Health conomics refers to the scientific discipline that compares the value of one healthcare program to another. It is a sub-discipline of Micro-economics. A health economic study evaluates the cost (expressed in monetary terms) and effects (expressed in terms of monetary value, effi cacy or enhanced quality of life) of a healthcare program or product. We can distinguish several types of health economic evaluation: cost-minimization analysis, cost-benefi t analysis, cost-effectiveness analysis and cost-utility analysis. Health economics studies serve to guide optimal healthcare resource allocation, in a standardized and scientifi cally grounded manner. Health economics research facilitates the translation of health technology assessment into useful information for healthcare decision-makers to ensure that society allocates scarce health care resources wisely, fairly and effi ciently. Health economics usually evaluate the outcomes like clinical, economics and humanistic outcomes per costs. Health economics research include pharmacoeconomics, clinical epidemiology, decision analysis, modeling, risk assessment, patient-reported outcomes (quality of life), database analyses, observational studies, and patients registries.
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Background Frailty is a wasting syndrome that presents loss of physiological function by aging, lowering of reserve capacity, and disability of body system. It is currently being considered an important issue in geriatrics. This study examined frailty level of Korean elderly in community and whether frailty can be meaningful a predictive factor for functional disability. Methods: Demographic characteristics, the number of chronic diseases and medications, cardiovascular health study (CHS) frailty index, study of osteoporotic fractures (SOF) frailty index, activities of daily living, Instrumental activities of daily living, depression, mini-mental state examination (MMSE) and fall history were examined for 302 men and women over 65 years old who visited the three community seniors welfare centers from February 2008 to June 2008. Results: There were defi nite differences of frailty status by age, educational level, marital status, monthly income, body mass index, the number of chronic diseases, the number of medications, depression, MMSE and fall history (P < 0.05), except in gender (P < 0.432). In logistic regression analysis for functional disability with frailty status defi ned by SOF frailty index, odds ratio to dependency of instrumental activities of daily living (IADL) from the healthy to the prefrail stage increased 6.84 times while from the healthy to the frail stage increased 130.87 times. These effects still increased after covariate adjustment. Also, the CHS frailty index showed the same result although there was some difference in odds ratio.Conclusion: There were meaningful correlations of frailty with functional disability when dividing Korean elderly's frailty levels into the healthy, the prefrail and the frail stages.
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Background It is important to evaluate the functional ability of the elderly for optimal care. This study was conducted to identify factors associated with dependence for activities of daily living (ADL) and instrumental activities of daily living (IADL) in elderly adults in Korea.Methods: A cross-sectional study of data from the third Korea National Health and Nutrition Examination Survey (KNHANES III) 2005 was undertaken. The sample consisted of 3,656 participants, 65 years of age or older. Multifactorial regression analysis was used to identify associations between ADL and IADL dependence and sociodemographics, lifestyle, and health history.Results: Among the 629 (17.2%) ADL-dependent and signifi cantly and independently associated factors were age, lower education level, health assistance or no-insurance, stroke, urinary incontinence, diabetes, arthritis, and lung cancer. Among the 1,674 (55.7%) IADL-dependent and significantly and independently associated factors were age, lower education level, single or widowed, male, stroke, arthritis, glaucoma and/or cataract. Conclusion: Functional dependence in older adults was directly related to aging and had multiple determinants. Awareness of these determinants should help design health programs that can identify individuals who are at high risk of losing their independence, and implement interventions for slowing or reversing the process.
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Background The prevalence of metabolic syndrome is increasing in Korea. The aim of this study was to establish if there is an association between the presence of metabolic syndrome and the development of gallbladder stones in Koreans.Methods: Among the subjects who visited a health promotion center of a general hospital from January 2001 to December 2005, a total of 34,574 adults was examined. Among them, the fi nal 34,470 adults (males 20,277, females 14,193) were included. Metabolic syndrome was defi ned if they fell under the three conditions of BMI ≥ 25 kg/m2, blood pressure ≥ 130/85 mmHg, fasting glucose 110 mg/dL, triglyceride ≥ 150 mmHg and low HDL-cholesterol (< 40 mg/dL in men, < 50 mg/dL in women). After adjusting for age and sex, logistic regression analysis was done to evaluate the relationship between metabolic syndrome and gallstones. Results: This study showed that the prevalence of metabolic syndrome was 17.6% (males 21.1%, females 12.4%). Gallbladder stone risk was increased according to BMI, high blood pressure, high fasting blood glucose and low HDL. Gallbladder stone risk was increased according to clustering of components of metabolic syndrome after adjustment for age and sex (1 criterion: OR = 1.42, 95% CI, 1.20-1.69, P = 0.000; 2 criterion: OR = 1.86, 95% CI, 1.57-2.21, P = 0.000; 3 criterion: OR = 2.02, 95% CI, 1.66-2.45, P = 0.000; 4 criterion: OR = 2.17, 95% CI, 1.66-2.85, P = 0.000; 5 criterion: OR = 2.17, 95% CI, 1.17-4.02, P < 0.014). Conclusion: Gallbladder stone risk was increased according to BMI, and increased with people who had combination of more metabolic syndrome components.
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Background Sexual dysfunction such as erectile dysfunction (ED) may be a hidden agenda, but, it should be dealt with by family physicians in primary care. We investigated the prevalence of ED and utilization of sexual consultation practice among community family physicians. Methods: We analyzed the subjects who were males aged over 30 and married who visited 10 community family clinics around Seoul, Korea and completed questionnaires related to erectile function and utilization of sexual consultation service from May 9 to 28 2009. ED was designated if the 5-item version of international index of erectile dysfunction (IIEF-5) scores were less than 17. Results: The average age of the responders was 45.6 years. The prevalence of ED was 43.3% and increased according to age, chronic disease, low educational history and low family income. Almost all of the mild ED patients answered that they needed sexual consultation. But, half of them had no plan to have a sexual consultation. Odds ratios (ORs) with 95% confi dence intervals (CIs) for having a sexual consultation or not according to variables were calculated with logistic regression. More severe ED (OR = 0.875; 95% CI, 0.827 to 0.926), existence of chronic disease (OR = 1.828; 95% CI, 1.026 to 3.260), inferior education (OR = 0.395; 95% CI, 0.196 to 0.796), and lower income (OR = 0.326; 95% CI, 0.124 to 0.857) were the factors which infl uenced to have a sexual consultation with a family physician.Conclusion: The prevalence of ED in family clinic was over 40%, but the utilization of sexual consultations was under 50%. We need to develop intervention strategies for more sexual counseling practice according to educational history, family incomes and status of ED in community family medicine clinics.
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Background Because low quality trials may lead to wrong conclusions, quality assessments are necessary. Thus, this study scrutinizes randomized controlled trials (RCTs) in the Journal of the Korean Academy of Family Medicine (KAFM) to assess the quantity and the quality. Methods: Upon extracting randomized controlled trials from all the articles published in the Journal of the KAFM from 1980 to 2005, assessments were made on the Jadad scale and the adequacy of allocation concealment. The selections and assessments were performed independently by two researchers, and adjustment of the differences were done by a third-party researcher. In addition, the factors that may affect the quality levels were analyzed. Results: Twenty-three trials were included. In 1980s, there were only 1.09% of the total original articles, but in 2000s, 2.63% were RCTs. The mean total Jadad score increased from 1 point in 1980s to 2.17 in 2000s, and the "good quality" trials also increased from 0% to 33.33%. As for the adequate allocation concealment, however, only two studies were observed in 2000s. The most lacking aspect was the appropriate double-blinding. Also, studies intervened by medicine or funded or examined by Institutional Review Boards (IRBs) tended to receive higher quality assessments. Conclusion: Although RCTs consistently increased in quantity and quality, in future studies, researchers should continue to strive towards achieving adequate allocation concealment and appropriate double-blinding. In addition, researchers must become more interested in receiving funds and examination by IRBs.
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Background Dietary supplements (DS) have been increasingly utilized as a way of the promoting health and com-plementary therapy. This study aimed to evaluate the patterns of dietary supplement use in Korean cancer patients and to examine the related factors. Methods: Between April and May of 2008, 366 patients who were hospitalized for diagnosis and treatment of cancer in a university affiliated tertiary hospital were surveyed using a self-administered structured questionnaire after receiving written informed consent. Among them, 322 patients with adequate answers were fi nally included. Results: Two hundred forty patients (72.3%) reported to have ever taken DS with the mean number of 3.6 ± 2.98. Vitamins were the most frequently used, followed by ginseng steamed red, ginseng, and glucosamine. The most infl uential factor regarding DS use was the recommendation by family members or relatives. The main reason for DS use was for resolution of fatigue, followed by supplementation of therapy, and immune enhancement. Information concerning DS most eager to know about was the effect of DS (44.6%), followed by interaction of DS with therapeutics (33.2%). Doctor (74.4%) was the most preferred health care provider to be consulted concerning DS, but only 34% of DS users have actually consulted with a doctor. Multiple logistic regression analysis showed that increasing age, Catholicism, and higher educational level were associated with higher use of DS. Conclusion: DS use was very prevalent in cancer patients. In spite of the great need, only small proportion of cancer patients using DS has consulted with a doctor.
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