BACKGROUND: Omega-5-gliadin (O5G) allergy, also known as wheat-dependent exercise-induced anaphylaxis, is commonly reported in the Western, but not Asian, populations. Although significant differences in O5G allergy presentation across different populations are likely but there have been no previous reports on this important topic.OBJECTIVE: To report on the prevalence and characteristics of O5G allergy in Hong Kong (HK) compared with the United Kingdom (UK).METHODS: O5G allergy patients attending Queen Mary Hospital (HK cohort), and Guy's and St Thomas' Hospital, London (UK cohort) were studied and compared.RESULTS: A total of 46 O5G allergy patients (16 HK; 30 UK) were studied. In the HK cohort, 55% of all patients previously labeled as “idiopathic anaphylaxis” were diagnosed with O5G allergy. Exercise was the most common cofactor in both cohorts, followed by alcohol and nonsteroidal anti-inflammatory drugs (NSAID). A higher proportion of the HK cohort reported NSAID as a cofactor (13% vs. 0%, p = 0.048). In the HK cohort, more patients presented with urticaria and cardiovascular manifestations (100% vs. 77%, p = 0.036; 100% vs. 70%, p = 0.015, respectively); the range of presentation was more diverse in the UK cohort. In HK fewer patients adhered to wheat avoidance (50% vs. 87%, p = 0.007) and more patients avoided cofactors only (44% vs. 10%, p = 0.008).CONCLUSION: O5G allergy appears relatively underdiagnosed in HK. Urticaria and cardiovascular manifestations are common; NSAID plays an important role as a cofactor and patients are less concordant with dietary avoidance measures than in the Western population.
Anaphylaxis ; Asian Continental Ancestry Group ; Cohort Studies ; Great Britain ; Hong Kong ; Humans ; Hypersensitivity ; Prevalence ; Triticum ; Urticaria

PURPOSE: The importance of human dignity in care is well-recognized. Care recipients' experiences with undignified care have been reported in many countries. However, few studies have measured these situations quantitatively, especially as there are no tools applicable to inpatients receiving ordinary daily care. This study aimed to develop a valid and reliable Inpatient Dignity Scale (IPDS) that can measure inpatients' expectations of and satisfaction with dignity in daily care. METHODS: We conducted a three-phase research project: item generation and a preliminary survey with 47 items related to patients' dignity in Japan, a main survey with 36 items with deliberate translation into English in Singapore, and a confirmatory survey with 35 items in England, with 442, 430, and 500 inpatients as participants in questionnaire surveys, respectively. Data from each survey were processed using factor analysis. RESULTS: Authors obtained a scale with a four-factor structure with acceptable reliability: (F1) respect as a human being, (F2) respect for personal feelings and time, (F3) respect for privacy, and (F4) respect for autonomy. CONCLUSION: The Inpatient Dignity Scale can be periodically used by hospital administrators or nurses to preserve inpatients' dignity in daily care by monitoring inpatients' views regarding their expectations of and satisfaction with dignity.
England ; Great Britain ; Hospital Administrators ; Humans ; Inpatients ; Japan ; Nursing ; Personhood ; Privacy ; Psychometrics ; Singapore

PURPOSE: Pediatric palliative care (PPC) is emphasized as standard care for children with life-limiting conditions to improve the quality of life. In Korea, a government-funded pilot program was launched only in July 2018. Given that, this study examined various PPC delivery models in other countries to refine the PPC model in Korea. METHODS: Target countries were selected based on the level of PPC provided there: the United Kingdom, the United States, Japan, and Singapore. Relevant literature, websites, and consultations from specialists were analyzed by the integrative review method. Literature search was conducted in PubMed, Google, and Google Scholar, focusing publications since 1990, and on-site visits were conducted to ensure reliability. Analysis was performed on each country's process to develop its PPC scheme, policy, funding model, target population, delivery system, and quality assurance. RESULTS: In the United Kingdom, community-based free-standing facilities work closely with primary care and exchange advice and referrals with specialized PPC consult teams of children's hospitals. In the United States, hospital-based specialized PPC consult teams set up networks with hospice agencies and home healthcare agencies and provide PPC by designating care coordinators. In Japan, palliative care is provided through several services such as palliative care for cancer patients, home care for technology-dependent patients, other support services for children with disabilities and/or chronic conditions. In Singapore, a home-based PPC association plays a pivotal role in providing PPC by taking advantage of geographic accessibility and cooperating with tertiary hospitals. CONCLUSION: It is warranted to identify unmet needs and establish an appropriate PPD model to provide need-based individualized care and optimize PPC in South Korea.
Adolescent ; Child ; Delivery of Health Care ; Disabled Children ; Financial Management ; Great Britain ; Health Services Needs and Demand ; Home Care Services ; Hospice Care ; Hospices ; Humans ; Japan ; Korea ; Methods ; Palliative Care ; Pediatrics ; Primary Health Care ; Quality of Life ; Referral and Consultation ; Singapore ; Specialization ; Tertiary Care Centers ; United States

BACKGROUND AND OBJECTIVES: The Chronic Otitis Media Questionnaire-12 (COMQ-12) was developed in the United Kingdom to assess disease specific Health-Related Quality of Life (HRQoL) of chronic otitis media (COM) patients. We assessed the validity of Korean version of COMQ-12 (K-COMQ-12) and its correlation with the disease activity of COM classified according to the type of surgery. MATERIALS AND METHOD: We translated the original COMQ-12 into Korean and also performed a back-translation of the translated text into English. Enrolled were 106 COM patients and 106 healthy subjects. Cronbach alpha was used to evaluate internal consistency, and factor analysis was performed to prove reliability. We compared K-COMQ-12 scores between normal subjects and COM patients to assess validity. The scores were also compared by dividing groups according to disease activity of COM. RESULTS: Cronbach's alpha showed good internal consistency (0.939). There was a significant difference in K-COMQ-12 scores between healthy subjects (1.99±4.34) and COM patients (22.69±12.41). Also, scores go higher as the disease activity of COM increased. A cut-off score of 6 of K-COMQ-12 sets 0.915 of sensitivity and 0.934 of specificity. CONCLUSION: The K-COMQ-12 is a reliable and valid tool to assess HRQoL in patients with COM. The K-COMQ-12 could be also used as an objective tool that reflects the disease activity of COM.
Great Britain ; Healthy Volunteers ; Humans ; Methods ; Otitis Media ; Otitis ; Quality of Life ; Sensitivity and Specificity

OBJECTIVE: Idiopathic Parkinson's disease (IPD) is a chronic progressive neurodegenerative movement disorder characterized by motor and non-motor symptoms that affects patients’ quality of life and caregiver burden. The aim of our study was to assess the caregiver burden (CB) in early and late stages of disease and to search if there was a relationship between quality of life and CB. METHODS: A total of 74 patients who were diagnosed as having IPD by a movement disorder neurologist according to United Kingdom Brain Bank Criteria and their caregivers were randomly selected for participation the study. Staging of PD was performed by the neurologist based on the Hoehn and Yahr (H&Y) Scale. Disease severity was determined using the Unified Parkinson's Disease Rating Scale (UPDRS). CB was evaluated using the Zarit Caregiver Burden Inventory (ZCBI). The Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory (BDI) were used to assess anxiety and depressive symptoms in patients with IPD and their caregivers. The Short-Form Health Survey instrument (SF-36) was used to evaluate quality of life of the patients. The Mini-Mental State Examination (MMSE) was administered to patients to evaluate gross cognitive status. RESULTS: Seventy-four patients (male, 58.1%) were included in the study. The mean age of patients was 66.18±8.5 and the mean duration of disease was 67.23±41.8 months. According to the H&Y scale, the patients were divided into two groups; stage I–II as early stage and stage III–V as late stage. Group 1 (H&Y I–II) consisted of 40 patients, and group 2 (H&Y III–V) comprised 34 patients. The mean duration of disease and UPDRS scores were significantly higher in group 2 (p=0.003, p=0.001, respectively). Significant differences were found in group 2 according to BDI. There were significant differences between group 1 and 2 according to SF-36 subdomains such as general health, emotional role, social functioning, pain, and mental health (p=0.019, p=0.038, p=0.005, p=0.004, p=0.014, respectively). However, there were no significant differences between these two groups concerning CB. CONCLUSION: Although CB was found in 35 (47.3%) caregivers in our study, we found no significant differences between the caregivers of patients with early and late-stage IPD patients. We thought that this might be due to strong family relationships and cultural dynamics in Turkey. Burden was found to be higher in depressive patients’ CGs and CGs who had depressive symptoms. It is important to recognize depressive symptoms earlier to protect the relationship between the CG and the patient because the main providers of care are family members.
Anxiety ; Brain ; Caregivers ; Depression ; Family Relations ; Great Britain ; Health Surveys ; Humans ; Mental Health ; Movement Disorders ; Parkinson Disease ; Quality of Life ; Turkey

BACKGROUND: Few studies have examined the effects of a forward rotating shift pattern on police employee performance and well-being. This study sought to compare sleep duration, cognitive performance, and vigilance at the start and end of each shift within a three-shift, forward rotating shift pattern, common in United Kingdom police forces. METHODS: Twenty-three police employee participants were recruited from North Yorkshire Police (mean age, 43 years). The participants were all working the same, 10-day, forward rotating shift pattern. No other exclusion criteria were stipulated. Sleep data were gathered using both actigraphy and self-reported methods; cognitive performance and vigilance were assessed using a customized test battery, comprising five tests: motor praxis task, visual object learning task, NBACK, digital symbol substitution task, and psychomotor vigilance test. Statistical comparisons were conducted, taking into account the shift type, shift number, and the start and end of each shift worked. RESULTS: Sleep duration was found to be significantly reduced after night shifts. Results showed a significant main effect of shift type in the visual object learning task and NBACK task and also a significant main effect of start/end in the digital symbol substitution task, along with a number of significant interactions. CONCLUSION: The results of the tests indicated that learning and practice effects may have an effect on results of some of the tests. However, it is also possible that due to the fast rotating nature of the shift pattern, participants did not adjust to any particular shift; hence, their performance in the cognitive and vigilance tests did not suffer significantly as a result of this particular shift pattern.
Actigraphy ; Fatigue ; Great Britain ; Humans ; Learning ; Police

The term new tobacco products (NTPs) refers to the new alternatives to conventional cigarettes. There are several kinds of NTPs in South Korea. The present study discusses the most widely used NTPs namely electronic cigarette (ECs) and heated tobacco products (HTPs). The aims of this study are to evaluate the risk related to the use of ECs and HTPs, introduce policy examples across different countries of management of this issue, and finally, present some policy implications of the problem and our response strategies. Since the advent of ECs, there has been a lot of debate about its risk. Some studies have reported that ECs are less harmful than conventional cigarettes and that they are effective in aiding smoking cessation. Nevertheless, the efficacy of ECs in smoking cessation and its potential health risks are still unclear. However, the obvious fact is that it is not harmless. Regulations on ECs differ from country to country. In many countries, they are strictly regulated as tobacco or toxic substances; however, in the United Kingdom, the use of ECs are included as part of their smoking cessation policy, and in Japan, they are treated as a form of medication. On the other hand, HTPs are the most recently introduced NTPs and they have attained sensational popularity because of the wrongly held belief that they are less harmful to health. So, what about our policy response to these two tobacco products? The research on ECs requires more systematic statistical monitoring, such as monitoring the ratio of dual-users. Further, the new EC smokers should be identified taking into account that the arguments for the use of ECs often emphasize smoking cessation or less risks to health, the government should further strengthen its policy to prevent those claims. The HTPs market experienced a very sharp growth and continues to grow because the government policy is too passive. Taking this as a lesson, it is necessary to approach NTPs, such as HTPs, proactively and increase their contribution to the National Health Promotion Fund by imposing greater taxes on them. Finally, considering the likelihood of NTPs being promoted as a less harmful tobacco product, it is essential to strictly regulate tobacco companies' publicity from the very beginning to ensure that potential consumer s are not mislead.
Electronic Cigarettes ; Financial Management ; Great Britain ; Hand ; Health Promotion ; Hot Temperature ; Japan ; Korea ; Smoking Cessation ; Social Control, Formal ; Taxes ; Tobacco Products ; Tobacco

Although 19 years have passed since the enforcement of the Framework Act on Health and Medical Services, the Plans for Development of Health and Medical Services has not been established. This Plan is a 5-year basic long-term plan that covers the whole of health and medical services. This Plan should point to the direction of 30 long-term plans of healthcare, and this Plan should serve as a combination and coordination of 30 long-term plans and 22 related laws. The United States, the United Kingdom, and Japan have established long-term healthcare plans (4-, 10-, and 20-year plans, respectively). The long-term health plan of the United States has been approached bottom-up, those of the United Kingdom and Japan have been approached top-down. The rapid environmental changes that Korea is and will be experiencing emphasize urgently the need for establishing the Plan for Development of Health and Medical Services.
Delivery of Health Care ; Great Britain ; Japan ; Jurisprudence ; Korea ; United States

OBJECTIVES: We analyzed Korea's data privacy regime in the context of protecting and utilizing health and medical big data and tried to draw policy implications from the analyses. METHODS: We conducted comparative analyses of the legal and regulatory environments governing health and medical big data with a view to drawing policy implications for Korea. The legal and regulatory regimes considered include the following: the European Union, the United Kingdom, France, the United States, and Japan. We reviewed relevant statutory materials as well as various non-statutory materials and guidelines issued by public authorities. Where available, we also examined policy measures implemented by government agencies. RESULTS: In this study, we investigated how various jurisdictions deal with legal and regulatory issues that may arise from the use of health and medical information with regard to the protection of data subjects' rights and the protection of personal information. We compared and analyzed various forms of legislation in various jurisdictions and also considered technical methods, such as de-identification. The main findings include the following: there is a need to streamline the relationship between the general data privacy regime and the regulatory regime governing health and medical big data; the regulatory and institutional structure for data governance should be more clearly delineated; and regulation should encourage the development of suitable methodologies for the de-identification of data and, in doing so, a principle-based and risk-based approach should be taken. CONCLUSIONS: Following our comparative legal analyses, implications were drawn. The main conclusion is that the relationship between the legal requirements imposed for purposes of personal information protection and the regulatory requirements governing the use of health and medical data is complicated and multi-faceted and, as such, their relationship should be more clearly streamlined and delineated.
Computer Security ; European Union ; France ; Government Agencies ; Great Britain ; Humans ; Japan ; Korea ; Privacy ; United States

OBJECTIVE: Multiple System Atrophy (MSA) and progressive supranuclear palsy (PSP) are rapidly progressive forms of degenerative Parkinsonism. The difficulties of diagnosing MSA and PSP in their early stages may lead to delayed referral to appropriate specialists and distress to patients, as well as delaying symptomatic treatment and participation in clinical trials. This work aimed to describe the symptoms that patients with MSA and PSP developed and plot their emergence relative to final diagnosis using a median onset in months. METHODS: Forty-seven patients from the United Kingdom with MSA or PSP diagnosed by a movement disorder specialist were interviewed with carers or relatives to establish milestone onset. This was corroborated using clinical notes and letters. RESULTS: In the MSA cohort (n = 23), autonomic symptoms (median 5.5 months before diagnosis) and falls (median 1 month before diagnosis) were the two clinical milestones which occurred before diagnosis. In the PSP cohort (n = 24), falling was the only milestone which occurred before diagnosis (median of 18.5 months). CONCLUSION: This study shows that PSP patients experience falling more than a year and a half an average before receiving a diagnosis and although MSA patients also tended to fall, this was much closer to the time of diagnosis. Further work with larger cohorts may illustrate whether these preliminary findings can be generalised to guide diagnosis and management.
Accidental Falls ; Advance Care Planning ; Caregivers ; Cohort Studies ; Delayed Diagnosis ; Diagnosis ; Great Britain ; Humans ; Movement Disorders ; Multiple System Atrophy ; Parkinsonian Disorders ; Referral and Consultation ; Retrospective Studies ; Specialization ; Supranuclear Palsy, Progressive