BACKGROUND: The use of therapeutic materials based on new health technology has increased in recent years in the field of medicine, raising concerns for medical practitioners regarding increased spending on the new therapeutic materials amid the rapid population ageing and increase of chronic diseases in Korea. While therapeutic materials have significant importance in the health care system, they have not been given appropriate attention in the academic world of Korea. The purpose of this study is to identify factors that affect the growth of expenditure on therapeutic materials and to derive implications for an effective management considering the diversity of therapeutic materials. METHODS: Using the claims data of the National Health Insurance Services, specific utilization patterns of groups of therapeutic materials in the middle classification level of Health Insurance Review and Assessment Service from 2007 to 2014 were analyzed. Four categories (J5083: drug eluting coronary stent, D0302: nonmetallic anchor, K6014: gauze, K6023: gauze) that exhibit unique patterns with respect to price and volume were selected. Then, decomposition analysis was performed to identify the largest contributor to the spending growth by dividing the products into existing, new, and abandoned products for the period between 2010 and 2013. RESULTS: The effect of new products had larger impact on spending growth than the effect of core items in drug eluting coronary stent (J5083) and nonmetallic anchor (D0302). In addition, existing products in general included items priced relatively lower when compared with another item manufactured by the same company. In the gauze category, however, existing products had the largest impact on expenditure and the effect of volume was greater than that in other categories. CONCLUSION: This study provides evidence that appropriate management measures classified by the characteristics of therapeutic materials are required for therapeutic materials pricing and reassessment in Korea.
Biomedical Technology ; Chronic Disease ; Classification ; Delivery of Health Care ; Health Expenditures* ; Health Status ; Insurance ; Korea ; National Health Programs* ; Stents

PURPOSE: This study evaluated the effect of loss of interproximal papilla, creating an undercut, on the accuracy of impression materials. MATERIALS AND METHODS: Two addition type silicone impression materials (Extrude(R) Wash, Imprint(TM) II Quick Step Light Body) and one alginate impression material (Cavex Impressional) were used to make impressions of a maxillary master model simulating clinical conditions with or without interproximal papilla. Stone was poured in the impressions and working casts were fabricated. A total of 6 groups with 6 working casts in each group were scanned using 3-dimensional optical scanner. The accuracy of the impressions was assessed by measuring the dimensional changes (DeltaI (%)) of 6 distances on working casts compared to a master model with a 3-dimensional digitizing and inspection software. The data were analyzed by two-way ANOVA (P<.05). RESULTS: Three of 6 distances showed statistically significant differences among the impression materials. Only 1 of 6 distances in alginate impression showed a statistically significant difference between casts with and without interproximal papilla (P=.047). CONCLUSION: The presence of undercut due to loss of interproximal papilla did not significantly influence the dimensional accuracy of addition type silicone and alginate impression materials.
Alginates ; Dental Impression Materials ; Silicone Elastomers

Objectives: ：The turnover rate of mental health workers in community mental health institutes is remarkably high.We explored the mediating effects of perceived work value on the relationship between burnout and turnover intention among mental health professionals working for community mental health centers and addiction centers. Methods: ：A total of 161 mental health workers completed this survey. We administered the Maslach Burnout Inventory-General Survey (MBI-GS) and the Michigan Organizational Assessment Questionnaire (MOAQ) (which explores turnover intention). Perceived work value was assessed using two items of the Scale of Resilience to Burnout.Associations were sought using the t-test, analysis of variance, correlation analyses, and hierarchical regression analyses. Results: ：The burnout level was significantly negatively correlated with perceived work value. Burnout was significantly positively correlated with turnover intention, and perceived work value significantly negatively correlated. Bootstrapping showed that perceived work value partially mediated the relationship between burnout and turnover intention. Conclusion ：Perceived work value may buffer turnover intention caused by burnout. Creation of an environment in which mental health workers feel that their work is valuable is important to prevent resignations.

BACKGROUND/OBJECTIVES: Inflammation is associated with various types of acute and chronic alcohol liver diseases. In this study, we examined whether umbelliferone (7-hydroxycoumarin, UF) ameliorates chronic alcohol-induced liver damage by modulating inflammatory response and the antioxidant system. METHODS: Rats were fed a Liber-Decarli liquid diet containing 5% alcohol with or without UF (0.05 g/L) for 8 weeks, while normal rats received an isocaloric carbohydrate liquid diet. RESULTS: Chronic alcohol intake significantly increased serum tumor necrosis factor-alpha (TNF-alpha) and interleukin 6 levels and decreased interleukin 10 level; however, UF supplementation reversed the cytokines related to liver damage. UF significantly suppressed hepatic lipopolysaccharide binding protein, toll-like receptor 4 (TLR4), nuclear factor kappa B, and TNF-alpha gene expression increases in response to chronic alcohol intake. Masson's trichrome staining revealed that UF improved mild hepatic fibrosis caused by alcohol, and UF also significantly increased the mRNA expressions and activities of superoxide dismutase and catalase in liver, and thus, decreased lipid peroxide and mitochondrial hydrogen peroxide levels. CONCLUSIONS: The findings of this study indicate that UF protects against alcohol-induced liver damage by inhibiting the TLR4 signaling pathway and activating the antioxidant system.
Animals ; Antioxidants* ; Carrier Proteins ; Catalase ; Cytokines ; Diet ; Fibrosis ; Gene Expression ; Hydrogen Peroxide ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Liver ; Liver Diseases ; NF-kappa B ; Rats* ; RNA, Messenger ; Superoxide Dismutase ; Toll-Like Receptor 4 ; Tumor Necrosis Factor-alpha

PURPOSE: This study evaluated the effect of polishing techniques on surface roughness of polymethyl methacrylate (PMMA), as well as the influence of light-cured surface glaze and subsequent brushing on surface roughness. MATERIALS AND METHODS: A total of 60 PMMA specimens (10x10x5 mm) were made and then divided into 6 groups of 10 each according to the polymerization methods (under pressure or atmosphere) and the surface polishing methods (mechanical or chemical polishing) including 2 control groups. The mechanical polishing was performed with the carbide denture bur, rubber points and then pumice and lathe wheel. The chemical polishing was performed by applying a light-cured surface glaze (Plaquit(R); Dreve-Dentamid GmbH). Accura 2000(R), a non-contact, non-destructive, optical 3-dimensional surface analysis system, was used to measure the surface roughness (Ra) and 3-dimensional images were acquired. The surface roughness was again measured after ultrasonic tooth brushing in order to evaluate the influence of brushing on the surface roughness. The statistical analysis was performed with Mann-Whitney test and t-test using a 95% level of confidence. RESULTS: The chemically polished group showed a statistically lower mean surface roughness in comparison to the mechanically polished group (P = .0045) and the specimens polymerized under the atmospheric pressure presented a more significant difference (P = .0138). After brushing, all of the groups, except the mechanically polished group, presented rougher surfaces and showed no statistically significant differences between groups. CONCLUSION: Although the surface roughness increased after brushing, the chemical polishing technique presented an improved surface condition in comparison to the mechanical polishing technique.
Atmospheric Pressure ; Dentures ; Polymerization ; Polymers ; Polymethyl Methacrylate ; Rubber ; Silicates ; Tooth ; Ultrasonics

PURPOSE: This study evaluated the detorque values of screws in a multiple implant-supported superstructure using stone casts made with 2 different impression techniques. MATERIAL AND METHODS: A fully edentulous mandibular master model and a metal framework directly connected to four implants (Branemark System(R); Nobel Biocare AB) with a passive fit to each other were fabricated. Six experimental stone casts (Group 1) were made with 6 non-splinted impressions on a master cast and another 6 experimental casts (Group 2) were made with 6 acrylic resin splinted impressions. The detorque values of screws (TorqTite(R) GoldAdapt Abutment Screw; Nobel Biocare AB) were measured twice after the metal framework was fastened onto each experimental stone cast with 20 Ncm torque. Detorque values were analyzed using the mixed model with the fixed effect of screw and reading and the random effect of model for the repeated measured data at a .05 level of significance. RESULTS: The mean detorque values were 7.9 Ncm (Group 1) and 8.1 Ncm (Group 2), and the mean of minimum detorque values were 6.1 Ncm (Group 1) and 6.5 Ncm (Group 2). No statistically significant differences between 2 groups were found and no statistically significant differences among 4 screws were found for detorque values. No statistically significant differences between 2 groups were also found for minimum detorque values. CONCLUSION: In a multiple external hexagon implant-supported prosthesis, no significant differences between 2 groups were found for detorque values and for minimum detorque values. There seems to be no significant differences in screw joint stability between 2 stone cast groups made with 2 different impression techniques.
Joints ; Prostheses and Implants ; Splints ; Torque

BACKGROUND: Community-acquired pneumonia is one of the main causes of hospitalization and death, especially in elderly patients. There have been many studies on prognosis for community-acquired pneumonia, but few in Korea. We sought to identify characteristics on admission predicting mortality in elderly patients hospitalized with community-acquired pneumonia and to compare mortality rates by PORT score with PORT study's ones. METHODS: We performed a retrospective study of 267 patients aged 65 years and over admitted with community- acquired pneumonia from January 2000 to December 2002. We reviewed demographic, clinical, laboratory, microbiological and radiologic data and identified independent factors associated with the mortality using logistic regression analysis. We classified patients into risk classes by PORT score and calculated the mortality rate. RESULTS: Among of 267 patients, 48 (18.0%) died. We identified six independent predictors of mortality; male (OR, 2,496; 95% CI, 1,012~6,153), lung cancer (OR, 3,409; 95% CI, 1,302~8,920), general weakness (OR, 5.218; 95% CI, 2,140~12,718), unable to walk (OR, 9,232; 95% CI, 2,228~38,257), BUN > or =30 mg/dL (OR, 3,327; 95% CI, 1.072~10.327), albumin <3 g/dL (OR, 3,219; 95% CI, 1,351~7,670) and pleural effusion (OR, 3.135; 95% CI, 1,052~9,342). Mortality rates of risk class II-V by PORT score were 6.7%, 9.5%, 30.4% and 34.4%, respectively. CONCLUSION: There were factors that were associated with mortality in elderly patients hospitalized with community-acquired pneumonia.
Aged* ; Hospitalization ; Humans ; Korea ; Logistic Models ; Lung Neoplasms ; Male ; Mortality* ; Pleural Effusion ; Pneumonia* ; Prognosis ; Retrospective Studies

OBJECTIVE: To investigate associations between stress, resilience, and burnout in three emotional job sectors. METHODS: We conducted a multi-group comparative study using structural equation modeling and latent mean analysis. In total, 806 participants (403 call center consultants, 270 mental health workers, and 133 school counselors) completed self-administered questionnaires including the Perceived Stress Scale, Korean version of the Connor-Davidson Resilience Scale, and Maslach Burnout Inventory-General Survey. RESULTS: Stress had significant direct effects on resilience and burnout, and resilience had significant direct effects on burnout in all groups. Resilience partially mediated these relationships among call center consultants and school counselors. Stress and burnout were highest in call center consultants, followed, in order, by mental health workers and school counselors. Resilience was highest in school counselors, followed, in order, by mental health workers and call center consultants. The effect size of the latent mean difference was highest for burnout, followed, in order, by resilience and stress. CONCLUSION: Our findings suggest that stress caused by emotional labor can contribute to burnout. Interventions targeted at different sectors are needed to reduce burnout.
Consultants ; Counseling ; Humans ; Mental Health

Since 2015, the Health Insurance Review and Assessment Service (HIRA) has performed annual qualitative assessments of asthma management provided by all medical institutions that care for asthma patients in Korea. According to the third report of qualitative assessment of asthma management in 2017, the assessment appears to have contributed to improving the quality of asthma care provided by medical institutions, especially primary clinics. However, there is still a gap between the ideal goals of asthma management and actual health care policies/regulations in real clinical settings, which leads to the state of standstill with respect to the quality of asthma management despite considerable efforts such as the qualitative assessment of asthma management by national agencies such as the HIRA. At this point, a harmonized approach is needed to raise the level of asthma management among several components including medical policies, efforts of academic associations such as education and distribution of the guideline for management, and reliable financial support by the government.
Asthma* ; Delivery of Health Care ; Education ; Financial Support ; Humans ; Insurance, Health* ; Korea* ; Physicians, Primary Care

Since the first survey done in 1983, this is the second national sample survey of medical students about their perception and evaluation on medical study, career plan, and medical care system. One out of every 10 students plus one in each class were systematically sampled from each grade year of 32 medical schools in Korea that had students from freshman to senior in November 1997. A questionnaire was developed by adding items related with recent changes in medical care environment and with viewpoint on medicine and physician as an occupation to the questionnaire used in 1983. The questionnaire was administered at each school under the supervision of designated collaborator of the same school in December 1997 through January 1998. A total of 1,386 students were sampled from a total of 11,987 medical students and 1,233 students(89.0%) filled out the questionnaire. Twelve students were excluded from the analysis because of incomplete response and the final analysis was done for 1,221 students. A few demographic characteristics of the sample were compared with those of the study population to check the representativeness of the sample and found no skew. The contents of the study were divided into three parts and the first part describes the study methods, demographic and other characteristics of the sample, students' viewpoint on medical education, and students' aptitude for medicine Male students accounted for 75.7% of the sample. The proportion of students who entered medical school right after graduating from a high school was 45.8% in Seoul and 53.4% in other than Seoul area. The students who classified their own political inclination conservative were 43.9% in Seoul and 33.0% in other than Seoul and the percentage of students with progressive inclination was higher in out of Seoul than Seoul area. The proportion of students who have a religion was 57.2%; Christian 31.0%, Catholic 15.2%, and Buddhist 9.5%. The educational level of fathers of students was far higher than the level of general population, e.g. 59.8% had college or higher education. Occupation of fathers was mainly white-collar worker; professional worker 21.2%, company employee 17.2%, government official 13.1%, manager 11.8%, and medical professional 8.7%. In the decision-making process to enter the medical school, 53.7% of the students were influenced by someone else and 62.1% of them were parents. Socio-economic factor was the most common reason for recommending medical school and it accounted 33.5% of the reasons. Medical students enjoy learning life phenomenon(47.2%) and human being(44.3%) in medical study but most disturbing factors are memory work(39.7%) and too much to study(34.1%). If students were given another chance to choose a college as a senior student in high school, 50.3% of them said that they would choose medical school. Only 6% of students have intention to change their major subject of study if they are allowed to change now. The proportion of students who consider their scholastic aptitude is compatible with medical study was 64.9% and such proportion increased with grade. The percentage of students who are going to recommend medical school to their own son in the future was 36.6% for male and 26.7% for female students and to their own daughter 33.6% and 27.7%, respectively.
Aptitude ; Surveys and Questionnaires* ; Education ; Education, Medical ; Fathers ; Female ; Humans ; Intention ; Korea ; Learning ; Male ; Memory ; Nuclear Family ; Occupational Groups ; Occupations ; Organization and Administration ; Parents ; Schools, Medical ; Seoul ; Students, Medical*