• Title/Summary/Keyword: Chronic Disease Management

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Does the Use of Asthma-Controller Medication in Accordance with Guidelines Reduce the Incidence of Acute Exacerbations and Healthcare Costs?

  • Lee, Suh-Young;Kim, Kyungjoo;Park, Yong Bum;Yoo, Kwang Ha
    • Tuberculosis and Respiratory Diseases
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    • v.85 no.1
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    • pp.11-17
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    • 2022
  • Background: In asthma, consistent control of chronic airway inflammation is crucial, and the use of asthma-controller medication has been emphasized. Our purpose in this study is to compare the incidence of acute exacerbation and healthcare costs related to the use of asthma-controller medication. Methods: By using data collected by the National Health Insurance Review and Assessment Service, we compared one-year clinical outcomes and medical costs from July 2014 to June 2015 (follow-up period) between two groups of patients with asthma who received different prescriptions for recommended asthma-controller medication (inhaled corticosteroids or leukotriene receptor antagonists) at least once from July 2013 to June 2014 (assessment period). Results: There were 51,757 patients who satisfied our inclusion criteria. Among them, 13,702 patients (26.5%) were prescribed a recommended asthma-controller medication during the assessment period. In patients using a recommended asthma-controller medication, the frequency of acute exacerbations decreased in the follow-up period, from 2.7% to 1.1%. The total medical costs of the controller group decreased during the follow-up period compared to the assessment period, from $3,772,692 to $1,985,475. Only 50.9% of patients in the controller group used healthcare services in the follow-up period, and the use of asthma-controller medication decreased in the follow-up period. Conclusion: Overall, patients using a recommended asthma-controller medication showed decreased acute exacerbation and reduced total healthcare cost by half.

Knowledge Structure of Posttraumatic Growth Research: A Network Analysis (네트워크 분석을 통한 외상 후 성장 지식구조 연구)

  • Shin, JooYeon;Kwon, Sunyoung;Bae, Ka Ryeong
    • Journal of Industrial Convergence
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    • v.20 no.10
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    • pp.61-69
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    • 2022
  • Posttraumatic growth literature has been rapidly expanding in multiple academic disciplines. Purpose of this study is to examine the knowledge structure of posttraumatic growth utilizing a network analysis. Papers published between 1996 and 2018 were searched on the Web of Science, focusing on terms related to posttraumatic growth. One thousand six-hundred and fifty-nine keywords were published 6,343 times in 1,780 papers; thus, a total of 322 keywords (5,195 appearances) were selected for the final analysis. The network analysis and network visualization tool used were NodeXL and PFnet, respectively. The keywords which appeared the most frequently were "Posttraumatic growth," followed by "Posttraumatic Stress Disease," "Cancer," and "Trauma." A total of 322 nodes have been reduced to 175 nodes and divided into a total of five groups. The five groups were "Posttraumatic Growth in Cancer, Chronic/Serious Illness, and Disability," "Posttraumatic Growth-related Psychological Variables and Psychotherapy," "Posttraumatic Growth in the Context of Death," "Cognitive Mechanisms of Posttraumatic Growth," and "Vicarious Posttraumatic Growth." This study provides a systematic overview on the knowledge structure of posttraumatic growth by quantitatively network analysis.

Factors influencing the health-related quality of life of postmenopausal women with diabetes and osteoporosis: a secondary analysis of the Seventh Korea National Health and Nutrition Examination Survey (2016-2018) (골다공증이 있는 폐경 후 당뇨 여성의 건강관련 삶의 질 영향요인: 제7기 국민건강영양조사 자료(2016-2018년) 활용)

  • Kim, Hyuk Joon;Kim, Hye Young
    • Women's Health Nursing
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    • v.28 no.2
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    • pp.112-122
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    • 2022
  • Purpose: The prevalence of osteoporosis in postmenopausal women is increasing, and diabetes patients have decreased bone density. Their health-related quality of life (HRQoL) is diminished by the resultant physical dysfunction and depression. The purpose of this study was to identify factors influencing HRQoL in postmenopausal women with diabetes and osteoporosis. Methods: This was a secondary data analysis of the Seventh Korea Health and Nutrition Examination Survey (2016-2018), which utilized a complex, multistage probability sample design. The participants in the study were 237 women with diabetes and osteoporosis. To evaluate the factors that influenced HRQoL, a complex-samples general linear model was constructed, and the Bonferroni correction was performed. Results: In this sample of women aged 45 to 80 years (mean±standard deviation, 71.12±7.21 years), the average HRQoL score was 0.83±0.18 out of 1.0. Factors influencing HRQoL were age (70s: t=-3.74, p<.001; 80s: t=-3.42, p=.001), walking for exercise more than 5 days a week (t=-2.83, p=.005), cerebrovascular disease (t=-8.33, p<.001), osteoarthritis (t=-2.04, p=.014), hypertension (t=2.03, p=.044), higher perceived stress (t=-2.17, p=.032), poor glycemic control (t=3.40, p=.001), waist circumference (t=-2.76, p=.007), sitting time per day (t=-2.10, p=.038), and a longer postmenopausal period (t=3.09, p=.002). Conclusion: In order to improve the HRQoL of postmenopausal women with osteoporosis and diabetes, it is necessary to implement intervention strategies that enable the effective management of chronic diseases, while preventing the complications of diabetes and minimizing stress through physical activity.

A Study on Ability of Cognitive Impairment According for Decreased Balance Function of Pneumoconiosis Patients

  • Tae Hoon Lee;Sang Seok Yeo
    • The Journal of Korean Physical Therapy
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    • v.35 no.4
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    • pp.111-116
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    • 2023
  • Purpose: Pneumoconiosis is a chronic lung disease in which the lungs become hardened due to the accumulation of fine mineral dust that has been breathed in at industrial sites. The lungs are unable to function properly, resulting in complications of several respiratory diseases. Methods: The subjects were 36 elderly adults (pneumoconiosis patients 18, healthy elderly 18) over the age of 65 years. The respiratory function was assessed using a spirometer to measure forced vital capacity (FVC), first second of forced expiration (FEV1), FEV1/FVC, and peak expiratory flow n(PEF). The static balance function test was determined by the center of mass (COM), ankle angle range, hip angle range, sway parameters, and reciprocal compensatory index (RCI). Cognitive function was measured by applying MoCA-k. Results: Comparison of respiration functions between the two groups showed statistically significant differences in FVC, FEV1, FEV1/FVC, and PEFs (p<0.05). Cognitive abilities showed statistically significant differences due to higher cognitive skills in the control group as compared to the patient group (p<0.05). Most results of the static balance capability measurements showed statistically significant differences between the groups (p<0.05). However, no statistically significant differences were obtained for COM AP Range, Angle AP Range, RCI ML Range, and AP Range (p>0.05). Conclusion: The results of the current study indicate that patients suffering from pneumoconiosis have less cognitive ability and balance function as compared to healthy elderly people. Therefore, we expect an improvement in the balance ability and cognitive function through systematic management and strengthening lung function training to improve the quality of life of pneumoconiosis patients.

Factors Affecting the Preparation of Advance Directives of Older People (노인의 사전연명의료의향서 작성에 영향을 미치는 요인)

  • Ji-Kyeong Park
    • Journal of The Korean Society of Integrative Medicine
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    • v.11 no.2
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    • pp.87-99
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    • 2023
  • Purpose : This study intended to provide essential data for developing measures for the stable settlement and expansion of the life-sustaining treatment decision system by identifying the effects on preparing advanced directives. Methods : The effects on preparing advance directives of older people were identified based on Andersen's behavioral model, using the 2020 Korean national survey on elderly. Data were statistically analyzed with SPSS Statistics ver 25.0 and the significance level (α) was set to .05. Results : For factors that influence the preparation of advance directives, the predisposing factor was .769 times less for women than men (p=.026). By age, it was 1.410 times higher (p=.006) for people in their 70s compared to people in their 60s and 1.675 times higher (p=.003) for those in their 80s. By the level of education, it was 1.617 times higher (p=.026) for those who have elementary school education compared to those who have no education, 1.596 times higher (p=.048) for those who have a middle school education, 2.313 times higher (p<.001) for those who have a high school education, and 3.827 times higher (p<.001) for those who have a college education. By religion, it was 1.328 times higher (p=.008) for those who have faith compared to those who do not. For possible factors, it was 2.325 times higher (p=.003) for those who spend 100,000 won or more on healthcare (monthly average) compared to those who do not spend. For necessary factors, it was 1.439 times higher (p=.041) for those with the chronic disease compared to those without. Conclusion : It is deemed a measure that can increase the preparation of advance directives, considering the characteristics of each cause, for the stable settlement of the life-sustaining treatment decision system.

The Role of Pharmacists' Interventions in Increasing Medication Adherence of Patients With Epilepsy: A Scoping Review

  • Iin Ernawati;Nanang Munif Yasin;Ismail Setyopranoto;Zullies Ikawati
    • Journal of Preventive Medicine and Public Health
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    • v.57 no.3
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    • pp.212-222
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    • 2024
  • Objectives: Epilepsy is a chronic disease that requires long-term treatment and intervention from health workers. Medication adherence is a factor that influences the success of therapy for patients with epilepsy. Therefore, this study aimed to analyze the role of pharmacists in improving the clinical outcomes of epilepsy patients, focusing on medication adherence. Methods: A scoping literature search was conducted through the ScienceDirect, PubMed, and Google Scholar databases. The literature search included all original articles published in English until August 2023 for which the full text was available. This scoping review was carried out by a team consisting of pharmacists and neurologists following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews and the Joanna Briggs Institute guidelines, including 5 steps: identifying research questions, finding relevant articles, selecting articles, presenting data, and compiling the results. Results: The literature search yielded 10 studies that discussed pharmacist interventions for patients with epilepsy. Five articles described educational interventions involving drug-related counseling with pharmacists. Two articles focused on similar pharmacist interventions through patient education, both verbal and written. Three articles discussed an epilepsy review service, a multidisciplinary intervention program involving pharmacists and other health workers, and a mixed intervention combining education and training with therapy-based behavioral interventions. Conclusions: Pharmacist interventions have been shown to be effective in improving medication adherence in patients with epilepsy. Furthermore, these interventions play a crucial role in improving other therapeutic outcomes, including patients' knowledge of self-management, perceptions of illness, the efficacy of antiepileptic drugs in controlling seizures, and overall quality of life.

Association between dietary fiber intake and kidney stones: results from the National Health and Nutrition Examination Survey (2011-2018)

  • Weinan Chen;Yang Hong;Sailimai Man; Tao Xu
    • Nutrition Research and Practice
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    • v.18 no.4
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    • pp.534-543
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    • 2024
  • BACKGROUND/OBJECTIVES: Studies on the impact of dietary fiber intake on kidney stones are few, and their results were controversial. This study aimed to explore the association between dietary fiber intake and kidney stones in the nationally representative population of the USA. SUBJECTS/METHODS: This cross-sectional research included 8,588 participants from the National Health and Nutrition Examination Survey, 2011 to 2018. Information regarding dietary fiber intake was obtained from a 24-h recall survey. Participants were categorized into different dietary fiber intake tertiles according to the average of 2 days of dietary recall data. The outcome was self-reported kidney stones. After adjusting for the traditional risk factors, a multivariate logistic regression model was used to examine the association between dietary fiber intake and kidney stones. RESULTS: Eight hundred seventy-two participants had kidney stones. The weighted prevalence (SE) of kidney stones in the lowest tertile, medium tertile, and highest tertile of dietary fiber intake was 11.8% (0.8%), 10.3% (0.8%), and 9.1% (0.8%), respectively. After adjusting for age, sex, race and ethnicity, education level, smoking status, alcohol consumption, physical activity, body mass index, hypertension, diabetes, dyslipidemia, daily water intake, chronic kidney disease stage 3-5, and total energy intake, participants with the highest tertile of fiber intake had a significantly lower risk of kidney stones (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.48-0.95) compared to those in the lowest tertile. Every 5 g/day increment in dietary fiber intake was associated with a significant decrease in risk of kidney stones (OR, 0.90; 95% CI, 0.83-0.98). CONCLUSION: An increase in dietary fiber intake was associated with a lower risk of kidney stones, suggesting adults should be encouraged to maintain an adequate dietary fiber intake to prevent the development of kidney stones. Our results provide evidence to formulate nutrition management strategies for the prevention of kidney stones.

A Study on the Relations Between a Health Promoting Daily Life Style and Self-Efficiency in University Students (대학생의 건강증진행위와 자기효능감과의 관계연구)

  • Huh, Eun Hee;Chung, Yeon Kang;Yeoum, Soon Gyo
    • Journal of the Korean Society of School Health
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    • v.11 no.2
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    • pp.203-215
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    • 1998
  • The purpose of this study is to inquire into the degree of health promotion activity in university students, and to find out the relationship between self-efficiency and health promotion behavior, Thus, we can offer basic data for developing an educational method or program for health promotion. For this research, data was collected from university men and women through a questionnaire from February 18 to March 20, 1998. A measuring instrument was based on lating reviews of health promotion behavior in chronic disease protection, perceived self efficiency, demographic factors, biological factors, and circumstatial factors. The content validity of the instrument was authenticated by two professors of nursing, and reliability was confirmed by 'cronbach' (${\alpha}^{\prime}$ after mortifying content through a pre-test on 30 students. 475 persons were analyzed in terms of average, percentage, t-test, ANOVA, Pearson's Correlation Coefficient, and Multiple Stepwise Regression by 'SPSS-PC'. The analyzed data is as follows: 1. Higher self-efficiency, as a cognitive-perceptual factor, has a beneficial effect on health promotion behavior (r=.479, p=.000). The result of analyzing the differences among a low group, a middle group, a high group in terms of self-efficiency reveals that the relationship between self-efficiency and health promoting behavior is meaningful. 2. The degree of health promoting behavior is 3.26 out of 6. Other figuresrelating to health promoting behavior, are as follows. self-actualization area (4.62), interpersonal area (4.60), stress management area (4.01), nutrition area (3.68), responsibility of health area (3.11), liquid and cigaret area (2.85), and exercise area (2.33). 3. The degree of self-efficiency was 6.81 out of 10. Other figures relating to self-efficiency are as follows. interpersonal area (7.89), self-actualization area (7.84), liquid and cigarette area (7.72), exercise area (6.88), stress management area (6.84), responsibility of health area (6.35), and nutrition area (6.34). 4. The different lerels of health promoting behavior according to a subject's general factos are following: age (p=0.003), sex (p=0.000), health concern of parents (p= 0.000), taking health programs (p=0.007), case history of familes (p=0.048). Health promoting behavier is also positirely affeted by the following: higher age, social sciences focus, religion, living the relatives', and the higher health concerns of parents. 5. The difference of self-efficiency according to a subject's general factors is positirely affected by sex (p=.008), the health concerns of parents (p=.004), body indexes (p=.001), and the higher health concerns of parents. 6. As the result of analyzing major factors, the most powerful factor appears to be self-efficiency, 26.6% of health promoting behavior. Suggestions: 1. Results of this study point to self-efficiency as a major factor in the health promoting behavior of university students. It is crucial, therefore, to develop a health program to promote self-efficiency and to study how to promote prerention of certain diseases. 2. That health promoting behavior appears low in this study shows that health education should be taken into the university class, with a focus on the daily life of students as its goal.

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A Study on the Teachers' Health Problems and Their Visiting Frequencies of School Clinics (교직원 건건문제(健建問題) 및 양호실(養護室) 이용실태(利用實態)에 관(關)한 연구(硏究))

  • Choi, Jae Sun
    • Journal of the Korean Society of School Health
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    • v.1 no.1
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    • pp.160-177
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    • 1988
  • This study is an analysis of the teachers' health problems that focuses on the frequencies and types of their visiting to school clinics and the management of health-related problems. The participants for this study are consisted of 1,650 teachers employed at 30 public schools in the Seoul area. Data for the study came from diagnostic records for 1986, the results of a questionaire-type survey conducted between June 20th and of the same year an from other documents recorded by school nurses. The main results of this study are as follows: 1. The teachers' health problems. a) According to health diagnosis records, 6.1 % of all teachers had a health problem. Liver-related ailments topped the list, followed by circulatory and diabetic problems. b) The survey data had 71.9 % of the respondents indicating that trey suffered from some health problem. The most frequent response concerned respiratory problems, followed by gastro-intestinal and nervous system problems. c) A check of clinic utilization records revealed that the main reasons for visiting are concerned with fatigue (30.5 %), gastro-intestinal(18.7 %) and respiratory(18.2 %) ailments. These three categories accounted for 67.4 % of total use. 2. Frequencies of their visiting to school clinics 40.5 % of the teachers indicated that they have visited the school clinic. And 62.0 % visited it with a self-diagnosed ailment and 15.3 % utilized the facility after a problem had been detected in a health examination. Clinics were visited a total of 1,458 times which breaks down to 0.9 times per month per teacher. For a patient, the figures are 2.2 times on the average with a range from 1 to 19. 3. Health management problems a) Of those respondents. 53.4 % stated that they didn't have enough time to consult about their health problems and diagnose their disease b) Also, 47.3 % of the respondents indicated that school nurses should give health counsels and health education. c) When questioned about improvements in the current system, the teachers placed importance on the prevention and management of chronic diseases (35.2 %) and pre- and posteducation concerning periodic health examinations In conclusion, the following points must be considered: First, school administrators need to pay more attention to the health problems of the teachers. Second, school nurses should be more active in managing a health program for teachers. Finally, education and training for nurses should be continually upgraded so that they can dispense proper and timely care for teachers.

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An Effect of the Self-Regulation Program for Hypertensives -Synthesis & testing of Orem and Bandura's theory- (본태성 고혈압 환자의 자가간호증진을 위한 자기조절 프로그램 효과 -Orem이론과 Bandura이론의 합성과 검증-)

  • Park, Young-Im;Hong, Yeo-Shin
    • Research in Community and Public Health Nursing
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    • v.5 no.2
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    • pp.109-129
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    • 1994
  • Chronic health problems has become a major concern and challenge to the health care professionals today. Especially hypertension, one of the leading primary cause of death in Korea, is a typical chronic disease requiring adequate and continuous management. Though these hypertensives need to maintain desirable health practice by themselves for their life time, many previous studies indicated that most of the essential hypertensives have no specific symptoms and thus, reluctant to follow appropriate medical regimens causing the condition further aggravated and complicated. Self-care is an essential factor that keeps chronic patients in control of their health and wellness. Thus this study was conducted to identify the effect of the comprehensive self-regulation program as a nursing intervention on the promotion self-care performance and improvement in physical parameters of hypertensives. For this purpose, a one group quasi-experimental research with pre and post test design was used. The subjects of the study was consisted of thirty persons with mild or moderate essential hypertension from two companies in Cheong-ju city. The whole program was carried out from October, 1993 to February, 1994. The self-regulation program was consisted with group education on hypertension and self-care, self-regulation including the blood pressure self-monitoring and recording, recording of daily self-care activities, and encouraging and reinforcing self-efficacy through verbal persuation and enactive attainment. The subjects were asked to measure their own blood pressure by themselves twice per day and to record blood pressure and the daily self-care performance according to the instructions provided during the whole period of 9 weeks. The instruments used for data collection in this study were as follows : 1) Instruments used for measuring the knowledge about hypertension, multiple health locus of control, and perceived benifits and barriers were adapted from previous studies and modified by author to be fit for the subjects. 2) Self-efficacy scale and self-care performance record were developed by the author. 3) Physiological parameters included systolic / diastolic blood pressure, body weight, level of blood cholesterol, and 24hour ambulatory blood pressure. The post-experimental Cronbach's Alpha as the reliability test of scales were 0.703-0.897, an appropriate level of confidence. The effect of the program was analyzed by experimental stages ; the first week, the fifth week, and the ninth week since the experimental imput began. Data were analyzed by the SPSS PC+ program with paired t-test and t-test, repeated measure ANOVA, and pearson's correlation to de termine the effect of program. The results were as follows : 1) After the self-regulation program, scores on knowledge(t=-2.41, p=.011), perceived self-efficacy (F=5.60, p=.001), self-care performance(F=22.31, p=.0001) were significantly higher than those before the program. 2) After the program, both systolic and diastolic blood pressure were significantly lower than those before the program(F=10.89 -13.11, p=.0001). However in 24hour ambulatory blood pressure, systolic mean pressure was nearly significantly lower, but not in diastolic mean pressure. 3) After the program, the body weight was significant decresed(t=5.53, p=.0001), but the blood cholesterol level was not decreased significantly except in those cases with higher cholesterol level. 4) There were significant relationships between changes in self-care performance and diastolic pressure at 1st week (r=.3389, p=.033) and changes in self-care performance and systolic pressure at 9th week(r=.3651, p=.024). 5) There were significant relationship between perceived self-efficacy and self-care performance at 5th week(r=.5313, p=.001) and 9th week (r=.3026, p=.052). 6) After the program, internal health locus of control and perceived benefits did not show significant change, but perceived barriers was significantly lower than those before the program (t=3.57, p=.0001). From the above results, it can be concluded that 1) The self-regulation program is an effective nursing strategy to promote self-care performance of hypertensives and to lower the blood pressure. Thus this program can be recommended in the management of the hypertensives in workplaces and community settings. 2) The synthesis of Orem's self-care theory and Bandura's self-regulation & self-efficacy theory in this study was proved to enhance explanation and prediction of the change of self-care behavior. Thus the result of the study would contribute in development of the self-care theory and an expansion of practice-theory.

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