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Background: The relationship between menopausal hormone therapy (MHT) and risk of Parkinson's disease (PD) remains controversial. Objective: This nationwide population-based cohort study investigated the association between MHT and PD development. Methods: Data from the National Health Insurance System of South Korea from 2007 to 2020 were used. The MHT group included women who underwent MHT for the first time between 2011–2014, while the non-MHT group included women who visited a healthcare provider for menopause during the same period but never received hormonal therapy. We used propensity score matching (1 : 1) to adjust for potential confounders, and Cox regression models to assess the association between MHT and PD. Results: We selected 303,260 female participants (n = 151,630 per MHT and non-MHT groups). The median age of the participants was 50 (48–54) years, and the follow-up period lasted 7.9 (6.9–8.9) years. Cox regression analysis revealed an increased risk of PD with MHT (hazard ratio [HR] 1.377, 95% confidence interval [CI] 1.184–1.602), particularly with tibolone (HR 1.554, 95% CI 1.297–1.861) and estrogen alone (HR 1.465, 95% CI 1.054–2.036). Tibolone and estrogen alone were linked to PD within three years; however, no association was observed after three years. In contrast, the use of combined estrogen-progesterone was linked to a higher risk of PD, which increased with the duration of MHT (HR 1.885, 95% CI 1.218–2.918 for over five years). Conclusions: This study demonstrated that the MHT is closely associated with the risk of PD in a regimen- and duration-specific manner. [ABSTRACT FROM AUTHOR]

Background: Although hypertension is a critical risk factor for dementia, the association between primary aldosteronism (PA) and dementia has been scarcely reported. We aimed to investigate whether the risk of dementia in patients with PA was elevated compared with patients with essential hypertension (EH). Methods: From the National Health Insurance Claim database in Korea (2003–2017), 3,687 patients with PA (adrenalectomy [ADX], n = 1,339, mineralocorticoid receptor antagonist [MRA] n = 2,348) with no prior dementia were age- and sex-matched at a 1:4 ratio to patients with EH (n = 14,741). The primary outcomes were all-cause dementia events, including Alzheimer's disease, vascular dementia, or other dementia combined with a prescription of one or more medications for dementia (donepezil, galantamine, memantine, or rivastigmine). Multivariable Cox regression models were used to evaluate the hazard ratios (HRs) and 95% confidence intervals for the outcome incidence rates between patients with PA and their EH matches. Results: During a median follow-up of 5.2 years, there were 156 cases of all-cause dementia (4.2%), 140 cases of Alzheimer's disease (3.8%), and 65 cases of vascular dementia (1.8%). Compared with EH, the risk of all-cause dementia was increased in treated PA (unadjusted hazard ratio [HR] 1.26; p < 0.011). Among PA, MRA group had higher risks of all-cause dementia, especially vascular dementia, adjusted for age, sex, income, comorbidities, and concurrent medication (adjusted HR 1.31; p = 0.027 and adjusted HR 1.62; p = 0.020, respectively) compared to EH. ADX group seemed to have a lower dementia risk than the EH group, but there was no statistical significance after full adjustment. This trend became more prominent when the dementia risks were evaluated from the time of hypertension diagnosis rather than treatment initiation for PA. Conclusion: The findings of this cohort study suggest that PA, especially the MRA group, is associated with an increased risk of dementia. Monitoring cognitive function in PA patients even after treatment initiation might be warranted to prevent dementia. [ABSTRACT FROM AUTHOR]

At first glance, it seems that South Korea's three fiscal systems (mid-term expenditure framework, top-down budgeting, and performance management) function well. However, each fiscal system operates separately and they are inefficient because they follow past practices. This article explains what the problems are and how to overcome them. [ABSTRACT FROM AUTHOR]

The South Korean government has been reforming its public expenditure management system since 2004. During this time, South Korea adopted new budgeting processes (for example mid-term expenditure framework, top-down budgeting, performance-based budgeting) and developed a new integrated financial information management system. In the course of implementing these reforms, South Korea has important insights and lessons to share with developing countries. South Korea may have valuable lessons for developing countries that want to create an advanced financial information system. Developing countries often use the World Bank and the IMF's ODA (official development assistance) to build an IFMIS. However, South Korea's second-generation DBAS is an alternative to consider and pilot. Governments adopting the South Korean model can specify particular subsets of IFMIS modules that fit their particular needs and budget systems, and a fully functioning adaptation can be assembled quickly and effectively. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcers are the main cause of non-traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Eight hundred and sixty diabetic patients were admitted to the diabetic wound centre of the Korea University Guro Hospital for foot ulcers between January 2010 and December 2013. Among them, 837 patients were successfully monitored until complete healing. Ulcers in 809 patients (96·7%) healed without major amputation and those in 28 patients (3·3%) healed with major amputation. Data of 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology and serology were collected from patients in the two groups and compared. Among the 88 potential risk factors, statistically significant differences between the two groups were observed in 26 risk factors. In the univariate analysis, which was carried out for these 26 risk factors, statistically significant differences were observed in 22 risk factors. In a stepwise multiple logistic analysis, six of the 22 risk factors remained statistically significant. Multivariate-adjusted odds ratios were 11·673 for ulcers penetrating into the bone, 8·683 for dialysis, 6·740 for gastrointestinal ( GI) disorders, 6·158 for hind foot ulcers, 0·641 for haemoglobin levels and 1·007 for fasting blood sugar levels. The risk factors for major amputation in diabetic foot patients were bony invasions, dialysis, GI disorders, hind foot locations, low levels of haemoglobin and elevated fasting blood sugar levels. [ABSTRACT FROM AUTHOR]

South Korea has gained international attention for its response to the Covid-19 pandemic: its so-called "K-Prevention". Dispersion and connection If we were to interpret the South Korean government's Covid-19 prevention regulations by the book, an entire staff and facility would be instantly off-limits if a single person among that organization's operating personnel were to be infected. While the urgency for dispersion of personnel to protect the dBrain was clear, the problem was that dBrain could only be operated at the locations where the government's secure network system had been installed. [Extracted from the article]