• Journal of Preventive Medicine and Public Health
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• v.53 no.5
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• pp.362-370
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• 2020

Objectives: Despite greater access to training positions and the presence of more women in emergency medicine, it has remained a men-dominated field. This study aims to identify the key issues causing the gender gap in Korea and establish measures to overcome them. Methods: Using the annual statistical reports of the National Emergency Medical Center and data published on the Korean Society of Emergency Medicine website, cases that listed the current status and positions of members in its organization and its committees were analyzed. Secondary analysis was conducted using data from the 2015 Korean Society of Emergency Survey that included physicians' demographics, academic ranking, years of experience, clinical work hours, training and board certification, core faculty status, position, and salaries. Results: As of September 2019, women account for only 12.7% of the total number of emergency physicians (EP) in Korea; of 119 chair/vice-chair academic positions, women represented only 9.2%. Women EP were more often assistant professors and fellowship-trained, with fewer in core faculty. However, they worked the same numbers of clinical hours as their men counterparts. The median annual salary of women EP was less than that of men EP after adjusting for academic hospital rank, clinical hours, and core faculty status. Conclusions: A gender gap still exists among Korean EP, and women earn less than men regardless of their rank, clinical hours, or training. Future studies should evaluate more data and develop system-wide practices to eliminate gender disparities.

• Journal of Sasang Constitutional Medicine
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• v.30 no.3
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• pp.24-39
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• 2018

Introduction The purpose of this study was to systematically review previous studies on Sasang type-specific pathophysiological symptoms in urination and defecation. Methods Peer-reviewed articles on type-specific pathophysiological symptoms of urination and defecation published until September 2016 were extracted from domestic and international six databases. Clinical characteristics from thirteen extracted articles were categorized into three urination domains of appearance of urine, capacity of bladder and urinary discomfort, and three defecation domains of irritability of bowel movement, functional constipation and discomfort from irregularity. Results As for the urination, Tae-Eum type showed dark color with foam, however So-Eum type had frequent urination and sensitivity to dysuria but no nocturia and residual urine sense. As for the defecation, So-Yang type showed frequent urgency and constipation, however So-Eum type reported loose stool. So-Yang type showed varied level of health status depending on defecation irregularity. There were disparities with rectal tenesmus among Sasang types. Discussion Six domains of urination and defecation related type-specific pathophysiological clinical symptoms were provided in this study. This study would contribute to the standardized clinical measures of Sasang typology in the near future.

• Nutrition Research and Practice
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• v.9 no.5
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• pp.547-553
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• 2015

BACKGROUNDS/OBJECTIVES: The effects of malnutrition on growth of toddlers and preschoolers by socioeconomic status are not well known. This study aimed to examine the effects of dietary intake on growth outcomes in toddlers and preschoolers by household income level. SUBJECTS/METHODS: The study population was a total of 1,687 children aged 1 to 5 years that participated in the KNHANES from 2009 to 2011. Growth of children was assessed by height for age (HFA) and weight for height (WFH). Children were classified into three groups according to children's HFA and WFH compared to the $10^{th}$ and $90^{th}$ percentiles of the 2007 Korean Children and Adolescent Growth Standard. Average monthly household income was divided into quartile groups. Dietary intake data were obtained by using the one day 24-hr recall method. Risks of inadequate intake of nutrients and unfavorable growth were estimated by using a multiple logistic regression model adjusted for sex, age, region, and energy intake. RESULTS: The low HFA group (<$10^{th}$ percentile) had significantly lower intakes of energy, carbohydrate, and thiamin as compared with the high group (${\geq}90^{th}$ percentile). For WFH status, vitamin C intake was lower in the low group than in the high group. Household income level was related to WFH status but not HFA. Children from lower income households were more likely to have high WFH than those from higher income households (P for trend = 0.038). Household income status was also significantly related with risk of inadequate intake of micronutrients such as thiamin (P for trend = 0.032) and vitamin C (P for trend = 0.002), showing higher odds of inadequate intakes in children from lower income households. CONCLUSIONS: Children from lower income households were prone to be overweight and to have inadequate intakes of micronutrients such as thiamin and vitamin C. To reduce nutritional and health disparities, collective action in the public sector is required from early life.

• The Korean journal of internal medicine
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• v.39 no.4
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• pp.668-679
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• 2024

Background/Aims: This cross-sectional study aimed to investigate biologics treatment disparities in rheumatoid arthritis (RA) patients based on socioeconomic status (SES). Methods: Data from the KOrean Observational Study Network for Arthritis (KORONA) database were analyzed to assess various factors associated with SES, health behaviors, and biologics use. Logistic regression and structured equation modeling (SEM) were utilized for data analysis. Results: Among 5,077 RA patients included, 393 (7.7%) patients were identified as biologics users. Within the entire cohort, 31.8% of the participants were in the low-income and low-education groups, and 39.3% of the participants were in the high-income and high-education groups. Despite the patients with low income or low education experienced higher disease activity at diagnosis, had more comorbidities, exhibited higher medication compliance, underwent more check-ups, and had more hospital admissions than their counterparts, the odds of patients with low-income receiving biologics were 34% lower (adjusted odds ratio = 0.76, 95% confidence interval: 0.60-0.96, p = 0.021) after adjustment for demographics and comorbidities. SEM and pathway analyses confirmed the negative impact of low SES on biologics use. Conclusions: The findings suggest that SES plays a significant role in biologics use among RA patients, indicating potential healthcare inefficiencies for low SES patients. Moreover, adverse healthcare habits negatively affect biologics use in RA patients. The study highlights the importance of considering socioeconomic factors while discussing biologics use and promoting equitable access to biologics for optimal RA management.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.1
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• pp.455-460
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• 2014

Background: The purpose of the present study was to determine geographic clustering of breast cancer incidence in Kanagawa Prefecture, using cancer registry data. The study also aimed at examining the association between socio-economic factors and any identified cluster. Materials and Methods: Incidence data were collected for women who were first diagnosed with breast cancer during the period from January to December 2006 in Kanagawa. The data consisted of 2,326 incidence cases extracted from the total of 34,323 Kanagawa Cancer Registration data issued in 2011. To adjust for differences in age distribution, the standardized mortality ratio (SMR) and the standardized incidence ratio (SIR) of breast cancer were calculated for each of 56 municipalities (e.g., city, special ward, town, and village) in Kanagawa by an indirect method using Kanagawa female population data. Spatial scan statistics were used to detect any area of elevated risk as a cluster for breast cancer deaths and/or incidences. The Student t-test was performed to examine differences in socio-economic variables, viz, persons per household, total fertility rate, age at first marriage for women, and marriage rate, between cluster and other regions. Results: There was a statistically significant cluster of breast cancer incidence (p=0.001) composed of 11 municipalities in southeastern area of Kanagawa Prefecture, whose SIR was 35 percent higher than that of the remainder of Kanagawa Prefecture. In this cluster, average value of age at first-marriage for women was significantly higher than in the rest of Kanagawa (p=0.017). No statistically significant clusters of breast cancer deaths were detected (p=0.53). Conclusions: There was a statistically significant cluster of high breast cancer incidence in southeastern area of Kanagawa Prefecture. It was suggested that the cluster region was related to the tendency to marry later. This study methodology will be helpful in the analysis of geographical disparities in cancer deaths and incidence.

• Korean Journal of Community Nutrition
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• v.26 no.6
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• pp.495-507
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• 2021

Objectives: This study examined regional differences in the intake of dietary total fat and saturated fatty acid (SFA) and their food sources among Korean adults. We also investigated the associations of SFA intake with metabolic diseases by region. Methods: This study included 13,926 adults (≥ 19y) who participated in the 2016 ~ 2019 Korea National Health and Nutrition Examination Surveys. The regions were divided into urban and rural areas according to the administrative districts where the participants lived. Using dietary data obtained from a 24-h recall, intake of total fat and SFA and their food sources were assessed by region. Metabolic diseases included obesity, abdominal obesity, and elevated total cholesterol and their association with SFA intake by region were examined using multiple logistic regression. Results: Of the participants, 19.6% lived in rural areas. In urban areas, the total fat and SFA intakes were higher than in rural areas: 21.2% of energy (%E) came from total fat and 6.9%E from SFA in urban areas, whereas 18.0%E came from total fat and 5.8%E from SFA in rural areas. The percentage of participants who exceeded the dietary reference intakes for total fat and SFA in urban areas was 16.5% and 41.9%, respectively, but 43.4% of participants in rural areas showed lower intake levels for total fat compared to the reference level. Young adults did not show regional differences in fat intake, and the percentage of subjects who exceeded the reference for SFA was high both in urban (58.5%) and rural (55.7%) areas. Among middle-aged and older adults, intake of fatty acids except for n-3 fatty acid was significantly higher in urban areas than in rural areas. About 69% of older adults in rural areas showed a lower intake of total fat compared to the reference level. The food sources for total fat and SFA were meat, soybean oil, eggs, and milk in both areas. The intake of fat from eggs, milk, mayonnaise, and bread was higher in urban areas, but the intake of fat from white rice and coffee mix was higher in rural areas. The SFA intake was positively associated with elevated serum total cholesterol in urban areas (4th quartile vs. 1st quartile, OR: 1.22, 95% CI: 1.06-1.40, P for trend: 0.043), but not in rural areas. Conclusions: Regional differences in total fat and SFA intakes and their food sources were observed among Korean adults. Our findings may help plan nutritional strategies to ameliorate regional health disparities.

• Journal of dental hygiene science
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• v.16 no.3
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• pp.225-234
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• 2016

The purpose of this study was to determine the oral health condition and behavioral status of Korean adults according to occupational status. The subjects were 7,676 adults, aged between 19 and 64 years, who completed both oral examination and questionnaire survey, among those who indicated that they were currently participating in economic activities, according to the data from the Fourth Korea National Health and Nutrition Examination Survey. Occupational class and employment status were selected as measures of occupational status. Complex-samples logistic regression models were used to assess the associations among oral health, behavioral, and occupational statuses. We found a significant occupational class-related difference in the oral health and behavioral statuses of both the men and women. In particular, the prevalence odds ratios of untreated dental caries in manual workers were 1.19 and 1.67 times higher than in non-manual workers, for men and women, respectively. As for oral health condition and behavioral status according to employment status, the health risk in temporary employment workers was higher than that in permanent employment workers. As for the prevalence odds ratios of the risk of dental caries, the highest values were observed for tooth brushing fewer than 3 times per day, not undergoing oral examinations, and chewing difficulty complaints. The risk of dental caries for agricultural, forestry, and fishing workers for both men and women was found to be the highest among other workers. Thus, strategies to promote workplace oral health in the microscopic and macroscopic perspectives should be developed to constantly monitor oral health problems, and to identify vulnerable social groups within occupational groups and the related factors that mediate oral health differences.

• Health Policy and Management
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• v.34 no.1
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• pp.78-86
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• 2024

Background: The purpose of this study was to determine the effectiveness of the specialty hospital system by comparing the medical use of inpatients who had artificial joint replacement surgery in specialty hospitals and non-specialty hospitals. Methods: This study utilized 2021-2022 healthcare benefit claims data provided by the Health Insurance Review and Assessment Service. The dependent variable is inpatient medical use which is measured in terms of charges per case and length of stay. The independent variable was whether the hospital was designated as a specialty hospital, and the control variables were patient-level variables (age, gender, insurer type, surgery type, and Charlson comorbidity index) and medical institution-level variables (establishment type, classification, location, number of orthopedic surgeons, and number of nurses). Results: The results of the multiple regression analysis between charges per case and whether a hospital is designated as a specialty hospital showed a statistically significant negative relationship between charges per case and whether a hospital is designated as a specialty hospital. This suggests a significant low in charges per case when a hospital is designated as a specialty hospital compared to a non-specialty hospital, indicating that there is a difference in medical use outcomes between specialty hospitals and non-specialty hospitals inpatients. Conclusion: The practical implications of this study are as follows. First, the criteria for designating specialty hospitals should be alleviated. In our study, the results show that specialty hospitals have significantly lower per-case costs than non-specialty hospitals. Despite the cost-effectiveness of specialty hospitals, the high barriers to be designated for specialty hospitals have gathered the specialty hospitals in metropolitan and major cities. To address the regional imbalance of specialty hospitals, it is believed that ease the criteria for designating specialty hospitals in non-metropolitan areas, such as introducing "semi-specialty hospitals (tentative name)," will lead to a reduction in health disparities between regions and reduce medical costs. Second, it is necessary to determine the appropriateness of the size of hospitals' medical staff. The study found that the number of orthopedic surgeons and nurses varied in charges per case. Therefore, it is believed that appropriately allocating hospital medical staff can maximize the cost-effectiveness of medical services and ultimately reduce medical costs.

• Health Policy and Management
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• v.34 no.2
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• pp.211-221
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• 2024

Background: The public health crisis caused by coronavirus disease 2019 emphasizes the need to expand and strengthen public hospitals. However, the overall perception of public hospitals remains negative. This negative perception can hinder the roles and functions of public hospitals, so this study aims to analyze the factors affecting negative perceptions of public hospitals. Methods: We used data from a survey on the public healthcare of Chungcheongbuk-do residents conducted by the Chungcheongbuk-do Public Health Policy Institute, and 1,916 adults aged 19 or older who responded to the survey were included in the study. Logistic regression analysis was used to analyze the impact of experiences with public hospitals use and evaluations of public healthcare and public hospital policies on the negative perception of public hospitals. Results: The experience of not using public hospitals (adjusted odds ratio [aOR], 1.69; 95% confidence interval [CI], 1.04-2.74) and negative evaluations of public healthcare and public hospital policies were found to significantly impact negative perceptions of public hospitals. In public healthcare policies, negative evaluations of the provision of essential medical care (aOR, 4.14; 95% CI, 2.59-6.62), regional disparities (aOR, 1.59; 95% CI, 1.02-2.49), coverage (aOR, 1.99; 95% CI, 1.25-3.16), and quality of care (aOR, 2.39; 95% CI, 1.50-3.80) were significantly associated with negative perceptions of public hospitals. In public hospital policies, negative evaluations of facilities and equipment (aOR, 3.74, 95% CI, 2.36-5.94), medical specialties and services (aOR, 1.91; 95% CI, 1.21-3.01), and quality of medical service (aOR, 2.71; 95% CI, 1.72-4.25) were also significantly associated with negative perceptions of public hospitals. Conclusion: This study emphasizes the need to improve perceptions of public hospitals by considering the experience with public hospitals use and evaluation of public healthcare and public hospital policies.

• Journal of agricultural medicine and community health
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• v.49 no.1
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• pp.37-49
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• 2024

Objectives: This study aimed to explore whether there are differences in smoking status between two regions of Wonju-City and Chuncheon-City, Gangwon State, and to determine whether the experience of smoking cessation programs in the region affects quit attempts. Methods: The study design was a cross-sectional study in which adults aged 19 and older living in two cities were surveyed using a pre-developed mobile app to investigate social capital for smoking cessation, and a total of 600 citizens were participated, including 310 in Wonju-City and 290 in Chuncheon-City. The statistical analysis was conducted using chi-square test and logistic regression analysis. Results: Wonju-City had a higher prevalence of current smoking than Chuncheon-City. Among smoking cessation programs operated by local public health centers, Wonju-City had a lower odds ratio for experience with smoking cessation education than Chuncheon-City (OR=0.52, 95% CI=0.33 to 0.81). When examining the effect of smoking cessation program experience on quit attempts, in Wonju-City, citizens who had completed smoking cessation education and used a smoking cessation clinic were more likely to attempt to quit than those who had not (OR=2.31 and OR=2.29, respectively). In Chuncheon-City, citizens who were aware of smoking cessation support services were 2.26 times more likely to attempt to quit smoking than those who were not, but statistical significance was not reached due to the small sample size. Conclusion: Therefore, healthcare organizations in both regions should develop more practical intervention strategies to increase smokers' quit attempts, reduce smoking rates in the community, and address regional disparities.