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Analysis of Frequent Disease and Medical Expenses Structure of Patients Admitted in a Vaterans Hospital (일개 보훈병원 입원환자의 상병 및 진료비 구조분석)

  • Kim, Kyoung-Hwan;Lee, Sok-Goo;Kim, Jeong-Yeon
    • Journal of agricultural medicine and community health
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    • v.30 no.1
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    • pp.1-14
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    • 2005
  • Objectives: This study attempts to analyze the length of hospital stay and expenses of frequent disease admitted in a Vaterans Hospital. Methods: Data was collected from January 1, 2001 to December 31, 2003 from the Claim records of 9,640 patients in a Vaterans Hospital. Results: The results were as follows: 1. In age & sex distribution, there was male 70.9%, female 29.1%, and 35.8% of them is 70 age group. Frequency by insurance program was Health insurance 78.1%, Medical aid 14.2%, no insurance 4.1%, others 3.6%. Distribution of each department was internal medicine 28.3%, orthopedic surgery 21.3%, surgery 16.6%, neurosurgey 7.1%, pediatrics 5.9%. Also, in the veterans group, male to female patient ratio was 99.3% male to 0.7% female, them over 70 years old was 51.6%, and them which live in daejeon was 43.5%. 2. In frequency of disease, there was gastroenteritis 4.8%, pneumonia 3.8%, cartaract 3.7%, cerebral infarct 3.2%, hyperplasia of prostate 3.0%. In frequency of korean standard classification of diseases, there was injury and poisoning and certain other consequences of external causes 17.1%, diseases of digestive system 16.1%, diseases of musculoskeletal system and connective tissue 13.9%, diseases of respiratory system 9.4%, diseases of genitourinary system 8.6%. Also, in veterans group, frequency of them was diseases of musculoskeletal system and connective tissue 19.4%, diseases of digestive system 16.8%, injury and poisoning and certain other consequences of external causes 15.7%, diseases of genitourinary system 9.7%, diseases of circuatory system 8.2%. 3. Average length of hospital stay was 29.0 days for total patients, 51.8 days for the veterans group, 15.7 days for the non-veterans one. Average total expenses was 3,669,579 won, the veterans group 7,263,877 won, the non-veterans one 1,560,333 won. The ratio of insurer to insuree was 55.2 : 44.8, the ratio of amount paid by patient in the veterans group 61.7%, in the non-veterans one 33.0%. 4. In items of medical expenses, fee for hospital accommodation was 34.7%, fee for medication 13.2%(injection 7.8%, drug 5.4%), fee for service 48.6%(physical therapy 26.3%, operation 9.7%, laboratory examination 5.2%, radiological examination 3.1%, etc), others 3.4%. In them for the veterans group, fee for physical therapy was 35.3%, fee for hospital accommodation 35.2%, fee for injection 6.2%, fee for operation 5.9%, for the non-veterans one, fee for hospital accommodation 35.7%, fee for operation 16.4%, fee for injection 11.4%, fee for laboratory examination 8.3%. 5. In the comparison of the frequency by Korean standard classification of diseases and distance between the hospital and home, the region under 21.5Km was more frequent in symptoms, signs an abnormal clinical and laboratory findings 56.0%, injury and poisoning and certain other consequences of external causes 55.6%, diseases of the eye and adnexa 52.9%, the one over 21.5Km was more frequent in neoplasms 57.4%, diseases of musculoskeletal system and connective tissue 55.9%, diseases of genitourinary system 53.5%.

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Usefulness of video-EEG monitoring in paroxysmal nonepileptic events of children and adolescents (소아와 청소년의 돌발적 비간질 발작의 진단에 있어 비디오-뇌파 모니터링의 유용성)

  • Lee, Jee Yeon;Lee, Hee Sun;Choi, Wook Sun;Eun, So Hee;Lee, Ki Hyung;Enu, Baik Lin;Lee, Joo Won
    • Clinical and Experimental Pediatrics
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    • v.51 no.1
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    • pp.62-66
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    • 2008
  • Purpose : In addition to epileptic seizures (ES), a variety of physiologic, organic and psychogenic disorders can manifest as paroxysmal behavioral events. Paroxysmal nonepileptic events (PNEs) are quite encountered in infants, young children, and adolescents. In a substantial proportion of cases, a careful history and examination will elucidate their nature. However, in other cases, it is necessary to differentiate PNEs from ES by video-electroencephalographic (EEG) monitoring. We report our experiences with PNEs in a group of children and adolescents who underwent video-EEG monitoring. Methods : From September, 2004 to June, 2006, one hundred thirty patients were monitored in the Pediatric Epilepsy Monitoring Units of Korea University Guro and Ansan hospitals. Their hospital charts were reviewed and video records of these events were analyzed. We observed all patients after video-EEG monitoring for more than 3 months. Results : Typical spells occurred during monitoring in 33 patients, not associated with a seizure pattern on EEG recordings. Two patients were diagnosed as frontal lobe epilepsy on basis of typical semiology and clinical characteristics, so 31 patients were documented to have PNEs finally. The mean age of patients was $7.2{\pm}5.8\;years$. The male to female ratio was 15 (48.4%) to 16 (51.6%). Among 31 patients, fifteen patients had associated disorders such as epilepsy, developmental delay, cerebral palsy, gastric ulcer, attention deficit hyperactivity disorder or depressive disorder. Somatoform disorder and factitious disorder was frequently seen in children more than 5 years old (P<0.05). Psychogenic disorder was more frequent in female (n=6) than in male (n=2) but there was no statistical significance (P>0.05). Conclusion : Our study suggests that video-EEG monitoring is an important diagnostic tool in the evaluation of paroxysmal behavioral events. With correct diagnosis of the PNEs, several unnecessary treatment could be avoided.

The Relationship Between Adiposity and Risk factors for Cadiovascular Disease at Normal Body Weight Male (정상 체중인 성인 남성에서 지방과다와 심혈관질환의 위험요인간의 관련성)

  • Kwon, Woo-Sung;Kim, Jun-Su;Chae, Jin-Wook;Lee, Keun-Mi;Jung, Seung-Pil;Moon, Yong
    • Journal of Yeungnam Medical Science
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    • v.20 no.1
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    • pp.62-70
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    • 2003
  • Background: Most of all studies about the relation between the health risk and obesity are based on the European and American data. The purpose of this study is to examine the relation between adiposity and risk factors for cardiovacular disease (CVD) in normal weight individuals. Materials and Methods: Normal weight subjects with a body mass index (BMI) between 18.5 and $23kg/m^2$ (76 subjects) and overweight subjects with a BMI between 23 and $25kg/m^2$ (53 subjects) were retained for this study. Normal weight subjects were divided into three group of each adiposity variable, then three group and the overweight group were evaluated for the presence of CVD risk factors and analyze the correlation coefficients between adiposity variables and risk factors controlled for age in normal weight, overweight groups. Using logistic regression analysis, the odds ratio (OR) for the prevalence of risk factors for each group of adiposity variables and the overweight group was estimated relative to the first group in normal weight subjects. Results: Systolic BP, diastolic BP, LDL cholestrol, HDL cholesterol, triglycerides in normal weight subjects were significantly correlated with all adiposity variables (P<0.01). Third group (3.7 for %fat and 4.7 for fat mass)of adiposity variables in the normal weight group and the overweight group (6.6 for %fat and 11.5 for fat mass) tended to have higher ORs compared to first group for risk factor variables. Conclusion: Normal weight subjects with elevated adiposity had higher prevalence of risk factors than normal weights subjects with less adiposity. Measuring of adiposity added additional information of cardiovascular disease risk factors in normal weight subjects.

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Development of Measurement Scale for Korean Scaling Fear-1.0 and Related Factors (한국형 스켈링공포(KSF 1.0)의 측정도구 개발 및 관련요인)

  • Cho, Myung-Sook;Lee, Sung-Kook
    • Journal of dental hygiene science
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    • v.9 no.3
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    • pp.327-338
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    • 2009
  • This study was to develop an instrument for multidimensional measurement of Korean scaling fear (KSF)-1.0 and analyze related factors. A sample of 720 subjects(scaling patients and community people) was studied in Daegu city from November in 2008 to March in 2009. Authors first conceptualized the KSF, item generation, item reduction, and questionnaire formatting were performed in the stage of the development. Item descriptive, missing%, item internal consistency, and item discriminant validity were analyzed in the item-level, also descriptive, floor and ceiling effect were analyzed in the scale-level. Cronbach's alpha, test-retest, inter-dimension correlations, and factor analysis were performed to evaluate the validity and reliability in the new instrument. Confirmative factor analysis was did to evaluate the fit of model. The results for item-level and scale-level were acceptable except item discriminant validity. The reliability for 0.92~0.96 of corelation coefficient range(Cronbach's alpha 0.96~0.98) was high in the test-retest, and there was no significant difference in paired t-test. Item internal consistency(range of pearson corelation coefficient 0.39~0.95) was also high. The result of explanatory factor analysis was the same as the intended dimension structure, also confirmatory factor analysis results revealed that the dimensional structure model were fined well in the evaluation of model fit($x^2$= 1245.66, df=146, p=0.0000; GFI=0.85; AGFI=0.80; RMSEA=0.10). Factors related to KSF by multiple regression were gender($\beta$=0.28, p=0.0004) and teeth brush method($\beta$=-0.15, p=0.0053) in scaling patients, also gender($\beta$=0.25, p=0.0002), educational level($\beta$=0.14, p=0.0155), teeth brush method($\beta$=-0.09, p=0.0229) and time of daily work out($\beta$=-0.10, p=0.0055) were significantly associated with KSF in no scaling group. In conclusion, The results of this study reveal that the new developed measurement scale was reliable and val id instrument for measuring the KSF in dental hygiene patients and community people. We recommend that further research should develop more the instrument for the Korean scaling fear.

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CHILDREN WITH CHRONIC CONVULSIVE DISORDER AND THEIR FAMILIES (경련성 질환 환아와 가족)

  • Cho, Soo-Churl;Kim, Boong-Nyun
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.13 no.1
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    • pp.67-75
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    • 2002
  • Objectives:This study was conducted to investigate the degree of psychopathologies of the family members of children with chronic convulsive disorder and evaluate the structures and dynamics of those families. Methods:The participant patients and family members were recruited from the population attending the outpatient clinic of department of pediatric neurology in Seoul National University Hospital in Korea. All the patients had idiopathic chronic convulsive disorder. Any patient with mental retardation, pervasive developmental disorder and gross brain pathology was excluded. As controls, normal students were chosen and their sex, age, achievement, socioeconomic status were matched to patients. The author interviewed the children and their family members twice and obtained informations about patient-parent relationship, patient-sibling relationship and others. For in-depth evaluation, we used family environment scales(FES), symptom Checklist-90-revised(SCL-90-R), self administered dependency questionnaire for mother(SADQ). Results:After interviewing with the parents of epileptic children, overprotection of parents, hostile feeling of siblings toward index children were higher than controls. The parental conflict was also more expressed than control families. According to results from FES, the scores of the subscales of expression, achievement-orientation, intelligence-orientation and active recreation were significantly lower than control group. The epileptic children showed higher dependency to parents especially in affection, communication and traveling areas of SADQ than control group. Maternal psychopathologies evaluated by SCL-90-R were much higher than the mothers of controls. According to T scores of SCL-90-R, about 40% of mothers with epileptic children had the risk of clinically significant depressive or anxiety disorders. Conclusion:These results suggested that the family members of epileptic children had more relationship problems and psychopathologies than control group and some mothers might have clinically significant depressive or anxiety disorders. so, effective psychiatric family interventions are needed for resolution of conflict and psychopathologies of family members.

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The Effects of Lifestyle Redesign Program on Time Usage and Quality of Life for Elderly with Stroke (라이프스타일 재설계 프로그램이 뇌졸중 노인의 시간 사용과 삶의 질에 미치는 효과)

  • Kim, Hyeong-Min;Jeon, Byoung-Jin
    • The Journal of Korean society of community based occupational therapy
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    • v.9 no.3
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    • pp.21-30
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    • 2019
  • Objective : This study was designed to identify the effects on the time usage and quality of life of seniors with stroke by applying lifestyle redesign programs on the theoretical basis of the Occupational Balance. Method : A pretest-posttest control group design was conducted for a total of 40 stroke elderly people living in nursing homes(20 experimental and 20 control groups). Prior assessment was conducted for two weeks before the application of the lifestyle redesign program. For the next 10 weeks, the lifestyle redesign program was applied seven times a week. After that, a week of post-evaluation was conducted. The time usage for the subjects was analyzed by Life Time Survey Table of the National Statistical Office(2009) and life quality for them was analyzed by World Health Organization Quality of Life-BRIEF (WHOQOL-BRIEF). Result : The comparison of time usage before and after application of the program demonstrated that for the experimental group, rest and sleep(t=-4.89, p<.001), and leisure(t=-4.67, p<.00b1) showed significant differences. In addition, intergroup comparison results showed that there were also significant differences in rest and sleep(t=-2.24, p<.01) and leisure(t=3.57, p<.01). The comparison of life quality showed a significant difference between two groups(t=6.80, p<.001). If you look at the sub-area of quality of life, a significant difference was identified in physical health(t=6.08, p<.001), psychological health(t=5.21, p<.001), living environment area(t=3.60, p<.01). Conclusion : Lifestyle redesign program actually reduced the time usage for rest and sleep for elderly with stroke living in nursing homes, and increased the time for participating in leisure life resulting in improved quality of life.

The Effects of Trunk Stabilization Training on a Stroke Patient's Postural Control and Activities of Daily Living: A Sing Subject Design (뇌졸중 환자의 체간안정화 훈련이 자세조절과 일상생활동작에 미치는 영향: 단일사례연구)

  • Nam, Ju-Hyeon;Shim, Gyeong-Bo;Gwak, Seong-Won
    • The Journal of Korean society of community based occupational therapy
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    • v.4 no.1
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    • pp.75-84
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    • 2014
  • Objective : This study intends to suggest an effective clinical intervention method for stroke patients by applying a trunk stabilization training program to a single stroke patient and investigating and analyzing the effects of the program on postural control and activities of daily living. Methods : The subject of this study was a 75 year-old female stroke patient hospitalized in C Hospital located in Gyeongju, Gyeongsangbuk-do. As for the research design, A-B-A reversal design was used with a single subject design; and the research period was a total of five weeks from April 21, 2014 to May 23, 2014. As for the research process, a total of 15 sessions were carried out including three sessions of baseline(A), nine sessions of an intervention period(B), and three sessions of maintenance(A'); and the trunk stabilization program was applied during the intervention period. To evaluate the participant's postural control and activities of living life, the Postural Assessment Scale for Stroke(PASS) and the modified Barthel Index(MBI) were used. Visual analysis was used in which collected data were plotted on a graph, using Microsoft Office Excel 2013. Results : In the postural control test, the mean scores improved from 11.7 in the baseline phase to 14.8 in the intervention phase and 15.3 in the maintenance phase. In the evaluation of activities of daily living, the score improved from 66(medium dependence) during the baseline period to 80(low dependence) after intervention and at the maintenance phase. Conclusion : It was found that the trunk stabilization training program showed effects on the stroke patient's postural control or alignment, and furthermore a beneficial improvement in the patient's performing the activities of daily living, as well.

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Risk Factors of Primary Nocturnal Enuresis (일차성 야뇨증의 위험 요인)

  • Lee, Soo-Jin;Yang, Jung-An;Yoo, Eun-Sun;Seo, Jang-Wan;Lee, Seung-Joo
    • Childhood Kidney Diseases
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    • v.4 no.1
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    • pp.69-76
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    • 2000
  • Purpose: The Pathogenesis of primary noctllrnal enuresis(PNE) is still controversial. Genetic factor and maturational delay of micturition reflex including arousal disorder, lack of nocturnal Arginine Vasopressin(AVP) release and functional bladder capacity have been suggested. We analyzed the risk factors of PNE. Methods: Fifty five children with PNE (20 enuretics diagnosed at school physical examination of the first grade students at Mok-Dong Elementary School and 35 enuretics (Age 6-7 year) diagnosed at Ewha Womans University Mok Dong Hospital) and 221 control students without PNE at school physical examination were included. Genetic, stress and developmental factors, arousability, water intake, urine volume, maximun voiding volume and daytime voiding dysfunction were compared. Results: 1) There was no significant difference between PNE and control group in sex ratio, birth order, percentage of working mothers, parental and child personality, age to start walking, school record and duration of sleep. 2) Family history in the PNE group was significantly higher than control group ($20.0\%\;vs\;2.7\%$)(P<0.05). 3) The difficulty in arousal in the PNE group was significantly more common than the control group ($70.9\%\;vs\;54.3\%$)(P<0.05). 4) Nocturnal water intake in the PNE group was significantly greater than the control group ($330{\pm}158.2\;mL\;vs\;235{\pm}129.5\;mL$). Nocturnal urine volume in the PNE group was significantly greater than the control group ( $390{\pm}61.5\;mL\;vs\;140{\pm}43.2\;mL$)(P<0.05). Daily water intake and daily urine volume did not significantly differ between the two groups. 5) Maximum urine volume per void in the PNE group was significantly lower than the control group ($107{\pm}35.9\;mL\;vs\;236{\pm}41.3\;mL$). Daytime voiding dysfunction in the PNE group was significantly more common than the control group ($80.0\%\;vs\;57.9\%$). The voiding frequency in the PNE group was significantly greater than the control group ($7.0{\pm}3.6\;vs\;5.4{\pm}1.6$)(P<0.05). Conclusion: In addition to genetic factors and maturational delay of micturition reflex (difficulty in arousal, nocturnal polyuria and decreased functional bladder capacity) nocturnal polydypsia was found to be the important risk factors fur PNE. So nocturnal fluid restriction should be encouraged as the first-line management of PNE.

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Clinical Evaluation of TightRope Cranial Cruciate Ligament Technique for Treatment of Cranial Cruciate Ligament Deficiency in Dogs (전방 십자인대 결손을 보이는 개에서 TightRope을 이용한 치료방법 평가)

  • Yoon, Hun-Young;Kim, Kyung-Hee;Jeong, Soon-Wuk
    • Journal of Veterinary Clinics
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    • v.29 no.6
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    • pp.455-459
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    • 2012
  • Nine dogs presented to the Veterinary Medical Teaching Hospital of Konkuk University and Woosung Animal Hospital with a history of pelvic limb lameness. On physical examination, 9 dogs all showed a consistent weight bearing lameness and mild muscle atrophy. There was cranial drawer sign with pain in 9 dogs. Mediolateral radiographic projection revealed cranial subluxation of the tibial tuberosity in a tibial compression view. The right and left stifle joints were affected in 7 dogs and 2 dogs respectively. TightRope cranial cruciate ligament (CCL) technique for treatment of CCL deficiency was performed. Polyester and nylon were used to stabilize the stifle in 3 dogs and 6 dogs respectively. Suture sizes were 0.8 mm (n = 2), 0.9 mm (n = 4), 1.1 mm (n = 2), and $1.1mm{\times}2$ strands (n = 1) in diameter. Mean (${\pm}SD$) surgical duration was $48.3{\pm}8.5$ minutes (range 35 to 60 minutes). Preoperative and postoperative mean (${\pm}SD$) cranial drawer signs were $8.6{\pm}1.6$ mm (rage 7 to 12 mm) and $1.2{\pm}1.0$ mm (rage 0 to 3 mm) respectively. Immediate postoperative radiographs of the affected limb revealed no evidence of cranial subluxation of the tibial tuberosity in a tibial compression view of 9 dogs. Normal limb function was regained in 8 dogs within 8 weeks postoperatively. A consistent weight bearing lameness resolved in all dogs after TightRope CCL technique, but reoccurred in one dog (case No. 6) 2 weeks after surgery. Cranial subluxation of the tibial tuberosity was identified in a tibial compression test. During the second surgery, breakage of surgical button was identified and a tibial wedge osteotomy was performed. Based on surgical time, complication, stifle stability, and functional recovery, the present study indicated that TightRope CCL technique is effective treatment for the dogs with CCL deficiency.

The Effects of Pet Dog-Assisted Activities on Self-Esteem, Depression and Cognitive Function among Elderly People (애완견 매개활동이 노인의 자기존중감, 우울 및 인지기능에 미치는 효과)

  • Shin, Esther;Lee, Sung-Kook
    • Journal of agricultural medicine and community health
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    • v.35 no.3
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    • pp.314-325
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    • 2010
  • Objectives: The purpose of this study was to investigate the effects of pet dog-assisted activities on self-esteem, depression and cognitive function of elderly people Method: The experimental group(pet dog-assisted group) consisted of 22 people over 65 years old out of about 90 elderly people registered with a home for the aged and the control group(non-pet dog assisted group) consisted of 22 people over 65 years old out of about 90 elderly people registered with another home for the aged in Daegu. Both groups had similar general characteristics, state of health, conduct on health and self-esteem, depression and cognitive abilities. Nineteen people who participated in the program at least 10 times out of 12, were chosen for the final analysis from the experimental group. For the control group, 20 people who responded to all three tests, which had been conducted before, 1 week after, and four week after the experiment, were analyzed. Result: Mean(${\pm}SD$) differences between before and 1 week after the experiment for self-esteem, depression, and cognitive function were 5.84(${\pm}3.06$), -3.26(${\pm}1.76$), 1.47(${\pm}1.26$), respectively. Those between before the experiment and 4 weeks after the experiment was 5.68(${\pm}3.64$), -3.94(${\pm}2.32$), 1.63(${\pm}0.96$), respectively. Those for control group between before and after the experiment were -0.40(${\pm}1.27$), 0.00(${\pm}0.92$), 0.15(${\pm}0.93$), respectively. Those for control group between before and 4 weeks after the experiment were -0.45(${\pm}2.24$), 0.25(${\pm}1.68$), 0.15(${\pm}0.93$), respectively. All the differences between experiment and control group in mean differences between before and 1 week after experiment, between before and 4 weeks after experiment were statistically significant(p<0.05). Conclusion: This study suggests that the pet-assisted activities can be useful solution for elderly people who have psychological and emotional problems caused by retrogression of physical, mental and social ability.