Cost-effectiveness of high-dose quadrivalent influenza vaccine versus standard-dose quadrivalent influenza vaccine for older people in a country with high influenza vaccination rate.

The highdose quadrivalent influenza vaccine (QIVHD) has shown improved protection against influenza and its complications in older adults. We aimed to evaluate the costeffectiveness of QIVHD compared with QIVSD among Korean adults aged ≥ 65 years in reducing influenzarelated disease burden. We evaluated the 2016/2017 and 2017/2018 seasons and their average values using a static decision tree model. The difference in efficacy between standard-dose (SD) and high-dose (HD) was calculated based on the results of a clinical trial comparing Fluzone® High-Dose Vaccine and Fluzone® Vaccine in older adults. Incremental cost-effectiveness ratios (ICERs) were assessed from the healthcare system perspective. A discount rate of 4.5% was applied to life-year-gained (LYG) values and utilities. We performed deterministic and probabilistic sensitivity analyses to account for both epidemiological and economic sources of uncertainty. In the analysis of the 2017/2018 season, the QIV-HD strategy generated an excess of 0.00182 life-years (Lys)/person and 0.003953 quality-adjusted life-years (QALYs)/person compared with QIV-SD. The ICER was 6,467.56 United States Dollars (USD)/QALY. In the analysis from the 2016/2017 season, QIV-HD caused a surplus of 0.00117 Lys/person and 0.003272 QALYs/person compared with QIV-SD. ICER was 7,902.46 USD /QALY. From the average data of the 2016/2017 and 2017/2018 seasons, an excess of 0.00147 Lys/person and 0.003561 QALYs/person were generated using QIV-HD compared with QIV-SD, while the ICER was 7,190.44 USD /QALY. From the healthcare system perspective, QIV-HD was a more cost-effective vaccination option in reducing influenza-related disease burden and healthcare costs in Koreans aged ≥ 65 years compared with QIV-SD.

Effects of COVID-19 outbreak on Korean adolescents: Impact of altered economic perception on physical activity, sedentary behavior, and stress levels in an age-, gender-, and BMI-matched study.

The current study is to examine the disparities in physical activity (PA), sedentary behavior (SB), and stress levels in Korean adolescents concerning changes in their perception of family economic status (ES) during COVID-19. Among a total of 6144 Korean adolescents aged 12 to 18, the participants were categorized into two groups based on their responses regarding changes in their family ES due to COVID-19: Declined ES (n = 3072) and Non-changed ES (n = 3072), with matching in terms of age, gender, and BMI. All variables were assessed using the 16th year (2020) of the Korean Youth Risk Behavior Survey. Statistical analyses were conducted using the SPSS 26.0 version, employing independent t-tests to examine anthropometrics' differences and multinominal logistic regression to predict the impact of perception of family ES on PA, SB, and stress while comparing the two groups. The significance level was set at α = 0.05. Adolescents in the Declined ES group were 1.2 times more likely to engage in MVPA for less than 420 mins/wk (OR = 1.16, p = 0.039), 1.7 times more likely to meet recommended muscular strength activities (i.e., ≥ 3 days/wk) (OR = 1.70, p < 0.001), 37% less likely to not meet recommended recreational sitting time (i.e., ≥ 840 mins/wk) (OR = 0.63, p < 0.01), and were 2.1 times more likely to experience very severe stress level than the Non-changed ES group (p < 0.001). These results shed light on the importance of promoting mental health care in adolescents, regardless of PA levels, for their well-being during potential future pandemics. Understanding the impact of perceived ES changes on health behaviors can inform targeted interventions and support strategies to improve the mental health outcomes of adolescents during challenging times.

Effects of socioeconomic status on physical activity and cardiovascular diseases prior to and during the COVID-19 pandemic in the older adults.

Purpose: This research seeks to evaluate the repercussions of socioeconomic status (SES) on physical activity (PA) among the older population, both pre and intra-COVID-19 pandemic. The study aims to scrutinize whether alteration in PA behaviors based on SES impacts cardiovascular diseases (CVDs). It is well established that PA has a significant association with CVDs and the pandemic has restricted PA in the older population. We endeavor to discern whether SES modulates PA levels and whether these levels of PA behavior subsequently influence the incidence of CVDs among older adults. Methods: The analytical framework of this study relies on the data procured from the Fact-Finding on the Status of Senior Citizens (FSSSC) survey conducted in 2017 and 2020, involving 10,299 (75 ± 6 years) and 10,097 (74 ± 6 years) participants, respectively. We employ Structural Equation Modeling (SEM) to elucidate the ramification of the COVID-19 pandemic on CVDs while accommodating potential mediating and confounding variables, including socioeconomic status, PA levels, body mass index (BMI), and gender, in the context of the pandemic and CVDs. Results: Our empirical models indicated a tendency for older adults of lower socioeconomic status (SES) to exhibit diminished levels of physical activity (PA) compared to their counterparts of higher SES, particularly considering the influence of the COVID-19 pandemic. Furthermore, prolonged engagement in PA is associated with a reduced risk of hypertension (p = 0.010), and congestive heart failure & arrhythmia (p < 0.001), when accounting for confounding factors. Conclusion: The COVID-19 pandemic has generated an SES-based disparity in PA among older adults, despite PA time being greater in older individuals with higher SES. Interestingly, this did not result in a reduction in CVDs. Therefore, the study emphasizes the need for targeted exercise programs may be necessary to mitigate health inequality among the older population.

Estimating the Total Societal Cost of a Hexavalent Vaccine versus a Pentavalent Vaccine with Hepatitis B in South Korea.

In South Korea, the ready-to-use hexavalent vaccine (against diphtheria, tetanus, pertussis, poliovirus, Haemophilus influenzae type b, and hepatitis B) is not listed despite its facility of no need to reconstitute. It, therefore, has the potential to augment the efficiency of prevention against the six infectious diseases, and it may reduce vaccine-related errors of reconstitution when compared with the currently used vaccination scheme of the pentavalent vaccine with the additional shots against hepatitis B. Given the assumed clinical equivalence between the two vaccination schemes, a cost-minimization analysis has been performed from a societal perspective including all the medical and non-medical direct and indirect costs when vaccinating one birth cohort. The results indicate that the ready-to-use hexavalent vaccine induces a cost reduction of KRW 47,155 (USD36.22) per infant or 12,026 million Korean Won ($9,236,417) in total for the whole birth cohort with 260,500 children. Using the ready-to-use hexavalent vaccine causes a lower infection rate, has fewer vaccination sessions, and may save much time as compared with the current vaccination scheme in place. The ready-to-use hexavalent vaccine may, therefore, benefit the National Immunization Program by reducing the total societal costs of vaccination while improving convenience of infants, parents, and medical care professionals.

An integrative literature review on intimate partner violence against women in South Korea.

Purpose: The purpose of this study was to analyze and synthesize the literature on intimate partner violence (IPV) against women in South Korea. Methods: Whittemore and Knafl's integrative review method was used. Studies in English and Korean were searched in seven electronic databases using the following combination of terms: "Korea," "females or women or girls," "intimate partner violence or domestic violence or domestic abuse." Results: Twenty-five studies were ultimately selected, all of which met the quality appraisal criteria with a grade of medium or higher, using Gough's weight of evidence. IPV was divided into marital violence and dating violence. Factors related to IPV were classified into intrapersonal, interpersonal, and social factors, and these three factors were linked together. Intrapersonal factors included general characteristics, perceptions, attitudes, psychological factors, and violent experiences. Interpersonal factors involved relationships with parents and partners. Finally, social factors and attributes were integrated into social support and influences on life. Conclusion: In order to minimize and prevent harm to women from IPV when caring for women who experienced IPV, multiple factors should be considered. Specifically, general and psychological characteristics, perceptions and attitudes toward IPV, relationships with families and partners, and available social support systems and resources should be considered. Moreover, these findings will be helpful for assessing women or providing interventions for victims of violence. Finally, more diverse IPV studies should be conducted by nurses in the future.

Medical Treatment with Somatostatin Analogues in Acromegaly: Position Statement.

The Korean Endocrine Society (KES) published clinical practice guidelines for the treatment of acromegaly in 2011. Since then, the number of acromegaly cases, publications on studies addressing medical treatment of acromegaly, and demands for improvements in insurance coverage have been dramatically increasing. In 2017, the KES Committee of Health Insurance decided to publish a position statement regarding the use of somatostatin analogues in acromegaly. Accordingly, consensus opinions for the position statement were collected after intensive review of the relevant literature and discussions among experts affiliated with the KES, and the Korean Neuroendocrine Study Group. This position statement includes the characteristics, indications, dose, interval (including extended dose interval in case of lanreotide autogel), switching and preoperative use of somatostatin analogues in medical treatment of acromegaly. The recommended approach is based on the expert opinions in case of insufficient clinical evidence, and where discrepancies among the expert opinions were found, the experts voted to determine the recommended approach.

Energy Expenditure of Daily Living Activities in 3- to 6-Year-Old Children.

BACKGROUND: There has been a call for updating the Youth Compendium of Energy Expenditure (YCEE) by including energy expenditure (EE) data of young children (ie, < 6-year-old children). Therefore, this study examined the activity EE in 3 to 6 year old children using indirect calorimetry. METHODS: Using Oxycon Mobile portable indirect calorimetry, both the oxygen consumption (VO2) and the EE of 28 children (Girls: 46%, Age: 4.8 ± 1.0, BMI: 16.4 ± 1.6) were measured while they performed various daily living activities (eg, watching TV, playing with toys, shooting baskets, soccer). RESULTS: Across physical activities, averages of VO2 (ml·kg·min-1), VO2 (L·min-1), and EE ranged from 8.9 ± 1.5 to 33.3 ± 4.8 ml·kg·min-1, from 0.17 ± 0.04 to 0.64 ± 0.16 L·min-1, and from 0.8 ± 0.2 to 3.2 ± 0.7 kcal·min-1, respectively. CONCLUSIONS: These findings will contribute to the upcoming YCEE update.

Activity Energy Expenditure in Youth: Sex, Age, and Body Size Patterns.

BACKGROUND: The assessment of physical activity (PA) and energy expenditure (EE) in youth is complicated by inherent variability in growth and maturation during childhood and adolescence. This study provides descriptive summaries of the EE of a diverse range of activities in children ages 7 to 13. METHODS: A sample of 105 7- to 13-year-old children (boys: 57%, girls: 43%, and Age: 9.9 ± 1.9) performed a series of 12 activities from a pool of 24 activities while being monitored with an indirect calorimetry system. RESULTS: Across physical activities, averages of VO2 ml·kg·min-1, VO2 L·min-1, EE, and METs ranged from 3.3 to 53.7 ml·kg·min-1, from 0.15 to 3.2 L·min-1, from 0.7 to 15.9 kcal·min-1, 1.5 MET to 7.8 MET, respectively. CONCLUSIONS: The energy costs of the activities varied by age, sex, and BMI status reinforcing the need to consider adjustments when examining the relative intensity of PA in youth.

Validity of SenseWear® Armband v5.2 and v2.2 for estimating energy expenditure.

We compared SenseWear Armband versions (v) 2.2 and 5.2 for estimating energy expenditure in healthy adults. Thirty-four adults (26 women), 30.1 ± 8.7 years old, performed two trials that included light-, moderate- and vigorous-intensity activities: (1) structured routine: seven activities performed for 8-min each, with 4-min of rest between activities; (2) semi-structured routine: 12 activities performed for 5-min each, with no rest between activities. Energy expenditure was measured by indirect calorimetry and predicted using SenseWear v2.2 and v5.2. Compared to indirect calorimetry (297.8 ± 54.2 kcal), the total energy expenditure was overestimated (P < 0.05) by both SenseWear v2.2 (355.6 ± 64.3 kcal) and v5.2 (342.6 ± 63.8 kcal) during the structured routine. During the semi-structured routine, the total energy expenditure for SenseWear v5.2 (275.2 ± 63.0 kcal) was not different than indirect calorimetry (262.8 ± 52.9 kcal), and both were lower (P < 0.05) than v2.2 (312.2 ± 74.5 kcal). The average mean absolute per cent error was lower for the SenseWear v5.2 than for v2.2 (P < 0.001). SenseWear v5.2 improved energy expenditure estimation for some activities (sweeping, loading/unloading boxes, walking), but produced larger errors for others (cycling, rowing). Although both algorithms overestimated energy expenditure as well as time spent in moderate-intensity physical activity (P < 0.05), v5.2 offered better estimates than v2.2.

Comparisons of prediction equations for estimating energy expenditure in youth.

OBJECTIVES: The purpose of this study was to compare the validity of Actigraph 2-regression models (2RM) and 1-regression models (1RM) for estimation of EE in children. DESIGN: The study used a cross-sectional design with criterion estimates from a metabolic cart. METHODS: A total of 59 children (7-13yrs) performed 12 activities (randomly selected from a set of 24 activities) for 5min each, while being concurrently measured with an Actigraph GT3X and indirect calorimetry. METRMR (MET considering one's resting metabolic rate) for the GT3X was estimated applying 2RM with vector magnitude (VM2RM) and vertical axis (VA2RM), and four standard 1RMs. The validity of the 2RMs and 1RMs was evaluated using 95% equivalence testing and mean absolute percent error (MAPE). RESULTS: For the group-level comparison, equivalence testing revealed that the 90% confidence intervals for all 2RMs and 1RMs were outside of the equivalence zone (range: 3.63, 4.43) for indirect calorimetry. When comparing the individual activities, VM2RM produced smaller MAPEs (range: 14.5-45.3%) than VA2RM (range, 15.5-58.1%) and 1RMs (range, 14.5-75.1%) for most of the light and moderate activities. CONCLUSIONS: None of the 2RMs and 1RMs were equivalent to indirect calorimetry. The 2RMs showed smaller individual-level errors than the 1RMs.

Development of an instrument for assessment of Korean nurses' attitudes toward obese patients.

AIM: The purpose of this study was to verify the validity and reliability of an instrument and to identify nurses' attitudes toward obese patients. METHODS: Basic questions were developed after a preliminary published work review, and content validity was verified by a group of experts. Principle components analysis was applied to the verified questions as a factor analysis, and a confirmatory factor analysis was used to verify whether each question qualified for a specific factor and construct reliability. Average variances were extracted and checked to appraise the reliability of each factor. RESULTS: The first 74 questions composed with reference to the published work to identify nurses' attitudes toward obese patients were tested for construct validity and modified via factor analysis to 32 questions. Then, the questions were again modified to 29 questions with four factors after a confirmatory factor analysis. Construct reliability and the average variance extracted for the factors were verified to demonstrate that this tool was highly reliable to explain the 29 factors under the four categories. CONCLUSION: These results show nurses' attitudes toward obese patients. Further research using various subject groups and appropriate measures is needed.

Severe hypoglycemia is a serious complication and becoming an economic burden in diabetes.

BACKGROUND: The prevalence of hypoglycemia is increasing due to the growing incidence of diabetes and the latest strict guidelines for glycated hemoglobin (HbA1c) levels under 7%. This study examined the clinical characteristics, causal factors, and medical costs of severely hypoglycemic patients in an emergency room (ER) of Uijeongbu St. Mary's Hospital. METHODS: The study consisted of a retrospective analysis of the characteristics, risk factors, and medical costs of 320 severely hypoglycemic patients with diabetes who presented to an ER of Uijeongbu St. Mary's Hospital from January 1, 2006 to December 31, 2009. RESULTS: Most hypoglycemic patients (87.5%, 280/320) were over 60 years old with a mean age of 69.5±10.9 years and a mean HbA1c level of 6.95±1.46%. Mean serum glucose as noted in the ER was 37.9±34.5 mg/dL. Renal function was decreased, serum creatinine was 2.0±2.1 mg/dL and estimated glomerular filtration rate (eGFR) was 48.0±33.6 mL/min/1.73 m(2). In addition, hypoglycemic patients typically were taking sulfonylureas or insulin and a variety of other medications, and had a long history of diabetes. CONCLUSION: Severe hypoglycemia is frequent in older diabetic patients, subjects with low HbA1c levels, and nephropathic patients. Therefore, personalized attention is warranted, especially in long-term diabetics with multiple comorbidities who may not have been properly educated or may need re-education for hypoglycemia.

Non-invasive assessment of changes in liver fibrosis via liver stiffness measurement in patients with chronic hepatitis B: impact of antiviral treatment on fibrosis regression.

BACKGROUND: Liver stiffness measurement (LSM) can assess liver fibrosis in patients with chronic hepatitis B (CHB). We evaluated whether LSM can be used to assess changes in liver fibrosis during antiviral treatment using nucleos(t)ide analogs in patients with CHB. METHODS: We recruited 41 patients with CHB who had significant liver fibrosis, normal or slightly elevated serum alanine aminotransferase (ALT) levels (≤2 × upper limit of normal), and detectable serum hepatitis B virus DNA before antiviral treatment. Patients in Group 1 (n = 23) and Group 2 (n = 18) underwent follow-up LSM after antiviral treatment for 1 and 2 years, respectively. RESULTS: The mean age, ALT and LSM value of all patients (34 men and 7 women) before antiviral treatment were 46.6 ± 9.5 years, 40.6 ± 17.2 IU/L and 12.9 ± 8.6 kPa, respectively. Hepatitis B e antigen (HBeAg) was detected in 31 patients (75.6%). Fibrosis stage was F2 in 12 (29.3%), F3 in 6 (14.6%) and F4 in 23 (56.1%) patients. After antiviral treatment, LSM values and DNA positivity decreased significantly as compared to baseline (P = 0.018 and P < 0.001 in Group 1; P = 0.017 and P < 0.001 in Group 2, respectively), whereas ALT levels were unchanged (P = 0.063 in Group 1; P = 0.082 in Group 2). CONCLUSIONS: Our preliminary data suggest that LSM can be used to assess liver fibrosis regression after antiviral treatment using nucleos(t)ide analogs in patients with CHB.