Reliability of the EOS Imaging System for Assessment of the Spinal and Pelvic Alignment in the Sagittal Plane

BACKGROUND: The sagittal alignment of the spine and pelvis is not only closely related to the overall posture of the body but also to the evaluation and treatment of spine disease. In the last few years, the EOS imaging system, a new low-dose radiation X-ray device, became available for sagittal alignment assessment. However, there has been little research on the reliability of EOS. The purpose of this study was to evaluate the intrarater and interrater reliability of EOS for the sagittal alignment assessment of the spine and pelvis. METHODS: Records of 46 patients were selected from the EOS recording system between November 2016 and April 2017. The exclusion criteria were congenital spinal anomaly and deformity, and previous history of spine and pelvis operation. Sagittal parameters of the spine and pelvis were measured by three examiners three times each using both manual and EOS methods. Means comparison t-test, Pearson bivariate correlation analysis, and reliability analysis by intraclass correlation coefficients (ICCs) for intrarater and interrater reliability were performed using R package “irr.” RESULTS: We found excellent intrarater and interrater reliability of EOS measurements. For intrarater reliability, the ICC ranged from 0.898 to 0.982. For interrater reliability, the ICC ranged from 0.794 to 0.837. We used a paired t-test to compare the values measured by manual and EOS methods: there was no statistically significant difference between the two methods. Correlation analysis also showed a statistically significant positive correlation. CONCLUSIONS: EOS showed excellent reliability for assessment of the sagittal alignment of the spine and pelvis.

The direction of restructuring of a Korea field epidemiology training program through questionnaire survey among communicable disease response staff in Korea / 한국역학회지

We used a survey about the need for an educational training of infectious disease response staff in Korea Centers for Disease Control and Prevention (KCDC) and officer in metropolitan cities and provincial government to conduct field epidemiological investigation. The survey was conducted from January 25 to March 15, 2016. A total of 173 participants were selected from four different groups as follows: 27 clinical specialists, 22 Epidemic Intelligence Service (EIS) officers, 82 KCDC staff, and 42 local health department officials. Results revealed that 83% of KCDC staff and 95% of local health department officials agreed on the need for educational training to strengthen capability of personnel to conduct epidemic research and investigation. The level of their need for training was relatively high, while self-confidence levels of individuals to conduct epidemic research and investigation was low. It was concluded that there was a need to develop training programs to enhance the ability of public health officials, EIS officers, KCDC staff, and local health department personnel to conduct epidemic research and investigation.

Healthcare worker infected with Middle East Respiratory Syndrome during cardiopulmonary resuscitation in Korea, 2015 / 한국역학회지

OBJECTIVES: During the outbreak of the Middle East Respiratory Syndrome (MERS) in Korea in 2015, the Korea Centers for Disease Control and Prevention (KCDC) confirmed a case of MERS in a healthcare worker in Daejeon, South Korea. To verify the precise route of infection for the case, we conducted an in-depth epidemiological investigation in cooperation with the KCDC.METHODS: We reviewed the MERS outbreak investigation report of the KCDC, and interviewed the healthcare worker who had recovered from MERS. Using the media interview data, we reaffirmed and supplemented the nature of the exposure.RESULTS: The healthcare worker, a nurse, was infected while performing cardiopulmonary resuscitation (CPR) for a MERS patient in an isolation room. During the CPR which lasted for an hour, a large amount of body fluid was splashed. The nurse was presumed to have touched the mask to adjust its position during the CPR. She suggested that she was contaminated with the MERS patient’s body fluids by wiping away the sweat from her face during the CPR.CONCLUSIONS: The possible routes of infection may include the following: respiratory invasion of aerosols contaminated with MERS-coronavirus (MERS-CoV) through a gap between the face and mask; mucosal exposure to sweat contaminated with MERS-CoV; and contamination during doffing of personal protective equipment. The MERS guidelines should reflect this case to decrease the risk of infection during CPR.

Healthcare worker infected with Middle East Respiratory Syndrome during cardiopulmonary resuscitation in Korea, 2015 / 한국역학회지

OBJECTIVES: During the outbreak of the Middle East Respiratory Syndrome (MERS) in Korea in 2015, the Korea Centers for Disease Control and Prevention (KCDC) confirmed a case of MERS in a healthcare worker in Daejeon, South Korea. To verify the precise route of infection for the case, we conducted an in-depth epidemiological investigation in cooperation with the KCDC. METHODS: We reviewed the MERS outbreak investigation report of the KCDC, and interviewed the healthcare worker who had recovered from MERS. Using the media interview data, we reaffirmed and supplemented the nature of the exposure. RESULTS: The healthcare worker, a nurse, was infected while performing cardiopulmonary resuscitation (CPR) for a MERS patient in an isolation room. During the CPR which lasted for an hour, a large amount of body fluid was splashed. The nurse was presumed to have touched the mask to adjust its position during the CPR. She suggested that she was contaminated with the MERS patient’s body fluids by wiping away the sweat from her face during the CPR. CONCLUSIONS: The possible routes of infection may include the following: respiratory invasion of aerosols contaminated with MERS-coronavirus (MERS-CoV) through a gap between the face and mask; mucosal exposure to sweat contaminated with MERS-CoV; and contamination during doffing of personal protective equipment. The MERS guidelines should reflect this case to decrease the risk of infection during CPR.

The direction of restructuring of a Korea field epidemiology training program through questionnaire survey among communicable disease response staff in Korea / 한국역학회지

We used a survey about the need for an educational training of infectious disease response staff in Korea Centers for Disease Control and Prevention (KCDC) and officer in metropolitan cities and provincial government to conduct field epidemiological investigation. The survey was conducted from January 25 to March 15, 2016. A total of 173 participants were selected from four different groups as follows: 27 clinical specialists, 22 Epidemic Intelligence Service (EIS) officers, 82 KCDC staff, and 42 local health department officials. Results revealed that 83% of KCDC staff and 95% of local health department officials agreed on the need for educational training to strengthen capability of personnel to conduct epidemic research and investigation. The level of their need for training was relatively high, while self-confidence levels of individuals to conduct epidemic research and investigation was low. It was concluded that there was a need to develop training programs to enhance the ability of public health officials, EIS officers, KCDC staff, and local health department personnel to conduct epidemic research and investigation.

Analysis of Vision Statements in 6th Community Health Plan of Local Government in Korea / 農村醫學 地域保健

OBJECTIVES: In this study, we analyzed vision statements of the 6th community health plan of local government in Korea. METHODS: We examined vision statements letters, missions and strategy plans, and long-term missions of 6th community health plans of 229 local government in Korea. We also analyzed the numbers of vision letters, sentence examination, word frequency, each vision statement with frequency analysis, chi-square test, and one-way ANOVA. RESULTS: Among 229 local government, 172(75.1%) of local government had the number of letters (Korean) less than 17 of vision statements, and there were a significant differences according to type of community health centers (p<0.05). Figuration (37.1%) were the most used in an expression of vision statement sentence, and special characters (43.2%) were the most used language except Korean. The most commonly used words of vision statement in order of frequency were ‘health’, ‘happiness‘, ‘with’, ‘citizen’, ‘city’, ‘100 years old’ etc. Chungcheong provinces and Daejeon metropolitan city had a highest score in directionality on phrase evaluation, and there were a significant differences according to regional classes of local government (p<0.01). Gyeongsang provinces, Ulsan, Daegu, and Busan metropolitan cities had a highest score in future orientation and sharing possibilities on phrase evaluation, and there were a significant differences according to regional classes of local government (p<0.01). CONCLUSIONS: Vision is one of the most important component of community health plan. We need more detailed ‘vision statement guideline’ and the community health care centers of local government should effort to make more clear and complete their vision.

A Retrospective Mid- and Long-term Follow-up Study on the Changes in Hematologic Parameters in the Highly Exposed Residents of the Hebei Spirit Oil Spill in Taean, South Korea

OBJECTIVES: This study aimed to analyze changes in hematologic parameters in the residents of the areas highly contaminated by the Hebei Spirit Oil Spill in 2007 and those who participated in the clean-up activities. METHODS: According to demographic characteristics, health status and behavior, and level of exposure to oil, we compared the hematologic results in 2009 and 2012 among 701 residents. The hematologic parameters were composed of white blood cell (WBC) count, and levels of hemoglobin, hematocrit (Hct), aspartate aminotransferase (AST), alanine aminotransferase (ALT), glucose, glycosylated hemoglobin (HbA1c), blood urea nitrogen (BUN), creatinine (Cr), total cholesterol (T-chol), high-density lipoprotein (HDL), and triglyceride (TG). RESULTS: Paired t-test revealed that the WBC count and levels of Hct, AST, ALT, glucose, and HbA1c significantly increased, whereas the BUN, Cr, HDL, and TG levels significantly decreased. Multiple linear regression modelling showed a relationship between the level of exposure to oil and temporal changes in Hct, glucose, HbA1c, and BUN levels. CONCLUSION: Our results suggest a relationship between level of exposure to oil and changes in hematologic parameters over 3 years. Further studies should be conducted to determine the impact of oil spill on health such as the occurrence of diseases.

Determinants of Mental Health Care Utilization in a Suicide High-risk Group With Suicidal Ideation / 예방의학회지

OBJECTIVES: The suicide rate in Korea is increasing every year, and is the highest among the Organization for Economic Cooperation and Development countries. Psychiatric patients in particular have a higher risk of suicide than other patients. This study was performed to evaluate determinants of mental health care utilization among individuals at high risk for suicide. METHODS: Korea Health Panel data from 2009 to 2011 were used. Subjects were individuals at high risk of suicide who had suicidal ideation, a past history of psychiatric illness, or had utilized outpatient services for a psychiatric disorder associated with suicidal ideation within the past year. The chi-square test and hierarchical logistic regression were used to identify significant determinants of mental health care utilization. RESULTS: The total number of subjects with complete data on the variables in our model was 989. Individuals suffering from three or more chronic diseases used mental health care more frequently. Mental health care utilization was higher in subjects who had middle or high levels of educational attainment, were receiving Medical Aid, or had a large family size. CONCLUSIONS: It is important to control risk factors in high-risk groups as part of suicide prevention strategies. The clinical approach, which includes community-based intervention, entails the management of reduction of suicidal risk. Our study identified demographic characteristics that have a significant impact on mental health care utilization and should be considered in the development of suicide prevention strategies. Further studies should examine the effect of mental health care utilization on reducing suicidal ideation.

Use of Emergency Medical Services and Characteristics of Urgent and Non-Urgent Adult Patients according to the Usual Source of Care: A Korea Medical Expenditure Panel Study

PURPOSE: Use of emergency rooms (ERs) has increased considerably in Korea. This increase has caused over-crowding and has increased the burden on ER services, created a lack of continuous service provided by ERs, and raised costs. The objective of this study was to examine the characteristics of ER use for urgent and non-urgent cases in 2009-2011. METHODS: In this multivariate analysis, we included data collected from the 2009-2011 Korea Medical Expenditure Panel Survey to assess independent factors associated with ER use in non-urgent settings. We consecutively included patients > or =19 years who had completed the survey until 2011. RESULTS: Among the 10,428 respondents, 19.1% of patients had used ERs. Patients who had used EDs were less likely to have attended graduate school (high school: odds ratio [OR], 0.78 [0.63-0.98]; university: OR, 0.69 [0.54-0.89]) or have chronic disease (OR: 0.68 [0.60-0.78]). In addition, patients who did not have a usual source of care (OR, 0.78 [0.70-0.87]) or those who did not have private insurance (OR, 0.86 [0.74-0.99]) were less likely to use ERs. In the 1,994 cases of ER use, however, the any factors were not affected in the non-urgent ER use group. CONCLUSION: The number of patients who used ERs has increased, and there were no significant differences in ER use between non-urgent and urgent patients. ERs may have been used for non-urgent cases owing to other reasons. Further studies on the reasons for non-urgent ER use and development of urgent patient criteria are required.

The prevalence of burnout and the related factors among some medical students in Korea / 한국의학교육

PURPOSE: This study was conducted to examine the relationship between the prevalence of burnout and its related factors in medical students in Korea. METHODS: All available medical students in the metropolitan city of Daejeon, Korea, were asked to answer self-administered questionnaires from July 1 to July 26 in 2013. A total of 534 medical students participated. The Maslach Burnout Inventory-Student Survey (MBI-SS) and structured questionnaires on related factors were used. Confirmatory factor analysis and Cronbach's alpha were used to verify the applicability of the MBI-SS to medical students in Korea. We also performed chi-square test and logistic regression analysis to identify the factors that were associated with burnout. RESULTS: The MBI-SS was reliable and valid in measuring burnout in Korean medical students. Our confirmatory factor analysis approved and explained the appropriateness of the model fit. The prevalence of burnout among medical students was 26.4% (n=141). Such rates were higher in students who were female, experienced greater levels of depression, had poor academic performance, feared dropping out, and were stressed by the poor quality of the class facilities. CONCLUSION: The MBI-SS is a valid instrument to measure academic burnout in Korean medical students. Further studies should be performed, because improvements in the mental health of medical students will benefit these doctors-to-be and their future patients.

The Prevalence of Cardiovascular Disease Risk Factors and the Framingham Risk Score in Patients Undergoing Percutaneous Intervention Over the Last 17 Years by Gender: Time-trend Analysis From the Mayo Clinic PCI Registry / 예방의학회지

OBJECTIVES: This study aims to investigate trends of cardiovascular disease (CVD) risk factor profiles over 17 years in percutaneous coronary intervention (PCI) patients at the Mayo Clinic. METHODS: We performed a time-trend analysis within the Mayo Clinic PCI Registry from 1994 to 2010. Results were the incidence and prevalence of CVD risk factors as estimate by the Framingham risk score. RESULTS: Between 1994 and 2010, 25 519 patients underwent a PCI. During the time assessed, the mean age at PCI became older, but the gender distribution did not change. A significant trend towards higher body mass index and more prevalent hypercholesterolemia, hypertension, and diabetes was found over time. The prevalence of current smokers remained unchanged. The prevalence of ever-smokers decreased among males, but increased among females. However, overall CVD risk according to the Framingham risk score (FRS) and 10-year CVD risk significantly decreased. The use of most of medications elevated from 1994 to 2010, except for beta-blockers and angiotensin converting enzyme inhibitors decreased after 2007 and 2006 in both baseline and discharge, respectively. CONCLUSIONS: Most of the major risk factors improved and the FRS and 10-year CVD risk declined in this population of PCI patients. However, obesity, history of hypercholesterolemia, hypertension, diabetes, and medication use increased substantially. Improvements to blood pressure and lipid profile management because of medication use may have influenced the positive trends.

Primary care research in South Korea: its importance and enhancing strategies for enhancement

Lively discussion has been underway regarding primary care in South Korea as an alternative medical policy in the face of rising medical costs and health care disparities. However, the lack of research about primary care in South Korea makes it difficult to move policymakers, so it is time to enhance primary care research in South Korea. Primary care research can be defined as research directed toward the better understanding and practice of the primary care function. Primary care research traditionally has included basic research, clinical research, health services research related to primary care, health systems research, and research on primary care training; and each field is complementary. In primary care research, participation of primary care physicians is essential because primary care research is different from other conventional studies of disease prevalence, patient characteristics, diagnostic methods, and the treatment environment. Primary care research findings in other countries cannot be applied to South Korea as the characteristics of the health system and medical practice are different. To enhance the research on primary care in South Korea, financial assistance, promoting the research capacity of primary care physicians, and more attention from primary care physicians to research are needed.

Association of the Length of Doctor-Patient Relationship with Primary Care Quality in Seven Family Practices in Korea

Countries with historically unlimited patient choice of medical provider, such as Korea, have been promoting rational health care pathways. Factors related to the length of doctor-patient relationship (DPR) for enhancing primary care in those countries should be studied. Participants were patients who had visited their family practices on six or more occasions over a period of more than 6 months. Five domains (21 items) of the Korean Primary Care Assessment Tool (first contact, coordination function, comprehensiveness, family/community orientation, and personalized care) and general questions were administered in the waiting rooms. From seven practices, the response rate was 83.7% (495/591). The older the age, the lower the income, the shorter the duration of education, the more the number of diseases the patients had, and in provincial cities rather than in Seoul, the longer length of DPR ( > or = 4 yr) was shown. The long-term DPR was associated with total primary care quality score (upper [ > or = 71.4] vs lower [ < 71.4], OR, 1.74; 95% CI, 1.10-2.76), especially with coordination function (OR, 1.01; 95% CI, 1.00-1.02), being adjusted for confounding variables. Strengthening the coordination function may have to be the first consideration in primary care policy in countries like Korea.

Prevalence Rates of and Related Factors to Constipation in Elementary School Students

BACKGROUND: This study was conducted to explore the prevalence of and the factors affecting constipation in elementary school students in urban and rural areas. METHODS: Study subjects were 585 grade 5 and 6 students. We conducted self-administered questionnaires during October, 2009. Outcome measure was the prevalence of constipation evaluated by the Rome III Diagnostic criteria for functional constipation. Independent variables were gender, grade, residence, mother's employment status, self-rated health status, number of family members, bowel movement habit, and health behavior (nutrition, exercise, and stress). RESULTS: The multiple logistic regression analysis showed that females, grade 5 students, those with working mothers, and those physically inactive reported having constipation significantly more often. CONCLUSIONS: Our study revealed that the female gender, increasing age, mother's employment status, and physical inactivity were risk factors for constipation in elementary school students. To improve bowel function in children, health education programs and school health promotion programs targeting healthy life habits should be implemented.

Up-to-date or Complete Immunization Coverage and Their Related Factors / 農村醫學 地域保健

OBJECTIVES: Understanding the predictor of immunization status in childhood is critical issue to improve National Immunization Program (NIP). The aims of this study were to verify the status of up-to-date or complete immunization coverage and to investigate its related factors. METHODS: As of 2005, according to local residence registry data, there were 2,188 children who aged 12 to 35 months in Nonsan city, Korea. We conducted household survey for aged 12 to 35 months children, using questionnaires to obtain data on the status of immunization such as BCG, DTaP (diphtheria, tetanus, and pertussis), Polio, and MMR (mump, measles, rubella). Finally 1,472 participated in the survey. The operating definitions used in this study were following; "Complete immunization rate" refers to the rate of children who received all immunization within recommended age intervals fully "on-time"; "The 4:3:1 series" means status of receiving the fourth diphtheria-tetanus-pertussis (4 DTP), the third Polio (3 Polio), and the first measles-mumps-rubella (1 MMR) doses. Multivariate logistic regression analyses were used to determine factors affecting complete vaccination coverage of children. RESULTS: Immunization rates of vaccine based on the vaccination card were from 92.7% to 96.4% except 4th DTaP (79.3%). Complete immunization rate of Korea NIP was 74.0% and that of the 4:3:1 series was 77.1%. A parent as primary caregiver (OR 0.59, 95% CI 0.39-0.87 at 19-35 months of children's age) and first-born children (OR 1.79, 95% CI 1.05-3.03 at 24-35 months of children's age) were significantly related to complete immunization coverage of Korea NIP. And a parent as primary care giver (OR 0.58, 95% CI 0.38-0.88 at 19-35 months of children's age) and first-born children (OR 1.94, 95% CI 1.21-3.14 at 19-35 months, OR 2.23, 95% CI 1.27-3.91 at 24-35 months of children's age) were significantly related to complete immunization rate of 4:3:1 series. CONCLUSIONS: Government should take actions to increase complete immunization rate. In particular, intervention on the secondary caregiver and non-first-born children should be needed.

Opinions of Infectious Disease Specialists on the Current Method for Isolation of Group 1 Nationally Notifiable Infectious Diseases in Korea

The purpose of the study was to collect the opinions of doctors who are specialists in infectious disease with regard to the current method used for isolation of patients with group 1 nationally notifiable infectious diseases in Korea. A web-based survey was conducted from June 27 to July 7, 2011. Relevant questions included: 1) adequacy of the current policy of forced hospital isolation; evaluation of current guidelines for release from hospital isolation; and 3) priority for policy switching from forced hospital isolation to home isolation. The rate of response to the survey was 28.4% (40 out of 140). First, the majority of infectious disease specialists in Korea believed that the current method of forced hospital isolation for patients with group 1 infectious diseases should be changed to the home isolation method. Second, if the Korean government changes its policy to home isolation, the top priority of the policy switch would be typhoid fever, followed by paratyphoid fever, shigellosis, cholera, and EHEC (enterohemorigic Escherichia coli). Regarding current guidelines for release from hospital isolation, in cases of shigellosis, EHEC, and hepatitis A, the majority of respondents supported the current guidelines, while they were not able to make collective opinions in cases of cholera and typhoid/paratyphoid fever. We were able to confirm that the majority of specialists want to change the current isolation method. Therefore, the Korean government should consider switching their policy from forced hospital isolation to home isolation.

Evaluation on the Accuracy of Vaccination Card for National Immunization Program in a 2005 Population-Based Survey in Nonsan, Korea / 農村醫學 地域保健

No abstract available.

Evaluation of the Current Status of Malaria Elimination Project in the Republic of Korea and Suggestion for Improvement of Its Efficacy

BACKGROUND: Vivax malaria had spread rapidly in areas adjacent to the Demilitarized Zone to reach more than 4,000 cases in 2000 in the Republic of Korea (ROK). After year 2000, annual cases decreased rapidly to reach less than 1,000 cases in 2004. However, the number increased again since 2005. Epidemiological characteristics of vivax malaria in the ROK are different before and after 2000. This article was aimed to evaluate the current status of malaria elimination project in the ROK for providing suggestions for its improvement. MATERIALS AND METHODS: We analyzed the total reported malaria cases during 2005 to 2007 and reviewed the record on the malaria eradication project performed by the authorizations including the Korea Center for Disease Control and Prevention. RESULTS: During 2005 to 2007, 45% of all the vivax malaria occurred in patients living in the non-prevalent areas; the interval between first symptom onset and diagnosis was longer in the non-prevalent areas compared to that in the prevalent areas. Education and publicity on malaria has not been properly performed in the non-prevalent areas. The military didn't take part in the control of the malaria infected discharged soldiers, most of whom might have been infected with malaria during their military service. CONCLUSION: For the efficient control of malaria and thus improving the effectiveness of the elimination project, education and publicity on malaria in the non-prevalent areas should be strengthened and cooperation between private and military sector regarding the ex-soldiers infected with malaria is essential. In addition, there should be bilateral communication among malaria-related teams within the Korea Centers for Disease Control and Prevention and also among all the malaria-related sectors. Furthermore, a common database on malaria patients and vector mosquitoes should be formed to grant access to all the malaria-related sectors. Improvement on report and surveillance system is also necessary.

Evaluation of the Current Status of Malaria Elimination Project in the Republic of Korea and Suggestion for Improvement of Its Efficacy

BACKGROUND: Vivax malaria had spread rapidly in areas adjacent to the Demilitarized Zone to reach more than 4,000 cases in 2000 in the Republic of Korea (ROK). After year 2000, annual cases decreased rapidly to reach less than 1,000 cases in 2004. However, the number increased again since 2005. Epidemiological characteristics of vivax malaria in the ROK are different before and after 2000. This article was aimed to evaluate the current status of malaria elimination project in the ROK for providing suggestions for its improvement. MATERIALS AND METHODS: We analyzed the total reported malaria cases during 2005 to 2007 and reviewed the record on the malaria eradication project performed by the authorizations including the Korea Center for Disease Control and Prevention. RESULTS: During 2005 to 2007, 45% of all the vivax malaria occurred in patients living in the non-prevalent areas; the interval between first symptom onset and diagnosis was longer in the non-prevalent areas compared to that in the prevalent areas. Education and publicity on malaria has not been properly performed in the non-prevalent areas. The military didn't take part in the control of the malaria infected discharged soldiers, most of whom might have been infected with malaria during their military service. CONCLUSION: For the efficient control of malaria and thus improving the effectiveness of the elimination project, education and publicity on malaria in the non-prevalent areas should be strengthened and cooperation between private and military sector regarding the ex-soldiers infected with malaria is essential. In addition, there should be bilateral communication among malaria-related teams within the Korea Centers for Disease Control and Prevention and also among all the malaria-related sectors. Furthermore, a common database on malaria patients and vector mosquitoes should be formed to grant access to all the malaria-related sectors. Improvement on report and surveillance system is also necessary.

The Related Factors of Willingness to Have an Additional Childbirth of Mother with Children in an Urban-Rural Area / 農村醫學 地域保健

OBJECTIVES: This study was conducted to investigate how willingness to have an additional childbirth was related to mother's general characteristics and various reasons for avoiding an additional childbirth. METHODS: By using organized questionnaire, we had face-to-face interviews with 722 mothers who had 12 to 36 months child in a urban-rural area of Chungcheongnam-do from 14 February to 19 February in 2005. Questionnaires included general characteristics composed of age, monthly income, number of children, major carers and mother's job status, and 6 reasons for avoiding an additional childbirth. We performed chi-square test and multiple logistic regression analysis. RESULTS: Of 722 mothers, 66.5% had no willingness to have an additional childbirth. In the multiple logistic regression analysis, old age of mother(95% CI of OR: 1.084-1.190), two or more children(95% CI of OR: 6.97-15.602) and weak norm about need for a child(95% CI of OR: 1.633-29.352) were independent related factors with willingness to have an additional childbirth. CONCLUSIONS: In our study, 2/3 women who already had children were appeared to have no willingness to have additional childbirth. Policies about family planning and controlling birth rate should be focused on eliminating barrier to additional childbirths.