• 가족자원경영과 정책
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• 제16권4호
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• pp.23-44
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• 2012

The purpose of this study is to examine the preference for living with adult children of the baby-boomer generation and the elderly based on independent variables such as demographic characteristics, the values of their children and the consciousness for supporting their parents. The National Survey of Korean Families was done by the Ministry of Equality and Family in 2010. Respondents were 664 baby boomers and 628 elderly, and the results are as follows. First, the baby boomers rely heavily on their spouse, whereas the elderly rely heavily on their children. While both groups desire to live with their spouse in their later years, and the elderly rely the most on their children, they are reluctant to live together. This result shows that the elderly have high expectations for financial and emotional support from their children, but in reality, the elderly have lower expectations for living together and they prefer to live alone or with their spouse. Second, the boomers, who for the most part live in big cities, have comparatively high average monthly income and jobs and own a house, consider filial obligation as their own responsibility and yet tend to live independently. The boomers, who have a relatively high education level, consider living with aged parents as the children's obligation and consider their children as the most reliable people in their lives, and thus have high expectations to live together with their children. Third, the elderly, with a spouse, who consider having raised children to be their happiness, while considering providing financial support for the aging parents to be the children's responsibility, at the same time accept that the obligation of support lies on themselves, the government or the society, and thus have lower expectations of living with their children in later years. The elderly, now living with their family, with generous financial plans for their aging years and considering the children's success as their own success, have higher expectations of living together with their children.

• Clinical and Experimental Pediatrics
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• 제53권10호
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• pp.872-879
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• 2010

Obstructive sleep apnea (OSA) in children is a frequent disease for which optimal diagnostic methods are still being defined. Treatment of OSA in children should include providing space, improving craniofacial growth, resolving all symptoms, and preventing the development of the disease in the adult years. Adenotonsillectomy (T&A) has been the treatment of choice and thought to solve young patient's OSA problem, which is not the case for most adults. Recent reports showed success rates that vary from 27.2% to 82.9%. Children snoring regularly generally have a narrow maxilla compared to children who do not snore. The impairment of nasal breathing with increased nasal resistance has a well-documented negative impact on early childhood maxilla-mandibular development, making the upper airway smaller and might lead to adult OSA. Surgery in young children should be performed as early as possible to prevent the resulting morphologic changes and neurobehavioral, cardiovascular, endocrine, and metabolic complications. Close postoperative follow-up to monitor for residual disease is equally important. As the proportion of obese children has been increasing recently, parents should be informed about the weight gain after T&A. Multidisciplinary evaluation of the anatomic abnormalities in children with OSA leads to better overall treatment outcome.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권3호
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• pp.251-262
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• 2022

Purpose: Endoscopic drainage is an established treatment modality for adult patients with pancreatic fluid collections (PFCs). Available data regarding the efficacy and safety of endoscopic drainage in pediatric patients are limited. In this systematic review and meta-analysis, we aimed to analyze the outcomes of endoscopic drainage in children with PFCs. Methods: A literature search was performed in Embase, PubMed, and Google Scholar for studies on the outcomes of endoscopic drainage with or without endoscopic ultrasonography (EUS) guidance in pediatric patients with PFCs from inception to May 2021. The study's primary objective was clinical success, defined as resolution of PFCs. The secondary outcomes included technical success, adverse events, and recurrence rates. Results: Fourteen studies (187 children, 70.3% male) were included in this review. The subtypes of fluid collection included pseudocysts (60.3%) and walled-off necrosis (39.7%). The pooled technical success rates in studies where drainage of PFCs were performed with and without EUS guidance were 95.3% (95% confidence interval [CI], 89.6-98%; I²=0) and 93.9% (95% CI, 82.6-98%; I²=0), respectively. The pooled clinical success after one and two endoscopic interventions were 88.7% (95% CI, 82.7-92.9%; I²=0) and 92.3% (95% CI, 87.4-95.4%; I²=0), respectively. The pooled rate of major adverse events was 6.3% (95% CI, 3.3-11.4%; I²=0). The pooled rate of recurrent PFCs after endoscopic drainage was 10.4% (95% CI, 6.1-17.1%; I²=0). Conclusion: Endoscopic drainage is safe and effective in children with PFCs. However, future studies are required to compare endoscopic and EUS-guided drainage of PFCs in children.

• 한국노년학
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• 제25권2호
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• pp.35-52
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• 2005

본 연구는 한국 노인을 대상으로 성공적 노후의 성취 수준을 측정하기 위한 척도를 개발하고, 개발된 '성공적 노후 척도'의 일반화 가능성을 검증하기 위한 목적으로 (1)선행연구를 통한 문항 개발, (2)1차 조사를 통한 문항 내용 확인, (3)전문가 집단과 노인 포커스 그룹에 의한 내용타당도 검증, (4)2차 조사를 통한 성공적 노후의 구성요인 확인, 그리고 (5)3차 조사를 통한 구성타당도와 동시타당도 확인까지의 5단계 척도개발 과정들을 순차적으로 진행하였다. 한국 노인의 '성공적 노후 척도'는 총 30문항으로서 '자기 효능감을 느끼는 삶' '자녀 성공을 통해 만족하는 삶' '부부간의 동반자적 삶' 그리고 '자기통제를 잘 하는 삶'의 네 가지 하위요인으로 구성됨을 확인하였다. 그리고 '성공적 노후 척도'의 신뢰도는 Cronbach's a값 0.94로 높은 내적 일치도를 보였고, 확인적 요인분석을 통해 요인과 문항 간의 관계가 통계적으로 유의미함을 확인하여 요인구조에 대한 구성타당도를 확인하였다. 그리고 본 척도는 삶의 만족도와 0.69의 높은 상관관계를 보임으로서 동시타당도도 입증되었다. 이상과 같은 척도의 개발은 노인복지 실천현장에서 사회측정도구로 활용되는데 기여할 것이다.

• Journal of Chest Surgery
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• 제47권5호
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• pp.437-443
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• 2014

The JCVSD (Japan Cardiovascular Surgery Database) was organized in 2000 to improve the quality of cardiovascular surgery in Japan. Web-based data harvesting on adult cardiac surgery was started (Japan Adult Cardiovascular Surgery Database, JACVSD) in 2001, and on congenital heart surgery (Japan Congenital Cardiovascular Surgery Database, JCCVSD) in 2008. Both databases grew to become national databases by the end of 2013. This was influenced by the success of the Society for Thoracic Surgeons' National Database, which contains comparable input items. In 2011, the Japanese Board of Cardiovascular Surgery announced that the JACVSD and JCCVSD data are to be used for board certification, which improved the quality of the first paperless and web-based board certification review undertaken in 2013. These changes led to a further step. In 2011, the National Clinical Database (NCD) was organized to investigate the feasibility of clinical databases in other medical fields, especially surgery. In the NCD, the board certification system of the Japan Surgical Society, the basic association of surgery was set as the first level in the hierarchy of specialties, and nine associations and six board certification systems were set at the second level as subspecialties. The NCD grew rapidly, and now covers 95% of total surgical procedures. The participating associations will release or have released risk models, and studies that use 'big data' from these databases have been published. The national databases have contributed to evidence-based medicine, to the accountability of medical professionals, and to quality assessment and quality improvement of surgery in Japan.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제10권1호
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• pp.51-59
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• 2007

목 적: 직장 항문기능검사법의 발달로 소아 만성 변비 환자 중에서도 성인에서와 마찬가지로 PFD를 보이는 경우가 있음이 알려지고 있다. 하지만 PFD 환자의 치료에 사용하는 BT는 소아에서는 협조가 어렵고, 소아 변비는 양호한 자연경과를 가진다는 보수적인 인식으로 인해 보편적으로는 시행되지 않았다. 소아 PFD에서의 BT의 효용성을 알아보기 위하여 이번 연구를 시행하였다. 방 법: 2002년 9월부터 2005년 2월까지 변지림 또는 보존 치료에 잘 반응하지 않는 만성 변비를 주소로 서울아산병원 소아과로 의뢰된 환아 중 직장 항문기능검사에서 PFD로 진단한 환아 70명을 대상으로 하였다. 진단을 위한 직장 항문기능검사로 배변조영술, 항문 직장내압검사, 배변 동작 시 근전도와 풍선배출검사 등이 시행되었다. BT는 항문내 근전도를 이용하였고, 주 2~3회를 기본으로 회당 20분 정도 실시하였다. 치료 종료시에도 풍선배출검사, 배변 동작 시 근전도를 실시하였다. 치료 전후에 Bristol 분류에 따른 대변 모양과 주당 배변 횟수, 배변 시간 등의 변화와 약물 치료 중단 여부등에 대해 설문으로 조사하였다. 치료 종료 6개월 이상 경과된 환아들을 대상으로 현재의 배변 상태에 대해 전화 설문을 시행하였다. 또한 PFD환아 중 BT를 거부했던 환아들을 대조군으로 하여 BT의 효과를 알아보았다. 결 과: BT 치료 전과 비교하여 치료 직후에 주당 배변 횟수, 변의 모양, 배변 시간 등의 증상과 항문내 근전도, 풍선배출검사 등의 결과는 모두 유의한 호전을 보였다. 평균 약 20개월의 추적 관찰 비교에서도 치료군과 대조군 사이에 성별, 나이, 주증상 등의 유의한 차이는 없었으나, 주당 배변 횟수, 배변 시간, 변 모양의 Bristol분류 등에서 유의한 차이를 보여, BT가 PFD의 증상을 호전시킨다는 것을 알 수 있었다. 하지만 추적 관찰에서 치료에 대한 주관적 만족도와 변지림의 호전은 두 군 간에 유의한 차이를 보이지 않았다. 직장 항문 기능검사 및 BT에 대한 거부감은 치료 성공률과 직접적 관련이 있었다. 결 론: 만성 변비나 변지림을 보이는 소아에서도 직장 항문기능검사에서 PFD를 보이는 경우가 있으며, 이 경우 성인에서와 같이 BT로 증상의 호전이 있었다. 장기 추적 관찰에서도 치료를 받은 군이 대조군보다 유의한 호전을 보였으며 특히 단기간 내에 증상의 호전이라는 측면에서는 유용하였다. 추후 소아 PFD에서 BT의 유용성에 대해 보다 많은 수의 대상에서 전향적인 대조군 연구가 필요하다고 생각한다.