Barriers and Facilitators of Pediatric Obesity Prevention and Management (POPM) Programs in Korea: Focusing on the Questionnaire About the Linkage in Community Level.

BACKGROUND: Recent global trends indicate a rise in pediatric obesity, reflecting patterns also observed in South Korea. Given its significant impact on chronic disease prevalence in adulthood, pediatric obesity poses potential societal challenges. For pediatric obesity-related prevention or management programs in community level to operate effectively, there needs to be a clear understanding of barriers and facilitators of the programs. This study aims to establish a foundation for policy implementation, contributing to pediatric obesity prevention and management (POPM) in Korea. METHODS: A survey was conducted among program providers involved in domestic POPM programs. A total of 577 individuals completed the survey, including those working in elementary and middle schools (n = 508) and public health centers (n = 69) nationwide. The questionnaire comprised 67 questions covering characteristics of respondents, purpose and contents of POPM programs, measurement of program outcome, level of inter- and intra-institutional linkage, difficulties in operating programs and factors that facilitate programs. A 5-point Likert scale was used for most questions. Descriptive statistics was employed to analyze characteristics of respondents in POPM programs. The level of linkage in POPM programs was assessed using perceived importance and actual degree of linkage. The difficulties in operating POPM programs were analyzed based on agreement responses, and facilitating factors of program activation were analyzed based on importance responses. RESULTS: The domestic POPM program showed low actual linkage compared to its perceived importance, both between institutions and among professions within institutions. Difficulties in operating the program included securing availability of students, encouraging participation of reluctant students and development of new programs. The survey suggested that schools require support from parents, guardians and family members, while public health centers need professional providers to facilitate such programs. CONCLUSION: The study highlights the urgent need for strategies to address pediatric obesity in South Korea. Weak institutional linkages hinder effective programs. Challenges include student availability, participation, and the need for innovative programs. New approaches to build partnerships in harmony among institutions are necessary. Implementing findings into policy can help prevent obesity in Korean children and adolescents.

Epidemiology and Risk Factors of Carbapenemase-Producing Enterobacteriaceae Acquisition and Colonization at a Korean Hospital over 1 Year.

Background: Carbapenemase-producing Enterobacteriaceae (CPE) are known to be primarily responsible for the increasing spread of carbapenem-resistant Enterobacteriaceae and have therefore been targeted for preventing transmission and appropriate treatment. This study aimed to describe the clinical and epidemiological characteristics and risk factors of CPE infection in terms of acquisition and colonization. Methods: We examined patients' hospital data, including active screening on patients' admission and in intensive care units (ICUs). We identified risk factors for CPE acquisition by comparing the clinical and epidemiological data of CPE-positive patients between colonization and acquisition groups. Results: A total of 77 CPE patients were included (51 colonized and 26 acquired). The most frequent Enterobacteriaceae species was Klebsiella pneumoniae. Among CPE-colonized patients, 80.4% had a hospitalization history within 3 months. CPE acquisition was significantly associated with treatment in an ICU [adjusted odds ratio (aOR): 46.72, 95% confidence interval (CI): 5.08-430.09] and holding a gastrointestinal tube (aOR: 12.70, 95% CI: 2.61-61.84). Conclusions: CPE acquisition was significantly associated with ICU stay, open wounds, holding catheters or tubes, and antibiotic treatment. Active CPE screening should be implemented on admission and periodically for high-risk patients.

Public Perception of the Concentration of Cardiac and Cerebrovascular Surgery to Metropolitan Hospitals.

BACKGROUND: This study investigates the perception of the general public regarding the concentration to metropolitan, hospitals of cardiac and cerebrovascular surgeries, and the perceived public need for government policies to resolve this issue. METHODS: A total of 800 participants were recruited for our telephone interview survey. Quota sampling was performed, adjusting for age and sex, to select by various geographic regions. Sampling with random digit dialing was performed; we called the randomly generated telephone numbers and made three attempts for non-responders before moving on to a different telephone number. RESULTS: Our sample population was 818 participants, 401 men (49.0%) and 417 women (51.0%). Our data showed that 85.5% of participants thought that cardiac surgery and neurosurgery patients are concentrated in large hospitals in Seoul. The principle reason for regional patients to want to receive surgery at major hospitals in Seoul was because of poor medical standards associated with regional hospitals (87.7%). We found that a vast majority of participants (97.5%) felt that government policies are needed to even out the clustering of cardiac surgery and neurosurgery patients, and that this clustering may be alleviated if policies that can specifically enhance the quality and the capacity of regional hospitals to carry out surgeries are adopted (98.3%). CONCLUSION: Government policy making must reflect public desiderata, and we suggest that these public health needs may be partially resolved through government-designated cardiac and neurosurgery specialist hospitals in regional areas.

Thoracic and Cardiovascular Surgeons' Perception of the Concentration of Cardiovascular Operations in Seoul Metropolitan Area's Hospitals.

BACKGROUND: The purpose of this study is to evaluate the concentration of cardiovascular surgical procedures in a metropolitan area and investigate the perception of specialists regarding governmental policies to resolve this imbalance. METHODS: From March to May 2015, surveys were distributed to members of the Thoracic and Cardiovascular Surgery Association. The final pool of research subjects consisted of 75 respondents. Subjects were queried regarding the concentration of cardiovascular operations in metropolitan areas, alternatives to the imbalance, and governmental policies to resolve the inequalities. RESULTS: Survey participants responded that South Korea needs governmental policies to alleviate the concentration of cardiovascular surgery patients in large metropolitan hospitals. Participants agreed that the freedom to choose medical institutions and improved accessibility to metropolitan hospitals due to advanced transportation systems were some of the causes for the concentration. A majority (98.7%) of respondents thought establishing thoracic and cardiovascular surgery centers in provinces was an appropriate solution to alleviate the concentration. Thoracic and cardiovascular surgery specialists were ranked as the number one group on which to focus development. CONCLUSION: Developing and carrying out policies to establish thoracic and cardiovascular surgery centers in provinces will alleviate the regional imbalance in available heart surgery services and an overall improvement in cardiovascular disease treatment in South Korea.

Trends in Percutaneous Coronary Intervention and Coronary Artery Bypass Surgery in Korea.

BACKGROUND: Coronary angioplasty has been replacing coronary artery bypass grafting (CABG) because of the relative advantage in terms of recovery time and noninvasiveness of the procedure. Compared to other Organization for Economic Cooperation and Development (OECD) countries, Korea has experienced a rapid increase in coronary angioplasty volumes. METHODS: We analyzed changes in procedure volumes of CABG and of percutaneous coronary intervention (PCI) from three sources: the OECD Health Data, the National Health Insurance Service (NHIS) surgery statistics, and the National Health Insurance claims data. RESULTS: We found the ratio of procedure volume of PCI to that of CABG per 100,000 population was 19.12 in 2014, which was more than triple the OECD average of 5.92 for the same year. According to data from NHIS statistics, this ratio was an increase from 11.4 to 19.3 between 2006 and 2013. CONCLUSION: We found that Korea has a higher ratio of total procedure volumes of PCI with respect to CABG and also a more rapid increase of volumes of PCI than other countries. Prospective studies are required to determine whether this increase in absolute volumes of PCI is a natural response to a real medical need or representative of medical overuse.

[Hospital Arrival Rate within Golden Time and Factors Influencing Prehospital Delays among Patients with Acute Myocardial Infarction].

PURPOSE: This research was done to identify the hospital arrival rate and factors related to prehospital delay in arriving at an emergency medical center within the golden time after symptom onset in patients with acute myocardial infarction (AMI). METHODS: Data used in the research was from the National Emergency Department Information System of the National Emergency Medical Center which reported that in 2014, 9,611 patients went to emergency medical centers for acute myocardial infarction. Prehospital time is the time from onset to arrival at an emergency medical center and is analyzed by subdividing arrival and delay based on golden time of 2 hour. RESULTS: After onset of acute myocardial infarction, arrival rate to emergency medical centers within the golden time was 44.0%(4,233), and factors related to prehospital delay were gender, age, region of residence, symptoms, path to hospital visit, and method of transportation. CONCLUSION: Results of this study show that in 2014 more than half of AMI patients arrive at emergency medical centers after the golden time for proper treatment of AMI. In order to reduce prehospital delay, new policy that reflects factors influencing prehospital delay should be developed. Especially, public campaigns and education to provide information on AMI initial symptoms and to enhance utilizing EMS to get to the emergency medical center driectly should be implemented for patients and/or caregivers.