• Journal of Korean Academy of Nursing
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• v.4 no.1
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• pp.162-178
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• 1974

The present study is purported to provide a basic information to be utilized by nurses to care and attend effectively for patients nearing the moment of death. Therefore, the primary purpose of the study has been placed upon grasping an understanding of the trends of death in general. For this purpose: 1. By utilizing the schneidman questionnaire, the trend of death has been categorized by 6 parts and analyzed. 2. A search has been conducted to find out dying patient's needs, nurse's attitudes viewed by the patient, and nurse attitudes to dying patient. The followings are itemized results of analysis: 1. Analysis by the schneidman questionnaire. (1) In general concepts of death. the first sighting of the occurrence of death was experienced upon strangers, grandfather and great grandfather. The death is openly discussed among people of all ages and sex. Ages in which the death is mostly feared were from 12 to well over 70 yews old that are evenly distributed regardless of difference in age. (2) As to the attitudes toward death the occurrence of death to most closely associated person influenced most upon the attitude of their own termination of lives. Among the reading materials, the maximum influence was effected by the Bible. In terms of religion, the thoughts of death were Influenced by religions education in case of the believers of the western religions (36%), and by their own health and physical conditions in case of the believers in the oriental religions (35%). In case of non-believer, their attitude toward death were largely determined through their own thinking meditation (45%). People aged 20 or thereunder revealed that they wished to know the day of their own death to be occurred (58%). However, the older the less thor wanted to know. (3) As to the choosing the time of death, 57% preferred senility, and 30% preferred the time in mediately following the prime period of their lives in general. In terms of religion, 85% of the believer in the oriental religion preferred senility, and 67% in the western religion, 58% in others, Therefore. the desiring of their lives to be terminated in earlier stage, not by the natural senility. sequenced as follows : Others, western religions and oriental religions. (4) Referring to the disposal of the corpse under the assumption that it had already occurred, majority desired the burial system. There has been seen a slight tendency to consider the importance of holding funeral services for the sake of survivors. Concerning the life insurance policy, it showed that the nurse had less belief in it than the patient (5) Upon the subject of life-after-death. religion wise, 72% of western religion believers preferred to have an existence of life-after-death: Among the believers of oriental regions, 35% desired this category, 30% did not mind either way. and 35% did not desire the existence of such a life-after-death. In others, 53% did not mind whether or not such a life existed. (6) In general, serious thoughts were not being attended to the commitment of suicide. 37% emphasized that such an act should be prevented. However, 30% insisted that such commitment should not be bothered, and that society possesses no right to prevented it. More male wished to commit suicide (13%) than females (9%). 2. Nurse's attitudes toward terminal patients and patient's needs. In the instance where the patient realized that their death is imminent, most of them showed desire to discuses mainly on the problems of life. When faced a situation of this nature, it is revealed that 40% of nurses could not furnish appropriate care for them.

• Journal of Korean Academy of Nursing
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• v.13 no.1
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• pp.7-21
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• 1983

For the flexible and rational distribution of limited existing health resources based on measurements of individual risk, the socalled Risk Approach is being proposed by the World Health Organization as a managerial tool in maternal and child health care program. This approach, in principle, puts us under the necessity of developing a technique by which we will be able to measure the degree of risk or to discriminate the future outcomes of pregnancy on the basis of prior information obtainable at prenatal care delivery settings. Numerous recent studies have focussed on the identification of relevant risk factors as the Prior infer mation and on defining the adverse outcomes of pregnancy to be dicriminated, and also have tried on how to develope scoring system of risk factors for the quantitative assessment of the factors as the determinant of pregnancy outcomes. Once the scoring system is established the technique of classifying the patients into with normal and with adverse outcomes will be easily de veloped. The scoring system should be developed to meet the following four basic requirements. 1) Easy to construct 2) Easy to use 3) To be theoretically sound 4) To be valid In searching for a feasible methodology which will meet these requirements, the author has attempted to apply the“Likelihood Method”, one of the well known principles in statistical analysis, to develop such scoring system according to the process as follows. Step 1. Classify the patients into four groups: Group $A_1$: With adverse outcomes on fetal (neonatal) side only. Group $A_2$: With adverse outcomes on maternal side only. Group $A_3$: With adverse outcome on both maternal and fetal (neonatal) sides. Group B: With normal outcomes. Step 2. Construct the marginal tabulation on the distribution of risk factors for each group. Step 3. For the calculation of risk score, take logarithmic transformation of relative proport-ions of the distribution and round them off to integers. Step 4. Test the validity of the score chart. h total of 2, 282 maternity records registered during the period of January 1, 1982-December 31, 1982 at Ewha Womans University Hospital were used for this study and the“Questionnaire for Maternity Record for Prenatal and Intrapartum High Risk Screening”developed by the Korean Institute for Population and Health was used to rearrange the information on the records into an easy analytic form. The findings of the study are summarized as follows. 1) The risk score chart constructed on the basis of“Likelihood Method”ispresented in Table 4 in the main text. 2) From the analysis of the risk score chart it was observed that a total of 24 risk factors could be identified as having significant predicting power for the discrimination of pregnancy outcomes into four groups as defined above. They are: (1) age (2) marital status (3) age at first pregnancy (4) medical insurance (5) number of pregnancies (6) history of Cesarean sections (7). number of living child (8) history of premature infants (9) history of over weighted new born (10) history of congenital anomalies (11) history of multiple pregnancies (12) history of abnormal presentation (13) history of obstetric abnormalities (14) past illness (15) hemoglobin level (16) blood pressure (17) heart status (18) general appearance (19) edema status (20) result of abdominal examination (21) cervix status (22) pelvis status (23) chief complaints (24) Reasons for examination 3) The validity of the score chart turned out to be as follows: a) Sensitivity: Group $A_1$: 0.75 Group $A_2$: 0.78 Group $A_3$: 0.92 All combined : 0.85 b) Specificity : 0.68 4) The diagnosabilities of the“score chart”for a set of hypothetical prevalence of adverse outcomes were calculated as follows (the sensitivity“for all combined”was used). Hypothetidal Prevalence : 5％ 10％ 20％ 30％ 40％ 50％ 60％ Diagnosability : 12% 23% 40% 53% 64% 75% 80%.

• Tuberculosis and Respiratory Diseases
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• v.56 no.1
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• pp.29-39
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• 2004

Background : The diagnostic and therapeutic approaches to mediastinal tumors and cysts have changed over the past three decades. This report summarizes our forty-two years of experience with these tumors. Methods : This study retrospectively reviewed 479 patients with primary mediastinal tumors and cysts that were diagnosed and managed over the past 17-year period (1985~2002) and compared them to the report of the previous 25-year result (1960~1985) in Yonsei University College of Medicine, Severance Hospital in Seoul, Korea. Results : During the 17 years, there were 479 cases of pathologically proven mediastinal tumors and cysts. Thymoma (38.2%) was the most common mediastinal tumor and has increased noticeably during recent years. The gender ratio showed a male predominance (1.3:1) and the age distributions were even over all the age groups. The most common sites of the tumor and the proportion(28.6%) of malignant tumors were the same as that previously reported. A diagnosis of a tumor in asymptomatic patients was possible in 174 cases (36.3%), which was higher that reported previously. The diagnostic yield of a fine needle aspiration biopsy was 68.6% in the total tumors and 80.9% in the malignant tumors. A surgical resection was the most frequently chosen treatment modality and was performed in 405 cases (84.6%). The complete resection rate was 91.1%, which is higher than the previous result of 78.8%. Conclusion : These results showed that the prevalence of mediastinal tumors and cysts, particularly thymoma, increased. A fine needle aspiration biopsy was a valuable preoperative differential diagnostic method for malignant tumors. The surgical and complete resection rate increased remarkably possibly due to the better applicable chest CT scans, the more frequent health check-up provided by the regular health promotion program for all people as a health insurance policy, and the improved diagnostic techniques in the pathologic, radiological, and clinical fields.

• Journal of Oral Medicine and Pain
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• v.35 no.4
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• pp.245-258
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• 2010

Smoking has been identified not as a major risk factor for circulatory and respiratory diseases but also as causes of various oral diseases. A number of clinical studies and regional health surveys have found an association between smoking and poor oral health status and between smoking and prognosis of dental treatments. However, there is few studies about status of smoking cessation treatment and policies in dentistry in Korea. The purpose of this study was to investigate the smoking patterns of outpatients and outcomes of short-term smoking cessation treatment in dental hospitals in Korea and, subsequently, to seek further smoking cessation services in dentistry. This study was sponsored by Korean Dental Association (KDA) and department of culture and welfare. 825 dental patients were voluntarily participated in a 4-week smoking cessation program with nicotine patch and 297 participants of them completed on smoking-related questionnaires. All participants were recruited from outpatients of 11 dental university hospitals (primarily in the department of oral medicine, oral surgery and periodontology) in Korea during 3-month period from October 2009 to January 2010. The Questionnaires included demographics, duration of smoking, heavy smoking index (HSI), number of thinking of quit smoking, duration of stop smoking and reasons to smoking, awareness of smoking effects on oral health, and their success rate after 4 weeks of nicotine patch program was investigated. The statistical analysis was carried by SPSS version 18.0 program and Chi-square test. According to the results of this study, male in their 30s to 50s were the most prevalent of all the participants and duration of smoking increased with age. Attempt rate to quit smoking (Quit smoking) was the highest in 30s and 40s with duration of quit smoking ranging 1 to 3 months. Emotional stresswas the most frequently reported reason for smoking, followed by habit and pleasure in order. All age group showed high HIS over 71% and awareness of smoking effects on oral diseases such as oral soft tissue diseases, periodontal diseases and dental caries was found relatively high (50~60%) Periodontal implant was the main reason for participation in the smoking cessation services in dental clinics and the success rate of, 4-week nicotine patch program of all the participants was 29.4%, extremely low compared to that of medical clinics. Systemic education for dentists to be able to provide interventions to quit smoking including counseling with the 5As'and development of available measures for smokers is needed as considered that the low success rate of the smoking cessation services in dentistry could be explained mainly by lack of dentists' strategies, experience and attention. Awareness and attention of dentists should be emphasized and their participation be encouraged by long-term, multidisciplinary policies such as establishment of insurance fee, which would made a considerable progress in preventing smoking-related oral diseases and promoting public oral health.

• Research in Community and Public Health Nursing
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• v.10 no.1
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• pp.70-79
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• 1999

This study attempts to encourage the development of a rehabilitation delivery system as a substitute service for hospitalization such as a community based intermediate facility or home health care. We need substitute services for hospitalization to curtail the length of stay for inpatients due to car accidents. It focused on developing an estimation for early discharge based on a detailed statement of treatment from medical records of 109 inpatients who were hospitalized at General Hospital in 1997. This study has three specific purposes: First, to find the mean length of stay and mean medical expenditure. Second, to estimate the mean of early discharge from the mean length of stay. Third, to analyize the income effect per bed from early discharge. In order to analyze the length of stay and medical expenditure of inpatients the author conducted a micro and macro-analysis with medical expenditure records. To estimate the early discharge we examined with a group of 4 experts decreases in the amount of treatment after surgery, in treatments, in tests, in drug methods. We also looked their vital signs, the start of ROM exercise, the time removel, a patient's visitations, and possible stable conditions. In addition to identifing the income effect due to an early discharge, the data was analyzed by an SPSS-PC for windows and Excell program with a regression analysis model. The research findings are as follows: First, the mean length of stay was 47.56 days, but the mean length of stay due to early discharge was 32.26 days. The estimation of early discharge days was shown to depend on the length of stay. The longer the length of stay, the longer the length before discharge. For example, if the patient stayed under 14 days the mean length of stay was 7.09 while an early discharge was 6.39, whereas if the mean length of stay was 155.73, the early discharge time was 107.43. The mean medical expenditure per day of car accident patients was found to be 169,085 Won, whereas the mean medical expenditure per day was shown to be in a negative linear form according to the length of stay. That is the mean expenditure for under 14 days of stay was 303,015 Won and the period of the hospitalization of 15 days to 29 days was 170,338 Won and those of 30 days to 59 days was 113,333 Won. The estimation of the income effect due to being discharged 16 days was around 2,350,000 Won with a regression analysis model. However, this does not show the real benefits from an early discharge, but only the income increasing amount without considering prime medical cost at a general hospital. Therefore, we need further analysis on cost containments and benefits incending turn over rates and medical prime costs. From these research findings, the following suggestions have been drawn, we need to develop strategies on a rehabilitation delivery system focused on consumers for the 21st century. Varions intermediate facilities and home health care should be developed in the community as a substitute for shortening the length of stay in hospitals. In home health care cases, patients who want rehabilitation services as a substitute for hospitalization in cooperation with private health insurance companies might be available immediately.

• The Korean Society of Law and Medicine
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• v.20 no.3
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• pp.143-174
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• 2019

Our Constitution obliges the state to protect the health of the people, and the Medical Law, which embodied Constitution, sets out in detail the matters related to open the medical institution, and one of them is to prohibit the operation of multiple medical institutions. By the way, virtually multiple medical institutions could be opened and operated because the Supreme Court had interpreted that several medical institutions could be opened if medical activities were not performed directly at the additional medical institution which was opened under the another doctor's license. However, some health care providers opened the several medical institutions with another doctor's license for the purpose of the maximization of profit, and did illegal medical cares like the unfair luring of patients, over-treatment, and commission treatment. Also, realistic problems such as the infringed health rights have arisen. Accordingly, lawmakers had come to amend the Medical Law to readjust the system of opening for medical institution so that medical personnel could not open or operate more than one medical institution for any reason. For this reason, the Constitutional Court recently declared a constitutional decision through a long period of in-depth deliberation because the constitutional petition and the adjudication on the constitutionality of statutes had been filed on whether Article 33 paragraph 8 of the revised medical law is unconstitutional. The Constitutional Court acknowledged the "justice of purpose" in view of the importance of public medical institutions, of the prevention from seduction of for-profit patients and from over-treatment, and of the fact that health care should not be the object of commercial transactions. Given the risk that medical personnel might be subject to outside capital, the concern that the holder of the medical institution's opening certificate and the actual operator may be separated, the principle that the human body and life should not be just a means, and the current system's inability to identify over-treatment, it also acknowledged the 'minimum infringement'. Furthermore, The Constitutional Court judged it is constitutional in compliance with the principle of restricting fundamental rights, such as 'balance of legal interests'. In this regard, legislative complements are needed in order to effectively prevent the for-profit management and the over-treatment the Constitutional Court is concerned about. In this regard, consumer groups actively support the need for legislation, and health care providers groups also agree on the need for legislation. Therefore, the legislators should respect the recent Constitutional Court's decision and in the near future complete the complementary legislation to reflect the people's interests.

• Journal of agricultural medicine and community health
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• v.35 no.3
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• pp.249-259
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• 2010

Objectives: The purpose of this study was to analyze the influence of four lifestyle-related diseases, diabetes, hypertension, obesity and hypercholesterolemia, on oral health in the rural elderly in Korea. Methods: We enrolled 399 subjects over 60 years of age over a six year period, year 2000-2006/ year 2001-2007. All subjects received a routine health examination as part of a program conducted by the National Health Insurance Corporation at Seongju-gun Public Health Center in Gyeongsangbuk-do Province, South Korea. All subjects were surveyed and examined to determine their general and oral health statuses. Results: Our results suggest that the duration of lifestyle-related diseases has a significant influence on oral health. The following factors were all significant in the results of analyses: duration of diabetes, tooth decay, which teeth had decayed, missing and filled teeth(DMFT), duration of hypertension, and duration of obesity and hypercholesterolemia(p<0.05). Our results also suggest that the number of lifestyle related diseases has a significant influence on oral health. Subjects with more than two diseases had significantly greater numbers of missing teeth and greater numbers of DMFT(p<0.01). The results of simple regression analysis indicate that patients exhibiting longer durations of diabetes also exhibit more tooth decay, and that patients exhibiting longer durations of hypertension and obesity are characterized by greater numbers of missing teeth. The longer the duration of any of the four lifestyle-related diseases we considered, the more DMFT we observed. Multiple regression analyses also demonstrated that longer duration of lifestyle-related disease was associated with greater numbers of missing teeth. As the number of lifestyle-related diseases increased, DMFT also increased. Conclusions: In summary, lifestyle-related diseases such as diabetes, hypertension, obesity and hypercholesterolemia have significant influences on oral health in the elderly. In this context, the prevention and management of lifestyle-related disease is critical for the maintenance and promotion of oral health.

• KDI Journal of Economic Policy
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• v.30 no.2
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• pp.157-183
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• 2008

'New Universities for Regional Innovation(NURI)' is a financial aid program designed to promote the development of universities as a major component of Regional Innovation System (RIS). In particular, this program emphasizes the role of regional universities to provide the qualified graduates for the regional economy. This paper is to evaluate the effect of NURI, focusing on the change of graduates' employment. The effect of the program can be evaluated by the quality of graduates' accumulated human capital, and graduates' employment performance represents the graduates' quality evaluated in the labor market. This is also believed to be a good performance indicator of the NURI program. We utilize the graduate employment survey of Korean Educational Development Institute (KEDI), and calculate the graduates' employment rates of the departments that received the financial support of NURI (treatment group). We also calculate the graduates' employment rates of the departments that applied for the support of the NURI program but were not selected (comparison group). By using difference-in-differences method, we compare the change of graduates' employment rates in treatment and comparison groups before and after the program came in effect. Compared with the employment rates in 2004 before the NURI program started, the graduates employment rates improved in both groups in 2005 and 2006. The improvement of the employment rates in the treatment group is larger than that in the comparison group. Moreover, the difference of improvement gets larger in the year 2006 than in 2005, which means those students who were affected more years by the NURI program are more likely to be employed. However, the difference is not statistically significant, and we cannot definetely conclude that NURI showed the desired effect on the quality of the college graduates. We calculate employment rates in two ways; whether to treat going on to graduate education as an employment or not. The result was qualitatively the same in both cases. We also tracked quality of employment by investigating the firm size where the graduates of the treatment group were employed. By utilizing data from the Employment Insurance Fund, we measure the firm size by the number of employees. We did not find any deterioration of employment quality between 2005 and 2006, though it deteriorates in 2007. Therefore, the improvement of employment rates until 2006, though not statistically significant, does not seem to come at the cost of employment quality. The interpretation of this result cannot help being very limited. First, this evaluation covers such a short time period. It only covers two years after the program started, 2005 and 2006. Second, the extent of the improvement in employment rates is not satisfactory considering the amount of financial support, even though it can be argued that the employment has improved since the inception of the program. Subsequent evaluation of the program is required to certify the NURI programs' longer term effectiveness.

• Journal of Hospice and Palliative Care
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• v.5 no.2
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• pp.146-154
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• 2002

Purpose : Death due to cancer has been continuously increasing, therefore cancer is the first in the cause of death now. A national policy for the elevation of medical costs in cancer patients is necessary, therefore, we searched for the medical costs and its related factors in terminal cancer patients for the effective reduction of the medical costs. Methods : We reviewed the medical records of 259 hospitalized terminal cancer patients who had died during the period of July 1, 2000 to June 30, 2002. History of cancer included type of cancer, type of past treatment, existence of metastasis. Clinical manifestation was examined and medical costs on last admission was categorized based on the account of charges of the department of patient affair on the last hospitalization. For analysis of factors related with medical costs, ANOVA was used. Results : Of the 259 patients, the number of male was 135 cases (52.1%), and the female, 124 cases (47.9%). The most frequent type of cancer was stomach (21.9%) cancer. Of the clinical manifestation, anorexia (87.6%) was the most frequent manifestation. Total medical costs was 740,628,045won, the mean costs was $285,968{\pm}3,070,272won$. The frequent category of medical costs was injection (32.0%), medical accommodation (27.9%), examination (14.0%), in order. The only factor related with mean medical costs was pain (P<0.05). Conclusion : If unnecessary injection of opioid analgesics is reduced, hospice care at home is activated and excessive examination is reduced In terminal cancer inpatients, it will be possible to reduce the medical costs in terminal cancer patients more effectively.

• Journal of the Korean Child Neurology Society
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• v.26 no.4
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• pp.227-232
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• 2018

Purpose: Febrile seizure (FS) is the most common type of seizure in children between 6 months to 5 years of age. A family history of febrile seizures can increase the risk a child will have a FS. Yet, prevalence of FS regarding external environment has not been clearly proved. This study attempts to determine the association between prevalence of FS and weather. Methods: This study included medical records from the Korea National Health Insurance Review and Assessment Service. Data were collected from 29,240 children, born after 2004, diagnosed with FS who were admitted to one of the hospitals in Seoul, Korea, between January 2009 and December 2013. During the corresponding time period, data from the Korea Meteorological Administration on daily monitoring of four meteorological factors (sea-level pressure, amount of precipitation, humidity and temperature) were collected. The relationships of FS prevalence and each meteorological factor will be designed using Poisson generalized additive model (GAM). Also, the contributory effect of viral infections on FS prevalence and weather will be discussed. Results: The amount of precipitation was divided into two groups for comparison: one with less than 5 mm and the other with equal to or more than 5 mm. As a result of Poisson GAM, higher prevalence of FS showed a correlation with smaller amount of precipitation. Smoothing function was used to classify the relationships between three variables (sea-level pressure, humidity, and temperature) and prevalence of FS. FS prevalence was correlated with lower sea-level pressure and lower humidity. FS prevalence was high in two temperature ranges (-7 to $-1^{\circ}C$ and $18-21^{\circ}C$). Conclusion: Low sea-level pressure, small amount of precipitation, and low relative air humidity may increase FS prevalence risk.