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The Economic Costs of Newly Diagnosed Lyme Disease (Lyme질환의 경제적 비용분석)

  • Pauly, M. V.;;Madaglia, M.
    • Health Policy and Management
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    • v.4 no.2
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    • pp.126-147
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    • 1994
  • Lyme 질환은 미국 코넷티컷주의 라임지방에서 관절염증상을 보이는 소아과환자에게서 1975년 처음 발견되었다, 사슴, 누루, 개 등에 기생하는 진드기에 의해 전염되며, 발병초기에는 감기증상을 수반한 황소의 눈과 비슷한 붉은 반점이 생긴다. 적기에 치료하지 않으면, 관절염, 심장질환, 안면신경마비 등으로 악화될 수 있다. 본 논문의 목적은 두가지로 나누어 볼 수 있다. 먼저, 진단초기의 Lyme질환과 관련된 의료 및 기타 경제적 비용을 저렴하게 계측할 수 있는 방법론을 개발하고 그 유효성을 검증하는 것이다. 둘째로 lyme질환의 비용에 대한 여러종류의 총괄적 계측치를 제공하고 발병의 위험요인을 색출하는 것이다. 본 논문에서는 차트분석이나 임상연구 등 고가의 비용이 수반되는 분석기법 대신에 Lyme질환 다발지역에 대한 설문조사를 실시하고 그 유효성을 재설문조사를 통해서 검증하는 방법을 사용하였다. 자료분석상의 난점은 조사대상자마다 응답하지 않은 항목(Missing Value)이 다르기 때문에, 총 비용을 계산할 때 모든 항목에 응답한 조사대상자만을 사용한다면 표본의 크기가 너무 작아지는 것이었다. 이에 대한 대안으로 총비용 및 부분별 비용의 합을 계산할 때 표본의 일부가 응답하지 않은 항목에 대해서는 그 항목에 응답한 나머지 조사대상자의 응답치 평균을 대체하는 방법을 사용하였다. 통계적 분석결과, 질환의 증상시작부터 설문조사시기까지 Lyme질환과 관련된 사회적 총비용은 US$ 6400으로 추정되었다. 이중에 200가량은 환자의 보호자와 관련된 비용이고 나머지는 환자와 관련되 것이다. 총의료비용의 평균은 계산방법에 따라서 US$ 3000-4200의 범위를 보였다. 응답되지 않은 항목을 해당항목에 대한 응답치평균으로 대체하였을 때 총의료비평균은 US$ 4108이었다. 시간비용을 생산성손실에 대한 사회적 가치와 실제임금 손실의 두가지 방법에 의해 계산되었다. 실제임금손실은 생산손실의 사회적 가치의 약 30%에 불과하였다. 본 논문의 결과는 의료비용 및 비용과 생산성손실에 대한 정보가 지역보건담당자에 의한 전화설문조사에 의해 경제적이고도 일관성 있게 수집될 수 있다는 근거로 해석될 수 있다.

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Study on Effect of Skin Soothing by Helianthus annuus (Sunflower) Seed Oil (Helianthus annuus (Sunflower) Seed Oil 의 항염 및 피부 개선 효과 연구)

  • Jimin So;Gaewon Nam
    • Journal of the Society of Cosmetic Scientists of Korea
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    • v.49 no.4
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    • pp.331-339
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    • 2023
  • In this study, in vitro and clinical studies were conducted to assess the anti-inflammatory effects and skin improvement effects, including moisturizing, sebum secretion-regulating, skin barrier function enhancing, and soothing of Helianthus annuus (Sunflower) seed oil. In in vitro study using cultured human epidermal keratinocytes induced with inflammation by lipopolysaccharide, significant decreases in inflammatory cytokines interleukin-6, interleukin-8, and tumor necrosis factor alpha was revealed, indicating the anti-inflammatory effects of H. annuus (Sunflower) seed oil. Additionally, the results of clinical study on subjects with sensitive skin demonstrated improved skin hydration, regulation of sebum secretion, enhanced skin barrier function, as well as amelioration of skin redness and acne, indicating positive effects on overall skin conditions after application of H. annuus (Sunflower) seed oil containing test product for 4 weeks. Results of this study demonstrated the potential of H. annuus (Sunflower) seed oil as an ingredient for cosmetic, targeting consumers with sensitive skin.

Development of a Skin Index Using Skin Characteristic Factors and Skin Biomarkers of Korean Women According to H igh Temperature and Low Humidity Environments (고온건조 환경에 따른 한국 여성의 피부 특성인자와 피부 바이오 마커를 활용한 피부 지수 개발)

  • Jihye Maeng;Gaewon Nam
    • Journal of the Society of Cosmetic Scientists of Korea
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    • v.49 no.4
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    • pp.341-348
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    • 2023
  • In this study, basic skin characteristic data was measured by measuring skin hydration, skin sebum secretion rate, skin melanin index, skin redness index, skin redness image analysis, transepidermal water loss (TEWL), and amount of stratum corneum before and after creating a temporary high temperature and low humidity environments targeting Korean women in their 20s to 50s. Stratum corneum by tape stripping was collected at each measurement and skin biomarkers including total protein content, carbonylated protein, neutral lipid, and lipid peroxidation were analyzed. Based on the results, the differences before and after creating a high temperature and low humidity environments were confirmed, the correlation between skin characteristics and skin biomarkers was confirmed, and a new skin index was created based on this. The new skin index can be used in product efficacy evaluation, and the possibility of constructing a new clinical study method and using skin biomarker discovery research through additional research was confirmed.

An Analysis of the Locational Selection Factors of the Small- and Medium-sized Hospitals Using the AHP : Centered on the Spine and Joint Hospitals (AHP를 이용한 중·소 병원 입지선택요인 분석 : 척추·관절 병원중심으로)

  • Kim, Duck Ki;Shim, Gyo-Eon
    • The Journal of the Korea Contents Association
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    • v.18 no.5
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    • pp.191-214
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    • 2018
  • This research empirically analyzed the selection factors and the locational selection factors of the medical service facilities according to the gradual increase of the importance of the selection factors and the locational selection factors regarding the establishments of the small- and medium-sized hospitals according to the rapid changes of the socio-economic conditions. By analyzing the priority order according to the levels of the importance of each evaluation item factor through a research related to the selection factors and the locational selection factors of the small- and medium-sized hospitals and by drawing what the important factors that have the influences on the competitiveness of the pre-existent small- and medium-sized hospitals are through the classification of the real estate locational factors and the non-locational factors, the purpose lies in utilizing them as the basic data and materials for the opening strategies of the small- and medium-sized hospitals considering the special, locational characteristics according to the important factors of the selection factors of the small- and medium-sized hospitals, regarding the medical suppliers that have been preparing, for opening the new, small- and medium-sized hospitals. Based on the results of the preceding researches and the researches on the case examples, 28 evaluation factors were arrived at in terms of the level of the medical treatment, the medical services, the accessibilities of the hospitals, the conveniences of the hospitals, and the physical environment. And, regarding the 28 detailed evaluation factors that had been collected, through the interviews with the related experts, the 5 factors of the medical level, the medical service, the expertise of the hospital, the convenience of the hospital, and the physical environment were selected as the upper class evaluation factors. And, according to each upper class, a total of 28 low-part evaluation factors were selected. Regarding the optimal evaluation factors that were selected, the optimal locational factors were selected by carrying out an AHP questionnaire survey investigation with 200 medical experts as the subjects. Regarding the AHP analysis results, similarly with the case examples of the precedent researches, the levels of the importance appeared in the order of the medical level, the medical services, the accessibility of the hospital, the physical environment, and the convenience. And the factors that were related to the facilities of a hospital appeared low. The results of this research can be applied in providing the basis for the decision-makings regarding the selections of the locations of the small- and medium-sized hospitals in the future.

Prophylactic Cranial Irradiation for Acute Lymphoblastic Leukemia in Childhood (소아 급성 림프모구성 백혈병의 예방적 전뇌 방사선조사)

  • Kim, In-Ah;Choi, Ihl-Bhong;Kang, Ki-Mun;Shinn, Kyung-Sub;Kim, Hack-Ki
    • Radiation Oncology Journal
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    • v.14 no.2
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    • pp.137-147
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    • 1996
  • Purpose : This report is the result f retrospective analysis for children who received prophylactic cranial irradiation combined with intrathecal chemotherapy. Materials and Methods : Ninety children with ALL who had got bone marrow remission after induction chemotherapy received PCI. All but 3 children were treated with a dose of 1800 cGy as a standard regimen. While the PCI was given, all patients received intrathecal chemotherapy. Results : Nine of 90 patients experienced CNS relapse during the duration of follow-up ranged from 36 to 96 months (median 60 months). Three children experienced BM relapse prior to CNS relapse. Therefore, CNS relapse rate as the first adverse event was $6.7\%$. Median time interval of CNS relapse was 16 months from the first day of hematologic complete remission. Eighty-nine percent of patients who had CNS relapse were associated with hematologic relapse. and $78\%$ of CNS relpase occurred during maintenance chemotherapy (on-therapy relapse). The CNS RFS at 2 and 5 years are $68\%$ and $42\%$, respectively with median of 43 months. The Prognostic factors affecting CNS RFS are initial WBC count (cut-off point of 50,000/ul), FAB subtype and CALGB risk criteria. The DFS at 2 and 5 years are 61 and $39\%$, respectively with median of 34 months. The prognostic factors affecting DFS are initial WBC count (cut-off point of 50,000/ul), FAB subtype, POG and CALGB risk criteria. Conclusions : In our study, $6.7\%$ of CNS relapse rate as a first adverse event was comparable with other studies. Various risk criteria was based on age at diagnosis and initial WBC count such as POG and CALGB criteria, had prognostic significance for CNS RFS and DFS. Prospective randomized trial according to prognostic subgroup based on risk criteria and systematic study about neuropsychologic function for long term survivors, are essential to determine the most effective and least toxic form of CNS prophylaxis.

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Tuberculin Reactivity in Neonates Vaccinated with BCG at Primary Care Clinics - With Two Types of BCG Vaccine and Two Strengths of PPD - (개원가의 신생아 BCG 접종 후 투베르쿨린 반응 평가 -접종 방법과 PPD 종류에 의한 차이 비교-)

  • Kim, Wan Ju;Lee, Sun Ho;Ahn, Sang Yoon;Yang, Seung Jae;Oh, Sung Hee
    • Pediatric Infection and Vaccine
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    • v.9 no.2
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    • pp.208-214
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    • 2002
  • Purpose : The number of newborns vaccinated with BCG of Tokyo 172 strain, which has been claimed to cause lesser degree of local adverse events including scar, has recently been increasing. However, tuberculin response to this vaccine has inadequately been studied, especially with newborns cared at primary care clinics. We, therefore, performed a study in newborns vaccinated with BCG at private pediatric offices and evaluated the response to PPD 2TU or PPD 5TU following vaccination with percutaneous or intradermal BCG. Methods : Two hundred infants who had been cared at three private pediatric offices were retrospectively enrolled in the study. One hundred fifty one infants had received percutaneous BCG(Tokyo strain); 129 infants had had tuberuclin test with PPD 2TU and the rest of 22 infants with PPD 5TU. Forty nine infants had received intradermal BCG(28 infants Copenhagen strain, I infant French strain, 20 infants unknown); 35 infants had had tuberculin test with PPD 2TU, 14 infants(11%) with PPD 5TU. Results : In infants vaccinated with percutaneous BCG, the mean induration diameter in tuberculin test was significantly greater with PPD 5TU($12.4{\pm}3.5mm$) compared to PPD 2TU ($9.2{\pm}4.4mm$). In infants vaccinated with intradermal BCG, the mean induration diameters in tuberculin test were $5.7{\pm}5.1mm$ to PPD 2TU and $6.6{\pm}4.8mm$ to PPD 5TU, which were not significantly different. The tuberculin response to PPD 2TU was significantly greater in infants vaccinated with percutaneous BCG compared to those with intradermal BCG. The tuberculin response to PPD 5TU was also significantly greater in infants vaccinated with percutaneous BCG compared to those with intradermal BCG. Conclusion : Percutaneous BCG(Tokyo strain) seems to cause greater response to tuberculin compared to intradermal BCG and PPD 2TU induces weaker response compared to PPD 5TU. Acknowledging some discrepancies from the previously reported data, which might have been due to the different source of the study subjects, more studies are needed to establish the range of tuberculin response following BCG vaccination in order to differentiate from tuberculosis.

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Influential Job-Related Characteristics for the Job Satisfaction and Turnover Possibility of Dental Hygienists (치과위생사의 직무만족과 이직가능성에 영향을 미치는 직무관련특성 요인)

  • Lee, Chun-Sun;Park, So-Yong;Park, Hye-Min;You, Youn;Shin, Eun-Kyung;Chae, Song-I;Han, Seong-Ok;Oh, Hye-Young
    • Journal of dental hygiene science
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    • v.12 no.6
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    • pp.666-674
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    • 2012
  • The purpose of this study was to examine the job-related characteristics of dental hygienists affecting their job satisfaction and turnover possibility. The subjects in this study were 297 dental hygienists who worked in dental hospitals and clinics in the metropolitan area. The dental hygienists who worked for three to less than five years, who were unmarried and who didn't benefit from any incentive systems expressed a greater satisfaction, and those who were married, whose workplaces were established jointly with other dental institutions in the form of a network and whose workplaces offered incentives were more likely to change their employment. As for influential factors for job satisfaction and turnover possibility, the respondents whose workplaces were established jointly with other dental institutions were less satisfied, and a larger number of patients and better communication led to higher satisfaction. Those who worked in general hospitals were more likely to change their employment, and better welfare benefits, more appropriate length of working hours and a larger number of patients led to lower turnover responsibility. The findings of the study ascertained that working environments were one of the factors to impact on job satisfaction and turnover possibility, and both of hospitals and dental hygienists should make an effort to improve working environments.

Impact of a 'Proactive Self-Audit Program of Fraudulent Claims' on Healthcare Providers' Claims Patterns: Intravenous Injections (KK020) (부당청구 예방형 자율점검제가 의료기관의 청구행태에 미치는 영향: 정맥 내 일시주사(KK020)를 중심으로)

  • Hee-Hwa Lee;Young-Joo Won;Kwang-Soo Lee;Ki-Bong Yoo
    • Health Policy and Management
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    • v.34 no.2
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    • pp.163-177
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    • 2024
  • Background: This study aims to examine changes in fraudulent claim counts and total reimbursements before and after enhancements in counterfeit claim controls and monitoring of provider claim patterns under the "Proactive self-audit pilot program of fraudulent claims." Methods: This study used the claims data and hospital information (July 2021-February 2022) of the Health Insurance Review and Assessment Service. The data was collected from 1,129 hospitals assigned to the pilot program, selected from the providers who filed a claim for reimbursement for intravenous injections. Paired and independent t-tests, along with regression analysis, were utilized to analyze changing patterns and factors influencing claim behaviors. Results: This program led to a reduction in the number of fraudulent claims and the total amount of reimbursements across all levels of hospitals in the experimental groups (except for physicians below 40 years old). In the control group, general hospitals and hospitals demonstrated some significant decreases based on the duration since opening, while clinics showed significant reductions in specified subjects. Additionally, a notable increase was observed among male physicians over the age of 50 years. Overall, claims and reimbursements significantly declined after the intervention. Furthermore, a positive correlation was found between hospital opening duration and claim numbers, suggesting longer-established hospitals were more likely to file claims. Conclusion: The results indicate that the pilot program successfully encouraged providers to autonomously minimize fraudulent claims. Therefore, it is advised to extend further support, including promotional activities, training, seminars, and continuous monitoring, to nonparticipating hospitals to facilitate independent improvements in their claim practices.

Agents Used for Pediatric Dental Sedation (소아치과 진정법에 사용되는 약제)

  • Kim, Jiyeon;Jeong, Taesung;Yang, Yeonmi;Yoo, Seunghoon;Choi, Sungchul;Shin, Teojeon
    • Journal of the korean academy of Pediatric Dentistry
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    • v.43 no.1
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    • pp.109-116
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    • 2016
  • Sedation is an indispensable part of contemporary pediatric dentistry. The Korean Academy of Pediatric Dentistry (KAPD) organized the dental sedation committee to help members perform safer and more effective sedation. The committee surveyed 111 members who practice dental sedation to figure out the present state of sedation in 2014. According to the survey, 86% of the respondents indicated that they were interested in continuing education of sedation. The most interesting topic was sedation related emergency management, followed by safe dosages of sedative drugs. However, it is not realistic to establish the recommended dosages as a guideline since the selection of agents and dosages depend on various factors. In order to provide successful sedation, pediatric dentist should make an individual sedation plan for each procedure. It is important to understand not only the properties of each sedative, but also interactions with other drugs. This article reviews useful information of commonly used agents for dental sedation and summarizes the recommended dosages from the Physicians' Desk Reference (PDR) and some famous pediatric dentistry textbooks.

An Interpretation of a Social Implication on the Transition of the Urban Park in Daegu (대구 도시공원의 변천에 나타난 사회적 의미 해석)

  • Lee, Jung-Youn;Jung, Tae-Yeol
    • Journal of the Korean Institute of Landscape Architecture
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    • v.41 no.3
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    • pp.72-82
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    • 2013
  • This study was done for analyzing processes on the planning and opening of chronological urban parks in Daegu City since the 1960s, and for interpreting the social meaning on changes of the urban parks with regards to historical circumstances during that period. In the 1960s, urban parks, which were recognized as one of urban planning facilities, were only designated for creating rather than created, although nationally several laws including urban planning act and park act were newly legislated. Rapid urbanization and increasing population in the 1970s led to create many urban parks. However, the policy for increasing parks had been not successful because of the lack of enough funds. In the 1980s, multi-purpose urban parks including stable area as well as active facilities were created for getting several attractions to urban residents. During this period, urban parks were recognized on an aesthetic perspective through vegetating plans on the city-beautiful movement for hosting consecutive international games. The citizen participation in urban parks and the increasing concern about urban environment were started in the 1990s, and the people living in an urban area were interested in the quantitative expansion and qualified renovation of the urban parks as well. Finally, modernistic urban parks were first introduced in the late period of Chosun Dynasty, however their substantial introduction was done in the 1960s. Through this study, the concept of an urban park as a public resting place for citizen in Daegu was thought to be mostly established in the 1990s as we have investigated on the social meaning derived from the periodical changes of urban parks.