• 한국사회복지학
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• 제56권3호
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• pp.113-133
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• 2004

본인부담과 관련한 이전의 연구들을 살펴보았을 때 외래와 입원 또는 상병별로 환자개인의 본인부담이 진료비에서 차지하는 비율을 파악하여 우리나라 건강보험이 안고 있는 보장기능의 취약성을 거론하거나 이와는 반대로 의료수요의 가격탄력성을 측정, 소비자의 도덕적 해이의 가능성을 지적하는데 초점을 맞추고 있음을 알 수 있다. 그러나 현재 환자본인이 부담하여야 하는 진료비규모를 파악하여 평균 본인부담액의 실제규모와 본인부담률을 밝히는 동시에 만성질환 보유여부, 의료보장의 종류, 또는 의료서비스 기관에 따른 본인부담의 비형평성 문제에 대하여 직접적으로 논의하는 작업은 극히 미미한 실정이다. 높은 본인부담의 결과로 경제적으로 취약하거나 만성질환에 시달리는 계층이 가장 큰 피해를 입게 된다는 점에서 이에 대한 심도 있는 임상적 및 정책적 논의는 절실하다. 이러한 맥락에서 본 연구는 의료서비스에 대한 계층간 본인부담의 차이가 형평성에 미치는 영향을 분석하고 이에 관련된 정책적 함의를 도출하는데 그 목적이 있다. 본 연구의 결과에서 소득 5분위 대비 최하위 계층의 경우 월등히 높은 만성질환 유병률을 보이고 있음에도 불구하고 최상위층의 6배가 넘는 과중한 본인부담을 안고 있음이 밝혀졌다. 또한 최종적인 회귀분석모형 분석결과는 의료이용 빈도 이외에 환자본인의 인구학적 특성, 가구소득, 만성질환 수, 보험의 종류, 상용치료기관의 종류가 본인부담의 규모를 결정짓는데 있어 영향을 미치는 결정적 요인들로 드러났다.

• 근관절건강학회지
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• 제4권1호
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• pp.1-14
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• 1997

It is reported that self-help education is effective to increase self-efficacy for the patients with chronic illness. Also self-efficacy Is proved to be an Important variable to effect the physical and psychological health state. Based upon this theoretical framework, KRHPS (Korean Rheumatology Health Professions Society) has administered for 2 years the self-help education increasing self-efficacy for the patients with arthritis. The group had a weekly session for 6 weeks. During the session, self-efficacy was increased by 1) actually performing a behavior, 2) listening to other patients talking about a successful experience or seeing other patients performing a behavior, 3) Instructor's or another patient's verbal persuasion, and 4) physiological cues experienced by themselves. Every group had 4-15 participants and 2 instructors. Data were collected by self-administered questionaire for 211 out of 361 participants. One hundred and fifty two subjects were analyzed because of missing values. As a result, it was confirmed that self-help education was effective to increase self-efficacy and self-efficacy was an important variable to Improve pain, depression, and ADL. Also it may fairly be said that nurses were right health-professionals to lead self-help groups for the patients with chronic illness. So it is important to facilitate many other self-help education for the patients with chronic illness.

• 한국노년학
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• 제37권4호
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• pp.871-891
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• 2017

한국의 중 고령자들이 60세 이전에 조기은퇴하는 현상의 주된 이유로 건강문제가 거론된다. 일부 선행연구에서는 은퇴 이후 시점에서의 건강과 조기은퇴 간의 관계를 알아보았다는 점에서 역인과관계 문제가 존재한다. 또한 근로 당시의 건강상태를 고려하지 않고 건강문제와 조기은퇴 간의 관계를 분석함으로 인해 건강문제의 영향력이 과대평가될 수 있는 문제점이 제기된다. 이를 보완하기 위하여 본 연구는 근로 시기와 비교해 건강상태의 악화가 조기은퇴에 어떠한 영향을 미치는지 알아보는 것을 목적으로 하였다. 고령화패널 1차 자료에서 조사된 45~52세 중 고령 근로자 1,049명을 대상으로 고령화패널 5차 자료까지의 추적연구를 통해 건강의 악화가 조기은퇴에 미치는 영향을 콕스의 비례위험모형으로 분석하였다. 그 결과 은퇴 이전 시점에서 치료가 필요한 만성질환의 증가는 자영업자의 은퇴 위험을, 주관적 건강상태의 악화는 임금근로자의 은퇴 위험을 유의하게 높이는 것을 확인했다. 이러한 결과는 역인과관계 문제와 편향 문제를 없애거나 줄인 상황에서도 건강 악화는 여전히 조기은퇴의 주된 원인임을 보여준다. 자영업자와 임금근로자 간 은퇴원인의 차이는, 자영업자의 근로신축성에 기인한 것으로 추측된다.

• 근관절건강학회지
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• 제4권2호
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• pp.197-220
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• 1997

The lack of a comprehensive theory describing the mechanism of adaptation scientifically has been one of the limiting factors for the development of nursing intervention of patients with chronic illness. Since Roy's theory provides the general conceptual framework depicting adaptation process with structural stimuli and control mechanism, it is appropriate to understand the process of adaptation. But in Roy's theory, the propositions about cognator and regulator as control mechanisms are not clearly defined. For this reason, most of the previous researches applying the Roy's theory have disregarded the study of cognator and regulator. For the patients with chronic illness such as rheumatoid arthritis, it was reported that adaptation states were different for the same stimuli due to the difference of the control mechanism. Moreover in nursing it is important to identify the control mechanism which can be and must be intervened by nurses. It was the Lazarus and Folkman's theory that proposed the control mechanism. They suggested that individual differences in the reaction against the perceived stress are due to the difference in appraisal and coping. Therefore, the synthesis of Roy's and Lazarus and Folkman's propositions might help to clearly understand the mechanism of adaptation. From this point, a theoretical framework has been developed and tested. The subjects were the 297 patients who had been diagnosed rheumatoid arthritis and attended the outpatient clinic. A hypothetical prediction model of adaptation was tested by the covariance structure analysis with PC-LISREL 7.13. As a result, the overall fit was good($x^2$=78.83, p=0.00 ; GFI=0.96 : AGFI=0.90 ; RMR=0.04) for the hypothetical model. In the final model added GA(5, 1), the overall fit was increased ($x^2$=57.82, p=0.003 ; GFI=0.97 ; AGFI=0.93 : RMR=0.036). Except the fact that illness symptoms affected physical adaptation directly, it was supported that focal and contextual stimuli affected physical and psychosocial adaptation through appraisal and coping. Therefore, it was asserted that the synthesis of two theory's propositions was appropriate. So this model would be useful for the theoretical framework in the nursing practice. And this study synthesizing and testing the theory might contribute to establish nursing's scientific base.

• 대한한방소아과학회지
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• 제13권1호
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• pp.191-204
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• 1999

Background: Nasal polyps are benign mass of nasal mucose, chronic sinusitis are swelling of nasal mucose, so nasal polyps and chronic sinusitis take a place at the same time. Nasal polyps are located lateral wall of nose, middle meatus, between middle nasal concha and inferior nasal concha. Objective: To demonstrate the effect of herbal medicine therapy in the chronic sinusitis and nasal polyps before and after treatment using computed tomography (CT). To compared before and after treatment of otitis media using earscope. Materials and methods: Five patients (4 mail and 1 femail) treated in our hospital between August 1998 and July 1999 were studied. Ages ranged from 9 to 23 years (mean age:13 years). All patients had a underlying family history, and past history(allergy or sinusitis of parents or brothers). Illness period was from 1 to 36 months (mean period:10.5 month). To ascertain the efficacy of treatment, CT were checked out. In the CT, three images were obtained 2cm interval on the coronal and axial plan. We classified treatment period into the type of allergic disease. Gamihyunggyeyungyo-tang was administered mainly. Gamigwaghyangjeungki-san, Gamizwakwi-eum and Gamihyangso-san were administered for through oral route additional symptoms. Results: Treatment period was from 126 to 157 days (mean period:140.7 days). To 3 patients with chronic sinusitis and nasal polyp, treatment period was 140.7 days, to 2 patients with otitis media and chronic sinusitis and nasal polyp, treatment period was 141.5 days. So they had no significance. Not nasal polyp from middle meatus, but also polypoid mucosal change of maxillary sinus is polyps Conclusion: We know that herbal medicine therapy is the effective treatment of pediatric chronic sinusitis and otitis media using earscope and CT. Herbal medicine therapy was effective in increasing immunity, inhibiting allergic reaction and inflammation of respiratory system. we practice ECP(eosinophil cataionic protein) and MAST examination, objectify herbal medicine therapy.

• 제3의학
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• 제2권1호
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• pp.13-23
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• 1997

Modern medicine can not solve all the problems caused by many intractable, chronic and aging related diseases hence more people have come to recognize the role of foods for the promotion of good health as well as prevention from illness. Further more, controlled diet are proven to be used as effective cures for certain diseases. In this paper, the definition, functional factors and mechanisms of designer(funtional) foods are reviewed. Especially, the biofuntional activities of herbal medicines which also can be treated as designer foods are intensively noted in this paper.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제28권1호
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• pp.4-13
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• 2017

The seeds of addiction are typically sown years prior to the onset of addictive substance use or engagement in addictive behaviors, due to the priming of the reward pathway (RewP) by alterations in the mechanism of stress-signaling from the hypothalamic-pituitary-adrenal axis (HPA) and related pathways. Excessive stress from a single-event and/or cumulative life experiences during childhood, such as those documented in the Adverse Childhood Experiences Study, is translated into neurobiological toxicity that alters the set-point of the HPA axis and limbic system homeostasis [suggested new term: regulation pathway (RegP)]. The resultant alteration of the RegP not only increases the risk for psychiatric and physical illness, but also that for early onset and chronic addictions by dysregulating the RewP. This paper reviews the interface of these symbiotic pathways that result in the phenotypic pathology of emotional dysregulation, cognitive impairment, and compulsive behaviors, as well as morbidity and shorter life expectancy when dysregulated by chronic stress.

• 성인간호학회지
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• 제24권5호
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• pp.540-545
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• 2012

Purpose: The purpose of the study was to compare level of functional independence and its correlates among community-dwelling older adults in rural areas between South Korea and the United Sates. Methods: The study employed a comparative and correlational design. Data were collected from 198 community-dwelling older adults in rural areas (South Korea=100, & US = 98). Functional independence, cognitive function, obesity and general characteristics were measured. Results: From both countries, approximately fifteen percent of older adults living independently had cognitive problems without any treatments. Among Korean older adults functional independence was associated with a number of chronic diseases and aging while in the United States the participants had a negative correlation with obesity and aging. Conclusion: For Korean older adults in rural areas, nurses should focus on monitoring older adults' abilities to manage chronic illness and designing self-management programs while in the United States the focus should be on healthy lifestyle programs about exercise and diet to increase functional independence.

• 전자공학회논문지
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• 제51권1호
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• pp.233-240
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• 2014

최근 노인인구의 증가하는 추세에 따라 만성질환자의 수도 증가하고 있으며 건강 관리문제가 중요하게 대두되고 있다. 본 논문에서는 만성질환자의 건강관리를 위한 유헬스케어 시스템을 구현하고자 한다. 제안한 만성 질환자 관리 시스템은 생체 계측 시스템과 모바일 게이트웨이 그리고 의료정보 관리 서버 그리고 클라이언트로 구성되면 생체 신호는 심전도, 혈압, 혈당, 산소포화도 등의 모듈로 구성하였다. 혈당체크는 이동성을 고려하여 생체계측 시스템으로 전송하는 방법과 게이트웨이로 전송하는 방법 중 선택할 수 있도록 구현하였다. 제안한 생체 계측 시스템과 모바일 게이트웨이는 블루투스 통신을 이용하여 전송한다. 전송된 생체 데이터는 모바일 게이트웨이에서 건강상태를 감시하거나 네트워크 서버로 전송하고 클라이언트을 이용하여 검색 할 수 있도록 하였다. 만성질환자의 생체신호 감시 시스템을 구현함으로서 측정되어진 생체 데이터를 모니터링하여 현재의 건강상태를 확인할 수 있었으며 모바일 환경에서 다양한 생체신호를 전송하였다.

• 한국산학기술학회논문지
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• 제14권8호
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• pp.3715-3723
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• 2013

본 연구의 목적은 요양시설 입소노인의 중증질환자와 명리학적 선천성질환의 상관관계, 스트레스 충격척도, 정서적 탈진척도 요인을 분석하고자 한다. 연구대상은 서울시에 소재하는 요양시설에 입소한 노인들 중에서 4대 중증질환자의 147명을 대상으로 2013년 3월 15일부터 5월 31일까지 실시하였다. 연구방법은 빈도분석, 상관분석, 단순회귀분석, t-test, 일원변량분석 등을 실시하였고, 실증분석은 모두 유의수준 5%에서 검증하였다. 분석결과 및 결론은 중증질환 자와 명리학적 선천성질환의 상관관계가 높게 나타났으며, 중증질환 판정시 스트레스척도가 높게 나타났다. 그리고 스트레스 척도가 높을수록 정서적 탈진척도도 높게 나타났다.