• Journal of the Korean Society of Physical Medicine
• /
• v.11 no.2
• /
• pp.115-121
• /
• 2016

PURPOSE: Many studies have reported the improvement of cognition through physical activity among subject with dementia. This study aimed to whether the current studies supports that physical activity intervention is efficacious on cognitive performance in subject with dementia. METHODS: Two independent reviewers searched National assembly library, RISS, KISS (2005-2015) using the concepts of dementia, exercise, and physical activity. We included randomized controlled trials that examined the efficacy of physical activity in subject with dementia. A meta-analysis was performed to estimate the effect sizes cognition with CMA (Comprehensive Meta-Analysis, version 2.2.064) soft-ware program. Nine randomized controlled trials were included, providing data from 133 individuals and excluding those failing to criteria of this study. RESULTS: The meta-analysis showed that physical activity intervention had a rather small effect sizes of 0.36 (95% confidence interval 0.14-0.59) on cognition performance in subject with dementia. Outcome measurement were MMSE-K (Mini-mental state examination Korean version) and LOCTA (Loewenstein Occupational Therapy Cognitive Assessment). We found heterogeneous among studies and there was difference between the studies (Q = 19.63, d(f)=12, $I^2= 38.88$). CONCLUSION: The present analysis suggests that physical activity interventions have the low effect sizes on cognition performance in subject with dementia Further studies will be required to develop the various programs for improving the cognitive performance in subject with dementia.

• Health Policy and Management
• /
• v.23 no.1
• /
• pp.90-100
• /
• 2013

Background: This study examined the relationships of dementia, stroke, and combined multimorbidity with long-term care utilizations among older people in South Korea. Methods: A nationally representative sample of 10,130 older adults who used long-term care services in 2010 were analyzed. We used the 5% sample of aged 65 years or older linked with National Health Insurance Corporation registry data of long-term care insurance system. The sample was categorized into three groups: dementia only (47.6%), stroke only (36.3%), and both dementia and stroke (16.1%). We estimated the use of institutional care, home care, and total expenditure of long-term care services, adjusting for the severity of each function (such as daily life, behavior or cognitive change, nursing care needs, and rehabilitation care needs) and sociodemographic characteristics. Results: Having dementia symptoms was positively associated with the use of institutional care services, on the other hand, having stroke symptoms was positively related with the use of home care. The total long-term care cost was higher in the group of having both dementia and stroke. Conclusion: Older persons with dementia symptoms and stroke symptoms have different patterns of long-term care utilization, and the multimorbidity increased the overall expenditure of long-term care utilization. These findings imply a need for differentiated management strategy targeting physically and cognitively impaired older persons, and special concerning for persons with multimorbidity conditions for long-term care insurance program in Korea.

• Journal of agricultural medicine and community health
• /
• v.16 no.2
• /
• pp.179-194
• /
• 1991

Despite its universal coverage of health insurance, the rural health insurance program(RHIP) stands at the crossroads in Korea. The RHIP has weaknesses in stability of financing, problems of inequities in the provision of health services and has suffered from high cost of running the program. The author has analyzed these problems from the perspective of health insurance policy and presented several options for improvement. First of all, this study urged the importance of a firm Governmental commitment of RHIP with the 50% subsidization of contributions as the Government had promised, instead of the current 40%. This can be justified from the 20% subsidization by the Government for the contributions of private school teachers and their dependents, who belong to richer segments of the population. Second, various cost containment measures ought to be sought curbing the rising demand for medical through strengthening health education and increasing individual responsibility, and tightening the claim review process. Third, this study requires the Government to run a demonstration project on the introduction of case payment system for primary health care. Fourth introducing an income-related cost sharing scheme is another possibility. Reforming the cost sharing formula for large medical expenditures is recommendable for a beginning. This measure can take the form of tax credit for medical expenditures of the poor. Fifth, the degree of financial adjustment among health insurance plans should be levelled up for enhancing stability of RHIP and social solidarity. Sixth, health policy should be redirected toward development of rural health resources and higher priority should be put on relieving difficulties in access to care. Seventh. the insurance plan owned-hospital needs to be developed or provision of health services in the medically underserved areas, and the need of such facilities is particularly acute for geriatric care, rehabilitation and renal dialysis, etc. Eighth, more generous insurance benefits are required of the elderly who are suffering the most : elimination of the maximum 180 days of benefit period and provision of glasses and artificial dentures, etc. Ninth. the economies of scale principle is working for the operating expenses of regional self-employed insurance plan. Thus, measures should be instituted to pursue an optimum size of health insurance plans. Lastly, excessive dependence on exclusion items is an evil so that some radical remedies are urgently required to cut them.

• Transactions of the Korean Society of Mechanical Engineers A
• /
• v.38 no.8
• /
• pp.837-848
• /
• 2014

This paper describes the development of a walking assistive robot for effective self-rehabilitation for elderly people facing an inconvenience in walking. The main features of the developed robot are enhanced safety and mobility using the baby walker and electric wheelchair mechanisms and an accurate walking tracking control algorithm using potentiometers and stereo cameras. Specifically, a pelvis supporter is designed to prevent the user from falling down and reduce the burden on their legs, and electric motors are used for easy locomotion with low effort. Next, the walking intention and direction of the user are automatically recognized by using potentiometers attached at the pelvis supporter so that the robot can track the user, and the rapidity and accuracy of the tracking were increased by applying a lower-body motion analysis algorithm with stereo cameras. Finally, the user-tracking performance of the developed robot was experimentally verified through stepwise walking assistance experiments.

• Korean Journal of Adult Nursing
• /
• v.25 no.1
• /
• pp.24-32
• /
• 2013

Purpose: The aim of the study was to identify the most appropriate fall-risk assessment tool for neurological patients in an acute care setting. Methods: This descriptive study compared the reliability and validity of three fall-risk assessment tools (Morse Fall Scale, MFS; St Thomas's Risk Assessment Tool in Falling Elderly Inpatients, STRATIFY; Hendrich II Fall Risk Model, HFRM II). We assessed patients who were admitted to the Department of Neurology, Neurosurgery, and Rehabilitation at Asan Medical Center between July 1 and October 31, 2011, using a constructive questionnaire including general and clinical characteristics, and each item from the three tools. We analyzed inter-rater reliability with the kappa value, and the sensitivity, specificity, predictive value, and the area under the curve (AUC) of the three tools. Results: The analysis included 1,026 patients, and 32 falls occurred during this study. Inter-rater reliability was above 80% in all three tools. and the sensitivity was 50.0% (MFS), 84.4%(STRATIFY), and 59.4%(HFRM II). The AUC of the STRATIFY was 82.8. However, when the cutoff point was regulated as not 50 but 40 points, the AUC of the MFS was higher at 83.7. Conclusion: These results suggest that the STRATIFY may be the best tool for predicting falls for acute neurological patients.

• Journal of Korean Academy of Nursing Administration
• /
• v.11 no.4
• /
• pp.361-369
• /
• 2005

Purpose: The purpose of the study was to analyze the present status of community health practitioner activities and efforts to improve the job performance. Method: This study employed descriptive exploratory design. The sample consisted of 1,892 community health practitioners which was 90 % of population of community health practitioners. The data was analyzed by using SPSS Windows 10.0. Result: The most popular activities of community health practitioners were women's health, chronic degenerative disease management, elderly health, and outpatient care of primary health care. The activities that community health practitioners want to strengthen were outpatient care, disease prevention, rehabilitation, health promotion, and counseling. The efforts to improve the job performance were consult to other health care professionals, discussion with patient and families to choose effective treatment options. Community health practitioners knew that they were exposed to malpractice and hould try to make many efforts to improve their performance. Conclusion: The roles and activities of community health practitioners should be changed to the shift of health care environment and systems.

• The Journal of Korean Physical Therapy
• /
• v.22 no.1
• /
• pp.9-17
• /
• 2010

Purpose: The purpose of this study was to compare the effects of Tai-Chi exercise (TCE) and resistance exercise (RE) when used as part of a community-based exercise program on improvement of physical function in elderly women with knee arthritis. Methods: Forty-seven women with knee arthritis participated in this study. They were assigned to one of two groups: the TCE group (n=22) or the RE group (n=25). Tai-Chi exercise and resistance exercise sessions were held for 1 hour per session, twice per week, for 8 consecutive weeks. At pre-treatment and post-treatment, subjects were tested using the following measurements: one-legged stand test (sec), a functional reach test (cm), a test of the strength of the knee extensor and flexor muscles, determination of the pathway of center of foot pressure and vertical ground reaction force for stance phase at pre and post treatment time points. An independent t-test and a ${\chi}^2$ were used to determine the significance of differences between group means using SPSS 12.0. Results: After 8 weeks of participation in the exercise programs, there were significant improvements for both groups in joint pain, difficulty of performing activity, muscle strength of knee extensor and flexor. Also, vertical ground reaction force increased at the loading response phase for both groups. The RE group was significantly different from TC group on the eyes-closed one-legged stand test (sec). Conclusion: Tai-Chi exercise and resistance exercise programs improve physical functioning and reduce pain and locomotion difficulties.

• The Journal of Korean Physical Therapy
• /
• v.12 no.1
• /
• pp.41-47
• /
• 2000

BACKGROUND AND PURPOSE. The purpose of this study is to investigate the effect of the disturbed vision on the gait distance parameters on the healthy young population. SUBJECTS. Twenty four healthy college aged individuals are randomly assigned to both a condition with a strobe light and the other condition without a strobe light. METHODS. The instrumentation used for gait analysis is the GaitRite electronic walkway system with a personal IBM computer. The examiner naked all the subjects to walk 6 times on the gait mat without the strobe light and. 6 times on the mat with the strobe light. The first 4 trials were practice and the last two trials were recorded in both conditions. The gait parameters analyzed were as follows : velocity, cadence, step length, and heel to heel base of support. RESULTS. Paired samples t-test used for this study did not found any significant differences between the two conditions because the p-values that were analyzed on the experiment were Utter than 0.05. The gait parameters that were analyzed included cadence, velocity, left and right heel to heel base of support, and left and right step length. DISCUSSION AND CONCLUSION. Based on this population, the condition of disturbed vision via the effect of the strobe light was not significantly challenging to compromise the body's sensory systems. However, in the elderly population, these systems can undergo age related changes. Visual changes rapidly decline in people 60 to 80 years of age and changes in the vestibular system include $20-40\%$ reduction in hair cells.

• Health Policy and Management
• /
• v.10 no.4
• /
• pp.99-115
• /
• 2000

This study was conducted to get a resonable set of budget allocation to public health programs. Matrix Delphi technique was used to obtain the logic of study results and eventually to form a human model which could predict opinion of professionals on budget allocation. Thirty-two professionals in academic and governmental area responded to Delphi survey. Questionnaire was developed using matrix formation, and the matrix was formed by 6 decision criteria on budget allocation and 26 public health programs. The decision criteria are as following: size of problem(morbidity), severity of problem, social equity, importance of prevention, technical feasibility and efficiency of programs. Severity of problem dropped out of the model because it had significant correlation with the size of problem. A total score of each program was obtained by weighting the relative importance of each criteria which also were given by survey respondents. These total scores indicate that the most important public health program is vaccination for infants and children in terms of budget allocation. Monitoring communicable diseases, mental health program, and anti-smoking program are the next. In addition, respondents were asked of the desirable budget size of each program. The result was rearranged by multiple regression model using the scores of each decision criteria. In this process, the current budget size of central government was provided to the respondents, and included in the model. h set of desirable budgets modified using tile model was obtained. Considering the current size of budget, tile results of the model is very different from that of the total score. Managing dementia is ranked the first. Health promotion program for the elderly, rehabilitation of the disabled and monitoring communicable diseases are the next. The need to increase the budget of vaccination for the infants and children was not found as so high. The matrix structure in Delphi survey gave us the precise basis to make optimal decision, and made it possible to develop an opinion predicting model. However the plentifulness and diversity of professional opinions were not fully obtained due to the limited number of decision criteria.

• The Journal of Korean Medicine
• /
• v.38 no.3
• /
• pp.13-29
• /
• 2017

Objectives: The objective of this review is to investigate the use of conventional Western medicine (WM) and complementary and alternative medicine (CAM) on leg cramps. Leg cramps are the occurrence of muscular spasm in the leg muscles which occur frequently in the elderly and are frequently observed in the clinical field. Methods: Relevant clinical studies were searched from five medical databases including PubMed, KISS, RISS, OASIS, and J-STAGE. Systematic review, clinical studies, and clinical practice guideline were included in this review. Results: In total, 27 clinical studies, 9 systematic review and meta-analysis, and 1 clinical practice guideline met the inclusion criteria. Included studies were classified and analyzed according to the type of intervention. Studies on quinine and magnesium have been most studied in WM and CAM, respectively. Although quinine shows some clinical effects on leg cramps, however, the risk of side effects are suggested. In addition, magnesium failed to improve the clinically significant effects in most studies. Five case reports using Oriental herbal medicine (OHM) were included and OHMs were effective in improving leg cramps without side effects, however, the quality of evidence was low. Clinical studies on other interventions were lacking. Conclusions: The results of this study indicate that there is no definite treatment standard for leg cramps until now, and there are limitations such as low level of evidence and side effects for each treatment. OHM can be an effective alternative to conventional intervention on leg cramps, therefore, related clinical studies are needed.