In 2016 and 2017, there were earthquakes greater than 5.0 in magnitude on the Korean Peninsula, which has previously been considered an earthquake-free zone. Patients with chronic kidney disease are particularly vulnerable to earthquakes, as the term “renal disaster” suggests. In the event of a major earthquake, patients on hemodialysis face the risk of losing maintenance dialysis due to infrastructure disruption. In this review, we share the experience of an earthquake in Pohang that posed a serious risk to patients on hemodialysis. We review the disaster response system in Japan and propose a disaster preparedness plan with respect to hemodialysis. Korean nephrologists and staff in dialysis facilities should be trained in emergency response to mitigate risk from natural disasters. Dialysis staff should be familiar with the action plan for natural disaster events that disrupt hemodialysis, such as outages and water treatment system failures caused by earthquakes. Patients on hemodialysis also need to be educated about disaster preparedness. In the event of a disaster situation that results in dialysis failure, patients need to know what to do. At the local and national government level, long-term preparations should be made to handle renal disaster and patient safety logistics. Moreover, Korean nephrologists should also be prepared to manage cardiovascular disease and diabetes in disaster situations. Further evaluation and management of social and national disaster preparedness of hemodialysis units to earthquakes in Korea are needed.
Cardiovascular Diseases ; Dialysis ; Disasters ; Earthquakes ; Emergencies ; Federal Government ; Gyeongsangbuk-do ; Humans ; Japan ; Korea ; Organization and Administration ; Patient Safety ; Renal Dialysis ; Renal Insufficiency, Chronic ; Water Purification

The purpose of this study was to compare wage treatment and the employment environment of school foodservice employees before and after conversion to indefinite contract status since September 2012 when the Ordinance on the Appointment of Education Officials (indefinite contract) under the Gangwon Provincial Superintendent of Education was applied as well as to examine the effects of wage treatment and the employment environment on job stability. The questionnaire survey was conducted from March 31 to April 10, 2017 for school foodservice employees working at 97 schools in Gangwon province. A total of 477 questionnaires were distributed and 470 questionnaires were used for the analysis. Statistical analysis was conducted using SPSS Window Ver.18.0. The detailed results of this study were as follows. First, wage treatment (2.29 vs. 3.16), employment environment (3.45 vs. 4.22) and job stability (1.88 vs. 2.35) revealed significantly positive perceptions after conversion to indefinite contract status compared to before conversion. Second, after analyzing leading factors influencing job stability, it was revealed that wage treatment (before: βâ = 0.516, P < 0.05; after: βâ=0.465, P < 0.05) had a positive (+) effect on job stability, whereas employment environment did not affect job stability. In conclusion, in the context that most school foodservice employees are contract employees, this study is significant in that the changes in the employment policies of the national government and education office were confirmed to have effects on school foodservice employees.
Education ; Employment ; Federal Government ; Gangwon-do ; Humans ; Salaries and Fringe Benefits

OBJECTIVES: The objectives of the research study were to determine ethical guidelines and principles applicable in the practice and research of eHealth and telehealth in the Philippines, how these are applicable to the Philippines, and to differentiate between the ethical issues in research and in clinical practice of eHealth.

METHODS: This research study used: 1) review of ethics manuscripts, guidelines and literature; 2) focused group discussion and key informant interviews of experts; and 3) triangulation. The information sought for the review were- 1) relevant policies, guidelines in eHealth that are pertinent to the discussion of eHealth ethics in the Philippines; 2) components of ethics in eHealth research; and 3) components of ethics in eHealth practice. The framework of the consultation with experts was to identify mechanisms and strategies in incorporating ethics in both eHealthpractice and eHealth research within the following- 1) in reference to existing laws, policies, and guidelines on ethics in medicine and health; and 2) in the context of the Philippine setting.

RESULTS: Based on the review, there are pertinent codes of ethics, applicable laws, policies and guidelines in eHealth, both in the international and local settings. The focus group discussion and key informant interview with experts yielded significant and deeper understanding on how to address the gaps and lapses of ethics applied to eHealth in the country. These recommendations were given which distinguish between the ethics in clinical practice and ethics in the planning and implementation of eHealth systems. There is also a need to resolve the problem of whose primary responsibility the patient is- the referring, commonly referred to as the attending physician in the local community, or the specialist from the center. The proposed resolution was also presented.

CONCLUSION: The study has shown how important eHealth in potentially promoting timely and improved health care access. However, there are still lapses and gaps in the implementation of policies and guidelines on and relating to eHealth in the Philippines as shown by the data culled from the review and the focus group discussions with the experts. With more specific ethical guidelines and relevant policies, the development and practice of eHealth and telehealth will be on its way in bridging the gap and aiding in health systems development in the Philippines, especially with the support of the national government and collaboration of various agencies and stakeholders.

OBJECTIVE: To describe the health human resource needs of government hospitals in the Philippines.
METHODS: All 733 licensed government hospitals were included in a survey except 75 of them which the Department of Health have been deploying medical specialists and medical officers to augment the needs of these 75 hospitals.
RESULTS: A total of 96 government hospitals responded to the self-administered survey questionnaire sent to them. Analysis showed 20% to 29% among the level 2, level 3 and level 4 hospital responders have their Chief of Hospitals still without a master's education degree as required by the Department of Health. Fifty-nine percent (59%) of all hospitals do not have nearby medical educational institutions while 28% of them do not have nearby nursing educational institutions.The greatest need, however, is in the adequacy of the number of doctors and nurses. The minimum required number of doctors and nurses has not been met based on the staffing pattern standards set by the Department of Health for the different hospital categories and by the required 40 work hours per week set for civil servants.
CONCLUSION: The decline in the adequate number of health human resources noted to start when local public hospitals were devolved from the national government to the local government units in 1991. With this inadequacy, one cannot expect these public hospitals to provide even fair quality of hospital care; thus, the need for the national government to intervene.

Biotechnology ; China ; Cooperative Behavior ; Cuba ; Federal Government ; Translational Medical Research

In Korea, the proportion of medical costs due to chronic diseases among total health care expenditures is increasing rapidly. This trend calls for immediate countermeasures. In the major developed countries in Europe, a gatekeeper system has been adopted at the national level as a universal policy to manage and prevent chronic disease. In South Korea, insurers and local governments offer management programs to individuals with chronic disease and metabolic syndrome under the Korean government's Health Plan 2020, but these programs are fragmented and there are some related limitations. The role of the national government is very important to overcome this problem because the chronic disease management systems of other players (insurers, local governments) must be integrated. In addition, the expert patients program, which is intended to improve the self-care skills of chronic disease patients, needs to be better promoted. Incentives should include "mileage programs" in which patients can accumulate points for successful self-care. It is also important to increase public awareness through large-scale promotional campaigns. Finally, it is necessary to raise funds to conduct national-level campaigns and provide incentives to patients, and to ensure that all processes establish an organic cooperation system. Such practices will maximize the positive effects of a nationwide chronic disease management system in South Korea.
Chronic Disease ; Collodion ; Delivery of Health Care ; Developed Countries ; Dietary Sucrose ; Europe ; Federal Government ; Financial Management ; Health Expenditures ; Humans ; Insurance Carriers ; Korea ; Motivation ; Republic of Korea ; Self Care

Along with the steady growth of health functional food (HFF) markets, research evaluating the human effects of HFF has been expanding. In this study, we investigated the regulatory and management system of human study on HFF in the USA, Japan and UK, and the Korean domestic regulations on HHF, medicines, medical devices, cosmetics and biotechnology in order to improve the domestic management system. In these four countries, institutional review board (IRB) or research ethics committee (REC) approvals are required for on human study of HHF, but regulatory and management systems differ from country to country. In the USA, human studies on HFF for structure/function claims do not require the FDA's prior approval but clinical trials of the disease treatment effects of HHF require prior approval from the FDA. In the USA, IRBs are managed by the Department of Health and Human Services (DHHS) rather than the FDA, and IRBs in those institutions which would execute the clinical trials requiring prior approval from the FDA or human studies funded by the USA federal government are required to be registered on the DHHS. In the UK, although the government does not require prior approval of human study, authorized RECs managed by the National Research Ethics Service (NRES) and other independent RECs review the human study. In Japan, human study for HFF must conform with "Ethical guidelines for epidemiological research" and IRB registration has not been required. In Korean domestic regulations, the responsibilities, compositions, functions and operations of IRBs on medicines, medical devices and biotechnology are legally specified, but not those of IRB on HHF. These foreign statuses for the management of human study on HFF and comparisons with Korean regulations are expected to be used as basic data to improve the domestic legal system.
Biotechnology ; Cosmetics ; Ethics Committees, Research ; Ethics, Research ; Federal Government ; Financial Management ; Functional Food ; Humans ; Japan ; Social Control, Formal ; United States Dept. of Health and Human Services

This year on May 21st, the full panel of the Supreme Court in Korea had first made a judgment on 'withdrawal of life-sustaining management'. In this case, where a 76 -year-old patient was represented by her children, while being in a persistent vegetative status, the Supreme Court ruled that if a patient is in an irreversible condition with imminent death and the discontinuation of treatment can be approved as the patient's self -determination, while such action will not be allowed in any other special circumstances. This judgement presented the general criteria and process of withdrawal of life -sustaining management in Korea for the first time. The Supreme Court also brought about the specific requirements of advance directives and decided that in case where legal proceedings are not taken, the hospital ethic committee constiting of medical specialists should decide whether the patient is in an irreversible condition. However, the judgment vaguely defined the concept of 'irreversible death-imminent condition' and did not clearly examine the relations between the patient's right on self-determination and the duty of the national government to protect the life of the people, and the discretionary power of the doctor.
Advance Directives ; Child ; Ethics Committees, Clinical ; Ethics, Institutional ; Euthanasia ; Federal Government ; Humans ; Judgment ; Korea ; Patient Rights ; Right to Die ; Specialization

In 1991, the Ministry of Health & Social affairs adopted a nationwide service program for neonatal screening of phenylketonuria, galactosemia, maple syrup urine disease, homocystinuria, histidinemia & congenital hypothyroidism for newborns delivered from low class pregnant women registered in health centers. Government decreased the test items from six to two, PKU & congenital hypothyroidism to increase test numbers with same budget from 1995. Government decided to test PKU & hypothyroidism for all newborns from 1997. 78 laboratories wanted to participate for neonatal screening test in 1999. Government didn't decide laboratory center for a certain district and placed responsibility on free competition. Government are planning to test 573,000 newborns from 1998, Government decided to screen 6 items PKU, congenital hypothyroidism, maple syrup urine disese, homocystinuria, galactosemia and congenital adrenal hyperplasia from 2006. 17 laboratores are participating now. The cost of screening test is supported by both the federal government and local government on a 40-60 basis. In case a patient with an inherited metabolic disease is diagnosed by screening of government program, special milk is provided at government's expense. Interlaboratory quality control was started 6 times a year from 1994. According to the government project, 3,707,773 newborns were screened. 86 PKU, 718 congenital hypothyroidism were detected. So incidence of PKU is 1/43,114 and congenital hypothyroidism is 1/4,612. Maeil dairy company produced new special formula for PKU, MMA and PA, MSUD, urea cycle disorder, homocystinuria, isovaleric acidemia from Oct. 1999. The cost benefit of performing screening procedures coupled with treatment has been estimated to be as high as 1.77 times in PKU, 11.11 times in congenital hypothyroidism than cost without screening. We are trying to increase the budget to test all newborns for Tandem mass sereening & Wilson disease from 2008. Now it is a very important problem to decrease laboratory numbers of neonatal screening in Korea. So we are considering 4-5 central laboratories which cover all newborns and are equipped with tandem mass spectrometer & enzyme immunoassay for TSH, 17OHP & enzyme colorimetric assay for galactose.
Acer ; Adrenal Hyperplasia, Congenital ; Budgets ; Congenital Hypothyroidism ; Cost-Benefit Analysis ; Federal Government ; Female ; Galactose ; Galactosemias ; Government Programs ; Hepatolenticular Degeneration ; Homocystinuria ; Humans ; Hypothyroidism ; Immunoenzyme Techniques ; Incidence ; Infant, Newborn* ; Korea* ; Local Government ; Maple Syrup Urine Disease ; Mass Screening* ; Metabolic Diseases* ; Milk ; Neonatal Screening ; Phenylketonurias ; Pregnant Women ; Quality Control ; Urea Cycle Disorders, Inborn

The poverty families, who take care of the demented elderly, can suffer from the deficiency of social services for dementia and the condition and nature the families have. Therefore, This study examines the burden of the poverty caring for the demented elderly. This study focused on the three points : the level of care burden of the families, who take care of the demented elderly ; the needs of welfare services ; the differences of care burden and service demand on trait of the families and the demented elderly. In order to achieve them, the 250 families, who take care of the demented elderly at home, were sampled and the primary caregivers of family member interviewed. Then, the statistics of the 226 people were analyzed by SPSSWIN. The major findings of the study were as follows : First, the level of the care burden the families of the demented elderly have, participated in this research, is higher than 'a little yes'. In a type of the care burden, the social & personal restriction is higher than the other types, including physical restriction, economical restriction, and reciprocal restriction. Second, some families had used service and had a low satisfaction, because of no various and adequate services. It shows that the services for the demented elderly and their families is not enough to use, that the services is not various for the families having many problem related the demented elderly. Third, there are many services needed by the families caring for the demented elderly : residential care facilities for the demented elderly ; day care service center ; short-term care services ; family counseling service ; services at home ; nursing services at home ; night care services ; family meeting. Fourth, the most difficult thing of caring is the economic burden of the families. The families are willing to take care of the demented elderly at home, if the government supports economically them and serves proper services to them. Finally, the lower income of the families is, the more time of caring the demented elderly in a day is, the lower vital functions of the demented elderly are, and the lower level of academic achievement, the higher level of care burden of the families is. According to the result, the level of the care burden can be affected by the family's economic capacity, the vital function of the demented elderly, and the existence of service for the demented elderly. For the elderly welfare especially, the demented elderly and their poverty families, three opinions may be suggested. First, the service programs based on community should be developed to reduce the burdens-economic, psychological, medical burden, etc. - of the poverty families caring for the demented elderly. These programs may include preventive service, education programs of dementia, diagnosis services, family counseling, and medical service. Second, the national government and the local government must try to make policies to solve the temporary problems of the family having the demented elderly.
Aged* ; Caregivers ; Counseling ; Day Care, Medical ; Dementia ; Diagnosis ; Education ; Federal Government ; Humans ; Local Government ; Night Care ; Nursing Services ; Poverty* ; Social Work