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Systematic Review : Comparative Safety and Efficacy of Mono- and Combination Therapy of Anti-hypertensive Agents Acting on the Renin-Angiotensin System (레닌-안지오텐신계에 작용하는 항고혈압 약제의 단독요법과 병용요법의 안전성 및 유효성에 대한 체계적 문헌고찰)

  • Choi, Kyung-Eob;Kim, Hyun-Kyung
    • Korean Journal of Clinical Pharmacy
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    • v.21 no.4
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    • pp.364-375
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    • 2011
  • Given that single blockade with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) can achieve only partial and undurable suppression of the Renin Angiotensin System (RAS), it has been hypothesized that dual blockage would be more beneficial in the management of blood pressure (BP) reduction and prevention of progressive chronic kidney disease (CKD) than either agent alone. Thus, it has been suggested that the combination of an ACEI and an ARB might provide renal benefits to hypertensive patients over and above BP reduction. However, this might also expose patients to additive or synergistic side effects. We attempted to conduct a systematic review to evaluate the benefits and harms of combination therapy in hypertensive patients with or without kidney diseases. MEDLINE and KoreaMed were searched for relevant randomized clinical trials in adult hypertensive patients with or without diabetes (restricted to 1997, limited to trials published in English). Results were summarized using the random-effects model, and between-studies heterogeneity was estimated with $I^2$. A final analysis of ten trials (23,928 patients) revealed that the combination of an ACEI and an ARB reduced blood pressure (SBP/DBP) by 3.95/2.02 mmHg (95% confidence interval [CI], -4.38 to -3.53/-2.33 to -1.71) compared with ACEI monotherapy, and 2.83/2.64 mmHg (95% CI, -3.25 to -2.41/-4.95 to -0.33) compared with ARB monotherapy. Eight trials (391 patients) demonstrated a significant reduction in 24h-proteinuria (weighted mean difference, 0.16 g/day, 95% CI, -0.26-0.05), but they did not translate into an improvement in GFR. Tests for heterogeneity showed no difference in effect among the studies. The combination therapy reduced proteinuria by 30% (95% CI, 23% to 37%) and 39% (95% CI, 31% to 48%) compared with ACEI monotherapy and ARB monotherapy, respectively. However, in patients who had proteinuria more than 0.5 g/day, the combination therapy failed to show significant reduction in urinary protein excretion. The current cumulative evidence suggests that diabetic patients with proteinuria on dual RAS blockade have an increase risk of adverse events such as hyperkalemia, hypotension, and so on, compared with ACEI or ARB alone. It is, therefore, proposed that the combination therapy should not be routinely used for the treatment of hypertension with or without compelling indications.

A Survey on Back Pain of Nurses (간호활동의 유형과 요통 발생에 관한 일 조사연구)

  • 한윤복
    • Journal of Korean Academy of Nursing
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    • v.7 no.1
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    • pp.39-46
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    • 1977
  • Despite the fact that it is not a fatal symptom. the lower back pain of human species is considered a health problem of modern society: 80% of world population experience it and the distress and dysfunction caused by interferes daily life as well as the general productivity. This study was performed to investigate the general tendency of lower back Pain on nurses: influence of nursing activities, working condition and the physical characteristics of nurses on the pain in order to provide data for prevention and treatment. 386 nurses working at 16 general hospitals throughout the country were sampled. Questionaries developed by the researcher was used for data gathering. Results are as follows : 1. Lower back pain was experienced by most(72.3%) of the nurses: the highest rate of -Pain experience was revealed to be the a9e group of 35-39 (80.8%) followed by 25-29 group (74.2%). 2. In almost all instances (91.4%), the first pain attack occurred before the age of 29, and in 73.1%. the attack occurred between the age of 15-24. 3. In 10.1%, the pain was almost persistent or occurred every other day frequency. In 9%, the pain was relieved by the administration of analgesics or "unable to move". 4. More than 6 days′sick leave due to the pain revealed to be in 2.2%. No significant difference was revealed between specialities of service. 5. Pain experience and the over or under weight revealed not to have significant relations. (X$^2$=0.55224, p〉0.7587) 6. The length of working hour of I. C. U. and O. R, revealed to be longer than that of nurses general ward, however. no significant difference on the rate of pain occurrence apparent. (X$^2$=0.4952, p〉0.8239) No significant difference on the rate of pain occurrence between nurses working over 46 hours/week and under 45 hours/week. (X$^2$=3.86241, p〉0.078318) 7. The most frequent Pain related movement revealed to be "lifting patient or heavy object" (24. 7%, N=68) followed by "the sameness of position, either standing or sitting"(16.8%) 8. Regular physical exercise revealed to have no significant influence on the rate of Pain occurrence. 9. Higher raft of pain experience was revealed in the group of nurses wearing eye glasses. Uncomfortable shoes revealed to have influenced the pain. 10. The most frequent pain relieving treatment revealed to be "rest" (54.2%, N= 151) followed by "analgesics" (12.6%, N=35) and "hot compress/fomentation"(10.5%, N=29). In 13.7% (N=38) no special care was given.

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A clinical study on patients with Cold Hypersensitivity on hands and feet and their autonomic nervous system function using of Heart Rate Variability(HRV) (수족냉증 환자의 실태 및 HRV(Heart Rate Variability)를 이용한 자율신경계 기능 평가 연구)

  • Kim, Eun-Sook;Hwang, Jae-Ho;Lee, Jin-Moo;Lee, Chang-Hoon;Cho, Jung-Hoon;Jang, Jun-Bock;Lee, Kyung-Sub;Choi, Jae-Ho
    • Journal of Oriental Medical Thermology
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    • v.5 no.1
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    • pp.1-13
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    • 2006
  • Objectives : This study was designed to analyze basic data for cold hypersensitivity patients with a questionnaire and investigate correlation between cold hypersensitivity and Heart Rate Variability(HRV). Methods : 49 patients who complain of cold hypersensitivity on hands and feet in ambulatory care were investigated in Oriental Gynecology, Kyunghee Oriental Medical Center and Women medical center, Kangnam Koreana hospital from May 1, 2006 to October 20, 2006. All patients were asked to answer a questionnaire. After careful I examination to rule out other disease which may affect Digital Infrared Thermal Imaging(DITI) and HRV data, patients were taken thermography for the diagnosis of cold hypersensitivity Based on the result of thermography, the patients were divided into two groups(Objective cold hypersensitivity and Subjective cold hypersensitivity). Then, these two groups were compared using HRV data which was measured in the supine position for 5 minutes. Results: 1. For most patients, cold hypersensitivity first developed during puberty. 2. The parts of the body that felt cold first time were hands and feet. 3. The cold sensation was increased in winter or at bedtime Showing that the sensation can be changed according to the level of coldness. 4. Among women who sufferfrom cold hypersensitivity, very few of them were treated. 5. More than half of cold hypersensitivity patients's family member also had a cold hypersensitivity. 6. The decrease in mean values of LF/HF ratio was observed in objective cold hypersensitivity group than subjective cold hypersensitivity group and the decrease was significant(P=0.014) when examined by Student t-test. Conclusions : It is necessary that the cold hypersensitivity patients should be treated carefully considering the facts mentioned above. And it can be suggested that dysautinomia be related with cold hypersensitivity and be evaluated by HRV.

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Convergent Study on Microbial Contamination of Toothbrushes According to Intraoral Bacteria Acidogenicity and Toothbrush Care (구강내 세균의 산생성도와 칫솔 관리법에 따른 칫솔 세균 오염에 관한 융합연구)

  • Park, Young-Nam;Ryu, Jae-ki
    • Journal of Convergence for Information Technology
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    • v.10 no.8
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    • pp.223-228
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    • 2020
  • Objective of this study was to compared the amount of bacteria in the toothbrush according to the management method of the toothbrush in use and the acidity of intraoral bacteria. Toothbrushes in use in more than one month of 50 healthy adults were collected and the number of bacteria and pH of the toothbrushes were measured. When the number of brushings per day was 4, the pH 4.97 and the microbial numbers was the lowest at 42.16(104×CFU/ml). When the replacement period of the toothbrush was 1 month, the pH 5.35 and the microbial numbers was the lowest at 19.80(104×CFU/ml). When stored in the bathroom, the pH 4.78, and the microbial numbers was highest at 149.46(104×CFU/ml). As a result, in order to block the germs of the toothbrush, it is necessary to develop a method that can easily disinfect the contaminated toothbrush at home. In addition, I think that it is necessary to educate about the proper brush cleaning and storage method when teaching brushing.

A Study on Relationship Between Fear During Pregnancy and Person and Environmental Variables in Pregnant Women (임부의 공포와 개인 및 환경변인의 상오관계에 관한 연구)

  • 정송자
    • Journal of Korean Academy of Nursing
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    • v.4 no.2
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    • pp.131-143
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    • 1974
  • Antenatal care is zoomed toward3 assisting the Individual to achieve safe and wholesome state of health during pregnancy. Nature of fear is assumed to be rooted to complex interaction between past experiences, human relationship and present state of health, however. specific relationship between fear and the variables have not yet been ascertained. This study is designed to investigate the nature of fear of pregnancy, and the correlation between fear and the personal and environmental variables such as personal characteristics past experiences. and psycho-social factors. During the period from October 23 to November 5, 215 pregnant and 104 non-pregnant women of similar chronological are group residing in Seoul were interviewed according to check-list by random General anxiety test, general personality test and test for fear of pregnancy, family according to specific variables such as past experiences of Pregnancy and childbirth, structure of family, family relationship and month of pregnancy was done to the group of pregnant women. To non-pregnant group, general anxiety test was performed to compare with pregnant group. Results of the study are as follows; 1. Hypothesis 1; Degree of general anxiety will be higher e pregnant women compared to that of non-pregnant women. There is no significant difference between the general anxiety of pregnant women and that of non-pregnant women. Therefore, hypothesis I is rejected. 2. Hypothesis 2: Fear of pregnancy and general anxiety will be correlated with personality factors. Through test for fear of pregnancy and general anxiety, a meager contra-correlation between fear and only two personal factors (R and E factor) is revealed but there is no significant correlation between fear and other personal factors (A.S. and T factor). Degree of fear of pregnancy tends to b: higher in the group with low personality factors; responsibility and emotional stability expect the correlation between ascendancy, sociability, and confidence-inferiority. non-significant. Through general anxiety test, level of general anxiety tends to be higher in the group. with low personality factors; responsibility. emotional stability, and confidence except ascendency and sociability, non-significant. Hypothesis 2 is partially supported. 3. Hypothesis 3; General anxiety and fear of pregnancy will be correlated with the past experience-ol pregnancy, and child-birth experience. Though general anxiety test and test for fear of pregnancy, non-significant difference is revealed by P〉.05 level Hypothesis 3 is rejected. 4. Hypothesis 4: General anxiety and fear of pregnancy will be correlated with the month at pregnancy will be correlated with the month of pregnancy. Through tests of general anxiety and fear, significant correlation is revealed degree of fear by-P〈.05 level (CR=1.98) and level of general anxiety by P〈.005 level (CR=3. 11) is higher in the earlier stage of pregnancy. Hypothesis 4 is supported. 5. Hypothesis 5, 6, 7; General anxiety and fear of pregnancy will be correlated with socio-economic status, family structure, and family relationship. Through general anxiety test and tear of pregnancy test, non-significant is revealed by P〉.05 level. Hypothesis 3.6.7 are rejected. Conclusion and recommendation Level of general: anxiety and degree of fear of pregnancy is shown not to be correlated with variables of past experiencers of pregnancy and child-birth. and family factors except the month of - pregnancy. Personal characteristics are shown to be partially contra-correlated meagerly with genera anxiety and fear of pregnancy. This study revealed contrasted results, in regard to presence of correlation between general anxiety and fear of pregnancy to other thesis. In this context. further studies under controlled environment is recommended.

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A Study on the Educational Contents on Child's Human Rights in a Manual of the Nuri Curriculum for 5 Year Old (만 5세 누리과정 교사용 지도서에 수록된 유아인권 관련 교육내용 분석)

  • Cho, Suk Young
    • Korean Journal of Childcare and Education
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    • v.10 no.6
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    • pp.369-390
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    • 2014
  • This study analyzed the educational contents related with child's human rights in a manual of the Nuri Curriculum for 5-year-olds based on the type and area of activity, 5 areas, and by life theme. The research results are as follows: First, the educational contents on child's human rights in activity type and area showed high frequency in the order of large and small group activity, child selected play activity, and outdoor activity, and among them, right to an education and right to play showed the highest frequency. Second, among the five categories, the area that conducts educational contents on child's human rights was the social relation category, and the area that showed the highest participation was the educational contents on human rights. On the other hand, the areas that were treated the least were physical activity and health. Third, the topic that treated the educational contents related with child's human rights was 'spring, summer, fall, winter,' and 'my family and I' treated educational contents on child's human rights in the lowest frequency. Also, whereas the right to education and right to play showed the highest frequency of educational contents on child's human rights among entire life themes, the educational contents on child's human rights of abuse and neglect(violence) were not treated at all in the entire life themes. Through the results of this study, it will be helpful in planning and deploying activities related with the child's human rights harmoniously, and intends to provide important basic data in organizing activities of human rights program linked with the elementary school. Furthermore, this study intended to provide basic information for developing a program of systematic child's human rights education for children in addition to the curriculum at a national level.

The Anticommons: BRCA Gene Patenting Controversy in the United States (유전자와 생명의 사유화, 그리고 반공유재의 비극: 미국의 BRCA 인간유전자 특허 논쟁)

  • Yi, Doogab
    • Journal of Science and Technology Studies
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    • v.12 no.1
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    • pp.1-43
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    • 2012
  • This paper examines the American Civil Liberties Union(ACLU)'s recent legal challenge on patents held by Myriad Genetics on two genes (BRCA1 and BRCA2) associated with a high risk of breast and ovarian cancer. Instead of analyzing the ACLU's objections to the BRCA patents in terms of its legal technicalities and normative ethical principles, this paper seeks to situate this legal case in the broader historical context of the shifting understanding of the relationship between private ownership, economic development, and the public interest in academic sciences. This paper first briefly chronicles a series of scientific developments and key legal decisions involving patenting of life forms, including genetically engineered micro-organisms animals and biological materials of human origins like cell cultures and genes, that led to the US Patent and Trademark Office(USPTO)'s official guidelines on human gene patenting in 2001. At another level, this paper analyzes the expansion of the scope of intellectual property rights in the life sciences in terms of shifting economic and legal assumptions about public knowledge and its role for economic development in the 1970s. I then show how these economic, legal, and ethical ideas that linked private ownership and the public interest have been challenged from the 1990s, calling for revisions in intellectual property laws regarding a wide array of life forms. The tragedy of the anticommons in human gene patenting, according to ACLU, has severely undermined creative scientific activities, medical innovations, access to health care and rights to life among cancer patient groups. ACLU's objection to human gene patenting on several US-constitutional grounds in turn suggests issues regarding intellectual property are critically linked to vital issues pertinent to the creative communities in arts and sciences, such as free exchange of ideas, censorship and monopoly, and free expression and piracy etc.

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Does Market Competition Reduce Hospital Charges & LOS for the Degenerative Lumbar Spinal Disease?: A Two-point Cross Sectional Study (병원시장 경쟁이 퇴행성 요추질환 환자의 진료비 및 재원일수에 미치는 영향)

  • Lee, Joo Eun;Park, Eun-Cheol;Lee, Sang Gyu;Kim, Tae Hyun
    • Korea Journal of Hospital Management
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    • v.22 no.4
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    • pp.33-49
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    • 2017
  • Background: Health care utilizations and costs of the patients with degenerative lumbar spine disease in Korea increased dramatically. We analyzed whether hospital market competition is associated with charges and length of stay for patients with degenerative lumbar spine disease. Methods: We used Medical claims data of 2002 and 2010 from the nationwide representative sample of National Health Insurance Service of Korea. The study subjects were inpatients with degenerative lumbar spine disease (N=24,768) in 2002 and 2010. We employed a multilevel linear mixed model that included patient- and hospital-level variables in hierarchical data. Results: Higher hospital competition was associated with lower charges (${\beta}=57.5$, p<.0001 in 2002; ${\beta}=353.7$, p<.0001 in 2010) and shorter length of stay (${\beta}=0.3$, p<.0001 in 2002; ${\beta}=0.9$, p<.0001 in 2010) in both 2002 and 2010. Compared to 2002, the magnitude of such association became greater in 2010. However, subgroup analyses show that the influence of competition on charges and length of stay differed by hospital size. Conclusions: This study showed that hospital market structure (e.g., hospital competition) affects hospital efficiency (i.e., hospital charges and length of stay). It is necessary to continue to monitor how changing market structure influences hospital outcomes, including more detailed outcomes such as patient satisfaction.

A Comparison Research on the Expected Satisfaction and Actual Satisfaction on VOC of one General Hospital (서울소재 일개 종합병원의 CRM에 대한 기대만족도와 실제만족도 비교와 VOC활용)

  • Ma, Yeon-Ji;Kim, Jeong-Ah;Park, Seung-Woo;Oh, Eun-Hwa;Moon, So-Young;Rhee, Hyun-Sill
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.11 no.3
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    • pp.1146-1152
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    • 2010
  • The Korean healthcare industry is rapidly changing along with the competition among hospitals. In the past, hospitals could make profit without designing competitive management strategies. Thus, they did not find importance in listening to customers' voices and identifying their wants. However, nowadays, the increasingly intense competition is encouraging hospitals to seriously consider competitive management strategies and Customer Relationship Management (CRM) activities to gain a competitive advantage and prosper. It tries to compare the expected satisfaction with the satisfaction of out-patient and in-patient and analysis of VOC(Voice of Customer). This survey was done from 27th, April, 2009 to 8th May and each 100 in-patients and out-patients. The paired t-test and descriptive analysis was used to analysis between before and after satisfaction. The result, the replied out-patients were the highest of I.M department, 43% and in-patients, surgery and other department are the highest each 22.0%. Nurses kindness is statistical significant in out-patients. Doctor, Nurse and staff's kindness and rounding service was statistical significant in in-patients. Totally, the satisfaction was lower than expected satisfaction, so the medical care institutions should analyst detailed the patient's satisfaction by VOC.

The Relationship Between Mothers' Safety Knowledge and Home Safety Practice (어머니의 안전 지식과 가정 안전 실천간의 관계)

  • Kim, Ji-Young;Youn, Jin-Ju;Kim, Yong-Lim
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.14 no.9
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    • pp.4240-4247
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    • 2013
  • This purpose of this study was to investigate the difference of safety practice and safety knowledge according to background variables of mothers and the relationship between practice and knowledge in safety of mothers. The subjects were 143 mothers in Iksan city. A questionnaire was made by the researcher on the basis of relevant materials. The data was analyzed by statistical methods such as frequency, Cronbach's ${\alpha}$, descriptive statistics, t-test, ANOVA, Scheffe and Pearson's correlation. The results are as follow: First, mothers' safety knowledge was higher than average. There were significant differences in emergence care, dangerous material, toy safety and young children' developmental character according to mothers' age. There were significant differences in dangerous situation, young children' developmental character and sum score of safety knowledge according to mothers' educational level. So there were significant differences in electrical fire safety, young children's developmental character according to children's age. Second, mothers typically practiced home safety. There were significant differences bathroom, entrance according to mothers' age. And there were significant differences room, kitchen and sum score of safety practice according to children's age. Third, there is no correlation between mothers' safety knowledge and home safety practice.