Factors Affecting Social Distance toward Mental Illness: A Nationwide Telephone Survey in Korea / 예방의학회지

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.

Measuring the Burden of Disease in Korea

This paper provides an overview of the Korean Burden of Disease (KBoD) study, which was the first such study to assess the national burden of disease using disability-adjusted life years (DALYs) in an advanced Asian country. The KBoD study generally followed the approach utilized in the original Global Burden of Disease study (GBD), with the exception of the disease classification and epidemiological data estimation methods used, and the relative weightings of disabilities. The results of the present study reveal that the burden of disease per 100,000 of the Korean population originates primarily from; cancer (1,525 Person Years, PYs), cardiovascular disease (1,492 PYs), digestive disease (1,140 PYs), diabetes mellitus (990 PYs), and certain neuro-psychiatric conditions (883 PYs). These results are largely consistent with those of developed countries, but also represent uniquely Korean characteristics.

Antihypertensive Drug Medication Adherence of People with Disabilities and its Affecting Factors in Korea / 예방의학회지

OBJECTIVES: The aims of this study were to estimate the antihypertensive medication adherence in people with a disability and a history of taking antihypertensive medication, and to identify the factors affecting medication adherence. METHODS: The National Health Insurance claims data were linked with the National Disability Registry. People with a disability, who received a prescription of antihypertensives, were identified from a total of 85,098 cases. Cumulative medication adherence (CMA) was used as an indicator of medication adherence. A CMA > 80% was defined as appropriate medication adherence. Multiple logistic regression analysis was used to identify the factors affecting medication adherence. RESULTS: The average CMA in a total of 85,098 patients was 79.5%. The appropriate adherence (CMA > or =80%) rate was 54.5% and 20.5% of patients had a CMA < 50%. Multiple logistic regression analysis revealed that the probability of appropriate adherence decreased with decreasing number of prescription days per visit, increasing number of providers, the patients' residential area moving from urban to rural areas, and when patients have an internal organ disability, auditory impairment, mobility impairment. CONCLUSIONS: The adherence to antihypertensive medication in people with a disability is influenced by various socio-economic, clinical and regional factors. In particular, the disabled who have locomotive and communication disabilities and internal organ impairments have a higher probability of under-adherence to antihypertensive medication adherence in Korea.

Disability Weights for the Korean Burden of Disease Study: Focused on Comparison with Disability Weights in the Australian Burden of Disease Study / 예방의학회지

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.

Estimation of the Burden of Major Cancers in Korea

We estimated the burden of diseases in Korea especially caused by major cancers using DALY (disability adjusted life year) measurement. Firstly, the burden of disease due to premature death was estimated by using YLLs (years life lost due to premature death) measurement developed by the global burden of disease study group. Secondly, for the calculation of the YLD (years lived with disability), the following parameters were estimated in the formula; incidence rate, case fatality rate and disability weight of major cancers. Thirdly, we estimated DALY of major cancers by adding YLLs and YLDs. The burden of major cancers for male per 100,000 population was attributed mainly to liver cancer (528.8 person-year), stomach cancer (451.4 person-year), and lung cancer (374.9 person-year). The burden of major cancers for female per 100,000 population was attributed mainly to liver cancer (140.0 person-year), stomach cancer (259.7 person-year), and lung cancer (125.2 person-year). Each of these cancers was responsible for the loss of over 100 person-year per 100,000 population based on our DALY measurement. We found the DALY method employed was appropriate to quantify the burden of disease. Thereby, it would provide a rational bases to plan a national health policy regarding the burden of disease caused by major cancers in Korea.

Measuring the Burden of Major Cancers in Korea Using Healthy Life-Year (HeaLY) / 예방의학회지

OBJECTIVES: This study introduced the healthy life-year(HeaLY), a composite indicator of disease burden, and used it to estimate the burden of major cancers in Korea. METHODS: We collected data from the national death certificate database, the national health insurance claims database and the abridged life table. This data was used to create a spreadsheet and estimate the burden of major cancers by sex in terms of HeaLYs. RESULTS: The burden of 10 major cancers for males was 2,248.97 person-year in terms of HeaLYs. Stomach cancer, liver cancer, and lung cancer were responsible for 75.2% of the burden of 10 major cancers The disease burden of 10 major cancers for females was estimated to be 1,567.58 person-years. About two thirds of HeaLYs lost were from stomach cancer, liver cancer, lung cancer, colorectal cancer, and breast cancer. The rankings among 10 major cancers were somewhat different in terms of both HeaLYs and deaths as the HeaLY method considers both mortality and morbidity. CONCLUSIONS: Despite the limitations of the data sources, we conclude that HeaLY can aid in setting policy priorities concerning major cancers by estimating the disease burden of these cancers. Time-series analysis of the disease burden using HeaLY and DALY will elucidate the strengths and weaknesses of both methods.

Severity Measurement Methods and Comparing Hospital Death Rates for Coronary Artery Bypass Graft Surgery / 예방의학회지

OBJECTIVE: Health insurers and policy makers are increasingly examining the hospital mortality rate as an indicator of hospital quality and performance. To be meaningful, a risk-adjustment of the death rates must be implemented. This study reviewed 5 severity measurement methods and applied them to the same data set to determine whether judgments regarding the severity-adjusted hospital mortality rates were sensitive to the specific severity measure. METHODS: The medical records of 584 patients who underwent coronary artery bypass graft surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups, Disease Staging, Computerized Severity Index, APACHElll and KDRG were used to quantify severity of the patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex to evaluate the hospitals' performance, the ratio of the observed number of deaths to the expected number for each hospital was calculated. RESULTS: The overall in-hospital mortality rate was 7.0%, ranging from 2.7% to 15.7% depending on the particular hospital. After the severity adjustment, the mortality rates for each hospital showed little difference according to the severity measure. The 5 severity measurement methods varied in their statistical performance. All had a higher c statistic and R2 than the model containing only age and sex. There was a little difference in the relative hospital performance evaluation by the severity measure. CONCLUSION: These results suggest that judgments regarding a hospital's performance based on severity adjusted mortality can be sensitive to the severity measurement method. Although the 5 severity measures regarding hospital performance concurred, more often than would be expected by chance, the assessment of an individual hospital mortality rates varied by the different severity measurement method used.

Burden of Disease in Korea: Years of Life Lost due to Premature Deaths / 예방의학회지

OBJECTIVES: The aim of this study was to estimate the burden of disease through an analysis of Years of Life Lost due to premature deaths, one component of the Disability-Adjusted Life Years (DALY). In addition, the cause of death statistics were adjusted to improve validity, and the results were compared with those of the Global Burden of Disease (GBD). METHODS: In closely following the approach taken in the original GBD study, most of the explicit assumptions and the value judgments were not changed. However, the statistics for some problematic concerns such as deaths of infants or those due to senility, were adjusted. Deaths, standard expected years of life lost (SEYLL), and potential years of life lost (PYLL) were computed using vital registration data compiled by the National Statistical Office. RESULTS: The burden for males is 1.8 and 2.3 times higher than that for females, according to SEYLL and PYLL, respectively. The proportions of deaths due to Group I, II, and III causes are 5.4%, 80.4%, and 14.3%, respectively, for PYLL, but in a major shift from Group II to III they are 6.3%, 66.2%, and 27.5%, respectively, for SEYLL. The proportion of Group III causes in Korea, 27.5%, is extremely high when compared to 10.1% for the world, 7.6% for developed countries, and 10.7% for developing countries. CONCLUSIONS: Estimation results showed that the total burden due to premature deaths is smaller than that for the entire world but larger than that for developed countries. The disease structure of Korea has changed to resemble that of developed countries. Also, an overly large portion of the total burden in Korea stems from injuries arising from car accidents.

Validation of the International Classification of Diseases 10th Edition Based Injury Severity Score(ICISS) / 예방의학회지

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.

Introduction And The Current Status Of Hospital Information Systems / 대한의료정보학회지

The purpose of this research was to understand the current status of hospital information system(HIS) in Korea. Our main interests were when hospitals adopted each component of HIS and how they developed and managed the system. Structured questionnaires were applied to the department of each hospital in charge of managing information system. All hospitals, 276 in 1997, were included, and among them 93.5% responded. The HIS has been rapidly developed to include medical record management system, order communication system, laboratory information system, and picture archiving and communication system. The software for HIS was developed extramurally in more than half of all hospitals, and usually hardware was secured by buying than leasing them. Recently more hospitals has separated departments for His as independent units in hospital.

Estimation of Benign Prostatic Hyperplasia Prevalence in Korea: An Epidemiological Survey Using International Prostatic Symptom Score(IPSS) in Yonchon County / 대한비뇨기과학회지

The prevalence of urinary symptoms associated with benign prostatic hyperplasia(BPH) was studied in a community-based, representative sample of 519 men over 50 years old for estimation of prevalence of BPH in Korea. Symptoms were assessed by the Korean version of International Prostatic Symptom Score(IPSS). Only 5(1%) men reported having undergone prostate surgery due to BPH and excluded from analysis. Among 514 men, nocturia and weak stream were the most prevalent symptoms and urgency was the least. Based on the IPSS, 31.7% of the men were free of urinary symptoms(IPSS 0), 45.1%, 18.7% and 4.5% of the men were minimally(IPSS 1-7), moderately(IPSS 8-19) and severely(IPSS 20-35) symptomatic, respectively. The proportion of severely symptomatic men approximately doubled with each decade of age. A good correlation was found between the total symptom score and the single disease-specific quality of life score that is included in the IPSS. Our estimation indicated that in 1995 approximately 800,000 Korean men had moderate to severe urinary symptoms that were likely to be associated with BPH. These results suggest that the prevalence of BPH in Korean men is substantially similar to Caucasian.

Development and Evaluation of a Field Education Program of Community Medicine / 한국의학교육

This paper describes the curriculum development and its evaluation on the field education program of community medicine (FPCM) offered to all senior grade medical students at a rural site by the Depar tment of Health Policy and Management, Seoul National University College of Medicine. The FPCM is a course of study designed to prepare the students to function effectively in a primary health care setting assuming medical practitioner's role in response to the community needs, and as a member of a health team. The FPCM curriculum is focused on those issue that are important to community-based medical education such as problem-based active learning, communication skills, attitudes, team work and leadership skills, and scientific way of thinking. It also stressed the utilization of local health resources as educational health resources. Some important outcome of the curriculum are as follows: 1) 96.2% of the students answered that the program were helpful and necessary as a part of medical education. 2) The preceptors replied that 'having the teaching experience' was most significant aspects of their perfomance. 3) The program completed without any constraints. 4) The FPCM curriculum will be applicable to other medical colleges even under the limitation of educational resources.

Development and Evaluation of an Exercise Course of Health Policy and Management / 한국의학교육

Importance of health policy and management in medical education is gradually accepted. Successful model of the curricula of health policy and management education in Korean is, however, yet be to deve loped. This paper describes the curriculum development process and its evaluation of an exercise course on the field of health policy and management. The curriculum is focused on those issues that are important to medical education such as small group dynamics, problem-based active learning, communication skills, attitudes, team work and leadership skills, and scientific way thinking. The student are expected to develop the ability and attitute through this course such as the appreciation of the concepts and the major tasks of health care, and the appreciation of the importance of establishing a collaborative interpersonal relationship with the medical personnels. Formats for the exercise are 1) analysis of data on the health services through the structured questions, 2) role play, 3) project and presentation, and 4) panel discussion. 70.5% of students appraised these formats of clerkships are necessary in medical education process. Students' achievement of each objectives are variable, but affirmative in general. Although some unsatisfactory aspects are exist, the clerkships are helpful and satisfactory in general. It provided with the opportunity for problem solving by themselve to the students, encouraged the team-spirit and motivation, and stimulate critical way of thinking.