• Title/Summary/Keyword: Value-based health care

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Prevalence and Risk Factors of Mood Disorders among One University Freshmen (일 대학 신입생들의 기분장애 유병률과 위험요인)

  • Song, Jung-Hee;Min, Kyung-Jun;Park, Jung-Duck;Choi, Byung-Sun
    • Journal of the Korean Society of School Health
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    • v.22 no.2
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    • pp.169-181
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    • 2009
  • Purpose: Mood disorders such as depression and bipolar disorder are a major mental health problem in college students. We investigate the prevalence of depression and bipolar disorder and the relevance of risk factors for these mood disorders among one college freshmen. Methods: The subjects were 2,865 college students who entered one university located in Seoul and Ansung in 2009. We used BDI (Beck Depression Inventory) for depression assessment and K-MDQ (Mood Disorder Questionnaire) for bipolar disorder assessment. Demographic and socioeconomic factors were measured by questionnaire. Height, weight, blood pressure, total cholesterol, complete blood cell count, and liver function test data were obtained by physical examination for freshmen. Chi-square test and multiple logistic regression were performed to analyze the possible risk factors for depression and bipolar disorder. Results: With different BDI cutoff value, 16 and 21, the prevalence of depression was 8.7% (male: 7.6%, female: 10.1%) and 2.4% (male: 2.5%, female: 2.3%), separately. 'Low economic status', 'urban birth place', and 'low grade at entrance' were significantly associated with depression. Using the original cutoff criterion, defined as clustering of 7 or more symptoms that caused moderate or severe problems, the prevalence of bipolar disorder was 1.3% (male: 1.4%, female: 1.1%). The risk factor of bipolar disorder was academic fields (art fields). Conclusion: Depression and bipolar disorder are common disease in college freshmen. Therefore, Campus-based mental health service program is needed to help with prevention of and early intervention of these mood disorders.

Studies on Antioxidant, Anti-inflammation and Moisturizing Activities of Gastrodia elata Flower Extract (천마꽃 추출물의 항산화, 항염, 보습 활성에 대한 연구)

  • Lee, Hong Gu;Kim, Gil Nam;Park, Dong Jun;Lee, So Young;Jin, Mu Hyun
    • Journal of the Society of Cosmetic Scientists of Korea
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    • v.47 no.3
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    • pp.219-226
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    • 2021
  • Gastrodia elata has a very low pollination rate in natural state, and even in artificial cultivation, there are very few individuals that bloom due to the degeneration, so little studies have been conducted. This study confirmed that the potential as a cosmetic ingredient by evaluating the antioxidant activity through the evaluation of DPPH radical scavenging activity, anti-inflammatory activity through the inhibitory effect on nitric oxide production, and the moisturizing activity through the effect on promoting hyaluronic acid production by artificially flowering G. elata flower. It was also confirmed that the appearance rate and flowering rate of G. elata harvested in spring were high, and the content of gastrodin was 0.36%. The IC50 value of G. elata flower extract was 0.045% and it was confirmed that G. elata flower extract had higher radical scavenging activity than G. elata root extract. The NO production inhibitory activity against the flower extract showed a significant inhibitory effect from 1% to 83.2%. Hyaluronic acid production promotion efficacy was not confirmed in the G. elata root extract, but the production rate increased with concentration dependence in the flower extract, and it was the highest at 46.9% when 0.02% treatment was performed. Based on the above research results, it is judged that G. elata flower extract has high potential for use as an antioxidant, anti-inflammatory, and skin moisturizing cosmetic ingredient.

Is it Meaningful to Use the Serum Cholinesterase Level as a Predictive Value in Acute Organophosphate Poisoning? (혈청 콜린에스테라제 활성도를 이용하여 유기인계 농약 음독 환자의 증증도를 예측할 수 있는가?)

  • Lee, Sang-Jin;Jung, Jin-Hee;Jung, Koo-Young
    • Journal of The Korean Society of Clinical Toxicology
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    • v.2 no.2
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    • pp.72-76
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    • 2004
  • Purpose: Dealing patients with organophosphate poisoning, cholinesterase level has been used as a diagnostic and prognostic value. But there are some controversies that the cholinesterase level is significantly related to the severity or prognosis of acute organophosphate poisoning. We evaluated the correlation between initial serum level of cholinesterase and APACHE II score as an index for severity, and we assessed cholinesterase levels for predicting value of weaning from mechanical ventilation. Method: From August 1996 to March 2003, 23 patients with organophosphate poisoning who needed ventilatory care were enrolled. Retrospective review was done for the serum level of cholinesterase, APACHE II score, and the duration of ventilatory care. The percentage of measured serum cholinesterase to median normal value was used to standardize cholinesterase levels from different laboratories. Result: There were tendencies that the lower initial serum of cholinesterase, the higher the APACHE II score (r=0.297) and the longer the duration of mechanical ventilation (r=-0.204), but they were not significant (p=0.264 and p=0.351 respectively). In 9 patients whose serum cholinesterase level were checked at the time of weaning, mean of measured cholinesterase level was $10.3\pm7.60\%$ of normal value. Conclusion: There was no significant relationship between initial level of serum cholinesterase and severity or duration of mechanical ventilation. General health status of patient, amount of ingestion, toxicity of agent should be considered as important factors for severity of poisoning. And the decision of weaning should be based not solely on the cholinesterase level but on the consideration of general and respiratory state of individual patients.

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The Current Status of Utilization of Palliative Care Units in Korea: 6 Month Results of 2009 Korean Terminal Cancer Patient Information System (말기암환자 정보시스템을 이용한 우리나라 암환자 완화의료기관의 이용현황)

  • Shin, Dong-Wook;Choi, Jin-Young;Nam, Byung-Ho;Seo, Won-Seok;Kim, Hyo-Young;Hwang, Eun-Joo;Kang, Jina;Kim, So-Hee;Kim, Yang-Hyuck;Park, Eun-Cheol
    • Journal of Hospice and Palliative Care
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    • v.13 no.3
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    • pp.181-189
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    • 2010
  • Purpose: Recently, health policy making is increasingly based on evidence. Therefore, Korean Terminal Cancer Patient Information System (KTCPIS) was developed to meet such need. We aimed to report its developmental process and statistics from 6 months data. Methods: Items for KTCPIS were developed through the consultation with practitioners. E-Velos web-based clinical trial management system was used as a technical platform. Data were collected for patients who were registered to 34 inpatient palliative care services, designated by Ministry of Health, Welfare, and Family Affairs, from $1^{st}$ of January to $30^{th}$ of June in 2009. Descriptive statistics were used for the analysis. Results: From the nationally representative set of 2,940 patients, we obtained the following results. Mean age was $64.8{\pm}12.9$ years, and 56.6% were male. Lung cancer (18.0%) was most common diagnosis. Only 50.3% of patients received the confirmation of terminal diagnosis by two or more physicians, and 69.7% had an insight of terminal diagnosis at the time of admission. About half of patients were admitted to the units on their own without any formal referral. Average and worst pain scores were significantly reduced after 1 week when compared to those at the time of admission. 73.4% faced death in the units, and home-discharge comprised only 13.3%. Mean length of stay per admission was $20.2{\pm}21.2$ days, with median value of 13. Conclusion: Nationally representative data on the characteristics of patients and their caregiver, and current practice of service delivery in palliative care units were obtained through the operation of KTCPIS.

The Study of the Nursing Students' Lived Experience of Clinical Practice at the Intensive Care Unit (간호학생의 중환자실 임상실습 체험 연구)

  • Park, Kyung-Sook;Hwang, Yun-Young;Choi, Eun-Hee
    • Korean Journal of Adult Nursing
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    • v.15 no.3
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    • pp.373-382
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    • 2003
  • Purpose: The purpose of this study is to investigate the perception of nursing students' on-site clinical experience at intensive care unit(ICU), which will help on developing fundamental tool to enhance the effect of their clinical practice. Method: Van Manens hermeneutic-phenomenological method has been used to analyze the data. Participants consisted of 74 third-year nursing students who performed the clinical practice at an ICU in C university hospital. The students got the group interviews and kept the clinical diaries. Data was collected from series of group interviews and contents of the students clinical diaries. Result: Major concerns related to students clinical practice were found as follows : "being nervous about unfamiliar machines and situations", "being frustrated about the patients", "feeling of helplessness", "being stupefied from witnessing a death", "realizing the importance of health", "realizing individual patient's precious value through family's love", "realizing the importance of treating a patient as humanbein g", "realizing the differences between theory and practice", "modelizing two aspects of nursing: professional and personal", "readiness to become a capable nurse". Conclusion: We are able to obtain in-depth understandings about the nursing students lived experience of clinical practice at the ICU. Based upon this, there is a need to develop a better nursing intervention enhance the effectiveness of the nursing students clinical practice.

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Priority Analysis of Criteria for Evaluation of Public Hospital Using Analytic Hierarchy Process (AHP를 이용한 공공병원 평가지표의 우선순위 및 가중치 개발)

  • Shim, Jae-Sun;Kwon, Young-Dae;Lee, Kun-Sei;Yang, Min-Hee;Park, Eun-Young
    • The Korean Journal of Health Service Management
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    • v.7 no.4
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    • pp.289-303
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    • 2013
  • This study looks at priorities in managing public hospitals by figuring out categories needed to examine the quality of each hospital. In order to analyze priorities and relative importance of valuation indicator in Seoul municipal hospitals, surveys were sent via e-mail to medical professionals who have participated in evaluation of municipal hospitals. The analytic hierarchy process (AHP) was conducted using the Expert Choice 11.5 program. The results show that 'providing public service' is considered to be the most important category for all kinds of public hospitals, followed by 'improving the quality of medical care', 'hospital management and governance', and 'efficient hospital management'. The importance of 'hospital management and governance' and 'efficient hospital management' is different depending on the types of hospitals, but the importance of 'providing public service' and 'improving the quality of care' remains the same regardless of the types of hospitals. Based on these results, the study comes to a conclusion that public hospitals should place high value on certain categories and their management purposes should differ depending on their specific fields and characteristics. This study will help furthering discussions on the identity and roles of public hospitals.

Estimation of Nursing Cost for Hemodialysis Using RBRVS(Resource Based Relative Value Scale);Severe Hemodialysis Patients (자원기준 상대가치를 이용한 혈액투석실 간호원가 산정;중증 대상자를 중심으로)

  • Kim, Moon-Sil;Han, Su-Jung;Kim, Jung-A;Kim, Ji-Hyun
    • Journal of Korean Academy of Nursing Administration
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    • v.11 no.1
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    • pp.33-44
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    • 2005
  • Purpose: This study was aimed to estimate nursing cost for hemodialysis of tertiary hospitals using Resource Based Relative Value Scale(RVRBS). Method: First, we calculated nursing workload of the each hemodialysis-nursing behaviors compared with basic nursing behavior(check vital sign) for the most severe hemodialysis patients in general hospitals. Second, we measured each spent time according to each nursing behaviors. Third, we computed Resource Based Relative Value(RBRV) scores and nursing expenses of each 14 nursing behavior for hemodialysis. Finally, we estimated nursing cost of each hemodialysis-behavior for the most severe hemodialysis-patients in general hospitals. Result: The mean RBRV scores for each nursing behaviors were from 218.9 to 383.9 points. The highest RBRV socres were 383.9(Complication during hemodialysis). The Nursing behavior that spent the most time was "access the vascular( 31.7 minutes)". Nursing cost per hemodialysis for the patient with severe condition was estimated 63,455(won). Conclusion: Total average workload was 347.6 points and total spent time was 306.5 minutes for 14 hemodialysis nursing behaviors provided to severe patients. There were clear differences in nursing workload and cost according to patient's severity-mild, moderate and severe class.

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Factors Influencing Asthma in Korean Adults: A Focus on Obesity and Systemic Inflammation (한국 성인의 천식 발생 영향요인: 비만 및 전신적 염증 상태를 중심으로)

  • Lee, Heashoon;Park, Jaewon
    • Journal of Home Health Care Nursing
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    • v.26 no.3
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    • pp.288-299
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    • 2019
  • Purpose: This study was conducted to identify factors influencing asthma, with a focus on obesity and systemic inflammation, in Korean adults. Methods: This study was a secondary analysis of data from the sixth Korea National Health and Nutrition Examination Survey (2015). A total of 3,693 individuals aged ≥19 years were included. The prevalence of asthma was 1.6% in the normal weight group (n=23), 1.4% in the overweight group (n=13), and 2.9% in the obese group (n=39). Data included markers associated with systemic inflammation such as high sensitivity C-reactive protein level, leukocyte count, hemoglobin level, and hematocrit value based on previous studies. The results were analyzed using a complex sampling design analysis and by multiple logistic regression analysis with SPSS WIN 24.0 program. Results: In the obese group, age between 50 and 59 years (adjusted odds ratio [AOR]=14.06, 95% confidence interval [CI]=1.84-27.14); age between 60 and 69 years (AOR=3.30, 95% CI=1.34-8.14); age ≥70 years (AOR=3.22, 95% CI=1.31-7.93); female gender (AOR=2.32, 95% CI=1.12-4.78); leukocyte count (AOR=1.18, 95% CI=1.01-1.38), and hemoglobin levels (AOR=0.60, 95% CI=0.45-0.81) were identified as factors influencing asthma. Conclusion: The results can be used to develop nursing interventions to prevent asthma associated with obesity in hospitals or home-based healthcare settings.

Role of Hyperinsulinemia in Increased Risk of Prostate Cancer: A Case Control Study from Kathmandu Valley

  • Pandeya, Dipendra Raj;Mittal, Ankush;Sathian, Brijesh;Bhatta, Bibek
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.2
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    • pp.1031-1033
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    • 2014
  • Aim: To investigate the effect of hyperglycemia and hyperinsulinemia on prostate cancer risk. Materials and Methods: This hospital based study was carried out using data retrieved from the register maintained in the Department of Biochemistry of a tertiary care hospital of Kathmandu, Nepal between $31^{st}$ December, 2011 and $31^{st}$ October, 2013. The variables collected were age, serum cholesterol, serum calcium, PSA, fasting blood glucose, serum insulin. Analysis was performed by descriptive statistics and testing of hypothesis using Excel 2003, R 2.8.0, Statistical Package for the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 Windows Version. Results: Of the total 125 subjects enrolled in our present study, 25 cases were of PCa and 100 were healthy controls. The mean value of fasting plasma glucose was 95.5 mg/dl in cases of prostatic carcinoma and the mean value of fasting plasma insulin was $5.78{\mu}U/ml$ (p value: 0.0001*). The fasting insulin levels ${\mu}U/ml$ were categorized into the different ranges starting from ${\leq}2.75$, >2.75 to ${\leq}4.10$, >4.10 to ${\leq}6.10$, > $6.10{\mu}U/ml$. The maximum number of cases of prostatic carcinoma of fasting insulin levels falls in range of > $6.10{\mu}U/ml$. The highest insulin levels (> $6.10{\mu}U/ml$) were seen to be associated with an 2.55 fold risk of prostatic carcinoma when compared with fasting insulin levels of (< $2.75{\mu}U/ml$). Conclusions: Elevated fasting levels of serum insulin appear to be associated with a higher risk of prostate cancer.

Problems and Solutions for Korean Medical Fee Contract System (건강보험 요양급여비용 계약의 문제점과 개선방안 연구)

  • Shin, Sung-Chul
    • Health Policy and Management
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    • v.19 no.1
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    • pp.1-30
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    • 2009
  • Korean medical fee contract system between the insurer and healthproviders was introduced in 2000. However, a continuous discord among contracting parties concerned and an irrational operation of an arbitration committee of Ministry for Health, Welfare and Family Affairs (MIHWAF) have made it difficult for them to reach to an agreement over last 8 years. The purpose of this study is to observe the current problems of contract system from the view of health insurance law and actual examples. Furthermore, I examined the of breakdown of negotiation by analyzing the eligibility of contracting parties, rationality of Resource Based Relative Value System (RBRVS) and contracting method and fairness of arbitration method in case of negotiation rupture. The results were as follows: First, since the introduction of medical fee contract system, there has been a problem in that both the president of National Health Insurance Corporation (NHIC) and health care provider association have not held strong negotiation power. Second, the frequent changes and notifications of Relative Value Units (RVUs) without any mutual consent between the insurer and provider association negatively have influenced the conversion factors and finally hindered the agreement of contract. Third, a current process that the conversion factors are mediated and determined at the arbitration committee of MIHWAF in the case of contract breakdown between contracting parties has some flaw in that the irrational composition of committee provoked the lack of fairness and objectivity of mediation. Fourth, we can not prospect a satisfactory outcome of arbitration committee because the mediation always has failed to proceed smoothly due to boycott of both committee members from insurer and providers over last 8 years. As a result, we have to make an every effort to resolve problems mentioned above and then dream of an advanced national health insurance system.