• 한국임상약학회지
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• 제19권2호
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• pp.167-179
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• 2009

Hypertension is one of the most common chronic diseases and it causes cardiovascular and cerebrovascular disease. While antihypertensive drug use increased, it took 15% of national health insurance drug expenditure. This study aimed to examine the pattern of antihypertensive drug prescription using National Health Insurance claims database and compare it with recommendations of Korea Hypertension Treatment Guidelines. Among the antihypertensive drugs, calcium channel blocker(64.4%) was most commonly prescribed class, and diuretics(44.6%), angiotensin II receptor blocker(33.3%), angiotensin converting enzyme inhibitor(11.7%) was followed. Approximately 81% of antihypertensives prescription were without cardiovascular or cerebrovascular disease, and among the comorbid conditions, diabetes(10.7%) was most common. calcium channel blocker(62.3%) was mostly prescribed class for hypertension with angina pectoris, angiotensin receptor blocker(45.3%) with myocardial infarction, diuretics(70.2%) and calcium channel blocker(49.5%) with congestive heart failure. For Hypertension with cerebrovascular disease, calcium channel blocker(68.0%) and angiotensin receptor blocker(43.3%) were prescribed mainly. When it comes to diabetes, calcium channel blocker(57.2%) was still mostly prescribed and angiotensin receptor blocker(45.9%) followed. But in hospitals and tertiary hospitals, angiotensin receptor blocker(65.7, 66.1%) was mostly prescribed for the patients with diabetes. For Hypertension with chronic renal disease, angiotensin receptor blocker(59.5%), calcium channel blocker(56.5%), diuretics(54.6%) were mainly used. Average number of classes per prescribing was $1.89{\pm}0.89$ class, average days per prescribing was $33{\pm}19$ day. Among the hypertension without comorbidity, 40.5% of prescription was monotherapy and 58.8% of polytherapy included diuretics. Among the outpatient prescriptions, calcium channel blocker was the most commonly used class, and the prescription pattern in clinic did not closely followed recommendations of Hypertension Treatment Guidelines.

• 대한간호학회지
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• 제27권3호
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• pp.694-704
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• 1997

This study was designed to assess the body fat distribution, and also to investigate the effects of body fat on glucose tolerance and on insulin secretion pattern by body mass index in offspring of parents with NIDDM. The subjects consisted of twenty parents with NIDDM who had been admitted to the Department of Internal Medicine or had been seen in the outpatient clinic at Kangnam St. Mary's Hospital, Catholic University between February to March, 1995. Twenty offspring were randomly selected from forty six offspring of twenty parents with NIDDM. As a control group, twenty healthy people without a family history of diabetes mellitus were matched by sex, age and body mass index(BMI). The results are as follows : 1. Mean fasting serum glucose and insulin levels and insulin / glucose ratio were significantly greater in offspring than in the control subjects with BMI 25kg /㎡ in the offspring and in the BMI<25kg /㎡ control subjects (P<0.05). 2. The total glucose area and insulin area were significantly greater in both the offsping and the control subjects with BMI≥25kg /㎡ than in both the offspring and the control subjects with BMI<25 kg /㎡(P<0.05). 3. Upper body skinfold thickness, Waist hip ratio(WHR), serum levels of total cholesterol and triglyceride(TG), total dietary calorie intake and protein intake in both the offspring and the control subjects with BMI≥25kg /㎡ were greater than those with BMI<25kg /㎡(P<0.05). On the other hand, HDL-cholesterol in both the offspring and the control subjects with BMI≥25kg /㎡ was lower than those with BMI< 25kg /㎡(P<0.05). 4. The major variables influencing the total glucose area were subscapular skinfold thickness and WHR and the major variables influencing the total insulin area were suprailiac skinfold thickness, WHR, TG and free fatty acid. In the light of the results, glucose intolerance and insulin resistance were affected by body mass index, Upper body fat, WHR and lipids(TG, Free fatty acid), it is implied that these are influencing factors on total glucose area and total insulin area. The identification of these factors might provide a useful tool to identify individuals at high risk of diabetes mellitus. Therefore, various nursing intervention programs to reduce obesity could be given to both the offspring of parents with NIDDM and to the obese healthy controls before diabetes mellitus develops.

• 생물정신의학
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• 제24권1호
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• pp.39-44
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• 2017

Objectives Angiotensin-converting enzyme (ACE) gene and plasma levels of cytokines, such as tumor necrosis $factor-{\alpha}$ ($TNF-{\alpha}$), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-10 (IL-10), have previously been determined to be associated with depression. The purpose of this study was to investigate the association of plasma levels of ACE and cytokines with recurrent depression. Methods A total of 52 participants (14 male, 38 female, aged $43.9{\pm}14.0years$) were enrolled after being diagnosed with depression by experienced psychiatrists using the Mini International Neuropsychiatric Interview from the outpatient clinic of the Department of Psychiatry, CHA Bundang Medical Center. The participants completed blood sampling, the Hamilton Depression Rating Scale (HAMD), the Beck Depression Inventory, the Beck Anxiety Inventory, and the Scale for Suicidal Ideation. Results ACE plasma levels are higher in patients with recurrent depression ($27.4{\pm}10.4U/L$) than in patients with newly diagnosed depression ($19.1{\pm}7.7U/L$) (p = 0.004). The levels of cytokines, such as $TNF-{\alpha}$, IL-4, IL-6, IL-10, are not significantly different between the two groups. Additionally, the ACE plasma level is negatively correlated with a reduction in the HAMD over six weeks (r = -0.429, p = 0.046, n = 22). Conclusions The current findings show that plasma ACE levels may be associated with recurrent depression and further suggest that the renin-angiotensin system could play a role in recurrent depression.

• 근관절건강학회지
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• 제6권2호
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• pp.211-225
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• 1999

This descriptive correlational study was carried to identify the relationship among social support, compliance, and psychosocial adjustment of patients with rheumatoid arthritis. The study was done with 100 rheumatoid arthritic patients who were visited in Outpatient clinic of university hospital in Taegu, Korea from the 23rd of February to the 20th of March in 1998. The Data were collected through person to person interviews which were performed by five researchers. The instruments used for this study were Yu's social support scale(1996), Cho's compliance scale(1987), and Kim's psychosocial adjustment scale(1997). The data was analyzed by using a t-test, Pearson correlation coefficient, ANOVA, and Tukey test with the SAS Program. The results of this study were as follows ; 1. The mean score of social support was 2.76 for 4 full marks, compliance was 3.20 for 5 full marks, and psychosocial adjustment was 2.26 for 4 full marks. 2. Hypothesis 1 : "The higher the social support degree, the higher the compliance degree of the rheumatoid arthritis patient". It was supported(r=0.54, p<0.001). Hypothesis 2 : "The higher the compliance degree, the higher the psychosocial adjustment degree of the rheumatoid arthritis patient". It was supported(r=0.34, p<0.001). Hypothesis 3 : "The higher the social support degree, the higher the psychosocial adjustment degree of the rheumatoid arthritis patient". It was supported(r=0.24, p<0.05). 3. In general, the spouse group compared to other groups was demonstrated as the most dependable group for patients to trust and expect support. And the sons and daughters group was shown higher than other groups in terms of social support(F=4.19, p=0.01). There was no difference in terms of compliance in degree. In the degree of psychosocial adjustment the highly educated group(more than high school) is a little higher than the lowly educated group(F=3.08, p=0.03). In the costs of medical care, the group that could afford was significant higher than the group which could not afford results in terms of the psychosocial adjustment degree(F=3.99, p=0.01). The outcome of this study is that the social support that related rheumatoid arthritic patients had an effect on the following compliance, and the following compliance helps psychosocial adjustment of patients. It also shows that social support related psychosocial adjustment. Therefore, to increase the level of psychosocial adjustment of rheumatoid arthritic patients, it will be effective in supportive nursing intervention to improve social support and compliance.

• 생물정신의학
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• 제24권2호
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• pp.75-81
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• 2017

Objectives Obsessive-compulsive disorder (OCD) is a chronic and disabling psychiatric disorder. The duration of untreated illness (DUI) has been suggested as one of the predictors of clinical course and outcome in various psychiatric disorders. There is increasing evidence that cognitive dysfunction is associated with the prognosis of OCD. The aim of this study was to investigate the influence of DUI on the neurocognitive functions in patients with OCD. Methods Sixty-two patients with a DSM-IV diagnosis of OCD from the outpatient clinic were included in this study. We defined the short DUI if the DUI was 2-year or less and the long DUI if it was longer than 2-year. Neurocognitive functions were assessed by visuospatial memory function test and 4 subsets of K-WAIS such as vocabulary, arithmetic, block design and picture arrangement. Differences in neurocognitive functions as well as clinical variables between OCD patients with short DUI and those with long DUI were investigated. Correlation analyses were also performed to determine the correlation between DUI and neurocognitive functions. Results Compared with the short DUI group, the long DUI group performed worse in the block design test, which measures executive function. The long DUI group also had a higher level of compulsive symptom severity than the short DUI group. However, the DUI was not correlated with neurocognitive functions. Conclusions Findings in this preliminary study suggest that the long DUI in patients with OCD is associated with more severe executive dysfunction. Studies with larger samples and longitudinal design are needed to further confirm the prognostic role of the DUI in OCD.

• Childhood Kidney Diseases
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• 제15권2호
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• pp.184-190
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• 2011

Henoch-Sch$\ddot{o}$nlein 자반증은 2-38%의 남자 환아에서음낭을침범할수있다. 음낭침범은 Henoch-Sch$\ddot{o}$nlein 자반증의 임상 경과 중 어느 시기에든 나타날 수 있으며, 자반이 나타나기 전 혹은 자반이 사라지고 난 후에도 나타날 수 있어 진단이 늦어지거나 오진될 수 있다. 특히 급성 음낭 통증이 동반된 경우 응급 수술이 필요한 고환염전과 감별하는 것이 중요하다. 첫번째 환자는 Henoch-Schonlein 자반증을 진단 받기 전 급성 음낭 통증이 발생하였으며, 두번째 환자는 Henoch-Schonlein 자반증을 치료받고 약 한 달이 경과한 후 급성 음낭 통증이 발생하여 방문하였다. 두 경우 모두 음낭 도플러 초음파 검사를 시행하였고 부고환으로는 증가된 혈류, 고환으로는 정상 혈류를 보여 부고환염을 진단하고 고환염전을 배제할 수 있었으며, 단기간의 스테로이드 치료를 통해 부고환염은 호전되었다. Henoch-Sch$\ddot{o}$nlein 자반증에서 동반된 급성 부고환염은 보존적 치료만을 통해 빠른 속도로 호전될 수 있는 질환이지만, 고환염전으로 오진되거나 이를 배제하지 못하는 경우 불필요한 수술이 시행될 수 있으므로 증상 발생 초기에 도플러 초음파 검사를 시행하는 것이 중요할 것으로 사료된다.

• 생물정신의학
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• 제21권3호
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• pp.107-113
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• 2014

Objectives Restless legs syndrome (RLS) is a sleep disorder characterized by uncomfortable and unpleasant sensations in the legs and an urge to move the legs, usually at night. The aim of this study is to investigate the incidence of RLS in patients with late life depression and its influence on various clinical outcomes such as severity of depression, sleep quality, cognitive function, and quality of life and accordingly, to elucidate the clinical significance of RLS in patients with late life depression (LLD). Methods This study enlisted 170 depressive patients aged 65 years or older from an outpatient clinic. Structured diagnostic interviews were performed using the Korean version of the Mini-International Neuropsychiatric Interview. All patients completed the questionnaires, including the International RLS Severity Scale, the Korean version of Short-Form 36-Item Health Survey (SF-36), and the Pittsburgh Sleep Quality Index (PSQI). The severity of depression was evaluated by the Korean form of the Geriatric Depression Scale (KGDS) and the level of global cognition was assessed by the Mini-Mental State Examination in the Korean version of The Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (MMSE-KC). Results The incidence of RLS was 17.6% in LLD patients. RLS was more prevalent among the subjects with major depressive disorder (MDD) than those with minor depressive disorder or subsyndromal depressive disorder. The RLS group showed higher score in the KGDS than the Non-RLS group but the difference did not reach the statistical significance (p = 0.095, Student t-test). The mean PSQI score was significantly higher in the RLS group than in the Non-RLS group (p = 0.001, Student t-test). The MMSE-KC score was also lower in the RLS group than in Non-RLS group (p = 0.009, analysis of covariance). But, there was no difference in the score of SF-36 between the RLS group and the Non-RLS group. Conclusions RLS is common in LLD patients, especially in the patients with MDD and is associated with poor sleep quality and cognitive dysfunction, indicating that RLS is clinically significant in patients with LLD. Therefore, RLS should be considered as an important clinical issue in the management of LLD.

• Parasites, Hosts and Diseases
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• 제53권3호
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• pp.321-327
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• 2015

A 50-year-old male visited the outpatient clinic and complained of fever, poor oral intake, and weight loss. A chest X-ray demonstrated streaky and fibrotic lesions in both lungs, and chest CT revealed multifocal peribronchial patchy ground-glass opacities with septated cystic lesions in both lungs. Cell counts in the bronchoalveolar lavage fluid revealed lymphocyte-dominant leukocytosis, and further analysis of lymphocyte subsets showed a predominance of cytotoxic T cells and few T helper cells. Video-assisted wedge resection of the left upper lobe was performed, and the histologic examination was indicative of a Pneumocystis jirovecii infection. Trimethoprim-sulfamethoxazole (TMP-SMX) was orally administered for 3 weeks; however, the patient complained of cough, and the pneumonia was aggravated in the follow-up chest X-ray and chest CT. Molecular studies demonstrated mutations at codons 55 and 57 of the dihydropteroate synthase (DHPS) gene, which is associated with the resistance to TMP-SMX. Clindamycin-primaquine was subsequently administered for 3 weeks replacing the TMP-SMX. A follow-up chest X-ray showed that the pneumonia was resolving, and the cough was also alleviated. A positive result of HIV immunoassay and elevated titer of HCV RNA indicated HIV infection as an underlying condition. This case highlights the importance of careful monitoring of patients with P. jirovecii pneumonia (PCP) during the course of treatment, and the molecular study of DHPS mutations. Additionally, altering the anti-PCP drug utilized as treatment must be considered when infection with drug-resistant P. jirovecii is suspected. To the best of our knowledge, this is the first case of TMP-SMX-resistant PCP described in Korea.

• 보건행정학회지
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• 제5권1호
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• pp.31-58
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• 1995

The Korean government achieved the universal coverage of health insurance in July 1989, and concomitantly introduced a new measure of regulated health care delivery system in using medical care. There are three reasons why the government took the new health care delivery system. Firstly, there was ample room for improving the allocative efficiency in the use of medical facilities. And the second one was to constrain the dramatic increase of medical demand under health insurance. Thirdly, and the most important reason was to alleviate the patient crowdedness in big general hospitals, particularly tertiary hospitals. There are essentially two different ways to control the use of health care : one is to cut the demand for health care, and the other to regulate behaviors of providers through the use of incentives/disincentives, demand-side approach or supply-side approach. The objective of this study is to examine whether or not medical care utilization behaviors under health insurance scheme have been changed among medical facilities such as clinic, hospital, general hospital and tertiary hospital in comparison with those before and after the introduction, particularly whether the patient crowdedness in tertiary hospitals has been alleviated or not. In order to conduct this study, the insurance claim data during the period of January 1989 and July 1992 were analyzed by focusing on diagnosis of both inpatients and outpatients, and especially the fifteen most frequent diseases in ambulatory care and the seven most frequent diseases in hospitalizatio. In addition, the same analyses were made on the changes in medical care utilization by specialty department. This was because the five departments, such as family medicine, ENT, eye, dermatology and rehabilitation, were exempted from applying the regulated health care delivery system in tertiary hospitals. The study revealed that a remarkable alleviation effect in the crowdness was noted for tertiary hospitals. This effect was most conspicuous for the most frequent mild diseases of both inpatient and outpatient care. For example, the fifteen most frequent OPD care at tertiary facilities have decreased as much as by 40%, of which 34% belonged to the cut in initial visits. Meanwhile, the proportion of those who used general hospitals and private practitioner's clinics have increased due to the shift of patients. The cases from the five special departments were also decreased, but not so much as other departments. A problem was noted that, as time passed by, the decreasing tendencies of crowdness at tertiary hospitals due to the regulated system became slightly smaller. Therefore, through complementary remedies are needed for the future implementation.

• Archives of Plastic Surgery
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• 제38권2호
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• pp.161-165
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• 2011

Purpose: Zygomaticomaxillary complex (ZMC) fracture is one of the most common facial injuries after facial trauma. As ZMC composes major facial buttress, it is a key element of the facial contour. So, when we treat these fractures, the operator should have a concern with the symmetry to restore normal appearance and function. But sometimes, unfavorable results may occur. The aim of this study is to analyze the unsatisfied midfacial contour after ZMC fractures reduction retrospectively and to point out the notandum. Methods: 369 patients, treated for fractures of the ZMC were included in the study. After the operation, such as open reduction and internal fixation (ORIF with titanium or absorbable materials), open reduction, and closed reduction, midfacial contour was evaluated with plain films and 3-dimensional computed tomography. And unfavorable asymmetric midfacial contours were correcterd by secondary correction and re-evaluated. Gross photographs were obtained at outpatient clinic. Results: Total of 38 patients had got a facial asymmetry and among of them 24 patients were treated secondary revisional ORIF operations for correction of unfavorable result of after primary reduction. Two of them had received tertiary operations, three patients had got osteotomy more than after one year and six patients had got minor procedures. The etiology of asymmetry were lateral displaced simple fracture of arch (n=2), lateral displaced comminuted fracture of arch (n=6), comminuted arch fracture combined posterior root fracture (n=9), and communited arch and body fracture (n=12), severely contused soft tissue (n=9). After the manipulations outcomes were acceptable. Conclusion: To prevent the asymmetry in ZMC fracture reduction, complete analysis of fracture, choice of appropriate operation technique, consider soft tissue, and secure of zygoma position are important. Especially, we should be more careful about communited fracture of zygomatic body and lateral displacement, root fracture of zygomatic arch. Because they are commom causes that make facial asymmetry. To get optimal result, ensure the definite bony reduction.