• Nutrition Research and Practice
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• 제14권6호
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• pp.621-636
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• 2020

BACKGROUND/OBJECTIVES: The Seoul Metabolic Syndrome Management (SMESY) program is a 1-yr lifestyle modification program targeting metabolic syndrome (MetS) in Seoul residents. This study investigated the associations between adherence to dietary guidelines and MetS among the SMESY program participants. SUBJECTS/METHODS: Data of 54,385 participants aged 20-64 yrs who completed the SMESY program in 2015, had information on adherence to dietary guidelines, and were not medicated for diabetes, hypertension, or dyslipidemia were analyzed. Participants underwent MetS screening and completed a lifestyle questionnaire including adherence to 10 dietary guidelines before and after participation. Participants were classified according to the number of MetS risk factors at baseline (MetS group, ≥ 3; risk group, 1-2; healthy group, none). Adherence to dietary guidelines was determined from the number of "yes" responses regarding the fulfillment of each guideline on ≥ 5 days/week. Multiple logistic regression was used to evaluate associations between newly diagnosed MetS and changes in adherence to dietary guidelines. RESULTS: In the MetS group, MetS prevalence decreased after the SMESY program (men, -41.9%p; women, -48.7%p), and all risk factors were significantly improved (P < 0.0001). All groups exhibited improved adherence to all dietary guidelines after participation (P < 0.0001). In the MetS group with positively changed adherence scores, the MetS prevalence decreased by -44.1%p for men and -49.5%p for women, whereas the prevalence in those with negative changes decreased by -38.1%p for men and -48.6%p for women. In the risk group, those with positively changed adherence scores had significantly decreased odds ratios (ORs) for newly diagnosed MetS compared with those with negative changes (OR, 0.70; 95% confidence interval [CI], 0.61-0.80 for men; OR, 0.88; 95% CI, 0.79-0.99 for women). CONCLUSIONS: The SMESY program may effectively reduce the risk of MetS among adults with risk factors by improving adherence to dietary guidelines.

• 보건교육건강증진학회지
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• 제30권4호
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• pp.41-56
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• 2013

Objectives: This article reviewed researches on intersectoral partnership of school health programs to suggest importance, current status and development plan of those. Methods: Domestic research papers were screened though Research Information Sharing Service (RISS), Koreanstudies Information Service System (KISS), Medical Library Information System (MEDLIS), Korean Medical Database (KMbase), and digital national assembly library. International papers were searched mainly via Pubmed. Results: Since intersectoral partnership is effective, comprehensive and universal approach for school health programs, many collaborative programs are universally progressing in various domain including smoking, alcohol, mental health and sexual behavior. On the other hand, intersectoral partnership of school health programs in Korea is still in the beginning stage, and there are few intersectoral partnerships. Moreover, there are several limitations including top-down approach, passive participation and lack of studies on the effect of intersectoral partnership. However, intersectoral partnerships in school health program including tuberculosis control system in school or WEE project are in progress, so it is worth looking forward in the future. Conclusions: To achieve successful intersectoral partnership in school health programs, appropriate partnership guideline for Korean society, policy support, active participation and improvement of consciousness in community stakeholders are needed.

• 한국학교보건학회지
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• 제28권2호
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• pp.67-78
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• 2015

The purpose of the study was to present a model of WHO Health Promoting School easily applicable to small-sized schools in rural areas. Methods: The study analyzed data of 11 small-sized schools in rural areas selected from 85 health promoting schools, an initiative led by the Ministry of Education from 2012 to 2014. Results: Through the analysis, the study found out the operation process of health promoting schools consists of five stages: system development, needs survey & survey on current status, school health policy development, program development & execution, and evaluation. In addition, the study was able to discover three key factors in operating health promoting schools: connection with curriculum, connection with community, and consensus among members. While it turned out the schools were following operation manuals faithfully, the biggest problem with operation was that the stages of needs survey, priority setting, and core task development were not closely coordinated. Conclusion: Although the model suggested in the study fails to reflect the characteristics of small-sized schools in rural areas, it is close to a universal model which could serve as a guideline when regular schools adopt the system of health promoting schools.

• 의료법학
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• 제9권2호
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• pp.181-207
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• 2008

With recent emphasis on evidence based medicine, clinical practice guidelines are seen as a potential mechanism by which unify various managerial and professional approaches to improving the quality of care. The development process of guidelines has been the subject of much research. and it is need translating the medical evidence of research into a clinical practice guidelines. the gathered evidence needs to be interpreted into a clinical, public health, policy, or payment context. The term 'clinical practice guidelines' can evoke a diverse range of responses from healthcare personnel. Clinical practice guidelines are increasingly used in patient management but some clinicians are not familiar with their origin or appropriate applications. Understanding the limitations as well as benefits of CPG could enable clinicians to have clearer view of the place of guidelines in every practice. In the context of increasing complaints and litigation in healthcare, the legal implications of clinical practice guidelines are of increasing importance. Clinical practice guidelines could, in theory, influence the manner in which the courts establish negligence by suggesting the doctor breached the duty of care by failing to provide the required standard of medical care. In several studies, the CPGs were relevent to and played a pivotal role in the proof of negligence. Much depends on the quality of guidelines and the tools developed and the authoritativeness of a guideline. Recently, there are several opinions the court also should review the validity and reliability of expert testimony including medical evidence. and widespread use of guidelines in malpractice lawsuit could lead the physicians to greater compliance with guidelines in the long term. In conclusion, Health care reformers, physicians as well as guidelines developers should understand that guidelines have both medical and legal aspects as a double-edges sword. so clinicians, legal representatives and decision-makers should not defer unduly to guidelines.

• 한국의료질향상학회지
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• 제9권1호
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• pp.52-64
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• 2002

Background : Coding of principal diagnosis is essential component for producing reliable health statistics. We performed this study to evaluate the current practice of principal diagnoses determination and coding, and to give some basic data to improve coding of principal diagnosis. Method : Nineteen medical record administrators (MRAs) of 3 university hospitals participated in coding principal Dx. from August 1, 2001 to August 31, 2001. From each hospital, 10 medical records of patients with high frequency disease were selected randomly. Each 10 medical records were grouped into three (A. B, C). Then, these 30 medical records were given to each MRAs for coding. At the same time questionnaire was given to each of them. Questions were to prove how they decide and code the principal diagnosis among many current diagnoses; how they decide and code the principal diagnosis when they see irrelevant diagnosis recorded as the principal diagnosis in medical record, when only tentative diagnoses were recorded without final diagnosis, and when different diagnoses were recorded in different sheets of same record. Agreement of coding among 3 hospitals were compared and survey results were analysed with SAS 6.12. Results : Agreement of coding was found in medical records 5-6 of each 10 medical records. Causes of disagreement were as follows. Difference of clinician's opinion from each hospital; mixed use of guideline from KCD-3 and guideline from DRG; difference in 4th digit classification according to the absence of pathology report in the medical record; difference of abbreviations among hospitals. 57.9% of MRAs selected the principal diagnosis recorded by physician, 42.1% of MRAs decided principal diagnosis after consulting to KCD-3 guideline. When there were difficulties in determining the principal diagnosis, 42.1% of MRAs decided principal diagnosis after discussion with the physician, 26.3% after discussion with fellow MRAs. Conclusion : There were differences in codings among hospitals. To minimize the difference, we suggest the development of disease-specific guidelines for coding in addition to the current general guideline such as KCD-3. To do this, Coding Clinic which can produce guidelines is needed.

• 보건교육건강증진학회지
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• 제33권4호
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• pp.55-65
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• 2016

Objectives: Members of Korean Healthy Cities Partnership(KHCP) has increased rapidly since 2006 and adopted Active Living Environments(ALE) as common theme in 2015. Academic definition and categorization, needs assessment and operational planning for making active living environments were required from KHCP. Methods: Literatures review, survey to members of KHCP, specialist discussion and consultation with members of KHCP have been done from October of 2015 to February of 2016. Results: ALE included humane(social networks), physical and political resources. Three categories and 13 items for ALE were identified. Present actions among member cities were variable and especially immature in physical environments. Indicators for ALE were not secured stably. Requirements for policy and physical environmental approach and adolescent programme were high. Priority areas for education and technical assistance were master planning, guideline and case, program and policy development, partnership development, and networking among cities. Representative projects among member cities were somewhat different from ideal models. Conclusions: Policy and environmental approaches needs to be reinforeced systemically for members of KHCP including securing stable indicators. More education and technical assistance also needed sustainably.

• 여성건강간호학회지
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• 제20권4호
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• pp.287-296
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• 2014

Purpose: The purpose of this study was to analyze the quality of reports on observational studies published in the Korean Journal of Women Health Nursing (KJWHN). Methods: Forty-six studies using cross-sectional designs published in KJWHN from January 2011 to June 2013 were selected for analysis. Selected articles were reviewed and evaluated by three reviewers using the 22 items of the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. As some of 22 items had more than one check point, further broken down, 34 checklist items were used for analysis. Results: Overall, the reviewed studies provided sufficient descriptions for many STROBE items. Seven of the 34 items were found to be not applicable, and 15 of the remaining 27 items (55.5%) were evaluated as 'sufficient' in reporting. Only one study included a flow diagram illustrating participation and this lack of flow diagram was the weakest area of reporting in this review. Conclusion: Clearer reporting of cross-sectional studies can be attained by attention to vulnerable areas of reporting, such as including a flow diagram of participants, descriptions of sources of bias and reason for non-participation, and describing limitations of the study. Issues regarding the application of STROBE statement items should be actively discussed in order to aid future revision and clarification of items included in STROBE statement.

• 보건교육건강증진학회지
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• 제33권4호
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• pp.47-54
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• 2016

Objectives: The prevalence of insufficient physical activity is relatively high in the Republic of Korea and it is increasing. The national strategies to improve physical activity are essential and are suggested in this paper. Methods: National level of physical activity is compared globally by WHO statistics. Korean National Health and Nutrition Survey showed the level of physical activity. National strategies to improve physical activity were suggested referring to the other countries' strategies, public health books and Health Plan 2020. Results: Prevalence of insufficient aerobic exercise in 2010 were 33.4%, 94.8% in over and 18 years old, 11~17 years old, respectively. And it is increasing. Sufficient exercise to fit the national guidelines of physical activity were done by 15.6% of Korean older and 19 years old. Prevalence of insufficient physical activity was high in the elderly, female, adolescent, rural area and lower income. The national spread of the physical activity guidelines, primary care physicians involvement, supports for the physical activity programs, development of the evaluation protocol for the programs and environmental supports are suggested. Conclusions: The government induced various efforts to improve the level of physical activity is needed urgently.

• 보건행정학회지
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• 제25권4호
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• pp.323-332
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• 2015

Background: Antibiotic resistance has been becoming serious challenge to human beings. Overuse of antibiotics, especially, for infants is concerned, but studies are very few for the prescribing pattern of antibiotic use for infants. This study analyzes prescribing patterns of antibiotics in outpatients of preschool children with acute respiratory tract infections in South Korea. Methods: Data are used from 2011 Health Insurance Review & Assessment Services-pediatric patients sample. Inclusion criteria is outpatient children (0 to 5 years) with top five frequent diseases. Prescription rates are analyzed by types of disease, provider, specialty, region, and ages. Binary or multinomial logit models are used to analyze determinants of providers' prescription pattern. Results: The main findings are as follows. First, distributions of prescription rates are shown as L-shape or M-shape depending on the types of disease. Second, the prescription variation is so large among providers, where providers are polarized as a group with low prescription rates and the other group with high prescription rates, though the shapes are shown diversified across types of disease. Third, prescription rates appear to be lower in pediatrics and higher in ENT (ear-nose-throat). Fourth, broad spectrum antibiotics are widely used among children. Finally, the logit analysis shows similar results with descriptive statistics, but partly different results across types of disease. Conclusion: Antibiotics for respiratory tract infections of infants are used excessively with a large variation among providers, and especially broad spectrum antibiotics are used. The prescription guideline for antibiotics should be provided for each specific disease to reduce antibiotic resistance in the future.

• 보건행정학회지
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• 제28권2호
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• pp.145-150
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• 2018

Background: The aim of this study was to investigate the current state of the assistive devices and appliances provision system for cerebral palsy patients registered with brain disability. Methods: From 2003 to 2013, we analyzed the records of cerebral palsy patients who had assistive devices and appliances provisioned at least once in their lives based on National Health Information Database. Patients with cerebral palsy were divided into three groups: infants and toddlers, school age and adolescence, and adults. Results: Data on short leg plastic orthoses, ankle joint orthoses, and wheelchair were mainly analyzed. The types of ankle joint orthoses divided into three categories: limited, $90^{\circ}$ limited, and Klenzac. Limited ankle joint orthoses was most frequently supported of the three in all age groups. Powered wheelchair and scooter were most supported to adult patients. When the re-supply duration was evaluated, the duration was suitable to the duration on guideline of regulation of re-supplement according to the related laws in adult patients but not in infants/toddlers and school age/adolescence as the actual re-supplement duration was much shorter than the reference value. Conclusion: This study confirmed the pattern of assistive devices and appliances supply differed depending on the age of cerebral palsy patients.