Comparative analysis of cardio-cerebrovascular complications in immigrants and native-born Koreans with diabetes: Risk factors and perspectives.

BACKGROUND: Given the rapidly increasing number of immigrants, it is crucial to address health care issues involving immigrants to facilitate their safe and secure settlement. Especially for common chronic diseases, such as diabetes, immigrants face more complex obstacles to manage their chronic conditions than do native-born residents. Therefore, we aimed to assess differences in the incidence and associated risk factors of cardio-cerebrovascular (CCV) complications of immigrants compared with native-born Koreans with diabetes. METHODS: Immigrants and native-born Koreans who had new diagnosis of diabetes and simultaneously received anti-diabetic prescriptions in 2012 were defined by using Korean National Health Insurance Claim Database(KNHICD). CCV complications were assessed at a 3-year follow-up from the index date. We assessed differences in the CCV complications and risk factors using multiple cox regression models. RESULTS: In total, 4,008 patients (668 of immigrants and 3,340 of native-born Koreans) who had newly diagnosed diabetes and simultaneously received anti-diabetic prescriptions in 2012 were selected. Immigrants with diabetes were at a 1.39 times higher risk of having CCV complications than native-born Koreans with diabetes (95% CI: 1.021-1.881). Patients who had a usual sources of care (USC) presented a significantly reduced risk of cardio-cerebrovascular complication (HR: 0.452; 95% CI: 0.342-0.598) in both immigrants and native Koreans. In subgroup analysis in immigrants, patients having USC showed decreased risk of CCV incidence (HR: 0.35, 95% CI: 0.175-0.703), whereas >60 years old and Charlson comorbidity index (CCI) score >1 presented increased risk of CCV complications. CONCLUSION: Immigrants with diabetes have a higher risk of CCV complications than native-born Koreans with diabetes. However, having a USC significantly decreased the risk of CCV complications. Therefore, the utilization of USC will benefit to reduce diabetic complications in immigrants as well as reduction of overall health care cost burden, it would be necessary to implement USC in diabetes care at the initial disease stage.

Drug-induced Parkinsonism: A strong predictor of idiopathic Parkinson's disease.

BACKGROUND: Although Idiopathic Parkinson's disease (IPD) develops in considerable patients with drug-induced Parkinsonism (DIP), the association hasn't been well defined. We aimed to evaluate the underlying association and risk factors of DIP and IPD. METHODS: A retrospective cohort study using National Health Insurance Claims data in 2011-2016 was conducted. New-onset DIP patients in 2012 were selected and matched with active controls having diabetes mellitus at a 1:4 ratio by age, sex, and Charlson's Comorbidity Index score. Comorbidity, causative drugs, and prescription days were evaluated as covariates. RESULTS: A total of 441 DIP were selected. During the 4-year follow up, 14 IPD events in the DM group but 62 events in the DIP group were observed (adjusted hazard ratio, HR: 18.88, 95% CI, 9.09-39.22, adjusting for comorbidities and causative drugs). IPD diagnosis in DIP was observed high in males compared to females (15.58/13.24%). The event was the most within the 1st year follow-up, mean days 453 (SD 413.36). Subgroup analysis in DIP showed calcium channel blocker (verapamil, diltiazem, and flunarizine) was significantly associated with increased IPD risk (HR: 2.24, 95% CI, 1.27-3.93). CONCLUSION: Increased IPD in DIP patients might not be from the causal toxicity of antidopaminergic effects but from a trigger by the causative drugs on the DIP patients who already had subclinical IPD pathology. DIP can serve as a strong proxy for IPD incidence. Subjects who develop DIP should be monitored carefully for potential IPD incidence.

Assessment of a medication management program targeting hypertension and diabetes patients: Impact on medication adherence.

BACKGROUND: The National Health Insurance Service in South Korea has conducted a telephone outreach program to improve medication adherence for hypertension and diabetes patients since 2014. OBJECTIVES: To evaluate the direct outcomes of the program. METHODS: Patients were identified among those who visited an outpatient clinic at least twice or used an inpatient service at least once for hypertension or diabetes during 6-month intervals and who were nonadherent based on the proportion of days covered (PDC) calculated. As a preliminary intervention, participants were mailed an information leaflet on their own medication adherence and other tips for effective self-management of chronic diseases. For the intervention, two phone calls and three phone messages were made to patients by 24 participating regional offices. Ultimately, 2,428 hypertension patients and 884 diabetes patients received the intervention. Propensity matching was used based on age, sex, and the Charlson Comorbidity Index to select 12,140 hypertension and 4,420 diabetes patients as controls in the non-participating regions. The outcome was PDC. Multivariate ordinary least squares or logistic regression analysis were used with difference-in-difference specification. RESULTS: The adjusted quarterly PDC increased by 1.96%p for hypertension (p = 0.023) and by 7.79%p for diabetes patients (p < 0.001). Approximately 40.6% and 51.7% of hypertension and diabetes patients in the treatment arm (p = 0.0069) became adherent after the intervention, whereas the corresponding proportions were 37.7% and 41.4% (p < 0.001) in the control group. Both treatment groups showed a higher likelihood of good medication adherence (hypertension: odds ratio = 1.157, 95% CI [1.058, 1.265]; diabetes: odds ratio = 1.532, 95% CI [1.323, 1.774]). The control group, who received only a print intervention with a mailed leaflet, also showed a dramatic increase in medication adherence. CONCLUSIONS: An insurer-coordinated telephone-administered program resulted in improvement of medication adherence among patients with hypertension and diabetes.

Antidepressant adherence and its predictors in immigrants with depression: A population-based study.

ABSTRACT: Immigrants in Korea are relatively vulnerable in terms of medication self-management and have low levels of medication adherence. We aimed to evaluate antidepressant adherence and its patterns in immigrants and to identify predictors of nonadherence.In this matched cohort study using the National Health Insurance claims database, immigrants who were newly prescribed antidepressants were identified (n = 2,398). The immigrants were matched with native-born Koreans in a 1:1 ratio. Antidepressant adherence was measured by the medication possession ratio at monthly intervals. Logistic regression was performed to compare antidepressant nonadherence between immigrants and native-born Koreans, and to identify factors affecting immigrants' nonadherence.The average medication possession ratio of immigrants was 27.1%, which was lower than that of native-born Koreans (30.9%) (P = .038). Immigrants had a lower likelihood of adherence than native-born Koreans (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.3-0.92). Older age, visiting a psychiatrist for the first diagnosis of depression (OR 2.24, 95% CI 1.60-3.13), achieving appropriateness of care (OR 3.54, 95% CI 2.51-4.98), and having a usual source of care (OR 1.69, 95% CI 1.25-2.27) were associated with a higher likelihood of adherence in immigrants.This study showed that antidepressant adherence of immigrants was lower than that of native-born Koreans. However, it appears that visiting a psychiatrist, achieving appropriateness of care, and having a usual source of care might increase antidepressant adherence among immigrants. Further research that focuses on cultural and/or linguistic factors affecting immigrants' adherence and healthcare utilization is suggested as a way to increase adherence.

Risk Factors and the Usual Source of Care on Non-Adherence to Antihypertensive Drugs in Immigrants with Hypertension.

BACKGROUND: Immigrants are vulnerable to suboptimal health care utilization including non-adherence of medication use. Thus, we aimed to identify the potential risk factors of non-adherence and evaluate whether utilizing a usual source of care was associated with medication adherence in immigrants. METHODS: We utilized the Korea National Health Insurance Claims Database between 2012 and 2015. Cases were immigrants who had antihypertensive prescriptions at the time of hypertension diagnosis in 2012. Controls were native-born Koreans with hypertension who were 1:1 matched to immigrants by age, sex, and Charlson comorbidity index. We used the medication possession ratio for three years to assess the adherence to antihypertensive drugs. The likelihood of non-adherence was evaluated between cases and controls by multivariate linear regression models stratified by age, sex, and number of clinic visits. We assessed the potential risk factors of non-adherence in immigrants by multivariate linear regression and logistic regression models, respectively. RESULTS: In total, 4114 immigrants and 4114 matched native-born Koreans with hypertension were included. The mean MPR was significantly lower in immigrants (56% vs 70%, p<0.0001). Immigrants showed almost two times the level of non-adherence as native-born Koreans (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.83-2.21). Stratified analyses on non-adherence presented the highest non-adherence (2.28 times) in immigrants in the younger group (30-49 years old) and the lowest non-adherence in immigrants in 65 and old group where the risk was 1.69 times higher than native Korean with the same age. The absence of a usual source of care significantly increased medication non-adherence by 1.31 to 1.58 times among immigrants. CONCLUSION: When the number of visited clinics increased, the degree of non-adherence increased consistently. Therefore, the systematization of registering with primary care (a usual source of care) might be a modifiable health care strategy to improve health care outcomes in immigrants.

Data sharing policies of journals in life, health, and physical sciences indexed in Journal Citation Reports.

BACKGROUND: Many scholarly journals have established their own data-related policies, which specify their enforcement of data sharing, the types of data to be submitted, and their procedures for making data available. However, except for the journal impact factor and the subject area, the factors associated with the overall strength of the data sharing policies of scholarly journals remain unknown. This study examines how factors, including impact factor, subject area, type of journal publisher, and geographical location of the publisher are related to the strength of the data sharing policy. METHODS: From each of the 178 categories of the Web of Science's 2017 edition of Journal Citation Reports, the top journals in each quartile (Q1, Q2, Q3, and Q4) were selected in December 2018. Of the resulting 709 journals (5%), 700 in the fields of life, health, and physical sciences were selected for analysis. Four of the authors independently reviewed the results of the journal website searches, categorized the journals' data sharing policies, and extracted the characteristics of individual journals. Univariable multinomial logistic regression analyses were initially conducted to determine whether there was a relationship between each factor and the strength of the data sharing policy. Based on the univariable analyses, a multivariable model was performed to further investigate the factors related to the presence and/or strength of the policy. RESULTS: Of the 700 journals, 308 (44.0%) had no data sharing policy, 125 (17.9%) had a weak policy, and 267 (38.1%) had a strong policy (expecting or mandating data sharing). The impact factor quartile was positively associated with the strength of the data sharing policies. Physical science journals were less likely to have a strong policy relative to a weak policy than Life science journals (relative risk ratio [RRR], 0.36; 95% CI [0.17-0.78]). Life science journals had a greater probability of having a weak policy relative to no policy than health science journals (RRR, 2.73; 95% CI [1.05-7.14]). Commercial publishers were more likely to have a weak policy relative to no policy than non-commercial publishers (RRR, 7.87; 95% CI, [3.98-15.57]). Journals by publishers in Europe, including the majority of those located in the United Kingdom and the Netherlands, were more likely to have a strong data sharing policy than a weak policy (RRR, 2.99; 95% CI [1.85-4.81]). CONCLUSIONS: These findings may account for the increase in commercial publishers' engagement in data sharing and indicate that European national initiatives that encourage and mandate data sharing may influence the presence of a strong policy in the associated journals. Future research needs to explore the factors associated with varied degrees in the strength of a data sharing policy as well as more diverse characteristics of journals related to the policy strength.

Effects of Systemic Glucocorticoid Use on Fracture Risk: A Population-Based Study.

BACKGROUND: Long-term glucocorticoid use increases fracture risk by reducing bone mass. This study evaluated the relationship between hip and vertebral fractures and the total amount of systematic glucocorticoid use. METHODS: We randomly selected 1,896,159 people aged 20 to 100 years who participated in the National Health Checkup program in 2006. The amount of glucocorticoids prescribed was calculated based on the defined daily dose (DDD). The total DDD was obtained by adding oral and parenteral glucocorticoids for 6 months from the index date. Subjects were categorized into four groups according to total glucocorticoid DDDs: non-users (DDDs=0), low users (0< DDDs ≤45), intermediate users (45< DDDs ≤90), and high users (90< DDDs). We followed them for 2 years. A multivariate Cox proportional hazard model was used to evaluate the effects of the total amount of glucocorticoid use on hip and vertebral fractures. RESULTS: Higher glucocorticoid use was associated with a higher risk of vertebral fracture. Relative to non-users, the vertebral fracture risk was 1.39 times higher in the low-user group, 1.94 times higher in the intermediate-user group, and 2.43 times higher in the highuser group. The risk of hip fracture was 1.72 times higher in intermediate users and 3.28 times higher in high users than in non-users. CONCLUSION: As the amount of glucocorticoid use for 6 months increased, the risk of hip and vertebral fractures became higher. In order to prevent fractures, it is necessary for doctors to evaluate the total amount of glucocorticoid prescribed to the patient and to provide appropriate treatment.

Trends in the Prevalence of Drug-Induced Parkinsonism in Korea.

PURPOSE: Discontinuation of offending drugs can prevent drug-induced parkinsonism (DIP) before it occurs and reverse or cure it afterwards. The aim of this study was to investigate the prevalence of DIP and the utilization of offending drugs through an analysis of representative nationwide claims data. MATERIALS AND METHODS: We selected DIP patients of ages ranging from 40 to 100 years old with the G21.1 code from the Korean National Service Health Insurance Claims database from 2009 to 2015. The annual standardized prevalence of DIP was explored from 2009 to 2015. Trends were estimated using the compound annual growth rate (CAGR) and the Cochran-Armitage test for DIP over the course of 6 years. Additionally, the utilization of offending drugs was analyzed. RESULTS: The annual prevalence of DIP was 4.09 per 100000 people in 2009 and 7.02 in 2015 (CAGR: 9.42%, p<0.001). Levosulpiride use before and after DIP diagnosis showed a clear trend for decreasing utilization (CAGR: -5.4%, -4.3% respectively), whereas the CAGR for itopride and metoclopramide increased by 12.7% and 6.4%, respectively. In 2015, approximately 46.6% (858/1840 persons) of DIP patients were prescribed offending drugs after DIP diagnosis. The most commonly prescribed causative drug after DIP diagnosis was levosulpiride. CONCLUSION: The prevalence of DIP has increased. To prevent or decrease DIP, we suggest that physicians reduce prescriptions of benzamide derivatives that have been most commonly used, and that attempts be made to find other alternative drugs. Additionally, the need for continuing education about offending drugs should be emphasized.

Socioeconomic determinants affecting the access and utilization of depression care services in immigrants: A population-based study.

BACKGROUND: It is imperative to address the health problems faced by immigrants in their destination countries in light of the current magnitude of migration processes worldwide. We aimed to evaluate the socioeconomic determinants of healthcare utilization in immigrants with depression. METHOD: A population-based cohort comprising all immigrants who were eligible for National Health Insurance coverage (permanent residents, marriage immigrants, and naturalized citizens) using the National Health Insurance Claims Database in 2011-2013 was established. Cases were defined as immigrants with new-onset depression. Controls were new-onset Korean patients with depression matched by age, sex, and Charlson comorbidity index in a 1:2 ratio. Appropriateness of care (AOC) was defined as visiting a clinic for depression management at least 3 times in the first 12 weeks and 4 times thereafter until 12 months post-cohort entry. RESULTS: A total of 2,378 immigrants and 4,756 matched Korean patients were identified. Of the immigrants, 30.0% achieved AOC, in contrast to 38.7% of Koreans (p < .0001). Adjusting for possible covariates, AOC was less likely for immigrants (adjusted OR (aOR), 0.760; 95% CI: 0.670-0.863). Medical Aid (aOR, 2.309; 95% CI, 1.479-3.610), rural residence (aOR, 1.536; 95% CI, 1.054-2.237), the presence of a psychiatric comorbidity (aOR, 1.912; 95% CI, 1.484-2.463), and visiting a psychiatrist (aOR, 2.387; 95% CI, 1.821-3.125) were associated with an increased likelihood of AOC in immigrants. CONCLUSION: Socioeconomic determinants included insurance type (Medical Aid and National Health Insurance), place of residence, psychiatric comorbid status, doctor specialty, easy access to medical services (clinic-based), and a SSRI-based treatment regimen. Those predictors should be taken into account when developing healthcare strategies for immigrants.

The supraclavicular artery island flap: a salvage option for head and neck reconstruction.

BACKGROUND: Some of head and neck cancer patients are in compromised general condition after ablation surgery and chemoradiation therapy, which makes secondary free tissue transfer quite challenging. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. In those cases, the pedicled flap vascularized by supraclavicular artery could be considered as an alternative to free flap. Despite several authors have demonstrated the clinical reliability of supraclavicular artery island flap (SCAIF), to date, SCAIF has not been widely used among reconstructive surgeon. In this article, we clarified vascular flow pattern and introduce simple surgical technique of SCAIF with a literature review. CASE PRESENTATION: Three patients who had underwent previous neck surgery and adjuvant therapy received maxillofacial reconstruction using SCAIF. It required only a few landmarks, flap harvesting was carried out, and the elapsed time gradually decreased to 15 min with experiences. There were no remarkable morbidities in both donor and recipient sites. CONCLUSION: SCAIF exhibited minimal anatomic variations and short learning curve of surgical techniques, which might be valuable reconstruction modality for beginning surgeon. And it can be beneficial option for the patients with vessel-depleted neck, medically compromised status for lengthened general anesthesia and failed free tissue transfer.

Effect of improved medication adherence on health care costs in osteoporosis patients.

Osteoporosis is a chronic disease that requires continuous health care spending for pharmacotherapy and examinations. Osteoporotic fractures are a major economic burden. However, little is known about the economic effects of osteoporosis and osteoporotic fractures in Korea.The purpose of this study was to determine the predictors of osteoporosis-related health care costs and to evaluate the economic effects of fracture prevention through medication adherence among osteoporosis patients.Using the Korea National Health Insurance Claims Database (KNHICD), we identified osteoporosis patients aged 50 years and older from 2011 to 2012. Annual health care costs of osteoporosis were analyzed from the insurer's perspective and compared between patients with fractures and those without fractures. Adherents were defined as patients with a medication possession ratio of ≥80%. A generalized linear model (GLM) was used to estimate the predictors of osteoporosis-related health care costs.The major predictors of osteoporosis-related health care costs were age, medication adherence, and the occurrence of fractures (P < .001). The proportion of fractures among non-adherents was approximately 1.1 times the proportion among adherents. Health care costs per patient with fractures were 3.8 times the costs per patient without fractures. Patients with fractures had higher health care costs due to hospitalization and outpatient costs but lower pharmacy costs than non-adherents. We estimated that about $5 million of health insurance expenses could be saved annually if all non-adherents became adherents.Improved osteoporosis medication adherence can reduce osteoporosis-related health care costs by preventing fractures. Persistent pharmacotherapy for osteoporosis is necessary to prevent osteoporotic fractures and to reduce osteoporosis-related health care costs.

Geographic variations in antibiotic prescription for pediatric acute upper respiratory tract infections in South Korea.

OBJECTIVE: This study aimed to investigate the factors affecting the geographic differences in antibiotic prescription rates in pediatric upper respiratory tract infections (URI) patients in South Korea. MATERIALS AND METHODS: We performed a nationwide cross-sectional study using 228 administrative districts of Korea, which are the unit of analysis. Prescription rate of antibiotics, the outcome variable, was measured as the proportion of antibiotic prescription days out of total visit days for the treatment of acute URIs using National Health Insurance Service (NHIS) claims data for 2012. Multivariate regression analysis was performed to identify factors affecting geographic variation in antibiotic prescription rates. RESULTS: The socioeconomic status of the district, as measured by the amount of local property tax payable and the proportion of individuals with higher level of education, were negatively correlated with prescription rate. The degree of competition in the hospital market within a district was positively associated with it. Patients living in areas with better access to family medicine physicians and those living in rural areas were less likely to use antibiotics to treat URIs. CONCLUSION: Our findings indicate the importance of considering demand factors as well as supply factors when developing intervention strategies for antibiotic overuse.
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Utilization of Osteoporosis-Related Health Services: Use of Data from the Korean National Health Insurance Database 2008-2012.

BACKGROUND: Osteoporosis and its related fractures are increasingly being recognized as major health problems because of the rapidly increasing elderly population. In this study, we investigated the annual trend of osteoporosis-related health services utilization. METHODS: Participants aged over 50 years were identified from the Korean National Health Insurance Service database between 2008 and 2012. Health service utilization rate and treatment rate were calculated through the operational definition. RESULTS: In this period, the number of osteoporosis patients, aged over 50 years, using the medical service, increased by 33.2%. This increase was higher in males than in females. Moreover, the number of newly diagnosed osteoporosis patients increased by 4.3% in women and 20.4% in men. To estimate the proportion of osteoporosis patients who utilize medical services, we analyzed prevalence data from the Korea National Health and Nutrition Examination Survey from 2008 to 2010. Less than 60% of patients with osteoporosis were estimated to have utilized medical services because of osteoporosis. Drug treatment rates were 34.1%, 31.1%, and 33.5% in 2008, 2009, and 2010, respectively. CONCLUSION: This study demonstrated an increasing trend in the utilization of the osteoporosis-related health services from 2008 to 2012 in Korea. The proportion of newly diagnosed osteoporosis patients and the prevalence of access to medical services increased more in men than in women. Therefore, an increasing need for prevention and treatment of male osteoporosis was observed. The osteoporosis treatment rate was lower than that for other chronic diseases; more efforts are needed to improve awareness regarding osteoporosis treatment.

Flap necrosis after palatoplasty in irradiated patient and its reconstruction with tunnelized-facial artery myomucosal island flap.

BACKGROUND: Tunneled transposition of the facial artery myomucosal (FAMM) island flap on the lingual side of the mandible has been reported for intraoral as well as oropharyngeal reconstruction. This modified technique overcomes the limitations of short range and dentition and further confirms the flexibility of the flap. This paper presents a case of reconstructing secondary soft palatal defect due to flap necrosis following two-flap palatoplasty in irradiated patient with lingually transposed facial artery myomucosal island flap. CASE PRESENTATION: The authors successfully reconstructed secondary soft palatal defect due to flap necrosis following two-flap palatoplasty in an irradiated 59-year-old female patient with tunnelized-facial artery myomucosal island flap (t-FAMMIF). CONCLUSIONS: Islanding and tunneling modification extends the versatility of the FAMM flap in the reconstruction of soft palatal defects post tumor excision and even after radiation, giving a great range of rotation and eliminating the need for revision in a second stage procedure. The authors thus highly recommend this versatile flap for the reconstruction of small and medium-sized oral defects.

Healthcare Costs of Osteoporotic Fracture in Korea: Information from the National Health Insurance Claims Database, 2008-2011.

BACKGROUND: The present study estimated healthcare costs of osteoporotic fractures including spine, hip, distal radius and humerus in Koreans over 50 years of age using national claims data. METHODS: Korea National Health Insurance data between 2008 and 2011 was searched for all claims records of outpatient visits or hospital admissions of patients ≥50-year-of-age. Osteoporosis-related fractures were identified using certain the International Classification of Diseases, Tenth Revision codes and site-specific physician claims for procedures in a patient age cut-off value of 50 years. The healthcare costs included acute phase costs accounting for emergency medical care given immediately after fracture, costs due to further hospitalization and surgical procedures, physiotherapy sessions according to the site of the fracture, and outpatient visits in the year after discharge. RESULTS: The total estimated healthcare costs of osteoporotic fractures in 2011 was $722 million. From 2008 to 2011, the total number and healthcare costs of osteoporotic fractures increased 28.9% (from 127,070 to 163,823) and 31.6% (from $549 million to $722 million), respectively. The portion of national health care expenditure was ranged from 2.3% in 2008 to 2.2% in 2011. The mean healthcare cost of osteoporotic fractures per person increased 2.1% from $4,321 in 2008 to $4,410 in 2011.The mean healthcare costs were highest for hip fractures followed by spine, humerus, and distal radius fractures. CONCLUSIONS: Total Healthcare costs of osteoporotic fractures in South Koreans ≥50-year-of-age increased between 2008 and 2011. This trend will likely continue, which is an important health problem in the elderly population and economically.

Multiple Oral Deep Penetrating Nevi Extending to the Masseter and Buccal Fat Pad.

The deep penetrating nevus (DPN) is a rare benign melanocytic tumor often clinically and histopathologically mistaken for malignant melanoma (MM) and other nevus types. This report describes an extremely rare case of multiple lesions of a large DPN in the oral cavity with extensive infiltration to the minor salivary gland, buccal fat pad, buccinators, and masseter muscles, yet with preservation of the normal anatomic architecture. After receiving a diagnosis of MM in another hospital, the patient was at risk for receiving a wide excision that included the masticatory muscles, facial nerve, and overlying skin. Histopathologically, distinct cellular properties were completely masked with heavy pigmentation, thus precluding a proper distinction of benignity versus malignancy. The proliferative capacity of the tumor was analyzed further by immunohistochemistry of bleached tissue sections and tumor behavior was indirectly evaluated by insufficient tumor stromal interaction, with the conclusion that the specimen was benign. Conservative surgery was limited to the oral cavity. Multiple DPNs in the oral cavity merit attention because of the high risk of being mistaken for MM, which would require a wider surgical excision of the head and neck region.

Characteristics of Retractions from Korean Medical Journals in the KoreaMed Database: A Bibliometric Analysis.

BACKGROUND: Flawed or misleading articles may be retracted because of either honest scientific errors or scientific misconduct. This study explored the characteristics of retractions in medical journals published in Korea through the KoreaMed database. METHODS: We retrieved retraction articles indexed in the KoreaMed database from January 1990 to January 2016. Three authors each reviewed the details of the retractions including the reason for retraction, adherence to retraction guidelines, and appropriateness of retraction. Points of disagreement were reconciled by discussion among the three. RESULTS: Out of 217,839 articles in KoreaMed published from 1990 to January 2016, the publication type of 111 articles was retraction (0.051%). Of the 111 articles (addressing the retraction of 114 papers), 58.8% were issued by the authors, 17.5% were jointly issued (author, editor, and publisher), 15.8% came from editors, and 4.4% were dispatched by institutions; in 5.3% of the instances, the issuer was unstated. The reasons for retraction included duplicate publication (57.0%), plagiarism (8.8%), scientific error (4.4%), author dispute (3.5%), and other (5.3%); the reasons were unstated or unclear in 20.2%. The degree of adherence to COPE's retraction guidelines varied (79.8%-100%), and some retractions were inappropriate by COPE standards. These were categorized as follows: retraction of the first published article in the case of duplicate publication (69.2%), authorship dispute (15.4%), errata (7.7%), and other (7.7%). CONCLUSION: The major reason for retraction in Korean medical journals is duplicate publication. Some retractions resulted from overreaction by the editors. Therefore, editors of Korean medical journals should take careful note of the COPE retraction guidelines and should undergo training on appropriate retraction practices.

Combined Effect of Blood Cadmium and Lead Levels on Coronary Heart Disease Prediction Risk in Korean Men.

This study was designed to investigate the combined effects of cadmium (Cd) and lead (Pb) on 10-year coronary heart disease (CHD) risk calculated using the Framingham risk score. The heavy metal data set of the Korean National Health and Nutrition Examination Survey IV and V (2008-2010) was analyzed. The 10-year CHD risk was significantly associated with the log-transformed blood Cd and Pb levels in Korean men. For the highest quartile of Cd and Pb, the odds ratio (OR) of the intermediate risk and beyond for CHD (10-year risk ≥10%) compared to the lowest quartile was 6.870 (Cd, 95% confidence interval [CI]: 4.58-10.30) and 3.127 (Pb, 95% CI: 2.09-4.69) after adjusting for confounders, respectively. The adjusted OR of the intermediate risk and beyond for CHD (10-year risk ≥10%) in the fourth quartile of both Cd and Pb was 12.2 (95% CI: 8.0-18.5) compared to the reference group (first and second quartiles of Cd and Pb). However, the association between log-transformed blood Cd and Pb and the 10-year CHD risk was not significant in Korean women.