• Title/Summary/Keyword: Major Adjustment

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The Comparison of ICSD and DSM-Ⅳ Diagnoses in Patients Referred for Sleep Disorders (정신과에 의뢰된 환자 중 수면장애에 대한 ICSD와 DSM-Ⅳ 진단 비교)

  • Lee, Bun-Hee;Kim, Leen;Suh, Kwang-Yoon
    • Sleep Medicine and Psychophysiology
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    • v.8 no.1
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    • pp.37-44
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    • 2001
  • Background: Sleep disorders are prevalent in the general population and in medical practice. Three diagnostic classifications for sleep disorders have been developed recently: The International Classification of Sleep Disorders (ICSD), The Diagnostic and Statistical Manual, 4th edition (DSM-IV) and The International Classification of Diseases, 10th edition (ICD-10). Few data have yet been published regarding how the diagnostic systems are related to each other. To address these issues, we evaluated the frequency of sleep disorder diagnoses by DSM-IV and ICSD and compared the DSM-IV with the ICSD diagnoses. Method: Two interviewers assessed 284 inpatients who had been referred for sleep problems in general units of Anam Hospital, holding an unstructured clinical interview with each patient and assigning clinical diagnoses using ICSD and DSM-IV classifications. Results: The most frequent DSM-IV primary diagnoses were "insomnia related to another mental disorder (61.1% of cases)" and "delirium due to general medical condition (26.8%)". "Sleep disorder associated with neurologic disorder (38.4% of cases)" was the most frequent ICSD primary diagnosis, followed by "sleep disorder associated with mental disorder (33.1%)". In comparing the DSM-IV diagnoses with the ICSD diagnoses, sleep disorder unrelated with general medical condition or another mental disorder in DSM-IV categories corresponded with these in ICSD categories. But DSM-IV "primary insomnia" fell into two major categories of ICSD, "psychophysiologic insomni" and "inadequate sleep hygiene". Of 269 subjects, 62 diagnosed with DSM-IV sleep disorder related to general medical condition or another mental disorder disagreed with ICSD diagnoses, which were sleep disorders not associated with general medical condition or mental disorder, i. e., "inadequate sleep hygiene", "environmental sleep disorder", "adjustment sleep disorder" and "insufficient sleep disorder". Conclusion: In this study, we found not only a similar pattern between DSM-IV and ICSD diagnoses but also disagreements, which should not be overlooked by clinicians and resulted from various degrees of understanding of the pathophysiology of the sleep disorders among clinicians. Non-diagnosis or mis-diagnosis leas to inappropriate treatment, therefore the clinicians' understanding of the classification and pathophysiology of sleep disorders is important.

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A Comparative Study on Attitude of the Collegiate an4 Non-Collegiate Nursing Students toward Their Clinical Affiliation in a Mental Hospital (정신과 간호 실습에 대한 간호 대학생과 간호학교 학생들의 태도 비교 연구)

  • 김소야자
    • Journal of Korean Academy of Nursing
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    • v.4 no.2
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    • pp.17-31
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    • 1974
  • Today, over seventy five percent of nursing in Korea provide a psychiatric experience in the basic curriculum. The psychiatric affiliation presents numerous major problems of adjustment to the student. The Importance of positive attitude toward the nursing care of psychiatric patients is recognized by the nursing profession. I have fined out the unfavorable attitude of non collegiate nursing students toward psychiatric nursing affiliation by previous research. This study was undertaken in response to a felt need to explore the use of several devices which might yield information about attitudes toward psychiatric nursing as a basis for future planning of the program offered at a selected hospital. This study is designed to meet the following objectives; (1) In order to find out the expressed attitudes of fifty·three collegiate nursing students toward their psychiatric affiliation. (2) To compare responses given by selected group of collegiate and non collegiate nursing students to same questionnaire (3) To determine the relationship between the attitudes of nursing students toward psychiatric nursing and the type of instructions where experience was obtained. A questionnaire, a Korean translation of the "Psychiatric Nursing Attitude Questionnaire" by Moldered Elizabeth fletcher, was administered to fifty-three collegiate nursing students who had completed a four-week psychiatric affiliation in a S hospital psychiatric ward during May 7, 1973 to Dec. 16, 1973. - The questionnaire of 100 statements was administered in the following way; (1) Part Ⅰ, Preconceptions, was, given in individual conferences with each subject, during the first few days of their affiliation, and again during the final week of affiliation. The responses to Part I were oral. (2) Part Ⅱ, Expectations, Part Ⅲ, Personal Relations, Part Ⅳ, Personal Feelings, and Part V, Attitudes and Activities of Patients were given to all of the subjects in a group meeting during the second week of the affiliation, and again, during the fourth week at the termination of the affiliation. Responses to Parts Ⅱ, Ⅲ, Ⅳ·, and V, were written. Each of the 100 statements of the questionnaire was considered to be either Positive or Negative. A favorable response was assigned the positive value of 1 and an unfavorable response was assigned the Negative value of O. The coefficient of correlation was computed between the two sets of scores for the fifty-three nursing students, The mean score, the standard deviation, and the differences in the means on each of the five parts of the questionnaire were computed and the relationships calculated by at-test. The results of the study were as follows; 1. There was no significant correlation between the two sets of the scores for the fifty-three nursing students during the four-week psychiatric affiliation. (r= 0.36) 2. There was no significant difference in the mean scores between the first and final tests for any of the questionnaire. 3. The Part Ⅰ, Preconceptions, data indicated collegiate nursing students have positive attitudes in preconceptions than non collegiate nursing students and preconceptions toward the psychiatric affiliation which affect their psychiatric nursing experience. 4. The Part Ⅱ, Expectations, data indicated more appropriate expectations of collegiate nursing students related to pre psychiatric affiliation orientation and sufficient theory learning than non-collegiate nursing students. 5. The Part Ⅲ, Personal relations, data indicated some students have negative attitudes in personal relations with normal people in respect to psychological security and social responsibilities. 6. The Part Ⅳ, Personal feelings, data indicated nursing students have psychological insecurity & inappropriateness. 7. The Part V, Attitudes and activities of patients, data indicated collegiate nursing students have more positive attitudes to the psychotic behavior of certain situations due to sufficient theory learning. 8. The data indicated collegiate·nursing students have more positive attitude than non-collegiate nursing students. 5. The Part Ⅲ, Personal relations, data indicated some students have negative attitudes in personal relations with normal people in respect to psychological security and social responsibilities. 6. The Part Ⅳ, Personal feelings, data indicated nursing students have psychological insecurity & inappropriateness. 7. The Part V, Attitudes and activities of patients, data indicated collegiate nursing students have more positive attitudes to the psychotic behavior of certain situations due to sufficient theory learning. 8. The data indicated collegiate·nursing students have more positive attitude than non-collegiate nursing students through psychiatric affiliation.

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Chronic pain control in patients with rheumatoid arthritis (만성통증 환자의 통증 조절)

  • Eun, Young
    • Journal of muscle and joint health
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    • v.2 no.1
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    • pp.17-40
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    • 1995
  • Rheumatoid arthritis is the one of the chronic diseases, one of its major symptoms is a chronic pain. Despite developing medical treatment and surgical techniques, it is suggested that to control the pain is the goal of the treatment. But pain is an inner experience and even those closest to the patient cannot truly observe its progress or share in its suffering. The National Academy of Sciences Institute of Medicine's report on Pain and Disability concluded that there is no objective measure of pain-(exactly) no pain thermometer-nor can there ever be one, because the experience of pain is inseparable from personal perception and social influence such as culture. To explore chronic pain experience is to understand the process and property of the patient's perception of pain through the response to pain, the coping with pain, and the adaptation to pain. Therefore a qualitative study was conducted in order to gain an understanding of pain experience of patients with RA in korea. I used naturalistic inquiry as a research methodology, which had 5 axioms, the first is that realities are multiple, constructed, and holistic, the second is that knower and known are interactive, inseparable, the third is only time and context bound working hypotheses(idiographic statements) are possible, the forth is all entities are in a state of mutual simultaneous shaping, so that it is impossible to distinguish causes from effects and the last is that inquiry is value-bound. Purposive sampling was conducted as a sampling. 20 subjects who experienced pain over 10 years, lived in middle-sized city and big city in Korea, and 17 women and 3 men. The subject's age was from 32 to 62 (average 48.8), all were married, living with their spouse and children, except two-one divorced and the other widow before they became ill. I collected data using In depth structured interview. I had interviews two or three times with each subject, and the interviews were conducted at each subject's home. Each interview lasted about two hours an average. A recording was taken with the consent of the subject. I used inductive data analysis-such as unitizing and categorizing. unitizing is a process of coding, whereby raw data are systematically transformed and aggregated into units. Categorizing is a process wherby previously unitized data are organized into categories that provide descriptive or inferential information about the context or setting from which the units were derived. This process is used constant comparative method. The pain controlling process is composed of behavior of pain control. The behaviors of pain control are rearranging of ADL, hiddening role conflict, balancing treatment, and changing social relation. Rearranging of ADL includes diet management, sleep management, and the adjustment of daily life activities. The subjects try to rearrange their daily activities by modified style of motions, rearranging time span & range of activities, using auxillary facilities, and getting help in order to keep on the pace of daily life. Hiddening role conflict means to reduce conflicts between sick role and their role as a family member. In this process, the subjects use two modes, one is to control the pain complaints, and the other is to internalize the value which is to stay home is good for caring her children and being a good mother. To control pain complaints is done by 'enduring', 'understanding' the other family members, or making them undersood in order to reduce pain. Balancing treatment is composed of two aspects. One is to keep the pain within the endurable level, the other is to keep in touch with medical personnel in order to get the information of treatment and emotional support. Changing social relation is made by information seeking and sharing, formation of mutual support relation, and finally simplification of social relationships. The subjects simplify their social relationships by refraining from relations with someone who makes them physically and psychologically strained. In particular the subjects are apt to avoid contact with in-laws, and the change of relation to in-laws results in lessening the family boundary. In the course of this process, they confront the crisis of family confict result in family dissolution. This crisis is related to the threat of self-existence. Findings from this study contribute to understanding the chronic pain experience. To advance this study, we should compare this result with other cases in different cultural contexts. I think to interpret these results, korean cultural background should be considered. Especially the different family concept, more broader family members and kinship network, and the traditional medical knowledge influences patients' behavior.

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Association between energy intake and skeletal muscle mass according to dietary patterns derived by cluster analysis: data from the 2008 ~ 2010 Korea National Health and Nutrition Examination Survey (군집분석으로 도출한 식사패턴별 에너지 섭취량과 골격근육량의 연관성 분석 : 2008 ~ 2010년 국민건강영양조사 자료를 활용하여)

  • Jang, Bo Young;Bu, So Young
    • Journal of Nutrition and Health
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    • v.52 no.6
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    • pp.581-592
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    • 2019
  • Purpose: This study investigated major dietary patterns among healthy Korean adults using cluster analysis and analyzed the relationship between energy intake and skeletal muscle mass. Methods: This study was conducted using the data from the 2008 ~ 2010 Korea National Health and Nutrition Survey. The data of 7,922 subjects aged 30 years and over, without any missing values, were included in the final analysis. K-means cluster analyses were conducted to identify the dietary patterns of the study subjects, which were based on the energy intake from 21 food groups using a 24-h recall method. The changes in energy intake with each dietary pattern, according to quartiles of skeletal muscle mass, were investigated. Results: Three dietary patterns were identified for both men and women: 'Flour, Animal fat', 'White rice' and 'Healthy mixed diet'. The association between energy intake and skeletal muscle mass for both men and women was significant only in the 'White rice' dietary pattern. In the 'White rice' pattern, the energy intake increased up to > 300 kcal from the lowest to the highest quartile of skeletal muscle mass after adjustment for covariates. Within the 'White rice' pattern, skeletal muscle mass was linearly associated with energy intake in all the age groups in men. Conclusion: Energy intake was significantly associated with changes in skeletal muscle mass only in the 'White rice' pattern. Furthermore, the degree of association between the change in skeletal muscle mass and energy intake differed according to gender. These results indicate that the association between skeletal muscle mass and energy intake may be specific to Korean people who are accustomed to a traditional Korean diet.

Development of Strategies to Improve Water Quality of the Yeongsan River in Connection with Adaptation to Climate Change (기후변화의 적응과 연계한 영산강 수질개선대책 개발)

  • Yong Woon Lee;Won Mo Yang;Gwang Duck Song;Yong Uk Ryu;Hak Young Lee
    • Korean Journal of Ecology and Environment
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    • v.56 no.3
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    • pp.187-195
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    • 2023
  • Almost all of the water from agricultural dams located to the upper of the Yeongsan river is supplied as irrigation water for farmland and thus is not discharged to the main stream of the river. Also, most of the irrigation water does not return to the river after use, adding to the lack of flow in the main stream. As a result, the water quality and aquatic health of the river have become the poorest among the four major rivers in Korea. Therefore, in this study, several strategies for water quality improvement of the river were developed considering pollution reduction and flow rate increase, and their effect analysis was performed using a water quality model. The results of this study showed that the target water quality of the Yeongsan river could be achieved if flow increase strategies (FISs) are intensively pursued in parallel with pollution reduction. The reason is because the water quality of the river has been steadily improved through pollution reduction but this method is now nearing the limit. In addition, rainfall-related FISs such as dam construction and water distribution adjustment may be less effective or lost if a megadrought continues due to climate change and then rainfall does not occur for a long time. Therefore, in the future, if the application conditions for the FISs are similar, the seawater desalination facility, which is independent of rainfall, should be considered as the priority installation target among the FISs. The reason is that seawater desalination facilities can replace the water supply function of dams, which are difficult to newly build in Korea, and can be useful as a climate change adaptation facility by preventing water-related disasters in the event of a long-term megadrought.

A Study on the Effective Independent Study of Nursing Student (간호학생의 효과적인 자율학습을 위한 조사연구)

  • 김광주;이향련
    • Journal of Korean Academy of Nursing
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    • v.8 no.1
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    • pp.16-42
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    • 1978
  • This survey was made for a month starting from November 15 to December 15, 1977 covering 711 students taking the junior. (3rd-yea.) and the senior. (4th-year) at nine college of nursing in Seoul concerning their perception and Attitude toward the profession of nursing, motive for the necessity of learning, environment of study, attitude of study and particulars relevant with study performance, particulars of library, references and reading, assignments and particulars of the degree of confidence for the learning achievement. Through the survey of the above Particulars, the following results were obtained by classifying all subject matters and by analysing motive of the selection of their course, awarding or not awarding of scholarships. 1. General characteristics: it was revealed that 406 students (57.1%) were attending at the junior. while 305 students (42.9%) were taking the senior. Thus, the total number was 711 and their average age was 21.4 years. Their dwelling category was; 73.9 percent of them resided at their parent's home, 214 students (30.1%) were awarded with scholarships. The reason to be attracted by nursing science was the possibility of continuing social life after graduation (43.5%). 2. Their perception and attitude toward the profession of nursing: According to the perception of profession by the students of each grade, students of the 4th grade showed comparatively strong conception. Also, students of the 4th grade showed more positive attitude in the purchase and reading of magazines relative with the science of nursing, in the reading of Code for Nurses and in their interest in the activity of nursing field. For the necessity of mission of nurse, 97.7 percent of the entire number of students covered responded to necessity. For the necessity of the particular humanity and particularity in the character of nurses, 95.8 percent of those students responded to necessity. By the each grade, students of the 4th grade showed more response. 3. As to professional field desired after completing the professional course: 57 percent of those students desired for clinician nurse while 55 percents desired for community health-nurse. 4. As to the environment of study: they were mostly satisfied with their present residential environment. However, they complained of inconvenience at their lecture-halls. Students of the 3rd grade showed more complain. As to their attitude toward the adjustment of environment of study, they showed a affirmative response. As to the opinion of factors which interfere with their study, comparatively strong response was showed in their scepticism in the science of nursing, insufficient comprehension in general learning, relation with professors n4 discrepancy in the method of study. According to opinions of students at each grade, students of the 4th grade showed more scepticism. 5. Particulars relative with their attitude and performance of study : As to their knowledge of the objectives of their study of subject, the majority was to study with a partial knowledge of the objectives of their study. As to the plan of study, a low percentage indicated management of routine life under regular scheduling. Students of the 4th grade responded to rather planned life. As to time spent in independent study, response to concentrated study when necessary was stronger than that to regular daily study. Students of the 4th grade showed stronger response to regular study than that of the 3rd grade. As to the contents of their note-taking, 67.4 percents of those students responded to such regulatory procedure performing in the lecture-hall as they listen to lectures. 17.3 percents of those students showed response to adding supplementary informations from references to what was entered in choir note-taking at their lecture-halls. 6. Particulars of library, references and reading books: As to receiving of instruction for the utilization of library and time of receiving such instruction 64.7 percents of those students had received such instruction. 66.7 percents of the those responded received such instruction at orientation conducted for freshmen. As to the convenience of the utilization of library, 49.9 percents of those students responded to convenience. However, students of the 3rd grade showed a much stronger response to inconvenience. As to the time of the utilization of library,92.5 percents of those students showed a response to occasional utilization for particular purpose than regular utilization. 53.2 percents of those students responded to ordinary in quantity that library have references. 34.2 percents of those students responded to insufficient. As to the particular relative with the method and field of reading: 53.5 percents of those students responded to intensive reading and was the majority. As to the reading field, fiction u as the majority. When read any books for their major, they usually rend Korean text-b, oks. 7. Particular relative with giving assignment: All respondents were well aware of the objectives of giving home tasks. As to the attitude toward assignments and performing home tasks, 54.8 percents of those students to making ostentatious study because of an excessive quantity of assignments imposed. For performing assignment, they showed comparatively positive response. Also, 52.2 percents of those students responded that they usually submitted complected assignment with references. 8. As to motive to realize the necessity of study : 55.6 percents of those students responded that they realized such necessity in communication with patients when they were engaged in clinical practice. Also, 8.6, the lowest percents of those students responded that they realized such necessity in the course of conversation with nurses when they were engaged in clinical practice. 9. As to the determination of their confidence in the performance of study relative with clinical experience: They showed a general inclination of having in nursing. The major response was that they came to well comprehend the patients families. the lowest response was that they could apply what was learned at lecture-hall to practice. This response incidentally showed the distance the lecture-hall and practical study. In general items, students of the 4th grade showed more favorable response than students of the 3rd grade and there was a significant difference. 10. As to the perception and attitude toward profession according to the motive of selecting the nursing science : Those who selected the nursing voluntarily showed stronger conception than those who selected the nursing through indirect influence. However, there was no significant difference on this point. Only there was a remarkable difference in the reading of Code for Nurses. 11. Those who showed a stronger conception in the profession of nursing according to the motives of attractive nursing science indicated a strong will and ability to manage stable life and comparatively strong response was shown in the management of good home life because of the good adaptability of the science to their character. This group showed a strong conception of the profession than those who responded that they prefer this profession out of a longing for the work of a hospital and for the easy obtaining of opportunity to immigrate to over seas and for economic cause and for high school grade. There was significant difference between these two groups, 12. As to the conception and attitude toward the profession of nursing according to benefits by scholarships, those who were benefitted by scholarship showed stronger conception of profession than those who did not receive scholarship and there was a remarkable difference between these two categories. However, there was no remarkable difference between these two categories in the extent of interest of the activities of nursing fields and in the reading of Code for Nurses. 13. As activation for study according to the benefits of scholarships, those who were benefitted by scholarships showed stronger response to the motive for study comparing with those who receive. 14. As to tile field of reading according to the benefits by scholarships, those who received scholarships tended to read autobiographies and essayers to a considerable extent. Those who did not receive scholarships tended to read novels. Those who received scholarships more read nursing boots than those who did not receive scholarships. 15. As to the attitude of study and doing of assignment according to benefits of scholarships, those who received scholarships managed a favorable life with schedules for study, More students of receiving scholarship showed a regular study for more than one hour per day. Also, in the method of doing home tasks, more students of receiving scholarship showed reference to relative books frequently for the submission of completed assignments.

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Rapid Rural-Urban Migration and the Rural Economy in Korea (한국(韓國)의 급격(急激)한 이촌향도형(離村向都型) 인구이동(人口移動)과 농촌경제(農村經濟))

  • Lee, Bun-song
    • KDI Journal of Economic Policy
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    • v.12 no.3
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    • pp.27-45
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    • 1990
  • Two opposing views prevail regarding the economic impact of rural out-migration on the rural areas of origin. The optimistic neoclassical view argues that rapid rural out-migration is not detrimental to the income and welfare of the rural areas of origin, whereas Lipton (1980) argues the opposite. We developed our own alternative model for rural to urban migration, appropriate for rapidly developing economies such as Korea's. This model, which adopts international trade theories of nontraded goods and Dutch Disease to rural to urban migration issues, argues that rural to urban migration is caused mainly by two factors: first, the unprofitability of farming, and second, the decrease in demand for rural nontraded goods and the increase in demand for urban nontraded goods. The unprofitability of farming is caused by the increase in rural wages, which is induced by increasing urban wages in booming urban manufacturing sectors, and by the fact that the cost increases in farming cannot be shifted to consumers, because farm prices are fixed worldwide and because the income demand elasticity for farm products is very low. The demand for nontraded goods decreases in rural and increases in urban areas because population density and income in urban areas increase sharply, while those in rural areas decrease sharply, due to rapid rural to urban migration. Given that the market structure for nontraded goods-namely, service sectors including educational and health facilities-is mostly in monopolistically competitive, and that the demand for nontraded goods comes only from local sources, the urban service sector enjoys economies of scale, and can thus offer services at cheaper prices and in greater variety, whereas the rural service sector cannot enjoy the advantages offered by scale economies. Our view concerning the economic impact of rural to urban migration on rural areas of origin agrees with Lipton's pessimistic view that rural out-migration is detrimental to the income and welfare of rural areas. However, our reasons for the reduction of rural income are different from those in Lipton's model. Lipton argued that rural income and welfare deteriorate mainly because of a shortage of human capital, younger workers and talent resulting from selective rural out-migration. Instead, we believe that rural income declines, first, because a rapid rural-urban migration creates a further shortage of farm labor supplies and increases rural wages, and thus reduces further the profitability of farming and, second, because a rapid rural-urban migration causes a further decline of the rural service sectors. Empirical tests of our major hypotheses using Korean census data from 1966, 1970, 1975, 1980 and 1985 support our own model much more than the neoclassical or Lipton's models. A kun (county) with a large out-migration had a smaller proportion of younger working aged people in the population, and a smaller proportion of highly educated workers. But the productivity of farm workers, measured in terms of fall crops (rice) purchased by the government per farmer or per hectare of irrigated land, did not decline despite the loss of these youths and of human capital. The kun having had a large out-migration had a larger proportion of the population in the farm sector and a smaller proportion in the service sector. The kun having had a large out-migration also had a lower income measured in terms of the proportion of households receiving welfare payments or the amount of provincial taxes paid per household. The lower incomes of these kuns might explain why the kuns that experienced a large out-migration had difficulty in mechanizing farming. Our policy suggestions based on the tests of the currently prevailing hypotheses are as follows: 1) The main cause of farming difficulties is not a lack of human capital, but the in­crease in production costs due to rural wage increases combined with depressed farm output prices. Therefore, a more effective way of helping farm economies is by increasing farm output prices. However, we are not sure whether an increase in farm output prices is desirable in terms of efficiency. 2) It might be worthwhile to attempt to increase the size of farmland holdings per farm household so that the mechanization of farming can be achieved more easily. 3) A kun with large out-migration suffers a deterioration in income and welfare. Therefore, the government should provide a form of subsidization similar to the adjustment assistance provided for international trade. This assistance should not be related to the level of farm output. Otherwise, there is a possibility that we might encourage farm production which would not be profitable in the absence of subsidies. 4) Government intervention in agricultural research and its dissemination, and large-scale social overhead projects in rural areas, carried out by the Korean government, might be desirable from both efficiency and equity points of view. Government interventions in research are justified because of the problems associated with the appropriation of knowledge, and government actions on large-scale projects are justified because they required collective action.

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