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BACKGROUND: The US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approved empagliflozin for reducing cardiovascular mortality and heart failure (HF) hospitalization in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). However, limited data are available on the generalizability of empagliflozin to clinical practice. Therefore, we evaluated real-world eligibility and potential cost-effectiveness based on a nationwide prospective HF registry. METHODS: A total of 3,108 HFrEF and 2,070 HFpEF patients from the Korean Acute Heart Failure (KorAHF) registry were analyzed. Eligibility was estimated by inclusion and exclusion criteria of EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction (EMPEROR-Reduced) and EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trials and by FDA & EMA label criteria. The cost-utility analysis was done using a Markov model to project the lifetime medical cost and quality-adjusted life year (QALY). RESULTS: Among the KorAHF patients, 91.4% met FDA & EMA label criteria, while 44.7% met the clinical trial criteria. The incremental cost-effectiveness ratio of empagliflozin was calculated at US$6,764 per QALY in the overall population, which is far below a threshold of US$18,182 per QALY. The cost-effectiveness benefit was more evident in patients with HFrEF (US$5,012 per QALY) than HFpEF (US$8,971 per QALY). CONCLUSION: There is a large discrepancy in real-world eligibility for empagliflozin between FDA & EMA labels and clinical trial criteria. Empagliflozin is cost-effective in HF patients regardless of ejection fraction in South Korea health care setting. The efficacy and safety of empagliflozin in real-world HF patients should be further investigated for a broader range of clinical applications. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01389843.

We examined whether quarantined individuals complied with rules to prevent transmission at home and whether the government provided appropriate support to individuals in quarantine. Between November 2020 and August 2021, we surveyed 198 individuals who had been or were quarantined at home without infection. The online survey results show that respondents experienced difficulties living in close quarters with their cohabitants and had low compliance with in-house hygiene rules. The government needed to provide adequate employment protection, living expense, or care support. Such failures of the system were mainly due to a lack of legal grounds for the government to operate. To improve compliance, the government can amend laws to permit active communication of public health messages with those quarantined at home and provide the necessary support. [ABSTRACT FROM AUTHOR]

Purpose: Acute myocardial infarction (AMI) and stroke are leading global causes of death and can be used to assess acute care quality. We examined the 30-day mortality trends after emergency department admission for AMI and stroke in Korea from 2008 to 2019, focusing on regional and income disparities. Materials and Methods: The AMI and stroke patients admitted to hospitals in Korea were collected from the claims data. We analyzed age and sex-standardized 30-day mortality for AMI, as well as hemorrhagic and ischemic strokes. Disparities in mortality were analyzed using absolute differences and relative ratios between the Organization for Economic Cooperation Development (OECD) and Korea, and among income levels and regions in Korea. A 12-year joinpoint regression was used to determine the annual percent change and the average annual percent change. Results: The trends in the 30-day AMI mortality of Korea were not significantly changed from 2008 to 2019; the gap remained at 1.2 between the OECD and Korea. Korea maintained lower mortality rates for hemorrhagic and ischemic stroke than the mean of OECD. In Korea, the 30-day hemorrhagic stroke mortality showed a constant decreasing trend for the higher-income group living in urban areas; it led to a widened gap based on income levels in urban areas. The 30-day mortality for ischemic stroke tended to decrease in the higher-income group and urban areas. Conclusion: National-level intervention is needed to manage regional and income-based disparities in AMI and stroke 30-day mortality. It is important to understand the variance in mortality rate by different geographical regions and income levels to establish an appropriate public health strategy. [ABSTRACT FROM AUTHOR]

Objective: To determine the normative values of the Korean version of the Modified Barthel Index (K-MBI) score for typically developing children in Korea and assess its suitability for use in children. Methods: Rehabilitation physicians and occupational therapists with children were invited through an online platform to participate in a survey assessing their children's performance of activity of daily living (ADL) using the K-MBI. The questionnaire encompassed queries on sociodemographic information of children and the assessment criteria outlined in the K-MBI. The standardized K-MBI scores by age were estimated using the nonlinear least squares method. Results: The analysis incorporated responses from a total of 206 individuals. K-MBI total scores showed a rapid increase over the first 8 years of life, with 99% of children achieving a score of 90 or higher by age 8. Mobility scores exhibited a swift increase during early childhood, surpassing 90% of the maximum score at 3 years of age and nearing 100% at 7 years of age. In contrast, self-care scores demonstrated a more gradual advancement, achieving approximately 100% of the maximum score by the age of 10 years. Conclusion: Age-specific normative values for K-MBI scores of typically developing children were established, which can be used as a reference in clinical care. While the K-MBI captured the overall trajectory of children's ADL development, it did not discern subtle differences across various developmental stages. There is a need for the development of more refined assessment tools tailored specifically to children. [ABSTRACT FROM AUTHOR]

Background: Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries. Recently, AMD prevalence in Korea has increased from 6.6% to 13.9% over the past decade, which may be a threat to the public health of Korean society. This study describes the current status, including risk factors, treatment, and economic burden of AMD in Korea. Current Concepts: Major AMD risk factors have been consistently reported, including age, hypertension, smoking, and ultraviolet radiation. The primary AMD treatment is intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF). Anti-VEGF was developed and improved in terms of efficacy and safety. However, AMD treatment's economic burden is significant. Therefore, several treatment strategies have been introduced, such as monthly, as-needed, and treat-and-extend injection strategies. Discussion and Conclusion: With the rapid increase in AMD prevalence in Korea, the economic burden of AMD management will be a significant challenge for the Korean healthcare system. Therefore, cost-effectiveness and resource allocation for AMD treatment needs to be investigated. [ABSTRACT FROM AUTHOR]

Background: The escalating conflict between the government and medical community, particularly the increase in medical school admissions by 2,000, has plunged Korea into a pressing healthcare crisis. This study delves into the heart of this dispute and proposes solutions to tackle critical issues in essential and regional healthcare. Current Concepts: Despite government assertions, the number of active physicians in Korea is increasing rapidly. With a similar physician-to-population ratio (2.65 per 1,000 inhabitants by 2022), Japan is reducing its number of medical school admissions. Korea is facing a severe shortage of essential medical fields crucial for public health, and significant regional healthcare disparities. These issues stem not from a lack of physicians, but from poor working conditions and inadequate payment systems of the National Health Insurance Services of Korea, leading to an inequitable medical ecosystem. It is crucial that policies affecting public health, such as increasing medical school admissions, are meticulously evaluated. This evaluation should consider future population projections, healthcare supply and demand systems, and financial aspects. Furthermore, any changes in medical policy should be grounded in scientific evidence and implemented in close collaboration with medical experts. Discussion and Conclusion: To effectively address imbalances in essential and regional healthcare, it is imperative to normalize the healthcare delivery system and foster an environment that motivates physicians to work voluntarily in these sectors. This change necessitates the implementation of supportive measures and financial strategies developed through extensive consultations with the medical community. [ABSTRACT FROM AUTHOR]

Background: The prevalence of metabolic syndrome (MetS) is increasing. While calcium and sodium are known nutritional factors used for managing MetS, few studies have focused on food-based analyses. This cross-sectional study examined the distribution of calcium- and sodium-rich food intake among Koreans with MetS. Methods: This cross-sectional analysis evaluated 130,423 participants from the Health Examinees-Gem cohort study. Foods contributing up to 90% of the calcium and sodium intake were selected from the semi-quantitative food frequency questionnaire, and consumption levels were calculated. MetS was defined as satisfying three or more criteria from the National Cholesterol Education Program Adult Treatment Panel III. The results are presented as odds ratios (OR) with an interquartile range (ORIQR) and 95% confidence interval. Results: Participants with MetS showed a low calcium intake (ORIQR = 0.95 and 0.92 for men and women, respectively), low consumption of dairy products (ORIQR = 0.92 and 0.89), beverages except for coffee or green tea (ORIQR = 0.97 and 0.96), and bread (ORIQR = 0.96 and 0.94). Men with MetS consumed high total sodium (ORIQR = 1.04), and large amounts of Kimchi (ORIQR = 1.03), fermented paste (ORIQR = 1.04), and noodles (ORIQR = 1.07). Women with MetS consumed more Kimchi than those without MetS (ORIQR = 1.04). The odds ratio for the low calcium and high sodium group compared to the high calcium and low sodium group was 1.26. Conclusion: The MetS group consumed less calcium-rich foods and more sodium-rich foods than those without MetS. Patients with MetS might benefit from precise recommendations of high calcium-rich and low sodium-rich foods. [ABSTRACT FROM AUTHOR]

Japanese encephalitis is a disease caused by the Japanese encephalitis virus (JEV) and is a concern for U.S. military personnel stationed in the Republic of Korea (ROK). The recent literature reports a potential shift from GI to GV as the dominant genotype circulating in east Asia. In the ROK, GV has been reported in a few Culex spp., but not in the main JEV vector, Cx. tritaeniorhynchus. The goal of this surveillance was to shed light on the current knowledge of the epidemiology of JEV in the ROK by analyzing mosquito collection data from three consecutive years, 2021–2023, and molecularly detecting and genotyping JEV in all Culex spp. collected in several military locations across the ROK. In this study, we detected only JEV GI in Cx. tritaeniorhynchus in 2021 samples. In contrast, all 2022 and 2023 positive samples were GV and detected in Cx. bitaeniorhynchus, Cx. orientalis, and Cx. pipiens. Results support a shift in JEV genotype in the ROK and suggest that for GV, Culex spp. other than Cx. tritaeniorhynchus may be playing an important role. [ABSTRACT FROM AUTHOR]

Individual's risk perception regarding specific hazards is a dynamic process that evolves over time. This study analyzed the relationship between the number of COVID‐19 cases and the South Korean public's risk perceptions from the outset of the pandemic to the recent past. More than 70 repeated cross‐sectional surveys were conducted biweekly to measure individuals' risk perception. An autoregressive integrated moving average with explanatory variable time series analysis was used to characterize the relationship between the number of COVID‐19 cases and level of risk perceptions. It revealed that individuals' risk perception and the number of COVID‐19 cases were not linearly related but were logarithmically correlated. This finding can be understood as a psychic numbing effect, suggesting that people's perception of risk is not linear but rather exponentially sensitive to changes. The findings also revealed a significant influence of individuals' trust in local governments on their risk perceptions, highlighting the substantial role played by local governments in direct risk management during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Objective: This study analyzed the mortality trends from avoidable causes in Korea from 1997 to 2021, to estimate its contribution to the overall mortality in different subgroups, including. Gender, age, and cause of disease. Methods: The all-cause and avoidable mortality were presented as a time series plot and average annual percent change. Trend of avoidable mortality was also analyzed by subgroups, disease causes and the percentage attributed to each causes. Results: The decline in avoidable mortality accounted for 82.6% of all-cause mortality reduction. Preventable mortality showed a more pronounced decline than treatable mortality, explaining 72.3% of the avoidable mortality reduction. In 1997-2001, avoidable death occurred in 72.2% (537,024 cases) of all-cause deaths, which declined to 60.0% (342,979 cases) in 2017-2021. The contribution of avoidable mortality in the decline of all-cause morality was greater in males (83.6%) than in females (79.3%). Conclusion: The decline in avoidable mortality and its contribution to the all-cause mortality reduction implies general improvement of the population health in Korea. Nevertheless, the heterogenous trend within different subgroups warrants more equitable design and implementation of health services and policies. [ABSTRACT FROM AUTHOR]

Simple Summary: Mosquito collection traps are an essential tool for monitoring mosquito density and species distribution. Various traps are used in mosquito surveillance projects in the Republic of Korea. However, there is a lack of comparative analysis of these traps. Therefore, we evaluated four traps that are widely used for mosquito surveillance. BLT showed superior collection efficiency in terms of the number of collected individuals and species evenness, whereas BGT showed the highest species diversity among all the traps. DMS is well adapted to urban areas and has an advanced function that can automatically count the number of mosquitoes. In our summary, we provide information about the traps and guidance for planning new mosquito surveillance projects. Monitoring mosquito populations is essential for controlling mosquito-borne diseases, and the selection of mosquito traps should be tailored to specific surveillance objectives. Here, we tested four mosquito traps for their efficiency and applicability: the Nozawa-style black light trap (BLT), BG-sentinel trap II (BGT), UV-LED Blackhole Plus Mosquito Buster trap (LED), and digital mosquito monitoring system (DMS). The traps were rotated weekly for a 24 h cycle at the same location for 13 weeks. Overall, 1649 female mosquitoes belonging to seven genera and sixteen species were collected by the traps. The traps exhibited differences in both the number of collected individuals and species composition. The BLT showed superior collection efficiency in terms of the number of collected individuals and species evenness, whereas the BGT showed the highest species diversity among all the traps. Thus, the BLT and BGT are the best choices for effective mosquito surveillance based on trap performance. Additionally, despite the relatively low efficiency of the LED and DMS observed in this study, the LED is known to be efficient when used for indoor conditions such as cowsheds, while the DMS has an advanced function that can automatically count the number of mosquitoes. Thus, our findings provide significant guidelines for planning new mosquito surveillance projects in the ROK. [ABSTRACT FROM AUTHOR]

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that requires significant experiences and skills and has various procedure-related complications, some of which can be severe and even result in the death of patients. Expanding ERCP availability has the advantage of increasing accessibility for patients. However, ERCP poses a substantial risk if performed without proper quality management. ERCP quality management is essential for both ensuring safe and successful procedures and meeting the social demands for enhanced healthcare competitiveness and quality assurance. To address these concerns, the Korean Pancreatobiliary Association established a task force to develop ERCP quality indicators (QIs) tailored to the Korean medical environment. Key questions for five pre-procedure, three intra-procedure, and four post-procedure measures were formulated based on a literature search related to ERCP QIs and a comprehensive clinical review conducted by experts. The statements and recommendations regarding each QI item were selected through peer review. The developed ERCP QIs were reviewed by external experts based on the latest available evidence at the time of development. These domestically tailored ERCP QIs are expected to contribute considerably to improving ERCP quality in Korea. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) recommends physical activity for more than 150 minutes a week to improve health and reduce disease burden; however, previous studies have shown a lack of participation among persons with disabilities. Logistic regression analysis was performed on National Health Insurance Service data to analyze the relationship between physical activity levels by disability type and socioeconomic factors. The results showed that women with disabilities exercised 0.663 times compared to men with disabilities and individuals with severe disabilities exercised 0.719 times compared to those with mild disabilities. Those from the highest income level households (adjusted odds ratio [AOR] = 1.442) and the re-employed (AOR = 1.119) exercised adequately. Thus, physical activity levels and socioeconomic factors are related in persons with disabilities. Exercise policies and programs are required to support persons with disabilities by income level. [ABSTRACT FROM AUTHOR]

The Rickettsia species transmitted by ticks are mostly classified within the spotted fever group rickettsiae (SFGR), which causes tick-borne rickettsiosis. Although efforts have been made to investigate their prevalence in the Republic of Korea (ROK), research has been limited to certain areas. Furthermore, the pooling method for ticks does not fully reflect the exact infection rate. Therefore, we aimed to perform molecular identification of SFGR in ticks to elucidate the current prevalence of tick-borne rickettsiosis in the ROK. The SFGR of ticks was identified using polymerase chain reaction targeting the 17 kDa antigen, ompA, and gltA, followed by sequencing for species identification and phylogenetic analysis. In total, 302 ticks belonging to four species (Haemaphysalis flava, H. longicornis, Ixodes nipponensis, and Amblyomma testudinarium) were collected between April and November 2022. The overall SFGR infection rate was 26.8% (81/302 patients). Both adult and nymphal ticks and the SFGR infection rate increased during April–May, reaching their peaks in June, followed by a marked decline in August and July, respectively. Phylogenetic analysis revealed three species (R. monacensis, R. heilongjiangensis, and Candidatus R. jingxinensis) of SFGR. Thus, our results emphasize the importance of tick surveys for the prevention and management of tick-borne rickettsiosis. [ABSTRACT FROM AUTHOR]

Objectives North Koreans have been facing chronic food shortages and malnutrition. This study examined the nutritional status of North Koreans and the perceptions of South Korean adults regarding their nutritional status. Methods The nutritional status was examined using nutritional indicators for the general population, children, and reproductive-aged women in North Korea. An online survey was conducted among 1,000 South Korean adults aged 19–69 years to investigate their perceptions regarding the nutritional status of North Koreans. Results Although the nutritional status of children in North Korea has consistently improved, significant progress in the general population and reproductive-aged women in the country remains elusive. The prevalence of malnutrition among North Korean children has decreased to a level that is not considered severe based on international standards, although it shows a substantial difference from that among South Korean children. The prevalence of undernourishment and food insecurity in North Korea remains over 40%. South Korean adults perceive the nutritional status of North Koreans as being more severe than it is in reality. Notably, a significant inconsistency exists between the perceived and actual nutritional status of North Korean children, with over 95% of South Korean adults perceiving North Korean children’s malnutrition as being more severe than it actually is. Moreover, South Korean adults in their 20s to 40s tended to perceive the nutritional status of North Koreans as being more severe than those in their 50s to 60s did. Conclusions The nutritional status of North Koreans is a matter of concern. The disparity between South Koreans’ perceptions of the nutritional status of North Koreans and the actual status highlights the need for accurate information dissemination to effectively address malnutrition in North Korea. These efforts could be instrumental in enhancing public awareness and fostering social consensus on food aid and nutritional support programs for North Korea.

Summary: Purpose: This study compared COVID-19 vaccination intentions in those with and without chronic diseases (CDs and non-CDs) in South Korea. We hypothesized that the factors associated with COVID-19 vaccination intentions would differ between CDs and non-CDs in South Korea. Methods: Using survey data collected through a Korean online panel in June 2021, we conducted a cross-sectional secondary data analysis. Of the 2292 participants, 411 had at least one chronic disease. To construct a comparable dataset, we selected non-CDs via a 1:1 case-control matching for age and gender. We then utilized a multivariable binary logistic regression model to explore the factors contributing to COVID-19 vaccination intentions in CDs and non-CDs. Results: All told, over 75% of participants in both groups indicated that they intended to vaccinate against COVID-19. In both groups, those who mistrusted general vaccine benefits reported significantly lower COVID-19 vaccination intentions. Regarding factors associated with vaccination intentions, CDs identified anxiety regarding coronavirus and exposure to COVID-19 vaccination promotions at the community level, while non-CDs highlighted hesitancy regarding vaccines and confidence in government/health services. Conclusion: Improving vaccination acceptance will require the development and implementation of tailored approaches for CDs and non-CDs and efforts to minimize general vaccine mistrust.

Objective To determine the normative values of the Korean version of the Modified Barthel Index (K-MBI) score for typically developing children in Korea and assess its suitability for use in children. Methods Rehabilitation physicians and occupational therapists with children were invited through an online platform to participate in a survey assessing their children’s performance of activity of daily living (ADL) using the K-MBI. The questionnaire encompassed queries on sociodemographic information of children and the assessment criteria outlined in the K-MBI. The standardized K-MBI scores by age were estimated using the nonlinear least squares method. Results The analysis incorporated responses from a total of 206 individuals. K-MBI total scores showed a rapid increase over the first 8 years of life, with 99% of children achieving a score of 90 or higher by age 8. Mobility scores exhibited a swift increase during early childhood, surpassing 90% of the maximum score at 3 years of age and nearing 100% at 7 years of age. In contrast, self-care scores demonstrated a more gradual advancement, achieving approximately 100% of the maximum score by the age of 10 years. Conclusion Age-specific normative values for K-MBI scores of typically developing children were established, which can be used as a reference in clinical care. While the K-MBI captured the overall trajectory of children’s ADL development, it did not discern subtle differences across various developmental stages. There is a need for the development of more refined assessment tools tailored specifically to children.

Objectives: Comorbidities increase susceptibility to severe coronavirus disease 2019 (COVID-19) infections, but limited information has been published regarding human immunodeficiency virus (HIV) and COVID-19 co-infections. This study explored the relationships among socioeconomic characteristics, sexual behaviors, and COVID-19 infection rates among Korean men who have sex with men (MSM) who are also living with HIV. Methods: Data were collected through a web survey aimed at members of the largest gay portal site in Korea, supported by the National Research Foundation of Korea (n=1005). The primary independent variables included COVID-19-related vaccinations and sexual behaviors. The dependent variable was the incidence of COVID-19 infection among respondents during the pandemic. For statistical analysis, hierarchical multiple logistic regression was performed, controlling for potential confounding variables. Results: Model I indicated that older MSM were less likely to contract COVID-19 (adjusted odds ratio [aOR], 0.98; 95% confidence interval [CI], 0.96 to 0.99). Model II demonstrated that HIV-positive MSM were nearly twice as likely to be infected with COVID-19 compared to their HIV-negative counterparts (aOR, 1.97; 95% CI, 1.14 to 3.41). Furthermore, even after accounting for COVID-19 vaccination status in model III, HIV-positive MSM continued to show a higher risk of infection (aOR, 1.93; 95% CI, 1.12 to 3.35). Conclusions: The findings of this study indicate that HIV-positive MSM are at an increased risk of contracting COVID-19, even when their vaccination status is considered. Therefore, it is essential to prioritize the prevention of COVID-19 infections in HIV-positive individuals by administering appropriate antiretroviral therapy and ensuring adherence to public health guidelines.

The relevance of the research topic is due to the active development of the U.S.-South Korean relations and their impact on inter-Korean relations. The role of the United States in the foreign policy of the Republic of Korea is great which not only limits it in developing of its own potential due to the direct dependence on decisions and actions but also hinders the normalization of relations between the two Koreas. The purpose of the research is to examine the dynamics of relations in the triangle ‘‘ROK (Republic of Korea) - DPRK (Democratic People’s Republic of Korea) - U.S.”. The main methods of the study include analyzing the events in the triangle ‘‘ROK - DPRK - the U.S.” as well as the texts of UNSC (United Nations Security Council) resolutions on nuclear non-proliferation on the Korean peninsula. The study concludes that despite South Korea’s attempts to stabilize relations with its northern neighbor, its pro-American course in foreign policy has prevented it from making significant concessions. For today, the ROK’s foreign policy is aimed at deepening cooperation with the US and its security partners in the region. Therefore no warming in relations between the two Koreas is expected in the near future.

PURPOSE: There has been little information about the impact of coronavirus disease 2019 (COVID-19) pandemic on esophagogastroduodenoscopy (EGD) and gastric cancer claims. This study aimed to measure the impact of COVID-19 pandemic on EGD and gastric cancer claims in South Korea. MATERIALS AND METHODS: This nationwide, population-based study compared the claims data of EGD, gastric cancer, early gastric cancer (EGC), advanced gastric cancer (AGC) and gastric cancer operation in 2020 and 2021 (COVID-19 era) to those in 2019 (before COVID-19 pandemic). RESULTS: The annual claims of EGD, gastric cancer, EGC, and AGC were reduced by 6.3%, 5.0%, 4.7%, and 3.6% in 2020 and by 2.2%, 1.0%, 0.6%, and 1.9% in 2021, respectively, compared to 2019. The amount of annual claims of gastric cancer operation was reduced by 8.8% in 2020, but increased by 0.9% in 2021, compared to those in 2019. The monthly claims of EGD, gastric cancer, EGC, AGC, and gastric cancer operation were mainly reduced in the first epidemic wave of COVID-19, but decreased in the 2nd to 4th epidemic wave. Compared to 2019, the monthly claim of EGD, gastric cancer, EGC, AGC, and gastric cancer operation were reduced by 28.8%, 14.3%, 18.1%, 9.2%, and 5.8% in March 2020 and by 17.2%, 10.8%, 10.3%, 7.2%, and 35.4% in April 2020, respectively. CONCLUSION: Negative impact of the COVID-19 pandemic on EGD, gastric cancer, EGC, AGC, and gastric cancer operation was worst during the first surge of COVID-19, but decreased in the 2nd to 4th epidemic wave of the disease in 2020 and 2021.

Purpose: Few studies have investigated the impact of biologics on the risk of major adverse cardiovascular events (MACEs) among Korean patients with psoriatic diseases. We compared the risk of MACEs and all-cause mortality among patients with psoriatic disease treated with tumor necrosis factor (TNF)-α and interleukin (IL)-12/23 inhibitors in Korea. Methods: Patients with psoriatic disease prescribed with TNF-α and IL-12/23 inhibitors since 2016 were selected from the Korean National Health Insurance Service (NHIS) Database. Follow-up data for MACEs and all-cause mortality between 2016 and 2020 were collected. A total of 2886 individuals were included, including 1987 IL-12/23 inhibitor users and 899 TNF-α inhibitor users. Results: Compared with IL-12/23 inhibitor users, TNF-α inhibitor users had a higher prevalence of dyslipidemia and a significantly higher risk of all-cause mortality but not MACE. After controlling for age, female TNF-α inhibitor users had a significantly increased risk of all-cause mortality. Meanwhile, after controlling for sex, TNF-α inhibitor users aged 60years or older demonstrated a significantly elevated risk of all-cause mortality. In conclusion, No statistically significant difference in MACE risk was observed between patients who used TNF-α and IL-12/23 inhibitors. Nevertheless, the use of IL-12/23 inhibitors, especially among older and female patients, resulted in a lower overall mortality. [ABSTRACT FROM AUTHOR]

The aim of this review is to provide practical guidance for the molecular diagnosis of parasitic diseases in Korea in 2024. Specifically, the prevalence of parasitic diseases, commercially available molecular diagnostic kits, and reference laboratories for molecular diagnosis are presented. It is based on the literature and the medical diagnosis device database of the Korea Disease Control and Prevention Agency. In Korea, molecular diagnostic kits are available for intestinal protozoa (Giardia lamblia, Entamoeba histolytica, Cryptosporidium hominis, and Cryptosporidium parvum), Trichomonas vaginalis, and malarial parasites. Molecular diagnosis of other parasites is also possible; however, there is no commercially available kit. Therefore, parasite samples or derivatives for molecular diagnosis should be sent to specific laboratories, the parasitology departments of medical schools, or the Division of Vectors and Parasitic Diseases, Bureau of Infectious Disease Diagnosis Control at the Korea Disease Control and Prevention Agency. In commercial diagnostic kits, multiplex real-time polymerase chain reaction (PCR) is used to rapidly and easily detect the amplified parasitic DNA. The loop-mediated isothermal amplification (LAMP) was developed to diagnose T. vaginalis and Acanthamoeba infections. Its merits are that it does not require a PCR machine and has a short test time of approximately 60 min. Although LAMP is not commercially available, it may be widely used to screen for parasitic diseases. Commercial molecular diagnostic kits for parasitic diseases are limited to the clinical setting in Korea. Available kits are used to diagnose certain intestinal protozoa, T. vaginalis, and to differentiate Plasmodium species using multiplex PCR.

Background : The COVID-19 pandemic increased the worldwide prevalence of metabolic syndrome. The purpose of this study was to assess health behavior adherence during the pandemic in adults who had engaged in a metabolic syndrome management program for at least 6 months. This assessment included an evaluation of health behavior changes, factors influencing adherence, and clinical parameters. The city-wide program was operated by the Seoul Metropolitan Government. Methods : Baseline and follow-up data were compared in 116 participants who engaged in the program for at least 6 months prior to the pandemic. Health behaviors and clinical parameters were examined. Generalized estimating equation analysis was used to identify sociodemographic variables influencing health behavior adherence over time. Results : Systolic blood pressure, waist circumference, and blood glucose improved (all P

Objectives: The present paper aimed to examine whether an aging workforce is associated with an increase in work-related fatal injuries and to explore the underlying reasons for this potential increase. Material and methods: Aged workers were defined as those who were at least 55 years old. Work-related fatalities were assessed in aged and young workers who were registered with the workers' compensation system in 2021 in the Republic of Korea. Total waged workers, based on raw data from the Local Area Labor Force Survey in 2021, were used as the denominator to estimate the work-related fatality rates. Results: Most work-related fatalities in the aged workers occurred among individuals working in the “construction sector” (58.9%), those with “elementary occupations (unskilled workers)” (46.1%), and those with the employment status of “daily worker” (60.8%). The estimated incidence (0.973/10,000) of work-related fatalities among aged workers was about four times higher than that (0.239/10,000) among younger workers. “Falling,” “collision,” “struck by an object,” and “trip and slip” were more frequent types of work-related fatalities among aged workers relative to young workers. The category of “buildings, structures, and surfaces” was a more frequent cause of work-related fatalities among aged workers than among young workers. Conclusions: Aged workers had a higher incidence of work-related fatalities than young workers. Frequent engagement in precarious employment and jobs, coupled with the greater physical vulnerability of aged workers, were likely causes of their higher level of work-related fatal injuries.

Background To investigate the real-world safety and effectiveness of dulaglutide in Korean adults with type 2 diabetes mellitus (T2DM). Methods This was a real-world, prospective, non-interventional post-marketing safety study conducted from May 26, 2015 to May 25, 2021 at 85 Korean healthcare centers using electronic case data. Data on patients using dulaglutide 0.75 mg/0.5 mL or the dulaglutide 1.5 mg/0.5 mL single-use pens were collected and pooled. The primary objective was to report the frequency and proportion of adverse and serious adverse events that occurred. The secondary objective was to monitor the effectiveness of dulaglutide at 12 and 24 weeks by evaluating changes in glycosylated hemoglobin (HbA1c), fasting plasma glucose, and body weight. Results Data were collected from 3,067 subjects, and 3,022 subjects who received ≥1 dose (of any strength) of dulaglutide were included in the safety analysis set (53% female, mean age 56 years; diabetes duration 11.2 years, mean HbA1c 8.8%). The number of adverse events reported was 819; of these, 68 (8.3%) were serious adverse events. One death was reported. Adverse events were mostly mild in severity; 60.81% of adverse events were considered related to dulaglutide. This study was completed by 72.73% (2,198/3,022) of subjects. At 12/24 weeks there were significant (P

Background: Glucose metabolism regulation is influenced by age and meal skipping, although research on their interplay with hyperglycemia remains limited. This study aims to explore the intricate relationship between meal-skipping patterns and hyperglycemia risk across distinct age groups in South Korean adults. Methods: Utilizing data from the Korea National Health and Nutrition Examination Surveys (KNHANES) conducted from 2013 to 2020, comprising 28,530 individuals aged 19 years and older, this study employed multivariable logistic regression models to examine the associations between meal-skipping patterns and the risk of hyperglycemia. Results: Meal-skipping patterns were categorized into three groups: no skipping (NS), skipping breakfast (SB), and skipping dinner (SD). Age groups were defined as "young" (aged 19–44), "middle-aged" (aged 45–64), and "elderly" adults (over 65 years old). Among "young" adults, SB was associated with a 1.33-fold higher risk of hyperglycemia (OR = 1.33, 95% CI = 1.14–1.54) compared to NS. Conversely, in "elderly" adults, SD was linked to a 0.49-fold reduced risk (95% CI = 0.29–0.82) when compared to NS. Additionally, we observed that the Korean Health Eating Index (KHEI) scores, representing the quality of diet on a scale of 0 to 100, were consistently lower in SB compared to NS across all age groups. Intriguingly, specifically among the "elderly" group, this score was higher in SD compared to NS (p < 0.001). Conclusions: This study demonstrates age-specific variations in the association between meal-skipping patterns and the risk of hyperglycemia. [ABSTRACT FROM AUTHOR]

Type 1 diabetes mellitus is a condition where the pancreas beta cells are destroyed due to autoimmune mechanisms or viral infections, resulting in the inability to produce insulin. The Korean government implements various support programs to aid in the health management of type 1 diabetes patients. To address some shortcomings and adapt to diverse needs arising from advancements in diabetes management device technology, related policies were revised starting on February 26, 2024. Key updates include application of the criteria for continuous glucose monitoring system sensors to users of sensoraugmented pumps and establishing consumable material subsidies for users of closed-loop insulin pumps who are younger than 19 years. Support amounts vary based on the type of insulin pump, which vary by application. Additionally, to enhance diabetes education for pediatric and adolescent patients and their families, insulin pump education is newly introduced, along with an expansion of educational counseling sessions. These policies may further aid in patients’ blood glucose management, with hopes for continued expansion of support in the future. [ABSTRACT FROM AUTHOR]

Background: According to the Diabetes Fact Sheet published by the Korean Diabetes Association, as of 2020, one in six adults (16.7%) over the age of 30 were diagnosed with diabetes. In this rapidly increasing prevalence of diabetes in Korea, the severity of diabetes to raise awareness of the importance of awareness, early detection, and active management. A public diabetes awareness survey was conducted in 2022 and 2023, and the survey contents by year were compared and presented. Methods: This survey was a structured online questionnaire conducted in October 2023, targeting a total of 1,000 adult men and women aged 20 or older nationwide through population proportional allocation according to age, sex, and residential area. Results: The survey results indicated that 91.4% of respondents perceive diabetes as a serious disease, and 68.3% of those without a diabetes diagnosis have expressed concerns about diabetes or hyperglycemia. However, awareness of ‘prediabetes’ and ‘glycated hemoglobin’ was only 61.3% and 38.1%, respectively. On the other hand, only one-third of the respondents reported maintaining an appropriate weight and waist circumference, eating regular meals, and engaging in regular exercise. While awareness and perceived necessity of insulin injections were high, the willingness to undergo injection therapy was only about 50%, indicating a need to provide information on the benefits of insulin therapy and its positive impact on quality of life. Conclusion: Therefore, raising awareness about the severity of diabetes, along with education and intervention, is necessary to facilitate early detection and proactive management of diabetes. [ABSTRACT FROM AUTHOR]

Simple Summary: The current epidemiology of porcine respiratory coronavirus (PRCV) in domestic pig farms in the Republic of Korea is not well understood. In this study, PRCV was found to still be present in Korean pig herds with a high seroprevalence. Genetic and phylogenetic analyses of PRCV S gene sequences suggested that Korean PRCV originated from European PRCV and has evolved in Korea. These findings will help expand knowledge about the epidemiology and genetic characteristics of PRCV in Korea. Porcine respiratory coronavirus (PRCV) is a member of the species Alphacoronavirus 1 within the genus Alphacoronavirus of the family Coronaviridae. A few studies have been conducted on the prevalence of PRCV since its first identification in 1997, but there have been no recent studies on the prevalence and genetic characterization of the virus in Korea. In this study, the seroprevalence of PRCV was determined in Korean pig farms using a commercially available TGEV/PRCV differential enzyme-linked immunosorbent assay kit. The farm-level seroprevalence of PRCV was determined to be 68.6% (48/70), similar to previous reports in Korea, suggesting that PRCV is still circulating in Korean pig herds nationwide. Among the 20 PRCV-seropositive farms tested in this study, PRCV RNAs were detected in 17 oral fluid samples (28.3%) from nine farms (45.0%), while TGEV RNAs were not detected in any sample. To investigate the genetic characteristics of Korean PRCV strains, genetic and phylogenetic analyses were conducted on PRCV spike gene sequences obtained in this study. The three Korean PRCV strains (KPRCV2401, KPRCV2402, and KPRCV2403) shared 98.5–100% homology with each other and 96.2–96.6% and 91.6–94.5% homology with European and American strains, respectively. A 224-amino acid deletion was found in the S gene of both Korean and European PRCVs but not in that of American PRCVs, suggesting a European origin for Korean PRCVs. Phylogenetic analysis showed that Korean PRCVs are more closely related to European PRCVs than American PRCVs but clustered apart from both, suggesting that Korean PRCV has evolved independently since its emergence in Korean PRCVs. The results of this study will help expand knowledge on the epidemiology and molecular biology of PRCV currently circulating in Korea. [ABSTRACT FROM AUTHOR]

The surveillance and epidemiological investigation systems for companion animals in South Korea are significantly underdeveloped compared to those for humans and livestock. Recent outbreaks, such as idiopathic neuromuscular syndrome and highly pathogenic avian influenza among cats, have highlighted the need for reliable systems. This short review conducts situation analysis regarding disease surveillance and epidemiological investigation for companion animals in South Korea. The current challenges include an absence of administrative leadership, a lack of legal support, and unreliable medical data. The recommendations for future directions include clear leadership by the Animal and Plant Quarantine Agency, amending the Act on the Prevention of Contagious Animal Diseases to include companion animals, and enhancing the quality of medical data through standardized coding systems, such as Systematized Nomenclature of Medicine Clinical Terms. In addition, sentinel surveillance rather than universal systems should be established to provide adequate incentives for local practitioners to provide data and develop sustainable public–private networks. These recommendations could be important for developing a comprehensive and sustainable system for disease surveillance and epidemiological investigation in the companion animal field. [ABSTRACT FROM AUTHOR]

High incidences of haemorrhagic fever with renal syndrome (HFRS) have been reported in the southern Republic of Korea (ROK). A distinct southern genotype of Orthohantavirus hantanense (HTNV) was identified in Apodemus agrarius chejuensis on Jeju Island. However, its association with HFRS cases in southern ROK remains elusive. We investigated the potential of the southern HTNV genotype as an etiological agent of HFRS. Samples from 22 patients with HFRS and 193 small mammals were collected in the southern ROK. The clinical characteristics of patients infected with the southern HTNV genotype were analysed. Amplicon-based MinION sequencing was employed for southern HTNV from patients and rodents, facilitating subsequent analyses involving phylogenetics and genetic reassortment. High-throughput sequencing of HTNV exhibited higher coverage with a cycle of threshold value below 32, acquiring nearly whole-genome sequences from six patients with HFRS and seven A. agrarius samples. The phylogenetic pattern of patient-derived HTNV demonstrated genetic clustering with HTNV from Apodemus species on Jeju Island and the southern Korean peninsula, revealing genetic reassortment in a single clinical sample between the M and S segments. These findings imply that the southern HTNV genotype has the potential to induce HFRS in humans. The phylogenetic inference demonstrates the diverse and dynamic characteristics of the southern HTNV tripartite genomes. Therefore, this study highlights the significance of active surveillance and amplicon sequencing for detecting orthohantavirus infections. It also raises awareness and caution for physicians regarding the emergence of a southern HTNV genotype as a cause of HFRS in the ROK. [ABSTRACT FROM AUTHOR]

Background: South Korea's public health doctor system requires physicians to provide primary healthcare in medically underserved areas, such as rural regions, as an alternative to mandatory military service. Recently, concerns have arisen over the decline in the number of public health doctors available in these underserved areas. This study reviews issues related to the public health doctor system and proposes strategies for enhancing its management. Current Concepts: The annual number of public health doctors has steadily decreased by approximately 46.6%, from 1,962 in 2008 to 1,048 in 2022. According to the survey, the reasons behind this decline include the lengthy service period of 36 months compared to the 18-month military service, poor working conditions, low financial support, unreasonable manpower deployment, and uncertain social status. Discussion and Conclusion: Several recommendations can enhance the effectiveness of the public health doctor system. First, the mandatory service period of 36 months should be shortened, and a military training period of 1–2 months should be incorporated into the overall service duration. Second, ensuring appropriate working hours, including holidays, along with improved working conditions and reasonable financial support and compensation, is essential. Third, the role of public health doctors should shift from solely providing basic primary healthcare to acting as public health managers in local communities. Lastly, a long-term plan should be developed to establish various types of medical institutions in medically underserved regions. [ABSTRACT FROM AUTHOR]

Body image is an important area for everyone because it affects self-esteem. A positive body image has also been found to have the potential to reduce unhealthy dieting behaviors. People who are more likely to engage in healthy weight control are associated with high self-esteem. Therefore, it was to investigate the relationship between body image, diet behavior, and self-esteem, and the mediating role of diet behavior in the relationship between body image and self-esteem. The cross-sectional study collected data from 386 workers (211 male, 175 female) in their 20s and 40s living in Seoul and Gyeonggi-do, South Korea. Body image was found to significant influence on diet behavior and self-esteem. Diet behavior was also found to have a significant influence on self-esteem, and diet behavior appeared to play a partial mediating role in the relationship between body image and self-esteem. Diet behavior can vary depending on how one perceives the concept of diet and participates in healthy weight control, which may also affect self-esteem. Body image can also be an important source of self-esteem evaluation and emphasizes that diet behavior, which has shown a mediating role, introduces a positive challenge that contributes to self-esteem. [ABSTRACT FROM AUTHOR]

Background: In February 2024, the South Korean government released a policy proposal for healthcare reform, with one of the main pillars being increased medical school admissions. This policy has sparked intense opposition from the physicians' top association. Most importantly, interns and residents--the bedrock of the medical workforce in Korean hospitals--began to leave en masse. Consequently, a medical crisis emerged, in which many medical and surgical procedures were delayed. Current Concepts: According to studies on comparative health policy and systems, the crisis could be attributed to the unique characteristics of the Korean healthcare system, in which the administration and doctors have failed to establish a substantive dialogue through which policy options are examined and deliberated. These dynamics necessitated the establishment of an institutional space for interest group politics, causing both to suffer from a lack of action repertoires. The stalemate we witness reflects the enduring patterns of the same issue. Discussion and Conclusion: To ensure the success of the current initiative, institutional arrangements must be established in which policymakers and physicians make a credible commitment to each other. Alternatives, for instance, include reactivating and regularizing the Health and Medical Services Policy Deliberation Committee, which could pave the way for establishing a venue where key stakeholders can discuss future agendas, such as how to ensure improved accessibility to "essential" care and mitigate its subnational variation, thereby creating a long-term vision for new health system governance in South Korea. [ABSTRACT FROM AUTHOR]

This study sought to assess disaster resilience in Korean metropolitan cities and explore the factors influencing disaster management in these cities. Statistical data from 17 metropolitan cities and provinces in Korea spanning the years 2016 to 2020 were collected. Data envelopment analysis (DEA), a method for estimating relative efficiency using multiple input and output variables, was employed to calculate the disaster resilience scores of these cities. The results indicate higher level of disaster resilience in capital regions and large cities in Korea, with social and economic characteristics significantly influencing resilience. Moreover, the study reveals that robust infrastructure, particularly in terms of housing, strongly impacts resilience scores. The use of DEA allows for the practical evaluation of relative resilience scores without requiring weighted value calculations, making it an effective methodology for assessing city resilience. This study aimed to assess how well Korean metropolitan cities are prepared for disasters and understand what factors affect their disaster management. We collected statistics data on the social, economic, infrastructure, community capital, and institutions of 17 Korean metropolitan cities and provinces from 2016 to 2020. We used a method called data envelopment analysis (DEA) to figure out how well these cities are handling disasters. The results show that capital regions and large cities in Korea are better at handling disasters. This is because factors such as social and economic characteristics have a significant impact on their ability to respond to disasters. Additionally, having strong infrastructure, especially when it comes to housing, plays a big role in how well a city can respond to disasters. Using DEA allowed us to evaluate how well cities are prepared for disasters without needing complicated calculations, making it a useful method for assessing city readiness for disasters. [ABSTRACT FROM AUTHOR]

This study investigated influencing factors in the relationship between body image, diet behavior, and self-esteem, according to the weight-loss experiences of workers in the Republic of Korea. A self-report survey assessed the demographic information, diet methods, diet behavior, body image, and self-esteem of workers residing in Seoul and Gyeonggi-do (male n = 211; female n = 175) who had dieting experience. Factors such as sex, body mass index (BMI), diet goals, and intrinsic motivation were found to influence diet behavior, body image, and self-esteem. Males more frequently reported healthy weight control, physical satisfaction, and self-esteem, suggesting that sex contributes at least partially to eating habits, body image, and self-esteem. Furthermore, significant differences were observed in healthy weight control and physical satisfaction among overweight workers, suggesting that overweight status alone does not necessarily increase body image risk, and efforts toward weight management should be acknowledged positively. Positive body image, healthy diet behavior, and high self-esteem were associated with weight maintenance efforts, indicating its potential to prevent unhealthy dieting, increase physical and appearance satisfaction, and boost overall self-esteem. Furthermore, when dieting to improve self-confidence, significant differences were noted in physical evaluation, appearance orientation, and self-esteem, underscoring the role of intrinsic motivation in self-esteem enhancement through dieting. [ABSTRACT FROM AUTHOR]

Objectives: Genetic factors are a major cause of osteoporosis. The present study evaluated the association of the apolipoprotein E (ApoE) genotype with bone mineral density (BMD) and its response to menopausal hormone therapy (MHT) in postmenopausal Korean women. Methods: This retrospective cohort study included 172 postmenopausal women with no endocrine diseases, medications, or lifestyles that would affect bone metabolism and who were continuously treated with MHT for at least 2 years. BMDs were measured at baseline and periodically. Results: Linear regression analysis demonstrated similar baseline BMDs at the lumbar spine, but significantly lower at the femur neck and total hip in the ApoE e4 carrier than in the noncarrier group, after controlling for age, body mass index, and history of MHT usage. Overall, the Wilcoxon signed rank test demonstrated that MHT increased the BMD percentage change at all three regions, and the Generalized Estimating Equation (GEE) demonstrated significant time trends at the lumbar spine and femur neck. ApoE e4 noncarriers exhibited a significant time trend in BMD changes at the femur neck, whereas e4 carriers exhibited a time trend at the lumbar spine. However, BMD changes at each time point were comparable at all regions between the groups. Notably, GEE adjusted for baseline characteristics and BMD revealed a significant interaction effect of time and ApoE e4 allele in BMD changes at the femur neck. Conclusions: Postmenopausal Korean women carrying the ApoE e4 allele demonstrated a lower hip BMD compared with e4 noncarriers. Furthermore, the e4 allele may modulate hip BMD responses to MHT. [ABSTRACT FROM AUTHOR]

Simple Summary: Honeybees (Apis mellifera) are crucial for our ecosystem, but they face various threats. This study investigates the detection of a new mite species emerging in Korean honeybees, Carpoglyphus lactis. Using the polymerase chain reaction method to amplify the Cytochrome c oxidase subunit 1 gene region, we examined the presence of C. lactis in honeybee colonies across nine provinces of the Republic of Korea. We found C. lactis in eight provinces in ROK, particularly during winter. This is the first identification of C. lactis in Korean honeybees. Identifying new threats is essential for beekeepers and researchers. Understanding the prevalence of C. lactis mite species and its impact on honeybee health will help develop strategies to protect bee populations. Apis mellifera, especially weak ones, are highly vulnerable to Carpoglyphus lactis mites, which can rapidly infest and consume stored pollen, leading to weakened colonies and potential colony collapse. This study aimed to ascertain and investigate the prevalence of this mite in honeybee colonies across nine provinces in the Republic of Korea (ROK). A total of 615 honeybee colony samples were collected from 66 apiaries during the spring and 58 apiaries during the summer of 2023. A 1242 bp segment of the Cytochrome c oxidase subunit 1 (COI) gene was amplified using the polymerase chain reaction method. The detection levels of C. lactis in the honeybees were compared between winter and summer. Based on the COI sequence analysis, the nucleotide sequence similarity of C. lactis mites isolated in the ROK with those from China (NC048990.1) was found to be 99.5%, and with those from the United Kingdom (KY922482.1) was 99.3%. This study is the first report of C. lactis in Korean apiaries. The findings of this study demonstrate a significantly higher detection rate in winter, which is 4.1 times greater than that in summer (p < 0.001). Furthermore, the results underscore the usefulness of molecular diagnostic techniques for detecting C. lactis mites. [ABSTRACT FROM AUTHOR]

Objectives: The population attributable fraction (PAF), an epidemiologic measure of exposures and health outcomes, can provide information on the public health impacts of exposures in populations. This study aimed to systematically summarize the PAF estimates of modifiable cancer risk factors in Korea. Methods: This review included studies that determined PAFs of modifiable risk factors for cancer in Korea. We performed systematic searches in EMBASE, MEDLINE, Cochrane library, and Korean databases for studies published up to July 2021. Two reviewers independently screened studies for eligibility, extracted data, and performed quality assessments of the included studies. Due to high variability among the data acquisition methods and PAF estimates, we presented the results qualitatively and did not perform quantitative data synthesis. Results: We reviewed 16 studies that reported the PAFs of risk factors for cancer, including smoking, alcohol consumption, obesity, and various cancer sites. We found considerable variability in the PAF estimates across exposure and cancer pairs. However, PAF estimates for smoking and respiratory cancer were consistently high in men. PAF estimates were higher in men than in women for smoking and alcohol consumption but higher in women for obesity. We found limited evidence for other exposures and cancers. Conclusion: Our findings may be used to prioritize and plan strategies to reduce cancer burden. We encourage further and updated assessments of cancer risk factors, including those not addressed in the studies included in this review, and their potential contributions to cancer burden to better inform strategies for cancer control. [ABSTRACT FROM AUTHOR]

Introduction: Examining the equity of health care and financial burden in households of deceased individuals in urban and rural areas is crucial for understanding the risks to both national and individual household finances. However, there is a lack of research on catastrophic health expenditure (CHE) in these households, specifically in urban and rural contexts. This study aims to identify the ability to pay and equity of CHE for both households of deceased individuals in urban and in rural areas. Methods: This study analysed data from the Korea Health Panel for 10 years (2009--2018) and targeted 869 deceased individuals and their households in the Republic of Korea (South Korea). Annual household income and living costs were adjusted based on equivalent household size, and the difference between these values represented the household's ability to pay. Out-of-pocket (OOP) expenditure included copayments and uninsured healthcare expenses for emergency room visits, inpatient care, outpatient treatments and prescription medications. CHE was defined as OOP expenditure reaching or exceeding 40% of the household's ability to pay. ANCOVA was performed to control for confounding variables, and the equity of CHE prevalence between urban and rural area was assessed using χ analysis. Results: Compared to urban households, the rural households of deceased individuals had, respectively, fewer members (2.7 v 2.4, p=0.03), a higher rate of presence of a spouse (63.8% v 70.7%, p=0.04) and a higher economic activity rate (12.7% v 20.5%, p=0.002). The mean number of comordities before death was 3.7 in both urban and rural areas, and there was no difference in the experience of using over-the-counter medicines for more than 3 months, emergency room, hospitalisation, and outpatient treatment. In addition, annual household OOP expenditures in urban and rural areas were US$3020.20 and US$2812.20, respectively, showing no statistical difference (p=0.341). This can be evaluated as a positive effect of various policies and practices aimed at alleviating urban--rural health equity. However, the financial characteristics of the household of the deceased in the year of death differed decisively between urban and rural areas. Compared to urban households, the annual income of rural households (US$15,673.80 v US$12,794.80, respectively, p≤0.002) and the annual ability to pay of rural households (US$14,734.10 v US$12,069.30, respectively, p=0.03) were lower. As a result, the 2 prevalence of CHE was higher in rural areas than in urban areas (68.3% v 77.6%, p=0.003). Conclusion: The findings of this study highlight the higher risk of CHE in rural areas due to the lower income level and ability to pay of the household of the deceased. It is evident that addressing the issue of CHE requires broader social development and policy efforts rather than individual-level interventions focused solely on improving health access and controlling healthcare costs. The findings of this study contribute to the growing evidence that income plays a crucial role in rural health outcomes. [ABSTRACT FROM AUTHOR]

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Background: As female social participation increases, the importance of femininity in leadership also increases. In Korea in 2021, 26.8% of 132,013 doctors and 35.1% of 3,099 medical students were female. However, no research has been conducted on the gender demographics of medical leaders. This study aims to define Korean medical leadership, investigate the gender ratio, and determine whether the proportion of women leaders differs in the academic and non-academic worlds. Methods: Korean medical leaders were defined as those in director or higher-level positions in organizations affiliated with the Korean Medical Association, 34 organizing societies under the Korean Academy of Medical Sciences (KAMS), and those who held dean and vice dean positions in 40 medical schools. Academic societies comprised KAMS, KAMS-affiliated societies, and medical schools; the rest were classified as non-academic organizations. Data were collected through website, e-mail, or telephonic surveys. Differences in the number of women leaders between academics and non-academics were analyzed using the chi-square test. Results: In total, 1,863 medical leaders were evaluated, with females accounting for 12.6%. The difference in the ratio of female leaders between academic and non-academic societies was not statistically significant (13.1% academic vs. 11.8% non-academic; P=0.445). Conclusion: The proportion of women leaders in the Korean medical field is relatively low compared with that of female doctors and medical students. The number of women in leadership positions and their effect on medical society will be observed periodically. [ABSTRACT FROM AUTHOR]

Background: On February 6, 2024, the Korean government announced a drastic increase in the medical schools' admission quota to 2,000, sending shockwaves through the medical community. In protest, residents submitted their resignations and medical students submitted their leaves of absence. Current Concepts: The government has used many shocking tactics in pushing for greater medical school quotas. First, the government used lies to incite public opinion and socially isolate a group of doctors. Second, it violently imposed law enforcement against residents in the process of promoting the medical school expansion policy. Third, it pursued a medical school expansion policy that did not consider the quality of medical education. Triggered by the government's rapid expansion of medical schools, fierce resistance from doctors and medical students has revealed structural contradictions in the Korean healthcare system. Discussion and Conclusion: In essence, the medical crisis of 2024 has been created by the government. The medical community cannot stop its legitimate criticism and resistance for the following reasons. First, this is not just a medical crisis but a crisis of the Korean constitution, rule of law, and democracy. Second, the fate of future generations depends on the resolution of the 2024 medical crisis. Third, the government's policies are not saving essential medicine, but pushing it off the cliff. [ABSTRACT FROM AUTHOR]

This study explores Korean-American parents' perceptions on successful transition to kindergarten (TTK) for their child on the autism spectrum. It further examines challenges experienced during this process, and possible predictors for their challenges. Findings from an online survey (N = 212) indicate that participants consider their child's behavioral readiness and cooperation with teachers as the most important school readiness skills for successful TTK. They further consider building positive relationships with teachers and providing support at home as the most important support parents could provide during this process. Moreover, the child being a vocal communicator, higher income and parent's educational level were found to buffer against their reported challenges, while first-generation immigrant status and restrictive school placement were found to predict more challenges.

BACKGROUND: Early-onset colorectal cancer (EOCRC) may differ by race and ethnicity, and recently South Korea has witnessed a surge in cases. We aimed to evaluate the clinical and pathological features of patients with EOCRC, and to determine the predictors of overall survival. METHODS: In this retrospective study, EOCRC was defined as CRC diagnosed in patients aged < 50 years, and late-onset CRC was defined as CRC diagnosed in those over 75 years of age. The clinical and pathological characteristics of patients with EOCRC were compared with late-onset CRC. We also used multivariable Cox proportional hazard models to find predictors of overall survival in patients with EOCRC. RESULTS: The proportion of early-onset CRC was 9.1% of 518 patients with CRC, and the clinical and pathological characteristics were similar between early-onset (n = 47) and late-onset CRC (n = 134). However, EOCRC had a preponderance for distal tumor location (70.2% vs. 50.7%, P = 0.02) and T1-2 stage disease (23.4% vs. 11.2%, P = 0.04), compared with those of late-onset CRC. Using multivariable Cox proportional hazard models, only vascular invasion (hazard ratio = 8.75, 95% confidence interval 1.139‒67.197) was found to be a risk factor for overall survival (P = 0.04) for patients with CRC. CONCLUSION: EOCRC had preponderance for distal tumor location and early T-stage disease, compared with late-onset CRC. Considering the increasing incidence of EOCRC, more studies on clinical and pathological characteristics of EOCRC may be warranted.