Risk of Ischemic Heart Disease in Patients With Postpancreatectomy Diabetes and Pancreatic Cancer: A Population-Based Study.

BACKGROUND: Postpancreatectomy diabetes can be caused by resection of functioning pancreatic tissue and is associated with postoperative pancreatic islet cell mass loss and subsequent endocrine dysfunction. Diabetes is a well-known risk factor for ischemic heart disease. However, no previous studies have investigated ischemic heart disease in patients with postpancreatectomy diabetes and pancreatic cancer. METHODS AND RESULTS: Rates of patients with diabetes diagnosed with pancreatic cancer who underwent pancreatectomy between 2002 and 2019 in South Korea were obtained from the Korean National Health Insurance Service database. Patient-level propensity score matching was conducted to reduce the possibility of selection bias, and multivariate Cox proportional hazards models were used to determine the association between postpancreatectomy diabetes and ischemic heart disease. In total, 30 242 patients were initially enrolled in the study. After applying exclusion criteria and propensity score matching, 2952 patients were included in the comparative analysis between the postpancreatectomy group with diabetes and the group without diabetes. Patients in the postpancreatectomy group with diabetes had significantly higher rates of ischemic heart disease than those in the group without diabetes. In total, 3432 patients were included in the comparison between the postpancreatectomy and prepancreatectomy groups with diabetes. There was no significant difference in the risk of ischemic heart disease between the postpancreatectomy and prepancreatectomy groups with diabetes. CONCLUSIONS: Patients who developed diabetes after pancreatectomy had a higher risk of ischemic heart disease than patients who did not develop diabetes after pancreatectomy, and the rate of ischemic heart disease in these patients was similar to that in patients preoperatively diagnosed with diabetes.

Antibiotic Prescription in Patients With Coronavirus Disease 2019: Analysis of National Health Insurance System Data in the Republic of Korea.

BACKGROUND: Although coronavirus disease 2019 (COVID-19) is a viral infection, antibiotics are often prescribed due to concerns about accompanying bacterial infection. Therefore, we aimed to analyze the number of patients with COVID-19 who received antibiotic prescriptions, as well as factors that influenced antibiotics prescription, using the National Health Insurance System database. METHODS: We retrospectively reviewed claims data for adults aged ≥ 19 years hospitalized for COVID-19 from December 1, 2019 to December 31, 2020. According to the National Institutes of Health guidelines for severity classification, we calculated the proportion of patients who received antibiotics and the number of days of therapy per 1,000 patient-days. Factors contributing to antibiotic use were determined using linear regression analysis. In addition, antibiotic prescription data for patients with influenza hospitalized from 2018 to 2021 were compared with those for patients with COVID-19, using an integrated database from Korea Disease Control and Prevention Agency-COVID19-National Health Insurance Service cohort (K-COV-N cohort), which was partially adjusted and obtained from October 2020 to December 2021. RESULTS: Of the 55,228 patients, 46.6% were males, 55.9% were aged ≥ 50 years, and most patients (88.7%) had no underlying diseases. The majority (84.3%; n = 46,576) were classified as having mild-to-moderate illness, with 11.2% (n = 6,168) and 4.5% (n = 2,484) having severe and critical illness, respectively. Antibiotics were prescribed to 27.3% (n = 15,081) of the total study population, and to 73.8%, 87.6%, and 17.9% of patients with severe, critical, and mild-to-moderate illness, respectively. Fluoroquinolones were the most commonly prescribed antibiotics (15.1%; n = 8,348), followed by third-generation cephalosporins (10.4%; n = 5,729) and beta-lactam/beta-lactamase inhibitors (6.9%; n = 3,822). Older age, COVID-19 severity, and underlying medical conditions contributed significantly to antibiotic prescription requirement. The antibiotic use rate was higher in the influenza group (57.1%) than in the total COVID-19 patient group (21.2%), and higher in severe-to-critical COVID-19 cases (66.6%) than in influenza cases. CONCLUSION: Although most patients with COVID-19 had mild to moderate illness, more than a quarter were prescribed antibiotics. Judicious use of antibiotics is necessary for patients with COVID-19, considering the severity of disease and risk of bacterial co-infection.

Subsequent pregnancy and long-term safety after breast cancer: a retrospective analysis of Korean health insurance data.

PURPOSE: Long-term safety of pregnancy after breast cancer (BC) remains controversial, especially with respect to BC biological subtypes. METHODS: We analyzed a population-based retrospective cohort with BC from 2002 to 2017. Patient-level 1:1 matching was performed between pregnant and nonpregnant women. The study population was categorized into 6 biological subtypes based on the combination of prescribed therapies. Subanalyses were performed considering the time to pregnancy after BC diagnosis, systemic therapy, and pregnancy outcomes. RESULTS: We identified 544 matched women with BC, who were assigned to the pregnant (cases, n = 272) or nonpregnant group (controls, n = 272) of similar characteristics, adjusted for guaranteed bias. These patients were followed up for 10 years, or disease and mortality occurrence after the diagnosis of BC. Survival estimates were calculated. The actuarial 10-year overall survival (OS) rates were 97.4% and 91.9% for pregnant and nonpregnant patients, respectively. The pregnant group showed significantly better OS (adjusted hazard ratio [aHR], 0.29; 95% confidence interval [CI], 0.12-0.68; P = 0.005) and did not have a significantly inferior disease-free survival (aHR, 1.10; 95% CI, 0.61-1.99; P = 0.760). CONCLUSION: Consistent outcomes were observed in every subgroup analysis. Our observational data provides reassuring evidence on the long-term safety of pregnancy in young patients with BC regardless of the BC biological subtype.

Association between haemorrhagic fever with renal syndrome and cancers.

OBJECTIVES: To investigate the risk of haematologic and solid organ malignancies in patients with haemorrhagic fever with renal syndrome (HFRS) compared with the general population. METHODS: This propensity-score-matched cohort study was conducted using data collected from the Korean national health insurance service (NHIS) between January 2003 and December 2017. The HFRS cohort included 5888 newly diagnosed cases of HFRS, and 412,804 general participants from the NHIS database were included as the control cohort. The incidence rate of malignancies was assessed and compared between the HFRS and control cohorts. RESULTS: There were 64 cases of haematologic malignancy in 236,286 person-years of observation, and 1245 cases of solid organ cancer in 209,333 person-years. The risks of haematologic malignancy and solid organ cancer were significantly higher in the HFRS cohort [adjusted hazards ratio (aHR) 4.10, 95% confidence interval (CI) 2.36-7.14] than the control cohort [aHR 2.97, 95% CI 2.60-3.38). In subgroup analysis, the HFRS cohort was associated with high hazard ratios for leukaemia and non-Hodgkin lymphoma. The HFRS cohort also had increased aHRs for all types of solid organ cancer. CONCLUSIONS: Patients with HFRS are at increased risk of both haematologic and solid organ malignancies compared with the general population, and this increased proportionally over time. Careful monitoring for malignancy after the onset of HFRS may be necessary.

Humidifier Disinfectant Consumption and Humidifier Disinfectant-Associated Lung Injury in South Korea: A Nationwide Population-Based Study.

Humidifier disinfectant (HD) is a household biocidal product used in humidifier water tanks to prevent the growth of microorganisms. In 2011, a series of lung injury cases of unknown causes emerged in children and pregnant women who had used HD in Korea. This study investigated changes in the nationwide number of cases of humidifier disinfectant-associated lung injury (HDLI) in concordance with nationwide HD consumption using data covering the entire Korean population. More than 25 kinds of HD products were sold between 1994 and 2011. The number of diagnosed HDLI, assessed by S27.3 (other injuries of lungs) of the Korea National Health Insurance Service (NHIS) data, sharply increased by 2005, subsequently decreased after 2005, and almost disappeared after 2011 in concordance with the annual number of HD sales. The number of self-reported HDLIs, assessed using data from all suspected HDLI cases registered in the Korea Ministry of Environment, changed with the annual number of HD sales, with a delay pattern, potentially induced by the late awareness of lung injury diseases. The present study suggests that changes in the nationwide annual consumption of HD products were consistent with changes in the annual number of HDLI cases in Korea.

Comparison of antiviral effect for mild-to-moderate COVID-19 cases between lopinavir/ritonavir versus hydroxychloroquine: A nationwide propensity score-matched cohort study.

OBJECTIVES: We aimed to compare the antiviral effect of hydroxychloroquine (HCQ) and lopinavir/ritonavir (LPV/r) in patients with COVID-19. METHODS: Nationwide retrospective case-control study was conducted to compare the effect of HCQ and LPV/r on viral shedding duration among patients with mild-to-moderate COVID-19 using the reimbursement data of National Health Insurance Service. After propensity score matching (PSM), multivariate analysis was conducted to determine statistically significant risk factors associated with prolonged viral shedding. RESULTS: Overall, 4197 patients with mild-to-moderate COVID-19 were included. Patients were categorized into three groups: LPV/r (n = 1268), HCQ (n = 801), and standard care without HCQ or LPV/r (controls, n = 2128). The median viral shedding duration was 23 (IQR 17-32), 23 (IQR 16-32), and 18 (IQR 12-25) days in the LPV/r, HCQ, and control groups, respectively. Even after PSM, the viral shedding duration was not significantly different between LPV/r and HCQ groups: 23 (IQR, 17-32) days versus 23 (IQR, 16-32) days. On multivariate analysis, old age, malignancy, steroid use, and concomitant pneumonia were statistically significant risk factors for prolonged viral shedding. CONCLUSION: The viral shedding duration was similar between HCQ and LPV/r treatment groups. There was no benefit in improving viral clearance compared to the control group.

Impact of obesity, fasting plasma glucose level, blood pressure, and renal function on the severity of COVID-19: A matter of sexual dimorphism?

AIMS: This study aimed to assess whether body mass index (BMI), fasting plasma glucose (FPG) levels, blood pressure (BP), and kidney function were associated with the risk of severe disease or death in patients with COVID-19. METHODS: Data on candidate risk factors were extracted from patients' last checkup records. Propensity score-matched cohorts were constructed, and logistic regression models were used to adjust for age, sex, and comorbidities. The primary outcome was death or severe COVID-19, defined as requiring supplementary oxygen or higher ventilatory support. RESULTS: Among 7,649 patients with confirmed COVID-19, 2,231 (29.2%) received checkups and severe COVID-19 occurred in 307 patients (13.8%). A BMI of 25.0-29.9 was associated with the outcome among women (aOR, 2.29; 95% CI, 1.41-3.73) and patients aged 50-69 years (aOR, 1.64; 95% CI, 1.06-2.54). An FPG ≥ 126 mg/dL was associated with poor outcomes in women (aOR, 2.06; 95% CI, 1.13-3.77) but not in men. Similarly, estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 was a risk factor in women (aOR, 3.46; 95% CI, 1.71-7.01) and patients aged < 70 years. CONCLUSIONS: The effects of BMI, FPG, and eGFR on outcomes associated with COVID-19 were prominent in women but not in men.

Factors associated with organized and opportunistic cancer screening: Results of the Korea National Health and Nutrition Examination Survey (KNHANES) 2007-2011.

BACKGROUND: Cancer is one of the leading causes of death in Korea. To reduce cancer incidence, the Korean National Cancer Center (KNCC) has been expanding its organized cancer screening program. In addition, there are opportunistic screening programs that can be chosen by individuals or their healthcare providers. The purpose of this study was to investigate factors associated with participation in organized and opportunistic cancer screening programs, with a particular focus on socioeconomic factors. MATERIALS AND METHODS: We used data from the Korea National Health and Nutrition Examination Survey (KNHANES), a cross-sectional nationwide study conducted by the Korean Ministry of Health and Welfare from 2007 to 2011. The study included information from 9,708 men and 12,739 women aged 19 years or over. Multinomial logistic regression analysis was conducted, adjusting for age, year of data collection, residential region, current smoking status, current alcohol consumption status, exercise, marriage status, job status, perceived health status, stress level, BMI, limitation of activities, cancer history, health insurance type, and private insurance status, to investigate the association between education level, economic status, and cancer screening participation. RESULTS: In terms of education level, disparities in attendance were observed only for the opportunistic screening program. In contrast, there was no association between education level and participation in organized screening. In terms of economic status, disparities in opportunistic screening participation were observed at all income levels, but disparities in organized screening participation were observed only at the highest income level. CONCLUSIONS: Our findings reveal that socioeconomic factors, including educational level and economic status, were not significantly associated with participation in organized cancer screening, except at the highest level of income.

The gender-specific association between age at first drink and later alcohol drinking patterns in Korea.

This study investigated the association between the age at first drink and later alcohol drinking patterns, and analyzed whether differences in the association exist among Korean adults according to gender. The subjects included 10,649 adults (5,405 men and 5,244 women) from the fourth Korean National Health and Nutrition Examination Survey between 2007 and 2009, which extracted the standard survey household by using the proportional systematic sampling method. Baseline individual characteristics, the age at first drink, and individual alcohol drinking patterns were obtained by specially trained interviewers or examiners. The association between the age at first drink and the adult alcohol drinking patterns was summarized with odds ratios and their confidence intervals obtained from multiple logistic regression analysis with sampling weights of KNHANES complex sample survey design. The results of this study show that age, co-habitation, occupation, smoking, and self-rated stress level were significantly related to the drinking patterns for men, whereas education, co-habitation, smoking, and self-rated stress level were significant factors for the drinking patterns of women. The association between the age at first drink and the adult alcohol consumption was significant for both genders and, interestingly, the alcohol drinking patterns were significantly differed by gender even after controlling for the individual characteristics. These results imply a need for gender-specific strategies to prevent hazardous alcohol consumption at a later time for Korean.

Truncation of N- and C-terminal regions of Streptococcus mutans dextranase enhances catalytic activity.

Multiple forms of native and recombinant endo-dextranases (Dexs) of the glycoside hydrolase family (GH) 66 exist. The GH 66 Dex gene from Streptococcus mutans ATCC 25175 (SmDex) was expressed in Escherichia coli. The recombinant full-size (95.4 kDa) SmDex protein was digested to form an 89.8 kDa isoform (SmDex90). The purified SmDex90 was proteolytically degraded to more than seven polypeptides (23-70 kDa) during long storage. The protease-insensitive protein was desirable for the biochemical analysis and utilization of SmDex. GH 66 Dex was predicted to comprise four regions from the N- to C-termini: N-terminal variable region (N-VR), conserved region (CR), glucan-binding site (GBS), and C-terminal variable region (C-VR). Five truncated SmDexs were generated by deleting N-VR, GBS, and/or C-VR. Two truncation-mutant enzymes devoid of C-VR (TM-NCGΔ) or N-VR/C-VR (TM-ΔCGΔ) were catalytically active, thereby indicating that N-VR and C-VR were not essential for the catalytic activity. TM-ΔCGΔ did not accept any further protease-degradation during long storage. TM-NCGΔ and TM-ΔCGΔ enhanced substrate hydrolysis, suggesting that N-VR and C-VR induce hindered substrate binding to the active site.

Variation in quality of men's health care by race/ethnicity and social class.

BACKGROUND: Until recently, minority and poor men have been characterized as "an invisible population," overlooked by public and private efforts to improve the health status of women, children, and the elderly. OBJECTIVE: This study compares the health care experiences of racial and ethnic minority men with that of white men, and low socioeconomic status with those of higher status. MEASURES/SUBJECTS: Quality-of-care measures in multiple clinical domains are evaluated. The authors use data from several databases, including the National Health Interview Survey, Medical Expenditure Panel Survey, and Health Care Cost and Utilization Project State Inpatient Database. The relative difference between each racial/ethnic and socioeconomic group and a fixed reference group is used to assess differences in use of services. Statistical significance is assessed using z tests. RESULTS: Hispanic men were much less likely to receive colorectal cancer screening (relative risk [RR] range, 0.61-0.69), cardiovascular risk factor screening and management (RR, 0.84-0.88), and vaccinations (RR, 0.47-0.94). Black and Asian men were significantly less likely to have received selected preventive services (adult immunization and colorectal cancer screening). The differences in end-stage renal disease care that black and white men received were statistically significant (RR, 0.39-0.97), with black men consistently receiving worse care. For some measures of management of end-stage renal disease, Asian men received care that was similar to or better than that received by non-Hispanic whites. CONCLUSION: Minority men are at a markedly elevated risk for the receipt of poor health care quality. However, generalizations about "minority" men are likely to be misleading and incomplete. There is a considerable variation in the magnitude, direction, and significance of these risks.