• 보험의학회지
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• 제33권2호
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• pp.12-14
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• 2014

Worldwide, stroke is the 2nd or 3rd leading cause of death and a major health problem. Recent advances in medical technology have significantly improved diagnosis and treatment strategies of ischemic stroke. The ischemic stroke subtype is an important determinant of mortality and long-term prognosis of patients. To estimate excess-risks of the ischemic stroke subtype, recently published article, Korean cohort study of stroke, was used as a source article. According to mortality analysis methodology from American academy of insurance medicine, the overall mortality ratio and excess death rate was the highest in patients with SOD, followed by those with CE. Calculated mortality ratio and excess death rate for subtype in this review are SOD, 920%/34‰; CE 267%/34‰; UI 209%/25‰; UM 190%/23‰; UN 188%/15‰; LAA 162%/15‰; LAC 117%/3‰.

• 보험의학회지
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• 제28권1_2호
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• pp.15-18
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• 2009

Background: Recent emergence of drug-resistant tuberculosis such as multidrug-resistant tuberculosis(MDR-TB) or extensively drug-resistant tuberculosis(XDR-TB) has become important health care problems. It has also became grave issues for insurance industries in determining medical risks. We have therefore strived to analyze the comparative mortality rates for drug-resistant tuberculosis through utilization of results from previous articles. Methods: Comparative mortality was calculated from source articles using mortality analysis methods. Results: Mortality ratio of MDR-TB was estimate to 1200%, and excess death rate was 110 per 1,000. Comparative mortality between MDR-TB and XDR-TB by Korean $study^{(1)}$ were 1750, 382, 405, 443, 1025, and 357%, for each 10 months study intervals, respectively. Total mortality ratio was 594% and total excess death rate was 60 per 1,000person. It was determined that the risk of XDR-TB was much greater than MDR-TB. Discussion; Pending the development of a novel anti-tuberculosis drug, it would be prudent to steer clear insuring XDR-TB during underwriting phase due to high medical cost that it creates.

• 보험의학회지
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• 제29권2호
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• pp.18-21
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• 2010

Background: The kidney transplantation is increasing. The kidney donation of a living donor is more common in Korea than in other countries. Underwriters may encounter a case of a kidney donor. So we need to determine medical risk for a living kidney donor. Methods: Comparative mortality figures were calculated from a source article using mortality analysis methods. Results: Mortality Ratio of a living kidney donor was estimated to 106%, and Excess Death Rate was 0.89 per 1000. Discussion: A healthy kidney donor is quite within standard, even better in terms of medical risk.

• 보험의학회지
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• 제30권2호
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• pp.12-15
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• 2011

Background: The beneficial effects of implantable cardioverter defibrillators (ICDs) in primary and secondary prevention patients are well established. However, data on potential differences between both groups in mortality are scarce. The aim of this study was to assess extra risk differences between primary and secondary prevention ICD recipients. Methods: Comparative mortality figures were calculated from a source article using mortality analysis methods. Results: Mortality ratio (MR) of primary and secondary prevention ICD recipients were 393% and 373%. Excess death rates (EDR) of both groups were 42 and 38 per 1,000. Discussion: MR and EDR were higher in primary prevention group. But, there was no significant difference.

• 한국농림기상학회지
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• 제21권1호
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• pp.1-28
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• 2019

본 연구에서는 한라산 사방향에 분포하는 구상나무 자생지 중 9개 조사구에 대하여 구상나무를 생목과 사목으로 구분하여 도면화하고, 그 밀도와 고사율을 분석하였다. 분석 결과, 구상나무는 조사구 내의 위치에 따라 밀도 및 고사율에 있어 상당한 불균질성을 보였다. 이는 위치에 따라 변화하는 특정 인자가 구상나무 고사를 발생시킬 것이라는 추정을 가능케 한다. 본 연구에서는 구상나무 밀도 및 고사율을 토대로 고도, 지형경사, 수계망, 일사량과 경사향 등의 지형적 요인과 구상나무 고사현상과의 관련성을 살펴보았다. 구상나무는 고도가 증가함에 따라 밀도가 증가하였으며, 고사율 또한 증가하였다. 지형경사와 고사율 사이에는 음의 상관관계가 인지되었으며, 수계망이 미약하게 발달한 완만한 곳에서 고사율이 높게 나타났다. 그리고 경사향에 따라 고사율이 크게 변화하는 것이 인지되었으며, 생목이 우세한 영역이 사목이 우세한 영역에 비해 평균 일사량이 많게 나타났다. 전반적으로 한라산 구상나무는 상대적으로 지형경사가 완만하고, 일사량이 적은 곳에서 많이 고사하는 것으로 나타났다. 지형경사가 완만할수록 상대적으로 토양수분 함량이 많고, 일사량이 적을수록 증발량이 적어져 토양수분 함량이 많다는 기존 연구결과를 고려하면, 토양수분 과다가 한라산 구상나무 고사의 원인으로 추정된다. 이는 근래의 한반도 및 제주 지역에서 나타나는 강수량 증가, 증발량 감소, 일조시간 감소 등의 일련의 기후변화 현상, 한라산 고도 증가에 따른 강수량 증가와 함께 나타나는 고사율 증가현상, 한라산 아고산지대에서의 식생변화 등의 증거들에 의해 뒷받침된다. 이번 연구에서 고도 및 지역에 따라 인지되는 구상나무 밀도와 고사율의 변화양상은 향후 구상나무 쇠퇴현상에 대한 수치 모델링 연구에 있어 공간변수로 활용될 수 있을 것으로 기대한다. 뿐만 아니라, 정사항공영상을 활용하는 개체단위의 수목분포 조사 방법은 향후 장기적 식생변화 연구에 있어 수치적 모니터링 기법으로 널리 활용될 수 있을 것이다.

• Journal of Trauma and Injury
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• 제21권2호
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• pp.100-107
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• 2008

Purpose: A traumatic lung cyst (TLC) is a rare complication and is usually detected with a pulmonary contusion. This study attempted to identify the prognostic factors and the clinical characteristics for pulmonary contusion with TLCs. Methods: We retrospectively reviewed the medical records and chest CT findings of 71 TLC patients who visited our hospital from January 2006 to December 2007. Patients were assessed for any clinical characteristics. We evaluated significant differences between the survival and the death groups for patients with a traumatic lung cyst. Results: The male-to-female ratio of patients with TLCs was 54:17, and the mean age of the patients was $37.70{\pm}19.78years$ with 36.6% of the patients being under 30 years fo age. The cause of blunt thoracic trauma was mainly pedestrian traffic accidents (26.8%) and falls (25.4%). Associated conditions included pulmonary contusion in 68 patients (95.7%), hemopneumothorax in 63 patients (88.7%), and rib fracture in 52 patitents (73.2%). There was no consistent relationship between the number of TLCs and the pulmonary contusion score. The overall mortality rate of TLC patients was 26.8%. Death correlated with a need for ventilatory assistance, mean arterial pressure, worst mean arterial pressure in 24 hours, initial pH and base excess, worst pH and base excess in 24 hours, refractory shock, initial GCS score, and pulmonary contusion score. Conclusion: The presence of the aforementioned predictors indicate serious injury, which is the main determinant of the outcome for thoracic injuries with TLCs.

• 보험의학회지
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• 제26권
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• pp.31-39
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• 2007

Background and main issue: In the Korean insurance market, an outstanding issue is the decrease of margin of risk ratio. This affects the solvency and profitability of insurance companies. Insurance medicine, which has been developed in Western countries, is so-called medical risk selection or medical underwriting. Medical risk selection is based on clinical follow-up study and mortality analysis methodology. Unfortunately, there have been few clinical follow-up studies, and no intercompany disease analysis system is available in the Korean insurance market. In practice, we use underwriting guidelines, which were developed by some global reinsurance companies. However, these guidelines were developed under clinical follow-up studies performed abroad. So, we cannot rule out underestimation of excess mortality factors such as mortality ratio, excess death rate, and life expectancy. It is necessary to perform medical assessment in claims administration. Comparing the insured's statement by medical records with products' benefit according to this procedure, we can make sound claim decisions and participate in the role of sound underwriting. We can call this scientific procedure as the verification of medical claims review. Another area of medical claims review is medical counsel for claims staff. Result: There is another insurance medicine in addition to medical risk selection. Independent medical assessment by medical records of insured is medical claims review. Medical claims review is composed of verification and counsel.

• 대한임상독성학회지
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• 제7권2호
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• pp.77-82
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• 2009

Purpose: In highly doses, endosulfan lowers the seizure threshold and elicits central nervous system stimulation, which can result in seizures, respiratory failure, and death. Management of seizure control is essential for survival and prognosis of intoxicated patients. This study assessed whether seizure time was an independent predictor mortality in patients with endosulfan poisoning. Methods: This retrospective study enrolled patients with endosulfan poisoning presenting to Masan Samsung Hospital and Gyeongsang National University Hospital from January 2003 to December 2008. The data were collected from clinical records and laboratory files. Using a multivariate logistic analysis, data on the total population was retrospectively analyzed for association with mortality. Results: Of the 24 patients with endosulfan poisoning, nineteen (79.1%) experienced seizure. The patients in the seizure group showed significantly lower Glasgow coma scale score, base excess, bicarbonate, and significant existence of mechanical ventilation, as compared to the non seizure group (n=5). Seizure, Glasgow coma scale score, systolic blood pressure, bicarbonate level, need for respiratory support, pulse rate, respiratory rate, pH, base excess, and seizure time were associated with mortality. The fatality rate of endosulfan poisoning was 54.1% with higher mortality among patients experiencing. Longer seizure time was associated with higher mortality. Conclusion: Seizure time can be a significant independent predictor of mortality in patients with acute endosulfan poisoning. Physicians should aggressively treat for seizure control in patients with acute endosulfan poisoning.

• 보험의학회지
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• 제29권1호
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• pp.12-15
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• 2010

Global prevalence of chronic obstructive pulmonary disease(COPD) is known to 5.6 ~ 9.8%. Then life insurance applicants from persons with COPD are frequently encountered, and the underwriter and insurance medical doctors are called on with some regularity to render assessments of the mortality risk associated with COPD. According to previous article which contains long-term follow up of COPD, mortality ratio and excess death rate were 230% and 29 per 1000, respectively. Nowadays molecular genetic methodology such as GWAS has been developed. So it might be possible that molecular diagnostic methods may be one of useful underwriting tools in the life insurance risk selection of COPD applicants.

• 보험의학회지
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• 제32권2호
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• pp.39-49
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• 2013

The textbook of insurance medicine is very bulky volume and it's revision time may be long. Nowadays medical knowledge and evidences are developing rapidly. It is necessary to revise current insurance risk of certain disease. Review of respiratory diseases in terms of insurance medicine may be valuable information for insurance doctors and life underwriters. Newly estimated mortality ratio and excess death rate of several respiratory diseases in this review are organizing pneumonia, 266%/44‰; multi-drug resistant tuberculosis, 1200%/110‰; idiopathic interstitial pneumonia, 869%/85‰; VATS lobectomy of stage I lung cancer, 550%/33‰; lymphangioleiomyomatosis 9826%/66‰; lung transplantation 2026%/92‰, respectively.