Comparison of Clinical Effectiveness and Safety of Drug-Coated Balloons versus Percutaneous Transluminal Angioplasty in Arteriovenous Fistulae: A Review of Systematic Reviews and Updated Meta-Analysis.

PURPOSE: To evaluate the clinical effectiveness and safety of drug-coated balloons (DCBs) compared with those of percutaneous transluminal angioplasty (PTA) for arteriovenous fistula (AVF) stenosis via a review of systematic reviews (SRs) and an update of the current meta-analysis. MATERIALS AND METHODS: Literature was searched to retrieve SRs comparing DCBs and PTA for AVFs. A narrative review of SRs and pooled analysis were performed. RESULTS: Eleven SRs were included. DCBs demonstrated favorable outcomes at 6 and 12 months compared with PTA, with improved patency in 7 SRs and a trend toward favorable outcomes without statistical significance in 3 SRs. Target lesion revascularization (TLR) was reported in 3 SRs; 2 reviews reported a significantly lower incidence in the DCB group than in the PTA group, whereas 1 review reported no significant differences at 12 months. Four studies reporting all-cause mortality revealed no significant difference between the 2 treatments. In the updated meta-analysis including 23 studies, DCBs demonstrated improved primary patency at 6 months (risk ratio [RR], 1.27; 95% CI, 1.07-1.50) and 12 months (RR, 1.36; 95% CI, 1.19-1.55) and were associated with a lower incidence of TLR at 6 months (RR, 0.54; 95% CI, 0.41-0.73) and 12 months (RR, 0.78; 95% CI, 0.62-0.99). There was no difference in mortality between the 2 groups for 24 months. CONCLUSIONS: A review of SRs and meta-analysis update revealed the consistent benefits of DCBs over PTA in treating AVFs in terms of primary patency and TLR. Compared with PTA, DCBs do not increase mortality risk.

An analysis of protective health behavior and polypharmacy among older patients: a nationwide cohort study.

BACKGROUND: This study analyzed the relationship between protective health behaviors and polypharmacy in individuals aged 65 years and older. METHODS: We used data from a nationwide survey (KNHANES) from 2012 to 2016 in conjunction with the health insurance claims databases. A total of 3297 adults aged 65 or older were included in the study. Polypharmacy was defined as more than 30 prescription days in 6 months with five or more different drugs. Health-related behaviors (BMI, smoking, drinking, regular walking, and living alone) were extracted for 6 months before measuring polypharmacy. We used multivariable logistic regression on polypharmacy for each protective health behavior, as well as a composite score of protective health behavior. Subgroup analysis was also conducted by age and sex. RESULTS: Among protective health behaviors, BMI < 25 (OR, 0.76; 95% CI, 0.66-0.88) and never smoking (OR, 0.78; 95% CI, 0.62-0.98) were associated with a lower risk of polypharmacy. Polypharmacy was significantly associated with BMI < 25 in both sex subgroups (male: OR, 0.71; 95% CI, 0.56-0.88; female: OR, 0.81; 95% CI, 0.67-0.99) and 65-79 subgroup (OR, 0.74; 95% CI, 0.63-0.86). The association between never smoking and polypharmacy was only significant in the 65-79 subgroup (OR, 0.71; 95% CI, 0.55-0.91). Participants with five protective health behaviors had a lower risk of polypharmacy than participants with zero or one health behavior, which was only statistically significant in the subgroup analysis of participants aged 65-79 years (OR, 0.52; 95% CI, 0.29-0.94). CONCLUSIONS: This study finds that health behaviors such as obesity and smoking are associated with a higher risk of polypharmacy. Furthermore, we confirm that a high score of protective health behaviors is associated with a lower risk of polypharmacy. Our findings indicate the need for geriatric-centered management of protective health behaviors to prevent polypharmacy.

Effect of the age of visual impairment onset on employment outcomes in South Korea: analysis of the national survey on persons with disabilities data.

BACKGROUND: Opportunities for paid employment provide meaningful ways for those with disabilities to participate in society and achieve financial independence. Although the onset age of disabilities can alter individuals' attitudes toward accepting their disabilities and their desire for work, the lack of data limits relevant empirical research. The purpose of this study is to examine the effect of the onset age on employment, job security (permanent vs. temporary), and wage level among visually impaired adults in South Korea. METHODS: We used three years of the National Survey on Persons with Disabilities data, 2011, 2014, and 2017, and included 583 participants in this study. We used a logistic regression model for the employment status and a multinomial logistic regression model for job security. We analyzed log monthly wage by a multivariate linear regression model, which subdivided the age groups, with 20-49 years old denoting prime-aged (n = 245) and 50-64 years old denoting late-middle-aged (n = 338). For each age group, we conducted a sub-analysis by sex. RESULTS: For prime-aged adults, the employment probability decreased as the age of visual impartment onset increased, and women in particular experienced a lower employment rate for both permanent and temporary jobs when their disability onset age was above 25. However, among permanent employees, monthly wages were higher if the onset age was 25 + compared to when the onset age was 0-5 years old. In late middle-aged adults, adult onset disabilities were associated with higher odds of employment and higher wages for temporary jobs, implying these individuals worked unskilled or manual jobs. CONCLUSIONS: In prime-aged adults, higher monthly wages among permanent employees showed that they were more likely to continue their original work, whereas in late-middle-aged adults, adult-onset disabilities were associated with a higher employment rate and higher wages for temporary jobs, suggesting the need for further investigation into job quality. These findings indicate a need for differentiated policy approaches considering the onset age of visual impairment to improve labor market outcomes throughout individuals' lifespans.

Immediate and Long-Term Outcomes of Reperfusion Therapy in Patients With Cancer.

Background and Purpose: Patients with acute stroke are often accompanied by comorbidities, such as active cancer. However, adequate treatment guidelines are not available for these patients. The purpose of this study was to evaluate the association between cancer and the outcomes of reperfusion therapy in patients with stroke. Methods: We compared treatment outcomes in patients who underwent reperfusion therapy, using a nationwide reperfusion therapy registry. We divided the patients into 3 groups according to cancer activity: active cancer, nonactive cancer, and without a history of cancer. We investigated reperfusion processes, 24-hour neurological improvement, adverse events, 3-month functional outcome, and 6-month survival and related factors after reperfusion therapy. Results: Among 1338 patients who underwent reperfusion therapy, 62 patients (4.6%) had active cancer, 78 patients (5.8%) had nonactive cancer, and 1198 patients (89.5%) had no history of cancer. Of the enrolled patients, 969 patients received intravenous thrombolysis and 685 patients underwent endovascular treatment (316 patients received combined therapy). Patients with active cancer had more comorbidities and experienced more severe strokes; however, they showed similar 24-hour neurological improvement and adverse events, including cerebral hemorrhage, compared with the other groups. Although the functional outcome at 3 months was poorer than the other groups, 36.4% of patients with active cancer showed functional independence. Additionally, 52.9% of the patients with determined stroke etiology showed functional independence despite active cancer. During the 6-month follow-up, 46.6% of patients with active cancer died, and active cancer was independently associated with poor survival (hazard ratio, 3.973 [95% CI, 2.528­6.245]). Conclusions: In patients with active cancer, reperfusion therapy showed similar adverse events and short-term outcomes to that of other groups. While long-term prognosis was worse in the active cancer group than the nonactive cancer groups, not negligible number of patients had good functional outcomes, especially those with determined stroke mechanisms.

Suicide risk within 1 year of dementia diagnosis in older adults: a nationwide retrospective cohort study.

BACKGROUND: Although severe dementia could protect against suicide death by decreasing a person's capacity to implement a suicide plan, patients with early dementia may have better cognition, giving them more sustained insight into their disease and better enabling them to carry out a suicide plan. This study investigated suicide risk in older adults within 1 year of receiving a diagnosis of dementia. METHODS: This study used National Health Insurance Service Senior Cohort data and included 36 541 older adults with newly diagnosed dementia (a Mini-Mental State Examination score ≤ 26 and a Clinical Dementia Rating score ≥ 1 or a Global Deterioration Scale score ≥ 3), including Alzheimer disease, vascular dementia and other/unspecified dementia, from 2004 to 2012. We selected older adults without dementia through 1:1 propensity-score matching using sex, age, comorbidities and index year, with follow-up throughout 2013. We estimated adjusted hazard ratios (AHRs) of suicide deaths within 1 year after diagnosis using a time-dependent Cox proportional hazards model. RESULTS: We verified 46 suicide deaths during the first year after a dementia diagnosis. Older adults with dementia had an increased risk of suicide death compared to those without dementia (AHR 2.57; 95% confidence interval [CI] 1.49-4.44). Older adults with Alzheimer disease (AHR 2.50; 95% CI 1.41-4.44) or other/unspecified dementia (AHR 4.32; 95% CI 2.04-9.15) had an increased risk of suicide death compared to those without dementia. Patients with dementia but without other mental disorders (AHR 1.96; 95% CI 1.02-3.77) and patients with dementia and other mental disorders (AHR 3.22; 95% CI 1.78-5.83) had an increased risk of suicide death compared to patients without dementia. Patients with dementia and schizophrenia (AHR 8.73; 95% CI 2.57-29.71), mood disorders (AHR 2.84; 95% CI 1.23-6.53) or anxiety or somatoform disorders (AHR 3.53; 95% CI 1.73-7.21), respectively, had an increased risk of suicide death compared to patients with those conditions but without dementia. LIMITATIONS: This study examined only elderly patients in South Korea, a population with a substantially higher suicide rate than the global population. Caution must be exercised when generalizing the results to populations with dissimilar backgrounds. CONCLUSION: Patients with dementia had an increased risk of suicide death within 1 year after diagnosis compared to those without dementia.

Post-market utilization patterns of Alzheimer's disease treatments in South Korea: comparison with countries with universal health coverage.

PURPOSE: This study aimed to compare the utilization of Alzheimer's disease (AD) treatments, donepezil, galantamine, rivastigmine, and memantine, in Korea with Australia and other countries with universal health coverage. METHODS: Reimbursement criteria and the patent status of four AD treatments in Korea and Australia were reviewed. The monthly spending and utilization of the treatments were extracted from the national electronic database in Korea and Australia. The defined daily dose per 1000 elderly population per day (DDD/1000e/day) were calculated from July 2008 to June 2019. Annual cost trends of Norway and England were compared with Korea and Australia. RESULTS: With the highest share of the use of donepezil in both countries, the cost and utilization of AD treatments in Korea increased more rapidly and remained higher than Australia. The cost of AD treatments in Korea increased by 15.5% every year during the study period, while the spending of the same drugs in Australia decreased by 10.5% annually. The utilization in DDD/1000e/day of AD treatments in Korea increased by 18.3% annually compared with 1.4% in Australia. When compared with Norway and England, countries with similar universal health coverage (UHC) system and elderly polupation, the cost of AD treatments in Korea was still higher with the opposite trend from other countries. CONCLUSIONS: Despite the similar UHC systems, there were considerable differences in the post-market utilization of AD treatments in Korea from Australia and other countries. This results can be attributed to differences in re-assessment system, pricing and reimbursement policies, and prescribing culture. This study provides a baseline to explore more comprehensive cross-country studies on rational use of medicines.

Time-varying and dose-dependent effect of long-term statin use on risk of type 2 diabetes: a retrospective cohort study.

BACKGROUND: We evaluated the effect of statin use on new-onset type 2 diabetes among individuals without atherosclerotic cardiovascular disease (ASCVD) using nationally representative South Korean claims data (2002-2013, N = 1,016,820). METHODS: A total of 13,698 patients (statin users 5273, non-statin users 5273) aged 40-74 years, newly diagnosed with dyslipidemia but without any history of diabetes or ASCVD, were selected in 2005. We followed up the final sample until 2013 and evaluated the cumulative incidence of type 2 diabetes. We used extended Cox regression models to estimate the time-varying adjusted hazard ratios of statin use on new-onset type 2 diabetes. We performed further analyses based on the cumulative defined daily dose of statin received per year to evaluate the degree of risk compared to non-statin users. RESULTS: Over the mean follow-up period of 7.1 years, 3034 patients developed type 2 diabetes; the number of statin users exceeded that of non-users, demonstrating that statin use significantly increased the risk of new-onset type 2 diabetes. The risk of new-onset type 2 diabetes differed among statin users according to cDDD per year (adjusted HR = 1.31 [95% CI 1.18-1.46] for less than 30 cDDD per year; 1.58 [1.43-1.75] for 30-120 cDDD per year; 1.83 [1.62-2.08] for 120-180 cDDD per year; and 2.83 [2.51-3.19] for more than 180 cDDD per year). The diabetogenic effect of pitavastatin was not statistically significant, but the risk was the largest for atorvastatin. Long-term exposure (≥ 5 years) to statins was associated with a statistically significant increase in the risk of new onset type 2 diabetes in all statin subtypes explored, with the highest magnitude for simvastatin (HR = 1.916, 95% CI 1.647-2.228) followed by atorvastatin (HR = 1.830, 95% CI 1.487-2.252). CONCLUSIONS: Statin use was significantly associated with an increased risk of new-onset type 2 diabetes. We also found a dose-response relationship in terms of statin use duration and dose maintenance. Periodic screening and monitoring for incident type 2 diabetes may be warranted in long-term statin users.

Poststroke suicide risk among older adults in South Korea: A retrospective longitudinal cohort study.

OBJECTIVES: The present study evaluated suicide risk within 1 year after discharge among older adults with stroke as a function of depression onset. METHOD: We used the Korean National Health Insurance Service-Senior cohort data and included first discharged patients with a stroke as the principal diagnosis. The comparison group was selected by a 1:2 case-control propensity score matching for age, sex, Charlson comorbidity index, and diagnosis year between 2005 and 2012. Suicide deaths were measured by code for causes of death from Statistics Korea, and the main outcome was suicide death within 1 year following discharge. An adjusted hazard ratio (AHR) of suicidal risk was measured using a Cox proportional hazard model. RESULTS: In the total sample of 128 286 older adults (aged 63-114 years), the higher suicidal risk was examined for stroke patients vs the comparison group (AHR = 1.4; 95% confidence interval [CI], 1.1-1.8). Stroke patients with depression had an increased suicide risk (AHR = 2.9; 95% CI, 1.8-4.8) but only for poststroke depression (AHR = 4.1; 95% CI, 1.8-9.5). Pre and poststroke depression suicidality (AHR = 4.8; 95% CI, 2.1-11.1) was also higher when compared to stroke patients without depression. CONCLUSIONS: Poststroke patients are at increased suicidal risk during 1 year following discharge. Furthermore, patients who were diagnosed with depression after a stroke are more likely to commit suicide than stroke patients without depression. This suggests a necessity for early suicide preventive intervention for stroke patients while considering depressive symptomology.

Dose response relationship of cumulative anticholinergic exposure with incident dementia: validation study of Korean anticholinergic burden scale.

BACKGROUND: The dose response relationship of nine-year cumulative anticholinergic exposure and dementia onset was investigated using the Korean version anticholinergic burden scale (KABS) in comparison with the Anticholinergic Cognitive Burden Scale (ACB). We also examined the effect of weak anticholinergics in the prediction of dementia. METHODS: A retrospective case-control study was conducted comprising 86,576 patients after 1:2 propensity score matching using the longitudinal national claims database. For cumulative anticholinergic burden estimation, average daily anticholinergic burden score during the 9 years prior to dementia onset was calculated using KABS and ACB and categorized as minimal, < 0.25; low, 0.25-1; intermediate, 1-2; and high, ≥ 2. Adjusted odds ratio (aOR) between cumulative anticholinergic burden and incident dementia was estimated. RESULTS: Patients with high exposure according to KABS and ACB comprised 3.2 and 3.4% of the dementia cohort and 2.1 and 2.8% of the non-dementia cohort, respectively. Dose-response relationships were observed between anticholinergic burden and incident dementia. After adjusting covariates, compared with minimal exposure, patients with high exposure according to KABS and ACB had a significantly higher risk for incident dementia with aOR of 1.71 (95% confidence interval (CI) 1.55-1.87) and 1.22 (CI 1.12-1.33), respectively. With the exclusion of weak anticholinergics, the association became stronger, i.e., 1.41 (CI 1.14-1.75) with ACB whereas the association became slightly weaker with KABS, i.e., 1.60 (CI 1.38-1.86). CONCLUSION: This study confirmed the dose response relationship for cumulative anticholinergic burden measured using the Korean specific anticholinergic burden scale with incident dementia.

Poverty and suicide risk in older adults: A retrospective longitudinal cohort study.

OBJECTIVES: We aimed to identify the impact of poverty on suicide risk in older adults. METHOD: The data used in this study was obtained from the National Health Insurance Service-Senior claims database from 2002 to 2013. A total of 558 147 individuals were followed for up to 12 years. Poverty was assessed from insurance premium levels, and causes of death were analysed by linking individuals' deaths to the data for causes of death from the National Statistics Office in South Korea. Cox proportional hazard models were used to analyse the associations between poverty and suicide deaths after adjustments for possible confounders. RESULTS: Among 558 147 older adults (aged 60-119 years), the poverty group had an increased risk of suicide compared with the high-income group (adjusted hazard ratio [AHR], 1.34; 95% confidence interval [CI], 1.22-1.47), and poverty-group males had a significantly higher risk of suicide than males in the high-income group (AHR, 1.50; 95% CI, 1.33-1.68). Adults aged 60 to 74 years in the poverty group had a higher risk of suicide than those with a high income in the same age group (AHR, 1.41; 95% CI, 1.27-1.57). However, no statistically significant income gradient was found for females or adults aged 75 years or older. CONCLUSIONS: Our findings revealed that poverty is a risk factor for death by suicide in older adults. Suicide prevention strategies for older adults should be specifically tailored by income level.

Testing for family influences on obesity: The role of genetic nurture.

A large literature has documented strong positive correlations among siblings in health, including body mass index (BMI) and obesity. This paper tests whether that is explained by a specific type of peer effect in obesity: genetic nurture. Specifically, we test whether an individual's weight is affected by the genes of their sibling, controlling for the individual's own genes. Using genetic data in Add Health, we find no credible evidence that an individual's BMI is affected by the polygenic risk score for BMI of their full sibling when controlling for the individual's own polygenic risk score for BMI. Thus, we find no evidence that the positive correlations in BMI between siblings are attributable to genetic nurture within families.

Assessment of the validity of multiple obesity indices compared with obesity-related co-morbidities.

OBJECTIVE: The aim of the present study was to compare selected obesity indicators with comprehensive health status. DESIGN: The study employed a pooled cross-sectional design. SETTING: BMI, waist circumference, waist-to-height ratio (WHtR) and body fat percentage were considered as indirect obesity indicators. The Edmonton Obesity Staging System (EOSS) was used as a composite indicator to comprehensively reflect obesity-related co-morbidities. Cohen's κ coefficient was used to evaluate inter-measurement agreement for obesity. Conformity of indirect obesity indicators to the EOSS was assessed based on percentage agreement (proportion classified as obese and severely unhealthy as a result of obesity among the total sample), sensitivity (proportion classified as obese among individuals severely unhealthy as a result of obesity) and specificity (proportion classified as non-obese among fairly healthy individuals). Logistic regression analysis was used to identify the sociodemographic factors most strongly associated with conformity.ParticipantsThe study included 17338 adults from the Korea National Health and Nutrition Examination survey conducted between July 2008 and May 2011. RESULTS: Level of conformity to the EOSS was highest for WHtR (60·77 %) and lowest for BMI (35·96 %). WHtR and BMI had the highest sensitivity (53·7 %) and specificity (98·4 %), respectively. Predictability of conformity was lower among men for all indirect obesity indicators. CONCLUSIONS: WHtR has the greatest potential to identify individuals at risk of health problems due to obesity. Individual demographic factors must be considered in selecting the most appropriate obesity measurement.

Associations between body shape, body adiposity and other indices: a case study of hypertension in Chinese children and adolescents.

Background: A Body Shape Index (ABSI) and the Body Adiposity Index (BAI) are used to quantify body shape for adults. However, only a few studies have been conducted confirming whether ABSI or BAI is a better index for predicating hypertension and pre-hypertension in Chinese children and adolescents.Aim: To estimate scaling exponents for using ABSI with Chinese children and adolescents, comparing body shape indices used for predicting hypertension and pre-hypertension and determine which obesity indices can serve as predictors.Subjects and methods: Data from children and adolescents aged 7-17 years in the 2011 Chinese Health and Nutrition Survey were analysed. Partial correlation analysis and receiver operating characteristics analysis were applied.Results: The area under curve (AUC) values for all the predictors are better for differentiating hypertension than pre-hypertension. Body Mass Index (BMI) gave the largest AUC in both children and adolescents. ABSI and ABSI-(C) (ABSI for Chinese children and adolescents) were unable to differentiate hypertension or pre-hypertension in the population. BAI could only differentiate pre-hypertension in girls aged 7-12 years (AUC = 0.353, p < 0.05).Conclusion: ABSI, ABSI-(C) and BAI are not more associated with hypertension or pre-hypertension than BMI, waist circumference and waist-to-height ratio in Chinese children and adolescents.

Relationships between self-reported asthma and pulmonary function and various measures of obesity.

OBJECTIVE: We explore the association with self-reported asthma and pulmonary function based on spirometry measurements using different measures to determine obesity because body mass index (BMI) is limited in not differentiating fat and muscle mass. METHODS: A multi-year cross-sectional study using Korean National Health and Nutrition Examination Survey data was conducted between July 2008 and May 2011. A total of 9409 subjects were included in the final analysis. RESULTS: Obesity was associated with self-reported asthma and pulmonary function limitations mainly in adult women aged between 40 and 65 years and elderly men aged 65 or older. The association was stronger when the measurement of obesity was based on body fat percentage or waist-to-height ratio (WHtR), compared to BMI. There was a higher self-reported asthma risk among obese women according to the WHtR [odds ratio (OR) = 1.817, 95% CI: (1.208, 2.735)]. There was an increased risk of pulmonary function limitation with abdominal obesity [OR 1.418, 95% CI (1.020, 1.972)], weight-to-height ratio [OR 1.467, 95% CI (1.058, 2.034)], and obesity with regard to body fat percentage [OR 1.753, 95% CI (1.251, 2.457)] in adult women. In elderly men, obesity based on body fat percentage was associated with an increased risk of pulmonary function limitation [OR 1.93, 95% CI (1.098, 3.388)]. CONCLUSIONS: Measures other than BMI should be examined when investigating the effect of obesity on self-reported asthma and pulmonary function limitation.

Potentially inappropriate medication and hospitalization/emergency department visits among the elderly in Korea.

OBJECTIVE: To investigate the association between potentially inappropriate medicine (PIM) use, defined using the American Geriatric Society (AGS) 2012 Beers criteria, and the risk of hospitalization or emergency department (ED) visits in elderly patients, and to examine the most frequently used PIMs among patients with adverse outcomes. DESIGN/SETTING: This was a retrospective study using National Health Insurance claims data from 2010 to 2012. INTERVENTION(S): Elderly patients who took PIMs are compared to those who were not taking PIMs. STUDY PARTICIPANTS: Elderly patients (n = 79 552) who visited medical institutions in Jeju Island during 2011. MAIN OUTCOME MEASURE: Hospitalization and ED visits were evaluated according to whether the patients took PIMs during the study period. The most frequent medications used by the PIM group were also investigated. RESULTS: The likelihood of hospitalization was higher in older patients who took at least one PIM than in those who were not taking PIMs during the study period (odds ratio 2.25, 95% confidence interval 2.09-2.44). Patients taking PIMs were more likely to visit EDs (odds ratio 1.59, 95% confidence interval 1.50-1.67). Among patients who were hospitalized or visited EDs, 45.5% had taken at least one PIM on that day. The most commonly used PIMs included chlorpheniramine maleate, diazepam, metoclopramide HCl and diclofenac sodium. CONCLUSION: Our findings indicate that PIM use can lead to negative health consequences, providing further evidence of the inappropriateness of these medications. Thus, pharmaceutical policies regarding PIM use may need to be implemented for elderly adults in Korea.

Assessing the risk of type 2 diabetes mellitus among children and adolescents with psychiatric disorders treated with atypical antipsychotics: a population-based nested case-control study.

To examine the associations between atypical antipsychotic (AAP) exposure and the development of type 2 diabetes mellitus (T2DM) in Korean pediatric patients with psychiatric disorders, we conducted a nested case-control study using the claims data of the National Health Insurance system of Korea between 2010 and 2014. A cohort of patients with psychiatric disorders was identified, and enrollment was taken as the date of the first psychiatric diagnosis. Cases involved patients with a diagnosis of T2DM or prescriptions for glucose lowering drugs after enrollment, and the identification of T2DM was defined as the index date. We performed a conditional logistic regression analysis for matched case-control data to assess associations between AAP exposure and T2DM, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) are presented. From 1,092,019 patients aged 2-19 years, we identified 20,263 cases with T2DM and 80,043 controls, matched by sex, age, enrollment date, and primary psychiatric diagnosis. After adjusting for comorbidities, psychotropic medication history, and the healthcare institution characteristics, the aOR of having T2DM was significantly higher in multi-AAP users compared with non-users (aOR 1.89; 95% CI 1.63-2.20). Particularly high ORs for T2DM were observed in clozapine users compared with non-users (aOR 3.47; 95% CI 1.88-6.41). We observed a linear relationship between the increase in risperidone dose and the increase in the risk of developing T2DM. Our findings suggest a significantly increased risk of developing T2DM in child or adolescent patients with psychiatric disorders exposed to AAPs compared with those not exposed to AAPs.

Breakfast consumption and depressive mood: A focus on socioeconomic status.

Skipping breakfast can be potentially harmful because breakfast consumption is considered one of the important health-related behaviors that benefit physical and mental health. As the rate of depression has increased recently, we investigated the association between the frequency of eating breakfast and depression in adults. We obtained the data from the 2013 Korean Community Health Survey; a total of 207,710 survey participants aged 20 years or over were studied. Participants were categorized into three groups by the frequency of breakfast consumption as follows: "seldom," "sometimes," and "always." We performed a multiple logistic regression to investigate the association between breakfast consumption and depressive mood. Subgroup analyses were conducted by stratifying socioeconomic variables controlling for variables known to be associated with depressive symptoms. Participants who had breakfast seldom or sometimes had higher depressive symptoms than those who always ate breakfast ("seldom": OR = 1.43, 95% CI 1.36-1.52; "sometimes": OR = 1.32, 95% CI 1.23-1.40). Subgroup analyses showed that this association was more marked in those who were 80 years or older, those who had low household income, or those with elementary school education level or less. The result of this study suggests that lack of breakfast consumption is associated with depression among adults with different socioeconomic factors.

BODY MASS INDEX AND SELF-EMPLOYMENT IN SOUTH KOREA.

This study assesses differential labour performance by body mass index (BMI), focusing on heterogeneity across three distinct employment statuses: unemployed, self-employed and salaried. Data were drawn from the Korean Labor and Income Panel Study. The final sample included 15,180 person-year observations (9645 men and 5535 women) between 20 and 65 years of age. The findings show that (i) overweight/obese women are less likely to have salaried jobs than underweight/normal weight women, whereas overweight/obese men are more likely to be employed in both the salaried and self-employed sectors than underweight/normal men, (ii) overweight/obese women have lower wages only in permanent salaried jobs than underweight/normal weight women, whereas overweight/obese men earn higher wages only in salaried temporary jobs than underweight/normal weight women, (iii) overweight/obese women earn lower wages only in service, sales, semi-professional and blue-collar jobs in the salaried sector than underweight/normal weight women, whereas overweight/obese men have lower wages only in sales jobs in the self-employed sector than underweight/normal weight women. The statistically significant BMI penalty in labour market outcomes, which occurs only in the salaried sector for women, implies that there is an employers' distaste for workers with a high BMI status and that it is a plausible mechanism for job market penalty related to BMI status. Thus, heterogeneous job characteristics across and within salaried versus self-employed sectors need to be accounted for when assessing the impact of BMI status on labour market outcomes.

Patient response to insurer-led intervention for medication adherence - a pilot study based on claims data in Korea.

OBJECTIVE: This study was designed to investigate patient responses to a medication counseling intervention program piloted by the National Health Insurance Service (NHIS), the national health insurer in Korea, to improve medication management in patients with hypertension, hyperlipidemia, or diabetes. METHODS AND MATERIALS: Interventions were conducted from July to September 2013 through direct mailing followed by two telephone-initiated counseling sessions for the medication discontinuation group (< 80% medication possession ratio (MPR) and ≥ 2 months of discontinuation) and the medication over-possession group (≥ 150% MPR). The telephone intervention was applied through two models: model 1 (counseling by NHIS staff only) and model 2 (counseling by NHIS staff with contract-based working pharmacists in community pharmacies). Multivariate logistic regression analysis was performed to identify factors affecting favorable responses of patients to the telephone-initiated intervention. Patient responses to the telephone-initiated intervention were evaluated by a counselor. RESULTS: In all, 891 patients were counseledvia telephone. Patient responses to the telephone-initiated intervention were favorablein 57.6%, neutral in 17.4% and not favorable in 24.9% overall. Counseling by NHIS staff together with pharmacists (model 2) produced more favorable responses from patients than counseling by NHIS staff alone (model 1) (OR 2.73, 95% CI 1.97 - 3.77). CONCLUSION: Our findings of favorable responses to interventions support a personalized approach by the NHIS to improve patient behavior for medication adherence.

The effect of competition on the relationship between the introduction of the DRG system and quality of care in Korea.

BACKGROUND: The diagnosis-related group-based prospective payment programme was introduced in Korea in 1997 as a pilot programme to control health spending. In July 2013, the programme was implemented throughout the nation. The aim of our study is to evaluate the relationship between quality of care and market competition following the introduction of the new payment system in Korea. METHODS: We conduct an observational analysis using National Health Insurance claim data from 2011 to 2014. We analyse data on readmission within 30 days, length of stay, and number of outpatient visits for 1742 hospitals and 821 912 cases. We use a generalized estimating equation model to evaluate readmission within 30 days and number of outpatient visits and a multi-level regression model to assess length of stay. RESULTS: Total readmission within 30 days is 10 727 (1.3%). High competition areas present a lower risk of readmission [odds ratio (OR): 0.95, P: 0.0277], a longer length of stay (1%, P < 0.0001), and an increased number of outpatient visits (Relative Risk: 1.11, P: 0.0011) as compared with moderate competition areas. Risk of readmission is higher in low competition areas as compared with moderate competition areas (OR: 1.21, P < 0.0001). CONCLUSION: The effects of the introduction of the new payment system differed by degree of market competition. Thus, evaluation about the effect of new payment system on hospital performance should be measured in combination with the degree of hospital market structure.