요양병원의 언어치료 현황

Objectives: To examine and compare the present situations of long-term care facilities regarding the services of speech and language therapy (SLT). Methods: Phone interviews across Korea were conducted with 1,233 hospitals that were established before October 2013 and were still operating as of March 2014. Whether the long-term care facilities were providing SLT services was examined and analyzed according to the region, the size of the facilities, existence of certification from an institution, and the presence of physiatrists. Furthermore, the working conditions of staff providing SLT including speech and language therapists were thoroughly examined. Results: The SLT services were dependent on regional factors. More than half of the facilities did not include SLT as a part of their services. Also, the use of SLT varied according to the size of the facilities. Bigger hospitals tended to have a higher percentage of language therapy implementation. Institutions certified by the Ministry of Health and Welfare of Korea and the Korea Institute for Healthcare Accreditation were more likely to provide SLT services. SLT services were provided more often when a physiatrist was present. Workers providing SLT differed depending on the region. Speech and language therapists were more likely to work full-time rather than part-time. Conclusion: This study shows the present state and availability of SLT at long-term care facilities, emphasizing the necessity of the service, and providing the basis for future studies.ope

Regional Differences in Medical Costs of Chronic Kidney Disease in the South Korean Population: Marginalized Two-Part Model

Background: There are regional gaps in the access to medical services for patients with chronic kidney disease (CKD), and it is necessary to reduce those gaps, including the gaps involving medical costs. Objective: This study aimed to analyze regional differences in the medical costs associated with CKD in the South Korean population. Methods: This longitudinal cohort study included participants randomly sampled from the National Health Insurance Service-National Sample Cohort of South Korea. To select those who were newly diagnosed with CKD, we excluded those who were diagnosed in 2002-2003 and 2018-2019. A total of 5903 patients with CKD were finally included. We used a marginalized two-part longitudinal model to assess total medical costs. Results: Our cohort included 4775 (59.9%) men and 3191 (40.1%) women. Of these, 971 (12.2%) and 6995 (87.8%) lived in medically vulnerable and nonvulnerable regions, respectively. The postdiagnosis costs showed a significant difference between the regions (estimate: –0.0152, 95% confidence limit: –0.0171 to –0.0133). The difference in medical expenses between the vulnerable and nonvulnerable regions showed an increase each year after the diagnosis. Conclusions: Patients with CKD living in medically vulnerable regions are likely to have higher postdiagnostic medical expenses compared to those living in regions that are not medically vulnerable. Efforts to improve early diagnosis of CKD are needed. Relevant policies should be drafted to decrease the medical costs of patients with CKD disease living in medically deprived areas.ope

Cohort Effects of Female Breast Cancer Incidence in Korea

Objectives: The purpose of the study is to review various methods in age-period-cohort (APC) analysis and to provide a guideline to choose adequate method evaluating age, period, and cohort effects. We investigated age, period, and cohort effects of breast cancer incidence between 1999 and 2011 in Korea. Methods: Data on female breast cancer incidence from 1999 to 2011 were drawn from the Korean national statistical office. The 5-year period of data units (1999-2003, 2004-2008, and 2009-2011) and 5-year age interval (30-34-80-84) were used to calculate 13 birth cohorts. The graphical approach, constrained generalized linear model (CGLM) approach, median polish approach and intrinsic estimator (IE) approach were used to estimate age, period, and cohort effects. Results: The age and period effects existed significantly in CGLM, median polish, IE approaches. The breast cancer incidence increased along with age and period. However, there was a difference in cohort effect. For CGLM, positive cohort effects for recent cohort emerged significantly, but for the other methods, no significant effects shown. Conclusions: While previous studies have used the CGLM method, CGLM depends on arbitrary parameter constraints. Therefore, we suggest median polish approach or IE approach for analyzing APC models to obtain more accurate results.ope

Evaluation of the Homogeneity of Korean Diagnosis Related Groups

Background: This study designed to evaluate the homogeneity of Korean diagnosis related group (KDRG) version 3.4 classification system. Methods: The total 5,921,873 claims data submitted to the Health Insurance Review and Assessment Service during 2010 were used. Both coefficient of variation (CV) and reduction in variance of cost were measured for evaluation. This analysis was divided into before and after trimming outliers at the level of adjacent DRG (ADRG), aged ADRG (AADRG) split by age, and DRG split by complication and comorbidity. Results: At the each three level of ADRG, AADRG, and DRG, there were 38.9%, 38.7%, and 30.0% of which had a CV >100% in the untrimmed data and there were 1.4%, 1.4%, and 1.9% in the trimmed one. Before trimming outliers, ADRGs explained 52.5% of the variability in resource use, AADRGs did 53.1% and DRGs did 57.1%. The additional explanatory power by age and comorbidity and complication (CC) split were 0.6%p and 4.6%p for each, which were statistically significant. After trimming outliers, ADRGs explained 75.2% of the variability in resource use, AADRGs did 75.6%, and DRGs did 77.1%. The additional explanatory power were 0.4%p and 2.0%p for each, which were statistically significant too. Conclusion: The results demonstrated that KDRG showed high homogeneity within groups and performance after trimming outliers. But there were DRGs CV >100% after age or CC split and the most contributing factor to high performance of KDRG was the ADRG rather than age or CC split. Therefore, it is recommended that the efforts for improving clinical homogeneity of KDRG such as review of the hierarchical structure of classification systems and classification variables.ope

Comparison of Estimation Methods of Cox Proportional Hazards Model with Interval-censored Data

Objectives: Our purpose was to compare the methods for the regression coefficients estimation in a Cox proportional hazards model with interval-censored data. Methods: The methods included the mid-point and right-endpoint imputation methods and 'intcox' method implemented following the algorithm proposed by Pan (1999, Journal of Computational and Graphical Statistics). Their performance was evaluated based on the estimated bias and mean squared error and the empirical coverage rate for the regression coefficients. Three methods were also discussed with real data analysis. Results: The 'intcox' method had the better performance than the other imputation methods. In particular a 95% coverage rate of the 'intcox' method was very close to 0.95, while the imputation methods were pretty less than 0.95. As a right censoring rate decreases, all the methods underestimated the true value, but the 'intcox' method seemed to be more stable than the others owing to smaller bias and mean squared error. With analyzing the breast cosmetics data, the effect size of treatment based on the 'intcox' method was the largest among three methods, but there was no difference in statistical significance among them. Conclusions: In many clinical studies the imputation methods were often used for dealing with the interval-censored data because they can be easily implemented using commercial softwares. However they may entail biased results as shown in simulation results such as low coverage rate. We recommend the ‘inxcox’ method or multiple imputation methods rather than the single imputation methods.ope

Modifying effects of resting heart rate on the association of binge drinking with all-cause and cardiovascular mortality in older Korean men: The Kangwha cohort study

Background: Although binge drinking and high resting heart rate independently affect cardiovascular and all-cause mortality risk, the combined effect of these two risk factors and their interaction has rarely been studied. This study examined the association between binge drinking and cardiovascular and all-cause mortality and evaluated the potential modifying effect on this association of resting heart rate in Korean men. Methods: Men aged 55 years or older in 1985 (n = 2600) were followed for cardiovascular and all-cause mortality for 20.8 years, until 2005. We estimated hazard ratios (HRs) for cardiovascular and all-cause mortality by binge drinking and resting heart rate using the Cox proportional hazard model. Results: Heavy binge drinkers (≥12 drinks on one occasion) with elevated resting heart rate (≥80 bpm) had a HR of 2.25 (95% confidence interval [CI], 1.47–3.45) for death from cardiovascular disease and 1.37 (95% CI, 0.87–2.14) for all-cause mortality compared to the reference group (non-drinking and resting heart rate 61–79 bpm). The HRs of dying from cardiovascular disease increased linearly from 1.36 to 1.52, 1.71, and 2.25 among individuals with resting heart rate greater than or equal to 80 bpm within the four alcohol consumption categories (non-drinking, non-binge, moderate binge, and heavy binge), respectively. Conclusions: Our findings suggest that, among older Korean men, heavy binge drinkers with an elevated resting heart rate are at high risk for cardiovascular and all-cause mortality.ope

Prevalence of Vitamin D Deficiency and Insufficiency in Korean Children and Adolescents and Associated Factors

Background: The objective of this study was to assess the serum 25-hydroxyvitamin D (25OHD) status and evaluate the associated factors in a Korean pediatric population aged 0-18 yr. Methods: Serum 25OHD levels were retrospectively analyzed in 13,236 Korean children and adolescents. 25OHD tests by chemiluminescent immunoassay were requested from 332 medical institutions nationwide in Korea between January 2014 and December 2014. Prevalence of vitamin D deficiency (VDD) and insufficiency (VDI) and the associated factors were analyzed. VDD and VDI were defined as serum 25OHD levels of <20.0 ng/mL and 20.0-29.9 ng/mL, respectively. Results: The 25OHD levels negatively correlated with age (r=-0.4033, P<0.001). Overall, 79.8% boys and 83.8% girls had hypovitaminosis D (VDI or VDD). The Odds ratios (ORs) of being in the VDD/VDI category as against the reference category of VDS (vitamin D sufficiency) were as follows: increase in age by 1 yr (OR=1.42/1.25, all P<0.001); girls (OR=1.32/1.16, P<0.001/P=0.004) compared to boys, spring (OR=1.61/1.80), fall (OR=1.31/1.28), and winter (OR=1.44/2.03, all P<0.001) compared to summer season; living in urban areas (OR=1.23, P<0.001) compared to rural areas. Conclusions: VDD and VDI are highly prevalent in children and adolescents in Korea. Serum 25OHD levels decreased significantly according to increasing age. Winter and spring seasons, increasing age, female sex, and living in urban areas are the factors associated with a high risk of VDD or VDI.ope

Distribution of dense breasts using screening mammography in Korean women: a retrospective observational study.

OBJECTIVES: This retrospective observational study evaluated the distribution of dense breasts by age group among healthy Korean women. METHODS: Participants were women aged 30 years and older who voluntarily underwent screening mammography between January 2007 and December 2011. Women who received the Breast Imaging Reporting and Data System for mammographic density of 3 or 4 were defined as having dense breasts. The proportion of women with dense breasts (PDB, %) was calculated by dividing the number of participants with dense breasts by the total number of participants. RESULTS: Among the 231,058 women who participated, 78.15% were classified as having dense breasts. PDB was highest in the youngest age group (PDB=94.87%) and lowest in the oldest age group. The greatest difference in PDB between adjacent age groups was observed in the group aged 60-64 years. CONCLUSIONS: The results show that the proportion of dense breasts by age group increased in all age groups, except in those aged 35-39 years. These findings suggest an association between the age distribution of dense breasts and trends in breast cancer incidence. Further studies are needed to estimate the change in breast cancer incidence rate by age and the accumulation of fatty breast tissue in Korean women.ope

Weight perception and its association with socio-demographic and health-related factors among Korean adolescents

BACKGROUND: Adolescence is a time of rapid growth with dramatic changes in physical appearance. The body image established at this time could affect their physical and mental health throughout their entire life. However, adolescents sometimes perceive themselves as underweight or overweight irrespective of actual weight status. The purpose of the present study was to examine the extent of weight misperception for Korean adolescents, to explore socio-demographic factors associated with weight misperception, and to examine gender-specific differences in the relationships between weight misperception and health-related factors. METHODS: We selected data on 3321 adolescents aged 12-18 years from the five-year Korea Health and Nutrition Examination Survey (KNHANES) datasets (2007-2011). Self-perceived weight status was compared with measured weight status by cross-tabulation. The generalized logit model was used to explore the socio-demographic factors associated with weight misperception, and separate logistic regression models were fitted to examine gender-specific differences in the relationships between weight misperception and health-related factors. RESULTS: Overall, 25.8 % of boys (overestimation 17.1 %; underestimation 8.6 %) and 29.3 % of girls (overestimation 24.0 %; underestimation 5.3 %) misclassified their weight status according to the objective standards. Weight overestimation was particularly prominent among underweight girls. Weight misperception was associated with socio-demographic factors such as gender, age, BMI, place of residence, and maternal education level. Weight overestimation and underestimation in boys and weight overestimation in girls were significantly related to inappropriate weight control practice. However, weight underestimation in girls seems to be negatively linked to inappropriate weight control practice. CONCLUSIONS: Based on the results of the present study, comprehensive intervention programs for adolescents and their parents could be devised to raise self-awareness of their weight status, to overcome weight misperception, and to prevent obesity and its related health risks.ope

The methodology for developing the 2007 Korean growth charts and blood pressure nomogram in Korean children and adolescents

Purpose : This study was to provide the methods of developing the growth charts and the blood pressure nomogram among Korean children and adolescents. Methods : The growth charts were developed based on the data from the national growth surveys for children and adolescents in 1998 and 2005. The percentile charts were developed through two stages. At the first stage, the selected empirical charts were smoothed through several fitting procedures including parametric and non-parametric methods. At the second stage, a modified LMS (lambda, mu, sigma) statistical procedure was applied to the smoothed percentile charts. The LMS procedure allowed to estimate any percentile and to calculate standard deviation units and z-scores. The charts for weight- for-age, height-for-age, BMI-for-age, weight-for-height and head circumference-for-age were developed by sex. Age and normalized height controlled sex-specific nomograms of systolic and diastolic blood pressure were developed by a fixed effect model of general regression using the data from 2005 national growth survey. Results : The significant systemic differences between the percentiles of growth charts and the empirical data were not found. The final output of the study is available from Korean Center for Disease Control and Prevention homepage, http://www.cdc.go.kr/webcdc/. Blood Pressure nomogram was tabulated by height percentiles and age using the regression coefficients analyzed with regression model. Conclusion : 2007 growth charts and blood pressure nomogram were the first products based on the statistical modeling using the national survey data. The further study on the methodology including data collection, data cleaning and statistical modeling for representative growth charts would be needed.ope