Journal of the Korean Academy of Child and Adolescent Psychiatry
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제21권3호
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pp.133-140
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2010
Tic disorders, including Tourette syndrome, are known as neurobiologic disorders and as such, much emphasis has been placed on isolating genetic determinants. Although previous reports involving studies of discordance among monozygotic twins have shown the importance of genetic predisposition, they have also supported a role for environmental factors in the development of tic disorders. Therefore, it is important to consider that both genetic and environmental factors contribute to their clinical expression. The goal of this article was to review recent reports regarding the role of environmental factors in development and progression of tics. Specific environmental factors associated either with a more severe course of illness or improved outcomes were discussed. Given that accumulating evidence had suggested the usefulness of behavior therapies in the suppression of tic disorders, particular emphasis was placed on the impact of several contextual factors.
Purpose; This study was conducted to investigate the relationship between self-efficacy, family support and health promotion behavior of the elderly in a community. Method: The sample consisted of 208 elderly and data was collected from November 18 to December 21, 2002. The instrument of this study was a structured questionnaire including health promoting behaviors, self-efficacy, family support, general characteristics. Analysis of the data was done by use of descriptive statistics, t or F, Pearson Correlation Coefficient, Stepwise multiple regression. Results: 1. The general characteristics related to health promoting behavior were gender, family structure, education level and monthly pocket money. 2. The general characteristics related to self efficacy were gender, age, family structure, education level, religion and monthly pocket money. 3. The general characteristics did not affect family support. 4. Health promoting behavior score was the highest in the interpersonal support (2.72) and in order was nutrition(2.65), stress management(2.31), self actualization(2.30), exercise(2.05), health responsibility(1.86). 5. There was a significantly high correlation between health promoting behavior and self efficacy(r= .605, p= .000), and family support(r= .500, p= .000) and between self-efficacy and family support were correlated relatively high(r= .498, p= .000) 6. Stepwise multiple regression analysis revealed that the most powerful predictor of health promotion behavior in elderly was self-efficacy (39.6%). A combination of self-efficacy, family support, monthly pocket money, education level and present illness status explained 48.5% of the variance for health promoting behavior. In conclusion, the results of this study showed that self-efficacy and family support are very important variables in explaining the health promoting behaviors in elderly. Therefore, these variables should be considered in nursing intervention development and education, especially, self-efficacy improving programs that considered exercise and health responsibility are expected to effect the health promoting behavior in elderly.
Purpose: This study was done to investigate the correlation of uncertainty, coping and health-promoting behavior in patients with gastric cancer who have undergone a gastrectomy. Methods: A descriptive correlational design was used and the participants were 120 gastric cancer patients from one general hospital. The structured questionnaire included Mishle's Uncertainty in Illness Scale, the Korean Cancer Coping Questionnaire, and the Health Promoting Lifestyle Profile. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson correlation coefficient, and multiple regression analysis. Results: There were significant negative correlations between uncertainty and intrapersonal coping (r=-.657, p<.001); between uncertainty and interpersonal coping (r=-.223, p=.014); and between uncertainty and health promoting behavior (r=-.594, p<.001). There were significant positive correlations between intrapersonal coping and health promoting behavior (r=.790, p<.001); and between interpersonal coping and health promoting behavior (r=.502, p<.001). Uncertainty, intrapersonal coping, and interpersonal coping explained 49% of health promoting behavior (F=21.312, p<.001). The factors that influenced health promoting behavior were intrapersonal coping (${\beta}=.582$, p<.001), and interpersonal coping (${\beta}=.246$, p<.001). Conclusion: The findings of this study indicate that intrapersonal coping and interpersonal coping were significant variables for health promoting behavior in patients with gastric cancer who had undergone a gastrectomy in the past six months.
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.
This study describes the application of the stages of change construct to fat intake by examining the associations of the stages of change with nutritional status and beliefs on health behavior. Data were obtained from apparently healthy 596 adults(326 females and 270 males) residing in large cities. Stages of change assessed by an algorithms based on 6 items were designed each subject into one of the 5 stages: precontemplation(PC), contemplation(CO), preparation(PR), action(AC) and maintenance(MA). Beliefs on health behavior were assessed by self efficacy as well as 4 belief scales from the Locus of Illness Control(LIC) developed using factor analysis such as internal disease cure and prevention and external disease cure and prevention. Energy and fat intakes were measured by a 39 item short form food frequency questionnaire. Regarding the 5 stages of change, MA stage comprised the largest group(37.9%), followed by Ac(30.7%), PC(11.4%), CO(10.4%) and PR(9.6%). Subjects who were females, older or healthier were more likely to belong to either AC or MA. Stage assignment of individuals was corroborated by their nutritional variables. Those in PC had the most energy and fat and those in MA ate the least for females. BMI was higher in PR than any other stages for both males and females. Those in PC were distinctive in that they were more externally oriented in terms of health control showing higher scores on external disease prevention(for males) and external disease cure(for females), and lower score on internal disease cure. On the other hand, those in MA received the highest scores on internal disease prevention and self efficacy, which suggested that they were more internally oriented. Canonical discriminant function analysis indicated that the 5 stages were importantly discriminated by BMI, self efficacy, internal disease prevention and external disease prevention for males and by fat intake, self efficacy and external disease cure variables for females. The results of our study confirm differences in stages of change in fat intake in terms of nutritional status and beliefs on heath behavior and indicate the need for taking these phases of change into account in nutrition advice. (Korean J Nutrition 34(2) : 222-229, 2001)
Purpose: The purpose of this study is to investigate medical care behaviors influencing accuracy of the payment based New diagnosis-related groups (DRG) compared to fee for service (FFS) in hospitalized patients with medical illness. Methodology: In order to estimate the difference in medical costs between New DRG and FFS depending on medical care behaviors, medical records and hospital claims data (n=4,232) were utilized, which were collected from a single public hospital during the first-half of 2018. Data were analyzed by descriptive statistics, t-test, chi-square test, and multivariate binary logistic regression. Findings: The average difference in medical costs between New DRG and FFS were KRW 506,711±13,945 with incentives and KRW -51,506±12,979 without incentives, respectively. Forty-four point two percent (44.2%, n=1,872) of total subjects were shown to have negative compensation in overall medical costs with New DRG compared to the costs with FFS. Medical care behaviors that affected on the negative compensation were the presence of severe bed sores on admission, medical consultations, death, operations, medications and laboratory or imaging tests with unit price over KRW 100,000, hospital-acquired complications or underlying comorbidities, elderly patients (≧65 years), and hospitalized for more than average inpatient days defined by New DRG (p<0.001). The difference in average medical cost between New DRG and FFS for a group with mild illness was KRW -11,900±10,544, whereas it was KRW -196,800±46,364 for a group with severe illness (p<0.0001). Practical Implications: These findings suggest that New DRG payment model without incentives may incompletely cover the variation of medical costs in real clinical practice. Therefore, policy makers need to consider that the current New DRG reimbursement should be focused and refined to improve accuracy of payment on medical care resources utilized in severe and complex medical conditions.
Most suicides(about 90%) occur in the context of psychiatric disorders. Prediction of suicide risk in patients with mental illness is very important in preventing suicide attempts. However, current approaches to predict suicidality are based on clinical history and have low specificity and biological markers are not yet included. Many studies have explored the association between different biological parameters and suicidality. Studies of cerebro-spinal fluid(CSF) demonstrated that 5-HIAA and HVA levels were lower in patients with a history of suicide. Platelet serotonin transporter and the 5-HT2 serotonin receptor have also been studied in relation to violence and suicide. Depressive patients with greater suicidal tendency had significantly lower cholesterol concentrations but some researchers failed to find the correlation. DST non-supression is reported to predict suicidality in major depression. Several studies demonstrated a relationship between intron 7 polymorphism of tryptophan hydroxylase and suicidal behavior. Since suicide is not occurred in a single disease, the systematic and comprehensive study in large samples with various diagnoses is necessary to find the biological and genetic predictors of suicidal behavior.
Background: The wood-processing industry has historically exhibited high rates of occupational hazards resulting in illness and injury. One of the major causes of high injury rates is small firm size, as resource constraints generally preclude hiring safety officers. This study examined the effect of a safety leadership training program that included coaching for managers on workers' safety behaviors and safety climate in three wood-processing companies. Methods: One or two managers at each site participated in this study. The manager training consisted of safety leadership education, safety observation, positive or corrective feedback on workers' behaviors, goal setting, and low-cost rewards for meeting goals. The dependent variable was the percentage of safe employee behaviors recorded on a critical behavior checklist developed for this study. Safety climate was measured before and after the intervention. An AB multiple baseline design across settings was adopted. After the baseline (A), the training program (B) was introduced to each site at different points in time. Results: After the introduction of safety leadership training, the mean rate of safety compliance increased by 15.3%, from 80.38% to 95.68%, and safety climate scores increased significantly from an average of 3.2 to 3.47. Conclusion: These results suggest that safety leadership coaching can be effective in improving safety management in small sawmilling sites. Implications, limitations, and possible future research directions are discussed.
Purpose: The purpose of this study was to investigate the relationship of self-efficacy, knowledge about the disease, and self-care behavior to the metabolic level in patients with NIDDM. Method: Data were collected from March 15 to April 15, 2001. Participants in the study were 48 patients with NIDDM who were seen regularly at the endocrinology out-patient department of Gwangju Christian Hospital. The data were collected through individual interviews and patient blood samples. The data were analyzed with SPSS/PC+, using t-test, ANOVA, Pearson correlation coefficients and Cronbach's Alpha. Result: 1. The mean score for self-efficacy was $71.37{\pm}15.56$, knowledge $15.00{\pm}2.84$, self-care behavior $63.18{\pm}13.10$. The mean score for HbAlc level was $7.66{\pm}1.77%$, HDL cholesterol level, $46.22{\pm}13.04 mg/dl$ and total cholesterol level, $187.93{\pm}41.45 mg/dl$. 2. There was a significant difference between patients with a spouse and those without one (t=-2.08, p=0.042), in knowledge according to level of obesity (t=5.14, p=0.010), duration of illness (t=3.22, p=0.031) and presence of complications related to diabetes (t=-2.58, p= 0.013). There were no significant differences in self-care behavior, but there were significant differences in sugar metabolic level according to sex (t=-2.02, p=0.050). 3. The correlation between diabetic patients' self-efficacy, knowledge and self-care behaviour and metabolic control was significantly related only to self-efficacy and self-care behavior (r=.692, p=0.000). Conclusion: It is necessary to improve self-efficacy, knowledge, and self-care behavior for patients with NIDDM by using nursing intervention programs to promote and maintain metabolic control.
We investigated elementary school students' knowledge, behavior, experience and preference of education method related to food safety in order to provide basic information for food safety educational program. A survey study was conducted with 569, fourth and sixth grade students, from two schools in Seoul and Ulsan. Students were asked thirty-two questions regarding food safety knowledge, behavior and experiences as well as their attitude to food safety class and preference for teaching method. The data was analyzed for the frequency analysis, t-test, chi-square test, one-way ANOVA and Pearson correlation using the SPSS/Windows. Results indicated that 91.9 percent of the respondents did not know what unsanitary food is. 67 percent of the respondents did not know the proper method of hand washing. Although the students' level of knowledge and behavior associated with food safety was low, there was meaningful correlation(r =.184, p<.01) between knowledge and behavior. Surprisingly, students in higher grade did not demonstrate an exceeding food safety knowledge and behavior. More than 50 percent of the subjects did not have food safety education either at home or school. 60 percent of the respondents interested in food safety and the majority recognized that a food safety education is needed. Students want to learn about unsanitary food(34.1%), foodborne illness(29.7%), food selection and storage method(21.3%), and personal hygiene(11.2%) through game, role play, and practice in real situation. These results suggest that development of food safety education program is needed through the elementary school year and the education program must include fun activities in which students can participate.
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