• Journal of Preventive Medicine and Public Health
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• 제47권6호
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• pp.327-335
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• 2014

Objectives: Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated. Methods: Suicides motivated by non-illness-related factors were identified using the investigator's note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status. Results: Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women. Conclusions: Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.

• Health Policy and Management
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• 제16권1호
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• pp.95-116
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• 2006

According to rapid increase of the population of senior citizens, there has been growing concern of Long-Tenn Care(LTC) services recently. Long-Tenn Care services, however, haven't been established systematically in Korea and the supply of LTC services is not sufficient despite the increase in the current social demand. This study aims to estimate the 'Willingness to Pay(WTP)' for LTC insurance which the government plans to introduce by means of social insurance, using Contingent Valuation Method(CYM). In addition, this study analyzes the factors affecting WTP for LTC insurance. An interview survey was carried out to derive WTP for LTC from 450 people who lived in Seoul aged 20 and above during the period from 16th to 21st of June 2003. Double-Bounded Dichotomous Choice Method was applied among several CVMs available to estimate both use value and no-use value of goods. There was pilot survey carried out prior to the main survey. The results show that the average monthly. WTP for LTC provided in home and residential setting is 18,192Won and 19,293Won, respectively. In the case of home care, WTP goes higher depending on reliability of LTC insurance policy and need for LTC insurance, as well as marital status, education and average monthly income. On the contrary, WTP is conversely affected by higher age and higher bids. In the case of institutional care, the factors affecting WTP are similar to those of home care, except age. This study followed NOAA's suggestions generally and the value derived through survey could be reliable. However, there can be the least bias in the process of survey because the CVM should be used under the supposed circumstances. Despite those limitations, it can be concluded that the amount the citizens are willing to pay for LTC is high enough to meet the costs needed to provide LTC.

• The Journal of Korean Academic Society of Nursing Education
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• 제25권3호
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• pp.366-377
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• 2019

Purpose: This study was conducted to analyze the correlations among the knowledge, stress, and self-care performance in tuberculosis patients. Methods: The participants consisted of 140 outpatients who had been diagnosed with tuberculosis in S University Hospital. Data were derived from self-report questionnaires and analyzed by SPSS 22.0. Statistical analysis included descriptive statistics and Pearson's correlation coefficients analysis. Results: Means of stress and self-care performance were 1.76 and 3.21, respectively. Percentage of correct answer of knowledge about tuberculosis was 71.8. Knowledge about tuberculosis was significantly different according to age (F=21.81, p<.001), marital status (F=13.79, p<.001), education (F=36.63, p<.001), and monthly income (F=16.23, p<.001). Stress was significantly different according to gender (t=3.58, p<.001). Self-care performance was significantly different according to age (F=5.74, p=.004), marital status (F=8.79, p<.001), education (F=9.15, p<.001), monthly income (F=7.87, p=.001), and attendance of tuberculosis education (t=2.34, p=.020). Self-care performance had significant correlation with knowledge about tuberculosis and stress. Conclusion: This study suggests that knowledge about tuberculosis and stress had significant correlations with self-care performance. Therefore, the nursing strategies of increasing knowledge about tuberculosis and decreasing stress which improve self-care performance should be developed for tuberculosis patients.

• Tuberculosis and Respiratory Diseases
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• 제68권4호
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• pp.218-225
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• 2010

Background: Bronchoalveolar lavage (BAL) is a useful technique to recover lower airway fluid and cells involved in many respiratory diseases. Miliary tuberculosis is potentially lethal, but the clinical manifestations are nonspecific and typical radiologic findings may not be seen until late in the course of disease. In addition, invasive procedures are often needed to confirm disease diagnosis. This study analyzed the cells and the T-lymphocyte subset in BAL fluid from patients with miliary tuberculosis to determine specific characteristics of BAL fluid that may help in the diagnosis of miliary tuberculosis, using a less invasive procedure. Methods: On a retrospective basis, we enrolled 20 miliary tuberculosis patients; 12 patients were male and the mean patient age was $40.5{\pm}16.2$ years. We analyzed differential cell counts of BAL fluid and the T-lymphocyte subset of BAL fluid. Results: Total cells and lymphocytes were increased in number in the BAL fluid. The percentage of CD4+ Tlymphocytes and the CD4/CD8 ratio in BAL fluid were significantly decreased and the percentage of CD8+ T-lymphocytes was relatively higher. These findings were more prominent in patients infected with the human immunodeficiency virus (HIV). In the HIV-infected patients, the proportion of lymphocytes was significantly higher in BAL fluid than in peripheral blood. There were no significant differences between the BAL fluid and the peripheral blood T-lymphocytes subpopulation. Conclusion: BAL fluid in patients with miliary tuberculosis demonstrated lymphocytosis, a lower percentage of CD4+ T-lymphocytes, a higher percentage of CD8+ T-lymphocytes, and a decreased CD4/CD8 ratio. These findings were more significant in HIV-infected subjects.

• Korean Journal of Human Ecology
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• 제15권5호
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• pp.719-727
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• 2006

The purpose of this study is to examine the job satisfaction and the job stress of British child care teachers. Respondents, including childminders, were 137 British child care teachers who worked in nursery school, day nursery, creche, and playgroup. In the survey on the job satisfaction of British child care teachers, they were asked to answer two items. In the survey on their job stress level, they were required to rate their job-related stress levels on a 5 point scale of 'Job Stress scale' by Davis et al(2003). The results indicated: firstly, the British child care teachers are much satisfied with their job and have the low level of job stress. Secondly, their job satisfaction depends on who runs the child care facilities, what position they have in the centers, how long they work for child care, what qualifications they have. The levels of their job stress depend significantly on their present position in the centers. Thirdly, the job satisfaction of British child care teachers is explained about 27%, is related to their performing of daily routine, their age, the management of child care centers and qualifications of the teachers.

• Journal of Korean Neurosurgical Society
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• 제56권4호
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• pp.334-337
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• 2014

Objective : The purpose of this study is to identify the risk factors associated with the development of germinal matrix-intraventricular hemorrhage (GM-IVH) and the relationship of the severity of disease and prematurity. Methods : A total of 168 premature neonates whose birth weight ${\leq}1500g$ or gestational age ${\leq}34$ weeks were examined by cranial ultrasound (CUS) for detection of GM-IVH among the babies admitted between January 2011 and December 2012 in our medical center neonatal intensive care unit. The babies were divided into two groups : GM-IVH and non-IVH. Clinical presentations, precipitating factors of the patients and maternal factors were analyzed. Results : In univariate analysis, gestational age, birth weight, delivery method, presence of premature rupture of membrane (PROM) and level of sodium and glucose were statistically meaningful factors (p<0.05). But only two factors, gestational age and presence of patent ductus arteriosus (PDA) were statistically meaningful in multivariate logistic regression (p<0.05). Delivery method [normal vaginal delivery (NVD) to Caeserean section] was borderline significant (p<0.10). Conclusion : Presence of PDA and gestational age were the important risk factors associated with development of GM-IVH.

• Tuberculosis and Respiratory Diseases
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• 제84권4호
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• pp.317-325
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• 2021

Background: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are significant public health issues in the world, but the epidemiological data pertaining to HAP/VAP is limited in Korea. The objective of this study was to investigate the characteristics, management, and clinical outcomes of HAP/VAP in Korea. Methods: This study is a multicenter retrospective cohort study. In total, 206,372 adult patients, who were hospitalized at one of the 13 participating tertiary hospitals in Korea, were screened for eligibility during the six-month study period. Among them, we included patients who were diagnosed with HAP/VAP based on the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) definition for HAP/VAP. Results: Using the IDSA/ATS diagnostic criteria, 526 patients were identified as HAP/VAP patients. Among them, 27.9% were diagnosed at the intensive care unit (ICU). The cohort of patients had a median age of 71.0 (range from 62.0 to 79.0) years. Most of the patients had a high risk of aspiration (63.3%). The pathogen involved was identified in 211 patients (40.1%). Furthermore, multidrug resistant (MDR) pathogens were isolated in 138 patients; the most common MDR pathogen was Acinetobacter baumannii. During hospitalization, 107 patients with HAP (28.2%) had to be admitted to the ICU for additional care. The hospital mortality rate was 28.1% in the cohort of this study. Among the 378 patients who survived, 54.2% were discharged and sent back home, while 45.8% were transferred to other hospitals or facilities. Conclusion: This study found that the prevalence of HAP/VAP in adult hospitalized patients in Korea was 2.54/1,000 patients. In tertiary hospitals in Korea, patients with HAP/VAP were elderly and had a risk of aspiration, so they were often referred to step-down centers.

• Journal of Preventive Medicine and Public Health
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• 제42권1호
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• pp.35-41
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• 2009

Objectives : The changing population age structure and rapidly increasing medical costs make providing high-quality, effective medical care for the elderly a challenge. This study assessed the satisfaction with medical care in terms of comprehensiveness, general satisfaction, and accessibility among community-dwelling Korean elders. Methods : Data were obtained from a nationwide representative sample of the older adults(aged 65 years old or older) living in the community, who participated in a 2006 telephone survey conducted using random digit dialing(n=881). General satisfaction, comprehensiveness and accessibility were measured using a 10-item satisfaction survey questionnaire. Descriptive analysis was used to assess the distribution of each of three components of subjective satisfaction. Analysis of covariance(ANCOVA) was used to examine the association of each of the three components with socioeconomic variables. Results : Comprehensiveness and general satisfaction were low among older people with a high socioeconomic status. Accessibility was evaluated as low among older people of low socioeconomic status, those living in rural areas and those who were medical aid beneficiaries. Conclusions : Urgent interventions should be considered in order to improve accessibility to medical care for elders of low socioeconomic status and those living in rural communities. Given the rapid aging of the population, we need to develop a monitoring system to improve the quality of geriatric care.

• The Korean Nurse
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• 제36권3호
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• pp.70-80
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• 1997

This study of elderly in-patient subjects' expected level of care given by family members and nurses is intended to provide foundational information for use by nurses is attending to elderly patients. The objects of the study were elderly in-patients over the age of 65 hospitalized at two General hospitals in Chonju: 102 subjects filled out the 60 question survey between December 16 and 24. 1996. The analysis process was conducted using SPSS producing percentage. mean and standard deviation. maximum and minimum values. t-test, ANOVA. and so on. The results are as follows: 1. From the general results of the survey. one can observe that statistically significant differences appeared in various levels of education of the subjects: no education(2.98). primary school completed(2.91). middle school or higher completed(2.77). As shown. the lower level of education correlates with higher care-giving expectation. 2. On a scale of 1(minimum) to 4(maximum). the mean levels of care expected by elderly inpatients from their families is 2.93. with a standard deviation of 0.28. The level of psychological care expected(mean 3.02. standard deviation 0.31) is higher than the level of care expected(mean 2.83. standard deviation 0.34). 3. The level of care expected among those of different levels of dependency for daily living (differentiated as dependent. partially dependent. independent) was highest among the partially dependent(mean 2.98. standard deviation 0.17). but the results were not statistically significant. 4. Elderly in-patients with high levels of emotive interaction with their families expected relatively high levels of physical care. while the highest levels of socio-psychological care were expected from those who reported normal levels of emotive interaction with their families. However. We can see that low levels of care are expected from those reporting low levels of emotive interaction with their families. Overall. the differences in the level of care expected between those reporting different levels of emotive interaction with their families was not shown to be statistically significant.

• Health Policy and Management
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• 제27권2호
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• pp.149-156
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• 2017

Background: This study was conducted to evaluate the performance of the Hierarchical Condition Category (HCC) model, identify potentially high-cost patients, and examine the effects of adding prior utilization to the risk model using Korean claims data. Methods: We incorporated 2 years of data from the National Health Insurance Services-National Sample Cohort. Five risk models were used to predict health expenditures: model 1 (age/sex groups), model 2 (the Center for Medicare and Medicaid Services-HCC with age/sex groups), model 3 (selected 54 HCCs with age/sex groups), model 4 (bed-days of care plus model 3), and model 5 (medication-days plus model 3). We evaluated model performance using $R^2$ at individual level, predictive positive value (PPV) of the top 5% of high-cost patients, and predictive ratio (PR) within subgroups. Results: The suitability of the model, including prior use, bed-days, and medication-days, was better than other models. $R^2$ values were 8%, 39%, 37%, 43%, and 57% with model 1, 2, 3, 4, and 5, respectively. After being removed the extreme values, the corresponding $R^2$ values were slightly improved in all models. PPVs were 16.4%, 25.2%, 25.1%, 33.8%, and 53.8%. Total expenditure was underpredicted for the highest expenditure group and overpredicted for the four other groups. PR had a tendency to decrease from younger group to older group in both female and male. Conclusion: The risk adjustment models are important in plan payment, reimbursement, profiling, and research. Combined prior use and diagnostic data are more powerful to predict health costs and to identify high-cost patients.