• Asian Pacific Journal of Cancer Prevention
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• 제14권12호
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• pp.7143-7147
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• 2013

Background: The survival outcomes for women presenting with early breast cancer are influenced by treatment decisions. In Malaysia, survival outcome is generally poor due to late presentation. Of those who present early, many refuse treatment for complementary therapy. Objective: This study aimed to explore the decision making experiences of women with early breast cancer. Materials and Methods: A qualitative study using individual in-depth interviews was conducted to capture the decision making process of women with early breast cancer in Malaysia. We used purposive sampling to recruit women yet to undergo surgical treatment. A total of eight participants consented and were interviewed using a semi-structured interview guide. These women were recruited from a period of one week after they were informed of their diagnoses. A topic guide, based on the Ottawa decision support framework (ODSF), was used to facilitate the interviews, which were audio recorded, transcribed and analysed using a thematic approach. Results: We identified four phases in the decision-making process of women with early breast cancer: discovery (pre-diagnosis); confirmatory ('receiving bad news'); deliberation; and decision (making a decision). These phases ranged from when women first discovered abnormalities in their breasts to them making final surgical treatment decisions. Information was vital in guiding these women. Support from family members, friends, healthcare professionals as well as survivors also has an influencing role. However, the final say on treatment decision was from themselves. Conclusions: The treatment decision for women with early breast cancer in Malaysia is a result of information they gather on their decision making journey. This journey starts with diagnosis. The women's spouses, friends, family members and healthcare professionals play different roles as information providers and supporters at different stages of treatment decisions. However, the final treatment decision is influenced mainly by women's own experiences, knowledge and understanding.

• Journal of Preventive Medicine and Public Health
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• 제56권5호
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• pp.467-474
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• 2023

Objectives: Diabetes mellitus (DM) is a serious public health issue that places a heavy financial, social, and health-related burden on individuals, families, and healthcare systems. Self-reported health-related quality of life (HRQoL) is extensively used for monitoring the general population's health conditions and measuring the effectiveness of interventions. Therefore, this study investigated HRQoL and associated factors among patients with type 2 DM at a primary healthcare center in Indonesia. Methods: A cross-sectional study was conducted in Klaten District, Central Java, Indonesia, from May 2019 to July 2019. In total, 260 patients with DM registered with National Health Insurance were interviewed. HRQoL was measured with the EuroQol Group's validated Bahasa Indonesia version of the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) with the Indonesian value set. Multivariate regression models were used to identify factors influencing HRQoL. Results: Data from 24 patients were excluded due to incomplete information. Most participants were men (60.6%), were aged above 50 years (91.5%), had less than a senior high school education (75.0%), and were unemployed (85.6%). The most frequent health problems were reported for the pain/discomfort dimension (64.0%) followed by anxiety (28.4%), mobility (17.8%), usual activities (10.6%), and self-care (6.8%). The average EuroQoL 5-Dimension (EQ-5D) index score was 0.86 (95% confidence interval [CI], 0.83 to 0.88). In the multivariate ordinal regression model, a higher education level (coefficient, 0.08; 95% CI, 0.02 to 0.14) was a significant predictor of the EQ-5D-5L utility score. Conclusions: Patients with diabetes had poorer EQ-5D-5L utility values than the general population. DM patients experienced pain/discomfort and anxiety. There was a substantial positive relationship between education level and HRQoL.

• 대한화장품학회지
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• 제42권4호
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• pp.393-401
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• 2016

자외선은 피부 노화를 가속화하여 피부 광노화를 유발하고, 일광 화상, 피부암 등을 유발한다. 자외선 차단제를 사용하더라도 일부 자외선에 의하여 피부 손상은 유발될 수 있기 때문에 자외선에 대한 피부 자체의 방어력을 올려주는 것이 필요하다. 최근, 식물에서 자외선 보호 기능을 하는 것으로 알려진 COP1이 사람의 피부에서도 자외선에 대한 반응들을 조절한다고 새롭게 밝혀졌다. 본 연구에서는, COP1과 그의 결합 단백질 DET1이 사람 피부의 각질형성세포에서 자외선에 대한 시그날 조절 물질인 c-Jun 단백질 양을 조절하는 것을 확인하였다. 자외선에 노출 시 COP1과 DET1 발현이 감소하였고, 그 영향으로 c-Jun 단백질이 증가하였다. 반대로 COP1과 DET1을 발현하는 DNA를 transfection 시켜줄 경우 c-Jun 단백질 양이 감소하였다. 피부 각질형성 세포에서 COP1과 DET1의 발현을 조절할 수 있는 물질을 탐색한 결과, 초피나무 열매 추출물이 COP1과 DET1의 발현을 증가시켜 주었다. 초피나무 열매 추출물은 c-Jun 시그날에 의해서도 조절되는 MMP1이 자외선에 의해 유도되는 것을 억제하였다. 뿐만 아니라, 초피나무 열매 추출물 PPAR-${\alpha}$ 활성이 있어 장벽강화를 통한 피부 보호 효과가 있는데, 자외선에 의하여 염증 유발 물질인 IL-6와 IL-8의 발현이 증가하는 것도 억제하였다. 사람의 팔에 자외선을 쪼여 준 경우에도 초피나무 열매 추출물이 홍반이 생기는 것을 억제하고 홍반에 의한 색소침착도 억제하였다. 종합적으로, 초피나무 열매 추출물은 다양한 메카니즘을 통하여 자외선으로부터 피부를 보호해 줄 것으로 기대된다.

• 동남아시아연구
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• 제28권1호
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• pp.173-218
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• 2018

본 연구는 지속가능개발목표(Sustainable Development Goals) 하에 보편적 건강보장(Universal Health Coverage) 달성을 목표로 전 국민의 건강보험 가입을 추진하고 있는 베트남의 보건의료 부문에 주목하여 보건의료 체계와 건강보험법의 개혁 과정에서 나타난 특징을 역사 문화적 맥락을 통해 파악해보고 개발의 관점에서 그 함의를 살펴보고자 한다. UHC의 세 가지 차원, 즉 인구 집단에 대한 보장성 확대, 다양한 의료서비스 제공, 그리고 재정적 보호를 기준으로 베트남 보건의료 부문의 현황을 요약하면 다음과 같이 정리할 수 있다. 첫째, 2015년 발효된 개정 건강보험법에서 가구 단위의 의무 가입과 그에 따른 건강보험료 정산 방식이 새로운 제도로 시행되고 있다는 점이다. 둘째, 1차 의료시설, 즉 사($X{\tilde{a}}$, Commune)급 단위의 보건소를 중심으로 예방 및 건강관리 서비스를 제공할 수 있는 의료 네트워크가 구축되어 있다는 점이다. 셋째, 의료보험법 및 다양한 제도 시행 이후 공공 지출이 증가하고 민간 지출이 감소하고 있지만 여전히 본인부담 의료비 지출(Out-of-Pocket Expenditure)이 많은 비중을 차지하고 있다는 점이다. 베트남의 사회건강보험 개혁은 현재 과도기이다. 따라서 베트남은 보건의료 체계와 건강보험 제도를 어떻게 구축해 나갈 것인가에 대한 문제가 더욱 중요할 수밖에 없는 시기적 상황에 당면해 있다. 제도와 체계에 대한 개발은 효율성보다는 그것을 고스란히 감당해내야 하는 주체, 즉 해당 사회의 구성원들에게 적절하고 정당한 방식으로 설계되어야 한다. 본 연구는 제도와 문화, 즉 제도를 공유하는 사회적 가치, 가족 문화 그리고 비공식적인 제도 등과의 상호작용 등으로부터 그 함의를 이끌어내고자 하였다.

• 의료법학
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• 제24권4호
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• pp.131-160
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• 2023

상시적 대면진료를 허용하는 것을 내용으로 하는 의료법 개정안이 제21대 국회에서 5건이 발의되었으나 각 개정안마다 중점적으로 다루는 내용에 차이가 있고, 비대면진료에 대한 의료계의 반대 입장, 정치적 상황 등이 맞물려 현재 '계속 심사' 안건으로 계류되어 있는 상태이다. 그러나 비대면진료의 안전성 확보의 첫 단계로서 의료법 개정이 반드시 필요하다는 공감대를 형성하였고, 비대면진료에 대한 정부의 추진 의지가 강한 상황이므로 머지않아 의료법은 개정될 가능성이 높다. 다만, 비대면진료 도입은 환자의 안전성 확보를 최우선으로 하는 방향으로 제도화, 입법 되어야 한다는 관점에서, 비대면진료의 대상 환자는 재진 환자 중심, 대상 질환은 만성질환 중심, 시행기관은 의원급 의료기관 중심, 비대면진료 수단은 최소한 화상시스템으로 제한, 의료인의 법적 책임은 의료인의 통제 범위 밖의 요인에 의한 사고에 대해서는 책임면제, 대면진료 요구권 마련 등의 방향성을 제안하였다. 최소한의 안전성을 확보할 수 있는 기준을 우선 입법하고, 향후 연구와 평가 등을 통해 비대면진료의 범위를 확대하는 것과 같이 단계적으로 접근하는 것이 바람직하다.

• Journal of Periodontal and Implant Science
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• 제43권1호
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• pp.30-36
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• 2013

Purpose: Implant stability at the time of surgery is crucial for the long-term success of dental implants. Primary stability is considered of paramount importance to achieve osseointegration. The purpose of the present study was to investigate the correlation between the insertion torque and primary stability of dental implants using artificial bone blocks with different bone densities and compositions to mimic different circumstances that are encountered in routine daily clinical settings. Methods: In order to validate the objectives, various sized holes were made in bone blocks with different bone densities (#10, #20, #30, #40, and #50) using a surgical drill and insertion torque together with implant stability quotient (ISQ) values that were measured using the Osstell Mentor. The experimental groups under evaluation were subdivided into 5 subgroups according to the circumstances. Results: In group 1, the mean insertion torque and ISQ values increased as the density of the bone blocks increased. For group 2, the mean insertion torque values decreased as the final drill size expanded, but this was not the case for the ISQ values. The mean insertion torque values in group 3 increased with the thickness of the cortical bone, and the same was true for the ISQ values. For group 4, the mean insertion torque values increased as the cancellous bone density increased, but the correlation with the ISQ values was weak. Finally, in group 5, the mean insertion torque decreased as the final drill size increased, but the correlation with the ISQ value was weak. Conclusions: Within the limitations of the study, it was concluded that primary stability does not simply depend on the insertion torque, but also on the bone quality.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권5호
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• pp.464-471
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• 2020

Purpose: Some probiotic strains reduce the duration of acute diarrhea. Because of strain and product specificity, each product needs to be supported by clinical data. This study aimed to test the efficacy of the synbiotic food supplement Probiotical (Streptococcus thermophilus, Lactobacillus rhamnosus, Lactobacillus acidophilus, Bifidobacterium lactis, Bifidobacterium infantis, fructo-oligosaccharides) in children with acute gastroenteritis of likely infectious origin. The primary endpoint was the number of children with normal stool consistency during the treatment duration. Methods: A total of 46 children (aged 3.6 months to 12 years) with acute gastroenteritis that started less than 48 hours prior to their visit at a hospital-based emergency department were included in this prospective, randomized, placebo-controlled trial. All children were treated with oral rehydration solution and placebo (n=20) or the test product (n=26). Results: Significantly more children had a normal stool consistency on days 1 and 2 in the probiotic group: 5 children (20%) on day 1 in the probiotic group compared with none in the placebo group (p=0.046). On day 2, 11 children in the probiotic group (46%) and 3 (16%) in the placebo group (p=0.024) had a normal stool consistency. The mean duration of diarrhea was shorter in the probiotic group compared with that in the placebo group (3.04±1.36 vs. 4.20±1.34 days) (p=0.018). Conclusion: The test product was shown to normalize stool consistency significantly more rapidly than the placebo. These data confirm the findings from a previous study in a larger group of children performed in a primary healthcare setting.

• Journal of Korean Neurosurgical Society
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• 제63권6호
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• pp.730-737
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• 2020

Objective : Spinal degeneration is a progressive disease, worsening over time. Lumbar degenerative disease (LDD) is a major spinal disease in elderly patients. Surgical treatment is considered for medically intractable patients with LDD and reoperation after primary surgery is not uncommon. The surgical outcome is occasionally unpredictable because of comorbidities. In the present study, the relationship between comorbidities and the incidence of reoperation for LDD over time was determined. Methods : The claims data of the health insurance national database were used to identify a cohort of patients who underwent spinal surgery for LDD in 2009. The patients were followed up until 2016. Medical comorbidity was assessed according to the Charlson comorbidity index (CCI). Cox proportional hazard regression modeling was used to identify significant differences in sex, surgery, age, causative disease, and comorbidity. Results : The study cohort included 78241 patients; 10328 patients (13.2%) underwent reoperation during the observation period. The reoperation rate was statistically higher (p<0.01) in males, patients 55-74 years and 65-74 years of age, and patients with decompression or discectomy. Significant association was found between increasing reoperation rate and CCI score (p<0.01). Based on multivariate analysis of comorbidities, the significantly higher reoperation rates were observed in patients with peripheral vascular disease, pulmonary lung disease, peptic ulcer, diabetes, and diabetes complications (p<0.01). Conclusion : The study results indicate the reoperation rate for LDD is associated with patient comorbidities. The comorbidities identified in this study could be helpful in future LDD studies.

• 대한간호학회지
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• 제37권2호
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• pp.242-248
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• 2007

Purpose. Parkinson's disease (PD) is a common neurodegenerative disorder characterized by motor disabilities and increasing dependence on others for daily life activities with consequent impact on patients' and caregivers' quality of life. The aim of this study was to elucidate the burden on primary caregivers of patients with PD, and identify related factors. Methods. A cross-sectional descriptive study. Seventy-six primary caregivers of PD patients in a neurology out-patient clinic, Seoul, Korea completed structured questionnaires, of which 68 were analyzed. The structured self-report questionnaire included (1) demographic information on the caregivers, (2) information regarding the disease characteristics of the patients, and (3) the subjective and objective caregiver burdens as assessed on Montgomery, Gonyea, & Hooyman's scale. Results. The mean age of the caregivers was 54.56 years, and spouses represented the largest proportion (47.0%). Caregivers of PD patients experienced high levels of burden (mean scores on the subjective and objective burdens were 45.22 and 34.90, respectively), which were comparable to the caregiver burdens in stroke, and higher than the caregiver burdens in general chronic disease. Older caregivers and spousal caregivers experienced significantly higher burdens (p=.004 and p=.019, respectively). A greater motor disability and higher modified Hoehn and Yahr grade were related to higher caregiver burden (p=.001 and p=.018, respectively). Conclusion. Caring for PD patients is associated with a high level of caregiver burden. Therefore, healthcare professionals should identify the burden of caregivers who look after PD patients and develop comprehensive management strategies both for patients and their caregivers.

• 한국응용약물학회:학술대회논문집
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• 한국응용약물학회 2008년도 Proceedings of the Convention
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• pp.119-142
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• 2008

Zizyphi Spinosi Semen (ZSS) has been widely used for the treatment of anxiety and insomnia in Korea and China. This experiment was performed to know whether sanjoinine A, one of major alkaloid compounds of ZSS has anxiolytic and hypnotic effects through the GABAergic systems. Our results showed that administration of sanjoinine A increased open arm entries and spent time in open arm in the elevated plus-maze and increased head dips in hole board test. Different from traditional anxiolytic, diazepam, sanjoinine A itself did not decrease locomotor activity and strength level in mice. Furthermore, Sanjoinine A (0.5-2.0 mg/kg) prolonged sleeping time and reduced sleeping latency induced by pentobarbital in a dose-dependent manner similar to muscimol, a $GABA_A$ receptor agonist. Sanjoinine A (0.25-1.0 mg/kg) also increased sleeping rate and sleeping time in the combined administration at the sub-hypnotic dose of pentobarbital and showed synergic effects with muscimol in potentiating sleeping onset and enhancing sleeping time induced by pentobarbital. However, sanjoinine A itself did not induce sleeping at the higher dose. In addition, both of sanjoinine A and pentobarbital increased chloride influx in primary cultured cerebellar granule cells. Sanjoinine A decreased the $GABA_A$ receptor ${\alpha}$-subunit expression and increased ${\gamma}$-subunit expression, and had no effects on abundance of ${\beta}$-subunit in primary cultured cerebellar granule cells, showing different expression of subunits from pentobarbital. In conclusion, sanjoinine A shows anxiolytic-like effects and augments pentabarbital-induced sleeping behaviors through the modification of GABAergic systems. [This work was supported by the Korea Research Foundation Grant funded by the Korean Government (MOEHRD) (The Regional Research Universities Program/Center for Healthcare Technology Development)].