• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제26권3호
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• pp.159-164
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• 2015

Objectives : The current study investigated the risk of smartphone addiction among children and adolescents with or without attention-deficit hyperactivity disorder (ADHD), risk of depression, anxiety, and self-esteem using the Smartphone Addiction Scale Proneness, Kovac's Children's Depression Inventory, State-Trait Anxiety Inventory, and Rosenberg Self-Esteem Scale, commonly used in clinical medicine. Methods : Ninety five students with ADHD who visited psychiatry outpatient clinics completed the questionnaire. At the same time, 592 middle and high school students living in a similar area regardless of ADHD diagnosis, completed the questionnaire as control subjects. Results : Overall, 40.0% of 95 ADHD and 12.8% of 592 control subjects were classified as the smartphone addiction proneness group, 26.3% of the ADHD subjects and 8.3% of the control group were classified as the depression group, and 32.6% of the ADHD subjects and 16.2% of the control group were classified as the anxiety group. Significant differences were observed between the two groups. Conclusion : The results of this study suggest that ADHD subjects are more prone to smartphone addiction, becoming depressed or anxious than those in the control group. From this study, we could suggest that students with ADHD are more easily affected by smartphone addiction than normal control subjects. In addition, we might understand how some psychiatric problems like depression, anxiety, and low self-esteem are related to ADHD and smartphone addiction.

• Asian Pacific Journal of Cancer Prevention
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• 제15권14호
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• pp.5721-5727
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• 2014

Objectives: To evaluate the performance of clustering methods used in the prognostic assessment of categorical clinical data for hepatocellular carcinoma (HCC) patients in China, and establish a predictable prognostic nomogram for clinical decisions. Materials and Methods: A total of 332 newly diagnosed HCC patients treated with hepatic resection during 2006-2009 were enrolled. Patients were regularly followed up at outpatient clinics. Clustering methods including the Average linkage, k-modes, fuzzy k-modes, PAM, CLARA, protocluster, and ROCK were compared by Monte Carlo simulation, and the optimal method was applied to investigate the clustering pattern of the indices including platelet count, platelet/lymphocyte ratio (PLR) and serum aspartate aminotransferase activity/platelet count ratio index (APRI). Then the clustering variable, age group, tumor size, number of tumor and vascular invasion were studied in a multivariable Cox regression model. A prognostic nomogram was constructed for clinical decisions. Results: The ROCK was best in both the overlapping and non-overlapping cases performed to assess the prognostic value of platelet-based indices. Patients with categorical platelet-based indices significantly split across two clusters, and those with high values, had a high risk of HCC recurrence (hazard ratio [HR] 1.42, 95% CI 1.09-1.86; p<0.01). Tumor size, number of tumor and blood vessel invasion were also associated with high risk of HCC recurrence (all p< 0.01). The nomogram well predicted HCC patient survival at 3 and 5 years. Conclusions: A cluster of platelet-based indices combined with other clinical covariates could be used for prognosis evaluation in HCC.

• 보건행정학회지
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• 제5권1호
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• Tuberculosis and Respiratory Diseases
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• 제71권1호
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• pp.30-36
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• 2011

Background: Pneumonia is commonly seen in outpatient clinics. it is widely known as the most common cause of death from infectious disease. Pneumonia has been diagnosed by its typical symptoms, chest X-ray and blood tests. However, both chest X-rays and blood tests have limitations in diagnosis. Thus primary care clinicians usually have been constrained due to a lack of adequate diagnostic tools. Vibration response imaging (VRI) is a newly emerging diagnostic modality, and its procedure is non-invasive, radiation-free, and easy to handle. This study was designed to evaluate the diagnostic usefulness of the VRI test among pneumonia patients and to consider its correlation with other conventional tests such as Chest X-ray, laboratory tests and clinical symptoms. Methods: VRI was performed in 46 patients diagnosed with pneumonia in Konkuk University Medical Center. VRI was assessed in a private and quiet room twice: before and after the treatment. Sensors for VRI were placed on a patient's back at regular intervals; they detected pulmonary vibration energy produced when respiration occurred and presented as specific images. Any modifications either in chest X-ray, C-reactive protein (CRP), white blood cell count (WBC) or body temperature were compared with changes in VRI image during a given time course. Results: VRI, chest X-ray and CRP scores were significantly improved after treatment. Correlation between VRI and other tests was not clearly indicated among all patients. But relatively severe pneumonia patients showed correlations between VRI and chest X-ray, as well as between VRI and CRP. Conclusion: This study demonstrates that VRI can be safely applied to patients with pneumonia.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제22권4호
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• pp.253-261
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• 2011

Objectives : This study aimed to investigate the efficacy and safety of Metadate CD (MCD) when given to Korean children and adolescents with attention-deficit hyperactivity disorder (ADHD). We also explored the effects of the drug on diverse neuro-cognitive functions. Methods : Ninety-one subjects with ADHD (mean age 8.6${\pm}$2.2 years) were recruited at 6 outpatient clinics in Seoul, Korea. We used the ADHD Rating Scale (ARS), Clinical Global Impression (CGI), and comprehensive attention test (CAT) to measure the drug's effects. Results : After 0.92${\pm}$0.32mg/kg/day of MCD were administered for 57.4${\pm}$7.6 days, there was a 48.5% reduction in the mean total ARS scores (p<.001). Fifty-seven subjects (64.8%) showed either much improved or very much improved outcomes on the CGI-Improvement scale. The CGI-Severity scale also decreased from an average of 4.7 to an average of 2.9 (p<.001). Errors and response time standard deviations of the CAT, sustained attention test-to-response tasks, the flanker test, and divided attention test scores decreased after treatment (p<.05). The forward memory span of the spatial working memory test scores increased (p<.05). Thirty-five patients (39.8%) experienced side effects, of which the most common were headache (14.8%), nausea (12.5%), and anorexia (9.1%). Conclusion : This open-label study suggests that MCD is effective and safe in improving the symptoms and neurocognitive functions of Korean children and adolescents with ADHD.

• Journal of Preventive Medicine and Public Health
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• 제26권3호
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• pp.457-468
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• 1993

본 연구는 1차 의료기관과 3차 진료기관의 검사 내용 및 이들 간의 중복검사율을 파악할 목적으로 대구직할시내 1개 3차 진료기관에 1992년 3월 16일부터 4월 11일까지 진료의뢰서를 갖고 내과, 일반외과, 정형외과, 신경외과 외래를 방문한 초진환자 498명을 대상으로 설문지 및 의무기록을 통해 조사하였는데 그 결과를 요약하면 다음과 같다. 대상자는 3차 진료기관이 속한 중진료권에 거주하는 환자가 48.8%였고 나머지가 대진료권에 속한 환자였으며, 1차 의료기관의 방문목적이 진단과 치료를 위해서 방문한 경우가 74.1%였고 진료의뢰서를 발급받기 위해서가 25.9%였다. 진료의뢰서를 본인이 원해 발급받은 경우가 전체의 52.6%였는데 순수하게 의사의 판단에 의해 발급받은 환자가 47.4%로서 아직도 환자 의뢰체계가 제대로 완비되었다고 말하기 어렵다. 진료의뢰서의 발급기관은 의원급이 67.5%, 병원급이 16.3%, 보건기관이 14.2%였다. 1차 의료기관에서 검사를 하고 3차 진료기관을 방문한 환자는 49.4%였는데, 이 중에서 진료한 1차 의료기관에서 다른 진료기관으로 검사를 의뢰해서 검사를 실시한 경우가 7.8%였다. 1차 의료기관에서는 대상자의 20.9%가 X-ray 검사를 받았고, 10.6%가 소변검사, 9.0%가 심전도검사를 받았으며, 의료보험 비급여 대상종목인 컴퓨터단층촬영과 초음파검사는 각각 3.4%, 6.4%였다. 3차 진료기관에서도 방문환자의 45.2%가 X-ray 검사를 받았고, 간기능검사 24.7%, 소변검사 19.1%, 심전도검사 15.7%의 순으로 나타났다. 1차 의료기관에서 검사를 받은 사람 중 검사결과지를 지참한 환자의 비율은 컴퓨터단층촬영이 76.5%로 가장 많았고, 다음이 초음파검사로 31.3%여서 고가 의료장비 이용시 검사결과지 지참율이 높았다. 1차 의료기관과 3차 진료기관에서의 중복검사율은 각 진료과에 따라 특성이 있으나 전체적으로 보면 갑상선 기능검사가 71.4%로 가장 높았고, 다음이 혈액검사(Routine CBC)가 67.9%, X-ray검사가 64.4%였다. 그리고 초음파검사 62.5%, 컴퓨터단층촬영 11.8%, 심전도검사 35.6%, 위내시경검사 45.2%였다. 1차 의료기관에서의 검사결과지를 지참한 경우만을 기준으로 하면 혈액 검사가 75.0%, 간기능검사가 72.7%로 높았으나 X-ray 52.2%, 초음파검사 60.0%였는데, 고가장비인 컴퓨터 단층촬영은 15.4%였다. 이상의 결과에서 3차 진료기관에서는 1차 의료기관에서 실시한 검사를 중복검사한 경우가 많고 1차 의료기관에서의 검사결과지를 지참하는 환자의 중복검사율도 특수한 경우를 제외하고는 큰 차이가 없었음을 감안할 때 진료의뢰시 보다 상세한 진료결과지를 지참하도록 하는 등 환자의뢰체계를 합리적으로 개선하여야 확인검사로 인한 중복검사를 경감시킬 수 있을 것으로 생각된다. 아울러 불필요한 검사를 줄이기 위해서는 의료분쟁을 줄일 수 있는 방안이 마련되어야 하고, 의료보험수가의 조정도 필요할 것이다.

• Pediatric Infection and Vaccine
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• 제14권1호
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• pp.55-61
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• 2007

목 적 : 열은 소아에서 매우 흔한 증상 중 하나이지만 부모들은 열 자체를 위험한 질환으로 인식하는 경우가 많다. 열에 대해 올바로 아는 것은 부모의 불필요한 염려를 덜고 환아의 질환과 진단 및 치료 과정을 이해하는데 도움을 줄 것이다. 이에 저자들은 소아의 열에 대한 부모들의 인식을 조사하고 과거와 비교하여 변화가 있는지 알아보고자 하였다. 방 법 : 2006년 5월부터 7월까지 3개월 동안 가톨릭대학교 성바오로병원 소아과 외래를 방문한 소아의 보호자들에게 열에 대한 지식, 태도, 대처 방법을 묻는 19문항의 설문조사를 실시하였다. 결 과 : 136명이 답하였으며 10년 전에 비하여 열에 대한 정보, 태도, 대처 방법 등에서 크게 개선된 점이 없었다. 열에 대한 기본 지식인 열의 기준과 측정 방법에 대해서 잘못 알고 있는 보호자가 많았고, 열성경련과 뇌손상의 가능성에 대한 염려는 여전히 지속되고 있었다. 열은 항상 해롭고 위험한 것이라고 생각하고 있었으며, 따라서 치료가 필요하지 않은 체온에서도 실제보다 심각한 결과를 걱정하며 해열제를 투여하고 병원에 방문하고 있음을 보여주었다. 결 론 : 보호자들은 열이 이로운 점을 가진 생리 반응중의 하나라는 사실을 인식하지 못하고 실제보다 심각한 결과를 예상하며 따라서 불필요한 우려와 치료를 택하게 된다. 이런 잘못된 인식은 시간의 경과에도 불구하고 큰 변화가 없었으며 따라서 소아과 의사들의 역할이 중요하다고 할 수 있다. 부모들에게 해열제를 사용하도록 할 때는 열이 해롭지 않으며 해열제의 목적은 열로 인한 아이의 불편감을 덜어주는 것임을 반복하여 알려주고, 더 나아가서는 소아과 의사들이 좀 더 체계적인 정보 및 교육 프로그램을 제공한다면 열에 대한 올바른 인식 형성에 도움이 되리라고 생각된다.

• 융합정보논문지
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• 제10권9호
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• pp.43-52
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• 2020

본 연구의 목적은 견관절 환자를 대상으로 동영상 교육을 개발하고 관절가동범위, 통증 및 삶의 질에 미치는 효과를 평가하기 위함이다. 본 연구는 2020년 1월부터 6월까지 G시 소재 대학병원의 정형외과 외래에 내원한 견관절 환자 중 실험군 30명, 대조군 26명을 대상으로 하였다. 자료분석은 SPSS를 이용하여 두 그룹의 일반적 특성 및 종속변수에 대한 사전 동질성 검정은 𝑥²-test, t-test로 분석하였다. 연구결과, 대상자의 사전 사후 점수 변화는 관절가동범위의 내회전 정도와 통증점수에서 유의한 차이가 있는 것으로 나타났으며, 관절가동범위의 굴곡, 외전 정도와 삶의 질에서는 유의한 차이가 없는 것으로 나타났다. 본 연구에서 동영상 교육의 임상 적용은 외래 뿐만 아니라 병동에서도 간호사의 환자교육에 소비되는 시간을 절약할 수 있어 간호 실무를 개선하는 방안으로 제시될 수 있다.

• 대한간호학회지
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• 제25권4호
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• pp.681-695
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• 1995

It has been noted that a genetic alteration of cells influenced by unhealthy lifestyle In addition to a series of other carcinogens increases various neoplasmic diseases. Therefore the importance of lifestyle that minimizes such impact on health should be emphasized. Since stomach cancer, the most common neoplasmic disease in Korea, is re-lated to the Korean lifestyle and as there's a possibility of its recurrence, people with stomach cancer need to lead a healthy lifestyle. The purpose of this study is to provide a basis for nursing intervention strategies to promote health promoting behaviors that are constructive to a healthy lifestyle. A multivariate model was constructed based on the fender's health promotion model and Booker's health belief model by including influential factors such as hope. The sample was composed of 164 patients with stomach cancer who visited outpatient clinics of a university hospital in Seoul. The following instruments were used in the study after some adaptation : Wallston and others' multidimensional health locus of control scale Laffrey's health conception scale, Lawston and others' health self- rating scale, Walker and others' health promotion lifestyle profile and Rogenberg's self esteem scale. In addition Moon's health belief scale was used with some modification. For self efficacy, the present author constructed a self-efficacy scale based on previous research. The above mentioned instruments were tested in a pilot study with 24 patients with stomach cancer. The reliabilities of instruments were tested with Cronbach's alpha(0.574∼0.949). Data were analyzed using a SAS program (or Pearson correlation coefficients, descriptive correlational statistics and stepwise multiple regression. The results are as follows : 1. The scores on the health promoting behavior scale ranged from 55 to 145 with a mean of 107.91 (S. D : 16.50). The mean scores(range 1-4) on the different dimensions were nutrition 3.14, exercise 2.48, stress management 2.69, health responsibility 2.65, interpersonal relationship 2.878E self actualization 2.85. 2. There were significant correlations among all the predictive variables & the health promoting behavior (r=.20-.55, p〈.01) 3. Stepwise multiple regression analysis showed that : 1) Hope was the main predictor and accounted for 29.8％ of the total variance. 2) Self efficacy, perceived barriers & self esteem accounted for an additional 14.6% of the total variance. 3) Hope, self efficacy, perceived barriers & self esteem altogether accounted for 44.3％ of the total variance. In conclusion, hope, self efficacy, perceived barriers & self esteem were identified as important variables that contributed to promote health promoting behavior.

• 근관절건강학회지
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• 제7권1호
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• pp.102-130
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• 2000

The aims of this study were to understand and to predict the determinant factors affecting the exercise behaviors and physical fitness by testing the Ponder's health promotion model, and to help the patients with rheumatoid arthritis and osteoarthritis perform the continuous exercise program, and to help them maximize the physical effect such as muscle strength. endurance, and fuctional status and mental effects including self efficacy and quality of life, and improve the physical and mental wellbeing, and to provide a basis for the nursing intervention strategies. We analyzed the clinical records of 208 patients with rheumatoid arthritis and degenerative arthritis who visited the outpatient clinics at H university hospital in Seoul between October 5, 1999 and October 24, 1999. Data were composed of self reported questionnaire and good of fitness score which were obtained by pedalling the ergometer of bicycle for 9 minutes. SPSS Win 8.0 and Window LISREL 8.12a were used for statistical analysis. 24 Of 54 hypothetical paths were supported in modified model, which was considered as a proper model with improved fit index. The physical fitness was directly influenced by exercise participation behavior and education level, and indirectly by physical fitness, while fatigue, physical disability, pastexercise behavior, life-style, self-efficacy, which explained 20% of physical fitness. The exercise participation were directly influenced by perceived benefits and self-efficacy, and indirectly influenced by life-style, fatigue and physical disability, and directly and indirectly by past exercise behavior, which explained 53% of exercise participation. Exercise score were directly affected by perceived health status, perceived benefits, self efficacy, and past exercise behavior, and were indirectly affected by fatigue, physical disability, and life-style, which explained 50%. Perceived health status were directly influeced by level of education, depression, sleep disorder, and physical disability, which explained 34% of perceived health status. Perceived benefit was directly influenced by fatigue, sleep disorder, physical disability, and life-style, which explained 45%. Perceived barriers was directly influenced by fatigue, sleep disorder, and lifestyle, which explained 9%. Self- efficacy was directly influenced by fatigue, physical disability, past exercise behavior, and level of education, which explained 61%. In conclusion, important variables for physical fitness were exercise participation and level of education, and variables affecting exercise participation were perceived self-efficacy, benefits, and past exercise behavior. Perceived self-efficacy of exercise was a significant predictor of exercise participation. Life-style, fatigue, and physical disability showed direct effects on perceived benefit, perceived barriers, and self-efficacy, and indirect effects on exercise behavior. Therefore, disease related factor should be minimized for physical performance and well being in nursing intervention for patients with rheumatoid arthritis, and plans to promote and continue exercise should be soaked to reduce disability. In addition, Exercise program should be planned and performed by the exact evaluation of exercise according to the ability of the patients and the contents to improve the importance of exercise and self efficacy in self control program, dedicated educational program should be involved.