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Bright Light Therapy in the Morning or at Mid-Day in the Treatment of Non-Seasonal Bipolar Depressive Episodes (LuBi): Study Protocol for a Dose Research Phase I / II Trial

  • Geoffroy, Pierre Alexis;El Abbassi, El Mountacer Billah;Maruani, Julia;Etain, Bruno;Lejoyeux, Michel;Amad, Ali;Courtet, Philippe;Dubertret, Caroline;Gorwood, Philip;Vaiva, Guillaume;Bellivier, Frank;Chevret, Sylvie
    • Psychiatry investigation
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    • 제15권12호
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    • pp.1188-1202
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    • 2018
  • Objective This study protocol aims to determine, using a rigorous approach in patients with bipolar disorder (BD) and non-seasonal major depressive episode (MDE), the characteristics of bright light therapy (BLT) administration (duration, escalation, morning and mid-day exposures) depending on the tolerance (hypomanic symptoms). Methods Patients with BD I or II and treated by a mood stabilizer are eligible. After 1 week of placebo, patients are randomized between either morning or mid-day exposure for 10 weeks of active BLT with glasses using a dose escalation at 7.5, 10, 15, 30 and 45 minutes/day. A further follow-up visit is planned 6 months after inclusion. Patients will be included by cohorts of 3, with at least 3 days of delay between them, and 1 week between cohorts. If none meet a dose limiting toxicity (DLT; i.e hypomanic symptoms), the initiation dose of the next cohort will be increased. If one patient meet a DLT, an additionnal cohort will start at the same dose. If 2 or 3 patients meet a DLT, from the same cohort or from two cohorts at the same dose initiation, the maximum tolerated dose is defined. This dose escalation will also take into account DLTs observed during the intra-subject escalation on previous cohorts, with a "Target Ceiling Dose" defined if 2 DLTs occured at a dose. Discussion Using an innovative and more ergonomic device in the form of glasses, this study aims to better codify the use of BLT in BD to ensure a good initiation and tolerance.

하악 편측 소수 잔존치 환자의 임플란트 보조 국소의치를 이용한 보철치료 증례 (Rehabilitation of mandibular edentulous patients with a few unilateral remaining teeth using implant-assisted removable partial denture: A case report)

  • 이범기;이용상
    • 대한치과보철학회지
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    • 제57권1호
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    • pp.42-48
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    • 2019
  • 하악 편측에 소수의 잔존치만 있는 증례에서 통상적인 국소의치로 수복하는 경우에 충분한 유지 및 저항을 얻기 어렵고, 무치악 치조제의 흡수에 따른 의치의 안정성 저하로 인해 잔존지대치에 유해한 힘이 가해질 것으로 예상된다. 이러한 경우에 다수의 임플란트를 이용한 고정성 보철로 수복하게 되면 여러 가지 장점이 있을 수 있으나, 해부학적, 경제적 요인에 의해 치료 방법으로 선택이 제한될 수 있다. 이에, 적은 수의 임플란트를 전략적 위치에 식립하여 임플란트 보조 국소의치(Implant-assisted removable partial denture, IARPD)의 제작을 대안으로 고려해 볼 수 있다. 본 증례보고에서는 전통적인 가철성 국소의치만으로는 적절한 지지, 유지, 안정이 어려운 두 임상증례에서 소수의 임플란트를 전략적 위치에 식립하고 로케이터(Locator) 부착장치를 적용하여 3년간 경과관찰을 통해 좋은 임상 결과를 확인하였기에 이를 보고하고자 한다.

Occupational Exposure to Metals in Shooting Ranges: A Biomonitoring Study

  • Vandebroek, Eline;Haufroid, Vincent;Smolders, Erik;Hons, Luc;Nemery, Benoit
    • Safety and Health at Work
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    • 제10권1호
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    • pp.87-94
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    • 2019
  • Background: Lead (Pb) exposure in shooting ranges has been reduced by various measures such as jacketed ammunition and lead-free primers. Nevertheless, this may lead to exposure to other metals, potentially resulting in adverse health effects. Methods: In a cross-sectional study, 35 subjects from seven different shooting ranges were studied: four shooting instructors, 10 police officers, 15 Special Forces, and six maintenance staff members. Metals and metalloids were determined in blood and urine by inductively coupled plasma-mass spectrometry. Results: The concentrations of most elements did not differ significantly between groups or compared to reference values, except for Sb and Pt in urine and Pb in blood. Mean values for Sb were considerably higher in urine from the Special Forces ($0.34{\mu}g/L$), the maintenance staff ($0.13{\mu}g/L$), and shooting instructors ($0.32{\mu}g/L$) compared to the police officers before shooting ($0.06{\mu}g/L$) and a Belgian reference value ($0.04{\mu}g/L$). For Pt, the Special Forces showed higher mean urinary concentrations ($0.078{\mu}g/L$) compared to a Belgian reference value (<$0.061{\mu}g/L$). Mean values for blood lead were markedly higher in the Special Forces ($3.9{\mu}g/dL$), maintenance staff ($5.7{\mu}g/dL$), and instructors ($11.7{\mu}g/dL$) compared to police officers ($1.4{\mu}g/dL$). One instructor exceeded the biological exposure index for blood Pb ($38.8{\mu}g/dL$). Conclusion: Since both Pb and Sb were found to be higher in shooting range employees, especially among frequent shooters, it is advisable to provide appropriate protective equipment, education, and medical follow-up for shooting range personnel in addition to careful choice of ammunition.

Transitional care for high-risk elderly patients pre/post discharge by collaboration between general hospital and community pharmacy: a pilot study

  • Park, Mi Seon;Lee, Ji Hee;Lee, Heung Bum;Kim, Ju Sin;Choi, Eun Joo
    • 한국임상약학회지
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    • 제32권1호
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    • pp.27-36
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    • 2022
  • Background: Medication-related problems (MRPs) frequently occur during the discharge period. Elderly patients, particularly, are at high risk for these problems due to polypharmacy and the use of potentially inappropriate medications. The purpose of this study was to build and implement collaboration between general hospital and community pharmacies to address MRPs among high-risk elderly patients before/after discharge. Methods: This retrospective study was conducted between June and December of 2020. The inclusion criteria were patients with aged ≥65 years; residents of Jeonju; discharged from Jeonbuk National University hospital; either on medication of exceeding 10 medications (or high-risk medications) after hospitalization through the emergency room, or having severe illness. Patients received medication reconciliation and counselling by hospital pharmacists before discharge and home-visit pharmaceutical care as follow-up by community pharmacists after discharge. Results: Twenty-two patients agreed to home-visit pharmaceutical services. Fifteen and 11 patients completed the first and second home-visit pharmaceutical care service, respectively. Forty-two MRPs were identified in 15 patients. The types of high-frequency MRPs were incorrect administration of drug, adverse drug reactions, medication non-compliance, drug-drug interactions, lifestyle modifications, and expired medication disposal. After consultation with the pharmacist, 34 out of 42 MRPs were resolved. Conclusions: Transitional care for high-risk elderly patients before and after discharge was successfully built and implemented through a collaboration between general hospital and community pharmacies. This study suggests that home-visit pharmaceutical services may have positive effects on the safe use of drugs during the transition period; however, additional research is needed to expand on these findings.

국가R&D보고서 참고문헌 기술항목 구축 개선방안 연구 (A Study on National R&D Report Reference Technological Improvement)

  • 이강산다정;이혜진;현미환
    • 한국융합학회논문지
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    • 제13권1호
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    • pp.31-42
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    • 2022
  • 본 연구의 목적은 한국과학기술정보연구원(이하 KISTI)에서 구축한 국가R&D보고서 데이터베이스의 참고문헌 데이터를 분석하여, 문제점을 도출하고 시스템 상의 구축 기술항목의 보완점을 찾는 것이다. 이를 위하여 KISTI DB에 등록된 국가R&D보고서의 참고문헌 기술 현황을 조사하고 현재 구축과정 및 지침, 유형, 항목 등의 구분의 작성 내용을 분석하였다. 이를 바탕으로 DB로 구축한 참고문헌 유형의 구분 결과에 대하여 적절성 및 정확성을 확인하였다. 그 결과 시스템으로 구축한 항목의 문제점과 구축 지침의 수정사항을 도출하였다. 이를 통해 데이터베이스 구축이 효율적으로 진행되도록 시스템 변경사항을 도출하여 데이터 품질이 향상될 것으로 기대된다. 또한 기술규정 표준화를 통하여 향후 제공할 수 있는 융합 서비스 방안에 대하여 후속 연구를 제안하였다.

말티즈에서 폭풍공포증 치료를 위한 클로미프라민, 알프라졸람의 투여가 행동 수정에 미치는 임상 1례 (A case of clomipramine and alprazolam on behavioral modification for the treatment of storm phobia in a Maltese)

  • 한세명;조재현;김충희
    • 한국동물위생학회지
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    • 제46권2호
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    • pp.167-173
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    • 2023
  • An 8-year-old female neutered Maltese dog exhibited signs of serious thunderstorm phobia including panting, wandering, shivering, hiding, crying or whining, or trying to escape from the house. In this study, we administered clomipramine and alprazolam and observed behavioral improvement for 3 years. Clinical symptoms measured according to the storm phobia assessment (SPA) were significantly high with an initial total score of 19 points. However, it improved to a total score of 8 on day 176 after drugs administration and returned to the normal level with the total score of 5 points on the 983 days. When the symptoms for the first 4 treatments and the last 4 treatments were compared in 2 groups, the total score of all clinical symptoms decreased to -62.83% in the last 4 treatments. This study found that treatment with alprazolam and clomipramine was associated with a decrease in clinical signs of storm anxiety, suggesting that two drugs would be effective in reducing symptoms caused by anxiety, thunderstorm phobia, and noise phobia. In this follow up study, we hope that more studies would be conducted on behavior modification for treatment of storm phobia in veterinary medicine.

한의학 정보환경의 변화와 오아시스의 미래전략 (The Analysis of Traditional Korean Medicine's Information Circumstance and the Future Plan of OASIS)

  • 예상준;김철;김진현;장현철;김상균;한정민;송미영
    • 대한한의학회지
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    • 제31권4호
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    • pp.49-62
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    • 2010
  • Objectives: Current information & communication technology is advancing very rapidly and the ripple effects are spreading all over society traditional Korean medicine (TKM) is no exception. We draw up afuture plan and target system's architecture of KIOM's OASIS to follow the information change and reinforce the supporting infra for TKM research. Methods: First, we analyzed the information circumstances of western and eastern medicine, both overseas and domestic, especially investigating the detailed changes domestically. Second, we grasped the present conditions of OASIS and compared it with other information portals. Finally, we drew a future plan and system architecture from the analysis results. Results: First, the information status of western medicine is much more advanced than TKM's, and overseas information circumstances are likewise more developed than domestics. Second, we found that OASIS is performing the central research infra role well in TKM. Finally we designed an information system architecture which is composed of an infra layer, an application layer and a service layer. Conclusion: We must integrate information materials such as literature, research manpower, facilities and standards to make TKM's knowledge portal successful. In detail, we have to make TKM's information classification code, build up the electronic TKM library and offer complementary and alternative medicine (CAM) trends.

정부가족계획사업의 피임보급전략에 관한 소고 (Review of Contraceptive Distribution Strategy for the Korean National Family Planning Program)

  • 조남훈;장영식
    • 한국인구학
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    • 제5권1호
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    • pp.117-132
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    • 1982
  • During the period of 1962 through 1981, a total of 11. 7 million cummulative acceptors have received contraceptive services under the national family planning program. The number of annual acceptors have steadly increased from 151, 200 in 1963 to 842, 200 in 1975, and since then it has maintained the range of 600, 000 to 800, 000 acceptors per year. From the beginning of the program, the IUD had been the principal method of contraception provided by the government program until 1976, at which time the government made female sterilization services available thorough the introduction of the laparoscopy method. The popularity of female sterilization has increased very rapidly during the last few years. Out of 614, 200 program acceptors in 1981, the proportion of female sterilization and IUD acceptors were virtually the same(26.8% and 27.2% respectively). Considering various anticipated problems such as a large proportion of contraceptive users for the fertility termination and the high discontinuation rates of IUD and other traditional method, the government has emphasized the distribution of female sterilization and deemphasized condom and pill contraceptives since 1978. However, the recent service statistics has revealed that the acceptance rate of female sterilization has steadly declined since 1979. Thus, the purpose of this analysis is to review the current government policy on contraceptive distribution with emphasis of female sterilization by estimating the prospect of sterilization acceptablilty. According to the Fifth Five-Year Plan for Family Planning Program(1982-1986) the annual average target of sterilization was set up to secure 230, 000 acceptors by the government sector during the period. If the sterilization target is to be met as planned, about 80 percent of exposed women aged 30-44 will be remained as sterilized women in 1985. This means the the high acceptance rate of sterilization shown in the past years can not be expected, unless the acceptors' age of sterilization is drastically lowered below 30 years. Accordingly, the current policy on contraceptive distribution with emphasis on sterilization should be gradually changed to encourage target population to use contraceptives for birth spacing by increasing access to such contraceptives as IUDs, pills, and condoms, and to improve continuation rates through better program management system including target setting, acceptors' follow-up, supervision, and evaluation system.

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국가별 건강보험체계에 따른 국가건강검진제도 비교 연구 (Comparative Study on the National Health Screening Programs according to the Health Insurance System)

  • 이예지;김은영;이동현
    • 보건행정학회지
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    • 제31권3호
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    • pp.272-279
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    • 2021
  • Background: Korea's health screening program has been faced the need for changes as the population and diseases structure are changing. In addition to Korea, many countries operate state-led health check-up programs to improve the health level of the people, and the operating methods of the program appear in various forms according to each country's health insurance system. This study examines other state-led health screening programs and proposes a direction for the development of Korea's health screening program. Methods: The study was conducted using the literature review method, and the "country" was set as a unit for the case analysis. The operating method of the health screening programs and the financial resources were compared according to the health insurance system. Five countries were selected as Korea, the United States, the United Kingdom, Japan, and Taiwan. Results: The analyzed countries mainly operate the health screening program as a management method for chronic diseases, but there were differences in the operating method, financing, and targeted subjects and examination items. In most countries, a risk assessment was performed prior to the examination (screening), and the subjects who needed the examination were first selected, and a follow-up management service was provided in accordance with the risk each individual exposed. Conclusion: Rather than applying the same screening method to populations with different risk levels, a health screening program will be constructed in consideration of the individual's health level and exposure risk, and the healthcare delivery system will be reorganized so that screening and treatment services can be linked.

비특이성 목 통증 재발의 심리적 인자 (Psychological Factors in Recurrent Non-specific Neck Pain)

  • 구미란;전덕훈
    • PNF and Movement
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    • 제22권2호
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    • pp.257-266
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    • 2024
  • Purpose: The aim of this study was to determine the influence of psychological and other risk factors on the recurrence of nonspecific neck pain. To achieve this, a nationwide cohort provided by the National Health Insurance Service in South Korea, with a three-year follow-up, was used. Methods: The study included patients who did not experience neck pain for the first year but were diagnosed with nonspecific neck pain (ICD-10 code: M54.2) in the second year. The progress of their neck pain recurrence was followed up for the next two years. Medical records, including age, gender, health insurance premium quintile, regional health vulnerability index score, initial onset duration, total hospitalization duration, and secondary diagnosis at onset, were extracted for analysis. Multivariate logistic regression analysis was performed to analyze the recurrence rate and risk factors for nonspecific neck pain recurrence. Results: Among a total of 591,215 patients, 29.2% experienced recurrence within two years. Patients with psychological disorders had a higher recurrence rate (30.6-33.8%) than those without psychological disorders (29.2%). Specifically, mood disorders (OR = 1.16) and stress-related disorders (OR = 1.06) were identified as risk factors for the recurrence of nonspecific neck pain. Older age (OR = 1.16-1.43), being female (OR = 1.17), being employed (OR = 1.23), and using medial aids (OR = 1.41) were also identified as risk factors. Conclusion: This study provides evidence for a high recurrence rate of nonspecific neck pain and highlights the need to consider psychological factors as well as personal factors in comprehensive interventions to prevent recurrent nonspecific neck pain.