• Title/Summary/Keyword: Multiple chronic conditions

검색결과 53건 처리시간 0.025초

Juvenile idiopathic arthritis: Diagnosis and differential diagnosis

  • Kim, Ki-Hwan;Kim, Dong-Soo
    • Clinical and Experimental Pediatrics
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    • 제53권11호
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    • pp.931-935
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    • 2010
  • Juvenile idiopathic arthritis (JIA) is comprised of a heterogeneous group of several disease subtypes that are characterized by the onset of arthritis before the age of 16 years and has symptoms lasting at least 6 weeks. The previous classification of JIA included seven different categories, whereas its current classification was compiled by the International League of the Association for Rheumatology, and replaced the previous terms of "juvenile chronic arthritis" and "juvenile rheumatoid arthritis," which were used in Europe or North America, respectively, with the single nomenclature of JIA. As mentioned above, JIA is defined as arthritis of unknown etiology that manifests itself before the age of 16 years and persists for at least 6 weeks, while excluding other known conditions. The clinical symptoms of JIA can be quite variable. Several symptoms that are characteristic of arthritis are not necessarily diagnostic of JIA and may have multiple etiologies that can be differentiated with careful examination of patient history. The disease may develop over days or sometimes weeks, thereby making the diagnosis difficult at the time of presentation. To make a clinical diagnosis of JIA, the first step is to exclude arthritis with known etiologies. Of note, late treatment due to excessive delay of diagnosis can cause severe damage to joints and other organs and impair skeletal maturation. Therefore, early detection of JIA is critical to ensure prompt treatment and to prevent long-term complications including the likelihood of disability in childhood.

Adolescent nutrition: what do pediatricians do?

  • Ryoo, Eell
    • Clinical and Experimental Pediatrics
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    • 제54권7호
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    • pp.287-291
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    • 2011
  • Multiple psychosocial problems and many chronic diseases of adulthood can be influenced by adolescent nutritional problems. In Korea, adolescent obesity and obesity related health risks have been increased and insufficient intakes of nutrients, such as calcium, iron and potassium, and distorted thinking about obesity are also common. However there are no comprehensive countermeasure because of the excessive burden of studies and the lack of community interest. And the nutrition guidelines that is suitable for Korean adolescent leaves something to be desired, and the pediatrician's concern is lacking yet. In the Korean dietary reference intakes 2010 that was revised according to the 2007 Korean National Growth Chart and 2007 Korean National Health and Nutrition Examination Survey, the range for adolescents is changed to the age 12-18 and dietary reference intakes of some nutrients mainly with vitamin D is changed. Recently several researches, about how school nutrition policies and media effect on eating habits and the weight concerns, and influences of public nutrition policies and fast food commercials have been actively studied to improve adolescent nutritive conditions. In this review, I summarize the dietary reference intakes for Korean adolescents that were revised in 2010, and current studies about the adolescent nutrition.

의료의 질 향상을 위한 환자중심 건강결과 측정의 국제 동향과 국내 시사점 - OECD PaRIS를 중심으로 (International Trends on Patient-Reported Outcome Measures for Improving Care Quality and Its Implication for South Korea: Focus on OECD PaRIS)

  • 최지숙;박영신;김지애;박춘선
    • 한국의료질향상학회지
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    • 제25권1호
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    • pp.11-28
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    • 2019
  • Purpose: The purpose of this paper is to derive implication on the adoption of PROMs (Patient-Reported Outcome Measures) to improve quality of care in South Korea. With this purpose, the paper examines the status of PROMs in South Korea and other countries including OECD's PaRIS (Patient Reported Indicators Survey) initiative, and reviews policy cases that have adopted PROMs to improve performance of healthcare system. Methods: We conducted literature review on OECD reports on PaRIS, peer-reviewed journals, and information from the websites of relevant institutions such as ICHOM, NQF and OECD. Results: To identify healthcare services of best values and support patient-centered health system, OECD has initiated PaRIS which develops, collects and analyzes patient-reported indicators for cross-countries comparison. PaRIS is implemented on two work streams: 1) collect, validate and standardize PROMs in the areas where patient-reported indicators already exist such as breast cancers, hip and knee replacement, and mental conditions, 2) develop a new international survey on multiple chronic conditions. Countries like England, U.S., Sweden and Netherlands use PROMs for measuring performance of hospitals and performance evaluation at the national level, and provide the financial incentives for reporting PROMs. Conclusions: The use of PROMs can support the current policy agenda that is the patient-centered healthcare system which has been emphasized to reinforce the primary and the community-based care. For the use of PROMs, it is recommended to actively participate in PaRIS initiative by OECD, select appropriate instruments for PROMs, and continue on standardization of them. This will assure patients' involvement in improving health system performance, systemize information generated in the process of adopting PROMs, and develop a system to evaluate performance.

RDW를 이용한 빈혈의 재분류 (Modified Classification of Anemia by ROW)

  • 황형기;현명수;심봉섭
    • Journal of Yeungnam Medical Science
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    • 제10권1호
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    • pp.58-67
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    • 1993
  • 1986년 5월부터 1991년 6월까지 약 5년간 영남대학교 외과대학 부속병원에 내원하여 혈액학적 소견상 빈혈이 동반된 환자 210명과 정상인 200명 도합 410명을 대상으로 Coulter Counter S-plus II로 일반혈액검사를 실시하여 MCV와 RDW 및 여러 적혈구 지수를 얻어서 빈혈의 새로운 분류를 시도하였고 외국인에 비하여 빈혈의 병인 양상이 다른 한국인의 혈액질환의 감별진단에 도움이 되는 가를 알아 보고자 본 연구를 시행하였다. 거의 모든 경우에 MCV의 증감은 MCH와 MCHC의 증감을 동반하였으나 RDW와는 무관하였다. 따라서 저색소성빈혈 혹은 정색소성빈혈등의 용어보다는 이질성빈혈 혹은 동질성빈혈의 용어를 사용함이 빈혈의 형태학적 분류에 더욱 의미있는 것으로 사료되었다. 이질성소구성빈혈에는 철결핍성빈혈이 속하였고 이질성정구성빈혈에는 급성백혈병과 골수로성빈혈이 여기에 속하였으며 이질성대구성빈혈에는 거대적아구성빈혈과 용혈성빈혈이 속하였다. 동질성소구성빈혈에는 만성질환에 의한 빈혈이 여기에 속하였으며 동질성정구성빈혈에는 급성출혈, 만성백혈병 및 다발성 골수종등에 의한 빈혈이 여기에 속하고 동질성대구성빈혈에는 재생활량성빈혈이 여기에 속하였다. 진단적인 의의가 큰 혈색소병은 본 연구에는 관찰되지 않았지만 한국인에 가장 많은 빈혈의 원인인 철결핍성빈혈과 만성질환에 의한 빈혈의 감별진단에 RDW가 유용한 것으로 생각되었다.

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한국인과 재미동포간의 건강증진행태의 차이에 관한 연구 (Study on a Difference of Health Behavior and Health Promotion between Korean American and Korean)

  • 이윤현
    • 한국학교ㆍ지역보건교육학회지
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    • 제20권3호
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    • pp.67-82
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    • 2019
  • Objectives: The purpose of this study is to analyze how the different lifestyles between Koreans and Korean Americans have significant effects on their health. Despite being the same race, Koreans and Korean Americans have different health conditions and health attitudes due to the acquired environmental factors such as social-economic factors, lifestyle risk factors, healthcare systems, and medical utilization. It is crucial to examine how the different lifestyle habits between Koreans and Korean Americans lead to various health conditions for establishing an effective health promotion policy. Methods: In this study, a comparative analysis was conducted using the National Health and Nutrition Survey of Korea and CHIS data of the United States in 2005 and 2015 to provide valuable insights when establishing such a policy. Results: The specific research purpose is as follows: First, socioeconomic factors, such as (1)living habits risk factors, (2)health satisfaction levels, (3)disease outbreaks, and (4)medical uses, are analyzed to find the distinct characteristics among Koreans, Korean Americans, and Americans. Second, the three groups --Koreans, Korean Americans, and Americans-- were compared based on their exposure to disease-related lifestyle risk factors related to their body mass index and their general health condition. The research results are as follows: First, all three groups improved health conditions in 2015 better than in 2005. Koreans maintained relatively higher general health conditions compared to other groups: their prevalence rate of chronic diseases such as diabetes, high blood pressure, heart disease, and asthma was lower than that of U.S. residents. Second, in regards to health behavior factors, the lifetime smoking experience for Koreans and Americans both decreased in 2015 compared to 2005, while the lifetime smoking experience for Korean Americans increased slightly. The number of smokers for Koreans has greatly decreased over a decade while that of Americans has moderately increased. Third, according to the results of the multiple regression, the general health conditions, which is a dependent variable, suggests that the number of men who answered they are healthy is greater than that of women in Korea, compared to the United States. Conclusions: In conclusion, the acquired environmental factors had more significant impacts on health than the racial factors did. Compared to 2005, the health behaviors and health levels of Korean Americans in 2015 gradually became more similar to those of Americans.

류마티스 관절염 환자에서 Adalimumab 사용 후 발생한 사르코이드증 1예 (Sarcoidosis Induced by Adalimumab in Rheumatoid Arthritis)

  • 이승호;김사일;송준석;김태형;손장원;김상헌;윤호주;김태환;신동호;박성수;곽현정
    • Tuberculosis and Respiratory Diseases
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    • 제71권6호
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    • pp.464-469
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    • 2011
  • Adalimumab is a full human monoclonal antibody that inhibits tumor necrosis factor-alpha (TNF-${\alpha}$). This has recently been shown to be effective in the treatment of rheumatoid arthritis (RA), ankylosing spondylitis, and other conditions. Sacoidosis is known to be the target for adalimumab but we describe a patient who has developed sarcoidosis with lung involvement during adalimumab therapy for RA. A 48-year-old woman, who was treated with adalimumab for 5 months, was admitted because of chronic cough and both hilar lymphadenopathy on chest radiography. Chest computed tomography revealed the enlargement of multiple lymph nodes in the right supraclavicular, subcarinal, both hilar and right axillary area. She was diagnosed with sarcoidosis based on the biopsy of supraclavicular lymph node, skin and lung through video-associated thoracoscopic surgery, which was non-caseating epitheloid cell granuloma and excluded from a similar disease. She was treated for sarcoidosis with prednisolone and methotrexate instead of adalimumab.

The Effect of Bojungykgitang-Chunbang on Activity of CD4+ T cell

  • Lee Tae Hyong;Kang Hee;Myung Eu Gene;Shim Bum Sang;Choi Seung Hoon;Kim Sung Hun;Ahn Kyoo Seok
    • 동의생리병리학회지
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    • 제18권2호
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    • pp.580-585
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    • 2004
  • BJYGC is often clinically used as a treatment of allergic rhinitis. This study was aimed to find out the effect BJYGC would have on the helper T cell, and how it can promote the subsets of helper T cells to regain their balance that they lost due to immunological diseases. Splenocytes were prepared from BALB/c mice was cultured without stimulation in the presence of BJYGC for 48 hr. The viability of CD4 T cells from Balb/c mouse were measured at various concentrations of BJYGC using the MTS assay. It was somewhat increased up to concentration of 400 ㎍/ml, but did not show any significant difference. Proliferation was measured using the MTS assay, CD4 Th cells were stimulated with anti-CD3/28 in the presence of BJYGC for 48 hr. As evidence for rapid T cell activation, CD25 expression by flow cytometry was evaluated at 10, 50, 100 and 200 ㎍/㎖ of BJYGC. Th cell differentiation experiments were performed to examine whether BJYGC can affect the Th polarization process. CD4 T cells were activated in culture under neutral, Th1-polarized or Th2-polarized conditions in the presence of BJYGC at 10, 100 and 200 ㎍/㎖. Cytokine production was measured by ELISA. This experiment proved that BJYGC could inhibit the secretion of both IL-4 and IFN-γ in neutral condition and polarized condition, too. Considering that BJYGC shows an excellent effect on treating allergies, the author can conclude that its pharmacological action may be associated with decreased IL-4 and, it may also regulate IFN-γ depending the host's need. Also, it was discovered that Th1 cell was pathologic in chronic inflammatory tissue specific diseases, such as insulin dependent diabetes mellitus, multiple sclerosis, RA, and uveitis. We are counting on the BJYGC to be able to control the tendency of Th1 cell predominancy in an immune reaction.

일부 지역사회 경로당 이용 노인의 삶의 질과 관련 요인 (Quality of Life and its Associated Factors among Some Elderly Residents Using a Hall for the Aged in a Community)

  • 임진영;박종;강명근;류소연
    • Journal of Preventive Medicine and Public Health
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    • 제40권5호
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    • pp.337-344
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    • 2007
  • Objectives: This study was performed to investigate the level of quality of life (QOL) and to identify its related factors among the elderly using a hall for the aged. Methods: The study subjects were 350 elderly people living in Nam Gu, Gwangju City. They were interviewed by questionnaire to collect information on social-demographic characteristics, health behaviors, health-related characteristics and QOL. We used statistical analysis methods such as T-test, ANOVA and multiple regression analysis to find which factors affected QOL. Results: The characteristics relating to physical functions were as follows: presence of spouse, education, alcohol drinking, teeth condition, arthritis, frequency of visiting the hall for the aged, and depression. Age, arthritis and depression were significantly related to role limitation due to physical problems. General health was related to gender, age, and depression, and vitality was related to education, frequency of visiting the hall, and depression. Role limitation due to emotional problems was related to age and depression, and mental health was related to age, hypertension, arthritis and depression. Conclusions: This study showed QOL of the elderly was significantly influenced by socio-demographic factors, and physical or emotional conditions. To improve QOL of the elderly, we need to develop programs to promote health and to manage chronic diseases of the elderly.

Copper Ion from Cu2O Crystal Induces AMPK-Mediated Autophagy via Superoxide in Endothelial Cells

  • Seo, Youngsik;Cho, Young-Sik;Huh, Young-Duk;Park, Heonyong
    • Molecules and Cells
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    • 제39권3호
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    • pp.195-203
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    • 2016
  • Copper is an essential element required for a variety of functions exerted by cuproproteins. An alteration of the copper level is associated with multiple pathological conditions including chronic ischemia, atherosclerosis and cancers. Therefore, copper homeostasis, maintained by a combination of two copper ions ($Cu^+$ and $Cu^{2+}$), is critical for health. However, less is known about which of the two copper ions is more toxic or functional in endothelial cells. Cubic-shaped $Cu_2O$ and CuO crystals were prepared to test the role of the two different ions, $Cu^+$ and $Cu^{2+}$, respectively. The $Cu_2O$ crystal was found to have an effect on cell death in endothelial cells whereas CuO had no effect. The $Cu_2O$ crystals appeared to induce p62 degradation, LC3 processing and an elevation of LC3 puncta, important processes for autophagy, but had no effect on apoptosis and necrosis. $Cu_2O$ crystals promote endothelial cell death via autophagy, elevate the level of reactive oxygen species such as superoxide and nitric oxide, and subsequently activate AMP-activated protein kinase (AMPK) through superoxide rather than nitric oxide. Consistently, the AMPK inhibitor Compound C was found to inhibit $Cu_2O$-induced AMPK activation, p62 degradation, and LC3 processing. This study provides insight on the pathophysiologic function of $Cu^+$ ions in the vascular system, where $Cu^+$ induces autophagy while $Cu^{2+}$ has no detected effect.

새 신체활동기준의 동향과 함의 (Features and implication of new physical activity guidelines)

  • 고광욱
    • 보건교육건강증진학회지
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    • 제35권5호
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    • pp.17-24
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    • 2018
  • Objectives: After many national physical activity guidelines have established, recent changes are deep and rapid. So the major features and implication to reverse worsening Korean physical activity indicator is desprate but related knowledge and informations are few. So review of recent features and implications of new physical activity guidelines have made. Methods: National physical activity guidelines of advanced countries were searched through snowballing methods. Major features were described according to the nation. Implication were drew through discussion for Korean realitiy. Results: New Australian physical activity and sedentary behaviour guideline explicitly included sedentary behaviour. The age in the guideline expanded to early years. Canada also presented 24-hour movement guidelines to early years. The second generation of the physical activity guidelines reflects the extensive amount of new knowledge. New aspects include discussions of additional health benefits related to brain health, additional cancer sites, and fall-related injuries; immediate and longer term benefits for how people feel, function, and sleep; further benefits among older adults and people with additional chronic conditions; risks of sedentary behavior and their relationship with physical activity; elimination of the requirement for physical activity benefits to occur in bouts of at least 10 minutes; and tested strategies that can be used to get the population more active. Conclusions: The most important message from the new guidelines is that the greatest health benefits accrue by moving from no, to even small amounts of, physical activity. Multiple studies demonstrate that the steepest reduction in disease risk occurs at the lowest levels of physical activity. People need to understand that even small amounts of physical activity are beneficial and that reductions in the risk of disease and disability occur by simply getting moving. So various evidence based proven strstegies are needed in Korea including workforce training.