• 한국환경보건학회지
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• 제43권1호
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• pp.1-22
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• 2017

'The worstest environment disaster', 'World's first biocide massacre', 'Home-based Sewol ferry disaster' are all phrases attached to the recent humidifier disinfectant disaster. In the spring of 2011, four of 8 pregnant women including 1 adult man passed away at a university hospital in Seoul due to breathing failure. Epidemiologic investigation conducted by the Korean CDC soon revealed the inhalation of humidifier disinfectant, which had been widely used in Korea during the winter, to be responsible for the disease. As well as lung fibrosis hardening of the lungs, other diseases including asthma, rhinitis, skin disease, liver disease, fetal disease or cancers have been researched for their relation with exposure to the products. By February 9, 2017, 5,342 cases had registered for health problems and 1,131 of them were already dead (20.8% mortality rate). Based on studies by government agencies and a telephone survey of the general population by Seoul National University and civic groups, around 20% of the general public of Korea has used these products. Since the market release of the first product by SK Chemical in 1994, over 7.1 million items from around 20 brands were sold up to 2011. Most of the products were manufactured by well-known large conglomerates such as SK, Lotte, Samsung, Shinsegye, LG, and GS, as well as some European companies including UK-based Reckitt Benckiser and TESCO, the German firm Henkel, the Danish firm KeTox, and an Irish company. Even though this disaster was unveiled in 2011 by the Korean government, the issue of the victims was neglected for over five years. In 2016, an unexpected but intensive investigation by prosecutors found that Reckitt Benckiser manipulated and concealed animal tests for its own brand and brought several university experts and company employees to court. The matter was an intense social issue in Korea from May to June with a surge in media coverage. The prosecutor's investigation and a nationwide boycott campaign organized by victims and environmental groups against Reckitt Benckiser, whose product had been used by more than 70% of victims, led to the producer's official apology and a compensation scheme. A legislative investigation organized after the April 2016 national election revealed the producers' faults and the government's responsibility, but failed to meet expectations. A special law for the victims passed the National Assembly in January 2017 and a punitive system together with a massive environmental epidemiology investigation are expected to be the only solutions for this tragedy. Sciences of medicine, toxicology and environmental health have provided decisive evidence so far, but for the remaining problems the perspectives of social sciences such as sociology and jurisprudence are highly necessary, similar to with the Minamata disease and Wonjin Rayon events. It may not be easy to follow this issue using unfamiliar terminology from medical and chemical science and the long, complicated history of the event. For these reasons the author has attempted to write this article in a question and answer format to render it easier to follow. The 17 questions are: Q1 What is humidifier disinfectant? Q2 What kind of health problems are caused by humidifier disinfectant? Q3 How many victims are there? Q4 What is the analysis of the 1,112 cases of death? Q5 What is the problem with the government's diagnostic criteria and the solution? Q6 Who made what brands? Q7 Has there been a recall? What is still on sale? Q8 Was safety not checked by any producers? Q9 What are the government's responsibilities? Q10 Is it true that these products were sold only in Korea? Q11 Why and how was it unveiled only in 2011 after 17 years of sales? Q12 What delayed the resolution of the victim issue? Q13 What is the background of the prosecutor's investigation in early 2016? Q14 Is it possible to report new victim cases without evidence of product purchase? Q15 What is happening with the victim issue? Q16 How does it compare with the cases of Minamata disease and Wonjin Rayon? Q17 Are there prevention measures and lessons?

• Tuberculosis and Respiratory Diseases
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• 제83권1호
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• pp.31-41
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• 2020

Background: Chronic cough is defined as a cough lasting more than 8 weeks and socio-economic burden of chronic cough is enormous. The characteristics of chronic cough in Korea are not well understood. The Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) published guidelines on cough management in 2014. The current study evaluated the clinical characteristics of chronic cough in Korea and the efficacy of the KATRD guidelines. Methods: This was a multi-center, retrospective observational study conducted in Korea. The participants were over 18 years of age. They had coughs lasting more than 8 weeks. Subjects with current pulmonary diseases, smokers, exsmokers with more than 10 pack-years or who quit within the past 1 year, pregnant women, and users of cough-inducing medications were excluded. Evaluation and management of cough followed the KATRD cough-management guidelines. Results: Participants with chronic cough in Korea showed age in the late forties and cough duration of more than 1 year. Upper airway cough syndrome was the most common cause of cough, followed by cough-variant asthma (CVA). Gastro-esophageal reflux diseases and eosinophilic bronchitis were less frequently observed. Following the KATRD cough-management guidelines, 91.2% of the subjects improved after 4 weeks of treatment. Responders were younger, had a longer duration of cough, and an initial impression of CVA. In univariate and multivariate analyses, an initial impression of CVA was the only factor related to better treatment response. Conclusion: The causes of chronic cough in Korea differed from those reported in other countries. The current Korean guidelines proved efficient for treating Korean patients with chronic cough.

• 한국가정과교육학회지
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• 제19권1호
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• pp.47-64
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• 2007

이 연구는 학생들이 유니버설디자인과 편의시설에 대한 이해를 증진시키고자 유니버설디자인을 적응한 편의시설 가운데 학교편의시설의 접근성을 실험하는 장애체험활동 교수 학습과정안을 개발하고 이 과정안에 따라 장애체험활동을 함으로써 학교편의시설의 실태를 파악하는데 연구의 목적이 있다. 개발한 자료는 학교편의시설 실험활동에 활용할 2차시분의 장애체험활동 교수 학습과정안과 장애체험활동 기록지, 활동 평가에 사용할 활동 평가지가 있다. 연구 대상학교는 통합교육을 실시하는 중학교 2개 학교와 일반 중학교 5개 학교로 설립기준, 지역, 건축년도, 학급 수, 건물 층수, 학교형태, 통합교육 실시여부 등을 고려하여 편의시설이 다양한 7개 학교를 임의 선정하였다. 대상학생 수는 학교별로 30명씩 희망자를 선정하고 실제 장애우(4명)를 포함하여 총 214명이 참여하였다. 각 실험조는 손이나 팔 장애우 팀, 목발 장애우팀, 휠체어 장애우팀과 더불어 비장애우 1개팀 총 15명으로 구성하였다. 학교편의시설 장애체험활동으로 학교편의시설의 접근성을 2005년 11월 26일부터 12월 24일까지 실험하였으며, 학교편의시설 평가는 장애체험활동 기록지 185부와 활동 평가지 200부를 평가하였다. 수집된 자료는 Spss/Win(version 10.0)을 이용하여 빈도 평균 백분율, 교차분석, t 검증, 일원분산분석, 요인분석, 신뢰도 분석을 하였다. 연구 결과, 학교편의시설이 편의증진법의 학교편의시설 기준에 미달되거나 설치율이 낮으며, 설치되어 있어도 접근하기 어렵거나 이용이 불편한 시설이 맡았기 때문에 대부분의 학생들이 학교에서 안전사고나 부상을 많이 경험하고 있었고, 학교편의시설에 대한 위험하고 불편하여 개선할 시설로 화장실, 복도, 계단을 지적하여 접근성 평가의 학교편의시설 실태와 일치하였다. 장애체험활동 교수 학습과정 안에 대한 평가는 장애체험활동에 대한 의견은 내용이 유익하고 만족스러우며 수업 시간에 배워야 할 내용으로 평가하였으며, 이 의견보다 학교편의시설을 바르게 설치해야하는 중요성을 알게 되거나 관심을 갖게 되었다는 인식 변화가 더 높았다. 학교편의시설의 불편한 점을 알게 되거나 학교편의시설이 장애우에게 불편할 것이라는 것을 알게 되었다는 비판 의식은 세요인 중 가장 높아 장애체험활동을 통해 학교편의시설의 접근성을 실험하는 교수 학습은 학교편의시설의 개념을 이해와 실태를 파악하여 학교편의시설이나 생활환경에 관심을 갖게 되고, 장애우 통합교육을 위한 학교의 물리적 환경 개선을 위해 효과적인 교육 프로그램으로 활용할 수 있으며 모든 사람들과 더불어 생활하는 공동체의식을 높이는데 기여할 것이다.

• Journal of Nutrition and Health
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• 제10권2호
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• pp.59-70
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• 1977

This study was designed to evaluate the changes and improvements in the Korean diet during the last thirty years (since independence in 1945), and to make recommendations for the improvement of their nutritional status, consequently contributing to the physical and mental welfare of the Korean people. The results and recommendations are as follows: 1. The total calorie and carbohydrate intake decreased by $8{\sim}12%$ in the 1970's, as compared with the 1940's and the 1950's. 2. The intake of calcium and vitamiu A increased $30{\sim}50%$ and $20{\sim}60%$ respectively in the 1960's and 1970's as compared with the 1940,s. But this intake level is still lower than the RDA values. 3. The vitamin C intake was somewhat higher in the mountainous and farming areas than in urban areas. 4. In the 1970's, the decrease of untriend intake due to seasonal variation was marked especially for protein, niacin, vitamin $B_1$, and vitamin C. 5. The consumption of protein foods (meats and legumes) increased in an amount of $15{\sim}36g$ per day. There was a marked increase in the intake of meat in farming areas and of milk in urban areas in the 1970's. This increased intake of animal proteins is a very desirable dietary change. 6. The cereal consumption was lowest in urban areal, but there was a general decrease in the intake of the cereal group in the entire area in the 1970's. For the farmers, the intake of cereal food decreased most, from 750 g to 576 g, but cereals still composed a high proportion of the entire diet. 7. Fruits and vegetables showed the highest intake for the urban people, as expected. For the whole area, this food group showed an increase of 8.7% in the 1970's, as compared with the 1960's. 8. The gradual ihcrease in the intake of the fats and oil group was a desirable dietary change. but the absolute amount was too low. 9. A 7% increase in height and a 9% incrrase in weight for growing children and adolescents was observed in the 1970's as compared with the 1940's, but several kinds of deficiency diseases, such as nutritional anemia and dental caries were still apparent in many areas. 10. To improve cur food life and to cope with food shortages faced in Korea, an efficient and nationwide nutrition education program should be implemented. This would maximize efficiency of intake from the limited food sources for a balanced diet. 11. As it is of utmost importance to provide growing children with a desirable physical, sccial mental, and especially nutritional environment, a well-planned and organized school feeding program should be practiced widely and efficiently. 12. Young mothers and pregnant women should be educated on the importance of their children's nutrition, especially for the critical fetal and infancy periods. 13. More thorough and continuous nutritional survey studies on the changes in dietary patterns for the entire nation should be pursued, evaluated and documented. This would Provide a good information guide for future nutritional study programs. 14. It is the nutritionistist's strong desire that national leaders, especially decision makers recognize the fact that improvement of the nutritional status of the People is one of the most economic and preventative ways of improving their physical and mental health. This is closely related to the economic development and strength of the nation.

• Journal of Nutrition and Health
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• 제4권1호
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• pp.1-19
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• 1971

Nutritional anemia is an important nutritional problem affecting large population groups in most developing countries. Nutritional anemia is caused by the absence of any dietary essential involed in hemoglobin formation or by poor absorption of these dietary components. The most likely causes are lack of dietary iron, and folate, vitamin $B_{12}$ and high qualify protein. Anemia is considered to be a late mainfeastation of nutritional deficiencies, and even mild anemia is not the earilest sign of such a deficiency. Therefore, the object of therapy is to correct underlying deficiency rather than merely its manifestation. Iron deficiency anemia is generally much the most common form of anemia. And it is very prevalent particularly in pregnant women and young children, especially under five year of life. According to the rapid growth rate of infants, dietary iron should he provided for infants over three months of age in adequate amounts for the synthesis of hemoglobin required by the increasing blood volume and for the demands of newly formed cells. The principal causes of iron deficiency anemia are an inadequate dietary iron content, interference with absorption of iron from the intestine, excessive losses of iron from the body, disturbance of iron metabolism by infection, and social and cultural environments. The present study is planned to obtain informations concerning nutritional anemia through anthropometric and biochemical determinations for the assessment of nutriture in pre-school children. Determination was taken in 226 pre-school children in ruraI arae in 1968, 122 pre-school children in 1970, and 1526 hospitalized pre-school children in 1970. The results of this study are as follows; (1) According to Iowa Malnutrition Borderline (85 percentile) for weight, the proportions of underweighed pre-school boys and girls in rural area were 47.2% and 46.2% in1968, and were 36.1% and 51.8% in 1970. According to Iowa Malnutrition Borderline for height, the proportions of underheight boys and girls in rural area were 30.5% and 33.7%, and were 26.2% and 21.8% in 1970. Malnutrition scores of underweight for height values of boys and girls in rural area were 19.3 and 17.3 in 1968, and the scores of boys and girls were 15.6 and 15.5 in 1970. (2) The mean hemoglobin values of boys and girls in rural area were $11.2{\pm}1.8g/100ml\;and\;11.4{\pm}1.6g/100ml$ in 1968. In 1970, the mean values of boys and girls in rural area were $11.3{\pm}1.3g/100ml\;and\;11.7{\pm}2.4g/100ml$. The mean hemoglobin values of hospitalized boys and girls were $11.9{\pm}2.2g/100ml\;and\;11.7{\pm}2.4g/100ml$ in 1970. It is found that 92 of 215 children (42.7%) in rural area had concentrations of hemoglobin less than 11.0g/100ml in 1968. In 1970, 55 of 121 children (45.4%) in rural area and 559 of 1526 hospitalized children (36.6%) had concentrations of hemoglobin less than 11.0g/100ml. (3) The mean hematocrit levels of hospitalized boys and girls were $35{\pm}26.8%\;and\;35.4{\pm}6.4%$ in 1970. And 443 of 1334 hospitalized children (33.2%) had hematocrit values below 33%. (4) The average mean corpuscular hemoglobin concentration levels of hospitalized boys and girls were $32.4{\pm}2.2\;and\;32.3{\pm}2.2$ in 1970. And 1016 of 1352 hospitalized children (75.1%) had the mean corpuscular hemoglobin values below 34. (5) The mean iron values of young children in rural area and hospitalized children were $62.0{\pm}6.3{\mu}g/100ml\;and\;60.7{\pm}22.8{\mu}g/100ml$. The proportions of anemia cases below $50{\mu}g/100ml$ in rural area was 37.9%, and 34.3% in hospitalized children. (6) The mean total iron binding capacity of young children in rural area was $376{\pm}57.88{\mu}g/100ml,\;and\;342.2{\pm}6.15{\mu}g/100ml$ in hospitalized children. (7) The average transferrin saturation percentage of young children in rural area was $16.9{\pm}4.7%,\;and\;18.0{\pm}8.4%$ in hospitalized children. The proportions of anemia cases below 15% of young chi1dren in rural area and hospitalized children were 48.3% and 41.2%. Therefore, authors wish to recommend that the following further studies should be undertaken: (1) Standardization of simplied laboratory examination of nutritional anemia. (2) The prevalence of nutritional anemia and the requirements of iron, folate, and vitamin $B_{12}$ of pre-school children. (3) The content and absorption of iron in Korean food. (4) The pathogenesis of nutritional anemia and prevention of parasitic disease. (5) Maternal health and nutrition education.

• Clinical and Experimental Pediatrics
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• 제56권10호
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• pp.439-445
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• 2013

Purpose: Previous studies suggest that the concentration of 25-hydroxyvitamin D [25(OH)D] in cord blood may show an inverse association with respiratory tract infections (RTI) during childhood. The aim of the present study was to examine the influence of 25(OH)D concentrations in cord blood on infant RTI in a Korean birth cohort. Methods: The levels of 25(OH)D in cord blood obtained from 525 Korean newborns in the prospective COhort for Childhood Origin of Asthma and allergic diseases were examined. The primary outcome variable of interest was the prevalence of RTI at 6-month follow-up, as diagnosed by pediatricians and pediatric allergy and pulmonology specialists. RTI included acute nasopharyngitis, rhinosinusitis, otitis media, croup, tracheobronchitis, bronchiolitis, and pneumonia. Results: The median concentration of 25(OH)D in cord blood was 32.0 nmol/L (interquartile range, 21.4 to 53.2). One hundred and eighty neonates (34.3%) showed 25(OH)D concentrations less than 25.0 nmol/L, 292 (55.6%) showed 25(OH)D concentrations of 25.0-74.9 nmol/L, and 53 (10.1%) showed concentrations of ${\geq}75.0$ nmol/L. Adjusting for the season of birth, multivitamin intake during pregnancy, and exposure to passive smoking during pregnancy, 25(OH)D concentrations showed an inverse association with the risk of acquiring acute nasopharyngitis by 6 months of age (P for trend=0.0004). Conclusion: The results show that 89.9% of healthy newborns in Korea are born with vitamin D insufficiency or deficiency (55.6% and 34.3%, respectively). Cord blood vitamin D insufficiency or deficiency in healthy neonates is associated with an increased risk of acute nasopharyngitis by 6 months of age. More time spent outdoors and more intensified vitamin D supplementation for pregnant women may be needed to prevent the onset of acute nasopharyngitis in infants.

• Pediatric Infection and Vaccine
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• 제22권2호
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• pp.63-68
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• 2015

목적: 저자들은 2013년 경기 북부의 한 병원에서 경험한 소규모 홍역 유행의 양상을 알아보기 위해 본 연구를 시행하였다. 방법: 2013년 8월부터 10월까지 가톨릭대학교 의정부성모병원에서 홍역으로 확진된 환아 15명의 의무기록을 후향적으로 분석하였다. 결과: 홍역으로 진단된 환아는 모두 15명으로, 신생아 1명, 영아 11명, 유아 3명이었으며 역전사 중합 효소연쇄반응법(RT-PCR)과 혈청 내 홍역 IgM 검사로 확진하였다. 모든 환아는 Measles-Mumps-Rubella (MMR) 접종을 받지 않았다. 홍역으로 확진된 환아의 바이러스 유전형은 모두 B3이었다. 9명(60%)의 환아가 원내 감염에 의해 홍역에 걸렸다. 잠복기는 8-15일이었고 발열은 접촉 후 평균 10일째 발생하여 평균 8일 동안 39도 이상으로 지속되는 양상을 보였다. 발진은 접촉 후 평균 13일째 발생하였다. 40%의 환아가 호흡기 합병증을 보였고 53%의 환아가 설사를 동반하였다. 결론: 우리나라는 꾸준한 접종 사업을 통해 홍역 퇴치 수준에 이르게 되었지만 홍역 재유행, 특히 영아에 대한 위험성을 간과할 수 없게 되었다. 영유아에서 홍역이 의심될 때에는 가속접종, 면역글로불린 투여와 같은 처치를 적극적으로 시행하는 것이 필요하다. 향후 홍역 유행을 막기 위한 첫 번째 단계로, 신생아, 영아, 가임기 여성의 홍역 IgG 항체가 재조사가 필요할 것으로 사료된다.

• Journal of Yeungnam Medical Science
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• 제10권1호
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• pp.68-76
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• 1993

1992년 10월 1일부터 1993년 3월 31월까지 영남대학교 의과대학 부속병원 산부인과에 입원하여 만삭분만한 정상산모 35명을 대조군으로, 경증 자간전증 환자 23명을 대상군으로 일산화탄소혈색소와 혈청 철의 농도를 측정하여 다음과 같은 결과를 얻었다. 혈청철의 농도는 임신성 고혈압 환자군에서 $86.5{\pm}6.1{\mu}g/dl$, 정상 산모군에서 $53.2{\pm}6.1{\mu}g/dl$로 임신성 고혈압 환자군에서 유의성 있게 증가하였고, 일산화탄소혈색소 농도도 각 군에서 분만 전 $0.61{\pm}0.21{\mu}g/dl$, $2.55{\pm}0.4{\mu}g/dl$, 분만후 $0.53{\pm}0.2{\mu}g/dl$, $1.21{\pm}0.4{\mu}g/dl$로 임신성 고혈압 환자군에서 높게 나타났다. 간세포 손상의 근거로서 SGOT, SGOP 및 적혈구 파괴의 근거로서 혈색소치와 혈액농축의 근거로소 적혈구용적치는 각각 양 군에서 의의있는 차이가 없었다. 이상의 결과로 미루어 보아 경증 자간전증 환자군에서 정상 산모군에 비하여 혈청 철과 일산화탄소혈색소가 훨씬 증가하였음을 관찰 할 수 있었다.

• Clinical and Experimental Pediatrics
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• 제49권4호
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• pp.381-387
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• 2006

목 적 : 신생아 루푸스는 전신성 홍반성 루푸스 산모의 자가 항체가 태반을 통해 태아에게로 넘어가 임상 증상을 보이는 질환으로 선천성 완전 방실 블록, 피부 병변, 간질환, 혈구 감소증을 특징으로 하는 질환이다. 이에 저자들은 전신성 홍반성 루푸스 산모의 출산아에서 선천성 완전 방실 블록의 빈도 및 출산아의 임상적 특징을 알아보고자 본 연구를 시행하였다. 방 법 : 1997년 1월부터 2005년 1월까지 한양대학교병원 류마티스 병원과 산부인과에서 진료받은 산모 55명의 57회의 임신결과와 태어난 49례의 신생아에 대한 임상기록을 후향적으로 검토하였다. 결 과 : 57례의 임신 중 5례(8.8%)의 자연유산, 1례(1.8%)의 사산이 있었고 15례(26.3%)의 조산, 8례(12.3%)의 부당 경량아의 빈도를 확인할 수 있었다. 57례의 임신 중 산전 초음파 검사에서 선천성 방실 블록 1례(1.8%)가 있었고 보호자 자의에 의해서 인공 유산이 행해졌다. 49례의 신생아 심전도 소견상 선천성 완전 방실 블록은 없었으며 모두 정상이었고 임상 기록상 피부병변이 있는 신생아는 없었다. 49례의 출산아 중 39례에서 혈액검사가 시행되었고 10례(25.6%)에서 혈액학적 이상이 있었다. 이 중 빈혈이 8례(20.5%), 중성구 감소증이 2례(5.1%), 혈소판 감소증이 3례(7.7%) 있었다. 자가 항체 anti-SSA(Ro)가 양성인 산모와 antiphospholipid 항체(aPL 항체)가 양성인 산모에서 미숙아 출산 빈도가 높았다(P=0.003, P=0.049). 항cardiolipin 항체(aCL 항체) 양성인 산모의 출산아가 인공환기요법을 받은 빈도가 높았다(P=0.018). 결 론 : 전신성 홍반성 루푸스 산모의 임신 중 선천성 완전 방실 블록의 빈도는 1.8%로 그 빈도가 낮았고 출산아 중 혈액학적 이상은 20% 이상에서 나타났다. 소홀히 하기 쉬운 피부병변에 대한 주의 깊은 추적 관찰로 신생아 홍반성 루푸스 진단에 관심을 가져야 할 것이다.

• 대한방사선기술학회지:방사선기술과학
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• 제39권2호
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• pp.237-246
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• 2016

방사성동위원소 사용시설 내/외 화장실 표면 방사선량률과 공간 방사선량률을 측정하여 화장실을 이용하는 환자 이외 방사선작업종사자 및 환자보호자 등의 안전성을 확보하고 방사선 방어 연구에 대한 기초 자료로 제시 하고자 한다. 2014년 5월 1일부터 7월 31일까지 인천광역시 소재 종합병원 방사성동위원소 사용시설 내/외 화장실 4곳의 공간 방사선량률과 작업 전/후 표면 방사선량률을 각각 측정하였다. 의료기관별 방사성동위원소 사용시설 내 화장실 이용 실태조사 결과 환자뿐만 아니라 환자 보호자, 일부 방사선 작업종사자까지 다양하게 이용하고 있었다. 화장실 내 공간 방사선량률 측정 결과 핵의학적 검사 중 감마촬영실을 이용하는 화장실의 누적 공간선량률은 8.86 mSv/hr으로 가장 높게 측정되었고, 방사성옥소 치료실 화장실은 7.31 mSv/hr, PET촬영실 화장실 2.29 mSv/hr, 외래 진료과 화장실 0.26 mSv/hr으로 각각 측정되었다. 방사성동위원소 작업 전/후 화장실 내 표면 방사선량률을 측정한 결과 대부분 환자 배설물이 직접 닫는 변기 앞에서 표면 방사선량률이 가장 높게 측정되었고, 화장실 내 중앙, 입구 순으로 측정되었다. 개봉선원은 물리적 반감기가 짧고 에너지가 낮아 비교적 안전하여 방사선 관리구역에서 안전하게 사용되고 있다. 그러나 저에너지 이며 짧은 반감기의 방사선원이라 하더라도 환자에게 투여되면 그 이후 환자는 움직이는 방사선원이 되며 환자가 이용하는 장소는 배설물에 의한 방사선 오염 장소가 된다. 따라서 효과적으로 유효선량을 최소화하고 불필요한 피폭선량을 줄이기 위해 방사성동위원소 투여 후 충분한 수분 섭취를 독려하여 생물학적 반감기를 낮추고, 물리적 반감기가 허용 선량이하로 될 때까지 주변인은 환자로부터 가급적 멀리 떨어져 생활하도록 권고되어야 한다.