• Health Policy and Management
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• v.30 no.1
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• pp.72-81
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• 2020

Background: The out-of-pocket maximum is one of the distinctive healthcare systems which sets a ceiling on co-payment in order to reduce the burden of households from the unpredictable medical expenditure. However, this leads to an increase in the demand for healthcare services especially in long-term care hospitals (LTCHs) in Korea. Methods: This study analyzed the influence factor of medical service overuse of 165,592 inpatients in LTCHs which out-of-pocket maximum is applied, by utilizing data from the National Health Insurance Service (2016). Based on Anderson Model, the medical service overuse, as a dependent variable, was defined as long-stay admission more than 180 days at the LTCHs. Independent variable was comprised of predisposing factors (gender, age), enabling factors (income level, types of out-of-pocket maximum) and need factors (illness level, patient use of tertiary hospital). Results: The most powerful factor of medical service overuse in LTCHs was availability of pre-payment for the out-of-maximum (odds ratio [OR], 191.66; p<0.001). This tendency was found in high income level status (p<0.001). Furthermore, mild inpatients (OR, 1.50; p<0.001) which had no experience with the tertiary hospitals (OR, 2.06; p<0.001) were more relevant to the medical service overuse in LTCHs, compared to the severe inpatients. Conclusion: It is suggested that a separate standard of out-of pocket maximum with regards to LTCHs is required to secure the beneficial functions of long-term hospitals and prevent unnecessary financial leakage to achieve sustainable and financially sound National Health Insurance.

• Kidney Research and Clinical Practice
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• v.36 no.3
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• pp.257-263
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• 2017

Background Rituximab (RTX) can be used as a rescue therapy for steroid-dependent nephrotic syndrome (SDNS). However, the efficacy and safety of long-term, repeated use of RTX are not established. This study was conducted to assess the efficacy and safety of long-term, repeated RTX treatment in children. Methods Eighteen consecutive child patients with SDNS who were treated with three or more cycles of RTX for one year or longer were recruited, and their medical records were retrospectively reviewed. Results The patients were followed for $4.7{\pm}1.9years$ and received $5.2{\pm}2.3cycles$ of RTX over $2.8{\pm}1.1years$. Approximately 70% of the additional RTX cycles were administered due to recovery of B-cells without relapse. The relapse rate decreased from $3.4{\pm}2.0per$ year initially to $0.4{\pm}0.8per$ year at the third year after RTX treatment. Approximately 10% of the RTX infusions were accompanied by mild infusion reactions. Eight patients showed sustained remission without any oral medication after the last cycle of RTX, while 10 patients had one or more episodes of relapse after the last cycle of RTX. The relapse rate in the latter group decreased from $2.8{\pm}1.5per$ year before RTX treatment to $1.3{\pm}0.8per$ year after cessation of RTX treatment. No significant differences in clinical parameters were found between the two groups. Conclusion This retrospective study showed that pre-emptive and long-term, repeated RTX treatment is relatively effective and safe in children with SDNS. However, well-designed prospective studies are needed to confirm these findings.

• The korean journal of orthodontics
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• v.54 no.1
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• pp.59-68
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• 2024

Objective: To investigate the long-term effects of maxillary skeletal expander (MSE) treatment on functional breathing. Methods: Objective measures of breathing, the peak nasal inspiratory flow (PNIF), and peak oral inspiratory flow (POIF), and subjective measures of breathing, the visual analog scale (VAS) and nasal obstruction symptom evaluation (NOSE) survey, were used to investigate the long-term effects of MSE in functional breathing. Seventeen patients, mean age 19.4 ± 3.9 years treated at the UCLA Orthodontics Clinic were assessed on their functional breathing at 3 timepoints: pre-expansion (T0), post-expansion (T1), and post-orthodontic treatment (T2). Results: Immediately after expansion (T1), all the objective functional breathing values were significantly increased in comparison to T0 (P < 0.05). The VAS total, VAS right and VAS left were significantly lower at T1 in comparison to T0 (P < 0.05). At 26.8 ± 3.9 months after MSE expansion (T2), PNIF total, PNIF right, PNIF left, and POIF were significantly higher when compared to T0 (P < 0.05). Also, VAS total, VAS right and VAS left were significantly lower at T2 when compared to T0 (P < 0.05). Additionally, there was a positive correlation between PNIF and the magnitude of expansion at anterior nasal spine and zygomaticomaxillary point (ZMA). There was a positive correlation between total VAS and the magnitude of expansion at the ZMA. There were no significant changes for the NOSE subjective breathing measurement at all time comparisons. Conclusions: Overall, MSE treatment produces an increased objective and subjective airway improvement that continues to remain stable in the long-term post expansion.

• The Journal of Korean Medicine
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• v.45 no.1
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• pp.251-256
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• 2024

Objectives: The purpose of this study was to report the short-term blood pressure-lowering effects observed in a patient with malignant hypertension through slow breathing maneuver with heart rate variability(HRV) biofeedback. Methods: Biofeedback sessions, totaling 13, each lasting 10 minutes, were administered. Blood pressure was measured pre and post-treatment, as well as thrice daily at 10 am, 4 pm, and 8 pm. Systolic blood pressure(SBP), diastolic blood pressure(DBP), and pulse rate were recorded for comparative analysis. Results: Before biofeedback, the average SBP, DBP, and pulse rate were 227.2±18.3, 135.2±11.0, and 104.4±5.3, respectively. Immediately post-biofeedback, these values changed to 213.7±15.2, 126.9±8.5, and 99.2±3.6. However, sustained long-term blood pressure reduction was not observed. Conclusions: The findings suggest that biofeedback therapy induces a short-term reduction in blood pressure in cases of malignant hypertension, potentially associated with autonomic nervous system regulation. Integrating biofeedback with other Korean medicine treatments, such as acupuncture or moxibustion, may offer a comprehensive approach for managing malignant hypertension.

• Clinical Endoscopy
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• v.56 no.1
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• pp.55-64
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• 2023

Background/Aims: Endoscopic submucosal dissection (ESD) has been established as a treatment modality for superficial esophageal squamous cell carcinoma (ESCC). Long-term follow-up data are lacking in Western countries. The aim of this study was to analyze long-term survival in a Western center. Methods: Patients undergoing ESD for ESCC were included. The analysis was performed retrospectively using a prospectively collected database. Results: R0 resection rate was 96.7% (59/61 lesions in 58 patients). Twenty-seven patients (46.6%) fulfilled the curative resection criteria (M1/M2) (group A), 11 patients (19.0%) had M3 lesions without lymphovascular invasion (LVI) (group B), and 20 patients (34.5%) had lesions with submucosal invasion or LVI (group C). Additional treatment was recommended after non-curative resection. It was not performed in 20/31 patients (64.5%), mainly because of comorbidities (75%). Twenty-nine out of 58 (50.0%) patients died during a mean follow-up of 3.7 years. Death was related to ESCC in 17.2% (5/29) of patients. The disease-specific survival rate after curative resection was 100%. Overall survival rates after 5 years were 61.5%, 63.6% and 28.1% for groups A, B, and C, respectively. The overall survival was significantly worse after non-curative resection (p=0.038). Conclusions: Non-curative resection is frequent after ESD for ESCC in Western patients. The long-term prognosis is limited and mainly determined by comorbidity. Early diagnosis and pre-interventional assessments need to be improved.

• Journal of the Korean School Mathematics Society
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• v.22 no.4
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• pp.461-482
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• 2019

The purpose of this study was to analyze the elementary pre-service teachers' perspectives on the use of the elementary mathematics textbooks by observing mathematics classes at the schools and to present suggestions on the use of textbooks in the mathematics classes. For this study, let 54 pre-service elementary school teachers observe a total of 54 classes (1,299 students) in the first through sixth grades at 15 areas in Seoul city. With the observations of the mathematics classes, the researcher analyzed the pre-service elementary teachers' perspectives on the use of resources including mathematics textbooks in the elementary mathematics classes. As a result of the study, the pre-service teachers recognized that mathematics textbooks are the main material for mathematics classes, but they think that they need to reconstruct the contents of the textbooks for effective teaching and learning mathematics. In addition, various additional materials need to be used in order to help students learn mathematics more effectively, including by differentiated materials. Also, instruments used in the classes were mainly consisted of TV and PPT data. Pre-service teachers were not much satisfied with the contents of the elementary mathematics textbooks. However, they did not feel the need for development of digital textbooks. The researcher suggested a long term research on how to use study materials such as textbooks within the overall mechanism of teaching and learning processes. Also, practical teacher education programs that include applications of textbooks at schools are necessary in order to improve the quality of mathematics teaching and learning.

• Journal of Korea Entertainment Industry Association
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• v.15 no.1
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• pp.117-129
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• 2021

Nowadays, the trend of early childhood education has focused on finding educational activities to enhance quality of learning with integrative, learner-centered experience by combining each subject and domain. Pre-service early childhood teacher's music drama activity is a sort of integrated education including literature, instrumental music, play, art and movement that are included in the culture and art for preschoolers to help them understand role and value of the art and directly influence personality and creativity and motive to arouse interest in various learning directly. It's expected to see that development of creative teaching plan for the music drama using piano ensemble could support basic research in integrated educational activity in the teacher training course and also, activate the music drama activity. Research findings and suggestion are as follows. First, the music drama activities are systematically and step-by-step implemented according to the audience according to the cooperative learning and creative plans of pre-service early childhood teachers. Second, if understanding characteristics of casts in the music drama and assigning their roles efficiently, it enhances approach of pre-service early childhood teacher music drama activity and activate it. Third, making music in music drama activities can be composed and arranged to suit the musical literacy and level of pre-service early childhood teacher. Fourth, pre-service early childhood teachers could have integrated experience and evaluation efficiently in the short term to use as reference for the teaching plan and data for the music drama.

• The Journal of the Korea Contents Association
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• v.13 no.1
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• pp.342-353
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• 2013

The purpose of this study was to investigate the effects of short-term Maum Meditation and to compare effects according to the length of the training period on mental health of teachers. In this research, 2 types of design were used which were one-group pre-posttest design and descriptive study. In short-term Maum Meditation group, 2 times of surveys were carried out, 75 teachers in the faculty training filled out the structured questionnaire. In Long-term Maum Meditation group, 101 teachers who were attending Maum Meditation above one-year filled out the structured questionnaire. The data were analyzed by SPSS WIN 14.0 program. The results showed that there was a significant difference in mental health including 9 subscales for short-term Maum Meditation group. Also, in long-term Maum Meditation group, there were significant differences in mental health excepting paranoid ideation. It was founded that Maum Meditation is the way for the mental health promotion in short-term and long-term period. So it is necessary to develop program according to training period for not only clinical application but also to strengthen coping ability for stress.

• Journal of Korean Neurosurgical Society
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• v.67 no.2
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• pp.237-248
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• 2024

Objective : Postoperative data on Cushing's disease (CD) are equivocal in the literature. These discrepancies may be attributed to different series with different criteria for remission and variable follow-up durations. Additional data from experienced centers may address these discrepancies. In this study, we present the results obtained from 96 endoscopic transsphenoidal surgeries (ETSSs) for CD conducted in a well-experienced center. Methods : Pre- and postoperative data of 96 ETSS in 87 patients with CD were included. All cases were handled by the same neurosurgical team between 2014 and 2022. We obtained data on remission status 3-6 months postoperatively (medium-term) and during the latest follow-up (long-term). Additionally, magnetic resonance imaging (MRI) and pathology results were obtained for each case. Results : The mean follow-up duration was 39.5±3.2 months. Medium and long-term remission rates were 77% and 82%, respectively. When only first-time operations were considered, the medium- and long-term remission rates were 78% and 82%, respectively. The recurrence rate in this series was 2.5%. Patients who showed remission between 3-6 months had higher long-term remission rates than did those without initial remission. Tumors >2 cm and extended tumor invasion of the cavernous sinus (Knosp 4) were associated with lower postoperative remission rates. Conclusion : Adenoma size and the presence/absence of cavernous sinus invasion on preopera-tive MRI may predict long-term postoperative remission. A tumor size of 2 cm may be a supporting criterion for predicting remission in Knosp 4 tumors. Further studies with larger patient populations are necessary to support this finding.

• Journal of the Korean Society of Environmental Restoration Technology
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• v.11 no.6
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• pp.130-142
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• 2008

The objective of this study is to analyze the types and current status of development projects that underwent environment assessment in recent three years and provide basic data to encourage environment-friendly development projects in the future. This study was conducted by analyzing the pre-environment review reports and environment impact statements of development projects that took place in Gyeonggi province. Key findings are as follows. First, a total of 2,465 development projects spanning $173km^2$ were undertaken in Gyeonggi province in recent three years. This is equivalent to three times of the area of Anyang city. Second, types of development projects were in the order of factories and industrial parks, road construction, town (housing estates) development, sports facilities and waste treatment facilities. Public projects accounted for about 30%, while private investment projects represented 70%, indicating that private sector projects were as twice as high. The findings of this study show that the development density of Gyeonggi-do should be examined as a whole in order to develop a comprehensive, long-term plan and harmonize conservation and development systematically in Gyeonggi-do in a holistic perspective.