• Sleep Medicine and Psychophysiology
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• v.13 no.2
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• pp.67-74
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• 2006

Introduction: Excessive daytime sleepiness and cataplexy are key features of narcolepsy. Modafinil is psychostimulant used in the treatment of narcolepsy. In this study, we evaluated effects of modafinil on nocturnal sleep structure and sleep latency in multiple sleep latency test and clinical features. Methods: Twelve narcoleptic patients (7 male, age: $22.9{\pm}2.6\;yrs$) were participated in the study. All of them had done nocturnal polysomnography (nPSG), multiple sleep latency test (MSLT), clinical symptoms scales and have repeated same procedure after taking 200 mg of modafinil. We have done linear mixed model analysis to describe effects of group, medication and nap time on these measures. Results: Modafinil did not affect clinical scales except PSQI which had been reduced after medication. In this study, Modafinil reduced total sleep time, sleep efficiency and increased wake after sleep onset and percent of arousal during sleep in nocturnal polysomnography and prolonged mean sleep latency in multiple sleep latency tests in both group. Discussion: Modafinil has stimulant effect of central nervous system but its effect on night sleep is less than other psychostimulants such as methylphenidate. We ascertained that modafinil affected total sleep time, sleep efficiency and percent of wake during sleep but did not effect on sleep structure. Modafinil was effective in the management of day time sleepiness. Modafinil can enhance alertness of control group without day time sleepiness.

• Tuberculosis and Respiratory Diseases
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• v.41 no.6
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• pp.624-631
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• 1994

Background: Genus of Aspergilli are ubiquitous saprophytic molds in nature, but its change from a saprophytic fungus to a pathogenic organism has occurred since the use of various antibiotics. The fungus affects the chronically ill and debilitated population. Recently frequency of the fungal infection is increasing in Korea with abuse of antibiotics and glucocorticoids. Method: We analyzed medical records of 52 patients with pulmonary aspergillosis seen at Hanyang University Hospital from 1980 to 1994. The results were as follows; Results: 1) Ages ranged between second to eighth decades with majority(50%) in the fourth to fifth decades. The male to female ratio was 1.1:1. 2) Hemoptysis and productive cough, the leading symptoms, occurred in 42.3% and 25% respectively. 3) On chest X-ray fingings, the characteristic "fungus ball" pattern were observed in 53.8% of the 52cases. 4) Sputum culture for aspergilli were positive in 21.6% of the cases. We performed fine needle aspiration in 22 patients and the diagnostic yield was 100%. 5) Thirty-six patients had history of treatment with antituberculous drugs under diagnosis of pulmonary tuberculosis for an average of 27.3 months. But sputum analysis for acid-fast bacilli were positive in 5.6%(2cases of 36cases), and postoperative pathologic findings showed that 38.9%(12 cases of 28cases) were combined with tuberculosis. 6) Right upper and left upper lobes were predominantly involved(34.6% and 19.2% respectively) and lobectomies were performed in 21 cases. 7) Underlying diseases were present in 47 cases and 48.9% of them were pulmonary tuberculosis. Conclusion: These results showed that pulmonary aspergillosis usually develops in patients with open cavitary pulmonary tuberculosis. And we must consider the possibility of pulmonary aspergillosis in a patient with hemoptysis and cavitary lung lesion.

• Tuberculosis and Respiratory Diseases
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• v.49 no.5
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• pp.585-593
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• 2000

Background : International consensus guidelines have recently been developed to improve the assessment and management of asthma. One of the major recommendation of these guidelines is that asthma severity should be assessed through the recognition of key symptoms, such as nocturnal waking, medication requirements, and objective measurements of lung function. Differential classification of asthma severity would lead to major differences in both long term pharmacological management and the treatment of severe exacerbation. Methods : This study examined the relationship between the symptom score and measurements of $FEV_1$ and PEF when expressed as a percentage of predicted values in asthmatics (n=107). Results : The correlation of $FEV_1$ % with PEFR% was highly significant (r=0.83, p<0.01). However, there was agreement in terms of the classification of asthma severity in 76.6% of the paired measurements of $FEV_1$ % and PEFR%. Agreement in the classification of asthma severity was also found in 57.1% of the paired analysis of $FEV_1$ % and symptom score. 39% of the patients classified as having moderate asthma on the basis of $FEV_1$ % recording would be considered to have severe asthma if symptom score alone were used. Low baseline $FEV_1$ and high bronchial responsiveness were associated with a low degree of perception of airway obstruction. Conclusion : The relationships between the symptom score, PEFR and $FEV_1$ were generally poor. When assessing asthma severity, age, duration, $PC_{20}$, and baseline $FEV_1$ should be considered.

• Tuberculosis and Respiratory Diseases
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• v.49 no.5
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• pp.614-623
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• 2000

Background : Diffuse alveolar hemorrhage (DAH) is rare but often fatal. To determine the clinical manifestations of DAH, its etiology, clinical course and prognosis were studied. Method : A retrospective analysis was performed in 21 patients that were diagnosed as DAH. Diagnosis of DAH was based on the presence of the "classical triad" of hemoptysis, anemia, and rapidly progressive infiltrates on chest X-ray and a finding of bronchoalveolar lavage or lung biopsy. Results : Thirteen patients (61.9%) had collagen vascular diseases (CVDs) as underlying disease and 10 patients had systemic lupus erythematosus. Females were more prevalent in CVD than in non-collagen vascular disease (NCVD). Otherwise, there were no significant differences between the two groups in terms of clinical manifestations. Dyspnea (95.2%), cough (76.2%), hemoptysis (61.9%), and fever (33.0%) were frequent symptoms. The initial creatinine level was higher in CVD than in NCVD ($3.27{\pm}3.15$ mg/dl vs. $1.19{\pm}0.94$ mg/dl, p=0.030). The corresponding drop in hemoglobin level was $2.69{\pm}1.26$ g/dl. Maximal drop in hemoglobin preceded the progression of infiltrates on the chest radiograph by $1.38{\pm}4.22$ days. The mortality rate was higher in the patients with NCVD than in those with CVD (50.0% vs. 23.1%). Conclusion : The DAH can occur not only in patients with CVD but also in those with NCVD. Higher creatinine level CVD in patients is associated with renal involvement in conjunction with DAH. The maximal drop in hemoglobin preceeding the progression of infiltrates on the chest radiograph suggests that the drop in hemoglobin is important for diagnosing DAH.

• Journal of dental hygiene science
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• v.4 no.3
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• pp.91-95
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• 2004

This study aims to analyze realities of oral health and related factors, and establish Structural Equation Modeling. The subjects of study were 9,340 elderly over age 65 who took the health examination(the first) for the local insured which National Health Insurance Corporation carried out in the survey area mentioned below from January 2002 to December 2002. The areas surveyed were 4 big cities including Seongbuk-ku, Seoul, 5 medium cities including Wonjusi, Gangwon-do, and 5 Counties including Yeong deok County, Kyeongbuk. Considering location and the scale of population, firstly, big unit areas(metropolitan city, province) were selected according to convenience, secondly, low unit areas(city, county, district) were selected randomly. The subjects were the elderly who took all tests including an oral examination and filled in the questionnaire. Major results from analysis are as follows: 1. Review of Composition Conception Validity As a result of analyzing composition conception validity of SEM including posture test, urine test, blood test, habits of eating, drinking and smoking, oral symptoms, and oral health status, using fit index such as GFI, CFI, TLI, and RMSEA, all were within fit range and composition conception validity was recognized. 2. As a result of analyzing SEM to find the relationship between each factor and oral health status, it was confirmed that all factors except urine test affected oral health status and the synthetic SEM to explain it could be established. In result, we could verify that the elderly of rural areas who had lesser experience of visiting a clinic and oral prophylaxis had a higher rate of caries, missing teeth, and denture need, and drinking and smoking negatively affected the rate of caries, periodontal, and missing teeth. Also, periodontal diseases were observed from 43.2% of the total elderly and much from the lower age. Most of oral disease can be prevented by right oral health behavior. Therefore through oral health professionals from each district public health center of the nation, oral health education for the elderly about right eating habits and oral health care should be carried out systematically and policy change to increase access to dental service is required lest that visiting a dental clinic should be impossible or oral health behaviors such as oral prophylaxis and denture wearing should be neglected by economic, geographical barriers. Also, to establish SEM to explain the relationship between oral health status and systemic health, more accurate test methods and effective index development should be preceded. Because items developed by National Health Insurance Corporation applied to this study without alteration, structuring a model had the uppermost limit. Continual study seems to be needed.

• Journal of agricultural medicine and community health
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• v.29 no.2
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• pp.223-235
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• 2004

Objectives: This study was to evaluate the actual condition of falls among community-dwelling elderly people and its related factors to prepare for the establishment of comprehensive prevention programs of senior population. Methods: The study subjects included 460 home residents over 65 years in a district of Chungnam Province and interviews were given to all of them, asking about experiences of falls and their related factors. The analysis of study results came to the following conclusions. Results: The rate of falls among total subjects was 35.5%. With the percentage by age and sex, over 70's and female were significantly higher than male(p=0.000) and under 69 (p=0.008). The groups with poor visual acuity and hearing ability had higher rate of falls than the normal groups based on their health status. In terms of place they experienced falls, out-door occurrence accounted for 53.4% of total falls, which was higher 46.6% of in-door. By season when falls are experienced, "winter" showed the greatest rate, and by time of the day, evening had the highest rate. By causes of falls, "Slippery ground"accounted for 30.5% and "Tumbled over" 23.5% of total falls, respectively, showing the major role of environmental causes for falls. For individual factors, "Irritability" and "Carelessness" occupied 11.3%, 10.8% of total falls, respectively. The Odds Ratios for falls in women was 2.19 times higher than in men, and those in 70's are 2.01 times higher than in 60's, and those with abnormal BMI was 3.68 times higher than in normal groups, and those with perceived symptoms was 1.94 times higher than those without. Conclusions: It is suggested that more consideration should be directed toward taking comprehensive and systematic prevention measures ranging from setting-up the injury-protective environments to allowing senior citizens to have competence in ADL activity as well as proper general health conditions, considering the higher rate of falls for elderly persons in a rural part of this country than that of western countries and the greater proportion of falls which can be ascribed to environmental factors.

• Journal of agricultural medicine and community health
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• v.36 no.4
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• pp.238-250
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• 2011

Objectives: This study was performed to investigate the service needs of the beneficiaries who had enrolled in home-based management programs for cancer patients. Methods: From March to May 2009, 676 cancer patients who were registered in home-based cancer patient management programs were selected as subjects for this study. The data were collected using a questionnaire along with a face-to-face interview performed by officers in charge of the home-based care programs of 47 regional health centers. Fifteen patients were excluded due to incomplete data, leaving 661 subjects who were ultimately enrolled in the study. Results: The mean age of subjects was $64.0{\pm}2.5$ years, and males comprised 45.1% (298/661) of the sample. The results of factor analysis for service needs showed that there were five main categories and Cronbach's alpha ranged from 0.593 to 0.890 for each factor. The service needs categories in order of importance were social support, information and education, psychological problems, physical symptoms and household chores. The service needs scores were significantly different when subjects were stratified by age, habitation, religion and disease classification. When we divided the subjects into complete remission, under treatment and terminally ill groups, the needs scores of the terminally ill patient group were significantly higher than those of the other groups (p<0.001). Conclusions: Service provision based on patient and beneficiary needs could be an effective intervention to reduce the economic burden of cancer management and to improve the quality of life of cancer patients receiving home-based care. Therefore, it is recommended that individual cancer patient care programs be developed and administered according to patient age, habitation and disease severity.

• Sleep Medicine and Psychophysiology
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• v.9 no.2
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• pp.106-114
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• 2002

Objectives: Daytime sleepiness is a common symptom and is associated with sleep behavior, sleep deprivation, and night shift, etc. It is also one of the most important symptoms of sleep disorders like obstructive sleep apnea (OSA). According to our survey on Korean literature, a few studies have dealt with daytime sleepiness, and we have not been able to locate any study comparing normal subjects with polysomnography-proven sleep disorder patients regarding daytime sleepiness. We aimed at comparing daytime sleepiness among normal healthy daytime workers, medical students being expected to have daytime sleepiness due to chronic sleep deprivation, and patients having sleep disorders diagnosed with polysomnography. We also studied the association between subjective daytime sleepiness and objective polysomnographic findings in patients with sleep disorders. Methods: One hundred three hospital workers, 137 medical students, and patients with sleep disorders were studied. Sleep disorders included OSA, periodic limb movements in sleep (PLMS), insomnia, and narcolepsy. The degree of subjective sleepiness in each group was measured by the Korean version of Epworth sleepiness scale and compared. The relationship between polysomnographic findings reflecting severity of sleep disorder in each patient group and subjective sleepiness was analyzed. As for patients with narcolepsy, the relationship between the mean sleep latency and subjective sleepiness was studied. Results: There was a significant difference of ESS score (F=68.190, dF=5.752, p<0.001) among daytime workers, medical students, and sleep disorder patients. In OSA patient group, the degree of the sleepiness had no significant correlation either with mean O2 satuaration (p=0.062) or with RDI (p=0.807). In PLMS patient group, there was no correlation between periodic limb movement index (PLMI) and subjective sleepiness (p=0.761). In narcolepsy patient group, the subjective sleepiness had no correlation with mean sleep latency measured with MSLT (p=0.055). Conclusion: We found a significant difference of subjective sleepiness among daytime workers, medical students, and patients with sleep disorders. However, no consistent correlation was found between severity of subjective sleepiness and objective polysomnographic findings reflecting severity of each sleep disorder. This research confirms that the evaluation of subjective sleepiness is important clinically, but it cannot substitute the objective measures such as nocturnal polysomnography and MSLT.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1234-1244
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• 1997

Background : Nowadays drug resistant tuberculosis is making problems in the treatment of pulmonary tuberculosis and its number is increasing. Several reasons for this are considered including irregular medication, poor drug compliance and wrong regimens. But there are treatment failure cases in spite of regular medication with short-term standard regimens. We reviewed clinical data of 50 patients to find out possible causes of this. Method : Subject of this study was 50 patients who failed in the primary treatment of pulmonary tuberculosis in spite of regular medication with short-term standard regimens. All of them were under treatment with secondary regimens in National Masan Tuberculosis Hospital on Oct 1996. The patient's records were analyzed retrospectively and direct interviews with patients were done. Results : There were relatively more patients in the age of 20th. Male overwhelmed in number. There were smoking in 22 patients and drinking in 24 patients during medication. 17(34%) patients had family history of tuberculosis. Public health center was the most common site for the initial diagnosis among medical institutes. 42 patients had subjective symptoms for pulmonary tuberculosis. 38 patients got sufficient explanation from medical institute about tuberculosis and medication courses. 24 patients had bilateral lesions on chest X-ray film and 43 patients had cavitary lesions. 29 patients had past history for pulmonary tuberculosis with regular medication. The results of drug sensitivity test showed resistance in 41 patients of whom we could get the results. Conclusion : Main cause of treatment failure of pulmonary tuberculosis in spite of regular medication with short-term standard regimens was drug resistance. Several factors were considered to be related to high prevalence of drug resistance, including age of 20th, male, family history for tuberculosis, bilateral lesions or remaining cavitary lesion on chest X-ray film.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.11 no.1
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• pp.251-268
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• 1998

125 Cases of Acne were treated by Acupuncture and Herb-med treatment during a three months duration from April 1996 to February 1998 in Kyung Hee Univ. Department of Ophthal, Otolaryngology. College of Oriental Medicine. We have observed the cases and the results as follows: 1. The age of average was 24.55 age : 21.91 in males, 24.55 in females. and in these, the gulf between males and females were showed statically significant diference. In the age of onset, averag was 16.96 age and mode was 18 age and male's average was 16.96 age, minimun was 11 age, maximum 40 age and female's average was 20.14 age, minimun was 10 age, maximum 40 age. and these were showed statically significant diference between males and females. 2. In the distribution of season, winter was the most with $37.8\%$ of out patients, the rest was similar to difference of each other. but there was clear difference between males and females. 3. In the duration of history, the average was 5.10 years and male's average was 5.13 years. on the other hand female's was 5.09 years but there is no any significant difference have a resemblance with each other. 4. In blood type, O type was the most with $35.20\%$ and there was in the order of A type was $26.40\%\;B\;type\;was\;23.20\%,\;AB\;type\;was\;15.20\%$ but these were not significant difference by the chi-tend and analysis of variance with total cases, males and females. 5. In select of the preference food, patients of the prefer worm food was $42.40\%\;and\;cool\;food\;was\;38.40\%,\;tepid\;food\;was\;24\%$ but these were no significant difference by the chi-test and ANOVA of each other. 6. the state of pulse classified into 11 type and average was 7.2 times, maximum was 29 times with Hyun Sae, at the same time, the female's average was 6.73 times, maximum was 27 times and male's average was 1.5 times. The result of test with each other, these were showed statically significant difference as compared total cases with males but there were not females ones. 7. In the frequency of the major cause, oversensitiveness was the most with $34.93\%$. secondly there was in order of indigestion $30.82\%$ and menstrual irregularity and menstruation pain $23.28\%$. constipation $10.96\%$ and these showed statically significant difference as compared the females with males on the result of test for difference with each other. 8. In frequency of the symptoms, itching was the most with $31.97\%$ and there was in order of nodule $20.49\%$, pustule $18.85\%,\;papule\;15.58\%,\;flare\;13.12\%$ and also these showed statically significant difference as compared the females with males 9. for the Distribution of acne region, face was the most with $64.06\%$ and there was in order of back $14.29\%,\;upper-chest\;11.69\%,\;neck\;7.79\%$ and there was no significant difference as compared total cases with males and females. 10. Acne applied 30 prescription to 4 weeks and over and 20 weeks and over was $23.3\%$, 30 weeks and over was $16.67\%$ and average of administration duration were 4.2 weeks(male's average 5.78, maximum 96 weeks and female's average 3.85, maximum 23 weeks) maximum was 96 weeks, minimum was 1 week. 11. In the acupuncture treatment, $96.6\%$ applied to acupuncture and average was 5.44 times, maximum 46 times, minimum 1 time(male's average 4.64, female's 5.62) but these were not any significant differeence. 12. for the medication, author made a investigation and comparison between control group with treated group in order to observe for the therapeutic effect during the 1 month and 2, 3. From these results, we can see that acne was improved by the oriental treatment. in the 1 month, average of control group was 13.24 and treated group was 11.78. these showed statically significant decrease in P<0.02 as compared the treated group with control group. In the 2 months, average of control group was 13.43 and treated group was 9.03. these showed statically significant decrease in P<0.003 as compared the treated group with control group. In the 3 months, average of control group was 13.78 and treated group was 8.06. these showed statically significant decrease in P<0.008 as compared the treated group with control group.