Journal of Preventive Medicine and Public Health

Special Article

Well-being Index Scores and Subjective Health Status of Korean Healthcare Workers: Yoonhee Shin, Bohyun Park, Nam-eun Kim, Eun Jeong Choi, Minsu Ock, Sun Ha Jee, Sue K. Park, Hyeong Sik Ahn, Hyesook Park; J Prev Med Public Health. 2022;55(3):226-233. Published online May 31, 2022; DOI: https://doi.org/10.3961/jpmph.22.114

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Abstract Summary PDF: Objectives
The aim of this study was to evaluate the subjective level of health-related quality of life of Korean healthcare workers using various quality-of-life instruments.
Methods
This study included 992 participants, who were doctors and nurses. A survey was conducted between November 28 and December 4, 2019. Data from 954 participants divided into 3 groups (physicians, residents, and nurses) were analyzed. Four measurement tools (29 questions) were used in the survey to evaluate subjective health status and well-being.
Results
In the Mayo Well-being Index, burnout during work (88.5%) and emotional difficulties caused by work (84.0%) were frequently cited by the respondents. Regarding questions on burnout and emotional difficulties, residents and nurses had the highest scores (91.0 and 89.6%, respectively). Emotional problems, such as anxiety, depression, and irritability, accounted for a high percentage (73.1%) of the total, while 82.2% of respondents reported that their work schedules interfered with their leisure and family time. There was no significant difference among the groups in subjective health status. However, 10.1% of the residents experienced very low quality of life, which was a higher proportion than that of physicians (2.7%) and nurses (5.2%).
Conclusions
The level of well-being that Korean medical workers experienced in relation to work was lower than the results of the United States healthcare workers surveyed using the same tool. This study was unique in that it conducted a subjective quality-of-life survey on Korean healthcare workers.; Summary

Korean summary
본 연구의 목적은 다양한 삶의 질 도구를 사용하여 한국 의료종사자들의 건강과 관련된 삶의 질에 대한 주관적인 수준을 평가하는 것이다. 피로와 정서적 어려움, 업무로 인한 일상생활의 방해 등 한국 의료종사자의 일부 삶의 질 점수가 낮았다. 의료 종사자의 소진 경험이 환자의 치료에 부정적인 영향을 미친다는 것을 고려할 때 의료 종사자들의 삶의 질을 향상시키는 정책이 마련되어야하며, 건강과 관련된 직업적 위험요인 연구도 추가적으로 필요하다.

English Abstract

Prognostic Impact of Charlson Comorbidity Index Obtained from Medical Records and Claims Data on 1-year Mortality and Length of Stay in Gastric Cancer Patients.: Min Ho Kyung, Seok Jun Yoon, Hyeong Sik Ahn, Se min Hwang, Hyun Ju Seo, Kyoung Hoon Kim, Hyeung Keun Park; J Prev Med Public Health. 2009;42(2):117-122.; DOI: https://doi.org/10.3961/jpmph.2009.42.2.117

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OBJECTIVES
We tried to evaluate the agreement of the Charlson comorbidity index values (CCI) obtained from different sources (medical records and National Health Insurance claims data) for gastric cancer patients. We also attempted to assess the prognostic value of these data for predicting 1-year mortality and length of the hospital stay (length of stay). METHODS: Medical records of 284 gastric cancer patients were reviewed, and their National Health Insurance claims data and death certificates were also investigated. To evaluate agreement, the kappa coefficient was tested. Multiple logistic regression analysis and multiple linear regression analysis were performed to evaluate and compare the prognostic power for predicting 1 year mortality and length of stay. RESULTS: The CCI values for each comorbid condition obtained from 2 different data sources appeared to poorly agree (kappa: 0.00-0.59). It was appeared that the CCI values based on both sources were not valid prognostic indicators of 1-year mortality. Only medical record-based CCI was a valid prognostic indicator of length of stay, even after adjustment of covariables (beta = 0.112, 95% CI = [0.017-1.267]). CONCLUSIONS: There was a discrepancy between the data sources with regard to the value of CCI both for the prognostic power and its direction. Therefore, assuming that medical records are the gold standard for the source for CCI measurement, claims data is not an appropriate source for determining the CCI, at least for gastric cancer.

Summary

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Journal of Breast Cancer.2010; 13(4): 409. CrossRef
A comparison of the Charlson comorbidity index derived from medical records and claims data from patients undergoing lung cancer surgery in Korea: a population-based investigation
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BMC Health Services Research.2010;[Epub] CrossRef
Health Outcome Prediction Using the Charlson Comorbidity Index In Lung Cancer Patients
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Evaluation Studies

Usefulness of Comorbidity Indices in Operative Gastric Cancer Cases.: Se Min Hwang, Seok Jun Yoon, Hyeong Sik Ahn, Hyong Gin An, Sang Hoo Kim, Min Ho Kyeong, Eun Kyoung Lee; J Prev Med Public Health. 2009;42(1):49-58.; DOI: https://doi.org/10.3961/jpmph.2009.42.1.49

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Abstract PDF

OBJECTIVES
The purpose of the current study was to evaluate the usefulness of the following four comorbidity indices in gastric cancer patients who underwent surgery: Charlson Comorbidity Index (CCI), Cumulative Illness rating scale (CIRS), Index of Co-existent Disease (ICED), and Kaplan-Feinstein Scale (KFS). METHODS: The study subjects were 614 adults who underwent surgery for gastric cancer at K hospital between 2005 and 2007. We examined the test-retest and inter-rater reliability of 4 comorbidity indices for 50 patients. Reliability was evaluated with Spearman rho coefficients for CCI and CIRS, while Kappa values were used for the ICED and KFS indices. Logistic regression was used to determine how these comorbidity indices affected unplanned readmission and death. Multiple regression was used for determining if the comorbidity indices affected length of stay and hospital costs. RESULTS: The test-retest reliability of CCI and CIRS was substantial (Spearman rho=0.746 and 0.775, respectively), while for ICED and KFS was moderate (Kappa=0.476 and 0.504, respectively). The inter-rater reliability of the CCI, CIRS, and ICED was moderate (Spearman rho=0.580 and 0.668, and Kappa=0.433, respectively), but for KFS was fair (Kappa=0.383). According to the results from logistic regression, unplanned readmissions and deaths were not significantly different between the comorbidity index scores. But, according to the results from multiple linear regression, the CIRS group showed a significantly increased length of hospital stay (p<0.01). Additionally, CCI showed a significant association with increased hospital costs (p<0.01). CONCLUSIONS: This study suggests that the CCI index may be useful in the estimation of comorbidities associated with hospital costs, while the CIRS index may be useful where estimatation of comorbiditie associated with the length of hospital stay are concerned.

Summary

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The Association between Charlson Comorbidity Index and the Medical Care Cost of Cancer: A Retrospective Study
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Journal of Breast Cancer.2010; 13(4): 409. CrossRef
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English Abstract

The Effect of the Cost Exemption Policy for Hospitalized Children under 6 Years Old on the Medical Utilization in Korea.: Kyeong Su Jeon, Seok Jun Yoon, Hyeong Sik Ahn, Hyun Woong Shin, Young Hye Yoon, Se Min Hwang, Min Ho Kyung; J Prev Med Public Health. 2008;41(5):295-299.; DOI: https://doi.org/10.3961/jpmph.2008.41.5.295

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Abstract PDF

OBJECTIVES
The Korean government in January 2006 instigated an exemption policy for hospitalized children under the age of six years old. This study examines how this policy affected the utilization of medical care in Korea. METHODS: A total of 1,513,797 claim records from the Health Insurance Review Agency were analyzed by complete enumeration methods. The changes of medical utilization were compared from 2005 to 2006. In addition, the changes of medical utilization between 2004 and 2005 were compared as a pseudocontrol group. RESULTS: The admission rate increased 1.14-fold from 15.20% in 2004 to 17.32% in 2005, and this further increased 1.08-fold to 18.65% in 2006. The increase of patients with a common cold (1.2-fold) was higher than that of both the general patients (1.08-fold) and the patients with the top 10 fatal diseases (0.91-fold). The average length of stay per case for clinics showed the highest increase rates (1.06-fold). The rates of patients with the common cold showed a higher increase (1.05-fold) than that of the general patients. The average medical expense per case was increased by 1.10-fold from 2005 to 2006, which was higher than that from 2004 to 2005 (1.04-fold). The increase rate for patients with the common cold was higher at 1.18-fold than that of the general patients. CONCLUSIONS: The cost exemption policy has especially led to an increase in the utilization of clinics and the utilization by patients with a common cold.

Summary

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Original Articles

A Case-Control Study on Association Between Hepatocellular Carcinoma and Infection of Hepatitis B and Hepatitis C Virus.: Hyeong Sik Ahn, Min Ho Kim, Young Sick Kim, Joung Soom Kim; Korean J Prev Med. 1997;30(1):1-16.

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Abstract PDF: To investigate the association between hepatocellular carcinoma(HCC) and infection of hepatitis B virus(HBV) and hepatitis C virus(HCV) in an HBV endemic area , a case-control study of 254 patients with HCC and of 1,270 age and sex matched health control subjects was done. Among the 254 HCC patients 166(65.4%) were positive for hepatitis B surface antigen(HBsAg), 49(19.3%) were positive for HCV antibody(anti-HCV Ab). The crude odd ratio of patients with HBsAg was 36.1(95% CI :22.4-58.2) and with anti-HCV Ab was 9.0(95% CI :5.5-14.6). In an analysis, which HBsAg(-), HBcAb(-), anti-HCV Ab(-) group was chosen as referent group, odd ratio of HBsAg(+) group was 14.4(95% CI: 7.2-28.9) and of anti- HCV Ab(+) was 10.7(95% CI: 2.9-40.0). Odd ratio of anti-HCV Ab(+), HBsAg(+) group and anti-HCV Ab(+), HBsAg(-), HBcAb(+) group for HCC were elevated to 27.3(95% CI : 9.0-82.9) , 15.9(95% CI:7.1-35.8) respectly. The odd ratio of anti-HCV Ab(-), HBsAg(-), HBcAb(+) group was 2.4(95% CI : 1.1-5.0). These result suggested that HBV and HCV were associated with HCC. In HBV endemic area patients with HBcAb alone should be considered risk group for HCC.; Summary

An Appropriateness Evaluation of Cesarean Section, Cholecystectomy, and Admission in Pediatric Pneumonia.: Chang Yup Kim, Hyeong Sik Ahn, Young Seong Lee, Young Dae Kwon, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 1992;25(4):413-428.

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Abstract PDF: The aim of this study was to evaluate the appropriateness of some kinds of surgery and admission, such as cesarean section (C/S), cholecystectomy, and pediatric pneumonia. For appropriateness evaluation, we ourselves developed some criteria, which were included in the category of explicit and linear criteria, with the assistance of specialists of relevant clinical field. The evaluation of appropriateness was performed by two family physicians. The major findings were as follows: 1. For ceserean section, 77.6% of deliveries were determined to be 'appropriate', but the level of appropriateness was not significantly different among hospitals between hospital groups by size. The most frequent indication of C/S was repeated operation, followed by cephalopelvic disproportion(CPD). The labor trials for vaginal delivery among repeated C/S and CPD cases were performed in 24.5% of pertinent deliveries. 2. About 73.8% of cholecystectomy cases was appropriate to one of the surgical indications, without significant differences among hospitals. Of surgical indications, 'sufficiently frequent and intense symptom recurrence' was the most frequent, and 'confirmed acute cholecystitis' was the second. 3. Of children admitted due to pneumonia, only 57.4% of cases satisfied admission criteria, and the level of appropriateness of admission was different among hospitals. The common reasons for admission were 'failure to initial treatment', 'suspected bacterial pnermonia', 'young infant', etc. We could find that there were differences of quality among hospitals in some procedures, especially in the pediatric pneumonia and labor trial before C/S, which suggested that the implementation of quality assurance activities would be necessary in this country. In this study, we used some simple and primitive research tools and the numbers of subjects and tracer procedures were limited. So advanced studies with plentiful subjects and more representative diseases or procedures should be tried.; Summary

A Study on the Insurance Contribution and Health Care Utilization of the Regional Medical Insurance Scheme.: Sang Il Lee, Hyun Rim Choi, Hyeong Sik Ahn, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 1989;22(4):578-590.

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Abstract PDF: This study was conducted to assess the equity in the regional insurance scheme through analysis of the computerized data from one regional insurance society and National Federation of Medical Insurance. We analysed the insurance contribution and benefit by the classes based on total and income-related contribution per household. The major findings of this study are as follows: 1. The average proportion of income-related contribution among the total was 39.2% and the upper classes show higher proportion of the income-related contribution. 2. The upper classes show higher health care utilization rate than the lower classes. It suggests that the lower classes have relatively large unmet medical needs. 3. The analysis through the Lorenz curve reveals that there exists transference of contributions from the upper to lower classes. But the cumulative percentage of insurance benefit is smaller than that of the number of the insured. It implies that regional medical insurance scheme in Korea has still some inequity in the context of social security principles.; Summary

Effect of Hyperoxia on Pregnancy in the Rat.: Seung Chul Lee, Soo Hun Cho, Hyeong Sik Ahn, Dork Ro Yun; Korean J Prev Med. 1989;22(1):71-80.

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Abstract PDF: The adverse effect of diving on the fetus may extend beyond n gestational process and outcome. Primiparous Sprague-Dawley rats were assigned to one of ten exposure schedules during gestatred PO2 level, the following question about the effect of exposing a pregnant female to high partial pressure of inspired oxygen has been raised. "What effect does an increased maternal PIO2 have on fetal arterial PO2 and therefore on possible fetal oxygen poisoning?" This study was carried out to observe the effects of maternal hyperoxia on gestational process and outcome. Primiparous Sprague-Dawley rats were assigned to one of ten exposure schedules during gestation. The treatment groups were subjected to either the high concentration of oxygen, or the high atmospheric pressure. On day 21 of gestation, laparotomy was performed to examine for number and distribution of implantations and live and resorbing embryos. Fetuses were weighed, and examined for gross malformations. Subsequently, they were fixed, measured in physical parameters, and examined for visceral anomalies. Minor visceral anomalies and anatomical variation was not found. Similarily, there were no significant differences when number of resorptions, mean fetal weights, pregnancy interruption rate were compared by analysis of variance. These results indicate that exposing rats to oxygen at increased atmospheric pressure doese not affect fetal health or survival.; Summary

Effect of Hyperbaric Oxygenation on Pulmonary Superoxide Dismutase Activity in Neonatal and Adult Rats.: Hyeong Sik Ahn, Soo Hun Cho, Dork Ro Yun, Dong Ryool Lee, Yong Sik Kim; Korean J Prev Med. 1989;22(1):51-56.

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Abstract PDF: To investigate the effect of hyperbaric oxygenation on superoxide dismutase activity, neonatal rats (7-10 days old) and adult rats (approximately 100 days old) were continuously exposed to hyperbaric oxygen environment of 2.4ATA for 8 hours and their superoxide dismutase activity were measured. Neonatal rats, all survived through exposure, showed significant increases in the pulmonary superoxide dismutase activity at immediately and 24 hours after exposure. Adult rats, whose 8 hour survival rates were 14 %, did not show any significant increase in the activity of pulmonary superoxide dismutase as compared to the control adult rats. These findings are indicating that increased tolerance to oxygen toxicity in neonatal animals during exposure may be attributed to the increase in activity of superoxide dismutase in neonatal rats.; Summary

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