Healthcare usage and cost for plantar fasciitis: a retrospective observational analysis of the 2010-2018 health insurance review and assessment service national patient sample data.

BACKGROUND: Plantar fasciitis (PF) is the most common cause of heel pain in adults, and the number of patients and medical expenses are increasing annually. However, studies on this condition are lacking. There is a need to investigate universally administered PF treatment and the associated costs. Therefore we analyzed the South Korean Health Insurance Review and Assessment Service data to investigate the distribution and healthcare usage of patients with PF. METHODS: A cross-sectional retrospective observational design was used in this study. Patients diagnosed with PF (ICD-10 code M72.2) between January 2010 and December 2018 in South Korea, of whom 60,079 had used healthcare at least once, were included in the study. We assessed healthcare usage and cost due to PF, treatment method, and visit route. All statistical analyses were performed with descriptive statistics using SAS 9.4 version. RESULTS: The number of treated cases of PF and patients with PF was 11,627 cases and 3,571 patients in 2010, respectively, which increased annually to 38,515 cases and 10,125 patients by 2018, respectively. The 45-54-year-old age group had the highest number of patients; the patient population was predominantly women. Physical therapy was used frequently in Western medicine (WM) institutions, where > 50% of the medicines prescribed to outpatients were analgesics. In contrast, acupuncture therapy was most commonly used in Korean medicine (KM) institutions. A high percentage of patients who visited a KM institution, followed by a WM institution, and then returned to the same KM institution had visited the WM institution for radiological diagnostic examination. CONCLUSION: This study analyzed nine years of period data from a patient sample of claims data from the Health Insurance Review and Assessment Service to examine the current status of health service use for PF in Korea. We obtained information on the status of WM/KM institution visits for PF treatment, which could be useful for health policymakers. Study findings regarding treatments often used in WM/KM, the frequency of treatments, and their costs could be used as basic data by clinicians and researchers.

Effectiveness of Chuna (or Tuina) Manual Therapy for Temporomandibular Disorder: A Systematic Review.

Background: Temporomandibular disorder (TMD) affects patients' quality of life (QoL) because of the resulting structural and functional impairment and pain. Objective: This study aimed to evaluate the evidence regarding the effectiveness, safety and improvement in QoL in patients who underwent Chuna manual therapy (CMT) for TMD. Methods: We searched 11 databases and included randomized controlled trials (RCT) on CMT for TMD published before March 2020. A meta-analysis was conducted, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method was used to evaluate the evidence level. We included 12 RCTs that compared CMT and conventional care. Results: CMT showed significantly better patient pain reduction, functional improvement and QoL. A superior result was seen in the use of CMT in conjunction with Traditional Chinese Medicine (TCM) or conventional care. CMT showed no minor or serious adverse events compared with medical treatments. The evidence level was low for all outcomes, except QoL. Conclusions: We found that CMT for TMD resulted in functional improvement, pain reduction and improvement in QoL, with fewer adverse events. However, since the evidence level varied from very low to moderate due to imprecision and the risk of bias with the included studies, we are limited in determining the efficacy of Chuna therapy using these studies. High-quality, well-designed and large-scale RCTs are needed to conclusively determine the clinical efficacy of CMT in TMD.

Association of temporomandibular disorders and tinnitus with health-related quality of life: A cross-sectional study using the Fifth Korea National Health and Nutrition Examination Survey.

BACKGROUND: Few studies have examined the associations of temporomandibular disorders (TMDs) and tinnitus with health-related quality of life on a national level. OBJECTIVE: We aimed to investigate the associations of TMDs, tinnitus and quality of life among the Korean population, aged 19 years or older. METHODS: Data were obtained from the fifth Korea National Health and Nutrition Examination Survey (2012; N = 5786). TMDs, tinnitus and health-related quality of life were assessed using self-report data from EuroQol-5 Dimension. Participants were divided into four groups: no TMD and no tinnitus, TMD present but no tinnitus, no TMD but tinnitus present and both TMD and tinnitus present. RESULTS: Among the participants, 21.88% had TMD, 24.93% had tinnitus, and 7.74% had both. The prevalence of most TMD and all types of tinnitus was higher among females than among males. The group with both TMD and tinnitus reported the highest percentage of problems in the usual activity, pain/discomfort and anxiety/depression dimensions. Moreover, the odds ratio (OR) for lower quality of life was significantly higher in the group with both TMD and tinnitus compared to the group without TMD and tinnitus: mobility (OR = 1.527, 95% confidence interval [CI]: 1.014-2.300), pain/discomfort (OR = 2.072, 95% CI: 1.570-2.735), anxiety/depression (OR = 1.692, 95% CI: 1.034-2.767), EQ-5D score (OR = 1.651, 95% CI: 1.121-2.431) and EQ-VAS (OR = 1.682, 95% CI: 1.246-2.269). CONCLUSION: The presence of both TMD and tinnitus has a considerable impact on HRQoL in the Korean population. In our study, the group with both TMD and tinnitus showed lower HRQoL than without TMD and tinnitus group. These results emphasise the need for a multilateral and comprehensive approach to address these disorders and provide baseline data for developing appropriate interventions.

Association between diabetes mellitus and anemia among Korean adults according to sex: a cross-sectional analysis of data from the Korea National Health and Nutrition Examination Survey (2010-2016).

BACKGROUND: There are many conflicting opinions regarding the association between anemia and diabetes mellitus (DM), and the mechanism by which DM influences anemia remains uncertain. Therefore, we aimed to investigate the association between anemia and DM in Korean adults and to analyze the risk factors for anemia among these patients according to sex. METHODS: This retrospective cross-sectional survey was conducted using data from the Korea National Health and Nutrition Examination Survey V, VI, and VII between January 2010 and December 2016. In total, 25,597 Korean adults aged ≥19 years (10,117 men, 15,480 women) were included. Patients with a fasting blood sugar level of ≥126 mg/dL or who have been diagnosed with DM were classified as the DM group. Anemia was defined as hemoglobin levels of < 13 g/dL in men and < 12 g/dL in women. Logistic regression analysis was used to adjust for demographic characteristics and lifestyle-, disease-, and health-related factors. RESULTS: Approximately 11.3% of patients had DM. The prevalence of anemia was significantly higher in the DM group than in the non-DM group. After adjusting for confounding factors, the odds of the prevalence of anemia in men were higher in the DM group than in the non-DM group (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.42-2.50, p < 0.0001). When investigated according to the serum creatinine level, the association was significantly stronger among women (OR 42.63, 95% CI 17.25-105.36, p < 0.0001) than among men (OR 6.30, 95% CI 3.08-12.90, p < 0.0001). CONCLUSIONS: We found a strong association between DM and anemia that was more prominent among men than among women. We also determined that the serum creatinine level had a greater influence on DM and anemia in women than in men.

Cross-sectional analysis of self-reported sedentary behaviors and chronic knee pain among South Korean adults over 50 years of age in KNHANES 2013-2015.

BACKGROUND: An increasing amount of evidence supports an association between sedentary behaviors and chronic knee pain. However, the association between the total daily duration of sedentary behavior and chronic knee pain in the general population remains unclear. We aimed to analyze the association between sedentary behavior and chronic knee pain in a study population representative of the general Korean population aged > 50 years while also considering the physical activity or body mass index (BMI). METHODS: This cross-sectional study used data from the 6th Korean National Health and Nutrition Examination Survey (KNHANES VI) of 2013-2015, which was completed by 22,948 Korean adult participants aged > 50 years. The participants were divided into two groups based on the status of the chronic knee pain. Data were analyzed using multivariable logistic regression after adjustment for age, sex, and individual factors. RESULTS: Longer sedentary behavior was correlated with chronic knee pain (p for trend = 0.02). Sedentary behavior exceeding 10 h/day was significantly associated with chronic knee pain (adjusted odds ratio, 1.28; p = 0.03). Participants with high levels of physical activity were less likely to suffer from chronic knee pain (adjusted odds ratio, 0.78; p = 0.00), and women with over 10 daily hours of sedentary behavior with high levels of physical activity were more likely to have chronic knee pain. A significant association was noted between chronic knee pain and obesity (≥30.0 kg/m2) individuals (adjusted odds ratio, 3.48; p = 0.04). CONCLUSIONS: Longer duration of sedentary behaviors was correlated with chronic knee pain. Our study suggests the need to encourage reductions in overall sedentary behavior to < 10 h daily. A high physical activity level is recommended, particularly for women > 50 years and those with obesity.

Anti-Inflammatory Effect of Ascochlorin in LPS-Stimulated RAW 264.7 Macrophage Cells Is Accompanied With the Down-Regulation of iNOS, COX-2 and Proinflammatory Cytokines Through NF-κB, ERK1/2, and p38 Signaling Pathway.

A natural compound C23 H32 O4 Cl, ascochlorin (ASC) isolated from an incomplete fungus, Ascochyta viciae has been known to have several biological activities as an antibiotic, antifungal, anti-cancer, anti-hypolipidemic, and anti-hypertension agent. In this study, anti-inflammatory activity has been investigated in lipopolysaccharide (LPS)-induced murine macrophage RAW 264.7 cells, since ASC has not been observed on the inflammatory events. The present study has clearly shown that ASC (1-50 µM) significantly suppressed the production of nitric oxide (NO) and prostaglandin E2 (PGE2 ) and decreased the gene expression of inducible NO synthase (iNOS) and cyclooxygenase-2 (COX-2) in a dose-dependent manner. Moreover, ASC inhibited the mRNA expression and the protein secretion of interleukin (IL)-1ß and IL-6 but not tumor necrosis factor (TNF)-α in LPS-stimulated RAW 264.7 macrophage cells. In addition, ASC suppressed nuclear translocation and DNA binding affinity of nuclear factor-κB (NF-κB). Furthermore, ASC down-regulated phospho-extracellular signal-regulated kinase 1/2 (p-ERK1/2) and p-p38. These results demonstrate that ASC exhibits anti-inflammatory effects in RAW 264.7 macrophage cells.

Acupuncture for insomnia after stroke: a systematic review and meta-analysis.

BACKGROUND: Insomnia is the common complaint among patients with stroke. Acupuncture has increasingly been used for insomnia relief after stroke. The aim of the present study was to summarize and evaluate evidence on the effectiveness of acupuncture in relieving insomnia after stroke. METHODS: Seven databases were searched from inception through October 2014 without language restrictions. Randomized controlled trials (RCTs) were included if acupuncture was compared to placebo or other conventional therapy for treatment of insomnia after stroke. Assessments were performed using the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI), the Athens insomnia scale (AIS), and the efficacy standards of Chinese medicine. RESULTS: A total of 165 studies were identified; 13 RCTs met our inclusion criteria. Meta-analysis showed that acupuncture appeared to be more effective than drugs for treatment of insomnia after stroke, as assessed by the PSQI (weighted mean difference, 4.31; 95 % confidence interval [CI], 1.67-6.95; P = 0.001) and by the efficacy standards of Chinese medicine (risk ratio, 1.25; 95 % CI, 1.12-1.40; P < 0.001). Intradermal acupuncture had significant effects compared with sham acupuncture, as assessed by the ISI (weighted mean difference, 4.44; 95 % CI, 2.75-6.13; P < 0.001) and the AIS (weighted mean difference, 3.64; 95 % CI, 2.28-5.00; P < 0.001). CONCLUSIONS: Our results suggest that acupuncture could be effective for treating insomnia after stroke. However, further studies are needed to confirm the role of acupuncture in the treatment of this disorder.

Sex differences in acupuncture effectiveness in animal models of Parkinson's disease: a systematic review.

BACKGROUND: Many animal experimental studies have been performed to investigate the efficacy of acupuncture in Parkinson's disease (PD). Sex differences are a major issue in all diseases including PD. However, to our knowledge, there have been no reviews investigating sex differences on the effectiveness of acupuncture treatment for animal PD models. The current study aimed to summarize and analyze past studies in order to evaluate these possible differences. METHOD: Each of 7 databases (MEDLINE, EMBASE, the Cochrane Library, 3 Korean medical databases, and the China National Knowledge Infrastructure) was searched from its inception through March 2015 without language restrictions. RESULTS: We included studies of the use of acupuncture treatment in animal models of PD. A total of 810 potentially relevant articles were identified, 57 of which met our inclusion criteria. C57/BL6 mice were used most frequently (42 %) in animal PD models. Most of the studies were carried out using only male animals (67 %); only 1 study (2 %) was performed using solely females. The further 31 % of the studies used a male/female mix or did not specify the sex. CONCLUSIONS: The results of our review suggest that acupuncture is an effective treatment for animal PD models, but there is insufficient evidence to determine whether sex differences exist. Future studies of acupuncture treatment for PD should use female animal models because they reflect the physiological characteristics of both males and females to fully evaluate the effect and the safety of the treatment for each sex.

Induction of Apoptosis and Antitumor Activity of Eel Skin Mucus, Containing Lactose-Binding Molecules, on Human Leukemic K562 Cells.

For innate immune defense, lower animals such as fish and amphibian are covered with skin mucus, which acts as both a mechanical and biochemical barrier. Although several mucus sources have been isolated and studied for their biochemical and immunological functions, the precise mechanism(s) of action remains unknown. In the present study, we additionally found the eel skin mucus (ESM) to be a promising candidate for use in anti-tumor therapy. Our results showed that the viability of K562 cells was decreased in a dose-dependent manner by treatment with the isolated ESM. The cleaved forms of caspase-9, caspase-3 and poly adenosine diphosphate-ribose polymerase were increased by ESM. The levels of Bax expression and released cytochrome C were also increased after treatment with ESM. Furthermore, during the ESM mediated-apoptosis, phosphorylation levels of ERK1/2 and p38 but not JNK were increased and cell viabilities of the co-treated cells with ESM and inhibitors of ERK 1/2 or p38 were also increased. In addition, treatment with lactose rescued the ESM-mediated decrease in cell viability, indicating lactose-containing glycans in the leukemia cells acted as a counterpart of the ESM for interaction. Taken together, these results suggest that ESM could induce mitochondria-mediated apoptosis through membrane interaction of the K562 human leukemia cells. To the best of our knowledge, this is the first observation that ESM has anti-tumor activity in human cells.

Effectiveness and safety of motion-style acupuncture treatment using traction for inpatients with acute low back pain caused by a traffic accident: A randomized controlled trial.

BACKGROUND: Musculoskeletal symptoms, such as neck pain and low back pain (LBP) are common after a traffic accident (TA). While motion-style acupuncture treatment (MSAT) is effective in relieving pain, MSAT using traction (T-MSAT) has rarely been studied, and evidence for its efficacy and safety is lacking. To address this gap, this study aimed to assess the effectiveness and safety of T-MSAT for pain and functional disturbances in patients with acute LBP caused by a TA. METHODS: This two-armed, parallel, assessor blinded randomized controlled trial, conducted at Jaseng Hospital of Korean Medicine, included 100 patients with acute LBP occurring within 1 week of a TA. The participants were randomly allocated (1:1 ratio) to receive either combined T-MSAT and integrative Korean medicine treatment (IKMT) or only conventional IKMT, applied for 3 consecutive days after admission. The primary outcome was the difference between numerical rating scale (NRS) scores for LBP at baseline and after treatment completion on day 4 after admission. RESULTS: At the primary endpoint, the difference in NRS scores for LBP between the T-MSAT and control groups was 0.94 (95% confidence interval [CI] 0.40-1.48). The T-MSAT group showed a significantly lower NRS score for LBP than the control group. Differences in visual analogue scale (VAS) scores between the T-MSAT and control groups were significant at baseline and discharge. The area under the curve of the VAS score showed a significant difference (-46.86 [95% CI -85.13 to -8.59]), indicating faster pain reduction in the T-MSAT group than in the control group. Recovery (30% pain reduction) was achieved more rapidly in the T-MSAT group than in the control group (log-rank test P = .005). Meanwhile, the NRS, VAS, Oswestry disability index, and quality of life scores at discharge or at the 12-week follow-up showed no significant difference. The rates of mild adverse events (AEs) were comparable between the groups. No severe AEs were reported, and none of the AEs were associated with the clinical trial. CONCLUSIONS: T-MSAT combined with IKMT is a safe treatment that can effectively and quickly reduce initial pain in patients with LBP.

Survey on the current usage of ultrasound-guided procedures in Korean Medicine Clinics and Hospitals.

Ultrasound-guidance is applied during the administration of Korean medicine (KM) interventions to improve the safety and effectiveness of the interventions. Although many case series and reports on the use of ultrasound-guided KM interventions have been reported, no study has investigated the current use of ultrasound-guidance in clinical practice by doctors of Korean medicine (KMDs). An online survey was conducted with questions examining the status of ultrasound-guidance usage among KMDs practicing in various KM clinical settings. Survey responses from 335 KMDs were collected. Ultrasound started to be widely used in the clinical practice of KM since 2022. The primary objective of using ultrasound-guidance was "To improve the accuracy and efficacy" by 54.6%. Ultrasound-guidance was most frequently applied for shoulder joint diseases, and pharmacopuncture was the most frequently used intervention (76.1% and 90.4%, respectively). The respondents reported that effectiveness could be enhanced the most in nerve entrapment syndromes and especially when used in shoulder joints. Over 90% of KMDs responded that the safety and efficacy of treatment, specialty, and patients' satisfaction were improved after adopting ultrasound-guidance. Moreover, 94.9% of KMDs agreed with the necessity for reimbursement of ultrasound-guidance in KM under national health insurance coverage. Most KMDs responded that they had positive perceptions regarding the clinical use of ultrasound-guidance in KM in terms of treatment effects, safety, and patient satisfaction, and the need for national health insurance coverage of the service. Our findings may provide practice-based evidence for conducting clinical studies.

Trends in healthcare utilisation of patients with migraine in South Korea: a retrospective observational study using Health Insurance Review and Assessment Service National Patient Sample data from 2010 to 2018.

OBJECTIVE: This study used 2010-2018 Health Insurance Review and Assessment Service National Patient Sample data to analyse the distribution and healthcare utilisation of patients with migraine in South Korea. DESIGN: Retrospective, observational study using serial cross-sectional data. PARTICIPANTS: Patients with primary diagnosis of G43, a Korean Standard Classification of Diseases-10 code for migraine, were included in the analysis. The exclusion criteria were missing code information; code for dental, health centre or psychiatry; institution type specified as nursing hospital, psychiatric hospital, dental hospital, midwifery centre or health centre; blank entries for total cost or days of care. 453 246 records of patients and 117 157 patients corresponding to those records were identified. OUTCOME MEASURES: Primary outcome measures were medical service utilisation status, treatment methods and drug use status associated with migraine. RESULTS: Cases and patients of migraine increased from 48 846 and 19 468 (2010) to 52 729 and 20 802 (2018), respectively, increases of 7.95% and 6.85%, respectively, compared with 2010. Total cost of care increased from $921 857.88 (2010) to $1 711 219.60 (2018). The most common age range of patients was 45-54 years, with 2.69 times more female than male patients. In Western medicine hospitals, subcutaneous or intramuscular injection therapy was used frequently, while in Korean medicine hospitals, acupuncture therapy was used. Among Western medicine outpatients, more than 50% of the therapeutics prescribed for acute migraine were simple analgesics or non-steroidal anti-inflammatory drugs. The number of prescriptions for the prevention of episodic migraine increased from 13 600 cases (2010) to 20 546 cases (2018), representing the steepest increase in drug utilisation. CONCLUSIONS: Treatments frequently used in Western and Korean medicine hospitals and their frequency of use and costs were identified. The findings of this study can be used as a basis for relevant health policy decisions.

Characteristics and difference of respiratory diseases in Korean adults aged ≥40 years: A cross-sectional study.

PURPOSE: National big data pertaining to the status of common respiratory diseases is essential to devising appropriate policies to promote proper treatment and prevention of respiratory diseases amid the prolonged coronavirus disease 2019 (COVID-19) pandemic. The aim of this study is to investigate the prevalence of common respiratory diseases and their association with sociodemographic characteristics, comorbidities, and medical history using 11 years (2008-2018) of the Korea National Health and Nutrition Examination Survey (KNHANES) data, ultimately to present foundational data for policy decision making and disease prevention measures. METHODS: Among the participants of the KNHANES survey (2008-2018), 93 028 adults aged ≥40 years who underwent a lung function test were included in this cross-sectional study. The participants were divided into four groups: Asthma, chronic obstructive pulmonary disease (COPD), asthma + COPD, and no respiratory disease. Their data were analyzed for demographic factors, health behavior, and disease-related factors. Multiple logistic regression was used to calculate the odds ratio (OR) adjusted for sex, age, household income, educational level, occupation, body mass index (BMI), smoking status, alcohol consumption, physical activity, and comorbidities. RESULTS: Of all participants, 1.83%, 12.63%, and 1.27% had only asthma, only COPD, and asthma + COPD, respectively. With respect to the patients with asthma who also had asthma + COPD, the OR of asthma + COPD was 5.272 in underweight patients and 6.479 in patients aged ≥70 years. Meanwhile, a high association between COPD and asthma + COPD was found in female patients, whereas asthma was more highly associated with asthma + COPD in male patients. CONCLUSION: The study confirmed that old age, sex, smoking status, BMI, previous history of atopic dermatitis, and lung cancer were independent risk factors for asthma, COPD, and asthma + COPD. The present study demonstrated the need for a multidisciplinary integrative approach to respiratory diseases, and the findings could be used for developing policies for the treatment of COVID-19 and respiratory diseases and the prevention of infectious diseases.

Is acupuncture an effective treatment for temporomandibular disorder?: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Acupuncture is used for treating various disorders, but its effects on temporomandibular disorder (TMD) remain unclear. This study aimed to assess the effectiveness and safety of acupuncture for TMD via a systematic review of randomized clinical trials. METHODS: A total of 11 Korean and worldwide databases were searched to identify acupuncture studies in adults with TMD. A Cochrane risk of bias assessment was performed on all articles; a meta-analysis, which involved the categorization according to the type of control used (inactive control, active control, or add-on), was subsequently performed. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation methodology. RESULTS: The qualitative analysis of randomized clinical trials with acupuncture as the intervention included 32 articles, 22 of which were included in the quantitative analysis (471 participants). Acupuncture significantly improved outcomes (effect rate, relative risk [RR]: 7.00, 95% confidence interval [CI]: 1.91, 25, 62; visual analog scale, standardized mean difference: 0.49, 95% CI: 0.24, 0.73) versus active controls (effect rate, RR: 1.19; 95% CI: 1.12, 1.27). In the analysis of add-ons, acupuncture significantly improved the effect rate and pain intensity (effect rate, RR: 1.36; 95% CI: 1.04, 1.77; visual analog scale, mean difference: -1.23; 95% CI -1.79, -0.67). However, the quality of evidence was determined to range from low to very low. CONCLUSION: Acupuncture in TMD significantly improved outcomes versus active controls and when add-on treatments were applied. However, as the quality of evidence was determined to be low, well-designed clinical trials should be conducted in the future.

Integrative Korean Medicine Treatments for Traumatic Facial Palsy Following Mandibular Fracture: A Case Report and Literature Review.

Prior studies exploring the effectiveness of traditional Korean medicine (TKM) treatment for facial palsy have mainly focused on Bell's palsy, and there are few studies on the effectiveness of TKM treatments for traumatic facial palsy following mandibular fracture. The patient was a 24-year-old Korean man with left-sided facial paralysis following a left mandibular fracture. Surgery was performed for the fracture and the facial palsy was treated using conventional medicine (CM) treatments for approximately 3 months, but there was no improvement observed in the patient's condition. Subsequently, the patient underwent an integrative Korean medicine treatment regimen consisting of acupuncture, pharmacopuncture, cupping, moxibustion, and herbal medication for a duration of 2 months. After 2 months of treatments, the House-Brackmann facial grading scale changed from Ⅴ to II and Yanagihara's unweighted grading score increased from 9 to 34. This case presentation and previous studies of traumatic facial palsy using TKM treatment show that TKM treatment may be considered a complementary or alternative treatment method to CM treatment in patients with traumatic facial palsy. PROSPERO registration number: CRD42023445051.

Analysis of Scoliosis-related Medical Services in South Korea Between 2010 and 2018: A Cross-sectional Study Using Health Insurance Review and Assessment Service Data.

STUDY DESIGN: Retrospective, cross-sectional study. OBJECTIVES: The aim of this study was to analyze types and cost of care for scoliosis and present health care utilization by patients to provide data on the standard treatment and cost for scoliosis in South Korea. SUMMARY OF BACKGROUND DATA: Scoliosis is defined as an abnormally laterally curved spine with a Cobb angle of ≥10°.Data are lacking on which treatments are popular for general scoliosis and which service categories incur the most cost in South Korea. METHODS: Data from the Health Insurance Review and Assessment Service-National Patient Sample were used. In total, 108,643 final cases and 32,362 patients in South Korea who received Western medicine care or Korean medicine care at least once with scoliosis (ICD-10 code M41) as the principal diagnosis during January 2010 to December 2018 comprised the study sample. We analyzed health care utilization according to certain factors (e.g., age, sex, payer type, type of visit, and medical institution), health care utilization by service category and service code, and medication prescriptions filled by private or hospital pharmacies. RESULTS: Patients aged 24 years or younger most frequently utilized health care services, with more female (64.84%) than male patients (35.16%). Most patients received only Western medicine care (92.18%), whereas 6.56% only received Korean medicine care. Most cases (99.37%) corresponded to outpatient. Regarding service category, treatment and surgery, examination, special equipment and radiologic diagnosis accounted for a substantial percentage. Regarding service code, cost of examination, imaging, and physiotherapy comprised a high percentage of Western medicine, whereas cost of examination, acupuncture, and cupping therapy accounted for a high percentage of Korean medicine. The most commonly prescribed medications for scoliosis in pharmacies were anti-inflammatory analgesics (nonsteroidal anti-inflammatory drugs), antacids, and skeletal muscle relaxers. CONCLUSION: The findings can be used as foundational data for experts such as health care policymakers, clinicians, and researchers.Level of Evidence: 4.

Association between depression and quality of life in stroke patients: The Korea National Health and Nutrition Examination Survey (KNHANES) IV-VII (2008-2018).

BACKGROUND: Stroke and depression are common diseases that affect quality of life (QoL). Although some recent studies have investigated the association between the two diseases, studies that examined the association between stroke, depression, and QoL are rare, with large-scale national-level studies lacking. We aimed to investigate the association between depression and QoL in stroke patients. METHODS: Data from the Korea National Health and Nutrition Examination Survey (KNHANES) IV-VII conducted in 2008-2018 were used, and 45,741 adults who were aged >40 years and had no missing data for stroke and depression were included in the analysis. The participants were first grouped by prevalence of stroke, and further divided by prevalence of depression. RESULTS: The overall prevalence of stroke was 3.2%, and the incidence was 9% higher in men than in women. Multiple logistic regression was performed after adjusting for demographic factors, health-related factors, and disease-related factors. The results confirmed that the stroke group with depression had a lower overall health-related quality of life, measured using EQ-5D, score compared to the stroke group without depression (-0.15). Moreover, the concurrent stroke and depression treatment group had the highest OR of 7.28 (95% CI 3.28-16.2) for the anxiety/depression domain. CONCLUSION: Depression was strongly associated with QoL in stroke patients. This association was more evident in stroke patients undergoing treatment for depression. Thus, clinical approaches that take QoL into consideration are needed for stroke patients with depression.

Cost-Utility Analysis of Chuna Manual Therapy and Usual Care for Chronic Neck Pain: A Multicenter Pragmatic Randomized Controlled Trial.

This study aimed to compare the cost-effectiveness of manual therapy and usual care for patients with chronic neck pain. A cost-utility analysis alongside a pragmatic randomized controlled trial was conducted in five South Korean hospitals. Data were procured from surveys and nationally representative data. Participants were 108 patients aged between 19 and 60 years, with chronic neck pain persisting for at least 3 months and a pain intensity score of ≥5 on the numerical rating scale in the last 3 days. The study was conducted for 1 year, including 5 weeks of intervention and additional observational periods. Participants were divided into a manual therapy (Chuna) group and a usual care group, and quality-adjusted life-years, costs, and the incremental cost-effectiveness ratio were calculated. The quality-adjusted life-years of the manual therapy group were 0.024 higher than that of the usual care group. From the societal perspective, manual therapy incurred a lower cost-at $2,131-and was, therefore, the more cost-effective intervention. From a healthcare system perspective, the cost of manual therapy was higher, with an incremental cost-effectiveness ratio amount of $11,217. Manual therapy is more cost-effective for non-specific chronic neck pain management from both a healthcare system and societal perspective.

A comparative study of postoperative outcomes after stapled versus handsewn gastrojejunal anastomosis for pylorus-resecting pancreaticoduodenectomy.

BACKGROUNDS/AIMS: A stapler is widely used in various surgeries, and there have been recent attempts to use it for performing duodenojejunostomy and gastrojejunostomy during pancreaticoduodenectomy. This study aimed to compare the postoperative results of handsewn gastrojejunostomy (HGJ) and stapled gastrojejunstomy (SGJ) limited to pylorus-resecting pancreaticoduodenectomy (PrPD) performed by a single surgeon. METHODS: This retrospective study was conducted between January 2014 and March 2020, and included 131 patients who underwent PrPD performed by a single surgeon. Of the total subjects, 90 were in the HGJ group and 41 in the SGJ group. RESULTS: The mean time of surgery was significantly shorter in the stapled group than in the handsewn group (450.4±75.4 min vs. 397.1±66.5 min, p<0.001). However, there were no significant differences between the groups in the rates of postoperative pancreatic fistula, bile leak, chyle leak, intra-abdominal fluid collection, postoperative bleeding, ileus, Clavien-Dindo, rate of reoperation, and 30-day mortality, including delayed gastric emptying (DGE) (n=11 vs. n=6, p=0.92). CONCLUSIONS: Gastrojejunostomy using a stapler in PrPD reduces the reconstruction time without any increase in the rate of complications, including DGE. Therefore, using a stapler for gastrojejunostomy in pancreaticoduodenectomy is feasible and safe.

Sex-related associations among anemia, body mass index, and kidney function in Koreans: A cross-sectional study with propensity analysis.

ABSTRACT: The association between anemia and body mass index (BMI) in Koreans, considering kidney function, has not been clarified. Thus, we aimed to examine the association between anemia and BMI among Korean adults aged ≥19 years.This retrospective cross-sectional study evaluated male and female Korean adults aged ≥19 years who participated in the 5th, 6th, and 7th Korean National Health and Nutrition Examination Surveys (KNHANES) conducted between 2010 and 2017 were used. The participants were classified as underweight, normal weight, and overweight according to their BMI. Anemia was defined as hemoglobin levels of <13 g/dL for men and <12 g/dL for women according to the World Health Organization standards. Kidney function was evaluated according to the estimated glomerular filtration rate (eGFR), with abnormal kidney function in men defined as eGFR <60 mL/min/1.73 m2. Clinicodemographic variables were analyzed using logistic regression adjusted for weight. After propensity score matching (PSM), 6596 study participants were divided into 2 groups of 3298 participants each. Additionally, subgroup analysis by sex and kidney function was performed.On PSM, similar distribution patterns were obtained between the anemia and non-anemia groups; significant differences in BMI; kidney function; level of hemoglobin, hematocrit, and serum creatinine; iron intake; and eGFR were also observed between these groups. Anemia and BMI showed a significant association in both crude and adjusted logistic regression models. In model 2, which was adjusted for age, sex, education level, household income, alcohol consumption, smoking status, and exercise period, underweight men with abnormal kidney function showed a significantly higher risk of anemia than did normal weight men (odds ratio [OR]: 3.27; 95% confidence interval [CI]: 1.25-8.57; P = .016). Meanwhile, overweight men showed a significantly lower risk of anemia than did normal weight men (OR: 0.48; 95% CI: 0.33-0.70, P < .001).Anemia is associated with BMI according to sex. Compared with normal weight men, underweight men with abnormal kidney function had a significantly higher prevalence of anemia after adjusting for kidney function and sex, thus highlighting their need for careful management for anemia.