• Journal of Preventive Medicine and Public Health
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• 제47권4호
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• pp.236-243
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• 2014

Objectives: Despite the recent emphasis on a patient-centered chronic care model, few studies have investigated its use in older adults in South Korea. We explored how older Korean adults perceive and cope with their chronic illness. Methods: We conducted focus group interviews in Seoul, Korea in January 2010. Focus groups were formed by disease type (hypertension and type 2 diabetes) and gender using purposive sampling. Inclusion criteria were patients aged 60 and over who had been diagnosed with diabetes or hypertension and received care at a community health center for at least six months prior to participation. Interview data were analyzed through descriptive content analysis. Results: Among personal factors, most participants felt overwhelmed when they received their diagnosis. However, with time and control of their acute symptoms using medication, their worry diminished and participants tended to denying being identified as a patient or sick person. Among socio-familial factors, participants reported experiencing stigma with their chronic illness and feeling it was a symbol of weakness. Instead of modifying their lifestyles, which might interfere with their social relationships, they resorted to only following their medicine regime prescribed by their doctor. Participants also reported feeling that their doctor only prescribed medications and acted in an authoritative and threatening manner to induce and reinforce participants' compliance with treatment. Conclusions: For successful patient-centered management of chronic illnesses, supportive environments that include family, friends, and healthcare providers should be established.

• 대한간호학회지
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• 제37권4호
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• pp.490-500
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• 2007

Purpose: The purpose of this study was to identify factors influencing the outcome of psychosocial rehabilitation for persons with chronic mental illness and to suggest a hypothetical model of psychosocial rehabilitation which is based on the relationship between influencing factors and then to test its fitness empirically. Method: Data was collected from persons with a chronic mental illness using a self-report questionnaire, and from their case managers using an observed rating questionnaire. A total of 220 cases were used in the final analysis, and a hypothetical model was verified through covariance structure analysis using LISREL. Result: 1) The fitness indices of the model were $X^2=133.77$ (df=48, p=.00), GFI=0.93, AGFI=0.87, RMR=2.32, NNFI=0.95 and NFI=0.95. Twelve paths among fifteen proved to be significant. 2) Psychosocial rehabilitation was influenced directly by symptoms, daily living skill and self-concept, and was influenced indirectly by the psychosocial rehabilitation program service. Psychosocial rehabilitation accounted for 32% of variance of these factors. Conclusion: This study is expected to contribute to understanding the psychosocial rehabilitation phenomena. Besides it will provide basic information for developing strategies of bio-psycho-sociological interventions and evaluations in regard to influential factors of psychosocial rehabilitation.

• 보건행정학회지
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• 제4권2호
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• pp.58-76
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• 1994

In order to study factors affecting the use of the ambulatory physician services. Andersen's model for health utilization was modified by adding the health behavior component and examined with three different approaches. Three different approaches were the multiople regression model, logistic regression model, and LISREL model. For multiple regression, dependent variable was reported illness-related visits to a physician during past one year and independent variables are variaous variables measuring predisposing factor, enabling factor, need factor and health behavior. For the logistic regression, dependent variable was visit or no-visit to a physician during past one year and independent variables were same as the multiple regression analysis. For the LISREL, five endogenous variables of health utiliztion, predisposing factor, enabling factor, need factor, and health behavior and 20 exogeneous variables which measures five endogenous variables were used. According to the multiple regression analysis, chronic illness, health status, perceived health status of the need factor; residence, sex, age, marital status, education of the predisposing factor ; health insurance, usual source for medical care of enabling factor were the siginificant exploratory variables for the health utilization. Out of the logistic regression analysis, health status, chronic illness, residence, marital status, education, drinking, use of health aid were found to be significant exploratory variables. From LISREL, need factor affect utilization most following by predisposing factor, enabling factor and health behavior. For LISREL model, age, education, and residence for predisposing factor; health status, chronic illess, and perceived health status for need factor; medical insurance for enabling factor; and doing any kind of health behavior for the health behavior were found as the significant observed variables for each theoretical variables.

• Child Health Nursing Research
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• 제12권3호
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• pp.295-303
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• 2006

Purpose: The purpose of this study was to describe the relationship between resilience and health-related quality of life and to identify the effect of resilience on health-related quality of life in children with chronic illness. Method: The participants in this study were 71 children who were seen at one of 3 hospitals, either in outpatient clinics or as admitted patients. The data were collected from March to October, 2005 and descriptive statistics, t-test or ANOVA, Pearson correlation coefficient and stepwise multiple regression were used to analyze the data. Result: Health-related quality of life was slightly low with a mean score of 2.85 (range 1-5). Health-related quality of life was significantly different according to age. There was a significant correlation between resilience and health-related quality of life. Resilience was a predictor of health-related quality of life and accounted for 45% of the variance. Conclusions: Resilience was shown to influence health-related quality of life of children with chronic illness. These findings suggest that the interventions to enhance resilience would be effective for the improvement of health-related quality of life.

• Journal of Preventive Medicine and Public Health
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• 제18권1호
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• pp.25-39
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• 1985

도시 영세지역 주민의 이환 및 의료이용 양상을 파악하기 위하여 1984년 7월 한 달 동안에 대구시 중구 남산 4동 영세지역 468가구의 가구원 2,002명과 대조지역 374가구의 가구원 1,709명을 대상으로 가구원의 일반적 특성, 질병이환 및 의료이용 양상 등을 면담조사 하였다. 영세지역과 대조지역의 성별, 연령별 분포는 비슷하였으나, 경제수준, 교육수준, 주거밀집도, 의료보장 종류별 분포는 유의한 차이를 보였다. 15일간의 상병 이환율은 영세지역이 1,000명당 131로 대조지역의 71보다 유의하게 높았고, 연령이 증가함에 따라 이환율도 증가하는 경향을 보였으나 65세이상의 노인층에서는 오히려 감소하였다. 년간 만성병 이환율도 영세지역이 1,000명당 134로 대조지역의 89보다 유의하게 높았고 나이가 증가함에 따라 이환율이 증가하였다. 15일간의 상병은 영세지역과 대조지역 모두 호흡기계 질환이 각각 24.0%, 29.8%로 가장 많았고 그 다음은 소화기계 질환으로 21.0%, 20.6%였으며 손상 및 중독은 영세지역이 10.3%인데 비해 대조지역은 3.3%였다. 만성병은 영세지역과 대조지역 모두 소화기계질환이 22.1%, 21.7%로 가장 많았고 그 다음으로 영세지역은 근골격계 질환으로 12.3%, 대조지역은 신경통으로 14.5%였으며, 순환기계 질환은 대조지역이 11.8%로 영세지역의 5.6% 보다 더 많은데 비해 손상 및 중독은 영세지역이 10.8%로 대조지역의 4.6%보다 더 많았다. 15일간의 상병으로 활동제한을 받은 일수는 영세지역이 평균 4.0일로 대조지역의 평균 2.2일보다 유의하게 높았다. 15일간의 상병이나 만성병을 치료받기 위해 영세지역은 약국을 더 많이 이용하고 대조지역은 병의원 외래를 더 많이 이용하였으며, 특히 의료보장 종류별로는 의료보험 가입자는 병의원 외래를, 그리고 일반환자는 약국을 더 많이 이용하였으며, 미치료율은 의료보장 종류에 관계없이 15일 이환의 경우 영세지역이 17.9%, 대조지역은 11.6%, 그리고 만성병은 영세지역이 15.2%, 대조지역은 9.2%로 영세지역의 미치료율이 대조지역보다 더 높았다. 15일간의 상병이나 만성병 모두 경제적인 이유로 치료받지 않은 경우가 가장 많았다. 영세지역의 이환율이 대조지역보다 높은 것은 경제수준, 교육정도, 주거밀집도 등 여러가지 사회 경제적인 요소가 관련된 것으로 나타났으므로, 영세민을 위한 보건사업 계획에는 이러한 사회 경제적인 요소들을 개선하는 노력을 병행해야 효과적인 보건사업이 추진될 것으로 생각된다.

• 정신신체의학
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• 제1권1호
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• pp.101-108
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• 1993

A case of a 38 year-old woman with histrionic personality who had chronic epigastric pain, dyspepsia and alternating bowel habit for more than 10 years was presented in detail on its course of two times of admission and follow-up. The diagnosis was thought as psychophy-siological disorder or gastrointestinal motility disorder of undefined etiology rather than hypo-chondriasis or Briquet's syndrome. She was characterized by sustained illness behavior and combined several physical illnesses. i.e. tuberculosis. anemia and hepatic stone. These physical diseases led to a blurring of psychological and physical boundaries regarding symptom formation. The points on consultation from medical part to psychiatric department were discussed and the supposed causal mechanisms in non-organic functional gastrointestinal disturbances were also reviewed. Physical and psychological modalities for the treatment and the abnormal illness behavior were mainly emphasized in this case.

• 보건의료산업학회지
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• 제7권4호
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• pp.143-151
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• 2013

The purpose of this study was to analyze the socio-economic factors, the factors affecting the private insurance, utilizing Korea National Health & Nutrition Examination Survey 2011. Findings of the study can be summarized as follows. First, participants with private insurance are young, high monthly income, low prevalence of chronic illness. Second, participants with private insurance and chronic illness were young and high monthly income. Third, Average monthly household income, the higher the age is younger. Private insurance and national health insurance was higher subscription rate. Consequently, participants with private insurance and uninsured of the major differences is the age and the average monthly income. Elderly, low income are needed health promotion and disease prevention for expanded medicare, welfare policies.

• 성인간호학회지
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• 제17권3호
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• pp.379-388
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• 2005

Purpose: This study was conducted to explore the degree of depression, perceived health status, chronic disease and quality of life(QOL) among rural elderly and to determine the factors related to their QOL. Method: The design of this study was a correlational study. The subjects were 423 elderly consisted of 157(37.1%) men and 266(62.9%) women dwelling in a rural area of N City. Data were collected from May to December, 2003 using a structured questionnaire. A stepwise multiple regression analysis was performed to identify the factors related to the QOL. Result: It was found that the mean score of QOL was in total with 2.15 out of 5.00 and women elderly's score was significantly lower than men(t=2.20, p=.028). Perceived health status showed statistically significant positive relationship with QOL(r=.608, p<.05), while depression(r=-.751, p<.01) and chronic illness(r=-.336, p<.01) showed statistically significant negative relationship. Depression was found to have the highest correlation with QOL among the subjects. Depression score explained QOL at the most, accounting for 36.8% of the variability, followed by perceived health(8.2%) and the number of chronic illness(.7%). Other factors related to the QOL were economic status and absence of spouse. Conclusion: In order to increase the QOL of rural elderly, it is necessary to decrease the depression, to increase their perceived health status and to decrease the number of chronic illness. We suggest the implementation of a program not only to promote physical health status and self-care ability but to take care of mental health for the rural elderly.

• 사회복지연구
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• 제41권2호
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• pp.35-65
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• 2010

본 연구는 최근에 이루어진 '건강보험 보장성 확대' 정책의 효과를 개인의 의료이용 및 건강수준을 중심으로 평가하였다. 2005년부터 시행된 건강보험 보장성 확대 정책은 암 등의 중증질환자에 대한 본인부담 경감, 입원환자 식대의 급여전환, 비급여항목의 급여전환, 본인부담상한제 시행 등을 주요 내용으로 한다. 이러한 정책 변화에 대해 만성질환을 보유하고 있어 의료욕구가 일반적으로 높은 제도의 주요 수혜집단에 비해 급성질환 등으로 의료서비스를 이용한 집단의 입원이용이 상대적으로 증가한 것과 제도의 직접적인 수혜집단인 중증질환자 집단의 입원이용이 상당 정도 증가한 것을 확인하였다. 또한 이러한 건강보험제도의 변화가 입원이용에서 혜택을 누린 중증질환자의 단기간의 건강평가지표인 2주간 이환경험 면에서 긍정적인 개선을 이끌어내고 있음을 확인하였다. 본 연구는 건강보험제도가 의료이용 및 건강수준에 인과적인 효과를 나타내고 있음을 확인하였고, 이후 건강보험 보장성 확대의 정책설계에 대한 정책적 함의를 제공한다.

• Journal of Preventive Medicine and Public Health
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• 제20권2호
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• pp.287-300
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• 1987

Island regions suffer from a shortage of health care in part because they are less developed, they cover a widespread area relative to the population, and due to transportation barriers. The purpose of this study was to assess the level of illness and the magnitude of medical care utilization, and to investigate the determinants of utilization in these area. The data were collected by means of a household survey conducted from February 16 to 25, 1987 on S islands which were selected in consideration of the size of the population, the distance from the main land, and the distribution of health care facilities. The household response rate was 89.1% (491 of 551 households), and 1971 persons were surveyed. The major findings of this study are as follows: 1) The morbidity rate of the island inhabitants was 27.7% during the two weeks, and 25.5 chronic illnesses and 9.1 acute illnesses per 100 persons, were noted. Differences in the magnitude of illness were statistically significant by sex, age, education, and family size. 2) The magnitude of total ambulatory carl utilization was 16.8 visits per 100 persons during the two weeks, which was less than that of other regions; and differences in the magnitude of total ambulatory care were statistically significant by sex, age, education, occupation, and family size. 3) Unmet needs were classified as 56.0% in chronic illnesses and 19.6% in acute illnesses; and differences in unmet needs were statistically significant by sex, age, education, occupation, income, and family size. 4) Statistically significant determinants in medical care utilization included the frequency of acute illness and chronic illness, and income in total utilization; the frequency of chronic illness and acute illness, and medical care insurance in physician visits. 5) According to the results of the path analysis, need factors had the greatest effect on utilization, and predisposing factors had more indirect effects through enabling or need factors than direct effects.