• 제목/요약/키워드: Risk Adjustment

검색결과 389건 처리시간 0.029초

요양급여적정성 평가자료를 이용한 예방적 항생제 사용과 수술부위 감염 발생의 관련성 연구 (Association Between Prophylactic Antibiotic Use and Surgical Site Infection Based on Quality Assessment Data in Korea)

  • 김경훈;박춘선;장진희;김남순;이진서;최보람;이병란;이규덕;김선민;염선아
    • Journal of Preventive Medicine and Public Health
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    • 제43권3호
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    • pp.235-244
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    • 2010
  • Objectives: To examine the prophylactic antibiotic use in reducing surgical site infection. Methods: This was a retrospective study for patients aged 18 years and older who underwent gastrectomy, cholecystectomy, colectomy, cesarean section and hysterectomy. The data source was quality assessment data of the Health Insurance Review & Assessment Service gathered from medical records of 302 national hospitals. Prophylactic antibiotic use was defined as: timely antibiotic administration or inappropriate antibiotic selection. We performed hierarchical logistic regression to examine the association between prophylactic antibiotic use and surgical site infection with adjustment for covariates. Results: The study population consisted of 16 348 patients (1588 gastrectomies, 2327 cholecystectomies, 1,384 colectomies, 3977 hysterectomies and 7072 cesarean sections) and surgical site infection was identified in 351 (2.1%) patients. The rates of timely antibiotic administration and inappropriate antibiotic selection varied according to procedures. Cholecystectomy patients who received timely prophylactic antibiotic had a significantly reduced risk of surgical site infection compared with those who did not receive a timely prophylactic antibiotics (OR 0.64, 95% CI=0.50-0.83), but no significant reduction was observed for other procedures. When inappropriate prophylactic antibiotics were given, the risk of surgical site infection significantly increased: 8.26-fold (95% CI=4.34-15.7) for gastrectomy, 4.73-fold (95% CI=2.09-10.7) for colectomy, 2.34-fold (95% CI=1.14-4.80) for cesarean section, 4.03-fold (95% CI=1.93-8.42) for hysterectomy. Conclusions: This study examines the association among timely antibiotic administration, inappropriate antibiotic selection and surgical site infection. Patients who received timely and appropriate antibiotics had a decreased risk of surgical site infection. Efforts to improve the timing of antibiotic administration and use of appropriate antibiotic are needed to lower the risk of surgical site infection.

Association between shift work and serum homocysteine level in female electronic manufacturing services workers

  • Jae Won Lim;Chan Woo Kim;Hyoung Ouk Park;Eui Yup Chung;Changho Chae;JunSeok Son;Young Hoo Shin;Seung Hyun Park;Sang Moon Choi
    • Annals of Occupational and Environmental Medicine
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    • 제35권
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    • pp.4.1-4.11
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    • 2023
  • Background: Shift work has been shown to increase the risk of cardiovascular disease (CVD) based on several evidences. The classic risk factors of CVD include age, hypertension, smoking, obesity and diabetes. Recently, the serum homocysteine level has been reported to be a valuable indicator of CVD risk. This study aimed to determine the variation in serum homocysteine level as a cardiovascular risk indicator among female workers according to shift work. Methods: The data of regular health examination of workers at an electronic manufacturing services company in Yeongnam region, South Korea in 2019 were examined in this study. The investigation was based on a cross-sectional study conducted on 697 female workers (199 day workers and 498 shift workers). The sociodemographic and biochemical characteristics were compared between day workers and shift workers. Through a logistic regression analysis, the odds ratio (OR) of the increased serum homocysteine level in relation to shift work was determined. Results: Compared to female day workers, female shift workers showed significantly higher level of serum homocysteine (8.85 ± 2.16 vs. 9.42 ± 2.04 μmol/mL; p = 0.001). The OR of day workers against shift workers was 1.81 (95% confidence interval [CI]: 1.25-2.63). With the adjustment of variables that may influence the level of serum homocysteine, the adjusted OR was 1.68 (95% CI: 1.09-2.60). Conclusions: The serum homocysteine level was significantly higher in shift workers than in day workers. It is thus likely to be a useful predictor of CVD in shift workers.

한국 성인 남녀의 커피 섭취와 건강관련 삶의 질 및 대사증후군과의 관련성 : 2013 ~ 2016 국민건강영양조사 자료를 이용하여 (Association of coffee consumption with health-related quality of life and metabolic syndrome in Korean adults: based on 2013~ 2016 Korea National Health and Nutrition Examination Survey)

  • 김혜숙;김유진;임예니;권오란
    • Journal of Nutrition and Health
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    • 제51권6호
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    • pp.538-555
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    • 2018
  • 본 연구에서는 2013 ~ 2016년 국민건강영양조사 자료를 이용하여 19 ~ 64세 성인 남녀의 커피 섭취 종류와 섭취량(정량적 식품섭취빈도조사 자료 활용)에 따른 일반사항, 총 당류를 포함한 영양섭취상태, 건강관련 삶의 질 및 대사증후군과의 관련성을 분석하였다. 남성과 여성 모두에서, 에너지 섭취량이 에너지필요추정량 (EER) 미만인 사람과 철분 섭취량이 평균필요량 (EAR) 미만인 사람의 비율이 3-in-1 커피 섭취군에서 낮았다. 커피를 섭취하지 않는 여성과 비교했을 때, 3-in-1 커피를 하루 2회 이하로 섭취하는 여성은 EQ-5D를 통해 조사한 건강 관련 삶의 질저하에 대한 위험이 19% 낮은 것으로 나타났으며, 남성과 여성 모두에서 섭취하고 있는 커피의 종류와 섭취량에 따라 대사증후군 관련 지표 및 대사증후군에 대한 위험에 차이가 없었다. 따라서 3-in-1 커피 섭취가 건강관련 삶의 질저하에 대한 낮은 위험과 관련이 있었으나, 대사증후군 및 관련 지표에 대한 위험과는 관련이 없다는 결론을 얻을 수 있었다. 앞으로 3-in-1 커피 섭취가 건강관련 삶의 질 및 대사증후군 나아가 사망률까지 이어지는 건강에 미치는 영향에 대한 기전을 파악하기 위해 이와 관련하여 잘 설계된 무작위 임상비교시험이나 코호트 연구가 필요하다.

성인과 노인 관상동맥증후군 초발 환자의 임상적 특성 및 치료추구행위 비교 (Comparison of Clinical Manifestations and Treatment-Seeking Behavior in Younger and Older Patients with First-time Acute Coronary Syndrome)

  • 황선영
    • 대한간호학회지
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    • 제39권6호
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    • pp.888-898
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    • 2009
  • Purpose: This study was conducted to examine and compare clinical manifestations and predicting factors for treatment-seeking delay among patients <65 and ${\geq}65\;yr$ with first-time acute coronary syndrome (ACS). Methods: A total of 288 patients who were diagnosed with ACS were individually interviewed at C university hospital in G-city from November 2007 to December 2008. Results: Median pre-hospital delays for younger and older patients were 5 and 12 hr, respectively. Younger patients were more likely to be current smokers, heavy drinkers, obese, stressed, and have an unhealthy diet and family history, and to complain of chest pain, left shoulder and arm pain, perspiration, and nausea. Older patients were more likely to have hypertension and diabetes, and to complain syncope and dyspnea. Logistic regression analyses showed that after adjustment for age, gender and education, progressive onset of symptom and no attribution to cardiac problem significantly predicted pre-hospital delay >3 hr in both younger and older patients. Low perceived health status was a significant independent predictor in older patients only. Conclusion: Health care providers should be concerned with different manifestations between younger and older adults, and educate people at risk for heart attack about symptoms and actions to get immediate help.

A Study on the Countermeasures for Securing Safety of Ship from Piracy Attacks

  • Noh, Seung-Dae;Kim, Cheol-Seung;Park, Sung-Hyeon
    • 한국항해항만학회지
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    • 제36권4호
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    • pp.273-278
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    • 2012
  • This study is concerned with the applicable countermeasures for securing safety of ship from piracy attacks. For improvements and countermeasures, we analyzed the recent anti-piracy trends. In spite of international community's various activities for safety navigating, the number of piracy in Gulf of Aden and in the vicinity of Somali waters has been increasing dramatically in the last few years, so has the number of piracy on Korean vessels. In case of piracy attack which based on Somalia, it continues constantly and widely not only near shore, but coastal and oceanic waters. This study figures out the limitations of international community's efforts including military and legal improvements. There are no studies concerning the countermeasures of bridge protection by piracy. This study suggested the additional installation of outside door of bridge as well as the adjustment of piracy operation area(POA) of Korea navy.

일반 질 지표로서의 병원 표준화 사망비에 대한 고찰 (How Can We Use Hospital-Standardized Mortality Ratio as a Quality Indicator of Hospital Care in Korea?)

  • 김선하;최은영;이현정;옥민수;조민우;이상일
    • 보건행정학회지
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    • 제27권2호
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    • pp.114-120
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    • 2017
  • The hospital standardized mortality ratio (HSMR) is a widely used generic measure for assessing quality of hospital care in many countries. However, the validity of HSMR as a quality indicator is still controversial. We critically reviewed characteristics of HSMR and suggested how to use HSMR as a quality indicator in the Korean setting. The association between HSMR and other quality measures of hospital care is inconclusive. In addition current HSMR model has shortcomings in risk adjustment because of the lack of clinical data, accuracy of disease coding, coding variation among hospitals, end-of-life care issues, and so on. Therefore, HSMR should be used as an indicator for improvement, not for judgement such as public reporting and pay-for-performance. More efforts will be needed to tackle practical and methodological weaknesses of HSMR in the Korean setting.

초등학생 대상의 산림치유 프로그램에 대한 체계적 문헌고찰 (A Systematic Review of Forest Therapy Programs for Elementary School Students)

  • 송민경;방경숙
    • Child Health Nursing Research
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    • 제23권3호
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    • pp.300-311
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    • 2017
  • Purpose: There are many forest and outdoor programs being offered but systematic reviews of effects are lacking. This study was done to identify content, format, and strategies of forest therapy programs for elementary school students. Methods: Literature search using keywords in English and Korean was performed using 6 electronic databases in December 2016. Search participants were elementary school students and interventions conducted in the forest. Seventeen forest therapy studies were selected for evaluation. Risk of Bias Assessment tool for non-randomized study was used for quality assessment. Results: All studies were quasi-experimental designs. Forest therapy programs included various activities in forests such as experience of five senses, meditation in the forest, walking in the forest, ecological play, observation of animals and insects. All studies used psychosocial health variables and forest healing programs had positive effects on sociality, depression, anxiety, self-esteem, stress, aggression, anger, and school adjustment. Limitations of these studies were vague reporting of the study, lack of ethical review and rigorous research designs. Conclusion: Forest therapy for elementary school child can be an effective way to improve psychosocial health. Future studies with rigorous study designs are needed to assess long-term effects of forest therapy on physical and psychosocial health.

폐경기 여성의 영양소섭취에 따른 치주질환과의 관련성: 국민건강영양조사 제6기 1차년도(2013) 자료를 이용하여 (Relationship between consumption of nutrition and periodontal diseases in Korean menopausal women: Based on the Korea national health and nutrition examination survey in 2013)

  • 황수연;김혜영
    • 한국치위생학회지
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    • 제18권1호
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    • pp.93-101
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    • 2018
  • Objectives: The purpose of this study was to investigate the relationship between consumption of nutrition and periodontal diseases in the Korean menopausal women. Methods: The data used for analysis were obtained from the sixth Korean National Health and Nutrition Examination Survey (2013). Subjects were 1,407 women aged over 35 years old. Data were analyzed by chi-square and t-test. Multiple regression analysis was also performed to assess the association between nutrition and periodontal diseases. Statistical significance level was set at p<0.05. Results: Using multiple logistic regression analysis after adjustment of age, education level, and BMI, we found significant relationship between intake of protein (OR: 0.31, 95%CI: 0.14-0.65), carbohydrate (OR:3.31, 95%CI 1.90-5.77) and risk for periodontitis. Conclusions: dequate intake of protein and decreased intake of carbohydrate may be recommended for prevention of periodontal diseases in the menopausal women.

Detection of superior genotype of fatty acid synthase in Korean native cattle by an environment-adjusted statistical model

  • Lee, Jea-Young;Oh, Dong-Yep;Kim, Hyun-Ji;Jang, Gab-Sue;Lee, Seung-Uk
    • Asian-Australasian Journal of Animal Sciences
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    • 제30권6호
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    • pp.765-772
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    • 2017
  • Objective: This study examines the genetic factors influencing the phenotypes (four economic traits:oleic acid [C18:1], monounsaturated fatty acids, carcass weight, and marbling score) of Hanwoo. Methods: To enhance the accuracy of the genetic analysis, the study proposes a new statistical model that excludes environmental factors. A statistically adjusted, analysis of covariance model of environmental and genetic factors was developed, and estimated environmental effects (covariate effects of age and effects of calving farms) were excluded from the model. Results: The accuracy was compared before and after adjustment. The accuracy of the best single nucleotide polymorphism (SNP) in C18:1 increased from 60.16% to 74.26%, and that of the two-factor interaction increased from 58.69% to 87.19%. Also, superior SNPs and SNP interactions were identified using the multifactor dimensionality reduction method in Table 1 to 4. Finally, high- and low-risk genotypes were compared based on their mean scores for each trait. Conclusion: The proposed method significantly improved the analysis accuracy and identified superior gene-gene interactions and genotypes for each of the four economic traits of Hanwoo.

다문화 가정 학령기 아동의 우울 영향 요인 (Factors Influencing the Experience of Depression among School-aged Children from Multicultural Families)

  • 문소현;이민경;이미정;심하진;조헌하
    • Child Health Nursing Research
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    • 제24권4호
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    • pp.434-442
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    • 2018
  • Purpose: The purpose of this study was to investigate factors affecting the experience of depression in school-aged children from multicultural families. Methods: Data from 1,812 school-aged children of multicultural families were collected from the 2015 National Multicultural Family Survey. Logistic regression was conducted based on complex sample analysis using SAS 9.4. Results: Significant predictors for experiencing depression were lower self-esteem, lower Korean proficiency, less time spent conversing with the father, lower degree of parental interest, poorer school adjustment, greater difficulties with schoolwork, and experiencing violence at school. Conclusion: This study showed that factors related to the individual, family, and school environment influenced the experience of depression. Based on a consideration of these factors, it is necessary to develop an effective program to prevent depression by establishing high-risk criteria for depression.