Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted diffusion (CHANTER) syndrome is characterized by an altered mental status. The acute MRI lesions show abnormal restricted diffusion imaging bilaterally and symmetrically in the cerebellum, hippocampus, and basal nuclei. This syndrome is an unknown syndrome and is presumed to be mainly an opioidinduced toxidrome. Here, we present a case study wherein we show that it can also be caused by an antidepressant overdose.

OBJECTIVES: This study was conducted to identify the demand and willingness to pay for oral hygiene services among elderly people with long-term care insurance. METHODS: Our study was a cross-sectional analysis. Subjects comprised 126 elderly individuals from long-term home-care centers. A total of 28 centers were selected through convenience sampling from among 78 centers in ○○. For analysis, semi-structured questionnaires that required about 20–30 minutes to complete were used. Analysis was performed using SPSS 23.0 software. RESULTS: The overall demand for oral hygiene services was 44.4%, and willingness to pay was 31.0%. Thirty-three people (58.9%) of elderly those who have demand for an oral hygiene service were willing to pay for the service, and 64 people (91.4%) who did not have a demand were not willing to pay for it. Among those with partial dependence on brushing, 65.6% had demand for oral hygiene services and 50.0% were willing to pay costs. Among basic livelihood beneficiaries, 69.6% were willing to pay for oral hygiene services; general subjects and relievers were less willing to pay. CONCLUSIONS: The overall demand for oral hygiene services among elderly people was 44.4%, and the willingness to pay was as low as 31.0%.
Aged ; Cross-Sectional Studies ; Dental Hygienists ; Humans ; Insurance, Long-Term Care ; Long-Term Care ; Oral Hygiene

BACKGROUND: Although many studies on vitamin D have been conducted, they have not been consistent regarding the method of measurement, the individuals investigated, and the season of blood sampling. Thus, this study was performed to investigate 25-hydroxy vitamin D [25(OH)D] levels and the prevalence of 25(OH)D deficiency by age, region, and season using the standard method for vitamin D measurement. METHODS: A total of 17,252 health examinees (9,180 men and 8,072 women) who were administered the vitamin D test at 16 health promotion centers in 13 cities in Korea from January to December 2013 were selected for this study. Measurements of 25(OH)D2 and 25(OH)D3 were performed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) using the MSMS Vitamin D Kit. RESULTS: The levels of 25(OH)D were significantly lower among women than men. The median 25(OH)D value was lowest among men and women in their 20s when compared to other age groups. We observed the lowest levels in January and February and the highest levels in August, September, and October. The prevalence of 25(OH)D deficiency (having levels of <10 ng/mL) was significantly higher among women than men. When different age groups were analyzed, the highest rates of 25(OH)D deficiency were found in their 20s, and prevalence decreased with age (up to an age of 60 years). Lastly, the prevalence of 25(OH)D deficiency was highest in Seoul and the Gyeonggi area when compared to other regions. CONCLUSIONS: Level of 25(OH)D and the prevalence of 25(OH)D deficiency differed by sex, age, month (season), and region.
Female ; Gyeonggi-do ; Health Promotion ; Humans ; Korea ; Male ; Mass Spectrometry ; Prevalence* ; Seasons* ; Seoul ; Tandem Mass Spectrometry ; Vitamin D Deficiency* ; Vitamin D*

BACKGROUND: Although many studies on vitamin D have been conducted, they have not been consistent regarding the method of measurement, the individuals investigated, and the season of blood sampling. Thus, this study was performed to investigate 25-hydroxy vitamin D [25(OH)D] levels and the prevalence of 25(OH)D deficiency by age, region, and season using the standard method for vitamin D measurement. METHODS: A total of 17,252 health examinees (9,180 men and 8,072 women) who were administered the vitamin D test at 16 health promotion centers in 13 cities in Korea from January to December 2013 were selected for this study. Measurements of 25(OH)D2 and 25(OH)D3 were performed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) using the MSMS Vitamin D Kit. RESULTS: The levels of 25(OH)D were significantly lower among women than men. The median 25(OH)D value was lowest among men and women in their 20s when compared to other age groups. We observed the lowest levels in January and February and the highest levels in August, September, and October. The prevalence of 25(OH)D deficiency (having levels of <10 ng/mL) was significantly higher among women than men. When different age groups were analyzed, the highest rates of 25(OH)D deficiency were found in their 20s, and prevalence decreased with age (up to an age of 60 years). Lastly, the prevalence of 25(OH)D deficiency was highest in Seoul and the Gyeonggi area when compared to other regions. CONCLUSIONS: Level of 25(OH)D and the prevalence of 25(OH)D deficiency differed by sex, age, month (season), and region.
Female ; Gyeonggi-do ; Health Promotion ; Humans ; Korea ; Male ; Mass Spectrometry ; Prevalence* ; Seasons* ; Seoul ; Tandem Mass Spectrometry ; Vitamin D Deficiency* ; Vitamin D*

BACKGROUND: Hepatitis B virus DNA quantification is essential for managing chronic hepatitis B (CHB). We compared the performance of artus HBV QS-RGQ (QIAGEN GmbH, Germany) and CAP/CTM v2.0 HBV assays (Roche Molecular Diagnostics, USA) in CHB patients. METHODS: A comparative evaluation between two assays was performed with 508 clinical serum samples. Precision, linearity, and the limit of detection (LOD) of QS-RGQ assay was evaluated by using the WHO standard 97/750 and clinical samples. RESULTS: Detection rates and viral loads as determined QS-RGQ assay were significantly lower than those from the CAP/CTM v2.0 assay (52.8% vs 60.6%; 3.55±1.77 IU/mL vs 4.18±1.89 IU/mL, P<0.0001). The kappa coefficient between qualitative results was 0.79 (95% confidence interval, 0.74 to 0.85). Bland-Altman plot found a mean difference of (QS-RGQ − CAP/CTM v2.0)=−0.63 log₁₀ IU/mL (95% limit of agreement, −1.48 to 0.22). Repeatability and total imprecision (% CV) of the QS-RGQ assay were 1.0% and 1.1% at 2,000 IU/mL, and 0.7% and 1.4% at 20,000 IU/mL, respectively. Linearity of this assay ranged from 31.6 to 1.0±10⁷ IU/mL, and the LOD was 2.95 IU/mL. CONCLUSIONS: The artus HBV QS-RGQ assay showed good performance but significantly decreased detection rate and viral load compared with CAP/CTM v2.0 assays. This assay recommends using plasma; however, we used stored serum because of the retrospective study design. Usually HBV DNA quantification is performed in plasma or serum, but sample type and clinical relevance of quantitative values should be considered when determining the clinical application of this reagent.
DNA ; DNA, Viral* ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Limit of Detection ; Pathology, Molecular ; Plasma ; Retrospective Studies ; Viral Load

Deterioration in the health care delivery system has been a growing problem in Korea. The concentration of mild patients with chronic disease in tertiary care centers or general hospitals other than in clinics results in the distortion of functional differentiation among various types of providers. This brings about not a coordination of care through well-organized a referral system but an undesirable competition between clinics and hospitals. In this study, we used a multivariate binary logistic model to estimate the factors associated with the diabetes outpatients' choice of tertiary care centers (TCCs) or general hospitals as their usual source of care. Data were collected from the 2008 Korean Health Panel. The unit of analysis was a diabetes outpatient (n=910). Our study results showed that 56% of all of the diabetes outpatients studied only used clinics for their care during the year of 2008 followed by general hospitals (16%), mixed (12%), TCCs (10%) and hospitals (6%). Among the various types of providers, TCC or general hospital users had the highest out-of-pocket payments per visit, but the lowest number of visits, tests, and prescriptions during the year of 2008. According to our regression analysis, patients with higher education, income, and Charlson Comorbidity Index levels were more likely to use TCCs or general hospitals. Compared with patients who enrolled in the National Health Insurance program, Medical Aid program enrollees were more likely to visit TCCs or general hospitals. In addition, being enrolled in private health insurance or having any disability was also positively associated with the greater use of TCCs or general hospitals. Our findings suggest that policy-makers should take into consideration the characteristics of patients in implementing policies related to the healthcare delivery system. It is also necessary to employ diverse approaches, such as regulation and incentives considering patent characteristics to reform the current defective aspects of health care utilization and provision.
Chronic Disease ; Comorbidity ; Delivery of Health Care ; Hospitals, General ; Humans ; Insurance, Health ; Korea ; Logistic Models ; Motivation ; National Health Programs ; Outpatients ; Prescriptions ; Referral and Consultation ; Tertiary Care Centers

Chronic diseases, such as hypertension and diabetes, account for 60% of global mortality. These conditions are directly related to unhealthy lifestyle habits, which are considered to be preventable risk factors, making it important to establish and maintain healthy habits. Several countries, including South Korea, have organized medical-based expert committees in order to develop and release lifestyle management guidelines. In this study, committees in the United States, United Kingdom, Netherlands, and Australia, and how they have developed guidelines, are scrutinized as benchmark policy cases. Physicians comprise most of the members of those committees, and most of the committees are operated independently from the government. All members of each committee are transparently listed on the committee's website, and the committees develop guidelines in a systematic and well-organized way. In comparison with these international committees, the relevant Korean committees (the Medical Guideline Committee and the Korean Preventive Services Task Force), have a number of things to change in terms of independence, expertise, and the process of developing guidelines. First, both of these committees are directly related to a governmental agency, the Korea Centers for Disease Control and Prevention. The proportion of physicians on the Medical Guideline Committee and the Korean Preventive Services Task Force is lower than that of other committees. Moreover, the focus of the current process of developing guidelines is limited to development itself, rather than the broader process, including re-assessment and feedback loops. This paper provides suggestions for the current lifestyle guideline committee based on case studies, with the ultimate goal of improving quality of life.
Advisory Committees ; Australia ; Benchmarking ; Centers for Disease Control and Prevention (U.S.) ; Chronic Disease ; Great Britain ; Hypertension ; Korea ; Life Style ; Mortality ; Netherlands ; Quality of Life ; Risk Factors ; United States

Chronic diseases, such as hypertension and diabetes, account for 60% of global mortality. These conditions are directly related to unhealthy lifestyle habits, which are considered to be preventable risk factors, making it important to establish and maintain healthy habits. Several countries, including South Korea, have organized medical-based expert committees in order to develop and release lifestyle management guidelines. In this study, committees in the United States, United Kingdom, Netherlands, and Australia, and how they have developed guidelines, are scrutinized as benchmark policy cases. Physicians comprise most of the members of those committees, and most of the committees are operated independently from the government. All members of each committee are transparently listed on the committee's website, and the committees develop guidelines in a systematic and well-organized way. In comparison with these international committees, the relevant Korean committees (the Medical Guideline Committee and the Korean Preventive Services Task Force), have a number of things to change in terms of independence, expertise, and the process of developing guidelines. First, both of these committees are directly related to a governmental agency, the Korea Centers for Disease Control and Prevention. The proportion of physicians on the Medical Guideline Committee and the Korean Preventive Services Task Force is lower than that of other committees. Moreover, the focus of the current process of developing guidelines is limited to development itself, rather than the broader process, including re-assessment and feedback loops. This paper provides suggestions for the current lifestyle guideline committee based on case studies, with the ultimate goal of improving quality of life.

PURPOSE: This study was performed to identify patient satisfaction with the emergency medical services (EMS) and its determinants. METHODS: Data were obtained from the first wave of the 2008 Korea Health Panel Survey. The unit of analysis was a case of patient visit of emergency department (ED) (n=1,280). Patient satisfaction with the EMS was categorized into two levels (1=satisfied, 2=dissatisfied). X2-test and logistic regression analysis were employed to find factors influencing the degree of EMS satisfaction. RESULTS: Among the 1,280 cases, 70.16% of patients were satisfied with the EMS. Patients who visited ED for accidents (odds ratio (OR)=1.42, p<0.05) were more satisfied with the services than those who visited ED for disease (reference). Also, patients who visited ED by private car (OR=3.05, p<0.05) or taxi (OR=4.00, p<0.05) or work (OR=4.78, p<0.01) showed higher satisfaction than those who visited ED by ambulance (reference) or 119 (OR=2.49, p<0.09). In addition, patients who experienced delay (reference) in ED admittance displayed lower satisfaction than those who did not (OR=2.06, p<0.001). Finally, patients who transferred to other hospitals (reference) after service completion indicated lower satisfaction than those who went back home (OR=4.04, p<0.0001) or were admitted (OR=5.69, p<0.0001). CONCLUSION: EMS policymakers should pay more attention not only to improve the quality level of ambulance or 119 service, but also to prevent ED delay.
Ambulances ; Emergencies ; Emergency Medical Services ; Humans ; Korea ; Logistic Models ; Patient Satisfaction