• Title/Summary/Keyword: Health service research

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Convergence Study in Development of Severity Adjustment Method for Death with Acute Myocardial Infarction Patients using Machine Learning (머신러닝을 이용한 급성심근경색증 환자의 퇴원 시 사망 중증도 보정 방법 개발에 대한 융복합 연구)

  • Baek, Seol-Kyung;Park, Hye-Jin;Kang, Sung-Hong;Choi, Joon-Young;Park, Jong-Ho
    • Journal of Digital Convergence
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    • v.17 no.2
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    • pp.217-230
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    • 2019
  • This study was conducted to develop a customized severity-adjustment method and to evaluate their validity for acute myocardial infarction(AMI) patients to complement the limitations of the existing severity-adjustment method for comorbidities. For this purpose, the subjects of KCD-7 code I20.0 ~ I20.9, which is the main diagnosis of acute myocardial infarction were extracted using the Korean National Hospital Discharge In-depth Injury survey data from 2006 to 2015. Three tools were used for severity-adjustment method of comorbidities : CCI (charlson comorbidity index), ECI (Elixhauser comorbidity index) and the newly proposed CCS (Clinical Classification Software). The results showed that CCS was the best tool for the severity correction, and that support vector machine model was the most predictable. Therefore, we propose the use of the customized method of severity correction and machine learning techniques from this study for the future research on severity adjustment such as assessment of results of medical service.

Integrated calibration weighting using complex auxiliary information (통합 칼리브레이션 가중치 산출 비교연구)

  • Park, Inho;Kim, Sujin
    • The Korean Journal of Applied Statistics
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    • v.34 no.3
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    • pp.427-438
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    • 2021
  • Two-stage sampling allows us to estimate population characteristics by both unit and cluster level together. Given a complex auxiliary information, integrated calibration weighting would better reflect the level-wise characteristics as well as multivariate characteristics between levels. This paper explored the integrated calibration weighting methods by Estevao and Särndal (2006) and Kim (2019) through a simulation study, where the efficiency of those weighting methods was compared using an artificial population data. Two weighting methods among others are shown efficient: single step calibration at the unit level with stacked individualized auxiliary information and iterative integrated calibration at each level. Under both methods, cluster calibrated weights are defined as the average of the calibrated weights of the unit(s) within cluster. Both were very good in terms of the goodness-of-fit of estimating the population totals of mutual auxiliary information between clusters and units, and showed small relative bias and relative mean square root errors for estimating the population totals of survey variables that are not included in calibration adjustments.

Chronic Obstructive Pulmonary Disease Is Not Associated with a Poor Prognosis in COVID-19

  • Kim, Youlim;An, Tai Joon;Park, Yong Bum;Kim, Kyungjoo;Cho, Do Yeon;Rhee, Chin Kook;Yoo, Kwang-Ha
    • Tuberculosis and Respiratory Diseases
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    • v.85 no.1
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    • pp.74-79
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    • 2022
  • Background: The effect of underlying chronic obstructive pulmonary disease (COPD) on coronavirus disease 2019 (COVID-19) during a pandemic is controversial. The purpose of this study was to examine the prognosis of COVID-19 according to the underlying COPD. Methods: COVID-19 patients were assessed using nationwide health insurance data. Comorbidities were evaluated using the modified Charlson Comorbidity Index (mCCI) which excluded COPD from conventional CCI scores. Baseline characteristics were assessed. Univariable and multiple logistic and linear regression analyses were performed to determine effects of variables on clinical outcomes. Ages, sex, mCCI, socioeconomic status, and underlying COPD were selected as variables. Results: COPD patients showed older age (71.3±11.6 years vs. 47.7±19.1 years, p<0.001), higher mCCI (2.6±1.9 vs. 0.8±1.3, p<0.001), and higher mortality (22.9% vs. 3.2%, p<0.001) than non-COPD patients. The intensive care unit admission rate and hospital length of stay were not significantly different between the two groups. All variables were associated with mortality in univariate analysis. However, underlying COPD was not associated with mortality unlike other variables in the adjusted analysis. Older age (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.11-1.14; p<0.001), male sex (OR, 2.29; 95% CI, 1.67-3.12; p<0.001), higher mCCI (OR, 1.30; 95% CI, 1.20-1.41; p<0.001), and medical aid insurance (OR, 1.55; 95% CI, 1.03-2.32; p=0.035) were associated with mortality. Conclusion: Underlying COPD is not associated with a poor prognosis of COVID-19.

A Study on the Punishment of Unlicensed Medical Practice -Focusing on Collaboration between Medical and Non-medical Personnel- (무면허 의료행위 처벌에 관한 고찰 -의료인과 비의료인의 협업관계를 중심으로-)

  • Yoon, Suh-Young
    • The Korean Society of Law and Medicine
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    • v.23 no.3
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    • pp.117-137
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    • 2022
  • Today, the medical system is changing into a comprehensive health care system in which collaborative relationships between medical professionals and non-medical personnels in neighboring occupational areas. The current medical act brands such "collaboration" as unlicensed medical practice, and punishes non-medical personnel who acted in the risk management of doctors as well as doctors collaborated with non-medical personnel as unlicensed medical practice. In order to narrow the gap between the legal system that regulates unlicensed medical practices and the medical reality, it is necessary to overcome the structural limitations of dualistic, nationalistic, and identity-oriented regulation of unlicensed medical practices. The legal interests of unlicensed medical practice have a dual nature as a personal legal interest of "human life and body" as well as a national legal interest of "maintenance and protection of the nation's medical license system", and it should be noted that the criteria for judging the legal interests protected by the regulations of criminal punishment should be found in "personal legal interest theory." In addition, when determining which behavior is a medical practice and evaluating its risk, the dimension of behavior and measures should be considered in a fair manner without being biased against the subject (identity) of the action. In other words, judging unlicensed medical practice should depend on whether the risk of side effects that may result from the act is reasonably managed. Considering the prospect of therapeutic dialogue between medical professionals and patients, it would be desirable for medical law policies to move in a way that does not fundamentally block the possibility of collaboration among pluralistic medical personalities.

Experiences of Ageism and "Self-Ageism" (노인차별 경험과 자기연령주의(self-ageism))

  • Kim, Juhyun;Oh, Hyein;Ju, Kyonghee
    • 한국노년학
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    • v.40 no.4
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    • pp.659-689
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    • 2020
  • This study focuses on the process of internalizing the perception of negative discrimination among elderly people who have experienced age discrimination. The grounded theory method was used to identify the age discrimination experienced by the elderly in their daily lives and to explore the consequences of such discrimination through self-ageism. According to the analysis results, the elderly respond not only to explicit discrimination but also to implicit discrimination. In this process, the stronger the pain of old age (poverty, disease, ignorance, and solitude) and the stronger the memory of failing to respond to discrimination, the higher the level of self-ageism. "Self-ageism" has internalized the negative image of the elderly, who have been discriminated against by age, resulting in disadvantages in terms of quality of life through various reject/separate/suspension actions in reality. In the presence of supportive resources such as health, institutional support, and caregivers, the elderly have room to overcome self-ageism through more active ways. However elderly people who cannot motivate themselves and they lack these resources, elderly are trapped in negative reflux caused by self-ageism and sustained a depressed and shrinking life. In this state, it is not easy to motivate themselves and make physical, cognitive, emotional and social responses. Therefore, in this analysis, we specifically noted two aspects, contextual conditions and interventional conditions, and proposed programs for synchronizing senior citizens and improving resiliency from a microscopic point of view, and argued for the need to develop systems such as supplementing welfare and health service systems related to the entire life cycle, expanding accessibility and 'age-integration' through 'Community Care', awareness improvement and anti-discrimination laws.

Comparison of Job Satisfaction among Employees according to Hospital Type (병원 형태에 따른 재직자 만족도 비교연구)

  • Kim, Cheol;Kwang-Hwan, Kim;Byoung Kwon, Lee;Hey-Jeong, Hwang
    • Journal of Digital Policy
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    • v.1 no.2
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    • pp.71-77
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    • 2022
  • The purpose of this study is to analyze the job satisfaction of hospital workers according to the type of hospital and to provide basic data for successful hospital management. For data analysis, frequency analysis and chi-square analysis are performed for general characteristics, and Kendall's tau correlation analysis is performed to see the correlation between statistically significant factors among job environment, value realization, organizational characteristics, and individual ability factors. did A total of 241 people working at primary, secondary, and tertiary medical institutions were surveyed. Among the value realization factors in the research results, self-esteem and rewarding (p<0.05), autonomy and creativity (p<0.05), and among personal competencies factors, workload (p<0.05) were statistically A significant difference was seen. Value realization and personal competence factors were found to influence job satisfaction (p<0.001). In conclusion, the most basic for the qualitative and quantitative growth of the hospital should be the job satisfaction of the internal members, on the basis of which positive medical services should be provided to the patients.

Rapid Rural-Urban Migration and the Rural Economy in Korea (한국(韓國)의 급격(急激)한 이촌향도형(離村向都型) 인구이동(人口移動)과 농촌경제(農村經濟))

  • Lee, Bun-song
    • KDI Journal of Economic Policy
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    • v.12 no.3
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    • pp.27-45
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    • 1990
  • Two opposing views prevail regarding the economic impact of rural out-migration on the rural areas of origin. The optimistic neoclassical view argues that rapid rural out-migration is not detrimental to the income and welfare of the rural areas of origin, whereas Lipton (1980) argues the opposite. We developed our own alternative model for rural to urban migration, appropriate for rapidly developing economies such as Korea's. This model, which adopts international trade theories of nontraded goods and Dutch Disease to rural to urban migration issues, argues that rural to urban migration is caused mainly by two factors: first, the unprofitability of farming, and second, the decrease in demand for rural nontraded goods and the increase in demand for urban nontraded goods. The unprofitability of farming is caused by the increase in rural wages, which is induced by increasing urban wages in booming urban manufacturing sectors, and by the fact that the cost increases in farming cannot be shifted to consumers, because farm prices are fixed worldwide and because the income demand elasticity for farm products is very low. The demand for nontraded goods decreases in rural and increases in urban areas because population density and income in urban areas increase sharply, while those in rural areas decrease sharply, due to rapid rural to urban migration. Given that the market structure for nontraded goods-namely, service sectors including educational and health facilities-is mostly in monopolistically competitive, and that the demand for nontraded goods comes only from local sources, the urban service sector enjoys economies of scale, and can thus offer services at cheaper prices and in greater variety, whereas the rural service sector cannot enjoy the advantages offered by scale economies. Our view concerning the economic impact of rural to urban migration on rural areas of origin agrees with Lipton's pessimistic view that rural out-migration is detrimental to the income and welfare of rural areas. However, our reasons for the reduction of rural income are different from those in Lipton's model. Lipton argued that rural income and welfare deteriorate mainly because of a shortage of human capital, younger workers and talent resulting from selective rural out-migration. Instead, we believe that rural income declines, first, because a rapid rural-urban migration creates a further shortage of farm labor supplies and increases rural wages, and thus reduces further the profitability of farming and, second, because a rapid rural-urban migration causes a further decline of the rural service sectors. Empirical tests of our major hypotheses using Korean census data from 1966, 1970, 1975, 1980 and 1985 support our own model much more than the neoclassical or Lipton's models. A kun (county) with a large out-migration had a smaller proportion of younger working aged people in the population, and a smaller proportion of highly educated workers. But the productivity of farm workers, measured in terms of fall crops (rice) purchased by the government per farmer or per hectare of irrigated land, did not decline despite the loss of these youths and of human capital. The kun having had a large out-migration had a larger proportion of the population in the farm sector and a smaller proportion in the service sector. The kun having had a large out-migration also had a lower income measured in terms of the proportion of households receiving welfare payments or the amount of provincial taxes paid per household. The lower incomes of these kuns might explain why the kuns that experienced a large out-migration had difficulty in mechanizing farming. Our policy suggestions based on the tests of the currently prevailing hypotheses are as follows: 1) The main cause of farming difficulties is not a lack of human capital, but the in­crease in production costs due to rural wage increases combined with depressed farm output prices. Therefore, a more effective way of helping farm economies is by increasing farm output prices. However, we are not sure whether an increase in farm output prices is desirable in terms of efficiency. 2) It might be worthwhile to attempt to increase the size of farmland holdings per farm household so that the mechanization of farming can be achieved more easily. 3) A kun with large out-migration suffers a deterioration in income and welfare. Therefore, the government should provide a form of subsidization similar to the adjustment assistance provided for international trade. This assistance should not be related to the level of farm output. Otherwise, there is a possibility that we might encourage farm production which would not be profitable in the absence of subsidies. 4) Government intervention in agricultural research and its dissemination, and large-scale social overhead projects in rural areas, carried out by the Korean government, might be desirable from both efficiency and equity points of view. Government interventions in research are justified because of the problems associated with the appropriation of knowledge, and government actions on large-scale projects are justified because they required collective action.

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A Study on the Variables Affecting the Intention to Use Healing Agriculture (치유농업 이용의도에 영향을 미치는 변인 고찰)

  • Kim, Ok Ja;Ha, Kyu Soo
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.13 no.4
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    • pp.59-72
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    • 2018
  • The purpose of this study is to investigate the factors affecting the intention to use healing farming by setting aged readiness, rural healing supply condition, and rural healing service as independent variables. This study has been started based on the idea that it is necessary to provide healing service through healing agriculture to the rapidly increasing elderly people and urban people who need mental rest. Therefore, the purpose of this study is to find out the various factors influencing intention to use healing agriculture through empirical analysis. Second, we want to examine whether the variables influenced the intention to use more. Third, based on the results of these tests, we suggest the policy for activation of healing agriculture by examining the factors necessary for the promotion of physical and mental health of the elderly in the aging society and the revitalization of healing agriculture for the mental healing of the urban people. For this study, a questionnaire survey was conducted for men and women over 30 years old, and the final 356 copies were analyzed. The validity of the research hypothesis was verified by linear regression analysis. The results of the analysis are as follows. First, the physical preparation, emotional preparation, and economic preparation of aged care preparations were found to have a significant effect on intention to use. Second, natural landscape, accessibility, and stability of rural healing supply conditions were found to have a significant effect on intention to use. But economics and expertise were dismissed. Third, crop cultivation, animal medication and healing facilities of rural healing service were proved to have significant influence on intention to use. In order to increase the utilization of healing agriculture, it is necessary for the consumer to be well prepared for aging. In rural healing supply conditions, accessibility and safety should be provided for healing facilities in rural healing services.And to increase the intention to use it.

Development of Evaluation Indicators for a Children's Dietary Life Safety Index in Korea (한국 어린이 식생활 안전지수의 평가 지표 개발)

  • Chung, Hae-Rang;Kwak, Tong-Kyung;Choi, Young-Sun;Kim, Hye-Young P.;Lee, Jung-Sug;Choi, Jung-Hwa;Yi, Na-Young;Kwon, Se-Hyug;Choi, Youn-Ju;Lee, Soon-Kyu;Kang, Myung-Hee
    • Journal of Nutrition and Health
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    • v.44 no.1
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    • pp.49-60
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    • 2011
  • This study was performed to develop a children's dietary life safety index required by the Special Act on Safety Management of Children's Dietary Life enacted in 2009. An analytical hierarchy process was used to obtain initial weights of dietary life safety evaluation indicators. The Delphi method was applied to develop the weights along with 98 food and nutrition professionals. Three representative policy indicators, nine strategy indicators, 11 main evaluation indicators, and 20 detailed evaluation indicators were selected for the children's dietary life safety assessment. Three policy indicators and nine strategy indicators were the following: children's food safety indicator (support level of children' safety, safety management level of children's favorite foods, and safety management level of institutional food service), children's nutrition safety indicator (management level of missing meals and obesity, nutrition management level of children's favorite foods, and nutrition management level of institutional food service), and children's perception and practice level indicator ("Dietary Life Law" perception level, perception, and practice level for dietary life safety management, perception, and practice level for nutrition management). Weights of 40%, 40%, and 20% were given for the three representative policy indicators. The relative importance of nine strategic indicators, which were determined by the Delphi method is as follows: For children’s food safety, support level of children's safety, safety management level of children's favorite foods, and safety management level of institutional food service were given weights of 12%, 9%, and 19%, respectively. For children's nutrition safety, the missing meals and obesity management level, nutrition management level of children's favorite foods, and the nutrition management level of institutional food service were given weights of 13%, 11%, and 16%, respectively. The "Dietary Life Law" perception level, perception and practice level of dietary life safety management, and perception and practice level of nutrition management were given weights of 4%, 7%, and 9%, respectively.

Quantity over Quality? Perception of Designating Long-Term Care Hospitals as Providers of Hospice and Palliative Care

  • Kim-Knauss, Yaeji;Jeong, Eunseok;Sim, Jin-ah;Lee, Jihye;Choo, Jiyeon;Yun, Young Ho
    • Journal of Hospice and Palliative Care
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    • v.22 no.4
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    • pp.145-155
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    • 2019
  • Purpose: Amendment to the Act on Decisions on Life-sustaining Treatment was recently enacted to designate long-term care hospitals as providers of hospice and palliative care. Despite its benefit of providing improved accessibility to end-of-life care, the amendment has raised concerns about its effect on quality of service. This study aimed to use information obtained from an expert group interview and previous studies to compare how cancer patients, family caregivers, physicians, and the general Korean population perceive the potential benefits and risks of this amendment. Methods: We conducted a multicenter cross-sectional study from July to October 2016. The included participants answered a structured questionnaire regarding the extent to which they agree or disagree with the questionnaire items indicating the potential benefits and risks of the amendment. Chi-square tests and univariate and multivariate logistic regression analyses were performed. Results: Compared with the general population, physicians agreed more that long-term care hospitals are currently not adequately equipped to provide quality hospice and palliative care. Family caregivers found improved access to long-term care hospitals more favorable but were more likely to agree that these hospitals might prioritize profits, thereby threatening the philosophy of hospice care, and that families might cease to fulfill filial responsibilities. Compared with the general population, cancer patients were more concerned about the potentially decreased service quality in this setting. Conclusion: Although potential service beneficiaries and providers expected improved accessibility of hospice and palliative care services, they were also concerned whether the system can provide adequate quality of end-of-life care.