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.

결핵치료제인 시판 리팜피신제제의 생체내 이용율

김종두,안기완,서영환,조경상,김철,김상도,홍순표 朝鮮大學校 附設 醫學硏究所 1992 The Medical Journal of Chosun University Vol.17 No.1

This study was attempted to investigate the dissolution rate and the bioavailability of commercially available rifampicin preparations after oral administration in nine normal volunteers. Cross-over design was used for the analysis. The dissolution test was conducted in artificial gastric juice and artificial intestinal juice using basket method with four rifampicin preparations (A, B, C, and D) which were pharmaceutically equivalent. The results were as follows; The dissolution rate was higher in the order of A>C>B>D in artificial gastric juice, and A>B>C>D in artificial intestinal juice. Area under the blood concentration time curve (AUC) was larger in order of A>C>B>D. Relative bioavailability(%) of rifampicin preparations were 93.6% for B, 97% for C, 84.4% for D preparation compared with standard A preparation. Peak blood concentration (Cmax) was higer in order of A>B>C>D. Peak time (Tmax) was larger in order of D>C>A>B. Absorption rate constant (Ka) was larger in order of B>A>D>C. there was little difference in elimination rate constant and biological half-life. The correlation of the dissolution rate in artificial gastric juice and area under the blood concentration time curve as well as correlation of the dissolution rate in artifical intestinal juice and peak time showed significant linear relationship. From the result of the this experiments, it can be concluded that for the choice of preparations, bioavailability must be performed in man because the bioavailability of rifampicin preparations showed big differences among commercial preparations which were abvertised as pharmaceutically equivalent, and that the bioavailability of rifampicin preparations in man partially could be predicted from the results of dissolution rate.

부산지역 소방공무원의 폐기능과 호흡기증상

김성훈,김정원,,김종은,손병철,김정호,이창희,장상환,이채관 大韓産業醫學會 2006 대한직업환경의학회지 Vol.18 No.2

목적: 본 연구에서는 소방관 집단의 호흡기 증상과 폐기능을 조사하여 호흡기 질환의 유병 정도를 비교 분석함으로써 소방관의 호흡기 질환과 화재 노출과의 관련성을 규명하고자 하였다. 방법: 2004년 11월 13일부터 동년 12월 15일까지 부산 소재 4개 소방서와 부속 파출소의 남성 소방공무원 699명을 대상으로 폐기능 검사와 호흡기 설문조사를 실시하였다. 호흡기 증상 설문은 BMRC에서 개발한 설문조사표를 이용하였다. FVC, FEV_(1), MMEF 예측치는 Morris의 폐기능 예측식을 사용하여 계산하였고, 폐기능 검사 이상을 판정하기 위하여 미국 NHNES 기준에 따라 정하였다. 폐기능 측정치와 호흡기 증상은 노출유무와 흡연여부로 집단을 나누어 각각 비교분석하였다. 유의수준은 p<0.05로 정하였다. 결과: 폐기능 비교에서 화재노출군이 FVC, FVC%, FEV_(1), FEV_(1)%, FEF_(25%)는 비노출군에 비해 통계학적으로 유의하게 저하되어 있었고, 이를 흡연여부에 따라 층화하였을 때, FVC 와 FEV_(1)은 흡연여부와 관계없이 노출 여부에 따른 차이를 보이나 FVC%, FEV_(1)%, PEFR은 흡연군에서만 차이를 보였다. 폐기능 검사 이상을 비교하면 전체적으로 화재노출군이 비노출군보다 폐기능 이상자의 수가 많았고 흡연군에서 FEV_(1) 이상자의 차이는 통계적으로 유의하였다. FVC, FEV_(1), MMEF를 종속변수로 하여 다중회귀분석을 시행하였을 때, FVC와 FEV_(1)은 부분적으로 화재노출유무와 관련성이 있었다. 호흡기 증상 조사에서 화재노출군은 비노출군에 비해 코막힘, 목아픔, 흉부압박감의 증상의 호소율이 통계학적으로 유의하게 높았으나, 이를 흡연여부에 따라 층화하면 이들 증상들은 경계역의 차이를 보였다. 결론: 이러한 결과들을 종합하면 소방관은 화재진압과정에서 노출되는 많은 호흡기 유독물질로 인해 급성 폐기능 저하와 높은 호흡기 증상 호소율을 보이며, 이는 화재노출 외에 흡연의 부가적 효과가 영향을 미친다고 생각된다. 따라서 폐기능이 저하된 경방군에서 주기적인 폐기능 검사가 실시되어야 하며, 금연과 호흡기 보호구의 철저한 착용이 권장되어야 하겠다. Objective: The purpose of this study was to evaluate the relationship between respiratory disorders and fire exposure by investigating and analyzing the lung function and respiratory symptoms of firefighters. Methods: The health effects of firefighting on respiratory function were investigated in 699 male fire officers in 4 fire departments in Busan by recording respiratory symptoms and measuring lung function. The data were analysed according to fire exposure and smoking habits. Results: Mean spirometric data showed significantly decreased levels in the fire-exposed group (FVC, -0.20 L; FVC%, -4.2%; FEV_(1) -0.21 L; FEV_(1)%, -5.1%; FEF25%, -0.13 L/SEE p<0.05). After stratification by smoking habits, FVC and FEV1 showed a significant difference between groups. The prevalence of spirometric abnormality was greater for the fire-exposed group than for the non-exposed group. Significantly higher prevalences of nasal stiffness (16.7% vs. 10.9%), sore throat (17.7% vs. 14.2%) and chest tightness (6.5% vs. 2.5%) were recorded in fire fighters compared to controls (p<0.05). However, after stratification by smoking habits, the 3 symptoms were showed only marginal differences in the smoking group. Conclusions: This study demonstrated that fire-exposed firefighters generally suffer a decline of lung function and a higher prevalence of respiratory symptoms. These results suggest that the exposure to routine firefighting activity is associated with adverse health effects to the respiratory system.

흰쥐 척수손상 후 운동회복 양식의 도식적 분석

김상수,김하용,심대무,송하헌,차상도,김종환 대한척추외과학회 1997 대한척추외과학회지 Vol.4 No.1

Objectives : To understand the motor recovery pattern after spinal cord injury, We designed the quantitative measuring method of locomotion recovery using computerized motion analysis combined with video recordings. Materials and Methods : Using computerized motion analysis technique, locomotions of the 10 cord-hemisected Sprague-Dawley rats on the treadmill were graphically analyzed. Patterns of foot trajectories were plotted on two dimensions before and after unilateral spinal cord hemisecion at T7 level. Result : Immediately following dorsal hemisection, patterns of foot trajectories altered dramatically. Walking speed, stride length and height of hindfoot movements were markedly reduced. Coordination of left and right hindlimb was also disrupted. Although the lesions were unilateral, locomotor behavior was distrubed bilaterally. However, by six weeks, stride length and coordination of hindlimbs returned to near normal but vertical movement of the hindlimb recovered very little. Forelimb-hindlimb coordination was also initially disrupted but partially returned within three weeks. Conclusion : Computerized motion analysis is a sensitive technique for the detection of minor motor deficits following nerve injuries.

중증 재생불량성 빈혈 환자에서 신우신염에 대한 광범위항생제치료 중에 속발한 Saccharomyces cerevisiae 진균감염 1예

김철희,이정호,이정찬,강정현,곽상혁,배광봉,김현수,김종숙,조덕연,김삼용 충남대학교 의과대학 지역사회의학연구소 1999 충남의대잡지 Vol.26 No.1

Most patients with aplastic anemia who do not respond to immunosuppressive treatment or are not candidates for bone marrow transplantation die of infection or bleeding. The neutropenia in acute leukemia, aplastic anemia, or occurring subsequently to chemotherapy and bone marrow transplantation increases susceptibility to infection. In general, the number of infectious episodes correlate with the degree and duration of neutropenia. Global immunosuppression produced by conditioning for bone marrow transplantation or graft-versus-host disease, is associated with unusual bacterial and fungal pathogens, or serious viral and protozoan infections. In addition, repeated treatment with broad-spectrum antibiotics is associated with the emergence of resistant organisms and fungal diseases because of the altered microbial microenvironment of the host. The incidence of invasive fungal infection caused by Saccharomycetes eerevisiae in immunosuppressed patients is very rare, compared with that of infection by candida or aspcrgillus species. Cases of Saccharomycetes cerevisiae fungemia occurring in the course of treatment with broad-spectrum antibiotics are reported in patients with extensive burn or with prosthetic valve endocarditis. We experienced a case of urinary tract infection by Saccharomycetes cerevisiae in a 27-year old female patient with severe aplastic anemia. We report the case with a review of relevant literatures.

Mycobacterium mageritense에 의한 당뇨병성 족부 감염증 1예

김충종,김낙현,김문석,김계형,전재현,박문석,박경운,박완범,박상원,김홍빈,김남중,오명돈,최강원 대한감염학회 2008 감염과 화학요법 Vol.40 No.6

Diabetic foot infection is one of the important complications in patients with advanced diabetes mellitus. Limb threatening infections such as osteomyelitis, abscess, and necrotizing fasciitis are frequently accompanied by the disease. Non-tuberculous mycobacterium (NTM) is a rare causative organism of diabetic foot infection. Thus, if one is not suspicious or meticulous, infection due to NTM will be easily overlooked and this will result in delayed diagnose and treat. Therefore, it is necessary to consider NTM as the causative organism if the wound does not respond to the conventional antibiotic treatment and the culture from the adequately obtained specimen reveals atypical acid-fast bacilli. We present a case of diabetic foot infection with osteomyelitis and abscess due to Mycobacterium mageritense, one of the rapid growing mycobacteria, that was successfully treated with surgical debridement and appropriate antibiotic treatment.

신장이식 환자에서 HCMV 항원혈증 검사의 임상적 유용성

김탁,성흥섭,박관태,김송철,김성한,최상호,김양수,우준희,박수길,한덕종,이상오 대한감염학회 2009 감염과 화학요법 Vol.41 No.2

Background : This study was performed to determine the cut-off value and the predictability of symptomatic human cytomegalovirus (HCMV) infection according to the peak value of HCMV antigenemia assay in kidney transplant recipients. Materials and Methods : We reviewed the results of HCMV antigenemia assay (Chemicon, CA, USA) in patients who received kidney transplantation at our institution from May 2003 through May 2008, and investigated the existence and the type of HCMV infection by the medical record review. Patients who underwent the test only once during the episode or those who received ganciclovir for more than 48hrs before the test were excluded. The receiver-operator characteristic curve was drawn and the point showing maximum likelihood ratio (LR) was chosen as the cut-off value of symptomatic HCMV infection. Results : A total of 689 episodes were screened and 134 episodes were enrolled. Thirty-three (24.6%) episodes were symptomatic HCMV infection, 23 (17.2%) episodes were associated with HCMV syndrome, and 10 (7.5%) episodes were tissue-invasive diseases. The maximum LR was 7.5 (95% confidence interval, 4.014.2) and the cut-off value was 29.5 cells/200,000 WBC. The sensitivity, specificity, Positive predictive value, and negative predictive value were 66.7%, 91.1%, 71.0%, and 89.3%, respectively. Conclusions : The cut-off value of symptomatic HCMV infection by the peak value of HCMV antigenemia assay in our study was similar with previous results, although the sensitivity was relatively low.

CD34+ 조혈 모세포 이식 2례

김정아,정현식,김원석,윤성수,이홍기,박찬형,박성규,김동욱,이종욱,한치화,민우성,김춘추,김동집 대한조혈모세포이식학회 1996 대한조혈모세포이식학회지 Vol.1 No.1

Background: In most solid tumors, the CD34 antigen has not been detected, so positive selection of CD34+ cells may reduce tumor cell contamination and the CD34+ cells are capable of reconstituting hematopoiesis. We tried CD34+ cell transplantation in two patients. Method: CD34+ cells from chemotherapy + G-CSF mobilized PBPCs or bone marrow were positively selected with an avidin-biotin immunoadsorption column (CEPRATE SC system). Case 1. One course of chemotherapy using cyclophosphamide(200㎎/㎡) and etoposide (4.2g/㎡), combined with G-CSF(5㎍/㎏) S.C. was used in a relapsed lymphoma patient. This patient responded to the induction chemotherapy. CD34+ cells from harvested bone marrow were selected by the CellPro immunoadsorption column. The total number of mononuclear cells loaded onto the CellPro was 2.4×10^(8)/㎏, with 1.1% CD34+ cells. After column separation, the total number of positively selected cells was 5.16×10^(6)/㎏. The number of CFU-GM was 76.8×10⁴/㎏. This patient was treated with melphalan (140㎎/㎡) and TBI (1200cGy) and the positively selected CD34+ cells were infused. The time to neutrophil recovery greater than 0.5×10^(9)/L was 19 days and the time to platelet recovery greater than 50×10^(9)/L was 21 days. Case 2. Two courses of mobilizing chemotherapy were given 4 weeks apart using taxol(210㎎/m2) and adriamycin(60㎎/m2), combined with G-CSF(5㎍/㎏) S.C. in a breast cancer patients with 7 axillary node metastasis. CD34+ cells from each single leukapheresis product were selected by the CellPro immunoadsorption column. In the first collection, the total number of nucleated cells was 4.4×10^(8)/kg, with 0.42% CD34+ cells. In the second collection, the total number of nucleated cell was 2.8× 10^(8)/㎏ with 0.43% CD34+ cells. After colum separation, the total numbers of collected cells were 4.0×106/kg and 4.8×10^(6)/kg, the total number of CD34+ cells were 1.2×10^(6)/㎏ and 0.82×10^(6)/㎏. Colonogenic assays of positively selected CD34+ cells gave rise to myeloid erythroid, and multilineage colonies, with a median of 190 CFU-GM, 190 BFU-E, and 164 CFU-GEMM per 1×10³ adsorbed cells, respectively. High-dose chemotherapy with cumulative doses of 40mg/㎡ mitoxantrone, 750mg/㎡ thioptepa, and 1000mg/㎡ carboplatin was administered. Positively selected CD34+ cells were rapidly infused 24 hours after the end of high-dose chemotherapy. The time to neutrophil recovery greater than 0.5×10^(9)/L was 16 days and the time to platelet recovery greater than 50×10^(9)/L was 20 days.

냉동 제대혈 세포의 체외 증폭

김삼용,김철희,배광봉,김현수,박상준,김종숙,윤환중,조덕연 충남대학교 암연구소 1998 癌共同硏究所 硏究誌 Vol.2 No.1

Background : Cord blood(CB), which has no HLA restriction, is an alternative to bone marrow for hematopoietic stem cell transplantation. The use of cord blood, however, is limited by the number of progenitor/stem cells necessary to reconstitute the older child or adult. Therefore, ex vivo expansion of CB could have tremendous impact on diverse clinical settings. We studied the ex vivo expansion of isolated population of CD34_(+) cells from cryopreserved CB cells. Methods : CD34 cells were isolated from cryopreserved CB mononuclear cells. Purified cells were cultured with various combinations of hematopoietic growth factors including erythropoietin(EPO), stem cell factor(SCF), granulocyte-colony-stimulating factor(G-CSF), gra-nulocyte, macrophage-colony-stimulating factor(GM-CSF), interleukin-1β(IL-1β), 1L-3, and IL-6. After 7, 10 or 14 days of culture, the fold increases of colony-forming unit- granu-locyte, macrophage(CFU-GM), burst-forming unit-erythroid(BFU-E), colony-forming unit-mix (CFU-Mix), and high proliferative potential colony-forming cell(HPP-CFC) were evaluated. Results : Ten-day culture with the combination of EPO, SCF, G-CSF, IL-1β, and IL-3 resulted in a median of 60-fold increase of CFU-GM, which was greater than those with the combinations of less than 5 growth factors. The addition of IL-6 or GM-CSF to this combination did not enhance CFU-GM expansion. Ten-day culture was significantly superior to 7-day culture for CFU-GM expansion. Prolongation of culture to 14 days, however, revealed decreased expansion of CFU-GM compared to 10 days. BFU-E and CFU-Mix were expanded to 2~5 folds in 7-day culture with the combination of EPO, SCF, and G-CSF. Further expansion was not achieved in 10-day culture and colonies disappeared in 14-day culture. HPP-CFC was expanded to a median of 7.5 folds in 7-day culture with the combination of EPO, SCF, G-CSF, IL-1β, IL-3, and IL-6. Neither 10-day or 14 day-culture enhanced expansion of HPP-CFU. Conclusion : Cryopreserved cord blood cells maintain ex vivo expansion potential. In our system, 10-day culture with the combination consisting of EPO, SCF, G-CSF, IL-1β, and IL-3 seems to be adequate for hematopoietic progenitor/stem cell expansion from cryopreserved cord blood cells.

무세포혈관과 자가 골수줄기세포를 이용한 조직공학적 인공혈관 제조

김동익,김병수,조승우,임정은,어현선,이민재,김종성,장인성 대한혈관외과학회 2004 Vascular Specialist International Vol.20 No.1