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Cost-Benefit Analysis of Back School Program for Occupational Low Back Pain Patients (직업성 요통환자에서 재활 프로그램(Back School Program) 도입의 비용-편익분석)

  • Ju, Yeong-Su;Ha, Mi-Na;Han, Sang-Hwan;Kwon, Ho-Jang;Cho, Soo-Hun;Kim, Chang-Yup;Kim, Sun-Min
    • Journal of Preventive Medicine and Public Health
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    • v.29 no.2 s.53
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    • pp.347-357
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    • 1996
  • Although occupational low back pain accounts for $20\sim40%$ of all occupational illness and injury, there are limited numbers of studies regarding the effectiveness of back school program. The objective of this study was to evaluate the economic benefit of back school program for early return to work of occupational low back pain patients in the current occupational injury compensation and management system. The cost-benefit analysis in this study was conducted to evaluate the relative magnitude of benefit to cost. The total cost was estimated by calculating the value of components in back school program according to governmental budget protocol. The back school program was consisted of three major approaches, pain center, work-hardening program and funcional restoration program and each of components had various facilities and experts. The total amount of cost was estimated as 250,866,220 won per year. The most promising type of back school program were quite intensive (a 3 to 5-week stay in a specialized center), therefore, if we adopted the 5-week stay course, 10 courses could be held in a year. Following to the medical act, 20 patients per doctor could participate in a each course, ie, total 200 patients in a year. As a result, we could estimate the cost of 1,254,331 won a patient. We estimated the benefit by using data of a few local labor offices about average medical treatment beneficiary and off-duty beneficiary of 46 occupational low back pain patients in 1994. Ullman and Larsson (1977) mentioned that the group of chronic low back pain patients who participated in back school program needed less time to recover by 48.4% of beneficiary duration. And in the trying to estimate the benefit, we asked 10 rehabilitation board certificate doctors about reduction proportion of treatment cost by introducing back school program. The answered reduction proportions were in the range of $30\sim45%$, average 39%. As a final result, we could see that the introduction of back school program in treatment of chronic occupational low back pain patients could produce the benefit to cost ratio as 3.90 and 6.28. And we could conclude that the introduction of back school program was beneficial to current occupational injury compensation and management system.

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Census Population vs. Registration Population: Which Population Denominator Should be used to Calculate Geographical Mortality (센서스인구 대 주민등록인구: 지역별 사망률 연구에서 어느 인구를 분모로 사용하여야 하나?)

  • Hwang, In-A;Yun, Sung-Cheol;Lee, Moo-Song;Lee, Sang-Il;Jo, Min-Woo;Lee, Min-Jung;Khang, Young-Ho
    • Journal of Preventive Medicine and Public Health
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    • v.38 no.2
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    • pp.147-153
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    • 2005
  • Objectives: Studies on the geographical differences in mortality tend to use a census population, rather than a registration population, as the denominator of mortality rates in South Korea. However, an administratively determined registration population would be the logical denominator, as the geographical areas for death certificates (numerator) have been determined by the administratively registered residence of the deceased, rather than the actual residence at the time of death. The purpose of this study was to examine the differences in the total number of a district population, and the associated district-specific mortality indicators, when two different measures as a population denominator (census and registration) were used. Methods: Population denominators were obtained from census and registration population data, and the numbers of deaths (numerators) were calculated from raw death certificate data. Sex- and 5-year age-specific numbers for the populations and deaths were used to compute sex- and age-standardized mortality rates (by direct standardization methods) and standardized mortality ratios (by indirect standardization methods). Bland-Altman tests were used to compare district populations and district-specific mortality indicators according to the two different population denominators. Results : In 1995, 9 of 232 (3.9%) districts were not included in the 95% confidence interval (CI) of the population differences. A total of 8 (3.4%) among 234 districts had large differences between their census and registration populations in 2000, which exceeded the 95% CI of the population differences. Most districts (13 of 17) exceeding the 95% CI were rural. The results of the sex- and age-standardized mortality rates showed 15 (6.5%) and 16 (6.8%) districts in 1995 and 2000, respectively, were not included in the 95% CI of the differences in their rates. In addition, the differences in the standardized mortality ratios using the two different population denominators were significantly greater among 14 districts in 1995 and 11 districts in 2002 than the 95% CI. Geographical variations in the mortality indicators, using a registration population, were greater than when using a census population. Conclusion: The use of census population denominators may provide biased geographical mortality indicators. The geographical mortality rates when using registration population denominators are logical, but do not necessarily represent the exact mortality rate of a certain district. The removal of districts with large differences between their census and registration populations or associated mortality indicators should be considered to monitor geographical mortality rates in South Korea.

Study on international accreditation for residue analysis laboratory (잔류물질분석의 국제공인시험기관 인정 관련 고찰)

  • Kim, MeeKyung;cho, Byung-Hoon;Kim, Dong-Gyu;Yun, Seon Jong;Lim, Chae-Mi;Park, Su-Jeong;Kim, Heuijin;Kim, Yeon Hee;Kim, Soo-Yeon;Yun, So Mi;Kwon, Jin-Wook;Son, Seong-Wan;Chung, Gab-Soo;Lee, Joo-Ho;Kang, Mun-Il
    • Korean Journal of Veterinary Research
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    • v.46 no.4
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    • pp.295-304
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    • 2006
  • Residual materials such as veterinary drugs, environmental contaminants, and pesticides are affecting food safety. High resolution techniques and quality controls are needed to analyze these materials from part per million to part per trillion quantities in food. In order to achieve quality results, standardized methods and techniques are required. Our laboratories were prepared to obtain a certificate of accreditation for ISO/IEC 17025 in the analytical criteria of animal drugs, dioxins, pesticides, and heavy metals. ISO together with IEC has built a strategic partnership with the World Trade Organization with the common goal of promoting a free and fair global trading system. ISO collaborates with the United Nations Organization and its specialized agencies and commissions, particularly those involved in the harmonization of regulations and public policies including the World Health Organization and CODEX Alimentarius for food safety measurement, management and traceability. Our goal was to have high quality analysts, proper analytical methods, good laboratory facilities, and safety systems within guidelines of ISO/IEC 17025. All staff members took requirement exams. We applied proficiency tests in the analysis of veterinary drugs (nitrofuran metabolites, sulfonamide and tetracyclines), dioxins, organophosphorus pesticides, and heavy metals (Cd, Pb, As) to the Food Analysis Performance Assessment Scheme (FAPAS) at Central Science Laboratory, Department for Environment Food and Rural Affairs (DEFRA), England. The results were very satisfactory. All documents were prepared, including system management, laboratory management, standard operational procedures for testing, reporting, and more. The criteria encompassed the requirements of ISO/IEC 17025:1999. Finally, the Korea Laboratory Accreditation Scheme (KOLAS) accredited our testing laboratories in accordance with the provisions of Article 23 of the National Standards Act. The accreditation will give us the benefit of becoming a regional reference laboratory in Asia.

Cigarette Smoking and Gastric Cancer Risk in a Community-based Cohort Study in Korea (흡연과 위암 발생의 관련성에 관한 지역사회 기반의 코호트 연구)

  • Kim, Yeon-Ju;Shin, Ae-Sun;Gwack, Jin;Jun, Jae-Kwan;Park, Sue-Kyung;Kang, Dae-Hee;Shin, Hai-Rim;Chang, Soung-Hoon;Yoo, Keun-Young
    • Journal of Preventive Medicine and Public Health
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    • v.40 no.6
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    • pp.467-474
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    • 2007
  • Objectives : Gastric cancer is the most common incident cancer in Korea. Although Helicobacter pylori infection is the most important risk factor for the development of gastric cancer, cigarette smoking has also been suggested to play an important role in the development of gastric cancer. The objective of this study is to evaluate the relationship between cigarette smoking and gastric cancer risk in a Korean population. Methods : The study population consisted of 13,785 subjects who had been enrolled in the Korean Multi-Center Career Cohort between 1993 and 2002. As of December 2002, 139 incident gastric cancer cases were ascertained through the Korea Central Cancer Registry and the National Death Certificate Database. Relative risks (RR) and 95% confidence intervals (CI) for gastric cancer were estimated using Cox#s proportional hazard model adjusted for age, education, alcohol drinking status and history of gastritis or ulcer. Results : Significant dose-response relationships were observed between the duration of smoking and the risk of gastric cancer among the male subjects in comparison to non-smokers: men who smoked for 20-39 years had a 2.09-fold (95% CI 1.00-4.38) increase, and those who smoked for more than 40 years had a 3.13-fold (95% CI 1.59-6.17) increase in the risk of gastric cancer ($P_{trend}<0.01$). Conclusions : This study suggests that a longer duration of cigarette smoking may increase the risk of gastric cancer development in a dose-response manner in Korean men. The association between smoking and gastric cancer risk in women should be verified in future studies with a larger number of cases.

A Study on a Secure Internet Service Provider Model Using Smart Secure-Pad (스마트 보안패드를 이용한 안전한 인터넷 서비스 제공 모델에 관한 연구)

  • Lee, Jae-Sik;Kim, Hyung-Joo;Jun, Moon-Seog
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.14 no.3
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    • pp.1428-1438
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    • 2013
  • Services take place in Internet environment, a formation of the trust relationship between user and service provider for services. Different authentication schemes such as using Certificate of Public Key Infrastructure authentication and using ID/PW for a simple user authentication have been proposed for trust relationship. In addition, in the case of electronic financial transactions, transaction integrity and non-repudiation features are provided. These services are provided in Internet environment, use various measures to ensure service safety. However, it was difficult to prevent attacks using existing security technology because of emergence of MITB attack that manipulate the memory area of the Web browser and social engineering attacks such as phishing/pharming, requires application of new security technologies became. In this paper, we propose a concept of smart secure-pad, and utilize it safely formed a trust relationship between user and service provider, a model has been proposed to ensure safety of data transmission. Proposed model's security evaluation results show security against to MITB attack and phishing/pharming that can't be prevent attack using existing security technology. In addition, service provider can easily apply the model in safe environment can provide Internet service using provided representative services applying the proposed model.

Consurmer's Recognition for the Label System and Policy of Environment-Friendly Agricultural Products (친환경 농산물의 인증제도 및 정책에 대한 소비자 인지도 조사연구)

  • Sin, Chul-Ro;Kim, Jin-Suk
    • Journal of agriculture & life science
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    • v.43 no.3
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    • pp.63-75
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    • 2009
  • The purpose of this study is to find out suggestions for government policy and expansion of consumption of environmental-friendly agricultural products(EFAP). For this purpose, we did research on purchasing pattern of EFAP and understanding of government environmental-friendly agricultural policy. First, the purchase of EFAP has been increased, because EFAP is safer. Consumers prefer department store because it is easier than any other marketing. Difficulties which consumers are facing when they purchase EFAP are price and credibility and small number of stores. Most favorable item is vegetable and the price of rice which consumers are willing to pay is really high. Second, not many consumers do recognize the label and system of EFAP. Third, most famous authentication institution agricultural products quality management service and other institutions are not recognized. Consumers recognize the certificate of origin. The government policy for safe food consumption is to intensify government supervision on foods. Suggestions from these results are as follow: First, the urgent problem to expand consumption of EFAP is credibility of EFAP. To make consumers trust EFAP, these are considered as useful solutions, i.e. recall, quality management service, standardization, and better quality. Second, government should be continue public relation, education and supervision of EFAP. Third, quality management should be continued. Not only central government but also local quality management institutions should continue quality management service. Last, local government should help farmers of EFAP to solve the difficulties of marketing.

A Study on Suitable Site for Day Nursery in Tae-gu (대구의 보육시설 현황과 입지선정)

  • Bae, Sook-Hee
    • Journal of the Korean association of regional geographers
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    • v.2 no.1
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    • pp.25-38
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    • 1996
  • As the proportion of women's participation in economic activities is rising, the increase of husband and wife both working and nuclear families makes children up-bringing a social problem. But many families have difficulties by the shortage of day nurseries which can solve it. As we can see in the research, the most urgent problem is the extension of nurseries in quantity. In Taegu, since it became a wide-area city, there are 473 nurseries. But in the respect of distribution, only less than 10% of Dongs have more than 7 nurseries and more than 90% of Dongs have less than 7 nurseries. Consequently nurseries are extremely insufficient. Moreover 29 Dongs don't have any nurseries at all and they take 18.6% of Dongs. The second problem is the unbalanced distribution of nurseries. West and north ward which are industrial complex and swarmed with low-income families, and Tal-sung county which is recently included in the wide-area city keenly need the establishment of nurseries. Besides, Bi-san 1 Dong and Non-gong which have only $1{\sim}2$ nurseries though they have high proportion of children and women who can be pregnant are also the areas which take precedence of nursery establishment. The third problem is that government support must be increased in the areas which have many small, petty and profit-making private nurseries so that good quality teachers can make breeding activities in nice facilities and environment. In materials which are obtained by the interviews with publich servants in charge of family welfare in some ward offices. Young and unexperienced persons who aquired certificate of qualification take day-nursery permits and run nurseries only a few months. and if the profits are insufficient, they sell the nurseries for premiums to third persons who are not qualified. Then the third managers only think of profits without thought of good quality childcare. As the result, the nurseries become asylums not nurseries. That is why the conditions of nursery establishment must be restricted to suitable scale and experienced persons. The fourth problem is that the nurseries in work places are extremely insufficient. The women who have jobs have many things to do before they go to work such as preparing meals and leaving children in the care of someone. Hence the childcare problem of working women must be solved. In nuclear families, childcare is the most serious problem for working women. The fifth one is the reduction of childcare expenses. Women must sacrifice themselves a lot to make social activities. To say nothing of physical and mental burden, they have to spend much of their salaries on childcare. And yet they don't take the benefit of good quality childcare. For the participation of women in public affairs, society must support the childcare problem to have then be devoted to their jobs without worries about their children. Therefore Taegu wide-area city must select west, north ward which are industrial complex and the low-income swarmed area before everything and establish many national, public and corporate nurseries which cost less expenses.

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A Study on Aviation Safety and Third Country Operator of EU Regulation in light of the Convention on international Civil Aviation (시카고협약체계에서의 EU의 항공법규체계 연구 - TCO 규정을 중심으로 -)

  • Lee, Koo-Hee
    • The Korean Journal of Air & Space Law and Policy
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    • v.29 no.1
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    • pp.67-95
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    • 2014
  • Some Contracting States of the Chicago Convention issue FAOC(Foreign Air Operator Certificate) and conduct various safety assessments for the safety of the foreign operators which operate to their state. These FAOC and safety audits on the foreign operators are being expanded to other parts of the world. While this trend is the strengthening measure of aviation safety resulting in the reduction of aircraft accident. FAOC also burdens the other contracting States to the Chicago Convention due to additional requirements and late permission. EASA(European Aviation Safety Agency) is a body governed by European Basic Regulation. EASA was set up in 2003 and conduct specific regulatory and executive tasks in the field of civil aviation safety and environmental protection. EASA's mission is to promote the highest common standards of safety and environmental protection in civil aviation. The task of the EASA has been expanded from airworthiness to air operations and currently includes the rulemaking and standardization of airworthiness, air crew, air operations, TCO, ATM/ANS safety oversight, aerodromes, etc. According to Implementing Rule, Commission Regulation(EU) No 452/2014, EASA has the mandate to issue safety authorizations to commercial air carriers from outside the EU as from 26 May 2014. Third country operators (TCO) flying to any of the 28 EU Member States and/or to 4 EFTA States (Iceland, Norway, Liechtenstein, Switzerland) must apply to EASA for a so called TCO authorization. EASA will only take over the safety-related part of foreign operator assessment. Operating permits will continue to be issued by the national authorities. A 30-month transition period ensures smooth implementation without interrupting international air operations of foreign air carriers to the EU/EASA. Operators who are currently flying to Europe can continue to do so, but must submit an application for a TCO authorization before 26 November 2014. After the transition period, which lasts until 26 November 2016, a valid TCO authorization will be a mandatory prerequisite, in the absence of which an operating permit cannot be issued by a Member State. The European TCO authorization regime does not differentiate between scheduled and non-scheduled commercial air transport operations in principle. All TCO with commercial air transport need to apply for a TCO authorization. Operators with a potential need of operating to the EU at some time in the near future are advised to apply for a TCO authorization in due course, even when the date of operations is unknown. For all the issue mentioned above, I have studied the function of EASA and EU Regulation including TCO Implementing Rule newly introduced, and suggested some proposals. I hope that this paper is 1) to help preparation of TCO authorization, 2) to help understanding about the international issue, 3) to help the improvement of korean aviation regulations and government organizations, 4) to help compliance with international standards and to contribute to the promotion of aviation safety, in addition.

Concerning the Constitution Court's constitutional decision and the direction of supplemental legislation concerning Article 33 paragraph 8 of the Medical Service Act - With a focus on legitimacy of a system that prohibits multiple opening of medical instituion, in the content of 2014Hun-Ba212, August 29, 2019, 2014Hun-Ga15, 2015Hun-Ma561, 2016Hun-Ba21(amalgamation), Constitutional Court of Korea - ('의료법 제33조 제8항 관련 헌법재판소의 합헌결정'에 대한 평가 및 보완 입법 방향에 대하여 -헌법재판소 2019. 8. 29. 2014헌바212, 2014헌가15, 2015헌마561, 2016헌바21(병합) 결정의 내용 중 의료기관 복수 개설금지 제도의 당위성 및 필요성을 중심으로-)

  • KIM, JOON RAE
    • The Korean Society of Law and Medicine
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    • v.20 no.3
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    • pp.143-174
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    • 2019
  • Our Constitution obliges the state to protect the health of the people, and the Medical Law, which embodied Constitution, sets out in detail the matters related to open the medical institution, and one of them is to prohibit the operation of multiple medical institutions. By the way, virtually multiple medical institutions could be opened and operated because the Supreme Court had interpreted that several medical institutions could be opened if medical activities were not performed directly at the additional medical institution which was opened under the another doctor's license. However, some health care providers opened the several medical institutions with another doctor's license for the purpose of the maximization of profit, and did illegal medical cares like the unfair luring of patients, over-treatment, and commission treatment. Also, realistic problems such as the infringed health rights have arisen. Accordingly, lawmakers had come to amend the Medical Law to readjust the system of opening for medical institution so that medical personnel could not open or operate more than one medical institution for any reason. For this reason, the Constitutional Court recently declared a constitutional decision through a long period of in-depth deliberation because the constitutional petition and the adjudication on the constitutionality of statutes had been filed on whether Article 33 paragraph 8 of the revised medical law is unconstitutional. The Constitutional Court acknowledged the "justice of purpose" in view of the importance of public medical institutions, of the prevention from seduction of for-profit patients and from over-treatment, and of the fact that health care should not be the object of commercial transactions. Given the risk that medical personnel might be subject to outside capital, the concern that the holder of the medical institution's opening certificate and the actual operator may be separated, the principle that the human body and life should not be just a means, and the current system's inability to identify over-treatment, it also acknowledged the 'minimum infringement'. Furthermore, The Constitutional Court judged it is constitutional in compliance with the principle of restricting fundamental rights, such as 'balance of legal interests'. In this regard, legislative complements are needed in order to effectively prevent the for-profit management and the over-treatment the Constitutional Court is concerned about. In this regard, consumer groups actively support the need for legislation, and health care providers groups also agree on the need for legislation. Therefore, the legislators should respect the recent Constitutional Court's decision and in the near future complete the complementary legislation to reflect the people's interests.

A Cohort Study on Risk Factors for Chronic Liver Disease: Analytic Strategies Excluding Potentially Incident Subjects (만성간질환 위험요인에 대한 코호트연구: 잠재적 발병자 집단을 감안한 분석전략)

  • Kim, Dae-Sung;Kim, Dong-Hyun;Bae, Jong-Myun;Shin, Myung-Hee;Ahn, Yoon-Ok;Lee, Moo-Song
    • Journal of Preventive Medicine and Public Health
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    • v.32 no.4
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    • pp.452-458
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    • 1999
  • Objectives: The authors conducted the study to evaluate bias when potentially diseased subjects were included in cohort members while analyzing risk factors of chronic liver diseases. Methods: Total of 14,529 subjects were followed up for the incidence of liver diseases from January 1993 to June 1997. We have used databases of insurance company with medical records, cancer registry, and death certificate data to identify 102 incident cases. The cohort members were classified into potentially diseased group(n=2,217) when they were HBsAg positive, serum GPT levels higher than 40 units, or had or has liver diseases in baseline surveys. Cox's model were used for potentially diseased group, other members, and total subjects, respectively. Results: The risk factors profiles were similar for total and potentially diseased subjects: HBsAg positivity, history of acute liver disease, and recent quittance of smoking or drinking increased the risk. while intake of pork and coffee decreased it. For the potentially diseased, obesity showed marginally significant protective effect. Analysis of subjects excluding the potentially diseased showed distinct profiles: obesity increased the risk, while quitting smoking or drinking had no association. For these intake of raw liver or processed fish or soybean paste stew increased risk; HBsAg positivity, higher levels of liver enzymes and history of acute liver diseases increased the risk. Conclusions: The results suggested the potential bias in risk ratio estimates when potentially diseased subjects were included in cohort study on chronic liver diseases, especially for lifestyles possibly modified after disease onset. The analytic strategy excluding potentially diseased subjects was considered appropriate for identifying risk factors for chronic liver diseases.

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