<sec><b>Objectives</b><p>This study aimed to determine regional differences and the factors that affect unmet medical needs.</p></sec><sec><b>Methods</b><p>Data from the 6th Korea National Health and Nutrition Examination Survey (2015) were used, and 4,946 health survey participants who provided responses on medical utilization and health behavior were included in the study.</p></sec><sec><b>Results</b><p>A statistically significant difference was observed in the incidence rate of unmet medical needs in terms of region. The independent variables that affected unmet medical needs were sex, age, education, region, household income, insurance type, smoking status, self-reported health status, and stress awareness. Gender (female), lower education level, rural residents, lowest household income, poor self-reported health status, and stress awareness increased the probability of unmet medical needs.</p></sec><sec><b>Conclusion</b><p>Our findings suggested that different policies and approaches should be considered for each population that is at risk to address the primary cause of the unmet medical needs. Further studies that include medical expenses and the relevant variables of an area should be conducted in the future.</p></sec>
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<sec><b>Objectives</b><p>Schoolchildren in developing countries are at greater risk of intestinal parasitic infections. This study aimed to estimate the prevalence and assess the risk factors of intestinal parasite infection among schoolchildren in rural areas of Peru.</p></sec><sec><b>Methods</b><p>A volunteer team from the Korea International Cooperation Agency (KOICA) conducted a campaign for parasite eradication called “Chao parasitos” at five schools in the peripheral highland regions of Huanuco in October 2013. The study collected questionnaires and stool samples from children of participating schools. <italic>Entamoeba coli</italic>, <italic>Iodamoeba buschii</italic>, and <italic>Chilomastix mesnil</italic> were classified as nonpathogenic parasites.</p></sec><sec><b>Results</b><p>The overall prevalence of intestinal parasite infection in the students was 100% (185/185). Among them, 25.9% (48/185) were infected only with nonpathogenic parasites whereas 74.1% (137/185) were infected with at least one pathogenic parasite. <italic>Ascaris lumbricoides</italic> was the most commonly detected (37.3%, 69/185), followed by <italic>Giardia lamblia</italic> (15.1%, 28/185) and <italic>I. buschii</italic> (11.9%, 22/185). Among lifestyle practices associated with parasitic infection, the rate of washing hands before meals was significantly lower in the students with pathogenic parasites compared to those with nonpathogenic parasites (77.4%, 106/137 vs. 93.8%, 45/48, <italic>p</italic> = 0.025).</p></sec><sec><b>Conclusion</b><p>The prevalence of intestinal parasite was 100%. Both personal hygiene and water supply facilities are required to eradicate parasite infection in rural areas of Peru.</p></sec>
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<sec><b>Objectives</b><p>We aimed to examine the effects of various leisure activities on cognitive impairment in young-old (aged 65–74 years) and old-old (aged ≥ 75 years) adults.</p></sec><sec><b>Methods</b><p>In total, 10,279 elderly Korean individuals from the 2014 Korean National Survey on Older Adults’ cohort were enrolled in our study. Cognitive impairment was assessed using the standardized score of the Mini-Mental State Examination for Dementia Screening, whereas leisure activities were recorded via self-reporting of the extent and type of leisure activity the subjects involved in over the past year. Multivariate logistic regression was used to assess the effect of leisure activities on cognitive impairment, while controlling for potential covariates.</p></sec><sec><b>Results</b><p>The subjects were more likely to participate in cognitive activities than in non-exercise physical activities. After controlling for selected covariates, involvement in cognitive activities was found to be a significant predictor of cognitive impairment in both the groups, whereas involvement in non-exercise physical activities was not a predictor of cognitive impairment in individuals aged ≥ 75 years. Moreover, depressive symptoms, rural residence, and hearing difficulties were common predictors of cognitive impairment among elderly-Korean-individuals.</p></sec><sec><b>Conclusion</b><p>Leisure activity involvement may help delay cognitive impairment, which is often concomitant with aging. Hence, an early intervention service may significantly benefit both young-old and old-old individuals.</p></sec>
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<sec><b>Objectives</b><p>Studies on <italic>Clostridium difficile</italic> are rare in Korea. We investigated the epidemiological characteristics of <italic>C. difficile</italic> isolates from patients with <italic>C. difficile</italic>-associated disease (CDAD) in Korea.</p></sec><sec><b>Methods</b><p>Multiplex polymerase chain reaction was performed to detect the presence of <italic>tcdA</italic> and <italic>tcdB</italic> toxin genes. Antimicrobial susceptibility test was carried out by the disk-dilution method. <italic>C. difficile</italic> strains were subtyped by automated repetitive-element palindromic PCR (rep-PCR).</p></sec><sec><b>Results</b><p>Among patients with CDAD, 73 (25.8%), 32 (11.3%), 32 (11.3%), and 26 (9.2%) suffered from pneumonia, cancer or neoplasm, diabetes, and colitis, respectively. Of all stool samples, 43 samples (15.2%) were positive for <italic>C. difficile</italic> strains. We observed two expression patterns of toxin genes: <italic>tcdA</italic>+/<italic>tcdB</italic>+ (86% isolates) and <italic>tcdA</italic>−/<italic>tcdB</italic>+ (14% isolates), with all isolates expressing <italic>tcdB</italic>. Furthermore, some isolates were resistant to clindamycin (65%), ampicillin (56%), and cefazolin (40%), but all were susceptible to vancomycin and metronidazole. The tested samples were classified into diverse clusters using automated rep-PCR.</p></sec><sec><b>Conclusion</b><p>Our findings revealed the characteristics and antibiotic resistance of <italic>C. difficile</italic> isolates from patients in Korea. The epidemiological data may provide valuable insight into development of treatment strategies for <italic>C. difficile</italic> infections in Korea.</p></sec>
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<sec><b>Objectives</b><p>The environment of long-term care hospitals (LTCHs) is critical to the management of the quality of their services and to patient safety, as highlighted by international studies. However, there is a lack of evidence on this topic in South Korea. This study aimed to examine the factors affecting healthcare quality in LTCHs and to explore the effectiveness of their quality management.</p></sec><sec><b>Methods</b><p>This study used a mixed methods approach with quantitative data collected in a national survey and qualitative data from semi-structured interviews with practice-based managers. The samples included 725 nationally representative LTCHs in South Korea for the quantitative analysis and 15 administrators for the in-depth interviews.</p></sec><sec><b>Results</b><p>A higher installation rate of patient-safety and hygiene-related facilities and staff with longer-tenures, especially nurses, were more likely to have better healthcare quality and education for both employees and patients.</p></sec><sec><b>Conclusion</b><p>The need for patient-safety- and hygiene-related facilities in LTCHs that serve older adults reflects their vulnerability to certain adverse events (e.g., infections). Consistent and skillful nursing care to improve the quality of LTCHs can be achieved by developing relevant educational programs for staff and patients, thereby strengthening the relationships between them.</p></sec>
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<sec><b>Objectives</b><p>This study aimed to estimate the cost of smear-positive drug-susceptible pulmonary tuberculosis (TB) treatment of the patients in the Azadshahr district, Golestan Province, Iran.</p></sec><sec><b>Methods</b><p>In this retrospective study, all new smear positive pulmonary TB patients who had been registered at the district’s health network between April, 2013 and December, 2015 and had successfully completed their treatment were entered into the study (45 patients). Treatment costs were estimated from the provider’s perspective using an activity-based costing (ABC) method.</p></sec><sec><b>Results</b><p>The cost of treating a new smear-positive pulmonary TB patient was US dollar (USD) 1,409.00 (Iranian Rial, 39,438,260), which can be divided into direct and indirect costs (USD 1,226.00 [87%] and USD 183.00 [13%], respectively). The highest cost (58.1%) was related to care and management of TB patients (including 46.1% human resources costs and 12% directly-observed treatment, short course implementation) and then respectively related to hospitalization (12.1%), supportive activity centers (11.4%), transportation (6.5%), medicines (5.3%), and laboratory tests and radiography (3.2%).</p></sec><sec><b>Conclusion</b><p>Using disease-specific cost studies can help the healthcare system management to have correct insight into the financial burden created by the disease. This can subsequently be used in prioritization, planning, operational budgeting, economic evaluation of programs, interventions, and ultimately in disease management.</p></sec>
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