Search Results (436)

Background/Objectives: Oral health has specific importance and consequences from a military and Navy standpoint. The aim of this study was to determine and compare caries prevalence and dental care in Spanish Navy personnel. Methods: A retrospective observational study was carried out with a sample size of 1318 individuals (34.65 ± 8.82 years old) stationed at the Rota naval base in Spain, whose dental charts were examined. Caries prevalence was assessed using the Decayed, Missing, Filled Teeth (DMFT) index; dental care was evaluated using the care index (CI); and demographic and occupational factors were recorded. Results: The population of this study had a mean DMFT index of 5.99 ± 4.71 and a CI of 79%. Through the results of the DMFT index and CI, the statistical significance of the age and rank variables (p < 0.01) was confirmed, with personnel >45 years old and non-commissioned officers (NCOs) having the highest mean DMFT values and the youngest and officer groups having the greatest CI variable. Comparing the DMFT index across genders and ages and between age and rank also revealed significant differences. Conclusions: This study’s findings show a low prevalence of cavitated caries (14.5%), with intermediate DMFT values and higher CIs compared to those in previous published data. Full article

Background: Prematurely born newborns with low birth weight constitute a group of patients who require special care from the first days of life. Prematurity and low birth weight affect about 13.4 million infants. Risk factors include placental disorders but also factors related to the mother, such as smoking, alcohol drinking, drug use, malnutrition, or certain diseases. It is imperative to educate women of reproductive age (15–49) about the basic factors influencing embryonic development, such as oral health, diet, medicine intake, and harmful habits. Even though most women are aware of the negative impact of harmful habits on the fetus, still too little attention is paid to oral health in pregnant women. Poor oral health may influence the well-being of the future mother, as well as of the child. Therefore, women of reproductive age and those who are pregnant must have adequate knowledge on this subject. The aim of this study was to assess the knowledge of Polish women of reproductive age (15–49) regarding oral health during pregnancy, including the impact of dental treatment, oral hygiene, and maternal oral conditions on pregnancy outcomes and the health of the newborn. Materials and Methods: This was a cross-sectional study of 508 women, in the reproductive age, whose age ranged from 18 to 49 years old. The surveys were conducted from April 2020 to November 2020. The questionnaire was originally developed based on the available literature and consisted of seven sections: basic information, general health and habits, pregnancy status and dental care, knowledge of treatment options during pregnancy, oral health status and its association with the risk of preterm birth, prematurity and the child’s oral health, and breastfeeding and oral development. Results: After excluding incomplete questionnaires, a total of 499 questionnaires were included in the analysis. Women participating in the study had a fairly good understanding of the impact of oral health on the fetus and the role of breastfeeding in the development of the stomatognathic system (from 50% to 70% correct answers). However, even though most respondents had completed higher education (344/68.94%), their knowledge of oral health, preterm birth, and low birth weight was very limited (including the impact of inflammation on the intrauterine development of the child or bacteria and transfer across the placenta). In these sections, the percentage of correct answers ranged from less than 20% to 50%. When analyzing knowledge by age, education, number of births, and place of residence, the highest levels of knowledge were observed among respondents with higher education, particularly those aged 27–32. Conclusions: Respondents had a fairly good understanding of the general impact of oral health during pregnancy and recognition of the importance of breastfeeding for infants. However, their knowledge about the impact of bacteria and inflammation in the mother’s oral cavity on prematurity and low birth weight was limited. Therefore, educating women of reproductive age and pregnant women on this topic is essential, as it may help reduce the adverse consequences of prematurity. Full article

Background: Community-acquired pneumonia (CAP) is the leading cause of death in infants aged 1–59 months. Concurrent with this, there is a need to prescribe antibiotics wisely in Vietnam due to concerns with rising antimicrobial resistance (AMR). Consequently, an urgent need has arisen to treat patients according to agreed guidelines. The aim of this study was to investigate the current management of infants under five years old with CAP in Vietnam as well as identify possible obstacles to adhering to national guidelines. Methods: A mixed-method approach was used incorporating both quantitative and qualitative data analysis in a leading hospital in Vietnam, which influences others. Data from 108 pediatric patient records were collected and analyzed. Subsequently, in-depth interviews were conducted with pediatric doctors treating these patients to ascertain possible reasons for non-adherence to guidelines. Results: The mean age of children diagnosed with CAP was 27.94 ± 12.99 months, with 82.4% having non-severe CAP, and 41.7% of children had previously used antibiotics before hospitalization. The median length of hospital stay was 7 days. All children were prescribed antibiotics, 91.4% of children received these initially intravenously, with third-generation cephalosporins being the most (91.7%) commonly prescribed. Cefoperazone/sulbactam was the most frequently prescribed (48.2%) antibiotic. However, on 96.1% of occasions cefoperazone/sulbactam was given at higher doses than the label instructions. Overall, 73.3% of antibiotics prescribed were “Watch” antibiotics. In addition, the proportion of initial antibiotic regimens that were consistent with current national guidelines was only 4.63%. Conclusions: There were considerable concerns with low adherence rates to current guidelines alongside high rates of prescribing of injectable third-generation cephalosporins due to various internal and external barriers. Antimicrobial stewardship programs with updated national guidelines are urgently needed in Vietnamese hospitals to treat CAP in children as part of ongoing measures to reduce increasing AMR rates. Such activities should also help improve antibiotic use in the community following improved education of trainee ambulatory care physicians regarding appropriate management of children with CAP. Full article

Background: This study examined treatment outcomes for cannabis use disorder (CUD) among adolescents (12–17 years old) in the United States. Methods: Data from the 2018–2021 Treatment Episode Data Set-Discharges (TEDS-D) included 40,054 adolescents diagnosed with CUD. Descriptive statistics, Chi-square tests, and multivariable logistic regression assessed treatment outcomes and factors associated with treatment completion. Results: Only 36.8% of adolescents completed treatment. The most common reasons for not completing treatment were dropping out (28.4%) and transferring to another facility/program (17.0%). Males and Black non-Hispanic adolescents had lower odds of completing treatment (OR = 0.79, 95%CI: 0.75–0.84), while Hispanic (OR = 1.13, 95%CI: 1.08–1.18), Asian (OR = 1.56, 95%CI: 1.3–1.86) and Native Hawaiian/Pacific Islander adolescents (OR = 2.31, 95%CI: 2.04–2.61) had higher odds of completion compared to their White counterparts. Independent living arrangements, homelessness, arrests in the past 30 days and younger age (<15 years old) decreased the likelihood of treatment completion. Adolescents with co-occurring mental health and substance use disorders also had lower completion rates (OR = 0.79, 95%CI: 0.77–0.86). Referral from schools/employers and treatment settings were associated with a higher success, particularly with stays of 4–6 months and 7–12 months. Conclusion: This study highlights the need for targeted CUD treatment programs that support at-risk adolescents, especially those experiencing homelessness or facing legal issues. High dropout and transition rates suggest a need for continuity of care and program integration between facilities. Strengthening coordination among public health officials, community organizations, and stakeholders is essential to developing culturally responsive treatment interventions that address social determinants of health, substance use, and mental health in this vulnerable population. Full article

Background: Trauma-related injuries are among the most common reasons for paediatric hospital presentations and represent a substantial component of orthopaedic care. Their management poses unique challenges due to ongoing skeletal development in children. While most reported fractures occur at home or during sports, prior studies have primarily used data from urban European populations, limiting the relevance of their findings for rural and regional settings. Urban-centred research often informs public healthcare guidelines, treatment algorithms, and infrastructure planning, introducing a bias when findings are generalised outside of metropolitan populations. This study addresses that gap by analysing fracture data from two rural trauma centres in New South Wales, Australia. This study assesses paediatric fractures resulting from severe injury mechanisms in rural areas, identifying common fracture types, underlying mechanisms, and treatment approaches to highlight differences in demographics. These findings aim to cast a light on healthcare challenges that regional areas face and to improve the overall cultural safety of children who live and grow up outside of the metropolitan trauma networks. Methods: We analysed data from two major rural referral hospitals in New South Wales (NSW) for paediatric injuries presenting between 1 January 2018 and 31 December 2022. This study included 150 patients presenting with fractures following severe mechanisms of injury, triaged into Australasian Triage Scale (ATS) categories 1 and 2 upon initial presentation. Results: A total of 150 severe fractures were identified, primarily affecting the upper and lower limbs. Males presented more frequently than females, and children aged 10–14 years old were most commonly affected. High-energy trauma from motorcycle (dirt bike) accidents was the leading mechanism of injury among all patients, and accounted for >50% of injuries among 10–14-year-old patients. The most common fractures sustained in these events were upper limb fractures, notably of the clavicle (n = 26, 17.3%) and combined radius/ulna fractures (n = 26, 17.3%). Conclusions: Paediatric trauma in regional Australia presents a unique and under-reported challenge, with high-energy injuries frequently linked to unregulated underage dirt bike use. Unlike urban centres where low-energy mechanisms dominate, rural areas require targeted prevention strategies. While most cases were appropriately managed locally, some were transferred to tertiary centres. These findings lay the groundwork for multi-centre research, and support the need for region-specific policy reform in the form of improved formal injury surveillance, injury prevention initiatives, and the regulation of under-aged off-road vehicular usage. Full article

Background/objectives: Despite advancements in early diagnosis and clinical practices guided by standardized care protocols, Merkel cell carcinoma (MCC) is marked by an unfavorable prognosis with a 5-year relative survival rate of 65%, based primarily on data collected prior to the introduction of immunotherapy. Regional nodal metastases affect 40–50% of MCC patients, while approximately 33% experience distant dissemination. Among these, bone and bone marrow metastases are particularly notable, although the characteristics and clinical implications of this metastatic disease in MCC remain poorly understood. Methods: A comprehensive review was conducted using the Medline database (via PubMed) up to January 2025. The search strategy included the string “(Merkel cell carcinoma AND (bone OR marrow))”. Results: A total of 1133 (69.3% male and 30.7% female) patients diagnosed with advanced MCC were collected. The median (IQR) age at diagnosis was 67.5 (12.65) years old. Overall, 201 (20.8%) cases of bone and/or bone marrow metastases were identified and linked to a primary known MCC in 75.7% of cases. Bone metastases (BMs) appear as the third most common metastatic site, following the liver (second) and lymph nodes (first). They show mixed biological and radiological behavior, with a marked preference for the axial skeleton over the appendicular one. Addressing the characteristics of metastatic bone disease, neurological symptoms were the most documented, whereas bone marrow involvement and leukemic spread seemed to be primarily related to immunosuppression. Multimodal treatment strategies, including platinum-based chemotherapy and radiotherapy, were the primary approaches adopted, reflecting therapeutic practices from the pre-immunotherapy era. Conclusions: The pattern of metastatic spread in MCC differs among studies, with the bones resulting as the third most common site of distant spread. Excluding head and neck MCC, which seems to be more regularly associated with liver metastases, the relationship between the primary tumor site and the development of bone or bone marrow metastases appears inconsistent. Overall, BMs mostly correlated with advanced MCC stages and poorer survival outcomes, with a median overall survival (OS) of 8 months (range 12.75–4). The integration of international guidelines, evolving evidence from clinical trials, and the expanding role of immune checkpoint inhibitors (ICIs) will contribute to improving systemic disease control and enhance patient care. Full article

Background/Objectives: Burnout and anger are prevalent among healthcare professionals in high-stress environments, particularly in addiction services. This study explores the relationship between burnout and anger among 124 operators working in public addiction services (SERD) in Calabria and Sicily. The objective is to assess how different anger dimensions contribute to burnout and identify protective factors that could inform targeted interventions. Methods: The sample consisted of 58 men and 66 women, with a mean age of 39.2 years (SD = 9.8), ranging from 25 to 59 years old. Burnout was measured using the Maslach Burnout Inventory (MBI), assessing emotional exhaustion, depersonalization, and personal accomplishment. Anger was evaluated through the State-Trait Anger Expression Inventory-2 (STAXI-2), examining trait anger, state anger, anger expression (anger-in, anger-out), and anger control. A cross-sectional design was used, with correlation and regression analyses controlling for gender and years of service. Results: High levels of burnout, particularly emotional exhaustion and depersonalization, were found. Emotional exhaustion correlated strongly with trait anger, indicating that individuals with a chronic predisposition to anger are more vulnerable to burnout. Suppression of anger (anger-in) significantly predicted depersonalization, exacerbating emotional disengagement from patients. Conversely, anger control acted as a protective factor, helping maintain a sense of personal accomplishment. Conclusions: These findings underscore the importance of emotional regulation in mitigating burnout among addiction service workers. Interventions such as emotional regulation training and anger management programs could help reduce psychological distress and promote resilience. Workplace strategies that support emotional well-being may improve both staff retention and patient care quality. Further research should explore longitudinal trends and intervention effectiveness. Full article

Background/Objectives: Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare autoimmune disorder caused by mutations in the AIRE gene. Approximately 60% of affected females develop premature ovarian insufficiency (POI) by age 30, often most commonly due to steroidogenic autoantibodies. Although APECED is typically diagnosed in childhood, its reproductive implications are underrecognized. This study reports a case of successful fertility preservation in an adult woman with APECED and reviews the relevant literature. Methods: We describe the clinical course of a 37-year-old woman with genetically confirmed APECED who underwent ovarian stimulation for fertility preservation. A comprehensive PubMed search was also conducted to identify English-language case reports on fertility preservation in APECED-associated POI. Results: The patient experienced menarche at age 13, adrenal insufficiency at 14, and menstrual irregularities from age 18. Genetic analysis confirmed an AIRE mutation (NM_000383: exon 11: c.1400+1G>A). Given her relatively high anti-Müllerian hormone level, she opted for fertility preservation and underwent six cycles of ovarian stimulation, resulting in the cryopreservation of 17 mature oocytes. During ovarian stimulation, multiple follicular developments were observed, but serum E2 levels remained low. The literature review identified fewer than 20 reported cases addressing fertility preservation in APECED, highlighting its rarity and the lack of standardized management. Conclusions: Although APECED frequently leads to early POI due to impaired steroidogenesis, residual ovarian function may persist. Early assessment of ovarian reserve and timely fertility counseling are crucial, even in asymptomatic patients or those diagnosed in childhood. Reproductive planning should be integrated into the long-term care of women with APECED. Full article

Background/Objectives: The INTegRated InterveNtion of pSychogerIatric Care (INTRINSIC) network introduces an innovative model of psychogeriatric care, combining tertiary mental healthcare with primary care for older adults in low-resource settings in Greece via telemedicine. This study explores viewpoints of healthcare professionals on care delivery within the frames of old-age mental telehealth services in low-resource settings. Methods: All healthcare professionals, including 13 medical and 11 non-medical professionals from diverse healthcare units in urban, rural, and insular areas, participated in a semi-structured survey. Thematic analysis identified key insights. Results: Most participants (N = 19) highlighted the high usability of the INTRINSIC services and their high satisfaction for being members of the network (N = 17) was attributed to the collaborative delivery of integrated, specialized healthcare services in primary healthcare (N = 17). Further identified advantages of the services included the positive impact on timely care delivery (N = 6), cost effectiveness, and alleviation of hospital strain. Healthcare professionals valued the holistic approach of the INTRINSIC services to psychogeriatric care (N = 8) and their role in the improvement of it in communities in low-resource settings (N = 13). However, challenges were also reported, including the low openness and reluctance of service users (N = 7), difficulties in using the INTRINSIC digital platform (N = 5), and increased workload (N = 5). Conclusions: Despite these issues, the INTRINSIC services embody an innovative telehealth model for delivering high-quality, tertiary, mental, and cognitive healthcare services to older adults in underserved areas. Full article

Background/Objectives: Sepsis is one of the most common causes of death worldwide, and its diagnosis remains a challenge for clinicians. The main purpose of this study was to appraise the diagnosis and antibiotic prescription pattern for sepsis admitted to the Emergency Department (ED), comparing Sepsis-2 to Sepsis-3 criteria. Methods: The study was conducted in an ED of a tertiary care medical center in Hungary. We included all adult patients who were diagnosed with sepsis in 2023. Data collection was made manually from UD MED System. Diagnosis was assessed based on Sepsis-2 and Sepsis-3 criteria, then compared. Further analyses were made only in cases with confirmed sepsis diagnosis. Antibiotic guideline adherence was determined according to the local guideline in force. Fisher’s exact test, t-test, and ANOVA were applied to compare categorical and continuous variables between groups. The Kaplan–Meier test was applied for probability of survival. Significant p-values were defined as below 0.05. Results: The substantial majority of patients recorded with sepsis in the ED met both the Sepsis-2 and Sepsis-3 criteria (80%), while the rate of misdiagnosis was similar (Sepsis-2: 16/91, 17.6% and Sepsis-3: 14/91, 15.4%). The most important identified risk factors in sepsis were old age (60+ years) and comorbidities (CCI ≥ 4). Elevated LDH (median 325 mg/dL) and decreased albumin levels (median 26 g/L) can be used as early indicators of sepsis. Although the time to first antibiotic administration was not associated with significantly better clinical outcomes, the guideline-adherent agent selection (Sepsis-2: 18/43, 41.9% and Sepsis-3: 19/46: 41.3%) led to a significantly longer survival (median 37 vs. 4 days). Conclusions: No significant differences were found in diagnostic accuracy or prediction of mortality between Sepsis-2 and Sepsis-3. Guideline-adherent antibiotics may lead to significantly higher survival rate in sepsis. Full article

Background: Community-acquired bacterial pneumonia (CABP) is a common and costly cause of hospitalization. Although severe CABP (sCABP) occurs in 10–25% of all pneumonia hospitalizations, little generalizable data examine its characteristics and outcomes or hospital resource utilization. Methods: We conducted a retrospective single-group cohort study of adults within the IQVIA hospital Charge Data Master, 2018–2022. We identified CABP via an ICD-10 code algorithm and sCABP was defined as an episode requiring ICU care. We examined baseline characteristics and outcomes, including mortality, costs, and readmission rates. We developed models to identify risk factors associated with readmissions. Results: Among 24,149 patients with sCABP, 14,266 (58.4%) were ≥65 years old and 55.2% were male. The majority were hospitalized in large (300+ beds, 50.9%), urban (91.9%) teaching (62.7%) institutions in the US Southern region (52.3%). The mean (SD) Charlson Comorbidity Index was 1.35 (2.33). The most common comorbidities were hypertension (16.7%), diabetes mellitus (15.7%), and chronic obstructive pulmonary disease (COPD) (12.9%). Hospital mortality was 15.9%. The mean (SD) hospital length of stay (LOS) and costs were 13.6 (12.1) and USD 91,965 (USD 133,734), respectively. An amount of 20% required a readmission within 30 days. Readmission was most strongly associated with older age and the presence of select comorbidities (diabetes mellitus, congestive heart failure, and COPD), each with an odds ratio > 1.4 and 95% confidence intervals excluding 1.0. Conclusions: Patients with sCABP comprise a large population with high mortality and 30-day readmissions. The intrinsic factors related to the latter lend themselves to early recognition and aggressive efforts at reducing complications. Full article

Objectives: Despite the relatively high incidence of vulvar cancer, there is a noticeable lack of studies in Romania and other Eastern European countries focused on evaluating the long-term oncological outcomes and Quality of Life (QoL) for patients with this condition. Methods: A total of 91 patients were included in the study. The first objective was to evaluate the 5-year overall survival (OS) in patients with vulvar cancer at International Federation of Gynecology and Obstetrics (FIGO) stages IA-IVA who underwent surgery, ±adjuvant radiotherapy (RT). Additionally, the study aimed to identify prognostic factors that could either positively or negatively influence survival outcomes in these patients. The second objective was to assess the QoL, conducted using validated questionnaires issued by the European Organization for Research and Treatment of Cancer, specifically the QLQ-CX30 and QLQ-VU34. Results: The patients had an average age of 67.7 years (38–91). At the time of assessment, 51.6% of the patients were alive. Additionally, the 5-year OS was reported at 45%. The multivariate analysis indicated that age ≤ 50 years (p < 0.03), FIGO stage IB (p < 0.007), and tumor differentiation grade I (p < 0.01) were associated with improved survival rates. Conversely, age > 80 years (p < 0.05), FIGO stages IIIB (p < 0.01) and IIIC (p < 0.06), tumor size > 5 cm (p < 0.02), positive resection margins (p < 0.03), lymph node metastasis (p < 0.06), and pelvic exenteration (p < 0.002) were identified as independent negative prognostic factors. Of the 47 living patients, 32 completed the QoL questionnaires. The respondents reported a decent overall QoL score of 65.3. However, treatment-specific symptoms, such as vulvar scarring, vulvar swelling, groin lymphedema, and leg lymphedema, had a negative impact on QoL. Consequently, functional symptoms like fatigue, pain, and sleep disturbances persisted, leading to a body image perception score of 33.7 on a scale from 0 to 100. Conclusions: This study highlights decent OS and QoL outcomes. It is important to note that vulvar cancer primarily affects older women. In this study, 51.6% of patients were over 70 years old at the time of surgery. Consequently, the 5-year OS of 45% could not be attributed solely to oncological factors, as most of these patients did not die from recurrences but rather from associated comorbidities. The findings of this study provide a foundation for future randomized controlled trials aimed at further enhancing vulvar cancer patients’ care and outcomes. Full article

Background: Client satisfaction with HIV service delivery reflects the ability of healthcare providers to effectively deliver care and treatment that meets the requirements and expectations of clients, and is associated with improved health outcomes, including increased retention in care and HIV viral suppression. The aim of the study was to conduct a client satisfaction study among PLHIV attending a large HIV clinic in Trinidad to identify the gaps in service delivery and factors associated with reduced HIV viral suppression. Methods: This cross-sectional study was conducted over the period April 2023–March 2024 among 362 clients attending the HIV clinic. A structured, pre-tested questionnaire collected demographic data and factors that affected client clinic experiences, including wait time, communication with staff, confidentiality, physical amenities and HIV viral suppression. Multivariable logistic regression was used to assess the likelihood of reporting satisfaction based on key independent variables. Results: Among participants, 219 (60.5%) were females, 202 (55.8%) were aged 30–49 years and 337 (93.1%) were virally suppressed. Participants reported satisfaction with overall care (95.3%), confidentiality (95.9%) and interactions with doctors (96.1%), nurses (98.6%) and other staff. Dissatisfaction was reported with facility-related, elements including the outdoor/tented waiting area (46.1%), the toilet/washrooms (37.0%) and the clinic wait time (31.8%). Participants were less likely to be satisfied with the amount of medication received if they had unsuppressed viral loads (p = 0.035), were aged 20–29 years old (p = 0.048) or had a tertiary education (p = 0.008). Conclusions: The study showed that 93.1% of the study participants were virally suppressed, and there was a general level of satisfaction with the overall care at the clinic, confidentiality and healthcare workers’ service delivery; however, gaps involving the physical facilities, wait times and medication services should be prioritized. Full article

Introduction: People with disabilities are characterized by suboptimal health and lower self-rating health. Their need for health care is greater, they often have a higher prevalence of health problems and they have more difficulty accessing health care. The aim of this study was to assess the health behaviors and health indicators of 12–18-year-old young people with intellectual disabilities and autism spectrum disorder, and to explore their school-related perceptions in the Northern Great Plain region of Hungary. Materials and Methods: A cross-sectional questionnaire survey was conducted with the participation of 185 young people. A custom questionnaire was used, based on the Health Behavior in School-aged Children (HBSC) survey, assessing eating habits, oral care, physical activity, mental well-being, and self-reported health status. The sample was categorized into three groups: the ID1 (Intellectual Disability level 1) group, encompassing young individuals with mild intellectual disability; the ID2 group, encompassing young people with moderate intellectual disability; and the ID+ASD group, encompassing young individuals affected by both intellectual disability and autism spectrum disorder. Results: Consumption of various food types was below optimal levels. Low intake of fruits and vegetables was common, with only 21.6% of the respondents consuming fruit daily and 23.8% consuming vegetables daily. ID1 group reported significantly higher rates of nervousness several times a week (17.8% vs. 5.6% and 6.9%, p < 0.001), sleep difficulties (28.8% vs. 7.4% and 15.5%, p = 0.032), and dizziness (9.6% vs. 1.9% and 3.4%, p = 0.022) compared to the other two groups. A third school-related factor, related to negative emotions, showed a near-significant difference (p = 0.064), suggesting that students with both autism spectrum disorder and intellectual disability perceive lower levels of acceptance from teachers. On school-free days, computer usage was significantly highest in the ID+ASD group; 50% of them used a computer for at least 4 h per day. Conclusions: To improve mental well-being among affected children, psychological support and the implementation of mental health programs are recommended. In addition to teaching stress management techniques and coping mechanisms, integrating relaxation techniques into comprehensive developmental programs—both individually and in groups—is advised. For teachers, it is recommended to acquire disability-specific communication strategies. Full article

Objectives: This study investigates the presence of crowding-in or crowding-out effects of long-term care insurance (LTCI) on older adults’ care in Korea. Additionally, it examines the influence of old-age income security and private systems, including private transfer income and private health insurance, on these effects. The analysis focuses on three aspects: family-provided care, private non-family care, and total care expenses. Methods: This study conducted logistic and linear regression. Logistic regression was used to examine the likelihood of receiving family-provided and private non-family care, while linear regression analyzed factors associated with total care expenditures. Results: The results reveal a crowding-in effect for family care, as greater utilization of public LTCI is positively associated with family-provided care. However, the relationship between public LTCI and private non-family care was not statistically significant, suggesting that the crowding-in effect on private care systems remains limited. Lastly, LTCI utilization was significantly associated with higher care expenditures. It is noteworthy that the current public LTCI in Korea has low coverage, resulting in insufficient care provision. Consequently, there is growing activity in the private care sector. Conclusions: These findings highlight the need for a more integrated approach to long-term care in Korea, balancing public, private, and family care resources. To achieve quality integrated long-term care for older people, policymakers should focus on expanding public LTCI coverage while fostering coordination between family caregivers and professional care services, ensuring a comprehensive and high-quality care system that meets the diverse needs of Korea’s aging population. Full article