• Nutrition Research and Practice
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• 제9권6호
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• pp.637-643
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• 2015

BACKGROUND/OBJECTIVES: Malnutrition in the elderly is a serious problem, prevalent in both hospitals and care homes. Due to the absence of a gold standard for malnutrition, herein we evaluate the efficacy of five nutritional screening tools developed or used for the elderly. SUBJECTS/METHODS: Elected medical records of 141 elderly patients (86 men and 55 women, aged $73.5{\pm}5.2years$) hospitalized at a geriatric care hospital were analyzed. Nutritional screening was performed using the following tools: Mini Nutrition Assessment (MNA), Mini Nutrition Assessment-Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002). A combined index for malnutrition was also calculated as a reference tool. Each patient evaluated as malnourished to any degree or at risk of malnutrition according to at least four out of five of the aforementioned tools was categorized as malnourished in the combined index classification. RESULTS: According to the combined index, 44.0% of the patients were at risk of malnutrition to some degree. While the nutritional risk and/or malnutrition varied greatly depending on the tool applied, ranging from 36.2% (MUST) to 72.3% (MNA-SF). MUST showed good validity (sensitivity 80.6%, specificity 98.7%) and almost perfect agreement (k = 0.81) with the combined index. In contrast, MNA-SF showed poor validity (sensitivity 100%, specificity 49.4%) and only moderate agreement (k = 0.46) with the combined index. CONCLUSIONS: MNA-SF was found to overestimate the nutritional risk in the elderly. MUST appeared to be the most valid and useful screening tool to predict malnutrition in the elderly at a geriatric care hospital.

• Journal of Nutrition and Health
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• 제6권2호
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• pp.17-24
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• 1973

The function of the liver is so complicated and important that various Hepatic diseases are occured due to functional retardation of liver. Above all, the incidence of Hepatitis and liver cirrhosis among Koreans has shown an increasing tendency recently. 113 cases of Hepatitis and 125 cases of liver cirrhosis which had been admitted, more than 10 days, to KOREA Hospital between November, 1968 and July,1972, were studied through clinic charts. (A) Hepatitis 1) of the 113 cases; 54 cases (47.7%) were Infectious hepatitis; 40 cases (35.4%) were chronic hepatitis 2) of the 113 cases ; 80 cases (70.8%) were male and 33 cases (29.2%) were female; the sex ratio was 2.4 : 1 The ages of the onset of the disease was as follows; 34 cases (30.1%) were among $30{\sim}40$. 3) Patients had abdominal pain (77.9%) anorexia (66.4 %) and general weakness(82.3%) as symptom and jaundice (94.7%) hepatomegaly (76.1%) as sign 4) 57 cases of all had complication 26 cases (45.6%) were parasite, 12 cases (21.1%) were diabeties mellitus. 5) 99 casea (87.6%) of all were improved and recovered. (B) Liver Cirrhosis 1) Etiologic factors are hepatitis (56cases) and alcoholics (28 cases). 2) of the 125 cases, 84 cases (67.2%) were male and 41 cases (32.8%) were female; the sex ratio was 2 : 1 The age of the onset of the disease was as follows; 47 cases (37.6%) were among 41-50. 3) Patients had symptoms: indigestion (64.8%), Abdominal pain (60%), general wenkness (35.2%) and signs; Hepatomegaly (61.6%) Ascites (59.2%), Jaundice(56.8%). 4) 107 cases of all had complications; Hepatic coma was 20 cases (18.7 %), Ascites was 16 cases (15.0%). 5) 69 cases (55.2%) were improved. (c) Treatment of Hepatitis and cirrhosis. 1) Absolutely (bed) rest. 2) A well-balanced diet adequate in calorie value, showed be given (High Carbohydrate, High Protein, High vitamin diet) if the patient's appetite is good and easily digested. 3) Drugs; (1) Vitamins (2) Digestants (3) Tranquize

• Journal of Nutrition and Health
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• 제39권7호
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• pp.641-648
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• 2006

This study was designed to evaluate the effect of the individual nutrition education for type 2 diabetes who participate the diabetes buffet. The subjects were 66 patients and divided into education (n=34) and control groups (n=32). The mean age of education and control groups were 59.8 and 56.6 years old, respectively. There were no differences in age and body mass index (BMI) between two groups. Initial glycosylated hemoglobin (HbA1c), post prandial plasma glucose (PP2), total plasma cholesterol, and blood pressure were not different between two groups. But fasting blood sugar (FBS) was higher in education group than in control group. On completion of the study, the education group showed significant decreases in body weight, BMI, FBS and PP2, however, the control group showed no changes in body weight, BMI and PP2, and showed a significant increase in FBS. Initial calorie and protein intakes of the education group did not meet the prescribed amount, however, mineral and vitamin intakes were higher than estimated average requirement (EAR). By the end of study, calorie and protein intakes were significantly increased to meet the prescription. In order to evaluate the effect of diet education, awareness of calorie requirement was used as an index of understanding diet prescription. The degree of awareness of calorie requirement was dependent on age: younger patients showed higher awareness than older subjects. The subject who showed better understanding of diet prescription showed lower levels of HbA1c, FBS, and PP2 at the end of the experiment period. The results of this study clearly show that individual diabetes diet education is effective to make the patient understand their diet prescription, and is effective to control body weight and blood sugar level. Awareness of calorie requirement could be used as an index of understanding of prescribed diet. Since age is an important variable to determine the awareness of calorie requirement, different strategies of nutrition education should be developed for different age groups, especially patients over 70 years old.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제8권1호
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• pp.133-138
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• 1997

Prader-Willi 증후군(Prader-Willi Syndrome, PWS)은 $50{\sim}-70%$ 정도의 환자에서 염색체 15번에 이상이 있음이 보고된 유전적인 질환으로서, 그 특징적인 임상양상은 심한 근긴장의 저하(hypotonia), 반사소실(areflexia), 섭식의 곤란(feeding difficulty), 저체온증(hypothermia), 성기왜소증(microgenitalia), 음낭저형성증(hypoplastic scrotum), 대식증(polyphagia), 포만감의 감소와 비만, 정신운동발달의 지연, 저성선기능증(hypogonadism) 및 안면과 척추의 기형 등이다. 또한 행동상의 여러 문제들이 동반되는데 분노발작, 피부를 심하게 뜯거나 발모광, 과도한 식욕과 관련된 음식 도벽증이 나타나므로 정신과적 치료가 필요하다. 본 증례는 14세된 PWS환자로서 비만과 대식증, 도벽증, 학업부진 및 생활부적응 문제 등으로 2주간의 입원과 약 1년간의 추적기간 동안 약물요법(fluoxetine 투여)과 행동요법, 그리고 가족요법을 받아 왔다. 장기간의 Fluoxetine투여를 통하여 비만과 식욕의 조절에는 효과가 만족스럽지 않았으나 우울감과 감정문제, 자살사고 및 행동문제들은 호전되었다.

• 한국임상약학회지
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• 제25권3호
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• pp.171-177
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• 2015

Background: Androgenetic alopecia (AGA), one of alopecias, requires continuous treatment in order to prevent or stop it, and patient's compliance is very important. Currently, only two drugs (finasteride, minoxidil) have been approved for AGA by Food and Drug Administration of United States (US FDA). However, another ${\alpha}-2$ reductase inhibitor, dutasteride, is approved by Korea Ministry of Food and Drug Safety (MFDS) through a phase III trial. For treatment, pharmacotherapy of AGA usually combines topical minoxidil 7% with one of oral <${\alpha}-2$ reductase inhibitor. Objectives: We evaluated the comparative efficacy and adverse effect between topical minoxidil 7%/finasteride 1 mg and topical minoxidil 7%/dutasteride 0.5 mg pharmacotherapy for outpatients with AGA. Also we evaluated the relationship between therapeutic effect and regular hospital visit. Method: This study was performed retrospectively based on electronic medical record (EMR) data of total 98 patients (topical minoxidil 7% with dutasteride 0.5 mg ($Avodart^{(R)}$) or finasteride 1 mg ($Alopecia^{(R)}$, $Propecia^{(R)}$) with diagnosis of AGA from department of dermatology at a secondary hospital from January $1^{st}$, to May $31^{st}$, 2014. Results: The efficacy and adverse event of topical minoxidil 7%/dutasteride 0.5 mg (DUTA group) were 100% and 45.7%, and of topical minoxidil 7%/finasteride 1 mg (FINA group) were 92.1% and 33.3%, respectively. The mean onset time of responses and adverse events in the FINA group were 3.86 months and 4.43 months. Those in the DUTA group were 3.97 months and 5.06 months. Conclusion: Both FINA and DUTA group were highly effective, but the DUTA group showed higher efficacy and adverse effects than those in the FINA group. Dutasteride may be another alternative in AGA treatment.

• 동아시아식생활학회지
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• 제5권1호
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• pp.7-19
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• 1995

This study was conducted to evaluate the nutritional status and diabetes management of diabetic patients in the Health Center. General characteristics, food habits, food intakes and the knowledge about diet therapy were investigated from ninety one diabetes subjects. Anthropometric assessment such as weight, hight, triceps skinfold thickness, and biochemical measurement of fasting blood glucose(FBG), post prandial 2 hours blood glucose(PP2), and hemoglobin A1c(HbA1c) were obtained form the subjects. The results were summarized as following : 1. The average of age was 60.9 years old and 83.5% of subjects was illiterate and primary school graduated. 2. Relative Body Weight(RBW) and % body muscle were 96.18${\pm}$13.6 and 33.56${\pm}$7.01%, respectively. Obese subjects whose body weight exceeded 120% of the ideal values were 3.3%. 3. The 86.8% of subjects were managed by oral hyperglycemic agents. 4. The mean of FBG, PP2, HbA1c were 140.75${\pm}$44.43mg/㎗, 7.60${\pm}$1.88%, respectively. 5. The mean daily intake of calorie was 1407㎉, and 73.6% of subjects lower caloric intake than prescribed calorie. when the degree of dietary compliance was expressed as Tunbridge score, 18.7% of total subjects was grouped as satisfactory, where as 20.9% and 60.4% could be considered as tolerable and hopeless, respectively. The nutrients intake were lower than RDA except for Vitamin A and Vitamin C and the ratio of carbohydrate : protein : fat was 72 : 14 : 14. 6. The mean score of knowledge test about diet therapy was 3.52${\pm}$2.19 out of possible 14.00 points. The above results suggested that the most of diabetic patient showed the poor nutritional status and they faced the lack of knowledge about diabetes management.

• 한국식품영양학회지
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• 제10권2호
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• pp.186-192
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• 1997

성별, 직업, 성품, 생활양식이 전혀 다른 K43과 C45 환자의 위 내시경적 소견과 치료방법을 논의하였다. K43은 잘못된 식습관과 스트레스에 의한 미란성 위염환자로서 제산제와 함께 H2-수용체 길항제, H+/K+-pump 억제제, prostaglandin 제제, colloidal bismuth, sucralfate prokinetics 등 전통적인 약물에서부터 부작용을 감소시킨 최근에 개발된 약물에 이르기까지 효과가 인정된 약물들을 폭넓게 사용하였으나 증상을 개선치 못하였으며, 임상병리 검사와 상복부 초음파 검사는 정상이었으나, 소화생리기능 검사에서 visceral hypersensitivity를 나타내었다. 그러나 C45는 평소에 두통으로 NSAIDs를 습관적으로 복용한 경험에 의하여 발생되었을 것으로 추정되는 전형적인 위·십이지장 궤양의 환자로서 H. pylori 박멸제와 함께 일반적인 소화성 궤양의 치료제로 활동기에서 치유기로 증상을 크게 완화시켰다. 특히 K43은 amitryptyline을 투여하였으나 난치성 환자로 남아 있다. 이러한 원인불명의 비궤양 환자는 미국에서 해마다 15%씩 증가하는 추세에 있고 적절한 치료법도 없으며, 우리 나라에서는 통계치도 없는 실정인 점을 지적하고 싶다.

• 대한지역사회영양학회지
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• 제16권4호
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• pp.488-496
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• 2011

The purpose of this study was to investigate the perception and utilization of Complementary and Alternative Medicine (CAM) for diabetic patients in Busan. The subjects were 227 patients at two general hospitals (over 400 bed). This study was performed through the interviewing process using questionnaires conducted from January to April, 2010. Of a total of subjects, 109 patients (48.0%) had taken CAM at least one time. The patients used CAM recognized that they were 'auxiliary medicines' (39.4%), 'supplementary health foods' (32.1%) and 'medicines' (19.3%), but inexperienced patients perceived them as 'supplementary health foods' (29.6%), 'unscientific treatment' (22.6%) and 'medicines' (20.2%), It was significantly different between two groups of patients (p < 0.001). The number of CAM types used for the patients was 51. The CAM types were plant foods (64.3%), dietary supplement (23.6%) and animal diets (12.1%). The patients used an average of 5.9 different kinds of CAM and an average of 3.8 years them and paid \93,345 per month. The patients with diabetic complications and for longer morbidity periods used CAM for significantly (p < 0.05) longer periods. The mean effectiveness scores of the patients used CAM were 3.31/5.00 for efficacy satisfaction, 3.58/5.00 for fewer side effects compared to those of oral drugs, 3.60/5.00 for psychological stability, 3.81/5.00 for easiness to use, and 3.06/5.00 for economic satisfaction. Of the patients that used CAM, 55.9% did not consult with doctors about CAM. More than two-thirds of the patients (77.1%) did not feel the need to consult with doctors.

• 의료법학
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• 제15권2호
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• pp.63-89
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• 2014

In 1976, the Dalkon Shield-intrauterine device injured several thousand women in U.S.A. which caused the changes of medical deivce regulation. The Medical Device Regulation Act or Medical Device Amendments of 1976 (MDA) was introduce. As part of the process of regulating medical devices, the MDA divides medical devices into three categories. The class II, and III devices which have moderate harm or more can use the section 510 (k), premarket notification process if the manufacturer can establish that its device is "substantially equivalent" to a device that was marketed before 1976. In 21 U.S.C. ${\S}$ 360k(a), MDA introduced a provision which expressly preempts competing state laws or regulations. After that, the judicial debates had began over the proper interpretation and application of Section 360(k) In February 2008, the U.S. Supreme Court ruled in Riegel v. Medtronic that manufacturer approved by the Food and Drug Administration (FDA)'s pre-market approval process are preempted from liability, even when the devices have defective design or lack of labeling. But the Supreme Court ruled in Medtronic Inc. v. Lora Lohr that the manufactures which use the section 510 (k) process cannot be preempted and in Bausch v. Stryker Corp. that manufactures which violated the CGMP standard are also liable to the damage of patient at the state courts. In 2009, the Supreme Court ruled in Wyeth v. Levine that patients harmed by prescription drugs can claim damages in state courts. This may cause a double standard between prescription drugs and medical devices. FDA Preemption is the legal theory in the United States that exempts product manufacturers from tort claims regarding Food and Drug Administration approved products. FDA Preemption has been a highly contentious issue. In general, consumer groups are against it while the FDA and pharmaceutical manufacturers are in favor of it. This issues also influences the theory of product liability of U.S.A. Complete immunity preemption is an issue need to be more declared.

• 한국식품영양학회지
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• 제11권2호
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• pp.165-170
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• 1998

교통사고로 인한 척추골절 환자 S75에서 손상부위에 따른 진단방사선학 및 보존적 치료 소견을 임상 문헌과 함께 고찰해 본 결과 다음과 같은 결론을 얻었다. 1. 흉요추 좌측방 단순필름에서 L1 요추에 설상변형 정도가 약 10%인 쐐기형 압박골절이 확인되었다. 2. L1 요추의 CT촬영 결과 추체부 전면에 궁형의 불규칙한 골 절편을 관찰할 수 있었으며, T12∼L1는 구조상 손상빈도가 높은 부위로 밝혀졌으며, Denis의 골절형태는 중간주와 후방주가 잘 보존된 전방주의 다발성 압박골절로 분류되었고, Cobb의 척추 만각증은 없었으며, Frankel의 신경손상 분류형태는 E형이었다. 3. 정형외과적 치료방법은 비수술 요법의 보존적 치료를 원칙으로 하였고, 수분·전해질, 영양 및 혈장제 대용으로 공급하는 수액과 함께 브스테로이드성 항염진통제, 근육 이완제를 투여하면서 철저한 침상안정을 유도하였다. 4. 수상후 3주째는 폴리에틸렌 back corset를 착용하고 조기재활을 시도하였으며, 수상 8주 후에도 경도의 불편감이 남아 있었으나, 추시 관찰한 결과 일정기간이 지나면서 점차 척추는 안정성을 찾게 되었다.