RESUMO
BACKGROUND: The tuberculin skin test (TST) is the standard tool to diagnose latent tuberculosis infection (LTBI) in mass screening. The aim of this study is to find an optimal cut-off point of the TST+ rate within tuberculosis (TB) contacts to predict the active TB development among adolescents in school TB outbreaks. METHODS: The Korean National Health Insurance Review and Assessment database was used to identify active TB development in relation to the initial TST (cut-off, 10 mm). The 7,475 contacts in 89 schools were divided into two groups: Incident TB group (43 schools) and no incident TB group (46 schools). LTBI treatment was initiated in 607 of the 1,761 TST+ contacts. The association with active TB progression was examined at different cut-off points of the TST+ rate. RESULTS: The mean duration of follow-up was 3.9+/-0.9 years. Thirty-three contacts developed active TB during the 4,504 person-years among the TST+ contacts without LTBI treatment (n=1,154). The average TST+ rate for the incident TB group (n=43) and no incident TB group (n=46) were 31.0% and 15.5%, respectively. The TST+ rate per group was related with TB progression (odds ratio [OR], 1.025; 95% confidence interval [CI], 1.001-1.050; p=0.037). Based on the TST+ rate per group, active TB was best predicted at TST+ > or = 16% (OR, 3.11; 95% CI, 1.29-7.51; area under curve, 0.64). CONCLUSION: Sixteen percent of the TST+ rate per group within the same grade students can be suggested as an optimal cut-off to predict active TB development in middle and high schools TB outbreaks.
Assuntos
Adolescente , Humanos , Área Sob a Curva , Surtos de Doenças , Seguimentos , Tuberculose Latente , Programas de Rastreamento , Programas Nacionais de Saúde , Prevalência , Testes Cutâneos , Pele , Teste Tuberculínico , Tuberculina , TuberculoseRESUMO
PURPOSE: The purpose of this study was to validate the Needs Assessment Tool for Case Management (NATCM) for use with Korean medical aid beneficiaries. METHODS: Psychometric testing was performed with a sample of 645 Korean medical aid beneficiaries, which included 41 beneficiaries who were selected using proportional sampling method, to examine intraclass correlation coefficients (ICC). Data were evaluated using item analyses, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Cronbach's alpha, and ICC. RESULTS: Through psychometric testing the final version of NATCM was found to consist of two subscales: 1) Appropriateness of Health Care Utilization (5 items) and 2) Self Care Ability (6 items). The two subscale model was validated by CFA (RMSEA=.08, GFI=.97, and CFI=.93). Internal consistency measured by Cronbach's alpha was .82, and subscale reliability ranged from .79 to .84. The ICC of the NATCM between case managers was .73 and between case managers and health care professionals. .82. CONCLUSION: This study suggests that the final version of NATCM is a brief, reliable, and valid instrument to measure needs of Korean medical aid beneficiaries. Therefore, the NATCM can be effectively utilized as an important needs assessment as well as outcome evaluation tool for case management programs in Korea.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividades Cotidianas , Povo Asiático , Administração de Caso , Nível de Saúde , Avaliação das Necessidades , Manejo da Dor , Psicometria , Inquéritos e Questionários , República da Coreia , Apoio SocialRESUMO
PURPOSE: This study was done to analyze the effects of tele-care case management services using secondary data. METHODS: A descriptive research design was utilized, and the participants were 134 medical aid beneficiaries who were in either the high-risk group or the preventive group. Case management services were delivered by 8 care managers. Data were analyzed using PAWS Statistics 17 through descriptive statistics and paired t-test. RESULTS: After the case management intervention, the participants' health quality of life, self-care competency, and reasonable medical care utilization increased significantly for the high-risk group. However there were no significant changes in the preventive group. CONCLUSION: The results showed that the tele-care case management services were effective for high-risk medical aid beneficiaries. Further studies with controls for constitutional variables and a comparison group are required to validate the robustness of the effectiveness of the case management program in the present study.
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Administração de Caso , Medicaid , Qualidade de Vida , Projetos de Pesquisa , AutocuidadoRESUMO
OBJECTIVES: In Korea, the top 10% of Medical Aid recipients represent nearly 60% of total payment, with the costs for those disabled for over 365 days representing approximately 30% of total payment. The purpose of this study was to compare Medical Aid use of the disabled with non-disabled recipients, and to identify contributing factors to the total payment in the top 2% of recipients identified as Medical Aid overusers. METHODS: Subjects (n=2,211) selected were > or =18-years-of-age and received >1000 days of co-payment-free type I Medical Aid. Case managers (n=200) conducted interviews in December 2006, and collected data from Health Insurance Review & Assessment Service. Amounts over the 9 months from January September 2006 were analyzed descriptively and using Chi-square, ANCOVA, and robust multiple linear regression. RESULTS: Disabled individuals (mean age 61.3 years) composed 36.6% of subjects; 44.8% of the disabled were male. On a monthly basis per capita, the disabled group averaged 10.5 outpatient days, total payment of 523,000 Korean Won(won), inpatient payment of 359,000won, and outpatient payment of 183,000won. All values exceeded the monthly average for non-disabled individuals. Contributing factors were identified as male gender (82,000won), elementary school or lower educational level (64,000won), residence in a small city (82,000won), lack of family support (61,000won), kidney disability (673,000won), intellectual disability (151,000won), and multiple disabilities (119,000won). CONCLUSIONS: The identification of contributing factors to Medical Aid use by those defined as disabled supports the adoption of comprehensive alternative policies such as strengthening of education and consultation services, provision of alternative facilities, and promotion of self-care.
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OBJECTIVES: The amount of medical utilization by Medical Aid recipients was 3.7 times that of patients with Korean Medical Insurance. This study aims to describe the surplus medicine and the medication-related utilization, and to determine factors contributing to surplus medicine. METHODS: Among those who used copayment-free Class I Medical Aid in 2005, 146,880 subjects who were > or =19 year-old and received >365 days medical treatment per year were studied with their case managers by conducting face-to-face interviews. The analytic methods were description, chi-square, t-tests, ANCOVA and multiple logistic regressions. RESULTS: Most subjects were female (68.6%), the elderly (62.5%), and the separated (61.6%), had an elementary graduation or less (74.8%), and had disabilities (33.2%). The percentage of subjects with surplus medicine was 18.5%. However, the percentage of females, the elderly, those with non-disabilities, the separated, the uneducated, those with a very poor perceived health status and those with an economical burden for medical treatment was 19.3%, 18.9%, 19.0%, 19.3%, 19.0%, 20.2% and 24.3%, respectively. For subjects with surplus medicine, averages for the number of used pharmacies, the pharmacy-visit days and the medication costs were 4.6 drugstores, 34.9 days and approximately 1,124 thousand Won. These values were higher than those without surplus medicine (4.4 drugstores , 33.8 days, and 1,110 thousand won, respectively). The odds ratios of the contributing factors to surplus medicine were female 1.11 (95% CI=1.07-1.14), the elderly 1.06 (95% CI=1.02-1.10), those with non-disabilities 1.08 (95% CI=1.05-1.12), the separated 1.14 (95% CI=1.10-1.18), the unmarried 1.12 (95% CI=1.07-1.18), the uneducated 1.03 (95% CI=1.01-1.08), those with a very poor perceived health status 1.04 (95% CI=1.01-1.08) and experiencing an economical burden for medical treatment 2.33 (95% CI=2.26-2.40). CONCLUSIONS: 18.5% of subjects had surplus medicine with a higher mean of medication cost. Therefore, health education and health promotion programs to prevent surplus medicine and to improve the appropriate usage of medication are necessary.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Análise de Variância , Intervalos de Confiança , Serviços de Saúde/estatística & dados numéricos , Mau Uso de Serviços de Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro de Serviços Farmacêuticos/estatística & dados numéricos , Razão de Chances , Medicamentos sob Prescrição/economia , República da Coreia , Fatores de Risco , Fatores de TempoRESUMO
PURPOSE: This study is a fact-finding research to understand the status of visiting nursing services operated by health centers in Korea and it aims to provide basic information for policy development on operation and management of visiting nursing services in health centers. METHOD: This study investigates the results of visiting nursing services in 242 health centers from Jan. 10 through Dec. 30, 2000, where 3,106 visiting nurses were employed by the public work program. RESULT: In 2000, 129,401 new household as service recipients was identified and that was 0.9% of Koreas total households (15,137,000), and 5.8% of low income households (2,242,000). The highest high risk group was dementia patients(aver. 55.2/1,000 person). Average number of households visited by visiting nurse were 4.5 households per day and the first-visited houses per visiting nurse were 1.1 households per day. The re-visiting rate was 71.3%. Total 4,059,130 service items were provided and assessment ranked the highest with 33.7%. The satisfaction level of clients on the nurses was an average of 3.17 points in the scale of 4 and the nursing service was a 2.60 points in a scale of 3. CONCLUSION: Visiting nursing service should continue to provide comprehensive healthcare services in cost-effective ways while cooperating with others.
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Assistência Integral à Saúde , Demência , Características da Família , Coreia (Geográfico) , Enfermeiros de Saúde Comunitária , Serviços de Enfermagem , Enfermagem , Formulação de PolíticasRESUMO
PURPOSE: The purpose of this study was to identify the theoretical characteristics and direction of inquiry in the discipline of nursing by analyzing doctoral dissertations. METHOD: The materials used in this study were 277 doctoral dissertations from five universities in Korea. The framework for the study was derived from Kim's(1993) alternative linkage among philosophy, theory, and method in nursing science. RESULT: Of the 277 dissertations it was found that there were 13 types of linkages out of a possible 54 types. Most of the dissertations (128 of 277) were done within the linkage of realism/etic/quantitative/explanatory knowledge type. Of the 218 dissertations within scientific realism, 42 were within relativism, and 17 within practicism. There were 134 dissertations of the explanatory knowledge type, 112 descriptive ones, and 31 prescriptive ones. Studies done within the etic quantitative methodology included 209 dissertations and within the emic perspective, 43 with qualitative methodology, and 7 with quantitative. CONCLUSION: The results show that it is necessary to develop more alternative linkages for nursing practice and this will lead to expanding nursing knowledge.
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Adulto , Feminino , Humanos , Dissertações Acadêmicas como Assunto , Coreia (Geográfico) , Pesquisa em Enfermagem/tendências , Filosofia em EnfermagemRESUMO
We describe unusual manifestations of congenital cystic adenomatoid malformation ( C.C.A.M.) of the lung, such as movable fungal ball-like intracystic blood clots and hemoptysis, which were detected in previously healthy 23 years-old woman. We identified blood clots only after left upper lobectomy and could not distinguish from fungal ball with radiographic methods. CCAM of the lung, rare and lethal form of congenital pulmonary cystic disease, was initially introduced by Ch'in and Tang in 1949. The histogenesis of this lesion is characterized by polypoid glandular tissue proliferation and overgrowth of mesenchymal elements due to cessation of bronchiolar maturation which occured in after 16weeks intrauterine period. In 80-95% of reported cases, the lesion was confined to a single lobe and there was no lobe and right and left lung predilection. The clinical presentation may be widely variable, ranging from intrauterine fetal death to late discovery in childhood with recurrent pulmonary infection. But there's no reports which were misdiagnosed with intracystic fungal ball. The treatment choice is lobectomy of affected lobe. There's a few case reports with rhabdomyosarcoma, bronchiolar cell carcinoma and myxosarcoma arising in CCAM patients. Therefore, early resection is recommended even if asymtomatic cases. We experienced a rare case of CCAM of the lung in 23 years old female, and there were intracystic fungal ball-like movable blood clots in lower portion of left lung. After left upper lobectomy was performed, now she is discharged and followed up without any complications.
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Feminino , Humanos , Adulto Jovem , Malformação Adenomatoide Cística Congênita do Pulmão , Morte Fetal , Hemoptise , Hemorragia , Pulmão , Mixossarcoma , RabdomiossarcomaRESUMO
Congenital cystic adenomatoid malformation(C.C. A.M.) is a rare variant of congenital pulmonary cystic diseases. C.C.A.M. was first distinguished from other pulmonary cystic lesions by Ch`in and Tang in 1949. It is characterized by cessation of bronchiolar maturation with an overgrowth of mesenchymal elements and proliferation of polypoid glandular tissue in the absence of normal alveolar differentiation. In 80% to 95% of cases, C.C.A.M. of the lung is confinded to a single lobe and there is no lobe predilection and right and left predominance. The clinical presentation may be widely variable, ranging from intrauterine fetal death secondary to nonimmune hydrops fetalis to discovery in childhood after recurrent pulmonary infections. Definitive treatment is removal of affected lobe. In rare instances, there is cases of myxosarcoma, embryonal rhabdomyosarcoma. Bronchoalveolar carcinoma arising in C.C.A.M.. So, resection is recommended even if they are asymtomatic. We have experienced a case of congenital cystic adenomatoid malformation (type II) of the lung in 15 year old man with pneumonia. After the improvement of pneumonia, surgical operation was performed. A brief review of the related literature is presented.
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Adolescente , Humanos , Malformação Adenomatoide Cística Congênita do Pulmão , Morte Fetal , Hidropisia Fetal , Pulmão , Mixossarcoma , Pneumonia , Rabdomiossarcoma EmbrionárioRESUMO
Mycoplasma Pneumonia is a main cause of primary atypical pneumonia and may present in a variety of ways. One auther has stated that the infiltrate is of a lobar segmental type, while others have found the infiltrates to be mainly reticular or interstitial. We experienced a case of mycoplasama pneumonia, whic h progressed to ARDS pattern rapidly and recovered completely after ventilator care.
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Mycoplasma , Pneumonia , Pneumonia por Mycoplasma , Ventiladores MecânicosRESUMO
St. Francisco General Hospital, Seoul, Korea. Although the incidence of pulmonary tuberculosis is declining, the number of extrapulmonary tuberculosis has remained constant. Tuberculous Lymphadenitis accounts for over 50% of total inflammatory lymphadenitis and the most common site is cervical lymph node. We report a case of single cervical tuberculous cold abscess associated with multiloculated and septated tuberculous pleurisy. Intracavitary urokinase instillation via percutaneous catheter is indicated in loculated and septated pleural effusion. And our result was satisfactory without complication.