Increased incidence of leukemia in patients with obstructive sleep apnea: Results from the national insurance claim data 2007-2014.

PURPOSE: Prior research suggests a link between obstructive sleep apnea (OSA) and the likelihood of developing a variety of solid tumors; however, there are no studies assessing OSA and leukemia. This study is the first to identify a potential association between OSA and leukemia using data from the Korea National Health Insurance Service database. METHODS: A total of 162,646 patients (≥20 years of age and without any cancer history) newly diagnosed with OSA between 2011 and 2017 were included. A control group of 813,230 subjects was selected using propensity score matching based on age and sex. The mean follow-up time was 4.4 ± 2.0 years. The primary endpoint was newly diagnosed leukemia of any type. The leukemia hazard ratio (95% confidence interval [CI]) was calculated for patients with OSA and compared with that of patients in the control group. RESULTS: The incidence of leukemia among patients with OSA was significantly higher than that in the controls (1.35 [1.05-1.74]). The hazard ratio was the highest, 1.74 in those under 40 years, and gradually decreased with age, to 1.38 in those aged 40-65 years and 0.96 in those over 65. In particular, the incidence of lymphoid leukemia (2.06 [1.18-3.60]) was higher than that of myeloid (1.34 [1.00-1.81]) or unspecified leukemia (0.60 [0.20-1.58]). CONCLUSION: OSA is associated with an increased incidence of leukemia, particularly in patients younger than 40 years of age.

Association of gastroesophageal reflux disease with increased risk of chronic otitis media with effusion in adults: A nationwide population-based cohort study.

ABSTRACT: This study aimed to evaluate the risk of developing chronic otitis media with effusion (OME) in individuals with gastroesophageal reflux disease (GERD).A retrospective propensity score-matched cohort study was performed using data from the Korea National Health Insurance Service. The GERD group (n = 3532) included certain individuals who had been diagnosed with GERD between January 2002 and December 2005. A comparison control group (n = 14,128) was calculated by 1:4 Propensity Score (PS) matching considering age, sex, and comorbidities and year of enrolment. Each patient was monitored until 2013. Survival analysis, the log-rank test, and Cox proportional hazard regression models were used to calculate the incidence, survival rate, and hazard ratio (HR) of chronic OME for each group.Among the 17,660 individuals included in the study population (53.2% male), the overall incidence of chronic OME during the 11-year follow-up was 1.84-fold higher in the GERD group than in the non-GERD group (1.8 vs 3.0 per 1000 person-year; adjusted HR 1.84; 95% confidence interval [CI], 1.46-2.31). Moreover, the adjusted HRs of developing chronic OME (allergic rhinitis, 1.69 [95% CI, 1.37-2.10]; asthma, 1.29 [95% CI, 1.02-1.64]; chronic rhinosinusitis, 1.61 [95% CI, 1.26-2.05]) were greater in study population with comorbidities.From long-term follow-up, the prevalence of chronic OME in adults was 1.84 times higher in the GERD group compared with the non-GERD group. Specifically, it found that allergic rhinitis, asthma, or chronic rhinosinusitis showed increase the risk of developing chronic OME than those without these conditions.

The incidence of prostate cancer is increased in patients with obstructive sleep apnea: Results from the national insurance claim data 2007-2014.

ABSTRACT: Some studies have demonstrated an increased risk of prostate cancer in patients with obstructive sleep apnea (OSA). However, the relationship is unclear and the results are conflicting. This study aims to investigate associations between OSA and prostate cancer using the Korea National Health Insurance Service database.A total of 152,801 men (≥ 20 years of age) newly diagnosed with OSA between 2007 and 2014 were included. A control group of 764,005 subjects was selected using propensity score matching by age and sex. The mean follow-up time was 4.6 years (range 2.3-6.9). The primary endpoint was newly diagnosed prostate cancer. The prostate cancer hazard ratio (95% confidence interval) was calculated for patients with OSA and compared to the control group.The incidence of prostate cancer among patients with OSA was significantly higher than that in controls (1.34 [1.23-1.49]). In particular, the incidence of prostate cancer was highest in patients aged 40-65 years (1.51 [1.32-1.72]).This study provides additional evidence for a link between OSA and prostate cancer.

Is septal deviation associated with headache?: A nationwide 10-year follow-up cohort study.

To investigate the potential relationship between septal deviation (SD) and headache using nationwide representative cohort sample data.This study used a nationwide cohort sample from the Korean National Health Insurance Service database. The cohort sample was composed of 1 million patients, which is obtained by propensity score matching from 2002 to 2013. There were 9171 individuals in the SD group and 28243 in the control or no SD group. The Kaplan-Meier survival analysis, the log-rank test, and Cox proportional hazard regression analysis were used to calculate the incidence, survival curve, and hazard ratio of headache for each group.There were no statistically significant differences in sex (P = .7708), age (P = .991), residential area (P = .9626), or socioeconomic status (P = .9982) between the 2 groups. The survival curve between SD and control or no SD showed a statistically significant difference. The adjusted hazard ratio for headache incidence during the 10-year follow-up period of the SD group was 1.37 (95% CI: 1.31-1.43).This cohort study suggests that SD is associated with headache. Therefore, these findings suggest that septoplasty can be considered as 1 of the treatment option in SD patients with headache.

Prospective assessment of gustatory function after radiotherapy for head and neck cancers.

BACKGROUND: Taste disorders are major causes of morbidity in patients undergoing head and neck irradiation. We quantitatively assessed the gustatory function of patients with head and neck cancers who underwent radiotherapy using recently developed standardised tools for measuring taste. METHODS: Twenty patients undergoing head and neck irradiation responded to a specific questionnaire and were assessed by olfactory and gustatory function tests. To assess changes over time, testing was performed before, immediately after, and at 2- and 4-week intervals following the start of radiotherapy. Concurrently, patients were evaluated for xerostomia from radiotherapy. RESULTS: A decrease in the taste recognition threshold was observed in the second week after the beginning of radiotherapy. The taste detection threshold improved within the 14th-18th week. Most affected patients demonstrated that their gustatory function primarily decreased independent of the olfactory function. Disturbances in taste were exponentially worsened beyond an accumulated dose of 30 Gy and involved all tastants. According to a multivariate analysis, radiation-induced taste impairment was not influenced by the degree of xerostomia. However, there was an association between the dose of irradiation and the severity of taste disturbance. CONCLUSIONS: In this preliminary study, we found that the taste function was worse 2 weeks after the start of radiotherapy and returned to pretreatment levels within 4.5 months. Taste disturbances were exponentially worse beyond an accumulated dose of 20 Gy. Taste dysfunction after radiotherapy was not influenced by the degree of xerostomia, whereas only the dose of irradiation was associated with the severity of taste dysfunction.

Publisher Correction: Feed gas effect on plasma inactivation mechanism of Salmonella Typhimurium in onion and quality assessment of the treated sample.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

Feed gas effect on plasma inactivation mechanism of Salmonella Typhimurium in onion and quality assessment of the treated sample.

A submerged dielectric barrier discharge (DBD) plasma reactor was used to inactivate artificially inoculated reference strains of Salmonella Typhimurium ATCC 14028 on sliced onion (3 cm × 3 cm). Salmonella Typhimurium reductions obtained after 10 min of treatment were 3.96 log CFU/slice and 1.64 log CFU/slice for clean dry air and N2 feed gas, respectively. Variations observed in Optical Emission Spectra (OES) for different feed gases are responsible for the inactivation level variations of Salmonella Typhimurium. The physiochemical properties of the onion slices, such as quercetin content, ascorbic acid content and color parameters, were monitored before and after treatment and the changes that occurred were measured to be in the acceptable range. Quercetin content was reduced only 3.74-5.07% for 10 min treatment, higher reduction was obtained for the use of clean dry air than that of N2 feed gas. Ascorbic acid loss was measured to be 11.82% and 7.98% for a 10 min treatment with clean dry air and N2 feed gas, respectively. The color parameters did not show significant changes upon treatment (p > 0.05) of the same duration for the uses of different feed gases.

Current practice and usual care of major cervical disorders in Korea: A cross-sectional study of Korean health insurance review and assessment service national patient sample data.

Neck pain is a highly common condition and is the 4th major cause of years lived with disability. Previous literature has focused on the effect of specific treatments, and observations of actual practice are lacking to date. This study examined Korean health insurance review and assessment service (HIRA) claims data to the aim of assessing prevalence and comparing current medical practice and costs of cervical disorders in Korea.Current practice trends were determined through assessment of prevalence, total expenses, per-patient expense, average days in care, average days of visits, sociodemographic characteristics, distribution of medical costs, and frequency of treatment types of high frequency cervical disorders (cervical sprain/strain, cervical intervertebral disc displacement [IDD], and cervicalgia).Although the number of cervical IDD patients was few, total expenses, per-patient expense, average days in care, and average days of visits were highest. The proportion of women was higher than men in all 3 groups with highest prevalence in the ≥50s middle-aged population for IDD compared to sprain/strain. Primary care settings were commonly used for ambulatory care, of which approximately 70% chose orthopedic specialist treatment. In analysis of medical expenditure distribution, costs of visit (consultation) (22%-34%) and physical therapy (14%-16%) were in the top 3 for all 3 disorders. Although heat and electrical therapies were the most frequently used physical therapies, traction use was high in the cervical IDD group. In nonnarcotics, aceclofenac and diclofenac were the most commonly used NSAIDs, and pethidine was their counterpart in narcotics.This study investigated practice trends and cost distribution of treatment regimens for major cervical disorders, providing current usage patterns to healthcare policy decision makers, and the detailed treatment reports are expected to be of use to clinicians and researchers in understanding current usual care.

Quality Assessment of Randomized Controlled Trials of Moxibustion Using STandards for Reporting Interventions in Clinical Trials of Moxibustion (STRICTOM) and Risk of Bias (ROB).

OBJECTIVES: To assess the quality and completeness of published reports of randomized controlled trials (RCTs) of moxibustion. METHOD: We searched six databases to retrieve eligible RCTs of moxibustion published from 2000 to December 2015. We used the STandards for Reporting Interventions in Clinical Trials of Moxibustion (STRICTOM) and Risk of Bias (ROB) tool to assess the completeness of reporting of RCTs of moxibustion and evaluate the reporting quality of included RCTs. RESULTS: Thirty-four studies of moxibustion were analyzed using STRICTOM and ROB. Of the 34 studies, the completeness percentage of STRICTOM varied from 33% to 100% (mean 68%, median 67%). The completeness of STRICTOM items showed a rising tendency along with the publication year. The STRICTOM items of setting and context (14.7%), rationale for the control (17.6%), and response (26.4%) showed incomplete reporting. The number of RCTs that rated a low risk of bias for allocation concealment (n=6), blinding of participants and personnel (n=1), and blinding of outcome assessment (n=4) appeared to be small. CONCLUSION: The quality of reporting of RCTs of moxibustion remains incomplete according to the STRICTOM and ROB tool at present. Researchers should consider the STRICTOM and ROB for improving not only the completeness of reporting but also the study design. General guidelines for RCTs of moxibustion are also required.

Effects of individual and neighborhood socioeconomic status on the risk of all-cause mortality in chronic obstructive pulmonary disease: A nationwide population-based cohort study, 2002-2013.

BACKGROUND: Numerous previous studies have shown that individual socioeconomic status (SES) is associated with mortality in patients with chronic obstructive pulmonary disease (COPD), but few empirical studies have evaluated the effects of individual SES and neighborhood deprivation on mortality in COPD patients. METHODS: We performed a prospective cohort study to examine the effect of socioeconomic disparity on all-cause mortality in newly diagnosed COPD patients in a setting with universal health care coverage. We used representative population-based nationwide cohort data from the Korean National Health Insurance claims database (2002-2013). We included patients who were at least 40 years old and newly diagnosed with COPD (N = 9275). To analyze the data, we utilized a frailty model and Cox's proportional hazard regression. RESULTS: A total of 1849 (19.9%) of the 9275 eligible participants died during the study period. Compared to high-income patients from advantaged neighborhoods, the adjusted hazard ratio (HR) for middle-income COPD patients who lived in advantaged and disadvantaged neighborhoods was 1.22 (95% CI, 1.03-1.43) and 1.36 (95% CI, 1.15-1.60), respectively. For low-income patients, the adjusted HR for patients who lived in disadvantaged neighborhoods was higher than for patients who lived in advantaged neighborhoods (HR, 1.43; 95% CI, 1.17-1.74 vs. HR, 1.36; 95% CI, 1.11-1.66). There was no difference in the adjusted HRs for high-income patients who lived in advantaged and disadvantaged neighborhoods (HR, 1.01; 95% CI, 0.84-1.22). CONCLUSIONS: Socioeconomic disparity contributes to all-cause mortality in COPD patients and neighborhood deprivation exacerbates the effect of individual SES on all-cause mortality in COPD patients.

Disparities in socioeconomic status and neighborhood characteristics affect all-cause mortality in patients with newly diagnosed hypertension in Korea: a nationwide cohort study, 2002-2013.

BACKGROUND: Previous studies have shown that contextual factors and individual socioeconomic status (SES) were associated with mortality in Western developed countries. In Korea, there are few empirical studies that have evaluated the association between SES and health outcomes. METHODS: We conducted cohort study to investigate the socioeconomic disparity in all-cause mortality for patients newly diagnosed with hypertension in the setting of universal health care coverage. We used stratified random sample of Korean National Health Insurance enrollees (2002-2013). We included patients newly diagnosed with hypertension (n = 28,306) from 2003-2006, who received oral medication to control their hypertension. We generated a frailty model using Cox's proportional hazard regression to assess risk factors for mortality. RESULTS: A total of 7,825 (27.6%) of the 28,306 eligible subjects died during the study period. Compared to high income patients from advantaged neighborhoods, the adjusted hazard ratio (HR) for high income patients from disadvantaged neighborhoods was 1.10 (95% CI, 1.00-1.20; p-value = 0.05). The adjusted HR for middle income patients who lived in advantaged versus disadvantaged neighborhoods was 1.17 (95% CI, 1.08-1.26) and 1.27 (95% CI, 1.17-1.38), respectively. For low income patients, the adjusted HR for patients who lived in disadvantaged neighborhoods was higher than those who lived in advantaged neighborhoods (HR, 1.35; 95% CI, 1.22-1.49 vs HR, 1.28; 95% CI, 1.16-1.41). CONCLUSIONS: Neighborhood deprivation can exacerbate the influence of individual SES on all-cause mortality among patients with newly diagnosed hypertension.

Clinical and economic consequences of failure of initial antibiotic therapy for patients with community-onset complicated intra-abdominal infections.

OBJECTIVES: Complicated intra-abdominal infection (cIAI) is infection that extends beyond the hollow viscus of origin into the peritoneal space, and is associated with either abscess formation or peritonitis. There are few studies that have assessed the actual costs and outcomes associated with failure of initial antibiotic therapy for cIAI. The aims of this study were to evaluate risk factors and impact on costs and outcomes of failure of initial antibiotic therapy for community-onset cIAI. METHODS: A retrospective study was performed at eleven tertiary-care hospitals. Hospitalized adults with community-onset cIAI who underwent an appropriate source control procedure between August 2008 and September 2011 were included. Failure of initial antibiotic therapy was defined as a change of antibiotics due to a lack of improvement of the clinical symptoms and signs associated with cIAI in the first week. RESULTS: A total of 514 patients hospitalized for community-onset cIAI were included in the analysis. The mean age of the patients was 53.3 ± 17.6 years, 72 patients (14%) had health care-associated infection, and 48 (9%) experienced failure of initial antibiotic therapy. Failure of initial antibiotic therapy was associated with increased costs and morbidity. After adjustment for covariates, patients with unsuccessful initial therapy received an additional 2.9 days of parenteral antibiotic therapy, were hospitalized for an additional 5.3 days, and incurred $3,287 in additional inpatient charges. Independent risk factors for failure of initial antibiotic therapy were health care-associated infection, solid cancer, and APACHE II ≥13. CONCLUSIONS: To improve outcomes and costs in patients with community-onset cIAI, rapid assessment of health care-associated risk factors and severity of disease, selection of an appropriate antibiotic regimen accordingly, and early infection source control should be performed.

Results of tuberculosis contact investigation in congregate settings in Korea, 2013.

OBJECTIVES: This study aimed to check the status of the contact investigation in congregate settings to eradicate tuberculosis (TB) in the Republic of Korea. METHODS: The "Integrated System for Disease and Public Health Management" is used for care and follow-up for patients and contacts of TB. We downloaded data for contact investigations conducted from January to December 2013. RESULTS: A total of 1,200 contact investigations in congregate settings were carried out by 25 field investigators in 2013. We performed the status of contact investigation, TB, and LTBI rate by age, accept rate of LTBI treatment, and complete rate of LTBI treatment during 2013. A total of 1,547 index TB patients, 149,166 contacts, and 259 additional TB patients were found through the investigation. Kindergartens showed the highest LTBI rate, 19.8%, among educational facilities. The second highest was in elementary schools and the subtotal LTBI rate of educational facilities was 7.8%. Social welfare/correctional facilities and workplaces showed relatively high LTBI rates of 23.8% and 23.6%, respectively. By age, individuals >35 years showed the highest LTBI rate, followed by those aged 0-4 years, 30-34 years, and 5-9 years, with rates of 18.1%, 16.4%, and 15.4% respectively. When comparing the tuberculin skin test (TST) positive conversion ratio by facility, middle school and high school were relatively high compared to the others. The accept rate of LTBI treatment in the workplace was lowest at 63% and the complete rate in elementary schools was lowest at 76.5%. CONCLUSION: TB contact investigation is considered as a meaningful strategy for preventing TB outbreaks in congregate settings and decreasing the prevalence of TB in young people. Results of this study could be used to establish the LTBI management policy.

High-quality, low-cost gastrectomy care at high-volume hospitals: results from a population-based study in South Korea.

OBJECTIVES: To evaluate associations among hospital volume, costs, and length of stay (LOS) and to assess whether reduced hospital cost of care adversely affected quality of care. DESIGN: Four-year, nationwide, population-based study. SETTING: Data were obtained from claims submitted to the South Korean National Health Insurance database. PATIENTS: We identified 48 938 patients at 274 hospitals who had undergone gastric resection from January 1, 2002, through December 31, 2005. Hospital volumes were divided into quartiles. MAIN OUTCOME MEASURES: Patient demographics and socioeconomic and clinical variables were investigated as factors that might affect costs and LOS. RESULTS: Independent predictors of higher costs and longer LOS included older age, increased Charlson score, and hospitals with fewer beds. After adjusting for relevant factors, an inverse relationship between volume and costs or LOS was found such that higher-volume hospitals had the lowest procedure costs and LOS. Results showed no association between hospital cost and quality of care. CONCLUSIONS: Higher hospital volume is predictive of lower costs and LOS for patients undergoing gastric resection. By referring these patients to high-volume centers, we may improve quality of care and reduce costs. Furthermore, high-quality care can be maintained when costs are lowered due to high volume.

Incidence of hip fractures in Korea.

Osteoporosis is a major public health problem in both Western and Asian populations. Because the aged population in Korea is increasing, the number of osteoporotic fractures is thought to be also increasing. However, there has been no nationwide analysis of osteoporotic fractures in Korea. We analyzed the incidence and cost of hip fracture from 2001 to 2004 by using data from the Health Insurance Review Agency, Korea. In the over 50 years age group, the number of hip fractures in women increased from 250.9/100,000 persons in 2001 to 262.8/100,000 in 2004, a 4.7% increase. However, that in men decreased from 162.8/100,000 in 2001 to 137.5/100,000 in 2004, a 15.5% decrease. Direct medical care costs of hip fracture increased from $62,707,697 in 2001 to $65,200,035 in 2004, and the proportional cost of hip fractures in the national medical costs increased by 4.5% over 4 years (from 0.200% in 2001 to 0.209% in 2004). On analysis of the population-based data obtained from the whole country from 2001 to 2004, the incidence rate of hip fractures in women, not in men, and its cost have increased in Korea. The gender distribution of hip fractures underlines the need for aggressive intervention in osteoporosis in elderly women.

Engineered cardiac tissues for in vitro assessment of contractile function and repair mechanisms.

For efficiently assessing the potential for grafted cells to repair infarcted myocardium, a simplified surrogate heart muscle system would offer numerous advantages. Using neonatal rat cardiac myocytes in a collagen matrix, we created thin cylindrical engineered cardiac tissues (ECTs) that exhibit essential aspects of physiologic cardiac muscle function. Furthermore, a novel cryo-injured ECT model of myocardial infarction offers the potential for the longitudinal study of mechanisms of cell-based cardiac repair in vitro.