Geographic information systems are useful tools for analyzing and explaining the changing spatial structures of medical services. This study identified underserved areas for out-ofhospital cardiac arrest (OHCA) using a geospatial methodology and provided a visual map of the spatial imbalances of OHCA. This study used geocoding of OHCA locations, emergency medical service (EMS) incidents, and administrative districts to demonstrate a technique for identifying underserved areas for EMS-assessed OHCA. We created a 1 km hexa-grid across Jeju Island and calculated the OHCA ratio (OHCA cases/total EMS incidents) for each grid. Underserved areas were detected through a hexagrid-based geospatial analysis (Getis-Ord Gi* statistics). A total of 366,155 EMS incidents occurred during the study period. Among these, 6,806 were EMS-assessed OHCA cases. An analysis of 1,903 overlapping grids revealed that the mean distance between grids with OHCA was 28.0±15.8 km. The mean EMS-assessed OHCA ratio (EMS-assessed OHCA cases/total EMS incidents) for each grid was 0.021±0.059. Based on the Getis-Ord Gi* OHCA ratio, 118 hot spot grids (z-score≥1.96) and 19 cold spot grids (z-score≤-1.96) were identified. This study proposed a geospatial methodology to define and identify underserved areas of EMS-assessed OHCA cases using hexa-grid-based hot- and cold-spot analysis.

OBJECTIVE: We aimed to develop the clinical guideline for headache by the systematic review and synthesis of existing evidence-based guidelines. The purpose of developing the guideline was to improve the appropriateness of diagnosis and treatment of headache disorder, and consequently, to improve patients’ pain control and quality of life. The guideline broadly covers the differential diagnosis and treatment of tension-type headache, migraine, cluster headache, and medication-overuse headache. METHODS: This is a methodological study based on the ADAPTE methodology, including a systematic review of the literature, quality assessment of the guidelines using the Appraisal of Clinical Guidelines for REsearch & Evaluation II (AGREE II) Instrument, as well as an external review using a Delphi technique. The inclusion criteria for systematic search were as follows: topic-relevant, up-to-date guidelines including evidence from within 5 years, evidence-based guidelines, guidelines written in English or Korean, and guidelines issued by academic institutions or government agencies. RESULTS: We selected five guidelines and conducted their quality assessment using the AGREE II Instrument. As a result, one guideline was found to be eligible for adaptation. For 13 key questions, a total of 39 recommendations were proposed with the grading system and revised using the nominal group technique. CONCLUSION: Recommendations should be applied to actual clinical sites to achieve the ultimate goal of this guideline; therefore, follow-up activities, such as monitoring of guideline usage and assessment of applicability of the recommendations, should be performed in the future. Further assessment of the effectiveness of the guideline in Korea is needed.
Cluster Headache ; Delphi Technique ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Government Agencies ; Headache Disorders ; Headache ; Korea ; Methods ; Migraine Disorders ; Quality of Life ; Tension-Type Headache

Depressive disorder is a common mental illness and remains a major cause of morbidity worldwide. The present study, a cross-sectional, nationwide, population-based survey assessed the prevalence of depression in the general population of Korea through a random sampling of the non-institutionalized population for the Korea National Health and Nutrition Examination Survey (KNHANES) VI. The Patient Health Questionnaire (PHQ)-9 was first introduced into the KNHANES to detect depression. The point prevalence of depression (PHQ score of 10 or higher) was 6.7% (95% confidence interval [CI], 5.7–7.6) in 4,949 subjects. Based on the analysis using the diagnostic algorithm of the PHQ-9, the prevalence of major depressive disorder was 2.7% (95% CI, 2.2–3.3). Multiple logistic regression analysis, after adjusting the sociodemographic variables, also showed that the factors associated with depression were perceived stress and health status. This study reported for the first time that the point prevalence of depression screened using the PHQ-9 in this nationwide survey of the Korean population was similar to that of the western countries. As the KNHANES to detect depression is conducted biennially, further studies on the accumulated data are expected in the future.
Depression* ; Depressive Disorder ; Depressive Disorder, Major ; Humans ; Korea* ; Logistic Models ; Nutrition Surveys* ; Prevalence*

OBJECTIVE: Although Type D personality has been associated with the prognosis of various cardiac diseases, few studies have investigated the influence of Type D personality on the cardiac and psychiatric prognoses of patients with atrial fibrillation (AF). METHODS: Depression, anxiety, and quality of life were measured at baseline and 6 months. The recurrence of AF was measured during 1-year following radiofrequency catheter ablation (RFCA) for AF. The Kaplan-Meier method with log-rank tests were used to compare the cumulative recurrence of AF. ACox proportional hazard model was conducted to identify factors that contribute to the recurrence of AF. RESULTS: A total of 236 patients admitted for RFCA were recruited. Patients with a Type D personality had higher levels of depression and anxiety and a poorer quality of life compared to controls. Although depression, anxiety, and quality of life had improved 6 months after RFCA, significant differences in psychiatric symptoms remained between patients with and without Type D personality. In the Cox models, the type of AF was the only factor that influenced the recurrence of AF. CONCLUSION: Our results suggest that Type D personality predominately influences psychological distress in patients with AF, but not the recurrence of AF.
Anxiety ; Atrial Fibrillation* ; Catheter Ablation* ; Catheters* ; Depression ; Follow-Up Studies* ; Heart Diseases ; Humans ; Methods ; Prognosis* ; Proportional Hazards Models ; Quality of Life ; Recurrence ; Type D Personality*

OBJECTIVES: The management of disaster should be immediate and sustainable. Further, it is hard to predict where the disaster will occur, using pre-exists governmental and non-governmental organizations are important. In this study, we tried to investigate the associated activities of organizations performed in Ansan city, in Sewol ferry accident. METHODS: A total 121 workers in 25 organizations were surveyd about organizations which they worked with, kind of works performed, frequency of meetings, satisfaction in activities and factors associated with dissatisfaction in usual state and in Sewol ferry accident state, respectively. The differences between those two situations were analyzed using paired t-test for continuous variables and Chi-square test or McNemar test for categorical variables. RESULTS: The total number of linkage of institutions were decreased(from n=397 to n=251) and the mean scores of rating satisfaction were significantly lower in most of organizations in disaster state. The rigid policy in performance evaluation was more likely associated with dissatisfaction in disaster state than usual state(p=0.045). CONCLUSIONS: For effective linkage of institutions, preparedness, such as understanding the capability of organizations in the communities and developing the protocol for associated activities, is important. The unnecessary and effortful performance evaluation should be sublated.
Disasters* ; Gyeonggi-do*