제2형 당뇨병 환자에서 적극적 환자 교육이 혈당조절에 미치는 효과

이윤욱,황원선,최선정,이동훈,김도현,이은희,홍은경,노혜림,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 현재까지의 당뇨병 교육에 대한 노력은 제한되었으며, 연구 결과를 보면 식사 조절 교육과 체중 조절 프로그램을 수행한 환자들 중 적극적이고 기간이 긴 교육을 받은 경우, 성공적 결과가 나타남을 알 수 있었다. 자가관리나 체중감량 등의 당뇨병 치료의 중요한 목표는 적극적이고 긴 기간의 교육 없이는 시행되기 어렵다. 본 연구에서는 외래에서 당뇨병 환자를 대상으로 시행할 수 있는 행동 및 식사 교육 등의 적극적 교육 프로그램을 개발하여 제2형 당뇨병 환자들을 대상으로 이들에게 식사 조절 방법에 대한 목표설정과 문제에 직면하였을 때의 해결 방법 등을 교육해서 궁극적으로는 적극적 자아관리에 연결될 수 있도록 도와주는 것을 목적으로 기존의 통상적 교육과 보다 적극적인 교육이 당뇨병 환자의 혈당 조절에 어떠한 영향을 미치는지에 대해 알아보기 위해 다음과 같은 연구를 시행하였다. 방법: 본 연구는 아주대학교 병원 내분비 대사 내과를 처음으로 방문하여 치료받았던 58명의 제2형 당뇨병 환자를 대상으로 하였다. 내원 환자들을 무작위하게 추출하여 진찰권 번호 끝자리에 따라 홀수는 통상적 교육군(conventional education group, CE)과 짝수는 적극적 교육군(intensive education group, IE)으로 나누어 교육하고, 3개월후에 교육의 효과를 평가하였다. 결과: 1) 연구 대상자들의 교육 전과 후의 공복혈당, 식후2시간 혈당 및 HbA_lc 치는 IE군과 CE군 모두 각 그룹 내에서, 유의적으로 감소하였다(p<0.05). IE군에서는 공복혈당이 12.4nmol/L에서 7.7nmol/L로, 식후2시간 혈당이 20.3nmol/L에서 10.9nmol/L으로, HbA_lc치가 9.4%에서 7.0%로 모두 교육 전에 비하여, 교육 후에 감소(p<0.05)하였고, CE군도 공복혈당은 10.9nmol/L에서 9.4nmol/L로, 식후2시간 혈당은 17.1nmol/L에서 14.6nmol/L으로 HbA_lc가 8.5%에서 7.3%으로 모두 교육 후에 감소하였다(p<0.05). 또한, 교육 전에 비하여 교육 후에 공복 혈당 및 HbA_lc치가 감소하는 정도는 IE군에서의 감소가 CE군에 비해 더 현저하였다Op<0.05). 2) 식사에 대한 태도는 3부분으로 나누어 식사에 대한 규칙성, 식사 내용의 균형성, 식사에 대한 태도 등으로 나누어 각각의 점수 및 총점을 비교하였으며 교육 전에 비해 교육 후에 연구 대상자들의 식태도가 향상되었음을 알 수 있었다. 두 그룹간의 차이를 분석한 결과 식사의 균형성 항목에서와 총점에서 유의적으로 두 그룹의 차이를 보여서 IE군에 CE군에 비해 식사의 균형성 측면이 향상되었고, 전체적인 식태도가 좋아졌음을 알 수 있었다(p<0.05). 결론: 비교적 긴 기간은 아니지만 적극적 교육을 받은 당뇨병 환자들이 통상적 교육을 받은 군보다 혈당 및 HbA_lc, 식태도 점수등의 수치의 호전뿐만 아니라 당뇨병 환자의 삶에서 중요한 부분을 차지하는 식사요법 관리 부분에 있어 향상됨을 알 수 있었다. Background: To this date, efforts to develop effective methods for the education of diabetic patients have been limited. The important goal of self-management and weight control for diabetic treatment can not be attained without long and intensive period of education. This study was undertaken to assess the effectiveness of an intensive educational program, of behavior and diet control, which was carried out on subjects with type 2 diabetes, on and out-patient basis. we compared the effectiveness of an intensive education programme with that of a conventional education programme for the self-management of type 2 diabetic patients. Methods: Subjects with type 2 diabetes were randomly selected, and allocated to one of two groups. One group received a conventional education programme of self-management(the CE group), and the second group received an intensive education progammes for three months, after which the effectiveness of the programmes were evaluate. Results: 1) The levels of fasting blood sugar(FBS), postprandial 2 hour blood sugar(PP2h) and HbA1c were significantly lowered in both groups following the intervention(p<0.05). In the IE group, the FBS declined from 12.4nmol/L to 7.7nmol/L, PP2h declined from 20.3nmol/L to 10.9nmol/L, and the HbA_lc showed a similar decline from 9.4 to 7.0% after intervention(p<0.05). In the Ce group, the FBS declined from 10.9 to 9.4nmol/l, the PP2h decreased from 17.1 to 14.6nmol/l, and the HbA_lc also decreased from 8.5 to 7.3% after intervention(p<0.05). The decrease in the FBS and HbA_lc following the educational intervention was more pronounced in the IE group than the CE group(p<0.05). 2) The effectiveness of the education programmes in promoting appropriate dietary behavior in the diabetic subjects was assessed by a scoring system in three parts: a regularity score, a balance score and an attitude score. From a comparative study of the three scores, the patients attitudes were observed to be much improved in both the groups following the intervention compared to before the programmes, but the balance and total scores were significantly higher in the IE group than the CE group(p<0.05). Conclusion: We can conclude that the intensive diabetic education programme is more effective than a conventional programme, not only in improving the patients' levels of glucose, HbA_lc, and dietary score, but also the diabetic patients self-control abilities, promoting behavioral change, and prompting problem solving capabilities in respect to the everyday problems that they have to face throughout their lives(J Kor Soc Endocrinol 18:63∼72, 2003).

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

귀인이론(歸因理論) 기반의 지역 공공인재학부 교육사업 성과평가에 관한 연구 - 동아대학교 석당인재학부 교육사업에 있어 집단별 의식차이 분석을 중심으로 -

이동규(Dong-Kyu Lee),민연경(Youn-Kyoung Min) 한국지방행정학회 2017 한국지방행정학보 (KLAR) Vol.14 No.1

The purpose of study is to identify influences of attribution of university headquarters, executive direction and management, student three groups - establishment･ establishment, management, entrance - to the performance evaluation index. This study offers development plan of the public sector honors college by analysing difference in group consciousness to the comparative significance of performance evaluation index for co-creation. The study attempt to investigate attribution theory and difference in group consciousness based on the 1st actions of 3 group results(establishment･ establishment, management, entrance) affect the performance evaluation indexes. For that, this study has developed 19 indicators, 5 Items for performance evaluation using program logic model and AHP method focusing on the seokdang honors college of Dong-A University. Analysis was pronounced differences between groups consciousness. University headquarters perceived the number of people passing exams, employment rates than other groups as important factors because university provides various benefits to attract talented student. On the other hand, executive direction and management perceived performance index of consultation program, training, attendance, the number of host because student motivation recognized as important. Student who demand for education services are recognized scholarship benefits(budget), the number of people passing exams of imput･initiative outcome item as major factors by opportunity costs for entrance to university located in Seoul. The study results suggest need for student･parents satisfaction as key performance indicator, good communication within the 3 groups of public sector honors college in order to improve the quality of operation since awareness about 17 of 19 performance indicators was a big gap. The study shows need for maintaining consistency･durability in government s policy to foster motivated talent in the community and joint venture creation.

스캔 설계 법칙 검사에 관한 연구

이재훈,김형국,조경연,임동욱,민형복 成均館大學校 科學技術硏究所 1997 論文集 Vol.48 No.2

Since testing of digital circuit is becoming increasingly important, many methodologies have been introduced to enhance design for testability (DFT). DFT was taken into account in the automated test procedure and improved reliability of the design. Both tasks are well suited for scan rule checker. This paper presents a scan rule checker for gate level digital circuits. The scan rule checker deals with basic rule check, basic scan rule check, muxed scan rule check, clocked scan rule check and lssd. Scan design informations were represented in the configuration file and libraries were modeled for the scan rule checker. It is an efficient way for the design for testability methodology.

장상피화생과 Helicobactor pylori와의 상관 관계에 관한 연구

이복희,김대수,이현숙,진영주,윤세진,송형근,성노현,정현용,이동호 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

In 1965 Lauren divided advanced gastric carcinoma into two main types-namely, "intestinal" and "diffuse" type carcinoma, which differ not only morphologically but also in their clinical and epidemiological characteristics. Moreover, a different histogenetic process has been postulated by many authors that intestinal type gastric carcinoma might arise from areas with intestinal metaplasia. Since Warren and Marshall reported the presence of Helicobacter pylori in the stomach in 1983, strong evidence has been obtained that there is a close relationship between Helicobacter pylori and chronic gastritis, atrophic gastritis, intestinal metaplasia, and intestinal type gastric carcinoma. To study the relationship between intestinal metaplasia and Helicobacter pylori infection, we performed gastroscopic biopsies and CLO tests taken from patients with epigastric pain. Only 87 patients with macroscopically suspected antral gastritis were included. The prevalence of intestinal metaplasia in gastric antral biopsies increased from 33.3% in the age group<30 years to 63.6% in the age group 60 years. When all patients were divided into two age groups-namely, (i)<50 years(n=41) and (ii)≥ 50 years(n-=46), intestinal metaplasia was found significantly more often in patients ≥ 50 years. ((i) 39.2%, (ii) 54.3%, p<0.0001). The prevalence of Helicobacter pylori in gastric antral biopsies decreased from 66.7% in the age group<30 years to 62.5%, in the age group in the age group 50 to 59 years. When all patients were divided into the same two age groups-namely(i)<50 years and (ii)≥50 years, the prevalence of Helicobacter pylori did not differ between two groups in a statistically significant way. The mean age of intestinal metaplasia positive patients who were also Helicobacter pylori positive was 48±11.0(mean±S.D.)years, whereas the mean age of intestinal metaplasia positive patients who were Helicobacter pylori negative was 52±9.7(mean±S.D.)years. In conclusion. although our data do not prove a causal relationship between Helicobacter pylori infection and the histogenesis of intestinal metaplasia, we suggest that Helicobacter pylori plays an important role in the development of intestinal metaplasia in the gastric mucosa. Whether Helicobacter pylori has to be present at all times during this process or is only necessary as a 'trigger', needs further research.

연폭로 근로자들에 있어서 신(腎)기능 장해 지표에 관한 연구

이상주,홍영습,김성률,김동일,김준연,정갑열 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.2

A range of indicators is available to assess renal dysfunction in lead exposure. This study was undertaken to find out which indicators were most valuable as markers of renal dysfunction. We selected 75 male workers from the secondary lead smelter, plastic stabilizer and radiator manufacturing industries (the "exposed" group) and 64 male office workers (the "control" group). Blood lead; blood zinc protoporphyrin; urine lead; urine coproporphyrin; δ-aminolevulinic acid dehydratase activity; and urine δ-aminolevulinic acid were chosen as indicators of lead exposure. Blood urea nitrogen; serum creatinine; serum uric acid; N-acetyl-β-D-glucosaminidase; urine albumin; urine α₁-microglobulin; and urine β₂-microglobulin were used as indicators of renal dysfunction. Urine α₁-microglobulin level was significantly associated with the lead exposre level. Blood urea nitrogen, urine N-acetyl-β-D-glucosaminidase and urine α₁-microglobulin levels were highly correlated with indicators of lead exposure. Urine α₁-microglobulin had the highest correlation with other indicators of renal function. In addition, the proportion of subjects with high urine α₁-microglobulin levels showed a gradient with lead exposure. Conclusively, blood urea nitrogen, urine N-acetyl-β-D-glucosaminidase and urine α₁-microglobulin are useful indicators, but urine α₁-microglobulin is the early and the most valuable indicator of renal dysfunction related to lead exposure.

산업생태학적 패러다임을 적용한 통합환경감사시스템

이윤규,고동원 경기대학교 2000 論文集 Vol.44 No.1

From the viewpoint of environmental policy, environmental audit system are particularly interesting as self-regulation methods. Other methods of environmental protection display self-regulation characteristics, but in environmental audit systems the operators are not only able to choose the methods to achieve the targets, but can also define the targets. The only requirement is a commitment to continuous improvement of the level of environmental protection. Target setting is decentralized, thus targets can change during the process. The ISO 14001 standard and the EMAS do not include prevention of occupational safety and health risks. This has been considered one of their weakness. Occupational health and safety matters can, however, easily be integrated into environmental audit system, although they cannot be certified as a part of these. By integrating environmental and safety matters the company can get synergy advances. In the following, we will consider those parts of environmental audit system which have connections to occupational health and safety matters, and we will propose integrated environmental audit system applied industrial ecology paradigm.

原料乳의 貯藏中 滴定酸度 및 總菌數의 變化에 關한 硏究 : Ⅲ. 原料乳에 過酸化水素를 處理했을 때의 貯藏時間 및 溫度에 따른 變化 Ⅲ. An Influence of Variation in the Temperature and Period during Storage in H_2O_2 Treated Raw Milk

李乙熙,趙永來,尹東根 진주산업대학교 1980 論文集 Vol.18 No.-

機械搾乳한 原料乳에 H_2O_2 0.05%(V/V)를 添加하여 總菌數 및 適定酸度의 變動狀態를 살펴 보기 위하여 3個의 溫度水準을 달리하여 2時間마다 H_2O_2를 處理하면서 2時間 간격으로 그 變動狀態를 調査한 결과는 다음과 같다. 1. 原料乳의 適定酸度 變化는 H_2O_2를 處理한 各 區에서 速度가 매우 늦었다. 2. 原料乳의 適定酸度는 20℃에서는 10時間까지 基準値(0.18%)이하였고 無處理區(T_0)에서는 6時間, 搾乳 卽時 處理한 區(T_1) 12時間, 2時間後 處理한 區(T_2)에서는 10時間 4時間後 處理한 區(T_3)에서는 8時間後에, 30℃의 경우는 4,12,10 및 8時間에 T_0,T_1,T_2 및 T_3에서 각각 基準値 以下였다. 3. 總生菌數는 5℃와 20℃에서 各區 共히 12時間까지 基準値 이하였고 30℃에서는 搾乳 卽時處理時는 10時間까지 2時間後 및 4時間後 處理한 區와 對照區에서는 8時間까지 保存可能하였다. 4. 大腸菌群은 12時間까지 점차적으로 增加되었으나 溫度差에 따라 增加 速度가 相異하였다. This experiment was conducted to determine the titrable acidity and microbiological change during storage in H_2O_2-­treated raw milk at intervals of two time. The sample were taken from the mixed milk by 5 Holstein cows in Jinju Agricultural & Forestry Junier Technical Collage. The raw milk was treated in 0.05% level with H_2O_2(35%V/V). The results obtained were as follows; 1. The titratable acidity of H_2O_2-­treated raw milk changed very slowly in all case temperature condition(5,20,30℃) compared with the controls. 2. The titratable acidity of raw milk was not found below the inedible level of the Government Standared(0.18%) until 12 hours in all case at 5℃ conditions, wherease 6,12,10 and 8 hours in control(T_0), lot of milking at once(T_1), after 2 hours(T_2) and after 4 hours(T_3) H_2O_2-­treated at 20℃, 4,12,10 and 8 hours in T_0, T_1, T_2 and T_3 at 30℃ conditions, respectively.

搾乳機 洗滌水에 관한 硏究 : 第Ⅰ報 過酸化水素 處理水準에 따른 原料乳의 貯藏性에 대하여 Ⅰ. On the storage property of Raw Milk to the level of H₂O₂-Treated Milker Washing Water

李乙熙,姜奉泰,尹東根 진주산업대학교 1981 論文集 Vol.19 No.-

This experiment was conducted to determine the titratable acidity microbiological change during 16 hours at 20℃ storage raw milk. It was milked Milker from immediately after washed 0, .3, .5 and .7% level with H_2O_2. The results obtained were as follow. 1. The titratable acidity changes very slowly in H_2O_2 treated Milker-washing water. 2. The titratable acidity of raw milk did not increased up to the inedible level of the Government standard untile 8 in control, 10 in T_1 and T_2 and 12 hours in T_3 Respectively. 3. The total bacterial and coliforms counts immediately after milk was 3.35×10 exp (5)/ml and 1.21×10 exp (4)/ml. 4. The total bacterial count of raw milk did not increased up to the inedible level of the Government standard untill 8 in control and 10 hours in H_2O_2 treated plot. 5. The coliforms grew rapidly in the H_2O_2-untreated Milker-washing water.

삽입형 심실제세동기 치료 : 6예 경험에 대한 보고 Initial Clinical Experience in 6 Patients

이동일,안신기,김종윤,김명희,김수영,이문형,김성순 대한순환기학회 1999 Korean Circulation Journal Vol.29 No.9