Hospice and Palliative Care Services in South Korea Supported by the National Health Insurance (NHI) Program

Previous main body of research on end-life-care in South Korea has focused on developing services quality in hospital settings or service payment system in National Health Insurance Program. The delivery system of hospice and palliative care services has evolved in diverse ways but there is little research on reviewing the past history of development and whole picture of them so far. So, the aim of this study is to review the old hospice and palliative care system and also to introduce the current one supported by the National Health Insurance Program in South Korea. The palliative care or hospice services in South Korea have been available in diverse settings and provided by different organizations (i.e. catholic hospitals or charity organizations). Finally, it was set up in 2004 that the hospice team or official Palliative Care Units (PCUs) was established in hospitals, in order to meet the end-of-life care for the patients with terminal cancer under the Cancer Control Act. The current hospice and palliative care services such as pain management, bereavement services, and counselling can be reimbursed by National Health Insurance program since 2008. Nevertheless hospice and palliative care services are available to dying patients, yet the utilization rate of hospice and palliative care services or the length of stay in the palliative care unit (PCU) is still relatively short compared to other country systems. South Korea is undergoing several efforts to expand the services in PCU along with the development of quality indicators for PCU. Hospice and palliative care services are still new in the health care system and unfamiliar to the public so it requires raising awareness for medical professionals and the public as well as further research.

The Association of Mercury and ALT with Obesity in Korean Adults Using Data from the Korea National Health and Nutrition Examination Survey for 11 Years(KNHANES 2005,2008-2017)

The association between heavy metals in the blood and obesity has been examined in many studies.However,inconsistencies have been observed in the results of these studies.The present study was conducted using data from 119,181 participants of the Korea National Health and Nutrition Examination Survey(KNHANES)for 11 years in 2005 and between 2008 and 2017.The subjects with missing heavy metal blood tests,health interview data,and health examination data were excluded from the study.The study population comprised 1,844 individuals(972 men,and 872 women)who were eligible for inclusion.It was found that obesity and abdominal obesity were associated with an increase in both blood mercury(P<0.001)and alanine aminotransferase(ALT)(P<0.001).After adjusting the confounding factors,those with concurrent high levels of ALT and the highest tertile of mercury showed an increased risk of obesity(odds ratio 4.46,95%confidence interval 2.23-8.90,P<0.001)as well as abdominal obesity(odds ratio 5.36,95%confidence interval 2.57-11.17,P<0.001).The interrelationship of mercury and ALT with the parameters of body mass index(P for interaction=0.009)and waist circumference(P for interaction=0.012),respectively,have been observed to be significant,suggesting that the reciprocal relationship could contribute to obesity and abdominal obesity.

The Next Era:Flourish of National Health Care & Medicine with the World Leading Artificial Intelligence

MODERN medical diagnosis and practice heavily rely on biological data and information from patients’ body.The progress of biomedical sensor,material and mathematical technology provided ever-increasing methods to gather data.While providing more choices and more comprehensive picture of patients’ conditions to doctors and practitioners,these progresses also require more labor efforts to read,analyze,and make decisions based on those data.It is very difficult for the medical human resources to grow at a speed that matches such need for diagnosis-related expert knowledge.The shortage of expertise has caused long waiting time for check report and fatal misjudged diagnosis in public health system,and it will compromise our ability to move towards a more precise,more personalized and more efficient future of medicine.

Low skeletal muscle mass is associated with non-alcoholic fatty liver disease in Korean adults： the Fifth Korea National Health and Nutrition Examination Survey

BACKGROUND： Sarcopenia and non-alcoholic fatty liver dis- ease （NAFLD） share similar pathophysiological mechanisms, and the relationship between sarcopenia and NAFLD has been recently investigated. The study investigated whether low skel- etal muscle mass is differentially associated with NAFLD by gender in Korean adults. METHODS： We conducted a cross-sectional analysis of the data from the Fifth Korea National Health and Nutrition Examination Survey. The skeletal muscle index （SMI） was obtained by the appendicular skeletal muscle mass divided by the weight. NAFLD was defined as a fatty liver index （FLI） 〉60 in the absence of other chronic liver disease. RESULTS： Among the included subjects, 18.3% （SE： 1.4%） in men and 7.0% （SE： 0.7%） in women were classified as having FLI-defined NAFLD. Most of the risk factors for FLI-defined NAFLD showed a significant negative correlation with the SMI in both genders. Multiple logistic regression analysis showed that low SMI was associated with FLI-defined NAFLD, inde- pendent of other metabolic and lifestyle parameters in both genders [males： odds ratio （OR）=1.35; 95% confidence inter- val （CI）： 1.17-1.54; females： OR=1.36; 95% CI： 1.18-1.55]. The magnitude of the association between FLI-defined NAFLD and low SMI was higher in middle aged to elderly males （OR-1.50; 95% CI： 1.22-1.84） than in males less than 45 years of age （OR=1.25; 95% CI： 1.02-1.52） and in premenopausal females （OR=l.50; 95% CI： 1.12-2.03） than in postmenopausal females （OR-1.36; 95% CI： 1.20-1.54）.CONCLUSIONS： Low SMI is associated with the risk of FLI- defined NAFLD independent of other well-known metabolic risk factors in both genders. This association may differ ac- cording to age group or menopausal status. Further studies are warranted to confirm this relationship.

Effects of China's National Essential Medicines Policy on the Use of Injection in Primary Health Facilities

The overuse of injection exists more than 20 years since economic reform in China.It is a persistent problem and seems becoming a new challenge in the new health reform period.This study was designed to assess the effect of national essential medicines policy(NEMP) on injection use at primary health facilities in China by investigating their prescription information.Questionnaires were designed and disseminated to collect empirical data on injection use at 120 primary health facilities in 6 provinces from January to September in 2010 and 2011.The injection use was measured as the indicator as the percentage of prescriptions with one or more injections.The results showed that the percentage of prescriptions with one or more injections was decreased from 38.91% to 36.82%(2 =11.158,P=0.001) in the all survey areas during the NEMP reform.The difference in level of the injection use in 2011 was significant among the eastern,central and western regions(2 =223.584,P=0.000);level of the injection use in western region was the lowest(27.73%),while that in the central region was the highest(43.10%).The level of the injection use in 2011 among different provinces was also of great difference(26.00%-58.25%,range:32.25%).The level of the injection use in 2011 was still much higher than the standard suggested by WHO for developing countries(13.4%-24.1%).It was concluded that NEMP has improved injection use in China,but the injection abuse situation remains serious,indicating that one of the priorities to the next stage of NEMP is to promote the rational use of drugs,especially the injection use.

Prevalence and associations of non-retinopathy ocular conditions among older Australians with self-reported diabetes:The National Eye Health Survey

AIM:To determine the prevalence and associations of non-retinopathy ocular conditions among older Australian adults with diabetes.METHODS:Multistage random-cluster sampling was used to select 3098 non-indigenous Australians aged 50 y or older(46.4%male)and 1738 indigenous Australians aged 40 y or older(41.1%male)from all levels of geographic remoteness in Australia.Participants underwent a standardised questionnaire to ascertain diabetes history,and a clinical examination to identify eye disease.We determined the prevalence of uncorrected refractive error,visually significant cataract,cataract surgery,age-related macular degeneration,glaucoma,ocular hypertension,retinal vein occlusion and epiretinal membrane among those with and without self-reported diabetes.RESULTS:Participants with self-reported diabetes had a higher prevalence of cataract surgery than those without diabetes(28.8%vs 16.9%,OR 1.78,95%CI:1.35-2.34 among non-indigenous Australians,and 11.3%vs 5.2%,OR 1.62,95%CI:1.22-2.14 among indigenous Australians).Diabetic retinopathy(DR)increased the odds of cataract surgery among self-reported diabetic indigenous and nonindigenous Australians(OR 1.89,P=0.004 and OR 2.33,P<0.001 respectively).Having diabetes for≥20 y and having vision-threatening DR increased the odds of cataract surgery among indigenous Australians with diabetes(OR 3.73,P=0.001 and 7.58,P<0.001,respectively).CONCLUSION:Most non-retinopathy ocular conditions are not associated with self-reported diabetes.However,to account for Australia’s worsening diabetes epidemic,interventions to reduce the impact of diabetes-related blindness should include increased cataract surgery services.

Role of Community Health Practitioners in National Development: The Nigeria Situation

This is a review paper that brings to focus, concepts of Community Health Practice that connect Community Health Practitioners’ Roles to National development in view of its composite index improvement measure of social welfare services provision among others for the citizens of a country over time, with particular emphasis on medical care component of such index aimed at reduction in diseases and poverty in the population. The objective of the review work is to determine the extent to which Community Health Practice, particularly by Community Health Practitioners is capable of ensuring National Development in democratic governance or otherwise, in the context of our country, Nigeria. The methodology applied was traditional review of published literatures concerning the subject and findings of operational research of programme implemented by Community Health Practitioners at the Primary Health Care facilities and household level in the communities. This paper emphasizes on Primary Health Care services delivery contribution to National Development, since it is the level where Community Health Practitioners are mainly commissioned to render their services. Home-Based Care Strategy for Integrated Maternal, Newborn and Child Health piloted in three (3) local government areas (Ahoada West, Etche and Oyigbo) in Rivers State, Nigeria, in 2012 and implemented by Community Health Practitioners, aimed at reducing maternal, newborn and child morbidity and mortality by 20% by 2015 in line with the United Nations (UN) Millennium Development Goals 4 and 5, had been shown to achieve an average of 26% improvement in utilization of maternal and newborn health services, an average of 27% overall reduction in maternal malnutrition status, an average of 14% overall improvement in under 5 years malnutrition status among others in 2013 on comparing with baseline indicators. Nigeria also attained 80% coverage in routine immunization in most vaccine preventable diseases except Tetanus Toxiod (TT) 2 (54%) in 2013 to achieve herd immunity of the community to prevent transmission of disease pathogen to cause a disease. Community Health Practitioners are the frontline Primary Health Care Professionals charged with the responsibility of implementation of immunization programmes in Nigeria and therefore contributing significantly to the prevention and control of targeted vaccine preventable diseases in Nigeria Health System. Our findings on factors militating against Community Health Practitioners’ Roles in National Development as elicited in this paper may form basis for empirical studies to determine the level of significance of each of these factors. In conclusion, it is when the Community Health parameters are adequately addressed that we can ensure sustainable National Development and we can say we have succeeded in our various strategic agenda of government at whatever level that makes up the complex whole. This brings to fore, the importance of the roles of Community Health Practitioners in health care delivery to National Development in the context of our country, Nigeria.

Geotechnical Investigation of Slopes along the National Highway (NH-1D) from Kargil to Leh, Jammu and Kashmir (India)

The national highways are always considered as the economic backbone of the country and have often assisted development work all along their routes. The National Highway (NH-1D) is the most strategic and the only all weather surface link between the two districts of Ladakh region (Kargil and Leh). The area under investigation experiences high vehicular traffic, particularly between March and August, as in the remaining months the Kargil and Leh districts?remain cutoff?from each other due to bad weather. In recent years, frequent occurrences of slope failures along the highway primarily affect the smooth functioning of the traffic movement which severely affects the life of the people of the area. Strategically, this road network is very important and plays a significant role in transportation and other activities. In order to ensure the stability of road network in the area, it becomes extremely important to understand the triggering mechanism of these failures. The present study made an attempt in this direction and the Slope Mass Rating (SMR) method has been used for slope stability analysis at different locations. The stability of the slopes was also assessed using kinematic analysis conjointly with SMR to identify the types of failure and its potential failure directions associated with each slope. The result obtained after calculating RMR from the selected facets ranges from 11 to 89 with lower values indicating presence of potentially unstable areas. Results have shown that in a total of 20 facets, 65.28% belong to wedge failure, 22.26%?belong to toppling failure and 12.45% belong to plane failure.

Immigrants’ Satisfaction from the National Health System in Greece: In the Quest of the Contributing Factors

Immigrants deserve special attention as they constitute a very sensitive social group, facing an increasing risk of social exclusion. The access of immigrants to health services is one of the most important factors, which contributes to their integration into the society of induction. The purpose of this study is to track and assess the immigrants’ satisfaction from the health services provided by the Greek National Health System (NHS). The satisfaction level assessment is examined in conjunction with demographic and socio-economic characteristics of the study participants, as well as with the characteristics that are related to their personal experience with the National Health System in Greece. The research was conducted from March 2012 to May 2013. The sample of the research comprises of 126 “first-generation” immigrants on legal permit of residence in Greece, who lived in the prefecture of Attica. It is panel study based on “snowball sampling” and the statistical analysis was conducted with the use of the Stata (ver. 11), while the statistical analysis used probit estimation techniques. The demographic and social variables—particularly the variables of gender, “understanding the Greek language”, “education”, “participation in the community of origin” and “insurance”—the variables of “health” and specifically “long-term diseases” and the variable of “trust” are found to be highly related with immigrants’ satisfaction degree from the Greek health system. Our research concludes that health is a fundamental, human right and immigrants’ access to health services is essential not only for their instant and effective treatment of their health problems and the improvement of their lives but also for ensuring the public health in Greece. In order to properly incorporate immigrants in Greece in particular, the health policy decision-makers have to pay attention to the contributing factors.

Prevalence of Non-Communicable Diseases and Number of Comorbidities According to Differences in Household Income Levels in Japan: Analysis from National Health and Nutrition Survey

Though it has been reported that in Western developed countries socioeconomic status is associated with non-communicable diseases (NCD), there are sparse evidence from Japan, midst an income gap that has been pointed out in recent years. Therefore, we examined the presence or absence of NCD and the number of comorbidities according to household income in Japanese, using data from the National Health and Nutrition Survey of 2010. 1287 men and 1659 women aged 20 - 79 years from households at 3 income levels (<2, 2 - 5.9, ≥6 million yen) were analyzed. Participants completed questionnaires regarding whether they had been diagnosed with NCD, as well as undergoing clinical laboratory tests. Logistic regression analyses were used for statistical analysis with adjustment for age, gender, household size, and population of municipalities. The prevalences of participants with high, medium, and low income were 22.3%, 57.6%, and 20.2%, respectively. Participants with the lowest income had the highest odds of hypertension (OR [95% confidence interval (CI)] = 1.71 [1.29 - 2.26], p p = 0.041), and stroke (5.07 [2.04 - 12.60] p < 0.001). Additionally, prevalences of participants with 2 or 3 NCD (hypertension, diabetes, and hypercholesterolemia) were 15.0% and 33.0% in high and low income levels, respectively. A low income could contribute to a high prevalence of NCD and large number of comorbidities among Japanese. Establishing a health policy in Japan is needed to enable an optimal health condition and lifestyle regardless of socioeconomic disparities.

Description of the National Institutes of Health

Introduction The National Institutes of Health （NIH）, a part of the U.S. Department of Health and Human Services is the nation＇s medical research agency-making important discoveries that improve health and save lives.Thanks in large part to NIH-funded medical research, Americans today are living longer and healthier. Life expectancy in the United States has jumped from 47 years in 1900 to 78 years as reported in 2009, and disability in people over age 65 has dropped dramatically in the past 3 decades. In recent years, nationwide rates of new diagnoses and deaths from all cancers combined have fallen significantly.

The National Health and Medical Research Council

Introduction The National Health and Medical Research Council （NHMRC） is Australia＇s leading expert body promoting the development and maintenance of public and individual health standards. NHMRC brings together within a single national organisation the functions of research funding and development of advice. One of its strengths is that it draws upon the resources of all components of the health system, including governments, medical practitioners, nurses and allied health professionals, researchers, teaching and research institutions, public and private program managers service administrators, community health organisations, social health researchers and consumers.

National Institutes of Health Funding for disease categories related to Neural Regeneration Research

The National Institutes of Health （NIH）, a part of the U.S. Department of Health and Human Services, is the nation＇s medical research agency-making important discoveries that improve health and save lives.Thanks in large part to NIH-funded medical research, Americans today are living longer and healthier. Life expectancy in the United States has jumped from 47 years in 1900 to 78 years as reported in 2009, and disability in people over age 65 has dropped dramatically in the past 3 decades. In recent years, nationwide rates of new diagnoses and deaths from all cancers combined have fallen significantly.

Merit and Evaluation Models for Managers in the National Health System： An Empirical Study

The national health system （NHS） complexity increase requires a review of the managerial human resources evaluation and recruiting methods, considering that nowadays doctors need to improve not just their clinical capabilities, but also managerial competences. At this end it is important to develop performances control models and to identify appropriate results indicators, with the aim of introducing an effective doctors selection system for managerial roles. The paper considers the Italian situation and tests the current evaluation and selection methods, by analysing the literature and the existing legislation and by interviewing experts. Moreover, in order to reach an innovative model, complex organizations have been taken into account as benchmarks. Three different categories of experts have been interviewed and texted： national health care organizations managers, companies managers, and business consultants. The 137 interviewed experts have been asked about four main questions concerning the evaluation for hiring managers as chief medical director, department director, and head of complex units. The conducted research suggests four different options in order to evaluate and to select heads of complex unit for the most strategic roles. By consequence, the analysis shows that required characteristics must be managerial attitudes as well as clinical capabilities.

The National Formation of the Right to Health:Taking Broadcast Gymnastics as an Example

Broadcast gymnastics,which was initiated in 1951,is one of the most widely adopted and popular mass sports activities in China,embodying the country's commitment to shaping the right to health of its citizens.The history and development of broadcast gymnastics are closely tied to the destiny of the nation,reflecting clear national will,and aiming to achieve the goal of“shaping new individuals”.The institutional forms of broadcast gymnastics can be categorized into three stages:“military simulation”,“administrative reinforcement”and“market competition”,each of which aligns with the objectives and needs of different periods.Taking the establishment and promotion of broadcast gymnastics in China as a focal point helps construct a doctrinal framework for the right to health.Based on the purposes and means of health shaping,the implementation of the right to health can be divided into four types:national health projects,citizens'health rights,the social health industry,and civic health consumption.National health projects,facilitated by legislative mechanisms,provide institutional support and supply for citizens'health rights.The right to health,as a social right,has both a subjective rights orientation and an objective value order orientation,thus establishing the individual's subject status in terms of their right to health.Its defense aspect is oriented toward rejecting excessive state intervention,while the benefit aspect directly links to the state's payment measures.The boundaries of state power also need to be defined in the social health industry and civic health consumption.Hence,developing broadcast gymnastics involves adjusting its relationship with the overall objectives of the state and individual citizens'needs.It involves balancing the use of administrative and market methods,continually innovating sports programs that better suit diverse needs,and actively participating in the competition of the fitness market.

英国NHS体系对我国卫生服务的启示

本文介绍英国NHS体系的特点,包括公平优先、兼顾效率,合理的分级保健体制,健全的医药体制及电子化健康服务,对我国卫生服务启示:动员社会资金投入卫生服务,推行家庭医师制度,推进药物制度建设,加强卫生信息化建设。

英国NHS改革对我国的启示

回望近30年的改革历程,以内部市场导向的NHS改革在提升医疗服务效率、增强医疗机构回应性以及控制医疗费用增长等方面取得了较好的成效。本文旨在考察和分析英国NHS改革的现实动因与路径选择,以期获得对英国NHS改革的理性认识及其对我国医疗卫生体制改革的有益启示。

英国国民医疗保健体制(NHS)探析

英国国民医疗保健体制优点与缺陷并存,较好地实现了公平,但卫生机构的效率始终不尽人意。值得我们借鉴的是:重视预防,胜于治疗;改革支付方式,逐步取消"以药养医"现象;培养技术精湛的社区医疗队伍,发展社区卫生服务至关重要;建立独立机构监管公立医院,促进服务质量的提高;利用信息化的有效手段,提供方便的卫生服务;扩大筹资渠道,打破政府垄断。