Ticlopidine, a widely used antiplatelet agent, has been rarely reported to cause thrombotic thrombocytopenic purpura (TTP). To the best of our knowledge, its occurrence has never before been reported in Korea. A 69 years old female patient suffered from an acute ischemic stroke. Ticlopidine 250mg bid was started and she followed an uneventful clin-ical course. The platelet count was normal on the 1st and the 12th day of ticlopidine administration. Around the 31st day, at home, she developed purpura, dyspnea and a stuporous mental status. Under the diagnosis of TTP, a plasma exchange was performed and her condition eventually returned to the baseline status. Ticlopidine induced TTP can developed abruptly despite close monitoring of platelet count, as illustrated by this case. Physicians prescribing ticlopi-dine should be aware of this potentially dangerous complication.
Aged ; Diagnosis ; Dyspnea ; Female ; Humans ; Korea ; Plasma Exchange ; Platelet Count ; Purpura ; Purpura, Thrombotic Thrombocytopenic* ; Stroke ; Stupor ; Ticlopidine*

A gap in the number of physicians caring for inpatients is expected in 2014 based on the restricted working hours for Korean medical residents. One potential solution is the use of hospitalists. The US hospitalist movement has proliferated due to high-quality care and economics. This movement has brought positive changes including a shorter length of hospital stay, increased quality of care, and greater patient satisfaction. Because the Korean government controls all suppliers and maintains a low financial compensation level for universal coverage, hospitals do not have the financial resources to introduce hospitalists. Therefore, in contrast to the US, the use of hospitalists must be developed as a cost-compensated system in Korea. Institutional strategies must be introduced to develop a hospitalist system in Korea. A hospitalist system in Korea would be distinct from that in the US. Further studies and specific strategies are needed that consider Korea's circumstances to effectively introduce a hospitalist system.
Compensation and Redress ; Hospital Medicine ; Hospitalists* ; Humans ; Inpatients ; Korea ; Length of Stay ; Patient Satisfaction ; Universal Coverage

Unmet healthcare needs are being used as an important indicator of the accessibility of healthcare services worldwide. To examine current status and trends of unmet needs in Korea, we used data from four sources: the Korea National Health and Nutrition Examination Survey (KNHANES, 2007–2017); the Community Health Survey (CHS 2008–2017); the Korea Health Panel Survey (KHP 2011–2015); and the Korean Welfare Panel Study (KOWEPS 2006–2017). The proportion of individual reporting unmet healthcare needs as of 2017 was 8.8% (KNHANES), 10.6% (CHS), and 12.4% (KHP as of 2015). The proportion of households reporting unmet healthcare needs due to cost was 0.5% (KOWEPS). Annual percentage change was −19.2%, −13.3%, −5.8%, and −13.3% respectively. Low income populations had more unmet healthcare needs than high income populations. However, unlike the last two studies, the main reason for unmet medical reasons was that there was no time regardless of income level.
Delivery of Health Care ; Family Characteristics ; Health Surveys ; Korea ; Nutrition Surveys ; Population Growth ; Poverty

Unmet healthcare needs do not end with the phenomenon itself, but lead to possibilities of increased severity of illness. Missed opportunities for treatment at the right timing increase possibilities of complications, and affect prognosis of disease. To examine current status and trends of unmet needs in Korea, we used data from four sources: the Korea National Health and Nutrition Examination Survey (KNHNES, '2007–2016); the Community Health Survey (CHS '2008–2016); the Korea Health Panel Survey (KHP '2011–2014); and the Korean Welfare Panel Study (KOWEPS '2006–2016). The proportion of individual reporting unmet healthcare needs as of 2016 was 8.8% (KNHNES), 11.5% (CHS), and 12.8% (KHP, as of 2014). Annual percentage change which characterizes trend for the follow-up period was −9.9%, −3.1%, and −1.3%, respectively. The proportion of individuals reporting unmet healthcare needs due to cost was 1.8% (KNHNES), 1.5% (CHS), and 3.0% (KHP). The proportion of households reporting unmet healthcare needs due to cost was 1.0% (KOWEPS). Annual percentage change was −10.0%, −15.2%, −5.4%, and −17.5%, respectively. Low income populations had more unmet healthcare needs than high income populations. Therefore, in order to improve unmet healthcare needs, it is necessary to focus on low income populations.
Delivery of Health Care ; Family Characteristics ; Follow-Up Studies ; Health Surveys ; Korea ; Nutrition Surveys ; Population Growth ; Poverty ; Prognosis

The definition of a policy problem is important in all stages of the policy processes, and especially in presidential election seasons, which usually open the political window. We propose priorities among the policy problems of Korean healthcare by the positioning approach, which compares Korea with Organization for Economic Cooperation and Development (OECD) countries using OECD health data. The range of positioning is 1 to -1 where 1 is the best or highest level among OECD countries, 0 is the average level, and -1 is the worst or lowest level. The positioning results show that the overall health status of Korea is good (positioning=0.34), but the suicide rate (-1.00) is a major problem. Healthcare human resources are scarce (-0.46), but rapidly increasing. Hospital beds and medical equipments are over-supplied (respectively 0.37, 0.33), but medical equipments that are utilized mainly in tertiary hospitals are below average. The utilization of healthcare is at the top level in doctors' consultations (0.97) and average length of stay (0.65). The quality of in-patient care is good (0.35), but quality of out-patient care is poor (-0.36). Healthcare costs are low (-0.73), but their growth rate is high. Among healthcare costs, the policy problems are large pharmaceutical expenditures and many households with catastrophic expenditures. This study determined the priorities of healthcare policy problems in Korea. The next step is to search for the factors that influence these policy problems and develop their solutions.
Delivery of Health Care ; Family Characteristics ; Health Care Costs ; Health Expenditures ; Humans ; Korea ; Length of Stay ; Outpatients ; Referral and Consultation ; Seasons ; Suicide ; Tertiary Care Centers

Background: Korea National Health Insurance Service (NHIS) is operated as a social insurance system in which people pay a portion of their monthly income as insurance premiums and receive benefits when they experience illness or injury. Since 2005, the national health insurance remained surplus accumulating cumulative reserves each year. However, as of 2018, NHIS revenue recorded 62.11 trillion won and spending of 62.29 trillion won. The deterioration of NHIS finances is expected to accelerate with the aging population, income growth, new medical technology development, and enhanced security policies. Methods: To examine the financial health and sustainability of NHIS, we estimated the future revenue and spending until 2030 using the data from Korea Health Insurance Review and Assessment Service statistical yearbook. 2004–2018 average percentage change in NHIS revenue and spending was calculated. We estimated the future NHIS financial status using two methods. In the first method, we calculated the revenue and spending of the future NHIS by applying the 2004–2018 average percentage change to the subsequent years consecutively. In the second method, we estimated the future NHIS financial status after adjusting for the predicted demographic changes such as the aging population and declining birth rate in South Korea. Results: The estimates from this study suggest that the NHIS’s cumulative reserves will run out by 2024. Conclusion In terms of spending on current health insurance, there should be a search for ways of more efficient spending and funding options.

Korean National Health Insurance (NHI) was established during only 12 yr from its inception (1977-1989), providing universal medical coverage to the entire nation and making a huge contribution to medical security. However, the program now faces many challenges in terms of sustainability. The low birth rates, aging population, low economic growth, and escalating demands for welfare, as well as unification issues, all add pressure to the sustainability of NHI. The old paradigm of low contribution - low benefits coverage - low NHI's fee schedule needs to be replaced by a new paradigm of proper contribution - adequate benefit coverage - fair NHI's fee schedule. This new paradigm will require reform of NHI's operating system, funding, and spending.
Health Care Reform ; Humans ; National Health Programs/*economics ; Program Evaluation ; Republic of Korea ; Risk Factors ; Universal Coverage/economics

OBJECTIVES: To comprehensively examine the relationship between current sleep duration and past suicidal idea or attempt among Korean adolescents. METHODS: Data came from the 2009 Korea Youth Risk Behavior Web-based Survey with 75 066 participants (with the participation rate of 97.6%) in 800 middle and high schools. Binary logistic regression was conducted by gender and depressed mood to identify significant factors for suicidal ideation/attempt. The dependent variable was the log odds of suicidal ideation/attempt, while the independent/control variables were sleep duration and other demographic, socio-economic and health-related factors. RESULTS: A negative association between sleep duration and suicidal ideation or attempt was weaker for those with depressed mood than for those without such experience in Korea for Year 2009. The odds ratio of suicidal ideation/attempt regarding less than 4 hours of sleep compared to 6 to 7 hours of sleep, was smaller in a group with depressed mood than in a group without such experience, for example, 1.64 (95% confidence interval [CI], 1.29 to 2.08) vs. 2.06 (95% CI, 1.34 to 3.17) for men's suicidal ideation, 2.50 (95% CI, 1.69 to 3.69) vs. 3.89 (95% CI, 1.74 to 8.66) for men's suicidal attempt. A negative association between age (or self-rated health) and suicidal ideation/attempt was also weaker for those with depressed mood than for those without such experience in the nation for the year. CONCLUSIONS: There was a negative association between sleep duration and suicidal ideation/attempt in Korea for Year 2009 and this association was weaker for those with depressed mood than for those without such experience. Based on the findings of this study, adolescents' better mental health and longer, more comfortable sleep might help to prevent their suicidal ideation and attempt in Korea.
Adolescent ; Demography ; Female ; Humans ; Internet ; Logistic Models ; Male ; Odds Ratio ; Republic of Korea ; Sex Factors ; *Sleep ; Socioeconomic Factors ; *Suicidal Ideation ; Suicide, Attempted/statistics & numerical data ; Time Factors ; User-Computer Interface

Objectives: The prevalence of cumulative trauma disorders of upper extremities mons watch assembly workers in small-scaled industry was studied. Methods: In 83 workers at five watch assembly factories, symptoms and psychosocial questionnaire, ergonomic Interview, physical examination were conducted. Results: Prevalence of self-reported symptoms was 54.2% and neck 34.9%, wrist/hand 31.3%, shoulder 30.1%, elbow/arm 18.0% by anatomical site. Prevalence of cumulative trauma disorders was 45.8%. Most common disease was myofascial pain syndrome (31.3%). The other diseases were De Quervain disease (9.6%), tenosynovitis/tendinitis at wrist/hand (9.6%), bicipital tendinitis(6.0%), fat. epicondylitis(4.8%), meIn. epicondylitis(2.4%), and cervical disc disease(2.4%). As result of ergonomic interview, repetitiveness was 79(98.8%). There were no differences in the prevalence of self-reported symptoms and cumulative trauma disorders for age, sex, marital status, duration of work In the study, The significant factors of cumulative trauma disorders were occupational task and psychosocial stress in the study. The prevalence of cumulative trauma disorders in high strain group was hlgher (68.4%) than other three groups. The prevalence of self-reported symptoms and cumulative trauma disorders in assembly task was higher (70.0%, 64.0%) than other two tasks. Conclusions: Prevalence of self-reported symptoms was 54.2%, prevalence of cumulative trauma disorders was 45.8% in watch assembly workers. In this study, factor related to self-reported symptoms was occupational task and factors relaxed to cumulative trauma disorders were occupational task and psychosocial stress. This results suggest that differences of ergonomics and environment in occupational task cause differences of prevalence of self-reported symptoms and cumulatlve trauma disorders.
Cumulative Trauma Disorders* ; De Quervain Disease ; Human Engineering ; Marital Status ; Myofascial Pain Syndromes ; Neck ; Physical Examination ; Prevalence* ; Questionnaires ; Shoulder ; Upper Extremity*

No abstract available.
Biofeedback, Psychology* ; Headache* ; Humans ; Muscle Tonus*