Background: There are limited data evaluating the cost-effectiveness of gastric cancer screening using endoscopy or upper gastrointestinal x-ray in the general population. Objective: To evaluate the cost-effectiveness of population-based screening for gastric cancer in South Korea by decision analysis. Methods: A time-dependent Markov model for gastric cancer was constructed for healthy adults 30 years of age and older, and a deterministic sensitivity analysis was performed. Cost-utility analysis with multiple strategies was conducted to compare the costs and effects of 13 different screening alternatives with respect to the following eligibility criteria: age at the beginning of screening, screening interval, and screening method. The main outcome measurement was the incremental cost-effectiveness ratio. Results: The results revealed that annual endoscopic screening from ages 50-80 was the most cost-effective for the male population. In the females, biennial endoscopy screening from ages 50-80 was calculated as the most cost-effective strategy among the 12 screening alternatives. The most cost-effective screening strategy may be adjustable according to the screening costs and the distribution of cancer stage at screening. The limitation was that effectiveness data were obtained from published sources. Conclusions: Using the threshold of $19,162 per quality-adjusted life year on the basis of the Korean gross domestic product (2008), as suggested by the World Health Organization, endoscopic gastric cancer screening starting at the age of 50 years was highly cost-effective in the Korean population. The national recommendation for gastric cancer screening should consider the starting age of screening, the screening interval, and the screening modality.
Osteoporosis, which causes mainly fracture of the spine, proximal femur and distal radius by minimal trauma, is a major public health problem and its prevalence is steadily increasing in Korea according to the development of public health care. There are reliable methods for diagnosis based on bone densitometry. Early detection and intervention are important for reducing the incidence of fractures. A consensus definition of osteoporosis, based on bone density measurement, has been developed by the World Health Organization(WHO). In this study, bone mineral density(RMD) was measured by dual energy x-ray absorptiometry(DEXA) at the proximal femur and lumbar spine in 132 post-menopausal women. The purpose of this study is to find influential factors on the BMD of the proximal femur and the lumbar spine and to analyze correlation between BMD and the problematic factors. We obtained the following results : 1. Mean BMD score, T-score and Z-score of the proximal femur were $0.81(g/cm^2)$, -2.45(S.D.) and -2.09(S.D.) respectively and in the lumbar spine were $0.83(g/cm^2)$, -2.02(S.D.), -2.43(S.D.) respectively. 2. In correlation analysis between BMD and many factors, correlation coefficients were -0.467, 0.212, -0.321 and 0.241 in age, height, duration after menopause respectively. BMI and the residuals were comparatively small. 3. Correlation coefficients to age matched BMD, in height and body weight were 0.222 and 0.241, in age and duration after menopause were -0.268, -0.282. 4. The fracture threshold of proximal femur BMD to the 90th percentile was $0.845(g/cm^2)$. 5. At the result of multiple regression analysis, age, body weight, $BMI(kg/m^2)$ and duration after menopause described as significant variables.
Background: In South Korea, 22.3% of women ${\geq}50years$ of age and 37% of women ${\geq}70years$ of age visit the doctor to obtain treatment for osteoporosis. According to the analysis of the National Health Insurance Services claim data between 2008 and 2012, the number and incidence of hip and vertebral fractures increased during the same period. Denosumab, a newly marketed medicine in Korea, is the first RANK inhibitor. Methods: A cost-utility analysis was conducted from a societal perspective to prove the superiority of denosumab to alendronate. A Markov cohort model was used to investigate the cost-effectiveness of denosumab. A 6-month cycle length was used in the model, and all patients were individually followed up through the model, from their age at treatment initiation to their time of death or until 100 years of age. The model consisted of eight health states: well; hip fracture; vertebral fracture; wrist fracture; other osteoporotic fracture; post-hip fracture; post-vertebral fracture; and dead. All patients began in the well-health state. In this model, 5% discounted rate, two-year maximum offset time, and persistence were adopted. Results: The total lifetime costs for alendronate and denosumab were USD 5,587 and USD 6,534, respectively. The incremental cost-effectiveness ratio (ICER) for denosumab versus alendronate was USD 20,600/QALY. Given the ICER threshold in Korea, the results indicated that denosumab was remarkably superior to alendronate. Conclusion: Denosumab is a cost-effective alternative to the oral anti-osteoporotic treatment, alendronate, in South Korea.
Journal of Physiology & Pathology in Korean Medicine
/
v.21
no.3
/
pp.748-754
/
2007
Electroacupuncture is the combined treatment of mechanical and electric stimuli on the needle head, on which electricity runs after acupuncturing at the acupuncture points. It is reported that its treatment effect depends on the parameter of stimulus, which is wave of stimulus, frequency, voltage, and duration of electric current. To get the effective treatment, stimulus intensity over threshold is needed. We planned to experiment whether acupuncture effect is affected by sex, age, and weight. After we conducted electric stimulus at Zusanli(ST 36) which is known to increase small intestinal motility in normal rats, we observed the effects and got the following results. Though the increased effects of small intestinal motility of electro-acupuncture at Zusanli(ST 36) did not show the difference of sex, this effect was observed to have a tendency to decrease according to weight increase without distinction of sex. But the effect of electro-acupuncture shown in 4, 5, 7 weeks old without distinction of sex was observed to have a tendency to decrease with the growing of weeks-old in the male rat group. And the significant change without specific tendency was observed in the 4, 5 weeks old female rat group. This result suggested that sex, weight, and age should be considered to get the efficient electro-acupuncture. The more experimental study should be advanced to investigate the correlation between the factors that can affect the acupuncture treatment, and, afterward, the interconnection into the clinical use.
Objectives: Though sulfur dioxide (SO2) is used widely at workplaces, itseffects on humans are not known. Thresholds are reportedwithout reference to gender or age and occupational exposure limits are basedon effects on lung functioning, although localized effects in the upper airways can be expected. This study's aim is to determine thresholds with respect to age and gender and suggests a new approach to risk assessment using breathing reflexes presumably triggered by trigeminal receptors in the upper airways. Methods: Odor thresholds were determined by the ascending method of limits in groups stratified by age and gender. Subjects rated intensities of different olfactory and trigeminal perceptions at different concentrations of $SO_2$. During the presentation of the concentrations, breathing movements were measured by respiratory inductive plethysmography. Results: Neither age nor gender effects were observed for odor threshold. Only ratings of nasal irritation were influenced bygender. A benchmark dose analysis on relative respiratory depth revealed a 10%-deviation from baseline at about 25.27 mg/$m^3$. Conclusion: The proposed new approach to risk assessment appearsto be sustainable. We discuss whether a 10%-deviation of breathingdepth is relevant.
Retinal prosthesis is regarded as the most feasible method for the blind caused by retinal diseases such as retinitis pigmentosa (RP) or age related macular degeneration (AMD). Recently Korean consortium launched for developing retinal prosthesis. One of the prerequisites for the success of retinal prosthesis is the optimization of the electrical stimuli applied through the prosthesis. Since electrical characteristics of degenerate retina are expected to differ from those of normal retina, we performed voltage stimulation experiment both in normal and degenerate retina to provide a guideline for the optimization of electrical stimulation for the upcoming prosthesis. After isolation of retina, retinal patch was attached with the ganglion cell side facing the surface of microelectrode arrays (MEA). $8{\times}8$ grid layout MEA (electrode diameter: $30{\mu}m$, electrode spacing: $200{\mu}m$, and impedance: $50k{\Omega}$ at 1 kHz) was used to record in-vitro retinal ganglion cell activity. Mono-polar electrical stimulation was applied through one of the 60 MEA channel, and the remaining channels were used for recording. The electrical stimulus was a constant voltage, charge-balanced biphasic, anodic-first square wave pulse without interphase delay, and 50 trains of pulse was applied with a period of 2 sec. Different electrical stimuli were applied. First, pulse amplitude was varied (voltage: $0.5{\sim}3.0V$). Second, pulse duration was varied $(100{\sim}1,200{\mu}s)$. Evoked responses were analyzed by PSTH from averaged data with 50 trials. Charge density was calculated with Ohm's and Coulomb's law. In normal retina, by varying the pulse amplitude from 0.5 to 3V with fixed duration of $500{\mu}s$, the threshold level for reliable ganglion cell response was found at 1.5V. The calculated threshold of charge density was $2.123mC/cm^2$. By varying the pulse duration from 100 to $1,200{\mu}s$ with fixed amplitude of 2V, the threshold level was found at $300{\mu}s$. The calculated threhold of charge density was $1.698mC/cm^2$. Even after the block of ON-pathway with L-(1)-2-amino-4-phosphonobutyric acid (APB), electrical stimulus evoked ganglion cell activities. In this APB-induced degenerate retina, by varying the pulse duration from 100 to $1200{\mu}s$ with fixed voltage of 2 V, the threshold level was found at $300{\mu}s$, which is the same with normal retina. More experiment with APB-induced degenerate retina is needed to make a clear comparison of threshold of charge density between normal and degenerate retina.
We implanted pacemakers using screw-in sutureless myocardial electrode in 40 patients between February, 1980 and November, 1982 at Seoul Nation University Hospital. Mean age of total patient who received the pacemaker implantation was 39.9 years, but excluding the patient who received the open heart surgery, mean age was 49.3 years. Cause of pacemaker implantation was complete A-V block in 13 patients, symptomatic sick sinus syndrome in 12 patients, complete A-V block after open heart surgery in 12 patients, second degree A-V block with dizziness in one patient, and atrial fibrillation with slow ventricular response in two patients. In thirty nine cases, electrodes were implanted by subxiphoid approach, on the diaphragmatic surface of right ventricle. I n one case, electrode was implanted through the left anterior thoracotomy. Acute stimulation threshold, measured in 35 patients, varied from 0.1 to 2.5 mA [mean 0.85 mA.], and R-wave amplitude [sensitivity], measured in 19 patients, varied from 2.9 mV to 11.5 mV [mean 7.6 mV]. There was no hospital death. The postoperative complications included wound seroma in two patients [5%], wound hematoma in three patients [7.5%], and pacing failure in one patient [2.5%]. The subxiphoid implantation of the pacemaker using sutureless myocardial lead was valuable in obtaining safe, reliable and long-term impulse generation.
Nuclear rings in barred galaxies are sites of active star formation (SF). We investigate SF and its feedback effects occurring in barred galaxies, for the first time, using high-resolution grid-based hydrodynamic simulations. The gaseous medium is assumed to be infinitesimally thin, isothermal, and unmagnetized. The SF recipes include a density threshold corresponding to the Jeans condition, a SF efficiency of 1%, and momentum feedback via Type II supernova events together with stellar-wind mass loss. To investigate various environments, we vary the gas sound speed as well as the efficiency of momentum injection in the in-plane direction. We find that when the sound speed is small, the surface density of a ring becomes largely independent of the azimuthal angle, resulting in star-forming regions distributed over the whole length of the ring. When the sound speed is large, on the other hand, the ring achieves the largest density at the contact points between the dust lanes and the ring where SF occurs preferentially, leading to a clear age gradient of star clusters in the azimuthal direction. Since rings shrink with time, a radial age gradient of star clusters naturally develop regardless of sound speed, consistent with observations. SF persists over 200 Myr, with an average rate of ${\sim}1.3M_{\odot}/yr$ similar to observed values. Rings gradually become hostile to SF as they lose gas into stars and turbulent motions dominate.
Achieving optimal sustainable yields (i.e., avoiding overfishing and maximizing fishery harvest at the same time) is one of the main objectives in fisheries management. Generally, management reference points (MRPs) such as fishing mortalities (Fmsy, F0.1, Fx%) have been suggested for the purpose. In this study, we intended to suggest MRPs for Korea chub mackerel Scomber japonicus stock, using a stochastic catch-at-age model (SCAA) and evaluate whether the current fishing intensity on the stock is appropriate. We used length frequency and catch-per-unit-effort data on the Korea chub mackerel stock collected from the large purse-seine fishery, and yields landed by all fisheries from years 2000 - 2019. We calculated yield per recruit and spawning potential ratio, and projected spawning stock biomass (SSB) under different fishing mortality, assuming annual recruitments were solely controlled by environmental effects (i.e., steepness of 1.0). Some of our major findings and suggestions were that the overfishing threshold would be F46%; i.e., the fishing mortality in the terminal year, 2019 was 0.257/year, which corresponded to F46%.
Being commonly diagnosed in elderly women and associated with comorbidities as well as ageing-related cardio-vascular changes, heart failure with preserved ejection fraction (HFpEF) has been recently considered as a distinct cardiogeriatric syndrome. Frailty is another frequent geriatric syndrome. HFpEF and frailty share common underlying mechanisms, often co-exist, and represent each other's risk factors. A threshold of 65 years old is usually used to screen patients for both frailty and HFpEF in research and clinical settings. However, both HFpEF and frailty are very heterogenous conditions that may develop at younger ages. In this review we aim to provide a broader overview on the coexistence of HFpEF and frailty throughout the lifetime. We hypothesize that HFpEF and frailty patients' profiles (young, elderly, superaged) represent a continuum of the common ageing process modified by cumulative exposure to risk factors resulting to a presentation of HFpEF and frailty at different ages. We believe, that suggested approach might stimulate assessment of frailty in HFpEF assessment and vice versa regardless of age and early implementation of targeted interventions. Future studies of pathophysiology, clinical features, and outcomes of frailty in HFpEF by age are needed.
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