• Journal of Preventive Medicine and Public Health
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• 제43권3호
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• pp.235-244
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• 2010

Objectives: To examine the prophylactic antibiotic use in reducing surgical site infection. Methods: This was a retrospective study for patients aged 18 years and older who underwent gastrectomy, cholecystectomy, colectomy, cesarean section and hysterectomy. The data source was quality assessment data of the Health Insurance Review & Assessment Service gathered from medical records of 302 national hospitals. Prophylactic antibiotic use was defined as: timely antibiotic administration or inappropriate antibiotic selection. We performed hierarchical logistic regression to examine the association between prophylactic antibiotic use and surgical site infection with adjustment for covariates. Results: The study population consisted of 16 348 patients (1588 gastrectomies, 2327 cholecystectomies, 1,384 colectomies, 3977 hysterectomies and 7072 cesarean sections) and surgical site infection was identified in 351 (2.1%) patients. The rates of timely antibiotic administration and inappropriate antibiotic selection varied according to procedures. Cholecystectomy patients who received timely prophylactic antibiotic had a significantly reduced risk of surgical site infection compared with those who did not receive a timely prophylactic antibiotics (OR 0.64, 95% CI=0.50-0.83), but no significant reduction was observed for other procedures. When inappropriate prophylactic antibiotics were given, the risk of surgical site infection significantly increased: 8.26-fold (95% CI=4.34-15.7) for gastrectomy, 4.73-fold (95% CI=2.09-10.7) for colectomy, 2.34-fold (95% CI=1.14-4.80) for cesarean section, 4.03-fold (95% CI=1.93-8.42) for hysterectomy. Conclusions: This study examines the association among timely antibiotic administration, inappropriate antibiotic selection and surgical site infection. Patients who received timely and appropriate antibiotics had a decreased risk of surgical site infection. Efforts to improve the timing of antibiotic administration and use of appropriate antibiotic are needed to lower the risk of surgical site infection.

• 정신신체의학
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• 제24권1호
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• pp.66-73
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• 2016

연구목적 소방관에서 기능성 소화불량의 유병률이 높고 기능성 소화불량의 발현과 악화에 심리사회적 요인이 깊이 연관되어 있음에도 불구하고 이에 관한 연구는 매우 부족한 상황이다. 따라서 본 연구에서는 소방관들을 대상으로 기능성 소화불량에 관련되는 심리사회적 요인의 특징을 알아보고 삶의 질에 미치는 영향을 파악하고자 하였다. 방 법 소방관 1,217명을 대상으로 로마 III 진단기준에 따라 기능성 소화불량 집단을 선별하였다. 인구학적 요인을 조사하였으며 심리사회적 요인을 평가하기 위해 Patient Health Questionnaire-9(PHQ-9), Generalized Anxiety Disorder questionnaire-7(GAD-7), Korean Occupational Stress Scale(KOSS), Ways of Coping Checklist(WCCL), Rosenberg's Self-Esteem Scale(RSES) 그리고 World Health Organization Quality of Life Scale abbreviated version(WHOQOL-BREF)를 사용하였다. 기능성 소화불량에 따라 집단을 나누고 교차분석(chisquare test)과 독립표본 t-검정(independent t-test)을 사용하여 집단 간의 차이를 알아보았다. 또한 KOSS의 각 하위 영역별로 기능성 소화불량의 위험도를 평가하기 위해 로지스틱 회귀분석(logistic regres-sion analysis)을 시행하였다. 기능성 소화불량 집단의 삶의 질과 독립변인들의 상관관계를 파악하기 위해 Pearson 상관분석(Pearson's correlation test)을 시행하였으며, 위계적 회귀분석(hierarchical regression anal-ysis)을 통해 기능성 소화불량 집단의 삶의 질에 영향을 미치는 예측 요인을 알아보았다. 결 과 기능성 소화불량 집단은 남성(p=0.006)이 많았고, PHQ-9(p<0.001), GAD-7(p<0.001), KOSS(p<0.001) 점수가 유의미하게 높았으며, RSES(p=0.008), WHOQOL-BREF(p<0.001) 점수는 유의미하게 낮았다. KOSS 하위 영역 중 높은 직무요구도(OR 1.94, 95% CI : 1.29-2.93), 부적절한 보상(OR 2.47, 95% CI : 1.61-3.81), 그리고 불편한 직장 문화(OR 1.51, 95% CI : 1.01-2.24)에서 기능성 소화불량의 위험도가 높았다. 기능성 소화불량 집단의 삶의 질에 대한 최종 회귀모델에서 우울증상과 직무스트레스가 낮고, 자아존중감이 높은 것이 삶의 질의 42.0%를 설명했다. 결 론 본 연구 결과 기능성 소화불량 및 삶의 질에 대한 심리사회적 요인의 영향이 확인되었다. 따라서 향후 기능성 소화불량의 평가에 있어 내과적 접근 뿐만 아니라 정신건강의학과적인 접근이 동시에 이루어져야 할 것으로 판단된다.

• 한국산학기술학회논문지
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• 제20권3호
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• pp.203-215
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• 2019

본 연구는 전국 보건기관 이용률과 보건기관 이용에 영향을 미치는 요인 중 개인특성과 지역특성변수를 규명하는데 목적이 있다. 자료는 개인특성변수 선정을 위해 2016 지역사회건강조사자료를 이용하였고, 지역특성변수는 국가통계포털과 한국환경공단의 대기환경 연보 자료를 이용하였다. 자료 분석은 독립표본 t-test, 분산분석, 다중로지스틱회귀분석을 이용하였고 보건기관 이용률에 대한 개인특성변수와 지역특성변수를 함께 분석하기 위해 다수준회귀분석을 이용하였다. 연구결과, 전체 보건기관 이용률은 25.54%이고 군, 시, 대도시 순으로 나타났다. 다수준회귀분석 결과, 고령지역, 여자, 높은 연령, 낮은 교육수준과 낮은 소득수준, 걷기 실천자, 영양표시 독해자, 우울감 경험자, 고혈압 진단을 받은 자, 건강검진을 받은 자, 필수 의료서비스 미충족자, 배우자가 있는 자, 기초생활수급권자에서 보건소 이용률이 증가하였다. 반면, 스트레스 인지자, 인구 천명당 보건의료인 수가 전국 평균이상이고 보건복지예산 비중과 재정자주도, 그리고 실업율이 평균 이상으로 높은 지역에서 보건소 이용이 감소하는 것으로 나타났다. 이상의 결과에서 중앙정부와 지자체는 지역보건의료정책 수립시 지역주민의 건강행태와 정신심리적 변수 등 개인특성 뿐 아니라 지역특성 변수들을 포괄적으로 분석하고 동시에 고려하는 것이 필요함을 시사한다.

• 한국생활과학회지
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• 제22권5호
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• pp.419-431
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• 2013

This study examined the childcare use pattern of the working mothers with preschool children and the factors affecting their use of multiple childcare. The 7th wave data of "Korea Welfare Panel Study" were analyzed for this study. The working mothers with preschool children were selected from the data set and a total of 292 working mothers were included in the analysis. More than 70% of the working mothers were using only one kind of childcare, mostly childcare center and kindergarten and 22.5% of the mothers were using more than two of childcare arrangements. Child factors, maternal factors, household factors, and economic factors were included in the hierarchical logistic regression model in the presented order to predict the use of multiple childcare. The results showed that the child's age and maternal education were positively related to the use of multiple childcare, while whether both parents live with the child, number of children within household, and the poverty status were negatively related to the use of it. Based on these results, we can confer that the main motive for multiple childcare use is to provide various experiences for their children.

• 지역사회간호학회지
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• 제26권2호
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• pp.140-149
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• 2015

Purpose: This study was conducted to identify activities of daily living, depression and self-rated health and related factors for Korean Elderly. Methods: Data from the survey for the Korean Longitudinal Study of Aging in 2010 were used. The data were analyzed using frequencies, weighted proportions, and hierarchical multiple logistic regression. Results: Significant difference was observed in health status induced by socioeconomic status between men and women, but not among age groups. Socioeconomic status was strongly associated with self-rated health among male and female elders. Being unschooled and low net family asset were significantly related with dependency in activities of daily living and depressive symptoms among men. Only low net family asset was significantly related with depressive symptoms among women. Family support provides a slight decrease to the negative relationship between socioeconomic status and health status, especially depressive symptoms. Conclusion: This study suggests that interventions to reduce health inequalities should target elderly with lower socioeconomic status and with poor family support, using a gender-specific approach.

• Journal of Preventive Medicine and Public Health
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• 제32권3호
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• pp.325-332
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• 1999

Objectives: The aim of this study is to identify major factors associated with physical functioning among the Korean elderly. Methods: Data come from a survey of a nationally representative sample of 2,058 older people aged 60 years or elder living in the community. A hierarchical functioning scale was constructed, using upper and lower body mobility, IADLs, and ADLs. Socioeconomic characteristics, chronic conditions, measures of health status, health service use, and social support were analyzed to explore their influence on functioning. Polytomous logistic regression analysis was conducted to identify major contributing factors to different levels of functioning. Results: Persons of older age, female, with chronic diseases (heart disease, stroke, fracture/dislocation) were consistently more likely to show a higher degree of functional limitation. There were variations, however, among other factors; e.g., those with arthritis were more likely to be only mildly impaired, but not moderately or severely impaired. Conclusions: Older Korean adults living in the community with impaired functioning constitute persons with diverse characteristics. Policy and program activities need to address specific needs of older people in different functioning states.

• 대한간호학회지
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• 제33권8호
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• pp.1153-1160
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• 2003

Purpose. 1) To identify the time taken from symptom onset to the arrival at the hospital (pre-hospital delay time) and time taken from the arrival at the hospital to the initiation of the major treatment (in-hospital delay time) 2) to examine whether rapid treatment results in lower mortality. 3) to examine whether the pre- and in-hospital delay time can independently predict in-hospital mortality. Methods. A retrospective study with 586 consecutive AMI patients was conducted. Results. Pre-hospital delay time was 5.25 (SD=10.36), and in-hospital delay time was 1.10 (SD=1.00) hours for the thrombolytic therapy and 50.24 (SD=121.18) hours for the percutaneous transluminal coronary angio-plasty (PTCA). In-hospital mortality was the highest when the patients were treated between 4 to 48 hours after symptom onset using PTCA (p=.02), and when treated between 30 minutes and one hour after hospital arrival using thrombolytics (p=.01). Using a hierarchical logistic regression model, the pre- and in-hospital delay times did not predict the in-hospital mortality. Conclusion. Pre- and in-hospital delay times need to be decreased to meet the desirable therapeutic time window. Thrombolytics should be given within 30 minutes after arrival at the hospital, and PTCA should be initiated within 4 hours after symptom onset to minimize in-hospital mortality of AMI patients.

• 보건의료산업학회지
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• 제10권2호
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• pp.83-97
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• 2016

Objectives : This study analyzed the factors that determine the use and type of medical examination services (MES) to develop a model explaining the use behavior of MES which could consequently contribute to policy implications for medical examinations. Methods : Based on Anderson's healthcare utilization model, the MES utilization model was developed by including the perceived needs for MES. The data were collected from an online survey of a population aged 20-39 years and from a telephone survey of a population aged 40 years or older, respectively. Chi-Square tests and hierarchical logistic regression analyses were done with SAS version 9.3. Results : Generally, as health status became lower, the use of MES increased. However, patients with two or more chronic diseases were less likely to use private MES compared to patients with one chronic disease. The perceived needs for MES were only related to the use of service and not to the choice of the MES type. Conclusions : There were different results for the significant determinants between the use of the MES and the choice of the MES type. The healthcare industry needs to aware of consumer needs to provide MES based on empirical findings.

• Journal of Preventive Medicine and Public Health
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• 제29권2호
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• pp.385-395
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• 1996

This study intends to examine the behavioral pattern and small area variations of health service utilization within Wonju city. We selected three small areas in Wonju city as the study site: Haksung-dong(central area of the city), Moonmak-myun (industrial area which is located 25km away from the center of the city), and Gure-myun (agricultural area which is located 32km away from the center). The data were collected by administering questionnaire interviews with 526 people in three areas. The questionnaire include the items on health service utilization behaviors, sociodemographic characteristics, health status, and perceptions. The statistical methods used for the analysis were ANOVA and hierarchical logistic regression. From the analysis, it was found that there was a variation of health service utilization by areas. Compared to those of other areas, the respondents from agricultural area showed a high probability of using health services. When respondents' personal characteristics were taken into account, the effect of dummy variables representing areas disappeared. Instead, the perceived health status became the prime factor of health service utilization. This result showed that the small area variations of health service utilization is due to the demand factor rather than the supply factor.

• 보건행정학회지
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• 제24권4호
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• pp.380-388
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• 2014

Background: The volume of surgery has been examined as a major source of variation in outcome after surgery. This study investigated the direct effect of surgery volume to in hospitals mortality and the moderating effect of structural complexity-the level of diversity and sophistication of technology a hospital applied in patient care-to the volume outcome relationship. Methods: Discharge summary data of 11,827 cancer patients who underwent surgery and were discharged during a month period in 2010 and 2011 were analyzed. The analytic model included the independent variables such as surgery volume of a hospital, structural complexity measured by the number of diagnosis a hospital examined, and their interaction term. This study used a hierarchical logistic regression model to test for an association between hospital complexity and mortality rates and to test for the moderating effect in the volume outcome relationship. Results: As structural complexity increased the probability of in-hospital mortality after cancer surgery reduced. The interaction term between surgery volume and structural complexity was also statistically significant. The interaction effect was the strongest among the patients group who had surgery in low volume hospitals. Conclusion: The structural complexity and volume of surgery should be considered simultaneously in studying volume outcome relationship and in developing policies that aim to reduce mortality after cancer surgery.