Impact of Regional Emergency Medical Access on Patients’ Prognosis and Emergency Medical Expenditure / 보건행정학회지

Background@#The purpose of this study was to examine the impact of the regional characteristics on the accessibility of emergency care and the impact of emergency medical accessibility on the patients’ prognosis and the emergency medical expenditure. @*Methods@#This study used the 13th beta version 1.6 annual data of Korea Health Panel and the statistics from the Korean Statistical Information Service. The sample included 8,119 patients who visited the emergency centers between year 2013 and 2017. The arrival time, which indicated medical access, was used as dependent variable for multi-level analysis. For ordinal logistic regression and multiple regression, the arrival time was used as independent variable while patients’ prognosis and emergency medical expenditure were used as dependent variables. @*Results@#The results for the multi-level analysis in both the individual and regional variables showed that as the number of emergency medical institutions per 100 km2 area increased, the time required to reach emergency centers significantly decreased. Ordinal logistic regression and multiple regression results showed that as the arrival time increased, the patients’ prognosis significantly worsened and the emergency medical expenses significantly increased. @*Conclusion@#In conclusion, the access to emergency care was affected by regional characteristics and affected patient outcomes and emergency medical expenditure.

The Current State of Maternity Care and Suggestions for Improvement in the Management of High-risk Pregnancies in South Korea

Since the year 2000, low birth rates have resulted in significant decreases to maternity care services throughout many Korean hospitals. However, there has been a concomitant increase in the number of high-risk pregnancies, due to growing trends in delayed marriages and subsequent pregnancies. Increased maternal age is a risk factor associated with complicated pregnancies and high-risk deliveries, both of which are strongly related to maternal death. With this in mind, the Ministry of Health and Welfare has supported the establishment of a regional perinatal center for high-risk pregnancies, estimated to be be fully completed by the year 2020. Despite this, maternity care services for high-risk pregnancies remain insufficient. According to previous reports, the total number of maternity care hospitals and beds available for high-risk pregnant women were 60 and 399, respectively. This is in stark contrast to previous bed estimates of 1,640. The establishment of a maternity care system for high-risk pregnant women is integral to ensuring optimal conditions for both pregnancy and childbirth. This review briefly evaluates the existing maternity care system for high-risk pregnancies, and proposes several new suggestions for improvements.

Churg-Strauss Syndrome as an Unusual Cause of Dysphagia: Case Report

Systemic vasculitis is a rare disease, and the diagnosis is very difficult when patient shows atypical symptoms. We experienced an unusual case of dysphagia caused by Churg-Strauss syndrome with lower cranial nerve involvement. A 74-year-old man, with a past history of sinusitis, asthma, and hearing deficiency, was admitted to our department for evaluation of dysphagia. He also complained of recurrent bleeding of nasal cavities and esophagus. Brain magnetic resonance imaging did not show definite abnormality, and electrophysiologic findings were suggestive of mononeuritis multiplex. Dysphagia had not improved after conventional therapy. Biopsy of the nasal cavity showed extravascular eosinophilic infiltration. All these findings suggested a rare form of Churg-Strauss syndrome involving multiple lower cranial nerves. Dysphagia improved after steroid therapy.