BACKGROUND: Concentration of patients to large hospitals is serious problem in Korea. The purpose of this paper is to propose appropriate policy direction to relieve concentration of patients to large hospitals. It is focused on evaluation of the possibility of family doctor system as a policy alternative to relieve concentration of patients to large hospital by empirically analyzing the effect of usual source of care (USC) on large hospitals medical care use. METHODS: Korea Health Panel conducted 2009, 2012, 2013 by KIHASA (Korea Institute for Health and Social Affairs) and NHIS (National Health Insurance Service) was used for analysis. For dependent variables, first, the ratio of the amount of using large hospital to total amount of using medical care, and second, the amount of using large hospital are estimated. Independent variables are having an USC and type of USC. Panel analysis was done with above variables. RESULTS: Main results are as follows. First, having an USC increases using large hospital. Second, having a domestic clinic type USC decreases using large hospital and ratio of using large hospital. Third, the effect of domestic clinic type USC is greater in older group, less income group, worse health status group, not having private insurance group, and having chronic disease group. CONCLUSION: These results show that family doctor program can be a policy alternative to relieve concentration of patients to large hospital. Nonetheless, primary care system in Korea is unsatisfied. It is recommended to reinforce primary care system and family doctor system to relieve concentration of patients to large hospitals.
Chronic Disease ; Humans ; Insurance ; Insurance, Health ; Korea ; Primary Health Care

Tardive dyskinesia is characterized by choreiform movements, or rhythmic abnormal involuntary movements of the face, mouth, tongue, trunk, and limbs. It is frequently associated with the use of neuroleptic medications. The choreiform movements are irreversible in some patients, even after the drug is withdrawn. Although no reliable treatment for tardive dyskinesia exists, atypical antipsychotics are associated with a significantly lower incidence of tardive dyskinesia than typical antipsychotics. Moreover, recent reports suggest that atypical antipsychotics may have a beneficial effect on tardive dyskinesia remission. Until recently, evidence for the effectiveness of aripiprazole on tardive dyskinesia has been mixed. Aripiprazole has a unique mechanism of action and has various effects in tardive dyskinesia. The drug acts as a partial D2 receptor agonist that can stabilize D2 up-regulation, and as a partial 5-HT1A receptor agonist and a 5-HT2A receptor antagonist, and can increase the release of dopamine in the striatum.
Antipsychotic Agents ; Chorea ; Dopamine ; Dyskinesias ; Extremities ; Humans ; Incidence ; Mouth ; Movement Disorders ; Piperazines ; Quinolones ; Receptor, Serotonin, 5-HT1A ; Receptor, Serotonin, 5-HT2A ; Tongue ; Up-Regulation ; Aripiprazole

No abstract available.

No abstract available.

Background: There is growing interest in adult attention-deficit hyperactivity disorder (ADHD) because many ADHD children have symptoms that last through adulthood, and adult ADHD has a high risk of comorbid mental disorders. This study examined the prevalence and comorbidities of adult ADHD, with a focus on depression and pathological internet use among Korean college students. Methods: This study included 1358 college students, who were asked to complete self-reporting questionnaires on their characteristics, ADHD symptoms, and related clinical factors. The study analyzed associations between ADHD and depression, anxiety, pathological internet use, and problematic alcohol use. Results: The prevalence rate of ADHD among college students was 5.7%. A significant association was determined between ADHD symptoms and school satisfaction, depression, anxiety, and pathological internet use. Multivariate analysis showed that ADHD symptoms in college students were significantly associated with depression and pathological internet use. Conclusion The prevalence of ADHD among college students was similar to that of children and adolescents. Moreover, the risk of depression and pathological internet use was high in the ADHD group. Early screening and intervention for ADHD and comorbidities will be required to prevent the negative consequences of the condition and help students adapt in the future.

The pediatric population with comorbidities is a high-risk group for severe coronavirus disease 2019 (COVID-19). As of January 2023, the COVID-19 vaccination rate for at least two doses among Korean children 5–11 years is low at 1.1%. We summarized the COVID-19 vaccination status for the pediatric population (5–17 years) with comorbidities through July 2022 using the National Health Insurance Service database. Pediatric patients with comorbidities had higher vaccination rates than the general pediatric population (2.4% vs. 1.1% in 5–11-year-olds [P < 0.001], 76.5% vs. 66.1% in 12–17-year-olds [P < 0.001]). However, there were substantial differences according to comorbidity category, and the 2-dose vaccination rate was lowest among children with immunodeficiency in all age groups (1.1% in 5–11-year-olds, 51.2% in 12–17-year-olds). The COVID-19 vaccination rate among Korean children has remained stagnant at a low proportion despite ongoing outreach. Thus, more proactive strategies are needed alongside continuous surveillance.

Systemic lupus erythematosus (SLE) is a multi organ-involving systemic disease and usually manifests as musculoskeletal and cutaneous presentation. Acute sialoadenitis in lupus patients is not a typical manifestation. We report the case of a 23-year-old woman who presented with both parotid and submandibular gland painful swelling with highly elevated level of serum amylase. Epileptic seizure unexpectedly occurred during conservative treatment of the mentioned disease. After a close examination for the systemic or underlying disease, SLE was detected by specific autoantibody. The patient was uneventfully discharged after steroid pulse therapy. Although it is a very rare manifestation, autoimmune disease such as SLE should be included in differential diagnosis, especially in young women, when acute sialoadenitis is not improved with conservative management.
Amylases ; Autoimmune Diseases ; Central Nervous System* ; Diagnosis, Differential ; Epilepsy ; Female ; Humans ; Lupus Erythematosus, Systemic* ; Seizures ; Sialadenitis* ; Submandibular Gland ; Young Adult

Hyperammonemic encephalopathy commonly occur in patients with liver disease, but it can also occur due to other causes. A portosystemic shunt without liver cirrhosis is one of the causes of non-cirrhotic hyperammonemic encephalopathy. Herein, we present a case of a 78-year-old male patient with hyperammonemic encephalopathy resulting from portosystemic shunts without liver cirrhosis, which was successfully treated with endovascular shunt closure.

Eagle's syndrome has various symptoms at cervico-facial lesion. Recently, we have experienced a case of Eagle's syndrome that developed after a blunt neck trauma. A 51-year-old man presented with a click sound when he turned his head to the right. The symptom had developed after a traffic accident that occurred 2 months ago. Physical examination revealed a long styloid process that was easily palpable and burging out into the right tonsillar fossa. Radiologic examination did not reveal any presence of fracture on stylohyoid complex including stylohyoid ligament. We underwent a transoral resection of styloid process and released a stylohyoid ligament. The patient immediately experienced a relief of the symptom following the operation. It might be elucidated that the patient had an elongated styloid process and that the neck trauma had developed due to the dislocation or pseudoarticulation between stylohyoid ligament and the hyoid bone. Transoral resection of styloid process released pseudoarticulation and relieved the symptom.
Accidents, Traffic ; Dislocations ; Head ; Humans ; Hyoid Bone ; Ligaments ; Middle Aged ; Neck* ; Physical Examination

Purpose: The aim of this study was to evaluate the pancreatic fat fraction (PFF) using magnetic resonance imaging (MRI) in children with and without obesity and to correlate PFF with body mass index (BMI) z-score, hepatic fat fraction (HFF), and ultrasonography-derived pancreato-perihepatic fat index (PPHFI). Methods: This prospective study included 45 children with obesity and 19 without obesity (control group). PFF and HFF were quantitatively assessed using the abdominal multi-echo Dixon method for MRI. The PPHFI was assessed using transabdominal ultrasonography. Anthropometric, MRI, and ultrasonographic characteristics were compared between the two groups. Correlations between PFF, HFF, PPHFI, and BMI z-scores in each group were also analyzed. Results: The PFF, HFF, PPHFI, and BMI z-score were higher in the group with obesity than in the control group (PFF: 6.65±3.42 vs. 1.78±0.55, HFF: 19.5±13.0 vs. 2.31±1, PPHFI: 3.65 ±1.63 vs. 0.94±0.31, BMI z-score: 2.27±0.56 vs. 0.42±0.54, p<0.01, respectively). PFF was correlated with BMI z-scores, PPHFI, and HFF in the obesity group, and multivariate analysis showed that PFF was strongly correlated with BMI z-score and PPHFI (p<0.05). The BMI z-score was strongly correlated with PFF in the control group (p<0.01). Conclusion These results suggest that MRI-derived PFF measures are associated with childhood obesity. PFF and PPHFI were also highly correlated in the obesity group. Therefore, PFF may be an objective index of pancreatic fat content and has the potential for clinical utility as a non-invasive biomarker for the assessment of childhood obesity.