Group occupational health service programme started in 1990 is one of the measures to cope with limited human and financial resources in occupational health. The programme has expanded rapidly to include 52 institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. This study has aims to develop the criteria to assess the quality of newly developed group occupational health service programme, and to investigate the quality of institutions, and finally to develop policies for the quality improvement. 1) Criteria development : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, followings are included as core elements of qualitative occupational health programme ; accessibility, continuity, comprehensiveness, technical quality, intersectoral collaboration, emphasis on preventive services, community participation, and adequacy. Again each element is divided into five major components of national health system infrastructure developed by the World Health Organization ; development of health resources, organized arrangement of resources, delivery of health care, economic support, and management. In turn, each component is categorized into three aspects of quality assessment, structure, process and outcome. Expert panel selected several criteria for each category to evaluate the programme. Criteria were modified according to each group of interviewees, to produce two sets of questionnaire, one for chief operating officer and another for nurses in the institutions, and the chief operating officer and workers in the workplace. 2) Subject : Of all 52 institutions, 25 voluntarily participated in the survey. At individual institution, chief operating officer and practicing nurses were interviewed in depth. After intensive education for interviewees, every interview was performed with standardized guideline and questionnaire. The quality of the 'Group occupational health service programme' was found to be lower than expected. Especially In continuity, comprehensiveness, technical quality, community participation and adequacy, lower quality in structural aspect was commonly identified throughout all the institutions. Quality in terms of accessibility and continuity highly varied among institutions. To improve quality of the programme, more comprehensive and systematic programme such as accreditation has to be introduced. In addition, human resources, governmental fund and information systems for individual workers are to be developed. As a long range plan, integration of occupational health services into the national health systems and pooling of financial resources and planned allocation should be considered.
Accreditation ; Consumer Participation ; Cooperative Behavior ; Delivery of Health Care ; Education ; Financial Management ; Health Resources ; Humans ; Information Systems ; Korea* ; Occupational Health Services* ; Occupational Health* ; Primary Health Care ; Quality Improvement ; Questionnaires ; Social Welfare ; World Health Organization

Although occupational low back pain accounts for 20~40% of all occupational illness and injury, there are limited numbers of studies regarding the effectiveness of back school program. The objective of this study was to evaluate the economic benefit of back school program for early return to work of occupational low back pain patients in the current occupational injury compensation and management system. The cost-benefit analysis in this study was conducted to evaluate the relative magnitude of benefit to cost. The total cost was estimated by calculating the value of components in back school program according to governmental budget protocol. The back school program was consisted of three major approaches, pain center, work-hardening program and functional restoration program and each of components had various facilities and experts. The total amount of cost was estimated as 250,866,220 won per year. The most promising type of back school program were quite intensive (a 3 to 5-week stay in a specialized center), therefore, if we adopted the 5-week stay course, 10 courses could be held in a year. Following to the medical act, 20 patients per doctor could participate in a each course, ie, total 200 patients in a year. As a result, we could estimate the cost of 1,254,331 won a patient. we estimated the benefit by using data of a few local labor offices about average medical treatment beneficiary and off-duty beneficiary of 46 occupational low back pain patients in 1994. Ullman and Larsson(1977) mentioned that the group of chronic low back pain patients who participated in back school program needed less time to recover by 48.4% of beneficiary duration. And in the trying to estimate the benefit, we asked 10 rehabilitation board certificate doctors about reduction proportion of treatment cost by introducing back school program. The answered reduction proportions were in the range of 30~45%, average 39%. As a final result, we could see that the introduction of back school program in treatment of chronic occupational low back pain patients could produce the benefit to cost ratio as 3.90 and 6.28. And we could conclude that the introduction of back school program was beneficial to current occupational injury compensation and management system.
Budgets ; Compensation and Redress ; Cost-Benefit Analysis* ; Health Care Costs ; Humans ; Low Back Pain* ; Occupational Injuries ; Pain Clinics ; Rehabilitation ; Return to Work

No abstract available.
Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans

OBJECTIVES: To determine the educational needs related to an integrated health and oral health project for community dental hygienists. METHODS: In this cross-sectional study, a survey was administered to 1,190 dental hygienists working in community health centers and 627 (about 53%) responded. The dependent variable was educational needs from oral health projects; the independent variables were region, job assignments, job position, and degree of self-development. Data were analyzed using descriptive statistics and chi-square tests, with PASW 20.0 (SPSS Inc., Chicago, IL, USA), and the significance threshold was .05. RESULTS: The educational needs of community dental hygienists were found to be high, at about 58.5 points out of 100. The highest educational needs were for oral health projects linked to public health projects. In this regard, participants reported a high need for "identification of issues and projects suited to the current state of the region," "establishment of strategies for integration of health and oral health projects," and "prioritization." CONCLUSIONS: Professional education for community dental hygienists should be expanded to include integration of health and oral health. It should be based on the assessment of these professionals' educational needs.
Community Health Centers ; Cross-Sectional Studies ; Dental Hygienists* ; Education, Professional ; Humans ; Oral Health* ; Public Health

BACKGROUND AND OBJECTIVES: Platelet activation and aggregation, with resultant arterial thrombus formation, play pivotal roles in the pathophysiology of acute coronary syndrome (ACS). The efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein IIb/IIIa receptor, combined with heparin, or low molecular heparin (LMWH), in the management of ACS were evaluated. SUBJECTS AND MEHTODS: One hundred seventeen patients (60.8+/-10.9 years, 76 male), with unstable angina or non-ST elevation myocardial infarction, who had ST-T changes and elevated troponin, were divided into 4 groups : Group I (n=30 : heparin alone), Group II (n=28 : LMWH, dalteparin alone), Group III (n=29 : tirofiban combined with heparin) and Group IV (n=30 : tirofiban with LMWH). The major adverse cardiac events (MACE) among the 4 groups, during 6-month clinical follow-ups, were compared. RESULTS: Percutaneous coronary intervention, or a coronary artery bypass graft, was performed in 23, 19, 19 and 22 patients from Groups I, II, III and IV, respectively (p=0.87). A minor bleeding complication developed in 2 (6.7%), 1 (3.6%), 1 (3.4%) and 2 patients (6.7%) in groups I, II, III and IV, respectively (p=0.79). During the six-month follow-up MACE occurred in 7 (30.4%), 6 (31.6%), 3 (15.8%) and 4 patients (18.2%) in groups I, II, III and IV, respectively (p=0.02 : Group I and II vs. Group III and IV). CONCLUSION: Tirofiban combined with LMWH is safe and may improve the long-term prognosis of patients with ACS.
Acute Coronary Syndrome* ; Angina, Unstable ; Angioplasty ; Blood Platelets* ; Coronary Artery Bypass ; Dalteparin ; Follow-Up Studies ; Glycoproteins* ; Hemorrhage ; Heparin ; Heparin, Low-Molecular-Weight* ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Platelet Activation ; Prognosis ; Thrombosis ; Transplants ; Troponin

BACKGROUND AND OBJECTIVES: Alpha lipoic acid (ALA) is beneficial for improving endothelial dysfunction and preventing atherosclerosis-related diseases. We evaluated the affect of ALA on stent restenosis in a porcine model. MATERIALS AND METHODS: The First experiment: Balloon overdilation injuries were performed in two coronary arteries in 12 pigs. Four weeks after the balloon overdilation injury, 24 bare metal stents were placed for 24 injured coronary arteries. We randomized into two groups (12 stents per group; control group: aspirin and clopidogrel only, ALA group: aspirin and clopidogrel plus 100 mg/kg ALA during 4 weeks). The Second experiment: Stents were randomly implanted in 2 coronary arteries in 8 pigs. Group I was the control stent group (n=8), and group II was the ALA coated stent group (n=8). Follow-up coronary angiogram and histopathologic assessment were performed at 4 weeks after stenting in both experiments. RESULTS: The First experiment On histopathologic analysis, the injury score and internal elastic lamina area did not differ significantly between the two groups. The neointimal area was 7.3+/-0.9 mm2 in the control group and 2.2+/-1.1 mm2 in the ALA group (p<0.001), and the histopathologic area of stenosis was 75.9+/-8.5% in the control group and 23.5+/-10.5% in the ALA group (p<0.001). The Second experiment: The injury score and internal elastic lamina area were not significantly different between the two groups. The neointimal area was 7.4+/-1.1 mm2 in the control group and 1.4+/-0.8 mm2 in the ALA group (p<0.001), and the histopathologic area of stenosis was 77.6+/-10.9% in the control group and 15.6+/-7.6% in the ALA group (p<0.001). CONCLUSION: Both a high dose of oral ALA and ALA coated stents inhibited neointimal hyperplasia in this porcine coronary artery stent restenosis model.
Administration, Oral* ; Aspirin ; Constriction, Pathologic ; Coronary Disease ; Coronary Vessels ; Follow-Up Studies ; Hyperplasia ; Stents* ; Swine ; Thioctic Acid*

BACKGROUND: Reticulated platelets (RP) are young platelets with a high mRNA that are newly produced from the bone marrow. Thiazole orange (TO) has been a RNA staining fluorescent dye for reticulocyte, and used for RP recently. The increased percentage of RP (RP%) reflects immaturity and hematopoietic activity of platelets, therefore it may be useful for the diagnosis of idiopathic thrombocytopenic purpura (ITP). METHODS: To assess the usefulness of RP in diagnosing ITP, we compared with RP%s of 50 ITP patients, 35 thrombocytopenic patients due to impaired production and 87 heathly normal controls. Platelets were stained with TO dye, followed by flowcytometric analysis. Platelet associated IgG (PAIgG) was also measured with the same samples. The standard gate was used as a reference with the unstained sample from a normal subject and the RP% was expressed as the percentage of TO positive cells of platelets. RESULTS: The RP% of patients with ITP was significantly higher than those of thrombocytopenia due to impaired platelet production and healthy controls (24.4+/-14.3% vs 8.6+/-5.2% and 8.0+/-5.1%, respectively). There was negative correlation between the platelet count and RP%, and positive correlation between MPV and RP%. In diagnosing for ITP, the sensistivity and specificity of RP% were 81% and 92%, respectively, and more valuable than those of PAIgG test. Using RP% and PAIgG at the same time, the diagnostic efficiency for ITP was not improved. The RP% of an ITP patient was changed to correspond with the disease progression, and that of an AML patient following chemotherapy was increased to precede the rising of the platelet count. CONCLUSION: It suggest that the measurement of reticulated platelets is a very useful test for diagnosis of ITP, furthermore it can be used to estimate the thrombopoietic activity before bone marrow examination.
Blood Platelets ; Bone Marrow ; Bone Marrow Examination ; Citrus sinensis* ; Diagnosis ; Disease Progression ; Drug Therapy ; Flow Cytometry ; Humans ; Immunoglobulin G ; Platelet Count ; Purpura, Thrombocytopenic, Idiopathic* ; Reticulocytes ; RNA ; RNA, Messenger ; Sensitivity and Specificity ; Thrombocytopenia

PURPOSE: The porosity of the bone cement is the most important cause of fatigue failure, the most common mode of failure of bone cement using widely in arthroplasty. It is important to evaluate the porosity of bone cement for improvement or development of bone cement, but the conventional 'stain, 'cut, and 'polish, manual method takes long time and efforts. So it is necessary to develop a new technique for evaluation of porosity of bone cement. We tried a technique using computer image analysis system to evaluate the porosity of bone cement specimen and assess efficacy of the method. Simultaneously we evaluated the relationship between the porosity of bone cement and fatigue failure. MATERIAL AND METHODS: We made 59, 2.5inch-length bone cement specimens(30 Simplex P, 29 Palacos R) using Simplex P and Palaces R which are widely using in clinical situation and checked radiogram using mammography film. After scanning the mammography film, we measured the porosity of the bone cement specimens using NIH(National Institute for Health) Image 1.6 version image analysis program. We also, measured the porosity of the bone cement specimens with conventional 'stain','cut' and 'polish' method, after then compared the results of two methods. Simultaneously, we evaluated the relationship between porosity & fatigue failure by loading 9.0, 10.0, 12.5 and 15.0 MPa load with frequency of 10Hz to the bone cement specimens under the physiologic condition. RESULTS: The coefficient of relation of simplex P and palaces R was 0.729 and 0.713 respectively, so there was high relationship between the image analysis system method and conventional one. It was easy and took shorter time to measure the porosity of bone cement specimens with image analysis system. There was high correlation between cement porosity and fatigue failure, regardless of level of load. CONCLUSION: It was very easy and fast to measure the porosity of the bone cement specimens with image analysis system and there was high correlation between cement porosity and fatigue failure.
Arthroplasty ; Fatigue ; Mammography ; Methylmethacrylate ; Porosity*

Educational evironment and condition strongly influence the quality of graduate medical education. However, in Korea educational environment of in-hospital graduate medical education and training has not been explored in details. To evaluate current situation, we investigated 1,859 graduate trainees(residents) by self-administered questionnaire from May to July in 1996. Major findings of the survey were as follows; 1. Major providers of education were senior trainees(46.7%), compared with other sources of training such as self-study(22.9%) and staff trainers(14.5%). 2. At hospitals with less than or equal to 500 beds, formal educational programs for training were more poorly developed than hospitals with more than 500 beds. Among them, weakness in programs of case conference, staff lecture and training in affiliated hospitals was more remarkable. 3. At small hospitals with less than or equal to 500 beds, satisfaction level of trainees on their training were lower than that of trained at hospitals with more than 500beds. Research, conference, discussion with senior residents, and outpatient care were more dissatisfactory in particular. 4. Significant barriers to ideal training were work overload(57.2%) and shortage of educational programs(19.0%). Most of trainees are not satisfied with environment and condition of their training programs. To improve the quality of graduate medical education which is closely related with health care quality in the near future, general environment of education such as work load and educational programs has to be reoriented.
Ambulatory Care ; Education ; Education, Medical, Graduate* ; Korea ; Quality of Health Care ; Surveys and Questionnaires

BACKGROUND: Recent studies and case reports have shown that recombinant factor VIIa (rFVIIa) treatment is effective for reversing coagulopathy and reducing blood transfusion requirements in trauma patients with life-threatening hemorrhage. The purpose of this study is to evaluate the effect of rFVIIa treatment on clinical outcomes and cost effectiveness in trauma patients. METHODS: Between January 2007 and December 2010, we reviewed the medical records of patients who were treated with rFVIIa (N=18) or without rFVIIa (N=36) for life-threatening hemorrhage due to multiple traumas at the Emergency Department of Pusan National University Hospital in Busan, Korea. We reviewed patient demographics, baseline characteristics, initial vital signs, laboratory test results, and number of units transfused, and then analyzed clinical outcomes and 24-hr and 30-day mortality rates. Thromboembolic events were monitored in all patients. Transfusion costs and hospital stay costs were also calculated. RESULTS: In the rFVIIa-treated group, laboratory test results and clinical outcomes improved, and the 24-hr mortality rate decreased compared to that in the untreated group; however, 30-day mortality rate did not differ between the groups. Thromboembolic events did not occur in both groups. Transfusion and hospital stay costs in the rFVIIa-treated group were cost effective; however, total treatment costs, including the cost of rFVIIa, were not cost effective. CONCLUSIONS: In our study, rFVIIa treatment was shown to be helpful as a supplementary drug to improve clinical outcomes and reduce the 24-hr mortality rate, transfusion and hospital stay costs, and transfusion requirements in trauma patients with life-threatening hemorrhage.
Adult ; Aged ; Aged, 80 and over ; Factor VIIa/*therapeutic use ; Hemoglobins/analysis ; Hemorrhage/complications/*drug therapy/mortality ; Humans ; Middle Aged ; Multiple Trauma/*complications ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time ; Recombinant Proteins/therapeutic use ; Retrospective Studies ; Treatment Outcome