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검색결과 1,954건 처리시간 0.029초

임종 전 말기 암 환자의 임상 증상 및 징후의 변화 (Clinical Change of Terminally Ill Cancer Patients at the End-of-life Time)

  • 고수진;이경식;홍영선;유양숙;박혜자
    • Journal of Hospice and Palliative Care
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    • 제11권2호
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    • pp.99-105
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    • 2008
  • 목적: 본 연구에서는 호스피스 병동에 입원한 말기 암 환자들을 대상으로 임상적으로 보다 정확한 잔여 수명을 예측하고자 임종의 시기에 객관적으로 임상적 증상 및 징후들의 변화를 관찰하였다. 방법: 강남성모병원 호스피스센터를 방분한 말기 암 환자를 대상으로 입원 시부터 임종까지 말기에 흔히 나타나는 증상과 신체적 징후의 변화를 관찰하였다. 증상의 정도는 $0{\sim}3$점수화하였으며 신체적 징후는 있다 또는 없다로 구분하였다. 이밖에 활력증후와 통증 정도, 진통제 사용을 관찰하였다. 결과: 호흡곤란, 혼수의 증상은 입원 시와 비교해서 임종 $1{\sim}2$일 전에 악화되었다. 대상자의 활동 수행 능력은 임종 시간이 가까워질수록 점진적으로 감소하였고, 섭취량과 소변 배설량도 줄어들었다. 특히 임종 $1{\sim}2$2일 전부터 현저하게 혈압이 감소하였다. 임종 시점을 기준으로 시기에 따라 증상의 변화가 유의하게 나타난 임상 지표는 활동수행 능력, 수축기 혈압, 구강건조증, 식욕저하, 쇠약감, 변비, 황달, 부종, 욕창, 호흡곤란, 진정, 혼수, 청색증, 호흡이상, 가래 끓는 소리, 눈을 뒤로 젖힘 등이었다. 결론: 말기 암 환자에서 수축기 혈압의 감소, 호흡곤란, 진정, 혼수, 청색증, 호흡이상, 가래 끓는 소리, 눈을 뒤로 젖힘 등의 증상이 나타나면 임종이 임박했음을 예상하여 가족들과 환자가 준비할 수 있도록 해야 하며, 의료진도 임종에 관한 돌봄을 시행하도록 해야 한다.

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일부(一部) 도시(都市) 영세지역(零細地域)의 보건실태(保健實態) (Health Status in Urban Slum Area)

  • 장임원;정규철
    • Journal of Preventive Medicine and Public Health
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    • 제10권1호
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    • pp.3-15
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    • 1977
  • In order to find out health problems among inhabitants in slum areas in Kwanak-Ku, Seoul, a series of health survey was conducted upon 510 households by interview from March to December, 1976. The results obtained were as follows: 1. Employments of householders were unstable; Out of 508 householders, 164(32.3%) were unemployed and 184 (36.2%) were daily or temporary employees. 2. Average number of households per house was 2.0 and average area of residential room per person was $4.0m^2$. 3. 476(93.3%) out of 510 households were supplied with tap water and rest of them made use of ground water as a source of drinking water. 4. Only 279(18.3%) out of 1527 live births were delivered at medical facilities, 496(32.7%) were at home attended by doctors or midwives and 358(25.1%) took prenatal care. The above findings were worse in urban slum area than in other urban area of relatively high economic level, but were better than in rural area of less medical facilities. 5. Initiation of treatment were delayed until their illnesses were advanced in most of the households, 472(92.5%) out 510. In the early stage of the illness, 131(25.6%) of the house-holds sought physicians in their clinics or general hospitals and 250 (40.9%) visited chemists, to toy drugs at first hand. Frequency of visits to physician increased to 52.8% as the disease aggravated in later stages. 6. Cost of medical expenditure per household amounted to 815 won, and was paid to, in the order of chemists, physicians, chinese herb stores, chinese herb doctors. 7. Concerning the health knowledge of the inhabitants, 273(53.9%) out of 506 respondents were aware of the infectivity of pulmonary tuberculosis, and 68(13.4%) of them checked regularly their chest findings by X-ray at least once every two years. 8. As for the family planning, although 448(87.3%) out of 510 respondents were in favor of it, 215 (41.8%) of them were actually practicing contraception. 9. About 40.6% (125 respondents) of them obtained information and knowledge concerning contraception through personal contact with family planning workers. 10. Nutritional status of housewives was generally poor: 49(38.3%) out of 128 housewives were found to be anemic and average serum protein level was $7.5{\pm}0.82g/dl$.

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Analysis of influential factors on respiratory symptoms of nail shop workers

  • Kim, Jung-ae;Kim, Su-min
    • International Journal of Advanced Culture Technology
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    • 제5권3호
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    • pp.24-34
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    • 2017
  • Nail art is a kind of nail painting or decoration that adds to the beauty. Throughout making nail art, the worker was on a dusty operation with the smoothing of chemicals and nails. People working at nail shops not only use a variety of chemicals, but also experience a lot of fine powder during the process of nail trimmings. While drying the chemical adhesive, the workers often complain of eye, nose and throat discomfort. In addition, the acrylic brush is characterized by a lot of smell when washed with washing solution. Also nail art workers directly influence the worker's breathing through the work done by placing the guest's hands in a work space called a nail table. Chemical ingredients used in nail art procedures include acetone, ethyl acetic acid, toluene, butyl acetic acid, glue, and top coating of nail varnishes. Prolonged inhalation of these substances may cause dizziness, vomiting, as well as impaired respiratory system. The purpose of this study is to investigate the respiratory symptoms of nail shop workers who are likely to be affected by work in nail shop and to find out which factors have the greatest influence if they have respiratory symptoms. Therefore this study is to provide basic data on the health management system of people engaged in nail shop and to develop health education program. For this study, the data collection was collected on July 7, 2017 for the nail shop workers attending the nail art trend seminar held in Gwangju, in Korea. The data were all 236. However, except for the poor data, 208 data were used for the final analysis. The questionnaire consisted of 30 in general questions, questions about self-efficacy in 24 questions. elf-efficacy measuring tool developed by A.Y, Kim, I. Y, Park(2001). The self-efficacy questionnaire consists of 24 items and is self-reported 7-point Likert scale. The reliability of this tool was cronbach alpha = .934.The collected data were analyzed using spss 18.0. Information of Research participant performed frequency analysis. To examine the effects of personal characteristics on self-efficacy, $X^2$ analysis was conducted. And also $X^2$ analysis was conducted to analyze the coughing symptom appearance according to individual and environmental factors. A hierarchical regression analysis was used to determine which of the personal and environmental factors influenced cough symptoms.

일부 농촌지역주민의 보건의식과 일차의료 이용 실태에 관한 조사 (A Study on the Awareness of Health and the Utilization of Primary Health Care in Rural Areas)

  • 위자형;곽정옥
    • 농촌의학ㆍ지역보건
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    • 제20권1호
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    • pp.51-60
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    • 1995
  • This study was to examine the awareness of health and the utilization of primary health care in rural areas. The data were obtained from self-administered questionnaire conducted 450 parents of Mi Gum md Su Dong middle school students in Nam yang Ju city, Kyung Gi-Do, Korea, from December 15 to 20 in 1993. The results were as follows : 1) Among the causes of disease, 'insufficient health care' was the highest(39.1%), and 'bad environment'(28.9%), 'complexity of life style'(17.8%) in next order. 2) In the priority between 'daily farm work' and 'primary health care', only 45.6% of respondents answered that primary health care is more important than the daily farm work. The 29.8% of respondents answered 'daily farm work', and the 23.1% answered 'the equal of the both'. 3) The 63.6% of the respondents recognized correctly, the meaning of primary health care. And the rate of information source in primary health care were 'TV and Radio'(42.2%), 'medical facilities'(23.3%), and 'newspaper and magazine'(11.3%) in order. 4) In the choice rate of medical facilities for primary health care, 'drug store' was the highest(34.9%), and 'local private clinic'(34.7%), 'health (sub)center'(15.8%), 'hospital'(10.2%) in next order. 5) The 53.5% of the respondents had experienced to visit the health (sub)center more than once. And the disfavorite reasons of health (sub)center were 'insufficient equipment'(36.7%), 'inavailable time to visit'(26.9%), and 'poor treatment'(9.1%). 6) Among the preference of the physicians for primary health care, 'specialist' was the highest rate of the respondents(54.2%), and 'general practitioner'(32.4%), and 'family doctor'(9.8%) in next order. The major obstacles in utilizing the medical facilities for primary health care were 'daily farm work'(41.6%), 'distance'(21.1%) and 'medical cost'(10.4%) in order. 7) The weakened reasons in health (sub)center function were 'insufficient medical equipment'(44.4%), 'the lack of resident's understanding for health (sub)center'(21.8%), and 'short thought of duty in health (sub)center personnel'(16.9%) in order.

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정교한 클럭 게이팅을 이용한 저전력 재구성 가능한 DSP 설계 (Design of a Low Power Reconfigurable DSP with Fine-Grained Clock Gating)

  • 정찬민;이영근;정기석
    • 대한전자공학회논문지SD
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    • 제45권2호
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    • pp.82-92
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    • 2008
  • 최근 많은 임베디드 시스템에서 통신이나 멀티미디어의 다양한 표준을 지원해야 하는 요구가 끊이지 않고 있다. 그러나 현실적으로 임베디드 시스템에서 요구하는 만큼의 표준이나 프로토콜을 위한 별개의 가속 IP들을 갖는 것은 불가능할 뿐만 아니라 상당히 힘든 작업이다. 그러므로 다양한 표준을 지원할 수 있는 가속 IP를 개발하는 것은 위와 같은 현재의 임베디드 시스템에서 요구하는 트렌드에 있어 중요하다 할 수 있다. 다양한 기능을 수행하는 하드웨어는 일반적으로 실행 환경이나 시스템 설정에 따라 다양한 기능들을 지원하기 위하여 동적으로 즉, 실행시간에 재구성 가능한 DSP를 사용하고 있다. 그러나 하나의 IP가 다양한 기능을 수행시키기 위해서는 필수불가결적으로 추가적인 면적을 차지하거나 추가적인 전력소모가 따른다. 그러므로 본 논문에서는 동적으로 재구성 가능한 하드웨어의 파워 소모를 줄이기 위해 정교한 클럭 게이팅을 사용하였고 또한 동적으로 재구성 가능한 하드웨어의 면적을 줄이기 위해 배럴 시프터(barrel shifter)를 이용한 곱셈기를 사용하여 메모리의 계수(Coefficient) 부분을 압축을 통해 메모리의 면적을 줄였다. 실행시간에 재구성 가능한 IP는 유사하지만 다른 기능들을 효과적으로 수행하기 때문에 이런 다기능 재구성 가능한 DSP IP의 전력소모를 성능에 영향 없이 줄이는 것은 상당히 난해한 일이다. 본 논문에서 제안한 정교한 클럭 게이팅은 동적으로 재구성 가능한 시스템에 아주 효율적으로 적용되었고 효과적인 결과를 도출하였다. 실험 결과는 본 논문에서 제시한 기법을 사용했을 시 사용하지 않았을 경우보다 최대 24%정도의 파워 절감 효과를 얻을 수 있었다. 또한 면적을 줄이기 위해서 기존의 일반적인 곱셈기를 사용하는 대신에 배럴 시프터(barrel shifter)를 이용한 곱셈기를 설계해 적용하였다. 기존 곱셈기를 제안한 곱셈기로 바꾸면 설계한 재구성 가능한 DSP의 구조상 많은 면적을 줄이는 것이 가능했다. 기존 곱셈기에 비해 제안된 곱셈기는 면적은 42%가 줄었으며, 전체적인 재구성 가능한 DSP의 면적에서 14% 감소한 결과를 도출하였다. 그러므로 본 논문은 재구성 가능한 특성을 갖는 IP의 단점인 파워 소모와 추가적인 면적을 효과적으로 보완한 면에 있어 큰 의의가 있다고 할 수 있다.

아동의 전정-고유감각 중심의 감각통합중재 효과에 대한 체계적 고찰: 국내연구를 중심으로 (A Systematic Review of Effects on Sensory Integration Intervention Based on Vestibular-Proprioceptive System for Children in Korea)

  • 박영주;공인주
    • 대한감각통합치료학회지
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    • 제13권2호
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    • pp.53-61
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    • 2015
  • 목적 : 아동을 대상으로 국내에서 실시하는 전정-고유감각 중심의 감각통합중재의 효과를 알아보기 위해 체계적 고찰을 사용하여 근거를 제시하고자 하였다. 연구방법 : 본 연구는 2015년 8~9월 동안 한국학술정보(KISS), 학술연구정보서비스(RISS), 누리미디어(DBpia)의 데이터베이스에서 '감각통합중재', '감각통합치료', '전정-고유감각'을 키워드로 검색하여 최종적으로 7개의 연구를 선정하였다. 각 연구는 근거의 질적 수준과 방법론적 질적 수준으로 분석하였고 그 결과는 연구 설계와 대상자, 중재, 결과측정, 결과에 따라 분석하였다. 결과 : 분석에 포함된 연구의 근거수준은 수준 III이 5개, 수준 IV가 1개, 그리고 수준 V가 1개이었다. Down과 Black의 기준에 따라 대상 연구의 방법론적 질을 살펴보면, '완벽'과 '우수'는 0개, '보통'은 2개, '나쁨'은 5개이었다. 발달지연을 대상으로 한 단일대상연구가 가장 많았고 결과측정은 운동영역에 대한 평가요소 빈도가 가장 높았으며 결과는 평가영역에 대한 긍정적인 향상이나 긍정적인 감소를 보였다. 결론 : 국내 전정-고유감각 중심의 감각통합중재의 특징을 제시하여 관련 분야 전문가들이 이에 대한 정보를 활용할 수 있도록 도움을 주고자 하였다. 앞으로 감각통합 중재에 대해 높은 근거 수준과 다양한 실험설계를 바탕으로 한 연구가 필요하다.

Passive Smoking and Breast Cancer - a Suspicious Link

  • Malik, Abhidha;Jeyaraj, Pamela Alice;Shankar, Abhishek;Rath, Goura Kishore;Mukhopadhyay, Sandip;Kamal, Vineet Kumar
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권14호
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    • pp.5715-5719
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    • 2015
  • Background: Breast cancer is the most common malignancy of women in the world. The disease is caused by infectious and non-infectious, environmental and lifestyle factors. Tobacco smoke has been one of the most widely studied environmental factors wiith possible relevance to breast cancer. The purpose of this study was to assess the impact of tobacco smoking in breast cancer patients in a hospital based cohort and to establish prognostic implications if any. Materials and Methods: A retrospective audit of 100 women with pathological diagnosis of invasive breast cancer was included in this study. The verbal questionnaire elicited information on current and previous history of exposure to smoking in addition to active smoking. All analyses were adjusted for potential confounders, including stage at presentation, alcohol intake, hormonal replacement therapy, oral contraceptive intake, obesity and menopausal status. Results: The mean age at presentation of breast cancer was $51.4{\pm}10.86$ years. Mean age of presentation was $53.1{\pm}11.5$ and $45.7{\pm}11.9$ years in never smokers and passive smokers, respectively. Age at presentation varied widely in patients exposed to tobacco smoke for >10 years in childhood from $40.3{\pm}12.0$ years to $47.7{\pm}13.9$ in patients exposed for > 20years as adults. Among passive smokers, 60.9% were premenopausal and 39.1% of patients were postmenopausal. In never smokers, 71.4% were post menopausal. Expression of receptors in non-smokers vs passive smokers was comparable with no significant differences. Metastatic potential in lung parenchyma was slightlyelevated in passive smokers as compared to never smokers although statistically non-significant. Conclusions: An inverse relationship exists between the intensity and duration of smoking and the age at presentation and poor prognostic factors. The results strongly suggest efforts should be taken to prevent smoking, encourage quitting and restrict exposure to second hand smoke in India.

Survival Rate and Prognostic Factors of Esophageal Cancer in East Azerbaijan Province, North-west of Iran

  • Mirinezhad, Seyed Kazem;Somi, Mohammad Hossein;Jangjoo, Amir Ghasemi;Seyednezhad, Farshad;Dastgiri, Saeed;Mohammadzadeh, Mohammad;Naseri, Ali Reza;Nasiri, Behnam
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권7호
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    • pp.3451-3454
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    • 2012
  • Background: Esophageal cancer in Iran is the sixth most common cancer and is particularly important in east Azerbaijan. The aim of this study was to calculate survival rates and define prognostic factors in esophageal cancer patients. Methods: In this study, all patients with esophageal cancer registered in the Radiation Therapy Center, during March 2006 to March 2011, were analyzed and followed up for vital status. Data were analyzed using the Kaplan-Meier method and the Cox proportional hazard models. Results: Out of 532 patients, survival information was available for 460, including 205 (44/ 5%) females and 255 (55/4%) males. The mean age was $65.8{\pm}12.2$, ranging from 29 to 90 years at the time of diagnosis. 1-, 3- and 5-year survival rates after diagnosis were 55%, 18% and 12%, respectively, with a median survival time of $13.2{\pm}.7$ (CI 95% =11.8-14.6) months. In the univariate analysis, age (P=0/001), education (P=0/001), smoking status (P= 0/001), surgery (P= 0/001), tumor differentiation (P= 0/003) and tumor stage (P= 0/001) were significant prognostic factors. Tumor morphology, sex, place of residence, tumor histology and tumor location did not show any significant effects on the survival rate. In multivariate analysis, age (P = 0/003), smoking (P= 0/01) and tumor stage (P= 0/001) were significant independent predictors of survival. Conclusion: In summary, prognosis of esophageal cancer in North West of Iran is poor. Therefore, reduction in exposure to risk factors and early detection should be emphasized to improve survival.

CYP2C19 Genotype Could be a Predictive Factor for Aggressive Manifestations of Hepatocellular Carcinoma Related with Chronic Hepatitis B Infection in Thailand

  • Nun-anan, Pongjarat;Chonprasertsuk, Soonthorn;Siramolpiwat, Sith;Tangaroonsanti, Anupong;Bhanthumkomol, Patommatat;Pornthisarn, Bubpha;Vilaichone, Ratha-korn
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권8호
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    • pp.3253-3256
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    • 2015
  • Background: Chronic hepatitis B virus (HBV) infection related hepatocellular carcinoma (HCC) is a major health problem in the Asia-Pacific region including Thailand. Several factors have been proposed as contributing to hepatocarcinogenesis. This study was aimed to investigate the impact of CYP2C19 genotypic polymorphism in HCC related to chronic HBV infection in Thailand. Materials and Methods: A cross-sectional study was performed between April 2014 and January 2015. Chronic HBV patients with HCC (n=50) and without HCC (n=50) were included. Clinical information and blood samples of all patients were collected. The CYP2C19 genotype was determined by polymerase chain reaction-restriction fragment length polymorphism method, and was classified as rapid metabolizer (RM), intermediate metabolizer (IM) or poor metabolizer (PM). Results: The CYP2C19 genotype frequencies of RM, IM and PM in HBV patients were found to be 19/50 (38%), 25/50 (50%) and 6/50 (12%), respectively. The CYP2C19 genotype frequencies of RM, IM and PM in HBV with HCC patients were 21/50 (42%), 25/50 (50%) and 4/50 (8%), respectively. The distribution of CYP2C19 genotype was not different between patients with and without HCC. Interestingly, among HBV with HCC patients, the RM genotype of CYP2C19 tended to increase risk of aggressive manifestation (OR=2.89, 95%CI=0.76-11.25, P-value=0.07), compared with non RM genotype carriers. Conclusions: CYP2C19 genotype IM was the most common genotype in Thai patients with chronic HBV infection. In addition, genotype RM could be an associated factor for aggressive presentation in HCC related to chronic HBV infection.

Awareness and Knowledge of Oral Cancer and Potentially Malignant Oral Disorders among Dental Patients in Far North Queensland, Australia

  • Formosa, Joseph;Jenner, Rachel;Nguyen-Thi, My-Duyen;Stephens, Caitlin;Wilson, Corey;Ariyawardana, Anura
    • Asian Pacific Journal of Cancer Prevention
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    • 제16권10호
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    • pp.4429-4434
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    • 2015
  • Background: Public awareness/knowledge on oral and pharyngeal cancer (OPC), potentially malignant disorders (PMODs) and their risk factors is crucial for prevention and early detection of OPC and PMODs. Yet, there are no published data available on the awareness and knowledge of OPC and PMODs among people living in Far North Queensland, Australia. Materials and Methods: This study was conducted as a cross sectional survey. A self-administered questionnaire was designed and consisted of relevant questions to ascertain socio-demographic information, awareness and knowledge of OPC, PMODs and risk factors and questions on participant's exposure to risk factors and dietary history were also included. Survey was carried out at the Dental Clinic of the James Cook University School of Dentistry (JCU Dental), Cairns, Australia. Subjects above the age of 20 years (n=366) were randomly selected during the period from 31st July to 6th September 2013 and questionnaire was distributed to complete while they are waiting for treatment. Data analysis was carried out using SPSS version 21 and the chi -squared test was employed to compare groups. P<0.05 was considered statistically significant. Results: The study revealed that 52.3% of the respondents were aware of the existence of OPC but only 19.0% were aware of PMODs. Of those who were aware of oral cancer, 92% agreed or strongly agreed that smoking is a strong risk factor for OPC. Similarly a relatively high proportion of the respondents agreed or strongly agreed that tobacco chewing (84%), tobacco chewing with areca nut (68%), chewing areca nut alone (51%) and exposure to actinic radiation (71%) as risk factors. However, the results for alcohol intake, age, and HPV infection were found to be relatively poor with proportions 33%, 34%, and 23% respectively. Conclusions: This study revealed an alarming lack of awareness and knowledge of OPC and PMODs.