Kyunghee Kim

Cameroon public health sector: shortage and inequalities in geographic distribution of health personnel

IntroductionCameroon is classified by the World Health Organization (WHO) as having a critical shortage of health personnel. This is further complicated by the geographic distributional inequalities of the national health workforce. This shortfall impedes Cameroons’ progress of improving the human resources for health (HRH) to meet up with the Millennium Development Goals (MDGs) by 2015. However, it is unknown whether the health workforce of Cameroon is distributed equally across geographic regions. Additionally, indicators other than population levels have not been used to measure health care needs. This study aimed to assess the adequacy, evenness of distribution and challenges faced by the health workforce across the different regions of Cameroon.MethodsNational health personnel availability and distribution were assessed by use of end-of-year census data for 2011 obtained from the MoPH data base. The inequalities and distribution of the workforce were estimated using Gini coefficient and Lorenz curve and linear regression was used to determine the relation between health personnel density and selected health outcomes. Alternative indicators to determine health care needs were illustrated using concentration curves.ResultsSignificant geographic inequalities in the availability of health workforce exist in Cameroon. Some regions have a higher number of physicians (per person) than others leading to poor health outcomes across the regions. 70 % of regions have a density of health personnel-to-population per 1,000 that is less than 1.5, implying acute shortage of health personnel. Poor working and living conditions, coupled with limited opportunities for career progress accounted for some documented 232 physicians and 205 nurses that migrated from the public sector. Significant distributional inequality was noticed when under-five infant mortality and malaria prevalence rate were used as indicators to measure health care needs.ConclusionOur results show an absolute shortage of public health personnel in Cameroon that is further complicated by the geographic distributional inequalities across the regions of the nation. Cameroon aims to achieve universal health coverage by 2035; to realize this objective, policies targeting training, recruitment, retention and effective deployment of motivated and supported health workforce as well as the development and improvement of health infrastructures remain the major challenge.

The influence of surgical factors on dislocation of the meniscal bearing after Oxford medial unicompartmental knee replacement: a case–control study

The aim of this study was to evaluate the risk factors for dislocation of the bearing after a mobile-bearing Oxford medial unicompartmental knee replacement (UKR) and to test the hypothesis that surgical factors, as measured from post-operative radiographs, are associated with its dislocation From a total of 480 UKRs performed between 2001 and 2012, in 391 patients with a mean age of 66.5 years (45 to 82) (316 female, 75 male), we identified 17 UKRs where bearing dislocation occurred. The post-operative radiological measurements of the 17 UKRs and 51 matched controls were analysed using conditional logistic regression analysis. The post-operative radiological measurements included post-operative change in limb alignment, the position of the femoral and tibial components, the resection depth of the proximal tibia, and the femoral component-posterior condyle classification. We concluded that a post-operative decrease in the posterior tibial slope relative to the pre-operative value was the only significant determinant of dislocation of the bearing after medial Oxford UKR (odds ratio 1.881; 95% confidence interval 1.272 to 2.779). A post-operative posterior tibial slope < 8.45° and a difference between the pre-operative and post-operative posterior tibial slope of > 2.19° may increase the risk of dislocation.

Risk perception and public concerns of electromagnetic waves from cellular phones in Korea.

In this study, the difference between the risk perception of electromagnetic waves from cellular phones and the risk perception of other factors such as environment and food was analyzed. The cause of the difference in the psychological and social factors that affect the group with high risk perception of electromagnetic waves was also analyzed. A questionnaire survey on the risk perception of electromagnetic waves from cellular phones was carried out on 1001 subjects (men and women) over the age of 20. In the group with high risk perception of electromagnetic waves from cellular phones, women had higher risk perception than men. Logistic regression analysis, where the group with high risk perception of electromagnetic waves and the group with low risk perception were used as dependent variables, indicated that the risk perception of electromagnetic waves in women was 1.815 times statistically significantly higher than the risk perception of men (95% CI: 1.340-2.457). Also, high risk perception of electromagnetic waves from cellular phones was observed when the subjects considered that they had more personal knowledge (OR: 1.416, 95% CI: 1.216-1.648), that the seriousness of the risk to future generations was high (OR: 1.410, 95% CI: 1.234-1.611), and their outrage for the occurrence of accidents related to electromagnetic waves was high (OR: 1.460, 95% CI: 1.264-1.686). The results of this study need to be sufficiently considered and reflected in designing the risk communication strategies and communication methods for the preventive measures and advice on electromagnetic waves from cellular phones.

In vitro metabolism of an estrogen-related receptor γ modulator, GSK5182, by human liver microsomes and recombinant cytochrome P450s.

GSK5182 (4‐[(Z)‐1‐[4‐(2‐dimethylaminoethyloxy)phenyl]‐hydroxy‐2‐phenylpent‐1‐enyl]phenol) is a specific inverse agonist for estrogen‐related receptor γ, a member of the orphan nuclear receptor family that has important functions in development and homeostasis. This study was performed to elucidate the metabolites of GSK5182 and to characterize the enzymes involved in its metabolism. Incubation of human liver microsomes with GSK5182 in the presence of NADPH resulted in the formation of three metabolites, M1, M2 and M3. M1 and M3 were identified as N‐desmethyl‐GSK5182 and GSK5182 N‐oxide, respectively, on the basis of liquid chromatography‐tandem mass spectrometric (LC‐MS/MS) analysis. M2 was suggested to be hydroxy‐GSK5182 through interpretation of its MS/MS fragmentation pattern. In addition, the specific cytochrome P450 (P450) and flavin‐containing monooxygenase (FMO) isoforms responsible for GSK5182 oxidation to the three metabolites were identified using a combination of correlation analysis, chemical inhibition in human liver microsomes and metabolism by expressed recombinant P450 and FMO isoforms. GSK5182 N‐demethylation and hydroxylation is mainly mediated by CYP3A4, whereas FMO1 and FMO3 contribute to the formation of GSK5182 N‐oxide from GSK5182. The present data will be useful for understanding the pharmacokinetics and drug interactions of GSK5182 in vivo. Copyright

A nationwide study of patients hospitalised for poisoning in Korea based on Korea National Hospital Discharge In-Depth Injury Survey data from 2005 to 2009

Objectives In light of the need to develop an integrated database on poisoning incidents in Korea, this study seeks to determine the characteristics of poisoning incidents in Korea by age, gender, location of incident, causative substance and patient prognosis. Data sources The Korea National Hospital Discharge In-Depth Injury Survey results (2005–2009) from the Korea Centers for Disease Control and Prevention were used. Participants 3826 participants in the survey who had been hospitalised for poisoning incidents. Results The poisoning hospitalisation rate per 100 000 population was higher in women (1.735) than in men (1.372) and increased with age: the rate was 0.458 among individuals aged ≤9 years, 0.481 among those aged 10–19 years, 1.584 among those aged 20–64 years and 4.053 among those aged ≥65 years. The intentional poisoning hospitalisation rate differed by gender and age group. Women aged ≤19 years and 20–64 years showed a higher hospitalisation rate than men, while men aged ≥65 years showed a higher hospitalisation rate than women in the same age group. The most common poisoning substance was pesticides (33.6%), while antiepileptic, sedative-hypnotic and antiparkinsonism drugs and psychotropic drugs, not elsewhere classified were also very common. Poisoning in those aged ≤9 years usually involved other drugs, while pesticides were the most common substances in those aged 20–64 years and ≥65 years. Conclusions This study analysed poisoning incidents in Korea from 2005 to 2009, by age and gender, causative substance, and characteristics. The results of this study may serve as evidence for new strategies in Korea to prevent poisoning.

A cross-sectional study of the association between mobile phone use and symptoms of ill health

Objectives This study analyzed the associations between mobile phone call frequency and duration with non-specific symptoms. Methods This study was conducted with a population group including 532 non-patient adults established by the Korean Genome and Epidemiology Study. The pattern of phone call using a mobile phone was investigated through face-to-face interview. Structured methods applied to quantitatively assess health effects are Headache Impact Test-6 (HIT-6), Psychosocial Well-being Index-Short Form, Beck Depression Inventory, Korean-Instrumental Activities of Daily Living, Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index, and 12-item Short Form Health Survey where a higher score represents a higher greater health effect. Results The average daily phone call frequency showed a significant correlation with the PSS score in female subjects. Increases in the average duration of one phone call were significantly correlated with increases in the severity of headaches in both sexes. The mean (standard deviation) HIT-6 score in the subgroup of subjects whose average duration of one phone call was five minutes or longer was 45.98 (8.15), as compared with 42.48 (7.20) in those whose average duration of one phone call was <5 minutes. The severity of headaches was divided into three levels according to the HIT-6 score (little or no impact/moderate impact/substantial or severe impact), and a logistic regression analysis was performed to investigate the association between an increased phone call duration and the headache severity. When the average duration of one phone call was five minutes or longer, the odds ratio (ORs) and the 95% confidence intervals (CIs) for the moderate impact group were 2.22 and 1.18 to 4.19, respectively. The OR and 95% CI for the substantial or severe impact group were 4.44 and 2.11 to 8.90, respectively. Conclusions Mobile phone call duration was not significantly associated with stress, sleep, cognitive function, or depression, but was associated with the severity of headaches.

Hazard Classification of Household Chemical Products in Korea according to the Globally Harmonized System of Classification and labeling of Chemicals

ObjectivesThis study was conducted to review the validity of the need for the application of the Globally Harmonized System of Classification and Labeling of Chemicals (GHS) to household chemical products in Korea. The study also aimed to assess the severity of health and environmental hazards of household chemical products using the GHS.Methods135 products were classified as ‘cleaning agents and polishing agents’ and 98 products were classified as ‘bleaches, disinfectants, and germicides.’ The current status of carcinogenic classification of GHS and carcinogenicity was examined for 272 chemical substances contained in household chemical products by selecting the top 11 products for each of the product categories. In addition, the degree of toxicity was assessed through analysis of whether the standard of the Republic of Korea’s regulations on household chemical products had been exceeded or not.ResultsAccording to GHS health and environmental hazards, “acute toxicity (oral)” was found to be the highest for two product groups, ‘cleaning agents and polishing agents’, and ‘bleaches, disinfectants, and germicides’ (result of classification of 233 household chemical products) at 37.8% and 52.0% respectively. In an analysis of carcinogenicity assuming a threshold of IARC 2B for the substances in household chemical products, we found ‘cleaning agents and polishing agents’ to contain 12 chemical substances and ‘bleaches, disinfectants, and germicides’ 11 chemical substances.ConclusionSome of the household chemical products were found to have a high hazard level including acute toxicity and germ cell mutagenicity, carcinogenicity, and reproductive toxicity. Establishing a hazard information delivery system including the application of GHS to household chemical products in Korea is urgent as well.

Public health concerns, risk perception and information sources in Cameroon

Abstract This study presents a descriptive account of ratings based on psychometric variables of perceived twenty-five health risk factors, their information sources and the confidence in the information sources among Cameroonians nationwide. Health risk factors such as HIV/AIDS, natural disasters, terrorism, unprotected sex, unemployment, alcohol consumption, street crime, cigarette smoking, poverty, malaria, cholera and motorcycle accidents were among the greatest perceived health risk factors by the population. On the other hand, female genital mutilation and natural health products were ranked the lowest posing health risk factors among Cameroonians. Also, women perceived more health risks than men, with large differences in the perceived risks of unemployment and chronic diseases. Respondents across the regions younger than forty years old reported greater concerns over health risk factors than those over forty years old. Media organisations, health and professional groups were reported as the main sources of information as well as greater confidence in information obtained from health personnel compared with other information sources among the population. The results obtained from this study showed public concern over several health risk factors, and policies directed towards the effective communication and management strategies of health risks within the communities aimed at the development of health prevention/promotion programmes of the nation should be encouraged.

Quasi-Experiment Study on Effectiveness Evaluation of Health Communication Strategies

This experimental study examined differences in doctor-patient relationships according to the health communication strategies during cases of medical malpractices occurred at primary medical institution. A total of 116 subjects aged in their 20s-50s was sampled. The first medical malpractice scenario chosen was the medical malpractice case most frequently registered at the Korean Medical Association Mutual Aid and the second scenario was associated with materials and devices as the cause of malpractice. Four types of crisis communication strategy messages were utilized, consisting of denial, denial + ingratiation, apology, and apology + ingratiation. Subjects were classified into four research groups by crisis communication strategy to measure levels of trust, control mutuality, commitment, and satisfaction, before and after the occurrence of medical malpractice and application of communication strategies. The findings of this study revealed that the apology strategy, compared with the denial strategy, showed a smaller difference before and after the application of communication strategies in all variables of trust (F = 8.080, F = 5.768), control mutuality (F = 8.824, F = 9.081), commitment (F = 9.815, F = 8.301), and satisfaction (F = 8.723, F = 5.638). Further, a significant interaction effect was shown between variables. The apology strategy, compared with the denial strategy, was effective in the improvement of doctor-patient relationships in both Scenarios I and II. For Scenario I, the apology strategy without ingratiation boosted commitment and satisfaction, but for Scenario II, utilizing the apology strategy with ingratiation boosted the effectiveness of trust and commitment.

Preprocessing-based speed profile calculation algorithm for radio-based train control

Radio-based train control system has driving headway shortening effect by real-time train interval control using two-way radio communication between onboard and wayside systems, and reduces facility investment because it does not require any track-circuit. Automatic train protection(ATP), the most significant part of the radio-based train control system, makes sure a safe distance between preceding and following trains, based on real-time train location tracing. In this paper, we propose the overall ATP train interval control algorithm to control the safe interval between trains, and preprocessing-based speed profile calculation algorithm to improve the processing speed of the ATP. The proposed speed profile calculation algorithm calculates the permanent speed limit for track and train in advance and uses as the most restrictive speed profile. If the temporary speed limit is generated for a particular track section, it reflects the temporary speed limit to pre-calculated speed profile and improves calculation performance by updating the speed profile for the corresponding track section. To evaluate the performance of the proposed speed profile calculation algorithm, we analyze the proposed algorithm with O-notation and we can find that it is possible to improve the time complexity than the existing one. To verify the proposed ATP train interval control algorithm, we build the train interval control simulator. The experimental results show the safe train interval control is carried out in a variety of operating conditions.