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Continuity of care (COC) has received attention over the past decade. COC has also become increasingly important for hospital managers and policy makers because of competitive health care market conditions. The purpose of this study was to assess the association between hospital charges and patients' continuity of care-assessed by three indices of continuity of care—among outpatients with hypertension in South Korea.
This study used the National Health Insurance Service–Cohort Sample Database from 2002 to 2013. A total of 247,125 participants were analyzed at baseline (2002); continuity of care was defined using the continuity of care index, the Herfindahl–Hirschman index (a new continuity of care index), and the “most frequent provider continuity” index. Primary analyses were based on the generalized estimating equation regression model, which accounts for correlation among individuals within each hospital.
After adjustment for age, sex, residential region, patient clinical complexity level, diagnosed code, hospital type, organization type, number of beds, number of doctors, and year, there was a negative correlation between hospital charges and continuity of care index (β=−0.163, P<0.0001), the Herfindahl–Hirschman index (β=−0.105, P<0.0001), and the “most frequent provider continuity” index (β=−0.131, P<0.0001). Subgroup analyses based on hospital type produced similar trends.
For all indices studied, hospital charges declined gradually with increasing continuity of care. Our study suggests that long-term, trusting partnerships between patients and physicians reduce hospital costs.
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The purpose of this study was to evaluate serum lipid levels in Korean adults after consumption of different types of yogurt.
Study subjects were 3,038 individuals (≥19 years of age) who participated in the 2012 Korean National Health and Nutrition Examination Survey. Yogurt intake was assessed with a food frequency questionnaire by using the 24-hour recall method. We conducted complex samples general linear analysis with adjustment for covariates.
The serum triglyceride levels in the group consuming viscous yogurt were lower than those in the group consuming non-viscous yogurt.
Consumption of viscous yogurt is associated with low serum triglyceride levels in Korean adults.
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The number of North Korean adolescent defectors entering South Korea has been increasing. The health behavior, including mental health-related behavior, and factors associated with depression in North Korean adolescent defectors residing in South Korea were investigated.
Data obtained from the Korea Youth Risk Behavior Web-Based Survey (2011–2014) dataset were utilized. In total, 206 North Korean adolescent defectors were selected, and for the control group, 618 matched South Korean adolescents were selected. Frequency analysis was used to determine the place of birth and nationality of the parents, chi-square tests were used to compare the general characteristics of the North and South Korean subjects, and multivariate logistic regressions were conducted to compare the health behavior of the two sets of subjects. To determine the factors associated with depression in the North Korean subjects, a logistic regression was performed.
The North Korean adolescents reported higher current smoking (adjusted odds ratio [aOR], 2.54; 95% confidence interval [CI], 1.48 to 4.35), current drinking (aOR, 1.85; 95% CI, 1.15 to 2.99), and drug use rates (aOR, 10.99; 95% CI, 4.04 to 29.88) than did the South Korean adolescents. The factors associated with depression in the North Korean adolescents were current smoking (aOR, 6.99; 95% CI, 1.62 to 30.06), lifetime drinking experience (aOR, 5.32; 95% CI, 1.51 to 18.75), and perceived stress (aOR, 4.74; 95% CI, 1.74 to 12.90).
There were differences in health behavior between the North and South Korean adolescents. A specialized approach for North Korean adolescent defectors is required to promote proper health behavior and adaptation to South Korean society.
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Friedewald equation is the most widely used method for estimating low-density lipoprotein cholesterol (LDL-C) level. However, due to potential over- or underestimation, many studies have used a modified equation. This study aimed to compare estimates by 4 different equations to directly measured LDL-C concentrations in order to propose the most appropriate method for LDL-C estimation in the Korean population.
We studied data of 4,350 subjects that included total cholesterol, high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and LDL-C concentrations that had been measured at one university hospital in Seoul. We investigated 4 equations: LDL-C by Friedewald's original equation (LDL-CF) and its 3 modifications. Pearson correlation analysis was performed to compare these estimates to the direct measurement.
Pearson correlation analysis revealed a good correlation among all 4 estimated LDL-C values and the directly measured LDL-C value. The Pearson coefficients were 0.951 for LDL-CF, 0.917 for LDL-C by Hatta equation (LDL-CH), 0.968 for LDL-C by Puavilai equation (LDL-CP), and 0.983 for LDL-C by Martin equation (LDL-CM). Martin equation (LDL-CM) resulted in the best approximation (mean difference from the direct measurement, 5.5 mg/dL; mean percentage difference from the direct measurement, 5.1%) and the best agreement with the direct measurement (86.1%). LDL-CP resulted in the second-best approximation (mean difference, 7.0 mg/dL; mean percentage difference, 6.2%; concordance, 82.5%). LDL-CM was found to be less influenced by TG and HDL-C levels than by LDL-CF.
Estimates by Martin equation had the best agreement with direct LDL-C concentrations and both Martin and Puavilai equations were superior to Friedewald equation for estimating LDL-C concentrations in Korean adults.
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Some studies have provided evidence for a possible association between vitamin D and testosterone levels; however, the evidence from studies in Koreans is inconsistent. In addition, insufficient evidence is available to support an association between seasonal variations in vitamin D and testosterone levels in Koreans. Therefore, we aimed to investigate the association between vitamin D and testosterone levels, and between seasonal variations in these levels in Korean men.
This cross-sectional study included 1,559 men, aged 25–86 years, who underwent a medical examination. We measured serum 25-hydroxyvitamin D (25[OH]D) and total testosterone levels, and compared other laboratory test results and patient lifestyle characteristics. On the basis of sample collection time, we categorized patients into four seasons, and analyzed seasonal variability in 25(OH)D and total testosterone levels.
The average participant age (±standard deviation) was 53.3±8.8 years, and the average serum 25(OH)D and total testosterone levels were 15.9±7.0 ng/mL and 5.1±1.6 ng/mL, respectively. In the analysis of variance (ANOVA) model, no significant association was found between 25(OH)D and testosterone levels (P=0.51). ANOVA of the average 25(OH)D levels in season-based groups revealed significant seasonal variations in 25(OH)D levels (P-value for trend <0.001). No significant association was found between seasonal variations in total testosterone levels (P=0.06). However, after adjustment for confounding variables, total testosterone and 25(OH)D showed significant seasonal variability (P=0.007 and P<0.001, respectively).
We found no significant correlation between serum 25(OH)D and total testosterone levels in Korean men. Moreover, serum 25(OH)D and total testosterone levels showed significant seasonal variations.
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Children who have experienced negative rearing behaviors show a lack of self-confidence due to emotional instability and are reserved in interpersonal relationships. This can lead to failure in social adaptation and a high risk of depression, suicide, criminal acts, and anti-social behaviors. Therefore, this study aims to analyze the effects of experiencing negative parental rearing behaviors, such as neglect and abuse, on adolescents' social withdrawal and aggression, by utilizing multivariate latent growth models.
Data from the Korean Children and Youth Panel Study (KCYPS), a survey conducted by the National Youth Policy Institute targeting a cohort of three different age groups (grade 1, grade 4, and grade 7), from 2010 to 2016 was used. Multi-stage stratified sampling methods were used in the KCYPS, which surveyed the students and parents of the selected grade levels. This study analyzed the data for grade 7, from second year (grade 8) to fourth year (grade 10).
Negative rearing experiences had a significant effect on social withdrawal and aggression, and this influence was shown to persist over the long term.
This study examined the long-term developmental trajectory in the relationship between risk factors for adolescent development. Furthermore, the relationship between risk factors was shown to have not only short term but long-term effects as well, which reinforces the limitations of previous studies.
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The prevalence of childhood obesity in South Korea has increased owing to economic improvement and the prevailing Westernized dietary pattern. As the incidence of chronic diseases caused by obesity is also expected to increase, effective interventions to prevent childhood obesity are needed. Therefore, we conducted a Delphi study to determine the priorities of a potential intervention research on childhood obesity prevention and its adequacy and feasibility.
The two-round Delphi technique was used with a panel of 10 childhood obesity experts. The panelists were asked to rate “priority populations,” “methods of intervention,” “measurement of outcomes,” “future intervention settings,” and “duration of intervention” by using a structured questionnaire. Finally, a portfolio analysis was performed with the adequacy and feasibility indexes as the two axes.
For priority populations, the panel favored “elementary,” “preschool,” and “middle and high school” students in this order. Regarding intervention settings, the panelists assigned high adequacy and feasibility to “childcare centers” and “home” for preschool children, “school” and “home” for elementary school children, and “school” for adolescents in middle and high school. As the age of the target population increased, the panelists scored increasing numbers of anthropometric, clinical, and intermediate outcomes as highly adequate and feasible for assessing the effectiveness of the intervention.
According to the results of the Delphi survey, the highest-priority population for the research on childhood obesity prevention was that of elementary school students. Various settings, methods, outcome measures, and durations for the different age groups were also suggested.
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Carbohydrate-deficient transferrin (CDT) is a useful biomarker to identify excessive alcohol consumption; however, few studies have validated the %CDT cut-off value in elderly men. This study estimated the optimal %CDT cut-off value that could identify excessive alcohol consumption in men aged ≥65 years.
This retrospective study included 120 men who visited the department of family medicine at Chungnam National University Hospital for health check-up between January 2010 and August 2013. At-risk drinking included heavy- and binge drinking. Heavy drinking was defined as more than seven standard drinks/wk, and binge drinking was defined as more than three standard drinks/d. The cut-off %CDT values for at-risk drinking were determined using receiver operating characteristic (ROC) curves.
Based on the ROC curves, the optimal %CDT cut-off values in ≥65-year-old men were 1.95% for at-risk drinking, 1.81% for heavy drinking, and 2.07% for binge drinking. The sensitivity, specificity, and positive and negative predictive values were 58.7%, 83.6%, 69.2%, and 76.2% for at-risk drinking, respectively. The AUROC were >0.7 for all three evaluated cut-offs.
Our results suggest that the %CDT cut-off value for at-risk drinking in elderly Korean men (≥65 years) should be readjusted to a lower value of 1.95%.
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The main aim of this study was to evaluate the achievements of some important goals of Iran's urban family physician plan. This plan was implemented when the country experienced economic instability. We examine whether an economic crisis affects the efficacy of a healthcare program.
We used the household income and expenditures survey data for 2011 (before program implementation) and 2012 (after program implementation). Changes in out-of-pocket payments and healthcare utilization were investigated using the propensity score matching estimator. Furthermore, changes in inequality in these two dimensions were examined.
No changes in out-of-pocket payments and healthcare utilization were found after the implementation of this program; however, inequality in out-of-pocket payments increased during the reform.
The urban family physician program was not implemented completely and many of its fundamental settings were not conducted because of lack of necessary healthcare infrastructure and budget limitations. Family physician programs should be implemented under a strong healthcare infrastructure and favorable economic conditions.
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We describe a case of non-tuberculous mycobacterial infection of the larynx in a previously well, immunocompetent young woman. Laryngeal mycobacterial infection is rare and currently accounts for less than 1% of all cases. A diagnostic dilemma often occurs because it may mimic laryngeal carcinoma, chronic laryngitis, or laryngeal candidiasis. This case highlights the importance of considering non-tuberculous mycobacterial infection in the differential diagnosis of laryngeal lesions.
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Amoxicillin-Clavulanic acid continues to be one of the most commonly used antibiotic combinations. Hepatic injury due to this antibiotic is rare. We report a case of amoxicillin-clavulanic acid induced hepatitis causing painless jaundice to bring to attention this rare side effect of this commonly used antibiotic. This is a case of a 62-year-old Caucasian female, who presented with acute onset severe painless jaundice, nausea, vomiting, and pruritus of less than 1-week duration. She had completed a course of amoxicillin-clavulanic acid 3 weeks prior to presentation. A careful history pointed to this simple diagnosis. It may be easily missed without an in-depth history and the patient may be subjected to unnecessary expensive tests. This case is reported to highlight cost conscious care by keeping in mind a rare side effect of the commonly used antibiotic.
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