• Journal of Preventive Medicine and Public Health
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• 제29권2호
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• pp.311-329
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• 1996

This study was designed to compare the level of medical utilization between the urban and rural areas of Korea and to explain the differences between the two regions. Data from the National Health Interview Survey performed by the Korean Institute of Health & Social Affairs in 1992 were used for this study utilizing a sample size of 21,841 people. The level of medical utilization such as the number of physician visits and the number of hospital admissions was compared between the regions with ANOVA. Various determinants for medical use were also compared by univariate analysis. Statistical models which included enabling factors, predisposing factors, need factors and region were constructed for bivariate analysis in order to further elucidate the level of medical utilization. The results were as follows: 1. There was greater medical use, both in terms of physician visits and inpatient care in the rural areas in spite of insufficient health resources. The particular reasons for higher medical utilization in rural areas were attributed to a higher number of initial physician visits as well as a longer the length of stay per hospital admission. Therefore, indicators representing the degree of met need (utilization/need) showed no significant difference between rural and urban areas in spite of the fact that the medical need is larger in rural areas. 2. Use of public health facilities received a significant portion of physician visits in the rural area. The government's effort to enhance primary health care through health centers, health subcenters and the nurse practitioner's post in rural areas has contributed to the increase of access to medical care in the rural areas. 3. There were some differences in the socio-demographic characteristics between two regions ; There were more elderly people over the age of 65: unstable marital status, less education and lower incomes also characterized the rural areas. Therefore, among rural people, there were more predisposing factors for medical use. Additionaly, need factors such as poor self-reported health status and high morbidity level were also high in the rural area. 4. In contrast it was learned that, the supply of health resources was mostly concentrated in the urban areas except for public health facilities. Therefore, geographical access to medical care was lower in the rural area both in terms travel time and travel cost. 5. The coefficient of the region variable was insignificant in the regression model which controlled the supply factor only. However, utilization was significantly higher in urban areas if the model included predisposing factors and need factors in addition to the supply factor. The results were interpreted as rural people have greater medical needs.

• Journal of Preventive Medicine and Public Health
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• 제39권6호
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• pp.493-498
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• 2006

Objectives : Diabetes has been reported as a risk factor for several cancers. However, the association between diabetes and gastric cancer has been inconsistent. The aim of this study was to evaluate the association between the fasting serum glucose level and gastric cancer risk in Korea. Methods : Among the members of the Korean Multi-Center Cancer Cohort (KMCC) from 1993 to 2004, a total of 100 incident gastric cancer cases were ascertained until December 31, 2002 and 400 controls were matched according to age, sex, and year and area of enrollment. Of the eligible subjects, those without fasting serum glucose level information were excluded, with a total of 64 cases and 236 controls finally selected. On enrollment, all subjects completed a baseline demographic and lifestyle characteristics questionnaire, and had their fasting serum glucose level measured. The Helicobacter pylori infection status was determined by an immunoblot assay using long-term stored serum. The odds ratios (ORs) were estimated using conditional and unconditional logistic regression models adjusted for the H. pylori infection status, smoking, drinking, education, follow-up period and matching variables. Results : The ORs for risk of gastric cancer according to the serum glucose level were 1.33 [95% CI=0.50-3.53] and 1.66 [95% CI=0.55-5.02] for the categories of 100-125 and 126 mg/dL or greater, respectively, compared to the category of less than 100 mg/dL. No increased risk of gastric cancer according to the serum glucose level was found (p-trend=0.337). Conclusions : This study provides no evidence for an association of the serum glucose level with gastric cancer.

• 한국인구학
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• 제30권3호
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• pp.107-135
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• 2007

본 연구에서는 우리나라 가구의 자녀수 결정요인을 Count 모형을 이용하여 분석하였다. 분석 기법으로는 자녀수가 감마(Gamma) count 분포를 따른다는 가정 하에 기본적인 회귀분석과 40세 이하 기혼여성의 완결출산에 대한 대리변수로 예상출산자녀수에 대한 회귀분석, 허들모형 그리고 기혼여성의 노동시장 참여와 자녀출산간의 내생성을 고려한 모형을 각각 이용하여 다각적인 방법론으로 출산결정요인을 분석하였다. 분석결과, 가구의 소득수준이 높을수록 40세 이상 기혼여성의 자녀수는 많은 것으로 나타나는 반면, $18{\sim}39$세 기혼여성의 경우에는 소득이 자녀수에 큰 영향을 미치지 못하는 것으로 보인다. 기혼여성의 경제활동참여는 39세 이하의 비교적 젊은 여성들에게서 출산 예상자녀수에 부정적인 영향을 주는 것을 뚜렷이 확인할 수 있고, 출산과 경제활동참여 간에는 내생성이 존재하는 것으로 확인되었다. 허들모형을 이용한 결과, 기혼여성의 학력은 자녀출산 여부에는 긍정적으로 작용할 수 있으나 자녀수 결정에는 부정적으로 작용하여 기혼여성 학력이 높을수록 출산율은 감소하게 된다. 다양한 회귀분석 결과에 근거할 때 Becker의 Quantity-Quality 모형의 핵심내용은 우리나라의 자녀수 결정에 있어서도 대체적으로 적용됨을 확인할 수 있다.

• Journal of Chest Surgery
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• 제53권3호
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• pp.104-113
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• 2020

Background: Accurate intraoperative assessment of mediastinal lymph nodes is a critical aspect of lung cancer surgery. The efficacy and potential for upstaging implicit in these dissections must therefore be revisited in the current era of uniportal video-assisted thoracoscopic surgery (VATS). Methods: A retrospective study was conducted in which 544 patients with stage I (T1abc-T2a, N0, M0) primary lung cancer were analyzed. To assess risk factors for nodal upstaging and to limit any imbalance imposed by surgical choices, we constructed an inverse probability of treatment-weighted (IPTW) logistic regression model (in addition to non-weighted logistic models). We also evaluated risk factors for early locoregional recurrence using IPTW logistic regression analysis. Results: In the comparison of uniportal and multiportal VATS, the resected lymph node count (14.03±8.02 vs. 14.41±7.41, respectively; p=0.48) and rate of nodal upstaging (6.5% vs. 8.7%, respectively; p=0.51) appeared similar. Predictors of nodal upstaging included tumor size (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.12-2.70), carcinoembryonic antigen level (OR, 1.11; 95% CI, 1.04-1.18), and histologically confirmed pleural invasion (OR, 3.97; 95% CI, 1.89-8.34). The risk factors for locoregional recurrence within 1 year were found to be number of resected N2 nodes, age, and nodal upstaging. Conclusion: Uniportal and multiportal VATS appear similar with regard to accuracy and thoroughness, showing no significant difference in the extent of nodal dissection.

• Tuberculosis and Respiratory Diseases
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• 제56권2호
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• pp.169-177
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• 2004

연구배경 : Cyclooxygenase는 비스테로이드성 항염증제의 주요 작용부위로 실험적 모델이나 역학적 연구에서 암 발생을 억제하는 것으로 알려져 있다. COX-2는 prostaglandin E2와 같은 prostaglandin 합성을 통해 종양의 성장, 침윤 그리고 신생혈관에 중요한 역할을 하는 것으로 알려져 있다. 본 연구에서는 절제된 비소세포폐암조직에서 COX-2의 발현과 COX-2의 예후인자로서의 의의를 조사해 보았다. 대상 및 방법 : 1997년부터 2002년까지 본원에 내원하여 원발성 비소세포폐암으로 진단 받은 후 근치 목적의 절제술을 받았던 환자 84명을 대상으로 파라핀 포매된 조직을 택하여 면역 화학염색 방법을 통하여 COX-2 의 발현을 관찰하였다. COX-2가 발현된 암세포의 비율이 10% 이상인 경우를 양성으로 하였다. 결 과 : 평균 연령은 63세, 남녀 비는 67:17이었으며, 조직병리학적 분류는 편평상피암 53례, 선암 24례, 대세포암 7례였다. 병기는 I 병기 37례, II 병기 29례, IIIA 병기 18례였다. 총 84례 중 COX-2는 양성군이 73%(61/84례), 음성군이 27%(23/84례)이었다. COX-2 발현과 TNM 병기, 조직학적 분류와는 유의한 상관관계가 없었으나, 중간 생존기간은 COX-2 양성군이 음성군보다 통계적으로 유의하게 짧았다. 결 론 : 비소세포폐암에서 COX-2 항원 발현 음성군이 중간 생존기간이 길었다.

• Asian-Australasian Journal of Animal Sciences
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• 제26권4호
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• pp.470-475
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• 2013

The objective of this study was to estimate genetic parameters that are to be used for across-herd genetic evaluations of seed stock pigs at GGP level. Performance data with pedigree information collected from swine breeder farms in Korea were provided by Korea Animal Improvement Association (AIAK). Performance data were composed of final body weights at test days and ultrasound measures of back fat thickness (BF), rib eye area (EMA) and retail cut percentage (RCP). Breeds of swine tested were Landrace, Yorkshire and Duroc. Days to 90 kg body weight (DAYS90) were estimated with linear function of age and ADG calculated from body weights at test days. Ultrasound measures were taken with A-mode ultrasound scanners by trained technicians. Number of performance records after censoring outliers and keeping records pigs only born from year 2000 were of 78,068 Duroc pigs, 101,821 Landrace pigs and 281,421 Yorkshire pigs. Models included contemporary groups defined by the same herd and the same seasons of births of the same year, which was regarded as fixed along with the effect of sex for all traits and body weight at test day as a linear covariate for ultrasound measures. REML estimation was processed with REMLF90 program. Heritability estimates were 0.40, 0.32, 0.21 0.39 for DAYS90, ADG, BF, EMA, RCP, respectively for Duroc population. Respective heritability estimates for Landrace population were 0.43, 0.41, 0.22, and 0.43 and for Yorkshire population were 0.36, 0.38, 0.22, and 0.42. Genetic correlation coefficients of DAYS90 with BF, EMA, or RCP were estimated to be 0.00 to 0.09, -0.15 to -0.25, 0.22 to 0.28, respectively for three breeds populations. Genetic correlation coefficients estimated between BF and EMA was -0.33 to -0.39. Genetic correlation coefficient estimated between BF and RCP was high and negative (-0.78 to -0.85) but the environmental correlation coefficients between these two traits was medium and negative (near -0.35), which describes a highly correlated genetic response to selection on one or the other of these traits. Genetic Trends of all three breeds tend to be towards bigger EMA or greater RCP and shorter DAYS90 especially from generations born after year 2000.

• Asian-Australasian Journal of Animal Sciences
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• 제29권11호
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• pp.1530-1540
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• 2016

This study was conducted to estimate the genetic parameters of ${\beta}$-hydroxybutyrate (BHBA) and acetone concentration in milk by Fourier transform infrared spectroscopy along with test-day milk production traits including fat %, protein % and milk yield based on monthly samples of milk obtained as part of a routine milk recording program in Korea. Additionally, the feasibility of using such data in the official dairy cattle breeding system for selection of cows with low susceptibility of ketosis was evaluated. A total of 57,190 monthly test-day records for parities 1, 2, and 3 of 7,895 cows with pedigree information were collected from April 2012 to August 2014 from herds enrolled in the Korea Animal Improvement Association. Multi-trait random regression models were separately applied to estimate genetic parameters of test-day records for each parity. The model included fixed herd test-day effects, calving age and season effects, and random regressions for additive genetic and permanent environmental effects. Abundance of variation of acetone may provide a more sensitive indication of ketosis than many zero observations in concentration of milk BHBA. Heritabilities of milk BHBA levels ranged from 0.04 to 0.17 with a mean of 0.09 for the interval between 4 and 305 days in milk during three lactations. The average heritabilities for milk acetone concentration were 0.29, 0.29, and 0.22 for parities 1, 2, and 3, respectively. There was no clear genetic association of the concentration of two ketone bodies with three test-day milk production traits, even if some correlations among breeding values of the test-day records in this study were observed. These results suggest that genetic selection for low susceptibility of ketosis in early lactation is possible. Further, it is desirable for the breeding scheme of dairy cattle to include the records of milk acetone rather than the records of milk BHBA.

• Asian Pacific Journal of Cancer Prevention
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• 제16권14호
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• pp.5923-5931
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• 2015

Background: Registry data from four major public hospitals indicate trends over three decades from 1980 to 2010 in treatment and survival from colorectal cancer with distant metastases at diagnosis (TNM stage IV). Materials and Methods: Kaplan-Meier product-limit estimates and Cox proportional hazards models for investigating disease-specific survival and multiple logistic regression analyses for indicating first-round treatment trends. Results: Two-year survivals increased from 10% for 1980-84 to 35% for 2005-10 diagnoses. Corresponding increases in five-year survivals were from 3% to 16%. Time-to-event risk of colorectal cancer death approximately halved (hazards ratio: 0.48 (0.40, 0.59) after adjusting for demographic factors, tumour differentiation, and primary sub-site. Survivals were not found to differ by place of residence, suggesting reasonable equity in service provision. About 74% of cases were treated surgically and this proportion increased over time. Proportions having systemic therapy and/or radiotherapy increased from 12% in 1980-84 to 61% for 2005-10. Radiotherapy was more common for rectal than colonic cases (39% vs 7% in 2005-10). Of the cases diagnosed in 2005-10 when less than 70 years of age, the percentage having radiotherapy and/or systemic therapy was 79% for colorectal, 74% for colon and 86% for rectum (&RS)) cancers. Corresponding proportions having: systemic therapies were 75%, 71% and 81% respectively; radiotherapy were 24%, 10% and 46% respectively; and surgery were 75%, 78% and 71% respectively. Based on survey data on uptake of offered therapies, it is likely that of these younger cases, 85% would have been offered systemic treatment and among rectum (&RS) cases, about 63% would have been offered radiotherapy. Conclusions: Pronounced increases in survivals from metastatic colorectal cancer have occurred, in keeping with improved systemic therapies and surgical interventions. Use of radiotherapy and/or systemic therapy has increased markedly and patterns of change accord with clinical guideline recommendations.

• 여성건강간호학회지
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• 제3권2호
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• pp.208-223
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• 1997

This study was made to suggest the nursing strategies for promoting the behaviors about bone mass health behaviors in order to prevent middle aged women's osteoporosis. This study was a descriptive-correlational design that also concerned to the types which improve bone mass promoting behaviors by inspecting patterns of health locus of control method out of recognizable variables of health improving models influencing on these bone mass promoting behaviors. For these purpose, data were collected by self reported questionnaire in middle school, from 158 women living in Seoul. The measuring tools used in this study about bone mass promoting behaviors and multidimensional health locus of control, were developed by author on the basis of literature review and analyzed by SPSS-PC window, into pearson's correlation, ANOVA, multiple regression, cluster analysis. Data was analyzed as follows. 1. 6 Multidimensional health locus of control scale clusters were existed. : a)cluster I (pure internal), b)cluster II(pure chance), c) cluster III(Believer in control), d), cluster IV(Type VI), e)cluster V(yea sayer), f) cluster VI(nay sayer). There were no findings of the powerful others external cluster and double external cluster. 2. The higher the value of internal health locus of control was, the better the bone mass promoting behaviors were(r=.2891, $p=.00^{**}$). The higher the value of chance external health locus of control was, the worse the bone mass promoting behaviors were(r=-.1367, $p=.00^{**}$). 3. On the basis of these relationships, 6 clusters were significantly different in the bone mass promoting behaviors(F=2.27, $p=.05^*$). The value of bone mass promoting behaviors was ranked the order of type VI>believer in control>pure internal>yea sayer>nay sayer>pure chance external highly. 4. Bone mass promoting behaviors were not significantly different as to age. Suggestion. Based on the results from the study, I would like to make some suggestions as follows. 1) To delay the loss of bone mass in middle aged women, the study on the cluster of the multidimensional health locus of control should be conducted repeatedly. 2) The tool of multidimensional health locus of control should be developed through a qualitative method adjusted on Korean' health culture.

• Asian Pacific Journal of Cancer Prevention
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• 제15권2호
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• pp.819-823
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• 2014

Objective: The aim was to evaluate roles of vitamin D3 (VD3) and beta-carotene (BC) in the development of esophageal squamous cell carcinoma (ESCC) in a high-risk area, Huai'an District, Huai'an City, China. Methods: 100 new ESCC diagnosed cases from 2007 to 2008 and 200 residency- age-, and sex-matched healthy controls were recruited. Data were collected from questionnaires, including a food frequency questionnaire (FFQ) to calculate the BC intake, and reversed phase high-performance liquid chromatography (RP-HPLC) was used to measure the serum concentrations of BC and VD3. Odds ratios (OR) and 95% confidence intervals (CI) were calculated in conditional logistic regression models. Results: The average dietary intake of BC was $3322.9{\mu}g$ (2032.4-5734.3) in the case group and $3626.8{\mu}g$ (1961.9-5827.9) in control group per capita per day with no significant difference by Wilcoxon test (p>0.05). However, the levels of VD3 and BC in the case group were significantly lower than in the control group (p<0.05). The OR values of the highest quartile and the lowest quartile of VD3 and BC in serum samples were both 0.13. Conclusion: Our results add to the evidence that high circulating levels of VD3 and BC are associated with a reduced risk of ESCC in this Chinese population.