• Health Policy and Management
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• v.17 no.2
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• pp.1-17
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• 2007

Limited coverage for health care services of National Health Insurance(NHI) in Korea has been ongoing policy issue but additional NHI financing through raising contribution or taxes in order to improve coverage faces substantial obstacles. Private health insurance(PHI) is often considered as an alternative financing source to improve coverage. Recent reform that attempted to stretch the role of PHI allowed life insurance companies to provide complementary PHI, indemnity plan which will pay for uncovered services by NHI and out-of-pocket spending for covered services. Although complementary PHI may relieve financial burden of patients, it may significantly raise NHI spending as well as total health expenditure since little out-of-pocket spending may increase utilization of health care. So far, there has not been enough discussion about concerns of potential adverse effect resulting from extended role of PHI. This study investigated potential increase of NHI spending followed by extension of complementary PHI through sensitivity analysis. The amount of NHI spending for services that would be covered by complementary PHI was calculated using 2005 NHI statistics and expected complementary PHI enrollment rate by age and sex. Expected utilization increases were obtained based on price elasticities$(-0.2{\sim}-0.5)$ from previous studies and expected coverage rate$(50{\sim}80%)$ of complementary PHI and then converted to monetary figures. Because coverage rate of complementary PHI has not been determined yet, we employed the sensitivity analysis using coverage rate of $50{\sim}80%$. Findings demonstrate that additional spending for health care services is expected to be $426{\sim}1,702$ billion won, corresponding amount payed by NHI $298{\sim}1,192$ billion won. In conclusion, since complementary PHI may raise NHI spending significantly, there should be an agreement whether this additional cost would be accountable and acceptable in our society. Potential inefficiency resulting from extended role of complementary PHI should be considered since public and private financing do not operate in isolation and there should be more discussion on proper role of PHI in Korea.

• Journal of Chest Surgery
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• v.53 no.3
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• pp.93-103
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• 2020

Background: Risk assessment for pulmonary resection in patients with early-stage non-small-cell lung cancer (NSCLC) is important for minimizing postoperative morbidity. Depletion of skeletal muscle mass is closely associated with impaired nutritional status and limited physical ability. We evaluated the relationship between skeletal muscle depletion and early postoperative complications in patients with early-stage NSCLC. Methods: Patients who underwent curative lung resection between 2016 and 2018 and who were diagnosed with pathological stage I/II NSCLC were included, and their records were retrospectively analyzed. The psoas volume index (PVI, ㎤/㎥) was calculated based on computed tomography images from routine preoperative positron emission tomography-computed tomography. Early postoperative complications, defined as those occurring within 90 days of surgery, were compared between the lowest sex-specific quartile for PVI and the remaining quartiles. Results: A strong correlation was found between the volume and the cross-sectional area of the psoas muscle (R²=0.816). The overall rate of complications was 57.6% among patients with a low PVI and 32.8% among those with a normal-to-high PVI. The most common complication was prolonged air leak (low PVI, 16.9%; normal-to-high PVI, 9.6%), followed by pneumonia (low PVI, 13.6%; normal-to-high PVI, 7.9%) and recurrent pleural effusion (low PVI, 11.9%; normal-to-high PVI, 6.8%). The predictors of overall complications were low PVI (odds ratio [OR], 2.18; 95% confidence interval [CI], 1.07-4.09; p=0.03), low hemoglobin level (OR, 0.686; 95% CI, 0.54-0.87; p=0.002), and smoking history (OR, 3.93; 95% CI, 2.03-7.58; p<0.001). Conclusion: Low PVI was associated with a higher rate of early postoperative complications in patients with early-stage NSCLC.

• Journal of Korean Public Health Nursing
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• v.10 no.1
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• pp.12-22
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• 1996

Currently. exchanges of industrial workers between countries are more active than ever. and the problem of AIDS in connection with the operation of preventive educational programs has reached a point where the issue cannot be limited to native people alone any more. Based on such judgement. this research has been carried out to provide basic study materials by grasping the latent factors representing the difference between countries in the levels of right knowledge. attitude and behavior with respect to AIDS maintained by workers who have grown in different social and cultural living background. During the period from Apr. 1. 1995 to Jun. 30. questionnaires. written both in Korean and English, were distributed to Korean and Malaysian employees working at certain Korean video manufacturers. and the results of replies. given by 80 workers who were analyzed through matched sampling· method where ages and sex matched by country. were used as the research materials. The gathered materials were analyzed through the SPSS package t-test. ANOVA. factor analysis and multiple stepwise regression methods. and the following results were obtained. 1. The 2 extracted latent factors could be named 'common. social' knowledge factor and 'in-depth. psychological' knowledge factor respectively. 2. The percentile points of 'external. social' knowledge factor. in the case of Korean workers. howed 90.0 at average. a figure 13.75 points higher than those of Malaysian workers. 76.25. On the other hand. the percentile points of the 'in-depth. psychological'knowledge factor showed 70.80 at average in the case of Korean workers. a figure 7.47 points lower than those of Malaysian workers. 78.33. Meanwhile. the difference in percentile points between the 2 latent factors was 8.54 at average. indicating that the points of 'in-depth. psychological' knowledge factor was lower than those of the 'external. social' knowledge factor. 3. As for Korean workers. the percentile points of the 'in-depth. psychological' knowledge factor showed higher points in office workers than in non-office workers. and such variables exhibited in the position of workers can explain the $7\%$ of the latent factor. The percentile points of the 'in-depth. psychological' knowledge factors. in the case of Malaysian workers. showed higher points in groups who had religion than in groups who did not. and higher points in groups who obtained information from newspapers than in groups who obtained from televisions or other sources; and with these 2 variables. $26\%$ of this latent factor can be explained. The results. of analysis described so far suggest that while Korean workers possessed general level of knowledge on AIDS. they had low level of practical knowledge as far as its depth is concerned. and that they had social prejudice on patients as well as on the AIDS infection route. In addition. because the overall knowledge level of Malaysian workers. is lower than that of Korean workers. it suggests that separate programs intended for Malaysian workers are required prior to executing integrated programs.

• The Korean Nurse
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• v.29 no.3
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• pp.25-35
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• 1990

It is a fact that there are recent increasing trends or incidence of the colorectal carcinoma among other colorectal diseases. In such trend, the early detection remain to be most important by the air contrast barium enema and total colonofiberscopy. There are several ways to prepare the colon for barium enema and colonofiberscopy which include several agents. The mechanical cleansing have been used most frequently since Brown's method was adapted to be most perfect for colon deansing. The ideal laxatives and enema solutions were limited to adequate dose, it's effectiveness, patient's diet and bowel habit, minimal side effect, low cost and simple to perform. In order to compare the effectiveness of various cleansing solutions, six experimental methods were formed as shown; 1. normal saline enema, 2. castor oil with normal saline enema, 3. castor oil with soap suds enema, 4. magnesium citrate with normal saline, 5. magnesium citrate with soap suds enema and 6. ingestion of Golyetly solution. The authors have compared and determined the degree of cleanness by an experienced endoscopist. The total number of patients was 247, age distribution was $43{\pm}15$ years old, and sex distribution was 133 males and 114 females. The grade I and II represented no difficulties at performing the colonofiberscopy, but grade ill and N had some difficulties, even unable to perform the colonofiberscopy. The effectiveness the cleansing agents, represented with grade I and II was 95.9% (47/49) in method 6, 93.2%(54/58) in method 2, 83.3%(30/33) in method 3, 70.0%(28/10) in method 5, 66.7%(16/24) in method i, and 45.7%(18/40) in method 4. Method 2 and 6 were the most effective in normal bowel habit patients. In constipated patients, method 6 was the most effective and all method except method 11 were effective in diarrhea patients. The degrees of less mucosal irritation by various bowel cleansing method were in the order of method 6(100%), 1(100%), 5(74%), 2(69%). In subjective symptoms and cleansing groups, abdominal distension, pain, nausea and vomiting were complained, and that's subject symptoms were in the order of method 3(88.9%), 6 (79.6%), 1(75%), 5(72.5%), 2(72.4%), 4(67.5%). In conclusion, we believe that the Golytely of the mechanical cleansing solution for colonofiberscopy was the most effective, but others depended on the patient's condition und bowel habit.

• Korean Journal of Head & Neck Oncology
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• v.13 no.2
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• pp.187-199
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• 1997

Thyroid carcinoma ranks low in incidence and as a cause of death when compared to carcinomas arising in the other site. With adequate surgical treatment, the prognosis of operable thyroid carcinoma is good. However, the extent of surgical resection in treatment of thyroid cancer remains still controversy. The aim of this study was to assess the results of thyroid cancer patients treated surgically and to analyze the prognostic factors affecting survival and to improve the survival rate. We retrospectively analyzed the outcome of a total of 278 thyroid cancer patients treated surgically at Inje University Paik Hospital from 1980 to 1995 and followed for 1 to 16 years. There were man in 47 and woman in 231 patients with age range of 14 to 79 years(mean 42 years). Histopathologic findings were papillary carcinoma in 233, follicular carcinoma in 33, mixed carcinoma in 7, medullary carcinoma in 2, and undifferentiated carcinoma in 3 patients, respectively. Operative procedures were unilateral lobectomy in 111, subtotal thyroidectomy in 100, and total thyroidectomy in 67 patients. Central node dissection was performed in 92, modified neck disseciton in 62, radical neck dissection in 28, and no node dissection in 96 patients. Thyroid hormone was administered for the period of 3 to 5 years to suppress endogenous TSH production. Overall 5-year survival rate according to Kaplan-Meier method was 91.1%. Independently, significant factors affecting the prognosis were age at diagnosis, tumor size, pathologic type, tumor stage, lymph node metastasis, angioinvasion, extrathyroidal extension, and 'risk' group category. but, the prognosis were not influenced by sex and capsular invasion. Patients at low risk or with small size carcinomas had long survival over 5 years with only lobectomy. Lymph node dissection was carried out with a limited type in no jugular metastasis, radical neck dissection was performed only therapeutically in proved jugular node metastasis. Fifteen patients were dead of tumor recurrence after surviving for three months to two and half years, and the cause of death was local recurrence in nine, bone metastasis in four and lung metastasis in two patients. In conclusion, more extensive surgery including total thyroidecotmy and systematic compartment-oriented dissection of the lymph node metastases in patient at high-risk group will results in better survival and lower recurrence rate.

• Journal of Distribution Science
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• v.12 no.6
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• pp.67-79
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• 2014

Purpose - This study aims to accomplish three major research goals. First, it strives to change consumers' focus from peripheral routes to a central route of public service advertising related to the good health policy, without problematic effects, by influencing consumers' knowledge or involvement. Second, this study examines the elaboration likelihood model (ELM) and construal level theory (CLT). Specifically, we consider that the central route of ELM might correspond with the focal goal of CLT. Third, this study analyzes ELM through CLT. That is, ELM predicted that low involvement would take the peripheral route, and high involvement would take the central route. Research design, data, and methodology - This study consisted of three experiments. The first experiment had a 2×2 between-subject design. The subjects were university students and the research period was approximately one year. The first independent variable was the involvement of the overweight issue; this variable was measured and split by the median. The second independent variable was the temporal distance (near vs. distant future); this variable was manipulated. The second experiment also had a 2×2 between-subject design. The first variable was the involvement of cervical adenocarcinoma prevention, and was considered already manipulated by sex. Specifically, males had a low involvement of the disease, but females had high involvement. The second independent variable was priming (power vs. submissive). Power priming would induce abstract thinking, but submissive priming would take concrete processing. The third experiment had a 2×2×2 between-subject design. The first variable was cognitive depletion, and was manipulated by memorizing 9-digit numbers. The second and third independent variables were involvement and abstract thinking induction, such as prior experiments. Data were collected through questionnaires, and were analyzed by an SPSS program. Major hypotheses were tested by examining the interaction effects through ANOVA. Results - Major findings are as follows. First, even for low-involved consumers in the overweight category, distant future manipulation induced them to focus not on the peripheral route but on the central route of the public service advertisement. This result does not correspond to the typical ELM prediction. Second, under power priming, low-involved males of the cervical adenocarcinoma category focused on the peripheral route because of the induction to abstract thinking. This result replicated the first experiment, and confirmed the theoretical robustness. Third, high-involved females focused not on the central but on the peripheral route under the mixed condition of cognitive depletion and near future manipulation. Depletion consumed cognitive resources, and the processing mode of consumers changed from systematic to heuristic. Conclusions - ELM needs to be complemented through CLT in context of public service good health advertising. Specifically, the involvement of ELM may impact consumers' thinking mode (abstract vs. concrete), and the interaction effects may influence consumers' focus on advertising (central vs. peripheral route). This study's limitations were bounded subjects, limited stimuli, and somewhat weak external validity.

• Journal of Korean Public Health Nursing
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• v.2 no.2
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• pp.99-116
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• 1988

This study examined the effect of Health Education on the aged. One of the Study objectives was to improve knowledge. attitude and self-care practice about diabetes of the aged who have responded positive in the urine sugar test. The other study objective was to find out factors influencing knowledge. attitude and self-care practice about diabetes. and the relationship among the three variables. The subjects, consisting of 45 positive responders in the urine sugar test, were selected from the elderly who attend elderly citizen center in southern part of Seoul Then they were divided into an experimental and a control group. The study design was set to compare the pre and post test data between the experimental and the control group with the measures of results from Health Education services including nursing care intervention programs on the aged diabetics. The first data collection was carried out in August. 1986 through questionaires and urine sugar testing. The second data collection was done in September, 1987 through the same methods. The results of the study are summarized as follows; 1. General characteristics of the subjects The experimental group has 9 females and 14 males and the control group has 12 females and 10 males. As for the educational level, more than half of the subjects in both group had completed at least 6 years of education. And there was no significant difference in urine sugar levels between the two groups. 2. The effect of Health Education on the extent of change in knowledge, attitude and self-care practice about diabetes was found to be significant. The first hypothesis that knowledge, attitude and self-care practice about diabetes in the aged will be unchanged by Health Education. was rejected by increased the three variables and decreased urine suger level in the experimental group. The second hypothesis that knowledge, attitude and self-care practice about diabetes wouldn't be concerned with each other, was rejected. That is. the three variables and urine sugar levels showed a significant positive relationship with each other but diabetic knowledge to urine sugar level had an insignificant positive relationship. The third hypothesis that the amount of learning Health Education will have no relationships with knowledge. attitude and self-care practice about diabetes. was rejected. That is, the more number of times an elderly person participated in Health Education. they increased their diabetic knowledge. attitude and self-care practice and decreased their urine sugar level. 3. Except for Health Education, an other factor influencing diabetic knowledge was educational level. And an other factor influencing the diabetic attitude was experience of the diagnosis of diabetes. 4. Except for Health Education. the other factors influencing self-care practice were experience of the diagnasis of diabetes, sex and experience of the hospitalization for diabetes. But factors influencing urine sugar level weren't found. Although the results seem to be plausible, this study is not without its problems. In paticular, the sample used is limited in its scope and size. So, more empirical work needs to be done for other diseases as well as diabetes before any general conclusions are to be made.

• Journal of Gastric Cancer
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• v.1 no.2
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• pp.106-112
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• 2001

Purpose: Even with excellent surgical outcome, recurrence of early gastric cancer (EGC) after a curative resection is not declining because the incidence of EGC is increasing. The aim of this study was to propose an appropriate treatment strategy by assessing the risk factors for recurrence of curatively resected early gastric cancer. Materials and Methods: Of 3662 patients who had undergone gastric resections for gastric cancer from 1987 to 1996, the cases of 1050 curatively resected EGC patients were reviewed retrospectively. Among those 1050 patients, 50 patients ($4.8\%$) were diagnosed as having recurrent cancer, which was confirmed by clinico-radiological examination or re-operation. The risk factors that determined the recurrence patterns were investigated by using univariate and multivariate analyses. Results: The mean time to recurrence was 30.9 months, and hematogenous recurrence was the most frequent type ($32.0\%$). Among the 50 recurred patients, peritoneal recurrence showed the shortest mean time to recurrence ($18.5\pm17.7$months). Between the recurred and the non-recurred patients, there was no statistically significant difference with respect to age, sex, operation type, tumor size, tumor location, gross appearance, or histological differentiation. However, depth of invasion (submucosal invasion) and nodal involvement were significantly different (P<0.001) between the two groups. Using logistic regression analyses, nodal involvement was the only significant risk factor for recurrence in early gastric cancer (P<0.001). The median survival after the recurrence had been diagnosed was 4 months. Conclusion: Although the prognosis for EGC patients is excellent and recurrence of EGC after a curative resection is rare, the time to recurrence and the patterns of recurrence in EGC patients were diverse and unpredictable, and the result after recurrence is dismal. Considering the impact of lymph node metastasis on recurrence of EGC, a systematic lymphadenectomy, rather than limited surgery, should be performed if lymph node involvement is confirmed pre- or intraoperatively. Also if the postoperative pathologic findings reveal lymph node involvement, adjuvant chemotherapy is recommended.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.578-582
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• 2009

Purpose: In extensive deep burn of the lower limb, due to less amount of soft tissue, bone is easily exposed. When it happens, natural healing or reconstruction with skin graft only is not easy. Local flap is difficult to success, because adjacent skins are burnt or skin grafted tissues. Muscle flap or free flap are also limited and has high failure rate due to deep tissue damage. The authors acquired good outcome by performing one - stage operation on bone exposed soft tissue defect with AlloDerm$^{(R)}$(LifeCell, USA), an acellular dermal matrix producted from cadaveric skin. Methods: We studied 14 bone exposed soft tissue defect patients from March 2002 to March 2009. Average age, sex, cause of burn, location of wound, duration of admission period, and postoperative complications were studied. We removed bony cortex with burring, until conforming pinpoint bone bleeding. Then rehydrated AlloDerm$^{(R)}$(25 / 1000 inches, meshed type) was applicated on wound, and thin split thickness(6 ~ 8 / 1000 inches) skin graft was done at the immediately same operative time. Results: Average age of patients was 53.6 years(25 years ~ 80 years, SD = 16.8), and 13 patients were male(male : female = 13 : 1). Flame burn was the largest number. (Flame burn 6, electric burn 3, contact burn 4, and scalding burn 1). Tibia(8) was the most affected site. (tibia 8, toe 4, malleolus 1, and metatarsal bone 1). Thin STSC with AlloDerm$^{(R)}$ took without additional surgery in 12 of 14 patients. Partial graft loss was shown on four cases. Two cases were small in size under $1{\times}1cm$, easily healed with simple dressing, and other two cases needed additional surgery. But in case of additional surgery, granulation tissue has easily formed, and simple patch graft on AlloDerm$^{(R)}$ was enough. Average duration of admission period of patients without additional surgery was 15 days(13 ~ 19 days). Conclusion: AlloDerm$^{(R)}$ and thin split thickness skin graft give us an advantage in short surgery time and less limitations in donor site than flap surgery. Postoperative scar is less than in conventional skin graft because of more firm restoration of dermal structure with AlloDerm$^{(R)}$. We propose that AlloDerm$^{(R)}$ and thin split thickness skin graft could be a solution to bone exposured soft tissue defects in extensive deep burned patients on lower extremities, especially when adjacent tissue cannot be used for flap due to extensive burn.

• Journal of Obesity & Metabolic Syndrome
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• v.26 no.1
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• pp.23-27
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• 2017

Background: In Korea, the prevalence of obesity has steadily increased, and the socioeconomic burden of obesity has increased along with it. In 2015, the National Health Insurance Service (NHIS) signed a memorandum of understanding with the Korean Society for the Study of Obesity (KSSO), providing limited open access to its databases so that the status of obesity and obesity management could be investigated. Methods: Using NHIS databases, we analyzed nationwide population-based studies for obesity using the definition of obesity (body mass index ${\geq}25kg/m^2$) in subjects over the age of 20. Age and sex standardization were used for all data. Results: The KSSO released the 'Obesity Fact Sheet 2016' using the 2006-2015 NHIS Health Checkup database. The prevalence of obesity steadily increased from 28.7% in 2006 to 32.4% in 2015, and the prevalence of abdominal obesity also steadily increased from 18.4% in 2009 to 20.8% in 2015. The prevalence of class II obesity steadily increased from 2006 to 2015, such that the total prevalence was 4.8% in 2015 (5.6% in men and 4.0% in women). The highest prevalence of obesity was found in Jeju Island, while the lowest prevalence was found in Daegu City. The highest prevalence of abdominal obesity was also found in Jeju Island, while the lowest prevalence was found in Gwangju City. Conclusion: Based on the Obesity Fact Sheet 2016, a strategy for reducing the prevalence of obesity is needed, especially in Korean men.