Living longer but in poor health: healthcare system responses to ageing populations in industrialised countries based on the Findings from the Global Burden of Disease Study 2019.

OBJECTIVES: This study aimed to examine changes in life expectancy (LE), health-adjusted life expectancy (HALE), unhealthy years of life, and disease burden of older people in industrialised countries and associations with health systems. METHODS: We used estimates of LE and HALE, unhealthy years of life, years of life loss (YLL), years lived with disability (YLD) for individuals aged 70 years and over in 33 industrialised countries from 1990 to 2019 from the Global Burden of Disease Study 2019. A linear regression analysis was conducted to examine the association of health outcomes with the Healthcare Access and Quality (HAQ) index. RESULTS: LE and HALE increased with improved HAQ index from 1990 to 2019. However, the number of unhealthy years of life increased. An increased HAQ index was associated with decreases in YLL. However, changes in YLD were relatively small and were not correlated with HAQ index. CONCLUSIONS: The healthcare system needs to more address the increased morbidity burden among older people. It should be designed to handle to healthcare needs of the ageing population.

Mid-Term Strategic Plan for the Public Health and Medical Care Cooperation in the Korean Peninsula.

As extensive as the concept of and the resources required for 'Health for Korean Unification' are, and due to the limited access to information on the state of health and medical care in North Korea, discussion on 'Health for Korean Unification' has tended to be intermittent and lacked concrete action plans. In this article, we specifically distinguished areas of cooperation and selected five executable agenda that meet the goals of international development cooperation: 1) Health security; 2) Easing the burden of major diseases; 3) Resilient healthcare system; 4) R&D cooperation; 5) Sustainable cooperation system. Then we provided corresponding strategic priorities and operative directions, in consideration of future military and political sanctions against North Korea. The strategies we outline are sustainable, preemptive for problems that might affect lives of South and North Korean citizens, and satisfy the unmet needs of the North Korean health system. Throughout the process, we utilized a special platform, the 'Korean Peninsula Healthcare Cooperation Platform,' designed to enable continual communication across sectors engaged in public health and medical care. By doing so, we take the first step to actually carry out the 'Health for Korean Unification,' which tended to have remained on the discussion agenda.

Safety outcomes of selective serotonin reuptake inhibitors in adolescent attention-deficit/hyperactivity disorder with comorbid depression: the ASSURE study.

BACKGROUND: Attention deficit-hyperactivity disorder (ADHD) is related to depressive disorder, and adolescents with both present poor outcomes. However, evidence for the safety of concomitantly using a methylphenidate (MPH) and a selective serotonin reuptake inhibitor (SSRI) among adolescent ADHD patients is limited, a literature gap aimed to address through this investigation. METHODS: We conducted a new-user cohort study using a nationwide claims database in South Korea. We identified a study population as adolescents who were diagnosed both ADHD and depressive disorder. MPH-only users were compared with patients who prescribed both a SSRI and a MPH. Fluoxetine and escitalopram users were also compared to find a preferable treatment option. Thirteen outcomes including neuropsychiatric, gastrointestinal, and other events were assessed, taking respiratory tract infection as a negative control outcome. We matched the study groups using a propensity score and used the Cox proportional hazard model to calculate the hazard ratio. Subgroup and sensitivity analyses were conducted in various epidemiologic settings. RESULTS: The risks of all the outcomes between the MPH-only and SSRI groups were not significantly different. Regarding SSRI ingredients, the risk of tic disorder was significantly lower in the fluoxetine group than the escitalopram group [HR 0.43 (0.25-0.71)]. However, there was no significant difference in other outcomes between the fluoxetine and escitalopram groups. CONCLUSION: The concomitant use of MPHs and SSRIs showed generally safe profiles in adolescent ADHD patients with depression. Most of the differences between fluoxetine and escitalopram, except those concerning tic disorder, were not significant.

Characteristics and Distribution of Surgical Diseases in North Korean Research Papers Published between 2006 and 2017.

BACKGROUND: Little is known about the surgical discipline in North Korea from the perspective of the outside world. This study aimed to examine the disease entities covered by articles published in the major medical journal in North Korea, "Surgery." METHODS: Content and frequency analyses of 2,132 articles published in "Surgery" from 2006 to 2017 were conducted. Two medical doctors who majored in surgery and anesthesiology perused the articles and compiled the diseases being elucidated in each article. The diseases described in each article were stratified into 13 surgical subspecialties. RESULTS: Articles from "Surgery," similar to articles from the Western surgical community, also covered a wide variety of surgical diseases from different subspecialties, and the number of publications continued to grow consistently. Moreover, a number of studies focused on the fields of orthopedics and general surgery dealing with benign diseases. Some articles focused on minimally invasive surgeries using laparoscopy. CONCLUSION: The studies published in the North Korean journal "Surgery" encompass various clinical areas, but their quality is unclear.

Association between Accreditation and In-Hospital Mortality in Patients with Major Cardiovascular Diseases in South Korean Hospitals: Pre-Post Accreditation Comparison.

The direct impact of hospital accreditation on patients' clinical outcomes is unclear. The purpose of this study was to evaluate whether mortality within 30 days of hospitalization for acute myocardial infarction (AMI), ischemic stroke (IS), and hemorrhagic stroke (HS) differed before and after hospital accreditation. This study targeted patients who had been hospitalized for the three diseases at the general hospitals newly accredited by the government in 2014. Thirty-day mortality rates of three years before and after accreditation were compared. Mortality within 30 days of hospitalization for the three diseases was lower after accreditation than before (7.34% vs. 6.15% for AMI; 4.64% vs. 3.80% for IS; and 18.52% vs. 15.81% for HS). In addition, hospitals that meet the criteria of the patient care process domain have a statistically lower mortality rate than hospitals that do not. In the newly accredited Korean general hospital, it was confirmed that in-hospital mortality rates of major cardiovascular diseases were lower than before the accreditation.

Contribution of stress and coping strategies to problematic Internet use in patients with schizophrenia spectrum disorders.

INTRODUCTION: Internet use is already high and increasing rapidly among people with psychotic disorders, but there have been few studies on problematic Internet use (PIU) among patients with schizophrenia spectrum disorders. This study aimed to measure the prevalence of PIU and identify the factors associated with PIU among patients with schizophrenia spectrum disorders. METHODS: A cross-sectional survey was performed that included 368 outpatients with schizophrenia spectrum disorders: 317 with schizophrenia, 22 with schizoaffective disorder, 9 with schizophreniform disorder, and 20 with other schizophrenia spectrum and psychotic disorders. The severity of psychotic symptoms and levels of personal and social functioning were assessed by the Clinician-rated Dimensions of Psychosis Symptom Severity (CRDPSS) scale and the Personal and Social Performance (PSP) scale, respectively. PIU was evaluated using Young's Internet Addiction Test (IAT). Additionally, the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Rosenberg Selfesteem Scale (RSES), and Brief Coping Orientation to Problems Experienced (COPE) Inventory were administered. RESULTS: PIU was identified in 81 (22.0%) of the 368 patients with schizophrenia spectrum disorders. Subjects with PIU were significantly younger and more likely to be male. Scores on the HADS, PSS, and dysfunctional coping dimension of the Brief COPE Inventory were significantly higher, and RSES scores were significantly lower, in the PIU group. Logistic regression analysis indicated that PIU in patients was significantly associated with scores on the PSS and dysfunctional coping dimension of the Brief COPE Inventory. CONCLUSIONS: Patients with schizophrenia spectrum disorders and PIU were significantly more likely to have high levels of perceived stress and dysfunctional coping strategies. Patients with schizophrenia spectrum disorders who also engage in PIU may benefit from interventions that help them to develop appropriate skills for coping with stress.

Bibliographical Characteristics of North Korean Medical Journals and Articles.

The aim of our work was to analyze the bibliographical characteristics of 9 North Korean medical journals and articles. All journals show only ten pieces of information, such as publication dates and table of contents, and do not provide submission guidelines and journal policy. Most of the journals were published four times a year. Editorials often share government policy. Research articles are very short and compressed. The journals often publish articles on oriental medicine and medical information useful to the public. In conclusion, the journals were published in their own unique style and format, which are far from the global standard.

Health Performance and Challenges in Korea: a Review of the Global Burden of Disease Study 2013.

The global burden of disease study (GBD) provides valuable information for evaluating population health in terms of disease burden. This study collected and reviewed GBD data in Korea for the year 1990 and 2013. The burdens of cancer, cardiovascular disease, communicable disease, and injuries have decreased remarkably, thereby greatly diminishing the overall disease burden on Korea. Meanwhile, the burdens due to non-fatal chronic diseases such as neuropsychiatric and musculoskeletal disease became major burden contributors. Responding to this circumstance presents a complex challenge to the Korean health system and Korean health policy.

Factors associated with self-rated sexual function in Korean patients with schizophrenia receiving risperidone monotherapy.

OBJECTIVE: This study aims to investigate the factors associated with sexual function in Korean patients with schizophrenia. METHODS: This study evaluated 169 patients with schizophrenia who were receiving risperidone monotherapy. The Visual Analog Scale was used to assess sexual function in terms of sexual desire, sexual arousal, and sexual satisfaction. The Positive and Negative Syndrome Scale, the Beck Depression Inventory, the Korean version of the Subjective Well-being under Neuroleptic Treatment-Brief Form (SWN-K) scale, and the Drug Attitude Inventory (DAI) were also administered. RESULTS: Sexual function was negatively associated with age, duration of illness, gender (female), marital status (single), the presence of tardive dyskinesia, and Beck Depression Inventory score, but positively associated with the SWN-K and DAI scores. A linear regression analysis revealed that being male and married had significant positive associations with sexual arousal, sexual satisfaction, and/or sexual desire, while the presence of tardive dyskinesia and a longer duration of illness were associated with poor sexual arousal and/or sexual desire. Additionally, sexual function was significantly associated with the SWN-K and DAI scores in multivariate analysis. CONCLUSIONS: The acknowledgement and management of sexual dysfunction in patients with schizophrenia by clinicians may be important for improvement of their quality of life and adherence to medication.

Differential trends and patterns of sociodemographic disparities in burden of mental disorders, substance use disorder and self-harm across age groups: ecological study in 204 countries using the Global Burden of Disease Study 2019.

BACKGROUND: It is well-known that socioeconomic status is associated with mental illness at both the individual and population levels, but there is a less clear understanding of whether socioeconomic development is related to poor mental health at the country level. AIMS: We aimed to investigate sociodemographic disparities in burden of mental disorders, substance use disorders and self-harm by age group. METHOD: Estimates of age-specific disability-adjusted life years (DALY) rates for mental disorders, substance use disorders and self-harm from 1990 to 2019 for 204 countries were obtained. The sociodemographic index (SDI) was used to assess sociodemographic development. Associations between burden of mental health and sociodemographic development in 1990 and 2019 were investigated, and sociodemographic inequalities in burden of mental health from 1990 to 2019 by age were estimated using the concentration index. RESULTS: Differential trends in sociodemographic disparities in diseases across age groups were observed. For mental disorders, particularly depressive disorder and substance use disorders, DALY rates in high SDI countries were higher and increased more than those in countries with other SDI levels among individuals aged 10-24 and 25-49 years. By contrast, DALY rates for those over 50 years were lower in high SDI countries than in countries with other SDI levels between 1990 and 2019. A higher DALY rate among younger individuals accompanied a higher SDI at the country level. However, increased sociodemographic development was associated with decreased disease burden for adults aged ≥70 years. CONCLUSIONS: Strategies for improving mental health and strengthening mental health system should consider a broader sociocultural context.

Outcomes of Ulnar Shortening Osteotomy with an Intramedullary Bone Graft for Idiopathic Ulnar Impaction Syndrome.

Background: Although several techniques for the treatment of ulnar impaction syndrome (UIS) have been introduced, there have still been reports on various complications such as delayed union, nonunion, refracture, wrist pain, plate irritation, and chronic regional pain syndrome. This study aimed to compare the differences in radiological and clinical outcomes of patients in which intramedullary bone grafting was performed in addition to plate stabilization with those without additional bone grafting during ulnar shortening osteotomies (USOs). Methods: Between November 2014 and June 2021, 53 wrists of 50 patients with idiopathic UIS were retrospectively reviewed. Patients were divided into 2 groups according to whether intramedullary bone grafting was performed. Among the 53 wrists, USO with an intramedullary bone graft was performed in 21 wrists and USO without an intramedullary bone graft was performed in 32 wrists. Demographic data and factors potentially associated with bone union time were analyzed. Results: There was no significant difference between the 2 groups when comparing postoperative radioulnar distance, postoperative ulnar variance, amount of ulnar shortening, and postoperative Disabilities of the Arm, Shoulder and Hand score. Compared to the without-intramedullary bone graft group, bone union time of the osteotomy site was significantly shortened, from 8.8 ± 3.0 weeks to 6.7 ± 1.3 weeks in the with-intramedullary bone graft group. Moreover, there were no cases of nonunion or plate-induced symptoms. Both in univariable and multivariable analyses, intramedullary bone grafting was associated with shorter bone union time. Conclusions: USO with an intramedullary bone graft for idiopathic UIS has favorable radiological and clinical outcomes. The advantage of this technique is the significant shortening of bone union time.

The economic burden of rheumatic heart disease in South Korea.

Understanding the impact of rheumatic heart disease (RHD) has become increasingly important among aging populations around the world, and Korea is no exception. This study was conducted to estimate total annual patient costs associated with RHD in Korea for 2008 using nationally representative data. The subjects were South Korean citizens with RHD (ICD-10 codes I01-I09). The primary information for this study was obtained from claims data compiled by the National Health Insurance Corporation of Korea. Direct medical care costs were estimated using expenses paid by insurers and patients for non-covered care and pharmaceutical costs. Direct non-medical costs were estimated using data on transportation costs for hospital visits and costs for caregivers. Indirect costs included the costs of productivity loss and premature death in RHD patients. The economic burden of RHD in 2008 was estimated at $67.25 million US dollars. The indirect costs amounted to 39.04 % (US $26.26 million) of the total RHD costs. When stratified by age, the costs incurred by the group of patients older than 60 years were US $31.63 million. The prevalence of the disease in the same age group was 791.07 cases per 100,000 people. This study confirms that the prevalence of RHD was highest in patients older than 60 years in 2008. Furthermore, the patterns of disease in South Korea were similar to patterns observed in other high-income countries. These findings indicate that secondary prevention strategies for the early detection of RHD are needed in South Korea.

Long-term trajectories of suicide ideation and its socioeconomic predictors: A longitudinal 8-year follow-up study.

OBJECTIVE: Suicide ideation is the first stage of suicide behavior, and the long-term course of suicide ideation is highly variable. The aim of this study is to identify trajectories of suicide ideation over an 8-year period and explore the association of socioeconomic status (SES) with suicide ideation trajectories. METHODS: We included 10,017 participants from Waves 7-15 of the Korea Welfare Panel Study; these have data on suicidal ideation (2012-2020). Trajectories analysis was conducted to identify distinct trajectories of suicidal ideation. Multinomial logistic regression was used to examine associations of SES with suicidal ideation trajectories. The interaction effects between current SES and prospective economic condition on trajectories were examined using a synergy index (SI). RESULTS: We identified three suicide ideation trajectory groups: low-stable, moderate-decreasing, and high-persistent. Individuals in both moderate-decreasing and high-persistent trajectories had poorer current SES and prospective economic conditions than low-stable trajectories. Interestingly, those reporting poorer prospective economic conditions had a greater risk of being in a high-persistent trajectory than being in a moderate-decreasing trajectory. Further, individuals with poorer current SES and prospective economic conditions were more likely to be in the high-persistent trajectory. CONCLUSIONS: Our findings demonstrated three distinct trajectories of suicide ideation which provide useful information for specific preventive interventions that could be developed. Moreover, poor prospective economic condition is a significant predictor of the high-persistent suicide ideation trajectory. Supporting economic difficulties and helping make goals and plans to strengthen positive thinking would help attenuate suicidal ideation and prevent suicidal behavior.

Changes in contributions of age- and cause-specific mortality to the widening life expectancy gap between North and South Korea, 1990-2019: An analysis of the Global Burden of Disease Study 2019.

Background: Life expectancy gaps between North and South Korea have increased but contributions to these gaps remain poorly understood. Using data from the Global Burden of Disease Study (GBD) 2019, we examined how much death from specific diseases contributed to these gaps in different age groups over three decades. Methods: Data for death numbers and population by sex and 5-year age groups in both North and South Korea from 1990 to 2019 were extracted from the GBD 2019 to calculate life expectancy. Joinpoint regression analysis was conducted to investigate changes in life expectancy in North and South Korea. We used decomposition analysis to partition differences in life expectancy within and between the two Koreas into changes in age- and cause-specific death contributions. Results: Life expectancy increased in two Koreas from 1990 to 2019, but North Korea experienced a marked decline in life expectancy during the mid-1990s. The life expectancy gaps between the two Koreas were greatest in 1999, with a difference of 13.3 years for males and 14.9 years for females. The main contributors to these gaps were higher under-5 mortality from nutritional deficiencies for males (4.62 years) and females (4.57 years) in North Korea, accounting for about 30% of the total gap in life expectancy. After 1999, the life expectancy gaps reduced but persisted with differences of about ten years by 2019. Notably, chronic diseases contributed to about 8 out of 10 years of life expectancy gap between the two Koreas in 2019. Differential cardiovascular disease mortality in the older groups was the main contributor to the life expectancy gap. Conclusions: The contributors to this gap have shifted from nutritional deficiencies in children younger than five years to cardiovascular disease among elderly people. Efforts for strengthening social and healthcare systems are needed to curb this large gap.

The Trend of Healthcare Needs among Elders and Its Association with Healthcare Access and Quality in Low-Income Countries: An Exploration of the Global Burden of Disease Study 2019.

To investigate the trend of healthcare needs among elders in low-income countries (LICs) and how changes in healthcare access and quality (HAQ) have correlated with these changes from 1990 to 2019, this study used estimates from the global burden of disease (GBD) 2019 study, including prevalence, years of life lost (YLLs), years lived with disability (YLDs), life expectancy (LE), health-adjusted life expectancy (HALE) and the HAQ index for years 1990 and 2019. We found increases in numbers of YLLs, YLDs, and prevalent cases due to NCDs, and the rate of increase was higher for all indicators of non-communicable diseases (NCDs) when compared with communicable, maternal, neonatal and nutritional diseases among elders. We also observed increases in LE and HALE among all countries. However, this was also challenged by increases in unhealthy life years (ULYs) and their constant percentage of LE. The HAQ index of LICs was also found to be low, although it had increased during the period. A reduction in the burden of acute diseases explains the increase in LE, but increases in ULYs and the NCD burden were also observed. LICs need to improve their HAQ to counter the growing threat of longer but less healthy lives.

The burden of malaria in sub-Saharan Africa and its association with development assistance for health and governance: An exploration of the GBD 2019 study.

Even with a reduced burden of malaria in sub-Saharan Africa (SSA), differences remain in the rate of change among countries and sub-regions. We used data from the Global Burden of Disease Study 2019 to establish the relationship between Development Assistance for Health (DAH) and governance and trends in malaria burden in SSA. The trend was estimated using the Joinpoint regression program and the Institute of Health Metrics and Evaluation's DAH database, and World Bank Governance Indicators to analyze the DAH and governance respectively from 2000 to 2017 and used two-way fixed effects to establish their association with the trend in the period. The findings showed decreases in SSA's age-standardised rates for disability-adjusted life years (ASDR) (-47% (95% uncertainty interval (UI) -69% to -14%)), deaths (-38% (95% UI -65% to -3%)), incidence (-35% (95% UI -44% to -25%)), and prevalence (-34% (95% UI -43% to -24%)). Decreases in ASDR were associated with increases in DAH (ß -134.18, standard error (SE) 27.26) and governance scores (ß -246.19, SE 39.13). The association between reductions in malaria burden and increases in DAH and in governance scores shows the need for accelerated funding of malaria programs and advocacy for better disease governance in malaria-endemic countries.Abbreviations: APC: Annual percentage change; ASDR: Age-standardised disability-adjusted life-year rate; ASIR: Age-standardised incidence rate; ASIR: Age-standardised incidence rate; ASMR: Age-standardised mortality rate; CSSA: Central sub-Saharan Africa; DAH: Development Assistance for Health; DALYs: Disability-adjusted life years; ESSA: Eastern sub-Saharan Africa; GBD: Global burden of disease; GHDx Global Health Data Exchange; IHME: Institute of Health Metrics and Evaluation; SDGs: Sustainable Development Goals; SSA: Sub-Saharan Africa; SSSA: Southern sub-Saharan Africa; UNSD: United Nations Statistics Division; USD: United States dollars; WGI: World Bank Governance Indicators; WHO: World Health Organization; WSSA: Western sub-Saharan Africa.

Correction: Trends and patterns of North Korea's disease burden from 1990 to 2019: Results from Global Burden of Disease study 2019.

[This corrects the article DOI: 10.1371/journal.pone.0277335.].

Financial Hardship, Depression, and Self-Esteem: Temporal Analysis Using a Korean Panel Study.

OBJECTIVE: Financial hardship influences depression risk, however, the pathway of the effect of financial hardship on depression and the role of self-esteem remain unclear. This study examined whether changes in financial hardship affected depression, and whether self-esteem mediated by this relationship. METHODS: Data from 99,588 observations of 15,331 individuals were extracted from 10 waves of the Korean Welfare Panel Study. The association between changes in financial hardship and depression was investigated using a generalized estimation equation, and the extent to which these associations were mediated by self-esteem was assessed. RESULTS: The results indicated that changes in financial hardship were associated with depression, with varying magnitude. Experiencing severe financial hardship over two consecutive years (odds ratio [OR]: 3.87, 95% confidence interval [CI]=3.09-4.85) or increased financial hardship over the previous year strongly influenced depression (e.g., OR: 3.88, 95% CI=3.09-4.86 for low financial hardship at t-1 year and high at t year). Self-esteem plays a mediating role in the relationship between changes in financial hardship and depression, where persistent financial hardship is associated with low self-esteem, leading to depression. CONCLUSION: These findings highlighted the importance of monitoring and intervention for financial hardship and psychological problems to help manage depression.

The association between the risk perceptions of COVID-19, trust in the government, political ideologies, and socio-demographic factors: A year-long cross-sectional study in South Korea.

Risk perception research, targeting the general public, necessitates the study of the multi-faceted aspects of perceived risk through a holistic approach. This study aimed to investigate the association between the two dimensions of risk perception of COVID-19, i.e., risk as a feeling and analysis, trust in the current government, political ideologies, and socio-demographic factors in South Korea. This study used a year-long repeated cross-sectional design, in which a national sample (n = 23,018) participated in 23 consecutive telephone surveys from February 2020 to February 2021. Most factors differed in the magnitude and direction of their relationships with the two dimensions of risk perception. However, trust in the current government, alone, delineated an association in the same direction for both dimensions, i.e., those with a lower level of trust exhibited higher levels of cognitive and affective risk perception. Although these results did not change significantly during the one-year observation period, they are related to the political interpretation of risk. This study revealed that affective and cognitive risk perceptions addressed different dimensions of risk perception. These findings could help governments and health authorities better understand the nature and mechanisms of public risk perception when implementing countermeasures and policies in response to the COVID-19 pandemic and other public health emergencies.