• 한국간호교육학회지
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• 제28권1호
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• pp.80-90
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• 2022

Purpose: This study was conducted to investigate the effect of tuberculosis-related knowledge and family support on medication adherence in tuberculosis patients. Methods: The data were collected from 175 patients diagnosed with tuberculosis at three general hospitals located in two provincial cities in South Korea from September 1 to November 31, 2020. The 160 questionnaires were analyzed using IBM SPSS WIN 25.0. Results: The patients' average score for tuberculosis-related knowledge was 15.85±5.87 (out of 25), for family support it was 22.03±9.20 (out of 35), and for medication adherence it was 5.11±2.68 (out of 8). There were significant differences in tuberculosis-related knowledge, family support, and medication adherence according to patients' general characteristics and significant positive relationships among tuberculosis-related knowledge, family support, and medication adherence. Factors affecting patients' tuberculosis medication adherence were history of stopping the medication, the importance of treatment among tuberculosis-related knowledge and family support, and these factors could explain 78% of patients' taking tuberculosis drugs. Conclusion: It could be concluded that the importance of tuberculosis treatment and family support are very important for improving patients' rates of medication adherence. Therefore, medical staffs caring for tuberculosis patients need to manage patients' medication of tuberculosis drugs with continuous consultation.

• Tuberculosis and Respiratory Diseases
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• 제76권6호
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• pp.257-260
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• 2014

Tuberculosis is a significant infectious problem in elderly patients with comorbidities in Korea. The age-associated diseases such as malignancy and diabetes mellitus may increase the risk of tuberculosis in this population. The medication treatments of tuberculosis in patients with comorbidities can cause adverse reactions to antituberculosis drugs and inadequate treatment responses. Thus, clinicians must carefully monitor the toxicity of antituberculosis therapy and the efficacy of treatment in patients with comorbidities.

• Journal of Preventive Medicine and Public Health
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• 제31권4호
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• pp.814-827
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• 1998

In this study we analyzed the insurance claims data to investigate the medical care utilization pattern of tuberculosis patients in private sector. We selected the claims of principal or secondary diagnosis with tuberculosis from claims database of National federation of Medical Insurance, from December 1995 to November 1996. Both spell-based analysis and person-based analysis were carried out. In spell-based analysis, type and location of treatment facilities, distribution of diagnoses, number of outpatient/inpatient treatments were analyzed. Additionally in person-based analysis, number of tuberculosis patients, demographic characteristics, number of treatments per person, frequency and pattern of change in source of care were analyzed. The results were as follows 1. The number of treatments with tuberculosis was 863,641 from 1 December 1995 to 30 November 1996. The number of patients was 313.964. 2. Most of tuberculosis patients in private sector were treated in general hospital (45.8%) and clinics(42.2%) 3. About 77.7% of tuberculosis patients who were treated more than two times did not change the source of care. 18,9% of tuberculosis patients changed source of care only once. Even when we limited tuberculosis patient to those who were treated more than five times and whose treatment period were longer than six months, 94.7% of patients did not change source of care at all, or changed treatment facility only once. 4. The probability of change in source of rare was higher in pulmonary tuberculosis, in twenties, and in rural area respectively than other tuberculosis. In conclusion, healer shopping of tuberculosis patients was not serious as expected. However special attention is needed to pulmonary tuberculosis in twenties and rural area.

• 한국방사선학회논문지
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• 제15권7호
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• pp.1021-1030
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• 2021

국내 결핵 환자 관리의 방안을 모색하고 결핵 정책의 기초자료를 제공하고자 2010년부터 2018년까지 통계청과 질병관리본부의 결핵 환자 통계 연보와 세계보건기구(WHO; World Health Organization)의 GLOBAL Tuberculosis Report 등의 자료를 수집하여, 국내 결핵 환자 현황을 분석하였다. 결과는 다음과 같다. 첫째, 국내 결핵 환자 발생 현황 결과는, 2018년 33,796명(65.9%), 신환자는 2018년 26,433명(51.5%)으로 약 21.3% 감소한 것으로 나타났다. 둘째, 국내 결핵 환자치료 현황은 과거 치료결과 불명확은 2018년 655명으로 2014년 대비 약 160% 증가한 것으로 나타났다. 셋째, 청소년 결핵환자 발생률은 10에서 14세는 2018년 1.8%, 15세에서 19세는 15.0%로 고등학생의 결핵 발생률이 높았다. 넷째, 나이별 결핵 환자 발생률을 보면 60대 이상의 대상자가 60% 이상의 결핵 유병률을 보였으며 특히 80세 이상의 노인결핵 환자가 증가하였다. 다섯째, 성별 결핵 환자발생률 현황은 2010년 대비 2018년에 남성이 여성보다 1.4배가 많은 것으로 나타났다. 여섯째, 전국적으로 결핵 유병률은 전남 1,419명(75.6%)이 가장 높았고, 세종 99명(33.4%)이 가장 낮았다. 일곱째, 국내 외국인 환자 수는 2012년 1,510명으로 지속적으로 늘어나 2016년에는 2,569명으로 증가한 것으로 나타났다. 이상의 결과에 따라 결핵 재발자, 고등학생, 60세 이상의 연령층, 80세 이상의 노인, 군대 등의 남성 집단, 외국인 대상의 신속하고 정확한 결핵 조기 검진정책과 관리가 필요하다.

• Clinical and Experimental Pediatrics
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• 제52권5호
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• pp.529-537
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• 2009

Drug-resistant tuberculosis in children has important implications for both the patients and tuberculosis control programs. In Korea, among all new patients, the isoniazid resistance rate was 9.9% and multidrug-resistant tuberculosis rate was 2.7% in 2004 (in patients aged 10-19 yr, the multidrug-resistant tuberculosis rate reached 2.1%). Tuberculosis in pediatric patients is difficult to diagnose because many children have nonspecific clinical signs and the detection rates of acid-fast bacilli smears and cultures are low. Therefore, every effort should be made to identify adult sources and obtain information on drug susceptibility because symptomatic adult patients have a higher chance of culture positivity and drug-susceptibility patterns are the same in most adult-child pair patients. Korean children are at significant risk of drug-resistant tuberculosis. As the isoniazid resistance rate is greater than 4% among the new cases in Korea, a four-drug regimen should be considered for initial treatment of children with active tuberculosis, unless drug-susceptibility test results are available. Treatment of drug-resistant tuberculosis in children is challenging and there are only few available data. Tuberculosis control programs should be continuous with specific focus on pediatric populations because they can serve as reservoirs for future active cases. Further studies are needed regarding treatment of drug-resistant tuberculosis in children.

• 대한후두음성언어의학회지
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• 제19권1호
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• pp.43-46
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• 2008

Background and Objectives : Clinical suspicion and appropriate diagnostic procedures are essential for the timely management of extrapulmonary type of mycobacterial disease. In the hope of suggesting a suitable guideline for the early diagnosis of laryngeal tuberculosis, the authors reviewed their clinical pathways and the characteristics of patients with laryngeal tuberculosis who were managed in the recent 10 years at a single tertiary referral hospital, Samsung Medical Center. Subjects and Method : Retrospective chart review was performed for the 25 adult patients with laryngeal tuberculosis. Among 25 cases, 12 were pathologically confirmed by laryngeal biopsy and the other 13 were clinically diagnosed by cumulative clinical information; definite laryngitis on laryngoscopy, positive AFB (acid fast bacillus) smear/culture or active pulmonary tuberculosis on chest X-ray, and substantial response to anti-tuberculosis medication. Results : Chest X-ray revealed active pulmonary tuberculosis in 72% of patients (N=18/25). Sputum AFB smear/culture was positive in 95% of all tested patients (N=21/22) and in 100% of the tested patients who have stable or no evidence of pulmonary tuberculosis (N=5/5). All patients except one who had coexisting laryngeal malignancy showed considerable improvement in their subjective symptoms and laryngeal findings within the first 2 months of anti-tuberculosis medications and they achieved complete response on subsequent sputum studies, chest X-ray and laryngeal findings after $7.0{\pm}2.3$ months of the medications. Conclusion : We suggest that chest X-ray and sputum AFB smear/culture to be the first step of work-up for the patients having laryngeal tuberculosis in suspicion since laryngeal tuberculosis is largely associated with active pulmonary tuberculosis and/or sputum AFB study offers high yield even in case of primary laryngeal tuberculosis. However laryngeal biopsy must be considered in case showing unsatisfactory response to the anti-tuberculosis medication for more than 2 months.

• Tuberculosis and Respiratory Diseases
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• 제81권3호
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• pp.241-246
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• 2018

Background: The "Tuberculosis Relief Belt Supporting Project (Tuberculosis Patient Management Project for Poverty Groups)" is a national program for socioeconomically vulnerable tuberculosis (TB) patients. We sought to evaluate the clinical and socioeconomic characteristics of poverty-stricken TB patients, and determined the need for relief. Methods: We examined in-patients with TB, who were supported by this project at the National Medical Center from 2014 to 2015. We retrospectively investigated the patients' socioeconomic status, clinical characteristics, and project expenditures. Results: Fifty-eight patients were enrolled. Among 55 patients with known income status, 24 (43.6%) had no income. Most patients (80%) lived alone. A total of 48 patients (82.8%) had more than one underlying disease. More than half of the enrolled patients (30 patients, 51.7%) had smear-positive TB. Cavitary disease was found in 38 patients (65.5%). Among the 38 patients with known resistance status, 19 (50%) had drug-resistant TB. In terms of disease severity, 96.6% of the cases had moderate-to-severe disease. A total of 14 patients (26.4%) died during treatment. Nursing expenses were supported for 12 patients (20.7%), with patient transportation costs reimbursed for 35 patients (60%). In terms of treatment expenses for 31 people (53.4%), 93.5% of them were supported by uninsured benefits. Conclusion: Underlying disease, infectivity, drug resistance, severity, and death occurred frequently in socioeconomically vulnerable patients with TB. Many uninsured treatment costs were not supported by the current government TB programs, and the "Tuberculosis Relief Belt Supporting Project" compensated for these limitations.

• Tuberculosis and Respiratory Diseases
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• 제42권5호
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• pp.654-659
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• 1995

연구배경: 결핵에서의 혈액학적인 변화는 그 양상이 다양하며, 이러한 변화는 단순폐결핵과 속립성결핵에서 차이가 있다고 알려져 있다. 지금까지 국내에서 단순폐결핵에 대한 말초 혈액의 혈액학적 변화에 대한 연구는 있었으나, 속립성결핵에서의 혈액학적 변화에 대한 보고는 거의 없는 실정이다. 이에 속립성결핵에서 말초혈액 및 골수에서의 혈액학적 변화를 알아보고자 본 연구를 시행하였다. 방법 1993년 8월부터 1994년 7월까지 전북대학교 병원에 입원한 환자들 중 단순흉부방사선사진 및 고해상도 전산화 단층사진상 속립성 결핵 소견을 보이며 객담도말과 배양검사, PCR검사에서 결핵균이 증명되었거나 골수검사에서 결핵성육아종을 보인 10예를 대상으로 하였다. 혈액학적 소견의 평가는 Dacie 등에 의해 기술되어진 정의에 따랐으며 혈액체취는 내원당시에 시행하였고 골수검채는 입원후 7일이내에 시행하였다. 결과: 말초혈액소견상 범혈구감소증 1예, 빈혈은 전예에서 있었으며 백혈구증가증은 10%, 백혈구감소증은 20%, 혈소판감소증은 30%, 임파구감소증은 90%, 단구증가증은 40%, 중성구증가증은 20% 그리고 중성구감소증은 환자의 10%에서 나타났다. 골수검사에서 임파구감소증은 30%, 임파구증가증은 20%, 형질세포감소증은 40%, 단구증가증은 전예(100%)에서 나타났으며, 저세포충실도는 30%, 적혈구조혈감소는 30% 그리고 과립구조혈증가와 감소가 각각 환자의 20%에서 나타났다. 골수육아종소견은 환자의 25%에서 나타났다. 결론: 속립성결핵의 혈액학적 변화는 혈구감소증의 경향을 보였으나 단구는 말초 및 골수 모두에서 증가하는 소견을 보였다. 이러한 소견은 속립성결핵의 감별진단에 있어서 도움을 줄 수 있올 것으로 기대된다.

• Tuberculosis and Respiratory Diseases
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• 제79권3호
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• pp.153-157
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• 2016

Background: Vitamin D is known to have diverse effects on various systems in the body. There is evidence to suggest that a link exists between the serum vitamin D status and tuberculosis. The present study was designed to assess the alterations in serum 25-hydroxyvitamin D levels in newly diagnosed sputum acid fast bacilli (AFB) positive pulmonary tuberculosis patients and to study the association, if any, between serum vitamin D levels and different levels of sputum smear positivity. Methods: Serum 25-hydroxyvitamin D levels were estimated in 65 sputum AFB positive pulmonary tuberculosis patients and 65 age and gender-matched healthy controls. Results: The levels of serum 25 hydroxy-vitamin D in tuberculosis patients were not statistically different from the levels of serum 25 hydroxy-vitamin D in healthy controls. However, among patients with pulmonary tuberculosis, there was a significant negative correlation between the levels of serum 25 hydroxy-vitamin D and levels of sputum positivity. Conclusion: Serum vitamin D levels negatively correlates with bacterial load in patients with active pulmonary tuberculosis.

• 대한간호학회지
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• 제26권3호
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• pp.697-708
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• 1996

Most efforts to improve tuberculosis treatment adherence target the patient and his or her behavior. This study examined the effects of behavioral modification training for these patients. Based on Bandura's behavioral principles of modeling, intervention strategies using a video program were devised to elicit specific patient target behaviors considered to improve patients' adherence to tuberculosis treatment regimens. A random assignment, two-group(experimental group and control group) research design including 81 subjects was used. The main outcomes measured were pill taking measured with the Medication Event Monitoring System(MEMS) Medication Cap, patients' self-efficacy, and their knowledge of tuberculosis. The findings are as follows : 1) There was a significant difference between the experimental group and the control group in patients' feelings of self-efficacy. That is, the patients who received the behavior modification program showed greater feeling of self-efficacy to initiate and change their behavior for the tuberculosis treatment regimen than the patients who did not receive the program(t=3.51, p=0.01). 2) There was a significant difference between the experimental group and the control group in patients' knowledge of tuberculosis. That is, the patients who received the behavior modification program showed higher level of knowledge of tuberculosis than the patients who did not receive the program(t=2.15, p=0.03) 3) There was a significant difference between the experimental group and the control group in patients' adherence to tuberculosis treatment regimens. That is, the patients who received the behavior modification program showed greater adherence to the treatment regimens than the patients who did not receive the program(t=5.11, p=0.00). The study findings provided useful insights into nursing practice, particularly in planning intervention strategies aimed at enhancing patients' adherence in tuberculosis that may also be relevant to other chronic diseases with patient adherence problems.