Clinical analysis of perimenopausal women presenting initially with dry eye symptom

目的探讨围绝经期妇女的干眼症状与干眼病诊断的相关性。方法分析56例具有干眼症状的围绝经期妇女眼部检查的临床资料,观察主诉为干眼症状患者的干眼病确诊率及其关系。结果56例以干眼症状为主要表现的围绝经期妇女,确诊水液缺乏型干眼17例(30.4%),蒸发过强型干眼12例(21.4%),混合型干眼8例(14.3%);不能诊断干眼病的19例(33.9%),最终诊断为围绝经期综合征。结论围绝经期妇女干眼病确诊率较高(66.1%),但部分干眼症状可以只是围绝经期综合征的精神神经症状的一种表现,临床诊断干眼应慎重。 【英文摘要】 Objective Diagnosis and treatment of dry eye are important for improving living quality.Present paper was to investigate the correlation between dry eye manifestations and diagnosis of dry eye disease in perimenopausal women.MethodsThe clinical data of 56 perimenopausal women presenting initially with dry eye symptoms including ocular symptoms,slit-lamp examination,tear film break-up time,basal and reflex Schirmer test,vital staining(fluorescence and rose bangle),and meibomian gland dysfunction examination ..

成人歯科保健に関する疫学調査 : 第1報 歯科疾患有病状況及び質問紙法による歯科保健意識調査

This study comprised 372 subjects (16-86 years old) living in Yasuda-town located in a north-east area of Niigata prefecture. Oral health status was assessed by inspection type examination and CPITN. A questionnaire about dental health was given to all subjects at the same time. Results were as follows. 1) Present teeth and missing teeth were in better condition compared to the second Niigata prefectural survey in 1987. 2) The Prevalence of periodontal disease was very high and symptoms were getting severer according to aging. 3) Not a few of subjects, particularly middle-aged, were anxious about their teeth and had some subjective symptoms about their dental health. 4) More than 70% of subjects experienced toothache. In addition, it seemed that toothache was felt severer than another 6 kinds of pain. 5) The conception of need for prosthodontic treatment seemed to be different between dentists and subjects who had not so many missing teeth. 6) Perceived ease of chewing for foods was getting poorer according to aging. In contrast, there was no relationship between age and self-assessed perception of chewing ability. This suggested that self-assessed perception of chewing ability was dependent on not only dental and prosthetic status but also another various factors.新潟県北蒲原郡安田町の成人を対象に口腔診査と質問紙法による歯科保健意識調査を行った｡372名が調査の対象となり,歯科疾患有病状況と各質問項目の回答の結果について分析,検討した｡有病状況は,現在歯及び喪失歯については,昭和62年第2回新潟県県民歯科疾患実態調査結果と比較してよりよい状態であったが,歯周疾患については,CPITN によって診査した結果,極めて多くの者が罹患しており,その症状は増齢に伴い重症化する傾向が認められた｡一万,意識調査では,各種の健康不安,現在の口腔に関する自覚症状,各部位の痛みの経験の有無,歯の痛みのきつさの認識度,義歯の使用状況,咀嚼の満足度及び咀嚼状況について質問した｡30代から60代の中年層を中心に,歯に関する健康不安や自覚症状のある者が少なからずいるとともに,歯の痛みを70%以上の者が経験しており,他の部位の痛みよりも強いと認識されているのではないかと思われた｡また,補綴必要とみなされる者の義歯の使用状況を喪失歯数別に集計したところ,比較的少数歯欠損の場合,歯科医側と一般の人々の間に補綴処置に関して感ずるニーズに違いがあることが示唆された｡咀嚼状況については,年齢上昇に伴い｢かめないものがある｣とする者が増加していたが,咀嚼の満足度は,喪失歯数の多い高齢者層にかむのに｢不自由している｣とする者が特に多いわけではなく,必ずしも歯や補綴の状況が反映しない可能性が示唆された｡departmental bulletin pape

成人歯科保健に関する疫学調査 : 第2報 咀嚼能力について

The subjects in this study were 372 adults living in Yasuda town, Niigata prefecture. Those were the same as in the first report. The relation between masticatory ability and number of missing teeth and the effect by using removable dentures were investigated in this report. First as subjective evaluation of masticatory ability, the subjects were asked about their ability to chew foods on the evaluation chart of masticatory efficiency with complete dentures by Yamamoto (Yamamoto's chart for short). Secondly as objective evaluation of masticatory ability, the amount of sugar elution from a chewing gum was measured after they had chewed a chewing gum 100 times. In the subjective evaluation of masticatory ability it became difficult for them to chew hard foods on the Yamamoto's chart with increasing number of missing teeth, and the kind of foods which could be chewed by the 8～14 missing teeth group of subjects widely differed from that by the 1～7 missing teeth group. Each of foods on the Yamamoto's chart was scored as follows : can be chewed (○) -2points, can be chewed by force or when chopped fine(△) -1point, cannot be chewed (×) -0point. The total score of each subject was defined as self-assessed score. It decreased with increasing number of missing teeth. The result of objective evaluation of masticatory ability was that the amount of sugar elution decreased with increasing number of missing teeth. But its decreasing trend was gentle as against self-assessed score which decreased sharply on the 15～21missing teeth group. The subjects using removable dentures were asked about their ability to chew foods on the Yamamoto's chart both with dentures and without dentures. It became difficult for them to chew hard foods with increasing number of missing teeth in the case without dentures. However their masticatory ability recovered fairly in the case with dentures. But even in the case with dentures most of them could not chew hard foods on the Yamamoto's chart.第1報で分析の対象となった新潟県北蒲原郡安田町在住の成人372名を調査対象として,咀嚼能力と喪失歯数との関連,および義歯使用の影響について分析,検討した｡まず咀嚼能力の主観的評価法として,山本式総義歯咀嚼能率判定表(以下, 咀嚼能率判定表と略す)に従って,食品摂取可能状況を質問するものとした｡次に客観的評価法として,チューインガムを一定回数かませ,ガムより溶出した糖の重量を測定することによって, 咀嚼能力を評価する方法を採用した｡主観的評価法による咀嚼能力については,喪失歯数が増加するに従って, 咀嚼能率判定表で咀嚼難易度の高い食品がかみにくくなる傾向があった｡また喪失歯が8～14歯で, 咀嚼可能な食品の種類が大幅に変化する傾向が認められた｡さらに,28食品の数値化による合計点を求め,これを自己評価得点とし,喪失歯数との関連を検討した結果,喪失歯数の増加に伴い, 自己評価得点が減少する傾向が認められた｡客観的評価法による咀嚼能力については,喪失歯数の増加に従って,溶出糖量が減少し, 咀嚼能力が低下していく傾向が認められた｡しかし減少の傾向は,自己評価得点の場合よりやや緩やかで,喪失歯が15～21歯以上から大きな減少となった｡義歯使用者については, 咀嚼能率判定表に従って,義歯使用時と非使用時における食品摂取可能状況を回答してもらった｡その結果,義歯非使用時には,喪失歯数の増加に伴い, 咀嚼難易度の高い食品がかみにくくなる傾向があった｡一方,義歯使用時には, 咀嚼能力は相当回復するものの, 咀嚼難易度の高い食品はほとんどかめないと判断しており,義歯による咀嚼能力の回復には,食品の種類において限界があることが示唆された｡departmental bulletin pape

新潟県における歯科診療所の状況について : 平成2年新潟県医療施設調査結果から

departmental bulletin pape

以人工智能改善診所醫療資訊系統之探索性研究

醫師在看診時，往往都需要花費不少時間在醫療資訊系統上撰寫病歷。而台灣診所使用醫療資訊系統的歷史約建立在三十年前健保申報的架構上，以現今的科技發展眼光來看，醫療資訊系統架構與功能顯得老舊。因此在醫師端，大部分的醫師仍僅使用最基本的功能，無法應用最新的科技達成增加醫師工作效率，進而提升與病患互動時間之效果。 近年來，人工智能相關技術與應用發展迅速，尤其在注重科學以數據做決策的醫療產業上，更是具備大量的研究與測試。研究者希望將人工智能的應用，整合進醫療資訊系統，以改善醫師日常工作上的痛點，因此發展以下兩個研究問題： 1. 診所醫師在使用醫療資訊系統時的痛點為何？ 2. 如何以人工智能解決醫師在使用醫療資訊系統時的痛點？ 根據文獻探討、六位醫師與兩位專家的深度訪談，研究者整理出人工智能具備六樣特性有潛力改善醫療資訊系統，其特性分別為靈活性、整合性、可取性、即時性、完整性、視覺化。並認為以下四點是人工智能有潛力改善之醫師痛點，分別為： 1. 看診時，無法快速瀏覽所需資料 2. 幾乎無合適套組適用於應付目前病患狀況的多端，以加速醫師撰寫病歷 3. 病患看診時無法快入精準表達症狀，消耗掉看診時間 4. 病患時常忘記回診 因此研究者對於醫療資訊系統改善建議有以下四點： 1. 利用人工智能相關技術，開發一面式摘要病患重要資料之功能 2. 開發人工智能協助撰寫病歷之功能 3. 完善診所資訊系統資料串接 4. 增加醫療資訊系統自動化提醒之功能 研究者希望藉由此探索性研究，減輕醫師在紙本作業的相關負擔，進而提升營運效率，增加醫師與病患之互動時長，改善醫療品質

Experiment on the Hydraulic Characteristics of Slit-Type Check Dam

摘要 本研究以梳子型防砂壩之開口寬度為主題，利用模型試驗，配合三種渠床 坡 度（3°、6°、9°）、三種流量（50l/min、60l/min、70l/min）及 二種試 料（粗：2mm、 細：0.84mm），於21cm寬之渠槽進行水理試驗， 並嘗試將多 開口斷面轉換成單一開口斷面，以探討總開口面積相同而開 口數不同之梳子 壩開口效應對上游土砂之攔阻效果，茲將研究結果分述 如下： 1.由試驗觀察得知，水流通過傳統防砂壩體前後，福祿數之變動不大，顯 示 此種壩型之溢洪道對於水流之束縮效應並不顯著。 2.由於本試驗供水條件所產生之流況不足以將傳統壩上游之堆積土砂沖刷 至 下游，因此傳統壩將完全阻擋上游之土砂，而梳子型防砂壩因開口較 傳統壩 低，因此，壩之上游面部份土砂將被水流經開口沖刷至下游，使 壩體上游產 生淘刷坑，顯示梳子壩不至於完全阻斷下游之供砂來源。 3.由於淘刷坑形成後之渠底較原堆積面降低，因此上游水流至此將受到緩 衝 作用，使流速減緩，而水流通過壩體時，因受開口之束縮效應使流速 增加， 相對應亦使開口處之水深較壩體上游之水深減小。 4.在本試驗條件下，當坡度或流量增大至足以使水流越流壩頂時，則開口 處 之流速將較淘刷坑未形成時之流速為緩，此則有助於淤砂之效果。 5.本文推導多開口斷面轉換成單一開口斷面之轉換係數與開口處之流速為 負 相關且經試驗證明之，而轉換係數愈大，表示梳子壩對上游淤砂之安 定效應 愈高，根據斷面轉換之結果，開口數愈多之開口壩，經轉換後斷 面之相對開 口效應愈大，表示其束縮效應愈小，則能量損失愈小，因此 ，其上游所產生 之淘刷坑規模較開口數少者為小。Abstract The purpose of this study is to investigate the relationship between the width of opening and the hydraulic parameters for slit-type check dam.Three channel slopes (3°、6°、9°),three flow rate and two size of sediments(gravel：2mm、sand：0.84mm) were used to conduct the channel experiments in the channel with 21cm width.To realize the effect of the interception of the slit-type check dam,the multiple opening slit dam was transformed to single opening slit dam in this study.The result are obtained as follow： 1. The variation of Froude number is not distinguished when the flow through the traditional check dam.This is expressed that the constrictive effect of the check dam is not distinguished. 2. Because the flow can''t scoure out the sediments at the upstream of the traditional check dam under the condition of the water supplied,the dam will almost intercept sediments.But the height of opening in slit dam is lower than the traditional dam,so the sediments will transport through the opening to the downstream with the flow and there is a pit to scoured out at the upstreamof dam. 3. The scoured pit where is formed between the dam and the original deposited sediments has a cushioning effect for the flow,the velocity will be decreasedat the scoured pit.When the flow through the opening of slit dam,the velocity was increased with the contrictive effect. Then,the water depth at the opening of dam is lower than that at the upstream. 4. Under the condition of this experiment,if channel slope or discharge is large enough to maybe the flow water over the top of dam,the velocity at the opening of dam was slower than that before the pit being formed. 5. It is derived that the velocity at the opening of dam is a negative relation with the coefficient of transformed section, and it is proved to be correct by the experiments.A larger of the coefficient of transformed section means that the slit dam has a higher effect for stabilized the deposited sediments.And the more the opening numbers is,the higher opening opening effect is.It is meanning that the constrictive effect is not significant with a more number of opening,and the energy loss also is not significant.Therefore,the scoured pit at the upstream is smaller than that with the less opening numbers