• Archives of Plastic Surgery
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• 제49권2호
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• pp.215-220
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• 2022

Background In Japan, there is a large regional disparity in plastic surgery availability. In order for plastic surgery to be widely available for all citizens, it is essential for at least one plastic surgery facility to be located in each secondary medical zone. Methods Using the Japan Society of Plastic and Reconstructive Surgery homepage and some databases, we extracted data on secondary medical zones that do not have a plastic surgery facility. The national and regional coverage rates were calculated. The coverage rate for each group divided by the degree of population concentration was also calculated. Results We found that 147 of 344 secondary medical zones did not have a plastic surgery facility, and the area coverage rate was found to be 57.27% nationwide. The coverage rate in terms of population was 87.07% (correlation coefficient of area and population coverage = 0.983). The area coverage rates in Hokkaido-Tohoku, Kanto, Chubu, Kansai, Chugoku-Shikoku, and Kyushu-Okinawa districts were 47.46, 72.15, 76.47, 62.79, 52.08, and 32.81%, respectively. The corresponding population coverage rates were 79.92, 91.62, 94.27, 90.59, 80.68, and 69.54%, respectively. The area coverage rates in metropolitan areas, provincial cities, and rural areas were 98.08, 75.90, and 15.87%, respectively. In contrast, the area coverage rate of dermatology was 62.79% and that of orthopaedics was 97.09%. Conclusion Unfortunately, it is estimated that more than 40% of secondary medical zones are underserved by plastic surgery, and 13% of the population is not able to fully benefit from this specialty in Japan.

• Journal of Preventive Medicine and Public Health
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• 제32권4호
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• pp.538-545
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• 1999

Objective : To compare the predictive power of International Classification of Diseases 10th Edition(ICD-10) based International Classification of Diseases based Injury Severity Score(ICISS) with Trauma and Injury Severity Score(TRISS) and International Classification of Diseases 9th Edition Clinical Modification(ICD-9CM) based ICISS in the injury severity measure. Methods : ICD-10 version of Survival Risk Ratios(SRRs) was derived from 47,750 trauma patients from 35 Emergency Centers for 1 year. The predictive power of TRISS, the ICD-9CM based ICISS and ICD-10 based ICISS were compared in a group of 367 severely injured patients admitted to two university hospitals. The predictive power was compared by using the measures of discrimination(disparity, sensitivity, specificity, misclassification rates, and ROC curve analysis) and calibration(Hosmer-Lemeshow goodness-of-fit statistics), all calculated by logistic regression procedure. Results : ICD-10 based ICISS showed a lower performance than TRISS and ICD-9CM based ICISS. When age and Revised Trauma Score(RTS) were incorporated into the survival probability model, however, ICD-10 based ICISS full model showed a similar predictive power compared with TRISS and ICD-9CM based ICISS full model. ICD-10 based ICISS had some disadvantages in predicting outcomes among patients with intracranial injuries. However, such weakness was largely compensated by incorporating age and RTS in the model. Conclusions : The ICISS methodology can be extended to ICD-10 horizon as a standard injury severity measure in the place of TRISS, especially when age and RTS were incorporated in the model. In patients with intracranial injuries, the predictive power of ICD-10 based ICISS was relatively low because of differences in the classifying system between ICD-10 and ICD-9CM.

• 보건행정학회지
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• 제20권2호
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• pp.1-16
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• 2010

Background : Clinical practice guidelines are an increasingly familiar part of clinical practice. Moreover, rigorously developed evidence based guidelines has been widely used. However, in Korea, some of published documents as clinical practice guidelines have shown considerable disparity in structure, contents and quality. This is mainly because there is no consensus on the definition and quality standard of clinical practice guidelines. The purpose of this study was to draw consensus on the definition and the quality standard about clinical practice guidelines. Method : We developed a questionnaire about the definition of clinical practice guidelines with inclusion criteria(23 items) and the quality standard(30 items). We selected 9 experts who had prior experience in developing and implementing guidelines. Rating methods for appropriateness of items were adopted from the RAND method. Consensus was drawn in three rounds. Results : Of the 47 items agreed, 40 items were determined to be appropriate. Clinical practice guidelines were defined as "scientifically and systematically developed statements to assist practitioners and patients on making decisions about appropriate health care for specific clinical circumstances." Narrative reviews, systematic reviews or health technology assessment without recommendations, translation of foreign guidelines, guidelines for patients only and training manuals were not considered as clinical practice guidelines. For the quality standard of clinical practice guidelines, 27 items were deemed necessary. Conclusions : The consensus on the definition with inclusion criteria and the quality standard of clinical practice guidelines carries an important meaning as the first attempt to draw a general agreement in our society. The unique achievement of the consensus reflects the current status of clinical practice guidelines that there has been a high tendency to adapt foreign guidelines. We hope efforts of this kind will continue to bring improvement in clinical practice guidelines.

• 치위생과학회지
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• 제14권2호
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• pp.207-213
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• 2014

본 연구는 국민건강영양조사 5기(2010~2012년) 원시자료를 이용하여 사회경제적 수준에 따른 주관적 구강건강 상태의 차이와 관련성을 분석하기 위하여 실시되었다. 주관적 구강건강 수준을 '좋다'와 '나쁘다'로 분류하여 사회경제적 수준이 건강불평등에 미치는 요인을 분해하여 다음과 같은 결과를 얻었다. 주관적 구강건강 상태는 남자에 비해 여자가 구강건강을 좋지 않다고 인식하는 것으로 나타났으며, 연령 증가 시 본인의 구강건강을 나쁘게 인식하는 것으로 분석되었다. 또한 교육수준이 낮을수록, 가구소득이 낮을수록 주관적 구강건강상태를 나쁘다고 자가 평가하는 경향을 보였다. 로지스틱회귀분석을 활용하여 주관적 구강건강 상태에 대한 영향 요인을 분석한 결과 사회계층에 따른 건강상의 차이는 남자에 비해서 여자에서 자신의 구강건강수준을 더 건강하게 인지할 확률이 높아지고 있으며 교육수준이 높을수록 건강하게 인지할 가능성이 높았다. 소득수준에 따른 주관적 건강수준에 대한 인식의 격차는 소득증가에 따라 더 심화되는 것으로 나타났다. 이상의 연구결과를 살펴보면 구강건강에 사회계층별 불평등은 존재하는 것으로 나타났다. 전체 국민의 구강건강을 증진하는 사업은 물론 사회 양극화에 따른 사회계층별 구강건강의 격차를 해소하기 위해 상대적으로 격차가 큰 취약계층에 적절한 정책적 지원이 고려되어야 할 것으로 사료된다.

• 한국치위생학회지
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• 제8권3호
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• pp.1-11
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• 2008

Oral health projects that cater to the disabled should be more prevailing in order to ensure the maintenance and successful promotion of the oral health of disabled people. 70 public dental clinics that conducted oral health projects geared toward the disabled were examined to get a precise grip on their oral health projects. The findings of the study were as follows: 1. 31 out of 70 public dental clinics investigated(44.3%) were equipped with two or more dental hygienists who were professional human resources in charge of the oral health projects for the disabled. As for the age and disability type of the beneficiaries of the oral health projects, adolescents(74.3%) and people with mental retardation(87.1%) benefited most from the oral health projects. Concerning the most common implementation frequency of the projects, the projects were carried out once to three times a week(62.9%). 2. The most dominant oral disease treatment provided to disabled people was amalgam treatment and resin treatment(68.6%), which were the early dental caries treatment. The most common preventive treatment that was offered to improve their oral health was oral prophylaxis(82.9%). As for reform measures for the oral health projects, education of personnels in charge of the projects and their specialization(58.6%) were most emphasized. 3. Regarding factors related to the preventive oral health projects for the disabled, the implementation of oral prophylaxis and toothbrushing education was linked to the age of the beneficiaries. More oral prophylaxis was offered to teens, and more toothbrushing education was provided to preschoolers and adolescents. The age of the beneficiaries and the number of dental hygienists responsible for the projects had something to do with the application of fluorides. 4. Concerning the relationship of the preventive oral health projects for the disabled to the number of dental hygienists, one of the personnels in charge of the projects, the application of fluorides( 54.4%) and pit & fissure sealing(56.8%) were more prevalent when there were two or more dental hygienists. There was a statistically significant disparity in that regard(p<0.05). The above-mentioned findings illustrated that in order to boost the oral health of the disabled, dental hygienists who are responsible for the oral health projects for the disabled should put ceaseless efforts into fostering their professional knowledge and ability and offering quality service to disabled patients. Every public dental clinic should be equipped with plenty of professional personnels to enlarge the scope of treatment and ensure the efficiency of treatment and the preventive projects.

• Nutrition Research and Practice
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• 제14권6호
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• pp.679-690
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• 2020

BACKGROUND/OBJECTIVES: Concerns about regional disparities in heathy eating and nutritional status among South Korean adults are increasing. This study aims to identify the magnitude of regional disparities in diet and nutritional status among Korean adults who completed the 2017 Korea National Health and Nutrition Examination Survey (KNHANES). SUBJECTS/METHODS: The participants were a nationally representative sample of Korean adults aged 19 years and older from the 2017 KNHANES (n = 6,126). We employed the svy commands in STATA to accommodate the complex survey design. The relative concentration index (RCI), absolute concentration index (ACI) and index of disparity were used to measure regional nutritional inequalities. RESULTS: Overweight and obese adults were more prevalent among the poor than among the rich in urban areas (RCI = -0.041; P < 0.05), while overweight and obese adults were more prevalent among the rich than among the poor in rural areas of South Korea (RCI = 0.084; P < 0.05). Economic inequality in fruit and vegetable intake ≥ 500 g per day was greater in rural areas than in urban areas in both relative size (RCI = 0.228 vs. 0.091, difference in equality = 0.137; P < 0.05) and absolute size (ACI = 0.055 vs. 0.023, difference in equality = 0.032; P < 0.05). CONCLUSIONS: This study provides useful information identifying opposite directions in the relative concentration curves between urban and rural areas. Adult overweight/obesity was more prevalent among the poor in urban areas, while adult overweight/obesity was more prevalent among the rich in rural areas. Public health nutrition systems should be implemented to identify nutritional inequalities that should be targeted across regions in South Korea.

• Nutrition Research and Practice
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• 제14권5호
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• pp.519-531
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• 2020

BACKGROUND/OBJECTIVES: Regional disparities in dietary factors might be related to regional disparities in cardiometabolic health. Therefore, this study investigated the associations of cardiometabolic risk factors and dietary factors with regional types in Korean adults. SUBJECTS/METHODS: Based on data from the 2007-2017 Korea National Health and Nutrition Examination Survey, the study included 39,781 adults aged ≥ 19 years who completed the dietary survey and a health examination. Healthy and unhealthy dietary factors (fat, sodium, fruit, and vegetable intakes) were evaluated using 1-day 24-h dietary recall method, as well as the use of nutrition labels with a questionnaire. RESULTS: Of the participants, 48.7%, 36.0%, and 15.2% lived in metropolitan, urban, and rural areas, respectively. Adults living in urban and rural had higher odds ratios (ORs) for obesity (OR for urban, 1.07; 95% confidence interval (CI), 1.01-1.14; OR for rural, 1.14; 95% CI, 1.05-1.24) than adults living in metropolitan areas; these associations were significantly observed in middle-aged adults. Compared to metropolitan residents, rural residents had lower ORs for hypertension in middle-aged (OR, 0.86; 95% CI, 0.76-0.96) and metabolic syndrome in older adults (OR, 0.78; 95% CI, 0.67-0.91). Regarding urban residents, a lower OR for diabetes in middle-aged adults (OR, 0.85; 95% CI, 0.74-0.97) and a higher OR for hypertension in older adults (OR, 1.19; 95% CI, 1.02-1.39) were observed. Overall rural residents had higher ORs of excessive carbohydrate, low fruit, and high salted-vegetable intakes than metropolitan residents. Low fruit intake was positively associated with obesity, metabolic syndrome, and hypertension, after adjustment for regional type and other confounders in total participants. CONCLUSIONS: These findings indicate that cardiometabolic risk and unhealthy dietary factors differ among regional types and age groups within Korea. Nutritional policy and interventions should consider regional types for prevention and management of cardiometabolic risk factors.

• Safety and Health at Work
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• 제11권2호
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• pp.127-135
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• 2020

A safe work environment is crucial in high-risk industries, such as construction refurbishment. Safety incidents caused by uncertainty and unexpected events in construction refurbishment systems are difficult to control using conventional safety management techniques. Resilience engineering (RE) is proposed as an alternative to traditional safety management approaches. It presents a successful safety management methodology designed to deal with uncertainty in high-risk work environments. Despite the fact that RE resides in the safety domain, there is no common set of RE indicators to measure and assess resilient in the work environment. The main aim of this research is to explore RE indicators that have been identified as important in developing and assessing the resilient work environment in high-risk industries, particularly in construction refurbishment. Indicators have been attained through a systematic literature review of research and scholarly articles published between the years 2004 and 2019. The literature review explored RE indicators in various industries. Descriptive analysis and co-occurrence-based network visualization were used for data analysis. The findings revealed 28 RE indicators in 11 different high-risk industries. The results show that the four commonly used indicators were: top-management commitment, awareness, learning, and flexibility, all of which have a strong relationship with RE. The findings of this study are useful for stakeholders when making decisions concerning the most important RE indicators in the context of their research or practice as this would avoid the ambiguity and disparity in the identification of RE indicators.

• 문화기술의 융합
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• 제5권2호
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• pp.101-109
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• 2019

본 연구는 지역사회에서 발생하는 노인 부부간의 폭력실태를 피해와 가해를 구분하여 파악하였다. 또한 부부폭력에 따른 정신건강의 차이를 분석함으로써 부부폭력이 부부관계에 미치는 부정적인 영향의 정도를 파악하는데 그 목적이 있다. 부부폭력은 정서적폭력, 경미한 신체폭력, 심각한 신체폭력, 성적폭력으로 구분하여 조사를 하였다. 정신건강은 우울, 스트레스, 공격성, 자존감으로 구분하였다. 분석 결과 부부폭력 피해의 경우 정서폭력이 29.9%로 가장 높았고, 신체폭력은 3% 미만으로 나타났다. 부부폭력 가해의 경우 정서폭력이 25.4%이고, 신체폭력은 2% 미만으로 나타났다. 부부폭력에 따른 정신건강의 차이 분석결과 피해의 경우는 폭력유형에 따라서 차이는 있으나 우울과 스트레스가 유의미한 차이를 나타냈으며, 가해의 경우는 공격성이 유의미한 차이를 나타냈다. 따라서 부부폭력은 폭력유형과 가해와 피해에 따라서 차이는 있지만, 부부의 정신건강에 미치는 영향이 상당한 것으로 나타남에 따라서 부부폭력 예방을 위한 다양한 복지프로그램을 도입하고, 활성화시켜야 할 것으로 판단된다.

• Nutrition Research and Practice
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• 제16권4호
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• pp.489-504
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• 2022

BACKGROUND/OBJECTIVES: This study examined socio-economic differences in diverse food consumption among children 6-23 months of age in South Asia and Southeast Asian countries. SUBJECTS/METHODS: Data from Demographic and Health Surveys in four countries in South Asia (n = 15,749) and four countries in Southeast Asia (n = 10,789) were used. Survey-design adjusted proportions were estimated for the following 10 food items: grains, legumes, dark green leafy vegetables (DGLV), vitamin A-rich fruits, vitamin A-rich vegetables, other fruits and vegetables (OFV), fish, meat, dairy, and eggs. An equity gap was defined as an arithmetic difference in the proportion of each food item consumed in the past 24-hours between the wealthiest and lowest quintiles and between rural and urban areas, denoted by percentage points (pp). RESULTS: The consumption of most of the 10 food items was higher in the wealthiest quintiles and urban areas across eight countries. The size of equity gaps was greater in Southeast Asia than in South Asia, particularly for vitamin A-rich fruits (3.3-30.0 pp vs. 0.3-19.6 pp), vitamin A-rich vegetables (12.1-26.7 pp vs. 2.4-5.9 pp), meat (17.7-33.4 pp vs. 3.4-13.4 pp), and dairy (14.7-32.5 pp vs. 3.3-11.4 pp). However, the size of equity gap in egg consumption was greater in Southeast Asia than South Asia (11.2-19.8 pp vs. 11.0-26.7 pp). Relatively narrower gaps were seen in the consumption of grains (0.3-12.9 pp), DGLV (0.6-12.4 pp), and fish (0.1-16.8 pp) across all countries. CONCLUSIONS: Equity gaps in food consumption differed by socio-economic status and region. Reducing equity gaps in nutrient-rich foods and utilizing regionally available food resources may increase child dietary quality.