Background: This study examined the effect of having a usual source of care on the degree of patient-centered communication among persons with disability. The role of the usual source of care has been emphasized to improve patient experience, especially for patients with complex health conditions. Methods: This study used the 2017–2018 Korean Health Panel data, and the final study observations were 22,475 (20,806 people without disability and 1,669 people with disability). We applied generalized estimating equation model to show the effect of having a usual source of care on patient-centered communication, and subgroup analysis considering the types and severity of disabilities. Results: Persons who have disabilities, compared with ones without it, significantly had more usual sources of care (32.4% vs. 24.6%). By type of disability, persons with mental (51.4%), internal organ (43.8%), visual (37%), and physical disabilities (31.6%) had more usual sources of care than hearing/speech (26.6%), and developmental disabilities (18.6%). The average score of patient-centered communication was higher among who had a usual sources of care (3.2 vs. 2.7), and the regression analysis showed that having a usual sources of care was positively associated with higher patient-centered communication score (β=0.476, p<0.05). However, the positive effects of usual sources of care was not observed among persons with severe hearing/speech, developmental, and mental disabilities. Conclusion This study showed that role of patient-centered communication was limited in persons with severe hearing/speech disabilities, developmental, and mental disabilities. The education programs and supports are needed to improve communication skills between medical staff and persons with specific types of disabilities.

PURPOSE: Maintaining body temperature is a key vital function of human beings, but little is known about how body temperature of high-risk infants is sustained during early life after birth. The aim of this study was to describe hypothermia in high-risk infants during their first week of life and examine demographic, environmental, and clinical attributors of hypothermia. METHODS: A retrospective longitudinal study was done from January 1, 2013 to December 31, 2015. Medical records of 570 high-risk infants hospitalized at Neonatal Intensive Care Units (NICU) of a university affiliated hospital were examined. Body temperature and related factors were assessed for seven days after birth. RESULTS: A total of 336 events of hypothermia (212 mild and 124 moderate) occurred in 280 neonates (49.1%) and most events (84.5%) occurred within 24 hours after birth. Logistic regression analysis revealed that phototherapy (aOR=0.28, 95% CI=0.10-0.78), Apgar score at 5 minute (aOR=2.20, 95% CI=1.17-4.12), and intra-uterine growth retardation or small for gestational age (aOR=3.58, 95% CI=1.69-7.58) were statistically significant contributors to hypothermia. CONCLUSION: Findings indicate that high-risk infants are at risk for hypothermia even when in the NICU. More advanced nursing interventions are necessary to prevent hypothermia of high-risk infants.
Apgar Score ; Body Temperature ; Gestational Age ; Humans ; Hypothermia* ; Infant* ; Infant, Newborn ; Intensive Care Units, Neonatal ; Logistic Models ; Longitudinal Studies ; Medical Records ; Nursing ; Parturition ; Phototherapy ; Retrospective Studies

PURPOSE: Many end-of-life care studies are based on the assumption that there is a shared definition of language concerning the stage of cancer. However, studies suggest that patients and their families often misperceive patients' cancer stages and prognoses. Discrimination between advanced cancer and terminal cancer is important because the treatment goals are different. In this study, we evaluated the understanding of the definition of advanced versus terminal cancer of the general population and determined associated socio-demographic factors. MATERIALS AND METHODS: A total of 2,000 persons from the general population were systematically recruited. We used a clinical vignette of a hypothetical advanced breast cancer patient, but whose cancer was not considered terminal. After presenting the brief history of the case, we asked respondents to choose the correct cancer stage from a choice of early, advanced, terminal stage, and don't know. Multinomial logistic regression analysis was performed to determine sociodemographic factors associated with the correct response, as defined in terms of medical context. RESULTS: Only 411 respondents (20.6%) chose "advanced," while most respondents (74.5%) chose "terminal stage" as the stage of the hypothetical patient, and a small proportion of respondents chose "early stage" (0.7%) or "don't know" (4.4%). Multinomial logistic regression analysis found no consistent or strong predictor. CONCLUSION: A large proportion of the general population could not differentiate advanced cancer from terminal cancer. Continuous effort is required in order to establish common and shared definitions of the different cancer stages and to increase understanding of cancer staging for the general population.
Breast Neoplasms ; Data Collection ; Delivery of Health Care* ; Discrimination (Psychology) ; Humans ; Logistic Models ; Neoplasm Staging ; Prognosis

Participation in a screening program by itself may not improve clinical outcomes. Treatment gaps in the program may limit its full benefit. We evaluated statin prescription rates for subjects with sustained hypercholesterolemia to assess the treatment gaps in the National Health Screening Program (NHSP) in Korea. A retrospective, random cohort was established among National Health Insurance Corporation (NHIC) members. Finally, we examined 465,499 individuals who attended the NHSP from 2003 to 2010 without any history of dyslipidemia, statin prescription, or hospitalization for cardiovascular events until the end of 2002. The subsequent statin prescription rates were identified from the NHIC medical service claim database from 2003 to 2011. Descriptive data and odds ratio from multivariate logistic analyses on statin prescription rates and the corresponding correlations were evaluated. The NHSP detected 114,085 (24.5%) cases of newly diagnosed hypercholesterolemia. However, only 8.6% of these received statin prescription within 6 months of diagnosis. For cases of sustained hypercholesterolemia determined in the next screening visit by the NHSP, the statin prescription rate increased, but only to 12.2%. Statin prescriptions were more common among females, older individuals, and hypertension or diabetes patients. Furthermore, the statin prescription rates had increased over the study period. The NHSP exhibited low statin prescription rate which has been improving. For the NHSP to be effective, it would be worthwhile to decrease the gap between the diagnosis of hypercholesterolemia and the following treatment.
Adult ; Chronic Disease ; Drug Prescriptions/statistics & numerical data ; Female ; Health Services Accessibility/statistics & numerical data ; Healthcare Disparities/*statistics & numerical data ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use ; Hypercholesterolemia/*diagnosis/epidemiology/*prevention & control ; Insurance Claim Reporting/statistics & numerical data ; Male ; Mass Screening/*utilization ; Middle Aged ; National Health Programs/*utilization ; Prevalence ; Republic of Korea/epidemiology ; Risk Assessment ; Treatment Outcome ; Young Adult

PURPOSE: As Korea is an aging society (WHO classification) and projected to be an aged society in 10 years, peripheral vascular diseases (PVD) in the elderly population has emerged as an important social and medical issue. But their prevalence was rarely reported in Korea. The purpose of this study is to define the prevalence of carotid artery stenosis (CAS), abdominal aortic aneurysm (AAA), and peripheral arterial occlusive disease (PAOD) of lower limb in the Incheon area. METHODS: Elderly men (> or =65 years) were referred randomly from the Incheon Federation of Korean Senior Citizens' Association (from Nov 2008 to Sep 2009) to Inha Univeristy Hospital, Incheon, Korea for a PVD screening program. The subjects were screened for CAS and AAA by duplex. CAS was defined as > or =50% internal CAS and AAA as > or =3 cm aortic diameter in minor axis. PAOD of lower limb was screened by measurement of ankle brachial index (ABI); ABI of < or =0.9 was considered abnormal. RESULTS: 1150 subjects were screened including 103 octogenarians (9.0%). Mean age was 72.3+/-0.2 years. Combined conditions were hypertension (54.3%), diabetes mellitus (25.2%), coronary artery disease (15.6%), dyslipidemia (18.9%), obesity (31.1%) and smoking history (71.7%). CAS was detected in 7.7% (89/1,150) subjects. Thirty-three (2.9%) were diagnosed with AAA. PAOD was detected in 50 subjects (4.4%). CONCLUSION: Prevalence of PVD in Korea is not lower compared to that of western countries, especially the USA and the UK. A nationwide program for timely detection and treatment for PVD should be developed.
Aged ; Aged, 80 and over ; Aging ; Ankle Brachial Index ; Aortic Aneurysm, Abdominal ; Arterial Occlusive Diseases ; Axis, Cervical Vertebra ; Carotid Stenosis ; Coronary Artery Disease ; Diabetes Mellitus ; Dyslipidemias ; Humans ; Hypertension ; Korea ; Lower Extremity ; Male ; Mass Screening ; Obesity ; Peripheral Vascular Diseases ; Prevalence ; Smoke ; Smoking ; Vascular Diseases

BACKGROUND: Studies on factors which may predict the risk of diabetes are scarce. This prospective cohort study was conducted to determine the association between adiponectin and type 2 diabetes among Korean men and women. METHODS: A total of 42,845 participants who visited one of seven health examination centers located in Seoul and Gyeonggi province, Republic of Korea between 2004 and 2008 were included in this study. The incidence rates of diabetes were determined through December 2011. To evaluate the effects of adiponectin on type 2 diabetes, the Cox proportional hazard model was used. RESULTS: Of the 40,005 participants, 959 developed type 2 diabetes during a 6-year follow-up. After the adjustment for age, body mass index (BMI), and waist circumference, the risks for type 2 diabetes in participants with normoglycemia had a 1.70-fold (95% confidence interval [CI], 1.21 to 2.38) increase in men and a 1.83-fold (95% CI, 1.17 to 2.86) increase in women with the lowest tertile of adiponectin when compared to the highest tertile of adiponectin. For participants with impaired fasting glucose (IFG), the risk for type 2 diabetes had a 1.46-fold (95% CI, 1.17 to 1.83) increase in men and a 2.52-fold (95% CI, 1.57 to 4.06) increase in women with the lowest tertile of adiponectin. Except for female participants with normoglycemia, all the risks remained significant after the adjustment for fasting glucose and other confounding variables. Surprisingly, BMI and waist circumference were not predictors of type 2 diabetes in men or women with IFG after adjustment for fasting glucose and other confounders. CONCLUSION: A strong association between adiponectin and diabetes was observed. The use of adiponectin as a predictor of type 2 diabetes is considered to be useful.
Adiponectin ; Body Mass Index ; Cohort Studies ; Confounding Factors (Epidemiology) ; Diabetes Mellitus ; Fasting ; Female ; Follow-Up Studies ; Glucose ; Humans ; Incidence ; Male ; Proportional Hazards Models ; Prospective Studies ; Republic of Korea ; Waist Circumference