• Tuberculosis and Respiratory Diseases
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• v.67 no.2
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• pp.105-112
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• 2009

Background: Solitary pulmonary nodules (SPN) are encountered incidentally in 0.2% of patients who undergo chest X-ray or chest CT. Although SPN has malignant potential, it cannot be treated surgically by biopsy in all patients. The first stage is to determine if patients with SPN require periodic observation and biopsy or resection. An important early step in the management of patients with SPN is to estimate the clinical pretest probability of a malignancy. In every patient with SPN, it is recommended that clinicians estimate the pretest probability of a malignancy either qualitatively using clinical judgment or quantitatively using a validated model. This study examined whether Bayesian analysis or multiple logistic regression analysis is more predictive of the probability of a malignancy in SPN. Methods: From January 2005 to December 2008, this study enrolled 63 participants with SPN at the Kangnam Sacred Hospital. The accuracy of Bayesian analysis and Bayesian analysis with a FDG-PET scan, and Multiple logistic regression analysis was compared retrospectively. The accurate probability of a malignancy in a patient was compared by taking the chest CT and pathology of SPN patients with <30 mm at CXR incidentally. Results: From those participated in study, 27 people (42.9%) were classified as having a malignancy, and 36 people were benign. The result of the malignant estimation by Bayesian analysis was 0.779 (95% confidence interval [CI], 0.657 to 0.874). Using Multiple logistic regression analysis, the result was 0.684 (95% CI, 0.555 to 0.796). This suggests that Bayesian analysis provides a more accurate examination than multiple logistic regression analysis. Conclusion: Bayesian analysis is better than multiple logistic regression analysis in predicting the probability of a malignancy in solitary pulmonary nodules but the difference was not statistically significant.

• Tuberculosis and Respiratory Diseases
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• v.65 no.4
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• pp.269-276
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• 2008

Background: Although the prevalence of tuberculosis infections (PTBI) is one of the basic epidemiologic indices, no survey has been carried out since 1995 because the nation-wide tuberculosis prevalence survey was changed to a surveillance system. Subjects without a BCG scar are examined in a tuberculin survey. However, it is very difficult to select these subjects under high vaccination coverage. It is important to evaluate the impact of BCG vaccinations on the tuberculin response and estimate the PTBI regardless of the BCG vaccination status. Methods: A nation-wide, school-based cross-sectional tuberculin survey was carried out among first graders in elementary school in 2006. A total of 5,148 children in 40 schools were selected by quota sampling. Tuberculin testing with 0.1 ml of two tuberculin units of PPD RT23 was carried out on 4,018 children. The maximum transverse diameter of induration was measured 48 to 72 hours later. The presence of a BCG scar was checked separately. Results: There were no BCG scars in 6.3% of the subjects. The mean induration size of tuberculin testing was $3.7{\pm}4.4mm$, which included 1,882 (46.8%) subjects with an induration size of 0 mm. The PTBI was 10.9% (439 subjects) using a cut-off point of ${\geq}10mm$ (conventional method). The annual risk of tuberculosis infections (ARTI) was 1.9% when the mean age of the subjects was assumed to be 6 years. There was no difference in the PTBI according to the presence or absence of a BCG scar [11.2% vs 7.6% (OR: 1.54, 95% CI: 0.98~2.43)]. Using a mirror image technique with 16 mm as the cut-off point, the PTBI and ARTI had decreased to 2.4% and 0.4% respectively. Conclusion: PTBI and ARTI, as estimated by conventional methods, appear to be high among BCG vaccinated children. A mirror image technique is more suitable for estimating the indices in a country with an intermediate burden of tuberculosis than the conventional method.

• Korean Journal of Environmental Agriculture
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• v.38 no.1
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• pp.54-60
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• 2019

BACKGROUND: Hydrogen fluoride is one of the 97 accident preparedness substances regulated by the Ministry of Environment (Republic of Korea) and chemical accidents should be managed centrally due to continual occurrence. Especially, hydrogen fluoride has a characteristic of rapid diffusion and very toxic when leaking into the environment. Therefore, it is important to predict the impact range quickly and to evaluate the residual contamination immediately to minimize the human and environmental damages. METHODS AND RESULTS: In order to estimate the accident impact range, the off-site consequence analysis (OCA) was performed to the worst and alternative scenarios. Also, in order to evaluate the residual contamination of hydrogen fluoride in crop, the samples in accident site were collected from 15-divided regions (East direction from accident sites based on the main wind direction), and the concentration was measured by fluoride ($F^-$) ion-selective electrode potentiometer (ISE). As a result of the OCA, the affected distance by the worst scenario was estimated to be >10 km from the accident site and the range by the alternative scenario was estimated to be about 1.9 km. The residual contamination of hydrogen fluoride was highest in the samples near the site of the accident (E-1, 276.82 mg/kg) and tended to decrease as it moved eastward. Meanwhile, the concentrations from SE and NE (4.96~28.98 mg/kg) tended to be lower than the samples near the accident site. As a result, the concentration of hydrogen fluoride was reduced to a low concentration within 2 km from the accident site (<5 mg/kg), and the actual damage range was estimated to be around 2.2 km. Therefore, it is suggested that the results are similar to those of alternative accident scenarios calculated by OCA (about 1.9 km). CONCLUSION: It is difficult to estimate the chemical accident-affecting range/region by the OCA evaluation, because it is not possible to input all physicochemical parameters. However simultaneous measurement of the residual contamination in the environment will be very helpful in determining the diffusion range of actual chemical accident.

• Health Policy and Management
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• v.34 no.2
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• pp.196-210
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• 2024

Background: In January 2018, revised elderly fixed outpatient copayment for the elderly were implemented. When people ages 65 years and older receive outpatient treatment at clinic-level medical institutions (clinic, dental clinic, Korean medicine clinic), with medical expenses exceeding 15,000 won but not exceeding 25,000 won, their copayment rates have decreased differentially from 30%. This study aimed to examine the changes of health utilization of elderly after revised elderly fixed outpatient copayment. Methods: We used Korea health panel data from 2016 to 2018. The time period is divided into before and after the revised elderly fixed outpatient copayment. We conducted Poisson segmented regression to estimate the changes in outpatient utilization and inpatient utilization and conducted segmented regression to estimate the changes in medical expenses. Results: Immediately after the revised policy, the number of clinic and Korean medicine outpatient visits of medical expenses under 15,000 won decreased. But the number of clinic outpatient visits in the range of 15,000 to 20,000 won and Korean medicine clinic in the range of 20,000 to 25,000 won increased. Copayment in outpatient temporarily decreased. The inpatient admission rates and total medical expenses temporarily decreased but increased again. Conclusion: We confirmed the temporary increase in outpatient utilization in the medical expense segment with reduced copayment rates. And a temporary decrease in medical expenses followed by an increase again. To reduce the burden of medical expense among elderly in the long run, efforts to establish chronic disease management policies aimed at preventing disease occurrence and deterioration in advance need to continue.

• Economic and Environmental Geology
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• v.36 no.6
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• pp.457-467
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• 2003

Soil Precise Investigation(SPI) for river deposits and farmland soils around Goro abandoned Zn-mine, Korea was performed to assess the pollution level of heavy metals(As. Pb, Cd, Cu) and to estimate the remediation volume for contaminated soils. Total investigation area was about 950000 $m^2$, which was divided into each section of 1500 $m^2$ corresponding to one sampling site and 545 samples for surface soil(0-10cm in depth) and 192 samples for deep soil(10-30cm in depth) from the investigation area were collected for analysis. Concentrations of Cu, Cd, Pb at all sample sites were shown to be lower than Soil Pollution Warning Limit(SPWL). For arsenic concentration, in surface soils, 20.5% of sample sites(104 sites) were over SPWL(6mg/kg) and 6.7%(34 sites) were over Soil Pollution Counterplan Limit(SPCL: 15mg/kg) suggesting that surface soils were broadly contaminated by As. For deep soils, 10.4% of sample sites(18 sites) were over SPWL and 0.6%(1 site) were over SPCL. Four pollution grades for sample locations were prescribed by the Law of Soil Environmental Preservation and Pollution Index(PI) for each soil sample was decided according to pollution grades(over 15.0 mg/kg, 6.00-15.00 mg/kg, 2.40-6.00 mg/kg, 1.23-6.00 mg/kg). The pollution contour map around Goro mine based on PI results was finally created to calculate the contaminated area and the remediation volume for contaminated soils. Remediation area with over SPWL concentration was about 0.3% of total area between Goro mine and a projected storage dam and 0.9% of total area was over 40% of SPWL. If the remediation target concentration was determined to over background level concentration, 1.1% of total area should be treated for remediation. Total soil volume to be treated for remediation was estimated on the assumption that the thickness of contaminated soil was 30cm. Soil volume to be remediated based on the excess of SPWL was estimated at 79,200$m^3$, soil volume exceeding 40% of SPWL was about 233,700 $m^3$, and soil volume exceeding the background level(1.23 mg/kg) was 290,760 TEX>$m^3$.

• Quality Improvement in Health Care
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• v.4 no.1
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• pp.50-63
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• 1997

Background : A pressure sore was defined as any skin lesion caused by unrelieved pressure and resulting in damage to underlying tissue. The health care institutions in the United States were reported the incident rate of pressure sores ranging from 6 to 14 %. Intensive Care Unit needed highest quality of care has been found over 40% incidence rate of pressure sore. Also, Annual expenditures for the care of pressure sores in patients in the United States have been estimated to be $7.5 billion; furthermore, 50 percent more nursing time is required to care for patients with pressure sore in comparison to the time needed to implement preventive measures against pressure sore formation. However, In Korea, there were little reliable reports, or researches, about incidence rates of pressure sore in health care institution including intensive care unit and about the integrated approach like CQI action team for risk assessment, prevention and treatment of pressure ulcers. Therefore, this study was to develop pressure sore risk assessment tool and the protocol for prevention of pressure sore formation through CQI action team activities, to monitor incident rate of pressure sore and the length of sore formation for patients at high risk, and to approximately estimate nursing time for sore dressing during research period as the effect of CQI action team. Method : CQI action team in intensive care unit, launched since early 1996, reviewed the literature for the standardized risk assessment tool, developed the pressure sore assessment tool based on the Braden Scale, tested its validity, compared on statistics including incidence rate of pressure sore for patients at high risk. Throughout these activities, CQI action team was developed the protocol, called as St. Marys hospital Intensive Care Unit Pressure Sore Protocol, shifted the emphasis from wound treatment to wound prevention. After applied the protocol to patients at high risk, the incident rate and the period of prevention against pressure development were tested with those for patients who received care before implementation of protocol by Chi-square and Kaplan-Meier Method of Survival Analysis. Result : The CQI action team found that these was significant difference of in incidence rate of pressure sores between patients at high risk (control group) who received care before implementation of protocol and those (experimental group) who received it after implementation of protocol (p<.05). 25% possibility of pressure sore formation was shown for the patients with 6th hospital day in ICU in control group. In experimental group, the patients with 10th hospital day had 10% possibility of pressure sore. Therefore, there was significant difference(p<.05) in survival rate between two groups. Also, nursing time for dressing on pressure sore in experimental group was decreased as much as 50% of it in control group. Conclusion : The collaborative team effort led to reduced incidence, increased the length of prevention against pressure sore, and declined nursing care times for sore dressing. However, there have had several suggestions for future study. The preventive care system for pressure sore should be applied to patients at moderate, or low risk throughout continuous CQI team activities based on Bed Sore Indicator Fact Sheet. Hospital-wide supports, such as incentives, would be offered to participants for keeping strong commitment to CQI team. Also, Quality Information System monitoring incidents and estimating cost of poor quality, like workload (full time equivalence) or financial loss, regularly in a hospital has to be developed first for supporting CQI team activities as well as empowering hospital-wide QI implementation. Being several limitations, this study would be one of the report cards for the CQI team activities in intensive care unit of an acute hospital and a trial of quality improvement of health care in Korea.

• Journal of Korea Spatial Information System Society
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• v.10 no.4
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• pp.77-88
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• 2008

There has been growing demands to manage the water quality of west coastal region due to the large scale urbanization along the coastal zone, the possibility of application of TMDL(Total Maximum Daily Loadings) to Han river, and the natural disaster such as oil spill incident in Taean, Chungnam. However, no system has been developed for such purposes. In this background, the demand of GIS based effective water quality management has been increased to monitor water quality environment and propose best management alternatives for Han river and Kyeonggi bay. This study mainly focused on the development of integrated water quality management system for Han river bas in and its estuary are a connected to Kyeonggi bay to support integrated water quality management and its plan. Integration was made based on GIS by spatial linking between water quality attributes and location information. A GIS DB was built to estimate the amount of generated and discharged water pollutants according to TMDL technical guide and it included input data to use two different water quality models--W ASP7 for Han river and EFDC for coastal area--to forecast water quality and to suggest BMP(Best management Practices). The results of BOD, TN, and TP from WASP7 were used as the input to run EFDC. Based on the study results, some critical areas which have relatively higher pollutant loadings were identified, and it was also identified that the locations discharging water pollutant loadings to river and seasonal factor affected water quality. And the relationship of water quality between river and its estuary area was quantitatively verified. The results showed that GIS based integrated system could be used as a tool for estimating status-quo of water quality and proposing economically effective BMPs to mitigate water pollution. Further studies need to be made for improving system's capabilities such as adding decision making function as well as cost-benefit analysis, etc. Also, the concrete methodology for water quality management using the system need to be developed.

• Tuberculosis and Respiratory Diseases
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• v.42 no.3
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• pp.332-341
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• 1995

Background: Measurement of bronchodilator response is necessary to establish reversibility of airflow obstruction that was helpful to estimate the diagnosis, treatment, and prognosis in obstructive airway disease. An useful index should be able to detect the bronchodilator response more sensitively not related with degree of airflow obstruction and also be independent of initial $FEV_1$. Method: Sensitivities of bronchodilator response in each group classified by degree of airflow obstruction in $FEV_1$, FVC, $FEF_{25\sim75%}$, Isovolume $FEF_{25\sim75%}$, sGaw were studied and correlation coefficients were calculated between initial $FEV_1$ and reversibilities expressed as absolute, %initial, % predicted, %possible in $FEV_1$. Result: Sensitivities of bronchodilator response were 61.5% in FVC, Isovolume $FEF_{25\sim75%}$ and sGaw, in severe group, and 56.3% in Isovolume $FEF_{25\sim75%}$ and sGaw, in moderate group, and 62.5% in $FEV_1$ and sGaw and 50.0% in FVC and Isovolume $FEF_{25\sim75%}$, in mild group, and 60.0% in sGaw and 58.0% in Isovolume $FEF_{25\sim75%}$ in total patients. Correlation coefficients between initial $FEV_1$(L) and absolute, % initial, % predicted, % possible were 0.15, -0.22(p<0.05), 0.02, 0.24(p<0.05) and correlation coefficients between initial $FEV_1$(% predicted) and absolute, % initial, % predicted, %possible were 0.06, -0.28(p<0.05), 0.08, 0.39(p<0.05). Conclusion: Volume related parameters were more sensitive index not related with degree of airway obstruction and the change in $FEV_1$ expressed as % predicted was the least dependent on initial $FEV_1$ and reversibilities, expressed as % initial or as % possible(predicted minus initial $FEV_1$)were correlated with initial $FEV_1$.

• Tuberculosis and Respiratory Diseases
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• v.57 no.5
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• pp.434-438
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• 2004

Background : An excessive endotracheal cuff pressure can cause tracheal injury, and insufficient cuff pressure may not generate an effective cuff seal. The peak inspiratory pressure influences the minimal occlusion pressure of the endotracheal tube cuff. However, the relationship between the minimal occlusion pressure and the tidal volume has not been investigated. This study was conducted to estimate the relationship between the tidal volume and the minimal occlusion pressure of the cuff. Methods : Ten mechanically ventilated patients were included. The minimal occlusion pressure of the cuff was measured using a pressure gauge. The basal tidal volume was increased and decreased as much as 10% whilst maintaining the same peak inspiratory pressure. The, minimal occlusion pressures were then measured in the high and low tidal volume state, respectively. Results : The peak inspiratory pressure was $32.6{\pm}4.72cmH_2O$ and the minimal occlusion pressure was $19.0{\pm}2.26$ mmHg in the basal ventilator setting. There was a significant relationship between the peak inspiratory pressure and the minimal occlusion pressure(r=0.77, p<0.01). The minimal occlusion pressure of the cuff was increased to $20.3{\pm}2.4$ mmHg in the high tidal volume state(p<0.05), and decreased to $16.8{\pm}3.01$ mmHg in the low tidal volume state (p<0.001). Conclusion : The minimal occlusion pressure of the cuff can be influenced by changes in the tidal volume as well as by the peak inspiratory pressure.

• Tuberculosis and Respiratory Diseases
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• v.64 no.2
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• pp.87-94
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• 2008

Background: Surveillance of TB drug resistance (DR) is essential for providing information on the magnitude and trends in resistance, for developing treatment guidelines and for monitoring the effect of interventions. Up to now national surveys of drug resistance of M. tuberculosis have been conducted four times since 1994 among patients registered at health centers. The purpose of this study is to estimate the prevalence of primary drug resistance among new cases identified in private sector, and to compare it with the previous national drug resistance surveys. Methods: The study collected results of drug susceptibility testing (DST) performed at the Korean Institute of Tuberculosis by the request of private sector from January 2003 to December 2005, and then finally selected new cases for the analysis from the database of Korean TB Surveillance (KTBS) by matching patients' name and social identification numbers. Results: Of the 5,132 new patients included in the study, 689 (13.4%) patients were found to have drug resistance at least one drug, 530 patients (10.3%) were isoniazid resistant, 195 patients (3.8%) were multi-drug resistant (MDR), and 21 patients (0.4%) were extensively drug resistant (XDR). The rate of drug resistance tended to decrease annually but it was not statistically significant. When compared with previous national DR surveys in 2003 and in 2004 respectively, they were not significantly different. Conclusion: The prevalence of DR among new cases managed in the private sector did not show significant difference from that of new patients registered in the public sector in the same year.