Who Are the People Willing to Pay for Physician Home Visits?

Background@#Since the recently announced Community Care Policy, there has been an opinion that Korea needs to establish an alternative medical model such as physician home visits. This study aimed to assess the need and willingness to pay (WTP) for physician home visits among the community-dwelling Korean older population and to determine the most important factors that influence older adults to decide to use a physician home visit service. @*Methods@#A total of 797 people aged 60 years or older who were randomly selected from a nationwide dataset using a multi-stage stratified sampling method answered a questionnaire on the need and WTP for physician home visits. @*Results@#A total of 39.3% of participants reported that they would like a physician home visit when they need help. Among older adults who needed physician home visits (n = 313), the WTP amount for physician home visits was 21,982 ± 17,546 KRW. Logit and Tobit regression analyses showed that the higher valuated need and WTP for physician home visits was associated with a lower level of physical/psychosocial functioning measured by EuroQol-five dimensions score (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01–1.27; P = 0.035) and a higher level of satisfaction when using community-based services such as public health centers (OR, 1.32; 95% CI, 1.02–1.72; P = 0.034), social welfare centers and Gyeong-ro-dang (OR, 1.61; 95% CI, 1.04–2.50; P = 0.033; β = 8.39; standard error, 3.63; P = 0.021). @*Conclusion@#This study provides evidence that the decision to pay for a physician home visit service is based upon the complex interactions among an individual's physical and psychosocial functioning, personal experiences of service utilization, and demographic factors. The value for physician home visits should be qualified based on the empirical data of WTP, which comes from a consumer-centered perspective.

The Relationship of Subclinical Hypothyroidism with Bone Mineral Density and Biochemical Bone Markers in Postmenopausal Women

BACKGROUND: It is well recognized that thyroid hormone stimulates bone turnover, increasing bone resorption, thus affecting bone mineral density, but few data are available on untreated subclinical hypothyroidism. The aim of this study was to examine whether bone mineral density is increased in postmenopausal subclinical hypothyroidism patients compared with postmenopausal normal thyroid function women, and to evaluate the relationship between thyroid hormones (TSH, FT(4)) and bone mineral density or various biochemical markers of bone metabolism. METHODS: This was a cross sectional study of 132 postmenopausal women aged from 51 to 70 who undertook health screening program in Pundang CHA general hospital from 1996 to 2001. They were divided into two groups; subclinical hypothyroidism group (n=52) and normal thyroid function group (n=80) matched by age. RESULTS: The total bone mineral density was significantly increased in the subclinical hypothyroid group than in the normal group (P<0.05). The serum osteocalcin was lower in the subclinical hypothyroidism group (P<0.05), but neither the alkaline phosphatase nor the deoxypyridinoline showed any significance. For all participants in this study, TSH, but not FT(4), exhibited significant correlation with the total bone mineral density (r=0.188, P<0.05), and with the osteocalcin (r=-0.191, P<0.05). Multiple regression analysis identified the TSH as an independent predictor of the total bone mineral density (beta=0.0410; P< 0.05). CONCLUSION: This study indicated that subclinical hypothyroidism is one of the factors which can elevate bone mineral density in postmenopausal women.

Enhancement of Human Monocyte Activities against Aspergillus fumigatus by Interleukin-15 / 대한의진균학회지

BACKGROUND: Despite recent advances in antifungal chemotherapy, invasive aspergillosis remains an important cause of morbidity and mortality in immunocompromised patients. Interleukin-15 (IL-15) is a cytokine that is known to enhance antifungal activities of monocytes against Candida albicans. OBJECTIVE: The purpose of this study is to investigate the potentials of IL-15 to enhance antifungal activities of monocytes against Aspergillus fumigatus. METHODS: Peripheral blood monocytes from healthy adults were incubated with 0, 1, 10, 100 ng/ml of IL-15 for 1, 2, and 4 days. Then, the ability of IL-15 to elicit the production of superoxide anion, the damage of hyphae by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, and the killing ability of Aspergillus fumigatus conidia was investigated. RESULTS: Incubation of peripheral blood monocytes with 100 ng/ml of IL-15 enhanced hyphal damage after 2 days (p<0.05), conidicidal activity from the first day (p<0.05), and increased the production of superoxide anion (O2- ) in response to phorbol myristate acetate. CONCLUSION: Our results indicate that IL-15 augments the microbicidal activity of human monocytes against Aspergillus fumigatus.