Narrative Review on the Trend of Childbirth in South Korea and Feasible Intervention to Reduce Cesarean Section Rate

In this study, we explored the current childbirth trend in South Korea to provide recent evidence on determinants of the cesarean section rate (CSR) and related policy interventions. We utilized national health insurance claim data to analyze the CSR. We also conducted a narrative review on factors associated with the CSR and examined evidence about interventions to reduce it. The CSR is rising in Korea; simultaneously, the overall number of births is declining. In 2012, 469,000 women gave birth, and 26.9% underwent a cesarean section. In 2021, 249,000 women gave birth, and 58.7% experienced a cesarean section. The CSR among women under age 25 was 26.7% in 2012, but by the first quarter of 2022, it was 51.6%. In 2012, the CSR in women aged 25–34 years was 34.9%; by the first quarter of 2022, it was 58.3%. We synthesized evidence on the determinants of CSR in three dimensions: users, providers, and systems. We also explored recent evidence on policy interventions to reduce the CSR, focusing on women and families, providers, and hospitals. Despite the rapid increase in the CSR in the last decade, efforts to investigate childbirth choice and women’s experiences have been insufficient. We could not locate systematic initiatives in the research community or government to lower the rate. More patient-centered efforts to reduce the high CSR rate are needed.

The effect of general health status, oral health behavior and status on quality of life in Korea adults / 대한구강보건학회지

Objectives@#The purpose of this study was to analyze the relations between general health status, oral health behavior, oral health status, and quality of life, as well as the mediating effects of oral health behavior and oral health status. @*Methods@#Subjects aged ≥19 years participated in a health questionnaire in the third year of the Japanese National Health and Nutrition Examination Survey (2015). @*Results@#Analysis of the overall path of periodontal disease showed that respiratory and circulatory diseases and oral health behaviors had statistically significant indirect effects on quality of life through the mediation of oral health behavior and oral health conditions, while analysis of the overall trend of the decayed, missing, and filled teeth (DMFT) index showed significant indirect effects on quality of life through mediation between oral and oral health conditions. As a result of these analyses, the association of general health status with quality of life, and its effect thereon, were confirmed through the intermediary of oral health behaviors and oral health conditions. @*Conclusions@#Therefore, further research is needed on the relation of general diseases to oral health management. Special oral health departments need to be established in both general and university hospitals, and dental hygienists in charge of oral care need to be deployed to improve oral health for general diseases. Manuals and systems for oral health management and oral health promotion need to be developed for certified dental hygienists in Japan, specifically for each systemic disease. For example, hygienists should have guidance on the oral health practices that help in the prevention of diabetes.

A study of the impact of dental hygienist concern on oral health care of the elderly / 대한구강보건학회지

OBJECTIVES: There is currently little research on dental hygienists' interest and need related to oral care. To perform elderly oral care effectively, dental hygienists must understand the features of aging in the elderly. The purpose of this study is to investigate how dental hygienists' interest affects oral care for the elderly.METHODS: 232 dental hygienists completed a self-reported questionnaire from March to April 2019. The questionnaires consisted of general characteristics of the subjects (6 items), elderly patient experience (11 items), and questions regarding aging (7 items). This study analyzed collected data by frequency analysis, ANOVA, Pearson correlation analysis, and multiple regression analysis.RESULTS: Correlation analysis between concern, need, and participation in elderly oral care showed a significant amount of correlation among all variables. We found that gender (P=0.022), education level (P=0.029), workplace type (P=0.002), and the proportion of future elderly patients were statistically significant (P=0.001) factors affecting the level of concern.CONCLUSIONS: The results of this study suggest that experience in treating and caring for the elderly are essential factors for raising the interest and understanding of oral health care for elderly patients. Therefore, we should consider the development of various programs to raise interest in oral health for the elderly.

Impact of incivility experienced by dental hygienists on organizational achievement-as a mediating effect of emotional exhaustion / 대한구강보건학회지

OBJECTIVES: Workplace incivility is experienced by dental hygienists, who perform a variety of tasks and roles in dentistry. Therefore, to enhance the performance of dental and medical institutions, it is necessary to identify dental hygienists experiencing incivility that affects the organizational performance. METHODS: Over a two-month period from May 1 to June 30, 2015, dental hygienists from 30 dental and medical institutions in Busan, the North and South Gyeongsang Provinces, Daegu, Seoul, and the Gyeonggi Province were convenience sampled. Data, from a total of 344 participants, were analyzed using the SPSS and AMOS statistical analysis software. RESULTS: Emotional exhaustion had a partial mediating effect on the relationship between patient incivility and job performance, a full mediating effect in relation to job satisfaction, and a partial mediating effect on the association with turnover intention. Meanwhile, emotional exhaustion had a full mediating effect on the relationships between superior incivility and job performance, as well as turnover intention, while a partial mediating effect in relation to job satisfaction. CONCLUSIONS: An in-depth review of interventions that can enable a mutually respectful working environment, and promote a healthy culture among dental hygienists in dental and medical institutions is needed.

Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians

Gastrointestinal endoscopy plays an important diagnostic and therapeutic role in the field of gastrointestinal disease. As endoscopies have become more common due to the nationwide screening program for digestive cancer and an increasing interest in health among the general public, the risk of infection transmission between patients has emerged as a clinical challenge. Although endoscopes can become highly contaminated with secretions and blood during use, the thorough reprocessing of an endoscope before it is reused in subsequent patients can be difficult due to its complicated structure. Although the incidence of endoscopy-associated infections has been reported to be extremely low, compelling evidence suggests that the actual incidence is underestimated. It has been well established that endoscopes reprocessed appropriately, in accordance with standard guidelines, have no risk of infection transmission. Although revised guidelines for endoscope reprocessing were released in Korea in 2015, suboptimal infection prevention practices during endoscope reprocessing have been reported. Under these circumstances, the Korean Society of Digestive Endoscopy developed the ‘Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians’ based on the currently available evidence. These guidelines provide accurate and updated information on reprocessing techniques, and can help improve the quality of reprocessing and compliance by health care personnel. As a result, infection control during gastrointestinal endoscopies can be expected to be achieved in Korea.

Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians

Gastrointestinal endoscopy plays an important diagnostic and therapeutic role in the field of gastrointestinal disease. As endoscopies have become more common due to the nationwide screening program for digestive cancer and an increasing interest in health among the general public, the risk of infection transmission between patients has emerged as a clinical challenge. Although endoscopes can become highly contaminated with secretions and blood during use, the thorough reprocessing of an endoscope before it is reused in subsequent patients can be difficult due to its complicated structure. Although the incidence of endoscopy-associated infections has been reported to be extremely low, compelling evidence suggests that the actual incidence is underestimated. It has been well established that endoscopes reprocessed appropriately, in accordance with standard guidelines, have no risk of infection transmission. Although revised guidelines for endoscope reprocessing were released in Korea in 2015, suboptimal infection prevention practices during endoscope reprocessing have been reported. Under these circumstances, the Korean Society of Digestive Endoscopy developed the ‘Guidelines of cleaning and disinfection in gastrointestinal endoscope for clinicians’ based on the currently available evidence. These guidelines provide accurate and updated information on reprocessing techniques, and can help improve the quality of reprocessing and compliance by health care personnel. As a result, infection control during gastrointestinal endoscopies can be expected to be achieved in Korea.

Erratum: Effects of plaque control according to professional toothbrushing and oral health education of orthodontic patients / 대한구강보건학회지

The authors confirm that the author name and the title were incorrect in the last isuse of the journal.

Effects of plaque control according to professional toothbrushing and oral health education of orthodontic patients / 대한구강보건학회지

OBJECTIVES: This study aimed to contribute to the development of an oral health education program on organized professional toothbrushing by determining its effects on plaque control in patients undergoing orthodontic treatment. METHODS: The subjects in the experimental group participated in the professional toothbrushing and oral health education weekly for 4 weeks, and those in the control group participated in the same program without professional toothbrushing education. RESULTS: The difference in knowledge, attitude, and behaviors on oral health was higher among the experimental group who underwent professional toothbrushing and oral health education program than those in the control group. The effects of toothbrushing time on the plaque index were significantly lower in experimental group than those in the control group. CONCLUSIONS: It is suggested that adequate oral health and professional toothbrushing education program should be implemented to improve oral health.

A comparative analysis of micro-organism colonization of tooth-brushes in a public bath based on the storage technique / 대한구강보건학회지

OBJECTIVES: Bacterial colonization on toothbrushes can cause stomatitis and other oral diseases such as dental caries and periodontitis. In this study we tested 18 toothbrushes, of which six were left exposedto the air, six were stored in a plastic bag, and six in a toothbrush case. METHODS: ATP (RLU: relatively light unit) values measured by ATP Luminometer were compared with APC (CFU: colony forming unit) by swabbing culture method using 3M™ petrifilm™ aerobic count plates. RESULTS: Swabs from toothbrushes left exposed in the air developed an average of 651.67±261.94 CFU, while the “In plastic bag” and the “In toothbrush case” specimens developed 593.17±354.33 and 120.83±68.87 CFU, respectively. CONCLUSION: The best option is to rinse the toothbrush well with water and to keep them dry in a well-ventilated area in order to reduce the growth of bacteria in a public bath.

A study on oral health knowledge and the need for oral health education among industrial workers / 대한구강보건학회지

OBJECTIVES: This study aimed to investigate the correlation between oral health behaviors of workers by examining the oral health awareness and the need for oral health education. METHODS: After the institutional review board approval, we surveyed industrial workers in Seoul, Gwangju, Changwon, and Goksung, in Korea, from July 19 to August 29, 2016. The final questionnaires (287 in total) were assessed using the SPSS 24.0 software for Windows (SPSS Inc. Chicago, IL, USA). The data were analyzed using frequency analysis, average, standard deviation, t-test, and the Pearson's correlation coefficient. RESULTS: Through the response of “yes” for the question, “oral health education experience,” we can see the respondents have high level of interest (P<0.001). And through the response of “yes” for the question, “Periodic oral Examination” and “regular scaling” and “oral care product use” we can see the respondents have high level of interest (P<0.001) and high importance (P<0.001), there was a statistically significant difference. On analyzing the correlations between workers, there was positive correlation oral health ‘Interest’ and ‘Importance’ (r=0.598, P<0.001). Of the 287 participants, 80.1% indicated that they did not receive any previous oral health education, while 85.4% indicated a willingness to attend oral health education programs in the future. Of the 80.1% of participants with no prior oral health education, 60.0% indicated lack of oral health education because of few opportunities to participate in such programs. They most prefer “Oral Hygiene Management” 64.8% for education contents and choose “Direct-education by inviting Expert” as the best education method 75.6%. CONCLUSIONS: It is necessary to develop oral health education programs suitable for the industrial field characteristics for people in workplace, and to enhance and expand oral health education services in the workplace in order to maintain interest in oral health.

An assessment of smoking cessation counseling among dental hygienists / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to assess recognition of smoking cessation education among dental hygienists and knowledge, attitudes, and practices related to smoking cessation counseling as well as to obtain basic data on smoking cessation counseling for effective oral care in dental offices. METHODS: After approval was obtained from the institutional review board, this study was carried out dental hygienists working in dental hospitals and clinics in Busan City, Gyeongnam and Gyeongbuk province, Korea. The final analysis captured information from 300 participants. Data were analyzed with SPSS 21.0. RESULTS: Of the 300 participants, 94.0% agreed that smoking cessation education is necessary, 17.5% reported smoking cessation education experience, and 65.7% reported intention to participate in smoking cessation education in the future. Dental hygienists' smoking cessation counseling activities showed a significant correlation between attitudes and practices (P<0.001). CONCLUSIONS: Counseling for smoking cessation provided by dental hygienists was positively correlated with the presence of smoking cessation knowledge and with the intention of participating in smoking cessation education. For dental hygienists to effectively counsel patients regarding smoking cessation, it is essential to integrate smoking cessation education into the dental school curriculum and to offer continuing education post-graduation.

Characteristics of Advanced Gastric Cancer Undetected on Gastroscopy / 대한소화기학회지

BACKGROUND/AIMS: Stomach cancer can be easily diagnosed via endoscopy, but also possible to be missed. The aim of this study was to investigate the clinical and endoscopic characteristics of advanced gastric cancers that were not diagnosed based on endoscopic examination. METHODS: We evaluated patients who had newly diagnosed advanced gastric cancer that was undetected via endoscopy within the last six months. RESULTS: Sixteen patients were included in this study. The locations of the cancers were the cardia in six cases, the greater curvature side of the body in eight cases and the antrum in two cases. The histological findings were tubular type adenocarcinoma in 11 cases, with ten cases of moderately to poorly differentiated adenocarcinoma and five cases of signet ring cell type adenocarcinoma. CONCLUSIONS: Even advanced gastric cancer lesions may not be detected during endoscopy. If a patient continues to complain of upper gastrointestinal symptoms, even though endoscopy does not find abnormal findings, repeated endoscopy and/or additional diagnostic studies should be considered.

Clinical impact of nonalcoholic fatty liver disease on other medical diseases / 대한내과학회지

Non alcoholic fatty liver disease (NAFLD) has been recognized as a hepatic manifestation of systemic metabolic disease associated with insulin resistance. Recent studies have reported that NAFLD is related with various systemic complications such as cardiovascular, renal, metabolic disease independent of obesity, other component of metabolic syndrome (MetS). Thus, NAFLD should be newly regarded as an early mediator of systemic metabolic disease as well as liver specific disease. The mechanisms of adverse effect of NAFLD on other medical diseases are not fully understood, so further study is needed for understanding and future management strategies of NAFLD.

Levofloxacin-Azithromycin Combined Triple Therapy for Helicobacter pylori Eradication / 대한소화기학회지

BACKGROUND/AIMS: Antibiotic resistance and poor compliance are the main causes of Helicobacter pylori (H. pylori) eradication failure. This study evaluated the eradication rate, tolerability, and compliance of levofloxacin- azithromycin combined triple therapy for H. pylori eradication. METHODS: 1) First-line eradication: A total of 78 H. pylori-positive patients were enrolled. Seventeen military men in Armed Forces Capital Hospital were treated with 7 days of levofloxacin-azithromycin combined triple therapy (omeprazole 20 mg bid, levofloxacin 500 mg od, and azithromycin 500 mg od), and 61 patients in Kangbuk Samsung Hospital were treated with standard PPI-based triple therapy (omeprazole 20 mg bid, amoxicillin 1.0 g bid, and clarithromycin 500 mg bid) for 7 days. 2) Second-line eradication: A consecutive series of 59 patients who failed H. pylori eradication with standard PPI-based triple therapy in Kangbuk Samsung Hospital were randomized to two groups. Thirty patients were retreated with 7 days of bismuth-based quadruple therapy (omeprazole 20 mg bid, bismuth 120 mg qid, metronidazole 500 mg tid, and tetracycline 500 mg qid), and remaining 29 patients were retreated with levofloxacin-azithromycin combined triple therapy. Patient's compliance and tolerability were evaluated at the end of treatment. The status of H. pylori infection was assessed 8 weeks later then. The successful eradication of H. pylori was defined as negative results from histology and CLO test, or 13C-urea breath test. RESULTS: First-line eradication rate of levofloxacin-azithromycin triple therapy was lower than that of standard PPI-based triple therapy, but there was no statistically significant difference (70.6% vs. 80.3%, p=0.390). Second-line eradication rate of levofloxacin-azithromycin combined triple therapy was significantly lower than that of bismuth-based quadruple therapy (ITT/PP 65.5%/73.1% vs. 90%/90%, p<0.0001). The compliances of all patients were more than 85%. Two of patients with levofloxacin-azithromycin combined triple therapy complained self-limiting side effects (mild dizziness; mild insomnia with general weakness). CONCLUSIONS: Levofloxacin-azithromycin combined triple therapy should not be recommended as the first-line or second-line H. pylori eradication regimen in Korea.

Upper Gastrointestinal Bleeding Due to Gastric Ectopic Pancreas in a Young Aged Person / 대한소화기내시경학회지

An ectopic pancreas is the presence of pancreatic tissue outside of its usual location. This condition rarely causes clinical symptoms, and the most commonly reported sites of these lesions are the stomach, the duodenum and jejunum. The presence of this ectopic tissue is not a rare condition, but its unusual locations, clinical symptoms, and complications are of clinical interest. We report a case of a gastric ectopic pancreas with recurrent upper gastrointestinal bleeding in a 20-year-old man.

Budd-Chiari syndrome associated with diaphragmatic hernia: A case report / 대한내과학회지

Budd-Chiari syndrome (BCS) is a rare disease caused by the obstruction of the hepatic venous outflow or the inferior vena cava above the hepatic vein. It has been attributed to various etiologic factors. Including intrinsic vascular thrombosis, hepatic tumor invasion/compression, or associated with an idiopathic obstructing membrane. However, in most cases no definitive etiologic factors have been identified. Recently, we experienced a case of 21-year-old man who had Budd-Chiari syndrome associated with diaphragmatic hernia. Venous flow returned to normal on reintroduction of the liver into the abdominal cavity and closure of the defect in the diaphragm. To our knowledge, this is the rare report in our country. Here, we report this case with review of literatures.

Clinical Significance of Serum and Urinary Neopterin Levels in Some Renal Diseases / 대한신장학회잡지

BACKGROUND: Neopterin is a pyrazino-pyrimidine compound, produced by human monocytes or macrophages primarily upon stimulation with gamma interferon. Neopterin is a marker associated with cell- mediated immunity. The levels of neopterin in body fluids are elevated in allograft rejection, infections, autoimmune diseases, malignancies, cardiac and renal diseases. We hypothesized that the levels of serum and urine neopterin maybe elevated in some renal disease including nephrotic syndrome (NS), chronic renal failure (CRF) and end stage renal disease (ESRD). METHODS: We examnined the serum and urinary neopterin levels in 19 patients with NS underwent renal biopsy, 8 patients with CRF, 64 patients with ESRD undergoing maintenance hemodialysis. Twenty-two healthy controls were enrolled to define the normal range of neopterin levels. Serum and urinary neopterin were measured by radiommunoassay method. We also correlated the levels of serum and urinary neopterin with many clinical parameters such as WBC, hemoglobin, hematocrit, BUN, creatinine, total protein, albumin, triglyceride, iron, total iron binding capacity. RESULTS: The serum neopterin levels elevated in patients with NS (14.1+/-30.9 ng/mL), CRF (28.2+/-19.4 ng/mL) and ESRD (68.6+/-25.5 ng/mL) than control (1.6+/-0.3 ng/mL). Particularly the patients with CRF and ESRD showed statistically significant elevation (p<0.05, p<0.01). The urine neopterin levels elevated in patients with NS (203.2+/-349.6 microgramol/mol creatinine), CRF (319.2+/-107.7 microgramol/mol creatinine) and ESRD (407.9+/-256.9 microgramol/mol creatinine) than control (108.9+/-57.9 microgramol/mol creatinine). Particularly the patients with CRF and ESRD showed statistically significant elevation (p<0.05, p<0.05). The serum neopterin showed significantly positive correlation with serum creatinine levels, inverse correlation with total iron binding capacity and serum triglyceride levels among clinical parameters in all groups (respectively p<0.01). The urine neopterin showed significant inverse correlation with hemoglobin (p< 0.05). CONCIUSION: The serum and urinary neopterin levels elevated in patients with some renal diseases. And also neopterin levels showed clinical correlations with some renal parameters in these patients. We suggest that serum and urinary neopterin levels may be useful marker to predict disease acitivity and prognosis in some renal diseases. They should be confirmed by a prospective study during a long-lasting and in a higher number of patients.

Significance of Endoscopy in the Investigation of Iron Deficiency Anemia / 대한소화기내시경학회지

BACKGROUND/AIMS: There is no consensus for the role of endoscopy in the etiologic investigation of iron deficiency anemia (IDA) in Korea. We carried out a retrospective study to evaluate the role of esophagogastroduodenoscopy (EGD) and colonoscopy for their etiologic diagnosis in IDA. METHODS: Between January 1998 and September 2003, 129 patients (male:female=19:110, mean age=43.6) had been grew EGD and colonoscopy for exam for the investigation of IDA at Kangbuk Samsung Hospital and Samsung Medical Center Medical records were retrospectively reviewed: RESULTS: Significant findings were found in 8.5% (11 cases: grade B reflux esophagitis by L.A. classification (1), angiodysplasia (1), severe erosive gastritis (2), and gastric ulcer (2) and duodenal ulcer (5), while 70% (89 cases) showed some abnormality in EGD examination. Significant findings were seen in 11% (14 cases: polyps >1 cm (2), angiodysplasia (1), bleeding hemorrhoids (5), inflammatory bowel disease (4) and colon cancer (2)), among 36% (46 cases) of patients with some abnormality in colonoscopy. CONCLUSIONS: Gastrointestinal lesions were frequently found in patients with IDA and significant proportion of them could be the source of blood loss. Therefore, EGD and colonoscopy should be included in the evaluation of IDA in Korea.

Effects of bovine colostrum in diclofenac induced gut injured rat model / 대한내과학회지

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed medicine but induce damage throughout the entire gastrointestinal tract including small intestine with protein and blood loss. Impaired epithelial barrier function, overgrowth of luminal bacteria and others have been implicated in the pathogenesis of NSAID induced enteropathy. Colostrum is a first milk produced after birth and is particularly rich in growth factors, immunoglobulins and antimicrobial peptides. The present study aimed to exam whether defatted bovine colostrum reduce small intestinal injury caused by diclofenac in the animals. METHODS: 64 rats were utilized in four groups; control group, diclofenac group, diclofenac with 5% colostrum group and diclofenac with 10% colostrum group. The animals with colostrum were fed with 5% or 10% colostral solution for 5 days before diclofenac administration. Small intestinal injury was induced by administering a single dose of diclofenac (50 mg/kg subcutaneously). Epithelial permeability, enteric aerobic bacterial counts, serum albumin and protein levels, and pathologic findings of distal ileum were measured. RESULTS: Diclofenac caused marked increase in intestinal permeability, enteric bacterial numbers and intestinal villous damage, and declines in serum levels of total protein and albumin. Co-administration of bovine colostrum reduced intestinal permeability and enteric bacterial numbers, declines in serum albumin and protein levels, and mucosal damage of small intestine induced by diclofenac. CONCLUSION: Bovine colostrums may have beneficial effects on preventing NSAID induced small intestinal injury and bacterial translocation.

Fibrinolytic Activities and Their Relations to Esophageal Variceal Bleeding in Patients with Liver Cirrhosis / 대한소화기학회지

BACKGROUND/AIMS: Esophageal variceal bleeding in liver cirrhosis is a major complication and has high mortality rate. We tried to find fibrinolytic parameters, which correlated with variceal bleeding in cirrhotic patients. METHODS: We divided the cirrhotic patients into two groups: bleeding group (group A, n=15) and non-bleeding group (Group B, n=17). Fibrinolytic parameters (fibrinogen, D-dimer, plasminogen, tissue plasminogen activator [t-PA], fibrin degradation product [FDP], and plasminogen activator inhibitor type-1 [PAI-1]) were compared between two groups. In the group A, serial samplings were taken at the initial period, 3 days, 8 days, 15 days and 6 weeks after the bleeding onset. RESULTS: Plasma levels of FDP and D-dimer in the group A were significantly higher than the group B (1.7 +/- 1.16 vs. 0.95 +/- 1.27 mg/L and 10.96 +/- 6.58 vs. 4.99 +/- 3.50 micro gram/mL, respectively, p value<0.05). The clinical, biochemical, and coagulation parameters didn't show significant differences in both groups. The fibrinolytic parameters were improved along with the hemodynamic stabilization in group A. CONCLUSIONS: Cirrhotic patients with increased fibrinolytic activity were at higher risk of bleeding. Thus, the measurement of these parameters would be useful to identify patients at higher risk of esophageal variceal bleeding.