• 한국의료질향상학회지
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• 제7권2호
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• pp.204-216
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• 2000

Background : There has been a concern that the quality of care provided to end-stage renal disease (ESRD) patients in the United States may not be as good as recommended. This paper illustrates a composite measure to assess, the quality of care received by ESRD patients undergoing in-center hemodialysis by incorporating outcomes for 4 major treatment areas. The 4 treatment areas are: dialysis treatments, anemia control, nutritional management, and blood pressure control. Methods : The major data source for the study was the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study Wave 1 (DMMS-1) d Sixteen categories of a composite quality indicator were constructed by combining 4 dichotomous variables (16=2*2*2*2). representing the optimal vs. less than optimal level of outcome for each of the 4 treatment outcome measure respectively. Optimal outcome level for each treatment area was defined based on the recommendation from the National Kidney Foundation: (a) delivered dialysis doses (Kt/V) ${\geq}$ 1.2; (b) hematocrit level ${\geq}$ 30%; (c) serum albumin concentration ${\geq}$ 3.8g/dl ; and (d) blood pressure of <140 / <90mmHg. The 16 quality indicator were ranked according to their relative quality weights, which were estimated from its association with the relative risk of survival, adjusting for patient's baseline severity and dialysis facility characteristics. Results : Out of the entire sample of 2,179 patients, only 229 (10%) meet th recommended outcome levels for all 4 treatment areas. Overall, the study patients were distributed evenly over the 16 quality indicators, indicating a great variation in the quality of ESRD care. It appears that the rank of the 16 quality-indicators is driven by serum albumin concentration, suggesting that serum albumin concentration may be the most powerful predictor of ESRD patient survival among the 4 outcome measures. Conclusion : The developed quality indicator has the advantage of describin a range of care for dialysis patients and thus providing a more complete picture of care as compared to previous studies that have focused on only single or few components of the ESRD care.

• 한국대기환경학회지
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• 제12권3호
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• pp.269-278
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• 1996

Airborne suspended particulates were collected by an Andersen high volume air sampler in a traffic area of Seoul from September 1990 to August 1991. Origanic matter extracted from particulates, their fractions, namely acidic, basic, neutral and carcinogenic subfractions (PAHs, nitroarenes) in neutral fractions were assayed for mutagenicity on TA98, TA100 and TA98NR deficient Salmonella strains, use of the pre-incubation method. The relative contribution to total mutanenicity of organic matters was highest in neutral fraction and was lowest in basic fraction. Among subfractions, that of neutral fraction was higher nitroarenes subfraction compared to PAHs subfraction. While the carcinogenic effect of benzo[a]pyrene was calculated as 0.96 persons/million persons based on unit risk estimates by extrapolation method, life time excess cancer risk estimate of EOM, neutral, PAH fraction based on their mutagenicity was calculated as 52, 42, 3.8 persons/million persons, respectively. These findings indicate that the mutagenic hazard of the partciculate, air organic complex mixture, may be dependent upon the mutagen composition in the particulate and interactions each of them. Therfore, health risk from air organic complex mixtures based on mutagenicity might be useful indicator for evaluation of actual risk.

• 대한간호학회지
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• 제34권8호
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• pp.1483-1490
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• 2004

Community-based centres were surveyed to determine the frequency of and risk factors for falls among elderly Koreans. We examined fall-related risk factors, including physiological and physical health, psychosocial functions, self-reported physical capacity and activity, vision, and the use of medication, among 351 elderly people aged 65 years or older, with ambulatory. Forty-two per cent of elderly Korean subjects reported at least one episode of falling in the previous 12 months, $38\%$ of whom had consequences that required either the attention of a physician or hospitalization. Factors significantly associated with an increased risk of falling were a restricted activity during the previous five years (adjusted OR 1.3), use of alternative therapy (adjusted OR 2.7), low knee flexor and extensor-muscle strength (adjusted OR 1.21 and 1.20), and poor balance with closed eyes (adjusted OR 8.32). We conclude that falls among older persons living in the community are common in Korea and that indicator of bad health and frailty or variables directly related to neuromuscular impairment are significant predictors of the risk of falling.

• 보건의료산업학회지
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• 제8권4호
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• pp.47-55
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• 2014

The purpose of this study was to analyze the differences in the outcome for CABG according to whether hospitals provided heart related surgeries. The 2011 National Inpatient Sample (NIS) and inpatient quality indicator principles from the Healthcare Research and Quality (AHRQ) were used for analysis. Hospitals were divided into three groups according to the surgeries they provided. The length of stay and in-hospital deaths were adjusted for the differences in risks. ANOVA was performed to examine the differences for the risk-adjusted in-hospital mortality rate and risk-adjusted length of stay among the three groups. The analysis results showed that hospitals providing CABG, PTCA, and PHS had lower risk-adjusted in-hospital mortality rates or similar risk-adjusted lengths of stay compared to those of hospitals providing only CABG. However, the three groups did not have statistically significant differences in outcome indicators. Another study will be needed with a larger sample.

• The Korean Journal of Pain
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• 제34권1호
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• pp.94-105
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• 2021

Background: Many patients with complex regional pain syndrome (CRPS) have been known to be at risk of suicide, due to severe pain and its comorbid conditions. The risk of suicide may be associated with affective instability, which is an indicator of emotional dysregulation. Particularly, unstable shifts in negative emotions are difficult to cope with, which may result in individuals feeling uncontrollable, hopeless, and entrapped. This study aimed to examine the role of affective instability in the relationship between pain intensity and suicide risk (suicidal ideation and impulsivity) in patients with CRPS, by employing a daily diary. Methods: Twenty-three patients registered at the CRPS Association in Korea were asked to complete a day-to-day routine for 15 days, followed by a diary composed of pain intensity, suicidal ideation, impulsivity, and positive and negative affects. Results: Results showed that the interactions between negative affective instability and daily pain intensity were statistically significant on daily suicidal ideation (coefficient = 0.41, t (21) = 2.56, P < 0.050) and daily impulsiveness (coefficient = 1.20, t (19) = 3.35, P < 0.010). However, those between positive affective instability and daily pain intensity were not. Conclusions: This study is the first attempt to investigate the role of affective instability on the relationship between daily pain intensity and daily suicide risk in patients with CRPS. Our findings suggest that health professionals pay considerable attention to the instability of negative affects when assessing and managing patients with CRPS at risk of suicide.

• 한국잡초학회지
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• 제17권1호
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• pp.73-79
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• 1997

Governments and industry have a growing interest in the harmonization of environmental test methods and risk assessment procedures. OECD are currently producing a set of harmonised test guidelines for studying the environmental fate and ecological effects of pesticides. FAO has published an environmental risk assessment procedure. This procedure, which is similar to those used in US and Europe, is based on calculating the ratio of the toxicity of a pesticide to indicator organisms to their level of exposure to the pesticide. The exposure depends on both the concentration of the pesticide and its bioavailability. Ratios which indicate a pesticide will not produce a harmful effect have been established using ecological field studies. Examples are presented for assessing the risk to aquatic ecosystems, earthworms and honeybees. Long-term field studies(up to 20 years) have also shown that pesticides can be used indefinitely without harming soil fertility. Herbicides can be used to avoid the ecologically damaging effects of using soil cultivations excessively for weed control.

• International Journal of Human Ecology
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• 제11권2호
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• pp.1-14
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• 2010

The main purpose of this study was to identify the impact of neighborhood settings on peer risks experienced by delinquent adolescents. A convenience sample of 1,086 youth who came to the attention of four county juvenile courts was used for the present study. The peer risk levels were measured through use of version 1.0 of the Global Risk Assessment Device (GRAD); in addition, neighborhood information obtained from the National Census was utilized. The results of the HLM demonstrated that there were significant between-neighborhood variations in peer risks and the neighborhood economic disadvantage variable was associated with peer risks after controlling for the variables of individual characteristics. The findings of this study add to the literature on juvenile delinquency by providing empirical support for the proposed model that illustrates the significant relationship between a neighborhood setting indicator and peer risks experienced by delinquent adolescents when practicing treatment or intervention programs with delinquent adolescents.

• 한국방재안전학회논문집
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• 제16권1호
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• pp.23-35
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• 2023

최근 기후변화로 인한 태풍, 국지성 집중호우 등 자연재해에 의한 피해가 급증하면서 행정안전부에서는 ｢소규모 공공시설 안전관리 등에 관한 법률(2016 개정)｣을 제정하고 각 지자체별로 소규모 공공시설을 조사하여 국가재난안전관리시스템(NDMS)에 등록하고 매년 3월 31일까지 안전점검을 실시하고 있다. 이를 위해 최근 각 지자체별로 소규모 공공시설 안전점검 및 정비계획 수립 용역이 발주되어 세천, 소교량, 농로, 마을진입로, 취입보, 낙차공의 6가지 유형의 시설물을 조사하여 DB화 하고, 각 시설물별 위험도 평가를 수행하여 위험시설의 경우 정비계획을 수립하고 있다. 그러나 현재까지 배포된 소규모 공공시설의 위험도 평가 방법은 현장조사자의 육안조사를 통해 이루어지고 있으므로, 위험도 평가가 주관적이고 모호한 형태로 이루어지고 있는 실정이다. 이에 본 연구에서는 소규모 공공시설 중 재해위험도가 가장 높은 세천에 대하여 위험도 정량평가지표를 제시함으로써 합리적이고 정량적인 위험도 평가가 이루어질 수 있도록 하였으며, 이를 통해 소규모 위험시설을 선정하여 정비계획 및 시행계획 수립에 있어 투명한 근거자료를 확보할 수 있도록 하였다.

• Journal of the Korean Data and Information Science Society
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• 제26권3호
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• pp.715-727
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• 2015

본 연구는 우리나라 요양병원의 간호인력 확보수준과 간호결과의 관련성을 파악하고 간호에 민감한 환자 결과를 알아봄으로써 요양병원의 적정 간호인력 확보에 대한 근거를 제공하기 위해 시행되었다. 자료는 건강보험심사평가원의 2012년 '요양병원 병원평가정보'를 바탕으로 분석하였다. 연구결과, 간호사 1인당 환자 수가 평균보다 많은 그룹에서 유치도뇨관 비율 (고위험군/저위험군)이 통계적으로 유의하게 높았다. 간호인력 1인당 환자 수가 평균보다 많은 그룹에서 일상생활수행능력이 감퇴한 환자비율 (치매환자군/비치매환자군), 요실금, 욕창이 새로 발생한 환자 (고위험군)비율이 통계적으로 유의하게 더 높았다. 그리고 요양병원의 등급이 향상될수록 입원환자의 간호결과가 더 좋아지는 것으로 나타났다. 이는 간호인력 확보수준이 높을수록 그리고 요양등급이 높을수록 환자의 간호결과에 긍정적인 영향이 나타난다는 결과이다. 따라서 요양병원에서 간호인력 수를 적정화시킬 수 있는 보다 강력한 정책적 접근이 필요하다는 것을 제안하는 바이다.

• 한국건설안전학회 논문집
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• 제4권1호
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• pp.9-15
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• 2021

최근 건축물이 대형화, 복합화되고 다양한 공법들이 시도되고 있다. 이에 건설장비 사용이 지속적으로 증가하고 있는 것은 물론, 그에 따른 안전사고도 지속적으로 증가하고 있다. 고용노동부 산업재해현황 발표자료에 따르면 건설업 사망사고 중 건설장비로 인한 사망사고 비율이 2009년부터 지속적으로 증가해오고 있는 실정이다. 범죄·교통 등 타산업의 안전분야에서는 평가지표 개발 또는 위험 지수 개발의 요구가 있어 정량적인 지수를 개발하는 연구가 지속적으로 연구가 진행되어 왔다. 반면에 건설장비는 재해사례를 분석하여 개선대책을 도출하는 연구는 되고 있으나, 위험 지수와 관련된 연구는 부재한 실정이다. 이에 본 연구에서는 사고사례를 기반으로 현장의 건설장비 위험 수준을 선행적으로 판단할 수 있는 정량적 지수를 개발하고, 현업에 활용 가능성도 확인해 보고자 한다.