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The study investigates whether differences in metalinguistic information contained in written corrective feedback (CF) mediate its effectiveness for second language (L2) development. To address this, metalinguistic CF was distinguished into three types in terms of how specific its metalinguistic information was. They were then compared among themselves and with non-metalinguistic direct CF in their efficacy for short-and long-term development of explicit and implicit L2 knowledge. The target features for written CF were the English articles, and explicit and implicit knowledge were measured by the error correction test and dictogloss writings by 93 EFL learners respectively. The results suggest that, for both explicit and implicit L2 knowledge, metalinguistic CF was beneficial for short-term development only when it had high levels of specific information while it was effective for long-term development regardless of its type. The findings are discussed from the perspective of SLA theory, and their pedagogical implications and suggestions for future research are put forth.

Simple Summary: This research investigates the effects of South Korea's national insurance coverage (NIC) expansion and the inclusion of genetic counselors on BRCA1/2 mutation testing rates in breast cancer patients. By analyzing data from the Samsung Medical Center, the study reveals a notable increase in testing rates following NIC expansion and the addition of genetic counselors. Particularly noteworthy is the rise in testing rates among triple-negative breast cancer (TNBC) patients under 60. Additionally, the involvement of genetic counselors led to a significant increase in follow-up patients undergoing testing. The NIC expansion also broadened insurance coverage for TNBC patients, thereby enhancing testing accessibility. These findings underscore the positive impact of NIC expansion and genetic counselor involvement on improving patient management. Addressing financial barriers to testing and integrating genetic counseling into healthcare practices present promising strategies for advancing early detection and tailored treatment approaches, thereby contributing to global efforts in cancer care and management. Purpose: This study aims to evaluate the impact of South Korea's national insurance coverage (NIC) expansion and the addition of genetic counselors on BRCA1/2 mutation testing rates in breast cancer patients. Materials and Methods: A retrospective review was conducted at the Samsung Medical Center (SMC), dividing patients into three groups: pre-NIC expansion, post-NIC expansion, and post-extra genetic counselor involvement. The number of BRCA1/2 tests performed and the detection rates among newly diagnosed and follow-up patients, particularly focusing on triple-negative breast cancer (TNBC) cases, were analyzed. Results: Post-NIC expansion, there was a significant increase in BRCA1/2 testing rates, with a gradual rise in detection rates while maintaining statistical significance. TNBC patients under 60 experienced substantial increases in testing rates. The number of follow-up patients recalled for testing also rose significantly after the extra genetic counselor involvement. Additionally, NIC expansion increased insurance coverage for TNBC patients, enhancing accessibility to testing. Conclusion: The study highlights the positive impact of NIC expansion and genetic counselor involvement on BRCA1/2 mutation testing rates and subsequent patient management. Addressing financial barriers to testing and incorporating genetic counseling significantly improve patient outcomes. This model provides a potential strategy for enhancing early detection and personalized treatment for breast cancer patients with BRCA1/2 mutations, contributing to global cancer management efforts. [ABSTRACT FROM AUTHOR]

Background: Among the older adults, hearing impairment is a common problem and may contribute to dementia. Objective: Therefore, we aimed to examine the association between hearing impairment and the risk of dementia among older adults in South Korea. Methods: Using the Korean National Health Insurance Service-Senior Cohort from 2005 to 2019, we collected data of 44,728 patients. Hearing impairment was determined using the national disability registry. Propensity score matching (1:1) was performed to match patients with and without hearing impairment (case: 22,364, control: 22,364). A Cox proportional hazards regression model was built to analyze the association between hearing impairment and dementia. Results: Patients with hearing impairment had a higher risk of dementia than those without hearing impairment (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.23–1.34). Assessing the degree of disability, both severe (HR = 1.25, 95% CI = 1.16–1.35) and mild conditions (HR = 1.29, 95% CI = 1.23–1.35) had an increased risk of dementia, respectively. Conclusions: Older patients with hearing impairment exhibit an increased risk of dementia, thereby warranting a new approach to dementia care among these patients regardless of the degree of hearing impairment. [ABSTRACT FROM AUTHOR]

Frailty has become increasingly relevant in a rapidly aging society, highlighting the need for its accurate identification and exploring associated clinical outcomes. Using a multidimensional framework to estimate frailty in a sample of community dwelling older adults, its effect on mortality, incurred healthcare costs and utilization were investigated. We obtained data from the 2008–2018 Korean Longitudinal Study of Aging (KLoSA). After excluding individuals aged < 65 years and those with missing data, a total of 3578 participants were included in our study. Cox proportional hazard analysis was conducted to investigate the impact of frailty on all-cause mortality by generating hazard ratios (HRs) and population attributable risks (PARs). Healthcare utilization and out-of-pocket costs incurred by frailty were examined using the Generalized Linear Mixed Model (GLMM). Subgroup analyses were conducted according to frailty components. Among 3578 older adults, 1052 individuals died during a 10-year follow up period. Compared to the low risk frailty group, the moderate risk group (HR: 1.52, 95% CI:1.37–1.69) and severe risk group (HR: 3.10, 95% CI: 2.55–3.77) had higher risks for all-cause mortality. 27.4% (95% CI: 19.0–35.3%) of all-cause mortality was attributable to frailty, and the PARs ranged from 0.5 to 22.6% for individual frailty components. Increasing frailty levels incurred higher total healthcare costs and cost per utilization, including inpatient and outpatient costs. Frailty also increased likelihood of inpatient use, longer length of stay and more frequent outpatient visits. Among the frailty components, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) in particular were linked to elevated mortality, higher incurred healthcare costs and utilization. Frailty-tailored interventions are of utmost relevance to policy makers and primary caregivers as frailty threatens the ability to maintain independent living and increases risk of detrimental outcomes such as mortality and increased utilization and out-of-pocket costs of healthcare in older adults. [ABSTRACT FROM AUTHOR]

Purpose: To develop an ethical and cultural infrastructure for Life-Sustaining Treatment (LST) plan, it is crucial to carefully analyze its impact and ensure that healthcare utilization is maintained at an appropriate level, avoiding excessive medical interventions. This study aims to investigate the effects of LST decisions on both healthcare expenditure and utilization. Methods: This cohort study utilized claims data from the National Health Insurance Service, encompassing all medical claims in South Korea. We included individuals who had planned to withdraw or withhold their LST between January and December 2018, identified by claim code IA71, IA72, IA73. We followed a total of 28,295 participants with documented LST plan who were deceased by June 2020. Participants were categorized into LST withdrawal / withholding and LST continuation groups. The dependent variables were healthcare expenditure and utilization. We construct a generalized linear model to analyze the association between these variables. Results: Out of the 28,295 participants, 24,436 (86.4%) chose to withdraw or withhold LST, while the rest opted for its continuation. Compared to the LST continuation group, those who chose to withdraw or withhold LST had 0.91 times lower odds for total cost. Additionally, they experienced 0.91 times fewer hospitalization days and 0.92 times fewer outpatient visits than those in the LST continuation group. Conclusion: Healthcare expenditure and utilization deceased among those choosing to withdraw or withhold LST compared to those continuing it. These findings underscore the significance of patients actively participating in decision regarding their treatment to ensure appropriate levels of medical intervention for LST. Furthermore, they emphasize the critical role of proper education and the establishment of a cultural framework for LST plans. [ABSTRACT FROM AUTHOR]

Background: The number of industrially injured workers (IIW) is increasing in Korea. However, little research has been conducted on whether first aid is performed at industrial sites or on the association between first aid for industrial injuries and the prognosis of IIW, including healthcare utilization. Methods: A total of 3,092 participants (2,562 males and 530 females) were analyzed during the 4-year study period, which contributed to 11,167 observations. Healthcare utilization was evaluated based on the number of outpatient visits, hospitalizations, and duration of hospitalization using a generalized estimating equation Poisson regression. Several time-varying socioeconomic characteristics and information about the injury were adjusted, and transfer time to the medical institutions was also considered. Results: During 4-year after the termination of medical treatment, participants who had not receive first aid visited outpatient clinics 15.243 times per year, and those who had visited 13.928 times per year, which is 16.16% less (adjusted relative risk [aRR]: 0.838, 95% CI = 0.740–0.950). Participants who had received on-site first aid with less than a 0.5-hour transfer time to the medical institutions visited outpatient clinics 14.87% less per year than those who had not received first aid (aRR: 0.851, 95% CI = 0.750–0.966). Conclusion: To reduce the long-term outpatient utilization rate for IIW after medical treatment, on-site first aid must be provided in a timely manner. Employee education and first aid training are also necessary. [ABSTRACT FROM AUTHOR]

Although faith-based programs are present in most prisons for offender rehabilitation, the effect of religion on prison inmates remains an understudied topic. In addition, existing research shows mixed results about the religious effect. The present study intends to not only advance the understanding of inmate's prison misconduct but also examine whether religion is likely to contribute to reducing the risk of misconduct using a non-Western sample of inmates. To assess the relationship between inmates' religion and prison misconduct, we applied negative binomial regression to analyze survey data from 986 Korean adult male inmates. Results showed that inmates who had a religious affiliation with Catholicism or Buddhism were less likely to report prison misconduct than those who had no religion. In addition, the inverse relationship was observed whether inmates had participated in religion before incarceration or came to participate in religion while incarcerated, depending on religious denomination. [ABSTRACT FROM AUTHOR]

Background: Whether infertility treatment predicts severe maternal morbidity in both singleton and twin pregnancies is controversial. We conducted this nationwide population-based cohort study to compare pregnancies conceived through assisted reproductive technology treatments, such as intrauterine insemination or in vitro fertilization, with unassisted pregnancies. Methods: This study included 269,930 women who experienced childbirth in 2018, using data of the National Health Insurance Service National Delivery Cohort in Korea. The primary outcome was assessed using a severe maternal morbidity algorithm developed by the Centers for Disease Control and Prevention in the United States. A modified Poisson regression was used to estimate the adjusted risk ratio of severe maternal morbidity. Results: Severe maternal morbidity occurred in 6,333 (2.3%) of 280,612 deliveries investigated. The risk of severe maternal morbidity was approximately 1.5-fold higher among women who received in vitro fertilization (risk ratio: 1.51, 95% confidence interval: 1.36–1.68) than among fertile women. However, no significant association between intrauterine insemination and maternal morbidity was identified. Via subgroup analysis, in vitro fertilization increased the risk of severe maternal morbidity by 1.6- and 1.3-fold in singleton and multiple births, respectively (singleton: risk ratio: 1.62, 95% confidence interval: 1.43–1.83; multiple birth: risk ratio: 1.31, 95% confidence interval: 1.07–1.60). Conclusions: This study suggested that in vitro fertilization was associated with the risk of severe maternal morbidity in both singleton and multiple births. Further research should identify patient- and treatment-specific factors that may mitigate or prevent adverse maternal health risks. [ABSTRACT FROM AUTHOR]

Background: The gap in treatment and health outcomes after diagnosis of pancreatic cancer is a major public health concern. We aimed to investigate the differences in the health outcomes and treatment of pancreatic cancer patients in healthcare vulnerable and non-vulnerable areas.Methods: This retrospective cohort study evaluated data from the Korea National Health Insurance Corporation-National Sample Cohort from 2002 to 2019. The position value for relative comparison index was used to define healthcare vulnerable areas. Cox proportional hazard regression was used to estimate the risk of mortality in pancreatic cancer patients according to healthcare vulnerable areas, and multiple logistic regression was used to estimate the difference in treatment.Results: Among 1,975 patients, 279 (14.1%) and 1,696 (85.9%) lived in the healthcare vulnerable and non-vulnerable areas, respectively. Compared with the non-vulnerable area, pancreatic cancer patients in the vulnerable area had a higher risk of death at 3 months (hazard ratio [HR]: 1.33, 95% confidence interval [CI] = 1.06-1.67) and 6 months (HR: 1.23, 95% CI = 1.03-1.48). In addition, patients with pancreatic cancer in the vulnerable area were less likely to receive treatment than patients in the non-vulnerable area (odds ratio [OR]: 0.70, 95% CI = 0.52-0.94). This trend was further emphasized for chemotherapy (OR: 0.68, 95% CI = 0.48-0.95).Conclusion: Patients with pancreatic cancer belonging to medically disadvantaged areas receive less treatment and have a higher risk of death. This may be a result of the late diagnosis of pancreatic cancer among these patients. [ABSTRACT FROM AUTHOR]

Background: Studies investigating the association between migraine and dementia have reported inconsistent findings. This study aimed to evaluate whether patients with migraine have an increased risk of dementia compared to individuals without migraine. Methods: We obtained data from the 2002–2019 Korean National Health Insurance Health Screening Cohort. Non-migraine controls were selected using a 1:1 risk-set matching with a time-dependent propensity score. The main outcome was the development of all-cause dementia, and the secondary outcome was the development of each cause of dementia (Alzheimer's, vascular, mixed or other specified, and unspecified dementia). The incidence rate of dementia was calculated using Poisson regression, and the association between migraine and dementia was evaluated using Cox proportional hazards regression. Results: Among 88,390 participants, 66.1% were female, and the mean baseline age was 55.3 ± 9.4 years. During the study period, dementia cases were identified in 4,800 of the 44,195 patients with migraine and 3,757 of the 44,915 matched controls. The incidence rate of dementia was 139.6 (95% confidence interval [CI], 135.7–143.5) and 107.7 (95% CI, 104.3–111.1) cases per 10,000 person-years in patients with migraine and matched controls, respectively. Patients with migraine had a 1.30 (hazard ratio [HR], 1.30; 95% CI, 1.25–1.35), 1.29 (HR, 1.29; 95% CI, 1.23–1.35), 1.35 (HR, 1.35; 95% CI, 1.19–1.54), 1.36 (HR, 1.36; 95% CI, 1.00–1.83), and 1.30 (HR, 1.30; 95% CI, 1.17–1.45) times higher risk of developing all-cause dementia, Alzheimer's dementia, vascular dementia, mixed or other specified dementias, and unspecified dementia than their matched controls, respectively. Conclusion: Our results suggest that migraine is associated with an increased risk of subsequent dementia. Further research is warranted to confirm these findings and to reveal the underlying mechanisms. [ABSTRACT FROM AUTHOR]

This study aimed to examine the association between lifestyle factors and metabolic syndrome risk in South Korean adults. Korea National Health and Nutrition Examination Survey 2016–2018 data were used. The study included 6,995 subjects (2835 male; 4,160 female). Multiple logistic regression was used to estimate the relationship between the lifestyle factors, including sedentary time, sleep duration, alcohol consumption, smoking status, and dietary intake. Metabolic syndrome prevalence in healthy adults was 25.6% and 12.4% in men and women, respectively. Male with over four lifestyle risk factors had a higher OR for metabolic syndrome risk (over four lifestyle factors: OR 1.97, CI 1.18–3.27). Female with more than one lifestyle risk factor had a higher OR for metabolic syndrome risk (one lifestyle factor: OR 1.58, CI 1.10–2.28; two lifestyle factors: OR 2.08, CI 1.39–3.11; three lifestyle factors: OR 1.94, CI 1.20–3.13). In particular, female with more lifestyle factors had increased likelihood of abdominal obesity, hypertension, and high triglycerides. Male with more lifestyle factors had increased likelihood of high triglycerides. Sedentary time was significantly associated with increased metabolic syndrome in male and female. This study found a significant association between the number of lifestyle risk factors and the risk of metabolic syndrome in Korean adults. The greater the number of lifestyle risk factors, the higher the risk of metabolic syndrome in both sexes. People with a greater number of poor lifestyle behaviors tended to exhibit increased likelihood of especially elevated triglyceride levels. [ABSTRACT FROM AUTHOR]

Introduction: In South Korea, to improve the quality of medical services provided to stroke patients, stroke quality assessments have been implemented since 2006. To further promote improvement of care, financial incentives were introduced since 2012. This study aims to examine the association between stroke quality assessments and mortality within 30 days among South Korean adults who underwent hemorrhagic stroke surgeries to provide evidence of the importance of such assessments. Methods: Data from 45,741 patients from 374 healthcare organizations, derived from the 2013–2016 claims data of the Korean Health Insurance Review and Assessment Service, were examined. To ensure homogeneity, only patients who underwent hemorrhagic stroke surgeries were selected. Healthcare organizations were classified based on whether stroke quality assessments were conducted. The dependent variable of this study was death within 30 days of hospitalization. A generalized linear mixed model was constructed to analyze the association between variables. Results: Healthcare organizations without stroke quality assessments exhibited a higher risk of mortality than those that did (adjusted odds ratio [OR] = 1.53, 95% confidence interval [CI] = 1.16–2.01). Among healthcare organizations with the lowest volume, those without stroke quality assessments had a higher risk of mortality than those that did (tertile 1 [low], adjusted OR = 1.38, 95% CI = 1.04–1.84). Among rural healthcare organizations, those without assessments had a higher risk of mortality than did those that did (adjusted OR = 1.61, 95% CI = 1.06–2.43). Conclusions: The study identified a significant relationship between stroke quality assessments and 30-day mortality. Healthcare organizations without stroke quality assessments may exhibit a comparatively higher risk of mortality. Future interventions to minimize mortality and provide evidence for policymakers and healthcare leaders could involve expanding the scope of stroke quality assessment. [ABSTRACT FROM AUTHOR]

Background: Although occupational exposure to noise and vibration is common, its effect on psychological wellbeing is poorly understood. This study investigated the relationship between occupational exposure to noise and vibration and anxiety among Korean workers. Methods: Data from the 5th Korean Working Conditions Survey, conducted in 2017, were used. Participants were classified into four groups according to their level of exposure, and anxiety was assessed using a self-report questionnaire. Logistic regression analysis was used to examine the significance of the association between exposure and anxiety. Results: Overall, 45,241 participants were enrolled in this study. The likelihood of anxiety increased, in both males and females, when exposed to both occupational noise and vibration (males: odds ratio (OR) = 2.25, confidence interval [CI] = 1.77–2.87; females: OR = 2.17, CI = 1.79–2.61). The association between the varying degrees of noise, vibration, and combined exposure showed a dose–response relationship among males. Conclusions: This study revealed that occupational noise and vibration exposure is associated with anxiety. These results suggest that more detailed regulations regarding occupational noise and vibration should be developed and implemented to ensure a safer environment for workers. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to examine the association of conventional cigarette smoking and electronic cigarette vaping with periodontal disease in South Korean adults.Methods: For this study, data from 13,551 participants, a subset derived from the Korean National Health and Nutrition Examination Survey conducted between 2013 and 2015, were examined. Participants were divided into four categories: electronic cigarettes vapers, conventional cigarettes smokers, ex-users, and non-users. Periodontal status was measured by the Community Periodontal Index. Multiple logistic regression analysis was performed to examine the association of periodontal disease with smoking and vaping individually.Results: Out of 187 men and 35 women who vape electronic cigarette, 67 (35.8%) men and 10 (28.6%) women had periodontal diseases. Out of 1,957 men and 363 women who smoke conventional cigarettes, 861 (44.0%) men and 121 (35.3%) women had periodontal diseases. Periodontal disease was more prevalent in each vapers and smokers than non-users in men (electronic cigarettes: odds ratio [OR] = 2.34, 95% confidence interval [CI] = 1.52 to 3.59, conventional cigarettes: OR = 2.17, 95% CI = 1.76 to 2.68). Furthermore, both vaping and smoking had significant relation to dental caries, toothache, and dental damages.Conclusions: Electronic and conventional cigarette use was each significantly associated with increased periodontal disease rates. After adjusting for demographic, socioeconomic, and health-related characteristics, both vaping and smoking each had significant association with periodontal diseases. Therefore, this study suggests that vaping may not be a safe alternative to smoking. Cessation of both types of cigarettes is necessary for maintaining oral health. [ABSTRACT FROM AUTHOR]

Background: Sleep problems increase the risk of premature illness and death. We evaluated the association between sedentary time and sleep quality among South Korean adults.Methods: The data of adults (aged ≥ 19 years) from the 2018 Korea Community Health Survey were analyzed. Sedentary time, which included hours spent sitting or lying down daily, was categorized into four standardized groups. Poor sleep quality was defined using the global cutoff point (> 5 points) of the Pittsburg Sleep Quality Index. Multiple logistic regression analyses were performed to identify the association between sedentary time (≤ 3.9, 4.0-5.9, 6.0-7.9, and ≥ 8 hours /day) and sleep quality, by sex.Results: Of the 224,118 participants, 35,784/100,454 men (35.6%) and 58,271/123,664 women (47.1%) had poor sleep quality. Compared with ≤ 3.9 h/day, sedentary times 4.0-5.9, 6.0-7.9, and ≥ 8 h/day were associated with worse sleep quality among men (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.08-1.16; OR: 1.19, 95% CI: 1.14-1.25; OR: 1.30, 95% CI: 1.25-1.34, respectively) and women (OR: 1.06, 95% CI: 1.03-1.10; OR: 1.12, 95% CI: 1.08-1.16; OR: 1.22, 95% CI: 1.18-1.26, respectively). In subgroup analyses of sleep quality, subjective sleep quality, latency, disturbance, use of sleeping medication, and daytime dysfunction showed a strong dose-response relationship with increasing sedentary time in both sexes.Conclusions: Regardless of sex, the longer the sedentary time, the stronger the association with poor sleep quality. Nationwide efforts are required to recommend standards for sedentary time and develop evidenced-based healthy behavior guidelines. [ABSTRACT FROM AUTHOR]

Background: The effect of menopausal hormone therapy (MHT) on gastrointestinal (GI) cancers is controversial, and no research has been conducted in the East. This study investigates the association between MHT and GI cancer risks in South Korea.Methods: A prescription-based cohort study was conducted using the NHIS Sample Cohort (2002-2013) of Korea. We used 1:5 propensity score matching, and 22,577 MHT users and 111,113 non-users were selected. Kaplan-Meier survival curves with log-rank tests were used. Cox proportional hazard models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Landmark analysis was used to determine dose-response relationship.Results: The median follow-up was 79.6 of months. Kaplan-Meier survival curve showed less frequent GI cancer diagnoses in MHT users compared to non-users (0.13 vs. 0.16 per 100,000 person-years). Menopausal hormone therapy was associated with decreased incidence of GI cancer (HR = 0.809, 95%CI = 0.691-0.946) and colorectal cancer (CRC) (HR = 0.757, 95%CI = 0.577-0.995). Gastric cancer (GC) incidence showed marginal significance (HR = 0.787, 95%CI = 0.605-1.023). The mortality from GI cancer was lower in MHT users than in non-users (HR = 0.737, 95%CI = 0.547-0.993). The relationship between MHT and GI cancer was stronger with increasing MHT dose in terms of both incidence (Ptrend = 0.0002) and mortality (Ptrend = 0.0064).Conclusions: The association between MHT use and reduced risks of GI cancers was attributed to CRC and GC and showed a dose-response relationship in a population-based cohort study. [ABSTRACT FROM AUTHOR]

Background: Low socioeconomic status deemed by income-based measures is a risk factor for depression. Material hardship is commonly used as a multidimensional socioeconomic indicator to identify the struggles that low-income households encounter that are not captured by conventional income-based measures. The aim of this study was to examine the effect of material hardship on depression. Methods: We used wave 3 (2008) to wave 12 (2017) panel data collected by the Korea Welfare Panel Study. The material hardship measure included six dimensions: food, housing, medical care, paying utility bills, education, and financial hardship. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CESD-11). A generalised estimating equation model was applied to test the causal association between material hardship and log transferred CESD-11. Results: The first time point comprised 3,866 participants. Those who continually experienced material hardship had higher depression scores (male: β = 2.82, female: β = 3.98, p-value: <.0001). Food hardship was the most critical risk factor (male: β = 3.29, female: β = 4.05, p-value: <.0001). Conclusions: Material hardship is associated with increased risk of depression, especially food hardship. We should consider guaranteeing food security, and community and policy makers should consider material hardship in their approach when identifying low-income populations at high risk for depression. [ABSTRACT FROM AUTHOR]

Global warming, one of the most serious aspects of climate change, can be expected to cause rising sea levels. These have in turn been linked to unprecedentedly large typhoons that can cause flooding of low-lying land, coastal invasion, seawater flows into rivers and groundwater, rising river levels, and aberrant tides. To prevent typhoon-related loss of life and property damage, it is crucial to accurately estimate storm-surge risk. This study therefore develops a statistical model for estimating such surges' probability based on surge data pertaining to Typhoon Maemi, which struck South Korea in 2003. Specifically, estimation of non-exceedance probability models of the typhoon-related storm surge was achieved via clustered separated peaks-over-threshold simulation, while various distribution models were fitted to the empirical data for investigating the risk of storm surges reaching particular heights. To explore the non-exceedance probability of extreme storm surges caused by typhoons, a threshold algorithm with clustering methodology was applied. To enhance the accuracy of such non-exceedance probability, the surge data were separated into three different components: predicted water level, observed water level, and surge. Sea-level data from when Typhoon Maemi struck were collected from a tidal-gauge station in the city of Busan, which is vulnerable to typhoon-related disasters due to its geographical characteristics. Fréchet, gamma, log-normal, generalized Pareto, and Weibull distributions were fitted to the empirical surge data, and the researchers compared each one's performance at explaining the non-exceedance probability. This established that Weibull distribution was better than any of the other distributions for modelling Typhoon Maemi's peak total water level. Although this research was limited to one city on the Korean Peninsula and one extreme weather event, its approach could be used to reliably estimate non-exceedance probabilities in other regions where tidal-gauge data are available. In practical terms, the findings of this study and future ones adopting its methodology will provide a useful reference for designers of coastal infrastructure. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to provide evidence for the need for social and welfare support in suicide prevention. Methods: Data were collected from the Korean Welfare Panel Study, 2011–2016. The study sample consisted of 7504 people (male: 3080 and female: 4424; mean age: 54.4 ± 16.6), with annual follow‐ups until 2016. A generalized linear mixed‐effects model using a logit link function with random intercept for longitudinal binary data was employed to identify the association between household income change and suicidal ideation status. Results: Suicidal ideation was found in 279 (3.7%) people at the baseline year. A drastic reduction in household income was associated with an increased probability of having suicidal ideation (adjusted odds ratio: 2.205, 95% confidence interval: 1.326–3.666). Using interaction analyses, those who had a drastic reduction in household income and were married, males, aged 40–49, and previously in a middle‐ to high‐income group showed a higher probability of having suicidal ideation. Conclusion: A drastic reduction in household income was associated with a higher probability of suicidal ideation, with specific differences according to gender, age, previous household income level, and marital status. This study reinforces the need for social and welfare support in suicide prevention policies and programs. [ABSTRACT FROM AUTHOR]

Background: A victim of child abuse can often develop mental illness. The early detection of mental illness of children could be supported by observing sleep quality. Therefore, we examined the relationship between sleep quality and the changes in child abuse by the child's own parents over the study period.Methods: Data from the 2011-2013 Korean Children and Youth Panel Survey was used, and 2012 was set as the baseline. Adolescents who had poor sleep quality in 2011 were excluded from the analysis to obtain the final study population of 1276 adolescents aged 14 and 15 years. The generalized estimating equation model (GEE) was used for statistical analysis.Results: Children who had experienced and/or were currently experiencing child abuse showed significantly poorer sleep quality (current year abuse only: odds ratio [OR] = 0.57, 95% confidence interval [CI] = 0.41, 0.79; prior year abuse only: OR = 0.72, 95% CI = 0.52, 0.99; continuous abuse: OR = 0.56, 95% CI = 0.39, 0.80) compared to children who had no experience of child abuse.Conclusion: Child abuse remains a traumatic experience that influences the quality of sleep and hinders the child's proper psychological development. We suggest approaching this issue at both the community and national levels to protect the victims. [ABSTRACT FROM AUTHOR]

Background: Although randomized trials provide a high level of evidence regarding the efficacy of non-vitamin K oral anticoagulants (NOACs), the results of such trials may differ from those observed in day-to-day clinical practice. Aims: To compare the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) between NOAC and warfarin in clinical practice. Methods: Patients with non-valvular atrial fibrillation (NVAF) who started warfarin/NOACs between January 2015 and November 2016 were retrospectively identified from Korea's nationwide health insurance claims database. Using inpatient diagnosis and imaging records, the Cox models with inverse probability of treatment weighting using propensity scores were used to estimate hazard ratios (HRs) for NOACs relative to warfarin. Results: Of the 48,389 patients, 10,548, 11,414, 17,779 and 8,648 were administered apixaban, dabigatran, rivaroxaban and warfarin, respectively. Many patients had suffered prior strokes (36.7%, 37.7%, 31.4%, and 32.2% in apixaban, dabigatran, rivaroxaban, and warfarin group, respectively), exhibited high CHA2DS2-VASc (4.8, 4.6, 4.6, and 4.1 in apixaban, dabigatran, rivaroxaban, and warfarin group, respectively) and HAS-BLED (3.7, 3.6, 3.6, and 3.3 in apixaban, dabigatran, rivaroxaban, and warfarin group, respectively) scores, had received antiplatelet therapy (75.4%, 75.7%, 76.8%, and 70.1% in apixaban, dabigatran, rivaroxaban, and warfarin group, respectively), or were administered reduced doses of NOACs (49.8%, 52.9%, and 42.8% in apixaban, dabigatran, and rivaroxaban group, respectively). Apixaban, dabigatran and rivaroxaban showed a significantly lower S/SE risk [HR, 95% confidence intervals (CI): 0.62, 0.54–0.71; 0.60, 0.53–0.69; and 0.71, 0.56–0.88, respectively] than warfarin. Apixaban and dabigatran (HR, 95% CI: 0.58, 0.51–0.66 and 0.75, 0.60–0.95, respectively), but not rivaroxaban (HR, 95% CI: 0.84, 0.69–1.04), showed a significantly lower MB risk than warfarin. Conclusions: Among Asian patients who were associated with higher bleeding risk, low adherence, and receiving reduced NOAC dose than that provided in randomised controlled trials, all NOACs were associated with a significantly lower S/SE risk and apixaban and dabigatran with a significantly lower MB risk than warfarin. [ABSTRACT FROM AUTHOR]

This article examines the applicability of general strain theory to correctional samples by testing whether prison strains are positively related to deviance among prisoners through strain-associated negative emotions and whether the negative emotions-deviance relationship is systematic in terms of inner versus outer directedness. Latent-variable structural equation modeling was applied to analyze survey data from 986 male prisoners in South Korea. First, an inmate's dissatisfaction with correctional officers was found to be positively related to anger and fear of victimization, whereas in-prison victimization was related only to the fear. Second, outer-directed emotion (anger) was positively related to outer-directed deviance (aggressive and property misconduct and anticipated reoffending) but not to inner-directed deviance (self-injury/suicide attempt). On the contrary, inner-directed emotion (fear) was related positively to the inner-directed deviance but inversely to property misconduct. Finally, some of the indirect relationships of victimization and dissatisfaction with deviance via negative emotions were found to be significant. [ABSTRACT FROM AUTHOR]

Background: This study examines the effects of a shift in medical coverage, from National Health Insurance (NHI) to Medical Aid (MA), on health care utilization (measured by the number of outpatient visits and length of stay; LOS) and out-of-pocket medical expenses.Methods: Data were collected from the Korean Welfare Panel Study (2010-2016). A total of 888 MA Type I beneficiaries and 221 MA Type II beneficiaries who shifted from the NHI were included as the case group and 2664 and 663 consecutive NHI holders (1:3 propensity score-matched) were included as the control group, respectively. We used the 'difference-in-differences' (DiD) analysis approach to assess changes in health care utilization and medical spending by the group members.Results: Differential average changes in outpatient visits in the MA Type I panel between the pre- and post-shift periods were significant, but differential changes in LOS were not found. Those who shifted from NHI to MA Type I had increased number of outpatient visits without changes in out-of-pocket spending, compared to consecutive NHI holder who had similar characteristics. However, this was not found for MA Type II beneficiaries.Conclusion: Our research provides evidence that the shift in medical coverage from NHI to MA Type I increased the number of outpatient visits without increasing the out-of-pocket spending. Considering the problem of excess medical utilization by Korean MA Type I beneficiaries, further researches are required to have in-depth discussions on the appropriateness of the current cost-sharing level on MA beneficiaries. [ABSTRACT FROM AUTHOR]

On-call workers are often on standby at night or on weekends and are called to perform work when unanticipated incidents occur. However, the effects of on-call duty on the mental health has received little attention. The objective of this study was to investigate the effects of on-call work on mental health problems among Korean wage workers. Korean wage workers (56,553) from the 2011–2014 Korean Working Condition Survey were enrolled. The outcome measures included insomnia or sleep disorder and depression or anxiety disorder. General characteristics, occupational and work environment characteristics were used to adjust for control variables. Among the Korean wage workers, 8.2% (N=4,653) performed on-call duties. On-call workers were more likely to experience insomnia or sleep disturbance (3.8%vs2.4%; p<.0001) and depression or anxiety disorder (2.2%vs1.2%; p<.0001) than those who did not have on-call duties. After adjusting for control variables, the odds ratio (OR) for insomnia or sleep disturbance was 1.56 (95% CI, 1.23–1.99), and the OR for depression or anxiety disorder was 2.23 (95% CI, 1.61–3.08). In conclusion, on-call work was associated with mental health problems in Korean wage workers. Therefore, we need to understand the problems of on-call workers, and try to improve their health care. [ABSTRACT FROM AUTHOR]

Background: Depression is a leading cause of disability, and it has been reported that more than 264 million people worldwide have depression. The causes of depression may be numerous, and physical health has also been linked to depression. Therefore, the aim of this study was to determine the effect of health behaviours on depression. Methods: This study used the data of 224,868 participants from the Community Health Survey, conducted in 2017. We defined health behaviours by combining three variables: no smoking, not belonging to high-risk drinking group, and walking frequently. Depression was measured using the Patient Health Questionnaire-9. Logistic regression was used to examine the association between health behaviours and depression. Results: Both men and women who did not practise health behaviours were more likely to experience depressive symptoms than those who did (men, odds ratio (OR): 1.48, 95% confidence interval (CI): 1.31–1.68; women, OR: 1.42, 95% CI: 1.32–1.53). Not walking frequently had the strongest association with depression in men and the risk of depression was the highest in women who smoked. Participants who did not practise any health behaviours were the most likely to have depressive symptoms (men, OR: 1.69, 95% CI: 1.38–2.07; women, OR: 3.08, 95% CI: 2.27–4.19). Conclusion: Our study found that lack of health behaviours is significantly associated with depression. Furthermore, the most influential factor of health behaviours in depression was different for men and women. It is necessary to manage depression through interventional methods customised to gender characteristics. Additionally, national-level policies are needed to encourage steps to improve personal lifestyles, including practising health behaviours. [ABSTRACT FROM AUTHOR]

Objectives: To assess the association between low muscle mass and osteoporosis in the Korean general population.Methods: We analyzed 14,429 participants (6,261 men and 8,168 women) from the 2009-2011 Korean National Health and Nutrition Examination Survey (KNHANES) aged 20 years or more.Main Outcome Measure: The association of low muscle mass with osteoporosis was investigated using multivariate logistic regression models that included age, marital status, residence, current smoking, monthly drinking, physical activities, strength exercise, comorbidity, and the use of dietary supplements, and in women postmenopausal status and experience of pregnancy.Results: After adjusting for covariates, low muscle mass was significantly associated with osteoporosis in the lumbar spine and femoral neck in both men (lumbar spine: OR 1.73, 95 % CI 1.08-2.76; femoral neck: OR 3.39, 95 % CI 1.69-6.80) and women (lumbar spine: OR 1.52, 95 % CI 1.17-1.97; femoral neck: OR 2.09, 95 % CI 1.56-2.80). Also, the association between low muscle mass and osteoporosis was significant in men and women in every age group except for men aged 50-64 years.Conclusion: Low muscle mass was significantly associated with osteoporosis in both men and women for all age groups, except for men aged 50-64 years. [ABSTRACT FROM AUTHOR]

Background: Campus alcohol policy has been associated with student alcohol consumption in numerous studies. However, more information is required to assess the extent to which school policy affects student drinking behavior; especially when both individual-level sociodemographic characteristics of students and area-level characteristics of college campuses are controlled for. Thus, this paper explores the association between campus alcohol policy and student alcohol consumption among a nationally representative sample of college students in South Korea, while controlling for both individual and area-level characteristics.Methods: We surveyed and analyzed the data of 4592 students from 82 colleges. Multilevel (hierarchical) linear modeling was used to identify the association between campus alcohol policy and alcohol consumption levels, measured via the AUDIT-C (Alcohol Use Disorders Identification Test - Consumption). Controlled individual-level characteristics included sex, year level, major, GPA (grade point average), pocket money, smoking status, stress level, depressive thoughts, suicidal thoughts, and number of clubs/organizations. Controlled area-level characteristics included college type, number of students, number of faculty members, number of workers/administrators, and region.Results: Compared to students unaware of their school's campus alcohol policy, students who self-reported that their campuses allow drinking in outdoor spaces (β = 0.755 p = 0.010) or in all areas (β = 0.820, p = 0.044) had higher AUDIT-C scores. Students attending schools with a large number of students, males, freshmen, students with low GPA, students with high amounts of pocket money, and smokers also had higher alcohol consumption scores relative to their peers. Alcohol education experience in the form of lectures, mail, and/or campaigns were not associated with student alcohol consumption levels.Conclusion: Our results suggest an association between self-reported campus alcohol policy and student alcohol consumption. College educators and administrators must be aware that relative to students unaware of their school's campus alcohol policy, students at colleges that allow drinking in outdoor spaces or all areas consume higher amounts of alcohol than their peers; even when area-level factors are controlled for.Trial Registration: Yonsei IRB (IRB number: Y-2017-0084). https://irb.yonsei.ac.kr Date of registration: 01/2017. Date of enrolment of first participant to trial: 03/01/2017. Y-2017-0084. [ABSTRACT FROM AUTHOR]

Background Severe maternal morbidity is an indicator for quality of maternal care. Recently, there has been growing interest in identifying which provision factors affect the quality of maternity care. The extent to off-hour delivery on SMM rates contributes to individual or provision factor in Korea has not been studied. This study aimed to determine the relationship between off-hour delivery and SMM during childbirth hospitalization. Methods This is a population-based retrospective cohort study. Data were extracted from the Korean National Health Insurance Service-National Sample Cohort for 90 072 cases of delivery in Korea between 2003 and 2013. The main outcome was SMM which was determined using the Center for Disease Control and Prevention's algorithm. A generalized estimating equation model with log link was performed for the relationship with SMM and day/time of delivery adjusted covariates. Results Of the 90 072 delivery cases, 2085 (2.31%) had SMM. Women who were on weekdays at night time or on weekend delivery had a higher risk of SMM compared with those who were on weekdays at daytime (RR 1.26, 95% CI 1.10–1.46, and RR 1.58, 95% CI 1.30–1.93, respectively). Conclusion Weekday at night time or weekend delivery was related to the risk of SMM. Policymakers should provide financial support and systematically allocate adequate human resources and labour facilities in vulnerable areas, as well as during weekends and night times to improve the quality of intrapartum and postpartum maternity care. [ABSTRACT FROM AUTHOR]

Background and Aim: Although endoscopic papillary large balloon dilation (EPLBD) has been widely used to facilitate the removal of difficult common bile duct stones, however, the outcomes have not yet been investigated in terms of the diameter of the balloon used. We aimed to compare the clinical outcomes between EPLBD using smaller (12–15 mm, S‐EPLBD) and larger balloons (> 15 mm, L‐EPLBD). Methods: Six hundred seventy‐two patients who underwent EPLBD with or without endoscopic sphincterotomy for common bile duct stone removal were enrolled from May 2004 to August 2014 at four tertiary referral centers in Korea. The outcomes, including the initial success rate, the success rate without endoscopic mechanical lithotripsy, the overall success rate, and adverse events between S‐EPLBD and L‐EPLBD groups, were retrospectively compared. Results: The initial success rate, the success rate without mechanical lithotripsy, the overall success rate, and the overall adverse events were not significantly different between the two groups. The rate of severe‐to‐fatal adverse events was higher in the L‐EPBLD group than in the S‐EPLBD group (1.6% vs 0.0%, 0.020). One case of severe bleeding and two cases of fatal perforation occurred only in the L‐EPLBD group. In the multivariate analysis, the use of a > 15‐mm balloon was the only significant risk factor for severe‐to‐fatal adverse events (>0.005, 23.8 [adjusted odds ratio], 2.6–214.4 [95% confidence interval]). Conclusions: L‐EPLBD is significantly related to severe‐to‐fatal adverse events compared with S‐EPLBD for common bile duct stone removal. [ABSTRACT FROM AUTHOR]

Objective: People who eat alone, which is becoming a new trend owing to the increasing proportion of one-person households in Korea, are more likely to become overweight and obese. Therefore, we investigated the association between having a dinner companion and BMI. Design: A linear regression model adjusted for covariates was utilized to examine the association between having a dinner companion and BMI. Subgroup analyses were performed, stratified by age group, gender, household income, educational level and occupation. Setting: We used the data from the Korean Health and Nutrition Examination Survey VI. Our primary independent variable was having a dinner companion while the dependent variable was BMI. Subjects: In total, 13303 individuals, aged 20 years or over, were analysed. Results: Compared with the solo eating group, BMI was lower in the family dinner group (β =−0·39, P <0·01) but not in the non-family dinner group (β =−0·06, P =0·67). The subgroup analysis revealed that the difference in BMI was most significant in young generations, such as those aged 20–29 years (β =−1·15, P< 0·01) and 30–39 years (β =−0·78, P =0·01). Conclusions: We found that people who eat dinner alone are more likely to become overweight and obese than those who eat with their family. This association was stronger in males and young adults than their counterparts. Considering the increasing trends in the proportion of single-person households and solo eating, appropriate intervention is needed. [ABSTRACT FROM AUTHOR]

Objective: We evaluate the effects of drug price reduction policy on pharmaceutical expenditure and prescription patterns in diabetes medication.Design: An interrupted time series study design using generalized estimating equations.Setting: This study used National Health Insurance claim data from 2010 to 2013.Participants: A total of 68 127 diabetes patients and 12 465 hospitals.Intervention(s): The drug price reduction policy.Main Outcome Measures: The primary outcome is pharmaceutical expenditure and prescription rate. To evaluate changes in prescription rate, we measured prescription rates such a brand-name drug and drug price reduction rate.Results: Although the drug price reduction policy associated with decreased pharmaceutical expenditure (-13.22%, P < 0.0001), the trend (-0.01%, P = 0.9201) did not change significantly compared with the pre-intervention period. In addition, the trends in the monthly prescription rate of brand-name drugs decreased (-0.14%, P = 0.0091), while the immediate change was an increase (5.72%, P < 0.0001). Regardless of the drug reduction rate, the prescription rate after the introduction of the drug price reduction policy decreased compared with the pre-intervention period, and this decline was significant for reduction rates of 0% (-2.74%, P < 0.0001) and 10% (-0.13%, P = 0.0018).Conclusions: Our results provide evidence of the effects of the drug price reduction policy on pharmaceutical expenditure and prescription patterns. This policy did not affect the prescribing behavior of healthcare providers and did not increase the use of drugs not subject to this policy. Although this study did not observe changes in the cost of pharmaceuticals after the introduction of the drug price reduction policy, further research is needed on the long-term changes in such costs. [ABSTRACT FROM AUTHOR]

Background: Endoscopic papillary large balloon dilation (EPLBD) without prior endoscopic sphincterotomy (EST) produces excellent outcomes for the treatment of large common bile duct (CBD) stones. However, it remains unclear how the outcomes of EPLBD alone compare with those of EPLBD with EST. In this study, we assessed the safety and therapeutic outcomes of EPLBD with vs. without EST for the removal of large bile duct stones.Methods: This prospective, multicenter study was conducted on 200 patients with bile duct stones of ≥ 10 mm in diameter. Patients were randomly assigned to an EPLBD alone group (n = 100) or an EPLBD with EST group (n = 100). These two groups were compared with respect to overall procedure-related adverse events, overall stone removal success rate, number of endoscopic sessions required for complete stone removal, need for mechanical lithotripsy, and total procedure time.Results: The incidence of adverse events was not significantly different between the groups (EPLBD alone vs. EPLBD with EST: overall adverse events 6 % vs. 4 %, P = 0.75; pancreatitis 1 % vs. 3 %, P = 0.62). Overall success (P = 0.35), initial success (P = 0.28), and the need for mechanical lithotripsy (P = 0.39) were also similar between groups. Median total procedure time tended to be greater in the EPLBD alone group (20.5 minutes) than in the EPLBD with EST group (18 minutes; P = 0.08).Conclusion: The therapeutic outcomes and adverse events of EPLBD alone for the removal of large bile duct stones were comparable to those of EPLBD with EST. [ABSTRACT FROM AUTHOR]

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Background: The aim of this study was to examine the pattern of social inequality in self-rated health among the employed using the Wright's social class location indicator, and to assess the roles of material, behavioral, psychosocial, and workplace environmental factors as mediating factors in explaining the social class inequality in self-rated health in South Korea.Methods: This study used data from the 4th Korea National Health and Nutrition Examination Survey from 2007 to 2009. Study subjects included the employed population of 4392 men and 3309 women aged 19-64 years. Subjects were classified into twelve social class positions based on the Wright's social class map. The health outcome was self-rated health. Material, psychosocial, behavioral, and workplace environmental factors were considered as potential mediators in explaining social class health inequality. We calculated prevalence ratios of poor self-rated health according to social class, adjusted for age and mediating factors using Poisson regression models.Results: Nonskilled workers and petty bourgeoisie reported worse self-rated health than other social classes among men. The age-adjusted prevalence of petty bourgeoisie and nonskilled workers were about four-fold greater than that of managers. Expert supervisors in the contradictory class location had a greater prevalence of poor self-rated health than experts in men. In women, the prevalence of poor self-rated health was greater in most social classes than their male counterparts, while the differences among social classes within women were not statistically significant. Workplace environmental factors explained the social class inequality by from 24 to 31% in nonskilled and skilled workers and nonskilled supervisors, respectively, and material factors showed an explanatory ability of about 8% for both nonskilled workers and petty bourgeoisie in men.Conclusions: We showed the inequality in self-rated health according to the Wright's social class in an industrialized Asian country. Policy efforts to improve workplace environments in nonskilled and skilled workers and nonskilled supervisors would have a moderate effect on reducing the magnitude of social class inequality in self-rated health. Furthermore, the means to improve power relations in the workplace should be devised to further reduce the social class inequalities in health. [ABSTRACT FROM AUTHOR]

Background: The Korean healthcare system is composed of costly and inefficient structures that fail to adequately divide the functions and roles of medical care organizations. To resolve this matter, the government reformed the cost-sharing policy in November of 2011 for the management of outpatients visiting general or tertiary hospitals with comparatively mild diseases. The purpose of the present study was to examine the impact of increasing the coinsurance rate of prescription drug costs for 52 mild diseases at general or tertiary hospitals on outpatient healthcare service utilization.Methods: The present study used health insurance claim data collected from 2010 to 2013. The study population consisted of 505,691 outpatients and was defined as those aged 20-64 years who had visited medical care organizations for the treatment of 52 diseases both before and after the program began. To examine the effect of the cost-sharing policy on outpatient healthcare service utilization (percentage of general or tertiary hospital utilization, number of outpatient visits, and outpatient medical costs), a segmented regression analysis was performed.Results: After the policy to increase the coinsurance rate on prescription drug costs was implemented, the number of outpatient visits at general or tertiary hospitals decreased (β = -0.0114, p < 0.0001); however, the number increased at hospitals and clinics (β = 0.0580, p < 0.0001). Eventually, the number of outpatient visits to hospitals and clinics began to decrease after policy initiation (β = -0.0018, p < 0.0001). Outpatient medical costs decreased for both medical care organizations (general or tertiary hospitals: β = -2913.4, P < 0.0001; hospitals or clinics: β = -591.35, p < 0.0001), and this decreasing trend continued with time.Conclusions: It is not clear that decreased utilization of general or tertiary hospitals has transferred to that of clinics or hospitals due to the increased cost-sharing policy of prescription drug costs. This result indicates the cost-sharing policy, intended to change patient behaviors for healthcare service utilization, has had limited effects on rebuilding the healthcare system and the function of medical care organizations. [ABSTRACT FROM AUTHOR]

Background: Cigarette pricing policy is one tool for controlling smoking behavior on a national scale. It is unclear, however, what effects such policy has on adolescents and which characteristic subgroups of adolescents are more or less sensitive to cigarette pricing policy.Materials and Methods: Our data came from the 2013 Korea Youth Risk Behavior Web-based Survey. The dependent variable was whether or not a participant was classified as a "persistent smokers," defined as a smoker who would continue smoking despite any price increase. Other variables of interest were smoking days (quantity), previous attempts to stop smoking, and previous education on smoking cessation. The statistical analysis was performed using weighted data and the SURVEYFREQ and SURVEYLOGISTIC procedures in SAS 9.3.Results: Among 7094 adolescent smokers (5349 males and 1745 females), 19.9% of males and 25.1% of females reported as persistent smokers. Compared with light smokers, heavy smokers are more likely to be persistent smokers (male: odds ratio [OR] = 2.45, 95% confidence interval [CI] = 2.04-2.95, P value < .001; female: OR = 3.23, 95% CI = 2.44-4.27, P value < .001). When we stratified the data by household income, previous attempts to stop smoking, and previous education on smoking cessation, that trend remained statistically significant.Conclusions: Because heavier smokers with higher risk of health-related consequences were less sensitive to pricing policy than mild smokers, pricing policy alone is not enough to reduce the societal burden caused by smoking. We suggest that additional cessation policy is needed along with pricing policy for adolescents with heavier smoking behavior in Korea.Implication: This study shows that heavy smokers are more likely to be persistent smokers despite the cigarette price increase policy, compared with light smokers in Korean adolescents. Because heavier smokers were less sensitive to pricing policy than mild smokers, pricing policy alone is not enough to reduce the societal burden caused by smoking. We suggest that additional tobacco control policies should be evaluated and effective ones implemented in addition to cigarette prices to reduce smoking among regular adolescent smokers. [ABSTRACT FROM AUTHOR]

Objectives: This study reports on patients who showed central pain due to injury of the spinothalamic tract (STT) caused by fall without direct head trauma. Design: Prospective study. Participants: Two patients with mild traumatic brain injury (TBI) resulting from a fall were enrolled. Patient 1 was a 21-year-old female who had suffered a pratfall with no history of direct head trauma. She had begun to feel pain in both upper trunk and lower back and the left leg since ~ 5 days after onset: constant tingling and throbbing sensation with allodynia. Patient 2 was a 39-year-old male who had suffered a pratfall without direct head trauma. He had begun to feel pain in both arms and legs since ~ 4 days after the fall: constant tingling and pricking sensation without allodynia or hyperalgesia. Results: On diffusion tensor tractograhpy (DTT) of patient 1, partial tearing of the right STT was observed at the subcortical white matter. On DTT of patient 2, partial tearing at the subcortical white matter was observed in the right STT and partial narrowing at the subcortical white matter was observed in the left STT. Conclusions: This study demonstrated injury of the STT in patients who suffered from central pain following a fall. The results suggest that minor indirect head trauma can cause traumatic axonal injury of the brain. [ABSTRACT FROM PUBLISHER]

A Radioactive Waste Information Management System (RAWINGS) currently in operation mainly manages the inventory and history of the operating waste. The system has the disadvantages of the entered information needing to be transferred manually from the site to the system, information getting incorrectly entered during the process or information going missing. Recently, the Nuclear Safety and Security Commission (NSSC) and Korea Radioactive Waste Agency (KORAD) called for the development of a digital system that can show information transparently in real-time regarding the preliminary inspections of RAdioactive Waste (RAW) and the assessment of its suitability for disposal before the radioactive waste is delivered to the disposal site. A Digital Twin (DT)system is being developed for the safety management of radioactive waste to address the problems that these systems have and meet the needs of disposal operators. This paper introduces the DT technology that uses Augmented Reality (AR) technology enabling users to check the contents of small-packaged wastes in radioactive waste drums without opening them, Internet of Things (IoT) sensor technology that checks the status of the drums in the radioactive waste storage and the RAWINGS system. Based on the performance of a prototype Digital Twin consisting of three modules (AR, IoT and RAWINGS), the augmented reality enables users to see the shape information and filling rate of small-packaged wastes in the radioactive waste drums and includes Quick Response (QR) code management. The basic data of the radioactive waste used in the augmented reality, as well as small packaged wastes and repackaged drums, were processed in conjunction with RAWINGS. In addition, real-time monitoring of radioactive waste drums loaded in the designated space (Y zone: an area where combustible waste is loaded within radioactive waste storage and TEST area: a section where drums scheduled to be transported to the disposal site are loaded) of the radioactive waste storage was possible by transmitting IoT sensor signals attached to the drum to the digital twin. Currently, augmented reality has an important role in enhancing the visibility and intuitiveness of radioactive waste information for radioactive waste managers and workers by overlapping digital information about radioactive waste storage. Due to the nature of radioactive waste, it is difficult to know what waste is inside the enclosed drum. However, the results of this study confirmed that waste contained in radioactive waste drums can be identified in real time in the Digital Twin rather than in the radioactive waste storage. This technology will be useful in determining the conformity of the radioactive waste acceptance criteria required by KORAD before the delivery of radioactive waste drums to disposal sites. [ABSTRACT FROM AUTHOR]

Background: This study investigated the changes of an injured fornix from early stage to chronic stage in a patient with mild traumatic brain injury (TBI), using diffusion tensor tractography (DTT). Methods: A 25-year-old female suffered from head trauma resulting from a pedestrian car accident. The patient showed a total score of 86 for memory impairment on the Memory Assessment Scale at 2 weeks after onset; however, her memory has been recovered to within normal range, with a score of 105 at 9 months after onset. Results: The middle portion of the right fornical crus showed narrowing and the discontinued left fornical crus was shortened on 9-month DTT compared with 2-week DTT. Two branches from the right fornical column and body were observed on 9-month DTT; in contrast, the two branches from the left fornical column and the left fornical body were elongated and shortened, respectively, on 9-month DTT compared with 2-week DTT. Conclusions: The narrowed lesion in the middle of the right fornical crus and the shortening of the discontinued left fornical crus appear to indicate degeneration following traumatic axonal injury. In contrast, the neural branches from both fornices appear to be related to the functional recovery mechanisms of the injured fornix. [ABSTRACT FROM AUTHOR]

Simple Summary: In pancreatic ductal adenocarcinoma, FOLFIRINOX and nab-paclitaxel are recommended as first-line chemotherapy regimens. However, there are limited data to predict the efficacy of the FOLFIRINOX regimen in patient outcomes. Platinum-based chemotherapy is tolerable and responsible in patients with DNA damage repair gene mutations. However, data are still limited, and no Asian data are available yet. Here, we sought to investigate the proportion of germline BRCA 1/2 mutations in patients with germline blood tests. Finally, we investigated the treatment response of FOLFIRINOX in patients with BRCA 1/2 mutations. We found that the presence of germline BRCA 1/2 mutations was associated with an improved overall response rate in pancreatic ductal adenocarcinoma patients treated with FOLFIRINOX. The high response rate in this analysis supports the preferential use of FOLFIRINOX therapy for patients harboring a BRCA germline mutation, and supports the need for early germline testing in order to select the best therapy. We evaluated the proportion of BRCA 1/2 germline mutations in Korean patients with sporadic pancreatic ductal adenocarcinoma (PDAC) and its effect on the chemotherapeutic response of FOLFIRINOX. This retrospective study included patients who were treated at two tertiary hospitals between 2012 and 2020, were pathologically confirmed to have PDAC, and had undergone targeted next-generation sequencing-based germline genetic testing. Sixty-six patients were included in the study (24 men; median age 57.5 years). In the germline test, BRCA 1/2 pathogenic mutations were found in nine patients (9/66, 13%, BRCA 1, n = 3; BRCA 2, n = 5; and BRCA 1/2, n = 1). There was no significant difference in the baseline characteristics according to BRCA mutation positivity. Among patients who underwent FOLFIRINOX chemotherapy, patients with a BRCA 1/2 mutation showed a higher overall response rate than those without a BRCA 1/2 mutation (71.4% vs. 13.9%, p = 0.004). Patients with a germline BRCA 1/2 mutation showed longer progression-free survival than those without a BRCA 1/2 mutation, without a significant time difference (18 months vs. 10 months, p = 0.297). Patients with a BRCA 1/2 mutation in the germline blood test had a higher response rate to FOLFIRINOX chemotherapy in PDAC. The high proportion of BRCA 1/2 germline mutations and response rate supports the need for germline testing in order to predict better treatment response. [ABSTRACT FROM AUTHOR]

This study investigates the economic feasibility of a hybrid renewable energy system (HRES) that uses geothermal and solar heat sources for water heating, space heating, and space cooling in a residential building in Korea. A small-scale HRES consists of a geothermal heat pump for heating and cooling, solar collectors for hot water, a gas-fired backup boiler, and incidental facilities. To determine whether the HRES will produce any economic benefits for homeowners, an economic analysis is conducted to compare the HRES with conventional methods of space heating and cooling in Korea. The payback period of a small-scale HRES is predicted as a maximum of 9 yrs by life cycle costing based on a performance index compared with conventional systems. However, the payback period of large-scale HRES above 400 RT is 6 yrs to 7 yrs. [ABSTRACT FROM AUTHOR]

Background: This study reports on a patient with traumatic brain injury (TBI) with a thalamic lesion in the ventroposterolateral nucleus which was demonstrated by diffusion tensor tractography (DTT) for the spinothalamic tract and its thalamocortical pathway (STP). Methods: One patient with TBI and eight normal control subjects were recruited. A 64-year-old woman who had suffered a motor vehicle accident presented with a persisting tingling sensation and pain in her right upper and lower extremities at 3 weeks after onset. The patient showed impaired touch sensation, but normal proprioception. Diffusion tensor imaging was performed at 1 month after onset. Fractional anisotropy (FA) and mean diffusivity were measured using a region of interest method along the STP. Results: DTT showed normal STP integrities as compared with normal controls. However, the FA values of the left STP at the thalamus were more than 2 SD decreased. The diminished FA value of the left STP in the left thalamus seems to indicate injury of the left ventrolateroposterior nucleus. Central pain and impaired touch sensation of right extremities supports the presence of left STP injury at the ventroposterolateral nucleus in this patient. Conclusion: It is believed that DTT for the STP provides a useful means of detecting thalamic injury in TBI. [ABSTRACT FROM AUTHOR]

Reduced-dose nonvitamin K antagonist oral anticoagulants (NOACs) are commonly prescribed to Asian patients with nonvalvular atrial fibrillation (NVAF). We aimed to compare the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) between patients treated with reduced-dose NOACs and those treated with warfarin, using the claims database in Korea. Patients with NVAF newly initiated on oral anticoagulants (OACs; apixaban, dabigatran, rivaroxaban, and warfarin) between 1 July 2015 and 30 November 2016 were included. Among all patients with NVAF treated with OACs, 5249, 6033, 7602, and 8648 patients were treated with reduced-dose apixaban, dabigatran, rivaroxaban, and warfarin, respectively. Patients treated with reduced-dose NOACs were older and had higher CHA2DS2-VASc and HAS-BLED scores than those treated with warfarin. Compared to warfarin, all reduced-dose NOACs showed significantly lower risk of S/SE (hazard ratios (95% confidence interval), 0.63 (0.52–0.75) for apixaban; 0.51 (0.42–0.61) for dabigatran; and 0.67 (0.57–0.79) for rivaroxaban) and MB (0.54 (0.45–0.65) for apixaban; 0.58 (0.49–0.69) for dabigatran; 0.73 (0.63–0.85) for rivaroxaban). In the real-world practice among Asians with NVAF, all reduced-dose NOACs were associated with a significantly lower risk of S/SE and MB compared to those of warfarin. [ABSTRACT FROM AUTHOR]

We examined antithrombotic treatment patterns with clinical characteristics and therapy changes over time in patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). Using the Health Insurance Review and Assessment service claims database (01JAN2007-30NOV2016) in Korea, we included adult patients with AF and PCI: (1) who underwent PCI with stenting between 01JAN2008 and 30NOV2016; (2) with ≥1 claim for AF (ICD code: I48) (3) with antithrombotics 1 day prior to or at the date of PCI; and (4) with CHADS2-VASc of ≥2. In this study, 7749 patients with AF who underwent PCI, triple therapy, dual therapy, dual antiplatelet therapy (DAPT), and single antiplatelet therapy were prescribed to 24.6%, 3.4%, 60.8%, and 11.0%, respectively. In the triple therapy group, 23.1% persisted with triple therapy for 12 months, whereas the remaining patients switched to a different therapy. In the entire cohort and several subgroups, the median treatment duration of triple therapy was 55–87 days. DAPT use for 12 months was the most common treatment pattern (62.6%) in the DAPT group (median treatment duration, 324–345 days). A significant discrepancy exists between the current guidelines and real-world practice regarding antithrombotic treatment with PCI for patients with AF. Appropriate use of anticoagulants should be emphasized. [ABSTRACT FROM AUTHOR]

Background: To examine the association between sitting time and non-alcoholic fatty liver disease among South Koreans aged ≥20 years. Methods: Data from the 2016–2018 Korea National Health and Nutrition Examination Survey were used for the analysis. Non-alcoholic fatty liver disease was diagnosed according to a hepatic steatosis index of > 36. Sitting time was categorized into as Q1, Q2, Q3, and Q4 using the age-adjusted quartile with Q4 being the longest sitting hour. Multiple logistic regression analysis was used to examine the association between sitting time and non-alcoholic fatty liver disease in South Korean population. Results: A total of 13,518 participants were enrolled. The odds for having NAFLD in Q1, Q2, Q3, and Q4 (sitting hours) were 1.07 (CI: 0.88–1.31), 1.16 (CI: 1.96–1.41), and 1.34 (CI: 1.11–1.61), respectively. The odds ratio increased in magnitude with longer hours of sitting time (test for trend: P-value = 0.0002). Conclusion: Advising physical exercises and discouraging sedentary activities may help to alleviate NAFLD among the South Korean population. [ABSTRACT FROM AUTHOR]

Background: South Korea is an aged society that continues to age rapidly. Therefore, the purpose of this study was to investigate the association between changes in lifestyle and cognitive functions in the South Korean elderly using a nationally representative survey.Methods: We analyzed data from the Korean Longitudinal Study of Aging (KLoSA) 2006-2016, a biannual panel survey. Multiple linear regression analysis was performed with repeated measurements data to examine the association between lifestyle change and cognitive functions over 2 years. Lifestyle combined the scores of four factors (smoking status, alcohol drinking status, body weight, and exercise), and then categorized them into four groups (Good→Good, Bad→Good, Good→Bad, and Bad→Bad) according to the two-year change. Cognitive functions were set according to the scores measured through the Korean Mini-Mental State Examination (K-MMSE).Results: Among females, the K-MMSE score was the highest in the Bad→Good group compared to the reference group, Bad→Bad (β = 0.914; SD = 3.744; p < .0001). The next highest scores were in the Good→Good group (β = 0.813; SD = 4.654; p = 0.0005) and the Good→Bad group (β = 0.475; SD = 4.542; p = 0.0481). Among males, only the K-MMSE of the Good→Good group was statistically significant (β = 0.509; SD = 3.245; p = 0.0077). The results of subgroup analysis showed that the K-MMSE scores of females who did not participate in any social activities were more affected by their lifestyle (Good-Good: β = 1.614; SD = 4.270; p = 0.0017, Bad-Good: β = 1.817; SD = 3.945; p < .0001). Subgroup analysis showed that females who started drinking more than a moderate amount of alcohol had lower K-MMSE scores (Good-Bad: β = - 2.636; SD = 2.915; p = 0.0011). Additionally, in both sexes, exercising, among the four lifestyle options, had a strong and significant association with higher K-MMSE scores.Conclusions: Following a healthy lifestyle or improving an unhealthy lifestyle can help people prevent or slow down cognitive decline. Regularly engaging in an adequate amount of exercise can help the cognitive function of the elderly. Females, specifically, can experience positive effects on their cognitive function if they participate in social activities while maintaining healthy lifestyles, in particular not drinking too much alcohol. [ABSTRACT FROM AUTHOR]

Background: The effect of noise and vibration exposure on disturbed sleep has been investigated in the past. However, this study was carried out to investigate the relationship between workplace noise and vibration exposure with insomnia amongst representative Korean workers, both simultaneously and separately. Methods: Our research analyzed an overall population of 30,837 workers aged 15 years or older using data derived from the 5th Korean Working Conditions Survey (KWCS) conducted in 2017. Chi-squared tests and logistic regression were performed to investigate baseline characteristics and to quantify the association between workplace exposure to noise and vibration with insomnia. Relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S) were calculated to measure interactions between simultaneous noise and vibration exposure with insomnia. Results: The prevalence of those who reported insomnia was 18.3% of the general population. Among men and women, insomnia in those who were exposed to noise only was 13.9% and 18.3%, respectively, and in those who were exposed to vibration only, it was 23.9% in males and 26.4% in females. Insomnia in those who were exposed to both noise and vibration simultaneously was 20.5% and 41.2% in men and women, respectively. The odds ratio (OR) of insomnia due to noise exposure was 1.10 and 1.07 in men and women, respectively. OR of vibration exposure was 1.84 in men and 1.58 in women. For noise plus vibration exposure OR was 1.83 in men and 3.14 in female workers, where the synergistic effect of noise and vibration exposure could be seen. The association between the varying degree of simultaneous noise plus vibration exposure with insomnia showed a dose–response relationship. The interaction measures showed a synergistic effect of simultaneous exposure in women but not in men. Conclusion: Our study revealed an association between occupational noise and vibration exposure and insomnia, both individually and simultaneously. Additional studies and research are required to further comprehend this relationship. [ABSTRACT FROM AUTHOR]

Backgrounds: We explored the association between working hours and unmet dental needs among adults who have experienced dental pain, and how this relationship varied by demographic and lifestyle factors. Methods: We used the data of 9594 adults who reported dental pain from the Korea National Health and Nutrition Examination Survey (KNHANES) V and VI. We conducted a logistic regression analysis to determine the association between working hours and unmet dental needs, followed by a subgroup analysis and Cochran-Armitage trend tests. Results: Among the 4203 male subjects, 1661 (39.5%) experienced unmet dental needs. They also showed a significant dose-response relationship between working hours and unmet dental needs (OR 1.21 [95% CI 0.97–1.51], OR 1.30 [95% CI 0.99–1.69], OR 1.33 [95% CI 1.04–1.71], OR 1.58 [95% CI 1.21–2.07] compared to no working hours), whereas female participants did not. The significance of the association was preserved among participants with increased consumption of alcohol, urban residence, and who brushed their teeth at least twice a day. It was also stronger among those who lacked access to dental services or did not perceive the need for dental care. Conclusion: Among adults who have experienced dental pain, unmet dental needs had higher odds of occurring in males who worked longer, and this relationship appears to be influenced by consumption of alcohol, region of residence, tooth-brushing frequency, and access to and perception of dental care. Accordingly, policies should be drafted to reduce unmet needs by considering these factors. [ABSTRACT FROM AUTHOR]

Background: In 2002, a voluntary diagnosis-related groups (DRGs) payment system was introduced in South Korea for seven disease groups, and participation in the DRGs was mandated for all hospitals beginning in 2013. The primary aim of this study was to compare results reflective of patient care between voluntary participation hospitals (VPHs) and mandatory participation hospitals (MPHs) governed by either the DRGs or fee-for-service (FFS) payment system.Methods: We collected DRGs and FFS inpatient records (n=3,038,006) from the Health Insurance Review and Assessment for the period of July 2011 to July 2014 and compared length-of-stay, total medical costs, shifting services to an outpatient setting, and readmission rates according to payment system, time of DRGs implementation, and hospital type. We analyzed the effects of mandatory introduction in DRGs payment system on results for patient care and used generalized estimating equations with difference-in-difference methodology.Results: Most notably, patients at MPHs had significantly shorter LOS and lower readmission rates than VPH patients after mandatory introduction of the DRGs. Shifting services to an outpatient setting was similar between the groups.Conclusions: Our findings suggest that the DRGs payment policy in Korea has decreased LOS and readmission rates. These findings support the continued implementation and enlargement of the DRGs payment system for other diseases in South Korea, given its potential for curbing unnecessary resource usage encouraged by FFS. If the Korean government deliberates on expansion of the DRGs to include other diseases with higher rates of complications, policymakers need to monitor deterioration of health care quality caused by fixed pricing. [ABSTRACT FROM AUTHOR]

Background: Alcohol use among adults with mild to severe disability is an under-researched topic in the literature. Few studies have attempted to assess the impact of alcohol misuse, abuse, and chronic alcoholism among this target group. Thus, we investigated the association between chronic alcoholism and mortality among disabled individuals in South Korea.Methods: We used data from the National Health Insurance Service National Sample Cohort (NHIS-NSC) for the years 2003-2013, which included data on 61,013 disabled individuals. Among these patients, a multivariate Cox proportional hazards model was used to estimate the hazard ratio of mortality associated with chronic alcoholism.Results: A total of 800 individuals died during the study period. Individuals who had medical claims for chronic alcoholism following their disability diagnosis had greater risk of mortality than individuals without chronic alcoholism (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.06-2.31, p = 0.0244). Individuals with a physical disability (HR: 2.30, 95% CI: 1.06-4.95, p = 0.0342), brain lesion (HR: 1.96, 95% CI: 1.03-3.74, p = 0.0405), and/or kidney failure (HR: 4.98, 95% CI: 1.07-23.25, p = 0.0411) had greatest mortality risk when diagnosed with chronic alcoholism, compared to individuals who were not diagnosed with chronic alcoholism.Conclusions: Chronic alcoholism following disability diagnosis was associated with greater mortality risk in a nationally representative population of disabled individuals, especially among individuals with a physical disability, brain lesion, and/or kidney failure. Such findings reveal that certain social and political measures must be implemented to help disabled individuals suffering from alcoholism, especially according to disability diagnosis. [ABSTRACT FROM AUTHOR]