Institute of Health Services Research

Seoul, South Korea

Institute of Health Services Research

Seoul, South Korea

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Rowe R.,University of Sheffield | Maughan B.,King's College London | Moran P.,King's College London | Ford T.,Institute of Health Services Research | And 2 more authors.
Journal of Child Psychology and Psychiatry and Allied Disciplines | Year: 2010

Background: Callous and unemotional (CU) traits might usefully subtype DSM-IV conduct disorder (CD). We investigate this hypothesis in a large, nationally representative sample of 5-16-year-olds. We also examine the characteristics of children with high CU traits but without CD. Methods: Data come from the 2004 British Child and Adolescent Mental Health Survey including 7,977 children, 5,326 of whom were followed up after 3 years. DSM-IV diagnoses of psychiatric disorder were based on parent, teacher and child report. CU traits were assessed by parent report. Results: Of the 2% of the sample who were diagnosed with DSM-IV CD, 46.1% were high on CU traits. In addition, 2.9% of the sample were high on CU traits without CD. Children with CD and CU traits showed more severe behavioural disturbance and were at substantially higher risk of CD diagnosis 3 years later. Children high on CU traits without CD showed evidence of disturbed functioning. Conclusions: Subtyping CD using CU traits identifies children with more severe and persistent psychopathology. Children with high CU traits but no CD diagnosis require further investigation. © 2009 Association for Child and Adolescent Mental Health.


Hamer M.,University College London | Ford T.,Institute of Health Services Research | Stamatakis E.,University College London | Dockray S.,University College London | And 3 more authors.
Archives of Pediatrics and Adolescent Medicine | Year: 2011

Objective: To examine the association between objectively assessed secondhand smoke (SHS) exposure and mental health in a representative sample of British children. Design: Cross-sectional study. Setting: Community-based population sample from the 2003 Scottish Health Survey. Participants: Nine hundred one nonsmoking children (mean [SD] age, 8.3 [2.5] years). Main Exposure: Exposure to SHS was determined from salivary cotinine level and self-report. Main Outcome Measure: Psychological distress assessed using the Strengths and Difficulties Questionnaire (SDQ). Results: Forty percent of the sample demonstrated high SHS exposure (cotinine level >0.70 ng/mL). Children with higher cotinine levels were more likely to live in areas of greater socioeconomic deprivation. Participants in the highest cotinine quartile (>0.70 ng/mL) had significantly higher total SDQ scores compared with those in the lowest quartile (age- and sex-adjusted mean difference = 2.8; 95% confidence interval, 1.6 to 3.9). There was evidence of a dose-response effect across the cotinine group (P trend=.001). Of the SDQ subscales, the strongest associations with cotinine levels emerged for hyperactivity and conduct disorder. These associations remained statistically significant after adjustment for possible confounders including social deprivation, single-parent status, body mass index, chronic illness, and physical activity. Conclusion: Objectively assessed SHS exposure was associated with poorer mental health among children. ©2011 American Medical Association. All rights reserved.


PubMed | South London & Maudsley NHS Foundation Trust, Institute of Health Services Research, Southwark Primary Care Trust and King's College London
Type: Journal Article | Journal: Clinical child psychology and psychiatry | Year: 2015

Typically the social-emotional development or mental health of under 5-year-old Children in Care (CiC) is not routinely assessed and there are few published data in the UK on the prevalence of difficulties for these children. Our hypothesis was that there could be a significant level of unidentified and unmet need within this group. A screening procedure was developed and piloted in a 12-month study assessing both child factors and the developing relationships between children and their caregivers. Previous screening studies have shown that recommendations for interventions are not reliably expedited. An intervention component was incorporated to address this and minimise delay in the children and their carers receiving support. Close inter-agency collaboration was integral to the establishment, implementation and high level of participation in the study. The screening proved acceptable to the majority of birth parents and caregivers, with 94% uptake of participants. In the year prior to screening only 10% of under-fives coming into care were identified as having difficulties in contrast to 67% of children in the screening cohort. The brief interventions offered were taken up in three-quarters of cases, leading to increased referrals on and access to mental health services for these children.


Sternberg S.A.,Institute of Health Services Research | Bentur N.,Myers JDC Brookdale Institute | Abrams C.,Johns Hopkins University | Spalter T.,Myers JDC Brookdale Institute | And 4 more authors.
American Journal of Managed Care | Year: 2012

Objectives: To determine whether a designation of frailty using the Adjusted Clinical Groups-diagnoses based computerized predictive model (ACG Dx-PM) can identify an elderly population who (1) have the clinical characteristics of frailty and (2) are frail as determined by the validated Vulnerable Elders Survey (VES), and to determine the ability of these tools to predict adverse outcomes. Study Design: Secondary analysis of administrative and survey data. Methods: Participants over age 65 years (n = 195) in an outpatient comprehensive geriatric assessment study at an Israeli health maintenance organization (HMO) were screened for frailty using the ACG Dx-PM and VES. Administrative and demographic data were also gathered. Results: Compared with ACG nonfrail patients, ACG frail patients were older and less likely to be married; had a higher rate of falls, incontinence, and need for personal care; and had a poorer quality of life consistent with a clinical picture of frailty. The ACG frailty tag identified a frail population using the VES frailty determination as the accepted standard with moderate success (area under the curve 0.62). Adjusting for sex and functional status in backward logistic regression, the ACG frailty tag predicted hospitalizations ( P <.032) and the VES frailty tool predicted emergency department visits (P <.016). Conclusions: The ACG frailty tag identified an elderly population with clinical characteristics of frailty and performed with moderate success compared with the VES. Both tools predicted adverse outcomes in older HMO members. A combined screening approach for frailty using predictive modeling with a function-based survey deserves further study.


Chung W.,Institute of Health Services Research | Oh S.-M.,Yonsei University | Suh T.,The Korea Institute for Health and Social Affairs | Lee Y.M.,Ajou University | And 2 more authors.
Health Policy | Year: 2010

Objective: In a rapidly aging society, inappropriately long geropsychiatric inpatient hospitalization is a challenging concern for mental health policy-makers and researchers. This study aimed to investigate patient and institutional factors affecting geropsychiatric inpatient length of stay (LOS), providing an overview of current geropsychiatric health care system in South Korea. Methods: This retrospective, population-based, cross-sectional study analysed nationwide reimbursement claim databases covering the entire elderly population of Korea between January 2005 and June 2006. Given the nested structure of the data, a multivariate multilevel regression analysis was performed. Results: The average LOS was 128 days. Males, patients with schizophrenia, and those enrolled in a National Medical Care Aid program tended to have longer hospital stays. Patient age was negatively related to LOS. Institutional variables related to longer hospitalizations included a psychiatric hospital, a higher number of beds, fewer human resource employees, a higher proportion of male, oldest old, and patients with dementia. Conclusions: Our results suggest that policies targeting geropsychiatric patients diagnosed with schizophrenia, enrolled in National Medical Care Aid programs, and admitted to psychiatric hospitals could reduce LOS. Additionally, the impact of the patient composition of a medical institution on LOS needs to be closely investigated. © 2009 Elsevier Ireland Ltd. All rights reserved.


Clark C.E.,Institute of Health Services Research | Arnold E.,St George's, University of London | Lasserson T.J.,St George's, University of London | Wu T.,University of Sichuan
Primary Care Respiratory Journal | Year: 2010

Aims: To assess the efficacy of herb and plant extracts in the management of asthma. Method: Systematic review and meta-analysis. Multiple database searches identified randomised placebo controlled trials of herbal interventions reporting at least one primary outcome measure. Where possible data were combined for meta-analysis. Primary outcome measures were lung function, exacerbations and reduction in corticosteroid use. Secondary outcome measures were symptoms and symptom scores, use of reliever medications, changes in rates of consultation and adverse effects. Results: Twenty-six studies reporting on 20 herbal preparations were included. Two of six studies reporting change in FEV1 were positive. Little data was available on frequency of exacerbations. For primary outcomes single studies of Boswellia, Mai-Men-Dong-Tang, Pycnogenol, Jia-Wei-Si-Jun-Zi-Tang and Tylophora indica showed potential to improve lung function, and a study of 1.8-Cineol (eucalyptol) showed reduced daily oral steroid dosage. Conclusions: Improvements in symptoms were not strongly supported by objective changes. Most trials were of small sample size, short duration, and poor methodology. Further adequately powered trials are needed to assess these compounds. Such trials should conform to CONSORT guidance, report standardised spirometry, and use validated symptom and severity scores. No recommendations for herbal treatment of asthma can be made from the current evidence. © 2010 Primary Care Respiratory Society UK. All rights reserved.


Lim S.,Yonsei University | Chung W.,Institute of Health Services Research | Kim H.,Yonsei University | Lee S.,Health Insurance Policy Research Institute
Health Policy | Year: 2010

Objective: This study aimed to identify the most influential socioeconomic indicator of smoking in South Korea. Methods: This study analyzed a nationally representative sample (6141 men and 7133 women aged 20-65) from the 2001 and 2005 Korea National Health and Nutrition Surveys. Weighted estimates were computed, adjusting for a complex survey design using "surveyfreq" and "surveylogistic" procedures of SAS 9.1 software. Results: The adjusted OR for smoking in renters compared to homeowners was 1.50 (95% CI: 1.32-1.71) in men and 3.21 (95% CI: 2.41-4.27) in women, and larger in the older than younger groups. For non-married versus married individuals, the OR was 1.37 (95% CI: 1.19-1.59) in men and 3.25 (95% CI: 2.48-4.25) in women; the OR in non-married renters compared married homeowners was 1.79 (95% CI: 1.45-2.22) in men and 10.63 (95% CI: 7.31-15.45) in women. Conclusion: Housing tenure was a strong predictor of smoking in South Korea and its significance was very pronounced in non-married individuals. Housing policies to encourage homeownership could be effective in reducing smoking in countries such as China, India, and Vietnam where house ownership is regarded as the ultimate financial safeguard, there are numerous, and traditional attitudes toward marriage are undergoing transition. © 2009 Elsevier Ireland Ltd. All rights reserved.


Kang H.G.,Yonsei University | Kwon K.H.,Yonsei University | Lee I.W.,Yonsei University | Jung B.,Yonsei University | And 4 more authors.
Asian Pacific Journal of Cancer Prevention | Year: 2013

Background: Lung cancer is a major cause of Korean female mortality and is clearly associated with smoking. The Korean National Health and Nutrition Examination Survey (KNHANES IV-2,3), which included both self-reports of smoking and urinary cotinine data, revealed a significant discrepancy between the prevalence of self-reported and biochemically-verified female smokers. The factors associated with accurate self-reporting of current smoking status remain poorly understood, however. Materials and Methods: We assessed the prevalence of smoking in KNHANES using both self-report and urinary cotinine data. Subsequently, using univariate and multivariate tests, we assessed whether age, intensity of smoking, marital status, relationship with cohabitants, education, occupation, residential area, or annual household income were associated with inaccurate selfreporting in Korean females. We also investigated whether the prevalence of inaccurate self-reports changed over the survey period, 2008-2009. Results: The prevalence of self-reported smoking was 47.8% in males and 6.6% in females. By contrast, the prevalence of smoking as assessed by urinary cotinine levels was 52.2% in males and 14.5% in females. Of the 746 females with urinary cotinine levels >50ng/ml, 407 (56.0%) provided inaccurate self-reports. In a multivariate model, age group(40-49: OR 3.54, 95%CI 1.42-8.86, p=0.007; ref :20-29), cotinine intensity(OR 0.999, 95%CI 0.998-0.999, p<0.001), marital status (married but without spouse: OR 0.37, 95%CI 0.15-0.94, p=0.037; ref :never married), relationship with cohabitants (living with a spouse and unmarried child: OR 2.63, 95%CI 1.44-4.80, p=0.002; living with 2 generations except unmarried child: OR 2.53, 95%CI 1.09-5.87, p=0.030; living with ≥3 generations: OR 3.25, 95%CI 1.48-7.10, p=0.003; ref :spouse only) and education(college or higher: OR 2.73, 95%CI 1.04-7.18, p=0.042; ref :elementary or less) were independently associated with inaccurate self-reports. Conclusions: The trend of smoking prevalence of Korean females is likely to decrease. However, an elevated prevalence of inaccurate self-reports by females remains. Factors related to the intensity of smoking and family status appear to influence whether a Korean female provides an accurate self-report when asked about smoking behavior.


Russell G.,University of Exeter | Ford T.,Institute of Health Services Research | Steer C.,University of Bristol | Golding J.,University of Bristol
Journal of Child Psychology and Psychiatry and Allied Disciplines | Year: 2010

Background: Data from epidemiology have consistently highlighted a disparity between the true prevalence of childhood psychiatric disorders and their recognition as defined by receiving a clinical diagnosis. Few studies have looked specifically at the level of unidentified autistic spectrum disorder (ASD) in the population. Method: Logistic regression was used to determine the behavioural traits associated with receiving a diagnosis of ASD using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). A composite score was derived to measure levels of autistic traits; undiagnosed children with scores matching those diagnosed with ASD were identified. Levels of educational provision beyond that provided by standard schooling were examined. Results: Fifty-five percent of children with autistic traits at the same levels as those who had an autism diagnosis had not been identified as needing extra support from education or specialised health services. Of those who were identified as having special needs, 37.5% had been formally diagnosed with an ASD. For children with impairment at the same level as that associated with Asperger's syndrome, 57% had no special provision at school, and were not accessing specialised health services. Twenty-six percent of those who did have special provision at school had an ASD diagnosis. Conclusions: The results suggest that there may be a substantial proportion of children on the autistic spectrum who are never identified by services. © 2010 Association for Child and Adolescent Mental Health.


Clark C.E.,Institute of Health Services Research | Smith L.F.P.,Institute of Health Services Research | Taylor R.S.,Institute of Health Services Research | Campbell J.L.,Institute of Health Services Research
BMJ (Online) | Year: 2010

Objective: To review trials of nurse led interventions for hypertension in primary care to clarify the evidence base, establish whether nurse prescribing is an important intervention, and identify areas requiring further study. Design: Systematic review and meta-analysis. Data sources: Ovid Medline, Cochrane Central Register of Controlled Trials, British Nursing Index, Cinahl, Embase, Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluation Database. Study selection: Randomised controlled trials of nursing interventions for hypertension compared with usual care in adults. Data extraction: Systolic and diastolic blood pressure, percentages reaching target blood pressure, and percentages taking antihypertensive drugs. Intervention effects were calculated as relative risks or weighted mean differences, as appropriate, and sensitivity analysis by study quality was undertaken. Data synthesis: Compared with usual care, interventions that included a stepped treatment algorithm showed greater reductions in systolic blood pressure (weighted mean difference -8.2 mm Hg, 95% confidence interval -11.5 to -4.9), nurse prescribing showed greater reductions in blood pressure (systolic -8.9 mm Hg, -12.5 to -5.3 and diastolic -4.0 mm Hg, -5.3 to -2.7), telephone monitoring showed higher achievement of blood pressure targets (relative risk 1.24, 95% confidence interval 1.08 to 1.43), and community monitoring showed greater reductions in blood pressure (weighted mean difference, systolic -4.8 mm Hg, 95% confidence interval -7.0 to -2.7 and diastolic -3.5 mm Hg, -4.5 to -2.5). Conclusions: Nurse led interventions for hypertension require an algorithm to structure care. Evidence was found of improved outcomes with nurse prescribers from non-UK healthcare settings. Good quality evidence from UK primary health care is insufficient to support widespread employment of nurses in the management of hypertension within such healthcare systems.

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