• Journal of Environmental Health Sciences
• /
• v.38 no.3
• /
• pp.184-194
• /
• 2012

Objectives: We investigated the effects of air pollution on allergic diseases (allergic rhinitis, asthma, atopic dermatitis) in metropolitan cities in Korea, adjusting for meteorological factors. Methods: Data on daily hospital visits and hospital admissions for 2003-2010 was obtained from the National Health Insurance Cooperation. Meteorological data was obtained from the Korea Meteorological Administration. We then calculated daily mean temperature, daily mean humidity, daily mean air pressure at sea level, and diurnal temperature range. We used data on air pollution provided by the National Institute of Environmental Research. Maximum daily eight-hour average ozone concentrations and the daily mean $PM_{10}$ were used. We estimated excess risk and 95% confidence interval for the increasing interquatile range (IQR) of each air pollutant using Generalized Additive Models (GAM) that appropriate for time series analysis. Results: In this study, we observed an association between ozone and hospital visits for allergic rhinitis, asthma, and atopic dermatitis in all metropolitan cities, adjusting for temperature, humidity, air pressure at sea level, diurnal temperature range, and day of the week. Ozone was associated with hospital visits for allergic rhinitis, asthma, and atopic dermatitis across all metropolitan cities. However $PM_{10}$ was associated with allergic-related diseases in only select cities. Also, ozone and $PM_{10}$ were associated with hospital admission for asthma in all cities except Gwangju. Hospitalization for the other diseases failed to show consistent association with air pollutants. Conclusion: In the findings of this study, there was a significant association between air pollutants and allergic-related diseases. More detailed research subdivided age group or conducting meta-analyses combining data of all cities is required.

• Korean Journal of Biological Psychiatry
• /
• v.24 no.3
• /
• pp.155-161
• /
• 2017

Objectives Decision-making in patients with schizophrenia has been known to be inefficient in both cognitive and affective aspects. The purpose of this study was to investigate the influence of anhedonia and self-esteem on the decision-making process in schizophrenia. Methods Twenty patients with schizophrenia and 21 healthy controls performed the 'apparel purchase decision-making task', during which they were asked to respond to the preference, fitness, and price suitability, before making the final purchase decision. Generalized estimating equation and correlation analysis were conducted to explore for the difference of decision making patterns and influential factors between the two groups. Results The patients showed lower odds ratio (OR) of the fitness on the apparel purchase decision than the controls [OR 0.190 ; 95% confidence interval (CI) 0.047-0.762, p = 0.019). In the patient group, there was no correlation between the number of purchased trials and the severity of anhedonia, but the number of purchased trials was negatively correlated with the Rosenberg Self-Esteem Scale score at a trend level (R = -0.436, p = 0.055). Conclusions Patients with schizophrenia considered the fitness of clothes less than healthy controls on apparel purchasing decisions. Schizophrenia patients with lower self-esteem were intended to buy more clothes.

• Journal of Preventive Medicine and Public Health
• /
• v.49 no.5
• /
• pp.260-274
• /
• 2016

Objectives: Previous epidemiological studies about oxidative stress and depression are limited by hospital-based case-control design, single-time measurements of oxidative stress biomarkers, and the small number of study participants. Therefore, in this study, we analyzed the association between biomarker of oxidative stress and depressive symptom scores using repeatedly measured panel data from a community-dwelling elderly population. Methods: From 2008 to 2010, a total of 478 elderly participants residing in Seoul, Korea, were evaluated three times. Participants underwent the Korean version of the Short Form Generic Depression Scale (SGDS-K) test for screening depression, and urinary malondialdehyde (MDA) levels were measured as an oxidative stress biomarker. We used a generalized estimating equation with a compound symmetry covariance structure to estimate the effects of oxidative stress on depressive symptom scores. Results: A two-fold increase in urinary MDA concentration was significantly associated with a 33.88% (95% confidence interval [CI], 21.59% to 47.42%) increase in total SGDS-K scores. In subgroup analyses by gender, a two-fold increase in urinary MDA concentration was significantly associated with increased SGDS-K scores in both men and women (men: 30.88%; 95% CI, 10.24% to 55.37%; women: 34.77%; 95% CI, 20.09% to 51.25%). In bivariate analysis after an SGDS-K score ${\geq}8$ was defined as depression, the third and the fourth urinary MDA quartiles showed a significantly increased odds ratio(OR) of depression compared to the lowest urinary MDA quartile (third quartile OR, 6.51; 95% CI, 1.77 to 24.00; fourth quartile OR, 7.11; 95% CI, 1.99 to 25.42). Conclusions: Our study suggests a significant association between oxidative stress and depressive symptoms in the elderly population.

• Journal of Korean Academy of Nursing
• /
• v.42 no.5
• /
• pp.719-729
• /
• 2012

Purpose: This study was done to examine relationships between nurse staffing level and postsurgical patient outcomes using inpatient database from the National Health Insurance. Methods: Records of 111,491 patients who received one of 12 types of surgery between January and December, 2009 were identified and analyzed in this study. Nurse staffing level was measured using adjusted nurse staffing grades from 0 to 7. Patient outcomes were defined as in-hospital mortality, or pneumonia, sepsis, or urinary tract infection after surgery. Logistic regression analyses estimated by Generalized Estimation Model, were used to analyze the association between nurse staffing level and patient outcomes. Results: An inverse relationship was found between nurse staffing and patient mortality. Compared with patients who were cared for in hospitals with the highest nurse staffing (Grades 0-1), increases in the odds of dying were found in those with Grades 6-7 [OR (odds ratio)=2.99, 95% CI (confidence interval)=1.94-4.60], those with Grades 4-5 (OR=1.78, 95% CI=1.24-2.57) and those with Grades 2-3 (OR=1.57, 95% CI=1.25-1.98). Lower nurse staffing level was also associated with higher number of cases in pneumonia and sepsis. Conclusion: Policies for providing adequate nurse staffing is required to enhance quality of care and lead to better perioperative patient outcomes.

• Health Policy and Management
• /
• v.27 no.3
• /
• pp.247-255
• /
• 2017

Background: South Korea has experienced problems with excessive pharmaceutical expenditures. In 2010, the South Korean government introduced an outpatient prescription incentive program to effectively manage pharmaceutical expenditures. Therefore, we examined the relationship between the outpatient prescription incentive program and pharmaceutical expenditures. Methods: We used data from the Korean National Health Insurance claims database, which included medical claims filed for 22,732 clinics from 2011-2014 to evaluate associated pharmaceutical expenditures. We performed multiple regression analysis and Poisson regression analysis using generalized estimating equation models to examine the associations between outpatient prescription incentives and the outcome variables. Results: The data used in this study consisted of 123,392 cases from 22,372 clinics (average 5.4 periods follow-up). Clinics that had received outpatient prescription incentives in the last period had better cost saving and Outpatient Prescribing Costliness Index (OPCI) (received: proportion of cost saving, ${\beta}=6.8179$; p-value < 0.0001; OPCI, ${\beta}=-0.0227$; p-value < 0.0001; reference = non-received). Moreover, these clinics had higher risk in the provision of outpatient prescription incentive (relative risk, 2.772; 95% confidence interval, 2.720 to 2.824). The associations were higher in clinics that had separate prescribing and dispensing programs, or had professional staff. Conclusion: The introduction of an outpatient prescription incentive program for clinics effectively managed problems with rapid increases of pharmaceutical expenditures in South Korea. However, the pharmaceutical expenditures still increased in spite of the positive impact of the outpatient prescription incentive program. Therefore, healthcare professionals and health policy makers should develop more effective alternatives (i.e., for clinics without separate prescribing and dispensing programs) based on our results.

• Safety and Health at Work
• /
• v.11 no.2
• /
• pp.235-240
• /
• 2020

Background: Cadmium exposure may induce chronic intoxication with renal damage. Silver soldering may be a source of cadmium exposure. Methods: We analyzed working environment measurement data and periodic health screening data from a small-scale silver soldering company with ten workers. Concentrations of cadmium in air from working environment measurement data were obtained. Concentrations of blood and urinary cadmium, urine protein, and urine β2-microglobulin (β2M) were obtained. The generalized linear model was used to identify the association between blood and urine cadmium and urine β2M concentrations. Clinical features of chronic cadmium intoxication focused with toxicological renal effects were described. Results: The mean duration of work was 8.5 years (standard deviation [SD] = 6.9, range = 3-20 years). Cadmium concentrations in air were ranged from 0.006 to 0.015 mg/㎥. Blood cadmium concentration was elevated in all ten workers, with a highest level of 34.6 ㎍/L (mean = 21.288 ㎍/L, SD = 11.304, range = 9.641-34.630 ㎍/L). Urinary cadmium concentration was elevated in nine workers, with a highest level of 62.9 ㎍/g Cr (mean = 22.151 ㎍/g creatinine, SD = 19.889, range = 3.228-62.971 ㎍/g creatinine). Urine β2M concentration was elevated in three workers. Urinary cadmium concentration was positively associated with urine protein concentration (beta coefficient = 10.27, 95% confidence interval = [4.36, 16.18]). Other clinical parameters were compatible with renal tubular damage. Conclusion: Cadmium intoxication may occur at quite low air concentrations. Exposure limit may be needed to be lowered.

• Journal of Environmental Health Sciences
• /
• v.40 no.5
• /
• pp.346-354
• /
• 2014

Objectives: Although a number of epidemiologic studies have examined the association between air pollution and mortality, data limitations have resulted in fewer studies of particulate matter with an aerodynamic diameter of ${\leq}2.5{\mu}m$ ($PM_{2.5}$). We conducted a time-series study of the acute effects of particulate matter with an aerodynamic diameter of ${\leq}10{\mu}m$($PM_{10}$) and $PM_{2.5}$ on the increased risk of death for all causes and cardiovascular mortality in Seoul, Korea from 2006 to 2010. Methods: We applied the generalized additive model (GAM) with penalized splines, adjusting for time, day of week, holiday, temperature, and relative humidity in order to investigate the association between risk of mortality and particulate matter. Results: We found that $PM_{10}$ and $PM_{2.5}$ were associated with an increased risk of mortality for all causes and of cardiovascular mortality in Seoul. A $10{\mu}g/m^3$ increase in the concentration of $PM_{10}$ corresponded to 0.44% (95% Confidence Interval [CI]: 0.25-0.63%), and 0.95% (95% CI: 0.16-1.73%) increase of all causes and of cardiovascular mortality. A $10{\mu}g/m^3$ increase in the concentration of $PM_{2.5}$ corresponded to 0.76% (95% CI: 0.40-1.12%), and 1.63% (95% CI: 0.89-2.37%) increase of all causes and cardiovascular mortality. Conclusion: We conclude that $PM_{10}$ and $PM_{2.5}$ have an adverse effect on population health and that this strengthens the rationale for further limiting levels of $PM_{10}$ and $PM_{2.5}$ in Seoul.

• Journal of Preventive Medicine and Public Health
• /
• v.39 no.1
• /
• pp.81-86
• /
• 2006

Background: A number of studies have reported associations between the ambient air pollution concentrations and various health outcomes. Especially, ozone is well known for primary risk factor of asthma attacks. The results of a recent study indicate that the size of the effect on health outcomes due to air pollution varied according to several conditions, including age, gender, race and the socioeconomic status. Therefore, this study was conducted to examine the associations of ozone with the childhood asthma hospitalizations as stratified by the socioeconomic status (SES) at the community level in Seoul, Korea, 2002. Methods: SES at aggregated levels was measured on the basis of average regional health-insurance rate per citizen in the area. We applied the generalized additive model to analyze the effect of ozone on asthma after controlling for the potential confounding variables that were capable of influencing the results. Results: Our analysis showed that the number of children who were hospitalized for asthma increased as the SES of the residence area decreased. The estimated relative risks of hospitalization for asthma, as stratified by the SES of the community level, were 1.12 (95% confidence interval 1.00-1.25) in districts with the highest SES levels, 1.24 (95% CI=1.08-1.43) within the moderate SES levels, and 1.32 (95% CI=1.11-1.58) in the districts with the lowest SES levels. Conclusions: Our analysis showed that exposure to air pollution did not equally affect the health status of individuals. This suggests that not only the biological-sensitivity markers, but also the SES of the subjects should be considered as potentially confounding factors.

• Health Policy and Management
• /
• v.28 no.1
• /
• pp.53-69
• /
• 2018

Background: This study investigates association modified category medical specialization (CMS) and hospital charge, length of stay (LOS), and mortality among lumbar spine disease inpatients. Methods: This study used National Health Insurance Service-cohort sample database from 2002 to 2013, using stratified representative sampling released by the National Health Insurance Service. A total of 56,622 samples were analyzed. The primary analysis was based on generalized estimating equation model accounting for correlation among individuals within each hospital. Results: Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had a shorter LOS (estimate, -1.700; 95% confidence interval [CI], -1.886 to -1.514; p<0.0001). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had a lower mortality rate (odds ratio, 0.635; 95% CI, 0.521 to 0.775; p<0.0001). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had higher hospital cost per case (estimate, 192,658 Korean won; 95% CI, 125,701 to 259,614; p<0.0001). However, inpatients admitted with lumbar spine surgery patients at hospitals with higher modified CMS had lower hospital cost per case (estimate, -152,060 Korean won; 95% CI, -287,236 to -16,884; p=0.028). Inpatients admitted with lumbar spine disease at hospitals with higher modified CMS had higher hospital cost per diem (estimate, 55,694 Korean won; 95% CI, 46,205 to 65,183; p<0.0001). Conclusion: Our results showed that increase in hospital specialization had a substantial effect on decrease in hospital cost per case, LOS, and mortality, and on increase in hospital cost per diem among lumbar spine disease surgery patients.

• Journal of Obesity & Metabolic Syndrome
• /
• v.27 no.4
• /
• pp.238-247
• /
• 2018

Background: We aimed to estimate the proportion of patients with diabetes who achieved target glycemic control, to estimate diabetes-related costs attributable to poor control, and to identify factors associated with them in the United Arab Emirates. Methods: This retrospective cohort study used administrative claims data handled by Abu Dhabi Health Authority (January 2010 to June 2012) to determine glycemic control and diabetes-related treatment costs. A total of 4,058 patients were matched using propensity scores to eliminate selection bias between patients with glycosylated hemoglobin (HbA1c) <7% and HbA1c ${\geq}7%$. Diabetes-related costs attributable to poor control were estimated using a recycled prediction method. Factors associated with glycemic control were investigated using logistic regression and factors associated with these costs were identified using a generalized linear model. Results: During the 1-year follow-up period, 46.6% of the patients achieved HbA1c <7%. Older age, female sex, better insurance coverage, non-use of insulin in the index diagnosis month, and non-use of antidiabetic medications during the follow-up period were significantly associated with improved glycemic control. The mean diabetes-related annual costs were $2,282 and $2,667 for patients with and without glycemic control, respectively, and the cost attributable to poor glycemic control was $172 (95% confidence interval [CI], $164-180). The diabetes-related costs were lower with mean HbA1c levels <7% (cost ratio, 0.94; 95% CI, 0.88-0.99). The costs were significantly higher in patients aged ${\geq}65$ years than those aged ${\leq}44$ years (cost ratio, 1.45; 95% CI, 1.25-1.70). Conclusion: More than 50% of patients with diabetes had poorly controlled HbA1c. Poor glycemic control may increase diabetes-related costs.