Medication adherence refers to the extent to which a patient takes medication according to prescription. In many cases, adherence to medication is defined as the proportion of prescribed drugs taken as prescribed over a certain period. However, there is no satisfactory level of adherence that can be applied uniformly to all diseases and medications. Patients with poor adherence experience worsening of conditions, complications, and increased risk for death, which increases medical expenses. Therefore, to improve medication adherence, healthcare providers should try to identify poor adherence, adjust prescriptions to optimize treatment according to the patient’s lifestyle, and educate patients to help them understand the value of medical treatment and the effects of adherence. The most practical way to identify poor adherence during clinical visits is by asking patients about their medication adherence in a non-judgmental manner. Reducing the number of doses is more effective than reducing the number of tablets to increase compliance. It is necessary to adopt innovative methods based on information technology in our healthcare system because of the labor-intensive nature of educational intervention to improve adherence.

OBJECTIVES: It is necessary to examine groups carrying out sexually risky behavior because the prevalence of sexually transmitted diseases (STDs) is high among them. In this study, the prevalence of STDs among homosexuals and sex-buying men in South Korea was investigated, along with their sexual risk factors. METHODS: Men who have sex with men (MSMs, n=108) were recruited in Seoul and Busan by applying the time location sampling method, while sex-buying men (n=118) were recruited from a john school in Gyeonggi province, the suburbs of Seoul. Dependent variables included past or present infection with syphilis, Chlamydia, gonorrhea, and human immunodeficiency virus. Independent variables included health behavior, social support, sexual behavior, and safe sex. RESULTS: It was found that when the MSMs were non-drunk while having sexual intercourse (odds ratio [OR], 0.132), they showed a higher STD infection rate when they had a higher number of anal sex partners (OR, 5.872), rarely used condoms (OR, 1.980), had lower self-efficacy (OR, 0.229), and were more anxious about becoming infected with an STD (OR, 3.723). However, the men who paid for sex showed high STD infections when they had more sex partners (OR, 2.286) and lower education levels (OR, 3.028). CONCLUSIONS: STD infections among the two groups were high when they were engaged with many sex partners and not having protected sex. In other words, there was a gap in risky sex behavior within such groups, which was significantly related to the possibility of developing an STD. Therefore, the preventive intervention against STDs for these groups needs to be expanded to include management of sex behaviors.
Adult ; Female ; *Homosexuality, Male ; Humans ; Male ; *Prostitution ; Qualitative Research ; Republic of Korea/epidemiology ; Risk Factors ; Sexually Transmitted Diseases/diagnosis/*epidemiology/*etiology ; *Unsafe Sex ; Young Adult

To deal with the burden of chronic illnesses, the Korean government has planned to adopt the Health Management Service Act (HMS) to reduce risk factors related to lifestyle, including diet and physical activity with reinforcement of dietitians and physical education instructors and other health professionals. We welcome the strategy to expand human resources for preventing cardio-cerebrovascular events (CVE); however, the delivery system of the HMS has stimulated heated debate. The current legislative bill lacks a comprehensive perspective of clinical preventive medicine. It states that HMS is not a medical service, and therefore the HMS facilities are not medical institutions and can be operated independently from medical professionals. By excluding medical specialists who could integrate information from patients in order to prevent CVEs, the bill is incompatible with the main purpose of HMS and will fail to achieve its goal. To suggest a solution to the debate, a patient-centered, evidence-based approach should be established in order to make an arena where all disciplines related to chronic disease prevention can contribute to the HMS. The participation of medical doctors who are fundamental to healthcare is essential for the successful establishment of an HMS delivery system in Korea.
Chronic Disease ; Delivery of Health Care ; Diet ; Evidence-Based Medicine ; Health Occupations ; Hot Temperature ; Humans ; Korea ; Life Style ; Motor Activity ; Physical Education and Training ; Preventive Medicine ; Reinforcement (Psychology) ; Risk Factors ; Specialization

In this paper, ethical principles and practice guidelines concerning the usage of public database for medical researches were developed and proposed. Although there are several personal health databases with comprehensive information of each individual, researches aiming at public good are often hindered because of legal, managerial and technical barriers to the usage of public databases. Ethical principles and guidelines are indispensible to promote medical research that will benefit society while protecting personal information from bleaching and abuse. These principles and guidelines should be a basis of trust and supports from society. For this purpose, the meaning of public good was given, and the current status of the linkage and usage of public databases were explored. As a result, three ethical principles-guaranteeing public good, protecting personal information, and transparency were established and eight recommendations were proposed.
Codes of Ethics ; Database Management Systems ; Ethics, Medical ; Humans ; Medical Record Linkage

OBJECTIVES: The aim of this study was to investigate whether a medium to high degree of total physical activity and indoor physical activity were associated with reduced all-cause and cardiovascular mortality among elderly Korean women. METHODS: A prospective cohort study was done to evaluate the association between physical activity and mortality. The cohort was made up of elderly (> or =65 years of age) subjects. Baseline information was collected with a self-administered questionnaire and linked to death certificates retrieved from a database. Cox proportional hazard models were used to estimate the hazard ratios (HRs) with 95% confidence interval (CI) levels. RESULTS: Women who did not suffer from stroke, cancer, or ischemic heart disease were followed for a median of 8 years (n=5079). A total of 1798 all-cause deaths were recorded, of which 607 (33.8%) were due to cardiovascular disease. The group with the highest level of total physical activity and indoor physical activity was significantly associated to a reduced all-cause mortality (HR, 0.60; 95% CI, 0.51 to 0.71 and HR, 0.58; 95% CI, 0.50 to 0.67, respectively) compared to the group with the lowest level of total physical activity and indoor physical activity. Additionally, the group with the highest level of total physical activity and indoor physical activity was significantly associated to a lower cardiovascular disease mortality (HR, 0.53; 95% CI, 0.40 to 0.71 and HR, 0.51; 95% CI, 0.39 to 0.67, respectively) compared to the group with the lowest level of total physical activity and indoor physical activity. CONCLUSIONS: Our study showed that regular indoor physical activity among elderly Korean women has healthy benefits.
Aged ; Aged, 80 and over ; Cardiovascular Diseases/*mortality ; *Cause of Death ; Cohort Studies ; Death Certificates ; Exercise/*physiology ; Female ; Follow-Up Studies ; Humans ; Korea ; Proportional Hazards Models ; Prospective Studies ; Risk Factors

The development of information technologies has led to the era of big data; such enormous collections of information on drugs and adverse drug reactions are stored in either a structured, a semistructured, or an unstructured form. Because of the nature of the emerging issue of drug safety, it is common for policy makers and healthcare professionals to make decisions without sufficient evidence. Big data may be used as an efficient pharmacovigilance tool, which enables us to recognize adverse drug reactions that may not have been identified in pre-marketing clinical trials, in order to capture the patterns of drug utilization and adverse events, and to predict the occurrence of adverse drug reactions. National surveillance systems using electronic health databases have been established successfully in the US and Europe. The Korea Institute of Drug Safety and Risk Management (KIDS) plans to establish a big data platform for pharmacovigilance in Korea. The big data may be effectively used for evidence-based regulatory and clinical decision making in the field of drug safety and risk management.
Administrative Personnel ; Decision Making* ; Delivery of Health Care ; Drug Utilization ; Drug-Related Side Effects and Adverse Reactions ; Europe ; Humans ; Korea ; Pharmacoepidemiology ; Pharmacovigilance ; Risk Management

Evaluation of scientific evidence in the medical literature is based on the research methodology, which can be the fundamental tool for medical professionals to improve their practice. Since analytic studies usually provide evidence for generating hypotheses and selecting appropriate research designs, this article aims to review the methods for evaluating the study quality in randomized controlled trials (RCTs), cohort studies, and case-control studies. Critical appraisal of systematic errors including selection bias, performance bias, attrition bias, detection bias, and publication bias are the essential elements of the evaluation. Clinical trials need to have an adequate description of sequence generation and allocation concealment, blinding for exposure measurement, completeness of follow-up and intention to treat analysis, and blinding for outcome evaluation. For cohort studies, like RCTs, appropriate control of confounding variables is needed to prevent selection bias, and blinding and completeness of follow-up are also very important. Matching of the case group to the control group, blinding of interviewers, and proper definition of the cases and controls are important to prevent bias in a case-control study. Since the process of critical appraisal depends on the quality of reporting, there have been efforts to improve the reporting quality of the medical literature. However, reporting all of the elements necessary to avoid bias does not automatically guarantee an exclusion of bias or the quality of a study; instead, what is important is the logical connection of the elements of a study and the eventual lucid expression of the elements.
Bias (Epidemiology) ; Case-Control Studies ; Cohort Studies ; Confounding Factors (Epidemiology) ; Follow-Up Studies ; Intention to Treat Analysis ; Logic ; Preventive Medicine ; Publication Bias ; Research Design ; Selection Bias

OBJECTIVES: The present study was conducted in order to examine the association between socioeconomic status (SES) and osteoporosis prevalence in Korea and to assess whether different associations are found in single-person households. METHODS: A cross-sectional population-based study was conducted using the Korea National Health and Nutrition Examination Survey, from 2008 to 2011. The study subjects were people aged > or = 50 years with osteoporosis as defined by bone mineral density. Multivariate logistic models were used to estimate prevalence odds ratios (pORs) and 95% confidence intervals (CIs). Gender differences in the likelihood of osteoporosis were analyzed based on household income, education level, and residential area. RESULTS: There were 8221 osteoporosis patients aged > or = 50 years, of whom 927 lived in single-person households. There was a gender-specific association between osteoporosis prevalence and all three SES factors that we analyzed: income, education, and residential area. After adjusting for age, SES, and health behaviors, including body mass index (BMI), low household income was only significantly associated with osteoporosis in men, whereas education level had an inverse relationship with osteoporosis only in women (p=0.01, p<0.001, respectively). However, after controlling for age and BMI, rural residency was only associated with osteoporosis in women living in single-person households (pOR, 1.59; 95% CI, 1.05 to 2.43). CONCLUSIONS: The Korean adult population showed a gender-specific relationship between SES and osteoporosis prevalence, with a different pattern found in single-person households.
Aged ; Asian Continental Ancestry Group ; Body Mass Index ; Bone Density ; Cross-Sectional Studies ; Female ; Humans ; Income ; Logistic Models ; Male ; Middle Aged ; Nutrition Surveys ; Odds Ratio ; Osteoporosis/*epidemiology ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; *Social Class ; *Socioeconomic Factors

PURPOSE: Lower urinary tract dysfunction is the most common complication after radical pelvic surgery. The aims of this study were to assess the effect of radical hysterectomy (RH) on the storage function of the lower urinary tract and to evaluate the impact of radiation therapy (RT) on postoperative urodynamic parameters. METHODS: This was a retrospective review of preoperative and postoperative urodynamic variables, which were prospectively collected. All women from 2006 to 2008, who underwent RH for uterine cervical cancer with a stage of 1A to 2B with or without adjuvant RT were enrolled. All patients were divided into two groups: group 1, without RT, and group 2, with adjuvant RT. Urodynamic studies were performed before, 10 days after, and 6 months after RH. RESULTS: A total of 42 patients with a mean (+/-standard error) age of 51.9 (+/-12.3) years were analyzed. There were no significant differences in age, body mass index or clinical stage between the two groups. On the 10th postoperative day, all parameters were decreased except postvoid residual volume. In comparison with group 2 (n=14), group 1 (n=28) showed a significant increase in bladder compliance. At 6 months postoperatively, bladder compliance in group 1 had increased four times or more compared with that on postoperative 10 days. However, it had increased only 2.5 times in group 2 at the same time point (P<0.001). CONCLUSIONS: The results of our study suggest that adjuvant RT after RH might result in a deterioration of bladder compliance. It is highly suggested that practitioners pay attention to low bladder compliance, especially in patients who have adjuvant RT after RH.
Body Mass Index ; Compliance ; Female ; Humans ; Hysterectomy ; Prospective Studies ; Residual Volume ; Retrospective Studies ; Urinary Bladder ; Urinary Tract ; Urodynamics ; Uterine Cervical Neoplasms

This study was conducted to estimate the prevalence rates and to explore associated factors of sarcopenic obesity (SO) in 2,221 Koreans over 60 yr-of age from the Fourth Korea National Health and Nutrition Examination Survey (2009). Participants were assessed by dual energy X-ray absorptiometry. Appendicular skeletal muscle mass divided by body weight was used to define sarcopenia and waist circumference was used to define obesity. We estimated the prevalence rates of SO according to age-groups, sex and region. In addition, each group was compared by demographic characteristics, metabolic status, nutrition, and physical activity. The prevalence rates of SO were 6.1% (95% confidential interval [CI] = 6.1-6.2) for men and 7.3% (95% CI = 7.3-7.3) for women, respectively. SO was positively associated with no current working and the number of combined medical conditions. High serum insulin level was positively associated with SO, whereas vitamin D was negatively associated with SO in both men and women. In conclusion, the prevalence rates of SO are 6.1% in men and 7.3% in women. SO is associated with insulin resistance, inappropriate nutrition, and low physical activity.
Age Factors ; Aged ; Aged, 80 and over ; Databases, Factual ; Demography ; Female ; Humans ; Insulin/blood ; Male ; Middle Aged ; Nutritional Status ; Obesity/*epidemiology/etiology ; Odds Ratio ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; Sarcopenia/*complications ; Sex Factors ; Vitamin D/blood ; Waist Circumference