Journal of Preventive Medicine and Public Health

Yong Ik Kim

32 Articles

Patterns of Unintentional Domestic Injuries in Korea.: Eun Jung Lee, Jin Seok Lee, Yoon Kim, Kunhee Park, Sang Jun Eun, Soo Kyung Suh, Yong Ik Kim; J Prev Med Public Health. 2010;43(1):84-92.; DOI: https://doi.org/10.3961/jpmph.2010.43.1.84

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OBJECTIVES
To investigate the patterns of unintentional home injuries in Korea. METHODS: The study population was 12,382,088 people who utilized National Health Insurance services due to injuries (main diagnosis codes S00 to T28) during 2006. Stratified samples(n=459,501) were randomly selected by sex, age group and severity of injury. A questionnaire was developed based on the International Classification of External Causes of Injury and 18,000 cases surveyed by telephone were analyzed after being projected into population proportionately according to the response rates of their strata. Domestic injury cases were finally included. RESULTS: Domestic injuries (n=3,804) comprised 21.1% of total daily life injuries during 2006. Women were vulnerable to home injuries, with the elderly and those of lower income (medical-aid users) tending to suffer more severe injuries. Injury occurred most often due to a slipping fall (33.9%), overexertion (15.3%), falling (9.5%) and stumbling (9.4%), with severe injury most often resulting from slipping falls, falls and stumbles. Increasing age correlated with domestic injury-related disability. CONCLUSIONS: The present findings provide basic information for development of home injury prevention strategies, with focus on the elderly.

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Associations between traumatic dental injuries due to violence and various drinking behaviors in Korea: A cross‐sectional study
Ji‐Young Son, Jaehyung Lim, Dong‐Hun Han
Dental Traumatology.2024;[Epub] CrossRef
Relationships between trauma death, disability, and geographic factors: a systematic review
Bona Hwang, Taewook Jeong, Jiyeon Jo
Clinical and Experimental Emergency Medicine.2023; 10(4): 426. CrossRef
The Relationship between Injury and Socioeconomic Status in Reference to the Fourth Korean National Health and Nutrition Examination Survey
Sung-Kyung Kim, Hyocher Kim, Kyungsuk Lee, Hee-Tae Kang, Sung-Soo Oh, Sang Baek Ko
Annals of Occupational and Environmental Medicine.2014;[Epub] CrossRef
The Relationship between Waist Circumference and Work-related Injury in Reference to the Fourth Korea National Health and Nutrition Examination Survey
Sung-Kyung Kim, Ji-Min Son, Jae-Young So, Hyocher Kim, Kyungsuk Lee, Sung-Soo Oh, Sang Ko
Annals of Occupational and Environmental Medicine.2013; 25(1): 29. CrossRef
Multilevel Analysis on Factors Influencing Death and Transfer in Inpatient with Severe Injury
Young Eun Choi, Kang Suk Lee
Health Policy and Management.2013; 23(3): 233. CrossRef
Spring cleaning as a safety risk: results of a population-based study in two consecutive years
Soheil Saadat, Mojgan Karbakhsh
BMC Public Health.2011;[Epub] CrossRef

Association between the Pattern of Prophylactic Antibiotic Use and Surgical Site Infection Rate for Major Surgeries in Korea.: Pilyong Sakong, Jin Seok Lee, Eun Jung Lee, Kwang Pil Ko, Cheol Hwan Kim, Yoon Kim, Yong Ik Kim; J Prev Med Public Health. 2009;42(1):12-20.; DOI: https://doi.org/10.3961/jpmph.2009.42.1.12

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OBJECTIVES
The purpose of this study was to analyze the association between the pattern of prophylactic antibiotic use (PAU) and the surgical site infection (SSI) rate for major surgeries in Korea. METHODS: We retrospectively reviewed the medical records of patients who underwent cardiac, colon and gastric surgery, hysterectomies and hip/knee replacements at 20 hospitals, and inclusive of over 500 beds. We randomly sampled 60 cases per surgery type for patients discharged between September and November, 2006. A total fo 2,924 cases were included in our analysis. Cox's proportional hazard analysis was conducted to evaluate the association between the pattern of PAU and SSI rate. RESULTS: The proportion of patients who received their first prophylactic antibiotics (PA) 1 hour before incision was 65.5%, who received inappropriate PAs was 80.8%, and the proportion of patients whose PA was discontinued within 24 hours of surgery was 0.5%. The average duration of PAU after surgery was 9 days. The relative risk (RR) of SSI in patients who received their first PA more than 1 hour before incision was significantly higher than for those who received it within 1 hour prior to incision (RR=8.20, 95% CI=4.81-13.99). Inappropriate PA selection increased SSI rate, albeit with marginal significance (RR=1.97, 95% CI=0.96-4.03). Also, prolonged PAU following surgery had no effect on SSI rate. CONCLUSIONS: These results suggest that the pattern of PAU in the surgeries examined was not appropriate. Errors in the timing of PAU and of PA selection increase SSI rate. SSI rate remained unaltered following prolonged PAU after surgery.

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The effect of first- and third-generation prophylactic antibiotics on hospitalization and medical expenditures for cardiac surgery
Sung-Jin Bae, Inah Kim, Jaechul Song, Euy-Suk Chung
Journal of Cardiothoracic Surgery.2022;[Epub] CrossRef
Comparison of erythrocyte sedimentation rate and C-reactive protein in patients with distal radius fractures according to the prophylactic antibiotic period: 1 day versus 1 week
Dae-Geun Kim, Byung Hoon Kwack
Archives of Hand and Microsurgery.2022; 27(2): 149. CrossRef
Influence of Duration of Prophylactic Antibiotics Therapy on Uncertainty of Recovery in Elective Laparoscopic Uterine Myomectomy Patients
Mi Young Jung, Kyung-Yeon Park
Journal of Korean Academy of Fundamentals of Nursing.2018; 25(4): 240. CrossRef
Comparing the Postoperative Complications, Hospitalization Days and Treatment Expenses Depending on the Administration of Postoperative Prophylactic Antibiotics to Hysterectomy
Mi Young Jung, Kyung-Yeon Park
Korean Journal of Women Health Nursing.2017; 23(1): 42. CrossRef
Factors affecting the rate of antibiotic prescription in dental practices
Hyesung Kim, Myeng Ki Kim, Hyungkil Choi
Journal of Korean Academy of Oral Health.2017; 41(1): 28. CrossRef
Convergence Research on Periodic Changes in the Quality Assessment of Surgical Prophylactic Antibiotics
Sae-Yie Yang, Kwang-Hwan Kim
Journal of Digital Convergence.2016; 14(6): 325. CrossRef
Risk Factors for Surgical Site Infections According to Electronic Medical Records Data
Young Hee Kim, Young-Hee Yom
Journal of Korean Academy of Fundamentals of Nursing.2014; 21(2): 151. CrossRef
Appropriateness of Surgical Antibiotic Prophylaxis in a Tertiary Hospital
Eun Young Nam, Hong Bin Kim, Hyunok Bae, Soyoung Moon, Sun Hee Na, Se Yong Kim, Doran Yoon, Ha Youn Lee, Joohae Kim, Chung-Jong Kim, Kyoung-Ho Song, Eu Suk Kim, Nam Joong Kim
Korean Journal of Nosocomial Infection Control.2014; 19(2): 64. CrossRef
Incidence and Risk Factors for Surgical Site Infection after Gastric Surgery: A Multicenter Prospective Cohort Study
Su Jin Jeong, Hea Won Ann, Jae Kyung Kim, Heun Choi, Chang Oh Kim, Sang Hoon Han, Jun Yong Choi, Kyong Ran Peck, Cheol-In Kang, Joon-Sup Yeom, Young Hwa Choi, Seung-Kwan Lim, Young Goo Song, Hee Jung Choi, Hee Jung Yoon, Hyo-Youl Kim, Young-Keun Kim, Min
Infection & Chemotherapy.2013; 45(4): 422. CrossRef
Overview of Antibiotic Use in Korea
Baek-Nam Kim
Infection & Chemotherapy.2012; 44(4): 250. CrossRef
The epidemiology and cost of surgical site infections in Korea: a systematic review
Kil Yeon Lee, Kristina Coleman, Dan Paech, Sarah Norris, Jonathan T Tan
Journal of the Korean Surgical Society.2011; 81(5): 295. CrossRef
A Prospective Study of Single-Dose Antibiotic Prophylaxis in Live Donor Nephrectomy
Ho Sung Jang, Kyung Hwa Choi, Seung Choul Yang, Woong Kyu Han
Korean Journal of Urology.2011; 52(2): 115. CrossRef
Association Between Prophylactic Antibiotic Use and Surgical Site Infection Based on Quality Assessment Data in Korea
Kyoung Hoon Kim, Choon Seon Park, Jin Hee Chang, Nam Soon Kim, Jin Seo Lee, Bo Ram Choi, Byung Ran Lee, Kyoo Duck Lee, Sun Min Kim, Seon A Yeom
Journal of Preventive Medicine and Public Health.2010; 43(3): 235. CrossRef
Antimicrobial Prophylaxis Using a 2nd Generation Cephalosporin after Laparoscopic Colorectal Resection: A Randomized Trial of 1-day vs. 3-day
Han Deok Kwak, Dong Jin Choi, Si Uk Woo, Jin Kim, Jun Won Um, Seon Hahn Kim
Journal of the Korean Surgical Society.2010; 78(6): 385. CrossRef
A Prospective, Multicenter, Randomized Trial for Duration of the Prophylactic Antibiotics after Elective Colorectal Surgery: 3 Days versus 5 Days
Ji Won Park, Jae Hwan Oh, Hyo Seong Choi, Sang-Bum Yoo, Young-Ju Choe, Sohee Park, Jung Man Kim, Kang Young Lee, Seung Kook Sohn, Hae Ran Yun, Ho-Kyung Chun, Woo Yong Lee
Journal of the Korean Society of Coloproctology.2010; 26(2): 123. CrossRef

The Socioeconomic Cost of Injuries in South Korea.: Kunhee Park, Jin Seok Lee, Yoon Kim, Yong Ik Kim, Jaiyong Kim; J Prev Med Public Health. 2009;42(1):5-11.; DOI: https://doi.org/10.3961/jpmph.2009.42.1.5

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OBJECTIVES
This study was conducted to estimate the socioeconomic cost of injuries in South Korea. METHODS: We matched claims data from national health insurance, automobile insurance and industrial accident compensation insurance (IACI), and mortality data obtained from the national statistical office from 2001 to 2003 by patients' unique identifier. Socioeconomic cost included both direct cost and indirect cost: the direct cost was injury-related medical expenditure and the indirect cost included loss of productivity due to healthcare utilization and premature death. RESULTS: The socioeconomic cost of injuries in Korea was approximately 1.9% of the GDP from 2001 to 2003. That is, 12.1 trillion KRW (Korean Won) in 2001, 12.3 trillion KRW in 2002, and 13.7 trillion KRW in 2003. In 2003, direct medical costs were 24.6% (3.4 trillion KRW), the costs for loss of productivity by healthcare utilization were 13.0% (1.8 trillion KRW), and the costs for loss of productivity by premature death were 62.4% (8.6 trillion KRW). CONCLUSIONS: In this study, the socioeconomic cost of injuries in Korea between 2001 and 2003 was estimated by using not only health insurance claims data, but also automobile insurance, IACI claims and mortality data. We conclude that social efforts are required to reduce the socioeconomic cost of injuries in Korea, which represented approximately 1.9% of the GDP for the time period specified.

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The characteristics and clinical outcomes of trauma patients transferred by a physician-staffed helicopter emergency medical service in Korea: a retrospective study
Myung Jin Jang, Woo Sung Choi, Jung Nam Lee, Won Bin Park
Journal of Trauma and Injury.2024; 37(2): 106. CrossRef
Relationships between trauma death, disability, and geographic factors: a systematic review
Bona Hwang, Taewook Jeong, Jiyeon Jo
Clinical and Experimental Emergency Medicine.2023; 10(4): 426. CrossRef
Positive correlation between regional emergency medical resources and mortality in severely injured patients: results from the Korean National Hospital Discharge In-depth Survey
Hyo Jung Lee, Yeong Jun Ju, Eun-Cheol Park
CJEM.2017; 19(06): 450. CrossRef
Characteristics and Outcomes of Trauma Patients via Emergency Medical Services
Dae Hyun Cho, Jae Gil Lee
Journal of Trauma and Injury.2017; 30(4): 120. CrossRef
Disability-Adjusted Life Years (DALYs) for Injuries Using Death Certificates and Hospital Discharge Survey by the Korean Burden of Disease Study 2012
Won Kyung Lee, Dohee Lim, Hyesook Park
Journal of Korean Medical Science.2016; 31(Suppl 2): S200. CrossRef
Current status and future perspective of regional trauma center in Korea
Kang Hyun Lee
Journal of the Korean Medical Association.2016; 59(12): 917. CrossRef
Characteristics of Korean Trauma Patients: A Single-center Analysis Using the Korea Trauma Database
Youngeun Park, Min Chung, Gil Jae Lee, Min A Lee, Jae Jeong Park, Kang Kook Choi, Sung Youl Hyun, Yang Bin Jeon, Dae Sung Ma, Yong-Cheol Yoon, Jungnam Lee, Byungchul Yoo
Journal of Trauma and Injury.2016; 29(4): 155. CrossRef
Analysis of KTDB Registered Trauma Patients from a Single Trauma Center in Korea
Byungchul Yu, Min Chung, Giljae Lee, Mina Lee, Jaejeong Park, Kangkook Choi, Sungyeol Hyun, Yangbin Jeon, Daesung Ma, Young-cheol Yoon, Jungnam Lee
Journal of Trauma and Injury.2015; 28(3): 123. CrossRef
The costs of hepatitis A infections in South Korea
Kyohyun Kim, Baek-Geun Jeong, Moran Ki, Mira Park, Jin Kyung Park, Bo Youl Choi, Weon-Seob Yoo
Epidemiology and Health.2014; 36: e2014011. CrossRef
Multilevel Analysis on Factors Influencing Death and Transfer in Inpatient with Severe Injury
Young Eun Choi, Kang Suk Lee
Health Policy and Management.2013; 23(3): 233. CrossRef
Trend of Mortality Rate and Injury Burden of Transport Accidents, Suicides, and Falls
Ki Sook Kim, Soon Duck Kim, Sang Hee Lee
Journal of Preventive Medicine and Public Health.2012; 45(1): 8. CrossRef

Factors Affecting Social Distance toward Mental Illness: A Nationwide Telephone Survey in Korea.: Sangjun Moon, Jin Seok Lee, Sue Kyung Park, Sun Young Lee, Yoon Kim, Yong Ik Kim, Youngsoo Shin; J Prev Med Public Health. 2008;41(6):419-426.; DOI: https://doi.org/10.3961/jpmph.2008.41.6.419

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OBJECTIVE
The purpose of this study was to investigate impact of knowledge, familiarity, and prejudice about mental illness as well as demographic factors on the social distance from mentally ill people, which is a proxy measure of discrimination. METHOD: To assess the impact of knowledge and familiarity, prejudice about mental illness and demographic factors on the social distance from mental illness, we conducted a telephone survey in South Korea with the responders being nationally representative people who were 18 years old or over (n=1040). Independent samples T-tests, one way ANOVA and linear regression analysis were performed to analyze the results of the survey. RESULT: The social distance from mental illness decreased as the knowledge and familiarity increased, but the social distance was increased as prejudice was increased. Prejudice had a greater impact on social distance than familiarity and knowledge. Females showed greater social distance than did males. A higher education level had a negative effect on social distance. CONCLUSION: To reduce the social distance from mentally ill people, efforts to increase the familiarity about mental illness as well as efforts to educate people about mental illness are important.

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Social Distance Attitudes of Nursing Students towards Adults with Mental Disorders
So Young Lee, Kyunghee Lee
Journal of Korean Academy of Psychiatric and Mental Health Nursing.2016; 25(4): 356. CrossRef
Public perceptions of risk in criminality: The effects of mental illness and social disadvantage
Claire Nee, Clare Witt
Psychiatry Research.2013; 209(3): 675. CrossRef
Factors Affecting Public Prejudice and Social Distance on Mental Illness: Analysis of Contextual Effect by Multi-level Analysis
Hyeongap Jang, Jun-Tae Lim, Juhwan Oh, Seon-Young Lee, Yong-Ik Kim, Jin-Seok Lee
Journal of Preventive Medicine and Public Health.2012; 45(2): 90. CrossRef
Effectiveness of an Education Program to Reduce Negative Attitudes Toward Persons With Mental Illness Using Online Media
Mia Seo, Hyun Lye Kim
Asian Nursing Research.2010; 4(2): 90. CrossRef

Factors Affecting National Health Insurance Mass Screening Participation in the Disabled.: Jong Hyock Park, Jin Seok Lee, Jin Yong Lee, Ji Young Hong, So Young Kim, Seong Ok Kim, Byong Hee Cho, Yong Ik Kim, Youngsoo Shin, Yoon Kim; J Prev Med Public Health. 2006;39(6):511-519.

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Abstract PDF: OBJECTIVES
As the disabled have higher prevalence rates and earlier onsets of chronic diseases than the nondisabled, their participation in mass screening is important for the early detection and intervention of chronic diseases. Nevertheless, in Korea, the disabled have lower participation rates in mass screening services than the nondisabled. The purpose of the study was to find determinants for the participation in the National Health Insurance (NHI) mass screening program among the disabled. METHODS: In this study, the NHI mass screening data of 423,076 disabled people, which were identified using the National Disability Registry (2003), were analyzed. Of the factors affecting the participation rates in mass screenings, the following variables were included for the analysis: socioeconomic stati, such as sex, age, category of health insurance program, region and income; disability characteristics, such as disability type, and severity. A multiple logistic regression analysis was used to evaluate the association between the participation rates, disability characteristics variables and demographic variables. RESULTS: The participation rate in mass screening of the disabled was 41.3%, but was lower in females, an age of more than 70 years, self-employed and for those with an average monthly insurance premium over 133,500 Won and in metropolitan regions. The participation rate was 1.31 times lower in females than males (95% CI=1.29-1.33); 3.50 times lower in the elderly (more than 70 years) than the younger (95% CI=3.33-3.67); 1.43 times lower in those who live in metropolitan areas (95% CI=1.40-1.46); 2.59 times lower for those in a health insurance program for the self-employed than for employees (95% CI=2.56-2.63); 1.19 times lower for the higher income (more than 133,500) than the lower income group (4,400-22,000) for the average monthly insurance premium (95% CI=1.15-1.23); 2.04 times lower for those with brain palsy and stroke disabilities than with auditory impairments (95% CI= 1.97-2.11) and 3.27 times for those with severe compared to mild disabilities (95% CI=3.15-3.40). CONCLUSIONS: The disabled with high severity, and locomotive and communication disabilities have lower participation rates in mass screening services in Korea.; Summary

Differences in Medical Care Utilization Rates of the Disabled and the Non-disabled with Ambulatory Care Sensitive Conditions.: Sang Jun Eun, Jee Young Hong, Jin Yong Lee, Jin Seok Lee, Yoon Kim, Yong Ik Kim, Youngsoo Shin; J Prev Med Public Health. 2006;39(5):411-418.

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The purpose of this study was to determine whether the disabled have worse access to primary care than the non-disabled. METHODS: We used the National Disability Registry data and the National Health Insurance data for the calendar year 2003, and we analyzed 807,380 disabled persons who had been registered until December 2001 and we also analyzed 1,614,760 non-disabled persons for nine ambulatory care sensitive conditions (ACSCs). The rates of physician visits and hospitalizations for the patients with ACSCs were compared between the disabled and the nondisabled. Multiple logistic regression analysis was used to evaluate the association between medical care utilization and disability and to assess the association between hospitalization and the number of physician visits while controlling for potential confounders. RESULTS: The numbers of physician visits per 100 patients were 0.78~0.97 times lower for the disabled than that for the non-disabled with five of nine ACSCs. The numbers of hospitalizations per 100 patients were 1.16~1.77 times higher for the disabled than that for the non-disabled with all the ACSCs. While the ORs of a physician visit for the disabled were significantly lower than that for the non-disabled with all the ACSCs (OR: 0.44~0.70), and the ORs of hospitalization for the disabled were significantly higher (OR: 1.16~1.89). The lower physician visit group (number of physician visits < or =1) was more likely to be hospitalized than the higher physician visit group (number of physician visits > or =2) (OR: 1.69~19.77). The effect of the physician visit rate on hospitalization was larger than the effect of disability on hospitalization. CONCLUSIONS: The results suggest that the disabled were more likely to be hospitalized for ACSCs due to their lower access to primary care.; Summary

Changes in Smoking Status among Current Male Smokers and Factors Associated with Smoking Cessation Success.: Jin Seok Lee, Yangjung Kim, Won Nyon Kim, Seung Sik Hwang, Yong Ik Kim; J Prev Med Public Health. 2006;39(4):339-345.

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Abstract PDF: OBJECTIVES
This study (a) investigated the rate of smoking cessation sucess for current male smokers, and (b) identified the factors that are associated with the smoking cessation success. METHODS: Data were collected from four follow-up surveys of 700 current male smokers. The follow-up period was from December 2004 to June 2005. Success of smoking cessation was defined as "maintaining a smoking cessation status for six months". The demographic and socioeconomic factors included age, the household income level and, occupation. The smoking behavioral factors were composed of the amount of smoking, the duration of smoking, the age of initiating smoking, the willingness to quit, the frequency of trying to quit smoking and the smoker`s attitude toward the anti-smoking policies. RESULTS: The proportion of quitters increased from 6.6% to 11.0% during the follow-up period. The majority of quitters answered that the increase of tobacco price acted as cue to achieve smoking cessation. The agestandardized experience and success rate of smoking cessation were 16.0% (95% C.I.=13.0% to, 19.0%) and 4.5% (95% C.I.=3.0% to, 6.0%), respectively. On the multivariate analysis, success for smoking cessation was associated with the willingness to quit smoking, low prior tobacco consumption, and agreement on the tobacco price increase. CONCLUSIONS: The results of this study suggest that the recent anti-smoking policies provided an opportunity to quit smoking. The results of this study can be used to establish evidence for further anti-smoking policies.; Summary

Estimating the Burden of Psychiatric Disorder in Korea.: Jae Hyun Park, Seok Jun Yoon, Hee Young Lee, Hee Sook Cho, Jin Yong Lee, Sang Jun Eun, Jong Hyock Park, Yoon Kim, Yong Ik Kim, Young Soo Shin; J Prev Med Public Health. 2006;39(1):39-45.

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Abstract PDF: OBJECTIVES
This study estimated the burden of disease especially caused by psychiatric disorders in Korea by using DALY, a composite indicator that was recently developed by the Global Burden of Disease study group. METHODS: First, 11 of the major psychiatric disorders in Korea were selected based on the ICD-10. Second, the burden of disease due to premature death was estimated by using YLLs (years of life lost due to premature death). Third, for the calculation of the YLD (years lived with disability), the following parameters were estimated in the formula: the incidence rate, the prevalence rate and the disability weight of each psychiatric disorder. Last, we estimated the DALY of the psychiatric disorders by adding the YLLs and YLDs. RESULTS: The burden of psychiatric disorder per 100,000 people was attributed mainly to unipolar major depression (1,278 person-years), schizophrenia (638 person-years) and alcohol use disorder (287 person-years). For males, schizophrenia (596 person-years) and alcohol use disorder (491 person-years) caused the highest burden. For females, unipolar major depression (1,749 person-years) and schizophrenia (680 person-years) cause the highest burden. As analyzed by gender and age group, alcohol use disorder causes a higher burden than schizophrenia in men aged 40 years and older. For females, unipolar major depression causes the highest burden in all age groups. CONCLUSIONS: We found that each of the psychiatric disorders that cause the highest burden is different according to gender and age group. This study's results can provide a rational basis to plan a national health policy regarding the burden of disease caused by psychiatric disorders.; Summary

Biosafety of Microbiological Laboratories in Korea.: Jin Yong Lee, Sang Jun Eun, Ki dong Park, Jong Kyun Kim, Jeong Soo Im, Yoo Sung Hwang, Yong Ik Kim; J Prev Med Public Health. 2005;38(4):449-456.

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Abstract PDF: OBJECTIVES
The biosafety level (BSL) practiced in microbiology laboratories in Korea according to the laboratory biosafety manual published by the World Health Organization (WHO) was evaluated using the data obtained by a survey. METHODS: Under the advise of Clinical Laboratory Physicians, 144 types of microorganisms were screened based on the guidelines of biosafety in microbiological and biomedical laboratories published by the US Center for Disease Control and Prevention and classified into 1-4 risk groups. A questionnaire containing 21 questions in 5 areas was developed using the biosafety manual by published WHO. Of the 1, 876 different organizations sent the survey, 563 responded to the survey (response rate: 30.0%). The species of microoganisms handled by as well as the biosafety level in microbiology laboratories were analyzed. RESULTS: There were 123 species of microorganisms handled in microbiology labs in Korea. The BSL required in 512 microbiology labs was answered by the survey responders as the first grade in 33 labs (6.4%), 2nd in 437 (85.4%), 3rd in 42 (8.2%), and 4th in none. The average number of items satisfied was 12.2, showing only a 57.9% satisfactory rate and normal distribution. CONCLUSIONS: The state of overall observance of BSL in most microbiology labs of Korea was evaluated as lagging compared with the standard set up by WHO. Therefore, the Korean government need to produce and distribute a biosafety manual in microbiology laboratories and make efforts to prevent this threat through measures such as training in biosafety in microbiology labs.; Summary

Estimating the Burden of Diseases due to High Alcohol Consumption in Korea.: Jung Kyu Lee, Yong Ik Kim, Seok Jun Yoon, Jin Yong Lee, Heeyoung Lee, Jong Hyock Park, Youngsoo Shin; J Prev Med Public Health. 2005;38(2):175-181.

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Abstract PDF: OBJECTIVES
This study estimated the burden of disease due to high alcohol consumption using DALY, a composite indicator recently developed by the Global Burden of Disease study group. The results were analyzed by age and sex. METHODS: Firstly, high alcohol consumption-related diseases, and their relative risk (RR), were selected. Secondly, population attributable fractions (PAFs) were computed using formulae, including the relative risk (RR) and prevalence of exposure (Pe). Thirdly, the DALYs of high alcohol consumption-related diseases were estimated. Lastly, the attributable burdens of diseases due to high alcohol consumption wereconcluded as being the sum of the products that multiplied the DALYs of high alcohol consumption-related diseases by their population attributable fraction (PAF). RESULTS: The burden of high alcohol consumption in Korea was 2992.3 person years (PYs) per 100, 000 persons in men, and 1426.6 in women. For men, the high alcohol consumption-induced diseases with the five biggest burdens were liver cirrhosis, hypertensive disease, liver cancer, cerebral infarction and intracerebral hemorrhage. For women, these were cerebral infarction, intracerebral hemorrhage, hypertensive disease, liver cirrhosis and liver cancer. CONCLUSION: This study highlighted the attributable fraction of diseases due to exposure to high alcohol consumption, by quantifying the results of exposure to risk factors. Therefore, it is now possible to assess interventions for risk factors in quantifiable terms in each population. Finally, measuring the risk factor burdens was expected to contribute to priority setting and effective resource allocation in public health policy.; 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

Factors Affecting the Diffusion of Health Center Information System.: Jin Yong Lee, Young Gyoung Do, Jung Gyu Lee, Gi Dong Park, Chang Yup Kim, Yong Ik Kim; Korean J Prev Med. 2003;36(4):359-366.

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Abstract PDF: OBJECTIVES
This study was conducted to review the diffusion process and factors affecting the adoption of the Health Center Information System (HIS). METHODS: Data were collected from POSDATA (private company), MOHW, other Ministries and local governments. To specify the date of adoption, supplementary information was collected from 40 health centers. The following three kinds of factors were analyzed. Internal factors included type, size, and innovativeness of health centers. Community factors were composed of population size, economic status, and level of education. Organizational environmental factors consisted of information score of the municipalities, financial support of the from central government, and the neighborhoodness of innovator health centers. RESULTS: All health centers in the metropolitan cities of Seoul, Gwangju and Jeju adopted the HIS. The laggards were those in the metropolitan cities of Busan (18.8%), Incheon (20.0%) and Daejun (20.0%), and cities with population more than 300, 000 (54.8%) and counties with health center hospitals (47.1%). Financially supported rural health centers adopted the HIS more rapidly than those not supported. The factors identified as being statistically significant (p< 0.05), from a univariate analysis by Kaplan-Meier method, were: (1) internal factors of the type, size and innovativeness of health centers; (2) community factors of population size and economic status; (3) organizational environmental factors of the central government financial support and the neighborhoodness of innovator health centers. A multivariate analysis, using a Cox proportional hazard method, proved the innovativeness of health centers, central government financial support and the neighborhoodness of innovator health centers, were statistically significant (p< 0.05). CONCLUSIONS: The innovativeness of health centers, financial support from central government and the neighborhoodness of innovator health centers, rather than community factors related to regional socioeconomic status, affected the adoption of the HIS in health centers. Further in-depth studies, modifying the MOHW's strategy to propagate the HIS to the laggard health centers, are recommended.; Summary

Disability Weights for Diseases in Korea.: Jung Kyu Lee, Seok Jun Yoon, Young Kyung Do, Young Hoon Kwon, Chang Yup Kim, Kidong Park, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 2003;36(2):163-170.

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Abstract PDF: OBJECTIVES
This study aimed to develop an evaluation protocol of disability weights using person trade-off, and to test the reliability of the developed protocol in a Korean context. METHODS: To develop the valuation protocol, the Global Burden of Disease (GBD) and the Dutch studies were replicated and modified. Sixteen indicator conditions were selected from the Korean version of disease classification, which was based on that of the GBD Study, and the person trade-off method referred to the Dutch method. RESULTS: The disability weights were valued in a two step panel study. The first step was a carefully designed group process by three panels, using person trade-off to establish the disability weights for sixteen selected indicator conditions. The second step consisted of interpolation of the remaining diseases, on a disability scale, by the individual members of three panels. The members of three panels were all medical doctors, with sufficient knowledge of the consequences of a broad variety of diseases. The internal consistency of the Korean disability weights was satisfactory. Considerable agreement existed within each panel and among the panels. CONCLUSIONS: It was feasible to use a modified evaluation protocol from those used in GBD and Dutch studies. This would provide a rational basis for an international comparative study of disability weights.; 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

Study of Disability-Adjusted Life Expectancy(DALE) Using National Health Interview Survey in Korea.: Young Hoon Kwon, Jung Kyu Lee, Young Kyung Do, Seok Jun Yoon, Chang Yup Kim, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 2002;35(4):331-339.

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Abstract PDF: OBJECTIVES
To measure DALE (Disability-Adjusted Life Expectancy) in Korea to find out how long Koreans live in a state of full heath. METHODS: DALE was calculated using the life table of 1999 and the disability prevalence from the National Health Interview Survey (NHIS), which was conducted with a sample of 13,523 households in 1998. The disability prevalence was measured using the annual prevalence of the long-term limitation of activities, which were divided into classes 1, 2, 3, 4, 5 and 6 according to the severity of the limitation. The disability weights were measured for each 6 class by conducting a survey of 16 healthcare professionals. The severity-adjusted disability prevalence was calculated by multiplying the disability prevalence of each class by the disability weights respectively. Healthy life years lost due to disability was calculated by multiplying the life expectancy by the severity-adjusted disability prevalence. Finally DALE was measured as the life expectancy minus healthy life years lost due to disability. RESUJLTS: DALE for 1999, which refers to the expectation of equivalent years of good health, were 72.5, 69.5 and 75.3 years, for total, for males and for females, respectively. The percentages for DALE out of the life expectancy were 95.8, 96.6 and 94.4% for total, for males and for females, respectively. CONCLUSIONS: DALE is a newly developed indicator, which could effectively show the healthy life expectancy of populations. A greater notice and use of DALE would be expected as life expectancies increase and the quality of life changes in Korea.; Summary

Application of the Theory of Planned Behavior and the Theory of Reasoned Action to Predicting Cervix Cancer Screening Behavior.: Kun Sei Lee, Yong Ik Kim, Chang Yup Kim, Young Soo Shin; Korean J Prev Med. 2001;34(4):379-388.

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Abstract PDF: BACKRGROUND: Cervix cancer is the most common form of cancer among Korea women. In spite of proof that cervical cancer screening could reduce death rates substantially, the screening rates reported by previous Korean studies remain stubbornly very low. Behavioral studies to increase the cervix cancer screening rate are essential in order to develop the cancer screening program. OBJECTIVE: To evaluate the factors which are related to the intention and behavior for cervix cancer screening using the Theory of Planned Behavior (TPB) and the Theory of Reasoned Action (TRA). METHODS: The survey was conducted from July 21st to 26th in 1998. Of 3,218 women, 393(12.2%) between 30 and 65 years old, voluntarily participated in the survey in the 3 Myeons in Choongju city. Charge-free cervix cancer screening was provided for the subjects 3 months later. RESULTS: The R-square of both TPB and TRA to the intention (30% and 42%, respectively) was greater than the actual behavior (21% and 13%, respectively. TPB and TRA were found to provide an appropriate framework for the study of cervix cancer screening behavior. However, TRA was more powerful in explaining the intention, not only because the perceived behavioral control component exhibited lower reliability and validity than other components(attitude and subjective norm), but also because there may have been a few limitations in this study design. Consequently, the use of TRA is preferred in attempting to explain intention and actual behavior in this study. CONCLUSIONS: This study suggests that a successful intervention program should focus on changing attitudes and reducing psychologic barriers, rather than on just providing information. Physician recommendations, and the support of family members and friends are also very important factors in cervix cancer program participation. Physicians, friends, family members, and opinion leaders in rural areas, all of whom could affect the individual subjective norm, may all have the potential to play great roles as facilitators.; Summary

Changes in Quality of Care for Cesarean Section after Implementation of Diagnosis-Related Groups/Prospective Payment System.: Jun Yim, Young Hun Kwon, Du Ho Hong, Chang Yup Kim, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 2001;34(4):347-353.

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Abstract PDF: OBJECTIVES
To determine the impacts of Diagnosis-Related Groups/Prospective Payment System (DRG/PPS) on the quality of care in cases of Cesarean section and to describe the policy implications for the early stabilization of DRG/PPS in Korea. METHODS: Data was collected from the medical records of 380 patients who had undergone Cesarean sections in 40 hospitals participating in the DRG/PPS Demonstration Program since 1999. Cesarean sections were performed in 122 patients of the FFS(Fee-For-Service) group and 258 patients of the DRG/PPS group. Measurements of quality used included essential tests of pre- and post-operation, and the PPI(Physician Performance Index) score. The PPI was developed by two obstetricians. RESULTS: Univariate analysis demonstrated significant differences in PPI scores according to the payment systems. With respect to the mean of PPI scores, a higher score was found in the DRG/PPS group than in the FFS group. However, the adjusted effect did not show significant differences between the FFS group and the DRG/PPS group. CONCLUSION: This study suggested that the problem of poor quality may not be related to the implementation of DRG/PPS in Cesarean section. However, this study did not consider the validity and reliability of the process measurement, and it did not exclude the possibility of data omission in medical records.; Summary

Current Status and Reasons for the Location Change of Primary Medical Institutions in Korea.: Beom Man Ha, Soon Ae Shin, Jin Seok Lee, Chang Yup Kim, Yong Ik Kim; Korean J Prev Med. 2001;34(3):219-227.

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Abstract PDF: OBJECTIVES
To understand the current status of the opening, closing and relocation of primary medical institutes in Korea and identify the underlying decision factors. METHODS: Sources of analyzed data included the medical institutional master file at the National Health Insurance Corporation (1998, 2000) and Regional Statistic Annual Bulletins. To investigate changes including the opening, closing and relocation, a total of primary medicalinstitutions (16,757 in 1998, 19,267 in 2000) were analysed. RESULTS: Between 1998 and 2000, there was a 15.0% (2,510) increase in the number of primary medical institutions and the rate of increase in the rural area was higher than the urban area, and higher for specialty clinics than primary practice. However, these findings did not suggestany improvement in the maldistribution of primary medical institutions. During the time period studied, newly opened and closed primary medical institutions numbered 4,085 and 1,573, respectively. Additionally, institutions thatrelocated numbered 2,729, or 16.3%of all primary medical institutions in operation in 1998. These openings and closings were more frequent among young doctors. As a result of our analysis on the underlying regional factors forrelocation, the factors that were statistically significant were local per capita tax burden and the number of schools per ten thousand persons. In the case of institutional factors, movements were significantly associated with gender and the location of primary medical institutions. CONCLUSIONS: In order to establish effective long-term intervention for primary medical institutions, further study and monitoring of primary medical institutions and the dentification of factors influencing opening location and relocation is necessary.; Summary

Relationship between Percutaneous Transluminal Coronary Angioplasty Volume and Associated Immediate Outcome.: Young Ho Khang, Yong Ik Kim, Chang Yup Kim, Young Sung Lee, Sunmean Kim, Jin Seok Lee, Byung Hee Oh; Korean J Prev Med. 2001;34(1):9-20.

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Abstract PDF: OBJECTIVES
To explore the relationship between Percutaneous Transluminal Coronary Angioplasty (PTCA) volume and the associated immediate outcome. METHODS: A total of 1,379 PTCAs were performed in 25 hospitals in Korea between October 1 and December 31 in 1997. Data from 1,317 PTCAs (95.5%) were collected through medical record abstraction. Inter-observer reliability of the data was examined using the Kappa statistic on a subsample of 110 PTCA procedures from five hospitals. Intra-observer reliability of the data was also examined. PTCA success and immediate adverse outcomes were selected as the outcome variables. A successful PTCA was defined as a case that shows less than 50% diameter stenosis and more than 20% reduction of diameter stenosis. Immediate adverse outcomes included deaths during the same hospitalization, emergency coronary artery bypass graft (CABG) within 24 hours after PTCA, and acute myocardial infarction within 24 hours after PTCA. The numbers of PTCAs performed in 1997 per hospital were used as the volume variables. RESULTS: Without adjusting for patient risk factors that may affect outcomes, procedures at high volume hospitals (200 cases per year) had a greater success rate (P=0.001) than low volume hospitals. There was a marginally significant difference (P=0.070) in major adverse outcome rates between high and low volume hospitals. After adjusting for risk factors, there were significant differences in procedural failure and major adverse outcome rates between high and low volume hospitals. CONCLUSIONS: After adjusting for patient clinical risk factors, the hospital volume of PTCA was associated with immediate outcomes. It is recommended that a PTCA volume per year be established in order to improve the immediate outcome of this procedure in Korea.; Summary

Factors Affecting Users' Satisfaction with Order Communicating System.: Jin Seok Lee, Chang Yup Kim, Bum Man Ha, Gilwon Kang, Byoung Yik Kim, Yong Ik Kim; Korean J Prev Med. 2000;33(4):436-448.

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Abstract PDF: OBJECTIVES
To identify the factors affecting users' satisfaction with the Order Communicating System(OCS) and to highlight the factors important for the successful establishment of OCS. METHODS: A Users Satisfaction survey was sent to 4,513 people, consisting of 1,503 doctors, 2,379 nurses, 255 pharmacists and 370 administrative workers in 16 hospitals which had introduced OCS. The response rate was 63.9%. Measurement of users' satisfaction was performed with the instrument which was used in Doll's study. Some aspects of Doll's instrument were adjusted according to the aims of this study. The classifying sections of this survey included age, job and status classification, computer experience , OCS education, duration of daily OCS use, type of order entering, number of personnel in the Hospital Information System's department, cost of OCS, problem frequency, proportion of work managed by hand, OCS type, and Hospital establishment type. RESULTS: There was a positive correlation between satisfaction level and managerial status throughout all job classifications. Irrespective of the importance of OCS education as a factor relating to users' satisfaction, the additional work load caused by OCS lowered users' satisfaction. Different factors affected users' satisfaction according to job and status classification. The composition of factors affecting the pharmacist and administrative worker satisfaction levels was simpler than that of the doctor and nurse levels. There were no statistically significant differences between the actual computer experience duration of daily OCS use and users' satisfaction with OCS. CONCLUSIONS: There was an understandable relationship between users' attitude to OCS and factors affecting users' satisfaction. The results of this study could be used as a basis for the successful expansion of the operation of OCS. But more detailed studies on users' satisfaction and further improvements of methodologies are required for the successful establishment of OCS.; Summary

Impacts of DRG Payment System on Behavior of Medical Insurance Claimants.: Beom Man Ha, Gilwon Kang, Hyoung Keun Park, Chang Yup Kim, Yong Ik Kim; Korean J Prev Med. 2000;33(4):393-401.

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Abstract PDF: OBJECTIVES
To evaluate the impacts of the DRG payment system on the behavior of medical insurance claimants. Specifically, we evaluated the case-mix index, the numbers of diagnosis and procedure codes utilized, and the corresponding rate of diagnosis codes before, during and after implementation of the DRG payment system. METHODS: In order to evaluate the case-mix index, the number of diagnosis and procedure codes utilized, we used medical insurance claim data from all medical facilities that participated in the DRG-based Prospective Payment Demonstration Program. This medical insurance claim data consisted of both pre-demonstration program data (fee-for-service, from November, 1998 to January, 1999) and post-demonstration program data (DRG-based Prospective Payment, from February, 1999 to April, 1999). And in order to evaluate the corresponding rate of diagnosis codes utilized, we reviewed 820 medical records from 20 medical institutes that were selected by random sampling methods. RESULTS: The case-mix index rate decreased after the DRG-based Prospective Payment Demonstration Program was introduced. The average numbers of different claim diagnosis codes used decreased (new DRGs from 2.22 to 1.24, and previous DRGs from 1.69 to 1.21), as did the average number of claim procedure codes used (new DRGs from 3.02 to 2.16, and previous DRGs from 2.97 to 2.43). With respect to the time of participation in the program, the change in number of claim procedure codes was significant, but the change in number of claim diagnosis codes was not. The corresponding rate of claim diagnosis codes increased (from 57.9% to 82.6%), as did the exclusion rate of claim diagnosis codes (from 16.5% to 25.1%). CONCLUSIONS: After the implementation of the DRG payment system, the corresponding rate of insurance claim codes and the corresponding exclusion rate of claim diagnosis codes both increased, because the inducement system for entering the codes for claim review was changed.; Summary

Measuring the Burden of Major Cancers due to Premature Death in Korea.: Seok Jun Yoon, Yong Ik Kim, Chang Yup Kim, Hyejung Chang; Korean J Prev Med. 2000;33(2):231-238.

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Abstract PDF: OBJECTIVE
To estimate the burden of diseases in Korea especially caused by major cancers using the YLL(years of life lost due to premature death) measurement. METHODS: First, we determined the parameters: such as age-specific standard life expectancy, age on death, sex, cause of death by analyzing the national death certificate data and life table collected during 1996 provided by the National Statistical Office. Secondly, we estimated the age group-specific YLL by employing standard expected years of life lost(SEYLL). Thirdly, final burden of disease due to premature death was estimated by using YLLs measurement which developed by global burden of disease study group. RESULTS: The burden of premature death by cancer for male was attributed mainly to liver cancer(514.5 person-year), stomach cancer(436.4 person-year), and lung cancer(367.7 person-year). Each of these cancers was responsible for the loss of over 100 person-year based on our YLL measurement. The burden of premature death by cancer for female was attributed mainly to liver cancer(135.1 person-year), stomach cancer(252.1 person-year), and lung cancer(121.8 person-year). Each of these cancers was responsible for the loss of over 100 person year based on our YLL measurement. CONCLUSION: We found the YLL method employed in this study was appropriate to quantify the burden of premature death. Thereby, it would provide a rational bases to plan a national health policy regarding premature death caused by cancer.; Summary

Health Behaviors Related to Hypertension in Rural Population of Korea.: Chang Yup Kim, Kun Sei Lee, Young Ho Khang, Jun Yim, Yong Jun Choi, Hae Kook Lee, Kyung Ho Lee, Yong Ik Kim; Korean J Prev Med. 2000;33(1):56-68.

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Abstract PDF: OBJECTIVES
To describe health behaviors related to hypertension in rural population of Korea and focused to identify inappropriate awareness, treatment, and control of hypertension. METHODS: We surveyed 5,517 adults (2,288 males, 3,229 females) older than 30 years in 58 rural areas, purposely sampled nationwide from December 1996 to February 1997. Blood pressure was checked twice at the time of the first visit. For those who showed high blood pressure using the JNC-6 criteria at their initial visit, we followed up their blood pressure one week later. Also information on the health behavior related to hypertension was collected through the person-to-person interview using structured questionnaire at the first visit. RESULTS: For the past one year, females had more experiences of checking their blood pressure than males (77.3% versus 69.5%, p=0.001). Through the results of consecutively checked blood pressure, only 51.7% of the hypertensives were aware of their condition. Of the hypertensives who aware of their condition, 44.4% did not receive any medication and/or recommendation. And 50.4% of the hypertensives who had anti-hypertensive medication were classified as still having hypertensive blood pressure by 160/95 mmHg criteria. Of the medicated, 54.8% were found to take medication regularly for the past six months. Among the medicated, only 11.4% knew the name of anti-hypertensive drug they had. CONCLUSIONS: 'Rule of halves', which works in the situation of no special efforts for hypertension control, was identified. This study showed that much efforts to control hypertension would be required in the rural population of Korea.; Summary

Validation of the International Classification of Diseases 10th Edition Based Injury Severity Score(ICISS).: Yoon Kim, Ku Young Jung, Chang Yup Kim, Yong Ik Kim, Youngsoo Shin; Korean J Prev Med. 1999;32(4):538-545.

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Abstract PDF: OBJECTIVE
To compare the predictive power of International Classification of Diseases 10th Edition(ICD-10) based International Classification of Diseases based Injury Severity Score(ICISS) with Trauma and Injury Severity Score(TRISS) and International Classification of Diseases 9th Edition Clinical Modification(ICD-9CM) based ICISS in the injury severity measure. METHODS: ICD-10 version of Survival Risk Ratios(SRRs) was derived from 47,750 trauma patients from 35 Emergency Centers for 1 year. The predictive power of TRISS, the ICD-9CM based ICISS and ICD-10 based ICISS were compared in a group of 367 severely injured patients admitted to two university hospitals. The predictive power was compared by using the measures of discrimination(disparity, sensitivity, specificity, misclassification rates, and ROC curve analysis) and calibration(Hosmer-Lemeshow goodness-of-fit statistics), all calculated by logistic regression procedure. RESULTS: ICD-10 based ICISS showed a lower performance than TRISS and ICD-9CM based ICISS. When age and Revised Trauma Score(RTS) were incorporated into the survival probability model, however, ICD-10 based ICISS full model showed a similar predictive power compared with TRISS and ICD-9CM based ICISS full model. ICD-10 based ICISS had some disadvantages in predicting outcomes among patients with intracranial injuries. However, such weakness was largely compensated by incorporating age and RTS in the model. CONCLUSIONS: The ICISS methodology can be extended to ICD-10 horizon as a standard injury severity measure in the place of TRISS, especially when age and RTS were incorporated in the model. In patients with intracranial injuries, the predictive power of ICD-10 based ICISS was relatively low because of differences in the classifying system between ICD-10 and ICD-9CM.; Summary

Determining the Location of Urban Health Sub-center According to Geographic Accessibility.: Kun Sei Lee, Chang Yup Kim, Yong Ik Kim, Youngsoo Shim; Korean J Prev Med. 1996;29(2):215-226.

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Abstract PDF: Decentralization to local governments and amending of Health center Law are to promote the efforts of health planning at the level of local agencies. In the health facility planning, it is important to take into account that what to be built, where to be located, how far should be service area and so forth, because health facilities are immovable, and require capital as well as personnel and consumable supplies. The aim of our study, answering to the question of 'where to be located?`, is to determine the best location of urban health sub-center. At the local level, planning is the matter of finding the best location of specific facility, in relation to population needs. We confine the accessibility, which is basic to location planning, to geographic one. Location-Allocation Model is used to solve the problem where the location is to maximize geographic accessibility. To minimize the weighted travel distance, objective function, Rk= aijwidij is used. Distances are measured indirectly by map measure-meter with l:25,000 Suwon map, and each potential sites, 10 administrative Dongs in Kwonson Gu, Suwon, are weighted by each number of households, total population, maternal age group, child age group, old age group, Relief for the livelihood, and population/primary health clinics. we find that Kuwoon-Dong, Seodun-Dong, Seryu3-Dong, according the descending orders, are best sites which can minimize the weighted distance, and conclude that it is reasonable to determine the location of urban health sub-center among those sites.; 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

An analysis an dassessment of diagnostic and therapeutic process in some freqent admissions and operations.: Chang Yup Kim, Yoon Kim, Young Dae Kwon, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 1993;26(3):400-411.

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Abstract PDF: The aim of this study is to analyze the variations among hospitals and hospital groups in resource use and procedures of diagnostic and therapeutic process, such as laboratory tests, radiologic examinations, tissue diagnosis, timing of surgery after admission, the time required for operation. The study was performed for five procedures including cesarean section(C/S), appendectomy, cholecystectomy, cataract extraction, and pediatric pneumonia. The 2,316 subjects were selected from medical insurance claims list, and from this list 413 cases were sampled for medical record review. The patterns of resource utilization and process of treatment were described according to hospitals and characteristics of hospital groups. The major results were as follows: 1. The numbers of laboratory and radiologic tests showed significant difference among hospitals and hospital groups. In case of hospital groups, we could find tendencies of more tests with increasing hospital bed size. 2. In general, the proportion of operative cases evaluated by tissue diagnosis postoperatively among all operations ranged from 28.3% to 1005. The proportion varied among hospital groups, of which general hospital A group(more than 15 specially) showed the highest proportion. 3. Post-admission delay until operation and the time required for operative procedure were not invariable among hospitals and hospital groups. The duration of operation in tertiary hospitals was slightly shorter than general hospitals, with varying statistical significance. We could find that probably there were differences of quality among hospitals in some components of procedures, which suggested that the implementation of quality assurance activities would be mandatory. In this study, we simply described the patterns of resource utilization and some features of clinical process, with institution of the need for advanced studies with in-depth analyses for each component of diagnosis and treatment procedures.; Summary

An Appropriateness Evaluation of Cesarean Section, Cholecystectomy, and Admission in Pediatric Pneumonia.: Chang Yup Kim, Hyeong Sik Ahn, Young Seong Lee, Young Dae Kwon, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 1992;25(4):413-428.

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Abstract PDF: The aim of this study was to evaluate the appropriateness of some kinds of surgery and admission, such as cesarean section (C/S), cholecystectomy, and pediatric pneumonia. For appropriateness evaluation, we ourselves developed some criteria, which were included in the category of explicit and linear criteria, with the assistance of specialists of relevant clinical field. The evaluation of appropriateness was performed by two family physicians. The major findings were as follows: 1. For ceserean section, 77.6% of deliveries were determined to be 'appropriate', but the level of appropriateness was not significantly different among hospitals between hospital groups by size. The most frequent indication of C/S was repeated operation, followed by cephalopelvic disproportion(CPD). The labor trials for vaginal delivery among repeated C/S and CPD cases were performed in 24.5% of pertinent deliveries. 2. About 73.8% of cholecystectomy cases was appropriate to one of the surgical indications, without significant differences among hospitals. Of surgical indications, 'sufficiently frequent and intense symptom recurrence' was the most frequent, and 'confirmed acute cholecystitis' was the second. 3. Of children admitted due to pneumonia, only 57.4% of cases satisfied admission criteria, and the level of appropriateness of admission was different among hospitals. The common reasons for admission were 'failure to initial treatment', 'suspected bacterial pnermonia', 'young infant', etc. We could find that there were differences of quality among hospitals in some procedures, especially in the pediatric pneumonia and labor trial before C/S, which suggested that the implementation of quality assurance activities would be necessary in this country. In this study, we used some simple and primitive research tools and the numbers of subjects and tracer procedures were limited. So advanced studies with plentiful subjects and more representative diseases or procedures should be tried.; 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

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

A Study on the Incidence of Carbon Monoxide Poisoning.: Soo Hun Cho, Young Soo Shin, Doek Hyoung Lee, Yong Ik Kim, Dork Ro Yun; Korean J Prev Med. 1985;18(1):1-11.

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Abstract PDF: A decade ago a survey on the population-base incidence rate of anthracite coal gas(mainly carbon monoxide) poisoning in Seoul area was investigated, resulting in the incidence rate of 306/10,000 risk population and 1 death/10,000. Another survey on the carbon monoxide poisoning was investigated during 1 year period from Apr. 1983 to Mar. 1984. Total subjects of risk population were 67,740 households covering 353,287 persons. The major findings of this survey are as follows: 1. Household-base incidence rate was 8.4%; spell-base 10.4%. 2. The incidence rate was the highest in houses having each of slate roof, cement wall, vinyl floor of bedroom and direct 'ondol' heating system. 3. Average 2.1 person was attacked from one incidence of the poisoning; severity-wise person-base incidence rates per 10,000 were 352 in mild poisoning, 54 in severe poisoning and 1.4 in death-overall incidence rate 407. Several facts were identified which supported that this figure was moderately underestimated. As the incidence of the poisoning is affected by socioeconomic and environmental factors, it is natural that one expects the incidence will decrease in proportion to general improvement of the above factors. Thus the results of these two surveys seemed preposterous. But further study suggested that the incidence rate (306/10,000) decade before had been significantly underestimated and corrected-rate should have been 478/10,000 level. 4. Age and sex distribution by the degree of the poisoning was uniform with little statistical difference; overall incidence rates by sex were 339/10,000 in male and 475/10,000 in female with significant statistical difference(p<.01). 5. 5.3% of the patients were treated at hospital or local clinic; 3.0% of the patients were hospitalized. Admission rate in comatose patient(severe poisoning) was 14.2%. In conclusion, carbon monoxide poisoning remains a major health problem by now.; Summary

A Stochastic Study for the Emergency Treatment of Carbon Monoxide Poisoning in Korea.: Yong Ik Kim, Dork Ro Yun, Young Soo Shin; Korean J Prev Med. 1983;16(1):135-152.

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Abstract PDF: Emergency medical service is an important part of the health care delivery system, and the optimal allocation of resources and their efficient utilization are essentially demanded. Since these conditions are the prerequisite to prompt treatment which, in turn, will be crucial for life saving and in reducing the undesirable sequelae of the event. This study, taking the hyperbaric chamber for carbon monoxide poisoning as an example, is to develop a stochastic approach for solving the problems of optimal allocation of such emergency medical facility in Korea. The hyperbaric chamber, in Korea, is used almost exclusively for the treatment of acute carbon monoxide poisoning, most of which occur at home, since the coal briquette is used as domestic fuel by 69.6 percent of the Korean population. The annual incidence rate of comatous and fatal carbon monoxide poisoning is estimated at 45.5 per 10,000 of coal briquette-using population. It offers a serious public health problem and occupies a large portion of the emergency outpatients, especially in the winter season. The requirement of hyperbaric chambers can be calculated by setting the level of the annual queueing rate, which is here defined as the proportion of the annual number of the queued patients among the annual number of the total patients. The rate is determined by the size of the coal briquette-using population which generate a certain number of carbon monoxide poisoning patients in terms of the annual incidence rate, and the number of hyperbaric chambers per hospital to which the patients are sent, assuming that there is no referral of the patients among hospitals. The queueing occurs due to the conflicting events of the "arrival" of the patients and the "service" of the hyperbaric chambers. Here, we can assume that the length of the service time of hyperbaric chambers is fixed at sixty minutes, and the service discipline is based on "first come, first served". The arrival pattern of the carbon monoxide poisoning is relatively unique, because it usually occurs while the people are in bed. Diurnal variation of the carbon monoxide poisoning can hardly be formulated mathematically, so empirical cumulative distribution of the probability of the hourly arrival of the patients was used for Monte Carlo simulation to calculate the probability of queueing by the number of the patients per day, for the cases of one, two or three hyperbaric chambers assumed to be available per hospital. Incidence of the carbon monoxide poisoning also has strong seasonal variation, because of the four distinctive seasons in Korea. So the number of the patients per day could not be assumed to be distributed according to the Poison distribution. Testing the fitness of various distributions of rare event, it turned out to be that the daily distribution of the carbon monoxide poisoning fits well to the Polya-Eggenberger distribution. With this model, we could forecast the number of the poisonings per day by the size of the coal-briquette using population. By combining the probability of queueing by the number of patients per day, and the probability of the number of patients per day in a year, we can estimate the number of the queued patients and the number of the patients in a year by the number of hyperbaric chambers per hospital and by the size of coal briquette-using population. Setting 5 percent as the annual queueing rate, the required number of hyperbaric chambers was calculated for each province and for the whole country, in the cases of 25, 50, 75 and 100 percent of the treatment rate which stand for the rate of the patients treated by hyperbaric chambers among the patients who are to be treated. Findings of the study were as follows. 1. Probability of the number of patients per day follows Polya-Eggenberger distribution. Hourly arrival pattern of the patients turned out to be bimodal, the large peak was observed in 7:00~8:00 a.m., and the small peak in 11:00~12:00 p.m. 2. In the cases of only one or two hyperbaric chambers installed per hospital, the annual queueing rate will be at the level of more than 5 percent. Only in case of three chambers, however, the rate will reach 5 percent when the average number of the patients per day is 0.481. 3. According to the results above, a hospital equipped with three hyperbaric chambers will be able to serve 166, 485, 83, 242, 55, 495 and 41, 620 of population, when the treatment rate are 25, 50, 75 and 100 percent. 4. The required number of hyperbaric chambers are estimated at 483, 962, 1,441 and 1,923 when the treatment rate are taken as 25, 50, 75 and 100 percent. Therefore, the shortage are respectively turned out to be 312, 791, 1,270 and 1,752. The author believes that the methodology developed in this study will also be applicable to the problems of resource allocation for the other kinds of the emergency medical facilities.; Summary

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