• 보건행정학회지
• /
• 제14권2호
• /
• pp.1-16
• /
• 2004

The study purpose was to find which factors affect selection of hospital network types. This study used the 1998 American Hospital Association Annual Survey Database from Health Forum. Among these U.S. hospitals, the researcher selected hospitals located in Metropolitan Statistical Areas. Therefore the final observation cases for analysis are 1,971 Metropolitan Statistical Area hospitals in the United States. To identify significant variables influencing hospital network types, the study used proportional odds logistics regression model on population size, Health Maintenance Organization penetration rate, and market competition rate of area including a hospital, types of hospital ownership, hospital bed size, proportion of Medicare patients and Medicaid patients in total hospital patients, and occupancy rate. Contrary to conventional wisdom, selection of hospital network types was influenced by population size of area which a hospital located, types of ownership, hospital bed size, and proportion of medicare patients rather than Health Maintenance Organization penetration. Population size 1,000,000-2,499,999 had the highest probability of selecting type IV (clinical-vertical integration) from an independent hospital, and a religious group owned hospitals and for-profit owned hospitals had the highest probability of selecting Type IV (clinical-vertical integration) from an independent hospital. A bed size had positive relation on selecting Type IV (clinical-vertical integration) from an independent hospital. Unlikely general belief that the selecting types of hospital network was determined by the change of health insurance policy such as Health Maintenance Organizations and Preferred Provider Organizations, the types of hospital network were influenced by community characteristics such as population size, and hospital characteristics.

• Radiation Oncology Journal
• /
• 제37권1호
• /
• pp.13-21
• /
• 2019

Purpose: Glioblastoma (GBM) carries a high propensity for in-field failure despite trimodality management. Past studies have failed to show outcome improvements with dose-escalation. Herein, we examined trends and outcomes associated with dose-escalation for GBM. Materials and Methods: The National Cancer Database was queried for GBM patients who underwent surgical resection and external-beam radiation with chemotherapy. Patients were excluded if doses were less than 59.4 Gy; dose-escalation referred to doses ≥66 Gy. Odds ratios identified predictors of dose-escalation. Univariable and multivariable Cox regressions determined potential predictors of overall survival (OS). Propensity-adjusted multivariable analysis better accounted for indication biases. Results: Of 33,991 patients, 1,223 patients received dose-escalation. Median dose in the escalation group was 70 Gy (range, 66 to 89.4 Gy). The use of dose-escalation decreased from 8% in 2004 to 2% in 2014. Predictors of escalated dose were African American race, lower comorbidity score, treatment at community centers, decreased income, and more remote treatment year. Median OS was 16.2 months and 15.8 months for the standard and dose-escalated cohorts, respectively (p = 0.35). On multivariable analysis, age >60 years, higher comorbidity score, treatment at community centers, decreased education, lower income, government insurance, Caucasian race, male gender, and more remote year of treatment predicted for worse OS. On propensity-adjusted multivariable analysis, age >60 years, distance from center >12 miles, decreased education, government insurance, and male gender predicted for worse outcome. Conclusion: Dose-escalated radiotherapy for GBM has decreased over time across the United States, in concordance with guidelines and the available evidence. Similarly, this large study did not discern survival improvements with dose-escalation.

• 농촌의학ㆍ지역보건
• /
• 제49권2호
• /
• pp.102-110
• /
• 2024

Objective: This study evaluated the health behavior level of urological cancer survivors after surgery. Understand the experience of change and identify the factors that affect it for health. Selection of the best intervention steps and effective intervention adopt a lifestyle. It is intended to contribute to the creation of basic data for development of guidelines. Methods: The study was conducted with patients diagnosed with urological cancer at a hospital in Seoul. Study data were obtained by having 100 patients who agreed to the study self-fill out a questionnaire through interviews, and the 2018 World Cancer Research Fund and American Institute for Cancer Research Score (2018 WCRF/AICR SCORE) was used to estimate the level of health behavior. Results: The study examines health behavior among urolgical cancer survivors based on the 2018 WCRF/AICR SCORE. Higher household income and younger age were associated with better health behavior scores, with those under 60 and earning over 3 million won being more likely to have higher scores. Conclusion: Based on these results, this study requires comprehensive data collection considering the missing variables, suggesting that high household income and young age can positively affect healthy behavior. In addition, we conclude that education for cancer survivors and development of strategies to bridge the health gap for low-income and elderly populations are necessary.

• 유통과학연구
• /
• 제18권4호
• /
• pp.73-78
• /
• 2020

Purpose: This study was to examine public access defibrillator (PAD) deployment on some golf courses and to analyze automatic external defibrillators (AEDs) demand by appropriate distance. Research design, data, and methodology: We conducted telephone interview on 124 golf courses in Gyeonggi and Gangwon province in South Korea. The area within 3 minutes by 3 minutes for retrieval and 1 minute for shock and 1.5 minutes by the American Heart Association (AHA)recommendation for community AED placement were calculated as 3.14×162㎡ and 3.14×100㎡. Results: The average area was 1,811,481.8㎡, and 29 (42.7%) in below 999,999㎡, 75 (60.5%) in 1,000,000 to 1,999,999㎡, 12 (9.7%) in 2,000,000 to 2,999,999㎡ took up. The average retrieval time was 161.8 seconds, and 5 (4.1%) in below 90 seconds, 10 (8.0%) in 91 to 180 seconds took up a small part. AED demands according to 3 and 1.5 retrieval minutes were 2,602 and 6,986 respectively. Average AED demands per golf course were 21.0 and 56.3 respectively on 124 golf courses. Conclusions: The numbers of AED needed in South Korean golf course were 5,880 to 15,764. To ensure defibrillation on the golf courses, the supply and distribution of AEDs should be strengthened.

• 미술이론과 현장
• /
• 제9호
• /
• pp.7-31
• /
• 2010

In this paper, I examine the development of the second stage of Chicano muralism and compare it with the first stage of the Chicano Mural Movement that was born out of the Civil Rights Movement. I then discuss the different aspects of the first stage in relation to the birth of institutionalized public art and question how Chicano murals influenced public art and, conversely, how mainstream public art transformed some of the attitudes and practices of Chicano muralism. Chicano murals initially functioned as a political mouthpiece for Chicano's human rights and as a tool to recover the Chicano people's cultural pride and legacy. However, the murals gradually developed into public art projects supported by the city or federal governments, who regarded them as an economic way to effectively communicate with the community. In this process of institutionalization, muralists became increasingly concerned with aesthetic quality and began to work more systematically. For example, amateur artists or community participants who produced the earlier murals were transformed into mural experts. Chicano essentialism and the politically volatile themes used previously were phased out and the new murals began to incorporate diverse subjects and people, for example, native culture, Blacks, and women. This phenomenon reflected the changing emphasis on multicultural understanding. This kind of institutionalization did not always draw positive results. Inadequate funds were the primary concern over the actual subject and creation of the mural work. Artists reduced the strong political metaphors and aestheticized the mural forms. However, their work was productive as well: thorough research on wall conditions and painting techniques was conducted and new processes and designs were developed. This paper examines the murals created for the 1984 Los Angeles Olympic Games, Judy Baca's works, and the Balmy Alley Mural Environment project in San Francisco's Mission District. Works by Las Mujeres Muralistas in Mission District, in particular, show case colorful patterns and the Latin American indigenous culture, exploring new interpretations of old icons and design. They challenged the stereotypical depictions of females and presented alternative visual languages that revised the male-centered mural aesthetics and elaborated on the aesthetics of Rasquachismo.

• Journal of Preventive Medicine and Public Health
• /
• 제53권4호
• /
• pp.220-227
• /
• 2020

Objectives: The aim of this study was to assess how different social determinants of health (SDoH) may be related to variability in coronavirus disease 2019 (COVID-19) rates in cities and towns in Massachusetts (MA). Methods: Data about the total number of cases, tests, and rates of COVID-19 as of June 10, 2020 were obtained for cities and towns in MA. The data on COVID-19 were matched with data on various SDoH variables at the city and town level from the American Community Survey. These variables included information about income, poverty, employment, renting, and insurance coverage. We compared COVID-19 rates according to these SDoH variables. Results: There were clear gradients in the rates of COVID-19 according to SDoH variables. Communities with more poverty, lower income, lower insurance coverage, more unemployment, and a higher percentage of the workforce employed in essential services, including healthcare, had higher rates of COVID-19. Most of these differences were not accounted for by different rates of testing in these cities and towns. Conclusions: SDoH variables may explain some of the variability in the risk of COVID-19 across cities and towns in MA. Data about SDoH should be part of the standard surveillance for COVID-19. Efforts should be made to address social factors that may be putting communities at an elevated risk.

• Clinical and Experimental Pediatrics
• /
• 제56권1호
• /
• pp.1-7
• /
• 2013

School bullying has become a major social problem in Korea after the emergence of media reports on children who committed suicide after being victimized by bullies. In this article, we review the characteristics of bullying, and investigate the role of the pediatrician in the prevention of and intervention against bullying and school violence. Bullying can take on many forms such as physical threat, verbal humiliation, malicious rumors, and social ostracism. The prevalence of bullying in various countries is approximately 10% to 20%. In Korea, the prevalence of school violence is similar but seems to be more intense because of the highly competitive environment. From our review of literature, we found that children who were bullied had a significantly higher risk of developing psychosomatic and psychosocial problems such as headache, abdominal pain, anxiety, and depression than those who were not bullied. Hence, it is important for health practitioners to detect these signs in a child who was bullied by questioning and examining the child, and to determine whether bullying plays a contributing role when a child exhibits such signs. Pediatricians can play an important role in the prevention of or intervention against school violence along with school authorities, parents, and community leaders. Moreover, guidelines to prevent school violence, such as the Olweus Bullying Prevention Program, KiVa of the Finish Ministry of Education, and Connected Kids: Safe, Strong, Secure of the American Academy Pediatrics, should be implemented.

• 대한예방의학회:학술대회논문집
• /
• 대한예방의학회 1994년도 교수 연수회(역학)
• /
• pp.7-11
• /
• 1994

Twenty years ago, the American Journal of Epidemiology published David Sackett's brief description of. clinical epidemiology and its practitioners [1]. This commentary was a useful focal point for an emerging discipline. By 1983, with clinical epidemiology already thriving in many academic medical centres, Walter Holland called into question both the term, 'clinical epidemiology', and the nature of the discipline [2]. More recently, clinical epidemiology has drawn strong criticism from John Last, a noted academician whose contributions include the editorship of the Maxcy-Rosenau Textbook of Public Health. Writing in the Journal of Public Health Policy in 1988 [3], Last referred to the 'uncritical enthusiasm' for clinical epidemiology in medical schools as 'a danger to health', and staked. a claim to the term 'epidemiology' as appropriate only to the description of what classical or population epidemiologists do. Faced with such views, practitioners and proponents of clinical epidemiology can respond in three ways. They can ignore the criticism, and go on about their business. They can reaffirm their differences and resort to defensive rhetoric. Or, the critique can become an opportunity for reflection about the nature of clinical epidemiology and its relations with sister disciplines in modem medical schools. The latter course is followed here by four physicians who-despite diverse backgrounds and interests-all consider their work to be in the field of clinical epidemiology.

• Journal of Trauma and Injury
• /
• 제36권3호
• /
• pp.165-171
• /
• 2023

Trauma remains a significant healthcare burden, causing over five million yearly fatalities. Notably, the liver is a frequently injured solid organ in abdominal trauma, especially in patients under 40 years. It becomes even more critical given that uncontrolled hemorrhage linked to liver trauma can have mortality rates ranging from 10% to 50%. Liver injuries, mainly resulting from blunt trauma such as motor vehicle accidents, are traditionally classified using the American Association for the Surgery of Trauma grading scale. However, recent developments have introduced the World Society of Emergency Surgery classification, which considers the patient's physiological status. The diagnostic approach often involves multiphase computed tomography (CT). Still, newer methods like split-bolus single-pass CT and contrast-enhanced ultrasound (CEUS) aim to reduce radiation exposure. Concerning management, nonoperative strategies have emerged as the gold standard, especially for hemodynamically stable patients. Incorporating angiography with embolization has also been beneficial, with success rates reported between 80% and 97%. However, it is essential to identify the specific source of bleeding for effective embolization. Given the severity of liver trauma and its potential complications, innovations in diagnostic and therapeutic approaches have been pivotal. While CT remains a primary diagnostic tool, methods like CEUS offer safer alternatives. Moreover, nonoperative management, especially when combined with angiography and embolization, has demonstrated notable success. Still, the healthcare community must remain vigilant to complications and continuously seek improvements in trauma care.

• Tuberculosis and Respiratory Diseases
• /
• 제63권5호
• /
• pp.405-411
• /
• 2007

연구배경: 본 연구를 통해 2005년도 ATS/ERS 폐활량검사 지침에서 제시한 재현성 기준을 한국 성인들에게 적용할 수 있는 지와, 한국 성인들의 폐활량 검사 시 재현성에 영향을 미치는 요인들을 알아보고자 하였다. 방 법: 국민건강영양조사, COPD 코호트, 지역사회 코호트로부터 얻은 성인 4,663명의 폐활량검사 결과를 이용하여 dFVC 및 $dFEV_1$를 계산하여 분포를 알아보고, 1994년도 ATS 지침 및 2005년도 ATS/ERS 지침을 만족하는 검사의 비율을 비교하였다. 다중회귀분석을 통해 개인적 특성 및 재현성 기준의 변화가 재현성에 영향을 미치는가를 알아보았다. 결 과: 폐활량검사를 시행한 사람들 중 95% 이상이 150ml 이내의 재현성 기준을 만족시켰다. 1994년도 ATS 지침에 따라 검사를 시행한 경우 재현성을 만족하지 않는 경우가 증가하였다. 다중회귀분석 결과 재현성에 영향을 주는 요인들은 신장, 연령, 체중, 폐쇄성폐질환 여부, 재현성 기준의 변화 등이었으나 재현성에 영향을 미치는 정도는 매우 작았다(0.5~3.0%). 결 론: 한국인에게도 2005년도 ATS/ERS에서 제시한 재현성 기준을 적용할 수 있을 것으로 생각하며, 이를 위해서는 변경된 재현성 기준에 대한 지속적인 홍보와 검사자 들에 대한 교육 및 정도 관리가 필요하다.