• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.3
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• pp.520-534
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• 2018

This study was conducted to understand the conceptual definition and characteristics of health inequality. To accomplish this, we analyzed data collected from 14 participants as well as from available literature regarding health inequality using the hybrid model introduced by Schwartz-Barcott and Kim. We categorized health inequality into nine attributes in three dimensions. These dimensions included "target", "precede", and "result," corresponding to the target, cause and consequence of health inequality, respectively. Specifically, we define health inequality as individuals, families, communities, socio-economic, or geographically distinct demographic groups that are treated unfairly and result in several problems such as loss of quality of life, reduction of survival rate, or aggravation of a disease due to (i) poor treatment by a hospital (ii) irregular meals, (iii) desperate need for work (for money), (iv) expensive medical care costs, (v) qualitative differences in medical care by regional groups (vi) the lack of knowledge regarding disease (vii) and inadequate health care because of lack of time. As a result of this unfair treatment, human rights violation occurs. The major contribution from this paper is that we provide a guideline for establishing strategies to reduce health inequality by identifying the concept of health inequality. Based on this study, we recommend development of an educational program to reduce health inequalities.

• Journal of Preventive Medicine and Public Health
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• v.32 no.2
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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.

• Journal of muscle and joint health
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• v.6 no.2
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• pp.211-225
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• 1999

This descriptive correlational study was carried to identify the relationship among social support, compliance, and psychosocial adjustment of patients with rheumatoid arthritis. The study was done with 100 rheumatoid arthritic patients who were visited in Outpatient clinic of university hospital in Taegu, Korea from the 23rd of February to the 20th of March in 1998. The Data were collected through person to person interviews which were performed by five researchers. The instruments used for this study were Yu's social support scale(1996), Cho's compliance scale(1987), and Kim's psychosocial adjustment scale(1997). The data was analyzed by using a t-test, Pearson correlation coefficient, ANOVA, and Tukey test with the SAS Program. The results of this study were as follows ; 1. The mean score of social support was 2.76 for 4 full marks, compliance was 3.20 for 5 full marks, and psychosocial adjustment was 2.26 for 4 full marks. 2. Hypothesis 1 : "The higher the social support degree, the higher the compliance degree of the rheumatoid arthritis patient". It was supported(r=0.54, p<0.001). Hypothesis 2 : "The higher the compliance degree, the higher the psychosocial adjustment degree of the rheumatoid arthritis patient". It was supported(r=0.34, p<0.001). Hypothesis 3 : "The higher the social support degree, the higher the psychosocial adjustment degree of the rheumatoid arthritis patient". It was supported(r=0.24, p<0.05). 3. In general, the spouse group compared to other groups was demonstrated as the most dependable group for patients to trust and expect support. And the sons and daughters group was shown higher than other groups in terms of social support(F=4.19, p=0.01). There was no difference in terms of compliance in degree. In the degree of psychosocial adjustment the highly educated group(more than high school) is a little higher than the lowly educated group(F=3.08, p=0.03). In the costs of medical care, the group that could afford was significant higher than the group which could not afford results in terms of the psychosocial adjustment degree(F=3.99, p=0.01). The outcome of this study is that the social support that related rheumatoid arthritic patients had an effect on the following compliance, and the following compliance helps psychosocial adjustment of patients. It also shows that social support related psychosocial adjustment. Therefore, to increase the level of psychosocial adjustment of rheumatoid arthritic patients, it will be effective in supportive nursing intervention to improve social support and compliance.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.2
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• pp.649-656
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• 2016

This study was a retrospective examination to identify the association of postoperative delirium of the prognosis on following femur fracture surgery in elderly patients. Data was collected from the medical records of elderly patients (aged 65 years or older), who underwent femur fracture surgery from July 2010 to January 2014, following on 3-years in one university hospital. A total of 68 patients were involved. There were 31 cases (45.6%) with delirium and 37 cases (54.4%) without delirium. The participant's average age was 80.8 (patients with delirium), and 81.8 (delirium without patients) years of age, respectively, and most of them were female. There was no significant difference between the two groups. Taking five or more medications, serum creatinine level, and the total medical costs were significantly different in the delirium group and non-delirium group. In addition, the proportional hazard model of Cox to determine the predictors for the major clinical outcome occurring after surgery revealed delirium, five or more multi-drug use, and an experience of transfusion to be significant predictors. In conclusion, postoperative delirium in the elderly undergoing femur fracture surgery can have a negative clinical outcome in patients and caregivers. Therefore, a preoperative evaluation and management of the risk factors will be necessary.

• Journal of Trauma and Injury
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• v.23 no.2
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• pp.89-95
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• 2010

Purpose: Whole-body CT is a very attractive diagnostic tool to clinicians, especially, in trauma. It is generally accepted that trauma patients who are not alert require whole-body CT. However, in alert trauma patients, the usefulness is questionable. Methods: This study was a retrospective review of the medical records of 146 patients with blunt multiple trauma who underwent whole body CT scanning for a trauma workup from March 1, 2008 to February 28, 2009. We classified the patients into two groups by patients' mental status (alert group: 110 patients, not-alert group: 36 patients). In the alert group, we compared the patients' evidence of injury (present illness, physical examination, neurological examination) with the CT findings. Results: One hundred forty six(146) patients underwent whole-body CT. The mean age was $44.6{\pm}18.9$ years. One hundred four (104, 71.2%) were men, and the injury severity score was $14.0{\pm}10.38$. In the not-alert group, the ratios of abnormal CT findings were relatively high: head 23/36(63.9%), neck 3/6(50.0%), chest 16/36(44.4%) and abdomen 9/36(25%). In the alert group, patients with no evidence of injury were rare (head 1, chest 6 and abdomen 2). Nine(9) patients did not need any intervention or surgery. Conclusion: Whole-body CT has various disadvantages, such as radiation, contrast induced nephropathy and high medical costs. In multiple trauma patients, if they are alert and have no evidence of injury, they rarely have abnormal CT findings, and mostly do not need invasive treatment. Therefore, we should be cautious in performing whole-body CT in alert multiple trauma patients.

• Proceedings of the Korean Society for Applied Microbiology Conference
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• 2000.04a
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• pp.3-6
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• 2000

Antimicrobial resistance has been a well-recognized problem ever since the introduction of penicillin into clinical use. History of antimicrobial development can be categorized based on the major antibiotics that had been developed against emerging resistant $pathogens^1$. In the first period from 1940 to 1960, penicillin was a dominating antibiotic called as a "magic bullet", although S.aureus armed with penicillinase led antimicrobial era to the second period in 1960s and 1970s. The second stage was characterized by broad-spectrum penicillins and early generation cephalosporins. During this period, nosocomial infections due to gram-negative bacilli became more prevalent, while those caused by S.aureus declined. A variety of new antimicrobial agents with distinct mechanism of action including new generation cephalosporins, monobactams, carbapenems, ${\beta}$-lactamase inhibitors, and quinolones characterized the third period from 1980s to 1990s. However, extensive use of wide variety of antibiotics in the community and hospitals has fueled the crisis in emerging antimicrobial resistance. Newly appeared drug-resistant Streptococcus pneumoniae (DRSP), vancomycin-resistant enterococci (VRE), extended-spectrum ${\beta}$-lactamase-producing Klebsiella, and VRSA have posed a serious threat in many parts of the world. Given the recent epidemiology of antimicrobial resistance and its clinical impact, there is no greater challenge related to emerging infections than the emergence of antibiotic resistance. Problems of antimicrobial resistance can be amplified by the fact that resistant clones or genes can spread within or between the species as well as to geographically distant areas which leads to a global concern$^2$. Antimicrobial resistance is primarily generated and promoted by increased use of antimicrobial agents. Unfortunately, as many as 50 % of prescriptions for antibiotics are reported to be inappropriate$^3$. Injudicious use of antibiotics even for viral upper respiratory infections is a universal phenomenon in every part of the world. The use of large quantities of antibiotics in the animal health industry and farming is another major factor contributing to selection of antibiotic resistance. In addition to these background factors, the tremendous increase in the immunocompromised hosts, popular use of invasive medical interventions, and increase in travel and mixing of human populations are contributing to the resurgence and spread of antimicrobial resistance$^4$. Antimicrobial resistance has critical impact on modem medicine both in clinical and economic aspect. Patients with previously treatable infections may have fatal outcome due to therapeutic failure that is unusual event no more. The potential economic impact of antimicrobial resistance is actually uncountable. With the increase in the problems of resistant organisms in the 21st century, however, additional health care costs for this problem must be enormously increasing.

• Korean Journal of Biological Psychiatry
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• v.26 no.2
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• pp.39-46
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• 2019

Antidepressants are widely used to treat depression in Korea, however, only a few studies have focused on the provider of the treatment. The aim of the study is to compare the differences between patients who were prescribed antidepressants by psychiatrists and those who were prescribed antidepressants by non-psychiatrists in South Korea. Patients with a diagnosis of depressive disorder who had been newly prescribed antidepressants in 2012 were selected from the Health Insurance Review and Assessment Service database. They were classified into two groups depending on whether they received the antidepressant prescription from a psychiatrist or non-psychiatrist. Sociodemographic, clinical, and depression related cost has been investigated. Treatment resistant depression, which is defined as a failure of two antidepressant regimens to alleviate symptoms, was also investigated. Prescription adequacy was assessed based on whether a regimen was maintained for at least 4 weeks. Among the 834694 patients with pharmaceutically treated depression (PTD) examined in this study, 326122 (39.1%) were treated by psychiatrists. Patients who were treated by psychiatrists were younger and had more psychiatric comorbidities than those treated by non-psychiatrists. They had longer PTD duration (229.3 days vs. 103.0 days, p < 0.05) and a larger proportion of treatment resistant depression (9.3% of PTD) when compared to those patients treated by non-psychiatrists. The patients treated by psychiatrists had a smaller proportion of inadequate antidepressant use compared to those patients in the non-psychiatrist group (44.5% vs. 65.1%, p < 0.05). The costs related to depression corrected with PTD duration were higher in the non-psychiatrist group (32214 won vs. 56001 won, p < 0.05). Patients who receive antidepressants from psychiatrists are patients with more severe, treatment-resistant depression. Psychiatrists prescribe antidepressants more adequately and cost- effectively than non-psychiatrists.

• Journal of Preventive Medicine and Public Health
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• v.35 no.2
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• pp.99-106
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• 2002

Objective : Until now, there have been no evidence-based guidelines produced for the mass screening of hyperlipidemia cases in Korea. This study was done to find the most efficient strategy for a hyperlipidemia-screening program among Korean adults, Method : Seven alternative strategies for hyperlipidemia screening were formulated and compared ir terms of cost-effectiveness. Cost and effectiveness were estimated from social perspectives and using a two-stage screening process (initial testing and additional testing for positives from the first test). A computerized database (based on persons who had visited a health promotion center in one teaching hospital for a routine health check-up) was used to determine the cost and the outcome of various strategies. Official data was used in calculating direct and indirect costs. Effectiveness was measured according to the number of persons who needed clinical intervention for hyperlipidemia. A stratified analysis, considering age group and sex, was then done. Sensitivity analyses, focusing on several uncertain parameters, were also done. Results : Of the seven test alternatives available, the most cost-effective strategy was a screening program, which consisted of an initial test of total cholesterol, high-density lipoprotein cholesterol and triglyceride. There was some variation in the rank of the cost-effectiveness ratios for the seven alternatives dependent on age group or gender. Conclusions : Current hyperlipidemia screening practice, for National Health Insurance beneficiaries, tests only the total cholesterol level with a cut-off value of 260mg/dl as an initial screening test. It is not the best strategy for cost-effectiveness, and should be modified. Different screening strategies taking age group and sex into account should be developed and used for the efficient mass screening of hyperlipidemia cases among Korean adults.

• Journal of Korean Society of Health-System Pharmacists
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• v.35 no.4
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• pp.409-417
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• 2018

Background : Febrile neutropenia (FN) is one of the side effects in the patients treated with chemotherapy, and the patients who have FN generally need immediate treatment with extended-spectrum antibiotics and hospitalization. Pegfilgrastim and pegteograstim, which are used for the prevention of FN as a granulocyte-colony stimulating factor (G-CSF), have been granted insurance coverage in the Republic of Korea for certain breast cancer patients using doxorubicin and cyclophosphamide (AC) from September 2016. Methods : The data of the patients with breast cancer using AC regimen and G-CSF were collected retrospectively. This study involves cost-utility analysis of pegfilgrastim and pegteograstim. In this study, we constructed a simple decision tree model for short-term observation and calculated quality-adjusted life year (QALY) and the direct medical costs from the medical provider's perspective. Results : From September 2016 to May 2017, 15 patients were treated with pegfilgrastim and 15 patients were treated with pegteograstim. As a result of dividing the average cost by QALY for each treatment group, it was observed that pegfilgrastim and pegteograstim were consumed 24,923,384 won and 22,808,336 won per 1QALY, respectively. Consequently, incremental cost effectiveness ratio (ICER) showed 2,115,048 won more per pegfilgrastim than pegteograstim per 1QALY, and the cost per 1QALY of both the drugs was lower than 30,500,000 won; the Koreans were willing to pay this amount. Conclusions : This study suggests that pegfilgrastim and pegteograstim can be used to improve the quality of life of breast cancer patients undergoing AC therapy. Among the two drugs, pegteograstim seems to be more cost-effective. However, since this study was conducted as a retrospective observation method on a small scale, it is associated with many limitations. Therefore, a long-term prospective cohort study is needed to supplement the present findings.

• Journal of Animal Science and Technology
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• v.63 no.5
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• pp.1008-1017
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• 2021

This study was conducted to investigate the effect of different fattening periods on the growth performance, carcass characteristics, and economic traits of Holstein steers. Sixty Holstein steers (8.0 ± 0.28 months old) with an average body weight (BW) of 231.88 ± 2.61 kg, were randomly allocated to five different fattening period treatments: 20, 21, 22, 23, and 24 months (n = 12 in each treatment group). Final BW and average daily gain (ADG) did not differ among the treatment groups during the early fattening period. At the late stage of the fattening period, the final BW of steers in the 24-month treatment group (812.84 kg) was greater (p < 0.05) than that of steers in the 20-month treatment group (750.39 kg). During the same period, steers in the 20- and 21-month treatment groups had a significantly higher (p < 0.05) ADG than those in the 22-month treatment group. The highest ADG (1.36 kg/day) was found in the 20-month treatment group (1.36), followed by the 21- (1.33 kg/day), 22- (1.22 kg/day), 23- (1.21 kg/day), and 24- (1.14 kg/day) month treatment groups. The feed conversion ratio (FCR) increased as the fattening period increased, and the FCR was 12.88% lower in the 20-month treatment group than in the 24-month treatment group. However, no significant differences were detected in back-fat thickness, loin area, marbling score, and chemical characteristics (water, crude protein, and crude fat content) among the treatment groups. The composition of fatty acids including C18:0, C18:1, saturated fatty acids, unsaturated fatty acids, and poly-unsaturated fatty acids did not differ among the experimental groups. As the fattening period increased, production costs increased, resulting in a decrease in gross income. The gross income for steers in the 24-month treatment group was 35.8% and 23.5% lower than that for steers in the 20- and 21-month treatment groups, respectively. Taken together, the best performance, including the ADG, FCR, and gross income, was obtained when the fattening program of the Holstein steers lasted 20 months.