• Communications for Statistical Applications and Methods
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• 제25권2호
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• pp.173-184
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• 2018

In medical or public health research, it is common to encounter clustered or longitudinal count data that exhibit excess zeros. For example, health care utilization data often have a multi-modal distribution with excess zeroes as well as a multilevel structure where patients are nested within physicians and hospitals. To analyze this type of data, zero-inflated count models with mixed effects have been developed where a count response variable is assumed to be distributed as a mixture of a Poisson or negative binomial and a distribution with a point mass of zeros that include random effects. However, no study has considered a situation where data are also censored due to the finite nature of the observation period or follow-up. In this paper, we present a weighted version of zero-inflated Poisson model with random effects accounting for variable individual follow-up times. We suggested two different types of weight function. The performance of the proposed model is evaluated and compared to a standard zero-inflated mixed model through simulation studies. This approach is then applied to Medicaid data analysis.

• Asian Journal for Public Opinion Research
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• 제3권3호
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• pp.131-144
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• 2016

One of the main indicators of the health status of a country is the Maternal Mortality Rate (MMR). In order to improve the MMR in Indonesia, the government has made a number of primary health centers (PHC) capable of providing basic obstetric and neonatal emergency care (PONED) services. The aim of this research is to learn how well PONED services have been implemented at the Baso PHC in Agam Regency as of 2015. We used a qualitative approach, with in-depth interviews and observations from June-August 2015. Ten respondents participated in the in-depth interviews, and observations were made about the infrastructure. The validity of the data is based on the standard of credibility, transferability, dependability, and confirmability of the content of the interviews. The analysis shows that there are still some obstacles in PONED PHC implementation, including the lack of human resources at the PHC and insufficient facilities, funding, and oversight, which causes many cases that should be handled by a PONED team to be referred to the hospital. Suggestions are provided to help improve policies and ultimately patient care.

• International Journal of Internet, Broadcasting and Communication
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• 제12권3호
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• pp.32-38
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• 2020

The deployment of geographically distributed wireless sensors has greatly elevated the capability of monitoring structural health in social-overhead capital (SOC) public infrastructures. This paper deals with the utilization of a distributed mobility management (DMM) approach for the deployment of wireless sensing devices in a structural health monitoring system (SHM). Then, a wireless sensing mechanism utilizing low-energy adaptive clustering hierarchy (LEACH)-based clustering algorithm for smart sensors has been analyzed to support the seamless data transmission of structural health information which is essentially important to guarantee public safety. The clustering of smart sensors will be able to provide real-time monitoring of structural health and a filtering algorithm to boost the transmission of critical information over heterogeneous wireless and mobile networks.

• Asian Pacific Journal of Cancer Prevention
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• 제14권12호
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• pp.7237-7241
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• 2013

Background: Smokeless tobacco use in South Asia is believed to be a significant contributor to morbidity and mortality. In India, only a few studies involving health educational intervention by health care providers have demonstrated reduction in smokeless tobacco usage. In the present study we assessed the cessation efforts towards smokeless tobacco by physicians in two high tobacco prevalence states of India. The study also identified opportunities and barriers for integration of tobacco cessation services in routine practices of physicians. Materials and Methods: This mixed method study involved qualitative (phase I) and quantitative research study (phase II). In phase I, 59 in-depth interviews with physicians were conducted. In phase II, a quantitative study conducted among 238 physicians. An inductive approach was followed to analyze qualitative data using ATLAS. Ti software. The Chi-square test was employed to test the association between different variables of interest using SPSS version 17. Results: The majority of physicians related only respiratory problems and cancer with smokeless tobacco. Other major health effects like cardio-vascular problems, oral diseases, and effects on reproductive and neonatal health were recognized only by a few physicians. The age-group of 10-19 years was identified as most vulnerable to smokeless tobacco use. Less than one-third of physicians reported recording smokeless tobacco history of all patients. Findings indicated that less than half of physicians provided information on harmful health effects of smokeless tobacco with regard to specific diseases. Conclusions: The study revealed a low level of knowledge of physicians about harmful effects of tobacco and their suboptimal engagement in tobacco control practices. The study indicates the need of capacity building initiatives to equip physicians with skills in tobacco cessation.

• 한국보건간호학회지
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• 제27권3호
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• pp.564-577
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• 2013

Purpose: The purpose of this study was to address differences between mental health according to sasang constitution and ego state among college students. Methods: Data for this cross-sectional study were collected by administration of questionnaires eliciting Woo's ego state scale, QSCC II for the sasang constitution classification, and SCL-90-R for mental health to 393 college students. Analysis was performed using IBM SPSS (version 19.0). Results: The Free Child ego and Adapted Child ego differed significantly among sasang types. The ego-gram pattern of So-eum type exhibited the N pattern (Nurturing Parent (NP)>Adapted Child (AC)>Adult (A)>Free Child (FC)>Critical Parent (CP), AC-high type), however, the ego-gram pattern of other constitution types showed the M pattern (NP>FC>A>AC>CP). No statistically significant differences in mental health were observed among sasang types, however, among ego states, AC and CP showed negative correlation with mental health status. Between So-eum type and So-yang type, AC was the factor predicting mental health. Between Tae-eum type and undefined type, AC and CP were factors predicting mental health. Conclusion: These findings suggest that sasang constitution could be an important factor in understanding the ego state and mental health status. We conclude that sasang constitution should be considered in interpretation of mental health status presentation in clients.

• 교육시설 논문지
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• 제20권1호
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• pp.27-36
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• 2013

The purpose of this study is to provide the configuration alternatives for the special classroom of the elementary school reflecting current trends of the health promotion education. Initiated by WHO(World Health Organization), the concept of health-promoting school has been widely advocated as an approach to enhance public health through school based health promotion. Korean Ministry of Education has also adopted the concept and many elementary schools has been participating in developing the curricula and educating students as the health promoting model schools. This study analyzes methodologies and education programs of current health promoting curriculum of the schools since 2009, explores the spacial features of other public facilities offering similar education program and surveys relating teachers. Based on the analysis, the study seeks the basic elements for health promoting classroom and deduces several classroom space configurations to optimize students' learning effects. This study can be a case method for other classroom typology studies especially with the current diversification tendency of elementary school education services.

• Asian Pacific Journal of Cancer Prevention
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• 제17권2호
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• pp.867-872
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• 2016

Background: Esophageal cancer is one of the most serious malignancies. Due to the aggressive nature of this cancer, the prognosis is poor. A network meta-analysis with simultaneous comparison of multiple treatments can help determine better treatment options that have higher effects on overall survival of patients with lower adverse events. The aim of this review is to simultaneously compare efficacy and adverse events of treatment interventions for esophageal cancer. Materials and Methods: In this review, only randomized control trials (RCT) will be considered for network meta-analysis. All international electronic databases including Medline, Web of Sciences, Scopus, Cochran's library, EMBASE and Cancerlit will be searched to find randomized control trials which compared two or more treatment interventions for esophageal cancer. A network plot will be drawn for visual representation of all available treatment interventions. Bayesian approach will be used to combine the direct and indirect evidence. Treatment effects (e.g. hazard ratio for time to event outcomes, risk ratio for binary outcomes, and rate ratio for count outcomes with 95% credible interval) will be reported. Moreover, cumulative probability of the treatment ranks will be reported using the surface under the cumulative ranking (SUCRA) graphs. Consistency assumption will be assessed by the loop-specific and design-by-treatment interaction approaches. Conclusions: The results of this study may be helpful for the patients, clinicians and health policy makers in selecting treatments that have the best effect on survival and lowest adverse events.

• 농촌의학ㆍ지역보건
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• 제30권2호
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• pp.227-240
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• 2005

현재 건강증진에 대한 다양한 논의가 진행 중으로 학자마다 정의가 다르고 동일한 학자도 문맥에 따라 다르게 사용하고 있는 경우가 많으며, 건강증진 내용의 스펙트럼이 행태변화만을 포함하는 가장 좁은 의미수준부터 지원체계, 질병예방, 건강보호 등을 포괄하는 가장 넓은 의미까지 다양하다. 건강증진의 개념을 어떤 것으로 받아들이든 정책, 개인 기술, 환경변화 등의 측면에서 지역사회(community)가 인간 집단을 포괄하고 있다는 점에서 건강증진의 가장 중요한 장이라는 것은 별로 이론이 없는 것 같다. 건강증진의 개념과 정의가 형성되어가는 시점에서 몇가지 주요한 논란점들이 있는데 그중에서도 건강증진의 접근전략에서 인구집단 전략과 고위험군 접근전략 간의 대립점이 가장 첨예한 논란중의 하나이다. 정부의 정책, 조직의 우선순위, 전문인의 행태 등이 각 개인의 노력과 같이 중요하거나 혹은 더 중요하다는 것이 이러한 입장이며, 건강과 행태에 영호t을 미칠 수 있는 사회체계와 환경에 대해 보다 큰 의사결정권을 가지는 것이 건강증진을 위해 중요하다고 주장한다. 이러한 이유로 건강증진을 논함에 있어 지역사회 전체를 통한 접근이 점점 더 강조하고 있다. 지역사회 건강증진 프로그램은 지역사회자원을 효율적 활용을 통한 보다 강화되고, 통합된, 포괄적, 협력적으로 수행되어져야한다. 이러한 방향은 1986년 오타와 헌장에의 건강증진의 정의에서 살펴볼 수 있으며, 광범위한 건강의 결정요인에 대한 접근이 필수적임을 알 수 있다. 신체활동은 건강의 주요한 결정요인이다. 인구집단 전략은 개인에 대한 신체활동 교육하는 것이 충분하지 않음을 제안한다. 개인 수준의 행태변화도 중요한 것이지만 이에 대한 집단적 변화를 불러줄 환경적 변화를 위한 전략과 균형을 이루어야 한다. 건강증진을 위한 신체활동 인구집단 전략은 사회적, 물리적 지지환경을 강화하고, 국가, 광역 및 기초자치 단체 수준에서 다양한 지역사회자원을 연계, 통합하여야 한다. 지속적인 공공교육 및 사회마케팅이 지역사회 신체활동 조직 및 기관, 산업장, 학교 등을 대상으로 지역사회 모든 주민들이 신체활동에 대한 관심을 증진시킬 수 있도록 협동적으로 이루어져야 한다. 정부와 기관 및 시민들은 지역사회차원의 운동개념으로 주최하고 참여하여 사회적 규범화 작업에 동참하여야한다. 기본적으로 적절하고 충분한 재원의 지원, 인적자원의 개발, 정책 및 입법이 제공되어야한다. 또한 국내외적으로 연구개발과 지식의 공유 및 교환이 요구된다. 한국에서는 전략적 우선순위가 높은 신체활동 프로그램의 범주를 지역 보건소를 기반으로 한 환경적 지원, 생애주기별 접근, 고위험군 및 질환군 접근 등으로 구분하였다. 지역사회에 기반한 신체활동 핵심 프로그램으로 하부구조 구축, 지원적 환경 제공, 지역사회 캠페인, 건강증진 교육 및 홍보, 노인 및 비만인을 위한 신체활동 프로그램, 그리고 운동처방 프로그램 등을 포함하였다. 신체활동증진 및 운동사업은 사회적, 물리적 지원환경 조성 등을 중심으로 전개하며, 보건소를 중심으로 한 운동사업은 지역 공공기관 및 민간기관 등과 연계하여 프로그램을 연동하며, 홍보 및 교육은 지역의 운동단체 및 기관, 각급 학교 등과 협력하여 운동에 대한 관심을 고취하고 신체활동 및 운동을 생활화하는 프로그램을 시행토록 한 전략을 지속, 강화토록 하여야 할 것이다.

• Toxicological Research
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• 제17권
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• pp.323-327
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• 2001

March 19, 1999, the renovation qf the runway of the Bo-Fai ai1field in Hua Hin, Prachubk-erikhan, Thailand, unearthed chemicals which were left over from the project "anch Hand Operation" held during the Vietnam war era. The chemical mixtures were analyzed by the US EPA, the Department oj Medical Sciences (DMSc), Ministry oj Public Health (MoPH) and the Pollution Control Department (PCD), the Ministry oj Science Technology and Environment (MOSTE) of Thailand, The samples were found to contain several defoliants used in the operation. They were 2,4-D, 2,4,5-T, Dicamba, Cocydelic acid, and Dioxins. Due to the complexity of the issue, the multiplicity of possible health effects, and the socio-economic implications for imports and exports, the Thai Society of Toxicology submitted a proposal to request World Health Organization (WHO), Geneva. The assistance is for the area of chemical safety and called for immediate action to explore the magnitude qf risk involved with Dioxins. In this paper we present our approach to health risk assessment which takes into an account the epidemiological studies of high-risk group exposed to the Ranch Hand operation. Dioxins are endocrine disruption chemicals which public concerns are developed due to presumption that a hazard exists (www.eva.gov/dioxins/html) for which current methodologies are deemed insufficient. The recent concepts of how oxidative stress toxicants may affect health end points and biomarkers of exposure of exposed individuals are discussed. While research activities are undergoing, The Thai Society of Toxicology do not anticipate significant risk to local residents and the environment due to our concurrence with opinion from the international experts invited by the World Health Organization proposed to the local experts at a workshop in Bangkok.n Bangkok.

• 보건행정학회지
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• 제13권3호
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• pp.35-51
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• 2003

This study purports to develop a quality assessment tool for the process of health promotion programs at public health centers(PHC). The draft of the assessment tool developed by the literature was distributed to 242 staffs who were in charge of the health promotion programs at PHCs for evaluating the feasibility of the tool on September and October 2002. The major results of the study were as follows; The quality assessment tool developed in the study consisted of four domains: strategic planning, program management, monitoring and evaluation, and resources and information. The strategic planning dealt with the function of the planning staff and committees, community data analysis, the feasibility of the program, and the approach methods for attaining the goal of the program. The program management included the items on the qualification and power of the program staff. The monitoring and evaluation included the items on the reporting and communication among program units, and feed back after monitoring. Finally, the resources and information dealt with community networking, clients' response, and consulting activity of the staff. The validity of the tools was tested and partly supported by both formative and criterion-related methods. The assessment tools developed in this study could be used by health promotion workers in the self-evaluation of the program quality. In conclusion, the quality assessment tool developed in the study will be a good safeguard for assuring the quality of the process of health promotion programs.