• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제3권1호
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• pp.129-137
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• 1992

이 논문에서는 Tolchhin의 증례분석을 토대로 청소년의 전화 정신 치료의 임상적 효용성을 분석하였고 국내외 문헌분석을 통해 치료과정에서 고려해야 할 몇가지 문제점과 치료원칙에 관해 기술 하였다. 정규적으로 정신치료를 받고 있는 대부분의 청소년들은 전화로 자신의 치료자와 직접 연락이 닿을 수 있음을 알고, 전화에 대한 답변을 얻을 수 있다는 사실을 알게 될때 도움을 받을 수 있다. 또한 치료자의 전화는 젊은 환자에게 긍정적인 치료적 동맹을 맺게 해 주는데 도움을 줄 수 있다. 전화 정신 치료는 외래치료가 힘든 학생들의 치료에 있어 보조적 치료기법으로 큰 도움을 주며, 매우 도전적이고 즉각적인 응답을 바라는 집단인 청소년에 대한 치료적 장비로서 중요하고 유용한 치료기법으로 기여할 수 있다.

• 대한불안의학회지
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• 제17권2호
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• pp.78-83
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• 2021

Objective : Current study investigated the association between internet addiction and suicidal attempts in psychiatric patients. Methods : Patients who visited emergency department or psychiatry outpatient unit of Chungnam National University Hospital from January 2020 to July 2021 were included in this study. Total of 192 participants, 96 suicidal attempt cases and 96 psychiatric control patients without history of suicidal attempt were matched by gender and baseline diagnosis. Depression and internet addiction were assessed by using Patient Health Questionnaire-9 (PHQ-9) and Young's Internet Addiction Test (IAT). Independent t-tests, and logistic regression analyses were conducted. Results : IAT scores were significantly higher in suicidal attempt case group (41.09±18.196 years) compared to psychiatric control patients without history of suicidal attempt (36.63±17.016 years) (p=0.040). Internet addiction (adjusted Odds Ratio [aOR]=2.049, 95% Confidence Interval [CI]=1.004-4.539, p=0.0493) was an independent risk factor for suicidal attempt in psychiatric patients after controlling age, gender, and sociodemographic factors, such as marital status, education level and employment status. Conclusion : This is the first study to investigate the relationship between internet addiction and suicidal attempt in psychiatric patients in Korea. Internet addiction is significantly associated with suicidal attempt in psychiatric patients, after adjusting sociodemographic variables. This study provides evidence to future studies to further investigate on causality of internet addiction and suicidality in psychiatric patients.

• Journal of Hospice and Palliative Care
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• 제26권4호
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• pp.185-189
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• 2023

Purpose: Limited research has been conducted on the prevalence of non-medical opioid use (NMOU) in Korean cancer patients who have received prescription opioids (PO). This study aimed to identify the potential proportion of NMOU in cancer patients who had been prescribed opioids in Korea. Methods: A retrospective cohort analysis was conducted on 14,728 patients who underwent cancer-related treatment between January 2009 and December 2019, using electronically collected data from a tertiary hospital in Korea. Information regarding the type and duration of opioid use was gathered. A detailed review of medical charts was carried out, focusing on patients who had been prescribed opioids for over 60 days beyond a 12-month period following the completion of their cancer treatment (long-term PO users). Results: Out of the 5,587 patients who were prescribed PO and followed up for at least 12 months, 13 cases of NMOU were identified, representing 0.23% of the patient population. Among the 204 long-term PO users, the rate was 6.37% (13/204). The most commonly misused opioids were oxycodone and fentanyl. For the group confirmed to have NMOU, the median duration of prescription was 1,327 days in total. Of the 13 patients diagnosed with NMOU, 9 reported withdrawal symptoms, 3 exhibited craving behavior for opioids, and 1 experienced both symptoms. Conclusion: This study found that 0.23% of cancer patients who had been prescribed opioids in Korea demonstrated NMOU. Despite this relatively low rate, careful monitoring is necessary to minimize the risk of NMOU in this population, especially among long-term PO users.

• 농촌의학ㆍ지역보건
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• 제34권1호
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• pp.24-33
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• 2009

2008년 9월 경상북도 영천시 소재 Y 지적장애인 특수학교에서 설사 유행이 신고되었고, 일부 환자의 검체에서 Shigella sonnei가 검출되었다. 이에 Y 학교와 초발 환자 신00이 기거하고 있던 경산시 소재 D 재활원에서 발생한 세균성이질에 관한 역학조사를 실시하였다. Y 학교와 D 재활원은 지적장애인을 위한 학교 및 생활시설로서 모두 직영급식을 하고 있다. 지적장애가 있는 학생과 원생들을 상대로 설문조사는 시행하지 않았고 교사와 직원들을 상대로 면담을 실시하였다. Y 학교와 D 재활원에서 직장 도말 검사를 각각 298건, 361건 실시하고 환경 검체 검사를 각각 60건, 20건을 실시하였다. 학교와 재활원의 환경조사를 실시하였고 음용수와 조리용수, 생활용수의 공급원을 파악하였다. 환자는 격리 치료하고 추가 환자 발생을 일일 능동 모니터링하였다. 환례는 2008년 9월 18일부터 9월 26일까지 Y 학교와 D 재활원의 구성원 중에서 설사(하루 2회 이상의 묽은 변)가 있는 경우 혹은 직장도말 배양검사 결과 Shigella sonnei 양성인 경우로 정의하였다. 환례 정의에 따라 조사 대상 659명 중 환례는 8명으로 1.2%의 발생률을 보였고 이들은 모두 Y 학교 학생이었다. 직장도말 배양검사 결과 Shigella sonnei가 5명의 학생에서 검출되었고, 이들 중 3명에서는 설사 증상이 있었으며 나머지 2명은 무증상이었다. 환례 8명 모두 단체숙식을 하고 있었는데 이들 중 2명은 Y 학교 기숙사 기린방에서 생활하였고, 4명은 D 재활원 온유방, 나머지 2명은 D 재활원의 까치방과 자비방에서 각각 생활하였다. Y 학교와 D 재활원의 환경조사 결과 특이사항이 없었으며, 공통적으로 음용수와 조리 용수는 상수도에서 공급받고 화장실의 생활용수는 하수도에서 공급받고 있었다. D 재활원의 지하수 1건에서 대장균군이 양성이면서 일반세균이 20,000 CFU/mL으로 나왔다. Pulsed-Field Gel Electrophoresis 검사에서 5건 모두 동일한 DNA 절편 양식을 보였다. D 재활원과 Y 학교에서 발생한 세균성이질은 동일한 균주에 의한 유행으로 판단한다. D 재활원의 온유방에서 현성 또는 불현성 감염자인 교사나 자원봉사자와의 직 간접 접촉을 통해 최초로 1명 이상의 원생에게 전파시켰을 가능성이 있다. 그 후 환례들과 직 간접 접촉에 의하여 D 재활원의 온유방 내, 다른 방과 Y 학교 학생에게 전파되었을 가능성이 있다고 추정한다. 단체 시설의 교사와 자원봉사자에 대하여 손씻기의 중요성이 더 강조되어야 하고 전염이 가능한 증상이나 질병이 있을 때에는 접촉이나 봉사 활동을 자제해야 할 것이다.

• 지역사회간호학회지
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• 제10권1호
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• pp.70-79
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• 1999

This study attempts to encourage the development of a rehabilitation delivery system as a substitute service for hospitalization such as a community based intermediate facility or home health care. We need substitute services for hospitalization to curtail the length of stay for inpatients due to car accidents. It focused on developing an estimation for early discharge based on a detailed statement of treatment from medical records of 109 inpatients who were hospitalized at General Hospital in 1997. This study has three specific purposes: First, to find the mean length of stay and mean medical expenditure. Second, to estimate the mean of early discharge from the mean length of stay. Third, to analyize the income effect per bed from early discharge. In order to analyze the length of stay and medical expenditure of inpatients the author conducted a micro and macro-analysis with medical expenditure records. To estimate the early discharge we examined with a group of 4 experts decreases in the amount of treatment after surgery, in treatments, in tests, in drug methods. We also looked their vital signs, the start of ROM exercise, the time removel, a patient's visitations, and possible stable conditions. In addition to identifing the income effect due to an early discharge, the data was analyzed by an SPSS-PC for windows and Excell program with a regression analysis model. The research findings are as follows: First, the mean length of stay was 47.56 days, but the mean length of stay due to early discharge was 32.26 days. The estimation of early discharge days was shown to depend on the length of stay. The longer the length of stay, the longer the length before discharge. For example, if the patient stayed under 14 days the mean length of stay was 7.09 while an early discharge was 6.39, whereas if the mean length of stay was 155.73, the early discharge time was 107.43. The mean medical expenditure per day of car accident patients was found to be 169,085 Won, whereas the mean medical expenditure per day was shown to be in a negative linear form according to the length of stay. That is the mean expenditure for under 14 days of stay was 303,015 Won and the period of the hospitalization of 15 days to 29 days was 170,338 Won and those of 30 days to 59 days was 113,333 Won. The estimation of the income effect due to being discharged 16 days was around 2,350,000 Won with a regression analysis model. However, this does not show the real benefits from an early discharge, but only the income increasing amount without considering prime medical cost at a general hospital. Therefore, we need further analysis on cost containments and benefits incending turn over rates and medical prime costs. From these research findings, the following suggestions have been drawn, we need to develop strategies on a rehabilitation delivery system focused on consumers for the 21st century. Varions intermediate facilities and home health care should be developed in the community as a substitute for shortening the length of stay in hospitals. In home health care cases, patients who want rehabilitation services as a substitute for hospitalization in cooperation with private health insurance companies might be available immediately.

• 재활치료과학
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• 제5권2호
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• pp.71-80
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• 2016

목적: 본 연구는 뇌졸중으로 인한 편마비 환자를 대상으로 거울치료의 임상적용 가능성 및 효과를 제시하는 데에 목적이 있다. 연구방법: 2005년 1월부터 2016년 1월까지 국외 학술지에 게재된 논문을 PubMed를 통하여 검색하였다. 포함기준과 배재기준을 고려하여 최종적으로 9개의 논문을 대상으로 분석하였다. 결과: 거울치료의 효과를 알아보기 위한 중재방법으로는 손목과 손의 단순한 움직임과 과제기반 거울치료가 사용되었다. 중재효과를 알아보기 위해 상지기능, 일상생활동작, 신체적 상태, 삶의 질 평가도구가 사용되었다. 상지의 기능은 근위부보다 원위부에서 더욱 효과가 있고, 일상생활동작에서도 유의한 효과가 있는 것으로 나타났으나, 삶의 질에서는 실험군과 대조군 사이에 유의한 차이가 없는 것으로 나타났다. 결론: 연구를 통해 임상 치료사들은 대상자의 특성에 따라 거울치료를 적절하게 사용할 근거를 찾을 수 있을 것이라 생각된다. 하지만 다양한 거울치료의 프로토콜로 인해 효율적인 적용방법을 확인하는 데 어려움이 있었다. 앞으로는 거울치료의 효과를 극대화 할 수 있는 체계화된 치료 프로토콜이 개발되어야 할 것이다.

• 한국병원경영학회지
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• 제16권2호
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• pp.98-116
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• 2011

In this study, we examined the effects of guardians' service quality perception(G-SQP) on patients' service quality perception(P-SQP) leading to patients' behavioral intention(P-BI) and the effects of G-SQP on guardians' behavioral intention(G-BI). To investigate the causalities of the variables, we collected national wide samples of 144 hospitals, 1456 patients and 1455 guardians of the patients and analyzed 1146 guardian-patient coupled cases refined with prerequisites such as missing value, outliers, normality and covariance conditions. Followed were contributions of the present study. First, G-SQP was a predictor of P-SQP. Second, in the first contribution statement, there was no statistically significant difference between inpatient and outpatient group. Third, proven was that G-SQP was a predictor of G-BI. Fourth, verified was that P-SQP was a predictor of P-BI. Fifth, G-SQP was a predictor of P-SQP being led to P-BI that meant P-SQP had a mediating role between G-SQP and P-BI. Since the guardians' perception affected patients' buying decision, the present study implied service managers of hospital settings should pay attention to guardians' perception of service quality as well as patients'. With such strategy, hospitals could improve financial performance in long-term.

• Preventive Nutrition and Food Science
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• 제8권1호
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• pp.24-28
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• 2003

There is evidence to suggest that cranberry juice supplements improve the health of the urinary tract by inhibiting the binding of fimbriated uropathogenic E. coli to the bladder mucosa. In patients with neurogenic bladders, urinary tract infections (UTI) are particularly common and often poorly managed by antibiotic treatment. A double-blind, randomized, placebo-controlled trial was undertaken on 29 geriatric and spinal cord injured patients with dysfunctional bladders. They received three times daily at mealtimes a 4 oz bottle of cranberry juice (Ocean Spray Cranberries, USA) or a specially prepared synthetic placebo drink. Two episodes of UTI arose in week one of cranberry intake and none thereafter, compared to four episodes of UTI in 4 placebo patients in weeks four, six and 10. Mean bacterial adhesion counts on bladder cells of the patients rose during the first month of treatment in 71 % of the placebo patients compared to only 31 % of cranberry patients (p < 0.001). The difference persisted to some extent for the second and third months. Bacterial adhesion levels correlated with culture findings (higher adhesion and higher viable counts in urine) (p < 0.001), positive leukocyte nitrite tests (136$\pm$131 bacteria per cell versus 52$\pm$86 in negative tests) (p < 0.001), and higher white blood cell counts (> 10) per high power field (126$\pm$125 versus 48$\pm$85 bacteria per cell) (p<0.001). E. coli was the most frequently isolated organism (40% samples) followed by K. pneumoniae (17%) and a number of other uropathogens. Group B Streptococci, and coagulase negative Staphylococcus were recovered from urine in 4 samples but were not associated with any red blood cell presence. The daily intake of cranberry juice, in amounts which are not detrimental to long term compliance, appeared to have a role in reducing the risk of bladder colonization and infection in a highly susceptible patient population.

• Tuberculosis and Respiratory Diseases
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• 제72권4호
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• pp.367-373
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• 2012

Background: Chronic obstructive pulmonary disease (COPD) is now regarded as a heterogenous disease, with variable phenotypes. Acute exacerbation of COPD is a major event that alters the natural course of disease. The frequency of COPD exacerbation is variable among patients. We analyzed clinical features, according to the frequency of acute exacerbation in COPD. Methods: Sixty patients, who visited Gyeongsang National University Hospital from March 2010 to October 2010, were enrolled. Patients were divided into two groups, according to their frequency of acute exacerbation. Frequent exacerbator is defined as the patient who has two or more exacerbation per one year. We reviewed patients' medical records and investigated modified Medical Research Council (MMRC) dyspnea scale, smoking history and frequency of acute exacerbation. We also conducted pulmonary function test and 6-minute walking test, calculated body mass index, degree of airway obstruction and dyspnea and exercise capacity (BODE) index and measured CD146 cells in the peripheral blood. Results: The number of frequent exacerbators and infrequent exacerbators was 20 and 40, respectively. The frequent exacerbator group had more severe airway obstruction (forced expiratory volume in one second [$FEV_1$], 45% vs. 65.3%, p=0.001; $FEV_1$/forced vital capacity, 44.3% vs. 50.5%, p=0.046). MMRC dyspnea scale and BODE index were significantly higher in the frequent exacerbator group (1.8 vs. 1.1, p=0.016; 3.9 vs. 2.1, p=0.014, respectively). The fraction of CD146 cells significantly increased in the frequent exacerbator group (2.0 vs. 1.0, p<0.001). Conclusion: Frequent exacerbator had more severe airway obstruction and higher symptom score and BODE index. However, circulating endothelial cells measured by CD146 needed to be confirmed in the future.

• 대한불안의학회지
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• 제8권2호
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• pp.93-98
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• 2012

Objective : Cortisol, a product of hypothalamus-pituitary-adrenal axis (HPA axis), is one of our defensive mechanisms in response to stress. The level of cortisol in the saliva is a major biomarker of the stress response by HPA axis and shows diurnal variation. We measured salivary cortisol level and its diurnal variation to compare the pattern of changes by degree of burn and Clinician-Administered PTSD Scale (CAPS) score. Methods : We measured the salivary cortisol levels of 37 subjects hospitalized in the burn center at our facility from March to June 2012. Salivary cortisol levels were measured at 6 : 00 AM and at 7 : 00 PM. All subjects were tested for CAPS to evaluate the severity of posttraumatic stress disorder and the Hamilton Depression Rating Scale to evaluate and to control the coexisting depression. Results : Factorial ANOVA test revealed that there was a statistically significant difference in terms of the effect of the interaction between the degree of burn and the patient's CAPS score. Unlike the mild burn group, in the severe burn group, the patients who had a low CAPS score didn't show a normal diurnal variation and the patients who had a high CAPS score showed the normal diurnal variation. After a few months follow up, we found a greater degree of psychiatric complications in severe burn patients that had a lower cortisol stress response. Conclusion : We suppose that the disappearance of the stress response changes in salivary cortisol seen in the severe burn group may be caused by an impaired stress response. Through followed observation of the subjects, this disruption of cortisol response may cause psychiatric problems afterwards.