Identifying the perception of difficulty in emergency department utilization recognized by Daegu citizens during the COVID-19 pandemic and its contributing factors

Objective@#The purpose of this study was to identify if there was a perception of difficulty in using emergency department (ED) services during the coronavirus disease 2019 (COVID-19) pandemic and the contributing factors to this situation through a cross-sectional public survey in a metropolitan city. @*Methods@#In November 2020, face-to-face interviews based on a structured questionnaire were conducted with 1,000 citizens. A multivariable logistic regression analysis was performed to identify the factors affecting the perception of difficulty in using the ED. @*Results@#Of the respondents, 65.2% (58.9% male and 71.3% female) perceived difficulty in using ED services during the pandemic. By age, 69.8% of those who had this perception were under the age of 40 years ; 63.2% were 40-64 years old, and 61.1% were over the age of 65. Of the total number of respondents, 24.8% and 13.8% said they would hesitate to visit ED for chest pain and neurological symptoms, respectively. As a result of multivariate analysis, the significant contributing factors were age under 40 years old, female gender, fear of in-hospital COVID-19 contagion, emergency medical technician (EMT) referral to the ED, and prior experience with the emergency medical service (EMS) dispatch center. @*Conclusion@#A significant percentage of respondents perceived that it was difficult to use ED services during the COVID19 pandemic, even when experiencing chest pain and neurological symptoms, which require urgent treatment. Younger age, women, and fear of nosocomial COVID-19 contagion appear to have aggravated this situation. Conversely, prior experience with the EMS dispatch center and visits to the EMT-recommended ED facilitated ED utilization.

Evaluation of the Public Health Emergency Response to the COVID-19 Pandemic in Daegu, Korea During the First Half of 2020 / 예방의학회지

Objectives@#This study evaluated the response in Daegu, Korea to the first wave of the coronavirus disease 2019 (COVID-19) pandemic according to a public health emergency response model. @*Methods@#After an examination of the official data reported by the city of Daegu and the Korea Centers for Disease Control and Prevention, as well as a literature review and advisory meetings, we chose a response model. Daegu’s responses were organized into 4 phases and evaluated by applying the response model. @*Results@#In phase 1, efforts were made to block further transmission of the virus through preemptive testing of a religious group. In phase 2, efforts were concentrated on responding to mass infections in high-risk facilities. Phase 3 involved a transition from a high-intensity social distancing campaign to a citizen participation–based quarantine system. The evaluation using the response model revealed insufficient systematic preparation for a medical surge. In addition, an incorporated health-related management system and protection measures for responders were absent. Nevertheless, the city encouraged the participation of private hospitals and developed a severity classification system. Citizens also played active roles in the pandemic response by practicing social distancing. @*Conclusions@#This study employed the response model to evaluate the early response in Daegu to the COVID-19 pandemic and revealed areas in need of improvement or maintenance. Based on the study results, creation of a systematic model is necessary to prepare for and respond to future public health emergencies like the COVID-19 pandemic.

Association Between Atrial Fibrillation and the Risk of Dementia in the Korean Elderly: A 10-Year Nationwide Cohort Study / 예방의학회지

Objectives@#The objective of this study was to determine the effect of atrial fibrillation (AF) on the risk of dementia in the Korean elderly. @*Methods@#A 10-year retrospective cohort study was conducted using the National Health Insurance Service-Senior Cohort database. We excluded those who were under 65 years of age as of January 2006 (n=46 113), those who were diagnosed with dementia between 2002 and 2005 (n=9086), and those with a history of stroke prior to AF diagnosis (n=8392). We used a Cox proportional hazards model with a time-varying covariate to determine whether AF is associated with the risk of dementia after adjusting for potential confounders. @*Results@#In univariable Cox regression, the hazard ratio (HR) of dementia according to AF status was 1.28 (95% confidence interval [CI], 1.23 to 1.33). After adjusting for potential confounders, AF was found to increase the risk of dementia (HR, 1.12; 95% CI, 1.07 to 1.17), Alzheimer dementia (HR, 1.12; 95% CI, 1.07 to 1.17), and vascular dementia (HR, 1.10; 95% CI, 1.03 to 1.18). In patients diagnosed with AF, the incidence of dementia was lower (HR, 0.50; 95% CI, 0.47 to 0.52) in patients who were treated with oral anticoagulants. @*Conclusions@#Investigating the potential risk factors of dementia in an aged society is important. We found a slightly higher risk of dementia in those with AF than in those without AF, and we therefore concluded that AF is a potential risk factor for dementia.

A Brief Telephone Severity Scoring System and Therapeutic Living Centers Solved Acute Hospital-BedShortage during the COVID-19 Outbreak in Daegu, Korea

With the epidemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2, the number of infected patients was rapidly increasing in Daegu, Korea. With a maximum of 741 new patients per day in the city as of February 29, 2020, hospital-bed shortage was a great challenge to the local healthcare system. We developed and applied a remote brief severity scoring system, administered by telephone for assigning priority for hospitalization and arranging for facility isolation (“therapeutic living centers”) for the patients starting on February 29, 2020. Fifteen centers were operated for the 3,033 admissions to the COVID-19 therapeutic living centers. Only 81 cases (2.67%) were transferred to hospitals after facility isolation. We think that this brief severity scoring system for COVID-19 worked safely to solve the hospital-bed shortage. Telephone scoring of the severity of disease and therapeutic living centers could be very useful in overcoming the shortage of hospital-beds that occurs during outbreaks of infectious diseases.

Directions and Current Issues on the Policy of Prevention and Management for Hypertension and Diabetes, and Development of Chronic Disease Prevention and Management Model in Korea / 農村醫學 地域保健

Objectives@#The purpose of this manuscript was to propose the policy and perspectives of prevention and management for hypertension and diabetes in Korea. @*Methods@#Authors reviewed the chronic disease prevention and management projects and models were executed in Korea until now, and analyzed and evaluated their performances. @*Results@#In the circumstances of Korea, the following several requisites should be improved ; Specific Korean strategy for development and pursuing of national level policy agenda for chronic disease management must be established. There are a need to establish several means of supplementing the weaknesses of the current chronic disease management policies and programs. Firstly, development and distribution of contents of guidelines on the systematic project execution regime (regarding systematization of local community, subjects and contents of the projects) with guarantee for the quality of chronic disease prevention and management are necessary. Secondly, there is a need for development of information system that can lead the chronic disease management programs currently being implemented. Thirdly, there is urgent need to develop resources such as cultivation of manpower and facilities for provision of education and consultation for the patients and holders of risk factors of chronic disease. Fourthly, there is a need for means of securing management system and financial resources for operation of policies and programs. @*Conclusions@#The results can be able to use as a road map, models, and direction and strategies of policies for chronic disease prevention and management of Korea.

Venous Thromboembolism in Children and Young Adults in Korea: Analysis of the Korean Health Insurance Review and Assessment Service Database

Effect of Allergic Rhinitis and Asthma on Oral Health / 치위생과학회지

BACKGROUND: This study aimed to investigate allergic rhinitis and the relationship between allergic diseases, such as asthma and allergic rhinitis, and dental caries and periodontal disease using the raw data from third year of the 6th Korean National Health and Nutrition Examination Survey.METHODS: A total of 3,729 subjects aged over 30 years who underwent examination for allergic diseases and an oral health checkup were selected. The data were analyzed using SPSS IBM SPSS ver. 25.0 (IBM Corp., USA). Composite sample cross correlation and composite sample logistic regression analyses were performed using the composite sample general linear model.RESULTS: On examining the socioeconomic characteristics of the subjects suffering from allergic disease and the relationship between allergic disease and oral health, allergic rhinitis was more frequently found in younger subjects with a higher level of education. Periodontal disease and dental caries were more frequent among female, older age groups, lower income earners, and subjects with a lower level of education (p<0.05). On examining the relationship between the oral health characteristics of the subject and allergic diseases and oral health, allergic rhinitis was more common in subjects with a good oral health status perception than those who answered “bad” to the oral health status question. The community periodontal index of treatment needs (CPITN) score was higher in subjects who answered “poor” to the oral health status question, lower frequency of brushing, and higher in subjects using secondary oral hygiene products; the decayed, missing and filled teeth (DMFT) index was higher in subjects with a perception of poor oral health status (p<0.05). The DMFT index was high in the asthma group, and the CPITN score was high in the group who answered “no” to allergic rhinitis.CONCLUSION: There is a relationship between asthma and allergic rhinitis and the DFMT index and CPITN score. Corresponding oral programs for allergic patients need to be developed.

Efficacy and Safety of a Mixed Extract of Trigonella foenum-graecum Seed and Lespedeza cuneata in the Treatment of Testosterone Deficiency Syndrome: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

PURPOSE: The aim of this study was to investigate the efficacy and safety of a mixed extract of Trigonella foenum-graecum seed and Lespedeza cuneata (TFGL) for the treatment of testosterone deficiency syndrome (TDS). MATERIALS AND METHODS: Patients were instructed to take a placebo or 200 mg TFGL capsule twice per day for 8 weeks. The primary efficacy variable was the change from baseline in the Aging Males' Symptoms scale (AMS), as well as levels of serum total and free testosterone. Secondary efficacy measurements included changes from baseline in the number of ‘yes’ answers on the Androgen Deficiency in the Aging Male (ADAM) questionnaire, levels of serum total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride, all domain scores of the International Index of Erectile Function (IIEF), perceived stress scale-10 (PSS-10), as well as changes in body composition. RESULTS: The TFGL group exhibited a significant improvement in the AMS scores at 8 weeks, total testosterone at 8 weeks, and free testosterone at 4 and 8 weeks. At 4 weeks, 25% of the TFGL group changed to negative in terms of ADAM scores and 34.1% of the TFGL group had negative scores at the end of the study. The TFGL group exhibited a significant improvement in total cholesterol, HDL-C, LDL-C, triglyceride, IIEF scores, and PSS-10 scores at 8 weeks. CONCLUSIONS: The mixed extract of TFGL resulted in significant improvements in symptoms of TDS, as measured by the AMS, ADAM, PSS-10 and testosterone levels.

Self-care Status of the Aged Diabetic Patients with Noncompliance / 農村醫學 地域保健

OBJECTIVE: The purpose of this study was to describe and understand self-care status of the aged diabetic patients with noncompliance after hospital discharge. METHODS: A qualitative research method was used for the study design. The participants were 15 diabetic patients aged 65 or older who had been admitted more than two times for hyperglycemia in the past 1 year in a general hospital in Daegu. Data were collected from November 1 2015 to March 1 2016 through in-depth personal interview. RESULTS: Patients' knowledge level on causes and symptoms of diabetes was low. Most participants rarely and irregularly checked blood sugar at home. They were under a lot of stress from their family. Due to old age and illness they did not have sufficient physical activity and they have had rarely regular meals. They considered the self-care education program unnecessary and there was limitations of accessibility for education. CONCLUSIONS: The aged diabetic patients who had the repeat admission did not perform self-care activities properly and had problems especially in blood glucose check, support from their family, and health education after returning home. More personalized and community-based self-management education programs will be necessary.

A Survival Analysis of Gastric or Colorectal Cancer Patients Treated With Surgery: Comparison of Capital and a Non-capital City / 예방의학회지

OBJECTIVES: The objective of the present study was to compare prognosis of patients with gastric or colorectal cancer according to places where they received surgeries. METHODS: The cancer patients underwent surgeries in sampled hospitals located in Daegu were matched 1:1 to the patients who visited sampled hospitals in Seoul using propensity score method. After the occurrences of death were examined, Kaplan-Meier method was used for survival analysis and the log-rank test was performed to compare the survival curves. RESULTS: A total of six out of 291 gastric cancer patients who had surgeries in Daegu died (2.1%) and ten deaths (3.4%) occurred from patients went Seoul hospitals. Out of 84 gastric cancer patients who had chemotherapy after surgeries in Daegu, 13 (15.5%) patients died while 18 (21.4%) deaths occurred among patients underwent surgeries in Seoul. Six deaths (6.9%) out of 87 colorectal cancer patients who had surgeries in Daegu were reported. Five patients (5.7%) died among the patients underwent surgeries in Seoul. Among the colorectal cancer patients with chemotherapy after surgeries, 13 patients (12.4%) who visited hospitals in Daegu and 14 (13.3%) patients who used medical centers in Seoul died. There were no significant differences according to places where patients used medical services. CONCLUSIONS: The result of this study is expected to be used as basic data for policy making to resolve centralization problem of cancer patients and to help patients to make rational choices in selection of medical centers.

Cultural Competence of Health Care Providers in Daegu and Satisfaction on Health Care Services of Chinese Medical Tourists / 보건행정학회지

BACKGROUND: This study aims at making a survey on health care service providers' cultural competence and making an appraisal of Chinese medical tourists on service quality, health care service providers' cultural competence, perceived value, and satisfaction. METHODS: The data was collected from August until November, 2014 and 150 health care service providers and 65 Chinese medical tourists from 12 medical institutions in Daegu were enrolled in analysis. RESULTS: The results showed that health care service provider's knowledge on Chinese culture was very low with 33.5% of correct answer. Health care service providers were found to get 3.82 point on a 5 point-scale in cultural perception, 3.53 points in cultural sensitivity, and 2.85 points in cultural skills. Chinese medical tourists were analyzed to give 4.08 points on a 5-point scale to satisfaction on health care service, followed by 4.01 points to health care service quality, 4.00 points to perceived value of health care service, and last 3.85 points to a health care service providers' cultural skills. However, there was a difference in points in cultural skills between health care service providers and Chinese medical tourists. Chinese medical tourists' satisfaction with health care service in Daegu was found to be comparatively high, but in relation to satisfaction with communication, it was found to be relatively low. CONCLUSION: Through this research, health care service providers' knowledge level of Chinese culture and cultural skills were low while they seemed to take a half-hearted attitude towards educational experience for building up cultural competence and foreign patient service response.

Knowledge, Health Belief, and Vaccination Behavior on Hepatitis A among University Students / 農村醫學 地域保健

OBJECTIVE: This study was to investigate the knowledge, health belief, and vaccination behavior on hepatitis A among university students. METHODS: A self-administered questionnaire survey was conducted from 3(rd) to 25(th) March, 2014 and 197 subjects were enrolled in statistical analysis. RESULTS: The result showed that the score for knowledge of the subjects on hepatitis A was 4.59±3.06 out of 15 points, for health belief 2.39±0.28 out of 4 points, and the vaccination rate of the subjects was 12.7%. There was significant difference in hepatitis A knowledge score according to experience of hepatitis A check-up and hepatitis A vaccination history of family members, and in health belief according to gender. For hepatitis A vaccination there was significant difference according to experience of hepatitis A check-up, family history of liver disease, hepatitis A vaccination history of family members, and education history of hepatitis A. As a result of logistic regression analysis experience of hepatitis check-up and hepatitis A vaccination history of family members were significant factors for hepatitis A vaccination. CONCLUSIONS: The level of knowledge, health belief for hepatitis A of the subjects was low and vaccination rate also low. The experience of hepatitis A check-up and hepatitis A vaccination history of family members were factors affecting hepatitis A vaccination. It would be necessary to develop programs for improving level of knowledge and health belief and raising the rate of hepatitis A vaccination for the university students in Korea.

Comparison of Health Behavior Change Before and After the Percutaneous Coronary Intervention among Coronary Artery Disease Patients / 農村醫學 地域保健

OBJECTIVES: The purpose of this study was to investigate health behaviors of patients before and after percutaneous coronary intervention (PCI). METHODS: The subjects of this study were 120 men and women whose age ranged from 40 years to 69 years among the patients who received percutaneous coronary intervention in Y university hospital that was located in Daegu city and who had diagnosed for 3 months or more and less than 2 years. Structured questionnaire was used to conduct self-administered survey from May 15 to October 12 in 2012. RESULTS: Patients's health behavior score was ranged from 46 to 94 points after the PCI intervention. The score was 65.42±12.99 points before and significantly increased up to 72.53±10.18 points after the PCI intervention (p<.001). According to subcategory of health behavior, significant differences were found in scores of health responsibility (increased interest in health, watching of lecture on health and behavior to be punctual on counseling or medical treatment), diet, smoking, and drinking (p<.001, p=.039, p=<.001). However, no significant change was found in practice efforts such as exercise, eating habits and relaxation for stress management. CONCLUSIONS: In conclusion, it is necessary to provide education and counseling that enabling patients to improve smoking, drinking, practicing exercise and healthy eating habits.

The Longitudinal Trend of Cardiac Surgery in Korea from 2003 to 2013

BACKGROUND: The purpose of this study was to investigate longitudinal changes of the utilization of operational and surgical medical care inside and outside a metropolitan area over 10 years, analyzing the residential areas of patients and the locations of medical facilities for major cardiovascular surgery. METHODS: Data analysis was conducted by classifying the addresses of patients and the locations of medical care facilities of metropolitan cities and provinces, using data from the National Health Insurance Corporation from January 2003 to December 2013. RESULTS: There is serious concentration of major heart surgery to medical facilities in Seoul; this problem has not improved over time. There were differences in percentages of surgical procedures performed in the metropolitan areas according to major diseases. In the case of Busan and Daegu provinces, at least 50% of the patients underwent surgery in medical facilities in the city, but there are other regions where the percentage is less than 50%. In the case of provinces, the percentage of surgical procedures performed in medical facilities in Seoul or nearby metropolitan cities is very high. CONCLUSION: Policies to strengthen the regional capabilities of heart surgery and to secure human resources are required to mitigate the concentration of patients in the capital area. Many regional multi-centers must be designated to minimize unnecessary competition among regional university hospitals and activate a win-win partnership model for medical services.

The effect of formaldehyde on neurobehavioral performance of student during cadaver dissection / 영남의대학술지

BACKGROUND: Formaldehyde is used to preserve cadaver in medical schools, and students are exposed to formaldehyde during cadaver dissection classes. When humans are exposed to formaldehyde, it induces mucosal inflammation, skin inflammation, and declining of neurobehavioral function including attention and memory executive functions. The purpose of this study is to identify the effects of formaldehyde exposure on student's neurobehavioral performance during cadaver dissection classes. METHODS: The level of formaldehyde was measured in a cadaver dissection class. A total of 16 students were randomly divided into two groups. One group wore respiratory protection masks, while the other group did not. Among many subtests in Korean Computerized Neurobehavioral test, backward digit span was tested on all subjects before and after the class. RESULTS: The length of memorized digit span between the two groups was not significant; however there was a greater decrease in neurobehavioral function after formaldehyde exposure in the non-mask group than the mask group. CONCLUSION: Formaldehyde exposure during cadaver dissection may likely decrease neurobehavioral performance of students. Therefore, proper ventilation system and respiratory protective equipment are necessary to protect medical school students from adverse effects of formaldehyde exposure.

Effects of Oral Exercise on Oral Function and Denture Satisfaction of the Elderly / 農村醫學 地域保健

OBJECTIVE: The purpose of this study is to examine the effects of oral exercise on oral function and denture satisfaction of the elderly using dentures. METHODS: The study was conducted with targets of the elderly in the 13 senior community centers in Cheongsong-gun, Gyeongsangbuk-do from September 2013 to April 2014. The study subjects were divided into two groups, the intervention group provided with 8 week oral exercise program and the control group without exercise. The data on oral function, denture satisfaction and oral health related quality of life (OHIP-14) were analyzed among the 79 subjects from the intervention group and the 71 subjects from the control group. RESULTS: For oral function, salivary flow rate, mouth opening, pronunciation and salty taste were significantly improved in the intervention group (p<0.01). There were significant differences in salivary flow rate, mouth opening, pronunciation and salty taste between the two groups (p<0.01). For denture satisfaction, there were significant differences in masticatory function, fixing function, general treatment satisfaction and total denture satisfaction between the two groups (p<0.05). There were significant differences between the two groups in the total points of oral health related quality of life. CONCLUSION: Oral exercise was effective in improving oral function and denture satisfaction of the elderly using dentures. To improve oral health related quality of life of the elderly further researches and programs will be necessary.

Effect of an Oral Hygienic Care Program for Stroke Patients in the Intensive Care Unit

PURPOSE: The effects of an oral hygienic care program (OHCP) have been reported in several diseases. However, no study exists investigating the influence of an OHCP on stroke patients or patients in the intensive care unit (ICU) has been reported, thus we sought to investigate the potential effect of an OHCP. MATERIALS AND METHODS: Fifty-six consecutive stroke patients who were admitted to the ICU were randomly assigned to two groups: the intervention (29 patients) and control groups (27 patients). The OHCP included tooth brushing with an inter-dental brush and tongue cleaner and cleaning with chlorhexidine was administered to patients by one dentist once per day during admission in the ICU (mean, 2.2 weeks). The plague index, gingival index, clinical attachment loss, and colonization degree of candida albicans were assessed. RESULTS: After OHCP, the plaque index, gingival index, and colonization degree of candida albicans in saliva showed a significant decrease in the intervention group compared to those of the control group (p0.05). CONCLUSION: Our OHCP was effective in improving the oral hygienic status and periodontal health of stroke patients during their stay in the ICU. Therefore, we recommend administration of the OHCP for stroke patients during their stay in the ICU.

Multiple Cancers in a Patient with Systemic Sclerosis and Aggravated Interstitial Lung Disease by Chemotherapy / 결핵및호흡기질환

Although the relationship between malignancy risk with systemic sclerosis (SSc) has been inconclusive, there are some previous studies for a positive correlation. Most patients with SSc have some degree of lung parenchymal involvement in the form of interstitial thickening and fibrosis. Interstitial lung disease is the most common pulmonary manifestation of SSc. Interstitial lung disease following chemotherapy (5-fluorouracil, leucovorin, and oxaliplatin [FOLFOX]) is an uncommon life-threatening complication and it is induced by oxaliplatin. We report a case of multiple cancers in a patient with SSc and aggravated interstitial lung disease by chemotherapy.

Erythropoietin Antibody-Positive Pure Red Cell Aplasia Diagnosed after Surgical Intervention for Malignant Gastric Ulcer Bleeding / 대한내과학회지

Rarely, patients on erythropoietin stimulating agent (ESA) therapy develop antibodies that neutralize both ESA and endogenous erythropoietin, resulting in antibody-mediated pure red cell aplasia (PRCA). The sudden development of severe transfusion-dependent anemia requires rapid recognition, the evaluation of PRCA, and prompt intervention after differentiating other causes of anemia, such as iron deficiency, occult bleeding, and infection. Here, we report the case of a 67-year-old male undergoing hemodialysis who presented with the anemia of chronic blood loss from a malignant gastric ulcer. Even after surgical intervention for stomach cancer and increasing the erythropoietin dosage, the anemia was not correctable and required monthly packed red blood cell transfusions. Further evaluation revealed positive erythropoietin antibody, and a bone marrow biopsy showed no red blood cell precursors, supporting the diagnosis of PRCA.

A Case of Bronchial Constriction Due to Buckwheat Allergy / 대한내과학회지

Buckwheat has been reported as a food allergen that can induce urticaria, angioedema and anaphylaxis. Moreover, it can cause occupational asthma and acute exacerbation in patients with asthma. Here, we present a case of an asthmatic patient with bronchial constriction due to buckwheat, who was treated for bronchial asthma and atopic dermatitis.