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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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Development and Assessment Individual Maximum Permissible Dose Method of I-131 Therapy in High Risk Patients with Differentiated Papillary Thyroid Cancer (물리학 선량법을 이용한 갑상선암의 개인별 최대안전용량 I-131 치료법 개발과 유용성 평가)

  • Kim, Jeong-Chul;Yoon, Jung-Han;Bom, Hee-Seung;JaeGal, Young-Jong;Song, Ho-Chun;Min, Jung-Joon;Jeong, Heong;Kim, Seong-Min;Heo, Young-Jun;Li, Ming-Hao;Park, Young-Kyu;Chung, June-Key
    • The Korean Journal of Nuclear Medicine
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    • v.37 no.2
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    • pp.110-119
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    • 2003
  • Purpose: Radioiodine (I-131) therapy is an effective modality to reduce both recurrence and mortality rates in differentiated thyroid cancer. Whether higher doses shows higher therapeutic responses was still debatable. The purpose of this study was to validate curve-fitting (CF) method measuring maximum permissible dose (MPD) by a biological dosimetry using metaphase analysis of peripheral blood lymphocytes. Materials and Methods: Therapeutic effects of MPD was evaluated in 58 patients (49 females and 9 males, mean age $50{\pm}11$ years) of papillary thyroid cancer. Among them 43 patients were treated with ${\Leq}7.4GBq$, while 15 patients with ${\geq}9.25GBq$. The former was defined as low-dose group, and the latter high-dose group. Therapeutic response was defined as complete response when complete disappearance of lesions on follow-up I-131 scan and undetectable serum thyroglobulin levels were found. Statistical comparison between groups were done using chi-square test. P value less than 0.05 was regarded as statistically significant. Results: MPD measured by CF method using tracer and therapeutic doses were $13.3{\pm}1.9\;and\;13.8{\pm}2.1GBq$, respectively (p=0.20). They showed a significant correlation (r=0.8, p<0.0001). Exposed doses to blood measured by CF and biological methods were $1.54{\pm}0.03\;and\;1.78{\pm}0.03Gy$ (p=0.01). They also showed a significant correlation (r=0.86, p=0.01). High-dose group showed a significantly higher rate of complete response (12/15, 80%) as compared to the low-dose group (22/43, 51.2%) (p=0.05). While occurrence of side effects was not different between two groups (40% vs. 30.2%, p=0.46). Conclusion: Measurement of MPD using CF method is reliable, and the high-dose I-131 therapy using MPD gains significantly higher therapeutic effects as compared with low-dose therapy.

Recent Research for the Seismic Activities and Crustal Velocity Structure (국내 지진활동 및 지각구조 연구동향)

  • Kim, Sung-Kyun;Jun, Myung-Soon;Jeon, Jeong-Soo
    • Economic and Environmental Geology
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    • v.39 no.4 s.179
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    • pp.369-384
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    • 2006
  • Korean Peninsula, located on the southeastern part of Eurasian plate, belongs to the intraplate region. The characteristics of intraplate earthquake show the low and rare seismicity and the sparse and irregular distribution of epicenters comparing to interplate earthquake. To evaluate the exact seismic activity in intraplate region, long-term seismic data including historical earthquake data should be archived. Fortunately the long-term historical earthquake records about 2,000 years are available in Korea Peninsula. By the analysis of this historical and instrumental earthquake data, seismic activity was very high in 16-18 centuries and is more active at the Yellow sea area than East sea area. Comparing to the high seismic activity of the north-eastern China in 16-18 centuries, it is inferred that seismic activity in two regions shows close relationship. Also general trend of epicenter distribution shows the SE-NW direction. In Korea Peninsula, the first seismic station was installed at Incheon in 1905 and 5 additional seismic stations were installed till 1943. There was no seismic station from 1945 to 1962, but a World Wide Standardized Seismograph was installed at Seoul in 1963. In 1990, Korean Meteorological Adminstration(KMA) had established centralized modem seismic network in real-time, consisted of 12 stations. After that time, many institutes tried to expand their own seismic networks in Korea Peninsula. Now KMA operates 35 velocity-type seismic stations and 75 accelerometers and Korea Institute of Geoscience and Mineral Resources operates 32 and 16 stations, respectively. Korea Institute of Nuclear Safety and Korea Electric Power Research Institute operate 4 and 13 stations, consisted of velocity-type and accelerometer. In and around the Korean Peninsula, 27 intraplate earthquake mechanisms since 1936 were analyzed to understand the regional stress orientation and tectonics. These earthquakes are largest ones in this century and may represent the characteristics of earthquake in this region. Focal mechanism of these earthquakes show predominant strike-slip faulting with small amount of thrust components. The average P-axis is almost horizontal ENE-WSW. In north-eastern China, strike-slip faulting is dominant and nearly horizontal average P-axis in ENE-WSW is very similar with the Korean Peninsula. On the other hand, in the eastern part of East Sea, thrust faulting is dominant and average P-axis is horizontal with ESE-WNW. This indicate that not only the subducting Pacific Plate in east but also the indenting Indian Plate controls earthquake mechanism in the far east of the Eurasian Plate. Crustal velocity model is very important to determine the hypocenters of the local earthquakes. But the crust model in and around Korean Peninsula is not clear till now, because the sufficient seismic data could not accumulated. To solve this problem, reflection and refraction seismic survey and seismic wave analysis method were simultaneously applied to two long cross-section traversing the southern Korean Peninsula since 2002. This survey should be continuously conducted.

Primary Orbital Lymphoma : A Retrospective Analysis of Results of Radiation Therapy (원발성 안와 림프종의 방사선치료 성적에 관한 후향적 분석)

  • Kim Sussan;Ahn Seung Do;Chang Hyesook;Kim Kyoung Ju;Lee Sang-wook;Choi Eun Kyung;Kim Jong Hoon;Huh Jooryung;Suh Cheol Won;Kim Sung Bae
    • Radiation Oncology Journal
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    • v.20 no.2
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    • pp.139-146
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    • 2002
  • Purpose : This study evaluated the treatment outcomes, patterns of failure, and treatment related complications of primary lymphoma patients who received definitive radiation therapy. Materials and Methods : A retrospective analysis was undertaken for 31 patients with primary orbital lymphoma at the Asan Medical Center between February 1991 and April 2001. There were 18 males and 13 females with ages ranging from 3 to 73 years (median, 44 years). The involved sites were 9 conjunctivae, 12 eyelids and 10 other orbits. The histological types were 28 MALT lymphomas (low-grade B-cell lymphoma of mucosa-associated lymphoid tissue type), 1 diffuse large B-cell lymphoma, 1 anaplastic large cell lymphoma and 1 lymphoblastic lymphoma. The Ann Arbor stages were all IE $(100\%)$. Ann Arbor stage III or IV patients were excluded from this study, Bilateral orbital involvement occurred in 6 cases. Radiation therapy was given with one anterior port of high energy electrons $(6\~16\;MeV)$ for the lesions located at the anterior structures like the conjunctivae or eyelids. Lesions with a posterior extension or other orbital lesions were treated with 4 or 6 MeV photons with appropriately arranged portals. In particular, lens blocks composed of lead alloy were used in conjunctival or eyelid lesions. Twelve patients received chemotherapy. The median follow-up period was 53 months. Results : The 5-year overall, cause-specific, and disease-free survival was $91\%,\;96\%,\;and\;80\%$, respectively. The complete response rate 6 months after radiation therapy was $100\%$. Local recurrences were observed in 2 patients at 16 and 18 months after completion of radiation treatment. They were salvaged with additional radiation therapy. Two patients developed distant metastases. A MALT lymphoma patient with a lung relapse was successfully salvaged with radiotherapy, but the other lymphoblastic lymphoma patient with bone marrow relapse expired. There were no severe complications but 5 patients developed radiation-induced cataracts and 2 patients developed dry eye. Conclusion : Most primary orbital lymphomas consisted of MALT lymphomas. Radiation therapy was a successful treatment modality for orbital lymphoma without any severe complications. In cases of local relapses, radiation therapy is also a very successful salvage treatment modality.

Clinical Results and Optimal Timing of OPCAB in Patients with Acute Myocardial Infarction (급성 심근경색증 환자에서 시행한 OPCAB의 수술시기와 검색의 정도에 따른 임상성적)

  • Youn Young-Nam;Yang Hong-Suk;Shim Yeon-Hee;Yoo Kyung-Jong
    • Journal of Chest Surgery
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    • v.39 no.7 s.264
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    • pp.534-543
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    • 2006
  • Background: There are a lot of debates regarding the optimal timing of operation of acute myocardial infarction (AMI). Off pump coronary artery bypass grafting (OPCAB) has benefits by avoiding the adverse effects of the cardio-pulmonary bypass, but its efficacy in AMI has not been confirmed yet. The purpose of this study is to evaluate retrospectively early and mid-term results of OPCAB in patients with AMI according to transmurality and timing of operation. Material and Method: Data were collected in 126 AMI patients who underwent OPCAB between January 2002 and July 2005, Mean age of patients were 61.2 years. Male was 92 (73.0%) and female was 34 (27.2%). 106 patients (85.7%) had 3 vessel coronary artery disease or left main disease. Urgent or emergent operations were performed in 25 patients (19.8%). 72 patients (57.1%) had non-transmural myocardial infarction (group 1) and 52 patients (42.9%) had transmural myocardial infarction (group 2). The incidence of cardiogenic shock and insertion of intra-aortic balloon pump (IABP) was higher in group 2. The time between occurrence of AMI and operation was divided in 4 subgroups (<1 day, $1{\sim}3\;days,\;4{\sim}7\;days$, >8 days). OPCAB was performed a mean of $5.3{\pm}7.1$ days after AMI in total, which was $4.2{\pm}5.9$ days in group 1, and $6,6{\pm}8.3$ days in group 2. Result: Mean distal an-astomoses were 3.21 and postoperative IABP was inserted in 3 patients. There was 1 perioperative death in group 1 due to low cardiac output syndrome, but no perioperative new MI occurred in this study. There was no difference in postoperative major complication between two groups and according to the timing of operation. Mean follow-up time was 21.3 months ($4{\sim}42$ months). The 42 months actuarial survival rate was $94.9{\pm}2.4%$, which was $91.4{\pm}4.7%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.26). The 42 months freedom rate from cardiac death was $97.6{\pm}1.4%$ which was $97.0{\pm}2.0%$ in group 1 and $98.0{\pm}2.0%$ in group 2 (p=0.74). The 42 months freedom rate from cardiac event was $95.4{\pm}2.0%$ which was $94.8{\pm}2.9%$ in group 1 and $95.9{\pm}2.9%$ in group 2 (p=0.89). Conclusion: OPCAB in AMI not only reduces morbidity but also favors hospital outcomes irrespective of timing of operation. The transmurality of myocardial infarction did not affect the surgical and midterm outcomes of OPCAB. Therefore, there may be no need to delay the surgical off-pump revascularization of the patients with AMI if surgical revascularization is indicated.

Clinical Analysis of the Recent Results of Coronary Artery Bypass Grafting (관상동맥 우회술의 최근성적에 대한 임상적 고찰)

  • Han, Sung-Ho;Kim, Hyuck;Lee, Chul-Bum;Chung, Won-Sang;Jee, Heng-Ok;Kang, Jung-Ho;Kim, Young-Hak
    • Journal of Chest Surgery
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    • v.35 no.7
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    • pp.523-529
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    • 2002
  • Background: Previous reports present that the early results of coronary artery bypass grafting (CABG) has been improving with the accumulation of surgical experience. We conducted a retrospective analysis of the patients who received CABG to evaluate the recent results of CABG. Material and Method: Between January 1996 and August 2001, 154 patients underwent CABG at Hanyang University Hospital. There were 47 patients(group I) who were operated between 1996 and 1998, and 107 patients(group II) who were operated thereafter. The preoperative diagnosis, operative procedure, mortality, and complications were analyzed retrospectively. Result: There were 35 males and 12 females in group I, and 78 males and 29 females in group II, which shows similar ratio of sexes between the two groups. The average age of patients for group I and group II was $55.9{\pm}6.2$ years and $61.0{\pm}8.0$ years, respectively, showing a significant increase in group II(p<0.05). The average left ventricular ejection fraction(LVEF) for group I and group II was $54.6{\pm}11.8$% and $56.9{\pm}13.0$%, respectively. The number of patients who had previous MI in group I and group II were 13 patients(27.7%) and 14 patients(13.1%), respectively, which shows a significant difference (p<0.05). All procedures were performed using the cardiopulmonary bypass(CPB) and moderate systemic hypothermia. Myocardial protection was achieved using intermittent hypothermic ischemia under ventricular fibrillation state or cold crystalloid cardioplegic solution for most of group I patients, whereas cold blood cardioplegic solution was used for group II patients. The mean CPB times for group I and group II were $149.2{\pm}48.7$ minutes and $113.1{\pm}30.6$ minutes, respectively. The mean aortic cross clamp times for group I and group II were $81.3{\pm}26.5$ minutes $72.2{\pm}23.9$ minutes, respectively. These figures show that CPB and aortic cross clamp times were significantly reduced in group II(p<0.05). The use of the left internal thoracic artery(LITA) was increased from 42%(20/47) for group I to 81% (87/107) for group II. The mean number of grafts also significantly increased from $2.5{\pm}0.6$ for group I to $3.0{\pm}1.1$ for group II(p<0.05). Intra-aortic balloon pump(IABP) was applied in 7 cases in group I and 17 cases in group II. Of these, 28.6%(2/7) and 52.9%(9/17) were broadly applied preoperatively in patients with LVEF<40% or congestive heart failure. The operative mortalities for group I and II were 10.6%(5/47) and 0.9%(1/107), respectively, which shows significant decrease for group II(p.0.05). Conclusion: This report suggest that CABG using CPB can recently be performed more safely in virtue of the accumulation of surgical experience with reduction in CPB and aortic cross clamp times and improved surgical techniques and myocardial protection. And we think that the optimal treatment of patients with left ventricular dysfunction associated with congestive heart failure and the extended application of IABP, especially have contributed to the reduction of operative mortality and morbidity.

20 Years Surgical Experiences for Ebstein's Anomaly (엡스타인 기형의 20년 수술 치험)

  • Lee, Sak;Park, Han-Ki;Lee, Chang-Young;Chang, Byung-Chul;Park, Young-Hwan
    • Journal of Chest Surgery
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    • v.40 no.4 s.273
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    • pp.280-287
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    • 2007
  • Background: We retrospectively evaluated the clinical results of surgically managing patients with Ebstein's anomaly. Material and Method: Between Feb. f 984 and June 2006, 50 patients who underwent surgical treatment for Ebstein's anomaly at Yonsei Cardiovascular Center were retrospectively reviewed. The mean age of the patients was 26.9 years and 19 patients were male, Associated anomalies included atrial septal defect (33), patent ductus arteriosus (2), ventricular septal defect (1), and pulmonary stenosis (4), and 90%, (45/50) of the patients had more than a moderate degree of tricuspid regurgitation. Carpentier type A was present in 6 patients, type B in 26, type C in 14 and type D in 4. Ten patients were associated with WPW syndrome. Conservative surgery was possible in 31 patients (tricuspid annuloplasty, plication of the atrialized RV), Fontan's operation was peformed in 4 patients, tricuspid valve replacement was done in 12 and palliative surgery was done in 2 patients. Thirteen patients were associated with hi-directional cavopulmonary shunt (BCPS: one and a half ventricular repairs): 10 patients with WPW syndrome and 4 patients with atrial fibrillation underwent concomitant ablation. Result: The postoperative median NYHA functional class $(3{\rightarrow}1)$ and the mean cardio-thoracic ratio $(0.65{\rightarrow}0.59)$ were decreased significantly (p<0.001, p=0.014). The mean oxygen saturation $(86.6{\rightarrow}94.1%)$, and median TR grade $(4{\rightarrow}1)$ were also significantly improved (p=0.004, p<0.001). For comparison of BCPS and conservative surgery, the preoperative right ventricular pressure (33.0 vs. 41.3 mmHg), the ICU stay (2.80 vs. 1.89 days), the hospital say (10.6 vs. 16.8 days), and the left ventricular ejection fraction (64.3 vs. 72.8%) were statistically different. Postoperative mortality occurred in 3 patients (6%) due to biventricular failure in 2 patients and sepsis in the other patient. The mean follow up duration was 101.5 months, and one patient died of Fontan failure and 6 patients required reoperation (bioprosthetic degenerative change (2) and Fontan conversion (4)). The overall survival rate at 10 years was 90.2%, the freedom from reoperation rate and rate of cardiac related events were 78.9% and 49.2%, respectively. Conclusion: Surgical management of Ebstein's anomaly can be performed safely, and the associated BCPS may be helpful for high-risk patients. Adequate application of surgical management may increase the long-term survival with a reduced rate of reoperation.

A Contemplation on Measures to Advance Logistics Centers (물류센터 선진화를 위한 발전 방안에 대한 소고)

  • Sun, Il-Suck;Lee, Won-Dong
    • Journal of Distribution Science
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    • v.9 no.1
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    • pp.17-27
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    • 2011
  • As the world becomes more globalized, business competition becomes fiercer, while consumers' needs for less expensive quality products are on the increase. Business operations make an effort to secure a competitive edge in costs and services, and the logistics industry, that is, the industry operating the storing and transporting of goods, once thought to be an expense, begins to be considered as the third cash cow, a source of new income. Logistics centers are central to storage, loading and unloading of deliveries, packaging operations, and dispensing goods' information. As hubs for various deliveries, they also serve as a core infrastructure to smoothly coordinate manufacturing and selling, using varied information and operation systems. Logistics centers are increasingly on the rise as centers of business supply activities, growing beyond their previous role of primarily storing goods. They are no longer just facilities; they have become logistics strongholds that encompass various features from demand forecast to the regulation of supply, manufacturing, and sales by realizing SCM, taking into account marketability and the operation of service and products. However, despite these changes in logistics operations, some centers have been unable to shed their past roles as warehouses. For the continuous development of logistics centers, various measures would be needed, including a revision of current supporting policies, formulating effective management plans, and establishing systematic standards for founding, managing, and controlling logistics centers. To this end, the research explored previous studies on the use and effectiveness of logistics centers. From a theoretical perspective, an evaluation of the overall introduction, purposes, and transitions in the use of logistics centers found issues to ponder and suggested measures to promote and further advance logistics centers. First, a fact-finding survey to establish demand forecast and standardization is needed. As logistics newspapers predicted that after 2012 supply would exceed demand, causing rents to fall, the business environment for logistics centers has faltered. However, since there is a shortage of fact-finding surveys regarding actual demand for domestic logistic centers, it is hard to predict what the future holds for this industry. Accordingly, the first priority should be to get to the essence of the current market situation by conducting accurate domestic and international fact-finding surveys. Based on those, management and evaluation indicators should be developed to build the foundation for the consistent advancement of logistics centers. Second, many policies for logistics centers should be revised or developed. Above all, a guideline for fair trade between a shipper and a commercial logistics center should be enacted. Since there are no standards for fair trade between them, rampant unfair trades according to market practices have brought chaos to market orders, and now the logistics industry is confronting its own difficulties. Therefore, unfair trade cases that currently plague logistics centers should be gathered by the industry and fair trade guidelines should be established and implemented. In addition, restrictive employment regulations for foreign workers should be eased, and logistics centers should be charged industry rates for the use of electricity. Third, various measures should be taken to improve the management environment. First, we need to find out how to activate value-added logistics. Because the traditional purpose of logistics centers was storage and loading/unloading of goods, their profitability had a limit, and the need arose to find a new angle to create a value added service. Logistic centers have been perceived as support for a company's storage, manufacturing, and sales needs, not as creators of profits. The center's role in the company's economics has been lowering costs. However, as the logistics' management environment spiraled, along with its storage purpose, developing a new feature of profit creation should be a desirable goal, and to achieve that, value added logistics should be promoted. Logistics centers can also be improved through cost estimation. In the meantime, they have achieved some strides in facility development but have still fallen behind in others, particularly in management functioning. Lax management has been rampant because the industry has not developed a concept of cost estimation. The centers have since made an effort toward unification, standardization, and informatization while realizing cost reductions by establishing systems for effective management, but it has been hard to produce profits. Thus, there is an urgent need to estimate costs by determining a basic cost range for each division of work at logistics centers. This undertaking can be the first step to improving the ineffective aspects of how they operate. Ongoing research and constant efforts have been made to improve the level of effectiveness in the manufacturing industry, but studies on resource management in logistics centers are hardly enough. Thus, a plan to calculate the optimal level of resources necessary to operate a logistics center should be developed and implemented in management behavior, for example, by standardizing the hours of operation. If logistics centers, shippers, related trade groups, academic figures, and other experts could launch a committee to work with the government and maintain an ongoing relationship, the constraint and cooperation among members would help lead to coherent development plans for logistics centers. If the government continues its efforts to provide financial support, nurture professional workers, and maintain safety management, we can anticipate the continuous advancement of logistics centers.

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Customer perception and expert assessment in restaurant food environment by region - Focused on restaurants in Suwon, Hwaseong city - (도시와 농촌의 한식 음식점 식생활 환경에 대한 고객 인식 및 전문가 평가 비교 - 수원, 화성지역 음식점을 중심으로 -)

  • Oh, Mi Hyun;Choe, Jeong-Sook;Kim, Young;Lee, Sang Eun;Paik, Hee Young;Jang, Mi Jin
    • Journal of Nutrition and Health
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    • v.47 no.6
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    • pp.463-474
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    • 2014
  • Purpose: The aim of this study was to assess the food environment, particularly focusing on restaurants in three areas (Suwon city, Hwaseong Byeongieom-dong, and Bibong-myun). Methods: A total of 662 persons were surveyed on customers' perceptions of the food environment in restaurants. A structured questionnaire composed of 30 questions on 7 factors, sanitation (4 items), displaying information (5), food quality (12), information on nutritional and healthy food choice (6), restaurant's accessibility (1), availability (1), and affordability (1) was used. In addition, an expert assessment of restaurant sanitation, and information on nutritional healthy food choice was conducted through visiting 126 restaurants. Results: Scores (range of score : 1~7) for each factors assessing the restaurant food environment were 5.06 for sanitation factors, 5.05 for displaying information factors, 5.13 for taste appearance factors, and 4.35 for healthy menu factors. Informations on nutritional healthy food choice showed a low rate: only 16.24% of the subjects answered that there is a message encouraging choice of healthy foods and 27.4% answered that menus contain nutritional information. Significant differences in food environment were observed by region (city, town, rural). The restaurants food environment in the rural area turned out to be poorer than that of the other two areas. In comparison of customer perception and expert assessment, significant differences were observed for 'Employee appearances and uniforms are clean and tidy' (p < .05), and 'There is a message encouraging the choice of healthy foods' (p < .05). Conclusion: This study provided evidence for differences of restaurant food environment by regions. In the rural area, there is a problem in restaurant's accessibility, availability, and affordability because of a lack of variety in menu items and restaurants. This results suggest that there is a need for more healthy food restaurants in the rural area.

Effects of Adjuvant Radiation Therapy and Chemotherapy Following Curative Surgery in Locally Advanced Rectal Cancer (국소 진행된 직장암에서 근치적 절제술 후 방사선치료와 항암화학요법과의 병용치료에 대한 효과)

  • Kang, Ki-Mun;Choi, Ihl-Bohng;Kim, In-Ah;Jang, Jee-Young;Shin, Kyung-Sub;Jang, Suck-Kyun;Lee, Jae-Hak;Kim, Young-Ha;Won, Chong-Man;Choi, Dong-Hwan;Kim, Jin-Seung;Park, Shinn-Hee
    • Radiation Oncology Journal
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    • v.15 no.2
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    • pp.121-128
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    • 1997
  • Purpose : To evaluate the effect of postoperative adjuvant radiation therapy and chemotherapy on the survival, pattern of failure and complication for locally advanced rectal carcinoma Materials and Methods : From October 1992 to September 1995, twenty eight patients with rectal carcinoma were treated by postoperative adjuvant radiation therapy and chemotherapy Radiation therapy was delivered with 6MV and 15MV linear accelerator, 180c0y fractions 5 day per week. Total radiation doses were 5040cGy in $B_{2+3}$ and 5580cGy in $C_{2+3}$. Within 4 weeks after radical surgery. 5-FU$(400mg/m^2/day)\;and\;Leucovorin(20mg/m^2/day)$ were administered by intravenous injection for 4 days during the first and fifth week of radiation therapy. The median follow up was 19 months with a range 2 to 47 months. Results : The 2 year overall survival and disease free survival rates were $78.6\%\;and\;70.8\%$, respectively. The 2 year overall survival was $93.0\%\;in\;B_{2+3}$ and $76.2\%\;in\;C_{2+3}$(p=0.11) The 2 year disease free survival was $79.4\%\;in\;B_{2+3}\;and\;69.2\%\;in\;C_{2+3}(p=0.13)$. The overall failure rate was $21.42\%$(6/28) including $10.72\%$(3/28) locoregional recurrence, $3.62\%$(1/28) distant metastasis and $7.12\%$(2/28) locoregional recurrence with distant metastasis. The overall locoregional recurrence rate was $17.92\%$(5/28). The 2 year locoregional recurrence rates were $13.32\%(2/15)\;and\;23.12\%$(3/13) for respectively for $B_{2+3}\;and\;C_{2+3}$ The difference between the locoregional recurrence of $B_{2+3}\;and\;C_{2+3}$ patients was not significant(p=0.07). Complications developed in 13 patients$(46.42\%)$, including 8 dermatitis, 7 loose stool, 6 leukopenia, 4 tenesmus, 2 diarrhea. In Univariate analysis, there was no statistically significant factor except for tumor grade in locoregional recurrence, disease free survival and overall survival rate(p=0.04, 0.05, 0.04). Conclusion : This study sugges1s that postoperative adjuvant radiation therapy and chemotherapy is effective in patients with locally advanced rectal cancer. Therefore these results need to be confirmed with a long term follow-up and larger number of patients with the further clinical trials including prospective controlled studies.

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