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2.
Int J Equity Health ; 23(1): 126, 2024 Jun 21.
Article in English | MEDLINE | ID: mdl-38907297

ABSTRACT

BACKGROUND: South Korea's National Health Insurance (NHI) system pursues universal health coverage, but it has not been able to alleviate patients' financial burden owing to limited coverage and a high proportion of out-of-pocket expenses. In 2017, the government announced a plan to strengthen universality by providing coverage for all unincluded services, expanding coverage, and alleviating household financial burden. We aimed to evaluate the effect of "Moon Care" with a focus on changes in health expenditures following policy implementation, and to provide empirical evidence for future policies to strengthen the NHI system's universality. METHODS: Using data from the 2016 and 2018 Korea Health Panel (KHP), we established a treatment group affected by the policy and an unaffected control group; we ensured homogeneity between the groups using propensity score matching (PSM). Subsequently, we examined changes in NHI payments, non-payments, and out-of-pocket payments (OOP); we performed difference-in-differences (DID) analysis to evaluate the policy's effect. RESULTS: Following policy implementation, the control group had a higher increase than the treatment group in all categories of health expenditures, including NHI payments, non-payments, and OOP. We noted significant decreases in all three categories of health expenditures when comparing the differences before and after policy implementation, as well as between the treatment and control groups. However, we witnessed a significant decrease in the interaction term, which confirms the policy's effect, but only for non-payments. CONCLUSIONS: We observed the policy's intervention effect over time as a decrease in non-payments, on the effectivity of remunerating covered medical services. However, the policy did not work for NHI payments and OOP, suggesting that it failed to control the creation of new non-covered services as noncovered services were converted into covered ones. Thus, it is crucial to discuss the financial spending of health insurance regarding the inclusion of non-covered services in the NHI benefits package.


Subject(s)
Health Expenditures , Humans , Republic of Korea , Health Expenditures/statistics & numerical data , National Health Programs/economics , Health Policy , Female , Universal Health Insurance/economics , Male , Insurance Coverage/economics , Middle Aged , Insurance, Health/economics , Adult
3.
J Affect Disord ; 361: 445-456, 2024 Jun 16.
Article in English | MEDLINE | ID: mdl-38889858

ABSTRACT

OBJECTIVES: This study underscores the importance of exploring AI's creative applications in treating depressive disorders to revolutionize mental health care. Through innovative integration of AI technologies, the research confirms their positive effects on preventing, diagnosing, and treating depression. The systematic review establishes an evidence base for AI in depression management, offering directions for effective interventions. METHODS: This systematic literature review investigates the effectiveness of AI in depression management by analyzing studies from January 1, 2017, to May 31, 2022. Utilizing search engines like IEEE Xplore, PubMed, and Web of Science, the review focused on keywords such as Depression/Mental Health, Machine Learning/Artificial Intelligence, and Prediction/Diagnosis. The analysis of 95 documents involved classification based on use, data type, and algorithm type. RESULTS: The study revealed that AI in depression management excelled in accuracy, particularly in monitoring and prediction. Biomarker-derived data demonstrated the highest accuracy, with the CNN algorithm proving most effective. The findings affirm the therapeutic benefits of AI, including treatment, detection, and disease prediction, highlighting its potential in analyzing monitored data for depression management. LIMITATIONS: This study exclusively examined the application of AI in individuals with depressive disorders. Interpretation should be cautious due to the limited scope of subjects to this specific population. CONCLUSIONS: To introduce digital healthcare and therapies for ongoing depression management, it's crucial to present empirical evidence on the medical fee payment system, safety, and efficacy. These findings support enhanced medical accessibility through digital healthcare, offering personalized disease management for patients seeking non-face-to-face treatment.

4.
Cost Eff Resour Alloc ; 22(1): 45, 2024 May 24.
Article in English | MEDLINE | ID: mdl-38790023

ABSTRACT

BACKGROUND: The rising older adult population has led to an increase in the prevalence of chronic diseases and medical expenses. Women tend to have a longer healthy life expectancy than men and are more likely to be exposed to urological disorders around the age of 50, resulting in substantial healthcare expenses throughout their lifetime. Urological disorders often require continuous treatment owing to their high risk of recurrence, contributing to an increased financial burden from medical costs. This study aimed to identify factors influencing medical expense in female patients with urological disorders and propose strategies to alleviate the associated financial burden. METHODS: We used data from the Korea Health Panel Survey conducted from 2011 to 2016. The final sample comprised 2,932 patients who visited hospitals for urological disorders. To identify the factors influencing medical expense among female patients with urological disorders, we employed a generalized estimating equation model. RESULTS: The results indicated that younger people and patients with middle-income levels tended to incur higher medical expenses. Furthermore, patients receiving treatment at tertiary hospitals and those enrolled in National Health Insurance also incurred higher health expenses. CONCLUSIONS: This study suggests that effective management of medical expenses related to urological disorders in women requires improvements in healthcare accessibility to facilitate early detection and continuous disease management. In addition, the findings highlight the potential benefits of digital health and non-face-to-face treatments in addressing these needs.

5.
Healthcare (Basel) ; 12(8)2024 Apr 18.
Article in English | MEDLINE | ID: mdl-38667617

ABSTRACT

This study aimed to emphasize the importance of physical education in maintaining sufficient physical activity by examining the average BMI of fifth- and sixth-grade elementary school students in Korea over multiple years. This study investigated changes in the average BMI of fifth- and sixth-grade elementary school students in Korea. It provided foundational data to suggest the role of physical education in student health and set future directions. The 2019-2021 Physical Activity Promotion System (PAPS) of the Korean Ministry of Education was used. Data corresponding to fifth- and sixth-grade students (124,693 from 2019, 126,226 from 2020, and 117,809 from 2021) in 1208 elementary schools in Korea were collected. Repeated measures ANOVA was conducted for the data analysis. The study findings are as follows: First, the average BMI of fifth- and sixth-grade elementary school students in Korea increased significantly in 2021 compared with 2019 and 2020. Second, changes in the yearly average BMI showed a significant difference depending on gender and grade. Obesity among fifth- and sixth-grade elementary school students in Korea increased steadily during 2019-2021, which may be due to a decrease in students' physical activity. Male students showed a steeper increase regardless of grade. During the study period, limited physical activity at school increased obesity rates. Physical education must play a role in students' health in preparation for future changes.

6.
Adv Drug Deliv Rev ; 208: 115238, 2024 05.
Article in English | MEDLINE | ID: mdl-38447933

ABSTRACT

Organoids are three-dimensional, multicellular constructs that recapitulate the structural and functional features of specific organs. Because of these characteristics, organoids have been widely applied in biomedical research in recent decades. Remarkable advancements in organoid technology have positioned them as promising candidates for regenerative medicine. However, current organoids still have limitations, such as the absence of internal vasculature, limited functionality, and a small size that is not commensurate with that of actual organs. These limitations hinder their survival and regenerative effects after transplantation. Another significant concern is the reliance on mouse tumor-derived matrix in organoid culture, which is unsuitable for clinical translation due to its tumor origin and safety issues. Therefore, our aim is to describe engineering strategies and alternative biocompatible materials that can facilitate the practical applications of organoids in regenerative medicine. Furthermore, we highlight meaningful progress in organoid transplantation, with a particular emphasis on the functional restoration of various organs.


Subject(s)
Neoplasms , Organoids , Animals , Mice , Tissue Engineering/methods , Regenerative Medicine , Bioengineering
7.
Sci Rep ; 14(1): 7325, 2024 Mar 27.
Article in English | MEDLINE | ID: mdl-38538740

ABSTRACT

The ability to modulate optical and electrical properties of two-dimensional (2D) semiconductors has sparked considerable interest in transition metal dichalcogenides (TMDs). Herein, we introduce a facile strategy for modulating optoelectronic properties of monolayer MoSe2 with external light. Photochromic diarylethene (DAE) molecules formed a 2-nm-thick uniform layer on MoSe2, switching between its closed- and open-form isomers under UV and visible irradiation, respectively. We have discovered that the closed DAE conformation under UV has its lowest unoccupied molecular orbital energy level lower than the conduction band minimum of MoSe2, which facilitates photoinduced charge separation at the hybrid interface and quenches photoluminescence (PL) from monolayer flakes. In contrast, open isomers under visible light prevent photoexcited electron transfer from MoSe2 to DAE, thus retaining PL emission properties. Alternating UV and visible light repeatedly show a dynamic modulation of optoelectronic signatures of MoSe2. Conductive atomic force microscopy and Kelvin probe force microscopy also reveal an increase in conductivity and work function of MoSe2/DAE with photoswitched closed-form DAE. These results may open new opportunities for designing new phototransistors and other 2D optoelectronic devices.

8.
Bioact Mater ; 35: 461-476, 2024 May.
Article in English | MEDLINE | ID: mdl-38404641

ABSTRACT

Obesity triggers inflammatory responses in the microenvironment of white adipose tissue, resulting in chronic systemic inflammation and the subsequent development of non-communicable diseases, including type 2 diabetes, coronary heart disease, and breast cancer. Current therapy approaches for obesity-induced non-communicable diseases persist in prioritizing symptom remission while frequently overlooking the criticality of targeting and alleviating inflammation at its source. Accordingly, this review highlights the importance of the microenvironment of obese white adipose tissue and the promising potential of employing immunotherapy to target it as an effective therapeutic approach for non-communicable diseases induced by obesity. Additionally, this review discusses the challenges and offers perspective about the immunotherapy targeting the microenvironment of obese white adipose tissue.

9.
Cell Rep ; 43(2): 113748, 2024 Feb 27.
Article in English | MEDLINE | ID: mdl-38324450

ABSTRACT

Animals are known to exhibit innate and learned forms of defensive behaviors, but it is unclear whether animals can escape through methods other than these forms. In this study, we develop the delayed escape task, in which male rats temporarily hold the information required for future escape, and we demonstrate that this task, in which the subject extrapolates from past experience without direct experience of its behavioral outcome, does not fall into either of the two forms of behavior. During the holding period, a subset of neurons in the rostral-to-striatum claustrum (rsCla), only when pooled together, sustain enhanced population activity without ongoing sensory stimuli. Transient inhibition of rsCla neurons during the initial part of the holding period produces prolonged inhibition of the enhanced activity. The transient inhibition also attenuates the delayed escape behavior. Our data suggest that the rsCla activity bridges escape-inducing stimuli to the delayed onset of escape.


Subject(s)
Claustrum , Male , Animals , Rats , Corpus Striatum , Learning , Neostriatum , Neurons
10.
Fundam Clin Pharmacol ; 38(2): 380-388, 2024 Apr.
Article in English | MEDLINE | ID: mdl-37818695

ABSTRACT

BACKGROUND: Using statins in combination with other drugs was reported to increase the risk of myopathy. However, there was a sparse number of studies on the incidence of adverse events (AEs) associated with the concomitant use of statin and contraindicated drugs in the real world. OBJECTIVES: This study aimed to identify the risk of concomitant use of statins with contraindicated drugs by exploring signals related to statin-drug interactions. METHODS: We performed a disproportionality analysis for drugs and AEs by applying the case/non-case study using the KIDS-KAERS database (KIDS-KD), 2016-2020. A case was defined as an individual case safety reports (ICSRs) including "rhabdomyolysis/myopathy." A non-case was defined as an ICSR, including all other AEs. We applied Ω shrinkage measure model, chi-square statics model, additive model, multiplicative model, and combination risk ratio model to detect signals of myopathy due to statin with concomitant drugs including antiviral agents, immunosuppressants, and antifungals. RESULTS: Among 1 011 234 ICSRs, 2708 were cases, with 861 cases of statin monotherapy and 1248 of concomitant uses of statin. The adjusted reporting odds ratios were 3.27 (95% confidence interval [CI]: 3.11-3.43), 8.70 (95% CI: 8.04-9.40), and 1.83 (95% CI: 1.73-1.94), respectively. Several combinations of signals were detected through an additive model or multiplicative model. CONCLUSION: Signals of an increased risk of myopathy associated with the use of statins with concomitant drugs, including contraindicated drugs, were confirmed in a real-world setting.


Subject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors , Muscular Diseases , Rhabdomyolysis , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects , Muscular Diseases/chemically induced , Muscular Diseases/diagnosis , Muscular Diseases/epidemiology , Rhabdomyolysis/chemically induced , Rhabdomyolysis/diagnosis , Rhabdomyolysis/epidemiology , Drug Interactions
11.
Chem Sci ; 14(38): 10610, 2023 Oct 04.
Article in English | MEDLINE | ID: mdl-37799996

ABSTRACT

[This corrects the article DOI: 10.1039/D3SC03514J.].

12.
Front Plant Sci ; 14: 1252016, 2023.
Article in English | MEDLINE | ID: mdl-37828927

ABSTRACT

The KIX domain, conserved among various nuclear and co-activator factors, acts as a binding site that interacts with other transcriptional activators and co-activators, playing a crucial role in gene expression regulation. In plants, the KIX domain is involved in plant hormone signaling, stress response regulation, cell cycle control, and differentiation, indicating its potential relevance to crop productivity. This study aims to identify and characterize KIX domains within the soybean (Glycine max L.) genome to predict their potential role in improving crop productivity. The conservation and evolutionary history of the KIX domains were explored in 59 plant species, confirming the presence of the KIX domains in diverse plants. Specifically, 13 KIX domains were identified within the soybean genome and classified into four main groups, namely GmKIX8/9, GmMED15, GmHAC, and GmRECQL, through sequence alignment, structural analysis, and phylogenetic tree construction. Association analysis was performed between KIX domain haplotypes and soybean seed-related agronomic traits using re-sequencing data from a core collection of 422 accessions. The results revealed correlations between SNP variations observed in GmKIX8-3 and GmMED15-4 and soybean seed phenotypic traits. Additionally, transcriptome analysis confirmed significant expression of the KIX domains during the early stages of soybean seed development. This study provides the first characterization of the structural, expression, genomic haplotype, and molecular features of the KIX domain in soybean, offering a foundation for functional analysis of the KIX domain in soybean and other plants.

13.
Chem Sci ; 14(37): 9996-10024, 2023 Sep 27.
Article in English | MEDLINE | ID: mdl-37772127

ABSTRACT

Next-generation battery development necessitates the coevolution of liquid electrolyte and electrode chemistries, as their erroneous combinations lead to battery failure. In this regard, priority should be given to the alleviation of the volumetric stress experienced by silicon and lithium-metal anodes during cycling and the mitigation of other problems hindering their commercialization. This review summarizes the advances in sacrificial compound-based volumetric stress-adaptable interfacial engineering, which has primarily driven the development of liquid electrolytes for high-performance lithium batteries. Besides, we discuss how the regulation of lithium-ion solvation structures helps expand the range of electrolyte formulations and thus enhance the quality of solid electrolyte interphases (SEIs), improve lithium-ion desolvation kinetics, and realize longer-lasting SEIs on high-capacity anodes. The presented insights are expected to inspire the design and synthesis of next-generation electrolyte materials and accelerate the development of advanced electrode materials for industrial battery applications.

14.
ACS Appl Mater Interfaces ; 15(28): 33693-33702, 2023 Jul 19.
Article in English | MEDLINE | ID: mdl-37417931

ABSTRACT

Ni-rich layered oxides are regarded as key components for realizing post Li-ion batteries (LIBs). However, high-valence Ni, which acts as an oxidant in deeply delithiated states, aggravates the oxidation of the electrolyte at the cathode, causing cell impedance to increase. Additionally, the leaching of transition metal (TM) ions from Ni-rich cathodes by acidic compounds such as Brønsted-acidic HF produced through LiPF6 hydrolysis aggravates the structural instability of the cathode and renders the electrode-electrolyte interface unstable. Herein, we present a multifunctional electrolyte additive, bis(trimethylsilyl) phosphorofluoridate (BTSPFA), to attain enhanced interfacial stability of graphite anodes and Ni-rich cathodes in Li-ion cells. BTSPFA eliminates the corrosive HF molecules by cleaving silyl ether bonds and enables the formation of a polar P-O- and P-F-enriched cathode electrolyte interface (CEI) on the Ni-rich cathode. It also promotes the creation of a solid electrolyte interphase composed of inorganic-rich species, which suppresses the reduction of the electrolyte during battery operation. The synergistic effect of the HF scavenging ability of BTSPFA and the stable BTSPFA-promoted CEI effectively suppresses the TM leaching from the Ni-rich cathode while also preventing unwanted TM deposition on the anode. LiNi0.8Co0.1Mn0.1O2/graphite full cells with 1 wt % BTSPFA exhibited an enhanced discharge capacity retention of 79.8% after 500 cycles at 1C and 45 °C. These unique features of BTSPFA are useful for resolving the interfacial deterioration issue of high-capacity Ni-rich cathodes paired with graphite anodes.

15.
J Med Econ ; 26(1): 781-792, 2023.
Article in English | MEDLINE | ID: mdl-37300440

ABSTRACT

AIMS: Strategies focus on securing the competitiveness of medical device corporations by strengthening their organizational capabilities, which, in turn, ensure their continuous development. This study aims to investigate both management strategies and organizational culture, which may affect the performance of these companies, and analyzes the influence of education and training investment. MATERIALS AND METHODS: We used data from the 3rd to 6th Human Capital Corporate Panel surveys by the Korea Research Institute for Vocational Education and Training as well as data from the Korea Information Service and 6,112 workers and 260 companies were analyzed. For the analysis, management strategy and organizational culture were set as independent variables, and corporation performance was set as the dependent variable. Additionally, investment in education and training was set as a control variable between the independent and dependent variables. Corporate performance was analyzed by dividing into organizational satisfaction and organizational commitment. RESULTS: Differentiation strategy and innovative culture had a positive (+) effect on organizational satisfaction, while cost leadership strategy and hierarchical culture had a negative (-) effect. On the other hand, in the case of interaction with education and training investment, cost leadership strategy and hierarchical culture had a positive (+) effect, while differentiation strategy and innovation culture had a negative (-) effect. In organizational commitment, innovation culture had a positive (+) effect, and hierarchical culture had a negative (-) effect. In the case of interaction with investment in education and training, only the hierarchical culture had a positive (+) effect. CONCLUSIONS: The innovation culture positively influenced the performance of medical device companies. Furthermore, cost leadership strategy, hierarchical culture, education and training investment improved the corporate performance of these companies. To enhance corporate performance, these companies should create an innovation culture and invest in education and training in accordance with the organizational culture.


COVID-19 has proven the excellence of Korea's medical devices, and the medical device industry is expected to continue to grow due to the increase in chronic disease and non-face-to-face treatment. However, the current medical device industry is monopolized by global companies with capital and technological prowess. To overcome this, Korean medical device companies are developing innovative medical devices centered on start-ups, but now is the time to strategically respond to them in order to compete with global companies. In general, companies establish management strategies for survival and growth by analyzing threats and opportunities based on the market environment to maintain the optimal organization according to market competition, government policies, and changes in consumer needs. Strategies are often established based on the culture of the organizations that make up the company. When it comes to strategy establishment, the medical device industry has special characteristics compared to other industries. The medical device industry is based on advanced technology and puts patient safety first, requiring continuous product upgrades. Therefore, it is an essential industry for employees to invest in education and training. The analysis shows the effectiveness of investment in education and training according to the management strategy and organizational culture of medical device companies. It was confirmed that when medical device companies create an Innovation culture, their performance improves. It also shows that when medical device companies adopt a cost leadership strategy, they need to increase their investment in education and training to improve corporate performance.


Subject(s)
Equipment and Supplies , Organizational Culture
16.
ACS Omega ; 8(19): 16833-16841, 2023 May 16.
Article in English | MEDLINE | ID: mdl-37214723

ABSTRACT

There is a critical need to develop high-performance supercapacitors that can complement and even rival batteries for energy storage. This work introduces a strategy to drastically enhance the energy storage performance of a supercapacitor by engineering electrode morphologies with ternary composites offering distinct benefits for the energy storage application. The electrodes were fabricated with conductive networks of carbon nanotubes (CNTs) coated with a zeolitic imidazole framework (ZIF) for high ion diffusivity and ion-accumulating molybdenum disulfide (MoS2) with various morphologies. These include flower-like (fMoS2), stacked-plate (pMoS2), and exfoliated-flake (eMoS2) structures from topochemical synthesis. CNT-ZIF-fMoS2 demonstrates an excellent energy density, reaching almost 80 Wh/kg, and a maximum power density of approximately 3000 W/kg in a half-cell. This is far superior to the electrodes containing pMoS2 and eMoS2 and attributed to the increased surface area and the faradaic reactivity offered by fMoS2. Additionally, the CNT-ZIF-fMoS2 electrode demonstrates exceptional stability with an ∼78% of capacitance retention over 10,000 cycles. This work suggests that the electrode morphologies can dominate the energy storage behaviors and that the heteromaterial approach may be crucial in designing next-generation supercapacitors.

17.
BMC Prim Care ; 24(1): 24, 2023 01 21.
Article in English | MEDLINE | ID: mdl-36670353

ABSTRACT

BACKGROUND: As the health paradigm shifts toward patient-centeredness, patients can actively participate in their own treatment. However, there is still a unilateral aspect of doctor-patient communication, so it is necessary to specify obstacles between doctors and patients. Therefore, this study attempted to extract obstacles that block doctor-patient communication and to analyze differences in perception of doctor-patient communication. METHODS: A total of 35 questionnaires composed of brainstorming for the study were distributed, and a total of 21 questionnaires were used for analysis. The collected data was analyzed by AHP using dress ver 17.0. RESULTS: As a result of the study, doctors ranked the priority of health communication in the order of professionalism, reliability, fairness, communication, and psychologically. On the other hand, for patients, the priority factors of health communication were communication, fairness, professionalism, reliability, and psychologically. CONCLUSION: In order to improve the quality of health communication between doctors and patients, doctors will be able to communicate from the patient's point of view and strengthen communication with patients by providing consistent medical services and patients need to trust the doctor and patients need to trust their doctors and participate in the medical process faithfully.


Subject(s)
Analytic Hierarchy Process , Health Communication , Humans , Reproducibility of Results , Physician-Patient Relations , Surveys and Questionnaires
18.
Ophthalmic Epidemiol ; 30(5): 499-508, 2023 10.
Article in English | MEDLINE | ID: mdl-36369827

ABSTRACT

PURPOSE: This study aims to investigate the association between antihypertensive use and the risk of cataract in a matched case-control study. METHODS: We analysed the Korean National Health Insurance Service-Health Screening Cohort database from 2002 to 2013. We defined 'cases' as patients prescribed antihypertensives and underwent their first eye cataract surgery between 2010 and 2013. 'Controls' were patients prescribed antihypertensives and no history of cataract surgery or diagnosis between 2002 and 2013. Four controls were matched to each case by several variables. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated for cataract risk using a conditional logistic regression model after adjustment. RESULTS: The analyses comprised 12,166 cases and 48,664 controls. The adjusted ORs for cataracts were 1.18 (95% CI: 1.12-1.24) in thiazide diuretics, 1.12 (95% CI: 1.07-1.18) in beta-blockers, 0.94 (95% CI: 0.90-1.00) in calcium channel blockers, 1.22 (95% CI: 1.14-1.30) in angiotensin-converting enzyme (ACE) inhibitors, and 0.97 (95% CI: 0.91-1.03) in angiotensin II receptor blockers compared to 'non-use' of each antihypertensive. CONCLUSION: In a nationwide case-control study, the use of thiazide diuretics, beta-blockers, or ACE inhibitors do not represent minimal clinical important difference in the risk of cataract and the use of calcium channel blockers or angiotensin II receptor blockers is not associated with an increased risk of cataracts compared to non-use of each antihypertensive. Given the benefits of treating hypertension, such as the reduction in further complications, we suggest there is no need to change current clinical practice for antihypertensives.


Subject(s)
Cataract , Hypertension , Humans , Antihypertensive Agents/adverse effects , Calcium Channel Blockers/adverse effects , Case-Control Studies , Sodium Chloride Symporter Inhibitors/therapeutic use , Hypertension/drug therapy , Hypertension/epidemiology , Hypertension/chemically induced , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Adrenergic beta-Antagonists/adverse effects , Cataract/chemically induced , Cataract/epidemiology , Cataract/complications , Angiotensin Receptor Antagonists/therapeutic use
19.
Eur J Clin Pharmacol ; 79(1): 159-171, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36443528

ABSTRACT

PURPOSE: We aimed to examine the risk of cardiovascular adverse events by tricyclic antidepressant (TCA) dosage among patients with chronic pain. METHODS: A retrospective cohort study was conducted using a nationwide sample cohort. Among patients aged ≥ 18 years with a chronic pain diagnosis and no history of cardiovascular events, we extracted users and non-users of TCAs through 1:1 propensity score matching. TCA users were categorized into three groups according to the mean defined daily dose (DDD): very low doses (< 0.15 DDD), low doses (0.15-0.34 DDD), and traditional doses (≥ 0.34 DDD). A 6-month follow-up was conducted with an intention-to-treat approach. We examined the hazard ratio of cardiovascular adverse events using Cox proportional hazards analysis. RESULTS: In total, 16,660 matched patients were followed up (8330 TCA users and 8330 non-users). TCA use did not significantly increase cardiovascular adverse events (hazard ratio [HR] 1.12, 95% confidence interval [CI] 0.94-1.33). Low-dose (0.15-0.34 DDD) TCAs (HR 1.37, 95% CI 1.08-1.74), particularly low-dose (0.15-0.34 DDD) nortriptyline (HR 2.11, 95% CI 1.44-3.08), was associated with an increased risk of cardiovascular adverse events. Administration of TCAs at the traditional dose (≥ 0.34 DDD) increased the risk of ischemic stroke (HR 2.08, 95% CI 1.11-3.88). CONCLUSION: Close monitoring of patients on long-term, low-dose use of TCAs should be conducted to avoid an increase in the cumulative dose, which increases the risk of cardiovascular adverse events.


Subject(s)
Antidepressive Agents, Tricyclic , Chronic Pain , Humans , Antidepressive Agents, Tricyclic/adverse effects , Retrospective Studies , Chronic Pain/drug therapy , Patients , Nortriptyline/adverse effects
20.
Infect Dis Ther ; 12(2): 443-458, 2023 Feb.
Article in English | MEDLINE | ID: mdl-36520333

ABSTRACT

INTRODUCTION: Although messenger RNA (mRNA) vaccines have been developed and widely utilized to mitigate the coronavirus disease (COVID-19) pandemic, it is essential to describe the adverse events (AEs) following immunization. This study aimed to identify the patterns associated with serious AE reports after mRNA COVID-19 vaccination in the World Health Organization (WHO)'s global scale database (VigiBase). METHODS: This study performed a latent class analysis (LCA) of reports of serious AEs following mRNA COVID-19 vaccination from VigiBase between December 28, 2020 , and February 28, 2022 (N = 312878). The Medical Dictionary for Regulatory Activities (MedDRA) System Organ Class (SOC) terms were selected for LCA. The reporting characteristics in accordance with the cluster were described. We used a multinomial logistic regression model to estimate the association between potential factors and each cluster. RESULTS: Five clusters of AE reports were distinguished through LCA: infection AEs (cluster 1), cardiac AEs (cluster 2), respiratory/thrombotic AEs (cluster 3), systemic AEs (cluster 4), and nervous system AEs (cluster 5). Compared to cluster 4, cluster 2 had a higher proportion of males (OR 2.98; 95% confidence interval (CI) 2.87-3.09), and cluster 1 had a longer time to onset than other AEs (≥ 14 days) (OR 16.2; 95% CI 15.5-16.9). CONCLUSION: Using LCA, we found five clusters of serious AEs following mRNA COVID-19 vaccination. Each cluster was distinguished by potential factors such as age, gender, region, and time to onset. We suggest that monitoring should carefully consider the patterns of young males with cardiac AEs and elderly individuals with thrombosis after respiratory AEs. Our findings could contribute to enhancing understanding of safety profiles and establishing management strategies for serious AEs of special interest following mRNA COVID-19 vaccination.

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