The Symptoms and the Response Related to Treatment-Seeking Time among patients with Acute Myocardial Infarction

본 연구는 서울과 경기 지역의 대학병원에 입원하였던 급성심근경색 간호대상자의 증상과 증상반응 요인, 치료추구시간 간의 특성과 관계를 파악하여, 치료추구행위를 증진시키기 위한 환자교육의 기초자료를 얻기 위한 서술적 조사연구이다. 연구대상자는 심장병동과 중환자실에 급성심근경색을 진단받고 최근 1개월간 입원경험이 있는 대상자로, 총 91명 중 특이점을 보인 3명을 제외한 88명이었다. 자료수집 시간은 2007년 10월 1일부터 11월22일까지였으며, 연구자와 연구보조원이 직접 동의를 받고, 설문지를 읽고 응답하도록 하였다. 본 연구의 도구는 총29문항으로, 일반적 특성 8문항, 급성심근경색 간호대상자의 증상 4문항, 증상반응 요인 16문항, 치료시간 1문항으로 구성되었다. 수집된 자료는 SPSS 13.0을 이용하여 실수와 백분율을 구하였으며, t-test와 ANOVA, Pearson's correlation analysis, Multiple regression을 사용하여 분석하였다. 본 연구의 결과는 다음과 같다. 1. 급성심근경색의 증상부위로 ‘가슴의 정중앙’ 부위가 22.3%로 가장 많은 비율을 나타내었고, 대상자의 13.1%가 가슴중앙과 부위에 ‘내리누름’의 느낌을 받았으며, 동반된 다른 증상으로는 ‘식은땀’이 27.3%로 가장 많았다. 대상자가 느꼈던 통증 정도는 평균 8.49점(SD= ±2.29)으로 높은 통증정도를 나타내었다. 2. 대상자의 치료추구시간은 평균 8.99(SD=±18.82)시간이었고, 과거에 심근경색을 경험했던 환자와 심근경색을 처음 진단받은 환자와의 치료추구시간에는 차이가 없는 것으로 나타났다. 3. 대상자의 증상부위에 따른 치료추구시간 차이는 왼쪽어깨(t= 2.671, p<.01), 왼쪽 팔(t= 2.87, p<.01)에 증상이 있었을 때, 메스꺼움(t= 2.138, p<.05), 구토(t= 2.797, p<.01)의 증상이 동반되었을 때, 치료추구시간이 짧았던 것으로 나타났으며, 통증정도와 치료추구시간은 역 상관관계를 나타내었다(r=-.352, p<.01), 4. 증상반응에 따른 각각의 요인과 치료추구시간 차이는 통계적으로 유의하지 않았고 증상반응의 인지적 요인 중, ‘증상이 나타났다 사라졌다 하여 지연’ 항목이 치료추구시간과 순 상관관계를 나타내었다(r=.194, p<.05). 5. 왼쪽어깨, 왼쪽 팔 증상, 메스꺼움, 구토, 통증정도, ‘증상이 나타났다 사라졌다 하여 지연되었다’ 항목의 변수는 치료추구시간을 21.2%로 설명할 수 있었으며, 가장 잘 설명하는 변수는 통증정도였다(t=-3.363, p<.01). 결론적으로 치료추구시간은 왼쪽어깨, 왼쪽 팔 증상, 메스꺼움, 구토, 통증정도, 인지적 요인 중 '증상의 호전과 재발반복으로 지연됨' 항목에 차이가 있으며 통증이 약할수록 지연되는 것으로 나타났다. 급성심근경색 간호대상자의 비전형적 증상을 간과하지 않고 증상반응에 대해 관심있게 간호사정을 해야 하며, 이를 바탕으로 급성심근경색 대상자와 가족을 고려한 교육프로그램의 개발이 요구된다.;The purpose of this study was to examine the symptoms, the response to the symptoms of acute myocardial infarction patients, and the relation to treatment-seeking time, and to get basic materials for patient education for improving their treatment-seeking behavior. The subjects of this study were patients who were diagnosed with acute myocardial infarction admitted to university hospitals. During the period from the 1^(st) of October to the 22^(nd) of November, 2007, the present researcher and assistants collected data by getting the patients' consent, reading the questionnaire and obtaining their replies. The questionnaire used in the study was composed of a total of 29 questions, of which 8 were on general characteristics, 4 on the acute myocardial infarction patients' symptoms, 16 on their response to the symptoms, and 1 on their treatment-seeking time. From the collected data were obtained real numbers and percentages using SPSS 13.0, and analyse were conducted through t-test, ANOVA, Pearson's correlation analysis and multiple regression. A total of 88 patients were included for the data analyses The results of this study are as follows. 1. Of the patients, 22.3% felt a symptom at the center of their chest, and 13.1% felt pressure on chest. The most frequent accompanying symptom was cold sweating (27.3%). The average level of pain of symptoms was 8.49 points (SD= ±2.29), showing a high level of pain. 2. The subjects' average treatment-seeking time was 8.99(SD=±18.82) hours. Patients with past history of myocardial infarction did not show any significant difference in treatment-seeking time. 3. As to difference in treatment-seeking time according to the site of symptom, treatment-seeking time was short when there was a symptom in the left shoulder (t= 2.671, p<.01) or in the left arm (t= 2.87, p<.01) and when there was an accompanying symptom such as nausea (t= 2.138, p<.05) and vomiting (t= 2.797, p<.01). In addition, the level of pain was in a negative correlation with treatment-seeking time (r=-.352, p<.01). 4. Difference in treatment-seeking time according to response of symptom was not statistically significant, but among the cognitive factors of response of symptom, the repeated recurrence of symptom was in a positive correlation with treatment-seeking time (r=.194, p<.05). 5. Left shoulder symptom, left arm symptom, nausea, vomiting, pain level, and 'delay because of the repeated recurrence of symptom' explained 21.2% of treatment-seeking time, and the variable with the highest explanatory power was the level of pain. In conclusion, treatment-seeking time was different according to left shoulder symptom, left arm symptom, nausea, vomiting, pain level, and the repeated recurrence of symptom, and it was delayed longer when the level of pain was low. We should not overlook atypical symptoms observed in acute myocardial infarction patients and should make careful nursing assessment on patients' response of symptoms. And based on this, we need to develop education programs for acute myocardial infarction patients and their families.논문개요 = vii I. 서론 = 1 A. 연구의 필요성 = 1 B. 연구의 목적 = 4 C. 용어의 정의 = 5 II. 문헌 고찰 = 7 A. 급성심근경색 간호대상자의 증상 = 7 B. 급성심근경색 간호대상자의 증상반응 요인 = 9 C. 급성심근경색 간호대상자의 치료추구시간 지연 관련요인 = 12 III. 연구 방법 = 15 A. 연구 설계 = 15 B. 연구 대상 = 15 C. 연구 도구 = 16 D. 자료 수집 방법 및 절차 = 18 E. 자료 분석 방법 = 18 F. 연구의 윤리적 측면 = 19 G. 연구의 제한점 = 19 IV. 연구결과 및 논의 = 20 A. 대상자의 일반적 특성 = 20 B. 대상자의 증상의 특성 = 24 C. 대상자의 증상반응 요인에 관한 특성 = 27 D. 대상자의 일반적 특성에 따른 치료추구시간의 차이 = 31 E. 대상자의 증상에 따른 치료추구시간의 차이 및 관계 = 33 F. 대상자의 증상반응 요인에 따른 치료추구시간 차이 및 관계 = 37 G. 대상자의 치료추구시간에 영향을 미치는 요인 = 43 V. 결론 및 제언 = 44 A. 결론 = 44 B. 제언 = 47 참고문헌 = 48 부록 = 55 Abstract = 6

Development of a comprehensive health promotion program for North Korean young adult defectors in South Korea

Purpose: The purpose of this study was to develop a comprehensive health promotion program for North Korean young adult defectors in South Korea. Methods: The comprehensive health promotion program consisted of nutrition, mental healthcare, physical activity and sexual behavior was developed on the basis of need assessment results. For the evaluation of the program, 70 North Korean young adults who were attending two alternative schools for North Korean defectors were recruited. The program had taken place once a week for 13 or 19 weeks. Effectiveness of the health promotion program was evaluated using anthropometric measurement, 3-day food records and a questionnaires that comprised the Hospital Anxiety and Depression Scale (HADS), the Short Form with 36 questions (SF-36) and health behaviors. The surveys were proceeded at the beginning and after the program. Results: After health promotion program, participants' height was significantly increased #p=0#004# and body fat mass #0=0#004# and percentage of body fat mass #p=0.003# were significantly decreased. The number of subjects who ate breakfast alone was decreased whereas the number of subjects who ate breakfast with friends was increased #p<0.001#. There were no significant changes in dietary intakes, mental health status and quality of life. North Korean young adult defectors' willingness to participate and interests in the health promotion program were high, however the practice rate was low. Conclusion: The health promotion program could induce interests and willingness to participate, but bring about limited effects on the health behaviors. These results imply that a health promotion program for North Korean young adult defectors should have a long-term strategy as well as short-term plan. Furthermore, it should be based on their health problems, health related behaviors, academic performance and daily life matters.OAIID:oai:osos.snu.ac.kr:snu2009-01/102/0000052039/8SEQ:8PERF_CD:SNU2009-01EVAL_ITEM_CD:102USER_ID:0000052039ADJUST_YN:YEMP_ID:A077862DEPT_CD:801CITE_RATE:0FILENAME:북한이탈 청소년을 위한 통합적 건강증진 프로그램 개발.pdfDEPT_NM:의학과EMAIL:[email protected]_YN:NCONFIRM:

Response Experiences with a Semi-Quantitative Food Frequency Questionnaire: A Qualitative Study using Cognitive Interview

The purpose of this research was to understand how individuals reflect on the frequency and quantity of foods that they consume. Participants selected 5 males and 15 females aged 30 years or older were first interviewed on the frequency of their food consumption. Then based on this data, they were given a cognitive interview using the method of verbal proving. The individual cognitive interviews were recorded with consent while being conducted after complete approval by the Seoul National University Institution Review Board. The recorded material was evaluated using a thematic analysis after transcribing them into text. By analyzing stages of reflection, the major barriers to make the device difficult are revealed: 1) More difficulty in remembering events over the course of a full year due to diversification in the types of food that people consume 2) difficulty calculating the average for seasonal foods 3) difficulty estimating the amount of consumption from the photos presented 4) difficulty estimating amount of consumption from the quantity presented 5) difficulty processing foods that people think are healthy and foods are unhealthy simultaneously 6) difficulty having to consider foods where target food goes in as an ingredient; 7) difficulties arising from having to increase frequency when the amount consumed is higher than the quantity that is presented 8) difficulty having to combine the frequency and quantity of each food item when numerous foods are clustered into one category. These findings show that the less participants were involved in cooking, the more diverse their eating habits were, and the more they tried to adhere to rules of filling out the questionnaire, the more it was difficult for them to come up with an answer to the question being asked. It therefore seems necessary to construct a Food Frequency questionnaire that is attentive to these problems that arise from the recall stages

Consumption of Han-Sik and its association with socioeconomic status among Filipino immigrant women: The Filipino women&apos;s diet and health study (FiLWHEL)

Objectives: This study examined the consumption of Han-sik and its association with the years of residencein Korea and the socioeconomic status among Filipino immigrant women of the Filipino Women&apos;s Diet andHealth Study (FiLWHEL). Methods: A total of 474 Filipino women married to Korean men were included in the analysis. Their dietaryintake was assessed using a single-day 24-hour recall. The participants provided information on thedemographics, socioeconomic, and health-related factors through face-to-face interviews. The generalized linearmodel and logistic regression model were used to examine the association between the socioeconomic statusand consumption of Han-sik. Results: The mean age of the participants was 34.3 years old, and the average duration of residence in Koreawas 8.2 years. Among 474 Filipino women, a total of 467 consumed Han-sik, with an average of 6.8 fooditems per day. The Han-sik foods that the participants consumed most frequently were rice, cabbage kimchi,mixed-grain rice, and fried eggs. The average ratio of Han-sik was 58.57%. The ratio of Han-sik showed nosignificant associations with the years of residence, years of living together with their husband, educationlevels, total annual family income, or linguistic competence of Korean. However, the ratio of Han-sik use wasassociated with cohabitation with parents-in-law; the odds ratio (95% confidence interval) was 2.41 (1.18-4.92,p-trend = 0.002) comparing the fourth quartile with the first quartile of the Han-sik ratio. Conclusions: Filipino immigrant women in the FiLWHEL study consumed a larger number of Han-sik thanPhilippine foods. In addition, cohabitation with their parents-in-law was associated with the consumption ofHan-sik. Further epidemiologic studies will be needed to determine how the diet affects the health andwellbeing of immigrant women in Korea.N