• 정신신체의학
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• 제26권1호
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• pp.51-58
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• 2018

연구목적 일 대학 병원 정신건강의학과의 불면증 외래 환자에서 doxepin 처방 패턴에 따른 doxepin 치료 중단율 및 중단 이유에 차이가 있는지 확인하고자 하였다. 방 법 불면증 치료를 위해 doxepin을 처방한 외래 환자 534명의 환자를 선별한 후, 전자의무기록을 후향적으로 검토하여 201명의 환자를 대상으로 doxepin 처방 2개월 후 치료 중단율을 조사하였고, doxepin 처방 패턴에 따라 처음으로 수면 목적의 약제로 doxepin을 처방 받은 환자들을 initial군, 기존에 복용하던 수면 목적의 약제를 유지하면서 doxepin을 추가 처방한 경우를 add-on군, 기존에 수면 목적의 약제를 복용하였고 기존 약제를 중단하고 doxepin으로 약물을 변경한 경우를 switching군으로 나누어 doxepin 중단률 및 중단 이유를 조사하고 세 그룹간에 비교하였다. 결 과 2개월 후 doxepin 치료 중단율은 56.2%였고, 세 군 간의 치료 중단율에 유의한 차이가 있었다. Initial군이 세 군 중에 가장 높은 치료 중단율을 보였고, add-on 군이 가장 낮은 치료 중단율을 보였다(p=0.018). 각 군별 doxepin 치료 중단의 이유에서는 효과부족(p<0.001), 이상반응(p<0.001)이 add-on군에서 유의하게 높게 확인되었고, 환자거부(p=0.022), 원인미상 및 추적실패(p<0.001)가 initial군에서 유의하게 높은 결과를 보였다. 결 론 본 연구 결과 실제 임상 진료 상황에서는 add-on 방법이 약물의 switching 방법보다 doxepin 치료 유지에 적합하며, 부작용을 예방하기 위해 기존에 복용하던 수면제 및 수면에 도움을 주는 약제를 단계적으로 줄여야 함을 확인하였다. 추후 대규모 전향적 연구를 통하여 doxepin 치료 중단과 관련된 다양한 변인 및 위험요인들이 체계적으로 평가될 필요가 있다.

• 보건교육건강증진학회지
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• 제17권1호
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• pp.81-93
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• 2000

This study is intended to investigate medication compliance and polypharmacy of the diabetic patients by age group in order to determine the major factors that influence their compliance. 198 ambulatory diabetic patients were interviewed, and the sample was divided into three groups based on the age: Young age group under 55, Borderline age group between 55 - 65, Old age group over 65. According to the study results, medication compliance for the old age group was 72.6% whereas 85.1% for the young age group. Medication compliance significantly decreased as the age of the patients increased. Also the degree of polypharmacy, the rate which patients take more than 6 prescription drugs, was 45.9% for the old group, whereas 31.2% for the young group. As the most important factor of polypharmacy, the number of doctors was statistically significant. With regard to prescription factors related to medication compliance, the amount of prescribed medication is statistically significant between the compliance group and non-compliance group. In addition, the amount of information provided to patients by pharmacists was determined to be a very significant factor. Also the level of ease in understanding the medication instructions varied significantly between the compliance group and the non-compliance group. In light of the empirical data and results for the diabetic patients, it is necessary to develop and implement various programs to improve medication compliance and to decrease the level of polypharmacy among the elderly, or "old", diabetic patients. patients.

• 성인간호학회지
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• 제18권4호
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• pp.660-667
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• 2006

Purpose: The purpose of this study was to investigate the effects of 12-week brisk walking and brisk walking plus diet program on C-Reactive Protein(CRP) in middle-aged obese hypertriglycemic($triglyceride{\geq}150mg/d{\ell}$) Korean women. Method: The subjects were 16 obese ($BMI{\geq}25$) hypertriglycemic middle-aged women (7 for brisk walking group, 9 for brisk walking plus diet group) who participated in a health promotion program at one public health center. Initially the brisk walking intervention consisted of walking for 20 minutes/day at an intensity of 40 to 50% of heart rate reserve(HRR) for 3 days/week and progressed to 50 minutes/day, 60 to 70% of their HRR, and 6 days/week. The diet intervention consisted of 60 minutes of group education and 20 to 30 minutes of individual counseling with a nutritionist every week. Data were analyzed with SPSS PC program. Results: There was no significant reduction in CRP levels in both brisk walking (Z=-1.70, p=0.088) and brisk walking plus diet group(Z=-0.31, p=0.752). In brisk walking only group, CRP levels were increased after the intervention. Conclusion: Brisk walking could increase the level of CRP when it is in the course of progression and diet could decrease the acute phase inflammatory response.

• 동의생리병리학회지
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• 제18권1호
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• pp.243-249
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• 2004

KBPT is the fortified prescription of Bang-pung-tong-sung-san(BPTS) by adding Spatholobi Clulis and Salviae Miltiorrzae Radix. BPTS prescription has been utilized in oriental medicine for the treatments of vascular diseases including hypertension, stroke, and arteriosclerosis. Yet, the overall mechanism underlying its activity at the cellular levels remains unknown. Using spontaneously hypertensive rat (SHR) model, we investigated whether the KBPTS has an effect on the pathophysiological parameters related to hypertension. Pretreatment of SHR with KBPTS was found to lower blood pressure and heartbeat rate. Levels of aldosterone. dopamine, and epinephrine were found to be significantly reduced in the serum of KBPTS-treated SHR. Histological examination of adrenal cortex and superior aorta showed that tissues from KBPTS-treated SHR rats were more intact and cleaner compared to saline-treated control. Levels of superoxide dismutase (SOD) protein in adrenal gland, aorta, myocardial tissue, and kidneys were higher in KBPTS-treated animals than control group. The present data suggest that KBPTS may play a role in normalizing cardiovascular function in SHR by controlling hypertension-related blood factors and superoxide stressors.

• 보건행정학회지
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• 제21권2호
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• pp.179-194
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• 2011

Although there have been studies regarding the separating policy of dispensary and medical practice, little study have provided a concrete empirical evidence to what extent the policy objectives are achieved. In this paper, we try to provide empirical evidence whether the policy separating dispensary from medical practice achieved the policy objectives, which representatively are reducing the mis-use or over-use of anti-biotic prescriptions and medicines, and decreasing the government spending for the cost of pharmaceutical support. By comparing the average of the rate of change of the number of medicines prescribed, the rate of anti-biotics prescribed, and the government spending for the cost of pharmaceutical support between the areas where the separation policy was implemented and the exceptional areas, we concluded that it is difficult to conclude that the policy separating dispensary and medical practice achieved its policy objects, as it first announced to achieve in the introduction of the policy in 2000. However, the limitation of this study is that the data, that can thoroughly analyze the effect of separating policy of dispensary from medical practice, cannot be collected as expected. Hence, we could not use a parsimonious empirical model to evaluate the effect of the policy introduced in 2000. Rather we used a simple statistical method to extract enough empirical evidence fro m the data available. In the near future, we would expect to see more research that analyze the exact effect of policy separating dispensary and medical practice with concrete empirical model using more sophisticated dataset.

• 한국임상약학회지
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• 제33권1호
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• pp.62-69
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• 2023

Objective: Adherence is an important component in the treatment of various diseases, and poor adherence to antidepressants in patients with major depressive disorder is common. Non-adherence can be more prevalent in elderly patients with multiple morbidity and polypharmacy, resulting in negative treatment outcomes. The purpose of this study was to analyze adherence to antidepressants in Korean elderly patients with major depressive disorder. Method: A retrospective study was conducted using the Korean National Health Insurance claims database, and the subjects of this study were patients aged 65 or older who received at least one prescription of antidepressant monotherapy for the treatment of major depressive disorder between January 1, 2020 and June 30, 2020. Adherence was measured using the proportion of days covered at 6 months after the initial antidepressant prescription date. Logistic regression analysis was used to identify factors associated with adherence. Results: A total of 416,766 patients were finally included in the study. Over half of patients were non-adherent (52.67%) to antidepressants. According to the multivariate logistic regression analysis, national health insurance or medical aid, taking selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors, and having comorbidities were significantly associated with greater rates of adherence in the study subjects. The highest adherence rate was observed in patients taking vortioxetine. Conclusion: There was a considerable rate of non-adherence in Korean elderly patients with major depressive disorder. Health care professionals should try to improve adherence in elderly patients with major depressive disorder.

• 대한지역사회영양학회지
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• 제3권1호
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• pp.76-93
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• 1998

Three hundred sixty-two(male 131, female 231) elderly aged over 65 in Chungb- uk area were interviewed to determine the disease states and drug usage patterns. The prebalence of disease was 78% and women reported more chronic diseases(83%) than men(71%). Elderly who live with spouse and have an occupation have a lower rate of disease. Average number of diseases of the elderly was $1.8\pm{1.1}$, and women$(2.1\pm{1.3)}$ have significantly higher average number of diseases than that of men$(1.4\pm{0.7)}$. Also the elderly in urban areas$(2.1\pm{1.4)}$ have significantly higher number of diseases than that of the elderly in rural areas$(1.6\pm{0.9)}$. Arthritis, hypertension, cardiovascular and gastric diseases were the most frequently listed chronic diseases in order for both men and women. Anemia and fracture of bone were relatively higher in women than in men. Particularly, the arthritis of the urban elderly have a rate of 1.5 times higher than that of the rural elderly. Fifty-two percent of the elderly were currently using drugs ; among drug users 71.2% used prescription drugs and 20.5% used nonprescription drugs. The average number taken per person was 2.1$\pm$1.4 and there was no sex or age difference. However, the elderly in rural areas $(2.7\pm{1.7)}$ consumed a significantly higher number of drugs than those in urban areas$(1.7\pm{0.7)}$. The average number of prescripti- on drugs taken was 2.0$\pm$1.4 while the average of nonprescription drugs taken was $(1.3\pm{0.6)}$. Analgesics and antihypertensive drugs were most commonly used. Vitamin and analgesics were the most frequently used self-prescribed drugs. It was noted that potential adverse drug interaction by concominant drug consumption for arthritis and antihypensive drug, abuse of digestants and antiacid without treatment of the underlying disease, and misuse of quick-acting bowel medications were problematic for the elderly. In addition drugs used for the elderly have some adverse effect on the digestive system. The types and composition of drugs used by the elderly were identified and presented. Medication compliance was poor and 13.5% reported adverse reactions such as edema, heartburn, nausea, and difficulty with eating. Seventeen percent of the elderly obtained drugs arranged by those other than medical staff. Also, even among those elderly who obtained drugs prescribed by a doctor, 69.1% of subjects had not receive instruction about potential adverse reactions. These results suggest that nutritional problems related to drug usage might exist and so dietitians, either individually or as members of health teams, need to have a better understanding of drug-nutrient interaction and closer supervision, and drug information/education service should therefore be provided to prevent or minimize adverse drug reaction in elderly users of medication.

• 음성과학
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• 제13권4호
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• pp.177-186
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• 2006

In an effort to enhance the quality of feature vector classification and thereby reduce the recognition error rate of the speaker-independent speech recognition, we employ the Mahalanobis distance in the calculation of the similarity measure between feature vectors. It is assumed that the metric matrix of the Mahalanobis distance be diagonal for the sake of cost reduction in memory and time of calculation. We propose that the diagonal elements be given in terms of the variations of the feature vector components. Geometrically, this prescription tends to redistribute the set of data in the shape of a hypersphere in the feature vector space. The idea is applied to the speech recognition by hidden Markov model with fuzzy vector quantization. The result shows that the recognition is improved by an appropriate choice of the relevant adjustable parameter. The Viterbi score difference of the two winners in the recognition test shows that the general behavior is in accord with that of the recognition error rate.

• 대한안전경영과학회지
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• 제19권1호
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• pp.87-94
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• 2017

In construction work, safety accidents often occur in combination with unstable physical and human conditions during preparation and execution of work. In Korea, the accident rate is higher to that of any country in the world. Therefore, it is necessary to take measures by fundamental prescription. In this paper, in the case of construction safety management, we tried to find a reasonable alternative through a questionnaire survey to apply to subcontracting and small-scale construction. In conclusion, workers who are well aware of the task could be able to reduce the accident rate by deploying them as safety management officers after receiving the training.

• Journal of Crop Science and Biotechnology
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• 제11권2호
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• pp.141-150
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• 2008

The response of grain yield(GY) and milled-rice protein content(PC) to crop growth status and nitrogen(N) rates at panicle initiation stage(PIS) is critical information for prescribing topdress N rate at PIS(Npi) for target GY and PC. Three split-split-plot experiments including various N treatments and rice cultivars were conducted in Experimental Farm, Seoul National University, Korea in 2003-2005. Shoot N density(SND, g N in shoot $m^{-2}$) and canopy reflectance were measured before N application at PIS, and GY, PC, and SND were measured at harvest. Data from the first two years(2003-2004) were used for calibrating the predictive models for GY, PC, and SND accumulated from PIS to harvest using SND at PIS and Npi by multiple stepwise regression. After that the calibrated models were used for calculating N requirement at PIS for each of nine plots based on the target PC of 6.8% and the values of SND at PIS that was estimated by canopy reflectance method in the 2005 experiment. The result showed that SND at PIS in combination with Npi were successful to predict GY, PC, and SND from PIS to harvest in the calibration dataset with the coefficients of determination ($R^2$) of 0.87, 0.73, and 0.82 and the relative errors in prediction(REP, %) of 5.5, 4.3, and 21.1%, respectively. In general, the calibrated model equations showed a little lower performance in calculating GY, PC, and SND in the validation dataset(data from 2005) but REP ranging from 3.3% for PC and 13.9% for SND accumulated from PIS to harvest was acceptable. Nitrogen rate prescription treatment(PRT) for the target PC of 6.8% reduced the coefficient of variation in PC from 4.6% in the fixed rate treatment(FRT, 3.6g N $m^{-2}$) to 2.4% in PRT and the average PC of PRT was 6.78%, being very close to the target PC of 6.8%. In addition, PRT increased GY by 42.1 $gm^{-2}$ while Npi increased by 0.63 $gm^{-2}$ compared to the FRT, resulting in high agronomic N-use efficiency of 68.8 kg grain from additional kg N. The high agronomic N-use efficiency might have resulted from the higher response of grain yield to the applied N in the prescribed N rate treatment because N rate was prescribed based on the crop growth and N status of each plot.