Background: Acute deterioration of patients in general wards often leads to major adverse events (MAEs), including unplanned intensive care unit transfers, cardiac arrest, or death. Traditional early warning scores (EWSs) have shown limited predictive accuracy, with frequent false positives. We conducted a prospective observational external validation study of an artificial intelligence (AI)-based EWS, the VitalCare - Major Adverse Event Score (VC-MAES), at a tertiary medical center in the Republic of Korea. Methods: Adult patients from general wards, including internal medicine (IM) and obstetrics and gynecology (OBGYN)—the latter were rarely investigated in prior AI-based EWS studies—were included. The VC-MAES predictions were compared with National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) predictions using the area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), and logistic regression for baseline EWS values. False-positives per true positive (FPpTP) were assessed based on the power threshold. Results: Of 6,039 encounters, 217 (3.6%) had MAEs (IM: 9.5%, OBGYN: 0.26%). Six hours prior to MAEs, the VC-MAES achieved an AUROC of 0.918 and an AUPRC of 0.352, including the OBGYN subgroup (AUROC, 0.964; AUPRC, 0.388), outperforming the NEWS (0.797 and 0.124) and MEWS (0.722 and 0.079). The FPpTP was reduced by up to 71%. Baseline VC-MAES was strongly associated with MAEs (P<0.001). Conclusions The VC-MAES significantly outperformed traditional EWSs in predicting adverse events in general ward patients. The robust performance and lower FPpTP suggest that broader adoption of the VC-MAES may improve clinical efficiency and resource allocation in general wards.

Objectives: Completeness and timeliness are key attributes of accurate disease surveillance. This study aimed to evaluate the completeness and timeliness of tuberculosis (TB) notification in the Republic of Korea, by comparing notification data from the Korean National Tuberculosis Surveillance System and reimbursement data from the National Health Insurance. Methods: We evaluated reimbursement data from 103,075 cases (2012–2014) and surveillance data from 215,055 cases (2011–2015); cases were matched using Resident Registration Numbers. Completeness was evaluated using notifications that were reported within 365 days of the corresponding insurance claim. Timeliness was evaluated using the delay between starting TB treatment and the corresponding notification. Multivariate logistic regression analysis was used to analyze factors that affected completeness (e.g., sex, age, institution type, and nationality). Results: The completeness values were 90.0% in 2012 (33,094/36,775), 93.0% in 2013 (31,445/33,803), and 94.0% in 2014 (30,537/32,497). The rates of notification within 7 days of the corresponding claim were 81.6% in 2012 (27,323/33,489), 79.8% in 2013 (25,469/31,905), and 80.4% in 2014 (24,891/30,978). Increases over time were observed in the sex-, age-, institution type-, and nationality-specific analyses. Multivariate analyses revealed that completeness was affected by institution type [hospitals: odds ratio (OR) = 1.82, p < 0.001; general hospitals: OR = 4.18, p < 0.001] and nationality (native Korean status: OR = 1.48, p < 0.001). Conclusion Notification completeness exhibited a 4.0% increase during 2012–2014 in Korea, and institution type and nationality significantly affected the completeness of TB notifications.

Unhealthy lifestyle behaviors such as smoking, alcohol consumption, and physical inactivity (multiple risks) often lead to serious health consequence and impaired health status. The purpose of this study was to investigate the trend in health-related behavioral factors over time among adults in South Korea (hereafter Korea). The data of 1,595,842 Koreans older than 19 years who participated in the 2008-2014 Korea Community Health Survey were analyzed to assess the trend in the prevalence of behavioral risk factors. Individual or clustering health-related behaviors were assessed according to sex, age, and region among 228,712 adults who participated in the 2014 survey. From 2008 to 2014, the age-adjusted prevalence of obesity and high-risk alcohol use increased the prevalence of male current smoking and marginally decreased walking ability. Over 7 years, the percentage of adults who reported having all three healthy behaviors (i.e., currently not smoking, not consuming alcohol or having high-risk alcohol use, and engaging in walking) decreased from 35.2% in 2008 to 29.6% in 2014. Increased efforts to emphasize multiple health-related behavioral risk factors, including reducing alcohol use and smoking, and to encourage walking are needed in the thirties and forties age groups in Korea.
Adult* ; Alcohol Drinking ; Health Surveys* ; Humans ; Korea ; Life Style ; Male ; Obesity ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Walking

In 2008, Korea Centers for Disease Control and Prevention initiated the first nationwide survey, Korea Community Health Survey (KCHS), to provide data that could be used to plan, implement, monitor, and evaluate community health promotion and disease prevention programs. This community-based cross-sectional survey has been conducted by 253 community health centers, 35 community universities, and 1500 interviewers. The KCHS standardized questionnaire was developed jointly by the Korea Centers for Disease Control and Prevention staff, a working group of health indicators standardization subcommittee, and 16 metropolitan cities and provinces with 253 regional sites. The questionnaire covers a variety of topics related to health behaviors and prevention, which is used to assess the prevalence of personal health practices and behaviors related to the leading causes of disease, including smoking, alcohol use, drinking and driving, high blood pressure control, physical activity, weight control, quality of life (European Quality of Life-5 Dimensions, European Quality of Life-Visual Analogue Scale, Korean Instrumental Activities of Daily Living ), medical service, accident, injury, etc. The KCHS was administered by trained interviewers, and the quality control of the KCHS was improved by the introduction of a computer-assisted personal interview in 2010. The KCHS data allow a direct comparison of the differences of health issues among provinces. Furthermore, the provinces can use these data for their own cost-effective health interventions to improve health promotion and disease prevention. For users and researchers throughout the world, microdata (in the form of SAS files) and analytic guidelines can be downloaded from the KCHS website (http://KCHS.cdc.go.kr/) in Korean.

We developed a prototype of web-based instruction(WBI) program to provide more convenient and more effective service to the public health officials. This web-based instruction program had specific objectives on vaccination for the public health officials who were working for national immunization program. This course had 21 chapters composed of hypertext or voice-based instruction. Using the WBI courseware of Korean Officials Trainging Institution(KOTI), 32 public health official volunteers joined this prototype 2 week program in April 2001. A Auestionnaire survey for evaluation of subjective satisfaction and related factors, cyber-education behavior, and internet using behavior was performed in April, 2001. Among the answered 29 subjects, 24 were female(82.8%). Mean age was 36.6% 6.16. 79.3% of the 29 subjects connected internet in their office. The highest frequent study duration was < 1 hr(51.7%) per connection. They represented relatively high subjective satisfaction in education form(78.6%), and contents(85.7%). But 62.3% of these subjects answered the subjective relative effectiveness score(which was as 100 in case of classical lecture form) was lower than 100. The place to connect internet was only statistically significant factor between these two groups in bivariable analysis. But we could not found any significant factors in multivariate analysis. 89.7% of the subjects answered they would like to participate any more WBI courses serviced by Korean National Health Institute. This study had restriction of small sample size.
Education ; Education, Distance ; Hypermedia ; Immunization Programs ; Internet ; Multivariate Analysis ; Public Health* ; Sample Size ; Vaccination ; Volunteers

Health and Welfare Training Center of Korean National Institute of Health (KNIH) has developed various education curricula for the officials who involved in the public health or welfare sectors. Still almost all education programs are off-line based. In off-line settings, both the lecturers and the students should come to KNIH from their counties to join the education programs, and it is impossible for the students to review or to re-practice the education contents. From September to October, 2000, we conducted a basic survey to evaluate the information infrastructure, internet use and attitude to the cyber education. The 183 institutions and 548 public health officials answered our questionnaire. The informationa infrastructure of each institution was not satisfactory for distance education via world wide web. The proportion of e-mail user was only about 62% of the answered subjects. But cyber- education was highly needed in both institutions and the surveyed officials. They answered that they would actively participate in the cyber-education(97%). The officials expected that the online education would be effective to acquire information, to increase the chance for participation and to reduce the education cost. The expected barriers of the cyber-education were the overload when they should undergo simultaneously education and working, lack of proper infrastructure, disinterest of their low capability of internet use.
Curriculum ; Education ; Education, Distance ; Electronic Mail ; Humans ; Internet ; Public Health* ; Surveys and Questionnaires