The Rehabilitation Services Utilization of People with Disabilities in a Rural Area / 農村醫學 地域保健

OBJECTIVES: This study was conducted to investigate the utilization and its determinants of rehabilitation services of people with disabilities in a rural area. METHODS: From March 2 to April 1, 2011, we interviewed 101 disabled people with either physical disabilities or brain lesions. The subjects completed questionnaires about the utilization of rehabilitation services, general characteristics (age, sex, marital status, education level, economic status, health insurance, housing, and employment) and disability characteristics (type, level, comorbidity, reason for the occurrence of the disability, self-rated degree of disability, and daily life care giver). Frequency, Pearson's chi-square test, and a multiple logistic regression were used for statistical analysis. RESULTS: This study showed that 70.3% of the people in this rural area with disabilities were using rehabilitation services. The two most common reasons for not using the services were "doubt about the effectiveness of the service" and "no facilities nearby." The facilities that the disabled people were currently using, in the order of most used to least, were general hospitals or clinics, rehabilitation centers, oriental medicine clinics, and public health centers. Only 19.7% of those who received rehabilitation responded that they were satisfied with the service. Significant factors in the utilization of rehabilitation services were sex, employment, self-rated economic status, and the reason for the occurrence of the disability. Women, people who were currently working, people who were of middle or higher economic status, or people who had acquired a disability were significantly more likely to use the services. CONCLUSIONS: A large number of people with disabilities in a rural area use rehabilitation services at present, but accessibility and satisfaction were low. Quantitatively and qualitatively, rehabilitation services for disabled people in a rural area should be centered around Community-based Rehabilitation (CBR). Effective strategies, for example reaching those who have not used the rehabilitation services, will be needed to improve services in rural areas.

Hepatocellular Carcinoma with Extensive Hepatic Artery Injury: Transcatheter Arterial Chemoembolization through Collaterals after Coil Embolization of Gastric Arteries

PURPOSE: To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE) after coil embolization of the gastroduodenal artery in hepatocellular carcinoma cases with multiple collateral arteries caused by proper hepatic artery injury. MATERIALS AND METHODS: Between March 1997 and November 1998, a prospective trial of transcatheter arterial chemoembolization (TACE) was performed through collaterals from the gastroduodenal artery of 31 hepato-cellular carcinoma patients with extensive proper hepatic artery injury due to repeated TACE. Among this number, 16 (group A) underwent TACE after coil embolization of the right gastric and gastroduodenal artery. The other 15 patients (group B) underwent TACE without coil embolization. The two groups had the same T-NM stage and Child-Pugh status. During the follow-up period, group A underwent additional TACE 3.3 times, and group B 2.8 times. The therapeutic effect of TACE was evaluated with computed tomography and by measuring alpha-fetoprotein levels. Complications were evaluated by means of gastrofibroscopy, laboratory data, and evalvation of the patients clinical symptoms. The results obtained after six months and one year were compared within and between each group. RESULTS: At six months follow-up, CT findings had improved or were unchanged in 11 patients(69 %) in group A, and four patients(27 %) in group B(p=0.032). In ten patients in each group, the level of alpha-fetoprotein was above 200 ng/ml. Its level was decreased in five patients(50%) and three patients(30%), respectively. The six-month survival rate was 81 %(13/16) in group A and 67 %(10/15) in group B (p=0.43), while the one-year survival figures for these two groups were 50 %(8/16) and 20%(3/15), respectively(p=0.135). In group A, the CT findings were steady in five out of eight patients(63%), while in group B, CT findings showed that tumors with increased alpha-fetoprotein levels had increased in size and/or number. In group A, it was found that in two (33 %) of six patients whose initial alpha-fetoprotein level was over 200ng/nl, this level had decreased. Acute gastric ulcer was found in two patients in group A, and mild acute pancreatitis in one. One patient in group B was also found to have an acute gastric ulcer. CONCLUSION: In view of the advanced disease stage of patients for whom a long period has elapsed since initial diagnosis, TACE after coil embolization of gastric arteries may be a safe and acceptable method for use in the treatment of hepatocellular carcinoma with extensive hepatic artery injury.

Current Status of Multicenter Cancer Cohort Study with Biological Materials Bank in Korea / 한국역학회지

This cohort study is a collaborative effort of 8 institutions. The goal is to establish a large scale cohort that can be followed for 10 or more years to assess the relationship between life-styles and cancer occurrence, and to evaluate the role of environmental exposures in the development of six major sites of cancers(stomach, liver, lung, colorectum, uterine cervix and female breast) in the rural population. Since 1993, 11,304 men and women aged over 35 living in four areas have been recruited. The number of target population is 30,000 persons, which is expected to be successfully recruited until 1999. Each subject has completed a detailed questionnaire on general life-styles, reproductive factors, and agricultural chemical exposures through the interview. Anthropometric measurements with body fat composition and the routine clinical laboratories were examined. For the cancer-free cohort, physical examination by the physicians and serologic tests for hepatitis markers, some tumor markers, and lipid profile have been done, but not all. In order to provide an opportunity to incorporate barious biomarkers of exposure and effect as well as genetic susceptibility, a biologic tissue bank has been established from blood and urine sample(plasma, WBC buffy-coat, RBC clots, and urine supernatant) stored at-70degrees C. Re-examination of changes in exposere to risk factors will be done periodically. Disease occurrence will be ascertained by the active(mainly through diagnosis by physicians) and the passive surveillance(through both death certificate and screening of medical utilization records).

Assessment of the Naktong river pollution after phenol spillage from the Kumi industrial estates II, Korea / 예방의학회지

The aquatic quality of the Naktong river after two of three months in June, 1991 with phenol spillage from a electrical factory in Kumi was investigated. The samples were collected at six sites of the Naktong river basin and Kachang and Kongsan lakes. Phenol was not detected from all water samples. Turbidity was very much increased to the down stream in the Naktong river. The BOD and COD values exceeded the 2nd grade(3 mg/l) of the Korean standard quality of Environmental Water Act at the all sampling sites of the Naktong river. Especially, the value of COD at Kaejin (12.5 mg/l) was poorly classified as to the 5th grade of water class for the environmental quality standards. Organophosphorous pesticides such as parathion, malathion, fenitrothion and diazinon were investigated but not detected. Diazinon was only detected at the Ilson bridge(1.42 ppb), Okkye stream(6.95 ppb), Waekwan bridge(0.32 ppb), Gangjung reservior(0.13 ppb), Kaejin(0.05 ppb). Of the carbamates such as carbanyl, isoprocarb and cabofuran, the carbofuran was detected all sites except tap water, and Kachang and Kongsan lakes. The content of heavy metals such ans Cd, Pb, Zn, Fe, Mn, Hg were not exceeding for drinking water standards at the all sampling region, but only mecury was detected from Okkye stream(0.018ppb) and Kaejin(0.09ppb). In the regions of Kachang and Kongsan lakes, the content of heavy metals were lower than that of reservoir of Naktong river.

Erythropoietin Bioassay in 7 Cases of Hydronephrosis and Renal Cell Carcinoma / 대한비뇨기과학회지

It has been well established that the kidney is the main organ producing erythropoietin (E.S.F.). Erythropoietin activity was reported to be increased in cases of renal tumor. cyst, polycystic disease and hydronephrosis. To study erythropoietic activity in hydronephrosis and renal cell carcinoma, erythropoietin bioassay by DeGowin method were performed in 7cases of hydronephrosis and renal cell carcinoma. Erythropoietin activity is significantly increased in renal cell carcinoma but not significantly increasedin hydronephrosis.