• 제목/요약/키워드: chronic disease/disability

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의원급 노인 외래 정률차등정책 효과분석 (The Effect of Changes in Medical Use by Changing Copayment of Elderly)

  • 나영균
    • 보건행정학회지
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    • 제30권2호
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    • pp.185-191
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    • 2020
  • Background: From January 2018, a policy was applied to differentially apply the co-payment for medical expenses of 15,000 won or more from 30% to 10%-30% for each medical fee. This policy lowers the burden on the medical use of the elderly, and it is necessary to analyze the effect of the policy by confirming changes in medical use and supply behavior after 2 years. Methods: The National Health Insurance Service's national medical use database was used. As for the analysis method, first, the medical use and medical supply behavior change over the age of 65 years were confirmed, and second, in order to check the net effect of the policy, the 66-year-old as the experimental group and the 63-year-old as the control group were selected as the control group. The propensity score matching was performed using the variables of age, living alone, income quartile, residence, disability, chronic disease, and co-morbid disease scores, and then it was analyzed using the difference in difference analysis method. Results: The share of the number of treatments under 15,000 won decreased from 37.0% in 2017 to 20.2% in 2018, while the share of the number of treatments under 15,001-20,000 won increased from 8.0% to 22.7%. It was confirmed that the reason for the increase in the cost of treatment per treatment was the result of the increase in the amount of physical therapy and examination. As a result of the policy effect, the burden of co-payment per person was reduced, and as a result, the number of hospital visits per person and the total medical cost per person increased. Conclusion: The self-pay rate differential policy reduced the burden of medical expenses for the elderly and confirmed the increase in medical use. However, the interpretation of the increase in medical use was not able to distinguish whether the unsatisfactory medical care was satisfied or the inducement demand. Efficient allocation of resources is a more important point in the future when the super-aged society is in front. It is necessary to prepare a plan to induce rational medical use within a range that does not impair the medical accessibility of the elderly.

한국 노인의 사회활동이 건강수명에 미치는 영향에 대한 생존분석: 성별 비교를 중심으로 한 13년간 분석 (Impact of Social Activities on Healthy Life Expectancy in Korean Older Adults: 13-Year Survival Analysis Focusing on Gender Comparison)

  • 양승민;최재성
    • 한국노년학
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    • 제41권4호
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    • pp.547-566
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    • 2021
  • 본 연구의 목적은 노인의 성별에 따른 사회활동 유형별 참여가 건강수명에 미치는 영향력을 분석하는 것이다. 이를 위해 고령화연구패널조사(KLoSA)의 1차(2006년)에서 7차(2018년)까지의 13년간 데이터 중 65세 이상 노인 4,029명(남성노인=1,710명, 여성노인=2,319명)의 자료를 사용하여 생존분석의 하나인 Cox 비례해저드모형(Cox proportional hazard model)으로 분석을 시도했다. 분석결과 첫째, 여성노인의 건강수명은 75.34세, 남성노인의 건강수명은 76.94세로 나타났다. 여성노인은 남성노인에 비하여 질병 및 장애의 발생 강도와 발생 비율이 더 컸고, 질병 및 장애가 발생한 노인의 비율도 더 높았다. 둘째, 남성노인과 여성노인의 건강수명에 공통적인 영향요인은 연령, 만성질환 수와 주관적 건강상태로 나타났다. 학력은 남성노인의 건강수명에만 유의한 것으로 나타났고, 거주지역, 과거 음주 경험, 삶의 만족도는 여성노인의 건강수명에만 유의한 것으로 나타났다. 셋째, 건강수명에 유의한 영향을 미치는 사회활동 유형은 남성노인의 경우 종교활동과 연고집단활동, 여성노인의 경우 종교활동으로 나타났다. 본 연구는 노인의 건강수명에 대한 사회적 활동 유형의 효과가 성별에 따라 다르다는 점을 보여준다. 또한, 건강수명 단축의 위험은 남성노인보다 여성노인이 상대적으로 높게 나타났다. 연구자들은 건강수명 연장을 위하여 성별 특성을 고려한 사회활동 참여의 기회 확대와 유형별 참여의 행태나 질에 대한 고려, 그리고 남녀 간 건강격차를 감소시키기 위한 정책개발의 필요성을 제안하였다.

관절염 환자의 운동행위 예측모형 (Pender의 재개정된 건강증진 모형에 의한) (Prediction Model of Exercise Behaviors in Patients with Arthritis (by Pender's revised Health Promotion Model))

  • 임난영;서길희
    • 근관절건강학회지
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    • 제8권1호
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    • pp.122-140
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    • 2001
  • The aims of this study were to understand and to predict the determinent factors affecting the exercise behaviors and physical fitness by testing the Pender's revised health promotion model, and to help the patients with rheumatoid arthritis and osteoarthritis perform the continous exercise program, and to help them maximize the physical effect such as muscle strength, endurance, and functional status and mental effects including self efficacy and quality of life, and improve the physical and mental well being, and to provide a basis for the nursing intervention strategies. Of the selected variables in this study, the endogenous variables included the physical fitness, exercise score, exercise participation, perceived benefits of action, perceived barriers of action to exercise, activity-related affect(depression) and perceived self-efficacy, interpersonal influences(family support), situational factors(duration of arthritis, fatigue) and the exogenous variables included personal sociocultural factor(education level), personal biologic factor(body mass index), personal psychologic factor(perceived health status) and prior related behavior factors(previous participation in exercise, life-style). We analyzed the clinical records of 208 patients with rheumatoid arthritis and degenerative arthritis who visited the outpatient clinics at H university hospital in Seoul. Data were composed of self reported qustionnaire and good of fitness score which were obtained by padalling the ergometer of bicycle for 9 minutes. SPSS Win 8.0 and Window LISREL 8.12a were used for statistical analysis. Of 75 hypothetical paths that influence on physical fitness, exercise participation, exercise score, perceived benefits of action, perceived barriers of action to exercise, activity-related affect(depression) and perceived self-efficacy, interpersonal influences(family support), situational factors(duration of arthritis, fatigue), 40 were supported. The physical fitness was directly influenced by life-style, perceived health status, education level, family support, fatigue, which explained 12% of physical fitness. The exercise participation were directly influenced by life-style, education level, past exercise behavior, perceived benefits of action, perceived barriers of action, depression and duration of arthritis, which explained 47% of exercise participation. Exercise score were directly affected by perceived self efficacy. BMI, life-style, past exercise behavior, perceived benefits of action, family support, perceived health status. perceived barriers of action, and fatigue, which explained 70%. Perceived benefits of action was directly influenced by BMI, life-style, which explained 39%. Perceived barriers of action were directly influeced by past exercise behavior, perceived health status, which explained 7%. Perceived self efficacy were directly influeced by level of education, perceived health status, life-style, which explained 57%. Depression were directly influeced by past exercise behavior, BMI, life-style, which explained 27%. Family support were directly influeced by life-style, perceived health status, which explained 29%. Fatigue were directly influeced by BMI, life-style, perceived health status. which explained 41%. Duration of arthritis were directly influeced by life-style, past exercise behavior, BMI, which explained 6%. In conclusion, important variables for physical fitness were life-style, and variable affecting exercise participation were life-style. Perceived self-efficacy of exercise was a significant predictor of exercise score. BMI, Life-style, perceived benefits of action, family support, past exercise behavior showed direct effects on perceived self-efficacy. Therefore, disease related factor should be minimized for physical performance and well being in nursing intervention for patients with rheumatoid arthritis, and plans to promote and continue exercise should be seeked to reduce disability. In addition, Exercise program should be planned and performed by the exact evaluation of exercise according to the ability of the patients and the contents to improve the importance of exercise and self efficacy in self control program, dedicated educational program should be involved. This study suggest that the methods to reduce the disease related factors, the importance of daily life-style, recognition of benefit of exercise, and educational program to promote self efficacy should be considered in the exercise behavior promotion and nursing intervention for continous performance. The significance of this study is also thought to provide patients with chronic arthritis the specific data for maximal physical and mental well being through exercise, chronic therapeutic procedure, daily adaptation and confrontation in nursing intervention.

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21세기 초 한국의 인구구조 및 질병양상 (Perspective on Population Characteristics and Health Problems of Koreans in 21st Century)

  • 김정순
    • Journal of Preventive Medicine and Public Health
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    • 제27권2호
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    • pp.175-185
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    • 1994
  • In order to anticipate disease pattern and health problems of Koreans in the 1st part of 21st century (by the year 2020), transition of population characteristics, mortality and morbidity data during the last 30 years Koreans have experienced were reviewed. On the actual basis of epidemiologic transition process that has undergone during last 30 years since 1960 along with socioeconomic development and successful implementation of selective national health policies (family planning, medical insurance and etc.), following changes can be expected in the 21st century in Korea, under the assumption that the current rate of progress is maintained. The population of South Korea alone will be doubled the population of 1960 by the year 2013 : aged Population older than 65 years will be increased from 3.3% in 1960 to 11.4% in 2020 with increased average age of the population from 23.6 year in 1970 to 39.2 year in 2020; urban population from 28% in 1960 to 83% in 2005. GNP/capita has increased tremendously from U.S. $120 in 1970 to $6,749 in 1992, and the government estimated it would be 519,350 in 2010 and $29,460 in 2020. Growth and developmental indices of children, educational achievement and social status of women also showed a remarkable improvement and anticipated to make futher progress. Leading causes of mortality and morbidity have shown a striking change during the last 30 years, from infectious diseases to chronic degenerative diseases and man-made injuries. Occurrence of communicable diseases may become minimal although viral hepatitis, venereal diseases Including AIDS, and well adapted herpes virus infections will maintain their endemic level. Newly evolving infectious agents, however, should be carefully monitored because of rapidly changing environments and human behaviours. Tuberculosis may increase up to the epidemic level when AIDS prevails. Ischemic heart diseases may increase steadily with increasing occurrence of hypertension and diabetes mellitus whereas cerebrovascular diseases may be decreased slowly. Musculaskeletal diseases which contribute a lot to the disability of aged people may be a major health problems due to increased aged population. Mental diseases, particularly that caused by alcohol and drug abuse, and senile dementia may become a prominent health problem. On the other hand injuries caused by traffic and industrial accidents that have shown most striking increase till now may be decreased considerably by intensive intervention. The health policies in the 21st century will be oriented to the health promotion for good quality life rather than life-savings.

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중증 주산기 가사 환아에서 시행한 초기 뇌파 검사의 임상적 의의 (The Significance of the Early Electroencephalographic Findings in Severely Asphyxiated Newborn Infants)

  • 이종욱;최원정;김천수;이상락;김준식
    • Clinical and Experimental Pediatrics
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    • 제46권8호
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    • pp.784-788
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    • 2003
  • 목 적 : 주산기 가사 환아는 뇌손상 정도에 따라 다양한 임상경과와 예후를 나타낸다. 이에 초기 뇌파의 소견이 저산소성 뇌증 환아의 임상경과와 예후를 예측할 수 있는지를 알아보고자 이 연구를 시행하였다. 방 법 : 1999년 7월부터 2002년 6월까지 계명대학교 동산의료원 소아과 신생아 중환자실에 1분 Apgar 점수 3점이하의 중증 주산기 가사소견으로 입원했던 만삭아를 생후 3일 이내에 시행한 초기 뇌파검사 소견으로 미세 변화군(정상, 국소성 극파 혹은 서파)과 전반적 이상군(다형성 극파, 돌발-억제파(burst-suppression), 전반적 저전위파)으로 나누어서 각 군간 입원시 혈액 검사소견(암모니아, 요산, 젖산, pH), 임상소견(입원기간, 산전 모성 위험인자 유무, 경련유무 및 지속기간, 기계적 환기 필요여부, 경구수유 시작시기), 예후(사망 혹은 발달장애 유무) 등을 비교하여 통계적 분석을 하였다. 결 과 : 총 25명 중 미세 변화군은 15명, 전반적 이상군은 10명이었으며 양군 모두 외부 출생아가 70% 이상으로 많았다. 두 군간 성별, 평균 재태 기간, 출생 체중은 유의한 차이가 없었다. 미세 변화군에 비해 전반적 이상군에서 산전 모성 위험인자 내재(20.0% vs 60.0%), 평균 경련 지속기간(1.5일 vs 5.5일), 기계적 환기가 필요한 경우(20.0% vs 60.0%) 및 경구수유 시작시기(3.2일 vs 9.9일)가 의미있게 늦었으나 경련 동반율(66.7% vs 100.0%)은 유의한 차이가 없었다. 사망 혹은 발달장애를 동반한 나쁜 예후로의 진행은 미세 변화군 중 13.3%에 비해 전반적 이상군 중 60.0%로 의의있게 많았다(P<0.05). 결 론 : 주산기 가사에 노출된 환아들의 초기 뇌파검사 소견에서 다형성 극파나 돌발-억제파, 전반적 저전위파 등의 전반적 이상이 있는 경우 나쁜 임상 경과와 예후를 보여서, 주산기 가사 환아들의 예후를 예견하는데 지표로 이용될 수 있으리라 생각된다.

노인의 정보화 수준에 영향을 미치는 건강특성 연구 (The effect of health related characteristics on the use of information and communication technology of older adults)

  • 구본미;주익현
    • 한국노년학
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    • 제40권4호
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    • pp.729-746
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    • 2020
  • 노년기 건강과 삶의 질 증진을 목적으로 정보통신기술(Information and Communication Technology: ICT)을 개발하고, 효과적으로 활용하기 위해서는 사용자인 노인의 개인적 특성을 다각적으로 파악하는 것이 중요하다. 본 연구는 건강 관련 요인을 세부적으로 구분하여 노인의 건강특성과 연령집단별 정보화 수준을 비교하고, 정보화 수준에 영향을 미치는 건강특성을 연령집단별로 탐색하는 것을 목적으로 한다. 정보화 수준은 정보통신기술의 9가지 기능을 사용할 수 있는 능력으로 측정하였다. 본 연구는 2017년 노인실태조사 자료를 사용하였으며, 연구대상은 65세 이상 노인 총 10,058명이다. 분석결과, 첫째, 연령집단별로 정보화 수준의 차이를 살펴보면 전기 노인(65~74세)의 정보화 수준이 가장 높고, 그다음 중기 노인(75~84세), 후기 노인(85세 이상) 순이다. 둘째, 건강특성별로 정보화수준을 비교한 결과 진단받은 만성질환 수가 적을수록, 주관적 건강상태가 높을수록, 그리고 인지기능, 우울, 시력, 청력, 보행기능, IADL이 정상인 경우는 그렇지 않은 집단에 비해 정보화 수준이 높게 나타났다. 셋째, 노인의 정보화 수준에 영향을 미치는 유의미한 요인은 연령, 학력, 가구소득, 주관적 건강, 우울, 인지, 시력제한, 보행기능제한이었다. 넷째, 정보화 수준에 영향을 미치는 건강특성은 연령집단별로 차이가 존재하였다. 전기노인(65~74세)의 경우 주관적 건강, 우울, 인지기능, 보행기능제한, IADL장애가 유의미한 영향요인이며, 중기 노인(75~84세)의 경우는 주관적 건강, 우울, 인지기능, 시력제한, 청력제한, 보행제한이 유의미한 영향요인으로 나타났다. 후기 노인(85세 이상)은 정보화 수준이 다른 연령집단에 비해 매우 낮으며, 이에 따라 건강특성의 영향도 우울과 인지기능만 유의미하였다. 본 연구결과를 통해 노인의 건강관리와 삶의 질 증진을 위한 정보통신기술 개발 및 이를 활용한 개입프로그램을 마련할 때 다양한 건강특성에 대한 고려가 필요함을 제시하였다.