• KDI Journal of Economic Policy
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• v.30 no.2
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• pp.99-128
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• 2008

Nearly all Koreans are insured through National Health Insurance(NHI). While NHI coverage is nearly universal, it is not complete. Coverage is largely limited to minimal level of hospital and physician expenses, and copayments are required in each case. As a result, Korea's public insurance system covers roughly 50% of overall individual health expenditures, and the remaining 50% consists of copayments for basic services, spending on services that are either not covered or poorly covered by the public system. In response to these gaps in the public system, 64% of the Korean population has supplemental private health insurance. Expansion of private health insurance raises negative externality issue. Like public financing schemes in other countries, the Korean system imposes cost-sharing on patients as a strategy for controlling utilization. Because most insurance policies reimburse patients for their out-of-pocket payments, supplemental insurance is likely to negate the impact of the policy, raising both total and public sector health spending. So far, most empirical analysis of supplemental health insurance to date has focused on the US Medigap programme. It is found that those with supplements apparently consume more health care. Two reasons for higher health care consumption by those with supplements suggest themselves. One is the moral hazard effect: by eliminating copayments and deductibles, supplements reduce the marginal price of care and induce additional consumption. The other explanation is that supplements are purchased by those who anticipate high health expenditures - adverse effect. The main issue addressed has been the separation of the moral hazard effect from the adverse selection one. The general conclusion is that the evidence on adverse selection based on observable variables is mixed. This article investigates the extent to which private supplementary insurance affect use of health care services by public health insurance enrollees, using Korean administrative data and private supplements related data collected through all relevant private insurance companies. I applied a multivariate two-part model to analyze the effects of various types of supplements on the likelihood and level of public health insurance spending and estimated marginal effects of supplements. Separate models were estimated for inpatients and outpatients in public insurance spending. The first part of the model estimated the likelihood of positive spending using probit regression, and the second part estimated the log of spending for those with positive spending. Use of a detailed information of individuals' public health insurance from administration data and of private insurance status from insurance companies made it possible to control for health status, the types of supplemental insurance owned by theses individuals, and other factors that explain spending variations across supplemental insurance categories in isolating the effects of supplemental insurance. Data from 2004 to 2006 were used, and this study found that private insurance increased the probability of a physician visit by less than 1 percent and a hospital admission by about 1 percent. However, supplemental insurance was not found to be associated with a bigger health care service utilization. Two-part models of health care utilization and expenditures showed that those without supplemental insurance had higher inpatient and outpatient expenditures than those with supplements, even after controlling for observable differences.

• Journal of the Korean Society of Environmental Restoration Technology
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• v.14 no.4
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• pp.1-10
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• 2011

This study was conducted to compare the growth of Zoysia japonica depending on different soil treatments in Saemangeum sea dike, which is filled with dredged soil. Zoysia japonica was planted using sod-pitching method on the control plot. On plots which were treated with forest soil and soil improvement, Zoysia japonica seeds were sprayed mechanically. Sixteen months after planting, coverage rate, leaf length, leaf width, and root length were measured and analyzed. Also, three Zoysia japonica samples per plot were collected to analyze nutrient contents. Coverage rate was 100% in B treatment plot(dredged soil+$40kg/m^3$ soil improvement+forest soil), in C treatment plots (dredged soil+$60kg/m^3$ soil improvement+forest soil), and D treatment plots (dredged soil+$60kg/m^3$ soil improvement), while only 43% of the soil surface was covered with Zoysia japonica on control plots. The width of the leaf on C treatment plots (3.79mm) was the highest followed by D treatment (3.49mm), B treatment (2.40mm) and control plots (1.97mm). Leaf and root length of D treatment was 30.18cm and 13.18cm, which were highest among different treatments. The leaf length of D treatment was highest followed by C, B, and A treatments. The root length of D treatment was highest followed by C, A, and B treatments. The nitrogen and phosphate contents of the above ground part of Zoysia japonica were highest in C treatment, followed by D, B, and A treatments. The nitrogen and phosphate contents of the underground part of Zoysia japonica were highest in D treatment, followed by C, A, and B treatments. C and D treatments showed the best results in every aspect of grass growth. The results of this study could be used to identify the cost effective way to improve soil quality for soil surface fixation on reclaimed areas using grass species.

• Clinical and Experimental Pediatrics
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• v.52 no.2
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• pp.159-166
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• 2009

Purpose : Iron deficiency anemia (IDA) is one of the most common nutritional deficiencies in children on a weaning diet. We investigated weaning practices in infants and children, as well as their mothers' knowledge about weaning. Methods : We investigated 129 children with IDA and 166 without IDA (aged 6-36 months) who had visited 10 university hospitals between March 2006 and July 2007. We investigated the hematologic values of both groups. A questionnaire on weaning was answered by the mothers of these children. Results : The hematologic values in the IDA group showed a significant difference from those in the comparison group (P<0.05). Children who were solely breastfed until 6 months of age were 85%, 34% (P<0.05), and weaning was started by 6.3, 6.4 months, respectively (P>0.05). Rice gruel, boiled rice, and fruit juice accounted for approximately 80% of the starting foods in both groups (P>0.05). Only 40% of the children in the IDA group had a balanced diet within a month, versus 38% in the comparison group. In response to questions about the necessity of iron-fortified foods for breast-fed infants, less than 50% of mothers in both groups answered correctly. In the IDA group, 42% showed serum ferritin less than 10 ng/mL, while 92% showed serum MCV less than 72 fL. Conclusion : In conclusion, collection of information on history should be thorough for feeding and selective examinations for IDA in high-risk groups. Considering the adaptation period, we suggest beginning children on a weaning diet at 45 months. In addition, we need to educate mothers on weaning practice, especially on the necessity of iron-fortified foods for breast-fed infants.

• Sleep Medicine and Psychophysiology
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• v.19 no.1
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• pp.27-34
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• 2012

Objectives: The analysis of heart rate variability (HRV) is a useful non-invasive tool to investigate the autonomic nerve function. Previous studies on the relationship between HRV and depression have been reported controversial results. Similarly, the correlation between the serum lipids and depression is debatable. The purpose of this study is to examine the relationship between heart rate variability, lipid profile and depression. Methods: A total of 42 patients with major depressive disorder (MDD) and 32 age and sex-matched normal subjects who had no previous history of major medical and mental illnesses were recruited for this study. A structured-interview was used to assess the general characteristics and psychiatric illness. HRV measures were assessed by time-domain and frequency-domain analyses. Psychological symptoms were measured using the Hamilton rating scale for anxiety (HAM-A), Hamilton rating scale for depression (HAM-D). In addition, the evaluation for lipid profile was performed by blood test. Results: In serum lipid profile test, MDD group showed higher cholesterol ($197.68{\pm}42.94$ mg/dL vs. $176.85{\pm}34.68$ mg/dL, p=0.044), TG ($139.45{\pm}92.54$ mg/dL vs. $91.4{\pm}65.68$ mg/dL, p=0.018), LDL ($130.03{\pm}33.18$ vs. $106.62{\pm}27.08$, p=0.004) level than normal control group. In HRV time domain analyses, the standard deviation of the NN interval (SDNN) was decreased in MDD group than normal control group, but was not significant ($32.82{\pm}14.33$ ms vs. $40.36{\pm}21.40$ms, p=0.078). ApEn (Approximate Entrophy) was significantly increased in MDD group than normal control group ($1.13{\pm}0.11$ vs. $0.91{\pm}0.18$, p<0.001). ApEn was correlated with LDL level (r=0.277, p=0.028), HAM-D scores (r=0.534, p<0.001) and HAM-A scores (r=0.470, p<0.001). Conclusions: MDD patients showed increased ApEn, one of the HRV measurement. And this ApEn was correlated with LDL, HAM-D and HAM-A scores. In this study, the analysis of ApEn would be a useful test of MDD.

• Journal of dental hygiene science
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• v.14 no.3
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• pp.325-331
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• 2014

The purpose of this study was to examine the self-perceived fatigue among 262 dental hygiene students, who have recently experienced clinical practice. In this study, a structured self-reported questionnaire was used to assess and analyze the severity of fatigue among the population. This study was performed from January to September in 2013 to effectively encompass clinical practice. The results are as follows: The self-perceived fatigue of the subjects was significantly higher in a subjective unhealthy group than a subjective healthy group (p=0.000), in a group that was unsatisfied with their program than a group that was satisfied with it (p=0.000), in a group that had dissatisfaction in clinical practice than a group that had satisfaction with it (p=0.000), in a group that had over five weekly of clinical practice than a group that didn't (p=0.000), in a group that had more than 100 patients a day than a group that didn't (p=0.000), in a group that had conflicts between fellow staff than those who didn't (p=0.000), in a group that did not exercise regularly than a group that did (p=0.016). The result of using multiple regression analysis revealed that the variable factors affecting the degree of the self-perceived fatigue were; subjective health status, satisfaction with a clinical practice, the length of clinical practice, the number of patients, and staff conflicts. These variable factors have the explanatory power of 44.5%. In conclusion, to decrease fatigue and allow students in clinical practice to perform effectively, clinical practice educators need to actively participate as a community and develop programs that will decrease the fatigue of students. In addition, in-depth research is needed on the effects of outside factors and variables affecting fatigue.

• Journal of Hospice and Palliative Care
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• v.22 no.1
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• pp.39-47
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• 2019

Purpose: This study was performed to investigate the current status of pediatric palliative care provision and how it is perceived by the palliative care experts. Methods: A descriptive study was conducted with 61 hospice institutions. From September through October 2017, a questionnaire was completed by experts from the participating institutions. Data were analyzed using SPSS 21.0. Results: Among 61 institutions, palliative care is currently provided for pediatric cancer patients by 11 institutions (18.0%), all of which are concentrated in Seoul, Incheon and Gyeonggi and Gyengsang provinces; 85.2% of all do not plan to provide specialized pediatric palliative care in the future. According to the experts, the main barriers in providing pediatric palliative care were the insufficient number of trained specialists regardless of the delivery type. Experts said that it was appropriate to intervene when children were diagnosed with cancer that was less likely to be cured (33.7%) and to move to palliative care institutions when their conditions worsened (38.2%); and it was necessary to establish a specialized pediatric palliative care system, independent from the existing institutions for adult patients (73.8%). Conclusion: It is necessary to develop an education program to establish a nationwide pediatric palliative care centers. Pediatric palliative care intervention should be provided upon diagnosis rather than at the point of death. Patients should be transferred to palliative care institutions after intervention by their existing pediatric palliative care team at the hospital is started.

• Journal of Hospice and Palliative Care
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• v.1 no.1
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• pp.39-46
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• 1998

Purpose : Hospice Care is considered as one of the most perfect solutions for the problems brought up as the number of chronically ill patients are increasing rapidly and most of social welfare oriented countries are seeking the quality of life. Our former studies(1996, 1997) were to find out the current status of the hospice care in Korea by surveying terminally ill patients and their family members as well as medical professionals. The former study was also to conduct the operation research by developing an information service system for training of hospice care teams and volunteers, and hospice patients management. The purpose of this study was that hospice information service system was tested by home visiting hospice care through visiting nurses. Methods : From October 1, 1997 to March 31, 1998, Twenty six terminal cancer patients were included in this study from Seoul National University Hospital and other hospital. Databases and homepage, hospice information service system were designed and developed for the information needed for the hospice care before this study by our research team and this services were available through the internet. Visiting nurses were trained about this system and they visited the patients with PC notebook and provided them hospice care with hospice information system. They collected physical, psychiatric, social data of the subjects at the first visit and during hospice care at home. Results : Sixteen subjects(61.5%) died during the study and the mean survival was 20.7 days. Anorexia(96.2%), immobility(88.5%) and pain(84.6%) were the major symptom in the 26 subjects, Altered nutrition(26.1%) and pain(12.4%) were the most frequent diagnoses in 226 nursing diagnoses of the subjects. Families understood and demanded the hospice care more than patients. And most patients and families didn't demand spiritual or social care. Conclusion : Through this demonstration study, it was found that we have to provide the information of pain management and nutritional support for patients by the nurses and visiting hospice nurse. The information service system needs to be upgraded with information and manpower of spiritual and social care according to the findings.

• The Journal of Korean Academy of Prosthodontics
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• v.46 no.5
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• pp.455-469
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• 2008

Statement of problems: In the area of dental care, the institutionalized elderly have placed the most vulnerable state, and we cannot find their subjective need of dental treatment because of the physical and mental disabilities, But we have no basic investigation of their oral health conditions. Purpose: The aims of the current study were to investigate the oral health status of institutionalized elderly patients who are in the least benefited side of dental service, and to analyze their dental treatment needs. Material and methods: The survey of the oral status was carried out on 758 institutionalized elderly, and 212 elderly who was more than 65 years old from D dental office, and it was based on the Guidelines of Oral Health Research of year 2000 in Republic of Korea. Results and conclusion: The DMFT index of the institutionalized elderly appeared higher than that of the same ages in control group, and it increased with age. The number of residual teeth of the institutionalized elderly appeared lower than that of the same ages in control group, and it decreased with age (P < .05). The number of fixed partial denture in institutionalized elderly was lower than that of the same ages in control group (P < .05). The percentage wearing removable partial denture was not significant between the elderly in institutions and the control group, and was not different according to age between the two groups. The percentage of institutionalized elderly wearing complete denture appeared lower than that of the same ages in control group, and it increased with age. The percentage of institutionalized elderly needing complete denture was higher than that of control group, and the percentage of elderly needing complete denture on the maxilla was higher than that of the mandible. 16.35% of the institutionalized elderly was living without denture in spite of their fully edentulous state. The need for complete denture increased rapidly with age. The number of valued teeth and dental prostheses in shortened dental arch concept and number of occluding pairs of teeth of institutionalized elderly were lower than that of the control group (P < .05). In institutionalized elderly, the number of residual teeth, the number of fixed partial dentures, and the percentage wearing removable partial dentures were higher in the mandible, and the percentage wearing complete dentures was higher in the maxilla (P < .05). The rate of institutionalized elderly needing prosthodontic treatment appeared to be 67.82%, where the number of occluding pairs of teeth was less than 10. When it is difficult to evaluate the subjective need of dental treatment as with the institutionalized elderly, estimation using the number of occluding pairs of teeth can be a useful indicator that can project treatment needs. For the oral health care of institutionalized elderly, it is essential to increase the awareness of nurses and caregivers who take care of them, about the importance of the oral health. Since the average life span and number of residual teeth are increasing gradually, the welfare policy should be changed to implementing regular dental examinations, preservative treatment forms and oral health control of dentulous patients where the traveling-treatment system and visit system are supplemented. And principles should be set that the present denture project of edentulous patients should be done by specialists who'll also be responsible for postmanagement. Through this research of institutionalized elderly, the oral health status which is worsened by aging could be confirmed. And the interest and positive participation of dental society on the elderly should come first in order to solve the rising treatment needs of the elderly patients.

• Journal of the Korean Society of Food Science and Nutrition
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• v.33 no.2
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• pp.305-310
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• 2004

The present study was aimed at investigating effects of chicory inulin and three kinds of oligosaccharides on lipid metabolism in rats fed a high-cholesterol diet. Nine Sprague-Dawley male rats weighing, about 190g were given one of five experimental diets, which were basal cholesterol diet (Control) isomaltooligosaccharide diet (IMO), Iructooligosaccharide diet (FO), chicory inulooligosaccharide diet (CIO) and chicory inulin diet (CI) for 5 weeks. In the oligosaccharide and inulin diets, 6% was added at the expense of sucrose. Rats were pair-fed to the intake of FO group which consumed the least amount, and their feces were collected during the last 4 days. Body weight gain was lower in Fo and CI groups compared with the Control group. Plasma glucose levels of FO and CIO groups were lower and plasma triglyceride concentrations of FO, CIO, and CI groups were lower than those of IMO group. Plasma cholesterol concentration did not differ among groups. Relative liver weight was lower in CIO group. Hepatic triglyceride and cholesterol did not differ among. groups. Fecal excretion of neutral steroid and bile acid were not different among groups, but fecal triglyceride excretion was significantly increased in FO and CI groups compared with the Control group. In conclusion, supplementation of oligosaccharides and chicory inulin at 6% of diets showed no significant hypolipidemic effect in rats fed a high cholesterol diet.

• Journal of Korean Home Economics Education Association
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• v.27 no.4
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• pp.19-35
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• 2015

The purpose of this study was to develop and evaluate a teaching learning process plan for the practice of caring and sharing to improve character of highschool students through Home Economics subject. The teaching learning process plan consisting of 13-session lessons has been developed and implemented according to the ADDIE model for the unit of 'Happy Family Life and Culture led by Family'. The unit was divided into two themes: Theme I caring through sharing and Theme II caring through practice. Six practice elements of caring and sharing such as communication, gratitude, courage, love, empathy, and environment drawn from Theme I are applied to Theme II. Various activities and teaching materials as well as questionnaire were developed. The plan was applied to 8 classes, 287 freshmen of S highschool in Jeonju-si from March to May, 2014. Three factors were drawn from 35 character-related items: self-perception, perception of caring and sharing, and practice of caring and sharing. These factors were related to respondents' satisfaction with family relationships and school life. Two factors except self-perception improved through 13 lessons. Students evaluated that the whole caring and sharing practice lessons of Theme I and II gave them the chance to realize a actual practice in everyday life was important even with small efforts such as cooking for special family. Also students commented that the praising workbook was impressive. All 23 items of evaluation gained from over 3.5 to 4.2 on 5-point scale. It can be concluded that the teaching learning process plan for the practice of caring and sharing for the unit of 'Happy Family Life and Culture led by Family' would improve character of highschool students through the Home Economics subject.