Has South Korea achieved the goals of national health insurance? Trends in financial protection of households between 2011 and 2018.

This study aims to investigate the evolution of financial protection of households against OOP in South Korea, where subsequent policies of expanding benefit coverage have been implemented primarily focusing on several severe diseases, by measuring catastrophic healthcare expenditure (CHE) and the characteristics of households vulnerable to CHE. Using the Korea Health Panel 2011-2018, this study analyzed CHE trends by the targeted severe diseases and other health problems and household income and examined the determinants of CHE using binary logistic regression. Our findings showed that CHE decreased in households with the targeted severe diseases but increased in households experiencing hospitalization that were not related to the targeted diseases, which appeared to have a significantly higher likelihood of CHE in 2018 than households with the targeted severe diseases. In addition, CHE was more prevalent and increased or remained stagnant among households whose heads had health problems than others. Inequalities in CHE also increased, showing increased Concentration Index (CI) and increased incidences of CHE in the lower income quartile during the study period. These results suggest that the current policies are insufficient to achieve its financial protection goals against healthcare expenditure in South Korea. In particular, benefit expansions targeting a specific disease may cause inequitable distribution of resources and may not enhance protection against households' financial burden.

Decomposing Disability Inequality in Unmet Healthcare Needs and Preventable Hospitalizations: An Analysis of the Korea Health Panel.

Objectives: This study examines the inequality between people with and without disabilities regarding unmet healthcare needs and preventable hospitalization. Methods: We used the Korea Health Panel of 2016-2018; the final analytical observations were 43,512, including 6.95% of persons with disabilities. We examined the differences in contributors to the two dependent variables and decomposed the observed differences into explained and unexplained components using the Oaxaca-Blinder approach. Results: Unmet healthcare needs and preventable hospitalizations were 5.6% p (15.36% vs. 9.76%) and 0.68% p (1.82% vs. 0.61%), respectively, higher in people with disabilities than in those without, of which 48% and 35% were due to characteristics that the individual variables cannot explain. Decomposition of the distributional effect showed that sex, age, and chronic disease significantly increased disparities for unmet healthcare needs and preventable hospitalization. Socioeconomic factors such as income level and Medical aid significantly increased the disabled-non-disabled disparities for unmet healthcare needs. Conclusion: Socioeconomic conditions increased the disparities, but around 35%-48% of the disparities in unmet healthcare needs and preventable hospitalization were due to unexplained factors, such as environmental barriers.

Active Surveillance Versus Immediate Surgery for Low-Risk Papillary Thyroid Microcarcinoma Patients in South Korea: A Cost-Minimization Analysis from the MAeSTro Study.

Background: Active surveillance (AS) has been established as an alternative to immediate surgery for low-risk papillary thyroid microcarcinoma (PTMC). Nonetheless, it remains difficult to decide between AS and immediate surgery, since limited objective evidence exists regarding risks and benefits. The aim of study is to compare the cumulative costs of AS and immediate surgery. Methods: To estimate cumulative costs, a hypothetical model is simulated based on the Multicenter Prospective Cohort Study of Active Surveillance on Papillary Thyroid Micro-Carcinoma (MAeSTro) study, a multicenter prospective cohort study of AS for PTMC. Direct and indirect costs are estimated from diagnosis to the treatment decision and follow-up for 10 years and a longer period. In the case of the scenarios, AS, AS to surgery due to changing their mind, and lobectomy (analyzed regardless of levothyroxine [LT4] treatment, as well as subdivided into lobectomy/LT4[-] and lobectomy/LT4[+]) are considered. A sensitivity analysis is performed using different discount rates to address uncertainties in future time costs. To compare the cumulative costs, we referred to previous research conducted in Hong Kong, the United States, and Japan. Results: The initial cost of AS is estimated to be 5.6 times lower than that of lobectomy (regardless of LT4 use), while the 10-year cumulative costs of AS ($2545) and lobectomy regardless of LT4 ($3045) are similar under a discount rate of 3%. However, in the long-term follow-up period, immediate surgery is going to be estimated more economical than AS. The costs of the two management approaches are similar in Hong Kong, but substantially different in the United States and Japan, implying that it could be affected by each country's national health insurance coverage and the thyroid ultrasound interval during follow-up. Conclusion: Considering both direct and indirect costs, the cumulative costs of AS and immediate surgery in low-risk PTMC patients are similar during 10 years, and surgery could be more economical for patients with a life expectancy in long-term follow-up. However, careful interpretation is needed for long-term follow-up and the country's health care system and environment. Nevertheless, considering the representative protocols and objective costs in South Korea, it is expected to be a key to suggest the appropriate treatment for PTMC patients.

How do perceptions of public health measures affect experience of unmet healthcare needs among older Korean adults during COVID-19 pandemic?

Increasing difficulties in the use of healthcare services after the COVID-19 outbreak is a major concern as ensuring access to healthcare services is a primary health policy goal. The aim of this study was to examine the impacts of public perceptions regarding COVID-19 related public health measures on older adults' experience of unmet healthcare needs in Korea. A total of 1961 participants from the Korea Health Care System Performance, over the age of 65, were included in the analyses. Three different logistic regression models were used to assess the impact of public perceptions - understanding, trust and satisfaction- regarding COVID-19 public health measures on unmet healthcare needs. Our results show that a poor understanding of public health measures was associated with higher odds of unmet healthcare needs among Korean older adults (OR:2.65, 95%CI: 1.79-3.94). However, trust and satisfaction of public health measures were not related to unmet healthcare needs. Our findings suggest that the importance of effective risk communication to facilitate better understand quarantine polices rather than emphasizing trust or satisfaction over public health measure.

Global occurrence and probabilistic environmental health hazard assessment of per- and polyfluoroalkyl substances (PFASs) in groundwater and surface waters.

Per- and polyfluoroalkyl substances (PFASs) have been used in consumer and military products since the 1950s but are increasingly scrutinized worldwide because of inherent chemical properties, environmental contamination, and risks to public health and the environment. The United States Environmental Protection Agency (USEPA) identified 24 PFASs of interest for further study and possible regulation. We examined 371 peer-reviewed studies published since 2001 to understand the occurrence and distribution of 24 priority PFASs in global surface waters and groundwater. We identified 77,541 and 16,246 data points for surface waters and groundwater, respectively, with total PFAS concentrations ranging from low pg/L to low mg/L levels. Most data were from Asia, Europe, and North America with some reports from Oceania. PFAS information from other geographic regions is lacking. PFASs levels are consistently higher in rivers and streams followed by lakes and reservoirs and then coastal and marine systems. When sufficient data were available, probabilistic environmental hazard assessments (PEHAs) were performed from environmental exposure distributions (EEDs) to identify potential exceedances of available guideline values for each compound by matrix, region, and aquatic system. Specifically, exceedances of USEPA drinking water lifetime health advisory levels were up to 74% for PFOS in groundwater from Oceania and 69% for PFOA in North American groundwater. Our findings support selection of environmentally relevant experimental treatment levels for future toxicology, ecotoxicology and bioaccumulation studies, and potable source water exposure investigations, while highlighting PFASs and major geographic locations requiring additional study and inclusion in global monitoring and surveillance campaigns.

Effect of an anti-adhesion agent on vision-based assessment of cervical adhesions after thyroid surgery: randomized, placebo-controlled trial.

Many patients experience cervical adhesions after thyroid surgery. To date, however, no studies have objectively measured the effects of anti-adhesion agents on cervical adhesion symptoms. This study evaluated the effects of an anti-adhesion agent on cervical adhesions after thyroid surgery, as determined using a system that measures the extent of marker movement objectively. One hundred patients were randomized in a 1:1 ratio to undergo thyroid surgery with or without the anti-adhesion agent Collabarrier. Using specially manufactured recording equipment, the position of the marker on neck skin was measured before surgery, and 2 weeks, 3 months, and 9 months after surgery. Relative change in marker distance, calculated by subtracting the marker position before surgery from the marker positions 2 weeks, 3 months, and 9 months after surgery, differed significantly in the groups of patients who underwent thyroid surgery with and without the anti-adhesion agent (P < 0.05). A novel measuring system can objectively evaluate the effectiveness of a thyroid anti-adhesion agent. The anti-adhesion agent used significantly reduced adhesions compared with the control group. The trial is registered at www.cris.nih.go.kr (KCT0005745; date of registration, 08/01/2021).

Assessment of Inter-Institutional Post-Operative Hypoparathyroidism Status Using a Common Data Model.

Post-thyroidectomy hypoparathyroidism may result in various transient or permanent symptoms, ranging from tingling sensation to severe breathing difficulties. Its incidence varies among surgeons and institutions, making it difficult to determine its actual incidence and associated factors. This study attempted to estimate the incidence of post-operative hypoparathyroidism in patients at two tertiary institutions that share a common data model, the Observational Health Data Sciences and Informatics. This study used the Common Data Model to extract explicitly specified encoding and relationships among concepts using standardized vocabularies. The EDI-codes of various thyroid disorders and thyroid operations were extracted from two separate tertiary hospitals between January 2013 and December 2018. Patients were grouped into no evidence of/transient/permanent hypoparathyroidism groups to analyze the likelihood of hypoparathyroidism occurrence related to operation types and diagnosis. Of the 4848 eligible patients at the two institutions who underwent thyroidectomy, 1370 (28.26%) experienced transient hypoparathyroidism and 251 (5.18%) experienced persistent hypoparathyroidism. Univariate logistic regression analysis predicted that, relative to total bilateral thyroidectomy, radical tumor resection was associated with a 48% greater likelihood of transient hypoparathyroidism and a 102% greater likelihood of persistent hypoparathyroidism. Moreover, multivariate logistic analysis found that radical tumor resection was associated with a 50% greater likelihood of transient hypoparathyroidism and a 97% greater likelihood of persistent hypoparathyroidism than total bilateral thyroidectomy. These findings, by integrating and analyzing two databases, suggest that this analysis could be expanded to include other large databases that share the same Observational Health Data Sciences and Informatics protocol.

Health related quality of life (HRQOL) of patients with End Stage Kidney Disease (ESKD) on hemodialysis in Addis Ababa, Ethiopia: a cross-sectional study.

BACKGROUND: End-Stage Kidney Disease, the most severe form of chronic kidney disease, is fatal if not treated by renal replacement therapy. Thus, patients with End-Stage Kidney Disease depend on hemodialysis as a lifesaving treatment for the remainder of their lives. However, the health-related quality of life (HRQOL) of patients on hemodialysis is much more underappreciated in resource limited countries. METHODS: A hospital based cross-sectional study was conducted in Addis Ababa, Ethiopia, from August 01 to October 31, 2019. All patients who were on hemodialysis in five randomly selected public and private hospitals (n = 125) were included in the study. Data were administered by trained nurses by using a standardized Kidney Disease Quality of Life questionnaire. Clinical data were extracted from the patients' medical charts. HRQOL was categorized as low, if the overall mean score was ≤ 50, or as high, if the overall mean score was > 50. Factors associated with lower HRQOL were identified by multi-variable binary logistic regression analysis and expressed by adjusted odds ratio (aOR) and its respective 95 % confidence interval. RESULTS: The mean age of the study participants (n = 125) was 50.33 years (± 15.07) and more than two-thirds (68.8 %) of the participants were males. The mean score of HRQOL was 49.08 ± 11.09, with 48.0 % (95 % CI: 42.2 - 54.5 %) of them had lower HRQOL. Unemployed patients (aOR = 2.40, 95 % CI: 1.10-5.90) and patients who had hemodialysis 2 times per week (aOR = 1.71, 95 % CI: 1.07-3.83) had lower HRQOL. Elderly patients had higher odds of having lower mean score on the burden of kidney disease (aOR = 2.07; 95 % CI 1.18-4.13) as compared to the younger patients. CONCLUSIONS: Nearly half of the patients with ESKD on hemodialysis had lower overall HRQOL which is associated with their unemployment status and frequency of hemodialysis per week. Elderly patients had lower mean score of burden of kidney disease. Therefore, quality of life of patients with chronic dialysis should be given special attention during the patients' care. Measures should be taken by the government to ensure accessibility and affordability of the hemodialysis services in the country.

Occurrence, Potential Sources, and Risk Assessment of Volatile Organic Compounds in the Han River Basin, South Korea.

Increasing public awareness about the aesthetics and safety of water sources has shifted researchers' attention to the adverse effects of volatile organic compounds (VOCs) on humans and aquatic organisms. A total of 17 VOCs, including 10 volatile halogenated hydrocarbons and seven volatile non-halogenated hydrocarbons, were investigated at 36 sites of the Han River Basin, which is the largest and most important drinking water source for residents of the Seoul metropolitan area and Gyeonggi province in South Korea. The VOC concentrations ranged from below detection limits to 1.813 µg L-1. The most frequently detected VOC was 1,2-dichloropropane, with a detection frequency of 80.56%, as it is used as a soil fumigant, chemical intermediate, and industrial solvent. In terms of geographical trends, the sampling sites that were under the influence of sewage and industrial wastewater treatment plants were more polluted with VOCs than other areas. This observation was also supported by the results of the principal component analysis. In the present study, the detected concentrations of VOCs were much lower than that of the predicted no-effect concentrations, suggesting low ecological risk in the Han River. However, a lack of available ecotoxicity data and limited comparable studies warrants further studies on these compounds.

Comparing the feasibility and accuracy of three-dimensional ultrasound to two-dimensional ultrasound and computed tomography angiography in the assessment of carotid atherosclerosis.

AIMS: Two-dimensional ultrasound (2D-US) is the mainstay imaging technique used to evaluate carotid atherosclerosis. An automated single sweep three-dimensional ultrasound (3D-US) technique became available. We evaluated the feasibility and accuracy of 3D-US in the assessment of carotid plaques compared to those of 2D-US. Carotid computed tomography angiography (CTA) was used as a reference. METHODS AND RESULTS: Among 126 stroke patients who underwent carotid 2D-US, 73 underwent 3D-US and carotid CTA. 3D-US was pursued when there were carotid plaques or when area stenosis was ≥ 20% by 2D-US. Both 2D- and 3D-US images of the carotid arteries were acquired using a dedicated ultrasound system that was equipped with the single sweep volumetric transducer. In total, 266 arteries from 73 patients were selected for comparison of the detection rate of carotid plaques between 2D- and 3D-US. Among the 73 patients, carotid CTA detected 139 plaques. 3D-US demonstrated a higher detection rate of carotid plaques than did 2D-US (108 plaques (77.9%) vs. 70 plaques (50.4%)) when using carotid CTA as a reference standard. Carotid plaque volume (PV) of 133 vessels from 73 patients were quantitatively evaluated using both 3D-US and carotid CTA. Plaque volume of carotid artery was comparable between 3D-US and CTA (148.5 ± 133.0 mm3 vs. 154.1 ± 134.6 mm3 , P = .998, R: 0.9825, P-value for r < .001). CONCLUSION: 3D-US using a single sweep technique was a feasible and accurate method of detecting arterial plaques and assessing plaque volume.

An Empirical Analysis of Delayed Monthly Bill Payments as an Early Risk Factor of Increased Suicidal Behavior.

This study examines the potential of delayed monthly bill payments as a predictor of suicidal behavior in South Korea with the highest suicide rate among developed countries. Using the Korea Welfare Panel Study, multivariable logistic regressions examined the association between suicide ideation/attempts and the frequency of late payments on utility bills or National Health Insurance premium during last three years. Confounding factors such as past depression and suicide ideation/attempts history were adjusted for. Among 10,988 individuals, 2.7% reported suicide ideation and 0.11% attempted suicide in the past year, while 7.1% reported they paid late once or more during the last three years. Adults with two or more delayed payment had 2.32 times increased odds of suicidal ideation and 10.99 times increased odds of suicide attempts, compared to having no late payments. Adjusting for other socio-economic characteristics rarely changed the relationship between late payments and suicide ideation/attempts (for suicidal ideation, OR = 2.11; for suicide attempts: OR = 7.44), suggesting the independent effect of late payments on suicide behavior. With these findings, it can be suggested that late payment is an important factor, preemptively signaling suicide behavior with serious consequences in health and life.

Longitudinal Assessment of Quality of Life According to Treatment Options in Low-Risk Papillary Thyroid Microcarcinoma Patients: Active Surveillance or Immediate Surgery (Interim Analysis of MAeSTro).

Background: In this ongoing multicenter prospective cohort study on active surveillance (AS) in low-risk papillary thyroid microcarcinoma (PTMC), we aimed to compare the quality of life (QoL) of participants based on their choice of treatment, that is, AS or immediate surgery (OP). Methods: QoL of 203 participants who chose AS and 192 participants who underwent OP was evaluated using a thyroid-specific QoL questionnaire at diagnosis and during follow-up (median 8 months). Results: The mean ages of the participants in the AS and OP groups were 47.3 ± 11.7 and 45.6 ± 10.5 years (p = 0.138), respectively, and the mean tumor sizes were 5.7 ± 1.6 and 6.5 ± 2.1 mm (p = 0.065), respectively. At baseline, significantly better psychological health (7.1 ± 1.3 vs. 6.8 ± 1.6, p = 0.023) and overall health (6.8 ± 1.2 vs. 6.5 ± 1.3, p = 0.018) were observed in the AS group than in the OP group. During follow-up, significantly better physical (7.9 ± 1.1 vs. 7.4 ± 1.2, p < 0.001), psychological (7.4 ± 1.3 vs. 6.9 ± 1.6, p = 0.004), and overall health (6.9 ± 1.0 vs. 6.5 ± 1.1, p = 0.002) were observed in the AS group than in the OP group, whereas spiritual health was comparable between the two groups. Compared with the AS group, the OP group experienced more fatigue, changes in voice and appearance, less satisfaction, and low fear of recurrence. The self-assessed financial burden was similar at baseline and follow-up in both groups. Conclusion: The QoL of PTMC patients is different according to the type of treatment. Better psychological health at baseline and physical and psychological health at follow-up were observed in the AS group than in the OP group. However, studies with longer follow-up periods are needed.

Positive and negative social support and depressive symptoms according to economic status among adults in Korea: cross-sectional results from the Health Examinees-Gem Study.

OBJECTIVES: The interaction between positive and negative social support as well as each domain of social support and income on depressive symptom has not been much explored. We aimed to examine the associations of positive and negative social support with the risk of depressive symptoms among urban-dwelling adults in Korea, focusing on those interaction effects. DESIGN: We used the first wave of a large-scale cohort study called The Health Examinees-Gem Study. Positive and negative support scores ranged between 0 and 6; the variables were then categorised into low, medium, and high groups. A two-level random intercept linear regression model was used, where the first level is individual and the second is the community. We further tested for interactions between each domain of social supports and household income. SETTING: A survey conducted at 38 health examination centres and training hospitals in major Korean cities and metropolitan areas during 2009-2010. PARTICIPANTS: 21 208 adult men and women aged between 40 and 69 in Korea (mean age: 52.6, SD: 8.0). OUTCOME MEASURES: Depressive symptoms score measured by Epidemiologic Studies-Depression Scale, with scores ranging from 0 to 60. RESULTS: Level of positive and negative social support showed a negative and positive association with depressive symptom score with statistical significance at p<0.05, respectively. When the interaction terms among household income and social supports were examined, a negative association between level of positive social support and depressive symptom score was more pronounced as income was lower and level of negative social support was higher. Similarly, positive association between level of negative social support and depressive symptom score was more pronounced as income was lower and level of positive social support was lower. CONCLUSIONS: Our findings suggest that strategies for encouraging positive social support and discouraging negative social support for disadvantaged individuals might be effective in reducing depression in Korea.

Neighborhood-level and individual-level socioeconomic status and self-reported management of ischaemic heart disease: cross-sectional results from the Korea Health Examinees Study.

OBJECTIVE: Several studies identified neighbourhood context as a predictor of prognosis in ischaemic heart disease (IHD). The present study investigates the relationships of neighborhood-level and individual-level socioeconomic status with the odds of ongoing management of IHD, using baseline survey data from the Korea Health Examinees-Gem study. DESIGN: In this cross-sectional study, we estimated the association of the odds of self-reported ongoing management with the neighborhood-level income status and percentage of college graduates after controlling for individual-level covariates using two-level multilevel logistic regression models based on the Markov Chain Monte Carlo function. SETTING: A survey conducted at 17 large general hospitals in major Korean cities and metropolitan areas during 2005-2013. PARTICIPANTS: 2932 adult men and women. OUTCOME MEASURE: The self-reported status of management after incident angina or myocardial infarction. RESULTS: At the neighbourhood level, residence in a higher-income neighbourhood was associated with the self-reported ongoing management of IHD, after controlling for individual-level covariates [OR: 1.22, 95% credible interval (CI): 1.01 to 1.61). At the individual level, higher education was associated with the ongoing IHD management (high school graduation, OR: 1.33, 95% CI: 1.08 to 1.65); college or higher, OR: 1.63, 95% CI: 1.22 to 2.12; reference, middle school graduation or below). CONCLUSIONS: Our study suggests that policies or interventions aimed at improving the quality and availability of medical resources in low-income areas may associate with ongoing IHD management. Moreover, patient-centred education is essential for ongoing IHD management, especially when targeted to patients with IHD with a low education level.

Effects of Participation in Social Activities on Cognitive Function Among Middle-Aged and Older Adults in Korea.

Cognitive function is a critical health issue in later life, the decline of which disrupts well-being and daily life function. Cognitive decline in older ages can also be understood in the context of the social environment such as social connectedness and engagement in personal life. This study aimed to examine: (1) whether participation in social activities contributes to preventing cognitive decline, and (2) what type of social activities are beneficial to maintaining cognitive function. Data from the Korean Longitudinal Study of Aging (KLOSA) 2006⁻2014, a longitudinal survey of the household-dwelling population aged 45 and older in Korea were used. The results revealed that Mini-Mental State Examination (MMSE) scores decreased with increasing age, at a rate of approximately 0.18 units across all age-gender groups, and the decrease was steeper for adults aged 65 and over. Participation in social gatherings was likely to delay the decline in cognitive function after the age of 65. In a gender-stratified model, social activity may not have an impact on the decline of cognitive function for men, whereas participation in social gatherings was negatively related to the decline of MMSE scores in women. This study suggests the need for a gender-stratified policy for preventing the decline of cognitive function while promoting engagement in social activities in Korean older adults.

Socioeconomic inequalities in the prevalence of biomarkers of cardio-metabolic disease in South Korea: Comparison of the Health Examinees Study to a nationally representative survey.

BACKGROUND/OBJECTIVES: This study aimed to examine socioeconomic inequalities in the prevalence of biomarkers of cardiovascular disease and diabetes in the newly developed large-scale genomic cohort study of Korean adults, the Health Examinees-Gem (HEXA-G), with a comparison of the nationally representative cross-sectional study, the Korea National Health and Nutrition Examination Survey (K-NHANES). SUBJECTS/METHODS: Using the HEXA-G and the K-NHANES from 2007-2012, we analyzed the age-adjusted relative risk (RR) and prevalence of enlarged waist circumference (EWC), elevated triglycerides (ET), low HDL cholesterol (LHC), elevated blood pressure (EBP) and elevated blood glucose (EBG) by income and educational groups for adults at age 40-69. RESULTS: For men, the prevalence of risk factors was similar across different income and educational groups (p>0.1), and between the K-NHANES and the HEXA-G. Among five risk factors, EBG showed the greatest discrepancy by 7 to 11 percentage points (i.e., the prevalence of 0.43 and 0.36 for college graduates, respectively, in K-NHANES and HEXA-G). For women, socioeconomic inequalities appeared for the five risk factors. Prevalence of risk factors was mostly lower in the HEXA-G than the K-NHANES, by approximately 11.0 percentage points. Especially, the discrepancy between K-NHANES and HEXA-G was largest in EBG (i.e., the prevalence of 0.31 and 0.20 for the lowest income groups, respectively). CONCLUSION: The HEXA-G shows broadly similar socioeconomic inequality in prevalence of cardio-metabolic risk factors to the nationally representative sample with more modest socioeconomic inequality among women in the HEXA-G than the K-NHANES.

Assessment of multidirectional movements of the common carotid artery in atherothrombotic stroke using dimensional speckle tracking carotid ultrasonography: A prospective, controlled cohort study.

AIM: We aimed to explore the relevance of multidirectional movements of the common carotid artery in atherothrombotic stroke. METHODS AND RESULTS: We prospectively enrolled 69 patients with atherothrombotic stroke (stroke group) and 69 age-matched and sex-matched controls (control group) who underwent carotid ultrasonography. Based on the speckle tracking technique, circumferential and radial movements of the common carotid artery were analyzed from transverse and longitudinal B-mode images of the common carotid artery. Peak longitudinal and radial displacements, strain, and strain rate were measured. Mean age of the overall population was 64 ± 11 years, and 57% (78 patients) were men. In the transverse image, circumferential strain was significantly lower in the stroke group than in the control group (5.6 ± 1.6 vs 4.2 ± 1.7, P < .001). In multivariate logistic regression analysis, circumferential strain was independently associated with stroke (odds ratio: 0.60, P = .001). Compared with conventional risk factors, as well as carotid intima-media thickness and carotid plaque, the addition of a strain parameter appeared to improve discrimination of a stroke event (area under the receiver operating characteristic curve: 0.65 and 0.75 vs 0.84, respectively; P < .05 for both). CONCLUSIONS: Circumferential strain of the common carotid artery might serve as a novel surrogate marker of atherothrombotic stroke. Multidirectional strain imaging of the common carotid artery may provide more information than conventional carotid ultrasonography and identify clinical risk factors for risk stratification of an acute stroke event.

Assessment of trends in socioeconomic inequalities in cancer screening services in Korea, 1998-2012.

BACKGROUND: This study aimed to examine how income-related inequalities in screening services for gastric and colorectal cancer in Korea have changed over the past decades, along with the implementation of the national cancer screening program, and also to quantify each contribution from various socio-demographic factors income-related inequalities with respect to these cancer screening services. METHODS: Three cycles (1998, 2005, and 2010-2012) of Korea National Health and Nutrition Examination Survey (KNHANES) were utilized. To measure income-related inequalities in the use of gastric and colorectal cancer, individuals over the age of 40 and the age of 50 were included respectively, and the Concentration Index (CI) was calculated for each cycle. To identify and quantify contribution from each socio-demographic factor, decomposition of the CIs was conducted. RESULTS: Throughout this study, CIs and horizontal inequity indices (HIs) steadily but consistently decreased, suggesting that inequalities and inequities in participation in gastric and colorectal cancer screening were weakened after the implementation of the national public cancer screening program. Decomposition analyses revealed that whereas decreases in inequalities mostly stemmed from income and educational levels; higher income and better education levels are still major contributors to the observed inequalities that influence participation in cancer screening services in Korea. CONCLUSION: Our empirical findings suggest that, although the policy of reducing out-of-pocket payment for cancer screening may contribute to the observed decreases in inequality, it alone is not likely to completely eliminate inequality. Further research is required to identify barriers that prevent people with lower socioeconomic status from participation in cancer screening, which allows equal access for equal need.

Predictors affecting personal health information management skills.

OBJECTIVES: This study investigated major factors affecting personal health records (PHRs) management skills associated with survey respondents' health information management related activities. METHODS: A self-report survey was used to assess individuals' personal characteristics, health knowledge, PHR skills, and activities. Factors underlying respondents' current PHR-related activities were derived using principal component analysis (PCA). Scale scores were calculated based on the results of the PCA, and hierarchical linear regression analyses were used to identify respondent characteristics associated with the scale scores. Internal consistency of the derived scale scores was assessed with Cronbach's α. RESULTS: Among personal health information activities surveyed (N = 578 respondents), the four extracted factors were subsequently grouped and labeled as: collecting skills (Cronbach's α = 0.906), searching skills (Cronbach's α = 0.837), sharing skills (Cronbach's α = 0.763), and implementing skills (Cronbach's α = 0.908). In the hierarchical regression analyses, education and computer knowledge significantly increased the explanatory power of the models. Health knowledge (ß = 0.25, p < 0.001) emerged as a positive predictor of PHR collecting skills. CONCLUSIONS: This study confirmed that PHR training and learning should consider a full spectrum of information management skills including collection, utilization and distribution to support patients' care and prevention continua.

Has the National Cancer Screening Program reduced income inequalities in screening attendance in South Korea?

PURPOSE: In 1999, the Korean government introduced the National Cancer Screening Program (NCSP) to increase the cancer-screening rate, particularly among the low-income population. This study investigates how the NCSP has decreased both relative and absolute income inequalities in the uptake of cancer screening in South Korea. METHODS: A nationally representative cross-sectional repeated data from the Korea National Health and Nutrition Examination Survey 1998-2012, managed by the Ministry of Health and Welfare, was used to assess changes over time and the extent of discontinuity at the NCSP-recommended initiation age in the uptake of screening for breast, colorectal, and gastric cancers across income quartiles. RESULTS: Relative inequalities in the uptake of screening for all cancers decreased significantly over the policy period. Absolute inequalities did not change for most cancers, but marginally increased from 9 to 14% points in the uptake of screening for colorectal cancer among men. At the recommended initiation age, absolute inequalities did not change for breast and colorectal cancers but increased from 5 to 16% points for gastric cancer, for which relative inequality significantly decreased. CONCLUSIONS: The NCSP, which reduced out-of-pocket payment, may not decrease absolute gap although it leads to overall increases in the uptake of cancer screening and decreases in relative inequalities. Further investigations are needed to understand barriers that prevent the low-income population from attending cancer screening.