Sex Differences in Factors Affecting Hospital Outpatient Department Visits: Korea Health Panel Survey Data From 2009 to 2016

This study intends to inspect the sex differences in proportion of hospital outpatient department (OPD) visits in overall outpatient (OP) visits using national panel data and to explore factors that influence the proportions by sex. This study analyzed data of the 2009-2016 Korea Health Panel Survey. Fractional logit regression was applied to analyze factors that affect proportion of hospital visits among outpatient visits. Analysis of related factors was carried out first for all analysis subjects and then by sex. The study data were provided by 7470 women (52.2%) and 6846 men (47.8%). The overall average number of OP visits was 13.0, and women showed a much higher frequency of visits (15.8) than men (9.9). The average proportion of hospital OPD visits among overall OP visits was 21.9%, and men showed a higher rate (25.1%) than women (19.5%). The analysis model including sociodemographic factors, economic factors, and health-related factors confirmed that men showed a higher rate of hospital usage than women. Type of medical security, household income, participation in economic activities, disability, and serious illnesses were significant variables for both sexes. Age, education level, marital status, and subscription to voluntary private health insurance were significant only for women, whereas region of residence was significant only for men. This study confirmed that there is a sex difference in proportion of hospital OPD visits and in the factors that affect the proportion of hospital OPD visits. Universal health coverage is provided through social health insurance, but there is a sex difference in hospital OPD visits, and factors related to socioeconomic status have a significant effect, especially on women's selection of health care institutions. More attention should be given to sex differences in factors affecting health care utilization.ope

Relationship between Physical Function Factors and Discrimination Experiences of the Elderly in Korea: The 2014 and 2017 National Survey on Living Conditions and Welfare Needs of Korean Older Persons

Background: Supporting the elderly population is presented as a social issue, and it affects age discrimination, which forms a negative perception and avoids the elderly. Since age discrimination lowers the quality of life of the elderly and hinders social unity, it may be important to research related factors. This study examined the physical function as a factor that influences discrimination experiences and aimed to identify the relationship between physical function factors and discrimination experiences. Methods: In this study, we analyzed 20,225 elderly from the 2014 and 2017 survey of living conditions and welfare needs of Korean older persons, conducted nationwide among older than 65 years. Physical function factors are activities of daily living, instrumental activities of daily living, sight discomfort, hearing discomfort, chewing discomfort, and leg strength as factors of interest. We performed multivariable logistic regression that reflected survey characteristics, adjusting for socio-demographic factors, health related factors, and social-support factors. Results: The number of elderly who faced discrimination experiences was 1,175 (5.8%). The results showed that the odds ratio of facing a discrimination experience in the dependent group was significantly higher compared to the independent group when being transferring out of the room (4.05; 95% confidence interval [CI], 1.50–10.88) and difficulty in hearing (1.25; 95% CI, 1.05–1.49). Even with respect to chewing ability, which was significant in models 1 and 2, they face more discrimination experiences (1.30; 95% CI, 1.11–1.53). Conclusion: These research results indicate that an important strategy for preventing age discrimination is to understand the physical function conditions of the elderly and promote the physical functions of the elderly related to transferring, hearing, and chewing; it is necessary to develop a practical intervention plan that considers these aspects.ope

Determinants of Purchasing Indemnity Private Health Insurance among Adolescents and Children

As interest in adolescent and children's health risks increases, there is an increase in subscriptions to indemnity private health insurance. The purpose of this study was to investigate determinants of purchasing indemnity private health insurance. We conducted panel logit regression analysis on the sample of 4,567 adolescent and children using Korean Health Panel data from 2009 to 2015. As a result, it was analyzed that the participation of private health insurance for children and adolescents was affected not only by the characteristics of children and adolescents (age, birth order, residence, disability) but also by the characteristics of father (indemnity, disability, chronic disease) and mother (age difference between her and her children, indemnity, unmet needs) and the economic level of households (income). In views of this study, it is necessary to continuously implement policies to strengthen the healthcare of children and adolescents in order to alleviate the anxiety about the health risks of children and the burden of medical expenses caused by late marriages and maternal births. In particular, it is necessary to consider policies for multi-child families and vulnerable classes.ope

Factors Associated with the Long-Stay Admissions in Geriatric Hospitals - Focused on Dementia’s Inpatients -

Purposes: The purpose of this study was to identify the factors related to the long-stay hospitalization of dementia patients aged 65 years or older who had received inpatient care at geriatric hospitals according to the minute facility characteristics and patient features. Methodology: This study was conducted on 317,353 cases of 1,512 geriatric hospitals using the Health Insurance Review and Assessment Service dataset. The data collected were processed using the SAS Enterprise Guide 4.3 for descriptive statistics, the chi-square test, and the binary logistic regression analysis. Findings: As a result of the study, in the facility characteristics of geriatric hospitals, the long-stay hospitalization of the aged with dementia were found to be related to the type of facility establishment, the number of hospital beds, the number of medical specialists, the number of nursing personnel, and the number of geriatric hospitals by region and province. In the personal features of patients, the long-stay hospitalization was found to be associated with the gender, age, insurance, and the patient classification groups. Practical Implication: Considering the results of this study, it seems that securing the sufficient medical personnel in a geriatric facility, providing the good quality medical services, and preparing the appropriate discharge plan can reduce the unnecessary long-stay hospitalization and spend the medical expenses for the older patients.22Nkc

Anti-adhesive effect of new material in a laminectomy model in rats

학위논문 (석사)-- 서울대학교 대학원 : 의학과 정형외과학전공, 2011.2. 이재협.Maste

Quantitative Multiplexed Immune Profiling of Advanced Gastrointestinal Stromal Tumors (GISTs): Impact of Tyrosine Kinase Inhibitors on the Tumor Immune Microenvironment

Background: The immune microenvironment of Gastrointestinal Stromal Tumors (GISTs) is largely unknown and there is no approved immunotherapeutic agent for the treatment of advanced GISTs. To investigate the potential application of novel immunotherapeutic strategies, we analyzed the immune microenvironment in tumors from patients with GISTs. Methods: A total of 80 surgical specimens of advanced GISTs were acquired from 67 patients. The specimens were grouped according to the treatment setting: tyrosine kinase inhibitor (TKI)-naïve group (n=20); imatinib-progressed and no exposure to sunitinib or regorafenib (IM-PD group, n=30); and imatinib-progressed, sunitinib and/or regorafenib-treated group (IM-PD/SU-treated group, n=30). Seven-color multiplex immunofluorescence staining was performed on all 80 specimens. RNA sequencing and gene expression analysis for immune-related gene expression were performed on the specimens of 29 patients (TKI-naïve [n=10], IM-PD [n=14], and IM-PD/SU-treated group [n=5]). Results: In TKI-naïve GISTs, the median number (interquartile range [IQR]) of immune cells per mm2 was: CD3+, 79.2 (22.4-434.5); CD3+/CD8+, 6.7 (1.5-75.6); CD3+/FoxP3+, 4.4 (0.3-28.3); CD68+/CD204+, 2.3 (1.1-41.1); CD68+/CD204-, 8.7 (2.0-20.1); CD3+/PD1+, 0.6 (0-2.0); and CD3+/TIM3+, 0.2 (0-2.5). In IM-PD/SU-treated GISTs, the median number (IQR) of immune cells per mm2 was: CD3+, 302.9 (63.4-502.9); CD3+/CD8+, 38.6 (8.9-105.4); CD3+/FoxP3+, 34.0 (6.6-59.7); CD68+/CD204+, 25.2 (6.4-54.2); CD68+/CD204-, 9.6 (4.0-28.9); CD3+/PD-1+, 2.3 (1.0-3.7); and CD3+/TIM3+, 1.8 (0-12.7). The regulatory T cells (CD3+/FoxP3+), M2 polarized macrophages (CD68+/CD204+), PD-1+ T cells (CD3+/PD-1+), and TIM3+ T cells (CD3+/TIM3+) were increased in the IM-PD/SU-treated group (P=0.047, P=0.023, P=0.016, and P=0.002, respectively). IM-PD/SU-treated GISTs had increased ratios of infiltrative T cells to tumor cells (CD3+ cells per DOG-1+ cells, P=0.03); PD-1+ T-cells to pan-T cells (CD3+/PD-1+ per CD3+, P=0.002); PD-1+ cytotoxic T cells to pan-T cells (CD8+/PD-1+ per CD3+, P=0.007); PD-L1+ T-cell to pan-T cells (CD3+/PD-L1+ per CD3+, P=0.005); regulatory T cells to pan-T cells (CD3+/FoxP3+ per CD3+, P=0.006); and PD-1+ tumor cells to total tumor cells (DOG-1+/PD-1+ per DOG-1+, P=0.01). Compared to IM-PD GISTs, IM-PD/SU-treated GISTs had increased ratios of cytotoxic T cells to pan-T cells (CD3+/CD8+ per CD3+; P=0.07) and TIM3+ T cells to pan-T cells (CD3+/TIM3+ per CD3+; P=0.03). IM-PD/SU-treated GISTs had increased M2 polarized macrophages compared to TKI-naive GISTs (P=0.049) and marginally increased M2 polarized macrophages compared to IM-PD GISTs (P=0.10). In the RNA sequencing (RNAseq) analysis, FoxP3 expression was marginally increased in IM-PD/SU treated GISTs compared to TKI-naive GISTs (P=0.11). IM-PD/SU-treated GISTs had marginally increased TIM3 expression compared to IM-PD GISTs (P=0.06). TIGIT expression was significantly increased in IM-PD/SU-treated GISTs compared to IM-PD GISTs (P=0.01). Conclusion: Immune cell infiltrates were increased and immunosuppressive phenotypes were predominant in the tumors treated with anti-angiogenic agents compared to those that were TKI-naive or treated with imatinib. These findings suggest that this patient population may be appropriate candidates for future immunotherapy clinical trials targeting T cells or macrophages. Further investigation is needed to define optimal immunotherapy strategies in specific subpopulations of patients with GIST.Docto

Factors Influencing the Purchase of Indemnity Private Health Insurance among the Elderly People Aged 65-75

Purpose: As an interest in the elderly medical expenses increases, elderly people are increasingly purchasing indemnity private health insurance. Authors tried to investigate factors of having the indemnity private health insurance among the elderly people aged 65-75 years. Methods: We conducted panel logit regression analysis on 2,465 subjects as of 2016 using Korean Health Panel from 2010 to 2016. The dependent variable was whether to enroll in the indemnity private health insurance. The explanatory variables included socio-demographic characteristics, economic factors, health status, and health behaviors. Findings: As a result of the analysis of factors of purchasing indemnity private health insurances, it was analyzed that people with larger family, educated, pensioner, high household income or no disability were more likely to have indemnity private health insurance. Practical Implications: Considering the results of this study, the factor of purchasing indemnity private health insurance among elderly people were more likely to be their economic than demographic characteristics such as sex, age, and marital status. Policy makers should make efforts to reduce the burden on the elderly medical expense and to improve equity of medical use through institutional improvement such as raising age limit and lowering premium of indemnity private health insurance and expansion of public health insurance.restrictio

Clinical outcomes of liposomal irinotecan plus fluorouracil/leucovorin for metastatic pancreatic adenocarcinoma in patients previously treated with conventional irinotecan-containing chemotherapy

Introduction: Liposomal irinotecan (nal-IRI) plus fluorouracil/leucovorin (5-FU/LV) has shown clinical benefit in patients with metastatic pancreatic adenocarcinoma (mPAC) who progressed on gemcitabine-based chemotherapy. However, its role in patients with mPAC previously treated with conventional irinotecan-containing chemotherapy has not been appropriately investigated. Methods: In this retrospective analysis, patients with mPAC who received nal-IRI plus 5-FU/LV after conventional irinotecan-containing regimen between January 2017 and March 2020, were identified from two referral cancer centers in South Korea. The ratio of time to progression (TTP) with nal-IRI plus 5-FU/LV to TTP with conventional irinotecan (TTPr) was analyzed with respect to the duration and cumulative dose of conventional irinotecan treatment. Results: In total, 35 patients treated with nal-IRI plus 5-FU/LV after the irinotecan-containing regimen were analyzed. The median age was 58 years and 16 (46%) patients were male. The median duration of conventional irinotecan therapy was 4.6 months at a median cumulative dose of 1230 mg. The objective response rate of nal-IRI plus 5-FU/LV was 2.9%, and stable disease was achieved in 11 (31.4%) patients. During the median follow-up of 9.2 [95% confidence interval (CI): 7.8-10.5] months, the median progression-free survival (PFS) and overall survival (OS) were 2.0 (95% CI: 1.4-2.6) months and 4.4 (95% CI: 3.6-5.7) months, respectively. The 6-month PFS and OS rates were 16.3% and 37.5%, respectively. The median TTPr was 0.41 (range, 0.07-2.07), showing a negative correlation with the cumulative dose of prior irinotecan therapy (R = -0.37, p = 0.041). A tentative negative correlation between TTPr and duration of prior irinotecan therapy was observed (R = -0.35, p = 0.062). The most common grade 3-4 toxicities were neutropenia (20%) and fatigue (8.6%). Conclusion: Nal-IRI plus 5-FU/LV showed modest effectiveness and manageable toxicities for patients with mPAC previously treated with conventional irinotecan-containing chemotherapy. The cumulative dose of prior conventional irinotecan therapy may be inversely correlated with the effectiveness of nal-IRI plus 5-FU/LV