Causes and Predictive Factors Associated with “Diagnosis Changed” Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

( Byung Ju Kang ),( Kyung Wook Jo ),( Tai Sun Park ),( Jung Wan Yoo ),( Sei Won Lee ),( Chang Min Choi ),( Yeon Mok Oh ),( Sang Do Lee ),( Woo Sung Kim ),( Dong Soon Kim ),( Tae Sun Shim ) 대한결핵 및 호흡기학회 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the “diagnosis changed” rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: “diagnosis maintained”, “diagnosis changed” (initially notified as TB, but ultimately diagnosed as non-TB), and “administrative error” (notified as TB due to administrative errors). Results: Excluding 17 patients in the “administrative error” group, the “diagnosis maintained” and “diagnosis changed” groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of “diagnosis changed” were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn`s disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a “diagnosis changed” result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high “diagnosis changed” rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the “diagnosis changed” rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of “diagnosis changed” cases is desirable.

Causes and Predictive Factors Associated with "Diagnosis Changed" Outcomes in Patients Notified as Tuberculosis Cases in a Private Tertiary Hospital

Kang, Byung Ju,Jo, Kyung-Wook,Park, Tai Sun,Yoo, Jung-Wan,Lee, Sei Won,Choi, Chang-Min,Oh, Yeon-Mok,Lee, Sang-Do,Kim, Woo Sung,Kim, Dong Soon,Shim, Tae Sun The Korean Academy of Tuberculosis and Respiratory 2013 Tuberculosis and Respiratory Diseases Vol.75 No.6

Background: The aim of our study was to evaluate the "diagnosis changed" rate in patients notified as tuberculosis (TB) on the Korean TB surveillance system (KTBS). Methods: A total of 1,273 patients notified as TB cases on the KTBS in one private tertiary hospital in 2011 were enrolled in the present study. Patients were classified into three groups: "diagnosis maintained", "diagnosis changed" (initially notified as TB, but ultimately diagnosed as non-TB), and "administrative error" (notified as TB due to administrative errors). Results: Excluding 17 patients in the "administrative error" group, the "diagnosis maintained" and "diagnosis changed" groups included 1,097 (87.3%) and 159 patients (12.7%), respectively. Common causes of "diagnosis changed" were nontuberculous mycobacterial (NTM) disease (51.7%, 61/118), and pneumonia (17.8%) in cases notified as pulmonary TB, and meningitis (19.5%, 8/41) and Crohn's disease (12.2%) in cases notified as extrapulmonary TB. Being older than 35 years of age (odds ratio [OR], 2.18) and a positive acid-fast bacilli stain (OR, 1.58) were positive predictors and a TB-related radiological finding (OR, 0.42) was a negative predictor for a "diagnosis changed" result via multivariate logistic regression analysis in pulmonary TB cases. Conclusion: Because of a high "diagnosis changed" rate in TB notifications to the KTBS, the TB incidence rate measured by the KTBS may be overestimated. Considering the worldwide trend toward increased NTM disease, the "diagnosis changed" rate may increase over time. Thus, when reporting the annual TB notification rate in Korea, the exclusion of "diagnosis changed" cases is desirable.

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.

한국 여성운동과 걸스카우트운동 : 과거·현재·미래 Yesterday, Present and Tomorrow

정세화,이동원,김미숙,박진숙,장화경,홍승아 이화여대 한국여성연구소 1988 여성학논집 Vol.5 No.-

One of the major implications of women's movements seems to lie in the fact that it tends to promote women's consciousness-raising and, thus, heighten social status of women in general. It would be very much the case when discussion centers around the emergence of Korean women's movements in modern sense. Due to the socio-political atmospheres of the lathe 19th century Korean society, its basic characteristics owe to strong tones of patriotic nationalism under the slogan of "learning is might enough to deal with the imperialistic foreign powers of the time." As such, ever since the introduction of women's enlightenment movements of the time, Korean women's movements have provided for the advancement of egalitarian society. However, assessing the effectiveness of programs that are practiced by the existing women's organizations in Korea, it deserves mention in that most programs are for the adult female members, assuming it would only be applicable to those adults. In this regard, it can be said that the Korean Girl Scout organization has worked a unique role to make up such voids in women's movements - most programs developed and exercised by the Girl Scout are reserved for those young girls. For instance, special activities like social services, field campaigns, and international gatherings would definitely work a profound impact in the formation of gender-role stereotypes of the youth. The present study tries to examine the Korean Girl Scout movement being the case of women's movement organization. Discussion will cover such topics as; historical reviews of Korean Girl Scout movement, principal organizational goals and its practice in real life, and internal dynamics of members between "staffs" and the ordinary members themselves-on perceptions of the movement, evaluation of leaderships, and the future orientations of the Girl Scout, etc. Various research methods are employed. Book reviews, in-depth interviews, questionnaires, and participant observations are utilized, when the respective measurement is required. Major findings of the study can be summarized as follows: (1) Numbers of Girl Scout membership have declined since 1980, while revealing its utmost pick upto mid-70s. In terms of regional distributions of the members, both Seoul and Kyung-Nam Branches are the most prosperous. Whereas commemoration ceremonies and camping works are considered most impressive programs, membership trainings and field works are the lowest. About 70 percent of the members show their length of activities in Girl Scout less than one year. Most members are involved in the activities based on self-decision in order to have social services, club memberships, or self actualizations. They are satisfied with most of the programs, especially when participating in the social service programs. (2) As for the staff members, about half of the leaders in the headquarters are newly appointed. Whereas majority of the 'field' staffs are young (in their 20s, or 30s), other leaders are considered old (most of them are in their 40s, 50s, or 60s). Half of the leaders are involved in the activities for less than 5 years. They are recruited by either colleagues' or office seniors' recommendations. Reasons to participate in the movement are to have self-actualized or to have opportunity for social services. All in all, leaders are satisfied with the Girl Scout activities mainly because they can see their youth members progressing and developing. (3) Several issues for the better organizational managements seem to be related. prevalence of aspirational differences between leaders and members tends to cause psychological burdens. Other problematics such as lack of free communication networks, tensions due to cohort differences, authoritarian leadership styles, and financial difficulties would hinder Girl Scout movement more promising and popular to all. Based on the research findings, two major suggestions might be in order. First, underlying rationales of the Girl Scout movement should be reoriented. A special emphasis on the creation of self-supportive 'androgynous individuals' would be the case (in this regard, an intensive program targeted for those pre-school-aged members would be the most effective). As a way to achieve the strategic reformulation, reliance on the interdisciplinary program (for example, coordination with the university) will be one possibility. Secondly, an organizational management should be sufficiently considered. provisions (tangible and intangible) for the 'field leaders' being the key leader group in the Girl Scout movement should be afforded enough to keep their participations voluntary and continuous.

한국 여성사 정립을 위한 인물 유형 연구 : from Ancient Times to Tae-han Che-guk(大韓帝國) 고대에서 대한제국 시대까지

정세화,최숙경,이배용,장필화,김영미,박진숙 이화여대 한국여성연구소 1988 여성학논집 Vol.5 No.-

This study is an attempt to analyse the types of women recorded in historical documents. The categories are broadly divided in three areas; political, social and familial spheres. In the political sphere, three queens in Shilla period, the only period in Korean history when a queen was the supreme ruler, and women who had a formal right to be involved in the determination of soverign successor, to assume regency, and who had various informal political influence. In the social sphere, women's economic and religeous activities were examined. Also women specialists such as medicine women, shamans and kisaeng (entertainers) are examined in this category. In the familial sphere, conjugal relationships of first (legitimate) wives and concubines, and women's status and activities are investigated. The gradual establishment of patriarchal system initiated by the state, and the conflict of women's interests in the process was analysed. As a result of this preliminary analyses, it became clear that the social position of women in Korean history was constricted with the growth of the power of the state. In the case of ancient Korea and Koryo period women's status in the family was comparatively higher and their personal activities were freer although their political and social activities were restricted. As time progressed, the establishment and reinforcement of partriarchal system of the state based on confucian ideology had crucial importance on the position of women in society. The system of family was restructured and carefully monitored, and the members of the family were closely controlled. The state sought the material and ideological bases of the power through these control. As a result, the status of women became more structurally subjugated to make heads of the family, especially after the mid Choson dynasty.

직무스트레스가 실업에 미치는 영향

정윤경,김형렬,박소영,홍정연,고상백,장세진 대한산업의학회 2007 대한직업환경의학회지 Vol.19 No.2

소규모 제조업에서 재해발생과 사업장 특성간의 관련성 분석

이건세,김형수,,장성훈,정최경희,오원기,최재욱,이관형,오지영 大韓産業醫學會 2006 대한직업환경의학회지 Vol.18 No.2

목적: 소규모 제조업 사업장의 재해 발생 유무에 따른 사업장 조직 특성을 비교하여 재해 발생과 관련된 요인을 사업장 수준에서 파악하고자 하였다. 방법: 한국산업안전공단이 실시한 2004년도 산업안전 보건 동향조사 자료 중 5인 이상 50인 미만 제조업 1,886개 사업장(가중치를 부여하여 추정한 모집단 사업장은 65,921개)의 재해(산재 및 공상, 경상 포함) 발생 여부와 사업장의 조직 특성(일반적 특성, 고용특성 및 산업안전보건 특성)간 다변량 분석을, 사업장의 일반적 특성은 지역, 산업형태, 업종 등이며, 고용특성은 전체 근로자중에서 생산직 근로자의 분포, 여성근로자의 분포, 1주일 평균 근로시간, 교대근무 등이며, 산업안전보건 특성은 안전관리자/보건관리자의 선임형태, 산업안전보건위원회, 노동조합, 매월 정기안전보건교육시간, 안전보건관리 규정, 안전보건활동 점수, 안전문화 점수 등이다. 결과: 다변량 분석결과 재해가 발생한 사업장이 갖는 특성은 다음과 같았다. 첫째, 사업장의 일반적 특성에서 지역별로는 경인권에 비해 전라권, 산업형태 면에서 원청에 비해 사외협력업체, 업종별로는 전자부품/통신에 비해 코크스/석유정제업, 목재/나무제품업, 음식료품, 조립 금속제품에서 위험도가 높았다. 둘째, 사업장의 고용 특성에서는 전체 구성원 중에서 생산직 근로자가 증가할수록 재해발생 사업장이 유의하게 증가하였으며, 여성근로자의 증가할수록 재해발생 사업장이 유의하게 감소하였다. 주당 근무시간이 증가할수록 재해 발생 사업장이 유의하게 증가하였으며, 교대 근무와 사업장의 재해발생과는 유의한 관련성이 없었다. 셋째, 사업장의 산업안전보건 특성에서는 안전관리자가 전임으로 근무할수록, 산안전보건위원회가 활발히 활동할수록, 노동조합이 설립될수록, 안전보건규정이 갖추어지지 않을수록, 정기보건교육시간이 많을수록, 안전문화수준이 낮을수록 재해발생 사업장이 유의하게 증가하였다. 결론: 소규모제조업에서 사업장의 조직 특성에 따라 사업장 재해율이 다름을 확인할 수 있었으며, 이는 산업재해의 예방을 위해서는 근로자 요인이외에도 사업장 수준에서의 관련요인에 대한 접근이 필요함을 의미한다. Objective: This study evaluated the relationship between injury occurrence and workplace organization in small-sized, manufacturing factories in Korea. Methods: Using data from the 2004 Occupational Safety and Health Survey in Korea, this study compared workplace organizational factors (general characteristics, employee characteristics and health and safety characteristics) with injury occurrence of 1,866 small-sized, manufacturing factories (65,921 population factories after weighting). General characteristics of factories comprised location, type and classification of industry. Employee characteristics comprised proportion of manual workers and female workers, average working hours per week and shiftwork. Health and safety characteristics comprised type of safety and health manager, committee for occupational safety and health, labor union, health and safety regulation, monthly health and safety training time, score of health and safety activity and score of safety culture. Results: The following characteristics of injury-occurrence in small-sized, manufacturing factories were determined by multivariate analysis. In terms of general characteristics, the risk of injury-occurrence was higher in Jeolla area than Gyeongin area in outside associate than other enterprises and in coke, refined petroleum products and nuclear fuel, wood and products of wood, food products and beverages and fabricated metal products, except machinery and furniture industries than television and communication equipment and apparatus industries. In terms of employee characteristics, injury-occurrence significantly increased in factories with greater proportion of manual worker and with a higher rate of working hours per week. But significantly decreased in factories with a higher proportion of female workers. In terms of health and safety characteristics, injury-occurrence significantly increased in factories with a self-appointed safety manager, with unorganized union, with a more active committee for occupational safety and health, with unimplemented health and safety regulation, with longer monthly safety and health training time, and with a lower score of safety culture. Conclusions: This study demonstrated that several factors of workplace organization were significantly related with injury-occurrence in factories. These findings are supposed to raise the need for making effort in workplace organization to improve injury prevention.

Pirenzenpine이 흰 쥐의 위궤양 형성에 미치는 영향

설무종,김호빈,장세경,김종숙 중앙대부설한국의과학연구소 1985 한국의과학 Vol.17 No.4

무릎관절의 미만형 색소 융모 결절성 활액막염에서 관절경을 이용한 육안적 활액막 전 절제술 후 방사선치료

장세경(Sei Kyung Chang),김재화(Jae Hwa Kim),하두회(Doo Hoe Ha),강혜윤(Hae Youn Kang),정소영(So Young Chong),신현수(Hyun Soo Shin) 대한방사선종양학회 2006 Radiation Oncology Journal Vol.24 No.3

색소 융모 결절성 활액막염(pigmented villonodular synovitis, PVNS)은 병인이 밝혀지지 않은 증식성 질환으로, 병변 의 범위에 따라 국소형과 미만형으로 분류되며, 조직학적으로 양성이지만 파괴적인 성향을 보이므로 연골의 파괴나 주위 조직으로 광범위한 침윤이 가능한 질환이다. 활액막 절제술이 일차적인 치료방법이지만 미만형인 경우에는 주위 조직을 침윤하는 성향 때문에 재발률이 높다. 재발이 반복된 후에는 수술적 절제가 어려워져서 병변부위의 절단이 필요하게 되므로, 광범위한 병변인 경우, 수술이 용이하지 않은 경우, 또는 불완전 절제가 시행된 경우 등에서 방사선치료를 시행하여 재발을 방지할 수 있다고 보고되고 있다. 저자들은 무릎관절의 미만형 색소 융모결절성 활액막염으로 관절경을 이용한 육안적 활액막 전 절제술 후 방사선치료를 시행한 2예를 경험하였기에 문헌고찰과 함께 보고하고자 한다. Pigmented villonodular synovitis (PVNS) is a rare proliferative disease involving synovial membranes. Natural history and etiology of PVNS are not well known. PVNS presents as localized or diffuse tumor like nodular lesion of the synovial lining of the joint and the synovial spaces adjacent to the joints. Though histologically benign, it is a very aggressive lesion, capable of bone destruction and widespread infiltration of surrounding tissues. Standard therapy is surgical resection, but due to the infiltrative growth, the recurrence rate is significantly high. After several relapses surgical treatment of diffuse PVNS becomes difficult and may require amputation of the involved limb. Radiotherapy can provide an effective treatment option for patients with large lesions or lesions which are not suitable for surgery, after incomplete resection to prevent relapses or to avoid amputation. We report 2 cases of diffuse PVNS in the knee joint treated with arthroscopic gross total synovectomy and radiotherapy.

동계 마우스 종양의 방사선 감수성 예측인자로서의 생물학적 표지자

장세경(Sei Kyung Chang),성진실(Jinsil Seong),김성희(Sung Hee Kim),신현수(Hyun Soo Shin) 대한방사선종양학회 2006 Radiation Oncology Journal Vol.24 No.2

목 적: 방사선 감수성이 다양한 동계(syngeneic) 마우스 종양들을 대상으로 50% 종양억제선량과 종양성장지연 등 방사선 감수성을 대변하는 지표와 방사선에 의해 유도되는 아포토시스 간에 상관관계가 있는지 여부를 알아보고자 하였다. 또한 아포토시스와 관련된 여러 유전물질의 기본(constitutive) 발현수준을 측정한 후 이들 상호 간의 상관관계를 분석하여 방사선 감수성을 예측할 수 있는 생물학적 표지자를 알아보고자 하였다. 대상 및 방법: 동계 마우스 종양으로는 난소암 OCa-I, 유방암 MCa-K, 편평상피세포암 SCC-VII, 섬유육종 FSa-II, 간암 HCa-I을 사용하였고 이들은 PCR-SSCP 검사상 p53이 모두 자연형인 종양들이었고 주령 8∼10 주인 C3H/HeJ 웅성 마우스를 사용하였다. 50% 종양억제선량과 종양성장지연 및 방사선에 의해 유도되는 아포토시스를 측정하여 이들과 방사선에 의해 유도되는 아포토시스간의 상관관계를 분석하여 방사선에 의해 유도되는 아포토시스로 방사선 감수성을 예측할 수 있는지 여부를 알아보고, 또한 아포토시스와 관련된 유전물질 p53, p21WAF1/CIP1, BAX, Bcl-2, Bcl-xL, Bcl-xs, p34 등의 기본 발현양상 및 발현수준을 Western blot과 농도계측기로 측정한 후 이들 상호 간의 상관관계를 분석하였다. 결 과: 방사선에 의해 유도된 아포토시스의 정도와 종양성장지연과의 사이에는 통계적으로 유의한 상관관계가 존재하였다(R=0.922, p=0.026). 50% 종양억제선량과의 사이에는 통계적 유의성은 변연수준이었으나(p=0.070) 상관관계의 경향을 보였다(R=-0.848). p21WAF1/CIP1과 p34의 기본 발현수준과 50% 종양억제선량(R=0.893, p=0.041와 R=0.904, p=0.035) 및 종양성장지연(R=-0.922, p=0.026와 R=-0.890, p=0.043) 사이에는 통계적으로 유의한 상관관계가 존재하였다. 즉, p21WAF1/CIP1과 p34의 기본 발현수준이 낮은 경우에 방사선 감수성이 높고, 기본 발현수준이 높은 경우에는 방사선 감수성이 낮은 상관관계가 존재함을 알 수 있었다. 결 론: 방사선에 의해 유도된 아포토시스의 정도로 종양의 방사선 감수성을 예측하여 볼 수 있을 것으로 생각하며, 종양의 방사선 감수성을 예측할 수 있는 생물학적 표지자로 p21WAF1/CIP1와 p34의 기본 발현수준이 이용될 수 있을 것으로 생각한다. Purpose: We investigated whether a relationship exists between tumor control dose 50 (TCD50) or tumor growth delay (TGD) and radiation induced apoptosis (RIA) in syngeneic murine tumors. Also we investigated the biological markers that can predict radiosensitivity in murine tumor system through analysis of relationship between TCD50, TGD, RIA and constitutive expression levels of the genetic products regulating RIA. Materials and Methods: Syngeneic murine tumors such as ovarian adenocarcinoma, mammary carcinoma, squamous cell carcinoma, fibrosarcoma, hepatocarcinoma were used in this study. C3H/HeJ mice were bred and maintained in our specific pathogen free mouse colony and were 8∼12 weeks old when used for the experiments. The tumors, growing in the right hind legs of mice, were analyzed for TCD50, TGD, and RIA at 8 mm in diameter. The tumors were also analyzed for the constitutive expression levels of p53, p21WAF1/CIP1, BAX, Bcl-2, Bcl-xL, Bcl-xs, and p34. Correlation analysis was performed whether the level of RIA were correlated with TCD50 or TGD, and the constitutive expression levels of genetic products regulating RIA were correlated with TCD50, TGD, RIA. Results: The level of RIA showed a significant positive correlation (R=0.922, p=0.026) with TGD, and showed a trend to correlation (R=-0.848), marginally significant correlation with TCD50 (p=0.070). It indicates that tumors that respond to radiation with high percentage of apoptosis were more radiosensitive. The constitutive expression levels of p21WAF1/CIP1 and p34 showed a significant correlation either with TCD50 (R=0.893, p=0.041 and R=0.904, p=0.035) or with TGD (R=-0.922, p=0.026 and R=-0.890, p=0.043). The tumors with high constitutive expression levels of p21WAF1/CIP1 or p34 were less radiosensitive than those with low expression. Conclusion: Radiosensitivity may be predicted with the level of RIA in murine tumors. The constitutive expression levels of p21WAF1/CIP1 or p34 can be used as biological markers which predict the radiosensitivity.