• 제목/요약/키워드: Medical illness

검색결과 906건 처리시간 0.039초

일반의약품과 전문의약품 의도적 음독 자살 시도자 특성 분석 연구 (A Study on the Characteristics of Intentional Self-Poisoning Patients : Comparison between Non-Prescription and Prescription Drugs)

  • 조을아;조지현;조경형;심현보
    • 정신신체의학
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    • 제28권2호
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    • pp.116-125
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    • 2020
  • 연구목적 자살시도로 응급실에 내원한 환자들 중 음독이 가장 높은 빈도를 보이고 있다. 본 연구에서는 음독 의약품에 따른 자살 시도자들의 특성을 분석하여 향후 임상 진료 현장에서 도움이 될 제언과 자살 예방 정책을 마련하는데 기초자료를 제공하고자 하였다. 방 법 2011년부터 2019년까지 서울 소재 1개 종합 병원 응급실에 음독 자살 시도 후 내원한 환자 574명의 의무기록을 후향적으로 검토하였다. 의무기록을 통해 인구통계학적 정보 및 자살 과거력, 정신건강의학과 과거력, 정신질환 외 기저질환력, 음독 약물의 종류 및 양, 획득 경로, 단일 혹은 혼합 음독여부 등에 대해서 조사 후 카이제곱 검정 및 독립표본 t-검정을 사용하여 통계 분석하였다. 유의한 결과에 대해서는 위험률 산출을 위해 오즈비를 구하였다. 결 과 일반의약품 음독군이 전문의약품 음독군에 비해 연령은 유의하게 낮았으며 국민건강보험 외 비율은 낮고 배우자가 있는 비율은 유의하게 높았다. 전문의약품 음독군은 일반의약품 음독군에 비해 비자발적 응급실 내원, 정신질환력 및 정신질환 외 기저질환력에서 높은 비율을 보였다. 전문의약품 중 벤조디아제핀 음독군은 비음독군에 비해 본인 처방 비율이 높은 반면 졸피뎀 음독군은 타인처방 비율이 높았다. 벤조디아제핀, 졸피뎀, 항우울제 단독 음독군이 복합 음독군에 비해 유의하게 정신질환력이 없는 비율이 높았다. 결 론 일반의약품 판매 규제에 대한 가이드라인이 필요할 것이며 임상 현장에서 자살 고위험군의 특성을 유념한 면담이 필요하다. 또한 자살 위험성이 높은 환자들에게 전문의약품 처방 시 추적 관찰 기간 및 처방 기간, 포장 방식에 대한 적극적인 고려가 필요할 것으로 보인다.

한국에서 노인용 미시간주정의존선별검사의 적용을 위한 예비연구 (A Preliminary Study for the Application of Michigan Alcoholism Screening Test-Geriatric Version in Korea)

  • 전진숙;오병훈;최영태
    • 생물정신의학
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    • 제6권1호
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    • pp.102-110
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    • 1999
  • Objectives : The alcohol dependence in elderly people has been prevalent because of increase in geriatric population. However, it is difficult to find out alcohol dependence in the aged, because they have less specific clinical features as compared with adult alcoholics. The aims of this study were to screen alcohol dependence among elderly Koreans and to know the clinical characteristics of Korean delerly alcoholics. Methods : The questionnaires translated into Korean such as Michigan Alcoholism Screening Test(MAST-K), the Brief MAST and the MAST-Geriatirc Version (MAST-KG) were used to screen alcohol dependence in the elderly alcoholic inpatients aged over 60(N=43), adult alcoholic inpatients within 20-59 Yrs of age(N=60), which were compared with age matched normal healthy aged(N=18) or adult controls(N=45). The demographic data such as sex, age, education, occupation, socioeconomic status, marital status, numbers of children, dwelling and religion as well as alcohol history such as duration of alcohol drinking, onset age, family history, impulsivity, somatic illness and motivation were also obtained to identify characteristic features of Korean aged alcoholics by structured interviews. Results : 1) The aged alcoholics had the charateristic features of more in males, lower age, low education levels, more in blue-collar workers, lower socioeconomic class, more in single, few babies, more living alone, having no religion without statistical significance. 2) The onset age of alcohol dependence was significantly higher in the aged alcoholics($45.3{\pm}13.6Yrs$) than in the adult alcoholics($27.7{\pm}8.7Yrs$)(p<0.0001). The duration of problematic alcohol drinking was significantly longer in the aged alcoholics($22.0{\pm}15.1Yrs$) than in adult alcoholics($14.2{\pm}8.4Yrs$)(p<0.01). Otherwise, there were no significant difference between aged and adult alcoholics in the family history, imulsivity, somatic illness and motivation. 3) The mean score of the MAST-K was significantly higher in the aged alcoholics($20.6{\pm}5.4$) than in the normal aged($6.7{\pm}4.4$)(p<0.0001), which was significantly lower than in the adult alcoholics($26.2{\pm}8.0$) and in normal adult controls($9.5{\pm}3.2$)(p<0.05). The mean score of the Brief MAST was significantly lower in the aged alcoholics($9.3{\pm}3.5$) than in the adult alcoholics($14.5{\pm}6.6$)(p<0.0001). The mean score of the MAST-KG was significantly higher in the aged alcoholics($10.6{\pm}3.5$) than in the normal aged($4.8{\pm}4.3$)(p<0.0001). The former was significantly lower than in the adult alcoholics($12.9{\pm}4.3$)(p<0.005), and the mean score was $4.5{\pm}2.8$ in normal adult controls. 4) The items which showed statistically significant differences between aged alcoholics and normal aged controls could be found in 10 items of the MAST-K(items 2, 3, 4, 5, 11, 14, 17, 21, 22 and 23), 2 items of the Brief MAST(items 2 and 9), and 7 items of the MAST-KG(items 6, 13, 18, 19, 22, 23 and 24)(p<0.01). Conclusions : The scores of the MAST-K, the Brief MAST and the MAST-KG were significantly lower in the aged alcoholics than those in the adult alcoholics (p<0.05). The statistically significant differences between aged alcoholics and normal aged controls could be found in 10 items of the MAST-K, 2 items of the Brief MAST and 7 items of the MAST-KG. Therefore, a briefer rating scales around 10 items are needed to screen alcohol dependence among Korean elderly people.

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우리나라 정신장애인 직업재활 현황 조사연구 (Current State of Vocational Rehabilitation Program for Individuals with Disabling Mental Illness in Korea)

  • 한명훈;김지웅;김도윤;박혜선;박한선;황태연;서용진;김승준;임우영;이상민
    • 정신신체의학
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    • 제25권2호
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    • pp.145-152
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    • 2017
  • 연구목적 정신장애인의 관리에서 있어서 탈원화와 공중보건 기반의 치료가 오랫동안 지속되어왔다. 본 연구는 국내 정신장애인 직업재활의 실태와 현황 및 효과성에 대해 확인하고자 하였다. 방 법 정신질환자에게 직업재활 프로그램을 운영하는 기관과 수를 파악하기 위하여 전화 및 전자 메일을 통하여 기본 조사를 시행하였다. 직업재활 프로그램을 운영하고 있는 시행 중에 있는 국내 108개 기관에 설문 양식을 배포하였다. 전체 응답률은 40.74% 였다. 결 과 각 기관의 직업재활 담당은 주로 정신보건사회복지사(47.8%)였으며, 조사 대상기관 중 100만원 미만 예산이 대부분(61.5%)이었다. 가장 보편적으로 운영하고 있는 직업재활 프로그램은 사례 관리 서비스(23.1%)였고, 그 다음은 정신사회 재활 프로그램(21.2%), 작업 훈련(17.9%) 이었다. 가장 효과가 좋다고 생각되는 프로그램은 사례관리 서비스(27.4%)였으며, 정신사회 재활 프로그램(19.8%), 작업훈련(17.9%) 순이었다. 직업 재활에 대한 주요 장애물로 조사된내용은 '국민 기초 생활 보장법 수혜 대상에서 제외되는 것에 대한 우려'였다. 결 론 본 연구 조사의 결과 직업재활프로그램이 필요하나 정부와 기관의 기본적인 지원이 여전히 부족한 것으로 나타났다.

소아에서 human metapneumovirus 감염증의 임상적 고찰 (Clinical Manifestation of Human Metapneumovirus Infection in Korean Children)

  • 백현;이양진;조형민;유은정;정권;김은영;김용욱;김경심;서진종;정윤석
    • Pediatric Infection and Vaccine
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    • 제15권2호
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    • pp.129-137
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    • 2008
  • 목 적 : hMPV는 네델란드에서의 첫 보고 이후 전 세계적으로 발견되며, 호흡기 감염의 주요한 원인 바이러스 중의 하나로 보고되고 있지만 우리나라에서의 보고는 드문 실정이다. 이에 저자들은 우리나라에서 hMPV가 유행하는지 확인하고, 소아에서의 임상 양상에 대해 알아보고자 하였다. 방 법 : 2005년 1월부터 2005년 12월까지 광주기독병원 소아과에 급성 호흡기 증상으로 입원한 환아 1,098명의 인후 도찰물을 채취하여 RT-PCR을 시행 후 hMPV가 검출된 25명의 환아들의 임상 기록지를 후향적으로 검토하여 이들의 임상 증상 및 검사 소견을 조사하였다. 결 과 : 1,098명 중 25명에서 hMPV가 검출되어 검출률은 2.2%이었다. 평균 연령은 2세 3개월(1개월-6세)이었고, 4월에서 6월에 집중적으로 검출되었다. 진단명은 폐렴(60%), 모세기관지염(20%) 순이었고 임상 증상은 기침이 25명(100%), 발열 20명(80%), 콧물 20명(80%) 순이었다. 신체 검진 상 나음이 13명, 천명이 10명에서 청진되었고 인후 발적이 8명, 고막 발적이 2명이었고 흉부 방사선 소견은 폐문 주위 간질 침윤이 10명, 폐 경화가 6명이었다. 4명(16%)에서 천식의 악화 소견을 보였고 hMPV와의 중복 감염은 마이코플라즈마 감염 3명, 보카바이러스 2명, 엔테로바이러스 1명이었다. 결 론 : hMPV는 입원이 요구되는 하부 호흡기 질환의 원인이 되며 2세 미만에서 호발하고 초봄과 여름까지 유행하며 주로 폐렴을 일으키는 바이러스로 천식의 악화와 관련이 있었다. 향후 hMPV 감염증의 진단과 치료 및 예방 대책을 수립하기 위해서는 보다 정확한 임상적, 역학적 조사 등의 연구가 필요할 것으로 사료된다.

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폐결핵 재치료 환자에서 Prothionamide, Cycloserine, Paraminosalicylic acid, Ofloxasine을 이용한 경구 4제 요법의 임상 효과 (Clinical Effects of Prothinoamide, Cycloserine, Para-Aminosalicylic Acid, Ofloxasine in Retreatment of Pulmonary Tuberculosis)

  • 홍재락;유민규;정재만;김영준;손말현
    • Tuberculosis and Respiratory Diseases
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    • 제43권5호
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    • pp.693-700
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    • 1996
  • 연구배경: 1980년대 들어서 폐결핵의 치료는 INH, RFP, EMB(또는 SM)의 6개월 표준 단기 요법이 정착되었고 치료 성적 또한 괄목한 만한 향상을 보여왔으나 초치료 실패 및 재치료 실패 환자에서는 약제 내성 및 약제 부작용으로 인한 치료 중단이 큰 문제가 되었다. 1980년대 개발된 Quinolone 계통의 항생제인 OFX은 감영성 호흡기 질환 치료제로서의 역할을 할 뿐만 아니라, 최근에는 결핵 치료제로 사용되고 있다. 이에 따라 저자들은 PTA, CS, PAS, OFX을 사용하여 폐결핵 환자들의 재치료 또는 재재치료의 임상효과를 알아보았다. 방법: 1993년 3월부터 1995년 8월까지 국립 공주 결핵병원에 입원하였던 객담내 결핵균 양성 환자중 초치료및 재치료에 실패한 환자로 추척이 가능한 66명을 대상으로하여 후향적 조사를 하였다. 결과: 1) 객담내 균음전 객담 도말 양성 환자 66명 중 42 명(64%)이 15개월내에 객담내 균음전되었다. 2) 흉부 X-선상의 호전은 경증에서는 3명(75%), 중등중에서는 23명(64%), 중증은 12명(46%)이었고, 전체적으로는 38명(58%)에서 호전되었다. 4) 질병 기간에 따른 균 음전율은 각100%(병력이 1년미만), 88%(1-3년), 80%(3-5년) 그리고 52%(5년이상)이었다. 5) 부작용 PTA의 부작용은 위장판 장애(소화불량, 구역, 구토, 복통등)와 경한 간기능 장애를 보여주었고, CS은 정신상태 이상(주로 불면과 감정장애)이 8명(12%)에서 있었으며, 경련은 없었다. PAS에 의한 위장 장애는 오심, 구토, 복부 불쾌감과 같은 위장장애가 대부분으로 41명(62%)에서 관찰되었다(Table 5). 결론: 폐결핵 치료 역시 다른 모든 질환과 마찬가지로 환자의 병력이 젊을수록, 흉부 X-선상의 병변이 적을수록 좋은 성적을 보였으며, 38명(58%)의 경우에는 X-선상의 호전을 보였으나 일부에서는 매우 제한적이고 더 이상의 호전을 기대하기가 어려울 것으로 생각되는 예도 있었다. 부작용으로는 위장장애(소화장애, 오심, 구토, 변비, 설사)가 주가 되었으며, 위장장애는 대부분의 경우에서는 규칙적인 증상 치료로 많은 호전을 가져 왔다. 또한 무엇보다도 전문가에 의한 적절한 치료약제의 결정과 지속적인 항결핵제 복용을 위한 정기적인 의사와의 면담 및 추후검사가 필요할 것으로 생각된다.

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고령자의 건강의식과 물리치료 인식에 관한 연구 (A Study of Health Consciousness and Physical Therapy Cognition of Old Ages)

  • 박환진;박래준;김한수
    • The Journal of Korean Physical Therapy
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    • 제12권2호
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    • pp.175-184
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    • 2000
  • This study which applies to the 403 healthy people who don't have particular diseases recently(193 urban aged. 210 rural aged) among male and female aged over 60 years old living in Daegu(city) and Gyungbook(agricultural village) is fulfilled from November 1st to December 31st by interview using the questioned paper which researcher developed, and reached to these tallowing conclusions. 1. Every aged men independent of the place residence answered positively yes but aged women had weak assurance of their health. Especially $38.6\%$ of rural aged women said yes and $51.4\%$ of rural aged women said no. 2. In the sleep and well-regulated life, urban and rural aged generally marked on the sound sleep. Compared with male and female, men answered they had better sleep and regulated life than women. 3. The percentage of the urban and rural aged's judgement on their activity was high and the percentage of the rural aged was lower than the percentage of the urban aged. 4. While $62.6\%$ of urban aged answered they were active. $38.6\%$ of rural female aged answered yes, This shows that the rural female aged regard their health is not good. 5. Compared with same generation. urban aged ranked lower than urban aged in the confidence of physical strength. Especially rural need women answered $42.1\%$ of them were weaker than the same generation. This shows that rural aged women don't have confidence in general physical activities. 6. Taking exercises three times a week which can influence on health cue to sixties and seventies aged ranked $26.1\%$, rarely do is $18.8\%$ and never do is$28.8\%$. Urban and rural aged do not exercise on the purpose of health. 7. The reason of exercise was to advance the physical strength and quality of motion$(34.9\%)$ to get rid of stress$(13.4\%)$ and to prevention of adult illness$(27.8\%)$, prevention of fatness$(15.3\%)$. Aged have a correct understanding that exercise can promote health and protect from the diseases of adult people because the items about the diseases of adult people was marked high. 8. Among the subject of total investigation, 209 persons answered. It showed necessary to recognize that the exercise is still important essential part between adult illness and health care. 9. The $67.7\%$ of urban aged men answered yes in the question of undergoing a physical examination but the rate of not undergoing a physical examination was high in rural aged and urban aged women. According to this, there were the difference of consciousness about health between urban and rural aged. and men and women. 10. Among the people who haying undergone the physical examination, $80.3\%$ of the aged went back to the hospital again because of the result. 11. In the case of stroke, most aged answered the would be placed under medical care. but $53.9\%$ of rural aged women answered they would rely on Chinese medicine. According to this. aged preferred Chinese medicine in some particular diseases. 2. The $58.1\%$ of whole object of this study answered that stroke would be recovered.

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남자 정신분열병 환자에서 성기능장애에 대한 검토 (Review of Sexual Dysfunction in Male Schizophrenics)

  • 최영태;전진숙;오병훈
    • 생물정신의학
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    • 제7권1호
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    • pp.85-98
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    • 2000
  • 1) 성기능장애 빈도는 정신분열병 환자군이 80%로 대조군 42%에 비해 유의하게 높았다(p<0.001). 성반응 주기에 따른 장애유형은 성적욕망장애 76%, 발기장애 75%, 발기유지장애 75%, 성적극치감의 질적감소 61%, 지루 50%, 사정시 정액량의 감소 44% 순서로 많았다. 성적극치감 횟수의 감소는 32%로 다른 장애유형에 비해 적었으며, 조루를 호소하는 경우도 15%나 되었다. 2) PRL 및 5-HT 측정치는 환자군에서 $28.5{\pm}20.6ng/ml$, $298.5{\pm}89.1ng/ml$으로서 대조군 $10{\pm}5.6ng/ml$, $169.2{\pm}37.8ng/ml$보다 유의하게 높았다(p<0.001). TST 측정치는 환자군이 $4.3{\pm}1.5ng/ml$, 대조군이 $4.5{\pm}1.2ng/ml$로 양군 모두 유의한 차이가 없었다. 3) 성기능장애를 증가시키는 변인은 결혼(미혼), 초발연령, 이병기간, 입원기간, 총약물투여기간 그리고 5-HT 측정치이었다. 특히 5-HT 비정상치군이 정상치군보다 성기능장애가 유의하게 높았다. 그러나 연령, 교육연한, 종교, 경제상태, PRL 및 TST 측정치, 항정신병약물용량, 약물역가, benztropine, ACSE, CGI, BPRS, PANSS, PANSS-CF, MMSE-K 점수와 성기능장애와는 무관하였다. 성기능장애는 정신분열병군에서 높았고, 성기능장애 유형별로는 성적욕망장애와 발기장애가 많았다. 미혼이거나, 초발연령이 높을수록, 질병에 이환된 기간이 길수록, 5-HT 농도가 높을수록 성기능장애가 증가하였다. 비록 혈중 5-HT 농도가 뇌 5-HT 활성을 어느정도 반영하는지는 알 수 없으나, 정신분열병 환자의 일차 병인인 과도한 5-HT 활성으로 인한 직접적인 성기능 억제효과 때문에 장애가 초래한다고 생각된다.

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도교의학(道敎醫學)에 관한 연구(硏究) (한의학(韓醫學)과 연관(聯關)된 부분(部分)을 중심(中心)으로) (The study of the relation between the medicine of Taoism and oriental medicine)

  • 이병서;윤창열
    • 대한한의학원전학회지
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    • 제6권
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    • pp.252-305
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    • 1993
  • I have studied the relation between a Taoist(道家) and the oriental medicine(韓醫學), it is summerized as following. 1. According to the relation between a Taoist(道家) and the oriental medicine, Lao-tzu(老子)' mathematical principle that had an influence on Three yin-three yang(三陰三陽) theory of the oriental medicine, idea of natural philosopy(自然無爲) and the freedom from avarace(無慾) on the oriental medicine. 2. Vital essence and energy theory(精氣設) in a Taoist not only can be seen in Lao-tzu' Do dug gyung(老子道德經), Maengza(孟子), Guanza(管子), but also its principle has something to do with Nei Ching's Vital essence and energy theory(精氣設). 3. Danjungpa(丹鼎派) can be divided into Naedansul(內丹術) which preserves through the breath and Oedansul(外丹術) which makes one a Taoist hermit. If he takes magic portions(金丹), they had a great effect on Yangsanghak(養生學) and was actually concerned with oriental doctors who was known to us. 4. If medicine of Taoism is classified, it can be divided into three categories. Boiled solution(渴液), Pharmacopea "Ben cao"(本草), Acupuncture & moxibustion(針灸), Magic portions(外丹) are used in the first category. Chinese setting-up and Therapeutic exercises(導引), Josik(調息), Naedan(內丹), Byugok(辟榖), Naeshi(內視), Banjung(房中) belong to second category. The religious contents such as Bu(符), Jeum(占), Cheum(籤), Ju(呪), Je(齊), Gido(祈禱), taboo are implied in third category. 5. In the history of the medicine of Taoism and oriental medicine, they are called animism, shamanism, Mu(巫) or Ye(毉), not separated at first period. In the end of junguk(戰國時代), Ye(醫) was clearly distinguished from Mu(巫) and then Mu(巫) was developed into medicine of Taoism and ye(毉) into the present form of oriental medicine. 6. The oriental medicine doctors that are concerned with Taoism are Bakgo(伯高), Geyugu(鬼臾區), Soyu(少兪), Noigong(雷公), Pyujak(篇鵲), Sunuyi(淳于意), Hwata(華陀), Hwangbomil(皇甫謐), Hangang(韓康), Dongbong(童奉), Heuson(許遜), Galhong(葛洪), Dohongyung(陶弘景), Damlan(曇鸞), uyjajang(葦慈藏), Sonsanak(孫思邈), Wanguing(王氷), Jegonghwalbul(濟公活佛), Yuwanso(劉完素), Judonge(朱丹溪), Leesijin(李時珍), Johakmin(趙學敏), Ougu1(吳杰) etc. 7. The view of a human body in the medicine of Taoism affected the oriental medicine on the ground that man was regarded as a microcosm(小宇宙), so he was compared to a nation or heaven and earth. 8. The anatomy of medicine of Taoism gave a detail description of five visceras and each organs, the heart, center of mental function, Mirie(尾閭) which has an relationship to the training of Naedan(內丹修練). In this resrect, as it is accord with the acupunture point of oriental medicine, therefore we can find that Taoism influenced oriental medicine, also explicit study was achieved. 9. Acient people believed that the goo in the human lxxIy, one of the characteristics of the medicine of Taoism cured the patients and then protected him from the disease. If a man was taken ill, they had him cured by making the god's name which corresponded to its disease, calling him communicating with him, and asking him to deprive him of illness. This treatment was used to live and be kept young eternally. In this respects, we can see that they emphasized on the attitude of Bulchiyibeung chimibeung(不治己病治末病) and psychological treatment. 10. Samsi thoery(三尸說) that one's fortune, disaster, health, and disease in the world are at the mercy of his good or bad conduct, is concerned with Taoism and treatment with the oriental medicine. 11. Guchung(九蟲) is more closly associated with the religious aspect rather than with the medical aspect. Because of the similarity of the mcdern parasitism, its study has an important meaning. 12. The respect for the human life is reflected in jeunsi(傳屍), with Samsi-guchung theory(三尸九蟲說), which is considered as mxIern tuberculosis.

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Variation of Hospital Costs and Product Heterogeneity

  • Shin, Young-Soo
    • Journal of Preventive Medicine and Public Health
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    • 제11권1호
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    • pp.123-127
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    • 1978
  • The major objective of this research is to identify those hospital characteristics that best explain cost variation among hospitals and to formulate linear models that can predict hospital costs. Specific emphasis is placed on hospital output, that is, the identification of diagnosis related patient groups (DRGs) which are medically meaningful and demonstrate similar patterns of hospital resource consumption. A casemix index is developed based on the DRGs identified. Considering the common problems encountered in previous hospital cost research, the following study requirements are estab-lished for fulfilling the objectives of this research: 1. Selection of hospitals that exercise similar medical and fiscal practices. 2. Identification of an appropriate data collection mechanism in which demographic and medical characteristics of individual patients as well as accurate and comparable cost information can be derived. 3. Development of a patient classification system in which all the patients treated in hospitals are able to be split into mutually exclusive categories with consistent and stable patterns of resource consumption. 4. Development of a cost finding mechanism through which patient groups' costs can be made comparable across hospitals. A data set of Medicare patients prepared by the Social Security Administration was selected for the study analysis. The data set contained 27,229 record abstracts of Medicare patients discharged from all but one short-term general hospital in Connecticut during the period from January 1, 1971, to December 31, 1972. Each record abstract contained demographic and diagnostic information, as well as charges for specific medical services received. The 'AUT-OGRP System' was used to generate 198 DRGs in which the entire range of Medicare patients were split into mutually exclusive categories, each of which shows a consistent and stable pattern of resource consumption. The 'Departmental Method' was used to generate cost information for the groups of Medicare patients that would be comparable across hospitals. To fulfill the study objectives, an extensive analysis was conducted in the following areas: 1. Analysis of DRGs: in which the level of resource use of each DRG was determined, the length of stay or death rate of each DRG in relation to resource use was characterized, and underlying patterns of the relationships among DRG costs were explained. 2. Exploration of resource use profiles of hospitals; in which the magnitude of differences in the resource uses or death rates incurred in the treatment of Medicare patients among the study hospitals was explored. 3. Casemix analysis; in which four types of casemix-related indices were generated, and the significance of these indices in the explanation of hospital costs was examined. 4. Formulation of linear models to predict hospital costs of Medicare patients; in which nine independent variables (i. e., casemix index, hospital size, complexity of service, teaching activity, location, casemix-adjusted death. rate index, occupancy rate, and casemix-adjusted length of stay index) were used for determining factors in hospital costs. Results from the study analysis indicated that: 1. The system of 198 DRGs for Medicare patient classification was demonstrated not only as a strong tool for determining the pattern of hospital resource utilization of Medicare patients, but also for categorizing patients by their severity of illness. 2. The wei틴fed mean total case cost (TOTC) of the study hospitals for Medicare patients during the study years was $11,27.02 with a standard deviation of $117.20. The hospital with the highest average TOTC ($1538.15) was 2.08 times more expensive than the hospital with the lowest average TOTC ($743.45). The weighted mean per diem total cost (DTOC) of the study hospitals for Medicare patients during the sutdy years was $107.98 with a standard deviation of $15.18. The hospital with the highest average DTOC ($147.23) was 1.87 times more expensive than the hospital with the lowest average DTOC ($78.49). 3. The linear models for each of the six types of hospital costs were formulated using the casemix index and the eight other hospital variables as the determinants. These models explained variance to the extent of 68.7 percent of total case cost (TOTC), 63.5 percent of room and board cost (RMC), 66.2 percent of total ancillary service cost (TANC), 66.3 percent of per diem total cost (DTOC), 56.9 percent of per diem room and board cost (DRMC), and 65.5 percent of per diem ancillary service cost (DTANC). The casemix index alone explained approximately one half of interhospital cost variation: 59.1 percent for TOTC and 44.3 percent for DTOC. Thsee results demonstrate that the casemix index is the most importand determinant of interhospital cost variation Future research and policy implications in regard to the results of this study is envisioned in the following three areas: 1. Utilization of casemix related indices in the Medicare data systems. 2. Refinement of data for hospital cost evaluation. 3. Development of a system for reimbursement and cost control in hospitals.

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노인의 거주 형태에 따른 일상생활동작(ADL) 및 도구적 일상 생활 동작(IADL)의 수행능력 비교 (A comparative study of ADL and IADL of residential home and home for the aged dwelling elderly)

  • 박찬의;장정훈;이재형
    • The Journal of Korean Physical Therapy
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    • 제18권4호
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    • pp.61-70
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    • 2006
  • 연구목적: 본 연구는 가정 거주노인과 시설 거주 노인의 일상생활동작(ADL)과 도구적 일상생활동작(IADL)을 비교 분석하여 노인 돌봄에 관여하는 의료 종사자, 특히 물리치료사와 작업치료사의 업무에 도움을 주고자 시행하였다. 방법: 일상생활동작 및 도구적 일상생활동작의 검진은 한국형 일상생활동작 평가서와 도구적 일상생활동작 평가서를 사용하여 거주 형태가 다른 두 노인 집단의 평가 결과를 분석하였다. 결과: 노인들의 일상생활동작과 도구적 일상생활동작의 수행 능력은 부부 동거, 자녀 수, 수입, 현재 앓고 있는 질병 및 나이에 의해 영향을 받고 있는 것으로 나타났다. 또한 일상생활동작 중에는 한 가지 동작이 도구적 일상생활동작은 한 가지 동작을 제외한 모든 동작에서 수행 능력의 차이를 보이고 있다. 부부가 함께 동거하는 노인이 홀로 사는 노인에 비해 전반적으로 일상생활 활동이 원활한 것으로 나타났다. 결론: 한국형 일상생활동작 평가서와 도구적 일상생활동작 평가서가 한국 노인의 일상생활 활동을 평가하는데 보다 사용하기 좋았다. 노인을 돌보는 의료 종사자 특히 물리치료사 및 작업치료사는 노인의 일상생활 활동을 증진시키기 위해 훈련을 시행한다면 일상생활동작 훈련에서는 목욕하기에 중점을 두고 도구적 일상생활동작의 훈련에서는 거의 모든 동작을 훈련 시켜야 할 것을 조언한다.

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