The purposes of the study were to develop an instrument for family value and to identify the relationships of family value, family hardiness, and family adaptation by appling the family value scale to family with cancer children. The study was conducted in three phases. 1) A survey was conducted from July 20 to August 20, 1999 and 18 items of general family value scale was modified from the data of 153 fathers and 164 mothers. 2) In-depth interviews were made with 29 parents of cancer children from April 20, 1998 to May 20, 1999 to develop family value scale with cancer children, and 12 statements were developed. 3) The final survey was conducted from July 18, 2000 to August 30, 2000 and the data from 309 parents of children who are diagnosed as cancer, 18 or less years of age, and treated either hospitalized or at the outpatient clinics were analyzed to identify the relationships of the concepts. The data analysis utilized SAS 6.12 and LISREL 8 for descriptive statistics, correlation, and Regression for path analysis. The study findings are as follows. The psychometric testing of general family value scale was Cronbach's alpha = 0.78. The reliability of the family value scale with cancer children showed the reliability as Cronbach's alpha = 0.73. Demographic characteristics showing significant correlations were cancer children's age, period of illness, period after completing treatment, mother's age, mother's education level, monthly income, payment type, confidence with health professional, and severity of children's illness. The correlation coefficients among major variables showed that family stressor was positively related with family strains(r=0.33, p < .001), and negatively related with family hardiness(r=-0.21, p < .001). Family strains was negatively related with family hardiness(r= -0.41, p < .001) and family adaptation(r=-0.46, p < .001). Correlations of family hardiness was positive with family value with cancer children(r=-0.31, p < .001), and negative with general family value(r=-0.16, p < .01). Family hardiness was positively related with family adaptation(r=0.35, p < .001). The causal relationship between study variables showed that family strains predicts general family value( gamma =0.12, t=2.02), family value with cancer children predicts family hardiness( gamma =0.31, t=6.30), family strains predicts family hardiness( gamma =-0.40, t=-7.70), family value with cancer children predicts family adaptation( gamma =-0.23, t=-4.11), and family hardiness predicts family adaptation( gamma =0.43, t=7.78).
Ambulatory Care Facilities ; Child* ; Education ; Fathers ; Health Occupations ; Humans ; Mothers ; Parents ; Psychometrics ; Statistics as Topic ; Child Health

The purpose of the study was to develop and test the model for the quality of life in mothers of children with nephrotic syndrome. A hypothetical model was constructed on the basis of previous studies and a review of literature. The conceptual framework was built around ten constructs. Exogenous variables included in this model were mother's health, father's health, marital intimacy, mother's attitude on children, economic state, side effect of steroid, severity of illness and social support. Endogenous variables were mother's burden and quality of life. Empirical data for testing the hypothetical model were collected by using a self-report questionnaire from 152 mothers of children with nephrotic syndrom at the outpatient clinics and in the hospital. The data was collected from May, 1999 to August, 1999. Reliability of the seven instruments was tested with Cronbach's alpha which ranged from 0.71 - 0.92. For the data analysis, SPSS 8.0 WIN program and LISREL 8.20 WIN program were used for descriptive statistics and covariance structural analysis. The results of covariance structural analysis were as follow : 1.The hypothetical model showed a good fit with the empirical data.[x2 = .56, df = 3, p = .90(p > .05 ), GFI = .99, AGFI = .99, RMSR = .005.] 2. For the parsimony of model, a modified model was constructed by deleting 1 variable and excluding 2 paths according to the criteria of statistical significance and meaning. 3.The modified model also showed a good fit with the data[x2 = 2.83, df = 7, p = .90( p > .05 ), GFI = 1.00, AGFI = .97, RMSR = .011]. The result of the testing of the hypothesis were as follows : 1.Mother's health( gamma 21 = .26, t = 4.16), father's health( gamma 22 = .19, t = 2.92), marital intimacy( gamma 23 = .26, t = 4.13) and social support( gamma 28 = .12, t = 2.03) had a significant direct effect on the quality of life. 2. Mother's burden( beta 21 = -.20, t = -3.10) had a significant negative direct effect on the quality of life. 3. Mother's attitude on children( gamma 14 = -.34, t = .-4.57), mother's health( gamma 11 = -.22, t = -2.96) and side effect of steroid ( gamma 16 = -.23, t = .-2.69) had a significant direct negative effect on the burden. The result of this study showed that mother's health, marital intimacy, mother's burden, father's health, and social support had a significant direct effect on the quality of life. Mother's attitude on children, mother's health, and side effect of steroid had a significant direct effect on mother's burden. These six variables, mother's health, marital intimacy, father's health, social support, mother's attitude on children and side effect of steroid were identified as relatively important variables. The results of this study suggest, it needed to determine the nursing intervention will alleviate mother's burden and promote a greater quality of life in mothers of children with nephrotic syndrom.
Ambulatory Care Facilities ; Child* ; Humans ; Mothers* ; Nephrotic Syndrome ; Nursing ; Quality of Life* ; Statistics as Topic ; Child Health

Ambulatory Care Facilities ; statistics & numerical data ; Animals ; Bites and Stings ; epidemiology ; China ; epidemiology ; Dogs ; Humans ; Outpatients ; statistics & numerical data

The purpose of this study was to identify the relationships between self-efficacy, self-esteem, health locus of control and sick-role behavioral compliance in diabetic patients and to identify the influencing factors for sick-role behavioral compliance. The subjects for study were 244 NIDDM patients from 2 hospitals, who were visiting the outpatient clinic in Taegu. Data were collected from Sep. 18.th to Oct. 5th 1996. In data analysis, SPSS/PC+ programs were utilized for descriptives, as well as Pearson correlation coefficient, t-test, ANOVA and stepwise multiple regression. The results were as follows : 1. The average score for the sick-role behavioral compliance was 50.38, for the self-efficacy was 1337.17, for the self-esteem was 27.81, for the internal health locus of control was 28.79, for the chance health locus of control was 20.55, for the powerful others health locus of control was 28.70. 2. The relationships between self-efficacy, self-esteem, health locus of control and sick-role behavioral compliance were significant. Sick-role behavioral compliance were significantly related to self-efficacy(r=0.36, 0.000), to self-esteem (r=0.19, p=0.001), to internal health locus of control(r=0.28, p=0.000), to powerful others health locus of control (r=0.28, p=0.000). 3. In the relationship between general characteristics and sick-role behavioral compliance there were significant differences in a job (t=-2.01, p=0.045), experience of diabetic education(t=2.32, p=0.022). 4. Stepwise multiple regression analysis was performed to identify the influencing factors for sick-role behavioral compliance. Self-efficacy, self-esteem, internal health locus of control, having or not having a job and experience of diabetic education accounted for 24% of the variance in sick-role behavioral compliance. The self-efficacy was the most predictive factor (R2=13%) followed by internal health locus of control, job, self-esteem and experience of diabetic education. The results suggest that self-efficacy is an important variable in the compliance of diabetic patients. For improvement in sick-role behavioral compliance nursing intervention needs to be directed at promoting self-efficacy.
Ambulatory Care Facilities ; Compliance* ; Daegu ; Diabetes Mellitus, Type 2 ; Education ; Humans ; Internal-External Control ; Nursing ; Statistics as Topic

The purpose of this study was to identify the effect of social support revealed in the time duration of sick role behavior compliance on the patients with hypertension using Quasi- experimental research design. Data collection was made through the interview survey technique from the hypertensive patients who received social support intervention (experimental group, n=41) and from those who were not exposed to the intervention(control group, n= 34). The subjects were registered in the cardiovascular outpatient clinic at the Chonnam National University Hospital from June 3, 1996 to November 30, 1997. X2-test or t- test, Repeated measures ANOVA were utilized in the data analysis. The results were as follows: 1. The effect of social support intervention on sick role behavior compliance was significant in 1 month(F=69.17, p=.000), 6 months (F=11.51, p=.001), and 12 months(F=.07, p=.789) and between two groups(1 month; F=153.70, p=.000, 6 months; F=13.94, p=.000, 12 months; F=6.72, p= .011). 2. The effect of social support intervention on blood pressure was not significant through all the periods of time (F=1.21, p=.274) between the two groups(F=.12, p=.732). In conclusion, it was showed that social support had an effect on sick role behavior compliance and the effect of social support continued for twelve months(F= 10.03, p=.002) However, the score of compliance tends to decrease after 6 months of intervention. Therefore, this study indicated that social support re-intervention would be needed between six and twelve months.
Ambulatory Care Facilities ; Blood Pressure ; Compliance ; Data Collection ; Humans ; Hypertension* ; Jeollanam-do ; Research Design ; Sick Role ; Statistics as Topic

PURPOSE: This study aimed to develop a model for estimating the quality of life mediated by adaptation to changes experienced after stomach cancer diagnosis and surgery in patients with gastrectomy and to verify the model based on the Cancer Survivor Adaptation Model by Naus et al. (2009) and literature reviews. METHODS: Data was collected from 297 gastric cancer patients who underwent a gastrectomy at an outpatient clinic of two university hospitals in Daegu city from May to August, 2016. The exogenous variableswere perceived gastrointestinal symptoms, self-efficacy, anxiety, social support, and spiritual well-being. The endogenous variableswere adaptation and quality of life, and adaptationwas themediating variable. For data analysis, structural equation modeling was performed using IBM SPSS 21.0 and AMOS 18.0. RESULTS: The fitness parameters of the final model showed a reasonable fit to the data. Based on R², the exogenous variables explained 73.9% of the quality of life of stomach cancer patients who underwent surgery, through the mediation of adaptation; adaptation alone explained 73.5% of quality of life. Adaptation of stomach cancer patients with gastrectomy was a factor that strongly influenced their quality of life. CONCLUSION: It is important for gastric cancer patients with gastrectomy to adapt well to changes after surgery in order to improve the quality of life. Nursing interventions to aid successful adaptation would ultimately exert positive influences and improve the patients' quality of life.
Ambulatory Care Facilities ; Anxiety ; Daegu ; Diagnosis ; Gastrectomy ; Hospitals, University ; Humans ; Negotiating ; Nursing ; Quality of Life ; Statistics as Topic ; Stomach Neoplasms ; Survivors

As a family respond to any stressful situation as a whole system, cancer diagnosis of a child, as a serious life event, could be emotional shock to destroy homeostasis of the family system. A family has a resilient capacity to adjust and adapt to stressful events. Previous studies have been focused on family stress and adaptation, but little attention has been given to family value as one of resilient factors. The data for model testing were collected from July 18, 2000 to August 30, 2000 and the analysis included 309 parents of children who are diagnosed as cancer, 18 or less years of age, and treated either hospitalized or at the outpatient clinics. The data analysis utilized SAS 6.12 and LISREL 8 for descriptive statistics, correlation, cluster analysis, factor analysis, and LISREL. The study findings are as follows. 1) Monthly income ( gamma =-0.28, t=-5.81) was the most important factor to explain family strain along with family support ( gamma =-0.11, t=-2.43), severity of children's illness ( gamma =0.26, t=5.22), and family stressor ( gamma =0.22, t=4.62). All of these factors together explained 40% of variance in family strain. 2) Among general family value, the relationship with the parents ( gamma =0.28, t=4.89) and relationship with the children ( gamma =0.20, t=3.60) showed positive effects to family value for cancer children, while relationship with the spouse ( gamma =-0.19, t=-3.22) and the age of the cancer children ( gamma =-0.11, t=-2.21) showed negative effects. These predictors together explained 22% of variance in family value for cancer children. 3)Family hardiness was explained mostly by family strain ( gamma =-0.53, t=-8.65) along with direct negative effects of family persistency and indirect negative effects of severity of children's illness, family stressor, relationship with the spouse, and the children's age. Family value for cancer children was the most important predictor with positive effect ( gamma =0.44, t=6.76) along with indirect effects of monthly income, relationship with the parents, relationship with the children, support from family and significant others, and confidence with the health professionals. 51% of variance in family hardiness was explained by all of these predictors. 4)The most important predictor for family adaptation was family stressor ( gamma =-0.50, t=-6.85) with direct and indirect negative effects along with the severity of children's illness ( gamma =-0.27, t=-5.21). However, family value for cancer children showed compromised total effect ( gamma =-0.13, t=-1.99) with negative direct effects ( gamma =-0.28, t=-3.43) and positive indirect effects ( gamma =0.14, t=3.01). Similarly, confidence with the health professionals also showed compromised total effect ( gamma =0.09, t=1.99) with positive direct effects and negative indirect effects. Family hardiness showed the biggest positive direct effects while other factors such as monthly income, family stressor, family persistence, support of family and significant others, relationship with the parents, relationship with the children, and relationship with the spouse, and children's age showed indirect effects only. 39% of variance in family adaptation was explained by all of these predictors.
Ambulatory Care Facilities ; Child* ; Diagnosis ; Health Occupations ; Homeostasis ; Humans ; Life Change Events ; Parents ; Shock ; Spouses ; Statistics as Topic ; Child Health

As a family respond to any stressful situation as a whole system, cancer diagnosis of a child, as a serious life event, could be emotional shock to destroy homeostasis of the family system. A family has a resilient capacity to adjust and adapt to stressful events. Previous studies have been focused on family stress and adaptation, but little attention has been given to family value as one of resilient factors. The data for model testing were collected from July 18, 2000 to August 30, 2000 and the analysis included 309 parents of children who are diagnosed as cancer, 18 or less years of age, and treated either hospitalized or at the outpatient clinics. The data analysis utilized SAS 6.12 and LISREL 8 for descriptive statistics, correlation, cluster analysis, factor analysis, and LISREL. The study findings are as follows. 1) Monthly income ( gamma =-0.28, t=-5.81) was the most important factor to explain family strain along with family support ( gamma =-0.11, t=-2.43), severity of children's illness ( gamma =0.26, t=5.22), and family stressor ( gamma =0.22, t=4.62). All of these factors together explained 40% of variance in family strain. 2) Among general family value, the relationship with the parents ( gamma =0.28, t=4.89) and relationship with the children ( gamma =0.20, t=3.60) showed positive effects to family value for cancer children, while relationship with the spouse ( gamma =-0.19, t=-3.22) and the age of the cancer children ( gamma =-0.11, t=-2.21) showed negative effects. These predictors together explained 22% of variance in family value for cancer children. 3)Family hardiness was explained mostly by family strain ( gamma =-0.53, t=-8.65) along with direct negative effects of family persistency and indirect negative effects of severity of children's illness, family stressor, relationship with the spouse, and the children's age. Family value for cancer children was the most important predictor with positive effect ( gamma =0.44, t=6.76) along with indirect effects of monthly income, relationship with the parents, relationship with the children, support from family and significant others, and confidence with the health professionals. 51% of variance in family hardiness was explained by all of these predictors. 4)The most important predictor for family adaptation was family stressor ( gamma =-0.50, t=-6.85) with direct and indirect negative effects along with the severity of children's illness ( gamma =-0.27, t=-5.21). However, family value for cancer children showed compromised total effect ( gamma =-0.13, t=-1.99) with negative direct effects ( gamma =-0.28, t=-3.43) and positive indirect effects ( gamma =0.14, t=3.01). Similarly, confidence with the health professionals also showed compromised total effect ( gamma =0.09, t=1.99) with positive direct effects and negative indirect effects. Family hardiness showed the biggest positive direct effects while other factors such as monthly income, family stressor, family persistence, support of family and significant others, relationship with the parents, relationship with the children, and relationship with the spouse, and children's age showed indirect effects only. 39% of variance in family adaptation was explained by all of these predictors.
Ambulatory Care Facilities ; Child* ; Diagnosis ; Health Occupations ; Homeostasis ; Humans ; Life Change Events ; Parents ; Shock ; Spouses ; Statistics as Topic ; Child Health

This study was designed to assess determinants of private clinics' productivity, and to compare city and county clinics in South Korea. We analyzed the revenue and patient data from all 9, 212 private clinics in South Korea. This data was obtained from the Korean National Health Insurance Corporation, during the period between 1996 and 1999. We used a mixed model for repeatedly measured data. The following listed variables were used in our analysis: sex and age of physician, number of beds of clinics, competitiveness of medical institution, inhabitants' incomes, the proportion of elderly in the administrative unit, and time effects. Age, sex, number of beds, and specialty were found to be the most relevant determinants for the productivity of private clinics in both urban and rural settings, and number of clinics and beds per 100, 000 and income of the administrative unit were found to be significant determinants, but only in city environments.
Urban Health ; Rural Health ; Private Practice/*organization & administration ; Korea ; Geography ; Efficiency, Organizational/*statistics & numerical data ; Cities ; Ambulatory Care Facilities/economics/*organization & administration/statistics & numerical data

INTRODUCTIONChronic kidney disease (CKD) is a major public health problem in Singapore. Efforts are being made to right-site CKD care (stage 1 to 3) from specialist outpatient clinics (SOCs) to general practitioners (GPs) to ease congestion. This study aims to identify factors influencing screening and management of CKD among GPs in Singapore.

MATERIALS AND METHODSA survey was conducted among the 1202 GPs between April and September 2010. The survey questionnaire was developed in collaboration with experts in nephrology and general practice, it included questions about screening, awareness and management of CKD.

POPULATION STUDIEDGPs registered with the National Healthcare Group General Practitioner (NHG GP) partner database.

RESULTSThree hundred and two GPs completed the survey. A total of 70% of the respondents were males and with their median years of practice as 18. A total of 86% of them reported screening for CKD while 50% of GPs were confident of managing patients with CKD stage 1; and 38% of GPs are aware of CKD guidelines. Majority of GPs (64%) agreed that right-siting of early CKD patients would ease congestion at SOCs. Some of the obstacles in CKD management listed by the GPs were lack of patient trust, experience and communication with the specialist and the inability of the patient to pay.

CONCLUSIONGPs screen patients for CKD, however their awareness of guidelines is limited. Opportunities exist for improving physician recognition of CKD, awareness of CKD guidelines, improving collaborative care and reimbursement for the patient and the provider. This study has identified factors which when addressed could lead to wider acceptance of CKD right-siting by both the patients and the GPs.

Ambulatory Care Facilities ; utilization ; Female ; General Practice ; Health Care Surveys ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Practice Patterns, Physicians' ; statistics & numerical data ; Renal Insufficiency, Chronic ; diagnosis ; therapy ; Singapore