• Journal of the Korean Society of School Health
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• v.32 no.2
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• pp.116-124
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• 2019

Purpose: This study was performed to measure the influence of drinking motives, drinking refusal self-efficacy, and self-determination on the intention to control drinking among nursing students. Methods: A cross-sectional survey was done with the participation of 258 nursing students attending four universities in G city. Data collection was conducted from May to June, 2018, using a self-report questionnaire. Data were analyzed using the t-test, ANOVA, $Scheff{\acute{e}}$ test, Pearson's correlation coefficients, and Hierarchical multiple regression. Results: The average scores for drinking motives, drinking refusal self-efficacy, self-determination, and intention to control drinking were 2.29, 4.54, 3.89, and 4.29 respectively. There were significant differences in the intention to control drinking according to grade, religion, and age of alcohol initiation. The factors influencing the intention to control drinking in nursing students were identified as self-determination (${\beta}=.24$), drinking refusal self-efficacy (${\beta}=.17$) and drinking motives (${\beta}=-.17$). This factor explained 26% of the nursing students' intention to control drinking. Conclusion: Therefore, it is necessary to develop a alcohol education program to improve the drinking culture of nursing college students and to improve their self-regulation skills in order to help them form a desirable drinking habit, and it is also necessary to apply the developed intervention program and test the effect.

• Health Policy and Management
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• v.31 no.4
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• pp.479-490
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• 2021

Background: Conflict in the medical world in 2020 led to the rejection of the national examination for doctors. This study explained the process until the end of the national test refusal situation triggered in 2020 through the signaling game theory. The government has succeeded in requiring medical students to take the national exam. Methods: To explain the rejection of the national examination, we first compose and show an example of two small non-signaling games where medical students know which type the government is of, then combine them to play a signaling game. Results: The behavior of the government and medical students was examined through the signaling game model. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the government makes an ultimatum, whatever the type. And the medical students accept it. They judged that the government could not be expected to abolish the policy. If COVID-19 had not occurred, medical students would have been able to continue the confrontation. Conclusion: The government instilled in the other party the perception that the government would not bend its policies because it was the surly type and would not be afraid of a strong confrontation. Through the image created in this way, the government was forced to accept the ultimatum by medical students. Academically, this study is to deal with the policy-making process through the signaling game theory. In the area of health care policy, this study suggests that various situations such as the type of government or the spread of COVID-19 can become important in addition to the rationality of the policy itself.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.18 no.2
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• pp.50-54
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• 2018

Jehovah's Witnesses do not accept blood transfusions, because of their particular interpretation of the Old and New Testaments. When people with such religious convictions are in need of medical care, their faith and belief may become an obstacle for proper treatment, and pose legal, ethical, and medical challenges for the health care providers. We report two inherited metabolic disorder cases in South Korea where the infants died whilst under medical care because of parental refusal of blood transfusions for religious reasons. Case 1 had methylmalonic acidemia, Down syndrome and associated congenital cardiac anomalies requiring surgery. Case 2 had anemia and methylmalonic acidemia requiring dialysis to treat hyperammonemia and metabolic acidosis. For effective medical management, they needed life-saving blood transfusions. As a part of alternative treatment, Erythropoietin was administered in both cases. As a result, two babies died from their extremely low hemoglobin and hematocrit. The hemoglobin concentrations below 2.7 g/dL without cardiac problem and 5.4 g/dL with cardiac anomaly complicated by pulmonary hypertension are considered life-threatening hemoglobin threshold. The medical professional must respect and accommodate religious beliefs of the patients who can make informed decisions. However, when parents or legal guardians oppose medical treatment of their babies and incompetent care receivers on cultural and religious grounds, the duty to assist and save persons exposed to serious danger, particularly life-threatening events must come first.

• The Korean Society of Law and Medicine
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• v.23 no.1
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• pp.37-80
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• 2022

By analyzing informed consent and the refusal of emergency medical treatment (called patient dumping) under the current Emergency Medical Service Act, this study suggests that an emergency medical professional is only liable for patient dumping if their duty to protect the patient's life takes precedence over the patient's right to self-determination. In emergency medical situations, as in general medical situations, medical treatment should be performed after the emergency medical professional informs the patient about the medical treatment, including its necessity and methods, and obtains consent from the patient. Refusing or evading the performance of emergency medical services on the excuse of the informed consent not considering a waiver or alteration of informed consent requirements without reasonable reasons violates the Emergency Medical Service Act and thus makes an emergency medical professional liable to administrative disposition or criminal penalty. In other words, depending on the existence of a waiver of alteration of the informed consent, patient dumping may be established. If the patient is a minor or has no decision-making ability, and their legal representative makes a decision against the patient's medical interests, the opinion of the legal representative is not unconditionally respected. A minor also has the right to decide over their body, and the decisions of their legal representatives should be in the patient's best interests. If the patient refuses treatment, in principle, the obligation of life protection of emergency medical professionals is the top priority. However, making these decisions in the aforementioned situations in the emergency medical field is difficult because of the absence of explicit regulations regarding these exceptional problems. This study aims to organize the following precedents of the Supreme Court of Korea. The court states that, when balancing the conflicting interests between the duty to provide emergency medical service and the duty to inform is unavoidable for emergency medical professionals, they should put the duty to protect the patient's life ahead of the duty to inform if the patient's life matters. Exceptionally, when a patient has seriously considered whether they should receive treatment before the emergency medical situation, their right to self-determination can be considered equal to the obligation of emergency medical professionals to provide emergency medical treatment. This research also suggests that an amendment of the Emergency Medical Service Act should include the following. First, the criteria for determining the decision-making ability of emergency patients should consist of medical content. Second, additional consent from a medical professional is unnecessary for first-aid treatment. Finally, new provisions for emergency medical obligations for minors, new provisions for the decision standard when there are conflicting opinions about the treatment of a patient, and new penalty provisions for professionals who suspend emergency medical examinations and treatments need to be established.

• Journal of The Korean Society of Clinical Toxicology
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• v.3 no.1
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• pp.33-39
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• 2005

Purpose: Nowadays the Korean society is in the center of time of the social change. Because of dissociation of traditional family, IMF (International Monetary Fund) crisis and economic recession, the mortality rate of suicidal attempts are increasing annually. The majority of suicidal attempts were by poisoning considering the characteristics of korean society. Therefore we studied to find out the characteristics of suicidal poisoning before and after social economic stress, and to suggest the direction for the proper management. Methods: We reviewed medical records of 547 patients of suicide by poisoning who visited the emergency medical centers of St. Mary's hospitals from 1997 to 2004. For the annual trends analysis, we analyzed the demographic and toxicologic data of these patients compared with before and after IMF crisis (1998) and the economic recession ($2003\~2004$). Results: At the time of IMF and the economic recession, the number of suicidal poisoning increased, especially in fifth decade. The refusal rate of toxicological emergency treatment increased. Also the mortality rate and the admission rate to ICU (Intensive Care Unit) increased during the same period. In the result of the comparison analysis, clinical severity and mortality of social problem group were higher. However they couldn't be treated appropriately because of financial problem and the family indifference. Conclusion: At the economic recession period, the severity of suicidal poisoned patients was high. But the refusal rate of toxicologic treatment also increased, so the patients had lost the chance for proper toxicologic treatment. Therefore they would be supported by medical institution and public health.

• The Korean Journal of Emergency Medical Services
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• v.25 no.3
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• pp.63-70
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• 2021

Purpose: The study aimed to collect data from patients who were rejected by emergency requests for transfer to a tertiary hospital through 119 EMT and to analyze the data in the hospital to improve the plan. Methods: We analyzed 4,702 cases of emergency requests made by patients who were rejected by 119 emergency assistance out of the 22,568 patients who visited the emergency medical center in the C area of G metropolitan city from January 2018 through December 2020. The collected data were analyzed using IBM SPSS Statistics Version XX (IBM Corp., Armonk, N.Y., USA). Results: The major medical department with the largest number of such cases was the department of emergency medicine, with 2,519 cases (53.6%). Simple bruises were the most common diagnosis, with 2,819 cases (61.2%). KTAS classification was the highest with 3,562 patients (75.8%) in grade 4. As for the results, 4,084 patients (86.9%) were discharged from the hospital. Conclusion: Most of the patients who were rejected by emergency requests were non-emergency patients and were discharged from the hospital. emergency requests must be rejected at public relations and sites. In addition, the law should be amended to specifically present the reasons for refusal of emergency requests.

• Clinical and Experimental Pediatrics
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• v.60 no.12
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• pp.379-384
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• 2017

Feeding is an interaction between a child and caregiver, and feeding difficulty is an umbrella term encompassing all feeding problems, regardless of etiology, severity, or consequences, while feeding disorder refers to an inability or refusal to eat sufficient quantities or variety of food to maintain adequate nutritional status, leading to substantial consequences, including malnutrition, impaired growth, and possible neurocognitive dysfunction. There are 6 representative feeding disorder subtypes in young children: infantile anorexia, sensory food aversion, reciprocity, posttraumatic type, state regulation, and feeding disorders associated with concurrent medical conditions. Most feeding difficulties are nonorganic and without any underlying medical condition, but organic causes should also be excluded from the beginning, through thorough history taking and physical examination, based on red-flag symptoms and signs. Age-appropriate feeding principles may support effective treatment of feeding difficulties in practice, and systematic approaches for feeding difficulties in young children, based on each subtype, may be beneficial.

• Journal of Veterinary Clinics
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• v.34 no.4
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• pp.283-286
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• 2017

A 4-month-old, female Maltese dog was referred with continuous heart murmur. Patent ductus arteriosus was diagnosed via radiography and echocardiography. The patient was untreated because of client's refusal. After 13 months, the dog was referred again with seizure and salivation. Laboratory examination revealed increased liver enzymes, hyperammonemia and decreased total cholesterol and total protein. Microhepatica was identified on abdominal radiography. CT angiography showed a shunt vessel that originated from the portal trunk to the prehepatic caudal vena cava and patent ductus arteriosus connecting proximal descending aorta with the main pulmonary artery. No portal vasculature toward liver is observed after shunt vessel. The patient was diagnosed as concurrent patent ductus arteriosus and congenital extrahepatic portosystemic shunt with suspected portal vein aplasia. In human, cardiac malformations are frequently observed in patients with congenital extrahepatic portosystemic shunt with portal vein aplasia. This report described concurrent patent ductus arteriosus and congenital extrahepatic portosystemic shunt with suspected portal vein aplasia in a dog.

• Journal of Preventive Medicine and Public Health
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• v.22 no.1 s.25
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• pp.162-168
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• 1989

This study was conducted to analyse attitudes to a new health care system in a rural community. The specific purpose of this thesis was to classify attitudes to the patient referral system in Kangwha county, and to identify factors affecting the attitudes. Sampling was done by a multi-stage stratified cluster sampling method from the population. The data were collected in Kangwha county through a structured interview survey for two weeks in June, 1957. Attitudes to the patient referral system were classified into four types based upon answers to questions about awareness of the system, the recognition for the necessity of the system, and opinions on the improvement of the system. The four types of attitudes were active acceptance(10.2%), partial acceptance (27.2%), refusal(35.8%), and indifference(26.7%). The respondent's age, educational level, age of head of household, medical insurance fee, the number of ill family members, and the percentage of medical utilization by the family were the variables which affected the attitudes. The medical insurance fee, respondent's age, age of head of household, and the percentage of medical utilization by the family were the statistically significant discriminant factors of the four types of attitudes.

• Clinical and Experimental Pediatrics
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• v.53 no.5
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• pp.634-638
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• 2010

Purpose: In Kyung Hee East-West Neo Medical Center, Seoul, Korea, efforts to raise rooming-in care success rate have been undertaken since when the hospital was established in 2006. We intended to analyze our experience over the past 3 years of period and to discuss the advantages of rooming-in. Methods: We analyzed the rooming-in practice rate, failure rate, and the breast feeding rate. Subjects were 860 normal healthy neonates from June 2006 to June 2009. Results: Among these 860 cases, 83 babies were required separation out of rooming-in in the middle of the course. Among these 83 cases, 70 cases had to stop the course due to poor condition of babies and 13 cases due to maternal condition. 70 cases of infant's causes consist of 68 cases of NICU admission and 2 cases of poor feeding support. The other 13 cases of separation include refusal by maternal condition. Therefore the success rate of rooming-in for the last 3 years was 90.3%, that is 777 cases among the total 860 cases. The percentage of exclusive breast feeding was 64%, that of mixed feeding with breast and formula feeding was 25%, and formula feeding only was 11%. Conclusion: We experienced successful rooming-in care for the last 3 years. Nursery facilities should educate and encourage the advantages of rooming-in, including the good formation of attachment between mother and infant, emotional stability, protection from infection, and increased breast feeding rate so that rooming-in care can be fully established.