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Risk Factors Related to Development of Delirium in Hospice Patients (호스피스 병동의 암환자에서 섬망 발생 위험 요인)

  • Ko, Hae Jin;Youn, Chang Ho;Chung, Seung Eun;Kim, A Sol;Kim, Hyo Min
    • Journal of Hospice and Palliative Care
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    • v.17 no.3
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    • pp.170-178
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    • 2014
  • Purpose: Delirium is a common and serious neuropsychiatric complication among terminally ill cancer patients. We investigated risk factors related to the development of delirium among hospice care patients. Methods: Between May 2011 and September 2012, we included patients who were mentally alert and had no psychiatric disease or drug addiction at the hospice ward of two local hospitals. Among them, participants who had been diagnosed with delirium by two doctors according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-4th edition) criteria were grouped as Delirium Group. We analyzed results of psychometric and other laboratory tests performed at the time of patient's admission - psychometric tests included cognitive function (mini-mental status examination, MMSE), depression (Beck Depression Inventory, BDI), anxiety, and insomnia (Insomnia Severity Index, ISI). Logistic regression analysis was used to compare delirium and the related factors. Cox's proportional hazard model was performed using significant factors of logistic regression analysis. Results: Of the 96 patients who met the inclusion criteria, 41 (42.7%) developed delirium. According to the logistic regression analysis, primary cancer site, cognitive impairment (MMSE < 24), depression ($BDI{\geq}16$), and insomnia ($ISI{\geq}15$) were significant factors related to delirium. Among the four factors, depression (OR 5.130; 95% CI, 2.009~13.097) and cognitive impairment (OR 5.130; 95% CI, 2.009~13.097) were found significant using Cox's proportional hazard model. Conclusion: The development of delirium was significantly related to depression and cognitive impairment among patients receiving hospice care. It is necessary to carefully monitor depression and cognitive function in hospice care.

Hearing Loss in the Workers Exposed to Organic Solvents and Noise (유기용제와 소음에 폭로된 근로자들의 청력 손실)

  • 김영기;이용환
    • Journal of Life Science
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    • v.9 no.2
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    • pp.136-145
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    • 1999
  • The purpose of this study was to evaluate the effect of organic slovents and noise on hearing loss. We selected organic solvents exposed group of 32 cases, noise exposed group of 31 cases, both noise and solvent exposed group of 31 cases, and control group of 53 cases and studied the relation between exposure level of noise and organic solvents and degree of hearing loss. The results were as follows. The subjects under investigation were exposed to noise and organic solvents under threshold limit values and the amount of urinary hippuric acid excretion were also under biological exposure indices. In case of noise, both noise and organic solvents exposed group and noise exposed group were more exposed than organic solvents exposed group(p<0.05). When urinary hippuric acid excretion were concerned, both noise iud organic solvents exposed group and organic solvents exposed group showed higher values than noise exposed group(p<0.05). In comparison of mean auditory threshold values by frequency, on the air conduction test, both noise and organic solvents exposed group showed significantly higher hearing loss than noise exposed group in 500Hz of right ear, 500 and 2000Hz of left ear(p<0.05). Forty-three cases among 147 subjects were regarded as hearing loss group and average age(42.6years) of hearing loss group was higher than normal groups average age of 38.0 years. Urinary hippuric acid excretions of hearing loss group were significantly higher than normal group(p<0.05). Thirty-eight percent(12cases) of noise exposed group, 40.6 $\%$(13cases) of organic solvents exposed group, 51.6 $\%$(16cases) of both noise and organic solvents exposed group, and 3.8 $\%$(2cases) of unexposed group were regarded as hearing losers. Exposed groups showed higher incidence of hearing loss than unexposed group but there were no significant differences among the exposed groups. The variables showing significant correlation with hearing loss were age and the amount of hippuric acid in urinary excretion. When age were adjusted for the purpose of seeing the effects of hearing losses due to organic solvent, urinary excretion of hippuric acids was the only variable with significant correlation with hearing loss (p<0.05). When odds ratio to hearing loss between control and exposed groups was considered, noise exposed group showed 6.1 times (95 $\%$ CI: 3.3-8.7), organic solvents exposed group showed 7.4 times (95 $\%$ CI: 3.5-14.6) and both noise and organic solvents exposed group showed 17.2 times(95% CI: 5.6-31.8) higher values than unexposed group(p<0.01). Above results suggest that health screening test of hearing loss is also needed in organic solvents exposed workers.

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Predictors of Participation Restriction in Community-dwelling Persons With Spinal Cord Injury (지역사회 거주 척수장애인의 참여 제약에 영향을 미치는 예측요인)

  • Kim, Yeon-Ju;Park, Ji-Hyuk;Kim, Jung-Ran;Park, Hae Yean
    • Therapeutic Science for Rehabilitation
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    • v.7 no.4
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    • pp.19-30
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    • 2018
  • Objective: The purpose of this study was to suggest predictors of participation restriction in community-dwelling Spinal Cord Injury (SCI) based on environmental, functional, injury-related, psychosocial, and sociodemographic factors. Methods: The participants were 82 community-dwelling SCI adults over the age of 18. They were all included in the American Spinal Injury Association's (ASIA) Levels A, B, and C. This study surveyed participants' participation using the CHART-K-SF, environmental factors using the CHIEF-25 Korean version, and functional factors using the SCIM III. Further, pain and distress were surveyed using Zung's Self-rating Pain and the PAD, self-esteem was assessed using the RSES, and self-efficacy using the GSS. Finally, information concerning injury levels, post-injury period, causes of injury-related factors, and sociodemographic factors such as gender, age, marriage, education level, and residence information were collected. The collected data were analyzed using SPSS Version 21.0 Results: Participants' risk factors were environmental and functional. The Nagelkerke's $R^2$ was.737. The OddsRatio(OR) of environmental factors(referent,0-1) was 40.346. Moreover, the OR of the $1^{st}$ quartile functional factor(referent,4thquartile) was 236. 621, and that of the$2^{nd}$ quartile was 21.174. In addition, the occupational predictors included the "policies" subscales in the CHART-K-SF, "physical/structural" in the CHIEF-25, and "mobility" in the SCIM III. Further, the predictors of "physical independence" were "services/assistance" in CHIEF-25, and "respiration and sphincter management' on the SCIM III. Additionally, "mobility" was predicted by "physical/structural" on the CHIEF-25 and "mobility" on the SCIM III. Conclusions: This study multidimensionally confirmed predictors of participation restriction. Through these facts, we investigated occupational therapists' roles in community setting. Therefore, this study's results will provide useful information for occupational therapy services, for which the goal is SCI participation improvement within the community.

A Study on the Prevalence and Risk Factors of Liver Dysfunction among the Workers in Chemical Factories (화학공장 근로자들의 간기능 이상 유병률 및 위험인자에 관한 연구)

  • Cheong, Hae-Kwan;Kim, Joung-Soon
    • Journal of Preventive Medicine and Public Health
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    • v.30 no.1 s.56
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    • pp.103-128
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    • 1997
  • The object of this study is to evaluate the possibility of chemical-induced liver disorder among workers exposed to various chemicals and to classify the the liver function abnormalities by causes and to analyse the risk factors for each liver disorders. A cross-sectional study including questionnaire survey, physical examination, laboratory tests and ultrasonography of liver was conducted on 1,126 workers, 459 workers in a coal chemical plant(company A) and 667 workers in an insulation material manufacturing factory(company B). An industrial hygienist reviewed the chemicals used in both companies and evaluated the work environments to classify the workers by chemical exposure semiquantitatively. The results are as follows: 1. Of 459 workers in company A, 83 workers(18.1%) are classified as nonexposed, group 163(35,5%) as short-term exposure group, 155(33.8%) as intermediately exposed group and 58(12.6%) as long-term exposed group bared on the mean daily exposure to hepatotoxic chemicals evaluated by an industrial hygienist. Of 667 workers in company B, 484(72.6%) workers were classified as nonexposed and 183(35.5%) as exposed group. 2. Workers with SGOT level higher than 40 IU/l were (10.0%) in company A and 77(11.5%) in company 3, and those with SGPT level higher than 35 IU/l were 118(25.7%) in company A and 198(29.7%) in company B. The differences were not significant between companies and between exposure groups(p>0.05). Workers with $\gamma-GT$ level higher than 62 IU/l were 29(6.3%) in company A and 77(11.5%) in company B (p<0.01). The difference between exposure groups was not significant(p>0.05) within companies. Workers with liver function abnormalities(defined as SGOT higher than 40 IU/l or SGPT higher than 35 IU/l) were 338(30.0%) among 1,126 workers. Of 338 workers with live. function abnormalities 139(12.3%) had fatty liver by ultrasonography, 79(7.0%) had alcoholic liver(defined as workers with liver function abnormalities with weekly alcohol consumption greater than 280 g for more than 5 years), 54(4.8%) had hepatitis B, 12(1.1%) had hepatitis C and the other 114(33.7%) was not otherwise classified. Prevalences of alcoholic liver and fatty liver were significantly lower in company A(prevalence ratio 0.24 for alcoholic liver, p<0.001, prevalence ratio 0.76 for fatty liver, p<0.05) but prevalences of liver disorders between exposure groups within companies were not significant(p>0.05). 3. Summary prevalence ratios(SPR) of live. function abnormalities, fatty live. and other liver disorders, adjusted by age and company were not significantly higher in exposed group in any chemicals(p>0.05) but in some chemicals, SPRs were significantly lower. 4. On simple analysis of risk factors for liver function abnormalities, prevalence odds ratio(POR) of those with age between 30 and 39 was 1.54(p<0.01) and those with age ever 40 was 1.51(p<0.01). POR of those with histories of liver disorders and general anesthesia was 1.77(p<0.001) and 4.02 for those with overweight and 6.23 for those with obesity, defined by body mass index(p<0.001). 5. On logistic regression analysis, risk factors of liver function abnormality were fatty liver(POR 2.92 for grade 1, 12.15 for grade 2), presence of hepatitis B surface antigen(POR 3.62) and obesity(POR 5.38 for overweight and 16.52 for obesity). Presence of hepatitis B surface antigen(POR 0.18) was the only preventive facto. of fatty live. Company(POR 0.30) and obesity(POR 2.49 for overweight, 4.52 for obesity) were related to the alcoholic live. Obesity(POR 2.94 for overweight) was the only significant risk factor of hepatitis B and there was no significant risk factor for liver function abnormality not otherwise classified. It is concluded that the evidence of liver disorder related with chemical exposure is not evident in these factories. It is also postulated that fatty liver and alcoholic liver is most common causes of liver function abnormalities among workers and effort for weight control and improvement of life style should be done.

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Understanding the Occurrence of Lung Cancer in Foundry Workers through Health Insurance Data (의료보험 전산자료 주상병명으로 파악한 주물공장 근로자들의 폐암)

  • Song, Jae-Seok;Kang, Seong-Kyu;Chung, Ho-Keun;Ahn, Yeon-Soon
    • Journal of Preventive Medicine and Public Health
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    • v.33 no.3
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    • pp.299-305
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    • 2000
  • Objectives : To investigate the difference in the occurrence of lung cancer between foundry workers and non-foundry workers by comparing the number of workers diagnosed with lung cancer through health insurance data. Methods : The study population was comprised of 28,884 workers who had undergone at least one general or special medical examination between January 1995 and December 1997 at the occupational health center. All of the subjects had health insurance during this period. We combined the medical examination data with the health insurance data to compare the number of foundry workers diagnosed with lung cancer and the number of non-foundry workers diagnosed with lung cancer. Results : Seven workers were diagnosed with lung cancer among the 1,591 foundry workers, compared to twelve workers among the 27,293 non-foundry workers (odds ratio: 10.04, 95% confidence interval: 3.95-25.55). The seven foundry workers diagnosed with lung cancer were all exposed to dust, and six out these seven workers were engaged in finishing or shake-out processes. Conclusions : Although the information for this study was obtained from health insurance data, which has limitations such as accuracy and completeness, the number of foundry workers diagnosed with lung cancer was significantly higher than that of non-foundry workers. Therefore, a well-designed cohort study should be followed to confirm the higher lung cancer rates in foundry workers.

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Depressive Disorders among Hansen Disease Patients Living in a Collective Farm (한 집단 농원 한센병 환자들의 우울장애)

  • Kim, Yun-Gu;Park, Min-Ho;Park, Jae-Won;Song, Joon-Ho;Sim, Seong-Gyun;Lee, Joo-Hyoung;Lee, Hee-Young;Yun, Dong-Il;Jung, Sung-Hwan;Min, Young-Sun;Bae, Geun-Ryang;Jung, Cheoll;Lim, Hyun-Sul;Cheong, Hae-Kwan
    • Journal of agricultural medicine and community health
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    • v.29 no.1
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    • pp.133-145
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    • 2004
  • Objectives: Depression is a major health concern that can be life threatening if not recognized and treated early. However, there is few report on the depressive disorder of Hansen disease patients in Korea. Therefore, the authors executed this study in order to check factors related to a depressive disorder of a Hansen disease patients and compare with factors to reach to a depressive symptoms of ordinary people with studying their life state and the trouble that Hansen disease patients were currently experiencing Method: The authors surveyed depressive symptoms using self-reported questionnaires in 74 Hansen disease patients and 84 controls. The severity of depressive symptoms was measured using Korean Form of Geriatric Depression Scale (KGDS) score. Result: Positive rate of depressive disorders among Hansen disease patients was 70.3% and that the referents was 31.0%. There is significant difference positive rate of depressive disorders between Hansen disease group and the referents in the factors such as gender, age, frequency of going out, familial type, and familial income. Depressive disorder of Hansen disease group was associated with sex, familial income. According to the multiple logistic regression, the odds ratios of the Hansen disease group versus referents, gender, familial income, frequency of going out were significant (p<0.05). Conclusion: Hansen disease patients had statistically significant higher depressive symptom score than the referents. Also, Hansen disease patients who have lower familial income were more likely to have depressive disorders. Therefore, Economical supports and policy are required for the Hansen disease patients.

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Factors associated with the attitude of South Korean adults toward food aid to North Korea (남한 성인의 대북식량지원에 대한 태도 관련 요인)

  • Nam, Youngmin;Yoon, Jihyun
    • Journal of Nutrition and Health
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    • v.53 no.2
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    • pp.215-229
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    • 2020
  • Purpose: This study examines the attitude of South Korean adults toward food aid to North Korea and factors associated with it. Methods: An online survey involving 1,000 adults aged 19-69 years was conducted between September-October 2019. Throughout South Korea, the subjects were proportionally distributed with respect to gender, age, and region, to represent South Korean adults. Results: A total of 44.6% of the respondents agreed (Agreement group), 36.7% disagreed (Disagreement group), and 18.7% neither agreed nor disagreed to food aid to North Korea. Compared to the Disagreement group, the Agreement group had a higher concern of food aid to North Korea and a more positive perception on the effect of it. The Agreement group selected "direct assistance from the government" whereas the Disagreement group chose "support through international organizations" as the most appropriate channel for food aid to North Korea. Logistic regression analysis revealed that South Korean adults showing a more positive perception on the effect of food aid to North Korea were more likely to agree to the aid (odds ratio [OR], 19.32). Moreover, compared to the conservatives, the progressives were more likely to agree to food aid to North Korea (OR, 5.94). South Korean adults in their 40-50s were more likely to agree to food aid to North Korea than those in their 20-30s (OR, 2.81). South Korean adults with a higher concern of food aid to North Korea (OR, 3.93) and a greater positive perception on Korean unification (OR, 1.88) were more likely to agree to food aid to North Korea. Conclusion: The most important factor associated with the attitude of South Korean adults toward food aid to North Korea was their perception on the subsequent effect. As strategies to draw social consensus on food aid to North Korea, we recommend systematizing the monitoring process on the effect of providing food aid to North Korea and informing the public of the outcomes.

Type A behavior pattern and social control of parents (A형행동양상과 부모의 사회적인 통제)

  • Lee, Choong-Won;Yoon, Nung-Ki;Suh, Suk-Kwon;Shin, Dong-Hoon
    • Journal of Preventive Medicine and Public Health
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    • v.23 no.1 s.29
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    • pp.22-32
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    • 1990
  • Associations between type A behavior Pattern (TABP) and parental social control were examined by a questionnaire survey in a sample of 803 undergraduates of the three universities in Daegu city in 1988. TABP was assessed by the Student Jenkins Activity Survey (SJAS, short form) and social control of parents by Bernstein and Brandis' Index of control and communication which were both dichotomized by median. The mean age of the sample was 20.7 (standard deviation, 2.2) and mean of total score of SJAS was 5.6 with its standard deviation and median, 2.7 and 5, respectively. In stratified analysis for TABP-social control association by the native place, sex and socioeconomic status (SES), males of rural origin with low SES showed odds ratio (OR), 2.49 but those with high SES 0.40. For females of rural origin, those with low SES showed OR, 1.02, whereas those with high SES did 0.35. For those who was of urban origin, males with low SES had OR 1.27, and those with high SES did 1.29. Females with high SES showed 0.85 and those with low SES 0.67. None of the TABP-social control associations among the strata showed confidence intervals not including unity. In multiple logistic regression by native place, for those with rural origin the only term showed a statistically significance was the social control-SES of parents interaction, OR 3.99 (95% confidence interval, $1.03{\sim}15.46$). For those of urban origin, none of the terms are statistically significant. These results suggest a social upward mobility by education of the rural disadvantaged group and a Confucian idea that regards academic achievement as one of social virtues, both of which may reflect the different sociocultural structures from the West.

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The Seroprevalence and Related Factors of Helicobacter pylori Infection (Helicobacter pylori 감염의 유병률과 관련요인에 관한 연구)

  • Kim, Yeung-Wook;Lee, Su-Ill;Cho, Byung-Mann;Koh, Kwang-Wook;Kim, Young-Sil;Kang, Su-Yong;Cha, Oae-Ri;Kim, Don-Kyoun
    • Journal of Preventive Medicine and Public Health
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    • v.29 no.3 s.54
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    • pp.669-678
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    • 1996
  • Helicobacter pylori is now recognized as causative agent of chronic gastritis and peptic ulcer, and strongly associated with development of gastric carcinoma. With development of sensitive and specific serologic tests to identify individuals infected with Helicobacter pylori, the epidemiologic study of this diseases has been investigated. But it's transmission route is not established, yet. The purpose of this study is to measure the prevalence of Helicobacter pylori infection in healthy children and young adults and to evaluate related factors for Helicobacter pylori infection in Korea. The seroprevalence of Ig G antibodies to Helicobacter pylori was determined using a Enzyme Linked Immunosorbent Assay and we obtained the information, such as demographic characteristics, monthly household income, numbers of family members in the house, numbers of persons using same room, type of house, and type of drinking water through the questionnaire survey. The observed overall seropositivity rate was 25.7%. The rate is increased progressively from 5.8% in the age group $1\sim3$ years to 44.4% in the age group $20\sim29$years($\chi^2$ for trend, p<0.001). Especially, the rate increased steeply from 6.5% in the age group $4\sim6$ years to 20.8% in the age group $7\sim9$ years, and this suggested that elementary school age was the major acquisition time of Helicobacter pylori infection. In multivariate logistic regression model, age, numbers of family members in the house, and type of house was statistically significant variables for Helicobacter pylori infection. Each odds ratio(93% CI) were as follows; base to age group $1\sim9$ years, age group $10\sim19$ years $3.6(2.0\sim6.4)$, age group $20\sim29$ years $7.3(4.1\sim13.1)$ and base to group of $1\sim3$ family members, group of $4\sim5$ family members $2.1(1.1\sim4.0)$, group of 6 or more family members $2.7(1.3\sim5.4)$ and base to apartment, single and multihouse $1.9(1.1\sim3.5)$. Sex, monthly household income, numbers of persons using same room, and type of drinking water was not statistically significant for Helicobacter pylori infection.

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Analysis of characteristics affecting the score-groups by supervisor and subordinate rating (하향평가와 상향평가 결과에 영향을 미치는 특성 분석)

  • Shin Ki Soo;Cho Woo Hyun;Park Young Yo;Jung Sang Huyk;Lee Hye Jean
    • Health Policy and Management
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    • v.15 no.1
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    • pp.97-117
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    • 2005
  • This study was designed to compare the differences m results of supervisor and subordinate rating. Data was collected from personnel evaluation and subordinate rating results for middle managers(n=68) in hospital from 3rd January to 20th March in 2004. Supervisor rating consisted of performance, ability and attitude evaluation. Subordinate rating consisted of leadership, ability and attitude evaluation. Collected data included sociodemographic characteristics, work department, work level, years of work, years at present level and whether working in a patient serving department. The difference of standardized supervisor and subordinate rating score was used to define groups as 'higher in supervisor rating group'. Groups were defined in total score, ability score and attitude score. Main results were as follows: 1. In total score, sectional chiefs were apt to be 'higher in subordinate rating group' while chief clerks were apt to be 'similar group' or 'higher in supervisor rating group'. Staffs in patient serving department were likely to be 'higher in supervisor rating group' and staffs in non-patient serving department were likely to be 'higher in subordinate rating group'. All these results were statistically significant. 2. In ability score, there were no statistically significant differences in age, sex, years of education, work department, work level, years of work and whether working in a patient serving department among 'higher in supervisor rating group', 'similar group' and 'higher in subordinate rating group'. 3. In attitude score, staffs in the department of medical affairs and the department of administration were apt to be 'higher in subordinate rating group'. Staffs in the department of nursing were apt to be 'higher in supervisor rating group'. Staffs in a patient serving department were likely to be 'higher in supervisor rating group' and staffs in a non-patient serving department were likely to be 'higher in subordinate rating group'. All these results were statistically significant. 4. Logistic analysis about total score showed that sectional chiefs had higher Odds Ratio(OR) to be in 'higher in subordinate rating group'. Staffs in a non-patient serving department had higher OR to be in 'higher in subordinate rating group'. Both these results were statistically significant. 5. Logistic analysis about ability score showed that sectional chiefs had higher OR to be in 'higher in subordinate rating group'. Staffs in a non-patient serving department had higher OR to be in 'higher in subordinate rating group'. These results were not statistically significant. 6. Logistic analysis about total score showed that sectional chiefs had higher OR to be in 'higher in subordinate rating group', but the difference was not statistically significant. Staffs in a non-patient serving department had significantly higher OR to be in 'higher in subordinate rating group'. In conclusion, there is no clear superiority between supervisor and subordinate rating in personnel evaluation. It would be better to use a mixed model. It's also suggested to use an intervening rate of application or scores considering work levels and work department in personnel evaluation. These results would be helpful for hospitals planning a supervisor and subordinate rating system for personnel evaluation.