Effect of Chronic Kidney Disease on All-Cause Mortality After Hip Fracture Surgery: A Retrospective Cohort Study.

In this retrospective cohort study, we investigated: (1) The impact of comorbid chronic kidney disease (CKD) on postoperative mortality in patients with a hip fracture; (2) mortality variations by dialysis type, potentially indicating CKD stage; (3) the efficacy of different hip fracture surgical methods in reducing mortality for patients with CKD. This study included 25,760 patients from the Korean National Health Insurance Service-Senior cohort (2002-2019) who underwent hip fracture surgery. Participants were categorized as CKD and Non-CKD. Mortality rate was determined using a generalized linear model with a Poisson distribution. The effect size was presented as a hazard ratio (HR) through a Cox proportional-hazard model. During follow-up, we ascertained that 978 patients (3.8%) had CKD preoperatively. Compared to the Non-CKD group, the mortality risk (HR) in the CKD group was 2.17 times higher (95% confidence interval [CI], 1.99-2.37). In sensitivity analysis, the mortality risk of in patients who received peritoneal dialysis and hemodialysis was 6.21 (95% CI, 3.90-9.87) and 3.62 times (95% CI, 3.11-4.20) higher than that of patients who received conservative care. Mortality risk varied by surgical method: hip hemiarthroplasty (HR, 2.11; 95% CI, 1.86-2.40), open reduction and internal fixation (HR, 2.21; 95% CI, 1.94-2.51), total hip replacement (HR, 2.27; 95% CI, 1.60-3.24), and closed reduction and percutaneous fixation (HR, 3.08; 95% CI, 1.88-5.06). Older patients with CKD undergoing hip fracture surgery had elevated mortality risk, necessitating comprehensive pre- and postoperative assessments and management.

Association between sedentary behavior and chronic kidney disease in Korean adults.

BACKGROUND: Chronic kidney disease (CKD) is a significant health care burden, with a worldwide prevalence of approximately 11%. The general population spends over 50% of the awake time sedentary activities. However, to the best of our knowledge, no study has evaluated the association between sedentary time and CKD, with a focus on both kidney damage and kidney function, in the South Korean population. Accordingly, the present study aimed to address this gap in the knowledge. METHOD: We used data from the 8th Korea National Health and Nutrition Examination Survey. The analysis included 9,534 participants, especially excluded those who had been diagnosed with kidney disease or who were currently undergoing treatment. Sedentary behavior was self-reported by the participants. An estimated glomerular filtration rate (eGFR) and/or albuminuria were used as measures for detection of CKD according to the guidelines of the Kidney Disease Improving Global Outcomes. We analyzed the data using multiple logistic regression. RESULTS: Among the women, the risk of CKD was significantly greater among those who sat for ≥ 12 h/d relative to those who sat for < 6 h/d, after adjusting for physical activity and other covariates (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.01-2.06). Similarly, among those who sat over 12 h/d, those who engaged in low levels of physical activity had a higher risk of CKD than those who engaged in high levels of activity (OR: 1.65, 95% CI: 1.04-2.61). No statistically significant results were found for men. CONCLUSION: Excessive sedentary behavior was associated with an increased risk of CKD, especially albuminuria, regardless of the level of physical activity, only in women. These findings emphasize the importance of avoiding excessive sitting for a long time and increasing overall physical activity levels.

Association between caregiver type and catastrophic health expenditure among households using inpatient medical services: using Korean health panel.

BACKGROUND: Caregiving services often place a financial burden on individuals and households that use inpatient medical services. Consequently, this study aimed to examine the association between the type of caregiver and catastrophic health expenditure among households utilizing inpatient medical services. METHODS: Data were extracted from the Korea Health Panel Survey conducted in 2019. This study included 1126 households that used inpatient medical and caregiver services. These households were classified into three groups: formal caregivers, comprehensive nursing services, and informal caregivers. Multiple logistic regression was used to analyze the association between caregiver type and catastrophic health expenditure (CHE). RESULTS: Households receiving formal caregiving had an increased likelihood of CHE at threshold levels of 40% compared to those who received care from family (formal caregiver: OR 3.11; CI 1.63-5.92). Compared to those who received formal caregiving, households using comprehensive nursing services (CNS) had a decreased likelihood of CHE (CNS: OR, 0.35; CI 0.15-0.82). In addition, considering the economic value associated with informal care, there was no significant relationship between households received formal caregiving and informal caregiving. CONCLUSION: This study found that the association with CHE differed based on the type of caregiving used by each household. Households using formal care had a risk of developing CHE. Households using CNSs were likely to have a decreased association with CHE, compared to households using informal and formal caregivers. These findings highlight the need to expand policies to mitigate the burden on caregivers for households forced to use formal caregivers.

Effects of life-sustaining treatment plans on healthcare expenditure and healthcare utilization.

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

Association between statin adherence and the risk of stroke among South Korean adults with hyperlipidemia.

BACKGROUND AND AIMS: The effectiveness of statins commonly used to prevent stroke may depend on adherence to treatment. We examined the association between statin adherence and stroke risk among South Korean adults with hyperlipidemia. METHODS AND RESULTS: The data of 128,052 and 129,390 participants with hyperlipidemia for the purpose of studying the risks of ischemic and hemorrhagic stroke, respectively, were collected from the Korean National Health Insurance Service-National Sample Cohort between 2002 and 2013. Participants were divided into groups according to statin adherence, calculated as the proportion of days covered (PDC; poor, moderate, good). The risk of ischemic and hemorrhagic stroke were analyzed using a Cox proportional hazards model. Individuals with poor PDC exhibited higher risks of ischemic and hemorrhagic stroke than those with good PDC (ischemic stroke: hazard ratio [HR] = 1.09, 95% confidence interval [CI] = 1.03-1.15, hemorrhagic stroke: HR = 1.37, 95% CI = 1.22-1.54). Women with poor PDC were at higher risk of ischemic stroke than those with good PDC (HR = 1.17, 95% CI = 1.09-1.26), while men with poor PDC exhibited a higher risk of hemorrhagic stroke than those with good PDC (HR = 1.55, 95% CI = 1.27-1.90). Individuals with disabilities who had poor PDC were at higher risk of ischemic stroke than those with good PDC (HR = 1.55, 95% CI = 1.24-1.93). CONCLUSIONS: We detected a significant association between statin adherence and ischemic and hemorrhagic stroke risk. Therefore, hyperlipidemia patients should adhere to statin treatment; such interventions are required to reduce the stroke risk.

Association between sedentary behavior and depression among South Korean adolescents.

BACKGROUND: The symptoms and outcomes of depressed mood are considered severe social issues among Korean adolescents. However, it is difficult to detect depressed mood and evaluate the factors associated with suicide among such individuals. Identifying the risk factors of depressed mood would allow for improved perspectives for interventions. Therefore, in this study, we investigated the association between sedentary behavior and the prevalence of depressed mood. METHODS: From 2014 to 2020, the Korea Youth Risk Behavior Survey (KYRBS), which is a web-based self-report survey, was used for analysis. A total of 366,405 individuals participated in this study. Sedentary behavior was divided into 3 groups based on the duration of sedentary behavior: low sedentary time group (LS, 25 percentile), middle sedentary time group (MS, from 25 to 75 percentile, reference), and high sedentary time group (HS, above 75 percentile). Further, sedentary behavior is divided into 4 subgroups based on weekdays or weekends and owing to studying or non-studying. The chi-square test and multivariate logistic regression were used in this study. RESULTS: Compared to the MS, which is the reference, male participants in both the LS and HS had experienced depressed mood (adjusted odds ratio (OR): 1.035, 95% CI = 1.003-1.068 in the LS, adjusted OR: 1.091, CI = 1.055-1.129 in the HS). Among females, only the HS was statistically significant (adjusted OR: 1.039, 95% CI = 1.011-1.069 in HS). Korean adolescents with longer sedentary durations during weekdays regardless of the cause of sedentary behavior are positively associated with depressed mood with suicidality in the HS for both genders. CONCLUSION: This study found a positive association between the prevalence of depressed mood and sedentary behavior, and it focused on the cause and timing. Interventions targeting sedentary behavior could be effective in reducing depressed mood and suicidality among adolescents.

Association between social phobia and the risk of arrhythmia using the Korean National Sample Cohort: a retrospective cohort study.

BACKGROUND: Social phobia shares symptoms with arrhythmias, such as palpitations and chest discomfort. However, it is unclear how social phobia is associated with the actual risk of arrhythmia. This study aimed to investigate whether social phobia is associated with the risk of arrhythmia using a nationally representative sample cohort. METHODS: This retrospective cohort study assessed data from the 2002-2013 Korean National Health Insurance Service National Sample Cohort. Using 1:3 propensity score matching for sex, age, income, and insurance status, 1514 patients with social phobia and 4542 control group patients were included in the study. Social phobia and arrhythmia were defined per the International Classification of Diseases, 10th revision. Using cox proportional hazard regression, hazard ratios (HRs) were calculated to estimate the risk of arrhythmia in patients with social phobia. RESULTS: There were statistically significant associations between social phobia history and elevated risks of arrhythmia. Patients with social phobia had a higher risk of arrhythmia after adjusting with covariates (HR = 1.78, 95%CI = 1.25-2.55). Among different types of arrhythmias, atrial fibrillation and flutter presented the highest risk (HR = 2.20, CI = 1.06-4.57) compared to paroxysmal tachycardia (HR = 1.07, CI = 0.39-2.91) and other cardiac arrhythmias (HR = 1.83, CI = 1.16-2.89). CONCLUSION: This study identified the association between social phobia and the risk of arrhythmia in a South Korean representative cohort. These results suggest that social phobia should be treated properly to reduce arrhythmia risks.

Association of perceived life satisfaction with attitudes toward life-sustaining treatment among the elderly in South Korea: a cross-sectional study.

BACKGROUND: Amidst rapid population aging, South Korea enacted the Well-dying Act, late among advanced countries, but public opinion on the act is not still clear. Against this background, this study aims to: 1) investigate factors affecting elderly individuals' attitude toward life-sustaining treatment, and 2) examine whether attitude toward life-sustaining treatment is related to their perceived life satisfaction. METHODS: Data from the 2020 Survey of Living Conditions and Welfare Needs of Korean Older Persons were used. There were 9,916 participants (3,971 males; 5,945 females). We used multivariable-adjusted Poisson regression models with robust variance to examine the association between perceived life satisfaction and attitude toward life-sustaining treatment and calculate prevalence ratios (PR) and 95% confidence intervals (CI). RESULTS: After adjusting potential confounders, the probabilities that the elderly who were dissatisfied with their current life would favor life-sustaining treatment were 1.52 times (95% CI: 1.15-1.64) and 1.28 times (95% CI: 1.09-1.51) higher for men and women, respectively, than the elderly who were satisfied. In addition, attitudes in favor of life-sustaining treatment were observed prominently among the elderly with long schooling years or high household income, when they were dissatisfied with their life. CONCLUSIONS: Our results suggested that for the elderly, life satisfaction is an important factor influencing how they exercise their autonomy and rights regarding dying well and receiving life-sustaining treatment. It is necessary to introduce interventions that would enhance the life satisfaction of the elderly and terminally ill patients and enable them to make their own decisions according to the values of life.

Si photonic-electronic monolithically integrated optical receiver with a built-in temperature-controlled wavelength filter.

We present a Si photonic-electronic integrated ring-resonator based optical receiver that contains a temperature-controlled ring-resonator filter (RRF), a Ge photodetector, and receiver circuits in a single chip. The temperature controller automatically determines the RRF temperature at which the maximum transmission of the desired WDM signal is achieved and maintains this condition against any temperature or input wavelength fluctuation. This Si photonic-electronic integrated circuit is realized with 0.25-µm photonic BiCMOS technology, and its operation is successfully confirmed with measurement.

Association between change in handgrip strength and cognitive function in Korean adults: a longitudinal panel study.

BACKGROUND: Muscular function, such as handgrip strength, has been suggested as an associated factor for cognitive impairment. This study investigated the association between temporal change in handgrip strength and cognitive function using longitudinal, nationwide data from Korean older adults. METHODS: Our study used data from the Korean Longitudinal Study of Aging (KLoSA). The analysis covered 6696 participants who had taken the handgrip strength test and Mini-Mental State Examination (MMSE) from 2006 to 2018. We adopted general estimating equations to assess the temporal effect of handgrip strength change on cognitive function. RESULTS: After adjusting for covariates, we observed an association between handgrip strength and low MMSE scores (ß = - 0.3142 in men, ß = - 0.2685 in women). Handgrip strength as a continuous variable was positively correlated with MMSE scores after adjustment (ß = 0.0293 in men, ß = 0.0347 in women). The group with decreased handgrip strength over time also showed greater odds for mild cognitive impairment (OR = 1.23, 95%CI = 1.05-1.27 in men, OR = 1.15, 95%CI = 1.05-1.27 in women) and dementia (OR = 1.393, 95%CI = 1.18-1.65 in men, OR = 1.19, 95%CI = 1.08-1.32 in women). CONCLUSIONS: This study identified the relationship between handgrip strength change and cognitive function among South Korean adults. According to our large, longitudinal sample, decreasing handgrip strength was associated with decline in cognitive function.

Efficacy of Retrievable Inferior Vena Cava Filter Placement in the Prevention of Pulmonary Embolism during Catheter-Directed Thrombectomy for Proximal Lower-Extremity Deep Vein Thrombosis.

BACKGROUND: Inferior vena cava (IVC) filter placement is not indicated for thrombolytic interventional treatment for deep vein thrombosis (DVT). We analyzed the efficacy and feasibility of retrievable IVC filter placement for the preventive management of embolic shedding during catheter-directed thrombectomy (CDT) for DVT of lower extremity. METHODS: Seventy patients (35 males and 35 females) who underwent retrievable IVC filter placement to prevent thrombus dislodgement during CDT in all symptomatic DVT with thrombus age suspected within 4 weeks of the lower extremity between March 2008 and January 2014 were included in this study. All patients underwent laboratory blood study, duplex ultrasound and/or computed tomography for diagnosis, treatment, and follow-up in accordance with treatment policy of our Uijeongbu St. Mary's hospital. Two types of retrievable IVC filters (OptEase Filter, Cordis, Roden, The Netherlands; Gunther Tulip Filter, Cook, Bloomington, IN) were used to prevent thromboembolic events during CDT. After filter placement, subcutaneous low-molecular-weight heparin and overlapped to warfarin or new oral anticoagulant tried to achieve a target international normalized ratio (INR) of 2.0-3.0 in warfarin patients. RESULTS: The thrombus was dislodged through the IVC filter during catheter-directed thrombolytic therapy in 22 patients (31.4%). In 22 cases, the thromboses were trapped by the retrievable IVC filter, and follow-up images showed thrombus capture. Thirty-four patients (48.6%) received percutaneous transluminal angioplasty (PTA). Additional stents were inserted in 23 patients (32.8%). Pulmonary embolism (PE) was not observed in patients implanted with retrievable IVC filters. CONCLUSIONS: Our study findings suggest that retrieval IVC filter placement during interventional treatments of DVT of lower extremity such as thrombectomy of vein thrombus with or without stent insertion at compressed deep vein is favorable and effective for protecting against PE or lethal complications. We recommend carefully that before the management of DVT thrombus of lower extremity, retrieval IVC filter placement should be considered for preventing morbidity related with the PE.

KBH-1, an herbal composition, improves hepatic steatosis and leptin resistance in high-fat diet-induced obese rats.

BACKGROUND: KBH-1 is an herbal mixture of Saururus chinensis, Curcuma longa and Polygala tenuifolia. Each herb has been reported to have various pharmaceutical activities; however, the synergistic effect of this herbal composition on obesity has not yet been determined. We investigated the alleviation effect of KBH-1 and its possible molecular mechanism in obesity-induced hepatic steatosis and leptin resistance in the hypothalamus. METHODS: We used HepG2 cells, primary neuronal cells and a high-fat diet (HFD)-induced obesity rat model to determine the effect of KBH-1 in vitro and in vivo on hepatic steatosis and leptin resistance accompanied by obesity. To identify the alleviation effect on lipid accumulation, HepG2 cells stimulated by FFA were stained with Oil Red O; in addition, immunoblotting and qPCR were performed to determine the effect of KBH-1 on the activation of proteins and nuclear enzymes in HepG2 cells and the steatotic liver of HFD-induced obesity rats. To examine the effect of KBH-1 on the leptin resistance of the hypothalamus and its possible molecular mechanism, we examined the effect of KBH-1 on the activation of the leptin resistance-related protein in primary cultured cortical neuron cells and the hypothalamus of an HFD-induced obesity rat model. In addition, we used HPLC analysis to identify the standard compound of KBH-1. RESULTS: KBH-1 not only suppressed the lipid deposition in HepG2 cells exposed to free fatty acids (FFA) but also significantly down-regulated major factors in lipogenesis and up-regulated major factors in lipolysis. Similarly, in a HFD-induced obesity model, KBH-1 improved hepatic steatosis by alleviating the effects on lipogenic genes and kinases. In addition, KBH-1 significantly improved the leptin-mediated signals impaired by obesity or FFA in the obesity model and primary cultured cortical neuron cells. In addition, KBH-1 was analyzed to include six standard compounds using HPLC analysis, among these compounds, onji-saponin B and curcumin were potently suppressed the level of triglycerides. CONCLUSIONS: KBH-1 exhibits alleviating effects by improving hepatic steatosis and leptin resistance by up-regulating the activation of AMPK and suppressing the expression of PPARγ. These findings show the potential of KBH-1 as a functional food supplement or preventive agent in the treatment of obesity.

Vigna angularis inhibits IL-6-induced cellular signalling and ameliorates collagen-induced arthritis.

OBJECTIVES: The present study was conducted in order to assess whether extracts or isolated compounds from Vigna angularis were able to suppress IL-6 signalling and to show the therapeutic effect on collagen-induced arthritis (CIA) in mice. METHODS: The effect of V. angularis on IL-6 signalling was studied by measuring Stat3-dependent luciferase activity, expression of inflammation-related genes, and phosphorylation of Janus kinase 2 (JAK2), signal transducer and activator of transcription 3 (STAT3) and extracellular signal-regulated kinase (ERK) induced by IL-6. CIA was induced by immunizing with bovine type II collagen. V. angularis extract (VAE) was administrated orally at 50 and 100 mg/kg from day 1 to day 28. Induction of arthritis was evaluated with a visual scoring system and histological analysis. RESULTS: Extracts or two triterpenoid compounds from V. angularis showed potent inhibitory effects on pSTAT3-inducible luciferase activity, STAT3 tyrosine phosphorylation and the expression of inflammation-related genes induced by IL-6. Administration of VAE significantly suppressed the progression of CIA, accompanied by a reduced antibody response to type II collagen and protection from tissue damage in knee joints. CONCLUSION: Administration of VAE has a therapeutic effect on CIA and this effect is associated with the inhibitory activity on IL-6/STAT3 signalling. These results suggest that extracts or compounds from V. angularis could be a useful treatment for diseases related to IL-6, including RA.

Association of the Type of Public Pension With Mental Health Among South Korean Older Adults: Longitudinal Observational Study.

BACKGROUND: As income and health are closely related, retirement is considered undesirable for health. Many studies have shown the association between pension and health, but no research has considered the association between contribution-based public pensions or their types and health. OBJECTIVE: This study investigates the association between the type of contributory public pension and depressive symptoms among older adults. METHODS: We analyzed the data of 4541 older adults who participated in the South Korea Welfare Panel Study (2014-2020). Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression scale. Public pensions in South Korea are classified into specific corporate pensions and national pensions. For subgroup analyses, pensioners were categorized according to the amount of pension received and the proportion of public pension over gross income. Analyses using generalized estimating equations were conducted for longitudinal data. RESULTS: Individuals receiving public pension, regardless of the pension type, demonstrated significantly decreased depressive symptoms (national pension: ß=-.734; P<.001; specific corporate pension: ß=-.775; P=.02). For both pension types, the higher the amount of benefits, the lower were the depression scores. However, this association was absent for those who received the smaller amount among the specific corporate pensioners. In low-income households, the decrease in the depressive symptoms based on the amount of public pension benefits was greater (fourth quartile of national pension: ß=-1.472; P<.001; second and third quartiles of specific corporate pension: ß=-3.646; P<.001). CONCLUSIONS: Our study shows that contributory public pension is significantly associated with lower depressive symptoms, and this association is prominent in low-income households. Thus, contributory public pensions may be good income sources for improving the mental health of older adults after retirement.

The Association between High-Caffeine Drink Consumption and Anxiety in Korean Adolescents.

BACKGROUND: As excessive caffeine intake may be associated with anxiety disorders, one of the most prevalent mental illnesses among adolescents globally, this study investigated the association between high caffeine consumption and anxiety in a nationally representative sample of South Korean adolescents. METHODS: 46,873 participants from the Korea Youth Risk Behavior Web-based Survey (KYRBS) 2022 were included. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire was used to evaluate anxiety symptoms. Survey questions determined the number of times each participant consumed high-caffeine drinks per week. The chi-square test was used to investigate and compare the general characteristics of the study population, and a modified Poisson regression was used to analyze the relationship. RESULTS: Both male and female participants reporting excessive high-caffeine drink consumption exhibited higher anxiety levels (adjusted prevalence ratio [aPR]: 1.19, 95% confidence interval [CI]: 1.08-1.31 in males; aPR: 1.14, CI: 1.05-1.23 in females). This association remained statistically significant in subgroup analyses, particularly among high school students and those with a shorter sleep duration. The relationship between high-caffeine drink consumption and anxiety strengthened with increasing anxiety levels. Additionally, there was a dose-dependent relationship between the prevalence of anxiety and high-caffeine drinks. CONCLUSION: High caffeine consumption increases anxiety in South Korean adolescents. This association proved consistent regardless of sex or other socioeconomic factors.

Trends in private caregiving cost after implementing a comprehensive nursing service covered by national health insurance: Interrupted time series.

BACKGROUND: The Korean government has implemented a comprehensive nursing care service system (CNS) to mitigate the stress faced by caregivers. OBJECTIVE: This study aimed to assess trends in the estimated average costs of private caregiving and determine the difference in costs between those using CNS and those not using it. DESIGN: A comparative interrupted time series analysis with a 2-year lag period verified total private caregiving cost trends; biannual differences in costs were evaluated based on using CNS. PARTICIPANTS: The main unit of analysis was episode. We extracted a total of 6418 episodes of hospitalization in acute care settings that included the use of caregiving services (formal, informal caregiving and CNS). METHODS: We conducted segmented regression to assess the impact of CNS on total private caregiving costs using data from 2012 to 2018, excluding the years 2015 and 2016 of the Korean Health Panel dataset. RESULTS: We presented that the immediate mean difference in total private caregiving costs between CNS users and non-users was -444.7 USD two years after the implementation of the CNS policy (95 % CI -714.5 to -174.5, p-value 0.001). Among individuals living in rural areas, two years after the implementation of the CNS policy, there was a significant immediate mean cost difference of -476.9 USD in total private caregiving costs between CNS users and non-users (p-value 0.011). Similarly, for episodes with a Charlson Comorbidity Index (CCI) score of 0 to 1, there was a substantial immediate mean cost difference in total private caregiving costs between CNS users and non-users, amounting to -399.9 USD two years after the CNS policy (p-value 0.008). CONCLUSIONS: This study evaluated the trend of total private caregiving costs between groups using and not using CNS. After two years of being covered by CNS health insurance, those who utilized CNS paid $433 less for their total private caregiving cost over a 6-month period, compared to those who did not use CNS. The adoption of CNS may be an effective system for relieving the financial burden on inpatients in need of private caregiving services. TWEETABLE ABSTRACT: Korean Comprehensive Nursing Service reduces private caregiving costs.

Effect of the peripartum depressive symptoms on the Internet use disorder of their offspring in late childhood: retrospective longitudinal study.

Internet use disorder (IUD) is an emerging social and mental health concern. This study aimed to analyze the relative risk of IUD in late childhood among children whose mothers experienced peripartum depressive symptoms. This study included 762 participants (397 boys and 365 girls) and was conducted in 2017 (aged 9) and 2019 (aged 11). We analyzed the adjusted relative risk of being at high risk for IUD based on whether the mother experienced depressive symptoms during pregnancy or one month after delivery. We also considered the persistence of depressed mood for 4 months after delivery and the severity of peripartum depressive symptoms. From 2017, 20.7% of boys and 14.0% of girls were at high risk of developing IUD. Compared to the non-peripartum depressive group, girls whose mothers experienced peripartum depressive symptoms and those that persisted for 4 months were 1.084 and 1.124 times more likely to be at high risk of IUD (95% confidence interval = 1.005-1.170 and 1.013-1.248), respectively. There were no statistically significant differences among boys. Peripartum depressed mood could be one of risk factors of IUD. IUD needs to be monitored in children whose mothers experienced peripartum depressive symptoms.

Association between antidepressants and the risk of diabetic foot ulcers and amputation in antidepressant-naïve type 2 diabetes mellitus patients: A nested case-control study.

AIMS: Antidepressants are widely used by individuals with type 2 diabetes mellitus (T2DM). This study aimed to explore the correlation between antidepressant use, considering specific antidepressant subclasses or cumulative doses, and diabetic foot ulcer (DFU) risk. METHODS: This nested case-control study was conducted using a representative population-based Korean cohort database from 2002 to 2019. Participants with DFUs were matched with participants without DFUs based on age, sex, date of T2DM diagnosis, and follow-up duration. In total, 791 DFUs and 3900 controls were included. The association between antidepressant use or cumulative dose of each antidepressant subclass, DFU risk and amputation risk was examined using a conditional logistic regression model. RESULTS: Antidepressant ever-use was associated with an increased incidence of DFUs compared with non-use. Furthermore, an increase in DFU risk was evident with increasing cumulative antidepressant dosage, particularly among tricyclic antidepressant (TCA) ever-users and selective serotonin reuptake inhibitors (SSRIs) ever-users. Additionally, antidepressant ever-users displayed a higher risk of DFUs requiring amputation, which was consistently observed when the cumulative dosages of overall antidepressants and TCAs were considered. CONCLUSION: Caution is advised when administering TCAs and SSRIs in antidepressant-naïve T2DM patients to reduce DFU and the consequent amputation risk.

Case Report: Cryptococcal Meningitis in a Previously Immunocompetent Patient with Coronavirus Disease 2019.

Cryptococcus neoformans infections occur most frequently in immunocompromised patients. Here, we report a case of cryptococcal meningitis in a previously immunocompetent 78-year-old female patient after treatment of COVID-19. Underlying diseases included hypertension, hyperlipidemia, and diabetes. The patient was critically ill and was treated with remdesivir, baricitinib, and dexamethasone. During hospitalization, her mental state changed, and C. neoformans was detected in the cerebrospinal fluid. She died despite receiving antifungal treatment. Treatment of COVID-19 may be a predisposing factor for C. neoformans infection. There is a need for concern and countermeasures for opportunistic fungal infections that may accompany COVID-19.

Impact of financial incentives for infection prevention and management on antibiotic use: A Korea National Health Insurance cohort study.

BACKGROUND: The Korean government implemented financial incentives to enhance infection prevention and management within general hospital settings. This study aimed to evaluate the impact of infection control compensation on antibiotic usage using a controlled interrupted time series analysis. METHODS: The main unit of analysis was 270,901 inpatient episodes extracted from the Korean National Health Insurance Service Cohort Database from 2013 to 2019. The 96-month period was examined before and after the intervention, which was set to September 1, 2017, by applying a 1-year lag time after the incentive was introduced. Segmented regression was used to estimate the effects of interventions in a controlled interrupted time series. Hospitals that received nationwide financial incentives for infection prevention and management were included in the analysis. The study's primary outcome was the use of antibiotics based on the WHO Access, Watch, and Reserve (AWaRe) classification of antibiotics, and the secondary outcome was the number of days of antibiotic use as days of therapy (DOTs) per patient day (PD). RESULTS: The probability of overall antibiotic use decreased between incentivized and unincentivized hospitals (odds ratio [OR], 0.922; 95% confidence interval [CI], 0.859-1.000). The difference in level change in the use of third-generation cephalosporins (OR,0.894; 95% CI, 0.817-0.977) and carbapenem (OR,0.790; 95% CI, 0.630-0.992) was significantly reduced between incentivized and unincentivized hospitals. The difference in slope change on DOTs/PD of glycopeptides was - 0.005 DOT/PDs, and that of carbapenem was - 0.003 between incentivized and unincentivized hospitals. CONCLUSION: We observed that incentives for infection prevention and management have had a positive impact on some aspects of antibiotic usage. A partial decrease was observed in antibiotic use, accompanied by a modest reduction in DOTs/PD, particularly for antibiotics aimed at addressing multidrug-resistant pathogens. Further investigation is necessary to establish evidence for extending these incentives.