• 한국산학기술학회논문지
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• 제18권7호
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• pp.490-499
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• 2017

현대사회의 복잡다기한 문제파악과 분석을 위해 최근들어 다양한 변수를 바탕으로 하는 복잡계 분석의 도입이 활발해 지고 있다. 외래부의 공간배치에 따른 환자들의 공간인지와 사용성을 미리 예측하는 것은 질 높은 병원서비스 제공을 위해 매우 중요한 요소라 할 수 있다. 객관적 분석을 위해 노인의 질환별 표준프로그램 절차 및 분석을 위한 지표를 마련하고 히트맵 분석과 정량적 분석을 통해 대기공간의 균일성을 평가하였다. 이에 본 연구에서는 요양병원을 대상으로 복잡계 분석 방법을 이용하여 진료공간 접수공간 상담공간의 배치변화에 따른 4개 대안의 대기공간 균일성을 분석하기 위해 73개의 셀을 설치하여 시뮬레이션을 구축하고 그에 따른 밀도를 도출하였다. 연구를 통하여 다음과 같은 결론을 얻을 수 있었다. 1)대기공간의 전체 공간밀도는 접수공간의 배치가 가장 큰 영향을 미친다. 2)검사공간과 진료공간의 확실한 분리배치가 대기공간의 균일성을 높여주는 방안이다. 3)접수공간의 위치가 입구에서 가까울수록 대기공간의 밀도균일이 커진다. 마지막으로 본 연구는 대기공간 균일성 평가에 이산사건 시뮬레이션의 적용방안에 관한 연구로서, 행위자기반모델이 공간분석 방법론으로서의 활용과 평가에 활용도를 가질 수 있음을 입증하였다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권5호
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• pp.2101-2107
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• 2014

Background: Single nucleotide polymorphisms (SNPs) affecting microRNA (miR) sequences may influence carcinogenesis. Our current study primarily aimed to confirm previously conducted association studies between rs2910164 found on miR-146a, and rs11614913 located on miR-196a2 polymorphisms and cancer phenotypes in the Japanese elderly population. rs2910164 (G/C) and rs11614913 (T/C) polymorphisms were determined by genotyping on the samples collected from 1,351 consecutive autopsy cases registered in the Japanese SNPs for geriatric research (JG-SNP) data base. Cancer samples were systematically reviewed, pathologically verified and assessed with respect to miR-146a and miR-196a2 genotypic variation. The current study covered 726 males and 625 females with a mean age of $80.3{\pm}8.9$ years. The study included 524 subjects without cancer and 827 subjects with at least one type of cancer, such as gastric (n=160), lung (n=148), colorectal (n=116) or others. Males with cancers (n=467) were more numerous than females (n=360). Both rs11614913 (CT: TT adjusted odds ratio (OR) 95% confidence interval (95%CI)=0.98 (0.75-1.28), p=0.873, CC: TT adjusted OR (95%CI)=1.06 (0.76-1.47), p=0.737, CT+CC: TT, adjusted OR (95%CI)=0.99 (0.77-1.29), p=0.990), and rs2910164 (CG: CC adjusted OR (95%CI)=1.12 (0.87-1.44), p=0.383, GG: CC adjusted OR (95%CI)=1.03 (0.71-1.48), p=0.887, CG+GG: CC adjusted OR (95%CI)=1.10 (0.87-1.39), p=0.446) polymorphisms did not show significant association with overall cancer in all subjects. However, "CC" genotype in rs11614913 polymorphism was significantly associated with increased gastric cancer (n=160) in all subjects (CC: CT+TT, adjusted OR (95%CI)=1.50 (1.02-2.22), p=0.040). We found that rs11614913 and rs2910164 do not pose general cancer risk, but rs11614913 may influence gastric cancer in Japanese elderly population. Confirmation of our study results requires further investigations with larger subject populations.

• 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.

• 한국융합학회논문지
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• 제12권12호
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• pp.389-399
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• 2021

본 연구는 국내·외 가정환경수정 관련 정책들을 살펴봄으로써 'Aging In Place; AIP' 실현을 위한 국내 가정환경수정 관련 제도의 방향성과 가정환경수정 전문가로서 작업치료사에게 요구되는 역량에 대해 살펴보고자 하였다. 국내 가정환경수정 분야의 확장과 작업치료사 역량 강화를 위해 가정환경수정의 설계와 중재 실현이 반영된 명확하고 실질적인 가정환경수정 프로세스 확립이 요구되며, 거주인의 구체적인 필요와 요구를 파악하는 평가와 국내 주택 유형의 특성을 반영한 가정환경 평가도구의 적절한 선택 및 표준화 과정이 필요하다. 또한 정책과 제도에 대한 이해 및 타 분야 전문가와의 소통·협력을 위한 관련 지식 기반 구축을 위해 노력해야 할 것이다. 제도적 측면에서는 기존의 저소득층, 장애인 중심으로 시행되었던 주택개조 지원제도에서 저소득 고령자를 포함하여 소득 수준에 관계없이 고령자가 자신의 노화에 적응해 갈 수 있는 주택개조 지원제도가 필요하다. 더불어 국외 사례에서와 같이 베리어프리(Barrier Free) 주택개조 지원제도와 정부와 지자체의 협력을 통한 지원범위 확대, 저리 융자와 조세 감면, 환경수정 서비스 관련 단체 및 기관들의 거버넌스 구축 등 다양하고 효율적인 방안 마련을 위해 노력할 필요가 있다.

• 대한간호학회지
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• 제26권4호
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• pp.768-781
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• 1996

The problem of care of patients and families with Alzheimer's disease has become a conscious raising social policy issue in Korea. The government of the Republic of Korea has become cognizant of the situation and has begun searching for ways to remedy it. Thus, there is a need for a comprehensive under-standing of the situation in which patients and their families are struggling and the enormous problems of care. With a realization of the urgent need, this study was done to investigate the situation and the care needs of families with patients with Alzheimer's Disease, and to compare the effectiveness of services utilized by the families in terms of cost and effects on patient's conditions and on family live. The Subjects for the study were 29 families with hospitalized patients, 25 families utilizing hospital outpatient clinics, 14 families utilizing day care facilities, and 16 families with homebound patients. A total of 84 families were interviewed by four trained interviewers using structured and semistructured questionnaires. The data produced from these interviews included : the patient's stage of Alzheimer's disease, patient's bizarre behavior, hours spent on patient care per day, family burden and quality of life, direct and indirect costs encountered in the care of patients, and the families' evaluation of the effectiveness of the services received. The data were analyzed to determine the relationships between family charactersistics, patient's conditions and services utilization. The effectiveness of each of the service entities was assessed through families evaluation and hoped for service and comparisons were made between services in terms of the cost-effectiveness ratios. After initial comparison of cost-effectiveness ratios, further analysis was done to compare between groups for incremental effectiveness for each incremental unit of cost to determine the most cost-effective service entities. The findings of the study are as fellows : 1. The choice of living arrangement and the types of services are a function of the stage of Alzheimer's condition and the economic status of the family. 2. Comparision of the cost of care showed that most expenses were encountered in by families with hospitalization, families using outpatient services, and families using day care services in that order. The least expense was involved in the care of homebound patients. The economic burden felt by families was in the same order as expenses. 3. The average number of hours spent on daily patient care was 9.9 hours for the outpatient clinic users, 9.7 hours for homebound patients, and 5.4 hours for day care users. 4. There were significant differences in the patient's conditions (CDRL), bizarre behaviors and the families's burden by living arrangement and /or types of service. However, no significant difference was found between groups in the family's quality of life. 5. The families rated the services of day care center as most effective for the care of the patients and families, except for a few families who had experienced some improvement in the patient's conditions. The outpatient clinic users expressed psychological comforts mainly in that the patient was being taken care of. For those hospitalized patients, families expressed the comfort of being relieved of the burden of care and that the patient is being professionally cared for. Form the analysis of the costs, hours of patient care, patient's bizarre behaviors, family's quality of life and burdens, and family's evaluation of services, it is concluded that up to the mid stage of Alzheimer's condition, the utilization of day care center services is found to be the most cost-effective, and toward the end stage of the Alzheimer's disease, it is hoped that there will be a establishment of long term or short term in-patient facilities for the protection of patients and preservation of the integrity of families for less cost. Thus. it was concluded that the family centered system of care is the most effective for Korea with systematic support systems developed for the care of patients and their families according to the needs of families as the patient's condition deteriorates.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.49.1-49.8
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• 2019

Background: The purpose of this study was to review the clinical features of oromaxillofacial infections in patients presenting to a hospital emergency ward, to identify the key factors affecting the requirement for hospitalization, and the potential risk factors predisposing to a prolonged length of hospital stay. Methods: A retrospective medical record review of the 598 patients treated for oromaxillofacial infection from 2013 to 2017 at the oral and maxillofacial surgery department, Yangsan Pusan National University Hospital, was conducted. The following information was collected from each patient: sex, age, past medical history, site of infection, etiology, admission or outpatient care, level of C-reactive protein (mg/dL), fascial spaces involved, treatment method, and duration of hospitalization. Chi-squared tests were used to identify risk factors, which were further analyzed using multivariable logistic regression. Results: A total of 606 patients were eligible for inclusion in the study, of which eight were excluded due to having incomplete charts; thus, 598 patients were included: 55% were male, mean patient age was 47.1 ± 19.9 years, and 12.9% of patients were diabetic. Furthermore, 71.2% of patients had infection originating in the mandible; the most common tooth of origin was lower posterior, and 29.8% of patients were hospitalized. Risk factors for hospital admission were elderly patients with concurrent disease, elevated C-reactive protein level, and multiple-space infection in the oromaxillofacial area. The duration of hospitalization was correlated with both diabetes and age. Conclusions: The requirement for hospital admission is determined by the severity of the infection; even severe infections, once treated with appropriate surgery, have no relation to the length of hospital stay. The important risk factors for increased duration of hospitalization are diabetes mellitus and older age. The understanding of risk factors associated with a prolonged hospital stay during the treatment of oromaxillofacial infection will aid in treatment planning as well as highlight the importance of adequate diabetes control in patients at risk of such infection.

• 대한임상검사과학회지
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• 제40권2호
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• pp.142-146
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• 2008

Facial palsy is a general nerve disease which is occurred in a lateral incomplete or complete facial palsy. But it makes man restrict a social activity and so it is very important that we know the prognosis factors of a patient for medical care. We want to investigate the position and the patterns of the facial palsy according to sex and age. In this study, we performed the excitability test of the facial nerve on 103 patients (male 45 and female 58) which diagnosed as the Bell's palsy having an acute facial palsy, and the rate of the facial palsy was 42% (43 case) in right oculi and 58% (60 case) in left oculi. The facial palsy was appeared widely from young to elderly patients and especially, the rate of the facial palsy was high in age groups from 40 to 50.

• 지역사회간호학회지
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• 제27권3호
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• pp.193-201
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• 2016

Purpose: The aim of the study is to determine factors influencing quality of caregiving by caregivers for the elderly with dementia. Methods: Data were collected from 87 caregivers for elders with dementia who had visited in Busan Metropolitan Center for Dementia and D-University hospital outpatient center from July 10 to September 30, 2015. A self-reported questionnaire was used to assess the severity of the elders' dementia and knowledge of dementia, burdens and quality of caregiving by the caregivers. The SPSS 21.0 version program was used for data analysis. Data were analyzed using descriptive statistics, Pearson's correlation, t-test, ANOVA and multiple regression. Results: Significant predictors of quality of caregiving by caregivers included caregivers' burdens (explanation power 25%), knowledge of dementia (explanation power 4%) and levels of education (explanation power 3%). These factors explained 32.3% of the variances in quality of caregiving. Conclusion: Burdens on caregivers were a major factor that decreased quality of caregiving, and knowledge of dementia was a factor that increased it. These findings show that educational programs and intervention for reducing burdens and improving knowledge of dementia are necessary to improve quality of caregiving by caregivers.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.1050-1054
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• 2000

Objective : The incidence of head injury has been increasing in the rural area. The author investigated the clinical features and difficulties in care of the acute head-injured patients in this area. Method and Material : The authors performed a retrospective review of radiological data and clinical records in patients with mild to moderate head injury. Cause, type of craniocerebral injury, delayed intracranial lesions, complications, its relation to alcohol abuse, and outcome were analyzed. Results : In total of 68 cases, 20(29.4%) victims were associated with acute alcohol intoxication. Motor vehicle accident was the leading cause of head injury and the most common craniocerebral lesion was basilar skull fracture. Eight(11.8%) patients showed delayed radiological and clinical deterioration and 40(58.8%) were followed-up regularly after discharge. The subdural hygroma was commonly noted in the elderly and alcoholics. Causes of thirty events that resulted in an atypical and difficult neurosurgical practice were as follows : delayed admission, premature discharge against doctor's request, refusal of radiological studies and admission, misunderstanding of disease entity, and unreasonable desire of transfer to tertiary hospitals. Inaccurate initial diagnoses were made by emergency doctors in twenty patients. During the course of treatment, there were a few complications such as alcohol withdrawal, acute otitis media, cerebrospinal fistula, facial weakness, and posttraumatic seizure. Outcome was good in 60(88.2%) patients. Conclusion : Most of minor head trauma patients in this series have shown good results, but we have to consider some possible complications and delayed intracranial lesions in these patients that should be managed with special cautions with various kinds of treatment difficulties.

• 보건교육건강증진학회지
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• 제33권4호
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• pp.47-54
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• 2016

Objectives: The prevalence of insufficient physical activity is relatively high in the Republic of Korea and it is increasing. The national strategies to improve physical activity are essential and are suggested in this paper. Methods: National level of physical activity is compared globally by WHO statistics. Korean National Health and Nutrition Survey showed the level of physical activity. National strategies to improve physical activity were suggested referring to the other countries' strategies, public health books and Health Plan 2020. Results: Prevalence of insufficient aerobic exercise in 2010 were 33.4%, 94.8% in over and 18 years old, 11~17 years old, respectively. And it is increasing. Sufficient exercise to fit the national guidelines of physical activity were done by 15.6% of Korean older and 19 years old. Prevalence of insufficient physical activity was high in the elderly, female, adolescent, rural area and lower income. The national spread of the physical activity guidelines, primary care physicians involvement, supports for the physical activity programs, development of the evaluation protocol for the programs and environmental supports are suggested. Conclusions: The government induced various efforts to improve the level of physical activity is needed urgently.