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Background There is debate about ultrasonography screening for thyroid cancer and its cost-effectiveness. This study aimed to evaluate the cost-effectiveness of early screening (ES) versus symptomatic detection (SD) for differentiated thyroid cancer (DTC) in Korea. Methods A Markov decision analysis model was constructed to compare the cost-effectiveness of ES and SD. The model considered direct medical costs, health outcomes, and different diagnostic and treatment pathways. Input data were derived from literature and Korean population studies. Incremental cost-effectiveness ratio (ICER) was calculated. Willingness-to-pay (WTP) threshold was set at USD 100,000 or 20,000 per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted to address uncertainties of the model’s variables. Results In a base case scenario with 50 years of follow-up, ES was found to be cost-effective compared to SD, with an ICER of $2,852 per QALY. With WTP set at $100,000, in the case with follow-up less than 10 years, the SD was cost-effective. Sensitivity analysis showed that variables such as lobectomy probability, age, mortality, and utility scores significantly influenced the ICER. Despite variations in costs and other factors, all ICER values remained below the WTP threshold. Conclusion Findings of this study indicate that ES is a cost-effective strategy for DTC screening in the Korean medical system. Early detection and subsequent lobectomy contribute to the cost-effectiveness of ES, while SD at an advanced stage makes ES more cost-effective. Expected follow-up duration should be considered to determine an optimal strategy for DTC screening.

In this study, a Delphi survey was conducted to generate the framework of a mathematics competency, called Attitude and Practice. Sixteen participants in the two consecutive rounds of the Delphi survey included mathematics education expert in student affect or educational psychology, and in-service mathematics teachers with a master’s degree or higher. We first established the definition of Attitude and Practice and identified their components while securing validity evidence from the Delphi survey results. Attitude and Practice are the competency to engage in mathematical activities with the joy and passion of doing mathematics as an individual or a group. Next, we characterized the components of Attitude and Practice as follows: (1) pleasure of learning mathematics, including interest, self-efficacy, and meta-affect (2) passion for mathematics including perseverance and seeking challenges, (3) doing mathematics together, including resolving conflicts and motivation for collaboration, and (4) global citizenship and enjoying mathematics culture. We defined and validated the specific components with the literature review and the Delphi survey responses. The results of this study will serve as a foundation of research to develop scenario-based assessments for students’ attitudes and practices. Furthermore, the framework established in this study can provide insights into the evaluation of mathematics competency of Attitude and Practice regarding Korean mathematics educators who have experienced difficulties in defining and assessing Attitude and Practice.

Purpose: Spirituality is an important domain and is related with physical and psychological symptoms in terminal cancer patient. The aim of this study is to examine how patients' spirituality is associated with their physical and psychological symptoms as it has been explored by few studies. Methods: In this cross sectional study, 50 patients in the palliative ward of a tertiary hospital were interviewed. Spiritual well-being, depression, anxiety and pain is measured by Functional Assessment of Chronic-Illness Therapy-Spirituality (FACIT-Sp), hospital anxiety and depression scale (HADS) and the Korean version of the Brief Pain Inventory (BPI-K). The correlations between patients' spiritual well-being and anxiety, depression and pain were analysed. The association between spiritual well-being and age, gender, palliative performance scale (PPS), religion, mean pain intensity, anxiety, depression were assessed by univariate and multivariate regression analyses. Results: Spiritual well-being was negatively correlated with the mean pain intensity (r=-0.283, P<0.05), anxiety (r=-0.613, P<0.05) and depression (r=-0.526, P<0.05). In multivariate regression analysis, spiritual well-being showed negative association with anxiety (OR=-1.03, 95% CI=-1.657∼-0.403, P=0.002) and positive association with the existence of religion (OR=9.193, 95% CI=4.158∼14.229, P<0.001). Conclusion: In this study, patients' anxiety and existence of religion were significantly associated with spiritual well-being after adjusting age, gender, PPS, mean pain intensity, depression. Prospective studies are warranted. [ABSTRACT FROM AUTHOR]