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.

7개 대학 병원에서 조사한 지역사회 폐렴의 원인균

정문현,김성민,강문원,최희정,정희진,이경원,한성우,송재훈,신형식,김의종,최강원,김민자,박승철,배현주,정윤섭,김준명,백경란,신완식,이규만,김양리 대한감염학회 1997 감염 Vol.29 No.5

목 적 : 폐렴은 많이 발생하면서 사망률이 크게 줄지 않는 질환이며, 이를 적절히 치료하기 위해서는 원인균의 상대적 빈도, 기저 질환에 따른 변화, 항균제 내성률, 사망에 관련된 인자들을 알아야 한다. 원인균의 빈도는 지역마다 차이가 있고 국내에서는 항균제 내성률이 높아 지역사회에서 발생한 폐렴을 치료하기 위한 경험적 항균제 선택에 도움이 되기 위해 서울 소재 6개 대학 병원과 천안의 1개 대학 병원이 참여하여 위의 사항들에 대해 조사를 하였다. 방 법 : 1995년에 내과에 입원했던 16세 이상 환자를 대상으로 했다. 퇴원 진단명이 폐렴 또는 폐결핵인 병록지을 찾았고, 이중에서 병원 감염을 제외하였다. 특이도를 높이기 위해, 이들 중에서 호흡기 증상이 있고 발열이나 저체온이 있으면서 흉부 X-선에서 이상 음영이 있는 환자만을 대상으로 했다. 폐결핵은 위의 기준에 입원 초기에 항균제 치료를 하고 입원 7일 이후에야 항결핵제가 투여된 경우만을 폐렴의 원인균으로 하였다. 혈액 배양에서 양성, 객담에서 항상균이나 M. tuberculosis가 증명된 경우, 혈청학적으로 항체가가 4배 이상 증가된 경우, 조직에서 원인균이 진단된 경우는 확정(definitive) 원인균으로 하였고, 객담에서 배양된 균이 그람 도말과 일치할때, 항결액제에 대한 반응으로 진단한 폐결핵, 단일 항체가 양성이고 이에 대해 항균제를 사용했을 때는 가능(probable) 원인균으로 정의하였다. 다세균 감염균은 각각 다 른 원인균으로 처리하였다. 임상 조사와 함께 임상병리과에서 S. pneumoniae, H. influenzae, M. catarrhalis, mycoplasma, 항상균에 대해 검사 의뢰 건수, 배양 양성수, 항균제 감수성 결과를 조사하였다. 결 과 : 폐렴의 증례 정의에 부합하지 않은 135명과 폐결핵의 정의에 해당하지 않는 230명을 제외하고 남은 246명의 평균 나이는 58.2세이고 남성이 142명(58.2%) 이었고, 71%의 환자에서 기저 질환이 있었다. 진단 방법의 시행 횟수는 혈액 배양 77.6%, 혈청 검사 18.3%, 기관지경 검사는 4.1%였고, 세균의 항원 검사를 한 예는 없었다. 원인균이 밝혀진 예는 77명(31.3%)이었다. 다세균 감염이 4명에서 있었고, 원인균의 상대적 빈도는 결핵 20명(확정 17, 가능 3: 6개 병원 자료), 폐렴구균 18(확정8 가능 10)명과 폐렴구균이 아닌 Streptococcus 3명 (모두 확정), H. influenzae 11명(모두 가능), 그람음성간균 11명(확정 7, 가능 4) (K. pneumoniae 8건), Mycoplasma 5명(확정 1, 가능 4), S. aureus 4명(확정 2, 가능 2), mucormycosis 1명(확정)이었다. 평균 입원 기간은 19일이고, 중환자실 입원률과 인공 호흡기 사용율은 각각 18%와 9.3%였다. 사망률은 13.8%였고 사망까지 평균 기간은 14.6일 이었다. 다변량 분석에서 사망을 예측할 수 있는 인자는 저체온과 빈호흡이었다. 임상병리과에서 배양되었던 모든 폐렴구균의 Penicillin 내성률은 서울 3개 병원에서 82-88%, 천안에서 72%였다. 폐렴 환자의 혈액에서 배양된 7주는 모두 Penicillin에 감수성이 있었다. K. pneumoniae 8주 모두 cefotaxime과 gentamicin에 감수성을 보였다. 결 론 : 후향적 조사이고 병원마다 원인균 진단에 차이가 있지만, 원인이 밝혀진 경우에는 결핵과 폐렴균이 흔하였고, 무균 부위에서 배양된 폐렴구균의 항균제 내성률은 낮았다. 원인이 밝혀지지 않은 경우가 많고, 혈청검사로 진단되는 원인균이 드물며, 분리균주가 적어 항균제 내성 정도를 추정하기 어려워, 이를 밝히기 위한 전향적 조사가 필요하다. Background : Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitation of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. Methods : medical records of adults (>15 years of age) hospitalized for CAP or pulmonary tuberculosis between April 1995 and March 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer of antibodies to “atypical”pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum withcompatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinucal response to anti- tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and Mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of resiratory pathogens from all body sites, and their clinical significance were evaluated. Results: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria,246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171(71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44(18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable: E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae and A. baumannii and K. pneumonias), S. aureus (2 definite and 2 probable) , and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8isolates). therates of admission to the intensive care unitand of using assisted ventilation were 18% and 9.3%, respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but seven isolated from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolated of k> pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. Conclusion: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which well be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.

한국 기혼여성의 일상적 삶의 질 향상에 관한 연구 (3) : 한국 기혼여성의 삶의 질 향상을 위한 프로그램 개발 연구 Development of A Program for the Enhancement of Korean Married Women's Quality of Life

김정자,최순,김선희,정영숙,김경연,심혜숙,문소정 부산대학교 여성연구소 1999 여성학연구 Vol.9 No.1

The purpose of this study was to develop a program for the enhancement of Korean married women's quality of life(LQ) based on the results of the first year study(1996) and the second year research(1998). In order to construct a program, a psycological type test was conducted to 505 women and four preliminary programs were carried out focusing on self-esteem, understanding of one's own personality dynamics, efficient communication, positive emotion, social belongingness and expressions of feelings of unfinished business. For the final program, Jung's theory of psychological type(MBTI), Satir's family therapy approach and psychodrama were applied. An experimental and a control group were designed consisting 16 women for each group. The program was carried out for 6 weeks for the experimental group. The result of treatment were as follows: l)There was a difference statistically in LQ related to family harmony, self-achievement and improvement of relationship with in-laws. 2)There was a statistical change in psychological factors of expression of feelings, self-esttem, communication, and positive emotions. 3) The program participants self reports indicate that the program was effective for the reconstruction of family relationship, self-understanding, group coherence, and instillation of hope. The reports also shows that the program was effective for the perceptual changes in parent-child, wife-husband and siblings' relationships. In conclusion, the program developed for the enhancement of Korean married women's life quality(LQ) based on the Jung's psychological type theory, Satir's family therapy approach and psychodrama was effective for the improvement of LQ.

한국 정상인에서 연령에 따른 뇌혈류분포와 혈류예비능의 변화 : Tc-99m HMPAO SPECT 에 의한 연구

문대혁,이희경,송호천,이재태,범희승,손혜경,정환정,민정준,김지열 대한핵의학회 1999 핵의학 분자영상 Vol.33 No.3

Purpose: The aim of this study was to evaluate the normal values of regional cerebral blood flow (rCBF) and cerebrovascular reserve (CVR) in normal children to aged volunteers using Tc-99m HMPAO. Materials and Methods: Thirty four right-handed normal volunteers (20 males, 14 females, mean age 40.3±24.9 years, range 4 to 82 years) were underwent rest/acetazolamide (ACZ) brain SPECT using Tc-99m HMPAO and the sequential injection and subtraction method. rCBF was estimated on the basis of a semiquantitative approach by means of right/left ratio, region/cerebellum and region to whole brain ratios in frontal, parietal, temporal, and occipital lobes, basal ganglia, thalami, and cerebellum. CVR was measured by means of % perfusion increase calculated as % mean count change compared to rest rCBF in each regions. Results: Mean values of right to left ratios range from 1.004 to 1.018. rCBF was highest in cerebellum and lowest in basal ganglia and thalami. Frontal and temporal rCBF decreased while occipital and thalami rCBF increased according to age. No sexual difference of rCBF was noted. Mean CVR was 29.9±12.9%. Mean CVR significantly increased to late teens, and declined thereafter. After 6th decade, CVR in both frontal lobes, left parietal lobe and right basal ganglia decreased significantly with advancing age. There was no sexual difference of CVR. Conclusion: Quantitative assessment of CVR was possible by ACZ Tc-99m HMPAO brain SPECT. It revealed that rCBF and CVR changed according to age in normal Korean volunteers. There was no sexual difference.

鐵筋콘크리트 構造物의 最適設計

鄭哲源,朴熙淳,孫鎔雨,崔圭文 圓光大學校 1989 論文集 Vol.23 No.2

이 論文에서는 最適化問題를 해결한다 : 彈牲設計에 비해 最大效率로 주어진 形態의 構造를 設計하여 모든 可能한 荷重組合下에서 그 構造의 崩壞와 그것의 臨界斷面의 first yield에 대한 어떤 지정된 最小荷重係數를 측정한다. 目的函數를 線形化하고, 모든 limit equilibrium constraint를 算出해 내는 方法을 개발하여 線形計劃法과 콤퓨터技法의 도움으로 그 問題를 해결한다. 관계되는 원리와 대응되는 最適解는 鐵筋콘크리트 連續보와 뼈대 構造를 例로서 설명되어 있다. The following optimization problem is solved in the paper : design a structure of given geometry for maximum efficiency vs. elastic design, so that under any possible load combination certain specified minimum load factors be guaranteed against both the collapse of the structure and the first yield of its critical sections. By linearizing the objective function and developing a method to generate all limit equilibrium constraints the problem is solved with the help of linear programming and computer techniques. The principles involved and corresponding optimal solutions are illustrated by the examples of a reinforced concrete continuous beam and frame.

箱子桁의 壓縮플랜지 挫屈에 대한 模型實驗解析

鄭熺孝,南文熙 慶尙大學校 1986 論文集 Vol.25 No.2

As box girder is the structure constituted by thin plates, security of the structure is greatly influenced by the collapse on compressional flange. The collapses of flange bring about stress concentration at upper sides of web, morever, if in case of the imperfect plate they were increased, tensile stress would occur at the middle point of upper flange and develop collapse failure at upper sides of web and projections of upper flange. The ratio a/b(both side-lengths of plate) of the collapse is decided by the distance of diaphragm, when load is increased up critical load the ratio a/b approaches 0.70. Designing the box girder, engineers must take into the influences of side stress that imperfects of flange and eccentric load arouse.

점증적 운동부하테스트를 통한 비만 아동의 운동자각도와 VO₂max 및 HRmax에 관한 연구

문희원,김정규 한국스포츠리서치 2004 한국 스포츠 리서치 Vol.15 No.6

The purpose or this study was to study or VO₂max. HRmax and RPE Following the GXT using the treadmill and cycle ergometer exercise in primary school children(BMI:25, 30% percent body rat). The results we obtained this study were as followings. 1. The change or VO₂max is higher on treadmill exercise than cycle ergometer exercise on treadmill and cycle ergometer to gradual maximum exercise. appeared 41.6±6.63 ㎖/kg/min on first treadmill exercise, 43.4±8.22 ㎖/kg/min on second treadmill exercise, 36.1±5.04 ㎖·kg/min on first cycle ergometer exercise. 37.5±3.52. ㎖/kg/min on first cycle ergometer exercise kept in mind as statistical(p<.05). 2. The change or HRmax is higher on treadmill exercise than cycle ergometer exercise on treadmill and cycle ergometer to gradual maximum exercise. appeared 199.8±5.49 beats/min on First treadmill exercise, 203.2±6.31 beats/min on second treadmill exercise. 195.0±12.71 beats/min on first cycle ergometer exercise. 195.0±6.84 beats/min on first cycle ergometer exercise kept in mind as statistical(p<.05). 3. The change of RPE is higher on treadmill exercise than cycle ergometer exercise on treadmill and cycle ergometer exercise kept in mind as statistical(p<.05).

자각증상으로 평가한 남성택시운전기사의 건강위험도

정문희,오경숙 한양대학교 의과대학 1997 한양의대 학술지 Vol.17 No.2

This survey was conducted to evaluate the level of health risks of taxi drivers. Data were collected from April 20 to May 8 of 1997 and analyzed by descriptive statistics of SPSS/PC+ package. 1. Fifteen percent of 139 taxi drivers could be classified as having high level of health risks, suggesting secondary medical examinations. 2. Most frequent symptoms related to their jobs included backache, joint pain, nervousness, etc. Most of the symptoms related to their daily-living patterns are mainly caused by improper eating habit and lack of regular exercise. According to the above outcomes, following services are recommendable for their health management : 1) regular medical examinations as individual unit, 2) health education as group unit, and 3) health promotion campaign as total job unit.

부산·경남지역 정부·공공기관의 홈페이지에 나타난 재활보조공학 서비스 사업 분석

정혜영,김환희,장문영 대한재활공학회 2008 보조공학저널 Vol.2 No.1

본 연구의 목적은 부산·경남지역을 대상으로 재활보조공학 서비스 제공에 대한 실태 조사를 통하여 서비스 현황을 파악하고 서비스 이용자들의 접근성을 높이는 것이다. 자료는 부산광역시와 부산시 보건소, 경상남도의 10개 시청과 10개 군청, 부산시에 위치한 장애인복지관, 경상남도에 위치한 장애인 복지관의 웹사이트 검색을 통해 수집하였다. 수집한 자료는 기관에 따른 재활보조공학 서비스 실태와 재활보조공학 기기의 영역에 따른 서비스 실태로 나누어 분석하였다. 기관에 따른 재활보조공학 서비스 현황을 살펴보면, 공공기관은 부산지역에 비해 경남지역에서 더 많은 재활보조공학 서비스가 제공되는 반면 장애인복지관의 경우 부산지역이 경남지역보다 더 많은 재활보조공학 서비스가 제공되고 있었다. 재활보조공학 기기의 영역별 현황을 살펴보면, 전체적으로 재활보조공학 기기의 다양성이 부촉하며 제공되는 재활보조공학 기기도 '운동성과 이동' 영역, '듣기와 듣기보조' 영역, '보기와 읽기보조' 영역에 집중되어 있음을 알 수 있었다. 재활보조공학 서비스를 필요로 하는 사람들이 서비스를 좀 더 빠르고 쉽게 제공받기 위해서는 지역별, 기관별 균형 있는 서비스 전달체계가 구축되어야 할 것이며 재활보조공학 기기의 다양성을 확보하는 제도적 장치가 마련되어야 할 것이다. This research was purposed to understand the present assistive technology service condition through investing the actual condition of the assistive technology service provided in Busan and Gyeongnam region, and promote the accessibility of the service users. The materials for this research were collected through the web sites of the public health centers in Busan, 10 city halls and 10 county offices in Gyeongnam region, and the rehabilitation centers for the disabled in Busan and Gyeongnam region. The actual condition of the assistive technology service and the diversity of the assistive technology devices according to each organization were analysed with these materials. The result of this research suggests that the public organizations in Gyeongnam region have provided more assistive technology service than ones in Busan, and the rehabilitation centers for the disabled in Busan have provided more assistive technology service than ones in Gyeongnam region, and that the diversity of assistive technology devices is insufficient, and the present devices of assistive technology are focused on mobility and transportation aids, hearing and listening aids, and vision and reading aids. Therefore, the diversity of assistive technoloey devices and the balance between institutions that provide assistive technology service should be devised.

생산직 남성근로자가 인식하는 신체활동량과 비만지수에 관한 연구

정문희,김효진 한양대학교 의과대학 1998 한양의대 학술지 Vol.18 No.1

The purpose of this study is to grasp the relationship between the amount of physical activities perceived by male workers and their body-mass index. To achieve such a purpose, this survey was conducted on 330 male workers by means of questionnaires during the period of July 1 to July 20. And collected data were sampled by matched sampling technique by sex, age, education and perception of socioeconomic class. Thus 70 selected data were statistically analyzed by CTAS(Computer Aided Teaching for Statistics). The obtained results are as follows. There were negative relationships between the amount of physical activities at work or after and body-mass index; Pearson correlation coefficients of the former and the latter were -0.33 and -0.25 respectively. The above results imply that the harder workers think their physical activities at work, teh lesser they perform their physical activities after work and the hihger their body-mass index will be increased. Therefore it is desirable that health management programs for workers should be developed into connecting their work sites with their homes and focused on the physical activities after work much more.