OBJECTIVES: This study was conducted to examine the association between health condition and leaving the labor market among middle-aged and older adults in South Korea. METHODS: Data was obtained from individuals aged 45 years and older participating in the 2006 and 2008 Korean Longitudinal Study of Ageing. We used various health measures including chronic diseases, comorbidities, traffic accident injuries, disabilit of instrumental activities of daily living, depressive symptoms, and self-rated health. The odds ratios of job loss, and retirement, versus employment were calculated using multinomial logistic regression by each health measure. RESULTS: In our cross-sectional and longitudinal analysis, health problems related to physical disabilities had the greatest effect on leaving the worksite. A shift in health condition from good to poor in a short period was a predictor of increased risk of unemployment but a persistent pattern of health problems was not associated with unemployment. Women with health problems showed a high probability of retirement, whereas among men, health problems instantly the possibility of both job loss and retirement. CONCLUSIONS: Health problems of middle aged and older workers were crucial risk factors for retirement and involuntarily job loss. Especially functional defect and recent health problems strongly and instanty affected employment status.
Aged ; *Chronic Disease ; Female ; Humans ; Logistic Models ; Longitudinal Studies ; Male ; Middle Aged ; Odds Ratio ; Republic of Korea ; *Retirement ; *Unemployment ; *Wounds and Injuries

OBJECTIVES: Serum uric acid levels have been reported to be associated with a variety of cardiovascular conditions. However, the direct association between uric acid levels and metabolic syndrome remains controversial. Thus, we evaluated the association of serum uric acid levels and metabolic syndrome in a community-based cohort study in Korea. METHODS: We performed cross-sectional analysis of baseline data of 889 males and 1491 females (aged 38 to 87) who participated in baseline examinations of the Korean Genome and Epidemiology Study: Kanghwa study. Blood samples were collected after at least an 8 hour fast. Uric acid quartiles were defined as follows: <4.8, 4.8-<5.6, 5.6-<6.5, > or =6.5 mg/dL in males; and <3.8, 3.8-<4.3, 4.3-<5.1, > or =5.1 mg/dL in females. Metabolic syndrome was defined by the National Cholesterol Education Program Adult Treatment Panel III Criteria with adjusted waist circumference cutoffs (90 cm for males; 80 cm for females). The association between serum uric acid quartiles and metabolic syndrome was assessed using multivariate logistic regression. RESULTS: The odds ratio for having metabolic syndrome in the highest versus lowest quartiles of serum uric acid levels was 2.67 (95% confidence interval [CI], 1.60 to 4.46) in males and 2.14 (95% CI, 1.50 to 3.05) in females after adjusting for age, smoking, alcohol intake, body mass index, total cholesterol, HbA1c, albumin, gamma-glutamyltransferase, blood urea nitrogen, and log C-reactive protein. The number of metabolic abnormalities also increased gradually with increasing serum uric acid levels (adjusted p for trend < 0.001 in both sexes). CONCLUSIONS: Higher serum uric acid levels are positively associated with the presence of metabolic syndrome in Korean males and females.
Adult ; Aged ; Aged, 80 and over ; Biological Markers/blood ; Cohort Studies ; Cross-Sectional Studies ; Female ; Humans ; Hyperuricemia/*blood ; Inflammation ; Logistic Models ; Male ; Metabolic Syndrome X/*blood ; Middle Aged ; Odds Ratio ; Prospective Studies ; Republic of Korea ; Risk Assessment ; Rural Health

OBJECTIVES: An ambulance can be a potential source of contagious or droplet infection of a community. We estimated the prevalence of positive carriage of tuberculosis (TB), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococci (VRE) in patients transported by ambulance. METHODS: This was a retrospective observational study. We enrolled all patients who visited a tertiary teaching hospital emergency department (ED). Blood, sputum, urine, body fluid, and rectal swab samples were taken from patients when they were suspected of TB, MRSA, or VRE in the ED. The patients were categorized into three groups: pre-hospital ambulance (PA) group; inter-facility ambulance (IA) group; and non-ambulance (NA) group. Adjusted odds ratio (OR) and 95% confidence intervals (CI) were calculated using a multivariable logistic regression model for the prevalence of each infection. RESULTS: The total number of patients was 89206. Of these, 9378 (10.5%) and 4799 (5.4%) were in the PA and IA group, respectively. The prevalence of TB, MRSA, and VRE infection were 0.3%, 1.1%, and 0.3%, respectively. In the PA group, the prevalence of TB, MRSA, and VRE were 0.3%, 1.8%, and 0.4%. In the IA group, the prevalence of TB, MRSA, and VRE were 0.7%, 4.6%, and 1.5%, respectively. The adjusted ORs (95% CI) of the PA and IA compared to the NA group were 1.02 (0.69 to 1.53) and 1.83 (1.24 to 2.71) for TB, 2.24 (1.87 to 2.69) and 5.47 (4.63 to 6.46) for MRSA, 2.59 (1.78 to 3.77) and 8.90 (6.52 to 12.14) for VRE, respectively. CONCLUSIONS: A high prevalence of positive carriage of TB, MRSA, and VRE in patients transported by metropolitan ambulances was found.
Adolescent ; Adult ; Aged ; *Ambulances ; Anti-Bacterial Agents/*therapeutic use ; Enterococcus/*drug effects ; Female ; Humans ; Male ; Methicillin-Resistant Staphylococcus aureus/*drug effects ; Middle Aged ; Prevalence ; Republic of Korea/epidemiology ; Retrospective Studies ; Staphylococcal Infections/*epidemiology ; *Transportation of Patients ; Tuberculosis/diagnosis/*epidemiology ; Vancomycin/*therapeutic use ; Vancomycin Resistance/*drug effects ; Young Adult

OBJECTIVES: Over the past several years, the incidence of hepatitis A infection has been increasing rapidly in the young-adult population in Korea. We examined the effects of area-level socioeconomic status and environmental hygiene on the incidence of hepatitis A. METHODS: This study is based on the registered national population of Korea and the national health insurance data from 2004 to 2008. A total of 73 459 individuals were confirmed to have had hepatitis A. The standardized incidences of hepatitis A in 232 districts adjusted for sex and age of people were calculated for each year, and the rate ratios of the incidence rates were estimated according to area-level socioeconomic status and environmental hygiene using multiple Poisson regression models. RESULTS: The incidence rates of hepatitis A infection were 15.6 (per 100 000) in 2004, 19.0 (per 100 000) in 2005, 27.2 (per 100 000) in 2006, 25.1 (per 100 000) in 2007, and 61.7 (per 100 000) in 2008. The analysis of the area-level effects showed that residential areas of the less deprived than other regions, areas with higher levels of education, and heavily populated areas were significantly associated with increased risk. CONCLUSIONS: There is a very strong possibility that both area-level socioeconomic status and environmental hygiene play a role in increasing the risk of hepatitis A infection in Korea. Therefore, to reduce hepatitis A infection, we need a nationwide strategy that considers these area-level characteristics.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Hepatitis A/*epidemiology/etiology ; Humans ; Incidence ; Infant ; Infant, Newborn ; Male ; Middle Aged ; *National Health Programs ; Poisson Distribution ; Republic of Korea/epidemiology ; Risk Factors ; Social Class ; Young Adult

OBJECTIVES: It is necessary to examine groups carrying out sexually risky behavior because the prevalence of sexually transmitted diseases (STDs) is high among them. In this study, the prevalence of STDs among homosexuals and sex-buying men in South Korea was investigated, along with their sexual risk factors. METHODS: Men who have sex with men (MSMs, n=108) were recruited in Seoul and Busan by applying the time location sampling method, while sex-buying men (n=118) were recruited from a john school in Gyeonggi province, the suburbs of Seoul. Dependent variables included past or present infection with syphilis, Chlamydia, gonorrhea, and human immunodeficiency virus. Independent variables included health behavior, social support, sexual behavior, and safe sex. RESULTS: It was found that when the MSMs were non-drunk while having sexual intercourse (odds ratio [OR], 0.132), they showed a higher STD infection rate when they had a higher number of anal sex partners (OR, 5.872), rarely used condoms (OR, 1.980), had lower self-efficacy (OR, 0.229), and were more anxious about becoming infected with an STD (OR, 3.723). However, the men who paid for sex showed high STD infections when they had more sex partners (OR, 2.286) and lower education levels (OR, 3.028). CONCLUSIONS: STD infections among the two groups were high when they were engaged with many sex partners and not having protected sex. In other words, there was a gap in risky sex behavior within such groups, which was significantly related to the possibility of developing an STD. Therefore, the preventive intervention against STDs for these groups needs to be expanded to include management of sex behaviors.
Adult ; Female ; *Homosexuality, Male ; Humans ; Male ; *Prostitution ; Qualitative Research ; Republic of Korea/epidemiology ; Risk Factors ; Sexually Transmitted Diseases/diagnosis/*epidemiology/*etiology ; *Unsafe Sex ; Young Adult

Since the reformation of the National Health Insurance Act in 2000, the Health Insurance Review and Assessment Service (HIRA) in the Republic of Korea has performed quality assessments for healthcare providers. The HIRA Value Incentive Program (VIP), established in July 2007, provides incentives for excellent-quality institutions and disincentives for poor-quality ones. The program is implemented based on data collected between July 2007 and December 2009. The goal of the VIP is to improve the overall quality of care and decrease the quality gaps among healthcare institutions. Thus far, the VIP has targeted acute myocardial infarction (AMI) and Caesarian section (C-section) care. The incentives and disincentives awarded to the hospitals by their composite quality scores of the AMI and C-section scores. The results of the VIP showed continuous and marked improvement in the composite quality scores of the AMI and C-section measures between 2007 and 2010. With the demonstrated success of the VIP project, the Ministry of Health and Welfare expanded the program in 2011 to include general hospitals. The HIRA VIP was deemed applicable to the Korean healthcare system, but before it can be expanded further, the program must overcome several major concerns, as follows: inclusion of resource use measures, rigorous evaluation of impact, application of the VIP to the changing payment system, and expansion of the VIP to primary care clinics.
Benchmarking ; Hospitals ; Humans ; *National Health Programs ; Quality Improvement/*economics ; Quality of Health Care/economics ; Reimbursement, Incentive/*organization & administration ; Republic of Korea

We conducted a systematic review to summarize providers' attitudes toward pay-for-performance (P4P), focusing on their general attitudes, the effects of P4P, their favorable design and implementation methods, and concerns. An electronic search was performed in PubMed and Scopus using selected keywords including P4P. Two reviewers screened target articles using titles and abstract review and then read the full version of the screened articles for the final selections. In addition, one reference of screened articles and one unpublished report were also included. Therefore, 14 articles were included in this study. Healthcare providers' attitudes on P4P were summarized in two ways. First, we gathered their general attitudes and opinions regarding the effects of P4P. Second, we rearranged their opinions regarding desirable P4P design and implementation methods, as well as their concerns. This study showed the possibility that some healthcare providers still have a low level of awareness about P4P and might prefer voluntary participation in P4P. In addition, they felt that adequate quality indicators and additional support for implementation of P4P would be needed. Most healthcare providers also had serious concerns that P4P would induce unintended consequences. In order to conduct successful implementation of P4P, purchaser should make more efforts such as increasing providers' level of awareness about P4P, providing technical and educational support, reducing their burden, developing a cooperative relationship with providers, developing more accurate quality measures, and minimizing the unintended consequences.
*Attitude of Health Personnel ; Humans ; Program Development ; Quality Improvement/*economics ; Quality of Health Care/economics ; Reimbursement, Incentive/*organization & administration ; Republic of Korea

The challenge facing the Korean National Health Insurance includes what to spend money on in order to elevate the 'value for money.' This article reviewed the changing issues associated with quality of care in the Korean health insurance system and envisioned a picture of an effective pay-for-performance (P4P) system in Korea taking into consideration quality of care and P4P systems in other countries. A review was made of existing systematic reviews and a recent Organization for Economic Cooperation and Development survey. An effective P4P in Korea was envisioned as containing three features: measures, basis for reward, and reward. The first priority is to develop proper measures for both efficiency and quality. For further improvement of quality indicators, an electronic system for patient history records should be built in the near future. A change in the level or the relative ranking seems more desirable than using absolute level alone for incentives. To stimulate medium- and small-scale hospitals to join the program in the next phase, it is suggested that the scope of application be expanded and the level of incentives adjusted. High-quality indicators of clinical care quality should be mapped out by combining information from medical claims and information from patient registries.
*National Health Programs ; Program Development ; Quality Improvement/*economics ; Quality of Health Care/economics ; Reimbursement, Incentive/*organization & administration/standards ; Republic of Korea

BACKGROUND: Many previous studies have shown that elevated homocysteine in the serum is a well known risk factor for cardiovascular disease and this is associated with other risk factors for cardiovascular disease, but any Korean data on this is limited. OBJECTIVES: This study aimed to calculate the prevalence of hyperhomocysteinemia and to analyze the relation between elevated homocysteine and the lifestyle factors of Korean adults. METHODS: We conducted a cross-sectional survey that included 650 men and 743 women (age range, 20 to 79 years) who were residents of Gwangju City in Gyeonggi-do. These subjects participated in the health interview and examination survey from November to December 2005. The total homocysteine, total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglyceride in the serum were measured. All the participants had their body composition measured such as height and weight, and we obtained health-related behavioral information through the self-entry questionnaire. RESULTS: Very right-handed skewed distributions of homocysteine were shown in men and women. The prevalence of hyperhomocysteinemia was 22.6% in men and 13.7% in women in Gwangju city. On the multiple logistic regression analysis, hyperhomocysteinemia was associated with age (OR=1.02, 95% CI=1.01-1.04), male gender (OR=1.60, 95% CI=1.02-2.52), severe general physical activity (OR=0.32, 95% CI=0.15-0.69) and nutrient consumption (OR=0.49, 95% CI=0.31-0.76). CONCLUSIONS: There is a great prevalence of hyperhomocysteinemia in adults of Gwangju City, Korea and it was associated with both genetic factors and lifestyle risk factors. This study can suggest that comprehensive lifestyle modification is needed in order to diminish the prevalence of hyperhomocysteinemia and to prevent CVD.
Adult ; Age Distribution ; Aged ; Cardiovascular Diseases/epidemiology/etiology ; Cross-Sectional Studies ; Female ; Health Behavior ; Health Surveys ; Humans ; Hyperhomocysteinemia/complications/*epidemiology ; Korea/epidemiology ; Lipids/blood ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Sex Distribution

OBJECTIVES: The objectives of this study were to determine the relationship between lifestyle-implementation and metabolic syndrome in an electronics research and development company, and to provide a foundation for health providers of health management programs for setting priorities. METHODS: From July 1 to July 16, 2008 we carried out a descriptive cross-sectional survey. Consecutive workers of one R & D company in Seoul, Korea (N=2,079) were enrolled in study. A checklist for lifestyle (from the National Health Insurance Corporation) consisted of questions regarding diet, drinking, smoking and exercise. After the survey, researchers obtained data from health profiles for metabolic syndrome(waist-circumference, triglycerides, HDL cholesterol, blood pressure and fasting blood sugar level). Lifestyle was recorded as good or not good. Statistical analysis of metabolic syndrome and the lifestyle of subjects was done using multiple logistic regression analysis. RESULTS: The prevalence of metabolic syndrome in our study gropu was 13.3% (N=277). After adjustment for age, the adjusted odds ratios (odds ratio, 95% confidence intervals) for metabolic syndrome increased in proportion to the number of bad habits: two (1.72, 1.23-2.44), three (2.47, 1.73-3.56), and four (3.63, 2.03-6.34). Relative to subjects eating both vegetables and meat', the OR for 'meat' eaters was 1.66 (1.18-2.31). Compared with 'non-smokers and ever-smoker', the OR for 'current-smoker' was 1.62 (1.25-2.10). Compared with 'Healthy drinker', the OR for 'unhealthy drinker' was 1.38 (1.05-1.83). CONCLUSIONS: Poor lifestyle was associated with an increased likelihood of metabolic syndrome. These findings suggest that lifestyle-based occupational health interventions for young employees should include a specific diet, smoking cessation, and healthy-drinking programs.
Adult ; Blood Glucose/analysis ; Blood Pressure ; Body Weights and Measures ; Cross-Sectional Studies ; *Electronics ; *Health Behavior ; Humans ; Korea ; *Life Style ; Lipids/blood ; Male ; Men's Health ; Metabolic Syndrome X/*epidemiology ; Prevalence ; *Research