• The Journal of Korean Medicine
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• v.21 no.4
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• pp.227-235
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• 2000

Background and Purpose : Medical and Neurological complications in patients with acute stroke may affect their prognosis including death rate, function and admission period. Some of these complications may be preventable. But few data exist regarding complications occurring in the first weeks. So we sought to observe the type, timing, and frequency of complications in hospitalized patients after stroke. Methods : We retrospectively examined the case notes of patients admitted in Won Kwang Oriental Medical Hospital after stroke. Two observers inspected the case notes using predifined diagnostic criteria and recorded the type, timing, and frequency of complications that occurred during the inpatient period. Results : Complications were recorded in 43 patients(82.7%). The most common medical complications were constipation(25.0%) and shoulder pain(21.2%). The most frequent serious medical problems were pulmonary infection(9.6%) and UTI(7.7%). The most common neurological complications were insomnia(34.6%) and dysphagia(23.7%). The most frequent serious medical problem was mental deterioration(7.7%). Conclusion : Complications after acute stroke are common. There were more medical complications than neurological complications. So we should compile much knowledge about medical complications and treat them actively. The differences between our study and previous studies are attributable to the different methods including patient selection and diagnostic criteria.

• Korean Journal of Adult Nursing
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• v.29 no.1
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• pp.98-107
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• 2017

Purpose: The purpose of this study was to investigate the effect of geriatric syndrome on mortality among community-dwelling older adults in Korea. Methods: Data were obtained from the Actual Living Condition of the Elderly and Welfare Need Survey, with a baseline study in 2008 and a 3-year follow-up of mortality data. The mortality risk was measured using the hierarchical Cox proportional hazard model. Results: In Cox regression analysis, male (Hazard Ratio [HR], 2.53; 95% Confidence Interval [CI], 2.12~3.01), old age (HR, 2.14; 95% CI, 1.82~2.53), low education level (HR, 1.31; 95% CI, 1.04~1.65), limitation in instrumental activities of daily living (HR, 1.91; 95% CI, 1.60~2.28), depressive symptoms (HR, 1.21; 95% CI, 1.01~1.43), and frailty (HR, 2.32; 95% CI, 1.78~3.03) significantly affected mortality risk. Conclusion: Based on the results of this study, nursing intervention programs should be provided to decrease preventable death in older adults.

• Journal of Preventive Medicine and Public Health
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• v.47 no.3
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• pp.129-135
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• 2014

Tobacco use is the most important preventable risk factor for premature death. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), the first international public health treaty, came into force in 2005. This paper reviews the present status of tobacco control policies in Korea according to the WHO FCTC recommendations. In Korea, cigarette use is high among adult males (48.2% in 2010), and cigarette prices are the lowest among the Organization for Economic Cooperation and Development countries with no tax increases since 2004. Smoke-free policies have shown incremental progress since 1995, but smoking is still permitted in many indoor public places. More than 30% of non-smoking adults and adolescents are exposed to second-hand smoke. Public education on the harmful effects of tobacco is currently insufficient and the current policies have not been adequately evaluated. There is no comprehensive ban on tobacco advertising, promotion, or sponsorship in Korea. Cigarette packages have text health warnings on only 30% of the main packaging area, and misleading terms such as "mild" and "light" are permitted. There are nationwide smoking cessation clinics and a Quitline service, but cessation services are not covered by public insurance schemes and there are no national treatment guidelines. The sale of tobacco to minors is prohibited by law, but is poorly enforced. The socioeconomic inequality of smoking prevalence has widened, although the government considers inequality reduction to be a national goal. The tobacco control policies in Korea have faltered recently and priority should be given to the development of comprehensive tobacco control policies.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1542-1549
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• 1992

From March 1986 to August 1992, 18 patients underwent diaphragmatic plication for the diaphragmatic paralyses complicating various pediatric cardiac procedures. Age at operation ranged from 16 day to 84 months with mean age of 11.8 months. In order of decreasing incidence, the primary cardiac procedures included modified Blalock-Taussig shunt [ 5 ], Arterial switch operation [ 4 ], modified Fontan operation [ 2 ], and others [ 7 ]. The suspicious causes of phrenic nerve injury included overzealous pericardial resection [ 7 ], direct trauma during the procedure [ 6 ], dissection of fibrous adhesion around the phrenic nerve [ 3 ] and unknown etiology [ 2 ]. The involved sides of diaphragm were right in 10, left in 7 and bilateral in one. The diagnosis was suspected by the elevation of hem-idiaphragm on chest x-ray and confirmed by fluoroscopy. The interval between primary operation and plication ranged from the day of operation to 38 postoperative days [mean : 14 days]. The method of plication were "Central pleating technique" described by Schwartz in 16 and other techniques in 2. Five patients expired after plication and the cause of death were not thought to be correlated directly with the plication itself. In the remaining 13 survivors, extubation or cessation of positive ventilation could be done between the periods of the day of plication and 14th postoperative days [mean; 3.8day]. We have made the following conclusions : 1] Phrenic nerve paralyses are relatively common complication after pediatric cardiac procedures and the causes of phrenic nerve injury are mostly preventable; 2] Phrenic nerve palsy is associated with corisiderable morbidity; 3] diaphragmatic plication is safe, reliable and can be applicable in patients who are younger age and require prolonged positive pressure ventilation.ntilation.

• Health Policy and Management
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• v.31 no.4
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• pp.399-408
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• 2021

The emergency medical service system in Korea was built upon the Emergency Medical Service Act, 1995 to respond adequately to be much in demand for emergency medical services. In addition, the government recognized the importance of the trauma care system and set out to plan for the designation and establishment of the regional trauma center by 2012. This study aimed to investigate features of quality management and trauma fee schedule on better understanding of trauma care system. First, quality management of the regional trauma center has been implemented by several quality programs involved in quality assessment, committee on trauma quality management, and mortality and morbidity conference. Second, the trauma fee schedule has reflected a specific quality of severe traumatic conditions and added the result to it, which are graded A, B, and C according to quality assessment. Although the government has contributed to instituting a trauma quality assessment program and trauma fee schedule for the regional trauma center, it could not lead to such a fixed standard for quality management of them. Therefore, it will promote discussion on the sustainability of the regional trauma center that requires reducing preventable trauma death rate and the way to apply comprehensive quality management.

• Korea Journal of Hospital Management
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• v.27 no.1
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• pp.43-57
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• 2022

Background: Avoidable mortality rate has been widely used as an indicator of the quality of health care and the degree of inequality in health levels. The purpose of this study was to identify the factors affecting the avoidable mortality rate in the region. Methods: The data was MDIS(Microdata Integrated Service) Causes of Death Statistics, and the analysis period was from 2010 to 2019. Panel analysis was performed to identify the influencing factors on the avoidable mortality rate. Findings: Result showed that the current smoking rate had a significant positive effects on the avoidable mortality rate of both men and women. And the smoking cessation trial rate, low salt diet rate, weight control trial rate, annual vaccination rate had a significant negative effect. In the social environment, the divorce rate had a significant positive effect. In the economy environment, financial independence and social welfare budget rate had a significant negative effect. In the physical environment, the factory area rate had a significant positive effect. Practical Implication: Practical implication in order to lower the local avoidable mortality rate, various social determinants of health as well as health care resources should be considered together.

• Journal of Preventive Medicine and Public Health
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• v.56 no.3
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• pp.205-211
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• 2023

Cancer management has become a major policy goal for the government of the Korea. As such, the government introduced the National Cancer Control Plan (NCCP) to reduce the individual and social burdens caused by cancer and to promote national health. During the past 25 years, 3 phases of the NCCP have been completed. During this time, the NCCP has changed significantly in all aspects of cancer control from prevention to survival. The targets for cancer control are increasing, and although some blind spots remain, new demands are emerging. The government initiated the fourth NCCP in March 2021, with the vision of "A Healthy Country with No Concerns about Cancer Anywhere at Any Time," which aims to build and disseminate high-quality cancer data, reduce preventable cancer cases, and reduce gaps in cancer control. Its main strategies include (1) activation of cancer big data, (2) advancement of cancer prevention and screening, (3) improvement in cancer treatment and response, and (4) establishment of a foundation for balanced cancer control. The fourth NCCP has many positive expectations, similar to the last 3 plans; however, cross-domain support and participation are required to achieve positive results in cancer control. Notably, cancer remains the leading cause of death despite decades of management efforts and should continue to be managed carefully from a national perspective.

• Journal of Trauma and Injury
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• v.28 no.4
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• pp.241-247
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• 2015

Purpose: To evaluate the influence of how the trauma care system is applied on the management of trauma patients. Methods: We divided the patients into a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in our institution. We compared the general characteristics, injury severity score, initial response time to the trauma patients, number of preventable deaths, and clinical outcomes between the two groups. Results: The numbers of patients in the pre-trauma system group and the post-trauma system group were 188 and 257, respectively. No differences in the patient's median ages, trauma scores (ISS, RTS, TRISS) and proportions of severe trauma patients (ISS>15) were observed between the two groups. The number and the proportion of patients who were admitted to our hospital were increased in the post-trauma system group. The time interval from trauma CP activation to emergency surgery or angio-embolization, and the patient's time spent in emergency room were shortened in the post-trauma system group. However, the lengths of the ICU stay and the hospital stay, and the number of in-hospital mortalities were not improved in the post-trauma system group. In severe trauma patients (ISS>15), there were no differences between the two groups in the number and the proportion of admitted patients, and the time interval from trauma CP activation to performing a diagnostic and therapeutic procedure was not shortened in the post-trauma system group. Conclusion: Application of the trauma care system has shortened the time between the initial response and patient management. However, this improvement was not enough to result in better clinical outcomes. More trauma physicians, multidisciplinary cooperation, and a well-organized trauma management process will be needed if the maximum efficacy of the trauma system is to be achieved.

• Health Policy and Management
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• v.34 no.1
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• pp.17-25
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• 2024

Background: This study aimed to assess the appropriate allocation of emergency medical beds across 17 provinces and presume the economic benefits associated with such allocation. Methods: To estimate the optimal allocation of emergency medical beds by province, data from the Statistics Korea's "cause of death statistics (2014-2021)," regional statistics on "area, population, gender, age," and "population projections" were utilized. The "number of emergency beds by city and district" provided by the Health Insurance Review and Assessment Service was also used. In estimating the economic benefits of preventing avoidable emergency deaths due to the expansion of emergency medical facilities, guidelines from the Korea Development Institute and the Korea Transport Institute were referenced to calculate the wage loss costs associated with emergency deaths and estimate the economic benefits. Results: The optimal ratio of emergency medical beds allocation by region was highest in Gyeonggi, Seoul, Gyeongnam, Gyeongbuk, and Busan, while Daejeon, Jeju, and Sejong showed lower ratios. Additionally, the prevention of avoidable deaths and economic benefits resulting from the increase in emergency medical facilities were highest in Gyeonggi, Seoul, Gyeongbuk, Gyeongnam, and Busan. However, when standardized by population, the prevention of avoidable deaths and economic benefits were analyzed to be highest in Gyeongbuk, Chungnam, Jeonnam, Gyeongnam, and Busan. Conclusion: The results of this study can serve as foundational data for future policy measures aimed at addressing the imbalance in the supply of emergency medical facilities across regions. Considering regional characteristics in the distribution of emergency medical facilities is expected to ultimately increase the efficiency of national finances and yield economic benefits.

• Nutritional Sciences
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• v.8 no.1
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• pp.42-49
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• 2005

Many of the non-communicable diseases, which are now the major causes of death and disability worldwide, can be linked to our lifestyles, and thus to what eat The life-style related risk factors are - to a great extent - preventable. Public health nutrition (PHN) policies are means through which govemments can have an enornous impact on the reduction of nutrition-related non-communicable diseases, such as diabetes, hypertension, obesity, cancer and cardiovascular disease, by creating and supporting environments which enable healthier food choices and which are conducive to healthy nutrition behavior. More and more countries are developing nutrition policies. Nutrition policies are tools through which governments can intervene and control nutrition-related concerns throughout all levels of society. The need for more concerted action in the Republic of Korea is demonstrated, by showing the lack of priority for nutrition issues. Four recommendations for action are made; the first recommendation places emphasis on the need to implement a structure at the political level, through which nutrition concerns can be addressed, such as a nutrition unit within the Ministry of Health and Welfare. The second recommendation stresses the need for a strong nutrition advocacy strategy, to raise the awareness of the gains that can be achieved by promoting healthy nutrition. The third recommendation calls for more vigorous regulations and stricter enforcement of food and nutrition advertisement, and the fourth recommendation emphasizes the need for a settings-bsed approach to nutrition interventions. Acknowledging the developments that have already occurred in Korea, public health nutrition has yet to become a priority on the agenda of policy makers in Korea.