Objective: To support tobacco control policies in Korea by providing the estimated annual economic burden attributed to cigarette smoking. Methods: The following two different approaches were used to estimate the cost: "disease specific" and "all causes". In the disease specific approach, we focused on estimating direct and indirect costs involved in treatments of cardiovascular, respiratory, and gastrointestinal diseases, and cancer as a result of smoking, by using an epidemiologic approach-the population attributable risk (PAR). To compute PAR, the relative risks of smoking in terms of physician visits, hospital admission, and death were estimated using the Cox proportional hazard model. In the all causes approach, we examined the differences in direct and indirect costs between smokers and non-smokers for all conditions and types of disease. The major data source was the Korea Medical Insurance Corporation cohort study, which had complete records of smoking status as of 1992 for 115 682 male and 67 932 female insured workers. Results: By the disease specific approach, the estimated costs attributable to smoking in 1998 in Korea ranged from US$2269.42 million ($4.89 million per 100 000 population; 0.59% of gross domestic product (GDP)) to $2956.75 million ($6.37 million; 0.78% of GDP). The all causes approach yielded a minimum cost of $3154.75 million ($6.79 million; 0.82% GDP) and a maximum of $4580.25 million ($9.86 million; 1.19% GDP). Conclusion: The study confirms that smoking places a substantial economic burden on Korean society. In light of this, our study provides evidence for a strong need to develop a national policy to effectively control tobacco consumption in Korea.
This study suggests that the GVL could be an option for airway management even by emergency physicians with little experience and no training in its use.
BACKGROUND AND PURPOSE:The association of perivascular spaces in the centrum semiovale with amyloid accumulation among patients with Alzheimer disease-related cognitive impairment is unknown. We evaluated this association in patients with Alzheimer disease-related cognitive impairment and b -amyloid deposition, assessed with [ 18 F] florbetaben PET/CT. MATERIALS AND METHODS: MR imaging and [ 18 F] florbetaben PET/CT images of 144 patients with Alzheimer disease-related cognitive impairment were retrospectively evaluated. MR imaging-visible perivascular spaces were rated on a 4-point visual scale: a score of $3 or ,3 indicated a high or low degree of MR imaging-visible perivascular spaces, respectively. Amyloid deposition was evaluated using the brain b -amyloid plaque load scoring system. RESULTS: Compared with patients negative for b -amyloid, those positive for it were older and more likely to have lower cognitive function, a diagnosis of Alzheimer disease, white matter hyperintensity, the Apolipoprotein E « 4 allele, and a high degree of MR imaging-visible perivascular spaces in the centrum semiovale. Multivariable analysis, adjusted for age and Apolipoprotein E status, revealed that a high degree of MR imaging-visible perivascular spaces in the centrum semiovale was independently associated with b -amyloid positivity (odds ratio, 2.307; 95% CI, 1.036-5.136; P ¼ .041).
CONCLUSIONS:A high degree of MR imaging-visible perivascular spaces in the centrum semiovale independently predicted b -amyloid positivity in patients with Alzheimer disease-related cognitive impairment. Thus, MR imaging-visible perivascular spaces in the centrum semiovale are associated with amyloid pathology of the brain and could be an indirect imaging marker of amyloid burden in patients with Alzheimer disease-related cognitive impairment.
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