Therapy with appropriate antimicrobial agents is an important component in the management of patients with liver, biliary and pancreatic infection. Acute cholangitis and cholecystitis are common conditions that may result in progressively severe infection. Infectious complications, both pancreatic (infected necrosis) and extrapancreatic (pneumonia, cholangitis, bacteremia, urinary tract infections, and so on), are a major cause of morbidity and mortality in patients with acute pancreatitis. Antimicrobial agents appropriate for initial therapy (empirical therapy or presumptive therapy) for various grades of severity of infections should be used. Local antimicrobial susceptibility patterns should be considered for use.

본 연구에서는 일반 음식점의 주방에서 발생하는 질병자의 특성을 분석하고자 2009년부터 2011년까지 음식점 주방에서 발생한 116명 질병자의 특성을 분석하였다. 일반 음식점 주방에서 발생한 질병자는 5인 미만의 영세음식점에서 63.8%가 발생했으 며, 성별분포는 여성작업자가 66.4%로 나타났다. 연령분포는 40～50대에서 63.8%가 나 타났으며, 근속기간별 분포에서는 2～5년 미만의 작업자가 전체 질병자의 58.7%를 차 지하였고, 작업관련성질환이 86.2%로 나타났다. 일반음식점 주방에서의 질병자 특징에 관한 연구결과는 주방에서 발생하는 질병에 관한 체계적인 예방대책을 세우는데 기초 자료로 이용될 수 있을 것이다.

An 18 years old female patient suffered from cerebrovascular occlusive disease, moyamoya disease, showed a huge cyst in her left mandibular body in the radiological observation. The lesion was asymptomatic and found during routine dental check. She had no experience of traumatic injury on her jaw. The cystic lesion was ovoid with irregular scalloping margin and multilobular image, and occupied the whole marrow space of mandibular body with slight expansion of buccal cortical bone. During operation the lesion showed an empty space covered with grayish white fibrous tissue. The luminal fibrous tissue and underlying bony tissue were curettaged and examined pathologically. In the histological observation the lesion was a pseudocyst lined by thick fibrous tissue. Some large vessels underwent atherosclerotic change, exhibiting thickened vessel walls which were partly distorted with hemorrhage and thrombi, and some small capillaries were extremely dilated with hemorrhage and subsequently resulted in perivascular ischemic change with chronic vasculitis. This mandibular cystic lesion was finally diagnosed as simple bone cyst (SBC) associated with moyamoya disease differentially from aneurysmal bone cyst (ABC), traumatic bone cyst (TBC), periapical odontogenic keratocyst, and central giant cell granuloma. Therefore, it was presumed that the thromboembolic and atherosclerotic vessels of moyamoya disease might increase the hemodynamic pressure of mandibular bone marrow tissue and subsequently was able to induce SBC.

The purpose of this study was to compare the validity of obesity indices among the body mass index (BMI), waist circumference (WC), and body fat percentage (BF%), and to determine which is the most useful index to predict the risk of chronic diseases of elderly people. This study was conducted as a cross-sectional study at welfare centers in Seoul. The total number of subjects was 261 (68 men and 193 women) with age ≥60 years. The distribution of obesity using 3 obesity indices in the subjects with hypertension, diabetes, or arthritis was BF%>WC>BMI in elderly men and WC>BF%>BMI in elderly women. In elderly women, odds ratios (ORs) for hypertension in BMI and WC quartiles were significantly increased in quartile 2 and 3 (p<0.05). The ORs for hypertension, hyperlipidemia, and arthritis in BF% quartiles were significantly increased in quartile 3 and 4 (p<0.05). The BF% was sensitive obesity index for predicting the occurrence of chronic disease in men, and the WC was sensitive index in women. Our results suggested maintaining BMI less than 23.5 kg/m2, WC less than 82 cm, and BF less than 35% in order to prevent chronic diseases in elderly women.

목 적: 농촌 노인의 근용안경 제작에 필요한 자료를 얻기 위해 고혈압과 당뇨 등의 일반적인 노인 질환과 안질환 등을 파악하여 질환과 근용안경 굴절력과의 연관성을 파악하고자 한다. 방 법: 설문 내용은 질환, 눈 수술, 눈 증상으로 구분하여 전라북도 농촌에 거주하는 60세 이상 노인 215명을 대상으로 설문조사를 실시하여 분석하였다. 결 과: 고혈압(49.8%)이 당뇨병(9.3%) 보다 유병이 높게 나타났고 각 질환은 여자가 남자보다 많았다. 백내장 수술자는 43.3%, 녹내장 수술자는 4.7%이었고, 녹내장 수술자는 고혈압과 당뇨병을 가지고 있었다. 눈꺼풀 수술자는 6명(2.8%)이었고 모두 여자 이였으며, 군날개를 수술한 사람은 없었다. 날파리증은 105명(48.8%)이 증상을 가지고 있었고 연령별로는 70대에서 가장 많았다. 눈마름 증상을 호소한 사람은 153명(71.2%)이었고 여자가 남자보다 많았으며 80대 이상에서 가장 많았다. 망막박리 증상은 28명(13.0%)이 호소하였고, 여자가 남자보다 많았다. 백내장수술, 녹내장수술, 눈꺼풀수술, 날파리증, 눈마름증, 망막박리증은 고혈압환자에서 많았다. 백내장, 녹내장, 눈꺼풀수술, 날파리증, 눈마름증, 망막박리증을 가지고 있는 사람과 정상인 사이에 근용안경 처방 굴절력은 차이가 없었다. 결 론: 고혈압과 당뇨병, 백내장 수술, 녹내장 수술, 날파리 증상 그리고 눈마름 증상은 노안의 상태를 파악하는데 도움이 되는 것으로 사료되며, 질환과 근용안경 굴절력과는 연관성이 없었다.

Deoxynivalenol (DON) and related trichothecene mycotoxins are extensively distributed in the cereal-based food and feed stuffs worldwide. Recent climate changes and global grain trade increased chance of exposure to more DON and related toxic metabolites in poorly managed production systems. Monitoring the biological and environmental exposures to the toxins are crucial in protecting human and animals from toxicities of the hazardous contaminants in food or feeds. Exposure biomarkers including urine DON itself are prone to shift to less harmful metabolites by intestinal microbiota and liver metabolic enzymes. De-epoxyfication of DON by gut microbes such as Eubacterium strain BBSH 797 and Eubacterium sp. DSM 11798 leads to more fecal secretion of DOM-1. By contrast, most of plant-derived DON-glucoside is also easily catabolized to free DON by gut microbes, which produces more burden to body. Phase 2 hepatic metabolism also contributes to the glucuronidation of DON, which can be useful urine biomarkers. However, chemical modification could be very typical depending on the anthropologic or genetic background, luminal bacteria, and hepatic metabolic enzyme susceptibility to the toxins in the diet. After toxin exposure, effect biomarkers are also important in estimating the linkage and mechanisms of foodborne diseases in human and animal population. Most prominent adverse effects are demonstrated in the DON-induced immunological and behavioral disorders. For instance, acutely elevated interleukin-8 from insulted gut exposed to dietaty DON is a dominant clinical biomarker in human and animals. Moreover, subchronic exposure to the toxins is associated with high levels of serum IgA, a biological mediator of IgA nephritis. In particular, anorexia monitoring using mouse models are recently developed to monitor the biological activities of DON-induced feed refusal. It is also mechanistically linked to alteration of serotoin and peptide YY, which are promising biomarkers of neurological disorders by the toxins. As animalalternative biomonitoring, huamn enterocyte-based assay has been developed and more realistic gut mimetic models would be useful in monitoring the effect biomarkers in resposne to toxic contaminants in the future investigations.

목적: 망막은 신경조직으로 구성되어 있으며, 안구 내 들어오는 빛을 시세포로 전달하는 중요 한 기능을 하고 있다. 이러한 망막질환은 실명을 일으키는 주된 요인이 된다. 본 연구에서는 대표적 망막질환인 당뇨망막병증과 황반변성을 중심으로 하여 이들의 최근 발병률의 증감분석 을 통해 실명 유발 안질환 관리의 중요성을 알아보고자 한다. 방법: 보건복지부 산하 질병관리센터에서 시행한 2012년 국민건강영양조사를 기초로 30-49세, 50-59세, 60-69세, 70세 이상의 연령과 동과 읍의 지역으로 나누어 당뇨병망막병증과 황반변 성의 발병률을 연령별 그리고 지역별로 각각 비교 분석하였다. 결과: 당뇨망막병증 발병률을 연령과 지역별로 분류한 결과 30-49세는 10.7%, 50-59세는 16.7%, 60-69세는 20.6%, 70세 이상은 18.9%를 나타내었다. 동과 읍 지역은 각각 16.6%와 17.0%를 나타내었다. 황반변성 발병률의 연령별 분류한 결과 40-49세는 1.3%, 50-59세는 4.5%, 60-69세는 10.1% 그리고 70세 이상은 16.3%로 연령이 증가할수록 높은 발병률을 나 타내었다. 결론: 당뇨망막병증은 동과 읍 지역의 구분 없이 발생하였으며, 연령이 증가하면서 발병률도 증가하였다. 황반변성 역시 연령이 증가할수록 발병률이 높았으며, 특히 60세 이후부터 발병률 이 급격히 상승하였다. 당뇨망막병증과 황반변성이 발생하는 가장 큰 원인은 연령 증가로 볼 수 있다. 건성 황반변성의 경우 노안으로 인해 노폐물이 쌓여서 발생하는 경우가 많다. 당뇨망 막병증 역시 고령화 사회로 진입하면서 성인 당뇨병의 이환율 증가와 함께 당뇨병망막병증 역 시 증가하는 것으로 보인다. 당뇨망막병증과 황반변성은 실명과도 연결된 중요한 질환으로 이 와 같은 안질환에 대한 예방을 위해 정기적인 검진 그리고 사회적인 관심과 주의가 더욱 필요 할 것으로 판단된다.

This study tried to develop a basis for quantitative index of working postures associated with WMSDs (Work-related Musculoskeletal Disorders) that could overcome realistic restriction during application of typical checklists for WMSDs evaluation. The baseline data(for a total of 603 jbs) for this study was obtained from automobile manufacturing company. Specifically, data for back posture was analyzed in this study to have a better and more objective method in terms of job relevance than typical methods such as OWAS, RULA, and REBA. Major statistical tools were clustering, logistic regression and so on. The main results in this study could be summarized as follows; 1) The relationship between working posture and WMSDs symptom at back was statistically significant based on the results from logistic regression, 2) Based on clustering analysis, three levels for WMSDs risk at back were produced for flexion as follows: low risk(< 18.5°), medium risk(18.5°～ 36.0°), high risk(> 36.0°), 3) The sensitivities on risk levels of back flexion was 93.8% while the specificities on risk levels of back flexion was 99.1%. The results showed that the data associated with back postures in this study could provide a good basis for job evaluation of WMSDs at back. Specifically, this evaluation methodology was different from the methods usually used at WMSDs study since it tried to be based on direct job relevance from real working situation. Further evaluation for other body parts as well as back would provide more stability and reliability in WMSDs evaluation study.

The psychiatric patients as subjects were categorized herein into disease- and accident-triggered groups to statistically compare them with each other in terms of various comparative items. At a result, male patients were more dominant than females and physical workers were outnumbered by mental workers in the two groups. Also, patients were more apparent at workplaces with at least 100 employees than the ones with less than 100 employees, and patients whose employment period is at least one year were more vulnerable to stress-related mental disorders than the ones whose employment period falls short of one year. The foregoing findings suggest that there is a need to take preventive measures considering vulnerable aspects in terms of mental disorders.

The purpose of this study was to verify the relationship between fire fighter's musculoskeletal disorder related observable symptom and their absence from disease and accident. Online questionnaire was distributed with a total of 7,673 fire fighters, and statistical analysis was conducted to the collected data. The result shows that on a one year basis, patients with musculoskeletal disorder related observable symptom felt symptom in sequence of back, shoulder, neck, knee. The result verified that 12.9% of absence of disease and 5.9% of absence of accident experienced these symptoms. Both absence from disease and absence from accident showed body part symptoms related to neck and shoulder. This study ascertained the relationship between fire fighters' absence and their musculoskeletal disorder related observable symptom. The author hopes this study to be used as a basis of precautionary program for absence management.

Century-old nutrition and health concepts can be revived and applied in the modern age in the forms of newly developed menus, recipes, and lifestyle education. Current medical nutrition therapy concepts were first described in the Chosun Dynasty (1392-1897) in Korea based on the philosophy that food and medicine originate from the same source, which is known as ‘food as medicine’. Recognizing the importance of culture, tradition, local diet, and lifestyle on health and medical nutrition therapy, we tried to rediscover traditional Korean approaches towards food consumption and nutrition through systematic review of the literature and developed contemporary menus accordingly. The medical nutrition therapy prescriptions described in ‘Shikryochanyo’ (1460) by the Chosun Dynasty’s royal physician Soonyi Jeao cover 45 different diseases. In this project, we developed contemporary menus for those disease models that are most prevalent in modern society. Menus developed with foods that are readily available today were evaluated for their nutritional content and adequacy using a computer-aided nutritional analysis program (CAN pro 3.0, developed by the Korean Nutrition Society for comparison with RDA for Koreans). Therefore, century-old nutrition and health concepts can be revived and applied in modern society as newly developed menus recipes and lifestyle education.

목적 : 도시와 농촌 간 만성질환이 있는 65세 이상의 노인을 대상으로 일반적 특성에 따른 신체활동 실천율과 신체활동에 따른 삶의 질 차이를 알아보고자 한다. 연구방법 : 만성질환을 갖고 있는 65세 이상 노인 1,039명을 연구 대상으로 하였다. 신체활동으로는 걷기, 유연성 운동,근력 운동을 조사하였고, 삶의 질은 EQ-5D (Euroqol-5 dimension)를 사용하여 삶의 질에 대한 자료를 수집하여 분석하였다. 결과 : 신체활동 실천율은 도시의 경우 연령, 성별, 배우자, 주택유형, 소득수준, 교육수준에 따라 유의한 차이를 보였고, 농촌의 경우 주택유형과 교육수준에 따라 유의한 차이를 보였다. 삶의 질에서, 도시의 경우는 걷기, 유연성 운동, 근력 운동을 실천 한 군의 운동능력, 자기관리, 일상생활활동, 통증/불편 영역에서 유의한 차이를 보였고, 농촌의 경우는 걷기를 실천 한 군의 운동능력에서 유의한 차이를 보였다. 결론 : 도시와 농촌 모두 만성질환 노인의 신체활동 실천율은 낮은 편이었고, 특히 도시보다 농촌에 거주하는 만성질환 노인의 신체활동 실천율이 더욱 낮게 나타났다. 만성질환노인의 신체적 기능을 높이고, 삶의 질에 긍정적인 영향을 미칠 수 있는 신체활동의 중요성에 대한 인식이 필요하다.

This study was conducted to investigate the characteristics of smartphone usage and posture of users during using smartphone. A survey was conducted for 983 smartphone users to understand the association between smartphone usage and including subjective symptoms associated with musculoskeletal disorders. Main results from the survey were as follows; 1) 18.8% of the subjects experienced musculoskeletal symptoms at least at one of body parts. Specifically, 8.1%, 5.6%, 4.1%, and 11.3% of the subjects experienced musculoskeletal symptoms at neck, shoulder, elbow, and hand respectively, 2) The symptoms of musculoskeletal disorders were also associated with amount of text message and time for daily usage of smartphone. Specifically, relative risks of musculoskeletal disorders at hand/wrist/fingers in terms of "amount of text message" and "time for daily usage" for experienced user were 1.425 and 1.368 respectively to inexperienced user. This study identified 'amount of text message' and 'time for daily usage' as the major risk factors of smartphone usage in terms of musculoskeletal symptoms. The results of the study provided a good basis in order to remove or reduce the risks associated with musculoskeletal symptoms due to smartphone usage.

연구목적은 방문재활 물리치료 도입을 위한 정책적 자료를 제시하여 방문재활 물리치료의 제도적 도입과 방문건강관리사업에서 방문물리치료의 활성화를 위한 정책적 기초자료를 마련하고자 한다. 연구방법은 전국 의료기관 51곳의 조사 자료와 가정간호 수가체계를 토대로 뇌혈관환자의 방문재활 물리치료의 비용-편익 분석을 직접비용 조사와 지불용의 접근법으로 1회 건당 물리치료의 순편익과 비용-편익 비를 산출한 후, 민감도분석을 통해 연간 사회적 순편익을 계산하여 경제적 이익을 조사하였다. 연구결과 첫째, 뇌혈관환자의 방문재활 물리치료 비용-편익 분석의 직접비용 조사에서 방문재활 물리치료 방식이 의료기관 내원방식보다 2.04배 경제적 이익이 높았고, 사회적 순편익은 19,255,406천원으로 분석되었다. 둘째, 지불용의접근법에서 1.84배 경제적 이익이 높았고, 사회적 순편익은 15,546,120천원으로 분석되어 의료기관 내원방식보다는 방문재활 물리치료방식이 더 저렴하며 경제적 이익으로 사업성에 따른 경제적인 효과가 있었다. 병원을 내원하여 물리치료를 받는 것보다 방문재활 물리치료의 도입으로 가정에서 물리치료를 받는 것이 경제적인 이익이 있는 것으로 조사되었다.

제주도 내 관광객수는 최근 5년간 꾸준히 증가했으며 2012년 12월을 기준으로 960만명을 돌파하였다. 서비스업의 전체 사업장 및 근로자 역시 최근 5년간 증가하였으며 서비스업 종사자의 경우 전체 근로자 173,996명의 47%를 차지하고 있다. 업무상질병자 중 근골격계질환자 수는 전체의 90%를 차지하고 있으며(2012년 12월 기준) 근로자의 신규유입이 적고 노령근로자가 많은 점을 감안하였을 때 업무상 질병 발생율은 향후 증가할 것으로 예상된다. 본 연구는 제주도 내 관광객 수 증가에 따른 서비스업 종사자의 근골격계질환 발생현황 분석으로 향후 제주도 내 발생되는 근골격계질환의 예방에 기여하고자 한다.