• 한국노년학
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• 제31권4호
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• pp.1047-1065
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• 2011

본 연구는 노인장기요양보험 대상자 및 등급 확대에 따른 대상자 규모와 소요 재정을 추계함으로써 제도의 안정적 발전 및 지속가능성을 제고하고, 향후 정책개발에 기초자료 제공을 목적으로 한다. 연구방법은 문헌조사와 독일, 일본 등 선험국의 대상자 확대 정책을 고찰하여 대상자 확대 전략을 수립하고, 국민건강보험공단의 노인장기요양보험 대상자 증가추이, 노인성 질환대상자 증가 추이 분석, 현행 등급별 대상자의 급여 현황을 파악하여 등급 확대에 따른 재정소요를 예측하였다. 구체적인 방법으로 대상자 및 4등급 확대를 위한 범위 또는 범주를 시나리오별로 구체화하고 세분화된 급여 수준을 분석하여 재정을 추계하였다. 분석결과 대상자는 2010년 31만명에서 2015년 최소 42만명, 최대 57만명이었고, 이에 따른 관리운영비를 제외한 재정은 2010년 2.5조에서 2015년 최소 3.6조, 최대 4.0조인 것으로 추계되었다. 결과적으로 4등급 확대 시기는 제도안정화와 선험국의 선례와 경험을 함께 고려할 때 도입 4년차인 2012년 또는 5년 차인 2013년이 적정할 것으로 보인다. 이로인한 재정은 확대 초기 약 3천억원에서 1조 4천억원이 급여수준에 따라 예측되고, 확대이후 4등급 인정자 및 필요 재정지출은 점차 줄어들 것으로 예측된다. 선험국의 예를 볼때 급격한 4등급 확대보다는 시설 및 인프라가 감당할 수 있고, 재정 부담이 가능한 범위 내에서 확대 규모를 도출하는 것이 바람직할 것으로 판단된다. 본 연구는 시의성 있는 연구를 제시하여 향후 정확한 대상자 확대 및 재정안정화를 추구하도록 방향성을 제시하였다.

• 대한간호학회지
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• 제33권5호
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• pp.580-590
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• 2003

Purpose: The study investigates the degree of maternal self-esteem, postpartal depression, and family function in mothers of normal and of low birth-weight infants. Method: A retrospective cohort design was applied to compare the variables of interest between a group of 73 mothers with normal birth weight infants and a group of 45 mothers with low birth-weight infants, using the maternal self-report inventory(MSRV), Edinburgh Postnatal Depression Scale(EPDS) and Family APGAR(FAPGAR). Result: The total mean score was 82.57 for MSRV, 8.45 for EPDS, and 6.83 for FAPGAR with no differences between two groups. A positive correlation was found between MSRV and FAPGAR, while a negative correlations between MSRV and EPDS, and FAPGAR and EPDS. Regardless of the direction of the relationship, the degrees of the correlations were stronger in low birth-weight mothers group than in normal group. Conclusion: No differences in MSRV, EPDS and FAPGAR between the normal and the low birth-weight group considered as beneficial effects of the follow-up management which low birth-weight group was engaged in. This suggested the early intervention(follow-up) for the family with risk factor(low birth-weight) could reduce negative outcomes such as the impaired maternal self-esteem and family function, and the occurrence of postpartal depression, retrospectively.

• 대한간호학회지
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• 제41권3호
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• pp.423-431
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• 2011

Purpose: The study was designed to determine the discriminating ability of a Bayesian network (BN) for predicting risk for pressure ulcers. Methods: Analysis was done using a retrospective cohort, nursing records representing 21,114 hospital days, 3,348 patients at risk for ulcers, admitted to the intensive care unit of a tertiary teaching hospital between January 2004 and January 2007. A BN model and two logistic regression (LR) versions, model-I and .II, were compared, varying the nature, number and quality of input variables. Classification competence and case coverage of the models were tested and compared using a threefold cross validation method. Results: Average incidence of ulcers was 6.12%. Of the two LR models, model-I demonstrated better indexes of statistical model fits. The BN model had a sensitivity of 81.95%, specificity of 75.63%, positive and negative predictive values of 35.62% and 96.22% respectively. The area under the receiver operating characteristic (AUROC) was 85.01% implying moderate to good overall performance, which was similar to LR model-I. However, regarding case coverage, the BN model was 100% compared to 15.88% of LR. Conclusion: Discriminating ability of the BN model was found to be acceptable and case coverage proved to be excellent for clinical use.

• 기본간호학회지
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• 제15권4호
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• pp.531-538
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• 2008

Purpose: The purpose of this study was to identify factors influencing Vancomycin-resistant enterococcus infection control among nurses in intensive care units. Method: Data were collected from August 15 to October 14, 2007 from 188 nurses working in intensive care units. The nurses answered a 26 item-questionnaire, which included management of the cohort (14 items), hand washing (6 items) and management of the environment (6 items). Descriptive statistics, t or F test, ANOVA, and multiple regression analysis were used with SPSS PC+ 14.0 to analyze the data. Results: The participant's level of awareness of Vancomycin-resistant enterococcus infection control was 3.87; that of compliance was 3.74. Significant factors influencing the level of compliance with Vancomycin-resistant enterococcus infection control were'the level of the awareness' and 'the type of intensive care unit'. These two variables accounted for 21.0% of variance for compliance with the Vancomycin-resistant enterococcus infection control among the participants. Conclusion: In order to develop a strategy to increase the compliance with Vancomycin-resistant enterococcus infection control, it is necessary to be concerned about 'the level of the awareness', 'the type of intensive care unit;', and 'experiences of caring for patients with Vancomycin-resistant enterococcus'.

• Genomics & Informatics
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• 제14권4호
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• pp.160-165
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• 2016

Over the past decade, the detection of gene-gene interactions has become more and more popular in the field of genome-wide association studies (GWASs). The goal of the GWAS is to identify genetic susceptibility to complex diseases by assaying and analyzing hundreds of thousands of single-nucleotide polymorphisms. However, such tests are computationally demanding and methodologically challenging. Recently, a simple but powerful method, named "BOolean Operation-based Screening and Testing" (BOOST), was proposed for genome-wide gene-gene interaction analyses. BOOST was designed with a Boolean representation of genotype data and is approximately equivalent to the log-linear model. It is extremely fast, and genome-wide gene-gene interaction analyses can be completed within a few hours. However, BOOST can not adjust for covariate effects, and its type-1 error control is not correct. Thus, we considered two-step approaches for gene-gene interaction analyses. First, we selected gene-gene interactions with BOOST and applied logistic regression with covariate adjustments to select gene-gene interactions. We applied the two-step approach to type 2 diabetes (T2D) in the Korea Association Resource (KARE) cohort and identified some promising pairs of single-nucleotide polymorphisms associated with T2D.

• 한국임상약학회지
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• 제25권3호
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• pp.131-137
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• 2015

Background: The protective effect of metformin against breast cancer is inconclusive. Objective: To evaluate the effect of metformin on breast cancer risk and mortality in patients with type 2 diabetes. Method: A comprehensive literature search was performed for pertinent articles published prior to June 30, 2014, using PubMed and EMBASE. Study heterogeneity was estimated with $I^2$ statistic. The data from the included studies were pooled and weighted by random-effects model. The quality of each included study was assessed on the basis of the 9-star Newcastle-Ottawa Scale and publication bias was evaluated by visual inspection of a funnel plot. Results: Ten studies were included in the meta-analysis of the association of metformin and breast cancer risk. By synthesizing the data from the studies, the pooled odds ratio (OR) was 0.72 (95% CI: 0.59, 0.87) (p = 0.0005). Three cohort studies were included for meta-analysis of the association between metformin and breast cancer-related mortality. Metformin was associated with a significant decrease in mortality (Risk ratio: 0.68; 95% CI: 0.51, 0.90, p = 0.007). Conclusion: The present meta-analysis suggests that metformin appears to be associated with a lower risk of breast cancer incidence and mortality in patients with type 2 diabetes.

• Asian Pacific Journal of Cancer Prevention
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• 제15권13호
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• pp.5161-5166
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• 2014

Our aim was to access the association between recreational physical activity (RPA) and risk of ovarian cancer (OC). The studies were retrieved from the PubMed and Embase databases up to February 20th, 2014. Risk ratios (OR) and 95% confidence intervals (CI) were used to estimate effect sizes. Random-effects or fixed-effects models were used to pool the data. The trim and fill method was applied for sensitivity analysis. Begg's rank correlation test and Egger's regression asymmetry test were employed to assess the publication bias. A total of 6 studies (435398 participants including 2983 OC patients) were included in this meta-analysis. The overall estimate indicated that there was weakly inverse association between RPA and OC risk (RR=0.90, 95%CI: 0.72-1.12, p=0.335). Meanwhile, for prospective cohort studies, a result consistent with the overall estimate was obtained (RR=1.12, 95% CI: 0.88-1.42, p=0.356). However, for case control studies, the pooled estimate of RR was 0.76 (95%CI: 0.64-0.90, p=0.002), indicating a clear significant association between RPA and OC risk. In addition, the sensitivity analysis indicated a significant link between RPA and risk of OC after removing Lahmann's study (RR=0.80, 95% CI: 0.68-0.93, p=0.004). No significant publication bias was found (Begg's test: p=1.00; Egger's test: p=0.817). In conclusion, our meta-analysis indicated a weakly inverse relationship between RPA and the occurrence of OC.

• Asian Pacific Journal of Cancer Prevention
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• 제13권3호
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• pp.791-794
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• 2012

A retrospective cohort study was carried out with 340 female breast cancer at a teaching university in northeast of Thailand recruited and followed-up until the end of 2006. Survival probabilities were estimated using the Kaplan-Meier method. 161 cases were alive after five years and 58 patients were lost to follow-up. The overall observed survival rates at 1, 3 and 5 years were 83.3%, 59.9% and 42.9%, respectively. When analysis was conducted for stage combined into 2 groups, early (stage I, II and unknown) and late (stage III and IV), the 5-year survival rate for early stage (60%; 95%CI: 0.51-0.67), was higher than for late stage (27%; 95%CI: 0.19-0.34) with high statistical significance (p<0.001). The hazard ratio of patients with stage IV was 11.6 times greater than for stage I (p=0.03). The findings indicate that the different stages of breast cancer markedly effect the overall survival rate.

• 보건의료산업학회지
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• 제14권1호
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• pp.93-102
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• 2020

Objectives: This study analyzed the prescription characteristics of medication for acute respiratory diseases before and after pay-for-performance to provide basic data on effective medical quality management policies. Methods: The research data were collected from the 2013-2014 sample cohort of the National Health Insurance Corporation, from Internal Medicine, Pediatrics, Otorhinolaryngology, Family Medicine and General practitioner clinics (classification of disease codes: J00-J06, J20-J22, J40 outpatients). Results: The antibiotics prescription rates decreased from 43.9% in 2013 to 43.5% in 2014 when the major diagnosis was for upper respiratory infections and increased from 62.0% in 2013 to 62.5% in 2014 when the major diagnosis was for lower respiratory infections. Conclusions: There is a need to identify the correct antibiotic prescription method by expanding the current assessment standards. Such standards must include acute lower respiratory infections and minor diagnoses as the current evaluation techniques focus only on the major diagnosis of acute upper respiratory infections.

• 한국콘텐츠학회:학술대회논문집
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• 한국콘텐츠학회 2016년도 춘계 종합학술대회 논문집
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• pp.383-384
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• 2016

The Special Needs Education Assessment Tool (SNEAT) were verified of reliability and validity. However, the reliability and validity has been verified is only Okinawa Prefecture, the national data has not been analyzed. Therefore, this study aimed to verify the reliability and construct validity of SNEAT in Miyagi Prefecture as part of the national survey. SNEAT using 55 children collected from the classes on independent activities of daily living for children with disabilities in Miyagi Prefecture between November and December 2015. Survey data were collected in a longitudinal prospective cohort study. The reliability of SNEAT was verified via the internal consistency method; the coefficient of Cronbach's ${\alpha}$ were over 0.7. The validity of SNEAT was also verified via the latent growth curve model. SNEAT is valid based on its goodness-of-fit values obtained using the latent growth curve model, where the values of comparative fit index (0.997), tucker-lewis index (0.996) and root mean square error of approximation (0.025) were within the goodness-of-fit range. These results indicate that SNEAT has high reliability and construct validity.