Suicide is a major problem in Korean health care and a serious social problem. In Korea, 12,463 people (24.3 per 100,000) lost their lives due to suicide in 2017. Although the government has established three National Comprehensive Plan of Suicide Prevention (2004, 2009, 2016), and National Action Plan of Suicide Prevention (2018), the suicide rate is still high. The suicide rate of the elderly is especially high. This is due to the economic vulnerability of the elderly in Korea. Therefore, in order to prevent suicide in Korea, mental health care approach and social welfare approach should be integrated. The intervention of preventing suicide of suicide attempters should include social welfare services as well as mental health program and should be based on community. There are many health problems, including prevention of suicide, which can not be solved only by the efforts of health care. Many health problems are social problems and the integrated approach is needed to solve them. In order to solve many health care problems and improve health, integrated approach of health, social science, and humanities is needed.

The term new tobacco products (NTPs) refers to the new alternatives to conventional cigarettes. There are several kinds of NTPs in South Korea. The present study discusses the most widely used NTPs namely electronic cigarette (ECs) and heated tobacco products (HTPs). The aims of this study are to evaluate the risk related to the use of ECs and HTPs, introduce policy examples across different countries of management of this issue, and finally, present some policy implications of the problem and our response strategies. Since the advent of ECs, there has been a lot of debate about its risk. Some studies have reported that ECs are less harmful than conventional cigarettes and that they are effective in aiding smoking cessation. Nevertheless, the efficacy of ECs in smoking cessation and its potential health risks are still unclear. However, the obvious fact is that it is not harmless. Regulations on ECs differ from country to country. In many countries, they are strictly regulated as tobacco or toxic substances; however, in the United Kingdom, the use of ECs are included as part of their smoking cessation policy, and in Japan, they are treated as a form of medication. On the other hand, HTPs are the most recently introduced NTPs and they have attained sensational popularity because of the wrongly held belief that they are less harmful to health. So, what about our policy response to these two tobacco products? The research on ECs requires more systematic statistical monitoring, such as monitoring the ratio of dual-users. Further, the new EC smokers should be identified taking into account that the arguments for the use of ECs often emphasize smoking cessation or less risks to health, the government should further strengthen its policy to prevent those claims. The HTPs market experienced a very sharp growth and continues to grow because the government policy is too passive. Taking this as a lesson, it is necessary to approach NTPs, such as HTPs, proactively and increase their contribution to the National Health Promotion Fund by imposing greater taxes on them. Finally, considering the likelihood of NTPs being promoted as a less harmful tobacco product, it is essential to strictly regulate tobacco companies' publicity from the very beginning to ensure that potential consumer s are not mislead.

The purpose of this research is to introduce the best practice of the Japanese national dementia strategy and explore implications to the Korean national de-mentia strategy. Interview was conducted among professions those who is in charge of Kumamoto dementia care practice in Kumamoto province, upon review of related literature and public documents. The Kumamoto model is im-plemented by the department of neuropsychiatry in public university hospitals, which can offer dementia-specialized medical ser-vices. Medical centers for dementia in public university hospitals play a leading role for managing practice and training local demen-tia centers specialist, coordinating medical services among medical institutions and community welfare facilities. In reference to the Kumamoto model, the Korean national dementia strategy can find implications in the direction of current system, specifically its ap-proaches toward policy governance.

Background: The purpose of this study was to evaluate the effectiveness and the level of self-management support on the Metabolic Syndrome Management Program at public health centers in Seoul metropolitan city.
Methods: The effectiveness on the Metabolic Syndrome Management Program were analyzed using secondary data from 1,312 community residents who were receiving program. The level of self-management support on Metabolic Syndrome Management Program was evaluated using an 'Assessment of Primary Care Resources and Supports for Chronic Disease Self-Management' from four public health centers.
Results: The effectiveness on the Metabolic Syndrome Management Program was showed that decreased smoking (p=0.044) and drinking (p<0.001), and increased healthy dietary habit (p<0.001) in health behaviors. It was showed that decreased triglyceride (p=0.002) and increased high-density lipoprotein cholesterol (p<0.001) in clinical indicators. The level of self-management support on Metabolic Syndrome Management Program was 98.1 points and it meaned that implementation is done in an organized and consistent manner using a team approach. There was difference in the level of self-management support by public health centers (p=0.003).
Conclusion: The Metabolic Syndrome Management Program in public health centers was effective, and level of self-management support was done as organizational level, but patient input and mental health were insufficient.

Background: This study is designed to estimate the factors that affect the level of three different performance (publicity, efficiency, profitability) among regional public hospitals.
Methods: The units of analysis are the regional 30 hospitals, which have the operating data during 22 years (from 1933 to 2014). The research method is used by fixed panel analysis. The publicity is measured by medicaid outpatient proportion and medicaid inpatient proportion. The efficiency is measured by two types of efficient score by DEA (data envelopment analysis). The profitability is measured by medical income to medical revenue and ROA (return on total asset).
Results: At first, the increase of bed gives negative affect to the publicity but give positive effect to the efficiency and profitability. Because it means the increase of the region population, it gives more profitability compare to hospital with small number of beds. The more the operating period is the higher effect to the publicity and efficiency because of it's refutation. The debt ratio gives negative effect to publicity, but positive effect to profitability. It is the normal belief that there is inverse relationship between publicity and profitability. The turnover rate of bed gives the negative affect to the publicity, but positive affect to the efficiency and profitability. That give us the implication that type of the inpatient make different effect the hospital performance. The ratio of labor cost give negative effect to all kind of performance. That means that the higher labor cost don't mean the higher publicity and labor cost control is very important factors to hospital performance. So the region hospital have to focus the labor factors more to make higher performance.
Conclusion: As the conclusion, the independent variables give similar effect to the efficiency and the profitability, but give inverse effect to the publicity. That means that if an region hospital want to make the more publicity, it loss the higher efficiency and profitability. Specially publicity is higher negative relation with the profitability.

Background: As of July 2015, per diem payment was changed from fee for service Therefore, this study aims to analyse changes in medical charges and medical services before and after enforcement of the palliative care, targeting palliative care wards in a general hospital, and provide basic data needed for development of per diem payment.
Methods: The subjects of the study were a total of 610 cases consisting of 351 patients of service fee who left hospital (died) from July 2014 to June 2016 and 259 ones of per diem payment at Chosun University Hospital in Gwangju Metropolitan City.
Results: The results are summarized as follows. First, after the palliative care system was applied, benefit medical service charges and insurance increased significantly (p<0.001). As benefit medical service charges increased, benefit private insurance payment increased significantly (p<0.001). Second, after the per diem payment was applied, total private insurance payment to medical institutes decreased significantly (p=0.050) and non-benefit also decreased significantly (p=0.001).
Conclusion: It is suggested that additional rewards in the obligatory palliative care items should be continuously remedied and monitored to provide good quality hospice palliative care.

Background: The purpose of this study was to examine the cultural competence of nurses caring for foreign patients in general hospitals.
Methods: The subjects are 308 nurses who work in general hospitals in Seoul and Gyeonggi-do. The data, collected using a structured questionnaire on cultural competence, coping strategy, multicultural experience, intercultural uncertainty, and intercultural anxiety, were analyzed using descriptive statistics, t-test, analysis of variance, Pearson's correlation analysis, and hierarchical multiple regression.
Results: Cultural competence was significantly associated with marital status, level of education, type of ward, and number of cared foreign patients. In hierarchical multiple regression analysis, the level of cultural competence was significantly associated with married, master degree qualified, high level of coping strategy and multicultural experience, and low level of cultural uncertainty.
Conclusion: The findings revealed the need for educational programs which can contribute to lower the intercultural uncertainty and to enhance coping strategies dealing with foreign patients. In addition, individual and organization efforts to provide opportunities to expand nurses' multicultural experience will affect nurses' cultural competence development.

Background: In this study, we aimed to investigate the drinking behaviors and drinking-related problems of college students in South Korea to produce national alcohol statistics.
Methods: We carefully examined the questionnaires and previous research developed in the previous research project and selected questions that reflect the special environment and culture of college students. In order to stratify a nationally representative sample of college students, the distribution of students around the country were found through the educational statistics database of the Korea Educational Development Institute. Based on this information, we conducted a survey in collaboration with Gallup (Korea) to survey and analyze the drinking behaviors of 5,024 Korean students.
Results: A nationwide cross-sectional survey was conducted in 2017, for Korean college students. A total of 5,024 students were recruited and analyzed. The monthly drinking rate was 78.0% for male students and 72.9% for female students. The high-risk drinking rate was 23.3% for male students and 17.2% for female students. The most popular category for number of drinks per drinking session was 'more than 10 glasses' per drinking session for both male (44.1%) and female (32.8%). On the alcohol use disorders identification test, the greatest proportion of male students were in the high-risk drinking category (score 8 to 15) 43.8%, followed by the 'low-risk drinking' (score 0 to 7) in 43.6%, 'alcohol abuse' (score 16 to 19) 7.2%, and 'alcohol dependence' (greater than 20) 5.4% categories, respectively. For female students, the greatest proportion of female students were in the 'low-risk drinking' in 49.6%, followed by 'high-risk drinking' 37.1%, 'alcohol abuse' 8.4%, and 'alcohol dependence' 4.9% categories, respectively.
Conclusion: The results of the study showed that the drinking behavior of Korean college students was excessive. Overall, it was found that the college population has a greater high-risk drinking behaviors than general adult population. Furthermore, these problem drinking behaviors were prominent among female college students. Results from the present study suggest that it is necessary to monitor the drinking behavior of college students with constant interest and to prepare policies and strategies suitable for these circumstances.

Background: This study investigates the association between sleep duration and diabetes mellitus (DM) in a large representative population-based survey in South Korea.
Methods: The fourth (2007-2009), fifth (2010-2012), and sixth (2013) Korea National Health and Nutrition Examination Survey data sets were used. A total of 37,989 individuals were selected for the study. Chi-square tests and multivariate logistic regression analyses were used to analyze whether general characteristics, health status, and health risk behaviors were associated with DM.
Results: After adjusting for confounders, the odds of DM in short sleepers (≤5 hr/day) and long sleepers (≥9 hr/day) were 1.033-times higher (95% confidence interval [CI], 0.913-1.169) and 1.334-times higher (95% CI, 1.140-1.562), respectively, compared with individuals who slept 7 hr/day. Subgroup analysis according to gender showed a U-shaped association for both genders, although it appeared stronger in men.
Conclusion: This study identified a U-shaped association between sleep duration and the risk for DM. Additional studies should help clarify the important information in this study.

Suicide is a major public health issue that causes over 800,000 deaths each year globally. Korea ranks high in suicide rates, in which around 24.3 per 100,000 individuals are reported to have died by intentional self-harm in 2017 according to Statistics Korea. The aim of this study was to examine the current status and trend of suicide ideation and attempt using data from the following five sources: Korean National Health and Nutrition Examination (KNHANES, '07-13, '15-17), Korean Community Health Survey (KCHS, '08-09, '13, '17), Korean Wealth Panel Study (KOWEPS, '12-17), Korea Health Panel Survey (KHP, '10-13), and Statistics Korea (1983-2017). Suicide ideation and attempts were also further examined based on equalized household income levels. Data published by Statistics Korea were used to show the updated suicide rate and number of deaths by intentional self-harm. The rate of suicide ideation at the recent year was 4.73% (KNHANES, '17), 6.96% (KCHS, '17), 1.63% (KOWEPS, '17), and 5.39% (KHP, '13). That of suicide attempts as recent year was 0.71% (KNHANES, '17), 0.32% (KCHS, '17), and 0.09% (KOWEPS, '17). Annual percentage change of suicidal ideation was -15.4% (KNHANES, '07-17), -2.5% (KCHS, '08-17), -8.6% (KOWEPS, '12-17), and -10.9% (KHP, '10-13). Annual percentage change of suicide attempts was -4.0% (KNHANES, '07-17), -4.4% (KCHS, '08-17), and -14.9% (KOWEPS, '12-17). Individuals with lower income levels were more likely to experience suicide ideation and attempts. Considering that Korea still shows a high suicide rate despite the continuously decreasing trend of suicide ideation and attempt, continuous observation and appropriate policy implementation regarding suicide related problems are necessary.