• Journal of Preventive Medicine and Public Health
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• v.40 no.1
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• pp.59-63
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• 2007

Objectives : Nitrogen dioxide $(NO_2)$ has been inconsistently associated with gradual decreases in lung function. Here, we studied the effects of $NO_2$ exposure in asthmatics by examining the association between changes in lung function and concentrations of $NO_2$ which were personally measured. Methods : Peak expiratory flow (PEF) and daily personal exposures to $NO_2$ were recorded on 28 patients with asthma (confirmed by methacholine provocation test) over 4 weeks. We used generalized estimating equations to assess the relationship between personal $NO_2$ exposure and PEF, adjusting for potential confounders such as age, gender, outdoor particulate matter, temperature, humidity, and exposure to environmental tobacco smoke. Results : The personal $NO_2$ exposures were higher than the corresponding ambient levels. The mean personal: ambient ratio for $NO_2$ was 1.48. The personal $NO_2$ exposures were not associated with the morning PEF, evening PEF, or the diurnal PEF variability. However, environmental tobacco smoke was negatively associated with both the morning and evening PEF. Conclusions : Among the asthmatic adults who participated in this study, we found no apparent impact of personal $NO_2$ exposures on the peak expiratory flow.

• The Journal of the Korea Contents Association
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• v.16 no.12
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• pp.480-491
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• 2016

This study aims to determine the factors associated with preparation for turnover in youth employees, using a data from the Youth Panel 2007-2013. Study population were composed by 17,037 employees and a generalized estimating equations (GEE) using panel logit model was performed. It was identified that socioeconomic(age, sex, level of education, monthly income and type of employment) and work-related factors(perception of difficulties in performing tasks compared to level of education, perception on the Job-Major match, stabilization of employment, autonomy and empowerment of jobs, peer relationship in workplace) were statistically significant variables. Based on the analysis, dissatisfaction on working environment or condition might lead to employees prepare to turnover and it is a series of activities that to improve welfare and find a suitable job for oneself.

• Journal of Korean Academy of Nursing
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• v.50 no.4
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• pp.631-640
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• 2020

Purpose: This study aimed to examine premenstrual symptoms (PMS) of shift nurses and identify the association between PMS, sleep, and occupational stress. Methods: This study was conducted with a secondary data analysis that used data from the Shift Work Nurse's Health and Turnover study. The participants were 258 nurses who were working in shifts including night shifts. PMS, sleep patterns (sleep time and sleep time variability), sleep quality, and the occupational stress of each participant were measured using the Moos Menstrual Distress Questionnaire, a sleep diary, an actigraph, the Insomnia Severity Index, and the Korean Occupational Stress Scale, respectively. Data were analyzed using SPSS 23 and STATA 15.1 to obtain descriptive statistics, Pearson's correlation coefficients, multiple linear regression with generalized estimating equations (GEE) and Baron and Kenny's mediating analysis. Results: The average PMS score, average sleep time, average sleep time variability, average sleep quality score, and average occupational stress score of the participants was 53.95 ± 40.45, 7.52 ± 0.89 hours, 32.84 ± 8.43%, 12.34 ± 5.95, and 49.89 ± 8.98, respectively. A multiple linear regression analysis with GEE indicated that sleep time variability (B = 0.86, p = .001), and sleep quality (B = 2.36, p < .001) had negative effects on nurses' PMS. We also found that sleep quality had a complete mediating effect in the relationship between occupational stress and PMS. Conclusion: These findings indicate that both sleep time variability and sleep quality are important factors associated with PMS among shift work nurses. To improve shift nurses' PMS status, strategies are urgently needed to decrease sleep time variability and increase sleep quality.

• Journal of Korean Clinical Nursing Research
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• v.28 no.1
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• pp.1-12
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• 2022

Purpose: The purpose of this study is to investigate the association between the nurse staffing level and the patient mortality using Korean National Health Insurance data. Methods: The data of 1,068,059 patients from 913 hospitals between 2015 and 2016 were analyzed. The nurse staffing level was categorized based on the bed-to-nurse ratio in general wards, intensive care units (ICUs), and hospitals overall. The x² test and generalized estimating equations (GEE) multilevel multivariate logistic regression analyses were used to explore in-hospital mortality and 30-day mortality after admission. Results: The in-hospital mortality rate was 2.9% and 30-day mortality after admission rate was 3.0%. Odd Ratios (ORs) for in-hospital mortality were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.72, 95% CI=0.63~0.84) and in ICUs with a bed-to-nurse ratio of less than 0.88 compared to that with 1.25 or more (OR=0.78, 95% CI=0.66~0.92). ORs for 30-day mortality after admission were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.83, 95% CI=0.73~0.94) and in ICUs with a bed-to-nurse ratio of less than 0.63 compared to that with 1.25 or more (OR=0.85, 95% CI=0.72~1.00). Conclusion: To reduce the patient mortality, it is necessary to ensure a sufficient number of nurses by improving the nursing fee system according to the nurse staffing level.

• Journal of agricultural medicine and community health
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• v.48 no.1
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• pp.13-27
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• 2023

Objectives: The purpose of this study is to investigate changes in public health-related perceptions of residents of Gangwon province after the outbreak of Coronavirus disease-19(COVID-19) of the public. Methods: We performed paired T-test analysis to measure the change in public health-related perceptions before and after COVID-19. We also utilized generalized estimating equations to identify demographic factors correlated with public health-related perceptions. Results: The public perceived public health as 'All citizens can use medical care and protect/promote health.' The concept was the most popular, from 94.3% in 2019 to 95.5% in 2020. In addition, after COVID-19, residents of Gangwon province's satisfaction with medical services increased, but the overall level was not high. Among the eight essential healthcare needs after COVID-19, cardiovascular disease and injury services have emerged as preferred services. However, by sociodemographic factors, distinctive responses were detected. Conclusions: Through COVID-19, Gangwon residents' awareness of the public's health rights has increased. Those living in vulnerable areas or with unmet medical care, supported strengthening public health care. In addition, although medical satisfaction has increased, it is not satisfied, so listening to the voices of the population group with low satisfaction is essential. Lastly, since the necessity of essential health care may change due to specific events, the local government needs to plan health projects reflecting the needs of residents. Therefore, when designing the public health care strategy in Gangwon province, the local government should consider not only political factors but also environmental factors, demographic and conceptual factors.

• Health Policy and Management
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• v.34 no.1
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• pp.38-47
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• 2024

Background: Korea's population of children and adolescents has decreased by 2.88 million over the past decade and is expected to decline further due to the unprecedented low birth rate. In the fee-for-service compensation system, the decline in the pediatric population relates directly to the profit decrease in the pediatric clinics. This study analyzed whether the worsening profits of pediatric clinics impacted their closure. Methods: We built annual data for pediatric and other department clinics (internal medicine, otolaryngology, and family medicine) using the status of medical institute and health insurance claims data from 2012 to 2022. Then, we analyzed whether institutional variables such as annual profit and regional variables (Herfindahl-Hirschman index, the number of clinics per 100,000, etc.) affected the closure of clinics. The methods used in this study are descriptive statistics and chi-square analysis. Odds ratios for each variable were estimated by generalized estimating equations (GEE). Results: The closure rate of pediatric clinics was 2.66%-7.04% in 2012-2022, which was consistently higher than those of internal medicine, otolaryngology, and family medicine clinics. The profit gap per institution between the pediatric and the other clinics grew from 126 million won in 2012 to 245 million won in 2019. In the GEE analysis, profit decrease compared to the previous year with lower profit was the main factor that increased the closure of pediatric and other department clinics. After adjusting profit-related variables, the decrease in the pediatric population itself did not relate to the closure of pediatric clinics. The number of pediatric clinics or monopolies also did not affect the closure of pediatric clinics. Conclusion: The worsening profit is the crucial factor for the closure of pediatric clinics, while the pediatric population is decreasing. For this reason, it is necessary to actively seek ways to maintain a stable treatment system for children and adolescents.

• Journal of Korea Water Resources Association
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• v.39 no.6 s.167
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• pp.533-544
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• 2006

The deposition of solids in combined sewer systems results in a loss of flow capacity that may restrict flow and cause a local flooding and enhanced solids deposition. In order to solve these problems and proper pipe management, estimation of solid loads from sewer and surface in a drainage basin is needed but this task is very difficult and extremely expensive. In this study, generalized procedures for estimating sewer solid loads during dry weather in combined sewer systems and for estimating solid loads on surface in a drainage basin developed by the U. S. Environmental Protection Agency were applied and analyzed in Gunja drainage basin in Korea. As result, the estimated solid loads from sewer and surface are 205.8,759kg/yr and 1,321,993kg/yr respectively, and total solid loads is 1,527,752kg/yr. The estimated solid removal from street cleaning, dredging from pipe system and pumping house is 1,486,636kg/yr. Therefore, the applied methods show resonable results. More reliable estimation can be achieved if long-term measurements and adjustment of estimation equations are carried out, and this estimation methods can be used usefully for the management of combined sewer system with reduction of cost and effort.

• Journal of Korea Water Resources Association
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• v.39 no.5 s.166
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• pp.405-415
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• 2006

The deposition of sewer solids during dry weather in combined sewer systems results in a loss of flow capacity that may restrict flow and cause a local flooding and enhanced solids deposition. Sewer solid accumulations in drainage systems also create the 'first-flush' phenomena during wet weather runoff periods. In order to solve these problems, measurement of these loadings for a given sewer system for extended period is needed but this task is very difficult and extremely expensive. In this study, generalized procedures for estimating sewer sediment solid during dry weather in combined sewer systems developed by the U. S. Environmental Protection Agency were applied in a drainage system in Korea. As result, the appropriate equation can be selected and applied according to the available data. However, the estimated solid sediment shows considerable difference between methods which classified by model and estimation methods of variable. The estimated values using equations (1) $\sim$ (4) are greater than that of equations (5) $\sim$ (9) and intermediate models show greater values than elaborate or simplest models. The comparison between simulated and measured solid deposition is difficult due to the absent of measurement data, but this estimation method can be used usefully for the management of sewer solid with reduction of cost and effort if the measurement is carried out and the equation is adjusted according to the actual drainage systems in Korea.

• Journal of Preventive Medicine and Public Health
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• v.37 no.4
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• pp.381-389
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• 2004

Objective : To compare the efficacy between SKI306X and Diclofenac by using generalized estimating equations (GEE) methodology in the analysis of correlated bivariate binary outcome data in Osteoarthritis (OA) diseases. Methods : A randomized, double-blind, active comparator-controlled, non-inferiority clinical trial was conducted at 5 institutions in Korea with the random assignment of 248 patients aged 35 to 75 years old with OA of the knee and clinical evidence of OA. Patients were enrolled in this study if they had at least moderate pain in the affected knee joint and a score larger than 35mm as assessed by VAS (Visual Analog Scale). The main exposure variable was treatment (SKI 306X vs. Diclofenac) and other covariates were age, sex, BMI, baseline VAS, center, operation history (Yes/No), NSAIDS (Y/N), acupuncture (Y/N), herbal medicine (Y/N), past history of musculoskeletal disease (Y/N), and previous therapy related with OA (Y/N). The main study outcome was the change of VAS pain scores from baseline to the 2nd and 4th weeks after treatment. Pain scores were obtained as baseline, 2nd and 4th weeks after treatment. We applied GEE approach with empirical covariance matrix and independent(or exchangeable) working correlation matrix to evaluate the relation of several risk factors to the change of VAS pain scores with correlated binary bivariate outcomes. Results : While baseline VAS, age, and acupuncture variables had protective effects for reducing the OA pain, its treatment (Joins/Diclofenac) was not statistically significant through GEE methodology (ITT:aOR=1.37, 95% CI=(0.8200, 2.26), PP:aOR=1.47, 95% CI=(0.73, 2.95)). The goodness-of-fit statistic for GEE (6.55, p=0.68) was computed to assess the adequacy of the fitted final model. Conclusions : Both ANCOVA and GEE methods yielded non statistical significance in the evaluation of non-inferiority of the efficacy between SKI306X and Diclofenac. While VAS outcome for each visit was applied in GEE, only VAS outcome for the fourth visit was applied in ANCOVA. So the GEE methodology is more accurate for the analysis of correlated outcomes.

• Korean Journal of Radiology
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• v.25 no.3
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• pp.267-276
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• 2024

Objective: To evaluate the diagnostic performance of susceptibility map-weighted imaging (SMwI) taken in different acquisition planes for discriminating patients with neurodegenerative parkinsonism from those without. Materials and Methods: This retrospective, observational, single-institution study enrolled consecutive patients who visited movement disorder clinics and underwent brain MRI and ¹⁸F-FP-CIT PET between September 2021 and December 2021. SMwI images were acquired in both the oblique (perpendicular to the midbrain) and the anterior commissure-posterior commissure (AC-PC) planes. Hyperintensity in the substantia nigra was determined by two neuroradiologists. ¹⁸F-FP-CIT PET was used as the reference standard. Inter-rater agreement was assessed using Cohen;s kappa coefficient. The diagnostic performance of SMwI in the two planes was analyzed separately for the right and left substantia nigra. Multivariable logistic regression analysis with generalized estimating equations was applied to compare the diagnostic performance of the two planes. Results: In total, 194 patients were included, of whom 105 and 103 had positive results on ¹⁸F-FP-CIT PET in the left and right substantia nigra, respectively. Good inter-rater agreement in the oblique (κ = 0.772/0.658 for left/right) and AC-PC planes (0.730/0.741 for left/right) was confirmed. The pooled sensitivities for two readers were 86.4% (178/206, left) and 83.3% (175/210, right) in the oblique plane and 87.4% (180/206, left) and 87.6% (184/210, right) in the AC-PC plane. The pooled specificities for two readers were 83.5% (152/182, left) and 82.0% (146/178, right) in the oblique plane, and 83.5% (152/182, left) and 86.0% (153/178, right) in the AC-PC plane. There were no significant differences in the diagnostic performance between the two planes (P > 0.05). Conclusion: There are no significant difference in the diagnostic performance of SMwI performed in the oblique and AC-PC plane in discriminating patients with parkinsonism from those without. This finding affirms that each institution may choose the imaging plane for SMwI according to their clinical settings.