[Economic impact according to health problems of workers]

Economic evaluation of acupuncture as an adjunctive treatment with usual care for mild-to-moderate knee osteoarthritis: A Markov model-based analysis

Background

Collaborative care (CC), in which acupuncture is combined with usual care (UC), improves clinical outcomes and increases costs in knee osteoarthritis (KOA). We evaluated the economic feasibility of CC for Korean female patients with mild-to-moderate KOA by using a cost-effectiveness approach.

Methods

Two alternatives for KOA (1. UC as a comparator; and 2. CC as an intervention) were defined based on clinical guidelines, official Korean statistics, and expert validation. Each alternative was simulated in a Markov model every 6 months for 10 years. Estimates of costs, utilities, and transition probabilities were obtained from official statistics and previous studies. The effectiveness of CC was synthesized from randomized controlled trials. A base-case analysis of a limited societal perspective, univariate sensitivity analysis, and probability sensitivity analysis were performed. An annual discount rate of 4.5% and threshold of 20,000 United States dollar per Quality-adjusted life year (USD/QALY) were applied.

Results

Every incremental cost-effectiveness ratio (ICER) of CC calculated from the analyses was sub-threshold. In the base-case analysis, with a limited societal perspective, the ICER was 11,085 USD/QALY. The ICERs from the univariate sensitivity analyses were -2,577-16,748 USD/QALY. The average ICER in the probability sensitivity analysis was 12,412 USD/QALY. When the threshold surpassed 8,000 USD/QALY, the cost-effectiveness of CC exceeded 50%. The probability was 70.27% when the threshold was 20,000 USD/QALY.

Conclusions

CC for Korean female patients with mild-to-moderate KOA was generally cost-effective. Considering the limitations of the evidence, we propose a re-evaluation using further clinical studies in the future.

Relationship between occupational stress, sleep disturbance, and presenteeism of shiftwork nurses

PURPOSE

This study aimed to determine the relationships between occupational stress, sleep disturbance, and presenteeism in shiftwork nurses in South Korea.

DESIGN

This cross-sectional study used survey data from 442 shiftwork nurses at two hospitals in South Korea. Data were collected between March 2018 and April 2020.

METHODS

A self-reported questionnaire was used to assess shiftwork nurses' demographic and job-related information, presenteeism, occupational stress, and sleep disturbance. Data were analyzed using descriptive statistics, multiple regression, and the PROCESS macro.

FINDINGS

The mean presenteeism score was 39.52. Multiple regression analysis revealed that job insecurity, interpersonal conflict, occupational climate, lack of reward, and job demand are significantly associated with presenteeism. Sleep disturbance was related to presenteeism and had a moderating effect on the relationship between occupational stress and presenteeism.

CONCLUSIONS

This study indicates that proper occupational climate, positive interpersonal relationships, and adequate sleep can reduce shiftwork presenteeism. Therefore, individual and organizational efforts to alleviate occupational stress and sleep disturbances are essential.

CLINICAL RELEVANCE

Organizational support is needed to maintain a positive occupational climate and interpersonal relationships and ameliorate sleep disturbance among shiftwork nurses.

Traditional medicine for the treatment of common cold in Korean adults: A nationwide population-based study

BACKGROUND

Traditional medicines (TMs) have been used to treat common cold in Asia, but no studies have been conducted to examine the trend of use for several years. The objective of this study was to analyze the prescription patterns of TMs for common cold using national claims data accrued over 7 years in Korea. This will contribute to the scientific evidence enhancing the understanding of TM use for the treatment of common cold.

METHODS

This study analyzed national claims data from the Health Insurance Review and Assessment Service database. We extracted data for diagnosis of common cold (Korean Standard Classification of Diseases: J00, Acute nasopharyngitis) and prescriptions of TMs for adults who visited all types of oriental medical institutions during 2010-2016. We estimated the prescription patterns of TMs by sex, age group, and year.

RESULTS

We extracted 3,014,428 prescriptions. The total number of prescriptions increased by 125.1% in 2016 compared to that in 2010. For all ages and periods, the number of prescriptions in women was higher than that in men. The age range with the most prescriptions was 70-79 years. The seven most prescribed TMs for common cold were Socheongnyongtang, Samso-eum, Yeongyopaedoksan, Insampaedoksan, Gumigohwaltang, Galgeuntang, and Hyeonggae-yeongyotang.

CONCLUSION

This was the first study to analyze the prescription patterns of TMs for common cold using National Health Insurance data in Korea. This study provides scientific evidences on the disease burden and the utilization pattern of TMs for common cold to support decision making on initiatives such as allocation and management of health resources.

[Effects of an Integrated Physical Activity Program for Physically Inactive Workers: Based on the PRECEDE-PROCEED Model]

PURPOSE

We aimed to examine the effects of an integrated physical activity (PA) program developed for physically inactive workers on the theoretical basis of the PRECEDE-PROCEED model.

METHODS

Participants were 268 workers in three departments of L manufacturing unit in South Korea. The three departments were randomly allocated into integration (n=86) (INT), education (n=94) (ED), and control (n=88) (CT) groups. The INT group received self-regulation, support, and policy-environmental strategies of a 12-week integrated PA program, the ED group received self-regulation strategies only, and the CT group did not receive any strategies. After 12 weeks, process evaluation was conducted by using the measures of self-regulation (autonomous vs. controlled regulation), autonomy support, and resource availability; impact evaluation by using PA measures of sitting time, PA expenditure, and compliance; and outcome evaluation by using the measures of cardiometabolic/musculoskeletal health and presenteeism.

RESULTS

Among process measures, autonomous regulation did not differ by group, but significantly decreased in the CT group (p=.006). Among impact measures, PA compliance significantly increased in the INT group compared to the CT group (p=.003). Among outcome measures, the changes in cardiometabolic/musculoskeletal health and presenteeism did not differ by group; however, systolic blood pressure (p=.012) and a presenteeism variable (p=.041) significantly decreased only in the INT group.

CONCLUSION

The integrated PA program may have a significant effect on increases in PA compliance and significant tendencies toward improvements in a part of cardiometabolic health and presenteeism for physically inactive workers. Therefore, occupational health nurses may modify and use it as a workplace PA program.

Socioeconomic and employment status of patients with rheumatoid arthritis in Korea

OBJECTIVES

This study investigates the prevalence of rheumatoid arthritis (RA) by gender and socio-economic characteristics. It also explores the differences in the employment status between RA patients and the general population without RA in Korea.

METHODS

We analyzed data from the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV) conducted from 2007 to 2009. Prevalence rates were estimated for female and male patients with RA in terms of age, residence, education, income level, and occupation type. The female respondents aged 45 to 64 were divided into the RA population and the non-RA population in order to compare the employment status between the two groups.

RESULTS

The annual physician-diagnosed RA prevalence rate was 1.45%. The prevalence rate was 2.27% for women and 0.62% for men. Individuals with RA had a significantly lower employment rate than individuals without RA (41.7 vs. 68.1%). The main reason for non-employment among RA patients was health-related problems (47.1%). There was statistically significant difference in employment type among the two groups. The experience rates for sick leave and sick-in-bed due to RA were 1.7 and 3.9%, respectively.

CONCLUSION

Middle- and old-aged women accounted for the majority of the Korean RA population, which had a significant lower employment rate compared to the population without RA for both sexes. RA resulted in considerable productivity loss in Korea.