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.

직무스트레스가 실업에 미치는 영향

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

교정용 브라켓과 호선 간의 마찰 저항력의 비교

서충환,정혜승,조진형,강경화 대한치과교정학회 2005 대한치과교정학회지 Vol.35 No.2

본 연구는 고정성 장치를 이용한 교정 치료에서 브라켓과 교정용 호선 사이의 활주 이동 동안 발생하는 마찰력에 디자인과 재질이 다른 각각의 브라켓과 여러 종류의 호선, 다양한 브라켓-호선 각도 등이 어떤 영향을 미치는가를 알아보기 위하여 4종의 브라켓(stainless steel twin 브라켓인 Gemini^(?), 좁은 근원심 폭경과 single bracket의 디자인이 포함된 Mini Uni-Twin^(?), metal-reinforced 세라믹 브라켓인 Clarity^(?), 세라믹 브라켓인 Transcend^(?)을 사용하고, 3종의 교정용 호선(0.016˝. 0.016×0.022˝ stainless steel호선, 0.016˝Nitinol)을 이용하여 브라켓-호선 각도를 0˚, 3˚, 9˚로 조절하면서 실험한 결과, Gemini^(?)는 유의하게 가장 낮은 정지, 운동 마찰력을 보였으며(P<0.001), Clarty^(?)는 0˚의 브라켓-호선 각도에, Transcend^(?)는 6˚와 9˚의 각도에서 유의하게 가장높은 정지, 운동 마찰력을 보였고(P<0.001), 0.016×0.022˝ stainless steel 각형 호선은 유의하게 가장 높은 정지, 운동 마찰력을 보였으며(P<0.01),0.016˝ stainless steel 원형호선은 0˚와3˚의 브라켓-호선 각도에서(P<0.01), 0.016˝ Nitinol은 6˚와9˚의 각도에서 (P<0.001)유의하게 가장 낮은 정지, 운동마찰력을 보였고 브라켓-호선 각도가 증가함에 따라 유의하게 정지, 운동마찰력도 증가 하였다(P<0.001) The object of this study was to evaluate how friction that occurs during the sliding movement of an orthodontic archwire through orthodontic brackets is differently affected by variant designs and ingredients of brackets and archwires and bracket-archwire angles. In order to simulate the situations which could occur during orthodontic treatment with fixed appliances, 4 types of brackets(Gemini^(?), a stainless steel twin bracket:Mini Uni-Twin^(?), a stainless steel bracket with a single bracket design and narrow mesio-distal width: Clarity^(?), a metal-reinforced cermic braket: T ranscend^(?), a ceramic bracket)and 3 types of orthodontic archwires (0.016˝, 0.016×0.022 stainless steel, 0.016˝ Nitinol)were used and the bracket-archwire angles were controlled as 0˚,3˚,6˚, and 9˚, Gemini^(?) significantly showed the lowest static and kinetic frictions (P<0.001). Clarity showed the highest static and kinetic frictions with a bracket-archwire angle of 0˚, and Transcend at 6˚ and 9˚(P<0.001). An 0.016×0.022˝ stainless steel rectangylar archwire significantly showed the highest static and kinetic frictions(P<0.01). The lowest static and kinetic frictions were observed when the bracket-archwire angles were 0˚ and 3˚ with 0.016˝ stainless steel round archwires(P<0.01), and 6˚ and 9˚ with 0.016 Nitinol(P<0.001). The static and kinetic frictions were increased as the bracket-archwire angles were increased(P<0.001).

난치성 전두엽 간질의 외과적 치료

김정목,김형일,김근수,김철진,이정청,이민철 대한신경외과학회 1996 Journal of Korean neurosurgical society Vol.25 No.11

Recent advances of neuroimaging and electrophysiological monitoring technique have contributed in improving the surgical outcome of frontal lobe epilepsy. The authors have analysed 36 consecutive cases of intractable frontal lobe epilepsy that were treated at our institute between September. 1992 and December, 1995 to determine the clinical, electrophysiological, and neuroimaging characteristics as well as to delineate the efficacy of surgical treatment in improving the seizure outcome. The patients consisted of 19 males and 17 females. The mean age of the seizure onset and the mean duration of epilepsy were 14.9 and 11.6 years, respectively. Magnetic resonance imaging(MRI) showed no lesion in 9 patients and pathological lesions in 27 patients. The types of the lesions observed included primary brain tumor, mostly low-grade glioma in 10 patients, cortical dysplasia in 4, posttraumatic scar in 4, neocortical gliosis in 3, cyst in 3, and postencephalitic atrophy in 3. Intracranial recordings were performed in 23 cases to determine the epileptogenic zone. The surgical outcome was graded according to Engle’s Classification as Class A in 20 patients. Class B in 2, Class C in 9, and Class D in 5. The surgical outcome was promising regardless of the presence or the absence of the lesion on MRI, invasive recording, age of seizure onset, and duration of epilepsy.

Rolandic Cortical Dysplasia : 증례보고 Case Report

김형일,정채경,최하영,Palmini, Andre,이민철,이정청 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.6

The advent of MRI enables us to make an in-vivo diagnosis of cortical dysplastic lesions which are highly epiletogenic and show the variety of seizure patterns. Authors report a case of rolandic cortical dysplasia who had highly intractable focal motor clonic seizures. Invasive recording with subdural grid was very helpful in delinating the epileptogenic area as well as in functional mapping of eloquent areas. Total removal of dysplastic lesion could treat this highly intractable epilepsy successfully.

한국인에게서 그레이브스병 약물치료의 적정기간

이형숙,이동훈,정희선,이종우,김정은,신승수,정윤석,이관우,김현만 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.1

연구배경: 그레이브스병의 치료에는 항갑상선제, 수술 및 방사성 요오드법이 선택되어 사용되고 있다. 이중 항갑상선제는 가장 많이 선호되고 있으나 낮은 관해율과 높은 재발율로 장기간 치료기간이 요구된다. 저자들은 그레이브스병 환자에게서, 선택되는 치료법의 선호도와 각 치료법의 관해율을 조사하고자 본 연구를 시행하였다. 또한 본 연구에서는 항갑선제 치료의 적정기간을 평가하고자 하였다. 방법: 아주대학교병원에 내원한 환자 중 1년 이상 추적관찰이 가능한 205명의 그레이브스병 환자를 대상으로 조사하였다. 항갑상제군, 수술군 및 방사성 요오드군은 각각 170명, 29명 그리고 6명이었다. ROC curve를 이용하여 약물치료의 예후예측인자를 분석하였다. 결과: 1) 그레이브스병 환자의 치료 방법의 선택은 항갑상선제군, 수술군 및 방사성 요오드군 각각 170명(83.0%), 29명(14.1%) 그리고 6명(2.9%)으로 항갑상선제 치료가 가장 선호되었다. 2) 그레이브스병의 관해율은 항갑상선제군, 수술군 및 방사성 요오드군에서 각각 60.0%(102/170명), 96.5%(28/29명) 그리고 83.0%(5/6명)으로 수술군이 가장 높았다. 3) ROC curve의 AUC는 치료기간과 진단시 TBII가 각각 0.709 및 0.648이었고 적절한 약물투여 추적 관찰기간은 26개월이었다. 결론: 그레이브스병의 일차 치료법으로는 항갑상선제가 선호되고 있으나 수술 및 방사성 요오드 치료군에 비해 상대적으로 낮은 관해율을 보였다. 따라서 항갑상선제 치료로 26개월 이상 관해가 되지 않을 경우에는 치료 방법의 변경을 고려하는 것이 관해율을 높이는데 도움이 될 것으로 생각된다. Background: Graves' disease in an organ specific autoimmune disease. Three kinds of therapeutic modalities (antithyroid drugs, ablation with radioactive iodine and subtotal thyroidectomy) are frequently performed for the management of this disease. The most popular therapeutic policy for the disease in Korea is antithyroid treatment. We analysed and compared the remission rates of all three modalities for Graves' disease, and evaluated the antithyroid modality to determine the correct duration of treatment. Subjects & Methods : The medical records of 205 patients with Graves' disease were reviewed. For the evaluation of the antithyroid modality medical treatment, antithyroid drugs were administered for more than 1 year. The prognostic factors associated with remission were analysed by means of an ROC curve. Results: 1) Of the 205 patients, proportions that received medical therapy, subtotal thyroidectomy and radioiodine therapy were 83.0, 14.1 and 2.9%, respectively. 2) The remission rates of the medical therapy, surgery and radioiodine therapy were 60.0, 96.5 and 83.0%, respectively. 3) The remission rate of the medical therapy was associated with the duration of medication and TBII activity. The determined proper duration for the antithyroid treatment was 26 months from the ROC curve analysis. Conclusion: The above results suggest that the proper duration of antithyroid treatment for Graves' disease is 26 months, after which time the subtotal thyroidectomy or radioiodine therapy should be considered if the disease has not remitted (J Kor Soc Endocrinol 18:24∼31, 2003).

골형성부전증 10예의 임상적 특징

이형숙,김현주,조재현,이승원,김현아,최준혁,송영준,김대중,이관우,정윤석 대한내분비학회 2003 Endocrinology and metabolism Vol.18 No.5

연구배경 및 방법: 골형성부전증은 비교적 희귀한 유전병으로 교원질 대사 장애로 인한 골의 취약성과 다발성 골절 및 척추측만증 등을 특징으로 한다. 유전방식과 표현형의 발현 정도에 따라 다양한 임상 양상을 보이며, 임상적 중증도에 따라 4가지 형태로 분류된다. 지금까지 국내 보고는 분만과정이나 태아 진찰시 골격이상으로 발견된 증례보고가 주였다. 저자들은 비교적 경미한 임상 양상을 보이는 예를 포함한 다수의 골형성부전증 환자들의 전반적인 임상적 특징에 대해 보고하는 바이다. 결과: 2001년 6월부터 2003년 2월까지 골형성부전증으로 진단받은 6 가계, 10예를 대상으로 하였다. 평균 나이는 27.3(5∼56)세였고 소아가 2예였다. 모두 상염색체 우성으로 유전되었으며, 제 I형이 4예, 제 III형이 4예, 그리고 제 IV형이 2예였다. 전 예에서 다수의 골절 경험이 있었고, 골밀도 저하와 골피질 두께 감소 소견이 관찰되었다. 전신의 평균 골밀도는 0.690(0.421∼1.039) g/cm²였다. 골형성지표로 측정된 sAlk는 소아의 경우만 증가되어 있었고, 골흡수지표로 측정된 uDPD의 평균치는 12.9(4.4∼36.3) nM/mM Cr으로 증가된 소견을 보였다. mobility score는 대부분 3,4단계에 속해 있었다. 중증형일수록 진단 시의 mobility score가 낮은 경향을 보였다. 결론: 한국인 골형성부전증 환자의 임상적 특징을 살펴본 결과 기존의 보고된 II형 외에도 I, III, IV형이 다양하게 존재함을 알 수 있었으며, 모든 예에서 상염색체 우성으로 유전됨을 확인할 수 있었다. 또한 모든 예에서 증가된 골흡수로 인한 골밀도 저하와 골절을 확인할 수 있었다. Osteogenesis Imperfecta (OI) is a relatively rare hereditary disease, which is characterized by multiple bone fractures and spine scoliosis, due to the fragility of bone, and is often associated with blue sclerae, deafness and dentinogenesis imperfecta. Four types of OI can be distinguished, according to the clinical findings. Although mutations affecting type I collagen are responsible for the disease in most patients, the mechanism by which the genetic defects cause abnormal bone development remains to be fully understood. Here, the clinical characteristics of 10 OI patient cases are reported, with a review of the literature. All the cases, including 4 type I, 4 type III and 2 type IV, inherited OI as an autosomal dominant trait. All the subjects had multiple old fractures and decreased bone densities. In this study, the biochemical marker of bone formation, serum alkaline phosphatase, was found to be increased only in the pediatric OI patients, while the biochemical marker of bone resorption, urinary deoxypyridinoline, was increased in all cases. The mobility score was found to correlate with the severity of the type on diagnosis (J Kor Soc Endocrinol 18:496∼503, 2003).

五令散의 作用機轉에 대한 考察

南炯臣,趙忠植,金哲中 대전대학교 한의학연구소 2001 한의학연구소 논문집 Vol.10 No.1

Oryoungsan which first recorded in Sanghanron, the clinical medical book consists of treating acute febrile disease according to its change, is one of the frequently used oriental medicines. these days, it has been prescribed in symptoms accompanied by edema mostly. therefore it is easy to consider it as a type of diuretics. In Sanghanron it was originally used in the symptoms of perspiration, decreased urine volume, thirsty, flatulence, these symptoms indicate loss of body fluid and the prescription which orders "taking warm water sufficiently" supports this. On this background, it is supposed that Oryoungsan treats dehydration after providing water and electrolytes. To consider that herbal medicines consisted of Oryoungsan make electrolytes go out of the body, The healing mechanism of dehydration doesn't meet this. Because Oryoungsan was used in condition of fever or in similar condition, it is more resonable to understand that restoration of increasing blood flow to the subcutaneous venous plexus regulating body temperature in febrile condition into body circulation, resulting into maintaining main blood volume and into treating decreased urine volume and thirsty is Oryoungsan's function in the dehydration or febrile condition. That is, symptoms are decreased or disappeared through restoring unbalance of internal body fluid. The other target is pain controls, especially chronic headache, facial pain and trigeminal neuralgia, it is suggested that the funciton of pain control of Oryoungsan is related to 5-HT(5-hydroxytrypamine), nerve transmitter in the endogenous analgesic system. Moreover it is also suggested that Oryoungsan is relate to 5-HT, considering the fact that gastroparesis, a symptom of cyclic vomiting syndrome treated with 5-HTID receptor agonist is similar to the 'bi(??)', symptoms appeared in the Oryoungsan-related disease.

남성 사무직 근로자들의 직무스트레스와 간기능 이상과의 관련성

홍정연,김형렬,이보람,김용규,구정완,박정일 大韓産業醫學會 2009 대한직업환경의학회지 Vol.21 No.2

목적: 사무직 근로자의 직무스트레스와 간기능 이상의 관련성을 파악하고자 하였다. 방법: 근로자 건강검진에 참여한 남성 사무직 근로자 664명을 대상으로 응답자 직접 기입식 건강 검진 문진 및 한국인 직무스트레스 측정도구(Korean Occupational Stress Scale)의 결과와 각 근로자의 간기능 검사결과를 통해 간기능 이상에 영향을 주는 요인에 대해 분석하였다. 결과: 직무요구도 및 전체 직무스트레스 수준이 높은 군에서 간기능 이상률이 증가하였다. 음주 행동과 BMI에 따라 근로자 군을 분류하였을 때, 직무요구도 및 전체 직무스트레스 수준이 높은 군에서 간기능 이상률이 증가 하였다. 불건강 음주를 하는 군과 BMI 25이상 비만자군의 경우 직무스트레스의 수준이 간기능 이상에 중요한 역할을 하는 것으로 나타났다. 결론: 직무요구도 및 전체 직무스트레스 수준이 높은 군에서 간기능 이상과 관련성을 보였다. 따라서 직무스트레스의 조직적 관리 및 접근을 통해 간기능 건강에 기여 할 수 있을 것이다. Objectives: We wanted to investigate the relationship between job stress and liver dysfunction in Korean male white collar workers. Methods: A total of 700 male white collar workers who worked at one electronic institute and who participated in an annual surveillance program were recruited: 664(94.9%) workers were initially recruited and the data for 36 workers was excluded due to poor responses and a past history of liver disease. The questionnaire survey included the participants' general characteristics, the job-related factors, the health-related behaviors and job stress. Job stress was assessed using the Korean Occupational Stress Scale-Short Form (KOSS-SF). We merged the job stress data with the individual liver function results by conducting annual surveillance. Multiple logistic regression analysis with adjusting it for the Confounding variables, including alcohol drinking and the body mass index (BMI), was used to evaluate the relationship between job stress and liver dysfunction. Results: After adjustment for the confounding variables, the proportion of liver dysfunction cases was significantly higher in the groups with a high level of job stress, as assessed by the 'job demands and total score'. After conducting a stratified analysis with considering alcohol drinking and the BMI, the prevalence odds ratio of liver dysfunction was higher in the groups with a high level of job stress, as assessed by the 'job demands and total score'. Conclusions: The results of this study suggest that the level of job stress (and especially that assessed by the job demands and total score) is related to liver dysfunction. Thus, further preventive efforts and studies are needed to reduce job stress and address liver dysfunction.

한 전자제품 연구소 종사자들의 생활습관 행태와 건강상태의 관련성

명준표,김형렬,최원선,조성은,이보람,구정완,이강숙,박정일 大韓産業醫學會 2009 대한직업환경의학회지 Vol.21 No.1

목적 학 전자제품 개발연구소의 근로자들을 대상으로 실시하였던 건강검진 자료를 이용하여 생활습관 상태와 건강상태를 파악하고 이들 사이의 관련성을 조사하고자 하였다 방법 건강검진을 받았던 수검자 3041명을 최종 대상자로 선정하였고 국민건강보험공단에서 제시한 건강검진 문진표 중 식이 음주 몹연 운동 항목을 이용하여 생활습관에 대한 평가를 실시하였다 건강검진결과를 이용하여 비만 혈압 당뇨 간장질환 이상지혈증에 대한 정상/비정상을 평가하였다 건강검진결과와 생활습관에 대한 평가는 다변량 로지스틱 희귀분석을 통하여 실시하였다 결과 조사 대상자의 생활습관 중 과도한 음주의 유병률은 1610명(52.9%) 운동 부족 2662명(86,2%) 흡연 952명(31.3%)이였다 건강검진 결과 비만인 군은 824명(27.1%) 고혈압 군은 198명(6.5%) FBS가 비정상 군은 28명 (0.9%) 간기능 검사 비정상 군은 462명(15.2%) 이상지혈증이 있는 군은 563명(18.5%)의 유병률을 보였다 다별량 로지스틱 희귀분석 결과 육류 위주의 식이는 비만 고혈압 간장질환(ALT r-GTP) 이상지혈증(LDL)과 관련이 유의하게 높았고 과도한 음주는 비만 고혈압 r-GTP 비정상의 위험도와 통계적으로 유의한 관련성이 있었다 운동 부족인 군은 HDL 비정상의 위험도가 높았으며 흡연군은 비만 당뇨 간장질환(ALT r-GTP) 이상지혈증(TG HDL)의 위험도가 통계적으로 유의하게 높았다 결론 전자제품 개발연구소 근로자들의 바르지 않은 생활습관(식이 음주 운동 흡연)은 비만 고혈압 당뇨 간장질환 이상지혈증과 관련이 있다 따라서 연구직 근로자들을 대상으로 한 사업장 건강증진 사업이 필요하다 Background An unhealthy lifestyle is the most important cause of lifestyle-induced illness (diabetes hypertension liver enzyme abnormality dyslipidemia etc) This study was carried out to evaluate that relation between employees lifestyle and their health status in a Korean electronic research and development company Methods We conducted a descriptive cross-sectional survey 3,041 consecutive workers in a Korean R&D company were enrolled in this study A checkup list for the health examination (from the National Health Insurance Coperation) which contained the information on the lifestyle, and the results of the health examination which contained information on the body mass index (BMI) systolic blood pressure (SBP) and diastolic blood pressure (DBP) and liver function tests (LFT AST ALT r-GTP) and Cholesterol profiles (total cholesterol TG, HDL, LDL) were done for all the subjects We evaluated the health profile as normal or abnormal Statistical analysis of the health profiles and the lifestyle of the employees was performing by using multiple logistic regression analysis Results The prevalence of 'excessive alcohol drinking was 52.9% (n=1,610) that for 'lack of exercise' was 86.2% (n=2,662), that for meat eating 12.2% (n=370) and that for current smoker was 31.3% (n=952) According to results of health examination the prevalence of obesity was 27.1%(n=824) hypertension was 7.1% (n=215) diabetes was 1.0% (n=30) abnormal LFT was 15.4% (n=469) and dyslipidemia was 18.7% (n=569) On multiple logistic regression analysis of the health profile and lifestyle 'meat eating' was related to obesity hypertension abnormal LFT (ALT, r-GTP) dyslipidemia (LDL) Excessive alcohol drinking was related to obesity hypertension abnormal LFT (r-GTP) Lack of exercise' was related to dyslipidemia (HDL) Current smoker was related to obesity, diabetes abnormal LFT (ALT r-GTP) and dyslipidemia (TG HDL) with statistically significance Conclusions For workers in the R&D company an unhealthy lifestyle (such as diet alcohol drinking lack of exercise and smoking) were related to obesity hypertension diabetes abnormal LFT and dyslipidemia Therefore health promotion is necessary for the young employees of an Korean R&D company