Effect of Mobile Health on Obese Adults: A Systematic Review and Meta-Analysis / 대한의료정보학회지

OBJECTIVES: This study was conducted to examine the effects of mobile health (mHealth), using mobile phones as an intervention for weight loss in obese adults. METHODS: An electronic search was carried out using multiple databases. A meta-analysis of selected studies was performed. The effects of mHealth were analyzed using changes in body weight and body mass index (BMI). RESULTS: We identified 20 randomized controlled trials (RCTs) involving 2,318 participants who fit our inclusion criteria. The meta-analysis showed that body weight was reduced with a weighted mean difference (WMD) of −2.35 kg (95% confidence interval [CI], −2.84 to −1.87). An examination of the impact of duration of intervention showed that weight loss was greater after 6 months of mHealth (WMD = −2.66 kg) than between three and four months (WMD = −2.25 kg); it was maintained for up to 9 months (WMD = −2.62 kg). At 12 months, weight loss was reduced to a WMD of −1.23 kg. BMI decreased with a WMD of −0.77 kg/m2 (95% CI, −1.01 to −0.52). BMI changes were not statistically significant at 3 months (WMD = −1.10 kg/m2), but they were statistically significant at 6 months (WMD = −0.67 kg/m2). CONCLUSIONS: The use of mHealth for obese adults showed a modest short-term effect on body weight and BMI. Although the weight loss associated with mHealth did not meet the recommendation of the Scottish Intercollegiate Guideline Network, which considers a reduction of approximately 5 to 10 kg of the initial body weight as a successful intervention. Well-designed RCTs are needed to reveal the effects of mHealth interventions.

Factors Affecting International Patient's Satisfaction with Korea Medical Services, Revisit and Recommendation Intention / 보건행정학회지

BACKGROUND: This study aims to analyze quality of and satisfaction with Korea medical services and identify factors affecting medical service satisfaction, revisit, and recommendation intention among international patients. METHODS: Secondary analysis of survey data conducted by Korea Health Industry Development Institute from June 10th to July 17th in 2013 was done using multiple regression and logistic regression analysis. The 191 international patients from 9 medical institutions in Seoul were enrolled. RESULTS: The results showed that international patients were satisfied with 85.6 points out of 100.0 points. International patients appraised higher in staff service rather than other services. Factors influencing medical service satisfaction were gender, religion, medical specialty, length of stay, and quality of medical services. Quality of medical service explained 29.8% of medical service satisfaction and especially, ‘doctor's care’ and ‘communication and patient respect‘ were significantly related to medical service satisfaction. Medical specialty had a significant influence on revisit intention. There were no statistically significant influencing factors of recommendation intention. Additionally, more satisfied patients were associated with higher revisit and recommendation intention. CONCLUSION: This study implies that quality of medical services is a critical factor for patient satisfaction and that satisfaction with medical services is an important factor for increasing revisit and recommendation intention among international patients. In addition, health care providers should consider cultural differences to enhance satisfaction with medical services for international patients. Therefore, multidimensional strategy is required to strengthen the cultural competency of healthcare providers.

Effect of Postpartum Outcomes in Mother's Upright Position During the Second Stage of Labor: Systematic Review

PURPOSE: The purpose of this study was to determine whether upright position is effective in labor through systematic review in randomized controlled trials. METHODS: We established the PICO (Patient-Intervention-Comparator-Outcome) strategy, and reviewed 282 literatures from national and international electronic databases, and finally selected 9 references based on inclusion and exclusion criteria. We evaluated the quality of references and carried out a meta-analysis. RESULTS: The maternal outcomes showed that the duration of their second-stage labor was 2.29 minutes shorter than that of the women in the recumbent position, and were less likely to have episiotomy. The other outcomes, including the mode of delivery, blood loss, hemoglobin level, use of oxytocin, use of analgesics, and perineal laceration, did not differ between the groups. The fetal heart rate abnormality occurred less than in the control group. The Apgar scores of the groups did not differ. CONCLUSION: There is evidence that an upright position in the second stage of labor reduces the duration of the second stage of labor, the incidence of episiotomy, and an abnormal fetal heart rate.

Health Promotion Researches Supported by the Korean Government

BACKGROUND: This study was carried out to examine the trends of government-supported health promotion research projects conducted in Korea over the past 12 years. METHODS: Research type, area of interest, organization, and expense of 726 research projects conducted from 1998 to 2009 were examined and the health promotion content analyzed. RESULTS: In Korea, 361 health policy researches (HPR) and 365 general health researches (GHR) were supported by the government during the defined time period. A total of 60.5 health promotion research were conducted annually with a total amount of 27.1 billion won provided (2.26 billion won per year). With the average research project lasting 8.5 months, HPR (7.7 months) projects were completed sooner than GHR (9.2 months). Those who majored in preventive medicine completed 177 research (24.4%), the most number of research projects, followed by public health (22.5%), and family medicine (15.6%). There were 641 health promotion research projects done mostly on policies, legal systems, and grasping current conditions, and only 85 (11.7%) clinical test research on the development or effects of health promotion programs. CONCLUSIONS: HPR have been increasing annually. However, our study could not be certain of how close the studies were to the government's health promotion policies. Furthermore, the main health promotion area, 'healthy living', was not researched as often as should be. Additionally, to improve applicability of the research projects, interdisciplinary cooperation should be promoted.

A Comparative Study on the Validity of Fall Risk Assessment Scales in Korean Hospitals

PURPOSE: The purpose of this study was to compare the validity of three fall risk assessment scales including the Morse Fall Scale (MFS), the Bobath Memorial Hospital Fall Risk Assessment Scale (BMFRAS), and the Johns Hopkins Hospital Fall Risk Assessment Tool (JHFRAT). METHODS: This study was a prospective validation cohort study in five acute care hospitals in Seoul and Gyeonggi-Do, Korea. In total, 356 patients over the age of 18 years admitted from December 2009 to February 2010 participated. The three fall risk assessment scales listed above were tested for sensitivity, specificity, positive predictive and negative predictive values. A receiver-operating characteristic (ROC) curve was generated to show sensitivities and specificities for predicting falls based on different threshold scores for considering patients at high risk. RESULTS: Based on the mean scores of each scale for falls, the MFS at a cut-off score of 50 had a sensitivity of 78.9%, specificity of 55.8%, positive predictive value of 30.8%, and negative predictive value of 91.4%, which were the highest values among the three fall assessment scales. Areas under the curve of the ROC curves were .761 for the MFS, .715 for the BMFRAS, and .708 for the JHFRAT. CONCLUSIONS: Accordingly, of the three fall risk assessment scales, the highest predictive validity for identifying patients at high risk for falls was achieved by the MFS.

Quality and Affecting Factor of Care for Patients Hospitalized with Pneumonia / 결핵및호흡기질환

BACKGROUND: The quality of care for patients with community acquired pneumonia needs to be improved; the factors affecting this care need to be analyzed. The objectives of this study were used to measure the performance of care processes of for patients with pneumonia and to determine those patient and hospital characteristics are associated with quality care. METHODS: The analysis was performed using data from 21 hospitals that had over 500 beds for 1,001 patients, who were sampled randomly. All patients were born before 31 December 1989, and discharged between the two months' August 2006 and October 2006. Performance process indicators were measured by respective hospital, and multivariate logistic regression was used to calculate associations between patients and hospital characteristics using 4 process indicators. RESULTS: Performance rates in timely assessment of oxygenation assessments and blood cultures, correct administration of antibiotic medications, and blood culture performed prior to initial antibiotics were 69.4%, 79.1%, 82.5% and 60.5%, respectively. Age had a positive affect on oxygenation assessment within 24 hours. Bed number, number of nurses per bed, annual number of emergency department visits, average percentage of beds filled, location and arrival time, and site were factors associated with process indicators. CONCLUSION: It is necessary to make up for the weak points in the process of care for patients with community acquired pneumonia, by enforcing quality assurance. To reduce performance rate variation among hospitals, improvement in care protocols is required for hospitals that have poor quality of care levels.