• 제목/요약/키워드: health impact assessment

검색결과 563건 처리시간 0.031초

Cost-Effectiveness Analysis of Home-Based Hospice-Palliative Care for Terminal Cancer Patients

  • Kim, Ye-seul;Han, Euna;Lee, Jae-woo;Kang, Hee-Taik
    • Journal of Hospice and Palliative Care
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    • 제25권2호
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    • pp.76-84
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    • 2022
  • Purpose: We compared cost-effectiveness parameters between inpatient and home-based hospice-palliative care services for terminal cancer patients in Korea. Methods: A decision-analytic Markov model was used to compare the cost-effectiveness of hospice-palliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice-palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Results: Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Conclusion: Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.

Effect of isoflavone supplementation on menopausal symptoms: a systematic review and meta-analysis of randomized controlled trials

  • Kang, Inhae;Rim, Chai Hong;Yang, Hee Sun;Choe, Jeong-Sook;Kim, Ji Yeon;Lee, Myoungsook
    • Nutrition Research and Practice
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    • 제16권sup1호
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    • pp.147-159
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    • 2022
  • BACKGROUND/OBJECTIVES: Complementary and alternative medicines can be used to alleviate climacteric symptoms that significantly affect the quality of life of postmenopausal women. Isoflavones are the most common plant-based therapies for postmenopausal changes, but the results of previous studies have been controversial. MATERIALS/METHODS: To investigate whether isoflavones would affect menopausal symptoms as well as ovarian hormones, we performed a systematic review and meta-analysis. The PubMed and EMBASE databases were used to perform the systematic search. Included studies were limited to randomized controlled trials (RCTs) assessing the impact of isoflavone supplementation on menopausal symptoms. RESULTS: Eleven studies were included for the final quantitative assessment. Isoflavone intervention was varied between 49.3 and 135 mg of isoflavones per day for 12 wk-2 yrs. The meta-analysis showed that supplementation of isoflavones significantly increased the estradiol levels (standardized mean difference [SMD] = 0.615, P = 0.035) and Kupperman index (SMD = 3.121, P = 0.003) but had no significant effect on hot flashes, follicle-stimulating hormone, and luteinizing hormone. However, both estradiol and the Kupperman index showed significant heterogeneity among studies (I2 = 94.7%, P < 0.001 and I2 = 98.1%, P < 0.001, respectively). CONCLUSIONS: Although the results showed a significant SMD in estradiol and the Kupperman index, the results should be interpreted with caution due to the high heterogeneity. Further validation with a larger RCT will be necessary. Overall, isoflavone supplementation has distinct effects on the climacteric symptoms and hormonal changes in postmenopausal women.

국내 소비재 기업의 지속 가능한 플라스틱 경영 전략 평가를 위한 지표 개발 (Evaluation of Sustainable Plastic Management Strategy of Korean Consumer Goods Companies)

  • 한수호;권성구;박준희;이정기;이재혁;성용준;황성연;옥용식
    • 한국환경과학회지
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    • 제32권11호
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    • pp.745-756
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    • 2023
  • Growing stringent global regulations in Korea poses a threat to corporate sustainability. Companies must respond strategically to navigate these regulations and avoid greenwashing. Objective of this research was to analyze how Korean companies are responding to the global trend of reducing plastic use and propose improved management strategies. Seven indicators were developed to assess companies' post-plastic strategies and applied to analyze the sustainability reports of Amore Pacific and LG Household & HealthCare. These indicators included, 1) disclosure of plastic raw materials used by weight or volume, 2) disclosure of recycled plastic raw materials used by weight or volume, 3) disclosure of waste recycling, reuse amounts, and disposal using waste treatment method 4) strategies to reduce environmental impact of plastics, 5) plastic packaging, reduce, recycle, reuse, and composting (in the real environment), 6) plastic management roadmap for the circular economy, and 7) education for sustainable plastic management. Based on the review of considered companies, we propose in-listed sustainable plastics management strategies: disclosing the ratio of plastic raw materials and recycled raw materials for all products, considering recycling rate throughout the product value chain, and not only for the production phase, reviewing carbon dioxide emissions based on life cycle assessment rather than reducing plastic consumption, studying the biodegradability of biodegradable plastics in natural environment such as soil, considering the consumer's perspective.

외래 급성 비부비동염 환자의 잠재적으로 부적절한 항생제 사용 (Potentially Inappropriate Prescriptions of Antibiotics in Patients with Acute Rhinosinusitis in Ambulatory Settings in South Korea)

  • 정다이;제남경
    • 한국임상약학회지
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    • 제33권4호
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    • pp.261-269
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    • 2023
  • Background: Acute rhinosinusitis (ARS) is a common condition encountered in ambulatory practice and is one of the most common reasons for antibiotic prescriptions. This study aimed to evaluate the potentially inappropriate antibiotic prescribing for ARS in South Korea and identify influencing factors. Methods: We analyzed Health Insurance Review and Assessment Service-National Patient Samples data. We selected outpatients aged 20 to 64 with ARS, prescribed antibiotics between February and November 2020. Potentially inappropriate antibiotic prescribing was categorized as: 1) inappropriate antibiotic selection and 2) inappropriate antibiotic dosage or duration. Multiple logistic regression was conducted to estimate the impact of various factors on inappropriate antibiotic prescribing. Results: Of 1,210 patients, 80.83% received potentially inappropriate ARS antibiotic prescriptions. Inappropriate antibiotic selection accounted for 43.55%, and inappropriate antibiotic dosage and duration contributed to 37.28%. Otolaryngologists had higher odds ratio (OR) of potentially inappropriate antibiotic prescribing compared to internal medicine practitioners, while dentists had lower OR. Patients aged 20 to 29 years had a higher OR than other age groups, and those who visited primary care clinics had a higher OR than those who visited hospitals. Conclusion: Potentially inappropriate antibiotic prescribing for ARS is prevalent in South Korea. This study identified physician specialty, patient age group, and the level of healthcare facility as factors influencing potentially inappropriate antibiotic prescriptions. Addressing this issue through targeted interventions, such as improved guidelines adherence and patient education, is imperative to mitigate the risks associated with antibiotic misuse and antibiotic resistance.

다중회귀분석을 이용한 남한강 내 보 건설 후 조류 발생량 예측 (The Study on the Prediction of Algae Occurrence by the Multiple Regression Analysis After Weir Construction at Namhan River)

  • 오승은;안홍규;채수권
    • 환경영향평가
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    • 제26권6호
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    • pp.470-478
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    • 2017
  • 본 연구는 SPSS(18 version)를 사용하여 남한강 보를 완공한 후에 해당되는 2012년부터 2015년까지의 기상, 수질 자료로 군집분석한 결과에 의해 평수기그룹과 가뭄기그룹으로 분류하고, 각 기간 그룹별로 강천보, 여주보 및 이포보로 공간적 그룹으로 분류하였다. 이와 같은 6개의 그룹에 대해서 조류 주의보 이상의 Chl-a 농도에 해당된 월별 자료로 다중회귀분석을 실시하였다. 시 공간적으로 분류된 6개 그룹을 Chl-a 농도와 3개의 기상요인, 11개의 수질 요인 및 유량 요인과의 상관분석을 수행하여, 상관분석결과를 회귀분석의 독립변수로 적용하고. 각 6개의 그룹 별로 Chl-a 농도 예측식을 도출하고자하였다. 위 연구방법으로 수행한 연구 결과는 아래와 같다. 군집분석을 실시한 결과 연 총강수량이 평년수준이었던 평수기그룹(2012~2013년)과 연 총강수량이 1,000mm/hr 미만으로 극심한 가뭄특성을 보였던 가뭄기그룹(2014~2015년)으로 시간적으로 분류되었다. 평수기그룹과 가뭄기그룹 별로 각 3개의 보 지점에서 조류 주의보 이상의 Chl-a 농도에 해당된 월은 평수기그룹은 3~8월이었고, 가뭄기그룹은 3월, 6~10월이었다. 각 6개의 그룹 별로 Chl-a 농도와 기상, 수질 및 유량 등의 요인과의 상관분석을 수행한 결과, 3개의 보 모두에서 평수기그룹보다 가뭄기그룹의 수온 및 유량이 Chl-a 농도와의 상관성이 증가하였다. 이는 극심한 가뭄에 의한 하천 내 유속 감소와 체류시간 증가로 인한 영향으로 판단된다. 6개의 그룹에 대한 상관분석을 수행한 결과에 따라 Chl-a 농도와의 상관성이 큰 기상, 수질 및 유량 요인들을 Chl-a 농도 예측식의 독립변수로 적용하여 다중회귀분석을 수행한 결과에 의하면, 남한강의 하류에 위치하고, 팔당댐과 직접적으로 연결되어 있는 이포보에 대한 Chl-a 농도 예측식의 $Ad.R^2$ 값은 평수기그룹에서 0.920, 가뭄기그룹 0.818로 우수한 선형성을 나타내었다.

다양한 노출 매트릭스를 통한 송전선로 주변과 비 주변 거주 초등학교 학생의 극저주파 자기장 노출량 평가에 관한 연구 (Exposure Assessment of Extremely Low Frequency Magnetic Fields by variable exposure matrices for the Selected Primary Schoolchildren Living Nearby and Away from a Overhead Transmission Power Line)

  • 김윤신;현연주;최성호;이철민;노영만;조용성;홍승철
    • 한국산업보건학회지
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    • 제16권4호
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    • pp.334-345
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    • 2006
  • The objectives of this study were to analyze and compare 24 hrs personal exposure levels of MF at microenvironments such as home, school, educational institute, internet pc game room, transportation, and other places according to time activity patterns using various metrics for children attending the primary schools located near and away from the power lines, and to characterize the major microenvironments and impact factors attributed personal exposure level. The study was carried out for 44 children attending a primary school away from the lines(school A) and 125 children attending a school away from 154 kV power lines(school B), all who aged 12 years and were 6 grade, from July 2003 to December 2003. All participants filled in a questionnaire about characteristics, residence, use of electrical appliances and others. Children wore a small satchel in which EMDEX II and Lite (Enertech, Co. Ltd) and a diary of activity list for period of registration in 20 minutes blocks. All statistical calculations were made with the SAS System, Releas 6.12. The summary of results was presented below. First, about the characteristics of subjects, there no differences between two groups. The subject almost spent about 56 % of their time at home and about 20~25 % of their time at school. Fifty percent of children spent 2 hours at private educational institutes. Second, the personal exposure measurements of children in school B was statistically higher than those of children in school A by various metrics such as arithmetic mean, geometric mean, percentile(5, 25, 50, 75, 95), maximum, rate of change metric, constant field metric. The arithmetic and geometric mean magnetic fields during the time the children were at school B were 0.98 and $0.86{\mu}T$ and were about 23 times higher than those of children were at school A. In conclusion, the significant major determinants of personal exposure level is the distance from the power line to microenvironments.

노인의 인지기능과 상지기능의 관련성에 관한 체계적 고찰 (A Systematic Review on the Association between Cognitive Function and Upper Extremity Function in the Elderly)

  • 문미숙;정민예
    • 재활치료과학
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    • 제5권2호
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    • pp.23-33
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    • 2016
  • 목적: 본 연구는 노인의 인지기능과 상지기능의 관련성을 알아보고자 하며, 근거 자료들을 P.I.C.O. 방법에 따라 제시하였다. 연구방법: 2015년 11월부터 2016년 1월까지 연구를 진행하였으며 2000년 1월부터 2015년 10월까지 국외 학술지에 개재된 논문을 Medline과 PubMed를 통하여 검색하였다. 검색용어로는 elderly, dementia, Alzheimer's disease, Mild cognitive impairment, age-related, aging, cognitive, upper extremity function, hand function, hand-grip strength, grip force, complex motor function, bimanual, dexterity, UE performance, coordination을 사용하였다. 연구결과: 본 고찰에 포함된 총 8개의 연구 중 7개의 연구에서 상지기능이 노화에 따라 영향을 받는다는 것으로 나타났고, 1개의 연구에서는 노화에는 영향을 받지 않으나, 쥐기 힘 및 성별에 의해 물건조작능력에 영향을 받는 것으로 나타났다. 연구 분석 결과 노인 및 치매환자의 인지기능이 상지기능에 영향을 미치며 상호 관련성을 보였다. 결론: 본 연구는 노인을 대상으로 인지기능이 상지기능에 미치는 영향 및 관련성을 알아보고자 하였으며, 인지기능 정도에 따른 작업치료 적용 및 중재기법을 선택하는데 근거 자료로 활용될 수 있을 것으로 사료된다. 향후 국내 연구에서는 다양한 평가도구를 사용하고 질적 수준이 높은 연구들이 체계적으로 이루어져야 할 것이다.

냉동제조 시설의 암모니아 누출사고 위험 분석 (Risk Analysis of Ammonia Leak in the Refrigeration Manufacturing Facilities)

  • 강수진?;이익모;문진영;천영우
    • 한국가스학회지
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    • 제21권1호
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    • pp.43-51
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    • 2017
  • 국내 냉동제조시설에서 암모니아 누출사고가 여전히 발생하고 있음을 볼 수가 있다. 암모니아는 가연성가스 및 독성가스이므로 사고 발생할 때 인체와 생태계에 큰 피해를 일으킬 수 있다. 국내 냉동제조시설의 암모니아 사고유형을 파악한 후 사고시나리오를 선정하여 피해범위를 산정하고 사고 빈도와 위험도를 분석하여 사고 피해를 최소화하는 대책 수립이 필요하다. 본 연구에서는 정량적 위험성 평가(QRA: quantitative risk assessment)의 분석 방법에 따라 암모니아 냉동시스템의 리시버 탱크에 대한 위험도를 분석하였다. 시나리오 분석 조건은 화학물질관리법에서 정하는 '사고시나리오 선정에 관한 기술지침' 및 미국 화학공정안전센터(CCPS: center for chemical process safety)의 가이드라인에 따라 정하였다. DVN사의 SAFETI 프로그램을 활용하여 시나리오에서 선정된 모든 사고 영향범위를 산정하고 빈도 분석을 통하여 리시버 탱크에 대한 위험도를 도출하였다. 빈도 값은 사건수 분석(ETA: event tree analysis)기법과 Part count 기법을 활용하였다. 연구 결과 암모니아 냉동시스템의 개인적 위험도는 7.71E-04/yr으로 도출되었으며, 사회적 위험도 1.17E-03/yr으로 도출되었다. 도출된 위험도는 국제 화재방지협회 (NFPA: national fire protection association)의 ALARP (as low as reasonably practicable) 범위를 적용하여 위험도의 적합성을 확인하였으며, 본 연구에서 제안한 위험도 산정 방법이 사고 피해 최소화 방안을 모색하는데 활용된다면 보다 좋은 결과가 도출될 것으로 판단된다.

영산강 수계 표층 퇴적물의 금속류 분포 및 오염도 평가 (Assessment of Heavy Metal Pollution in Surface Sediments of the Yeongsan River)

  • 양해종;강태우;봉기문;정효진;양원준;한종학;정희정;황순홍;김경현
    • 환경분석과 독성보건
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    • 제21권4호
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    • pp.292-303
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    • 2018
  • The particle sizes and heavy metal concentrations (Pb, Zn, Cu, Cd, Hg, As, Cr, Ni, Li, Al) of surface sediments of the Yeongsan River were analyzed to assess the distribution and pollution level of heavy metals. The distribution of particle sizes was dominated by sand in the upstream sites (MS1-MS7) and by silt loam in the downstream sites (MS8-ML3), but MS3 and MS6, located slightly upstream of the two weirs, were found to be loamy sand and silt loam, respectively. The concentrations of Pb, Zn, Cu, Cd and Hg were higher at the upstream sites, while As, Cr, Ni and Li were higher at the downstream sites. The heavy metals of crustal origin (As, Cr, Ni and Li) were strongly correlated with particle size, while the other heavy metals (Pb, Zn, Cu, Cd and Hg) were weakly correlated with particle size. Considering their concentrations, most of heavy metals were evaluated as having almost no toxic effects on benthic organisms, at all sites. In addition, anthropogenic contamination by the $I_{geo}$, EF and CF were found to have no impact at most sites, with only low levels of pollution at the others. Using the PLI method, the MS2 and MS3 sites, located upstream, were assessed to be affected by anthropogenic contamination. Most importantly, Zn, Cu and Hg were found to be the elements responsible for most pollution, and they were highest at the upstream sites, implying pollution by domestic sewage and urban discharge.

머신러닝을 활용한 뇌졸중 환자의 기능적 결과 예측: 체계적 고찰 (Predicting Functional Outcomes of Patients With Stroke Using Machine Learning: A Systematic Review)

  • 배수영;;남상훈;홍익표
    • 재활치료과학
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    • 제11권4호
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    • pp.23-39
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    • 2022
  • 목적 : 본 연구는 뇌졸중 환자의 기능적 결과를 예측하기 위한 인구통계학적 및 임상학적 특징과 머신러닝의 사용을 체계적으로 분석하고 요약하기 위해 수행되었다. 연구방법 : PubMed, CINAHL과 Web of Science를 사용하여 2010년부터 2021년 사이에 게재된 연구를 검색하였다. 주요 검색어는 "machine learning OR data mining AND stroke AND function OR prediction OR/AND rehabilitation"을 사용하였다. 뇌 이미지 처리 기법만을 분석한 연구, 딥러닝만 적용한 연구와 전체 본문을 열람할 수 없는 연구는 제외되었다. 결과 : 검색한 결과, 총 9편의 국내외 논문을 선정했다. 선정된 논문에서 가장 많이 사용된 머신러닝 알고리즘은 서포트 벡터 머신(support vector machine, 19.05%)과 랜덤포레스트(random forest, 19.05%)였다. 9개 중 7개의 연구에서 뇌졸중 환자의 기능을 예측하기 위해 중요하다고 추출된 변수를 결과로 제시했다. 그 결과, 5개(55.56%)의 연구에서 뇌졸중 환자의 기능을 예측하기 위해 환자의 임상적 특성이 아닌 modified ranking scale (mRS) 및 functional independence measure (FIM)과 같은 초기 또는 퇴원 평가 점수가 중요하다고 도출되었다. 결론 : 이 연구는 mRS 및 FIM과 같은 뇌졸중 환자의 초기 또는 퇴원 평가 점수가 임상적 특성보다 기능적 결과에 더 많은 영향을 미칠 수 있음을 나타냈다. 따라서, 뇌졸중 환자의 기능적 결과를 향상시키기 위한 최적의 중재를 개발하고 적용하기 위해서는 뇌졸중 환자의 초기 및 퇴원 시 기능적 결과를 평가하고 검토하는 것이 필요하다.