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Objectives: To perform a comparison between health behaviors and health status of employees with those of the general population, to evaluate the association between employee health behaviors, health status, and absenteeism. Methods: Cross-sectional study enrolled 2433 employees from 16 Korean companies in 2014, and recruited 1000 general population randomly in 2012. The distribution of employee health behaviors, health status, and association with absenteeism were assessed. Results: Employees had significantly worse health status and low rates of health behaviors maintenance compared with the general population. Multiple logistic regression model revealed that regular exercise, smoking cessation, work life balance, proactive living, religious practice, and good physical health status were associated with lower absenteeism. Conclusions: Maintaining health behaviors and having good health status were associated with less absenteeism. This study suggests investment of multidimensional health approach in workplace health and wellness (WHW) programs. [ABSTRACT FROM AUTHOR]

Background Smoking is by far the most important cause of cancer that can be modified at the individual level. Cancer incidence and mortality rates in Korea are the highest among all Asian countries, and smoking prevalence in Korean men is one of the highest in developed countries. The purpose of the current study was to perform a systematic review and provide an evidence-based assessment of the burden of tobacco smoking-related cancers in the Korean population. Methods Sex- and cancer-specific population-attributable fractions (PAF) were estimated using the prevalence of ever-smoking and second-hand smoking in 1989 among Korean adults, respectively, and the relative risks were estimated from the meta-analysis of studies performed in the Korean population for ever-smoking and in the Asian population for passive smoking. National cancer incidence data from the Korea Central Cancer Registry and national cancer mortality data from Statistics Korea for the year 2009 were used to estimate the cancer cases and deaths attributable to tobacco smoking. Results Tobacco smoking was responsible for 20,239 (20.9%) cancer incident cases and 14,377 (32.9%) cancer deaths among adult men and 1,930 (2.1%) cancer incident cases and 1,351 (5.2%) cancer deaths among adult women in 2009 in Korea. In men, 71% of lung cancer deaths, 55%-72% of upper aerodigestive tract (oral cavity, pharynx, esophagus and larynx) cancer deaths, 23% of liver, 32% of stomach, 27% of pancreas, 7% of kidney and 45% of bladder cancer deaths were attributable to tobacco smoking. In women the proportion of ever-smoking-attributable lung cancer was 8.1%, while that attributable to second-hand smoking among non-smoking women was 20.5%. Conclusions Approximately one in three cancer deaths would be potentially preventable through appropriate control of tobacco smoking in Korean men at the population level and individual level. For Korean women, more lung cancer cases and deaths were attributable to second-hand than ever-smoking. Effective control programs against tobacco smoking should be further developed and implemented in Korea to reduce the smoking-related cancer burden. [ABSTRACT FROM AUTHOR]

Objective: Little is known regarding cervical cancer survivors' employment status, which represents social integration of cancer survivors as a pivotal domain of long-term quality of life. The goal of this study was to assess the correlates of unemployment and evaluate the impact on the comprehensive quality of life in cervical cancer survivors. Methods: We enrolled 858 cervical cancer survivors from the gynecologic oncology departments of multi-centers in Korea. Factors associated with unemployment were identified using multivariate logistic regression analyses. We assessed different health-related quality of life domains with multivariate-adjusted least-square means between cervical cancer survivors who currently work and do not. Results: After diagnosis and treatment, the percentage of unemployed survivors increased from 50.6% to 72.8%. Lower income (adjusted odds ratio [aOR], 1.97; 95% confidence interval [CI], 1.38 to 2.81), medical aid (aOR, 1.58; 95% CI, 1.05 to 2.38), two or more comorbidities (aOR, 1.80; 95% CI, 1.12 to 2.90), current alcohol drinkers (aOR, 2.33; 95% CI, 1.54 to 3.52), and employed at the time of diagnosis (aOR, 10.72; 95% CI, 7.10 to 16.16) were significantly associated with unemployment. Non-working groups showed significant differences with respect to physical functioning, role functioning, depression, and existential well-being. Conclusion: The proportion of unemployed cervical cancer survivors seems to increase, with low-income status and the presence of medical aid negatively being associated with employment, in addition to other comorbidities and previous working status. Effort should be made to secure the financial status of cervical cancer survivors. [ABSTRACT FROM AUTHOR]

Agenerally accepted consensus of end-of-life (EOL) care decision-making did not appear in Korean medical society until the year 2009. To enhance physician's ethical perception of EOL care, consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Medical Association, Korean Academy of Medical Science, and Korean Hospital Association, were published on October 13, 2009. In this article, the characteristics and issues with the guidelines are presented to improve understanding by physicians who interact with EOL patients. According to the guidelines, physicians should identify, document, respect, and act on hospitals inpatients' needs, priorities, and preferences for EOL care. The guidelines advocate that competent patients express their right of self-determination in EOL care decisions through advance directives. However, there are barriers to adopting advance directives as a legitimate tool of EOL decision-making in our current society. The guidelines stressed the importance of open communication between care-givers and patients or their surrogates. Through communication, physicians can create a plan regarding how to manage EOL until the patients' last day of life. Concerted actions among the general public, professionals, other stake-holders for EOL care, and governmental organizations to improve EOL care in our society are also stipulated. Physicians, who know the clinical meaning of the treatments available to EOL patients, should play a central role based on the consensus guidelines to help patients and their families make informed decisions about EOL care. [ABSTRACT FROM AUTHOR]

Background: Clinical effectiveness of Helicobacter pylori eradication in gastric cancer survivors after endoscopic resection of early gastric cancer (EGC) was recently established in a randomized controlled trial. We aimed to establish long-term cost-effectiveness in gastric cancer survivors after endoscopic resection of EGC. Materials and Methods: A Markov model was constructed to compare the costs and outcomes of the two intervention strategies: (1) eradicate H. pylori after complete resection of EGC by endoscopy (2) do not eradicate. Estimates for variables in the model were obtained by extensive review of published reports. Analyses were made from the Korean public healthcare provider’s perspective. Results: Base-case analysis indicated H. pylori eradication costs less (US$ 29,780 vs. US$ 30,594) than no eradication, and save more lives (mean life expectancy from eradication: 13.60 years vs. 13.55 years). One-way and three-way sensitivity analyses showed the robustness of the cost-effectiveness results. Conclusion: In this selective population with very high risk of developing gastric cancer, H. pylori eradication should be considered for reimbursement with priority to prevent subsequent cancer and also reduce health care cost. [ABSTRACT FROM AUTHOR]

Although some studies suggest that conformity with consensus recommendations for breast cancer therapy is associated with increased survival, the data are not clear. We identified patients in four hospital-based breast cancer registries in Korea who had undergone primary curative surgery (stage 0-III) from 1993 through 2002 (n = 8,407). We collected demographic and clinical characteristics such as age, stage, treatment, and hormone receptor status. We gathered 1993-2004 mortality data by linkage to the National Statistical Office. During the follow-up period of 43,145 person-years (mean, 5.13 years), we identified 899 deceased cases. We used the standard Poisson regression model to estimate the hazard ratio (HR) for survival in relation to conformity with guidelines for chemo-, hormone, and locoregional therapy. Guideline compliance for systemic therapy increased from 24.0% in 1993 to 83.8% in 2002. Among mastectomy patients with <4 positive lymph nodes and tumors <5 cm, postmastectomy radiotherapy was associated with poor survival (HR 2.07; 95% CI: 1.53-2.81). Tamoxifen use was associated with better survival among patients with hormone receptor-positive tumors (HR 0.57; 95% CI: 0.45-0.73) and with poorer survival among hormone receptor-negative patients who had affected nodes (HR 1.58; 95% CI: 1.01-2.44). Relative to conformity, non-conformity with both chemo- and hormone therapy guidelines was associated with a 76% higher risk of death. Compliance with consensus recommendations for chemo- and hormone therapy is significantly associated with better survival. Overuse of post-mastectomy radiotherapy and tamoxifen beyond the consensus recommendations may be harmful. [ABSTRACT FROM AUTHOR]

This study aimed to test the reliability and validity of the Korean version of McGill Quality of Life Questionnaire (MQOL-K) for use with 140 palliative care patients in Korea. Our results confirmed the suitability of using the 16 questions of the questionnaire clustered into four domains (physical, psychological, existential and support) as in the original version of the MQOL, although the distribution of items among the domains differed somewhat from the original. The MQOL-K demonstrated moderate to high internal consistency (Cronbach's α, 0.62–0.90), convergent validity without scaling error, and a good concurrent validity with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, sense of dignity, and general health perception. In addition, we tested the clinical validity of the MQOL-K using a known group comparison to quantify sensitivity. Regression results indicated that the existential and psychological domains had independent effects on the overall quality of life of patients in Korea. Therefore, the MQOL-K is deemed suitable for assessing the quality of life in a Korean palliative care setting. [ABSTRACT FROM AUTHOR]

Previous studies about the quality of life (QOL) in stomach cancer survivors focused on selected clinical parameters and did not consider the broader implications for overall health and QOL. We evaluated the impact of demographic and treatment-related factors on the QOL of stomach cancer survivors. We asked 391 stage I–III stomach cancer survivors who had been disease-free for at least 1 year after surgery to complete a demographic questionnaire, the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire, and its stomach module, QLQ-STO22. Survivors undergoing total gastrectomy reported greater eating restrictions than those undergoing subtotal gastrectomy. Receiving chemotherapy or radiotherapy did not significantly affect any QLQ-C30 or QLQ-STO22 scores. Role and emotional functioning improved with increasing age, and stomach-specific symptoms (pain, eating restrictions, and anxiety) lessened. Compared with female survivors, male survivors had better physical and role functioning. Smoking status was also a significant negative predictor of physical functioning and anxiety. Comorbidities and selected demographic characteristics had a greater effect than type of treatment on the QOL of post-operative stomach cancer patients. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the contribution of type of illness, socio-demographic factors, and area of residence to the place of death in a country with increasing hospital deaths. Design: Descriptive study of hospital deaths using a 10-year death registration database from the Korean National Statistical Office. Setting and participants: Through the National Vital Statistics System, 2 402 259 deaths were registered in Korea from 1992 to 2001. Measurement and main results: There was a significant trend toward an increase in the proportion of hospital deaths, from 16.6% in 1992 to 39.9% in 2001. The proportion of deaths at home decreased over that period, from 72.9 to 49.2%. The risk of hospital death versus home death was lower for those aged 75 years and over (adjusted odds ratio: 0.212; 95% confidence interval: 0.210 – 0.214) compared with those <55 years, and for people who were highly educated (2.04; 2.02 – 2.06), had white-collar jobs (1.55; 1.54 – 1.57), and resided in areas with more available hospital beds (2.46; 2.42 – 2.51). Compared with other causes of death, the risk of dying in hospital was higher for patients with ischaemic heart disease (1.83; 1.79 – 1.86), cancer (1.25; 1.23 – 1.26) and chronic lower respiratory disease (1.21; 1.18 – 1.23). Conclusions: Trends in place of death are influenced by available hospital beds, socio-demographic factors and the nature of the terminal disease, in a country with increasing hospital deaths. These associations should be viewed within the context of culture and local health care systems. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to validate the Korean version of the Brief Pain Inventory (BPI-K), a pain assessment tool that has been validated in several languages. Methods: The sample consisted of 132 patients in Seoul who had recurrent or metastatic cancer and who expressed pain. The Korean version of the Beck Depression Inventory (BDI-K), the Eastern Cooperative Oncology Group (ECOG) performance status score, the Pain Management Index (PMI), and the PMI-Revised (PMI-R) were used to further validate the BPI-K. Results: Cronbach alphas, computed for the pain interference and pain severity item, were 0.93 and 0.85, respectively. Confirmatory factor analysis of the BPI-K items showed a two common-factor solution for the BPI-K, consistently demonstrated in other language versions of the BPI. The mean pain interference score was more correlated with the BDI-K scale (r = 0.44) and ECOG (r = 0.39) than the mean pain severity score. Seventy-four percent of the patients in the Seoul sample had inadequate analgesia using the PMI. Conclusion: The BPI-K is a valid and useful instrument for assessing cancer pain and pain impact in Korea. [ABSTRACT FROM AUTHOR]