• Health Policy and Management
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• v.25 no.3
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• pp.197-206
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• 2015

Background: The purpose of this study was to propose a method for developing a measure of hospital-wide all-cause risk-standardized readmissions using administrative claims data in Korea and to discuss further considerations in the refinement and implementation of the readmission measure. Methods: By adapting the methodology of the United States Center for Medicare & Medicaid Services for creating a 30-day readmission measure, we developed a 6-step approach for generating a comparable measure using Korean datasets. Using the 2010 Korean National Health Insurance (NHI) claims data as the development dataset, hierarchical regression models were fitted to calculate a hospital-wide all-cause risk-standardized readmission measure. Six regression models were fitted to calculate the readmission rates of six clinical condition groups, respectively and a single, weighted, overall readmission rate was calculated from the readmission rates of these subgroups. Lastly, the case mix differences among hospitals were risk-adjusted using patient-level comorbidity variables. The model was validated using the 2009 NHI claims data as the validation dataset. Results: The unadjusted, hospital-wide all-cause readmission rate was 13.37%, and the adjusted risk-standardized rate was 10.90%, varying by hospital type. The highest risk-standardized readmission rate was in hospitals (11.43%), followed by general hospitals (9.40%) and tertiary hospitals (7.04%). Conclusion: The newly developed, hospital-wide all-cause readmission measure can be used in quality and performance evaluations of hospitals in Korea. Needed are further methodological refinements of the readmission measures and also strategies to implement the measure as a hospital performance indicator.

• Korean Journal of Pharmacognosy
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• v.48 no.3
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• pp.237-242
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• 2017

In this study, to investigate of safety for Benzo(a)pyrene in medicinal herb, 8 kinds of selected commercial herbal medicines (Rehmanniae Radix, Rehmanniae Radix Preparata, Amomi Tsao-Ko Fructus, Cimicifugae Rhizoma, Cyperi Rhizoma, Magnoliae Cortex, Scutellariae Radix, Scrophulariae Radix) were analysed using the high performance liquid chromatography with fluorescence detector and assessed the health risk. The levels of benzo(a)pyrene were from non-detection to $28.1{\mu}g/kg$, and the average was $3.6{\mu}g/kg$. Based on a nationwide survey of the consumption of medicinal herb by the Korean population, we estimated the potential risk from the ingestion of benzo(a)pyrene. The estimated daily intake of benzo(a)pyrene was 1.6 ng/kg b.w./day for group only know the daily average intake of medicinal herb. The MOE (margin of exposure) of benzo(a)pyrene for estimate of health risk was $1.93{\times}10^5$. Therefore, health risk from benzo(a)pyrene through intake of herbal medicine was considered negligible.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.22 no.3
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• pp.235-243
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• 2012

Objectives: The purpose of this study is the work environment management method through risk assessment and investigation of the work place that deals with Ammonium nitrate, based on information in and outside the country. Methods: This study suggests method of work environment management through risk assessment and investigation of the work place that deals with Ammonium nitrate, and finds out cases of Ammonium nitrate causing hazard, danger and health risk, based on literature investigation. Results: Rats exposed repeatedly to $LD_{50}$ 2,217 mg/kg(rat), $LC_{50}$ 88.8 mg/L(rat, skin) which cause high level of skin irritation, reported 1 $mg/m^3$ of NOAEL, while LOAEL was less than 100 mg/kg for the rats orally administered with the $LD_{50}$ 2,217 mg/kg(rat), $LC_{50}$ 88.8 mg/L(rat, skin), for 13 weeks. Domestically 31,640 ton/y of ammonium nitrate has been used in 22 workplace and the result of workplace assessment was 0.0171-0.9983 $mg/m^3$. ADD was 8.77-59.63 ${\mu}g/kg-day$ according to the exposure scenario. In other words the result of the risk assessment goes beyond the 'standard 1'. Conclusions: Ammonium nitrate creates a high level of irritation and toxicity when coming in breathe it or contact with skin, and is classified as category3 of GHS and specific target organ toxicant (irritating respiratory system). Exposure level at work places needs to be maintained under $1mg/m^3$, to prevent workers from being damaged.

• Environmental Analysis Health and Toxicology
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• v.12 no.3_4
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• pp.31-41
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• 1997

Public concerns about hazardous health effect from the exposure to organic by-products of the chlorination have been increased. There are numerous studies reporting that chlorination of drinking water produces numerous chlorinated organic by-products including THMs, HAAs, HANs. Some of these products are known to be animal carcinogens. The purpose of this study was to estimate health risk of DBPs by chlorinated drinking water ingestion in Seoul based on methodologies that have been developed for conducting risk assessment of complex-chemical-mixture. The drinking water sample was collected seperately at six water treatment plant in Seoul at March, April, 1996. In tap water of households in Seoul, DBPs were measured wilfh the mean value of 36.6 $\mu$g/L. Risk assessment processes,. which include processes for the estimation of human cancer potency using animal bioassay data and calculation of human exposure, entail uncertainties. In the exposure assessment process, exposure scenarios with various assumptions could affect the exposure amount and excess cancer risk. The reference dose of haloacetonitriles was estimated to be 0.0023 mg/kg/day by applying dibromoacetonitrile NOAEL and uncertainty factor to the mean concentration. In the first case, human excess cancer risk was estimated by the US EPA method used to set the MCL (maximum contaminant level). In the second and third case, the risk was estimated for multi-route exposure with and without adopting Monte-Carlo simulation, respectively. In the second case, exposure input parameters and cancer potencies used probability distributions, and in the third case, those values used point estimates (mean, and maximum or 95% upper-bound value). As a result, while the excess cancer risk estimated by US EPA method considering only direct ingestion tended to be underestimated, the risk which was estimated by considering multi-route exposure without Monte-Carlo simulation and then using the maximum or 95% upper-bound value as input parameters tended to be overestimated. In risk assessment for Trihalomethanes, considering multi-route exposure with adopting Monte-Carlo analysis seems to provide the most reasonable estimations.

• Health Policy and Management
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• v.31 no.4
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• pp.451-461
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• 2021

Background: Readmissions related to lack of quality care harm both patients and health insurance finances. If the factors affecting readmission are identified, the readmission can be managed by controlling those factors. This paper aims to identify factors that affect readmissions of convalescent rehabilitation patients. Methods: Health Insurance Review and Assessment Service claims data were used to identify readmissions of convalescent patients who were admitted in hospitals and long-term care hospitals nationwide in 2018. Based on prior research, the socio-demographics, clinical, medical institution, and staffing levels characteristics were included in the research model as independent variables. Readmissions for convalescent rehabilitation treatment within 30 days after discharge were analyzed using logistic regression and generalization estimation equation. Results: The average readmission rate of the study subjects was 24.4%, and the risk of readmission decreases as age, length of stay, and the number of patients per physical therapist increase. In the patient group, the risk of readmission is lower in the spinal cord injury group and the musculoskeletal system group than in the brain injury group. The risk of readmission increases as the severity of patients and the number of patients per rehabilitation medicine specialist increases. Besides, the readmission risk is higher in men than women and long-term care hospitals than hospitals. Conclusion: "Reducing the readmission rate" is consistent with the ultimate goal of the convalescent rehabilitation system. Thus, it is necessary to prepare a mechanism for policy management of readmission.

• Analytical Science and Technology
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• v.13 no.6
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• pp.1089-1096
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• 2000

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.25 no.4
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• pp.482-492
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• 2015

Objectives: Exposure Assessment for workplace hazards where the exposure level is below occupational exposure limits(OELs) has been performed without considering either the degrees of risk or exposure levels and has failed to lead to intervention in many cases. The objective of this study was to suggest and test an application framework for risk assessment methodology under the current exposure assessment system in Korea. Materials: First, we investigated the exposure assessment systems in Korea and other countries. To adopt some risk assessment techniques, we also analyzed risk assessment systems and compared them to exposure assessment systems. A few suggestions were made. We held a public hearing during an industrial hygiene conference and took surveys using a questionnaire. Results: The first suggestion was to implement the risk assessment and exposure assessment through a "one-stop" system. In that case, one expected question would be who has been doing the jobs so far. In most cases, industrial hygiene consulting services or laboratories have been performing exposure assessment for business owners. Business owners are required to perform risk assessment. As two different groups of people will be required to implement two things in a one-stop system, they need to share information. As an information vehicle to share information, commonly filed survey checklists were suggested. The second suggestion was to categorize exposure level into four groups instead of the current binary divisions based on OELs. In the risk assessment system, exposure level is divided into four groups utilizing the cut-points of 10%, 50%, and 100% of OELs. The same schema can be adopted in the exposure assessment system and different levels of requirements can be assigned for each group. The third suggestion was regarding the regulation system. To provide the suggestions some thrust toward being implemented in the field, changes should be made in the legal system. Two different types of new exposure assessment result reporting forms were suggested. Some investigations such as an ergonomic survey are officially accepted as risk assessment under the current legal system. A few items were suggested to be included in the exposure assessment result reporting to be accepted as risk assessment. A pilot study in two small factories was performed and pointed out the strengths and weakness of our suggestions. Conclusions: Discussions and studies on the improvement of the exposure assessment system have been held for decades and no tangible changes have yet been made. We hope this result can help realize healthy lives for workers in Korea.

• The Korean Journal of Food And Nutrition
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• v.18 no.4
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• pp.357-366
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• 2005

Elder people in Korea was affecting the nutritional status by following factors : low energy intakes, low food diversity, and poor quality of nutrition. Management a nutrition education program was planned to change the elder's nutrition knowledge and improve their nutritional status. There are seven kinds of indicator - knowledge for health questionnaire (before and after education) - we have investigated elderly nutrition education group in Su-Jung ku, Sung-Nam city. The items of surveyed was general characteristics and anthropometric measurement of the elder people, their mini dietary assessment index score, nutritional risk, nutrition knowledge test, and it's valuation comparisons between the before and after every education we did. According to the results of mini dietary assessment index score, the mean was 22.7 at the maximum 30 points and $94.2\%$ of respondents got more than nomal group. The nutritional risk score was the highest in 'high risk' group. Also the results of nutrition knowlede test showed that the mean increase $35.1\%$ of respondents. Therefore, significant improvement results showed by nutrition education programs in elders. These results suggests that the educating nutrition programs fur elder's encouraging eating behavior themselves and changing their knowledge in nutrition.

• Safety and Health at Work
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• v.12 no.2
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• pp.174-183
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• 2021

Background: Toluene diisocyanate (TDI) is a highly reactive chemical that causes sensitization and has also been associated with increased lung cancer. A risk assessment was conducted based on occupational epidemiologic estimates for several health outcomes. Methods: Exposure and outcome details were extracted from published studies and a NIOSH Health Hazard Evaluation for new onset asthma, pulmonary function measurements, symptom prevalence, and mortality from lung cancer and respiratory disease. Summary exposure-response estimates were calculated taking into account relative precision and possible survivor selection effects. Attributable incidence of sensitization was estimated as were annual proportional losses of pulmonary function. Excess lifetime risks and benchmark doses were calculated. Results: Respiratory outcomes exhibited strong survivor bias. Asthma/sensitization exposure response decreased with increasing facility-average TDI air concentration as did TDI-associated pulmonary impairment. In a mortality cohort where mean employment duration was less than 1 year, survivor bias pre-empted estimation of lung cancer and respiratory disease exposure response. Conclusion: Controlling for survivor bias and assuming a linear dose-response with facility-average TDI concentrations, excess lifetime risks exceeding one per thousand occurred at about 2 ppt TDI for sensitization and respiratory impairment. Under alternate assumptions regarding stationary and cumulative effects, one per thousand excess risks were estimated at TDI concentrations of 10 - 30 ppt. The unexplained reported excess mortality from lung cancer and other lung diseases, if attributable to TDI or associated emissions, could represent a lifetime risk comparable to that of sensitization.

• Journal of agricultural medicine and community health
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• v.44 no.3
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• pp.138-143
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• 2019

Objectives: The purpose of this study was to assess the ergonomic risk factors in beekeeping, and to evaluate the effectiveness of assistive device hive lift. Methods: This study included 30 subjects of beekeeper in Pocheon, Korea. We assessed the ergonomic risk of main task in beekeeping with NLE, OWAS and evaluate the effectiveness of hive lift. We also surveyed prevalence of musculoskeletal symptoms among the subjects based on the Korea Working Condition Survey. Results: Moving to different floral origin, internal inspection of beehives, feeding syrup is the most burdensome to musculoskeletal system (NLE LI value=2~3. OWAS action category=4). The prevalence of musculoskeletal symptoms (lower and upper extremities) among the subjects was over 80 %. The introduction of assistive devices in the three hazardous tasks has dramatically reduced the risk by removing manual lifting hives (OWAS action category<1). Conclusions: Beekeeping is a heavy workload on the musculoskeletal system because it has a lot of manual lifting task. As a result of applying the hive lift, the burden could be reduced.