Journal of Preventive Medicine and Public Health

Sang Il Lee

21 Articles

The Decline of Health-Related Quality of Life Associated with Some Diseases in Korean Adults.: Seol Ryoung Kil, Sang Il Lee, Sung Cheol Yun, Hyung Mi An, Min Woo Jo; J Prev Med Public Health. 2008;41(6):434-441.; DOI: https://doi.org/10.3961/jpmph.2008.41.6.434

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OBJECTIVES
This study was conducted to measure the decline in the health-related quality of life (HRQoL) associated with some diseases in South Korean adults. METHODS: The EQ-5D health states in the 2005 National Health and Nutrition Examination Survey (NHNES) and the Korean EQ-5D valuation set were used to obtain the EQ-5D indexes of the study subjects. Each disease group was defined when the subjects reported to the NHNES that they were diagnosed with the corresponding disease during the previous 1 year by physicians. Since the distributions of the EQ-5D indexes in each subgroup were negatively skewed, median regression analysis was used to estimate the effects of specific diseases on the HRQoL. Median regression analysis produced estimates that approximated the median of the EQ-5D indexes and there are more robust for analyzing data with many outliers. RESULTS: A total of 16,692 subjects (6,667 patients and 10,025 people without any disease) were included in the analysis. As a result of the median regression analysis, stroke had the strongest impact on the HRQoL for both males and females, followed by osteoporosis, osteoarthritis, rheumatic arthritis, and herniation of an intervertebral disc. While asthma had a significant impact on the HRQoL only in men, cataract, temporo-mandibular dysfunction, and peptic ulcer significantly affected the HRQoL only in women. CONCLUSIONS: Stroke and musculoskeletal diseases were associated with the largest losses of the HRQoL in Korean adults.

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Raed A. Joundi, Joel Adekanye, Alexander A. Leung, Paul Ronksley, Eric E. Smith, Alexander D. Rebchuk, Thalia S. Field, Michael D. Hill, Stephen B. Wilton, Lauren C. Bresee
Journal of the American Heart Association.2022;[Epub] CrossRef
Factors Affecting Health-Related Quality of Life in Multimorbidity
Eunmi Lee, Sunkyung Cha, Geun Myun Kim
Healthcare.2021; 9(3): 334. CrossRef
Factors Influencing on Health-Related Quality of Life among Men Osteoporosis Patients over 50 Years
Ji Young Kim, Youngran Yang
Korean Journal of Adult Nursing.2020; 32(2): 145. CrossRef
Health-Related Quality of Life and Related Factors in Persons with Preserved Ratio Impaired Spirometry: Data from the Korea National Health and Nutrition Examination Surve
I Re Heo, Ho Cheol Kim, Tae Hoon Kim
Medicina.2020; 57(1): 4. CrossRef
Cancer site differences in the health‐related quality of life of Korean cancer survivors: Results from a Population‐based Survey
Mikyung Ryu, Jee‐In Hwang
Public Health Nursing.2019; 36(2): 144. CrossRef
Factors affecting the health‐related quality of life in community‐dwelling elderly people
Geun Myun Kim, Myung Sun Hong, Wonjung Noh
Public Health Nursing.2018; 35(6): 482. CrossRef
Health-related quality of life assessment according to socio-demographic characteristics and health behavior among Gyeonggi-do citizens: focused on gender difference
Sun-Hee Joung, YeogSeon Hong, AeRee Sohn
Korean Journal of Health Education and Promotion.2015; 32(3): 33. CrossRef
Prediction Model for Health-Related Quality of Life of Elderly with Chronic Diseases using Machine Learning Techniques
Soo-Kyoung Lee, Youn-Jung Son, Jeongeun Kim, Hong-Gee Kim, Jae-Il Lee, Bo-Yeong Kang, Hyeon-Sung Cho, Sungin Lee
Healthcare Informatics Research.2014; 20(2): 125. CrossRef
A Study on Factors in Quality of Life of Patients with Acute Cerebral Infarction One Year after Diagnosis
Seung-Ok Shin, So Yeon Ryu
Journal of the Korea Academia-Industrial cooperation Society.2014; 15(1): 274. CrossRef
Effect of Arthritis and Comorbid Chronic Conditions on Health-related Quality of Life in Korean Elderly
Ji-Young No, Soon-Young Kim, In-Sun Kweon, Hae-Sung Nam
Journal of the Korea Academia-Industrial cooperation Society.2014; 15(6): 3751. CrossRef
Impact of Post-Stroke Cognitive Impairment with No Dementia on Health-Related Quality of Life
Jung Hyun Park, Beom Joon Kim, Hee-Joon Bae, Jisung Lee, Juneyoung Lee, Moon-Ku Han, Kyung Yoon O, Seong Ho Park, Yeonwook Kang, Kyung-Ho Yu, Byung-Chul Lee
Journal of Stroke.2013; 15(1): 49. CrossRef
Difference in Health-related Quality of Life among Social Classes and Related Factors in Korea
Gyeong-Tae Lim, In-Sun Kwon, Soon-Young Kim, Young-Chae Cho, Hea-Sung Nam
Journal of the Korea Academia-Industrial cooperation Society.2012; 13(5): 2189. CrossRef
Relationship between Low Back Pain and Health-Related Quality of Life among Some Elderly
Kyeong-Ae Oh, Jong Park, Dae-Jung Jeon, Mi-Ah Han, Seong-Woo Choi
Journal of agricultural medicine and community health.2012; 37(3): 156. CrossRef
Regional differences in health status in China: Population health-related quality of life results from the National Health Services Survey 2008
Sun Sun, Jiaying Chen, Magnus Johannesson, Paul Kind, Ling Xu, Yaoguang Zhang, Kristina Burström
Health & Place.2011; 17(2): 671. CrossRef
Population health status in China: EQ-5D results, by age, sex and socio-economic status, from the National Health Services Survey 2008
Sun Sun, Jiaying Chen, Magnus Johannesson, Paul Kind, Ling Xu, Yaoguang Zhang, Kristina Burström
Quality of Life Research.2011; 20(3): 309. CrossRef

General Population Time Trade-off Values for 42 EQ-5D Health States in South Korea.: Min Woo Jo, Sang Il Lee; J Prev Med Public Health. 2007;40(2):169-176.; DOI: https://doi.org/10.3961/jpmph.2007.40.2.169

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Abstract PDF

OBJECTIVES
This study was conducted to elicit quality weights for 42 EQ-5D health states with the time trade-off (TTO) method from the general population of South Korea. METHODS: We selected the same EQ-5D health states as those in the UK MVH study. The Korean version of EQ-5D questionnaire and TTO method were used for the valuation process. We interviewed 500 people as a representative sample of the general population in Seoul and Gyeonggido. The result was compared with those from UK, Japan, and USA by Spearman's rank correlation and t-test. RESULTS: TTO values for 42 EQ-5D health states and 'unconscious' state were obtained from the general South Korean population. The best one was '11112' state and the worst one was 'unconscious' state. The states worse than death were '33323', '33333', and 'unconscious' states, which had negative TTO values. There was a strong correlation between TTO values of the EQ-5D health states and those of their corresponding states from UK, Japan, and USA (Spearman's correlation coefficient: 0.885, 0.882, and 0.944, respectively, p <0.001). However, absolute TTO values of most EQ-5D health states were significantly different from those of their corresponding states in other foreign studies (UK: 41/42, USA: 32/42, Japan: 15/17). CONCLUSIONS: We found that the Korean general population TTO values for EQ-5D health states were different from those of other foreign studies, suggesting that a specific Korean valuation set should be developed and used for economic evaluation studies in South Korea.

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Health-Related Quality of Life of Post-Stroke Patients in a Public Hospital
Mijung Jang, Heedong Park, Miyoung Kim, Galam Kang, Hayan Shin, Donghyun Shin, KyooSang Kim
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Factors Affecting the Health-related Quality of Life of Older Adults with Unmet Healthcare Needs Based on the 2018 Korean National Health and Nutrition Examination Survey: A Cross-Sectional Study
Su-Jin Seo, Ju-Hee Nho
Journal of Korean Academy of Fundamentals of Nursing.2022; 29(2): 258. CrossRef
Effects of Combined Exercise and Far-Infrared Radiation Therapy on The Body Composition, Blood Level, Cortisol, Range of Motion (ROM) and Chronic Pain Level in Elderly Women with Chronic Diseases
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Effects of the elderly's oral health status and dental care utilization on their health-related quality of life
Seong Hyeon Chae, Chun-Bae Kim
Oral Biology Research.2019; 43(1): 88. CrossRef
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Eun-Young Jung, Hyung-Wook Kang, Dong-Kyun Park
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Health-Related Quality of Life in Korean Adults with Hearing Impairment: The Korea National Health and Nutrition Examination Survey 2010 to 2012
Min Kwan Baek, Young Saing Kim, Eun Young Kim, Ae Jin Kim, Won-Jun Choi, Pietro Cipresso
PLOS ONE.2016; 11(10): e0163999. CrossRef
The Incidence and Risk Factors of Metabolic Syndrome in Rural Area
Hee-Jung Yoon, Sung-Kook Lee
Journal of the Korea Academia-Industrial cooperation Society.2015; 16(6): 3934. CrossRef
Health-related quality of life according to breakfast in elderly
Ji-Yeon Kim
Journal of the Korea Academia-Industrial cooperation Society.2015; 16(7): 4668. CrossRef
Effect of Staged Education Program for Hypertension, Diabetes Patients in a Community (Assessment of Quality of Life Using EQ-5D)
Jung Jeung Lee, Hye Jin Lee, Eun Jin Park
Journal of agricultural medicine and community health.2014; 39(1): 37. CrossRef
Levels of Health-related Quality of Life (EQ-5D) and Its Related Factors among Vulnerable Elders Receiving Home Visiting Health Care Services in Some Rural Areas
Jong Im Kim
Journal of Korean Academy of Community Health Nursing.2013; 24(1): 99. CrossRef
Estimating Quality Weights for EQ-5D Health States with the Time Trade-Off Method in South Korea
Min-Woo Jo, Sung-Cheol Yun, Sang-Il Lee
Value in Health.2008; 11(7): 1186. CrossRef

Does a Higher Coronary Artery Bypass Graft Surgery Volume Always have a Low In-hospital Mortality Rate in Korea?.: Kwang Soo Lee, Sang Il Lee; J Prev Med Public Health. 2006;39(1):13-20.

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Abstract PDF: OBJECTIVES
To propose a risk-adjustment model with using insurance claims data and to analyze whether or not the outcomes of non-emergent and isolated coronary artery bypass graft surgery (CABG) differed between the low- and high-volume hospitals for the patients who are at different levels of surgical risk. METHODS: This is a cross-sectional study that used the 2002 data of the national health insurance claims. The study data set included the patient level data as well as all the ICD-10 diagnosis and procedure codes that were recorded in the claims. The patient's biological, admission and comorbidity information were used in the risk-adjustment model. The risk factors were adjusted with the logistic regression model. The subjects were classified into five groups based on the predicted surgical risk: minimal (<0.5%), low (0.5% to 2%), moderate (2% to 5%), high (5% to 20%), and severe (=20%). The differences between the low- and high-volume hospitals were assessed in each of the five risk groups. RESULTS: The final risk-adjustment model consisted of ten risk factors and these factors were found to have statistically significant effects on patient mortality. The C-statistic (0.83) and Hosmer-Lemeshow test (x2=6.92, p=0.55) showed that the model's performance was good. A total of 30 low-volume hospitals (971patients) and 4 high-volume hospitals (1,087patients) were identified. Significantdifferences for the in-hospital mortality were found between the low- and high-volume hospitals for the high (21.6% vs. 7.2%, p=0.00) and severe (44.4% vs. 11.8%, p=0.00) risk patient groups. CONCLUSIONS: Good model performance showed that insurance claims data can be used for comparing hospital mortality after adjusting for the patients' risk. Negative correlation was existed between surgery volume and in-hospital mortality. However, only patients in high and severe risk groups had such a relationship.; Summary

Changes in Mortality Inequality in Relation to the South Korean Economic Crisis: Use of Area-based Socioeconomic Position.: Young Ho Khang, Sung Cheol Yun, In A Hwang, Moo Song Lee, Sang Il Lee, Min Woo Jo, Min Jung Lee; J Prev Med Public Health. 2005;38(3):359-365.

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Abstract PDF: OBJECTIVE
An abrupt economic decline may widen the socioeconomic differences in health between the advantaged and disadvantaged in a society. The aim of this study was to examine whether the South Korean economic crisis of 1997-98 affected the socioeconomic inequality from all-causes and from cause-specific mortality between 1995 and 2001. METHODS: Population denominators were obtained from the registration population data, with the number of death (numerators) calculated from raw death certificate data. The indicator used to assess the geographic socioeconomic position was the per capita regional tax revenue. Administrative districts (Si-Gun-Gu) were ranked according to this socioeconomic measure, and divided into equal population size quintiles on the basis of this ranking. The sex- and 5-year age-specific numbers of the population and deaths were used to compute the sex- and age-adjusted mortality rates (via direct standardization method), standardized mortality ratios (via indirect standardization methods) and relative indices of inequality (RII) (via Poisson regression). RESULTS: Geographic inequalities from all-causes of mortality, as measured by RII, did not increase as a result of the economic crisis (from 1998-2001). This was true for both sexes and all age groups. However, the cause-specific analyses showed that socioeconomic inequalities in mortalities from external causes were affected by South Korean economic crisis. For males, the RIIs for mortalities from transport accidents and intentional self-harm increased between 1995 and 2001. For females, the RII for mortality from intentional self-harm increased during the same period. CONCLUSIONS: The South Korean economic crisis widened the geographic inequality in mortalities from major external causes. This increased inequality requires social discourse and counter policies with respect to the rising health inequalities in the South Korean society.; Summary

Census Population vs. Registration Population: Which Population Denominator Should be used to Calculate Geographical Mortality.: Young Ho Khang, In A Hwang, Sung Cheol Yun, Moo Song Lee, Sang Il Lee, Min Woo Jo, Min Jung Lee; J Prev Med Public Health. 2005;38(2):147-153.

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Abstract PDF: OBJECTIVES
Studies on the geographical differences in mortality tend to use a census population, rather than a registration population, as the denominator of mortality rates in South Korea. However, an administratively determined registration population would be the logical denominator, as the geographical areas for death certificates (numerator) have been determined by the administratively registered residence of the deceased, rather than the actual residence at the time of death. The purpose of this study was to examine the differences in the total number of a district population, and the associated district-specific mortality indicators, when two different measures as a population denominator (census and registration) were used. METHODS: Population denominators were obtained from census and registration population data, and the numbers of deaths (numerators) were calculated from raw death certificate data. Sex- and 5-year age-specific numbers for the populations and deaths were used to compute sex- and age-standardized mortality rates (by direct standardization methods) and standardized mortality ratios (by indirect standardization methods). Bland-Altman tests were used to compare district populations and district-specific mortality indicators according to the two different population denominators. RESULTS: In 1995, 9 of 232 (3.9%) districts were not included in the 95% confidence interval (CI) of the population differences. A total of 8 (3.4%) among 234 districts had large differences between their census and registration populations in 2000, which exceeded the 95% CI of the population differences. Most districts (13 of 17) exceeding the 95% CI were rural. The results of the sexand age-standardized mortality rates showed 15 (6.5%) and 16 (6.8%) districts in 1995 and 2000, respectively, were not included in the 95% CI of the differences in their rates. In addition, the differences in the standardized mortality ratios using the two different population denominators were significantly greater among 14 districts in 1995 and 11 districts in 2002 than the 95% CI. Geographical variations in the mortality indicators, using a registration population, were greater than when using a census population. CONCLUSION: The use of census population denominators may provide biased geographical mortality indicators. The geographical mortality rates when using registration population denominators are logical, but do not necessarily represent the exact mortality rate of a certain district. The removal of districts with large differences between their census and registration populations or associated mortality indicators should be considered to monitor geographical mortality rates in South Korea.; Summary

Impact of Risk Adjustment with Insurance Claims Data on Cesarean Delivery Rates of Healthcare Organizations in Korea.: Kwang Soo Lee, Sang Il Lee, Kyung Seo, Young Mi Do; J Prev Med Public Health. 2005;38(2):132-140.

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Abstract PDF: OBJECTIVES
To propose a risk-adjustment model from insurance claims data, and analyze the changes in cesarean section rates of healthcare organizations after adjusting for risk distribution. METHODS: The study sample included delivery claims data from January to September, 2003. A risk-adjustment model was built using the 1st quarter data, and the 2nd and 3rd quarter data were used for a validation test. Patients' risk factors were adjusted using a logistic regression analysis. The c-statistic and Hosmer-Lemeshow test were used to evaluate the performance of the risk-adjustment model. Crude, predicted and risk-adjusted rates were calculated, and compared to analyze the effects of the adjustment. RESULTS: Nine risk factors (malpresentation, eclampsia, malignancy, multiple pregnancies, problems in the placenta, previous Cesarean section, older mothers, bleeding and diabetes) were included in the final riskadjustment model, and were found to have statistically significant effects on the mode of delivery. The c-statistic (0.78) and Hosmer-Lemeshow test (chi2=0.60, p=0.439) indicated a good model performance. After applying the 2nd and 3rd quarter data to the model, there were no differences in the c-statistic and Hosmer-Lemeshow chi2. Also, risk factor adjustment led to changes in the ranking of hospital Cesarean section rates, especially in tertiary and general hospitals. CONCLUSION: This study showed a model performance, using medical record abstracted data, was comparable to the results of previous studies. Insurance claims data can be used for identifying areas where risk factors should be adjusted. The changes in the ranking of hospital Cesarean section rates implied that crude rates can mislead people and therefore, the risk should be adjusted before the rates are released to the public. The proposed risk-adjustment model can be applied for the fair comparisons of the rates between hospitals.; Summary

Proportion of Death Certificates Issued by Physicians and Associated Factors in Korea, 1990-2002.: Min Woo Jo, Young Ho Khang, Sungcheol Yun, Jin Yong Lee, Moo Song Lee, Sang Il Lee; J Prev Med Public Health. 2004;37(4):345-352. Published online November 30, 2004

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Abstract PDF: OBJECTIVES
Previous studies showed that death certification by physicians was an important predictor to improve the quality of death certificate data in South Korea. This study was conducted to examine the proportion of death certificates issued by physicians and associated factors in South Korea from 1990 to 2002. METHODS: Data from 3, 110, 883 death certificates issued between 1990 and 2002, available to the public from the National Statistical Office of Korea, were used to calculate the proportion of death certificates issued by physicians and to examine associated factors with logistic regression analysis. RESULTS: The overall proportion of death certificates issued by physicians increased from 44.6% in 1990 to 77.6% in 2002 (mean: 63.5%). However, the proportion was greatly influenced by the deceased's age. In 2002, more than 90% of the deceased aged 51 or less were certified by physicians. A higher proportion was found among deceased who had tertiary education (college or higher) living in more developed urban areas. CONCLUSION: The information regarding the cause of death for younger, well-educated deceased in urban areas of South Korea may show a higher level of accuracy. Epidemiologic research using information on causes of death may well benefit from the continually increasing proportion of death certificates issued by physicians in the future in South Korea.; Summary

Disability Weights for the Korean Burden of Disease Study: Focused on Comparison with Disability Weights in the Australian Burden of Disease Study.: Young Kyung Do, Seok Jun Yoon, Jung Kyu Lee, Young Hoon Kwon, Sang Il Lee, Changyup Kim, Kidong Park, Yong Ik Kim, Youngsoo Shin; J Prev Med Public Health. 2004;37(1):59-71.

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Abstract PDF: OBJECTIVE
This study aimed to measure the disability weights for the Korean Burden of Disease study, and to compare them with those adopted in the Australian study to examine the validity and describe the distinctive features. METHODS: The standardized valuation protocol was developed from the Global Burden of Disease (GBD) study and the Dutch Disability Weights study. Disability weights were measured for 123 diseases of the Korean version of Disease Classification by three panels of 10 medical doctors each. Then, overall distribution, correlation coefficients, difference by each disease, and mean of differences by disease group were analyzed for comparison of disability weights between the Korean and Australian studies. RESULTS: Korean disability weights ranged from 0.037 to 0.927. While the rank correlation coefficient was moderate to high (rs=0.68), Korean disability weights were higher than the corresponding Australian ones in 79.7% of the 118 diseases. Of these, war, leprosy, and most injuries showed the biggest differences. On the contrary, many infectious and parasitic diseases comprised the greater part of diseases of which Korean disability weights were lower. The mean of the differences was the highest in injuries of GBD disease groups, and in cardiovascular disease, injuries, and malignant neoplasm of the Korean disease category. CONCLUSION: Korean disability weights were found to be valid on the basis of overall distribution pattern and correlation, and are expected to be used as basic data for broadening the scope of burden of disease study. However, some distinctive features still remain to be explored in following studies.; Summary

Efficient DRG Fraud Candidate Detection Method Using Data Mining Techniques.: Duho Hong, Jung Kyu Lee, Min Woo Jo, Kidong Park, Sang Il Lee, Moo Song Lee, Chang Yup Kim, Yong Ik Kim; Korean J Prev Med. 2003;36(2):147-152.

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Abstract PDF: OBJECTIVES
To develop a Diagnosis-Related Group (DRG) fraud candidate detection method, using data mining techniques, and to examine the efficiency of the developed method. METHODS: The study included 79, 790 DRGs and their related claims of 8 disease groups (Lens procedures, with or without, vitrectomy, tonsillectomy and/or adenoidectomy only, appendectomy, Cesarean section, vaginal delivery, anal and/or perianal procedures, inguinal and/or femoral hernia procedures, uterine and/or adnexa procedures for nonmalignancy), which were examined manually during a 32 months period. To construct an optimal prediction model, 38 variables were applied, and the correction rate and lift value of 3 models (decision tree, logistic regression, neural network) compared. The analyses were performed separately by disease group. RESULTS: The correction rates of the developed method, using data mining techniques, were 15.4 to 81.9%, according to disease groups, with an overall correction rate of 60.7%. The lift values were 1.9 to 7.3 according to disease groups, with an overall lift value of 4.1. CONCLUSIONS: The above findings suggested that the applying of data mining techniques is necessary to improve the efficiency of DRG fraud candidate detection.; Summary

Cost-Effectiveness Analysis of a Hyperlipidemia Mass Screening Program in Korea.: Yeon Soon Cha, Young Ho Khang, Moo Song Lee, Weechang Kang, Sung Hoon Jeon, Kee Lak Kim, Sang Il Lee; Korean J Prev Med. 2002;35(2):99-106.

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Abstract PDF: OBJECTIVE
Until now, there have been no evidence-based guidelines produced for the mass screening of hyperlipidemia cases in Korea. This study was done to find the most efficient strategy for a hyperlipidemia-screening program among Korean adults. METHOD: Seven alternative strategies for hyperlipidemia screening were formulated and compared in terms of cost-effectiveness. Cost and effectiveness were estimated from social perspectives and using a two-stage screening process (initial testing and additional testing for positives from the first test). A computerized database (based on persons who had visited a health promotion center in one teaching hospital for a routine health check-up) was used to determine the cost and the outcome of various strategies. Official data was used in calculating direct and indirect costs. Effectiveness was measured according to the number of persons who needed clinical intervention for hyperlipidemia. A stratified analysis, considering age group and sex, was then done. Sensitivity analyses, focusing on several uncertain parameters, were also done. RESULTS: Of the seven test alternatives available, the most cost-effective strategy was a screening program, which consisted of an initial test of total cholesterol,high-density lipoprotein cholesterol and triglyceride. There was some variation in the rank of the cost-effectiveness ratios for the seven alternatives dependent on age group or gender. CONCLUSIONS: Current hyperlipidemia screening practice, for National Health Insurance beneficiaries, tests only the total cholesterol level with a cut-off value of 260mg/dl as an initial screening test. It is not the best strategy for cost-effectiveness, and should be modified. Different screening strategies taking age group and sex into account should be developed and used for the efficient mass screening of hyperlipidemia cases among Korean adults.; Summary

Inter-hospital Comparison of Cesarean Section Rates after Risk Adjustment.: Sang Il Lee, Young Ho Khang, Beom Man Ha, Moo Song Lee, Weechang Kang, Hee Jo Koo, Chang Yup Kim; Korean J Prev Med. 2001;34(4):337-346.

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Abstract PDF: OBJECTIVE
To determine the clinical risk factors associated with the mode of delivery decision and to compare cesarean section rates after adjusting for risk factors identified among Korean hospitals. METHODS: Data were collected from 9 general hospitals in two provincial regions by medical record abstraction during February 2000. A total of 3,467 cases were enrolled and analyzed by stepwise logistic regression. Performance of the risk-adjustment model (discrimination and calibration) was evaluated by the C statistic and the Hosmer-Lemeshow test. Crude rates, predicted rates with 95% confidence intervals, and adjusted rates of cesarean section were calculated and compared among the hospitals. RESULTS: The average crude cesarean section rate was 53.2%, ranging from 39.4% to 65.7%. Several risk factors such as maternal age, previous history of cesarean section, placenta previa, placental abruption, malpresentation, amniotic fluid abnormality, gestational anemia, infant body weight, pregnancy-induced hypertension, and chorioamnionitis were found to have statistically significant effects on the mode of delivery. It was confirmed that information about most of these risk factors was able to be collected through the national health insurance claims database in Korea. Performance of the risk-adjustment model was good (c statistic=0.815, Hosmer-Lemeshow test=0.0621). Risk factor adjustment did lead to some change in the rank of hospital cesarean section rates. The crude rates of three hospitals were beyond 95% confidence intervals of the predicted rates. CONCLUSIONS: Considering that cesarean section rates in Korean hospitals are too high, it is apparent that some policy interventions need to be introduced. The concept and methodology of risk adjustment should be used in the process of health policy development to lower the cesarean section rate in Korea.; Summary

Complementary and Alternative Medicine Use in Korea: Prevalence, Pattern of Use, and Out-of-pocket Expenditures.: Sang Il Lee, Young Ho Khang, Moo Song Lee, Hee Jo Koo, Weechang Kang, Changgi D Hong; Korean J Prev Med. 1999;32(4):546-555.

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Abstract PDF: OBJECTIVES
To determine the prevalence, pattern, and out-of-pocket expenditure of complementary and alternative medicine (CAM) utilization in Korean adult population. METHODS: We conducted a representative telephone survey of 2,042 persons aged 18 or older. Data about any health problem, details of their use of medical doctors(MDs) offices/hospitals/ pharmacies services and CAM during the preceding 12 months were collected with structured questionnaire. RESULTS: The utilization rate of CAM among Korean adults was 29% in one year. A total of 231 kinds of CAM was identified from this survey. Annual out-of-pocket expenditure associated with CAM use in 1998 amounted to pound $1.88 billion and was comparable to 40.8% of out-of-pocket expenditure paid for MDs offices/ hospitals/pharmacies services. Among those(N=424) who paid for both MDs offices/hospitals/pharmacies services and CAM, 35.8% paid more for CAM. CAM gave more satisfaction than western medicine to those who had experience of both types of therapy. About half of CAM users were willing to recommend CAM to others. Disclosure rate to physician among CAM users was not high(40.6%). CONCLUSION: CAM became a popular source of health care in Korea. Korean spent a substantial amount of out-of-pocket money on CAM without any public control. Because CAM use is likely to be increased rapidly through lay referral system, health policy makers and health professionals should pay more attention to CAM for making appropriate utilization of CAM.; Summary

Reliability and Validity of the Korean Version of ISAAC Questionnaire.: Seong Woo Choi, Yeong Su Ju, Dae Sung Kim, Jae Yong Kim, Ho Jang Kwon, Dae Hee Kang, Sang Il Lee, Soo Hun Cho; Korean J Prev Med. 1998;31(3):361-371.

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Abstract PDF: Recent increases of asthma and allergies in childhood made the need for a standardized approach to international and regional comparisons of their prevalence and severity. To address these issues, "International Study of Asthma and Allergies in Childhood (ISAAC)" is currently underway. In Korea, "Nationwide Study of Asthma and Allergies in Korean Children" began in 1995 according to ISAAC protocol. ISAAC written and video questionnaires were used in this survey, but their reliability and validity were not evaluated properly yet. In this study, our aim was to evaluate the reliability and validity of two kinds of questionnaires and their usefulness in international and regional comparisons. The test and retest of two questionnaires were completed by male(n=110) and female(n=111) middle school students with two and three weeks interval each. Kappa(or weighted kappa) were calculated from each questions and validity coefficients were estimated from those statistics. In Korean version of written questionnaire, the questions for allergic rhinitis, atopic dermatitis, allergic conjunctivitis, and food allergy proved to have high kappa values(or weighted kappa values) and validity coefficients and they can be used in further studies without any correction. But some questions about asthma(especially nocturnal cough, wheezing in exercise, and severe asthma) and drug allergy need to be revised for better understanding to study subjects. Video questionnaire has the same degree of reliability and validity when compared to written questionnaire and this is the unexpected result. Accordingly, it also need to be revised to overcome the racial and cultural differences of the study subjects. In conclusion, the Korean version of written and video questionnaires may be considered to be useful methods in international and regional comparisons of asthma and allergic diseases in childhood after correction of some questions.; Summary

Professional Socialization of Medical Students.: Dal Sun Han, Byung Hee Cho, Sangsoo Bae, Chang Yup Kim, Sang Il Lee, Young Jo Lee; Korean J Prev Med. 1996;29(2):265-276.

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Abstract PDF: This paper concerns professional socialization of medical students. Professional socialization, in the context of this paper, means the process through which a layperson becomes a doctor equipped with professional identity and values. While medical education does not include such process in the curriculum, medical students obtain certain values and identity informally. The dependent variables were professional values and professionalism. The former means the desirable attributes required to conducting professional works such as humane attitudes, science-oriented mind, capability for organizational management. The latter means socio-political reasoning with which doctors can rationalize their privileges such as autonomy. A specially designed questionnaire was developed. The data were collected from five medical schools for 1,318 students in 1994. A total of 1,070 cases were finally included in the statistical analysis. The students emphasized the human factor in the professional values. Their attitude did not change with the grade. Other independent variables such as motives for entering a medical school, socioeconomic status, satisfaction with medical education, etc. also did not influence professional values. It implies that professional values were not consolidated among the students. However, the factors of professionalism change significantly with the grade. It implies that the students paid more attention to socio-political issues related to doctor`s interests as the grade went up. And the factor scores for professionalism were higher for those students who had more positive attitude towards doing medical practice for profit, expected higher income, and were more conservative about social reform. Other independent variables did not influence professionalism. It seems that the students also give emphasis on professionalism, like current medical doctors, mainly because of their concern with recent unfavorable changes in economic conditions of medical care providers.; Summary

Measurement of Ambulatory Patients' Satisfaction and Its Influencing Factors in a Tertiary Hospital.: Sang Il Lee; Korean J Prev Med. 1994;27(2):366-376.

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Abstract PDF: Patients' evaluation of hospital care is one of the most important aspects of quality assessment. Survey allows patients to judge subjectively the events that occur during their hospital visit if performed properly. This study describes the result of a research effort to develop outpatient questionnaire that has sufficient validity and reliability to be used to measure patients' perception of satisfaction in Korea and to investigate influencing factors on patients' satisfaction. Self-administered questionnaire was developed for outpatient and the survey was conducted covering 827 outpatients in a tertiary hospital. It was confirmed by factor analysis that patients evaluate several components of ambulatory care distinctly ;hospital environment, administration and ancillary services, and medical care. We found strong evidence of construct validity and internal consistency for the above three dimensions of hospital process. On the contrary, reliability of overall outcome measures was low. It suggests that three items concerning overall outcome measures have some different meanings in patients' perception. Using logistic regression analysis it was found that previous health status, cost evaluation, and improvement in health status have significant influences on the level of patients' overall satisfaction and that patient's sex, experience of previous visit, expectation for improvement, cost evaluation, and improvement in health status are strongly related with intention to recommend hospital. In spite of some limitations the results of this study can be used helpfully as baseline informations for developing self-administered questionnaire and for exploring the influencing factors on patients' satisfaction. Further comprehensive research efforts should be made on the measurement of ambulatory patients' satisfaction and its related factors in current Korean situation.; Summary

A Case-Control Study of Primary Liver Cancer and Liver Disease History.: Dong Hyun Kim, Byung Joo Park, Keun Young Yoo, Yoon Ok Ahn, Hyo Suk Lee, Chung Yong Kim, Sang Il Lee, Moo Song Lee, Hyung Sik Ahn, Heon Kim, Tae Soo Park; Korean J Prev Med. 1994;27(2):217-225.

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Abstract PDF: The relationship between past liver disease history and the risk of primary liver cancer was analyzed in a hospital-based case-control study conducted in Seoul on 165 patients with histologically or serologically confirmed hepatocellular carcinoma and individually age-and sex-matched 165 controls in hospital for ophthalmologic, ontologic, or nasopharyngeal problems. Significant association were observed for liver diseases occurring 5 or more years before liver cancer diagnosis[OR, 4.9;97% confidence interval(CI), 1.6~14.0) and family history of liver disease(OR, 9.0;95% CI, 2.1~38.8). These associations were mot appreciably modified by allowance for major identified potential confounding factors, From these results, it is possible to speculate that liver cell injuries caused by Considering the significant effect of family history of liver diseases on PLCA risk after adjusting past liver disease history, there might be genetic susceptibility in the carcinogenic mechanism of liver cancer. Further investigations are needed to clarify the effect of family history of liver disease on PLCA risk.; Summary

The epidemiology of delays in a teaching hospital.: Yoon Kim, Kun Sei Lee, Chang Yup Kim, Yong Ik Kim, Young Soo Shin, Sang Il Lee; Korean J Prev Med. 1993;26(4):650-660.

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Abstract PDF: This study aims to describe the causes of medically unnecessary hospital stay at a teaching tertiary hospital, using modified version of Delay Tool in which the causes of delay are divided into six major categories ; delay related to test scheduling, test results, surgery, medical staff, patient/family, and administration. For the analysis of hospital stay, 6,479 inpatient-days were reviewed in two medical and four surgical departments for one month. Initially inappropriate hospital stays were identified using Appropriateness Evaluation Protocol(AEP), and causes of delay listed in Delay Tool were assigned to each of them. In both medical and surgical services, the most important cause of delay was related to medical staffs, ranging from 3.6% to 51.6% of total inpatient days. Next important category was delay related to test scheduling in medical services(4.7~9.2%), and delay related to surgery in surgical services(7.3~15.0%). Among subcategories of delay related to medical staffs, delay due to conservative care was the most important cause of inappropriate hospital stay(2.9~46.4%). Each clinical departments had different distribution among delay categories, which could not be fully justified by their clinical characteristics. The Delay Tool would be helpful in exploring factors related to the inefficient use of hospital beds. As a measurement tool of inappropriate hospital stay, however, the Delay Tool should be refined in the definitions of categories and its contents.; Summary

A Study on the Insurance Contribution and Health Care Utilization of the Regional Medical Insurance Scheme.: Sang Il Lee, Hyun Rim Choi, Hyeong Sik Ahn, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 1989;22(4):578-590.

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Abstract PDF: This study was conducted to assess the equity in the regional insurance scheme through analysis of the computerized data from one regional insurance society and National Federation of Medical Insurance. We analysed the insurance contribution and benefit by the classes based on total and income-related contribution per household. The major findings of this study are as follows: 1. The average proportion of income-related contribution among the total was 39.2% and the upper classes show higher proportion of the income-related contribution. 2. The upper classes show higher health care utilization rate than the lower classes. It suggests that the lower classes have relatively large unmet medical needs. 3. The analysis through the Lorenz curve reveals that there exists transference of contributions from the upper to lower classes. But the cumulative percentage of insurance benefit is smaller than that of the number of the insured. It implies that regional medical insurance scheme in Korea has still some inequity in the context of social security principles.; Summary

An Experimental Study on the Protective Effects of Ginseng Extract to Oxygen Toxicity.: Jae Young Park, Sang Il Lee, Dork Ro Yun; Korean J Prev Med. 1989;22(2):208-214.

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Abstract PDF: The protective effects of Panax Ginseng extract to oxygen toxicity of mice were studied under 5 ATA hyperbaric oxygen atmosphere. The findings observed are as follows: 1) Administration of Ginseng water extract manifested the prolonging survival time of mice to oxygen toxicity by hyperbaric oxygen atmosphere. After 18 hours of single Ginseng water extract administration and three days, seven days of consecutive Ginseng water extract administration showed the protective effect against oxygen toxicity. 2) Three days and seven days of consecutive Ginseng water extract administration showed the more efficient protective effect than single Ginseng Water extract administration. 3) Seven days of consecutive Ginseng water extract administration did not showed the more efficient protective effect than three days of consecutive Ginseng water extract administration.; Summary

A Study on the Regional Function of Health Care by the Disease Pattern of the Inpatients.: Huyn Rim Choi, Sang Il Lee, Young Soo Shin, Yong Ik Kim; Korean J Prev Med. 1988;21(2):390-403.

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Abstract PDF: The objectives of the study were to provide the basic informations needed in the development of balanced medical services throughout the nation. As the national health care system was expanding rapidly along with the economic growth, quantitative re-evaluation of the system is of great need. For that reason, characteristics of the admitted patients were analyzed for the case-mix and patients' flow within and through regions. Materials were 421,530 cases of inpatients, who were reported through Medical Insurance Corporation(KMIC) for insurance claim, during the period of March 1, 1985 through February 28, 1987. Korean Diagnosis Related Groups(K-DRGs) classification system was adopted for the study of case-mix and 189 cities and countries were classified into 5 district groups by factor analysis results of K-DRGs. The major findings of this study were as follows ; 1) Factor analysis of case-mix, employing K-DRG system, revealed 5 distinct functional district groups. Group A(18 district) was prominent for tertiary medical care. In group B(36 districts), rather simple procedures were prevalent. Group C(26 districts) was distinctive for the medical care of well organized internal medicine practices with qualified clinical laboratories. Group D(17 districts) was characterized by relatively high balanced medical care. Group E (92 districts) was with very low level of medical care. 2) Analysis of the case-flow through the districts showed 3 types of flow patterns ; inflow, outflow, and balanced types. Inflow type of case-flow was found in Group A, C and D while Group B and E showed outflow type. Inflow was most prominent in Group A and Group E was of typical outflow type. Group B was consistently the outflow type except for Major Diagnostic Category XX regardless of the disease treaders, but Group C and D were inflow or outflow types according to the disease tracers.; Summary

An Experimental Study on the Efficacy of Vitamin E against Oxygen Toxicity.: Sung Gyu Lee, Sang Il Lee, Soo Hun Cho, Dork Ro Yun; Korean J Prev Med. 1986;19(2):184-192.

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Abstract PDF: Since the wide spread application of hyperbaric oxygenation in clinical setting, the problems of oxygen toxicity have been attracting a deep interest from the researchers on hyperbaric medicine as a practical issue. Among extensive research trials, the study on the protective agents against oxygen toxicity occupied one of the most challenging field. As the mechanisms of oxygen toxicity, the role of the oxygen free radicals produced by peroxidation process are strongly accepted by the leading researchers on oxygen toxicity, the probable protective effects of antioxidant against oxygen toxicity are sustaining a sufficient rationale. In this study, the author attempted to evaluate the effect of vitamin E as a protective agent against oxygen toxicity through the observation of death rate, convulsion rate, time to convulsion, and macroscopic and microscopic pathological changes of experimental rats exposed to 100% oxygen at 5 ATA for 120 minutes. The findings observed are as follows: 1) The death rate, convulsion rate, time to convulsion, organ/body weight ratio and microscopic pathological findings were identified as reliable objective and quantitative indices for oxygen toxicity. 2) Vitamin E showed excellent protective effects against CNS and pulmonary oxygen toxicity as a strong antioxidant. The most effective dose seemed to be around 400 mg/kg. 3) The results of this study are supporting the oxygen free radical hypothesis on oxygen toxicity.; Summary

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