Requirements for Cerebrovascular Surgery in Comprehensive Stroke Centers in South Korea

Kim, Tackeun,Oh, Chang Wan,Park, Hyeon Seon,Lee, Kunsei,Lee, Won Kyung,Lee, Heeyoung The Korean Neurosurgical Society 2018 Journal of Korean neurosurgical society Vol.61 No.4

Objective : Cerebrovascular disease (CVD) was the third most common cause of death in South Korea in 2014. Evidence from abroad suggests that comprehensive stroke centers play an important role in improving the mortality rate of stroke. However, surgical treatment for CVD is currently slightly neglected by national policy, and there is still regional imbalance in this regard. For this reason, we conducted a survey on the necessity of, and the requirements for, establishing regional comprehensive cerebrovascular surgery centers (CCVSCs). Methods : This investigation was performed using the questionnaire survey method. The questionnaire was consisted with two sections. The first concerned the respondent's opinion regarding the current status of demand and the regional imbalance of cerebrovascular surgery in South Korea. The second section asked about the requirements for establishing regional CCVSCs. We sent the questionnaire to 100 board members of the Korean Society of Cerebrovascular Surgeons. Results : Most experts agreed that cerebrovascular surgery patients were concentrated in large hospitals in the capital area, and 83.6% of respondents agreed that it was necessary to alleviate the regional imbalance of cerebrovascular surgery. With regards to personnel, over 90% of respondents answered that at least two neuro-vascular surgeons and two neuro-interventionists are necessary to establish a CCVSC. Regarding facilities, almost all respondents stated that each CCVSC would require a neuro-intensive care unit and hybrid operating room. The survey asked the respondents about 13 specific neurovascular surgical procedures and whether they were necessary for a regional CCVSC. In the questions about the necessity of cerebrovascular surgical equipment, all seven pieces of equipment were considered essential by all respondents. A further five pieces of equipment were considered necessary on site: computed tomographic angiography, magnetic resonance angiography, conventional angiography, surgical microscope, and surgical navigation. Our results may provide a basis for future policy regarding treatment of cerebrovascular disease, including surgery. Conclusion : Raising the comprehensiveness of treatment at a regional level would lower the national disease burden. Policies should be drafted regarding comprehensive treatment including surgery for cerebrovascular disease, and related support plans should be implemented.

병원서비스 평가 항목을 이용한 건국대학병원의 평가 : 환자 만족도를 중심으로

이건세 건국대학교 의과학연구소 1997 건국의과학학술지 Vol.7 No.-

Patient satisfaction is one of the most important variables that determines medical service utilization. Patient satisfaction may affect utilization of physician services, and that utilization, in turn, may affect satisfaction. The aims of this study is to discover the levels of satisfaction and to evaluate the Kon-Kuk hospital services. The self-administrative questionnaire was made with modification of sorne items which is used generally in hospital evaluation programme. Patient satisfaction was evaluated for 29 items, these items are catagorized by hospital facility, doctor's service, nurse's service, administration service, para-medical personnel's service, booth, toilet, and hospital foods. 56 patients among 204 eligible patients who discharged from November 14, 1996 to November 25, 1996 were completed questionnaire finally (response rate was 27.5%). The satisfaction was scored on a scale from 5 (very satisfied) to 1 (very unsatisfied). The average satisfaction scorn of nurse service, doctor's services, administration service , para-medical personnel's service, booth, toilet, and hospital food were 3.52, 3.25, 3.34, 3.21, 2.76, 2.75, 2.99 respectively. The patients were relatively more satisfied with personal services including nurse, doctor, and para-medical personnel. The satisfied patients had intention to recommend Kon-Kuk hospital to friends and acquaintances. Patient satisfaction scores are ranged from 3.46 to 2.70, and Kon-Kuk hospital got 61 points out of 100, comparing with other hospital in Chungju-city, Chungju medical center got 58 points. Hose hospital got 54 points. patients's satisfaction with Kon-Kuk hospital service is not high at this survey, further researches and activities focused on quality assessment, quality improvement are required.

Evaluation of the hypertension disease management program in Korea.

Kim, Younmi,Lee, Kunsei,Shin, Eunyoung,Kim, Hyeongsu,Kyung Ja June Science Press 2010 Asia-Pacific journal of public health Vol.22 No.3

<P>This study evaluated how the Hypertension Disease Management Program (HDMP) affects patient's blood pressure, knowledge, health behaviors, and use of medical services. Evaluation was performed by 2 measures, which were before and after comparison within the management group (n = 210) and comparison between the management group and control group (n = 1050) in 2005. Systolic and diastolic blood pressure of management group significantly decreased from 137.5 and 86.0 mm Hg to 131.2 and 83.8 mm Hg (P < .001, P < .01), respectively. Dieting, snack control, consumption of low-sodium meals, low-cholesterol meals, and fruits or vegetables, regular checking of blood pressure, and stress management techniques significantly increased after HDMP. However, there was no significant difference in the use of medical service between the disease management group and the control group. This study showed that the HDMP improved lifestyle and reduced blood pressure on the disease management group, but changed neither medical costs nor use of medical services. Long-term evaluation should be performed to determine if the HDMP reduce medical costs and use of medical services.</P>

고혈압 노인에 대한 사례관리의 효과

김윤미(Kim, Yunmi),신은영(Shin, Eunyoung),이건세(Lee, Kunsei) 한국노년학회 2006 한국노년학 Vol.26 No.3

본 연구는 건강보험공단의 고혈압 사례관리 프로그램이 노인대상자들의 혈압과 건강행위 변화 그리고 의료이용에 미친 영향을 평가하고자 시도되었다. 대상자들은 사례관리사들로부터 사례관리 지침에 의한 8~12주간의 프로그램을 제공받은 노인 33명이었으며, 측정내용은 사례관리 문제목록 및 목표달성 정도, 혈압과 건강행위 변화, 일상생활과 건강증진 실천, 의료이용 실적 등이 포함되었다. 사례관리 중재 결과 이전에 비하여 수축기혈압의 감소, 고혈압 관련 증상 경험 수 감소, 지식과 인지수준 향상, 일상생활과 건강증진 행위 실천이 증가한 것으로 나타났다. 연구 결과 고혈압 사례관리사업이 지역사회에 거주하는 노인 고혈압 대상자의 자가관리 능력을 향상하고 적절한 의료이용을 유도하는 바람직한 접근 방법임이 확인되었다. 향후 건강보험공단의 사례관리 사업에 대한 지속적인 모니터링과 평가로 사업의 성과를 높이고, 사업대상을 확대할 필요가 있을 것으로 사료된다. The aim of our study was to evaluate the effects of the case management program for the elderly with hypertension in community. The subjects were 33 elderly people with hypertension who received 12 weeks case management program by case managers. We measured blood pressure, health behaviors, health promotions and medical utilization. As the result of this analysis, we found decreased systolic blood pressure, decreased numbers of the symptoms on hypertension, increased knowledge and cognition, and increased health behavior. The number of hospital visits and the medical cost decreased. Case management program for the elderly with hypertension was significantly effective in our study.

제조업사업장의 산업안전보건 비용

오원기,김형수,엄창수,장성훈,이건세,정최경희,김근회,이관형 大韓産業醫學會 2008 대한직업환경의학회지 Vol.20 No.1

목적: 산재예방과 근로자의 건강증진을 위하여 대부분의 사업장은 산업안전보건 비용을 지출하고 있다 본 연구는 근로자 규모별 및 업종별 제조업 사업장의 산업안전 보건 비용의 규모 및 구성요소의 상대적 크기를 파악하여 제조업 사업장의 산업안전보건 비용의 수준을 제시하고자 하였다. 방법: 2005년도 동향조사에 참여한 제조업 사업장 중 근로복지공단의 2004년도 확정보험료 자료와 연결이 가능하였던 1,228개 제조업 사업장에 대하여 동향조사에서 파악한 8개 항목의 산재예방 투자비용과 산재보험료 자료를 이용하여 산업안전보건 비용을 계산하였다. 결과: 근로자 1인당 산업안전보건 비용은 근로자 5인 이상 50인 미만 사업장의 경우 99만원,근로자 50인 이상 300인 사업장 87만원 및 근로자 300인 이상 사업장 177만원이었다. 5인 이상 50인 미만 사업장과 50인 이상 300인 미만 사업장에서는 산업안전보건 비용중 산재보험료가 각각 62.8%와 52.8%로 가장 많았으며,다음으로 안전시설 및 보호장치 투자비로 각각 20.1%,19.1%이었다. 300인 이상 사업장에서는 산재보험료 37.5%,인력유지비 23.0%,안전시설 및 보호장비 투자비 22.8% 순이었다. 5인 이상 50인 미만 사업장에 비해 근로자 규모가 증가할수록 인력유지비,활동비,건강관리비 및 기타비용은 유의하게 증가하였으며,작업환경측정비와 산재 보험료는 유의하게 감소하였다. 결론: 2004년도 제조업 사업장이 지출한 산업안전보건 비용의 수준은 규모별 및 업종별로 매우 다양하였다. 산재 예방과 건강증진 측면에서 산업안전보건 비용에 대한 체계적이고 지속적인 접근이 요구된다. Objective: This study evaluated the cost for occupational health and safety in manufacturing factories in Korea according to the factory's size and the industrial classification. Methods: The costs to prevent occupational injuries and promote the general health of the workers were calculated by using the data of The Occupational Safety and Health Survey in Korea in the year of 2005 and the data of the Industrial Accident Compensation Insurance (IACI) Premiums at the same factories for the year of 2004. Results: The mean cost per one worker was as follows: 990,000 won for the factory with 5∼49 workers, 869,000 won for the factory with 50∼299 workers and 1,773,000 won for the factory with more than 300 workers, In the factories with 5∼49 workers and 50∼299 workers, the premium for the IACI was the largest portion of the cost (62.8% and 52.8%, respectively) and the cost for gear to protect workers from dangerous machinehes was the next biggest portion of the cost (20.1% and 19.1%, respectively). The largest portion of the cost in the factories with more than 300 workers was the premium for the IACI (37.5%). Conclusions: The investment costs to prevent occupational injuries and to promote the general health of the workers were very diverse according to the size of the factories and the industrial classification. To reduce the occupational injuries and to promote the general health of the workers, systematic and continuous approaches to evaluate the investment costs for the occupational health and safety are required.

공군 항공기 소음이 초등학생의 소음 민감도, 정서 및 행동에 미치는 영향

오원기(Wonki Oh),김형수(Hyeongsu Kim),장성훈(Sounghoon Chang),이건세(Kunsei Lee),김근회(Keunwhoe Kim),최희정(Heejung Choe),함은미(Eunmee Ham),손주형(Juhyoung Son) 한국농촌의학 지역보건학회 2008 농촌의학·지역보건 Vol.33 No.3

본 연구는 공군 항공기 소음에 노출되는 초등학생을 대상으로 소음에 대한 민감도와 정서상태 및 아동의 행동에 대한 부모의 평가를 통해 항공기 소음 노출과 초등학생의 정서 및 행동과의 관련성을 파악하고자 수행되었다. 연구는 먼저 소음노출 지역과 대조지역간 주간 소음을 측정하여 비교하였으며, 다음으로 항공기 소음노출 지역 6개 초등학교 4, 5, 6학년 학생 272명과 학부모 272명, 대조지역 2개 초등학교 4, 5, 6학년 학생 91명과 학부모 91명을 대상으로 초등학생은 소음에 대한 민감도와 정신심리적 특성 및 학부모는 소음에 대한 민감도 및 초등학생에 대한 행동평가를 구조화된 설문지를 이용하여 평가하였다. 먼저 항공기 이착륙관련 환경소음은 수준은 노출지역의 주중 주간 소음수준(Leg55)은 평균 67.6 dB(A)으로 대조지역의 소음수준 57.1 dB(A), 58.2 dB(A), 60.2 dB(A)보다 유의하게 높은 것으로 나타났다. 노출군에서 초등학생의 소음 민감도 점수는 15.1점으로 대조군의 16.6점에 비해 낮았으나 유의성은 없었다(p=0.056). 또한 노출군에서 초등학생의 간이정신진단점수는 18.6점으로 대조군의 20.5점에 비해 낮았으나 역시 유의성은 없었다(p=0.165). 노출군에서 학부모에 의한 초등학생 행동평가점수는 15.5점으로 대조군의 13.2점보다 유의하게 높았다(p=0.043). 노출군에서 부모의 소음민감도 점수는 27.5점으로 대조군 학부모의 민감도 점수 24.1에 비해 유의하게 높았다(p=0.045). 본 연구결과는 부모의 초등학생 행동평가는 실제 소음노출에 의한 영향보다는 부모의 소음에 대한 민감도가 학생에게 더 큰 영향을 미치고 있음을 보여주고 있다. 공군 항공기 소음이 초등학생에게 미치는 건강영향에 대하여 지속적인 연구가 진행되어야 할 것이다. Objectives : We evaluated the effect of the aircraft noise on the behavior and affect status of the local elementary school students. Methods : The daytime noise levels of the exposed and control areas were compared and the self answered questionnaires from 272 students and their parents of the exposed area and 91 of the control area were collected. The questionnaires are regarding the noise sensitivity and the psychosocial status of the students, noise sensitivity of the parents and the parents" behavioral evaluation for their children. Results : The mean noise level of the exposed area (67.6 dB(A)) showed higher level than the control area (57.1 dB(A), 58.2 dB(A), 60.2 dB(A)) and it was statistically significant. The mean score for noise sensitivity and the mean score for brief mental exam. in the exposed students were lower than the mean scores in the control group but they were not statistically significant (p=0.056 & 0.165). The mean score for behavioral evaluation of students by their parents in the exposed area(15.5) was higher than the mean score in the control group(13.2) and it was statistically significant(p=0.043). The mean score for noise sensitivity in the exposed parent(27.5) was higher than the mean score in the control group(24.1) and it was statistically significant(p=0.045). Conclusions : This study revealed that the noise sensitivity of the parents affected the behavioral evaluation of the students than noise-exposure itself. The further study is needed to evaluate relationship between aircraft noise and it"s effect on children"s health.

성인 남성의 금연 준비단계에 영향을 미치는 요인

연정운(Yeon, Jeong-Woon),김형수(Kim, Hyeongsu),이건세(Lee, Kunsei),장성훈(Chang, Sounghoon),최희정(Choi, Heejung),함은미(Ham, Eunmi),명준표(Myong, Jun Pyo) 한국간호과학회 2012 Journal of Korean Academy of Nursing Vol.42 No.3

Factors Affecting the Designation of Cerebrovascular Diseases as Work-Related in Administrative Litigation

Kim, Hyeongsu,Choi, Jaewook,Rim, Hwayoung,Chang, Sounghoon,Lee, Kunsei The Korean Academy of Medical Sciences 2008 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.23 No.2

<P>The purpose of this study was to identify factors that could be used as standardized criteria for evaluating occupational diseases in initial assessments or requests for examination. Using 100 administrative litigation cases on the work-relatedness of cerebrovascular diseases (CVDs) by the Seoul Branch of the Korea Labor Welfare Corporation (KLWC) from 1997 to 2002, we estimated the relationship between the investigated variables and designation of the work-relatedness of the CVD. As for the age, the odds ratio of the acceptance rate of a case as work-related in subjects over 60 yr of age was 0.08 (95% CI, 0.01-0.75), which was compared to subjects under 30 yr of age. Regarding working hours, the odds ratio of the acceptance rate of a case as work-related in CVDs in those over 56 hr was 9.50 (95% CI, 1.92-47.10) when compared to those less than 56 hr. As for the benefit type, the odds ratio of the acceptance rate of a case as work-related in medical benefits was 5.74 (95% CI, 1.29-25.54), compared to survivor benefits. As for the criteria for defining situations as work overload, the odds ratio of the acceptance rate of a case as work-related in injured workers was 12.06 (95% CI, 3.12-46.62), compared to that in non-injured workers. Our findings show that the criteria for defining situations of work overload played an important role in assessing the work-relatedness of CVDs in administrative litigation, and it is necessary to make the scientific evidence on judgement of work-relatedness on overwork.</P>

톨루엔 및 크실렌 노출 근로자에서 안식향산나트륨 섭취에 따른 요중 대사산물 농도의 시간적 변화

정최경희(Kyunghee Jung-Choi),장성훈(Sounghoon Chang),김형수(Hyeongsu Kim),오원기(Wonki Oh),고상백(Sang Baek Koh),이건세(Kunsei Lee),박수경(Suekyung Park) 대한직업환경의학회 2006 대한직업환경의학회지 Vol.18 No.3

Risk of cancer, cardiovascular disease, thromboembolism, and mortality in patients with rheumatoid arthritis receiving Janus kinase inhibitors: a real-world retrospective observational study using Korean health insurance data

Hong Ki Min,Hyeongsu Kim,Ho Jin Jeong,Se Hee Kim,Hae-Rim Kim,Sang-Heon Lee,KunSei Lee,Soon-Ae Shin,Jong Heon Park 한국역학회 2023 Epidemiology and Health Vol.45 No.-

OBJECTIVES: This study investigated whether Janus kinase inhibitors (JAKis) raise the risk of cardiovascular disease (CVD), venous thromboembolism (VTE), and cancer in patients with rheumatoid arthritis (RA). METHODS: We conducted a real-world retrospective observational study using data obtained from the Korean National Health Insurance Service database. Two data sets were analyzed: tumor necrosis factor inhibitor (TNFi)/JAKi-naive RA patients (set 1) and all RA patients who used TNFis or JAKis (set 2). The incidence rate ratios (IRRs) and hazard ratios (HRs) for acute myocardial infarction (AMI), stroke, cardiovascular (CV)-related mortality, major adverse cardiovascular events (MACE), VTE, arterial thromboembolism (ATE), cancer, and all-cause mortality were compared between the JAKi and TNFi groups. RESULTS: Set 1 included 1,596 RA patients (JAKi group: 645; TNFi group: 951), and set 2 included 11,765 RA patients (JAKi group: 2,498; TNFi group: 9,267). No adverse events (AEs) showed significantly higher IRRs in the JAKi groups than in the TNFi groups of sets 1 and 2. The HRs for MACE in the JAKi groups of sets 1 and 2 were 0.59 (95% confidence [CI], 0.35 to 0.99) and 0.80 (95% CI, 0.67 to 0.97), respectively. The JAKi group of set 2 showed a significantly higher risk of all-cause mortality (HR, 1.71; 95% CI, 1.32 to 2.20), but the other AEs did not demonstrate increased risks in the JAKi groups. CONCLUSIONS: In this study, JAKis did not increase the risk of AMI, stroke, CV-related mortality, MACE, VTE, ATE, or cancer in Korean RA patients relative to TNFis.