삼풍사고 생존자들에서의 급성 외상후스트레스장애 : 발생빈도, 예측인자, 증상 변화에 대한 예비적 연구 A Preliminary Study on Incidence, Predictors and Pattern of Symptom Changes

김승태,김병로,홍경수,정유숙,유범희,김도관 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.3

목적 : 삼풍 백화점 붕괴 사고로 대단위 스트레스에 노출된 생존자들에서 급성 외상후스트레스장애(PTSD)의 발생빈도를 조사하고, 증상 발현에 대한 예측인자와 시간경과에 따른 증상 변화의 양상을 살펴보기 위하여 전향적 임상연구를 시행하였다. 방법 : 생존자 32명을 사고 후 1개월(1차 평가), 3개월(2차 평가) 경과 시점에, 한글 번역판 PTSD-I(DSM-III-R),을 사용하여 PTSD의 진단과 증상 정도를, Hamiltons Anxiety Scale(HAS)과 Hamiltons Depression Scale(HDS)을 사용하여 불안과 우울 증상의 정도를 평가하였다. PTSD 증상 심각도에 대한 예측인자는 단계적 선택 방법을 거친 다중회귀분석을, PTSD 증상의 변화는 paired t-test를 통해 살펴보았다. 결과 : 사고 발생 후 3개월 동안의 급성 PTSD 발생빈도는 완전한(true) PTSD가 41%, 부분성(partial) PTSD가 48%였다. 1차 평가시 HDS 점수가 PTSD-I 점수에 유의하게 기여하였고 동반자 사명여부는 HDS 점수와 부분적으로 관련되어 있었다. 2차 평가시에는 의식상실 유무가 PTSD-I, HDS, HAS 점수에 유의하게 기여하였다. 1, 2차 평가 기간 동안 PTSD-I 전체 점수는 변화가 거의 없었지만 재경험, 과각성 증상군 점수는 회피 증상군에 비해 유의하지는 않으나 상대적으로 감소하는 경향을 보였다. 결론 : 삼풍 사고 후 급성 PTSD의 발생빈도는 매우 높았고 사고 당시 동반자의 사망, 우울증의 정도, 의식상실 경험등이 생존자의 급성기 PTSD 증상 정도에 영향을 미치고 있었다. PTSD의 회피 증상은 재경험, 과각성등의 증상들에 비해 시간 경과에 따른 변화가 적은 경향이 있었다. Objective : This is a prospective clinical study on survivors of the collapse accident of a major department store building occurred in Seoul in June 1995 to investigate the incidence of acute PTSD, to identify risk factors affecting the severity of PTSD symptoms, and to evaluate the pattern of symptom changes over time. Method : Thirty-two victims were interviewed with modified Korean version of the PTSD-I(DSM-III-R) to determine the severity of symptoms and diagnosis of PTSD. Degrees of anxiety and depression were measured with Hamilton's Anxiety Scale(HAS) and Depression Scales(HDS) respectively. Subjects were assessed in series at one month(time point 1) and three month(time point 2) from the time the accident occurred. Results : The incidence of PTSD in the subjects over the 3 months was 41% using by full criteria and 48% by partial criteria. Regression analysis at the time point 1, the HDS score, which was partially related with death of accompanied persons(friends/relatives/colleagues), contributed significantly to the PTSD-I variances. At the time point 2, loss of consciousness contributed significantly to the variance of the PTSD-I, HDS and HAS scores. Between time point 1 and time point 2, the overall severity of PTSD symptoms for all the subjects has remained almost unchanged. However, re-experience and hyperarousal symptoms were improved almost unchanged. However, re-experience and hyperarousal symptoms were improved in comparison with avoidance symptoms, although not statistically significant. Conclusions : This study results show a high risk of developing PTSD and partial PTSD among the building collapse victims. The death of accompanied person, severity of depression and loss of consciousness are all regarded as major factors affecting the severity of PTSD. Of PTSD symptom clusters, avoidance symptoms are likely to be less changeable than re-experience and hyperarousal symptoms over time.

경주지역 여고생의 초경과 체성장간의 관계

김준섭,권오구,박진석,오종수,박정현,박제식,안세한,이용환,서정호,신태섭,최영배,김덕수,이관,박수경 東國大學校醫學硏究所 2002 東國醫學 Vol.9 No.1

본 연구는 경주지역 1개 고등학교 3학년 여고생을 대상으로 초경 시작 전인 초등학교 4학년부터 고등학교 2학년까지의 키, 몸무게, 가슴둘레 수치와 초경 연령을 파악하여 여성의 초경이 빠를수록 체성장 속도의 변화가 있을 것이라는 가설을 기초로 두 요인간의 관련성을 파악하고자 시행되었다. 경주시 1개 여자고등학교 3학년생 총 317명에 대해 ㅊ경 나이, 초경시 심리 상태, 초경이 시작되었을 때의 상담 여부와 상담하였던 사람, 부모 신장과 초경전후의 식사 규칙성, 다이어트 경험, 수면시간, 스트레스, 음주/흡연 여부, 질병력 등에 대한 설문 조사를 시행하였고, 초등학교 4학년부터 고등학교 2학년까지의 키, 몸무게, 가슴둘레에 대한 정보는 건강기록부에서 확보하였다. 상기 대상자 중 건강기록부가 분실된 39명, 초경나이에 대해 응답하지 않았던 29명 및 결석 등으로 조사를 하지 못하였던 42명을 제외한 조사 대상자는 206명으로 선정하였다. 대상자들의 초경연령 평균값(Mean±SD)은 13.0±1.11이었고, 초등학교 4학년부터 고등학교 2학년까지의 초경 이후 신장 성장률은 감소하였으며, 초경연령이 빠른 군이 초등학교 때는 신장에 있어서 우위를 차지하나 고등학교에 오면서 신장은 비슷한 수준이 되었다. 초경후 1-2년 사이에 체중과 흉위의 증가율은 감소하였고, 초경연령이 빠른 군이 초등학교와 고등학교 사이에 체중과 흉위에서 모두 우위를 차지하였다. 본 연구의 결과는, 흔히 이차 성징의 시작 시점 혹은 사춘기의 시작 시점으로 보고있는 초경 연령이 청소년기의 성장과 밀접한 관련성이 있고, 특히 체중과 흉위의 성장 속도와 밀접한 관련성이 있음을 시사한다. To understand the onset of menarche in relation to changes in physical growth that take place during female adolescence, especially the changes in height and weight velocity. The 207 senior in one women high school of Kyongju were investigated in April 3 to 8, 2001. We collected the information, relation in the age at menarche, height & weight of parents, regularity of eating, and obesity diet, duration of sleeping, sickness & stress near age at menarche, by self-recording. The status of height, weight & chest circumference between the 4th grade of primary school and the junior of high school was collected by individual Health Record. The results were followed; The average age at menarche was 12.95±1.11 years old and the most frequent age of menarche is 13 years. After menarche, the velocity of height, weight and chest circumference were decreased. The most rapid group of menarche hold dominant position in height during elementary school. As time passed, they dont hold dominant position in height. The most rapid group of menarche get an advantage in the weight and the girth of chest after elementary school. The height of subjects is directly proportional to the height of their parents. These results suggest that the starting age at menestuation can be closely associated with physical growth and development.

성관련 강좌가 대학생들의 성지식에 미치는 효과

김영순,손수경 韓國學校保健學會 2005 韓國學校保健學會誌 Vol.18 No.1

Purpose: The purpose of this study was to confirm the effects of lectures on sexuality and investigate changes in students' sexual knowledge and consciousness. Method: The subjects in this study were 50 students at K University in Busan, and the research period was from the 8^(th) of March to the 7^(th) of June 2004. This study was designed to be one-group pretest-posttest. Data were analyzed by frequencies, percentages, means, standard deviations, paired t-test and x^(2)-test using the SPSS 10.0 program. Results: 1. The score of sexual knowledge increased from 14.48 before the education to 15.70 after and the difference was statistically significant (t=3.926, p<.001). 2. Significant differences of sexual consciousness were observed in 'the extent of sexual behavior’ (x^(2)=12.584, p<.05), 'the meaning of intercourse’ (x^(2)=46.014, p<.001), 'the self attitude of premarital purity’ (x^(2)=84.686, p<.001), 'the premarital intercourse’ (x^(2)=75.323, p<.001), 'the definition of purity’ (x^(2)=23.770, p<.001), 'the general premarital purity attitude’ (x^(2)=32.305, p<.001), 'the conception of love, sex and marriage’ (x^(2)=38.452, p<.001) and ‘the premarital sex experiences’ (x^(2)=50.210, p<.001). Conclusions: This study showed that a sexuality course has effects on increasing sexual knowledge and changing the consciousness in university students.

부정교합 분류에 따른 초경시기와 골성숙도에 관한 연구

김경호,백형선,손은수 대한치과교정학회 1998 대한치과교정학회지 Vol.28 No.4

부정교합 환자에서 사춘기 성장 가속화시기의 치료는 악안면 골격 부조화의 교정과 안모의 개선에 상당한 영향을 미치므로 사춘기의 성장을 예측하고 성장 잠재력을 평가하는 것은 매우 중요하다. 따라서 교정학에 있어서 개개인의 성장 가속화시기와 연관해서 신체의 성장 발육상태를 평가하는 것은 매우 중요하며 교정치료시 반드시 고려되어야 한다. 이에 본 연구에서는 부정교합 분류에 따라 초경시기에 차이가 있는지와 초경시 골성숙도를 조사하기 위해, I급 부정교합자 64명, II급 부정교합자 51명, III급 부정교합자 38명의 초경 전후 3개월 이내의 수완부골 방사선 사진을 이용하여 골성숙도를 평가한 결과 다음과 같은 결론을 얻었다. 1. 초기 평균 연령은 12.50±1.01세 였다. 2. 각 군별 초경연령은 I급 부정교합군이 12.36±1.04세, II급 부정교합군이 12.81±1.03세, III급 부정교합군이 12.32±0.82세로서, II급 부정교합군이 I급 부정교합군 과 III급 부정교합군에 비해 늦은 초경연령을 보였다. 3. 초경시 수완부 골성숙도는 부정교합에 따른 차이가 없었다. 4. 초경시 수완부 골성숙도는 SMI 7이 45.10%, SMI 8이 27.45%, SMI 9가 10.46%, SMI 6이 7.84%, SMI 10이 7.84%, SMI 5가 1.31% 였다. 5. 초경연령과 수완부 골성숙도는 통계적으로 유의한 상관관계를 보였다 (p<0.05, r=0.25430). In order to correct a maxillofacial-skeletal disharmony sucessfully and achieve a favorable facial profile, orthodontic treatment must begin at pubertal growth spurt. Therefore predicting the pubertal growth pattern and evaluating the growth potential is very important. For an orthodontist, estimating skeletal maturity in relation to one`s personal growth spurt is essential and it must be considered into the treatment. The objective of this study was to find out whether there was a difference in menacheal age among different malocclusion groups and to evaluate the skeletal maturity at menarche. The subjects were 64 Class I malocclusion patients, 51 Class II patients and 38 Class III patients. Skeletal maturity was estimated from handwrist radiographs of these patients. Handwirst radiographs were taken between 3 months before and after the menarche. The results were as follows. 1. The mean chronologic age of menarche was 12.50±1.01 years. 2. For the Class I malocclusion group the mean age of menarche was 12.36±1.04 years, for Class II 12.81±1.03 years and for Class III 12.32±0.82 years. According to these results Class II malocclusion patients started mensturation later than Class I and Class III malocclusion patients. 3. No difference was found considering the skeletal maturity at menarche among the malocclusion groups. 4. The skeletal maturity index at menarche was SMI 7 for 45.10%, SMI 8 for 27.25%, SMI 9 for 10.465, SMI 6 for 7.84%, SMI 10 for 7.84% and SMI 5 for 1.31% patients. 5. Statistically there was a significant correlation between skeletal maturity estimated by handwrist radiographs and menacheal age (p<0.05, r=0.25430).

소아ㆍ청소년 및 성인 우울신경증 환자에 대한 Paroxetine의 항우울 및 항불안 효과 검증 : ADOLESCENT AND ADULT DEPRESSIVE NEUROSIS 위약과의 이중맹 교차 비교실험

김승태,홍경수 대한소아ㆍ청소년정신의학회 1994 소아청소년정신의학 Vol.5 No.1

요 약 본 연구의 목적은, 선택적 serotoin 재흡수 차단제(sell·ctive serotonin re-uptake inhibitors : SSRI)로서 불안중상을 동반한 비정신병적 우울증에 효과적인 치료제로 알려지 고 있는 paroietine의 항우울 및 항불안 효과를 검증하고. 성별 및 연령별로 효과의 차이를 파악하는 것이다. 이를 위해 8∼55세 사이의 우울신경증 환자 23B명을 대상으로 paroxetine 과 위약을 이중맹 교차방식으로 투여한 후,우울 및 불안 증상의 호전도를 Hamilton Depression Scale(HDS)과 Hamilton Anxeity Scale(HAS)로 측정하여 다음과 같은 결과를 얻었다. 1) BBDS로 측정된 우울증상에 대해, 성별 및 연령별로 구분된 8개 대상군에서 모두 paroxetine이 위약에 비해 통계적으로 유의하게 높은 호전 효과를 보였다. 2) HAS로 측정된 불안증상에 대해서도, 성별 및 연령별로 구분된 8개 대상군에서 모 두 paroxedne이 위약에 비해 통계적으로 유의하게 높은 호전 효과를 보였다. 3) 위약과 비교시, paroxetine의 항우울 효과는 소아· 청소년 여자 환자군에서 가장 두드 러졌고, 항불안 효과는 남,녀 소아 환자군과 35세 이하의 성인 여자 환자군에서 가장 높은 경향을 보였다. 4) 부작용으로는, 전체 232례 중 3례에서 paroxetille 투여 후 경미한 소화불량 및 복통증상 을 나타내었으나, 3례 모두 약물의 감량이나 투여중단 없이 회복이 가능했다. 이상의 결과에서 paroxetine은 소아 · 청소년 및 성인 우울신경증 환자에서 2주 이내에 위 약보다 유의하게 우수한 항우울 및 항불안 효과를 나타내는 것을 알 수 있었다. 향후 보다 장기간의 치료실험을 통하여 이러한 효과의 장기간 지속성에 대한 검증이 필요할 것이다. ABSTRACT Paroxetine is a potent and selective serotoin re-uptake inhibitor. It is well known as an effective and safe antidepressant and increasingly used for neurotic or non-psychotic depression with anxiety symptoms. The present study assessed antidepressant and antianxiety efficacy and tolerability of paroxetine against placebo in child-adolescent and adult depressive neurosis patients. 232 subjects aged 8-55 years and meeting DSM-ID-R criteria for depressive neurosis or dysthymia were divided into 8 subgroups according to their sex and age(8-1l years old,12-17 years old, 18-35 years old and 36-55 years old subgroups in each male and female group). In each subgroup, the randomly assigned half of the patients were treated with paroxe-tine(10-30mg/day) and the others with placebo for the first 2 weeks in double blind fashion.After 1 week of drug-washout period, paroxetine and placebo groups were crossed over. The depression and anxiety symptoms were assessed with Hamilton Depression Scale(HDS) and Hamilton Anxiety Scale(HAS) at baseline and every 1 week during the trial periods. The levels of reduction in HDS and HAS scores from baseline after 2-week trial were compared between paroxetine- and placebo- treated periods by paired t-test In all the 8 subgroups, statisti-cally significant differences between paroxetine and placebo were found on the antidepressant efficacy after 2-week treatment The antidepressant efficacy of paroxetine compared to placebo was most prominent in child and adolescent female groups. On anxiety symptoms, paroxetine was also significantly more effective than placebo. The antidepressant efficacy of paroxetine compared to placebo was most prominent in male and female child groups and young adult female group aged 18?5 years. As for the adverse effects of paroxetine, 3 out of 232 subjects reported mild indigestion and abdominal pain. However, in all the 3 cases, the symptoms improved without reduction of dosage or discontinuation of the drug. In conclusion, paroxetine showed significantly higher antidepressant and antianxiety efficacy compared to placebo in child-adoles-cent and adult depressive neurosis patients after 2-week treatment Further trials of paroxetine in depressive neurosis are warranted to elucidate the long-term antidepressant and antianxiety efficacy of paroxetine.

Cycloconverter運轉特性 改善에 관한 考察

李敬德,金秀植 군산대학교 1985 群山水産專門大學 硏究報告 Vol.19 No.3

In this paper we have described on the characteristics of cycloconverter using unsymmetrical gate control system, tried to research for the phase control of firing method and circuit composition to getting with stability for cycloconverter driving in good condition against troubles. Experimental results are as follows. 1.\The input power factor is improved to 2-3 (%) approximately as compared with former cycloconverter driving and output power waveforms or input power waveforms are show a good result. 2.When load power factor is 1-0.8, the characteristics of input harmonic current and output harmonic voltage are improved greatly as compared with symmetrical control type, on the other hand, harmonic distortion factor is improved to 99 (%) against output voltage waveforms. 3.If we were applied unsymmetrical gate control system for cycloconverter driving, we could be decreased effectively capacity of condenser for input power factor improvement and transformer, in addition, we should be solved a problem in simply that thyristor cost and element in increase in quantity and complicated gate firing circuit construction. By means of improvement of characteristic, cut down price of thyristor and design for LSI construction with a new attempt.

인지도 조사에 의한 건국의대 의학과 교육목적 및 교육목표의 평가

박수경,김진국,김소정,김형수,이건세,장성훈 건국대학교 의과학연구소 2004 건국의과학학술지 Vol.14 No.-

This study was conducted to survey the recognition and accuracy for educational goal and objectives of College of Medicine, Konkuk University on students and professors with using 18 items of questionnaire from May 15 through June 30, 2004. The recognition for educational goal of College of Medicine, Konkuk University in participating students and professors were 93-95%. And recognition for 3 objectives of College of Medicine, Konkuk University on participating students and professors were 84-87%, 95% respectively. However the accuracy for detail educational objectives using other college of medicine were 46-59% in first student survey, 44-67% in second student survey and 58-72% in professor survey. Therefore it is need to advertize 3 objectives to students and professors. And it is also necessary to refine the contents of educational objectives to more suggesting directions than broad goal of ideal.

身體 微細畸形 및 産科的 合倂症과 精神分裂症의 家族歷

홍경수,주연호,김용식,신철진,강웅구,이중서,정희연,주은정 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.4

저자들은 정신분열병의 일부에서는 태생기 동안 유전 외적인 환경적 요인이 크게 작용할 것이라는 가정 하에 형제 정신분열병 환자군(남 15. 여 7)과 산발성 정신분열병 환자군(남 16, 여 7) 및 정상 대조군(남 16, 여 7)을 대상으로 가족력에 따른 산과적 합병증과 신체 미세 기형을 비교하였다. 산과적 합병증은 Lewis 척도를 이용하여 연구 대상의 어머니와 면담하여 평가하였고 신체미세기형은 Waldrop 척도를 이용하여 측정하였다. 또한 산과적 합병증 및 신체 미세기형과 가족력에에 따라 발병 연령 등의 임상 양상들이 차이를 보이는지 비교함으로써 정신분열병을 좀 더 동질적인 아형으로 나눌 수 있는지를 검토하였다. 1) 형제 환자군, 산발성 환자군 및 정상 대조군의 세균에서 산과적 합병증의 개개의 항목 및 전체 점수의 유의한 차이는 없었다. 신체 미세기형의 경우 입의 미세기 형에서 유의한 차이가 있었으나 그 외에 각 부위별 점수 및 전체 점수에서는 세 군간에 유의한 차이가 없었다. 그러나 대부분의 신체 미세기형 세부 항목 및 전체점수에서 산발성 환자군이 형제 환자군에 비해 높은 신체 미세기형의 점수를 보이는 경향이 있었다. 2) 산과적 합병증의 전체 점수와 신체 미세기형의 전체 점수 사이에 상호 연관성을 찾아볼 수 없었다. 3) 발병연령·정신병리·약물에 대한 반응·병전 기능수준·지연성 운동장애 유무 등의 임상 양상들을 비교하였을때 산발성 환자군과 형제 환자군간에 유의한 차이가 없었다. 4) 산과적 합병증 및 신체 미세기형과 임상 양상들을 비교하였을 때, 형제 환자군에서 분만시간과 회복시 전반적 기능수준간에, 산발성 환자군에서 산과적 합병증의 전체 점수와 발병 연령간에 상관관계가 있었으나 전체적으로 일관된 결과가 도출되지는 못하였다. 위와 같은 결과를 종합하여 볼 때, 산과적 합병증이나 신체 미세기형이 정신분열병의 원인을 밝히는데 유익한 도구가 될 수는 있지만, 가족력 유무에 따라 정신분열병을 보다 동질적인 아형으로 구분하기 힘들다고 생각되었다. In order to test the hypothesis that familial schizophrenics have fewer chances of receiving organic insults during the fetal neural development than sporadic schizophrenics, the authors compared obstetric complications, minor physical anomalies, and other clinical features in sibling schizophrenics, sporadic schizophrenics and controls. Obstetric complications were evaluated by the scale of Lewis, and minor physical anomalies were measured by the Waldrop scale. Sporadic schizophrenics had a significantly higher Waldrop score for mouth than sibling schizophrenics. Although there was some tendency of higher total scores for minor physical anomalies in sporadic schizophrenics, there were no statistically significant differences in obstetric complications and the other minor physical anomalies among three groups. There was no significant correlation between obstetric complications and minor physical anomalies. The clinical features such as age of onset, psychopathology, response to drugs, premorbid functioning, and tardive dyskinesia were not significantly different between sibling and sporadic scizophrenics. In conclusion, while the obstetric complications and minor physical anomalies were suggested to be useful in the search for the cause of schizophrenia, it was difficult to categorize schizophrenics into more homogeneous groups according to family history of schizophrenia using the parameter of obstetric complications and/ or minor physical anomalies.

위암환자의 피로와 영양상태의 관계

손수경,한영인,김경희 고신대학교 전인간호과학연구소 2003 전인간호과학연구 학술모음집 Vol.2 No.-

Purpose. The purpose of this study was to identify the relationship between fatigue and nutritional status in patients with gastric cancer. Design. A orrelational and crossectional study design was used Method. The data was collected from July to August 2002. 59 subjects with gastric cancer were recruited K university hospital in Busan, Korea. Fatigue was measured using the Revised Piper Fatigue Scale developed by Piper et. al (1998). The parameters for nutritional status included body weight, body mass index, hemoglobin, Hct, total protein, albumin and lymphocyte count. Result. 1) The fatigue score was mean 94.31±22.08(mean average 4.48±1.00) The subdimension that showed behavior/severity score at 34.15±8.76, cognitive/mood score at 22.00±7.93, sensory score at 21.67±5.56, and affective score at 20.81±6.69. And among the parameters for nutritional starus, BMI, Hb, Hct were not included normal rage. 2) There was a significant difference in present diet(F=3.343, P= .026) according to general characteristics in the fatigue in patients with gastric cancer. 3) The disease-related characteristics such as Age, treatment type, after period diagnosis, care giver, payment were frequently related to poorer nutritional status. Subjects received chemotherapy showed lower lymphocyte level than subjects received operation, and the subjects were diagnosis less than 1 month, were showed lower Hematocrete level. 4) There was a significant negative correlation between fatigue and nutritional status(r= -.371, P=.004). Conclusion. Patients with gastric cancer experience in fatigue. Considering the relationship between fatigue and nutritional status, nurses can identify the risk group most vulnerable to fatigue and malnourishment in order to provide appropriate interventions for them

석회유담즙증 1예

이지아,김도영,정혜경,문일환,신수연,곽재진 梨花女子大學校 醫科大學 醫科學硏究所 2003 EMJ (Ewha medical journal) Vol.26 No.1

Milk of calcium bile or limy bile is a rare disorder in which the gallbladder lumen is filled with a thick, paste-like, radio-opaque material. Churchman first reported a case of curious deposition of calcium salts within the gallbladder in 1911. Volkmann first used the term Kalkmilchgalle or "milk of calcium bile" in 1926. The radio-opaque material is almost entirely composed of calcium carbonate by weight. The mechanisms by which bile turns limy and radio-opaque or the time required for this biochemical alteration to occur are not well understood. The limy bile is found mostly in a gallbladder complicated by cholecystitis. Recently, we experienced a 33 year old woman who had a milk of calcium bile in the gallbladder lumen. We report this case with a review of literature.