결핵의 진단법으로서 중합효소 연쇄반응 검사의 가치

서상철,은상진,김한길,송경은,서장수,최성만,이원길,김재식,김중명 慶北大學校 醫科大學 1994 慶北醫大誌 Vol.35 No.1

목적 : 결핵균 동정을 위한 중합효소 연쇄반응을 임상병리검사로서 적용하기 위한 기초 실험으로 분석학적 예민도와 특이도를 알아보고 검토된 조건에 의한 중합효소 연쇄반응을 실제 임상 가검물에 적용하기 위함이다. 재료 및 방법 : Ziehl-Neelsen염색 양성인 객담, 뢰벤스타인-젠센(Loewenstein-Jensen) 배지에서 분리된 결핵균 및 M. tuberculosis H37Rv를 비롯한 항산균 표준균주 11주와 비항산균 10주를 사용하여 2가지 DNA의 분리법, 3set 프라이머, 3종류 중합효소, 2가지 미량 원심시험관 및 Easy-Cycler^R(Ericomp사, 미국)와 수조형으로 검사를 시행하여 DNA 증폭 산물을 비교하였다. 또한 이미 지일-닐슨 염색법에 의한 선별검사에서 음성을 나타낸 객담 53예, 소변 101예, 삼출액 128예, 뇌척수액 54예 등 총 370예의 임상가검물을 대상으로 하여 위에서 검토된 중합효소 연쇄반응 조건으로 검사한 성적과 지일-닐슨 염색법, 배양법 성적과 비교하였다. 결과 : DNA분리방법 2가지와 3가지 중합효소는 분석학적 예민도와 5fg로 나타나 차이를 발견할 수 없었으며, 프라이머 P1, P2쌍은 예민도가 5fg, 프라이머 INS1, INS2쌍과 프라이머 Pt3, Pt6쌍의 예민도는 0.5fg이었다. Easy-Cycler^R가 수조형에 비해 높고, 미량 원심시험관은 Robbins사 제품이 Sarstedt사 제품에 비해 높은 분석학적 예민도를 나타냈다. 프라이머 P1, P2쌍과 프라이머 INS1, INS2와 Pt3, Pt6 2쌍의 프라이머의 특이도에 있어서는 항산균 표준균주 중 M. tuberculosis H37Rv, M. tuberculosis ATCC 27294, M. bovis ATCC 29312의 3주에서 특이 증폭 띠를 관찰할 수 있었다. 그러나 비결핵성 항산균 8주에는 특이 증폭 띠를 나타내지 않았다. 또 비항산균 10주에도 특이 증폭 띠가 관찰되지 않았다. 따라서 Robbins사의 미량 원심시험관과 proteinase-K법에 의한 DNA분리방법에 Easy-Cycler^R를 사용하여 프라이머 INS1, INS2쌍으로 일차 중합효소 연쇄반응을 시행한 후 프라이머 Pt3, Pt6쌍으로 이차중합효소 연쇄반응을 시행하는 방법을 370예의 임상가검물에 시행하였고 지일-닐슨 염색법과 결핵균배양검사도 동시에 시행한 결과 중합효소 연쇄반응 양성은 106예(28.6%), 배양 양성은 27예(7.3%) 및 염색 양성은 18예(4.9%)였으며, 결핵환자는 141명(38.1%)였다. 370예의 임상 가검물로 시행한 중합효소 연쇄반응의 진단학적 예민도와 특이도, 양성결과 예측치 및 음성결과 예측치는 68.8%, 96.1%, 91.5% 및 83.3%로 각각 나타났다. 결론 : 결핵균 동정을 위한 중합효소 연쇄반응은 배양검사에 비해 신속하며, 분석학적인 예민도와 특이도가 뛰어나므로 결핵 진단을 위한 임상병리검사로서 유용하다고 사료됨. In this study, We investigated the optimal conditions of polymerase chain reaction(PCR) assay for the rapid identification of Mycobacterium tuberculosis in clinical specimens as routine laboratory test. So we have compared two DNA isolation methods, 3 polymerases, 2 set of primer, 2 kinds of thermocycler and 2 microtubes. We evaluated two DNA isolation methods, bead-beating method and proteinase-K method, the latter was more sensitive than the former. In comparision of two sets of primers, P1 and P2 primers detecting 123-base pair fragment of IS6110 made from Biosnthesis(U. S. A.) and INS1 and INS2 primers detecting 245-base pair fragment of IS986 showed equally sensitive results ie. 5fg. Specificity of primers were tested and INS1 and INS2 primers gave 245-base pair product from M. tuberculosis H37Rv, M. tuberculosis ATCC 27294 and Mycobacterium bovis ATCC 29312 but not from 8 nontuberculous mycobacterial strains such as M. kansasii ATCC 12478, M. terrae ATCC 15755, M. intracellurae ATCC 13950, M. avium ATCC 25281, M. gordonae ATCC 14470, M. fortuitum ATCC 6841, M. smegmatis ATCC 19420, M. scrofulaceum ATCC 19981. Coagulase-positive staphylococcus, coagulase-negative staphylococcus, streptococcus, Esccherichia coli, Serra-tia marcescens, Klebsiella pneumoniae, Enlerobacter aerogenes, Enterobacter cloacae, Acinetobacter calcoaceticus, Pseudomonas aerugonosa showed no 245-base pair amplification product. PCR by the P1 and P2 primers showed 123-base pair amplification product from M. tuberculosis H37Rv, M. tuberculosis ATCC 27294 and Mycobacterium bovis ATCC 29312 but not from 8 nontuberculous mycobacterial strains such as M. kansasii ATCC 12478, M. terrae ATCC 15755, M. intracellularae ATCC 13950, M. avium ATCC 25281, M. gordonae ATCC 14470, M. fortuitum ATCC 6841, M. smegmatis ATCC 19420, M. scrofulaceum ATCC 19981. Coagulase-postive staphylococcus, coagulase-negative staphylococcus, streptococcus, Escherichia coli, Serratia marcescens, Klebsiella pneumoniae, Enlerobacter aerogenes, Enterobacter cloacae, Acinelobacler calcoaceticus, Pseudomonas aeruginosa showed no 123-base pair amplification product. In comparision of polymerase, Taq DNA polymerase^R(Promega Co., U. S. A.) was more cost effective than Ampli Tag^R(Perkin-Elmer Cetus, U. S. A.), but these two were equally sensitive and specific in the detection of M. tuberculosis-specific DNA. Tac polymerase (Korea'Biotech, Korea) showed many nonspecific bands. In comparision of thermocycler, Easy-Cycler^R(Ericomp, U. S. A.) was more sensitive than water-bath type and in that of microtubes Robbin's were more sensitive than Sarstedt's PCR results were compared with results of culture for M. tuberculosis and Ziehl-Neelsen stain in 370 clinical specimens that were negative by initial Ziehl-Neelsen stain. There were 27 specimens(7.3%) that were positive for M. tuberculosis by culture, 18(4.9%) specimens that were positive by Ziehl-Neelsen stain, and 106 specimens(28.6%) that were positive for PCR and 141 cases that were positive for tuberculosis. Overall sensitivity, specificity, positive predictive value and negative predictive value were 68.8, 96.1, 91.5 and 83.3% respectively, for PCR; 19.1, 100, 100, and 66.8%, respectively for culture; and 12.8, 100, 100, and 59.0% respectively for Ziehl-Neelsen stain.

간호사의 임상 실무 경험

서문자,손행미,강현숙,권성복,김주현,박영숙,이은희,임난영,조경숙,지성애 성인간호학회 2002 성인간호학회지 Vol.14 No.4

purpose: This study was conducted to describe qualitatively the entities of nurse's experiences in general hospitals and to suggest basic data guiding research on developing Standards of clinical nursing practice in Korea. Method: Fourteen nurses working at general hospitals with over 300 beds in Seoul were interviewed in-depth until saturation using tape-recorders and transcription. Result: The central theme of clinical nursing practice experienced by subjects was "being with clients" that means accepting client's personal character, solving client's needs and providing client-centered nursing. A also "being with clients" was felt to be the responsibility of nurses which was learned from their nursing schools. The nursing strategies performed in order to be with patients were proving skillful nursing techniques, accepting, educating, emotional support, advocating, and self-reflecting, the subjects experienced somewhat problematic affects such as difficulties in interpersonal relationship, work overload, negative image of nursing, deficit of self-confidence for nursing actions, poor working conditions, and unfair treatment. Nurses at the hospital practiced with pride when they felt that they were accepted by clients. Conclusion: Further research is needed to analysis problems in clinical practice and the comparison of nurses' experiences of clinical practice, with nurses' experiences in various settings.

간호실무에서 신봉이론(Espoused theories)에 대한 탐색적 연구

서문자,김혜숙,이은희,박영숙,조경숙,강현숙,임난영,김주현,이소우,조복희,이명하,지성애,하양숙,손영희,권성복,김희진,추진아 성인간호학회 2001 성인간호학회지 Vol.13 No.1

As a nursing practice involves nurses' actions in a specific context of health care, this study has focused on exploring the espoused theories in nursing practice within the action science perspectives, Espoused theories are the belief, principles, and rationale expressed by the practitioner as guiding her/his actions in a situation of practice. The data were analysed qualitatively and 25 elements of espoused theories of nursing action were identified and clustered into 6 categories. The 25 elements of espoused theories are as follows: The clinical nurse worked in wholistic and individual nursing, focussed on the patient's needed, comfort and supportive nursing (5 theories of nursing goal) ; excellent skills, knowledge based, assessment and data collection, explaining, educating or a scientific basis(6 theories of nursing intervention): advocacy, value oriented, treatment, account- ability and commitment(4 theories of nursing ethics) ; human respect. partnership, trust(3 theories of patient-nurse relationship) : knowledgable, accumulated clinical experiences and personally lived experiences. positive perspectives(4 theories of nurse), role of intervention. rewarding peer relationship(3 theories of situations) The above mentioned espoused theories are similar to that of nursing textbooks which students learned through basic nursing education and almost the same as the Acts ofa Nurse in Korean. However, we are doubtful whether nurses actually do as they think. Therefore. it is recommended to review the theories-in-use in order to and any discrepancies between the espoused theories and the reality of nursing actions

원전 사고를 대비한 장거리 대기 확산모델 개발

서경석,김은한,한문희 대한방사선 방어학회 2002 방사선방어학회지 Vol.27 No.3

대기 중으로 방출된 방사성물질의 이동·확산 현상을 이해하기 위하여 3차원 장거리 확산 모델이 개발되었다. 모델은 수평방향으로 방출점으로부터 수천 키로 미터의 거리까지 공기중 농도와 지표면 침적을 계산하도록 설계되었다. 수직 난류운동은 혼합층 내와 혼합층 위로 분리하도록 고려하였다. 시험계산은 동북 아시아권의 영역을 고려하였고, 방출점은 중국의 동쪽 지점을 가정하였다. 계산된 농도분포는 바람장에 의해 방출점의 남동방향을 향해 주로 이동되었다. 개발된 모델은 완전 사고시 방사선 피해를 추정하기 위하여 이용될 것이며, 모델은 장거리 야외 확산실험의 자료를 이용하여 비교·검증 연구를 통하여 보완될 것이다. The three-dimensional long-range dispersion model has been developed to understand the characteristics of the transport and diffusion of radioactive materials released into atmosphere. The model is designed to compute air concentration and ground deposition at distances up to some thousands of kilometers from the source point in horizontal direction The vertical turbulent motion is considered separately within the mixing layer and above the mixing layer. The test simulation was performed in the area of Northeast Asia. The release point was assumed in the east part of China. The calculated concentration distributions are mainly advected toward the southeast part of release point by the wind fields. The developed model will be used to estimate the radiological consequences against a nuclear accident. The model will be supplemented by the comparative study using the data of the long-range field experiments.

중․고등학생의 의복 구매 실태 및 맞음새에 관한 연구

어미경;홍은희;홍수숙;서미아 한양대학교 2005 韓國 生活 科學 硏究 Vol.25 No.1

Surveying actual wearing conditions and fitness of clothes for middle and high school students, this study intends to grasp the problem of ready-made clothes worn by middle and high school students and to suggest the size system of ready-made clothes appropriate for adolescents. The objects for survey were 796 middle and high school students at the age of 13~18, attending from the 1st grade of middle school to the 3rd grade of high school and 7 middle and high schools located in southern and northern part of Seoul were selected. The result of study is as follows. Preferring common casual most, middle and high school students show the highest tendency of wearing clothes in the ordinary fitness. It was found that middle school students bought clothes with parents and high school students, with friends. As the reason for middle and high school students’ not purchasing clothes at the corner of children’s wear, boy student answered that the size of casual or sports wear does not fit and girl student answered that design or color looks young. The largest dissatisfaction on clothes is complaint on price, which is followed by design in the case of middle school students and by size in the case of high school students. When it comes to the fitness of clothes, middle school students are more satisfied than high school students. In the case of jacket, trousers and shirts, boy students are more satisfied than girl students. Though obese students are most satisfied with the shoulder width of jacket and coat, they are less satisfied with all items of skirt and trousers.

원예치료프로그램이 정신장애자의 우울감에 미치는 효과

정은경,이명희,서정근 한국화훼연구회 2001 화훼연구 Vol.9 No.1

The purpose of this study was to identify effects of horticultural therapy on the depression of psychiatric patients. The experimental group was 12 patients, who received horticultural therapy far one hour per week for 15weeks. The control group was 12 patients, who did not received horticultural therapy, 24 patients were examined before and after program of horticultural therapy at once respectively. The results of the study were as follows; The experimental group showed the decrease on depression. As following general characteristic of patients, people who is man, single, over 5years in hospital and academic carrier educated under middle school graduate, had the decrease on depression. Through above results we can prove the effects of horticultural therapy on the depression of psychiatric patients. On the Other hand, more professional study will be required.

부산지역 중학생의 식습관에 다른 영양지식과 식품기호도 조사 : 식습관에 관한 분석

정은경;서재수 고신대학교 자연과학연구소 2011 고신대학교 자연과학연구소 논문집 Vol.19 No.-

본 연구는 중학생들의 식습관과 영양지식이 균형 있는 영양 섭취와 건강 관리에 있어서 매우 중요한 요소임을 인식하여, 중학생들 외 영양지식 및 식습관 파 관련된 식품기호도를 분석하고, 각 요인 간에 상관관계를 조사한 그 결과는 아래와 같다. 첫째, 조사 대상자의 인적특성에서 아버지의 연령은 '40 대 (83.7%)'로 가장 많았고, 어머니 역시 '40대 (72.0%)'가 가장 많았다. 교육정도는 아버지의 교육정도가 '대학교 졸업(54.8%)' 이 많았고, 어머니도 '대학교 졸업 (45.8%)'이 가장 많은 것으로 나타났다. 형제 수는 2명인 학생이 69.3%로 가장 많았으며, 어머니가 직장을 가지는 경우가 64.7%로 조사되었다. 가정에서의 식사 관리는 대부분 '어머니(85.3%)'가 하는 것으로 조사되었다. 둘째, BMI가 '1 학년(20.3)', '2학년(21.3)', '3학년(20.7)' 로 나타났으며, 전체적으로 50.5%의 학생들이 정상 체중이었고, '저체중(26.5%)', '과체중(13.8%)', '비만(9.5%)'로 나타났다. 특히 1학년의 경우 다른 학년에 비해 저체중 비율이 34.5%로 가장 높았다. 영양지식은 부모로부터 접한다는 응답이 36.5%로 많았고, 어머니가 직장이 있는 경우 대중매체를 통해 영양지식을 접한다는 비율이 31.7% 로 높게 나타났다. 영양교육의 필요성은 전 학년의 72.2%가 필요하다고 하였고, '1 학년(80.5%)' 이 '2학년(66.5%)' 과 '3학년(69.5%)'에 비해 더 크게 인식 하고 있었다. 셋째, 조사 대상자의 90.2%가 아침식사를 한다고 응답하였다. 부연령과 부학력, 가계소득이 높을수록 아침식사를 하는 비율도 많아지는 것으로 조사되었다. 아침식사를 먹지 않는다고 답한 59명은 '시간이 부족해서(42.2%)' 라고 답했다. 간식횟수는 '가끔 먹는다(28.2%)' 고 하였고, 외식횟수는 '월 2-3 회(36.5%)' 로 가장 많았다. 편식의 유무는 48.8%가 편식을 하며, '맛이 없어서 (50.5%)' 라는 응답이 많이 나타났다. 식사 시간은 59.6%의 학생이 규칙적으로 식사하며, 식사량은 부모의 학력이 낮을수록 불규칙적인 식사형태를 보였다. The purpose of this study was to examine the nutrition knowledge, eating habits and food preference of middle schoolers. The subjects in this study were some middle schoolers in the region of Dongrae-gu, Busan, to whom school food service was provided. Their eating habits, nutrition knowledge and food preference were investigated. The findings of the study were as follows: 1) The largest number of their fathers were in 40s(83.7%), and the greatest number of their mothers were in 40s(72.0%) also. By academic credential, many of the fathers were college graduates(54.8%), and a lot of the mothers were college graduates as well(45.8%). The largest number of the students had two siblings(69.3%), and many of their mothers were working(64.7%). Their mothers were mostly in charge of their meals at home(85.3%). 2) The BMI of the seventh, eighth and ninth graders were respectively 20.3, 21.3 and 20.7, Overall, 50.5 percent had a normal weight. The rates of the underweight, overweight and obese students respectively stood at 26.5, 13.8 and 9.5 percent. Specifically, the rate of underweight was higher among the seventh graders(34.5%). The students whose mothers were working acquired relatively more information on nutrition through mass media(31.7%). As to the necessity of nutrition education, 72.2 percent felt the need for that, and the seventh graders(80.5%) more considered that to be relatively necessary than eighth(66.5%) and ninth graders(69.5%). 3) The 90.2 percent of the selected students had breakfast. The percentage of having breakfast was higher among the students whose fathers were older, whose fathers were better educated and whose household income was larger. Out of 59 students who didn't have breakfast, 42.2 percent cited time constraints as the reason. In regard to snack-eating frequency, 28.2 percent had a snack from time to time. The most dominant eating-out frequency was twice or three times a month(36.5%). As to unbalanced diet, 48.8 percent had an unbalanced diet, and percent did that because they found meals to be untasty. Concerning eating time, 59.6 percent took meals on a regular basis, and those whose parents were less educated had a more unfixed amount of meals.

원예치료프로그램(HTP)이 정신장애인의 자아상태, 대인관계 및 면역글로블린 IgG함량에 미치는 효과

정은경,이시래,서정근 한국식물인간환경학회 2000 인간식물환경학회지 Vol.3 No.3

The purpose of this study was to identify the effects of horticultural therapy on egostate, personal relationship and contents of immunoglobulin G in psychiatric patients. The experimental group was 16 patients, who received horticultural therapy for one hour per week for 15weeks. The control group was 16 patients, who did not received horticultural therapy. The data of subjects were collected before and after program of therapy at once for each. The result of the study were as follows: 1.The experimental group was decreased on critical patient egostate. 2.There was no significant difference on negativity to self and others of personal relationship in both groups. 3.The experimental group tended to be improved on contents of immunoglobulin G. Through above result, more concrete and scientific verification on the effects of horticultural therapy will be needed.

원전 중대사고시 피폭경로 및 핵종의 방사선 피폭에 대한 상대적 중요도 해석

황원태,김은한,김병우,서경석,한문희 대한방사선 방어학회 1994 방사선방어학회지 Vol.19 No.3

원자력발전소의 중대 사고시 대기로 방출된 방사성물질에 의해 피폭자가 사고후 일생동안 받게 될 전신 피폭선량의 핵종의 상대적 중요도를 방출점으로부터 거리에 따라 각 피폭결로에 대해 평가하였다. 방사능운과 지표에 침적된 방사성물지에 의한 외부피폭,호흡과 오염된 음식물섭취에 의한 내부피폭이 피폭경로로 고려되었다. 오염된 음식물섭취에 의한 영향은 우리나라 환경을 고려하여 개발된 동적 섭식경로모델 KORFOOD를 사용하여 침적시점과 침점후 시간에 따른 음식물내 방사성물질의 농도 변화를 고려하였다. 방출점으로부터 80 km까지 피폭선량을 평가한 결과, 오염된 음식물섭취에 의한 영향이 가장 놓았다. 핵종별 기여도는 방사능운에 의한 외부피폭과 호흡에 의한 내부피폭의 경우 I, 침적된 방사성물질에 의한 외부피폭의 경우 Cs에 의한 영향이 가장 높았다. 오염된 음식물섭취에 의한 내부피폭의 경우 Cs은 여름철 침적, Sr은 겨울철 침적에 보다 중요한 영향을 미쳤다. In the case of a severe accident of a nuclear power plant, the whole body does and the relative importance of the radionuclides during the lifetime of an exposed person were estimated for each exposure pathway with distances from the release point. The external exposure pathways due to immersion of radioactive could and deposition of radioactive materials on the ground, and the internal exposure pathways due to inhalation and ingestion of contaminated foodstuffs were estimated considering the variation of radioactive concentration in the foodstuffs according to deposition time and elapsed time after deposition using a dynamic ingestion pathway model applicable to Korean environment, named "KORFOOD". As the results up to 80 km from the release point, the effects due to ingestion of contaminated foodstuffs showed the highest contribution to total exposure does. The contribution of I isotopes was the highest in the case of the external does due to immersion of radioactive cloud and internal does due to inhalation. The contribution of Cs isotopes was highest in the case of the external does due to deposition of radioactive materials on the ground. In the case of the internal does due to ingestion of contaminated foodstuffs, Cs deposition in summer and Sr deposition in winter, respectively, were the most dominant radionuclide to whole body.

원자력 사고 중 핵종의 건·습침적에 따른 농작물 오염 영향

황원태,김은한,서경석,한문희,최용호,이창우 대한방사선 방어학회 2002 방사선방어학회지 Vol.27 No.3

핵종의 지표 침적 모델의 고찰과 함께 방사성물질의 공기중 농도로부터 건침적 뿐 아니라 습침적에 따른 농작물 오염 영향을 분석, 고찰하였다. 이를 위해 방사성물질의 지표 침적량으로부터 농작물의 오염을 평가하는 기존 동적 섭식경로모델을 공기중 농도 또는 지표 침적량으로부터 평가할 수 있도록 개선하였다. 평가결과, 방사성물질의 지표 침적량은 습침적에 의한 영향이 건침적에 의한 영향보다 뚜렷이 높으나, 농작물의 오염정도는 핵종, 강우율 등에 따라 다르게 나타났다. 이러한 현상은 방사성물질의 지표 침적과 농작물에로의 차단중 어느 과정이 농작물 오염에 보다 지배적으로 작용하는가에 기인한다. Combined with deposition model onto the ground of radionuclides, the influence of radioactive contamination to agricultural products was analyzed due to wet deposition as well as dry deposition from radioactive air concentration during a nuclear emergency. The previous dynamic food chain model, in which initial input parameter is only radionuclide concentrations on the ground, was improved for the evaluating of radioactive contamination to agricultural products from either radionuclide concentrations in air or radionuclide concentrations on the ground. As the results, in case of deposition onto the ground, wet deposition was more dominant process than dry deposition. While the contamination levels of agricultural products were dependent on the a variety of factors such as radionuclides and rainfall rate. It means that the contamination levels of agricultural products are determined from which is more dominant process between deposition on the ground and interception onto agricultural plants.