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Aim: This study aimed to determine the utility of chronic kidney disease (CKD)-related health states in the Korean general population by using the standard gamble (SG) method., Methods: Seven hypothetical CKD-related health states were developed and revised based on previous publications. Data from 242 individuals from the Korean general population were obtained via computer-assisted personal interviews and used to evaluate the CKD-related health states by using the visual analogue scale (VAS) and SG methods. Mean and median utility values were calculated for each health state. To assess the reliability of the valuation, some samples were retested and evaluated using intraclass correlation coefficients (ICC)., Results: In all health states, the utility weights from SG were higher than those from VAS. The difference in utility values between the two valuation methods ranged from 0.258 to 0.308. The utility value of CKD grade 3 was the highest and that of peritoneal dialysis (PD) was the lowest. The utility weights tended to decrease in accordance with the progression of CKD. CKD grade 3 was assigned a SG utility value of 0.878, whereas PD was assigned 0.507. The SG utility values of predialysis end-stage renal disease, haemodialysis, kidney transplantation (KT), and post-KT recovery states were 0.666, 0.547, 0.748 and 0.827, respectively. The mean ICC (SD) at the individual level was 0.746 (0.281) for the SG scores., Conclusion: Our results could be used to measure the burden of kidney disease or to evaluate the economic efficiency of CKD-related interventions., (© 2020 Asian Pacific Society of Nephrology.)

Objectives: Previous studies have demonstrated that the general public can report various patient safety incidents (PSIs) that are not identified by other methods. In this study, we investigated the characteristics of PSIs that the general public experience in Korea., Methods: In face-to-face surveys, participants were asked to report the frequency and type of PSIs, level of patient harm, and whether the PSIs were perceived as a medical error. We conducted logistic regression analysis to identify the sociodemographic factors of participants associated with their PSI experiences. Additionally, we analyzed relationships between the perception of PSIs as a medical error and both the type of PSIs and level of patient harm., Results: Among the 700 participants surveyed, 24 (3.4%) and 37 (5.3%) individuals reported that they or their family members experienced PSIs, respectively. Participants with at least a college degree were more likely to report PSI experiences than those with a lower educational level (odds ratio, 3.54; 95% confidence interval, 1.86-6.74). Whereas approximately half of participants (48.2%) involved in PSI experiences that caused no harm thought that there were medical errors in their PSIs, all participants (100%) who experienced PSIs with severe harm responded that medical errors occurred in their PSIs., Conclusions: The general public can report their experiences with PSIs. Periodic surveys that target the general public will provide additional data that reflect the level of patient safety from the viewpoint of the general public.

Objective: The aim of this study was to estimate the progress of insomnia prevalence and incidence over the past several years. Also, this study compared survival rates between individuals with and without insomnia., Methods: The National Health Insurance Service-National Sample Cohort (NHIS-NSC) from 2002-2013 was used for this study. Prevalent cases of insomnia were defined using ICD-10 codes F51.0 or G47.0, or a prescription of sedatives. Cox's proportional hazard analysis was conducted to compare survival rates between insomnia patients and people without insomnia., Results: In 2013, there were 46,167 (5.78%) insomnia patients over 20 years old in this cohort. Insomnia was more common among women and the elderly. Annual incidence over the past several years remained steady but the prevalence increased. The survival of insomnia patients was lower than that of people without insomnia, and the hazard ratio for overall mortality was 1.702 (p<0.001)., Conclusion: This large-scale population-based cohort study provided current epidemiologic indicators of insomnia in the Korean general population.

Background: The world is currently experiencing a pandemic of coronavirus disease 2019 (COVID-19). In Korea, as in other countries, the number of confirmed cases and deaths due to COVID-19 have been rising. This study aimed to calculate the burden of disease due to COVID-19 in Korea., Methods: We used data on confirmed cases and deaths due to COVID-19 between January 20 and April 24, 2020 provided by the Korea Centers for Disease Control and Prevention, the local governments and the public media to determine disability-adjusted life years (DALYs) by sex and age. Morbidity was estimated directly among the confirmed, cured, and fatal cases. Disability weights were adopted from previous similar causes on the severity of COVID-19 for the years of life lived with disability (YLDs). The years of life lost (YLLs) were calculated using the standard life expectancy from the 2018 life tables for each sex and age., Results: The YLDs were higher in females (155.2) than in males (105.1), but the YLLs were higher in males (1,274.3) than in females (996.4). The total disease burden attributable to COVID-19 in Korea during the study period, was estimated to be 2,531.0 DALYs, and 4.930 DALYs per 100,000 population. The YLDs and the YLLs constituted 10.3% and 89.7% of the total DALYs, respectively. The DALYs per 100,000 population were highest in people aged ≥ 80 years, followed by those aged 70-79, 60-69, and 50-59 years, but the incidence was the highest in individuals aged 20-29 years., Conclusion: This study provided the estimates of DALYs due to COVID-19 in Korea. Most of the disease burden from COVID-19 was derived from YLL; this indicates that decision-makers should focus and make an effort on reducing fatality for preparing the second wave of COVID-19., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2020 The Korean Academy of Medical Sciences.)

Objectives: Many countries and organizations have promoted the disclosure of patient safety incidents (DPSI). However, reporting frequency and quality of DPSI fall short of patient and caregiver' expectations. In this study, we examined the attitudes toward DPSI of the general public representing the Korean population., Methods: Survey questions were developed based on a previous systematic review and qualitative research. Face-to-face interviews using paper-based questionnaires were conducted. We explored attitudes toward DPSI in various scenarios and opinions on methods to facilitate DPSI., Results: Almost all participants answered that it is necessary to disclose major errors (99.9%) and near misses (93.3%). A total of 96.6% (675/699) agreed that "DPSI will lead physicians to pay more attention to patient safety in the future," and 94.1% (658/699) agreed that "DPSI will make patients and their caregivers trust the physician more." Although 79.7% (558/700) agreed that "apology law will limit patients' ability to prove physicians' negligence," 95.4% (668/700) agreed with "I support the introduction of apology law." Moreover, 90.6% (634/700) agreed with "I support the introduction of mandatory DPSI.", Conclusions: This study showed the overwhelmingly positive attitude of the public toward DPSI. The positive opinion of the public about apology law suggests the possibility of introducing the disclosure policy coupled with legislation of apology law in South Korea.

Background and Aims: To assess whether predictors of success in stopping smoking vary as a function of income level in Korean smoking cessation services., Design: Prospective study of predictors of smoking cessation up to 6 months' follow up., Participants: A sample of 954 people (mean age 49.13 ± 10.69 years; 863 [90.5%] men) enrolled in the Korean National Health Insurance Service smoking cessation programme in 2015., Measures: The outcome measure was self-reported continuous abstinence up to 6-month follow up. Predictors were income and other sociodemographic variables as well as smoking-related variables measured at baseline., Results: The continuous 6-month abstinence rate was 30.5%. The adjusted odds of 6-month continuous abstinence were lower among low-income versus the middle- or high-income smokers (OR, 0.54; 95% CI, 0.35-0.84), those with severe versus light/moderate cigarette dependence (OR, 0.72; 95% CI, 0.52-0.98), and use of bupropion versus varenicline (OR, 0.60; 95% CI, 0.39-0.91). The association between cigarette dependence and outcome was only present among low-income smokers., Conclusions: Lower income, higher cigarette dependence, and choice of bupropion versus varenicline are associated with lower chances of stopping smoking in Korean smoking cessation services, but the association with cigarette dependence is only found in low-income smokers., (© 2019 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

As patients in South Korea play the main role in choosing healthcare providers, understanding their attitudes and beliefs toward medical institutions is essential. This study evaluated the public's perspectives on doctors and local clinics. A face-to-face interview survey was conducted with 1000 participants who represent the South Korean adult population. The questionnaire consisted of four domains: personal information; trust level for nine professionals, including doctors; healthcare utilization behavior and attitudes regarding local clinics; and assessment of local clinics. The trust level of the doctor was highest (3.16 out of 4) among nine professionals. 85.3% of the participants frequently visited local clinics because of accessibility. The main reason for visiting hospitals over local clinics was the belief that doctors employed at hospitals would be better qualified. People were generally satisfied with the service of local clinics but wanted more facilities and equipment. Among six attributes of primary care, "first contact" and "accessibility" got higher scores in importance and current performance. Lastly, the participants suggested that improving the quality of doctors was most important for the reinforcement of primary care. Efforts to consider public opinion should be made before establishing healthcare policies for primary care.

Background: Burden of disease can be used to prioritize the healthcare budget allocation. We analyzed the research and development (R&D) budget of the Ministry of Health and Welfare (MOHW) in 2018 and compared the results with those of the 2015 Korean National Burden of Disease (KNBD) study., Methods: The 2018 MOHW R&D Project integrated implementation plan was used to analyze the R&D budget of the MOHW. The budget was allocated according to the KNBD disease group and according to the budget lines. The allocated budget was compared with the economic burden and the disability adjusted life years (DALYs) in 2015. Also, for budget targets for risk factors, DALYs of attributable risk factors were compared with corresponding budgets., Results: In 2018, the MOHW major R&D budget of USD 435.1 million accounted for 3% of the total government budget. Within the disease specific R&D budget, 35.9% was allocated to communicable disease groups, 64.1% to non-communicable diseases, and 0% to injury and violence. Among level 2 disease groups, neoplasm was ranked first. Among risk factors, climate change and behavioral risk were targeted for R&D., Conclusions: It would be difficult to say that current R&D allocations focus to minimize the burden of disease. A mismatch was observed between the R&D budget and the burden of disease in terms of economic burden and DALYs. There was a similar finding for risk factors R&D. A novel approach for allocating government R&D funding that is based on the goal of minimizing the disease burden in the Korean population should be considered., Competing Interests: Disclosure: The authors have no potential conflicts of interest to disclose.

Background: Disease burden can be represented by health-related parameters such as disability-adjusted life years and economic burden. Economic burden is an important index, as it estimates the maximum possible cost reduction if a disease is prevented. This study aimed to determine the economic burden of 238 diseases and 22 injuries in Korea in 2015., Methods: Economic burden was estimated with a human resources approach from a social perspective, and direct and indirect costs were calculated from insurance claims data and a cause of death database. Direct costs were divided into medical costs (including hospital admission, outpatient visit, and medication use) and nonmedical costs (including transportation and caregiver costs). Indirect costs from lost productivity, either from the use of healthcare service or premature death, were analyzed., Results: In 2015, the estimated economic burden was USD 133.7 billion (direct: USD 65.5 billion, indirect: USD 68.2 billion). The total cost of communicable diseases was USD 16.0 billion (11.9%); non-communicable diseases, USD 92.3 billion (69.1%); and injuries, USD 25.4 billion (19.0%). Self-harm had the highest costs (USD 8.3 billion), followed by low back pain (LBP, USD 6.6 billion). For men, self-harm had the highest cost (USD 7.1 billion), while LBP was the leading cost (USD 3.7 billion) for women., Conclusion: A high percentage of Korea's total socioeconomic disease burden is due to chronic diseases; however, unnoticed conditions such as infectious diseases, injuries, and LBP are high in certain age groups and differ by gender, emphasizing the need for targeted social interventions to manage and prevent disease risk factors., Competing Interests: Disclosure: The authors have no potential conflicts of interest to disclose.

Background: It is extremely important to objectively take a view of population health to provide useful information to decision makers, health-sector leaders, researchers, and informed citizens. This study aims to examine the burden of disease in Korea as of 2015, and to study how the burden of disease changes with the passage of time., Methods: We used results from the Korean National Burden of Disease and Injuries Study 2015 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive disability-adjusted life years (DALYs) by gender and age groups from 2007 to 2015. DALYs were calculated as the sum of the years of life lost (YLLs) and the years lived with disability (YLDs)., Results: In 2015, the burden of disease for Korean people was calculated at 29,476 DALYs per 100,000 population. DALYs caused by low back pain were the highest, followed by diabetes mellitus and chronic obstructive pulmonary disease. The burden of disease showed a consistently increasing trend from 2007 to 2015. Although YLLs have been on the decrease since 2011, the increase in YLDs has contributed to the overall rise in DALYs. The DALYs per 100,000 population in 2015 increased by 28.1% compared to 2007., Conclusion: As for the diseases for which the burden of disease is substantially increasing, it is needed to establish appropriate policies in a timely manner. The results of this study are expected to be the basis for prioritizing public health and health care policies in Korea., Competing Interests: Disclosure: The authors have no potential conflicts of interest to disclose.

Background: For the Korean Burden of Disease (KBD) 2015 study, we have amended disability weights for causes of disease adapting the methodology of the KBD disability weight 2012 study., Methods: We conducted a self-administered web-based survey in Korea using ranking five causes of disease. A total of 605 physicians and medical college students who were attending in third or fourth grade of a regular course performed the survey. We converted the ranked data into paired comparison data and ran a probit regression. The predicted probabilities for each cause of disease were calculated from the coefficient estimates of the probit regression. 'Being dead (1)' and 'Full health (0)' were utilized as anchor points to rescale the predicted probability on a scale from 0 to 1., Results: As a result, disability weights for a total of 289 causes of disease were estimated. In particular, we calculated the disability weights of 60 causes of disease considering severity level. These results show that prejudice about the severity of cause of disease itself can affect the estimation of disability weight, when estimating the disability weight for causes of disease without consideration of severity. Furthermore, we have shown that disability weights can be estimated based on a ranking method which can maximize efficiency of data collection., Conclusion: Disability weights from this study can be used to estimate disability adjusted life year and healthy life expectancy. Furthermore, we expected that the use of the ranking method will increase gradually in disability weight studies., Competing Interests: Disclosure: The authors have no potential conflicts of interest to disclose.

The premature birth rate in Korea has increased from 13.5% in 2008 to 15.7% in 2013. The complications of premature birth are a major determinant of neonatal mortality and morbidities. The purpose of this study was to estimate the burden of premature birth in Korea using disability-adjusted life years (DALY). DALY consists of years of life lost (YLL) and years lost due to disability (YLD). In this study, preterm birth complications refer to nine diseases: P07, P22, P25, P26, P27, P28, P52, P77, P612, and H351 (International Classification of Diseases-10th Revision). YLL was calculated using mortality data from the 2012 National Health Insurance Data. YLD is a function of the prevalence, disability weight (DW), and duration of each complication. DW was determined by the Korean Disability Weight Study for National Burden of Disease in Korea 2013/2015. The burden of premature birth in Korea is 79,574 DALY (YLL: 43,725; YLD: 35,849). The burden for men (DALY: 43,603; YLL: 24,004; YLD: 19,599) is higher than that of women (DALY: 35,970; YLL: 19,720; YLD: 16,250). This study could provide essential data for evaluating the effects of policies intended to reduce preterm birth.

Background: Globally, allergic diseases are very common in childhood and may affect children's quality of life. This study aimed to explore health-related quality of life of elementary school students with allergy symptoms using the EQ-5D-Y and to examine the validity and feasibility of the EQ-5D-Y., Methods: The study subjects were the students within 50 elementary schools which voluntarily participated in research project. In this sample population, the EQ-5D-Y questionnaire was self-administered by the students, and demographic and health information were collected from the student's parents. The parents' information was used to investigate the proportion of students with allergic symptoms (wheezing, runny or blocked nose, and itchy rash) in the past 12 months. In addition, we analyzed the correlation of symptom reporting and EQ-5D-Y including EQ-VAS., Results: The overall return was 9117 responses, of which 198 (2.2%) lacked responses on the EQ-5D-Y dimension and 1258 (13.8%) on the VAS score. There were significant differences in symptom reporting in all EQ-5D-Y dimensions between groups with or without allergic symptoms. Particularly, there was a large difference in reporting rates in 'having pain or discomfort' and 'feeling worried, sad or unhappy' dimensions. As the number of allergic symptoms increased, in all dimensions also the problem reporting rate tended to increase., Conclusions: As expected, the presence of allergic symptoms is inversely correlated with the quality of life of children. The EQ-5D-Y instrument proved to be useful in terms of feasibility and construct validity in assessing the quality of life of Korean elementary school students.

Purpose: The standard gamble (SG) method is the gold standard for valuing health states as a utility, although it is accepted that it is difficult to valuate health states. This study was conducted in order to compare the SG with the rating scale (RS) and time trade-off (TTO) techniques in terms of their feasibility, comparability, and reliability in a valuation survey of the general Korean population., Methods: Five-hundred members of the general Korean population were recruited using a multi-stage quota sampling method in Seoul and its surrounding areas, Korea. Respondents evaluated 9 EQ-5D-5L health states using a visual analogue scale (VAS), SG, and TTO during a personal interview. Feasibility was assessed in aspects of the level of difficulty, administration time, and inconsistent responses. Comparability was evaluated using intraclass correlation coefficient (ICC) and the Bland-Altman approach. Test-retest reliability was analyzed using the ICC., Results: Of the three methods, VAS was the easiest and quickest method to respond. The SG method did not differ significantly compared to the TTO method in administration time as well as the level of difficulty. The SG and TTO values were highly correlated (r = 0.992), and the average mean difference between the SG and the TTO values was 0.034. The ICCs of the VAS, SG, and TTO scores were 0.906, 0.841, and 0.827, respectively., Conclusions: This study suggests that the SG method compared with the VAS and TTO method was feasible and offered a reliable tool for population-based, health state valuation studies in Korea.

Background: Determining the cost of a disease is one of the approaches to estimate the burden of the disease. This study was aimed to estimate the socioeconomic burden of chronic kidney disease (CKD) by CKD stages and treatment strategies in Korea., Methods: This was a population-based study designed to estimate the cost of CKD according to CKD stages and treatment strategies from a societal perspective in Korea using multiple data sources. Costs of CKD stages III, IV, and V, hemodialysis (HD), and peritoneal dialysis (PD) were estimated with a prevalence-based method. Costs of kidney transplantation (KT) and post kidney transplantation were estimated using an incidence-based method. Costs consisted of direct medical cost, productivity loss cost due to hospitalization and outpatient visit, caregiver cost, and transportation cost., Results: Direct medical cost per year per patient with CKD stages III, IV, and V were 1205, 1963, and 8035 Euros, respectively. Direct medical cost per year per patient receiving HD and PD was 34,554 and 25,806 Euros, respectively. Medical cost per year per KT patient was 68,798 Euros. Direct medical cost which accounted for 70% of the total cost of CKD IV and 87% of the total cost of post KT. Cost associated with productivity loss was approximately 8-20%., Conclusions: Our findings could be useful for evaluating cost-effectiveness of various CKD interventions including the screening strategy. This study also emphasizes a remarkable increase in the socioeconomic burden associated with the progression of CKD in patients.

Objectives: We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI)., Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them., Results: There was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI., Conclusions: The reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.

Teenage mothers are at high risk for maternal and neonatal complications. This study aimed to evaluate the socioeconomic circumstances of teenage pregnancy, and determine whether these increased risks remained after adjustment for socioeconomic circumstances in Korea. Using the National Health Insurance Corporation database, we selected women who terminated pregnancy, by delivery or abortion, from January 1, 2010 to December 31, 2010. Abortion, delivery type, and maternal complications were defined based on the International Classification of Diseases-10th Revision. We compared teenagers (13-19 years at the time of pregnancy termination) with other age groups and investigated differences based on socioeconomic status, reflected by Medical Aid (MA) and National Health Insurance (NHI) beneficiaries. We used multivariate analysis to define the factors associated with preterm delivery. Among 463,847 pregnancies, 2267 (0.49%) involved teenagers. Teenage mothers were more likely to have an abortion (33.4%) than deliver a baby when compared with other age groups (20.8%; P < 0.001). About 14.4% of teenage mothers had never received prenatal care throughout pregnancy. Among teenage mothers, 61.7% of MA recipients made fewer than 4 prenatal care visits (vs 38.8% of NHI beneficiaries) (P < 0.001). Teenage mothers more often experienced preterm delivery and perineal laceration (P < 0.001). Teenage mothers (<20 years) were 2.47 times more likely to have preterm delivery than older mothers (20-34 years; P < 0.001). Teenage mothers had higher risk of inadequate prenatal care and subsequently of preterm delivery, which remained significantly higher after adjusting for socioeconomic confounding variables and adequacy of prenatal care in Korean teenagers (P < 0.001).

We sought to estimate the prevalence of coronary atherosclerosis by coronary computed tomographic angiography (CCTA) and to identify risk factors attributable to the development of coronary atherosclerosis in an asymptomatic Asian population. We analyzed 6,311 consecutive asymptomatic individuals aged 40 and older with no prior history of coronary artery disease (CAD) who voluntarily underwent CCTA evaluation as part of a general health examination. The mean age of study participants was 54.7 ± 7.4 years, and 4,594 (72.8%) were male. After age and gender adjustment using the population census of the National Statistical Office, the prevalence of plaque was 40.5% [95% confidence interval (CI) 38.1-42.9], and significant CAD (diameter stenosis ≥50%) was observed in 9.0% (95% CI 7.7-10.2). Individuals with significant CAD were significantly older than those without (59.2 ± 8.8 vs. 54.0 ± 7.1 years, p < 0.001). Compared with individuals with no cardiovascular risk factors, there was a higher prevalence of significant CAD in individuals with diabetes mellitus [standardized rate ratio (SRR) 2.66; 95% CI 1.93-3.68; p < 0.001], hypertension (SRR 2.24; 95% CI 1.69-2.97; p < 0.001), or hyperlipidemia (SRR 1.65; 95% CI 1.25-2.17; p < 0.001). There was also a greater prevalence of significant CAD in individuals with an intermediate or high Framingham risk score (SRR 5.91; 95% CI 2.34-14.95; p < 0.001) or a high atherosclerotic cardiovascular disease risk score (SRR 8.04; 95% CI 3.04-21.23; p < 0.001). The prevalence of coronary atherosclerosis in this Asian population was not negligible and was associated with known cardiovascular risk factors and high-risk individuals.

Background: Internet search queries have become an important data source in syndromic surveillance system. However, there is currently no syndromic surveillance system using Internet search query data in South Korea., Objectives: The objective of this study was to examine correlations between our cumulative query method and national influenza surveillance data., Methods: Our study was based on the local search engine, Daum (approximately 25% market share), and influenza-like illness (ILI) data from the Korea Centers for Disease Control and Prevention. A quota sampling survey was conducted with 200 participants to obtain popular queries. We divided the study period into two sets: Set 1 (the 2009/10 epidemiological year for development set 1 and 2010/11 for validation set 1) and Set 2 (2010/11 for development Set 2 and 2011/12 for validation Set 2). Pearson's correlation coefficients were calculated between the Daum data and the ILI data for the development set. We selected the combined queries for which the correlation coefficients were .7 or higher and listed them in descending order. Then, we created a cumulative query method n representing the number of cumulative combined queries in descending order of the correlation coefficient., Results: In validation set 1, 13 cumulative query methods were applied, and 8 had higher correlation coefficients (min=.916, max=.943) than that of the highest single combined query. Further, 11 of 13 cumulative query methods had an r value of ≥.7, but 4 of 13 combined queries had an r value of ≥.7. In validation set 2, 8 of 15 cumulative query methods showed higher correlation coefficients (min=.975, max=.987) than that of the highest single combined query. All 15 cumulative query methods had an r value of ≥.7, but 6 of 15 combined queries had an r value of ≥.7., Conclusions: Cumulative query method showed relatively higher correlation with national influenza surveillance data than combined queries in the development and validation set.

Purposes: This study aimed to measure utilities, which are quantitative terms incorporating preferences, for various health states of epilepsy with partial seizure in the general population in South Korea. It also aimed to find socio-demographic characteristics associated with the utility scores., Methods: Utility scores using Time Trade-Off (TTO), Visual Analog Scale (VAS), and EuroQol five Dimension (EQ-5D) were obtained from 300 people aged 16 and over by face-to-face interviews. We measured utilities for three hypothetical health states of epilepsy for which scenarios were defined based on the frequency of partial seizure: seizure-free, seizure reduction, and withdrawal. We compared utilities with varying seizure frequency using a repeated-measures ANOVA, and analyzed the association between utilities and socio-demographic characteristics using a generalized estimating equation (GEE)., Results: The mean utility scores for withdrawal state, seizure reduction state, and seizure-free state were 0.303, 0.493, and 0.899, respectively, when measured by TTO. VAS yielded the mean utility scores of 0.211, 0.424, and 0.752 for respective health states, and corresponding scores with EQ-5D were 0.261, 0.645, and 0.959. The utility scores for the three health states were statistically different in TTO, VAS, and EQ-5D. The withdrawal state had the lowest utility scores. There were differences in mean utilities for the three health states across the three methods. Utilities by EQ-5D tended to have higher values than those by TTO and VAS. Utilities by VAS had the lowest values. In GEE analysis, the severity of epilepsy and household income were significantly related to utility scores., Conclusion: The withdrawal state of epilepsy had the lowest utility value and the seizure-free state had the highest by all three techniques of utility measurement used. There were significant differences in utilities between one severity level of epilepsy and another. Utility was associated with household income and the severity of disease. Utility scores for distinct epilepsy states obtained in this study could facilitate health economic analyses of epilepsy treatments and thus help decision making in resource allocation., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Improvements in mobile telecommunication technologies have enabled clinicians to collect patient-reported outcome (PRO) data more frequently, but there is as yet limited evidence regarding the frequency with which PRO data can be collected via smartphone applications (apps) in breast cancer patients receiving chemotherapy., Objective: The primary objective of this study was to determine the feasibility of an app for sleep disturbance-related data collection from breast cancer patients receiving chemotherapy. A secondary objective was to identify the variables associated with better compliance in order to identify the optimal subgroups to include in future studies of smartphone-based interventions., Methods: Between March 2013 and July 2013, patients who planned to receive neoadjuvant chemotherapy for breast cancer at Asan Medical Center who had access to a smartphone app were enrolled just before the start of their chemotherapy and asked to self-report their sleep patterns, anxiety severity, and mood status via a smartphone app on a daily basis during the 90-day study period. Push notifications were sent to participants daily at 9 am and 7 pm. Data regarding the patients' demographics, interval from enrollment to first self-report, baseline Beck's Depression Inventory (BDI) score, and health-related quality of life score (as assessed using the EuroQol Five Dimensional [EQ5D-3L] questionnaire) were collected to ascertain the factors associated with compliance with the self-reporting process., Results: A total of 30 participants (mean age 45 years, SD 6; range 35-65 years) were analyzed in this study. In total, 2700 daily push notifications were sent to these 30 participants over the 90-day study period via their smartphones, resulting in the collection of 1215 self-reporting sleep-disturbance data items (overall compliance rate=45.0%, 1215/2700). The median value of individual patient-level reporting rates was 41.1% (range 6.7-95.6%). The longitudinal day-level compliance curve fell to 50.0% at day 34 and reached a nadir of 13.3% at day 90. The cumulative longitudinal compliance curve exhibited a steady decrease by about 50% at day 70 and continued to fall to 45% on day 90. Women without any form of employment exhibited the higher compliance rate. There was no association between any of the other patient characteristics (ie, demographics, and BDI and EQ5D-3L scores) and compliance. The mean individual patient-level reporting rate was higher for the subgroup with a 1-day lag time, defined as starting to self-report on the day immediately after enrollment, than for those with a lag of 2 or more days (51.6%, SD 24.0 and 29.6%, SD 25.3, respectively; P=.03)., Conclusions: The 90-day longitudinal collection of daily self-reporting sleep-disturbance data via a smartphone app was found to be feasible. Further research should focus on how to sustain compliance with this self-reporting for a longer time and select subpopulations with higher rates of compliance for mobile health care.

Context: Although the prevalence of both metabolic syndrome (MetS) and fractures increases with advancing age, studies on possible associations between these conditions in men are limited and the results are inconsistent., Objective: The objective of the study was to clarify the impact of MetS on the male risk of incident fractures., Design and Setting: This was a large, longitudinal study with an average 3-year follow-up period., Participants: Korean men (n = 16 078) aged 50 years or older who had undergone comprehensive routine health examinations participated in the study., Main Outcome Measures: Incident fractures found after baseline examinations were identified using selected International Classification of Diseases, tenth revision, codes in the nationwide claims database of the Health Insurance Review and Assessment Service of Korea., Results: In total, 158 men (1.0%) developed incident fractures. The fracture event rates for subjects with and without MetS were 26.2 and 35.7 per 10 000 person-years, respectively. After adjustment for potential confounders, subjects with MetS had a much lower risk of incident fractures than subjects without MetS (hazard ratio 0.662, 95% confidence interval 0.445-0.986). Furthermore, subjects with three and four or more MetS components had a 49.4% and 50.4% lower risk, respectively, of incident fractures compared with the subjects without any MetS components. Importantly, additional adjustment for body mass index eliminated the statistical significance of these associations., Conclusion: Our current results indicate that the beneficial effects of MetS in reducing fracture risk could be explained by the general obesity that accompanies MetS, although other related factors, such as greater padding effect, peripheral aromatization, or adipokine changes, may also contribute.

Purpose: The EQ-5D-5L was developed to compensate for a high ceiling effect and lack of descriptive richness of the EQ-5D-3L. We evaluated psychometric properties of EQ-5D-5L in the general population., Methods: Six hundred of adults were sampled from the general population in South Korea using a multistage stratified quota sampling method. Participants completed the EQ-5D-5L, EQ-5D-3L, and SF-36v2. One hundred participants were resurveyed for reliability evaluation. The ceiling effect, known-groups construct validity, convergent and discriminant validity, and reliability of EQ-5D-5L were evaluated., Results: A smaller proportion of participants answered 'no problem' to all dimensions of EQ-5D-5L (61.2 %) than EQ-5D-3L (65.7 %, p < 0.01), indicating a reduced ceiling effect. Female, elderly, low-educated, and low-income participants reported health problems more frequently, indicating known-groups construct validity. The mobility dimension of EQ-5D-5L was better correlated with the physical component score (|r| = 0.48) than the mental component score (|r| = 0.25) of the SF-36v2, and the anxiety/depression dimension was better correlated with mental component score (|r| = 0.45) than physical component score (|r| = 0.34), indicating convergent and discriminant validity. The intraclass correlation coefficient of EQ-5D-5L index was 0.75., Conclusions: The EQ-5D-5L has a smaller ceiling effect than the EQ-5D-3L and is a valid and reliable instrument to measure health-related quality of life in the general population.

Purpose: To evaluate the psychometric properties of the Korean short form-36 health survey version 2 for assessing the general population and to provide normative data on the general population., Methods: Six hundred members of the general Korean population were recruited using a multistage quota sampling method. Data quality was evaluated in terms of the completeness of the data and the response consistency index. Each psychometric property was evaluated using descriptive statistics, item internal consistency, item discriminant validity, known-group validity, internal consistency reliability, and exploratory factor analysis., Results: The rate of missing data was low, and the rate of consistent responses was similar to conventional criteria. Item internal consistency was acceptable across all scales, whilst item discriminant validity was satisfactory for five of the eight scales. Social functioning was the least acceptable in terms of not only item discriminant validity but also item consistency reliability (Cronbach's alpha = .64). Test-retest Pearson correlation coefficients ranged from .54 to .80. In known group comparison, male sex, age <60 years, high educational status, and the absence of any comorbidities were associated with higher scores than their counterparts. Item factor analysis yields the presence of six factors, accounting for 68.8% of the variance., Conclusion: The findings of this study generally support the use of the Korean short form-36 version 2 for evaluating the general population, although caution is recommended when interpreting the vitality, social functioning, and mental health scales. Further research is needed in Korea., (Copyright © 2013. Published by Elsevier B.V.)

This study was conducted to assess views of healthcare organizations on pay-for-performance (P4P) in terms of its design, possible effects, and unintended consequences. This is a cross-sectional, self-administered, internet-based survey. Eligible healthcare organizations were 3605 organizations in Korea. Healthcare organizations of 522, including 31 tertiary teaching hospitals, 182 general hospitals, 158 hospitals, and 152 clinics, were participated in this survey. Rates of awareness and support of P4P, preferred P4P program design, and possible effects and unintended consequences resulting from the P4P program were identified. There were variations in the awareness and support from the type of healthcare organization. The preferred design was quite different from the current design of the P4P program. They believed that the P4P program would not have a significant economic impact on their organizations, but that the P4P program could stimulate positive changes in their practice behaviors. They also showed considerable concerns about unintended consequences. P4P implementing agency such as HIRA in Korea should make an effort to improve healthcare organizations' understanding of the program. Also, HIRA could take into consideration of reflecting their reasonable opinions regarding its design components and unintended consequences., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: To estimate quality weights of EQ-5D health states with the time trade-off (TTO) method in the general population of South Korea., Methods: A total of 500 respondents valued 42 hypothetical EQ-5D health states using the TTO and visual analog scale. The quality weights for all EQ-5D health states were estimated by a random effects model and compared with those from studies in other countries., Results: Overall estimated quality weights for all EQ-5D health states from this study were highly correlated with those from previous studies, but quality weights of individual states were substantially different from those of their corresponding states in other studies., Conclusions: The Korean value set differed from value sets from other countries. Special caution is needed when a value set from one country is applied to another with a different culture.

Objective: Public media reports of institutional Cesarean section rates have been used as a tool to reduce unnecessary surgical births. We examined women's awareness of the public release of this information according to socio-demographic characteristics in South Korea., Methods: The public release of institutional Cesarean section rates occurred on July 7, 2000. Seven months later, from February 7 to 14, 2001, we conducted a cross-sectional telephone survey of South Korean women aged 20-49 years (N=505, response rate=57.3%) with a nationwide sample using a proportionate quota and systematic random sampling method., Results: A total of 228 women (45.1% of 505) were aware of the public release of Cesarean section rates 7 months before. The awareness level differed by age and parity. After adjusting for age and parity, the awareness level was patterned by women's educational attainment and income. Women with low socioeconomic status held a lower awareness level compared with their counterparts. Level of respondent's interest in health related information was significantly associated with awareness of public release. Socioeconomic differentials in awareness were partly explained by the level of respondent's interest in health related information., Conclusion: Policy efforts to increase awareness of public media reports on institutional Cesarean section rates among disadvantaged women are needed.

Objectives: An abrupt economic decline may widen the socioeconomic differences in health between the advantaged and disadvantaged in a society. The aim of this study was to examine whether the South Korean economic crisis of 1997-98 affected the socioeconomic inequality from all-causes and from cause-specific mortality between 1995 and 2001., Methods: Population denominators were obtained from the registration population data, with the number of death (numerators) calculated from raw death certificate data. The indicator used to assess the geographic socioeconomic position was the per capita regional tax revenue. Administrative districts (Si-Gun-Gu) were ranked according to this socioeconomic measure, and divided into equal population size quintiles on the basis of this ranking. The sex- and 5-year age-specific numbers of the population and deaths were used to compute the sex- and age-adjusted mortality rates (via direct standardization method), standardized mortality ratios (via indirect standardization methods) and relative indices of inequality (RII) (via Poisson regression)., Results: Geographic inequalities from all-causes of mortality, as measured by RII, did not increase as a result of the economic crisis (from 1998-2001). This was true for both sexes and all age groups. However, the cause-specific analyses showed that socioeconomic inequalities in mortalities from external causes were affected by South Korean economic crisis. For males, the RIIs for mortalities from transport accidents and intentional self-harm increased between, 1995 and 2001. For females, the RII for mortality from intentional self-harm increased during the same period., Conclusions: The South Korean economic crisis widened the geographic inequality in mortalities from major external causes. This increased inequality requires social discourse and counter policies with respect to the rising health inequalities in the South Korean society.

Objective: To examine the trends in the relationship between caesarean section rates in South Korea and its correlates., Design: Five rounds (1988, 1991, 1994, 1997 and 2000) of population-based National Fertility and Family Health Survey of South Korea., Setting: South Korea. Sample Mothers (N= 9184) aged 15-44 years., Methods: Caesarean rates were calculated according to correlates and then directly adjusted to five-year age and parity groups. Distribution of all samples (9184 mothers) was standard, producing age- and parity-adjusted caesarean rates. Linear trends of correlates with caesarean rates were examined for ordinal variables such as education, income, urbanisation level (area of residence) and level of prenatal visits., Main Outcome Measure: Age- and parity-adjusted caesarean section rates., Results: As caesarean rates rose by year, the relationship of caesarean section with education, occupation and area of residence has been reversed. Associations between caesarean rates, income level, place of delivery and level of prenatal visit were found in 1988 but disappeared by 2000. In 2000, relatively low caesarean rates were found in variables that will be more prevalent in the future, such as higher maternal education, higher maternal occupation and residence in big cities., Conclusion: Caesarean rates may have reached a plateau in South Korea. No maternal or health service factors were detected to further increase the proportion of caesarean deliveries.

Objectives: Studies on the geographical differences in mortality tend to use a census population, rather than a registration population, as the denominator of mortality rates in South Korea. However, an administratively determined registration population would be the logical denominator, as the geographical areas for death certificates (numerator) have been determined by the administratively registered residence of the deceased, rather than the actual residence at the time of death. The purpose of this study was to examine the differences in the total number of a district population, and the associated district-specific mortality indicators, when two different measures as a population denominator (census and registration) were used., Methods: Population denominators were obtained from census and registration population data, and the numbers of deaths (numerators) were calculated from raw death certificate data. Sex- and 5-year age-specific numbers for the populations and deaths were used to compute sex- and age-standardized mortality rates (by direct standardization methods) and standardized mortality ratios (by indirect standardization methods). Bland-Altman tests were used to compare district populations and district-specific mortality indicators according to the two different population denominators., Results: In 1995, 9 of 232 (3.9%) districts were not included in the 95% confidence interval (CI) of the population differences. A total of 8 (3.4%) among 234 districts had large differences between their census and registration populations in 2000, which exceeded the 95% CI of the population differences. Most districts (13 of 17) exceeding the 95% CI were rural. The results of the sex- and age-standardized mortality rates showed 15 (6.5%) and 16 (6.8%) districts in 1995 and 2000, respectively, were not included in the 95% CI of the differences in their rates. In addition, the differences in the standardized mortality ratios using the two different population denominators were significantly greater among 14 districts in 1995 and 11 districts in 2002 than the 95% CI. Geographical variations in the mortality indicators, using a registration population, were greater than when using a census population., Conclusion: The use of census population denominators may provide biased geographical mortality indicators. The geographical mortality rates when using registration population denominators are logical, but do not necessarily represent the exact mortality rate of a certain district. The removal of districts with large differences between their census and registration populations or associated mortality indicators should be considered to monitor geographical mortality rates in South Korea.

Objectives: Previous studies showed that death certification by physicians was an important predictor to improve the quality of death certificate data in South Korea. This study was conducted to examine the proportion of death certificates issued by physicians and associated factors in South Korea from 1990 to 2002., Methods: Data from 3, 110, 883 death certificates issued between 1990 and 2002, available to the public from the National Statistical Office of Korea, were used to calculate the proportion of death certificates issued by physicians and to examine associated factors with logistic regression analysis., Results: The overall proportion of death certificates issued by physicians increased from 44.6% in 1990 to 77.6% in 2002 (mean: 63.5%). However, the proportion was greatly influenced by the deceased's age. In 2002, more than 90% of the deceased aged 51 or less were certified by physicians. A higher proportion was found among deceased who had tertiary education (college or higher) living in more developed urban areas., Conclusions: The information regarding the cause of death for younger, well-educated deceased in urban areas of South Korea may show a higher level of accuracy. Epidemiologic research using information on causes of death may well benefit from the continually increasing proportion of death certificates issued by physicians in the future in South Korea.