Analysis of the current status outpatient utilization of medical and Korean traditional medical institutions: focuse on outpatient frequent outpatient diseases

The purpose of this study was to analyze the current status of utilization of medical and Korean traditional medical institutions. In this study, we used a sample cohort database from the National Insurance Service and frequency analysis was performed. The major results are as follows. First, the majority of users of medical institutions were found to use medical facilities. However, patients with three musculoskeletal disorders and two disease of respiratory diseases showed higher utilization rates of Korean traditional medical institutions and a highter overlapping utilization rate than those with other diseases. Second, they also visited medical facilities more often and spent more on medical expenses than those who used only medical institutions. Therefore, there is a need for policies that directly or indirectly restrict the use of overlapping medical care for the same disease so that limited medical resources can be used efficiently.

Priority analysis of the healthcare policy using analytic hierarchy process

The purpose of this study was to suggest signposting strategy for healthcare policy. Analytic hierarchy process analysis was used to classify the decision levels of healthcare policies using the Delphi professional survey and a literature review. National health insurance was identified as a priority healthcare policy. After that, arranged in order of priority, were the healthcare delivery system, health and medical care, and healthcare resources. Among the sub-levels in healthcare policy, the reimbursement system was a priority policy. This study confirmed that healthcare providers are interested in national health insurance. because their greatest concern was the reimbursement system. Consequently, in order to determine and implement healthcare policy efficiently, the government should consider the opinions of healthcare providers.

An Analysis of Effects of Differential Coinsurance Policy and Utilization of Outpatients Care by Types of Medical Institutions / 보건행정학회지

BACKGROUND: The purpose of this study is to analyze the effects of differential coinsurance policy on prescription drug coverage of outpatients by types of medical institutions. METHODS: In this study, we used a sample cohort database of the National Health Insurance Service and frequency analysis and marginal logistic regression model using generalized estimating equation were used for statistical analysis. RESULTS: The summary on the major research is followed. First, about 16% of patients who used only tertiary or general hospital due to 52 ambulatory care sensitive conditions before policy implementation moved to hospitals and clinics. However, about 57% of them still use tertiary or general hospital. Second, the factors influencing the utilization of hospitals and clinics after the implementation of the policy were gender, age, and income level. As a result, the policy is effective to reduce the medical use of outpatient mental patients in tertiary or general hospital, but the effect is not significant. CONCLUSION: Therefore, in order to achieve the purpose of the policy for establishing the health care delivery system, it is necessary to adjust the co-payment so as to feel the burden on the co-payment when the outpatient for 52 ambulatory care sensitive conditions is used at the tertiary or general hospital.

Effect of atopic dermatitis on the natural course of food allergy in infants and young children

PURPOSE: There have been studies showing that food allergy plays a role in the pathogenesis of atopic dermatitis. However, there have been few studies about the effect of atopic dermatitis on remission of food allergy. Thus, this study aimed to evaluate the difference in remission according to the presence of atopic dermatitis in infants and young children with milk or egg allergy. METHODS: A retrospective study was performed on 109 infants and young children with IgE-mediated food allergy in a tertiary hospital. They divided into food allergy with atopic dermatitis (FA with AD) and without atopic dermatitis (FA without AD). RESULTS: In the milk allergy group, initial milk-specific IgE levels were 21.16±27.98 kU(A)/L and 11.36±22.88 kU(A)/L, respectively, in FA with AD and FA without AD under 12 months of age. The remission rates of milk allergy at 36 months of age were 64.9% and 90.0%, respectively, in FA with AD and FA without AD. In the egg allergy groups, initial egg-specific IgE levels were 34.48±36.72 kU(A)/L and 15.66±28.60 kU(A)/L, respectively, in FA with AD and FA without AD under 12 months of age. The remission rates of egg allergy at 36 months of age were 61.2% and 90.0% in children with FA with AD and FA without AD. CONCLUSION: Atopic dermatitis may play an important role in the natural history of food allergy in infants. Different strategies are needed for the management of food allergy in young children with atopic dermatitis.

Fractional exhaled nitric oxide in Korean children with allergic rhinitis

PURPOSE: Fractional exhaled nitric oxide (FeNO) is useful for the diagnosis of allergic rhinitis (AR) as well as bronchial asthma (BA). However, FeNO may differ according to race, age, and other determinants. There have been few studies about FeNO in Korean children with AR. The aims of this study were to evaluate the value of FeNO in AR and to compare FeNO, and determinants of FeNO levels between AR, BA, and combined AR and BA. METHODS: This study included 647 children aged 5 to 17. The children were classified into 5 groups after performing the skin test, FeNO measurement, the pulmonary function test, and the methacholine challenge test: those with nonallergic rhinitis (NAR), those with AR, those with BA, and those with combined AR and BA, and healthy controls,. RESULTS: The values of FEV1 (forced expiratory volume in one second) %predicted were 94.4%+/-12.6%, 93.8%+/-20.7%, 90.0%+/-17.4% in AR, BA, and combined AR and BA, respectively. The values of FeNO in AR (32.3+/-25.0 ppb), BA (31.1+/-20.5 ppb), and combined AR and BA (34.5+/-30.4 ppb) were significantly higher compared to those of NAR (16.8+/-13.5 ppb) and controls (15.9+/-12.5 ppb). There was no significant difference in FeNO among AR, BA, and combined AR and BA. FeNO was significantly higher in patients with > or =4 positive results (36.6+/-29.2 ppb) than in those with <4 positive skin test results (27.6+/-20.7 ppb). When the receiver operating characteristic curve analysis for prediction of AR showed 0.756 of area under the curve, the cutoff level of FeNO was 16 ppb. CONCLUSION: In this study, children with AR had increased levels of FeNO. It is suggested that AR may have eosinophilic bronchial inflammation without BHR or clinical asthma.

Prevalence and allergens of allergic rhinitis in children and adolescents in Gwangju

PURPOSE: Allergic rhinitis (AR) is one of the most common childhood diseases in Korea. In this study, we aimed to investigate the prevalence and allergens of childhood AR in Gwangju. METHODS: From April 2013 to September 2013 in Gwangju, skin prick test and questionnaire survey were performed targeting 2,330 children in total (350 kindergartners, 930 elementary school students, 589 middle school students, and 461 high school students). RESULTS: The overall prevalence of AR was 23.5% (female 21.3%, male 26.1%). According to age groups, prevalence of AR was 14.9% (female 10.7%, male 19.8%) in kindergartners, 24.5% (female 18.8%, male 29.4%) in elementary school students, 23.3% (female 18.1%, male 27.6%) in middle school students, 26.2% (female 27.7%, male 23.2%) in high school students. The most common allergen was Dermatophagoides pteronyssinus (79.7%), followed by Dermatophagoides farina (72.2%), birch (14.0%), alder (12.0%), Japanese hop (9.2%), Alternaria (8.9%), cat fur (7.2%), Japanese cedar (6.9%), ryegrass (6.6%), willow (6.0%), pine (5.4%), oak (4.9%), mugwort (4.3%), orchard grass (4.0%), sheep fescue (3.7%), fat hen (3.4%), ragweed (3.4%), and maple (3.4%). CONCLUSION: This research figures out the prevalence and the detailed allergens of AR in Gwangju children. We suggest that more vegetation data of Japanese cedar should be surveyed in recent future.

Increased Tuberculosis Burden Due to Demographic Transition in Korea from 2001 to 2010 / 결핵및호흡기질환

BACKGROUND: Notified tuberculosis (TB) cases in Korea have not decreased over the last decade (2001-2010). METHODS: To clarify the reasons, we analyzed an annual report on notified tuberculosis patients and age-specific population drift in Korea. RESULTS: Compared to the age-specific notified TB cases between 2001 and 2010, distinctive features in notified TB cases and new cases increased markedly in people aged 45-54 years and in patients over 65 years old, whereas those between 15-34 years in 2010 decreased drastically. In particular, notified TB individuals over 65 years old occupied 29.6% of the cases in 2010, which was 1.5 times higher than that in 2001. The main reason not to decrease in notified TB patients for the last decade (2001-2010) was due to the increasing elderly population as well as the aging of baby boomers, which have a higher risk of TB development. CONCLUSION: Korea needs to pay attention to the older population in order to successfully decrease the burden of TB in the future.

The National Status of Tuberculosis Using Nationwide Medical Records Survey of Patients with Tuberculosis in Korea / 결핵및호흡기질환

BACKGROUND: The epidemiology of tuberculosis (TB) has been assessed based on the data of the analysis of TB patients notified to the surveillance system in Korea. However, the national status of TB is not validated through this surveillance system. The objective is to determine the epidemiology of TB and to understand the accurate status of TB patients treated in private institutions. METHODS: Medical records of 53,579 patients who had been diagnosed with TB in 2008 were analyzed. RESULTS: Among 53,579 patients, the number of sputum smear positive cases was 15,639(29.2%) and the number of new cases was 39,191 (73.1%). The drug resistance rate of new cases was 5.3%, while the rate stood at 13.3% for TB patients with treatment history. The number of multi-drug resistant TB (MDR-TB) patients was 2,472 (4.6%), which consists of 2.9% of new cases and 9.3% of TB patients with prior treatment history. The number of extensively drug-resistant TB patients was 749 (1.4%), consisting of 1.1% of new cases and 2.2% of TB patients with prior treatment history. In terms of treatment outcomes, 66.4% of all TB patients, 70.5% of new cases, 64.4% of relapse cases, and 46.8% of MDR-TB cases were cured or completed. It was inferred that in 2008, the total number of TB patients reached 70,767, 145.6 per 100,000 people (95% confidence interval, 145.5~145.7). CONCLUSION: We conclude that the medical records review of the Health Insurance Review and Assessment Service (HIRA) data can be very effective in promoting the understanding of the current status of TB in private institutions.

The National Status of Tuberculosis Using Nationwide Medical Records Survey of Patients with Tuberculosis in Korea / 결핵및호흡기질환

BACKGROUND: The epidemiology of tuberculosis (TB) has been assessed based on the data of the analysis of TB patients notified to the surveillance system in Korea. However, the national status of TB is not validated through this surveillance system. The objective is to determine the epidemiology of TB and to understand the accurate status of TB patients treated in private institutions. METHODS: Medical records of 53,579 patients who had been diagnosed with TB in 2008 were analyzed. RESULTS: Among 53,579 patients, the number of sputum smear positive cases was 15,639(29.2%) and the number of new cases was 39,191 (73.1%). The drug resistance rate of new cases was 5.3%, while the rate stood at 13.3% for TB patients with treatment history. The number of multi-drug resistant TB (MDR-TB) patients was 2,472 (4.6%), which consists of 2.9% of new cases and 9.3% of TB patients with prior treatment history. The number of extensively drug-resistant TB patients was 749 (1.4%), consisting of 1.1% of new cases and 2.2% of TB patients with prior treatment history. In terms of treatment outcomes, 66.4% of all TB patients, 70.5% of new cases, 64.4% of relapse cases, and 46.8% of MDR-TB cases were cured or completed. It was inferred that in 2008, the total number of TB patients reached 70,767, 145.6 per 100,000 people (95% confidence interval, 145.5~145.7). CONCLUSION: We conclude that the medical records review of the Health Insurance Review and Assessment Service (HIRA) data can be very effective in promoting the understanding of the current status of TB in private institutions.

Drug Resistance Rate of New Pulmonary Tuberculosis Patients Treated from the Private Sector in 2003~2005 / 결핵및호흡기질환

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

A Study on the Seasonal and Topographic Variations of the Skin Color of Young Women / 대한피부과학회지

Sixty-five volunteers whose skin had never been tanned intentionally participated in this experiment. The skin colors of extensor and flexor of forearm, fore-head, and cheek were measured with Color and Color Difference Meter(Nippon Denshoku Kogyo Co. CP6R 1001-DP) which represents .kin color as 'L, a, and b in values. The L, a', and b values mean the degree of ligntness, redness, and yellowness respectively. Measurement has been performed seven times repeatedly in a year at regular intervals. From the study, the following results were obtained. ]'lexor skin of forearm showed the highest lightness in a year compared to the other regions. All of the regions examined showed the highest lightness in spring compared to the other seasons. 3. Cheek skin showed the highest redness among the four checked regions in a year. 4, All of the checked regions showed the higher redness in summer than in spring. and autumn. 5 All of the checked regions showed the lowest yellowness in May.

A Case of Acquired Digital Fibrokeratoma / 대한피부과학회지

Acquired digital fibrokeratoma is an uncommon, solitary, round, firm, more or less hyperkeratotic projection, most frequently situated on fingers or toes but occasionally on the other locations. It arises out of a collarette of slightly raised skin and may have slight or great resemblance to a rudimentary supernumerary digit or may be mistaken for some other more ordinary condition such as an odd cutareous horn. We experienced a case of acquired digital fibrokeratoma on the right second finger in a 25-year-old male. We treated it with total excision.

A Case of Solitary Keratoacanthoma Originated from Verruca Vulgaris / 대한피부과학회지

Keratoacanthoma is a benign neoplasm that develops as a protruding mass especially on the central part of face, We experienced a case of keratoacanthoma that developed on the nasal vestibule after the eradication of verruca vulgaris on the same site by surgical intervention 3 months before. We treated it with total excision and skin graft.

A Case of Penile Horn / 대한피부과학회지

Penile Horn occurs as a single or multiple lesions. It usually starts as warty growth that later becomes hyperkeratotic and assumes the appearance of a horn. A 22-year-old male patient was presented with a slow growing, asymptomatic, dark brownish colored, corn-shaped, protruding mass on prepuce of the penis for 5 months. Histopathologic finding showed verruca vulgaris. We think that penile horn in this case may be come from verruca vulgaris.

A Case of Eccrine Spiradenoma / 대한피부과학회지

Eccrine spiradenoma is clinically characterized by a solitary, movable, tender noduie occurring most frequently on the ventral surfase of the upper body. A striking symptom is paroxysmal pain. Histopathologically, the encapsulated lobules of the tumor are composed of masses of basophilic cells, usually arranged in whorls, cords, and pseudogland.s. Within the whorls and pseudoglands, two types of celIs are notedperipheral intensely staining cells and central pale-staining cells. We describe herein a patient with an indolent eccrine spiradenoma, which had been diagnosed histopathologically.