• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7409-7414
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• 2013

Background: Delay in diagnosis of breast cancer is associated with a poorer survival and a pivotal contribution to this delayed diagnosis comes from patient delay in presenting at a clinic. Reasons involved must be evaluated in order to decrease this reducible delay. Objectives: i) To evaluate the reasons for patient delay in diagnosis of breast cancer; ii) to investigate any association with other variables. Materials and Methods: A 6 month cross sectional study (from July 2012 to Dec 2012), was carried out in Surgical and Oncology Units of Civil Hospital, Karachi. A total of 100 females diagnosed with breast cancer of any histological type were interviewed after informed consent and relevant data were collected. Due ethical clearance was obtained. Results: Mean age was $47.5{\pm}12.1$ years with a range from 25-77 years. Mean duration of delay was $5.13{\pm}4.8$ months, from shortest 1 month to longest 36 months. Duration of delay was observed to be no delay (<1 month) in 28%, short delay (1-3 months) in 30% and long delay (>3 months) in 42% of patients. Considering the symptoms as "harmless" (39%) was the most frequent reason of delay followed by "temporary" (20%) and the "use of traditional methods" (12%). Most common reason for later approaches was an increase in the size of the lump (41%). Statistically significant association (p-value <0.05) of longer patient delay was obtained with being single, being illiterate, painless breast lump as the first symptom, negative family history of breast cancer and vague attribution of the symptoms. Conclusions: Significant delay in approach to health care facility was observed in our study due to variable reasons given by women. Sufficient awareness regarding breast cancer, its symptoms and favorable effects of a timely diagnosis on prognosis must be imparted to our general population.

• 한국사회정책
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• v.25 no.1
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• pp.99-123
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• 2018

Purpose: This study empirically investigates the utilization and expenditure of health care and long-term care at the last year of life for long-term care beneficiaries in Korea. Methods: This study used National Health Insurance and Long-term Care Insurance claims data of 271,474 LTCI beneficiaries, who died from July 2008 to December 2012. Their cause of death, place of death, health care costs, and the provision of aggressive care were analyzed. Results: Cardio-vascular disease(29.8%) and cancer(15.3%) were reported as their major cause of death, and hospital(64.4%), home(22.0%), social care facility(9.2%) were analyzed as the place of death. 99.3% of subjects used both health care and long-term care during the last 1 year of life. The average survival period were 516.2 days after they were LTCI beneficiaries. The health care expenditure gradually increased near the death, and the last month were three times more rather than the first month. Furthermore, 31.8% experienced some aggressive cares(CPR, blood transfusion, hemo-dialysis, etc.) at the last month of life. Conclusion: The results of this study suggest that it is important to develop the end of life care policies(for example, hospice, advanced care directives) for the LTCI beneficiaries. They might contribute to the improvement of quality of life and the reduction of health care expenditure of the elderly at the end-of-life.

• Journal of Hospice and Palliative Care
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• v.21 no.3
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• pp.75-83
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• 2018

Purpose: To provide effective palliative care, it is important to predict not only patients' life expectancy but their discharge status at a time of inpatient admission to a hospice care facility. This study was aimed to identify meaningful life expectancy indicators that can be used to predict patients' discharge status on admission to the facility. Methods: Among 568 patients who were admitted to the hospice ward of P hospital from April 1, 2016 through December 31, 2017, 377 terminal cancer patients were selected. This retrospective cohort study was performed by using performance status, symptoms and signs, socioeconomic status, laboratory findings on admission. Results: Alive discharge was associated with a good performance status that was measured with the Karnofsky and Eastern Cooperative Oncology Group (ECOG) scales and the Global health and Mental status. Less anorexia, dyspnea, dysphagia and fatigue were also associated with symptoms and signs. Associated laboratory findings were close to normal Complete Blood Cell (CBC) count, Liver Function Test (LFT) and Blood Urea Nitrogen (BUN). Conclusion: Our findings suggest that Karnofsky Performance Status (KPS), ECOG, Global health, Mental status, anorexia, dyspnea, dysphagia, fatigue, CBC, LFT, BUN are meaningful indicators when predicting discharge status for inpatients. Further investigation is warranted.

• Korean Journal of Hospice Care
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• v.2 no.2
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• pp.49-57
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• 2002

Background: The purpose of this study is to find out to how much influence religion had on the quality of life in patients admitted to the hospice facility at Saemmul's House. Terminal cancer patients were assessed one to two weeks after admittance to Saemmul's House. Metohd: The subjects of this study were numbered at 75 patients and were admitted to the hospice facility at Sammul's house between January 2002 and July 2002. The data regarding quality of life was collected using a questionnaire prepared by the sammul Hospice and were analyzed by means of ANOVA and T-test. Result: As a result of this study, there was no noticeable difference in quality of physical, psychosocial life between the patients with conviction of salvation and the other patients. However, it shows that the former enjoyed a higher spiritual quality of life than the latter. In case of baptized patients and unbaptized patients, there were no differences in terms of physical and psychosocial quality of life, but the baptized patients demonstrated a higher spiritual quality of life. After admittance, patients were grouped by duration of conviction of salvation I.e., those that believed more than 5 years and those that believed less than 5 years. In terms of physical, psychosocial quality of life, there was little difference between the two groups. However, those who believed more than 5 years demonstrated a higher spiritual quality of life. However, there was no difference in quality of life among patients, regardless of their belief in God, after receiving spiritual care at the hospice. Conclusion: We got a few conclusions in accordance with result gained by this study. First, spiritual support is very important to improving quality of patients' lives in hospices. Second, hospice programs are needed keenly and spiritual support for patients from trained experts is needed 24 hours a day. Third, because trained experts(ministry) are urgently needed to lend spiritual support, hospice courses must be taught at all colleges of theology. Fourth, a hospice program must provide a proper atmosphere that can give spiritual support and therefore all hospices must build such as environment. Fifth, a tool for spiritual support of hospice must be developed.

• The Journal of the Korea Contents Association
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• v.18 no.1
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• pp.76-89
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• 2018

The purpose of this study is to analyze factors affecting a grade maintenance of long-term care service users. Using 2008-2014 long-term care raw data of National Health Insurance Service(NHIS), the predictors were examined through the logistic regression by long-term care beneficiaries of grade. The results showed that there are differences by 3 factor groups and grade groups(1-3 grade). In socio-demographic factors, in the 1, 3 grade, Individuals 64 or younger presented a much higher probabilities of the grade maintenance than those 85 and over. In the 3 grade, people of living alone, resident of rural area presented a much higher probabilities of the grade maintenance than others. In disease factors, In the 1 grade, people with dementia presented a much higher probabilities of the grade maintenance than other 2, 3grades. In the 2 grade, people with stroke, fracture presented a much higher probabilities of the grade maintenance than others. In the 3 grade, people with cancer presented a much higher probabilities of the grade maintenance than others. In service factors, In the 2, 3grade, people having more renewal numbers presented a much higher probabilities of the grade maintenance than others. In the 1 grade, people who use facility benefits for more days presented a much higher probabilities of the grade maintenance than others. In the 2 grade, people who use in-home benefits for more days presented a much higher probabilities of the grade maintenance than others. Based on the finding of study, implications and future research directions were discussed for policy considerations.

• Asian Journal of Atmospheric Environment
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• v.8 no.1
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• pp.35-47
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• 2014

The purpose of the study is to evaluate the pollution level (gaseous and particle phase) in the public facilities for the PAHs, non-regulated materials, forecast the risk level by the health risk assessment (HRA) and propose the guideline level. PAH assessments through sampling of particulate matter of diameter < 2.5 ${\mu}m$ ($PM_{2.5}$). The user and worker exposure scenario for the PAHs consists of 24-hour exposure scenario (WIES) assuming the worst case and the normal exposure scenario (MIES) based on the survey. This study investigated 20 PAH substances selected out of 32 substances known to be carcinogenic or potentially carcinogenic. The risk assessment applies major toxic equivalency factor (TEF) proposed from existing studies and estaimates individual Excess Cancer Risk (ECR). The study assesses the fine dusts ($PM_{2.5}$) and the exposure levels of the gaseous and particle PAH materials for 6 spots in each 8 facility, e.g. underground subway stations, child-care facilities, elderly care facilities, super market, indoor parking lot, terminal waiting room, internet caf$\acute{e}$ (PC-rooms), movie theater. For internet caf$\acute{e}$ (PC-rooms) in particular, that marks the highest $PM_{2.5}$ concentration and the average concentration of 10 spots (2 spots for each cafe) is 73.3 ${\mu}g/m^3$ (range: 6.8-185.2 ${\mu}g/m^3$). The high level of $PM_{2.5}$ seen in internet cafes was likely due to indoor smoking in most cases. For the gaseous PAHs, the detection frequency for 4-5 rings shows high and the elements with 6 rings shows low frequency. For the particle PAHs, the detection frequency for 2-3 rings shows low and the elements with 6 rings show high frequency. As a result, it is investigated that the most important PAHs are the naphthalene, acenaphthene and phenanthrene from the study of Kim et al. (2013) and this annual study. The health risk assessment demonstrates that each facility shows the level of $10^{-6}-10^{-4}$. Considering standards and local source of pollution levels, it is judged that the management standard of the benzo (a)pyrene, one of the PAHs, shall be managed with the range of 0.5-1.2 $ng/m^3$. Smoking and ventilation were considered as the most important PAHs exposure associated with public facility $PM_{2.5}$. This study only estimated for inhalation health risk of PAHs and focused on the associated cancer risk, while multiple measurements would be necessary for public health and policy.

• Korean Journal of Hospice Care
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• v.5 no.1
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• pp.74-81
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• 2005

Purpose: The purpose of this study is to help apply spiritual care in clinics by testing whether spiritual support like prayer and praise, which is appled on a patient who has been cared for by Facility Hospice can have an effect on their physical pain, emotional anxietv, loneliness and well being. Method: This research was done on a subject patient who had been hospitalized in Saemmul from Jan, 2002 to June, 2003, and who could easily communicate. Questionnaire of quality of life, they had this test from the date of admission into the hospital 1week, 3week, 5week later. The Target was 182 people for the hospital data, 124 people after one week, 84 people after 3 weeks and 54 people after for 5 weeks later. For statistics, SPSS for Window(SPSS inc. ver.10), student T-test and one way ANOVA were used. The interrelation between pray and pain was analyzed by the "Pearson correlation". In case where the P-value was below 0.05, we concluded it had statistical-value. Results: When we compared both the party which had a low degree of peace by prayer and praise and the B party which had the highest degree, B party had an increasing tendency for less anxiety and loneliness and more well-being. Each of the data 0, 1, 3 and 5 week showed visible difference between both parties. Conclusion: First, in case that a late cancer patient is hospitalized, the difference for tranquility and pain control by prayer and praise is not noticeable. While, 1 and 3 weeks later, the difference is visible, so we concluded the relationship between the cancer patient's spiritual tranquility and physical pain are closely related with each other. Also the patients who are in spiritual peace by prayer and praise can control the pain better than the other patients. Second, because the patient who can feel calm from the data of being admitted into the hospital is mentally calm, both party's difference is noticeable in each period of the 1, 3 and 5th week. Compared with other patients, the object patients who have spiritual tranquility will have less anxiety and loneliness and more tranquility.

• Journal of Music and Human Behavior
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• v.13 no.2
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• pp.17-30
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• 2016

This study aimed to examine the current state of music therapy for adults with intellectual disabilities (ID) by conducting a survey of music therapists. Completed surveys from 32 certified music therapists were included for analysis. The questionnaire was composed of 38 items that asked about the participants' background, work environment and music therapy implementation experience (including assessment, goal establishment, intervention strategy and difficulties). The results of the study showed that music therapy for adults with ID was practiced in diverse facilities. Enhancing social interaction was the most frequently set goal by music therapists, whereas facilities mostly required the music therapy services for emotional stability. Also, instrument playing was used most among music activities, and musical structure was considered most when choosing music for therapy. Among the influential institutional factors, characteristics of the facility were considered most frequently, and the level of functioning was the most considered in terms of client-related factors. To advance the effective use of music therapy interventions with adults with ID, development of music therapy assessment tools and more active communication with facility staff were also suggested when working with this population.