• Quality Improvement in Health Care
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• v.7 no.2
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• pp.218-228
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• 2000

Background : Among 'structure', 'process' and 'outcome' approaches, outcome evaluation is considered as the most direct and best approach to assess the quality of health care providers. Risk-adjustment is an essential method to compare outcome across providers. This study has aims to judge performance of hospitals by severity adjusted mortality rates of coronary artery bypass graft (CABG) surgery. Methods : Medical records of 584 patients who got the CABG surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups was used to quantify severity of patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex. For evaluation of hospital performance, we calculated ratio of observed number to expected number of deaths and z score [(observed number of deaths - expected number of deaths)/square root of the variance in the number of deaths], and compared observed mortality rate with confidence interval of adjusted mortality rate for each hospital. Results : The overall in-hospital mortality was 7.0%, ranged from 2.7% to 15.7% by hospital. After severity adjustment the mortality by hospital was from 2.7% to 10.7%. One hospital with poor performance was distinctly divided from others with good performance. Conclusion : In conclusion, severity-adjusted mortality rate of CABG surgery might be applied as an indicator for hospital performance evaluation in Korea. But more pilot studies and improvement of methodologies has to be done to use it as quality indicator.

• Journal of Preventive Medicine and Public Health
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• v.27 no.2 s.46
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• pp.313-325
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• 1994

A cross-sectional study was conducted in an effort to investigate the effect of air pollution on respiratory symptoms. Two groups of female aged more than 20 living in the unpolluted rural area of Taebul (n=159) and urban area of Taegu (n=140) were selected. The ATS-DLD-78 questionnaire was translated into Korean and administered with minor modification. The proportion of smoker was less than 1% in both area. Exposure to smoking and higher educational level were more frequent in Taegu. Age-adjusted prevalence rates of 'chronic cough', 'chronic sputum', 'wheezing', and 'dyspnea' were higher in Taegu than in Taebul. In particular, the prevalence rate of 'chronic sputum' in Taegu was found to be higher, which was statistically significant. Exposure to smoking and education level were not concerned with all respiratory symptom prevalence rates. In conclusion, this study Indicates that an urban factor is related to the rates of respiratory symptoms in Korea.

• Journal of Preventive Medicine and Public Health
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• v.35 no.4
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• pp.305-312
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• 2002

Objectives : The reproductive history of women has been suggested to have a possible influence on the risk of osteoporotic fractures. The purpose of this study was to assess the association between reproductive history and hip fractures in the elderly women. Methods : The study subjects were drawn from women members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, whose reproductive histories were available, and who were beneficiaries of the Korea Medical Insurance Corporation (KMIC) in 1993 and lived in Busan city, Korea. The information on reproductive histories, and possible confounders, were collected from mailed questionnaires. Potential hip fracture cases were collected from the claims data obtained between 1993 and 1998, with a hospital survey conducted to confirm the final diagnoses. Rate ratios and their 95% confidence intervals, were calculated using a Cox's proportional hazard model. Results : Following up 5,215 women for 6 years, 51 cases were confirmed with hip fractures. When adjusted for age, weight and physical activity, the rate ratio of hip fractures in women who had given birth three or more times was 0.56 (95% CI: 0.25-1.25), compared with those who had given birth two or less times. When adjusted for age, number of births, weight and physical activity, the rate ratio in women who first gave birth when younger than 22 years was 0.60 (95% CI: 0.34-1.08) compared with those who had giving birth at 22 years or older. Conclusions : According to these findings, an early age when first giving birth might decrease the risk of hip fractures in elderly Korean women.

• Health Policy and Management
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• v.26 no.1
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• pp.30-38
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• 2016

Background: This study purposed to analyze the relationship between spatial distribution of Diabetes prevalence rates and regional variables. Methods: The unit of analysis was administrative districts of city gun gu. Dependent variable was the age- and sex- adjusted diabetes prevalence rates and regional variables were selected to represent three aspects: demographic and socioeconomic factor, health and medical factor, and physical environment factor. Along with the traditional ordinary least square (OLS) regression analysis, geographically weighted regression (GWR) was applied for the spatial analysis. Results: Analysis results showed that age- and sex-adjusted diabetes prevalence rates were varied depending on regions. OLS regression showed that diabetes prevalence rates had significant relationships with percent of population over age 65 and financial independence rate. In GWR, the effects of regional variables were not consistent. These results provide information to health policy makers. Conclusion: Regional characteristics should be considered in allocating health resources and developing health related programs for the regional disease management.

• Journal of Preventive Medicine and Public Health
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• v.34 no.1
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• pp.21-27
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• 2001

Objectives : To develop a model that will predict the mortality of patients undergoing Coronary Artery Bypass Graft (CABG) and evaluate the perfermance of hospitals. Methods : Data from 564 CABGs peformed in six general hospitals were collected through medical record abstraction by registered nurses. Variables studied involved risk factors determined by severity measures. Risk modeling was performed through logistic repression and validated with cross-validation. The statistical performance of the developed model was evaluated using c-statistic, $R^2$, and Hosmer-Lemeshow statistic. Hospital performance was assessed by severity-adjusted mortalities. Results : The developed model included age, sex, BUN, EKG rhythm, Congestive Heart Failure at admission. acute mental change within 24 hours, and previous angina pectoris history. The c-statistic and $R^2$ were 0.791 and 0.001, respectively. Hosmer-Lemeshow statistic was 10.3(p value=0.2415). One hospital had a significantly higher mortality rate than the average mortality rate, while others were net significantly different. Conclusion : Comparing the quality of service by severity adjusted mortality rates, there were significant differences in hospital performance. The severity adjusted mortality rate of CABG surgery may He an indicator for evaluating hospital performance in Korea.

• Journal of Korean Academy of Nursing
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• v.37 no.2
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• pp.171-178
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• 2007

Purpose. To identify trends in patient satisfaction adjusted for sociodemographic factors and health status from 1989-2003. Methods. Five repeated cross-sectional surveys were used. The study sample included 290,534 household members 20 years of age and over from the five survey periods of 1989, 1992, 1995, 1999, and 2003. Satisfaction was measured using a five-point scale, ranging from "very satisfied" to "very dissatisfied." Crude satisfaction rates, representing the proportion of patients satisfied (very satisfied or satisfied), were calculated for each survey period. Satisfaction rates adjusted for age, sex, marital status, education, and self-rated health status were calculated for each of the five years. Results. Crude satisfaction rates increased from 15.4% in 1989 to 40.5% in 2003. The proportions of satisfaction and dissatisfaction were reversed after 15 years had passed. However, the satisfaction trend was not linear throughout the different years, with 1992 being the year with the lowest satisfaction rate (9.7%). These trends in crude rates did not change even after adjusting for patient characteristics. The odds of satisfaction in 1992 were 38% lower (odds ratio 0.62, 95% CI 0.60 to 0.64) than the odds in 1989. In 2003, the odds of satisfaction were 4.01 times (95% CI 3.89 to 4.13) the odds for 1989. Older, female, married, and less-educated people were more likely to be satisfied. Patients who rated their health as 'very good' had the highest satisfaction rate, and those with "neutral" health ratings had the lowest. General hospitals achieved substantial improvement whereas pharmacies became the lowest-rated of all institutions. Conclusions. The Korean health system has achieved better patient satisfaction rates over the past 15 years. Increased health expenditure, resources, and quality improvement efforts may have contributed to this progress.

• The Journal of Korean Society for School & Community Health Education
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• v.14 no.2
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• pp.93-112
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• 2013

Objectives: This study was conducted to investigate the incidence rate of noise-induced hearing loss (NIHL) in Korean youths using the National Health Insurance Data Methods: We obtained the case of NIHL with the National Health Insurance Data and calculated the incidence rate of NIHL after classifying them by year (from 2005 through 2008), age, gender, birth cohort. Results: The age-adjusted incidence rate by year of NIHL per 100,000 population increased by 40.6% from 13.8 persons in 2005 to 19.4 persons in 2008, which showed a increasing trend every year. In particular, the incidence rate per 100,000 population among the adolescents (15-19 years of age) shot up by 78.2% from 8.7 persons in 2005 to 15.5 persons in 2008. According to the incidence rate by birth cohort of NIHL, the birth cohorts showed the gradually increase in incidence rate as time passed by. Adolescents in early 20s (20-24 years of age) had a higher incidence rate than teenage and men had a higher incidence rate than women. Conclusions: The results suggest that incidence rate of NIHL in Korean youths has rapidly increased among adolescents. Therefore, it is required to educate adolescents about the risk of hearing loss due to noise, establish program to prevent NIHL among adolescents and provide them with health education on hearing loss prevention.

• Journal of Sasang Constitutional Medicine
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• v.17 no.3
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• pp.12-21
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• 2005

1. Objectives Though the distributional rate of Sasangin was mentioned in ${\ulcorner}$Dongyi Suse Bowon${\lrcorner}$, there were few studies on the distributional rate of Sasangin in Korea. So, this study was conducted to estimate the distributional rate of Sasangin in Korea. 2. Methods The medical records of 1,423 subjects who have taken diagnosis of Sasang constitution from January 2003 to June 2003 at a health examination center of a hospital in Seoul were reviewed. Then distributional rate of Sasang constitution were analyzed and age sex-adjusted standardized distributional rate were estimated by direct standardization using a reference population of 2000 aged from 20 to 70 years. 3. Results and Conclusions (1) The total number of subjects were 1,423(Males : 704(49.5%) / Females : 719(50.5%)). And the mean age of the subjects was $46.3{\pm}11.4$ years(males : $45.4{\pm}11.3$ / females $47.1{\pm}11.4$). (2) Among the 1,423 subjects, distributional rate of Taeumin, Soyangin, and Soeumin were 46.9%, 29.1% and 24.0%(Male : Taeumin 48.2%, Soyangin 37.9%, Soeumin 13.9% / Female: Taeumin 45.6%, Soyangin 20.4%, Soeumin 33.9%). (3) Age sex-adjusted standardized distributional rate of Taeumin, Soyangin, and Soeumin were 45.4%, 28.2% and 26.4%(Male : Taeumin 50.8%, Soyangin 35.1%, Soeumin 14.1% / Female: Taeumin 39.5%, Soyangin 21.0%, Soeumin 39.4%) (4) The rate of Soeumins was higher than that mentioned in ${\ulcorner}$Dongyi Suse Bowon${\lrcorner}$,and the distributional rate of Sasangin according to sex was different. (5) So it was thought that the distributional rate of Sasangin in Korea was different from that mentioned in ${\ulcorner}$Dongyi Suse Bowon${\lrcorner}$.

• Journal of Preventive Medicine and Public Health
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• v.32 no.4
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• pp.435-442
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• 1999

Objectives: The purpose of this study was to examine the twelve-year incidence of hypertension, and to find risk factors for the incidence in adult population in Kangwha County, Korea. Methods: In 1986, 413 males(mean age 37 years) and 434 females(mean age 33 years) were examined in the Kangwha Study, Among 764 non-hypertensive participants, 164 males and 214 females were reexamined in 1998. Blood pressure(BP) was measured with standard mercury sphygmomanometers. Multiple logistic regression analysis was used to estimate the relative risk of risk factors on the incidence of hypertension. Results: During the 12-year period, 68 of 164 males and 53 of 2f4 females developed hypertension. In a multiple logistic model adjusted for age and pulse rate, baseline BP, baseline body mass index(BMI) and BMI change during the follow-up period were significantly related to the incidence of hyperiension. Adjusted relative risk(RR)s of baseline high-normal BP were 3.90(95% CI: 1.81-7.84) in males, and 12.72(95% CI: 3.70-30.73) in females. Compared with lower baseline BMI group, adjusted RRs of middle baseline BMI group were 2.66(95% CI: 1.19-5.70) in males, and 2.33(95% CI: 0.95-5.55) in females. Adjusted RRs of upper baseline BMI group were 3.52(95% CI: 1.53-7.67) in males and 3.63(95% CI: 1.50-8.43) in females. Increase of BMI was positively related to the incidence in males(adjusted RR=2.71, 95% CI: 1.00-6.71) and females(adjusted RR=3.05, 95% CI: 1.29-6.88). Conclusions: The twelve-year incidence of hypertension was 41.5% in males, and 25.8% in females. Baseline BP, baseline BMI, and BMI change were strongly related to the incidence of hypertension.

• Journal of dental hygiene science
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• v.10 no.3
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• pp.141-146
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• 2010

The purpose of this study was to survey the knowledge of parents, to prepare basic data for the development of adjusted water fluoridation program. The survey with self-administrated questionnaire was carried out to n 1,418 parents of school-children in Kimje city and then analyzed obtained the results. The data were analysed using the chisquare test. Over all, 58.4 percent of parents has heard about adjusted water fluoridation. 50.1% respondents knew very well the object of water fluoridation program which is implemented to prevent dental caries. The recognition rate of water fluoridation were different according to respondent's education level(p=.000) and income(p=.019). The approval rate of water fluoridation were different according to respondent's education level age level and income(p<.001). The parents had the affirmative opinion for the adjusted water fluoridation was 4.5 times more than the negative opinion. Respondents approving and opposing for the implementation of water fluoridation were 82.3% and 17.7%, respectively. The recognition rate and approval rate of water fluoridation had the affirmative opinion for the adjusted water fluoridation was more than the negative opinion. Respondents approving and opposing for the implementation of water fluoridation were 85.5% and 14.2%, respectively. The parents of school children had affirmative opinion to the adjusted water fluoridation. So for implementation of the water fluoridation, it is required to reinforce education for inhabitants through delivery of right information and various publicity activities.