• Journal of Preventive Medicine and Public Health
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• 제47권4호
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• pp.206-215
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• 2014

Objectives: The hospital standardized mortality ratio (HSMR) has been widely used because it allows for robust risk adjustment using administrative data and is important for improving the quality of patient care. Methods: All inpatients discharged from hospitals with more than 700 beds (66 hospitals) in 2008 were eligible for inclusion. Using the claims data, 29 most responsible diagnosis (MRDx), accounting for 80% of all inpatient deaths among these hospitals, were identified, and inpatients with those MRDx were selected. The final study population included 703 571 inpatients including 27 718 (3.9% of all inpatients) in-hospital deaths. Using logistic regression, risk-adjusted models for predicting in-hospital mortality were created for each MRDx. The HSMR of individual hospitals was calculated for each MRDx using the model coefficients. The models included age, gender, income level, urgency of admission, diagnosis codes, disease-specific risk factors, and comorbidities. The Elixhauser comorbidity index was used to adjust for comorbidities. Results: For 26 out of 29 MRDx, the c-statistics of these mortality prediction models were higher than 0.8 indicating excellent discriminative power. The HSMR greatly varied across hospitals and disease groups. The academic status of the hospital was the only factor significantly associated with the HSMR. Conclusions: We found a large variation in HSMR among hospitals; therefore, efforts to reduce these variations including continuous monitoring and regular disclosure of the HSMR are required.

• Diabetes and Metabolism Journal
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• 제42권6호
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• pp.488-495
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• 2018

Background: Skeletal muscle plays a major role in glucose metabolism. We investigated the association between thigh muscle mass, insulin resistance, and incident type 2 diabetes mellitus (T2DM) risk. In addition, we examined the role of body mass index (BMI) as a potential effect modifier in this association. Methods: This prospective study included 399 Japanese Americans without diabetes (mean age 51.6 years) who at baseline had an estimation of thigh muscle mass by computed tomography and at baseline and after 10 years of follow-up a 75-g oral glucose tolerance test and determination of homeostasis model assessment of insulin resistance (HOMA-IR). We fit regression models to examine the association between thigh muscle area and incidence of T2DM and change in HOMA-IR, both measured over 10 years. Results: Thigh muscle area was inversely associated with future HOMA-IR after adjustment for age, sex, BMI, HOMA-IR, fasting plasma glucose, total abdominal fat area, and thigh subcutaneous fat area at baseline (P=0.033). The 10-year cumulative incidence of T2DM was 22.1%. A statistically significant interaction between thigh muscle area and BMI was observed, i.e., greater thigh muscle area was associated with lower risk of incident T2DM for subjects at lower levels of BMI, but this association diminished at higher BMI levels. Conclusion: Thigh muscle mass area was inversely associated with future insulin resistance. Greater thigh muscle area predicts a lower risk of incident T2DM for leaner Japanese Americans.

• Journal of Preventive Medicine and Public Health
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• 제43권2호
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• pp.138-150
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• 2010

Objectives: There are at least three conceptual models for the effects of the childhood social environment on adult health: the critical period model, the social mobility model, and the cumulative risk model. However, few studies have investigated all three different models within the same setting. This study aims to examine the impact of childhood and adulthood socioeconomic positions and intergenerational social mobility over the life course on the health in adulthood based both on the critical period model and the social mobility model. Methods: This study was conducted on 9583 adults aged between 25 and 64 years old and they were the respondents to the Korea Welfare Panel Study (2006). A multivariate logistic regression analysis was carried out, using the critical period model and the social mobility model out of the life course approaches, to look into the impact of childhood and adulthood socioeconomic positions and intergenerational social mobility on the health status in adulthood. Results: Household income and occupation out of the adulthood socioeconomic position indicators had an independent influence on the adulthood health status. The childhood socioeconomic position indicators, except for the place of childhood residence, affected the adulthood health status even after adjustment for the adulthood socioeconomic position. The effect of intergenerational social mobility was also statistically significant even after adjusting for the adulthood socioeconomic position, but it became insignificant when the childhood socioeconomic position was additionally adjusted for. Conclusions: Adulthood health is indeed affected by both the childhood and adulthood socioeconomic positions as well as intergenerational social mobility. This result shows that a life course approach needs to be adopted when dealing with health issues.

• 한국치위생학회지
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• 제10권4호
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• pp.595-605
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• 2010

Objectives : A precedent research has documented that occupational stress is closely associated with increased the risk of fatigue and decreased in job satisfaction. This study was conducted in an effort to assess the relationship of occupational stress to self-perceived fatigue and job satisfaction by using job strain model. Methods : The number of respondents was 122 dental hygienist who work in dental clinic and period of the investigation was July 2009 through september 2009. A structured questionnaire was employed to evaluate the participants' sociodemographics, job-related factors, health-related behaviors, occupational stress, job satisfaction and self-perceived fatigue. Occupational stress and self-perceived fatigue were assessed using the Korean Occupational Stress Scale-Short form (KOSS-SF) and the Multidimensional Fatigue Scale (MFS), respectively. Results : In job strain model, the ratio of Q2(High Strain Job) group that more susceptible to disease by stress than other group was 16% and the proportion of high fatigue group(Q3, Q4 group) and low job satisfaction group(Q3, Q4 group) was 48%, 45% respectively. In logistic regression analyses, a High Strain Job group was associated with higher odds of react factor(fatigue, job satisfaction) and the odds was down by 3.3%~7.5% after adjustment for age, smoking, alcohol drinking, regular exercise. So the effective strategy for fatigue, job satisfaction reduction for dental hygienist requires additional program focusing on innovated work environment that provide a enough leisure time and exercise program considering the personality traits. Conclusions : The results of this study suggest that occupational stress is a determinant predictor of self perceived fatigue and job satisfaction. Thus, a stress management program for the reduction of occupational stress, and the promotion of dental hygienist impact assessment health and quality of life is strongly recommended.

• 중소기업연구
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• 제31권4호
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• pp.67-93
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• 2009

본 연구는 1999년 1월 1일부터 2007년 12월 31일까지 한국거래소의 유가증권시장과 코스닥시장에 상장된 혁신형 중소기업을 대상으로 재무적 제약과 배당스무딩간의 관계를 실증분석 하였으며, 주요한 분석결과는 다음과 같다. 기업들은 목표 배당성향을 가지고 있으며, 실제 배당성향이 목표 배당성향에서 이탈하면 다시 배당지급을 부분적으로 조정한다. 배당조정속도는 Lintner(1956)의 배당조정모형의 핵심변수인 전기 주당배당과 당기 주당이익을 사용하여 거의 대부분 측정할 수 있으며, 잔여배당이론과 그 이후에 등장한 배당신호이론, 대리인이론, 케이터링 이론 및 거래비용이론에 관한 대용변수들은 배당조정속도에 부분적으로 영향을 미친다. 그리고 전기 주당배당은 당기 주당이익보다 배당조정속도에 더 큰 영향을 미치는데, 이는 기업들이 특별한 이유가 없는 한 전기 주당배당 수준을 장기적으로 유지하는 안정적인 배당정책을 선호한다는 증거가 된다. 혁신형 중소기업은 비혁신형 중소기업보다 배당조정속도가 더 빠르다. 혁신형 중소기업은 R&D 투자에 따른 미래의 성장성과 수익성을 담보로 하여 장기적으로 안정적인 배당정책을 유지할 수 있다. 다시 말해, 혁신형 중소기업은 배당지급이 목표 배당성향에서 이탈하더라도, R&D 투자에 따른 미래의 성장성과 수익성을 담보로 하여 목표 배당성향을 향하여 배당지급을 신속하게 조정하여 배당스무딩을 효과적으로 달성할 수 있다. 그리고 혁신형 중소기업 중에서도 재무적 비제약 기업은 재무적 제약 기업보다 배당조정속도가 더 빠르다. 이는 재무적 비제약 기업일수록 자본시장을 통한 외부 자금조달이 용이하기 때문에 주당배당을 신속하게 조정한다는 증거가 된다. 따라서 자본시장 접근성이 용이하여 재무적 제약을 적게 받는 기업일수록 외부 자금조달이 용이하기 때문에 배당지급을 더 신속하게 조정함으로써 배당스무딩을 더 효과적으로 달성할 수 있다. 그리고 중소기업청이 정책적 목적으로 분류한 혁신형 중소기업(벤처기업, 이노비즈기업, 경영혁신형기업)은 비혁신형 중소기업보다 배당조정속도가 더 빠르다. 중소기업청에서 정책적 목적으로 분류한 혁신형 중소기업은 신용보증지원, 정책자금지원, 조세혜택, 공공입찰 우선권 부여 등과 같은 다양한 정책적 혜택으로 인해 재무적 제약을 적게 받기 때문에 배당지급을 더 신속하게 조정할 수 있다. 결론적으로, 한국거래소의 유가증권시장과 코스닥시장에 상장된 혁신형 중소기업은 비혁신형 중소기업보다 배당조정속도가 더 빠르고, 혁신형 중소기업 중에서도 재무적 비제약 기업은 재무적 제약 기업보다 배당조정 속도가 더 빠르다. 다시 말해, 중소기업 중에서도 R&D 집중도가 높은 혁신형 중소기업은 R&D 투자에 따른 미래의 성장성과 수익성을 담보로 하여 배당스무딩을 신속하게 할 수 있고, 혁신형 중소기업 중에서도 자본시장 접근성이 좋은 기업은 재무적 제약을 적게 받기 때문에 배당스무딩을 더 신속하게 할 수 있다. 따라서 중소기업 경영자는 R&D 집중도를 증가시키고 자본시장 접근성을 높여 재무적 제약을 회피함으로써 신속한 배당스무딩을 통해 장기적으로 안정적인 배당정책을 유지할 수 있다고 생각한다. 그리고 중소기업청이 정책적 목적으로 분류한 혁신형 중소기업(벤처기업, 이노비즈기업, 경영혁신형기업)의 경우에도 배당조정속도가 비혁신형 중소기업보다 더 빠르게 나왔다. 이러한 결과는 배당정책의 측면에서 중소기업청의 혁신형 중소기업 정책을 지지하는 실증적인 증거가 된다.

• Journal of the Korean Data and Information Science Society
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• 제26권6호
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• pp.1317-1325
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• 2015

두 집단간을 비교하는 다양한 임상연구에서 수집된 데이터를 분석할 때 질환에 미치는 영향을 알아보는 방법으로는 현 시점에서 어떤 특정 질환을 일으킬 수 있는 위험요인포함 우, 무에 띠라 연구대상자를 나누어, 추적 관찰하는 전향적 임상연구에서의 분석과 현 시점에서 질환 유, 무에 따라 위험요인을 과거의 연구대상자의 관찰기록을 바탕으로 확인하는 후향적 임상연구에서의 분석이 있다. 접근 방법과 연구 설계는 다르지만 두 가지 연구의 목적은 두 집단 간 명확한 차이를 확인하는데 있으며, 나아가 두집단의 분류에 영향을 주는 변수가 무엇인지를 알아보는 방법이다. 특히 임상연구에서 두 집단을 비교할 때 성별과 나이와 같은 기본적 특성변수의 영향을 통제한 상태에서 임상적 변수들의 집단 간 차이와 영향을 살펴보아야 한다. 하지만 후향적 연구에서는 과거의 관찰기록을 바탕으로 분석이 진행되는 연구이므로 연구대상자를 두 집단으로 무작위 할당하지 못했기 때문에 기본적인 특성변수들이 차이가 나는 경우가 빈번하게 발생할 수 있다. 이를 해결하기 위하여 임상자료를 분석하는 방법으로 공변량을 사용한다. 대표적으로 공변량을 사용하는 분석방법으로는 공분산분석, 수정회귀모형, propensity score matching 방법 등이 있다. 본 연구는 후향적 임상연구에서 공변량을 이용한 자료 분석 방법 및 propensity score matching 방법을 소개하고, 실제 위암 환자들의 재발관련 자료에 적용하여, 그 필요성을 확인한다.

• 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.

• 한국환경보건학회지
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• 제38권6호
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• pp.460-471
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• 2012

Objectives: Due to global warming resulting from climate change, there has been increasing interest in the relationship between temperature and mortality. These temperature-related deaths depend on diverse conditions related to a given place and person, as well as on time. This study examined changes in the impact of high temperatures on death in summer, using the effect and burden of elevated temperatures on deaths in Seoul and Daegu. Methods: A Poisson regression model was used to estimate short-term temperature effects on mortality. Temperature-related risks were divided into three time periods of equal length (1996-2000, 2001-2005, and 2006-2010). In addition, in order to compare the impact of high temperatures on deaths, this study calculated the proportion of attributable deaths to population, which simultaneously considers the threshold and the slope above the threshold. Results: The effect and burden of high temperatures on deaths is high in Daegu. However, the impact (i.e. the effect and burden) of elevated summer temperatures on deaths has declined over the past 15 years. Sensitivity analyses using alternative thresholds show the robustness of these findings. Conclusion: This study suggests that the attributable burden of high temperatures on deaths to be more plausible than relative risk or threshold for comparing the health impact of high temperatures across populations. Moreover, these results contain important implications for the development or the adjustment of present and future strategies and policies for controlling the temperature-related health burden on populations.

• 조명전기설비학회논문지
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• 제28권7호
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• pp.97-105
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• 2014

This article examines the causality relationship among SMP, base-load share, LNG import price, and exchange rate in Korean power market during 2002~2012, using unit root test, cointegration test, and vector error correction model(VECM). The cointegration test shows that 4 variables without unit root have been in the long-run causality. As the results of ECM, SMP is analyzed to have been unilaterally caused from LNG import price and base-load share in the shot-run, while it has been unilaterally caused from LNG import price and exchange rate in the long-run. This article has the following policy implications: the adjustment of exchange rate to reduce he risk of LNG import price and the proper securement of base-load share for the long-run stability of SMP.

• Nutrition Research and Practice
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• 제10권1호
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• pp.81-88
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• 2016

BACKGROUND/OBJECTIVES: Serum ferritin levels are significantly increased after menopause and greatly affect women's health. The aim of this study was to investigate the dietary and non-dietary factors associated with high ferritin levels in postmenopausal women. SUBJECTS/METHODS: Among adult women in 2010-2012, qualified postmenopausal women (n = 3880) were separated into quartiles of serum ferritin. The variable differences among the quartiles of ferritin were determined using either procsurvey chi-square test (${\chi}^2$-test) among categorical variables, or GLM (Generalized Linear Model) among continuous variables. The odds ratio for high ferritin in relation to dietary factors was also determined using procsurvery logistic analysis. RESULTS: Age, obesity, drinking habit, and blood glucose levels were found to be significant indicators of high serum ferritin level after adjusting for all confounding factors. Among the food groups, grain, milk, vegetable, and seaweed intakes were significantly associated with high ferritin levels, but after adjusting for all confounding factors, only grains and vegetables remained significant factors. Among the nutrient groups, calcium, vitamin A, and vitamin C intake were significant factors, but after adjustment, none of the nutrient groups analyzed were associated with a high risk of ferritin. CONCLUSION: Age, obesity, drinking habit, and glucose levels, as well as inadequate intakes of grains and vegetables, were found to be significantly associated with high serum ferritin levels in postmenopausal Korean women.