• 응용통계연구
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• 제29권1호
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• pp.41-59
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• 2016

지속적인 사망률 개선으로 인한 평균 수명연장은 인구 고령화의 주요인이며 연금 공급자의 재정건전성에 심각한 영향을 미치는 원인으로 지목되기에 정확한 미래 사망률의 예측은 현 시점에서 선행되어야할 중요한 과제다. 본 연구는 미래 사망률을 예측하는 대표적인 확률적 사망률 모형인 Lee-Carter 모형을 사용하여 과거 생명표로 산출한 왜도를 기반으로 미래 사망률 지수를 간접적으로 예측하는 왜도예측방식을 제시한다. 기존의 Lee-Carter 모형을 이용한 사망률 예측방식은 사망률 지수를 추정하고 미래값을 직접 예측함으로써 미래 사망률이 지나치게 개선되는 현상을 보이며, 이를 바탕으로 산출된 연금액과 지급기간 추정 등 연금 공급자의 리스크 관리에 영향을 미친다. 본 연구는 기존 예측 방식의 사망률 예측 결과와 제시한 왜도 예측 방식의 사망률 예측 결과를 비교함으로써 기존 사망률 예측 방식의 문제점을 지적한다. 분석결과 왜도 예측을 통한 Lee-Carter 모형의 사망률 예측은 기존 방식보다 사망률 개선효과를 더 적게 반영하며 장수리스크를 덜 왜곡한다는 데 의의가 있다고 할 수 있다. 하지만 기존 방식 간 차이를 감안하여 적정한 미래 사망률 수준을 찾기 위해 임의로 부여한 가중치에 대해 향후 검토가 필요할 것으로 보인다.

• 한국임상약학회지
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• 제26권3호
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• pp.207-212
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• 2016

Objective: Prescription rate of dabigatran and rivaroxaban, which are the direct oral anticoagulants (DOAC), has increased. We have analyzed the prescription trend and medication use of dabigatran and rivaroxaban in patients with non-valvular atrial fibrillation (NVAF). Methods: It was retrospectively studied from September 2012 to April 2014 using the electronic medical records and the progress notes. Patients with NVAF (n=424) were evaluated on the medication use, prescribing preferences, adverse drug reactions (ADRs) and the availability of prescription reimbursement of dabigatran (n=210) and rivaroxaban (n=214). Results: Dabigatran was prescribed higher than rivaroxaban (23.3% versus 7.5%, p<0.001) in the neurology department, but rivaroxaban was prescribed higher compared to dabigatran in the cardiology department (87.4% versus 74.3%, p<0.001). Dabigatran was prescribed more than rivaroxaban in high risk patients with CHADS2 score ${\geq}3$ (44.3% versus 31.3%, p=0.006). Dabigatran patients seemed to have more ADRs than patients with rivaroxaban (25.2% versus 11.2%, p<0.001), but no serious thrombotic events and bleeding were found. Only 35.6% (n=151) were eligible for prescription reimbursement by the National Health Insurance (NHI). Bridging therapy (86, 31.5%) and direct-current cardioversion (57, 20.2%) were main reasons of ineligibility for reimbursement. Conclusion: Prescription preferences were present in choosing either dabigatran or rivaroxaban for patients with NVAF. Inpatient protocols and procedures considering patient-factors in NVAF need to be developed.

• 치위생과학회지
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• 제17권5호
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• pp.447-453
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• 2017

The purpose of this study was to analyze the relationship between objective oral health status determined by dentists, self-perceived subjective oral health status, and oral health related quality of life (OHRQoL) in the elderly. The related factors affecting OHRQoL in the elderly were also surveyed. Four hundred and thirty elderly individuals who visited the three public health centers and four dental clinics in Busan were selected by convenience sampling. Twelve dental hygienists investigated the subjective oral health status and OHRQoL using the 14-item Oral Health Impact Profile (OHIP-14) and twentyone dentists examined the objective oral health status, including healthy remaining teeth, treated remaining teeth, functional remaining teeth, missing teeth, and non-treated missing teeth. Data were analyzed using SPSS ver. 12.0. OHRQoL was higher when oral and periodontal status was perceived as healthy, when there was no toothache, no interference in mastication, and when study subjects had the ability of food softening. It was also higher when study subjects had ${\geq}20$ remaining teeth and <9 missing teeth, and were wearing denture. The related factors affecting OHRQoL of the elderly were the type of medical insurance, toothache, ability of food softening, perception of periodontal status, and the number of healthy remaining teeth. There was a significant relationship between the subjective-objective oral health status and OHRQoL in the elderly. A continuous oral health care system aimed at retaining ${\geq}20$ healthy remaining teeth is needed to improve oral health and OHRQoL for the elderly, especially for the elderly receiving medical aid.

• 보건의료산업학회지
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• 제10권3호
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• pp.235-244
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• 2016

Objectives : Using several waves of the Panel Study of Worker's Compensation Insurance(PSWCI), this study analyzed the effect of female workers on the health and lifestyles of korean workers in the sample year of 2014 (The first survey was completed in August-October 2013;, the second survey was completed in August-October 2014.) Methods : The research subjects were 24,672 women among workers who responded to the 2014 PSWCI panel report. Statistical analyses were performed with SAS version 9.4 (SAS Institute Inc., Cary, NC, USA). Results : According to the results of the analysis, women showed differences in female temporary workers, working conditions, classification of occupation, working period, and health conditions based on work-time conditions. The results show that female workers with disabilities have a direct positive effect on life satisfaction as we anticipated in the hypothesis. Conclusions : Female workers should focus on factors identified in this study when developing employment interventions to improve a health promoting lifestyle for their work environment.

• 한국사회복지학회:학술대회논문집
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• 한국사회복지학회 2005년도 춘계학술대회자료집
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• pp.387-411
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• 2005

The purpose of this article is to analyse the expenditure structure of the welfare mix; in order to grasp the holistic feature of the Korean social welfare. Most of all, the article attempts to elaborate the estimation methods of social welfare expenditure by including the components from which has been excluded so far - indirect tax expenditure of the government, nursery payments of households, life insurance pay-outs for survivors, inter-household private income transfers and the value of caring work of the family. In so doing, the article estimates that the total social welfare expenditure including state, enterprise, market, NPOs and family reached at 24.7% of GDP in 2000, which is approximately 2.5 times more than public social welfare expenditure. It implies that non-state, private sectors dominates the structure of social welfare provisions in Korea. In addition, based on the analyses of the expenditure structure, the article defines the main feature of Korea's welfare mix as the 'mixed structure of the welfare mix dominated by the protective family', or 'expanded public sector, relatively limited market, and protective family'. Such a family-dominated welfare mix structure in Korea indicates that the fundamental source of solidarity of the Korean social welfare system is family and, therefore, the welfare regime of Korea can be classified as 'Conservative'.

• 한국임상약학회지
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• 제32권3호
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• pp.178-184
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• 2022

Background: Migraine is one of the leading causes of poor quality of life and disability, and migraine incidences in pediatrics are increasing. Proper medication is important for the preventive and acute treatment of migraine. This study aimed to identify the current status of prescribed medication in pediatric patients with migraine. Methods: We used data from a sample of pediatric patients from the Health Insurance Review and Assessment Service (HIRA-PPS-2018) and analyzed the status of prescription drugs and frequency of visits to medical institutions with migraine diagnoses in pediatric patients. Results: A total of 12,228 pediatric patients diagnosed with migraine during 2018 were analyzed. Among these patients, 7,170 (58.64%) were girls and 9,510 (77.77%) were adolescents. Additionally, 9,157 patients (74.89%) received acute treatment, and 592 patients (4.84%) received combination therapy with analgesics and triptans. Acetaminophen for acute treatment and flunarizine for preventive treatment were the most commonly prescribed. In most children and adolescents, acute treatment drugs were prescribed for less than 14 days. Conclusion: Analgesics, such as acetaminophen or non-steroidal anti-inflammatory drugs, were prescribed frequently for acute treatment in pediatric patients with migraine. The drug prescription duration was within the recommended range, indicating a low risk of overdose. For preventive treatment, clinically studied medication for pediatric patients with migraine was used.

• Childhood Kidney Diseases
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• 제27권2호
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• pp.111-116
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• 2023

Purpose: This article was to investigate the association between urinary tract infections (UTIs) and high weight status in infancy. Methods: We conducted a nationwide matched cohort study from January 2018 to December 2020 using data from the Korean National Health Insurance System and the Korean National Health Screening Program for Infants and Children. We analyzed the association between UTI diagnosis codes and high weight status (which was defined as being in the 90th percentile or higher of weight-for-age). Results: We found that 22.8% of infants with UTIs exhibited high weight status, compared to 20.0% of non-UTI infants (P<0.001). Per our multivariable analyses, the adjusted odds ratio for high weight status was 1.09 (95% confidence interval, 1.06-1.13). Conclusions: UTI in the first 12 months of life was associated with a weight-for-age percentile of ≥90. Our findings corroborate those of previous single-center studies and emphasize the importance of careful monitoring for this at-risk group.

• 대한간호
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• 제36권3호
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• pp.49-69
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• 1997

The urgent needs to establish hospice care systems in Korea arise from the following reasons: 0) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e. g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accomodate other medical insurance beneficiaries; (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life; (6) medical and nursing care of AIDS patient in terminal stage; (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage. grouped in hospice and non-hospice care patients. reveal what they want visiting nursing care to help their pain control. psychological. social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains. the non-hospice care patients. in addition to their desire for pain control. demanded more psychological. social and spiritual helps as well. The results of this research could be utilized to 0) define the standard of hospice care. (2) provide the guidance for hospice medical care costs. (3) establish the database of hospice care systems. (4) develop softwares. (5) build communication network through Medinet. and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy. nursing care. and social welfare programs.

• 보건행정학회지
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• 제27권2호
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• pp.167-176
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• 2017

Background: This study aimed to analyze the impact of community health care resources on the place of death of older adults with dementia compared to those with cancer in South Korea, using public administrative big data. Methods: Based on a literature review, we selected person- and community-level variables that can affect older people's decisions about where to die. Data on place-of-death and person-level attributes were obtained from the 2013 death certification micro data from Statistics Korea. Data on the population and economic and health care resources in the community where the older deceased resided were obtained from various open public administrative big data including databases on the local tax and resident population statistics, health care resources and infrastructure statistics, and long-term care (LTC) insurance statistics. Community-level data were linked to the death certificate micro data through the town (si-gun-gu) code of the residence of the deceased. Multi-level logistic regression models were used to simultaneously estimate the impacts of community as well as individual-level factors on the place of death. Results: In both the dementia (76.1%) and cancer (87.1%) decedent groups, most older people died in the hospital. Among the older deceased with dementia, hospital death was less likely to occur when the older person resided in a community with a higher supply of LTC facility beds, but hospital death was more likely to occur in communities with a higher supply of LTC hospital beds. Similarly, among the cancer group, the likelihood of a hospital death was significantly lower in communities with a higher supply of LTC facility beds, but was higher in communities with a higher supply of acute care hospital beds. As for individual-level factors, being female and having no spouse were associated with the likelihood of hospital death among older people with dementia. Conclusion: More than three in four older people with dementia die in the hospital, while home is reported to be the place of death preferred by Koreans. To decrease this gap, an increase in the supply of end-of-life (EOL) care at home and in community-based service settings is necessary. EOL care should also be incorporated as an essential part of LTC. Changes in the perception of EOL care by older people and their families are also critical in their decisions about the place of death, and should be supported by public education and other related non-medical, social approaches.

• Journal of Genetic Medicine
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• 제4권1호
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• pp.1-5
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• 2007

Unprecedented amount of genetic information being generated from the result of Human Genome Project (HGP) and advances in genetic research is already forcing changes in the paradigm of health and disease. The ultimate goal of genetic medicine is to use genetic information and technology to develop new ways of treatment or even prevention of the disease on an individual level for 'personalized medicine'. Genetics is play ing an increasingly important role in the diagnosis, monitoring and management of common multifactorial diseases in addition to rare single-gene disorders. While wide range of genetic testing have provided benefits to patients and family, uncertainties surrounding test interpretation, the current lack of available medical options for the diseases, and risks for discrimination and social stigmatization may remain to be resolved. However an increasing number of genetic tests are becoming commercially available, including direct to consumer genetic testing, yet public is often unaw are of their clinical and social implications. The personal nature of information generated by a genetic test, its power to affect major life decisions and family members, and its potential misuse raise important ethical considerations. Therefore appropriate genetic counseling is needed for patient to be informed with the benefits, limitations and risks of genetic tests, prior to informed consent for the tests. Physician also should be familiar with the legal and ethical issues involved in genetic testing to tell patients how w ell a particular genetic risk factor relates with likelihood of disease, and be able to provide appropriate genetic counseling. Genetic counseling become a mandatory requirement as global standard for many genetic testing such as prenatal diagnosis, presymtomatic DNA diagnostic tests and cancer susceptibility gene test for familial cancer syndrome. In oder to meet the challenge of genetic medicine of 21 century in korean health care system, professional education program and certification board for medical genetics specialist including non-MD genetic counselors should be addressed by medical society and regulatory policy of national health insurance reimbursement for genetic counseling to be in place to promote the implementation of clinical genetic service including genetic counseling for proper genetic testing.