• Child Health Nursing Research
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• v.15 no.1
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• pp.5-14
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• 2009

Purpose: The purpose of this study was to determine the effect of an education program on child health and safety for teachers in child daycare centers. Method: Using a nonequivalent one group pretest-posttest design, 41 day care staff(N=41) from 12 day care centers in Seoul and D-gun in Chung-Nam were assigned to experimental group. A program that is appropriate for preventing injuries and protecting the health of young children at child daycare centers was developed. Health and safety education program was provided for the intervention group for 2 weeks two times. Results: After education session, the mean score of knowledge, self confidence, practice on safety and health in child care teachers were significantly increased. There were significant differences in the degree of knowledge according to education, and in the degree of practice according to age. Conclusions: The education program for child care teachers was effective in promoting knowledge, self confidence and practice on child health and safety. The results suggest that health and safety education program should be provided systematically and continuously for child care teachers.

• Journal of Preventive Medicine and Public Health
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• v.43 no.6
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• pp.496-504
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• 2010

Objectives: The purpose of this study was to analyze the effect of outpatient cost-sharing on health care utilization by the elderly. Methods: The data in this analysis was the health insurance claims data between July 1999 and December 2008 (114 months). The study group was divided into two age groups, namely 60-64 years old and 65-69 years old. This study evaluated the impact of policy change on office visits, the office visits per person, and the percentage of the copayment-paid visits in total visits. Interrupted time series and segmented regression model were used for statistical analysis. Results: The results showed that outpatient cost-sharing decreased office visits, but it also decreased the percentage of copayment-paid visits, implying that the intensity of care increased. There was little difference in the results between the two age groups. But after the introduction of the coinsurance system for those patients under age 65, office visits and the percentage of copayment-paid visits decreased, and the 60-64 years old group had a larger decrease than the 65-69 years old group. Conclusions: This study evaluated the effects of outpatient cost-sharing on health care utilization by the aged. Cost sharing of the elderly had little effect on controlling health care utilization.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.19 no.3
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• pp.353-362
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• 2012

Purpose: The objective of this study was to examine the correlation between HbA1C, self-care behavior, and quality of life among depressed and non-depressed patients with type II diabetes Methods: Data were collected between May 26 and July 5, 2011 using a questionnaire. The questionnaire included depression (CES-D), self-care behavior and quality of life. Hemoglobin A1C was ed from medical records. Data were analyzed by descriptive statistics, t-test, $x^2$-test, ANCOVA and Pearson's correlation coefficient. Results: In this study sample (n=301), 20.9% of diabetic patients (n=69) were depressed. After adjustment for relevant covariates, depressed patients showed to have lower self-care behavior (2.8 vs 3.4, p<.001) and quality of life (2.8 vs 3.5, p<.001) scores, but the difference in HbA1C was no longer significant. Conclusion: This study suggests that the assessment and intervention for depressed diabetic patients can result in effective self-care behavior, which accordingly leads to improvement of the quality of life.

• Therapeutic Science for Rehabilitation
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• v.8 no.2
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• pp.55-66
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• 2019

Objective : The purpose of this study is to confirm whether the effectiveness of the program is sustainable 9 months after project completion for the children and adolescents participating in a childcare and rehabilitation support project. Methods : This study was carried out in three phases: pre-(2016.5~6), post-(2016.10~12) and follow-up evaluation phases (2017.9) of 120 children and adolescents who participated in a treatment and rehabilitation of children project in 2016. The analysis was conducted using a repeated mesures ANOVA to identify changes in problem behaviors. Results : The problem behavior of preschoolers in middle and high schools decreased after the post-evaluation compared to the pre-evaluation, and the effect of treatment was maintained afterward. Elementary school students displayed fewer problem behaviors after the post-evaluation than in the pre-evaluation, and follow-up more. Conclusions : This study confirms that the effects of therapy are maintained for a long period of time. Furthermore, it has been confirmed that therapeutic intervention is effective for children and adolescents in foster care.

• Dementia and Neurocognitive Disorders
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• v.22 no.2
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• pp.49-60
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• 2023

Background and Purpose: The National Responsibility Policy for Dementia Care was implemented in September 2017 in Korea. This study aimed to compare dementia incidence in Seoul and Gangwon-do before and after the implementation of this policy. Methods: We extracted insurance claim data from the Korean Health Insurance Review and Assessment Service for people diagnosed with diabetes, hypertension, or dyslipidemia for the first time in Seoul and Gangwon-do, Korea. We defined two enrollment groups based on the policy implementation date: 1) January 1, 2015 to December 31, 2016 (Index 1, pre-implementation), and 2) January 1, 2017 to December 31, 2018 (Index 2, post-implementation). Each group was followed up for 1 year from the time of enrollment. Then, we calculated hazard ratios to compare the incidence of dementia between the two groups, and between Seoul and Gangwon-do. Results: In Seoul, the incidence of dementia was significantly lower in Index 2 than in Index 1 (hazard ratio [HR], 0.926; 95% confidence interval [CI], 0.875-0.979). However, the incidence rate did not differ between the 2 groups (HR, 1.113; 95% CI, 0.966-1.281) in Gangwon-do. In Index 1, the incidence of dementia did not differ between Seoul and Gangwon-do (HR, 1.043; 95% CI, 0.941-1.156), but in Index 2, was significantly higher in Gangwon-do than in Seoul (HR, 1.240; 95% CI, 1.109-1.386). Conclusions: After implementing the National Responsibility Policy for Dementia Care, the dementia incidence rate decreased significantly in Seoul, consistent with other studies, but not in Gangwon-do.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.6
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• pp.3887-3889
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• 2013

Introduction: Mesothelioma is a rare neoplasm arising from mesothelial surfaces with the malignant pleural mesothelioma (MPM) as the most common form. Secondline chemotherapy in MPM is still controversial and in this study we evaluated whether it is superior to best supportive care. Materials and Methods: A total of 51 patients with MPM from Acibadem Kayseri Hospital, Kayseri Training and Research Hospital and Erciyes University were analyzed retrospectively. The patients treated with secondline chemotherapies (SLCT) were compared with those treated with best supportive care (BSC) for overall survival. Results: The median overall survival (OS) for firstline chemotherapy${\rightarrow}$SLCT and firstline chemotherapy${\rightarrow}$BSC groups were 20.3 and 14.7 months respectively (p=0.079). After firstline chemotherapy the median OS for SLCT and BSC were 5.9 and 4.7 months (p=0.355). Discussion: Although there was a trend for improvement in overall survival in patients treated with secondline chemotherapy, the difference was not statistically significant. Our results do not support the proposal that secondline chemotherapy could be effective in patients with MPM.

• Health Policy and Management
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• v.23 no.4
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• pp.326-342
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• 2013

Background: Engaging and Involving stakeholders who have different interests in changing health care policies are difficult task. As the literature on the governance in Korean health care field is rare, this study aims to provide empirical evidence of 'governing health policy'-the ways health care policy is made, implemented, and evaluated from a political perspective. Methods: The authors of this study conducted interviews with elites in policy and clinical areas, which was considered to be the most effective approach to gather in-depth information about the background of changing payment policy as well as the barriers or contributors for making the policy sustainable. A total of 14 experts (3 government officials, 2 representatives from medical profession, 3 professors form academic field, and 6 healthcare providers from New DRG pilot program hospitals) participated in 2 hour long interviews. Results: There was a perception gap of the feasibility and substantiality of new payment system among elites. The score was higher in government officers than those in scholars or clinical experts. Next, the interviewees indicated that Korean New DRG might not sustain without significant efforts to improving democratic aspects of the governance. It is also notable that all interviewees except healthcare providers provided negative expectation of the contribution of new payment system to increase administration efficiency. For clinical efficiency, every stakeholders perceived there was no increased efficiency after introduction of New DRG payment. Like general perception, there was a wide gap between the perception of stakeholders in quality change after implementing the new payment system. Finally, interview participants negatively assumed about the likelihood of New DRG to remain a case of successful reforms. Conclusion: This study implied the importance of social consensus and the governance of health policy.

• Tuberculosis and Respiratory Diseases
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• v.83 no.1
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• pp.42-50
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• 2020

Background: Fractional exhaled nitric oxide (FeNO) is regarded as a potential biomarker for identifying eosinophilic inflammation. We aimed to evaluate the clinical implication of FeNO and its influence on inhaled corticosteroids (ICS) prescription rate in Korean chronic obstructive pulmonary disease (COPD) patients. Methods: FeNO level and its association with clinical features were analyzed. Changes in the prescription rate of ICS before and after FeNO measurement were identified. Results: A total of 160 COPD patients were divided into increased (≥25 parts per billion [ppb], n=74) and normal (<25 ppb, n=86) FeNO groups according to the recommendations from the American Thoracic Society. Compared with the normal FeNO group, the adjusted odds ratio for having history of asthma without wheezing and with wheezing in the increased FeNO group were 2.96 (95% confidence interval [CI], 1.40-6.29) and 4.24 (95% CI, 1.37-13.08), respectively. Only 21 out of 74 patients (28.4%) with increased FeNO prescribed ICS-containing inhaler and 18 of 86 patients (20.9%) with normal FeNO were given ICS-containing inhaler. Previous exacerbation, asthma, and wheezing were the major factors to maintain ICS at normal FeNO level and not to initiate ICS at increased FeNO level. Conclusion: Increased FeNO was associated with the history of asthma irrespective of wheezing. However, FeNO seemed to play a subsidiary role in the use of ICS-containing inhalers in real-world clinics, which was determined with prior exacerbation and clinical features suggesting Th2 inflammation.

• Tuberculosis and Respiratory Diseases
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• v.79 no.4
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• pp.214-233
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• 2016

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

• Journal of Korean Academy of Nursing
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• v.43 no.3
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• pp.352-360
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• 2013

Purpose: In this study an examination was done of the effects of the American Society of PeriAnesthesia Nurses (ASPAN) Evidence-Based Clinical Practice Guidelines on body temperature, shivering, thermal discomfort, and time to achieve normothermia in patients undergoing total knee replacement arthroplasty (TKRA) under spinal anesthesia. Methods: This study was an experimental study with a randomized controlled trial design. Participants (n=60) were patients who underwent TKRA between December 2011 and March 2012. Experimental group (n=30) received active and passive warming measures as described in the ASPAN's guidelines. Control group (n=30) received traditional care. Body temperature, shivering, thermal discomfort, time to achieve normothermia were measured in both groups at 30 minute intervals. Results: Experimental group had slightly higher body temperature compared to control group (p=.002). Thermal discomfort was higher in the experimental group before surgery but higher in the control group after surgery (p=.034). It decreased after surgery (p=.041) in both groups. Time to achieve normothermia was shorter in the experimental group (p=.010). Conclusion: ASPAN's guidelines provide guidance on measuring patient body temperature at regular intervals and on individualized and differentiated hypothermia management which can be very useful in nursing care, particularly in protecting patient safety and improving quality of nursing.