만성정신질환자의 계속입원치료 심사에 관한 연구

정인원,박환규,정연복,김수일,원구연,김교형,신철진 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.6

연구목적: 정신보건법에 근거하여 매월 정기적으로 개최된 충청북도 정신보건심판위원회를 통하여 정신질환자의 계속입원치료 청구 심사의 현황과 문제점을 파악하고 개선사항을 지적함으로써 정신질환자의 효율적인 관리를 유도하고 인권남용의 여지를 차단하고자 한다. 방 법: 충청북도 내의 정신의료기관에서 계속입원치료 심사청구서 및 진단서, 보호의무자의 동의서 등을 제출한 정신질환자들을 대상으로 계속입원치료 청구에 대한 승인 여부를 매달 정기적으로 심사하였다. 1년 6개월여동안 심사한 자료를 정리하여 진단 및 보호의무자, 의료보장별 특성과 불승인률 등을 분석하였다. 결 과: 충청북도 심판위원회에 계속입원치료를 청구한 정신질환자는 21차례의 위원회 동안 총 7,981명이었으며, 진단별로 정신분열병은 80.9%, 알콜중독은 8.1%, 치매 등 기타는 11.0%이었다. 또한 보호의무자는 시장 또는 군수가 29.8%, 부모가 26.9%, 형제가 26.1%, 부부가 6.3%, 자녀가 5.9%, 기타가 5.0%로 나타났으며, 의료보장은 의료보호가 73.0%, 의료보험이 27.0%이었다. 이들 중에서 196명이 계속입원치료를 불승인받아서 전체 불승인률은 2.46%이었으며 정신분열병과 알콜중독 환자의 진단별 불승인률은 각각 0.73%와 17.6%이었다. 결 론: 정신과 병상의 대부분이 장기적으로 입원하는 만성 정신질환자들로 구성되어 있어서 이들에 대한 별도의 대책이 시급하다. 또한 계속입원치료가 불승인되어 퇴원한 환자들의 재활 및 사회적응을 위한 사회적 지지 체계가 부족하며, 특히 환자의 인권보호를 위한 구체적인 기준 등이 필요하다. Objectives: This study was to develop effective managements and to avoid the abuse of human rights in mentally-ill patients. The Mental Health Judgement Board of Chungchongbuk-do province has been held monthly since August, 1997 according to the Mental Health Act. In this study, the procedures and the problems of judging continuing hospitalization of chronic mentally-ill patients were reviewed. Methods: The mentally-ill patients who submitted the request for continuing hospitalization with the certificate of charged doctor and the agreement of caregiver were reviewed by the Mental Health Judgement Board of Chungchongbuk-do province. The analysis of the diagnoses, caregivers, medical care systems, and rejection rate for the patients were done. Results: Total mumber of mentally-ill patients who requested for continuing hospitalization were 7,981 from twenty-one monthly meetings. The diagnostic distributions were 80.9% for schizophrenic patients, 8.1% for alcoholics and 11.0% for others including dementia. As for the caretakers, the rate of majors was 29.8%, parents 26.9%, sibling 26.1%, spouse 6.3%, offspring 5.9%, and others 5.0%. And 73.0% of the patients were on Medicaid and 27.0% were insured. The patients who got the rejection for continuing hospitalization were 196 at the rate of 2.46%. And the rejection rates of schIzophrenic and alcoholic patients were 0.73% and 17.6%, respectively. Conclusions: New policies for decreasing longterm hospitalization of chronic mentally-ill patients are required. And the social support systems for psychiatric rehabilitation and readjustment are presently insufficient for the already discharged mentally-ill. Moreover, the practical guidelines for human rights of patients remains to be suggested.

사업장 근로자의 건강위험 평가도구 개발

정규철,이용애,홍윤철,조희숙,박혜숙,임현술,하은희 이화여자대학교 환경문제연구소 1998 이화환경연구 Vol.2 No.-

Health Risk Appraisal(HRA) is usually defined as a process by which we expect of individual's chances of acquiring specific diseases within a defined period of time. The concept of worksite as an area of health maintenance and promotion is newly developing. Our movement for health promotion of employees has been increasingly known in the worksite. The aim of this study is to develop health risk appraisal tools about health promotion at the worksite for employees. We performed this study by two steps: one step was to develop a HRA questionnaire of worksites in Korea, another was to evaluate the reliability of the questionnaire. For developing HRA questionnaire, we reviewed scientific examples at first, and then weighted the score by delphi. To evaluate the reliability of developed questionnaire, we carried out survey by test-retest method. A total of 131 employees completed HRA questionnaire on two times. The results are as follows. The total score of health risk in unhealthy workers was higher than that of healthy workers. The range of test-retest reliability of responses to the questionnaire was 0.57-0.94. Therefore it seems that this questionnaire was very suitable to assess the health behavior of workers. In conclusion, the developed HRA questionnaire can be used as a tool for evaluating health behavior and for providing health counseling materials.

미생물을 이용한 폐수중 중금속 제거/회수기술 개발

정윤철 嶺南大學校 環境問題硏究所 1993 環境硏究 Vol.12 No.2

유해물질의 폐수배출허용기준 설정을 위한 조사·평가체계연구

정윤철,손대희 한국물환경학회 ( 구 한국수질보전학회 ) 2002 한국물환경학회지 Vol.18 No.2

鳥嶺山 自然休養林地域의 森林植生에 關한 硏究

辛壽哲,鄭玧洙 건국대학교 자연과학연구소 1999 建國自然科學硏究誌 Vol.10 No.1

To investigate the structure of the forest vegetation of Mt. Joryong recreation forest area in Chungbuk district, fourteen plots of natural forest and two plots of artificial forest were set up. As the result of classification and ordination analysis the study area was divided into four proups. which were Larix leptolepis community, Quercus mongolitca community. Quercus ariena community, Pinus rigida community. species diversity indices range of each communitiy was 0.7902~1.4192, Quercus aliena community showed the highest value and Larix leptolepis community showed the lowest value among the communities. The similarity indices range of each community was 25.77~57.45%, between Quercus monglica community and Quercus aliena community showed the highest value while Quercus aliena community and Larix leptolepis community showed the lowest value among the communities. The comparision of site quality index of Mt. Joryong recreation forest area with nationwide, Larix leptolepis, Pinus densiflora, Quercus mongolica, and Qugrcus altena estimated average site quality index while Pinus rigida showed below the average of nationwide was caused by high stem dencity.

고지방식이가 백서 골격근 및 지방조직의 지방분해에 미치는 영향

김철희,정윤이,이성진,박중열,홍성관,김홍규,서교일,이기업 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.24 No.6

연구배경:지방산화의 증가가 골격근에서 인슐린 저항성을 유발한다는 주장이 꾸준히 제기되어 나왔으나, 최근 제2형 당뇨병 환자나 인슐린저항성 상태에서 골격근의 지방산화능이 저하되어 있다는 보고도 있어 논란이 있는 상태이다. 본 연구에서는 고지방식이를 투여하여 인슐린저항성을 유발한 백서에서 microdialysis 기법을 이용하여 조직내의 지방분해 결과로 간질액내로 방출되는 글리세롤 농도를 골격근 및 지방조직에서 직접 측정하여 지방분해의 변화를 알아보고자 하였다. 방법:정상 Sprague­Dawley 백서를 두 군으로 나누어 4주간 고지방식이 및 저지방식이를 투여하였다. 4주간 기저상태 및 고인슐린 정상혈당 클램프 중의 골격근 및 지방조직에 microdialysis probe를 삽입하고 일정한 농도의 글리세롤을 포함하는 dialysate를 통과시켜 주입액과 유출액의 글리세롤 농도 차이로부터 조직 간질의 글리세롤 농도를 산출하엿다. 결과:기저상태에서 골격근 및 지방조직 간질의 글리세롤 농도는 저지방식이군에 비하여 고지방식이군에서 유의하게 낮았다. 고인슐린 정상혈당 클램프 중에는 골격근 및 지방조직 간질의 글리세롤 농도가 양군에서 모두 억제되었는데, 기저 상태와 마찬가지로 골격근 및 지방조직 모두에서 저지방식이군보다 고지방식이 군에서 더 낮았다. 기저 상태에 대한 고인슐린 클램프중의 글리세롤 방출 억제 정도는 저지방식이군에 비하여 고지방식이군에서 덜 억제되는 경향을 보였는데, 골격근조직에서만 통계적으로 유의하였다. 결론:본 연구 결과는 고지방식이에 의한 인슐린저항성 모델에서 골격근 및 지방조직내 지방분해가 억제되어 있음을 보여주며, 기존의 포도당­지방산 cycle 이론과는 달리 조직내 지방산화의 증가보다는 지방산화능의 감소에 따른 세포내 지방축척이 인슐린저항성과 관련될 가능성을 시사하였다. Background : It has been hypothesized that increased fat oxidation reduces glucose utilization in skeletal muscle, and is responsible for the insulin resistance associated with obesity or high-fat feeding. In contrast, there have been reports that fat oxidation capacity was decreased in skeletal muscles from insulin resistant subjects. This study was undertaken to examine whether insulin resistance in high-fat fed rats is associated with increased lipolysis in skeletal muscle and adipose tissue. Methods : Two groups of Sprague-Dawley rats were fed either high-fat or low-fat diets for 4 weeks. Lipolysis in skeletal muscle and adipose tissue was determined by measurement of interstitial 1 glycerol concentrations by a microdialysis method in basal and hyperinsuline mic-euglycemic clamp conditions. Results : In basal state, plasma glycerol levels and interstitial glycerol concentrations of skeletal muscle, and adipose tissue were lower in high-fat fed than in low-fat fed rats. The degree of suppression of glycerol release by the hyperinsuline mia was smaller in the high-fat diet than in the low-fat diet group. However, plasma and interstitial glycerol concentrations during the hyperinsuline mic euglycemic clamps were also lower in the high-fat diet group. Conclusion : Lipolysis was decreased in skeletal muscle and adipose tissue of insulin resistant, high-fat fed rats. These results support the idea that limited fat oxidation capacity resulting in lipid accumulation in tissues, rather than increased fat oxidation perse, is responsible for the insulin resistance associated with high-fat feeding (J Kor Diabetes Asso 24:641~651, 2000).

노인외상환자의 예후 인자

문철규,전정민,최성혁,문준동,이성우,홍윤식 大韓應急醫學會 1999 대한응급의학회지 Vol.10 No.2

Background: It has been documented that certain prognostic factors may affect the outcomes of the old aged victims by trauma. Considering that trauma is the sixth most common cause of death in people over the age of 65 years and there is a rapid growth of elderly population, it is paramount to understand the prognostic factors when dealing with geriatric trauma patients. Hypothesis and Goals: It can be hypothesized that the prognostic factors should be determined independently between populations being consisted of different races, countries, socio-economic states, cultures, or so on. Thus, the study was designed to evaluate the factors affecting the outcomes of elderly Korean trauma patients. Methods: One hundred forty six patients aged over 65 years were retrospectively reviewed, who visited the Emergency Center of Korea University from January, 1997 to June, 1998. Of 146 patients, 7 were excluded due to discharge against advice or transfer to the other hospitals. Parameters analyzed were age, sex, mechanism of injuries, body region injured, Injury Severity Score (ISS), previous medical illness, hospital morbidity, duration of hospital stay, and cost. Each patient was classified into improved or not-improved group depending on the outcomes, and young-old or old-old group depending on the age. The factors affecting the hospital stay in improved patients were analyzed in the parameters of previous medical illness, hospital morbidity, multiple injuries, ISS, and age. All statistical tests were conducted with two-tailed levels of 0.05. Results: Of 139 patients, the mean age was 74±7.1 years, mean ISS 9.3±7.26, mean hospital stay 27±27.1 days. Most commonly injured body region was the extremities due to fall from a level surface. Rate of previous illness showed 0.94 medical diseases per person and were aggravated after trauma in 39 patients (60.9%). Hospital morbidity rate was 0.46 incidents per person. There were no differences in age and duration of hospital stay between the improved and the not-improved group. Substantial differences were noted in affected body region, incidence of previous illness, and hospital morbidity between the groups (p=NS). Not-improved group had higher ISS(p<0.05). ISS, previous illness and hospital morbidity affected the duration of hospital stay in the improved group. Hospital stay was 40±25.1 days in patients with ISS over 6 while 6±8.6 days in those with ISS 5(p<0.05). Hospital stay in the improved was 26±26.9 days while 31±24.8 days in the improved old-old group (p=NS). Hospital stay in the young-old minor trauma (ISS5) patients with previous illness and hospital morbidity was 26±10.1 days while 4±7.3 days in those without previous illness and hospital morbidity (p<0.05). Conclusion: Previous medical illness and hospital morbidity, not age, are predictive of outcomes of geriatric trauma patients with respect to hospital stay. As most of the hospital morbidity was a trauma-induced aggravation of previous medical illness and hospital morbidity contributing poor outcomes can be potentially avoidable, routine aggressive care for the geriatric trauma patients with previous medical illnesses is needed.

이차성 기질화 폐렴이 동반된 피부근염 1예

박철연,권정석,정진욱,이충기,현대성,최정윤 영남대학교 의과대학 2008 Yeungnam University Journal of Medicine Vol.25 No.2

Dermatomyositis is characterized by progressive, symmetric, Proximal muscle weakness and a nonsuppurative inflammatory myopathy of unknown etiology involving predominantly skeletal muscles. It is also characterized by typical skin lesions. Interstitial lung disease has a poor prognosis when it is associated with dermatomyositis. Organizing pneumonia is a disease in which granulation tissue fills the lumina of terminal and respiratory bronchioles and extends into the distal airspaces. The cryptogenic nature of the process is appreciated in that organizing pneumonia patterns of injury can be seen in secondary forms of the disease (secondary organizing pneumonia). Organizin pneumonia has been reported to occur in 5~10% in dermatomyositis-polymyositis patients Anti-histidyl tRNA synthetase antibody (anti-Jo-1) is a Predictive disease marker that is reported to occur in up to 70% of patients. We describe a 49-year-old male dermatomyosits patient who presented with organizing pneumonia and was found to have negative anti-Jo-1 antibody.

사업장 근로자의 건강위험 평가도구 개발

홍윤철,임현술,하은희,정규철,조희숙,박혜숙,이용애 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.4

Health Risk Appraisal(HRA) is usually defined as a process by which we expect of individual's chances of death or acquiring specific diseases within a defined period of time. The concept of worksite as an area of health maintenance and promotion is newly developing. Our movement for health promotion of employees has been increasingly known in the worksite. The aim of this study is to develop health risk appraisal tools about health promotion at the worksite for employees. We performed this study by two steps; one step was to develop a HRA questionnaire of worksites in Korea, another was to evaluate the reliability of the questionnaire. For developing HRA questionnaire, we reviewed scientific examples at first, and then weighted the score by delphi. To evaluate the reliability of developed questionnaire, we carried out survey by test-retest method. A total of 131 employees completed HRA questionnaire on two times. The results are as follows. The total score of health risk in unhealthy workers was higher than that of healthy workers. The range of test-retest reliability of responses to the questionnaire was 0.57-0.94. Therefore it seems that this questionnaire was very suitable to assess the health behavior of workers. In conclusion, the developed HRA questionnaire can be used as a tool for evaluating health behavior and for providing health counseling materials.

식품중 중금속 규격 과학화를 위한 조사연구(Ⅲ) : 음료수의 중금속 향량에 대하여 Heavy metal contents beverages

김명철,김미혜,권기성,정소영,박성국,이윤동,이승훈,김은정,강민철,박효정 식품의약품안전청 2001 식품의약품안전청 연보 Vol.5 No.-

본 연구는 국내에 유통되고 있는 음료류중 중금속 함량을 파악하여 식품공전 제 ·개정시 과학적 기초자료로 활용하고자 수행하였다. 출 2☞7여건의 음료류에 대하여 유도결합플라스마 분광기(ICP), 원자홉광광도 계(AAS) 및 수은분석기 등을 치용하여 납, 카드윰 등 중금속함량을 측정하였으며 그 결과는 다음과 같다 [단위 : min-ma)t(irran) ; mrk3 ; f : 0.0001-0.0025(0.0003), As :불검출곰.OB45(0.0003), Pb : 불검출-0.0893(0.0041),Cd ' 불검출곤.0064(0.0011), Cfl : 불검출.(i9(0.05), Mn : 불검출글.찌(0.16), Zn : 불검출-12.85(0.뽀), Sn :불검출-45.36(1.97). 본 조사결과 우리나라에서 유통되고 있는 음료류 중 납 등 중금속 함량은 외국의 모니터랑 결과와 유사하였다. 또한 우리나라 국민이 음료류를 통한 중금속 섭취량은 FAO/UTfO에서 설정한 잠 정주간섭취처용량의 약 0.OleO.06% 이하로 매우 낮았다. 편 연구조사에서 먼어진 결과는 음료류 중 납 기준 설정을 위한 중요한 기초자료로 활용할 수 있는 것으로 사료된다. This study was conducted to estimate the cantents of heavy netals in beverages and to fIFovide a scientific basis for heav)· meta3 standardizatior of Korea Food Code. The contents of rriercur17(Hg), lead(Pb), cadmium(Cd), arsenic(As), manganese(Mn),ziac(Zn), tin(Sn) and topper(Cu) were determined in a total of 20? samples of beverages usinga mercury anal!'zer, aromic absorption spectrophotometer(AAS) and inductiuety coupled plasmaspectrometer(fcpl. The vatues of heavy metals In beverages were as fellows (min-max (mean) , mg/krl , Hg : 0.DOOI-0.0095(0.0004), As : ND-0.0245(0.0003), Pb ND-0.0893(0.0041), Cd : ND-0.0064(0.0011),Cu : ND-1.69(0.03), Mn : ND-3.94(0.16), Zn ND-12.85(0.28), Sn : ND-45.36(1,97). Our results weresimilar to thofe reported by other countries. It is thought that our results could be utilizedimportant references toT es?ablish the standard of lead in beverages.