• 대한불안의학회지
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• 제2권1호
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• pp.17-21
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• 2006

SSRIs have been considered as the first line of treatment for patients with panic disorder since 1990s along with cognitive behavioral treatments. High potency benzodiazepines (e.g. alprazolam, clonazepam) have had advantages in anti-panic effects. However, these drugs have limitations of treating panic disorder because of their dependency, tolerance and withdrawal. Serotonin and noradrenaline reuptake inhibitors (SNRIs) such as venlafaxine were introduced as antidepressants since 1990s. Recently, it is confirmed that SNRIs have the remarkable anti-panic effects although some concerns about its cost, tolerance, withdrawal, side effects such as dry mouth, constipation, and hypertension have emerged. In this regard, further study is required to confirm the efficacy of long term treatment of panic disorder. Despite these concerns, venla-faxine extended-release is an effective treatment in patients with panic disorder.

• Journal of Preventive Medicine and Public Health
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• 제22권2호
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• pp.223-235
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• 1989

To grasp the idea about how drugs are used under Medical Insurance Scheme, the amount and share of drug cost in the total medical fee have been reviewed and analyzed for different types of patients (in-patient out-patient), medical institutions and frequently seen diseases and following findings were revealed. In 1986, drug cost took 32.78% of total medical fee for in-patients and 32.98% for out-patients averaged over 30% share as a whole. When drug cost per case in 1980 be indexed to 100, it has shown steady growth to become 200 for in-patients and about 150 for out-patients in 1986. The contribution of drug cost to the total medical fee is, regardless of patient type-in-patients and out-patients, the highest in University hospitals and followed by General hospitals, Hospitals and Clinics in decending order That for the most frequent 10 diseases came out the highest,79 a with the essential benign hypertension of out-patients in the General hospitals, 61% for the gastric ulcer of out-patients in Hospitals and 33% for the female genital diseases of out-patients in Clinics. The drug cost of oral formula was contributed the most, 7.93% by cardiovascular agents followed by hepatic detoxicants(5.47%) and out-patients(4.93%), and that of injectable formula was contributed the most by antibiotics(24.17%), followed by protein amino-acid preparations(6.19%). The order of drug usage by specialty for the in-patients was the highest with internal medicine followed by general surgery and E.N.T, and that for the out-parients was in the order of Internal medicine, neuropsychology and Ob/Gy. This study revealed that the drug dependency was characteristically different to specialty. In view of the fact that drug cost on average exceeds over 30% of total medical fee, proper drug administration appears to be vitally important for the stabilization of the financial standing of the Medical Insurance Scheme. As a consequence, drug usage guidelines including antibiotics usage shall be established first of all and the voluntary participation for the regulation of drug usage and propagation of the guidelines to medical institutions are strongly coerced.

• 간호행정학회지
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• 제11권4호
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• pp.401-414
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• 2005

Purpose: This study was to evaluate the utilization of health care service and to provide supportive data for health care policy making in one urban area in Korea. Method: This study tested the significance of public health service using the database of an university hospital and public health center from Feb. 2000 to Dec. 2004. Data were analyzed by multidimensional analysis and data mining technique and produced the information on the classification of utilization characteristics by main disease and the total cost of use and disease association with the users of the public health center. Results: The Results were as follows: 1) Top 10 diseases in the area accounted for 22.4% of total frequency for the most recent 5 years in university hospital, while 59.0% in public health center. 2) There were significant correlations between university hospital and public health center user's insurance type and place of residence: It showed higher use of public health center for free service beneficiaries residing in Seoul than residents in nearby or local area. The medical insurance types for hospital users were more various than those for public health center users. 3) The use of hospital for patients of hypertension, diabetes mellitus and hyperlipidemia was tended to concentrate in mostly autumn and winter since August 2000, while the cost of using public health center for those patients has been steadily reduced since July 2000. 4) As a result of cluster analysis, there were classified into three homogeneous groups according to the total cost of using public health service, age, and the frequency of use. 5) The association analysis on patients with chronic disease in public health center produced a detailed information on accompanying diseases related to the incidence rate of disease of high frequency due to aging, information on drug abuse and immune disease. Conclusion: The health care policy for local community should be evaluated continuously. And the policy to build an integrated data warehousing by public health indicator system and to enhance the faithfulness of data is required.

• 대한지역사회영양학회지
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• 제17권3호
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• pp.341-352
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• 2012

It is well established that excessive sodium intake is related to a higher incidence of chronic diseases such as hypertension, stroke, coronary heart disease, cardiovascular disease and gastric cancer. Although the upper limit of the current sodium intake guideline by WHO is set at 2,000 mg/day for adults, sodium intake of Koreans is well over 4,700 mg/capita/day implying an urgent need to develop and implement sodium intake reduction policy at the national level. This study investigated the cost-effectiveness of the sodium intake reduction policy, for the first time, in Korea. Analyses were performed using most recent and representative data on national health insurance statistics, healthcare utilization, employment information, disease morbidity/mortality, etc. The socioeconomic benefits of the policy, resulting from reduced morbidity of those relevant diseases, included lower medical expenditures, transportation costs, caregiver cost for inpatients and income losses. The socioeconomic benefits from diminished mortality included reductions in earning losses and welfare losses caused by early deaths. It is estimated that the amount of total benefits of reducing sodium intake from 4.7 g to 3.0 g is 12.6 trillion Korean Won; and the size of its cost is 149 billion Won. Assuming that the effect of sodium intake reduction would become gradually evident over a 5-year period, the implied rate of average return to the sodium reduction policy is 7,790% for the following 25 years, suggesting a very high cost-effectiveness. Accordingly, development and implementation of a mid-to-long term plan for a consistent sodium intake reduction policy is extremely beneficial and well warranted.

• 보건행정학회지
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• 제19권2호
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• pp.21-35
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• 2009

Limited studies examined Medical Aid recipients' perception for amount of medical use. This study aimed to identify self-perception(optimal, under and overutilization) for amount, and real amount of medical use, and to determine factors associated with the perception. Subjects were 2,489 Medical Aid recipients among top 2% overusers in 2005. 200 case managers(CM) managing them conducted survey. CM interviewed them using 2005 medical claiming data from the Health Insurance Review & Assessment Service and structured questionnaire. Despite of overusers, perception of overutilization was only 26.9% and 23.6% in Class I and Class II, and that of underutilization was 21.4% and 18.7% respectively. In Class I, monthly total outpatient cost per capita of overutilization perception in 2006 was 206 thousand won higher than 150 thousand won of optimal utilization. Amounts of outpatient visit-days and prescribed cases of overutilization perception were higher than those of optimal and underutilization(p <0.0001). In Class II, overutilization perception had more prescribed cases(p 0.004). After adjustment of confounding factors including age and sex, the associated factors(odds ratio) with overutilization perception were hypertension(1.25), arthritis(1.32), depression(1.66), visit of multi medical institutions(3.09), and those of the underutilization were female(1.34), disabled(1.27), no family support(1.49), living in medium and small city(1.48), experience of unabled-visit to medical institution(2.54), frequent visit-recommendation from physician (1.36). In conclusion, education and consult are needed for subjects to improve the reasonable decision of medical use, and the self-care ability to manage diseases and symptoms. We suggest reinforcing the alternative service in community instead of costly medical institution.

• International Journal of Computer Science & Network Security
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• 제21권9호
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• pp.19-30
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• 2021

Diabetes Mellitus (DM) is one of common chronic diseases leading to severe health complications that may cause death. The disease influences individuals, community, and the government due to the continuous monitoring, lifelong commitment, and the cost of treatment. The World Health Organization (WHO) considers Saudi Arabia as one of the top 10 countries in diabetes prevalence across the world. Since most of the medical services are provided by the government, the cost of the treatment in terms of hospitals and clinical visits and lab tests represents a real burden due to the large scale of the disease. The ability to predict the diabetic status of a patient without the laboratory tests by performing screening based on some personal features can lessen the health and economic burden caused by diabetes alone. The goal of this paper is to investigate the prediction of diabetic and prediabetic patients by considering factors other than the laboratory tests, as required by physicians in general. With the data obtained from local hospitals, medical records were processed to obtain a dataset that classified patients into three classes: diabetic, prediabetic, and non-diabetic. After applying three machine learning algorithms, we established good performance for accuracy, precision, and recall of the models on the dataset. Further analysis was performed on the data to identify important non-laboratory variables related to the patients for diabetes classification. The importance of five variables (gender, physical activity level, hypertension, BMI, and age) from the person's basic health data were investigated to find their contribution to the state of a patient being diabetic, prediabetic or normal. Our analysis presented great agreement with the risk factors of diabetes and prediabetes stated by the American Diabetes Association (ADA) and other health institutions worldwide. We conclude that by performing class-specific analysis of the disease, important factors specific to Saudi population can be identified, whose management can result in controlling the disease. We also provide some recommendations learnt from this research.

• The Korean Journal of Pain
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• 제28권3호
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• pp.169-176
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• 2015

This review has focused on important but less visible aspects of fibromyalgia (FM) with respect to the high impact of this disorder on patients and societies. FM is a common but challengeable illness. It is characterized by chronic widespread pain, which can be accompanied by other symptoms including fatigue, sleep disturbances, cognitive dysfunction, anxiety and depressive episodes. While our understanding of this debilitating disorder is limited, diagnosis and treatment of this condition is very difficult, even in the hands of experts. Due to the nature of disease, where patients experience invalidation by medical services, their families and societies regarding the recognition and management of disease, direct, indirect and immeasurable costs are considerable. These clinical and economic costs are comparable with other common diseases, such as diabetes, hypertension and osteoarthritis, but the latter usually receives much more attention from healthcare and non-healthcare resources. Present alarming data shows the grave and "iceberg-like" burden of FM despite the benign appearance of this disorder and highlights the urgent need both for greater awareness of the disease among medical services and societies, as well as for more research focused on easily used diagnostic methods and target specific treatment.

• Clinical and Experimental Pediatrics
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• 제64권1호
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• pp.31-36
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• 2021

Background: The diagnosis of esophageal varices (EV) is based on the findings of esophagogastroduodenoscopy (EGD), biopsy, and serum markers. Thus, noninvasive cost-effective tests through which high-risk EV children can be diagnosed are needed. Purpose: This cross-sectional study aimed to identify the noninvasive markers for EV in children with liver cirrhosis. Methods: A total of 98 children with liver cirrhosis were evaluated in this study. The spleen size, platelet count, serum albumin, liver function test results, and risk scores were evaluated prior to endoscopy. The endoscopic investigations aimed to identify the presence of EV and red signs, and determine varices sizes. Results: Endoscopy revealed varices in 43 subjects (43.9%). The spleen size, platelet count, international normalized ratio, aspartate aminotransferase to platelet ratio index (APRI), platelet count to spleen size ratio, and risk score differed significantly between patients with and without EV on univariate analysis; however, the logistic regression analysis showed no differences, indicating that none of these parameters were independently associated with the presence of EV. Conclusion: Platelet count, risk score, platelet count to spleen size, and APRI can be useful tools for the identification of high-risk patients with EV and might reduce the need for invasive methods like EGD.

• 디지털융복합연구
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• 제13권8호
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• pp.375-385
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• 2015

본 연구의 목적은 흡연율의 지역간 변이 정도와 흡연율에 영향을 미치는 요인을 살펴보는 데 있다. 분석을 위해 2009-2011년 질병관리본부의 지역사회건강조사 자료와 국민건강보험공단의 자료를 사용하였다. 흡연율에 영향을 미치는 요인을 파악하기 위해 상관분석, 다중회귀분석을 이용하였으며, 지역간 변이 분석을 위해 의사결정나무 모형을 이용하였다. 연구결과, 지역간 흡연율의 변이요인은 고위험음주율, 고혈압관리교육 이수율, 금연캠페인 경험율, 스트레스 인지율, 고혈압 유병률, 건강보험료, 당뇨병 유병률, 비만율, 근력운동 실천율로 나타났다. 융복합 기반으로 지역별 흡연율의 변이를 파악하는 것은 흡연율을 감소시키기 위한 지역별 맞춤형 보건프로그램을 수행하는데 매우 중요하다. 향후 흡연율이 높은 지역의 원인과 대상에 맞는 구체적인 관리방안을 모색하는 노력이 필요할 것이다. 본 연구의 결과는 효과적인 흡연관리사업 방안을 도출하는 데 필요한 기초자료로 의미있게 활용될 수 있으리라 여겨진다.

• Journal of Preventive Medicine and Public Health
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• 제32권2호
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• pp.162-169
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• 1999

Objectives: The aim of this study was to investigate the attitudes toward complementary and alternative medicine among 1,490 residents(339 households) in Suwon city. Methods: All respondents were asked about types, frequency, effects, side-effects, views, and cost of complementary or alternative medicine through a questionnaire from July 24th to 27th. Six therapies were investigated: diet; acupuncture/ massage/ chiropractic etc., mind control such as Ki/ Yoga/ spiritual therapy/ relaxation therapy etc.; nutritional supplements, cultural remedies; and Herb medications Results: The results of this survey were as follows: 35.6% of respondents had experiences with at least one or more types of complementary and alternative medicine. The average number of different types of therapies used was 3.4. More experience with various types of therapies were found among those respondents of higher education, older age group, higher income, married group, religious group than among the opposite groups of respondents. Herb medications were used most frequently(39.8%), followed by minor grains(37.9%), Ginseng(23.8%), Boshintang(21.5%), acupuncture(20.3%), Gaesojou(15.3%) Gingko nut(12.0%), mushroom(11.5%), Cupping therapy(10.2%), and black goat(0.0%). Acupuncture and Herb medications were used for treatment of hypertension the most frequently; minor grains or silkworm for treatment of diabetic mellitus; vegetables for treatment of obesity; acupuncture, Cupping Therapy, Herb medications for treatment of rheumatism; and acupuncture, Herb medications, or exercises for treatment of Cerebro Vascular Accident(CVA). The average costs of treatment were 108,000 Won for hypertension, 87,200 Won for diabetic mellitus, 16,800 Won for obesity, 68,800 Won for rheumatism, and 87,500 Won for CVA. Among 10.9% of respondents, there were 13 cases of side-effects with acupuncture, Herb medications, and Gaesojou. Among the cases of side-effects, majority was due to Herb medications. Respondents reported that Cupping Therapy was the most effective, followed by acupuncture, Ginseng, Gingko nut, Boshintang, black goat, minor grains, Gaesojou, Herb medications, vegetables, and mushroom. In response to the views of complementary and alternative medicine which they had used, they recommended minor grains first, followed by Ginseng, acupuncture, Gingko nut, Cupping Therapy, vegetables, Boshintang, black goat, mushroom and Herb medications. In contrast, they did not recommend Herb medications, acupuncture, nor Gaesojou. Conclusions: These findings indicate that many people use various complementary and alternative medicine without any guidelines for treatment of serious chronic diseases not even to invigorate themselves. It is, therefore, suggested that medical doctors or scientists verify the true effects or side-effects from the most common complementary or alternative therapies through experiments. Also medical doctors should provide a comfortable atmosphere for discussion among doctors and patients who would like to try these therapies.