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Purpose@#This study aimed to examine the adequacy of current nurse staffing levels by identifying nursing activities and workload. @*Methods@#The study used a mixed-method design. A nursing activity survey was conducted using the work sampling method over 2 working days with 119 general ward nurses. A focus group interview was conducted with 12 nurses. Quantitative and qualitative data were analyzed using SPSS 20.0 and content analysis, respectively. @*Results@#The most amount of time was spent on medication (in direct nursing) and electronic medical record documentation (in indirect nursing). The appropriate nurse-to-patient ratio is 1:7.7 for the day shift, 1:9.0 for the evening shift, and 1:11.9 for the night shift. However, the current nurse-to-patient ratio is 1:9.4, 1:11.0, and 1:13.8 for the day, evening, and night shifts, respectively. Therefore, the current nurse staffing level is insufficient for the workload. In the focus group interview, the main reasons cited for being unable to complete tasks within working hours were communication and coordination, and the nursing electronic medical record. The essential nursing activities of basic nursing and emotional support were overlooked owing to a heavy workload. Therefore, an adequate nurse staffing level should be higher than the measured quantitative workload. @*Conclusion@#These results suggest the general wards of tertiary hospitals should evaluate the adequacy of their current nurse staffing and allocate sufficient nurses to improve patient safety and nursing care quality.
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Background@#Since the emergence of hypervirulent strains of Clostridioides difficile, the incidence of C. difficile infections (CDI) has increased significantly. @*Methods@#To assess the incidence of CDI in Korea, we conducted a prospective multicentre observational study from October 2020 to October 2021. Additionally, we calculated the incidence of CDI from mass data obtained from the Health Insurance Review and Assessment Service (HIRA) from 2008 to 2020. @*Results@#In the prospective study with active surveillance, 30,212 patients had diarrhoea and 907 patients were diagnosed with CDI over 1,288,571 patient-days and 193,264 admissions in 18 participating hospitals during 3 months of study period; the CDI per 10,000 patientdays was 7.04 and the CDI per 1,000 admission was 4.69. The incidence of CDI was higher in general hospitals than in tertiary hospitals: 6.38 per 10,000 patient-days (range: 3.25–12.05) and 4.18 per 1,000 admissions (range: 1.92–8.59) in 11 tertiary hospitals, vs. 9.45 per 10,000 patient-days (range: 5.68–13.90) and 6.73 per 1,000 admissions (range: 3.18–15.85) in seven general hospitals. With regard to HIRA data, the incidence of CDI in all hospitals has been increasing over the 13-year-period: from 0.3 to 1.8 per 10,000 patient-days, 0.3 to 1.6 per 1,000 admissions, and 6.9 to 56.9 per 100,000 population, respectively. @*Conclusion@#The incidence of CDI in Korea has been gradually increasing, and its recent value is as high as that in the United State and Europe. CDI is underestimated, particularly in general hospitals in Korea.
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The expansion of antiretroviral therapy (ART) has resulted in a reduction in numbers of new human immunodeficiency virus (HIV) infections and acquired immunodeficiency syndrome (AIDS)-related deaths worldwide, except in some regions. As people with HIV live long and healthy lives, their health issues are also changing. In this review, we briefly summarize the global HIV epidemic and examine the changing trends in the epidemiology of HIV in Korea.Current Concepts: Since 2013, more than 1,000 new infections have been reported in Korea every year, and after reaching its peak at 1,223 in 2019, approximately 1,000 were reported each year during the coronavirus disease 2019 pandemic. Most newly infected people were men, and the proportion of young people aged 20 to 40 years, men who have sex with men, and foreigners has been steadily increasing. AIDS was the most common cause of death, and cancer, chronic diseases, and suicide were also important causes of death in Korea.Discussion and Conclusion: Achieving sustained ART and viral suppression is approaching the UNAIDS 95-95-95 targets in Korea, but additional research and efforts are required to reduce late presentation and scale-up of HIV diagnosis. Targeted and coordinated prevention programs to prevent HIV among people from key populations are also needed. Additionally, supportive services for older people with HIV, including cancer screening and chronic disease management, and multifaceted efforts to reduce stigma and discrimination against people with HIV are needed in Korea.
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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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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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The Yoon Suk Yeol administration is promoting the “Global Leap of the Biohealth Industry” as one of its 120 key national policies.Recently, the administration has been showing its commitment by establishing various strategies and presenting blueprints for policy implementation. However, the results felt on the ground are still not sufficient. The biohealth industry is a difficult field to generate policy effects because the related regulations are intricately intertwined and the diverse administrative tasks are scattered in various government departments, where inter-departmental interests differ. To solve this problem, an innovative governance system should be established. In order for the government’s recent approach to establish a government-wide control tower to be effective, it should demonstrate a proactive policy commitment and be given practical power to coordinate the interests between departments.
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The issue of increasing the number of physicians is emerging. Because the physician workforce is a critical component of the health care system, and substantial costs are involved in training personnel, a cautious approach is required. The demand to increase the number of physicians is based on the contention that there are difficulties in accessing essential health services and the need to prepare for future demands such as fostering physician-scientists. However, simply increasing the number of physicians is not an appropriate approach to address these demands, especially considering that the effects of such an increase will appear 10 years later. Moreover, it is concerned that the current argument for increasing the physician workforce is intertwined with political interests. When considering the impact on the health care system, decisions regarding the expansion of the physician workforce should be based on evidence. Additionally, rather than temporarily responding to social issues, it is expected that a governance system will be established to continuously discuss and decide on fostering medical personnel.
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As the industrial paradigm shift, often condensed as the “4th Industrial Revolution,” gains momentum, there is a growing need to actively introduce digital healthcare into the medical field. The new administration announced its commitment to become a global leader in the biohealth and digital healthcare sector. To fulfill this pledge, preemptive policy leadership and attention from the government are required. The recent issue of legislating non-face-to-face medical care suggests that introducing digital healthcare goes beyond simply adopting new technologies. Incorporating digital healthcare involves changing the existing healthcare delivery process and coordinating the roles of stakeholders. To successfully change the structure of the medical industry, a mid- to long-term roadmap should be meticulously organized and promoted. Policy efforts are needed to resolve conflicts and lead to compromises through continuous communication with interest groups.
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As part of efforts to internally strengthen the research ethics capacity of the Korean Academy of Health Policy and Management, we have compiled research ethics issues that are frequently encountered in public health researches. Firstly, when reusing research reports or dissertations as papers, efforts should be made to avoid unfair duplicate publication. Compliance with the institutional review board exemption process is required, and additional efforts should be devoted during the text recycling process to prevent self-plagiarism or unjust duplicate publication.
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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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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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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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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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Epidemiological information on hepatitis A among people living with HIV (PLHIV) in Korea is scarce. This retrospective study was performed at a tertiary care hospital and included 756 PLHIV with anti- hepatitis A virus (HAV) IgG tests. Between 2012 and 2021, the age at antiHAV IgG seroconversion is gradually delayed, and the proportion of individuals susceptible to HAV infection increased among adult PLHIV in Korea. The independent risk factors for HAV seropositivity were female sex and HBs antigen (Ag) positivity. Therefore, HAV vaccination is highly recommended for young PLHIV, especially for women or HBsAg-positive individuals.
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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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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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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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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@#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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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.