Clinical Features of COVID-19 in Uzbekistan

Background@#As of April 30, 2020, a total of 2,039 cases of the novel coronavirus disease 2019 (COVID-19) were confirmed in the Republic of Uzbekistan after the first detection on March 15. Reports on symptoms of COVID-19 are non-specific and known to vary from asymptomatic, mild to severe, or fatal. This study aimed to analyze the symptomatic and clinical characteristics of study participants based on the medical records of participants hospitalized with COVID-19 in Uzbekistan. @*Methods@#We collected all data from medical records of COVID-19 confirmed patients in 19 hospitals from 13 regions of Uzbekistan between March 15 and April 30. We selected 1,030 patients discharged from the hospitals after COVID-19 treatment as study participants, excluding those with missing data. Further, we collected demographics, symptoms, clinical outcomes, and treatment data through medical records. @*Results@#More than half (57.6%) of confirmed cases of COVID-19 were males, and the median age was 36.0 years. The most frequent symptoms at the first inspection on hospital admission of all patients were fatigue (59.7%), dry cough (54.1%), pharyngalgia (31.6%), headache (20.6%), and anorexia (12.5%). Compared to the oldest group, the youngest group showed a lower frequency of symptoms. About half of the group aged 18–49 years reported that they came from abroad. One-fifth of patients in group 50–84 received oxygen support, while no patients in group aged 0–17 years received oxygen support. About two-thirds of the participants from intensive care unit (ICU) came from abroad, whereas 42.1% of the non-ICU group returned from other countries. Regarding symptoms, 16.9% of the patients in the ICU group were asymptomatic, while 5.8% in the non-ICU group were asymptomatic. @*Conclusion@#This study suggests that the medical delivery system and resource distribution need to be implemented based on clinical characteristics by age and severity to delay and effectively respond to the spread of infections in the future. This study analyzed symptoms of COVID-19 patients across Uzbekistan, which is useful as primary data for policies on COVID-19 in Uzbekistan.

What are the Barriers to Antenatal Care Utilization in Rufisque District, Senegal?: a Bottleneck Analysis

BACKGROUND: This study aimed to analyze the barriers affecting the utilization of antenatal care (ANC) among Senegalese mothers. METHODS: Health facility staffs were surveyed to examine the availability coverage of ANC (infrastructural capacity of health posts to handle maternal and newborn healthcare). A total of 113 women of childbearing age were surveyed to identify factors associated with the accessibility coverage (physical, economic, and information accessibility factors), acceptability coverage (socio-cultural features, social acceptance, and language), and effectiveness coverage (ratio of mothers having completed 4 visits) of ANC. Further, to identify the socio-cultural factors and the specific characteristics of the barriers, 5 focus group discussions were conducted with women of childbearing age, their husbands and mothers-in-law, community health workers, and health facility staff. The effectiveness coverage of ANC was analyzed by reviewing materials from the District Health Information System 2 of Senegal. RESULTS: Key barriers of ANC utilization were associated with acceptability coverage. ANC during early pregnancy was avoided owing to the negative social stigma surrounding miscarriage. The survey results indicated an extremely high miscarriage rate of 30.9% among the participants. The social stigma towards unmarried mothers caused them to hide their pregnancy, which deterred ANC utilization. The husband was the final decision maker and social supporter on ANC utilization. CONCLUSION: To promote the utilization of ANC services among pregnant women in Senegal, it is important to alleviate the social stigma towards miscarriages and unmarried mothers, and to provide greater social support for pregnancies and newborn deliveries within family.

A follow-up study of the association between mobile phone use and symptoms of ill health

Objectives: The duration and frequency of mobile phone calls, and their relationship with various health effects, have been investigated in our previous cross-sectional study. This 2-year period follow-up study aimed to assess the changes in these variables of same subjects. Methods: The study population comprised 532 non-patient adult subjects sampled from the Korean Genome Epidemiology Study. The subjects underwent a medical examination at a hospital in 2012/2013 and revisited the same hospital in 2014/2015 to have the same examination for the characteristics of mobile phone use performed. In addition, to evaluate the effects on health, the Headache Impact Test-6 (HIT-6), Psychosocial Well-being Index-Short Form, Beck Depression Inventory, Korean-Instrumental Activities of Daily Living, Perceived Stress Scale, Pittsburgh Sleep Quality Index, and 12-item Short Form Health Survey were analyzed. For all these tests, the higher the score, the greater the effect on health. Variances between scores in all the indices in the baseline and follow-up surveys were calculated, and correlations of each index were analyzed. Results: The average duration per call and HIT-6 score of the subjects decreased significantly compared with those recorded two years ago. The results showed a slight but significant correlation between call duration changes and HIT-6 score changes for female subjects, but not for males. HIT-6 scores in the follow-up survey significantly decreased compared to those in the baseline survey, but long-time call users (subjects whose call duration was ≥5 minutes in both the baseline and follow-up surveys) had no statistically significant reduction in HIT-6 scores. Conclusions: This study suggests that increased call duration is a greater risk factor for increases in headache than any other type of adverse health effect, and that this effect can be chronic.

A follow-up study of the association between mobile phone use and symptoms of ill health

Objectives: The duration and frequency of mobile phone calls, and their relationship with various health effects, have been investigated in our previous cross-sectional study. This 2-year period follow-up study aimed to assess the changes in these variables of same subjects.Methods: The study population comprised 532 non-patient adult subjects sampled from the Korean Genome Epidemiology Study. The subjects underwent a medical examination at a hospital in 2012/2013 and revisited the same hospital in 2014/2015 to have the same examination for the characteristics of mobile phone use performed. In addition, to evaluate the effects on health, the Headache Impact Test-6 (HIT-6), Psychosocial Well-being Index-Short Form, Beck Depression Inventory, Korean-Instrumental Activities of Daily Living, Perceived Stress Scale, Pittsburgh Sleep Quality Index, and 12-item Short Form Health Survey were analyzed. For all these tests, the higher the score, the greater the effect on health. Variances between scores in all the indices in the baseline and follow-up surveys were calculated, and correlations of each index were analyzed.Results: The average duration per call and HIT-6 score of the subjects decreased significantly compared with those recorded two years ago. The results showed a slight but significant correlation between call duration changes and HIT-6 score changes for female subjects, but not for males. HIT-6 scores in the follow-up survey significantly decreased compared to those in the baseline survey, but long-time call users (subjects whose call duration was ≥5 minutes in both the baseline and follow-up surveys) had no statistically significant reduction in HIT-6 scores.Conclusions: This study suggests that increased call duration is a greater risk factor for increases in headache than any other type of adverse health effect, and that this effect can be chronic.

Challenges for health care sector goals of United Nations Sustainable Development Goals in Korea

No abstract available.

Facts and cautions regarding international medical ventures

The "Act on Overseas Medical Expansion and Foreign Patient Attraction Support"(legislation no. 13599), due to be enacted by the National Assembly during the general meeting on June 23, 2016, will give institutionalized support and fully recognize the efforts for medical tourism-that is, the overseas expansion of medicine and ingress of foreign patients. However, before jumping into medical tourism, the failures of previous ventures in this field must be analyzed. The absence of specific goals and strategies, insufficient planning and analysis of feasibility, the lack of international experience, and glocalization and marketing failures of previous projects are all areas in which improvement is advised. Further, overseas medical expansion is only possible when various considerations are examined, such as the influence on the domestic medical market, as well as plans for securing the management capacity to ensure economic feasibility and risk management of medical institutions.

Quasi-Experiment Study on Effectiveness Evaluation of Health Communication Strategies

This experimental study examined differences in doctor-patient relationships according to the health communication strategies during cases of medical malpractices occurred at primary medical institution. A total of 116 subjects aged in their 20s-50s was sampled. The first medical malpractice scenario chosen was the medical malpractice case most frequently registered at the Korean Medical Association Mutual Aid and the second scenario was associated with materials and devices as the cause of malpractice. Four types of crisis communication strategy messages were utilized, consisting of denial, denial + ingratiation, apology, and apology + ingratiation. Subjects were classified into four research groups by crisis communication strategy to measure levels of trust, control mutuality, commitment, and satisfaction, before and after the occurrence of medical malpractice and application of communication strategies. The findings of this study revealed that the apology strategy, compared with the denial strategy, showed a smaller difference before and after the application of communication strategies in all variables of trust (F = 8.080, F = 5.768), control mutuality (F = 8.824, F = 9.081), commitment (F = 9.815, F = 8.301), and satisfaction (F = 8.723, F = 5.638). Further, a significant interaction effect was shown between variables. The apology strategy, compared with the denial strategy, was effective in the improvement of doctor-patient relationships in both Scenarios I and II. For Scenario I, the apology strategy without ingratiation boosted commitment and satisfaction, but for Scenario II, utilizing the apology strategy with ingratiation boosted the effectiveness of trust and commitment.

Empowerment of Korean Medical Association with KMA Policy system developing

Recently, the Korean Medical Association (KMA) launched the KMA Policy system based upon the American Medical Association (AMA) Policy system. The KMA's official positions on health issues and medical ethics, as well as its constitution, bylaws, and directives, will be included in the KMA Policy system. The AMA's organizational structure and decision making process provided essential information for developing the KMA Policy system. Through the KMA Policy system, hereafter, the KMA should introduce a procedure not only to decide upon positions on various health issues but also a means to open them to the public. In addition, the KMA can expect the continuity and transparency of work, enhanced benefits to members, public credibility, and growth of its social reputation by means of KMA Policy. Furthermore, the system would be beneficial for both KMA members and the public, as they can easily access KMA Policy, and, in turn, access the healthcare systems of Korea and its medical knowledge. To achieve a successful KMA Policy system, the definite authority and responsibility should be granted to the organizational bodies of the KMA, for example, the House of Delegates and Board of Trustees, and the regional societies and other sections. These various groups must then efficiently divide up their work and cooperate systematically. Moreover, it is crucial that each individual member of the KMA pay much more attention to health issues and participate in the decision making process on KMA Policy.

Proposed Master Plan for Reform of the National Infectious Disease Prevention and Management System in Korea

A Middle East respiratory syndrome (MERS) - coronavirus (CoV) cluster that attacked Korea in May 2015 revealed several weaknesses in Korea's health care system in the face of the crisis of an emerging infectious disease and its public health implications. This experience has shown that is necessary to prepare comprehensive countermeasures through the cooperation of civil and public agencies to prevent a second or even third MERS outbreak and to control future crises of infectious disease and public health. The MERS Policy Committee of the Korean Medical Association has thus proposed a master plan for reform of the national infectious disease prevention and management system to prepare a new framework for national infectious disease prevention and control. The specific targets of the master plan are improvement of the system of usage of medical services and of the medical culture among national health insurance subscribers, improvement of the emergency room management system to prevent the spread of infectious disease, the establishment of a support system to promote effective voluntary infectious disease prevention activities among medical institutions, the building of a public health crisis communication system in collaboration with medical organizations, the establishment of an independent Ministry of Health and capacity building of the Korea Centers for Disease Control (KCDC), the securing of an advanced research and development system in the field of prevention and control of infectious disease, and the capacity building of professional epidemiologists and personnel needed to prevent and control infectious disease. The five core strategies of the master plan have been planned by medical experts in this order of priority: the reform of the healthcare delivery system, the independence of the Ministry of Health and capacity building of the KCDC, fundraising for a public infection management fund, enforcement of medical organization infection control, and improvement of the emergency room management system.

A study on establishing a technical safety assessment system for the Korean telemedicine system

Telemedicine is a critical infrastructure that directly affects people's lives. In this vein, the government announcement of the introduction of a telemedicine service has caused controversy among the government and medical institutions over the safety of the service. Before the introduction of the telemedicine service, its technical safety and effectiveness should be validated. The telemedicine system should be supported by proper policies to ensure a secure, continuous service. To this end, we have conducted research to derive the security requirements from domestic and foreign standards and laws relating to telemedicine and information security. Based on the derived requirements, we have developed a security standard for telemedicine that facilitates the objective assessment of the security of the telemedicine service. Furthermore, we have analyzed the vulnerabilities of telemedicine devices through penetration tests. Finally, using a risk analysis method, we have created risk scenarios that might occur in the provision of telemedicine services, and have calculated risk levels and expected loss for each scenario. We expect that the results of this research will be a basis for ensuring a sufficient budget and staff for the safety of telemedicine, and for establishing relevant policies.

Estimating financial loss to medical clinics resulting from the Middle East respiratory syndrome coronavirus outbreak in Korea

Korea experienced an unprecedented national level disaster caused by the Middle East respiratory syndrome (MERS) in the first half of 2015. Because of the secretiveness of the government and the insufficiency of the nation's quarantine system, Korea could not effectively respond to the MERS coronavirus (CoV) outbreak. Many people suffered huge losses across most sectors, and medical clinics were no exception. Now the Korean Government and many professionals are discussing the matter of compensation. This study aimed to provide evidence for the necessity of compensation support. We conducted a questionnaire survey of the level of economic damage over the course of a month. The financial loss rate of medical clinics that experienced MERS damage has decreased by more than half over the previous year. The total financial loss of 48 medical clinics was about 1.6 billion Korean won (KRW) based on insurance benefits and 3.4 billion KRW based on sales. Due to the spreading of the MERS-CoV outbreak after May 20, 2015 in Korea, the loss rate in June was much higher than that in May or July. In July, the financial position tended to be restored to more than half of that in June but had not fully recovered to the level prior to the MERS-CoV outbreak. As most of the population, including professionals, perceive that the government is liable for damages from the MERS-CoV outbreak, the authorities concerned should prepare a compensation and redress plan. Furthermore, we expect our study to be used as good evidence for a redress plan for medical clinics damaged by the MERS-CoV outbreak.

The state of medical malpractice caused by private practice physicians (2010-2012): analysis through incident reports at Korean Medical Association Medical Indemnities Mutuals

This study was conducted to understand the current state of medical malpractice through analyzing recorded incidents by characteristics of medical intervention, and treatment results classified by treatment type and so on. The data for this study were extracted from the recorded incidents of medical malpractices committed by private practice physicians, which were provided by the Korean Medical Association Medical Indemnity Mutuals (KMAMA). The analysis was based on the treatment codes registered as primary medical practice of the respective private practice physicians at the time of joining KMAMA Medical malpractice occurrence rate by region was highest in Daegu with 7.1%. Analysis of causes of malpractice by codes showed dermatology/urology/plastic surgery department's C5 (standard medical care [outpatient] including standard injection, drug administration, simple topical anesthesia, simple treatment+regional anesthesia [spinal/epidural anesthesia]+general anesthesia [intravenous/inhaled anesthesia]) had the highest number of incidents with 223 cases. For the cases of death as prognosis, code B2, consisting of "basic treatment+regional anesthesia, intra-articular injection, epidural nerve block," had the highest incidents. This study concluded with the suggestion for the need to establish a system that will allow reporting and sharing incidents of private practice medical malpractice, and the necessity of acknowledging the importance of sharing such knowledge among medical practitioners.

Current status of state telemedicine policy in the United States and policy implications for Korea

The main objective of this study to propose an implementation about telemedicine policy in Korea through analyzing current status of state telemedicine policy in the United States. To achieve the result, three types of data sets were used to draw conclusions; 1) status of insured service of telemedicine in each state, 2) physician practice standards related to telemedicine, and 3) licensure. Analyzed results indicated differentiation in insured status of telemedicine service among private insurance parity law, medicaid coverage parity law, and state employee health plan parity in each states. Only two states provide insured service of telemedicine without any limits or certain conditions. Other states have a strict regulation or coverage condition about providing insurance. Each states also apply rigorous standards to telemedicine providers about physician practice standards and licensure. Some states restrict telemedicine itself or provide strict regulation process of telemedicine in Physician-patient encounter. Also, the most strict type 'full state license' and 'consulting exemptions (applied in certain condition)' are applied in most of states. On the basis of study result, environmental and conditional requirement implementation in application of telemedicine policy in Korea is provided in conclusion.

Current epidemiological situation of Middle East respiratory syndrome coronavirus clusters and implications for public health response in South Korea

Since May 20, 2015, when the first case of Middle East respiratory syndrome (MERS) in South Korea was confirmed, the cluster case in South Korea has grown to become the largest observed case following Saudi Arabia within the span of one month. Akin to what was observed in the Middle East, confirmed cases were infected through nosocomial transmission where the cluster is largely limited to patients, healthcare workers, and visitors to patients in healthcare facilities with confirmed cases. A major difference from the outbreaks in the Arabian Peninsula has been the large number of tertiary transmission cases in South Korea, which had reached forty cases by June 12. This observation may suggest that despite the lack of genetic mutation of Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea, the virus may be behaving differently from that of the Middle East. The higher infectiousness of 'super-spreaders' in South Korea also suggests that this assertion should be under further investigation. Suggestions of inadequate triage in emergency rooms, particularly at Samsung Medical Center which accounts for the most nosocomial infection with 60 cases, have been made by several organizations as the basis for this rapid spread. This, however, does not account for the fact that triage was impossible to implement, since the presence of MERS-CoV in South Korea was unknown during the index patient's stay at the healthcare facilities. This paper aims to identify the key factors in the amplified spread of MERS-CoV in South Korea. The first is the initial failure to confirm diagnosis promptly and to isolate the index case after confirmation of MERS in hospital and the lack of detail in tracking potential exposures in the community of the index case before isolation. The second is the early inadequate measures the Korea Centers for Disease Control and Prevention took in categorizing close contacts. Due to inconsistencies in defining what constitutes close contact, a number of cases were neglected from quarantine and were not subjected to investigation. Finally, confirmed or potential MERS patients were admitted for treatment and observation at medical facilities without adequate disease control measures or rooms, such as ventilated single rooms or airborne precaution rooms. Due to the rigid position that MERS-CoV cannot be transmitted via airborne means, infection control measures has so far neglected evidence that smaller droplets (aerosol) containing the virus can act similar to airborne agents, which may account for the widespread and rapid transmission in a emergency room and a patient's room in hospital. Although the South Korean government expects newly confirmed cases to abate in the coming few weeks, without stringent implementation of clearly defined guidelines to control further transmissions, the cessation of the current trend may continue for an extended period. Additionally, due to the high infection rate of super-spreaders in South Korea, efforts to screen for potential super-spreaders and a thorough investigation of those confirmed to be super-spreaders should be done to quickly identify source of infection, to potentially lower the number of secondary, tertiary transmissions and prevent possible quaternary transmissions.

Lessons learned from Middle East respiratory syndrome coronavirus cluster in Korea

No abstract available.

Public health crisis response and establishment of a crisis communication system in South Korea: lessons learned from the MERS outbreak

It is widely believed that effective communication is critical for the containment of the spread of emerging infectious diseases. Various media outlets and studies have pointed out communication failure as one of the key components that contributed to the wide and rapid spread of Middle East respiratory syndrome coronavirus in South Korea. To address these concerns, we first outline the definitions of risk and crisis communication and why they are important. We then illustrate communication models and guidelines utilized in three organizations (World Health Organization, US Centers for Disease Control and Prevention, and UK Public Health England) for health or disaster control. By analyzing the current guidelines for infectious diseases in South Korea and they were actually applied during the Middle East respiratory syndrome situation, we will assess what went wrong and what went right. Finally, we will suggest various measures that will help to ensure similar tragedies do not happen again.

Mobile phone use and risk of glioma: a case-control study in Korea for 2002-2007

OBJECTIVES: There has been a growing concern about the possible carcinogenic effects of the electromagnetic radiofrequency fields emitted from mobile phones. The purpose of this study was to investigate the association between mobile phone use and the development of gliomas in Korea. METHODS: Our study methods were based on the International Interphone study that aimed to evaluate possible adverse effects of mobile phone use. This study included 285 histologically-confirmed Korean patients 15 to 69 years of age, with gliomas diagnosed between 2002 and 2007 in 9 hospitals. The 285 individually matched controls were healthy individuals that had their medical check-up in the same hospitals. Unconditional logistic regression was used to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for use of mobile phones. RESULTS: For the entire group, no significant relationship was investigated between gliomas and regular use of mobile phones, types of mobile phones, lifetime years of use, monthly service fee, and the other exposure indices. Analyses restricted to self-respondents showed similar results. For ipsilateral users, whose the body side for usual mobile phone use match the location of glioma, the aORs (95% CIs) for lifetime years of use and cumulative hours of use were 1.25 (0.55 to 2.88) and 1.77 (0.32 to 1.84), respectively. However, the contralateral users showed slightly lower risk than ipsilateral users. CONCLUSIONS: Our results do not support the hypothesis that the use of mobile phones increases the risk of glioma; however, we found a non-significant increase in risk among ipsilateral users. These findings suggest further evaluation for glioma risk among long-term mobile phone users.

Mobile phone use and risk of glioma: a case-control study in Korea for 2002-2007

OBJECTIVES: There has been a growing concern about the possible carcinogenic effects of the electromagnetic radiofrequency fields emitted from mobile phones. The purpose of this study was to investigate the association between mobile phone use and the development of gliomas in Korea. METHODS: Our study methods were based on the International Interphone study that aimed to evaluate possible adverse effects of mobile phone use. This study included 285 histologically-confirmed Korean patients 15 to 69 years of age, with gliomas diagnosed between 2002 and 2007 in 9 hospitals. The 285 individually matched controls were healthy individuals that had their medical check-up in the same hospitals. Unconditional logistic regression was used to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for use of mobile phones. RESULTS: For the entire group, no significant relationship was investigated between gliomas and regular use of mobile phones, types of mobile phones, lifetime years of use, monthly service fee, and the other exposure indices. Analyses restricted to self-respondents showed similar results. For ipsilateral users, whose the body side for usual mobile phone use match the location of glioma, the aORs (95% CIs) for lifetime years of use and cumulative hours of use were 1.25 (0.55 to 2.88) and 1.77 (0.32 to 1.84), respectively. However, the contralateral users showed slightly lower risk than ipsilateral users. CONCLUSIONS: Our results do not support the hypothesis that the use of mobile phones increases the risk of glioma; however, we found a non-significant increase in risk among ipsilateral users. These findings suggest further evaluation for glioma risk among long-term mobile phone users.

Public health concerns and risk perceptions in Korea: Focusing on the residents of the metropolitan cities

This study aimed to measure the variation in the levels of risk perception associated with various health risk factors. We analyzed the variables of psychological paradigms that may affect such risk perception levels. According to the perception survey results, the perception of the risk of medical malpractice appeared to be at the highest level compared to other risk factors. According to the analysis of differences in psychological paradigms of health risk factors between genders, the known extent of hazard that medical malpractice, medicines side effects, vaccination accidents, acquired immune deficiency syndrome (AIDS), and food poisoning was much high in female than in male. According to the evaluation of the severity of the risk to future generations, it appeared that women believed that vaccination accidents, AIDS, chronic diseases such as diabetes and hypertension, smoking, and drinking would have a greater effect on the risk to future generations than did men. The significance of this study is that the psychological paradigm affecting the perception level of health risk factors and the risk perceptions themselves have been analyzed by a survey of adults from the general population of Korea.

Blood Cadmium Concentration of Residents Living near Abandoned Metal Mines in Korea

The purpose of this study was to investigate demographic and lifestyle variables and blood cadmium concentrations in residents living near abandoned metal mines in Korea. Blood cadmium concentrations were measured in 15,161 subjects living around abandoned metal mines (exposed group, n = 14,464) and compared with those living in designated control areas (control group, n = 697). A questionnaire was provided to all subjects to determine age, gender, mine working history, times of residence, smoking habits and dietary water type. The geometric mean (95% confidence intervals) of blood cadmium concentration (1.25 [1.24-1.27] microg/L) in the exposed group was significantly higher than in the control group (1.17 [1.13-1.22] microg/L). Mean residence time and mine working history in the exposed group were significantly higher than in the control group. Blood cadmium concentrations increased with increasing age, and residence time in both groups, and blood cadmium concentrations were higher in current-smokers than in non-smokers in both groups. This study shows the geometric mean of blood cadmium concentration in abandoned mining areas are higher than in non-mining areas in the general adult Korean population.