• Journal of Hospice and Palliative Care
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• 제9권2호
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• pp.106-111
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• 2006

목적: 말기 암환자에서 마약성 진통제를 사용한 통증 조절과 호스피스를 통한 보존적 치료는 매우 유용한 치료 방법이다. 그러나 많은 환자들과 환자의 보호자들은 중독과 내성에 대한 두려움 때문에 마약성 진통제의 사용을 충분히 하지 못하고 있다. 그리고 또한 다수의 환자와 보호자들은 호스피스가 환자의 상태가 돌이킬 수 없는 지속적으로 악화되는 것과 같이 생각하기 때문에 호스피스를 받아들이는 것을 꺼려한다. 이 연구의 목적은 한국 문화에서 가족구성원이 건강관리에 결정적인 역할을 하기 때문에 말기 암 환자의 보호자들의 호스피스와 마약성 진통제의 사용에 대한 인식도를 분석하고 평가하였다. 방법: 이 연구에서는 총 54명의 말기 암환자의 보호자들이 참가했다. 설문지는 총 마약성 진통제와 호스피스에 관한 15문항으로 구성되었다. 결과: 연구는 다음과 같은 결과를 나타내었다. 1) 환자보호자의 반 이상(56.7%)이 호스피스에 대한 인식이 없었다. 2) 환자 보호자의 81.8%가 호스피스 치료가 말기 암환자에게 유익하다는 데 동의했다. 3) 보호자의 85.1%는 경제적 부담을 갖고 있었다. 4) 환자의 83.2%가 24시간 동안 통증의 호소했다. 5) 보호자의 85.8% 마약성 진통제가 통증을 조절할 수 있음을 믿고 있었으나 또한 79.1%와 79.6%보호자들은 마약성 진통제의 사용이 중독과 내성을 발생시킨다고 믿었다. 결론: 여전히 통증 조절을 위한 마약성 진통제 사용에 있어 보호자의 벽이 존재했다. 또한 말기 암 환자 보호자에게 호스피스에 대한 정보가 부족했다. 그러므로 약사와 의사 의한 마약성 진통제에 대한 교육이 통한 말기암환자에 있어 적절한 통증 조절을 위해 필요하다. 그리고 호스피스에 대한 좀 더 정확한 정보를 말기 암 환자에게 제공하여야 한다.가족간병인의 삶의 질에 많은 영향을 주는 교정 가능한 인자로 나타났다. 말기 암 환자 간병인의 간병 시간 및 경제적 부담을 감축하기 위한 사회적 지원이 필요하다. 봉사자와의 관계는 매우 좋다가 81.2%로 대부분을 차지하였고, 병원직원과의 관계는 매우 좋다가 69.7%였고, 다음은 대체로 좋다가 21.2%의 순이었다. 봉사활동에 대해 가족이나 친구의 지지는 어떠한가는 매우 좋다가 83.2%로 대부분을 차지하였다. 2. 대상자의 자원봉사활동 만족도는 평점 $3.09{\pm}0.49$(도구범위 $1{\sim}4$점)로 중간정도이었다. 영역별로 살펴보았을 때 만족도가 가장 높았던 영역은 사회적 접촉영역($3.48{\pm}0.61$)이었고, 다음은 성취영역($3.43{\pm}0.53$), 사회적 인정영역($3.35{\pm}0.70$)의 순이었다. 만족도가 가장 낮았던 영역은 사회적 교환영역($1.65{\pm}0.63$)이었다. 3. 대상자의 인구사회학적 특성에 따른 봉사활동 만족도를 분석한 결과 성별(t=2.038, P=0.044), 결혼상태(F=3.806, P=0.013)에 따라 유의한 차이를 보였다. 4. 대상자의 자원봉사활동 실태에 따른 봉사활동 만족도를 분석한 결과병원봉사활동기간(F=3.326, P=0.008), 봉사활동을 하는 주된 이유(F=2.707, P=0.035), 봉사활동을 위한 교육을 받은 여부(t=-1.982, P=0.050), 봉사활동의 평가 빈도(F=7.877, P=0.000), 봉사활동이 자신의 기술이나 능력에 적합도(F=2.712, P=0.049), 관리자와의 관계(t=-2.517, P=0.013), 다른 병원직원과의

• 한국응급구조학회지
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• 제5권1호
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• pp.37-51
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• 2001

This study is aimed at examining the ethical values of EMT students. The results below are based on the revised questionnaires, which can be applicable to EMT from the original questionnaires developed by Lee(1990), with a sample of 124 students consisting of 63 first and 61 second year students, conducted November 2-8, 2001. Data were analyzed using SPSS in terms of means, standard deviations, t-test, ANOVA, Pearson's correlation coefficient. The results are as follows: 1. In the area of Human life, all subjects showed utilitarian disposition. All respondents perceived the item "When patients recognizing there is no hope for survival ask for euthanasia, it is ethically right to accommodate their opinions." as the most utilitarian item, whereas they perceived the item "When an hopeless patient is on cardiac arrest, it is ethically right to do CPR as the most deontoogical item. 2. In the area of patient relationship, all students of two groups took on deontoogical characteristics, but there were no statistically significant differences between two groups. All students perceived an item "EMT have to keep it secret if patients disclose their suicide intentions and ask for absolute secrecy" the most utilitarian item, whereas they perceived an item "Even though patients act and speak in a very rude manner, EMT people should do their best to provide care for patients." as the most deontoogical item. 3. In the area of task relationship, first year students perceived an item "Given time limitations, it is ethically right to give priority to the patients who can be rehabilitated over the patients who can't be fully recovered." as the most utilitarian item, whereas second year students perceived an item "Under no circumstances should any placebo be administered to patients." as the most utilitarian item. All students perceived an item "When EMT students see an unconscious person lying in the street, they have to give him/her emergency treatment." as the most deontoogical item. 4. In the area of coworker relationship, all students of two groups took on deontoogical disposition, but there were no significant differences between two groups. All students of two groups perceived an item "Suppose you are regarded as the person who would be promoted. However, you think that your coworker is more competent than you. In that case you should tell your supervisor about your coworker." as the most utilitarian item. First year students perceived an item, whereas second year students perceived an item "When you observe coworkers' misconduct at work, it is ethically right to ignore their misdeeds." as the most deontoogical item. 5. This study demonstrated that for the first year students, there is a correlational relationship between areas of human life and task relationship, and between areas of task relationship and coworker relationship, whereas for the second year students, there is a correlational relationship between areas of human life and task relationship. 6. In areas of human life and task relationship, there are significant differences according to attitudes toward EMT and attendance at ethics training sessions. In the area of coworker relationship, there are significant differences according to religion, attendance at ethics training sessions, and a code of ethics. Recommendations for future research, 1. Sample items to measure ethical values and the instrument tailored to the needs of EMT should be developed. 2. A longitudinal study to track ethical value changes according to the amount of work experience is needed. 3. A code of ethics and/or ethics training, which could apply in actual situations, should be implemented.

• 핵의학기술
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• 제20권1호
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• pp.32-36
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• 2016

핵의학검사에서 $^{131}I$은 갑상선암 및 질환의 진단, 치료등 핵의학 검사에서 많이 사용되고 있다. $^{131}I$은 ${\gamma}$선과 ${\beta}^-$선을 방출하여 검사와 치료를 할 수 있고, 높은 집적율과 신장을 통한 빠른 배설이 용이 하지만, $^{131}I$(364 keV)은 $^{99m}Tc$(140 keV)보다 고에너지이기 때문에 작업을 수행 시 조작 및 투여 과정에서 $^{99m}Tc$보다 술자의 피폭을 줄이기 위해 외부피폭 방어의 3요소인 거리, 시간, 차폐 중에 차폐에 주안점을 두어 $^{131}I$ 조작 시 차 폐체 착용 전과 후의 피폭선량의 차이를 비교하고자 한다. Apron(보통 Pb 0.5 mm) 착용 시 $^{99m}Tc$은 90%이상이 차폐가 되지만, $^{131}I$은 고에너지이기 때문에 차폐효과가 비교적 낮고, 고용량의 경우 산란선(2차) 및 제동방사선의 영향으로 오히려 더 피폭을 받을 수 있다. 하지만 저용량(74 MBq) 고에너지의 경우 이에 대한 특별한 보고나 Guide Line이 마련되어 있지 않아, $^{131}I$ 조작 시 Apron 착용 유무에 따른 술자의 피폭선량을 정량적으로 분석하고자 한다. 본원 핵의학과에서 2014년 6월부터 2014년 12월까지 7개월 동안 갑상선암 치료 및 진단을 위한 저용량$^{131}I$을 투여하기 위해 방문한 갑상선암 환자를 대상으로 준비과정부터 투여 시까지 연구기간 동안 갑상선, 가슴, 고환 3곳에 Apron 안쪽과 바깥쪽 각각 1개씩 총 6개의 TLD를 부착한 뒤 $^{131}I$검사 과정부터 투여 시 까지의 방사선 피폭선량을 측정하였다. 총 작업시간은 설명시간 3분, 분배시간 1분, 투여시간 1분으로 각각 1인당 5분이내로 설정하였다. TLD 위치설정은 일반적으로 피폭선량을 측정하는 가슴과 방사선 감수성이 높은 갑상선 및 고환으로 설정하였다. 준비과정은 $^{131}I$을 $2m{\ell}$ 주사기를 이용해 74MBq을 분배한 뒤 생리식염수와 희석해 $2m{\ell}$의 용량을 만들어 분배한다. $^{131}I$을 분배 후 환자에게 투여 시 컵에 물을 $100m{\ell}$ 담고 분배한 $^{131}I$을 희석하여 환자 1 m 정도 거리를 두고, 경구투여 한다. 그리고 경구투여 한 $2m{\ell}$ 주사기와 컵을 폐기하는 과정을 Apron과 TLD를 착용한 상태에서 시행하였다. Apron과 TLD는 방사선 피폭이 미치지 않는 보관실에 따로 보관하였고, 서울방사선 서비스에 의뢰하여 피폭선량을 측정하였다. 연구기간 동안 저용량 $^{131}I$ 검사 시 갑상선, 가슴, 고환 부위에 Apron 안과 밖d[착용한 TLD의 매월 누적선량을 인원수로 나눈 결과를 가지고, SPSS Version. 12.0K를 이용해 Wilcoxon Signed Rank Test를 사용하여 통계를 시행하였다. 그 결과 갑상선(p = 0.345), 가슴(p = 0.686), 고환(p = 0.715)은 모두 p > 0.05으로 유의한 차이가 없음을 알 수 있었다. 그리고 연구기간 동안의 총 누적선량의 변화를 백분율로 환산하였을 때, 갑상선 -23.5%, 가슴 -8.3%, 고환 19.0%로 나타났다. Wilcoxon Signed Rank Test를 사용한 결과 통계적으로 유의한 차이가 없는 것으로 나타났다(p > 0.05). 또한 7개월간의 누적선량으로 차폐율을 계산 했을 때 에는 Apron 안쪽과 바깥쪽의 피폭선량의 변화가 불규칙적으로 나타나는 결과를 보였다. 이 결과는 백분율로 표현 시 변화폭이 커보이지만, 누적 피폭선량이 소수점 이하이므로 큰 변화라고 보기 어렵다. 그러므로 고에너지 저용량 $^{131}I$ 투여 시 Apron을 착용유무와 상관없이 일정한 거리를 두고 최대한 빠른 시간 내에 투여를 종료하는 것이 피폭선량을 줄이는 데 도움이 될 것이다. 본 연구는 $^{131}I$ 투여시간을 1인당 각 5분 이내로 투여 할 수 있도록 제한하고, 거리를 1 m로 일정하게 하여 작업 할 수 있도록 하였으나 통계 시 N수가 적어서 비모수적인 방법으로 통계를 시행함으로써 정확한 결과를 얻기에 부족한 부분이 있었다. 또한 저용량 $^{131}I$ 투여 시 각 1인당 피폭선량을 직독식 선량으로 측정하지 못하고, TLD를 이용한 누적선량으로 측정한 결과 값이므로 전자선량계 및 포켓선량계를 이용한 측정이 이루어진다면 더 효과적인 결과를 얻을 수 있을 것으로 사료된다.

• 한국방사선학회논문지
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• 제18권3호
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• pp.187-201
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• 2024

골다공증은 전 세계적으로 주요한 건강 문제임에도 불구하고, 골절 발생 전까지 쉽게 발견되지 않는 단점을 가지고 있습니다. 본 연구에서는 골다공증 조기 발견 능력 향상을 위해, 복부 컴퓨터 단층 촬영(Computed Tomography, CT) 영상을 활용하여 정상-골감소증-골다공증으로 구분되는 골다공증 단계를 체계적으로 분류할 수 있는 딥러닝(Deep learning, DL) 시스템을 개발하였습니다. 총 3,012개의 조영제 향상 복부 CT 영상과 개별 환자의 이중 에너지 X선 흡수 계측법(Dual-Energy X-ray Absorptiometry, DXA)으로 얻은 T-점수를 활용하여 딥러닝 모델 개발을 수행하였습니다. 모든 딥러닝 모델은 비정형 이미지 데이터, 정형 인구 통계 정보 및 비정형 영상 데이터와 정형 데이터를 동시에 활용하는 다중 모달 방법에 각각 모델 구현을 실현하였으며, 모든 환자들은 T-점수를 통해 정상, 골감소증 및 골다공증 그룹으로 분류되었습니다. 가장 높은 정확도를 갖는 모델 우수성은 비정형-정형 결합 데이터 모델이 가장 우수하였으며, 수신자 조작 특성 곡선 아래 면적이 0.94와 정확도가 0.80를 제시하였습니다. 구현된 딥러닝 모델은 그라디언트 가중치 클래스 활성화 매핑(Gradient-weighted Class Activation Mapping, Grad-CAM)을 통해 해석되어 이미지 내에서 임상적으로 관련된 특징을 강조했고, 대퇴 경부가 골다공증을 통해 골절 발생이 높은 위험 부위임을 밝혔습니다. 이 연구는 DL이 임상 데이터에서 골다공증 단계를 정확하게 식별할 수 있음을 보여주며, 조기에 골다공증을 탐지하고 적절한 치료로 골절 위험을 줄일 수 있는 복부 컴퓨터 단층 촬영 영상의 잠재력을 제시할 수 있습니다.

• 임상이비인후과
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• 제29권2호
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• pp.212-222
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• 2018

Background and Objectives : The purpose of this study was to compare the measured values of acoustic and auditory perceptual assessments between normal and functional dysphonia (FD) groups. Materials and Methods : 102 subjects with FD and 59 normal voice groups were participated in this study. Mid-vowel portion of the sustained vowel /a/ and two sentences of 'Sanchaek' were edited, concatenated, and analyzed by Praat script. And then auditory-perceptual (AP) rating was completed by three listeners. Results : The FD group showed higher acoustic voice quality index version 2.02 and version 3.01 (AVQIv2 and AVQIv3), slope, Hammarberg index (HAM), grade (G) and overall severity (OS), values than normal group. Additionally, smoothed cepstral peak prominence in Praat (PraatCPPS), tilt, low-to high spectral band energies (L/H ratio), long-term average spectrum (LTAS) in FD group were lower than normal voice group. And the correlation among measured values ranged from -0.250 to 0.960. In ROC curve analysis, cutoff values of AVQIv2, AVQIv3, PraatCPPS, slope, tilt, L/H ratio, HAM, and LTAS were 3.270, 2.013, 13.838, -22.286, -9.754, 369.043, 27.912, and 34.523, respectively, and the AUC of each analysis was over .890 in AVQIv2, AVQIv3, and PraatCPPS, over 0.731 in HAM, tilt, and slope, over 0.605 in LTAS and L/H ratio. Conclusions : In conclusion, AVQI and CPPS showed the highest predictive power for distinguishing between normal and FD groups. Acoustic analyses and AP rating as noninvasive examination can reinforce the screening capability of FD and help to establish efficient diagnosis and treatment process plan for FD.

• Journal of Microbiology and Biotechnology
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• 제25권7호
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• pp.1170-1176
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• 2015

Ginsenosides, the major active component of ginseng, are traditionally used to treat various diseases, including cancer, inflammation, and obesity. Among these, compound K (CK), an intestinal bacterial metabolite of the ginsenosides Rb₁, Rb₂, and Rc from Bacteroides JY-6, is reported to inhibit cancer cell growth by inducing cell-cycle arrest or cell death, including apoptosis and necrosis. However, the precise effect of CK on breast cancer cells remains unclear. MCF-7 cells were treated with CK ($0-70{\mu}M$) for 24 or 48 h. Cell proliferation and death were evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and flow cytometry assays, respectively. Changes in downstream signaling molecules involved in cell death, including glycogen synthase kinase $3\beta$ ($GSK3\beta$), $GSK3\beta$, $\beta$-catenin, and cyclin D1, were analyzed by western blot assay. To block $GSK3\beta$ signaling, MCF-7 cells were pretreated with $GSK3\beta$ inhibitors 1 h prior to CK treatment. Cell death and the expression of $\beta$-catenin and cyclin D1 were then examined. CK dose- and time-dependently inhibited MCF-7 cell proliferation. Interestingly, CK induced programmed necrosis, but not apoptosis, via the $GSK3\beta$ signaling pathway in MCF-7 cells. CK inhibited $GSK3\beta$ phosphorylation, thereby suppressing the expression of $\beta$-catenin and cyclin D1. Our results suggest that CK induces programmed necrosis in MCF-7 breast cancer cells via the $GSK3\beta$ signaling pathway.

• Parasites, Hosts and Diseases
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• 제59권6호
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• pp.615-623
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• 2021

Human sparganosis is a food-borne parasitic disease caused by the plerocercoids of Spirometra species. Clinical diagnosis of sparganosis is crucial for effective treatment, thus it is important to identify sensitive and specific antigens of plerocercoids. The aim of the current study was to identify and characterize the immunogenic proteins of Spirometra erinaceieuropaei plerocercoids that were recognized by patient sera. Crude soluble extract of the plerocercoids were separated using 2-dimensional gel electrophoresis coupled with immunoblot and mass spectrometry analysis. Based on immunoblotting patterns and mass spectrometry results, 8 antigenic proteins were identified from the plerocercoid. Among the proteins, cysteine protease protein might be developed as an antigen for diagnosis of sparganosis.

• 한방비만학회지
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• 제15권1호
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• pp.9-23
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• 2015

Objectives: This study was investigated the improvement effects of Pakistani Ephedra herba-containing Gangji-hwan-1, 2, 3 (Di-fatty; DF-1, 2, 3), Chinese Ephedra herba-containing Gangjihwan-4 (DF-4) and combination of DF-1 and Gamisoche-hwan (GSH) on obesity in a high fat diet-fed obese mouse model. Methods: Eight-week-old C57BL/6N mice were divided into seven groups: a normal lean group given a standard diet, an obese control group given a high fat diet, and DF-1, 2, 3, 4, and DF-1+GSH groups given a high fat diet with DF-1, 2, 3, 4 (40, 80, 160, 80 mg/kg), and DF-1+ GSH (80 mg/kg), respectively. After 8 weeks of treatment, body weight gain, feeding efficiency ratio (FER), blood lipid markers, liver histology, and fat weight and histology were examined. Results: Body weight gain was significantly decreased in DF and DF-1+GSH groups compared with control. The extent of decreases was eminent in DF-1+GSH group. FER and circulating concentration of leptin were decreased in DF and DF-1+GSH groups compared with control. Circulating concentrations of triglyceride, glucose and insulin were decreased in DF and DF-1+GSH groups compared with control. The size of adipocytes were decreased by DF and DF-1+GSH groups compared with control, whereas the adipocyte number per unit area was increased by them, suggesting that DF and DF-1+GSH groups decreased the number of large adipocytes. Conclusions: In conclusion, these results suggest that DF and DF-1+GSH groups decrease FER, plasma leptin concentration, blood anti-obesity biomarkers and fat mass, improves body weight gain. In addition, these effects were more effective in DF-1+GSH combination group than in DF-1, 2, 3, 4 groups.

• Annals of Surgical Treatment and Research
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• 제95권5호
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• pp.286-296
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• 2018

Purpose: Sentinel lymph node (SLN) biopsy (SLNB) is widely accepted for staging of melanoma patients. It has been shown that clinico-pathological features such as Breslow thickness, ulceration, age, and sex are better predictors of relapse and survival than SLN status alone. The aims of this study were to evaluate the long-term (10-year) prognostic impact of SLNB and to determine predictive factors associated with SLN metastasis, relapse, and melanoma specific mortality (MSM). Methods: This was a prospective observational study on 289 consecutive patients with primary cutaneous melanoma who underwent SLNB from January 2000 to December 2007, and followed until January 2014, at an Italian academic hospital. Results: SLN was positive in 64 patients (22.1%). The median follow-up was 116 months (79-147 months). Tenyear disease-free survival and melanoma specific survival were poor in patients with positive SLN (58.7% and 66.4%, respectively). Only the increasing Breslow thickness resulted independently associated to an increased risk of SLN metastasis. Cox regression analysis showed that a Breslow thickness >2 mm was an independent predictor of relapse, and male sex and Breslow thickness >2 mm was a predictor of MSM. At 10 years, SLN metastasis was not significantly associated to either relapse or MSM. Conclusion: After the fifth year of follow-up, SLN metastasis is not an independent predictive factor of relapse or mortality which are mainly influenced by the characteristics of the primary tumor and of the patient. Patients with a Breslow thickness >2 mm regardless of the SLN status should be considered at high risk for 10-year relapse and mortality.

• 대한지역사회영양학회지
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• 제3권1호
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• pp.76-93
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• 1998

Three hundred sixty-two(male 131, female 231) elderly aged over 65 in Chungb- uk area were interviewed to determine the disease states and drug usage patterns. The prebalence of disease was 78% and women reported more chronic diseases(83%) than men(71%). Elderly who live with spouse and have an occupation have a lower rate of disease. Average number of diseases of the elderly was $1.8\pm{1.1}$, and women$(2.1\pm{1.3)}$ have significantly higher average number of diseases than that of men$(1.4\pm{0.7)}$. Also the elderly in urban areas$(2.1\pm{1.4)}$ have significantly higher number of diseases than that of the elderly in rural areas$(1.6\pm{0.9)}$. Arthritis, hypertension, cardiovascular and gastric diseases were the most frequently listed chronic diseases in order for both men and women. Anemia and fracture of bone were relatively higher in women than in men. Particularly, the arthritis of the urban elderly have a rate of 1.5 times higher than that of the rural elderly. Fifty-two percent of the elderly were currently using drugs ; among drug users 71.2% used prescription drugs and 20.5% used nonprescription drugs. The average number taken per person was 2.1$\pm$1.4 and there was no sex or age difference. However, the elderly in rural areas $(2.7\pm{1.7)}$ consumed a significantly higher number of drugs than those in urban areas$(1.7\pm{0.7)}$. The average number of prescripti- on drugs taken was 2.0$\pm$1.4 while the average of nonprescription drugs taken was $(1.3\pm{0.6)}$. Analgesics and antihypertensive drugs were most commonly used. Vitamin and analgesics were the most frequently used self-prescribed drugs. It was noted that potential adverse drug interaction by concominant drug consumption for arthritis and antihypensive drug, abuse of digestants and antiacid without treatment of the underlying disease, and misuse of quick-acting bowel medications were problematic for the elderly. In addition drugs used for the elderly have some adverse effect on the digestive system. The types and composition of drugs used by the elderly were identified and presented. Medication compliance was poor and 13.5% reported adverse reactions such as edema, heartburn, nausea, and difficulty with eating. Seventeen percent of the elderly obtained drugs arranged by those other than medical staff. Also, even among those elderly who obtained drugs prescribed by a doctor, 69.1% of subjects had not receive instruction about potential adverse reactions. These results suggest that nutritional problems related to drug usage might exist and so dietitians, either individually or as members of health teams, need to have a better understanding of drug-nutrient interaction and closer supervision, and drug information/education service should therefore be provided to prevent or minimize adverse drug reaction in elderly users of medication.