• Research in Community and Public Health Nursing
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• v.15 no.4
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• pp.551-565
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• 2004

Purpose: The purpose of this study is to develop a day care center model focused on public health institutions for the elderly residing in their homes. Method: Research design for this study was a mult-level research, which consisted of a related literature review, an Internet search for knowledge of the current situation at home and abroad, on-site interviews, questionnaires collected from a sample of residents in a rural area, and a key-informants approach. Results: 1) The subjects of service - Generalized service should be provided to the elderly, 65 years and older, regardless of their assets. 2) The contents of service - Providing pre-health oriented and post-social welfare service that can integrate and satisfy a wide variety of public health and welfare needs of the elderly would strengthen the health care service of a day care center for the elderly. 3) Delivery system - Basic-level local self-governments should become a central operating body, and establishing a properly adjusted delivery system to a rural area after considering the efficiency and the access of vulnerable rural areas is needed based on modification of 'a Special Law for Agricultural and Fishery Areas' (rural public health center>rural health sub-center ${\rightarrow}$ unified health sub-center ${\rightarrow}$ public health hospital (public health center) ${\rightarrow}$ public welfare office). 4) Facility - Public health facilities such as public health centers and sub-centers should be located in areas that can easily access the facilities. 5) Funding - For day care center for the elderly in local self-government, the central government should modify a relevant implementation of subsidy in and provide some facilities and service regardless of the degree of self reliance of local self-government. 6) Human resources - It is needed to guarantee the period of workers of a day care center for the elderly, at least 3 to 5 years, with considering their specialty on aged care and avoiding circulation based positions. Furthermore, appropriate specially trained personnel such as medical workers and social workers should be placed to take care of both health service and welfare through strengthening of 'rules of law of elderly welfare,' Conclusion: future research is needed to test the model through a demonstration study using a model which may be developed in the future and to standardize the appraisal criteria of people hoping to enter a day care center for the elderly.

• Architectural research
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• v.13 no.3
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• pp.31-40
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• 2011

Profit-keeping behaviors naturally occur in the market to satisfy consumers, and the logic behind it lies in the economies of scale. On the flip side, some commodities transacted in the market are not available or can not be easily acquired unless the demand is high enough. Under this proposition, some consumers rise and find their own solution to meet the services at a reasonable cost or at an adequate level. The commonly adopted way is to establish a cooperative, and it stirs purchasing power by pooling resources and further bargains price and service quality. As a consumer cooperative, housing cooperatives notably found in rural towns enable the elderly to continue independent living. This study is to take a closer look at residential life of the rural elderly in housing cooperatives. Utilizing in-depth focus group interviews with 40 residents in four housing cooperatives, this qualitative research draws main factors affecting the decision to move in, residential assessment, and strengths and weakness of living in a housing cooperative. The primary factor influencing the moving decision is to continue to independent living in a familiar community, and the bottom line is planning ahead. Frailty and bereavement are found to be the leading occasions for them to move. The participants are satisfied with the independent living arrangement, and particularly, cited such features as safety and security, elderly-friendly design, common spaces, freedom, social activities and efficient living. Also, it is stated that some cooperative natures such as control over the property and giving a voice on management render positive impacts on the satisfaction with communal living. In spite of all the benefits and strengths, participants face with a public notion that an independent living arrangement like a housing cooperative has never done before in rural towns, so that most people recognize it as part of dependent living arrangements like nursing home.

• Korean Journal of Clinical Pharmacy
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• v.31 no.1
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• pp.61-78
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• 2021

Background and Objective: The use of potentially inappropriate medications (PIMs) increases the risk of negative health outcomes, including drug-related admissions. Tools for structured medication review have been developed to ensure optimal medication use and safety. Here, we aimed to evaluate medication use review (MUR) tools for community-dwelling older patients. Methods: We performed a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). We searched PubMed, Embase, and the Cochrane Library from 1991 to 2020, excluding tools that are specifically applied to hospitalized patients or nursing home residents. We identified the most common inappropriate medications, drug-disease interactions, drug-drug interactions and prescribing omissions presented among tools. Results: From among 9,788 identified reports screened, 60 met our inclusion criteria; finally, 27 were eligible for data analysis considering originality and up-to-dateness. Most tools presented explicit criteria (93%), and only one was specific to community-dwelling elderly. The most common PIM was tricyclic antidepressants. Use of diltiazem and verapamil in patients with heart failure and the combination of nonsteroidal anti-inflammatory analgesics and warfarin were the most frequent disease-specific PIM and drug-interaction, respectively. Conclusions: Although several medication review tools have been developed for older adults, specific guidelines for community-dwelling populations remain limited. Furthermore, the list of PIMs differed among available tools. In future, specific but integrating MUR tools need to be developed for clinical practice considering this population.

• Journal of Korean society of Dental Hygiene
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• v.14 no.5
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• pp.723-730
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• 2014

Objectives : This research was conducted to investigate geriatric care workers' oral care, and the oral care conditions of residents of elder care facilities in relation to workers' knowledge of oral care. Methods : A survey was conducted from November 2011 to February 2012 with geriatric-care workers in elder care facilities located in Busan and other areas of Gyeongsangnam-do. Results : With regard to their oral self-care practices, 52.5% of the geriatric workers "brushed their teeth from top to bottom" and 58.1% brushed their teeth 3 times a day. Further, 52.0% did not use any oral care products, while 36.5% used Mouthrinese. The workers who brushed their teeth in their own ways or from top to bottom had significantly higher oral care knowledge scores than those who brushed from left to right (p<.05). Concerning oral hygiene care for residents, 72.6% of the geriatric workers recommended that elders visit dentists for oral care, 96.6% helped elders oral wash their teeth every day, and 54.7% used oral care products for the elders. The workers who did not recommend visits to dental clinics scored slightly higher than those who did (p<.05). Additionally, those who did not help elders oral wash their teeth scored significantly higher than those who did (p<.05). Except for oral wash to recuperated old man and recommendation of visiting the dentist, relation between oral care and knowledge about oral health and oral hygiene care is plus mutual relation. Conclusions : To manage the accuracy and quality of oral care work performed by geriatric care workers in elder care facilities, enhancing standard training and education on oral care is necessary. Providing systematic, regular education on such knowledge and practices would also be essential.

• Journal of agricultural medicine and community health
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• v.16 no.2
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• pp.97-119
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• 1991

Korea has made a rapid economic development since the last three decades. This has helped Korea narrow the gap in health service differences in resource availability and in quality of care. However urban and rural differentials are still remarkable. This study has maintained that health status of rural residents is inferior to that of urban dwellers. Therefore, this study was carried out to develop policy measures for improving health services in rural areas. In order to achieve the objective of this study the authors collaborated closely and made field visits, interviews and conducted an extensive literature review regarding rural health services. The following policy options are recommended as a summary ; First, the quality of rural health personnel is a single most important factor influencing the level of rural health services. An innovative program for public health doctors to the internship and/or residency training program such as specialty board program of family medicine. Second, dissatisfaction regarding employment of public health doctors is problematic. More rational employment and deployment programs are needed to meet their personal desire. One way to do this is to make it wide open and competitive. Third this study shows how to increase physician productivity in the rural public health sector. Incentive system needs to be elaborated for the career development of rural health workers. University linked job opportunity as clinical professor is an example. Fourth, without straightening the function of health centers and subcenters, the future of rural health services is doomed to failure. Straightening primary health care is one way to enrich the program of public health facilities and reactivating the operation of health center/hospital is another. A close linkage of public facilities with private hospitals is a minimum requirement for the operation of health delivery system within a health district. Fifth, some measures are urgently required to enhance hospital services in medically underserved areas. Financial subsidy, tax exemption, long-term public loans and higher priority of health manpower deployment are some of them. Sixth, new health programs should be in tiated to meet changing needs of peoples in rural areas. Home health care program, hospice program, nursing home, residential program for the elderly are recommended.

• Journal of agricultural medicine and community health
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• v.26 no.2
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• pp.15-41
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• 2001

Since medical clients and the community they live in are expected to be center of future public health and medical care system, new service programs must be developed with patients focused on in line with widening public access of information and social participation. Patients- focused service shall mean the area- oriented provision of public health service. In this study, health officers working at public health centers, public health sub- centers and medical offices in Jeonbuk- do area were taken for population in order to investigate their attitudes toward and knowledge about the service area assigning system under the public health programs. Findings from the survey to 260 health officers, divided by general category, are as follows : Government officers at public health organizations appeared to have high grade of understanding to the service area assigning system and also great appreciation for the necessity of it. Regarding the timing for the system to be introduced, they support the gradual implementation and, as for the type of service to be provided, they preferred home nursing and treatment of chronic diseases. Highly positive responses were centered on the health classes under the health promotion projects, and as far as health projects for the old are concerned, services for home nursing, for the disabled and for home- alone people are favored most. On the other hand, budgeting, manpower and reorganization are rated as prerequisite to establishment of the service area assigning system. From the viewpoint of system side, the improvement of working conditions is rendered as most urgent, while the information system for establishing the service area assigning system is conceived far from satisfactory. Proper assignment of specialists was noted as mostly important to establish the delivery system for medical service through the service area assigning system by team. As merits of the service area assigning system, it is pointed out that, through the system, health clients can better be managed and the nursing quality will be improved thank to the enhanced specialization. It is also perceived that the district health service is not well prepared to respond to the increased and diversified needs of community people and, furthermore, service programs of health centers have not been fully developed. The most serious problem standing in the way to expansion of health projects is, it is noted, uniformity (formality) of the project. Based on the results of the survey which suggest time has ripen to introduce the service area assigning system, following strategies are proposed to anchor down the system as soon as possible: First, we should introduce the system gradually, starting from the area selected, and in consideration of area specialities, refraining from the hitherto stereotyped way of providing health service. Second, we should seek to properly assign the specialists and improve the working conditions of the assigned officers by securing sufficient budget, since it is a most urgent step to lay foundation for the service area assigning system. Third, best service program should be developed to meet the satisfaction of community people by responding to their needs and solidifying the management of medical clients. Fourth, wide scope of study should further be conducted in order to help this system take roots in the central living of community residents since pilot project on the experimental base attended by specialists only can not win popularity among the masses.

• 한국노년학
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• v.38 no.3
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• pp.705-723
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• 2018

In this study we review the selected articles on elderly health and medical care published in the Journal of the Korea Gerontological Society (JKGS) in the last 40 years, and make suggestions for future research directions for gerontological health and medical care issues. Of all the 40 year publications from volume 1 (1980) to 38 (2017), we first examined the 30th anniversary review on the subject of gerontological nursing care and healthcare policies published in JKGS from 1980 (vol. 1, No. 1) to 2008 (vol. 28, No. 2), and reviewed recent 237 researches of this decade (out of all 655 articles from 2008, vol. 28, No. 3 to 2017, vol. 38, No. 4). We could find the following trends. Firstly, the analysis of the primary authors in the past 10 years revealed that those in public health, nursing and other health-related including physical education areas have dealt the subjects focusing on physical health while those in social welfare mostly on mental health. That is, physical health has been the prime subject of researches in the health and medical care area. Secondly, in the same period quantitative researches were accounted for 89.9%, which is similar to the trend of the first 30 years 81.5 %. On the other hand, qualitative studies were only 11 cases and the focus group interview were the most frequently used method comprising 33.3% among them. Thirdly, the non-experimental researches in the past 10 years comprise 65.4%, which was 82.7% in 1980 2008 period, indicating the increasing trend in experimental researches to deal with the issues in medical and healthcare fields. Lastly, the subjects of the researches were mostly the elders who are healthy, residents of city areas, or home dwellers, and 60% of them were over 65 years old in the past 10 years while the proportion was 42.7% in the previous review period. 81.6 % of the researches in the past 10 years was dealing both genders, slightly decreased trend compared to 88.5% of the previous review period. This study reveals that the researches in non-experimental physical health remains the main stream of JKGS despite the efforts by some researchers to diversify the methods and subjects. Systematic and in-depth researches employing multidisciplinary, qualitative, longitudinal and meta-analytical approaches are called for to guide the gerontolgical health issues with preventive and proactive perspectives.

• Architectural research
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• v.8 no.1
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• pp.1-7
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• 2006

Various housing measures are needed for the rapidly aging society of Korea. In particular, the welfare policy for the elderly has changed towards the community care. Taking this fact into consideration, it is necessary to have the establishment of a system that offers the elderly appropriate welfare services at their appropriate residence (ageing in place) for the effectiveness of the community care. In this aspect, there are a number of implications to Korea to study merits and demerits of the Health Facilities for the Aged (HFA) in Japan. The society of Japan has been rapidly aging since 1970, and Korea is to face the same situation. As for the data of this study, a total of 2,393 facilities (as of November 1999) mentioned in the annual report of the Japanese Ministry of Health, Labor and Welfare were classified based on types of their establishment: (1) free-standing structures (603 facilities); (2) annexes to hospitals (981 facilities); (3) annexes to welfare facilities (511 facilities); and (4) annexes to clinics (298 facilities). Next, 239 facilities were selected through taking a sample of 10 percent from each type of the HFA mentioned above. This was done through the random sampling method with the computer program of MS EXCEL. The Implications of the results of analyses are as follows. First, most of the health facilities were planned with the scale that was larger than the scale of standard special nursing homes in terms of the total floor area. Precise equations that were to obtain precise results of the scale of the HFA and the appropriate number of residents were obtained through the method of the regression analysis. Korea and Japan have similarities in terms of culture, society and family relations; however, the two countries also have differences in terms of the application of laws on the establishment of houses, hospitals, and welfare facilities. As for planning the scale of the HFA, the realities of Korea should be considered. Second, as for the functional aspect of the HFA with a condition of returning home, the place before and after the HFA showed the pattern of 'from a residential place to a residential place' and 'from a hospital to a hospital.' This reveals a close correlation with the types of the HFAs and operational ways of the facilities. Its cause is considered to be the aspect of the operation and management of the HFA rather than the aspect of its function of providing services in association with medical and health facilities. Therefore, when intermediate welfare facilities are considered in Korea, it is strongly advised to consider the problem of annexes to other facilities and efficiency of sharing of the facilities in terms of its operation and management.

• Journal of muscle and joint health
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• v.5 no.1
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• pp.39-56
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• 1998

This study was an quasi-experimental study, done to identify factors Influencing the reduction of symptoms in patients with fibromyalgia. The primary purpose of the study was to develop a Self-Help Program suitable for patients with fibromyalgia in Korea. The secondary purpose was to identify the effects of a Self-Help Program which included stretching exercise. This study was carried out between Feb. 24 and July 8, 1997 and patients in the study Included out patient diagnosed with fibromyalgia based on the criteria developed by the American College of Rheumatology(1990) and H, University which is a tertiary patient care clinic for Rheumatism. The experimental group included 38 patients who were residents of Seoul or Kyungi province, and a control group of 38 patients who were residents of other areas. The control patients were matched to the experimental group patients and they were selected considering the number of tender points on the Fibromyalgia Impact Questionnaire score and a score of self-efficacy. The experimental group participated in a Self-Help Program based on the American Arthritis Foundation(1995) guidelines. The program participants participated in a small group which consisted of 12-15 members attending the program once a week, for 6 weeks with each program lasted two to two and a half hours. The stretching exercise was carried out in each patient's home every day following the video tape exercise provided by the researcher, and the researcher provided encouragement and concern to the patients by calling them once a week. The number times the exercise was performed was divided by the number of participants to calculate the percentage of performance and determine the amount of exercise. Self-efficacy was measured by the Self-Efficacy Scale developed by Lorig et al. (1989) for arthritis patients. The degree of pain was converted to scores based on the Visual Analog Scale, the number of tender points was converted to scores based on the criteria of the ACR(1990) and of Yunus. Depression was measured by CES-D and physical disability, sleep disturbance, fatigue, and anxiety of patients with fibromyalgia were measured by the Fibromyalgia Impact Questionnaire. The level of the exercise performance was converted to scores using the number of times the exercise was performed following the video tape prepared by Association of Rheumatology Health Professionals. Data were analyzed by SPSS windows and the results ire described below. 1. The experimental group which participated in the Self-Help Program showed higher efficacy scores than the control group when both groups were analyzed for depression and the number of tender points as common variables(F=9.146, p=.003). 2. The experimental group which participated in the Self-Help Program showed lower scores than the control group, for pain, the number of tender points, depression, physical disability, fatigue, sleep disturbance and anxiety. These symptoms of fibromyalgia can all be seen to have subsided(F=9.483, p=.003 : F=32.680, p=.001 ; F=11.104, p=.001, F=5.344 : p=.024, F=7.630 : P=.007, F=15.6512, p=.003 : F= 7.5412, p=.008). 3. In the experimental group, the self-efficacy score for the first three weeks showed a positive correlation with the exercise-performance score for four to six weeks (r=.387, p=.043). 4. In the experimental group, the relationship between the level of exercise-performance and the reduction of symptoms showed a significant correlation only to physical disability(r= -.500, p=.001). 5. In the experimental group, the relationship between the self-efficacy score and pain, the number of tender points, depression, physical disability, fatigue, sleep disturbance and anxiety score showed inverse correlations and thus, a reduction of symptoms occured when the self-efficacy score increased(r=-.325, p=.004 ; r= -.253, p=.027, r=-.452, p=.001 : r=-.434, p=.001 ; r=-.316, p=.005 ; r=-.460, p=.001 ; r=-.397, p=.014). Therefore, self-efficacy improved following the Self-Help Program including the stretching exercise. It was also found that physical symptoms (pain, number of tender points, level physical disability) and psychological symptoms (depression, fatigue, sleep disturbance, anxiety) were reduced. Moreover, It was found that the higher the self-efficacy, the the higher the degree of achievement of goals set for the stretching exercises. In addition, the level of exercise-performance influenced the level of physical disability, one of the symptoms of fibromyalgia. Accordingly, the conclusions from this study are that exercise-performance and the reduction of symptoms is achieved through promotion of self-efficacy. Therefore, it is proposed that are the Self-Help Program including stretching exercises is an appropriate nursing intervention for the reduction of symptoms of fibromyalgia.

• Quality Improvement in Health Care
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• v.7 no.2
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• pp.138-155
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• 2000

Background: Factors related to waiting and staying time for patient care in emergency care center (ECC) were examined during 1 month from Apr. 1 to Apr. 30, 1997 at an ECC of Yeungnam university hospital in Taegu metropolitan city, to obtain the baseline data on the strategy of effective management of emergency patients. Method: The study subjects consisted of the 1,742 patients who visited at ECC and the data were obtained from the medical records of ECC and direct surveys. Results: The mean interval between ECC admission time and initial care time by each ECC duty residents was 83.1 minutes for male patients and 84.9 minutes for female patients, and mean ECC staying time (time interval between admission and final disposition from ECC) was 718.0 minutes in men and 670.5 minutes in women. As the results, the mean staying time in ECC was higher in older age, and especially the both of initial care time and staying time were highest in patients of medical aid, and shortest in patients of worker's accident compensation insurance. The on admission or not, previously endotracheal-intubation state of patient. The ECC staying ti initial care time was much more delayed in patients of not having previous medical records and the ECC staying time was higher in referred patients from out-patient department, in transferred patients from the other hospitals and patients having previous records, and in patients partly used the order-communicating system. The factors associated with the initial care time were the numbers of ECC patients and the existence of any true emergent patients, being cardiopulmonary resuscitation (CPR) statusme was much more longer in patients of drug intoxication, in CPR patients, in medical department patients, in transfused patients and in patients related to 3 or more departments. And according to the numbers of duty internships, the ECC staying time for four internships was more longer than for five internships and after admission ordering was done, also-more longer in status being of no available beds. As above mentioned results, the factors for the ECC staying time were thought to be statistically significant (P<0.01) according to the patient's age and the laboratory orders and the X-ray films checked. And also the factor for the ECC staying time were thought to be statistically significant (P<0.01) according to the status being of no available beds, the laboratory orders and/or the special laboratory orders, the X-ray films checked, final disposing department, transferred to other hospital or not, home medication or not, admission or not, the grades of beds, the year grades of residents, the causes of ECC visit, the being CPR status on admission or not, the surgical operation or not, being known personells in our hospital. Conclution: Authors concluded that the relieving method of long-staying time in ECC was being establishing the legally proved apparatus which could differentiate the true emergency or non-emergency patients, and that the methods of shortening ECC staying time were doing definitely necessary laboratory orders and managing beds more flexibly to admit for ECC patients and finally this methods were thought to be a method of unloading for ECC personnels and improving the quality of care in emergency patients.