• Safety and Health at Work
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• v.14 no.4
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• pp.488-491
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• 2023

This study aims to ascertain occupations potentially at greatest risk of exposure to SARS-CoV-2 based on pre-lockdown working conditions in France. We combined two French population-based surveys documenting workplace exposures to infectious agents, face-to-face contact with the public, and working with colleagues just before the pandemic. Then, for each 87-level standard French occupational grouping, we estimated the number and percentage of the French working population reporting these occupational exposure factors, by gender, using survey weights. As much as 40% (11 million) of all workers reported at least two exposure factors. Most of the workers concerned were in the healthcare sector. However, army/police officers, firefighters, hairdressers, teachers, cultural/sports professionals, and some manual workers were also exposed. Women were overrepresented in certain occupations with potentially higher risks of exposure such as home caregivers, childminders, and hairdressers. Our gender-stratified matrix can be used to assign prelockdown work-related exposures to cohorts implemented during the pandemic.

• 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 Preventive Medicine and Public Health
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• v.53 no.4
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• pp.266-274
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• 2020

Objectives: Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017. Methods: We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index. Results: The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05). Conclusions: Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.

• Korea Journal of Hospital Management
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• v.16 no.3
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• pp.1-18
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• 2011

In this study, population census(2005 & 2008) from Statistics Korea and the statistical data of the number of hospital beds by healthcare facilities classification from Ministry of Health and Welfare were used. For analyzing distribution of hospital beds, hospital beds were classified as acute care beds, long-term care beds and all hospital beds, which is including acute and long-term care beds. Regional areas, which are city(si), county(goon) for the study and district(gu) were reclassified as metropolitan city, city(si) and county(goon). Because there were 165 regional areas in 2005 and 2008, 84 and 81 areas were classified as metropolitan city and/or city and county, respectively. Gini index were calculated for hospital beds from each year, and Lorenz curves were drawn. The following summary presents the findings of this study. Compared to the year 2005 and 2008, the Gini index was 0.24472, and hospital bed numbers increased slightly by 0.80% than in 2005. In case of acute care beds, the Gini index was 0.23797(0.13%), and there was no big difference; however, the Gini index for long-term care beds was 0.41091, and there was a 30.25% decrease, which shows improvement to reduce disparities. It might result from an increase in long-term care beds up to 476.2%. For geographical equality of hospital beds, the Gini index and Lorenz curve, which can be compared the degree of inequality in the distribution of hospital beds reasonably and possibly show statistical data, should be used. Through this study, the distribution policy of hospital beds should be established.

• Journal of Preventive Medicine and Public Health
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• v.51 no.5
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• pp.257-262
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• 2018

Objectives: Smoking cessation decreases morbidity and mortality due to chronic obstructive pulmonary disease (COPD). Pharmacotherapy for smoking cessation is highly effective. However, the optimal prescription rate of smoking cessation medications among smokers with COPD has not been systemically studied. The purpose of this study was to estimate the national prescription rates of smoking cessation medications among smokers with COPD and to examine any disparities therein. Methods: We conducted a retrospective study using National Ambulatory Medical Care Survey data from 2007 to 2012. We estimated the national prescription rate for any smoking cessation medication (varenicline, bupropion, and nicotine replacement therapy) each year. Multiple survey logistic regression was performed to characterize the effects of demographic variables and comorbidities on prescriptions. Results: The average prescription rate of any smoking cessation medication over 5 years was 3.64%. The prescription rate declined each year, except for a slight increase in 2012: 9.91% in 2007, 4.47% in 2008, 2.42% in 2009, 1.88% in 2010, 1.46% in 2011, and 3.67% in 2012. Hispanic race and depression were associated with higher prescription rates (odds ratio [OR], 5.15; 95% confidence interval [CI], 1.59 to 16.67 and OR, 2.64; 95% CI, 1.26 to 5.51, respectively). There were no significant differences according to insurance, location of the physician, or other comorbidities. The high OR among Hispanic population and those with depression was driven by the high prescription rate of bupropion. Conclusions: The prescription rate of smoking cessation medications among smokers with COPD remained low throughout the study period. Further studies are necessary to identify barriers and to develop strategies to overcome them.

• Research in Community and Public Health Nursing
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• v.31 no.spc
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• pp.525-533
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• 2020

Purpose: Workers in special employment relationship (WSERs) are workers in nonstandard employment arrangements who lack worker protection accorded in standard employment arrangements. This study aimed to describe self-rated health (SRH) and depressive symptoms (DS) among Korean WSERs in comparison to regular wage workers (RWW) and identify associations between working conditions and those outcomes. Methods: In this study, secondary data analysis using the 5th Korean Working Conditions Survey was used. The sample totaled 29,120, including 1,538 WSERs and 27,564 RWWs. Sociodemographic and work-related characteristics were employed as explanatory variables and SRH and DS as dependent variables. Using multiple logistic regression, the determinants of fair/poor SRH and DS were identified. Results: The prevalence rates for fair/poor SRH and DS in WSERs were 25.2% and 28.3%, respectively, and 20.7% and 25.0% in RWWs, respectively. Compared to RWWs, WSERs had 31% (aOR=1.31, 95% CI=1.14~1.49) and 20% (aOR=1.20, 95% CI=1.06~1.36) higher odds of SRH and DS, respectively. Some factors, such as a lack of rest guarantee and sickness presenteeism, had a larger influence in the WSER than in the RWW group. Conclusion: Compared to RWWs, WSERs reported having poorer working conditions and were more likely to report poor general and mental health. Therefore, in Korea, public health policymakers should consider measures to protect the working conditions and health of WSERs, a growing segment of the working population. The study produced new epidemiological evidence regarding the relationships between employment arrangements and health.

• Journal of Preventive Medicine and Public Health
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• v.55 no.4
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• pp.379-388
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• 2022

Objectives: Throughout history, societies have been impacted by inequality. Many studies have been conducted on the topic more broadly, but only a few have investigated inequalities in out-of-pocket health payments (OHP). This study measures OHP inequality trends among the Iranian households. Methods: This study used data from the Iranian Statistics Center on Iranian household income and expenditures. The analysis included a total of 995 300 households during the 36 years from 1984 to 2019. The Gini coefficient, Atkinson index, and Theil index were calculated for Iranian OHP. Results: Average Iranian household OHP increased from 33 US dollar (USD) in 1984 to 47 USD in 2019. During this 36-year span, the average±standard deviation Gini coefficient for OHP was 0.73±0.04, and the Atkinson and Theil indexes were 0.68±0.05 and 1.14±0.29, respectively. The Gini coefficients for the subcategories of OHP of outpatient diagnostic services, medical assistant accessories, hospital inpatient services, and addiction cessation were 0.70, 0.61, 0.84, and 0.64, respectively. Conclusions: In this study, we scrutinized trends of inequality in the OHP of Iranian households. Inequality in OHP decreased slightly over the past four decades. An analysis of trends among different subgroups revealed that affluent households, such as households with insurance coverage and households in higher income deciles, experienced higher inequality. Therefore, lower inequality in health care expenditures may be related to restricted access to health care services in Iran.

• Health Policy and Management
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• v.32 no.2
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• pp.205-215
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• 2022

Background: The purpose of this study is to identify the factors infecting the medical care utilization from a new perspective by newly classifying the categories of administrative districts using the urban decline index and medical vulnerability index as indicators. Methods: This study targeted 150,940 people who used medical services using the 2015 cohort database (DB), 2010-2015 urban regeneration analysis index DB, and 2014-2015 public health and medical statistics DB. The decline of the region was classified using the urban decline index typed using k-means clustering and the medical vulnerability index typed using the quantile score calculation. Regression analysis was performed 3 times with medical expenditure, length of stay, and the number of outpatient visits as dependent variables. Results: There were 37 stable region (47.4%), 29 health vulnerable region (37.2%), and 12 decline region (15.4%). The health vulnerable region had lower medical expenditure, fewer outpatient visits, and a higher length of stay than the stable region. The decline region was all higher than the stable region but had no significant effect. Conclusion: The factors that cause the health disparity between regions are not only factors related to individual health behavior but also environmental factors of the local community. Therefore, there is a need for a systematic alternative that properly considers the resources within the community and reflects the characteristics of the population.

• Korean Journal of Clinical Pharmacy
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• v.33 no.3
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• pp.153-167
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• 2023

Objective: Bipolar disorder displays a spectrum of manifestations, including manic, hypomanic, depressive, mixed, psychotic, and atypical episodes, contributing to its chronic nature and association with heightened suicide risk. Creating effective pharmacotherapy guidelines is crucial for managing bipolar disorder and reducing its prevalence. Treatment algorithms grounded in science have improved symptom management, but variations in recommended medications arise from research differences, healthcare policies, and cultural nuances globally. Methods: This study compares Korea's bipolar disorder treatment algorithm with guidelines from the UK, Australia, and an international association. The aim is to uncover disparities in key recommended medications and their underlying factors. Differences in CYP450 genotypes affecting drug metabolism contribute to distinct recommended medications. Variances also stem from diverse guideline development approaches-expert consensus versus metaanalysis results-forming the primary differences between Korea and other countries. Results: Discrepancies remain in international guidelines relying on meta-analyses due to timing and utilized studies. Drug approval speeds further impact medication selection. However, limited high-quality research results are the main cause of guideline variations, hampering consistent treatment conclusions. Conclusion: Korea's unique Delphi-based treatment algorithm stands out. To improve evidence-based recommendations, large-scale studies assessing bipolar disorder treatments for the Korean population are necessary. This foundation will ensure future recommendations are rooted in scientific evidence.

• Journal of The Korean Society of Integrative Medicine
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• v.11 no.4
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• pp.199-211
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• 2023

Purpose : Rapid population aging in South Korea is emerging as serious social problems, and interest in the health-related quality of life of the elderly is also increasing. Therefore, this study attempted to provide basic data to develop measures to improve the health-related quality of life of the elderly by identifying the impact of the elderly's dietary lifestyle on the health-related quality of life. Methods : Utilizing raw data from the Korea national health and nutrition examination survey spanning from 2011 to 2020, this study focused on individuals aged 65 and above. After excluding cases with missing data, 12,731 individuals were included in the final analysis. Various statistical methods including frequency analysis, t-tests, ANOVA, Scheffé test and hierarchical regression analysis were performed using SPSS 25.0 for windows. The statistical significance level (α) was set at .05. Results : The main results of this study were as follows. Firstly, dietary lifestyle exhibited variations depending on gender, age, education level, individual income, basic livelihood type, household type, self-rated health status, and chewing difficulty (p<.001). Secondly, there were disparities in health-related quality of life (as measured by the EQ-5D index) based on gender, age, education level, residence, individual income, basic livelihood security, self-rated health status, and chewing difficulty (p<.001). Thirdly, the EQ-5D index showed that elderly individuals' dietary lifestyle adversely impacted their health-related quality of life (F=353.74, p<.001). Conclusion : Therefore, it is necessary to prepare policies to improve the health-related quality of life by maintaining a proper diet for the elderly, and customized support and management is required taking into account the elderly's gender, age, education level, individual income, basic livelihood security, household type, self-rated health status, chewing difficulty etc.