한국인 직무 스트레스 측정도구의 개발 및 표준화

장세진,고상백,강동묵,김성아,강명근,이철갑,정진주,조정진,손미아,채창호,김정원,김정일,김형수,노상철,박재범,우종민,김수영,김정연,하미나,박정선,이경용,김형렬,공정옥,김인아,김정수,박준호,현숙정,손동국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Background and Purposes: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002-2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Forty-three items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. Results: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. Conclusion: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.

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.

뼈에 발생한 악성 림프종 환자의 치료 효과 판정에서 ^(18)F-FDG Positron Emission Tomography의 유용성

김남돈,박연희,기승석,박용진,김형준,류백렬,김흥태,김성은,천기정,최창운,임상무 대한핵의학회 2003 핵의학 분자영상 Vol.37 No.5

원발성골림프종은 매우 드문 질환이기는 하나, 복합항암요법이나 방사선 치료등에 높은 반응율을 보이며, 좋은 예후를 가지는 림프절의 비호지킨 림프종의 일종이다. 그러나, 치료 효과 판정에 있어 골병변의 특이성에 의한 모호한 방사선학적 특징으로 어려움이 있어 왔다. 본 증례는 위와 같은 원발성골림프종 환자에서 PET 스캔을 사용하여 민감하게 완전 반응을 평가할 수 있었던 예로, 앞으로 다른 고식적인 방법과 함께 이 질환의 진단과 치료 평가 있어 유용하게 사용 될 수 있을 것으로 전망할 수 있었다. Purpose: Accurate assessment of the lesion after treatment of patients with bone lymphoma is difficult. In this patient who demonstrated complete remission after chemotherapy, the regions of fluorine-18 fluorodeoxyglucose (^(18)FFDG)PET uptake diminished more rapidly following therapy, indicating a complete response at much earlier stage than did Magnetic Resonance Imaging (MRI) or CT based findings. With the conventional methods, such as MRI and CT. It was difficult to assess whether the residual tumor tissue was viable or not. Decision to complete response is very important in patients with ymphoma to plan the further treatment. We experienced a patient with primary lymphoma of bone who revealed complete response to chemotherapy on ^(18)FFDGPET while CT showed persistent destructive bone lesion. Thus, ^(18)FFDGPET study after therapy may be superior to CT in the evaluation of response to treatment in primary lymphoma of bone.

간 세포암에서 VEGF, TGF-β1, b-FGF 발현의 의의

김성용,남충현,주종우,채만규,백무준,이문수,김형철,안현철,김홍수,김창진,김창호 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.1

Purpose: Angiogenesis is important for the proliferation and the metastasis of solid tumors. The growth of a solid tumor is widely recognized to depend on the process of neovascularrozation. Without angiogenesis, tumors cease to grow beyond even a few milimeters in diameter. It has been shown that tumor vascular density is an independent prognostic marker in several types of human tumors and is known to correlate with poor prognosis. To date, many angiogenic factors have been identified, such as transforming growth factor-α(TGF-α), transforming growth factor-β(TGF-β), fibroblast growth factor family(FGF), vascular endothelial growth factor(VEGF), platelet derived endothelial cell growth factor(PD-ECGF), tumor necrosis factor-α(TNF-α), and angiogenin. Hepatocellular carcinoma(HCC) is the second most common tumor in Korean males and is known as a typical hypervascular tumor with frequent portal vein invastion. The authors identified the expreesion of VEGF, TGF-β1, and b-FGF in HCC specimens and evaluated the relationship between these growth factors and the clinicopathologic characteristics of HCC. Method: We reviewed the medical records of 30 patients who were diagnosed as hepatocellular carinoma treated with hepatic resection between January 1994 and December 1998 in Soonchunhyang University Chunan Hospital. The selection of the cases was decided according to the condition of paraffin block fixation. The prognostic factors such as age, sex, tumor size, concentration of serum α-fetoprotein, presence of liver cirrhosis, presence of tumor emboli in portal vein, TMN stage, amount of transfusion during the operation, hepatitis B virus(HBV) infection, and Edmonson-Steiner(E-S) grade were investigated. Relationship between the prognostic factors and the immunopathologic expression of the TGF-β1, b-FGF, and VEGF was examined. Result: Thirty patients (24 males, 6 females) were included in the current study. The patient's mean age was 50.6 years and the age ranged from 36 to 65 years. The mean size of the tumor was found to be 5.2cm. All the patients were follewed up for 7 to 63 months. Child's classification A patients were 23(76.7%)cases, B patients were 7(23.3%)cases, and C was none. Immunohistochemical staining of HCC tumor mass in VEGF expression patients were 17(56.7%), b-FGF expression patients were 10(33.3%), and TGF-β1 expression patients were 10(33.3%). VEGF expression or more than one positive expression among the three factors correlated with tumor size and the stage of HCC but did not correlated with other clinicopathological characteristics. TGF-β1 and b-FGF did not correlate with any clinicopathological characteristics. Conclusion: The results suggest that the expression of VEGF or more than one positive expression among the three factors in HCC cells may be a significant prognostic factor of HCC.

생체분해성 망막압정을 이용한 망막고정에 대한 실험적 연구

김용백,민병무,김창식,박근성,김승영,길숙종,조항진,이성복,노승무,송규상,강대영,조준식,양준묵,정경수,최선웅,이진호,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

Biodegradable retinal fixation devices obtain mechnical fixation of the retina with desirable chorioretinal scarring and with the potential for local, sustained release of antimetabolites and steroids to inhibit proliferative vitreoretinopathy. We manufactured a biodegradable retinal tack with barb that was designed in order to prevent intrusion from implantation of retinal tacks. This study was carried to evaluate the efficacy for retinal fixation and the capability for sustained release of drugs with a newly designed biodegradable retinal tack Biodegradable retinal tacks were made of polymers of glycolic acids and were designed with barbs in a shape to prevent the disinsertion. Biodegradale retinal tacks are divided into 3 parts, a conical portion that is inserted into the sclera, a cylinder portion that remains in the vitreous, and a neck portion between the pin and the cylinder. The tapered conical end was manufactured to allow easy insertion through the retina and choroid into the sclera. A cylinder portion was manufactured with a tapered angle that fixes firmly into the orifice of 19 gauge spinal needle. A neck portion, 0.4 mm in diameter, was designed to prevent disinsertion from following implantation of retinal tack. The applicator was a 19 gauge spinal needle and its orifice was prepared to 15°angle to accept the tapered cylinder portion of the retinal tack. The retinal tacks, secured in the needles, were passed through the formed vitreous and inserted into the retina, choroid, and sclera and were released by pushing the internal needle, usually within 2-3mm of the medullary ray of the posterior rabbit retina A retinal tack was placed in each of 8 pigmented rabbit eyes. Slit-lamp biomicroscopy, indirect ophthalmoscopy and fundus photography were performed periodically from 1 day to 8 weeks after surgery. Eight eyes were enucleated and studied by light microscopy at 8 weeks. Biomicroscopic evaluation of the animals revealed edemas adjacent to the retinal surfaces immediately after insertion of the biodegradable retinal tacks in all the animals. These edemas disappeared after 1 week. The first noticeable change in the size of retinal tacks was shown after 2weeks. The size of the retinal tacks gradually got smaller, decreasing to about one-half at 4 weeks and about one-third at 8 weeks. All retinal tacks remained in inserted places without any movement for an 8 week period. On light microscopy, epiretinal proliferations were seen to extend into the vitreous cavity. Cellular capsules that lined the inner aspect of the scleral defect caused by tack insertion were found. However the adjacent retina had a normal cytologic appearance and architecture in all specimens. We manufactured a biodegradable retinal tack that is designed to prevent intrusion from implantation of retinal tacks. All biodegradable retinal tacks reduce in size with time, but no retinal tacks extruded from the inserted place. The newly designed biodegradable retinal tack can be used for retinal fixation and may be used as a vehicle for the introduction of pharmacologic agents to prevent the cellular events that promote proliferative vitreoretinopathy.

1995년 및 1996년에 국내에서 분리된 풍진바이러스의 염기서열 및 계통분석

백락주,송기준,정재희,정희진,김우주,김민자,송진원,김세연,이용주,박광숙,강주일 대한감염학회 1997 감염 Vol.29 No.3

목적: 유소아에서 경한 발진성 질환을 일으키는 풍진바이러스는 토가바이러스과에 속하며 일회 감염으로 평생면역을 획득하는 것으로 알려져 왔다. 그러나 1960년대 후반 풍진예방접종이 시행된 이후 선진국의 경우 풍진 호발 연령이 유소아에서 청소년 층으로 변화하는 양상을 나타내었으며 우리 나라의 경우에도 1995년에서 1996년도 사이에 발생한 풍진대유행기에 주로 중 고등학생층에서 풍진이 호발하였다. 주기적인 풍진의 유행에도 불구하고 우리 나라에서는 최근까지도 풍진 바이러스의 분리나 유전정보에 대한 연구보고가 없어 이에 대한 연구를 시행하였다. 방법: 1995년에서 1996년에 발생한 풍진 환자의 인후분비물을 채취하여 세포배양법으로 풍진바이러스 분리를 시도하였으며, 분리된 풍진바이러스의 RNA를 추출하여 역전사 중합효소연쇄반응법으로 증폭한 후 염기서열 및 아미노산 서열을 결정 분석하였다. 결과: 세포배양을 통해 7주의 풍진바이러스를 분리하였으며 국내 풍진바이러스주들은 염기서열상 92.5-100%의 동질성을 나타내었고, 백신주 RA27/3과는 2.2-6.4%의 차이를 보였다. 아미노산서열상에서는 국내에서 분리된 풍진바이러스주들은 98.3-100%의 동질성을 나타내었고, 백신주 RA27/3과는 1.7%이하의 차이를 보였다. 계통분석 결과 국내에서는 최소한 2가지 유형의 풍진바이러스가 유행하였다. 결론: 국내에서 유행한 풍진바이러스주의 E1 gene 부위를 기존에 알려진 외국의 분리주나 백신주와 비교시 의미있는 차이는 관찰되지 않았으며 Vero E6 세포는 풍진바이러스의 분리배양에 유용함을 알수 있었다. 그러나 풍진바이러스의 지속적인 변이 양상이 관찰된 사실은 체계적이고 지속적인 풍진바이러스 감시체계의 필요성을 제시하였다. Background: The age group of Rubella virus (RV) infection in most industrialized nations located in temperate climates, has in large part shifted from children to young adults since introducing of the RV vaccine in late 1960's. Interestingly, there were rubella outbreakes from 1995 through 1996 in Korea, and middle and high school students were mostly affected during that time. Although continued of genetic information of rubella viruses circulated in Korea. Method: To isolate RV circulated in Korea, and determine the phylogenetic relationship between RV strains in Korea and RV isolates from other geographic regions including vaccine strains, we inoculated nasopharyngeal secretion samples from clinically diagnosed rubella patients to Vero E6 cells, and sequenced corresponding region of the 5' EL encoding genomic regions of RV isolates. Result: Seven RV strains isolated from Korea showed 93.6 to 97.8% and 98.3 to 100% sequence homologies in nucleotide and amino acid levels, respectively, compared to RA27/3 vaccine strain. Phylogenetic tree based on 359bp of RV indicated that at least two different groups of RV circulated in Korea during 1995-1996 epidemics. Conclusion: Our data suggested that mutant RV strains were possiblely not the cause of recent rubella epidemics in Korea.

생체분해성 고분자를 이용한 사시수술용 제형개발 및 효용성에 대한 연구

민병무,김용백,김승영,김창식,박근성,길숙종,조항진,이성복,노승무,송규상,강대영,조준식,양준묵,정경수,최선웅,이진호,김학용,인현빈 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.1

A new device, muscle clamping system was developed to facilitate exact quatifying technique A strabismus surgery, and reduce the risk of complications. The device is composed of a lower fixing body with three jaws and an upper supporting body. They are used to clip an extraocular muscle and fix it to the sclera with a single bite. Superior rectus recession on 16 rabbit eyes were performed with this new device. Conjunctival injection, muscle adhesion strength, and light microscopic findings were examined at 1, 2, 4 and 8 weeks postoperatively. The Conjunctival injection were minimal, adhesion power ranged from 420 to 600 gram gravity, which is sufficient in withstand the normal pull of human extraocular muscle. In microscopic exam, some Inflammatory cells and fibrosis were found. The new device was technically easy, fast, and accurate, so it may be useful in stabismus surgery.

경락(經絡)과 정신양생(精神養生)의 관계 설정(設定)에 대(對)한 고찰(考察)

백진웅,김광호,Baek Jin-Woong,Kim Kwang-Ho 대한예방한의학회 2001 대한예방한의학회지 Vol.5 No.2

It is thought that Kim Hong-kyeong followed the existing theory of Meridian(經絡) and supplemented his unique perspectives in interpreting it. And he tried to relate Meridian with hygiene of mind. I took up with the research on the assumption that the review of Kim's method can present new perspectives to the study of relationship between Meridian and hygiene of mind. The results of my study are as follows: 1. Kim followed common theory of Meridian and then added his unique perspectives to it. His method of interpretation has one characteristic. By introducing Idealism(唯心論), he understood 'Meridian' as the path of the mind and the emotion. Especially I think his hypothesis that acupuncture can be widely used in mental diseases as well as body related diseases and its applications to treatment are very valuable. 2. Meridian and hygiene of mind are close together. I think Kim's unique trial is something new in studying relationship between Meridian and hygiene of mind but requires more research on it.

범가자미, Verasper variegatus의 난황단백질 분리 및 면역학적 특성

백혜자,한창희,김우진,박중연,김진한,김윤 동의대학교 기초과학연구소 1998 基礎科學硏究論文集 Vol.8 No.1

The yolk protein of spotted flounder, Verasper variegatus was purified by precipitation with cold distilled water, followed by Sepharose CL-6B column chromatography. The purified protein was identified as vitellin by Ouchterlony's immunodiffusion test and immunoelectrophoresis. The purified vitellin from ovarian crude extracts has same antigenic determinants with the female specific serum protein, vitellogenin. The molecular weight of purified vitellin was estimated about 550kD by gel filtration. The vitellin was composed of three major subunits with molecular weight of about 108, 85 and 31 kD, and two minor subunits. The vitellin was identified by western blot analysis using anti-vitellin antibody.

후천성 면역 결핍증에서의 폐렴구균 감염 부검 1예 : An Autopsy Report

이미숙,우준희,진소영,김종원,최창현,김양수,김은옥,김백남,이동화,류지소 대한감염학회 1996 감염 Vol.28 No.3

28세 남자의 후천성 면역 결핍증 환자에서 S. pneumoniae 폐렴이 합병되어 사망한 1예를 경험하여 부검소견과 함께 보고하는 바이다. Pulmonary infections such as Pneumocystis carinii, cytomegalovirus, and tuberculosis are a major cause of morbidity and mortality in patients with human immunodeficiency virus(HIV) infection. Patients with HIV infection are at increased risk for bacterial pneumonia in addition to opportunistic infection. Although in a primary defect, HIV infection is associated with substantial dysfunction of humoral immunity, which predisposes patients to bacterial infections, particularly with encapsulated organisms, such as Streptococcus pneumoniae. We report a case of 28 year-old Korean male with HIV infection who died of respiratory failure due to pneumococcal pneumonia with autopsy findings.