정신요양시설에 거주하는 정신장애인의 삶에 관한 포토보이스 연구

안희철(Ahn, Hee Cheol),김민아(Kim, Min Ah),박경미(Park, Gyung Mi) 한국정신건강사회복지학회 2016 정신보건과 사회사업 Vol.44 No.3

본 연구는 정신요양시설에 거주하는 정신장애인의 삶을 당사자의 시각에서 이해하고자 포토보이스 방법을 이용했다. 이를 위해 경기도의 정신요양시설에 거주하는 6명의 정신장애인을 대상으로 2016년 1월부터 4월까지 7회에 걸쳐 포토보이스 프로그램을 실시했다. 연구참여자들은 스스로 정한 주제에 대하여 사진을 촬영했고 집단토론을 통해 사진에 담겨 있는 자신의 경험과 느낌을 공유했다. 주제 분석결과, ‘내 과거의 상처’(어린시절의 상처, 외롭고 쓸쓸했던 젊은 시절, 정신질환으로 인한 고통), ‘병과 함께 하고 있는 요양생활’(자유롭지 못했던 초기 요양생활, 세상과의 단절, 요양생활에서의 회복), ‘그래도 그리운 나의 가족’(가족에 대한 서운함, 가족에 대한 그리움, 가족에 대한 고마움), ‘나의 일터에서 겪은 편견과 차별’(차별적인 태도, 직업역량에 대한 편견, 편견과 차별을 극복하기 위한 노력), ‘세상과 함께 하고 싶은 나의 미래’(독립에 대한 바람, 내가 꿈꾸는 미래, 미래를 위한 준비)에 대한 5개의 대주제와 15개의 하위주제가 도출되었다. 본 연구를 통해 정신요양시설에 거주하는 정신장애인이 성장과정에서 겪은 심리적 외상에 대한 치료적 개입과 가족 지지의 강화, 사회적 낙인의 해소, 회복지향적인 요양환경의 조성과 평생계획의 제공 등이 필요함을 제시했다. Using photovoice methodology, this study explored the lives of persons with psychiatric disabilities in a mental health care facility. Seven sessions of the photovoice project were conducted with 6 individuals with psychiatric disabilities living in a mental health care facility in Gyeonggi province, Korea between January and April 2016. Through group discussions, participants shared their experiences and feelings related to the photos they took concerning themes on which they had agreed. The following 15 subthemes within 5 themes emerged from the thematic analysis: my past life with trauma (my childhood trauma, loneliness in my young adulthood, suffering from mental illness), my days at a nursing care facility (feeling in a cage, social exclusion, recovery), the longing for my family (feeling of disappointment, feeling of yearning, feeling of appreciation), prejudice and discrimination in the workplace (discriminatory attitude, prejudice regarding my ability, my efforts to overcome prejudice and discrimination), and my future in society (my hope for independent living, my hope for a career and future, my plan to achieve my life goals). Study findings highlight the need for services that treat trauma in individuals with psychiatric disabilities during childhood and adulthood, strengthen family support, reduce social stigma, build recovery-oriented care environments, and provide permanency planning.

정신요양시설 거주 정신장애인의 자기결정이 회복에 미치는 영향

안희철(Ahn, Hee Cheol),김민아(Kim, Min Ah) 한국정신건강사회복지학회 2017 정신보건과 사회사업 Vol.45 No.4

본 연구는 과정으로서의 회복 관점에서 정신요양시설 거주 정신장애인의 자기결정이 회복에 미치는 영향을 파악하고 사회적 지지의 조절효과를 검증하였다. 서울, 경기, 인천, 대전 지역에 위치한 정신요양시설에 거주하고 있는 성인 정신장애인 320명이 설문조사에 참여하였다. 연구대상자의 평균 연령은 54.34세였고 평균 유병기간은 24.68년이었으며 정신요양시설 총입소기간은 평균 16.97년이었다. 연구참여자들의 회복 정도는 5점 척도(0~4점)에서 평균 2.37점이었고, 자기결정 정도는 평균 3.27점으로 건강영역에서 가장 높았으며 직업영역에서 가장 낮았다. 위계적 회귀분석 결과, 이들의 회복에 영향을 미치는 요인은 자기결정과 증상으로 높은 수준의 자기결정과 낮은 수준의 증상이 높은 수준의 회복과 관련이 있었다. 일반지지(가족지지 및 동료지지)는 자기결정과 회복과의 관계에서 유의미한 조절효과가 검증된 반면, 전문가지지의 조절효과는 나타나지 않았다. 본 연구결과를 바탕으로 정신요양시설에 거주하는 정신장애인이 자기결정을 확대할 수 있는 거주환경을 제공하고, 가족ㆍ동료지지를 증진함으로써 이들의 진정한 회복을 도모하는 방안을 제언하였다. The purpose of this study is to verify the effect of self-determination on the recovery and to test the moderating effect of social support among persons with mental illness living in mental health care facilities. A total of 320 adults with mental illness living in mental health care facilities in Seoul, Gyeonggi, Incheon, and Daejeon completed self-reported questionnaires. The average age of the participants were 54.34 years and average time since diagnosis were 24.68 years. They had been residing in the facilities for 16.97 years on average. The recovery level of the study participants was 2.37 points on a 5-point Likert scale (0~4 points). The level of self-determination averaged 3.27 points, with the highest in health and the lowest in occupational area. Results from hierarchical regression analyses indicated that self-determination and psychiatric symptoms were significant factors affecting recovery. Higher levels of self-determination and lower levels of symptoms were significantly associated with higher levels of recovery. The moderating effects of family and peer support were significant in the relationship between self-determination and recovery, whereas professional support was not. These findings have practice and policy implications for improving the recovery of adults with mental illness living in mental health care facilities by developing better residential environments for self-determination and increasing family and peer support.

흉부 외상 환자에서 경식도 심초음파에 의한 대동맥 손상 진단의 유용성

안희철 ( Hee Cheol Ahn ),오성범 ( Sung Bum Oh ),김호중 ( Ho Jung Kim ),김현 ( Hyun Kim ),이강현 ( Kang Hyun Lee ),황성오 ( Sung Oh Hwang ),김헌주 ( Hun Joo Kim ) 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Background: Early recognition of thoracic aortic disease is critical to reduce morbidity and mortality. The accuracy and safety of TEE in trauma patients has recently challenged to traditional diagnostic modality for assessing thoracic aortic disease such as computed tomogram (CT) scan, aortography, and magnetic resonance imaging (MRI). The purpose of this study was to evaluate the utility of TEE as an emergency diagnostic procedure for detection of thoracic aortic injury in trauma patients. Methods: From March 1998 to October 2002, 21 traumatic patients who had a suspicious of thoracic aortic injury and underwent TEE as the first diagnostic tool in the emergency department were enrolled. Indications of TEE in the suspicious thoracic aortic disease were typical chest pain, mediastinal widening or massive left side hemothorax. Results: There was no complication during TEE or post procedure of TEE in all patients. The findings of TEE were as followings: aortic dissection was 9 cases (43%), periaortic hematoma was 5 cases (24%), and aortic rupture, aneurysm, intramural hematoma, RA rupture, cardiac tamponade, and both hemothorax was 1 case in each other. The open thoracotomy on 11 patients were performed and emergency department thoracotomy on 2 patients were performed. Ten patients were performed conservative management. Conclusion: We suggest that TEE is a useful and safe diagnostic modality to detect thoracic aortic injury in hemodynamically unstable patient after trauma.

미치광이 풀 중독에 의해 발생한 조증

최기훈,안희철,안무업,정재봉,김성은,배지훈,서정열,조준휘,박찬우,옥택근,Choi Gi Hoon,Ahn Hee Cheol,Ahn Moo Eob,Chung Jae Bong,Kim Sung Eun,Bae Ji Hoon,Seo Jeong Yeol,Cho Jun Hwi,Park Chan Woo,Ok Taek Gun 대한임상독성학회 2004 대한임상독성학회지 Vol.2 No.1

In emergency department, the clinicians occasionally meet some patients with toxicity caused by ingestion of unknown wild edible greens or herbal agents. Due to there was few quantitative or qualitative studies about the mechanism or clinical features of these materials, it' s hard to approach to the patients and start the initial management in emergency department. Authors experienced the case of poisoning by Scopolia Japonica ingestion. We report this case with review of Scopolia Japonica.

염소가스 노출 환자의 1년간 추적관찰

권혁술,손유동,안희철,안지윤,Kwon, Hyuk-Sool,Sohn, You-Dong,Ahn, Hee-Cheol,Ahn, Ji-Yun 대한임상독성학회 2008 대한임상독성학회지 Vol.6 No.2

Purpose: Chlorine gas is a common irritant that usually causes mild respiratory symptoms. One severe symptom, RADS (Reactive Airway Dysfunction Syndrome), is not well known to physicians. We analyzed the clinical features of chlorine gas exposure. Methods: We prospectively collected 25 cases of chlorine gas exposure near our emergency center on January 10th, 2007, and analyzed demographic data, event-to-ER interval, symptoms, and laboratory results based on medical records. Results: Only 2 patients out of 25 were admitted because of severe symptoms, the rest were discharged without complications. Sixty percent of them visited the ER within 12 h of exposure. The most common symptoms were chest discomfort (60%), headache (40%), nausea (40%), throat irritation (26%), and cough (32%). Two out of eight dyspnea cases showed abnormal pulmonary function, but only one case was diagnosed as RADS. Conclusion: Most symptoms after chlorine gas exposure can be treated conservatively. However, patients with chlorine exposure should be followed up long term for delayed complications.

응급실에서 이동식 단순 X-선 검사와 피폭선량과의 상관관계: 코호트 연구

김유정 ( Yu Jung Kim ),안희철 ( Hee Cheol Ahn ),손유동 ( You Dong Sohn ),안지윤 ( Ji Yoon Ahn ),박승민 ( Seung Min Park ),이원웅 ( Won Woong Lee ),이영환 ( Young Hwan Lee ) 대한임상독성학회 2013 대한임상독성학회지 Vol.11 No.2

Purpose: This study was conducted in order to determine the relationship between the number of portable X-rays and the radiation exposure dose for emergency medical service providers working in the emergency department (ED). Methods: A prospective study was conducted from February 15, 2013 to May 15, 2013 in the ED in an urban hospital. Six residents, seven emergency medical technicians (EMT), and 24 nurses were enrolled. They wore a personal radiation dosimeter on their upper chest while working in the ED, and they stayed away from the portable X-ray unit at a distance of at least 1.8 m when the X-ray beam was generated. Results: The total number of portable x-rays was 2089. The average total radiation exposure dose of emergency medical service providers was 0.504±0.037 mSv, and it was highest in the EMT group, 0.85(0.58-1.08) mSv. The average of the total number of portable X-rays was highest in the doctor group, 728.5(657.25-809). The relationship between the number of portable X-rays and the radiation exposure dose was not statistically significant(-0.186, p=0.269). Conclusion: Under the condition of staying away from the portable X-ray unit at a distance of least 1.8 m, the relationship between the number of portable X-rays and the radiation exposure dose was not statistically significant.

봄나물 섭취 후 이상 행동을 주요 증상으로 내원한 환자 1례

옥택근,김윤성,박찬우,문중범,최기훈,서정열,안희철,안무업,조준휘,Ohk Taek-Geun,Kim Yoon-Seong,Park Chan-Woo,Moon Joong-Bum,Choi Ki-Hoon,Seo Jeong-Yeul,Ahn Hee-Cheol,Ahn Moo-Wob,Cho Jun-Hwi 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.1

With well-being boom recently, the common people, but not experts, are increasingly taking in them directly by picking wild herbs. However, only experts can distinguish between edible vegetables and poisonous herbs from the wild herbs. Especially, it is not even easy for experts to distinguish them only by looking into buds in spring without flowers or fruit. So, sometimes many patients are being carried into the emergency room by the toxic symptom after taking by misunderstanding the poisonous herbs as edible vegetables. For herb intoxication as well as drug intoxication, what kinds of vegetables patients took in, and when and how much they took in them are important information for curing. Of course, in the case of intoxicating in the wild herbs, the patients can have a lot of symptoms and sings-hemodynamic alteration and abnormal neurologic sign as well as gastrointestinal symptoms-according to the kinds of herbs which they took in. Therefore, it is difficult to find the kinds of herbs which they took in through the specific symptoms. Recently we experienced a case with showing typical anticholinergic symptoms after ingestion of Scopolia japonica. As a result, the publicity activities about the wild plants needs because if the person without their previous knowledge take in the poisonous herbs, serious side effects can be produced..

Nicotine 패치에 의한 Nicotine 중독 증례

손유동,이재성,강구현,최정태,안무업,서정열,안희철,Sohn, You-Dong,Lee, Jae-Sung,Kang, Gu-Hyun,Choi, Jung-Tae,Ahn, Moo-Eob,Seo, Jeong-Youl,Ahn, Hee-Cheol 대한임상독성학회 2007 대한임상독성학회지 Vol.5 No.1

Nicotine poisoning arising from the use of nicotine patches is rare. However, because nicotine patches are classified as an OTC drug, the risk of misuse or abuse is increasing. Nicotine poisoning using nicotine patches shows an unusual clinical presentation compared to that from oral ingestion of multiple doses of nicotine. We present a case of misused nicotine patches that cause a nicotine poisoning. A thirty-nine year-old healthy man visited the ER with complaints of an intermittent cramping abdominal pain with nausea and vomiting. Upon physical examination, there were no specific findings except increased bowel sounds, and the patient's initial laboratory findings were also unremarkable except for an increased bilirubin level. CT revealed a mild degree of fatty liver. The patient's symptoms did not improve any further with conservative management. During his ED stay, we meticulously took his history again, and we discovered that he had used nicotine patches for three days, six days before admission, and had misused the nicotine patches as NSAID patches. The patient's diagnosis of nicotine poisoning was confirmed by a urine cotinine level ten times the normal value. After a 12-hour stay in the ED, his symptoms disappeared without any specific management.

피부 찰과상을 통한 파라쿼트 중독에 의한 사망 1례

김성은,조준휘,천승환,이승용,최기훈,배지훈,서정열,안희철,안무업,옥택근,박찬우,Kim, Sung-Eun,Cho, Jun-Hwi,Cheon, Seung-Whan,Lee, Seung-Young,Choi, Ki-Hoon,Bae, Ji-Hoon,Seo, Jeong-Yeul,Ahn, Hee-Cheol,Ahn, Moo-Eob,Ok, Taek-Gun,Park, Chan 대한임상독성학회 2005 대한임상독성학회지 Vol.3 No.2

Paraquat, is a widely used for its great effect as a herbicide. But the mortality rate by paraquat intoxication is known to be very high. It is thought to act by changing form to superoxide and peroxide free radical. Almost paraquat intoxication is through ingestion. A few intoxication of paraquat is through skin absorption. But there was no known death case through skin absorption. We experienced a case of a expired patient by paraquat intoxication through skin abrasion and scratching wound. A 75-year-old man was visited emergency room after motorcycle accident during transporting paraquat. He has multiple abrasion and scratching wound on extremities, and pelvic bone fracture. There was no evidence of ingestion of paraquat. But serum/urine gramoxone level was all positive. In spite of wound irrigation and hemoperfusion, his condition was been gone form bed to worse. 2 days after, multiple organ failure and the respiratory arrest were developed and he was expired. Paraquat intoxication through skin wound is extremely dangerous and death by that could possibly happen

네일 건(Nail Gun) 사고에 의한 경부 관통상 1례

한종순 ( Jong Soon Han ),손유동 ( You Dong Sohn ),안지윤 ( Ji Yoon Ahn ),안희철 ( Hee Cheol Ahn ),권혁술 ( Hyuk Sool Kwon ),서강열 ( Gang Yeol Seo ),조광윤 ( Kwang Yun Cho ),박승민 ( Seung Min Park ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.1

Powered by compressed air, a nail gun is an essential alternative tool to a hammer on any construction site. This useful machine launches nails at high speed, automatically embedding them in a piece of wood in only a fraction of a second. In spite of its convenience, life-threatening and fatal nail gun injuries can occur when a nail gun is misused, such as in a suicide attempt, or when the operator has insufficient training because combustion nail guns are capable of firing projectiles at velocities higher than 150 m per second. Although injuries by nail guns are rarely reported, there have been reports of nail gun injuries to the head and the trachea in Korea. In the emergency room, the authors experienced a patient injured by an accidental shooting of a nail gun while working in construction. In that accident, a nail penetrated the patient`s cervical vertebra through the left cheek. This report is aimed at studying medical treatment for patients with penetrating injuries caused by nail guns. (J Korean Soc Traumatol 2011;24:48-51)