Certificate Education for Geriatric Physician: Satisfaction and Feasibility / 예방의학회지

OBJECTIVES: Korea faces a number of challenges to meet demands in the area of geriatric professional medicine in a country with a rapidly ageing population. We evaluated the satisfaction and feasibility of the current education certification for geriatric physicians. METHODS: Geriatric physicians who were deemed qualified by the Korean Geriatrics Society during the period of 2001 to 2005 (n=2,200) were asked to complete structured questionnaires sent to them by mail about their satisfaction of and need for certificates of education, as well as their opinions on their geriatric specialty training. A total of 419 physicians responded. Descriptive analysis and hierarchical regression were performed to rate the respondents.satisfaction, the characteristics of the need for clarity and utility in education certification, and the characteristics of their patients. RESULTS: Although most respondents were satisfied with their education certification, those who had more elderly patients, aged 65 or older, and those who had more cognitively impaired patients, rated their education as significantly lower than did other physicians. Both groups expressed the need for more the comprehensive care and assessment concerning of their education. Multiple regression analysis indicated that satisfaction with geriatric physician qualification was associated with a physician's age, specialty, and percentage of elderly patients. CONCLSIONS: This study suggests that the current system of education certification is limited in terms of feasibility and physician satisfaction.

An Assessment of Introducing Internet Reporting System for Enhancing Influenza Surveillance

BACKGROUND: Influenza is one of the most important diseases that should be monitored for its activities and antigenic changes throughout the world. In Korea, there is a nationwide influenza surveillance system in which 649 sentinel clinics and hospitals (selected by the regional population distribution) have participated. However, there were a few crucial problems due to the low level of participation in the system and the time consuming process of collecting laboratory diagnosis results. To increase the participation and Influenza-Like Illness (ILI) case reporting rate, the internet reporting system of the influenza surveillance was introduced. METHODS: The surveillance data obtained through online were analysed and a questionnaire survey was conducted to sentinel physicians. RESULTS: The average annual participation rate was 53% in the season 2001-2002 and it was increased to 61.8% in 2002-2003. After we introduced the internet reporting system, the annual participating rate rose up to 74.0%. The average annual reporting rate of ILI was 6.9%, 6.6% and 11.4% in the season 2001-2002, 2002-2003 and 2003-2004, respectively. The utility rate of internet reporting system was 62.4%. According to the questionnaire survey (n=109), 57.8% of sentinels answered that the change of reporting system helped to promote the participation rate to the influenza surveillance attributing it to the public advertisement (46.0%) and the convenience of the internet reporting system (30.2%). CONCLUSION: By introducing the internet reporting system which enhances the influenza surveillance, higher rate of sentinel participation can be achieved.

Disparities in Participation in Health Examination by Socio-economic Position among Adult Seoul Residents / 예방의학회지

OBJECTIVES: To determine the disparity in the rate people undergo health examinations according to socioeconomic position (SEP) and the changes in this disparity with time. METHODS: Seoul citizens}health profile data from 1997 to 2005 were analyzed. The study subjects were 40 years old and over, and the total number of subjects was 6,601 in 1997, 8,994 in 2001, and 8,819 in 2005. Those aged 60 years and over were eliminated from the analysis of subjects}occupation. We used education, family income and occupation as indicators of SEP. The age-standardized health examination attendance rate for each year was calculated according to the education, family income and occupation. The odds ratios (ORs) from multiple logistic regressions were adjusted for age. RESULTS: The disparity in the rate of attendance according to the SEP decreased from 1997 to 2005 but still existed. Even though the disparities among the subgroups according to education, family income and occupation were not that high, the disparity between the group with the highest SEP and the other groups was considerable. CONCLUSIONS: Our findings suggest that unequal access to health examination services according to socioeconomic position still exists. This disparity has decreased recently but the disparity according to level of education was the greatest.

Educational Differences in Health Care Utilization in the Last Year of Life among South Korean Cancer Patients / 예방의학회지

OBJECTIVES: There have been few studies examining the differences in health care utilization across social classes during the last year of life. Therefore, in this study we analyzed the quantitative and qualitative differences in health care utilization among cancer patients across educational classes in their last year of life, and derived from it implications for policy. METHODS: To evaluate health care utilization by cancer patients in the last year of life, Death certificate data from 2004 were merged with National Health Insurance data (n=60,088). In order to use educational level as a social class index, we selected the individuals aged 40 and over as study subjects (n=57,484). We analyzed the differences in the medical expenditures, admission days, and rates of admission experience across educational classes descriptively. Multiple regression analysis was conducted to evaluate the association between medical expenditures and independent variables such as sex, age, education class, site of death and type of cancer. RESULTS: The upper educational class spent much more on medical expenditures in the last one year of life, particularly during the last month of life, than the lower educational class did. The ratio of monthly medical expenditures per capita between the college class and no education class was 2.5 in the last 6-12 months of life, but the ratio was 1.6 in the last 1 month. Also, the lower the educational class, the higher the proportion of medical expenditures during the last one month of life, compared to total medical expenditures in the last one year of life. The college educational class had a much higher rate of admission experiences in tertiary hospitals within Seoul than the other education classes did. CONCLUSIONS: This study shows that the lower educational classes had qualitative and quantitative disadvantages in utilizing health care services for cancer in the last year of life.

Continuity of Care of Patient with Diabetes and Its Affecting Factors in Korea / 예방의학회지

OBJECTIVES: The objectives of this study were to estimate the continuity of care for all Koreans with diabetes and to identify factors affecting the continuity of care. METHODS: We obtained National Health Insurance claims data for patients with diabetes who visited health-care providers during the year 2004. A total of 1,498,327 patients were included as study subjects. Most Frequent Provider Continuity (MFPC) and Modified, Modified Continuity Index (MMCI) were used as indexes of continuity of care. A multiple linear regression analysis was used to identify factors affecting continuity of care. RESULTS: The average continuity of care in the entire population of 1,498,327 patients was 0.89+/-0.17 as calculated by MFPC and 0.92+/-0.16 by MMCI. In a multiple linear regression analysis, both MFPC and MMCI were lower for females than males, disabled than non-disabled, Medicaid beneficiaries than health insurance beneficiaries, patients with low monthly insurance contributions, patients in rural residential areas, and patients whose most frequently visited provider is the hospital. CONCLUSIONS: The continuity of care for patients with diabetes is high in Korea. However, women, the disabled and people of low socio-economic status have relatively low continuity of care. Therefore, our first priority is to promote a diabetes management program for these patients.

Complementary and Alternative Medicine (CAM) Use and Its Determining Factors among Patients with Rheumatic Disorder in Korea

BACKGROUND: There is a wide spread increase in the use of CAM by patients with rheumatic disease. This study was performed to identify the prevalence of CAM use and determining factors affecting CAM use by patients with rheumatic disease. METHODS: From October 23 to November 31 in 2003, face-to-face structured interviews were conducted in a rheumatology hospital in Seoul. A total of 182 patients with rheumatic disease, who visited the hospital, participated. RESULTS: CAM was used by 59.3% (95% CI=52.1~66.2%) of the patients with rheumatic disease. The most common use of CAM was traditional Chinese medicine such as acupuncture and herbs. Demographic variables were not predictive for the use of CAM. As the duration of disease was longer, probability on CAM use was lower (odd ratio: 0.922, 95% CI=0.855~0.994). CAM use on disabled people who registered were 4.623 (95% CI=1.105~19.348) times higher than non-disabled. CONCLUSION: CAM use is common in patients with rheumatic disease. The duration of disease and physical disability were the influencing factors for using CAM. These findings support a need for outcome studies on the effectiveness of CAM in rheumatic disease, as well as the improvement of providing patients with information on CAM usage.

Complementary and Alternative Medicine (CAM) Use and Its Determining Factors among Patients with Rheumatic Disorder in Korea

BACKGROUND: There is a wide spread increase in the use of CAM by patients with rheumatic disease. This study was performed to identify the prevalence of CAM use and determining factors affecting CAM use by patients with rheumatic disease. METHODS: From October 23 to November 31 in 2003, face-to-face structured interviews were conducted in a rheumatology hospital in Seoul. A total of 182 patients with rheumatic disease, who visited the hospital, participated. RESULTS: CAM was used by 59.3% (95% CI=52.1~66.2%) of the patients with rheumatic disease. The most common use of CAM was traditional Chinese medicine such as acupuncture and herbs. Demographic variables were not predictive for the use of CAM. As the duration of disease was longer, probability on CAM use was lower (odd ratio: 0.922, 95% CI=0.855~0.994). CAM use on disabled people who registered were 4.623 (95% CI=1.105~19.348) times higher than non-disabled. CONCLUSION: CAM use is common in patients with rheumatic disease. The duration of disease and physical disability were the influencing factors for using CAM. These findings support a need for outcome studies on the effectiveness of CAM in rheumatic disease, as well as the improvement of providing patients with information on CAM usage.

A Study on Characteristics of Core Projects Described in 3rd Community Health Plans / 예방의학회지

OBJECTIVE: The 3rd community health plan let health centers select and promote core projects considering budget and manpower. This study analyzed the content and selection processes of core projects, using the nationwide 3rd community health plans, to give relevant information on health center policies. METHODS: Classification criteria for content analysis of core projects were established and verified through a literature review and by specialist discussions. Fifty plans were selected by stratified proportional random sampling for regional characteristics. And coding criteria standardized through coding repetition and discussion, by 2 persons (k> 0.7). Using stratified proportional random sampling for 16 cities and provinces, regional characteristics, 117 plans were selected, and the contents of the core project selection processes and program contents analyzed. RESULTS: The survey was used by 59.8 % of samples as a core project decision-making method. The participants included 98.6, 81.4, 40 and 38.6% of the health staffs, residents, medical institutions, and administrators, respectively. Discussion was used by 15.4% of samples. The participants were health staffs by 100% as a great. The ranking of the frequencies of the selected core projects were, in order; chronic disease control, health promotion, elderly health, maternal-child health, and oral health at 16.4, 14.8, 14.3, 12.7 and 11.9%, respectively. Analyses on the chronic disease control and elderly health contents showed the diversity of object disease, high rates of visitors on patient detection programs, high rates of unclear target populations, and the provision of medical exams and treatments as the main services, with high variations in business per-formance. The national health budgets for health centers in 2003 were about 910 and 240 million won for chronic disease control and elderly health, respectively, which were less than for the other five priority core projects. CONCLUSION: The chronic disease control and elderly health at the health centers were not standardized for object disease, patient detection program, target population, service provision, and national support budget was insufficient. Thus it is necessary to develop standard guidelines, and increase financial support, for chronic disease control and elderly health.

Socioeconomic Costs of Obesity for Korean Adults / 예방의학회지

OBJECTIVE: To estimate the socioeconomic costs of obesity in Korea, 1998. METHODS: The 1998 National Health and Nutrition Examination Survey (1998 NHNES) data was used and 10,880 persons who had taken health examinations were selected for study. Essential hypertension, NIDDM (non insulin-dependent diabetes mellitus), dyslipidemia, osteoarthritis, coronary heart disease, stroke were included as obesity related disease. The data of direct costs of obesity was obtained from the National Federation of Medical Insurance. The category of indirect costs was the loss of productivity caused by premature death and admission, time costs, traffic costs, nursing fees due to obesity. Multiple logistic regression model was developed to estimate prevalence odds ratio by obesity class adjusted demographic and socio-ecnomic factors and calculate PAF (Population Attributable Fraction) of obesity on obesity related disease. And we finally calculated the socioeconomic costs of obesity in relation to BMI with PAF. RESULTS: The direct costs of obesity were 2,126 billion~965 billion Won in considering out of pocket payment to uninsured services, and the indirect costs of obesity were 2,099 billion~1,086 billion Won. Consequently, in considering out of pocket payment to uninsured services, the socioeconomic costs of obesity were 4,225 billion~2,050 billion Won, which corresponded to about 0.094% ~0.046% of GDP and 1.88%~0.91 of total health care costs in Korea. CONCLUSIONS: Obesity represents a major health problem with significant economic implications for the society. This results are conservative estimates as far as all obesity related disease and all health care and indirect costs were not included due to missing information. Further studies are needed to caculate socioeconomic costs of obesity more exactly.

Development and Evaluation of the Reliability and Validity of the VSSS-82 Korean Version for Measuring Satisfaction with Community-based Mental Health Services in Psychiatric Patients / 예방의학회지

OBJECTIVES: To develop a Korean version of VSSS-82 for measuring the multi-dimensional satisfaction with community-based mental health services in psychiatric patients and to investigate both the reliability and validity of the Korean version. METHODS: The VSSS-82 English version was translated and back-translated with some modification. Data from 68 psychosis patients using community-based mental health services in three Community Mental Health Centers (CMHCs) was collected through a personal interview survey regarding the satisfaction and suitability of service. Variability of satisfaction and internal consistency, discriminant validity, and concurrent validity of the VSSS-82 Korean version were evaluated. RESULTS: A higher number of dissatisfied subjects and significant pairwise differences for the dimensions were found. The Crohnbach's alpha coefficient, a measure of internal consistency, ranged from 0.56 (overall satisfaction) to 0.90 (skills and behavior) and significant differences in satisfaction was found in patients by the self-rated suitability of service. CONCLUSIONS: The VSSS-82 Korean version is a reliable and valid instrument for measuring multi-dimensional satisfaction with community-based mental health service.

Increasing Prevalence of Obesity Related Disease for Koreans Associated with Overweight and Obesity / 예방의학회지

OBJECTIVE: To develop a better understanding of the relationship between weight status and the prevalence of obesity related diseases in the Korean population. METHODS: The 1998 Korean National Health and Nutrition Survey was used and 10,880 persons who had previously taken health examinations were selected for study. The Korean Society for the Study of Obesity's classification of weight status was used. Hypertension, diabetes mellitus, dyslipidemia, osteoarthritis, chronic heart disease, stroke were included as obesity related disease. A logistic regression model was developed to estimate the prevalence odds ratio by obesity class adjusted for demographic and socio-economic factors and we converted the odds ratio to a prevalence ratio using the base line prevalence of disease to aid in the interpretation of the ratios. RESULTS: The prevalence of obesity was 26.3% based on the KSSO classification (BMI> or =25). A graded increase in the prevalence ratio was observed with increasing severity of overweight and obesity for all health outcomes with the exception of chronic heart disease in men and stroke in both men and women. With normal weight individuals as the reference, for men who were younger than 50 years, the prevalence ratios were highest for hypertension BMI or =30: 4.83(95% CI=3.78-5.84). The prevalence ratios for dyslipidemia were as high as hypertension, but were lower than hypertension for diabetes mellitus and osteoarthritis. Prevalence ratios generally were greater in younger adults. The prevalence of having 2 or more obesity related diseases increased with weight status category, except in people who were older than 50 years. CONCLUSIONS: Based on results, obesity is an increasingly important health problem in Korea and the disease burden increases according to weight status. For Korean adults, the strongest relationship was seen between weight status and hypertension and dyslipidemia. In older people the impact of excess weight and obesity is stronger than that seen in younger people. Increased efforts in the study of obesity and prevention and treatment of obesity and obesity related disease are required.

Health Care Delivery Systems of North & South Korea

No abstract available.

Health Care Delivery Systems of North & South Korea

No abstract available.

Change of Medical Utilization Claims in Self-employees before and after the Economic Crisis in Korea / 예방의학회지

OBJECTIVES: To investigate the changing pattern of medical utilization claims following the economic crisis in Korea. METHODS: The original data consisted of the claims of the 'Medical insurance program of self-employees' between 1997 and 1998. The data was selected by medical treatment day ranging between 1 January and 30 June. Medical utilizations were calculated each year by the frequency of claims, visit days for outpatients, length of stay for inpatients, total days of medication, and the sum of expenses. RESULTS: The length of stay as an inpatient in 1998 was decreased 4.7 percent in comparison to 1997. However, inpatient expenses in 1998 increased 10.8 percent as compared to 1997. Inpatient hospital claims in 1998 increased 6.2 percent over 1997, although general hospital inpatient claims in 1998 decreased 3.3 percent in comparison to 1997. The outpatient claim frequency decreased 7.3 in 1998 percent as compared to 1997. Outpatient visit days of in 1998 were decreased 8.5 percent in comparison to that recorded in 1997. Outpatient claim frequencies of 'gu region' in 1998 decreased 10.5 percent comparison to that in 1997, but 'city and gun region' decreased less than 'gu region'. CONCLUSIONS: Medical utilization in 1998 deceased in relation to 1997. Medical utilization by outpatients decreased more than that of inpatients. Medical utilization by 'gu regio n' decreased more than the other regions.

National Economic Infrastructure and Private Medical Practitioners and Health Econimics

No abstract available.

Differences in Health Behaviors among the Social Strata in Korea / 예방의학회지

OBJECTIVES: To analyze differences in health behaviors among the social strata in Korea by using the 1995 National Health and Health Behavior Survey Data. METHODS: Study participants numbered 2,352 men and 1,016 women aged between 15-64 years old, with housewives, students and non-waged family workers excluded. Health behaviors in this study were defined according to the recommendations of the Alameda 7 study. The measure of health behaviors was based on the Health Practices Index(HPI; 0-5 range, with the exclusion of snacking between meals and regularly eating breakfast) developed by the Alameda County research. The significance of the relationship between social strata and HPI was assessed by considering the adjusted means from the multi-variate model. RESULTS: For men, incidence rates of never having smoked, no/moderate use of alcohol, regular exercise, and regular 7-8 hours sleep per night were higher in the upper social strata. Meanwhile, for women, incidence rates of never having smoked, no/moderate use of alcohol, appropriate weight, regular exercise, and regular 7-8 hours sleep per night were higher in the upper strata. HPI varied significantly among social strata in both sexes (p<0.001), a result which held true when adjusted for age, education, income, social insurance type, marital status and region. CONCLUSIONS: Health behaviors assessed by Health Practices Index(HPI) varied significantly among social strata for both sexes. Therefore, the existing gap in health behaviors among social strata can be corrected more effectively by target oriented health promotional activities.

The State of the Art of Preventive Medicine in North Korea With Reference to the Content Analysis of a Medical Textbook / 예방의학회지

OBJECTIVES: The most frequently cited health related slogan in North Korea is that socialistic medicine is preventive medicine. It implies that North Korea puts preventive medicine at the operational center of its national health care system. This study aimed at examining and comparing preventive medicine practices in North Korea with those of South Korea. METHODS: Efforts have been made to obtain a textbook for analysis its contents. Many people have iassisted in the study by joining the interview. Some of these people are as follows: a former professor of PyongYang Medical School, NK physicians living in South Korea, WHO staffs, diplomatic officials, etc. The major items of analysis consisted of industrial medicine and hygiene, nutrition, school health, epidemiology, health statistics and heath policy & management. RESULTS: Public health philosophy is finely rooted and well integrated in the operation of the North Korean national health care system, particularly in the area of industrial medicine and hygiene. Preventive medicine with a strong health surveillance system spanning a number of broad social organizations is a major tool to improve the health of the people in North Korea. The emphasis on preventive medicine has a close relationship with the 'Juche Philosophy' and the shortage of pharmaceuticals and medical equipment. To cope with the shortage problem, North Korean health workers are encouraged to grow medicinal herbs. We have found that they put little effort into teaching newly emerging diseases, such as AIDS, VDT syndrome, hazards of EMF, and agricultural chemical poisonings. Of the subjects of the preventive medicine text, 78.9% coincide with those of South Korean industrial health manuals and 34.2% with South Korean epidemiology texts. However, an absolute difference was found to exist between the heath policies and management systems. CONCLUSION: In North Korea, the concept of preventive medicine functions as the basic philosophic strategy of the national health care system. It differs greatly from the South Korean system in both practice and educational content. Its contribution to society is simply incomparable to that of South Korea. More communication and further study is called for in order to improve the preventive medicine practices in the future.

No title available

No abstract available.

An analysis of opinion polls for family medicine specialists on the implementation of family doctor registration system in Korea

BACKGROUND: Since the Independence in 1945, the Republic of Korea (ROK) has maintained fundamentally the liberal health care system by the influence of U.S.A. Therefore, as in the case of U.S.A., the primary health care system of ROK has fallen in the chaos. Recently, the new government of ROK seems to retry the introduction of 'Family Doctor Registration System (FDRS)' in spite of the 1996's failure. In order to conduct FDRS efficiently, there should be a thorough investigation on the opinions of doctors and people in the community. This study was conducted with a view to collecting necessary information regarding the implementation of FDRS. METHODS: By mailing, the self-administered questionnaires were collected twice during March 18 to May 12 in 1998. The questionnaire had been prepared through several discussions, pretest, and final correction by five family physicians and two health care policy professors. The subjects consisted of 2,093 family physicians. RESULTS: Though the overall response rate was only 28.2% (591) subjects, age distribution for the study subjects was similar to that of average family physicians. The subjects consisted of 451 males and 138 females. The number of those whose age was less than 40 was 49.9% (195). "The group that agrees with the introduction of FDRS" was 58.5% of all respondents; "the group that objects 14.4%; and the group undetermined" 24.7%. The 73.6% of all respondents had negative opinion on increased administrative work. Only 21.3% expected their net income to increase. On multiple logistic regression analysis, relatively large city rather than metropolitan Seoul, the smaller number of visiting patients a month, regular resident training experience, and male sex resulted in having a significant positive relationship with the introduction of FDRS. Further analyses are called for to identify differences of opinions between family physicians and single specialty medical practitioners. CONCLUSIONS: The results of this survey should be reflected into the health care policy when retrying to implement FDRS in Korea.

Relationship between BMI and prevalence of hypertension & diabetes mellitus based on national health interview survey

BACKGROUND: Recently the Korean society has been challenged with the rapid growth of obese population due to the improved socioeconomic status and lifestyle changes over the past decades. Not only has obesity been known as one of major risk factors for various diseases including cardiovascular diseases(e.g. hypertension, coronary heart disease and stroke) and diabetes mellitus, but it has also increased the death from obesity-related diseases. It has been required, however, to establish our own obesity criteria adjusted for Korean since much difference is expected to exist in the degree of obesity between white and Asian people. Therefore, this study was designed to provide with primary data to help establish new criteria through identifying the distribution of Body Mass Index(BMI), and then analysing its relatian with some obesity-related diseases. METHODS: This study calculated BMI and related it to some obesity-related diseases by analysing data from 1995 National Health Interview Surveys, in which a random sample of 5,750 Korean at the age of 15-69 had self-reported their heights, body weights and diagnoses with obesity-related diseases by physicians. Variables under consideration include potential risk factors(e.g. alcohol intakes, smoking, exercise, etc.) as well as demographics of the sample population. RESULTS: Average BMI(kg/m(2)) were 21.6+/- 2.6 for male and 21.7+/-4.8 for female(mean+/-SD), which increased in direct proportion to the increase of age until the age reached the group of 40-59, and then followed by the inverse in its relation with the age at 60 and over. It was revealed, however, that prevalences of obesity-related diseases such as hypertension, diabetes mellitus etc. were the highest among the population group with their BMI of 23.8~35.6. In short, this study identified the proportional relation of BMI with the prevalence of obesity-related diseases. CONCLUSIONS: In this study, the prevalence for hypertension and diabetes mellitus was shown to be higher than the average among population with their BMI of 21.9~238, whose figure is much lower than both 26.4, the value of the 90th percentile proposed in MONICA prot and 25, the current WHO criteria of obesity. However, a Japanese study reported that the health risk began to increase at the BMI of 23 with risks for obesity-related diseases dramatically increased at the BMI of 26-27 and over, and concluded that because Asian has more body fats accumulated within the upper body part compared with the white, the Asian persons are more obese, though less in terms of BMI, than the white. Therefore, future works should be focused on establishing our own criteria for obesity with health risks through determining the association of BMI with prevalence of various diseases in Korea.