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Background: Fractional microneedle radiofrequency (FMR) devices deliver energy to the deep dermis through insulated microneedles without destroying the epidermis. These FMR devices have been shown to be effective for the treatment of wrinkles, acne scars and large pores. In this study it was postulated that FMR energy could specifically affect the sweat glands, preserving the skin surface even if sweat glands were seated in the deep dermis. Objective: To evaluate the efficacy and safety of FMR for primary axillary hyperhidrosis (PAH) treatment and to conduct a histological analysis before and after treatment. Methods: Twenty patients with PAH had 2 sessions of bipolar FMR treatment at 4-week intervals. Clinical improvement was evaluated using a Hyperhidrosis Disease Severity Scale (HDSS) and photographs were taken using the starch-iodine test at every visit and 2 months after the last treatment. The amount of sweat reduction was indirectly assessed using a Tewameter™. Skin biopsies were obtained from 3 of the enrolled patients before and after treatment. The satisfaction and adverse reactions of the research participants were recorded at every follow-up visit. Results: HDSS scores decreased significantly from a baseline of 3.3 to 1.5 and 1.8 after the first and second months of posttreatment follow-up sessions, respectively (p < 0.001). In response to a subjective assessment at 1 month after the second treatment, 75% of patients (n = 15) had an HDSS score of 1 or 2, and 70% of patients (n = 14) expressed more than 50% improvement in their sweating. The starch-iodine reaction was also remarkably reduced in 95% of patients (n = 19) after FMR treatment. Histological findings showed a decrease in the number and size of both apocrine and eccrine glands 1 month after the final treatment. Side effects were minimal and included mild discomfort, transient swelling and postinflammatory hyperpigmentation. Conclusion: FMR treatment was effective for the treatment of PAH without significant adverse reactions due to direct volumetric heating of the lower dermis.

Purpose Although Korea has the highest incidence of gastric cancer worldwide and D2-lymphadenectomies are routinely performed, radiotherapy (RT) practice patterns have not been well studied. Therefore, we examined RT usage trends for neoadjuvant/adjuvant patients and identified factors associated with RT. We also examined survival benefits and net medical cost advantages of adding RT. Materials and methods Patients diagnosed with gastric cancer who underwent gastrectomy from 2002-2013 were identified using National Health Insurance Service-National Sample Cohort. Results Annually, 30.9 cases per 100,000 population in crude rate underwent gastrectomy in 230 hospitals and 49.8% received neoadjuvant/adjuvant therapy in 182 hospitals. For neoadjuvant/adjuvant patients, postoperative chemo-RT was administered in 4% of cases in 26 hospitals. No significant trends regarding treatment type were observed over time. Having undergone RT was inversely associated with being ≥ 60 years old and having a low income. Having undergone RT was positively related to having a Charlson comorbidity index ≥ 4, hospital location and hospital volume (≥ 2,000 beds). Significant portions of patients treated with RT in this nation (52%) were concentrated in one large-volume hospital. Use of RT linked to increased cost of primary treatment, yet not to reduced overall medical expense. RT did not influence both on overall and disease-specific survivals after adjusting for potential confounders (p > 0.05). Conclusion RT was uncommonly utilized as adjuvant or neoadjuvant treatment by physicians in Korea. Despite intrinsic drawback in this data, we did not find either survival benefit or net medical cost advantage by adding RT in adjuvant treatment.

Supplemental Digital Content is available in the text, The uncomfortable symptoms of atopic dermatitis (AD) often trigger psychological stress. We investigated the association between AD severity and outpatient visits to psychiatrists using Korean National Health Insurance claims data from 2004 to 2013. This was a retrospective cohort analysis; we estimated hazard ratios (HRs). Of the 266,182 subjects, 18,290 (6.9%) had a history of visiting a psychiatrist, and 25,419 (9.5%) were diagnosed with AD. Compared with the subjects without AD, subjects with AD had a higher HR for visiting a psychiatrist (3.70, 95% confidence interval [CI]:48 3.43–3.98), and this significantly increased as the complexity of the AD medications increased. Subjects who received topical treatments plus a systematic steroid (HR: 4.88, 95% CI: 4.51–5.27) and those who received topical treatments plus a systematic steroid plus a systematic calcineurin inhibitor (HR: 9.56, 95% CI: 4.29–21.28) had higher HRs compared with those without AD. Severe AD patients exhibited greater psychological stress than those without AD or with mild AD symptoms. Moreover, medication diversity may represent an efficient and low-cost method by which to identify a vulnerable population.

Background Numerous studies suggesting the relation between self-rated health (SRH) and depression have been reported using different measures. Therefore, we attempted to determine the difference in a depressive scale based on the different ways of measuring health between global SRH (SRH-global) and age-comparative SRH (SRH-age). Then, the combined effect of SRH-global and SRH-age on depressive symptoms was further investigated. Methods Data from the Korean Longitudinal Study of Ageing (KLoSA) from 2008 to 2012 were analyzed. We divided the SRH-global and SRH-age into three levels—high, middle, and low—and combined each into nine new categories (SRH-combi). The Center for Epidemiologic Studies Depression Scale-10 Korean edition was used as the dependent variable. Results A total of 8621 participant were enrolled at baseline. Individuals with lower SRHs-age compared to SRH-global tended to be more vulnerable to depressive symptoms. Low SRH-global with low (b = 0.654, p

Supplemental Digital Content is available in the text, Unnecessary use of high-quality resources in general hospitals hinders treatment of patients with urgent and complicated conditions. Thus, the Korean Government has sought to reduce general hospital visiting of patients with 52 mild diseases, including hypertension. The higher cost sharing for medical expenses and medications from general hospitals were enacted in 2009 and 2011, respectively. We determined whether these regulations were effective through evaluating changing trends in first-visited healthcare organizations and defined the first visiting healthcare organization level (primary clinics, hospital, and general hospital) as an outcome measure. Data of 32,830 mild hypertension patients from 2004 to 2013 were retrieved from the Korean National Health Insurance Service National Sample Cohort. This was a retrospective study involving a large national cohort with patient samples (representing 2% of the total Korean population) stratified on the basis of sociodemographic information. Mutinomial logistic regression were performed for the first visiting to different health organizations, compared to the first visiting to primary clinics. Patients in 2012 and 2013 had significantly lower odds (“2012”: 0.68, 95% confidence interval [CI]: 0.56–0.81/“2013”: 0.66, 95% CI 0.54–0.81) of first visiting general hospitals compared with those in 2008, although decreased tendencies (albeit nonsignificant) were already evident in 2010 and 2011. Thus, government health policies for cost-containment seem effective in decreasing first visiting of general hospitals among patients with mild essential hypertension. These policies have since extended to Medical Aid beneficiaries; thus, it is needed to continue monitor their results carefully.

Background Previous studies have examined associations between sitting time and negative health outcomes and mental health. However, the relationship between overall sitting time and major depressive disorder (MDD) in South Korea has not been studied. This study examined the association between MDD and overall sitting time and physical activity in South Koreans. Methods Data from the sixth Korean National Health and Nutrition Examination Survey (KNHANES), a cross-sectional, nationally representative survey, were analyzed. Total participants were 4145 in 2014. MDD was assessed using the Patient Health Questionnaire (PHQ-9). Participants’ data regarding self-reported sitting time and physical activity were analyzed via multiple logistic regression. Results Results showed that people who sat for 8–10 h (OR: 1.56, 95% CI: 1.15–2.11) or more than 10 h (OR: 1.71, 95% CI: 1.23–2.39) had increased risk of MDD compared to those who sat for less than 5 h a day. Subgroup analysis showed that the strongest effect of reported sitting time on risk of MDD was found in men with lower levels of physical activity who sat for 8 to 10 h (OR: 3.04, 95% CI: 1.15–8.01) or more than 10 h (OR: 3.43, 95% CI: 1.26–9.35). Level of physical activity was not an independent predictor for MDD. Conclusions Sitting for long periods was associated with greater risk of MDD in South Korean adults. Reducing sitting time in people with MDD could help to prevent associated physical health problems and may improve mental health. Electronic supplementary material The online version of this article (doi:10.1186/s12888-017-1439-3) contains supplementary material, which is available to authorized users.

Introduction: Dementia is the leading cause of disability worldwide in the elderly individuals. Although prior studies have examined psychiatric symptoms in dementia caregivers, few studies have examined physician-diagnosed depression in the family caregiver of a patient with dementia. Methods: We used data from 457 864 respondents from the Korea Community Health Survey. We used logistic regression to examine the relationship between physician-diagnosed depression and cohabitation with a patient with dementia. Results: Cohabitation with a patient with dementia (1.2% of the Korean population) was significantly associated with physician-diagnosed depression. The significance remained in females when the data were stratified by sex. A significant association also occurred among males with low family income. Conclusion: To reduce the burden of dementia, we need a management policy that includes the caregiver as well as the patient with dementia. In particular, political management for the vulnerable population, male caregiver in low-income family and female caregiver in high-income family, should be prepared.

Background: The socioeconomic status of a person has an impact on his or her access to kidney transplantation as has been reported in western countries. This study examined the association between income level and kidney transplantation among chronic kidney disease patients undergoing dialysis in South Korea. Methods: We analyzed data from 1,792 chronic kidney disease patients undergoing dialysis and listed in the Korean National Health Insurance Claim Database (2003-2013). The likelihood of receiving the first kidney transplant over time was analyzed using competing risk proportional hazard models on time from initiating dialysis to receiving a transplant. Results: Of 1,792 patients on dialysis, only 184 patients (10.3%) received kidney transplants. Patients with medical aid had the lowest kidney transplantation rate (hazard ratio 0.29, 95% CI 0.16-0.51). A lower income level was significantly associated with a low kidney transplantation rate, after adjusting for covariates, compared to patients in the high-income level group. Conclusions: Our findings indicate that in South Korea, the total number of kidney transplants is remarkably low and there exists income disparity with regard to access to kidney transplantation. Thus, we suggest that plans be implemented to encourage organ donation and increase organ transplant accessibility for all patients irrespective of their socioeconomic status.

Figure S3. Values of estimates for CES-D by each nine SRH-combined categories by gender. SRH means self-rated health. SRH-global is general self rated health, while SRH-age is age-comparative self–rated health. Among men, subjects with low SRH-age and all kinds of SRH-global levels (low; b = 0.825, p

Background Cytosolic NADP+-dependent ICDH (IDPc) has an antioxidant effect as a supplier of NADPH to the cytosol, which is needed for the production of glutathione. Objective To evaluate the expression of IDPc in melanocytes and to elucidate its role as an antioxidant. Methods The knock-down of IDPc expression in immortalized mouse melanocyte cell lines (melan-a) was performed using the short interfering RNA (siRNA)-targeted gene silencing method. After confirming the silencing of IDPc expression with mRNA and protein levels, viability, apoptosis and necrosis, as well as ROS production in IDPc-silenced melanocytes were monitored under conditions of oxidative stress and non-stress. Also, the ratio of oxidized glutathione to total glutathione was examined, and whether the addition of glutathione recovered cell viability, decreased by oxidant stress, was checked. Results The expression of IDPc in both primary human melanocytes and melan-a cells was confirmed by Western blot and RT-PCR. The silencing of IDPc expression by transfecting IDPc siRNA in melan-a cells was observed by Western blotting and real-time RT-PCR. IDPc knock-down cells showed significantly decreased cell viability and an increased number of cells under apoptosis and necrosis. IDPc siRNA-treated melanocytes demonstrated a higher intensity of DCFDA after the addition of H2O2 compared with scrambled siRNA-treated melanocytes, and a lower ratio of reduced glutathione to oxidized glutathione were observed in IDPc siRNA transfected melanocytes. In addition, the addition of glutathione recovered cell viability, which was previously decreased after incubation with H2O2. Conclusions This study suggests that decreased IDPc expression renders melanocytes more vulnerable to oxidative stress, and IDPc plays an important antioxidant function in melanocytes.

Background: Segmental vitiligo (SV), which frequently accompanies poliosis, indicating a poor prognosis that is likely resistant to treatments. Objectives: In this study, we performed a retrospective analysis to evaluate the treatment response to 308 nm excimer laser in SV patients. Methods: A retrospective chart and photographic review was performed on 80 SV patients who had been treated with 308 nm excimer laser for >3 months. Results: Eighty patients with SV (mean age: 24.0 years ± 15.3, males: 50%) were included in this study. The mean grade of repigmentation was 2.3 after 20.6 months of mean treatment duration; 23.8% of 80 patients showed grade 4, 20% showed grade 3, and 56.2% showed grade 1–2 repigmentation. However, none of them achieved complete repigmentation with excimer laser. The degree of repigmentation was positively correlated with treatment duration (r=0.315, P=0.004) and cumulative ultraviolet (UV) dosage (r=0.366, P=0.001), whereas it was negatively correlated with disease duration (r=−0.265, P=0.017). Conclusion: This study suggests that SV has a better repigmentation response when excimer laser is used at earlier stages of the disease and long-term use and high cumulative UV energy of the excimer laser elicit better responses. Additional treatments like surgical procedures in addition to excimer laser should be considered for complete repigmentation.

To investigate the association between spouse cognitive status and depressive symptoms in cohabiting spouses, and to further analyze how participation in social network-enhancing activities interplays in the objected relationship.Data from the Korean Longitudinal Study of Aging, 2006-2012, were used. A total of 2782 male and 2515 female married participants currently cohabiting with their partners were included in the baseline. The association between spouse cognitive status and depressive symptoms, measured using the Center for Epidemiological Studies Depression scale, was investigated through the generalized estimating equation model.When setting the participants living with spouses of normal cognitive function as reference, participants living with spouses having mild dementia (male β 0.7349, P ≤ 0.0001; female β 0.8042, P ≤ 0.0001), and moderate and severe dementia (male β 1.1504, P ≤ 0.0001; female β 1.2462, P ≤ 0.0006) showed higher depression scores in a dose-response relationship. Additionally, male and female subjects participating in social network facilitating activities had lower increases in depression scores than their non-participating counterparts.Spouse cognitive impairment is associated with increasing depression scores in cohabiting caregivers. Individuals not participating in social network-facilitating activities are more vulnerable to the negative mental health effects of spouse cognitive impairment. Hence, considering the increasing importance of late life depression and cognitive decline in aging societies, it is important to note the protective effects of social network and support in addressing the mental health of spouse caregivers. Geriatr Gerontol Int 2017; 17: 973-983.

The aim of the present study was to examine a relationship between altered social activity and quality of life in later life.Data came from the Korean Longitudinal Study of Aging (2006-2012), which consisted of 7096 participants aged 45 years or older. Change in social activity was classified into four categories; that is, "consistent non-participation," "participation to no participation," "no participation to participation" and "consistent participation." Social activity was divided into various elements, and the same analysis was carried out for each element. The linear mixed model was used to investigate the association between changes in social activity and quality of life among middle-aged and elderly Koreans.Those with changes from "participation to no participation" (b 2.253, P 0.0001), "no participation to participation" (b 3.348, P 0.0001) and "consistent participation" (b 6.624, P 0.0001) were more likely to be satisfied with their lives than those with "consistent non-participation" (P 0.0001 for trend). In addition, the impact of the positive relationship between consistent participation in social activity and quality of life varied across different elements of social activity. The positive association was particularly strong for religious activities, friendship organization, leisure/culture clubs, family/school reunion and voluntary work (b 1.451, P 0.0004; b 5.049, P 0.0001; b 4.903, P 0.0001; b 4.757, P 0.0001; b 4.562, P 0.0001; respectively, for consistent participation vs consistent non-participation).Consistent participation in religious activities, friendship organizations, leisure/culture clubs, family/school reunion ,and volunteer work improves quality of life among middle aged and older Koreans. Geriatr Gerontol Int 2017; 17: 132-141.

Background Studies conducted on patients with stroke in countries other than Korea demonstrated a phenomenon known as the weekend effect on 7-day, 30-day, and in-hospital mortalities. We studied patients with stroke using nationwide cohort data to determine if there was a weekend effect on mortality in a Korean population. Methods Nationwide cohort data, collected from 2002 to 2013, were searched for all hospitalizations via the emergency department due to ischemic stroke. Cox's proportional hazards frailty model was employed, and we adjusted for all patient and hospital characteristics. Results There were 8957 patients with ischemic stroke admitted via the emergency department: 2632 weekend admissions and 6325 weekday admissions. Of these, 478 (5.3%) patients were dead. After adjusting for patient and hospital characteristics, the frailty model analysis revealed significantly higher in-hospital mortality in patients admitted on weekends than in those admitted on weekdays (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.01-1.47). We obtained consistent results for the 30-day mortality findings (HR, 1.27; 95% CI, 1.04-1.55). However, no significant differences were observed in the 7-day mortality (HR, 1.13; 95% CI, .88-1.45). Conclusions Weekend admission for ischemic stroke was significantly associated with higher in-hospital and 30-day mortality after adjusting for individual characteristics and hospital factors.

Objective Excessive health expenditure (EHE) is a global issue for households suffering from high-cost medical conditions, low incomes and limited insurance coverage. After the international financial crisis of 2008, EHE became a social problem in developed countries. Such economic crisis might induce severe mental stress, resulting in suicidal ideation. Methods We used the Korean Welfare Panel Study (KoWePS) from 2011 to 2013 and selected primary income earners, who were defined as practical and economic representatives of households; the total number of analysed samples was 4247 of 5717 households in the database. We only included households that had never experienced EHE before 2011. To examine the temporal relationship between EHE and suicidal ideation, we conducted a logistic regression analysis. Results Among 4247 participants, 146 (3.4%) experienced suicidal ideation, whereas 4101 (96.6%) did not. One scale of depression score (OR=1.28, CI 1.23 to 1.34, p

Objectives We examined correlations between number and gender of offspring and health-related quality of life (HRQoL) and quality of life (QoL) in older adults. Setting We used data from the 2006–2012 data sets of the Korean Longitudinal Study of Aging. Participants There were 10 242, 8680, 7907 and 7480 participants in 2006, 2008, 2010 and 2012, respectively. Interventions Number and gender of offspring. Primary and secondary outcome measures We measured participants’ QoL and HRQoL using a visual analogue scale developed by the Korea Labour Institute and which is similar to the EQ-VAS, a European measure. Results We estimated the HRQoL and QoL of individuals with offspring. Estimates for the HRQoL and QoL of parents with no offspring were −7.762 and −9.384, respectively (both p

To investigate whether having an offspring protects against or increases the risk of depressive disorders.Data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 and 2012 was assessed using longitudinal data analysis. We have included 10,149 research subjects at baseline and estimated the prevalence of depressive disorders for those with children.The number of offspring was from zero to five or more, and the composition of offspring is from zero boys and zero girls to two or more boys and two or more girls. For parents with zero offspring, the estimate for depressive disorder was 0.464 higher (SE: 0.123, p-value: 0.000, OR: 1.389; 95% CI: 1.176-1.640) and for parents with five or more offspring, the estimate for depressive disorder was 0.1 higher (SE: 0.104, p-value: 0.013, OR: 1.315; 95% CI: 1.150-1.504) compared to parents with two offspring. For parents with zero boys and zero girls, the estimate for depressive disorder was 0.599 higher (SE: 4.750, p-value:0.0001, OR: 1.539; 95% CI: 1.298-1.825), and for parents with two or more boys and two or more girls, the estimate for depressive disorder was 1.328 higher (SE: 3.820, p-value: 0.000, OR: 1.328; 95% CI: 1.189-1.482) compared to parents with one boy and one girl.Our results indicate that there is a large effect of offspring on the prevalence of depressive disorder, with significant positive effects for mothers. Fathers are at lower risk for depressive disorder than mothers, and the graph was U-shaped.

OBJECTIVES: Mental health disorders and suicide are an important and growing public health concern in Korea. Evidence has shown that both globally and in Korea, obesity is associated with an increased risk of developing some psychiatric disorders. Therefore, we examined the association between distorted body weight perception (BWP) and suicidal ideation. Methods: Data were obtained from the 2007-2012 Korea National Health and Nutritional Evaluation Survey (KNHANES), an annual cross-sectional nationwide survey that included 14 276 men and 19 428 women. Multiple logistic regression analyses were conducted to investigate the associations between nine BWP categories, which combined body image (BI) and body mass index (BMI) categories, and suicidal ideation. Moreover, the fitness of our models was verified using the Akaike information criterion. Results: Consistent with previous studies, suicidal ideation was associated with marital status, household income, education level, and perceived health status in both genders. Only women were significantly more likely to have distorted BWP; there was no relationship among men. In category B1 (low BMI and normal BI), women (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.48 to 3.42) were more likely to express suicidal ideation than women in category B2 (normal BMI and normal BI) were. Women in overweight BWP category C2 (normal BMI and fat BI) also had an increased OR for suicidal ideation (OR, 2.25; 95% CI, 1.48 to 3.42). Those in normal BWP categories were not likely to have suicidal ideation. Among women in the underweight BWP categories, only the OR for those in category A2 (normal BMI and thin BI) was significant (OR, 1.34; 95% CI, 1.13 to 1.59). Conclusions: Distorted BWP should be considered an important factor in the prevention of suicide and for the improvement of mental health among Korean adults, especially Korean women with distorted BWPs. Key words: Body mass index, Weight perception, Body image, Obesity, Suicide, Suicidal ideation Language: en

Background: Although the prevalence of cancer is increasing, it is no longer synonymous with death. The number of cancer survivors is estimated to be increasing due to development in medical treatments and social programs; cancer survivors are increasingly returning to work after long-term unemployment. Thus, we examined the quality of life (QOL) and the factors associated with return of cancer survivors to the workplace. Materials and Methods: This study was performed using the 2008 Community Health Survey administered by the Korea Centers for Disease Control and Prevention (N= 548). We used Chi-square tests to compare demographic variables based on self-perceived health status, and analysis of variance (ANOVA) to compare QOL scores among groups. We also performed a mixed-model analysis of the relationship between QOL and factors at the workplaces of cancer survivors. Results: Based on the results of our study, the overall QOL of cancer survivors was associated with ‘mutual respect’, ‘free emotional expression’, occupation, and age. Moreover, different trends of QOL according to self-perceived health were identified on additional analysis. In the ‘bad’ self-perceived health group, QOL was significantly different according to income. The QOL of cancer survivors in the low-income group was lower than in the other groups. Conversely, the ‘normal’ group had a lower QOL caused by ‘no mutual respect’ and “no free emotional expression” in the workplace. The QOL in the ‘good’ group based on self-perceived health was higher in the younger age group. Conclusions: There may be a significant relationship between QOL and workplace factors for cancer survivors, although further study is needed to investigate this relationship in detail. This may facilitate formulation of policy and efforts to prevent and manage the decline in the QOL of cancer survivors returning to work.

Cancer is one of the leading causes of morbidity and mortality worldwide. Recently, survival rates of cancer patients have been improving. Many patients are diagnosed with cancer at an age when their career is an important component of their lives, and job status can have a significant impact on health-related quality of life (HRQOL). The purpose of this study was to determine the association of job status and HRQOL with respect to particular situations, such as long-term cancer survival and the presence of comorbid conditions, as compared with the general population.Data on a total of 27,089 eligible participants from the 2007-2012 Korea National Health and Nutrition Examination Survey were used in the study. To identify factors associated with the HRQOL of long-term cancer survivors, multiple linear regression analysis was performed. HRQOL was measured by the EuroQol five-dimension instrument (EQ-5D).People who once had a job and lost it because of health issues have been shown to have a lower EQ-5D (β =-8.997, p 0.0001) than those who still have their jobs. Although long-term cancer survivors with comorbid conditions showed only a trend toward a lower EQ-5D, in a subgroup analysis, those in the 'Job loss due to health issue' group had a significantly lower EQ-5D (β =-8.739, p 0.0001).There was a significant association between job status and HRQOL in study participants. This study suggests that individuals who are long-term cancer survivors or have comorbid conditions need particular attention, and a specialized job rehabilitation program should be developed.

Objectives To examine the sex-specific factors associated with being unaware of one's hepatitis B virus surface antigen (HBsAg) seropositivity status in a large, HBsAg-positive population of Koreans. Methods In total, 1197 subjects aged 19 years or older who were HBsAg-positive according to data from the 2007-2012 Korea National Health and Nutrition Examination Survey were included. Subjects were considered unaware of their HBsAg seropositivity status if they answered that they had no knowledge of being previously infected by the hepatitis B virus (HBV) or diagnosed with HBV hepatitis. Multivariate Poisson regression models with robust variance estimate were used to assess the significance of the variables using weighted frequencies. Results The majority (77.8%) of HbsAg-positive Korean adults (females, 81.9%; males, 74.6%) were unaware of their HBsAg seropositivity status. We found that sex (female: prevalence ratio [PR] 1.19), household income (low: PR, 1.15), marital status (never married: PR, 1.18), self-rated health (moderate: PR, 1.14; good: PR, 1.12), and alcohol use (at least 2-3 times/wk: PR, 1.21) were associated with being unaware. In females, age (50 to 59 years: PR, 1.29; ≥ 70 years: PR, 1.30), household income (low: PR, 1.37; middle-low: PR, 1.24), and marital status (never married: PR, 1.33) were associated with being unaware. In males, self-rated health (moderate: PR, 1.14; good: PR, 1.21) and alcohol use (at least 2-3 times/wk: PR, 1.21) were associated with being unaware. Conclusions Factors related to the socioeconomic status of females and the health-related behaviors of males were found to be associated with being unaware of one's HBsAg seropositivity status.

Our objective was to investigate whether gaps between socioeconomic stratum and subjective social class affect the prevalence of depressive symptoms. We collected data from the Korean Health Panel Survey, years 2009 and 2011, and performed a longitudinal analysis of 12,357 individuals at baseline (2009), estimating the prevalence of depressive symptoms among individuals with disparate socioeconomic stratum (High, Middle, or Low household income and education level, respectively) and subjective social class (High, Middle, or Low). The odds ratio for depressive symptoms among individuals with High household income and High social class, or Low household income and Low social class, was 0.537 and 1.877, respectively (p

Femur fracture is an emerging public health concern in aging societies, owing to the substantially high morbidity and mortality. Because the recent increase in femur fracture incidence in Asian populations is comparable to that in the West, it is necessary to investigate the association between socioeconomic status (SES) and mortality after femur fracture in developed Asian societies.Data were obtained from the National Health Insurance Claims Database. During 2002 to 2013, femur fractures were newly diagnosed in 5441 patients among 1025,340 enrollees. Multiple logistic regression and the Cox proportional model were used to investigate the associations between individual SES and probability of surgery and mortality after femur fracture.Of 5441 patients, 1928 (35.4%) received surgery. Patients with low (odds ratio [OR] = 0.87, 95% confidence interval [CI]: 0.75-0.99) and middle (OR = 0.85, 95% CI: 0.74-0.98) income were less likely to undergo surgery than high-income patients. Patients with low (hazard ratio [HR] = 1.12, 95% CI: 1.01-1.24) and middle (HR = 1.20, 95% CI: 1.08-1.33) income had a higher HR for mortality. This difference was more prominent in patients who underwent surgery (low income: HR = 1.07, 95% CI: 0.94-1.21; middle income: HR = 1.18, 95% CI: 1.04-1.33) than in patients with conservative treatment (low income: HR = 1.24, 95% CI: 1.04-1.49; middle income: HR = 1.30, 95% CI: 1.08-1.56).Femur-fracture patients with low SES are less likely to receive surgery for and more likely to die after femur fracture. The difference in mortality risk remained even when only the patients who received surgery were considered, suggesting that we need to consider support measures for these deprived patients.

Background Nonablative radiofrequency (RF) devices have been shown to be clinically effective for the treatment of moderate to severe acne lesions. Objective To evaluate the efficacy and safety of a fractionated microneedle RF device in the treatment of inflammatory acne vulgaris. Methods Eighteen patients (15 male, 3 female; mean age 27, range: 19–33; Fitzpatrick skin type IV) with moderate to severe acne vulgaris who were treated with two sessions of fractionated microneedle RF at 1-month intervals were enrolled in this study. Results Evaluation of improvement, which took into account number of inflammatory acne lesions, showed that two of the 18 patients had grade 4 clinical improvement, eight had grade 3 improvement, and six had grade 2 improvement. Improvement scores in terms of lesion severity were also evaluated. One of the 18 patients had grade 4 clinical improvement, eight grade 3, and seven grade 2. No patient had worsening of inflammatory acne lesions. Conclusion Fractionated microneedle RF can have a positive therapeutic effect on inflammatory acne vulgaris and related scars. In addition, this technique does not worsen active acne lesions.

To the Editor, A 57-year-old woman presented with multiple, asymptomatic, variable-sized, erythematous nodules that had been present for the previous two months on both inferior periorbital areas and the perioral area (Fig. 1A and B). She had undergone a session of tattooing on the upper vermilion border and three sessions of autologous fat injection (AFI) into the forehead and both cheeks four years previously. Fresh fat was used during the first session of AFI, and cryopreserved fat was used during the second and the third sessions for retouching at one month intervals. The skin lesions did not completely coincide with injection or with tattooing sites, and she had no injection history of allogeneic fillers or implants. Fig. 1 (A and B) Multiple, asymptomatic, variable-sized, lightly erythematous nodules on both inferior periorbital areas and the perioral area. (C and D) Non-caseating granulomatous inflammation around numerous round to oval lipid materials and multiple microcysts ... A skin biopsy was performed on the periorbital area and histopathologic findings revealed a noncaseating granulomatous inflammation around numerous round to oval lipid materials and multiple microcysts in the superficial and deep dermis (Fig. 1C and D). There were no granules of dye and Ziehl-Neelsen and Warthin-Starry staining revealed no organisms. The granulomatous lesions were treated by intralesional injection of triamcinolone and showed partial response. AFI has several advantages, it is relatively cheap, easy to harvest, available in abundance, and autogenic compared to artificial fillers; thus, it is commonly used for facial rejuvenation.1 AFI is regarded as a relatively safe filler due to the low potential risks, although some severe adverse reactions including acute vision loss and hemiplegia due to fat embolism have been reported.1-3 However, granuloma formation raises a fundamental question about AFI, because autologous cells should not be recognized as foreign eliciting immunologic reactions. Recently, a few cases of granuloma formation after AFI have been reported, and cryopreservation of fat has been mentioned as a possible cause.3 Freezing is known to damage adipocytes through osmotic stress and intracellular ice formation, and compared with fresh fat, calcification and fibrosis are more frequently associated with frozen fat injection.2,4 In the present case, cryopreserved fat cells were used to recover lost volume and for retouching after the initial injection. Although the foreign body reaction observed in our case could not be proven to have originated from cryopreserved fat, nonviable adipocytes damaged by cryopreservation might have induced foreign body granuloma formation, as the patient clearly denied injection of allogeneic fillers, implants, or any other substance aside from AFI. Although the skin lesions did not coincide with injection sites, the presence of fat vacuoles in non-injection sites was observed on histopathology, confirming its migration. Interestingly, in previously reported cases, all granulomas appeared in the eyelids, and were mainly explained by local migration and possible lymphatic migration of cryopreserved fat.3 Lymphatic spread of injected silicone has been previously reported,5 and in our case, granulomas in the perioral area were located in the buccinator lymph node area, supporting the possibility of lymphatic spread. Our case suggests that cryopreserved, nonviable fat vacuoles from forehead and cheek injections might migrate into the periorbital and perioral areas via lymphatic drainage, leading to a granulomatous reaction (Fig. 1E); thus, operators should recognize foreign body granuloma as a possible complication of AFI.

Many reports have described the presence of alopecia areata (AA) associated with other autoimmune diseases, which support the autoimmune nature of AA. Additionally, AA has been reported in association with malignancy as a paraneoplastic symptom. In this report, we describe three patients with diffuse large B-cell lymphoma, alveolar soft part sarcoma, and cavernous sinus arteriovenous fistula with embolization treatment, respectively, who characteristically presented with rectangular-patterned occipital AA.

Background Although persons with disabilities need access to comprehensive and consistent healthcare services, a significant number of the poor with disabilities do not receive Medical-Aid due to the conditions of eligibility. We aimed to compare the financial burden of healthcare services between two groups of poor persons with disabilities: those not enrolled in Medical-Aid and Medical-Aid enrollees. Methods This study used the 1st–8th data (2008–2014 year) of Panel Survey of Employment for the Disabled (PSED) conducted by the Korea Employment Agency for the Disabled. We classified adults who did not exceed 100 % of the poverty level into two groups (N = 3,010). The first group consisted of enrollees in Medical-Aid (n = 1,259) and the second group comprised those not enrolled in Medical-Aid (n = 1,325). We applied generalized estimating equations (GEEs) to assess the independent effect of enrollment in Medical-Aid on catastrophic health expenditures (CHE). Results We found that about 4.2 % of the poor not enrolled in the Medical-Aid experienced CHE and the poor not enrolled in Medical-Aid were 2.1 times more likely to experience CHE than Medical-Aid enrollees after applying multivariate models adjusted for several covariates. Conclusions Given the additional expenses for treatment and rehabilitation caused by disability-related health problems, persons with disabilities are more likely to face barriers to needed medical services. Thus, policy makers need to expand the number of people receiving Medical-Aid by loosening the strict criteria for those with disabilities.

Background: We examined the long-term effects of parental divorce timing on depression using longitudinal data from the Korean Welfare Panel Study. Methods: Depression symptoms were measured using the 11 items of Center for Epidemiologic Scale for Depression (CES-D-11), and we categorized parental divorce timing into ‘early childhood’, ‘adolescent’ and ‘none’. Results: Although participants who experienced parental divorce during adolescence exhibited a significantly higher CES-D-11 score ( p = .0468), ‘early childhood’ participants displayed the most increased CES-D-11 score compared to the control group ( p = .0007). Conversely, among participants who were unsatisfied with their marriage, those who experienced parental divorce in early childhood showed lower CES-D-11 scores, while ‘adolescent period’ participants exhibited significantly higher CES-D-11 scores ( p = .0131). Conclusion: We concluded that timing of parental divorce exerts substantial yet varied effects on long-term depression symptoms and future marriage satisfaction.