BMI and perceived weight on suicide attempts in Korean adolescents: findings from the Korea Youth Risk Behavior Survey (KYRBS) 2020 to 2021.

BACKGROUND: Suicide is a leading cause of death in South Korea (hereafter 'Korea'), and there is evidence that body weight and perceived weight affecting suicide have a significant effect on suicidal behavior in adolescence. This study investigated the association between body mass index (BMI), perceived weight, and suicide attempts in adolescents. METHODS: We included nationally representative data for a total of 106,320 students in our final analysis. We calculated and stratified BMI (underweight, normal weight, overweight) to determine the correlation between BMI and suicide attempts. We stratified the participants into three groups (perceived as underweight, normal weight, and overweight) for subjective body weight perception to analyze the relationship between subjective body weight perception and suicide attempts. We further analyzed the combination of BMI and subjective body weight perception to determine the relationship between suicide attempts and distorted subjective weight perception. RESULTS: Compared with perceiving oneself as having a normal weight, the odds ratios (ORs) for suicide attempts were significantly increased in the group perceiving themselves as overweight. In addition, those who perceived themselves as overweight but were underweight according to their BMI were at significantly increased risk of suicide attempts relative to those who perceived themselves as about the right weight. CONCLUSIONS: There was a significant association with suicide attempts in the underweight and perceived overweight group. This shows the importance of combining BMI and perceived weight when examining the relationship between weight and suicide attempts in adolescents.

Interaction between blood cadmium and lead concentration and physical activity on hypertension from the Korean national health and nutrition examination survey in 2008-2013.

BACKGROUND: Previous studies have suggested that blood Cd, Pb exposure, and physical activity levels may influence the development of hypertension. This study aimed to investigate the relationship between blood Cd, Pb levels, and hypertension by the level of physical activity in Korean adults using The Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: We used data from the KNHANES (2008-2013), a nationally representative, cross-sectional, population-based study. We included 8,510 participants who had records of blood Cd, Pb and, blood pressure measurements. Multiple logistic regression was used to examine the association between blood Cd and Pb exposure and the development of hypertension, as well as the modifying effects of physical activity levels. Additive interaction was estimated using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S). RESULTS: Following covariates adjustments, we found significant associations of blood Cd and Pb with higher hypertension prevalence. This association was more apparent in low physical activity while blood Cd and Pb concentrations were not significantly associated with hypertension in participants with more activity. Additionally, there was a significant interaction between blood Cd and physical activity on hypertension risk (RERI = 0.17, 95% CI: -0.36-0.7; AP = 0.12, 95% CI: -0.28-0.52; S = 1.75, 95% CI:1.36-2.14). CONCLUSIONS: Our results suggest that low physical activity may substantially amplify the adverse effects of blood Pb and Cd exposure on hypertension risk. However, interactions were only found for Cd. Further studies are needed to confirm these findings.

Urinary bisphenol A and its analogues and haemato-biochemical alterations of pregnant women in Korea.

INTRODUCTION: Bisphenol F (BPF) and bisphenol S (BPS) are chemical substitutes for, and may have similar physiological effects to, bisphenol A (BPA). Bisphenols provoke endocrine disorders and are cytotoxic, oxidize hemoglobin, and induce morphological changes in human red blood cells (RBC). It is more sensitive to changes in the RBC number and hemoglobin (Hb) level during pregnancy. Therefore, we investigated the effects of bisphenols (BPs) and their substitute compounds on hemopoiesis and the serum biochemical parameters of pregnant women. METHODS: The study population comprised 196 pregnant women from the MAKE cohort study, recruitment for which occurred from 2017 to 2019. We measured the levels of BPA, BPF and BPS in urine samples and collected data on socioeconomic, lifestyle, and environmental factors at visits to the hospital. The associations between the levels of the three BPs and biochemical parameters were analyzed by multiple linear regression. RESULTS: The geometric mean urinary concentrations of specific gravity adjusted BPA, BPF, and BPS were 2.1, 0.2, and 0.1 µg/L, respectively. There was a significant negative association between the urinary concentration of BPA and the Hb level (ß = -0.5, p = 0.02). After stratifying by the median concentrations of the three BPs, the maternal urinary BPA level had a significantly negative effect on the RBC count, HB level, and hematocrit in the high BPA concentration group (RBC, ß = - 0.5, p = 0.001; Hb, ß = -1.4, p = 0.002; Hct, ß = -5.0, p = 0.001). CONCLUSIONS: BPA has a harmful effect on hemato-biochemical changes that occur during pregnancy. Further studies should investigate the relation between widespread exposure to bisphenols and effects on human health.

Positive effects of medical staffing on readmission within 30 days after discharge: a retrospective analysis of obstetrics and gynecology data.

BACKGROUND: Improving quality of care is a major healthcare goal; however, the relationship between limited resources and appropriate healthcare distribution has always been problematic. Planning for resource shortages is important for improving healthcare quality. The aim of our study was to evaluate the effects of manpower planning on improvements in quality of care by estimating the effects of medical staffing on readmission within 30 days after discharge. METHODS: We conducted an observational study using 2011-14 National Health Claim data from 692 hospitals and 633 461 admissions. The database included information on uterine (including adnexa) procedures (195 270 cases) and cesarean deliveries (438 191 cases). The outcome variable was readmission within 30 days after discharge. A generalized estimating equation model was used to evaluate associations between readmission and medical staffing. RESULTS: The number of doctors and the proportion of registered nurses (RNs) were significantly associated with a lower risk of readmission within 30 days (proportion of RNs, Relative Risk (RR): 0.97, P values: 0.0025; number of doctors, RR: 0.96, P values: <0.0001). The number of nurses (RNs + licensed practical nurses) was not associated with readmission within 30 days (RR: 1.01, P values: <0.0001). CONCLUSION: Our results suggested that higher numbers of doctors and higher proportions of RNs were positively correlated with a lower risk of readmission within 30 days. Human resource planning to solve manpower shortages should carefully consider the qualitative aspects of clinical care and include long-term planning.

A retrospective study on cholera understanding and WASH (water, sanitation, and hygiene) behavior among adolescents in three regions of La Gonâve, Haiti.

BACKGROUNDS: This study assesses the impact of Water, Sanitation, and Hygiene (WASH) interventions on cholera understanding and hygiene practices in La Gonâve Island, Haiti. It examines the changes after implementing interventions in seven villages across the Downtown, Mountain, and Seaside regions. METHODS: A retrospective investigation surveyed 210 school students from each region using a validated questionnaire. It assessed knowledge, attitudes, practices (KAP), and environmental aspects related to cholera and hygiene. Data analysis involved descriptive statistics and chi-square tests. RESULTS: The study highlights significant disparities in education levels, toilet ownership, and healthcare access. Challenges in finding public toilets (86.67%) and accessing water sources (67.78%) are consistent across regions, with Seaside facing financial constraints (85.00%) and water cost concerns (91.67%). Attitudes toward hygiene vary, with the Mountain region having the highest 'Never' responses for handwashing (38.89%), and Downtown leading in water treatment practices (11.67%). There is a strong willingness to share health knowledge, particularly in Downtown (100.00%). Seaside (83.33%) and Downtown (73.33%) revealed a higher cholera awareness, while nearly half of Mountain students lacked knowledge (54.44%). CONCLUSIONS: This study highlights significant disparities in WASH practices among La Gonâve's adolescents in Downtown, Mountain, and Seaside regions. Urgent interventions are crucial for improving sanitation, ensuring clean water access, and implementing targeted hygiene education, especially in the resource-constrained Mountain and Seaside areas. The findings underscore the vital roles of adolescents and schools in disseminating knowledge, with further research needed to explore intervention differences.

Socioeconomic disparity in cervical cancer screening among Korean women: 1998-2010.

BACKGROUND: Cervical cancer is the sixth most common cause of cancer among Korean women and is one of the most preventable cancers in the world. This study aimed to investigate the change in cervical cancer screening rates, the level of socioeconomic disparities in cervical cancer screening participation, and whether there was a reduction in these disparities between 1998 and 2010. METHODS: Using the Korean Health and Nutrition Examination Survey, women 30 years or older without a history of cervical cancer and who completed a health questionnaire, physical examination, and nutritional survey were included (n = 17,105). Information about participation in cervical cancer screening was collected using a self-administered questionnaire. Multiple logistic regression analysis was performed to investigate the relationship between cervical cancer screening participation and the socioeconomic status of the women. RESULTS: The cervical cancer screening rate increased from 40.5% in 1998 to 52.5% in 2010. Socioeconomic disparities influenced participation, and women with lower educational levels and lower household income were less likely to be screened. Compared with the lowest educational level, the adjusted odds ratios (ORs) for screening in women with the highest educational level were 1.56 (95% confidence interval (CI): 1.05-2.30) in 1998, and 1.44 (95% CI: 1.12-1.87) in 2010. Compared with women with the lowest household income level, the adjusted ORs for screening in women with the highest household income level were 1.80 (95% CI: 1.22-2.68), 2.82 (95% CI: 2.01-3.96), and 1.45 (95% CI: 1.08-1.94) in 2001, 2005, and 2010, respectively. CONCLUSION: Although population-wide progress has been made in participation in cervical cancer screening over the 12-year period, socioeconomic status remained an important factor in reducing compliance with cancer screening.

Nonlinear Associations between Blood Cadmium Concentration and Thyroid Hormones According to Smoking Status in Korean Adults: The Korea National Health and Nutrition Examination Survey (KNHANES).

Research on the association between blood cadmium (BCd) exposure and thyroid hormone levels in the general population has been inconclusive. Therefore, we examined the associations between BCd and thyroid hormones according to smoking status in Korean adults (N = 1170, Men = 722, Women = 448) using multiple linear regression and restricted cubic splines analysis with data from the Korean National Health and Nutrition Examination Survey (2013). The geometric mean of BCd was 0.74 µg/L in all study participants and was higher in smokers (1.01 µg/L) than in nonsmokers (0.65 µg/L). Restricted cubic splines analysis revealed nonlinear trends between BCd and free thyroxine in smokers (p for nonlinearity = 0.02). By contrast, there were no significant associations between BCd and thyroid hormones in either men or women. In conclusion, nonlinear associations may exist between BCd and free thyroxine in smokers. Our study provides empirical support for the future formulation of an acceptable concentration range of BCd and offers a new concept for preventing thyroid problems.

Influence of serum ferritin combined with blood cadmium concentrations on blood pressure and hypertension: From the Korean National Health and Nutrition Examination Survey.

BACKGROUND: Previous studies have suggested that cadmium (Cd) exposure and serum ferritin levels may influence the development of hypertension. OBJECTIVE: We evaluated whether the association between blood Cd levels and the development of hypertension could be modified by serum ferritin levels in a representative sample of the adult population of South Korea. METHODS: We used data from the Korean National Health and Nutrition Examination Survey (2008-2012), a nationally representative, cross-sectional, population-based study. We included 5752 adults aged 19 years and older who had records of blood Cd and ferritin levels and blood pressure measurements. Multiple logistic regression was used to examine the association between Cd exposure and the development of hypertension, as well as the modifying effects of serum ferritin. RESULTS: Men had higher levels of serum ferritin, and women had higher levels of Cd. Smoking in men was significantly associated with high blood pressure and risk of hypertension. Significantly fewer women were smokers, and the combination of abnormal serum ferritin levels and high Cd levels was significantly associated with high systolic blood pressure [odds ratio (OR) = 2.11; 95% confidence interval (CI) = 1.04-4.28], high diastolic blood pressure (OR = 2.07; 95% CI = 1.04-4.12), and increased hypertension risk (OR = 1.83; 95% CI = 1.03-3.25) in women who never smoked. CONCLUSIONS: Our results provide further evidence that individuals with abnormal serum ferritin levels should limit their exposure to Cd to prevent hypertension.

A scoping review on population-centered indicators for cancer care continuum.

Purpose: The purpose of this study was to develop prioritized cancer indicators and measure the population-based monitoring of the entire life cycle of cancer care, guiding the improvement of care delivery systems. Methods: Scoping review was performed based on the Joanna Briggs Institute's methodology. Electronic databases were searched in PubMed, Cochrane Library, EMBASE, Ovid Medline, RISS, KISS, and KoreaMed. The searches were limited to articles published in English between 2010 and 2020. No restrictions were applied regarding the publication status or country of origin, and all study designs were included. Gray literature was used to broaden the search's scope, identify new recommendations, need to be in connect with subject experts, and explore pertinent websites. The process and selected indicators were analyzed based on their frequency distribution and percentage. Results: The literature search yielded 6,202 works. In addition, national and international cancer guidelines were obtained from official database reports. A total of 35 articles and 20 reports regarding cancer indicators were finally selected for data synthesis. Based on them, 254 core sets of cancer indicators were identified. The selected indicators were classified into six domains based on the continuum of cancer care and survivor's life cycle, namely, primary prevention (61, 24.0%), secondary prevention (46, 18.1%), treatment (85, 33.5%), quality of care (33, 13.0%), survivor management (33, 13.0%), and end-of-life care (14, 5.5%). Conclusion: There is a growing interest in developing specific areas of cancer care. Cancer indicators can help organizations, care providers, and patients strive for optimal care outcomes. The identified indicators could guide future innovations by identifying weaknesses in cancer prevention and management.

Urinary Concentrations of Bisphenol Mixtures during Pregnancy and Birth Outcomes: The MAKE Study.

Bisphenols are endocrine disruptors that may be associated with altered fetal growth in humans, and they have similar biological functions to mimic hormones. In addition, aggregated chemicals showed an adverse effect although individual concentration was at a low level. However, most studies between bisphenols and birth outcomes have focused on the effect of individual bisphenol. Thus, we explored the associations of urinary bisphenol mixtures with birth outcomes. We conducted a prospective birth cohort study in South Korea. One hundred eighty mother-infant pairs were recruited from 2017 to 2019. Bisphenol A (BPA), bisphenol F (BPF), and bisphenol S (BPS) in one spot urine were analyzed using ultra-performance liquid chromatography-tandem mass spectrometry. We used two statistical approaches to examine potential associations of BPA, BPF, and BPS with birth weight and gestational age: (1) multivariable linear regression; (2) Bayesian kernel machine regression (BKMR). The geometric means of BPA, BPF, and BPS were 2.1, 0.2, and 0.1 µg/L, respectively. In stratified linear analyses by each median value, a higher BPF was positively associated with birth weight (g) (ß = 125.5; 95% CI: 45.0 to 205.9). Mixture analyses using BKMR suggested an inverse association between bisphenol mixtures and birth weight. Our findings suggest that in utero bisphenol exposure may influence birth weight and that such relationships may differ considering non-linearity and the combined effect.

Prenatal Exposure to Parabens Affects Birth Outcomes through Maternal Glutathione S-Transferase (GST) Polymorphisms: From the Mothers and Kids Environmental Health (MAKE) Study.

INTRODUCTION: Human exposure to parabens is very common in daily life, and prenatal exposure to these chemicals is associated with poor birth outcomes. Therefore, the aim of this study was to investigate the effect of glutathione S-transferase (GST) polymorphisms on the association between prenatal exposure to parabens and birth outcomes. METHODS: We conducted a multivariate analysis involving 177 subjects to determine the association between paraben concentrations and birth outcomes in mothers with GST mu 1 (GSTM1) and GST theta 1 (GSTT1) polymorphisms from 2017 to 2019. Furthermore, we determined the interactive effect between paraben levels and GSTM1/GSTT1 polymorphisms using regression analysis, in addition to a generalized linear model after stratifying GSTM1/GSTT1 genotype into three categories. RESULTS: Methyl and propyl paraben concentrations were significantly and positively associated with birth weight (methyl, ß = 116.525, 95% confidence interval (CI) = 22.460-210.590; propyl, ß = 82.352, 95% CI = 9.147-155.557) in individuals with the GSTM1-null genotype. Moreover, the propyl paraben concentration was significantly associated with an increase in gestational age (ß = 0.312, 95% CI = 0.085-0.539) in individuals with the GSTM1-null genotype. CONCLUSIONS: This study reported the association between prenatal paraben exposure and birth outcomes in individuals with GST polymorphisms. We found positive relationships of maternal exposure to methyl parabens with birth weight in both mothers with GSTM1 and GSTT1-null genotypes.

Urinary bisphenol A and thyroid function by BMI in the Korean National Environmental Health Survey (KoNEHS) 2012-2014.

Bisphenol A (BPA) is one of the largest amounts of chemicals in daily life and source of polycarbonate plastics, epoxy resins, medical equipment, plastic consumer products. Recent studies reported that the effects of BPA on human health in the thyroid hormone. Therefore, this study aimed to indicate the association between urinary BPA concentration and thyroid function in total triiodothyronine (T3), thyroxine (T4), thyroidal stimulating hormone (TSH) and stratified the population by body mass index (BMI). This study was performed on 6478 adults aged 19 years and older based on the Second Korean National Environmental Health Survey (KoNEHS, 2012-2014). We measured BPA in urine and total T3, T4 and TSH in serum from the 2nd KoNEHS study. The multiple regression analysis was performed to assess the association of urinary BPA concentrations with thyroid hormone after BMI stratification. Urinary BPA associated with thyroid hormone. Especially, BPA is related to T3 (-0.627) in all group, and T4 (-0.060, -0.098) in all group and the group of BMI 25.0kg/m2 or more negatively. When stratified by BPA, T3 and T4 were significantly decreased with the high BPA exposure compared with the low BPA exposure for BMI more than 25.0kg/m2 (adjusted ß = -3.402, 95% CI: 4.942, -1.862, adjusted ß = -0.209, 95% CI: 0.328, -0.090). However, no obvious associations were found between BPA concentration and TSH. The results of urinary BPA decrease with T3 and T4 levels increase in the higher BMI group is a new finding which does not exist in recent studies of Korea.

Association between Possibility of Purchasing Cigarettes and E-cigarette Experience among Korean Adolescent Smokers.

BACKGROUND: To aim of this study was to examine the association between perceived possibility of purchasing cigarettes and e-cigarette experience among adolescents who currently smoke cigarettes. METHODS: Data were derived from the Korea Youth Risk Behavior Web-Based Survey; a total of 29,169 current smokers participated. The dependent variable was e-cigarette experience in the previous month. Analyses included χ2 test and survey logistic regression. RESULTS: A perceived easy possibility of purchasing cigarettes increased the odds of e-cigarette experience (odds ratio, 1.19; 95% confidence interval, 1.07-1.33) compared to when it was perceived as impossible. An easy possibility of purchasing cigarettes increased the odds of e-cigarettes experience among males aged 12-15 or 17 years compared to when it was impossible to purchase cigarettes. CONCLUSION: A perceived easy possibility of purchasing cigarettes was more likely to increase e-cigarette experience among adolescents. Laws restricting adolescents' access to e-cigarettes must be strengthened.

Effect of pre existing respiratory conditions on survival of lung cancer patients: A nationwide population-based cohort study.

BACKGROUND: Common diseases with potential to increase the risk of death from lung cancer have so far not been studied in large populations. METHODS: We did a population-based retrospective cohort study using nationwide health insurance claims data from 2005 to 2012 in Korea including 205 403 lung cancer patients. Multivariate-adjusted hazard ratios (aHRs) of lung cancer mortality by presence, time intervals with lung cancer diagnosis and combinations of pre-existing chronic obstructive pulmonary disease (COPD), pneumonia, asthma and tuberculosis were calculated using the Cox-proportional hazards model. RESULTS: The total number of person-years of follow-up was 397 780 and 60.2% of patients died (mean survival 23.2 months after lung cancer diagnosis). Lung cancer patients with previous respiratory disease had increased aHR for mortality (COPD, hazard ratio [HR] = 1.32, CI 1.29-1.35; pneumonia, HR = 1.14, CI 1.08-1.19; and asthma, HR = 1.11, CI 1.06-1.16). Risks were positively associated with longer duration of pre-existing disease diagnosis; cases with >5 years since diagnosis compared to <2 years: COPD, HR = 2.91, CI 2.82-3.00; pneumonia, HR = 1.67, CI 1.51-1.85; asthma, HR = 1.56, CI 1.45-1.68; and tuberculosis, HR = 2.03, CI 1.90-2.17. Furthermore, elevated HRs of death were found among patients with multiple pre-existing co-morbidities. CONCLUSION: Hazards of death from lung cancer are significantly increased in cases with pre-existing lung disease, and worse with longer durations, and with multiple combinations before cancer diagnosis. Patients and physicians should be aware of these meaningful risk/prognostic factors for lung cancer when identifying high-risk patient groups.

Effects of a change in social activity on quality of life among middle-aged and elderly Koreans: Analysis of the Korean longitudinal study of aging (2006-2012).

AIM: The aim of the present study was to examine a relationship between altered social activity and quality of life in later life. METHODS: Data came from the Korean Longitudinal Study of Aging (2006-2012), which consisted of 7096 participants aged 45 years or older. Change in social activity was classified into four categories; that is, "consistent non-participation," "participation to no participation," "no participation to participation" and "consistent participation." Social activity was divided into various elements, and the same analysis was carried out for each element. The linear mixed model was used to investigate the association between changes in social activity and quality of life among middle-aged and elderly Koreans. RESULTS: Those with changes from "participation to no participation" (b 2.253, P < 0.0001), "no participation to participation" (b 3.348, P < 0.0001) and "consistent participation" (b 6.624, P < 0.0001) were more likely to be satisfied with their lives than those with "consistent non-participation" (P < 0.0001 for trend). In addition, the impact of the positive relationship between consistent participation in social activity and quality of life varied across different elements of social activity. The positive association was particularly strong for religious activities, friendship organization, leisure/culture clubs, family/school reunion and voluntary work (b 1.451, P < 0.0004; b 5.049, P < 0.0001; b 4.903, P < 0.0001; b 4.757, P < 0.0001; b 4.562, P < 0.0001; respectively, for consistent participation vs consistent non-participation). CONCLUSION: Consistent participation in religious activities, friendship organizations, leisure/culture clubs, family/school reunion ,and volunteer work improves quality of life among middle aged and older Koreans. Geriatr Gerontol Int 2017; 17: 132-141.

Impact of co-payment for outpatient utilization among Medical Aid beneficiaries in Korea: A 5-year time series study.

BACKGROUND: The Korean government implemented an outpatient co-payment scheme in July 2007 to control Medical-Aid beneficiaries' overutilization of healthcare services. OBJECTIVES: To assess changes in the utilization of medical services resulting from the outpatient co-payment scheme. METHODS: 410,142 subjects were selected and health insurance reimbursement data from July 2006 to June 2011 was examined. We assessed the changes in the total medical cost, total adjusted patient days, inpatient days, inpatient total medical cost, the number of outpatient visits, and outpatient total medical cost using segmented regression analysis. RESULTS: Following the introduction of the policy, the number of outpatient visits per person fell by 0.16 days in July 2008, and by 0.06 days in July 2010, compared to June 2007. The outpatient total medical cost per person rose by $4.11 in July 2010 compared to June 2007. The inpatient utilization increased constantly during the period of the study. So the total medical cost as well as the total adjusted number of patient days also increased constantly. CONCLUSION: The outpatient co-payment policy was effective for reducing the number of outpatient visits. It could not control the cost per outpatient visit and inpatient utilization. So the total medical cost was increased.

Association between employment status change and depression in Korean adults.

OBJECTIVES: This study investigated the association between employment status and depression. METHODS: Data from the Korea Welfare Panel Study (KOWEPS) collected from 2008 to 2011 were used. A total of 7368 subjects were included in this study after exclusion of subjects with missing data and those who were self-employed or could not work. Depression was assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). Employment status, age, sex, region, education, marital status, income, head of household, self-rated health, smoking status, drinking habits, and the current year's and the previous year's CES-D scores were included in the model as independent variables. A generalised linear mixed-effects model for longitudinal binary data was used. RESULTS: Compared with those who were permanently employed, individuals who moved from permanent to precarious employment (OR 1.45, 95% CI 1.23 to 1.70) or to unemployment (OR 1.78, 95% CI 1.30 to 2.43) and from precarious employment to unemployment (OR 1.65, 95% CI 1.32 to 2.06) showed a significantly increased the odds of having depression. Continuing precarious employment (OR 1.54, 95% CI 1.30 to 1.83) or unemployment (OR 1.45, 95% CI 1.23 to 1.70) also significantly increased the odds of having depression. These results were particularly identified in men and head of household women. The effects were not significant among non-head of household women. CONCLUSIONS: Precarious employment and unemployment were clearly associated with having depression. In addition, in view of our findings, policy makers should consider sex and head of household status when developing welfare policies. The inequity between precarious jobs and permanent jobs should be tackled.

Association between reduction in copayment and gastric cancer patient concentration to the capital area in South Korea: NHI cohort 2003-2013.

Since 2004, the South Korean government has introduced a policy that decreases copayment for cancer patients by strengthening public coverage in the National Health Insurance (NHI) system (first phase=copayment for outpatient care from 30% to 20%; second phase=copayment for total medical expenditures from 20% to 10%; third phase=copayment for total medical expenditures from 10% to 5%). We aimed to investigate the relationship between the policy introduction and patient visits to hospitals in the capital area. We used data from the NHI Cohort 2003-2013, which included all medical claims (7193 cases) filed for 2124 patients who visited the hospital due to stomach cancer, and performed a segmented Poisson regression analysis. Of all hospital visits, 40.6% of patients were from the capital area. After the introduction of the second phase of the policy, there was an increase in patient concentration in the capital area, although there were no significant effects on patient concentration during the first and third phases of the policy. In conclusion, our findings suggest that the introduction of a policy that reduces copayment for cancer patients had a substantial impact on patient concentration in the capital area. Therefore, health policymakers should consider effective alternatives including efficient allocation of medical resources or support for the more vulnerable population as flexible benefit plans to aid healthcare utilization by cancer patients.

Effects of Offspring-Related Characteristics on Depressive Disorder among Cancer Patients and Survivors.

OBJECTIVE: To investigate the influence of offspring-related characteristics on the prevalence of depressive disorders among cancer patients and those who survived cancer for at least 45 years. MATERIALS AND METHODS: Data were obtained from the Korean Longitudinal Study of Aging (KLoSA). To investigate the association between offspring and depressive disorder among cancer patients and survivors, we analyzed data from 292 cancer patients and survivors drawn from a total subject pool of 16,613 individuals at baseline. RESULTS: According to our results, the odds ratio (OR) for subjects with five or more offspring developing depressive disorder was -0.794 (p-value: 0.039, SE: 0.329) compared with that of those with two offspring. In addition, the adjusted effect of the number of male and female offspring on the presence of depressive disorder showed that the OR for those with three or more female offspring for developing depressive disorder was -0.958 lower (SE: 0.305, p-value: 0.012) than it was for those with no female offspring. CONCLUSIONS: This article provides evidence for an association between offspring-related characteristics and depressive disorders among cancer patients and survivors. Therefore, offspring may be important contributors to the emotional status of cancer patients and survivors. Further study should precisely need to measure depressive disorders because of self-reported data.