BACKGROUND: The purpose of this study is comparison of the results between regression and multi-level analysis to find out factors influencing outcome indicators (in-hospital death, length of stay, and medical charges) of stroke patients. METHODS: By using patient sample data of Health Insurance Review & Assessment Service, patients admitted with stroke were selected as survey target and 15,864 patients and 762 hospitals were surveyed. RESULTS: For the results of existing regression analysis and multi-level analysis, models were assessed through model suitability index value and as a result, the value of results of multi-level analysis decreased compared to the results of regression, showing it is a better model. CONCLUSION: Factors influencing in-hospital death of stroke patients were analyzed and as a result, intra-class correlation (ICC) was 13.6%. In factors influencing length of stay, ICC was 11.4%, and medical charges, ICC was 17.7%. It was found that factors influencing the outcome indicators of stroke patients may vary in every hospital. This study could carry out more accurate analysis than existing research findings through analysis of reflecting structure at patient level and hospital level factors and analysis on random effect.
Humans ; Insurance, Health ; Length of Stay ; Multilevel Analysis ; Regression Analysis ; Stroke*

PURPOSE: The purpose of this study was to examine factors influencing new graduate nurse turnover. METHODS: This study was carried out as a secondary analysis of data from the 2010 Graduates Occupational Mobility Survey (GOMS). A total of 323 nurses were selected for analysis concerning reasons for turnover. Data were analyzed using descriptive statistics and multilevel survival analysis. RESULTS: About 24.5% of new nurses left their first job within 1 year of starting their jobs. Significant predictors of turnover among new nurse were job status, monthly income, job satisfaction, the number of hospitals in region, and the number of nurses per 100 beds. CONCLUSION: New graduate nurses are vulnerable to turnover. In order to achieve the best health of the nation, policy approaches and further studies regarding reducing new graduate nurse turnover are needed.
Job Satisfaction ; Multilevel Analysis ; Personnel Turnover ; Survival Analysis*

OBJECTIVE: To investigate the relationships of occupational class, educational level and deprivation with mortality in Korea. METHODS: This study used existing South Korean national data on occupation, educational level, and deprivation and death. Mortality was investigated using registered death data from 1993 to 1997 obtained from the Korean National Statistics Office (NSO) with denominators drawn from the 1995 Census. Statistical analysis consisted of poisson regression modeling and multilevel analysis. RESULTS: The lower occupational class (manual workers) group had a higher mortality rate than the higher occupational class (non-manual workers) group. Educational level, and deprivation were both inversely related withand mortality. Occupation was strongly associated with education. Area-based deprivation indicators and individual indices for social class made an independent contribution to the mortality risk. CONCLUSIONS: The findings of this study suggests that the relationships of occupational class, educational level and deprivation with mortality appears to be stronger in Korea than in European countries.
Censuses ; Education ; Korea* ; Mortality* ; Multilevel Analysis ; Occupations ; Social Class

PURPOSE: This study aims to investigate the individual and environmental factors related to emotional/behavioral problems to early adolescence in Korea by applying multilevel modeling. METHODS: From the database of the 2014 Korean Child and Youth Panel Survey (KCYPS), the researchers selected 1,977 adolescents who are in the second year of middle school. Multilevel model analysis was performed to estimate the impact of relevant factors at the individual and environmental levels. RESULTS: At the individual level, the significant factors associated with emotional/behavioral problems included BMI and study tendency in boys, and drinking, study tendency and economic levels in girls. At the environmental level, the significant factor associated with emotional/behavioral problems included relationship with the teacher. CONCLUSION: The emotional/behavioral problems of early adolescence are influenced not only by the individual factors but also by the environment factor. Therefore, the environment surrounding the adolescents should also be considered to prevent emotional/behavioral problems.
Adolescent* ; Child ; Drinking ; Female ; Humans ; Korea ; Multilevel Analysis ; Problem Behavior*

OBJECTIVES: With an increasing number of studies highlighting regional social capital (SC) as a determinant of health, many studies are using multi-level analysis with merged and averaged scores of community residents' survey responses calculated from community SC data. Sufficient examination is required to validate if the merged and averaged data can represent the community. Therefore, this study analyzes the validity of the selected indicators and their applicability in multi-level analysis. METHODS: Within and between analysis (WABA) was performed after creating community variables using merged and averaged data of community residents' responses from the 2013 Community Health Survey in Korea, using subjective self-rated health assessment as a dependent variable. Further analysis was performed following the model suggested by WABA result. RESULTS: Both E-test results (1) and WABA results (2) revealed that single-level analysis needs to be performed using qualitative SC variable with cluster mean centering. Through single-level multivariate regression analysis, qualitative SC with cluster mean centering showed positive effect on self-rated health (0.054, p<0.001), although there was no substantial difference in comparison to analysis using SC variables without cluster mean centering or multi-level analysis. CONCLUSIONS: As modification in qualitative SC was larger within the community than between communities, we validate that relational analysis of individual self-rated health can be performed within the group, using cluster mean centering. Other tests besides the WABA can be performed in the future to confirm the validity of using community variables and their applicability in multi-level analysis.
Health Surveys ; Korea ; Multilevel Analysis ; Self-Assessment ; Social Capital*

OBJECTIVES: This study was conducted to identify discrepancies in oral health behaviors among communities in cities, counties, and districts (si , gun, and gu administrative divisions of South Korea) and to determine their correlations with socioeconomic status, examined in terms of the social deprivation index. METHODS: Data for 220,258 individuals, covering 247 communities, were extracted from a 2008 community health survey, and the frequency of brushing the teeth after lunch, flossing and interdental brushing was calculated and analyzed. Considering the characteristics of the data collected at individual and regional levels, a multilevel random-intercept logistic regression model was used for the analysis. RESULTS: A regional-level discrepancy was found in after-lunch brushing and the use of auxiliary oral hygiene items, with interclass correlations of 0.03 and 0.04, respectively. In particular, the odds ratio of using auxiliary oral hygiene items in the communities with the lowest socioeconomic status was as low as 0.49, compared to the highest level, thus demonstrating a conspicuous intercommunity difference. CONCLUSIONS: The regional-level correlation between socioeconomic status and oral health behaviors indicates the need for the establishment of oral health-related intervention policies based on community characteristics.
Health Surveys ; Logistic Models ; Lunch ; Multilevel Analysis ; Odds Ratio ; Oral Health* ; Oral Hygiene ; Social Class ; Tooth

OBJECTIVES: To examine the complaint proportion and characteristics of musculoskeletal symptoms and to find risk factors of musculoskeletal symptoms among caterers for school lunch services. METHODS: The study subjects were 385 caterers who were working for school lunch services in 71 elementary schools and 114 housewives who had visited a hospital for routine health check-up. A self-recording questionnaire was used to investigate the general characteristics, labor conditions, job stress and nature of musculoskeletal symptom. Caterers were surveyed from September to October in 2003 and the housewives during September by post. The ergonomic risk factors were examined for the caterers of an elementary school in Kyonggi Province in November, 2003. RESULTS: The complaint proportion of self-reported positive musculoskeletal symptoms was 52.0% and that of severe musculoskeletal symptoms was 24.9%. Ergonomic assessment revealed that washing the dishes, carrying the soup containers and cleaning the sewage drain were highly risky activities in terms of repetitive and heavy weight-bearing motions. As for personal factors, the caterers having severe musculoskeletal symptoms had high psychological job demand. As for the workplace factors, the proportion of schools having severe musculoskeletal symptoms was significant higher where each caterer prepared more than 150 lunches. Among schools without school lunchroom, more schools had caterers having severe musculoskeletal symptoms. Using multilevel analysis, we found that the number of lunches to be prepared per caterer was a significant risk factor of severe musculoskeletal symptoms (O.R. 4.67). CONCLUSIONS: This study showed that the number of lunches prepared per caterer has a significant influence on the development of musculoskeletal disorder and that caterers work in an ergonomically highly risky job environment. The study results suggest that the number of caterers be increased to decrease the number of lunches prepared per caterer and the ergonomic environment be improved.
Gyeonggi-do ; Humans ; Lunch* ; Multilevel Analysis* ; Musculoskeletal Diseases ; Questionnaires ; Risk Factors* ; Sewage ; Weight-Bearing

PURPOSE: The purpose of this study is to examine the factors associated with neurological outcome and to provide ideas for improving the operation of the emergency medical system in Korea. METHODS: A total of 95,911 out-of-hospital cardiac arrests (OHCAs) with cardiac etiology who were transported by 119 EMS ambulances for seven years from 2006 to 2012 in Korea were analyzed. According to these data there is a multilevel structure, so that patient's neurological outcome in the same region is not independent but interrelated, therefore two-level (patient-region) logistic regression analysis was applied to adjust this correlation. RESULTS: The adjusted odds ratio (OR) in the group in which Cardiopulmonary Resuscitation (CPR) was performed by a bystander was 1.27 for good neurological outcome. The adjusted OR in the group with implementation of an automated external defibrillator (AED) before arrival at the hospital was 4.11 for good neurological outcome. The adjusted OR in the numbers of emergency physicians compared with <3 was 2.76 (3-4), 4.24 (≥5) and the adjusted OR in OHCAs volume of each hospital compared with <50 was 2.31 (50-64), 2.51 (65-102), and 2.94 (≥103). The adjusted OR in deprivation level compared with <2 was 0.72 (≥2). CONCLUSION: The neurological outcome was significantly better in the group in which CPR was performed by a bystander and AED was applied early. The neurological outcome tended to be significantly better in hospitals with higher numbers of emergency physicians and higher volume of OHCAs, in less deprived districts.
Ambulances ; Cardiopulmonary Resuscitation ; Defibrillators ; Emergencies ; Korea ; Logistic Models ; Multilevel Analysis ; Odds Ratio ; Out-of-Hospital Cardiac Arrest*

PURPOSE: We investigated the role of individual and community level factors on diabetes screening test behavior. METHODS: We used individual-level data from 170,193 adults aged 30 years or older who were not diagnosed with diabetes and participated in the 2009 community health survey. Community-level data includes 253 communities and were collected from various national statistics. Multilevel logistic regression analysis was conducted. RESULTS: The rate of diabetes screening within the year prior to this study was 53.2%. Community variance of Model I, Model II and Model III was 0.236, 0.252 and 0.238, respectively. The proportional change in variance of Model II and Model III was -6.8% and -1.2%. The odds ratio for participation of diabetic screening of areas with bottom financial independence compared to areas with top was 0.84 (95% confidence interval, 0.74-0.96); the odds ratio of areas with top internist compared to areas with bottom was 1.15 (95% confidence interval, 1.01-1.31). CONCLUSION: This study identified a contextual effect influencing the participation of Korean adults in diabetes screening. It is necessary to develop specific policies that consider not only individual factors, but also community factors relating to individual behaviors to increase the likelihood of diabetes screening.
Adult ; Aged ; Diabetes Mellitus ; Health Surveys ; Humans ; Logistic Models ; Mass Screening ; Multilevel Analysis ; Odds Ratio

OBJECTIVETo analyze the correlation between population characteristics and work ability of employees with a multilevel model, to investigate the important influencing factors for work ability, and to provide a basis for improvement in work ability.

METHODSWork ability index (WAI)was applied to measure the work ability of 1686 subjects from different companies (n=6). MLwi N2.0 software was applied for two-level variance component model fitting.

RESULTSThe WAI of employees showed differences between various companies (χ2=3.378 6, P=0.0660); working years was negatively correlated with WAI (χ2=38.229 2, P=0.0001), and the WAI of the employees with 20 or more working years was 1.63 lower than that of the employees with less than 20 working years; the work ability of manual workers was lower than that of mental-manual workers (χ2=8.2726, P=0.0040), and the work ability showed no significant difference between mental workers and mental-manual workers (χ2=2.086 0, P=0.148 7).

CONCLUSIONFrom the perspective of probability, the multilevel model analysis reveals the differences in work ability of employees between different companies, and suggests that company, work type, and working years are the important influencing factors for work ability of employees. These factors should be improved and adjusted to protect or enhance the work ability of employees.