• Title/Summary/Keyword: Risk management factors

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Management of Patients with Rib Fractures: Analysis of the Risk Factors Affecting the Outcome (늑골골절 환자 치료: 결과에 영향을 주는 위험인자 분석)

  • Kim, Han-Yong;Kim, Myoung-Young
    • Journal of Chest Surgery
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    • v.43 no.3
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    • pp.285-291
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    • 2010
  • Background: Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. A rib fracture that is secondary to blunt thoracic trauma is an important indicator of the severity of the trauma. The purpose of study was to determine the morbidity and mortality rates and the management of rib fractures. Material and Method: We performed a retrospective study that involved all the blunt trauma patients with rib fractures, excluding those that were transferred to other hospital within 3 days, that were seen at our hospital between May 2002 and December 2008. Of the 474 admitted patients, 454 met the inclusion criteria. There were 356 male and 98 females, and their overall mean age was 53 years (range: 5~90 years). The outcome parameters included the mechanism of injury, the number of fractured ribs, the length of stay in the ICU, the Injury Severity Score (ISS), the length of the hospital stay, the pulmonary complications and the mortality. Result: The mechanism of trauma included traffic accidents in 189 (41.7%) cases, slipping down in 103 (22.7%) cases, falls in 85 (18.7%) cases, cultivator accidents in 30 (6.6%) cases, industrial accidents in 32 (7.0%) cases and assault in 15 (3.3%) cases. Intrathoracic injury was noted such as hemothorax in 269 (59.3%) cases, pneumothorax in 144 (31.7%) cases, pulmonary contusion in 95 (20.9%) cases, subcutaneous emphysema in 29 (6.4%) cases and great vessel injury in 5 (0.1%) cases. Conservative treatment was administered to most of the patients. Tube thoracostomy was administered in 234 (51.5%) cases, whereas thoracotomy was performed in 18 (4.0%) cases. The mean duration of thoracostomy was $5.2{\pm}6.2$ days. Most of the cases with rib fracture were treated in wards and their mean duration of hospital stay was $22.5{\pm}20$ days. The mean Injury Severity Score (ISS) was $14.8{\pm}10.9$ (range: 3~75). The mortality rate was calculated to be 4.8% (n=22). The main factors correlated with an adverse outcome were the number of ribs fractured, the duration of thoracostomy and pulmonary disease. Industrial insurance affected the length of hospitalization. Pulmonary contusion and the Injury Severity Score (ISS) affected the mortality. Conclusion: Rib fractures are a indicator of severe injury. Because of the complication and associated injuries, we believe these patients should be admitted for evaluation and treatment. Recent studies on the impact of rib fractures after blunt trauma have shown that patients as young as 40 years of age demonstrate increased morbidity and mortality with similar injuries as compared to that of older patients. The ISS and pulmonary contusion influenced the mortality rate. Patients with isolated rib fractures should be hospitalized if the number of fractured ribs is one or more.

The Effect of Antifibrinolytic Therapy in Prevention of Rebleeding before Early Aneurysm Surgery (뇌동맥류의 조기수술 전 재출혈 방지를 위한 항섬유소용해제 투여의 효과)

  • Lee, Chang Young;Yim, Man Bin;Lee, Jang Chull;Son, Eun Ik;Kim, Dong Won;Kim, In Hong
    • Journal of Korean Neurosurgical Society
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    • v.30 no.9
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    • pp.1065-1071
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    • 2001
  • Object : This study was conducted to evaluate whether short-term intravenous infusion of tranexamic acid (AMCA) was able to improve the management outcome by preventing rebleeding without increasing vasospasm and hydrocephalus associated with the long-term administration of this agent in the patients with aneurysmal subarachnoid hemorrhage(SAH) who were planned for the early surgery. Methods : During the period from June, 1996 to May, 1998, 137 patients admitted within 3 days of their SAH and planned for early surgical intervention were subject to study population. Of these, 60 patients who had been treated with AMCA were classified as AMCA treated group and 77 patients without AMCA treatment as AMCA untreated group. Initially, prognostic factors for rebleeding, vasospasm, hydrocephalus and outcome following SAH including age, sex, clinical grade, CT grade, site of ruptured aneurysms, admission day after SAH, surgery day after SAH, number of aneurysms and hypertension history, were analyzed and compared between AMCA treated group and untreated group. Secondly, the incidence of rebleeding, symptomatic vasospasm and hydrocephalus were compared between the two groups. Also, the management outcome of the patients was compared between the two groups. Results : There were no significant differences in prognostic factors between the two groups. The rebleeding rate was 0% in the AMCA treated group whereas the rate was 7.8% in the untreated group. This difference was statistically significant. The incidences of symptomatic vasospasm and hydrocephalus were found not to be significantly different between the two groups. Of the treated group, 31.7% of patients developed hydrocephalus compared to 32.5% of those at the untreated group. Fourteen(23.3%) patients in treated group developed symptomatic vasospasm and 6 of them(10%) suffered stroke whereas incidences of these in untreated group were 25.9% and 11.7%, respectively. The AMCA treated group showed more favorable outcome than that of untreated group. There was no case of death by rebleeding in the AMCA treated group while one of the main causes of death in the untreated group was rebleeding. Conclusion : Short-term high-dose AMCA administration is considered beneficial in improving outcome and diminishing the risk of rebleeding in the patients who suffer from an aneurysmal SAH prior to early surgical intervention.

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Development of evaluation items for adolescents' dietary habits and nutritional practices reflecting eating behaviors and food environment (식행동, 식생활 환경을 반영한 청소년의 식생활·영양 실천 평가 항목 개발)

  • Jimin Lim;Hye Ji Seo;Jieun Oh
    • Journal of Nutrition and Health
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    • v.57 no.1
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    • pp.136-152
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    • 2024
  • Purpose: A comprehensive evaluation item was developed to assess adolescent dietary habits and nutritional practices, considering food intake, eating behaviors, and food culture, such as social support and food environment. Methods: The 59 candidate items of the evaluation checklist were obtained based on the results of the eighth Korea National Health and Nutrition Examination Survey data, Korea Dietary Reference Intakes, dietary guidelines for adolescents, Youth Risk Behavior Survey data, national nutrition policies and dietary guidelines, and literature reviews. Four hundred and three middle and high school students residing in metropolitan areas participated in a survey using the 58-item checklist, which was selected through expert evaluation and content validity ratio analysis. The construct validity of the assessment tool for the quality of adolescent diets was assessed by exploratory factor analyses to determine if the checklist items were organized properly and whether the responses to each item were distributed adequately. Results: The Bartlett sphericity test was significant for each area (p <0.001), and the eigen values were greater than one. The Kaiser-Meyer-Olkin and cumulative proportions by areas were food intake (0.765 and 56.8%, respectively), eating behaviors (0.544 and 64.8%, respectively), and food environment (0.699 and 62.4%, respectively). Twenty-two checklists were determined for the final evaluation items for the adolescents' dietary habits and nutritional practices and were categorized into three distinct factors: food intake (10 items), eating behaviors (4 items), and food environment (8 items). Conclusion: The evaluation items for adolescent dietary habits and nutritional practices is a useful checklist for easily and quickly assessing the dietary qualities and reflecting Korean adolescents and their food environmental factors related to a sustainable diet.

Characteristics of PMS and PMDD in Female College Students (여대생에서의 월경전기증후군 및 월경전불쾌장애의 특성)

  • Lee, Moon-Soo;Yang, Jae-Won;Ko, Young-Hoon;Ko, Seung-Duk;Joe, Sook-Haeng
    • Korean Journal of Psychosomatic Medicine
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    • v.20 no.1
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    • pp.22-31
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    • 2012
  • Objectives : We investigated the prevalence and functional impairment of premenstrual dysphoric disorder (PMDD) and premenstrual syndrome(PMS) in young women. Methods : A total of 1063 female college students were recruited from two urban areas(Seoul and Suwon) of Korea. Questionnaires for sociodemographic data and risk factors of PMDD, attitude about menstruation, and the Premenstrual Symptoms Screening Tool(PSST) were applied. Results : The prevalence of severe moderate to severe PMS and PMDD were 16.9% and 11.7%, respectively. There were differences in the alcohol and coffee consumption, severity of menstrual cramp, and family history of PMS among the moderate to severe PMS, PMDD, and no/mild PMS groups. Although some participants did not fulfill diagnostic criteria for PMDD, they showed significant functional impairment. Participants with negative attitude about menstruation reported premenstrual symptoms more frequently than those with positive or ambivalent attitude about menstruation. Conclusion : These results suggest that PMS and PMDD were prevalent and associated with functional impairment in young females. Some participants reported significant functional impairments although they did not meet the full DSM-IV diagnostic criteria for PMDD. Negative attitude about menstruation was associated with more premenstrual symptoms experiences.

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Public Health Risks: Chemical and Antibiotic Residues - Review -

  • Lee, M.H.;Lee, H.J.;Ryu, P.D.
    • Asian-Australasian Journal of Animal Sciences
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    • v.14 no.3
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    • pp.402-413
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    • 2001
  • Food safety is a term broadly applied to food quality that may adversely affect human health. These include zoonotic diseases and acute and chronic effects of ingesting natural and human-made xenobiotics. There are two major areas of concern over the presence of residues of antibiotics in animal-derived foodstuffs with regard to human health. The first is allergic reactions. Some antibiotics, such as penicillins can evoke allergic reactions even though small amounts of them are ingested or exposed by parenteral routes. The second is development of antibiotic resistance in gut bacteria of human. Recently multi-resistant pneumococcal, glycopeptide-resistant enterococci and gram negative bacteria with extended-spectrum $\beta$-lactamases have spread all over the world, and are now a serious therapeutic problem in human. Although it is evident that drugs are required in the efficient production of meat, milk and eggs, their indiscriminate use should never be substituted for hygienic management of farm. Drug should be used only when they are required. In addition to veterinary drugs, environmental contaminants that were contaminated in feed, water and air can make residues in animal products. Mycotoxins, heavy metals, pesticides, herbicides and other chemicals derived from industries can be harmful both to animal and human health. Most of organic contaminants, such as dioxin, PCBs and DDT, and metals are persistent in environment and biological organisms and can be accumulated in fat and hard tissues. Some of them are suspected to have endocrine disrupting, carcinogenic, teratogenic, immunodepressive and nervous effects. The governmental agencies concerned make efforts to prevent residue problems; approval of drugs including withdrawal times of each preparation of drugs, establishment of tolerances, guidelines regarding drug use and sanitation enforcement of livestock products. National residue program is conducted to audit the status of the chemical residues in foods. Recently HACCP has been introduced to promote food safety from farm to table by reducing hazardous biological, chemical and physical factors. Animal Production Food Safety Program, Quality Assurance Programs, Food Animal Residue Avoidance Databank are para- or non-governmental activities ensuring food safety. This topic will cover classification and usage or sources of chemical residues, their adverse effects, and chemical residue status of some countries. Issues are expanded to residue detection methodologies, toxicological and pharmacokinetic backgrounds of MRL and withdrawal time establishments, and the importance of non-governmental activities with regard to reducing chemical residues in food.

The Age-Related Trend in Blood Pressure and the Prevalence of Hypertension in Korean Adults (한국 성인의 연령에 따른 혈압변화 양상과 고혈압 유병률)

  • Lee, Dae-Taek;Lee, Yong-Soo
    • Journal of Life Science
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    • v.22 no.2
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    • pp.148-155
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    • 2012
  • A cross-sectional analysis of blood pressure (BP) changes and the current prevalence and distribution of hypertension among age groups in Korea were conducted. Systolic (SBP), diastolic (DBP), and pulse (PP) pressures were evaluated. Residents visiting a local Community Health Center for a health check-up and/or participating in the Health Promotion Program were included for the analyses. A total of 6,570 subjects (2,809 men, 3,761 women) were divided into five age groups: 30-39, 40-49, 50-59, 60-69, and $70\leq$ years. Comparisons were made between sex and among age groups. SBP and DBP were continuously elevated, while men showed higher levels than women until their mid-60s; then, the trend was reversed. DBP in men became elevated from their 30s, reaching the highest in the 40s then slowly decreasing. DBP in women increased up to their 40s and 50s, then reached a plateau. PP increased rapidly from the 50s in both sexes. The major contributor of age-related BP elevation may be large artery stiffness in men, particularly from their 50s, while the blood pressure elevation of women may relate to diverse factors including large artery stiffness, stroke volume, and ventricular ejection rate. The rapid elevation of PP after the 50s in both men and women could represent a risk of cardiovascular or coronary mortality, particularly with increasing age. The current data showed a higher rate of hypertension in both sexes compared to previous reports. When those with both high-normal BP and hypertension are looked at in combination, BP management of the target population should be drastically elevated.

Characteristics of Small Business Start-Up and Effect of Preparation of Small Business Start-up on Business Performance -Focusing on Mediating Effect of Self-Efficacy (소상공인 창업자특성과 창업준비과정이 창업성과에 미치는 영향에 관한 연구 : 자기효능감 매개효과를 중심으로)

  • Kang, Young-Uk;Ha, Kyu-Soo
    • Journal of Digital Convergence
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    • v.10 no.9
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    • pp.239-251
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    • 2012
  • This study aims to seek the policies and the plans for the successful small business start-up through an exploratory study about the factors affecting the success rate of small business start-up. To measure the performance of the start-up business(sales revenue, net profit, and outcome expectancy), the characteristics of founders (experience, psychological characteristics) and the preparation of small business start-up were measured as independent variables and the self-efficacy was measured as a parameter. 427 small business owners were targeted and structured self-administered questionnaires were collected from them. For the data process, a multiple regression analysis by SPSS 18.0 was conducted. The findings demonstrated the experience in the same business, the need for achievement, the risk-taking propensity, the preparation period for business start-up had a significant effect on self-efficacy, and experience of failure and the ratio of net worth had a significant effect on sales revenue and net profit, and the locus of control had a significant effect on outcome expectancy through the self-efficacy, a parameter. It was also noted the self-efficacy of small business owners and the business performance varied depending on the characteristics of them and the preparation process of the business start-up. Based on the those findings, the theoretical and practical implications were discussed and the suggestions about the limits of the study, future policies and studies were made.

A Study on the Improvement of Design for Safety(DfS) System (설계안전성검토(DfS) 제도의 개선방안 연구)

  • Lee, Solim;Cho, Sungwoo;Kim, Dongeon;Yu, Jiyoung;Lee, Eunmi
    • Journal of the Korea Institute of Construction Safety
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    • v.2 no.2
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    • pp.70-75
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    • 2019
  • The purpose of this study is to conduct survey on the DfS system for employees who perform construction-related tasks, analyze the results, and present improvement directions. The results of the survey showed that the system was gradually being settled, with about 82% and 93% positive results on the recognition and necessity of the system. In addition, the three highest response rates for the improvement of the system were first, improving the expertise of DfS-related performance personnel, second, improving the awareness of DfS-related actors, and third, reflecting the appropriate costs associated with DfS. For the realization of the above improvements, it was proposed to prepare a curriculum for improving the professionalism of the staff, to implement an incentive system for improvement of perception, and to prepare appropriate payment criteria for preparing reports available during the construction phase. In addition, the Korea Infrastructure Safety and Technology Corporation will need to perform its active role in order to become a system for preemptive management of risk factors for construction accidents from the design stage.

Study on the Methods of Security and Quality Evaluation of smart Healthcare System (스마트 헬스케어 시스템의 보안성 품질평가 방법에 대한 연구)

  • Yang, Hyo-Sik
    • Journal of Digital Convergence
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    • v.15 no.11
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    • pp.251-259
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    • 2017
  • Recently, the smart healthcare industry that grafted the Internet of Things (IoT) onto the healthcare and medical services is being highlighted. Smart healthcare refers to the healthcare and medical services offered on the basis of information communication technologies including application, wearable devices and platforms, etc. The number of next generation smart healthcare devices are increasing in the smart healthcare industry through the combination of information technology (IT) and Bio Technology (BT), which are the most active areas among the 6T, which are the areas of the next generation industry. With the emergence of a diverse range of smart healthcare systems or devices, whether the smart healthcare system can be linked with other systems organically and the security and quality of the system have become important elements of evaluation. In this Study, the characteristics and service types of smart healthcare systems were examined, and the trends in the technology and industry of the smart healthcare system were analyzed. Moreover, this Study aims to develop the evaluation method for security and standards for quality evaluation by deducing the factors for the evaluation of smart healthcare system on the basis of the results of aforementioned examination. It is anticipated that this can induce improvement of quality and development of highly reliable products of a smart healthcare system, and will become the core technology to substitute the technology protection barrier.

Mammography Screening Uptake among Female Health Care Workers in Primary Health Care Centers in Palestine - Motivators and Barriers

  • Nazzal, Zaher;Sholi, Hisham;Sholi, Suha;Sholi, Mohammad;Lahaseh, Rawya
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.5
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    • pp.2549-2554
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    • 2016
  • Background: Early detection remains the cornerstone of breast cancer control in terms of outcome and survival. Thus far the only breast cancer screening method proven effective is mammography. The awareness of female health care workers (HCW) about breast cancer prevention is of vital importance, as their beliefs and behavior may have a major impact on other women. This study was designed to assess mammography screening uptake among female healthcare workers at primary healthcare centers, and to identify the primary motivators and barriers that affect uptake results. Materials and Methods: A cross sectional study design was used to assess mammography screening by 299 female healthcare workers who completed a self-administered questionnaire that assessed demographics, screening uptake, motivators and barriers. Results: The mean age was 46 years (within age of risk). The majority (95.1%) demonstrated adequate knowledge about breast cancer and mammography screening and 50% of the participants reported having at least one mammogram; however only 21% of them had regularly scheduled mammograms. The most frequent reported motivator was the perceived benefit that early detection of breast cancer is important for its management (89.6%), followed by the belief that mammography can detect breast cancer before its symptoms appear (84.4%). On the other hand, the most frequent barrier reported was being busy (46.7%), followed by the lack of perceived susceptibility (41.5%). Conclusions: Mammography screening was found to be sub-optimal in a population of HCW's with 50 % stating that they received a mammogram at least once, and a minority reported regular screening. There is a pressing need for educational programs aimed at removing the barriers that limit compliance with recommendations for mammography screening, and to emphasize the importance of early detection in breast cancer treatment. Ensuring the availability and accessibility of screening services, particularly for healthcare workers within their work settings are other important factors that would improve the acceptance and compliance for mammography screening programs.