• 대한임상독성학회지
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• 제17권1호
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• pp.21-27
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• 2019

Purpose: Mortality rate in the health services research field is frequently considered as a proxy for measuring healthcare quality. We compared the mortality rate and hospitalization levels among patients with poisoning. Methods: A population-based study of hospital size and level based on the Korean health insurance and assessment service was conducted to identify the impact of hospital level on patient mortality. Results: We analyzed a total of 16,416 patients, of which 7,607 were from tertiary hospitals, 8,490 were from general hospitals, and 319 were from hospitals. The highest mortality rate of diagnosis regarding poisoning was T60.31 (other herbicides and fungicides, 16%), followed by T60.0 (organophosphate and carbamate insecticides, 12.7%). There was no statistical difference in mortality among hospital levels for gender. Among age groups, tertiary hospitals had lower mortality than general hospitals and hospitals for patients aged more than 70 years (11.9% mortality at tertiary vs 14.2% at general and 23% at hospital; p=0.003, adjusted z score=-6.9), general hospitals had lower mortality than tertiary hospitals and hospitals for patients aged 18 to 29 (0.6% at general vs 2.4% at tertiary and 3.7% at hospital; p=0.01, adjusted z score=-4.3), and hospitals had lower mortality than tertiary hospitals and general hospitals for patients between 50 and 59 years of age (0% at hospital vs 6.4% at general and 8.3% at tertiary; p=0.004). Conclusion: Overall, there was no significant difference between mortality and hospital level among poisoned patients. However, to establish an efficient treatment system for patients with poisoning, further studies will be needed to identify the role of each facility according to hospital level.

• 재활복지
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• 제21권1호
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• pp.47-70
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• 2017

본 연구의 목적은 역학적 요인(우울), 행위적 요인(일상생활 수행능력), 소인요인(자기효능감), 강화요인(가족지지, 전문가 지지), 촉진요인(자원이용가능성, 접근성)이 농촌지역 재가 장애인의 삶의 질에 미치는 영향요인을 파악하기 위한 것이다. 연구의 개념적 기틀은 Green과 Kreuter의 PRECEDE 모형을 기반으로 하였다. ${\bigcirc}$군 보건소에서 실시한 지역사회중심 재활사업 기초조사 결과 자료를 근거로, 기초조사에 참여한 190명중 186명이 최종분석에 포함되었다. 선택된 요인들과 삶의 질 간의 직 간접 경로를 파악하기 위하여 AMOS 19.0을 이용하여 자료를 분석하였다. 모형 검증 결과 농촌지역 재가 장애인의 삶의 질은 85.5%의 설명력을 가지며, 역학적 요인(우울)과 강화요인(가족지지, 전문가지지)에 의해 직접적 영향을 받은 반면, 행위적 요인(일상생활수행능력), 소인요인(자기효능감), 촉진요인(자원이용가능성, 접근성)을 통하여 간접적 영향을 미치는 것으로 나타났다. 본 연구 결과는 농촌지역 재가 장애인의 삶의 질 증진을 위한 재활사업 계획 시 우울을 감소시키거나 가족이나 건강전문가로부터의 지지를 강화해야 할 필요성을 조명하였다. 뿐만 아니라 자기효능감 향상을 위한 전략을 세우고 지역의 보건기관과 전문 의료기관과의 연계를 확대하는 것도 농촌지역 재가 장애인을 위한 지역사회 중심 재활서비스에 유용할 수 있음을 제안하였다.

• 고령자･치매작업치료학회지
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• 제12권2호
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• pp.1-11
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• 2018

목적 본 연구는 노령 또는 치매로 활동제한이 있는 노인과 활동제한이 없는 노인의 사회인구학적 특성, 우울, 삶의 질, 그리고 미충족 의료를 비교하고자 하였다. 연구방법 데이터는 2016년 국민건강영양조사 원시자료를 이용하였으며, 노령 또는 치매로 활동제한이 있는 노인 32명과 활동제한이 없는 노인 1201명을 비교분석하였다. 연구결과 노령 또는 치매로 활동제한이 있는 노인은 활동제한이 없는 노인보다 나이가 유의하게 많았으며(p<.001), 가구소득은 낮았고(p<.05), 결혼상태는 사별이 더 많았다(p<.001). 노령 또는 치매로 활동 제한이 있는 노인은 활동제한이 없는 노인보다 우울이 더 높았고(p<.001), 삶의 질은 유의하게 낮았다(p<.001). 미충족 의료 여부는 노령 또는 치매로 활동제한이 있는 노인이 활동제한이 없는 노인보다 적절한 의료 서비스를 받지 못하고 있었다(p<.001). 결론 치매 또는 노령으로 인한 활동제한이 있는 노인은 활동제한이 없는 노인과 비교하여 가구소득이 더 낮으며, 배우자가 사별인 경우가 더 많고 우울이 더 심각하고 삶의 질이 낮음에도 불구하고 의료서비스를 충분히 받지 못하고 있는 것으로 나타났다. 이러한 결과는 치매 및 노령 인구의 건강관리를 위한 복지체계의 개선이 필요함을 시사한다.

• 대한통합의학회지
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• 제7권2호
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• pp.111-119
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• 2019

Purpose : The aim of this study was to investigate patterns of medical use among juveniles and adolescents, including for chronic disease, in Korea. The study sought to do the following: (a) investigate the extent to which chronic diseases account for medical expenditures, (b) investigate and the socio-demographic characteristics associated with medical use, and (c) identify the differences in medical use between juveniles and adolescents. Methods : We used data from the 2015 Korean Health Panel and selected 12 variables. The socio-demographic characteristics investigated included, growth period (juvenile, adolescents), gender, family income, national basic livelihood act status, disability registration, and degree of disability. There were five medical factors that were considered: emergency room use, hospitalization use, hospital outpatient use, chronic disease, and medical expenditure. Data were analyzed using stepwise multiple and logistic regression. Results : The prevalence of chronic disability in juveniles and adolescents was 31.1 % and 1 %, respectively. The factors affecting medical expenditures included hospitalization use, hospital outpatient use, family income, disability, gender, chronic disease, and emergency room use ($R^2=.160$, p<.05). For national basic livelihood act recipients, the probability of having chronic disease was about 1.6 times higher (OR=1.597, 95 % CI=1.092-2.335, p=.016), compared with non-national basic livelihood act recipients. People with disabilities were 6.6 times more likely than those without disabilities to suffer from chronic disease (OR =6.571, 95 % CI=2.776-15.556, p<.001). Hospital outpatient user was 2.3 times higher than non-user (OR=2.260, 95 % CI=1.702-3.001, p<.001). Juveniles had a 1.7 times and 6.2 times higher likelihood of emergency rooms user (OR=1.654, 95 % CI=1.270-2.155, p<.001), and hospital outpatient user than adolescents (OR=6.208, 95 % CI=4.443-8.676, p<.001). Conclusion : The findings of this study suggest that health care services for juveniles is needed to manage chronic diseases that have an effect on medical expenditures.

• Korean Journal of Acupuncture
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• 제37권4호
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• pp.209-230
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• 2020

Objectives : Practice-Based Research Networks (PBRNs), collaborations of practitioners and academic researchers, have provided platforms for conducting research to address clinical questions generated from daily routine care. This review aimed to critically analyse articles from PBRNs that are related to complementary and integrative medicine (CIM) and to suggest future directions for a PBRN which is appropriate for Korean Medicine (KM). Methods : PubMed, PBRN registries in Agency for Healthcare Research and Quality and relevant PBRN websites were searched up to November 2019 for research articles from PBRNs that focused on CIM regardless of study design. Methodological quality of the included studies was assessed. The included studies were read in full, classified and summarised according to their topics. Results : A total of 51 articles published from 1998 through 2020 were included in this review. They were categorised into three principal themes based on research questions and findings: health services research (embracing researches examining characteristics of patients and CIM practitioners/practices, and communication between patients and practitioners); effectiveness and safety of CIM practices/interventions; and feasibility studies of instruments and interventions in PBRN settings. The study designs varied including surveys (n=30), prospective observational studies (n=6), 2ndary analyses of existing studies (n=7), protocols (n=7), retrospective chart review (n=1) and qualitative study (n=1). Quality of the included studies greatly varied. Conclusions : PBRNs can serve as a feasible platform for conducting practice-relevant research on KM and CIM. Considering growing demands on evidence-base for routine practice of KM amid various stakeholders, a PBRN in KM community and further researches nested within PBRN designs are warranted.

• 대한치과의료관리학회지
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• 제8권1호
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• pp.1-7
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• 2020

Dental settings have unique characteristics that warrant specific infection control considerations, including (1) prioritizing the most critical dental services and provide care in a way that minimizes harm to patients due to delayed care, or harm to personnel from potential exposure to persons infected with the COVID-19 disease, and (2) proactively communicate to both personnel and patients the need for them to stay at home if sick. For health care, an interim infection prevention and control recommendation (COVID-19) is recommended for patients suspected of having coronavirus or those whose status has been confirmed. SARS-CoV-2, which is the virus that causes COVID-19, is thought to be spread primarily between people who are in close contact with one another (within 6 feet) through respiratory droplets that are produced when an infected person coughs, sneezes, or talks. Airborne transmission from person-to-person over long distances is unlikely. However, COVID-19 is a new disease, and there remain uncertainties about its mode of spreads and the severity of illness it causes. The virus has been shown to persist in aerosols for several hours, and on some surfaces for days under laboratory conditions. COVID-19 may also be spread by people who are asymptomatic. The practice of dentistry involves the use of rotary dental and surgical instruments, such as handpieces or ultrasonic scalers, and air-water syringes. These instruments create a visible spray that can contain particle droplets of water, saliva, blood, microorganisms, and other debris. While KF 94 masks protect the mucous membranes of the mouth and nose from droplet spatter, they do not provide complete protection against the inhalation of airborne infectious agents. If the patient is afebrile (temperature <100.4°F)* and otherwise without symptoms consistent with COVID-19, then dental care may be provided using appropriate engineering and administrative controls, work practices, and infection control considerations. It is necessary to provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub (ABHR) with 60%~95% alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins. There is also the need to install physical barriers (e.g., glass or plastic windows) in reception areas to limit close contact between triage personnel and potentially infectious patients. Ideally, dental treatment should be provided in individual rooms whenever possible, with a spacing of at least 6 feet between the patient chairs. Further, the use of easy-to-clean floor-to-ceiling barriers will enhance the effectiveness of portable HEPA air filtration systems. Before and after all patient contact, contact with potentially infectious material, and before putting on and after removing personal protective equipment, including gloves, hand hygiene after removal is particularly important to remove any pathogens that may have been transferred to the bare hands during the removal process. ABHR with 60~95% alcohol is to be used, or hands should be washed with soap and water for at least 20 s.

• 재활치료과학
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• 제10권1호
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• pp.63-75
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• 2021

목적 : 본 연구는 보건소에 근무하는 작업치료사들의 지역사회 재활 및 보건서비스 제공에 관한 업무 경험에 대한 이해를 통해 향후 건강한 지역사회를 만들기 위해 보건소 작업치료사들의 역할 및 업무들을 알아보고자 하였다. 연구방법 : Giorgi의 현상학적 연구방법론을 적용하여, 지역사회 내 근무하는 보건소 작업치료사 6명에게 심층 인터뷰를 진행하였다. 사전 동의를 통해 대화 내용은 녹음되었고, 녹음된 자료는 패턴화된 반응이나 주제를 분석하고자 Colaizzi의 주제 분석법(Thematic analysis) 7단계에 따라 분석하였다. 결과 : 분석 결과, 4개의 범주와 16개의 주제, 24개의 하위요인을 도출하였다. 보건소 내 작업치료사가 주로 행하는 업무 영역 및 역할은 대상자 평가, 방문재활치료, 치매관리사업, 지역사회 연계사업으로 나타났다. 그 외 작업치료사가 느끼는 건강한 지역사회를 만들기 위해 향후 보건소에서 필요한 중재는 사례관리 및 프로그램 매니지먼트, 다양한 보상적 접근방법 적용, 건강한 생활습관을 위한 중재로 나타났다. 보건소 근무 시 작업치료사들이 경험하는 어려움으로는 작업치료사의 인력 부족, 고용 불안정으로 인한 사기저하, 실적 위주의 행정 정책으로 인한 업무의 부담감, 전문인력 간 소통의 부족으로 나타나는 업무 효율성 저하가 나타났다. 반면에 보건소에서 근무하는 작업치료사들이 느끼는 보람으로는 치료의 자율성 보장을 가장 큰 장점으로 응답하였다. 보건소 작업치료사의 역량 강화를 위해 필요한 교육으로는 보건행정, 보건소 실습으로 나타났다. 결론 : 본 연구결과는 현재 보건소 및 치매 안심 센터의 필수인력으로 자리 잡은 작업치료사들의 향후 업무 범위 및 역할과 관련된 가이드라인과 지역사회 공공서비스 내 역량 있는 작업치료사를 양성하기 위한 교육의 기초자료로 활용될 수 있을 것이다.

• 한국치위생학회지
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• 제21권4호
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• pp.467-479
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• 2021

Objectives: The purpose of this study was to investigate the awareness of the performance and necessity of oral health promotion activities and seek ways to revitalize the professional role of dental hygienists in oral healthcare for the efficient oral care of the elderly. Methods: Eighty-five dental hygienists in charge of oral health promotion projects at public health centers and 38 dental hygienists in network dental clinical trials were investigated for their learning experience, performance experience, feasibility, and necessity of dental hygienists for general and oral health service items for the elderly. The collected data were analyzed using frequency analysis, chi-square test, and Mann-Whitney U test. Results: The degree of performance possibility according to the learning experience and performance experience of the dental hygienist for the whole body and oral health promotion activity items for the elderly showed that the degree of performance possibility was higher among those with experience compared to the non-experienced person, and it was statistically significantly higher (p<0.05). Conclusions: The dental hygienist's professional oral health service is a necessary system to improve practical knowledge and skills and to provide a wide range of professional oral health services for the elderly.

• 정보처리학회논문지:소프트웨어 및 데이터공학
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• 제11권4호
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• pp.163-168
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• 2022

클라우드 컴퓨팅과 사물인터넷의 대중화에 따라 사물인터넷 컴퓨팅 환경에 존재하는 인터넷 연결이 가능한 장치들의 수가 점차 증가하고 있다. 또한 스마트홈, 헬스케어 등 사물인터넷을 이용한 다양한 인터넷 응용이 많아짐에 따라 통신 지연 및 연산의 신뢰성과 같은 지표의 서비스품질과 관련된 연구들이 진행되고 있다. 사물인터넷 응용의 서비스품질 향상을 위해 중앙집중형 클라우드 서버에 연결하기 보다 장치와 가까이 존재하고 중앙집중형 클라우드 서버와의 오프로드(offload) 협업을 위해 에지 컴퓨팅(edge computing)이 결함된 클라우드-포그 컴퓨팅 환경이 주목을 받고 있다. 하지만 클라우드-포그 컴퓨팅 환경에서 장치들이 이동성을 특성을 가질 때 사물인터넷 응용 서비스의 연속성이 떨어지고 서비스품질 수준이 저하되는 문제점이 발생하고 있다. 이 논문에서는 에지 기반 포그 컴퓨팅 환경에서 이동성 지원을 위한 라이브 마이그레이션 기반 자원 관리 기법을 제안한다. 제안하는 자원 관리 알고리즘은 사용자의 이동성 방향과 속도를 기반으로 일정 시간 뒤의 위치를 예측하고 이를 기반으로 라이브 마이그레이션을 통해 사물인터넷 서비스 이주를 지원한다. 성능 평가를 통해 제안하는 자원 관리 알고리즘의 효용성을 측정하였으며, 성능 실험에서 정지시간(downtime)과 서비스 작업의 신뢰성이 크게 향상됨을 보였다.

• Journal of Preventive Medicine and Public Health
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• 제55권1호
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• pp.88-97
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• 2022

Objectives: This study investigated the determinants of depression in adolescents and young adults. Methods: The present study analyzed data from the 2018 Indonesia Basic Health Survey (Riset Kesehatan Dasar; RISKESDAS). The study subjects were adolescents (15-17 years old) and young adults (18-24 years old). In total, 64 179 subjects were included. Univariable, bivariable, and multivariable logistic regression analyses were performed to determine associations between youths' characteristics, risky behavior, chronic disease, parents' health, and youths' depression. Results: The prevalence of depression was 5.1% in adolescents and 5.6% in young adults. The risk factors for depression in adolescents were being women (adjusted odds ratio [aOR], 3.53; 95% confidence interval [CI], 2.89 to 4.30; p<0.001), an ex-smoker (aOR, 2.99; 95% CI, 2.10 to 4.25; p<0.001), or a current smoker (aOR, 2.60; 95% CI, 1.97 to 3.44; p<0.001); consuming alcohol (aOR, 2.00; 95% CI, 1.33 to 3.01; p=0.001), having a chronic disease (aOR, 2.64; 95% CI, 1.41 to 4.96; p=0.002); maternal depression (aOR, 2.47; 95% CI, 1.97 to 3.09; p<0.001); and paternal depression (aOR, 2.63; 95% CI, 1.98 to 3.50; p<0.001). In young adults, the risk factors were being women (aOR, 2.23; 95% CI, 1.82 to 2.75; p<0.001) or an ex-smoker (aOR, 2.47; 95% CI, 1.67 to 3.67; p<0.001), consuming alcohol (aOR, 2.42; 95% CI, 1.89 to 3.09; p<0.001), maternal depression (aOR, 3.12; 95% CI, 2.54 to 3.84; p<0.001), and paternal depression (aOR, 2.80; 95% CI, 2.17 to 3.63; p<0.001). Conclusions: Being women, smoking, drinking alcohol, having a chronic disease, and having a parent with depression were crucial factors associated with youth depression. Mental health screening, prevention, and treatment should involve collaboration among primary healthcare, schools, universities, professionals, and families.