What is the relationship between the local population change and cancer incidence in patients with dyslipidemia: Evidence of the impact of local extinction in Korea.

BACKGROUND: Changes in the local population are intricately linked to healthcare infrastructure, which subsequently impacts the healthcare sector. A decreasing local population can result in lagging health infrastructure, potentially leading to adverse health outcomes as patients may be at risk of not receiving optimal care and treatment. While some studies have explored the relationship between chronic diseases and local population decline, evidence regarding cancer is insufficient. In this study, we focused on how deteriorating management of chronic diseases such as dyslipidemia could influence the risk of cancer. We investigated the relationship between changes in the local population and cancer incidence among patients with dyslipidemia. METHODS: This cohort study was conducted using claims data. Data from adult patients with dyslipidemia from the National Health Insurance Service-National Sample Cohort conducted between 2002 and 2015 were included. Population changes in each region were obtained from the Korean Statistical Information Service and were used to link each individual's regional code. Cancer risk was the dependent variable, and Cox proportional hazards regression was used to estimate the target associations. RESULTS: Data from 336,883 patients with dyslipidemia were analyzed. Individuals who resided in areas with a decreasing population had a higher risk of cancer than those living in areas with an increasing population (decrease: hazard ratio (HR) = 1.06, 95% CI = 1.03-1.10; normal: HR = 1.05, 95% CI = 1.02-1.09). Participants living in regions with a low number of hospitals had a higher risk of cancer than those in regions with a higher number of hospitals (HR = 1.20, 95% CI = 1.12-1.29). CONCLUSION: Patients in regions where the population has declined are at a higher risk of cancer, highlighting the importance of managing medical problems caused by regional extinction. This could provide evidence for and useful insights into official policies on population decline and cancer risk.

Effects of life-sustaining treatment plans on healthcare expenditure and healthcare utilization.

PURPOSE: To develop an ethical and cultural infrastructure for Life-Sustaining Treatment (LST) plan, it is crucial to carefully analyze its impact and ensure that healthcare utilization is maintained at an appropriate level, avoiding excessive medical interventions. This study aims to investigate the effects of LST decisions on both healthcare expenditure and utilization. METHODS: This cohort study utilized claims data from the National Health Insurance Service, encompassing all medical claims in South Korea. We included individuals who had planned to withdraw or withhold their LST between January and December 2018, identified by claim code IA71, IA72, IA73. We followed a total of 28,295 participants with documented LST plan who were deceased by June 2020. Participants were categorized into LST withdrawal / withholding and LST continuation groups. The dependent variables were healthcare expenditure and utilization. We construct a generalized linear model to analyze the association between these variables. RESULTS: Out of the 28,295 participants, 24,436 (86.4%) chose to withdraw or withhold LST, while the rest opted for its continuation. Compared to the LST continuation group, those who chose to withdraw or withhold LST had 0.91 times lower odds for total cost. Additionally, they experienced 0.91 times fewer hospitalization days and 0.92 times fewer outpatient visits than those in the LST continuation group. CONCLUSION: Healthcare expenditure and utilization deceased among those choosing to withdraw or withhold LST compared to those continuing it. These findings underscore the significance of patients actively participating in decision regarding their treatment to ensure appropriate levels of medical intervention for LST. Furthermore, they emphasize the critical role of proper education and the establishment of a cultural framework for LST plans.

The effects of hospice care on healthcare expenditure among cancer patients.

PURPOSE: It is necessary to estimate the hospice usage and hospice-related cost for entire cancer patients using nationwide cohort data to establish a suitable ethical and cultural infrastructure. This study aims to show the effects of hospital hospice care on healthcare expenditure among South Korean cancer patients. METHODS: This study is a retrospective cohort study using customized health information data provided by the National Health Insurance Service. Individuals who were diagnosed with stomach, colorectal, or lung cancer between 2003 and 2012 were defined as new cancer patients, which included 7,176 subjects. Patients who died under hospital-based hospice care during the follow-up period from January 2016 to December 2018 comprised the treatment group. Healthcare expenditure was the dependent variable. Generalized estimating equations was used. RESULTS: Among the subjects, 2,219 (30.9%) had used hospice care at an average total cost of 948,771 (± 3,417,384) won. Individuals who had used hospice care had a lower odds ratio (EXP(ß)) of healthcare expenditure than those who did not (Total cost: EXP(ß) = 0.27, 95% confidence intervals (CI) = 0.25-0.30; Hospitalization cost: EXP(ß) = 0.32, 95% CI = 0.29-0.35; Outpatient cost: EXP(ß) = 0.02, 95% CI = 0.02-0.02). CONCLUSION: Healthcare expenditure was reduced among those cancer patients in South Korea who used hospice care compared with among those who did not. This emphasizes the importance of using hospice care and encourages those hesitant to use hospice care. The results provide useful insights into both official policy and the existing practices of healthcare systems.

Association of absolute and relative hand grip strength with all-cause mortality among middle-aged and old-aged people.

OBJECTIVES: This study aimed to examine the association of absolute and relative hand grip strength (HGS) with the risk of all-cause mortality among middle-aged and old-aged people in South Korea. Considering that both absolute HGS and relative HGS could be effective measures, an in-depth investigation is necessary to compare the effects of both measures on mortality. METHODS: Data of 9,102 participants, derived from the Korean Longitudinal Study of Aging from 2006 to 2018, were examined. HGS was divided into two categories: absolute HGS and relative HGS (defined as HGS divided by body mass index). The risk of all-cause mortality was the dependent variable. Cox proportional hazard regression was used to analyze the association between HGS and all-cause mortality. RESULTS: The average of absolute and relative HGS were 25.6 ± 8.7 kg and 1.1 ± 0.4 kg/BMI, respectively. The all-cause mortality rate decreased by 3.2% as absolute HGS increased by 1 kg (adjusted hazard ratio [HR] = 0.968, 95% CI = 0.958-0.978). An increase in relative HGS by 1 kg/BMI was associated with a 22% reduction in risk of all-cause mortality (adjusted HR = 0.780, 95% CI = 0.634-0.960). Individuals with more than two chronic diseases, there was a decrease in all-cause mortality as absolute HGS increased by 1 kg and relative HGS by 1 kg/BMI (absolute HGS; adjusted HR = 0.97, 95% CI = 0.959-0.982, relative HGS; adjusted HR = 0.483, 95% CI = 0.325-0.718). CONCLUSIONS: Our study findings showed that both absolute and relative HGS were inversely associated with the risk of all-cause mortality; a higher absolute/relative HGS was associated with a lower risk of all-cause mortality. Moreover, these findings highlight the importance of improving HGS to alleviate the burden of adverse health problems.

Cancer care patterns in South Korea: Types of hospital where patients receive care and outcomes using national health insurance claims data.

BACKGROUND: Although strengthening coverage has improved cancer care, there are concerns related to medical distortion. Previous studies have only examined whether patients visit a specific hospital, and not the continuum of patients with cancer, resulting in a lack of evidence in South Korea. This study aimed to investigate the patterns in hospital type for cancer care and analyze their association with outcomes. METHODS: The data for this study were obtained from the National Health Insurance Services Sampled Cohort database. This study included patients with four types of cancer (top four cancer incidence in 2020): gastric (3353), colorectal (2915), lung (1351), and thyroid (5158) cancer. The latent class mixed model was used to investigate cancer care patterns, and multiple regression or survival analysis was performed to examine medical cost, length of stay (LOS), and mortality. RESULTS: The patterns in each cancer type were classified into two to four classes, namely, mainly visited clinics or hospitals, mainly visited general hospitals, mainly visited tertiary hospitals (MT), and tertiary to general hospitals through trajectory modeling based on the utilization of cancer care. Compared to the MT pattern, other patterns were generally associated with higher cost, LOS, and mortality. CONCLUSION: The patterns found in this study may be a more realistic way of defining patients with cancer in South Korea compared to previous studies, and its association-related outcomes may be used as a basis to address problems in the healthcare system and prepare alternatives for patients with cancer. Future studies should review cancer care patterns related to other factors such as regional distribution.

Association of polypharmacy with all-cause mortality and adverse events among elderly colorectal cancer survivors.

BACKGROUND: The risk of inappropriate drug exposure in elderly colorectal cancer (CRC) survivors after the initial cancer treatment has not been well studied. This study investigated the association of polypharmacy (PP) with overall survival, hospitalization, and emergency room (ER) visits among older CRC survivors. METHODS: A retrospective cohort study was conducted using the Korean National Health Insurance claims data follow-up from 2002 to 2017. Participants comprised those aged ≥65 years who were hospitalized with a diagnosis of CRC received cancer treatment and survived at least 2 years from the initial CRC diagnosis between 2003 and 2012. PP was defined based on the number of individual drugs during the third year, after 2 years of survival since the initial cancer treatment. PP was categorized as follows: non-PP (zero to four prescribed drugs); PP (five to nine drugs), and excessive PP (≥10 drugs). Main outcomes are all-cause mortality, hospitalization, and ER visits. RESULTS: Of the 55,228 participants, 44.5% died, 83.1% were hospitalized, and 46.1% visited the ER. The PP and excess PP groups showed increased risk of all-cause mortality, hospitalization, and ER visit compared with the low PP group, and was highly associated among groups including patients aged 65 to 74 years and those in low-level frailty groups. CONCLUSIONS: These risks can be minimized by increasing awareness and enhancing behaviors among health care professionals, especially clinician and pharmacists, to be aware of potential drug interactions, review, and ongoing monitoring. PLAIN LANGUAGE SUMMARY: The risk of inappropriate drug exposure in older colorectal cancer (CRC) survivors after the initial cancer treatment has not been well studied. Polypharmacy was associated with adverse outcomes, including all-cause mortality, hospitalization, and emergency room visits among older CRC survivors and it was particularly associated with those who were 65 to 75 years and those with low risk of frailty. When prescribing drugs, physicians should be mindful of finding a balance between adequate treatment of diseases and avoiding adverse drug effects in survivors of CRC.

Non-cancer health risks in firefighters: a systematic review.

osFirefighters are occupationally exposed to hazardous factors that may increase their risk of disease. However, non-cancer disease risk in firefighters has not been systematically examined. This systematic review aimed to identify non-cancer disease risk in firefighters and determine whether the risk differs according to job characteristics. We searched the Cochrane Library, Embase, PubMed, and KoreaMed databases using relevant keywords from their inception to April 30, 2021. The Risk of Bias Assessment Tool for Non-randomized Studies version 2.0 was used to assess the quality of evidence. Due to study heterogeneity, a narrative synthesis was presented. The systematic literature search yielded 2,491 studies, of which 66 met the selection and quality criteria. We confirmed that the healthy worker effect is strong in firefighters as compared to the general population. We also identified a significant increase in the incidence of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder (PTSD) in firefighters compared to other occupational groups. Contradictory results for the risk of PTSD and anxiety disorders related to rank were reported. Sufficient evidence for increased risk of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and PTSD was available. The risk of non-cancer diseases varied depending on job type, years of service, and rank. However, caution should be exercised when interpreting the results because the classification criteria for firefighters' jobs and ranks differ by country.

Health behavior changes and mortality among South Korean cancer survivors.

Considering the rapid growth in the number of cancer survivors, the successful management of their health behaviors requires further attention. However, there are lack of information about cancer survivors' health behaviors and the risk of mortality using Korean cohort data. This study aimed to examine the effects of health behavior changes on mortality among cancer survivors and to develop a validated nomogram. This cohort study was conducted using claims data. Data from adult cancer survivors from the National Health Insurance Service-National Sample Cohort, conducted between 2002 and 2015, were included. Individuals who were alive for five years after their cancer diagnosis were defined as cancer survivors. Cox proportional-hazards regression was used to estimate the target associations. Discrimination (Harrell's C-index) and calibration (Hosmer-Lemeshow test) were employed to validate the nomogram. Data from 9300 cancer survivors were used for analysis. Compared to non-smokers, those who started or quit smoking had a higher risk of all-cause mortality. Those who were physically inactive had a higher risk of all-cause mortality than those who were continuously active. In the nomogram, the C-index value was 0.79 in the training data and 0.81 in the testing data. Hosmer-Lemeshow test was not significant, demonstrating a good fit. We found that individuals with unhealthy behaviors had a higher risk of mortality, thereby highlighting the importance of managing health behaviors among cancer survivors. The development of a validated nomogram may provide useful insights regarding official policies and existing practices in healthcare systems, which would benefit cancer survivors. Our study could provide the evidence to inform the priority of guideline for managing the health behavior among cancer survivors.

Association between changes in handgrip strength and depression in Korean adults: a longitudinal panel study.

Depression in older adults is a global socioeconomic burden. Identifying factors, such as physical activity or exercise that can help prevent depression is important. We aimed to investigate the relationship between changes in handgrip strength and the presence of depression using longitudinal, nationwide data of older Korean adults. Data from the Korean Longitudinal Study of Aging were used in this study. A total of 6783 participants who had undergone a handgrip strength test and completed the short-form Center for Epidemiologic Studies Depression Scale (CESD-10-D) questionnaire from 2006 to 2018 were included. General estimating equations were used to assess the temporal effect of the changes in handgrip strength on depression. A decrease in handgrip strength was associated with high CESD-10-D scores (ß = 0.1889 in men, ß = 0.1552 in women). As a continuous variable, handgrip strength was negatively correlated with CESD-10-D scores(ß = - 0.0166 in men, ß = - 0.0196 in women). Changes in the handgrip strength were associated with depressive symptoms in our longitudinal study. Those who experienced a decrease in handgrip strength had severe depressive symptoms compared to those with unchanged or increased handgrip strength. These findings can be used to guide general health policies for the prevention of depression.

The Association between Perceived Discrimination and Mental Health of Wage Workers with Disabilities: Findings from the Panel Survey of Employment for the Disabled 2016-2018.

Despite efforts to integrate society, persons with disabilities (PWD) still experience considerable discrimination. Therefore, this study examined the association between experiences of discrimination and stress/depressive symptoms in wage working PWD. This study used data from the Panel Survey of Employment for the Disabled 2016-2018 in South Korea. This study included 1566 wage working PWD aged 15-64. The dependent variable was stress and depressive symptoms, and the independent variable was the experience of discrimination due to disability in daily life (Never, Rarely, Often, and Regularly) and the experience of discrimination at the workplace (0, 1, 2, ≥3). This study used a generalized estimating equations model to consider the repeated measurement data. Wage working PWD who experienced more discrimination in their daily life due to disability and at workplaces showed a higher odds ratio (OR) of stress and depressive symptoms than those who did not experience discrimination. As a result of the analysis including both discrimination experiences, those who always experienced discrimination due to disability in daily life had the highest OR to stress and depression (OR = 2.64, 95% Confidence Interval (CI): 1.37-5.08; OR = 4.96, 95% CI: 2.58-9.56, respectively). According to the experience at workplaces, wage working PWD who faced discrimination by two factors (OR = 1.66, 95% CI: 1.22-2.25) had the highest OR of stress, and those who experienced three or more factors had the highest OR of depressive symptoms (OR = 1.33, 95% CI: 0.83-2.11). Discrimination due to disability in daily life was more associated with the mental distress of working PWD than discrimination at workplaces. For the mental health of working PWD, not only policies or systems to eliminate discrimination in the workplace, but also overall social integration efforts based on improving awareness, are needed so that they do not experience discrimination in their daily life.

Nationwide Implementation of Nonpharmaceutical Interventions During the Coronavirus Disease 2019 Pandemic Is Associated With Decreased Incidence of Pneumocystis jirovecii Pneumonia in Kidney Transplant Recipients.

This study aimed to investigate the impact of nationwide nonpharmaceutical interventions against coronavirus disease 2019 (COVID-19) on the incidence of Pneumocystis jirovecii pneumonia (PCP) in kidney transplant recipients. The monthly incidence of PCP during the COVID-19 period decreased significantly compared to that of the pre-COVID-19 period in kidney transplant recipients.

Association between gastric cancer and the risk of depression among South Korean adults.

OBJECTIVES: The diagnosis and treatment of cancer are stressful events that could trigger psychological distress in a large number of cancer patients. The aim of this study was to examine the association between gastric cancer and the risk of new onset of depression among South Korean adults. METHODS: Data from 12,664 participants aged over 40 years was derived from the National Health Service National Sample Cohort (2002-2013). The case cohort consists of patients who received a diagnosis of gastric cancer between 2002 and 2009, and the corresponding control group was selected through 1:1 propensity score matching (case: 6332, control: 6332). The new onset of depression was considered as the dependent variable. A Cox proportional hazards regression model was built to analyze the associations between variables in consideration. RESULTS: Individuals with gastric cancer had a higher risk of new onset of depression than those without cancer (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.13-1.45.) Female gastric patients had a higher risk of depression compared to male patients (Female; HR = 1.89, 95% CI = 1.66-2.16, Male; HR = 1.25, 95% CI = 1.10-1.41). Gastric cancer patients in their 60s had the highest risk of new onset of depression compared to other age groups and no cancer group (HR = 1.61, 95% CI = 1.40-1.85). Gastric cancer patients who were previously diagnosed with depression prior to their diagnosis of cancer had a higher risk of new onset of depression than gastric cancer patients without antecedent diagnosis of depression (Past Depression (Yes); HR = 5.17, 95% CI = 4.10-6.51, Past Depression (No); HR = 1.35, CI = 1.21-1.51). CONCLUSIONS: The study identified a significant relationship between gastric cancer and depression among South Korean adults, suggesting that the diagnosis and treatment of gastric cancer increases the risk of new onset of depression, especially among female patients between 60 and 69 years old of high income and living in metropolitan regions. Pre-existing health conditions also appeared to be a risk factor. Thus, in consideration of treatment efficacy and patients' quality of life, the results of the study emphasizes the need for attentive intervention, while distinguishing the most vulnerable groups.

Effect of Pelvic Floor Muscle Training Using Pressure Biofeedback on Pelvic Floor Muscle Contraction and Trunk Muscle Activity in Sitting in Healthy Women.

Pelvic floor muscle training (PFMT) has been recommended as the first choice as one of the effective methods for preventing and improving urinary incontinence (UI). We aimed to determine whether pressure biofeedback unit training (PBUT) improves short term and retention performance of pelvic floor muscle contraction. The muscle activities of the external oblique (EO), transversus/internal oblique (TrA/IO), multifidus (MF) and the bladder base displacement were measured in the verbal feedback group (n = 10) and PBU group (n = 10) three times (baseline, post-training, and at the 1-week follow-up). Surface electromyographic activity was recorded from the EO, TrA/IO, and MF muscles. The bladder base displacement was measured using ultrasound. The results were analyzed using two way mixed ANOVA. The bladder base displacement may have elevated more in the PBU group than in the verbal feedback group due to decreased TrA/IO activity. These findings indicate that PBUT is a better method than verbal feedback training.

Association between statin adherence and the risk of stroke among South Korean adults with hyperlipidemia.

BACKGROUND AND AIMS: The effectiveness of statins commonly used to prevent stroke may depend on adherence to treatment. We examined the association between statin adherence and stroke risk among South Korean adults with hyperlipidemia. METHODS AND RESULTS: The data of 128,052 and 129,390 participants with hyperlipidemia for the purpose of studying the risks of ischemic and hemorrhagic stroke, respectively, were collected from the Korean National Health Insurance Service-National Sample Cohort between 2002 and 2013. Participants were divided into groups according to statin adherence, calculated as the proportion of days covered (PDC; poor, moderate, good). The risk of ischemic and hemorrhagic stroke were analyzed using a Cox proportional hazards model. Individuals with poor PDC exhibited higher risks of ischemic and hemorrhagic stroke than those with good PDC (ischemic stroke: hazard ratio [HR] = 1.09, 95% confidence interval [CI] = 1.03-1.15, hemorrhagic stroke: HR = 1.37, 95% CI = 1.22-1.54). Women with poor PDC were at higher risk of ischemic stroke than those with good PDC (HR = 1.17, 95% CI = 1.09-1.26), while men with poor PDC exhibited a higher risk of hemorrhagic stroke than those with good PDC (HR = 1.55, 95% CI = 1.27-1.90). Individuals with disabilities who had poor PDC were at higher risk of ischemic stroke than those with good PDC (HR = 1.55, 95% CI = 1.24-1.93). CONCLUSIONS: We detected a significant association between statin adherence and ischemic and hemorrhagic stroke risk. Therefore, hyperlipidemia patients should adhere to statin treatment; such interventions are required to reduce the stroke risk.

Association between occupational noise and vibration and anxiety in the South Korean working population: a cross-sectional study.

BACKGROUND: Although occupational exposure to noise and vibration is common, its effect on psychological wellbeing is poorly understood. This study investigated the relationship between occupational exposure to noise and vibration and anxiety among Korean workers. METHODS: Data from the 5th Korean Working Conditions Survey, conducted in 2017, were used. Participants were classified into four groups according to their level of exposure, and anxiety was assessed using a self-report questionnaire. Logistic regression analysis was used to examine the significance of the association between exposure and anxiety. RESULTS: Overall, 45,241 participants were enrolled in this study. The likelihood of anxiety increased, in both males and females, when exposed to both occupational noise and vibration (males: odds ratio (OR) = 2.25, confidence interval [CI] = 1.77-2.87; females: OR = 2.17, CI = 1.79-2.61). The association between the varying degrees of noise, vibration, and combined exposure showed a dose-response relationship among males. CONCLUSIONS: This study revealed that occupational noise and vibration exposure is associated with anxiety. These results suggest that more detailed regulations regarding occupational noise and vibration should be developed and implemented to ensure a safer environment for workers.

Association between social phobia and the risk of arrhythmia using the Korean National Sample Cohort: a retrospective cohort study.

BACKGROUND: Social phobia shares symptoms with arrhythmias, such as palpitations and chest discomfort. However, it is unclear how social phobia is associated with the actual risk of arrhythmia. This study aimed to investigate whether social phobia is associated with the risk of arrhythmia using a nationally representative sample cohort. METHODS: This retrospective cohort study assessed data from the 2002-2013 Korean National Health Insurance Service National Sample Cohort. Using 1:3 propensity score matching for sex, age, income, and insurance status, 1514 patients with social phobia and 4542 control group patients were included in the study. Social phobia and arrhythmia were defined per the International Classification of Diseases, 10th revision. Using cox proportional hazard regression, hazard ratios (HRs) were calculated to estimate the risk of arrhythmia in patients with social phobia. RESULTS: There were statistically significant associations between social phobia history and elevated risks of arrhythmia. Patients with social phobia had a higher risk of arrhythmia after adjusting with covariates (HR = 1.78, 95%CI = 1.25-2.55). Among different types of arrhythmias, atrial fibrillation and flutter presented the highest risk (HR = 2.20, CI = 1.06-4.57) compared to paroxysmal tachycardia (HR = 1.07, CI = 0.39-2.91) and other cardiac arrhythmias (HR = 1.83, CI = 1.16-2.89). CONCLUSION: This study identified the association between social phobia and the risk of arrhythmia in a South Korean representative cohort. These results suggest that social phobia should be treated properly to reduce arrhythmia risks.

Association between Stroke Quality Assessments and Mortality within 30 Days among Patients Who Underwent Hemorrhagic Stroke Surgeries in South Korea.

INTRODUCTION: In South Korea, to improve the quality of medical services provided to stroke patients, stroke quality assessments have been implemented since 2006. To further promote improvement of care, financial incentives were introduced since 2012. This study aims to examine the association between stroke quality assessments and mortality within 30 days among South Korean adults who underwent hemorrhagic stroke surgeries to provide evidence of the importance of such assessments. METHODS: Data from 45,741 patients from 374 healthcare organizations, derived from the 2013-2016 claims data of the Korean Health Insurance Review and Assessment Service, were examined. To ensure homogeneity, only patients who underwent hemorrhagic stroke surgeries were selected. Healthcare organizations were classified based on whether stroke quality assessments were conducted. The dependent variable of this study was death within 30 days of hospitalization. A generalized linear mixed model was constructed to analyze the association between variables. RESULTS: Healthcare organizations without stroke quality assessments exhibited a higher risk of mortality than those that did (adjusted odds ratio [OR] = 1.53, 95% confidence interval [CI] = 1.16-2.01). Among healthcare organizations with the lowest volume, those without stroke quality assessments had a higher risk of mortality than those that did (tertile 1 [low], adjusted OR = 1.38, 95% CI = 1.04-1.84). Among rural healthcare organizations, those without assessments had a higher risk of mortality than did those that did (adjusted OR = 1.61, 95% CI = 1.06-2.43). CONCLUSIONS: The study identified a significant relationship between stroke quality assessments and 30-day mortality. Healthcare organizations without stroke quality assessments may exhibit a comparatively higher risk of mortality. Future interventions to minimize mortality and provide evidence for policymakers and healthcare leaders could involve expanding the scope of stroke quality assessment.

Increasing disparities in the proportions of active treatment and 5-year overall survival over time by age groups among older patients with gastric cancer in Korea.

Purpose: As older patients with gastric cancer increase in Korea, no consensus indicative of anti-cancer treatment exists for the oldest old (age 85+). We investigated potential disparities in the proportion of surgery-including active treatment and the degree of survival improvement over time by age groups, and whether heterogeneity exists in the protective effect of time period on overall survival (OS) by age at diagnosis clusters. Materials and methods: A nationwide cohort (N = 63,975) of older patients with gastric cancer (age at diagnosis 70+) in 2005-2012 were followed until the end of 2018. Patients were categorized into four time period groups by their year of diagnosis. Cancer treatment patterns and 5-year OS were analyzed accordingly, and a random coefficients Cox model with random intercepts and random slopes of time period by age at diagnosis clusters was employed. Results: The mean age of patients was 76.4, and 60.4% were males. Most patients had 0-1 comorbidities (73.3%) and low-risk frailty scores (74.2%). Roughly two-thirds of patients received some form of anti-cancer treatment (62.4%), and while the number of comorbidities and the proportion of high-risk frailty scores trended toward an increase, the proportion of patients receiving anti-cancer treatment increased from 58% in 2005-2006 to 69.6% in 2011-2012. The proportion of surgery-including active treatment increased to over 70% in the 70-74 years old group, while stagnating at 10% in the 90+ years old group. Differences in the slope of 5-year OS improvement resulted in a widening survival gap between the old (age 70-84) and the oldest old. The protective effect of time period on OS hazard in the oldest old was not monotonically reduced with increasing "chronological" age but varied quite randomly, especially among female patients. Conclusion: Our study showed no upper age limit in terms of benefiting from the advances in the detection and treatment of gastric cancer over time. Thus, "functional" age rather than "chronological" age should be the criterion for anti-cancer screening and treatment, and actual implementation of proven treatments in the oldest old patients to reduce their non-compliance with treatment in clinical practice is needed to improve gastric cancer survival for all.

Association between change in handgrip strength and cognitive function in Korean adults: a longitudinal panel study.

BACKGROUND: Muscular function, such as handgrip strength, has been suggested as an associated factor for cognitive impairment. This study investigated the association between temporal change in handgrip strength and cognitive function using longitudinal, nationwide data from Korean older adults. METHODS: Our study used data from the Korean Longitudinal Study of Aging (KLoSA). The analysis covered 6696 participants who had taken the handgrip strength test and Mini-Mental State Examination (MMSE) from 2006 to 2018. We adopted general estimating equations to assess the temporal effect of handgrip strength change on cognitive function. RESULTS: After adjusting for covariates, we observed an association between handgrip strength and low MMSE scores (ß = - 0.3142 in men, ß = - 0.2685 in women). Handgrip strength as a continuous variable was positively correlated with MMSE scores after adjustment (ß = 0.0293 in men, ß = 0.0347 in women). The group with decreased handgrip strength over time also showed greater odds for mild cognitive impairment (OR = 1.23, 95%CI = 1.05-1.27 in men, OR = 1.15, 95%CI = 1.05-1.27 in women) and dementia (OR = 1.393, 95%CI = 1.18-1.65 in men, OR = 1.19, 95%CI = 1.08-1.32 in women). CONCLUSIONS: This study identified the relationship between handgrip strength change and cognitive function among South Korean adults. According to our large, longitudinal sample, decreasing handgrip strength was associated with decline in cognitive function.

Association of the type of counselor with suicidal ideation and suicide attempts: a survey of South Korean adolescents.

BACKGROUND: Counseling for adolescents who consider or attempt suicide may help reduce suicide rates. However, the impact of the type of counselor (e.g., father, mother, sibling, friend, teacher, other) on suicidal ideation/suicide attempts remains unclear. Therefore, we examined this association in Korean adolescents. METHODS: Using data from the 2015 Korea Youth Risk Behavior Web-based Survey of 65,485 adolescents, we examined risk factors for suicidal ideation/suicide attempts according to sex using a multiple logistic regression analysis. In a subgroup analysis, we investigated the associations between counselor type and suicidal ideation/suicide attempts stratified by the cause of stress for both sexes. RESULTS: Male participants were less likely to consider suicide when counseled by their mother (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.70-0.90) or friend (OR 0.89; 95% CI 0.80-0.99) and to attempt suicide when counseled by a friend (OR 0.74; 95% CI 0.60-0.92) than were those who did not receive any counseling. Female participants were less likely to attempt suicide when counseled by their mother (OR 0.66; 95% CI 0.53-0.82) or friends (OR 0.70; 95% CI 0.58-0.83) than when not counseled. Furthermore, adolescents with achievement/career choice-related and family problems were at a lower risk of suicide ideation/suicide attempts when counseled by their mother or friend than when they received no counseling. CONCLUSIONS: Suicidal ideation/suicide attempts showed different associations for both sexes in accordance with the type of counselor. Even if counseling by specialists for issues such as achievement/career choice-related or family matters is needed, the risk of suicide could be reduced through counseling by the people around them. Therefore, adolescents should form mutually supportive relationships through active communication with surrounding people.