Health Behaviors Before and After the Implementation of a Health Community Organization: Gangwon's Health-Plus Community Program.

OBJECTIVES: Community organization is a resident-led movement aimed at creating fundamental social changes in the community by resolving its problems through the organized power of its residents. This study evaluated the effectiveness of health community organization (HCO), Gangwon's Health-Plus community program, implemented from 2013 to 2019 on residents' health behaviors. METHODS: This study had a before-and-after design using 2011-2019 Korea Community Health Survey data. To compare the 3-year periods before and after HCO implementation, the study targeted areas where the HCO had been implemented for 4 years or longer. Therefore, a total of 4512 individuals from 11 areas with HCO start years from 2013 to 2016 were included. Complex sample multi-logistic regression analysis adjusting for demographic characteristics (sex, age, residential area, income level, education level, and HCO start year) was conducted. RESULTS: HCO implementation was associated with decreased current smoking (adjusted odds ratio [aOR], 0.73; 95% confidence interval [CI], 0.57 to 0.95) and subjective stress recognition (aOR, 0.79; 95% CI, 0.64 to 0.97). Additionally, the HCO was associated with increased walking exercise practice (aOR, 1.39; 95% CI, 1.13 to 1.71), and attempts to control weight (aOR, 1.36; 95% CI, 1.12 to 1.64). No significant negative changes were observed in other health behavior variables. CONCLUSIONS: The HCO seems to have contributed to improving community health indicators. In the future, a follow-up study that analyzes only the effectiveness of the HCO through structured quasi-experimental studies will be needed.

Impact of primary prophylaxis by pegfilgrastim in diffuse large B-cell lymphoma treated with R-CHOP.

Febrile neutropenia (FN) and chemotherapy-induced neutropenia (CIN) are common conditions that lead to dose reduction or delayed chemotherapy in patients with diffuse large B-cell lymphoma (DLBCL). Primary prophylaxis (PP) with long-acting granulocyte colony-stimulating factor (G-CSF) was introduced in South Korea in 2014. We aimed to investigate the effects of PP on FN-related hospitalization and death in patients with DLBCL receiving rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Korean individuals (n = 11,491) with incident DLBCL and receiving R-CHOP during 2010-2016 were followed for FN-related hospitalization and mortality. The PP exposure group (patients during 2014-2015, n = 3599), patients during 2010-2016 (n = 11,491), and patients receiving PP during 2014-2016 (n = 4421) were compared with the non-exposure group (patients during July 2011-June 2013, n = 3017), patients in 2013 (n = 1596), and patients not receiving PP during 2014-2016 (n = 1289), respectively. Multivariable-adjusted hazard ratios (HRs) were calculated using the Cox model. The PP exposure group had 16% lower FN-related hospitalizations than the non-exposure group (HR = 0.84, P < 0.001). PP exposure had no beneficial effect on 1-year (HR = 0.98, P = 0.782) and 5-year mortality (HR = 0.97, P = 0.474). Patients in 2014 (HR = 0.85, P < 0.001), 2015 (HR = 0.88, P = 0.003), and 2016 (HR = 0.80, P < 0.001) had a decreased risk of FN-related hospitalizations compared with those in 2013. Among patients receiving their first R-CHOP cycle during 2014-2016, the HR for FN-related hospitalization was 0.90 (P = 0.014) in PP users compared with non-users. PP with a long-acting G-CSF lowered the FN-related hospitalization risk but did not benefit survival in patients with DLBCL receiving R-CHOP.

Gender Difference in the Effect of Short Sleep Time on Suicide among Korean Adolescents.

A close association between the duration of sleep and suicide has been reported in previous studies. This study was designed to investigate whether there is a difference in the effects of sleep duration on suicide by gender. This study was conducted based on the results of a volunteer online survey for adolescents in middle and high school in the Republic of Korea. The results showed that the effect of a depressive mood on short sleep time and on suicide was not different between male and female adolescents. It has been reported that the direct effect of short sleep time on increasing suicidal ideation is 2.50 times higher in female than in male adolescents. Differences in the metabolism of sex hormones and sleep-associated neurotransmitters might have affected this result, but further studies are needed to clarify more obvious mechanisms. In addition, this result should be considered when establishing sleep education for adolescents.

Associated factors for cognitive impairment in the rural highly elderly.

BACKGROUND: Among the symptoms commonly faced by an increasingly aged population, dementia, preceded by cognitive impairment, most threatens their quality of life. Dementia is a well-recognized burden, not only for individuals who face the disease and for their families, but also for entire nation. AIMS: The purpose of this study was to identify associated factors for cognitive impairment in a very elderly population via a screening study design in Sokcho, a rural area in South Korea. METHODS: Trained nurses screened patients from 75-84 years of age for dementia using the Mini-Mental State Examination for Dementia Screening (MMSE-DS) and conducted interviews to determine their socioeconomic status, education level, and living conditions (i.e., with or without family). RESULTS: In total, 4,369 subjects (1,646 males, 2,723 females) were enrolled in this study. Reported MMSE-DS scores decreased with increasing age and to a greater degree in less educated subjects (p < 0.001). Subjects requiring medical assistance or living alone exhibited lower MMSE-DS scores compared to those who did not require medical assistance or who lived alone (p < 0.001). CONCLUSION: We found that less education, lower socioeconomic status, and living alone were associated factors for cognitive impairment based on this study of an elderly population.

Pre-migration Trauma, Repatriation Experiences, and PTSD Among North Korean Refugees.

Many studies on refugees suggested that refugees' traumatic events associated with post-traumatic stress disorder (PTSD). However, it is unknown whether refugees' PTSD was caused by their negative experience before or after the entry of their destination country. Thus, a separation of refugees' pre-migration from their post-migration experience is particularly important in understanding the causal impact of trauma. Using a sample from North Korean refugees, this study investigates the prevalence of PTSD symptoms, the impact of tortured trauma, repatriation experiences, on PTSD among North Korean refugees (n = 698). We found that North Korean refugees in our sample (a) demonstrated a high rate of current probable PTSD; (b) were demonstrated a higher frequency of repatriation experiences with a greater risk for PTSD symptoms. The findings suggest that particular types of trauma for populations with particular socio-demographic characteristics may be at a greater risk of PTSD.

Insufficient sleep and suicidal ideation: a survey of 12,046 female adolescents.

OBJECTIVES: Adolescence is a period of adaptation to social, hormonal, and physical changes. Because of these changes, adolescents are at risk for depression and suicidal thoughts. Female adolescents tend to be more sensitive to hormonal and emotional changes. Although the reciprocal relationship among depression, poor sleep quality, and suicide has been studied, whether decreased sleep time leads to depression-mediated suicide or induces suicide itself remains to be determined. Therefore, this study aimed to analyze (using a path analysis) the indirect (i.e., due to depression) and direct effects of sleep on suicidal ideation for female adolescents. METHODS: We use nationally representative data from the Korean juvenile health behavior online survey to analyze the sleep effects on suicidal ideation. A total of 12,046 Korean female adolescents were included in this study. We analyzed data from the juvenile health behavior online survey (2017) conducted by the Korea Centers for Disease Control and Prevention and identified variables that could affect the mental health of female adolescents. A path analysis was performed to determine the direct role of sleep in suicidal ideation. RESULTS: Decreased sleep was one of the several risk factors for suicidal ideation. Unexpectedly, after controlling for other risk factors including depression and socioeconomic factors, insufficient sleep was found to have direct effects on suicidal ideation. The indirect effect of insufficient sleep on suicidal ideation was mediated by depression. CONCLUSION: Sleep is a modifiable factor that could reduce the suicide rate among female adolescents and could be targeted through public health prevention efforts.

Effect of Fentanyl Nasal Packing Treatment on Patients With Acute Postoperative Pain After Nasal Operation: A Randomized Double-Blind Controlled Trial.

PURPOSE: Nasal packing is an option for bleeding control after endoscopic sinus surgery and septoplasty. Although new packing materials have been developed, patients still suffer from pain and require additional analgesics treatments. In this study, a prospective, randomized, and double-blind controlled trial was designed to evaluate the effect of fentanyl-soaked packing on pain after endoscopic sinus surgery and septoplasty. METHODS: One hundred fifty-two patients who underwent nasal surgeries due to chronic rhinosinusitis or nasal septal deviation were enrolled in this study. At the end of operation, 50 mcg fentanyl-soaked biodegradable synthetic polyurethane foams packing Nasopore or Merocel were applied to a group of 79 patients, and saline-soaked ones were applied to another group of 73 patients. To evaluate the influence of fentanyl on postoperative nasal pain, patients' conditions were assessed via means of Numeric Rating Scale, patient satisfaction, and Ramsay Sedation Scale. In addition, symptoms of headache or sore throat and any signs of cardiopulmonary-relevant indicators were monitored. RESULTS: The fentanyl group had significantly decreased Numeric Rating Scale and increased patient satisfaction in every operation type for the majority of postoperative time periods ( P < .05) with reduced postoperative headache and sore throat compared to the control group. The fentanyl group showed a higher score on Ramsay Sedation Scale than the control group ( P < .05 in group including endoscopic sinus surgery). There were no significant differences in cardiopulmonary-relevant indicators between the 2 groups ( P > .05). CONCLUSION: Fentanyl group showed significantly reduced postoperative pain without serious adverse effects. We suggest that topical fentanyl application to nasal packs can be a useful method to reduce pain during the early postoperative period after endoscopic sinus surgery and septoplasty.

A Test of an Integrative Model Using Social Factors and Personality Traits: Prediction on the Delinquency of South Korean Youth.

To more fully comprehend juvenile delinquency, it is necessary to take an integrative approach, with consideration of both personality traits of social risk factors. Many scholars argue the necessity and strength of integrative approach on the ground that juvenile delinquency is an outcome of interplay of individual and social factors. The present study examines the general applicability of an integrative model of personal traits and social risk factors to youth delinquency in the South Korean context. The empirical results show that the delinquency predictors in the current South Korean sample are closely aligned to Loeber and Farrington's theoretical propositions and that found in Western nations. Perhaps this is because South Korea has undergone rapid Westernization for the last decades. Because the correlates in this sample and Western theoretical propositions and studies overlap, an integrative model of personality trait and social risk factors is indeed generally applicable to South Korea. This finding also depicts the extent of Westernization in the South Korean society at least among adolescents. Limitations of the present study and directions for the future study are discussed.

Seropositivity among Korean Young Adults Approximately 2 Years after a Single-Dose Vaccination against Hepatitis A Virus.

We previously observed 80.7% seropositivity and a significant interaction between gender and hepatitis A virus (HAV) vaccine type (Havrix vs. Epaxal) on the seropositivity approximately 11 months after single-dose HAV vaccinations in Korean young adults. Our objective was to evaluate seropositivity approximately 2 years after a single-dose HAV vaccination and the influence of demographic characteristics on seropositivity, including the interaction between gender and vaccine type. Seronegative medical school students were randomly vaccinated with Havrix or Epaxal. Based on a total serum anti-HAV antibody titer cutoff of 20 IU/mL, 338 participants (76.0%) of the 445 vaccinees were seropositive 20-25 months after a single-dose HAV vaccination. The seropositive rates were similar after vaccination with Havrix (77.0%) and Epaxal (74.9%). Univariate analysis indicated that female (p = 0.052) and less obese (p < 0.001) participants had a higher seropositive rate, whereas other characteristics such as age, alcohol use, smoking history, vaccine type, and follow-up duration were not associated with seropositivity. Multivariate analysis indicated that women (p = 0.026) and participants with moderate alcohol use (p < 0.001) showed significantly higher seropositive rates than men and participants with no or low alcohol use, respectively. The seropositive rates after vaccination with Havrix and Epaxal were 70.9% and 67.5% in men and 87.7% and 91.3% in women, respectively (p for interaction = 0.304). Compared with the seropositive rate approximately 11 months after vaccination, the seropositive rate decreased substantially only in men in the Havrix group (11.0% points), and consequently, the interaction between gender and vaccine type disappeared while seropositivity remained high (87.7% and 91.3% in Havrix and Epaxal groups, respectively) among women approximately 2 years after vaccination. Further studies are needed to assess whether the seropositive rate would be maintained in all groups more than 2 years after a single-dose HAV vaccination.

Exploring the non-linear relationship between alcohol consumption and depression in an elderly population in Gangneung: the Gangneung Health Study.

PURPOSE: The purpose of this study was to examine a J-shaped relationship between alcohol consumption and depression among the elderly in South Korea. MATERIALS AND METHODS: Cross-section data were drawn from a community-based sample of individuals 60 years of age and older (n=1819). Respondents completed the Alcohol Use Disorders Intensification Test (AUDIT) and the Korean Beck Depression Inventory. Using a regression approach, the effect of alcohol consumption as a non-linear effect was assessed in relation to gender, marital status, exercise, smoking, age, education, and physical and mental health. RESULTS: AUDIT total score were found to exert linear and quadratic effects that were significantly associated with higher depression scores among sample respondents. The results lend support to a J-shaped relationship between alcohol use and depression, wherein abstainers and problem drinkers were at a higher risk of depression. CONCLUSION: This study confirms a J-shaped (i.e., curvilinear) relationship between alcohol consumption and depression among elderly South Koreans, similar to that frequently found in studies of Western-based samples. The findings of this study, therefore, imply the applicability of the J-shaped relationship hypothesis for non-Western society samples and within different cultural contexts.

The immunogenicity of a single dose of hepatitis A virus vaccines (Havrix® and Epaxal®) in Korean young adults.

PURPOSE: Assessing the immunogenicity of a single dose of hepatitis A virus (HAV) vaccines is important because some people receive only a single dose. However, previous studies have shown variable results and have not examined the effects of demographic characteristics other than gender. This study was performed to examine the immunogenicity of a single dose of HAV vaccine according to the vaccine type and demographic characteristics in young adults. MATERIALS AND METHODS: Seronegative medical school students were randomly allocated to receive either Havrix or Epaxal. RESULTS: After approximately 11 months, the seroconversion rate in 451 participants was 80.7%. In men, the Havrix group showed a significantly higher seroconversion rate (81.9%) than the Epaxal group (69.2%), whereas both vaccine groups showed similarly high immunogenicity in women (Havrix: 90.1%, Epaxal: 92.9%; P for interaction=0.062). According to the results of a multivariate analysis, Epaxal showed significantly lower immunogenicity than Havrix only in men. Age, obesity, drinking, smoking, and follow-up time did not significantly affect seroconversion in either gender. CONCLUSION: The seroconversion rate of single-dose HAV vaccines was low in men, particularly in those who received Epaxal. Our results suggest that gender effects should be considered when comparing the immunogenicity of different HAV vaccines.

Pre- and Post-Angioplasty Perfusion CT with Acetazolamide Challenge in Patients with Unilateral Cerebrovascular Stenotic Disease.

OBJECTIVE: Perfusion computed tomography (PCT) has the ability to measure quantitative value and produce maps of mean transit time (MTT), cerebral blood flow (CBF), and cerebral blood volume (CBV). We assessed cerebral hemodynamics by using these parameters and acetazolamide (ACZ) challenge for pre- and post-procedural evaluation in patients with unilateral cerebrovascular stenotic disease. METHODS: Thirty patients underwent pre-procedural PCT with ACZ challenge, and 24 patients (80%) was conducted follow up PCT after angioplasty with same protocol. The mean MTT, CBF, and CBV were measured and compared in both middle cerebral arterial (MCA) territories before and after ACZ challenge. Hemispheric ratio and percent change after ACZ challenge were calculated before and after angioplasty. RESULTS: The mean stenosis rate was 76.6%. Significant increases in MTT (32.6%, p=0.000) and significant decreases in CBF (-14.2%, p=0.000) were found in stenotic side MCA territories. After ACZ challenge, there were significant changes in MTT (37.4%, p=0.000), CBF (-13.1%, p=0.000), and CBV (-10.5%, p=0.001) in pre-procedural perfusion study. However, no significant increases were found in MTT, or decreases in CBF and CBV in post-procedural study. There were no significant changes after ACZ challenge also. In addition, the degrees of these changes (before and after ACZ challenge) were highly correlated with the stenotic degrees in pre-procedural perfusion study. CONCLUSION: PCT with ACZ challenge appears to be a useful tool to assess the cerebral perfusion status especially in patients with unilateral symptomatic stenotic disease.

Family factors associated with children's handwashing hygiene behavior.

Despite the importance of children's hand hygiene and family influence on children's behaviors, few studies have been dedicated to identifying family factors affecting handwashing practice. This study investigated the entire group of sixth-grade students (N = 2323) and their parents (N = 2089) at 11 elementary schools randomly selected from the Seoul Metropolitan Area, Korea. The results show that parents' handwashing practice, parent and child bonding, and shared time have a significant correlation with children's hand hygiene practice. The thoroughness of hand cleansing is more likely to be associated with health education, parents' practice of proper handwashing, greater parent-child bonding, and a greater amount of shared time with parents. Parent-child bonding and shared time are crucial in promoting children's hand hygiene. These results imply that public health policies need to be targeted at not only providing health education but at increasing parent-child bonding and shared time in order to promote children's health more effectively.

Effects of a hypertension management program by Seongcheon primary health care post in South Korea: an analysis of changes in the level of knowledge of hypertension in the period from 2004 to 2009.

The objective of this study was to examine the effects of a hypertension management program provided by a primary health care post located in a distant rural area in South Korea on the level of knowledge of hypertension. The panel data consisted of a total of 319 people or the entire population aged above 40 years of five villages located in Goseong-gun, Gangwon province, South Korea. Preliminary interviews were conducted with all the residents prior to their enrollment in the health care post's hypertension management program. After 5 years of program operation, follow-up interviews were carried out with the same population. A total of 207 participants who completed both interviews were used in the final analysis. First, only the hypertensive group who participated in the program exhibited a significant difference in the level of knowledge. Second, educational level was associated with the level of knowledge in the entire group. Third, the effects of the program differed by gender, with men demonstrating more significant variations in knowledge upon participating in the program. For effective use of resources, considering that the effects of a hypertension education programs worked differently for groups, more customized hypertension management programs need to be targeted at each group to improve the effectiveness of hypertension education programs.

Identifying barriers to Papanicolaou smear screening in Korean women: Korean National Health and Nutrition Examination Survey 2005.

OBJECTIVE: This study was conducted to provide a nationwide analysis on barriers to cervical cancer screening in Korea. METHODS: Data used for this study was obtained in a survey called Korean National Health and Nutrition Examination Survey (KNHANES) 2005, which collected data from 2,590 Korean women aged older than 21 years who had not had a hysterectomy and were eligible for Papanicolaou (Pap) smears. Multivariate analysis was adopted to control each demographic factor and unhealthy behavior variable. Demographic factors included age, education, income, job and region; health-related behavior factors were defined as current smoking, obesity, hormone replacement therapy and disability. RESULTS: The study found that cervical cancer screening rate was significantly positively associated with income (odds ratio [OR], 1.002; 95% confidence interval [CI], 1.001 to 1.002), with education (OR, 1.324; 95% CI, 1.030 to 1.703), with job (OR, 1.420; 95% CI, 1.030 to 1.957), and with hormone replacement therapy (OR, 3.732; 95% CI, 2.354 to 5.916). Meanwhile, the age (OR, 0.977; 95% CI, 0.968 to 0.985), disability (OR, 0.358; 95% CI, 0.143 to 0.894) and smoking (OR, 0.447; 95% CI, 0.280 to 0.715) were significantly negatively associated with one's chances to take cervical cytology. CONCLUSION: In order to increase the rates of Korean women taking Pap test, cervical cancer screening programs will have to pay special attention to the elderly, low-income group, smokers, and the disabled.

[Out-of-pocket health expenditures by non-elderly and elderly persons in Korea].

OBJECTIVES: The purpose of this study was to determine the impact of the sociodemographic and health characteristics on the out-of-pocket health spending of the individuals aged 20 and older in Korea. METHODS: We used the data from the 2001 National Public Health and Nutrition Survey. The final sample size was 26,154 persons. Multiple linear regression models were used according to the age groups, that is, one model was used for those people under the age of sixty-five and the other was used for those people aged sixty-five and older. In these analyses, the expenditures were transformed to a logarithmic scale to reduce the skewness of the results. RESULTS: Out-of-pocket health expenditures for those people under the age of 65 averaged 14,800 won per month, whereas expenditures for those people aged 65 and older averaged 27,200 won per month. In the regression analysis, the insurance type, resident area, self-reported health status, acute or chronic condition and bed-disability days were the statistically significant determinants for both age groups. Gender and age were statistically significant determinants only for the non-elderly. CONCLUSIONS: The findings from this study show that the mean out-of-pocket health expenditures varied according to the age groups and also several diverse characteristics. Thus, policymakers should consider the out-of-pocket health expenditure differential between the elderly and non-elderly persons. Improvement of the insurance coverage for the economically vulnerable subgroups that were identified in this study should be carefully considered. In addition, it is necessary to assess the impact of out-of-pocket spending on the peoples' health care utilization.

Determinants of private clinics' productivity: a comparison of city and county clinics in Korea.

This study was designed to assess determinants of private clinics' productivity, and to compare city and county clinics in South Korea. We analyzed the revenue and patient data from all 9,212 private clinics in South Korea. This data was obtained from the Korean National Health Insurance Corporation, during the period between 1996 and 1999. We used a mixed model for repeatedly measured data. The following listed variables were used in our analysis: sex and age of physician, number of beds of clinics, competitiveness of medical institution, inhabitants'incomes, the proportion of elderly in the administrative unit, and time effects. Age, sex, number of beds, and specialty were found to be the most relevant determinants for the productivity of private clinics in both urban and rural settings, and number of clinics and beds per 100,000 and income of the administrative unit were found to be significant determinants, but only in city environments.

Association between the implementation of a laboratory information system and the revenue of a general hospital.

CONTEXT: A laboratory information system (LIS) is a useful tool for the management of laboratory processes and data, as well as for improving quality. OBJECTIVE: To examine the association between the implementation of a LIS with the outpatient and inpatient revenues of a general hospital. DESIGN: This study analyzed the outpatient and inpatient revenue data of all 212 general hospitals in South Korea; data were obtained from the Korean National Health Insurance Corporation during the period from 1996 through 1999. The mixed model was used for the repeated measure data. The following listed variables were used in the analysis: LIS implementation status, the population size, the state of competition, average local income, the hospital location, the hospital size, whether or not the hospital was a teaching hospital, whether the hospital was private or public, and the effect of the implementation time. RESULTS: The revenues from both the outpatient and inpatient departments were significantly higher 1 year after implementing a LIS, even after controlling for confounding variables. CONCLUSIONS: Although the causality needs to be clarified, the implementation of a LIS was found to be significantly associated with higher outpatient and inpatient revenues.

Does the physician order-entry system increase the revenue of a general hospital?

OBJECTIVE: The purpose of this study was to examine whether the physician order-entry system (POE) could increase the outpatient and inpatient revenue of hospitals. METHOD: We analyzed the inpatient and outpatient revenue data of all general hospitals (212) in South Korea obtained from the Korean National Health Insurance Corporation (KNHIC) during the period from 1996 to 1999 using the mixed model for repeated measure data. RESULTS: Analysis of the 4-years' panel data showed that both outpatient and inpatient revenues increased significantly after POE introduction. The hospital characteristics significantly influencing inpatient revenue were the number of beds, number of physicians and the tertiary status of a hospital; whereas those for outpatient revenue were the number of beds, number of physicians, the private status of a hospital, the tertiary status of a hospital and the urban status of a hospital. CONCLUSION: The revenues from both outpatients and inpatients were found to be increased after the introduction of the POE, while controlling for population size, competition, income, hospital location, hospital size, tertiary status and public status.

Association of the implementation of PACS with hospital revenue.

The purpose of this study is to assess the association of implementation of PACS with the inpatient and outpatient revenue of a general hospital. The authors analyzed the in- and outpatient revenue data of all general hospitals (212) in South Korea obtained from the Korean National Health Insurance Corporation (KNHIC) during the period from 1996 through 1999 using the mixed model for repeated measure data. The following variables were used in the analysis: status of picture archiving and communication systems (PACS) implementation, population size, state of competition, inhabitant's income, hospital location, hospital size, whether a tertiary hospital, whether public or private, the effect of year. The revenues from both in- and outpatient departments were significantly higher one year after the introduction of PACS while controlling for the confounding variables. Although the causality needs to be clarified, the implementation of PACS was correlated significantly to the increased amount of inpatient and outpatient revenue.