Continuity of care is a core dimension of high-quality care in the management of disease. The purpose of this study was to investigate the association between continuity of care and lumbar surgery in ...patients with moderate disc herniation. The Korean National Sample Cohort was used. The target population consisted of patients who have had disc herniation more than 6 months and didn't get surgery and red flag signs within 6 months from onset. The population was enrolled from 2004 to 2013. The Bice-Boxerman Continuity of Care was used in measuring continuity of care. The marginal structural model with time dependent survival analysis was used. In total, 29,061 patients were enrolled in the cohort. High level of continuity of care was associated with a lower risk of lumbar surgery (HR, 0.27; 95% CI, 0.20-0.27). When the index was calculated only with outpatient visits to primary care with related specialty, the HR was 0.49 (95% CI: 0.43-0.57). In exploratory analysis, patients with lumbar stenosis and spondylolisthesis had higher risk of having a low level of continuity of care. These results indicate that continuity of care is associated with lower rates of lumbar surgery in patients with moderate disc herniation.
The current public health research agenda was to identify the means to reduce oral health inequalities internationally. The objectives of this study were to provide evidence of inequality in unmet ...dental needs and to find influencing factors attributable to those among South Korean adults.
Pooled cross-sectional data from the fourth Korean National Health and Nutrition Examination Survey (2007-2009) on 17,141 Korean adults were used. Demographic factors (sex, age, and marital status), socioeconomic factors (education level, employment status, and income level), need factors (normative dental needs and self-perceived oral health status), and oral health-related factors (the number of decayed teeth, the presence of periodontitis, and the number of missing teeth) were included. Multiple logistic regression analysis was performed.
Of South Korean adults, 43.9% had perceived unmet dental needs, with the most common reason being financial difficulties. The disparities in unmet dental care needs were strongly associated with income level, normative treatment needs, and self-perceived oral health status. The low-income group, people with normative dental treatment needs, and those with perceived poor oral health status were more likely to have unmet dental needs. There was considerable inequality in unmet dental care needs due to economic reasons according to such socioeconomic factors as income and education level.
Public health policies with the expansion of dental insurance coverage are needed to reduce inequalities in unmet dental care needs and improve the accessibility of dental care services to vulnerable groups who are experiencing unmet dental care needs due to socioeconomic factors despite having normative and self-perceived needs for dental treatment.
This study aims to analyze South Korea’s experience during the COVID-19 outbreak through a gendered lens. We briefly introduce the COVID-19 outbreak in Korea, scrutinize gendered vulnerability in ...contracting the virus, and then analyze the gendered aspects of the pandemic response in two phases: quarantine policy and mitigation policy. The authors elicit four lessons from the analysis. First, gender needs to be mainstreamed at all stages of a public health emergency response. Second, in addition to medical care, all formal and informal care work should be considered as an essential component of health care systems. Third, a people-centered approach in health governance should be prioritized to make women’s voices heard at every level. Fourth, medical technology and resources to cope with pandemic should be produced and distributed in an equitable manner, acknowledging differential vulnerability and susceptibility.
We aimed to examine the association between employment status and self-reported unmet healthcare needs and to identify factors influencing self-reported unmet healthcare needs by employment status. ...Nationally representative data from the 2012 Korea National Health and Nutrition Examination Survey were used. Participants were classified by employment status as either permanent or precarious workers. Explanatory variables included sociodemographic, labor-related, and health-related factors. Multivariate logistic regression ascertained the association between employment status and self-reported unmet healthcare needs and explanatory factors associated with self-reporting of unmet healthcare needs. Precarious workers had a higher prevalence of self-reported unmet healthcare needs than permanent workers, with a statistically significant odds ratio (OR) (1.74; 95% confidence interval (CI), 1.19⁻2.54). Male precarious workers working >40 h per week were more likely to self-report unmet needs than male precarious workers working <40 h (OR, 3.90; 95% CI, 1.40⁻10.87). Female precarious workers with a lower household income were about twice as likely to self-report unmet needs. Working hours and household income were significantly influential factors determining self-reporting of unmet healthcare needs, especially among precarious workers. Policy interventions to improve access to healthcare for precarious workers are needed.
In rural areas of Korea, where public transportation infrastructure is lacking and alternative systems are poor, the elderly experience inconveniences in using healthcare, although their need is ...high. This study aimed to analyze the association between the convenience of transportation and unmet healthcare needs among the rural elderly.
The data used were collected in the 2016 Community Health Survey among rural elderly individuals aged 65 or older. Dependent variable was the unmet healthcare needs, explanatory variable was the convenience of transportation. The elderly were divided into 3 groups: with no driver in the household, with a driver, and the elderly individual was the driver (the self-driving group). Covariates were classified into predisposing, enabling, and need factors. They included gender, age, education, income, economic activity, household type, motor ability, subjective health level, number of chronic diseases, anxiety/depression, and pain/discomfort. The data were analyzed using logistic regression and stratification.
A significant association was found between the convenience of transportation and unmet healthcare needs. When examined unadjusted odds ratio of the group with a driver in the household, using the group with no driver as a reference, was 0.61 (95% confidence interval CI, 0.54 to 0.68), while that of the self-driving group was 0.34 (95% CI, 0.30 to 0.38). The odds ratios adjusted for all factors were 0.69 (95% CI, 0.59 to 0.80) and 0.79 (95% CI, 0.67 to 0.91).
We confirmed a significant association between inconvenient transportation and unmet healthcare needs among the rural elderly even after adjustment for existing known factors. This implies that policies aimed at improving healthcare accessibility must consider the means of transportation available.
Socioeconomic disadvantages interact with numerous factors which affect geriatric mental health. One of the main factors is the social relations of the elderly. The elderly have different experiences ...and meanings in their social lives depending on their socio-cultural environment. In this study, we compared the effects of social relations on depression among the elderly according to their living arrangement (living alone or living with others) and residential area.
We defined social relations as "meetings with neighbors" (MN). We then analyzed the impact of MN on depression using data from the Korean Longitudinal Study of Aging Panel with the generalized estimating equation model. We also examined the moderating effect of living alone and performed subgroup analysis by dividing the sample according to which area they lived in.
MN was associated with a reduced risk of depressive symptoms among elderlies. The size of the effect was larger in rural areas than in large cities. However, elderly those who lived alone in rural areas had a smaller protective impact of MN on depression, comparing to those who lived with others. The moderating effect of living alone was significant only in rural areas.
The social relations among elderlies had a positive effect on their mental health: The more frequent MN were held, the less risk of depressive symptoms occurred. However, the effect may vary depending on their living arrangement and environment. Thus, policies or programs targeting to enhance geriatric mental health should consider different socio-cultural backgrounds among elderlies.
We aimed to evaluate the health effects of precarious employment based on a counterfactual framework, using the Korea Labor and Income Panel Survey data. At the 4th wave (2001), information was ...obtained on 1991 male and 1378 female waged workers. Precarious work was defined on the basis of workers employed on a temporary or daily basis, part-time, or in a contingent (fixed short-term) job. The outcome was self-rated health with five response categories. Confounding factors included age, marital status, education, industry and occupation of current employment, household income, residential area, and prior health status. Propensity scores for each individual to be a precarious worker were calculated from logistic models including those covariates, and based on them, precarious workers were matched to non-precarious workers. Then, we examined the effects of precarious employment on health and explored the potential intermediary variables, using ordered logistic Generalized Estimating Equations models. All analyses were performed separately by gender. Precarious workers were found to be in a lower socioeconomic position and to have worse health status. Univariate matched analyses showed that precarious employment was associated with worse health in both men and women. By further controlling for socio-demographic covariates, the odds ratios were attenuated but remained significant. Job satisfaction, especially as related to job insecurity, and monthly wage further attenuated the effects. This suggests that to improve health status of precarious workers in Korea, policy strategies need to tackle the channeling of the socially disadvantaged into precarious jobs. Also, regulations to eliminate discrimination against precarious workers in working conditions or material reward should be introduced and enforced. There is no doubt that job insecurity, which is pervasive among workers in Korea, should be minimized by suspending market-oriented labor policies which rely on quantitative flexibility.
Although community-based health insurance (CBHI) schemes have been considered as an intermediate stage to achieve universal health coverage (UHC) in low-resource settings, there is a knowledge gap on ...ways to make it better.
More than 4000 Nepalese households were randomly selected and surveyed.
Logistic and multivariate multinomial regressions were estimated.
Overall, 88% of included household heads were willing to join CBHI, 61% were willing to pay annual premium less than 600 Nepalese rupees (US$5.6) per household, and more than a half (53%) responded that the government should subsidize a significant portion of the premium. Results showed that a higher level of social capital was significantly related with an increase in odds of accepting higher premiums, while individuals' health status and age did not have such associations. Individuals with bonding social capital were more likely to be inclined to join CBHI. Persons who said they can lend money for a living expense (bonding capital) did not want the government to subsidize the scheme, while this negative association would be reversed if persons had both bonding and bridging social capitals.
We found significantly positive relationships between social capital and willingness to join and willingness to pay for CBHI in Nepal. Policymakers, aiming to achieve UHC, should be advised that bonding and bridging social capital have differing relationships with willingness to cooperate the external funding sources.
•There have not been enough lessons from experiences in community-based health insurance (CBHI).•A household survey in Nepal was used to analyze the demand for potential markets for CBHI.•A higher level of social capital was significantly related with an increase in odds of accepting higher premiums.•Individuals with bonding social capital were more likely to be inclined to join CBHI.•People with high level of bonding capital (with low level of bridging capital) would be reluctant to cooperate with others.
Peroxisome proliferator-activated receptor alpha (PPARα) is a nuclear hormone receptor involved in the transcriptional regulation of lipid metabolism, fatty acid oxidation, and glucose homeostasis. ...Its activation stimulates antioxidant enzymes such as catalase, whose expression is decreased in aged human skin. Here we investigated the expression of PPARα in aged and ultraviolet (UV)-irradiated skin, and whether PPARα activation can modulate expressions of matrix metalloproteinase (MMP)-1 and procollagen through catalase regulation. We found that PPARα mRNA level was significantly decreased in intrinsically aged and photoaged human skin as well as in UV-irradiated skin. A PPARα activator, Wy14643, inhibited UV-induced increase of MMP-1 and decrease of procollagen expression and caused marked increase in catalase expression. Furthermore, production of reactive oxygen species (ROS) was suppressed by Wy14643 in UV-irradiated and aged dermal fibroblasts, suggesting that the PPARα activation-induced upregulation of catalase leads to scavenging of ROS produced due to UV irradiation or aging. PPARα knockdown decreased catalase expression and abolished the beneficial effects of Wy14643. Topical application of Wy14643 on hairless mice restored catalase activity and prevented MMP-13 and inflammatory responses in skin. Our findings indicate that PPARα activation triggers catalase expression and ROS scavenging, thereby protecting skin from UV-induced damage and intrinsic aging.
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