• Journal of Korean Academy of Nursing
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• v.26 no.4
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• pp.768-781
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• 1996

The problem of care of patients and families with Alzheimer's disease has become a conscious raising social policy issue in Korea. The government of the Republic of Korea has become cognizant of the situation and has begun searching for ways to remedy it. Thus, there is a need for a comprehensive under-standing of the situation in which patients and their families are struggling and the enormous problems of care. With a realization of the urgent need, this study was done to investigate the situation and the care needs of families with patients with Alzheimer's Disease, and to compare the effectiveness of services utilized by the families in terms of cost and effects on patient's conditions and on family live. The Subjects for the study were 29 families with hospitalized patients, 25 families utilizing hospital outpatient clinics, 14 families utilizing day care facilities, and 16 families with homebound patients. A total of 84 families were interviewed by four trained interviewers using structured and semistructured questionnaires. The data produced from these interviews included : the patient's stage of Alzheimer's disease, patient's bizarre behavior, hours spent on patient care per day, family burden and quality of life, direct and indirect costs encountered in the care of patients, and the families' evaluation of the effectiveness of the services received. The data were analyzed to determine the relationships between family charactersistics, patient's conditions and services utilization. The effectiveness of each of the service entities was assessed through families evaluation and hoped for service and comparisons were made between services in terms of the cost-effectiveness ratios. After initial comparison of cost-effectiveness ratios, further analysis was done to compare between groups for incremental effectiveness for each incremental unit of cost to determine the most cost-effective service entities. The findings of the study are as fellows : 1. The choice of living arrangement and the types of services are a function of the stage of Alzheimer's condition and the economic status of the family. 2. Comparision of the cost of care showed that most expenses were encountered in by families with hospitalization, families using outpatient services, and families using day care services in that order. The least expense was involved in the care of homebound patients. The economic burden felt by families was in the same order as expenses. 3. The average number of hours spent on daily patient care was 9.9 hours for the outpatient clinic users, 9.7 hours for homebound patients, and 5.4 hours for day care users. 4. There were significant differences in the patient's conditions (CDRL), bizarre behaviors and the families's burden by living arrangement and /or types of service. However, no significant difference was found between groups in the family's quality of life. 5. The families rated the services of day care center as most effective for the care of the patients and families, except for a few families who had experienced some improvement in the patient's conditions. The outpatient clinic users expressed psychological comforts mainly in that the patient was being taken care of. For those hospitalized patients, families expressed the comfort of being relieved of the burden of care and that the patient is being professionally cared for. Form the analysis of the costs, hours of patient care, patient's bizarre behaviors, family's quality of life and burdens, and family's evaluation of services, it is concluded that up to the mid stage of Alzheimer's condition, the utilization of day care center services is found to be the most cost-effective, and toward the end stage of the Alzheimer's disease, it is hoped that there will be a establishment of long term or short term in-patient facilities for the protection of patients and preservation of the integrity of families for less cost. Thus. it was concluded that the family centered system of care is the most effective for Korea with systematic support systems developed for the care of patients and their families according to the needs of families as the patient's condition deteriorates.

• Korean Journal of Social Welfare
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• v.57 no.2
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• pp.5-40
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• 2005

Social welfare centers and residential care facilities where provide the socially disadvantaged with proper social services, face financial difficulties. This is because not only of the lack of governmental support, but also of social welfare centers and residential care facilities' lack of skills in developing abundant resources from the private sector. In this context, this study tried to find factors affecting resource mobilization of the social welfare facilities to devise policies in resource development. Mail survey was conducted with the structured questionnaire. Employees in charge of community resource development were asked to answer the questionnaire. The study population were welfare centers and residential care facilities. A total of 293 community welfare centers and 632 residential care facilities responded to the survey. The response rate was about 62%. The dependent variables of the study were the amount of resource mobilization in the year 2001 which was measured as the number of donors, the total amount of donation, and estimated amount of gift-in-kind. Three types models were constructed per each welfare institution. Independent variables were selected based on the previous research findings: community environment factor, structural factor, and resource development factor. Multiple regression was utilized to analyze the data. The resource development factor turned out to be significant variable in various models. In the models of donors, the amount of donation, and the amount of gift-in-kind (except for the welfare center model), at least one out of six variables of the resource development factors was significant welfare center. Welfare centers which establish the resource development department or hire employees to take care of resource development, utilize computer softwares to file donors, and utilize donor management programs, have more donors and/or donations than their counterparts. In addition, residential care facilities located in urban area have more donors and donations, and among residential facilities those for the disables, those with longer history and more employees, receive more donations than their counterparts. As for the gift-in-kind model, the welfare centers located in high income area and residential care facilities for the elderly, children and mentally retarded receive less gift-in-kind than their counterparts Based on the above findings, this study suggested that to mobilize resources the welfare centers as well residential care facilities need to have community resource development department or resource development staffs, adopt computer software to systematically organize donors, and utilize donor mobilizing and maintaining programs.

• Sleep Medicine and Psychophysiology
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• v.13 no.1
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• pp.27-32
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• 2006

Objectives: Nasal continuous positive airway pressure (nCPAP) is the treatment of choice and has been shown to reduce the frequency of nocturnal respiratory events, improve sleep architecture, and decrease daytime sleepiness in patients with obstructive sleep apnea syndrome (OSAS). However, little is known about the compliance of nCPAP treatment in Korea. Our objective was to look into the nCPAP compliance and examine the factors influencing it. Methods: We reviewed the records of one hundred and twenty consecutive patients with OSAS referred for nocturnal polysomnography with nCPAP pressure titration during the period of January 1995 through April 1999 to the Seoul National University Hospital. We performed a telephone interview and obtained data from eighty-three patients. Results: In sixty patients who had accepted nCPAP treatment, twenty-six patients (43.3%) were still using nCPAP device, while thirty-four patients (56.7%) stopped using it. Fifteen patients (25%) were using nCPAP device everyday. In thirty-four patients who discontinued nCPAP use, twenty-five patients (73.5%) did within the first three months, and thirty-one (91.2%) within the first year. Significant predictor of long-term nCPAP use was the presence of subjective daytime sleepiness before nCPAP application. Conclusions: Long-term compliance with nCPAP treatment appears to be associated with the presence of subjective daytime sleepiness before nCPAP application. Long-term compliance with nCPAP may be mostly predicted from the usage pattern within the first three months of use.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.6 no.1
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• pp.56-64
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• 1995

Family is a primary unit of the major socialization processing for children. Parents among the family members are one of the most important figures from whom the child and adolescent acquire a wide variety of behavior patterns, attitudes, values and norms. An organization of family members product family structural functioning. Abnormal family structure is one of the most important reference models in the learning of antisocial patterns of behavior. Therefore incest and child sexual abuse including spouse abuse, elderly abuse, and neglect occurs in the abnormal family structural setting. In particular, incest, a specific form of sexual abuse, was once thought to be a phenomenon of great rarity, but our clinical experiences, especially over the past decade, have made us aware that incest and child sexual abuse is not rare case and on the increasing trend. Therefore, the aim of this study was to determine the family problem and dynamics of incest family, and character pattern of post-incest adolescent victim in Korea. A total of 1,838 adolescents from middle and high school(1,237) and juvenile correctional institute(601) were studied, sampled from Korean student population and adolescent delinquent population confined in juvenile correctional institutes, using proportional stratified random sampling method. The subjects' ages ranged from 12 to 21 years. Data were collected through questionnaire survey. Data analysis was done by IBM PC of Behavior Science Center at the Korea university, using SAS program. Statistical methods employed were Chi-square, principal component analysis and t-test etc. The results of this study were as follows ; 1) Of 1,071 subjects, 40(3.7%) reported incest experiences(sibling incest : 1.6% ; another type of incest : 2.1%) in their family setting. 2) The character pattern of post-incest adolescent victim was more socially maladjusted, immature, impulsive, rigid, anxious and dependent than non-incest adolescent. Also they showed some problem in academic performance and their assertiveness. 3) The other family members of incest family revealed more psychological and behavioral problem such as depression, alcoholism, psychotic disorder and criminal act than the non-incest family, even though there is no evidence of the context between them. 4) The family dynamics of incest family tended to be dysfunctional trend, as compared with non-incest family. It showed that the psychological instability of family member, parental rejection toward their children, coldness and indifference among family member and marital discordance between the parents had significant correlation with incest.

• Journal of agricultural medicine and community health
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• v.30 no.2
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• pp.227-240
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• 2005

Health promotion has more comprehensive approaches in recent years. Nevertheless we accept the concept of health promotion differently, we are agree on that community is the most important field in health promotion which includes population at the aspect of health policy, individual skill and, environment. And there are a number of different approaches to health promotion. In them, 'population approaches' and 'high -risk group approaches' has the most different characteristics. 'Population approaches' is equally important or more important than 'individual approaches' for maintaining and promoting population health. Almost part of this article contents is the summary of the guideline and population strategy of health promotion in Korea, 1999 - 2005. Community based health promotion program should be reinforced, integrated, comprehensive, collaborative through efficiently utilizing community resources. Recent new orientation of community health program is integrated health program, we can find this orientation at Ottawa charter 1986. Comprehensive approaches with the determinant factors for health are essential task. Physical activity is a key health determinant. The population-health approach suggests that educating people about physical activity is not enough. Individual behavior changes are important too, but need to be balanced with strategies for environmental change. Population strategy with physical activity for health promotion should be developed through improving social and physical supportive environment, linking and integrating community resources between public and private sectors in national, regional and local level. Continuous public education and social marketing should be provided through collaborating with community physical activity organization, facilities, work-places and school for increasing concern of all the people of community about physical activity. Governments, agencies and citizens should held and participate to building movement. And the strategy that various 'active for life' program should be developed, delivered, maintained and reinforced continuously. Basically, adequate and sufficient financing, developing human resources, policies and legislation would be provided and supported fully too. At last, research development and knowledge exchange are required domestically and internationally. In Korea, we had classified the category of strategic priority of physical activity programs by environmental support, life-course approach, high-risk group approach and disease group approach for physical activity program based on community health center. Community based core programs for physical activity that includes infrastructure building and establishment of supporting environment, community campaign, health promotion education and public service announcement, physical activity programs for elderly and obesity, exercise prescription program.

• Journal of Hospice and Palliative Care
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• v.9 no.2
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• pp.77-85
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• 2006

Purpose: The purpose of this study is to develop the basic curriculum for the nurses who work at hospice and palliative care settings. Methods: Seven curricula of hospice and palliative care for the nurses in Korea and other countries were reviewed, and Education Need for hospice and palliative care was surveyed from 162 nurses by mailing the questionnaires to hospice palliative care settings. Results: 1. The curricula of hospice and palliative care for the nurses in Korea and other countries in common include 'understanding of hospice and palliative care', 'understanding of lift and death', 'pain and symptom management for person with terminal disease', 'on-the-spot study and practical training', 'management of hospice and palliative ward', 'hospice and palliative care at home', 'physical assessment', 'therapeutic communication skills', 'children's hospice', 'administration and management of hospice and palliative care', 'interdisciplinary team of hospice and palliative care', 'ethics and laws in hospice and palliative care', 'psychological, social and spiritual care', 'care of the dying', 'bereavement care', etc. 2. The scores above 3.3 were marked for 34 items in education Need Survey. The highest scores were given in the order for the items 'understanding of death and dying', 'attitude and response to death and dying', 'understanding and assessment of pain' etc. respondents marked that they have been trained for 'pain and symptom management', 'ethics and laws in hospice and palliative care', 'building the system for cooperation and publicity activities in hospice' etc. 3. The basic curriculum of hospice and palliative care for the nurses requires 78 studying hours for 17 subjects, comprising 48 hours of theory education and 30 hours of practical training. The education methods are lectures, discussions, and case studies. Conclusion: The efforts of developed basic curriculum should be evaluated after educating nurses. It is necessary to develop the standard curriculum and regularly update it based on the result of education Need Survey for actively working nurses in hospice and palliative care settings.

• Journal of the Korean Institute of Traditional Landscape Architecture
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• v.31 no.3
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• pp.25-37
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• 2013

The purpose of this study is to draw reasonable management plans to reinforce essence of Ohyundan(五賢壇: Five sprit tablets), a sacred site and monument of Jeju, by investigating and analyzing current status and problems of cultural landscape elements(e.g. architectural structures, installation, letters carved on the rocks, actual vegetation, etc.) while grasping placeness contained in Ohyundan through consideration of its history and transition process of Ohyundan a future being and shrine of Gyulrim Seowon(橘林書院) in Jeju. Results derived from research are summarized as follows. Ohyundan is noted due to its placeness in that it was a place for Gyulrim Seowon, Jeju's one and only Saaek Seowon(賜額書 院) and it was a symbolic space of exile culture in Jeju. As it is inferred from Gyulrim Seowon, which is dangho(堂號: clan name) of Seowon, orchards surrounding all over places are a signature landscape element that shows placeness of the past Ohyundan. Joduseok(俎豆石: altar stone), representing a core installation of Ohyundan and ancestral tablet of five spirits, created a refined place by putting up common stones around altar and founding blocked stones to wall. This refinement and thrift served basic mind of Neo-Confucianism, and led to of Jeju's Jonyang mind(spend-thrift mind). In conclusion, a practice plan is a prerequisite to restore essence of Ohyundan by actively excluding installations not suitable for placeness or overly designed such as Jeju Hyangrodang(a center for the elderly) and numerous monument houses. On the other hand, together with Joduseok, as letters carved on the rocks such as 'Jeungjoo Byukrip(曾朱壁立)' and 'Gwangpoongdae(光風臺)' and Yoocheonseok serve as a signature landscape that well shows mind of five spirits and teaching of Neo-Confucianism, and also a trace from a confucian viewpoint deeply rooted in Jeju, they are judged as a cultural landscape corresponding to the essence of place in Ohyundan which requires proactive preservation and plans for public relations. Together with this, although many different old big trees such as Pinus densiflora , Pinus thunbergii, Quercus variabilis, Celtis sinenis, Zelkova serrata and Rhus succedanea are a landscape element that increases sacred Ohyundan and commemorative value, now required is thorough entity tree management by assigning serial number on them as many of them were dead or removed resulting from transition process of land use. Further, to reinforce quality of site location belonging to Gyulrim Seowon, a prerequsite is to review plans that create Gyulrim at reinstalled site of building and raw land.

• Sleep Medicine and Psychophysiology
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• v.24 no.1
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• pp.38-45
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• 2017

Objectives: Sleep disturbance is a very rapidly growing disease with aging. The purpose of this study was to investigate the prevalence of sleep disturbances and its predictive factors in a three-year cohort study of people aged 60 years and over in Korea. Methods: In 2012 and 2014, we obtained data from a survey of the Korean Social Life, Health, and Aging Project. We asked participants if they had been diagnosed with stroke, myocardial infarction, angina pectoris, arthritis, pulmonary tuberculosis, asthma, cataract, glaucoma, hepatitis B, urinary incontinence, prostate hypertrophy, cancer, osteoporosis, hypertension, diabetes, hyperlipidemia, or metabolic syndrome. Cognitive function was assessed using the Mini-Mental State Examination for dementia screening in 2012, and depression was assessed using the Center for Epidemiologic Studies Depression Scale in 2012 and 2014. In 2015, a structured clinical interview for Axis I psychiatric disorders was administered to 235 people, and sleep disturbance was assessed using the Pittsburgh Sleep Quality Index. The perceived stress scale and the State-trait Anger Expression Inventory were also administered. Logistic regression analysis was used to predict sleep disturbance by gender, age, education, depression score, number of coexisting diseases in 2012 and 2014, current anger score, and perceived stress score. Results: Twenty-seven percent of the participants had sleep disturbances. Logistic regression analysis showed that the number of medical diseases three years ago, the depression score one year ago, and the current perceived stress significantly predicted sleep disturbances. Conclusion: Comorbid medical disease three years previous and depressive symptoms evaluated one year previous were predictive of current sleep disturbances. Further studies are needed to determine whether treatment of medical disease and depressive symptoms can improve sleep disturbances.

• Journal of Hospice and Palliative Care
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• v.10 no.3
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• pp.137-144
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• 2007

Purpose: The purpose of this study is to identify and assess the needs of the cancer patients and their families and provide basic data to meet with their needs. Methods: This is a descriptive study using questionnaire method. Questionnaire were collected by mail from 76 discharged patients from a hospice ward from May until the end of October, 2004, and data were analyzed by SPSS 10.0. Results: Admitted patients had needs of pain control (85.5%), non-pain symptoms (63.2%) such as vomiting, dyspnea, ascites, etc, and emotional and spiritual problem solving (28.9%, 14.5%). Interests of patients were health care of himself/herself (65.8%), concern for their spouses left alone (32.9%), and future of their children (15.8%). In families' needs of care of 5 areas, "information on patient's status and treatment/nursing care" was shown most high score ($3.48{\pm}0.62$). In detailed questions, they request most 'to inform the prognosis of patients' and the next is 'to inform the reasons that nursing care was required'. The next highest score was to 'inform family roles' ($3.39{\pm}0.64$), and next was spiritual support ($3.11{\pm}0.79$), and emotional support ($3.08{\pm}0.72$). Expectations of family on the treatment were comfortable dying (73.4%) scored the highest. Patients' families were satisfied with volunteer service most in service area (97.4%). The next was pain control (89.5%) and nursing service (77.6%). Conclusion: Health care staff should identify the actual needs of families caring cancer patients and they should operate realistic programme which can give continuous and assistance by reflecting individual needs and characteristics. With these srategies, the quality of life of patients and families can be improved. And then the intervention programme should be developed to measure subjective nursing care needs of terminally ill cancer patients and their families.

• Journal of Hospice and Palliative Care
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• v.11 no.1
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• pp.42-50
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• 2008

Purpose: Undertreatment of canter pain, especially due to the differences in the perception of pain between the patients and caregivers, is a well recognized problem. The purpose of this study were to determine if there exist differences in communication about pain intensity scores between patients and their family caregivers in Korea. Methods: A total of 127 patient-family caregiver dyads who have experienced canter pain participated in this study at a hospital in Seoul for six months. The data were obtained by fare to face interview with a structured questionnaire based on Brief Pain Inventory-Korean version and other previous researches. The clinical information for all patients was compiled by reviewing their medical records. Results: Patients' 'worst-pain for 24-hour' and 'right-now-pain' scores estimated by family caregivers were significantly higher than those by patient themselves. The degree of agreement between patients and family caregivers in the estimate of patients' 'worst-pain for 24-hour' intensity categories was 78.7% for 'severe pain', 40% for 'no pain', 27.5% for 'mild pain' and 22.9% for 'moderate pain'. In case of 'right-now-pain' intensity categories, the agreement was 50% for 'severe pain', 47.2% for mild pain, 46.3% for 'no pain', and 26.3% for 'moderate pain'. Conclusion: This study demonstrates that the degree of agreement between patients and family caregivers in the estimate of patients 'pain intensity categories was less than 50% except for 'severe pain'. The results indicate that Korean family caregivers tend to overestimate the canter pain intensity of their caring patients, especially, when a lancer patient has 'moderate' or 'mild pain'. Health Providers are advised to educate patient-family caregiver dyads to use a pain measurement scale to promote their agreement in pain Intensity stores. Further analyses and studies are needed to identify the factors and differences that influence their communication about pain intensity scores between patients and their family caregivers.