간호실무 : 지역사회 당뇨노인의 혈당조절, 자기관리 정도와 우울

김세안 ( Se An Kim ),송미순 ( Mi Soon Song ) 서울대학교 간호과학연구소 2012 간호학의 지평 Vol.9 No.2

Purpose: The purpose of this study was to examine the relationship between glucose control, diabetes self-care and depression in community dwelling older adults with type 2 diabetes mellitus. Methods: The cross-sectional survey data of 148 older adults at a senior center were analyzed in this study. We collected data on diabetes self-care, depression, and demographics by face-to-face interviews. Blood samples for HbA1C were obtained from the participants. Results: The average duration of diabetes for the participants was 10.6±9.31 years. Fifty percent of the participants had HbA1c higher than 7.0% (mean 7.179%). The level of diabetes self-care was related to depression (r=-.225, p<.01). HbA1c was positively related with the duration of diabetes diagnosis (r=.224, p<.01). The only sub-dimension of diabetes self-care that was related to depression was exercise (r=-.307, p<.01). Conclusion: Only half of the community dwelling older adults with type 2 diabetes had an optimal level of diabetes control. Supported by the evidence, the longer the duration of diabetes since the initial diagnosis, the poorer the glucose control was. Identification and intervention for depression in people with diabetes should be considered to improve diabetes self-care, especially to perform more exercise.

PBXN-109가 장전된 155 mm 고폭탄의 순폭현상 해석

김보훈(Bohoon Kim),김민성(Minsung Kim),양승호(Seungho Yang),오세안(Sean Oh),김진석(Jinseok Kim),최상경(Sangkyung Choi),여재익(Jai-ick Yoh) 한국추진공학회 2014 한국추진공학회지 Vol.18 No.5

PBXN-109가 충전된 155 mm 고폭탄의 동조폭발 해석

김보훈(Bohoon Kim),김민성(Minsung Kim),양승호(Seungho Yang),오세안(Sean Oh),여재익(Jai-ick Yoh) 한국추진공학회 2014 한국추진공학회 학술대회논문집 Vol.2014 No.5

하나의 탄약이 폭발하였을 경우 에너지가 다른 탄약으로 전달되어 폭발을 야기해 최종적으로 연쇄적인 폭발에 이를 수 있다. 본 연구에서는 PBXN-109(64% RDX, 20% Al, 16% HTPB)가 충전된 155 mm 고폭탄의 일대일 동조폭발(one-on-one sympathetic detonation)에 대한 2차원 하이드로다이나믹 수치해석을 수행하였다. 여폭약과 수폭약간 거리 및 중간 완충제에 따른 순폭 여부를 예측하였다. 계산 결과, 가까운 거리의 화약 간 순폭은 충격 점화로 인해 발생하며, 상대적으로 먼 거리의 경우에는 케이스의 파손으로 발생한 파편과의 충돌이 주요 원인으로 나타났다. 완충제는 폭굉파와 파편의 효과를 억제하여 동조폭발의 발생 확률을 낮출 수 있을 것으로 예측되었다. Sympathetic detonation of high explosives occurs when a detonating donor initiates neighboring acceptor. The present study focused on one-on-one sympathetic detonation employing 155 mm high explosive filled with PBXN-109 using 2D a hydrodynamics. The unbuffered and buffered sympathetic detonations were simulated while changing the distance between munitions in order to investigate the detonation behavior. The sympathetic detonation is caused by a shock impact for unbuffered munitions at a close range, while at a longer range, blast fragment penetration is the primary mechanism. Buffers can reduce the incidence of sympathetic detonations by reducing the shock stimulus and impeding fragments.

Intervention Strategies Based on Information-Motivation-Behavioral Skills Model for Health Behavior Change: A Systematic Review

장선주,최수영,김세안,송미순 한국간호과학회 2014 Asian Nursing Research Vol.8 No.3

Purpose: This study systematically reviewed research on behavioral interventions based on theinformation-motivation-behavioral skills (IMB) model to investigate specific intervention strategies thatfocus on information, motivation, and behavioral skills and to evaluate their effectiveness for people withchronic diseases. Methods: A systematic review was conducted in accordance with the guidelines of both the NationalEvidence-based Healthcare Collaborating Agency and Im and Chang. A literature search was conductedusing electronic databases. Randomized controlled trials that tested behavioral interventions based onthe IMB model for promoting health behaviors among people with chronic diseases were included. Fourinvestigators independently reviewed the studies and assessed the quality of each study. A narrativesynthesis was used. Results: A total of 12 studies were included in the review.Nine studies investigated patients with HIV/AIDS. The most frequently used intervention strategies were instructional pamphlets for the informationconstruct, motivational interviewing techniques for the motivation construct, and instruction or roleplaying for the behavioral skills construct. Ten studies reported significant behavior changes at the firstpost-intervention assessment. Conclusion: This review indicates the potential strength of the IMB model as a theoretical framework todevelop behavioral interventions. The specific integration strategies delineated for each construct of themodel can be utilized to design model-based interventions.

재가 여성장애인의 건강관련 삶의 질과 관련요인 분석

이혜영,서문자,김세안 한국간호과학회 2005 Journal of Korean Academy of Nursing Vol.35 No.4

Purpose: The purpose of this study was to investigate the factors that influenced health related quality of life in women with disabilities. The other purpose was to examine the correlations of activities of these women's daily life, self esteem, and health promoting behavior with health related quality of life. Method: The subjects consisted of120 adult disabled women. Data was collected from February to June2004 using structured questionnaires. Spearman's correlation, and multiple regression were used to test the quality of life with K-ADL, self esteem, and health promoting behaviors by using SPSS 12.0 for windows. Result: The health related quality of life of women with disabilities was related to educational level, marital status, residential type, cause of acquired disability and disability of spouse. In addition, it was related to self esteem (r=.385, p=0.00), health promoting behaviors(r=.428, p=0.00), K-ADL(r=-.419, p=0.00) and K-IADL(r=-.439, p=0.00). Activities of daily life, self esteem and health promoting behaviors were significant predictors 37.3% (=0.212, p=0.000) to explain quality of life in disabled women. Conclusion: The more self esteem, health promoting behaviors, K-ADL and K-IADL are positive, the more the health related quality of life is good. Further studies need to be done to investigate additional effects of health related quality of life and to investigate nursing approaches to improve their health related quality of life with significant predictors.

재가 여성장애인의 건강관련 삶의 질과 관련요인 분석

이혜영,서문자,김세안 한국간호과학회 2005 Journal of Korean Academy of Nursing Vol.35 No.3

노인을 위한 당뇨병 자기관리 지식 측정 도구(DSMK-O) 개발

송미순(Song, Misoon),김세안(Kim, Se-an),최수영(Choi, Suyoung),서경산(Seo, Kyoungsan),이수진(Lee, Soo Jin),김은호(Kim, Eun Ho) 한국노년학회 2013 한국노년학 Vol.33 No.3

본 연구는 당뇨병 노인에게 적용 가능한 당뇨병 자기관리 행위와 관련된 지식 정도를 확인할 수 있는 도구(Diabetes Self-Management Knowledge for Older Adults, DSMK-O) 를 개발하기 위한 방법론적 연구이다. 문헌고찰과 미국당뇨교육자협회가 제시한 자기관리 표준의 7개 자기관리 영역을 기초로 23문항의 DSMK-O 도구의 예비문항을 구성 후, 4명의 전문가 집단으로부터 내용타당도를 검증받았다, 타당도 및 신뢰도 확인을 위하여 65세 이상 노인복지회관을 이용하는 당뇨병 노인 150명을 대상으로 일대일 면담을 통해 DSMK-O 도구로 자료수집을 하였다. 신뢰도는 K-R 20으로 측정하여 .539이었다. DSMK-O점수는 동시에 측정한 당뇨병 지식도구(Diabetes Knowledge Test) (r=.366, p<.001), 당뇨병 자기관리 수행 정도(Summary of Diabetes Self-Care Activities) (r=.293, p<.001)점수와 유의한 상관관계를 보여 준거타당도가 지지되었다. 수렴타당도 평가를 위해 당뇨병 교육 경험의 유무에 따른 DSMK-O 점수를 평가한 결과 유의한 차이가 있어(p<.001) 수렴타당도가 지지되었다. 그러나 구성타당도를 위해 적용한 요인분석은 7개영역으로 구분되지 않았다. 최종 확정된 22개문항의 DSMK-O 정답률은 문항에 따라 24.7-98.7% 범위이고 평균정답률은 75.22%이었다. 본 연구에서 개발된 DSMK-O는 당뇨병 노인의 당뇨병 자기관리 지식 정도를 측정하고 자기관리 교육의 효과를 평가하는데 유용하게 사용할 수 있을 것이다. This study aimed to develop and validate the Diabetes Self-Management Knowledge Scale for Older Adults (DSMK-O). Preliminary items were developed according to a literature review and the guidelines set by the American Association of Diabetes Educators (AADE). The preliminary 23-item DSMK-O scale of 7 self-management domains were evaluated for content validity by experts. After a pilot test with older adults, a survey was performed with 150 community-dwelling older adults with diabetes to confirm both the reliability and validity of the scale. The reliability by K-R 20 was .539. As the result of the criterion-related validity, the DSMK-O score was significantly correlated with the Diabetes Knowledge Test (r = .366, p < .001), and Summary of Diabetes Self-Care Activities (r = .293, p < .001). Subjects who had previous diabetes education scored significantly higher on the DSMK-O than subjects who had not (p < .001), which supported convergent validity. The percentage of correct answers for each item ranged from 24.7% to 98.7%, and the total item mean was 75.22%. In conclusion, the DSMK-O scale showed acceptable reliability and validity and can be utilized to test the diabetes self-management knowledge of older community-dwelling adults.

노인의 당뇨병 관리 자기효능감 측정도구 개발 및 평가

송미순(Song, Misoon),최수영(Choi, Suyoung),김세안(Kim, Se-an),서경산(Seo, Kyoungsan),이수진(Lee, Soo Jin),김은호(Kim, Eun Ho) 대한근관절건강학회 2014 근관절건강학회지 Vol.21 No.3

다엽제한기 소조사면의 6 MV 광자선 출력선량계수

이호준,최태진,오영기,전경수,이용희,김진희,김옥배,오세안,김성규,예지원,Lee, Ho Joon,Choi, Tae-Jin,Oh, Young Kee,Jeun, Kyung Soo,Lee, Yong Hee,Kim, Jin Hee,Kim, Ok Bae,Oh, Se An,Kim, Sung Kyu,Ye, Ji Woon 한국의학물리학회 2014 의학물리 Vol.25 No.1

종양부위의 입체적이고 선택적인 치료가 가능해 임상표적부피(clinical target vlume, CTV)에 높은 선량으로 집중조사하고 부작용을 현저히 줄이는 세기조절방사선치료는 치료예후를 향상시키고 있다. 방사선세기조절 치료는 MLC의 개방면적과 개방시간으로 조사면내 플루언스를 조정하므로 소형조사면의 선량이 누적되어 원하는 선량이 조사하게 된다. 따라서 소형조사면과 계층형 조사면의 출력선량계수의 정확성은 곧 Portal MU 결정에 정확성을 더할 수 있고, 종양에 조사되는 선량의 정확성을 향상할 수 있으므로, 이 연구는 Clinac Ex (Varian) $3{\times}3cm^2$에서 $0.5{\times}0.5cm^2$까지 조사면을 선정하였고 방사선은 6 MVX선의 소형조사면의 출력선량계수를 평가하였다. 조사면은 다엽제한기를 $40{\times}40cm^2$로 개방하고 Collimator jaw를 이용한 것과 Collimator를 $10{\times}10cm^2$로 고정하고 다엽제한기에 의한 조사면으로 구분하여 출력선량계수가 결정되었다. 검출기는 유효체적이 $0.01cm^3$이고 내경 2 mm인 CC01 (Scanditronix-Wellope)이온전리함과 SFD 다이오드 검출기(0.6 mmØ, $500{\mu}m$ 두께, Scanditronix-Wellope)와 다이아몬드 검출기(T60003, PTW)와 X-Omat film을 사용하였다. 결과는 다엽제한기 조사면의 출력선량계수는 $3{\times}3cm^2$에서 $0.899{\pm}0.0106$, $2{\times}2cm^2$에서 $0.855{\pm}0.0106$, $1{\times}1cm^2$에서 $0.764{\pm}0.0082$, $0.5{\times}0.5cm^2$에서 $0.602{\pm}0.0399$를 얻었다. Jaw를 $10{\times}10cm^2$로 고정하고 다엽제한기의 조사면의 출력계수는 MLC를 $40{\times}40cm^2$에 jaw에 의한 소형조사면의 것보다 최대 3.8% 높게 나타남을 확인하였다. 따라서 세기조절방사선치료 TPS에는 collimator jaw 보다 다엽제한기 조사면 크기의 출력선량계수가 설정되는 것이 중요함을 의미한다. The IMRT is proper implement to get high dose deliver to tumor as its shape and selective approach in radiation therapy. Since the IMRT is performed as modulated the radiation fluence by the MLC created the open shapes and its irradiation time, the dose of segment of radiation field effects on the cumulated portal dose. The accurate output factor of small and step shape of segment is important to improve the determination of deliver tumor dose as it is directly proportional to dose. This experiment performed with the 6 MV photon beam of Clinac Ex(Varian) from $3{\times}3cm^2$ to $0.5{\times}0.5cm^2$ small field size for collimator jaw in MLC free and/or for MLC open field in fixed collimator jaw $10{\times}10cm^2$ using the CC01 ion chamber, SFD diode, diamond detector and X-Omat film dosimetry. As results of normalized to the reference field of $10{\times}10cm^2$ of MLC, the output factor of $3{\times}3cm^2$ showed $0.899{\pm}0.0106$, $0.855{\pm}0.0106$ for $2{\times}2cm^2$, $0.764{\pm}0.0082$ for $1{\times}1cm^2$ and $0.602{\pm}0.0399$ for $0.5{\times}0.5cm^2$. The output factor of MLC open field has shown a maximum 3.8% higher than that of the collimator jaw open field.