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Clinical Practice Guideline for Cardiac Rehabilitation in Korea

  • Kim, Chul;Sung, Jidong;Lee, Jong Hwa;Kim, Won-Seok;Lee, Goo Joo;Jee, Sungju;Jung, Il-Young;Rah, Ueon Woo;Kim, Byung Ok;Choi, Kyoung Hyo;Kwon, Bum Sun;Yoo, Seung Don;Bang, Heui Je;Shin, Hyung-Ik;Kim, Yong Wook;Jung, Heeyoune;Kim, Eung Ju;Lee, Jung Hwan;Jung, In Hyun;Jung, Jae-Seung;Lee, Jong-Young;Han, Jae-Young;Han, Eun Young;Won, Yu Hui;Han, Woosik;Baek, Sora;Joa, Kyung-Lim;Lee, Sook Joung;Kim, Ae Ryoung;Lee, So Young;Kim, Jihee;Choi, Hee Eun;Lee, Byeong-Ju;Kim, Soon
    • Journal of Chest Surgery
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    • v.52 no.4
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    • pp.248-329
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    • 2019
  • Background: Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and 3 additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea. Methods: This study is based on an analysis of CPGs elsewhere in the world, an extensive literature search, a systematic analysis of multiple randomized control trials, and a CPG management, development, and assessment committee comprised of 33 authors-primarily rehabilitation specialists, cardiologists, and thoracic surgeons in 21 university hospitals and 2 general hospitals. Twelve consultants, primarily rehabilitation, sports medicine, and preventive medicine specialists, CPG experts, nurses, physical therapists, clinical nutritionists, and library and information experts participated in the research and development of these CPGs. After the draft guidelines were developed, 3 rounds of public hearings were held with staff members from relevant academic societies and stakeholders, after which the guidelines were further reviewed and modified. Results: CR involves a more cost-effective use of healthcare resources relative to that of general treatments, and the exercise component of CR lowers cardiovascular mortality and readmission rates, regardless of the type of coronary heart disease and type and setting of CR. Conclusion: Individualized CR programs should be considered together with various factors, including differences in heart function and lifestyle, and doing so will boost participation and adherence with the CR program, ultimately meeting the final goals of the program, namely reducing the recurrence of myocardial infarction and mortality rates.

The Influence of Moral Distress and Moral Sensitivity on Moral Courage in Nursing Students (간호대학생의 도덕적 용기에 대한 도덕적 고뇌와 도덕적 민감성의 관계)

  • YUN, Hye-Young;KIM, Sun-Ki;JANG, Hyo-Eun;HWANG, Sin-Woo;KIM, Sang-Hee
    • Korean Journal of Medical Ethics
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    • v.21 no.4
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    • pp.360-376
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    • 2018
  • Nursing students experience ethical conflicts that lead to moral distress and moral sensitivity in clinical practice. Most nursing students have some difficulty in speaking up when faced with morally challenging situations. Hence, increasing moral courage of these students is important to improve the quality of practice, and carry out nursing responsibilities. However, research on the moral distress, moral sensitivity, and moral courage of nursing students has not been reported in South Korea. The purposes of this study were to (a) identify the levels of moral distress, moral sensitivity, and moral courage of nursing students and (b) examine the influence of moral distress and moral sensitivity on moral courage. Data were collected through a survey using self-reported questionnaires sent to senior nursing students at two nursing colleges in Seoul and Gyeonggido. A total of 138 senior nursing students participated in the survey. The data were analyzed using the IBM SPSS Statistics 23 program by Pearson's correlation coefficients and multiple regression analysis. The mean scores of the moral distress thermometer, moral distress, moral sensitivity, and moral courage were $3.53{\pm}2.18$, $57.33{\pm}43.35$, $134.98{\pm}13.98$, and $56.33{\pm}12.75$, respectively. The significant factors influencing moral courage were the moral distress thermometer and patient-centered nursing, which was a subcomponent of moral sensitivity. The explanatory power of the model was 5%. This study confirms that nursing students, like nurses, experience moral distress. It is therefore important to create organizational environments that support the moral courage of nursing students.

Job Characteristics and Status of Community Occupational Therapist : Focus on OTs in Public Health Centers (지역사회 작업치료사의 업무 특성 및 실태 조사 : 보건소 근무 작업치료사를 중심으로)

  • Min, Kyoung-chul;Kim, Eun-hee;Woo, Hee-soon
    • The Journal of Korean society of community based occupational therapy
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    • v.10 no.3
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    • pp.37-52
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    • 2020
  • Objective : This study was conducted to identify occupational therapists working in public health centers, the characteristics and actual conditions of occupational therapists in the community, and use them as basic data on occupational therapists in the community as of 2020. Methods : 77 questionnaires were replied by e-mail from OTs work at nationwide health public centers. Job characteristics and status were analysed by descriptive statistics and check correlation between job satisfaction and other factors. Results : Most survey respondents were female(77.9%) and 20-30(96.1%).. Some occupational therapists worked for dementia related team(72.7%) and others worked for like visiting care, health care, and rehabilitation center etc. Rate of experiences of public health center was 1-2 years(67.5%), the most common type of contract was flexible part-time worker(61%) and work intensity(94.8%) and satisfaction of work was very high(85.7%). The highest difficulty of their job was budget administrative work(26.7%) and of non-work difficulty was inequality under contracts(27.2%). They usually participated at dementia shelter, visiting OT, group OT. Difficulty of their job was high in budget administration, dementia shelters, and visiting work treatments. Goals of treatment were high in improvement of cognitive ability and, family support. Frequency of treatment was high in improvement of cognitive therapy, family support, and evaluation. Occupational therapy targets for health centers were dementia, the general elderly, and adult brain lesions, including those for ordinary people, psychiatric disorders and children. It was found that the primary occupations for evaluation were nurses (35.7%) and occupational therapists (33.7%), and that MMSE-DS, SGDS, and SMCQ were used a lot. Conclusion : This study could identify the job characteristics and status of community OTs. We hope that this result could be basic data for building expertise and role for community OTs in changing situations like community cares.

Factors Influencing Satisfaction on Home Visiting Health Care Service of the Elderly based on the degree of chronic diseases (만성질환 유병상태에 따른 노인 방문건강관리 서비스 만족도 영향요인 연구)

  • Seo, Daram;Shon, Changwoo
    • 한국노년학
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    • v.41 no.2
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    • pp.271-284
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    • 2021
  • This study was conducted to derive factors that affect the satisfaction of home visiting health care services and to develop effective community care models by using the results of Seoul's outreach service which is the basis for Korean community care. The population of the study was the elderly aged 65 and 70 who participated in the Seoul's outreach community services 3rd stage (July 2017 - June 2018) and 4th stage (July 2018 to June 2019). 2,200 people were extracted by the proportional allocation method and home visit interviews were conducted on them. Subjects were divided into sub-groups based on chronic disease prevalence, and logistic regression was conducted to derive factors that affect the satisfaction of home visiting health care services. The results demonstrated that the elderly without chronic diseases were more satisfied when they received health education and counseling services, the elderly with one chronic disease were more satisfied when they received Community resource-linked services. In the case of elderly people with two or more chronic diseases, the service satisfaction level is increased when health condition assessment and Community resource-linked services are provided. Regardless of whether or not they have chronic diseases, service delivery time was a factor that increased satisfaction in home visiting health care. And the degree of explanation understanding was a factor that increased satisfaction for both single and complex chronic patients. Home Visiting health care services based on the community is a key component of the ongoing community care. In order to increase the sustainability and effectiveness of community care in the future, Community-oriented health care services based on the degree of chronic diseases of the elderly should be provided. In order to provide more effective services, however, it is necessary (1) to establish a linkage system to share health information of the subject held by the National Health Insurance Service to local governments and (2) to provide capacity-building education for visiting nurses to improve the quality of home visiting health care services. It is hoped that this study will be us ed as bas ic data for the successful settlement of community care.

Emotional Regulation's influence on Authentic Leadership and Change Oriented Organizational Citizenship Behavior (감성활용이 오센틱리더십과 변화적 조직시민행동에 미치는 영향)

  • Kang, Yoonhee;Kim, Jong Kwan
    • Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology
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    • v.8 no.8
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    • pp.1-9
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    • 2018
  • Emotional Intelligence is the ability to recognize, facilitate, understand and control and utilize one's and other's emotions and has been researched extensively in last 20 years. Of the four domains of emotional intelligence, Emotional Regulation, the ability for one to manage and modify one's emotional reactions in order to achieve goal-directed outcomes, with its influence on authentic leadership and change oriented organizational citizenship behavior was researched by surveying 300 nurses at large metropolitan hospitals in B city in South Korea. Previous research demonstrated in relationship based and long term oriented cultures, such as Korea, Japan and Chinese cultures, ability to regulate emotions is critical component in successful social dynamics yet research the topic is minimal in Korea. Authentic leadership is a leader displaying sincerity and authentic behavior and through such, trust is gained in followers and collaboration is formed. Change oriented organizational citizenship behavior is a proactive behavior where the individual performs behaviors not included in his job functions voluntarily. The results indicate the three out of four sub domains of authentic leadership influenced positively to change oriented organizational citizenship behavior with the exception of balanced information processing. Moreover, Emotional Regulation partially mediated between authentic leadership and change oriented organizational citizenship behavior. Such results validated previous studies that indicated authentic leadership as possible antecedents of individual proactive behaviors and by examining authentic leadership and change oriented organizational citizenship behavior with emotional regulation as a mediator proved possibility as another potential antecedent of change oriented organizational citizenship behavior in hospital setting.

Effects of Telephone Hotline Counseling Program on Stroke Care (뇌졸중 환자에 적용한 핫라인 전화상담 프로그램의 효과)

  • Baik Kyun Kim;Dong-Wan Kang;Do Yeon Kim;Jung Hyun Park;Ji-Seok Woo;Young-Hee Kim;Hyun-Sook Kim;Min-Joo Moon;Jeong-Yoon Lee;Hyung Seok Guk;Nakhoon Kim;Sang-Won Choi;Hakyeu Ahn;Bosco Seong Kyu Yang;Jun Yup Kim;Jihoon Kang;Moon-Ku Han;Hee-Joon Bae;Beom Joon Kim
    • Health Policy and Management
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    • v.33 no.2
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    • pp.185-193
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    • 2023
  • Background: This study focuses on the establishment and operation of a stroke patient hotline program to help patients and their caregivers determine when acute neurological changes require emergency attention. Method: The stroke hotline was established at the Gyeonggi Regional Cerebrovascular Center, Seoul National University Bundang Hospital, in June 2016. Patients diagnosed with stroke during admission or in outpatient clinics were registered and provided with stroke education. Consulting nurses managed hotline calls and made decisions about outpatient schedules or emergency room referrals, consulting physicians when necessary. The study analyzed consultation records from June 2016 to December 2020, assessing consultation volumes and types. Outcomes and hotline satisfaction were also evaluated. Results: Over this period, 6,851 patients were registered, with 1,173 patients (18%) undergoing 3,356 hotline consultations. The average monthly consultation volume increased from 29.2 cases in 2016 to 92.3 cases in 2020. Common consultation types included stroke symptoms (22.3%), blood pressure/glucose inquiries (12.8%), and surgery/procedure questions (12.6%). Unexpected outpatient visits decreased from 103 cases before the hotline to 81 cases after. Among the 2,244 consultations between January 2019 and December 2020, 9.6% were recommended hospital visits, with two cases requiring intra-arterial thrombectomy. Patient satisfaction ratings of 9-10 points increased from 64% in 2019 to 69% in 2020. Conclusion: The stroke hotline program effectively reduced unexpected outpatient visits and achieved high patient satisfaction. Expanding the program could enhance the management of stroke-related neurological symptoms and minimize unnecessary healthcare resource utilization.

Development of case-based learning and co-teaching clinical practice education model for pre-service nurses (예비간호사를 위한 사례기반학습 및 코티칭 임상실습 교육모형 개발)

  • Hyunjeong Kim;Heekyoung Hyoung;Hyunwoo Kim;Seryeong Kim
    • Journal of Christian Education in Korea
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    • v.72
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    • pp.245-271
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    • 2022
  • The purpose of this study is to develop a nursing clinical practice education model that applies case-based learning and co-teaching to nursing students, and to secure the validity of the developed model. To verify the validity of the nursing clinical practice education model, it was applied to the subject of 'Health Response and Nursing VI (Perception/ Cognition) Practice' in the 2nd semester of 2021 at J University in Jeonju, and the instructor's response to the model was evaluated. Surveys and focus group interviews were conducted on confidence in clinical practice and teaching and learning models. After deriving the case-based learning stage and co-teaching elements through a review of precedent literature and case studies, an initial model was devised after expert review, and the devised model was reviewed for internal validity by nursing education experts, and then modified and supplemented. As a result of the learner response evaluation conducted after applying the model to the clinical practice subject for external validation verification, the confidence in clinical performance was 4.22 points and the satisfaction with the teaching-learning model was 4.68 points. Summarizing the results of the focus group interview, the importance of prior learning and the learning of selected cases based on actual cases, learning terminology and professional knowledge, eliminated fear of the practice field, felt familiar, and learned various cases. He said that he was able to think critically through the time to organize the knowledge learned in the practice field. In addition, through co-teaching, it was found that field leaders and advisors taught the theoretical and practical aspects at the same time through examples, thereby experiencing practical education closer to practice. It is expected that the nursing clinical practice education model developed through this study, applying case-based learning and co-teaching, will be an effective teaching and learning model that can reduce the gap between theory and practice and improve the clinical performance of nursing students.

A Study Concerning Health Needs in Rural Korea (농촌(農村) 주민(住民)들의 의료필요도(醫療必要度)에 관(關)한 연구(硏究))

  • Lee, Sung-Kwan;Kim, Doo-Hie;Jung, Jong-Hak;Chunge, Keuk-Soo;Park, Sang-Bin;Choy, Chung-Hun;Heng, Sun-Ho;Rah, Jin-Hoon
    • Journal of Preventive Medicine and Public Health
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    • v.7 no.1
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    • pp.29-94
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    • 1974
  • Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.

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Dietary Behavior Related to Salty Food Intake of Adults Living in a Rural Area according to Saline Sensitivity (농촌 지역의 중년이후 성인의 염분 민감도에 따른 짠 음식 섭취 관련 식행동)

  • Kim, Mi-Kyoung;Han, Jang-Il;Chung, Young-Jin
    • Journal of Nutrition and Health
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    • v.44 no.6
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    • pp.537-550
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    • 2011
  • This study was conducted to identify behavioral characteristics of salty food intake according to saline sensitivity of adults living in a rural area. Anthropometry and blood pressure were measured and salt intake-related dietary behavior was surveyed by questionnaires through interviews with 402 subjects aged ${\geq}$ 40 years in Chungcheongbuk-Do, Korea. The percentages of overweight and obese among the subjects were 37.8% and 3.8% respectively. Mean blood pressure of the subjects was in the normal range, but the distribution of subjects who were normotensive, high normal, and hypertensive was 48.7%, 17.7%, and 33.6% respectively. Approximately 27% of all subjects habitually consumed salty food, which was the smallest group, followed by 38.1% normal and 35.1% not-salty food. However, 34.6% of the eldest group of ${\geq}$ 65 years consumed salty food. The saline insensitive group showed a higher percentage of irregular meals, overeating, speed-eating, an unbalanced diet, a preference for fried food, and habitual intake of salty foods. These subjects recognized the risk for eating salty food, but they lacked the will to reduce their salty food intake. Compared to spouses and family members, experts such as doctors, nurses, and dieticians were the most influential for reducing the salty food intake of subjects. Saline sensitive group had relatively better control over salty food intake at every meal, eating out, and even when eating salty food that the spouse preferred. The saline sensitive group ate more frequently vegetables and fruits, whereas the saline insensitive group ate more frequently hot spicy foods. In conclusion, the results suggest that it is necessary to establish a social atmosphere toward reducing salt intake at the level of the government and food industry and to set action plans to be available for nutrition education programs to reduce salt intake nationwide.

Primiparas만 Perceptions of Their Delivery Experience and Their Maternal-Infant Interaction : Compared According to Delivery Method (초산모의 분만유형별 분만경험에 대한 지각과 모아상호작용 과정에 관한 연구)

  • 조미영
    • Journal of Korean Academy of Nursing
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    • v.20 no.2
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    • pp.153-173
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    • 1990
  • One of the important tasks for new parents. especially mothers, is to establish warm, mutually affirming interpersonal relationships with the new baby in the family, with the purpose of promoting the healthy development of the child and the wellbeing of the whole family. Nurses assess the quality of the behavioral characteristics of the maternal-infant interaction. This study examined the relationships between primiparas pereptions of their delivery experience and their maternal infant interaction. It compared to delivery experience of mothers having a normal vaginal delivery with those having a casearean section. The purpose was to explore the relationships between the mother's perceptions of her delivery experience with her maternal infant interaction. The aim was to contribute to the development of theoretical understanding on which to base care toward promoting the quality of maternal-infant interaction. Data were collected directly by the investigator and a trained associate from Dec. 1, 1987 to March 8, 1988. Subjects were 3 random sample of 62 mothers, 32 who had a normal vaginal delivery and 30 who had a non-elective cesarean section (but without other perinatal complications) at three general hospitals in Seoul. Instruments used were the Stainton Parent -infant Interaction Scale(1981) and the Marut and Mercer Perception of Birth Scale(1979). The first observations were made in the delivery room (for vaginally delivered mothers only), followed by day 1, day 2, day 3, and 2 weeks, 4 weeks, 6 weeks and 8 weeks after birth, for a total of 7-8 contacts(Cesarean section mothers were observed on days 4 and 5 but the data not used for analysis). Observations in the hospital were made during the hour prior to scheduled feedings. The infant was placed beside the mother. Later contacts were made at home. Data analysis was done by computer using as SPSS program and indulded X² test, paired t-test, t-test, and Pearson Correlation coefficient ; the results were as follows. 1. Mothers who had a normal vaginal delivery tended to perceive the delivery experience more positively than cesarean section mothers(p=0.002). The finding supported the hypothesis I that perception of delivery would vary according to the method of delivery. Mothers' perceptions of birth were classified into three dimensions, labor, delivery and the bady. There was a significantly different and positive perception by the vaginally delivered mothers to the delivery experience(p=0.000) but no differences for labor or the bady according to the delivery method(p=0.096, p=0.389), 2. Mothers who had a normal vaginal delivery had higher average maternal-infant interaction scores(p=0.029) than mothers who had a cesarean section. There were similar higher scores for the 1st day(p=0.042), 2nd day (p=0.009), and the 3rd day(p=0.006) after delivery but not for later times. The findings supported the hypothesis Ⅱ that there would be differences in maternal-infant interaction for mothers having vaginal and cesarean section deliveries. However these differences deccreased section deliveries. However these differences decreased over time . by eight weeks the scores for vaginal delivery mothers averaged 8.1 and for cesarean section mothers, 7.9. 3. The more highly positive the pereption of the delivery experience, the higher the maternal-infant interaction score for all subjects(F=.3206, p=.006). The findings supported the hypothesis Ⅲ that there would be correlations between perceptions of delivery and maternal-infant interaction. The maternal infant interaction was highest when the perception of the bady and deliery was positive(r=.4363, p=.000, r=.2881, p=.012). No correlations between perceptions of labor and maternal-infant interaction were found(p=0.062). 4. The daily maternal-infant interaction score for the initial contact after birth to 8 weeks postpartum had the lowest average score 5.20 and the highest 7.98(in a range of 0-10). This subjects group of mothers needed nursing intervention to promote their maternal- infant interaction. The daily scores for the maternal-infant over the period of eight weeks. However, there were significantly different increases in maternal-infant interaction only from the first to second day(p=0.000) and from the fourth to sixth weeks after birth(P=0.000). 5. When the eight items of maternal-infant interaction were evaluated separately, “Expresses feelings about her role as mother” had the highest average score, 1.64(ina range of 0-3)and “Speaks to baby” the lowest, 0.9. All items, with the possible exception of “Expresses feelings about her role as mother”, suggested the subjects' need of nursing intervention to promote maternal-infant interaction. 6. There were positive correlations between certain general charateristis, namely, both a higher economic status(p=0.002) and breast feeding(p=0.202) and maternal - infant interaction. There were positive correlations between a mother's confidence in her role as a mother and the perception of the birth experience(p=0.004). For mothers who had a cesarean section, a positive perception of the birth experience was related to the duration of her marriage(p=0.010), a wanted pregnancy (P=0.030) and her confidence in her role as a mother(p=0.000). Pereptions of birth for mothers who had a normal vaginal delivery were positive than those for mothers who had a cesarean section. The level of maternalinfant interaction for mothers delivered vaginally was higher than for cesarean section mothers. The relationship between perception of birth and materanalinfant interaction was confirmed. Cesarean section has an impact on the mother's perceived experience of birth which, in turn, is positively related to maternal-infant in turn, is positively related to maternal-infant interaction. Nursing intervention to enhance maternal-infant interaction should begin in prenatal classes with an exploration of the potential impact of cesarean section on the perceptions of the birth experience and continue throughout the perinatal and post-natal periods to promote the mother's ability to control with this crisis experience and to mobilize social support. Nursing should help transform a relatively negatively perceived experience into an accepted, positively perceived and self affirming experience which enhances the maternal-infant relationship.

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