• Clinical and Experimental Pediatrics
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• 제52권11호
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• pp.1249-1259
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• 2009

목 적:소아 성장호르몬결핍증의 저신장 치료에 사용되는 성장호르몬 생물학적 제제인 서방형 주사제의 비용-효과성을 사회적 관점에서 기존 매일 주사제와 비교하여 평가하고자 한다. 방 법:성장 호르몬 치료를 받는 환아를 대상으로 시각화 척도 방법에 의해 건강 관련 효용을 측정하였다. 2008년 7월, 이 연구에 참여한 2개 병원에서 저성장증 치료를 받고 있는 149명의 환아 보호자에게 매일 주사제에 대한 효용과 주 1회 주사제를 사용할 경우 기대되는 효용을 인터넷을 통해 설문조사 하였다. 성장호르몬 주사요법 중 매일 주사제와 주 1회 주사제 투여에 소요되는 직․간접 비용은 차이가 없으므로, 두 제형의 의약품비만을 비교하였다. 결 과:매일 주사제에서 주 1회 주사제로 전환할 경우 예상되는 효용값은 0.584에서 0.784로 증가하며, 연평균 추가비용은 4,060,811원이 발생한다. 점증적 비용-효용비는 20,304,555원/QALY (quality-adjusted life year gained)로 계산되었다. 시나리오 분석 결과, 점증적 비용-효용비는 최소 15,751,198원/QALY에서 최대 25,489,929원/QALY이다. 결 론:Base case 및 시나리오 분석결과에서 제시하는 점증적 비용-효용비는 우리 나라 1인당 GDP의 0.85-1.37배 범위 내에 있으므로 매우 안정적으로 비용-효과성이 있는 것으로 판단된다. 따라서, 매일 주사제에서 주1회 주사제로의 투약방법 변경은 비용-효과적이라 할 수 있으며, 주 1회 주사제가 추가 비용을 부담하더라도 경제성이 우수하다고 결론지을 수 있다.

• 한국콘텐츠학회논문지
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• 제13권11호
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• pp.187-197
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• 2013

2007년 8월부터 건강보험 보장성 확대 정책의 일환으로 6세 미만 어린이 외래환자에 대한 본인부담금 경감제도가 시행되었다. 본 연구는 본인부담금 경감제도가 시행된 2007년 8월을 기준으로 제도 시행 전인 2006년 8월부터 2007년 7월까지와 제도 시행 후인 2007년 8월부터 2008년 7월까지 전후 1년 동안 외래진료 민감질환으로 외래를 방문한 6세 미만 환자들의 의료이용 변화를 분석하였다. 의료이용 변화는 제도 시행전후 외래 환자 수 증감율, 외래방문일수, 방문당 평균 진료비로 파악하였는데, 6~10세 환자를 대조군으로 설정하여 이중차이방법을 적용한 다중 회귀분석을 적용하였다. 제도 시행 후 외래진료 민감질환으로 외래를 방문한 환자는 대상군과 대조군 모두 증가하였는데, 특히 대상군에서 증가율이 높았다. 그러나, 대상군은 대조군에 비해 제도 시행에 따른 외래방문일수와 방문당 외래진료비의 증감율은 일정한 양상을 보이지 않고 그 차이 또한 적었다. 6세 미만 어린이 외래 본인부담 경감제도는 외래환자 수 증가라는 의료이용 변화를 가져왔으나, 실질적인 의료 접근성을 나타내는 외래방문일수, 방문당 평균 진료비는 큰 차이가 없었다. 따라서, 제도의 궁극적인 목표인 의료 접근성 향상을 달성하기 위하여 적극적인 제도홍보와 함께 소득계층별로 본인부담률을 상이하게 설계하는 등의 의료 취약계층에 초점을 둔 정책이 요구된다.

• 한국산학기술학회논문지
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• 제18권10호
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• pp.490-498
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• 2017

본 연구는 유치원을 이용하는 부모들을 대상으로 방과후과정과 특성화활동 이용 현황을 살펴보고, 그 결과를 토대로 효과적인 정책 개선 방안을 제안하는 데 그 목적이 있다. 693명의 부모를 대상으로 면담원이 부모와 대면 면담조사를 실시하였고, 수집된 자료는 백분율, 평균과 표준편차 등을 이용하여 결과를 산출하였다. 먼저 방과후과정 이용현황을 조사한 결과를 보면, 첫째, 방과후과정 이용에 따른 추가 부담 지출 비율이 전체 조사 대상의 약 38.2%이며, 추가 비용의 평균액은 약 62,850원이었다. 비용부담과 만족도를 5점 만점 기준으로 볼 때, 보통수준으로 나타났다. 둘째, 방과후과정 참여 이유로는 부모의 맞벌이, 자녀가 친구들과 시간을 함께 보내게 하고 싶어서 등과 같은 순으로 나타났다. 다음으로 방과후특성화활동 이용 현황을 살펴본 결과는 다음과 같다. 첫째, 방과후특성화활동 이용 유아 비율은 조사 대상의 약 68.2%이며, 그 중에서 비용 지출 유아는 약 79.0%, 평균 이용 개수는 약 2.69개이며, 평균 비용은 83,540원으로 조사되었다. 둘째, 선호하는 교육프로그램은 영어가 압도적인 비율로 높게 나타났으며, 자녀들이 활동을 좋아해서 참여한다고 응답한 비율이 가장 높았다. 셋째, 방과후특성화활동 개선요구 사항으로는 교육내용의 내실화가 1순위로 제시되었다. 마지막으로 방과후특성화활동으로 인해 부모의 사교육비 지출이 감소되었다는 응답비율이 높게 나타났다. 이와 같은 조사 결과를 토대로 방과후과정 및 특성화활동 성격에 맞는 적합한 교육프로그램 개발 및 실행 등의 개선 방안을 논의하였다.

• 가정과삶의질연구
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• 제29권4호
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• pp.205-216
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• 2011

Unequal distribution of shares among children during intergenerational transference of assets has been prevalent in Korea. This study intends to examine whether parental contribution, in the form of a cash gift, is differentiated between the bride's side and the bridegroom's side at marriage and by age group. This pattern may also change according to the generation. Questionnaires were equally distributed to members of three previously delineated age groups: 20' s-30' s, 40's -50's, and 60's and above who are married or have been married at least once and reside in Seoul or Gyeonggi province. A total of 700 questionnaires were analyzed using SPSS and the data were sorted by age group. The results indicate an apparent difference between the husband's side and the wife's side in providing funding for housing at marriage in that a large portion of the funding is provided by the husband's side. Among various funding sources, a cash gift from the couple's parents appears to fund the largest portion of the total cost for housing and marriage. Results show that a cash gift from the couple's parents funds a larger portion of housing expenses for younger generations, a phenomenon that becomes more severe and apparent the younger the couple is.

• 한국의료질향상학회지
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• 제5권1호
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• pp.58-75
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• 1998

Background : In Korea, the rational use of antibiotics are rarely controlled, and their patterns of utilization are not understood. In order to reduce the excessive use and to improve the appropriate use of antibiotics, it is necessary to accurately determine present uses of antibiotics in hospitals. Methods : Analysis of the use of prescription drugs was performed on NFMI(National Federation of Medical Insurance) 1994 medical expense claim data. A stratified sampling by types of hospitals, departments, and diseases was obtained from 1994 August data. Patients with secondary diseases were excluded. In this study, 2,697 adults with URI, 6,397 children with URI, 704 adults with bronchitis, and 1,838 children with bronchitis were included. Results : Most patients were prescribed medication (95.2-99.6%). Of the patients prescribed medication, more than 85% of URI patients and more than 91% of bronchitis patients were prescribed antibiotics. Antibiotics expenses accounted for 14% of total medical expenses in adults and 9% of total medical expenses in children. In adults with URI, antibiotics expenses accounted for 52% of drug expenses. Of the patients prescribed antibiotics, average number of antibiotics used was 1.6-1.7. For patients who are prescribed antibiotics, drug expenses were 62-97% greater than patients not prescribed antibiotics. When children were prescribed antibiotics, the highest price of drugs prescribed were 3.4-fold greater. In addition, the number of drugs prescribed also increased by more than one. Elderly patients, more than 60 years, were prescribed antibiotics less frequently. Children less than 10 years and elderly patients greater than 60 years old were prescribed fewer antibiotics than other patients. And they were prescribed medications for longer days than other patients. Conclusion : This study demonstrated that the average rate of prescribing antibiotics was higher in Korea than other countries. Measures to reduce overuse of antibiotics and to improve the appropriate prescription of antibiotics must be considered for cost effective treatment and overall health of people.

• 대한영양사협회학술지
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• 제5권2호
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• pp.117-127
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• 1999

This study was carried out to provide the improvable way of foodservice management to dietitian in the elementary schools. For this purpose the serving pattern of food, menu planning, nutrition education, leftover management and difficulties in foodservice were investigated. The survey was conducted through questionnaires, which were collected from 249 dietitions randomly selected in Taejon and Chung Nam. Data were analyzed by SAS program. The main results of this study are as follows. The children in Taejon took foods in the class room(65.7%) and those in Chung Nam in the dinning hall(89.9%)(p<0.01). In menu planning the balance of nutrition(42.6%) was mainly considered and then food preference(19.7%), variety of menus(16.1%), food cost(16.1%), composition of food color, taste and texture(3.2%), skills of food making(1.6%) and the number of students(0.8%). They referred cooking magazines(47.7%), the previous menu(42.2%), children's opinion(7.2%) for planning menu. The insufficiency of implements and devices for food(24.1%) and lack of season's food(20.4%) were indicated as difficulties in their job. 34.5% of dietitians used a standard menu, 79.5% investigated food preference of children, 74.3% evaluated taste of foods before serving, and 80.7% regularly checked leftover. The major reason for leftover was careless of the teacher in charge in Taejon and bad taste of foods nutrition in Chung Nam(p<0.001). 98.5% of them answered that they had the responsibility for nutrition education in elementary school. They had a hard time in relationship with the staffs in school(40.6%) and employees for food(39.8%), and lack of market information(38.2%). To efficiency of dietitian's work can be enhanced by reflecting the results of children's food preference and leftover, by using standard cooking method and proper cooking utensil, and by performing nutrition education for children by themselves.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권3호
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• pp.143-149
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• 2019

Background: Uncooperative behavior of children due to dental anxiety may interfere with the effective delivery of dental care and compromise the quality of treatment provided. Injection of local anesthesia is one of the most anxiety-inducing stimuli in pediatric dentistry. This study aimed to compare the efficacy of a child-friendly device, having a combined effect of vibration and distraction, with the conventional method of injection on pain, anxiety, and behavior of pediatric patients aged 6-11 years. Methods: This randomized, crossover, split-mouth study included 30 children requiring a bilateral inferior alveolar nerve block. The children were equally divided into two groups: group 1, aged 6-8 and group 2, aged 9-11 years. All children were injected with anesthesia using the conventional and device method in two separate sessions. They were assessed for anxiety by measuring the pulse rate before and during the administration of local anesthesia. Behavior was assessed using Faces, Legs, Activity, Cry, Consolability (FLACC) scale, and the child's experience while receiving anesthesia was assessed using the Wong Bakers Pain Rating Scale. Results: Results showed that the children who received local anesthesia using the device method had a lower mean pulse rate, FLACC scores, and pain rating scores than those who received local anesthesia using the conventional method. Conclusion: The device method was more effective than the conventional method in managing pain, anxiety, and behavior of patients aged 6-11 years. The device is a cost effective, simple, and child-friendly product for administrating local anesthesia in pediatric patients.

• 대한예방한의학회지
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• 제23권2호
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• pp.25-42
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• 2019

Objectives : The purpose of this study was to identify factors that affect the utilization of Korean medicine (KM) among children with cerebral palsy (CP) and explore a processing model of decision-making by their parents. Methods : We conducted an individual in-depth interview with 21 mothers of children with CP who were recruited during the observational study. A grounded theory of Strauss and Corbin was used for qualitative analysis. Thus, collected data were classified into open coding including 121 concepts, 27 sub-categories and 7 categories. Results : The central phenomenon of the process of using KM for children with CP is 'KM as an optional treatment not essential'. Therefore there are many obstacles to starting KM treatment and it is easily interrupted for various reasons, unlike general rehabilitation treatment. However, if the patient experiences the therapeutic effect, the parents want to continue KM treatment. They try to provide treatment as much as possible if they can afford it. The parents give priority to general rehabilitation treatment and value the information and experience provided by the caregivers in similar situation as well as expert opinions. Conclusions : To expand and generalize KM treatment for children with CP, efforts to change interventional conditions such as treatment effect, treatment cost, treatment compliance, and convenience of treatment based on the understanding of the strategy used by the parents in KM utilization.

• 동아시아식생활학회지
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• 제15권6호
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• pp.644-654
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• 2005

The purpose of this study was to investigate the related factors to nutritional supplements intake of elementary school student aged 7 to 12 years in Incheon area. The subjects were 631 mothers of elementary school students and cross-sectional study was conducted by a self-administered questionnaire. In view of the relation with general circumstances, taking nutritional supplements was shown to be significantly associated with general and socio-demographic factors such as father's job, mothers concern about children's academic record, family's monthly income and food cost, and the experience of other family members' taking nutritional supplement. In view of the relation with anthropometric and health-related factors, taking nutritional supplement was associated with elementary school student' weight obesity index, mothers evaluation of children's height and weight mother's concern about health and growth of children, and ,disease of children. In view of the dietary behavior-related factors, taking nutritional supplements was associated with skipping breakfast, food habits, and mothers beliefs and attitude about nutrition and nutritional supplements. However, it was shown that mothers nutritional knowledge did not affect taking nutritional supplements. Therefore, it may be suggested that general and socio-demographic factors, anthropometric and health-related factors, dietary behavior-related factors, and mother's nutritional beliefs and attitude are important determinants in children's taking nutritional supplements.

• Nutrition Research and Practice
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• 제5권1호
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• pp.40-45
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• 2011

Hemoglobin and zinc protoporphyrin (ZPP) tests are commonly used to screen for iron deficiency, but little research has been done to systematically evaluate the sensitivity and specificity of these two tests. The goal of this study was to evaluate the effectiveness of zinc protoporphyrin/heme (ZPP/H) ratio as a point-of-service screening test for iron deficiency among preschool-aged children by comparing the sensitivity and specificity of hemoglobin, ZPP/H ratio, and serum ferritin (SF). Also completed were assessments for the prevalence of anemia, iron deficiency (ID), and iron deficiency anemia (IDA) with indicators of ferritin models. This study was carried out with 95 children ages 3 to 6 y. Anthropometric measurements were assessed and blood samples were analyzed for hemoglobin, SF, transferrin saturation (TS), and ZPP. Anemia was common and the prevalences of anemia, ID, and IDA were 14.7%, 12.6%, and 5.2%, respectively. The ZPP/H ratio was strongly and significantly correlated with hemoglobin. And ZPP/H ratio was a more sensitive test for ID than hemoglobin or SF measurement, correctly identifying more than twice as many iron-deficient children (sensitivity of 91.7%, compared to 41.7% for hemoglobin and SF). However, ZPP/H ratio had lower specificity (60.2%, compared to 89.1% for hemoglobin or 96.4% for SF) and resulted in the false identification of more subjects who actually were not iron deficient than did hemoglobin or SF. Low hemoglobin concentration is a late-stage indicator of ID, but ZPP/H ratio can detect ID at early stages and can be performed easily at a relatively low cost. Therefore, ZPP/H ratio can serve as a potential screening test for pre-anemic iron deficiency in community pediatric practices.