• 보건행정학회지
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• 제28권4호
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• pp.352-359
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• 2018

Background: The purpose of this study is to propose an analysis of trends and characteristics of high-cost patients who take over 40% of total national health insurance medical expenses. Methods: It has been analyzed the tendency of high-cost patients by open data based on the medical history information of 1 million people among national health insurance subscriber from 2002 to 2015. To conduct detailed study of characteristics of high-cost patients, multiple regression has been performed by sex, age, residence, main provider, and admission status based on the top 5% group. Results: The amount of medical expenses and the number of high-cost patients have gradually increased in decades. The number of high-cost patients for Korean won (KRW) 5,000,000 category has increased by 7.6 times, KRW 10,000,000 category has increased by 14.1 times in comparing of year 2002 and 2015. Top 5% medical expenses have increased by 4.6 times. In consideration of the characteristics of patients, the incidence of high medical expenses has been higher in female patients than male ones, the older patients than in the younger. Patients residence in Gyeonsang or Jeonla province have had a high incidence of medical expenses than other area. The disease including dementia, cerebral infarction, and cerebrovascular disease for high-cost patients has been also increased. Conclusion: The major increase factor for high medical expenses is the aging of population. The elderly population receiving inpatient care residing in the province that increases high medical costs have to management. There is an urgent need to develop a mechanism for predicting and managing the cost of high-cost medical expenses for patients who have a heavy financial burden.

• 한국산업보건학회지
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• 제32권2호
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• pp.129-136
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• 2022

Objectives: Given the real problems at industrial sites related to the Serious Accident Punishment Act (SAPA), it has become controversial as a particularly important issue in terms of occupational safety and health. I intend to examine in detail what are the problems and how to approach them. Methods: The contents of SAPA were reviewed focusing on whether its provisions conform to the principles of occupational safety and health, whether they fit the related legal theory, and whether they are effective for accident prevention. The purpose of this study is to examine whether there is a problem with SAPA from the perspective of the effectiveness of accident prevention by combining occupational safety & health management theory, and legal theory. Results: In order to ensure the effectiveness of SAPA, it should be revised to increase the predictability and implementation of safety and health measure standards. Otherwise, it is expected that there will be not only economic and social costs in the short term, but also side effects that disrupt the safety law system, resulting in a considerable number of post-mortem conditions in the mid- to long term. Conclusions: It is easy to see in comparative law that raising the legal punishment alone does not have the effect of preventing industrial accidents. SAPA should be revised as soon as possible in the direction of faithfully and elaborately reorganizing the standards for safety and health measures.

• 대한영양사협회학술지
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• 제28권2호
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• pp.67-84
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• 2022

This study aimed to explore the status of food service outsourcing behavior of long-term care institutions (LTCIs) through a cross-sectional survey using a questionnaire administered between July 16th and August 7th, 2020. The survey respondents were either dietitians or facility managers, who worked at 731 nursing homes, 477 group homes, and 673 day-care centers. Approximately 25.9% of nursing homes, 11.7% of group homes, and 33.1% of day-care centers used a managed-services company to operate their food service units. The main reason for outsourcing food service by nursing homes was related to the staffing of dietitians and cooks, whereas group homes and day-care centers outsourced food services due to factors relating to meal costs and the cooking process. Almost all the LTCIs entered into private contracts for outsourced food services. Only a few food service contracts included the types of meals, nutrition standards such as protein and calories per meal, and the parameter or ratio of food cost. Of the respondents, 84.5% from nursing homes, 87.5% from group homes, and 87.1% from day-care centers agreed that the quality of outsourced food services of the LTCIs should be regulated. Meals are essential for maintaining the health and functional status of LTCI users. As more LTCIs outsource their food services, we suggest the following: (1) Increasing the minimum dietitian staffing standards for LTCIs as per the Welfare of Senior Citizens Act and requiring at least one dietitian for every nursing home, (2) Making it mandatory to use a standard food service contract template when drafting food service contract, and (3) Developing realistic standards for food service operations considering the size and operation type of the LTCIs.

• 치위생과학회지
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• 제23권2호
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• pp.154-168
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• 2023

Background: Legal regulations and fees have been established in Korea to provide visiting oral health care services to individuals with long-term care insurance (LTCI). However, beneficiaries of this service are very limited. Therefore, to improve the Korean system we propose a comparative analysis with the Japanese system. Methods: This study is a descriptive analysis based on secondary data, such as statistics, laws, and service record forms from Korea and Japan. The most recent institutional documents were obtained through a Google search. The variables investigated were financial resources of LTCI, co-payment structure, monthly limit of LTCI benefits, care levels of LTCI, service providers, service costs, contents of service, and the number of cases of service. Results: In both Korea and Japan, LTCI is financed through a combination of taxes and insurance premiums. However, the monthly limit for receiving LTCI services in Japan is about 2.4 times higher than in Korea. Visiting medical and dental treatment is also possible in Japan. Furthermore, nursing staff can provide daily oral health care services according to dental hygienists' instruction unlike Korea. Oral health care services in Korea are focused on oral hygiene and prevention of oral diseases, while Japan additionally provides oral function screening, patient education for oral health management, and training for nursing staff to enhance oral function, eating, and swallowing of the patients. Conclusion: We concluded that the possibility of visiting dental treatment, differences in monthly limit of LTCI benefits, oral function assessment and guidance, as well as collaboration with other healthcare professionals contributed to the difference in the frequency of utilization of visiting oral health care services between Korea and Japan.

• Safety and Health at Work
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• 제15권2호
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• pp.228-235
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• 2024

Background: Glove reuse poses risks, as chemicals can persist even after cleaning. Decontamination methods like thermal aeration, recommended by US OSHA, vary in effectiveness. Some studies show promising results, while others emphasize the importance of considering both permeation and tensile strength changes. This research advocates for informed glove reuse, emphasizing optimal thermal aeration temperatures and providing evidence to guide users in maintaining protection efficiency. Methods: The investigation evaluated Neoprene and Nitrile gloves (22 mils). Permeation tests with toluene and acetone adhered to American Society for Testing Materials (ASTM) F739 standards. Decontamination optimization involved aeration at various temperatures. The experiment proceeded with a maximum of 22 re-exposure cycles. Tensile strength and elongation were assessed following ASTM D 412 protocols. Breakthrough time differences were statistically analyzed using t-test and ANOVA. Results: At room temperature, glove residuals decreased, and standardized breakthrough time (SBT)₂ was significantly lower than SBT₁, indicating reduced protection. Higher temperature decontamination accelerated residual removal, with ∆SBT (SBT₂/SBT₁) exceeding 100%, signifying restored protection. Tensile tests showed stable neoprene properties postdecontamination. Results underscore thermal aeration's efficacy for gloves reuse, emphasizing temperature's pivotal role. Findings recommend meticulous management strategies, especially post-breakthrough, to uphold glove-protective performance. Conclusions: Thermal aeration at 100℃ for 1 hour proves effective, restoring protection without compromising glove strength. The study, covering twenty cycles, suggests safe glove reuse with proper decontamination, reducing costs significantly. However, limitations in chemical-glove combinations and exclusive focus on specific gloves caution against broad generalization. The absence of regulatory directives on glove reuse highlight the importance of informed selection and rigorous decontamination validation for workplace safety practices.

• 한국환경보건학회지
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• 제37권2호
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• pp.165-169
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• 2011

Between January 2010 and March 2011, there were three outbreaks of foot and mouth disease (FMD) in South Korea. Over 3.45 million animals (5,660 farms) were slaughtered, which was 33.3% of the existing pigs, 8.4% of dairy cows and 3.4% of cattle. FMD disaster costs were estimated at around three billion Korean won. Nine civil servants were killed, over 150 people were wounded and 4,788 landfills were confronted with a pollution problem. Vaccination and slaughter are the two basic alternatives for eradication of FMD. Altho ugh slaughter is more violent, risky and expensive than vaccination, the Korean government had chosen only slaughter eradication by the end of 2010. Even though over three million animals were killed, FMD spread out over most of the country. Finally, the government chose to begin vaccination. Following vaccination, outbreaks decreased dramatically. The purpose of this report is a cultural analysis of the related decision-making process, laws and systems. For the culture analysis, we utilize interviews, symposiums, laws, FMD manual, government reports and press releases. In conclusion, we found that the FMD massacre was influenced by cultural and organizational factors. The cultural factors were economism, cheapening of the value of life, biased perceptions and fears. The organizational factors were a closed process of decision-making, monopoly system, a small homogeneous group and group-think. Therefore, more studies will be needed for those factors of FMD disasters in national-scale cases.

• 여성건강간호학회지
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• 제15권4호
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• pp.261-269
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• 2009

Purpose: The purpose of this study was to investigate health management state during pregnancy, childbirth, and postpartum of immigrant women. Methods: A descriptive research design was employed. Data were collected from 182 immigrant women who lived in four provinces and D city. Subjects were completed the following questionnaires: demographic, medical service use, pregnancy and childbirth, and health management during the ante-postpartum. Results: The average age of subjects was 28.96 and 83 subjects (45.6%) were coming from Vietnam. 55 Subjects (30.2%) were within the low-income group with less than 4 million won per month. So, 62 subjects were uninsured women because of the expensive costs. Subjects mainly visited a health care center with their husband. On the using a health care center, subjects complained about communication difficulties and transportation problems. 42 Subjects were pregnant but 21.4% of pregnant subjects did not receive ante-natal care. Subjects got information about pregnancy and childbirth through their husbands and husband's family. Conclusion: Nursing intervention to manage the pregnancy, childbirth, and the postpartum of immigrant women need to be developed and should include strategies to take care of themselves after delivery and provide knowledge and information about ante-postpartum.

• 지역사회간호학회지
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• 제26권3호
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• pp.278-291
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• 2015

Purpose: This study was conducted to examine differences in health care utilization and related costs between before and after the introduction of the designated doctor system, and to find out factors making the differences. Methods: Data were collected from 200 medical aid beneficiaries having one or more chronic diseases, registered in the designated doctor system during the year of 2012, and the relationship between the use of health services and claimed medical expenses was analyzed through paired t-test and multiple regression analysis using the SPSS 18.0 program. Results: There was a decrease in the number of total benefit days and the number of outpatient and medication days, but some cases showed an increase after the designation of medical institution. In general, hospital stay increased after the introduction of the system. However, the number of medical institutions utilized was reduced in most cases after designation. Conversely, medical expenses increased in most cases after the designation of medical institution. Conclusion: These results suggest that a detailed scheme to designate medical institutions should be made in consideration of the seriousness of illness and classification of medical institutions not only for the beneficiaries' enhanced health but for the effective management of medical aid fund.

• 보건행정학회지
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• 제29권3호
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• pp.357-367
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• 2019

Background: This study evaluated the cost-effectiveness of 21 different national dyslipidemia screening strategies according to total cholesterol (TC) cutoff and screening interval among 40 years or more for the primary prevention of coronary heart disease over a lifetime in Korea, from a societal perspective. Methods: A decision tree was used to estimate disease detection with the 21 different screening strategies, while a Markov model was used to model disease progression until death, quality-adjusted life years (QALYs) and costs from a Korea societal perspective. Results: The results showed that the strategy with TC 200 mg/dL and 4-year interval cost \4,625,446 for 16.65105 QALYs per person and strategy with TC 200 mg/dL and 3-year interval cost \4,691,771 for 16.65164 QALYs compared with \3,061,371 for 16.59877 QALYs for strategy with no screening. The incremental cost-effectiveness ratio of strategy with TC 200 mg/dL and 4-year interval versus strategy with no screening was \29,916,271/QALY. At a Korea willingness-to-pay threshold of \30,500,000/QALY, strategy with TC 200 mg/dL and 4-year interval is cost-effective compared with strategy with no screening. Sensitivity analyses showed that results were robust to reasonable variations in model parameters. Conclusion: In this study, revised national dyslipidemia screening strategy with TC 200 mg/dL and 4-year interval could be a cost-effective option. A better understanding of the Korean dyslipidemia population may be necessary to aid in future efforts to improve dyslipidemia diagnosis and management.

• Safety and Health at Work
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• 제10권3호
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• pp.355-361
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• 2019

Background: Painters in the automotive sector are routinely exposed to volatile organic solvents, and the levels vary depending on the occupational health and safety controls enforced at the companies. This study investigates the levels of exposure to organic vapors and the existence of controls in the formal economy sector in southern Colombia. Methods: This is an exploratory study of an observational and descriptive character. An analysis of solvents is conducted via the personal sampling of painters and the analysis of samples using the National Institute for Occupational Safety and Health 1501 method. The amount of solvents analyzed varied according to the budget allocated by the companies. The person in charge of the occupational safety and health management system was interviewed to learn about the exposure controls implemented at the companies. Results: A medium exposure risk for toluene was found in one company. Another presented medium risk for carbon tetrachloride, xylene, ethylbenzene, and n-butanol. The others showed low risk of exposure and that the controls implemented were not sufficient or efficient. Conclusion: These results shed light on the working conditions of these tradespeople. The permissible limits established by Colombian regulations for the evaluated chemical contaminants were not exceeded. However, there were contaminants that exceeded the limits of action. The analysis of findings made it possible to propose improvements in occupational safety and health management systems to allow the optimization of working conditions for painters, prevent the occurrence of occupational diseases, and reduce costs to the country's health system.