Accident prevention activity and accident experience in the Republic of Korea military

Introduction: According to data released by the Korea National Statistical Office, the number of accidents has been decreasing since 2012. However, a considerable number of deaths related to safety accidents (23-46 deaths) are still reported annually. This study aimed to observe the correlation between accident prevention activities in the Republic of Korea (ROK) military and the incidence of safety accidents. Methods: The study used data from the 2014-2015 Military Health Survey and included 13 618 responses (Army: 8414 (61.8%); Navy/Marine: 2262 (16.6%); Air Force: 2942 (21.6%)) from the ROK military personnel. Accident experiences and thoughts on accident prevention activities were self-reported. Multiple logistic regression analysis was used to examine the validity of accident prevention activity and accident experience. Results: Of the 13 618 military personnel who responded, 12.0% reported experiencing safety accidents in the military and 1020 (7.5%) felt that accident prevention activities in the military were insufficient. On logistic regression analysis, we found a significant difference (insufficiency OR=1.56, CI 1.31 to 1.86). In particular, military personnel who belong to the Army and Navy were more likely to think that accident prevention activities were insufficient. In addition, military personnel who experienced falls/slips, crash, and laceration/puncture wound/amputation/penetrating wound accidents were more likely to think accident prevention activities were insufficient. Conclusions: Our study found that accident prevention activities in the military and accident experiences were related. It is necessary for the ROK Ministry of Defense, Army, Navy and Air Force headquarters to re-evaluate their accident prevention systems.ope

Improved Inpatient Care through Greater Patient-Doctor Contact under the Hospitalist Management Approach: A Real-Time Assessment

Objective: To examine the difference between hospitalist and non-hospitalist frequency of patient-doctor contact, duration of contact, cumulative contact time, and the amount of time taken by the doctor to resolve an issue in response to a medical call. Research Design and Measures: Data from 18 facilities and 36 wards (18 hospitalist wards and 18 non-hospitalist wards) were collected. The patient-doctor contact slip and medical call response slips were given to each inpatient ward to record. A total of 28,926 contacts occurred with 2990 patients, and a total of 8435 medical call responses occurred with 3329 patients. Multivariate logistic regression analyses and regression analyses were used for statistical analyses. Results: The average frequency of patient-doctor contact during a hospital stay was 10.0 times per patient for hospitalist patients. Using regression analyses, hospitalist patients had more contact with the attending physician (β = 5.6, standard error (SE) = 0.28, p < 0.0001). Based on cumulative contact time, hospitalists spent significantly more time with the patient (β = 32.29, SE = 1.54, p < 0.0001). After a medical call to resolve the issue, doctors who took longer than 10 min were 4.14 times (95% CI 3.15-5.44) and those who took longer than 30 min were 4.96 times (95% CI 2.75-8.95) more likely to be non-hospitalists than hospitalists. Conclusion: This study found that hospitalists devoted more time to having frequent encounters with patients. Therefore, inpatient care by a hospitalist who manages inpatient care from admission to discharge could improve the care quality.ope

Disparities in diabetes-related avoidable hospitalization among diabetes patients with disability using a nationwide cohort study

Diabetes is an ambulatory care sensitive condition that quality of care can prevent complications development and hospitalization needs. However, diabetes patients with disability face greater challenges with receiving quality diabetes care than those without disabilities. This study examined diabetes-related avoidable hospitalizations (DRAH) focusing on the association with disability. We used nationally representative health insurance cohort data from 2002 to 2013. The study population is people who were newly diagnosed with type 2 diabetes. We measured the cumulated number of DRAH using the Prevention Quality Indicators (PQIs). The variables of interest were disability severity and type. We performed a recurrent events analysis using Cox proportional hazard regression model. Among 49,410 type 2 diabetes patients, 12,231 (24.8%) experienced DRAHs at least once during the follow-up period. Among the total population, 5924 (12.0%) diabetes patients were registered as disabled. The findings report that disability severity was significantly associated with higher risks for DRAH, where severely disabled diabetes patients showed the highest hazard ratio of 2.24 (95% CI 1.80-2.79). Among three DRAH indicators, severely disabled diabetes patients showed increased risks for long-term (AHR 2.21, 95% CI 1.89-2.60) and uncontrolled (AHR 2.28, 95% CI 1.80-2.88) DRAH. In addition, intellectual (AHR 5.52, 95% CI 3.78-8.05) and mental (AHR 3.97, 95% CI 2.29-6.89) disability showed higher risks than other types of disability. In conclusion, diabetes patients with disability are at higher risk for DRAH compared to those without disabilities, and those with intellectual and mental disabilities were more likely to experience DRAH compared to those with physical or other types of disability. These findings call for action to find the more appropriate interventions to improve targeted diabetes primary care for patients with disability. Further research is needed to better understand determinants of increasing risks of DRAH.ope

Pioglitazone use associated with reduced risk of the first attack of ischemic stroke in patients with newly onset type 2 diabetes: a nationwide nested case-control study

Background: Pioglitazone use is known to be associated with a reduced risk of recurrent stroke in patients with diabetes mellitus (DM) who have a history of stroke. However, it is unclear whether this benefit extends to patients without a history of stroke. We aimed to evaluate the association between pioglitazone use and development of first attack of ischemic stroke in patients with newly diagnosed type 2 DM. Methods: Using longitudinal nationwide data from the 2002-2017 Korean National Health Insurance Service DM cohort, we analyzed the association between pioglitazone use and incidence of primary ischemic stroke using a nested case-control study. Among 128,171 patients with newly onset type 2 DM who were stroke-free at the time of DM diagnosis, 4796 cases of ischemic stroke were identified and matched to 23,980 controls based on age, sex, and the onset and duration of DM. The mean (standard deviation) follow-up time was 6.08 (3.34) years for the cases and controls. Odds ratios (ORs) and 95% confidence intervals (CIs) for the association between ischemic stroke and pioglitazone use were analyzed by multivariable conditional logistic regression analyses adjusted for comorbidities, cardiometabolic risk profile, and other oral antidiabetic medications. Results: Pioglitazone use was associated with a reduced risk of first attack of ischemic stroke (adjusted OR [AOR] 0.69, 95% CI 0.60-0.80) when compared with non-use. Notably, pioglitazone use was found to have a dose-dependent association with reduced rate of ischemic stroke emergence (first cumulative defined daily dose [cDDD] quartile AOR 0.99, 95% CI 0.74-1.32; second quartile, AOR 0.77, 95% CI 0.56-1.06; third quartile, AOR 0.51, 95% Cl 0.36-0.71; highest quartile, AOR 0.48, 95% CI 0.33-0.69). More pronounced risk reduction was found in patients who used pioglitazone for more than 2 years. A further stratified analysis revealed that pioglitazone use had greater protective effects in patients with risk factors for stroke, such as high blood pressure, obesity, and current smoking. Conclusions: Pioglitazone use may have a preventive effect on primary ischemic stroke in patients with type 2 DM, particularly in those at high risk of stroke.ope

Is time-to-treatment associated with higher mortality in Korean elderly lung cancer patients?

Lung cancer is a leading cause of cancer-related deaths in many countries, including South Korea. As treatment delays after diagnosis may correlate with survival, this study aimed to investigate the association between time-to-treatment and one-and five-year overall mortality in patients aged 60 years or above. Survival analysis using the Cox proportional hazard model were conducted after controlling for all independent variables. Of a total of 1,535 individuals who received surgical treatment due to lung cancer, 837 patients received treatment within 30 days and 698 after 30 days of initial diagnosis. Individuals who received surgical treatment after 30 days of diagnosis were more likely to die within 1-year (Hazard Ratio, HR: 1.15, 95% Confidence Interval, CI: 1.01-1.32) and 5-year (HR: 1.16, 95% CI: 1.02-1.33) compared to those who received treatment within 30 days. The increase in mortality risk with time delay persisted when applying other cut-off times, including standards at 2, 3, and 6 months. We also found that the mortality rate of lung cancer patients differs depending on age (74 years or younger), household income (<80 percentile), patient severity, and the residing region. Our findings show that time delay is an important factor that can influence the outcome of lung cancer patients, highlighting the importance of monitoring and providing appropriate and timely treatment.restrictio

Association between perceived environmental pollution and poor sleep quality: results from nationwide general population sample of 162,797 people

Objective/background: Perceived environmental pollution may play a significant role in understanding environmentally induced health-related symptoms. This study aimed to determine whether perceived environmental pollution is associated with poor sleep quality. Methods: We conducted a cross-sectional study using data from a nationwide sample of 162,797 individuals aged ≥19 years from the 2018 Korea Community Health Survey. The Pittsburgh Sleep Quality Index was used for assessing sleep quality. Five types of perceived environmental pollutants involving air, water, soil, noise, and green space were assessed. We investigate the association between perceived environmental pollution and poor sleep quality. We also investigated whether an increasing number of perceived environmental pollutants magnified the odds of poor sleep quality. Results: The prevalence of poor sleep quality was 42.7% (n = 69,554), and 15.6%, 10.1%, 11.9%, 23.0%, and 11.5% reported perceived environmental pollution concerning air, water, soil, noise, and green space, respectively. A perception of air, soil, or noise pollution was significantly associated with poor sleep quality. In addition, those perceiving a greater number of environmental pollutants had significantly higher odds of poor sleep quality. Notably, this association was magnified in individuals living in rural areas. Conclusions: Perceived environmental pollution was significantly associated with poor sleep quality. Our results suggest that a more comprehensive exposure to environmental pollution may not only have a worse effect on health outcomes including sleep quality.restrictio

의원급 만성질환관리 프로그램이 제 2 당뇨병 환자의 의료이용과 사망에 미치는 영향

서론: 인구의 고령화, 의료기술의 발달, 생활방식 등의 변화로 만성질환은 전 세계적으로 급증하고 있으며, 이로 인한 합병증 발생과 의료비 지출의 부담 또한 증가하고 있다. 만성질환의 관리를 최적화하고 환자의 결과를 개선하기 위해서는 일차의료의 역할이 중요하다. 일차의료 기반 만성질환관리 프로그램은 당뇨병 환자의 의료이용행태에 대한 변화와 개선을 위해 도입되었으나, 당뇨 관련 건강 결과 개선에 직접적인 효과를 본 연구는 부족한 실정이다. 본 연구는 일차의료 기반 만성질환관리제가 새로 진단된 제2형 당뇨병을 가진 환자의 의료이용행태와 건강 결과 및 사망에 미치는 영향을 파악하고자 하였다. 연구방법: 시간 의존 공변량 사용한 성향점수 매칭법(Propensity score matching with time-dependent covariates)을 사용하여 일차의료 기반 만성질환관리 프로그램에 참여한 중재군과 참여하지 않은 대조군을 1:5 비율로 매칭하였으며, 매칭 변수로는 연령, 성별, charlson 동반질환지수, 인슐린 사용여부, 당뇨 합병증 발생, 당뇨 합병증으로 인한 입원을 사용하였다. 총 31,368명의 연구대상자를 최종 선정하였으며, 다중 선형회귀분석 (Multiple regression), 음이항 포아송 회귀 분석(Negative binomial Poisson regression), 층화콕스비례위험모델(Stratified Cox proportional hazard model), 경쟁위험(Competing risk)을 적용한 층화콕스비례위험모델 (Stratified Cox proportional hazard model)을 사용하여 의약품 복약순응도, 치료 지속성, 외래 방문 횟수, 입원 횟수, 재원 일수, 응급실 방문횟수, 모든 사망 및 당뇨합병증으로 인한 의료이용 및 사망을 분석하였다. 연구결과: 연구대상자 31,368명 중 16.67%(5,228명)는 중재군에, 83.33%(26,140명)는 대조군에 배정되었다. 중재군의 로그 치환 치료지속성은 대조군보다 15% 높았으며(Exp(β): 1.15, 95% CI: 1.14-1.16), 중재군의 로그 치환 의약품 복약순응도 또한 대조군보다 12% 높았다(Exp(β): 1.12, 95% CI: 1.12-1.13). 중재군의 외래방문 횟수는 대조군에 비해 64% 높았으나(RR: 1.64, 95% CI: 1.58-1.71), 입원 횟수와 재원 일수는 대조군보다 각각16% (RR: 0.84, 95% CI: 0.79-0.90), 21% (RR: 0.79, 95% CI: 0.72-0.87) 낮았다. 하지만, 응급실 방문횟수는 두 군 간 통계적으로 유의미한 차이는 없었다. 모든 사망자는 3.18%(999명)이며, 중재군은 모든 사망에 대한 위험비가 대조군에 비해 38% 낮았다(HR: 0.62, 95% CI: 0.51-0.77). 마지막으로, 중재군의 당뇨병 합병증 관련 입원횟수 및 사망위험비는 대조군에 비해 각각 18% (RR: 0.82, 95% CI: 0.76-0.88), 37% (HR: 0.63, 95% CI: 0.42-0.93) 낮았으나, 재원 일수와 응급실 방문횟수에 대해서는 통계적으로 유의미한 차이는 없었다. 결론: 본 연구에서는 의원급 만성질환 관리프로그램이 모든 원인 및 당뇨 합병증 관련 의료이용 결과와 사망에 긍적적인 영향을 미치는 것을 확인하였다. 의원급 만성질환 관리프로그램은 치료지속성과 복약순응도를 증가시키고, 외래 방문 횟수, 입원 횟수, 재원 일수, 모든 원인 사망위험 감소에 영향을 주는 것을 확인 할 수 있었다. 또한 이 프로그램에 참여하는 대상자들에게서 당뇨 합병증으로 인한 입원 횟수와 사망위험을 감소시키는 효과를 확인할 수 있었다. 환자에게는 진찰료 본인부담 경감과 더불어 건강지원서비스 제공 등의 혜택을 제공하고, 참여의원에는 평가를 통한 인센티브를 제공하여 환자 관리의 질을 향상했기 때문에 만성질환관리 프로그램이 환자의 의료이용 행태와 건강상태에 긍정적인 효과를 미쳤을 가능성이 있다. 하지만 프로그램 도입 이후 3년이라는 단기 효과만을 확인할 수 있었기 때문에 의원급 만성질환관리 프로그램의 장기 효과를 평가하는 후속 연구가 필요하다. Background: The incidence of chronic diseases is rapidly increasing worldwide due to aging population, thereby causing a burden because of higher life expectancy, advances in medical technology, and changes in lifestyle. Primary care is required to optimize the management of chronic diseases and improve patients’ outcomes. Although the primary care-based management program (PCDMP) can change and improve the behaviors of diabetes patients, it is not clear whether it is directly effective in improving diabetes-related health outcomes. This study investigated the effect of PCDMP on mortality and healthcare utilization outcomes among patients with newly diagnosed type 2 diabetes mellitus. Methods: We included 31,368 participants after propensity score matching with time-dependent covariates at a 1:5 ratio using age, sex, Charlson comorbidity index, insulin use, hospitalization due to diabetes complications, and onset of diabetes complications. We investigated the effect of the PCDMP on continuity of care (COC), medication possession ratio (MPR), health care utilization outcomes, and mortality using multiple linear regression, negative binomial (NB) Poisson regression, stratified Cox proportional hazard model, and stratified Cox proportional cause-specific hazard model. Results: Of 31,368 participants, 16.67% (n = 5,228) were allocated to the intervention group, while 83.33% (n = 26,140) were allocated to the control group. The intervention group had higher log-transformed COC than the control group (Exp(β): 1.15, 95% confidence interval (CI): 1.14-1.16). The intervention group’s log-transformed MPR was higher than that of the control group (Exp(β): 1.12, 95% CI: 1.12-1.13). The intervention group had a higher risk ratio (RR) for outpatient visits than the control group (RR: 1.64, 95% CI: 1.58-1.71). In contrast, the intervention group had a lower RR for hospitalization than the control group (RR: 0.84, 95% CI: 0.79-0.90). The RR for length of stay (RR: 0.79, 95% CI: 0.72-0.87) of the intervention group was lower than that of the control group. However, emergency department visits did not show significant differences. The proportion of all-cause mortality was 3.18% (n = 999). The intervention group had a lower hazard ratio (HR) for all-cause mortality than the control group (HR: 0.62, 95% CI: 0.51-0.77). Finally, PCDMP reduced diabetes complication-specific hospitalization (RR: 0.82, 95% CI: 0.76-0.88) and mortality (HR: 0.63, 95% CI: 0.42-0.93). However, there was no significant association regarding length of stay (RR: 0.92, 95% CI: 0.83-1.02) and emergency department visits (RR: 0.94, 95% CI: 0.87-1.01). Conclusions: This study found that PCDMP had positive and desirable effects on all-cause and diabetes complication-specific healthcare utilization outcomes and mortality. PCDMP was associated with an increase in COC and MPR and a reduction in all-cause mortality and hospitalization and length of stay after controlling for covariates. Moreover, participation in the program was associated with a reduction in diabetes complication-specific mortality, hospitalization, and length of stay outcomes. Although we observed a positive impact of the PCDMP, the effect was for a short term, hence warranting further studies to investigate whether the short-term effects could be sustained over a longer duration of the program.open박

Risk of suicide death in psychiatric patients according to the level of continuity of care and area deprivation: A population-based nested case-control study

Continuity of care and area deprivation have been implicated as possible risk factors of suicide in psychiatric patients. This nested case-control study aimed to examine the association between continuity of care and area deprivation and suicide death in patients with psychiatric disorders. Data were collected from the Korean National Health Insurance Service National Sample Cohort, 2003-2013. The subjects were 974 patients with psychiatric disorders who completed suicides. Each case was compared to three control cases with propensity score matching by gender, age, and follow-up period with incidence density sampling, comprising the final control group of 2,922 living patients. Hazard ratios (HR) for suicide risk considering continuity of care and area deprivation were analysed using a multiple conditional logistic regression. The average follow-up periods between the case and control groups were not statistically different (case: 277.6 weeks, control: 271.4 weeks, p = .245). Both poor continuity of care and higher area deprivation proved to be associated with increased risk of suicide (poor continuity of care; adjusted HR [AHR]: 3.38, 95% confidence intervals [CI]: 2.58-4.43, highest area deprivation; AHR: 1.93, 95% CI: 1.53-2.44). Poor continuity of care combined with highest area deprivation showed a negative synergistic effect on a highly increased risk of suicide (AHR: 2.88, 95% CI: 1.45-5.74). Age was effect modified between suicide risk and poor continuity of care as well as suicide risk and higher area deprivation. A strong patient-provider relationship with good continuity of care may lead to a lower possibility of suicide in psychiatric patients. Moreover, improving community capacity for suicide prevention as well as appropriate postvention should be addressed.restrictio