• 한국의료질향상학회지
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• 제2권1호
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• pp.68-84
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• 1995

Background: Guideline for practice is useful because it can be the standard for assessment and way to improve quality. We need to take account of expert opinion and consensus as well as scientific evidences to develope practice guideline because it should be practical. Delphi method has been developed to gather opinions from experts fairly. This study was designed to develop practice guideline and apply it to practices as a method to improve quality in primary medical care. Methods: Hypertension(in adults over 18 years old) was selected as a target problem. Self questionnaires about management of hypertensive patients were developed by a researcher with advice of 11 experts. The questionnaires were designed to response as a 5 pont scale. The results of previous questionary were given to respondents in second and third questionnaires. If needed, the questionnaires were changed on the previous responses. The items with medium greater than or equal to 4 point in 1st and 2nd responses were accepted in guideline. The items with medium lesser than or equal to 3 point were questioned again about whether they can be excluded or not. The criteria for assessment was made with reference to guideline and applied to 85 hypertensive patients of 9 family practitioners. At 3 months after practice guideline had been given to family practitioners, performance of same practitioners was assessed with 36 new hypertensive patients. Results: 23 professors in family medicine, 22 family practitioners and 6 cardiologists, responded among 50, 50, 15 respectively. Practice guideline with 33 items was developed as a result of 3 times questionaires. The difference of responses between professors in family medicine, family practitioners and cardiologists was not significant. Performance of practice was improved in diagnosis, history taking about 6 fields, laboratory examination and decision making about time of pharmaceutical prescription. It was not improved in physical examination, life style modification, method of pharmaceutical prescription, choice of initial antihypertensives and history taking about duration of disease and diet habit. It was decreased in history taking about psychosocial factors. The assessment scores were low in history taking, physical examination and life style modification before and after use of practice guideline. Conclusion: Practice guideline for hypertension could be developed by Delphi method. Performance of practice improved partially after use of guideline.

• 한국산학기술학회논문지
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• 제17권6호
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• pp.147-156
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• 2016

본 연구는 대사증후군 환자의 건강관리를 위한 기초자료를 제공하고자 대사증후군 환자의 호전과 그 관련된 요인을 파악하였다. 2013년 1월부터 2014년 12월까지 대학병원 종합검진센터에서 2년 연속 검진 받은 만 20세 이상 성인 중 2013년 검진에서 대사증후군 진단을 받은 280명을 대상으로 하였다. 자료 분석은 SPSS WIN18.0을 이용하여 평균과 표준편차, t-검정, ${\chi}^2$ 검정, 로지스틱 회귀분석을 하였다. 연구결과 호전군의 대사증후군 구성요소는 기준년도(2013년)의 3개에서, 추적년도(2014년)에 2개로 감소된 비율이 60.6%로 가장 높았다. 호전군은 기준년도에 비해 추적년도에 허리둘레, 수축기 혈압, 중성지방의 감소 및 고밀도 지단백 콜레스테롤 증가가 유의한 차이를 보였다. 대사증후군 호전군과 유지군 간에는 음주, 운동, 열량, 지방, 당질 섭취 및 지질저하제 복용에서 유의한 차이를 보였다. 로지스틱 회귀분석에서 대사증후군 호전에는 운동, 열량섭취, 당뇨병 복용 유지가 유의한 영향력을 보였다. 본 연구의 결과 대사증후군 관리를 위해서는 운동증가, 식생활개선을 위한 중재프로그램 제공이 필요하며, 이를 지속적으로 관리하기 위한 보건교육 강화가 요구되었다.

• Journal of Nutrition and Health
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• 제45권4호
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• pp.372-389
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• 2012

The objective of this study is to select a simple and easy measurable food behavior checklist for the development of Nutrition Quotient (NQ) for children, which reflects children's diet quality, as well as to evaluate the validity of the items in the food behavior checklist. The first 36 items in the checklist were established by an expert review, modifying the preliminary 50 items in the checklist, which had been selected by a literature review and the Korean National Health and Nutrition Examination Survey data. 341 children in 5th and 6th grades at an elementary school participated in a one-day dietary record survey, and later responded to 36 food behavior questions of the checklist. Pearson's correlation coefficients between the responses to the food behavior checklist items along with the mean nutrient intakes of the children were calculated. From the result, in which responses of food frequency and food behavior items showed certain association with the dietary record data, a second checklist with 22 items was selected. A survey was conducted by using the second checklist. 1,393 children in the 5th and 6th grades at 12 elementary schools in metropolitan cities, such as Seoul, Busan, Gwangju, Daegu, Daejeon, and Incheon, participated in the survey. Further, an exploratory factor analysis was performed. After the analysis, 19 items (10 items from food frequency and 9 items from food behavior) were finalized as the food behavior checklist items for the NQ. The final 19 food behavior checklist items were composed of 5 factors: 'Balance', 'Diversity', 'Moderation', 'Regularity', and 'Practice'. This study is a significant first trial to establish a comprehensive system for evaluating children's food habit and diet quality. This checklist might need continuous modification and revision reflecting the change of children's dietary life and the social environment.

• Perspectives in Nursing Science
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• 제13권2호
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• pp.88-95
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• 2016

Purpose: Gestational weight gain and prepregnancy body weight are important factors of childbirth outcomes, which further cause obesity, metabolic diseases, or psychological problems later in women's lives. Changes in diet, westernized lifestyle, traditional postpartum care, and childbirth at older age are thought to be threats to proper weight management in Korean women of reproductive age. Public health and antenatal care need to focus on the proper body weight management of women by carefully planning pregnancy to postpartum periods. Purpose: This study explored the body weight changes from pregnancy to postpartum and the related characteristics in women within 12 months after childbirth. Methods: A cross-sectional, retrospective study was conducted with 102 Korean women within 12 months after childbirth. Data were collected using an online survey system, and a structured questionnaire available for electronic self-administration was modified to include demographics, obstetrical history, and body weight at 6 time points. The International Physical Activity Questionnaire and Eating Habit Measurement instruments were also used in data collection. A professional survey agency recruited the participants, and data were automatically saved and then analyzed. Results: The average age of the participants was 33.8 years, 48% were housewives and were well-educated. Seventy-two percent of the participants were primiparas and 82% had breastfed their babies. The body mass index (BMI) ranged from 17.3 to 27.8, indicating that 21.5% of the participants were overweight or obese. The mean gestational weight gain was 11.8 kg, and weight loss was apparent during the first 3 months postpartum. The mean decline in weight was 3.4 kg at one year after childbirth. Women wanted to lose 5.6 kg (range: 3~20 kg), however 44% of them reported that they had not engaged in any weight control efforts. Further, 72% of them reported having engaged in a low level of physical activity. Body weight was not associated with women's characteristics, physical activity score, and diet. Conclusion: Women's awareness of gestational weight gain, lifestyle modification, and the risk of prolonged weight retention should be promoted through the antenatal and women's healthcare systems. As pregnancy and childbirth are critical events that affect women's health, integrative education to ensure healthy transition to life after delivery is required.

• Asian-Australasian Journal of Animal Sciences
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• 제9권1호
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• pp.1-25
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• 1996

The pathogenesis of atherosclerosis can not be summarized as a single process. Lipid infiltration hypothesis and endothelial injury hypothesis have been proposed and investigated. Recent developments show that there are many points of potential interactions between them and that they can actually be regarded as two phases of a single, unifying hypothesis. Among the many risk factors of atherosclerosis, plasma homocysteine and lipoprotein(a) draw a considerable interest because they are independent indicators of atherogenicity. Triglyceride (TG)-rich lipoproteins (chylomicron and VLDL) are not considered to be atherogenic but they are related to the metabolism of HDL cholesterol and indirectly related to coronary heart disease (CHD). LDL can of itself be atherogenic but the oxidative products of this lipoprotein are more detrimental. HDL cholesterol has been considered to be a favorable cholesterol. The so-called 'causalist view' claims that HDL traps excess cholesterol from cellular membranes and transfers it to TG-rich lipoproteins that are subsequently removed by hepatic receptors. In the so-called 'noncausalist view', HDL does not interfere directly with cholesterol deposition in the arterial wall but instead reflects he metabolism of TG-rich lipoproteins and their conversion to atherogenic remnants. Approximately 70-80% of the human population shows an effective feedback control mechanism in cholesterol homeostasis. Type of dietary fat has a significant effect on the lipoprotein cholesterol metabolism and atherosclerosis. Generally, saturated fatty acids elevate and PUFA lower serum cholesterol, whereas MUFA have no specific effect. EPA and DHA inhibit the synthesis of TG, VLDL and LDL, and may have favourable effects on some of the risk factors. Phospholipids, particularly lecithin, have an antiatherosclerotic effect. Essential phospholipids (EPL) may enhance the formation of polyunsaturated cholesteryl ester (CE) which is less sclerotic and more easily dispersed via enhanced hydrolysis of CE in the arterial wall. Also, neutral fecal steroid elimination may be enhanced and cholesterol absorption reduced following EPL treatment. Antioxidants protect lipoproteins from oxidation, and cells from the injury of toxic, oxidized LDL. The rationale for lowering of serum cholesterol is the strong association between elevation of plasma or serum cholesterol and CHD. Cholesterol-lowing, especially LDL cholesterol, to the target level could be achieved using diet and combination of drug therapy. Information on the link between cholesterol and CHD has decreased egg consumption by 16-25%. Some clinical studies have indicated that dietary cholesterol and egg have a significant hypercholesterolemic effect, while others have indicated no effect. These studies differed in the use of purified cholesterol or cholesterol in eggs, in the range of baseline and challenge cholesterol levels, in the quality and quantity of concomitant dietary fat, in the study population demographics and initial serum cholesterol levels, and clinical settings. Cholesterol content of eggs varies to a certain extent depending on the age, breed and diet of hens. However, egg yolk cholesterol level is very resistant to change because of the particular mechanism involved in yolk formation. Egg yolk contains a factor of factors responsible for accelerated cholesterol metabolism and excretion compared with crystalline cholesterol. One of these factors could be egg lecithin. Egg lecithin may not be as effective as soybean lecithin in lowering serum cholesterol level due probably to the differences of fatty acid composition. However, egg lecithin may have positive effects in hypercholesterolemia by increasing serum HDL level and excretion of fecal cholesterol. The association of serum cholesterol with egg consumption has been widely studied. When the basal or control diet contained little or no cholesterol, consumption of 1 or 2 eggs daily increased the concentration of plasma cholesterol, whereas that of the normolipemic persons on a normal diet was not significantly influenced by consuming 2 to 3 eggs daily. At higher levels of egg consumption, the concentration of HDL tends to increase as well as LDL. There exist hyper-and hypo-responders to dietary (egg) cholesterol. Identifying individuals in both categories would be useful from the point of view of nutrition guidelines. Dietary modification of fatty acid composition has been pursued as a viable method of modifying fat composition of eggs and adding value to eggs. In many cases beneficial effects of PUFA enriched eggs have been demonstrated. Generally, consumption of n-3 fatty acids enriched eggs lowered the concentration of plasma TG and total cholesterol compared to the consumption of regular eggs. Due to the highly oxidative nature of PUFA, stability of this fat is essential. The implication of hepatic lipid accumulation which was observed in hens fed on fish oils should be explored. Nutritional manipulations, such as supplementation with iodine, inhibitors of cholesterol biosynthesis, garlic products, amino acids and high fibre ingredients, have met a limited success in lowering egg cholesterol.

• Journal of Chest Surgery
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• 제29권9호
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• pp.1003-1009
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• 1996

식도위장문합술에서 주로 사용되는 원형기계를 사용하는 문합술은 편리하며 누공발생률이 적은 술기이나 문합부의 협착이 잘 생기며 이는 문합기가 작은 경우에 발생빈도가 높다. 경부에서 식도위장문합시 기계문합식으로 편리하게 수술하면서 협착을 방지하는 수술수기로흉강경용 봉합기를 사용하는 방법을 고폰하여서 임상적용한 결과를 보고한다. 식도암 환자 13례에서 식도재건술에 흉강경용 봉합기를 사용하여 경부식도위장 문합을 하였고 수술후 평균 8개월 관찰하여 문합부의 헙착발생을 관찰하였다. 식도암환자 13례중 수술후 사망한 1례를 제외한 12례중 1례에서 술후 위장궤사에 의한 누공이 있었고, 11례에서는 협착증상 없었다. 경부식도위장 문합술에서 흉강경용 봉합기를 사용한 결과 수술이 편리하고 협착 및 누공의 발생률은 매우 낮다. 흉강경용 봉합기 문합술식은수술이 간편하고,작은 내경의 식도와위장문합에서 생기는문합부의 협착을 방지할 수 있는 수술로 경부의식도장관문합의 변형술식으로 적용할 수 있다.

• 한국산학기술학회논문지
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• 제16권12호
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• pp.8437-8446
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• 2015

본 연구는 초등학교 5~6학년 비만아동에게 식이요법, 운동요법 및 행동수정요법을 포함한 비만관리프로그램을 주 1회씩 12회에 걸쳐 시행한 실험군과 줄넘기 운동만을 적용한 대조군을 비교 확인하는 비동등성 대조군 전후시차 설계 연구이다. 효과를 확인하기 위해 혈중지질농도를 측정하였으며, 수집된 자료는 SPSS Windows 18.0 Program을 이용하여 ${\chi}^2$-test, t-test, ANOVA, Pairwise Comparisons으로 분석하였다. 비만관리프로그램은 총콜레스테롤은 대조군(m=40.7)이 실험군(m=16.95)에 비해 더 큰폭으로 증가하였으며(F=4.21, p=.049), 중성지방은 실험군이 $21.55mg/d{\ell}$가 감소하였으나, 대조군은 $37.45mg/d{\ell}$가 증가하였다(F=4.25, p=.049). 본 프로그램을 기초로 수정 보완하여 활용한다면 학교건강증진사업의 일환으로서 실효성을 거둘 수 있을 것으로 기대한다.

• 대한지역사회영양학회지
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• 제8권3호
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• pp.319-326
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• 2003

The purposes of this study were: a) to develop the a quality measurement tool for the contract-managed hospital foodservice, and b) to evaluate their performance with the developed quality measurement tool, and c) to verify the reliability and validity of the quality measurement tool. The developed quality measurement tool comprised two parts, which were foodservice management and medical nutrition care service. The foodservice management part was classified into six functional categories which were Menu, Procurement and Storage, Production and Distribution, Facility and Utility, Sanitation and Safety, and Management and Evaluation. The medical nutrition care service part indicated the medical nutrition care provided. Quality measurement tool had 91 standards and 324 indicators. The quality measurement tools were distributed to the hospital foodservice manager employed by the foodservice company. The 324 indicators were measured by foodservice manager on the 5-Likert-type scales, and then adapted to a 100 point scale. The SPSS Ver. 11.0 was used for statistical analysis. The categories whose scores were evaluated as being high were Procurement', General Sanitation', Personal sanitation' and Waste' and the categories whose scores were evaluated as being low were Diet Order Manual', Standard Recipe', Appropriateness (Facility and Utility)', Check (Facility and Utility)'and Information Management'. All the categories of medical nutrition service were evaluated as having seriously low scores. Therefore, it was necessary for the contract-managed hospital foodservice to improve its performance in the area of medical nutrition care service. For the verification of the developed quality measurement tool, the reliability obtained by calculating Cronbach's α was 0.8747, and the content validity was also proved by scrutiny of the modification of the Professional group's techniques. (Korean J Community Nutrition 8(3) : 319∼326, 2003)

• Asian Pacific Journal of Cancer Prevention
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• 제13권6호
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• pp.2481-2484
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• 2012

Aim: The risk factors mostly strongly associated with gastric cancer are gastric bacteria Helicobacter pylori and diet. Using a case-control study among residents in Jinan, we examined the association between the salt taste and gastric cancer according to H. pylori infection, smoking and histological type as well as tumor site. Methods: This population-based case-control study included 207 cases and 410 controls. Data on potential risk factors of gastric cancer were obtained by interview of cases and controls with a questionnaire, salt taste preference was measured for all subjects, and IgG antibodies to H. pylori were applied to assess infection. Risk measures were determined using unconditional logistic regression. Results: The proportions of salt taste at intervals of 1.8-7.2 g/L and ${\geq}7.2$ g/L were significantly higher in cases than controls, with ORs of 1.56 (1.23-3.64) and 2.03 (2.12-4.11), respectively, subjects with high salt intake having an elevated risk for gastric cancer when infected with H. pylori. Significant modification by smoking and tumor site was observed across the different measures of salt intake, the highest salt taste showed higher cancer risk in ever smokers or with non-cardia cancers. Conclusion: Our study supports the view that high intake of sodium is an important dietary risk factor for gastric cancer, with a synergistic effect found between salt and H.pylori and smoking, dependent on the tumor site.

• Nutrition Research and Practice
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• 제1권4호
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• pp.321-327
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• 2007

The purpose of this study was to assess the relationship between the mother's interest in weight control and its association with the preschooler's obesity and weight related concerns. This was a cross-sectional study based on 470 parents' self-reports. To score interests in weight control, mothers rated each of 6 items on a five-point Likert scale ranging from disagree (1) to agree (5). The perceptions of mothers' weights and their children's weights, mothers' Body Mass Index (BMI), preschoolers' Weight-Length Index (WLI) (%), and weight-related concerns were determined. The mothers' BMI was significantly correlated with interest scores of weight control in mothers (r=0.632, p<0.001) while their children's obesity was weakly correlated with the mothers' interest scores (r=0.133, p=0.025). Mothers with a high interest of weight control reported higher percentages of family history of obesity than mothers with lower interests (63.2% vs. 36.8%, p<0.001). Two-thirds of the mothers (65.4%) were accurate in their perceptions about their weights. Similarly, 63.7% of mothers knew exactly their children's weight-statuses. Compared with mothers with low interest in weight controls, mothers with high interest in weight control had lower correct-perceptions about their weights (p<0.05) but higher correct-perceptions about their children's weights. More than two-thirds of mothers (85%) reported not worrying about their children's obesity in the future. Only 14.3% of the mothers were satisfied with their current weight statuses. Three-fourths of mothers preferred exercise as an effective weight-control method for their children, 20% preferred diet therapy and 5.5% preferred behavior modification. More girls were overweight / obese, than boys (overweight: 16.1% (girl) vs. 12.8% (boy), obese: 5.4% (girl) vs. 4.5% (boy)). About 40% of overweight girls' mothers had low interests in their weight controls with low correct-perceptions in their children's weights, which suggests possible elevated risk of obesity, especially in girls, in the future.