• Journal of agricultural medicine and community health
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• v.24 no.2
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• pp.315-329
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• 1999

Recently, dissatisfaction with aspects of health care has been complemented by directly at complaints such as informal, formal and litigation. But some people take action and other not in spite of feeling of dissatisfaction. This study was to investigate an accounts of patient's disagreement with doctor's care from a community sample, and make a distinction between felt disagreement and disagreement actions. This study was done in six hundred forty residents in Sungjoo County of Kyungbuk Province and Nonman city of Chungnam Province. The questionnaires of interview included sociodemographic data, health status data, a nature of patient's disagreement with doctor and actions taken following or during the disagreement episode. Approximately sixteen percent of sample reported a disagreement, and nine percent reported action taken following or during the disagreement episode. Age, educational attainment, income and area were significantly related with experience of disagreement episode in univariate analysis. In people who experienced the disagreement episode, nearly forty-one percent reported on disagreement about the diagnosis related, twenty-eight percent reported doctor-patients relationship related, twenty percent reported treatment related, and eleven percent reported prescription drug related. In people who experienced actions taken following or during the disagreement episode, nearly fifty-four percent acted as 'sought a second opinion or visit other doctor', thirty-six percent acted as 'verbally challenged the doctor', thirty-two percent acted as 'stopped prescribed treatment or medication', twenty-nine percent acted as 'made repeat visits to the same doctor', twenty-five percent acted as 'eventually left and changed doctor'. Results of multivariate analysis, age, marital status, have or haven't chronic disease, and general satisfaction with health service were significantly related with experience of disagreement episode and marital status was significantly related with experience of actions taken following or during the disagreement episode. This study is experimental and exploratory trial about a relationship between patient's disagreement with doctor and actions taken following or during the disagreement episode in some community of Korea. We find that patient's disagreement with doctor and actions taken following or during the disagreement episode is latent in our community. We suggest that the relationship between felt disagreement and disagreement action is more complicated and worthy of further study.

• The korean journal of orthodontics
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• v.31 no.2 s.85
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• pp.159-172
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• 2001

Three dimensional analysis of malocclusion and craniofacial deformation is essential for the successful orthodontic treatment. But the orthodontists are not familiar with diagnosis and treatment plane based on lateral cephalometric analysis. Since orthodontists do not posses a sufficient knowledge in standard value of posteroanterior cephalometric anaysis and of clinical importance for transverse jaw growth. In this study male(n=130) and female(n=171) aged from 6 to 16 and diagnosed as Class I malocclusion were selected to analysis width of cranium, maxilla and mandible on the posteroanterior cephalogram. The changes as a function of chronologic age and cervical vertebrae maturity index(CVXI) were examined. The Proper regression model was selected by sex with polynominal regression models and method of variable selection. Mean of each measurements and 70% confidence interval of individual measurement according to age was assesed and a graphs were made. Results are as follows :1. All the measurements for the width are gradually incresed as increase in chronologic age and CVMI. From the total amount of change between age 6 and 16, there is a tendency that mandibular width is broader than maxillary width and the width of male is broader than female. 2. There is no statistically significant sexual difference in Mx-Mn difference, Mx-Mn width differential, Mx/Mn ratio according to age and CVMI. 3. Mean of each measurement and 70% confidence interval of individual measurement according to age and sex were assessed and graphs were made for maxillary width, mandibular width, Mx-Mn difference, Mx/Mn ratio. 4. The width of maxilla and mandible in Korean children are broader than Western children during growth period.

• Research in Community and Public Health Nursing
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• v.10 no.1
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• pp.154-172
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• 1999

In order to analyse the prevalence rate of hypertension and the actual conditions of control, we selected five districts out of eleven eups and myuns in Chinan Country. We administered structured questionaries to 309 adults above the age of 40, computerized the data using SPSS - PC+. More than 40.1% of adults over 40 in Chinan County have health disorders ranging from high blood pressure to hypertension including alert high blood pressure at 36.2%, relatively high. Among general characteristics, differences in the rate of hypertension were influenced by age, occupation and places of residence. Over 71 who are engaged in agriculture, who don't have jobs, who reside in Sungsu, Jungchun, Chinan-eup all have higher hypertension rates than other groups. Accordingly, the control of hypertension should be focused on these people. As a result of the control of blood pressure, the survey showed 93.0% of the subjects were checked mainly at hospitals clinics, health centers subhealth centers and community health posts more than once a year, relatively high level of blood pressure management. However, the difference between their blood pressure measurements at ordinary times and the level of blood pressure at the time of research was quite considerable. Only 47.3% of the subjects diagnosed with high blood pressure and 70.3% of the subjects with normal blood pressure recognized their blood pressure accurately 52.7% of the subjects diagnosed with high blood pressure showed errors in understanding their blood pressure at normal times. Because these errors can cause problems in the control of blood pressure, proper management should be executed through a systematic examination. As a result of the high blood pressure control condition, the average period of hypertension was 74.5( ${\pm}92.8$) months, 92.3% of the subjects were diagnosed with high blood pressure at hospitals clinics, health centers subhealth centers community health posts, but only 29.5% were examined after a general check up on high blood pressure was completed. 70.5% were diagnosed with high blood pressure only after measuring their blood pressure. 14.1% of the subjects were hospitalized because of falls influenced by high blood pressure. 33.3% attended hospitals and health centers regularily for medical treatment and this shows how low the rate of the control of blood pressure. Most people did not undergo medical treatment, because they had no painful symptoms (46.7%), they didn't need to take the medicine(28.9%), or they forget to take the medicine(20.0%). These problems in the control of hypertension were discovered in the process of diagnosing high blood pressure at health medical institutions. Many people did not recognize the need for consistent control of blood pressure. That is, although the diagnosis for high blood pressures performed at hospitals clinics, health centers subhealth centers and community health posts, was 92.3%, more than 70.5% of the subjects were not examined completely with regard to blood pressure. Accordingly, heath medical institutions must diagnose high blood pressure not only by only measuring blood pressure but also by using systematic process of examination. As for the people diagnosed with high blood pressure, one should perform consistent medical approaches and help them to recognize the importance of the continuous control of blood pressure through subject-oriented education. Problems the subjects experienced were the following numbness in the limbs easily paralyzed stitches in their shoulders which felt painful, stiff necks, occiputs felt heavy, headaches when they got up in the morning, felt dizzy when standing and moving their heads and poor eyesight. The rate of knowledge related to high blood pressure was 78.7 points, comparatively low. Whether they had normal blood pressure or hypertension made no difference. These results are not desirable. Adult-oriented education forgot the prevention and management of high blood pressure should be implemented. Hypertensive-oriented education should be especially reinforced. Because there was a difference in the level of knowledge according to age, academic career, occupation or place of residence, education related to hypertension should be intensified and focused on those over the age of 71 those who did not attend school, those who do not have jobs and are engaged in agriculture and residents living in Bugui, Jungchun regions. The degree of healthy life practice in hypertensives is poor, particularly weight control, as opposed to people who have normal blood pressure. It makes no difference in smoking, the amount of daily smoking, drinking, the control of salt because each result means that they are not practicing healthy life or modifying their life-style. The development and programs to improve a healthy life should be executed.

• The Korean Journal of Emergency Medical Services
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• v.15 no.1
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• pp.47-63
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• 2011

Purpose : This research is to examine the work and job satisfaction of paramedics in the emergency room of university hospitals. This research is done to provide basic data needed for establishing work realms of paramedics in hospitals and to enhance their degree of satisfaction. Methods : Research questionnaire survey was conducted on 141 paramedics working in the emergency room of 32 university hospitals from August 24, 2010 to September 30, 2010 through direct visits and telephone interviews or email to explain the purpose of this research and assurance of confidentiality of responses on the questionnaires. As the tool for the degree of job satisfaction, 'The Index of Work Satisfaction' developed by Slavitt, et al(1978) and revised and supplemented by Soon-shim Kim and Hye-ran Kwon(2002) was used. The collected data were analyzed by evaluating frequency, percentage, mean, standard deviation, t-test and ANOVA, Cronbach's $\alpha$ by using SPSS WIN 18.0 program. Results : 1. Investigating the work and role of paramedics in the emergency room of university hospitals, electrocardiogram(EKG) was found to be highest with $\alpha$ was widely used with the rate of patient evaluation and test area. In the medical treatment for patients area, cardiopulmonary resuscitation(CPR) with 95%(134 persons) and ventilation assistance through ambu bagging(BVM) with 95%(134 persons) were found to be high. $\alpha$ were performed. In the role within the hospital and other areas, a member of CPR team in the hospital accounted for 78%(110 persons). 2. In the measurements of the job satisfaction of paramedics working at university hospitals, the total mean score was 2.91. The mean score in each question area indicated: section on job 3.48, autonomy 3.05, interaction 3.01, organizational demand 2.85, working conditions 2.67, salaries 2.40. This result obviously demonstrates the work of paramedics itself was most satisfied but the salaries were most dissatisfied. 3. In the measurements of the job satisfaction of paramedics working at university hospitals, job satisfaction based on the general characteristics showed significant difference in age (F=6.547, p=.002), gender (F=4.436, p=.000) marital status (F=-3.270, p= .001), religion (F=2.041, p= .043), motive for application (F=3.603, p= .015), and salary (F=6.658, p= .000). 대학병원 응급실 내 1급 응급구조사의 업무와 직무만족도 The Journal of the Korean Society of Emergency Medical Technology Vol. 15 (1) 63 4. In the measurements of the job satisfaction of paramedics working at university hospitals, job satisfaction based on the working environmental characteristics showed significant difference in total number of paramedics (F=3.779, p= .012), form of employment (F=5.601, p= .001), existence or non-existence of intention to change jobs (F=-4.037, p= .000). Conclusion : The work of paramedics in the emergency room of university hospitals consists of lots of treatment processes after specialized diagnosis and performance of professionally subdivided works. However, current legislation does not reflect such circumstances to which paramedics are exposed; thus, it should be considered for further revision and modification. The degree of job satisfaction of paramedics in the emergency room of university hospitals was high but low in salaries and working conditions were the weak points. The measures to enhance their degree of job satisfaction should be taken though improvement of labor conditions such as consideration of the rate of increase in salaries, compensation for overtime work, providing rest areas, improvement of current employment system, and conversion of temporary employees into regular employees.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.13 no.1
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• pp.30-35
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• 2010

Purpose: Infectious ileocecitis is an infection confined to the ileocecal area and one of the most common causes of pediatric abdominal pain. This study was performed to demonstrate the clinical features of infectious ileocecitis in children. Methods: The medical records and radiologic findings of 37 patients with ileocecitis diagnosed by ultrasonography and/or computed tomography, who were admitted to Pusan National University Hospital from January 2004 and July 2008, were reviewed retrospectively. Viral gastroenteritis and secondary ileocecitis were excluded. Results: The mean age of the patients was 4.8${\pm}$3.4 years. One-half of the patients were preschool children. The chief complaint was abdominal pain (75.7%), diarrhea (10.8%), and vomiting (8.1%). Accompanying symptoms were fever (56.8%), vomiting (21.6%), and diarrhea (16.2%). The mean duration of abdominal pain, fever, diarrhea, and vomiting was 3.8${\pm}$2.1, 3.0${\pm}$1.9, 3.4${\pm}$1.9, and 2.4${\pm}$2.3 days, respectively. The frequency of diarrhea and vomiting was 5.8${\pm}$2.2 and 4.0${\pm}$2.8 per day, respectively. Diagnosis was made by abdominal ultrasonography in 22 patients (59.5%), abdominal CT in 2 patients (5.4%), and both modalities in 13 patients (35.1%). Besides the radiologic finding of thickening of the bowel wall, mesenteric lymphadenitis (59.5%), ascites (5.4%), and both mesenteric lymphadenitis and ascites (16.2%) were revealed. The mean duration of illness was 7.5${\pm}$5.0 days. There were no specific laboratory findings, and culture studies with stool or blood were negative. All of the patients recovered completely without specific treatment. Conclusion: Infectious ileocecitis has acute appendicitis-mimicking symptoms, but is self-limited within a few days, thus unnecessary treatment and work-up is avoided. However, distinguishing infectious ileocecitis from appendicitis, inflammatory bowel disease, and mesenteric lymphadenitis is important.

• Radiation Oncology Journal
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• v.24 no.4
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• pp.243-247
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• 2006

$\underline{Purpose}$: To evaluate the treatment results and prognostic factors of palliative radiation therapy in the patients with unresectable advanced pancreatic cancer. $\underline{Materials\;&\;Methods$: Thirty-seven evaluable patients with unresectable advanced pancreatic cancer who were treated by palliative radiation therapy for pain relief at the Department of Radiation Oncology, Kangnam St. Mary's hospital, the Catholic University of Korea between March 1984 and February 2005 were analysed retrospectively. There were 22 men and 15 women. Age at diagnosis ranged from 30 to 80 (median 57) years. Twelve patients (32.4%) had liver metastases and 22 patients (59.5%) had lymph node metastases. Radiation therapy was delivered to primary tumor and regional lymph nodes with $1{\sim}2\;cm$ margin, and total dose was $3,240{\sim}5,580\;cGy$ (median 5,040 cGy). Chemotherapy with radiotherapy was delivered in 30 patients (81%) with 5-FU alone (21 patients) or gemcitabine (9 patients). The follow-up period ranged from 1 to 44 months. Survival and prognostic factors were analysed using Kaplan-Meier method and log-rank test respectively. $\underline{Results}$: Overall mean and median survival were 11 and 8 months and 1-year survival rate was 20%. Among 33 patients who were amenable for response evaluation, 7 patients had good response and 22 patients had fair response with overall response rate of 87.9%. Mild to moderate toxicity were observed in 14 patients with nausea, vomiting, and indigestion, but severe toxicity requiring interruption of treatment were not observed. Chemotherapy didn't influence the survival and symptomatic palliation, but the group containing gemcitabine showed a tendency of longer survival (median 12 months) than 5-FU alone group (median 5.5 months) without statistical significance (p>0.05). The significant prognostic factors were Karnofsky performance status and liver metastasis (p<0.05). Age, sex, tumor location, lymph node metastasis, and CA 19-9 level did not show any prognostic significance (p>0.05). $\underline{Conclusion}$: Radiation therapy was effective for symptomatic palliation in the patients with unresectable advanced pancreatic cancer and would play an important part in the survival benefit with gemcitabine or other targeted agents.

• Economic and Environmental Geology
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• v.37 no.5
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• pp.569-583
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• 2004

The rock properties of the West pagoda in the Gameunsaji temple site are composed mainly of dark grey porphyritic granodiorite with medium grained equigranular texture and developed with small numerous dioritic xenoliths. These xenoliths occurred with small holes due to different weathering processes. As a weathering results, the rock properties of this pagoda occur wholly softened to physical hardness because of a complex result of petrological, meteorological and biological causes. Southeastern part of the pagoda deteriorated seriously that the surface of rock blocks showed partially exfoliations, fractures, open cavities in course of granular decomposition of minerals, sea water spray and crystallization of salt from the eastern coast. The Joint between blocks has small or large fracture cross each other, contaminated and corrupted for inserting with concrete, cement mortar, rock fragments and iron plates, and partially accelerated coloration and fractures. There are serious contamination materials of algae, fungus, lichen and bryophytes on the margin and the surface on the roof stone of the pagoda, so it'll require conservation treatment biochemically for releasing vegetation inhabiting on the surface and the discontinuous plane of the blocks because of adding the weathering activity of stones and growing weeds naturally by soil processing on the fissure zone. Consisting rock for the conservation and restoration of the pagoda would be careful choice of new rock properties and epoxy to reinforce for the deterioration surfaces. For the attenuation of secondary contamination and surface humidity, the possible conservation treatments are needed.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1308-1317
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• 1997

Background : Pulmonary aspergillomas usually arise from colonization and proliferation of Aspergillus in preexisting cavitary lung disease of any cause. About 15% of patients with tuberculous pulmonary cavities were found to have aspergilloma. We analyzed the clinical features and course of 91 patients with pulmonary aspergilloma. Method : During the ten-year period from June 1986 to May 1996, 91 patients whose condition was diagnosed as pulmonary aspergilloma at 4 university hospitals in Taegu city were reviewed. All patients fulfilled one of the following criteria : 1) histologic evidence of aspergilloma within abnormal air space in tissue sections, or 2) a positive Aspergillus serum precipitin test with the radiologic finding of a fungus ball. The histological diagno-sis was established in 81 patients(89.0%) and clinical diagnosis in 10 patients(11.0%). Results : 1) The age range was 22 to 65 years, with an average of 45 years. A male and female ratio was 1.7 : 1 (57 men and 34 women). 2) Hemoptysis was far the most frequent symptom(89%), followed by cough, dyspnea, weakness, weight loss, fever, chest pain. 3) In all but 14 cases(15.4%) there had been associated conditions. Pulmonary tuberculosis was far the most frequent underlying condition found(74.7%), followed by bronchiectasis (6.6%), cavitary neoplasm(2.2%), pulmonary sequestration(1.1%). 4) The involved area was usually in the upper lobes; the right upper lobe was involved in 39(42.9%), the left upper lobe in 31(34.1%), the left lower lobe in 13(14.3%), the right lower lobe in 7(7.7%), and the right middle lobe in 1(1.1%). 5) On standard chest roent geno gram the classic "bell-like" image of a fungus ball was found in 62.6% of the subjects. On CT scan, 88.1% of the subjects in which they were done. 6) The surgical therapy was undertaken in 76 patients, and medical therapy in 15 patients, including 4 patients with intracavitary instillation of amphotericin B. 7) The surgical modality was lobectomy in 55 patients(72.4%), segmentectomy in 16 patients(21.1%), pneumonectomy in 4 patients(5.3%), wedge resection in 1 patient(1.3%). The mortality rate was 3.9% (3 patients) ; 2 patients died of sepsis and 1 died of hemoptysis. The postoperative complications were encountered in 6 patients (7.9%), including each one patient with respiratory failure, bleeding, bronchopleural fistula, empyema, and vocal cord paralysis. 8) In the follow-up cases, each 2 patients of 71 patients with surgical treatment and 10 patients with medical treatment had recurrent hemoptysis. Conclusion : During follow-up of the chronic pulmonary disease with abnormal air space, if the standard chest roentgenograms are insufficient to detect a fungus ball, computed tomographic scan and serum precipitin test are likely to aid the diagnosis of patients with suspected pulmonary aspergilloma. A reasonable recommendation for management of a patient with aspergilloma would be to reserve surgical resection for those patients who have had severe, recurrent hemoptysis. And a well controlled cooperative study to the medical treatment such as intracavitary antifungal therapy is further needed.

• Journal of Korean Medical classics
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• v.12 no.2
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• pp.92-109
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• 1999

They say Y$\breve{o}$k'ak(易學) is the root of Oriental studies. This means philosophy, astronamy, geography, medicine, music, numbers are all based on Yin-Yang, and Five phases theory of Y$\breve{o}$k'ak. Nowadays studies are very much specialized but as we go back to old times, we cannot dearly set these studies apart. All the studies can be comprehensively understood with Y$\breve{o}$k'ak(易學). The original purpose of Y$\breve{o}$k'ak is to predict future with highly symbolized signs, Sang-Su(象數). However you cannot fully understand Y$\breve{o}$k'ak without knowing the principle of change in Sang-Su itself. We have to keep thinking about how we should further study Y$\breve{o}$k'ak, treat diseases with Sang-Su, and how Sang-Su can be used in medicine. As a previous step to this process, I will consider relationship of Y$\breve{o}$k'ak and medicine in this paper. This study will help us to set the goal and method in studying medicine. Conclusions of this paper are following: 1. The purpose of understanding a subject is to understand the principle of the subject. The principle of every subject can be turned into principle of changes in the universe. This principle is not affected by time nor space. It is only seen through the changes of subjects. 2. The reason we cannot easily understand the principle is that we have biased mind. How we should overcome this is through developing virtue, and by keep inspecting things over and over. 3. We see the outcome of changes inside but we should not neglect the principle. Therefore we see the principle through Sang. Sang is in between Principle(理) and Things(物), thereby has characteristics of both. Which means it is much like Principle but specific Things is related and it is much like Things but it is not easily understood. 4. There are various kinds of Sang. Mind-Sang(心象) is an image that comes before expressing it with symbols or words. When it is expressed in symbols or words, it is no longer considered as same Sang. Sang in symbol are Kwaesang(卦象), Hyosang(爻象) and Sang in words is Kyesa(卦辭). The characteristic of all these Sang is that it cannot be explained through the logics. 5. If we call Sanghak as the study with Sang, the method is same as that of understanding the principle. The fundamental purpose of Sanghak is to understand the principle of things and then apply this principle to the practical world so that the world can be a better place. So I would say Sanghak is the study of a saint and a ruler. 6. Since the object of medicine is human being who are the mixture of Principle and Ki, we can use Sang which is also related to both Principle and Ki. Actually terms we use in Oriental medicine are not easily understood without the knowledge of Sanghak. 7. When we diagnose a patient, we are looking for Sang that comes from the body inside. When we do the treatment, we cannot neglect the original change that's happening in our body. Therefore studying Sang is a necessary step to do the full diagnosis and treatment. 8. The method of studying medicine is first to get rid of biased mind, taking right Sang from various classics and then apply those Sang to actual situations.

• Radiation Oncology Journal
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• v.22 no.2
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• pp.124-129
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• 2004

Purpose : To evaluate the clinical findings, prognosis and treatment strategy of patients with neuroendocrine carcinoma of cervix. Materials and Methods: Thirteen patients with neuroendocrine carcinoma of cervix were included in this study, as confirmed histologically and immunohistochemically at the Dongsan Medical Center, Keimyung University, between May 1944 and October 2001. The mean age of patients was 56 years with a range of 32 to 78 years of age. According to the FIGO staging system, there were 5 patients with stage IB carcinoma, 5 patients with IIA, and 3 patients with stage IIB. Four patients underwent radical hysterectomy with pelvic lymphadenectomy, 3 of these patients also received postoperative radiotherapy, and one patient underwent extrafascial hysterectomy after radiotherapy. Primary radiotherapy was done in 9 patients, and 3 were irradiated postoperatively. Nine patients received chemotherapy, 7 received neoadjuvant and 2 received concurrent chemoradiotherapy. The radical purpose of radiotherapy consisted of external irradiation to the whole pelvis (4,500 $\~$5,400 cGy) and intracavitary irradiation (3,000 $\~$ 3,500 cGy). Results : The mean follow up duration was 36 months with a range of 3 to 104 months. The overall 5-year survival rate was 61.5$\%$ and the 5-year survival rates for stage IB, IIA, IIB were 60.0$\%$, 60.0$\%$, and 66.7$\%$ respectively (p=0.99). Eight patients are still alive without disease, and all of the 5 patients with recurrence are dead due to distant metastasis. Conclusion : Neuroendocrine carcinoma of cervix is highly aggressive, with early lymphatic dissemination and a high rate of distant recurrence. Therefore, an aggressive therapeutic strategy Is required to obtain pelvic and distant disease control. Multimodal therapy should be considered at the time of Initial diagnosis.