OBJECTIVE: Patients are becoming more active in communicating with doctors, forming e-communities, and participating in decision-making process of their treatment plans. However, only a few studies have examined how digitalized healthcare affects patients' and doctors' attitudes towards medical care services and deliverance structure, and the problems that might stem from these changes. In this study, we 1) explored the current changes in patients' healthcare utilization patterns and delivery structures, 2) examined the emerging behaviours and awareness of the participants, and 3) proposed how to prepare for such changes. METHODS: Face-to-face interviews and a group discussion with both Korean and US experts on consumer health informatics were conducted. Interview guidelines were developed based on reviews of recent studies on consumer health informatics. RESULTS: While the American scholars had larger expectations about the scope of the changes in the health care system induced by the digitalization of healthcare, compared to the Korean scholars, the interviewees and group discussion participants from both countries all agreed on the changes in medical environment and the increasing importance of medical information. The changes induced by the digitalization of healthcare were categorized as follows: (1) in the structure and location of healthcare service delivery, (2) in the doctor-patient communication methods, and (3) in the role of patients and increasing emphasis in empowerment. CONCLUSION: We expect that digitalized healthcare will continue to affect the doctor-patient relationship and change the deliverance structure. In order to better prepare for the fundamental paradigm shift in the healthcare system and increase the benefits to society of these changes, continuous and concerted policy efforts to protect the privacy and security of private information, alleviate the digital divide, and secure the quality of digitalized clinical knowledge will be required.
Delivery of Health Care ; Humans ; Informatics ; Power (Psychology) ; Privacy

Objectives: Clozapine is the most effective atypical antipsychotic agent for the treatment-resistant schizophrenia (TRS), however, only 40%–70% of TRS patients respond to clozapine. Moreover, TRS encompasses various symptom dimensions. Therefore, augmentation with other medications for clozapine is frequently applied. However, the prescription pattern of clozapine and combined medications in Korea is yet to be examined. This study aims to investigate the maintenance treatment pattern of clozapine and augmentation agents in one Korean tertiary hospital. Methods: The patients with schizophrenia spectrum disorders under clozapine maintenance, defined as one-year clozapine continuation, were subjected for analysis. Medication data at one-year time-point after clozapine initiation was extracted and analyzed. Results: Among total 2897 patients having clozapine prescription experience from January 2000 to December 2018, 1011 patients were on clozapine maintenance. The mean age of clozapine initiation was 30.2 ± 11.3 years, and the maintenance dose of clozapine was 217.8 ± 124.3 mg/day. Combination rate of antipsychotics, mood stabilizers, and antidepressants were 43.5%, 25.3%, 38.6%, respectively. Most frequently prescribed drugs in each category were aripiprazole, valproate, and sertraline. Olanzapine equivalent dose of combined antipsychotics was 10.4 ± 7.7 mg/day. Male patients were prescribed higher dose of combined antipsychotics and higher rate of antidepressants. Female patients had later onset of clozapine prescription. Patients with two or more combined antipsychotics were prescribed higher dose of clozapine and higher rate of antidepressants compared to patients with one combined antipsychotic. Conclusions Taken together, among the patients taking clozapine, a substantial rate of patients were under polypharmacy. The present findings based on the real-world prescription pattern could provide the valuable clinical information on the treatment of TRSrelated conditions.

Objective: Clozapine is considered the most reliable drug for treatment-resistant schizophrenia. In 2014, a generic formulation of clozapine (Clzapine) was introduced in Korea. This study was performed to provide clinical information regarding the use of clozapine and to compare efficacy and tolerability when converting from the brand-name formulation (Clozaril) to the generic formulation during longterm maintenance treatment among Korean patients with schizophrenia. Methods: This mirror-image study retrospectively investigated the electronic medical records of patients who had switched from Clozaril to Clzapine with a ≥1-year duration for each formulation. Clinical data were collected, including information regarding clozapine use, psychiatric hospitalization, co-medications, and blood test findings. Data before and after the switch were compared using paired t-tests. Results: Among 332 patients, the mean 1-year dosages were 233.32±149.35 mg/day for Clozaril and 217.36±136.66 mg/day for Clzapine. The mean clozapine concentration-to-dose ratios were similar before and after the switch (Clozaril, 1.33±0.68; Clzapine, 1.26±0.80). Switching from Clozaril to Clzapine resulted in no significant differences in the hospitalization rate, hospitalization duration, or laboratory findings (liver function parameters, serum cholesterol level, and serum glucose level). Equivalent doses of co-prescribed antidepressants were decreased, but concomitant medications otherwise showed no significant differences. Conclusion Clinical efficacy and tolerability appear comparable when switching to Clzapine during clozapine maintenance treatment. This study offers descriptive real-world clinical insights into clozapine maintenance treatment in Korea, thereby providing patients with more treatment options and contributing to the development of maintenance guidelines tailored to the Korean population.

OBJECTIVES: This study examined the trends in gender disparity in the self-rated health of people aged 25 to 64 in South Korea, a rapidly changing society, with specific attention to socio-structural inequality. METHODS: Representative sample data were obtained from six successive, nationwide Social Statistics Surveys of the Korean National Statistical Office performed during 1992 to 2010. RESULTS: The results showed a convergent trend in poor self-rated health between genders since 1992, with a sharper decline in gender disparity observed in younger adults (aged 25 to 44) than in older adults (aged 45 to 64). The diminishing gender gap seemed to be attributable to an increase in women's educational attainment levels and to their higher status in the labor market. CONCLUSIONS: The study indicated the importance of equitable social opportunities for both genders for understanding the historical trends in the gender gap in the self-reported health data from South Korea.
Adult ; Age Factors ; Data Collection ; Educational Status ; Employment/classification/economics ; Female ; *Health Status Disparities ; Humans ; Male ; Middle Aged ; Republic of Korea ; Sex Factors ; *Social Change ; Social Class ; Women's Health/*trends ; Women's Rights/*trends

OBJECTIVES: Despite the recent emphasis on a patient-centered chronic care model, few studies have investigated its use in older adults in South Korea. We explored how older Korean adults perceive and cope with their chronic illness. METHODS: We conducted focus group interviews in Seoul, Korea in January 2010. Focus groups were formed by disease type (hypertension and type 2 diabetes) and gender using purposive sampling. Inclusion criteria were patients aged 60 and over who had been diagnosed with diabetes or hypertension and received care at a community health center for at least six months prior to participation. Interview data were analyzed through descriptive content analysis. RESULTS: Among personal factors, most participants felt overwhelmed when they received their diagnosis. However, with time and control of their acute symptoms using medication, their worry diminished and participants tended to denying being identified as a patient or sick person. Among socio-familial factors, participants reported experiencing stigma with their chronic illness and feeling it was a symbol of weakness. Instead of modifying their lifestyles, which might interfere with their social relationships, they resorted to only following their medicine regime prescribed by their doctor. Participants also reported feeling that their doctor only prescribed medications and acted in an authoritative and threatening manner to induce and reinforce participants\' compliance with treatment. CONCLUSIONS: For successful patient-centered management of chronic illnesses, supportive environments that include family, friends, and healthcare providers should be established.
Aged ; Chronic Disease ; Community Health Centers ; Diabetes Mellitus, Type 2/*diagnosis ; *Disease Management ; Female ; Focus Groups ; Humans ; Hypertension/*diagnosis ; Interviews as Topic ; Life Style ; Male ; Middle Aged ; *Perception ; Republic of Korea ; Social Support

PURPOSE: The current study was conducted for evaluation and comparison of dietary behavior and food intake in different regions of Lao PDR. METHODS: The survey was conducted on 979 people aged 40~59 years old living in 25 urban provinces and 25 rural provinces in four districts (VTE Capital-Chanthabuly, Xaysetha, VTE Province-Phonhong, and Thoulakhom) of Laos. General demographic information, health status, and dietary behavior were surveyed using a questionnaire. RESULTS: The literacy ratio (p = 0.000), education level (p = 0.000), asset ownership level (p = 0.000), and government and private employee ratio (p = 0.000) were higher in urban subjects compared with rural subjects. The mean value of weight (p = 0.000), waist circumference (p = 0.000), and diastolic blood pressure (p = 0.009) and alcohol consumption (p = 0.000), self-rated health status (p = 0.001), and the rate of obesity (p = 0.000) were significantly higher in urban subjects compared with rural subjects. However, the rate of current smoker was significantly higher in the rural group (p = 0.023). Meals are becoming more westernized by higher frequency of eating out, consumption of fatty meat and fried or stir-fried food in urban areas compared to rural areas. Urban subjects had relatively better balanced meals compared to rural subjects whereas they consumed insufficient meals per day and consumed meals irregularly compared to rural subjects. Intake of fruit and milk was significantly higher in urban subjects compared with rural subjects. However, the intake of vegetables was significantly higher in rural areas than urban areas. CONCLUSION: The result of this study showed that the traditional Lao diet is being replaced by an unhealthy western dietary pattern, which may be a risk factor for increasing development of non-communicable disease (NCD) in Lao PDR. Planning of proper personalized nutritional intervention and education in each area is needed to decrease the health risks of NCD.
Alcohol Drinking ; Blood Pressure ; Diet* ; Eating* ; Education ; Fruit ; Humans ; Laos ; Meals ; Meat ; Milk ; Obesity ; Ownership ; Risk Factors ; Vegetables ; Waist Circumference

OBJECTIVES: The aim of this cross-sectional study was to compare the subjective quality of life in the four groups of antipsychotics according to the risk of weight gain in patients with schizophrenia. METHODS: One hundred and thirty-two patients with schizophrenia that had taken the same antipsychotics for more than 1 year were enrolled in the analyses. Anti-psychotic agents were classified by the risk of weight gain into four groups : serious, common, not unusual, and unusual. The quality of life was measured with the Schizophrenia Quality of Life Scale Korean version, 4th Revision (SQLS-R4K). We analyzed the correlation between the total score of SQLS-R4K and clinical variables. RESULTS: The SQLS-R4K score was significantly different in the four anti-psychotic groups (F=5.200, p=0.002). Gender, type of anti-psychotics (typical, atypical), duration of treatment with current antipsychotics, duration of illness, and Body Mass Index were not significantly correlated with the SQLS-R4K score. CONCLUSION: The subjective quality of life was different according to the risk of weight gain groups of anti-psychotic agents.
Antipsychotic Agents ; Body Mass Index ; Cross-Sectional Studies ; Humans ; Quality of Life ; Schizophrenia ; Weight Gain

OBJECTIVES: Many antipsychotics are associated with hyperprolactinemia and sexual dysfunction. This study investigated the prevalence of hyperprolactinemia and amenorrhea and explored the association between hyperprolactinemia and sexual dysfunction. METHODS: We analyzed 285 patients with schizophrenia or schizoaffective disorder who had been taking antipsychotics more than one year, examining their serum prolactin levels and administering the Arizona Sexual Experience Scale (ASEX) to evaluate for sexual dysfunction. We conducted an ANCOVA to evaluate the effect of hyperprolactinemia on ASEX score and amenorrhea. RESULTS: We found hyperprolactinemia in 52.3% of the patients, finding it to be more common in females (60.8%) than in males (49%). Patients taking risperidone had the highest prevalence of hyperprolactinemia (86.5%), and patients taking aripiprazole showed no hyperprolactinemia. Amenorrhea prevalence was 21.5%. Hyperprolactinemia did not significantly affect ASEX scores, but it significantly affected amenorrhea. CONCLUSION: Many patients taking antipsychotics still experience hyperprolactinemia in a real clinical setting. The prevalence of hyperprolactinemia varies among antipsychotics. Clinicians should consider the possibility of antipsychotic-induced hyperprolactinemia, with its potential adverse effects, when treating such patients.
Amenorrhea ; Antipsychotic Agents ; Arizona ; Female ; Humans ; Hyperprolactinemia ; Male ; Piperazines ; Prevalence ; Prolactin ; Psychotic Disorders ; Quinolones ; Risperidone ; Schizophrenia ; Aripiprazole

OBJECTIVES: While cervical cancer is one of the leading cancers among women worldwide, there are a number of effective early detection tests available. However, the participation rates in cervical cancer screening among Korean women remain low. After the nationwide efforts in 1988 and thereafter to encourage participation in cervical cancer screening, few studies have investigated the effects of socioeconomic inequality on participation in cervical cancer screening. The purpose of this study was to investigate 1) the level of socioeconomic disparities in receiving cervical cancer screening by age group and 2) if there was an improvement in reducing these disparities between 1995 and 2001. METHODS: Using data from the Korean National Health Status, Health Behavior and Belief Survey in 1995, and the Korean National Health and Nutrition Examination Surveys from 1998 and 2001 (sample sizes of 2,297, 3,738, and 3,283), age-standardized participation rates were calculated according to education level, equivalized household income, and job status. Odds ratios and the relative inequality index (RII) were also calculated after controlling for age. RESULTS: Women with lower education levels were less likely to attend the screening test, and the disparities by education level were most pronounced among women aged 60 years and older. The RIIs among women 60 years and older were 3.64, 4.46, and 8.64 in 1995, 1998, and 2001, respectively. Higher rates of participation were reported among those in the highest income category, which was more notable among the middle aged women (40s and 50s). An inconsistent trend in the rate of participation in cervical cancer screening by occupational level was found. CONCLUSIONS: Indicators of socioeconomic position seem to have varying impacts on the inequalities in the rates of participation in cervical cancer screening according to age group. These results demonstrate the need for more aggressive and age-based interventions and policy programs to eliminate the remaining inequalities.
Adult ; Educational Status ; Female ; Health Care Surveys ; Healthcare Disparities ; Humans ; Korea ; Mass Screening/*utilization ; Middle Aged ; Odds Ratio ; Patient Acceptance of Health Care/*statistics & numerical data ; *Social Class ; Uterine Cervical Neoplasms/*diagnosis ; Women's Health

We aim to investigate the effect of fronto-temporal transcranial direct current stimulation (tDCS) on the interactions among functional networks and its association with psychotic symptoms. In this pilot study, we will determine possible candidate functional networks and an adequate sample size for future research. Seven schizophrenia patients with treatment-refractory auditory hallucinations underwent tDCS twice daily for 5 days. Resting-state fMRI data and measures of the severity of psychotic symptoms were acquired at baseline and after completion of the tDCS sessions. At baseline, decreased functional network interaction was negatively correlated with increased hallucinatory behavior. After tDCS, the previously reduced functional network connectivity significantly increased. Our results showed that fronto-temporal tDCS could possibly remediate aberrant hallucination-related functional network interactions in patients with schizophrenia.
Hallucinations ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Pilot Projects ; Sample Size ; Schizophrenia ; Transcranial Direct Current Stimulation