Eligibility and Cost-Utility Analysis of Dapagliflozin in Patients with Heart Failure Across the Whole Spectrum of Ejection Fraction in South Korea.

BACKGROUND: The DAPA-HF and DELIVER trials demonstrated the clinical benefits of dapagliflozin in heart failure (HF) patients across the entire ejection fraction (EF) spectrum. However, further investigation is needed for the real-world application of dapagliflozin in HF patients. This study examines the proportion of real-world HF patients eligible for dapagliflozin and evaluates the cost-effectiveness of adding dapagliflozin to current HF therapy. METHODS: Data from the nationwide prospective registry, the Korean Acute Heart Failure (KorAHF) registry, were used to determine dapagliflozin eligibility based on the enrollment criteria of the DAPA-HF/DELIVER trials. A cost-utility analysis was conducted using a Markov model to assess the cost-effectiveness of dapagliflozin by comparing it to the standard of care. RESULTS: Out of 5178 KorAHF patients, 48.7% met the enrollment criteria of the DAPA-HF/DELIVER trials, while 89.5% met the label criteria (US Food and Drug Administration, European Medicines Agency, and Korean Ministry of Food and Drug Safety). Eligibility was highest among HF patients with preserved EF (55.3% vs. HF with mildly reduced EF and HF with reduced EF 46.4%). Dapagliflozin proved to be cost-effective, with an incremental cost-effectiveness ratio (ICER) of 4557 US dollar (US$) per quality-adjusted life year, which falls below the US$18,182 willingness-to-pay threshold. The cost-effectiveness benefit was more pronounced in patients with a left ventricular EF (LVEF) ≤ 40% (ICER US$3279 for LVEF ≤ 40% vs. US$8383 for LVEF > 40%). CONCLUSIONS: Discrepancies in dapagliflozin eligibility were observed between real-world data and clinical trial results. The addition of dapagliflozin to HF therapy proved to be highly cost-effective across the entire EF spectrum.

Real-World Eligibility and Cost-Effectiveness Analysis of Empagliflozin for Heart Failure in Korea.

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

Association between exposure to violence, job stress and depressive symptoms among gig economy workers in Korea.

Background: Gig workers, also known as platform workers, are independent workers who are not employed by any particular company. The number of gig economy workers has rapidly increased worldwide in the past decade. There is a dearth of occupational health studies among gig economy workers. We aimed to investigate the association between exposure to violence and job stress in gig economy workers and depressive symptoms. Methods: A total of 955 individuals (521 gig workers and 434 general workers) participated in this study and variables were measured through self-report questionnaires. Depressive symptoms were evaluated by the Patient Health Questionnaire-9 when the score was greater than or equal to 10 points. The odds ratio with 95% confidence interval was calculated using multivariable logistic regression adjusted for age, sex, working hours, education level, exposure to violence and job stress. Results: 19% of gig economy workers reported depressive symptoms, while only 11% of general workers reported the depressive symptoms. In association to depressive symptoms among gig economy workers, the mainly result of odds ratios for depressive symptoms were as follows: 1.81 for workers type, 3.53 for humiliating treatment, 2.65 for sexual harassment, 3.55 for less than three meals per day, 3.69 for feeling too tired to do housework after leaving work. Conclusions: Gig economic workers are exposed to violence and job stress in the workplace more than general workers, and the proportion of workers reporting depressive symptoms is also high. These factors are associated to depressive symptoms. Furthermore, the gig workers associated between depressive symptoms and exposure to violence, job stress.

Self-Esteem Trajectories After Occupational Injuries and Diseases and Their Relation to Changes in Subjective Health: Result From the Panel Study of Workers' Compensation Insurance (PSWCI).

BACKGROUND: Occupational injuries and diseases are life events that significantly impact an individuals' identity. In this study, we examined the trajectories of self-esteem among victims of occupational injury and disease and their relation to health. METHODS: The Panel Study of Workers' Compensation Insurance conducted annual follow-ups on workers who had experienced occupational injury or disease. A total of 2,000 participants, who had completed medical care, were followed from 2013 to 2017. Growth mixture modeling was utilized to identify latent classes in the self-esteem trajectory. Additionally, logistic regressions were conducted to explore the association between trajectory membership, baseline predictors, and outcomes. RESULTS: Three distinct trajectory classes were identified. Total 65.8% of the samples (n = 1,316) followed an increasing self-esteem trajectory, while 31.1% (n = 623) exhibited a constant trajectory, and 3.1% (n = 61) showed a decreasing trajectory. Individuals with an increasing trajectory were more likely to have a higher educational attainment (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.20-2.88), an absence of a moderate-to-severe disability rating (OR, 0.49; 95% CI, 0.25-0.96), no difficulty in daily living activities (OR, 0.81; 95% CI, 0.75-0.88), and were economically active (re-employed: OR, 2.46; 95% CI, 1.52-3.98; returned to original work: OR, 4.46; 9% CI, 2.65-7.50). Those with a decreasing self-esteem trajectory exhibited an increased risk of poor subjective health (OR, 1.89; 95% CI, 0.85-4.85 in 2013 to OR, 3.17; 95% CI, 1.04-13.81 in 2017), whereas individuals with an increasing trajectory showed a decreased risk (OR, 0.54; 95% CI, 0.43-0.68 in 2013 to OR, 0.44; 95% CI, 0.33-0.57 in 2017). CONCLUSION: Our findings emphasize the diversity of psychological responses to occupational injury or disease. Policymakers should implement interventions to enhance the self-esteem of victims.

Multidimensional employment precariousness mediates the association between low educational attainment and poor subjective well-being: results from a nationwide cross-sectional study in South Korea.

OBJECTIVE: This paper explored how multidimensional employment precariousness (MEP) mediates the relationship between educational attainment and subjective well-being. METHODS: A nationwide sample of 46 919 Korean workers participated in surveys between 2017 and 2020. Educational attainment was divided into four categories: elementary school, middle school, high school, and college. Subjective well-being was assessed using the 5-item World Health Organization Well-Being Index, and MEP was evaluated using a modified version of the Employment Precariousness Scale (ERPES-E), with scores ranging from 0 to 100 and higher scores indicating worse employment precariousness. A counterfactual-based logistic mediation analyses were used to estimation. RESULTS: The mean MEP score was 36.0 [standard deviation (SD) 12.1] for college education, 44.3 (SD 11.5) for high school, 49.5 (SD 10.1) for middle school, and 51.1 (SD 10.0) for elementary school. The prevalence of poor subjective well-being was 24.0% for college education, 31.3% for high school, 40.6% for middle school, and 44.8% for elementary school. Odds ratios (OR) for the total effect of education on the poor subjective well-being were 1.44 [95% confidence interval (CI) 1.37-1.53] for high school, 2.19 (95% CI 1.98-2.24) for middle school, and 2.40 (95% CI 2.04-2.82) for elementary school when compared to college education. The OR for the indirect effect mediated through MEP were 1.27 (95% CI 1.25-1.29) for high school, 1.46 (95% CI 1.42-1.51) for middle school, and 1.53 (95% CI 1.48-1.59) for elementary school, accounting for 63.9%, 48.5%, and 48.6% of the total effect, respectively. CONCLUSION: Our study suggests that MEP is an important contributor to the disparities in subjective well-being resulting from educational gradients.

Assessment of acute inhalation toxicity of citric acid and sodium hypochlorite in rats.

BACKGROUND: Citric acid (CA) and sodium hypochlorite (NaOCl) have been used to disinfect animals to protect them against avian influenza and foot-and-mouth disease. OBJECTIVES: We performed a good laboratory practice (GLP)-compliant animal toxicity study to assess the acute toxic effects of CA and NaOCl aerosol exposure in Sprague-Dawley rats. METHODS: Groups of five rats per sex were exposed for 4 h to four concentrations of the two chemicals, i.e., 0.00, 0.22, 0.67, and 2.00 mg/L, using a nose-only exposure. After a single exposure to the chemicals, clinical signs, body weight, and mortality was observed during the observation period. On day 15, an autopsy, and then gross findings, and histopathological analysis were performed. RESULTS: After exposure to CA and NaOCl, body weight loss was observed but recovered. Two males died in the CA 2.00 mg/L group and, two males and one female died in the 2.00 mg/L NaOCl group. In the gross findings and histopathological analysis, discoloration of the lungs was observed in the CA exposed group and inflammatory lesions with discoloration of the lungs were observed in the NaOCl exposed group. These results suggest that the lethal concentration 50 (LC50) of CA is 1.73390 mg/L for males and > 1.70 mg/L for females. For NaOCl, the LC50 was 2.22222 mg/L for males and 2.39456 mg/L for females. CONCLUSIONS: The Globally Harmonized System is category 4 for both CA and NaOCl. In this study, the LC50 results were obtained through a GLP-based acute inhalation toxicity assessment. These results provide useful data to reset safety standards for CA and NaOCl use.

Infrared Clinical Enamel Crack Detector Based on Silicon CCD and Its Application: A High-Quality and Low-Cost Option.

Enamel cracks generated in the anterior teeth not only affect the function but also the aesthetics of the teeth. Chair-side tooth enamel crack detection is essential for clinicians to formulate treatment plans and prevent related dental disease. This study aimed to develop a dental imaging system using a near-IR light source to detect enamel cracks and to investigate the relationship between anterior enamel cracks and age in vivo. A total of 68 subjects were divided into three groups according to their age: young, middle, and elderly. Near-infrared radiation of 850 nm was used to identify enamel cracks in anterior teeth. The results of the quantitative examination showed that the number of enamel cracks on the teeth increased considerably with age. For the qualitative examination, the results indicated that there was no significant relationship between the severity of the enamel cracks and age. So, it can be concluded that the prevalence of anterior cracked tooth increased significantly with age in the young and middle age. The length of the anterior enamel cracks tended to increase with age too; however, this result was not significant. The silicon charge-coupled device (CCD) with a wavelength of 850 nm has a good performance in the detection of enamel cracks and has very good clinical practicability.

Edible unclonable functions.

Counterfeit medicines are a fundamental security problem. Counterfeiting medication poses a tremendous threat to patient safety, public health, and the economy in developed and less developed countries. Current solutions are often vulnerable due to the limited security levels. We propose that the highest protection against counterfeit medicines would be a combination of a physically unclonable function (PUF) with on-dose authentication. A PUF can provide a digital fingerprint with multiple pairs of input challenges and output responses. On-dose authentication can verify every individual pill without removing the identification tag. Here, we report on-dose PUFs that can be directly attached onto the surface of medicines, be swallowed, and digested. Fluorescent proteins and silk proteins serve as edible photonic biomaterials and the photoluminescent properties provide parametric support of challenge-response pairs. Such edible cryptographic primitives can play an important role in pharmaceutical anti-counterfeiting and other security applications requiring immediate destruction or vanishing features.

Maculopathy from an accidental exposure to welding arc.

Welding light can cause photic retinal injury. We report binocular maculopathy induced by a brief exposure to electric arc welding light in a patient who could not equipped with protective device because of narrow space. A 47-year-old man performed electric arc welding for approximately 10-15 min without wearing protective device because of narrow space and subsequently experienced eye discomfort and decreased visual acuity. At the initial visit, his best corrected visual acuity was 0.5. Fundus examination, optical coherence tomography (OCT) and multifocal electroretinogram (mfERG) were performed. OCT showed disruption in the ellipsoid zone, and mfERG amplitudes in the central 10° were markedly reduced in both eyes. The decrease in visual acuity had been noted for at least 18 months. Using the proper protective device is essential in welding, despite short time periods of work. For patients with welding-induced photokeratitis, doctors should also consider the possibility of photic retinal injury.

KSHF Guidelines for the Management of Acute Heart Failure: Part I. Definition, Epidemiology and Diagnosis of Acute Heart Failure.

The prevalence of heart failure (HF) is on the rise due to the aging of society. Furthermore, the continuous progress and widespread adoption of screening and diagnostic strategies have led to an increase in the detection rate of HF, effectively increasing the number of patients requiring monitoring and treatment. Because HF is associated with substantial rates of mortality and morbidity, as well as high socioeconomic burden, there is an increasing need for developing specific guidelines for HF management. The Korean guidelines for the diagnosis and management of chronic HF were introduced in March 2016. However, chronic and acute heart failure (AHF) represent distinct disease entities. Here, we introduce the Korean guidelines for the management of AHF with reduced or preserved ejection fraction. Part I of this guideline covers the definition, epidemiology, and diagnosis of AHF.

KSHF Guidelines for the Management of Acute Heart Failure: Part III. Specific Management of Acute Heart Failure According to the Etiology and Co-morbidity.

The prevalence of heart failure (HF) is on the rise due to the aging of society. Furthermore, the continuous progress and widespread adoption of screening and diagnostic strategies have led to an increase in the detection rate of HF, effectively increasing the number of patients requiring monitoring and treatment. Because HF is associated with substantial rates of mortality and morbidity, as well as high socioeconomic burden, there is an increasing need for developing specific guidelines for HF management. The Korean guidelines for the diagnosis and management of chronic heart failure (CHF) were introduced in March 2016. However, CHF and acute heart failure (AHF) represent distinct disease entities. Here, we introduce the Korean guidelines for the management of AHF with reduced or preserved ejection fraction. Part III of this guideline covers management strategies optimized according to the etiology of AHF and the presence of co-morbidities.

Effects of perceived job insecurity on depression, suicide ideation, and decline in self-rated health in Korea: a population-based panel study.

PURPOSE: To investigate the effects of job security on new development of depressive episode, suicide ideation, and decline in self-rated health. METHODS: Data from the Korea Welfare Panel Study from 2012 to 2015 were analysed. A total of 2912 waged workers self-assessed their depressive episode, suicide ideation, and health annually by answering the questionnaire. Participants were divided into three groups according to the level of job security: high, intermediate and low. To evaluate the influence of job security, we performed survival analysis after stratification by gender with adjustment for covariates. The result was further stratified by whether the respondent was the head of household. RESULTS: After adjusting for covariates, men in low job security group showed significantly higher hazard ratios (HRs) for depression (HR 1.27, 95% CI 1.01-1.60), suicide ideation (HR 3.25, 95% CI 1.72-6.16), and decline in self-rated health (HR 1.73, 95% CI 1.16-2.59). Women showed significantly higher HR of depression in the intermediate (HR 1.37, 95% CI 1.01-1.87) and low (HR 1.50, 95% CI 1.12-1.99) job security group. Male head of household with low job security showed significantly higher HR of depression, suicide ideation, and decline in self-rated health. Non-head-of-household women with intermediate and low job security showed higher risk of depression than those with high job security. CONCLUSIONS: We found that perceived job insecurity is associated with the new development of depressive episode, suicide ideation, and decline in self-rated health.