The Effect of Telehealth on Patterns of Health Care Utilization and Medication Prescription in Patients with Diabetes or Hypertension During COVID-19: A Nationwide Study.

Background: In response to the coronavirus disease-19 pandemic, audio-based telehealth services for consultation and medication prescription were temporarily introduced in Korea. This study investigated the impact of telehealth services on patterns of health care utilization and medication prescription in patients with hypertension or diabetes. Methods: The 2019 to 2021 Health Insurance Review and Assessment Service claims data were used. The difference-in-difference approach was used to investigate the effect of telehealth services between the case and control group before and after the intervention period. The pre-intervention period was from February 24, 2019, to February 23, 2020, and the post-intervention period from February 24, 2020, to February 23, 2021. The control group included individuals who used in-person outpatient services and the case group those who utilized both telehealth and in-person services. Results: A total of 250,640 patients with hypertension and 154,212 patients with diabetes were included. The use of telehealth services was associated with an increase in outpatient visits in those with hypertension (0.07, p = 0.0027) and diabetes (0.32, p < 0.0001). A decrease in hospitalizations (-0.2%, p = 0.0007) and emergency department visits (-0.11%, p = 0.0016) was found in individuals with hypertension. Policy implementation also resulted in an increase in medication possession ratio (MPR) and the proportion of appropriate prescription in patients with hypertension (MPR: 3.0%, p < 0.0001, prescription: 3.1%, p < 0.0001) and diabetes (MPR: 3.4%, p < 0.0001, prescription: 1.7%, p < 0.0001). Conclusions: The findings confirm a relationship between implementing telehealth services and improved patterns of health care utilization and medication prescription, suggesting the potential benefit of telehealth in managing chronic diseases.

A re-examination of tourism and peace: The case of the Mt. Gumgang tourism development on the Korean Peninsula.

Tourism can transcend governmental boundaries by bringing people closer together through the understanding of different cultures, heritages, and beliefs. Therefore, it is potentially one of the most important vehicles for promoting peace among the peoples of the world. Although previous South Korean governments have historically proposed a variety of actions to contribute to peace on the Korean Peninsula, there has been little success. However, the Mt. Gumgang tourism development, the hallmark of the Sunshine Policy of former president of South Korea, Dae Jung Kim, is different from previous tourism initiatives as it has had more tangible and practical outcomes that have contributed to the promotion of peace on the divided Peninsula. To this end, the South Korean government has applied the insights of neofunctionalism to the Mt. Gumgang tourism development. This is an approach to integration theory from the perspective of liberalism that has been heralded in international politics. According to this approach, it is expected that the Mt. Gumgang tourism development can be used as a tool to maintain peaceful circumstances, which results in spill-over effects, enlargement of activity scopes, and a heightened level of commitment on the Korean Peninsula. The purpose of this study is to empirically test the hypothesis that the Mt. Gumgang tourism development contributes to the peace of the Korean Peninsula by employing the theory of neofunctionalism. To test this hypothesis, this study proposes a Peace Index and investigates the spill-over effects by utilizing the Mt. Gumgang tourism development as a test case. The results of this study indicate that the view that tourism contributes to peace is valid but tenuous since the impact of the Mt. Gumgang tourism development in the promotion of peace was less significant than expected. Consequently, the results of this study also indicate that neofunctionalism, which has been developed for western political systems, needs to be re-examined when applied to the unique, dynamic, and complex political circumstances on the Korean Peninsula.

Tissue recommendations for precision cancer therapy using next generation sequencing: a comprehensive single cancer center's experiences.

To generate accurate next-generation sequencing (NGS) data, the amount and quality of DNA extracted is critical. We analyzed 1564 tissue samples from patients with metastatic or recurrent solid tumor submitted for NGS according to their sample size, acquisition method, organ, and fixation to propose appropriate tissue requirements.Of the 1564 tissue samples, 481 (30.8%) consisted of fresh-frozen (FF) tissue, and 1,083 (69.2%) consisted of formalin-fixed paraffin-embedded (FFPE) tissue. We obtained successful NGS results in 95.9% of cases. Out of 481 FF biopsies, 262 tissue samples were from lung, and the mean fragment size was 2.4 mm. Compared to lung, GI tract tumor fragments showed a significantly lower DNA extraction failure rate (2.1 % versus 6.1%, p = 0.04). For FFPE biopsy samples, the size of biopsy tissue was similar regardless of tumor type with a mean of 0.8 × 0.3 cm, and the mean DNA yield per one unstained slide was 114 ng. We obtained highest amount of DNA from the colorectum (2353 ng) and the lowest amount from the hepatobiliary tract (760.3 ng) likely due to a relatively smaller biopsy size, extensive hemorrhage and necrosis, and lower tumor volume. On one unstained slide from FFPE operation specimens, the mean size of the specimen was 2.0 × 1.0 cm, and the mean DNA yield per one unstained slide was 1800 ng.In conclusions, we present our experiences on tissue requirements for appropriate NGS workflow: > 1 mm2 for FF biopsy, > 5 unstained slides for FFPE biopsy, and > 1 unstained slide for FFPE operation specimens for successful test results in 95.9% of cases.

Determinants of health care expenditures and the contribution of associated factors: 16 cities and provinces in Korea, 2003-2010.

OBJECTIVES: The purpose of this study was to classify determinants of cost increases into two categories, negotiable factors and non-negotiable factors, in order to identify the determinants of health care expenditure increases and to clarify the contribution of associated factors selected based on a literature review. METHODS: The data in this analysis was from the statistical yearbooks of National Health Insurance Service, the Economic Index from Statistics Korea and regional statistical yearbooks. The unit of analysis was the annual growth rate of variables of 16 cities and provinces from 2003 to 2010. First, multiple regression was used to identify the determinants of health care expenditures. We then used hierarchical multiple regression to calculate the contribution of associated factors. The changes of coefficients (R(2)) of predictors, which were entered into this analysis step by step based on the empirical evidence of the investigator could explain the contribution of predictors to increased medical cost. RESULTS: Health spending was mainly associated with the proportion of the elderly population, but the Medicare Economic Index (MEI) showed an inverse association. The contribution of predictors was as follows: the proportion of elderly in the population (22.4%), gross domestic product (GDP) per capita (4.5%), MEI (-12%), and other predictors (less than 1%). CONCLUSIONS: As Baby Boomers enter retirement, an increasing proportion of the population aged 65 and over and the GDP will continue to increase, thus accelerating the inflation of health care expenditures and precipitating a crisis in the health insurance system. Policy makers should consider providing comprehensive health services by an accountable care organization to achieve cost savings while ensuring high-quality care.

Change in waist circumference and the progression of subclinical atherosclerosis in type 2 diabetes patients.

OBJECTIVE: We aimed to assess the effect of reducing body weight, waist circumference, and various metabolic parameters on the progression of carotid intima media thickness (IMT) in Korean type 2 diabetes patients. METHODS: This study comprised of 173 patients. Anthropometric measurements, metabolic parameters, and carotid IMT were measured at baseline and 1 year later. RESULTS: There were significant differences in waist circumference, HbA1c, and mean left and right IMT after 1 year. The change in waist circumference correlated with changes in HbA1c and changes in right and left IMT after adjusting for age, sex, and medications that could influence the IMT. In multiple regression analysis, the change in waist circumference was a significant predictor of the progression of maximum right and left IMT, with a marginal significance for the latter, and mean left IMT, independent of changes in body weight, BMI, HbA1c level, and the use of anti-hyperlipidemic, antiplatelet agents and thiazolidinediones. CONCLUSION: Controlling abdominal obesity seems to have a significant impact on the progression of subclinical atherosclerosis in patients with diabetes, and therefore, more efforts should be made toward reducing waist circumference to inhibit overt atherosclerotic diseases.

Triiodothyronine level predicts visceral obesity and atherosclerosis in euthyroid, overweight and obese subjects: T3 and visceral obesity.

OBJECTIVE: We assessed how thyroid hormones affect the visceral obesity and atherosclerosis in euthyroid, overweight and obese Asian subjects. METHODS: Metabolic parameters and thyroid hormone levels were measured in 177 subjects who visited obesity clinic at Gangnam Severance Hospital. Total adipose tissue area (TAT), subcutaneous adipose tissue area (SAT), visceral adipose tissue area (VAT) were quantified by computerized tomography scan, and, pulse wave velocity (PWV) was measured as a marker of atherosclerosis. RESULTS: T3 was significantly related to all the measures of abdominal fat, TAT (P = 0.001), SAT (P = 0.015), VAT (P < 0.001), and waist circumference (P = 0.001) as well as BMI (P = 0.017) and total body fat percent (P = 0.001) after adjusting for age and sex. In multiple regression analysis, T3 was independently associated with VAT (ß = 0.486, P = 0.009). There was a positive correlation between T3 and PWV. CONCLUSIONS: T3 level is positively associated with the amount of visceral fat and PWV. Visceral obesity seems to cause an increase in circulating T3 level as an adaptational response to increase the energy expenditure, and thus a more close attention and an effort to assess cardiovascular risks should be made to people with high normal T3 level.

Usefulness of brachial-ankle pulse wave velocity as a predictive marker of multiple coronary artery occlusive disease in Korean type 2 diabetes patients.

Multiple coronary artery occlusive disease (multiple CAOD) is the most fatal and frequently observed coronary artery disease in type 2 diabetes patients, but no simple, non-invasive screening tool is available yet. The aim of this study is to evaluate the arterial stiffness in type 2 diabetes patients using brachial-ankle pulse wave velocity (baPWV), to demonstrate the correlation between arterial stiffness and multiple CAOD, and to suggest the cutoff point of baPWV for predicting multiple CAOD in Korean type 2 diabetes patients. One hundred and eighty-one diabetes and 262 non-diabetes patients were enrolled in the study. Routine anthropometric and serologic data were collected. baPWV was measured the day before coronary angiography, and the severity of CAOD was assessed with Gensini score after angiography. baPWV and Gensini score were significantly increased in diabetes patients and Gensini score had a positive correlation with baPWV. Subjects in the highest tertile of baPWV showed odds ratio of 3.06 for multiple CAOD compared to the lowest tertile. In ROC curve, baPWV at 1635 cm/s showed 73% sensitivity and 75% specificity with AUC 0.76 in diabetes patients in detecting multiple CAOD. Therefore, baPWV may be utilized a screening tool for predicting multiple CAOD, especially in type 2 diabetes patients.

Association of abdominal obesity with atherosclerosis in type 2 diabetes mellitus (T2DM) in Korea.

The aim of this study was to investigate the relationship between obesity, insulin resistance and atherosclerosis in type 2 diabetes mellitus (T2DM) patients. Total 530 patients with T2DM were included. To evaluate the severity of atherosclerosis, we measured the coronary artery calcification (CAC) score, intima-media thickness (IMT) of the common carotid artery, and the ankle-brachial pressure index (ABPI). Subjects were classified according to body mass index (BMI), a marker of general obesity, and waist-to-hip ratio (WHR), a marker of regional obesity. The insulin sensitivity index (ISI) was measured by the short insulin tolerance test. All subjects were classified into four groups, according to BMI: the under-weight group, the normal-weight (NW) group, the over-weight (OW) group, and the obese (OB) group. WHR and systolic blood pressure, triglycerides (TG), HDL-cholesterol (HDLC), free fatty acids (FFA), fibrinogen, and fasting c-peptide levels were significantly different between BMI groups. TG, HDL-C, FFA, fibrinogen and ISI were significantly different between patients with and without abdominal obesity. In the OW group as well as in the NW group, carotid IMT, ABPI and CAC score were significantly different between patients with and without abdominal obesity. This study indicates that abdominal obesity was associated with atherosclerosis in T2DM patients.