2003년 국내 중증급성호흡기증후군 진료 현황 및 문제점 분석

이진수,김은실,정문현,백제중,정선화,안주희,최영화,이선희,고철우,김성범,김민자,박승철,기현균,송재훈,최상호,김양수,이상오,조용균,박영훈,정숙인,김연숙,이흥범,손창희,장성희,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

목적 : 2002년 말 중국에서 SARS가 발생한 이후 국내에서도 2003년 10월까지 총 3명의 추정환자, 17명의 의심환자가 보고되었다. 향후 추가적인 SARS의 유행이 우려되는 상황에서, 그간의 SARS 환자 진료에 있어서의 실질적인 준비사항, 진료 현황 등에 대한 조사를 통해 문제점을 파악하여, 향후 더 나은 대비가 될 수 있도록 개선점을 제시하고자 하였다. 재료 및 방법 : SARS로 의심되는 환자를 진료 경험이 있는 병원의료진을 대상으로 2003년 10월에 설문조사를 실시하였다. 설문에는 SARS 환자 진료 시의 실질적인 조치, 진료 현황, 병실, 응급실 및 외래에서의 격리 시설과 준비사항, 보건당국의 관리와 지원에 관한 사항을 포함하였다. 결과 : 대상이 되는 22개 병원 중 17개(17/22, 77.2%) 병원이 설문에 응하였다. SARS 환자를 위한 격리실은 응급실, 외래, 일반병실 및 중환자실에서 각각 9개(9/17, 52.9%), 5개(5/17, 29.4%), 15개(15/16, 93.7%), 4개(4/16, 25%) 병원에서 음압처리가 되어있지 않은 일인실 혹은 다인실이 사용되었고, 1개(1/16, 6.3%) 병원에서만 일반병실에서 음압격리실이 운영되었다. 입원환자의 진찰 시 개인보호구의 착용은 거의 모든 의료기관에서 이루어졌다. 보건당국에서 SARS지정병원의 시설 등을 사전에 확인한 곳은 1곳(1/12, 8.3%)이였고, 14개 병원(14/15, 93.3%)에서는 보건당국에 의뢰한 검사결과를 통하 받지 못하였다. 결론 : 의료기관에서 SARS 환자용 격리실뿐만 아니라 기존의 격리실 설비 등이 미흡하였으며, 특히 중환자실 및 외래의 준비가 더욱 부족하였다. 보건당국의 의료기관에 대한 종합적인 지원이 부족하였고, 병원과의 원활한 연계가 잘 이루어지지 않았다. SARS 만이 아닌 격리를 필요로 하는 질환의 적절한 진료를 위해 향후 병원 시설의 정비와 정부차원에서의 보다 구체적이고 실질적인 대책마련이 필요하다. Background : There was an worldwide outbreak of the Severe Acute Respiratory Syndrome (SARS) originated from China in late 2002. During that period three cases of suspected SARS and 17 cases of probable SARS were reported in Korea. With the concerns about the reemergence of SARS-coV transmission, it is important to be prepared for any possibility. So, this study is aimed to analysis the past measures in managing SARS and propose the amendatory plans to improve the preparedness. Materials & Methods : Questionnaires were collected among clinicians with any experience in managing the probable or suspected SARS cases in Oct. 2003. 17 out of 22 hospitals responded to the questionnaire. The contents in the questionnaire were practical activities, personal equipments, response plans, isolation facilities in emergency centers, outpatient clinics, general wards and intensive care units, and relationship with the public health department. Results : The dedicated isolation rooms in emergency centers, outpatient clinics, general wards, and intensive care units were prepared in 9 (9/17, 52.9%), 5 (5/17, 29.4%), 15 (15/16, 93.7%), and 4 (4/16, 25.0%) hospitals, respectively. Except for one hospital that newly made negative pressure room for SARS, single or multi-bed rooms without airborne infection control were used in all the other hospitals. The personal precaution principles were kept quite well in general wards. Before the designation of SARS hospital by the public health department prior evalution to see if the hospital was suitable for managing SARS was conducted in only 1 (1/12, 8.3%) hospital. The results of laboratory diagnosis were reported back in 1 (1/15, 6.6%) hospital. Conclusions : The isolation facilities which can control airborne infection were almost deficient not only for SARS but also for other respiratory transmissible diseases. For the infection control of transmissible diseases including SARS, more investment is needed on medical facilities and comprehensive support from the public health department required.

癩의 免疫에 關한 硏究 : 癩患者의 末梢血液 T 및 B 淋巴球 測定에 關한 硏究

殷熙哲,金原錫,金洪植,金道一 大韓癩學會 1981 癩學 會誌 Vol.14 No.1

치수유래 구심성 신경섬유의 삼차신경 감각핵군에서의 연접특성

배용철,이은희,최민기,홍수형,김현정,남순현,김영진 대한소아치과학회 2001 大韓小兒齒科學會誌 Vol.28 No.2

일차연접부위에서 악안면 영역에서 유래하는 유해자극의 전달 및 처리기전을 이해하고자 horseradish pe개xidase를 치수지배 구심성 신경섬유를 표식한 후 연수후각에서 미세구조 및 연절 양상을 분석하여 다음과 같은 결과를 얻었다. 표식종말은 소수의 큰 치밀소포가 관찰되는 종말 (S형) 및 다수의 치밀소포를 함유하는 종말 (LDCV형)등 2종류로 분류할 수 있었다. S형 및 LDCV형 표식종말의 연접양식은 유사하였으며, 다수의 표식종말이 1개 혹은 2개의 neurofile과 연접을 이루어 대단히 단순한 연접양상을 보였다. 표식종말은 가지돌기체 보다는 다수의 가지돌기가시와 연접을 이루는 빈도가 높았다. 표식종말이 세포체 및 이에 인접한 근심부 가지돌기와 연접하는 경우는 드물었으며, 소수의 표식종말에서 p-ending과 연접하는 경우를 보였다. 표식종말의 체적, 표면적, 사립체의 체적, neurofile과 접하는 면적, 활성부위의 면적, 단위표식종말당 연접소포의 수 및 연접소포의 밀도등은 넓은 범위의 계측치를 나타내었으며, 이는 5명 및 LDCV형 표식종말 사이에 유의한 차이가 없었다. 이상의 결과로 미루어보아 연수후각에서 치수유래 구심성 신경섬유 종말의 연접양식은 고유의 특징을 보이며 이는 신경회로의 기능과 밀접한 상관관계를 가지는 것으로 판단되었다. Little is known about processing mechanism of pain sensation of the oral cavity at the 1st synapse of trigeminal sensory nuclei. Serial ultrathin sections of tooth pulp afferent terminals, identified by the transganglionic transport of 1% wheatgerm agglutinin conjugated horseradish peroxidase, were investigated wih electron microscope. Quantitative ultrastructural analysis was performed on digitizing tablet connected to Macintoshi personal computer (software: NIH Image 1.60, NIH, Bethesda, MD). Labeled boutons could be classified into two types by the shapes of containing vesicles : S bouton which contained mainly spherical vesicles (Dia. 45-55 nm) and few large dense cored vesicles (Dia. 80-120nm), and LDCV bouton, which contained spherical vesicles as well as large number of large dense coredd vesicles. Most of the parameters on the ultrastruotural characteristic and synaptic organization of labeled boutons were similar between S and LDCV boutons, except shapes of containing vesicles. Majority of the labeled boutons showed simple synaptic arrangement. The labeled bouton were frequency presynaptic to dendritic spine, and to a lesser extent, dendritic shaft. They rarely synapsed with soma and adjacent proximal dendrite. A small proportion of labeled boutons made synaptic contacts with presynaptic pleomorphic vesicless containing endings and synaptic triad. Morphometric parameters of labeled boutons including volume and surface area, total apposed area, mitochondrial volume, active zone area, vesicle number and density showed wide variation and theme were not significantly different between S and LDCV boutons. The present study revealed characteristic features on ultrastructure and synaptic connection of pulpal afferents which may involved in transmission of oral pain sensation.

1999년도 전남 지역내 저소득층 주민암 검사 실시에 따른 암유병률 조사연구

선승철,박준영,장판기,이영춘,이은희 한국건강관리협회 2000 건협 Report Vol.3 No.-

사업장 근로자의 건강위험 평가도구 개발

홍윤철,임현술,하은희,정규철,조희숙,박혜숙,이용애 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.4

Health Risk Appraisal(HRA) is usually defined as a process by which we expect of individual's chances of death or acquiring specific diseases within a defined period of time. The concept of worksite as an area of health maintenance and promotion is newly developing. Our movement for health promotion of employees has been increasingly known in the worksite. The aim of this study is to develop health risk appraisal tools about health promotion at the worksite for employees. We performed this study by two steps; one step was to develop a HRA questionnaire of worksites in Korea, another was to evaluate the reliability of the questionnaire. For developing HRA questionnaire, we reviewed scientific examples at first, and then weighted the score by delphi. To evaluate the reliability of developed questionnaire, we carried out survey by test-retest method. A total of 131 employees completed HRA questionnaire on two times. The results are as follows. The total score of health risk in unhealthy workers was higher than that of healthy workers. The range of test-retest reliability of responses to the questionnaire was 0.57-0.94. Therefore it seems that this questionnaire was very suitable to assess the health behavior of workers. In conclusion, the developed HRA questionnaire can be used as a tool for evaluating health behavior and for providing health counseling materials.

우리 나라 보건관리대행서비스 평가 연구

하은희,조수헌,김선민,주영수,한상환,하미나,권호장,홍윤철,김창엽 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.1

Group occupational health service programme started in 1990 is one of the measures to cope with limited human and financial resources in occupational health. The programme has expanded rapidly to include 52 institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. This study has aims to develop the criteria to assess the quality of newly developed group occupational health service programme, and to investigate the quality of institutions, and finally to develop policies for the quality improvement. 1) Criteria development : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, followings are included as core elements of qualitative occupational health programme; accessibility, continuity, comprehensiveness, technical quality, intersectoral collaboration, emphasis on preventive services, community participation, and adequacy. Again each element is divided into five major components of national health system infrastructure developed by the World Health Organization; development of health resources, organized arrangement of resources, delivery of health care, economic support, and management. In turn, each component is categorized into three aspects of quality assessment, structure, process and outcome. Expert panel selected several criteria for each category to evaluate the programme. Criteria were modified according to each group of interviewees, to produce two sets of questionnaire, one for chief operating officer and another for nurses in the institutions, and the chief operating officer and workers in the workplace. 2) Subject : Of all 52 institutions, 25 voluntarily participated in the survey. At individual institution, chief operating officer and practicing nurses were interviewed in depth. After intensive education for interviewees, every interviewees, every interview was performed with standardized guideline and questionnaire. The quality of the 'Group occupational health service programme' was found to be lower than expected. Especially in continuity, comprehensiveness, technical quality, community participation and adequacy, lower quality in structural aspect was commonly identified throughout all the institutions,. Quality in terms of accessibility and continuity highly varied among institutions., To improve quality of the programme, more comprehensive and systematic programme such as accreditation has to be introduced. In addition, human resources, governmental fund and information systems for individual workers are to be developed. As a long range plan, integration of occupational health services into the national health systems and pooling of financial resources and planned allocation should be considered.

Naltrexone으로 전처치된 사회적 음주자에서 음주 유발 후 음주 갈망과 혈장 β-endorphin의 변화

김은희,손인기,이영식,나철 대한신경정신의학회 2000 신경정신의학 Vol.39 No.4

연구목적: Opioid 길항제인 날트렉손은 알코올리즘 환자와 정상인의 음주행위에 영향을 준다는 보고가 있다. 그러나 날트렉손의 임상효과에 대한 기전은 아직 명확하지 않다. 이에 저자들은 사회적 음주자에서 날트렉 손의 임상효과 여부와 그 작용기전을 규명하고자 하였다. 방법: 사회적 음주자 15명을 대상으로 날트렉손을 이중맹검, 교차, 위약대조법으로 1주일간 전처치한 후, 음주 유발 검사를 통하여 알코올의 정신신테반응, 음주에 대한 갈망욕구와 혈장 β-endorphin과 ACTH, 혈청 cortisol 농도의 변화를 비교하였다. 결과: 1) NTX 전처치시 위약 전처치시보다 두통, 어지러움, 예민해짐, 피곤함, 주간 중 졸리움, 오심, 식욕감소 등의 부작용을 더 많이 경험하였으며(p<0.05), 혈청 GOT/GPT에 대한 영향은 차이가 없었다. 2) NTX 전처치시 음주갈망은 위약 전처치시와 비교하여 음주 전에는 차이가 없었으나, 음주 후 20분과 60분에서는 NTX 전처치시 음주갈망이 위약 전처치시 음주갈망 보다 유의하게 낮았다(p<0.05). 3) NTX 전처치시 어지러움증은 음주후 20분 뒤에는 두드러지지 않지만, 음주후 60분이 경과시에는 유의하게 높았고(p<0.05), NTX 전처치시에 음주 후 기타 신체적 불편감을 더 많이 호소하였으나 통계적인 의미는 없었다. 위약 전처치시 NTX 전처치시보다 기분이 상승되는 경향을 보였지만 통계적 의의는 없었다. 4) 음주 직전을 기준으로 한 음주 후 20분에서 혈장 β-endorphin 농도 변화율은 NTX 전처치시에 위약 전처치시보다 유의하게 증가하였다(p<0.05). 그러나 음주 직적을 기준으로 한 음주 후 60분에서 혈장 β-endorphin 농도변화율은 차이를 보이지 않았다. 5) 음주 직전을 기준으로 한 음주 후 20분에서 혈장 ACTH 농도 변화율은 NTX 전처치시에 위약 전처치시보다 유의하게 적은 감소율을 보였다(p<0.05). 그러나 음주 직전을 기준으로 한 음주 후 60분에서 혈장 β-endorphin 농도변화율은 차이를 보이지 않았다. 6) 음주 직전을 기준으로 한 음주 후 결정 cortisol 농도 변화율은 NTX 전처치시와 cortisol 전처치시에 차이가 없었다. 결론: NTX는 사회적 음주자에서 음주갈망의 감소를 야기하며, 이는 NTX의 신체적, 심리적 불편감 등의 간접적 결과하기 보다는 NTX의 opioid 긍정 강화체계에 대한 차단작용과 NTX의 알코올 유사효과라 여겨진다. Objectives: The present study was performed to evaluate whether naltrexone treatment are effectively lowering the urge of alcohol drinking, and to investigate the its mechanism of action. Methods: 15 healthy mals social drinkers were voluntarily participated. The experimental method was double-blind placebo-controlled cross over design. Subjects ingested a naltrexone (50mg)/day or placebo for 1 week. Plasma β-endorphin, plasma ACTH and serum cortisol levels were measured before, at 20 minutes and at 60 minutes after alcohol exposure. Subjects completed self-report questionnaires such as the visual analog scales of drink urge and the alcohol sensation scales at regular intervals. Results: 1) During naltrexone pretreatment period, subjects reported more headache, dizziness, nere-ousness, fatigue, day somnolence, nausea, and decreased appetite than placebo pretreatment period. But serum GOT/GPT levels were not significantly different between two pretreatment periods. 2) In case of naltrexone pretreatment, subjects reported significantly less urge to alcohol drink on the self-reporting urge scales, especially at post-drinking 20 minutes and 60 minutes than placebo pretreatment. 3) After alcohol challenge, subjects reported significantly more dizziness on the alcohol sensation scales in case of naltrexone pretreatment, and reported less mood elevation trend though it was not statistically significant. Other scores were not significantly different between two pretreatments. 4) Plasma β-endorphin levels were significantly different when treated with naltrexone. In case of naltrexone-pretreatment, the increasing degree of plasma β-endorphin during 20 minutes after alcohol challenge was significantly higher than placebo pretreatment. 5) Basal plasma ACTH level and basal serum cortiso level were not significantly different between two pretreatments. After alcohol challenge, only the decreasing degree of plasma ACTh levels during 20 minutes was significantly lowered in the naltrexone pretreatment than placebo pretreatment. Conclusion: Naltrexone reduced urge to alcohol drinking in social drinker. The action mechanism of naltrexone may be partially blocking opioid positive reward system and partally alcohol mimicking its property.

사업장 근로자의 건강위험 평가도구 개발

정규철,이용애,홍윤철,조희숙,박혜숙,임현술,하은희 이화여자대학교 환경문제연구소 1998 이화환경연구 Vol.2 No.-

Health Risk Appraisal(HRA) is usually defined as a process by which we expect of individual's chances of acquiring specific diseases within a defined period of time. The concept of worksite as an area of health maintenance and promotion is newly developing. Our movement for health promotion of employees has been increasingly known in the worksite. The aim of this study is to develop health risk appraisal tools about health promotion at the worksite for employees. We performed this study by two steps: one step was to develop a HRA questionnaire of worksites in Korea, another was to evaluate the reliability of the questionnaire. For developing HRA questionnaire, we reviewed scientific examples at first, and then weighted the score by delphi. To evaluate the reliability of developed questionnaire, we carried out survey by test-retest method. A total of 131 employees completed HRA questionnaire on two times. The results are as follows. The total score of health risk in unhealthy workers was higher than that of healthy workers. The range of test-retest reliability of responses to the questionnaire was 0.57-0.94. Therefore it seems that this questionnaire was very suitable to assess the health behavior of workers. In conclusion, the developed HRA questionnaire can be used as a tool for evaluating health behavior and for providing health counseling materials.

도시 개발에 따른 기상장 변동의 3차원 수치해석에 관한 연구

이희철,이범주,이도훈,이은태 경희대학교 산학협력기술연구원 1999 산학협력기술연구논문집 Vol.5 No.-

Selenium 부족 식이가 흰쥐 간장에 미치는 영향

김은희,이현기,양영철,차인준 인제대학교 1990 仁濟醫學 Vol.11 No.3

Se 부족에 의하여 랫트의 체중과 사료 섭취량은 감소되었으며 혈중 LDH, GOT와 간장조직의 glutathion 농도는 정상보다 증가되었다. Se 부족군의 조직학적 소견은 간세포의 공포화 변성, 간조직의 PAS 반응 저하, LDH 활성화 감소 및 ACP 활성의 증가를 나타내었으며, rER의 분절화 현상 및 감소와 mitochondria의 종창 등이 관찰되었다. The objective of this study was to determine the effect of Se-deficient diet on the weight gain, chemical changes in plasma and microstructural change of liver in rat. Rats were divided into 2 diet groups (Se-deficient diet) and control diet and sacrificed after 21days of feeding. Levees of LDB, GOT, GPT of Plasma arid glutathione of liver were determined and light microscopic and electron microscopic observation of ret liver were performed. Total weight gaits (P<0.05) and feed efficiency radio (P<0.001) were significantly lower in Se-deficient group than in control group, whereas the levels of plasma LDH (P<0.001) and GOT (P<0.05) were increased significantly in Se-deficient group. Furthermore, the levels of total glutathione (P<0.01) and reduced glutathione (P<0.001) showed significant increase in Se-deficient group. Light microscopic observations showed that cytoplasmic blooning degeneration and pyknosis of nuclei were often found around portal canal of Se-deficient group by H-E straining. PAS staining also showed weakly positive reaction around central area, whereas PAS negative reacting cells were often observed around portal canal of Se-deficient group. Histochemical staining skewed that cytochrome oxidase activity were very active in both groups, whereas LDH activity was significantly decreased arid ACPase activity was significantly increased in Se-deficient group. Electron microscopic observation showed that the number of rER were decreased and the blooning degeneration of rEr was often observed in Se-deficient group. Mitochondria with mayeline figure arid wooly density were also observed in Se-deficient group. Light microscopic observations showed that cytoplasmic blooming degeneration and pyknosis of nuclei were often found around poral canal of Se-deficient group by H-E staning. PAS staining also showed weakly positive reaction around central area, whereas PAS negative reacting cells were often observed around portal canal of Se-deficient group. Histochemical staining showed that sytochrome oxidase activity were very active in both groups, whereas LDH activity was significantly decreased and ACPase acclivity was significantly increased in Se-deficient group. Electron microscopic observation stewed that the number of rER were decreased and the blooning degeneration of rER was often observed in Se-deficient group. Mitochondria with myeline figure and wooly density were also observed in Se-deficient group.