaluate the relationship between atherosclerotic carotid plaques and cardiac function measured by echocardiography in elderly patients with ischemic stroke. METHODS: A total of 415 patients aged >60 yrs with acute ischemic stroke were divided into two groups according to the presence(groups I, n=195, 140 males) or absence(group II, n=220, 112 males) of carotid plaques. We evaluated the asso ciation of the presence of plaques with age, sex, potential vascular risk factors, other carotid images, and cardiac function by echocardiography. RESULTS: Of the 415 patients, carotid plaques were found in 195 cases. Mean plaque size was 2.44+/-0.7mm on the right side and 2.32+/-0.75mm on the left. Plaques were located more frequently in the carotid bulb(68%) than in the common carotid artery(32%). 57% were calcified plaques and 72%, multiple plaques. Group I(with carotid plaques) had a significantly higher percentage of males(73.6%, p<0.001), hypertension(68.5%, p=0.043), diabetes(28.7%, p=0.029), and dyslipidemia(60.1%, p=0.008). In addition, group I had thicker carotid IMT than group II(Right: 0.86 vs. 0.70mm, p<0.001, Left: 0.90 vs. 0.73mm, p<0.001), lower common carotid artery end diastolic flow velocity(Right: 13.37 vs. 15.73m/s, p=0.002, Left: 14.46 vs.17.24m/s, p=0.004), and higher E/E'level(11.57 vs. 9.36, p=0.001). Old age, dyslipidemia, and diastolic dysfunction were independently associated with carotid plaques. CONCLUSION: Our results indicated that old age, male gender, diabetes, hypertension, and dyslipidemia are more com- mon in patients with carotid plaques than in those without. Old age, male gender, dyslipidemia, and diastolic dysfunc- tion are independent risk factors of carotid plaques in elderly patients with ischemic stroke. We further concluded that though left ventricle systolic function is not associated with carotid plaques in elderly patients with ischemic stroke, left ventricle diastolic dysfunction is.
Aged ; Carotid Arteries ; Carotid Artery, Common ; Dyslipidemias ; Echocardiography ; Heart Ventricles ; Humans ; Hypertension ; Male ; Plaque, Atherosclerotic ; Risk Factors ; Stroke