Chronic Disease Patterns and Their Relationship With Health-Related Quality of Life in South Korean Older Adults With the 2021 Korean National Health and Nutrition Examination Survey: Latent Class Analysis.

BACKGROUND: Improved life expectancy has increased the prevalence of older adults living with multimorbidities, which likely deteriorates their health-related quality of life (HRQoL). Understanding which chronic conditions frequently co-occur can facilitate person-centered care tailored to the needs of individuals with specific multimorbidity profiles. OBJECTIVE: The study objectives were to (1) examine the prevalence of multimorbidity among Korean older adults (ie, those aged 65 years and older), (2) investigate chronic disease patterns using latent class analysis, and (3) assess which chronic disease patterns are more strongly associated with HRQoL. METHODS: A sample of 1806 individuals aged 65 years and older from the 2021 Korean National Health and Nutrition Examination Survey was analyzed. Latent class analysis was conducted to identify the clustering pattern of chronic diseases. HRQoL was assessed by an 8-item health-related quality of life scale (HINT-8). Multiple linear regression was used to analyze the association with the total score of the HINT-8. Logistic regression analysis was performed to evaluate the odds ratio of having problems according to the HINT-8 items. RESULTS: The prevalence of multimorbidity in the sample was 54.8%. Three chronic disease patterns were identified: relatively healthy, cardiometabolic condition, arthritis, allergy, or asthma. The total scores of the HINT-8 were the highest in participants characterized as arthritis, allergy, or asthma group, indicating the lowest quality of life. CONCLUSIONS: Current health care models are disease-oriented, meaning that the management of chronic conditions applies to a single condition and may not be relevant to those with multimorbidities. Identifying chronic disease patterns and their impact on overall health and well-being is critical for guiding integrated care.

Association between Endoscopist Volume and Interval Cancers after Colonoscopy: Results from the National Colorectal Cancer Screening Program in Korea.

Purpose: The rate of interval colorectal cancer (iCRC) is now accepted as a key performance indicator of organized colorectal cancer (CRC) screening programs. We aimed to examine the association between endoscopist volumes and the rate of iCRC among individuals with a positive fecal immunochemical test (FIT) within a nationwide population-based CRC screening program. Materials and Methods: Individuals aged ≥50 years who underwent colonoscopy after a positive FIT from January 1, 2019 until December 31, 2020 in the Korean National Cancer Screening Program (KNCSP) were enrolled. We converted the data into per-endoscopist screening results, calculated the iCRC rates per endoscopist, and compared them to the previous year's annual volume that was divided into five groups (V1, 1-9; V2, 10-29; V3, 30-59; V4, 60-119; V5, ≥120). Results: A total of 10,412 endoscopists performed 216,907 colonoscopies. Overall, the average rate of iCRC per endoscopist was 8.46 per 1,000 examinations. Compared with the group with the highest volume (V5 group), the rate of iCRC was 2.21 times higher in the V1 group. Similar trends were observed in the other groups (V2: Relative risks [RR], 2.15; 95% Confidence Interval [CI], 1.57-2.94; V3: RR, 1.56, 95% CI, 1.15-2.13; V4: RR, 1.18; 95% CI, 0.83-1.67). Conclusion: The findings emphasize that endoscopists with lower procedure volumes have higher risks of interval cancer being missed or undetected. To maximize the preventative impact of colonoscopy for colorectal cancer, this issue should be addressed by monitoring endoscopist volumes and variations in performances.

Latent class analysis of health behaviors, anxiety, and suicidal behaviors among Korean adolescents.

BACKGROUND: This study examined how health behavior patterns are associated with anxiety and suicidal behaviors among Korean adolescents. METHODS: Data were collected from a national cross-sectional sample of adolescents (n = 54,948, 51.5 % boys) in the 2020 Korea Youth Risk Behavior Web-based Survey. Latent class analysis was conducted based on 12 health behaviors (e.g., eating habits, physical activity, and substance use) using the R-based Jamovi 2.3.21 program. RESULTS: Four classes of health behaviors were identified: Class 1 (boys: 45.4 %, girls: 34.4 %) engaged in healthy behaviors; Class 2 (boys: 31.7 %; girls: 22.3 %) had unhealthy eating habits; Class 3 (boys: 18.0 %; girls: 39.9 %) had the lowest physical activity; and Class 4 (boys: 5.0 %, girls: 3.4 %) engaged in substance use, including smoking, drinking, and problematic smartphone use. Overall, girls had a higher odds ratio (OR) for anxiety and suicidal behaviors than boys did. Among girls, Class 4 had a higher OR for anxiety (OR = 2.78, 95 % confidence interval [CI] = 2.40-3.21), suicidal ideation (OR = 3.99, 95 % CI = 3.46-4.62), suicide plan (OR = 3.32, 95 % CI = 2.66-4.16), and suicide attempts (OR = 5.62, 95 % CI = 4.43-7.12) than Class 1. LIMITATIONS: This study has a few limitations including the participants' response bias, the use of a self-report survey, and the lack of diagnosis by clinicians. CONCLUSION: Adolescents engaging in substance abuse (Class 4) were more prone to anxiety symptoms and suicidal behaviors (ideation, plan, and attempts) than those engaged in healthy behaviors (Class 1). We suggest that more attention is needed to develop suicide prevention strategies that consider adolescent substance use patterns such as current smoking, drinking, and problematic smartphone use.

Influenza vaccination before and during the COVID-19 pandemic in the elderly in South Korea.

BACKGROUND: Influenza epidemics are a significant cause of mortality and morbidity in older adults; thus, vaccination is recommended. However, the coronavirus disease 2019 (COVID-19) pandemic could affect influenza vaccination. METHODS: The influenza vaccination rate was estimated from the Korea Community Health Survey data from 2011 to 2021 using Joinpoint regression. We used multiple logistic regression analysis from each two flu seasons data before (2017-18 and 2018-19 seasons) and during (2019-20 and 2020-21 seasons) the COVID-19 pandemic to identify older adults who were not been vaccinated during the COVID-19 pandemic. Additionally, we stratified changes in influenza vaccination according to the flu season, demographic and socioeconomic characteristics, and health status. RESULTS: The annual percentage change in influenza non-vaccination rate from 2010-11 to 2018-19 seasons and from 2019-20 to 2020-21 seasons was -8.31% (confidence interval (CI), -9.60 to -7.00) and 11.41% (CI, -3.22 to 28.25), respectively. Compared to before COVID-19, in the 2019-20 and 2020-21 seasons, the odds ratio (OR) of non-vaccination was 0.87 (CI, 0.83-0.91) and 1.18 (95% CI, 1.13-1.24), respectively. The decrease in influenza vaccination among older individuals with higher education (OR, 1.24; CI, 1.11-1.39) was greater than that among those with lower education (OR, 1.09; CI, 0.98-1.22). Older individuals with the lowest income level or poor self-rated health showed reduced influenza vaccination. CONCLUSIONS: We estimated the trends of influenza vaccination and identified subgroups with decreased vaccination rates during the COVID-19 pandemic among older adults in South Korea. Health policy decision-makers, practitioners, and researchers should consider the implications of COVID-19 on changes in influenza vaccination, particularly for older individuals at risk of influenza.

A Comparison of Changes in Health Behavior, Obesity, and Mental Health of Korean Adolescents Before and During the COVID-19 Pandemic: Online Cross-Sectional Study.

OBJECTIVE: The health behavior and mental health problems of adolescents have shown a variety of changes due to the coronavirus disease-2019 (COVID-19) pandemic. This study compared health behavior, obesity, and mental health among Korean adolescents before and during the early COVID-19 pandemic. METHODS: Population-based and cross-sectional data from the 2019 and 2020 Korea Youth Risk Behavior Web-Based Surveys were used. Data of 57,048 and 54,948 adolescents from the 2019 and 2020 surveys, respectively, were compared. Multiple logistic regression analysis was conducted to compare health behavior, obesity, and mental health before and during the COVID-19 pandemic. RESULTS: The adjusted odds ratio (aOR) of overweight, obesity, and body image perceived subjectively as fat, were higher in the 2020 sample compared to the 2019 sample. The aOR of the frequency (more than 3 times a week) of fast-food consumption was higher in 2020 than in 2019. However, the aOR of physical activity, alcohol use, and smoking experience were lower in 2020 than in 2019. In addition, during COVID-19, adolescents were less likely to have perceived severe stress, depressive moods, and suicidal ideation. CONCLUSION: Current evidence suggests the co-occurrence of positive and negative changes in health behavior, obesity, and mental health among Korean adolescents during the early COVID-19 pandemic. The results contribute insights for monitoring adolescents' health behavior and promoting their mental health during school shutdowns.

Problematic Smartphone Use and Its Relationship With Anxiety and Suicidal Ideation Among South Korean Adolescents.

OBJECTIVE: This study aimed to investigate the prevalence of problematic smartphone use (PSU) among adolescents and its association with anxiety and suicidal ideation. METHODS: The 16th cross-sectional, population-based Korea Youth Risk Behavior Web-Based Survey was administered in 2020 and included 54,948 adolescents. We used the Korean version of the smartphone overdependence scale and the 7-item Generalized Anxiety Disorder scale to assess PSU and anxiety. Suicidal ideation was assessed through responses to the self-report question. Multiple logistic regression analyses with complex sampling were conducted to identify the association of PSU with anxiety and suicidal ideation. RESULTS: In total, 25.1% of the adolescents reported PSU, 33.2% had anxiety symptoms, and 10.9% had seriously considered suicide during the past 12 months. Girls with PSU had a higher risk of anxiety (adjusted odds ratio [aOR], 2.81; 95% confidence interval [CI], 2.65 to 2.97) and suicidal ideation (aOR, 1.77; 95% CI, 1.64 to 1.91) than non-PSU girls. Boys with PSU reported more anxiety (aOR, 2.89; 95% CI, 2.72 to 3.07) and suicidal ideation (aOR, 1.82; 95% CI, 1.66 to 1.99) than the non-PSU group. In addition, girls with the lowest household income reported more suicidal ideation than girls with the highest household income (aOR, 3.40; 95% CI, 2.69 to 4.28). CONCLUSION: This study demonstrated the prevalence of PSU among South Korean adolescents in 2020. The prioritization of the detection of PSU and the identification of psychological factors may help improve the diagnosis and management of mental health problems and potentially yield significant psychosocial benefits.

Association of Social Support and Postpartum Depression According to the Time After Childbirth in South Korea.

OBJECTIVE: This study examined the association between social support and postpartum depression (PPD) according to the time after childbirth within 12 months in South Korea. METHODS: Data were collected from 1,481 women in Chungnam Province, South Korea from September 21 to 30, 2022. Multivariate logistic regression models were used to examine the association between social support and PPD. Subgroup analysis of the associations of support from family, friends, and significant others with PPD according to the time after childbirth was undertaken using crude and adjusted models. RESULTS: Of the participants, 39.91% had PPD. The prevalence of PPD was 36.05% at <3 months, 37.50% at 3≤ to <6 months, and 44.41% at 6≤ to <12 months. A 1-point increase in the social support score was associated with an increase in the adjusted odds ratio of PPD of 0.91 (95% confidence interval=0.90-0.93). Social support from family was significantly associated with PPD regardless of the time after childbirth. Support from significant others was significantly associated with PPD after 6≤ to <12 months. CONCLUSION: Family support should be provided consistently to women after birth; social connections with significant others can prevent PPD.

Is social support associated with postpartum depression, anxiety and perceived stress among Korean women within the first year postpartum?

PURPOSE: This study aimed to examine the association between social support, postpartum depression (PPD), anxiety and perceived stress among women within 12 months of childbirth in South Korea. METHODS: A cross-sectional, web-based survey was conducted from 21 to 30 September 2022 and included women within 12 months of childbirth in Chungnam Province, South Korea. A total of 1486 participants were included. Multiple linear regression models were used to evaluate the association between social support and mental health. RESULTS: In total, 40.0% of the participants had mild to moderate PPD; 12.0%, anxiety symptoms; and 8.2%, perceived severe stress. Social support (from family and significant others) is significantly associated with PPD, anxiety and perceived severe stress. Current maternal health problems, unplanned pregnancy and low household income were risk factors for PPD, anxiety and perceived stress. The increase in the time elapsed after childbirth showed a positive association with PPD and perceived severe stress. CONCLUSIONS: Our findings provide insights to identify at-risk mothers and emphasize the importance of social support in families, early screening and continuous monitoring for postpartum women to prevent PPD, anxiety and stress.

The risk of obstructive sleep apnea is highly correlated with depressive symptoms among the Korean adults population: results from the 2020 Korea National Health and Nutrition Examination Survey.

OBJECTIVES: We aimed to examine the association between Obstructive Sleep Apnea (OSA) risk, health behaviors, and depressive symptoms in a representative Korean sample. METHODS: Cross-sectional data from the 2020 Korea National Health and Nutrition Examination Survey (KNHANES) were analyzed. The sample included 4,352 adults aged 40 years and older. Multiple linear regression analysis was performed to examine the association between OSA risk, health behaviors, and depressive symptoms. RESULTS: In total, 23.1% of the participants reported a high risk of OSA. Of the respondents, 39.8%, 19.0%, 27.2%, and 8.7% reported hypertension, snoring, tiredness, and observed apnea, respectively. The prevalence of moderate-severe depressive symptoms among adults with high-risk OSA was 7.5%. The significant associations between OSA risk and sex with PHQ-9 were shown in univariate linear regression. In the multiple linear regression analysis, the association between high risk of OSA and PHQ-9 showed in total (B = 1.58; P < 0.001), male (B = 1.21; P < 0.001), and female (B = 1.93; P < 0.001). CONCLUSIONS: A high risk of OSA was associated with an increased prevalence of depressive symptoms. Monitoring the risk factors of depressive symptoms, including OSA, or unhealthy behaviors may decrease the mental health issues of middle-aged and older adults.

Trends in health behaviors and mental health among Korean adolescents in Korea over 5 years, 2017-2021: focusing on the comparisons before and during the COVID-19 pandemic.

Objectives: We investigated recent trends in health behaviors and mental health conditions among Korean adolescents from 2017 to 2021 and compared the changes before and during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Data analysis was conducted on 289,415 adolescents participating in the Korea Youth Risk Behavior Web-Based Survey, an annual cross-sectional study from 2017 to 2021. All analysis was conducted using sex stratification, and the annual percentage change (APC) was calculated. Results: Alcohol consumption and smoking decreased in the first year of the COVID-19 pandemic compared with before, except for girls from the low-income level. The prevalence of inadequate physical activity for both boys and girls increased in 2020 compared with the pre-COVID-19 period and decreased again by 2021. The prevalence of obesity in both sexes increased regardless of the period (boys, APC = 8.2%, 95% confidence intervals (CI), 6.4-10.1; girls, APC = 3.3%, 95% CI, 1.8-4.8). The prevalence of stress, depression, and suicidal ideation, plans, and attempts for both sexes decreased in 2020 compared to the pre-COVID-19 period. By 2021, this prevalence had returned to a level similar to before the pandemic. No significant APC changes were observed in the prevalence of mental health. Conclusions: These findings demonstrate the trends and APCs in health behaviors and mental health conditions among Korean adolescents over the last 5 years. We must pay attention to the heterogeneous and multifaceted features of the COVID-19 pandemic.

Association Between Changes in Oral Health-Related Quality of Life and Depressive Symptoms in the Korean Elderly Population.

Objectives: The aim of this study was to examine the association between changes in oral health related quality of life (OHRQoL) and depressive symptoms in the elderly South Koreans. Methods: We used the 2018 and 2020 Korean Longitudinal Study of Ageing data. Our study population was a total of 3,604 participants aged over 65 in 2018. The independent variable of interest was the changes in the Geriatric Oral Health Assessment Index as OHRQoL between 2018 and 2020. The dependent variable was depressive symptoms in 2020. Multivariable logistic regression analyzed the associations between changes in OHRQoL and depressive symptoms. Results: Participants with improvement in OHRQoL over 2-year period were likely to have fewer depressive symptoms in 2020. Especially, changes in the oral pain and discomfort dimension score was associated with depressive symptoms. A decline in oral physical function, such as difficulty in chewing and speaking, was also associated with depressive symptoms. Conclusion: Negative change in OHRQoL is a risk factor for depression in elderly. This results suggest the importance of maintaining good oral health in later life, as a protective factor against depression.

Associations between binge drinking experience, depressive mood, and suicidality in adolescents: Based on the 2021 Korea Youth Risk Behavior Web-based Survey.

BACKGROUND: This study aimed to investigate the associations between binge drinking experience (BDE), depressive mood, and suicidality among Korean adolescents. METHODS: We analyzed the 17th population-based and cross-sectional data from the Korean Youth Risk Behavior Web-based Survey. Multiple logistic regression analysis was performed to compare BDE, depressive mood, and suicidality by sex. RESULTS: In 54,848 adolescents, the prevalence of BDE was 5.3 % in boys and 4.4 % in girls. The prevalence of suicidal ideation, plans, and attempts among girls was 7.8 %, 2.4 %, and 1.4 %, respectively. The prevalence of suicide attempts among girls with both BDE and depressive moods was higher than that among boys. Boys with both BDE and depressive mood had 12.60 times and 14.50 times higher adjusted odds ratio (aOR) of suicide ideation and plan, respectively, compared with the non-drinking/non-depressed group. Girls with both BDE and depressive mood had 22.06 times higher aOR of suicide attempts than the non-drinking/non-depressed group. LIMITATIONS: The study has few limitations including the use of self-report questionnaires, participants' response bias, and lack of diagnosis by mental health professionals. CONCLUSIONS: These findings represent the prevalence of suicidality among South Korean adolescents with BDE or depressive mood. Since adolescents with both BDE and depressive mood showed particularly high suicidality, it is necessary to establish mental health services, such as proper prevention strategies and targeted interventions.

Socio-economic factors associated with mental health outcomes during the COVID-19 pandemic in South Korea.

Background: Individuals are at an increased risk of adverse mental health outcomes during the COVID-19 pandemic. To reduce the impact on mental health outcomes that were induced by national-level policies, which may influence an individual at the community level, exploring the comprehensive relations between individual and environmental factors are needed. The aim is to examine socio-ecological factors associated with mental health outcomes, including depressive and anxiety symptoms, with the perspective of support to provide interventions that help the community during future disease outbreaks. Method: From 5 November to 20 November 2020, a cross-sectional and population-based study was conducted to assess the socio-ecological factors of mental health outcomes during the COVID-19 pandemic. A total of 1,000 participants, aged 20-69 years, in Chungnam Region, South Korea, were included in this study. Multiple linear regression models were used to examine the association between socio-ecological factors and mental health outcomes. The primary outcomes were individuals' mental health outcomes which are measured by PHQ-9 and GAD-7 scores. Results: Of the 1,000 participants, the average PHQ-9 was 4.39, and GAD-7 was 3.21 during the COVID-19 pandemic. Specifically, the participants with moderate or severe levels of PHQ-9 and GAD-7 were 12.6 and 6.8%, respectively. Higher levels of depressive and anxiety symptoms were associated with participants who were single, reported a lower household income, had decreased support from friends or family, and increased stress from the workplace or home. In subgroup analyses by age, gender, and household income, a similar trend was reported in individual and interpersonal-level factors. There were significant associations between regional-level factors, including gross regional domestic product (GRDP), mental health institutions, psychiatrists, nurse-to-population ratios, and individuals' mental health outcomes. Conclusion: The management of depressive and anxiety symptoms of individuals during the pandemic was better explained by individual and interpersonal characteristics rather than regional-level factors, highlighting the need for more policies aimed at these lower levels.

Depression, anxiety, and stress in Korean general population during the COVID-19 pandemic.

OBJECTIVES: The aim of this study was to investigate the prevalence and risk factors of poor mental health in the general Korean population during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional, population-based, online survey-based study was conducted from November 5 to 20, 2020 and included adults aged 20-49 years in Chungnam Province, Korea. A total of 549 adults were included. RESULTS: In total, 18.8% of the participants had symptoms of depression, 10.6% had symptoms of anxiety, and 5.1% had a high level of perceived stress during the COVID-19 pandemic. Higher levels of stress (odds ratio [OR], 3.13; 95% confidence interval [CI], 1.13 to 8.67), anxiety (OR, 2.33; 95% CI, 1.09 to 4.49), and depression (OR, 3.00; 95% CI, 1.64 to 5.50) were found among never married, widowed, divorced, and separated people than among married/cohabiting/partnered participants. Participants who felt increased stress at home during the COVID-19 outbreak reported more depression (OR, 2.45; 95% CI, 1.49 to 4.05) and anxiety (OR, 2.42; 95% CI, 1.31 to 4.50). Women had higher risks of anxiety (OR, 1.97; 95% CI, 1.09 to 3.58) and stress (OR, 6.40; 95% CI, 2.30 to 17.85) than men. Participants with the highest household income were less likely to report symptoms of stress than those with the lowest household income (OR, 0.24; 95% CI, 0.06 to 0.96). CONCLUSIONS: The participants in this study exhibited poor mental health index scores, suggesting that some people are at risk for mental health problems during the COVID-19 pandemic. Being married was independently and significantly associated with a lower likelihood of depression, anxiety, and stress.

Urinary incontinence and the association with depression, stress, and self-esteem in older Korean Women.

The objectives were to investigate the prevalence of urinary incontinence (UI) and its relationships with depression, stress, and self-esteem in older Korean women from the Korean Study of Women's Health Related Issues (K-Stori), a nationally representative cross-sectional survey. A total of 3000 women between 65 and 79 years were the final study subjects. We applied multiple linear regression models to analyze associations with depression, stress, and self-esteem levels in relation to UI types. Types of urinary incontinence included stress, urge, and mixed UI. UI affects at least one in two older Korean women (52.2%). The prevalences of SUI, UUI, and MUI were 45.7%, 39.6%, and 33.1%, respectively. UI was found to be adversely associated with depression, stress, and self-esteem: women with UI reported significantly higher levels of depression and stress and lower levels of self-esteem than those without UI. Women with MUI reported significantly greater impairment than the women with SUI or UUI. Our results provide an evidence base for the evaluation of mental health in older women with incontinence. The prioritization of UI detection and the identification of psychological factors may help improve the diagnosis and management of UI and potentially yield significant economic and psychosocial benefits.

The 30-day unplanned readmission rate and hospital volume: a national population-based study in South Korea.

OBJECTIVE: To examine the association between hospital volume and the unplanned 30-day readmission rate as a quality measure. DESIGN: A retrospective cross-sectional study. SETTING: The Korea healthcare system is operated by a single payer under the National Health Insurance Service. PARTICIPANTS: Using national health claims data of the Health Insurance Review and Assessment in South Korea, we examined 1 296 275 adult discharges (≥18 years old) from 90 hospitals (≥500 beds) in the 2013 calendar year. MAIN OUTCOME MEASURES: We analysed the 30-day, unplanned, observed-to-expected standardized readmission rate for hospitals and for five specialty cohorts: medicine, surgery/gynaecology, cardiovascular, cardiorespiratory, and neurology. We assessed the association between hospital volume by tertiles and the 30-day standardized readmission rates with and without adjustment for hospital characteristics. RESULTS: The rate for the lowest-volume hospitals was 6.10 compared with 6.20 for the highest-volume hospitals. We observed the standardized readmission rates did not differ significantly between the lowest- and highest-volume groups, except for the neurology cohort, which remained significant after adjusting for hospital characteristics. CONCLUSIONS: The standardized readmission rates were not associated with hospital volume, except for the neurology cohort, in which the standardized readmission rate was significantly higher in the highest-volume hospitals than in lowest- and intermediate-volume hospitals, which was not consistent with the typical association of greater hospital volume with better outcomes. This association was independent of hospital characteristics. Therefore, the rate of readmissions should be used with caution when gauging the quality of hospital care according to hospital volume.

Patient and hospital factors associated with 30-day unplanned readmission in patients with stroke.

Stroke is frequently associated with readmission; moreover, readmission is regarded as an important indicator of the quality of stroke care. Thus, we investigated factors associated with 30-day readmission in patients with stroke in South Korea. We used claims data from 2013 for stroke (I60-I62) patients (n=44 729) in 94 hospitals and classified unplanned readmission according to the Centers for Medicare and Medicaid guidelines. We used multilevel models to investigate patient (age, gender, type of insurance, admission via emergency room, length of stay, type of stroke, Elixhauser Index Score) and hospital (stroke care quality grade, location of hospital, type of hospital, number of doctors and nurses per 100 beds) factors associated with readmission within 30 days of discharge. Among the 44 729 patients admitted due to stroke, 9.2% (n=4124) were readmitted to hospital and 7.6% (n=3379) had unplanned readmissions. Regarding patient characteristics, medical aid and longer hospital stay were associated with 30-day readmission rate. Among hospital factors, patients admitted to a low-grade hospital or a non-capital area hospital were more likely to be readmitted within 30 days of discharge. We identified patient and hospital factors associated with 30-day readmission among stroke patients. In particular, patients admitted to hospitals with higher quality stroke care showed lower readmission rates.

Undergraduate medical students' perceptions and intentions regarding patient safety during clinical clerkship.

BACKGROUND: The purpose of this study was to examine undergraduate medical students' perceptions and intentions regarding patient safety during clinical clerkships. METHODS: Cross-sectional study administered in face-to-face interviews using modified the Medical Student Safety Attitudes and Professionalism Survey (MSSAPS) from three colleges of medicine in Korea. We assessed medical students' perceptions of the cultures ('safety', 'teamwork', and 'error disclosure'), 'behavioural intentions' concerning patient safety issues and 'overall patient safety'. Confirmatory factor analysis and Spearman's correlation analyses was performed. In total, 194(91.9%) of the 211 third-year undergraduate students participated. RESULTS: 78% of medical students reported that the quality of care received by patients was impacted by teamwork during clinical rotations. Regarding error disclosure, positive scores ranged from 10% to 74%. Except for one question asking whether the disclosure of medical errors was an important component of patient safety (74%), the percentages of positive scores for all the other questions were below 20%. 41.2% of medical students have intention to disclose it when they saw a medical error committed by another team member. CONCLUSIONS: Many students had difficulty speaking up about medical errors. Error disclosure guidelines and educational efforts aimed at developing sophisticated communication skills are needed. This study may serve as a reference for other institutions planning patient safety education in their curricula. Assessing student perceptions of safety culture can provide clerkship directors and clinical service chiefs with information that enhances the educational environment and promotes patient safety.

Association between re-admission rate and hospital characteristics for ischemic heart disease.

OBJECTIVE: Hospital re-admission is considered an important marker of patient health outcomes and healthcare system performance. Korea introduced the Korean Diagnosis Procedure Combination (KDPC) for all regional public hospitals in July 2012. This study examined re-admission rates within 30 days to assess whether the hospital payment system is associated with the re-admission rate, focusing on ischemic heart disease. METHODS: A cross-sectional study was conducted using national claims data for 2013. We analyzed data of patients with a major diagnosis of ischemic heart disease who were admitted to general hospitals with more than 500 beds in Korea. Of the eight general hospitals, two that have been operating under the new Korean payment system were public hospitals using the KDPC, and the remaining six were private general hospitals with fee for service (FFS) systems. Multiple logistic regression analysis was used to identify associations between re-admission rate and hospital characteristics. RESULTS: The study analyzed 4,290 cases (889 cases in KDPC and 3,401 cases in FFS). The 30-day unplanned re-admission rate was higher in KDPC than in FFS (7.9% vs 5.6%, respectively). The unplanned re-admission odds ratios of KDPC was 1.74. CONCLUSIONS: KDPC had higher 30-day unplanned re-admissions rates than did FFS.