OBJECTIVES: The purpose of the study was to identify a gap between consumer characteristics and utilization of health information on the Internet. METHODS: A telephone survey of nationally representative samples was conducted using structured questionnaires, and 1,000 of the 1,189 responses obtained were included in our analysis. The following variables were included in the analysis as potential predictors of health information use on the Internet: predisposing factors such as gender, age, and education status; enabling factors such as region and monthly household income; consumer need for health information; and attitude to health. Multiple logistic regression analysis was used to evaluate the association between utilization rate and the potential predictors. RESULTS: Thirty-nine percent of consumers had obtained health information on the Internet over a one-year period. The utilization rates were higher for consumers who were young, educated, worked in the office setting, had higher incomes, wanted health information, and were able to use the Internet. The utilization rate was 5.35 times higher in the younger group (20-30 years) than in the elderly group (95% CI=2.21-12.97); 2.21 times higher for office workers than for manual workers (95% CI=1.16-4.20); 3.61 times higher for college graduates than for middle school graduates and below (95% CI=1.07-11.59); 1.99 times higher for people with monthly household incomes over 3,000,000 won than for those with monthly household incomes below 1,500,000 won (95% CI=1.01-3.92). CONCLUSIONS: There needs to be a paradigm shift, with consideration of not only Internet accessibility in the digital age, but also consumer ability and attitudes toward utilization of health information.
Adult ; Age Factors ; Consumer Health Information/*methods ; Female ; Health Status ; Humans ; Internet/*utilization ; Male ; Middle Aged ; Residence Characteristics ; Sex Factors ; Socioeconomic Factors

OBJECTIVES: The aims of this study were to estimate the antihypertensive medication adherence in people with a disability and a history of taking antihypertensive medication, and to identify the factors affecting medication adherence. METHODS: The National Health Insurance claims data were linked with the National Disability Registry. People with a disability, who received a prescription of antihypertensives, were identified from a total of 85,098 cases. Cumulative medication adherence (CMA) was used as an indicator of medication adherence. A CMA > 80% was defined as appropriate medication adherence. Multiple logistic regression analysis was used to identify the factors affecting medication adherence. RESULTS: The average CMA in a total of 85,098 patients was 79.5%. The appropriate adherence (CMA > or =80%) rate was 54.5% and 20.5% of patients had a CMA < 50%. Multiple logistic regression analysis revealed that the probability of appropriate adherence decreased with decreasing number of prescription days per visit, increasing number of providers, the patients' residential area moving from urban to rural areas, and when patients have an internal organ disability, auditory impairment, mobility impairment. CONCLUSIONS: The adherence to antihypertensive medication in people with a disability is influenced by various socio-economic, clinical and regional factors. In particular, the disabled who have locomotive and communication disabilities and internal organ impairments have a higher probability of under-adherence to antihypertensive medication adherence in Korea.
Adult ; Aged ; Antihypertensive Agents/*administration & dosage ; Comorbidity ; Disabled Persons/*statistics & numerical data ; Drug Utilization ; Female ; Health Services Accessibility ; Humans ; Insurance Claim Review ; Korea/epidemiology ; Logistic Models ; Male ; Middle Aged ; National Health Programs ; Patient Compliance/*statistics & numerical data ; Residence Characteristics ; Socioeconomic Factors

OBJECTIVES: The objective of this study was to evaluate the performance of risk-adjusted mortality models for colorectal cancer surgery. METHODS: We investigated patients (n=652) who had undergone colorectal cancer surgery (colectomy, colectomy of the rectum and sigmoid colon, total colectomy, total proctectomy) at five teaching hospitals during 2008. Mortality was defined as 30-day or in-hospital surgical mortality. Risk-adjusted mortality models were constructed using claims data (basic model) with the addition of TNM staging (TNM model), physiological data (physiological model), surgical data (surgical model), or all clinical data (composite model). Multiple logistic regression analysis was performed to develop the risk-adjustment models. To compare the performance of the models, both c-statistics using Hanley-McNeil pair-wise testing and the ratio of the observed to the expected mortality within quartiles of mortality risk were evaluated to assess the abilities of discrimination and calibration. RESULTS: The physiological model (c=0.92), surgical model (c=0.92), and composite model (c=0.93) displayed a similar improvement in discrimination, whereas the TNM model (c=0.87) displayed little improvement over the basic model (c=0.86). The discriminatory power of the models did not differ by the Hanley-McNeil test (p>0.05). Within each quartile of mortality, the composite and surgical models displayed an expected mortality ratio close to 1. CONCLUSIONS: The addition of clinical data to claims data efficiently enhances the performance of the risk-adjusted postoperative mortality models in colorectal cancer surgery. We recommended that the performance of models should be evaluated through both discrimination and calibration.
Adult ; Aged ; Colorectal Neoplasms/*mortality/surgery ; Databases, Factual ; Female ; Hospital Mortality ; Hospitals, Teaching ; Humans ; Logistic Models ; Male ; Middle Aged ; Models, Psychological ; *Models, Theoretical ; Neoplasm Staging ; Odds Ratio ; Quality of Health Care ; Risk Adjustment

A survey was conducted by the staff of the College of Medicine and School of Public Health, Seoul National University in cooperation with Seoul Special City from 1 December 1967 through 28 February 1968, on such events as delivery, death, abortion and pregnancy. The survey directed to a total population of 47,811 residing in 9,157 households led us to the following findings: 1. Two year averages of crude birth rate, crude death rate and natural increase rate were 30.1, 5.6 and 24.5, respectively. 2. Of all deliveries, home and hospital deliveries constituted 61.1 per cent and 35.5 per cent, respectively. 3. Deliveries other than hospital deliveries were found to be attended more often by mother-in-laws(26.5 per cent) than by doctors or midwives(23.4 per cent). 4. About 52 per cent of all women having experiences in pregnancy during the last two years had an experience of consulting a doctor at least one time throughout whole period of pregnancy. 5. In most cases scissors were used to cut umbilical cords, of which 71.0 per cent were not sterilized and only 28.3 per cent sterilized. 6. In many cases placenta was incinerated(48,2 per cent) and on many other occasions it was thrown away into water(28.3 per cent). 7. Cement page(37.4 per cent), gauze and absorbent cotton(29.8 per cent)were found to be most frequently used to receive new-born babies. 8. In 1966 8.8 per cent of the women had at least one abortion induced and in 1967 the percentage was 9.2 per cent. 9. Nearly all(95.8 per cent) of the induced abortions reportedly were done at doctor's clinics. 10. Of all the abortions induced 65.3 per cent were done by specialists in obstetrics, 30.3 per cent by general practitioners and 2.7 per cent by midwives. 11. Those who experienced spontaneous abortions were 1.9 per cent of all women both in 1966 and 1967. 12. About 9.2 per cent of women investigated were found to be currently pregnant. 13. Age specific death rate turned out to be highest among those under 1 year of age. 14. Ten major causes of death in their order of frequency were: 15. Places of death can be classified into homes(75.3 per cent) and hospitals(13.2 per cent). 16. Method of disposing of corpses comprised burials(54.2 per cent) and cremations(44.6 per cent). 17. Infant, neonatal and hebdomadal mortality rates have been computed at 32.2, 18.9 and 13.7, respectively. 18. Infants were found to have died either at homes(81.5 per cent) or at hospitals(18.5 per cent). 19. Birth registrations had been done for about 18.5 per cent of the dead infants.
Abortion, Induced ; Abortion, Spontaneous ; Birth Rate ; Cadaver ; Cause of Death ; Family Characteristics ; Female ; General Practitioners ; Humans ; Infant ; Midwifery ; Mortality ; Obstetrics ; Parturition* ; Placenta ; Population Growth ; Pregnancy ; Public Health ; Seoul* ; Specialization ; Umbilical Cord

PURPOSE: When it comes to cancer care, the psychological well-being of family caregivers has gotten its deserved attention. However, the specific roles that the family caregivers take have not been examined as much. The current study aimed to investigate the distribution of family caregivers' roles, particularly in a family-oriented culture, Korea. MATERIALS AND METHODS: A sample of 439 participants was recruited from 11 national and regional cancer centers in Korea. The participants who were 60 years old or above went through treatments for their gastric, colorectal, or lung cancer. The individual survey included questions regarding the family type, living arrangement, and the sources of support when it comes to their physical, emotional, financial, and decision-making needs. RESULTS: The responses from the participants showed that cancer caregiving is shared by multiple family caregivers; the major source of support for elderly cancer patients on diverse domains was their spouse; patients' reliance on their daughter(s) increased for emotional support; and patients' reliance on their son(s) stood out for financial support and decision-making support. Also, the older the patients were, the heavier their reliance was on the adult children, including sons, daughters, and daughters-in-law. CONCLUSION: Future support programs for elderly cancer patients are suggested to involve multiple family caregivers to encourage effective and efficient intervention. Also, the limitations of the current study and the suggestions for future research are discussed.
Adult Children ; Aged ; Caregivers ; Financial Support ; Humans ; Korea ; Lung Neoplasms ; Nuclear Family ; Republic of Korea ; Residence Characteristics ; Spouses

There are more than 1,000 million people with disability worldwide, about 15% of the global population. The prevalence of disability has been rising because of aging populations and the increase in people with chronic diseases. Even though it is well known that people with disability have an increased risk of chronic diseases and mortality at a younger age, health policies have not been developed correspondingly.Current Concepts: Disability epidemiology is a study of the patterns, distributions, determinants, and outcomes of disabling conditions. From the medical model perspective, people with disabilities are just ill or abnormal. To overcome the limitations of the medical model, the World Health Organization developed the International Classification of Functioning, Disability and Health.Discussion and Conclusion: Using the International Classification of Functioning, Disability and Health model based on a biopsychosocial framework, the healthcare community should work together to develop and implement action plans to improve the health of those with disabilities. These policies are essential to care for acute-stage disabilities, build an integrated care system, and provide a better environment for people with disability.

Background: Food insecurity may contribute to mental health indicators such as stress, anxiety, or depression. We investigated whether food insecurity was associated with mental health indicators and health-related quality of life (HRQoL) in a representative sample of the Korean population. Methods: This study enrolled 12,987 adults without a history of medically serious disease from the 2012, 2013, and 2015 Korea National Health and Nutrition Examination Survey. Household food security status was categorized as “food security,” “mild food insecurity,” and “moderate/severe food insecurity.” The association between mental health and HRQoL was evaluated using a multivariate logistic regression model with food security as the reference group. Results: The adjusted odds ratio of adverse mental health or low HRQoL increased significantly in mild or moderate/severe food insecurity compared to food security. In the moderate/severe food insecurity group, it was 1.98% (95% confidence interval [CI], 1.31– 2.99) higher for perceived stress, 3.58% (95% CI, 2.44–5.26) higher for depression symptoms, 4.16% (95% CI, 2.68–6.45) higher for suicidal ideation, and 2.81% (95% CI, 1.91–4.15) higher for quality of life. Conclusion Food insecurity was strongly associated with negative mental health status and poor HRQoL. There is a need for a dietary support program that provides psychosocial support to those experiencing food insecurity.

OBJECTIVES: To evaluate associations between hospital volume, costs, and length of stay (LOS), and clinical and demographic outcome factors for five types of cancer resection. The main dependent variables were cost and LOS; the primary independent variable was volume. METHODS: Data were obtained from claims submitted to the Korean National Health Insurance scheme. We identified patients who underwent the following surgical procedures: pneumonectomy, colectomy, mastectomy, cystectomy, and esophagectomy. Hospital volumes were divided into quartiles. RESULTS: Independent predictors of high costs and long LOS included old age, low health insurance contribution, non-metropolitan residents, emergency admission, Charlson score > 2, public hospital ownership, and teaching hospitals. After adjusting for relevant factors, there was an inverse relationship between volume and costs/LOS. The highest volume hospitals had the lowest procedure costs and LOS. However, this was not observed for cystectomy. CONCLUSION: Our findings suggest an association between patient and clinical factors and greater costs and LOS per surgical oncologic procedure, with the exception of cystectomy. Yet, there were no clear associations between hospitals’ cost of care and risk-adjusted mortality.
Colectomy ; Cystectomy ; Emergencies ; Esophagectomy ; Hospital Costs ; Hospitalization ; Hospitals, Public ; Hospitals, Teaching ; Humans ; Insurance, Health ; Korea* ; Length of Stay ; Mastectomy ; Mortality ; National Health Programs ; Ownership ; Pneumonectomy

PURPOSE: Early diagnosis and an improved survival rate have emerged as important issues for cancer survivors returning to work during the prime of their working life. This study investigated the attitudes of the general public towards cancer survivors returning to work in Korea and attempted to identify the factors influencing this negative attitude. MATERIALS AND METHODS: A general public perception survey regarding cancer survivors returning to work, targeting 2,000 individuals between 40-70 years of age, was conducted as face-to-face home visit. RESULTS: The public expressed a negative attitude towards cancer survivors returning to work, in terms of both perception and acceptance. Negative perception was higher among those in metropolitan areas compared with urban/rural areas (odds ratio [OR], 1.71), with monthly incomes < $2,000 compared with > $4,000 (OR, 1.54), and with patient care experience compared with those without (OR, 1.41). Negative acceptance was higher among those with monthly incomes < $2,000 compared with > $4,000 (OR, 1.71) and those with patient care experience compared with those without (OR, 1.54). The common factors between acceptance and perception that influenced negative attitude included area of residence, patient care experience, and monthly income. CONCLUSION: This study identified negative attitudes towards cancer survivors returning to work in South Korea and the factors influencing the reintegration of cancer survivors into society. It is necessary to promote community awareness and intervention activities to enable access to community, social, and individual units for the social reintegration of cancer survivors.
Early Diagnosis ; House Calls ; Humans ; Korea* ; Patient Care ; Return to Work ; Social Stigma ; Survival Rate ; Survivors*

OBJECTIVES: This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea. METHODS: This population based study included all 8868 females who underwent radical mastectomy for breast cancer between January 2002 and June 2003. Follow-up for mortality continued from January 2002 to June 2006. The patients were divided into 4 socioeconomic classes according to their socioeconomic status as defined by the National Health Insurance contribution rate. The relationship between socioeconomic status and all-cause mortality after breast cancer surgery was assessed using the Cox proportional hazards model with adjusting for age, the Charlson's index score, emergency hospitalization, the type of hospital and the hospital ownership. RESULTS: Those in the lowest socioeconomic status group had a significantly higher hazard ratio of 2.09 (95% CI =1.50 - 2.91) compared with those in the highest socioeconomic group after controlling for all the identifiable confounding variables. For all-cause mortality after radical mastectomy, all the other income groups showed significantly higher 3-year mortality rates than did the highest income group. CONCLUSIONS: The socioeconomic status of breast cancer patients should be considered as an independent prognostic factor that affects all-cause mortality after radical mastectomy, and this is possibly due to a delayed diagnosis, limited access or minimal treatment leading to higher mortality. This study may provide tangible support to intensify surveillance and treatment for breast cancer among low socioeconomic class women.
Adult ; Aged ; Breast Neoplasms/diagnosis/mortality/*surgery ; Cohort Studies ; Female ; Humans ; Mastectomy, Radical/mortality ; Middle Aged ; *Mortality ; Prognosis ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Socioeconomic Factors