• Health Policy and Management
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• v.29 no.3
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• pp.357-367
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• 2019

Background: This study evaluated the cost-effectiveness of 21 different national dyslipidemia screening strategies according to total cholesterol (TC) cutoff and screening interval among 40 years or more for the primary prevention of coronary heart disease over a lifetime in Korea, from a societal perspective. Methods: A decision tree was used to estimate disease detection with the 21 different screening strategies, while a Markov model was used to model disease progression until death, quality-adjusted life years (QALYs) and costs from a Korea societal perspective. Results: The results showed that the strategy with TC 200 mg/dL and 4-year interval cost \4,625,446 for 16.65105 QALYs per person and strategy with TC 200 mg/dL and 3-year interval cost \4,691,771 for 16.65164 QALYs compared with \3,061,371 for 16.59877 QALYs for strategy with no screening. The incremental cost-effectiveness ratio of strategy with TC 200 mg/dL and 4-year interval versus strategy with no screening was \29,916,271/QALY. At a Korea willingness-to-pay threshold of \30,500,000/QALY, strategy with TC 200 mg/dL and 4-year interval is cost-effective compared with strategy with no screening. Sensitivity analyses showed that results were robust to reasonable variations in model parameters. Conclusion: In this study, revised national dyslipidemia screening strategy with TC 200 mg/dL and 4-year interval could be a cost-effective option. A better understanding of the Korean dyslipidemia population may be necessary to aid in future efforts to improve dyslipidemia diagnosis and management.

• Korean Public Health Research
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• v.44 no.4
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• pp.25-34
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• 2018

Objective : This study aimed to examine the association Self-Rated Health(hereafter SRH) and Activities of Daily Living(hereafter ADL), Independent Activities of Daily Living(hereafter IADL) among Korean elderly. Methods : Using nationally representative cross sectional studies called 2014 Survey of living conditions and welfare needs of Korean elder persons. We used SRH as an independent variable, disabilities of ADL and IADL as dependent variables. Logistic regression was implemented and potential confounders such as socio-economic status, demographic characteristics and others were adjusted. Results : It was revealed that people who were female(than male) and 75 or more years old(than less than 75 years old) were shown to have poor SRH and disabilities of both ADL and IADL. In logistic regression model, poor SRH was associated with ADL and IADL disabilities. Especially, their association was more remarkable among male than among female. It can be understood that socio-economic contexts affect quality of life among elderly and SRH can be differently perceived by gender. Conclusions : Our notable findings showed that gender perspective is needed to understand SRH and daily living among elderly.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.26 no.1
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• pp.23-33
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• 2023

Purpose: The incidence and prevalence of inflammatory bowel disease (IBD) are increasing along with an increasing number of patients with comorbid conditions like psychiatric and behavioral disorders, which are independent predictors of quality of life. Methods: Non-overlapping years (2003-2016) of National Inpatient Sample and Kids Inpatient Database were analyzed to include all IBD-related hospitalizations of patients less than 21 years of age. Patients were analyzed for a concomitant diagnosis of psychiatric/ behavioral disorders and were compared with IBD patients without psychiatric/behavioral disorder diagnoses for outcome variables: IBD severity, length of stay and inflation-adjusted hospitalization charges. Results: Total of 161,294 IBD-related hospitalizations were analyzed and the overall prevalence rate of any psychiatric and behavioral disorders was 15.7%. Prevalence rate increased from 11.3% (2003) to 20.6% (2016), p<0.001. Depression, substance use, and anxiety were the predominant psychiatric disorders. Regression analysis showed patients with severe IBD (odds ratio [OR], 1.57; confidence interval [CI], 1.47-1.67; p<0.001) and intermediate IBD (OR, 1.14; CI, 1.10-1.28, p<0.001) had increased risk of associated psychiatric and behavioral disorders than patients with a low severity IBD. Multivariate analysis showed that psychiatric and behavioral disorders had 1.17 (CI, 1.07-1.28; p<0.001) mean additional days of hospitalization and incurred additional $8473 (CI, 7,520-9,425; p<0.001) of mean hospitalization charges, independent of IBD severity. Conclusion: Prevalence of psychiatric and behavioral disorders in hospitalized pediatric IBD patients has been significantly increasing over the last two decades, and these disorders were independently associated with prolonged hospital stay, and higher total hospitalization charges.

• Journal of the Korean Institute of Navigation
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• v.14 no.4
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• pp.53-70
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• 1990

Much efforts have been made to improve the training education system for last decades. however, it still leaves much room form improving the system. The reason for this is that the have been many changes in given educational conditions, national and international, and that there existed the lack of training facilities on shore and the limits of capacity on the training ship. The existing program adopts a straight-through system of which the course has to be completed at same time, and also forces students to study the course, disregarding their aptitude for sea life. Consequently, the program resulted in frustrating the learning desire of some students and, as a consequence, in deteriorating the quality of the entire training education. This paper aims to develop an efficient training program including curriculla by the literature survey and the teaching and sea experiences on the training ship "HANBADA" and merchant ships, where the authors have been for many years. Compared with the existing one, the new training model suggested in this paper has some advantages as follows : First, the new model adopts multi-state system which consists of various short-term training courses according to each purpose. This system will be helpful for student to find their aptitude for sea life earlier and to understand classes of major subjection shore. Second, the model includes new curriculla which consist of core subjects (for example, navigation, marine operation, marine transportation, watch keeping and nautical English for deck cadets and internal and external combustion engine, auxiliary machinery, electric and electronics and engine maintenance for engine cadets), by incorporating existing 20 subjects in 5 subjects. These curriculla may contribute to embodying the characteristics of training education where the above mentioned subjects must be linked with each other. In order to implement this new training model efficiently and effectively, the following prerequisties must be prepared : $\circled1$ The contents of each subject included in the new model should be systematically developed. $\circled2$ The educational schedule should be adjusted according to the new model.new model.

• Nutrition Research and Practice
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• v.12 no.1
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• pp.69-77
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• 2018

BACKGROUND/OBJECTIVES: Metabolic risk factors should be managed effectively in patients with type 2 diabetes mellitus (T2DM) to prevent or delay diabetic complications. This study aimed to compare the self-management levels of diet and metabolic risk factors in patients with T2DM, according to the duration of illness, and to examine the trends in self-management levels during the recent decades. SUBJECTS/METHODS: Data were collected from the Korea National Health and Nutrition Examination Surveys (KNHANES, 1998-2014). In our analysis, 4,148 patients with T2DM, aged ${\geq}30years$, were categorized according to the duration of their illness (< 5 years, 5-9 years, and ${\geq}10years$). Demographic and lifestyle information was assessed through self-administered questionnaires, and biomarker levels (e.g., fasting glucose level, blood pressure, or lipid level) were obtained from a health examination. Dietary intake was assessed by a 24-recall, and adherence level to dietary guidelines (meal patterns and intake levels of calories, carbohydrates, vegetable/seaweed, sodium, and alcohol) were assessed. Multivariable generalized linear regression and unconditional logistic regression models were used to compare the prevalence rates of hyperglycemia, dyslipidemia, and hypertension according to the duration of patients' illness, accounting for the complex survey design of the KNHANES. RESULTS: In the multivariable adjusted models, patients with a longer duration (${\geq}10years$) of T2DM had a higher prevalence of hyperglycemia than those with a shorter duration of T2DM (< 5 years) (odds ratio 2.20, 95% confidence interval 1.61-3.01, P for trend < 0.001). We did not observe any associations of disease duration with the prevalence of hypertension and dyslipidemia. In addition, the adherence levels to dietary recommendations did not significantly differ according to disease duration, except adherence to moderate alcohol consumption. There were significant decreasing trends in the prevalence of hyperglycemia in patients with a duration of illness ${\geq}10years$ (P for trend = 0.004). CONCLUSION: Although the proportion of patients with adequate control of glucose levels has improved in recent decades, poorer self-management has been found in those with a longer disease duration. These findings suggest the need for well-planned and individualized patient education programs to improve self-management levels and quality of life by preventing or delaying diabetic complications.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.20
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• pp.8607-8612
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• 2014

Background: Breast cancer patients experience a variety of altered appearance - such as loss or disfigurement of breasts, discolored skin, and hair loss - which result in psychological distress that affect their quality of life. This study aims to evaluate the impact of socioeconomic status on the altered appearance distress, body image, and quality of life among Korean breast cancer patients. Materials and Methods: A cross-sectional survey was conducted at advocacy events held at 16 different hospitals in Korea. Subjects were eligible to participate if they were 18 years of age or older, had a histologically confirmed diagnosis of breast cancer, had no evidence of recurrence or metastasis, and had no psychological problems at the time of the survey. Employment status, marital status, education, and income were assessed for patient socioeconomic status. Altered appearance distress was measured using the NCI's cancer treatment side effects scale; body image and quality of life were measured by the EORTC QLC-C30 and BR23. Means and standard deviations of each outcome were compared by socioeconomic status and multivariate linear regression models for evaluating the association between socioeconomic status and altered appearance distress, body image, and quality of life. Results: A total of 126 breast cancer patients participated in the study; the mean age of participants was 47.7 (SD=8.4). Of the total, 83.2% were married, 85.6% received more than high school education, 35.2% were employed, and 41% had more than $3000 in monthly household income. About 46% had mastectomy, and over 30% were receiving either chemotherapy or radiation therapy at the time of the survey. With fully adjusted models, the employed patients had significantly higher altered appearance distress (1.80 vs 1.48; p<0.05) and poorer body image (36.63 vs 51.69; p<0.05) compared to the patients who were unemployed. Higher education (10.58, standard error (SE)=7.63) and family income (12.88, SE=5.08) was positively associated with better body image after adjusting for age, disease stage at diagnosis, current treatment status, and breast surgery type. Similarly, patients who were married and who had higher education had better quality of life were statistically significant in the multivariate models. Conclusions: Socioeconomic status is significantly associated with altered appearance distress, body image, and quality of life in Korean women with breast cancer. Patients who suffer from altered appearance distress or lower body image are much more likely to experience psychosocial, physical, and functional problems than women who do not, therefore health care providers should be aware of the changes and distresses that these breast cancer patients go through and provide specific information and psychosocial support to socioeconomically more vulnerable patients.

• Research in Community and Public Health Nursing
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• v.14 no.1
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• pp.106-119
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• 2003

This study was executed to develop the model of the format of the day care center which supplies the total service on the health care in the day time and social program related with the work and to evaluate the processing courses which was adjusted for 3 years from March 1999 to December 2001 in order to improve the quality of life of the family who experience dementia, dementia prevention, and the old and the burden of daily activities. The processing courses of this business model were evaluated to the confirmation on the health condition, application of the nursing processes, and the precise medical examination, and 20 sorts of social programs. The methods used in this model were the simplified MMSE-K, Ability for ,Daily Life(ADL), Instrumental Activities of Daily Living(IADL), and nursing process, and so on. The execution effects of this model are as follows. 1. It can contribute to the delay in the dementia process of the old people who are related with the dementia and maintenance and improvement of the health by confirming the stopping of the process of the dementia as the objective estimation method while the dementia symptom is maintained as the current condition through the medical and social total services. 2. The reduction of the burden for the daily care of the subject people and their families for the old people who are concerned with the dementia helped to improve the quality of life of the subject people and their family by enabling them to have jobs. 3. It enabled them to positively cope with the demand for the health and nursing of the local residents related to the old people. 4. It enabled them to enhance the recognition for the socialization of the local social organization and residents for the old people. 5. It enabled them to reinforce the related system among the local social organizations, and develop and provide the various social programs which are proper for the old people.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.19
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• pp.8503-8508
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• 2014

Background: After the WHO recommended HPV vaccination of the general population in 2009, government support of HPV vaccination programs was increased in many countries. However, this policy was not implemented in Korea due to perceived low cost-effectiveness. Thus, the aim of this study was to analyze the cost-utility of HPV vaccination programs targeted to high risk populations as compared to vaccination programs for the general population. Materials and Methods: Each study population was set to 100,000 people in a simulation study to determine the incremental cost-utility ratio (ICUR), then standard prevalence rates, cost, vaccination rates, vaccine efficacy, and the Quality-Adjusted Life-Years (QALYs) were applied to the analysis. In addition, sensitivity analysis was performed by assuming discounted vaccination cost. Results: In the socially vulnerable population, QALYs gained through HPV vaccination were higher than that of the general population (General population: 1,019, Socially vulnerable population: 5,582). The results of ICUR showed that the cost of HPV vaccination was higher for the general population than the socially vulnerable population. (General population: 52,279,255 KRW, Socially vulnerable population: 9,547,347 KRW). Compared with 24 million KRW/QALYs as the social threshold, vaccination of the general population was not cost-effective. In contrast, vaccination of the socially vulnerable population was strongly cost-effective. Conclusions: The results suggest the importance and necessity of government support of HPV vaccination programs targeted to socially vulnerable populations because a targeted approach is much more cost-effective. The implementation of government support for such vaccination programs is a critical strategy for decreasing the burden of HPV infection in Korea.

• Korean Journal of Psychosomatic Medicine
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• v.25 no.1
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• pp.56-62
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• 2017

Objectives : The objective of this study was to investigate the relationship between psychological distress and pain in cancer patients. Methods : 249 patients with cancer who visited National Health Insurance Service Ilsan Hospital between April 2013 and March 2014 were evaluated with National Cancer Center Psychological Symptom Inventory(NCC-PSI) which consisted of Modified Distress Thermometer(MDT) and Modified Impact Thermometer(MIT). Each scale was divided into 3 subscales targeting separate symptoms: insomnia, anxiety, and depression. Psychological distress was defined as positive for those who scored above the cutoff values in at least one of all six subscales. The Numeric Rating Scale for Pain(NRS-Pain) was used to assess the subjective severity of pain. Logistic regression was performed to investigate the association between psychological distress and pain. Results : Univariate logistic regression analysis showed that pain, gender, compliance, and two subscale scores of Hospital Anxiety and Depression Scale(HADS) were significantly associated with psychological distress. Multivariate logistic regression analysis showed that pain and HADS anxiety subscale score maintained a statistically significant association with psychological distress adjusted for variables including age, gender, years of education, Eastern Cooperative Oncology Group performance status, cancer stage, Charlson Comorbidity Index, compliance, and HADS depression subscale score. One point increase in pain was 1.31 times more likely to cause psychological distress. In secondary analysis, pain was significantly associated with all subscales of NCC-PSI, except MIT-anxiety subscale. Conclusions : This study suggests that NCC-PSI, a screening tool for psychological distress, reflects pain. We recommend that physicians who treat cancer patients consider the examination of psychological distress which provides comprehensive evaluation of various factors regarding quality of life.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.8
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• pp.3153-3157
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• 2015

Background: Incidence and mortality rates for cancer have increased dramatically in the recent 30 years in Taiwan. However, not all patients receive treatment. Treatment refusal might impair patient survival and life quality. In order to improve this situation, we proposed this study to evaluate factors that are related to refusal of treatment in cancer patients via a cancer case manager system. Materials and Methods: This study analysed data from a case management system during the period from 2010 to 2012 at a medical center in Northern Taiwan. We enrolled a total of 14,974 patients who were diagnosed with cancer. Using the PRECEDE Model as a framework, we conducted logistic regression analysis to identify independent variables that are significantly associated with refusal of therapy in cancer patients. A multivariate logistic regression model was also applied to estimate adjusted the odds ratios (ORs) with 95% confidence intervals (95%CI). Results: A total of 253 patients (1.69%) refused treatment. The multivariate logistic regression result showed that the high risk factors for refusal of treatment in cancer patient included: concerns about adverse effects (p<0.001), poor performance(p<0.001), changes in medical condition (p<0.001), timing of case manager contact (p=.026), the methods by which case manager contact patients (p<0.001) and the frequency that case managers contact patients (${\geq}10times$) (p=0.016). Conclusions: Cancer patients who refuse treatment have poor survival. The present study provides evidence of factors that are related to refusal of therapy and might be helpful for further application and improvement of cancer care.