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.

A Study on the Policy Decision Making Process of Seoul-Type Paid Sick Leave:Applying Kingdon’s Multiple Streams Model / 보건행정학회지

In 2019, the Seoul metropolitan government established its own ‘Seoul-type paid sick leave project’. Although the central government had to introduce such a system, which is also called sickness benefits, it was not implemented. In order to understand the process by which the Seoul government has implemented such a policy, this study used Kingdon’s multiple streams framework. As a result, in the problem stream, it was found that the economic burden of sickness has been considered only in terms of medical expenses in the past of Korea. Then Songpa’s three women and Middle East respiratory syndrome incidents raised awareness of the necessity of the sickness benefit system in 2014 and 2015. In the political stream, several social affairs such as national health insurance huge surpluses and the 2017 presidential election opened policy window. At that time, Seoul Mayor actively promoted sickness benefits as a policy entrepreneur. In the policy stream, the sickness benefit system has gained new attention through political events. To summary, these three streams flowed separately and then they assembled around huge political affairs. As a result, it was confirmed that Kingdon’s model is the most effective theory than any other models in analyzing the health care policy decision process in Korea.

Designing the Sickness Benefit Scheme in South Korea: Using the Implication from Schemes of Advanced Nations / 보건행정학회지

Currently, the South Korean Government does not provide sickness benefits from the National Health Insurance, which is different from most other Organization for Economic Cooperation and Development countries. The sickness benefit guarantees a part of lost income due to injuries or diseases. The purpose of this study is to propose a sickness benefit scheme for South Korea. To this end, we compare health care systems, sickness benefit schemes, and delivery systems of those in Germany, Japan, and Sweden, focusing on the seven categories: management authority, object, level of payment, duration of payment, qualification requirements, connection with paid sick leave of workplace, and financial resources, and as to delivery system, the six categories: the number of procedures, transferring document between institutions, whether or not utilizing electronic reporting system, applicant, and administrative convenience. Based on the implications derived from the case study, we propose the sickness benefit scheme and its delivery pathway and other details for South Korea. This study is first to propose the sickness benefit for health insurance in Korea with its level of details. More studies should follow with case studies of other countries, as well as productive debates to build a feasible and sustainable sickness benefit system in South Korea.

Laparoscopic Treatment for Psoas Abscess / 대한정형외과학회잡지

Psoas abscess is a rare and high mortality disease if there is no appropriate treatment. The surgical approach of psoas abscess is very difficult because psoas muscle is anatomically located within retroperitoneum. Recently, computed tomography guided percutaneous catheter drainage with proper antibiotic therapy has shown good results. If this therapy fails to resolve the psoas abscess, surgical treatment may be necessary. We experienced two cases of psoas abscess resolved by surgical drainage using laparoscopy. We report two successful results with relevant literatures.

Early Comminuted Fracture of an Alumina Liner in a Ceramic on Ceramic Total Hip Arthroplasty / 대한정형외과학회잡지

The authors experienced a case of early fracture of an alumina ceramic liner after ceramic-on-ceramic total hip arthroplasty, without any history of trauma. A 47-year-old male visited our center, due to a sudden crunching sound from the right hip at three weeks, after a ceramic-on-ceramic total hip arthroplasty for the osteonecrosis of right femoral head. Plain radiographs revealed multiple radio-opaque fragments around the displaced neck of the femoral stem. There were severely comminuted fracture of the ceramic liner with slight black staining of the surrounding tissue, and even damaged the surface of the ceramic head, on the operative field. The fractured liner and a damaged head were replaced with a new ceramic liner and head, after the removal of the fractured ceramic fragments, as completely as possible. Careful follow up with a caution for early ceramic liner fracture should be required in ceramic-on-ceramic total hip arthroplasty.

Modified Scarf Osteotomy for Hallux Valgus with Lesser Metatarsalgia / 대한족부족관절학회지

PURPOSE: The purpose of this study was to evaluate the radiological and clinical results of modified scarf osteotomy for hallux valgus with lesser metatarsalgia. MATERIALS AND METHODS: Total 19 patients (24 feet) were reviewed by medical records and radiographs. All patients were female and the mean age at the time of operation was 46.4 years. The mean follow-up time was 14.8 months. We modified original scarf osteotomy by adding the procedure of closing wedge osteotomy at the medial side of distal fragment for achieving of the supination of the first metatarsal head. Additionally, Akin osteotomy of the first proximal phalanx was done in 16 patients (20 feet) and no lesser metatarsal operation was done. First-second intermetatarsal, hallux valgus and distal metatarsal articular angles were analyzed radiologically before and after the operation. And 3-dimensional CT was used to evaluate the supination of the first metatarsal head. Clinical results were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) score and persistence of lesser metatarsalgia. RESULTS: First-second intermetatarsal and hallux valgus angles were reduced from the mean pre-operative values of 14.2degrees and 32.5degrees to 8degrees and 12.5degrees, respectively, 12 months after the operation. And the supination of the first metatarsal head was confirmed by 3-dimensional CT. The mean AOFAS score improved from 41.4 points pre-operatively to 87.2 points at follow-up. Lesser metatarsalgia still remained in 2 patients (2 feet). CONCLUSION: Modified scarf osteotomy would be an effective surgical procedure, especially, for achieving downward displacement and supination of the first metatarsal head in hallux valgus with lesser metatarsalgia.

The Thickness of Normal and Repaired Rotator-cuff Measured in MRI

Purpose: To compare the thickness of the repaired full-thickness rotator-cuff tear to that of normal rotator-cuff in young and old persons and evaluate the relationship between the tear size and the repaired thickness in the full-thickness tear using MRI. Materials and Methods: The thickness of the rotator-cuff of the repaired full thickness tear(age: 45~77, mean 63.3 years, 19 patients: group 1) were compared with those of old intact patients (age: 46~69, mean 57.9 years, 23 patients: group 2) and young intact patients (age: 18~30, mean 23.3 years, 22 patients: group 3). The tear length and width was measured in oblique coronal and oblique sagittal view of MRA, respectively, and the thickness was measured in coronal oblique view 15mm anterior to the posterolateral margin of the glenoid. Correlation between the preoperative tear size (the bigger one between the length and the width) and the postoperative thickness in group 1 was also evaluated statistically. Results: The postoperative rotator-cuff thickness in group 1 was 3.0 mm in average, which was inversely proportional to the preoperative tear size (P<0.001). The rotator-cuff thickness was 3.9mm in group 2 and 5.0mm in group 3, and there was statistically significant difference among the three groups(P<0.05). Conclusion: The rotator-cuff thickness decreases with age and the postoperative thickness in the full-thickness tear was inversely proportional to the tear size, smaller than that of the intact rotator-cuff.

A case of Uterine Arteriovenous Malformation / 대한산부인과학회잡지

Arteriovenous malformation of uterus is a rare disease in gynecology, and it's etiology, diagnosis, classification is not definitely established. We have experienced a patient, 22-year-old woman with a uterine arteriovenous malformation presenting with vaginal bleeding, no other symptom. Diagnosis was established by pelvic ultrasonography and angiography, and the treatment was done by embolization of arteriovenous malformation of uterus. We report a case of uterine arteriovenous malformation with a brief review of the literatures.

Stress Fracture in Posterior Aspect of the Tibia

PURPOSE: To determine correlation between stress fracture of the posterior tibia and flexor digitorum longusmuscle injury caused by athletic or sporting activity during adolescence. MATERIALS AND METHODS: Eleven casesdiagnosed as stress fracture after X-ray and MR imaging of the lower leg were reviewed. With regard to eachfracture, the following features were noted: age, sex, and athletic or sporting activity of the patient, and site.Using MR imaging techniques, axial and sagittal T1 and T2 weighted images were obtained in all cases and T1-GdDTPA images in seven. RESULTS: The activities undertaken were running (n=3), football (n=2), ballet (n=2),taekwando (n=1), badminton (n=1), field hockey (n=1), and basketball (n=1). MR images revealed localized corticalthickness (n=11), linear intramedullary callus showing a low signal on T1 and T2 weighted images (n=9), marrowhyperemia (n=7), and flexor digitorum longus muscle injury showing a high signal on T1-Gd DTPA and T2 weightedimage (n=7). CONCLUSION: Stress fracture of the posterior tibia might be induced by flexor digitorum longusmuscle activity induced by athletic or sporting activities during adoleseence.

Usefulness of CISS Technique in the MR Imaging Diagnosis of Intraocular Lesions

PURPOSE: To assess the usefulness of CISS images in the diagnosis of intraocular lesions, we compared CISSimages with 3mm and 1mm sliced spin-echo T2-weighted images. MATERIALS AND METHODS: In 14 patients with 15intraocular lesions(retinal detachment 10, choroidal melanoma, 2 ; cavernous hemangioma, 1 ; PHPV, 1 ; andretinoblastoma, 1). we used a 1.5T MR unit obtain CISS images and 3mm and 1mm sliced spin-echo T2-weighted images.All lesions were analyzed, and after dividing them into two subgroups(linear lesions, n=11 ; mass lesions, n=4),CISS and spin-echo T2-weighted images were compared for detection rate and conspicuity. RESULTS: With regard tothese two parameters, CISS images were superior to 1mm and 3mm sliced spin-echo T2-weighted images. For theassessment of linear lesions, CISS images (detection rate, 100% ; conspicuity, 2.88) were superior to both 1mm and3mm sliced spin-echo T2-weighted images. For mass lesions CISS images were superior to 3mm sliced spin-echoT2-weighted images, but for conspicuity, there was no significant difference between CISS images (2.75) and 1mmsliced spin-echo T2-weighted images(2.2). CONCLUSION: Due to their higher detection rate and greater conspicuity,CISS images were superior to spin-echo T2-weighted images for the diagnosis of intraocular lesions less than 3mmin diameter ; for the diagnosis of intraocular lesions, they might therefore be a useful adjunct to SE images.

Role of EPI in Diagnosing Cavernous Hemangioma & Small HCC: Comparision with Fast T2-Weighted MR Imaging

PURPOSE: To compare single-shot echo-planar MR imaging(EPI) with breath-hold fast T2-weighted imaging(HASTEor Turbo spin-echo T2WI) for evaluation of the role of EPI in distinguishing small hepatocellular carcinoma fromcavernous hemangioma. MATERIALS AND METHODS: We retrospectively evaluated MR images of 35 patients (21 cases ofsmall HCC and 14 cases of cavernous hemangioma). EPI and breath-hold fast T2WI images were obtained and comparedon the basis of lesion detection sensitivity, lesion-to-liver signal intensity ratio(SIR), contrast ratio(CT), andlesion-to-liver contrast to noise ratio(CNR). RESULTS: For the detection of small HCC, the sensitivity of EPI andbreath-hold fast T2WI were equal in 14 of 21 cases(71.4%). The detection sensitivity of cavernous hemangioma withEPI and breath-hold fast T2WI was 100%(14/14). Mean SIR on breath-hold fast T2WI was 2.02+/-0.45 for small HCC and3.65+/-0.97 for cavernous hemangioma; on EPI, the corresponding figures wer 2.91+/-0.57 and 6.98+/-1.37. Mean CR onbreath-hold fast T2WI was 1.16+/-0.58 for small HCC and 2.65+/-0.57 for cavernous hemangioma; On EPI, the figuresobtained were 2.27+/-0.52 and 6.26+/-2.19, respectively. Mean CNR on breath-hold fast T2WI was 14.24+/- 4.098 forsmall HCC and 50.28+/-10.96 for cavernous hemangioma, while on EPI, the corresponding figures were 13.84+/-3.02 and45.44+/-11.21. CONCLUSION: In detecting focal hepatic mass, the sensitivity of EPI and breath-hold fast T2WI arecomparable; for the diagnosis of small HCC and cavernous hemangioma, EPI can provide additional information.