• 한국병원경영학회지
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• 제25권3호
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• pp.38-52
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• 2020

Purpose: The purpose of the study is to suggest the main functions and implications of public hospitals to effectively respond to the future epidemic crisis based on analyzing the accessibility to designated Coronavirus Disease 2019 (COVID-19) medical institutions of Seoul and examining the main features of the quarantine of Seoul municipal hospitals. Method: To analyze the response and function of Seoul municipal hospitals, we reviewed the Infectious Disease Control and Prevention ACT, 258 articles of Seoul Metropolitan Government press releases from January to the end of April, 48 articles of Seoul Metropolitan Government's daily newsletters, 2019 Health Bureau Budget report. We also referred to internal data of Seoul Children's Hospital, Seoul Seobuk Hospital, and Seoul Eunpyeong Hospital during the same period. Besides, the accessibility to medical institutions was analyzed by using the COVID-19 data which was announced daily basis. Results: The accessibility of COVID-19 patients living in the Southeastern part of Seoul to a medical institutions was 16.2km on a distance basis, and it was the lowest accessibility among four regions of Seoul since it took about 40 minutes by car. On the other hand, patients living in the Northeast part had the highest accessibility, as the access to medical institutions was 10.7km and 27 minutes by car. Also, the main functions of the municipal hospital of Seoul against COVID-19 were to shift the public hospital function to COVID-19 patients only hospitals, to perform the epidemiological investigation by medical doctors, and to support the operation of self-isolation facilities, community treatment centers and triage rooms of community health centers. Conclusion: Through the experience of COVID-19, we suggested that the functions of public hospitals will be reorganized as the reinforcement of infectious disease treatment and mental health for quarantined patients, cooperation with private hospitals, supporting for strengthening community health capacity and preparation for another epidemic.

• Tuberculosis and Respiratory Diseases
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• 제67권5호
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• pp.430-435
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• 2009

Background: Thus far, research studies on community-acquired pneumonia (CAP) have focused on its clinical severity. Recently, it has been determined that procalcitonin (PCT) level is correlated with severity of CAP. A retrospective study conducted at our hospital used risk predictability and PCT to determine whether or no PCT is useful in assessing the severity of CAP. Methods: This study covered 92 CAP cases that were admitted to the respiratory department at Changwon Fatima Hospital between July 1, 2008 and June 30, 2009. All enrolled subjects were measured for infection markers and risk predictability. Results: Based on hospital admission data, enrolled subjects had Pneumonia Severity Index (PSI) scores serving as risk predictors showed that both PCT and white blood cell (WBC) were statistically significant as infection markers (p=0.001, 0.037). Thus, this study used ROC curves in PSI for data analysis. As a result, it was determined that the area under curve (AUC) of PCT and WBC was 0.694 and 0.593 respectively, indicating that PCT has a higher test value for WBC, when PCT was higher than 0.745 ng/mL. In addition, it was found that PCT levels higher than 0.745 ng/mL had higher PSI scores than the group with PCT lower than 0.745 ng/mL (p=0.032). Conclusion: In order to predict risk of pneumonia cases admitted due to symptoms of CAP, it is important to consider PCT as well as PSI, and follow-up monitoring of PCT cases.

• International Journal of Internet, Broadcasting and Communication
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• 제16권1호
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• pp.314-320
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• 2024

Objectives: This study aimed to identify the prevalence of falls in community-dwelling older adults and to identify associated factors using the 2019 Community Health Survey. Methods: The original data was from the 2019 Community Health Survey, and the study sample comprised 1,642 older adults aged 65 years and older in Jeju province. Data collection was conducted from August 16 to November 20, 2019, through an interview done by a trained investigator. Respondents were queried about demographic characteristics, riding bicycles, hospital treatment due to an accident or poisoning in the previous year, fall experiences in the past year, fear of falling, self-management status, and pain and discomfort. Multivariate logistic regression analysis was used to evaluate for associations between potential risk factors and falls. Results: The prevalence of falls in this community-dwelling older adults was 13.1%. Falls were associated with riding bicycles (odds ratio = 4.7; 95% confidence interval: 2.26-9.81), fear of falling (odds ratio = 0.3; 95% confidence interval: 0.24-0.49), hospital treatment due to an accident or poisoning in the previous year (odds ratio = 7.8; 95% confidence interval: 5.02-12.19), self-management status (odds ratio = 0.6; 95% confidence interval: 0.34-0.89), and pain and discomfort (odds ratio = 0.6; 95% confidence interval: 0.40-0.87). Conclusions: We found that the prevalence of approximately about 13% of older adults living in a community has experienced falls. Based on the results of the study, we provided primary data to develop the care management intervention program to prevent falls and avoid risk factors that cause falls in community-dwelling older adults.

• 보건행정학회지
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• 제14권2호
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• pp.1-16
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• 2004

The study purpose was to find which factors affect selection of hospital network types. This study used the 1998 American Hospital Association Annual Survey Database from Health Forum. Among these U.S. hospitals, the researcher selected hospitals located in Metropolitan Statistical Areas. Therefore the final observation cases for analysis are 1,971 Metropolitan Statistical Area hospitals in the United States. To identify significant variables influencing hospital network types, the study used proportional odds logistics regression model on population size, Health Maintenance Organization penetration rate, and market competition rate of area including a hospital, types of hospital ownership, hospital bed size, proportion of Medicare patients and Medicaid patients in total hospital patients, and occupancy rate. Contrary to conventional wisdom, selection of hospital network types was influenced by population size of area which a hospital located, types of ownership, hospital bed size, and proportion of medicare patients rather than Health Maintenance Organization penetration. Population size 1,000,000-2,499,999 had the highest probability of selecting type IV (clinical-vertical integration) from an independent hospital, and a religious group owned hospitals and for-profit owned hospitals had the highest probability of selecting Type IV (clinical-vertical integration) from an independent hospital. A bed size had positive relation on selecting Type IV (clinical-vertical integration) from an independent hospital. Unlikely general belief that the selecting types of hospital network was determined by the change of health insurance policy such as Health Maintenance Organizations and Preferred Provider Organizations, the types of hospital network were influenced by community characteristics such as population size, and hospital characteristics.

• 한국보건간호학회지
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• 제13권2호
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• pp.12-25
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• 1999

This study examines individual determinants of hospital days in community-dwelling elders by estimating a linear structural equation model based upon Andersen's behavioral model. Data were collected through a national survey of elders in Korea in 1994. The subjects for this secondary data analysis were 1687 non-institutionalized elders aged 60 years or older. Except for the effect of age and gender on family help. the predisposing components had direct effects on the enabling components. Of the effects of the enabling components. family help had a direct effect on self-evaluated health; economic status had a direct effect on chronic disease and self-evaluated health; and access had a direct effect on chronic disease. functional health status and self-evaluated health. Of the enabling components. residence and family help directly affected hospital days. Self-evaluated health revealed the greatest direct effect on hospital days followed by functional health. Overall. the effects of the predisposing components and the enabling components on hospital days were not prominent. Since the model explained only $4\%$ of the variance in hospital days. the magnitude of the effect of the need components cannot be judged in terms of equity of distribution of health services. In particular. the effect of family help in the model reveals the importance of family support in health management of elders. The implications of these analyses for improving the proposed model of hospital days were discussed.

• Tuberculosis and Respiratory Diseases
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• 제80권2호
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• pp.201-209
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• 2017

Background: Methicillin-resistant Staphylococcus aureus (MRSA) infection is a severe and life-threatening disease in patients with community-onset (CO) pneumonia. However, the current guidelines lack specificity for a screening test for MRSA infection. Methods: This study was retrospectively conducted in elderly patients aged ${\geq}65years$, who had contracted CO-pneumonia during hospitalization at the Jeju National University Hospital, between January 2012 and December 2014. We analyzed the risk factors of MRSA in these patients and developed a scoring system to predict MRSA infection. Results: A total of 762 patients were enrolled in this study, including 19 (2.4%) with MRSA infection. Healthcare-associated pneumonia (HCAP) showed more frequent MRSA infection compared to community-acquired pneumonia (4.4% vs. 1.5%, respectively; p=0.016). In a multivariate logistic regression analysis, admissions during the influenza season (odds ratio [OR], 2.896; 95% confidence interval [CI], 1.022-8.202; p=0.045), chronic kidney disease (OR, 3.555; 95% CI, 1.157-10.926; p=0.027), and intensive care unit admission (OR, 3.385; 95% CI, 1.035-11.075; p=0.044) were identified as predictive factors for MRSA infection. However, the presence of HCAP was not significantly associated with MRSA infection (OR, 1.991; 95% CI, 0.720-5.505; p=0.185). The scoring system consisted of three variables based on the multivariate analysis, and showed moderately accurate diagnostic prediction (area under curve, 0.790; 95% CI, 0.680-0.899; p<0.001). Conclusion: MRSA infection would be considered in elderly CO-pneumonia patients, with three risk factors identified herein. When managing elderly patients with pneumonia, clinicians might keep in mind that these risk factors are associated with MRSA infection, which may help in selecting appropriate antibiotics.

• Journal of Preventive Medicine and Public Health
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• 제49권4호
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• pp.240-248
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• 2016

Objectives: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) adversely impacts food security in households of people living with HIV/AIDS (PLWHA). Little research has focused on food insecurity among PLWHA in India. The purpose of this study was to identify the prevalence of and factors relating to food security in households of PLWHA in the Siliguri subdivision of Darjeeling, West Bengal, India. Methods: A cross-sectional community-based study was carried out among 173 PLWHA residing in Siliguri and registered at the Anti-retroviral Therapy Centre of North Bengal Medical College & Hospital. Data was collected at the household level with interviews of PLWHA using a food security survey instrument. We analyzed the associations using logistic regression. Results: The prevalence of household food security among the participants was 50.9% (88/173). Five years or more of schooling, higher socioeconomic class and males were found to be significantly associated with a higher likelihood of food security. A later stage of the disease and the presence of other family members with HIV/AIDS were significantly associated with a lower likelihood of food security. The major coping strategies to deal with food insecurity in the acute phase HIV infection included borrowing money (56.1%), followed by spousal support, loans from microfinance institutions, banks, or money lenders, borrowing food, or selling agricultural products. Conclusions: The present study revealed that only about half of households with PLWHA were food secure. Prior interventions relating to periods of food and economic crisis as well as strategies for sustaining food security and economic status are needed in this area.

• Tuberculosis and Respiratory Diseases
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• 제69권6호
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• pp.450-455
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• 2010

Background: High cortisol levels are frequently observed in patients with severe infections are of prognostic value in sepsis. The aim of this study was to evaluate the clinical usefulness of serum cortisol in assessment for the severity of community-acquired pneumonia (CAP). Methods: This study analyzed the results of 52 CAP subjects admitted in Changwon Fatima Hospital between July 2008 to May 2010. Total serum cortisol, infection markers such as C-reactive protein (CRP), procalcitonin (PCT) and CURB (Confusion, Uremia, Respiratory rate, Blood pressure)-65 were examined retrospectively. Results: In clinically unstable subjects on admission day 4, baseline serum cortisol, CURB-65, and CRP were elevated significantly compared to those of stable subjects. Area under curve (AUC) of cortisol, CRP, and CURB-65 from ROC curves were 0.847, 0.783, and 0.724 respectively. In the subjects with serum cortisol ${\geq}22.82{\mu}g/dL$, CRP, PCT, CURB-65 score, and mortality were significantly elevated. Conclusion: These findings suggest that measurement of serum cortisol in early stage may provide helpful information in the assessment of CAP severity.

• Asian Pacific Journal of Cancer Prevention
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• 제13권6호
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• pp.2781-2789
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• 2012

Assessment of perceptions of the community, the determinants and development of their behavior regarding common malignancies, helps in establishing evidence-based activities for prevention and early diagnosis of cancer. However information on this important aspect is lacking in our country. Qualitative methods were here used to obtain information through in depth interviews and Focus Group Discussions (FGDs) with all categories of identified stakeholders. Most were unaware of the activities of the cancer control program. Even the providers were not fully conversant. All respondents mentioned lack of diagnostic and treatment facilities in government, primary and secondary level facilities. Perceptions of different categories of stakeholders regarding why many community members did not attend screening camps and other services reflect the determinants of community behavior, acting independently as well as in combination. The cancer control program was thought to be restricted only to some private facilities and overcrowded government tertiary care facilities where the visits were time consuming. Almost all the facilities were considered curative oriented. Issues of supervision, monitoring and feedback were inadequately addressed by providers who were inadequately trained in many program activities. The program lacked effective planning, coordination and appropriate implementation at the grass roots level in Delhi. Social mobilization was grossly inadequate, as most of the community members were unaware of the existence of the program. Misconceptions about the risk factors, signs and symptoms, diagnosis, and treatment were common amongst community members as well as many of the providers. Thus the national cancer control program in our country needs further community participation and social mobilization. Accessibility, availability, acceptability and affordability of various preventive, curative and rehabilitative activities, as well as intersectoral coordination, training, supervision and monitoring of program activities, all need to be addressed to ensure the success of this important public health program.

• 약학회지
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• 제57권1호
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• pp.63-69
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• 2013

The objectives of the study are to investigate pharmacy remuneration levels stratified by the number of prescriptions dispensing and the type of nearby medical facilities using the Korean National Health Insurance (NHI) database, and to classify community pharmacies based on the characteristics. Claims data of all community pharmacies were extracted from the Korean NHI database from January 1 to June 30, 2010. A total of 14,985 pharmacies were included for the analysis. The remuneration amounts per pharmacist were directly associated with the number of prescription dispensing, and varied by the type of nearby medical facilities where more than 90% of prescriptions dispensed at the pharmacy are issued from. We classified pharmacies to six groups according to the number of prescription dispensing and the type of nearby medical facilities; (1) pharmacies with equal to or less than 200 prescriptions per month per pharmacist, (2) pharmacies near a general hospital, (3) pharmacies near a regular hospital, (4) pharmacies near a clinic, (5) pharmacies near multi clinics, and (6) pharmacies that do not belong to the above types. Compared to pharmacies near a clinic or multi clinics, pharmacies near a general hospital showed a lower number of prescription dispensing per pharmacist, but the income from dispensing fees was higher (p<0.05). The new taxonomy of community pharmacies can be a useful basis for further policy development in pharmacy remuneration system.