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OECD High Production Volume Chemicals Program: Ecological Risk Assessment of Copper Cyanide (대량생산화학물질 초기위해성평가: 시안화구리의 초기 생태위해성평가)

  • Baek, Yong-Wook;Kim, Eun-Ju;Yoo, Sun-Kyoung;Ro, Hee-Young;Kim, Hyun-Mi;Eom, Ig-Chun;Kim, Pil-Je
    • Korean Journal of Ecology and Environment
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    • v.44 no.3
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    • pp.272-279
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    • 2011
  • Copper cyanide is a chemical produced in large quantities with 2,500 tonnes being produced in 2006. It is mainly used for electroplating copper, particularly alkali-Cu plate and brass plating. The purpose of this study is to reassess the physicochemical properties and environmental fate of copper cyanide based on reliable data and and to conduct an ecotoxicity test according to the OECD test guidelines as an initial environmental risk assessment (need to state where this was done). Metal containing inorganic substances are not subject to degradation, biodegradation or hydrolysis. Aquatic toxicity tests of copper cyanide were conducted according to OECD test guideline 201, 202 and 203 for green algae, daphnia, and fish, respectively. The following acute toxicity test results were obtained for aquatic species: 0.089 mg $L^{-1}$ (Algae, 72 Hr-$EC_{50}$); 0.21 mg $L^{-1}$ (flea, 48 Hr-$LC_{50}$); 0.62 mg $L^{-1}$ (Fish, 96 Hr-$ErC_{50}$). The chemical possesses properties indicating a hazard for the aquatic environment (acute toxicity in fish, daphnia and algae below 1.0 mg $L^{-1}$). As a result of this study, copper cyanide has become a candidate for detailed risk assessment. Countries that produce this chemical in significant quantities are recommended to perform specific assessments.

Voiding cystourethrography in children with an initial episode of febrile urinary tract infection (생후 처음으로 발생한 발열성 요로감염 환자의 배뇨성 방광 요도 조영술)

  • Lee, Hae Jeong;Lee, Won Deok;Kim, Hyun Seok;Kim, Tae Hong;Lee, Joo Seok;Cho, Kyung Lae
    • Clinical and Experimental Pediatrics
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    • v.49 no.6
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    • pp.653-658
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    • 2006
  • Purpose : Because voiding cystourethrography(VCUG) is an invasive method, we studied whether VCUG could be postponed through evaluation of alternative non-invasive tests including renal ultrasonography and $^{99m}Tc$-DMSA renal scan. Methods : We reviewed the medical records of 175 patients initially diagnosed with febrile urinary tract infection during the one year period of 1999, and compared 3-tests : renal ultrasongraphy, $^{99m}Tc$-DMSA renal scan, and VCUG. Results : Renal ultrasonography didn't contribute to the prognostication of pyelonephritis(photopenic areas) or vesicoureteral reflux(VUR). Presentation of photopenic areas in $^{99m}Tc$-DMSA renal scan was related to VUR. If both findings of renal ultrasonography and $^{99m}Tc$-DMSA renal scans were normal, this condition was closely related to normal results in VCUG. And if both examinations were abnormal, the condition was closely related to VUR. But this state could not always guarantee the normal result from VCUG because of low sensitivity in finding VUR. Conclusion : In cases in which acute phyelonephritis is demonstrated by $^{99m}Tc$-DMSA renal scan, VCUG is required. In addition to this, if the conditions of hydronephrosis, vesicoureteral dilatation, increases of renal volume, and changes of echogenesity are shown by renal ultrasonography, VCUG should be performed. If a patient has difficulty undergoing VCUG, temporary postponement of VCUG can be taken into consideration, but only in cases where both examinations of renal ultrasonography and $^{99m}Tc$-DMSA renal scan are normal. Nevertheless, close observation is be advised even in this case.

Change of hemostatic markers according to the clinical state in Kawasaki disease (가와사끼병의 임상경과에 따른 지혈성 표지의 변화와 임상적 의의)

  • Kim, Yong Beom;Yoon, You Sook;Lee, Sang Yun;Kil, Hong Ryang
    • Clinical and Experimental Pediatrics
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    • v.50 no.12
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    • pp.1247-1251
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    • 2007
  • Purpose : Pathologically, Kawasaki disease (KD) is associated with widespread vascular endothelial damage in the acute phase. The vasculitis induced endothelial injury leads to coagulation abnormalities. Abnormalities of endothelial function, platelet activation, and fibrinolysis are present during acute phase and long after the onset of KD. The aim of study is to evaluate the change of hemostatic markers in the clinical stages of KD and to assess the hemostatic markers to be a useful indicator of the development of coronary artery lesion (CAL). Methods : Seventy four KD patients diagnosed in Chungnam National University Hospital from November 2004 to June 2007. Eleven febrile control and eleven healthy children were selected for healthy control. All blood samples were collected before and after Intravenous gammaglobulin (IVGG), $2^{nd}$ week, and $4^{th}-8^{th}$ week of illness of KD. Results : Initial D-dimer level of Kawasaki disease showed meaningful difference compared to control group (P<0.05). D-dimer and fibrinogen degradation products (FDP) before IVGG increased compared with normal control group and decreased after IVGG administration. It is normalized until 2 weeks later, and continue to decreasing. D-dimer and FDP were significantly different according to the CAL before IVGG. Conclusion : The hemostatic markers may change to the clinical stage of KD, which may suggest the degree of endothelial injury. Increased some hemostatic markers may be the predictors for development of CAL.

Genetic Environments of Hydrothermal Vein Deposits in the Pacitan District, East Java, Indonesia (인도네시아 동부자바 빠찌딴(Pacitan) 광화대 열수 맥상 광상의 성인 연구)

  • Choi, Seon-Gyu;So, Chil-Sup;Choi, Sang-Hoon;Han, Jin-Kyun
    • Economic and Environmental Geology
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    • v.28 no.2
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    • pp.109-121
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    • 1995
  • The hydrothermal vein type deposits which comprise the Kasihan, Jompong and Gempol mineralized areas are primarily copper and zinc deposits, but they are also associated with lead and/or gold mineralization. The deposits occur within the Tertiary sedimentary and volcanic rocks in the Southern Mountain zone of the eastern Java island, Indonesia. Mineralization can be separated into two or three distinct stages (pre-and/or post- ore mineralization stages and main ore mineralization stage) which took place mainly along pre-existing fault breccia zones. The main phase of mineralization (the main ore stage) can be usually classified into three substages (early, middle and late) according to ore mineral assemblages, paragenesis, textures and their chemical compositions. Ore mineralogy and paragenesis of the three areas in the district are different from each other. Pyrite, pyrrhotite (/arsenopyrite), iron-rich (up to 20.5 mole % FeS) sphalerite and (Cu-)Pb-Bi sulfosalts are characteristic of the deposits in the Kasihan (/Jompong) area. On the other hand, pyrite + hematite + magnetite + iron-poor (2.7 to 3.6 mole % FeS) sphalerite assemblage is restricted to the Gempol area. Fluid inclusion data suggest that fluids of the main ore stage evolved from initial high temperatures (near $350^{\circ}C$) to later lower temperatures (near $200^{\circ}C$) with salinities ranging from 0.8 to 10.1 equiv. wt. percent NaCl. Each area represents a separate hydrothermal system: the mineralization at Kasihan and Jompong were largely due to early fluid boiling coupled with later cooling and dilution, whereas the mineralization at Gempol was mainly resulted from cooling and dilution by an influx of cooler meteoric waters. Fluid inclusion evidence of boiling indicates that pressures of ${\geq}95$ to 255 bars (${\geq}95$ bars for the Gempol area: $\approx$ 120 to 170 bars for the Jompong area: $\approx$ 140 to 255 bars for the Kasihan area) during portions of main ore stage mineralization. Equilibrium thermodynamic interpretation indicates that the evolution trends of the temperature versus fS2 variation of ore stage fluids in the Pacitan district follow two fashions: ore fluids at Kasihan and Jompong changed from the pyrite-pyrrhotite sulfidation stage towards pyritehematite- magnetite state, whereas those at Gempol evolved nearly along pyrite-hematite-magnetite reaction curve with decreasing temperature. The sulfur isotope compositions of sulfide minerals are consistent with an igneous source of sulfur with a ${\delta}^{34}S_{{\Sigma}s}$ value of about 3.3 per mil. The oxygen and hydrogen isotopic compositions of the fluids in each area indicate a progressive shift from the dominance of highly exchanged meteoric water at early hydrothermal systems towards an un- or less-exchanged meteoric water at later hydrothermal systems.

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Effect of Biodegradable Waste Particle Size on Aerobic Stabilization Reactions in MBT System (생분해성 폐기물 입경이 MBT시스템과 연계된 호기성안정화반응에 미치는 영향)

  • Kwon, Sang-Hagk;Ban, Jong-Sub;Kim, Su-Jin;Phae, Chae-Gun
    • Journal of Korean Society of Environmental Engineers
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    • v.33 no.7
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    • pp.523-529
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    • 2011
  • This study has been performed to examine the influence of the size of particles on the stabilization in the aerobic stabilization equipment connected with MBT system. The biodegradable waste inside the reactor (60% of food waste, 25% of paper waste, 2% of wood waste and 5% of compost) has been charged in same composition. The degree of stabilization was compared and analyzed after charging with adjustment of particle size in 5 mm, 10 mm, 20 mm, 50 mm, 100 mm and state of no separation. The experiment revealed that highest temperature beyond $65^{\circ}C$ was shown in the particle size of less than 50 mm in change of temperature and the highest temperature was about $50^{\circ}C$ in reactor of 100 mm and no separation. The proportionality between generated quantity of $CO_2$ and particle size was not observed, even the highest in generated quantity was shown in over 100 mm. The weight changes based on wet and dry conditions in the reaction process showed the 30% and 46% of reduction in the smallest particle size of 5 mm and it showed the trend of the lower reduction rate at the bigger particle size. The water soluble $COD_{Cr}$ and TOC showed the reduction rate of 60% in reactor of particle size in 100 mm and no separation while the reduction rate comparing to the initial stage of reaction in the reactor of less than 50 mm was 80%. Such result derived the conclusion of acceleration in the decomposing stabilization of biodegradable material due to the decomposing rate of organic substance as the particle size of biodegradable waste gets smaller. It is concluded as necessary to react in adjustment under 50 mm of particle size as much as possible.

Effect of $Ca^{2+}$ and $Ca^{2+}-antagonists$ on the Spontaneous Contractions and Electrical Activities of Guinea-pig Stomach (기니피그 위 평활근의 자발적 수축과 전기적 활동에 대한 $Ca^{2+}$$Ca^{2+}$-길항제 영향)

  • Rhie, Sang-Ho;Kim, Ki-Whan
    • The Korean Journal of Physiology
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    • v.21 no.2
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    • pp.241-257
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    • 1987
  • The effects of external $Ca^{2+}$ and $Ca^{2+}-antagonists$ on the spontaneous contractions and electrical activities were investigated in guinea-pig stomach in order to clarify the mechanism for the generation of slow waves. Electrical responses of circular smooth muscle cells were recorded using glass capillary microelectrodes filled with 3 M KCl. All experiments were performed in tris-buffered Tyrode solution which was aerated with 100% $O_2$ and kept at $35^{\circ}C$. The results obtained were as follows: 1) The amplitude of spontaneous contractions was maximal at around 2-4 mM $Ca^{2+}$, whereas their frequency was inversely related with external $Ca^{2+}$ within the range of 0.5 to 16 mM $Ca^{2+}$. 2) Verapamil suppressed the amplitude of spontaneous contraction in a dose-dependent manner, while the frequency of spontaneous contractions was almost not changed over the whole concentration of verapamil $(0.01{\sim}5\;mg/l)$. 3) Manganese increased both the amplitude and the frequency of spontaneous contractions dose-dependently in low $Mn^{2+}$ (below 0.05 mM $Mn^{2+}$), while their amplitude and frequency were decreased in high $Mn^{2+}$ (above 0.1 mM $Mn^{2+}$). 4) The ampltude and maximum rate of rise of slow waves were incrased in high $Ca^{2+}$ solution. In $Ca^{2+}-free$ solution, the spontaneous contractions recorded simultaneously with slow waves ceased and tonic contraction ($Ca^{2+}-free$ contracture) was developed in parallel with membrane depolarization and the disappearance of slow waves. 5) Verapamil (1 mg/1) decreased the amplitude and maximum rate of rise of slow waves and it depolarized the membrane by about 6 mV, whereas the frequency of slow waves was not affected by verapamil. 6) Manganese showed different characteristic effects between low and high $Mn^{2+}$ on the slow waves: In low $Mn^{2+}$ (0.05 mM $Mn^{2+}$), the initial rapid increases and the subsequent gradual decreases in three parameters of slow waves (amplitude, rate of rise, and frequency of slow waves) till a new steady state were observed. However, in high $Mn^{2+}$ (0.5 mM $Mn^{2+}$) slow waves disappeared and membrane was depolarized. From the above results, the following conclusions could be made: 1) $Ca^{2+}$ is necessary for a generation of the slow waves, even though it is small amount. 2) Verapamil suppresses the spontaneous contractions of gastric antral strip by the decreases in amplitude and maximum rate of rise of slow waves, while this drug does not block the $Ca^{2+}-channel$ involved in the generation of slow waves. 3) Manganese has dual actions on the $Ca^{2+}-channels$; the $Ca^{2+}-channel$ involved in the generation of slow waves (or Na-Ca exchange system) or the channel for the generation of spike potentials are stimulated by a low concentration of $Mn^{2+}$, while both the $Ca^{2+}$. Channels are blocked by high concentration of $Mn^{2+}$.

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Clinical review of Typhoid Fever Patients (장티브스에 관한 임상적 관찰)

  • 최정신
    • Journal of Korean Academy of Nursing
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    • v.6 no.1
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    • pp.60-71
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    • 1976
  • The author reviewed the medical records of 96 typhoid fever patients who were diagnosed, admitted, and treated at Sea grave Memorial Hospital from January 1 , 1973 through August 31, 1975. Diagnosis was determined by clinical observation, aerology and bacteriology, eighty patients were treated medically, the remaining 16 patients required surgical intervention. The following results were obtained: 1) The age distribution of the patients revealed that 33.3% wert between 10 and 19 years old 21.9% were between 20 and 29, and 19.8% were between 30 and 39. The majority of patients were from these more active age groups. Male to female sex ratio was 1.3 : 1 2) Seasonal distribution was observed. Most illness occurred in the summer and autumn month 5. 3) 84. 3%of the patients came from farm families. 4) Duration between onset and admission averaged 16.0 days. The group without compilations was admitted after an average of 15. 1 days; The group with complications was ad-matted after an average of 19.4 days. 5) Methods of treatment before admission were as follows: 10.4% at medical clinics, 61, 5% at pharmacies (antibiotics 47.9%, other. drugs 13.5%), 7.3% by herb medications, 20.8% had no treatment. 6) Main clinical symptoms were as follows: fever 93.8%, headache 47.9%, abdominal pain 47.9%, chills 38.5%, cough 36.5%, general weakness 26.0%, nausea e vomiting 24.0% and generalized pain 21.9%. 7) Temperature of patients on admission: 22.9% were 39f or more, 67.6% were between 37℃ and 38℃, and 9.4% were 37℃ or less. 8) Occurrence of intensional bleeding after onset of disease averaged 9.3 days; perforation occurred at an average of 19. 1 days. 9) Interval between onset of major complication and surgical intervention averaged 2.8 days. 10) Among the 68 patients who underwent the bacteriological test the positive rate was 44.1% (30). The positive ,ales to, each separate culture method were as follows: 20.4% in the blood culture, 40.4% in the stool culture and 6.7% in the urine culture. Among these bacteriological positive patients 15 patients had a negative results or less than 160 titer of vidal reaction. 11) The initial vidal test of the total group showed a counts of 160 titer or more in 60.4% and less than 160 titer in 39.6%, 12) W. B. C. Counts in the uncomplicated group indicated that 32.5% were 6,000/㎣ or less, 47.5% were between 6,000 and 10,000, arid 20.0% were 10,000/㎣ or more. In the complicated group, 37.6% were 6,000/㎣ or less, 25,0% were 6,000-10,000/㎣ and 37.6% were 10,000/㎣ or more. 13) Duration of hospital stay of the patients averaged 6.4 days in the uncomplicated group and 12.7 days in the complicated group. 14) Subdiaphragmatic free air simple X-ray was found in 91.7% of the perforated cases. 15) Duration of antibiotic therapy until an febrile state was attained averaged 4.8 days in the uncomplicated group and 6.5 days in the complicated group. 16) Operative procedures were as follows: one layer simple closure of their perforation with or without debasement in 56.3%, drainage only in 6.3%, small bowel resection with primary anastomosis in 18.8% , externalization in 6.3%, cholecystectomy in 6.3%, The clinical findings of this study suggest the following recommendations. According to Top's report; 1% of typhoid fever patients treated with chlorarnphenicol and 2% of patients treated with other drugs become chronic carriers. Therefore, importance should be given to the strict control of these carriers. Immunization, improvement of sanitation and living standards are all needed for the prevention and treatment of disease, but a more serious problem is a lack of knowledge on the part of patients and their families. Thus it is most urgent to enlighten the citizens about the transmission and hygiene related to contagious disease. Legal restriction of sale of antibiotics at drug stores without a physician's prescription is an urgent matter for public health administrators. An even more important nursing responsibility is the reemphasis on health education both in the clinical setting and in the home.

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Follow-up Study of Condylar Bone Changes using Cone Beam Computed Tomography in Patients with Osteoarthritis (측두하악장애 골관절염 환자에서 cone-beam CT를 이용한 관절면의 변화 추적 연구)

  • Ko, Chul-Hee;Kim, Byeong-Soo;Ko, Myung-Yun;Jeong, Sung-Hee;Ok, Soo-Min;Ahn, Yong-Woo
    • Journal of Oral Medicine and Pain
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    • v.37 no.1
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    • pp.33-45
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    • 2012
  • This study was designed to assess follow-up study of condylar bone changes using cone beam computed tomography in patients with osteoarthritis. The author performed clinical examination for osteoarthritis patients who visited Orofacial Pain Clinic, Department of Oral Medicine, Pusan National University Hospital. CBCT(Cone beam computed tomography) was taken for 228 joints in 114 subjects. After average 10 months, CBCT was retaken. A Oral medicine and Oral radiologist evaluated CBCT each other. Condyle bone changes were classified by no bone change, flattening, erosion, osteophyte and sclerosis. The obtained results were as follow. 1. The condylar bone changes of osteoarthritis in temporomandibular disorder were as follow: 1) The transitions of each types of condylar bone changes was maintained at the initial state of the majority. 2) The transition of erosion was distributed erosion, flattening, sclreosis, osteohyte in order. 3) The transition of flattening was distributed flattening, osteohyte, normal, sclreosis in order. 4) The transition of osteohyte was distributed osteohyte, erosion, sclreosis, flattening in order. 5) The transition of sclreosis was distributed sclreosis, osteohyte, erosion, normal in order. 2. The signs and symptoms according to transition of each types of condylar bone changes were as follow 1) In the transition of condylar bone changes from erosin to erosion, pain, noise, LOM and MCO had symptomatic improvement. In the transition of condylar bone changes from erosin to flattening, pain, LOM, MCO had symptomatic improvement. In the transition of condylar bone changes from erosin to no bony change, pain, noise, LOM had symptomatic improvement. In the transition of condylar bone changes from erosion to flattening than the maintenance of eosion, MCO had symptomatic improvement. 2) In the transition of condylar bone changes from flattening to flattening, pain, noise and MCO had symptomatic improvement. In the transition of condylar bone changes from flattening to sclerosis, LOM had symptomatic improvement. 3) In the transition of condylar bone changes from osteophyte to osteophyte, pain, LOM and MCO had symptomatic improvement.

Characteristics of the ( Pb, La ) $TiO_3$ Thin Films with Pb/La Compositions (Pb/La 조성에 따른 ( Pb, La ) $TiO_3$ 박막의 특성 변화)

  • Kang, Seong-Jun;Joung, Yang-Hee;Yoon, Yung-Sup
    • Journal of the Korean Institute of Telematics and Electronics D
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    • v.36D no.1
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    • pp.29-37
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    • 1999
  • In this study, we have prepared PLT thin films having various La concentrations by using sol-gel method and studied on the effect of La concentration on the electrical properties of PLT thin films. As the La concentration increases from 5mol% to 28mol%, the dielectric constant at 10kHz increases from 428 to 761, while the loss tangent decreases from 0.063 to 0.024. Also, the leakage current density at 150kV/cm has a tendency to decrease from 6.96${\mu}A/cm^2$ to 0.79${\mu}A/cm^2$. In the result of hysteresis loops of PLT thin films, the remanent polariation and the coercive field decrease from 9.55${\mu}C/cm^2$ to 1.10${\mu}C/cm^2$ and from 46.4kV/cm to 13.7kV/cm, respectively. With the result of the fatigue test on the PLT thin films, we have found that the fatigue properties are improved remarkably as the La concentration increases from 5 mol% to 28mol%. In particular, the PLT28) has paraelectric phase and its charge storage clensity and leakage current density at 5V are 134fC/${\mu}cm^2$ and 1.01${\mu}A/cm^2$, respectively. The remanent polarization and coercive field of the PLT(10) film are 6.96${\mu}C/cm^2$ and 40.2kV/cm, respectively. After applying of $10^9$ square pulses with ${\pm}5V$, the remanent polarilzation of the PLT(10) film decreases about 20% from the initial state. In the results, we conclude that the 10mol% and the 28mol% La doped PLT thin films are very suitable for the capacitor dielectrics of new generation of DRAM and NVFRAM respecitively.

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A Theory Construction on the Care Experience for Spouses of Patients with Chronic Illness (만성질환자 배우자의 돌봄 경험에 대한 이론 구축)

  • Choi, Kyung-Sook;Eun, Young
    • Journal of Korean Academy of Nursing
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    • v.30 no.1
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    • pp.122-136
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    • 2000
  • Chronic illness requiring attention and management during a long period of time puts great burden onto patients, their family and society. For patients with chronic illnesses, providing social support is the most important, and the fundamental support comes from their spouses. Amount and quality of support from spouses seems to differentiated according to the sex of patients. Female patients tend to believe that their spouses are not very supportive. Therefore, the researchers assessed the burden of husbands of female arthritis patients to discover the factors that result in greater burden. Also, they developed a theoretical model of husbands′ care for their wives through a qualitative research into husbands′ experience. Method 1: The study material was 650 female arthritis patients registered in an arthritis clinic. The questionnaire about the disease experience of female arthritis patients and the burden of husbands were sent. Returned questionnaires numbered 210(32.3%) and 27 were excluded because of inadequate answers. The remaining 183 questionnaires were analyzed. The mean age of the patients was 51 years and the mean age of spouses was 55 years. The mean marital period was 28 years. The average duration since diagnosis was 9.1 years. Education level was varied from primary school to graduate school, and average income/month was 1,517,300 won. Method 2: Initial questionnaire studies on the burden of husbands were performed. Among 183 responding husbands, 23 consented to participate for a qualitative research. Data was obtained by direct and telephone interviews. The mean age of participants was 58 years, and the educational level and socioeconomic status also varied. Result: 1. Husbands′ burden: The average burden was 57.68 with a range of 6-96. 2. Burden and general characteristics: The husband′s burden correlated with the age of the patients, numbers in the family, therapy methods, patient′s level of discomfort, patient′s disease severity, patient′s level of dependence and the husband′s understanding of the level of severity. 3. Linear correlation analysis on burden: The husbands′ burden is explained in 22.5% by husband′s recognition of level of severity and husbands′ age. 4. There were four patterns of the burden on husbands: both objectve burden and subjective burden were high(pattern I), both of objectve burden and subjective burden were low(pattern II), objective burden was high but subjective burden was low(pattern III), objective burden was low but subjective burden was high(pattern IV). The pattern was correlated with the family income, educational level of the patients and their husbands, therapy methods, patient′s level of discomfort, patient′s disease severity, patient′s level of dependence and husband′s understanding of level of severity. 5. The core category of the caring experience of the husbands with arthritis patients was "companionship". The causal factor was the patients′ experience due to symptoms : physical disfigurement, pain, immobility, limitation of house chores, and limitation of social activities. Contextural factors are husbands′ identification of housework and husbands′ concern about the disease. The mediating factors are economic problems, fear of aging, feeling of limitation and family support. The strategy for interaction is mind control and how to solve emotional stress. The "companionship" resulted from caring activities, participation of household activities, helping patients′ to coping with emotional experience. 6. Companionship is established through the process of entering intervention, and caring state of mind. Entering intervention is the phase of participation of therapy and involvement of houseworks. The caring phase consists of decision on therapy, providing therapy, providing direct care, and taking over the household role of wife. Through caring phase, the changing phase set a stage in which husbands consolidate the relationship with their wives, and are reminded of the meaning of marriage. As a result, in changing phase, husbands′ companionship is enhanced. In conclusion, nursing care of chronic illnesses should include a family member especially the spouse. All information on disease shoud be provided to patients and whole family member. Strong support should also be provided to overcome difficulties in taking over role of other sex. Then the quality of life of patients and families will be much improved.

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