• 지역사회간호학회지
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• 제26권3호
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• pp.278-291
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• 2015

Purpose: This study was conducted to examine differences in health care utilization and related costs between before and after the introduction of the designated doctor system, and to find out factors making the differences. Methods: Data were collected from 200 medical aid beneficiaries having one or more chronic diseases, registered in the designated doctor system during the year of 2012, and the relationship between the use of health services and claimed medical expenses was analyzed through paired t-test and multiple regression analysis using the SPSS 18.0 program. Results: There was a decrease in the number of total benefit days and the number of outpatient and medication days, but some cases showed an increase after the designation of medical institution. In general, hospital stay increased after the introduction of the system. However, the number of medical institutions utilized was reduced in most cases after designation. Conversely, medical expenses increased in most cases after the designation of medical institution. Conclusion: These results suggest that a detailed scheme to designate medical institutions should be made in consideration of the seriousness of illness and classification of medical institutions not only for the beneficiaries' enhanced health but for the effective management of medical aid fund.

• Safety and Health at Work
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• 제11권1호
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• pp.10-18
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• 2020

Background: The elevated risk of occupational infection such as tuberculosis among health workers in many countries raises the question of whether the quality of occupational health and safety (OHS) and infection prevention and control (IPC) can be improved by auditing. The objectives of this study were to measure (1) audited compliance of primary health-care facilities in South Africa with national standards for OHS and IPC, (2) change in compliance at reaudit three years after baseline, and (3) the inter-rater reliability of the audit. Methods: The study analyzed audits of 60 primary health-care facilities in the Western Cape Province of South Africa. Baseline external audits in the time period 2011-2012 were compared with follow-up internal audits in 2014-2015. Audits at 25 facilities that had both internal and external audits conducted in 2014/2015 were used to measure reliability. Results: At baseline, 25% of 60 facilities were "noncompliant" (audit score<50%), 48% "conditionally compliant" (score >50 < 80%), and only 27% "compliant" (score >80%). Overall, there was no significant improvement in compliance three years after baseline. Percentage agreement on specific items between internal and external audits ranged from 28% to 92% and kappa from -0.8 to 0.41 (poor to moderate). Conclusion: Low baseline compliance with OHS-IPC measures and lack of improvement over three years reflect the difficulties of quality improvement in these domains. Low inter-rater reliability of the audit instrument undermines the audit process. Evidence-based investment of effort is required if repeat auditing is to contribute to occupational risk reduction for health workers.

• 한국생활과학회지
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• 제13권5호
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• pp.751-763
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• 2004

This study aims to identify children's after-school facilities in Cheonan, to evaluate their programs, and to further suggest desirable directions of those programs. During this study, we found that the facilities in Cheonan are much less in numbers and no better than we expected. Especially, it is shown that most of the study rooms there are evaluated as relatively the worst facilities in terms of space organization, health care and safety, daily schedule and management, and program evaluation process. In conclusion, this study proposes that such facilities should be greatly expanded and improved in the program development as well as in the working environment. We also propose to newly establish a regional center which supports and certifies educational programs of each after-school facility.

• Journal of Hospice and Palliative Care
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• 제10권3호
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• pp.120-127
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• 2007

Bereavement is the state of loss resulting from death. Grief is the emotional response associated with loss, intense and acute sorrow resulting from loss. Complicated grief represent a pathological outcome involving social, physical, emotional, cognitive, spiritual morbidity. The common psychiatric disorders associated complicated grief or abnormal grief responses include clinical depression, anxiety disorders, alcohol abuse or other substance abuse, and dependence, psychotic disorders, and post-traumatic stress disorder (PTSD). Grief tasks involve a series of stage or phases following an important loss that gradually permit adjustment and recovery. Three phases of grief involve phase 1 (walking the edges), phase 2 (entering the depths), and phase 3 (reconnecting the world). For intervention to be effective they need to be individually tailored to abnormal grief reaction or unresolved grief reaction. Clear understandings of complicated grief, abnormal responses, factors increasing risk after bereavement will often enable us to prevent psychiatric disorders in bereaved patients.

• Tuberculosis and Respiratory Diseases
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• 제70권5호
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• pp.397-404
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• 2011

Background: To evaluate chest CT findings of pandemic influenza A/H1N1 pneumonia without co-infection. Methods: Among 56 patients diagnosed with pandemic influenza A/H1N1 pneumonia, chest CT was obtained in 22 between October 2009 and Februrary 2010. Since two patients were co-infected with bacteria, the other twenty were evaluated. Predominant parenchymal patterns were categorized into consolidation, ground glass opacity (GGO), and mixed patterns. Distribution of parenchymal abnormalities was assessed. Results: Median age was 46.5 years. The CURB-65 score, which is the scoring system for severity of community acquired pneumonia, had a median of 1. Median duration of symptoms was 3 days. All had abnormal chest x-ray findings. The median number of days after the hospital visit that Chest CT was performed was 1. The reasons for chest CT performance were radiographic findings unusual for pneumonia (n=13) and unexplained dyspnea (n=7). GGO was the most predominant pattern on CT (n=13, 65.0%). Parenchymal abnormalities were observed in both lungs in 13 cases and were more extensive in the lower lung zone than the upper. Central and peripheral distributions were identified in ten and nine cases, respectively. One showed diffuse distribution. Peribronchial wall thickening was found in 16 cases. Centrilobular branching nodules (n=7), interlobular septal thickening (n=4), atelectasis (n=1), pleural effusion (n=5), enlarged hilar and mediastinal lymph nodes (n=6 and n=7) were also noted. Conclusion: Patchy and bilateral GGO along bronchi with predominant involvement of lower lungs are the most common chest CT findings of pandemic influenza A/H1N1 pneumonia.

• Tuberculosis and Respiratory Diseases
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• 제56권2호
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• pp.203-209
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• 2004

MTX는 골육종이나 진행된 비호치킨씨 임파종과 같은 종양성 질환 뿐아니라 건선이나 류마치스 관절염, 유육종증, 웨그너씨 육아종증등의 양성질환에서도 널리 쓰여지는 약물이다. MTX에 의한 폐독성은 약제를 투여받은 환자들 중 0.3-7.5%정도에서 나타나는 것으로 알려져 있다. 급성 또는 만성의 경과로 나타나는 MTX 폐렴의 예가 기술되어 있지만 전형적으로는 MTX를 투여한지 수개월내에 증상이 나타나는 아급성의 임상경과를 취하는 경우가 많다. 조직병리학적으로는 NSIP의 형태로 나타나는 경우가 가장 흔한 것으로 되어 있으나 BOOP나 DAD로 나타나는 경우도 드물게 보고되고 있으며 그 중 육아종의 형성을 보이는 예는 34.7% 정도로 알려져 있다. 우리나라에서는 NSIP나 DAD로 나타난 MTX 폐장염의 예가 보고되어있다. 저자들은 과민성 폐장염의 형태로 발현한 MTX에 의한 폐독성의 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 한국치위생학회지
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• 제6권1호
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• pp.49-61
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• 2006

This study was intended to identify the pregnant women's oral health care behaviors and the necessity of active oral care so as to use in the dental hygiene education at dental clinics as basic materials to inform the importance of oral health during pregnancy and instruct how to improve it. And to suggest a dental service direction for dental hygienists, 150 pregnant women who visited the Ostetrics and Genecology Clinics located in tl,e north part of Cholla province were surveyed with questionnaire on their oral care behaviors, from september to October in 2004. The findings were as below: 1. 43.8% of the pregnant women have ever used the dental care institutes within the recent 3 months during pregnancy period. The purpose of the visits was mostly treatment of dental caries, accounting for 40.0%. Next came the treatment of periodontal diseases, accounting for 33.8%. 2. At dental care service, 84.7% of the pregnant women informed the clinic staff of their pregnancy, 12.0% of the pregnant women were having periodical oral examination. 3. 56.7% of the pregnant women have ever inquired about oral care methods, 24.0% of the pregnant women have ever taken any oral health education, of whom 47.1% had higher schooling over graduate school, with a statistically signifiant difference. 4. 55.3% of the pregnant women made changes in their oral care practice after they got pregnant. Change of oral care practices was more obvious in those who had higher schooling background, of whom specialist women accounted 76.9%. Change of oral care practices after pregnancy was statistically significantly different to the academic background and occupation. 5. Of the changes in oral care practice after pregnancy, 51.8% of the pregnant women answered they got sensitive to change in their oral status, and 39.8% increased the frequency of tooth brushing. 6. In selecting a tooth paste after they got pregnant, 58.0% of the women didn't give any special consideration to the kind of tooth paste, while 10.7% women as low selected such tooth pastes that contain fluoride. 7. Pregnant women's route for gathering oral care information was mostly mass media and Internet which accounted for 50.7%.

• Journal of Preventive Medicine and Public Health
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• 제46권3호
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• pp.147-154
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• 2013

Objectives: Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses. Methods: Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status. Results: Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (p<0.001). The number of medical care visits for psychiatric disorders prior to suicide significantly increased only in 40- to 64-year-old men (p=0.002), women <40 years old (p=0.011) and women 40 to 64 years old (p= 0.021) after adjustment for residence, socioeconomic status, and morbidity. Conclusions: Most of the suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.

• Tuberculosis and Respiratory Diseases
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• 제67권6호
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• pp.569-573
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• 2009

Idiopathic pulmonary alveolar proteinosis (PAP) is a rare disorder characterized by surfactant component accumulation in the alveolar space. Idiopathic PAP has recently been recognized as a autoimmune disease of impaired alveolar macrophage function caused by autoantibodies against granulocyte-macrophage colony-stimulating factor (GM-CSF). While whole lung lavage has been the standard treatment, not every patient shows a complete response. Subcutaneous injection or inhalation of GM-CSF is another promising treatment option for PAP. A 45-year-old patient visited our hospital for dyspnea, he was diagnosed as PAP and underwent whole lung lavage. Eighteen months later, the patient had not achieved complete remission in despite of initial response. After then he was administered with GM-CSF (5 ${mu}g/kg/day$, subcutaneous injection) for fivetimes a week during 2 months. Nine months later, the abnormal shadows in high-resolution computed tomography (HRCT) decreased and the patient fully recovered in forced vital capacity. After 60 months, the HRCT scan showed complete remission of PAP.

• Journal of Oral Medicine and Pain
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• 제26권4호
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• pp.309-318
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• 2001

The purposes of the study were (1) to evaluate the olfactory identification ability in those who have bad breath, (2) to determine the olfactory detection threshold for methyl mercaptan in normal subjects and those who have bad breath, and (3) to evaluate the effect of oral hygiene care on the olfactory detection threshold for methyl mercaptan. Sixteen male subjects with bad breath (male odor group), 9 male subjects without bad breath (male non-odor group), and 10 female subjects without bad breath (female non-odor group) were included for the study. Olfactory identification ability was assessed by administrating the Cross-Cultural Smell Identification Test (CC-SIT), and the olfactory detection threshold for methyl mercaptan was measured by two-alternative forced-choice single-staircase detection threshold procedure in a double-blinded condition. The geometric mean of the last four staircase reversal points of a total of seven reversals is used as the threshold. For the male odor group, after 1 month of intensive oral hygiene care for reducing oral volatile sulfur compounds (VSC) concentration, the olfactory detection threshold for methyl mercaptan was measured again and compared to the initial value. The ANOVA was used to test the group difference of olfactory threshold and olfactory identification ability and the paired t-test was used to test the difference of olfactory threshold between before and after reduction of oral VSC in male odor group. The results were as follows : 1. There was no significant difference in olfactory identification ability among those who have bad breath and normal male or female subjects. 2. The olfactory detection threshold for methyl mercaptan was about 8.4 ppb in normal male and female. 3. There was a tendency that male subjects with bad breath showed a higher olfactory detection threshold for methyl mercaptan when compared to those of no bad breath. 4. The olfactory detection threshold for methyl mercaptan returned to a normal level after 1 month of intensive oral hygiene care for reducing oral VSC.