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.

정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

임신 중 고혈압성 질환에 대한 임상적 고찰

김경철,정명철,김호성,조민형,고재환,김용봉 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Objective: The aim of this study was to investigate the clinical charact eristics of pregnancy induced hypertension(PIH). Methods: We retrospectively evaluated the clinical characteristics through the collected data of 176 PIH cases treated at Seoul Paik hospital from March 1995 to December 2002. Results: The proportions of severe PIH, mild PIH, and chronic hypertension were 70%, 24%, and 6% of the cases, respectively. According to maternal age, the highest rate of 45% was noted in the group of 26-30 years of age. The rate of cesarean(80%) was higher than the rate of vaginal delivery(20%). The blood pressure was controlled by hydralazine for 70% of the patients. The rate of single gestation was 90%. The birthweight of 20% of the newborn were 2500gm or more. The anemia, twin pregnancy, postpartum hemorrhage, pulmonary edema, and infection were found in 30%, 10%, 3%, 2%, and 1% of the PIH patients, respectively. In respect of the perinatal complications, the rates of low birth weight, stillbirth, and neonatal death were 80%, 3%, and 1%, respectively. Conclusion: We were able to decrease the mortality and morbidity of PIH patients and neonates with strict antenatal care and proper treatment.

프로야구 손상의 임상적 분석

김철준,김명화,김미정,신명진,윤준오,김상규 대한스포츠의학회 1995 대한스포츠의학회지 Vol.13 No.1

Baseball is rapidly getting popularity in Korea as it has been in U.S.A and Japan. During the last decade, threre were several studies about baseball injuries which oriented mainly to the overuse injuries of growing baseball players. But there was no study the professional baseball players systematically. This study was surposed to see the general characteristics of baseball injuries and to provide the prevention and rehabilitation programs if recommended. The number of 83 injuries of 60 baseball players was analysed according to the position, injury site, diagnosis, injury mechanism and duration of injury. The mean age and height of 60 subjects were 24.6 years old and 180.65㎝, respectively. The baseball position of 82 injured cases were composed of 27 pitchers, 30 infielder, 19 outfielder and 6 catchers. The characteristics of injury were as follows: 1.The number of chronic injury was 56 cases(68.3%) and the percentage of chronic injury of pitchers was up to 81.5% compared 73.3% of infielder and 47.4% of outfielder. 2. The injury rate of both lower and upper extremitis were equal and the rate of lower back problems was the second, which should be concerned. 3. The number of cases injured by direct collison is as low as 15(18.3%). The most common secondary cause of injury was aggressive throwing itself and 26 out of 49 cases injured not by direct collision. 4. More concern should be payed about the low back problems and about the catcher and the field players as much as pitchers from now one.

정상인에서 베타3-아드레날린 수용체 유전자의 변이가 복부 비만도 및 지질대사에 미치는 영향

김영선,윤석기,김철희,서교일,김학선,김극배,변동원,유명희 순천향의학연구소 1998 Journal of Soonchunhyang Medical Science Vol.4 No.1

The β₃-adrenergic receptor is expressed in visceral adipose tissue in humans and is thought to contribute to the regulation of the resting metabolic rate and lipolysis. We studied the influence of a mutation in the β₃ -adrenergic receptor gene(Trp64Arg) on body fat distribution, central obesity, lipid metabolism in 65 healthy young male adults. One out of 65 subjects were homozygous (Arg/Arg) for the trp64Arg mutation, 17 subjects were heterozygous (Trp/Arg), and 47 lacked the mutation(Trp/Trp). The body weight, height, body mass index, waist-to-hip ratio were similar between the subjects with- and without the mutation. Total body fat, abdominal fat amount, body fat distribution, serum total- and HDL-cholesterol, triglyceride, glucose, and insulin concentrations were also not different according to the presence or absence of the mutation. These results suggested that Trp64Arg mutation in β₃-adrenergic receptor gene is not a major contributing factor for central obesity or change in lipid metabolism in Korean young adults.

경피적 자궁동맥 색전술로 치료한 산후 출혈 1례

정명철,김호성,김경철,노지현,고재환,김용봉,권동일 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Postpartum hemorrhage remains one of the leading causes of maternal deaths. The major causes of postpartum hemorrhage include uterine atony, retained placental fragment, placenta accreta, and lower genital tract lacerations. Conservative treatment is based on administration of uterotonic drugs, vaginal packing, and surgical repair of genital tract lacerations. When bleeding fails to respond to conservative treatment, surgical ligation of uterine vessels or hemostatic hysterectomy is performed. We present a case of postpartum bleeding treated by selective uterine arterial embolization with a brief review of previous literatures of postpartum hemorrhage & uterine arterial embolization.

현훈 환자 Neuron Specific Enolase의 임상적 의의

김원주,김선곤,유철형,김원찬,김용덕,최영철,이명식 대한신경과학회 1998 대한신경과학회지 Vol.16 No.4

청주대학교 간호학과 교육과정 개발 연구

안경주 김철규 전해옥 김봉정 김혜숙 채명옥 윤현정 한달롱 김아린 청주대학교 보건의료과학연구소 2014 보건의료과학연구 Vol.3 No.1

Dynamics in the workplace and in society have contributed to the paradigm shift to outcome-based education. This study was performed to develop the curriculum based on assessment of existing program for the baccalaureate nursing program at Cheongju University. We used three steps-Analysis, Design, and Development-in ADDIE model for developing curriculum. The subjects were 18 graduate nurses, 41 nursing students, 38 parents, and 2 nursing team leaders for analysis of core competence. In conclusion, developing an outcome-based curriculum might be used to facilitate the students' development and evaluate the competence of the student during and on completion of the nursing baccalaureate program at Cheongju University.

항갑상선제로 치료한 그레이브스병 환자의 관해예측인자

남일송,윤여일,김선규,김용현,이주영,목지오,윤석기,김철희,김영선,변동원,서교일,유명희 순천향의학연구소 2001 Journal of Soonchunhyang Medical Science Vol.7 No.2

Background: Most cases of Graves' disease have been treated by antithyroid drugs in Korea. The major drawbacks of antithyroid drugs are the relative high rate of relapse and the inconvinience of long term therapy. Measurement of TBII and TRH stimulation test have been considered as the most reliable tests predicting relapse, but the predictive power is not high enough to use in clinical situation. This study was performed to find good prognostic indicators in Graves' disease patients after the discontinuation of antithyroid drug therapy. Subjects and methods : We restrospectively evaluated 96 patients with Graves' disease who showed normal TRH test at the end of antithyroid drug therapy and were followed for more than one year. Serum T3, T4, T3/T4 ratio, TBII, Anti-TPO Ab and TGAb levels were measured at the time of diagnosis and at the end of therapy. Two to three months after withdrawal of antithyroid medication, serum TSH and free T3 responses to TRH were examined. These parameters were compared between the relapse group and the remission group. Results : Among the 96 patients, 22 patients(22.9%) relapsed(Group Ⅱ) and 74 patients(77.1%) remained in remmision(Group Ⅰ). No significant difference was observed between the relapse and the remission group in clinical parameters, serum T3, T4, TSH, T3/T4 ratio, TBⅡ and Anti-TPO Ab determined before and after treatment. Serum TSH and free T3 levels measured after TRH stimulation were also similar in both groups. Serum TGAb levels determined at the end of treatment were significantly higher in the remission group(p<0.05). Relapse following the discontinuation of therapy occured within 24 months in 72.7% of the relapsed cases. After 24 months, relapse rate was reduced significantly. Conclusion : These results suggest that high serum TGAb levels could be a favorable prognostic indicator for the long term remission of Graves' disease treated with antithyroid drugs, and may suggest that Hashimoto's thyroiditis is combined with Graves' disease in those patients.

Brucella abortus 국내 분리주의 36kDa 외막단백을 암호하는 omp2b 유전자의 염기 분석

허지연,김지영,송근호,김명철,박창식,김태용,김정화,전무형 한국수의공중보건학회 2003 예방수의학회지 Vol.27 No.1

B. abortus 국내 분리주의 분자유전학적 성상을 규명하고 분자역학적 연구에 필요한 기초자료를 얻기위해 36kDa OMP를 암호하는 omp2b 유전자를 PCR법으로 확인하고, 그리고 omp2b 유전자의 핵염기 서열과 아미노산 서열을 결정하고 이 결과를 Brucella 표준균주 및 여러 동물에서 분리된 Brucella 분리주와 상호 비교 분석하였던 바 다음과 같은 결과를 얻었다 1. B. abortus 분리주 (7주)에 대해 omp2b primers를 이용하여 PCR을 수행 한 바 공시한 참조균주와 분리균주 모두에서 1,251bp의 특이한 DNA 절편이 각각 증폭되었다 2. omp2b 유전자의 1,089bp에 대한 염기서열과 이에 대한 362개의 아미노산 서열을 결정하였다. 분리균주의 omp2b 유전자의 염기서열을 참조균주와 비교 분석한 결과 B. abortus 2308 (biovar 1) 및 B. abortus B3196 (biovar 5)과는 99.6%~l00% 및99.5%~99.9%의 매우 높은 상품성을 나타내었고, B. abortus 45/20 (biovar 1)과는 97.1%~97.4%의 상품성을 나타내었다. 또한 362개의 아미노산 서열에 대해 분석하였던 바, 분리균주들은 B. abortustus 2308 (biovar 1) 및 B. abortus B3196 (biovar 5)과는 99.2%~l00%의 매우 높은 상품성을 보였으며, B. abortus 45/20 (biovar 1)과는 96.4%~97.2%의 상품성을 보였다. 3. 본 시험에 공시된 브루셀라균주의 omp2b 유전자서열과 여러 동물에서 분리된 브루셀라 분리주의자료를 바탕으로 phylogenetic tree를 작성 한 바, 국내 분리주는 B. abortus 2308 (biovar 1), B. abortus B3196 (blovar 5), B. abortus 45/20 (biovar 1), B. suis 1330 (biovar 1), B. melitensis 16M (biovar 1), B. canis NCTC 01854, B. neotomae 5k33과 97.3%이상의 높은 근연성을 보이며 동일한 cluster에 소속되었으며, omp2b 유전자는 매우 잘 보존됨을 알 수 있었다. omp2b gene of Brucella abortus isolates encoding 36kDa outer membrane protein (OW) was amplified by polymerase chain reaction (PCR) and the sequences of nucleotide and amino acid were determined and analyzed to obtain the basic data for molecular epidemiological features of brucellosis in Korea. In PCR using omp2b primers for the gene of 36kDa OMP, the specific signals at 1,251bp were demonstrated, The nucleotide sequences of omp2b gene of 1,089bp were sequenced by dye terminator cycle sequencing method, and 362 amino acid sequences were predicted. As compared the nucleotide sequences with those of B. abortus reference strains, the isolates showed the very high homology to the reference strains ranging 97.1%-100%. The similar results were also obtained in the analysis of the amino acid sequences. In the phylogenetic tree, the isolates clustered with the reference strains and the majority of strains originated from pig, dog, wood rat and cattle.