Even though suicide ranks as the fourth cause of death and is causing a significant loss in Korea, it seems that the conventional notion regarding suicide as a feasible way of solving a troublesome life situation hinders early recognition and proper management of suicide. This article reviews suicide prevention strategies recommended based on robust experience and scientific understanding of the characteristics of the suicide problem. In the UK, a suicide prevention strategy was formed at the national level suggesting significant goals to reduce the rate of suicide. In the US, the Institute of Medicine study committee examined the state of the science base, gaps in knowledge, strategies for prevention, and research designs for the study of suicide. This recommendation includes more science-based, coherent and well-coordinated multidisciplinary approaches, and thus suggests important practical recommendations for a suicide prevention strategy of Korea. The author concludes that suicide should be defined as a treatable and even preventable medical condition. Constructing a national network of suicide research, data surveillance, developing tools for suicide prevention including early detection and safety planning, and comprehensive insurance coverage are recommended.
Cause of Death ; Depression ; Institute of Medicine (U.S.) ; Insurance Coverage ; Korea ; Research Design ; Suicide

Improving mental health and reducing the burden of mental illness are complementary strategies which, along with the treatment and rehabilitation of people with mental disorders, significantly improve population health and well-being. A Institute of Medicine report describes a range of interventions for mental disorders that included treatment and maintenance, reserving the term "prevention" for efforts that occur before onset of a diagnosable disorder. Mental health problems affect 10-20% of children and adolescents worldwide. Despite their relevance as a leading cause of health-related disability and their long lasting consequences, the mental health needs of children and adolescents are neglected. Early intervention can help reduce the significant impacts that children and adolescents with serious mental health problems may experience. Screening is the first step in early intervention, recognizing emotional and behavioral problems and providing help at an early stage. It is essential to implement early intervention in a sensitive and ethical manner to avoid any of the negative outcomes.
Adolescent* ; Child* ; Early Intervention (Education) ; Humans ; Institute of Medicine (U.S.) ; Mass Screening ; Mental Disorders ; Mental Health* ; Primary Prevention ; Rehabilitation ; Resin Cements

The purpose of this study was to investigate weight gain during pregnancy based on pre-pregnant Body Mass Index, to compare eating habits based on the recommended standards for weight gain presented by the Institute of Medicine, and to identify factors affecting the weight gain of pregnant women. The subjects were grouped into three categories according to the recommended weight gain standards presented by the Institute of Medicine: the inadequate group, the adequate group and the excessive group. The excessive group had a significantly higher pre-pregnant Body Mass Index than that of the two other groups. Based on a comparison of the eating habits and nutrient intake of the women to the recommended standards for weight gain, the excessive gain group had large meals and ate more frequently outside of the home when compared to the pre-pregnancy period. Based on an analysis of correlations between weight gain during pregnancy and diet factors, the adequate gain group had positive correlation between weight gain and a "balanced meal" and had negative correlation with "convenience meals". The excessive gain group had a positive correlation with "convenience meals" and had a negative correlation with "meal skipping." All the pregnant women were more frequent in the "overeating categories" and all ate more "fruit," as their weight gain was higher. In particular, the excessive gain group was frequently evaluated as "overeating". These results indicate that the factors affecting weight gain during pregnancy were the Body Mass Index before pregnancy, eating types, and eating habits. As the Body Mass Index before pregnancy was higher, the ingestion of a 'balanced meal' was less, and overeating and gluttony were more frequent. Therefore weight gain was enhanced.
Body Mass Index ; Diet ; Eating ; Female ; Humans ; Hyperphagia ; Institute of Medicine (U.S.) ; Meals ; Pregnancy ; Pregnant Women ; Weight Gain

PURPOSE: To compare parameters of confocal scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT] II) in high myopia with age- and sex-matched emmetropes. METHODS: A hospital-based cross-sectional study was conducted among Nepalese subjects aged 18 to 35 years at BP Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Maharajgunj, Kathmandu from November 2015 to October 2016. Fifty consecutive subjects with high myopia (spherical equivalent ranging from −6.00 to −12.00 diopters) and age- and sex-matched emmetropic subjects were enrolled for comparison. Correlations between disc area and other HRT parameters, asymmetry between the right and left eyes, and comparisons between male and female subjects in both high myopic and emmetropic groups were evaluated. RESULTS: Disc area was not significantly (p = 0.11) larger in high myopic eyes than in emmetropic eyes. HRT parameters in highly myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes. Disc area was found to be significantly positively correlated with inter disc parameters and significantly negatively correlated with rim to disc area ratio in the high myopia group. Disc area and other intra-disc parameters showed significant correlations between right and left eyes in both high myopia and emmetropia, and no significant differences between males and females from a Nepalese population. CONCLUSIONS: Characteristics of HRT parameters in high myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes in a Nepalese population. The effect of disc area on HRT parameters differed significantly only in height variation contour by emmetropic eyes.
Cross-Sectional Studies ; Emmetropia ; Female ; Humans ; Institute of Medicine (U.S.) ; Lions ; Male ; Myopia ; Ophthalmoscopy ; Optic Disk ; Optic Nerve ; Retinaldehyde

OBJECTIVE: Pre-pregnancy weight and excess weight gain during pregnancy were associated with obstetric outcomes and plasma leptin was reported to have association with postpartum weight retention. The purpose of this study was to examine the relationships between pregnancy related factors including plasma leptin and weight gain during pregnancy and postpartum weight retention. METHODS: Seventy-five women were observed through pregnancy and 6 months postpartum. First trimester, third trimester and postpartum leptin were measured by radioimmunoassay. Weight gain categories were based on the Institute of Medicine recommendations. Relationships between pregnancy related factors and leptin were examined. And relationship between leptin and postpartum weight retention was also examined. RESULTS: Among subjects, 44.0% of women had concerns for postpartum weight retention and 18.9% had diet controls for postpartum weight management. Initial BMI categories by IOM classification were underweight, 29 (38.7%), normal, 37 (49.3%), and overweight group, 9 (12.0%). Underweight group was largely below IOM weight gain recommendation and overweight group was largely over IOM weight gain recommendation (P=0.013). First trimester leptin was correlated with pregravid BMI (r=0.678, P=0.000), maternal weight at term (r=0.547, P=0.006) and postpartum BMI (r=0.608, P=0.002), but not correlated with weight gain during pregnancy and postpartum weight retention. Third trimester leptin was not correlated with above variables. Initial BMI categories by IOM were significantly correlated with first trimester leptin, leptin at 5 weeks postpartum, maternal weight at term (0.741, P=0.000), weight at 5 weeks postpartum (r=0.728, P=0.001) and weight at 6 months postpartum (r=0.684, P=0.002). CONCLUSION: These results suggest that first trimester plasma leptin may predict maternal weight at term and initial BMI categories may be a predictor of maternal weight at 5 weeks postpartum and 6 months postpartum. However, weight gain during pregnancy was not correlated with postpartum weight retention.
Classification ; Diet ; Female ; Humans ; Institute of Medicine (U.S.) ; Leptin ; Overweight ; Plasma ; Postpartum Period* ; Pregnancy ; Pregnancy Trimester, First ; Pregnancy Trimester, Third ; Radioimmunoassay ; Thinness ; Weight Gain

OBJECTIVE: To evaluate the risk of emergency cesarean section according to the prepregnancy body mass index (BMI) and gestational weight gain per the 2009 Institute of Medicine guidelines. METHODS: A retrospective analysis of data from 2,765 women with singleton full-term births (2009 to 2012) who attempted a vaginal delivery was conducted. Pregnancies with preeclampsia, chronic hypertension, diabetes, planned cesarean section, placenta previa, or cesarean section due to fetal anomalies or intrauterine growth restriction were excluded. Odds ratios (ORs) and confidence intervals (CIs) for emergency cesarean section were calculated after adjusting for prepregnancy BMI or gestational weight gain. RESULTS: Three-hundred and fifty nine (13.0%) women underwent emergency cesarean section. The adjusted OR for overweight, obese, and extremely obese women indicated a significantly increased risk of cesarean delivery. Gestational weight gain by Institute of Medicine guidelines was not associated with an increased risk of cesarean delivery. However, inadequate and excessive weight gain in obese women was highly associated with an increased risk of emergency cesarean section, compared to these in normal BMI (OR, 5.56; 95% CI, 1.36 to 22.72; OR, 3.63; 95% CI, 1.05 to 12.54; respectively), while there was no significant difference between normal BMI and obese women with adequate weight gain. CONCLUSION: Obese women should be provided special advice before and during pregnancy for controlling weight and careful consideration should be needed at the time of vaginal delivery to avoid emergency cesarean section.
Body Mass Index* ; Cesarean Section* ; Emergencies* ; Female ; Humans ; Hypertension ; Institute of Medicine (U.S.)* ; Odds Ratio ; Overweight ; Parturition ; Placenta Previa ; Pre-Eclampsia ; Pregnancy ; Retrospective Studies ; Weight Gain*

OBJECTIVES: To evaluate the mobile health applications (apps) developed by a single tertiary hospital in Korea with a particular focus on quality and patient safety. METHODS: Twenty-three mobile health apps developed by Asan Medical Center were selected for analysis after exclusion of the apps without any relationship with healthcare or clinical workflow, the apps for individual usage, and the mobile Web apps. Two clinical informaticians independently evaluated the apps with respect to the six aims for quality improvement suggested by the United States Institute of Medicine. All discrepancies were resolved after discussion by the two reviewers. The six aims observed in the apps were reviewed and compared by target users. RESULTS: Eleven apps targeted patients, the other 12 were designed for healthcare providers. Among the apps for patients, one app also had functions for healthcare providers. 'My cancer diary' and 'My chart in my hand' apps matched all the six aims. Of the six aims, Timeliness was the most frequently observed (20 apps), and Equity was the least observed (6 apps). Timeliness (10/11 vs. 10/12) and Patient safety (10/11 vs. 9/12) were frequently observed in both groups. In the apps for patients, Patient-centeredness (10/11 vs. 2/12) and Equity (6/11 vs. 0/12) were more frequent but Efficiency (5/11 vs. 10/12) was less frequent. CONCLUSIONS: Most of the six aims were observed in the apps, but the extent of coverage varied. Further studies, evaluating the extent to which they improve quality are needed.
Chungcheongnam-do ; Delivery of Health Care ; Health Personnel ; Humans ; Institute of Medicine (U.S.) ; Korea ; Patient Safety ; Patient-Centered Care ; Quality Improvement* ; Telemedicine* ; Tertiary Care Centers* ; United States

Since release of the Institute of Medicine (IOM) report, To Err Is Human: Building a Safer System, patient safety has emerged as a global concern in the provision of quality health care. In response to growing recognition of the importance of patient safety, some medical schools in other countries have created and/or implemented patient safety curricula. In Korea, however, patient safety medical curriculum has not been actively discussed by medical educators. The purpose of this article is to introduce patient safety concepts and the global efforts on patient safety medical education. Specifically, this article describes; 1) current concepts in patient safety, 2) global trends of patient safety movement and education, 3) contents, instructional and assessment methods of patient safety education for both undergraduate medical education and graduate medical education, suggested in the previous studies, 4) WHO Patient Safety Guide for Medical Curriculum developed by the Medical Education Team within the World Alliance for Patient Safety and 5) known barriers against patient safety education. Patient safety is a major priority for all healthcare providers. In reality, however, teaching and learning about patient safety in medical curriculum offers a challenge to all medical schools, especially, the health care environment is not favorable to physicians such as Korea. More attention and recognition about patient safety by all health personnel and medical educators is needed. In addition, the national conversation about medical errors and patient safety and how best to incorporate it to the existing curriculum should be discussed.
Curriculum ; Delivery of Health Care ; Education, Medical ; Education, Medical, Graduate ; Education, Medical, Undergraduate ; Health Personnel ; Humans ; Institute of Medicine (U.S.) ; Korea ; Learning ; Medical Errors ; Patient Safety ; Schools, Medical

Since release of the Institute of Medicine (IOM) report, To Err Is Human: Building a Safer System, patient safety has emerged as a global concern in the provision of quality health care. In response to growing recognition of the importance of patient safety, some medical schools in other countries have created and/or implemented patient safety curricula. In Korea, however, patient safety medical curriculum has not been actively discussed by medical educators. The purpose of this article is to introduce patient safety concepts and the global efforts on patient safety medical education. Specifically, this article describes; 1) current concepts in patient safety, 2) global trends of patient safety movement and education, 3) contents, instructional and assessment methods of patient safety education for both undergraduate medical education and graduate medical education, suggested in the previous studies, 4) WHO Patient Safety Guide for Medical Curriculum developed by the Medical Education Team within the World Alliance for Patient Safety and 5) known barriers against patient safety education. Patient safety is a major priority for all healthcare providers. In reality, however, teaching and learning about patient safety in medical curriculum offers a challenge to all medical schools, especially, the health care environment is not favorable to physicians such as Korea. More attention and recognition about patient safety by all health personnel and medical educators is needed. In addition, the national conversation about medical errors and patient safety and how best to incorporate it to the existing curriculum should be discussed.
Curriculum ; Delivery of Health Care ; Education, Medical ; Education, Medical, Graduate ; Education, Medical, Undergraduate ; Health Personnel ; Humans ; Institute of Medicine (U.S.) ; Korea ; Learning ; Medical Errors ; Patient Safety ; Schools, Medical

Since 2006, type 1 diabetes in Finland has plateaued and then decreased after the authorities' decision to fortify dietary milk products with cholecalciferol. The role of vitamin D in innate and adaptive immunity is critical. A statistical error in the estimation of the recommended dietary allowance (RDA) for vitamin D was recently discovered; in a correct analysis of the data used by the Institute of Medicine, it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L. Another study confirmed that 6201 IU/d was needed to achieve 75 nmol/L and 9122 IU/d was needed to reach 100 nmol/L. The largest meta-analysis ever conducted of studies published between 1966 and 2013 showed that 25-hydroxyvitamin D levels <75 nmol/L may be too low for safety and associated with higher all-cause mortality, demolishing the previously presumed U-shape curve of mortality associated with vitamin D levels. Since all-disease mortality is reduced to 1.0 with serum vitamin D levels ≥100 nmol/L, we call public health authorities to consider designating as the RDA at least three-fourths of the levels proposed by the Endocrine Society Expert Committee as safe upper tolerable daily intake doses. This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter. Actions are urgently needed to protect the global population from vitamin D deficiency.
Adaptive Immunity ; Child ; Cholecalciferol ; Finland ; Humans ; Institute of Medicine (U.S.) ; Milk ; Mortality ; No-Observed-Adverse-Effect Level ; Public Health ; Recommended Dietary Allowances ; Vitamin D Deficiency ; Vitamin D* ; Vitamins* ; Young Adult