• 제목/요약/키워드: Accidental injury

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영유아의 구강위생관리방법 개선에 관한 연구 (IMPROVEMENT OF ORAL HYGIENE METHODS FOR EARLY CHILDHOOD)

  • 이광희
    • 대한소아치과학회지
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    • 제34권2호
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    • pp.264-272
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    • 2007
  • 연구 목적은 영유아의 구강위생관리방법을 개선하기 위한 것으로서, 시중의 영유아용 구강위생관리용품을 조사하여 분류하고 안전성에 대한 문헌고찰을 실시하였으며, 익산시내 영유아 보육자들 672명에게 구강위생관리용품의 사용경험을 포함한 구강위생관리방법에 대하여 조사하였다. 영유아용 구강위생관리용품은 구강 티슈, 손가락 칫솔, 성장단계별 칫솔, 전동칫솔, 어린이용 칫솔, 삼켜도 되는 영유아용 치약을 포함한 성장단계별 치약, 어린이용 불소치약 등이 있었다. 사용 경험은 구강티슈가 62.5%, 손가락 칫솔이 70.9%, 3단계 칫솔이 55.9%, 삼켜도 되는 영유아용 치약이 87.4%이었다. 이를 닦아주기 시작한 때는 이가 날 때부터와 생후 1년경이 79.0%, 생후 2년경과 3년경이 21.0%이었고, 이닦기 중 치약을 삼키는 비율은 48개월 미만에서 22%이었고 $48{\sim}59$개월에서는 9%, 60개월 아상에서는 3%로 감소하였다. 보육자가 어린이 이를 닦아주는 비율은 48개월 미만에서 52%, $48{\sim}59$개월에서는 42%이었고 60개월 이상에서는 26%이었다. 영유아기 구강위생관리의 기본 방법은 이닦기를 통해 치아표면의 치태를 제거하는 것이며, 이닦기의 주된 방법은 칫솔질이고 치약을 보조적으로 사용할 수 있다. 구강위생용품 사용시에는 질식, 삼킴, 목구멍 손상 등에 주의해야 한다. 일반적으로 3세 이전에는 불소치약의 사용이 권장되지 않으며, 사용시에는 최소량을 사용하고, 삼키지 않고 뱉도록 보호자가 지도 감독하여야한다.

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Retrospective clinical study of mandible fractures

  • Jung, Hai-Won;Lee, Baek-Soo;Kwon, Yong-Dae;Choi, Byung-Jun;Lee, Jung-Woo;Lee, Hyun-Woo;Moon, Chang-Sig;Ohe, Joo-Young
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • 제40권1호
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    • pp.21-26
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    • 2014
  • Objectives: The purpose of this article is to analyze the incidence, demographic distribution, type, and etiology of mandible fractures that were treated by the Department of Oral and Maxillofacial Surgery in Kyung Hee University Dental Hospital from January 2002 to December 2012. Materials and Methods: This was a descriptive and analytic retrospective study that evaluated 735 patients that were treated for mandible fracture. Results: This study included 1,172 fractures in 735 patients. The ratio of male to female patients was 5.45 : 1; the maximum value was in patients between 20 and 29 years (38.1%) and the minimum in patients over 70 years old. The monthly distribution of facial fractures peaked in the fall and was lower during winter. No specific correlation was identified based on the annual fracture distribution. Among the 735 fracture patients, 1.59 fracture lines were observed per patient. The most frequent site was the symphysis, which accounted for a total of 431 fractures, followed by the angle (348), condyle (279), and body (95). The symphysis with angle was the most common site identified in combination with fracture and accounted for 22.4%, followed by symphysis with condyle (19.8%). The angle was the most frequent site of single fractures (20.8%). The major cause of injury was accidental trauma (43.4%), which was followed by other causes such as violence (33.9%), sports-related accidents (10.5%), and traffic accidents (10.1%). Fracture incidents correlated with alcohol consumption were reported between 10.0%-26.9% annually. Conclusion: Although mandible fracture pattern is similar to the previous researches, there is some changes in the etiologic factors.

간호·간병통합서비스 이용환자의 낙상발생률과 낙상의 특성 (Incidence Rate and Characteristics of Falls in Patients Using Comprehensive Nursing Care Service)

  • 손재이;박병규;이찬희;안금희;김정남;박민현;최은영;부은희;강민진;홍정화
    • 보건행정학회지
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    • 제29권2호
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    • pp.172-183
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    • 2019
  • Background: Falls are the most frequent adverse events reported in hospitals. The aim of this study was to investigate the incidence rate and characteristics of falls in patients who used comprehensive nursing care service in National Health Insurance Service Ilsan Hospital. Methods: Incidence rate of falls was investigated in patients using comprehensive nursing care service, from July 2013 to Jun 2017 and compared with those not using this service. The characteristics and risk factors for falls, and fall-related injuries were obtained. Results: Among the 62,445 patients who used the comprehensive nursing care service for 4 years, total of 672 falls were reported. The incidence rate of falls per 1,000 patients-day was 1.15. The percentage of fall-related injuries was 26.9% and that of major injury was 2.2%. Although the incidence rate of all falls was slightly higher in patients using comprehensive nursing care service than those not using this service, falls-related injuries were not correlated with the implementation of this service. Conclusion: The falls could be more frequently detected and reported in comprehensive nursing care service, but there was no difference in fall-related injuries.

학령전기 소아에서 추락으로 인한 경증 두부손상의 특징에 대한 후향적 관찰 연구 (The characteristics of mild head injuries in preschool-age children fall: a retrospective observational study)

  • 성민석;이지숙;전우찬;박준석;김경환;신동운;김훈;박준민;김현종
    • 대한응급의학회지
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    • 제29권5호
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    • pp.423-429
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    • 2018
  • Objective: Falling is a common cause of head injury in preschool aged children. We investigated the characteristics of mild head injuries caused by falling and the association between body weight and occurrence of traumatic brain injuries (TBI). Methods: This retrospective observational study was conducted on head-injured preschool-aged children that visited the emergency department from January 2012 to December 2015. Characteristics such as age, sex, weight, free fall height, floor type, and presence of TBI, as defined as cerebral hemorrhage or skull fracture, were investigated. We calculated body weight percentiles by calibrating age and weight and categorized them into four quartile ranges. We grouped all included cases into two groups according to the presence of TBI. The characteristics of the two groups were compared by using chi-square test, and the association with TBI was investigated by using binomial logistic regression. Results: A total of 701 children were included, and TBI was observed in 95 children. Children with TBI were younger. The proportion of children with TBI was higher in the third and fourth quartiles of the body weight group as well as according to soft floor and fall from high height (${\geq}1m$). The odds of soft floor being associated with TBI was higher than the odds for hard floor (odds ratio, 2.734; 95% confidence interval [CI], 1.597-4.680). The odds of high height (${\geq}1m$) being associated with TBI was higher than that for low height (odds ratio, 2.306; 95% CI, 1.155-4.601), and the odds ratio for the weight percentile group was 1.228 (95% CI, 1.005-1.499). Conclusion: Prevalence of TBI after falling in preschool-aged children might be associated with high fall-height and body weight quartiles.

응급구조사 직무기술서 작성에 따른 일의 요소별 빈도 및 중요도 조사 연구 (Investigating Research on the Degree of Frequency and Importance of Tasks for Framing the EMTs Occupational Description)

  • 김태민;김효식;유순규
    • 한국응급구조학회지
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    • 제5권1호
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    • pp.199-212
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    • 2001
  • This research, aiming at analyzing the Emergency Medical Technicians' duties prior to establishing a baseline for question development in the national exams to qualify for the EMTs, investigated the importance and frequency per unit specified in the description with the EMTs to be subjects working on the task spot by means of questionnaires. The EMT duties were classified into 9 items like 1) the notification and response, 2) the scene size-up, 3) the patient assessment, 4) the emergency care, 5) the patient transport, 6) the duties at hospital clinics, 7) the operational management, 8) the receiving and responding to a call, 9) the self-development, and put the functional tasks into 52 items, describing the task elements into 177 items, and then questioned 112 EMTs working on the spot from July 21 through August 30, 2000, which showed the following results. 1) The distribution of subjects' career showed the highest rate with 33.9% for those who careered "less than a year", only 13.4% for those with more than 4 years and the highest rate with 43.8% for those who aged at 20-25. And 70.5% of all those who were questioned was the junior college graduates, 58.9% for those working at fire station and 29.5% working at hospital clinics. 2) Looking at the distribution of frequency and importance for each task element, questioning 'the patients main symptoms', 'accidental type', 'place of the patients identification' showed the highest rate in both frequency and importance in the field of "notification and response". 3) In the "scene size-up", identifying the patients showed the highest rate of frequency and importance, compared to other field of tasks, among which "identifying the patients' state" showed the highest rate of frequency (2.66) and importance (2.81). 4) In the "patient assessment", "identifying the patients" showed the high rate of frequency and importance in most elements of task, especially the importance showed the highest rate with 2.83 for the task of airway management and the cervical immobilization during "the primary assessment", and the frequency showed the highest rate for questioning the past case of the task of grasping the patients' history. 5) In the "emergency care", "the management of the heart attacked patients" and "the advanced cardiac life support" showed a high rate in the importance, whereas the frequency showed a very low rate. The high rate of frequency during the emergent task was the management of "musculoskeletal system injury patients" and of "the gastro-intestinal and urinary genital system injury patient support." In care of the patients with heart attack, the management of the airway showed the highest rate with 2.95, whereas the management of alcoholic abused patients and of dying patients, showed comparatively lower rate of assessment in the importance. The frequency of tasks showed the highest rate with 2.69 in the control of bleeding and the lowest with 0.47 in the management of abnormal delivery of child. 6) As to the patient transport, "the emergency transport" showed the highest rate with 2.74 and the unemergent transport with 2.55 in the importance, and the task importance at hospital showed the highest rate with 2.89 in managing the cardio-pulmonary resuscitation and with 2.60 in identifying the patient state. 7) Of all the tasks related with "operational task", the high importance was to "educate for the management of the first responder", but the frequency of tasks mostly showed a low rate and "receiving and responding to a call" showed relatively a high rate of importance and frequency. And related with "the self-development", "the health care management" and "the stress control" on working spot showed a high rate, but the frequency mostly showed a low rate.

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대퇴경부 골절 환자의 입원 생활 (The Hospital Life of the Patient with Femoral Neck Fracture)

  • 김경자;지성애
    • 간호행정학회지
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    • 제2권1호
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    • pp.35-56
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    • 1996
  • Nowerdays, the increase of traffic accidents and old age population make the Femoral Neck Fracture(FNF) patients increase. By the improvement of education and standard of living the patients demand better medical service than before. This study is designed to give practical help for the FNF patients by observing their hospital life and establish practical nursing strategies for the FNF patients. For these purposes the Ethnographic Participant Observation was adopted. By this study is focused on the hospital life patient's view. For this end, the field study adopted orthopedic ward in the C University Hospital with 400 beds in Seoul. The object patients of the study were twelve patients. The patients experienced five stages : Embarrassment, Conflict, Stability, Independent, and Extension Stage. The findings and prepared nursing strategies are stated as follows. First, in the Embarrassment Stage they suffered embarrassment, anxiety, pain, they could not do ordinary things. The patients who accidental fractures had anxiety from unfamiliar tests and from hospitalization itself. They lamented that they could not ordinary things, and do nothing but obeying the hospital, and endure the pain. They recognized the changed environment and resigned themselves to life in the ward. In this stage, full openness by the nurses is needed. Second, the attribute of the Conflict Stage were conflict, fear, curiosity, belief, reflection. When they sign the consentment form, they experience conflicts about the possibility of complication, fear of recovery from anesthesia, curiosity about the operation procedure, post - operation state, reflection on their past life, and promise to care for their family members after discharge and keep their religious life faithfully. And they accepted the operation depending on God, believing in modern medicine, and the surgeon. Asking for their changed informations, they expected positive results from the operation. In this stage, an empathic attitude by the nurses is needed. Third, the attribute of the Stability Stage were relief, gratitude, difficulty with excretion, and pain. When they awoke from anesthesia, they felt relief because of a the end of the operation, but they experienced extreme pain, difficulty of excretion in bed. They accepted the changed environment and expected recovery. In this stage, support by the nurses is needed. Fourth, the attributes of the Independence Stage were freedom, exercise, nurturing, anxiety, and discomfort. When they ambulated and exercised, they experienced freedom. They showed exhibited weakness of the digestive organs and discomfort hospital's space, structure, and facilities, the delay of medical certificate issue the lack of prompt response by the medical agents. They ate nurturious food and felt anxiety on the end of hospital life and returning to their ordinary life. They showed the independence of overcoming their environment by increasing exercise and expected their discharges. In this stage, respect by the nurses is needed for the patients to, overcome their environment and prepare for their independence. Fifth, the attributes of the Extension Stage were pessimism, isolation, dissatisfaction, and pain. Accompanied injury and old age made their ward life extend to over seven weeks. They exhibited weariness, melancholy, skeptisis, general pessimistic feeling, and desperation caused by their isolated life. They experienced the digestive discomfort caused by the prolonged medication and psycological pain caused by long-time hospitalization. As a, result, their dissatisfaction on the human, physical, and systematic environments had been increased. They acquired critical power and sought for something to do spending their time. They expected vaguely about the returning of their ordinary life. In this stage, counseling is needed by the nurse to overcome positively their psychological, social, and physical problems. The process of the FNF patient's ward life starts from the dependent state, when they are hospitalized, and gradually progresses to self-fulfillment in order to keep independent life. As a result, the FNF patients showed "Response in Challenge" or "Adaptation in Conflict" through their experiences of social, physical, and psychological difficulties.

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방사선에 전신 조사된 마우스 음와 세포의 아포토시스 유도를 이용한 생물학적 선량 측정 모델 개발 연구 (Mouse model system based on apoptosis induction to crypt cells after exposure to ionizing radiation)

  • 김태환
    • 대한수의학회지
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    • 제41권4호
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    • pp.571-578
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    • 2001
  • 방사선 피폭선량의 예측을 위한 방사선 민감 지표 모델 개발의 일환으로 apoptotic fragment assay법이 방사선에 피폭된 후 체내 피폭선량을 예측할 수 있는 지표로의 이용 가능성을 평가하기 위하여 코발트-60 감마선과 의료용 싸이크로트론 50MeV($p{\rightarrow}Be^+$) fast neutron 을 0.25Gy에서 1Gy의 선량을 마우스에 각각 전신 조사한 후 소장 음와세포내 apoptotic crypt cell의 수적 변화를 관찰하였다. 저선량 조사군에서 apoptotic crypt cell의 출현 빈도가 1Gy까지 급격하게 증가한 것으로 보아 방사선이 stem cell 지역에 있는 crypt cell의 형태학적 변화를 유발하는 것으로 나타났다. 이상의 결과는 아포토시스가 손상된 세포를 제거하므로 손상된 방사선 민감 표적 장기의 항상성 유지에 중요한 역할을 하는 것으로 판단되었다. Apoptotic fragments의 발생빈도에 대한 선량-반응 곡선에 있어서 음와세포는 중성자조사군이 $y=0.18+(9.728{\pm}0.887)D+(-4.727{\pm}1.033)D^2$ ($r^2=0.984$)으로, 반면에 감마선조사군은 $y=0.18+(5.125{\pm}0.601)D+(-2.652{\pm}0.7000)D^2$ ($r^2=0.970$)의 식을 얻었다. 이와 같이 중성자조사군과 감마선조사군은 공히 linear quadratic model 로 관찰되었다. apoptotic fragments 의 발생빈도와 조사 선량간에 유의한 효과가 있는 것으로 확인되었다. 이상의 결과에서 조사선량의 증가에 비례하여 방사선 민감 세포의apoptotic fragments 가 수적으로 증가하였으며, 고준위 방사선과 저준위 방사선은 선량 반응 관계식과 시간 경과에 따른 영향이 매우 유사하였으며, 마우스 음와세포의 apoptosis 유도에 대한 중성자선의 방사선 생물학적 효과비(RBE)는 2.072이였다. 그리고 모든 방사선조사군에서 방사선피폭 후 4시간과 6시간에 apoptosis 유도가 가장 많았으며, 음와세포의 형태학적 소견은 정상 대조군에서 관찰되지 않는 전형적인 apoptotic fragments 가 나타났다. 따라서 음와 세포에서의 아포토시스 유도는 방사선 피폭으로 발생된 세포 손상의 생물학적 영향 평가검색, 방사선 방호제의 민감도 검사, 방사성 동위원소의 체내 오염에 대한 체내 피폭선량 예측의 지표 및 방사선 민감 표적장기의 손상정도 파악에 이용 가능할 것임. Apoptotic fragment assay 법은 0.25Gy에서 1Gy 까지의 선량에서 간편하고 빠르며 재현성이 있는 지표로서 방사선 민감 표적 장기의 선량 반응 평가와 방사선 피폭후 조기 피폭선량 예측을 위한 방사선 생물학적 선량측정법의 좋은 지표로 사용할 수 있을 것으로 사료됨.

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형법상 제조물책임과 인과관계의 확정 (Product Liability and Causation in Criminal Law)

  • 이석배
    • 의료법학
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    • 제17권2호
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    • pp.3-28
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    • 2016
  • 민사법에서 제조물 책임이 전문용어로 정착된 반면, 형사법에서는 일반적으로 받아들여진 전문용어는 없다. 민사법에서 제조물책임과 달리 형사책임에서는 개개인의 책임성과 규범질서의 장애가 중요하다. 즉 구체적인 개개인의 의무위반행위가 그리고 제조물이 법익위태화 또는 법익침해라는 결과를 야기했다는 인과관계가 입증되어야 한다. 형법에서 제조물 책임은 일반 거동범을 제외하고는 상해죄 또는 과실치상죄, 살인죄 또는 과실치사죄가 주로 문제가 된다. 물론 결과발생과 관련된 행위가 작위인지 부작위인지 구별되어야 하고, 그 행위와 결과사이에 인과관계가 입증되어야 하며, 고의 혹은 과실도 인정되어야 한다. 이 글에서는 우리나라, 독일, 스페인 등에서 실제로 문제가 되었던 판례들을 분석하여 인과관계의 확정에서 드러난 문제점을 중심으로, 특히 제조물과 관련된 형사책임을 인정하기 위한 핵심문제인 인과관계의 문제를 중심으로 살펴보았다. 이 글에서는 인과관계의 검토단계를 자연과학적 인과법칙과 규범적 인과관계로 나누어 2단계로 검토하는 견해를 따랐다. 이 절차에 따른 제조물의 형사책임을 인정하기 위한 인과관계의 입증은 우선 그 제조물의 특정물질이 결과발생을 야기할 수 있는 일반적인 위험성이 있어야 하고, 그것을 전제로만 구체적인 사안에서 인과관계의 검토가 의미가 있는 것으로 보았다. 일부 판례와 학설에서 나타나는 것처럼, 일반적 인과관계 자체가 전혀 존재하지 않는 경우에도 자유심증에 의해 구체적 인과관계를 확정한다고 하더라도 일반적 인과법칙에 반하는 것이 아니며, 법관의 심증을 경험법칙보다 우위에 놓은 것도 아니므로 구체적 인과관계의 인정이 가능하다는 견해가 있다. 하지만 이 글은 구체적 인과관계를 인정하기 위한 전제인 객관적이고 합리적으로 의심없는 인과법칙이 존재하지 않는다면 법관은 "의심스러울 때는 피고인의 이익으로(in dubio pro reo)" 원칙에 따라 무죄를 선고해야 하며, 사실상 입증책임의 전환의 효과가 있는 자유심증이라는 방식으로 객관적으로 입증되지 않는 사실에 대한 부담을 피고인이 지도록 하는 것은 허용되지 않는다는 입장을 취하였다. 법관의 임무는 인과관계가 100% 확실하다는 데 대한 합리적 의심이 없어야 한다는 것으로 보기 때문에 인과관계를 추정하는 것이지만, 일반적 인과관계가 100% 확실한 것을 의미하는 것이 아니라 통계적으로 유미의한 인과관계가 있다는 점을 인정하는 것이 라는 점을 강조하였다.

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