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Objective@#We aimed to examine the effectiveness of personalized light intervention using a blue-enriched light-emitting-diodes device on rest–activity rhythm (RAR) and light exposure rhythm (LER) in patients with mild and moderate Alzheimer’s disease (AD). @*Methods@#AD patients with poor sleep quality and/or insomnia symptoms were assigned into either an experimental group (EG) or control group (CG) in a single-blind design. Personalized light intervention was given at 9–10 h after individual dim light melatonin onset, lasting for 1 h every day for two weeks in the EG (77.36±5.79 years, n=14) and CG (78.10±7.98 years, n=10). Each patient of CG wore blue-attenuating sunglasses during the intervention. Actigraphy recording at home for 5 days was done at baseline (T0), immediate postintervention (T1), and at four weeks after intervention (T2). The variables of RAR and LER were derived using nonparametric analysis. @*Results@#We found a significant time effect on the intradaily variability (IV) of RAR at T2 with respect to T0 (p=0.039), indicating reduced IV of RAR at four weeks after personalized light intervention regardless of blue-enriched light intervention. There was a time effect on the IV of LER at T1 with respect to T0 (p=0.052), indicating a reduced tendency in the IV of LER immediately after intervention. @*Conclusion@#Our personalized light intervention, regardless of blue-enriched light source, could be useful in alleviating fragmentation of RAR and LER in AD patients.
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Purpose@#This study aimed to identify the factors affecting the degree of perineal injury in women who gave birth at a natural childbirth hospital. @*Methods@#This descriptive correlational study aimed to confirm the effect of delivery at a natural childbirth hospital on perineal injury in women. We analyzed the medical records of 358 women who gave birth naturally to infants in the cephalic position at >37 weeks gestation in 2018 at an obstetric clinic in Seoul. Data were analyzed using Spearman rank correlation coefficient to identify variables affecting perineal injury, and multiple regression was used to identify the factors affecting perineal injury. IBM SPSS version 28.0 for windows was used for data analysis. @*Results@#There were significant negative correlations between the degree of perineal injury and birth order (r=0.73, p<0.001), number of previous vaginal deliveries (r=-0.70, p<0.001), and age (r=-0.30, p<0.001). However, there were significant positive correlations between the degree of perineal injury and parity (r=0.83, p<0.001), labor duration in stage I (r=0.35, p<0.001), labor duration in stage II (r=0.37, p<0.001), fluid hydration (r=0.28, p<0.001), epidural anesthesia (r=0.27, p<0.001), and oxygen supply (r=0.26, p<0.001). Factors affecting the degree of perineal injury were parity (b=0.10, p=0.007) and birth order (b=-0.09, p=0.014), and the explanatory power of this model was 52.0% (F=130.054, p<0.001). @*Conclusion@#The degree of perineal injury was highest in the primiparous group and decreased as the birth order increased. Therefore, to prevent perineal injury during childbirth, nursing care with minimal intervention such as epidural anesthesia is required for primiparous women.
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Background/Aims@#The clinical efficacy and safety of CT-P13 are comparable to originator infliximab for Crohn’s disease in CT-P13 3.4 study (NCT02096861). We performed a multivariate logistic analysis to demonstrate the association between early infliximab trough levels and treatment outcomes of CT-P13 and originator infliximab. @*Methods@#Early serum infliximab trough levels and anti-drug antibody (ADA) levels were compared between CT-P13 (n=100) and originator infliximab (n=98) groups. Receiver operating characteristic (ROC) analysis and multivariate logistic analysis were conducted to identify optimal cutoffs of serum infliximab trough levels and predictive factors for clinical outcomes. @*Results@#The median infliximab trough levels were not different between CT-P13 and originator infliximab groups at week 6, week 14, and in median ADA levels at week 14, respectively. ROC analysis found an infliximab concentration threshold of 4.5 μg/mL at week 6 and 4.0 μg/mL at week 14 as the cutoff value with the highest accuracy for the prediction of clinical outcomes. Serum infliximab trough levels at weeks 6 and 14 predicted clinical remission at weeks 30 and 54, and endoscopic remission at week 54. The combinations of clinical remission or C-reactive protein normalization with an early infliximab trough level improved the prediction of long-term clinical or endoscopic remission. @*Conclusions@#A threshold in serum infliximab trough level at week 6 and week 14 was highly predictive for long-term clinical outcomes. There were no statistical differences in serum infliximab trough levels and ADA levels between CT-P13 and originator infliximab.
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Ephedra is a genus of the Ephedraceae family and is found in temperate regions, such as Central Asia and Europe. Among the various ephedra species, Ma Huang (Ephedra herb) is derived from the aerial parts of Ephedra sinica Stapf, Ephedra equisetina Bunge, and Ephedra intermedia Schrenk & C.A. Mey. Ma Huang contains various ephedra alkaloids, including (-)-ephedrine, (+)-pseudoephedrine, (-)-norephedrine, (+)-norpseudoephedrine, (-)-methylephedrine, and (+)-methylpseudoephedrine, which are found naturally as single enantiomers, although they can be prepared as racemates. Although the use of Ma Huang in foods is prohibited in Korea, products containing Ma Huang can be imported, and so it is necessary to develop a suitable analytical technique for the detection of Ma Huang in foods. Herein, we report the development of analytical methods for the detection of ephedra alkaloids in products containing Ma Huang. Following sample purification by solid phase extraction, quantitative analysis was performed using ultra-performance liquid chromatography-triple quadrupole mass spectrometry (UPLC-MS/MS). Additionally, the enantiomers were successfully separated using HPLC-DAD. We successfully analyzed various food samples, where the ephedra alkaloids were qualitatively and quantitatively determined, and the enantiomers were separated. It is expected that these methods may contribute toward preventing the distribution of illegal products containing Ma Huang.
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2022 was a time when the global healthcare system was challenged and has grown in response to the coronavirus disease 2019 pandemic. In addition, various issues accumulated in the process of quantitative growth have emerged in the Korean healthcare system. For instance, problems of sustainability in health insurance finances and removing bubbles from excessive medical utilization should be urgently resolved as tasks that occurred in the process of expanding the coverage of the health insurance system. The deficit of applicants for the pediatrician residency program suggests that expanding health insurance coverage alone has limitations in providing essential medical services. There is a need to incentivize doctors who provide essential medical care services. In 2023, we hope that efforts to enhance and internally reinforce the healthcare system will be concentrated.
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Purpose@#This study aimed to identify the relationships among disease severity, anxiety, depression, social support, unpleasant symptoms and self-care among patients with atrial fibrillation based on the unpleasant symptom theory, and to examine the mediating effects of unpleasant symptoms. @*Methods@#A cross-sectional study was conducted. The participants were 216 patients with atrial fibrillation who were being followed up on an outpatient basis at a university hospital in Seoul. Data were collected from November 1, 2020 to June 30, 2021, using self-report questionnaires. Data were analyzed using IBM SPSS/WIN 27.0 and PROCESS macro with 95% bias-corrected bootstrap confidence interval(CI). @*Results@#The average age of participants in this study was 66.0years. Disease severity (β=10.19,p<.001) and depression (β=1.53, p<.001) had significant positive relationships with unpleasant symptoms. Also, unpleasant symptoms (β=-0.03, p=.006) had a negative relationship with physical activity, which is a subscale of self- care. Social support (β=0.06, p<.001) was positively related with physical activity. Unpleasant symptoms showed a mediation effect in the relationship between disease severity and physical activity (Bias corrected bootstrap CI -0.65, -0.04). Depression had an indirect effect on physical activity that was mediated by unpleasant symptoms (Bias corrected bootstrap CI -0.11, -0.00). @*Conclusion@#The findings of this study suggest that integrated strategies including physical, psychological, and social factors should be considered to promote self-care in patients with atrial fibrillation.
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Background@#Infections caused by multidrug-resistant Pseudomonas aeruginosa (MDRPA) have been on the rise worldwide, and delayed active antimicrobial therapy is associated with high mortality. However, few studies have evaluated increases in P. aeruginosa infections with antimicrobial resistance and risk factors for such antimicrobial resistance in Korea. Here, we analyzed changes in antimicrobial susceptibility associated with P. aeruginosa bacteremia and identified risk factors of antimicrobial resistance. @*Methods@#The medical records of patients with P. aeruginosa bacteremia who were admitted to a tertiary hospital between January 2009 and October 2020 were retrospectively reviewed. Antibiotic resistance rates were compared among the time periods of 2009–2012, 2013–2016, and 2017–2020 and between the intensive care unit (ICU) and non-ICU setting. Empirical antimicrobial therapy was considered concordant, if the organism was susceptible to antibiotics in vitro, and discordant, if resistant. @*Results@#During the study period, 295 patients with P. aeruginosa bacteremia were identified. The hepatobiliary tract (26.8%) was the most common primary site of infection. The rates of carbapenem-resistant P. aeruginosa (CRPA), MDRPA, and extensively drug-resistant P. aeruginosa (XDRPA) were 24.7%, 35.9%, and 15.9%, respectively. XDRPA showed an increasing trend, and CRPA, MDRPA, and XDRPA were also gradually increasing in non-ICU setting. Previous exposure to fluoroquinolones and glycopeptides and urinary tract infection were independent risk factors associated with CRPA, MDRPA, and XDRPA. Previous exposure to carbapenems was an independent risk factor of CRPA. CRPA, MDRPA, and XDRPA were associated with discordant empirical antimicrobial therapy. @*Conclusion@#The identification of risk factors for antimicrobial resistance and analysis of antimicrobial susceptibility might be important for concordant empirical antimicrobial therapy in patients with P. aeruginosa bacteremia.
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With the increase in vaccinations worldwide, the world is facing the era of coexisting with coronavirus disease 2019 (COVID-19). The government announced that it will change its focus of public health emergency response system, gradually toward daily recovery from November. Hence, this article reviews an overview of policy tasks to prepare for the era of coexistence with COVID-19. The three key policies that should be considered are as follow: (1) vaccination should be administered promptly to improve the immunity of the target population; (2) the government should advance the medical capability for critically ill patients and reorganize the patient delivery system; and (3) epidemiological surveillance system should be reformed in a direction to raise the social capacity.
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Background@#The purpose of this study was to extract the major areas of interest in health insurance research in Korea, and infer policy agendas related to health insurance by analyzing research keywords. @*Methods@#For this study, 2,590 articles were selected from among 7,459 academic papers related to health insurance published between January 1987 and December 2018, which were looked up using the Research Information Sharing Service (RISS). Keyword extraction and keyword network analysis were performed using the KrKwic, KrTitle, and UCINET software. @*Results@#First, the number of studies in the area of health insurance continued to increase in all government terms, and it was not until after the 2000s that the subjects of health insurance researches were diversified. Second, degree centrality showed that ‘medical expenditure’ and ‘medical utilization’ were consistently high–ranking keywords regardless of the government in power. Aging and long-term care insurance-related keywords were ranked higher in the Lee Myung-bak government, Park Geun-hye government, and Moon Jae-in government. Third, betweenness centrality showed the same high ranking in key topics such as medical expenditure and medical utilization, while the ranking of key keywords differed depending on the interests and characteristics of each government policy. @*Conclusion@#We confirm that health insurance as a research topic has been the main theme in Korean health care research fields. Research keywords extracted from articles also corresponded to the main health policies promoted during each government period. Efforts to systematically investigate policy megatrends are needed to plan adaptive future policies.
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The ethical environment in academic research is rapidly changing at a global level. Further, social expectations and public interest toward research ethics are also escalating in Korea. Understanding and applying ethical issues in academic research has become increasingly important. To conform to such changes in the ethical environment, the official journal of the Korean Academy of Health Policy and Management has been consistently establishing and modifying rules and principles regarding research ethics. For instance, we amended the submission guidelines to further address the policies for gendered innovations. For this editorial of the current issue, we would like to organize and share several ethical concerns, which recently gained considerable attention. We hope this review provides scholars with practical guidelines to comprehend and incorporate critical ethical issues into academic research.
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The 2022 Presidential election is approaching. Because health policies are intimately connected to other policies and involve multiple stakeholders, it is difficult to promote policy changes. Hence, the presidential election, during which policymakers are replaced, is a great timing for making policy improvements. Several important policies have been introduced and promoted throughout the presidential election process. However, these policies have been implemented without going through sufficient discussion among the experts but rather through the voices of minority groups with stronger political will. This eventually posed an obstacle to the balanced development of the entire health care system. The current medical system faces challenges that need to be addressed in the medium and long term. In particular, we should be wary of the populistic approach. We look forward to seeing more policy commitments, proposed through the evidence-based policy process and sufficient amount of discussion among the experts.
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Background@#Among the issues caused by the increase of one-person households the health problems and primary medical needs of one-person elderly households among the issues with the increase in one-person households is very important. The purpose of this study was to identified health care needs and problems of one-person elderly households by comparing health behavior, health status, disease prevalence rate, and medical needs to one-person elderly households and multi-person households. @*Methods@#Data were obtained from the 2017 Community Health Survey. In this study, 66,211 people who were over 60 years of age without missing variables were included in the final analysis. @*Results@#One-person households showed poorer overall health behaviors, such as nutritional behaviors, exercise behaviors, drinking and smoking behaviors, and poorer subjective and objective health status than multi-person households. Furthermore, albeit the high requirement of medical services for mental health outcomes such as suicide attempts, the rate of not receiving services was also high indicating high barriers to receive and access health care. @*Conclusion@#Comprehensive and direct comparison of health and medical factors revealed the medical vulnerability and unmet needs in terms of health promotion in the single-person elderly households. These results can be applied as the basic information to understand the needs and medical problems of these risk groups by primary medical doctors who predominantly treat single-person elderly households and can also be used as basic data for policy development in order to solve these unmet medical care needs.
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With this as a momentum of approval Pfizer vaccine against coronavirus disease 2019 (COVID-2019), it is changed to the era of vaccine rapidly. Most countries are trying to reserve effective vaccines and inoculate vaccines into high-risk populations for achieving community immunity. I reviewed several vaccine-related issues to be confronted for moving up to the end of COVID-2019:the efficacy and effectiveness of the approved vaccines, the priorities for vaccination into target groups, side effects, and distrust towards COVID-2019 vaccines. Evidence-based decision-making in the policy process and collaboration with professional groups are the most effective strategies for driving successful vaccination policy.
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With this as a momentum of approval Pfizer vaccine against coronavirus disease 2019 (COVID-2019), it is changed to the era of vaccine rapidly. Most countries are trying to reserve effective vaccines and inoculate vaccines into high-risk populations for achieving community immunity. I reviewed several vaccine-related issues to be confronted for moving up to the end of COVID-2019:the efficacy and effectiveness of the approved vaccines, the priorities for vaccination into target groups, side effects, and distrust towards COVID-2019 vaccines. Evidence-based decision-making in the policy process and collaboration with professional groups are the most effective strategies for driving successful vaccination policy.
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Background@#Among the issues caused by the increase of one-person households the health problems and primary medical needs of one-person elderly households among the issues with the increase in one-person households is very important. The purpose of this study was to identified health care needs and problems of one-person elderly households by comparing health behavior, health status, disease prevalence rate, and medical needs to one-person elderly households and multi-person households. @*Methods@#Data were obtained from the 2017 Community Health Survey. In this study, 66,211 people who were over 60 years of age without missing variables were included in the final analysis. @*Results@#One-person households showed poorer overall health behaviors, such as nutritional behaviors, exercise behaviors, drinking and smoking behaviors, and poorer subjective and objective health status than multi-person households. Furthermore, albeit the high requirement of medical services for mental health outcomes such as suicide attempts, the rate of not receiving services was also high indicating high barriers to receive and access health care. @*Conclusion@#Comprehensive and direct comparison of health and medical factors revealed the medical vulnerability and unmet needs in terms of health promotion in the single-person elderly households. These results can be applied as the basic information to understand the needs and medical problems of these risk groups by primary medical doctors who predominantly treat single-person elderly households and can also be used as basic data for policy development in order to solve these unmet medical care needs.
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Background@#Family support and medical staff support of hemodialysis patients are related to sick-role behavior, and sick-role behavior is related to physiological indicators such as interdialytic weight gain and control of potassium and phosphorus in the blood. @*Methods@#The subjects were 139 hemodialysis patients. Data were collected on demographic and disease- related characteristics, social support (family support and medical staff support), sick-role behavior, and physiological indicators (interdialytic weight gain, blood potassium, and blood phosphorus). @*Results@#Degrees of family support and medical staff support were both nearly 3.85 points, and sick-role behavior was 3.96 points. Family support (r=0.449, P<0.001) and medical staff support (r=0.421, P<0.001) were positively correlated with sick-role behavior, and sick-role behavior was inversely correlated with interdialytic weight gain (r=-0.218, P=0.010) and blood phosphorus (r=-0.170, P=0.045). @*Conclusions@#The higher the degree of family support and medical staff support, the higher the degree of sick-role behavior. In addition, the higher the level of sick-role behavior, the lower the physiological indicators of interdialytic weight gain and blood phosphorus. Therefore, in order to improve sick-role behavior and physiological indicators, it is necessary to develop and apply an enhanced intervention program through family support and medical staff support.
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Purpose@#The purpose of this study was to evaluate the effect of aerobic exercise on serum lipids, body weight, and body mass index in adults with hypertension using a systematic review and meta-analysis. @*Methods@#Six electronic databases (PubMed, EMBASE, Cochrane library, CINAHL, PsycINFO, SPORTDiscus) and five domestic databases were searched for randomized controlled trials studies.We used random effect models to derive weighted mean differences (WMD) and their 95% confidence intervals (CI) of aerobic exercise on serum lipids, body weight, and body mass index. @*Results@#Nineteen studies met our inclusion criteria. In comparison with the control group, triglyceride level (TG) (-13.49 mg/dL, 95% CI: -26.74 to -0.24) and body weight (-0.62 kg, 95% CI: -1.08 to -0.16) difference between follow-up and baseline was significantly reduced in the aerobic exercise group. However, no difference was found in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and body mass index (BMI). @*Conclusion@#Aerobic exercise is effective in reducing the TG level and body weight in adults with hypertension. In order to improve levels of serum TC, LDL-C and HDL-C of hypertensive patients, it’s needed to combine other intervention methods such as diet therapy.
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Purpose@#The purpose of this study was to analyze the characteristics and effects of the forest therapy programs for adult patients. @*Methods@#Six databases (PubMed, Cochrane library, CiNii, PsychoInFO, AGRICOL, EMBASE) and six domestic databases were systematically searched with language restrictions of Korean, English, and Japanese. The systematic review was based on the Preferred Reporting Items Systematic Reviews and Meta-Analysis (PRISMA) flow diagram. @*Results@#Twenty five studies met the inclusion criteria. A systematic review identified adult patients classified as 1) disease of the circulatory system, 2) mental and behavioral disorders, 3) malignant neoplasms, 4) etc. (diabetes mellitus, chronic pain). This integrative review showed a positive effect of the forest therapy program for adult patients on physiological indices such as blood pressure, heart rate, heart rate variability, level of stress hormone, and natural killer cells as well as social · psychological indices such as the Profile of Mood States (POMS), anxiety, depression, and quality of life. @*Conclusion@#The results of this study could be useful key principles in developing and applying the forest therapy programs in nursing intervention. Further research should be conducted to develop the forest therapy programs suitable for each patient group and measure its effectiveness.
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Purpose@#This study aimed to identify factors associated with the occurrence of chemotherapy-induced peripheral neuropathy (CIPN) and to study its impact on health-related quality of life (HRQoL) in patients with breast cancer. @*Methods@#In total, 137 women with breast cancer who had undergone more than one cycle of chemotherapy were recruited for this descriptive study from the outpatient department of a university hospital in Incheon, Korea. Data were collected using a self-reported questionnaire, which included the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CIPN20 and EORTC QLQ-C30. @*Results@#The mean CIPN score between patients was 13.57 on the sensory scale, 15.87 on the motor scale, and 25.06 on the autonomic scale. Of the studied socio-demographic, disease and treatment, and health behavior-related factors, only the chemotherapy regimen was significantly associated with CIPN (t = 2.50, p= .013). Taxane-based chemotherapy was significantly related to higher CIPN scores. Regression analyses revealed that CIPN was a factor that was significantly influential on HRQoL, adjusting for socio-demographic and clinical factors. @*Conclusion@#This study suggests that oncology nurses need to be aware of the increased risk of CIPN in patients with breast cancer undergoing taxane-based chemotherapy. In addition, interventions for alleviating CIPN may be required to improve HRQoL among these patients.
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Purpose@#The purpose of this study was to evaluate the effect on blood pressure (BP) and heart rate (HR) according to aerobic exercise characteristics in adults with hypertension using a systematic review and meta-analysis. @*Methods@#The related researches were selected from PubMed, EMBASE, Cochrane library, CINAHL, PsycINFO, SPORTDiscus and 5 domestic databases up to September 4, 2019. To estimate the effect size, random effect models were used to derive weighted mean differences (WMD) and their 95% confidence intervals (CI) of aerobic exercise on BP and HR. @*Results@#A total of 37 RCTs with 1,813 samples were included. Aerobic exercise was found to significantly reduce systolic BP (WMD, - 8.29 mmHg; 95% CI, - 10.12 to - 6.46), diastolic BP (WMD, - 5.19 mmHg; 95% CI, - 6.24 to - 4.14) and HR (WMD, - 4.22 beats/min; 95% CI, - 5.36 to –3.09). In detail, systolic BP and diastolic BP were significantly decreased in all groups of exercise types, frequency and duration. Systolic BP and diastolic BP were significantly decreased in the moderate and vigorous-intensity group.Exercise characteristics with the most dramatical change in systolic BP were water-based training, moderate-intensity, 3 times a week and 8 to 11 weeks of duration. In diastolic BP, the greatest effect size was over 24 weeks of exercise. @*Conclusion@#Moderate aerobic exercise, especially water-based exercise can be an important part of lifestyle modification for hypertensive patients. Also, it can be recommended in a variety of clinical settings for lowering BP and HR. However, there is insufficient evidence that low-intensity exercise is effective in lowering BP.