• Tuberculosis and Respiratory Diseases
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• v.84 no.1
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• pp.46-54
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• 2021

Background: The aim of this study was to investigate inhaler device handling in elderly patients. Inhaler devices with respect to misuse and error correction were also compared. Methods: Inhaler use technique was assessed using standardized checklists at the first visit and 3-month follow-up visit after retraining. The primary outcome was difference in the acceptable use ratio among inhaler devices. Secondary outcomes included differences in error correction, the most common step of misuse, and factors affecting the accuracy of inhaler use. Results: A total of 251 patients (mean age, 76.4 years) were included. The handling of 320 devices was assessed in the study. All patients had been trained before. However, only 24.7% of them used inhalers correctly. Proportions of acceptable use for Evohaler, Respimat, Turbuhaler, Ellipta, and Breezhaler/Handihaler were 38.7%, 50.0%, 61.4%, 60.8%, and 43.2%, respectively (p=0.026). At the second visit, the acceptable use ratio had increased. There were no significant differences among inhaler types (Evohaler, 63.9%; Respimat, 86.1%; Turbuhaler, 74.3%; Ellipta, 64.6%; and Breezhaler/Handihaler, 65.3% [p=0.129]). In multivariate analysis, body mass index, Turbuhaler, and Ellipta showed positive correlations with acceptable use of inhalers, whereas Chronic Obstructive Pulmonary Disease Assessment Test score showed a negative correlation. Conclusion: Although new inhalers have been developed, the accuracy of inhaler use remains low. Elderly patients showed more errors when using pressurized metered-dose inhalers than using dry powder inhalers and soft-mist inhalers. However, there were no significant differences in misuse among inhaler devices after individual training. Results of this study suggests that repeat training is more important than inhaler type.

• Tuberculosis and Respiratory Diseases
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• v.86 no.2
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• pp.133-141
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• 2023

Background: The present study evaluated the association between participation in a rehabilitation program during a hospital stay and 1-year survival of patients requiring at least 21 days of mechanical ventilation (prolonged mechanical ventilation [PMV]) with various respiratory diseases as their main diagnoses that led to mechanical ventilation. Methods: Retrospective data of 105 patients (71.4% male, mean age 70.1±11.3 years) who received PMV in the past 5 years were analyzed. Rehabilitation included physiotherapy, physical rehabilitation, and dysphagia treatment program that was individually provided by physiatrists. Results: The main diagnosis leading to mechanical ventilation was pneumonia (n=101, 96.2%) and the 1-year survival rate was 33.3% (n=35). One-year survivors had lower Acute Physiology and Chronic Health Evaluation (APACHE) II score (20.2±5.8 vs. 24.2±7.5, p=0.006) and Sequential Organ Failure Assessment score (6.7±5.6 vs. 8.5±2.7, p=0.001) on the day of intubation than non-survivors. More survivors participated in a rehabilitation program during their hospital stays (88.6% vs. 57.1%, p=0.001). The rehabilitation program was an independent factor for 1-year survival based on the Cox proportional hazard model (hazard ratio, 3.513; 95% confidence interval, 1.785 to 6.930; p<0.001) in patients with APACHE II scores ≤23 (a cutoff value based on Youden's index). Conclusion: Our study showed that participation in a rehabilitation program during hospital stay was associated with an improvement of 1-year survival of PMV patients who had less severe illness on the day of intubation.

• Journal of Preventive Medicine and Public Health
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• v.57 no.2
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• pp.185-196
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• 2024

Objectives: Excess mortality associated with long-term exposure to fine particulate matter (PM_2.5) has been documented. However, research on the disease burden following short-term exposure is scarce. We investigated the cause-specific mortality burden of short-term exposure to PM_2.5 by considering the potential non-linear concentration-response relationship in Korea. Methods: Daily cause-specific mortality rates and PM_2.5 exposure levels from 2010 to 2019 were collected for 8 Korean cities and 9 provinces. A generalized additive mixed model was employed to estimate the non-linear relationship between PM_2.5 exposure and cause-specific mortality levels. We assumed no detrimental health effects of PM_2.5 concentrations below 15 ㎍/m³. Overall deaths attributable to short-term PM_2.5 exposure were estimated by summing the daily numbers of excess deaths associated with ambient PM_2.5 exposure. Results: Of the 2 749 704 recorded deaths, 2 453 686 (89.2%) were non-accidental, 591 267 (21.5%) were cardiovascular, and 141 066 (5.1%) were respiratory in nature. A non-linear relationship was observed between all-cause mortality and exposure to PM_2.5 at lag0, whereas linear associations were evident for cause-specific mortalities. Overall, 10 814 all-cause, 7855 non-accidental, 1642 cardiovascular, and 708 respiratory deaths were attributed to short-term exposure to PM_2.5. The estimated number of all-cause excess deaths due to short-term PM_2.5 exposure in 2019 was 1039 (95% confidence interval, 604 to 1472). Conclusions: Our findings indicate an association between short-term PM_2.5 exposure and various mortality rates (all-cause, non-accidental, cardiovascular, and respiratory) in Korea over the period from 2010 to 2019. Consequently, action plans should be developed to reduce deaths attributable to short-term exposure to PM_2.5.

• Journal of Korean Society of Occupational and Environmental Hygiene
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• v.22 no.2
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• pp.100-106
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• 2012

Objectives: Diazinon is an insecticide which acts as a contact stomach and respiratory poison, and used throughout the world to control a wide range of sucking and chewing insects and mites on a range of crops. In this study, the airborne diazinon levels were measured for farmers, pest control operaters, landscapers, and agricultural chemicals sellers, and an assessment of the health risk to the workers was presented. The exposure scenario was based on the route of inhalation and skin absorption. The "OSHA Method No. 62" was used to sample and measure the airborne diazinon levels. The skin wipe method was applied to measure the level of the diazinone exposure through the skin. For the determination of exposure scenario, the exposure factors were surveyed for the daily average inhalation rate and the exposure period and frequency and time of diazinone as well as the body weight and lifetime of the workers. The median values of exposure frequency and exposure time were selected after evaluating the validity of those. Methods: The highest level of the diazinon exposure in the air was $107.21ug/m^3$ in farmers, followed by $93.53ug/m^3$ in landscapers, at $31.40ug/m^3$ in pest control operators, and $1.04ug/m^3$ in agricultural chemical seller. The amount of skin absorption was the highest in farmers at 63.39 ug/day, followed by landscapers at 10.47 ng/day, pest control operaters at 4.26 ng/day, and agricultural chemicals sellers at 0.34 ng/day. The hazardous indices calculated using toxicological reference value were 2.79 for pest control operaters, 0.41 for landscapers, 0.07 for agricultural chemicals sellers, and 0.06 for farmers. Conclusions: While the farmers were exposed to the high levels of diazinon through the air and skin, the pest control operaters, landscapers and agricultural chemicals sellers have more the diazinon hazards than the farmer based on the risk assessment in this study.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.1
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• pp.14-17
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• 2016

Hoarseness is a postoperative complication of thyroidectomy, mostly due to damage to the recurrent laryngeal nerve (RLN). Hoarseness may also be brought about via vocal cord dysfunction (VCD) due to injury of the vocal cords from manipulations during anesthesia, as well as from psychogenic disorders and respiratory and upper-GI related infections. The clinician or surgeon should 1) document assessment of the patient's voice once a decision has been made to proceed with thyroid surgery ; 2) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility 3) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, once a decision has been made to proceed with thyroid surgery 4) educate the patient about the potential impact of thyroid surgery on voice once a decision has been made to proceed with thyroid surgery ; 5) inform the anesthesiologist of the results of abnormal preoperative laryngeal assessment in patients who have had laryngoscopy prior to thyroid surgery ; 6) take steps to preserve the external branch of the surperior laryngeal nerve(s) when performing thyroid surgery ; 7) document whether there has been a change in voice between 2 weeks and 2 months following thyroid surgery ; 8) examine vocal fold mobility or refer the patient for examination of vocal fold mobility in patients with a change in voice following thyroid surgery ; 9) refer a patient to an otolaryngologist when abnormal vocal fold mobility is identified after thyroid surgery ; 10) counsel patients with voice change or abnormal vocal fold mobility after thyroid surgery on options for voice rehabilitation.

• Journal of Environmental Health Sciences
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• v.38 no.4
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• pp.277-290
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• 2012

Objectives: Diesel engine exhaust (DE) accounts for a significant percentage of air pollutants that are associated with various health outcomes including mortality, asthma, chronic bronchitis, respiratory tract infection, etc. In June, 2012, the International Agency for Research on Cancer (IARC) released the assessment results that classified DE as "carcinogenic to humans" (Group 1). This review is therefore focused on the lung cancer risks of DE. Methods: Literatures were searched using PubMed with key words of "diesel exhaust", "lung cancer", and other related terms for the period between 1990 and 2012. A total of 295 articles were searched and sixteen epidemiologic studies were identified as potentially relevant. Results: Sixteen epidemiologic studies about the lung cancer risks of workers exposed to DE in various occupations were summarized in two tables, 1) retrospective cohort studies and 2) case-control studies. Increased lung cancer risk, although not always smoking adjusted, was observed in 6 out of 8 retrospective cohort studies and 4 of 8 case-control studies. Conclusions: Diesel fuel is widely used in Korea. Exposure to DE is confirmed to be a human carcinogen by IARC. Noncancer health risks of DE also need careful attention as DE is a major source of fine-particle pollution. Along with the efforts for reducing the DE emission through improvements of diesel engines and fuel, and the use of alternative fuels, comprehensive health risk assessment of DE should be conducted to minimize the adverse health effects.

• Clinical and Experimental Pediatrics
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• v.63 no.5
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• pp.184-188
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• 2020

Background: Many critically ill patients require transfer to a higher-level hospital for complex medical care. Despite the publication of the American Academy of Pediatrics guidelines for pediatric interhospital transportation services and the establishment of many pediatric transport programs, adverse events during pediatric transport still occur. Purpose: To determine the incidence of adverse events occurring during pediatric transport and explore their complications and risk factors. Methods: This prospective observational study explored the adverse events that occurred during the interhospital transport of all pediatric patients referred to the pediatric intensive care unit of Ramathibodi Hospital between March 2016 and June 2017. Results: There were 122 pediatric transports to the unit. Adverse events occurred in 25 cases (22%). Physiologic deterioration occurred in 15 patients (60%). Most issues (11 events) involved circulatory problems causing patient hypotension and poor tissue perfusion requiring fluid resuscitation or inotropic administration on arrival at the unit. Respiratory complications were the second most common cause (4 events). Equipment-related adverse events occurred in 5 patients (20%). The common causes were accidental extubation and endotracheal tube displacement. Five patients had both physiologic deterioration and equipment-related adverse events. Regarding transport personnel, the group without complications more often had a physician escort than the group with complications (92% vs. 76%; relative risk, 2.4; P=0.028). Conclusion: The incidence of adverse events occurring during the transport of critically ill pediatric patients was 22%. Most events involved physiological deterioration. Escort personnel maybe the key to preventing and appropriately monitoring complications occurring during transport.

• Journal of Environmental Impact Assessment
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• v.20 no.5
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• pp.747-755
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• 2011

This study was investigated the relationship between the temperature and the mortality of aged (${\geq}65$ yr) during the winter seasons from 1992 to 2007 in Seoul, Korea by utilizing climate data and death records. The study also estimated the future risks by employing the projections of the population in Seoul, Korea and climate change scenario of Korea from 2011 to 2030. The limitation of this study was the impossibility in the prediction of daily mortality counts. Therefore, daily death numbers could be predicted based on the future population projection for Korea and the death records of 2005. The result indicated that risks increased by 0.27%, 0.52%, 0.32% and 0.41% in association with the $1^{\circ}C$ decrease in daily minimum temperature from the mortality counts of total, respiratory, cardiovascular, and cardiorespiratory in the past date while 0.31%, 0.42%, 0.59% and 0.66% in the future. Based on the results obtained from this study, it is concluded that the risk in the future will be higher than the past date although there is an uncertainty in estimating death counts in the future.

• Journal of the Korean Society of Physical Medicine
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• v.15 no.3
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• pp.135-147
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• 2020

PURPOSE: The purpose of this paper is to provide a review of physiotherapy intervention for patients with COVID-19 during their hospital admission and post-discharge. METHODS: The recommendations and guidelines of physiotherapy management, medical management, and general information of the WHO, Australian Physiotherapist, European Respiratory Society, British Thoracic Society, and American Thoracic Society were reviewed. RESULTS: This paper contains general information on COVID-19, including medical management, and the importance of physiotherapy approaches including an assessment of the patients' function, such as the 6-minute walking test, five sit to stand or sit to stand for one minute to measure their function as their recovery journey. The patients' quality of life, anxiety, and depression should be considered. Physiotherapy management should be based on an assessment of the patient's presenting impairments, including inclusion and exclusion of physiotherapy intervention. The paper also approaches step by step with the disease progress, from an intensive care unit, the general ward in the acute phase, through to the rehabilitation ward if needed, and post-discharge as an outpatient.. CONCLUSION: The paper has a limitation due to the unknown factor of the natural history of COVID-19. Depending on the patients' recovery journey and the rehabilitation needed, any physiotherapy interventions should focus on what the patients' need on their journey to recovery, e.g., pulmonary, cardiac, neurological, and general rehabilitation. In addition, applying personal protection equipment for treating physiotherapists is a mandatory requirement because this protects from the transmission of COVID-19.

• Journal of the Korean Magnetics Society
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• v.24 no.6
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• pp.191-196
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• 2014

The purpose of this study is to evaluate the reproducibility and usefulness of an image through the fusion of the computed tomography image and the magnetic resonance image by using a self-produced phantom when planning the treatment, and also to compare and analyze the target dose on the acquired image. The size of small hole and the reproducibility of capacity existed in the phantom on the image of the phantom obtained by the computed tomography and the magnetic resonance image of the phantom scanning with different intensity of magnetic field are compared, and the change of dose in the random target is compared and analyzed.