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FAMILY DYNAMICS OF INCEST PERCEIVED BY ADOLESECENTS (청소년이 지각한 근친상간의 가족역동)

  • Kim, Hun-Soo;Shin, Hwa-Sik
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.6 no.1
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    • pp.56-64
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    • 1995
  • Family is a primary unit of the major socialization processing for children. Parents among the family members are one of the most important figures from whom the child and adolescent acquire a wide variety of behavior patterns, attitudes, values and norms. An organization of family members product family structural functioning. Abnormal family structure is one of the most important reference models in the learning of antisocial patterns of behavior. Therefore incest and child sexual abuse including spouse abuse, elderly abuse, and neglect occurs in the abnormal family structural setting. In particular, incest, a specific form of sexual abuse, was once thought to be a phenomenon of great rarity, but our clinical experiences, especially over the past decade, have made us aware that incest and child sexual abuse is not rare case and on the increasing trend. Therefore, the aim of this study was to determine the family problem and dynamics of incest family, and character pattern of post-incest adolescent victim in Korea. A total of 1,838 adolescents from middle and high school(1,237) and juvenile correctional institute(601) were studied, sampled from Korean student population and adolescent delinquent population confined in juvenile correctional institutes, using proportional stratified random sampling method. The subjects' ages ranged from 12 to 21 years. Data were collected through questionnaire survey. Data analysis was done by IBM PC of Behavior Science Center at the Korea university, using SAS program. Statistical methods employed were Chi-square, principal component analysis and t-test etc. The results of this study were as follows ; 1) Of 1,071 subjects, 40(3.7%) reported incest experiences(sibling incest : 1.6% ; another type of incest : 2.1%) in their family setting. 2) The character pattern of post-incest adolescent victim was more socially maladjusted, immature, impulsive, rigid, anxious and dependent than non-incest adolescent. Also they showed some problem in academic performance and their assertiveness. 3) The other family members of incest family revealed more psychological and behavioral problem such as depression, alcoholism, psychotic disorder and criminal act than the non-incest family, even though there is no evidence of the context between them. 4) The family dynamics of incest family tended to be dysfunctional trend, as compared with non-incest family. It showed that the psychological instability of family member, parental rejection toward their children, coldness and indifference among family member and marital discordance between the parents had significant correlation with incest.

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A Preliminary Study of Ecological Aspects of Food on a Kind of Gom-Tang(Beef Soup made with Internal Organs and Bone) Intake (식생태학적(食生態學的) 관점(觀點)에서 본 곰탕류(類) 섭취(攝取)에 관한 예비적연구(豫備的硏究))

  • Kwon, Sun-Ja;Adachi, Miyuki;Mo, Su-Mi;Choi, Kyung-Suk;Kim, Ju-Hye;Koh, Hee-Jung
    • Journal of the Korean Society of Food Culture
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    • v.6 no.4
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    • pp.421-432
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    • 1991
  • This study was conducted to investigate the intake of a kind of Gom-Tang (Beef soup made with internal organs and bone), which is the Korean traditional food, and factors affecting the eating behavior of customers. Two hundred male customers of a H Korean Restaurant specialized in Gom-Tang, which is a well-known restaurant in Seoul, were surveyed from June 26 to 29, 1990. The results were shown as follows. (1) ${\ulcorner}$Frequency of intake${\lrcorner}$ and ${\ulcorner}$preference${\lrcorner}$ were very high. Those who took a kind of Gom-Tang ${\ulcorner}$more than once a week${\lrcorner}$ were 66.5% of the subjects. Those who evaluated ${\ulcorner}$good${\lrcorner}$ for the taste and flavor were 86.5% and 59.0% of the subjects, respectively. (2) The reasons why they chose a kind of Gom-Tang from among many Korean traditional foods were ${\ulcorner}$preference${\lrcorner}$ and ${\ulcorner}$phygiological condition${\lrcorner}$ in ${\ulcorner}$high frequency of intake${\lrcorner}$ group. ${\ulcorner}$Phygiological condition${\lrcorner}$ was more critical factor than ${\ulcorner}$preference${\lrcorner}$ in ${\ulcorner}$low frequency of intake${\lrcorner}$ group. (3) The effect of the intake of a kind of Gom-Tang on health was evaluated as ${\ulcorner}$healthy${\lrcorner}$ (80.5%). ${\ulcorner}$No effect${\lrcorner}$ and ${\ulcorner}$harmful${\lrcorner}$ were 30.5% and 6.5%, respectively. (4) ${\ulcorner}$High frequency of intake${\lrcorner}$ group, mainly more than 50 years of age, had a high ${\ulcorner}$preference${\lrcorner}$ and ${\ulcorner}$food knowledge${\lrcorner}$ as well as positive ${\ulcorner}$eating behavior${\lrcorner}$ and ${\ulcorner}$healthy state${\lrcorner}$, ${\ulcorner}$Middle frequency of intake${\lrcorner}$ group, mainly the forties, had a high ${\ulcorner}$preference${\lrcorner}$, but had less positive ${\ulcorner}$eating behavior${\lrcorner}$ than ${\ulcorner}$high frequency of intake${\lrcorner}$ group. ${\ulcorner}$Low frequency of intake${\lrcorner}$ group, mainly the twenties and thirties, had a medial ${\ulcorner}$preference${\lrcorner}$. They took a kind of Gom-Tang for reasons of ${\ulcorner}$on the recommendation of friends${\lrcorner}$ better than ${\ulcorner}$preference${\lrcorner}$. Foregoing results showed that ${\ulcorner}$a kind of Gom-Tang${\lrcorner}$ was a typical food recognized as ${\ulcorner}$healthy${\lrcorner}$ as well as ${\ulcorner}$delicious${\lrcorner}$. This may suggest that ${\ulcorner}$a kind of Gom-Tang${\lrcorner}$ is a candidate for the effective food on nutritional education.

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A Study on Market Expansion Strategy via Two-Stage Customer Pre-segmentation Based on Customer Innovativeness and Value Orientation (고객혁신성과 가치지향성 기반의 2단계 사전 고객세분화를 통한 시장 확산 전략)

  • Heo, Tae-Young;Yoo, Young-Sang;Kim, Young-Myoung
    • Journal of Korea Technology Innovation Society
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    • v.10 no.1
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    • pp.73-97
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    • 2007
  • R&D into future technologies should be conducted in conjunction with technological innovation strategies that are linked to corporate survival within a framework of information and knowledge-based competitiveness. As such, future technology strategies should be ensured through open R&D organizations. The development of future technologies should not be conducted simply on the basis of future forecasts, but should take into account customer needs in advance and reflect them in the development of the future technologies or services. This research aims to select as segmentation variables the customers' attitude towards accepting future telecommunication technologies and their value orientation in their everyday life, as these factors wilt have the greatest effect on the demand for future telecommunication services and thus segment the future telecom service market. Likewise, such research seeks to segment the market from the stage of technology R&D activities and employ the results to formulate technology development strategies. Based on the customer attitude towards accepting new technologies, two groups were induced, and a hierarchical customer segmentation model was provided to conduct secondary segmentation of the two groups on the basis of their respective customer value orientation. A survey was conducted in June 2006 on 800 consumers aged 15 to 69, residing in Seoul and five other major South Korean cities, through one-on-one interviews. The samples were divided into two sub-groups according to their level of acceptance of new technology; a sub-group demonstrating a high level of technology acceptance (39.4%) and another sub-group with a comparatively lower level of technology acceptance (60.6%). These two sub-groups were further divided each into 5 smaller sub-groups (10 total smaller sub-groups) through two rounds of segmentation. The ten sub-groups were then analyzed in their detailed characteristics, including general demographic characteristics, usage patterns in existing telecom services such as mobile service, broadband internet and wireless internet and the status of ownership of a computing or information device and the desire or intention to purchase one. Through these steps, we were able to statistically prove that each of these 10 sub-groups responded to telecom services as independent markets. We found that each segmented group responds as an independent individual market. Through correspondence analysis, the target segmentation groups were positioned in such a way as to facilitate the entry of future telecommunication services into the market, as well as their diffusion and transferability.

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Empirical Analysis on Bitcoin Price Change by Consumer, Industry and Macro-Economy Variables (비트코인 가격 변화에 관한 실증분석: 소비자, 산업, 그리고 거시변수를 중심으로)

  • Lee, Junsik;Kim, Keon-Woo;Park, Do-Hyung
    • Journal of Intelligence and Information Systems
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    • v.24 no.2
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    • pp.195-220
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    • 2018
  • In this study, we conducted an empirical analysis of the factors that affect the change of Bitcoin Closing Price. Previous studies have focused on the security of the block chain system, the economic ripple effects caused by the cryptocurrency, legal implications and the acceptance to consumer about cryptocurrency. In various area, cryptocurrency was studied and many researcher and people including government, regardless of country, try to utilize cryptocurrency and applicate to its technology. Despite of rapid and dramatic change of cryptocurrencies' price and growth of its effects, empirical study of the factors affecting the price change of cryptocurrency was lack. There were only a few limited studies, business reports and short working paper. Therefore, it is necessary to determine what factors effect on the change of closing Bitcoin price. For analysis, hypotheses were constructed from three dimensions of consumer, industry, and macroeconomics for analysis, and time series data were collected for variables of each dimension. Consumer variables consist of search traffic of Bitcoin, search traffic of bitcoin ban, search traffic of ransomware and search traffic of war. Industry variables were composed GPU vendors' stock price and memory vendors' stock price. Macro-economy variables were contemplated such as U.S. dollar index futures, FOMC policy interest rates, WTI crude oil price. Using above variables, we did times series regression analysis to find relationship between those variables and change of Bitcoin Closing Price. Before the regression analysis to confirm the relationship between change of Bitcoin Closing Price and the other variables, we performed the Unit-root test to verifying the stationary of time series data to avoid spurious regression. Then, using a stationary data, we did the regression analysis. As a result of the analysis, we found that the change of Bitcoin Closing Price has negative effects with search traffic of 'Bitcoin Ban' and US dollar index futures, while change of GPU vendors' stock price and change of WTI crude oil price showed positive effects. In case of 'Bitcoin Ban', it is directly determining the maintenance or abolition of Bitcoin trade, that's why consumer reacted sensitively and effected on change of Bitcoin Closing Price. GPU is raw material of Bitcoin mining. Generally, increasing of companies' stock price means the growth of the sales of those companies' products and services. GPU's demands increases are indirectly reflected to the GPU vendors' stock price. Making an interpretation, a rise in prices of GPU has put a crimp on the mining of Bitcoin. Consequently, GPU vendors' stock price effects on change of Bitcoin Closing Price. And we confirmed U.S. dollar index futures moved in the opposite direction with change of Bitcoin Closing Price. It moved like Gold. Gold was considered as a safe asset to consumers and it means consumer think that Bitcoin is a safe asset. On the other hand, WTI oil price went Bitcoin Closing Price's way. It implies that Bitcoin are regarded to investment asset like raw materials market's product. The variables that were not significant in the analysis were search traffic of bitcoin, search traffic of ransomware, search traffic of war, memory vendor's stock price, FOMC policy interest rates. In search traffic of bitcoin, we judged that interest in Bitcoin did not lead to purchase of Bitcoin. It means search traffic of Bitcoin didn't reflect all of Bitcoin's demand. So, it implies there are some factors that regulate and mediate the Bitcoin purchase. In search traffic of ransomware, it is hard to say concern of ransomware determined the whole Bitcoin demand. Because only a few people damaged by ransomware and the percentage of hackers requiring Bitcoins was low. Also, its information security problem is events not continuous issues. Search traffic of war was not significant. Like stock market, generally it has negative in relation to war, but exceptional case like Gulf war, it moves stakeholders' profits and environment. We think that this is the same case. In memory vendor stock price, this is because memory vendors' flagship products were not VRAM which is essential for Bitcoin supply. In FOMC policy interest rates, when the interest rate is low, the surplus capital is invested in securities such as stocks. But Bitcoin' price fluctuation was large so it is not recognized as an attractive commodity to the consumers. In addition, unlike the stock market, Bitcoin doesn't have any safety policy such as Circuit breakers and Sidecar. Through this study, we verified what factors effect on change of Bitcoin Closing Price, and interpreted why such change happened. In addition, establishing the characteristics of Bitcoin as a safe asset and investment asset, we provide a guide how consumer, financial institution and government organization approach to the cryptocurrency. Moreover, corroborating the factors affecting change of Bitcoin Closing Price, researcher will get some clue and qualification which factors have to be considered in hereafter cryptocurrency study.

A Influence Effect of Mid-life Religious Life and Faith Maturity on the Couples' Life Satisfaction (중년기 종교 활동과 신앙성숙도가 부부생활만족도에 미치는 영향분석연구)

  • Jeong, Jin-O;Byeon, Sang-Hae;Kim, Jong-Su
    • 한국벤처창업학회:학술대회논문집
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    • 2009.10a
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    • pp.265-288
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    • 2009
  • The study has found that the main reasons affecting to the mature conjugal relations of middle-aged persons are closely related with sede factors brought about after marriage. Comparatively the factors before marriage have more or less weak power on the conjugal relations. They are mature relations wp between husbands and wives, stable and enough incede, and religious activities, which have deep relations with the satisfactory conjugal relations. C. G. Jung divided the whole life span as self-assuredness period in the first half and self-convergence period in the second half. The first is the period when one does his or her best to get external and physical self. On the contrary, the second is the middle-aged period one finds his or her meaning of life in the religious, philosophical, intuitional, and spiritual world, which lead life into harmony and integration. Therefore if one overcomes some psychological crisis related with middle-aged development he or she can enjoy happy senescence(old age). The study has suggested through literature investigation the definition of middle age and the developmental traits of middle age, and the relations between religions and conjugal relations of middle-aged husbands and wives. Futhermore, it has analyzed the theories which religions have close relations with the life satisfaction of middle-aged conjugal relations. In order to give an analysis the influence of the variable of religious activities and religious maturity, with the degree of conjugal satisfaction, 400 middle age are selected as the object of the study whose ages are ranging from 35 years to 60 years, and who reside in Seoul or near Seoul. They were asked to fill out the questionnaires asking about religious activities, religious maturity, and the conjugal satisfaction from March 25th to April 30th, 2009. The results of the survey have been statistically processed and analyzed. First, the higher religious maturity gives positive influence on the general religious activities including public service, human relations, and spiritual stability. That is, this result indicates that the individual, spiritual, and formal religious activities give to a degree influence on the religious maturity. Second, the maturity of religious life resulting from religious activities has a causation with the satisfaction of conjugal life. In more details, religious activities has a positive influence on the satisfaction of conjugal life(T=31.36, p<.001) In more details, religious activities has a positive influence on the religious maturity(T=31.36, p<.001), and religious activities has a positive influence on the satisfaction of conjugal life(T=33.81, p<.001), and the religious maturity has a positive influence on the satisfaction of conjugal life(T=28.64, p<.001) Third, as we analyze the main effects which religious activities and the religious maturity could give influence on the satisfaction of conjugal life, it is found that both religious activities(F=15.95, p<.001) and the religious maturity(F=23.94, p<.001) give a positive influence on the satisfaction of conjugal life. In conclusion, it is sure that religious activities and the religious maturity have a close relations with the satisfaction of conjugal life. Therefore it can be said that religious activities at the protestant religion, buddhism, and catholic religion can give an important influence on the satisfaction of middle-aged conjugal life.

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Case study of Music & Imagery for Woman with Depression (우울한 내담자를 위한 MI(Music & Imagery) 치료사례)

  • Song, In Ryeong
    • Journal of Music and Human Behavior
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    • v.5 no.1
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    • pp.67-90
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    • 2008
  • This case used MI techniques that give an imagery experience to depressed client's mental resource, and that makes in to verbalism. Also those images are supportive level therapy examples that apply to positive variation. MI is simple word of 'Music and Imagery' with one of psychology cure called GIM(Guided Imagery and Music). It makes client can through to the inner world and search, confront, discern and solve with suitable music. Supportive Level MI is only used from safety level music. Introduction of private session can associate specification feeling, subject, word or image. And those images are guide to positive experience. The First session step of MI program is a prelude that makes concrete goal like first interview. The Second step is a transition that can concretely express about client's story. The third step is induction and music listening. And it helps to associate imagery more easily by used tension relaxation. Also it can search and associate about various imagery from the music. The last step is process that process drawing imagery, talking about personal imagery experience in common with therapist that bring the power by expansion the positive experience. Client A case targets rapport forming(empathy, understanding and support), searching positive recourse(child hood, family), client's emotion and positive support. Music must be used simple tone, repetition melody, steady rhythm and organized by harmony music of what therapist and client's preference. The client used defense mechanism and couldn't control emotion by depression in 1 & 2 sessions. But the result was client A could experience about support and understanding after 3 sessions. After session 4 the client had stable, changed to positive emotion from the negative emotion and found her spontaneous. Therefore, at the session 6, the client recognized that she will have step of positive time at the future. About client B, she established rapport forming(empathy, understanding and support) and searching issues and positive recognition(child hood, family), expression and insight(present, future). The music was comfortable, organizational at the session 1 & 2, but after session 3, its development was getting bigger and the main melody changed variation with high and low of tune. Also it used the classic and romantic music. The client avoids bad personal relations to religious relationship. But at the session 1 & 2, client had supportive experience and empathy because of her favorite, supportive music. After session 3, client B recognized and face to face the present issue. But she had avoidance and face to face of ambivalence. The client B had a experience about emotion change according depression and face to face client's issues After session 4. At the session 5 & 6, client tried to have will power of healthy life and fairly attitude, train mental power and solution attitude in the future. On this wise, MI program had actuality and clients' issues solution more than GIM program. MI can solute the issue by client's based issue without approach to unconsciousness like GIM. Especially it can use variety music and listening time is shorter than GIM and structuralize. Also can express client's emotion very well. So it can use corrective and complement MI program to children, adolescent and adult.

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Utilization Pattern of Complementary Therapy in Hypertension, Diabetes and Chronic Arthritis Patients Visited to Local Health Center (일개 보건소를 방문하는 고혈압, 당뇨 및 관절염환자의 보완요법 이용실태)

  • Park, Ae-Ju;Park, Jae-Yong;Han, Chang-Hyun
    • Journal of agricultural medicine and community health
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    • v.28 no.2
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    • pp.107-122
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    • 2003
  • Objectives: The objective of this study is to investigate the use rate and some aspect of complementary therapies used by patients with chronic illness(hypertension, diabetic mellitus and chronic arthritis). Methods: 600 patients visiting the health center for one month(Jan. 2001) were interviewed on their complementary therapies used by the subjects for the previous year. Results: About fourteen-eight percent of the respondents used therapies; 35% of patients with hypertension, 44.6% of patients with diabetic mellitus and 62.9% of patients with chronic arthritis, which shows the highest rate among patients with three chronic disease. The use rate of complementary therapies indicates few meaningful differences according to the general characteristics of the interviewees. Hypertension patients used herb medication(31.0%) acupuncture(29.6%) and most of all the other therapies. Diabetic patients used dietary therapy(57.5%) and herb medication(35.1%). Chronic arthritis patients used acupuncture(85%) and herb medication(34.7%). 36.8% of all the patients who used complementary therapies tried more than two therapies. 18.3% of hypertension patients, 24.1% of diabetic patients and 55.9% of chronic arthritis patients used more than two therapies. Acupuncture(47%) was used most frequently, followed by herb medications(26.3%), health assistance utensils(21.8%). oriental therapy(21.8%), physical therapy(9.5%), health assistance food(8.4%), herb(7.7%), Korea hand acupuncture(3.2%), abdomen respiration(1.1%), and pore therapy(0.7%) Oriental clinic was visited most frequently(42.8%), which was used to cure diseases(61.8%), and to relieve symptoms(26.0%). (p<0.001) The cost spent on complementary therapies last year was 90,000 won(40.3%) and there are some cases of more than 500,000 won(31.2%). Most of the patients(56.1%) were satisfied with the complementary therapies, with 6% of them having side effects. 74% of the patients used complementary therapies answered that they would continue them and 56.1% of them also answered that they would continue them and 56.1% of them also answered that they would advise other patients to do them. Advantages(compared with those of orthodox medical treatment) are psychological comfort(28.1%), body protection(26.0%), effectiveness(20.0%). 34% of the patients using complementary therapies wanted to have informational orientation on complementary therapies. These findings reveal that a considerable number of patients with chronic illness(47.5%) tried a variety of complementary therapies. Though 6% of the patients using therapies had side effects, most of the subjects seemed satisfied with them and they are supposed to continue them. Conclusions: In conclusion, health center personnels and medical doctors should pay more attention to the complementary therapies used by patients with chronic illness. They also have to try their best to advise more scientific and informative complementary programs with less side effects and more help to improve their conditions.

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The Effect of the Use of Concept Mapping on Science Achievement and the Scientific Attitude in Ocean Units of Earth Science (해양단원 개념도 활용 수업이 과학성취도 및 태도에 미치는 효과)

  • Han, Jung-Hwa;Kim, Kwang-Hui;Park, Soo-Kyong
    • Journal of the Korean earth science society
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    • v.23 no.6
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    • pp.461-473
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    • 2002
  • Concept mapping is a device for representing the conceptual structure of a subject discipline in a two dimensional form which is analogous to a road map. In the teaching and learning of earth science, each concept depends on its relationships to many others for meaning. Using concept mapping in teaching helps teachers and students to be more aware of the key concepts and relationships among them. The purpose of this study is to investigate the effect of the use of concept mapping on science achievement and the scientific attitude in ocean units of earth science. The results of this study are as follows; first, the science achievement of a group of concept mapping teaching is significantly higher than that of the group of traditional teaching. Also, when the achievement levels are compared among different cognitive ability groups, the effect is more significant in mid or lower level student groups than in high level groups. The use of concept mapping is more effective when the concepts have a distinct concept hierarchy. Second, the scores of the test of ‘attitude toward scientific inquiry’ and ‘application of scientific attitude’ of the group of concept mapping teaching are significantly higher than those of the group of traditional teaching, whereas the scores of the test of ‘interest in science learning’ of concept mapping teaching is not different from those of group of traditional teaching. Third, the survey on the use of concept mapping shows a positive response across the tested groups. The use of concept mapping is more beneficial in fostering the comprehension of the topic. A concept map of student's own construction facilitates the assessment of learning, thus promising the usefulness of concept mapping as a means of evaluation. In regard to retention aspect, concept mapping is considered to be more effective in confirming and remembering the topic, while less effective in the aspects of activity and interest. In conclusion, the use of concept maps makes learning an active meaningful process and improves student's academic achievement and scientific attitude. If the concept mapping is more effectively as an active teaching strategy, more meaningful learning will be attained.

Nutritional Status and Health Risks of Low Income Elderly Women in Gwangju Area (광주지역 저소득층 여자노인의 영양상태와 건강위험요인에 관한 연구)

  • Yang, Eun-Ju;Bang, Hee-Myung
    • Journal of Nutrition and Health
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    • v.41 no.1
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    • pp.65-76
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    • 2008
  • This study was performed to identify association between nutritional status and health risks of the elderly. This was a cross-sectional study involving low income elderly women in Gwangju, Korea (${\geq}$65y, n = 92). Socio-demographics, life style characteristics, health conditions, dietary intakes based on 24h-recall method, anthropometric measures, and clinical biochemistry parameters were examined. Anthropometric and clinical parameters included wt, ht, waist, hip, body protein, body fat, abdominal fat, total cholesterol, HDL-cholesterol, triglyceride, total protein, albumin, hemoglobin, hematocrit, fasting blood glucose, ferritin, IL-2, IL-6, TNF-${\alpha}$, CRP, TAS, TBARS, systolic blood pressure, and diastolic blood pressure. The subjects were divided into three groups based on age (65-74y, 75-84y, 85y${\leq}$) and were divided into two groups according to the sum of the Nutrition Screening Initiative (NSI) checklist score (adequate nutritional status, NSI score ${\leq}$3; at risk of malnutrition, NSI score >3). Mean and frequency of variables were estimated. Analysis of Variance, Tukey test, Chi-square test, and Multiple linear regression analyses were performed. Mean BMI and body fat were 25.1 $kg/m^2$ and 40.0%, respectively. However, for over 80% of subjects, the intakes of energy, fiber, thiamin, riboflavin, niacin, folate, Ca, K, and Zn were less than the Korean DRI (EAR or AI). The subjects who had lower NSI score tended to have better health status, eat meals frequently, have less depression, and exercise regularly. The subjects who had higher NSI score tended to have tooth problems, to eat alone most of time, and to be physically unable to cook or feed. Serum IL-6 and TNF-${\alpha}$ were significantly related with nutritional status which suggested higher tendency of inflammatory response. Serum IL-2, TAS, and glucose were significantly correlated with body fat (%) or abdominal fat (%). These results suggest that improving the nutritional status, increasing regular exercise, maintaining normal weight are beneficial to health care of low income elderly women.

Rectal Bleeding and Its Management after Irradiation for Cervix Cancer (자궁경부암 환자에서 방사선치료 후에 발생한 직장출혈과 치료)

  • Chun Mison;Kang Seunghee;Kil Hoon-Jong;Oh Young-Taek;Sohn Jeong-Hye;Jung Hye-Young;Ryu Hee Suk;Lee Kwang-Jae
    • Radiation Oncology Journal
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    • v.20 no.4
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    • pp.343-352
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    • 2002
  • Purpose : Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. This study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. Materials and Methods : total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The Point A dose from the HDR brachytherapy was 28 Gy to 30 Gy $(4\;Gy\times7,\;or\;5\;Gy\times6)$. The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months $(12\~86\;months)$. Results : The incidence of rectal bleeding was $12.7\%$ (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was $8.5\%$. Most complications $(92.6\%)$ developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding an icruCRBED greater than 100 Gy $(19.7\%\;vs.\;4.2\%)$, an EBRT dose to the parametrium over 55 Gy $(22.1\%\;vs.\;5.1\%)$ and higher stages of III and IV $(31.8\%\;vs.\;10.5\%)$. In the multivariate analysis, the icruCRBED was the only significant factor (p>0.0432). The total parametrial dose from the EBRT had borderline significance (p=0.0546). Grade 1 bleeding was controlled without further management (3 patients), or with sucralfate enema 1 to 2 months after treatment. For grade 2 bleeding, sucralfate enema for 1 to 2 months reduced the frequency or amount of bleeding but for residual bleeding, additional coagulation was peformed, where immediate cessation of bleeding was achieved (symptom duration of 3 to 10 months). Grade 3 bleeding lasted for 1 year even with multiple transfusions and coagulations. Conclusion : Moderate and several rectal bleeding occurred in $8.5\%$ of patients, which is comparable with other reports. The most significant risk factor for rectal bleeding was the accumulated dose to the rectum (icruCRBED), which corrected with consideration to biological equivalence. Prompt management of rectal bleeding, with a combination of sucralfate enema and coagulation, reduced the duration of the symptom, and minimized the anxiety/discomfort of patients.