• Title/Summary/Keyword: Primary care setting

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Diagnosis and Treatment of Restless Leg Syndrome and Periodic Limb Movement of Sleep (하지불편 증후군과 주기성 사지운동장애의 진단과 치료)

  • Ham, Byung-Joo
    • Sleep Medicine and Psychophysiology
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    • v.10 no.1
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    • pp.26-31
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    • 2003
  • Restless leg syndrome (RLS) and periodic limb movement of sleep (PLMS), often concurrent, come under diagnosed disorders of sleep and treatable condition. RLS symptoms are evoked in the limbs at rest and increase in the evening and during the night. PLMS is characterized by periodic episodes of repetitive limb movements caused by muscle contractions during sleep. RLS is often associated with a sleep complaint and PLMS. Both RLS and PLMS represent one of the most commonly encountered sleep disorders in a primary care setting. The circadian rhythm and the presence of PLMS cause sleep disturbances in RLS. The emphasis on pathophysiology includes consideration of central nervous system localization, neurotransmitter, and the role of iron metabolism. Dopaminergic agents are considered the treatment of choice for RLS and PLMS. With proper diagnosis and effective treatment patients' ability to fall asleep and maintain sleep improves, and their sense of well being increases.

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Multiple Tuberculous Splenic Abscesses in a Child (소아에서 발생한 비장의 다발성 결핵성 미세농양 1예)

  • Park, Chan-Yong;Choi, Soo-Jin-Na;Chung, Sang-Young;Kim, Shin-Kon
    • Advances in pediatric surgery
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    • v.12 no.2
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    • pp.244-250
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    • 2006
  • Splenic abscess is a rare clinical condition with a reported incidence of 0.14 % to 0.70 % in various autopsy series. Primary tuberculosis of the spleen as a cause of splenic abscess is even rarer, especially in the antitubercular era. Infants and children have a higher predisposition to extra-pulmonary tuberculosis than adults and tend to develop severe extra-pulmonary disease such as miliary tuberculosis and meningitis. The diagnosis of tuberculosis in infants and children can be difficult because of nonspecific symptoms and clinical findings. Computed tomography establishes the diagnosis of splenic abscess and demonstrates the number and location of abscesses. Splenectomy is the standard of care in most clinical setting. We present a 4-year-old girl who had multiple tuberculosis splenic abscesses and was treated successfully with splenectomy.

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A Case Study of Ergonomic Analysis and Improvement of a Machinery Manufacturing Company (기계설비 제조업체의 인간공학적 진단 및 개선사례)

  • Park, Hee‐Sok;Heo, So‐rim
    • Journal of the Ergonomics Society of Korea
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    • v.25 no.4
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    • pp.153-157
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    • 2006
  • The objective of this study was to establish a systematic ergonomic program for the prevention and control of work-related musculoskeletal disorders(WMSDs) in a machinery manufacturing company. The steps such as looking for the signs of WMSDs problems, setting the stage for action, training-building in-house expertise, gathering and examining the evidence of WMSDS, developing controls of health care management, and proactive ergonomic interventions were applied. The primary success factors were management commitment and encouragement, and harmonious union-management relations.

Health Education for Improving the Effectiveness of Community Health Programmes (지역사회 보건사업을 위한 보건교육)

  • 김공현
    • Korean Journal of Health Education and Promotion
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    • v.15 no.1
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    • pp.205-218
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    • 1998
  • Health education is the first of the nine essential services of primary health care which has been advocated as a key in achieving “Health for All” by World Health Organization and its Member States since 1978. The purpose of this paper is to assist community health workers to improve the effectiveness of community health programmes through understanding key issues related to health education, and applying the recommended skills to conducting their health education programmes in the community. Chapter 1 shows the relationship between health and behavior, and the importance of understanding several key factors for people's health behavior in designing and implementing health education programmes in the specific community, and discusses ways to facilitate people's health behavior changes. Chapter 2 deals with conducting face-to-face health education with emphasis on counselling skills, and chapter 3 touches with health education for informal group, in particular at the hospital setting. Chapter 4 introduces how to create a supportive verbal communication climate, and proposes applying these skills to health education so as to improve the effectiveness of health education.

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The association of physicians' caring attitude with patient satisfaction: an analysis of the national e-survey data

  • Park, Chanhyun;Kim, Namhyo;Shin, Dong Yeong;Feldman, Steven R.;Balkrishnan, Rajesh;Chang, Jongwha
    • Korea Journal of Hospital Management
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    • v.20 no.2
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    • pp.15-27
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    • 2015
  • As patient satisfaction is a crucial component of improved health care outcomes, there is a need to evaluate the relationship between physicians' attitude and patients' satisfaction. The objective of this study is to examine the relationship between patients' satisfaction and physicians' friendly and caring attitudes by using recent physician ratings by patients. Data from a cross-sectional survey using a convenience sampling was utilized to examine the relationship between physicians' attitudes and patients' satisfaction. The independent variable was the physician's attitude, and the dependent variables were patients' satisfaction with the physician and the office setting. A total of 273,994 patients it the US were included. The patients' average (standard deviation, SD) satisfaction with the physician was 78.08 (0.14), and the average (SD) satisfaction with the office setting was 78.62 (0.12) out of 100. Physicians' attitude was a significant predicting factor impacting the patients' satisfaction with the physician and the office setting (p < 0.001). To facilitate patients' satisfaction with healthcare, a continuous effort to develop physicians' ability to communicate in an empathetic manner should be undertaken so that patients perceive their physicians as empathetic.

Effect of sodium restriction on blood pressure of unstable or uncontrolled hypertensive patients in primary care

  • De Keyzer, Willem;Tilleman, Katrien;Ampe, Jan;De Henauw, Stefaan;Huybrechts, Inge
    • Nutrition Research and Practice
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    • v.9 no.2
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    • pp.180-185
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    • 2015
  • BACKGROUND/OBJECTIVES: The aims of the present study are: 1) to quantify sodium consumption of patients with unstable or uncontrolled hypertension, 2) to investigate if reduced sodium intake can lower BP in these patients, and 3), to assess the acceptability and feasibility of this approach. SUBJECTS/METHODS: This study included 25 adults (age: 50+ years) with frequently elevated BP or patients with uncontrolled, uncomplicated hypertension despite drug treatment in a general practice setting. BP and salt intake (24h urinary excretion and food records) were measured at baseline and after a sodium reduced diet. RESULTS: Mean (${\pm}SD$) systolic (SBP) over diastolic (DBP) blood pressure (mmHg) at baseline was $150.7({\pm}9.5)$/$84.149({\pm}5.6)$. Mean urinary sodium excretion was 146 mmol/24h. A reduction of 28 mmol sodium excretion decreased SBP/DBP to $135.5({\pm}13.0)$/$82.5({\pm}12.8)$ (P < 0.001). After one month of no dietary advice, only in 48%, SBP was still ${\leq}140mmHg$. CONCLUSION: Assessment of sodium intake using food records, 24h urine collections and probing questions to identify use of sodium containing supplements or drugs are essential for tailored advice targeted at sodium intake reduction. The results of the present study indicate that reduced sodium intake can lower BP after 4 weeks in unstable or uncontrolled hypertensive patients.

Hearing loss screening tool (COBRA score) for newborns in primary care setting

  • Poonual, Watcharapol;Navacharoen, Niramon;Kangsanarak, Jaran;Namwongprom, Sirianong;Saokaew, Surasak
    • Clinical and Experimental Pediatrics
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    • v.60 no.11
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    • pp.353-358
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    • 2017
  • Purpose: To develop and evaluate a simple screening tool to assess hearing loss in newborns. A derived score was compared with the standard clinical practice tool. Methods: This cohort study was designed to screen the hearing of newborns using transiently evoked otoacoustic emission and auditory brain stem response, and to determine the risk factors associated with hearing loss of newborns in 3 tertiary hospitals in Northern Thailand. Data were prospectively collected from November 1, 2010 to May 31, 2012. To develop the risk score, clinical-risk indicators were measured by Poisson risk regression. The regression coefficients were transformed into item scores dividing each regression-coefficient with the smallest coefficient in the model, rounding the number to its nearest integer, and adding up to a total score. Results: Five clinical risk factors (Craniofacial anomaly, Ototoxicity, Birth weight, family history [Relative] of congenital sensorineural hearing loss, and Apgar score) were included in our COBRA score. The screening tool detected, by area under the receiver operating characteristic curve, more than 80% of existing hearing loss. The positive-likelihood ratio of hearing loss in patients with scores of 4, 6, and 8 were 25.21 (95% confidence interval [CI], 14.69-43.26), 58.52 (95% CI, 36.26-94.44), and 51.56 (95% CI, 33.74-78.82), respectively. This result was similar to the standard tool (The Joint Committee on Infant Hearing) of 26.72 (95% CI, 20.59-34.66). Conclusion: A simple screening tool of five predictors provides good prediction indices for newborn hearing loss, which may motivate parents to bring children for further appropriate testing and investigations.

The Seosan County Family Planning/Maternal & Child Health Service Research Project, Korea -Project Design and Findings of the Baseline Survey- (가족계획(家族計劃) 및 모자보건사업(母子保健事業)의 효율적 통합방안(統合方案)에 관한 연구(硏究)(서산군(瑞山郡)) -기초조사보고(基礎調査報告)-)

  • Bang, S.;Cho, T.H.;Lee, S.J.;Han, S.H.;Lim, K.J.;Ahn, M.Y.
    • Journal of Preventive Medicine and Public Health
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    • v.16 no.1
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    • pp.163-192
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    • 1983
  • In order to facilitate the Korean government's efforts in integrating family planning and maternal & child health at the primary health care level (or township level), the Soon Chun Hyang College of Medicine, with the financial and technical assistance of WHO, has under-taken a service research project. The project has employed a quasi-experimental study design introducing interventions tat provide crucial factors lacking in the ongoing government programs such as midwives and qualified referral physicians. The study is being conducted in three locations, one control area and two study areas. Before introducing trained Nurse/Midewives into the study areas, a baseline prevalence survey was undertaken from 15 July 1981 to 10 August 1981 in selelcted townships of Seosan County. In this sample survey of bath the study and control areas, 2,484 eligible women (97% reponse rate) were interviewed to obtain benchmark data on basic evaluation indicators related to family planning and maternal and child health. The salients results were summarized as follows.: 1. CONTACT RATES WITH HEALTH WORKERS; During the year preceding the survey, 12% of women were visited by government health workers. The primary reason for such visits by health workers was family planning (45% of the visits). About 34% of the women visited the health centers during the year. The primary reason for visiting health centers was immunizations for their children (45% of the visits). 3. FAMILY PLANNING USE RATE; The baseline data showed little difference between women in the study area and the control area on contraceptive use. Approximately 59% were currently using some methods. However, among those current users, almost half were practicing less effective methods of birth control such as rhythm or withdrawal. Among other methods, the tubectomy was the most popular (16%), while use of the IUD, oral pill and condom together reached only 14%. 3. PRENATAL CARE RATE; About 75% of the women reported no prenatal care for their last births (the youngest child of each women), Additionally, among women received prenatal care, over half had only one visit. 4. ATTENDANCE AT DELIVERY; Most of the women surveyed (over 80%) were attended by a non-medical person during their last delivery. These figures are somewhat comparable to the national figure of 84% for remote areas. 5. POSTNATAL CARE; The proportion of women reporting postnatal care was only 4.5%, and postnatal care was not received by the majority of women surveyed. 6. CHILD HEALTH CARE: In contrast to the low rate of maternity care for women themselves, most women reported obtaining immunization care for their children. About 75% of the women obtained Polio and/or DPT, 58% BCG, and 44% Measles vaccine for their children. However, in terms of illness care, while 35% of the women stated that their youngest child had been sick during the month preceding the survey, only 28% of these women took their child to the clinic for treatment. 7. COMPLICATIONS OF PREGNANCY AND DELIVERY AND ABNORMALITIES IN THE NEWBORN; Among all last deliveries, 18% of the women had pregnancy complications and 9% of the women had complications during delivery About 5% of the women reported abnormality in their most recent newborn. 8. REPRODUCTION EFFICIENCY; PERINATAL MORTALITY AND INFANT MORTALITY Based on data from the pregnancy history in this survey, reproduction efficiency was estimated. Out of the 11,154 pregnancies reported by all women surveyed, foetal loss was 21% (almost 16% were induced abortions) and infant deaths before reaching one year old were 3.1%. The reproduction efficiency was, therefore, reduced to 76%. In terms of perinatal and infant mortality rates, the former was 40.2 per 1,000 total births and the latter was 39.3 per 1,000 live births. Both rates described J shaped relationships with age of mothers and parity, and they were also correlated with birth interval and mother's education. In summary, this baseline survey data indicated a need for (1) improving contraceptive practices with more effective methods to prevent unwanted pregnancies and (2) providing better services for maternal and child care to protect wanted pregancies. In the Korean rural setting. the author believes that the latter is more important as the value of each child has increased as a result of the family planning campaign for the past two decades. This calls for more effective integration of Family Planning and MCH programmes to meet the needs of the family in each stage of the child bearing and rearing period with deploying more qualified personnel than the current government program personnel.

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Feasibility Study of Case-Finding for Breast Cancer by Community Health Workers in Rural Bangladesh

  • Chowdhury, Touhidul Imran;Love, Richard Reed;Chowdhury, Mohammad Touhidul Imran;Artif, Abu Saeem;Ahsan, Hasib;Mamun, Anwarul;Khanam, Tahmina;Woods, James;Salim, Reza
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.17
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    • pp.7853-7857
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    • 2015
  • Background: Mortality from breast cancer is high in low- and middle-income countries, in part because most patients have advanced stage disease when first diagnosed. Case-finding may be one approach to changing this situation. Materials and Methods: We conducted a pilot study to explore the feasibility of population-based case finding for breast cancer by community health workers (CHWs) using different data collection methods and approaches to management of women found to have breast abnormalities. After training 8 CHWs in breast problem recognition, manual paper data collection and operation of a cell-phone software platform for reporting demographic, history and physical finding information, these CHWs visited 3150 women >age 18 and over they could find-- from 2356 households in 8 villages in rural Bangladesh. By 4 random assignments of villages, data were collected manually (Group 1), or with the cell-phone program alone (Group 2) or with management algorithms (Groups 3 and 4), and women adjudged to have a serious breast problem were shown a motivational video (Group 3), or navigated/accompanied to a breast problem center for evaluation (Group 4). Results: Only three visited women refused evaluation. The manual data acquisition group (1) had missing data in 80% of cases, and took an average of 5 minutes longer to acquire, versus no missing data in the cell phone-reporting groups (2,3 and 4). One woman was identified with stage III breast cancer, and was appropriately treated. Conclusions: Among very poor rural Bangladeshi women, there was very limited reluctance to undergo breast evaluation. The estimated rarity of clinical breast cancer is supported by these population-based findings. The feasibility and efficient use of mobile technology in this setting is supported. Successor studies may most appropriately be trials focusing on improving the suggested benefits of motivation and navigation, on increasing the numbers of cases found, and on stage of disease at diagnosis as the primary endpoint.

Thoracic Scoliosis in Patients with Primary Spontaneous Pneumothorax

  • Lee, Yeiwon;Kim, Young Jin;Ryu, Han Young;Ku, Gwan Woo;Sung, Tae Yun;Yoon, Yoo Sang;Kim, Tae-Kyun
    • Journal of Chest Surgery
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    • v.51 no.4
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    • pp.254-259
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    • 2018
  • Background: Primary spontaneous pneumothorax (PSP) affects patients without clinically apparent lung disorder found in tall and thin young male. Scoliosis refers to curves exceeding $10^{\circ}$ Cobb angle observed through chest X-ray and affects 2% to 4% of adolescents. Both conditions are commonly encountered in primary health care setting. The aim of this study is to access the correlation of thoracic scoliosis and PSP in adolescent. Methods: A retrospective analysis was conducted for patients diagnosed for PSP in Konyang University Hospital between January 2010 and March 2017. Chest X-rays of 222 patients and 155 normal control (NC) cases were reviewed to measure the Cobb angle. Greater than $10^{\circ}$ of Cobb angle is diagnosed as scoliosis. Results: Scoliosis in patient with PSP has higher incidence than that of NC group (p<0.001). Median value of Cobb angle is $12.9^{\circ}$ in PSP group and $14.7^{\circ}$ in NC group. Directional relationship between scoliosis and pneumothorax in PSP group is also observed; 40.5% cases are ipsilateral and 59.5% are contralateral. Conclusion: PSP patients tend to have thoracic scoliosis more commonly compared with normal healthy adolescent. Scoliosis may contribute to heterogeneity of alveolar pressure which exacerbates subpleural bleb formation that can cause pneumothorax. The causal relationship is unclear and further studies are needed in the future.