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.

Inoue Balloon을 이용한 PMV의 장·단기 결과 분석

진은선,이연아,전숙,김현숙,정승묵,박상선,최락경,임달수,홍석근,황흥곤 대한순환기학회 2003 Korean Circulation Journal Vol.33 No.11

치조골 상실에 따른 상악 치아군 저항중심의 변화에 관한 유한요소해석

성상진,김인태,국윤아,전윤식,김성훈,모성서 대한치과교정학회 2009 대한치과교정학회지 Vol.39 No.5

효과적인 교정치료계획의 수립을 위하여 치열군의 저항중심의 위치에 대한 평가는 필수적이다. 이번 연구의 목적은 상악 치열군(4전치, 6전치, 14치아)에서 치조골 손실에 따른 저항중심의 위치변화를 조사해보고자 하였다. 상악 전치열 14개 치아와 치주인대 및 0 mm, 2 mm, 4 mm 손실된 치조골의 3차원 유한요소 모델을 제작하였고 각 치아군(4전치, 6전치, 14치아)별로 치관부를 협측, 설측호선 및 splint wire로 고정하여 치아군 모델을 제작한 후 상악 중절치의 절단연 중점에서 연장된 splint wire에 4전치와 6전치군에는 200 g, 14치아군에는 400 g의 후방 견인력과 압하력을 적용하여 저항중심의 수직적, 수평적 위치를 분석하였다. 4전치군에서 저항중심의 수직 위치는 치조골 0 mm, 2 mm, 4 mm 손실에 따라 중절치의 절단연에서 치근방향 13.5 mm, 14.5 mm, 15 mm, 수평 위치는 후방 12 mm, 12 mm, 12.5 mm, 6전치군에서는 치근방향 13.5 mm, 14.5 mm, 15.5 mm, 후방 14 mm, 14 mm, 14.5 mm, 14치아군에서는 치근방향 11 mm, 13 mm, 14.5 mm, 후방 26.5 mm, 27 mm, 25.5 mm에 위치하였다. 모든 치아군에서 저항중심은 치조골 손실에 따라 치근첨 방향으로 이동하였으나, 치조정과의 거리는 가까워졌고, 4전치군과 6전치군에서 저항중심은 치조골 손실에 따라 후방으로 이동하였으나, 14치아군에서는 치조골 2 mm 손실 시에는 후방으로 이동하였으나, 4 mm 손실 시에는 전방으로 이동하였다. Objective: The aim of this study was to investigate the changes in the center of resistance of the maxillary teeth in relation to alveolar bone loss. Methods: A finite element model, which included the upper dentition and periodontal ligament, was designed according to the amount of bone loss (0 mm, 2 mm, 4 mm). The teeth in each group were fixed with buccal and lingual arch wires and splint wires. Retraction and intrusion forces of 200 g for 4 and 6 anterior teeth groups and 400 g for the full dentition group were applied. Results: The centers of resistance were at 13.5 mm, 14.5 mm, 15 mm apical and 12 mm, 12 mm, 12.5 mm posterior in the 4 incisor group; 13.5 mm, 14.5 mm, 15 mm apical and 14 mm, 14 mm, 14.5 mm posterior in the 6 anterior teeth group; and 11 mm, 13 mm, 14.5 mm apical and 26.5 mm, 27 mm, 25.5 mm posterior in the full dentition group respectively according to 0 mm, 2 mm, 4 mm bone loss. Conclusions: The center of resistance shifted apically and posteriorly as alveolar bone loss increased in 4 and 6 anterior teeth groups. However, in the full dentition group, the center of resistance shifted apically and anteriorly in the 4 mm bone loss model.

두경부자세 및 혀, 설골의 위치가 두개안면형태에 미치는 영향에 관한 연구

오진섭,태기출,국윤아,김상철 대한치과교정학회 1998 대한치과교정학회지 Vol.28 No.4

두경부 자세 및 혀, 설골의 위치와 두개안면골격간의 연관성을 알아보기 위해, 원광대학교 치과대학 재학생 중 선천적 두경부 이상이나 결손치가 없고 과거 교정 치료나 보철치료의 경험이 없는 남자 50명과 여자 40명을 대상으로 natural head position(NHP)상태에서 두부방사선 사진을 채득하여 전통적인 두개내 참고선과 두개의 진성 참고선을 이용하여 계속한 결과 다음과 같은 결론을 얻었다. 1. 두경부 자세변수들에서는 남녀간 차이가 없었으나, 설골의 위치는 남자가 여자에 비해 더 전하방에 위치하였으며, 더 큰 전하방 경사도를 보였다. 2. 경추의 경사도가 클수록 NHP에서 안면돌출도는 작게 나타났으며, 경추의 전방만곡이 증가할수록 수직적인 안모형태를 보였다. 3. 두경부각이 작을수록 두개저에 대하여 설골이 전방에 위치하였으며, 두경부각과 설골의 수직적인 위치는 연관성을 보이지 않았다. 4. 하악골이 전돌될수록 설골은 전방에 위치하였으며, 두개안면형태와 설골의 수직적인 위치는 미약한 연관성을 나타냈다. The purpose of this study was to examine the associations of head posture, the position of the tongue or the hyoid bone to craniofacial structure. Cephalograms taken in Natural head position(NHP) of 90 dental students (50 in male, 40 in female, 20 to 30 years in age) were traced and measured using the extracranial true horizontal and vertical lines. The obtained results were as follows; 1. There was no sex difference in head posture, but the hyoid bone was placed anteroinferiorly in male more than in female and anteroinferior inclination of the hyoid bone showed greatly in male. 2. The more inclined was the cervical column, the less prognathic was the face in natural head posture, and the larger cervical curvature, the more vertical pattern of the face. 3. The less small showed craniocervical angulation, the more anteriorly placed was the hyoid bone to the cranial base, and there was no significantly association between craniocervical angulation and the vertical position of the hyoid bone. 4. The more prognathic was the mandible, the more anteriorly placed was the hyoid bone, and there was slightly association between the craniofacial morphology and the vertical position of the hyoid bone.

구미지역 직업성질환 감시체계

김성아,김진석,전혜리,정상재,김상우,이채용,함정오,유재영,최태성,하봉구,조민환,우극현 大韓産業醫學會 2003 대한직업환경의학회지 Vol.15 No.1

목적: 구미지역 내 대학병원이자 특수건강진단·보건관리대행기관의 산업의학전문의, 보건관리대행 간호사, 사업장 간호사를 중심으로 직업성질환감시체계를 구축하여 주요 직업성질환들의 발생현황과 규모를 파악하고자 하였다. 또한 연차적으로 산업, 직업, 업무내용 등에 따른 분포나 원인을 기존 자료원(특수건강진단의 직업병 유소견자와 산재요양승인 되는 직업병자)과 비교하여 분석·기술하고 예방 및 관리를 포함한 보건의료기술개발까지을 포함하는 종합적인 감시체계를 구축하고 운용하고자 하였다. 방법: 구미지역의 산업적 특성에 맞는 직업성질환감시체계를 구축하고 지역 감시체계의 모델을 제시하였다. 6대 감시대상 직업성질환(독성 간염, 직업성천식, 직업성 근골격계질환, 직업성 피부질환, 직업성 암, 수지진동증후군)의 실행적 환례정의, 보고양식 및 보고체계 개발, 분석양식 및 결과 배포 형식을 개발하였으며, 그 유병규모를 파악하고, 감시질환의 분포 및 특성, 관련인자 등을 분석·기술하고자 하였다. 이때, 1년간의 환례분석시 직업병 유소견자 및 직업병 요양자에 대한 자료와 함께 비교 분석하였으며, 노동통계자료를 이용하여 년간 발생률을 추정하였다. 결과: 2001. 1. 1일부터 2002.4.30일까지 총 287건이 보고되었으며, 직업성 근골격계질환 132건(46.0%), 직업성 피부질환 100건(34.8%), 독성간염 34건 (11.8%), 직업성천식 16건 (5.6%), 수지진동증후군 5건 (1.7%) 이었으며 직업성 암은 한건도 보고되지 않았다. 보고경로별로는 보건관리대행에서 33건 (11.5%), 해당 유해인자별로 실시되는 특수검진 외의 각종 건강진단업무 수행 중 발견된 환례에 대한 보고가 206건(71.7%)이었다. 직종별 분류의 결과는 섬유업종사자, 단순노무종사자, 음식업종사자 등이 다수를 차지하였다. 근골격계질환의 경우, 수근관증후군이 42건(33%), 외상과염/내상과염이 39건(30%)로 가장 많았다. 직업성 피부질환은 97건이 접촉성 피부염으로 유기용제류가 59건(59%)으로 가장 많고, 니켈 및 에폭시수지에 의한 알레르기성 접촉성 피부염이 각각 6건과 5건이었다. 독성 간염은 모두 DMF 나 DMAc에 의한 것으로, 근무시작 후부터 간기능이상이 발견되기까지의 근무기간은 대부분이 3개월 이하이며, 1개월 이하인 경우도 10건이나 되었다. 동 기간 중 감시환례에 대해 산재요양 자료와 중복여부를 확인한 결과, 중복되는 것은 하나도 없었다. 특수건강진단에서 직업병유소견자로 판정된 경우는 독성간염에서 3건이 있었으며, 나머지 질환은 중복되는 것은 없었다. 2001도 구미지역의 근로자수와 보고환례건수를 이용하여 연간 발생률을 추정하였다. 근로자 10만 명당 연간 발생률은 상지 근골격계질환은 63.6명, 피부질환 48.2명, 독성 간염 17.9명, 천식 7.7명, 수진진동증후군 2.4명이었다. 참여예상인원은 총 46명이었으며, 실제 참여자수는 21명, 평균참여율은 46%, 실제 참여 1이당 평균 보고건수는 산업의학전문의가 28건으로 가장 많았고, 대행간호사는 45,건, 사업장 간호사는 3.3건이었다. 결론: 지역 감시체계는 기존 통계자료들에서 발견되지 않았던 직업성질환의 발견에 유용한 통계원이며, 특히 지역의 특성과 여건을 고려하여 체계화된 시스템을 구축하여 운용한다면 더 성과가 클 것이다. Objectives: Area-based occupational disease surveillance in Kumi (KODS) was used to collect data on occupational diseases. The data was used to estimate the magnitude of the diseases, to analyze for their characteristics and to find links for their intervention and prevention. Methods: Since January 2001, occupational physicians and nurses in Occupational Health Service (OHS) have reported six major occupational diseases; occuaptional musculoskeletal disorders of the upper extremities (MSDUE), occupational dermatoses, toxic hepatitis, occupational asthma (OA), hand-arm vibration syndrome (HAVS), and occupational cancer. For the respective diseases, a reporting sheet and operational diagnostic criteria were developed by the KODS. An analysis of the KODS data, collected over a certain period, was compared with data from the Korea Labor Workers Corporation (KLWC) and the Specific Health Examination (SHE), and the incidence rates of the diseases estimated. Results: Between Jan 2001 and Apr 2002, 287 cases of the six major occupational disease were reported. Of these, there were 132 (46.0%), 100 (34.8%), 34 (11.8%), 16 (5.6%), and 5 (1.7%), cases of MSDUE, occupational dermatoses, toxic hepatitis, OA, and HAVS, repectively. But, there were no cases of occupational cancer. 33 (11.5%) of the incidence were reported via the OHS, 206 (71.7%) from health checkups, and the other 48(16.8%) from other routes. The synthetic fibers and electronic components manufacturing industries accounted for the greatest number of reported cases. With resport to occupation, the greatest numbers of incidence were reported from the elementary occupations, textile workers, assemblers, and cooks and food services worker, in that order. Of the MSDUE cases, carpal tunnel syndrome and epicondylitis were the two most common diseases. Most of the occupational dermatoses were due to contact dermatitis, with organic solvents (59%), nickel (6%), and epoxy resin (5%) accounting for the majority of these cases. All cases of toxic hepatitis were induced by dimethylformamide or dimethylacetamide, which were reported by a unique monitoring system. During same period, there were no cases claimed by workers to the KLWC, and only three cases from SHE, were identified. Using data from workers' number and surveillance, the annual incidence of MSDUE, dermatoses, hepatitis, OA, and HAVS, per 100,000 workers were 63.6, 48.2, 17.9, 7.7, and 2.4, respectively. Conclusions: These results show that an area-based surveillance system can be very effective for the collection of data on work-related diseases, at least in Kumi.

세균성 수막염에서 발생한 치명적 뇌경색 1례

안준성,김민아,김상진,김응규 인제대학교 2006 仁濟醫學 Vol.27 No.-

Bacterial meningitis is frequently fetal or lead to severe neurological impairment. Cerebral infarction is a well known sequele of meningitis, occurring in as many as 10-20% of patients. But fetal cerebral infarction in bacterial meningitis is rare. We report a 61 year old woman who was admitted due to fever, headache and mental change for 3 days. On admission 7 days follow up Brain-CT revealed large and massive infarctions on both hemispheres. When bacterial meningitis is caused by Streptococcus pneumonia, there is a high prevalence of cerebral infarctions. The underlying mechanisms of cerebral infarction in bacterial meningitis are vasculitis, thrombosis, arachnoiditis, and compression of the arterial supply at the foramen magnum by herniation of the cerebellar tonsil.

피로와 의료이용, 업무상 사고 및 질병결근

장세진,고상백,강동묵,김성아,정진주,이철갑,강명근,현숙정,조정진,차봉석,박종구 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Objectives: This study examined the relationship of fatigue to medical utilization, occupational accident and sickness absence. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project, 2002~2004). A total of 30,146 employees categorized within the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were recruited. A structured-questionnaire was used to assess the participants' sociodemo-graphics, job-related factors, health-related behaviors, personality trait, self=perceived fatigue (MFS) and the frequency of medical utilization, occupational accident and sickness absence. Data on medical utilization and occupational accident were confirmed from company health records. Chi-square test and logistic regression analysis were used to elucidate the relationship of self-perceived fatigue to medical utilization, occupational accident and sickness absence. Results: In logistic regression analyses, self-perceived fatigue was associated with medical utilization (outpatient), occupational accident and sickness absence although the strength of the associations was higher in the blue collar workers except for medical utilization. For medical utilization, the white collar worker's adjusted odds ratios of outpatient utilization for workers scoring in the third quartile and the highest quartile, compared to workers scoring in the lowest quartile were 1.50 (95% CI: 1.20-1.87) and 2.16 (95% CI: 1.69-2.75), respectively. The blue collar workers' adjusted odds ratios of outpatient utilization for workers scoring in the second (OR: 1.23, 95% CI: 1.06-1.43), third (OR: 1.42, 95% CI: 1.22-1.66) and highest quartile (OR:1.83, 95% CI: 1.55-2.17), respectively, compared to workers scoring in the lowest quartile were statistically significant. However, no associations were found between fatigue and inpatient utilization for either the white or blue collar workers. The blue collar workers' adjusted odds ratios of being injured for workers scoring in the second, third and highest quartile were 1.41 (95% CI: 1.00-2.00), 1.57 (95% CI: 1.10-2.22) and 2.41 (95% CI: 1.69-3.44), respectively, compared to those scoring in the lowest quartile, but, those of the white collar workers were not significant. There was more likely to an increased risk of sickness absence in workers scoring in the second, third and highest quartile compared to those scoring in the lowest quartile in both white and blue collar workers, but the magnitudes of risk were higher in the blue collar workers than the white collars workers. Conclusion: This result suggests that fatigue is a determinant predictor of medical utilization, occupational accident and sickness absence, and that the pattern of risks for the three outcomes differs according to the occupational type. Some limitations of this study and considerations for future study were also discussed.

위팔근육 위축 양측마비 2예

안준성,김민아,김상진,김응규 인제대학교 2006 仁濟醫學 Vol.27 No.-

Brachial amyotrophic diplegia, a relatively stable variant of motor neuron disease, is characterized by weakness that is isolated to upper limbs and spared lower extremities, respiratory and bulbar musculature. This disease should be differentiated from other disease such as multifocal motor neuropathy, amyotrophic lateral sclerosis, monomelic amyotrophy and progressive muscular atrophy. We report two cases of brachial amyotrophic diplegia.

사상체질과 신체형태지수와의 연관성

박경아,김희진,허경석,안수경,이성호,이종은,이원택 대한췌담도연구회 2000 대한췌담도연구회지 Vol.5 No.4

감염된 가축과의 직접 접촉 없이 발생한 브루셀라증 환자1례와 축산 부산물 시장에서의 역학조사 : Sero-epidemiology Study on Market, by-product, Stock-raising

정성주,김성범,박대원,정혜원,기세윤,권정아,박만석,박미연,정희진,김우주 대한감염학회 2004 감염과 화학요법 Vol.36 No.3

브루셀라증은 전 세계적으로 발생하는 인수공통 전염병중에 하나로서, 본 증례는 국내에서 감염된 가축에 대한 노출력이 없는 집단에서 현증 브루셀라증이 발생한 첫 증례이기에 문헌 고찰과 함께 보고한다. 또한 환자가 근무하였던 축산물 부산물 시장에서 역학 조사를 실시하여, 현증환자 및 기감염자를 발견하여 축산물 부산물 시장 근무자에서 현증 브루셀라증이 발생할 위험성을 평가하였다. 역학 조사 결과 축산물 부산물을 다루는 일을 하는 사람들에서 감염된 가축과의 직접 접촉이 없이도 브루셀라증이 발생할 수 있음을 알 수 있었다. Brucellosis is a world-wide zoonotic disease. We report the first case of brucellosis in South Korea that is not related to direct contract with intected cattles. The patient had been working in the market of by-product, stock raising for twenty years and complained of 1-month history of fever, chill, and intermittent epistaxis. We confirmed brucellosis by anti-brucella antibody test and PCR. After 6 weeks' treatment with rifampicin and doxycycline, fever and chilling subsided, and, generalized weakness and oral intake improved. We performed seroepidemiology study against workers who were working in the same market as the patient. However, we couldn't find out other cases with seropositivity. We concluded that although the workers of by-product market have a risk of getting brucellosis, the risk is low.