BACKGROUND: This study aimed to analyze the impact of community health care resources on the place of death of older adults with dementia compared to those with cancer in South Korea, using public administrative big data. METHODS: Based on a literature review, we selected person- and community-level variables that can affect older people's decisions about where to die. Data on place-of-death and person-level attributes were obtained from the 2013 death certification micro data from Statistics Korea. Data on the population and economic and health care resources in the community where the older deceased resided were obtained from various open public administrative big data including databases on the local tax and resident population statistics, health care resources and infrastructure statistics, and long-term care (LTC) insurance statistics. Community-level data were linked to the death certificate micro data through the town (si-gun-gu) code of the residence of the deceased. Multi-level logistic regression models were used to simultaneously estimate the impacts of community as well as individual-level factors on the place of death. RESULTS: In both the dementia (76.1%) and cancer (87.1%) decedent groups, most older people died in the hospital. Among the older deceased with dementia, hospital death was less likely to occur when the older person resided in a community with a higher supply of LTC facility beds, but hospital death was more likely to occur in communities with a higher supply of LTC hospital beds. Similarly, among the cancer group, the likelihood of a hospital death was significantly lower in communities with a higher supply of LTC facility beds, but was higher in communities with a higher supply of acute care hospital beds. As for individual-level factors, being female and having no spouse were associated with the likelihood of hospital death among older people with dementia. CONCLUSION: More than three in four older people with dementia die in the hospital, while home is reported to be the place of death preferred by Koreans. To decrease this gap, an increase in the supply of end-of-life (EOL) care at home and in community-based service settings is necessary. EOL care should also be incorporated as an essential part of LTC. Changes in the perception of EOL care by older people and their families are also critical in their decisions about the place of death, and should be supported by public education and other related non-medical, social approaches.
Adult ; Certification ; Community Health Services* ; Death Certificates ; Delivery of Health Care ; Dementia* ; Education ; Female ; Hospices ; Humans ; Insurance ; Korea* ; Logistic Models ; Long-Term Care ; Population Characteristics ; Spouses ; Taxes ; Terminal Care

PURPOSE: This study aimed to investigate the relationship among nurses' workplace bullying experience, organizational culture, and organizational commitment. METHODS: Nurses who had worked for more than 6 months (N=299) were selected from 5 general hospitals. Data were collected from August to September 2014, using a self- reported questionnaire, and were analyzed using SPSS version 20.0. RESULTS: Among the participants, 17.7% reported having experienced workplace bullying. Those who had experienced workplace bullying reported significantly lower relation-oriented culture, innovation-oriented culture, and organizational commitment as compared to the other group (t=-2.50, p=.016; t=-2.60, p=.011; t=-2.91, p=.004, respectively). Rank-oriented culture was higher in those who had experienced workplace bullying as compared to those who had not (t=2.76, p=.007). CONCLUSION: Those who had experienced workplace bullying had higher scores on rank-oriented culture and lower scores on innovation-oriented culture, relation-oriented culture, and organizational commitment. To reduce workplace bullying among nurses, hospital managers should improve the relation-oriented organizational culture and alleviate the rank-oriented culture.
Bullying* ; Hospitals, General ; Organizational Culture*

BACKGROUND: Interictal spikes in gelastic epilepsy-hypothalamic hamartoma syndrome are mainly in the fronto-temporal area. Current source analysis of the interictal spikes has not been done enough. We tried the current source analysis in 2 patients with gelastic epilepsy-hypothalamic hamartoma syndrome using both of the discrete and distributed models. METHODS: Twenty 1 sec epochs including the negative peak of the spikes, were selected from one or two electroencephalographic recordings respectively in each patient. These 20 epochs were averaged into a single spike. The current dipole sources of the averaged spike were analyzed and located on a spherical head model. The current source density of the negative peak point of the averaged spike was located on the Talairach human brain map. RESULTS: The current dipole sources were in the right subcallosal gyrus, or the right or left anterior cingulate gyri. The current source density was distributed in the bilateral medial frontal area including the anterior cingulate gyri. CONCLUSIONS: The interictal spikes of patients with gelastic epilepsy-hypothalamic hamartoma syndrome may be generated by the current sources located in the bilateral medial frontal area.
Brain ; Hamartoma ; Head ; Humans