Vocabulary

decipher
1 풀다, 해독하다, 판독하다 2 확실하게 하다 3 판독, 암호 해독

extenuating circumstances
정상 참작이 되는 상황, (형기의) 경감 사유

lenity
U 자비, 관대함, C 관대한 조치

castration
거세

eunuch
거세된 남자, 환관(宦官), 유약한 남자

Osteoporosis

Diagnosis

검사법
DXA - 방사선 적음, 비용-중간, 치료결과추적-허가
발뒤꿈치 - 없음, 낮음, 비허가
qCT - 많음, 비쌈, 비허가

최초검사 보험대상: 연령 및 폐경 기준
고위험요소 1개이상 있는 65세 미만의 폐경 후 여성
65세이상 여성, 70세 이상 남성

최초검사 보험대상: 기타 검사 대상
비외상성(fragility) 골절 - 척추압박골절, 손목골절, 고관절 골절
골다공증 유발 할 수 있는 질환 또는 약물 사용 - 스테로이드, 갑상선 기능 항진, 류마티스 질환
기타 골다공증 검사가 반드시 필요한 경우
- 중풍, 퇴행성 고관절/슬관절 질환으로 걸음걸이 이상
- 내이 이상으로 반복적 어지러움증
- 당뇨병성 망막증, 백내장, 녹내장
-> 낙상의 위험이 높음

남성골다공증
- 일차성(50%) - 특발성, 노인성
- 이차성(50%) - 스테로이드과다(15%), 성선기능저하증(10%), 과도한 음주(7%), 고칼슘뇨증 등

BMD 해석
폐경후 여성/50세이상 남성 T score -1.0이상(정상), -1.0~-2.5(골감소증), -2.5이하(골다공증)
폐경전, 50세 이전 남성 Z-score -2.0초과(괜찮음), -2.0이하(예상범위 이하로 판단)
퇴행성 변화로 인해 주위와 1.0이상 차이나는 수치는 빼고 해석

T-L spine X-ray: 압박골절 확인
SQ grade
0(normal)
1(mild) - 20-25% 감소
2(moderate) - 25-40% 감소
3(severe) - 40%이상 감소

골다공증의 치료
일반적 치료 + 약물 치료
일반적 치료: 칼슘, VitD, 체중부하&근육강화운동(주3회 1번에30분이상), 금연,
과도음주피함(2drink 미만), 낙상방지(시력교정, 약제, hip protector)
약물치료: 골흡수 억제제, 골형성 촉진제

1일 권장량
칼슘: 50세이상 1200mg (max 2500mg)
vitD: 800IU (max 2400IU)

약물치료 지침
대퇴골 혹은 척추골절
T-score <= 2.5
골감소증
- 과거기타 골절
- 골절위험 증가된 이차성 원인
- 10년내 대퇴골 골절 위험도 >= 3% or 주요 골다공증골절위험>=20%

MEDICATIONS
Inhibitors of bone resorption
bisphosphonate
SERMs
Calcitonin
Estrogen +/- progestin(EPT)
Denosumab
Cathepsin-K inhibitor
GLP-2
Stimulators of bone formation
(Fluoride)
PTH
Mixed mechanism of action
Active vitD metabolites
Strontium ranelate

각 비스포스포네이트제제의 특징
포사맥스 플러스 D - Colecalciferol 5600IU
맥스마빌 - Alendronate 5mg + Calcitriol 0.5ug
악토넬 - 조기골절예방효과, 월 150mg 출시
본비바 - 월 1회 복용, 3개월 한번 주사
아클라스타 - 년 1회 주사, 40만원/회

골표지자 보험가이드라인
2008년 5월 1일자로 보험 적용 기준 확대
골다공증 약물 치료 시작 전 1회
골다공증 약물 치료 3-6개월 후 약제 효과 판정을 위해 실시시 1회 각 1종 인정
골흡수표지자: DPD, NTX, CTX
골형성표지자: Osteocalcin, bone specific ALP

검사 비용
DPD 5910원 (보험수가 14790)
Osteocalcin 4830 (12080)
Calcium 580 (1464)
Phosphorus 580 (1464)
vitD 3060 (7660)
E2 5560 (13908)

정신과 질환의 개론

의료에서의 인간관
생물-정신-사회적 모델
발생-발달-성장-성숙-생산-노화-사망


Behavior
intake
processing
output
fight-flight
*exploration
sex


적응: 기능발달->뇌발달->전두엽발달
갈등 -> psychosomatic Sx.


인간발달
신체발달, 뇌의 발달
공자, Darwin, Freud, Piaget, Erikson, Kohlberg, Skinner


발달과 장애
조숙
미숙-고착, 지연, 퇴행 - 환경과의 적응 실패
환경과의 적응 - 발달 - 성숙 - 적응강화


우울증: 2-25%
동기(motivation)
의식(conscious)
논리 vs 정서
생명 -> brain stem

neurotransmitter
NE: 각성, 불안
DOPA: 각성, 쾌감, 흥분
serotonin: 수면, 식욕, 성기능, 공격성
ACh: 기억
GABA: 안정, 수면
Endorphin: 진통, 다행감


치매: ACh ↓, Schizo: DA↑


정신분석학

정신장애 사회적 원인
- 대인관계, 사회환경, 문화/종교 요인
- 스트레스, 바람직하지 않은 경험
- 상실
죽음, 사회적 퇴장, 퇴직, 은퇴 * 재산, 명예, 미모, 자존심 상실


depression은 상실이 key


증상의 형성
disorder 장애
syndrome 증후군
symptom 증상
sign 징후
defense mechanism

'과제'를 수행하게


organic mental disorder -> 치매, 섬망, 물질
psychotic disorder
neurotic disorder
personality disorder


중 neurotic disorder --->>>

anxiety -> impending stress
- somatization disorder
- dissociative disorder
- adaptational disorder
- factitious disorder

Want to Lose Weight? Avoid Skinny Overeaters

Monday, Sep. 28, 2009
Want to Lose Weight? Avoid Skinny Overeaters
By Sean Gregory

If you're looking to lose weight, here's a simple tip: don't dine with the skinny dude who stuffs his face. According to a study that will appear in the April 2010 issue of the Journal of Consumer Research, both the size and the consumption habits of our eating companions can influence our food intake. And contrary to existing research that says you should steer clear of eating with heavier people who order large portions, it's the beanpoles with the big appetites you really need to avoid. "They're big trouble," says Gavan Fitzsimons, a marketing professor at Duke's Fuqua School of Business and one of the study's co-authors.
To test the effect of social influence on eating habits, researchers conducted two experiments. In the first, 95 undergraduate women were individually invited to a lab ostensibly to participate in a study about movie viewership. Before the film began, each woman was asked to help herself to a snack of either M&M's or granola. Another "participant," who was actually an actor hired by the research team, grabbed her food first, in full view of the subjects at the snack line. In her natural state, the phony participant weighed 105 lb. and wore a size 0. But in about half the cases, she wore a prosthetic designed by an Academy Award–winning costume studio. The fat suit increased her weight to 180 lb. and puffed her clothes to a size 16. (See the top 10 food trends of 2008.)
Both the fat and the skinny versions of the actor scooped five tablespoons of food (approximately 71 g of granola or 108 g of M&M's) onto a plate. That's a heap. The subjects followed suit, taking more food than they normally would have had they eaten alone. However, the subjects took significantly higher portions when the actor was thin. During the movie — a five-minute clip from the Will Smith film I, Robot — they also ate significantly more if the actor was skinny. "It's our intuition sometimes that you don't want to eat with big people because you're afraid you'll eat more," says Fitzsimons. "In fact, the opposite is true." (See how hula hoops can help you lose weight.)
What happens when a thin person takes a small portion? Again, we tend to mimic those around us. For the second test, in one scenario the actor took two pieces of small candy from a set of snack bowls. In the other scenario, she took 30 pieces. Under the lots-of-food condition, the results mimicked the first test: subjects grabbed and ate significantly more candy when the actor was thin. Under the little-food condition, the subjects took the lead of the actor and restrained their candy consumption. However, in this scenario it was the obese lunch date who posed a threat: the subjects ate more if the actor was wearing a fat suit. (Watch TIME's video "How to Lose Weight Like a Real Loser.")
Each of these tests illustrates the psychological trait known as anchoring. Humans tend to latch on to one specific piece of information when making decisions, in this case the habits of the actor. The social environment is extremely influential. If this fellow study subject is going to take an above-average number of M&M's, so will I. Call it the "I'll have what she's having" effect. (See pictures of what makes you eat more food.)
However, we adjust the influence of the social environment on the basis of how we perceive the people around us. So if an obese person is helping himself to a large portion, I'll hold back a bit because, well, I see the ultimate results of his eating habits and don't want the stigma associated with being overweight. But if the thin person eats a lot, why shouldn't I follow suit? If she can gorge herself and still keep trim, why can't I?
At the same time, if a thin dining companion orders a small portion, I too will hold back because I want to mirror the habits of a body type to which many people aspire. However, if an overweight person orders light, I'll make an adjustment. Obviously, small portions aren't working for him. If tiny meals don't help you stay trim, what's the point? Get me the cheeseburger deluxe.
Read "Why Exercise Won't Make You Thin."
Read "The Working Person's Diet: Too Busy to Eat Right."

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Find this article at:
http://www.time.com/time/business/article/0,8599,1926060,00.html