병원중심 가정간호관리대상 범위 확대를 위한 기초연구(II) - 자동차보험가입 입원환자를 대상으로 -

박은숙,이숙자,박영주,유호신,Park, Eun-Sook,Lee, Sook-Ja,Park, Young-Ju,Ryu, Ho-Sihn 한국가정간호학회 2000 가정간호학회지 Vol.7 No.1

This study was an attempt to encourage the development of a rehabilitation delivery system and programs as a substitute service for hospitalization on the case of car accident patients, such as hospital based home health care nursing services. Various substitute services for hospitalization are required to curtail the length of stay for inpatients who were hospitalized with car accident compensation insurance. It focused on developing an estimation an early discharge day for car accident inpatients based on detailed statements of treatment for 111 inpatients who were hospitalized at the General Hospital in 1997. This study had four specific purposes as follows. First. to find out the utilization of medical services. Second, to estimate the time of early discharge and income increasing effect based on early discharge for those patients. Third, to identify the factors affecting total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze the length of stay and medical expenditure for inpatients who were hospitalized due to car accidents, the authors conducted micro- and macro-analysis of medical and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria, such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the test consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, and stable conditions. In addition to identifying variables affecting medical expenditure, and the length of stay and income effect due to early discharge day, the data was analyzed with a multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study were as follows. First. the mean length of stay was 50.3 days. whereas the mean length of stay due to early discharge was 34.3 days at the hospital. The estimation of time of early discharge depended on the length of stay. The longer the length of stay, the longer the length of time of early discharge : for instance a length of stay under 10 days was estimated as correlating to a mean length of stay of 6.6 days and early discharge of 6.5. The mean length of stay was 217.4 days and the time of early discharge was 110.1 respectively. The mean medical expenditure per day was found to be 169.085 Won and the mean medical expenditure per day showed negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to being discharged 16 days early was around 2,244,000 won per bed. However. this sum does not represent the real benefits resulting from early discharge, but rather the income increasing amount without considering medical prime cost in the general hospital. Therefore, further analysis is required on the cost containments and benefits as turn over rate per bed as the medical prime costs. The length of stay was most significant and was positive to the total medical expenditure, as expected. Surgery and patient's residential area was also an important variable in explaining medical expenditure. The level of complications was the most significant variable in explaining the length of stay. There was a high level for need a home health care nursing service which further supports early discharge for accident patients. In addition, when the patient was discharged. they needed follow up care for complications suffered during the car accident. $86.8\%$ of discharged patients responded that they needed home health services after early discharge. From these research findings, the following suggestions have been drawn. Strategies on a health care delivery system must be developed in order to focus on the consumer's needs and being planned for 21 century health policy in Korea. Community based int

장애아 어머니의 불확실성, 사회적 지지 및 무력감

박은숙,오원옥,Park Eun Sook,Oh Won Oak 한국아동간호학회 1999 Child Health Nursing Research Vol.5 No.2

The purposes of this study were to measure the degree of perceived uncertainty, social support & powerlessness, to examine the relationship between the perceived uncertainty, social support & powerlessness and then to find the predictors of powerlessness in mother's of handicapped children. The subjects of this study consist of 102 mothers of handicapped children, registered at rehabilitation & handicapped children school. Data was collected from September 1998 to March 1999. The tools used in this study were Mishel's the Parents' Perception of Uncertainty Scale (28 item, 4 likert scale), Miller's Powerlessness measurement Scale(28 itewt 4 likert scale) & Cohen's Interpersonal Support Evaluation List (40 items, 4 likert scale). Data was analyzed by t-test, ANOVA, Duncan comparison, Pearson Correlation coefficient & Stepwise multiple regression Results of this study are summarized as follows : 1. Mothers perceived their uncertainty to be slightly high(Mn 2.50). The degree of perceived uncertainty by the four components were followed as : lack of clarity(2.69), unpredictability(2.56), ambiguity(2.56) & lack of information(2.46). The degree of perceived uncertainty of the mothers of handicapped children revealed to be influenced significantly by age of children, admission experience, disability types of children. 2. The degree of mothers' powerlessness was measured to be slightly high(Mn 2.14). The degree of perceived powerlessness of the mothers with handicapped children revealed to be influenced significantly by age of children, duration of illness admission experience,8E marital status of the mothers. 3. Mothers perceived their social support to be slightly high(Mn 2.71). The degree of perceived social support revealed to be influenced significantly by sex of children, married state of mothers. 4. Mothers' uncertainty was related positively to the mothers' powerlessness(r=.33, p=.0008). And also mothers' powerlessness was related inversely to social support(r=-.50, p=.0001). But, mothers' uncertainty was not related to social support significantly. 5. To analyze the variables which affect powerlessness, stepwise regression was implemented. As a result, about 61% of the powerlessness were explained by social support, marital status of the mothers and perceived uncertainty. Based upon these results, it is recommended that the nurses, who are caring handicapped children and their families, provide various support programs for them to overcome their difficulties. Also programs which decrease the uncertainty & powerlessness used social support multidimensionally & individually are recommended to be developed.

원전종사자의 방사선 노출과 암사망 위험도와의 관련성에 대한 메타분석

박은숙,문기은,김한나,이원진,진영우,Park, Eun-Sook,Moon, Ki-Eun,Kim, Han-Na,Lee, Won-Jin,Jin, Young-Woo 대한예방의학회 2010 예방의학회지 Vol.43 No.2

Objectives: We conducted a meta-analysis to investigate the relationship between low external doses of ionizing radiation exposure and the risk of cancer mortality among nuclear power plant workers. Methods: We searched MEDLINE using key words related to low dose and cancer risk. The selected articles were restricted to those written in English from 1990 to January 2009. We excluded those studies with no fit to the selection criteria and we included the cited references in published articles to minimize publication bias. Through this process, a total of 11 epidemiologic studies were finally included. A publication bias was tested for using Egger's test. The homogeneity test was performed before the integration of each of the standardized mortality ratios (SMRs) and the result proved that the studies were heterogeneous. Results: We found significant decreased deaths from all cancers (SMR = 0.75, 95% CI = 0.62 - 0.90), all cancers excluding leukemia, solid cancer, mouth and pharynx, esophagus, stomach, rectum, liver and gallbladder, pancreas, lung, prostate, lymphopoietic and hematopoitic cancer. The findings of this meta-analysis were similar with those of the 15 Country Collaborative Study conducted by the International Agency for Research on Cancer. A publication bias was found only for liver and gallbladder cancer (p = 0.015). Heterogeneity was observed for all cancers, all cancers excluding leukemia, solid cancer, esophagus, colon and lung cancer. Conclusions: Our findings of low mortality for stomach, rectum, liver and gallbladder cancers may explained by the health worker effect. Yet further studies are needed to clarify the low SMR of cancers, for which there is no useful screening tool, in nuclear power plant workers.

아동간호사의 공감정도에 관한 연구 -간호사와 입원아동 어머니를 대상으로-

박은숙,석민현,정경숙,Park Eun Sook,Suk Min Hyun,Jung Kyung Sook 한국아동간호학회 1997 Child Health Nursing Research Vol.3 No.2

Empathy is an essential factor for establishing therapeutic relationship. Especially for pediatric nursing, the nurses need to know how to perceive children's feeling and thought and to express her understanding about them affectively. So, empathy is considered as an important concept in pediatric nursing. This study was attempted to measure the empathic ability of pediatric nurses by pediatric nurses and mothers of hospitalized children. The subject of this study consisted of 83 pediatric nurses and 106 mothers of hospitalized children in 4 hospitals in Seoul and 1 hospital in Kyung-Gi. Data were collected from Jan. 14 to Feb. 6, 1997, by the questionnair method. The instrument for this study was the Empathic Construct Rating Scale : ECRS(60-item, 5 point scale). Data were analyzed by descriptive statistics, t-test and ANOVA. Results of this study are summarized as follows 1. Pediatric nurses perceived their empathic ability to be moderately high (Mn=3.71). The level of perceived empathic ability of the pediatric nurses showed no significance by general characteristics. 2. The mothers of hospitalized children perceived nurses' empathic ability to be moderate(Mn=3.27). The level of perceived nurses' empathic ability of the mothers of hospitalized children showed significant differences by the experience of hospitalization of the children and the age of the mothers. 3. The perceived nurses' empathic ability of the mothers was significantly low than of the pediatric nurses(t=6.50, P<.001). From the above results, it can be concluded, that the empathic ability of the pediatric nurses is not sufficient for caring children and mothers of ficiently. So, the pediatric nurses' empathic ability is needed to improve through facilitative relationship training as refreshment in-service education program.

흉추에 생긴 MRSA에 의한 신생아 골수염 1례

박은숙,신선희,김성구,윤혜선,Park, Eun Sook,Shin, Seon Hee,Kim, Sung Goo,Yoon, Hae Sun 대한소아감염학회 2002 Pediatric Infection and Vaccine Vol.9 No.2

골수염은 신생아에서는 드문 질환이며 신생아 중환자실 입원 환아 100명당 1~3명 정도에서 나타난다. 척추의 골수염은 이 중 1~2%를 차지하며 진단상의 어려움과 합병증으로 치료가 어렵다. 환아는 재태연령 34+2주, 출생체중 1.6 kg으로 생후 22일째 혈액 배양에서 MRSA가 발견되어 2주간 항생제 치료 후 다시 발열이 있어 입원치료 하였다. 자기 공명 영상상 흉추 7~8 부위의 골수염이 나타나 8주간의 vancomycin 정맥치료 결과 임상적, 방사선학적으로 호전되어 퇴원하였다. 저자들은 MRSA의 감염으로 척추의 골수염을 가진 신생아 1례를 경험하였기에 보고하는 바이다. Vertebral osteomyelitis represents only 1% to 2% of osteomyelitis and may pose a diagnostic conundrum, with disastrous consequences if diagnosis and therapy are delayed. We report a neonate with the unique association of vertebral osteomyelitis and MRSA infection. A 1-month-old boy was admitted to the hospital for evaluation of high fever and decreased oral intake. He was born at 34 wks, and his birth weight was 1.6 kg. We founded MRSA on his blood culture. Magnetic resonance imaging study showed findings of T7-T8 vertebral osteomyelitis. With 8 weeks of intravenous vancomycin treatment, the patient improved clinically and radiologically.

HBe항원 양성 산모에서 출생한 HBe항원 양성인 신생아의 추적관찰

박은숙,이해경,오창희,김성구,윤혜선,송원근,이영아,Park, Eun Sook,Lee, Hae Kyung,Oh, Chang Hee,Kim, Sung Ku,Yun, Hae Sun,Song, Won Keun,Lee, Young Ah 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.6

목 적 : HBsAg 양성이면서 HBeAg 양성인 산모에서 태어난 신생아에서 출생 직후 HBsAg은 음성이면서 HBeAg 양성이 어떤 의미가 있는 것인지에 대해 알아보았다. 방 법: 1996년 12월부터 1999년 3월까지 HBsAg과 HBeAg이 모두 양성인 산모로부터 출생한 신생아 중에서 HBsAg 음성이면서 HBeAg 양성인 신생아 22명을 대상으로 추적 관찰하였다. 결 과 : 1) 분만 산모의 총 수 4,338명 중 HBsAg 양성은 4.9%(213/4338), HBsAg 양성인 산모에서 HBeAg을 검사한 183례 중 HBeAg 양성은 41.5%(76/183)이었다. 2) HBeAg 양성인 산모에서 출생한 신생아에서 HBeAg 검사를 시행 받은 49례에서 HBsAg 음성이고 HBeAg 양성인 신생아는 36례로 73.5%이었다. 이중 추적관찰이 가능했던 22례에서 태반을 통해 전달된 HBeAg이 2개월 내에 소실된 경우가 7례(31.3%)로 가장 많았으며 90%이상이 12개월 내에 소실되었으며 결국 22례 모두에서 소실되는 소견을 보였다. 단 1례에서 HBeAg은 소실되었으나 6개월에 HBsAg이 양성이었다. 결 론: HBeAg이 양성인 간염 보균산모에서 신생아의 HBeAg은 감염이라기 보다는 태반을 통해 전달되는 산모의 HBeAg으로 일시적인 현상이며 임상적인 문제없이 소실되는 것으로 사료된다. Purpose : The objectives of this study are to evaluate the significance of HBeAg positivity in infants born to HBeAg and HBsAg positive mothers. Methods : The HBeAg status of 22 HBeAg positive, HBsAg negative infants born to HBeAg and HBsAg positive mothers from December 1996 to March 1999 were evaluated by enzyme immunoassay. Results : The number of HBsAg positive carrier mothers was 213(4.9%) out of 4,338 pregnant women. HBeAg was positive in 76(41.5%) out of 183 HBsAg positive mothers. Only 49 infants born to 76 HBeAg positive mothers could be evaluated; 36 infants were HBeAg positive and HBsAg negative. Laboratory follow up was possible in 22 infants. HBeAg disappeared in 7 cases within two months and in 20 cases within 12 months(over 90%). Ultimately, twenty-two babies who were HBsAg-negative and HBeAg-positive became negative for HBeAg, however, one showed HBsAg in follow up of 6 months of age. Conclusion : HBeAg positivity in infants born to HBeAg positive mothers may result from the maternofetal transmission and this HBeAg eventually disappeared without clinical significance.

Recombinant Adeno-associated Virus-Mediated Gene Transfer in Homocystinuria Mice

박은숙,Park, Eun-Sook The Korean Society of Inherited Metabolic Disease 2005 대한유전성대사질환학회지 Vol.5 No.1

Homocystinuria is a metabolic disorder caused by a deficiency of cystathionine ${\beta}$-synthase (CBS). Patients with homocystinuria show clinical symptoms such as mental retardation, lens dislocation, vascular disease with life-threatening thromboembolisms and skeletal deformities. Generally, the major treatments for CBS deficiency include pharmacologic doses of pyridoxine or dietary restriction of methionine. However, there is no effective treatment for this disease up till today and gene therapy can be an attractive novel approach to treatment of the disease. We investigated whether a recombinant adeno-associated virus could be used as a CBS gene transfer vector to reduce the excessive homocysteine level in the homocystinuria mouse model. Recombinant adeno-associated virus vector encoding the human CBS gene (rAAV-hCBS), driven by EF1-a promoter, was infused into CBS-deficient mice ($CBS^{-/-}$) via intramuscular (IM) and intraperitoneal (IP) injection. IP injection was more efficient than IM injection for prolongation of lives and reduction of plasma homocysteine levels. After 2 weeks of gene transfer by IP injection, serum homocysteine level was significantly decreased in treated mice compared with the age-matched controls and the life span was extended about 1.5 times. Also, increased expression of CBS gene was observed by immunohistochemical staining in livers of treated $CBS^{-/-}$ mice and microvesicular lipid droplets was decreased in cytoplasm of liver. These results demonstrate the possibility and efficacy of gene therapy by AAV gene transfer in homocystinuria mice.

만성질환아 어머니의 아동질병으로 인한 불확실성 경험

박은숙,Park Eun Sook,Martinson M.I. 한국아동간호학회 1998 Child Health Nursing Research Vol.4 No.2

The purpose of this study was to build a substantive theory about the experience of the maternal uncertainty in childhood chronic illness. The qualitative research method used was grounded theory. The interviewees were 12 mothers who have cared for a child who had chronic illness. The data were collected through in-depth interviews with audiotape recording done by the investigator over a period of nine months. The data were analyzed simutaneously by a constant comparative method in which new data were continuously coded into categories and properties according to Strauss and Corbin's methodology. The 34 concepts were identified as a result of analyzing the grounded data. Ten categories emerged from the analysis. The categories were lack of clarity, unpredictability, unfamiliarity, negative change, anxiety, devotion normalization and burn-out. Causal conditions included : lack of clarity, unpredictability, unfamiliarity and change ; central phenomena : anxiety, being perplexed ; context. seriousness of illness, support ; intervening condition : belief action/interaction strategies devotion, overprotection ; consequences : normalization, burn-out. These categories were synthesized into the core concept-anxiety. The process of experiencing uncertainty was 1) Entering the world of uncertainty, 2) Struggling in the tunnel of uncertainty, 3) Reconstruction of the situation of uncertainty. Four hypotheses were derived from the analysis : (1) The higher the lack of clarity, unpredictability, unfamiliaity, change, the higher the level of uncertainty (2) The more serious the illness and the less the support, the higher the level of uncertainty. (3) The positive believes will influence the devoted care and normalization of the family life. Through this substantive theory, pediatric nurses can understand the process of experiencing maternal uncertainty in childhood chronic illness. Further research to build substantive theories to explain other uncertainties may contribute to a formal theory of how normalization is achieved in the family with chronically ill child.

만성질환아 어머니의 질병에 대한 불확실성 정도와 양육태도

박은숙,Park Eun Sook 한국아동간호학회 1996 Child Health Nursing Research Vol.2 No.2

The purposes of this study were to measure the degree of perceived uncertainty and to identify the rearing attitudes of mothers with chronically ill children, and to examine the relationship between the perceived uncertainty and the rearing attitude of these mothers. The subjects of this study consisted of 133 mothers with chronically ill children, registered at 2 university hospitals in Seoul. Data was collected from April 1 to May 31, 1996. The Parents' Perception of Uncertainty Scale(28-item 4 point scale) and the Maternal Behavior Research Instrument (49-item 5 point scale) were used. Data was analyzed by Cluster analysis, ANOVA MANOVA and t-test. Results of this study are summarized as follows : 1. Mothers perceived their uncertainty to be slightly high (Mn 2.48). The degree of perceived uncertainty by the four components slightly differed unpredictability(2.72), lack in clarity(2.58), vagueness (2.52) and lack of information(2.04) . The degree of perceived uncertainty of mothers with ill children revealed to be influenced significantly by the age of the ill children, duration of illness after the diagnosis, and the experience of hospitalization. 2. Among the rearing attitudes : moderatlely high affective(Mn 3.98) and resrictive(Mn 3.58) attitudes of mothers toward their ill children were identified. Mothers tend to give positive evaluations of their childrens' behaviors (Mn 3.38) and less rejection(Mn 2.81). 3. Mothers' rearing attitude were correlated with the degree of perceived uncertainty in illness ; mothers in the Low Perceived Uncertainty Group (Mn 1.99) revealed the highest affective (Mn 4.08), the lowest resrictive(Mn. 2.72) attitudes and tendency to give positive evaluations of their childrens' behaviors (Mn 3.54) compared to the High Perceived Uncertainty Group(Mn 3.26) and Moderate Perceived Uncertaity Group(Mn 2.57). 4. The degree of perceived uncertainty, the duration of illness after the diagnosis and the experience of hospitalization revealed to be significantly influential to the rearing attitude of mothers with chronically ill children. From the above results, it can be concluded that predicting and controlling mothers' uncertainty are necessary for improved, efficient nursing interventions and normal growth & development of the chronically ill children.

16 세기 호남 사대부 한시의 특성에 대한 일고찰 - 박상 , 임억령 , 고경명을 중심으로 -

박은숙(Eun Sook Park) 한국한문학회 2002 韓國漢文學硏究 Vol.0 No.29