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.

응급실을 내원한 65세 이상 노인 환자의 분석

김진년,김태훈,강양욱,오명,김상철,김성훈,권계형,남홍우,이홍순,유형준 대한노인병학회 2001 대한노인병학회지 Vol.5 No.3

몇 가지 임상분리균주에 대한 Biospot^(�)의 살균효과

김상일,신정희,김요숙,이지영,최수미,위성헌,김양리,강문원 대한병원감염관리학회 2001 의료관련감염관리 Vol.6 No.2

우라늄 투여후 간조직에서의 효소활성도의 변화

김국찬,이강석,김진규,김인규,박효국,천기정,김상복 대한방사선 방어학회 1993 방사선방어학회지 Vol.18 No.2

우라늄 피폭후 효소활성도가 내부피폭의 biomarker로서의 가능성을 연구하기 위하여 수서생물인 잉어9Caprinus carpio)의 복강내 우라늄 투여시 간조직에서 일어나는 여러가지 효소계의 변화를 조사하였다. 이러한 효소활성도의 변화는 우라늄 내부피폭의 biomarker로서 가능성을 가지고 있으며 연구결과는 다음과 같다. 1) 6일째까지 우라늄을 주사하여 적출한 간에서의 전체단백질량은 계속 감소하고 있다. 2) 세포내의 lysosome내에 함유하고 있는 acid protease와 β-glucuronidase의 활성도는 6일째 투여후까지 활성도가 감소하고 있다. 3) Alkaline phosphatase의 경우 6일째 우라늄 투여후까지 증가하고 있으며 반대로 acid phosphatase의 경우 6일째 우라늄 투여후까지 활성도가 급격히 증가하였고 glutamate oxaloacetate transaminase의 활성도는 완만하게 증가하고 있다. 4) Creatine kinase의 활성도는 완만한 감소를 보이고 있으며 malate dehydrogenase는 첫번 우라늄 투여후에 활성도가 급격히 감소하였고 3일째 우라늄 투여후에는 활성도가 거의 나타나지 않았다. We examined various enzyme activity changes by intraperitioneal injection uranium in the carp liver. These enzyme activity changes can be used as biochemical indicators of internal exposure to uranium. The results were followings ; 1) Total protein concentration decreased by intraperitoneal injection in the carp liver. 2) Lysosomal acid protease and β-glucronidase activities increased in the liver until sixth intraperitoneal injection of uranium, but lysosomal acid phosphatase activities decreased in the liver until the sixth injection of uranium. 3) Alkaline phosphatase activities sharply increased and Glutamate oxaloacetate Transaminase activities steadily decreased in the liver until the sixth injection of uranium. 4) Creatine %kinase activities steadily decreased and malate dehydrogenase activities sharply decreased in the liver after the primary injection of uranium. Any malate dehydrogenase activities was not detected after sixth injection of uranium.

서울의 Penicillinase Producing Neisseria gonorrhoeae 발생빈도(1998)

김재홍,김준호,반재용,이정우,황성주,정준규,정성태,강진문,조흔정,홍창의,정혜신,이한승,김이선,이봉길,이종호,선영우,한기덕,윤성필,이성훈,안종성,박석범,문승현,조항래,김형섭,류지호,황재영,박준홍,손상욱 한양대학교 의과대학 2001 한양의대 학술지 Vol.21 No.1

In recent years, gonorrhea has been pandemic and remains one of the most common STDs in the world, especially in developing countries. For the detection of a more effective therapeutic regimen and assessing the prevalence of Penicillinase Producing Neisseria gonorrhoeae(PPNG), we have been trying to study the patients who have visited the Venereal Disease Clinic of Choong-Ku Public Health Center in Seoul since 1980 by menas of the chromogenic cephalosporin method. In 1998, 93 strians of N. genorrhoeae were isolated, among which 60(64.5%) were PPNG. The prevalence of PPNG in Seoul, which had been decreased to 39% in 1996 after a peak of 74.3% in 1993, is increased to 64.5% in 1998.

특수교육 정보화 체제 구축 방안 연구

김종무,강경숙,강대식,Kim-Sung, Kellie K. 국립특수교육원 2001 연구보고서 Vol.- No.8

본 연구는 특수교육 정보화 관련 국내 · 외 문헌자료와 사례를 소개하고, 국내 특수교육정보화 실태 조사를 실시하여 첫째, 기초 통계자료를 확보하고 둘째, 효율적이면서도 실제적인 정보화체제 구축방안을 제시하는데 그 목적이 있다. 그동안 국내에서 광범위하게 추진되었던 교육정보화 사업에 있어서 전체 학교 학내망 설치와 같은 가시적인 정보화기반 구축 사업에 대해서는 전반적으로 성공적이라는 평가를하고 있지만 특정 수요 집단에게는 정보격차의 심화 및 접근성 문제의 심각성 등 부정적인 결과를 초래하기도 하였다. 이에 본 연구에서는 국내·외 특수교육 정보화 사례와 자료를 소개하고, 국내 특수교육정보화 실태를 파악하기 위한 설문조사를 실시하였다. 설문조사 대상은 특수학교 교사, 학생, 장애학생 부모, 장애인관련 단체 및 기관, 시 · 도교육청이었고, 조사 결과 특수학교 교사의 경우 컴퓨터 보유, 인터넷 사용 등에 있어서는 매우 양호하게 나타났으나 정보 활용기술에 해당하는 영역 즉, 장애학생을 교수하기 위한 자료의 제작과 교수-학습과정에서의 적용 수준에서는 저조하게 나타났다. 비장애학생과 비교할 수는 없지만 장애학생의 컴퓨터보유와 인터넷 사용 유 ·무에 관해서는 40~60%의 응답자가 긍정적으로 응답하였고 체계적인 지원이 수반된다면 좋은 결과가 있을 것으로 분석되었다. 본 연구에서는 정보화 지원 체제 구축 방안으로 크게 예산지원과 행정지원을 포함하여 특수학교, 교사, 학부모, 장애학생, 행정가, 장애인관련 기관 등의 요소로 구분하여 지원 방안을 제시하였다. 소개된 지원내용을 간략히 정리하면 다음과 같다. 첫째, 특수교육정보화 체제 구축을 위한 예산 지원은 외국의 사례에서도 나타났듯이 안정성과 지속성을 확보하기 위하여 '초·중등교육법', '특수교육진흥법'을 통해 지원에 관한 세부 사항을 법으로 규정해야한다. 둘째, 특수교육 정보화 사업과 관련된 부처간 행정 협조체제의 수립과 사업 중복성 등을 피하기 위하여 전담기구나 기관의 지정이 요구된다. 셋째, 특수학교의 경우, 학내망 설치와 더불어 장애인 접근성 문제의 해결을 위한 프로그램 개발과 하드웨어 장비의 지원, 교실간 네트워크 구축, 학교간 WAN 구축 등의 사업이 추진되어야 하며, 특수학급의 경우는 정보화 환경구축이 미흡하기 때문에 소속 교육청 과의 네트워크 구축을 통한 정보공유 및 행정업무의 연계가 필요하고, 다양한 교수-학습자료의 지원이 절실히 요구된다. 넷째, 특수교육 교사의 연수 기회를 확대하고 전문성을 키워줄 수 있는 연수내용과 방법의 개선이 필요하다. 장애학생 교육을 위한 학습자료 제작 기법, 장애인용 프로그램 사용법, 특수단말 장비 및 정보매체 활용 기법 등의 프로그램을 개발하여 집체+원격+화상 형태의 입체적인 연수가 요구된다. 다섯째, 장애학생 부모를 위한 정보화 지원은 학교-교육청간 협력하에 부모 교육 프로그램을 개발하여 우선, 학교와 인근 지역의 장애인관련 기관을 활용하여 정보소양 교육을 실시하고, 언제, 어디서나 교육이 가능한 원격이나 사이버시스템 등을 매개로 부모의 여건을 배려해줄 수 있는 편리한 교육방법이 준비되어야 한다. 여섯째, 교육청별 특수교육 담당장학사의 정보화 수준은 양호한 것으로 평가되지만 특수교육 정보화를 위한 특수학교(급) 교사의 연수지원을 위한 예산규모의 확보나 프로그램 개발 지원 등은 매우 부족한 것으로 나타났는데, 교육부(국립특수교육원)를 중심으로 전체 교육청의 특수교육 정보화 업무를 단일 체제로 묶는 인프라를 구축하여 예산, 프로그램, 네트워크 등을 공유토록 하여 효율성을 확보해야 한다. 일곱째, 장애인관련 단체는 정보화 업무 담당자를 배치하여 장애인과 일반인을 대상으로 활발한 정보화 교육이 이루어지고 있었지만 재정지원이 아직도 부족하고, 장애인용 프로그램과 기기의 보급이 부족하여 한계가 있는 것으로 드러났는데, 마찬가지로 장애인관련 기관을 하나로 묶는 인프라의 구축을 통해 사용되는 프로그램을 표준화시키고 예산지원의 중복성을 피해야하며 기관 이용자에 대한 관리의 편리성도 함께 도모해야 할 것이다. This study intends to collect baseline data and to present effective and practical methods of establishing special education IT system. An extensive review of both domestic and foreign literature and case studies of best practices were conducted for this research as well as the evaluation of the current state of technology usage and adoption in special education in Korea. Previous nationwide educational technology projects have accomplished notable and successful results such as building Intranet for schools. However, such efforts have, in away, created and aggravated the disproportionate gap, often called as the digital divide, against certain groups of people with unique needs. Also, the accessibility to such technology and information has emerged as a serious problem as the role of technology expanded. This study introduced both domestic and foreign examples of technology in special education and relevant resources, and conducted a large-scale survey to examine the current stage of technology adoption and usage in special education in Korea. The survey was administered to special education teachers, students, parents of students with disabilities, disability-related organizations and relevant agencies, and to municipal and provincial department of education. The results found satisfactory levels of computer ownership and usage of Internet among special education teachers. However, utilizing and incorporating such Information and technology into classroom activities and into teaching material development were still limited. Although the data were not comparable to those from students without disabilities, about 40 to 60 percent of the respondents showed positive attitudes toward computer ownership and Internet usage of students with disabilities, suggesting desirable outcomes with appropriate systematic support. Based on the findings, this study recommended detailed methods of building broad financial or budgetary assistance systems for special education schools, teachers, parents, students, administrators, and disability-related organizations. First, as shown in the experiences of foreign countries, financial support from the government to establish the system for the special education information technology has to be mandated under the 'Elementary and Secondary Education Act', the 'Special Education Promotion Act' to ensure and enhance stability and continuity. Second, designation of a single commanding and responsible agency is called for to efficiently coordinate inter-agency collaboration among governmental agencies and departments, and to avoid redundancy of work. Third, for special education schools, tasks such as building school-wide Intranet, development of software solving accessibility issues, subsidizing funds for computer hardware purchase, connecting classrooms through networking system and establishing inter-school WAN are of critical importance. Fourth, the contents and methods of professional development and training for special education teachers should be improved to professionalize teachers, and expansion of such opportunities are also called for. Fifth, IT support for parents of students with disabilities is also important. Parent education and training programs should be developed through active collaboration between local department of education and schools, and such training programs may be offered at schools or disability-related facilities. Distance learning or online courses, which the parents can access regardless of time or location, are other feasible alternatives. Sixth, the results found that administrative staffs of special education at each local department of education displayed satisfactory competence levels. However, the amount of budget assigned for special education teacher training or program development was seriously insufficient. Therefore, the Ministry of Education (or KISE) should build a universal infrastructure of IT, which encompasses and shares budget, program and network systems across all the IT offices of the local department of education. Seventh, although most disability organizations have IT specialist and offered IT education programs for both persons with and without disabilities, they have been experiencing continued problems of insufficient financial support and lack of adaptive technology devices and accessible programs. Therefore, building a universal infrastructure across disability organizations is called for to standardize programs, to prevent overlaps in funding, and thus, to enhance administrative efficiency.

중추신경계 합병증을 동반한 삼일열 말라리아 1례

김문석,김가연,강유민,김낙현,전재현,박완범,김홍빈,김남중,박상원,홍윤호,오명돈 대한감염학회 2009 감염과 화학요법 Vol.41 No.5

Plasmodium vivax malaria is an endemic disease in Korea, which rarely causes severe complications including those occurring in the cerebrum. There are limited numbers of complicated cases that have been reported around the world. We experienced a case of vivax malaria with cerebral complication: cognitive impairment and ataxia. A 55-year-old female with diabetes mellitus presented to the emergency department with acute fever of two days’ duration. She did not have any history of travelling abroad or receiving blood transfusions. Peripheral blood smear revealed vivax malaria with parasitemia density of 0.53 percent. She demonstrated loss of orientation, especially regarding time and place, and ataxia. Although the initial hydroxychloroquine treatment for malaria was successful, cognitive impairment and ataxia persisted and were not recovered. Brain MRI showed no structural abnormality. Brain PET showed diffuse hypometabolism in right parieto-temporal lobe of the brain.

Nitric Oxide에 의한 난소 과립세포의 Apoptosis 조절에 대한 연구

강한승,이석자,김외리,이채관,신창숙,김성태,강성구 인제대학교기초과학연구소 1998 자연과학 Vol.2 No.-

여포의 퇴화가 진행되는 기작에서 apoptotic cell death 와 nitric oxide (NO)의 연관성에 관하여 실험하였다. 난소의 apoptosis는 GnRH에 의해 유도되고 스테로이드에 의해 억제된다. 여포에서 과립 세포의 apoptosis에 대한 호르몬의 영향과 NO 생산효과를 조사하기 위하여 중간크기 (직경 5-6 ㎜)의 여포에서 non-apoptotic 과립세포를 분리하여 스테로이드, GnRH agonist, GNRH agonist+SNP, 그리고 NO 공여체인 SNP를 처리하여 24시간동안 배양하였다. 배양된 과립세포에서 게놈 DNA를 추출하여 apoptotic DNA절편화 경향을 알아보았고, 배양액과 griess reagent를 반응시켜 nitrite 농도를 측정하였다. 스테로이드 호르몬을 처리하였을 때, 대조군에 비해 NO 생성이 다소 증가하였으며 apoptotic DNA 절편화도 억제되었다. GnRH agonist 처리군에서는 apoptotic DNA 절편화가 가속화 양상을 나타내었으며 NO 생성은 다소 감소하였다. 그러나 GnRH agonist+SNP 그리고 SNP 처리군에서는 apoptotic DNA 퇴화가 억제되었으며 NO 농도는 대조군에 비해 현저히 높았다. 위의 실험 결과로 보아 과립세포 분화와 여포성숙과 퇴화과정에서 호르몬과 NO가 밀접한 관련이 있는 것으로 사료된다. To study the regulation of porcine follicular cell apoptosis by steroids, GnRH agonist and nitric oxide, we have analyzed DNA fragmentation, the hallmark of apoptosis, and nitrite production in porcine granulosa cells. In, ovarian apoptosis is induced by GnRH but is prevented by steroids. Apoptosis is confined to the granulosa cells but it was not clear whether apoptosis of granulosa cell was regulated by NO in vitro. So non-apoptotic granulosa cells isolated, grown at 37℃, for 24 hrs, and treated with / without SNP, GnRH agonist, and sterioid, respectively. In cultured granulosa cells were used to extract genomic DNA and culture media was assayed for nitrite concentration. Nitrite production of culture media was increased and apoptotic DNA fragmentation was supressed in SNP treated groups, GnRH agonist+SNP, and estrogen, progesterone. Nitrite concentration in culture media was decreased and apoptotic DNA was induced treated with GnRH agonist. These data suggest that NO production and apoptosis may be involved of granulosa cell differentiation and ovarian follicular atresia by SNP, estrogen and progesterone. Moreover, NO can overcome the granulosa cell apoptosis induced by GnRH agonist.

Associations of serotonergic genes with poststroke emotional incontinence

Kim, Jae‐,Min,Stewart, Robert,Kang, Hee‐,Ju,Bae, Kyung‐,Yeol,Kim, Sung‐,Wan,Shin, Il‐,Seon,Kim, Joon‐,Tae,Park, Man‐,Seok,Cho, Ki‐,Hyun,Yoon, Jin‐ John Wiley Sons, Ltd 2012 INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Vol.27 No.8

<P><B>Objectives</B></P><P>Poststroke emotional incontinence (PSEI) has been associated with serotonergic dysfunction. Polymorphisms of serotonin transporter (5‐HTT) and serotonin 2a receptor (5‐HTR2a) genes may regulate serotonergic signaling at brain synapses, and this study was to investigate associations with PSEI in an East Asian population.</P><P><B>Methods</B></P><P>In 276 stroke cases, PSEI was diagnosed by Kim's criteria. Covariates included age, gender, education, history of depression or stroke, current depression, and stroke severity and location. Genotypes were ascertained for 5‐HTT gene‐linked promoter region (5‐HTTLPR), serotonin transporter intron 2 variable number tandem repeat, 5‐HTR2a 1438A/G, and 5‐HTR2a 102 T/C. Associations with PSEI were estimated by using logistic regression models, and gene–gene interactions were investigated by using the generalized multifactor dimensionality reduction method.</P><P><B>Results</B></P><P>PSEI was present in 37 (13.4%) patients. The 5‐HTT gene‐linked promoter region <I>s</I>/<I>s</I> genotype was independently associated with PSEI. No associations with STin2 VNTR and 5‐HTR2a genes were found, and no significant gene–gene interactions were identified.</P><P><B>Conclusions</B></P><P>Stroke patients with 5‐HTTLPR <I>s</I> allele had higher susceptibility to PSEI, which underlines the potential role of serotonergic pathways in its etiology. Copyright © 2011 John Wiley & Sons, Ltd.</P>

위절제술 환자의 표준진료지침 개발 및 적용 효과

김은희,김철규,이순교,김순덕,이혜옥,권정순,이경미,이민미,심순미,유용만,신종식,강은희,이상일,김병식,오성태,육정환,박수길 한국의료QA학회 2003 한국의료질향상학회지 Vol.10 No.2

Background : Gastric cancer is the most common malignant tumor in Korea. surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for recucing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and unplanned readmission rate between the pre-pathway group(n=67) and the post-pathway group(n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days(p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was of satistically significant(p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korea hospital settings.