OBJECTIVE: In respect of the health and safety of the public, universal access to health care is an issue of the greatest importance. The geographic distribution of doctors is one of the important factors contributing to access to health care. The aim of this study is to assess the imbalances in the geographic distribution of neurosurgeons across Korea.METHODS: Population data was obtained from the National Statistical Office. We classified geographic groups into 7 metropolitan cities, 78 non-metropolitan cities, and 77 rural areas. The number of doctors and neurosurgeons per 100000 populations in each county unit was calculated using the total number of doctors and neurosurgeons at the country level from 2009 to 2015. The density levels of neurosurgeon and doctor were calculated and depicted in maps.RESULTS: Between 2009 and 2015, the number of neurosurgeons increased from 2002 to 2557, and the ratio of neurosurgeons per 100000 populations increased from 4.02 to 4.96. The number of neurosurgeons per 100000 populations was highest in metropolitan cities and lowest in rural areas from 2009 to 2015. A comparison of the geographic distribution of neurosurgeons in 2009 and 2015 showed an increase in the regional gap. The neurosurgeon density was affected by country unit characteristics (p=0.000).CONCLUSION: Distribution of neurosurgeons throughout Korea is uneven. Neurosurgeons are being increasingly concentrated in a limited number of metropolitan cities. This phenomenon will need to be accounted when planning for a supply of neurosurgeons, allocation of resources and manpower, and the provision of regional neurosurgical services.
Geographic Mapping ; Health Manpower ; Health Services Accessibility ; Hospital Distribution Systems ; Korea ; Neurosurgeons ; Neurosurgery ; Resource Allocation

The Sustainable Development Goals (SDGs), officially known as ‘Transforming our world: the 2030 agenda for sustainable development’ has 17 “Global Goals” with 169 targets. This is the resolution by member countries as an intergovernmental agreement that acts as the Post 2015 Development Agenda (successor to the Millennium Development Goals). In conjunction with the United Nations SDG, World Health Organization published “The global strategy on human resources for health: workforce 2030”. It is primarily aimed at planners and policy-makers of WHO Member States and, its contents are of value to all relevant stake holders including medical education providers in the health workforce area. This article tried to explore the future direction of medical education to achieve the SDG in relation to Korean context.
Conservation of Natural Resources* ; Education, Medical* ; Health Manpower ; Humans ; Public Sector ; Social Control, Formal ; Social Skills ; United Nations ; World Health Organization

OBJECTIVES: Since 2000, the National Health Service (NHS) in the United Kingdom (UK) has challenged for a large-scale reforms. This study aims to review those reforms to reflect in the dental care system in Korea. METHODS: Reports and papers that were published from 2000 to 2015 and were related to the NHS dental care system and reforms were searched. Among them, official reports from the government or organization were prioritized. RESULTS: In 2002, the “NHS Dentistry: Options for Change” report suggested rebuilding the structure to meet the standard of care, improving the remuneration system, and modernizing the workforce. Eight years later, the government proposed the “NHS Dental Contract: Proposals for Pilots” to improve accessibility to oral health and dental care. The pilot was based on three elements: registration, capitation, and quality. In 2015, the Department of Health announced the “Dental Contract Reform: Prototypes.” These prototypes include the clinical pathway, measurement and remuneration by quality of care, and a weighted capitation and quality model reimbursement system. CONCLUSIONS: The changes to the UK dental care system has implications. First, national coverage should be extended to improve accessibility to dental care. Second, the dental care system is necessary to reform focused on patient-centered and prevention. Third, registration and remuneration by quality of care needs to be introduced. Fourth, change should start from the basic steps, such as forming consensus or preparing manuals, to strengthening personnel and conducting a pilot study. Most of all, the new system will center on clinical leadership.
Consensus ; Critical Pathways ; Delivery of Health Care* ; Dental Care ; Dentistry ; Great Britain ; Health Care Reform* ; Health Manpower ; History of Dentistry ; Korea ; Leadership ; Legislation, Dental ; National Health Programs ; Oral Health ; Pilot Projects ; Remuneration ; Standard of Care

BACKGROUND:The incidence of human immunodeficiency virus (HIV) infection in the Philippines is increasing. HIV-related stigma in the health care setting is a known barrier to healthcare access for people living with HIV (PLHIV).

OBJECTIVE: The study aimed to identify stigmatizing attitudes and practices towards PLHIV among healthcare workers in Philippine General Hospital.

METHODS: In this cross-sectional descriptive study, 375 healthcare workers were recruited via convenience sampling. A standardized questionnaire developed by the Health Policy Project was used.

RESULTS: The study demonstrated concerns regarding transmission, particularly during drawing blood (87.1%),assisting in labor and delivery (82%), and dressing wounds (80.4%). Use of special infection-control measures (76.1%),wearing double gloves (72.8%), additional infection-control procedures during labor and delivery (72.2%), and wearing gloves during all aspects of patient care (70.2%) were reported as well. Perceptions such as the belief that pregnant women who are HIV positive must inform their families of their HIV status (82.1%), and that PLHIV engage in irresponsible behaviors (69.1%) and are promiscuous (66.4%) were also detected.

CONCLUSION: The study confirmed the presence of HIV-related stigma among healthcare workers in Philippine General Hospital.This finding could potentially catalyze the development of stigma-reducing measures which could hopefully translate to improved healthcare for PLHIV.

Human ; Male ; Female ; Hiv Infections ; Social Stigma ; Health Services Accessibility ; Social Discrimination ; Health Care Facilities, Manpower, And Services ; Hiv

INTRODUCTIONParenteral nutrition (PN) is indicated for patients who are unable to progress to oral or enteral nutrition. There are no local studies done on estimating the cost of PN in acute settings. The aims of this study are to describe the demographics, costs of PN and manpower required; and to determine the avoidable PN costs for patients and hospital on short-term PN.

MATERIALS AND METHODSPatient data between October 2011 and December 2013 were reviewed. Data collected include demographics, length of stay (LOS), and the indication/duration of PN. PN administration cost was based on the cost of the PN bags, blood tests and miscellaneous items, adjusted to subsidy levels. Manpower costs were based on the average hourly rate.

RESULTSCosts for PN and manpower were approximately S$1.2 million for 2791 PN days. Thirty-six cases (18.8%) of 140 PN days were short-term and considered to be avoidable where patients progressed to oral/enteral diet within 5 days. These short-term cases totalled $59,154.42, where $42,183.15 was payable by the patients. The daily costs for PN is also significantly higher for patients on short-term PN (P <0.001).

CONCLUSIONIn our acute hospital, 90% of patients referred for PN were surgical patients. Majority of the cost comes from the direct daily cost of the bag and blood tests, while extensive manpower cost was borne by the hospital; 18.8% of our cohort had short-term avoidable PN. Daily PN may cost up to 60% more in patients receiving short-term PN. Clinicians should assess patient's suitability for oral/enteral feeding to limit the use of short-term PN.

Enteral Nutrition ; Health Care Costs ; Health Manpower ; economics ; Hematologic Tests ; economics ; Hospitals ; Humans ; Length of Stay ; economics ; Medical Overuse ; economics ; prevention & control ; Nutritional Support ; economics ; utilization ; Parenteral Nutrition ; economics ; utilization ; Singapore ; Time Factors

To discuss the standardization of the practitioner's posture in acupuncture operation. Based on the relevant discussion on 'way to holding needle' recorded in Lingshu (Miraculous Pivot) and in association with the clinical acupuncture practice, it was required to standardize the practitioner's posture in acupuncture operation in reference to Lingshu (Miraculous Pivot). The standard standing posture of the practitioner is the precondition of acupuncture operation; the standard holding needle with the puncture hand is the key to the exercise of acupuncture technique and the regular standing orientation is the need of acupuncture operation. The three aspects are complemented each other, which is the coordinative procedure in acupuncture operation and enable the practitioner's high concentration with the body, qi and mind involved.
Acupuncture ; manpower ; Acupuncture Therapy ; instrumentation ; standards ; Health Personnel ; standards ; Humans ; Posture

The adequacy of the urologist work force in Korea has never been investigated. This study investigated the geographic distribution of urologists in Korea. County level data from the National Health Insurance Service and National Statistical Office was analyzed in this ecological study. Urologist density was defined by the number of urologists per 100,000 individuals. National patterns of urologist density were mapped graphically at the county level using GIS software. To control the time sequence, regression analysis with fitted line plot was conducted. The difference of distribution of urologist density was analyzed by ANCOVA. Urologists density showed an uneven distribution according to county characteristics (metropolitan cities vs. nonmetropolitan cities vs. rural areas; mean square=102.329, P<0.001) and also according to year (mean square=9.747, P=0.048). Regression analysis between metropolitan and non-metropolitan cities showed significant difference in the change of urologists per year (P=0.019). Metropolitan cities vs. rural areas and non-metropolitan cities vs. rural areas showed no differences. Among the factors, the presence of training hospitals was the affecting factor for the uneven distribution of urologist density (P<0.001).Uneven distribution of urologists in Korea likely originated from the relatively low urologist density in rural areas. However, considering the time sequencing data from 2007 to 2012, there was a difference between the increase of urologist density in metropolitan and non-metropolitan cities.
Cities/statistics & numerical data ; Health Services Accessibility/*statistics & numerical data/trends ; Korea/epidemiology ; Physicians/*supply & distribution/trends ; Republic of Korea/epidemiology ; Rural Health Services/*manpower/statistics & numerical data/trends ; Rural Population/statistics & numerical data/trends ; Urban Health Services/*manpower/statistics & numerical data/trends ; Urology/*manpower/*statistics & numerical data/trends

PURPOSE: This study aimed to develop a job description for healthcare managers of metabolic syndrome management programs using task analysis. METHODS: Exploratory research was performed by using the Developing a Curriculum method, the Intervention Wheel model, and focus group discussions. Subsequently, we conducted a survey of 215 healthcare workers from 25 community health centers to verify that the job description we created was accurate. RESULTS: We defined the role of healthcare managers. Next, we elucidated the tasks of healthcare managers and performed needs analysis to examine the frequency, importance, and difficulty of each of their duties. Finally, we verified that our job description was accurate. Based on the 8 duties, 30 tasks, and 44 task elements assigned to healthcare managers, we found that the healthcare managers functioned both as team coordinators responsible for providing multidisciplinary health services and nurse specialists providing health promotion services. In terms of importance and difficulty of tasks performed by the healthcare managers, which were measured using a determinant coefficient, the highest-ranked task was planning social marketing (15.4), while the lowest-ranked task was managing human resources (9.9). CONCLUSION: A job description for healthcare managers may provide basic data essential for the development of a job training program for healthcare managers working in community health promotion programs.
*Administrative Personnel ; Adult ; Attitude of Health Personnel ; Community Health Centers/*manpower ; Focus Groups ; Humans ; Job Description/*standards ; Metabolic Syndrome X/*therapy ; Middle Aged ; Republic of Korea ; Task Performance and Analysis ; Young Adult

OBJECTIVETo investigate the knowledge, attitudes, and practices regarding blood-borne occupational exposure among reproductive health staff in Tianjin, China.

METHODSBy random, stratified, and clustered sampling, 507 reproductive health-related medical workers in Tianjin were selected. A Self-Administered KAP Questionnaire on blood-borne occupational exposure was employed to gauge the general characteristics, awareness of knowledge, attitudes to occupational exposure, implementation of pre-exposure protection, incidence of occupational exposure, and demands for continuing education.

RESULTSAmong all respondents, 63.15% (305/483) were aware of the reporting procedures and related departments after the incidence of occupational exposure. The awareness rate of classification of HIV occupational exposure was 48.45% (234/483). About preventive medication time after HIV and hepatitis B virus exposure, the awareness rates were 37.89% (183/483) and 31.47% (152/483), respectively. The average score of occupational exposure knowledge among respondents was 74.45±14.00. The multivariate analysis indicated that medical staff of obstetrics and gynecology, females, doctors and high-level medical institutions showed significantly higher awareness than urology professionals, males, nurses, and medical staff of primary health care institutions, respectively (t = 12.140, t = 5.428, t = 2.582, F = 4.218, P<0.05). Of the respondents, 93.17% (450/483) and 94.41% (456/483) thought that washing hands properly and wearing protective glasses were effective methods for the prevention of occupational exposure, but only 15.94% (89/483) and 3.93% (19/483) adhered to proper hand washing and wearing protective glasses within nearly one year in practical work. Of the respondents, 60.46% (292/483) had experienced the occupational exposure during their vocation, and 95.65% (462/483) needed respective trainings.

CONCLUSIONThe awareness of occupational exposure among reproductive health-related medical staff is lacking, especially in preventative medication and reporting procedures after the incidence of occupational exposure. The implementation of protective measures is inadequate and incidence of occupational exposure is higher. Therefore, continuing education is necessary to improve the knowledge and attitudes towards occupational exposure in medical staff. At the same time, strict and effective supervision and management system should be established.

Adult ; Blood-Borne Pathogens ; Female ; Health Knowledge, Attitudes, Practice ; Health Personnel ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Occupational Exposure ; prevention & control ; Reproductive Health Services ; manpower ; Surveys and Questionnaires ; Young Adult

OBJECTIVETo assess the policies and programs on the capacity of prevention and control regarding non-communicable diseases (NCDs) at the Centers for Disease Control and Prevention (CDCs) at all levels and grass roots health care institutions, in China.

METHODSOn-line questionnaire survey was adopted by 3 352 CDCs at provincial, city and county levels and 1 200 grass roots health care institutions.

RESULTS1) On policies: 75.0% of the provincial governments provided special funding for chronic disease prevention and control, whereas 19.7% city government and 11.3% county government did so. 2) Infrastructure:only 7.1% county level CDCs reported having a department taking care of NCD prevention and control. 8 263 staff members worked on NCDs prevention and control, accounting for 4.2% of all the CDCs' personnel. 40.2% CDCs had special funding used for NCDs prevention and control. 3)Capacity on training and guidance:among all the CDCs, 96.9% at provincial level, 50.3% at city level and 42.1% at county level had organized training on NCDs prevention and control. Only 48.3% of the CDCs at county level provided technical guidance for grass-roots health care institutions. 4) Capacities regarding cooperation and participation: 20.2% of the CDCs had experience in collaborating with mass media. 5) Surveillance capacity: 64.6% of the CDCs at county level implemented death registration, compare to less than 30.0% of CDCs at county level implemented surveillance programs on major NCDs and related risk factors. In the grass roots health care institutions, 18.6% implemented new stroke case reporting system but only 3.0% implemented program on myocardial infarction case reporting. 6) Intervention and management capacity: 36.1% and 32.2% of the CDCs conducted individualized intervention on hypertension and diabetes, while less than another 20% intervened into other NCDs and risk factors. More than 50% of the grass roots health care institutions carried follow-up survey on hypertension and diabetes. Rates on hypertension and diabetes patient management were 12.0% and 7.9% , with rates on standard management as 73.8% and 80.1% and on control as 48.7% and 50.0%, respectively. 7) Capacity on Assessment: 13.3% of the CDCs or health administrations carried out evaluation programs related to the responses on NCDs in their respective jurisdiction. 8) On scientific research: the capacity on scientific research among provincial CDCs was apparently higher than that at the city or county level CDCs.

CONCLUSIONPolicies for NCDs prevention and control need to be improved. We noticed that there had been a huge gap between county level and provincial/city level CDCs on capacities related to NCDs prevention and control. At the grass-roots health care institutions, both prevention and control programs on chronic diseases did not seem to be effective.

China ; Chronic Disease ; prevention & control ; Community Health Services ; manpower ; organization & administration ; Humans