• Journal of Korean Neurosurgical Society
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• 제65권2호
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• pp.269-275
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• 2022

Objective : The coronavirus disease 2019 (COVID-19) pandemic is affecting the characteristics of patients with head injuries. This study aimed to evaluate the effect of the COVID-19 pandemic on patients with head injuries at a regional emergency medical center in South Korea. Methods : From April 2019 to November 2020, 350 patients with head injuries were admitted to our hospital. The study period was divided into the pre-COVID-19 (n=169) and COVID-19 (n=181) eras (10 months each). Patients with severe head injuries requiring surgery (n=74) were categorized into those who underwent surgery (n=41) and those who refused surgery (n=33). Results : Head injuries in pediatric patients (<3 years) were more frequent in the COVID-19 era than in the pre-COVID-19 era (8.8% vs. 3.6%, p=0.048). More patients refused surgery in the COVID-19 era than in the pre-COVID-19 era (57.9% vs. 30.6%, p=0.021). Refusal of surgery was associated with old age (67.7±14.5 vs. 52.4±19.1, p<0.001), marital status (married, 84.8% vs. 61.0%, p=0.037), unemployment (42.4% vs. 68.3%, p=0.034), COVID-19 era (66.7% vs. 39.0%, p=0.021), and lower Glasgow coma scale scores (6.12±3.08 vs. 10.6±3.80, p<0.001). Multivariable logistic regression analysis revealed that refusal of surgery was independently associated with old age (adjusted odds ratio [OR], 1.084; 95% confidence interval [CI], 1.030-1.140; p=0.002), COVID-19 era (adjusted OR, 6.869; 95% CI, 1.624-29.054; p=0.009), and lower Glasgow coma scale scores (adjusted OR, 0.694; 95% CI, 0.568-0.848; p<0.001). Conclusion : We observed an increased prevalence of head injuries in pediatric patients (<3 years) during the COVID-19 pandemic. Additionally, among patients with severe head injuries requiring surgery, more patients refused to undergo surgery during the COVID-19 pandemic.

• Journal of Korean Neurosurgical Society
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• 제67권1호
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• pp.73-83
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• 2024

Objective : The Act on Life-Sustaining Treatment (LST) decisions for end-of-life patients has been effective since February 2018. An increasing number of patients and their families want to withhold or withdraw from LST when medical futility is expected. This study aimed to investigate the status of the Act on LST decisions for patients with acute cerebrovascular disease at a single hospital. Methods : Between January 2017 and December 2021, 227 patients with acute cerebrovascular diseases, including hemorrhagic stroke (n=184) and ischemic stroke (n=43), died at the hospital. The study period was divided into the periods before and after the Act. Results : The duration of hospitalization decreased after the Act was implemented compared to before (15.9±16.1 vs. 11.2±18.6 days, p=0.127). The rate of obtaining consent for the LST plan tended to increase after the Act (139/183 [76.0%] vs. 27/44 [61.4%], p=0.077). Notably, none of the patients made an LST decision independently. Ventilator withdrawal was more frequently performed after the Act than before (52/183 [28.4%] vs. 0/44 [0%], p<0.001). Conversely, the rate of organ donation decreased after the Act was implemented (5/183 [2.7%] vs. 6/44 [13.6%], p=0.008). Refusal to undergo surgery was more common after the Act was implemented than before (87/149 [58.4%] vs. 15/41 [36.6%], p=0.021) among the 190 patients who required surgery. Conclusion : After the Act on LST decisions was implemented, the rate of LST withdrawal increased in patients with acute cerebrovascular disease. However, the decision to withdraw LST was made by the patient's family rather than the patient themselves. After the execution of the Act, we also observed an increased rate of refusal to undergo surgery and a decreased rate of organ donation. The Act on LST decisions may reduce unnecessary treatments that prolong end-of-life processes without a curative effect. However, the widespread application of this law may also reduce beneficial treatments and contribute to a decline in organ donation.

• 동서간호학연구지
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• 제20권2호
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• pp.93-102
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• 2014

Purpose: This study aimed to investigate the characteristics of patients attempting suicide and to analyze treatment determination factors for patients with mental illness who go to an emergency center for treatment. Methods: Data collected from 117 suicide attempters who visited Busan Regional Emergency Medical Center were analyzed using frequency, percentage, ${\chi}^2$-test with SPSS/WIN 15.0. Results: Only 31 cases consulted with the psychiatric department; the other attempters' refused to consult (26.5%). Among the 31 attempters who consulted, 23 cases (74.2%) were suffering from depression. The most common reason (38.6%) suicidal attempters gave to refuse psychiatric treatment was "I'm not mad. I don't need the psychiatric treatment". Treatment determination factors for mental illness were religion (p<.001), past history (p=.017), financial satisfaction (p=.048), previous history of suicidal attempts (p=.006), sleep disturbance (p<.001), expression of suicide (p=.010), and type of leaving the emergency room (p=.020, p<.001). Conclusion: Results suggest that people frequently misunderstand psychiatric treatment which leads to their refusal to accept psychiatric treatment. Therefore hospitals need to develop standard guidelines and procedures for suicidal attempters with the collaboration of emergency and psychiatry departments. In addition, medical teams need to provide attempters appropriate information and encourage them to actively seek psychiatric treatment.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제33권1호
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• pp.2-15
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• 2022

Objectives: Children with attention-deficit/hyperactivity disorder (ADHD) tend to be noisy and violate rules with their disruptive behaviors, resulting in greater difficulties with off-task behaviors and being at risk for social refusal. The visual activity schedule (VAS) intervention program is a frequently used method to teach multiple skills involving on-task, use of schedules, transition behaviors, social initiation, independent play skills, classroom skills, and academic skills. The current systematic review aimed to examine the efficacy of using VAS intervention in reducing problem behaviors in children with ADHD between 5 and 12 years of age. Methods: Systematic searches were conducted using two electronic databases (PubMed and Scopus) to identify relevant studies published in English between 2010 and 2020. Four studies met the inclusion criteria: two studies examined the effect of schedule-based tasks and the use of an iPad on classroom skills, while the other two examined randomized clinical trials (RCTs) of psychosocial treatment for ADHD inattentive type and a cross-sectional study examined the impact of the group size on task behavior and work productivity in children with ADHD. Results: The findings indicate that the interventions used in all four studies could lead to increased satisfaction among participants and parents, as well as a reduction in problem behavior. In terms of the research indicators, the RCT had low quality, while the others were of high quality. Conclusion: A larger number of studies and the ADHD clinical population would help to increase the generalizability of future reviews of treatments in this context.

• Journal of Animal Science and Technology
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• 제63권6호
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• pp.1453-1463
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• 2021

Feeding is the most important behavior that represents the health and welfare of weanling pigs. The early detection of feed refusal is crucial for the control of disease in the initial stages and the detection of empty feeders for adding feed in a timely manner. This paper proposes a real-time technique for the detection and recognition of small pigs using a deep-leaning-based method. The proposed model focuses on detecting pigs on a feeder in a feeding position. Conventional methods detect pigs and then classify them into different behavior gestures. In contrast, in the proposed method, these two tasks are combined into a single process to detect only feeding behavior to increase the speed of detection. Considering the significant differences between pig behaviors at different sizes, adaptive adjustments are introduced into a you-only-look-once (YOLO) model, including an angle optimization strategy between the head and body for detecting a head in a feeder. According to experimental results, this method can detect the feeding behavior of pigs and screen non-feeding positions with 95.66%, 94.22%, and 96.56% average precision (AP) at an intersection over union (IoU) threshold of 0.5 for YOLOv3, YOLOv4, and an additional layer and with the proposed activation function, respectively. Drinking behavior was detected with 86.86%, 89.16%, and 86.41% AP at a 0.5 IoU threshold for YOLOv3, YOLOv4, and the proposed activation function, respectively. In terms of detection and classification, the results of our study demonstrate that the proposed method yields higher precision and recall compared to conventional methods.

• Clinical and Experimental Vaccine Research
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• 제12권3호
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• pp.209-215
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• 2023

Purpose: The delay in acceptance or refusal to get vaccinated despite the availability of services is called vaccine hesitancy. The Global Polio Eradication Initiative in Pakistan faced consistent barriers preventing the eradication of the disease in the country. Similarly with the advent of the coronavirus disease 2019 (COVID-19) pandemic mass vaccination drives were initiated to a vaccine hesitant population. The aim of this study is to explore the prevalence and reasons for COVID-19 vaccine hesitancy in the Pakistani population. Materials and Methods: Cross-sectional study conducted during July to September 2021 using a snowball sampling technique targeting the adult population of Pakistan. The modified version of the vaccine hesitancy questionnaire related to the Strategic Advisory Group of Experts on Immunization Vaccine Hesitancy matrix was distributed online. Results: Out of 973 participants, 52.4% were immediately willing to take the vaccine and constituted the acceptance group whereas the remaining 47.6% who were still not sure formed the hesitant group. Support from leaders was found to be statistically significant for the difference between the hesitant and acceptance groups (p-value=0.027). Hesitant people were concerned about the effectiveness of the vaccine (60.9%) and potential side effects (57.9%) as it was not sufficiently tested prior to launch (44.7%). Age and education were significant factors affecting the acceptance of vaccination. The most trusted source of information regarding vaccination was health care workers (43.8%). Conclusion: A moderately high prevalence of vaccine hesitancy was reported in Pakistan. To overcome it, policymakers need to address the reasons for it. Leaders, celebrities, and healthcare workers can play an instrumental role in dispelling conspiracy theories regarding vaccines and making the vaccination drive a success.

• 한국응급구조학회지
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• 제15권2호
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• pp.85-99
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• 2011

Purpose: The purpose of this study is to examine the EMT student's attitude to the disabled and provide the basic materials of educational program to make them have right awareness and attitude of the disabled. Methods: The subjects of this study were 348 of 339 emergency medical students at three departments of emergency medical in G metropolitan city who gave consent to take part in the research and the data were collected for 10 days from Mar. 2 to 11, 2011. It used DFS (Disability Factor Scale) developed by Siller (1967) and revised and complemented by Lee Jong Nam (1997) after validity and reliability test. Data collected were analyzed with technical statistics, t-test and ANOVA using SPSS/ PC 12.0 Results: The results of this study are summarized as follows. 1. On the question that there are the disabled around the subjects, 74.7% of the respondents answered 'none', and on the question of having concerns on the disabled problems, 61.5% of the respondents answered 'they have no concerns on them'. In addition, on the question of effective methods for improving a negative awareness of the disabled, many of subjects responded the governmental support must be a priority. 2. The subjects' attitude to the disabled scored average 3.13 and they have positive attitude to the disabled. In six sub-areas of attitude to the disabled, tension in contact with the disabled scored 2.90, inferred emotional disorder 2.79, unconditional repulsion 2.78, refusal to friendly relation 2.74, limitation of other functions undamaged 2.66 and distorted identification 2.65. 3. Variable showing a significant difference in the results of analysis according to general characteristics of subjects was age and those who are over '21' showed more positive attitude to the disabled than those who are below '20'. 4. In the results of analysis according to the subjects' disability related characteristics, those who have the disabled in their friends or family and have concerns on the disabled problems have a positive attitude to the disabled. Promotion and education through mass communication for changing the awareness of the disabled into a positive attitude will be most effective. Conclusion: Consequently, positive attitude of EMT student's to the disabled can be fostered by continuous contact with the disabled and their participation in voluntary services in the dimension of individual or school will be important and also the various practical methods such as enlightenment movement and supply of right information through mass communication should be sought.

• 의료법학
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• 제23권3호
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• pp.3-44
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• 2022

2020. 2.경 대한민국에서 코로나19 감염증의 대유행이 시작될 당시 문제가 되었던 대구 지역 A종교단체의 역학조사 방해 사건을 중심으로 면밀히 검토한 결과, 역학조사관이 특정 단체에게 명단 제출을 요구하였을 때, 이에 불응하거나 편집된 누락 명단을 제출한 행위에 대하여 역학조사에 해당하지 아니한다는 취지로 선고된 사례가 있는 반면, B열방센터 행사 출입자명단 미제출 사건의 경우 '출입자 명단' 등을 요구받았음에도 정당한 이유 없이 거부한 사실에 대하여 '출입자 명단의 제공은 역학조사에 수반되는 역학조사 간의 연결 과정을 형성하는 핵심적 사실행위로, 이를 거부하는 것도 역학조사 거부, 방해행위에 해당'하므로 적법하게 명단을 요구할 수 있어 처벌이 가능하다는 사례도 있다. 교인명단 제출요구가 역학조사에 해당하는지 여부와 관계없이 교인명단 제출 거부 또는 누락 행위가 곧 역학조사 거부·방해행위에 해당하는 경우도 있는데, 역학조사와 직접 관련성, 역학조사를 위한 것임이 외부적으로 표시되어 인식되었는지 여부, 명단의 역학조사 외의 목적으로 전용될 가능성 등을 종합적으로 고려하여 역학조사에 수반되는 사실행위를 방해함으로써 결과적으로 역학조사가 거부 내지 방해되는 결과가 발생한 경우에는 역학조사 방해가 된다는 하급심 판결의 논리가 설득력이 있다. 역학조사 결과 확인된 각 감염병환자등이나 접촉자 등에 대해 설문조사나 인체검체 채취 및 시험과 같은 역학조사가 실시되지만, 개별적인 사람에 대해 실시되는 역학조사가 서로 독립하여 존재할 수 없으며 역학조사의 연결 과정을 확인하고 추적하는 과정이 역학조사에 필수적으로 수반되며 이러한 연결고리를 확인하는 과정을 누군가 고의로 방해하거나 거부하게 되면, 역학조사가 직접적이고 현실적으로, 광범위하게 방해되는 결과가 발생하기 때문이다. 이 글에서는 주로 ① 감염병예방법상 역학조사와 정보 제공 요청은 차이점이 있으나 정보 제공 요청의 경우에도 역학조사에 해당되는 영역이 있다는 점, ② 코로나19의 의학적 특성과 역학조사의 연속성을 감안하면 역학조사관의 명단요구 행위가 역학조사에 해당할 여지가 있다는 점, ③ 특정한 경우에는 역학조사 방해죄가 위계공무집행방해에 해당할 수 있다는 점, ④ 2020. 9. 29.부터 감염병예법상 정보제공요청을 거부하는 경우에 징역형 또는 벌금형의 처벌규정이 신설되어 운용되고 있다는 점 등을 지적하여, 향후 감염병예방법의 적용 및 역학조사 실무 운용에 있어 도움이 되고자 한다.

• Clinical and Experimental Pediatrics
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• 제52권7호
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• pp.778-784
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• 2009

목 적 : 대소변 훈련 시기와 기간 및 부작용과 이에 영향을 주는 인자 등을 살펴보고, 부모들에게 적절한 교육이 되는 자료를 살펴보고자 이 연구를 시작하였다. 방 법 : 2009년 1월부터 2009년 2월까지 전주예수병원과 전주, 익산, 군산지역 소아청소년과 의원에 방문하는, 만 2-6세 아기 1,370명의 부모를 대상으로 성별, 주거 지역, 가족 관계, 기저귀 종류, 훈련 시작 시기, 낮과 밤에 각각 대소변 가린 시기, 부작용, 엄마의 교육 정도, 맞벌이 여부, 경제 수준 등에 대해서 설문조사하였으며, 대소변 훈련 시작 시기와 기간, 완료 시기 및 영향을 주는 인자와 부작용을 분석하였다. 결 과 : 훈련 시작 시기와 완료 시기는 남녀 차이가 없었으며, 군 지역 거주, 위에 형제 자매가 있는 경우, 천기저귀를 사용하는 경우, 맞벌이, 경제 수준이 낮은 경우에 빨랐다. 낮에 대변 가리기, 낮 소변 가리기, 밤 소변 가리기 완료 시기는 각각 23.7개월, 24.8개월, 32.7개월이었으며, 훈련에 필요한 기간은 각각 4.8개월, 5.9개월, 14.0개월이었다. 훈련 완료 시기는 훈련을 18개월 이전에 시킨 경우에는 22.9개월로 18-24개월의 25.9개월, 25개월 이상의 31.0개월보다 일찍 훈련을 마칠 수는 있었으나, 기간은 18개월 이전에 시킨 경우가 8.4개월로 18-24개월의 5.6개월, 25개월 이상의 3.8개월보다 더 걸렸다. 부작용은 유분증, 변비, 거부 반응, 숨기 순이었으며, 18개월 이전에 훈련을 시킨 경우가 그 이후에 시킨 경우보다 유분증과 거부 반응이 많았다. 결 론 : 대소변 훈련 시기는 최소한 18개월 이후에 아기의 발달사항을 종합적으로 고려한 후에 하는 것이 좋을 것으로 판단되었으며 향후 우리나라의 적절한 권고가 만들어져야 할 것이다.

• 의료법학
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• 제18권2호
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• pp.3-46
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• 2017

의사의 설명의무는 의사가 환자에게 이미 시행한 의료행위, 시행 중인 의료행위 및 장래에 시행할 의료행위와 환자의 요양상 수칙에 관하여 적극적 체계적으로 진술함으로써 환자가 그 내용을 인식하게 할 법적 의무를 총칭한다. 이 의무는 환자의 알 권리에 대응하는 보고성 설명의무, 환자의 동의권 거절권에 대응하는 기여성 설명의무, 요양지도성 설명의무로 나뉜다. 설명의무를 분류하는 것은 각각의 기능과 법적 성질이 다르고, 법적 성질이 다름에 따라 그 위반 시의 효과, 특히 손해배상책임의 대상과 범위가 달라지기 때문이다. 이 주제에 관하여 우리나라에서는 지난 40년 가까운 기간 동안 많은 이론의 발전이 있었고, 그를 토대로 대법원 판결의 논리도 상당히 정치하게 전개되어 왔다. 그러나 여전히 학계와 실무계 일각에서는 용어와 개념의 혼동, 학설과 판례 논리에 대한 이해 부족을 목격하게 되고, 심지어 대법원 판결문 내의 전후 문맥에서 그리고 관련 있는 복수의 판례 사이에서 논리와 이론의 불일치를 발견하게 되는 것이 사실이다(이것은 합리적 근거와 설득력을 지닌 견해의 분립을 지적하는 것이 아니다). 위와 같은 견해와 문제의식을 기초로 해서, 의사가 부담하는 설명의무의 기능별 분류와 법적 성질 및 그 위반 시의 효과를 우리나라 학설과 판례를 중심으로 분석 정리한다.