Evaluation of the Public Health Emergency Response to the COVID-19 Pandemic in Daegu, Korea During the First Half of 2020 / 예방의학회지

Objectives@#This study evaluated the response in Daegu, Korea to the first wave of the coronavirus disease 2019 (COVID-19) pandemic according to a public health emergency response model. @*Methods@#After an examination of the official data reported by the city of Daegu and the Korea Centers for Disease Control and Prevention, as well as a literature review and advisory meetings, we chose a response model. Daegu’s responses were organized into 4 phases and evaluated by applying the response model. @*Results@#In phase 1, efforts were made to block further transmission of the virus through preemptive testing of a religious group. In phase 2, efforts were concentrated on responding to mass infections in high-risk facilities. Phase 3 involved a transition from a high-intensity social distancing campaign to a citizen participation–based quarantine system. The evaluation using the response model revealed insufficient systematic preparation for a medical surge. In addition, an incorporated health-related management system and protection measures for responders were absent. Nevertheless, the city encouraged the participation of private hospitals and developed a severity classification system. Citizens also played active roles in the pandemic response by practicing social distancing. @*Conclusions@#This study employed the response model to evaluate the early response in Daegu to the COVID-19 pandemic and revealed areas in need of improvement or maintenance. Based on the study results, creation of a systematic model is necessary to prepare for and respond to future public health emergencies like the COVID-19 pandemic.

Complications and Socioeconomic Costs Associated With Falls in the Elderly Population

OBJECTIVE: To explore the incidence, characteristics, complications and socioeconomic impacts associated with falls in community-dwelling elderly. METHODS: From September 1, 2015 to October 12, 2015, a questionnaire-based survey was conducted involving a total of 2,012 elderly who lived in Guro-gu (Seoul), Yeongdeungpo-gu (Seoul), Yangpyeong-gu (Gyeonggi-do), Dalseong-gu (Daegu), and Jung-gu (Daegu). The subjects were interviewed using a structured questionnaire to obtain demographic characteristics and comprehensive falling histories. The socioeconomic cost related to falls was estimated using the statistical data provided by the Health Insurance Review and Assessment Service. RESULTS: Falls were recorded in 666 out of the 2,012 subjects (33.1%) during the past year. Frequent falls occurred during December, in the afternoons, when the floor was slippery. The most common injuries included the low back and the most common injury type was sprain. The total direct costs related to falls involving the 2,012 subjects were 303,061,019 KRW (Korean won). The average medical cost related to falls in the 2,012 subjects was 150,627 KRW and the average medical cost of 666 subjects who experienced falls was 455,047 KRW. Estimates of the total population over the age of 60 years showed that the annual direct costs associated with falls in Korea over the age of 60 years were about 1.378 trillion KRW. CONCLUSION: This study was conducted to explore the incidence, characteristics, complications, and socioeconomic impacts of falls in community-dwelling elderly. This study is expected to be used as a source of basic data for the establishment of medical policy for the elderly and the development of a fall prevention program for the elderly in Korea.

Exploring Nursing Intention, Stress, and Professionalism in Response to Infectious Disease Emergencies: The Experience of Local Public Hospital Nurses During the 2015 MERS Outbreak in South Korea

PURPOSE: This study aimed to examine levels of stress and professionalism of nurses who provided nursing care during the 2015 Middle East respiratory syndrome outbreak based on their experience, to investigate the nurses' intention to respond to possible future outbreaks in relation to their experience during the outbreak, and to determine the relationship between the outbreak experience and nursing intention considering stress and professionalism. METHODS: A self-administered questionnairewas designed based on modifications of related questionnaires, and used to assess levels of stress, professionalism, and nursing intention according to participants' experiences during the outbreak. Multiple regression analysiswas used to examine the relationship between the outbreak nursing experience and nursing intention considering stress and nursing professionalism. RESULTS: The overall stress, professionalism, and nursing intention scores for the firsthand experience group were 33.72, 103.00, and 16.92, respectively, whereas those of the secondhand experience group were 32.25, 98.99, and 15.60, respectively. There were significant differences in professionalism and nursing intention scores between the groups (p = .001 and p < .001, respectively). The regression analysis revealed that the regression estimate between stress and nursing intention was B(SE) = −0.08(0.02), beta = −0.21, p < .001 and the regression estimate between professionalism in nursing and nursing intention was B(SE) = 0.05(0.01), beta = 0.23, p < .001. CONCLUSIONS: Prior outbreak nursing experience was importantly associated with intention to provide care for patients with a newly emerging infectious disease in the future considering stress and professionalism. Gathering information about nurses' experience of epidemics and regular assessment of job stress and professionalism are required.

A Survival Analysis of Gastric or Colorectal Cancer Patients Treated With Surgery: Comparison of Capital and a Non-capital City / 예방의학회지

OBJECTIVES: The objective of the present study was to compare prognosis of patients with gastric or colorectal cancer according to places where they received surgeries. METHODS: The cancer patients underwent surgeries in sampled hospitals located in Daegu were matched 1:1 to the patients who visited sampled hospitals in Seoul using propensity score method. After the occurrences of death were examined, Kaplan-Meier method was used for survival analysis and the log-rank test was performed to compare the survival curves. RESULTS: A total of six out of 291 gastric cancer patients who had surgeries in Daegu died (2.1%) and ten deaths (3.4%) occurred from patients went Seoul hospitals. Out of 84 gastric cancer patients who had chemotherapy after surgeries in Daegu, 13 (15.5%) patients died while 18 (21.4%) deaths occurred among patients underwent surgeries in Seoul. Six deaths (6.9%) out of 87 colorectal cancer patients who had surgeries in Daegu were reported. Five patients (5.7%) died among the patients underwent surgeries in Seoul. Among the colorectal cancer patients with chemotherapy after surgeries, 13 patients (12.4%) who visited hospitals in Daegu and 14 (13.3%) patients who used medical centers in Seoul died. There were no significant differences according to places where patients used medical services. CONCLUSIONS: The result of this study is expected to be used as basic data for policy making to resolve centralization problem of cancer patients and to help patients to make rational choices in selection of medical centers.

Enrollment in Private Medical Insurance and Utilization of Medical Services Among Children and Adolescents: Data From the 2009-2012 Korea Health Panel Surveys / 예방의학회지

OBJECTIVES: The purposes of this study were to examine the status of children and adolescents with regard to enrollment in private medical insurance (PMI) and to investigate its influence on their utilization of medical services. METHODS: The present study assessed 2973 subjects younger than 19 years of age who participated in five consecutive Korea Health Panel surveys from 2009 to 2012. RESULTS: At the initial assessment, less than 20% of the study population had not enrolled in any PMI program, but this proportion decreased over time. Additionally, the number of subjects with more than two policies increased, the proportions of holders of indemnity-type only ('I'-only) and of fixed amount+indemnity-type ('F+I') increased, whereas the proportion of holders with fixed amount-type only ('F'-only) decreased. Compared with subjects without private insurance, PMI policyholders were more likely to use outpatient and emergency services, and the number of policies was proportionately related to inpatient service utilization. Regarding out-patient care, subjects with 'F'-only PMI used these services more often than did uninsured subjects (odds ratio [OR], 1.69), whereas subjects with 'I'-only PMI or 'F+I' PMI utilized a broad range of inpatient, outpatient, and emergency services relative to uninsured subjects (ORs for 'I'-only: 1.39, 1.63, and 1.38, respectively; ORs for 'F+I': 1.67, 2.09, and 1.37, respectively). CONCLUSIONS: The findings suggest public policy approaches to standardizing PMI contracts, reform in calculation of premiums in PMI, re-examination regarding indemnity insurance products, and mutual control mechanisms to mediate between national health insurance services and private insurers are required.

Effectiveness of Participatory Action-Oriented Training (PAOT) Methods for the Management Metabolic Syndrome in Korean Manufacture Workers for Three-years / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to examine the effectiveness of Participatory Action-Oriented Training (PAOT) programs in korean manufacture workers with metabolic syndrome for three years. METHODS: A total of 890 workers with risks of metabolic syndrome were recruited from one workplace. The experimental group (n=51) received PAOT program for the preventive management on metabolic syndrome, while the control group (n=51) received conventional program. RESULTS: In the experimental group who participated in PAOT program, percentage of achieved action plans was 73.4% at three months, 75.8% at six months, 82.8% at three years. After three years, the rate of risk factor in the experimental group has significantly decreased from 1.94±1.77 to 0.76±1.25 for moderate exercise, and from 1.72±2.01 to 1.04±1.59 for the strenuous exercise. Systolic and diastolic blood pressure has significantly decreased from 125.06±11.83 to 117.65±19.94, from 83.45±13.38 to 76.39±8.09 mmHg. In addition, risk factor score also decreased from 3.31±0.61 to 1.41±0.89. CONCLUSION: To improve the effectiveness of PAOT program for the management of risk factors of metabolic syndrome, there is a need to continue implement programs and analyze the long-term effects are required in the workplace.

Effects of Social Support and Class Cohesiveness on Health-related Quality of Life in Middle School Students / 農村醫學 地域保健

OBJECTIVES: Health-related quality of life (HRQoL) is an important outcome for middle school students. This study was designed to illustrate the effect of social support and class cohesiveness associated on HRQoL. METHODS: The subjects comprised 516 students from three middle schools in Daegu, South Korea that responded to a self-administered questionnaire in February 2014. The purposes of the questionnaire were explained to the subjects. RESULTS: The total mean of HRQoL was 81.1+/-15.3. Social functioning showed the highest score of 87.1+/-15.3 and emotional functioning showed the lowest score of 73.8+/-21.5. Teacher support (B=3.185, p=0.001) had a significant effect on the physical health summary scores. Class cohesiveness (B=2.237, p=0.022), friendships (B=5.102, p<0.001) and teacher support (B=2.498, p=0.006) had a significant effect on the psychosocial health summary scores. Finally, class cohesiveness (B=2.137, p=0.016), friendships (B=4.133, p<0.001) and teacher support (B=2.670, p=0.001) had a significant effect on the overall scores. CONCLUSION: The results of this study provide a basis for the development of strategies to improve health-related quality of life for middle school students, namely that relevant programs should be based on the improvement of social support and class cohesiveness.

Incidence of and Factors for Self-reported Fragility Fractures Among Middle-aged and Elderly Women in Rural Korea: An 11-Year Follow-up Study / 예방의학회지

OBJECTIVES: This community-based cohort study was performed to investigate the incidence of and factors related to self-reported fragility fractures among middle-aged and elderly women living in rural Korea. METHODS: The osteoporosis cohort recruited 430 women 40 to 69 years old in 1999, and 396 of these women were followed over 11 years. In 1999, questionnaires from all participants assessed general characteristics, medical history, lifestyle, menstrual and reproductive characteristics, and bone mineral density. In 2010, self-reported fractures and the date, site, and cause of these fractures were recorded. Cox proportional hazards models were used to calculate hazard ratios (HRs). RESULTS: Seventy-six participants among 3949.7 person-years experienced fragility fractures during the 11-year follow-up. The incidence of fragility fractures was 1924.2 per 100 000 person-years (95% confidence interval [CI], 1491.6 to 2356.8). In the multivariate model, low body mass index (HR, 2.66; 95% CI, 1.13 to 6.24), a parental history of osteoporosis (HR, 2.03; 95% CI, 1.18 to 3.49), and postmenopausal status (HR, 3.50; 95% CI, 1.05 to 11.67) were significantly related to fragility fracture. CONCLUSIONS: Fracture prevention programs are needed among postmenopausal, rural, Korean women with a low body mass index and parental history of osteoporosis Korea.

Incidence of Metabolic Syndrome and Relative Importance of Five Components as a Predictor of Metabolic Syndrome: 5-Year Follow-up Study in Korea

The aim of this study was to describe the incidence of metabolic syndrome and to identify five components as metabolic syndrome predictors. The final study included 1,095 subjects enrolled in a rural part of Daegu Metropolitan City, Korea for a cohort study in 2003. Of these, 762 (69.6%) subjects had participated in the repeat survey. During the five-year follow-up, incidence density was significantly higher for women than for men (men, 30.0/1,000 person-years; women, 46.4/1,000 person-years). In both men and women, incidence of metabolic syndrome showed a significant increase with increasing number of metabolic syndrome components at baseline. Compared with individuals presenting none of components at baseline, relative risks were increased 1.22 (men; 95% CI, 0.43-3.51), 2.21 (women; 95% CI, 0.98-4.97) times more for individuals with one component of metabolic syndrome and 5.30 (men; 95% CI, 2.31-12.13), 5.53 (women; 95% CI, 2.78-11.01) times more for those who had two components. In multivariate analysis, the most powerful risk factor for metabolic syndrome was abdominal obesity in men and low HDL-cholesterol in women (adjusted relative risk, 3.28, 2.53, respectively). Consequently, finding a high risk group for metabolic syndrome according to gender and prevention of metabolic syndrome through lifestyle modification are essential.

Factors Related to Increasing Trends in Cigarette Smoking of Adolescent Males in Rural Areas of Korea / 예방의학회지

OBJECTIVES: Cigarette smoking prevalence among adolescent males in rural areas of Korea has increased in recent years. The aim of this study was to explore the factors related to increasing trends in cigarette smoking among adolescent males living in rural areas. METHODS: The raw data from the Korea Youth Risk Behavior Web-based Survey from 2006 to 2009 were used. Data were analyzed by using the method of complex survey data analysis considering complex sampling design. Multiple logistic regression models were used to explore the factors affecting cigarette smoking. We evaluated the linear time trends in the prevalence of factors that were related to current smoking status and the linear time trends in cigarette smoking in groups stratified by the exposure to each factor using logistic regression models. Finally, we examined the contributions of the factors to the time trends in cigarette smoking by adjusting for each of those factors in the baseline regression models and changes in the adjusted odds ratio by survey year. RESULTS: A statistically significant increasing trend in smoking was observed after adjusting for the factors affecting cigarette smoking. Significant factors related to cigarette use were perceived stress, experience with depression, current alcohol drinking, exposure to secondhand smoke, and academic performance. The factor related to increasing trends in cigarette smoking was academic performance. CONCLUSIONS: Stress about academic performance is an important factor affecting the increase in cigarette smoking among adolescent males in a rural area of Korea.

Development and Evaluation of a Community Staged Education Program for the Cardiocerebrovascular Disease High-risk Patients / 農村醫學 地域保健

OBJECTIVE: This study was conducted to evaluate an education program for cardiocerebrovascular high-risk patients. METHODS: This program was developed according to Tyler's model for curriculum development. To evaluate the effects of this program, we measured clinical outcome change (weight, waist circumference, systolic blood pressure, diastolic blood pressure) and behavior change stages (checking blood pressure, blood sugar levels, doing physical activity, consistent maintenance of food intake, eating low amounts of salt, abstention from tobacco and alcohol) before and 4 weeks after participation in the education program. The group of subjects consisted of High-risk group patients who attended basic program(32 patients), and staged program(37 patients) during KHyDDI meetings from Oct. 2009 to May 2010. RESULTS: The staged educational program was developed three aspects(disease, nutrition and exercise)and three stages(basic, in-depth and individual education). In the staged education program, the evaluations were made by measuring clinical outcome and stage of behavior before and after education. Significant differences were found in waist circumference, systolic blood pressure, diastolic blood pressure, consistent maintenance of food intake(p<0.05), and eating low salt(p<0.001) and their self efficacy. CONCLUSION: In the practice-oriented staged education program, significant differences were found in the clinical outcomes and stage of behavior before and after education. Possible limitations of the study include the small number of participating subjects and the short follow-up management period, but the results indicate that continued application of this program could contribute to the prevention of cardiocerebrovascular diseases for the elderly patients with long periods of chronic diseases.

The Effect of Participatory Approach Program for Cardiovascular Disease Prevention in the Workplace / 대한산업의학회지

OBJECTIVES: The purpose of this study was to develop a program applying participatory action-oriented training (PAOT) methods for the management of cardiovascular disease risk factors and to assess its effectiveness in the workplace. METHODS: The cardiovascular disease risk factors of 817 workers in the workplace were assessed, and periodic health examination was conducted. Sixty-four workers (7.8%) were selected as a moderate-risk group and high risk group, and performed the participatory approach program for cardiovascular disease preventive management. RESULTS: The sixty-four workers who participated in the participatory approach program made a total of 246 action plans, 3.8 action plans per person and 115 action plans were achieved after three months, so that 46.7% of action plans have been achieved. In the intervention group that participated in the program, the rate of smoking decreased from 36.2% to 8.6% and systolic and diastolic blood pressure significantly decreased from 140.0+/-9.4 mmHg to 134.2+/-12.3 mmHg and from 92.6+/-7.1 mmHg to 80.0+/-9.8 mmHg respectfully. In addition, risk factor score also decreased by 0.3, whereas the control group who did not participate in the program also showed a significant reduction in the mean systolic and diastolic blood pressure. Regular exercise increased from 8.5% to 16.0%. CONCLUSIONS: To improve the effectiveness of the participatory approach program for the management of cardiovascular disease risk factors, the need to continues implementing programs and analysis of the long-term effects are required.

Prevalence of Diabetes Mellitus and Prediabetes in Dalseong-gun, Daegu City, Korea

BACKGROUND: The aim of the present study was to determine the population-based prevalence of diabetes mellitus (DM) and prediabetes in a rural district of Daegu City, Korea. METHODS: Between August and November 2003, a community-based health survey of adults aged 20 years and older was performed in the rural district of Dalseong-gun in Daegu City. A total of 1,806 of all eligible individuals agreed to participate. Fasting plasma glucose was measured in all participants. Two hour oral glucose tolerance was measured in the 1,773 participants for whom there was neither an established diagnosis of DM nor evidence of DM according to fasting glucose levels. The prevalence of DM and prediabetes was determined according to the 2003 criteria of the American Diabetes Association. Subjects with prediabetes were classified into one of three categories of glucose intolerance: isolated impaired fasting glucose (IFG); isolated impaired glucose tolerance (IGT); or combined IFG and IGT. RESULTS: The prevalence of DM was 12.2%. The highest prevalence rates were observed in subjects in their seventies. A total of 34.7% of all subjects who were assigned a diagnosis of DM in the present study had not been diagnosed previously. The prevalence of prediabetes was 22.7%. The highest prevalence rates were observed in subjects in their fifties. CONCLUSION: The present study identified prevalence rates of 12.2% for DM (age-standardized prevalence rate [ASR], 6.8%), and 22.7% for prediabetes (ASR 18.5%). These results emphasize the need for community health promotion strategies to prevent or delay the onset of DM in individuals with prediabetes.

Incidence and Estimation of Socioeconomic Costs of Falls in the Rural Elderly Population

BACKGROUND: This study was done to delineate the incidence and socioeconomic cost of fall-related injuries in the rural elderly population. METHODS: From February 1, 2010 to March 31, 2010, a questionnaire-based interview survey was conducted on 2,295 persons 65 years or older living in rural communities (1 Myoen and 1 Eup of Gyoengsangnam-do). The socioeconomic cost due to falls in the elderly in 2009 was estimated using direct and indirect costs. The direct costs included medical costs covered by health insurance and those not covered by insurance. The indirect costs included nursing care, diapers, transportation, health function foods, medical assistance device, and productivity loss. RESULTS: Of the 2,295 subjects, 735 (32.0%) had suffered from fall-related injuries during the previous year. The direct costs of these injuries calculated to be 596,466,000 Won (56.6%). The indirect costs was 458,081,000 Won (43.4%). Of the indirect cost, loss of productivity was 274,993,000 Won, health function foods was 65,531,100 Won, nursing care was 48,755,000 Won, and transportation was 43,122,000 Won. The total socioeconomic costs (direct costs+indirect costs) of the study subjects was 1,054,547,000 Won. The socioeconomic costs per person was 459,500 Won for the total number of study subjects and 1,435,000 Won for the 735 subjects. CONCLUSION: When the above calculated socioeconomic cost for the 2,295 subjects is applied to the 1,067,262 Korean rural elderly population in 2009, the socioeconomic costs owing to fall-related injuries can be estimated to as much as 343,614,988,000 Won. In the future, the socioeconomic costs due to injuries such as falls is expected to increase as the elderly population increases. Therefore, injury prevention programs and studies for reducing the socioeconomic costs in the elderly community are needed.

Bicycle Riding: Impact on Lower Urinary Tract Symptoms and Erectile Function in Healthy Men / 대한배뇨장애요실금학회지

PURPOSE: Recently, reports in the mass media have implicated that bicycle riding increases the risk of erectile dysfunction and prostatic diseases. So, we evaluate the impact of bicycle riding on erectile function and lower urinary tract symptoms (LUTS) in healthy general men. METHODS: From 26 June 2010 to 20 July 2010, we investigate degree of LUTS (voiding and storage symptoms), using International Continence Society-male Questionnaire (ICS-mQ) and erectile function using International Index of Erectile Function-5 Questionnaire (IIEF-5) in 5 work places (personnel of public office, hospital, university, etc.) of which bicycle riding club members were doing active club activities. Respondents, who participated in club activities for 6 months and longer, were classified as the bicycle club (142 men; age, 44.02+/-8.56). Ones who do not ride bicycles were classified as the control group (83 men; age, 42.13+/-7.85). People who were having the history of urological and other chronic diseases (diabetes, vascular disease, heart disease, etc) were excluded from both groups. RESULTS: Bicycle club is not significantly associated with increased prevalence of LUTS (bicycle club, 2.1 to 57.7% control, 4.8 to 73.5%) and erectile dysfunction (bicycle club, 46.1% control, 55.4%). The total mean score (storage/voiding/erectile function) of bicycle club (13.93+/-1.95/11.14+/-3.49/20.46+/-5.30) were not significantly different from control (14.35+/-2.49/11.52+/-3.38/20.40+/-4.07) (P=0.190 to 0.968). CONCLUSIONS: These results suggested that bicycle riding as exercise or hobby has no negative effect on LUTS and erectile function in healthy general men, although this research data were limited to the questionnaire analysis.

Accuracy of Death Certificates Completed by Medical Students / 農村醫學 地域保健

OBJECTIVES: The purpose of this research was to evaluate the ability of completing death certificates among medical students. METHODS: The self-administered questionnaires were completed, during May to August 2007, by 380 medical students in senior. The questionnaire was composed of 10 cases to write the death certificate. The cause-of-deaths written by students were compared with the gold standards and their errors in the certificates also evaluated. RESULTS: Mean agreement score for 10 underlying cause-of-deaths completed on the lowest line of part I in the death certificate (UC1) was 4.8+/-1.7, and for underlying cause-of-death selected by a coder of the death certificates (UC2) was 5.6+/-1.5. The UC1 and UC2 were significantly higher among the students having the case-oriented education for death certificate than others. For the major errors in the certificates completed by students, the students having the error with no antecedent cause were highest, the error with two or more conditions secondly highest. Mean number of errors was significantly lower in the case-oriented education group than others. CONCLUSIONS: Errors are common in the death certificates completed by medical students in senior. The accuracy of death certification may be more improved with the case-oriented education than the traditional method.

Educational Needs of Elderly Hypertensive or Diabetes Patients and Educators for Education Program Development of Cardiocerebrovascular High-risk Group / 農村醫學 地域保健

OBJECTIVES: This study was conducted to examine the educational needs of elderly hypertensive or diabetes patients and educators for the education program development of cardiocerebrovascular high-risk group in community. METHODS: This study was conducted with 60 hypertensive or diabetes patients aged 65 years or above (cardiocerebrovascular high-risk group) who had registered KHyDDI(Korea Hypertension Diabetes Daegu Initiative) Project and attended Hypertension-Diabetes Intervention Center Program, and with 44 educators in the center between June and August, 2009. Data were collected using questionnaires including general characteristics, educational objectives, curriculum, contents, and methods. RESULTS: The major findings of this study were as follows: In education methods, cardiocerebrovascular high-risk group and educators both preferred small-grouped(5-9 persons) or individual education, 30min-1 hour, 50%-50% of theory-practice ratio, 3 months of education. In education contents, both groups needed all the suggested contents. Five categories would be suggested for the development of education program. The first category was that there was no significant difference between cardiocerebrovascular high-risk group's needs and knowledge. The second was category of low knowledge level in cardiocerebrovascular high-risk group's knowledge. The repeated education would be necessary for this category. The third was category with large standard deviation in cardiocerebrovascular high-risk group's knowledge. Individual education would be necessary for this category. The fourth category was that there was significant difference between cardiocerebrovascular high-risk group's knowledge and knowledge assessed by educators. The improvement of educator's education skill would be necessary for this category. The fifth category was that there was significant difference between cardiocerebrovascular high-risk group and educator's needs. CONCLUSIONS: Small group or individualized and staged education reflecting above cardiocerebrovascular high risk group and educators' needs should be developed for more effective education to prevent and manage the cardiocerebrovascular disease.

Factors that Affect Medication Adherence in Elderly Patients with Diabetes Mellitus / 당뇨병

BACKGROUND: This study was conducted to evaluate the factors affecting medication adherence in geriatric diabetic patients treated at private clinics and tertiary hospitals. We compared the factors affecting medication adherence between these two patient groups. METHODS: We included 108 diabetic patients older than 65 years treated at one tertiary hospital and 157 patients older than 65 years treated at two private clinics. We conducted an interview survey based on the Health Belief Model, and used a questionnaire that included the self-efficacy variable. For the medication adherence, Morisky's self-report was used. RESULTS: The medication adherence based on Morisky's self-report was significantly higher in tertiary hospital patients (61.1%) compared to private clinic patients (43.2%) (P < 0.01). The results showed that drug storage and self-efficacy were factors affecting adherence to medication in tertiary hospital patients (P < 0.05). The adherence was high in cases of proper drug storage (odds ratio [OR], 5.401) and in cases with high self-efficacy (OR, 13.114). In private clinic patients, financial level (P < 0.05), recognition of the seriousness of diabetes complications (P < 0.05) and self-efficacy (P < 0.01) were associated with medication adherence. The medication adherence was significantly lower in patients whose financial state were moderate than those with lower (OR, 0.410), and medication adherence was significantly higher in patients who had higher perceived severity (OR, 2.936) and in patients with higher self-efficacy (OR, 4.040). CONCLUSION: Different strategies should be used to increase medication adherence in geriatric diabetic patients, depending on institutions whether they are treated.

Job Stress, Job Satisfaction and Occupational Commitment Among Korean Emergency Physicians

PURPOSE: Recent reports suggest that many professionals, including emergency physicians, suffer from job stress and psychosocial stress. Emergency physicians also report a high premature attrition rate. Our goal was to investigate the levels of job and psychosocial stress and the relationship between these stresses and abandonment of their own specialty. METHODS: Data was collected using a cross-sectional mail survey with a self-administered questionnaire. The questionnaire included 49 questions in scales relating to job stress, job satisfaction and plans for their remaining years in their specialty. Three hundred and forty-two emergency physicians participated in this study and completed the questionnaire RESULTS: Among the 342 questionnaires, 132(48.4%) were returned. Multivariate analysis of variance revealed statistically significant differences in job stress and psychosocial stress between academic emergency physicians and clinical emergency physicians. The average scores for job stress, job satisfaction and psychosocial stress among emergency physicians were, respectively, 3.35+/-0.57, 2.93+/-0.50 and 2.33+/-0.78. Mean levels of job stress and psychosocial stress were higher among academic emergency physicians. Job satisfaction and occupational commitment were also higher among academic emergency physicians. Variables such as patient load, working hours per week, and night shifts proved unimportant. Of clinical emergency physicians, 54% planned on leaving their specialty within ten years. CONCLUSION: Job stress and psycosocial stress of academic emergency physicians were higher, but job satisfaction and occupational commitment were higher. Job stress and psycosocial stress of clinical emergency physicians were lower, but premature attrition rate were higher.

The Factors Implicated When an Individual Starts to Smoke Again After a 6 Month Cessation / 예방의학회지

OBJECTIVES: This study was conducted to examine the factors implicated when people start smoking again after a 6 month cessation, and was carried out at the smoking cessation clinic of a public health center. METHODS: The study subjects were 191 males who had attended the smoking cessation clinic of a public health center for 6 months in an attempt to quit smoking. Data was collected, by phone interview, regarding individual smoking habits, if any, over the 6 month study period. The factors which may have caused an individual to smoke again were examined. This study employed a health belief model as it theoretical basis. RESULTS: Following a 6 month cessation, 24.1% of the study group began to smoke again during the 6 month test period. In a simple analysis, the factors related to individuals relapsing and smoking again included barriers of stress reduction, body weight gain and induction of smoking by surroundings among perceived barriers factor of our health belief model (p<0.05). In multiple logistic regression analysis for relapsed smoking, significant factors included barriers of stress reduction and induction of smoking by surroundings (p<0.05). The most important reason of for an individual to relapse into smoking was stress (60.9%) and the most likely place for a relapse to occur was a drinking establishment (39.1%). CONCLUSIONS: Our results indicate that both regular consultations and a follow-up management program are important considerations in a public health center program geared towards maintaining smoking cessation.