• Archives of Plastic Surgery
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• v.49 no.2
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• pp.215-220
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• 2022

Background In Japan, there is a large regional disparity in plastic surgery availability. In order for plastic surgery to be widely available for all citizens, it is essential for at least one plastic surgery facility to be located in each secondary medical zone. Methods Using the Japan Society of Plastic and Reconstructive Surgery homepage and some databases, we extracted data on secondary medical zones that do not have a plastic surgery facility. The national and regional coverage rates were calculated. The coverage rate for each group divided by the degree of population concentration was also calculated. Results We found that 147 of 344 secondary medical zones did not have a plastic surgery facility, and the area coverage rate was found to be 57.27% nationwide. The coverage rate in terms of population was 87.07% (correlation coefficient of area and population coverage = 0.983). The area coverage rates in Hokkaido-Tohoku, Kanto, Chubu, Kansai, Chugoku-Shikoku, and Kyushu-Okinawa districts were 47.46, 72.15, 76.47, 62.79, 52.08, and 32.81%, respectively. The corresponding population coverage rates were 79.92, 91.62, 94.27, 90.59, 80.68, and 69.54%, respectively. The area coverage rates in metropolitan areas, provincial cities, and rural areas were 98.08, 75.90, and 15.87%, respectively. In contrast, the area coverage rate of dermatology was 62.79% and that of orthopaedics was 97.09%. Conclusion Unfortunately, it is estimated that more than 40% of secondary medical zones are underserved by plastic surgery, and 13% of the population is not able to fully benefit from this specialty in Japan.

• Journal of Preventive Medicine and Public Health
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• v.32 no.4
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• pp.538-545
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• 1999

Objective : To compare the predictive power of International Classification of Diseases 10th Edition(ICD-10) based International Classification of Diseases based Injury Severity Score(ICISS) with Trauma and Injury Severity Score(TRISS) and International Classification of Diseases 9th Edition Clinical Modification(ICD-9CM) based ICISS in the injury severity measure. Methods : ICD-10 version of Survival Risk Ratios(SRRs) was derived from 47,750 trauma patients from 35 Emergency Centers for 1 year. The predictive power of TRISS, the ICD-9CM based ICISS and ICD-10 based ICISS were compared in a group of 367 severely injured patients admitted to two university hospitals. The predictive power was compared by using the measures of discrimination(disparity, sensitivity, specificity, misclassification rates, and ROC curve analysis) and calibration(Hosmer-Lemeshow goodness-of-fit statistics), all calculated by logistic regression procedure. Results : ICD-10 based ICISS showed a lower performance than TRISS and ICD-9CM based ICISS. When age and Revised Trauma Score(RTS) were incorporated into the survival probability model, however, ICD-10 based ICISS full model showed a similar predictive power compared with TRISS and ICD-9CM based ICISS full model. ICD-10 based ICISS had some disadvantages in predicting outcomes among patients with intracranial injuries. However, such weakness was largely compensated by incorporating age and RTS in the model. Conclusions : The ICISS methodology can be extended to ICD-10 horizon as a standard injury severity measure in the place of TRISS, especially when age and RTS were incorporated in the model. In patients with intracranial injuries, the predictive power of ICD-10 based ICISS was relatively low because of differences in the classifying system between ICD-10 and ICD-9CM.

• Health Policy and Management
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• v.20 no.2
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• pp.1-16
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• 2010

Background : Clinical practice guidelines are an increasingly familiar part of clinical practice. Moreover, rigorously developed evidence based guidelines has been widely used. However, in Korea, some of published documents as clinical practice guidelines have shown considerable disparity in structure, contents and quality. This is mainly because there is no consensus on the definition and quality standard of clinical practice guidelines. The purpose of this study was to draw consensus on the definition and the quality standard about clinical practice guidelines. Method : We developed a questionnaire about the definition of clinical practice guidelines with inclusion criteria(23 items) and the quality standard(30 items). We selected 9 experts who had prior experience in developing and implementing guidelines. Rating methods for appropriateness of items were adopted from the RAND method. Consensus was drawn in three rounds. Results : Of the 47 items agreed, 40 items were determined to be appropriate. Clinical practice guidelines were defined as "scientifically and systematically developed statements to assist practitioners and patients on making decisions about appropriate health care for specific clinical circumstances." Narrative reviews, systematic reviews or health technology assessment without recommendations, translation of foreign guidelines, guidelines for patients only and training manuals were not considered as clinical practice guidelines. For the quality standard of clinical practice guidelines, 27 items were deemed necessary. Conclusions : The consensus on the definition with inclusion criteria and the quality standard of clinical practice guidelines carries an important meaning as the first attempt to draw a general agreement in our society. The unique achievement of the consensus reflects the current status of clinical practice guidelines that there has been a high tendency to adapt foreign guidelines. We hope efforts of this kind will continue to bring improvement in clinical practice guidelines.

• Journal of dental hygiene science
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• v.14 no.2
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• pp.207-213
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• 2014

How to eliminate health disparity to ensure health equity is one of major issues that are handled across the world. The purpose of this study was to examine any possible differences in self-rated oral health state according to socioeconomic status and the relationship between the two based on the data of the 5th National Health & Nutrition Examination Survey of 2010~2012. As for differences in self-rated oral health state according to sociodemographic characteristics, the women considered themselves to be in poorer oral health than the men. The older respondents found themselves to be in poorer oral health, and there was a tendency that the respondents who were less educated and whose household income was smaller rated their own health as worse. When a logistic regression analysis was made to determine influential factors for self-rated oral health status, the women perceived they were in better oral health than the men did, and the better-educated respondents were more likely to consider themselves healthier. Concerning disparities in self-rated health state according to income level, there were broader differences in that regard according to an increase of income. The findings of the study illustrated that there was oral health inequity according to social stratum. It's required to make a nationwide effort to promote national oral health, and appropriate support should especially be provided for disadvantaged people at the same time in order to get rid of the gap in oral health among different social classes, as there is a yawning gap between them and the other classes.

• Journal of Korean society of Dental Hygiene
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• v.8 no.3
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• pp.1-11
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• 2008

Oral health projects that cater to the disabled should be more prevailing in order to ensure the maintenance and successful promotion of the oral health of disabled people. 70 public dental clinics that conducted oral health projects geared toward the disabled were examined to get a precise grip on their oral health projects. The findings of the study were as follows: 1. 31 out of 70 public dental clinics investigated(44.3%) were equipped with two or more dental hygienists who were professional human resources in charge of the oral health projects for the disabled. As for the age and disability type of the beneficiaries of the oral health projects, adolescents(74.3%) and people with mental retardation(87.1%) benefited most from the oral health projects. Concerning the most common implementation frequency of the projects, the projects were carried out once to three times a week(62.9%). 2. The most dominant oral disease treatment provided to disabled people was amalgam treatment and resin treatment(68.6%), which were the early dental caries treatment. The most common preventive treatment that was offered to improve their oral health was oral prophylaxis(82.9%). As for reform measures for the oral health projects, education of personnels in charge of the projects and their specialization(58.6%) were most emphasized. 3. Regarding factors related to the preventive oral health projects for the disabled, the implementation of oral prophylaxis and toothbrushing education was linked to the age of the beneficiaries. More oral prophylaxis was offered to teens, and more toothbrushing education was provided to preschoolers and adolescents. The age of the beneficiaries and the number of dental hygienists responsible for the projects had something to do with the application of fluorides. 4. Concerning the relationship of the preventive oral health projects for the disabled to the number of dental hygienists, one of the personnels in charge of the projects, the application of fluorides( 54.4%) and pit & fissure sealing(56.8%) were more prevalent when there were two or more dental hygienists. There was a statistically significant disparity in that regard(p<0.05). The above-mentioned findings illustrated that in order to boost the oral health of the disabled, dental hygienists who are responsible for the oral health projects for the disabled should put ceaseless efforts into fostering their professional knowledge and ability and offering quality service to disabled patients. Every public dental clinic should be equipped with plenty of professional personnels to enlarge the scope of treatment and ensure the efficiency of treatment and the preventive projects.

• Nutrition Research and Practice
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• v.14 no.6
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• pp.679-690
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• 2020

BACKGROUND/OBJECTIVES: Concerns about regional disparities in heathy eating and nutritional status among South Korean adults are increasing. This study aims to identify the magnitude of regional disparities in diet and nutritional status among Korean adults who completed the 2017 Korea National Health and Nutrition Examination Survey (KNHANES). SUBJECTS/METHODS: The participants were a nationally representative sample of Korean adults aged 19 years and older from the 2017 KNHANES (n = 6,126). We employed the svy commands in STATA to accommodate the complex survey design. The relative concentration index (RCI), absolute concentration index (ACI) and index of disparity were used to measure regional nutritional inequalities. RESULTS: Overweight and obese adults were more prevalent among the poor than among the rich in urban areas (RCI = -0.041; P < 0.05), while overweight and obese adults were more prevalent among the rich than among the poor in rural areas of South Korea (RCI = 0.084; P < 0.05). Economic inequality in fruit and vegetable intake ≥ 500 g per day was greater in rural areas than in urban areas in both relative size (RCI = 0.228 vs. 0.091, difference in equality = 0.137; P < 0.05) and absolute size (ACI = 0.055 vs. 0.023, difference in equality = 0.032; P < 0.05). CONCLUSIONS: This study provides useful information identifying opposite directions in the relative concentration curves between urban and rural areas. Adult overweight/obesity was more prevalent among the poor in urban areas, while adult overweight/obesity was more prevalent among the rich in rural areas. Public health nutrition systems should be implemented to identify nutritional inequalities that should be targeted across regions in South Korea.

• Nutrition Research and Practice
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• v.14 no.5
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• pp.519-531
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• 2020

BACKGROUND/OBJECTIVES: Regional disparities in dietary factors might be related to regional disparities in cardiometabolic health. Therefore, this study investigated the associations of cardiometabolic risk factors and dietary factors with regional types in Korean adults. SUBJECTS/METHODS: Based on data from the 2007-2017 Korea National Health and Nutrition Examination Survey, the study included 39,781 adults aged ≥ 19 years who completed the dietary survey and a health examination. Healthy and unhealthy dietary factors (fat, sodium, fruit, and vegetable intakes) were evaluated using 1-day 24-h dietary recall method, as well as the use of nutrition labels with a questionnaire. RESULTS: Of the participants, 48.7%, 36.0%, and 15.2% lived in metropolitan, urban, and rural areas, respectively. Adults living in urban and rural had higher odds ratios (ORs) for obesity (OR for urban, 1.07; 95% confidence interval (CI), 1.01-1.14; OR for rural, 1.14; 95% CI, 1.05-1.24) than adults living in metropolitan areas; these associations were significantly observed in middle-aged adults. Compared to metropolitan residents, rural residents had lower ORs for hypertension in middle-aged (OR, 0.86; 95% CI, 0.76-0.96) and metabolic syndrome in older adults (OR, 0.78; 95% CI, 0.67-0.91). Regarding urban residents, a lower OR for diabetes in middle-aged adults (OR, 0.85; 95% CI, 0.74-0.97) and a higher OR for hypertension in older adults (OR, 1.19; 95% CI, 1.02-1.39) were observed. Overall rural residents had higher ORs of excessive carbohydrate, low fruit, and high salted-vegetable intakes than metropolitan residents. Low fruit intake was positively associated with obesity, metabolic syndrome, and hypertension, after adjustment for regional type and other confounders in total participants. CONCLUSIONS: These findings indicate that cardiometabolic risk and unhealthy dietary factors differ among regional types and age groups within Korea. Nutritional policy and interventions should consider regional types for prevention and management of cardiometabolic risk factors.

• Safety and Health at Work
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• v.11 no.2
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• pp.127-135
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• 2020

A safe work environment is crucial in high-risk industries, such as construction refurbishment. Safety incidents caused by uncertainty and unexpected events in construction refurbishment systems are difficult to control using conventional safety management techniques. Resilience engineering (RE) is proposed as an alternative to traditional safety management approaches. It presents a successful safety management methodology designed to deal with uncertainty in high-risk work environments. Despite the fact that RE resides in the safety domain, there is no common set of RE indicators to measure and assess resilient in the work environment. The main aim of this research is to explore RE indicators that have been identified as important in developing and assessing the resilient work environment in high-risk industries, particularly in construction refurbishment. Indicators have been attained through a systematic literature review of research and scholarly articles published between the years 2004 and 2019. The literature review explored RE indicators in various industries. Descriptive analysis and co-occurrence-based network visualization were used for data analysis. The findings revealed 28 RE indicators in 11 different high-risk industries. The results show that the four commonly used indicators were: top-management commitment, awareness, learning, and flexibility, all of which have a strong relationship with RE. The findings of this study are useful for stakeholders when making decisions concerning the most important RE indicators in the context of their research or practice as this would avoid the ambiguity and disparity in the identification of RE indicators.

• The Journal of the Convergence on Culture Technology
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• v.5 no.2
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• pp.101-109
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• 2019

This study aims to understand realities of senior couple's violence by dividing them into victim and assaulter, and then grasp the degree of the effect of violence on desirable cohabitation. Conjugal violence was divided into emotional, minor physical, severe physical and sexual violence. Mental health was subdivided into depression, stress, aggression and self-esteem. Emotional violence appeared most often at 29.9%, and physical violence was under 3% in the case of being victimized, while emotional violence accounted for 25.4% and physical violence for under 2% in the case of offense. The effect of conjugal violence on mental health was that depression and stress increased significantly although some disparity existed between types of violence. In the circumstances of inflicting violence, the degree of aggression was significantly different in common. In conclusion, conjugal violence has a great influence on couple's mental health though the extent of damage was different depending on the type of violence and whether the person was the victim or attacker. So diverse welfare program should be implemented and activated.

• Nutrition Research and Practice
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• v.16 no.4
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• pp.489-504
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• 2022

BACKGROUND/OBJECTIVES: This study examined socio-economic differences in diverse food consumption among children 6-23 months of age in South Asia and Southeast Asian countries. SUBJECTS/METHODS: Data from Demographic and Health Surveys in four countries in South Asia (n = 15,749) and four countries in Southeast Asia (n = 10,789) were used. Survey-design adjusted proportions were estimated for the following 10 food items: grains, legumes, dark green leafy vegetables (DGLV), vitamin A-rich fruits, vitamin A-rich vegetables, other fruits and vegetables (OFV), fish, meat, dairy, and eggs. An equity gap was defined as an arithmetic difference in the proportion of each food item consumed in the past 24-hours between the wealthiest and lowest quintiles and between rural and urban areas, denoted by percentage points (pp). RESULTS: The consumption of most of the 10 food items was higher in the wealthiest quintiles and urban areas across eight countries. The size of equity gaps was greater in Southeast Asia than in South Asia, particularly for vitamin A-rich fruits (3.3-30.0 pp vs. 0.3-19.6 pp), vitamin A-rich vegetables (12.1-26.7 pp vs. 2.4-5.9 pp), meat (17.7-33.4 pp vs. 3.4-13.4 pp), and dairy (14.7-32.5 pp vs. 3.3-11.4 pp). However, the size of equity gap in egg consumption was greater in Southeast Asia than South Asia (11.2-19.8 pp vs. 11.0-26.7 pp). Relatively narrower gaps were seen in the consumption of grains (0.3-12.9 pp), DGLV (0.6-12.4 pp), and fish (0.1-16.8 pp) across all countries. CONCLUSIONS: Equity gaps in food consumption differed by socio-economic status and region. Reducing equity gaps in nutrient-rich foods and utilizing regionally available food resources may increase child dietary quality.