연구논문 : 만성 바이러스간질환에서 간섬유화의 다양한 비침습 혈청표지자검사의 비교

김선민 ( Sun Min Kim ),손주현 ( Joo Hyun Sohn ),김태엽 ( Tae Yeob Kim ),노영욱 ( Young Wook Roh ),은창수 ( Chang Soo Eun ),전용철 ( Yong Cheol Jeon ),한동수 ( Dong Soo Han ),오영하 ( Young Ha Oh ) 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.4

목적: 만성 바이러스간질환에서 병의 경과와 예후를 평가하고 치료반응을 예측함에 있어 간섬유화의 진단은 중요하다. 최근 간섬유화 평가에 표준방법이지만 침습적 간생검을 대신하여 여러 가지 비침습적 진단법이 이용되고 있고, 또한 새로운 검사법들이 개발되고 있다. 저자들은 만성 B형 및 C형간염 환자를 대상으로 임상에서 광범위하게 흔히 시행하는 혈액검사와 임상 소견을 이용한 아래와 같은 진단법들만으로 간섬유화를 얼마나 정확하게 평가할 수 있는지 알아보고, 단일 검사로 간섬유화를 평가하는 데 유용하다고 알려져 있는 hyaluronic acid(HA)와 IV형 콜라겐 농도와 비교하여 그 임상적 유용성을 평가하였다. 대상과 방법: 2002년 3월부터 2007년 2월까지 만성 바이러스간 질환으로 간생검을 시행받은 225명의 환자(HBV 180명, HCV 43명, HBV+HCV 2명)를 대상으로 분석하였다. 간생검을 시행하는 날에 말초혈액검사, 혈액응고검사, 혈청생화학검사를 시행하고, 혈중 HA, IV형 콜라겐 농도를 측정하였다. 간섬유화의 정도는 F0(섬유화가 없음), F1(문맥역 섬유화), F2(문맥주변부 섬유화), F3(섬유성 격막) 및 F4(간경변증)의 4단계로 구분하였다. 대상 환자를 F0-1, F2-4 혹은 F0-2, F3-4의 두 집단으로 분류하여 두 집단을 구분하고자 할 때 AAR(AST/ALT ratio), API(age-platelet index), APRI(AST to platelet index), CDS(cirrhosis discriminant score), platelet count, HA, IV형 콜라겐의 예측능을 area under the receiver operating characteristic curve (AUROC)값을 이용하여 비교하였다. 결과: 대상환자의 섬유화의 단계는 F0 집단은 17명, F1 집단은 40명, F2 집단은 61명, F3 집단은 74명, F4 집단은 33명이었다. 의미 있는 간섬유화를 F2 이상으로 판단할 때, 의미 있는 섬유화의 예측에 대한 AUROC 값은 APRI=0.822, CDS=0.776, platelet count=0.773, API=0.756, HA=0.749, IV형 콜라겐=0.718, AAR=0.642 순이었고, F3 이상의 광범위한 섬유화 예측에 대한 AUROC값은 CDS=0.835, platelet count=0.795, API=0.794, HA=0.766, AAR=0.711, IV형 콜라겐=0.697, APRI=0.691 순으로 관찰되었다. 결론: 만성 바이러스간질환에서 간섬유화를 평가하는 데 임상 소견 및 혈액검사를 이용한 방법들이 비침습적 진단법 중 단독 검사로도 유용한 것으로 알려져 있는 혈중 HA와 IV형 콜라겐 농도와 비교하여 우월하거나 대등하였다. 특히 APRI는 다른 인자들에 비해 F2 이상의 의미 있는 섬유화를 예측하는 데 가장 유용하였고, CDS는 F3 이상의 광범위한 섬유화를 예측하는 데 가장 유용하였다. Background/Aims: The aim of this study was to determine the clinical performances of noninvasive serum markers for the prediction of liver fibrosis in chronic viral liver diseases. Methods: We analyzed a total of 225 patients with chronic viral liver diseases (180 with hepatitis B virus, 43 with hepatitis C virus, and 2 with hepatitis B+C virus) who underwent a liver biopsy procedure at the Hanyang University Guri Hospital between March 2002 and February 2007. Serum was also obtained at the time of liver biopsy. Liver fibrosis was staged according to the scoring system proposed by the Korean Study Group for the Pathology of Digestive Diseases. Various noninvasive serum markers were evaluated, including the aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), age-platelet (AP) index, AST/platelet ratio index (APRI), cirrhosis discriminant score (CDS), platelet count, hyaluronic acid (HA), and type IV collagen. Results: There were 17, 40, 61, 74, and 33 patients at stages F0, F1, F2, F3, and F4, respectively. The overall diagnostic accuracies of each marker, as determined by the area under receiver operating characteristics curves, were APRI=0.822, CDS=0.776, platelet count=0.773, AP index=0.756, HA=0.749, type IV collagen=0.718, and AAR=0.642 for predicting significant fibrosis (≥F2); and CDS=0.835, platelet count=0.795, AP index=0.794, HA=0.766, AAR=0.711, type IV collagen=0.697, and APRI=0.691 for predicting extensive fibrosis (≥F3). Conclusions: Conclusions: All noninvasive serum markers evaluated in this study were useful for predicting significant or extensive liver fibrosis in chronic viral liver diseases. In particular, APRI was most useful for the prediction of significant fibrosis, and CDS was most useful for the prediction of extensive fibrosis. (Korean J Hepatol 2009;15:454-463)

Multiple myeloma 환자에서 Bortezomib치료 후 발생한 마비성 장폐색증 1례

김준영,이원식,손창학,박성길,진한영,박석주,조영완,정은욱,강명주,박정하,주영돈 인제대학교 2006 仁濟醫學 Vol.27 No.-

Bortezomib is the first clinically available proteasome inhibitor that is clinically effective in the treatment of multiple myeloma. A proteasome inhibitor acts through multiple mechanisms to arrest tumor growth, tumor spread, and angiogenesis. The main adverse effects of bortezomib are gastrointestinal symptoms, cytopenia, fatigue, and peripheral neuropathy. To date, severe paralytic ileus has not been reported as a toxic effect of bortezomib treatment in multiple myeloma. Bortezomib is a novel agent that has only been used clinically for 30 months, so a need exists to further evaluate its toxicity. We report a case of grade Ⅲ (NCI CTCAE v3.0) or grade Ⅳ(SWOG toxicity criteria) paralytic ileus in a 65-year-old man with relapsed multiple myeloma who underwent one cycle of single-agent bortezomib treatment scheduled in a 21-day cycle (1.3 mg/㎥ as a single i.v. bolus on days 1, 4, 8, and 11).

보건관리자 직무평가도구의 개발

하은희,박혜숙,김영주 이화여자대학교 의과대학 2003 EMJ (Ewha medical journal) Vol.26 No.2

Objectives : The purpose of this study is to deliver effective worksite health management by specifying job of occupational physician, occupational nurse, occupational hygienist and making job reference manual and health performance audit. Therefore, We can contribute to disease prevention and health promotion of workers by enhancing quality of worksite health management. Method : The methodology of making performance audit is comprised of developing audit questions and weighting the questions. Measures are made by scoring the values. The question-naires were grouped by the categories and sections. This occupational audit was distributed to the health personnel of 350 workplaces by mail. The self-administered results were returned and analyzed, Results : We plot the field of occupational health service by basic policy, preventive health service, health care, administration, and other services. We gave the weight A on the primary job, B on the supplementary job, and C on the minor job. This weight was made through the delphi procedures where 30 specialists joined. Basic policy got score of 16.1% preventive health service got 36.5%, health care 20.4%, administration 10.9%, and other services 10.1%. Further weightings on the questionnaire sections were made through the survey on specialists and final weighting on each questionnaire was made by making formula considering weights of each stage. The audit was composed of 96 questions which has dichotomos scales and full score was 1,000. Person-nels from 80 workplaces (23%) replied the audit and the scores of physicians, nurses, and hygienists were 608.6, 587.1 and 535.4, respectively, all a little higher than 500. Discussion : The health performance audit can be used by the sorksite health personnels providing health service. However, this work would not be complete without further comprehe-sion and application in the real settings. 목적: 본 연구에서는 사업장 보건과리를 활성화하기 위하여 사업장에서 수행되고 있는 산업보건관리직무를 객관적으로 평가할 수 잇는 사업장 보건관리직무 평가항목과 평가척도를 개발하고자 하였다. 방법: 평가항목은 산업보건서비스의 내용별로 대항목, 소항목, 세부항목으로 구분하였다. 평가도구의 타당성을 검증하고 실제 사업장에서의 직무활동을 평가하여 평가의 기준을 현실에 맞게 설정하고자 위의 과정을 거쳐 만들어진 평가도구를 350개 사업장의 보건관리자에게 설문조사를 통해 적용하였다. 연구대상자는 산업간호사와 산업위생관리기사의 경우 한국산업안전공단 안전교육원에서 실시하는 보수교육자 이수자명단을 이용하였으며 설문실시기간은 1996년 7월 24일부터 8월 24일가지로 하여 우편설문의 형식을 취하였다. 결과: 1차 설문조사결과 산업보건의사, 산업간호사, 산업위생관리기사의 평균점수를 보면 기본방침 14.5%, 예방보건 서비스 39.0%, 치료서비스 18.0%, 관리 및 행정서비스 17.2%, 기타서비스 10.3%로 예방보건서비스가 가장 높은 점수를 보였다. 이 결과를 다시 1차 설문에 응하여준 응답자에게 통보하고 2차 Delphi를 시행한 결과 기본방침 16.1%, 예방보건서비스 36.5%, 치료서비스 20.4%, 관리 및 행정서비스 16.9%, 기타서비스 10.1%로 예방보건 서비스의 점수는 다소 낮아지고 기본방침과 치료서비스의 점수가 올라가는 결과를 보여주었다. 산업보건학계, 대행기관, 사업장 실무 인력인 산업보건의사 10인, 산업간호사 10인, 산업위생관리기사 10인을 대상으로 한 설문조사를 통해 대항목 각각을 100%로 하였을 때의 소항목의 점수(백분율)를 구하였다. 기본방침 중에서는 기본방침의 설정이 가장 높은 점수를 보였으며 예방보건서비스중에서는 건강상담 및 보건교육이 가장 높은 점수를 보였다. 치료서비스 중에서는 환자치료가 관리 및 행정 서비스에서는 기록 및 보고가 높은 점수를 보였다. 우편설문을 보낸 350개 사업장중 85개 사업장, 110명의 보건관리자에서 직무평가설문에 응답하였으며 응답사업장 보건관리자들의 직종별 인원수는 의사 41명, 간호사 78명, 산업위생관리기사 24명, 환경관리기사 65명, 기타 2명으로 산업위생관리기사 대신 환경관리기사를 채용한 사업장이 많았다. 응답사업장의 업종은 대부분이 제조업이었으나 매우 다양하였고 규모별로는 300인 미만이 38.5%, 300~999인 사업장이 32.5%, 1000인 이상이 28.8%었다. 결론: 본 평가도구가 개발목적에 부합되기 위해서는 사업장에 실제로 적용하여 사업장에서 실제 사용해 보고 이 결과를 바탕으로 사업장 규모별, 업종별로 내용을 분석하여 직무를 평가함으로써 문제를 파악하고 특히 보건관리 인력을 얼마만큼 투입할 것인가를 결정할 때에 반영되어야 할 것이다. 그리고 보건관리자의 직무 즉, 사업장내 산업보건서비스를 올바로 수행하기 위한 보건관리자의 교육훈련제도지에 대한 정책이 마련되어야 할 것이다.

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.

건강증진학교 모형개발 : Based on Health Center of University 대형 보건소 활동을 중심으로

하은희,조희숙,윤영옥,강명근 韓國學校保健學會 2001 韓國學校保健學會誌 Vol.14 No.1

Objectives: The purpose of this study is to develop a health-promoting program centered on the university-health center and to provide a developed program for students and faculties. Methods: A survey was conducted of 719 female students and 238 faculties concerning their health-promoting programs. Based on the results of the survey, we developed programs that could be applied to students and faculties. After operating the programs, we developed further models by evaluating the effectiveness and satisfaction. Conclusions: We selected a comprehensive health-promoting program that included weight control, preventive inoculation, sex education and control of disease based on repsective needs. We also applied programs developed through collaboration with other departments from September 1998 to August, 1999. Users of the preventive inoculation-program increased by one point five during the year. Also, participants were generally satisfied with the weight control program and succeeded in reducing weight We hope that we can set up this program and expand it by developing various other projects in Korea. Key Words: Modeling, Health-Promoting School, Health Center of University

문항 반응 이론에 의한 학습자 평가 시스템 설계 및 구현

송은하,박복자,하태령,정영식 한국컴퓨터교육학회 2003 컴퓨터교육학회 논문지 Vol.6 No.2

기존의 학습자 평가 시스템은 교수자의 주관적인 관점과 견해에 의해 각 문항의 난이도가 결정되는 단점을 가지고 있다. 본 논문에서는 학습자의 개별 능력 평가가 가능하고 개인별 학습 수준에 적합한 문항을 난이도, 변별도 및 추측도를 이용하여 학습자에게 제공함으로써 개인별 문항 평가가 가능한 학습자 평가 시스템을 개발하고자 한다. 본 연구의 학습자 평가 시스템은 CAT 기법의 문항 반응 이론 중 3-모수 로지스틱 모델을 이용하여 개발한다. In existing the learner testing system, it has a weak point to determine differently the difficulty of each question which has been estimated by teacher's view and the subjective stand point. In this paper, we develops the learner testing system which supports the estimation of the individual ability of learner, provides the questions for suitable to the individual learner level, and able to estimate the question of individual that used by three parameters such as the difficulty parameter, discrimination parameter, and guessing parameter. Also, it is applied to three-parameters logistic model of IRT(Item Response Theory) for using CAT(Computer Adaptive Testing) technique.

동서양의 식용꽃에 대한 고찰 : 조리방법을 중심으로

김영순,이정희,오순덕,정은미,최지영,유은순,장정미,정진선,하상민 高麗大學校 倂設 保健大學 保健科學硏究所 2001 保健科學論集 Vol.27 No.2

Edible flower means a flower that is good to eat is subject to either cooking or appetizing. In general, people eat edible flower as raw so that the loss of vitamin and inorganic are minimal. Edible flower is usually utilized as salad material or aromatic, decoration for jelly or cake and solid stuff in soup. Thus, decorating food by edible flower improves flavor, fragrance and appetite. Edible flower serves various purposes both east and west. In Korea, Edible flower is mainly subject to soup, cooked potherbs, frying, tea stuff, brewing and etc, whereas in Japan, its various usage covers cooked potherbs, pickle, sliced raw fish, frying, salad, jelly and decoration. On the other hand, Edible flower is used as numerous salad and tea stuff, condiment, roasting, meat, sweets and desserts in Western Hemisphere.

人蔘이 卵巢摘出로 誘發된 흰쥐의 骨多孔症 예방에 미치는 효능

정국영,서부일,이은숙,변부형,신순식,박지하 대한본초학회 2004 大韓本草學會誌 Vol.19 No.1

Objectives : The present study has been undertaken to investigate the effects of Ginseng Radix on prevention of osteoporosis in ovariectomized rats. Methods : In this experiment, the rats were ovariectomized. Rats were administered by 2 kinds of medicine, Estradiol, Ginseng Radix. The levels of bone mineral density, osteocalcin, ALP, phosphorus, calcium in serum, deoxypyridinoline in urine, calcium, phosphorus, ash weight of bone, body weight and uterus weight were measured. Results : The levels of spinal bone mineral density was significantly increased in comparison with OVX group at 8 weeks in Ginseng Radix group. The levels of serum didn t show significant change in comparison with OVX group in Ginseng Radix group. The levels of urine deoxypyridinoline showed significant decrease in comparison with OVX group in Ginseng Radix group. The levels of femoral and fibula-tibial ash weight didn t show significant increase in comparison with OVX group in Ginseng Radix group. The levels of femoral and fibula-tibial calcium showed significant increase in comparison with OVX group in Ginseng Radix group. The levels of femoral and fibula-tibial phosphorus showed significant increase in comparison with OVX group in Ginseng Radix group. The levels of body weight didn t show significant changes in comparison with OVX group in Ginseng Radix group. The levels of uterus weight didn t show significant changes in comparison with OVX group in Ginseng Radix group. Conclusions : Reviewing these experimetal results, it appears that Ginseng Radix have efficacy on prevention of osteoporosis. And further study should be conducted to illustrate in depth the curing and prevention of osteoprosis.

대학생의 건강증진 프로그램 참여의사에 영향을 미치는 주요 요인에 관한 연구

김영복,하은희,김주영,윤영옥 韓國保健敎育.健康增進學會 2001 보건교육건강증진학회지 Vol.18 No.1

This study purposed to examine the participative intention for health promotion program in a university and to find out the factors to associate with the participative intention. The data were based on the self-reported questionnaires from 746 women who study in E university, and this survey performed May, 1998. This study performed to analyze the participative intention for health promotion programs and the factors associate with health promotion program using x2-test and trend test by the PC-SAS 6.12. The major findings were as fellows: 1. The tendency of participative intention for health promotion programs showed that Influenza preventive program was the highest among the health promotion programs, and the next were Weight control program, Rubella preventive program, Fitness program. On the other hand, Smoking preventive program and Non-drinking program were lower than the other program. 2. The four significant factors on participative intention for health promotion programs were grade, concern for health, and behavior change experience through the health education. On the other hand, the cognitive level for health, experience for health education were not the significant factors associate with the participative intention for health promotion programs. 3. The relationship between factors and each health promotion program showedthat Rubella preventive program, Influenza preventive program, Weight control program, Smoking cessation program and Non-drinking program were associated with the grade or the health concern. And Chronic diseases preventive program was associated with the grade and the concern for health. Fitness program and Sex education program were associated with the concern for health and the behavior change experience through health education.

밀레니엄 광고세대의 커리어 행로(carrer path)에 관한 문헌연구

최은하,김재영 남서울대학교 2004 남서울대학교 논문집 Vol.10 No.1

This paper aims at study of the career path that is the most important decision factor of millennium generation's lifestyle. Because millennium generation will be new market indicator, of 21 century. For this study, this paper is based on generation Gap that is dealt with all social science. Where Traditionalists seek to build lifetime careers, Boomers to build stellar careers, and Xers to build portable careers, the career path ClashPoint for Millennials will be around parallel careers. Millennials' programmed live have made them true multitaskers. Millennials are already quite capable of learning several jobs simultaneously and performing them admirably. Millennials are throwing out the old model that you're either a waitress, a hostess, or running the register. In a tight labor market, making sure scarce Millennials can cover more than one position is a smart strategy. In a contracting economy, it's cost-effective to put Millennials' multitasking abilities to use rather than hire more employees. Plus, cross-training is a great retention strategy, which reduces the expense of turnover. Futurists predict that Millennials will experience as many as ten career changes in their lifetimes. That's career changes, not job changes-meaning they will recycle their skills and talents and personal preferences into new application again and again and again. Throughout their careers, this generation will be ready, willing, and able to adapt to an organization's evolving structure.