Strengthening primary care has always been a major policy issue in most developed countries to achieve the health care system's goals, and policy makers continuously try to use payment system as an effective tool to improve overall performance of primary care. In this paper, we examined the various payment methods and growing trends in primary care payment system in some developed countries. Overall, a common form of payment for primary care doctors is a blend of fee-for-service (FFS), capitation, and pay-for-performance (P4P). In addition, many countries are still in the way of many new trials to find the right way to provide primary care service effectively, to meet the complex health care needs of populations. In Korea, primary care system is not well-established, and other institutional arrangements are not in good conditions for primary care, either. FFS, which is a dominant payment method in Korea, is not favorable for achieving good attributes of primary care. Mixing various payment components, like capitation, P4P to current FFS is essential to provide the optimal incentive structures for primary care physicians. Also, new models to encourage doctor-patient relationships with appropriate P4P mechanisms could be used as an early step in reforming primary care payment system gradually.
Administrative Personnel ; Delivery of Health Care ; Developed Countries ; Fee-for-Service Plans ; Humans ; Korea ; Motivation ; Physicians, Primary Care ; Primary Health Care ; Reimbursement, Incentive

Injury is a major public health concern because it is a major cause of death and may cause lifelong disabilities. New environmental risk factors, such as extreme climates, are now emerging, and the vulnerable elderly population is rapidly growing. Therefore, understanding the epidemiological characteristics and trends of injury is necessary to establish preventive policies and actions.Current Concepts: Injury accounts for 13.3% of the disease burden in Korea, which is higher than the global proportion (9.8%). In addition, in 2019, the life years lost due to injury in Korea was 973,030, which is also higher than in the other 37 countries of the Organisation for Economic Co-operation and Development (OECD). Mortality due to injury has shown a downward trend, while mortality due to falls has shown an upward trend since 2010. Mortality due to injury in Korea is higher than the OECD average, and mortality due to intentional self-harm was the highest. Intentional self-harm accounts for 50.8% of deaths due to injury. In hospitalization due to injury, falls account for the largest proportion (38.5%) and frequently occur in older adults.Discussion and Conclusion: Although the mortality rate of injury is decreasing, the magnitude of injury in Korea is still higher than the OECD average. We hope these findings are used as basic data to find a targeted approach for injury prevention.

IL-22, a pleiotropic cytokine, is known to have a profound effect on the regeneration of damaged intestinal barriers. The tissue-protective properties of IL-22 are expected to be potentially exploited in the attenuation and treatment of colitis. However, because of the disease-promoting role of IL-22 in chronic inflammation, a comprehensive evaluation is required to translate IL-22 into the clinical domain. Here, we present the effective production of soluble human IL-22 in bacteria to prove whether recombinant IL-22 has the ability to ameliorate colitis and inflammation. IL-22 was expressed in the form of a biologically active monomer and non-functional oligomers. Monomeric IL-22 (mIL-22) was highly purified through a series of 3 separate chromatographic methods and an enzymatic reaction. We reveal that the resulting mIL-22 is correctly folded and is able to phosphorylate STAT3 in HT-29 cells. Subsequently, we demonstrate that mIL-22 enables the attenuation of dextran sodium sulfate-induced acute colitis in mice, as well as the suppression of pro-inflammatory cytokine production. Collectively, our results suggest that the recombinant mIL-22 is suitable to study the biological roles of endogenous IL-22 in immune responses and can be developed as a biological agent associated with inflammatory disorders.

OBJECTIVE: This study investigated the prevalence of insomnia and its associated factors among community-dwelling Korean elderly. METHODS: A cross-sectional survey examining a person's physical and psychological health status, including sleep, was administered among 1,500 individuals aged 65 and older. All participants were community-dwelling Korean elderly. RESULTS: We found that the overall prevalence of insomnia during the preceding month was 43.1%, including difficulty initiating sleep (27%) and difficulty maintaining sleep or early morning awakening (37.9%). Multiple logistic regression analysis showed that chronic diseases [odds ratio (OR) 2.42, 95% confidence interval (CI) 1.59-3.71], depression (OR 1.86, 95% CI 1.31-2.63), female (OR 1.63, 95% CI 1.27-2.10), suicidal ideation (OR 1.60, 95% CI 1.05-2.45), poor perceived health (OR 1.57, 95% CI 1.14-2.17), unemployment (1.51, 95% CI 1.13-2.03) were associated with an increased prevalence of insomnia. CONCLUSION: Insomnia is prevalent among community-dwelling Korean elderly, and multiple psychosocial factors are associated with insomnia.
Aged* ; Chronic Disease ; Cross-Sectional Studies ; Depression ; Female ; Humans ; Logistic Models ; Prevalence* ; Psychology ; Sleep Initiation and Maintenance Disorders* ; Suicidal Ideation ; Unemployment

We describe a patient with sensory polyneuropathy and cobalt intoxication. The cause of cobalt intoxication was metallosis of a metal-on-metal hip joint composed of cobalt-chrome alloy. A nerve conduction study revealed axonal sensory polyneuropathy, which improved slightly after chelation therapy and revision surgery. This case implies that a history of arthroplasty should not be neglected in the context of sensory polyneuropathy.
Alloys ; Arthroplasty ; Arthroplasty, Replacement, Hip* ; Axons ; Chelation Therapy ; Cobalt* ; Hip Joint ; Humans ; Neural Conduction ; Polyneuropathies*

No abstract available.
Aged, 80 and over ; Ascorbate Oxidase/*metabolism ; Ascorbic Acid/administration & dosage/blood/*chemistry ; Breast Neoplasms/pathology ; Cholesterol/*blood ; *Colorimetry ; Enzyme Assays ; Female ; Humans ; Injections, Intravenous ; Intestine, Small/surgery ; Kidney/physiopathology ; Male ; Middle Aged ; Palliative Care ; Recurrence

No abstract available.
Humans ; Neuromyelitis Optica ; Spondylitis, Ankylosing

As a minor blood antigen, the Duffy blood group has 5 antigens which are Fya, Fyb, Fy3, Fy4 and Fy5. When the Duffy group is implicated in delayed transfusion reactions, one expects to find anti-Fya rather than Fyb. We experienced a case of delayed hemolytic transfusion reaction caused by anti-Fyb antibody. A 69 year-old woman was referred having had hematuria, fever, chill and jaundice 9 days after transfusion. The hemoglobin was 9.5mg/dl, reticulocyte count 1.4%, liver function test showed total bilirubin 10.8mg/dL, LDH 5,225IU/L, alkaline phosphatase 26IU/L. Indirect antiglobulin test was positive, while the direct one was negative. A delayed hemolytic transfusion reaction was suspected as patient's serum was reacted with panel cells for the antibody identification test and the anti-Fyb was finally identified. The patient recovered without specific treatment. There were no severe complication and sequele.It appears to be the first reported case of hemolytic transfusion reaction caused by anti-Fyb in Korea.
Aged ; Alkaline Phosphatase ; Bilirubin ; Blood Group Incompatibility ; Coombs Test ; Female ; Fever ; Hematuria ; Humans ; Jaundice ; Korea ; Liver Function Tests ; Reticulocyte Count

Since bone matrix is known to contain osteoinductive substance, many studies have been carried out for its clinical applications. But there are still controversies about its regeneration effects and bone induction. This study was performed to compare the bone induction and regeneration between bone matrix particles (BMP) and demineralized bone matrix particles (DMP). About 700 mm BMP and DMP were made from long bone of adult rabbit. They were allografted into the artificial defect formed at medial surface of tibia and observed using LM and fluorescent microscopy. More fibrin networks and osteoblasts were formed in the graft groups than in control group after 3 days of graft. At one week after graft active endochondral and intramembranous ossification were taking place by osteoinduction around the DMP, whereas osteoinduction is rarely seen around the BMP. Most of regenerated trabecular bone was replaced by immature lamellar bone in DMP group, while some amount of fibrous and trabecular structures still remained in the defect in BMP group at 4 weeks after graft. More rapid bone regeneration and maturity were seen in DMP grafted group than in BMP grafted and control groups in fluorescent microscopy at each week after graft. These results suggest that demineralized bone matrix graft is more effective than that of mineralized bone matrix in regeneration of bone defect and endochondral bone formation is not necessary in osteoinduction.
Adult ; Allografts* ; Bone Matrix ; Bone Regeneration ; Fibrin ; Humans ; Microscopy ; Osteoblasts ; Osteogenesis ; Rabbits* ; Regeneration* ; Tibia ; Transplants

Purpose: This quasi-experimental single group study aimed to confirm the effects of discharge education using a systematic discharge education program on anxiety and parenting confidence in mothers of premature babies. Methods: This study conducted discharge education for 3 to 5 days prior to the discharge of 29 mothers of premature babies born in the neonatal intensive care unit. Data were collected between April 1, 2021, to June 30, 2021, and were examined. The hypotheses were analyzed using the Wilcoxon signed-rank test. Results: Discharge education using a systematic discharge education program was effective in increasing the parenting confidence of mothers with premature babies (z=-3.839, p<0.001). However, it was not effective in reducing anxiety (z=-1.712, p=0.087). Conclusion The effects of the systematic discharge education program development and discharge education systematized discharge nursing education, reduced mothers’ anxiety in raising premature babies at home after discharge, and contributed to improving parenting confidence.