• 제목/요약/키워드: care management

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중증 원외폐렴으로 사망한 환자의 임상적 분석 (Clincal Manifestations of Patients Dying of Severe Community Acquired Pneumonia)

  • 최원일;송정호;권오영;허정숙;황재석;한승범;전영준
    • Tuberculosis and Respiratory Diseases
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    • 제41권5호
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    • pp.537-545
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    • 1994
  • 연구배경: 중증 원외폐렴은 1987년 영국흉부학회에서 453명의 원외폐렴환자를 대상으로 전향적조사를 한 이후, 여러 학자들에 의해 조기에 위험군을 찾아내어 치료에 도움을 주려는 노력이 있어 왔다. 외국의 경우 중증 원외폐렴에 관한 많은 보고가 있으나 국내에서는 중증 원외폐렴에 대한 임상양상과 특징이 잘 연구되지 못한 상태이다. 이에 본 관찰에서는 계명대학교 동산병원에 입원하여 중증 원외폐렴으로 중환자실에서 치료중 사망한 환자 10명을 대상으로 임상적 고찰을 하였다. 방법: 1987년 7월 부터 1993년 7월 까지 계명대학교 동산병원에서 면역억제 치료중이거나 폐암으로 인한 이차성 폐렴 그리고 결핵성 폐렴을 제외한 원외폐렴으로 498명이 입원하였다. 중환자실에서 치료를 받은 환자는 77명이었으며 이들중 치료중에 사망한 10예를 대상으로 나이, 성별, 임상소견, 검사실성적, 중환자실 전원이유, 원인균, 항생제치료, 및 입원기간 등을 후향적으로 분석하였다. 결과: 1) 10예중 남자가 7예 여자가 10예로 남자의 발생빈도가 높았고, 연령분포는 20대에서 70대까지의 분포를 보였으나 60대 이상이 7예로 고령에서 가장 많은 분포를 보였으며 평균나이는 56.2세였다. 2) 입원당시 임상양상은 호흡수증가 5예, 저산소혈증 5예, 의식변화 4예, 청색증 4예, 백혈구감소증 4예, 백혈구증가증 4예, 혈청 크레아티닌증가 4예, 저혈압 3예, 저알부민혈증 3예 순으로 관찰되었다. 이학적검사에서 이상소견이 없는 경우가 2예였고 한가지만 이상소견을 가지는 경우가 3예에서 관찰되었다. 검사실성적에서는 모든 환자에서 한가지이상의 이상소견이 관찰되었다. 3) 객담배양 검사에서 E.coli와 Enterobacter species가 각각 한 예씩 검출되었으며, 객담도말검사에서는 그람양성구균만 검출된 경우가 6예, 그람양성구균과 그람음성간균이 함께 검출된 경우가 2예에서 관찰되었다. 4) 중환자실로 전원된 이유로는 저산소혈증 5예, 고탄산혈증 2예, 산혈증 2예, 심장 또는 폐정지 2예, 신부전 2예, 간부전 2예의 순으로 관찰되었다. 5) 사용한 항생제는 aminoglycoside 8예, 1세대 cephalosporin 7예, 3세대 cephalosporin 5예, vancomycin 2예였으며 환자당 평균 2.7종류의 항생제를 사용하였다. 가장 많이 사용한 항생제 조합은 1세대 cephalosporin과 aminoglycoside 였다. 6) 평균 입원일수는 11.2일 이었으며, 7예(70%)에서 5일 이내에 사망하였다. 결론: 대부분의 사망환자는 입원초기에 사망하여 조기 집중치료가 중요할 것으로 생각되며, 고령의 환자는 많은 주의를 요할 것으로 사료된다. 앞으로 조기에 위험군을 확인하기 위한 노력이 필요할 것으로 생각된다.

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여성 골관절염 환자의 일상생활 수행능력 (A Study on Degree of Daily Living Activities among Women with Osteoarthritis)

  • 양경라;이선자
    • 근관절건강학회지
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    • 제5권1호
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    • pp.57-71
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    • 1998
  • This study purports to examine sociodemographic characteristics and those factors associated with osteoarthritis in women experiencing the disease in order to make suggestions for the prevention and management of osteoarthritis in women. The subjects were 143 women who were diagnosed to have osteoarthritis and under follow-up care at an outpatient department of a university-affiliated hospital. The data were collected through personal interviews by using the structured questionnaire between October 6 and October 24, 1997. The degree of daily living activities was measured with 24 items, which were made based upon Katz Index, Barthel Index and Functional Status Index. Each item has 4 response categories : (1) being able to do alone with any difficulty, (2) being able to do alone with some difficulty, (3) being able to do alone with the help of a person or an instrument, (4) not being able to do at all. The data was analyzed with correlation analysis, t-test, ANOVA, and regression analysis. The results are summarized as follows : 1. As for the age of the subjects, 59.4% were between 45 and 64 years, while 28% were 65 years and above. The subjects having religion were 71.7% and 44.1% of the subjects were protestants. The educational level was low : 31.5% graduated from elementary school, while 30.1% had no formal education. Those married subjects were 72%. Fifty nine percent of the subjects evaluated their economic status as middle class. 2. Those people from whom the subjects currently receive some help were spouses in 35.8% of the subjects. Likewise, 50% of the subjects indicated spouse as the people from whom they want to receive help. 3. The score of the ability of daily living activities ranged between 48 and 96, with the mean of 78.94. Those means of physical activity, ADL(activities of daily living) and IADL(instrumental activities of daily living) were 14.89, 13.97 and 50.09, respectively. Except for the items of carrying heavy stuff and of washing clothes in the sitting position the subjects showed independence in more than 90% of the items, where Independence is defined as being able to do alone or with the help of a person or an instrument. 4. The increase in age was a significant predictor of the decrease in the ability of daily living activities. Those graduated from middle school and above showed a significantly higher degree in the ability of daily living activities than those with less educational level. The married women revealed significantly higher scores in physical activity, ADL, and IADL than the unmarried ones. The ability of daily living activities was not significantly related to having religion, economic status and living with family. 5. The average duration of experiencing osteoarthritis was 4 years and 7 months. Regarding the site of the onset, 65% of the subjects indicated knees. The women with osteoarthritis for less than 3 years were 65%. The ability of daily living activities was significantly different by the duration of illness : the longer the duration of illness, the less the ability of activities. The above findings suggest the need for developing those programs for prevention disabilities in performing daily living activities and for managing diseases targeting the women of middle and old age, with low educational level, and with unmarried status. In addition, there should be developed an instrument for measuring the ability of daily living activities which reflects daily lives of Korean women with osteoarthritis in order to examine comprehensive effects of osteoarthritis on women's daily lives in this country.

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여성 골다공증환자의 골다공증에 대한 지식, 건강증진행위 및 삶의 질과의 관계 연구 (A Study of Correlation among the Knowledge of the Disease, Health Promoting Behaviors and the Quality of Life in the Female Patients with Osteoporosis)

  • 이혜영
    • 근관절건강학회지
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    • 제8권1호
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    • pp.65-85
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    • 2001
  • Osteoporosis is the disease that is the most controversial issue with the aging tendency in 1990. It is an important issue in dealing with the health management for women in middle life. This study is designed to determine the relationships among the level of the knowledge of osteoporosis, the health promoting behaviors and the quality of life. The test has conducted a questionnaire survey of women with osteoporosis. This is a study that focused an interrelation of above issues and its purpose is to gain a foundation of a nursing intervention that can help to improve the qualify of life of an osteoporosis patients. The method of collecting data is collecting a questionnaire survey, individual interviews and records and the collected 123 questionnaire surveys are utilized for an data analysis. Questionnaire surveys are conducted in K and S Universities infirmaries and K general hospital in Seoul and C and J general hospital in near Seoul area from Sep. 27th to Nov. 4th, 2000. The instruments of this study were as follows: Yoon's used the revised and supplemented instrument to test the level of the knowledge of osteoporosis and she referred to the substance of Cassells & Knotz. Lee's revised and supplemented the instrument called Health Promoting Life style Profile that were invented by Walker, Sechrist & Pender and she used it to test the health promoting behaviors with the questionnaires added by this researcher. They are not related to the quality of life but relevant to the patients. Ro's tested the quality of life with the instrument that was invented by herself. The results of this study were as follows. 1. The general characteristics of this study subjects showed that the age of the patients was concentrated from 50 to 59. The periods after menopause was mainly from 6 to 10 years. Subjective symptoms that patients usually complain were musculoskelectal symptoms. 2. The results of measuring the level of the knowledge of osteoporosis, the health promoting behaviors and the quality of life were following. The level of the knowledge was the score 19.83 and it was above middle score out of the score 27 as full marks. In the result of the health promoting behaviors test, the score average was 2.58 with 4 point rating scale and it was about middle score. The quality of life test showed that average score was 2.92 with 5 point rating scale and it indicated that the quality was also around middle score. 3. The statistical test in the activities for promoting health according to the general characteristics of the patients showed that only monthly income has statistically significant difference(F-4.761, p=.004). The same test for the qualify of life indicated that the quality of life was higher from 1 to 5 years after menopause but it was not meaningful statistically. 4. In the correlation among the level of knowledge of osteoporosis, the health promoting behaviors and the qualify of life of the patients, showed a relationship between the health promoting behaviors and the qualify of life. The higher the health promoting behaviors, it was also higher the quality of life. But it was statistically significant with significant positive correlation.

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보건소(保健所) 행정(行政)의 기선을 위(爲)한 연구(硏究) (A Study on the Administrative Enhancement for Health Center Activities)

  • 문옥륜
    • Journal of Preventive Medicine and Public Health
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    • 제3권1호
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    • pp.97-110
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    • 1970
  • This survey was conducted to evaluate not only the present status of health center directors-their personal histories, their will to private practice in the future, their responses to governmental policies, -but also the distribution of doctorless myons, budget and subsidy, and director's opinions to the enhancement of health center activities. This survey questioned 116 health center directors and 16 health personnel from August to October of 1970 and obtained the following results; 1) The average ages of directors of kun, city, and total health centers were $43.2{\pm}7.8,\;42.1{\pm}7.7,\;and\;42.9{\pm}10.3$ respectively. 2) The average family sizes of directors of kun, city, and total health centers were $5.6{\pm}2.7,\;5.6{\pm}2.1,\;and\;5.6{\pm}2.6$ respectively. 3) Directors holding M. D. degrees were 79.3%, those holding qualified M. D. degrees ('approved director') were 20.7%. 4) M. P. H., M. S., and Ph. D. holders were 6.0%, 6.1%, and 4.3% respectively. 5) The average duration of present directorship in kun and city were 30.2 months and 20.4 months respectively. 6) The majority of directors had been employed in related fields before assuming current position : directorship at other health center 26.7%, army 22.4%, health subcenter 21.6%, private practice 19.0%. 7) Average length of directorship is 41.8 months. Average length of public health career, including health subcenter and present position, is 56.5 months. 8) Both rural and urban experience in health centers for regular directors is 16.3% and for approved directors, 12,5%. A total of 15.5% of all survey directors had experience in both rural and urban health center. 9) A total of 70.7% of health center directorships were staffed by local doctors. 10) Nearly 40% wanted to quit the directorships within 3 years and 60.3% had already experienced private practice. 11) Of the regular directors 17.4% felt strongly about devoting their lives to public health fields, but only 4.1% of the approved approved directors felt so. 12) There wire 432 doctorless myons among 996 respondent myons and 4.5 doctorless myons per kun. 13) The percentage of doctorless myon by Province are as follows, Cholla buk-do 57.2%, Cholla nam-de 55.0%, Kyungsang nam-do 52.0%, Kyungsang buk-do 49.7%, Chungchong but-do 42.4%, Kyonggi-do 32.9%. Cheju-do 30.8%, Kangwon-do 25.8%. 14) Two thirds of health critters have experienced the abscence of the director for a certain period since 1966 and the average span of the abscence was 18.2 months. 15) The percentage of doctorless myons increased proportionally with the span of the director's abscence. 16) The average budgets of health centers, kun, city and ku, were $W15.03\;million{\pm}W4.5\;million,\;W22.03\;million{\pm}W17.80\;million,\;W13.10\;million{\pm}W7.9\;million$ respectively. 17) Chunju city had the highest health budget per capita(W344) while Pusan Seo ku had the lowest(W19). 18) Director's medical subsidies are W30,000-50,000 in kun, and roughly W20,000 in city. 19) The older of priority in health center activities is T.B. control(31.1%), Family Planning and M. C. H.(28.0%), prevention of acute communicable disease and endemic disease (18.2%) and clinical care of patients(14.3%). 20) Nearly 32% opposed in principle the governmental policy of prohibiting medical doctors from going abroad. 21) Suggestions for immediate enhancing the position of director of health centers and subcenters: (1) Raise the base subsidy (48.2%), (2) Provide more opportunities for promotion (20.7%), (3) Exemption from army services(12.1%), (4) Full scholarship to medical students for this purpose only (7.8%). 22) A newly established medical school was opposed by 56.9% of the directors, however 33.6% of them approved. 23) Pertaining to the division of labor in Medicine and Pharmacy, the largest portion (31.9%) urged the immediate partial division of antibiotics and some addictive drugs to be given only by prescription. 24) More than half wanted a W70,000 level for the director's medical subsidies, white 36.2% stated W50,000. 25) Urgently needed skills in the kun are clinical pathologist (38.6%) and doctor (health center director) (25.5%); while in the city nurse (37.1%), doctors(clinical)(31.4%) and health educators(14.4%) are needed. 26) Essential treatment for the better health center administration; raising the base subsidy (22.7%), obtaining the power of personal management (19.3%) and the establishment of a Board of Health (14.3%). etc.

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PET 이용 현황 및 전망 (Current Status and Future Perspective of PET)

  • 이명철
    • 대한핵의학회지
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    • 제36권1호
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    • pp.1-7
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    • 2002
  • Positron Emission Tomography (PET) is a nuclear medicine imaging modality that consists of systemic administration to a subject of a radiopharmaceutical labeled with a positron-emitting radionuclide. Following administration, its distribution in the organ or structure under study can be assessed as a function of time and space by (1) defecting the annihilation radiation resulting from the interaction of the positrons with matter, and (2) reconstructing the distribution of the radioactivity from a series of that used in computed tomography (CT). The nuclides most generally exhibit chemical properties that render them particularly desirable in physiological studies. The radionuclides most widely used in PET are F-18, C-11, O-15 and N-13. Regarding to the number of the current PET Centers worldwide (based on ICP data), more than 300 PET Centers were in operation in 2000. The use of PET technology grew rapidly compared to that in 1992 and 1996, particularly in the USA, which demonstrates a three-fold rise in PET installations. In 2001, 194 PET Centers were operating in the USA. In 1994, two clinical and research-oriented PET Centers at Seoul National University Hospital and Samsung Medical Center, was established as the first dedicated PET and Cyclotron machines in Korea, followed by two more PET facilities at the Korea Cancer Center Hospital, Ajou Medical Center, Yonsei University Medical Center, National Cancer Center and established their PET Center. Catholic Medical School and Pusan National University Hospital have finalized a plan to install PET machine in 2002, which results in total of nine PET Centers in Korea. Considering annual trends of PET application in four major PET centers in Korea in Asan Medical Center recent six years (from 1995 to 2000), a total of 11,564 patients have been studied every year and the number of PET studies has shown steep growth year upon year. We had 1,020 PET patients in 1995. This number increased to 1,196, 1,756, 2,379, 3,015 and 4,414 in 1996,1997,1998,1999 and 2000, respectively. The application in cardiac disorders is minimal, and among various neuropsychiatric diseases, patients with epilepsy or dementia can benefit from PET studios. Recently, we investigated brain mapping and neuroreceptor works. PET is not a key application for evaluation of the cardiac patients in Korea because of the relatively low incidence of cardiac disease and less costly procedures such as SPECT can now be performed. The changes in the application of PET studios indicate that, initially, brain PET occupied almost 60% in 1995, followed by a gradual decrease in brain application. However, overall PET use in the diagnosis and management of patients with cancer was up to 63% in 2000. The current medicare coverage policy in the USA is very important because reimbursement policy is critical for the promotion of PET. In May 1995, the Health Care Financing Administration (HCFA) began covering the PET perfusion study using Rubidium-82, evaluation of a solitary pulmonary nodule and pathologically proven non-small cell lung cancer. As of July 1999, Medicare's coverage policy expanded to include additional indications: evaluation of recurrent colorectal cancer with a rising CEA level, staging of lymphoma and detection of recurrent or metastatic melanoma. In December of 2001, National Coverage decided to expand Medicare reimbursement for broad use in 6 cancers: lung, colorecctal, lymphoma, melanoma, head and neck, and esophageal cancers; for determining revascularization in heart diseases; and for identifying epilepsy patients. In addition, PET coverage is expected to further expand to diseases affecting women, such as breast, ovarian, uterine and vaginal cancers as well as diseases like prostate cancer and Alzheimer's disease.

고등학생의 치과이용실태와 통증 경험에 따른 치과공포에 대한 연구 (Study of Utilization of Dental High School and according to the Pain Experienced Dental Fear)

  • 전보혜;최영숙
    • 치위생과학회지
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    • 제14권1호
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    • pp.59-66
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    • 2014
  • 본 연구는 청소년들이 느끼는 치과에 대한 공포와 불안감에 대해 알아보고 치과이용 실태와 과거 통증 경험 등이 어떤 영향을 미치는지에 관하여 알아보고자 경기 지역 일부 고등학교 352명을 대상으로 설문조사를 실시하여 다음과 같은 결과를 얻었다. 주사바늘이 살을 찌를 때($3.19{\pm}1.43$)와 마취용 주사바늘을 볼 때의 두려움($3.14{\pm}1.44$)이 높게 나타났고, 치아삭제용 드릴 소리($2.82{\pm}1.38$)와 치아삭제용 드릴을 볼 때의 두려움($2.74{\pm}1.36$), 치과 내원 시 근육 긴장($2.51{\pm}1.34$), 치료 대기 시 두려움($2.45{\pm}1.37$), 치아삭제 시 두려움($2.43{\pm}1.31$) 등의 순으로 나타났다. 치과치료 실태에 따라 치과 공포와 불안 수준에 차이가 있는지를 살펴본 결과, 충치치료를 받기위해 방문한 집단($2.75{\pm}0.94$)이 스켈링을 위해 방문한 집단($1.50{\pm}0.65$)에 비해 치과에 대한 공포와 불안감을 많이 느끼는 것으로 나타났다(p<0.01). 치과 공포와 불안에 영향을 미칠 것으로 예측되는 과거 치과 치료 시 통증 경험 수준은 3.45로 비교적 높게 나타났고, 가족이나 친구의 치과치료에 대한 통증을 들은 경험은 3.26점, 마취 미비 상태에서의 치과치료 경험은 2.47점으로 높지 않은 것으로 나타났다. 과거 치과 이용 시 통증 경험과 치과 공포 불안간의 관련성을 살펴보기 위하여 상관분석을 실시한 분석 결과 치과 치료 시 통증 경험과 마취 미비 상태에서의 치료 경험, 그리고 가족/친구의 치과치료 통증을 들은 경험 등의 변인 모두 치과에 대한 공포와 불안감과 유의미한 정(+)적 상관관계를 보였다. 학생의 성별과 현재의 치아 건강상태, 흡연 여부, 그리고, 치과치료 시 통증 경험, 마취 미비상태에서의 치료 경험, 가족/친구의 치과치료 통증을 들은 경험 등 과거의 치과 통증 경험 등의 변인이 치과 공포와 불안에 영향을 미치는 중요 예측 변인이었다.

종합병원 방사선사의 건강증진행위 관련요인 분석 (Analysis of Influencing Factors Related to Health Promotion Behavior in Hospital Radiological Technologists)

  • 고종경;권덕문;강영한
    • 대한방사선기술학회지:방사선기술과학
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    • 제32권4호
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    • pp.381-391
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    • 2009
  • 연구목적 : 방사선사의 건강증진행위에 영향을 미치는 요인을 분석하여 바람직한 건강관리에 도움을 주고, 향후 방사선사의 건강증진 프로그램 개발을 위한 기초 자료로 활용하고자 한다. 연구방법 : 종합병원에 근무하는 방사선사 총 234명을 대상으로 건강지각과 건강증진행위에 대한 설문조사를 시행하였다. 건강지각에 대한 설문은 현재 건강, 건강관심, 민감성 등 총 20문항이었고, Cronbach's $\alpha$는 0.79였다. 건강증진행위의 설문은 자아실현, 건강책임, 운동, 영양, 대인관계지지, 스트레스 관리 등 총 47문항이었고, Cronbach's $\alpha$값은 0.93이었다. 건강증진행위와 관련이 있는 단변량 분석은 평균비교분석(t-test, ANOVA)을 하였고, 건강지각 요인과 건강증진행위와의 관련성은 상관분석(Pearson's Correlation Coefficient) 을 하였다. 건강증진행위에 영향을 미치는 요인은 단계별 다중회귀분석(Stepwise Multiple Regression)을 시행 하였다. 연구결과 : 일반적 특성 중 건강증진행위와 관련 있는 요인은 연령, 결혼, 연봉, 직급, 경력, 고용, 종교 등이었고, 건강생활습관 관련 특성 중 건강증진행위와 관련이 있는 요인은 흡연유무, 운동여부 등이었다. 대상자의 건강증진행위 수행정도는 평균 2.90점, 표준편차 0.37이었다. 민감성, 건강관심, 현재건강 등으로 구분한 건강지각 요인과 건강증진행위와의 상관관계는 각각 양의 상관관계가 있었다(p<0.01). 건강증진행위에 영향을 미치는 요인으로는 민감성, 현재건강, 운동여부, 흡연유무, 근무경력 등이었고, 건강지각 요인 중 민감성이 가장 영향이 큰 것으로 나타났다. 즉, 건강지각에 대한 민감성, 현재건강 점수가 높을수록 건강증진행위 점수가 높았고, 규칙적으로 운동하는 군, 과거흡연군, 근무경력이 높은 군에서 건강증진행위점수가 높았다. 결 론 : 방사선사가 건강증진행위에 대한 점수를 높이려면 먼저 스스로의 건강에 대해 지각하고, 병에 걸리지 않으려는 노력이 필요하며, 건강한 생활을 추구하여야 한다. 또한 근무 경력과 년차에 관계없이 금연과 규칙적으로 운동을 하는 것이 반드시 필요하다.

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톨루엔에 폭로된 근로자의 뇨중 마뇨산량에 관한 연구 (A Study on the Concentration of Hippuric Acid in Urine of Workers Exposed to Toluene)

  • 박은미;노재훈;문영한
    • Journal of Preventive Medicine and Public Health
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    • 제20권2호
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    • pp.228-235
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    • 1987
  • 유기용제 사업장의 그라비아 인쇄부에 근무하는 근로자 101명과 유기용제에 노출되지 않은 72명을 선택하여 뇨중 마뇨산량과 사업장의 공기중 톨루엔 농도를 측정하여 상관성을 구하였으며 설문조사를 통한 자각증상 호소율을 조사하여 다음과 같은 결론을 얻었다. 1) 작업부서별 공기중 톨루엔 농도는 유기용제를 혼합하면서 인쇄하는 부서에서 평균 $544.13{\pm}7.75ppm$으로 가장 높았으며 유기용제 혼합부서에서 $463.27{\pm}5.24ppm$ 인쇄 (1)부서 에서 $393.56{\pm}45.69ppm$ 인쇄 (2)부서에서 $248.38{\pm}45.16ppm$ 인쇄(3)부서 $159.38{\pm}18.51ppm$이었다. 2) 작업부서별 뇨중 마뇨산량은 유기용제를 혼합하면서 인쇄하는 부서의 근로자에서 평균 $6034.84{\pm}1298.35mg/l$로 가장 높았으며 유기용제 혼합부서의 근로자에서 $4798.44{\pm}784.53mg/l$ 인쇄(1)부서의 근로자에서 $2883.06{\pm}701.90mg/l$ 인쇄(2)부서 의 근로자에서 $1449.98{\pm}905.19mg/l$ 인쇄(3)부서의 근로자에서 $598.52{\pm}299.43mg/l$였다. 3) 작업 장 공기중 톨루엔 농도와 마뇨산량과의 상관계수는 r=0.868(p<0.01)으로 정상관 관계를 나타냈다 (Y=7,18X+349.57) 4) 실험군이 대조군보다 더 많은 자각증상을 호소하였다.

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만성(漫性) 위장장애증상(胃腸障碍症狀)을 가진 농촌주민(農村住民)들의 위내시경(胃內視鏡) 검사소견(檢査所見) (Gastroscopic Findings of Rural Residents with Symptoms of Chronic Gastrointestinal Disorder)

  • 박정한;천병열;이동구;최용환
    • Journal of Preventive Medicine and Public Health
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    • 제19권1호
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    • pp.85-90
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    • 1986
  • 농촌주민들 가운데 만성 상부위장장애증상을 가진 사람들이 어떤 위장질환을 갖고 있는지를 조사하고 그 관리대책을 마련하기 위하여 1984년 7월${\sim}8$월에 성주와 영천군의 전 주민들을 대상으로 최근 6개월이상 상부위장장애증상으로 고통을 받으면서도 의사의 진단을 받아본 적이 없으며 본 조사에 응한 20세이상의 남자 106명, 여자 108명, 합계 214명을 대상으로 위내시경 검사를 시행하였다. 대상자의 16.8%가 위궤양, 15.4%가 십이지장궤양, 14.0%가 위염, 그리고 3.7%가 위암이었으며 내시경 검사상 아무런 병소부위가 발견되지 않았던 경우가 52.3%나 되었다. 위궤양은 남자가 26.4%로 여자의 7.4%보다 많았으며(p<0.01) 십이지장궤양도 남자가 20.8%로 여자의 10.2%보다 많았다(p<0.01). 남자의 7.5%가 위암이었으며 여자들 가운데는 한 명도 없었으며 60대에서 가장 높은 유병율을 보였다. 위장장애증상이 있음에도 내시경검사상 아무런 병소부위가 없는 사람이 남자는 35.9%인데 비해 여자는 68.5%였다. 위장장애증상과 내시경소견 사이에는 특별한 연관성이 없었다. 본 조사에서 위궤양이 십이지장궤양보다 더 많은 것은 농촌지역 주민들의 식생활 및 사회생활관경과 관련이 있는 것으로 생각된다. 위암은 조기발견이 치료에 가장 중요하나 증상이 있어도 진찰을 받지않는 사람이 많은 것은 농촌주민들의 암에 대한 인식부족과 의료기관이용의 어려움등에 기인된 것으로 생각되므로 집단검진과 같은 위암조기발견을 위한 국가적시책이 마련되어야 할 것이다.

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다발성 외상 환자에서 발생되는 급성 호흡 곤란 증후군의 예측 인자로서 혈청 페리틴의 의의 (Significance of Serum Ferritin in Multiple Trauma Patients with Acute Respiratory Distress Syndrome)

  • 지예섭;김낙희;정호근;하동엽;정기훈
    • Journal of Trauma and Injury
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    • 제20권2호
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    • pp.57-64
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    • 2007
  • Purpose: Clinically, acute respiratory distress syndrome (ARDS) occurs within 72 hours after acute exposure of risk factors. Because of its high fatality rate once ARDS progresses, early detection and management are essential to reduce the mortality rate. Accordingly, studies on early changes of ARDS were started, and serum ferritin, as well the as injury severity score (ISS), which has been addressed in previous studies, thought to be an early predictive indicator for ARDSMethods: From March 2003 to March 2005, we investigated 50 trauma patients who were admitted to the intensive care unit in Dongguk University Medical Center, Gyeongju. The patients were characterized according to age, sex, ISS, onset of ARDS, time onset of ARDS, serum ferritin level (posttraumatic $1^{st}\;&\;2^{nd}$ day), amount of transfused blood, and death. Abdominal computed topography was performed as an early diagnostic tool to evaluate the onset of ARDS according to its diagnostic criteria. The serum ferritin was measured by using a $VIDAS^{(R)}$ Ferritin (bioMeriux, Marcy-1' Etoile, France) kit with an enzyme-linked fluorescent assay method. For statistical analysis, Windows SPSS 13.0 and MedCalc were used to confirm the probability of obtaining a predictive measure from the receiver operating characteristics (ROC) curve. Results: The ISS varied from 14 to 66 (mean: 33.8) whereas the onset of ARDS could be predicted with the score above 30 (sensitivity: 90.0%, specificity: 60.0%, p<0.05). On the posttraumatic $1^{st}$ day, the serum ferritin levels were measured to be from 31 mg/dL to 1,200 mg/dL (mean: 456 mg/dL), and the onset of ARDS could be predicted when the value was over 340 mg/dL (sensitivity: 80.0%, specificity: 65.0%, p<0.05). On the posttraumatic $2^{nd}$ day, the serum ferritin levels were measured to be from 73 mg/dL to 1,200 mg/dL (mean: 404 mg/dL), and the onset of ARDS could be predicted when the value was over 627 mg/dL (sensitivity: 60.0%, specificity: 92.5%, p<0.05). The serum ferritin levels and the ISS were significantly higher on the posttraumatic $1^{st}$ and $2^{nd}$ day in the ARDS group, suggesting that they are suitable indices predicting the onset of ARDS, however relationship between the serum ferritin levels and the ISS was not statistically significant. Conclusion: In this study, we discovered increasing serum ferritin levels in multiple- trauma patients on the posttraumatic $1^{st}$ & $2^{nd}$ day and concluded that both the serum ferritin level and the ISS were good predictors of ARDS. Although they do not show statistically significant relationship to each other, they can be used as independent predictive measures for ARDS. Since ARDS causes high mortality, further studies, including the types of surgery and the methods of anesthesia on a large number of patients are essential to predict the chance of ARDS earlier and to reduce the incidence of death.