Unmet healthcare Needs Status and Trend of Korea in 2019 / 보건행정학회지

Unmet healthcare is an important indicator to measure accessibility of healthcare services. To examine the latest status of unmet healthcare needs in South Korea, the four different data which is composed of nationally representative sample of South Korean population were used; the Korea Health and Nutrition Examination Survey (KNAHANES, 2007–2019), the Community Health Survey (CHS, 2008–2019), the Korea Health Panel Survey (KHP, 2011–2017), and the Korean Welfare Panel Study (KOWEPS, 2006–2019). The proportion of individuals reporting unmet healthcare needs were 5.8% (KNHANES), 5.3% (CHS), and 11.6% (KHP). Annual percentage change (APC) which identifies trend for the follow-up period was -9.5%, -8.0%, and -6.5%, respectively. The proportion of individuals reporting unmet healthcare needs due to cost were 1.1% (KNAHANES), 0.7% (CHS), 2.4% (KHP), and 0.4% (KOWEPS). The APC was -10.5%, -14.2%, -12.2%, and -19.6%, respectively. Compared to last year, the rate of unmet healthcare needs has declined in general.However, the low-income and the elderly population were reporting the highest rate of unmet health care needs, and the disparity between lowest and highest groups were remained. These results suggest that adequate benefit coverage is needed for low-income and elderly population.

Unmet Healthcare Needs Status and Trend of Korea in 2018 / 보건행정학회지

Unmet healthcare needs lead to increased disease severity, increased likelihood of complications, and worse disease prognosis. To examine the latest status of unmet healthcare needs in South Korea, the four different data configured with nationally representative sample of South Korean population were used: the Korea Health and Nutrition Examination Survey (KNAHANES, 2007–2018), the Community Health Survey (CHS, 2008–2018), the Korea Health Panel Survey (KHP, 2011–2016), and the Korean Welfare Panel Study (KOWEPS, 2006–2018). The proportion of individuals reporting unmet healthcare needs were 7.8% (KNHANES, 2018), 8.8% (CHS), and 10.8% (KHP, 2016). Annual percentage change which characterizes trend for the follow-up period was -9.1%, -3.2%, and -6.8%, respectively. The proportion of individuals reporting unmet healthcare needs due to cost were 1.2% (KNAHANES, 2018), 1.2% (CHS, 2018), 2.5% (KHP, 2016), and 0.5% (KOWEPS, 2018). Annual percentage change which characterizes trend for the follow-up period was -10.3%, -12.0%, -11.3%, and -18.8, respectively. The low-income population and the elderly population were vulnerable groups reporting the highest rate of unmet health care needs. The rate of unmet healthcare needs has been declining since the past decade, still, the disparity between different income groups and age groups suggests that there are many challenges to address.

Unmet Healthcare Needs Status and Trend of Korea in 2017 / 보건행정학회지

Unmet healthcare needs are being used as an important indicator of the accessibility of healthcare services worldwide. To examine current status and trends of unmet needs in Korea, we used data from four sources: the Korea National Health and Nutrition Examination Survey (KNHANES, 2007–2017); the Community Health Survey (CHS 2008–2017); the Korea Health Panel Survey (KHP 2011–2015); and the Korean Welfare Panel Study (KOWEPS 2006–2017). The proportion of individual reporting unmet healthcare needs as of 2017 was 8.8% (KNHANES), 10.6% (CHS), and 12.4% (KHP as of 2015). The proportion of households reporting unmet healthcare needs due to cost was 0.5% (KOWEPS). Annual percentage change was −19.2%, −13.3%, −5.8%, and −13.3% respectively. Low income populations had more unmet healthcare needs than high income populations. However, unlike the last two studies, the main reason for unmet medical reasons was that there was no time regardless of income level.

MYH9 nephropathy

MYH9-related disorder is an autosomal dominant disease caused by a mutation in the MYH9 gene, which encodes nonmuscle myosin heavy chain IIA (NMMHC-IIA). This disease is characterized by giant platelets, thrombocytopenia, granulocyte inclusion bodies, proteinuria, and high-pitch sensorineural deafness. Nephropathy has been observed in 30% of patients with MYH9-related disorder. The characteristic features are early onset proteinuria and rapidly progressing renal disorder. However, the prognosis of MYH9 nephropathy remains unclear. Herein, we describe a 36-year-old woman who presented with proteinuria and was diagnosed with MYH9 nephropathy via renal biopsy and gene analysis. Her proteinuria improved after administration of an angiotensin II receptor blocker, but was aggravated after changing to a calcium channel blocker.

Evaluation of Peptide Nucleic Acid Probe-based Real-time PCR for Detection of Mycobacterium tuberculosis Complex and Nontuberculous Mycobacteria in Respiratory Specimens

BACKGROUND: A peptide nucleic acid (PNA) probe-based real-time PCR (PNAqPCR(TM) TB/NTM detection kit; PANAGENE, Korea) assay has been recently developed for the simultaneous detection of Mycobacterium tuberculosis complex (MTBC) and nontuberculous mycobacteria (NTM) in clinical specimens. The study was aimed at evaluation of the performance of PNA probe-based real-time PCR in respiratory specimens. METHODS: To evaluate potential cross-reactivity, the extracted DNA specimens from Mycobacterium species and non-mycobacterial species were tested using PNA probe-based real-time PCR assay. A total of 531 respiratory specimens (482 sputum specimens and 49 bronchoalveolar washing fluid specimens) were collected from 230 patients in July and August, 2011. All specimens were analyzed for the detection of mycobacteria by direct smear examination, mycobacterial culture, and PNA probe-based real-time PCR assay. RESULTS: In cross-reactivity tests, no false-positive or false-negative results were evident. When the culture method was used as the gold standard test for comparison, PNA probe-based real-time PCR assay for detection of MTBC had a sensitivity and specificity of 96.7% (58/60) and 99.6% (469/471), respectively. Assuming the combination of culture and clinical diagnosis as the standard, the sensitivity and specificity of the new real-time PCR assay for detection of MTBC were 90.6% (58/64) and 99.6% (465/467), respectively. The new real-time PCR for the detection of NTM had a sensitivity and specificity of 69.0% (29/42) and 100% (489/489), respectively. CONCLUSIONS: The new real-time PCR assay may be useful for the detection of MTBC in respiratory specimens and for discrimination of NTM from MTBC.

Association between IL17A/IL17RA Gene Polymorphisms and Susceptibility to Alopecia Areata in the Korean Population

BACKGROUND: Alopecia areata is marked by autoimmune assault on the hair follicle resulting in hair loss. T helper 17 cell subset has important roles in protecting the host against extracellular pathogens, however, also promotes inflammatory pathology in autoimmune disease, and it expresses both interleukin (IL)-17A and IL-17F, which can signal via the IL-17 receptor A. OBJECTIVE: To investigate the significance of IL17A and IL17RA gene polymorphisms in the susceptibility to alopecia areata. METHODS: We conducted case-control association study of 238 alopecia areata patients and 270 matched healthy controls. Allele frequency of total 2 single nucleotide polymorphims in the IL17A gene and 4 single nucleotide polymorphims in the IL17RA gene were studied. The statistical analyses were performed according to onset age, the presence of familyhistory, clinical subtypes, and presence of nail involvement or body hair involvement. RESULTS: One single nucleotide polymorphim (rs879577) of IL17RA gene showed significant difference between alopecia areata patients group and controls group (p= 0.0288). One single nucleotide polymorphim (rs4819554) of IL17RA gene showed significant difference between the early onset and late onset alopecia areata (p=0.0421). CONCLUSION: IL17RA gene polymorphism might contribute to the increased susceptibility to alopecia areata in Korean population, and IL17RA gene polymorphism may be associated with onset age.

Prognostic Value of Serum S100 Protein by Elecsys S100 Immunoassay in Patients with Spontaneous Subarachnoid and Intracerebral Hemorrhages

OBJECTIVE: The serum S100 protein has been known to reflect the severity of neuronal damage. The purpose of this study was to assess the prognostic value of the serum S100 protein by Elecsys S100 immunoassay in patients with subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) and to establish reference value for this new method. METHODS: Serum S100 protein value was measured at admission, day 3 and 7 after bleeding in 42 consecutive patients (SAH : 20, ICH : 22) and 74 healthy controls, prospectively. Admission Glasgow coma scale (GCS) score, Hunt & Hess grade and Fisher grade for SAH, presence of intraventricular hemorrhage, ICH volume, and outcome at discharge were evaluated. Degrees of serum S100 elevation and their effect on outcomes were compared between two groups. RESULTS: Median S100 levels in SAH and ICH groups were elevated at admission (0.092 versus 0.283 microgram/L) and at day 3 (0.110 versus 0.099 microgram/L) compared to healthy controls (0.05 microgram/L; p<0001). At day 7, however, these levels were normalized in both groups. Time course of S100 level in SAH patient was relatively steady at least during the first 3 days, whereas in ICH patient it showed abrupt S100 surge on admission and then decreased rapidly during the next 7 days, suggesting severe brain damage at the time of bleeding. In ICH patient, S100 level on admission correlated well with GCS score (r=-0.859; p=0.0001) and ICH volume (r=0.663; p=0.001). A baseline S100 level more than 0.199 microgram/L predicted poor outcome with 92% sensitivity and 90% specificity. Logistic regression analyses showed Ln (S100) on admission as the only independent predictor of poor outcome (odd ratio 36.1; 95% CI, 1.98 to 656.3). CONCLUSION: Brain damage in ICH patient seems to develop immediately after bleeding, whereas in SAH patients it seems to be sustained for few days. Degree of brain damage is more severe in ICH compared to SAH group based on the S100 level. S100 level is considered an independent predictor of poor outcome in patient with spontaneous ICH, but not in SAH. Further study with large population is required to confirm this result.

High Prevalence of Ceftazidime-Resistant Klebsiella pneumoniae and Increase of Imipenem-Resistant Pseudomonas aeruginosa and Acinetobacter spp. in Korea: a KONSAR Program in 2004

A nationwide antimicrobial resistance surveillance has been conducted since 1997 in Korea. In this study, susceptibility test data generated in 2004 by KONSAR group hospitals were analyzed and compared to those at a commercial laboratory. In hospitals, the rank orders of organisms in 2004 were identical to those in 2003. The most prevalent species was Staphylococcus aureus (20.2%) in hospitals, but Escherichia coli (29.7%) in the commercial laboratory. The proportions of Enterococcus faecium to all isolates of Enterococcus faecalis plus E. faecium were 47.2% in hospitals and 24.9% in the commercial laboratory. The mean resistance rates of significant antimicrobial-organism combinations in hospitals were: oxacillin-resistant S. aureus (68%), oxacillin-resistant (penicillin- nonsusceptible) Streptococcus pneumoniae (68%), vancomycin-resistant E. faecium (25%), cefotaxime-resistant E. coli (14%), ceftazidime- and cefoxitin-resistant Klebsiella pneumoniae (34% and 32%, respectively), and imipenem-resistant Acinetobacter spp. and Pseudomonas aeruginosa (17% and 24%, respectively). In conclusion, oxacillin-resistant staphylococci, expanded-spectrum cephalosporin-resistant K. pneumoniae, and imipenem-resistant Acinetobacter spp. and P. aeruginosa were prevalent in 2004. Increasing trends were observed for vancomycin-resistant E. faecium, cefoxitin- resistant E. coli and K. pneumoniae, and imipenem-resistant Acinetobacter spp. and P. aeruginosa. Certain antimicrobial- organism combinations were also prevalent among the commercial laboratory-tested strains.

Analysis of Clinical Features and Hepatitis B Virus DNA Level in the Concomitant Cases of Hepatitis B Surface Antigen and Antibody / 대한임상미생물학회지

BACKGROUND: After an infection with HBV, HBsAg is the first virologic marker detectable in the serum. If anti-HBs against 'a'determinant of HBsAg appears, HBsAg will disappear and the patients will recover from the HBV infection in most cases. However, we encounter not infrequently concomitant cases of HBsAg and anti-HBs. In this study we evaluated HBV DNA levels in concomitant cases to aid in the interpretation of these serologic results. METHODS: This study included 36 cases with positivity for both HBsAg and anti-HBs in an electrochemiluminescent immunoassay as well as a radioimmunoassay. They were tested for HBeAg, anti-HBe, and HBV DNA levels. RESULTS: Chronic viral hepatitis was the most frequent diagnosis (15/36 : 41.7%) and AST and ALT levels were normal in 17 (47.2%) and 20 (55.6%) cases, respectively, among total 36 concomitant cases. HBeAg was positive in 24 and anti-HBe in 17 cases. HBV DNA was positive in 33 cases (91.7%). including all 24 HBeAg positive cases and 9 (75%) of 12 HBeAg negative cases; 6 (50%) of 12 HBeAg negative cases had HBV DNA levels higher than 105 copy/mL. CONCLUSIONS: This study showed that viral replication still exists in most cases of concomitant HBsAg and anti-HBs, and even in some HBeAg negative cases. So in the concomitant cases, HBV DNA quantitation may aid in the interpretation of clinical significance of these cases.

Quality of Life in Psoriasis Patients / 대한피부과학회지

BACKGROUND: Psoriasis is a chronic inflammatory skin disease and it has been shown to impact the quality of life (QOL) of the patients to which was known to be almost the same degree as other more life threatening disorders. Until now little is known about the impact of psoriasis on QOL in Korean psoriasis patients. OBJECTIVE: To investigate psoriasis related to the quality of life on the physical, social, psychologic aspects. METHOD: We applied forty one questionnaires to 100 psoriasis patients. And all the patient's condition was evaluated by the Psoriasis Area and Severity Index (PASI). RESULTS: 1. Disability score of PDI on the physical, social, and psychological aspects were 2.20, 1.65, and 1.78, respectively. 2. Physical disability showed no differences according to age(between below 39 years old group and above 40 years old group), marriage, and sex. However, the group with higher PASI score (>15) showed more disability than the group with lower PASI score in the physical aspect (p15) group showed more disability than the lower PASI score group in the social aspect (p15) group showed more disability than the lower PASI score group in the psychologic aspect (p<0.01). CONCLUSION: Most of psoriasis patients had moderate to severe disadvantage in their QOL. Therefore, it is important for the dermatologist to recognize patient's physical, social, and psychologic distress on counseling and management. And further research is needed to determine appropriate parameter to measure the degree of disability of psoriasis patients on quality of life aspect.

A Case of Cutaneous Metastasis from Carcinoma of the Urinary Bladder / 대한피부과학회지

Metastasis to the skin from the urinary bladder carcinoma are very rare and their incidence is 1% to 2% of the cutaneous metastasis. A 78-year-old man developed cutaneous metastasis 2 years later after the diagnosis of carcinoma of the bladder had been made. He visited our department with skin colored, soft, tender, subcutaneous nodule on the lower abdomen which had been detected 5 days ago. Histologic examination of the skin lesion showed atypical cells having hyperchromatic and pleomorphic nuclei. Herein we report a case of cutaneous metastasis from carcinoma of the urinary bladder in a 78-year-old man.

Four Cases of Spitz Nevus / 대한피부과학회지

Spitz nevus is a benign tumor of melanocytic origin. The lesion is a usually asymptomatic, solitary, reddish or pinkish, hairless, dome-shaped, smooth-surfaced, and firm papule or nodule, measuring less than 1.0cm in the greatest diameter. In most instances, it is encountered most commonly on the face and extremities in the first two decades of life. The histologic picture of the lesion reveals numerous uniform nests of spindle cells and epithelioid cells with sparse pigmentation in the dermis. We report herein four cases of Spitz nevus with a review of literatures.

A Case of Dermatofibrosarcoma Protuberans in Childhood / 대한피부과학회지

Dermatofibrosarcoma protuberans(DFSP) is an uncommon fibrohistiocytic tumor of intermediate malignancy that usually occurs in early or mid-adult life as a nodular cutaneous mass. The tumor occurs most frequently on the trunk or the proximal extremities. A 14-year -old boy was seen for red-brown, hard plaques and nodules on the anterior neck. This asymptomatic lesion had appeared at the age of one year as an erythematous patch and had thereafter slowly enlarged. Recently the lesion grew more rapidly. Biopsy specimens of both the nodule and plaque showed a tumoral proliferation of spindle-shaped cells with a storiform arrangement, being suggestive of DFSP. Immunohistochemical staining for CD34 was positive. The patient was treated with a wide and deep excision. We report herein a case of DFSP in a 14-year -old boy.

A Case of Malassezia Folliculitis in an Infant with Liver Cirrhosis / 대한피부과학회지

Malassezia folliculitis is characterized by pruritic follicular papules and pustules by Malassezia which are inhabitants of normal skin. We report a case of Malassezia folliculitis in a 12-month-old female, with a history of liver cirrhosis due to congenital biliary atresia. She presented with erythematous papules and pustules on the face 4 months ago. The diagnosis of Malassezia folliculitis was established by Parker ink-KOH direct microscopy. The lesions were successfully treated with topical ketoconazole cream for 2 weeks.

A Case of Allergic Contact Dermatitis Due to Sodium Sulfite Contained in Nizoral(R) Cream / 대한피부과학회지

Sodium sulfite is an antioxidant, a preservative and a reducing agent, widely used in the foods, beverages, drugs, cosmetics, and pharmaceutical industries. Oral ingestion or inhalation of it in asthmatic patients may provoke asthmatic attack, urticaria, angioedema, and anaphylaxis. A 28-year-old male presented with well-demarcated erythematous scaly patch with itching sensation on the left lower leg. He had applied Nizoral(R) cream on the erythematous patch of the left lower leg for 7 days and the skin lesion was aggravated. Patch tests with Nizoral(R) cream 'as is' showed positive reaction and sodium sulfite, the ingredient of Nizoral cream, revealed positive reaction.

Effect of PUVA on Nerve Growth Factor Expression in Cultured Keratinocytes

Nerve growth factor (NGF) is an important autocrine growth factor and also a survival factor for keratinocytes. NGF may act in the hyperproliferative condition, psoriasis. Clinically, the combination of psoralen and UVA (PUVA) has been used in the treatment of a wide variety of cutaneous disorders, such as psoriasis and vitiligo. However, the precise therapeutic mechanism of PUVA on the dermatologic diseases remains unclear. The purpose of this study was to examine whether the expression of NGF in cultured keratinocytes is influenced by PUVA. Thus, normal human keratinocytes were isolated from neonatal foreskin, and the third to fifth-passaged cells were used in this study. The cells were exposed to various doses of UVAss (30, 60, 120 mJ/cm2) after adding 8-methoxypsoralen (8-MOP) to examine the expression of NGF mRNA. The RNA and protein of the cells were extracted at various time points (1, 8, 24 hours) after UVA irradiation to examine the expression of NGF mRNA and production of NGF protein. In keratinocytes, there were no differences in the expression of NGF mRNA between the different doses of UVA irradiation, however, the expression of NGF mRNA in UVA and PUVA groups tended to increase as the time increased. The expression of NGF mRNA was the highest in PUVA group, followed by UVA group and the lowest in 8-MOP group. The expressions of NGF protein at 1 and 8 hours after UVA irradiation were lower in the PUVA group than in the other groups. This study showed that the expression level of NGF protein in keratinocytes was relatively lower in the PUVA groups than in the other groups, suggesting that the therapeutic mechanism of PUVA in psoriasis is related to the decrease of NGF protein.

A Case of Vaselinoma-Associated Wound Infection Caused by a Catalase-Negative Staphylococcus aureus / 대한임상병리학회지

Staphylococci are known to produce catalase, but there have been a few case reports of catalase-negative Staphylococcus aureus. The present report describes the first case of catalase-negative S. aureus associated with vaselinoma to our knowledge. We isolated a catalase-negative strain of S. aureus from a penile wound of a 35-year-old man who injected with vaseline into his penis 9 months ago. Colony morphology and biochemical reactions of the strain were typical of S. aureus except for catalase. The patient was diagnosed as having vaselinoma with wound infection and was successfully treated by the surgical removal of the vaseline granuloma and the administration of appropriate antibiotics. Catalase-negative S. aureus is considered to be a very rare variant of S. aureus. To date the number of reported cases of catalase-negative S. aureus is very few, so further studies need to be conducted to evaluate its clinical relation.

A Case of Neonatal Malassezia Pustulosis Identified as Malassezia Sympodialis / 대한의진균학회지

Neonatal Malassezia pustulosis can be defined as pustules on face and neck, age at onset, younger than 1 month, isolation of Malassezia by direct microscopy in pustular material, elimination of other causes of neonatal pustuloses, and response to topical ketoconazole therapy. We report a case of neonatal Malassezia pustulosis in a 20-day-old male. Direct microscopic examination on smears for pustules showed forms of Malassezia yeasts and culture yielded Malassezia sympodialis. The lesions were remarkably improved by topical ketoconazole cream for 14 days.

A Case of Photoallergic Contact Dermatitis Due to Ketoprofen Plaster / 대한피부과학회지

Ketoprofen, a propionic acid derivative is a non-steroidal anti-inflammatory drug with analgesic activity and it is used in the symptomatic treatment of rheumatoid arthritis and osteoarthritis. When exposed to sunlight, ketoprofen is broken down into various benzophenones. 3-ethyl-benzophenone as the major photoproduct is responsible for the photoallergic reaction to ketoprofen. A 30-year-old male presented with well-demarcated erythematous patches with itching sensation on both his ankle areas. He had applied Ketotop(R) plasters on both his ankle areas for arthralgia, and then the Ketotop(R) plaster-detached areas were exposed to sunlight. Patch test and photopatch test with?as is?showed positive reaction in photopatch test and the ingredients of Ketotop(R) plaster revealed positive reaction to the ketoprofen contained in Ketotop(R) plaster in photopatch test.

Assessment of the Characteristics of Illness Behavior and Quality of Life in Patients with Androgenetic Alopecia / 대한피부과학회지

BACKGROUND: Androgenetic alopecia is a common, genetically predisposed condition among men and women, which commences at any age after puberty. It may significantly affect a variety of psychological and social experiences and the individual's quality of life(QOL). OBJECTIVE: The purpose of this study was to investigate the impact of androgenetic alopecia on patient's illness behavior and quality of life. METHODS: A total of 192 male patients with androgenetic alopecia were enrolled and interviewed with structured questionnaire which contained 26 items including personal information, social, psychological questions and the patients' knowledge of androgenetic alopecia. RESULTS: 1. The mean age of the patients was 27 years old. The proportion of patients under 30 years old was 79.7%. 2. The mean age of onset in the patients was 24 years old. 3. Using the Norwood's classification, the proportion of type IIIa, type III, type IIIvertex and female pattern was 76.1%. And that of type I and II was 16.1%. 4. The 177 patients (92.2%) showed dissatisfaction about their hair states and 116 patients (60.5%) made efforts to conceal and compensate for their alopecia. The peer teasing about their condition was reported by 134 patients (69.8%). 5. Most unmarried patients (89.3%) thought that hair loss would erode their chances for romance. 6. Only 33 patients (17.2%) had experiences of professional treatments. CONCLUSION: This study confirms that androgenetic alopecia has significant impact on the overall QOL of patients.