Institutional and individual factors associated with functional outcomes in nursing home residents under long-term care insurance in Korea: A multilevel analysis.

OBJECTIVE: The purpose of this study was to analyze the relationship between institutional and individual characteristics that influence changes in the functional outcomes of nursing home residents. METHODS: Long-term Care Insurance claims data with basic information of nursing home(n = 3,263) and long-term care needs assessment data of nursing home residents(n = 34,717) was used. The independent variable was classified into individual (level 1) and nursing home characteristics (level 2). Changes in physical function, cognitive function, and behavioral symptoms were used as dependent variables. RESULTS: The institutional factors of nursing homes contributed relatively little to substantial changes in function of nursing home residents. Ownership, size, and nursing home staff including care worker and physical/occupational therapist were important determinants of functional changes in nursing home residents. CONCLUSION: To improve the quality of nursing homes in Korea, regulations on staffing should be modified, and an disincentive policy should be introduced for low-quality institutions.

Effects of a Dementia Special Care Unit on the Changes in Physical Function, Cognitive Function, and Problematic Behaviors among Nursing Home Residents.

BACKGROUND: This study compared changes in physical function, cognitive function, and problematic behaviors among nursing home residents with dementia between the dementia specialized care and general units. METHODS: To assess the effects of a dementia specialized care unit (D-SCU), this study applied the difference-in-differences method. While the D-SCU was introduced in July 2016, the service was provided in January 2017. We defined the pre-intervention period as July 2015 to December 2016 and the post-intervention period as January 2017 to September 2018. We matched long-term care (LTC) insurance beneficiaries using the propensity score matching method to minimize selection bias. After this matching, two new groups were obtained, each with 284 beneficiaries. To characterize the actual effects of the D-SCU on physical function, cognitive function, and problematic behaviors among dementia beneficiaries, we conducted a multiple regression analysis that controlled for demographics, LTC need, and LTC benefit utilization. RESULTS: The physical function score significantly increased according to the time effect, and the interaction term between time and the use of D-SCU was significant. Therefore, the activities of daily living (ADL) score of the control group increased by 5.01 points more than that in the group of beneficiaries using the D-SCU (p<0.001). However, the interaction term had no significant effect on cognitive function or problematic behavior. CONCLUSION: These results revealed the partial effect of the D-SCU on LTC insurance. Further research is required that considers the variables of service providers.

Effects of Changes in Physical Activity with Cognitive Decline in Korean Home-Dwelling Older Adults.

PURPOSE: The rapidly increasing older adults' population of South Korea has increased the socioeconomic burden on society due to cognitive decline. In this study, we examined the association between changes in physical activity in the older adults and their cognitive function, a primary criterion for the diagnosis of dementia, using panel data from the 2012-2018 Korean Longitudinal Study of Aging. PATIENTS AND METHODS: This study used baseline (2012) and biennial assessment of follow-up data (2014, 2016, 2018) from Korean Longitudinal Study of Aging. A total of 1733 older adults with the Korean version of the Mini Mental State Examination (K-MMSE) scores in the normal range at the time of the first investigation were included in the study. Physical activity was classified into three categories: inactivity, low physical activity, and high physical activity. Changes in physical activity from 2012 were classified into five groups: remained active, became active in 2016, became active in 2014, became inactive, and remained inactive. Participants' general and health-related characteristics were used as control variables. Descriptive statistics, chi-square tests, and logistic regression analysis were used for analysis. RESULTS: The baseline mean age of the older adults in 2012 was 71.63 years; of the total 1733 participants, 57.1% were inactive, 5.7% had low physical activity, and 37.3% had high physical activity. Changes in physical activity were significantly associated with cognitive decline. Compared to the group that continued regular physical activity, the risk of cognitive decline increased in the case of participants who became or remained inactive. CONCLUSION: Results highlighted the importance of continuous physical activity and its relation to cognitive function. Encouraging continuous physical activity in the older adults has a positive effect on the prevention of cognitive impairment and dementia. Thus, exercise-based interventions should be implemented a community health service.

Carved Turn Control with Gate Vision Recognition of a Humanoid Robot for Giant Slalom Skiing on Ski Slopes.

The performance of humanoid robots is improving, owing in part to their participation in robot games such as the DARPA Robotics Challenge. Along with the 2018 Winter Olympics in Pyeongchang, a Skiing Robot Competition was held in which humanoid robots participated autonomously in a giant slalom alpine skiing competition. The robots were required to transit through many red or blue gates on the ski slope to reach the finish line. The course was relatively short at 100 m long and had an intermediate-level rating. A 1.23 m tall humanoid ski robot, 'DIANA', was developed for this skiing competition. As a humanoid robot that mimics humans, the goal was to descend the slope as fast as possible, so the robot was developed to perform a carved turn motion. The carved turn was difficult to balance compared to other turn methods. Therefore, ZMP control, which could secure the posture stability of the biped robot, was applied. Since skiing takes place outdoors, it was necessary to ensure recognition of the flags in various weather conditions. This was ensured using deep learning-based vision recognition. Thus, the performance of the humanoid robot DIANA was established using the carved turn in an experiment on an actual ski slope. The ultimate vision for humanoid robots is for them to naturally blend into human society and provide necessary services to people. Previously, there was no way for a full-sized humanoid robot to move on a snowy mountain. In this study, a humanoid robot that transcends this limitation was realized.

Switched electromechanical dynamics for transient phase control of brushed DC servomotor.

Robotic tasks often exceed the scope of steady-state or periodic behavior, which necessitates generally-applicable models of actuators intended to generate transient or aperiodic motion. However, existing electromechanical models of servomotors typically omit consideration of the switching power converter circuits required for directional, speed, or torque control. In this study, a multi-domain framework is established for switched electromechanical dynamics in servomotor systems for their analysis and control in general aperiodic tasks including transient phases. The switched electromechanical dynamics is derived from the individual models of the internal DC motor, gear train, and H-bridge circuit. The coupled models comprehensively integrate all possible distinct switching configurations of on-state, off-state, and dead time. A combination of cycle averaging with piecewise analytical solutions of the non-smooth dynamics is introduced to handle different temporal scales from high-frequency electrical to low-frequency mechanical variables. System parameters were estimated from experimental data using a dual-servomotor test platform. The model was validated for predictive accuracy against measured data in two distinct tasks-dynamic braking of a pendulum system and sinusoidal trajectory following. The model was also used to formulate the servomotor power consumption, which was implemented for optimal control demonstration and energy analysis. In particular, the servomotor power consumption model provided true optimality (minimization) when compared with the squared rotor torque and the positive rotor mechanical power that are commonly used as proxy models. While the focus of this work is on permanent-magnet, armature-controlled brushed DC servomotors, the approach is applicable to general electromechanical systems with switching-based control.

Effect of Subjective Economic Status During the COVID-19 Pandemic on Depressive Symptoms and Suicidal Ideation Among South Korean Adolescents.

PURPOSE: This study identified the relationships between perceived household economic status and household economic downturn due to COVID-19 and adolescent depressive symptoms and suicidal ideation. METHODS: Participants for this study were extracted from the 13th Korea Youth Risk Behavior Web-Based Survey, conducted from August to November 2020. The participants comprised 54,948 middle and high school students selected by stratified random cluster sampling. RESULTS: The prevalence rates of depressive symptoms and suicidal ideation were 25.2% and 10.9%, respectively. Multivariate logistic regression analysis showed that lower perceived household economic status significantly predicted higher prevalence of depressive symptoms and suicidal ideation. Participants who perceived that their household economic status had declined because of COVID-19 were more likely to have experienced depression and suicidal ideation. These results were similar regardless of the participants' perceptions of household economic status. CONCLUSION: This study found that in the ongoing pandemic, there is a need for an active mental health promotion program for adolescents from low-income households, especially those who experienced a recent decline in the household economy.

Optimization of allyl isothiocyanate sanitizing concentration for inactivation of Salmonella Typhimurium on lettuce based on its phenotypic and metabolome changes.

Allyl isothiocyanate (AITC), a natural compound, is a promising food additive and preservative because of its safety and effectiveness. In order to determine optimal AITC concentrations for disinfection of food pathogen on lettuce without compromising postharvest quality, various concentrations of AITC (0, 1, 2.5, 5 and 7.5 µL L-1) were applied to Salmonella Typhimurium inoculated lettuce in air-tight box at 7 °C. As a result, the decline in visual quality, weight loss via cell membrane damage, and significantly reduced antioxidant activity were observed in lettuce treated with an AITC concentration of 2.5 µL L-1, 5 µL L-1 or higher. Moreover, metabolome analysis showed pattern of increased respiratory and cell damage, such as lipid peroxidation. Based on physiological changes, 1 µL L-1 was determined as the optimal AITC concentration that significantly reduced S. Typhimurium population (4.01 log CFU g-1) on lettuce.

Disagreement between a public insurer's recommendation and beneficiary's choice of long-term care services in Korea.

This study examined the disagreement between an insurer's recommendation for long-term care (LTC) services and beneficiaries' choices and analyzed the factors associated with the disagreement. Data from the National Long-Term Care Insurance (LTCI) and the Standard Care Plan were merged to create a dataset of 43,319 LTCI beneficiaries. The dependent variable was the disagreement between beneficiaries and insurers. Predisposing, enabling, and needs factors were independent variables based on the Andersen's Model. Disagreement between the insurer's recommendation of home care services and the beneficiaries' choice of institution service was 6.7% (n = 2357). The opposite disagreement occurred in 23.0% (n = 1820) of cases. A multivariate analysis showed that the OR for disagreement between insurer-recommended home care services and beneficiary-selected institution services increased with age, living with someone, having Medical Aid, living in a facility, and having high care needs, dementia, and poor subjective hearing. The OR for disagreement between insurer-recommended institution service and beneficiary-selected home care service increased for men and decreased for those 90 years or older, living with someone, having Medicaid etc, and living at institution. Korean beneficiaries of LTCI have a high preference for aging in their home, and changes in LTCI contents must be made to address the needs of this population.

Staff mix and nursing home quality by level of case mix in Korea.

AIM: The purpose of the present study was to identify the relationship between staff mix in nursing homes and quality of care by level of case mix in Korea. METHODS: Data used in the present study came from Long-Term Care Insurance claims data with basic information of nursing homes with >29 beds (n = 1137) and quality evaluation reports. Staff mix was calculated as the number of nursing staff, social workers and care workers per total staff number. RESULTS: In multinomial logistic regression analyses, institutions with a higher ratio of social workers were classified as top-quality class institutes after controlling ownership, location, size and percentage of high level of care needs residents. In analyzing the higher case mix nursing homes, institutions with a high ratio of nursing staff and social workers were more likely to be classified as top-quality class than the lowest class institutions. However, there was no significant association between quality of care and ratio of staff mix in the lower case mix nursing homes. CONCLUSIONS: A higher staff mix was positively related to nursing home quality of care, but the relationship was affected by case mix of residents' care demand. Therefore, the current minimum staffing standard for personnel in nursing homes should be modified considering the acuity of the residents. Geriatr Gerontol Int 2019; 19: 438-443.

Injury pyramid of unintentional injuries according to sex and age in South Korea.

OBJECTIVE: The injury-related disease burden in South Korea is relatively high compared to that in other nations. This study was conducted to identify the scale and causes of injury by severity, using an injury pyramid and analyzing the sex and age-dependent differences and the basic demographic characteristics. METHODS: Unintentional injury was estimated for each group after classifying injury-related deaths, hospitalizations, and outpatient department (OPD) visits based on their severity. The injury pyramid was calculated by classifying the injury outcomes into deaths, hospitalizations, and outpatient visits. RESULTS: The incidence of unintentional injury included 31.74 deaths, 1,715.27 hospitalizations, and 7,317.55 OPD visits per 100,000 persons. The incidence of injury was higher among males than that among females. There were more hospitalizations and OPD visits than deaths among females. The mortality and hospitalization rates due to injury per 100,000 persons were the highest among those ≥75 years old, and the OPD visit rate was the highest among preschool children aged 0 to 6 years. The injury mechanisms that caused most deaths and hospitalizations in South Korea were injuries related to traffic, falls, poisoning, and burns/fires. CONCLUSION: The scale of unintentional injury varies based on sex, age, and injury mechanism; additionally there are differences in the incidence of injuries between males and females depending on their age and injury mechanism. The high incidence of injury in elderly people could be a factor that increases the burden of injury in South Korea; hence, it is necessary to develop an injury prevention program that targets the elderly.

Endoscopic navigation system with extended field of view using augmented reality technology.

BACKGROUND: While endoscopic skull base surgery (ESBS) has emerged as an alternative surgical option, the limited field of view of the endoscope may lead to the surgeon's fatigue and discomfort. METHODS: The developed navigation system includes extended augmented reality (AR), which can provide an extended viewport to a conventional endoscopic view by overlaying 3D anatomical models generated from preoperative medical images onto endoscope images. To enhance the accuracy of the developed system, we adopted state-of-the-art endoscopic calibration and tracking techniques based on an optical tracking system. RESULTS: The mean spatial errors of AR was ~1 mm, which falls in the acceptable range of accuracy for ESBS. For the simulated surgical tasks with the developed system, the number and duration of error events were decreased. CONCLUSIONS: The results show that the human subject can perform the task more precisely and safely with the developed AR-based navigation system than with the conventional endoscopic system.

Effect of antihypertensive medication adherence on hospitalization for cardiovascular disease and mortality in hypertensive patients.

Antihypertensive medication treatment is one effective management strategy to prevent cardiovascular disease (CVD) and mortality. However, little research has been conducted on the rates of antihypertensive medication adherence and the effect of antihypertensive medication adherence on health outcomes in South Korea. We searched the Korean National Health Insurance Claims Database for records from 2003 to 2007. Patients in this study were 18 years of age or older and they were diagnosed with hypertension and newly prescribed antihypertensive medication in 2003. Adherence to antihypertensive medication was estimated as the medication possession ratio (MPR). Multivariate Cox regression was used to evaluate the association between medication adherence and adverse health outcomes after adjusting for patient demographics and clinical characteristics. Our study population consisted of 40,408 patients with a mean age of 51 years. Among the patients, 50.3% were men, 4.0% had Medicaid health insurance, 17.8% had diabetes, 20.9% had dyslipidemia and 42.4% were adherent (MPR ≥ 80%). Nonadherent patients (MPR<80%) were younger and more likely to have Medicaid health insurance; they had lower rates of diabetes and dyslipidemia compared with adherent patients. In the Cox multivariate analysis, nonadherence increased the risk of all adverse health outcomes, including all-cause mortality and hospitalization for CVD (hazard ratio: 1.57, confidence interval: 1.40-1.76). In conclusion, our study indicates that medication adherence is important for reducing hospitalization due to CVD and mortality.