BACKGROUND: Mental health issues such as stress and depression have been regarded as major social problems in Korea. We investigated the relationship between stress and depression with unmet medical needs (UMN). METHODS: Using the nationwide database of 2010 Korea National Health and Nutritional Examination Survey (K-NHANES), subjects aged 19 years or above were selected (n=6,055). In the K-NHANES questionnaire, subjects were asked about their UMN experience, severity of stress, and perceived depression lasting at least 2 weeks over the past year. The effects of stress and depression on UMN were analyzed in 4 models established by adding predisposing, enabling and need factors in a step-wise fashion. The risks for UMN were also assessed according to the causes of UMN. RESULTS: Individuals who felt stress ‘very often’ (odds ratio (OR) 3.28, 95% CI=2.23-4.86) and ‘often’ (OR 2.53, 95% CI=1.93-3.31) and who experienced depression (OR 1.68, 95% CI=1.35-2.10) reported significantly elevated UMN rates, and these effects were substantial especially for the individuals who had UMN due to economic constraint. Females, lower education level, lower income, unemployed status, and negative perceptions about health status were found to be additional risk factors for UMN. CONCLUSION: Our results confirmed the risks of stress and depression on UMN. It is strongly advisable to create initiatives to improve mental health, particularly stress and depression, and to fulfill individuals' medical utilization needs.
Depression* ; Education ; Female ; Humans ; Korea ; Mental Health ; Risk Factors ; Social Problems

OBJECTIVE: Seoul City has implemented the Safe Pharmacy in 2013. This study aimed to ascertain the success factors of the smoking cessation service of the Safe Pharmacy. METHODS: The data for the smoking cessation registration cards were obtained from the pharmacies which participated in 2014 Safe Pharmacy. The sample included 289 smokers in 6 districts who participated at least one sessions of smoking cessation service. the service included both behavioral intervention and nicotine replacement therapy. In order to identify the effectiveness of the smoking cessation service, logistic regression analysis was used. The dependent variable was the success of quitting smoking at the 4th week. The independent variables included age, sex, employment, chronic disease, district, smoking amount, registration path, supporters for quitting smoking and number of service sessions. RESULTS: Fifty eight point eight percent of the sample successfully quit smoking at the 4th week. Unemployment, higher smoking amount, and less service sessions were negatively related to the success of quitting smoking. There were differences in the success rate across districts. Age, sex, chronic disease, registration path, and anti-smoking supporters were not related to the success rate. CONCLUSION: Pharmacy can be an effective community resource for smoking cessation. Factors that could increase the effectiveness of smoking cessation service of the Safe Pharmacy and possible ways to enhance the participation of pharmacies in smoking cessation services were also discussed.
Chronic Disease ; Employment ; Logistic Models ; Nicotine ; Pharmaceutical Services ; Pharmacies ; Pharmacy* ; Seoul ; Smoke* ; Smoking Cessation* ; Smoking* ; Unemployment

BACKGROUND: We investigated the impact of financial compensation on patients' decision of participation in clinical trials and the related factors with patients' attitudes and considerations. METHODS: A survey questionnaire was placed from October 31 to November 16, 2017 to the subjects who were enrolled in the trials of chronic diseases. Patients' socio-demographic characteristics were collected and the potential reasons for participating in the trials were assessed using 5-likert scores. RESULTS: Sixty eight of 110 respondents (61.8%) indicated to participate clinical trials regardless of financial compensation. The differences were found between patients who were unwilling to participate without compensation and those who were willing to participate regardless of compensation in mean ages (43.9 years vs. 52.0 years, p<0.05), marital status (married, 47.6% vs 79.4%, p<0.01), religions (yes, 45.2% vs 67.6%, p<0.05) and monthly income (≥3 million won, 19.0% vs 45.6%, p<0.01). The potential reasons for participation in the trials between two groups were doctor's suggestion (52.4% vs. 77.9%, p<0.01), the expectation of health improvement (54.8% vs. 73.5%, p<0.05), the types and numbers of procedure (33.3% vs. 16.2%, p<0.05) and the duration of clinical trials (59.5% vs. 27.9%, p=0.001). In regression analysis, the monthly income of ≥ 3 million won (odd ratio, OR=3.221, p=0.026,) and the duration of trials (OR=0.290, p=0.017) were related to the group with the willingness to participate regardless of compensation. CONCLUSION: This stady showed that more than half of study subjects would participate in the clinical trials of chronic diseases regardless of financial compensation.
Chronic Disease* ; Compensation and Redress ; Humans ; Marital Status ; Surveys and Questionnaires

OBJECTIVE: Infection is very common in the elderly, so there is a high prevalence of antibiotics use among this population. Especially, due to the emergence of resistant bacteria, the use of vancomycin is growing. The purpose of this study was to evaluate risk factors associated with vancomycin-induced nephrotoxicity in elderly patients. METHODS: The subjects of this study were patients over 18 years old who received intravenous vancomycin in a general hospital located in Gangneung-si, Korea between August 1, 2013 and July 31, 2015. Data collection regarding vancomycin use and baseline characteristics was conducted using computerized hospital database. Logistic regression analysis was used to identify risk factors associated with vancomycin-induced nephrotoxicity. RESULTS: A total of 290 patients were finally included, and 191(66%) out of these patients were age 65 or older. The incidence of vancomycin-induced nephrotoxicity was 11.0%, 12.6%, and 7.0% in the all adult patients, the elderly patients, and the non-elderly patients, respectively. There were significant differences in comorbidities between patients with nephrotoxicity and patients without nephrotoxicity in the all adult patients, and there were significant differences in vancomycin duration, comorbidities, and number of nephrotoxic agents between patients with nephrotoxicity and patients without nephrotoxicity in the elderly patients. However, according to the logistic regression analysis, there was no significant risk factor that increases the incidence of vancomycin-induced nephrotoxicity in all three age groups. CONCLUSION: There were no differences in risk factors that increase the incidence of vancomycin-induced nephrotoxicity between all adult patients, elderly patients, and non-elderly patients. Further studies with larger sample sizes to identify risk factors associated with vancomycin-induced nephrotoxicity in the elderly to improve the outcome of pharmacotherapy are required.
Acute Kidney Injury ; Adult ; Aged* ; Anti-Bacterial Agents ; Bacteria ; Comorbidity ; Data Collection ; Drug Therapy ; Hospitals, General ; Humans ; Incidence ; Korea ; Logistic Models ; Prevalence ; Risk Factors* ; Sample Size ; Vancomycin

OBJECTIVE: The perioperative management of antithrombotic therapy is often challenging and it requires a fine balance between the risk of hemorrhage and thrombosis. We aimed to evaluate the antithrombotic management for moderate to high risk patients in real world setting. METHODS: Among the patients who were consulted to the neurologist for the evaluation of perioperative risk from 2010 to 2012, patients undergoing moderate to high risk surgery and taking antithrombotics within 30 days were identified. We analyzed the timing of discontinuation and reinitiation of antithrombotic drugs before or after surgery as well as the status of bridging therapy. In addition, the conformity with the guideline suggested by American College of Chest Physicians was assessed. The rate of thromboembolic event and major hemorrhage were also investigated. RESULTS: A total of 329 patients were included. The concordance rate of warfarin stop and restart time with guideline was 23.4% and 10.3%, respectively. Continuing aspirin in patients undergoing coronary artery bypass surgery or non-cardiac surgery in patients with high risk for cardiovascular events were 59.2% and 2.6%, respectively. Bridging therapy was adopted in 92.9% and 81.2% in patients who had received anticoagulant before surgery and who were at high and low risk thromboembolism, respectively. In entire cohorts, 30-day incidence of major bleeding and thromboembolic event were 31.9% and 3.0%. Co-morbid renal disease were shown as independent predictor for major bleeding (adjusted OR 2.65. 95% CI 1.33-5.28). CONCLUSION: The concordance rate with guideline regarding perioperative antithrombotic use was low and bridging therapy was prevalent in patients undergoing moderate to high risk surgery.
Anticoagulants ; Aspirin ; Cohort Studies ; Coronary Artery Bypass ; Hemorrhage ; Humans ; Incidence ; Thorax ; Thromboembolism ; Thrombosis ; Warfarin

BACKGROUND: Pharmacy curriculum change was made from a 4-year program to a 2+4 year program in year 2009 in Korea. The change has resulted in more educational exposures on patient-centered practice environments for about 1,400 hours in the last year of the professional pharmacy program. When the Middle East Respiratory Syndrome (MERS) outbreak hit Seoul and suburban areas and propagated to other provinces in Korea, emergency response to avoid student infection in the pharmacy practice sites became an urgent issue. While other health professional programs such as medicine and nursing had activated emergency preparedness manuals, timely and clear guidelines were not disseminated to all pharmacy programs and protective measures largely relied on individual pharmacy program. METHODS: A survey was developed by the Committee on Pharmacy Practice Experience Programs in the Korean College of Clinical Pharmacy to document the status of pharmacy programs during the Korea MERS outbreak in 2015. The 10-question survey was distributed to the pharmacy practice experience coordinators to 34 out of 35 pharmacy schools in Korea by emails. RESULTS: Our findings showed that 82.4% of the program coordinators (28/34) responded to the survey, 96.4% of the programs did not have emergency preparedness manuals, administrative meetings were held in 89.3% of the pharmacy programs, the rotation schedules were modified or withheld in 53.6% of schools, and the changes were mostly observed from the programs classified as MERS outbreak regions. CONCLUSION: Further needs in establishing the emergency preparedness manual should be explored for pharmacy education stakeholders.
Appointments and Schedules ; Civil Defense ; Coronavirus Infections* ; Curriculum ; Education* ; Education, Pharmacy ; Electronic Mail ; Emergencies ; Health Occupations ; Humans ; Korea ; Middle East* ; Nursing ; Pharmacy* ; Schools, Pharmacy ; Seoul

The prevalence of diabetes and its related morbidity and mortality are being increased. Despite the advancement of evidence-based pharmacotherapy in the management of diabetes, many patients in our country do not achieve satisfied therapeutic outcomes. Pharmaceutical care service can be defined as a patient-centered clinical service provided by pharmacists to improve therapeutic outcomes and quality of life of patients, by identifying, and preventing or resolving drug-related problems (DRPs). Pharmaceutical care service is interdisciplinary team-based practice, and is provided through collaborative practice agreement (CPA) between one or more physicians and pharmacists. This article describes a model of pharmaceutical care service which can be adopted in our country for patients with diabetes in the ambulatory care settings. With the successful implementation of this service, clinical, economic, and humanistic outcomes of patients will be improved. Therefore, by actively implementing pharmaceutical care service, pharmacist should contribute to the promotion of patients' health and to the advancement of health care delivery system.
Ambulatory Care* ; Delivery of Health Care ; Drug Therapy ; Humans ; Mortality ; Pharmaceutical Services* ; Pharmacists ; Prevalence ; Quality of Life

BACKGROUND: Venous thromboembolism (VTE) is a common and life-threating condition in cancer patients. Low molecular weight heparins (LMWH), such as dalteparin, are recommended in the treatment of VTE. Also, rivaroxaban, an orally administered direct factor Xa inhibitor, was approved for the treatment of VTE. It showed similar efficacy to standard therapy (LMWH or warfarin) and was associated with significantly lower rates of major bleedings. However, in the real world, bleeding has been reported to occur frequently in cancer patient receiving rivaroxaban. The goal of this research was to analyze bleeding risks between rivaroxaban and dalteparin for treatment of VTE in cancer patients. METHODS: Medical records of oncology patients who were treated with rivaroxaban or dalteparin for VTE from July 2012 to June 2014 were retrospectively reviewed. Data collected were as follows: age, sex, weight, height, cancer types and stages, ECOG (eastern cooperative oncology group) PS (performance score), VTE types, concurrently used medications, study drug information (dose and duration of therapy), INR (international normalized ratio), PT (prothrombin time), and platelet counts. Bleeding was classified into major bleedings, clinically relevant non-major bleedings, and minor bleedings. RESULTS: A total of 399 patients were included in the study. Of these patients, 246 were treated with rivaroxaban and 153 with dalteparin. Bleeding rates were significantly higher in the rivaroxaban group than in the dalteparin group (adjusted odds ratio (AOR) 2.09, 95% CI 1.22-3.60) after adjusting for confounders. In addition, rivaroxaban remained independently associated with 1.78-fold (95% CI 1.14-2.76) shorter time to bleeding compared to dalteparin after adjusting other factors known to be associated with poor outcomes. CONCLUSION: This study suggested that rivaroxaban was associated with an increased risk of bleedings in cancer patients.
Dalteparin* ; Factor Xa ; Hemorrhage* ; Heparin, Low-Molecular-Weight ; Humans ; International Normalized Ratio ; Medical Records ; Odds Ratio ; Platelet Count ; Retrospective Studies ; Rivaroxaban* ; Venous Thromboembolism*

BACKGROUND: Alopecia areata (AA) is a very disturbing and expensive disorder in which the exact etiology is not known and it is yet to be treated completely well. Most alopecia patients exhibit some inflammation in the hair follicles regardless of the causes. The clinical symptoms of alopecia present very diversely while the prime symptom is local intermittent fever which are related to inflamed cells. METHODS: This study aimed to evaluate how repetitive intermittent fever can damage the normal human dermal fibroblast (NHDF) cells and investigated the cytotoxic and proliferative effects after application of new candidate drugs (ibuprofen, menthol, cetirizine) for alopecia in comparison to minoxidil. RESULTS: This study demonstrated that ibuprofen, menthol, or/and cetirizine can prevent or slow down the damage of NHDF cells from intermittent fever in early alopecia. Aggressive preventative intervention with those drugs before complete destruction of hair follicle by excessive repetitive fever, is a very important step for alopecia therapy and these drugs are recommended as candidate drugs for alopecia in the future. CONCLUSION: Aggressive preventative intervention with drugs before complete destruction of hair follicles (NHDF cells) by excessive repetitive fever is a very important step for alopecia therapy or progression.
Alopecia Areata ; Alopecia* ; Cetirizine* ; Fever* ; Fibroblasts ; Hair Follicle ; Humans ; Ibuprofen* ; Inflammation ; Menthol* ; Minoxidil

OBJECTIVE: Midazolam is mainly metabolized by cytochrome P450 (CYP) 3A. Inhibition or induction of CYP3A can affect the pharmacological activity of midazolam. The aims of this study were to develop a population pharmacokinetic (PK) model and evaluate the effect of CYP3A-mediated interactions among ketoconazole, rifampicin, and midazolam. METHODS: Three-treatment, three-period, crossover study was conducted in 24 healthy male subjects. Each subject received 1 mg midazolam (control), 1 mg midazolam after pretreatment with 400 mg ketoconazole once daily for 4 days (CYP3A inhibition phase), and 2.5 mg midazolam after pretreatment with 600 mg rifampicin once daily for 10 days (CYP3A induction phase). The population PK analysis was performed using a nonlinear mixed effect model (NONMEM® 7.2) based on plasma midazolam concentrations. The PK model was developed, and the first-order conditional estimation with interaction was applied for the model run. A three-compartment model with first-order elimination described the PK. The influence of ketoconazole and rifampicin, CYP3A5 genotype, and demographic characteristics on PK parameters was examined. Goodness-of-fit (GOF) diagnostics and visual predictive checks, as well as bootstrap were used to evaluate the adequacy of the model fit and predictions. RESULTS: Twenty-four subjects contributed to 900 midazolam concentrations. The final parameter estimates (% relative standard error, RSE) were as follows; clearance (CL), 31.8 L/h (6.0%); inter-compartmental clearance (Q) 2, 36.4 L/h (9.7%); Q3, 7.37 L/h (12.0%), volume of distribution (V) 1, 70.7 L (3.6%), V2, 32.9 L (8.8%); and V3, 44.4 L (6.7%). The midazolam CL decreased and increased to 32.5 and 199.9% in the inhibition and induction phases, respectively, compared to that in control phase. CONCLUSION: A PK model for midazolam co-treatment with ketoconazole and rifampicin was developed using data of healthy volunteers, and the subject's CYP3A status influenced the midazolam PK parameters. Therefore, a population PK model with enzyme-mediated drug interactions may be useful for quantitatively predicting PK alterations.
Cross-Over Studies ; Cytochrome P-450 CYP3A ; Cytochrome P-450 Enzyme System* ; Cytochromes* ; Drug Interactions ; Genotype ; Healthy Volunteers ; Humans ; Ketoconazole ; Male ; Midazolam* ; Pharmacokinetics* ; Plasma ; Rifampin