Search Results (2,807)

Background/Objectives: Patients with diabetes mellitus face increased risk of severe outcomes and mortality from COVID-19. Dipeptidyl peptidase-4 (DPP-4) inhibitors, widely used antidiabetic agents, are hypothesized to affect COVID-19 outcomes via anti-inflammatory and immune-modulating mechanisms. However, real-world evidence, especially in Korean populations, remains limited. Methods: We conducted a retrospective cohort study using Korea’s nationwide Health Insurance Review and Assessment (HIRA) database. Adults with diabetes hospitalized for confirmed COVID-19 between 1 March 2021, and 28 February 2022, were included and stratified by DPP-4 inhibitor use. The primary outcome was 30-day all-cause mortality. Cox proportional hazards models adjusted for age, sex, and comorbidities estimated hazard ratios (HRs). Subgroup analyses examined angiotensin receptor blocker (ARB) and insulin use. Results: Among 16,134 eligible patients, 7082 received DPP-4 inhibitors. The 30-day mortality rate was lower in DPP-4 inhibitor users than non-users (4.3% vs. 10.3%, p < 0.0001). Adjusted analyses showed DPP-4 inhibitor use was associated with reduced mortality risk (adjusted HR: 0.455; 95% CI: 0.414–0.499). Subgroup analyses yielded consistent results across ARB and insulin users. Kaplan-Meier curves demonstrated higher survival probability in the DPP-4 inhibitor group. Conclusions: In this nationwide Korean cohort, DPP-4 inhibitor use was associated with lower mortality among hospitalized diabetic patients with COVID-19. While these findings suggest a potential benefit, causality cannot be confirmed due to the observational design. Prospective studies are needed to verify these associations and explore underlying mechanisms. Full article

The Internet of Medical Things (IoMT) is revolutionizing healthcare by enabling continuous monitoring and real-time data collection through interconnected medical devices such as wearable sensors and smart health monitors. These devices generate sensitive physiological data, including cardiac signals, glucose levels, and vital signs, that are integrated into electronic health records (EHRs). Machine Learning (ML) and Deep Learning (DL) techniques have shown significant potential for predictive diagnostics and decision support based on such data. However, traditional centralized ML approaches raise significant privacy concerns due to the transmission and aggregation of sensitive health information. Additionally, compliance with data protection regulations, such as the Health Insurance Portability and Accountability Act (HIPAA) and General Data Protection Regulation (GDPR), restricts centralized data sharing and analytics. To address these challenges, this study introduces FED-EHR, a privacy-preserving Federated Learning (FL) framework that enables collaborative model training on distributed EHR datasets without transferring raw data from its source. The framework is implemented using Logistic Regression (LR) and Multi-Layer Perceptron (MLP) models and was evaluated using two publicly available clinical datasets: the UCI Breast Cancer Wisconsin (Diagnostic) dataset and the Pima Indians Diabetes dataset. The experimental results demonstrate that FED-EHR achieves a classification performance comparable to centralized learning, with ROC-AUC scores of 0.83 for the Diabetes dataset and 0.98 for the Breast Cancer dataset using MLP while preserving data privacy by ensuring data locality. These findings highlight the practical feasibility and effectiveness of applying the proposed FL approach in real-world IoMT scenarios, offering a secure, scalable, and regulation-compliant solution for intelligent healthcare analytics. Full article

Retrieval-Augmented Generation (RAG) combined with Large Language Models (LLMs) introduces a new paradigm for clinical-trial data analysis that is both real-time and knowledge-traceable. This study targets a multi-site, real-world data environment. It builds a hierarchical RAG pipeline spanning an electronic health record (EHR), National Health Insurance (NHI) billing codes, and image-vector indices. The LLM is optimized through lightweight LoRA/QLoRA fine-tuning and reinforcement-learning-based alignment. The system first retrieves key textual and imaging evidence from heterogeneous data repositories and then fuses these artifacts into the contextual window for clinical report generation. Experimental results show marked improvements over traditional manual statistics and prompt-only models in retrieval accuracy, textual coherence, and response latency while reducing human error and workload. In evaluation, the proposed multimodal RAG-LLM workflow achieved statistically significant gains in three core metrics—recall, factual consistency, and expert ratings—and substantially shortened overall report-generation time, demonstrating clear efficiency advantages versus conventional manual processes. However, LLMs alone often face challenges such as limited real-world grounding, hallucination risks, and restricted context windows. Similarly, RAG systems, while improving factual consistency, depend heavily on retrieval quality and may yield incoherent synthesis if evidence is misaligned. These limitations underline the complementary nature of integrating RAG and LLM architectures in a clinical reporting context. Quantitatively, the proposed system achieved a Composite Quality Index (CQI) of 78.3, outperforming strong baselines such as Med-PaLM 2 (72.6) and PMC-LLaMA (74.3), and reducing the report drafting time by over 75% (p < 0.01). These findings confirm the practical feasibility of the framework to support fully automated clinical reporting. Full article

This study investigates the impact of the COVID-19 pandemic on clinically diagnosed depression in South Korea, focusing on gender disparities and structural risk factors such as job loss and childcare burden. Although mental health inequalities have received growing attention during the pandemic, most existing research relies on self-reported survey data with inherent limitations. To address this gap, we utilized administrative health data from a 2% stratified random sample of the total population (N = 297,368) in the National Health Insurance Database, focusing on employed individuals without a prior history of depression. Multivariable Cox proportional hazard regression revealed that women had significantly higher risks of depression than men, particularly among those in their 20s to 40s, those who experienced job loss, those who had children aged 7–9, and those who belonged to high-income groups. These findings suggest that the intersection of employment instability and caregiving responsibilities disproportionately affected women’s mental health during the pandemic. The results underscore the urgent need for gender-sensitive public health policies that expand childcare support, institutionalize flexible work arrangements such as telecommuting, and enhance access to targeted mental health services to reduce pandemic-induced gender disparities in mental health. Full article

Background/Objectives: We analyzed recent changes in the incidence of glaucoma and associated visual impairment (VI) in Korea over a 16-year period. Methods: We utilized nationwide, longitudinal cohort data from the Korea National Health Insurance System (KNHIS) National Health Screening Cohort from 2004 to 2019 to evaluate the age-standardized incidence rate (SIR) of glaucoma and glaucoma-related VI. VI was determined based on KNHIS health examinations and the National Registry for Visual Disability. The incidence rates were estimated per 100,000 person-years. Joinpoint regression analysis was applied to assess significant changes in incidence trends, and subgroup analyses were conducted by age and sex. Results: The age-SIR of glaucoma increased from 864.1 per 100,000 in 2004 to a peak of 1101.1 in 2016, followed by a decline to 978.9 in 2019. Joinpoint regression identified a significant rise from 2007 to 2015 (annual percent change [APC]: +3.92%), with a subsequent decline (APC: –3.30%). The incidence of glaucoma-related severe VI decreased from 26.23 per 100,000 in 2004 to 8.76 in 2012, remaining stable thereafter at 12.49 in 2019. The VI-to-incidence ratio also declined from 0.030 in 2004 to 0.009 in 2012, which remained stable thereafter at 0.013 in 2019. Females consistently exhibited higher glaucoma incidence but lower VI rates than males. Conclusions: These recent trends highlight the evolving landscape of glaucoma epidemiology in Korea and underscore the need for sustained early detection efforts and optimized patient management. Full article

Background/Objectives: Carbon-ion radiotherapy (CIRT) is now covered by Japan’s health insurance for patients with hepatocellular carcinoma (HCC) tumors measuring ≥4 cm. However, no studies have compared intrahepatic control between CIRT and hepatectomy in these patients. Methods: We retrospectively analyzed intrahepatic control in 51 patients with HCC tumors ≥4 cm. Among them, 38 underwent CIRT (60 Gy in four fractions), while 13 underwent systematic hepatectomy. Intrahepatic recurrence was classified as local or intrahepatic distant. We evaluated local, distant, and total intrahepatic control rates at 1 and 2 years. Results: In the CIRT group, the local control rates at 1 and 2 years were 81.5% and 76.3%, whereas the intrahepatic distant control rates were 68.5% and 63.2% (p = 0.0495), respectively. Among patients aged <80 years, the 2-year intrahepatic control rate did not significantly differ between CIRT and hepatectomy. However, it was significantly lower in patients aged ≥80 years treated with CIRT than in those aged <80 years (73.7% vs. 42.1%, p = 0.0100), with similar trends in local (92.3% vs. 63.2%, p = 0.0381) and distant control (78.9% vs. 47.3%, p = 0.0259). Conclusions: CIRT may be as effective as hepatectomy for HCC tumors ≥4 cm in patients aged <80 years, but its efficacy declines in older patients, warranting age-tailored strategies. Full article

Background/Objectives: Chronic kidney disease (CKD) and osteoporosis are critical public health concerns, particularly among older adults, due to their prevalence and associated complications. While CKD-related disruptions in bone mineral metabolism are believed to increase osteoporosis risk, this relationship remains unclear in diverse populations such as Korea. Methods: This longitudinal cohort study utilized data from the Korean National Health Insurance Service Health Screening Cohort (2002–2019), including 13,622 patients with newly diagnosed CKD and 54,488 matched controls. CKD was defined as having at least two outpatient or inpatient records with ICD-10 codes N18 or N19 and/or evidence of dialysis treatment claims, following a 1-year washout period to exclude prevalent cases. Individuals with a prior history of osteoporosis or incomplete baseline data were excluded. Propensity score overlap weighting was applied, and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models, with subgroup analyses based on demographic and clinical factors. Results: CKD was not associated with an increased risk of osteoporosis. On the contrary, CKD patients exhibited an 18% lower risk of developing osteoporosis compared to controls (HR = 0.82, 95% CI: 0.77–0.87, p < 0.001). This inverse association was more pronounced among women, non-smokers, individuals with low alcohol consumption, and those with a higher comorbidity burden. Conclusions: These findings suggest that certain subgroups of CKD patients may have a reduced risk of osteoporosis, highlighting the importance of individualized risk assessment and tailored preventive strategies. Full article

Background: Prostate cancer (PCa) is one of the most common malignancies among men in Saudi Arabia and contributes significantly to cancer-related morbidity and mortality. The objective of this survey was to evaluate community awareness and screening practices related to PCa among men in the Asir region of Saudi Arabia. Method: A cross-sectional study was conducted from 5 October to 25 December 2024 among men aged 40 and above in the Asir region, excluding those with a prior PCa diagnosis. Using convenience sampling, 399 participants were recruited via social media and community outreach. Data were collected through a self-administered online questionnaire covering demographics, medical history, PCa knowledge, information sources, prevention, screening awareness, and barriers. Informed consent was obtained from all participants. Results: The study comprised 399 male participants, with 37.09% aged 40–50, 36.34% aged 51–60, and 26.56% over 60. Most participants (363; 90.97%) were married, 245 (61.4%) had a university education, 282 (70.67%) lived in urban areas, and 180 (45.11%) were employed. Over half of the participants, 222 (55.63%), had a personal history of prostate problems. Additionally, 272 (68.17%) had health insurance, and 153 (38.34%) reported a monthly income between 10,000 and 14,999 SAR. The study found that 329 (82.5%) participants had good knowledge of PCa but only 197 (49.4%) had good awareness of screening methods. Key predictors of good awareness of PCa screening included a personal history of prostate problems (odds ratio—OR = 4.791, p = 0.000, confidence interval—CI 2.727–8.418) and health insurance (OR = 0.359, p = 0.000, CI 0.203–0.636). Common barriers to screening were affordability, n = 116 (29.07%), and perceived good health, n = 201 (50.37%). Additionally, 154 participants (38.59%) found screening uncomfortable, while 156 (39.59%) believed the Digital Rectal Exam (DRE) was harmful or embarrassing. Significant differences in perceived barriers were found based on age (F = 11.449, p < 0.001), education (F = 2.608, p = 0.051), occupation (F = 3.668, p = 0.026), family history (F = 17.407, p < 0.001), and income (F = 5.148, p = 0.006). Conclusions: The study highlights a significant gap between general knowledge and specific awareness of prostate cancer (PCa) screening among men in the Asir region. Although 82.5% demonstrated good overall knowledge, only 49.4% were aware of screening methods, and just 44.36% had undergone PSA testing. Common barriers included perceived good health, fear of diagnosis, embarrassment, and financial concerns. However, due to the use of convenience sampling, online distribution, and geographic restriction to the Asir region, the findings may not be generalizable to the broader male population in Saudi Arabia, particularly older men and those in rural areas. Addressing these gaps requires targeted education, empowerment of healthcare providers, and coordinated public health strategies to enhance early detection and reduce the PCa burden. Full article

Background: Alcohol-associated liver disease (AALD) represents significant health burdens worldwide. This study aims to provide a comprehensive overview of the AALD outcomes that were incompletely understood. Methods: The current study utilizes data from the National Health and Nutrition and Examination Survey (NHANES) from 2011–2020, using a stratified, multistage probability cluster design. AALD in the NHANES was defined using clinical laboratory data and self-reported alcohol use, among which fibrosis-4 score of >2.67. Analysis is conducted using weighted, logistic, and Cox linear regression. Results: The initial sample included 23,206 participants aged 20 and older, with recorded cardiovascular status and AST/ALT levels. Participants reporting AALD had a higher percentage of college degrees (p < 0.001) and were more likely to be daily smokers. Asians exhibited the highest rates of AALD compared to other demographics (p < 0.001). The prevalence in private insurance is significantly greater than Medicaid, but the usage trends have been increasing in Medicaid. The trends of advanced fibrosis have been increasing in blacks and Asians, while they have been decreasing among whites and Mexicans. Those with AALD also had higher mean systolic and diastolic blood pressure, as well as elevated fasting glucose levels (p < 0.001). The mortality rate among AALD participants with heart diseases was 25%, compared to 3% among those without (p < 0.001). After adjusting for potential confounding variables, no statistically significant associations were found between AALD status and HF or CAD. However, a clinically significant increase in the odds of stroke was observed within the AALD group (p < 0.001). Conclusions: Our findings indicate Asians have the highest rates of AALD. The trends of advanced fibrosis have been increasing in blacks and Asians. There is an increased prevalence of AALD with heart diseases and a significant increase in mortality with stroke. Full article

Although organizational resilience is well established, refining the systematic quantitative evaluation of health systems resilience (HSR) remains an ongoing opportunity for advancement. Research either focuses on individual HSR indicators, such as social welfare policy, public expenditure, health insurance, healthcare quality, and technology, or broadly examines socio-economic factors, highlighting the need for a more comprehensive methodological approach. This study employed the Slacks-Based Measure (SBM) within Data Envelopment Analysis (DEA) to analyze efficiency by maximizing outputs. It systematically examined key HSR factors across countries, providing insights for improved policymaking and resource allocation. Taking a five-year (2016–2020) dataset that covered 55 to 56 countries and evaluating 17 indicators across governance, health systems, and economic aspects, the paper presents that all sixteen top-ranked countries with a perfect efficiency score of 1 belonged to the high-income group, with ten in Europe, highlighting regional HSR differences. This paper concludes that adequate economic resources form the foundation of HSR and ensure stability and sustained progress. A properly supported healthcare workforce is essential for significantly enhancing health systems and delivering quality care. Last, effective governance and the equitable allocation of resources are crucial for fostering sustainable development and strengthening HSR. Full article

Background/Objectives: The expansion of National Health Insurance (NHI) coverage for dental implants in South Korea has substantially increased implant placements among older adults. While implants offer functional and esthetic benefits, their lack of periodontal ligaments alters occlusal force distribution, potentially increasing biomechanical stress on adjacent or opposing teeth. This study aimed to investigate the association between the increased number of dental implants and the incidence of cracked teeth following the introduction of implant insurance. Methods: A retrospective analysis was conducted using the Clinical Data Warehouse of Seoul St. Mary’s Dental Hospital. Patients who underwent molar crown restorations between 2014 and 2022 were included. The incidence and clinical features of cracked teeth were compared before (2014–2015) and after (2016–2022) the introduction of implant insurance. Statistical analyses assessed differences in symptom presentation, pulp status, and treatment outcomes. Results: Among 5044 molars restored with crowns, 1692 were diagnosed with cracks. The incidence of cracked teeth significantly increased after NHI coverage for implants (25.5% vs. 32.6%, p < 0.001). Cases after insurance implementation showed fewer signs and symptoms at initial presentation (67.4% vs. 50.0%, p < 0.001), reduced irreversible pulpitis (37.2% vs. 25.8%, p < 0.001), and increased preservation of pulp vitality (46.9% vs. 57.8%, p < 0.001). These shifts may reflect changes in occlusal adjustment practices and earlier clinical intervention. Conclusions: The findings suggest a temporal link between increased implant placement and the rising incidence of cracked teeth. Implant-induced occlusal changes may contribute to this trend. Careful occlusal evaluation and follow-up are essential after implant placement, and further prospective studies are warranted to confirm causality and refine prevention strategies. Full article

Background/Objectives: The two major subtypes of inflammatory bowel disease (IBD)—Crohn’s disease (CD) and ulcerative colitis (UC)—are known to increase the likelihood of developing colorectal cancer (CRC). While this relationship has been well studied in Western populations, evidence from East Asia remains limited and inconsistent. Using nationwide cohort data, this study explored the potential connection between IBD and CRC in a large Korean population. Methods: We conducted a retrospective cohort study using data from the Korean National Health Insurance Service–National Sample Cohort from 2005 to 2019. A total of 9920 CRC patients were matched 1:4 with 39,680 controls using propensity scores based on age, sex, income, and region. Overlap weighting and multivariable logistic regression were used to evaluate the association between IBD and CRC. Subgroup analyses were conducted to assess effect modification by demographic and clinical factors. Results: IBD markedly increased the likelihood of developing CRC (adjusted odds ratio (aOR) = 1.38; 95% confidence interval (CI): 1.20–1.58; p < 0.001), with the association primarily driven by UC (aOR = 1.52; 95% CI: 1.27–1.83). CD appeared unrelated to heightened CRC risk overall, though a significant association was observed among low-income CD patients (aOR = 1.58; 95% CI: 1.15–2.16). The UC–CRC association persisted across all subgroups, including patients without comorbidities. Conclusions: Our findings support an independent association between IBD—particularly UC—and increased CRC risk in Korea. These results underscore the need for personalized CRC surveillance strategies that account for disease subtype, comorbidity burden, and socioeconomic status, especially in vulnerable subpopulations. Full article

Objective: This study aimed to investigate the impact of depression and anxiety disorders on mortality in women diagnosed with gynecologic cancers, utilizing nationwide retrospective cohort data. Methods: Data from the Korean National Health Insurance Service (NHIS) database, covering women diagnosed with cervical, endometrial, or ovarian cancers between 2007 and 2014, were analyzed. Women diagnosed with depression or anxiety disorders within one year after cancer diagnosis were identified and compared with a control group comprising patients with gynecologic cancers who did not develop either disorder during the same post-diagnosis period. Mortality was evaluated as the primary outcome. Results: Of 85,327 women analyzed, 784 (0.9%) were diagnosed with depression or anxiety disorders. Patients with depression or anxiety exhibited significantly higher mortality (38.4% vs. 29.9%; p < 0.001). Multivariate analysis indicated that depression significantly increased mortality risk (OR 1.46, 95% CI 1.27–1.66), whereas anxiety alone showed no significant effect (OR 0.97, 95% CI 0.74–1.27). Combined depression and anxiety showed the highest mortality risk (OR 1.47, 95% CI 1.31–1.65). Conclusions: Depression and anxiety disorders are significant predictors of increased mortality in women with gynecologic cancers, emphasizing the necessity for integrated mental health assessment and interventions in oncologic care to improve both survival and quality of life. Full article

Background/Objectives: Urban green space has been increasingly recognized as a determinant of maternal and child health. This study investigated the association between prenatal exposure to different types of green space and the risk of congenital anomalies in South Korea. Methods: We analyzed data from the National Health Insurance Service (N = 142,422). Green space exposure was measured at the area level and categorized into grassland and forest; statistical analysis was performed using generalized estimating equations and generalized additive models to analyze the associations. Additionally, subgroup and sensitivity analyses were performed. Results: GEE analysis showed that a 10% increase in the proportion of grassland in a residential district was associated with a reduced risk of nervous system (adjusted odds ratio [aOR]: 0.77, 95% confidence interval [CI]: 0.63–0.94) and genitourinary system anomalies (aOR: 0.83, 95% CI: 0.71–0.97). The subgroup analysis results showed significance only for male infants, but the difference between the sexes was not significant. In the quartile-based analysis, we found a slightly significant p-value for trend for the effect of forests on digestive system anomalies, but the trend was toward increasing risk. In a sensitivity analysis with different exposure classifications, the overall and nervous system anomalies in built green space showed that the risk decreased as green space increased compared to that in the lowest quartile. Conclusions: Our results highlight the importance of spatial environmental factors during pregnancy and suggest that different types of green spaces differentially impact the offspring’s early health outcomes. This study suggests the need for built environment planning as part of preventive maternal and child health strategies. Full article

This article describes the design, methods, and baseline characteristics of the social needs assessment (SNA) of participants enrolled in an ongoing randomized clinical trial implementing a comprehensive approach to improving diabetes self-management and providing an intensive Diabetes Self-Management Education and Support (iDSMES) Program at St. Vincent’s House Clinic, a primary care practice serving resource-challenged diverse populations in Galveston, Texas. Standardized SNA was conducted to collect information on financial needs, psychosocial well-being, and other chronic health conditions. Based on their identified needs, participants were referred to non-medical existing community resources. A series of in-depth interviews were conducted with a subset of participants. A team member independently categorized these SNA narratives and aggregated them into two overarching groups: medical and social needs. Fifty-nine participants (with a mean age of 53 years and equal representation of men and women) completed an SNA. Most (71%) did not have health insurance. Among 12 potential social needs surveyed, the most frequently requested resources were occupational therapy (78%), utility assistance (73%), and food pantry services (71%). SNA provided data with the potential to address barriers that may hinder participation, retention, and outcomes in diabetes self-management. SNA findings may serve as tertiary prevention to mitigate diabetes-related complications and disparities. Full article