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김진주 ( Jin Joo Kim ), 김나영 ( Nayoung Kim ), 박현경 ( Hyun Kyung Park ), 조현진 ( Hyun Jin Jo ), 신철민 ( Cheol Min Shin ), 이상협 ( Sang Hyup Lee ), 박영수 ( Young Soo Park ), 황진혁 ( Jin Hyeok Hwang ), 김진욱 ( Jin Wook Kim ), 정숙향) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.5
Background/Aims: In spite of the improvement of medical treatment for the peptic ulcer disease (PUD), PUD is still one of the common upper gastrointestinal diseases. The purpose of this study was to evaluate the risk factors and general characteristics of Korean patients diagnosed as PUD at a single third referral center. Methods: A total of 310 patients, diagnosed as PUD through endoscopy during one year of 2007 at Seoul National University Bundang Hospital were, retrospectively, evaluated regarding age, gender, Helicobacter pylori (H. pylori) positivity, clinical manifestations, comorbidities and medications. In addition, PUD was analyzed in the aspect of ulcer location, type of visit, gastrointestinal bleeding, and age. Results: The mean age was 61.5 years old (48.1% over 65) and 208 (66.7%) patients were men. The rate of H. pylori infection was 47.8%, and any ulcerogenic medication history such as antiplatelet agents and NSAIDs was found to be 21.0% (65 patients). The rate of idiopathic peptic ulcer without evidence of H. pylori and NSAIDs was found to be 40.6% (126 patients). Among 310 PUD patients, bleeding symptoms such as melena, hematemesis and hematochezia occurred in 110 patients (35.5%). Conclusions: PUD was more prevalent in the elderly patients and frequently associated with bleeding. Substantial proportion of PUD patients had neither H. pylori infection nor history of ulcerogenic medications, suggesting of increasing prevalence of idiopathic PUD. (Korean J Gastroenterol 2012;59:338-346)
김진주 ( Jin Joo Kim ), 신종환 ( Jong Hwan Shin ), 임용수 ( Yong Su Lim ), 김정권 ( Chung Kwon Kim ), 김재광 ( Jae Kwang Kim ), 현성열 ( Sung Youl Hyun ), 양혁준 ( Hyuk Jun Yang ), 이근 ( Gun Lee ), 최영철 ( Young Cheol Choi ) 대한응급의학회 2008 大韓應急醫學會誌 Vol.19 No.5
Purpose: Relative adrenal insufficiency is common in intensive care unit patients. Basal cortisol and the cortisol response following the injection of synthetic corticotropin were prospectively evaluated in postresuscitation patients after cardiac arrest. Methods: This is a prospective cohort study of relative adrenal insufficiency of patients with return of spontaneous circulation (>24 hours) after cardiac arrest who were admitted to the intensive care unit over three-year period from January 2005 to December 2007. Relative adrenal insufficiency was measured the next day after return of spontaneous circulation following cardiac arrest. Results: Seventy-five patients were included over three years. Relative adrenal insufficiency developed in 41 patients. In patients with relative adrenal insufficiency, SOFA (sequential organ failure assessment) and lactate were elevated (p=0.03, 0.048), mortality was higher (p=0.014) and basal cortisol concentrations were significantly increased (p=0.001). In patients with therapeutic hypothermia, there were no significant differences with or without relative adrenal insufficiency (p=0.847). The factors associated with mortality, as assessed by multiple logistic regression were relative adrenal insufficiency, therapeutic hypothermia and the time from arrest to the start of cardiopulmonary resuscitation. Conclusion: Both basal cortisol and the cortisol response after the injection of synthetic corticotropine must be considered in predicting patients outcome. For patients with relative adrenal insufficiency, some specific treatments such as cortisol can be considered. More prospective multicenter study is needed.
Cardiac arrest in infants, children and adolescents is rare but critical; survival from out-of-hospital pediatric cardiac arrest is estimated at 8% to 12%. Mild therapeutic hypothermia was shown to improve the neurologic outcome of postcardiac arrest syndrome in adults and neonatal hypoxic-ischemic encephalopathy, but its use has been limited in children. We report 3 cases where therapeutic hypothermia was successfully done in infants and children. The initial rhythm was ventricular fibrillation of a 13 year old child, asystole in an 11 month old infant, and in 7 aged children. Therapeutic hypothermia was induced and maintained successfully for 24 hours via endovascular and surface cooling methods. The older child with ventricular fibrillation awoke from being comatose after rewarming and cessation of sedatives. The 11 month old and the 7 aged children died during the 16 days following admission and being discharged with a neurologic disability. There is lack of evidence that therapeutic hypothermia improves neurologic outcomes in pediatric cardiac arrest patients, but in adults and in neonatal hypoxicischemic encephalopathy, we can speculate that therapeutic hypothermia in pediatric patients will have a good outcome. A multicenter randomized study is needed as are guidelines and common protocols about pediatric therapeutic hypothermia.
Snake bite during pregnancy is rare condition, and when it occurs there are two patients, mother and fetus. Timing is particularly important for pregnant women bitten by a snake. The earlier in the pregnancy the bite occurs, the more hazard to the fetus there is, and there are case reports of snake-bite-induced abortion and malformation of the fetus. The usefulness of antivenin during pregnancy is debatable. We report a case of snake bite during third-trimester pregnancy in a patient with general symptoms of envenomation and progressing edema in the bitten leg who was successfully treated with an emergency Caesarian section following the administration of antivenin.
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본 연구는 미래 진로에 걱정이 많은 고등학교 2학년을 대상으로 진로장벽과 진로자기효능감 및 학교적응 간의 관계를 분석하고, 청소년 진로상담과 학교생활에 대한 시사점을 얻고자 하였다. 이를 위해 경기지역의 전문계, 인문계 고등학생 732명을 대상으로 진로장벽과 진로자기효능감 및 학교적응에 관한 설문조사를 실시하고 그 결과를 분석하였다. 연구 결과, 첫째, 고등학생의 성별에 따른 진로장벽을 살펴본 결과, 여학생들이 남학생들 보다 진로장벽을 높게 지각한 것으로 나타났으며, 학교적응에서도 어려움을 더 느꼈다. 둘째, 인문계 고등학생들이 진로자기효능감의 하위요인인 목표선택을 더 높게 지각하였고, 실업계 학생들이 진로 장벽의 하위요인인 경제의 어려움을 더 높게 지각하였다. 셋째, 학교적응에서는 남학생이 여학생보다 교사, 학교규칙 및 환경에서 높게 나타났고, 인문계 학생이 학교수업과 친구에서 높게 나타났다. 이러한 결과를 바탕으로, 고등학생의 학교적응을 높이기 위해서는 특히 여학생들이 인식하고 있는 진로장벽을 낮추는 교육적 노력이 필요하며, 고등학생들의 진로목표설정을 높일수 있는 진로교육이 필요하다. The purpose of this study was to investigate the relationship among career barrier, career self-efficacy, and school adjustment of second grade students in high schools who were worrying about their future career and offer the implications for guidance of adolescents career counseling and their school life. The subjects of this study were 732 academic and vocational high school students in Kyounggi-Do. The results were as follows; First, female students had higher perceived career barriers and more difficulties in their school adjustment. Second, academic high school students had higher perceived selecting goals in sub-factors of career self-efficacy and vocational high school students had higher perceived economic hardship in sub-factors of career barrier. Third, male students had higher perceived teacher, school rule/environment in sub-factors of school adjustment, and academic high school students had higher perceived school lesson, friend in sub-factors of school adjustment. Results suggest that, to improve school adjustment of adolescents, educational efforts to reduce the career barriers are needed especially for female students. Also educations are needed to improve the skills for setting their career goals.
본 연구는 지체장애인의 고용유지 및 일자리 만족도에 미치는 영향 요인을 분석하고자 하였다. 이를 위해 장애인고용패널 6차년도(2013)에 조사된 자료(N=563)를 활용하였으며, 빈도분석 및 위계적 회계분석 등의 통계적 분석을 통해 추론된 주된 결론은 다음과 같다. 첫째, 지체장애인의 고용유지 기간은 6년 이상의 비율이 가장 높았고, 일자리 만족도는 전반적으로 ``보통``수준으로 나타났다. 둘째, 성별, 장애등급, 주관적 사회경제적 지위, 월평균임 금, 사업체 규모, 적성부합 여부 요인은 고용유지에 긍정적 영향을 미치는 것으로, 학력, 고용체결여부, 자격증여부, 고용서비스 경험은 부정적 영향을 미치고 있는 것으로 나타났다. 셋째, 일자리 만족도에 미치는 영향 요인으로는 장애등급, 일상생활 만족도, 정규직 여부, 일자리 안전상황, 하루 평균 근무시간, 적성부합 여부, 대인관계 능력은 긍정적으로, 성별, 주관적 사회경제적 지위, 업무종류, 일자리 차별경험은 부정적 영향을 미치는 것으로 나타났다. 이러한 연구결과에 근거하여 지체장애학생을 위한 직업교육의 방향성과 연계하여 지체장애인의 고용유지와 일자리 만족도를 높이기 위한 방안에 대해 논의하였다. This study aimed to examine general characteristics of wage earners with physical disabilities, and also investigate influence factors on their job maintenance and job satisfaction. To these ends the frequency analysis and descriptive analysis, hierarchical regression analysis and dummy variable transformation were carried out. And the results were as follows. First, as for characteristics of job maintenance period, those with more than 6 years of employment accounted for the highest percentage. As for characteristics of job satisfaction, the overall average was ``moderate`` level. Second, as for factors affecting job maintenance, gender, the rate of disability, subjective socioeconomic status, average monthly wage, size of business and aptitude of job had positive effect. Third, as for influence factors on job satisfaction, the rate of disability, daily life satisfaction, permanent position, security of job, average working hour per day, aptitude of job and interpersonal ability had positive effect. Based on findings of the study and its implication, the study proposed a practical intervention methods to keep employment stable and improve job