Inequality, abuse of women and duration of breastfeeding, Colombia, 2010: Ecological study / Desigualdad, maltrato de la mujer y duración de la lactancia materna, Colombia, 2010: Estudio ecológico

Abstract Introduction: Breastfeeding decreases morbidity, mortality and promotes health in the mother and child. The lower morbidity in relative terms in breastfed versus non-breastfed infants reduces healthcare costs. In Colombia, the duration of breastfeeding is far from desirable times and continues to decline. Objectives: The objectives were (a) to determine economic inequality based on poverty at the ecological level during exclusive breastfeeding (EBF) and total breastfeeding (BF) and (b) to establish the social determinants of EBF and BF using the territory as a unit of analysis. Method: An ecological study was conducted based on data collected in the National Survey of the Nutritional Situation of 2010 in Colombia regarding the median duration of exclusive breastfeeding and total breastfeeding. The data was summarized in 24 departments or geodemographic units that represent the Colombian territory (n=24). Fourteen variables representing the economic, social, human and structural development levels in the territory were related by linear regression to explain the duration of EBF and BF. Results: EBF lasted 1.18 months (95% CI: 1.00 to 1.36), and BF lasted 14.79 months (95% CI: 13.50 to 16.08). Economic inequality was low, and the Gini coefficient was 0.35 for EBF and 0.10 for BF. The EBF duration is affected by the gender empowerment measure (GEM) (β =-1.94, p=0.006) and medical coverage (%) (β =-0.02, p=0.060). The BF duration is explained by the monetary poverty (β =0.12, p=0.007) GEM (β =-9.94, p=0.033) and female abuse rate x 100,000 (β =0.01, p=0.005). Conclusions: The impact of social and human development is greater than the economic aspect as a determinant of EBF and BF duration in Colombia. Exclusive and total breastfeeding are phenomena explained differently.

Resumen Introducción: La lactancia materna disminuye la morbilidad, la mortalidad y promueve la salud de la madre y del niño. La menor morbilidad en términos relativos en los niños amamantados frente a los no amamantados reduce los costes sanitarios. En Colombia, la duración de la lactancia materna está lejos de los tiempos deseables y sigue disminuyendo. Objetivos: Los objetivos fueron (a) determinar la desigualdad económica basada en la pobreza a nivel ecológico durante la lactancia materna exclusiva (LME) y la lactancia materna total (LMT) y (b) establecer los determinantes sociales de la LME y la LMT utilizando el territorio como unidad de análisis. Método: Se realizó un estudio ecológico a partir de los datos recogidos en la Encuesta Nacional de Situación Nutricional de 2010 en Colombia sobre la mediana de duración de la lactancia materna exclusiva y la lactancia materna total. Los datos se resumieron en 24 departamentos o unidades geo demográficas que representan el territorio colombiano (n=24). Catorce variables que representan los niveles de desarrollo económico, social, humano y estructural del territorio se relacionaron mediante regresión lineal para explicar la duración de la LME y la LMT. Resultados: La LME tuvo una duración de 1,18 meses (IC 95 %: 1,00 a 1,36), y la LMT tuvo una duración de 14,79 meses (IC 95 %: 13,50 a 16,08). La desigualdad económica fue baja, y el coeficiente de Gini fue de 0,35 para la LME y de 0,10 para la LMT. La duración de la LME se ve afectada por la medida de empoderamiento de género (GEM) (β =-1,94, p=0,006) y la cobertura médica (%) (β=-0,02, p=0,060). La duración de la LMT se explica por la pobreza monetaria (β =0,12, p=0,007) GEM (β =-9,94, p=0,033) y la tasa de maltrato femenino x 100 000 (β =0,01, p=0,005). Conclusiones: En Colombia el impacto del desarrollo social y humano es mayor que el aspecto económico como determinante de la LME y de la duración de la LMT. La lactancia materna exclusiva y total son fenómenos que se explican de manera diferente.

Direct-acting antivirals for chronic Hepatitis C are effective and safe: an observational study in Londrina/PR

Abstract This study aimed to evaluate the effectiveness and safety of direct-acting antivirals in a Unified Health System pharmacy of Londrina, Brazil. A descriptive observational study was performed from June 2017 to June 2018. Sociodemographic, clinical, and therapeutic variables of patients were collected from secondary data sources. Effectiveness was evaluated by sustained virologic response (SVR) and safety was evaluated by adverse events (AEs) and drug interactions (DIs). The mean population (N=30) was 56.6±11.3 years old and almost all patients had comorbidities (93.3%) and concomitant drugs (96.7%). Effectiveness evaluation was possible in 17 patients, and all of them (100.0%) achieved SVR. Eighteen patients (60.0%) reported 38 AEs, mostly mild, such as stomach symptoms and headache. No statistical relation was found between AE occurrence and treatment duration, Ribavirin use, number of comorbidities or number of concomitant drugs. A total of 48 DIs were reported, 18 being severe, and were managed by the pharmacist. The study indicates that the treatment was effective and safe.

Assessment of Willingness to pay for Community-Based Health Insurance among Artisans in a selected Community of Ekiti State, Southwest Nigeria

Background: Community-based health insurance (CBHI) has emerged as a more efficient and equitable approach to healthcare financing. It was designed to ensure that sufficient resources are made available for members to access effective healthcare. This study assessed the willingness to pay (WTP) for CBHI among artisans in a town in Ekiti State, South West Nigeria. Methods: This was a cross-sectional survey conducted among 416 artisans in a town in Ekiti State. A semi-structured interviewer-administered questionnaire was designed and used for data collection on sociodemographic data and WTP for CBHIS. Data entry and analysis was done using IBM SPSS software version 25.0. Results: The mean age and standard deviation of the respondents was 29.7±10.9 years with male to female ratio of 1:1.4. Most of the respondents were willing to pay (86.3%) and willing to enroll other household members (73.6%) in the CBHI. A large percentage (44.3%) of those willing to pay were ready to pay between ₦1,000-₦5,000 (US$2.63­US$13.16) per year while 39.6% preferred frequency of payment to be annually. Positive predictors of WTP for CBHI were age groups ≥50 years and 40-49 years than <20 years (AOR:13.270, 95%CI: 1.597-110.267; AOR:142.996, 95%CI: 10.689-1913.009). Females than males (AOR:9.155, 95%CI: 3.680-22.775), tertiary level of education than no formal of education (AOR:23.420, 95%CI: 1.648-850.921), no children than ≥5 children (AOR:20.099, 95%CI: 2.705-149.364), earn ≥₦30,000 (US$78.95) than <₦30,000 (AOR:2.248, 95%CI: 1.278-6.499). often and somethings fall ill than seldom fall ill (AOR:6.505, 95%CI: 1.623-26.065; AOR:4.889, 95%CI: 1.674-14.279) Conclusion: WTP for CBHI was high among the artisans, however, there is a variation across the amount and frequency of payment. Therefore, policy that is flexible enough to allow artisans enroll and pay a premium that is affordable, at an acceptable frequency, should be formulated by the Government.

Percepções da equipe de enfermagem sobre preparo e administração de medicamentos em pediatria / Percepciones del equipo de enfermería sobre la preparación y administración de medicamentos en pediatría / Nursing team's perceptions of preparation and administration of medicines in pediatrics

RESUMO Objetivo: analisar as percepções da equipe de enfermagem sobre preparo e administração de medicamentos em pediatria. Método: estudo de abordagem qualitativa realizado na clínica pediátrica de um hospital público. Entrevistaram-se vinte profissionais de enfermagem por meio de questões norteadoras sobreo processo de administração de medicamentos em seu local de trabalho e fatores que contribuem para os erros de medicação. As entrevistas foram gravadas e posteriormente transcritas. Os resultados foram categorizados de acordo com análise de conteúdo e o referencial teórico foi a segurança do paciente. Resultados: as categorias identificadasforam processo de trabalho relacionado à medicação; precarização do trabalho em saúde; sistema de medicação: prescrição médica; e protocolos relacionados a medicamentos. A prescrição médica foi apontada comoum dos fatores indutoresde erro de medicação, além da interrupção durante o preparoe administração de medicamentos e ausência de protocolo sobre os cuidados específicos em pediatria. Situações como sobrecarga profissional, conflitos, falta de materiais eestrutura física inadequada foram percebidas no processo de medicação em pediatria. Conclusão: as percepções da equipe de enfermagem demonstrarama necessidade de espaços de diálogos dentro da equipe multiprofissional e maior envolvimento da gestão na busca de um cuidado seguro prestado ao paciente.

RESUMEN Objetivo: analizar las percepciones del equipo de enfermería sobre la preparación y administración de medicamentos en pediatría. Método: estudio de abordaje cualitativo realizado en la clínica pediátrica de un hospital público. Fueron entrevistados veinte profesionales de enfermería por medio de preguntas orientadoras sobre el proceso de administración de medicamentos en su local de trabajo ylos factores que contribuyen para los errores de medicación. Las entrevistas fueron grabadas y posteriormente transcriptas. Los resultados fueron categorizados según el análisis de contenido yel referencial teórico fuela seguridad del paciente. Resultados: las categorías encontradas fueron proceso de trabajo relacionado a la medicación; precarización del trabajo en salud; sistema de medicación: prescripción médica; y protocolos relacionados a medicamentos. Laprescripción médica fue señalada como uno de los factores inductores de error de medicación, además de la interrupción durante la preparación yadministración de medicamentos y ausencia de protocolo sobre los cuidados específicos en pediatría. Situaciones tales como sobrecarga profesional, conflictos, falta de materiales y estructura física inadecuada fueron percibidas en el proceso de medicación en pediatría. Conclusión: las percepciones del equipo de enfermería demostraronla necesidad de espacios de diálogos dentro del equipo multiprofesional y una mayor participación de la gestiónen la búsqueda de un cuidado seguro prestado al paciente.

ABSTRACT Objective: to analyze the nursing team's perceptions of preparation and administration of medicines in pediatrics. Method: qualitative study conducted in the pediatric clinic of a public hospital. Twenty nursing professionals were interviewed by using guiding questions about the medication administration process in their workplace and factors that contribute to medication errors. The interviews were recorded and later transcribed. The results were categorized according to content analysis and the theoretical framework was patient safety. Results: the categories that have been identified are medication-related work process; poor health work conditions; medication system: medical prescription; and medication-related protocols. Medical prescription has been pointed out as one of the factors that lead to medication errors, in addition to interruption during the preparation and administration of medicines and the absence of a protocol on specific care in pediatrics. Situations such as professional overload, conflicts, lack of materials, and poor physical structure have been noticed in the medication process in pediatrics. Conclusion: the nursing team's perceptions have shown the need for spaces of dialogue within the multiprofessional team and greater management commitment and involvement in the search for safe patient care.

Social Inequalities of Oral Anticoagulation after the Introduction of Non-Vitamin K Antagonists in Patients with Atrial Fibrillation

BACKGROUND AND OBJECTIVES: Nationwide social inequalities of oral anticoagulation (OAC) usage after the introduction of non-vitamin K antagonist oral anticoagulants (NOACs) have not been well identified in patients with atrial fibrillation (AF). This study assessed overall rate and social inequalities of OAC usage after the introduction of NOAC in Korea.METHODS: Between January 2002 and December 2016, we identified 888,540 patients with AF in the Korea National Health Insurance system database. The change of OAC rate in different medical systems after the introduction of NOAC were evaluated.RESULTS: In all population, overall OAC use increased from 13.2% to 23.4% (p for trend <0.001), and NOAC use increased from 0% to 14.6% (p for trend <0.001). Compared with pre-reimbursement (0.48%), the annual increase of OAC use was significantly higher after partial (1.16%, p<0.001), and full reimbursement of OAC (3.72%, p<0.001). Full reimbursement of NOAC (adjusted odds ratio, 2.10; 95% confidence interval, 2.04–2.15) was independently associated with higher OAC use. However, the difference of overall OAC usage between tertiary referral hospitals and nursing or public health centers increased from 17.9% in 2010 to 36.8% in 2016. Moreover, usage rate of NOAC was significantly different among different medical systems from 37.2% at the tertiary referral hospital and 5.5% at nursing or public health centers.CONCLUSIONS: Introduction of NOACs in routine practice for stroke prevention in AF was associated with improved rates of overall OAC use. However, significant practice-level variations in OAC and NOAC use remain producing social inequalities of OAC despite full reimbursement.

Clinical Guidance for Point-of-Care Ultrasound in the Emergency and Critical Care Areas after Implementing Insurance Coverage in Korea

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

Towards universal quality health care through an independent accreditation agency: A review

Background@#Guaranteeing quality of health care services is part of the objectives of Republic Act No. 11223 or the Universal Health Care (UHC) Act of 2019. In assuring that quality services are delivered by health care providers, they must be accredited to participate in the National Health Insurance Program. The UHC Act mandates the Philippine Health Insurance Corporation (PhilHealth) to recognize third party mechanisms as basis of granting incentives for health facilities that deliver services of higher quality. This review aimed to identify lessons and experiences from literature that can be adopted and contextualized in the Philippine setting, for strategic policies on strengthening the national health facility accreditation system. @*Methods@#A systematic review of literature was conducted to generate evidence-based recommendations from discussions on cross country experiences and local government initiatives towards improved accreditation system. @*Results@#By virtue of the UHC Act, a form of strategic purchasing is further institutionalized through a rating system that incentivizes health facilities that provide better services in terms of quality, efficiency, and equity. It is imperative to consider the country’s previous and current gaps and challenges in accreditation and adopt the best practices of other countries, as appropriate to Philippine's local settings. A tool is proposed in creating a national hospital accreditation system using the domains of leadership and governance, financing and sustainability, standards development, program management, and continuing quality improvement. @*Conclusion and Recommendations@#With the legitimacy of third party accreditation body mandated by the UHC Act, operationalization of the prescribed mechanisms and organizational structure must enjoin all pertinent stakeholders and be supported by sustainable funds and technical assistance by the government.

Big Data-Driven Approach for Health Inequalities in Foreign Patients with Injuries Visiting Emergency Rooms / 대한의료정보학회지

Sociodemographic Factors Associated with Participation in Diabetes Education among Community-Dwelling Adults with Diabetes

Violence at work in emergency care units: nurses' experiences / Violência no trabalho em unidades de pronto atendimento: vivências de enfermeiros / Violencia laboral en los centros de emergencia: experiencia de los enfermeros

Objectives: to understand the perception of nurses in emergency care units about the violence experienced at work. Method: qualitative study conducted through 21 individual interviews between November and December 2018 in two emergency care units in a city in Paraná. Symbolic Interactionism was adopted as the theoretical framework and the Thematic Content Analysis technique was used to evaluate the data. Results: from the thematic category experiencing psychological violence in the nurses' daily work, it was evidenced that it was related to threats against their lives, cursing, humiliation, embarrassment, attempt to defame them, as well as pressure from subordinates. In the category experiencing physical violence in the nurses' daily work, it was found that it was imposed through pushing, pulling hair, throwing objects, the presence of firearms and knives and, even, witnessing murder. Conclusion: nurses suffered acts of violence by external and internal people, from the emergency care units themselves. Managers, nurses and society need to look reflexively and critically at the violence that happens and implement actions to avoid them, thus providing a safe working environment for all involved and educate society in order to make the reduction of violence a priority in public policies.

Objetivos: compreender a percepção de enfermeiros de unidades de pronto atendimento sobre a violência vivenciada no trabalho. Método: estudo qualitativo realizado por meio de 21 entrevistas individuais entre novembro e dezembro de 2018 em duas unidades de pronto atendimento de uma cidade paranaense. Foi adotado o Interacionismo Simbólico como referencial teórico e a técnica de Análise de Conteúdo Temática para avaliar os dados. Resultados: da categoria temática vivenciando a violência psicológica no cotidiano laboral do enfermeiro evidenciou-se que esteve relacionada com ameaças contra as suas vidas, xingamentos, humilhações, constrangimentos, tentativa de denegri-los, bem como pela pressão dos subordinados. Já na categoria vivenciando a violência física no cotidiano laboral do enfermeiro verificou-se que foi impetrada por meio de empurrões, puxões de cabelo, arremesso de objetos, presença de armas de fogo e de facas e, até, o presenciamento de assassinato. Conclusão: os enfermeiros sofreram atos de violência por pessoas externas e internas, das próprias unidades de pronto atendimento. Os gestores, os enfermeiros e a sociedade precisam olhar reflexiva e criticamente para as violências que acontecem e implementar ações para evitá-las e, assim, propiciar um ambiente laboral seguro para todos os envolvidos, sensibilizando a sociedade para que a redução da violência seja uma prioridade nas políticas públicas.

Objetivos: comprender la percepción de los enfermeros de unidades de atención de emergencia sobre la violencia experimentada en el trabajo. Método: estudio cualitativo realizado a través de 21 entrevistas individuales entre noviembre y diciembre de 2018 en dos unidades de atención de emergencia en una ciudad de Paraná. El Interaccionismo Simbólico se adoptó como marco teórico y la técnica de análisis de contenido temático se utilizó para evaluar los datos. Resultados: desde la categoría temática situaciones de violencia psicológica en la práctica cotidiana de los enfermeros, se evidenció que la misma se hallaba vinculada con amenazas contra sus vidas, insultos, humillaciones, situaciones embarazosas, intento de denigración, así como la presión de los subordinados. En la categoría situaciones de violencia física en la práctica cotidiana de los enfermeros, se descubrió que se imponía a través de empujones, tirones de cabello, arrojando objetos, con la presencia de armas de fuego y cuchillos e, incluso, presenciando asesinato. Conclusión: los enfermeros sufrieron actos de violencia por parte de personas externas e internas, a las propias unidades de atención de emergencia. Los gerentes, las enfermeras y la sociedad deben mirar reflexiva y críticamente la violencia que ocurre e implementar acciones para evitarla y, de ese modo, ofrecer un ambiente de trabajo seguro para todos los involucrados, además de crear conciencia en la sociedad para que la reducción de la violencia se convierta en prioridad de las políticas públicas.

Protección de la salud en el trabajo: de lo indemnizatorio mercantil al real cuidado de la salud / Protection of health at the workplace: from monetary compensation to true health care

Este artículo cuestiona los mecanismos de protección de la salud en el trabajo desarrollados internacionalmente hasta ahora por el campo de la seguridad y la salud en el trabajo. Su objetivo fue hacer un análisis de los enfoques de la salud ocupacional y el aseguramiento que han estructurado la praxis hegemónica de la protección de la salud en el trabajo y contrastarlos con el enfoque de la salud de los trabajadores proveniente del campo de la medicina social­ salud colectiva. La metodología usada para el desarrollo del artículo fue la de una investigación documental, conjugada con la experiencia en formación, investigación y organización en el campo de la salud de los trabajadores del autor del artículo. Las reflexiones epistémicas, ontológicas, metodológicas, políticas y prácticas, sobre la base de lo revisado documentalmente, permitieron sostener que a pesar de algunos beneficios de los mecanismos tradicionales de protección de la salud en el trabajo, los enfoques de la salud ocupacional y el aseguramiento no transforman las condiciones de trabajo que históricamente han generado efectos negativos sobre la salud y la vida de los trabajadores, mientras que el enfoque de salud del trabajador proporciona elementos que aportan a configurar una protección integral del cuidado de la salud en trabajo, con un sentido de autonomía y emancipación de los trabajadores y una apuesta real por la transformación tanto de las condiciones de trabajo, como de las del modo de producción(AU)

This paper questions the mechanisms of protection of health at the workplace currently applied globally in occupational safety and health. The author performed an analysis of occupational health and insurance approaches that have driven the hegemonic practice of occupational health protection, and contrasted them with an approach centered on workers' health coming from the field of social medicine/collective health. The methodology used for the development of the paper was that of a documentary investigation, combined with the author's experience in training, research and organization in occupational health. The epistemic, ontological, methodological, political and practical reflections, on the basis of the documentary review, allows the author to postulate that, despite some benefits of the traditional mechanisms of occupational health protection, these approaches do not transform the working conditions that have historically generated negative effects on the health and life of workers. In contrast, the workers' health-centered approach provides elements that contribute to configuring an integral protection of health care in the workplace, with a sense of autonomy and emancipation of workers and true commitment to the transformation of both working conditions and those of the means of production(AU)

Decreto de Urgencia que establece medidas para la Cobertura Universal de Salud. D.U N° 017-2019 / Emergency Decree that establishes measures for Universal Health Coverage. D.U N° 017-2019

El documento contiene las medidas urgentes para garantizar la protección del derecho a la salud a través del cierre de la brecha de población sin cobertura de seguro en el territorio nacional, de conformidad con lo dispuesto en la Ley N° 29344, Ley Marco de Aseguramiento Universal en Salud.

Situación actual y retos para la Universidad de Ciencias Médicas de las Fuerzas Armadas Revolucionarias / Current situation and challenges for the University of Medical Sciences of the Revolutionary Armed Forces

La Universidad de Ciencias Médicas de las Fuerzas Armadas Revolucionarias de Cuba (Ucimed FAR), fue fundada el 7 de octubre de 1981, por el acuerdo No. 1074 del Comité Ejecutivo del Consejo de Ministros. Acaba de cumplir 37 años. En este periodo ha sufrido varias transformaciones, con una última etapa que comenzó en 2008. Actualmente se distingue, por ser la única institución de su tipo en el país, que forma oficiales de perfil médico y estomatológico de nivel superior. Existe el firme propósito de garantizar la formación del relevo, para que el futuro esté seguro, y egresen de nuestras aulas los mejores graduados(AU)

El seguro chileno contra accidentes del trabajo y enfermedades profesionales: lecciones y desafíos a 50 años de su creación / Chilean insurance against workplace accidents and occupational diseases: lessons and challenges 50 years after its creation

El sistema chileno de salud laboral sobrevivió a las enormes transformaciones que introdujo en materia de seguridad social la Dictadura Militar, y se suele presentar como un modelo a seguir en otras latitudes. En el presente artículo se expone un breve análisis de dicho sistema, comenzado por la ley del Seguro contra Accidentes del Trabajo y Enfermedades Profesionales que le da origen, para luego evaluar la operación del sistema, a fin de identificar sus mayores fortalezas y debilidades. También se revisan algunas propuestas de cambio que han aparecido en los últimos años. Se concluye que el sistema cuenta con un alto nivel de reconocimiento y legitimidad, y que presenta un desarrollo importante en el plano curativo para las tres cuartas partes de los trabajadores que están afiliados. En contraste con la cobertura que reciben los accidentes del trabajo, presenta baja sensibilidad ante las enfermedades profesionales, además de importantes desafíos en el plano preventivo, que podrían llevar a revisar algunos supuestos sobre los cuales se construyó(AU)

The Chilean occupational health system survived the enormous transformations introduced by the Military Dictatorship with regard to social security. This system is often suggested as a model to emulate overseas. In this article, I analyze the system, beginning with the law that regulates the Insurance against work accidents and occupational diseases which origins the system. Then, I examine its performance, and as a whole I identify its strengths and weaknesses. I also review some of the proposals of modification that have appeared in the last years. I conclude that the system counts on a high level of recognition and legitimacy, and that it presents an important level of development at the therapeutics sphere three fourths parts of those workers who are affiliated. In contrast with the coverage given to accidents at work, the system presents low sensibility with regard to occupational diseases, on top of important challenges in the preventive sphere. These critical elements could take us to review the basic assumptions under which the system was built on(AU)

Privacy Enhanced Healthcare Information Sharing System for Home-Based Care Environments / 대한의료정보학회지

OBJECTIVES: Home-based nursing care services have increased over the past decade. However, accountability and privacy issues as well as security concerns become more challenging during care provider visits. Because of the heterogeneous combination of mobile and stationary assistive medical care devices, conventional systems lack architectural consistency, which leads to inherent time delays and inaccuracies in sharing information. The goal of our study is to develop an architecture that meets the competing goals of accountability and privacy and enhances security in distributed home-based care systems. METHODS: We realized this by using a context-aware approach to manage access to remote data. Our architecture uses a public certification service for individuals, the Japanese Public Key Infrastructure and Health Informatics-PKI to identify and validate the attributes of medical personnel. Both PKI mechanisms are provided by using separate smart cards issued by the government. RESULTS: Context-awareness enables users to have appropriate data access in home-based nursing environments. Our architecture ensures that healthcare providers perform the needed home care services by accessing patient data online and recording transactions. CONCLUSIONS: The proposed method aims to enhance healthcare data access and secure information delivery to preserve user's privacy. We implemented a prototype system and confirmed its feasibility by experimental evaluation. Our research can contribute to reducing patient neglect and wrongful treatment, and thus reduce health insurance costs by ensuring correct insurance claims. Our study can provide a baseline towards building distinctive intelligent treatment options to clinicians and serve as a model for home-based nursing care.

Prognostic influence of Korean public medical insurance system on breast cancer patients

PURPOSE: To investigate the prognostic influence of Korean public medical insurance system on breast cancer patients. METHODS: Data of 1,068 patients with primary invasive breast cancer were analyzed. Korean public medical insurance status was classified into 2 groups: National Health Insurance and Medical Aid. Kaplan-Meier estimator and Cox proportional hazards model were used for survival analysis. RESULTS: The Medical Aid group showed worse prognoses compared to the National Health Insurance group both in overall survival (P = 0.001) and recurrence-free survival (P = 0.006). The Medical Aid group showed higher proportion of patients with tumor size > 2 cm (P = 0.022), more advanced stage (P = 0.039), age > 50 years (P = 0.003), and low education level (P = 0.003). The Medical Aid group showed higher proportion of patients who received mastectomy (P < 0.001) and those who received no radiation therapy (P = 0.013). The Medical Aid group showed a higher rate of distant recurrence (P = 0.014) and worse prognosis for the triple negative subtype (P = 0.006). Medical insurance status was a significant independent prognostic factor in both univariate analysis and multivariate analysis. CONCLUSION: The Medical Aid group had worse prognosis compared to the National Health Insurance group. Medical insurance status was a strong independent prognostic factor in breast cancer. Unfavorable clinicopathologic features could explain the worse prognosis for the Medical Aid group. Careful consideration should be given to medical insurance status as one of important prognostic factors for breast cancer patients.

Medical Travel among Non-Seoul Residents to Seek Prostate Cancer Treatment in Medical Facilities of Seoul / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study aims to investigate the trend in medical travel by non-Seoul residents to Seoul for treatment of prostate cancer and also to investigate the possible factors affecting the trend. MATERIALS AND METHODS: This study represents a retrospective cohort study using data from theKoreanNationalHealth Insurance System from 2002 to 2015. Annual trends were produced for proportions of patients who traveled according to the age group, economic status and types of treatment. Multiple logistic analysiswas used to determine factors affecting surgeries at medical facilities in Seoul among the non-Seoul residents. RESULTS: A total of 68,543 patients were defined as newly diagnosed prostate cancer cohorts from 2005 to 2014. The proportion of patients who traveled to Seoul for treatment, estimated from cases with prostate cancer-related claims, decreased slightly over 9 years (28.0 at 2005 and 27.0 at 2014, p=0.02). The average proportion of medical travelers seeking radical prostatectomy increased slightly but the increase was not statistically significant (43.1 at 2005 and 45.4 at 2014, p=0.26). Income level and performance ofrobot-assisted radical prostatectomy were significant positive factors for medical travel to medical facilities in Seoul. Combined comorbidity diseases and year undergoing surgery were significant negative factors for medical travel to medical facilities in Seoul. CONCLUSION: The general trend of patients travelling from outside Seoul for prostate cancer treatment decreased from 2005 to 2014. However, a large proportion of traveling remained irrespective of direct distance from Seoul.

Estimated Incidence and Cost Projections of Cataract Surgery in the Republic of Korea

PURPOSE: We sought to predict the future incidence and health expenditures of cataract surgery in the Republic of Korea. METHODS: From 2011 to 2015, National Health Insurance claims data were used to estimate the incidence and prevalence changes of cataract surgery according to demographic characteristics (year, sex, residence, and age). Based on the above results and changes in future population distribution, we estimated the incidence of cataract surgery by 2030. Considering the cost of cataract surgery from 2011 to 2015, we also predicted future health expenditures for cataract surgery. RESULTS: A total of 2,236,107 eyes of 1,591,176 patients underwent cataract surgery from 2011 to 2015. The total number of operated eyes per year increased, from 427,729 to 492,700 (+15%), and the number of patients increased from 306,710 to 346,056 (+12%) from 2011 to 2015. The cost of cataract surgery reimbursed by the National Health Insurance Service (NHIS) increased from 408,307,530,900 won ($360 million) to 449,334,367,080 won ($399 million) (+9%). The future prevalence of cataract surgery was predicted to reach 562,003 in 2030 from 346,056 in 2015. The cost of cataract surgery is expected to increase from 449 billion won ($399 million) in 2015 to 641 billion won ($570 million) in 2030. CONCLUSIONS: Cataract surgery and medical expenses will increase due to social aging. Therefore, we need policies to secure medical resources and expand insurance indications.