• Clinical and Experimental Pediatrics
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• v.51 no.10
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• pp.1077-1084
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• 2008

Purpose : Despite the seriousness of bacterial meningitis in children, there is little information on the incidence, causative organisms, mortality rate and age distribution. We studied the frequency by age group and causal pathogens, and clinical characteristics in children with bacterial meningitis in the private sector in Korea. Methods : The medical records containing the data on bacterial meningitis patients under 18 years of age confirmed by cerebrospinal fluid (CSF) findings were retrospectively analyzed from September, 1993 to August, 2006 at Ewha Womans University Mokdong Hospital. Results : Eighty-one cases of bacterial meningitis were observed. Overall the most common organism was Streptococcus agalactiae (group B streptococcus, GBS) (30 cases, 37.0%) followed by Haemophilus influenzae (22 cases, 27.2%), Streptococcus pneumoniae (12 cases, 14.8%), Escherichia coli (3 cases, 3.7%), Neisseria meningitidis (1 case, 1.2%) and others (13 cases, 16.0%). In neonates and young infants under 2 months, the most common organism was GBS. In children between 3 months, and 5 years, the most common organism was H. influenzae. S. pneumoniae was the most common organism in children over 5 years of age. Thirty-one patients (38.3%) had complications. Of all ages, the mortality rate of bacterial meningitis markedly decreased compared with the previously reported rate. Conclusion : In neonates, GBS meningitis was most common. The frequency of H. influenzae meningitis decreased after the introduction of H. influenzae type b vaccination. A strategy for the prevention of GBS meningitis in neonates should be established. The influence of the pneumococcal conjugate vaccine on S. pneumoniae meningitis should be studied.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.12 no.1
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• pp.115-124
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• 2001

Objective：The purpose of this study was to compare the clinical features of children with three subdiagnoses of tic disorder(transient tic disorder(TTD), chronic tic disorder(CTD) and Tourette’s disorder (TD)) and to exam the factors related with illness severity of them. Method：Subjects were 69 children who met DSM-IV criteria for tic disorder and 43 control children. All subjects were investigated demographic and clinical factors related to tic. The severity of tic was assessed with the Yale Global Tic Severity Scale(YGTSS) in tic disorder children. The Child Behavior Checklist(CBCL) was accomplished by parents of all subjects. Results：Children with TTD had not only shorter duration of tic symtoms but also milder tic severity and impairment than those with CTD and TD. They also had significantly lower scores on most CBCL subscales than children with CTD and TD, while they were similar with controls in all the CBCL subcale scores except aggressive behavior. Children with CTD and those with TD were similar to each other in clinical variables except number of tic symptom and scores on CBCL social problem subscale. The interference and intensity of motor tic symptoms and duration of tic symptoms were significant predictors of global impairment score on YGTSS, while the presence of comorbid ADHD was a preictor of the total behavior problem score of CBCL. Conclusion：These findings indicate that duration of tic symptoms and the presence of comorbid ADHD as well as the severity of tic symptoms strongly associated with the illness severity of children with tic disorder. These results also suggest that those clinical factors may be more important for assessing the severity of illness and determining the treatment strategy than the sub-diagnosis itself in children with tic disorder.

• Women's Health Nursing
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• v.5 no.1
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• pp.111-132
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• 1999

This correlational descriptive study sought to define the relationship between the experience of Sanhujori, Korean tradition non-professional postpartal care after delivery and abortion and present physical symptom distress of arthritis female who visited to outpatient clinic of rheumatic internal medicine at three hospital located in Seoul, Pusan, Chongju, Korea. Data from a convenience sample of 98 women who orally agreed to be respondent were collected from September 1, 1998 to October 31, 1998 for two months by way of interview with semi-structured questionnaire. Data analysis consisted of frequency, percentage, mean, S. D., Pearson Correlation Coefficient, t-test, ANOVA and Scheffe test as a post hoc by SPSS. The results of the study were as follows ; Mean age of participants as 52.8 years and mean number of children 3.3. Mean frequency of child birth was 3.1 times per woman, 67.4% of respondents had menopause, 57.0% did not have Sunhujori after abortion. The health status implies the subjective health status women perceived, which came from the three points of view of the present, comparative with other of same age and changed after delivery. The respondents of 76.1% perceived them as unhealthy and the main sites of physical symptom distress were upper & lower extremities including knee and hand 34.8%, shoulder 26.5%, waist 22.4%. Women perceived the etiology of the arthritis as 'did Sanhujori wrongly' 36.7%, 'aging process' 24.5%, 'stress' 16.3%, 'overwork' 15.3%, 'Immunocompromize' & 'physical constitution' 7.1% respectively, 'character' 3.1%, 'genetic' 2.0%, 'malnutrition' 1.0%. The mean period of Sanhujori after delivery was 20.4 at the first child and 18.1 at the second child. The higher frequency of child birth, the shorter period of Sanhujori. For the subjective evaluation of whether the women did Sanhujori well or not, the rate of 'did Sanhujori well' was the highest rank in the first child and the rate of 'did not particularly Sanhujori well' was the highest rank in the last child. There was a significant positive correlation between physical function disability and rheumatoid arthritis symptom at the level of 1% of significance statistically(r=.406). And a positive correlation between physical function disability and Sanhubyung symptom at the level of 5% of significance statistically(r=.224). There was a significant positive correlation among rheumatoid arthritis symptom, Sanhubyung symptom and menopause symptom at the level of 1%-5% of significance statistically. Most of all, the correlation between Sanhubyung symptom and menopause symptom was the higher than others. There was a negative correlation between the present physical symptom distress and experience of Sanhujori(r=.-130), however it was not significant statistically. However, there was a positive correlation between subjective health status and experience of Sanhujori at the level of 1% of significance statistically(r=.328). In conclusion, this finding reconfirmed the positive relationship between the perceived health status and experience of Sanhujori after delivery among women of arthritis. It provides a challenge to the professional care givers to study further on the effects of Sanhuiori after abortion or delivery on the physical symptom distress from the variouis aspects through the cross-sectional and longitudinal research. The strategy for the development of the appropriate intervention for primary prevention of sequele after childbirth and quality of care for desirable health outcomes for postpartal women with considering deeply on the relationship between women's health and postapartal care.

• KDI Journal of Economic Policy
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• v.30 no.2
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• pp.99-128
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• 2008

Nearly all Koreans are insured through National Health Insurance(NHI). While NHI coverage is nearly universal, it is not complete. Coverage is largely limited to minimal level of hospital and physician expenses, and copayments are required in each case. As a result, Korea's public insurance system covers roughly 50% of overall individual health expenditures, and the remaining 50% consists of copayments for basic services, spending on services that are either not covered or poorly covered by the public system. In response to these gaps in the public system, 64% of the Korean population has supplemental private health insurance. Expansion of private health insurance raises negative externality issue. Like public financing schemes in other countries, the Korean system imposes cost-sharing on patients as a strategy for controlling utilization. Because most insurance policies reimburse patients for their out-of-pocket payments, supplemental insurance is likely to negate the impact of the policy, raising both total and public sector health spending. So far, most empirical analysis of supplemental health insurance to date has focused on the US Medigap programme. It is found that those with supplements apparently consume more health care. Two reasons for higher health care consumption by those with supplements suggest themselves. One is the moral hazard effect: by eliminating copayments and deductibles, supplements reduce the marginal price of care and induce additional consumption. The other explanation is that supplements are purchased by those who anticipate high health expenditures - adverse effect. The main issue addressed has been the separation of the moral hazard effect from the adverse selection one. The general conclusion is that the evidence on adverse selection based on observable variables is mixed. This article investigates the extent to which private supplementary insurance affect use of health care services by public health insurance enrollees, using Korean administrative data and private supplements related data collected through all relevant private insurance companies. I applied a multivariate two-part model to analyze the effects of various types of supplements on the likelihood and level of public health insurance spending and estimated marginal effects of supplements. Separate models were estimated for inpatients and outpatients in public insurance spending. The first part of the model estimated the likelihood of positive spending using probit regression, and the second part estimated the log of spending for those with positive spending. Use of a detailed information of individuals' public health insurance from administration data and of private insurance status from insurance companies made it possible to control for health status, the types of supplemental insurance owned by theses individuals, and other factors that explain spending variations across supplemental insurance categories in isolating the effects of supplemental insurance. Data from 2004 to 2006 were used, and this study found that private insurance increased the probability of a physician visit by less than 1 percent and a hospital admission by about 1 percent. However, supplemental insurance was not found to be associated with a bigger health care service utilization. Two-part models of health care utilization and expenditures showed that those without supplemental insurance had higher inpatient and outpatient expenditures than those with supplements, even after controlling for observable differences.

• Journal of Preventive Medicine and Public Health
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• v.27 no.3 s.47
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• pp.447-463
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• 1994

Despite the public health importance of injury and poisoning in terms of its high mortality and incidence, epidemiologic information to be utilized are scarce in Korea. This study was carried out in 1990 on a representative sample population (about 55,000 persons) along with the 6th National Tuberculosis Prevalence Survey in order to estimate the magnitude of injury and poisoning occurrence and to identify its epidemiologic characteristics which can be aided for establishing preventive strategy. Pre-tested and structured Questionnaire was used by trained interviewer to collect data including general information of the person, various information on the injury and poisoning during the past one year such as time and place of its occurrence, its nature and external causes, type of medical institute attended, duration of treatment and outcome of the accident occured. In analysis of the data collected incidence rates per 1000 persons by sex, age group and its nature as well as external causes, and relative frequencies were calculated. The result obtained are as followings; 1. The incidence rate per 1000 was 30 for both sexes, 39 for male and 22 for female, male being 1.8 times more frequent than female. Age adjusted incidences were not much different from the crude rates. Age group specific rate curve showed bimodal shape in both sexes, small peaks in preschool children and higher peaks in older ages. The incidence rate per 1000 people by area was highest in Jeon-bug province (57/1000) and the lowest in Daegu city(11/1000). 2. The place where the injuries occured were road in 46%, within the boundary of house in 25%, and working place in 12% The injuries and poisoning had occured more frequently during the months from March to August of the year than other months. 3. The relatively frequent injuries by its nature were contusion with intact skin surface (19%), fracture of upper limb (13%), open wound of head, neck and trunk (12%) and fracture of lower limb (11%) among males; contusion with intact skin surface (28%), sprains and strains of joints and adjacent muscle (14%), fracture of upper limb (10%) and fracture of lower limb (9%) among females. Higher incidence rate among males than females were fracture of skull (4.5 times), open wound and fractures of limbs ($2{\sim}3$ times). Age specific rate of injuries and poisoning by its nature showed increasing pattern by age in fractures of upper and lower limbs and sprains & strains of joints whereas the age group of 30's showed highest incidence in open wounds of upper limb. Fractures of radius and ulna in upper limb, fractures of tibia & fibula and ankle in lower limb were most frequent among fractures of upper and lower limbs. The frequent injuries among sprains and strains of joints and adjacent muscles were that of ankle, foot and back, and among open wound were that of head and fingers. 4. Relative frequency of injuries and poisoning by external causes showed following order : other accidents (25%), accidental falls (23%), motor vehicle accident (22%) and other road vehicle accident (14%) among males and accidental falls (37%), motor vehicle accident (24%) and other accident (18%) among females. The external causes revealing higher incidences among males than females, were other road vehicle accident (4.8 times), vehicle accident not elsewhere classifiable (4.4 times), accidental poisoning (4.4 times), accidents due to natural and environmental factors (2.8 times), and sucide & self-inflicted injuries (2.8 times). Age specific incidence by external causes for frequent injuries showed that incidence of other accident steadily increased from 10's till age 50's; motor vehicle traffic accident increased from age 20's and dropped after age 60's; on the other hand accidental fall increased strikingly by age. The most frequent external causes among motor vehicle traffic accidents was motor vehicle traffic accident involving collision with pedstrain (69%), pedal cycle accident (30%) and other road vehicle accident (71%) among other road vehicle accidents; falls on same level from slipping, tripping or standing (44%) and other falls from one level to another among accidental falls; accidents caused by machinary (32%) for male and striking against or struck accidentally by objects or person for female among other accidents. 5. Seventy nine percent of the injuries and poisonings were treated in general hospital or hospital/clinic. The duration of treatment ranged from a few days to 123 weeks; the majority(52%) took under 2 weeks, 36% for $3{\sim}8$ weeks and 4% over 21 weeks. 6. The accident resulted in full recovery of normal healthy state in 62%, residual functional defects in 21% and on process of treatment in 16%.

• Tuberculosis and Respiratory Diseases
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• v.63 no.5
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• pp.423-429
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• 2007

Background: Alveolar recruitment (RM) is one of the primary goals of respiratory care for an acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The purposes of alveolar recruitment are an improvement in pulmonary gas exchange and the protection of atelectrauma. This study examined the effect and safety of the alveolar RM using pressure control ventilation (PCV) in early ALI and ARDS patients. Methods: Sixteen patients with early ALI and ARDS who underwent alveolar RM using PCV were enrolled in this study. The patients data were recorded at the baseline, and 20 minutes, and 60 minutes after alveolar RM, and on the next day after the maneuver. Alveolar RM was performed with an inspiratory pressure of $30cmH_2O$ and a PEEP of $20cmH_2O$ in a 2-minute PCV mode. The venous $O_2$ saturation, central venous pressure, blood pressure, pulse rate, $PaO_2/FiO_2$ ratio, PEEP, and chest X-ray findings were obtained before and after alveolar RM. Results: Of the 16 patients, 3 had extra-pulmonary ALI/ARDS and the remaining 13 had pulmonary ALI/ARDS. The mean PEEP was 11.3 mmHg, and the mean $PaO_2/FiO_2$ ratio was 130.3 before RM. The $PaO_2/FiO_2$ ratio increased by 45% after alveolar RM. The $PaO_2/FiO_2$ ratio reached a peak 60 minutes after alveolar RM. The Pa$CO_2$ increased by 51.9 mmHg after alveolar RM. The mean blood pressure was not affected by alveolar RM. There were no complications due to pressure injuries such as a pneumothorax, pneumomediastinum, and subcutaneous emphysema. Conclusion: In this study, alveolar RM using PCV improved the level of oxygenation in patients with an acute lung injury and acute respiratory distress syndrome. Moreover, there were no significant complications due to hemodynamic changes and pressure injuries. Therefore, alveolar RM using PCV can be applied easily and safely in clinical practice with lung protective strategy in early ALI and ARDS patients.

• Journal of dental hygiene science
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• v.10 no.1
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• pp.17-24
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• 2010

The purpose of this study was to provide the basic data for effective intervention of oral health behaviors strategy and to compare the actual conditions about hypertension and diabetes case management of the elderly at the hall for the aged and the D senior's college. The research method was a questionnaire including hypertension and diabetes case management of the elderly and the subjects were 174 of the elderly(65 age over) at the hall for the aged(100) and the senior's college(74). The results of this study were as follows; 1. Hypertension 1)The incidence of hypertension of elderly at the hall for the aged and the senior's college were 32.2%. 2)83.9% of the hypertension cases were initially diagnosed during hospital examination(p < 0.05). 3)Regular blood pressure checks were performed more than one time monthly on 76.8% of the cases(p < 0.05). 4)Blood pressure control was well controlled on 75%(p < 0.05). 5)85.7% of the elderly at the hall for the aged took hypertension drugs daily and 42.9% of the elderly at the senior's college took no drug alternatively(p < 0.05). 2. Diabetes 1)The incidence of the diabetes of elderly at the hall for the aged and the senior's college were 14.4%. 2)80.0% of the diabetes cases were initially diagnosed during hospital examination(p < 0.05). 3)64.0% of the cases did not have blood sugar measuring instrument(p < 0.05). 4. In the quality of life, the thinking of no difficulty in walking and no anxiety/depression was more presented on the elderly at the senior's college than those at the hall for the aged(p < 0.05). 5. The subjective health condition scores were higher on the elderly at the senior's college than those at the hall for the aged(p < 0.05).

• The Journal of Korean Academic Society of Nursing Education
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• v.1 no.1
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• pp.17-23
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• 1995

One of the biggest problems of Nursing Education in Korea is the division among nursing education programs of the last 3 and 4 years. To solve this problem, Nursing community must do variable trials to achieve the unity of a 4-year educational program. With this, we need to observe the phenomena and reality of the present 4-year nursing educational program that we have. The object of this study is to analyse and discuss that we have. The object of this study is to analyse and discuss the problems and future strategies of 4-year Nursing Baccalaureate program. 1. Problems as nursing department in Medical School. 1) Many 4-year nursing baccalaureate programs are operating under the medical school as nursing department. So the academic development in nursing department is unprogressive and is not approved as unique discipline. 2) The operating system between nursing and medical department are different even though they are in the same school. 3) Inequality between nursing and medical department : In many case, the nursing professor can not attend administraion committees to discuss the medical school's operation because of many differences between nursing and medical organization. 4) Weakness of the leadership and the student activities in nursing student : The nursing student involvement is usually passive because of the difference of curriculum, less number than medical students and the difference between 4-year and 6-year education program. 5) There is the obscurity of the relationship between department of nursing and other departments in whole university. 2. Problems in nursing itself 1) We need to reconstruct nursing discipline. We must change from the disease centered model to health centered model and life cycle centered model so that we can be distinguished from medicine. We also must change from hospital centered nursing to all population centered nursing, 2) The improvement of curriculum ; When the independent framework of nursing discipline become established, we need to improve the curriculum. 3) The education of clinical practice ; Most nursing school programs are divided into professors who are lecturing the theory and clinical teachers who are teaching the nursing technique in the clinic. So, what is needed in nursing discipline is that the professors have a dual position. In America, The professor is required to be a clinical specialist and to have his or her clinic so that the professor become a good role model, teach the clinical practice effectively, and give the student the practice field. 4) To extend fields of nursing : At first, the school nurse must become the school health educator, a real teacher. The nurse must establish and operate a childern's wellbeing center or nursery school, a disabled people's house or senile's wellbeing center, a mental health center, and a health promotion clinic for healthy people. 5) The name 'nursing department' need to be considered. When the focus is to be changed from the disease model to health improvement model, we take into consideration change 'nursing college', 'nursing department' and 'nursing profession' to 'health science college' or 'health wellbeing college'. 6) We must have highly qualified academic students. Each Nursing educational faculties must have the high qualified students through the development of nursing educational program and the increment of scholarship. The Korean Nurses Association and The Korean Clinical Nurses Association need to make an endeavor for the improvement of work condition and payment of clinical nurses of hospitals who consist of 70% of all nursing manpower. 3. Improvement Strategy 1) All nursing educational program must be changed 4-year program gradually. 2) Nursing department need to try to become nursing college. 3) We need to study many researches for improvement of the problem in nursing discipline and nursing education. We need more interdisciplinary researches, and we need to be granted for that research. 4) We need to have many seminars and workshops thoughout the whole country to expand a sense of nursing education. 5) Drawing up a policies plan for the nursing educational improvement : The Korean Nurses Association, The Korean Academic Nursing Association, Korea Nursing College and department President's Committee, and Korea Academic Society of Nursing Education must try for the development of nursing educational improvement and ask for government frame the policy to develop nursing education.

• Journal of radiological science and technology
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• v.29 no.3
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• pp.197-210
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• 2006

This study explored several agenda related to license system, education, professional work of radiological technologists(RTs) and a transition process of law for them to investigate a developmental strategy of RTs as a professional career. The results are as followings : 1. The national license system for RTs was started from 1965, 1965-1972 x-ray technicians(medical assistance), 1973-present(2006) radiotechnologist(medical technologist) since then. 2. The average pass ratio of national license examination(1965-2006) for RTs was 46.6%. The method, subjects and level of the examination should be improved. 3. The education term for RTs has been changed since 1963 ; 1963-1990 two year college, 1991-1999 three year college, 2000-2006 four year and three year college depending on universities and colleges. As of 2006, there are twelve 4-year universities and eighteen 3-year colleges. The total number of new students were 1,956. 4. The new developmental paradigm should be made for technology education of RTs corresponding to the development of medicine and science. 5. The qualification system of clinical specialists in radio-technology field needs to be operated not by the non-governmental body(The Korean Radiological Technologists Association) but by the governmental body. 6. The vertical relationship among RTs, doctors and other medical workers should be rebuilt through the revision of law. Especially, doctors and dentists 'guidance authority' for RTs should be changed to 'request authority'. 7. The service extent of RTs should be extended in medical fields corresponding to professional work of RTs and a revision of the law needed for this situation.

• Korean Journal of Psychosomatic Medicine
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• v.10 no.1
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• pp.8-17
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• 2002

Objective : Increasing in frequency and success of hematopoietic stem cell transplantation and improved survival rates have led to growing concerns regarding the psychosocial aspects of hematopoietic stem cell transplantation recipients. In this study, we have examined the stress coping strategies and related psychiatric symptom in the hematopoietic stem cell transplantation recipients. Methods : In this study, we examined the psychological stress symptoms of hematopoietic stem cell transplantation recipients and differences of psychosocial variables between active coping group and passive coping group. Twenty nine recipients of hematopoietic stem cell transplantation were recruited prospectively and assessed at 2 weeks pretranplant and at 1-2 days posttranplant. Thirty normal controls were recruited. Assessments included a psychiatric interview, a variety of standardized questionnaires (Ways of Coping Questionnaires, Perceived Stress Scale, Hospital Depression and Anxiety Scale, Short-Form 36 Health Survey). Results : Hematopoietic stem cell transplantation patients showed higher degree of depression (p<0.001) and anxiety (p=0.011) symptoms than normal control group. However, no differences of depression and anxiety symptoms between pretransplant and posttransplant status were showed. And, passive coping group showed higher degree of depression (p=0.046) and anxiety symptoms (p<0.001) than active coping group. Conclusions : Our results suggested that many hematopoietic stem cell transplantation recipients would exhibit severe to moderate symptoms of anxiety and depression. Also, it seemed likely that passive coping style might influence the development of negative affect such as anxiety and depression. The implications of these findings were discussed in terms of the need to monitor the coping strategies and apply the appropriate psychiatric intervention. And, further prospective studies about long-term survival and psychological adaptive functions of hematopoietic stem cell transplantation patients are recommended.