Woorim Kim

Quality of life in Korean patients with inflammatory bowel diseases : ulcerative colitis, Crohn's disease and intestinal Behçet's disease

Abstract Health-related quality of life (HRQOL) is an important outcome factor in chronic diseases such as inflammatory bowel disease (IBD). This study used the Korean translation of the disease-specific, self-administered Inflammatory Bowel Disease Questionnaire (IBDQ) to compare HRQOL in ulcerative colitis (UC; n=98), Crohns disease (CD; n = 49), and intestinal Behçets disease (BD; n = 34). In addition to the current status, patients were asked retrospectively to recall their symptoms at the beginning and during the worst period of their disease. Disease activity was measured by St. Marks Activity Index, Crohns disease Activity Index (CDAI), and the Harvey-Bradshaw Index (HBI). In all IBD patients, including those with BD, the IBDQ total score during the worst period was significantly lower than that at present and that at the beginning of the disease. However, there were no significant differences between groups regarding the total IBDQ score or its various dimensions. In UC a strong correlation between IBDQ scores and St. Marks Activity Index was observed (r = –0.708, P<0.001). IBDQ scores were also highly correlated with CDAI and HBI in both CD (r=–0.506, P<0.001 for CDAI; r = –0.600, P<0.001 for HBI) and BD (r = –0.687, P<0.001 for CDAI; r = –0.531, P<0.001 for HBI). However, the current IBDQ score was not related to demographic parameters such as gender, age, educational status, economic status, and marital status as well as disease factors such as duration of disease, history of operation or hospital admission, extent of disease in UC, involved region in CD, and clinical type in BD. We conclude that the Korean IBDQ is a responsive and promising instrument for measuring HRQOL of IBD patients in clinical trials. In addition, the IBDQ can be helpful in developing a disease-specific activity index in BD.

Role of caspase-3 in apoptosis of colon cancer cells induced by nonsteroidal anti-inflammatory drugs

Abstract Epidemiological studies have demonstrated that nonsteroidal anti-inflammatory drugs (NSAIDs) decrease the incidence of and mortality from colon cancer. In addition, NSAIDs reduce the number and the size of polyps in patients with familial adenomatous polyposis. The mechanisms responsible for the antineoplastic effect of NSAIDs are not yet completely understood, but one of the possible mechanisms is an induction of apoptosis. We explored the role of caspase-3, a major apoptosis-executing enzyme, in NSAID-induced apoptosis of colon cancer cell line HT-29. Treatment of HT-29 cells with indomethacin induced a dramatic increase in caspase-3-like protease activity measured by a cleavage of the fluorogenic substrate Ac-DEVD-AMC. Western blot analysis showed that indomethacin treatment led both to decrease in pro-caspase-3 and to cleavage of its substrate poly(ADP-ribose) polymerase (PARP). Furthermore, the caspase- 3-like protease inhibitor Ac-DEVD-CHO attenuated indomethacin- induced DNA fragmentation dose dependently. However, mRNA expression of CASP genes was not affected by the addition of indomethacin, highlighting the importance of posttranslational modification of this enzyme for the activation. These results suggest that NSAIDs, including indomethacin, induce apoptosis in colon cancer cells through a caspase-3 dependent mechanism which may contribute to the chemopreventive functions of these agents.

Effect of working hours and precarious employment on depressive symptoms in South Korean employees: a longitudinal study

Objectives Long working hours and precarious employment are relatively common in South Korea. Since both can impact on mental health, this study examined their independent and combined effects on depressive symptoms of employees. Methods Data were from the Korean Welfare Panel Study (KOWEPS), 2010–2013. A total of 2733 full-time employees without depressive symptoms were analysed. Hierarchical logistic regression models were used to investigate the effect of the number of working hours per week (eg, 35–40 hours, 41–52 hours, 53–68 hours, and >68 hours) and employment status (permanent vs precarious employment) on depressive symptoms, measured using the Center for Epidemiological Studies Depression (CES-D) 11 scale. Results Compared with individuals working 35–40 hours/week, employees working above 68 hours (OR 1.57, 95% CI 1.05 to 2.34) had higher odds of depressive symptoms after full adjustment. Similarly, precarious employees (OR 1.34, 95% CI 1.02 to 1.75) showed worse mental health than permanent employees. In the combined effect model, employees in precarious employment who worked above 68 hours/week (OR, 2.03 95% CI 1.08 to 3.83) exhibited the highest odds of depressive symptoms compared with permanent employees working 35 to 40 hours/week. Conclusions Long work hours and precarious employment status were associated with higher odds of depressive symptoms. The findings highlight the importance of monitoring and addressing the vulnerable groups of employees to reduce the mental health burden of economically active individuals.

Association between reduction in copayment and gastric cancer patient concentration to the capital area in South Korea: NHI cohort 2003–2013

Since 2004, the South Korean government has introduced a policy that decreases copayment for cancer patients by strengthening public coverage in the National Health Insurance (NHI) system (first phase=copayment for outpatient care from 30% to 20%; second phase=copayment for total medical expenditures from 20% to 10%; third phase=copayment for total medical expenditures from 10% to 5%). We aimed to investigate the relationship between the policy introduction and patient visits to hospitals in the capital area. We used data from the NHI Cohort 2003-2013, which included all medical claims (7193 cases) filed for 2124 patients who visited the hospital due to stomach cancer, and performed a segmented Poisson regression analysis. Of all hospital visits, 40.6% of patients were from the capital area. After the introduction of the second phase of the policy, there was an increase in patient concentration in the capital area, although there were no significant effects on patient concentration during the first and third phases of the policy. In conclusion, our findings suggest that the introduction of a policy that reduces copayment for cancer patients had a substantial impact on patient concentration in the capital area. Therefore, health policymakers should consider effective alternatives including efficient allocation of medical resources or support for the more vulnerable population as flexible benefit plans to aid healthcare utilization by cancer patients.

Effective strategy for improving health care outcomes: Multidisciplinary care in cerebral infarction patients

Multidisciplinary teams provide effective patient treatment strategies. South Korea expanded its health program recently to include multidisciplinary treatment. This study characterized the relationship between multidisciplinary care and mortality within 30 days after hospitalization in cerebral infarction patients. We used the National Health Insurance claim data (n = 63,895) from 120 hospitals during 2010-2013 to analyze readmission within 30 days after hospitalization for cerebral infarction. We performed χ(2) tests, analysis of variance and multilevel modeling to investigate the associations between multidisciplinary care and death within 30 days after hospitalization for stroke. Deaths within 30 days of hospitalization due to cerebral infarction was 3.0% (n = 1898/63,895). Multidisciplinary care was associated with lower risk of death within 30 days in inpatients with cerebral infarction (odds ratio: 0.84, 95% confidence interval: 0.72-0.99). Patients treated by a greater number of specialists had lower risk of death within 30 days of hospitalization. Additional analyses showed that such associations varied by the combination of specialists (i.e., neurologist and neurosurgeon). In conclusion, death rates within 30 days of hospitalization for cerebral infarction were lower in hospitals with multidisciplinary care. Our findings certainly suggest that a high number of both neurosurgeon and neurologist is not always an effective alternative in managing stroke inpatients, and emphasize the importance of an optimal combination in the same number of hospital staffing.

The effect of childhood and current economic status on depressive symptoms in South Korean individuals: a longitudinal study

BackgroundMental health inequality along the economic strata is prominent in South Korea, particularly as intergenerational material transfer is becoming increasingly important in gaining economic status. Therefore, this study aimed to investigate the relationship between current and childhood economic status and depressive symptoms in adults aged 20 or above.MethodsThis study used data from the Korean Welfare Panel Study (KOWEPS), 2010 to 2013. A total of 9,645 individuals aged 20 years or above without depressive symptoms in 2010 were analyzed. The effect of childhood and current economic status, categorized into low, middle, and high groups, on depressive symptoms was investigated using hierarchical logistic regression models. Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D 11) scale. Subgroup analysis was performed based on education level.ResultsCompared to the middle current-middle childhood economic status group, the low-low group (OR: 1.88, CI: 1.61-2.20), low-middle group (OR: 1.68, CI: 1.43-1.98), and low-high group (OR: 1.64, CI: 1.34-2.01) were more likely to have depressive symptoms. The high-low group (OR: 0.68, CI: 0.55-0.84), high-middle group (OR: 0.67, CI: 0.56-0.81), and high-high group (OR: 0.45, CI: 0.27-0.75) were less likely to have depressive symptoms. This trend was generally maintained with regard to education level, but the effects were not statistically significant in the high current economic status groups among participants with a university degree or above.ConclusionLow current economic status was associated with a higher likelihood of depressive symptoms. In particular, the low current-low childhood economic status group showed the highest likelihood of depressive symptoms, suggesting the adverse mental health effects of prolonged poverty. Therefore, the findings reveal that mental health inequalities are present along the economic strata and require proper addressing of the mental health of lower income individuals.

Mortality in schizophrenia and other psychoses: Data from the south korea national health insurance cohort, 2002-2013

Individuals with psychoses show excess mortality, which is a major public health concern. This study examined all-cause and suicide mortality rates in Korean patients diagnosed with schizophrenia, mood disorder, or mental and behavioral disorder due to psychoactive substance use and to compare this with that of the general population. Data were from the National Health Insurance cohort, 2002 to 2013. A total of 107,190 cases aged 15 years or over were included. Mortality rates per 100,000 person years (PY) were obtained. Poisson regression modelling was conducted to quantify the effect of baseline characteristics on all-cause and suicide mortality risks. Standardized mortality ratios (SMRs) were also calculated. All-cause mortality was the highest among mental and behavioral disorder patients (1,051.0 per 100,000 PY), followed by schizophrenia (949.1 per 100,000 PY) and mood disorder patients (559.5 per 100,000 PY). Highest suicide mortality was found in schizophrenia (177.2 per 100,000 PY), mental and behavioral disorder (143.7 per 100,000 PY), and mood disorder patients (59.7 per 100,000 PY). The rate ratios (RRs) for all-cause and suicide mortality were reduced for younger populations and women. Psychoses patients had higher all-cause (schizophrenia, SMR 2.4; 95% confidence interval [CI] 2.2–2.5; mood disorder, SMR 1.4; 95% CI 1.3–1.5; mental and behavioral disorder, SMR 2.6; 95% CI 2.5–2.8) and suicide (schizophrenia, SMR 8.4; 95% CI 7.2–9.6; mood disorder, SMR 2.8; 95% CI 2.1–3.5; mental and behavioral disorder, SMR 6.8; 95% CI 5.7–7.9) mortality rates than the general population. These findings infer that efforts should be made to reduce excess mortality in psychoses.

Sleep disorders and risk of hospitalization in patients with mood disorders: Analysis of the National Sample Cohort over 10 years

Medical utilization due to organic sleep disorders has increased remarkably in South Korea, which may contribute to the deterioration of mental health in the population. We analyzed the relationship between organic sleep disorders and risk of hospitalization due to mood disorder. We used data from the National Health Insurance Service (NHIS) National Sample Cohort 2002-2013, which included medical claims filed for the 15,537 patients who were newly diagnosed with a mood disorder in a metropolitan region, and employed Poisson regression analysis using generalized estimating equation (GEE) models. By the results, there was a 0.53% hospital admission rate among 244,257 patients with outpatient care visits. Patients previously diagnosed with an organic sleep disorder before specific outpatient care had a higher risk for hospitalization. Such associations were significant in females, patients with a longer duration of disease, or those who lived in the largest cities. In conclusion, considering that experiencing a sleep disorder by a patient with an existing mood disorder was associated with deterioration of their status, health policy makers need to consider insurance coverage for all types of sleep disorders in patients with psychological conditions.

Depressive symptoms of house-poor persons: Korean panel data evidence

Background: There are no studies researching the relationship between house-poor persons and mental health. Therefore, this study aimed to investigate the relationship between house-poor status and depressive symptoms. Aim: To examine the relationship between the house-poor and depressive symptoms according to household income. Methods: Data from the Korean Welfare Panel Study were used. House-poor were defined as people having possession with over 10% house-related interest in disposable income. About 7,565 participants over the age of 19 years were followed up from 2011 to 2013. The generalized estimating equations were used for analysis. Results: Individuals with more house-related debt showed increasingly higher depression scores (possession with under 5% related debt to disposable income β = 0.2024, p = .1544; under 10% β = 0.7030, p = .0008; over 10% β = 1.3207, p < .0001). Individuals possessing houses with over 10% ratio of house-related debts to disposable income had higher depression scores than individuals without house ownership (no possession β = 0.8927, p < .0001). Conclusion: Individuals without houses and individuals owning houses with higher percentages of house-related interests showed higher levels of depressive symptoms. Therefore, this study affirmed that the importance of considering the most vulnerable groups in addressing the mental health of individual.

The impact of occupation according to income on depressive symptoms in South Korean individuals: Findings from the Korean Welfare Panel Study

Background: In South Korea, societal perceptions on occupation are distinct, with people favouring white collar jobs. Hence both occupation type and income can have mental health effects. Aim: To examine the relationship between occupational classification and depression, along with the combined effect of occupational classification and household income. Methods: Data were from the Korean Welfare Panel Study (KOWEPS), 2010–2013. A total of 4,694 economically active participants at baseline were followed. Association between occupational classification and depression, measured using the Center for Epidemiological Studies Depression (CES-D) scale 11, was investigated using the linear mixed effects model. Results: Blue collar (β: 0.3871, p = .0109) and sales and service worker groups (β: 0.3418, p = .0307) showed higher depression scores than the white collar group. Compared to the white collar high-income group, white collar low income, blue collar middle income, blue collar middle-low income, blue collar low income, sales and service middle-high income, sales and service middle-low income and sales and service low-income groups had higher depression scores. Conclusion: Occupational classification is associated with increasing depression scores. Excluding the highest income group, blue collar and sales and service worker groups exhibit higher depression scores than their white collar counterparts, implying the importance of addressing these groups.