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Patient-related Barriiers to Pain Management in General Population (일반인의 통증관리 장애정도)

  • Yoo, Yang-Sook;Choe, Sang-Ok;Cho, Young-Yi;Koh, Su-Jin;Hor, Soo-Jin;Jeon, Ji-In;Kwon, So-Hi
    • Journal of Hospice and Palliative Care
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    • v.10 no.4
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    • pp.184-189
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    • 2007
  • Purpose: This study was to explore barriers to effective pain management in general population. Methods: Total 163 Participants completed the Barrier Questionnaire-II (BQ-II), a 27-item on a six point scale, from May to June in 2007. BQ-II consisted of four subscales which were 1) physical effects (PE) addressing beliefs that side effects of analgesics are inevitable and concerns about tolerance, fatalism (Fa) addressing fatalistic beliefs about cancer pain and its management, Communication (Co) addressing the beliefs of 'good patient' and concerns of distracting physician from underlying disease, and harmful effects (HE) addressing fear of addiction and harmful effect to immune system of pain medicine. Results: The BQ-II total had an internal consistency of 0.877 in this study. HE was the biggest barrier (3.03) followed by PE (2.73), Fa (2.15), and Co (1.71). Items appeared as great concerns were 'there is a danger of becoming addicted to pain medication'(3.58), 'using pain medicine blocks your ability to know if you have any new pain' (3.18), 'pain medicine is very addictive' (3.09), 'when you use pain medicine your body becomes used to its effects and pretty soon it won't work any more' (3.09), and 'drowsiness from pain medicine is difficult to control' (3.09). Only 12 respondents (7.4%) reported that they took any type of pain education, however, those who took pain education represented significantly lower barriers to pain management than who did not (P=.029). Conclusion: This result suggests the strategies for public education to surmount cancer pain.

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Psychiatric symptoms of workers exposed to organic solvents (유기용제 취급자들에게 정신증상)

  • Lee, Seoung-Hoon;Yoon, Nung-Ki;Lee, Jong-Young;Suh, Suk-Kwon
    • Journal of Preventive Medicine and Public Health
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    • v.25 no.1 s.37
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    • pp.1-12
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    • 1992
  • To assess the pattern of psychiatric symptoms and to evaluate the relationship between exposure related variables(duration of work and urinary hippuric acid concenturation) and psychiatric symptoms in organic solvent exposed workers, case control study of forty-two solvent exposed workers and ninethy-six non-exposed workers was conducted. The general health questionnaire 28(GHQ28) was administered to evaluate psychiatric symptoms and urinary hippuric acid concenturations was measured to estimate the present status of solvent exposure in exposed group and to estimate normal level in non-exposed group. The mean concenturation of urinary hippuric acid was significantly higher in exposed group (2.953g/creatinine g) than non-exposed group(0.395g/creatinine g) (P<0.01). The total positive rates of symptoms were significantly higher in exposed group(28.2%) than non-exposed group(17.5%)(P<0.05). The positive rates of symptoms for four sub-scales of GHQ28 in exposed group were in the order of somatic symptoms, anxiety, social dysfunction, depression and in the order of social dysfunction, anxiety, depression, somatic symptoms in non -exposed group. The positive rates of symptoms for somatic symptoms and anxiety were significantly higher in exposed group than non-exposed group (P<0.05) and the proportion of workers with six or more positive symptoms(dysthymic states) in exposed group were significantly higher than non-exposed group (P<0.01). After the effect of age, sex, level of income, level of education, and duration of work were controlled, the total score of GHQ28 was still significantly different between exposed and non-exposed group(P<0.01). In multipile logistic regression analysis on the dysthymic state, the odds ratio of level of income was statictically significant in both group. The odds ratios of exposure related variables such as duration of work and hippuric acid concenturations were not statistically significant but there was a tendency that exposure related variables had an affect on dysthymic state in exposed group. In future, continuous evaluation of psychiatric symptoms on organic solvent exposed workers and studies to detect the factors that affect on psychiatric symptoms are required.

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Analyses of the Studies on Cancer-Related Quality of Life Published in Korea (암 환자 삶의 질에 대한 국내 연구논문 분석)

  • Lee Eun-Hyun;Park Hee Boong;Kim Myung Wook;Kang Sunghee;Lee Hye-Jin;Lee Won-Hee;Chun Mison
    • Radiation Oncology Journal
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    • v.20 no.4
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    • pp.359-366
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    • 2002
  • Purpose : The purpose of the present study was to analyze and evaluate prior studies published in Korea on the cancer-related quality of life, in order to make recommendations for further research. Materials and Methods : A total of 31 studies were selected from three different databases. The selected studies were analyzed according to 11 criteria, such as site of cancer, domain, independent variable, research design, self/proxy rating, single/battery instrument, translation/back translation, reliability, validity, scoring, and findings. Results : Of the 31 studies, approximately half of them were conducted using a mixed cancer group of patients. Many of the studies asserted that the concept of quality of life had a multidimensional attribute. Approximately 30% were longitudinal design studies giving information about the changes in quality of life. In all studies, except one, patients directly rated their level of quality of life. With respect to the questionnaires used for measuring the quality of life, most studies did not consider whether or not their reliability and validity had been established. In addition, when using questionnaires developed in other languages, no studies employed a translation/ back-translation technique. All studies used sum or total scoring methods when calculating the level of quality of life. The types of variables tested for their influence on qualify of life were quite limited. Conclusion : It is recommended that longitudinal design studies be peformed, using methods of data collection whose validity and reliability has been confirmed, and that studies be conducted to identify new variables having an influence on the quality of life.

The National Survey of Breast Cancer Treatment Pattern in Korea (1998): The Use of Breast-Conserving Treatment (1998년도 우리나라 유방암 치료 현황 조사: 유방보존술 적용 실태를 중심으로)

  • Shin Hyun Soo;Lee Hyung Sik;Chang Sei Kyung;Chung Eun JE;Kim Jin Hee;Oh Yoon Kyung;Chun Mi Sun;Huh Seung Jae;Loh Jun Kyu;Suh Chang-Ok
    • Radiation Oncology Journal
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    • v.22 no.3
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    • pp.184-191
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    • 2004
  • Purpose: In order to improve the proper use of radiotherapy and breast-conserving treatment (BCT) in the management of breast cancer, current status of breast cancer treatment in Korea was surveyed nationwide and the use of BCT were evaluated. Materials and Methods: Patients characteristics and treatment pattern of 1048 breast cancer patients from 27 institutions diagnosed between January, 1998 and June, 1998 were analyzed. The incidence of receiving BCT was analyzed according to the stage, age, geography, type of hospital, and the availability of radiotherapy facility. Results: Radical mastectomy was peformed in 64.8$\%$ of total patients and 26$\%$ of patients received breast- conserving surgery (BCS). The proportions of patients receiving BCT were 47.5$\%$ in stage 0, 54.4$\%$ in stage I, and 20.3$\%$ in stage II, Some of the patients (6.6$\%$ of stage I, 10.1$\%$ of stage II and 66.7$\%$ of stage III) not received radiotherapy after BCS. Only 45$\%$ of stage III patients received post-operative radiotherapy after radical mastectomy. The proportion of patients receiving BCT was different according to the geography and availability of radiotherapy facilities. Conclusion: Radiotherapy was not fully used in the management of breast cancer, even in the patients received breast-conserving surgery. The proportion of the patients who received BCT was lower than the report of western countries. To improve the application of proper management of breast cancer, every efforts such as a training of physicians, public education, and improving accessibility of radiotherapy facilities should be done. The factors predicting receipt of BCT were accessibility of radiotherapy facility and geography. Also, periodic survey like current research is warranted.

기호학적 분석을 통한 영상애니메이션 연구

  • Lee Jong-Han
    • Broadcasting and Media Magazine
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    • v.10 no.1
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    • pp.85-98
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    • 2005
  • About the phenomenon of being imaged of everything, the scholars of the humanities who had studied on the simple reason structure in a text have been in a big agony how accept it. Especially, semiologists have studied about this for a long time and the points at issues of Saussure, Peirce as well as Umbeto Eco are more outstanding. Being based upon his philosophic interesting from medieval esthetics to modern semiotics, Eco was very concerned about the field of general esthetics and poputar arts like television and cartoons. He connected the mutual open-relations between 'signifier' and 'signified' debated in Semiotics with the open and vague modern arts and regarding it as a deviation from the custom, intensively studied the film-media. Saussure is a representative figure of semiotics and explained Sign and the character of semiotics as the division into two parts such as signifier/ signified, form/ substance, langue/ parole, synchrony/ diachrony. The triadic semiotics (the theory that Sign is composed of the triadic structure like sign, referent and interpretant) of Peirce put the new item- 'interpretant' in sign and referent to connect them and open the possibility to introduce time in to the Sign. In this paper, I try to analyze a cartoon film in the semiotic structure with the systemic, reasonable and logical approach and analysis as as possible. While the images shown through a film were depended on the romantic and impressional judge in the past, due to semiotics, it' s quite possible to correlate the procedure of symbolization to social coherence so that we analyze the incredible power of images to suck audiences with the systemetic Sign. I accept all ot film-images including a cartoon film as not the simple esthetic arts but a social custom and system, want to serve as a aid to properly understand world and humanbeings and prevent the film-image from being mystic. A cartoon and a cartoon film which were begun with the link of a text and an illustration give shape to all of images such as materials, places and even thoughts with a cartoon icon existed in only a cartoon. A cartoon and a cartoon film simply and exquistely conceptualize the complex and vague attribute of an organic creature and extend them infinetly beyond language. However, it can be exploited as a mysticism to temptate the general public and a faking material. In addition to that, it can distort our world-knowledge engaging a political power and the massive power of mass media. In this paper, being based on semiotics to approach a cartoon film in a scientific and organic system, I conclude that a non-linguistic cartoon expression is entangled with the manifold signs and implies the supplementary meanings just like a regular linguistic expression. It remarks that the iconic images of a cartoon film are composed of the social codes and can be analyzed on grounds of a linguistic system.

Current Status and Activation Plan of Hospice Palliative Care in Korea - Based on Hospice Palliative Care Facilities Survey (국내 호스피스.완화의료 현황 및 활성화 방안 - 호스피스.완화의료 기관 조사를 바탕으로)

  • Kyung, Min-Ho;Jang, Yu-Mi;Han, Kyung-Hee;Yun, Young-Ho
    • Journal of Hospice and Palliative Care
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    • v.13 no.3
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    • pp.143-152
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    • 2010
  • Purpose: This study aimed to evaluate the current status of hospice palliative care facilities in Korea. Based on the result, we attempted to suggest activation plans of hospice palliative in Korea. Methods: To conduct a survey, we obtained a list of hospice palliative care facilities from related agencies and academic societies. A survey was conducted from February, 2009 to March, 2009. The survey was consisted of general characteristics of organizations, manpower, facilities & equipments, and so on. In addition, we used data from Statistics Korea to estimate the number of beds required and the bed occupancy rate. Results: Total number of facilities responded to the questionnaire were 53. Forty-two facilities were general hospitals and 6 facilities were clinics among the total 53 facilities, and 18.8% of facilities were located in Seoul, Incheon and Gyeonggido. Overall bed occupancy rate was rather low as 21.9%, and there were 4 provinces where bed occupancy rates were 0%. Deaths in hospice palliative care facilities during 2008 were 6.3% of total deaths from cancers. As for the questions about the financial status of facilities, 86% of facilities were answered financial insufficiency. Also more than half of the facilities gave financial insufficiency as the reason for shortage of human resource supplies and inability to achieve the standard for authorization by the government. Facilities answered in order to activate the hospice palliative care, governmental support is needed, mostly in financial support (71.2%), donation tax deduction (43.1%), and setting up a public utility foundation (23.5%). Conclusion: This study showed low rates of hospice palliative care use and bed occupancy in Korea. Regional variance in bed occupancy rate was significantly high. As a roadblock for these problems, most of the facilities cited financial insufficiency. Therefore, there must be some action plans to boost financial support to activate hospice palliative care in Korea. Finally, efforts to improve these circumstances including lack of understanding about hospice and palliative care, are needed as well.

A Efficacy of One-Stop Service in the Outpatient Clinic at the University Medical Center (3차 의료기관 외래진료에 있어 One stop service 도입의 효과)

  • Lee, Suk-Yeon;Chang, Sung-Goo
    • Korea Journal of Hospital Management
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    • v.6 no.2
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    • pp.70-85
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    • 2001
  • This study has been conducted, on the reservation of specific examinations during seven months starting from June 1999 and ending December as the Group I for these of one stop service and as the Group II for those of existing direct reservation made by patients or patrons, to understand the differences between the two groups. The survey was extended to the patients visiting specific departments of K hospital with sample sizes of 154 for the Group I and 155 for the Group II. The findings of the survey are as follows: First, as the general characteristics of the sample, male patients account for 67% of the total and female patients 33%, with the former twice as large as the latter. The average age of the patients is 51, indicating relatively high level. By the geographical area of residence, metropolitan area is 80.7% and the other area 19.3%, showing most of the patients are from metropolitan area. The general characteristics do not have statistical significance between the Group I and the Group II(p>0.05). Second, regarding the ratio by the number of examinations, the Group I shows 37.0% for one examination and 63.0% for two examinations, while the Group IT indicates 30.3% for one examination and 69.7% for two examinations. The populations by the number of examinations do not have statistical difference between the two Groups(p>0.05). Third, regarding the time required for the reservation of examinations by the number of examinations, the Group I shows 9.8 minutes for one examination and 19.8 minutes for two examinations, with the average of 16.1 minutes. The Group IT indicates 19 minutes for one examinations and 25.7 minutes for two examinations, with the average of 23.7 minutes. Though the time required for the reservation by the number of examinations do not have statistical significance, the time required for the Group I was shortened. Fourth, regarding the time required for the reservation of examinations by the age range of patients, the Group I shows 21.7 minutes for 70-79 years of age, 17.5 minutes for 60-00 years of age, and 15.2 minutes for 30-39 years of age. The Group II indicates 27.2 minutes for 70-79 years of age, 26.3 minutes for 60-69 years of age, 24.4 minutes for 50-59 years of age, and 22.4 minutes for 30-39 years of age. The time required for the reservation gets longer as the age range moves up, and has statistical significance (p<0.05). Fifth, regarding the ratio by the range of time of required for reservation, the Group I shows 41.6% for 11-20 minutes, and 38.3% for 1-10 minutes, while the Group II indicates 43.9% for 11-20 minutes, 29% for 21-30 minutes, and 14.2% for 31-40 minutes. Statistical significance is revealed (p=0.001). Sixth, concerning the length of movement course by the number of examinations, the Group I shows 37 meters regardless of the number of examinations. The Group II indicates an average of 188 meters for one examination and 189 meters for two examinations, with the difference 151 meters between the Groups, and representing statistical significance (p=0.001). Based on the above findings. one-stop service contributes to the reduction of both the time and the movement course and therefore is considered to be beneficial to the patients, and the improve the efficiency of the hospitals in terms of the space and the time.

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A Comparative Analysis of the Level of Occupational Health : Before and After the Subsidiary Program on Health Care Management of Small Scale Industries (영세사업장 보건관리 지원사업 실시 전후의 산업보건수준 비교 분석)

  • Jung, Hye Sun
    • Korean Journal of Occupational Health Nursing
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    • v.4
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    • pp.58-83
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    • 1995
  • The small scale industries which have less than 30 employees occupy 86.5% of total number of industries in Korea. And though they have higher accident rate and lower environmental condition than big industries, it has been not mandatory to appointing health care manager at factory. So, from 1993, government subsidizes to the health care management of small industries. The purpose of this study is to identify the real feature of health care status in small industries, and to evaluate the level of health care management, before and after the subsidiary program. 65 small plating industries which have been managed by the same health care management support institution in 1993 were selected for study. Of the 65 industries, 3 which have not taken both environmental evaluation and health screening in 1994, and 9 which have closed were excluded from study sample. And the remaining 53 were analyzed by using the results of environmental evaluation and health screening, reported to the Ministry of Labor, before and after the subsidiary program, the analysis was done by the comparison of the two year paired data of the same industry. Over-permissible-limit rate, health screening implementation rate, above grade C rate were calculated and compared. The status of health care management ; 1. Of the sample industries, 96.9% provide protective equipment and 80.0% set up ventilating system. Protective gloves (89.2%) and protective clothing (80.0%) are widely provided, but ear plugs (4.6%) are rarely provided. 21.5% of the protective equipment are well put on, and 40.4% of the ventilating systems function well. 2. In 1993, 35 industries, 53.8% of the sample, checked working environment twice. Over-permissible-limit rates of heavy metal (12.2%), suspended particle (11.1%), noise (5.5%) were high. To put on protective equipment and to set up local ventilating system were pointed out by the examiners. 3. General health screening was done at 63.1% of the sample industries and 35.3% of total workers were examined. Specific health screening was done at 93.8% of the sample industries and 75.4% of workers were examined. 15.5% of workers was provided to be above grade C and to have digestive system disease (43.3%), circulatory disease (18.9%), and hematopoietic disease (14.2%), etc. 4. In 1993, the subsidiary program of health care management was provided in forms of health education, health counseling, and rounding check of working field. And 61.5%, 83.0%, 55.4% of sample industries respectively received it. The average visit per industry was 1.8. Comparisons of the level of occupational health before and after the subsidiary program ; 1. Over-permissible-limit rates of hazardous factors of 1993 and that of 1994 were compared. The rates of suspended particle, noise, organic solvent of 1994 (37.5%, 13.4%, 24.2% respectively) were higher than that of 1993 (25.0%, 6.0%, 6.3% respectively). In the case of acid, there was no difference between the rate of 1993 and that of 1994. Only the rate of heavy metal decreased from 12.9% in 1993 to 3.0% in 1994. 2. General health screening was done at 38.7% of the sample industries in 1993 and at 44.6% in 1994. But the implementation rate of specific health screening decreased from 72.4% in 1993 to 64.6% in 1994. 3. The implementation rate of specific health screening was analyzed by some health factors. The rate of suspended particle increased from 61.8% in 1993 to 91.2% in 1994. But the rates of the others-noise, organic solvent, heavy metal, specific chemical substances-decreased. 4. Above grade C rate in health screening increased from 27.8% in 1993 to 35.5% in 1994. But that of endocrine disorders and pulmonary disease decreased.

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Species-specific Expression of Rpia Transcript in Cumulus-oocyte-complex (난자-난구세포 복합체에서 발현하는 Rpia 유전자의 종 특이적 발현)

  • Kim, Yun-Sun;Yoon, Se-Jin;Kim, Eun-Young;Lee, Kyung-Ah
    • Clinical and Experimental Reproductive Medicine
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    • v.34 no.2
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    • pp.95-106
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    • 2007
  • Objective: We previously identified differentially expressed genes (DEGs) between germinal vesicle (GV) and metaphase II (MII) mouse oocyte. The present study was accomplished as a preliminary study to elucidate the role of ribose 5-phosphate isomerase A (Rpia), the essential enzyme of the pentose phosphate pathway (PPP), in oocyte maturation. We observed expression of Rpia in the mouse and porcine oocytes. Methods: Expression pattern of the 11 MII-selective DEGs in various tissues was evaluated using RT-PCR and selected 4 genes highly expressed in the ovary. According to the oocyte-selective expression profile, we selected Rpia as a target for this study. We identified the porcine Rpia sequence using EST clustering technique, since it is not yet registered in public databases. Results: The extended porcine Rpia nucleotide sequence was submitted and registered to GenBank (accession number EF213106). We prepared primers for porcine Rpia according to this sequence. In contrast to the oocyte-specific expression in the mouse, Rpia was expressed in porcine cumulus and granulosa cells as well as in oocytes. Conclusion: This is the first report on the characterization of the Rpia gene in the mouse and porcine ovarian cells. Results of the present study suggest that the mouse and porcine COCs employ different mechanism of glucose metabolism. Therefore, the different metabolic pathways during in vitro oocyte maturation (IVM) in different species may lead different maturation rates. It is required to study further regarding the role of Rpia in glucose metabolism of oocytes and follicular cell fore exploring the regulatory mechanism of oocyte maturation as well as for finding the finest culture conditions for in vitro maturation.

Underpricing of Initial Offerings and the Efficiency of Investments (신주(新株)의 저가상장현상(低價上場現象)과 투자(投資)의 효율성(效率成)에 대한 연구(硏究))

  • Nam, Il-chong
    • KDI Journal of Economic Policy
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    • v.12 no.2
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    • pp.95-120
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    • 1990
  • The underpricing of new shares of a firm that are offered to the public for the first time (initial offerings) is well known and has puzzled financial economists for a long time since it seems at odds with the optimal behavior of the owners of issuing firms. Past attempts by financial economists to explain this phenomenon have not been successful in the sense that the explanations given by them are either inconsistent with the equilibrium theory or implausible. Approaches by such authors as Welch or Allen and Faulhaber are no exceptions. In this paper, we develop a signalling model of capital investment to explain the underpricing phenomenon and also analyze the efficiency of investment. The model focuses on the information asymmetry between the owners of issuing firms and general investors. We consider a firm that has been owned and operated by a single owner and that has a profitable project but has no capital to develop it. The profit from the project depends on the capital invested in the project as well as a profitability parameter. The model also assumes that the financial market is represented by a single investor who maximizes the expected wealth. The owner has superior information as to the value of the firm to investors in the sense that it knows the true value of the parameter while investors have only a probability distribution about the parameter. The owner offers the representative investor a fraction of the ownership of the firm in return for a certain amount of investment in the firm. This offer condition is equivalent to the usual offer condition consisting of the number of issues to sell and the unit price of a share. Thus, the model is a signalling game. Using Kreps' criterion as the solution concept, we obtained an essentially unique separating equilibrium offer condition. Analysis of this separating equilibrium shows that the owner of the firm with high profitability chooses an offer condition that raises an amount of capital that is short of the amount that maximizes the potential profit from the project. It also reveals that the fraction of the ownership of the firm that the representative investor receives from the owner of the highly profitable firm in return for its investment has a value that exceeds the investment. In other words, the initial offering in the model is underpriced when the profitability of the firm is high. The source of underpricing and underinvestment is the signalling activity by the owner of the highly profitable firm who attempts to convince investors that his firm has a highly profitable project by choosing an offer condition that cannot be imitated by the owner of a firm with low profitability. Thus, we obtained two main results. First, underpricing is a result of a signalling activity by the owner of a firm with high profitability when there exists information asymmetry between the owner of the issuing firm and investors. Second, such information asymmetry also leads to underinvestment in a highly profitable project. Those results clearly show the underpricing entails underinvestment and that information asymmetry leads to a social cost as well as a private cost. The above results are quite general in the sense that they are based upon a neoclassical profit function and full rationality of economic agents. We believe that the results of this paper can be used as a basis for further research on the capital investment process. For instance, one can view the results of this paper as a subgame equilibrium in a larger game in which a firm chooses among diverse ways to raise capital. In addition, the method used in this paper can be used in analyzing a wide range of problems arising from information asymmetry that the Korean financial market faces.

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