• Journal of Korean Public Health Nursing
• /
• v.6 no.2
• /
• pp.70-107
• /
• 1992

This study was intended to assess the need of home nursing care and analyze the effect of home nursing care, and find out the problems during the performance of home nursing care for the chronic patients among the low-income people in urban area. Data collection by interview was carried out from Nov. 1991 to Jul. 1992. The main results were as follows; 1) Total subjects for the need assessment of home nursing care were 123 households wi th 488 persons in a urban poor area. Over half of households $(57.7\%)$ was teenage family. The overall living conditions were poor and the average monthly income was 580 thousands won. $74.8\%$ of subjects was covered by medical care insurance and only $4.7\%$ was covered by public assistance. The morbidity rate was $8.2\%$ among 488 subjects and $27.5\%$ of them was not treated at all, $30\%$ was treated in utilizing pharmacies or local clinics. 2) The subjects of home nursing care were 46 with Hypertension or DM who agreeded the participation of study among registered patients at a public health center in Incheon. Home visiting was performed at intervals per one month for one year. Most of them were the elder(mean age=61 years) and long term patients(7.8 years continued). Home nursing care was effective. That is, blood pressure(including systolic and diastolic pressure) was significantly reduced (t(n=22)=2.31, P=.031, t(n=24)=4.16, P=.000 respectively) and knowledge of disease(t(N=46)=-7.63, P=.000), attitude of disease (t(N =46) = -4.92, P=.000), and self-care(t(N =46) = -4.89, P= .000) were significantly improved through home nursing care. But there was no difference in blood sugar for diabetics between the beginning and the end of visits. At the beginning of visit for home nursing care, sex$(\beta=-0414,\;t=-3.012)$ and nursing need({3=.310, t=2.164) were influencing self-care, and duration of disease$(\beta=.297,\;t=2.106)$ and nursing need $(\beta=.385, t=20417)$ were influencing blood pressure, blood sugar level. Namely, the subjects who were male and had higher nursing need showed better self-care and the longer duration of disease and the higher nursing need were relationship with the better blood pressure and blood sugar level. At the end of visit for home nursing care after one year, the blood pressure and blood sugar level was influenced by age $(\beta.320,\;t= 2.242)$, duration of disease ($(\beta.352,\;t= 2.395)$ and nursing need $(\beta=.350,\;t=2.623)$ and self-care had no influencing factor. The higher age and the longer duration of disease and the higher nursing need were relationship with the better blood pressure and blood sugar level. 3) The problems that were found out during the performance of home nursing care were the absent of useful protocols for services and the clear evaluation base, and the difficulty of teaching elders who were the major part of our subjects.

• The Journal of the Korean dental association
• /
• v.58 no.9
• /
• pp.536-545
• /
• 2020

In preparing for the era of Korean reunification, it is essential to consider the integration of medical systems and human resources. While Korean dental practitioners are expanding their activities in various fields both domestically and internationally, there are many restrictions on the activities for improving the health of North Korean people due to political and historical reasons even nowadays. In addition, there is little is known about the current state of dental health in North Korea. We analyzed the reports published by the World Health Organization (WHO) and the Ministry of Public Health of North Korea prepared individually or in cooperation, and investigated the current status of the health care strategy applied to the dental field by conducting a full investigation of the 2018 『Rodong』newspaper. Based on the above, we tried to grasp the major health care strategies in North Korea and their application. Understanding the direction and status of North Korea's health care system would be an important cornerstone for international cooperation and practical activities to improve oral health care of North Koreans in the future. And there is a need that studies should be steadily conducted in various methods to overcome the heterogeneity of the two Koreas in the long-term perspective.

• Journal of Korean Academy of Nursing Administration
• /
• v.7 no.2
• /
• pp.205-221
• /
• 2001

It will become more and more popular to use the long-term care facilities and home health care services with the chronic disease increasing. It depends on how much the consumers would pay and purchase the services. They might get more benefits from that kind of services than from ordinary hospitalization. So far, the study of determining the medical service price has focused most often on the efforts from the providers' view. But it must be reasonable to include the consumers' value for the service. This study was performed to assess WTP(Willingness to Pay) for home health care service in order to apply to the determination of nursing price in a reasonable manner. In this study, respondents were asked if they would pay for the service's intangible benefits under the four different types(open-ended minimum WTP, open-ended maximum WTP, bidding WTP, referendum WTP). The contingent valuation method is a potentially useful tool in understanding how people value the benefits of the service. As a result, average open-ended minimum WTP was W16,015 per day among 65 respondents. Average open-ended maximum WTP was W29,154 per day among 65 respondents. Average bidding WTP was W26,300 per day among 65 respondents. Average referendum WTP was W22,200 per day among 70 respondents. The results of regression analyses were also consistent with theoretical prediction, e.g., increasing WTP with consumers' value for the service, state of patients, and household income. This study demonstrated that it was more reasonable to consider the consumers' value in determining the services' price. In addition, a further study is needed to test the validity of this CV method and to determine a proper nursing price based on the consumers' view.

• International Journal of Advanced Culture Technology
• /
• v.7 no.2
• /
• pp.28-33
• /
• 2019

Electronic health records (EHRs) enable us to use and re-use electronic data for various multiple purposes, such as public reporting, quality improvement, and patient outcomes research. Current hospital-acquired pressure injury (HAPI) risk assessment instruments have not been specifically developed for intensive care unit (ICU) patients and showed false positive rates in this specific populations. Previous research studies report a number of risk factors; however, it is still not clear what factors influence ICU HAPI in this population. As part of a larger research study, we performed an exploratory analysis by using a large electronic health record data. The aims of this study were to compare characteristics of patients who developed HAPIs during their ICU stay with those who did not, and to determine whether the two groups were different in the aspects of length of ICU stay, discharge disposition, and discharge destinations. We conducted chi-square test and t-test for group comparison. Association was examined by using bivariate analyses. Pearson correlation coefficients were used to examine correlation between LOS and number of medications. Our findings suggest a number of consistent and potentially modifiable risk factors, such as sedation, feeding tubes, and the number of medications administered. The mortality of the HAPI group was significantly higher than the non-HAPI group in our data. Discharge disposition was significantly different between the groups. 67% of the HAPI group transferred to intermediate or long-term care hospitals whereas 57.7% of the non-HAPI group went home after discharge. Awareness of these risk factors can lead to clinical interventions that can be preventative in the ICU setting.

• Quality Improvement in Health Care
• /
• v.5 no.2
• /
• pp.324-334
• /
• 1998

Background : Strategic planning is an organizationwide or systemwide, ongoing look into the future usually of 2~3 years, based on objective analysis of the current environment and trends, but it can incorporate both short-term and long-term goals. The strategic planning process includes external analysis, internal analysis, issue analysis, development of mission, vision and values, and lastly development of organizational goals and objectives. As a part of the strategic quality planning process, certain service lines, important organizationwide functions, or key processes supporting these functions can be prioritized to expedite and roll out certain strategic goals. This is called strategic quality initiatives. Methods : We organized a quality improvement team, a subgroup of 21st century vision planning corps of our medical center, and pursued QI activities for improvement of healthcare environment, particularly in the admission setting. We developed a strategic quality initiative based on the results of patient satisfaction surveys, and carried out functions of self-directed work team. Results : The strategic goal was to be the benchmark for peer group hospitals in Korea for providing cost-effective best-practice. The QI team included 3 medical doctors, 1 nurse, 1 social worker, and 1 QI consultant as well as many operational members to support services and quality initiatives met every Tuesday for 18 weeks. Outcome objectives were to improve patient satisfaction score. The issues included in the objectives were comfort, temperature, noise, cleanliness of the admission wards, quality and education of patient meals, matters regarding the admission process, and an appurtenant facility such as restaurant or convenience store. Every issue was discussed and recommendations, conclusions and opportunities were implemented. Conclusions : By developing a strategic quality initiative as a part of the strategic quality planning process, and pursuing a self-directed work team, certain sen/ice lines, important organizationwide functions, or key processes supporting these functions can be improved effectively within a short period. Strategic quality initiatives serve to support, or roll out, certain strategic goals that are relevant to performance improvement and development of specific measurable outcome objectives, and associated performance measure for each initiative. Each strategic quality initiative should include a statement of intent outcome objectives, and performance measures. We will come back with follow up of the strategic quality initiative, for improvement of healthcare environment, and results of patient satisfaction re-survey.

• Journal of Yeungnam Medical Science
• /
• v.2 no.1
• /
• pp.191-202
• /
• 1985

As the result of a significant improvement in the economic situation and development of scientific techniques in Korea during the last 20 years, the life expectancy of the Korean people has lengthened considerably and as a result the number of old aged people has markedly increased. Such an increase of the number of aged people brought about many problems. Authors would like to take a medical look at the "Problem of old aged people" presently facing us in Korea. Currently the number of people over 65 has increased rapidly and is 1,620,000, 4% of total population. But it is still much lower than 8.9% in Japan, 10.7% in U.S.A., and 14.9% in the United Kingdom. Over 25% of these aged people were found to have at least more than one disease which requires medical care. Diseases occur in the circulatory system, 30.9%, respiratory system, 17.1%, digestive system 8.6%, mental disorders, 8.4%, malignant neoplasms, 7.0%. About 51% of the aged over 65 are under medical security benefit, mostly with partial coverage plan. Their clinic visit rate was very low (2.0% in 1981), which might be due to financial reasons. Since diseases affecting the aged progress chronically, early detection and long term care are utter most important. However there is almost no special facility, long term care center or geriatric specialist. For proper management of medical problems in the growing population of the Korean eldery expansion of medical security coverage, greater number of specialized facilities, education of geriatric special manpower and efficient operating system should be established.

• Tuberculosis and Respiratory Diseases
• /
• v.56 no.6
• /
• pp.619-627
• /
• 2004

Background : Corticosteroids in combination with cytotoxic drugs are the mainstays of therapy for idiopathic pulmonary fibrosis (IPF). However, there has been no regimen showing any survival benefit. The aim of this study was to describe a short-term clinical experience on interferon gamma-1b (IFN-${\gamma}1b$) therapy for IPF, as an antifibrotic agent. Methods : Medical records of 27 patients who were treated with IFN-${\gamma}1b$ (2 million IU, 3 times a week, subcutaneous injection) were retrospectively reviewed. Treatment response was assessed using ATS/ERS criteria in 17 patients who received IFN-${\gamma}1b$ for more than 6 months. In addition, we compared the efficacy of IFN-${\gamma}1b$ therapy with that of cyclophosphamide${\pm}$prednisolone therapy (n=26). Results : The median age of IFN-${\gamma}$ treated group (M:F=19:8) was 59 years (44-74 years). Compared to the patients who showed a stable response at 6 months (n=12), the deteriorated group (n=5) had worse baseline lung function (FVC, $55.4{\pm}11.3%$ vs. $70.7{\pm}10.9%$, p=0.019; DLco, $50.3{\pm}7.3%$ vs. $76.9{\pm}19.6%$, p=0.014). Lower baseline $PaO_2$ on room air breathing was observed in the deteriorated group ($68.6{\pm}7.8mmHg$ vs. $91.4{\pm}6.6mmHg$ p=0.001). Subcutaneous IFN-${\gamma}1b$ did not show better efficacy than prednisolone. Five patients discontinued IFN-${\gamma}$ because of severe side effects. ARDS developed in one patient, who eventually died. Conclusion : The administration of IFN-${\gamma}1b$ is not desirable for patients diagnosed with IPF with poor lung function. Long-term and large-scaled clinical studies are needed for its efficacy in IPF.

• Preventive Nutrition and Food Science
• /
• v.16 no.4
• /
• pp.394-407
• /
• 2011

Better understanding of the complex factors leading to human diseases will be necessary for both long term prevention and for managing short and long-term health problems. The underlying causes, leading to a global health crisis in both acute and chronic diseases, include finite global health care resources for sustained healthy human survival, the population explosion, increased environmental pollution, decreased clean air, water, food distribution, diminishing opportunities for human self-esteem, increased median life span, and the interconnection of infectious and chronic diseases. The transition of our pre-human nutritional requirements for survival to our current culturally-shaped diet has created a biologically-mismatched human dietary experience. While individual genetic, gender, and developmental stage factors contribute to human diseases, various environmental and culturally-determined factors are now contributing to both acute and chronic diseases. The transition from the hunter-gatherer to an agricultural-dependent human being has brought about a global crisis in human health. Initially, early humans ate seasonally-dependent and calorically-restricted foods, during the day, in a "feast or famine" manner. Today, modern humans eat diets of caloric abundance, at all times of the day, with foods of all seasons and from all parts of the world, that have been processed and which have been contaminated by all kinds of factors. No longer can one view, as distinct, infectious agent-related human acute diseases from chronic diseases. Moreover, while dietary and environmental chemicals could, in principle, cause disease pathogenesis by mutagenic and cytotoxic mechanisms, the primary cause is via "epigenetic", or altered gene expression, modifications in the three types of cells (e.g., adult stem; progenitor and terminally-differentiated cells of each organ) during all stages of human development. Even more significantly, alteration in the quantity of adult stem cells during early development by epigenetic chemicals could either increase or decrease the risk to various stem cell-based diseases, such as cancer, later in life. A new concept, the Barker hypothesis, has emerged that indicates pre-natal maternal dietary exposures can now affect diseases later in life. Examples from the studies of the atomic bomb survivors should illustrate this insight.

• Health Policy and Management
• /
• v.28 no.3
• /
• pp.217-221
• /
• 2018

Korea Institute for Family Planning (KIFP) was established on July 1, 1971 (Law 2270) and Korea Health Development Institute (KHDI) was established on April 19, 1976 (Law 2857). Korea Institute for Population and Health (KIPH) was formed through the merger of KIFP and KHDI (Act 3417) on July 1, 1981. Korea Institute for Health and Social Affairs (KIHASA), the former KIPH, was renamed KIHASA on December 30, 1989 (Law 4181) with its additional function of research in social security. It was transferred on January 29, 1999 to the Office of State Affairs Coordination pursuant to the Law on the Establishment, Operation and Promotion of State-Sponsored Organizations (Law 5733). Annually it conducts approximately 50 short- and long-term research projects to accumulate a wide range of research experience. Also it studies and evaluates the primary issues of national health services, health and medical industries, social insurance, social security, family welfare, and population. it conducts joint research projects and active information exchange programs with related domestic and international organizations through seminars and conferences. It executes specific research and development projects according to the government's requests. it educates and trains people domestically and abroad by disseminating a wide-range of information on health and social affairs. it conducts national household surveys on areas of fertility, health and medical care of the disabled, the elderly, and low-income earners. The mid- and long-term research goals of KIHASA should be established and managed systematically. A new organization such as 'Center for Policy Evaluation' is needed to enhance research abilities and experiences. Able research personnels should be recruited and current researchers should try to develop their abilities.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.27 no.1
• /
• pp.37-42
• /
• 2024

Purpose: Limited data exist regarding outcome and morbidity associated with portosystemic shunts in the pediatric transplant population. Our study assesses the outcomes of pediatric patients who underwent a portosystemic shunt procedure, both with and without liver transplantation (LT). Methods: This study retrospectively reviewed the medical records of pediatric patients aged 0-19 years who underwent shunt placement between 2003 and 2017 at a tertiary care center. The analysis included cases of shunt placement with or without LT. Results: A total of 13 pediatric patients were included in the study with median age of 8.8 years. Among the cases, 11 out of 13 (84.6%) underwent splenorenal shunt, 1 (7.7%) underwent a mesocaval shunt, and another 1 (7.7%) underwent a Modified Rex (mesoportal) shunt. Additionally, 5 out of 13 (38.5%) patients had LT, with 4 out of 5 (80.0%) receiving the transplant before shunt placement, and 1 out of 5 (20.0%) receiving it after shunt placement. Gastrointestinal bleeding resulting from portal hypertension was the indication in all cases. A total of 10 complications were reported in 5 patients; the most common complication was anemia in 3 (23.1%) patients. At the most recent follow-up visit, the shunts were functional without encephalopathy, and no deaths were reported. Conclusion: Shunt placement plays a crucial role in the management of patients with portal hypertension. Our study demonstrates favorable long-term outcomes in pediatric patients who underwent shunt placement. Long term shunt outcomes were similar and unremarkable in patients with LT and without LT.