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.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1998)

김재홍,김준호,반재용,이정우,황성주,정준규,정성태,강진문,조흔정,홍창의,정혜신,이한승,김이선,이봉길,이종호,선영우,한기덕,윤성필,이성훈,안종성,박석범,문승현,조항래,김형섭,류지호,황재영,박준홍,손상욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria gonorrhoeae(PPNG), we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by menas of the chromogenic cephalosporin method. In 1998, 93 strians of N. genorrhoeae were isolated, among which 60(64.5%) were PPNG. The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 64.5% in 1998.

급성 백혈병 환자에서 감염증의 양상 및 예후인자에 관한 연구 : 1988년∼1995년까지

정희진,김병수,신상원,김열홍,김우주,김민자,김준석,박승철,김권범 대한감염학회 1998 감염 Vol.30 No.3

목적 : 급성 백혈병의 경우 골수기능이 억제되고 항암화학요법에 따른 골수기능 저하로 감염의 위험이 증가하며 감염의 치료가 환자의 생존에 큰 영향을 미치게 된다. 이에 저자들은 1988년부터 1995년까지 고대 구로병원에 급성 백혈병으로 입원했던 환자들 중 입원 기간 내 감염이 있었던 경우를 대상으로 하여 감염의 위험인자 및 감염증의 예후를 후향적으로 분석함으로써 향후 급성 백혈병환자의 감염의 치료에 대한 지침을 얻고자 하였다. 방법 : 급성 백혈병으로 확진된 환자들 중 감염병에 이환된 경우를 대상으로 하여 각각을 미생물학적 확인감염, 임상적 확인감염, 그리고 설명 불가열로 구분하였다. 각각의 경우에서 감염 당시의 호중구 수, 호중구 감소 기간, 항암화학요법과의 연관성, 감염 병소, 배양된 검체 및 원인균, 선택적 소화관 살균법의 사용여부 및 골수회복 여부 등을 조사한 후 환자의 예후와 어떤 관계가 있는 지 조사하였다. 결과 : 연구 대상은 총 113예로 남녀비는 46:67 이었고 평균연령은 34±13세, 진단은 급성 골수성 백혈병 (AML)이 84예, 급성 림프구성 백혈병(ALL)이 29예였으며, 감염시 평균 호중구수는 663±1678/㎣이었고, 호중구 감소 기간은 평균 18±13일이었다. 감염양상은 항암화학요법과 연관된 감염이 84예로 대부분이었고 미생물학적 확인 감염이 40예로서 35%였으며, 폐렴과 원발성 패혈증이 각각 20예와 19예로 가장 많았고, 카테터 연관 감염이 7예로 나타났다. 배양된 균주는 E. coli가 10예(25%)로서 가장 많았으며, 전체적으로 E. coli, P. aeruginosa, K. pneumoniae 등의 그람음성균이 63%로 대부분을 차지하였으나 최근 그람양성구군 및 진균의 분리율이 증가하는 양상을 보였다. 감염증의 예후를 분석한 결과 진균 감염인 경우나 호중구 감소 기간이 긴 경우 사망률이 높았으며 그 중에서도 골수 기능이 회복 여부가 환자들의 생존과 통계적으로 유의한 연관이 있었다.(P=0.01). 결론 : 급성 백혈병 환자들에서의 감염은 관해유도화학요법 후 초래되는 호중구 감소와 유의한 관계가 있으며, 폐렴 및 패혈증의 임상양상을 보이는 경우가 흔하고, 원인균별로는 그람 음성균이 주류를 이루나 최근 그람 양성균 감염이 증가하는 추세를 보였다. 감염의 예후 인자로는 진균 감염인 경우나 호중구 감소 기간이 긴 경우 사망률이 높았으나 골수 기능의 회복여부가 결정적인 역할을 하는 것으로 나타나, 향후 급성 백혈병 환자의 치료에 있어 감염 빈도의 감소와 감염에서의 조속한 회복을 위해서는 골수 기능의 회복에 중점을 두어야 할 것으로 사료된다. Background : Infection is one of the most important and fatal complications in patients with acute leukemia. The characteristics of infection in acute leukemic patients are different from those in other diseases by the lack of normal inflammatory responses or distinct clinical evidence except fever. To improve the outcome of acute leukemia, it is very important to recognize the risk factors, patterns and prognostic factors of acute leukemia. Methods : We analyzed retrospectively the patterns of infection from 113 febrile patients with acute leukemia from January, 1988 to December, 1995. To determine the prognostic factors and the outcome of infection, the following variables were analyzed: the presence of neutropenia, use of chemotherapeutic agents, type and site of infections, isolated organisms, gastrointestinal decontamination, duration of neutropenia, and bone marrow recovery. Results : Out of 113 febrile patients with acute leukemia, 84 infection episodes(74%) occurred after chemotherapy. The mean duration of neutropenia was 18±13 days. The incidence of microbiologically-documented infection(MDI) was 35%(40/113). Pneumonia was the most common infection(26%), followed by primary sepsis(24%), catheter-related infection(9%). In cases of MDI, 63% were caused by gram-negative bacteria, followed by gram-positive bacteria(28%), and fungi(10%). Escherichia coli(25%) was the most common isolated in MDI. Regarding the prognostic factors in cases with infections, the recovery of bone marrow function was the only statistically significant factor(P=0.01). Conclusion : Infection has been a major cause of morbidity and mortality in acute in acute leukemic patients. To prevent infection and thereby improve the prognosis of acute leukemia, restoration of bone marrow function at early stage is important.

2인과 3인의 기본 심페소생술 비교

정준영,이창현,김현정,도호석,이삼범,도병수 大韓應急醫學會 1997 대한응급의학회지 Vol.8 No.1

Study objectives: To compare the quality of CPR provided by medical students and pre-EMTs perfoming three-rescuer CPR with that achieved by same students trained to provide standard two-rescuer CPR and to find the most effective method of resuscitation and to educate this methods to students. Material and methods: From July 1 to September 30, 1996, we had trained 60 groups consisted of the medical students, students of EMS technology and pre-EMT. Each group practiced two-rescuer CPR and three-rescuer CPR for 120 minutes with Resusci? Anne and perfomed CPR for at least 3 minutes without feedback. To eliminate any visual cues of perfomance the mannequin's recorder was hidden. Each actions were recorded by Resusci? skillmeter and Laerdal printer. To compare the quality of two-rescuer CPR and three-rescuer CPR, we analyzed the data by SPSS with paired t-test. Results: Three-rescuer teams delivered a mean minute ventilation and a mean minute cardiac compression substantially greater than that produced by two-rescuer teams(11.30±1.85 vs 9.09±2.22, p<0.001; 99.22±12.42 vs 95.12±15.75, p<0.001). Three-rescuer teams produce the more correct actions in chest compression and ventilation(93.84±7.56% vs 83.49±16.94%, 90.90±9.33% vs 77.00±17.06%). Conclusion: Three-rescuers can produce better CPR than two rescuers when a bag-valve-mask devices is used and the technique is easily learned and readily retrained, so we think that repeated education and training of this CPR methods to students is needed.

급성흉통으로 내원한 환자에서 심근경색증을 조기 발견하기 위한 TROP-T?Rapid Assay의 유용성

정준영,이창현,김현정,도호석,이삼범,도병수 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Study Objectives : In the past, measurement of cardiac enzymes(i.e. CK and/or CK-MB, GOT, LDH)and myoglobin, cardiac specific serum troponin-T were widely used for the diagnosis of acute myocardial infarction, but it need a long time and have low specificity. Thus new diagnostic modality, TROP-T?? Rapid Assay, is very easy and rapid qualitative methods, is needed for the early detection of acute myocardial infarction. Methods : Total CK, GOT, LDH, myoglobin and serum troponin-T activities were measured in patients presenting with acute chest pain at the emergency department and at the same time TROP-T? Rapid Assay was done. Final diagnosis and diagnostic usefulness was evaluated. Results : Overall diagnotic sensitivity and specificity of initial results were as follows; TROP-T? Rapid Assay, 77.3, 100.0; myoglobin, 63.6, 70.4; CK, 95.5, 96.3; GOT, 86.4, 96.3; LDH, 90.9, 92.6; serum troponin-T, 86.4, 96.3, respectively. Conclusion : The TROP-T?? Rapid Assay is simple method and has a short time and nearly same sensitivity and specificity compared to other cardiac enzymes. Thus this is considered useful method in the early detection of acute myocardial infarction at emergency department.

외상성 간손상과 비장손상시 CT분류의 의의

정준영,이창현,김현정,도호석,이삼범,도병수 大韓應急醫學會 1997 대한응급의학회지 Vol.8 No.1

The Organ Injury Scaling Committee of the American Association for the Surgery of Trauma recently published a consensus classification of hepatic and splenic injuries. The hepatic and splenic injury scales, based on parenchymal laceration and intrahepatic hematoma, include grade 1 to 6 and grade 1 to 5 respectively, representing the least to most severe injury. Forty-eight patients with hepatic and splenic injury were evaluate by abdominal CT from January 1995 to May 1996 and we compared abdominal CT grading with operative grading. Four CT grades did not correlate with operative finding. CT grading showed a sensitivity of 80%, specificity 80% in regard to operative grading. We conclude that 1) CT is an accurate technique to determine the extent of hepatic and splenic injury. 2) CT grading of hepatic and splenic trauma has a high correlation with operative grading.

甘豆湯 전탕액과 구성약물이 배양심근세포 박동수에 미치는 영향

박준배,권강범,황인진,김우경,김희찬,오광수,이호섭,류도곤 대한동의병리학회 2001 동의생리병리학회지 Vol.15 No.4

To test the protective effect of herbal medicine on myocardial damage against adriamycin-induced myocardiotoxicity, cytotoxicity of adriamycin was examined using MTT assay and protective effect of herbal medicine in the presence of water extract of Gamdu-tang, Gamigamdu-tang, or single constituents of these prescriptions was examined using counting of beating rate. The results of these experiments were obtained as follows : Adriamycin resulted in a decrease in viability and beating rate in cultured myocardial cells. Gamdu-tang water extract shows effects of protection from the cardiocyte toxicityinduced by adriamycin treatment such as increases beating rate. Gamigamdu-tang water extract shows the similar protective evvect as shown in gamdu-tang treatment on the decreasing of beating rate induced by adriamycin. Radix Glycyrrhizae, Semen Glycine, and Folium Phyllostachyos water extract shows a significant effect of protection for cardiotoxicity induced by adriamycin in cultured myocardial cells. These results show that adriamycin elicits toxic effects in cultured myocardial cells derived from neonatal mouse, and suggest teat water extract of gamdu-tang, gamigamdu-tang, Radix Glycyrrhizae, Semen Glycine, or Folium Phyllostachyos is very effective in the prevention of adriamycin-induced cardiotoxicity/

응급센터 입원환자의 통증처치에 대한 응급의학적 고찰

도병수,김현정,정준영,도호석,이창현,이삼범 대한응급의학회 1996 대한응급의학회지 Vol.7 No.2

Study objective: To recognize importance of pain management in ED and properly manage the ED patients complaining pain by analyzing the intervals between arrival time in ED and pain medicine starting time, the types and the administered routes of pain medicine. Design: Retrospective review of ED charts Setting: University teaching hospital Participants: The patients had admitted in ED of Yeungnam University Hospital with a chief complaint of acute abdominal pain or pain due to bone fracture between June 1, 1995 and December 31, 1995. Results: The study group consisted 256 patients, 161 of them female. ED administrations of analgesics were 103 cases, 17 of them administered more than two times. The average time interval between arrival time and medication time was 169.02±120.25 minutes. Each types of perceived analgesics were antispasmodics 55 cases(53.40%), NSAID 26 cases(25.24%) and opioid 19 cases(18.45%). Every analgesics were administered through intramuscular routes, except only 3 cases. Violences of patients or relatives due to delayed pain control were occured 32 cases, 5 cases of them self-discharged and looked for other hospitals. Conclusion: Emergency physicians including interns and residents delayed management so long and ordered inappropriate administration routes and types of analgesics. So we thought proper protocols about pain management in ED were established.

비대칭 군집분석법의 소개 및 사례분석

이광진,김범준 목원대학교 사회과학연구소 1998 社會科學硏究 Vol.- No.2

전통적인 군집분석 이론에서는 대칭인 거리행렬을 바탕으로 군집현상을 파악한다. 본 연구에서는 비대칭 상사성행렬이 주어진 경우 이를 거리행렬로 변환하지도 않으면서 비대칭 상사성행렬이 주어진 경우 이를 거리행렬로 변환하지도 않으면서 그리고 비대칭성도 그대로 유지하면서 개체들간의 군집 또는 결합현상을 분석할 수 있는 비대칭 군집분석(asymmetric cluster analysis)의 내용을 간략하게 정리하여 소개하면서, 두 개의 실 제자료를 통해 이의 유용성을 보이고자 함이 목적이다.

소각장별 비산재 중의 중금속 용출 특성 및 존재형태

이우근,김준수,김진범 江原大學校 附設 環境硏究所 1998 環境硏究 Vol.15 No.-

본 연구는 도시폐기물 소각시설에서 발생되는 비산재 중에 함유된 중금속으 존재형태 및 용출 툭성을 알아보기 위해 수행되었다. 용출 실험은 KSLT, TCLP, MALT법을 이용하였고 중금속의 존재형태별 분포에는 다음과 같이 5가지 형태로 구분하였다.; exchangeable, carbonate, reducible, organic, residual fraction.용출 심험 결과에 의하면 pH 4로 일정하게 유지한MALT법에 의한 중금속 용출량이 가장 높 This study was carried out to estimate the fractional composition and leaching properties of heavy metals in fly ash generated from three municipal solid waste incinerators(MSWI). Three leaching tests are used in this work. These are Korea Standard Leaching Test(KSLT)), Toxicity Characteristic Leaching Procedure (TCLP), Maximum Availability Leaching Test(MALT) method. The fractional composition of heavy metals is classified into five fractions; exchangeable, carbonate, reducible, organic, residual fraction. According to the leaching tests, it seems that the highest amounts of heavy metals are leached by MALT method in which pH of 4.0 maintains constantly. From the results of the fractional composition of heavy metals, above 45% of Cd is leached by the change of pH or/and concentrations at I and J incinerators. And 91% of Cd is extracted under the reducible environment at B incinerator. But Cu may be leached under the strong acidic environment. The amount of Cu at B incinerator is less leached than that of I and J incinerators due to high residual fraction. About 35% of Ni in fly ashes at three incinerators exists in reducible fraction. It is probably leached under the reducible environment. Pb may be leached under the weak acidic environment at I and J incinerators, but in case of S incinerator leached under the strong acidic environment.