The Effect of Depression on the Use of Medical Service: Focusing on Patients with Chronic Physical Illness among Middle-Aged and Elderly Women / 보건행정학회지

Background@#Patients with the chronic physical illness are more likely to experience depression, and the accompany of chronic physical illness and depression is particularly high in middle-aged and elderly women. Considering that depression is associated with somatization and the decline of therapeutic compliance when accompanied by chronic physical illness, middle-aged and elderly women who experience depression among chronic physical illness may increase their use of medical services. This study is to identify the effect of depression on the use of medical services, especially among middle-aged and elderly women with chronic physical illness. @*Methods@#This study used the 2016 Korean Health Panel. For analysis, it used T-test, negative binomial regression, and multivariate regression combining propensity score matching. @*Results@#First, depressive groups had a higher number of medical service utilization and total medical expenditure than the non-depressive group. Second, depression significantly increased medical service utilization (β=0.17, p=0.04) at the 5% significance level. Also, depression significantly increased total medical expenditure (β=0.37, p=0.08) at the 10% significance level. @*Conclusion@#For those who have chronic physical illness among middle-aged and elderly women, the experience of depression was confirmed to be a factor affecting the use of medical services. In the end, it is important to come up with policy countermeasures for middle-aged and elderly women accompanied by depression and chronic physical illness.

The Effect of Depression on the Use of Medical Service: Focusing on Patients with Chronic Physical Illness among Middle-Aged and Elderly Women / 보건행정학회지

Background@#Patients with the chronic physical illness are more likely to experience depression, and the accompany of chronic physical illness and depression is particularly high in middle-aged and elderly women. Considering that depression is associated with somatization and the decline of therapeutic compliance when accompanied by chronic physical illness, middle-aged and elderly women who experience depression among chronic physical illness may increase their use of medical services. This study is to identify the effect of depression on the use of medical services, especially among middle-aged and elderly women with chronic physical illness. @*Methods@#This study used the 2016 Korean Health Panel. For analysis, it used T-test, negative binomial regression, and multivariate regression combining propensity score matching. @*Results@#First, depressive groups had a higher number of medical service utilization and total medical expenditure than the non-depressive group. Second, depression significantly increased medical service utilization (β=0.17, p=0.04) at the 5% significance level. Also, depression significantly increased total medical expenditure (β=0.37, p=0.08) at the 10% significance level. @*Conclusion@#For those who have chronic physical illness among middle-aged and elderly women, the experience of depression was confirmed to be a factor affecting the use of medical services. In the end, it is important to come up with policy countermeasures for middle-aged and elderly women accompanied by depression and chronic physical illness.

Trends in the utilization of dental outpatient services affected by the expansion of health care benefits in South Korea to include scaling: a 6-year interrupted time-series study

PURPOSE: This study utilized a strong quasi-experimental design to test the hypothesis that the implementation of a policy to expand dental care services resulted in an increase in the usage of dental outpatient services. METHODS: A total of 45,650,000 subjects with diagnoses of gingivitis or advanced periodontitis who received dental scaling were selected and examined, utilizing National Health Insurance claims data from July 2010 through November 2015. We performed a segmented regression analysis of the interrupted time-series to analyze the time-series trend in dental costs before and after the policy implementation, and assessed immediate changes in dental costs. RESULTS: After the policy change was implemented, a statistically significant 18% increase occurred in the observed total dental cost per patient, after adjustment for age, sex, and residence area. In addition, the dental costs of outpatient gingivitis treatment increased immediately by almost 47%, compared with a 15% increase in treatment costs for advanced periodontitis outpatients. This policy effect appears to be sustainable. CONCLUSIONS: The introduction of the new policy positively impacted the immediate and long-term outpatient utilization of dental scaling treatment in South Korea. While the policy was intended to entice patients to prevent periodontal disease, thus benefiting the insurance system, our results showed that the policy also increased treatment accessibility for potential periodontal disease patients and may improve long-term periodontal health in the South Korean population.

Changes in dental care access upon health care benefit expansion to include scaling

PURPOSE: This study aimed to evaluate the effects of a policy change to expand Korean National Health Insurance (KNHI) benefit coverage to include scaling on access to dental care at the national level. METHODS: A nationally representative sample of 12,794 adults aged 20 to 64 years from Korea National Health and Nutritional Examination Survey (2010–2014) was analyzed. To examine the effect of the policy on the outcomes of interest (unmet dental care needs and preventive dental care utilization in the past year), an estimates-based probit model was used, incorporating marginal effects with a complex sampling structure. The effect of the policy on individuals depending on their income and education level was also assessed. RESULTS: Adjusting for potential covariates, the probability of having unmet needs for dental care decreased by 6.1% and preventative dental care utilization increased by 14% in the post-policy period compared to those in the pre-policy period (2010, 2012). High income and higher education levels were associated with fewer unmet dental care needs and more preventive dental visits. CONCLUSIONS: The expansion of coverage to include scaling demonstrated to have a significant association with decreasing unmet dental care needs and increasing preventive dental care utilization. However, the policy disproportionately benefited certain groups, in contrast with the objective of the policy to benefit all participants in the KNHI system.

The mediation effects of psychological factors in the relationship between mouth dryness and oral health related quality of life / 대한구강보건학회지

OBJECTIVES: The aim of this study was to investigate the role of psychological factors as mediators in the casual relationship between mouth dryness and oral health-related quality of life of adults and to explore gender differences in what psychological factors play an important role in mediating the path of mouth dryness to quality of life. METHODS: Self-administered questionnaires were distributed to 321 adults who are above 20 and under 65 years of age. Collected data were analyzed via statistical packages using a multi-group analysis through the SEM (Structural Equation Model). RESULTS: Based on the statistical analysis, stress was a major psychological factor in male subjects. While depression served as a main mediator in female subjects. We discovered that the path coefficients of the following paths showed significant gender differences: mouth dryness --> depression, depression --> quality of life, stress --> quality of life. CONCLUSIONS: A gender-specific approach regarding effective prevention of stress and depression may be important for understanding the relationship between mouth dryness and quality of life.

Dressing Materials in the STSG Donor Site Management: A Comparative Study

Split-thickness skin graft is a frequent, necessary method of treatment in burn patients. After harvesting a split thickness skin graft, there is a variety of options in the post-operative management of the donor site created. Dressing materials provide an occlusive and wet environment and aids in superior wound healing. Of the commercially available dressing materials, Medifoam(R), Allevin(R) and Polymem(R) are the most commonly used materials during the early phases of epithelization. Medifoam-B(R) is a more absorbant dressing material compared to other dressing materials. Its swelling ratio is 1200% and it contains a layer of wound promoters and antibiotics. The purpose of this study is to compare medifoam-B(R), Allevyn(R) and Polymem(R) in the healing time, infection rate, absorption ratio and pain degree. This study is based on 30 patient who underwent split-thickness skin graft in Hanil General Hospital from March 2002 to July 2002. All skin grafts were harvested with an electric dermatome, with a thickness depth of 0.012 to 0.016 inches. Three divisions of each donor site was managed separately with each different materials through postoperative days 0 to 1. Absorption property, infection rate, pain degree, time to complete epithelization were assessed. Medifoam-B(R) performed superior to Allevyn(R), Polymem(R). In conclusion, We suggest Medifoam-B(R) as a useful alternative in the management of the split-thickness donor site wound in the early phases.

Reconstruction of Soft Tissue Defect in Hand Using Reverse Dorsal Digital and Metacarpal Artery Island Flap in Electrical Burn Patient

The hand is frequently affected area in high voltage electrical burn injury as an input or output sites. Therefore, proper treatment method should be applied in order to achive aesthetic and funtioning hand. To reconstruction of soft tissue defect in hand, a variety of treatment have been, but most are associated with drawbacks, such as limited range, limited application, long time surgery, 2nd stage surgery, large donor defect. The reverse dorsal digital and metacarpal island flaps use the dorsal skin of the digital or metacarpal areas, and they are based on the arterial branches anastomosing the volar and dorsal arterial networks. The series of 15 cases of reconstruction for soft tissue defect due to electrical burn in hand were reviewed. Most cases survived completely and we could gain satisfactory results. Advantages of these flaps are minimal defect in donor site, good reliability, short time and easy technique, versatile variation, usefulness in secondary reconstruction. In conclusion, our result suggested that the reverse dorsal digital and metacarpal artery island flap are very useful methods for reconstruction of soft tissue defect due to electrical burn in hand, functionally and aetheticallly.

Diagnostic Significance of the Endoscopy-guided Biopsy with Tonsillectomy in Suspected Occult Primary Tumor / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An occult primary tumor is defined as histologic evidence of malignancy in the cervical lymph nodes with no apparent primary site of origin for the metastatic tumor. MATERIALS AND METHODS: Twenty-three patients who have failed to detect primary tumor on their initial physical examinations, endoscopy and other imaging studies, underwent endoscopy-guided biopsy under the general anesthesia. The histologic examination of frozen sections was done in the operation room. For those failing to give results by the histologic study, we performed the ipsilateral tonsillectomy biopsy. RESULTS: Nine primary lesions were identified: four cases of tonsillar fossa, one case each of nasopharynx, base of tongue, hypopharynx, supraglottis, and esophagus. In the three of the four tonsillar cancer cases, the primary foci were also identified by tonsillectomy biopsy. All the patients whose primary foci were tonsillar fossa showed metastasis of the jugulodigastric lymph node. CONCLUSION: Our results indicate that patients who are considered to have occult primary tumor should be evaluated by endoscopy-guided biopsy under the general anesthesia. Also, this study finds that if the histologic result of the frozen section were negative, ipsilateral tonsillectomy can be justified, especially for patients who show metastasis of jugulodigastric cervical lymph node.

A Clinical Study of Tracheotomy in Pediatrics / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tracheotomy, although an inevitable procedure in some situations, is often avoided in pediatrics for its frequent and serious complications. So, authors studied clinical characteristics of tracheotomy as observed in pediatrics. MATERIALS AND METHODS: 138 children who underwent tracheotomy during the past twenty years since 1977 were investigated. We analyzed distribution of age and gender, annual frequency, causative disorders for tracheotomy and complications. RESULTS: 1) Number of tracheotomy performed tended to be decreased with time: 2) Tracheotomy was performed two times more frequently in males than in females, and most frequently below eight years old: 3) Most frequent causative disease was head injury (27.5%): 4) Most frequent indication of tracheotomy was ventilator support (49.3%): 5) The history of endotracheal intubation before tracheotomy was 86.2%: 6) The complications of the tracheotomy developed in 39.9%, with the most frequent complications being granulation formation (18.1%), followed by tracheal stenosis (17.4%). 7) Frequency of late complication was relatively lower in the shorter intubation period group (22.9%) than in the longer intubation period groups (51.5% and 33.3%): 8) Late complications were lower in the group who had not been supported by a ventilator: 9) Late comlications did not occurre in cases who were decannulated before 1 month. CONCLUSION: We found that factors associated with complications were duration of endotracheal intubation before tracheotomy, history of ventilator care and timing of decannulation.