The purpose of this study is to estimate the minimum optimal scale(MOS) of the self-employed health insurance associations. Considering the high proportion of operating expenses, the author have selected 254 regional health insurance associations from the 1990 Finance Report of the self-employed health insurance programs. both a quadratic function and a hyperbolic function were chosen for the analysis. The dependent variables are the average maintenance cost per insured person and per household, and the independent variables are the number of insured members and of household. The minimum optimal scale was obtained from the differentiation of the quadratic function. Major findings are summarized as follows: 1. The M.O.S. was calculated as 166,174 members (27,442 households) for the rural self-employed health insurance associations and 258,462 members (75,446 households) for the urban. Providing that both the rural and urban health insurance associations would e integrated, the M.O.S. be found to become 231,687 members (68,101 households) 2. Compared with the optimal minimum scale, the magnitude of the current health insurance association found to be much smaller, less than half of the optimal scale. 3. In order to reduce the operating cost, it is necessary to enlarge the operational scale of self-employed health insurance associations.
Family Characteristics ; Humans ; Insurance ; Insurance, Health* ; Korea* ; Urban Health

The purpose of this study is to estimate cesarean section rate in Korea and analyze the socioeconomic variables and health resources which affect regional variation in the rate. Samples were drawn from the record of vaginal and cesarean section deliveries based upon insurance claim bills which have been submitted to the National Federation of Medical Insurance for the first three months, January through March, 1991. The results are obtained as follows: It was found that, cesarean section rate was increasing rapidly up to 23.1% in 1991. Cesarean section per 10 thousand insured people was 4.8 and the number of cesarean section per 10 thousand insured eligible(15-49 years old) female was 7.6. The fee for normal delivery was 109,489 won and that for cesarean section was 390,024 won. The average days of hospitalization in normal delivery was 2.3 days, and those in cesarean section was 7.6 days. On the average cesarean section has a longer of stay as much as by 4.3 days and cost 3.6 times more than normal deliveries. Cesarean section rates vary among medical facilities: 19.8% at clinics 37.6% in small-scale hospitals, and 29.1% in general hospitals. The regional variation of cesarean section rates was also fairly prominent. The South Cheju Gun has the highest rate of cesarean section, 56.2%. Meanwhile no cesarean section cases has been reported in Sunchang Gun during the period of this study. The variation is noted among provinces. The rate for Cheju province has been 3.4 times higher than that for Chunnam. The number of cesarean section per 10 thousand insured people vary greatly among regions, too. This study has found that there exists significant regional variations among various geographic units in terms of average length of stay, average cost, number of obsretricians and number of beds. Multiple regression analysis was done to identify factors explaining the regional variance of various cesarean section rates: In the urban areas, no significant explaining variables were noted except the number of beds for the dependent variable of cesarean section cases per 10 thousand insured eligible females. The smaller the number of bed, the more cases of cesarean section was noted for an urban area. The is mostly because the rate of cesarean section is higher in medium-size hospitals than in large general hospitals. In the rural areas, the factor of education has been found significant for all three dependent variables. The higher the educational level, the rate of cesarean section is most likely to rise. An income variable measured by the amount of monthly insurance contribution has been identified a powerful predictor in explaining the variance of cesarean section rates. The same has been noted for the number of obstetricians. Similar findings are observed for the country as a whole. The income level has been found as the most powerful explaining factor in the regional variance of cesarean section rates. In general the rate is higher in the urban areas, and lower in the area with more small hospitals. As this is the initial attempt to identify the factors relevant to the regional difference in the rates of cesarean section, more elaborated study is urgently required.
Cesarean Section* ; Education ; Fees and Charges ; Female ; Health Resources ; Hospitalization ; Hospitals, General ; Humans ; Insurance ; Jeju-do ; Korea* ; Length of Stay ; Pregnancy

Isolated situs in versus of the stomach with otherwise normal position of the thoracic and abdominal vescera isan extremely rare anomaly occurring in two distinct forms. Majority of cases are associated with eventration of the diaphragm and are reported as being confused with spontaneous pneumothorax of pyopneumothorax at base of the right lung. The right sided stomach may produce interesting and confusing changes in liver scan. We have experienced 2 cases of the isolated dextrogastria.
Diaphragm ; Liver ; Lung ; Pneumothorax ; Stomach

A marked accumulation of eosinophils occurs in several disorders, such as allergic diseases, parasitic infections, and cancers. Recently we experienced a case of clonorchiasis with a presentation of peripheral eosinophilia and eosinophilic infiltration in the liver. A 46-year-old man was admitted to the hospital because of epigastric pain. The white boold cell count was 33,900/mm3 with 70% eosinophils. Two stool examinations were negative for parasite eggs. Skin test gave a positive test for Clonorchis sinensis. CT showed inhomogeneous enhancement with multiple subcapsular low attenuation in the liver. The pathological features of the liver, which were characterized by marked infiltration of eosinophils in the periportal and intralobular areas and no evidence of parasitic ova, granuloma, or tumor, suggested that the lesions were caused by the hypereosinophilic syndrome. He was treated with corticosteroids. During management, however, antibody against C. sinensis in serum using micro-ELISA was positive and a stool specimen gave a positive test for C. sinensis ova. We diagnosed clornorchiasis and administered praziquantel to him. Peripheral eosinophilia has improved.
Adrenal Cortex Hormones ; Angioplasty ; Arteries ; Cell Count ; Clonorchiasis* ; Clonorchis sinensis ; Eggs ; Eosinophilia* ; Eosinophils* ; Granuloma ; Humans ; Hypereosinophilic Syndrome ; Liver* ; Middle Aged ; Ovum ; Parasites ; Parasitic Diseases ; Praziquantel ; Skin Tests ; Stents

PURPOSE: We conducted comparative analysis of dietary behavior and food and nutrient intakes of Korean elderly in urban and rural areas using the 2014 Korea National Health and Nutrition Examination Survey (KNHANES). METHODS: This study was conducted on 1,239 participants (urban elderly: 867, rural elderly: 372) aged 65 years and over who participated in the health examination and nutrition survey in the 6th 2014 KNHANES. Dietary behaviors, including skipping meals, eating out frequencies, and food and nutrient intakes were analyzed using 24-hour recall data. Analysis of complex sample design data through SPSS 19.0 was used for the analysis. RESULTS: The rate of skipping dinner was higher in urban (6.5%) than in rural elderly (3.6%) (p < 0.05), and the frequency of eating out per week of urban elderly (1.73) was higher than that of rural elderly (1.35) (p < 0.001). The rural elderly consumed a greater amount of grain compared to urban elderly, whereas consumption of water, seaweed food, and dairy products was lower in rural than in urban areas (p < 0.05). The rural elderly consumed significantly less highly unsaturated fatty acids, n-6 fatty acids, phosphorus, iron, vitamin A, carotene, niacin, and vitamin C in comparison with elderly in urban areas. Comparison of the percentages of Dietary Reference Intakes for Koreans (KDRIs) between the two groups showed that intakes of vitamin A and vitamin C were significantly lower in the rural elderly than in urban elderly. CONCLUSION: The elderly in rural areas showed unbalanced food and nutrient intakes compared to the elderly in urban areas. Therefore, customized nutrition education according to residential areas should be developed and provided to rural elderly to improve their health and nutritional status.
Aged* ; Ascorbic Acid ; Carotenoids ; Dairy Products ; Eating ; Education ; Fatty Acids, Omega-6 ; Fatty Acids, Unsaturated ; Humans ; Iron ; Korea* ; Lunch* ; Meals ; Niacin ; Nutrition Surveys* ; Nutritional Status ; Phosphorus ; Recommended Dietary Allowances ; Seaweed ; Vitamin A ; Water

BACKGROUND: There are some previous reports about partial D in Korea. However, the frequency of the partial D in Korea is still unknown. In this study, subtypes of partial D were analyzed by the use of various commercially available anti-D reagents. METHODS: We collected 273 cases determined as RhD negative by RhD typing using the tube method with monoclonal IgM/IgG anti-D reagent (Bioscot. Livingston, UK) from 80,062 cases that were screened between January 2004 and August 2007. The cases were divided into three periods (I, II, III), according to the manufacturers and numbers of anti-D reagents used. A weak D test was performed by using the tube method with various anti-D reagents. The cases with different reactivity between anti-D reagents were determined as partial D, and further analyzed the subtypes by reactivity patterns according to the target epitope of anti-D reagents. An additional test using the ID-Partial D Typing Card (DiaMed, Cressier, Switzerland) was conducted during period III. RESULTS: Five cases showed reactivity patterns of weak D and 16 cases showed reactivity patterns of partial D. Ten cases of partial D were typed as DVI and three cases were typed as DFR. During period III, five cases were typed as DVI and one case was typed as DFR. These results were different from the results obtained with the use of the ID-Partial D Typing Card. CONCLUSION: DVI, which is the most common subtype of partial D, is also common in Korea. Therefore, RhD typing and a weak D test should be performed using combined anti-D reagents that enable the differentiation of DVI from other subtypes.
Indicators and Reagents* ; Korea

BACKGROUND: Insulin resistance is related to central obesity and the amount of skeletal muscle. A simple and practical anthropometric marker for muscle mass is not known, although waist circumference (WC) is used as an indicator of abdominal obesity. The aims of this study were to investigate whether arm (AC) and thigh circumferences (TC) can be used as an indicator of muscle mass and if they are related to muscle strength. METHODS: A total of 110 obese (body mass index [BMI]> or =25 kg/m2) women with type 2 diabetes were enrolled, and WC, AC, and TC were measured. Abdominal visceral fat (AVF), subcutaneous fat (ASF), and total fat (ATF) were assessed by computed tomography, regional muscle (MM), and fat mass by dual-energy X-ray absorptiometry, muscle strength by one repetition maximum (1RM) of both extremities (chest and leg press) and insulin resistance by KITT. RESULTS: The mean age was 56.2+/-7.3 years, duration of diabetes was 4.2+/-4.4 years, and BMI was 27.2+/-2.8 kg/m2. WC was correlated with ATF, AVF, and ASF (r=0.728, P<0.001; r=0.515, P<0.001; r=0.608, P<0.001, respectively). Arm MM was correlated with AC (r=0.500, P<0.001), and leg MM with TC (r=0.291, P=0.002). Upper 1RM was related to AC/WC ratio (r=0.359, P<0.001), and lower 1RM was to TC/WC ratio (r=0.286, P=0.003). Insulin resistance had significant relations with AVF, WC, and total MM (r=-0.262, P=0.008; r=-0.217, P=0.029; r=0.160, P=0.031, respectively). CONCLUSION: The muscle mass was related to extremity circumferences, and muscle strength was to extremity/waist circumference ratio in obese women with type 2 diabetes.
Absorptiometry, Photon ; Arm ; Diabetes Mellitus, Type 2 ; Extremities ; Female ; Humans ; Insulin Resistance ; Intra-Abdominal Fat ; Leg ; Muscle Strength ; Muscle, Skeletal ; Muscles ; Obesity, Abdominal ; Subcutaneous Fat ; Thigh ; Waist Circumference

BACKGROUND: There is controversy over whether aerobic or resistance exercise is more effective for improving endothelial function in type 2 diabetes mellitus (T2DM). This study was aimed to investigate the effects of an aerobic and resistance training program on endothelial function, and the influences of glycemic control, body weight changes, and aerobic capacity in T2DM. METHODS: Total 40 overweight women with T2DM were assigned into 3 groups: an aerobic exercise group (AEG, n=13), resistance exercise group (REG, n=12), and control group (CG, n=15), and followed either brisk walking for the AEG or resistance band training for the REG, 60 minutes per day, 5 days per week for 12 weeks with monitoring daily activity using accelerometers. We assessed endothelial function by flow-mediated dilation (FMD), and aerobic capacity by oxygen uptake at anaerobic threshold (AT_VO2) at baseline and following training program. RESULTS: The mean participants' age was 57.0+/-6.8 years, and body mass index (BMI) was 27.0+/-2.3 kg/m2. After intervention, FMD increased by 2.2+/-1.9% in AEG, which differed from REG and CG (P=0.002), despite of decreased body weight (BW) in both AG and RG (2.8+/-2.5%, P=0.002; 1.6+/-2.0%, P=0.017, respectively). A significant increased AT_VO2 and decreased HbA1c were found only in AEG. In all participants, FMD was changed with the significant relations to the AT_VO2 (r=0.348, P=0.035), but not to HbA1c levels or BW. CONCLUSION: Aerobic exercise appears to be more beneficial than resistance exercise for improving endothelial function in T2DM. In addition, aerobic capacity could be a better predictor of changes in FMD than BW and glycemic control.
Anaerobic Threshold ; Body Mass Index ; Body Weight ; Body Weight Changes ; Diabetes Mellitus, Type 2 ; Exercise ; Female ; Humans ; Overweight ; Oxygen ; Resistance Training ; Walking

BACKGROUND: Arterial stiffness is an important factor in atherosclerosis. Thus we examined whether aerobic exercise could reduce arterial stiffness in obese women with type 2 diabetes without diabetic complication. METHODS: A total of 35 women with type 2 diabetes (body mass index, 26.6+/-2.8 kg/m2; age, 56.4+/-1.9 years; duration of diabetes, 4.7+/-4.8 years) were assigned to aerobic exercise group (AEG) or control group (CG). AEG completed a 12-week exercise program (3.6 to 5.2 metabolic equivalents, 3 day/week, 60 min/day), with their exercise activities monitored by accelerometers. We measured abdominal total fat area (TFA), visceral fat area (VFA), and subcutaneous fat area (SFA) by computed tomography, insulin sensitivity by insulin tolerance test (K(ITT)), and augmentation index (AIx) by SphygmoCor at baseline and at the end of the 12-week program. RESULTS: The AIx was improved in the AEG compared with the CG (P<0.001). The percent change of AIx had significant correlation with the improvement of physical activity energy expenditure (PAEE), aerobic capacity, TFA, and SFA (r=-0.416, P=0.013; r=0.560, P<0.001; r=0.489, P=0.003; r=0.531, P=0.001, respectively), but not with insulin sensitivity, energy intake, or VFA. CONCLUSION: Improvement in aortic stiffness by aerobic exercise is related with the improvement of aerobic capacity, PAEE, and total fat but not with insulin sensitivity or energy intake in obese women with type 2 diabetes.
Abdominal Fat ; Atherosclerosis ; Diabetes Complications ; Diabetes Mellitus, Type 2 ; Energy Intake ; Energy Metabolism* ; Exercise* ; Female ; Humans ; Insulin ; Insulin Resistance* ; Intra-Abdominal Fat ; Metabolic Equivalent ; Motor Activity* ; Subcutaneous Fat ; Vascular Stiffness*

A right-sided aortic arch (RAA) is a rare congenital anomaly, and Stanford type B dissection aneurysms involving this anomaly is also uncommon. Surgical approaches to dealing with an RAA are complicated by the unusual anatomical features of the condition. Here we report the case of a 47-year-old male who had a type B dissecting aneurysm involving an RAA with Kommerell's diverticulum. Graft replacement was successfully performed with an uneventful postoperative course.
Aneurysm, Dissecting/radiography/*surgery ; Aorta, Thoracic/*abnormalities/radiography/*surgery ; Aortic Aneurysm, Thoracic/radiography/*surgery ; Blood Vessel Prosthesis Implantation/methods ; Diverticulum/radiography/*surgery ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed