Cost-utility analysis of transitional care services for older inpatients with chronic obstructive pulmonary disease (COPD) in Korea.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with a high readmission rate and poses a significant disease burden. South Korea initiated pilot projects on transitional care services (TCS) to reduce readmissions. However, evidence from cost-effectiveness analyses remains undiscovered. This study aimed to evaluate the cost-effectiveness of TCS in patients with COPD from the healthcare system' perspective. METHOD: A cost-utility analysis was conducted using a Markov model containing six components of possible medical use after discharge. Transition probabilities and medical costs were extracted from the National Health Insurance Service Senior Cohort (NHIS-SC), and utility data were obtained from published literature. Sensitivity analyses were performed to test the robustness of the results. RESULTS: Conducting TCS produced an incremental quality-adjusted life years gain of 0.231, 0.275, 0.296 for those in their 60s, 70s, and 80s, respectively, and cost savings of $225.16, $1668, and $2251.64 for those in their 60s, 70s, and 80s, respectively, per patient over a 10-year time horizon. The deterministic sensitivity analysis indicated that the TCS cost and the cost of readmission by other diseases immensely impact the results. The probabilistic sensitivity analyses showed that the probability that the incremental cost-effectiveness ratio is below $23,050 was over 85%, 93%, and 97% for those in the 60s, 70s, and 80s, respectively. CONCLUSIONS: TCS was the dominant option compared to usual care. However, it is advantageous to the healthcare budget preferentially consider patients aged over 70 years with severe TCS symptoms. In addition, it is essential to include the management of underlying comorbidities in TCS intervention. TRIAL REGISTRATION: Clinical Research Information Service (CRIS), KCT0007937. Registered on 24 November 2022.

Facilitating and barrier factors to the implementation of a transitional care program: a qualitative study of hospital coordinators in South Korea.

BACKGROUND: Transitional care is an integrated service to ensure coordination and continuity of patients' healthcare. Many models are being developed and implemented for this care. This study aims to identify the facilitators and obstacles of project performance through the experiences of the coordinator in charge of the Community Linkage Program for Discharge Patients (CLDP), a representative transitional care program in Korea. METHOD: Forty-one coordinators (nurses and social workers) from 21 hospitals were interviewed using a semi-structured questionnaire, and thematic analysis was performed. RESULT: Three themes were found as factors that facilitate or hinder CLDP: Formation and maintenance of cooperative relationships; Communication and information sharing system for patient care; and interaction among program, regional, and individual capabilities. These themes were similar regardless of the size of the hospitals. CONCLUSION: A well-implemented transitional care model requires a program to prevent duplication and form a cooperative relationship, common computing platform to share patient information between institutions, and institutional assistance to set long-term directions focused on patient needs and support coordinators' capabilities.

Factors Associated With Caregivers' Preference for Digital Technologies to Support Older Adults.

Family members often serve as primary caregivers to their parents and relatives. Information and communication technology (ICT) plays an important role in facilitating this caregiving role through using Internet of Things (IoTs) caregiving services. However, there is limited evidence regarding factors influencing caregivers' acceptance of new technologies. The current study investigated factors affecting caregivers' intentions to use ICT-based IoTs. Chi-square test was used to contrast differences in distributions between categorical variables. Binary logistic regression was performed to identify factors associated with increased intention to use ICT-based IoTs. Male caregivers showed increased intentions of using these products and considered the psychological burden as well as the diverse factors associated with adopting IoTs. On the other hand, female caregivers considered relieving their care burdens and social influences. As such, findings indicated that female caregivers demonstrated increased intention, which is associated with their care burdens, and relieving a similar experience would be a significant motivation. Further studies are needed not only for specific measures to reduce psychological burden but also for physical burden. Marketing strategies for spreading awareness of IoT technologies require more investment and initiatives. [Journal of Gerontological Nursing, 48(8), 33-41.].

Evaluation of Food Labeling Policy in Korea: Analyzing the Community Health Survey 2014-2017.

BACKGROUND: As Koreans adopt more Westernized diets, consumer demands for processed food products are growing. The Korean government implemented a food labeling system to help people reasonably choose processed foods. This study investigated the utilization of these food labels among Koreans, as well as demographic differences between users and non-users of food labels, ultimately presenting foundational data for strategies to enhance dietary lifestyles by facilitating the use of food labeling. METHODS: Data from the 2014-2017 Community Health Survey were used. The Cochran-Armitage trend test was performed to investigate whether food labeling awareness and utilization increase over time; a data mining technique called decision tree analysis was then used to examine the effects of sociodemographic factors on the use of food labeling for each of the 4 years. RESULTS: Food labeling awareness increased by 4.5% over 4 years; the Cochran-Armitage trend test showed that this increase was statistically significant (χ² = 1,068.21; P < 0.001). Food labeling utilization increased significantly but marginally, by 0.3%, over 4 years (χ² = 20.154; P < 0.001). Decision tree analysis showed that food labeling users comprised mainly women in their 30s-50s currently in graduate school or with a graduate degree; the non-user group comprised mainly divorced/widowed/separated people in their 70s who were elementary school grads or below. CONCLUSION: Education level, which could be related to health literacy, substantially affected the use of food labeling. Education level is a typical socioeconomic index, and if people who are less educated tend not to use food labeling, it can lead to health inequity. Thus, food labeling should be reformed with consideration of health literacy among the less-educated social classes. From a health communication perspective, images and pictures can boost consumers' understanding, which should be considered to improve comprehensibility of food labeling.

What Factors Impact Consumer Perception of the Effectiveness of Health Information Sites? An Investigation of the Korean National Health Information Portal.

Lay public's concerns around health and health information are increasing. In response, governments and government agencies are establishing websites to address such concerns and improve health literacy by providing better access to validated health information. Since 2011, the Korean government has constructed the National Health Information Portal (NHIP) website run in collaboration with the Korean Academy of Medical Sciences (KAMS). This study therefore aimed to 1) examine consumer use of NHIP, with respect to the usage patterns, evaluation on health information provided, and perceived effectiveness of the site; and 2) identify factors that may impact perceived effectiveness of the site. An online survey was conducted with 164 NHIP users, recruited through a popup window on the main screen of the portal website from October to November 2015. The significant predicting factors supported by the data include the relevance of health information on the site, the usefulness of information in making health decisions, and the effective visualization of information. These factors can inform future efforts to design more effective health information websites, possibly based on metadata systems, to further advance the lay public's information seeking and health literacy.

A scoping review of consumer needs for cancer information.

OBJECTIVE: This study was a scoping review of research on cancer-related health information seeking and needs of patients, survivor, non-patients, and caregivers. METHODS: This study used the COSI model to search for articles published from 2007 to 2017. RESULTS: In total, 117 articles with titles and abstracts including the following terms were selected: cancer, health, information, seeking. Non-patients obtained information from the Internet, doctors, and media, whereas patients obtained information from doctors, the Internet, and media. Information needs were the highest for treatment, prognosis, and psychosocial support. Patients had the highest need for information on prognosis and treatment, whereas non-patients had the highest need for general cancer information, prevention, and cancer examination. Caregivers sought information about treatment, psychosocial support, and prevention. CONCLUSION: This study revealed an increase in the number of research articles identifying cancer patients' information needs. Cancer patients rely on health professionals for information; thus, relevant materials are needed. Furthermore, not only medical but also psychosocial support information is needed. PRACTICE IMPLICATIONS: There is a need for cancer information from health professionals, and thus for patient-centered training materials. Furthermore, a survey system to evaluate consumers' cancer information needs should be developed.

Genome Sequencing Analysis of Atypical Shigella flexneri Isolated in Korea.

OBJECTIVES: An atypical Shigella flexneri strain with a plural agglutination pattern [i.e., reacting not only with serum samples containing type antigen II but also with serum samples containing group antigens (3)4 and 7(8)] was selected for genome sequencing, with the aim of obtaining additional comparative information about such strains. METHODS: The genomic DNA of atypical S. flexneri strain NCCP 15744 was sequenced using an Ion Torrent PGM sequencing machine (Life Technologies, USA). The raw sequence data were preprocessed and reference-assembled in the CLC Assembly Cell software (version 4.0.6; CLC bio, USA). RESULTS: Ion Torrent sequencing produced 1,450,025 single reads with an average length of 144 bp, totaling ~209 Mbp. The NCCP 15744 genome is composed of one chromosome and four plasmids and contains a gtrX gene. Among the published genome sequences of S. flexneri strains, including 2457T, Sf301, and 2002017, strain NCCP 15744 showed high similarity with strain 2002017. The differences between NCCP 15744 and 2002017 are as follows: i) NCCP 15744 carries four plasmids whereas 2002017 carries five; ii) 19 genes (including CI, CII, and cro) were lost in the SHI-O genomic island of NCCP 15744 and six genes were gained as compared with strain 2002017. CONCLUSION: Strain NCCP 15744 is genetically similar to 2002017, but these two strains have different multilocus sequence types and serotypes. The exact reason is unclear, but the 19 lost genes may be responsible for the atypical seroconversion of strain NCCP 15744.

Comparison of Enterohemorrhagic Escherichia coli (EHEC) O157 and EHEC Non-O157 Isolates from Patients with Diarrhea in Korea.

We compared 47 enterohemorrhagic Escherichia coli (EHEC) O157 isolates with 184 EHEC non-O157 isolates from Korean patients with diarrhea. In the O157 group, the strains harboring both Shiga toxin genes (stx1 and stx2) were detected with highest frequency, whereas the strains harboring only stx1 gene were most frequently detected in the non-O157 group. Eight virulence genes (eaeA, hlyA, ehx, iha, efa1, tir, toxB, and espA) were found to show a higher frequency of occurrence in the O157 group than in the non-O157 group. In addition, the symptom of bloody diarrhea was exhibited at a higher rate in the O157 group (51.1%) than in the non-O157 group (16.8%). Our findings demonstrate that EHEC O157 strains are more frequently implicated in cases of bloody diarrhea in the Korean population than EHEC non-O157 strains.

Surveillance of Bacillus cereus Isolates in Korea from 2012 to 2014.

OBJECTIVES: To investigate the prevalence and toxin production characteristics of non-emetic and emetic Bacillus cereus strains isolated via the laboratory surveillance system in Korea. METHODS: A total of 667 B. cereus strains were collected by the Korea National Research Institute of Health laboratory surveillance system from 2012 to 2014. The collected strains were analyzed by geographical region, season, patient age, and patient sex. Additionally, the prevalence rates of enterotoxin and emetic toxin genes were evaluated. RESULTS: The isolation rate of B. cereus strains increased during the summer, but the isolation rate was evenly distributed among patient age groups. Emetic toxin was produced by 20.2% of the isolated strains. The prevalence rates of five enterotoxin genes (entFM, nheA, cytK2, hblC, and bceT) were 85.0, 78.6, 44.5, 36.6, and 29.7%, respectively, among non-emetic strains and 77.8, 59.3, 17.8, 11.9 and 12.6%, respectively, among emetic strains. Thus, the prevalence rates of all five enterotoxin genes were lower in emetic B. cereus. CONCLUSION: The prevalence of enterotoxin genes differed between non-emetic and emetic B. cereus strains. Among emetic B. cereus strains, the prevalence rates of two enterotoxin genes (cytK2 and hblC) were lower than those among the non-emetic strains. In both the emetic and non-emetic strains isolated in Korea, nheA and entFM were the most prevalent enterotoxin genes.

Internal Motivation, Perceived Health Competency, and Health Literacy in Primary and Secondary Cancer Prevention

Objective: The aim of this study was to identify associations of internal motivation, perceived health competency, and health literacy with primary and secondary cancer prevention. Methods: A telephone survey was conducted with a sample of 2,700, 30-69 year olds, proportionally extracted from Gangwon Province, South Korea. The dependent variables were actions in primary and secondary prevention and the explanatory variables were 13 questions in three areas: internal motivation (4 items), perceived health competency (4 items), and health literacy (5 items). Result: Multiple linear regression analysis showed that internal motivation, perceived health competency, and health literacy positively impacted primary prevention after controlling for gender and age. As internal motivation, perceived health competency, and perceived literacy increased by 1 point, primary prevention scores increased by 0.11, 0.11, and 0.07 points, respectively. In addition, logistic regression results for secondary prevention showed that health literacy had a positive impact on secondary behavior. As health literacy increased by 1 point, the odds ratio of the practice of secondary prevention was 1.4 times higher. Conclusion: This study suggests that primary and secondary prevention of cancer are significantly related to intrinsic motivation factors, perceived health competency, and actual health literacy. Health literacy concepts that cover the capacity of health management in comprehensive areas need to be applied to education and promotion for improvement of primary and secondary prevention of cancer.

Enteric Bacteria Isolated from Diarrheal Patients in Korea in 2014.

OBJECTIVES: The aim of this study was to characterize the pathogens responsible for causing diarrhea according to season, region of isolation, patient age, and sex as well as to provide useful data for the prevention of diarrheal disease. METHODS: Stool specimens from 14,886 patients with diarrhea were collected to identify pathogenic bacteria from January 2014 to December 2014 in Korea. A total of 3,526 pathogenic bacteria were isolated and analyzed according to season, region of isolation, and the age and sex of the patient. RESULTS: The breakdown of the isolated pathogenic bacteria were as follows: Salmonella spp. 476 (13.5%), pathogenic Escherichia coli 777 (22.0%), Vibrio parahaemolyticus 26 (0.74%), Shigella spp. 13 (0.37%), Campylobacter spp. 215 (6.10%), Clostridium perfringens 508 (14.4%), Staphylococcus aureus 1,144 (32.4%), Bacillus cereus 356 (10.1%), Listeria monocytogenes 1 (0.03%), and Yersinia enterocolitica 10 (0.3%). The isolation rate trend showed the highest ratio in the summer season from June to September for most of the pathogenic bacteria except the Gram-positive bacteria. The isolation rate of most of the pathogenic bacteria by patient age showed highest ratio in the 0-19 year age range. For isolation rate by region, 56.2% were isolated from cities and 43.8% were isolated from provinces. CONCLUSION: Hygiene education should be addressed for diarrheal disease-susceptible groups, such as those younger than 10 years, aged 10-19 years, and older than 70 years, and monitoring for the pathogens is still required. In addition, an efficient laboratory surveillance system for infection control should be continued.

Intrinsic motivation factors based on the self-determinant theory for regular breast cancer screening.

The purpose of this study was to identify factors of intrinsic motivation that affect regular breast cancer screening and contribute to development of a program for strategies to improve effective breast cancer screening. Subjects were residing in South Korea Gangwon-Province and were female over 40 and under 69 years of age. For the investigation, the Intrinsic Motivation Inventory (IMI) was modified to the situation of cancer screening and was used to survey 905 inhabitants. Multinominal logistic regression analyses were conducted for regular breast cancer screening (RS), one-time breast cancer screening (OS) and non-breast cancer screening (NS). For statistical analysis, IBM SPSS 20.0 was utilized. The determinant factors between RS and NS were "perceived effort and choice" and "stress and strain" - internal motivations related to regular breast cancer screening. Also, determinant factors between RS and OS are "age" and "perceived effort and choice" for internal motivation related to cancer screening. To increase regular screening, strategies that address individual perceived effort and choice are recommended.

Molecular characterization of Enterotoxigenic Escherichia coli strains isolated from diarrheal patients in Korea during 2003-2011.

Enterotoxigenic Escherichia coli (ETEC) is one of the major causes of infectious diarrhea in developing countries. In order to characterize the molecular features of human ETEC isolates from Korea, we investigated the profiles of enterotoxin and colonization factor (CF) genes by polymerase chain reaction (PCR) and performed multilocus sequence typing (MLST) with a total of 291 ETEC strains. The specimens comprised 258 domestic strains isolated from patients who had diarrhea and were from widely separated geographic regions in Korea and 33 inflow strains isolated from travelers visiting other Asian countries. Heat-stable toxin (STh)-possessing ETEC strains were more frequent than heat-labile toxin (LT)-possessing ETEC strains in the domestic isolates, while the detection rates of both enterotoxin genes were similar in the inflow isolates. The profile of CF genes of domestic isolates was similar to that of inflow isolates and the major CF types of the strains were CS3-CS21-CS1/PCF071 and CS2-CS3-CS21. Most of these 2 CF types were detected in ETEC strains that possess both lt and sth genes. The major MLSTST types of domestic isolates were ST171 and ST955. Moreover, the 2 major CF types were usually found concomitantly with the 2 major MLST STs, ST171 and ST955. In conclusion, our genotyping results may provide useful information for guiding the development of geographically specific vaccines against human ETEC isolates.

Factors related to condom use behavior among club-working women in South Korea: importance of subjective norms and customer-related attitudes.

The primary aim of this study was to understand factors associated with condom use behavior among club-working women and identify the most influential factors to be addressed in future health programs. A total of 158 club-working women were surveyed from 3 midsize cities in South Korea from July to September 2004. Survey questionnaires were developed based on the theory of planned behavior. A total of 7 distinct themes emerged: Health aspects, Customer related, Pleasure related, Finance related, Societal norm, Occupational norm, and Perceived control. The results indicated that the Customer-related theme, Societal norm, and Occupational norm were statistically significant factors affecting condom use. On the other hand, self-related factors such as health, pleasure, and finance are not significantly related to the condom use behavior of club-working women in South Korea, suggesting that the currently used knowledge-focused education programs may not be sufficient for this population.

Awareness of cancer and cancer screening by Korean community residents.

The purpose of this study was through a survey of awareness of cancer and cancer screening of Korean community residents to identify the stereotypes of cancer and bases for development of improved screening programs for early detection. Subjects were residing in South Korea Gangwon-Province and were over 30 years and under 69 years old. The total was 2,700 persons which underwent structured telephone survey questionnaires considered with specific rates of gender, region, and age. For statistical analysis, PASW Statistics 17.0 WIN was utilized. Frequency analysis, the Chi-square (χ?) test for univariate analysis, and logistic regression analysis were performed. The awareness of cancer and cancer screening in subjects differed by gender, region and age. For the idea of cancer, women thought about death less than men (OR: 0.73, p<0.001). On the other hand, women had negative thoughts - fear/terror/suffering/pain/pain - more than their male counterparts (OR: 2.04, p<0.001). Next, for the idea of cancer screening, women recognized fear/terror more than men (OR: 1.38, p<0.01). The higher age, the more tension/anxiety/worry/burden/irritated/pressure (OR: 1.43, p<0.01, OR: 2.15, p<0.001, OR: 2.49, p<0.001)). People may be reminded of fear and death for cancer and of fear, terror, tension and anxiety for cancer screening. To change vague fear and negative attitudes of cancer could increase the rate of cancer screening as well as help to improve the quality of life for community cancer survivors and facilitate return to normal social life. Therefore, it is necessary to provide promotion and education to improve the awareness of cancer and cancer screening.

Antibiotic resistance of bacteria isolated from the internal organs of edible snow crabs.

Antibiotic resistance and microbiota within edible snow crabs are important for the Chionoecetes (snow crab) fishing industry. We investigated these parameters using culture methods and antibiotic susceptibility tests with six internal organs from three species of Chionoecetes. Each sample revealed many unexpected microbial species within Chionoecetes internal organs. On the basis of 16S rRNA sequence analysis of 381 isolates, the most abundant genera identified in Chionoecetes opilio were Acinetobacter spp. (24%), Bacillus spp. (4%), Pseudomonas spp. (34%), Stenotrophomonas spp. (28%), and Agreia spp. (11%). In Chionoecetes sp. crabs, Acinetobacter spp. (23%), Bacillus spp. (12%), and Psychrobacter spp. (20%) were most prevalent, while Agreia spp. (11%), Bacillus spp. (31%), Microbacterium spp. (10%), Rhodococcus spp. (12%), and Agrococcus spp. (6%) were most abundant in C. japonicus. Our antibiotic resistance test found resistance to all nine antibiotics tested in 19, 14, and two of the isolates from C. opilio, Chionoecetes sp., and, C. japonicus respectively. Our results are the first to show that microbes with antibiotic resistance are widely distributed throughout the internal organs of natural snow crabs.

Ras/ERK1 pathway regulation of p27KIP1-mediated G1-phase cell-cycle arrest in cordycepin-induced inhibition of the proliferation of vascular smooth muscle cells.

Cordycepin, the main constituent of Cordyceps militaris, demonstrated an anti-atherogenic effect in experimental animals. However, the effects of cordycepin on cell-cycle regulation and the signaling pathway in vascular smooth muscle cells (VSMC) remain largely unknown; therefore, unexpected roles of cordycepin-induced inhibition in VSMC growth were investigated. Mechanisms in cordycepin-treated VSMC were examined via an MTT assay, a thymidine uptake experiment, FACS analysis, immunoblot analysis, kinase assay, immunoprecipitation assay, and transient transfection assays. Cordycepin inhibited cell growth, induced G1-phase cell-cycle arrest, down-regulated cyclins and cyclin-dependent kinase (CDK) expression, and up-regulated p27KIP1 expression in VSMC. Cordycepin induced activation of JNK, p38MAPK and ERK1/2. Blocking of the ERK function using either ERK1/2-specific inhibitor U0126 or a small interfering RNA (si-ERK1) reversed p27KIP1 expression, inhibition of cell growth, and decreased cell-cycle proteins in cordycepin-treated VSMC. Ras activation was increased by cordycepin. Transfection of cells with dominant negative Ras (RasN17) mutant genes rescued cordycepin-induced ERK1/2 activity, increased p27KIP1 expression, inhibited cell proliferation, and reduced cell cycle proteins. In conclusion, our findings indicate that Ras/ERK1 pathways participate in p27KIP1-mediated G1-phase cell-cycle arrest induced by cordycepin via a decrease in cyclin/CDK complexes in VSMC.

Audience segmentation to promote lifestyle for cancer prevention in the Korean community.

OBJECTIVES: This study was designed to segment the audience group of '10 lifestyle for cancer prevention' based on demographic characteristics and the level of knowledge about each guideline for cancer prevention among the community in South Korea. METHODS: Participants were chosen through stratified random sampling according to the age and gender distribution of Gangwon province in South Korea. A telephone survey was conducted from 6 to 15 calls among 2,025 persons on October 2008. A total of 1,687 persons completed the survey (response rate: 83.3%). Survey items were composed of socio-demographic characteristics such as age, gender, income, education, and residence area and the knowledge level of '10 guidelines for cancer prevention', developed by 'Korean Ministry of Health and Welfare' and covering smoking cessation, appropriate drinking, condom use, and regular physical activity and so on. We selected the priority needed to promote awareness and segmented the audience group based on the demographic characteristics, homogeneous with respect to the knowledge level using Answer Tree 3.0 with CHAID as a data mining algorithm. RESULTS: The results of analysis showed that each guideline of ' 10 lifestyle for cancer prevention' had its own segmented subgroup characterized by each demographic. Especially, residence area, city or county, and ages were the first split on the perceived level of knowledge and these findings suggested that segmentation of audiences for targeting is needed to deliver more effective education of patients and community people. In developing the strategy for effective education, the method of social marketing using the decision tree analysis could be a useful and appropriate tool. CONCLUSION: The study findings demonstrate the potential value of using more sophisticated strategies of designing and providing health information based on audience segmentation.