OBJECTIVES: The aim of this study was to estimate the burden of disease through an analysis of Years of Life Lost due to premature deaths, one component of the Disability-Adjusted Life Years (DALY). In addition, the cause of death statistics were adjusted to improve validity, and the results were compared with those of the Global Burden of Disease (GBD). METHODS: In closely following the approach taken in the original GBD study, most of the explicit assumptions and the value judgments were not changed. However, the statistics for some problematic concerns such as deaths of infants or those due to senility, were adjusted. Deaths, standard expected years of life lost (SEYLL), and potential years of life lost (PYLL) were computed using vital registration data compiled by the National Statistical Office. RESULTS: The burden for males is 1.8 and 2.3 times higher than that for females, according to SEYLL and PYLL, respectively. The proportions of deaths due to Group I, II, and III causes are 5.4%, 80.4%, and 14.3%, respectively, for PYLL, but in a major shift from Group II to III they are 6.3%, 66.2%, and 27.5%, respectively, for SEYLL. The proportion of Group III causes in Korea, 27.5%, is extremely high when compared to 10.1% for the world, 7.6% for developed countries, and 10.7% for developing countries. CONCLUSIONS: Estimation results showed that the total burden due to premature deaths is smaller than that for the entire world but larger than that for developed countries. The disease structure of Korea has changed to resemble that of developed countries. Also, an overly large portion of the total burden in Korea stems from injuries arising from car accidents.
Cause of Death ; Cost of Illness ; Developed Countries ; Developing Countries ; Female ; Health Transition ; Humans ; Infant ; Judgment ; Korea* ; Life Expectancy ; Male ; Mortality, Premature*

OBJECTIVE: Health insurers and policy makers are increasingly examining the hospital mortality rate as an indicator of hospital quality and performance. To be meaningful, a risk-adjustment of the death rates must be implemented. This study reviewed 5 severity measurement methods and applied them to the same data set to determine whether judgments regarding the severity-adjusted hospital mortality rates were sensitive to the specific severity measure. METHODS: The medical records of 584 patients who underwent coronary artery bypass graft surgery in 6 general hospitals during 1996 and 1997 were reviewed by trained nurses. The MedisGroups, Disease Staging, Computerized Severity Index, APACHElll and KDRG were used to quantify severity of the patients. The predictive probability of death was calculated for each patient in the sample from a multivariate logistic regression model including the severity score, age and sex to evaluate the hospitals' performance, the ratio of the observed number of deaths to the expected number for each hospital was calculated. RESULTS: The overall in-hospital mortality rate was 7.0%, ranging from 2.7% to 15.7% depending on the particular hospital. After the severity adjustment, the mortality rates for each hospital showed little difference according to the severity measure. The 5 severity measurement methods varied in their statistical performance. All had a higher c statistic and R2 than the model containing only age and sex. There was a little difference in the relative hospital performance evaluation by the severity measure. CONCLUSION: These results suggest that judgments regarding a hospital's performance based on severity adjusted mortality can be sensitive to the severity measurement method. Although the 5 severity measures regarding hospital performance concurred, more often than would be expected by chance, the assessment of an individual hospital mortality rates varied by the different severity measurement method used.
Administrative Personnel ; Coronary Artery Bypass* ; Coronary Vessels* ; Dataset ; Hospital Mortality ; Hospitals, General ; Humans ; Insurance Carriers ; Judgment ; Logistic Models ; Medical Records ; Mortality* ; Risk Adjustment ; Severity of Illness Index ; Transplants

Clavicle medial end fracture is rare, and it has not been studied extensively. Although there is debate regarding its treatment methods, because of the complications of conservative treatment, surgical treatment has been considered more than conservative treatment. This study describes a surgical method using double-plate fixation for treatment of clavicle medial end fractures in which plates were used on each anterior and superior border according to the anatomical structure of the clavicle. In addition, we report operative results of three patients treated by double-plate fixation.
Clavicle* ; Humans

This paper describes the curriculum development and its evaluation on the field education program of community medicine (FPCM) offered to all senior grade medical students at a rural site by the Depar tment of Health Policy and Management, Seoul National University College of Medicine. The FPCM is a course of study designed to prepare the students to function effectively in a primary health care setting assuming medical practitioner's role in response to the community needs, and as a member of a health team. The FPCM curriculum is focused on those issue that are important to community-based medical education such as problem-based active learning, communication skills, attitudes, team work and leadership skills, and scientific way of thinking. It also stressed the utilization of local health resources as educational health resources. Some important outcome of the curriculum are as follows: 1) 96.2% of the students answered that the program were helpful and necessary as a part of medical education. 2) The preceptors replied that 'having the teaching experience' was most significant aspects of their perfomance. 3) The program completed without any constraints. 4) The FPCM curriculum will be applicable to other medical colleges even under the limitation of educational resources.
Community Medicine* ; Curriculum ; Education* ; Education, Medical ; Health Policy ; Health Resources ; Humans ; Leadership ; Primary Health Care ; Problem-Based Learning ; Seoul ; Students, Medical ; Thinking

OBJECTIVES: The aims of this study were to estimate the antihypertensive medication adherence in people with a disability and a history of taking antihypertensive medication, and to identify the factors affecting medication adherence. METHODS: The National Health Insurance claims data were linked with the National Disability Registry. People with a disability, who received a prescription of antihypertensives, were identified from a total of 85,098 cases. Cumulative medication adherence (CMA) was used as an indicator of medication adherence. A CMA > 80% was defined as appropriate medication adherence. Multiple logistic regression analysis was used to identify the factors affecting medication adherence. RESULTS: The average CMA in a total of 85,098 patients was 79.5%. The appropriate adherence (CMA > or =80%) rate was 54.5% and 20.5% of patients had a CMA < 50%. Multiple logistic regression analysis revealed that the probability of appropriate adherence decreased with decreasing number of prescription days per visit, increasing number of providers, the patients' residential area moving from urban to rural areas, and when patients have an internal organ disability, auditory impairment, mobility impairment. CONCLUSIONS: The adherence to antihypertensive medication in people with a disability is influenced by various socio-economic, clinical and regional factors. In particular, the disabled who have locomotive and communication disabilities and internal organ impairments have a higher probability of under-adherence to antihypertensive medication adherence in Korea.
Adult ; Aged ; Antihypertensive Agents/*administration & dosage ; Comorbidity ; Disabled Persons/*statistics & numerical data ; Drug Utilization ; Female ; Health Services Accessibility ; Humans ; Insurance Claim Review ; Korea/epidemiology ; Logistic Models ; Male ; Middle Aged ; National Health Programs ; Patient Compliance/*statistics & numerical data ; Residence Characteristics ; Socioeconomic Factors

Importance of health policy and management in medical education is gradually accepted. Successful model of the curricula of health policy and management education in Korean is, however, yet be to deve loped. This paper describes the curriculum development process and its evaluation of an exercise course on the field of health policy and management. The curriculum is focused on those issues that are important to medical education such as small group dynamics, problem-based active learning, communication skills, attitudes, team work and leadership skills, and scientific way thinking. The student are expected to develop the ability and attitute through this course such as the appreciation of the concepts and the major tasks of health care, and the appreciation of the importance of establishing a collaborative interpersonal relationship with the medical personnels. Formats for the exercise are 1) analysis of data on the health services through the structured questions, 2) role play, 3) project and presentation, and 4) panel discussion. 70.5% of students appraised these formats of clerkships are necessary in medical education process. Students' achievement of each objectives are variable, but affirmative in general. Although some unsatisfactory aspects are exist, the clerkships are helpful and satisfactory in general. It provided with the opportunity for problem solving by themselve to the students, encouraged the team-spirit and motivation, and stimulate critical way of thinking.
Curriculum ; Delivery of Health Care ; Education ; Education, Medical ; Health Policy* ; Health Services ; Humans ; Leadership ; Motivation ; Problem Solving ; Problem-Based Learning ; Thinking

The prevalence of urinary symptoms associated with benign prostatic hyperplasia(BPH) was studied in a community-based, representative sample of 519 men over 50 years old for estimation of prevalence of BPH in Korea. Symptoms were assessed by the Korean version of International Prostatic Symptom Score(IPSS). Only 5(1%) men reported having undergone prostate surgery due to BPH and excluded from analysis. Among 514 men, nocturia and weak stream were the most prevalent symptoms and urgency was the least. Based on the IPSS, 31.7% of the men were free of urinary symptoms(IPSS 0), 45.1%, 18.7% and 4.5% of the men were minimally(IPSS 1-7), moderately(IPSS 8-19) and severely(IPSS 20-35) symptomatic, respectively. The proportion of severely symptomatic men approximately doubled with each decade of age. A good correlation was found between the total symptom score and the single disease-specific quality of life score that is included in the IPSS. Our estimation indicated that in 1995 approximately 800,000 Korean men had moderate to severe urinary symptoms that were likely to be associated with BPH. These results suggest that the prevalence of BPH in Korean men is substantially similar to Caucasian.
Epidemiology ; Humans ; Korea* ; Male ; Middle Aged ; Multiple Endocrine Neoplasia Type 1 ; Nocturia ; Prevalence* ; Prostate ; Prostatic Hyperplasia* ; Quality of Life ; Rivers

Although studies on malrotation of the humerus possibly leading to dysfunction of the shoulder have been reported, studies on its causes are inadequate. The authors encountered a patient complaining of malrotation accompanied by dysfunction of the shoulder which occurred during treatment of a distal humeral fracture. The patient recovered the shoulder function by only correcting malrotation of the humerus without direct treatment on the shoulder, and we report it herein with a review of the literature.
Humans ; Humeral Fractures ; Humerus* ; Shoulder*

Alzheimer’s disease (AD) progressively inflicts impairment of synaptic functions with notable deposition of amyloid-β (Aβ) as senile plaques within the extracellular space of the brain. Accordingly, therapeutic directions for AD have focused on clearing Aβ plaques or preventing amyloidogenesis based on the amyloid cascade hypothesis. However, the emerging evidence suggests that Aβ serves biological roles, which include suppressing microbial infections, regulating synaptic plasticity, promoting recovery after brain injury, sealing leaks in the blood-brain barrier, and possibly inhibiting the proliferation of cancer cells. More importantly, these functions were found in in vitro and in vivo investigations in a hormetic manner, that is to be neuroprotective at low concentrations and pathological at high concentrations. We herein summarize the physiological roles of monomeric Aβ and current Aβ-directed therapies in clinical trials. Based on the evidence, we propose that novel therapeutics targeting Aβ should selectively target Aβ in neurotoxic forms such as oligomers while retaining monomeric Aβ in order to preserve the physiological functions of Aβ monomers.

We estimated the burden of diseases in Korea especially caused by major cancers using DALY (disability adjusted life year) measurement. Firstly, the burden of disease due to premature death was estimated by using YLLs (years life lost due to premature death) measurement developed by the global burden of disease study group. Secondly, for the calculation of the YLD (years lived with disability), the following parameters were estimated in the formula; incidence rate, case fatality rate and disability weight of major cancers. Thirdly, we estimated DALY of major cancers by adding YLLs and YLDs. The burden of major cancers for male per 100,000 population was attributed mainly to liver cancer (528.8 person-year), stomach cancer (451.4 person-year), and lung cancer (374.9 person-year). The burden of major cancers for female per 100,000 population was attributed mainly to liver cancer (140.0 person-year), stomach cancer (259.7 person-year), and lung cancer (125.2 person-year). Each of these cancers was responsible for the loss of over 100 person-year per 100,000 population based on our DALY measurement. We found the DALY method employed was appropriate to quantify the burden of disease. Thereby, it would provide a rational bases to plan a national health policy regarding the burden of disease caused by major cancers in Korea.
Adult ; Aged ; Female ; Health Policy ; Humans ; Korea/epidemiology ; Liver Neoplasms/epidemiology/mortality ; Lung Neoplasms/epidemiology/mortality ; Male ; Middle Aged ; Neoplasms/*epidemiology/mortality ; Quality-Adjusted Life Years ; Stomach Neoplasms/epidemiology/mortality