• Health Policy and Management
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• v.1 no.1
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• pp.116-135
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• 1991

Few studies have been conducted on the detailed routes of medical care utilization under the National Health Insurance. This study was undertaken to identify the utilization patte군 of health care facilities among industrial workers and their dependents. One of the largest health insurance association was purposively chosen for this objective. The association had 345, 757 members as of 31 December, 1990. The study sample of 297, 948 subjects have been drawn from the membership pool on the basis of their continuous membership status during 1 January through 31 December 1990. This study has tried to identify differential utilization patterns between acute and chronic conditions, and among standard income classes. All the diagnoses were recoded in a manner to achieve the objective of this study. As for acute diseases, most age group had used one medical facility as much as by 60% except the age group of 1-4, This young age group had used over three different health facilities as much as by 10.9-15.8%. The finding suggests that some policy measures by sought for remedying the excessive/inappropriate use of services. In addition, mid-income classes(between 17 and 48) were more likely to use multiple sources of care than lower income classes(between 1 and 16) and upper income classes(above 49). This study has revealed that chronic cases are more likely to pursue multiple sources of care, however those with chronic conditions tend to use single health facility more than those with acute conditions(67.9% versus 52.4%). As many as 12.2% have visited more than three health facilities in chronic conditions, but 5.9% for acute conditions. The most likely source of care was primary clinics for both acute and chronic conditions. Compared with the role of general hospital, small-size hospitals found to play a minimal role in the care and referral of patients. This indicates the need of strengthening the function of small-size hospitals. While a minor cross utilization of western medicine and pharmacy was noted, no significant boundary crossing was identified between western medicine and oriental medicine, or between pharmacy and oriental medicine. It is too early to confirm that whether there is substitutability or cross utilization among these alternative sources of care. A further study is needed to identify these relationship.

• Journal of Preventive Medicine and Public Health
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• v.24 no.4 s.36
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• pp.485-495
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• 1991

This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discouraging the use of tertiary care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131 (3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care utilization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.

• Asia-pacific Journal of Multimedia Services Convergent with Art, Humanities, and Sociology
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• v.9 no.11
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• pp.1015-1026
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• 2019

The purpose of this study is to develop evaluation indexes for improving the quality of long-term care institutions (facility salary) evaluation in the sense that the applicability and effectiveness of previous studies related to the development of evaluation indexes for long-term care facilities for elderly are insufficient. There was this. To this end, an analytical review of the 2018 long-term care institution (accommodation benefit) evaluation index, an analysis of Japan's elderly long-term care home evaluation index, and the elderly long-term care facility workers in Korea and the special care home for the elderly in Japan FGI on evaluation indicators and evaluation system was conducted. Based on the results of the research, evaluation indicators were developed in terms of supporting users to receive high quality services. The characteristics of the elderly, that is, the characteristics of elderly diseases that are difficult to maintain and improve, the direction and transparency of institutional operation, and the need for terminal care were reflected. Forty-three evaluation indicators were presented, covering institutional operations, environment and safety, beneficiary rights protection, payroll process, and payroll results. In addition, we proposed a four-step multi-level evaluation system that can improve the efficiency of the evaluation process by improving the redundant and unnecessary evaluation process.

• Journal of Environmental Health Sciences
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• v.46 no.4
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• pp.359-367
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• 2020

Objectives: Exposure to mold is strongly associated with adverse health effects (development or exacerbation of allergic diseases). We reviewed the health effects of mold exposure and explored to determine the annual distribution of indoor mold in facilities with susceptible populations. Methods: The health effects of mold exposure were mainly summarized by reviewing related papers and WHO research reports. We selected 10 facilities, including daycare centers, postpartum care centers, medical institutions, and elderly care facilities within the Seoul Metropolitan. Mold sampling was performed once every week or once every quarter from February 2016 to 2017. In addition, fungal species analyses was performed, and distribution status by month and facility was analyzed in the same manner as concentration. Results: Adverse health effects attributed to fungal exposure are largely divided into allergic symptoms, toxic effects, and infectious effects. Monthly mean concentrations of mold indoors and outdoors was 368.8 CFU/㎥ (geometric mean 213.4 CFU/㎥) and 496.0 CFU/㎥ (327.9 CFU/㎥), respectively. The indoor concentration has begun to increase in February, peaked in July, declined in August, increased again until October, and then decreased in November. About 36 genera of indoor fungal species were found in each facility. Cladosporium sp., Penicillium sp., Fusarium sp., Aspergillus sp., Alternaria sp., and Arthrinium sp. were observed as the dominant species. Conclusions: Our findings showed that the overall level of indoor mold was below the 500 CFU/㎥ level recommended by the Ministry of Environment. The development of DNA-based assessment and expanding facilities to be monitored for mold would be necessary for preventive aspects.

• Journal of Korean Biological Nursing Science
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• v.16 no.3
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• pp.244-250
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• 2014

Purpose: The purpose of this study was to investigate medication and related factors including: gender, age, duration of hospitalization, MMSE, and ADL in elderly who were hospitalized in long-term care facilities. Methods: A total of 282 elderly people who were hospitalized for more than a month were asked to fill in a structured questionnaire which was used to collect data regarding their gender, age, duration of hospitalization, MMSE, ADL, and medication. Results: The average number of drugs per patient was 7.50. Subjects taking 6-7 medications were the highest ranking (23.7%). According to multiple regression analysis, the most significant factor relating to the number of drugs prescribed for each subject were the ages of the subjects (p=.007). Conclusion: We found that the number of prescribed drugs taken by those who were hospitalized were related to age. A tailored strategy is needed to decrease the number of drugs according to age and to control the medicines prescribed to the elderly who are hospitalized in long-term care facilities.

• Korean Institute of Interior Design Journal
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• v.27 no.3
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• pp.14-23
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• 2018

The spatial planning of the elderly care facility plans is analyzed using space syntax in terms of encouraging the social interaction of the residents in this study. First, through the visibility graph analysis, openness and accessibility of space is analysed. Second, the walking behavior of residents through agent analysis model is simulated. Third, the space planning methods for the elderly care facilities are proposed based on the results. The results are as follows. According to the visibility graph analysis, the main corridor has high visual openness and high accessibility. The visual openness and accessibility of the unit living room, where social interaction among residents is possible in each unit, is low. Space planning is needed to increase direct protection and observation of employees to the unit living room. The location of the nurse station that manages the entire floor needs to be located where the openness and accessibility is most high. The nursing station should have a high degree of connectivity to the entire space, so that any accidents can be managed and contact is accessible. Through the agent simulation the flow from the center to each unit space is highest in the corridor space and the inflow to the private rooms and the living room are similar. Therefore, it is necessary to plan the accessibility of the unit living room more for the natural inflow of residents.

• Research in Community and Public Health Nursing
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• v.15 no.2
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• pp.209-217
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• 2004

Purpose: The purpose of this study was to construct the structure, process and outcome of community-based home care nursing service and to examine their validity. Method: There were two steps. The first step was developing the structure and process of community-based home care and the second was evaluating the outcome of community-based home care. Home care services were provided to 25 clients who had health problems. Data on these clients were analyzed. Result: According to Albrecht Model, in the developed structure and process of community-based home care, structure contained facility's philosophy, organization, delivery system, steering committee, office, equipments, medical instruments, the home care nurse and client of home care nursing. Process contained classification of client. nursing diagnosis and nursing intervention. The majority of clients were men (56%). The service was used mostly by people aged over 50 (82%). The most frequent nursing diagnoses were altered urinary elimination (23.2%). impaired skin integrity (21.8%) and risk for infection (17.6%). Nursing interventions included wound care (16.7%), tube care (15.1%) and catheter care (14.5%). Conclusion: Several strategies are suggested from this study: first, activate a referral system within the national health care system: second, increase public information on home care nursing: third, develop home care nursing services for elderly people: and fourth, construct a cooperation system between home care services and social welfare services.

• Journal of the Korean Home Economics Association
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• v.40 no.5
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• pp.195-210
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• 2002

The purpose of this study were to find out the difference of needs of caring between care-givers and non care-givers, and to suggest the way of lessening vigorous task of care-givers for the elderly with dementia. Data were collected from 130 nationwide respondents intentionally divided into two groups; care-givers and non care-givers in the middle aged with middle and upper income. Collected data were analyzed by frequency, percentage, t-test using SPSS package. Since the result of survey, unexpectedly, showed no difference between two groups, it could be explained as that these two groups commonly had same needs of caring for the elderly with dementia. Major findings were as follow; 1) Most Koreans stiff thought family should be the main care-giver for the elderly with dementia prior to nation or society. 2) Responsibility of caring for the elderly with dementia would be better to be shared with children instead of focusing to a child. 3) They thought ideal residential facilities for the elderly with dementia were small-scale professional dementia facility(group home) rather than home or general elderly housing. 4) Professional dementia care hospital was one of the most needed facilities for the elderly with dementia, followed by short-stay and dar-care center. 5) It was revealed care-giving task was vigorous showing that most care-givers spent 1-5 hours a day for caring, while 13% of respondents spent 11-24 hours a duty. 6) 90% of care-givers took the responsibility of main care-giver because of duty of offsprings or spouses, and wanted to be free from their current circumstances. From the result of this survey researchers would like to suggest the establishment of diverse facilities for professional dementia care to lessen the caring burden for the elderly with dementia: group home, chronic hospital, short-stay, day-care center. Financial support from the government for the housing renovation of the caring families should be considered seriously afterward. It is needed to give the opportunity to select proper paid dementia care facilities according to their income and situation of household.

• Journal of Preventive Medicine and Public Health
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• v.31 no.3 s.62
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• pp.564-578
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• 1998

Most extended care facilities have admitted both the healthy and unhealthy elderly, among which members' average caring demand vary. The Aged Welfare Law, however, currently provides no reasonable basis on the staffing policy for extended care facilities. It just reflects the admitted number of the elderly rather than differences in members' average caring demand among facilities. This study is designed to estimate the need for caring staff on the basis of the correlation between the individual health status measured by various tools including Activities of Daily Living and caring demand by actual service time for each one. The sample included all of the admitted elderly(187 persons) in 4 extended care facilities, two in Seoul and the other two in Kangwon-Do over the survey period October 5 through October 20, 1996. The survey process consisted of 3 stages. (1) The current staffing information was collected through self-completed written questionnaires left for head of official in each facility. (2) Six graduate students at School of Public Health interviewed all residents to collect information on their health status and sociodemographics. The response rate for the interview was relatively high(85%). (3) Information on direct and indirect caring time consumed for each residents came from self-completed written questionnaires given to nurses and helpers in each target facilities. Analysis of the data was made using Pearson's correlation and multiple regression technique through SAS program. Based on this procedure, the following was found. 1. No facility meet the staffing standard in the Aged Welfare Law completely. 2. It is actual service time that is most correlated with ADL(Activities of daily living). 3. When all of the elderly are divided by four groups based on the level of ADL, the mean values of needed caring time in each group are 15, 21, 36 and 88 minutes respectively. 4. There is no significant difference among facilities in distribution of elderly person by group. 5. No facility meets the estimated number of nurses and helpers which reflects health status of the admitted elderly. Therefore, it is required that severity of the admitted elderly be considered in establishing staffing standard for extended care facility.

• Korean Journal of Childcare and Education
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• v.7 no.4
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• pp.205-221
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• 2011

This study purposed to examine the interaction effects of child care teachers' child care efficacy and burnout on their job turnover intention and occupational turnover intention. For this purpose, we conducted a questionnaire survey with 251 child care teachers. The results of this study are summarized as follows. First, child care teachers' occupational turnover intention was stronger than their job turnover intention. Second, job turnover intention to another child care facility was affected by burnout, but occupational turnover intention to another job was affected by high burnout, low child care efficacy, and interaction between the two factors. With regard to the interaction effects, child care teachers with high burnout were found to control their occupational turnover intention through child care efficacy. Accordingly, in order to prevent child care teachers' job turnover and occupational turnover, it is necessary to develop strategies to reduce their burnout experienced in child care activities and enhance their child care efficacy.