• Title/Summary/Keyword: age group difference

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The Bone Mineral Density Impact Factors of Adult Women before the Menopause - based on the National Health and Nutrition Examination Survey - (폐경 전 성인여성의 골밀도 영향 요인 - 국민건강영양조사 자료를 이용하여 -)

  • Kim, Kyung-Hee;Lee, Jung-Hee;Yeo, Jin-Dong
    • Journal of the Korean Society of Radiology
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    • v.9 no.3
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    • pp.147-168
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    • 2015
  • In this research, we have analyzed the impact factors on the bone mineral density thru the examination of bone density difference in the entire femur, femoral neck and lumbar of adult women before the menopause in accordance with the general features, lifestyle, eating habits, health and body composition. The survey was conducted among adult women before the menopause and older than 30 years based on the data of the National Health and Nutrition Examination Survey carried out in the 4th term (2008-2009) and 5th term (2010-2011) and we would like to provide the research results for the establishment of recommendations or guidelines for the treatment of adult women before the menopause with regard to the impact factors on the bone mineral density and for the development of health education materials for the accurate measurement of bone mineral density of young women in order to prevent the postmenopausal osteoporosis. With respect to the general features of adult women before the menopause, the bone mineral density was higher in the entire femur at age 40-44, femoral neck at 35-39, in high-school education level, in the earlier menarche group, without smoking experiences, with regular walking time and exercise frequency and with the habits of eating no hamburger or pizza. With regard to the body composition, the bone mineral density was higher in obesity and lower in underweight cases, higher among people with abdominal obesity and weight control experiences. In terms of total body fat ratio, total amount of fat and muscle, the bone mineral density got gradually increased from the 1st quarter (Q1) to the 4th quarter(Q4). The obesity, disease, total amount of fat and muscle were shown to be significantly related with the bone mineral density in this research and it is required for young women to keep the adequate weight and the normal BMI in order to increase the bone mineral density. For the prevention of osteoporosis, it is advised to keep the right habits including regular exercise and no smoking discipline from the growing period and achieve the maximum bone mass thru the control of proper weight from a young age.

A Clinical Analysis of Pneumonia in Acute Drug Intoxication (급성 약물 중독환자에서 발생된 폐렴의 임상양상 및 위험인자에 대한 고찰)

  • Yoon, Hyun Ju;Son, Ji Woong;Choi, Eu Gene
    • Tuberculosis and Respiratory Diseases
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    • v.59 no.4
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    • pp.380-388
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    • 2005
  • Background : Acute drug intoxication has recently become an important issue in the social and clinical areas. There are various complications associated with acute drug intoxication such as pneumonia, but the process is was not fully understood. The aim of this study was to analyze our cases of pneumonia associated with acute drug intoxication and to determine the associated risk factors. Methods : Forty four cases out of 237 patients, who were acute drug intoxicated from May 2000 to Feb. 2005, were diagnosed with pneumonia at the Konyang University hospital. These cases were analyzed by a retrospective review of their medical records. Results : The incidence of pneumonia in acute drug intoxication was 18.6%. There was no gender difference in terms of the incidence, but the age group with the highest incidence was in the $5^{th}$ decade (22.5%) followed by the $7^{th}$ decade (17.9%). Most common drug of associated with pneumonia was organophosphate insecticides, and the others were herbicides. Suicidal attempts were the most common motive of intoxication. The incidence of pneumonia was increased in old age (${\beta}=0.128$, p<0.05). A drowsy or comatous mental status was an independent risk factors of pneumonia (${\beta}=-0.209$, p=0.006). A longer hospital duration was also a risk factor for pneumonia (${\beta}=0.361$, p<0.001). The intubated state, intensive care unit care and longer duration of admission correlated with the course of pneumonia in acute drug intoxicated patients (p<0.05). The culture study revealed MRSA to be most common pathogen. Conclusion : The incidence of pneumonia associated with acute drug intoxication was higher in the older aged patients, those with a decreased initial mental status and a longer hospital duration. The number of days in the intensive care unit and intubation were associated prognostic factors for pneumonia in acute drug intoxication patients.

Blood Pressure of Healthy Newborns in the First Week of Life (분당 차병원에서 출생한 신생아 혈압치 비교)

  • Lee Jung-Sun;Park Shin-I;Park Hye-Won;Kim Se-Hyun;Hah Tae-Sun;Lee Jun-Ho
    • Childhood Kidney Diseases
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    • v.9 no.1
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    • pp.8-14
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    • 2005
  • Purpose : This study was peformed to study normative blood pressure data in full-term neonates that may be used to facilitate Identification of neonatal hypertension.Methods : 383 newborns born in our hospital from May 2003 to January 2004 were enrolled in this study Using an oscillometric device(BP-88 NEXT, COLIN Corp.), their blood pressures were measured more than one time within a week after birth. According to each clinical variable such as sex, delivery mode, birth weight, gestational age and presence of maternal disease or perinatal problems, we divided the population into groups and calculated the mean blood pressures of each group. We compared mean blood pressures between the divided groups according to each clinical variable statistically.Results : Mean systolic and diastolic blood pressure of the Population was 70.8$\pm$ 10.9 mmHg and 43.4 $\pm$ 8.0 mmHg, respectively. There was no satistically significant difference in blood pressure according to clinical variables. Mean systolic pressure showed positive correlation with birth weight and gestational age(r=0.1420, 0.03130).Conclusion : Our results are almost in agreement with Zubrow's data from 695 newborns in U.S.A, 1995. Our data may be helpful for early detection and management of neonatal hypertension, thereby maintaining renal function ,and preventing possible complications of renal disease.

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The Relation between Frailty, Social Support, and Health-related Quality of Life in Old-Old Elderly (후기노인의 허약, 사회적 지지, 건강관련 삶의 질 간의 관계)

  • Lee, Jeong Hwa;Kim, Eun Hwi;Suh, Soon Rim
    • 한국노년학
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    • v.38 no.4
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    • pp.891-903
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    • 2018
  • This study investigated the relation between frailty, social support, and health-related quality of life to provide basic data to improve the health-related quality of life of old-old elderly who are a high risk group for frailty. For this descriptive study, one-on-one interviews with structured questionnaires were conducted for elderly aged 75 years or older at elderly welfare facilities in K county from March 01 to 31 in 2016, and a total of 211 elderly were interviewed. The collected data were analyzed by t-test, Pearson's correlation coefficient, and path analysis using SPSS/WIN and AMOS 18.0 program. For the differences between the age groups, those aged over 80 years had a significantly higher frailty (t=-2.51, p=.013) and a lower health-related quality of life than those aged below 80 years (t=3.29, p=.001); however, there was no significant difference in social support (t=1.28, p=.201). The correlation between frailty, social support and health-related quality of life showed that as frailty became higher, social support (r=-.21, p=.003) and health-related quality of life (r=-.65, p<.001) were significantly lower, and health-related quality of life was significantly higher with a higher social support (r=.18, p=.010). As a result of investigating the mediating effects of frailty between social support and health-related quality of life, social support had a significant direct effect on frailty (${\beta}=-.21$, p=.016) and frailty had a significant direct effect on health-related quality of life (${\beta}=-.06$, p=.004); however, social support had no significant direct effect on health-related quality of life (${\beta}=.00$, p=.562). Social support had a significant indirect effect on health-related quality of life and a mediating effect on frailty (${\beta}=.01$, p=.012); therefore, the full mediation effect of frailty between social support and health-related quality of life was verified. Social support prevents frailty, and improving frailty enhances health-related quality of life. Therefore, it is necessary to develop a multifactorial frailty prevention program that includes age-specific social support strategies to improve the health-related quality of life in old-old elderly.

A Study of Depression in Female Seniors Living Alone: A Comparison Between the Young-old and the Old-old Adults (여성 독거노인의 우울에 관한 연구: 전기와 후기노인의 비교를 중심으로)

  • Jin-Seop Lim;Je-sun Kim
    • Journal of Industrial Convergence
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    • v.22 no.1
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    • pp.149-162
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    • 2024
  • This study is a longitudinal study of female older adults living alone, one of the most vulnerable groups in our society, to determine how their depression changes over time and what factors affect their depression. At the same time, considering that there is a large difference in age among the same older adults, this study divided the female older adults into the young-old and the old-old to see how the predictors of depression in each group differ from each other. The main findings are as follows First, depression among female older adults living alone appears to have a declining pattern over time. In the conditional model, factors affecting the initial level of the depression trajectory among women living alone were found to be associated with lower initial depression values among those living in metropolitan areas rather than non-metropolitan areas, better subjective health, and those who did not exercise. Next, we examined the factors affecting rate of change (slope) in depression among female living alone older adults and found that the higher the age, the larger the metropolitan area, the better the subjective health, the less socializing, and the more socializing, the greater the decrease in depression level. Finally, there were some differences in the pathways affecting the initial value and slope of depression among female older adults living alone between the early and late older adults. Specifically, the higher the initial level of participation in social activities, the greater the change in depression among the late older adults, while there was no significant relationship among the early older adults. In the early older adults, better initial subjective health was associated with a larger change in depression than in the late older adults. Only in the late older adults did those who regularly exercised in the early years have higher initial depression values than those who did not. Based on the results of the above analyses, suggestions were made to reduce depression among female older adults living alone.

Research on the Relation between Musculoskeletal symptoms and Diagnosis using Moire Topography among Workers at an Automobile Manufacturing Plant (자동차회사 근로자를 대상으로 한 근골격계 자각증상과 moire 영상 진단과의 관계 연구)

  • Chun Eun-Joo;Lee Young-Gil;Jahng Doo-Sub;Lee Ki-Nam;Song Yung-Sun
    • Journal of Society of Preventive Korean Medicine
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    • v.5 no.2
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    • pp.69-92
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    • 2001
  • The purposes of this study were to offer foundation making more certain standards of musculoskeletal disorder diagnosis, We researched musculoskeletal symptoms degrees, frequencies, and cares and then examined relation between musculoskeletal symptoms and diagnosis of musculoskeletal conditions using moire topography among workers at an automobile manufacturing plant. Therefore we propose the possibility of moire topography as diagnosing utilities of musculoskeletal disorders. Methods: This study was to examine the general characteristics, complaints of musculoskeletal symptoms, and work-related musculoskeletal disorder rates of cervicobrachial and lumbar area by survey among 435 workers at an automobile manufacturing plant and then to show each frequency and percentage, In the diagnosis using moire topography, we studied pain control necessity of cervicobrachial and lumbar area, 435 subjects were classified by 5 levels: A(no symptoms), B(need management), C(need treatment) and then more divided by B1(light symptoms)/B2(heavy symptoms), C1(light symptoms)/C2(heavy symptoms), And musculoskeletal areas were divided by 2 parts, cervicobrachial area(neck, shoulder, arm&elbow, and wrist&hand) and lumbar area, Then, frequency and percentage of each musculoskeletal areas(cervicobrachial and lumbar area) were appeared. At last, Pearson's chi-square test analysis was utilized to observe the relation between diagnosis using moire topography and general characteristics and the relation between diagnosis using moire topography and work-related complaint of musculoskeletal symptoms of cervicobrachial and lumbar area, Results: The subjects employed for this research were categorized into; by gender, all of them were males(l00%): by age, under 35 years 12 %, 36-40 years 56.3%, 41-45 years 26.3 %, and above 46 years 5.3% with 36-40 years accounting for most of it. By living location, owned houses represented 69.7%, rented houses 23.4%, monthly-rented 1.6%, the others 5.3%; by education, middle school and lower represented 3.0%, high school 89.4%, and junior college and higher 7.6% with high school occupying most of the group. By marital status, married represented 95.2%, unmarried 4.1%, and the others 0.7% with most of them married; by alcohol, drinking represented 81.8% and non-drinking 18.2%; by smoking status, smoking represented 53.6%, non-smoking 46.4% with no big difference between them. By working time(hours/week), below 50 represented 26.9%, 50-60 67.6%, above 60 5.5%; by working time(hours/day), below 9 represented 21.6%, 10-12 73.1%, above 13 5.3%; by job tenure(years), below 10 represented 25.1%, 11-15 54.3%, 16-20 15.2%, above 21 5.5%. By personal income per year, below 30 million won represented 11.0%, 30-40 84.8%, above 40 4.1%; by sleeping hours, below 6 hours represented 26.7%, 7-8 hours 69.9%, above 9 hours 3.4%. Complaint rates of musculoskeletal symptoms and work-related musculoskeletal disorder rates were 63.9% and 54.9% with shoulder area occupying most of both them. By pain degree of musculoskeletal symptoms, shoulder area represented $2.73{\pm}0.84$, lumbar area $2.66{\pm}0.86$, wrist and hand area $2.59{\pm}0.86$, neck area $2.55{\pm}0.74$, and arm and elbow area $2.48{\pm}0.71$. By cares about musculoskeletal symptoms, taking medication or care represented 34.4%-46.7%, absence or leave 15.4%-28.7%, and job transfer 6.3%-11.5%. So experienced cases more than one thing among cares about musculoskeletal symptoms represented 39.6%-54%. In the diagnosis using moire topography, pain control necessity of cervicobrachial area was shown below; A(no symptoms) 20.7%, B1(need management/light symptoms) 64.6%, B2(need management/heavy symptoms) 11.5%, C1(need treatment/light symptoms) 3.0%, C2(need treatment/heavy symptoms) 0.2%. By lumbar area, A(no symptoms) 8.7%, B1(need management/light symptoms) 52.2%, B2(need management/heavy symptoms) 30.3%, C1(need treatment/light symptoms) 8.7%, C2(need treatment/heavy symptoms) was none. In the relation between pain control necessity and general characteristics, age(P=0.013), education(P=0.000), and job tenure(P=0.012) with pain control necessity showed differences with significance. The relation between pain control necessity and complaint of musculoskeletal symptoms of cervicobrachial and lumbar area showed no difference with significance; in cervicobrachial area represented P=0.708, lumbar area P=0.318 Conclusions: This study for musculoskeletal symptoms on workers at automobile manufacturing plant showed that complaint rates of musculoskeletal symptoms for cervicobrachial and lumbar area were so high, 63.9%. But Pearson's chi-square test analysis was utilized to study the relation between musculoskeletal symptoms and the diagnosis using moire topography, showed no differences with significance. They have no differences with significance, but the prevalence rates of diagnosis using moire topography for cervicobrachial and lumbar area were more higher than complaint rates of musculoskeletal symptoms; complaint rates of musculoskeletal symptoms were 52.4%, 34.5% and the diagnosis using moire topography were 79.3%, 91.3% for cervicobrachial and lumbar area. The results of this study indicate that the diagnosis using moire topography can find weak musculoskeletal disorders that an individual can not feel, not be judged work-related musculoskeletal disease. Therefore, this study has an important meaning that diagnosis using moire topography can predict and control own physical condition complete musculoskeletal disorders beforehand, since oriental medicine theory considers that prevention is important.

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The Usefulness of Noninvasive Positive Pressure Ventilation in Patients With Acute Respiratory Failure after Extubation (기관내 관 제거 후 발생한 급성 호흡부전에서 비침습적 양압 환기법의 유용성)

  • Na, Joo-Ock;Lim, Chae-Man;Shim, Tae-Sun;Park, Joo-Hun;Lee, Ki-Man;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Koh, Youn-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.3
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    • pp.350-362
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    • 1999
  • Background: Acute Respiratory failure which is developed after extubation in the weaning process from mechanical ventilation is an important cause of weaning failure. Once it was developed, endotracheal reintubation has been done for respiratory support. Noninvasive Positive Pressure Ventilation (NIPPV) has been used in the management of acute or chronic respiratory failure, as an alternative to endotracheal intubation, using via nasal or facial mask. In this study, we evaluated the usefulness of NIPPV as an alternative method of reintubation in patients who developed acute respiratory failure after extubation. Method: We retrospectively analyzed thirty one patients(eighteen males and thirteen females, mean ages $63\pm13.2$ years) who were developed acute respiratory failure within forty eight hours after extubation, or were extubated unintentionally at medical intensive care unit(MICU) of Asan Medical Center. NIPPV was applied to the patients. Ventilatory mode of NIPPV, level of ventilatory support and inspiratory oxygen concentration were adjusted according to the patient condition and results of blood gas analysis by the attending doctors at MICU. NIPPV was completely weaned when the patients maintained stable clinical condition under 8 $cmH_2O$ of pressure support level. Weaning success was defined as maintenance of stable spontaneous breathing more than forty eight hours after discontinuation of NIPPV. Respiratory rate, heart rate, arterial blood gas analysis, level of pressure support, and level of PEEP were monitored just before extubation, at thirty minutes, six hours, twenty four hours after initiation of NIPPV. They were also measured at just before weaning from NIPPV in success group, and just before reintubation in failure group. Results: NIPPV was successfully applied to thirty-one patients of thirty-two trials and one patient could not tolerated NIPPV longer than thirty minutes. Endotracheal reintubation was successfully obviated in fourteen patients (45%) among them. There was no difference in age, sex, APACHE III score on admission at MICU, duration of intubation, interval from extubation to initiation of NIPPV, baseline heart rate, respiratory rate, arterial blood gas, and $PaO_2/FiO_2$ between the success and the failure group. Heart rate and respiration rate were significantly decreased with increase $SaO_2$ after thirty minutes of NIPPV in both groups(p<0.05). However, in the patients of failure group, heart rate and respiratory rate were increased again with decrease in $SaO_2$ leading to endotracheal reintubation. The success rate of NIPPV treatment was significantly higher in the patients with COPD compared to other diseases(62% vs 39%) (p=0.007). The causes of failure were deterioration of arterial blood gas without aggravation of underlying disease(n=9), aggravation of undelying disease(n=5), mask intolerance(n=2), and retained airway secretion(n=l). Conclusion: NIPPV would be a useful therapeutic alternative which can avoid reintubation in patient who developed acute respiratory failure after extubation.

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The Relationship between Perceived Stress and Coping Strategies in Patients with Chronic Low Back Pain (만성요통 환자들에서 스트레스지각과 대응전략 간의 관계)

  • Shin, Yoon-Sik;Koh, Kyung-Bong
    • Korean Journal of Psychosomatic Medicine
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    • v.10 no.1
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    • pp.18-26
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    • 2002
  • Objectives : The object of this study was to investigate the relationship between coping strategies and perceived stress or pain discomfort in patients with chronic low back pain. 80 patients with chronic low back pain and 100 normal controls participated in this study. Methods: Global assessment of recent stress (GARS) scale and Stress Response Inventory (SRI) were used to measure perception for stressors and stress responses. Coping scale and pain discomfort scale were used to measure coping strategies and pain perception. Results : Scores of perceived stress related to work or job, interpersonal relationship, changes in relationship, sickness or illness and the total scores on the GARS scale were significantly higher in those with chronic low back pain than normal controls. Scores of the SRI fatigue subscale scored significantly higher in those with chronic low back pain than normal controls. No significant difference was found on total scores of the pain discomfort scale between those with chronic low back pain and normal controls. The patients with chronic low back pain scored significantly higher on planful problem solving and positive reappraisal than normal controls. In the patient group, pain perception had significant positive correlations with total scores of the SRI and scores of stress perception related to illness or injury. The extent of escape-avoidance showed significant negative correlations with age, whereas the extent of distancing or escape-avoidance had significant negative correlations with the level of education. Significant difference was also found in accepting responsibilities between male subjects and females. However, no significant correlations were found between coping strategies and perceived stressors, stress responses or pain perception. Conclusion : The results suggest that patients with chronic low back pain were more likely to use more active coping strategies than normal controls, though the former had more perception for stressors than the latter. It was also found that coping strategies used by the patients were associated with sociodemographic factors, but that they were not associated with perceived stressors, stress responses or pain perception.

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Semi-Longitudinal Study on Growth Development of Children Aged 6 to 16 (한국인 정상아동 6세~16세의 악안면 성장에 관한 준종단적 연구)

  • Jeong, Mi;Hwang, Chung-Ju
    • The korean journal of orthodontics
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    • v.29 no.1 s.72
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    • pp.51-72
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    • 1999
  • In orthodontic field, it is very important to understand the normal growth. Such an understanding can be derived from observation of normal growth in various samples from childhood to adulthood, and this builds a foundation from which growth abnormality or variation can be defined. Thus, a broad data collection of normal children, as well as basic study reviewing such data become necessary. The relationship between the mean values of cephalometric measurements in Growth and Development was studied among the groups(boys and girls) of Korean chidren from the ages 6-years to 16-years. 220 boys 170 girls were chosen as subjects : Cephalometric X-ray were taken for 3 years and hard tissue analysis on McNamara and Ricketts Analysis which was divided into measurements of 5 parts(Cranial base, Cranial base and Maxilla & Mandible, Maxilla and Mandible, Mandible, Dental measurements). The relationship of craniofacial growth was studied. The following conclusions were obtained: 1. There were statistically significant differences in anterior cranial base between the two sexes of 14 and 15-year grouips. 2. In comparison of growth amounts among different age groups, statistically singnificant difference in Posterior facial height exhisted among $10\~11,\;12\~13\;and\;14\~15$ year-old interval groups. This pattern increased with aging. 3. Na perpendicular to A showed earlier growth peak in females(11-12years) than males(12-13years). When horizontal measurements of point A and Pogonion are compared, mandibular growth appeared to be greater. 4. Maximum growth peak of cranial base and mandible was earlier in females (11-12years) than males(13-14 years). 5. Upper central incisor flared out with aging, and there were increases in lower incisor to A-Pg, and lower incisor inclination There was significant difference between the two sexes in 10-year-old group.

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A Study on the Decisive Factors in Personal Health Maintenance Practice of Housewives Living in Younhi Area Apartments (연희지역 아파트주부의 건강관리실천의 결정요인분석에 관한 조사연구)

  • 김인숙
    • Journal of Korean Academy of Nursing
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    • v.8 no.2
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    • pp.89-102
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    • 1978
  • Owing to the development of modern science, prolonging man's life, the sudden increase of population and betterment of the standard of living has increased health needs. In order to fulfill these health needs, more active plans for developing health should be made. Health education is one of the methods at hand that can improve the health behavior of the community and the individual through the contact of individuals with their groups. Proper understanding of the characteristics of the sampled group and participation of individuals within the community for the development of their health plan are needed for efficient health education. This study was attempted for the purpose of presenting some data helpful for pre-paring the fundamentals of a health education plan that can improve personal health maintenance practice of a community through efficient health education by investigating the relationship between the response of subjects to personal health maintenance practice and selected decisive factors in personal health maintenance practice. The subjects for this study were a systematic sample of 120 housewives selected from 600 housewives from B Zone Apt. Younhi-3-Dong in Seoul. Data was collected for 4 days from May 16th to May 19th, 1578 through personal interviews with questionnaires by well trained interviewers. Percentage, t-test and stepwise multiple regression analysis by use of EDPS were employed for statistical analysis. Results of this study can be summarized : 1. General characteristics of subjects Subjects over 20 and below 40 years of age formed 62.5% of the toed and the rest were subjects of 40 years and upward. 76.7% of the subjects have less than 4 children. 51.3% of the subjects had completed at least the senior high school course. 2. The response of subjects to personal health maintenance practice. Ratios of personal health maintenance practice to the maximum score for each category are as follows; 84.1% in the category of population and family planning, which was the highest ratio; 82.4% in the prevention of accidents; 68.0% in control of communicable disease; 67.8% in personal health care and habits of daily life, 64.3% in mental health and 52.5% in control of parasites, which was the lowest. 3. The response of subjects to selected decisive factors. in personal health maintenance practice. The arithmetic mean of the score for each decisive factor was as follows: the mutual relation between family members marked 18.33, which is under 73,3% of the maximum score; the degree of interest in health marked 34.48, 70.0% of the maximum score: the degree of utilization and demand for health care facilities marked 25.79 or 64.5% of the maximum score and health maintenance of the family marked 11.58, 43.6% of the maximum score. 4. The relationship between personal health maintenance practice and general characteristics of subjects. 1) There was a significant difference in the numbers of children. (t = 1.83, d.f. =117, p< 0.1) 2) There was a significant difference in the contact rates with mass-media, (t = 5.02, d.f. = 118, p< 0,05) 5. The multiple correlation between personal health maintenance practice and their selected decisive factors. 1) The factor“the degree of interest in health”could account for personal health maintenance practice in 43.6% of the sample. (R = 0.6602, R²= 0,4359, F = 91.1678, p< 0.001) 2) When the factor,“health maintenance of family”is added to this, it accounts for 51.2% of personal health maintenance practice. (R = 0.7158, R²= 0.5124, F = 61.4653, p< 0.001) 3) When the factor,“mutual relations between family members”is also included, it accounts for 53.7% of personal health maintenance practice. (R = 0.7324, R²= 0.5365, F = 44.7509, p< 0.001) 4) When the factor, “the degree of utilization and demand for health care facilities”is included, it accounts for 55.1% of personal health maintenance practice. (R = 0.7421, R²= 0.5507, F = 35.2430, p< 0.001).

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