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PubMed | National Evidence based Healthcare Collaborating Agency NECA, Inje University and Sungkyunkwan University
Type: Journal Article | Journal: International journal of psychiatry in medicine | Year: 2015

Depression and diabetes are closely biologically and behaviorally intertwined. We examined the impact of comorbid diabetes mellitus on the incidence of serious psychiatric outcomes among patients with depression.We used claims data from the Korean Health Insurance Review & Assessment Service database of patients who were diagnosed with depression within one year of an index prescription for antidepressants between January 2007 and June 2008. We investigated the association between the comorbidity of diabetes mellitus and serious psychiatric outcomes of depression, such as psychiatric hospitalization, psychiatric emergency room visits, and suicide attempts.Among 200,936 patients with depression, 74,160 (36.9%) had diabetes mellitus, including 57,418 (28.6%) with complications. The incidence of serious psychiatric outcomes was 3.3% in patients with depression without diabetes and 6.7% in patients with depression and diabetes mellitus. Patients with depression and diabetes mellitus complications showed higher rates of serious outcomes than that did those without diabetes mellitus complications (odds ratio, 1.19; 95% confidence interval, 1.11-1.13). Similarly, depressed patients with micro and macrovascular diabetic complications were more likely to experience serious outcomes than those without diabetes mellitus complications (odds ratio, 2.2; 95% confidence interval, 2.07-2.34).Our results showed that comorbid diabetes mellitus can increase the risk of serious outcomes of depression, such as suicide and hospitalization, and thus may alter the antidepressants prescription patterns and healthcare service use among patients with depressive disorders.


Kim S.,Seoul National University | Kim S.,National Evidence based Healthcare Collaborating Agency NECA | Kim S.,Takemi Program in International Health | Kwon S.,Seoul National University | Kwon S.,National Evidence based Healthcare Collaborating Agency NECA
Social Science and Medicine | Year: 2015

To increase financial protection for catastrophic illness, South Korean government expanded the National Health Insurance (NHI) benefit coverage for cancer patients in September 2005. This paper investigated whether the policy has reduced inequality in catastrophic payments, defined as annual out-of-pocket (OOP) health payments exceeding 10% annual income, across different income groups. This study used the NHI claims data from 2002 to 2004 and 2006 to 2010. Triple difference estimator was employed to compare cancer patients as a treatment group with those with liver and cardio-cerebrovascular diseases as control groups and the low-income with the high-income groups. While catastrophic payments decreased in cancer patients compared with those of two diseases, they appeared to decrease more in the high-income than the low-income group. Considering that increased health care utilization and poor economic capacity may lead to a smaller reduction in catastrophic payments for the low-income than the high-income patients, the government needs to consider additional policy measures to increase financial protection for the poor. © 2015 Elsevier Ltd.


Kim Y.,National Evidence based Healthcare Collaborating Agency NECA | Yang B.,Seoul National University
Health Policy | Year: 2011

Objectives: The compositions of health expenditures by households in South Korea with and without catastrophic health expenditures were compared. Also, relationships between catastrophic health expenditures and household incomes, and between such health expenditures and expenditure patterns were explored. Methods: Data from the 2006 South Korean Household Income & Expenditure Survey, a representative survey of 90,696 households were analyzed. We used a double-hurdle model to assess each income source and expenditure category. The independent variable was the presence of catastrophic health expenditure. Results: After adjusting for household characteristics, the results showed that earned, business, and property incomes were significantly lower, but transfer and loan incomes were significantly higher in households with catastrophic health expenditures than in those without such health expenditures. All consumption categories, other than health expenditure, were significantly lower in households with catastrophic health expenditures than in those without catastrophic health expenditures. This suggests that households with catastrophic health expenditures faced challenges in offset by the potentially excessive health expenditure and may have been obliged to reduce consumption of other items. Conclusions: The expansion of insurance coverage and lowering of out-of-pocket rates in the South Korean Health Insurance benefits could be a necessary first step in protecting households from the occurrence of health related economic catastrophes. © 2010 Elsevier Ireland Ltd.


Kim S.,National Evidence based Healthcare Collaborating Agency NECA | Kim S.,Seoul National University | Kim S.,Harvard University | Kwon S.,National Evidence based Healthcare Collaborating Agency NECA | Kwon S.,Seoul National University
Health Policy | Year: 2014

Background: To improve financial protection against catastrophic illness, the Korean government expanded the benefit coverage of the National Health Insurance (NHI) for cancer patients in 2005. This paper examined whether the policy has reduced income-inequality in the use of tertiary care hospitals. Methods: We evaluated the effect of the policy on income-inequalities in outpatient visits and inpatient admissions to tertiary care hospitals, based on triple difference estimators. Using nationwide claims data of the NHI from 2002 to 2010, we compared cancer patients as a treatment group with liver disease and cardio-cerebrovascular disease as control groups and the lower-income with the highest-income group. Results: Before the introduction of the policy, lower-income cancer patients utilized less inpatient and outpatient services in tertiary care hospitals than high-income patients did. After the benefit coverage was expanded, while the incidence and total number of inpatient admissions to tertiary care hospitals increased among cancer patients compared with liver diseases, lower-income cancer patients experienced a greater increase than those of higher-income did compared with both diseases. The use of outpatient services increased more in cancer patients than those of both diseases; however, the gap between the highest- and the lowest-income rarely decreased, except the incidence of visits when compared to liver disease. Conclusion: Our findings indicated that the expanded NHI benefits coverage partially improved income-related inequalities in inpatient admissions to tertiary-care hospital, but not in outpatient visits. © 2014 Elsevier Ireland Ltd.


Kwak S.Y.,Ministry of Health and Welfare | Yoon S.-J.,Korea University | Oh I.-H.,Kyung Hee University | Kim Y.-E.,National Evidence based Healthcare Collaborating Agency NECA
BMC Health Services Research | Year: 2015

Background: In January 2006, the Korean government implemented a copayment waiver policy for hospitalized children under the age of 6 years to reduce the economic burden on patients. This policy was implemented from 2006 to 2007 in Korea and involved hospitalized children under the age of 6 years. The goal of this study is to evaluate the effect of the copayment waiver policy on health insurance beneficiaries. Methods: The change in medical service utilization before and after the policy implementation was analyzed using data from the national health insurance corporation (NHIC) and compared with medical aid beneficiaries who were already exempt from copayment. The "difference in difference" method was applied to determine the net effect of the copayment waiver policy. Results: The net effect of policy implementation on NHIC beneficiaries was unclear by the "difference in difference" method because the number of inpatient days and hospital expenditure after policy implementation showed opposite results. The copayment waiver policy did not decrease the intensity of health care utilization when compared with the medical aid beneficiaries group. Among the NHIC beneficiaries, patients who utilized medical services for fatal disease and those with the low premiums group were more affected by the policy. Conclusions: The net effect of copayment waiver policy remains unclear. Therefore, further studies are needed to determine the effects of policies implemented to reduce the economic burden on patients, such as the herein-described copayment waiver policy. © 2015 Kwak et al.; licensee BioMed Central.


PubMed | National Evidence based Healthcare Collaborating Agency NECA, Dankook University and Kyung Hee University
Type: | Journal: Life sciences | Year: 2015

Heat shock protein 70 (HSP70), one of the major HSPs, has been reported to suppress apoptosis and formation of pathogenic proteins in neurodegenerative disorders. Geranylgeranylacetone (GGA), an anti-ulcer drug, induces HSP70 and thereby protects against cellular damage in various diseases. We investigated the effect of GGA on hydrogen peroxide (H2O2)-induced neurotoxicity in human neuroblastoma SH-SY5Y cells.H2O2-induced neuronal toxicity was measured by a CCK-8 assay and Hoechst 33342 staining. We also assessed oxidative stress and apoptosis by measuring reactive oxygen species (ROS) generation with 2,7-dichlorofluorescein diacetate (DCFH-DA), caspase-3 activity, and mitogen-activated protein kinase (MAPK) pathway.GGA showed a concentration-dependent inhibition on H2O2-induced apoptotic cell death. H2O2-induced induction of HSP70 was enhanced by GGA pretreatment. GGA effectively suppressed the up-regulation of Bax and down-regulation of Bcl-2. GGA also blocked the H2O2-induced phosphorylation of extracellular signal-regulated kinase 1/2 (ERK1/2). In addition, GGA attenuated H2O2-induced ROS generation and caspase-3 activity.These results demonstrate that GGA protects SH-SY5Y cells from H2O2-induced apoptosis, at least in part by enhancing HSP70 production. Neuroprotective properties of GGA indicate that this compound may be a potential therapeutic agent for the treatment and prevention of neurodegenerative diseases.


Lee S.,National Evidence based Healthcare Collaborating Agency NECA | Yoon D.H.,Yonsei University | Kim K.N.,Yonsei University | Shin D.A.,Yonsei University | Ha Y.,Yonsei University
Spine | Year: 2014

STUDY DESIGN.: Cross-sectional study. OBJECTIVE.: To investigate an association between tobacco exposure as determined by urine cotinine and bone mineral density (BMD) in femoral neck and lumbar spine. SUMMARY OF BACKGROUND DATA.: Loss of BMD is 1 of the major causes of spine and femoral neck fractures in the elderly population. There is limited literature on risk factors to loss of BMD, in particular, among males. METHODS.: We analyzed data of 770 males older than 30 years, which were collected from the cross-sectional Fifth Korea National Health and Nutrition Examination Survey, with t tests, analysis of variance, and multiple linear regressions. RESULTS.: The means of femoral neck BMD (T score) significantly decreased with increasing age, -0.08, -0.63, and -1.49 in males aged 30 to 40 years, 50 to 69 years, and 70 to 95 years, respectively (P < 0.001). The same trend was observed in lumbar spine BMD. Although education (P < 0.001) and income (P = 0.021) were associated with femoral neck T score, only education (P = 0.034) was associated with lumbar spine T score. The group who had urine cotinine level of more than 10 μg/mL (active smokers or nonsmokers who were exposed to second-hand smoking) had lower femoral neck T score (-0.43 ± 0.98) than the group who had cotinine level of 10 μg/mL or less (-0.33 ± 0.89) (P = 0.114). In the multiple linear regressions, age, urine cotinine level, and body mass index were statistically related to femoral neck and lumbar spine T score. CONCLUSION.: Our findings suggest that tobacco exposure by active or passive smoking and lower body mass index seem to exert a negative effect on femoral neck and lumbar spine BMD. © 2014 Lippincott Williams and Wilkins.


Na K.-S.,Catholic University of Korea | Chung S.-H.,Catholic University of Korea | Kim J.K.,B and Eye Center | Jang E.J.,National Evidence Based Healthcare Collaborating Agency NECA | And 3 more authors.
Investigative Ophthalmology and Visual Science | Year: 2012

PURPOSE. We compared the 3-year outcomes with regard to efficacy, stability, and safety of LASIK and surface ablation performed at multiple centers in Korea. METHODS. The charts of 5109 eyes that underwent LASIK or surface ablation, including LASEK, epi-LASIK, and photorefractive keratectomy (PRK), at multiple centers between 2002 and 2005 were reviewed. Of these, 577 LASIK-treated eyes and 577 propensity score-matched surface-ablated eyes were included in this cohort study. A standardized case report form (CRF) was completed based on a review of the 3-year follow-up chart. The CRF included the preoperative, surgical, and postoperative data for the refractive error, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), IOP, corneal thickness, keratometry, corneal topography, Schirmer test, and tear breakup time (TBUT). RESULTS. The efficacy index calculated after 3 years and the postoperative spherical equivalents measured at 3 months or 3 years did not differ between the LASIK and surface ablation groups. Although myopic regression was observed in the surface ablation group through postoperative years 1 and 2, this difference did not affect the visual acuity significantly. Surface ablation did carry a higher cumulative incidence of corneal haze. CONCLUSIONS. LASIK and surface ablation produced similar postoperative visual efficacy after corneal healing. The outcome predictability did not differ between the 2 groups, but myopic regression was observed more frequently in the surface ablation group. Corneal haze after surface ablation is much more common than reported previously. © 2012 The Association for Research in Vision and Ophthalmology, Inc.


Ahn J.,National Evidence based Healthcare Collaborating Agency NECA
Journal of the Korean Medical Association | Year: 2011

Non-pharmacological treatments (NPTs) including psychotherapies and behavioral therapies have proven to be an effective treatment tool for patients with depression. More importantly, NPTs reduce drop-out rates for pharmacotherapy when combined with it. Given that one of the major obstacles to effective treatment of depression is low adherence to antidepressant therapies, NPTs deserve more attention in treating patients with depression. This study aims to analyze the current status of NPTs for patients with depression and the relationship with adherence to antidepressant therapies in Korea. The Health Insurance Review Agency (HIRA)'s claims database from 2006 to 2008 was used in the analysis and those patients with at least one inpatient diagnosis with depression or twice diagnosed in outpatient services were included in the analysis (n=290,188). NPTs were identified by HIRA treatment codes in each claim except a routine care treatment (HIRA treatment code, NN011). Adherence to antidepressant therapies was defined as 180-day medication possession ratio. The claims for NPTs decreased almost 25% in 2008 while the number of patients with depression and the claims for antide-pressants were consistently increasing during the same period. Those patients with claims for 4 or more NPTs showed a higher adherence rate than those without. The downward trend of NPT use deserves more attention since it may reduce adherence to pharmacotherapies and increase future medical costs through more relapses from the lowered adherence rates. © Korean Medical Association.


PubMed | National Evidence based Healthcare Collaborating Agency NECA
Type: Journal Article | Journal: Clinical oral implants research | Year: 2016

The purpose of this study was to compare patient satisfaction and oral health-related quality of life (OHRQoL) among fully edentulous patients treated with either fixed implant-supported prostheses (FP), removable implant-supported prostheses (RP), or complete dentures (CD).Eighty-six patients - 29 FP, 27 RP, and 30 CD patients - participated in this study. The survey was conducted using face-to-face interviews with a questionnaire that included a patient satisfaction scale and Oral Health Impact Profile (OHIP-14). We measured patient satisfaction after prosthetic treatments and OHRQoL before and after the treatments.After prosthetic treatments, OHRQoL increased in all three groups (P<0.05). The FP and RP groups showed no significant difference in patient satisfaction and OHRQoL, and both groups showed greater improvement compared with the CD group. Specifically, the OHRQoL dimensions of functional limitation, physical pain, psychological discomfort, and psychological disability in the FP group, and functional limitation in the RP group, improved greatly in comparison with the CD group (P<0.05).Although further research is still needed, prosthetic treatments may provide superior OHRQoL for fully edentulous patients. In particular, both the FP and RP treatments provided significantly greater improvement of OHRQoL and patient satisfaction than the CD treatment. Reliable information of OHRQoL and patient satisfaction helps experts and patients choose the best prosthetic treatment option.

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