일자리 참여 프로그램이 노인의 자아존중감과 생활만족도에 미치는 영향

민순 ( Soon Min ),주리애 ( Ree Aie Ju ),정현필 ( Hyon Pil Jung ),정영주 ( Young Ju Jung ),김미란 ( Mi Ran Kim ),김윤경 ( Yun Gyung Kim ) 경희대학교 동서의학연구소 2008 동서간호학연구지 Vol.14 No.2

본 연구는 G시 D복지관에 있는 60세 이상 된 노인 70명을 대상으로 일자리 참여 프로그램이 노인들의 자아존중감과 생활만족도에 미치는 영향을 파악하고자 한다. 단일군 전후 원시실험설계로 노인들의 대조군이 없는 현실적인 문제를 갖고 있어 비교할 수 없는 제한점을 갖고 있지만 노인들에게 일자리를 참여시키므로 그들을 돕는데 의미를 두고 있으며, 본 프로그램에서 얻어진 결과를 토대로 논의하고자 한다. 일자리 프로그램에 참여하기 전 자아인식의 평균이 참여 전3.31에서 참여 후 3.50으로, 자아가치는 참여 전 평균이 3.04에서 참여 후 3.46으로, 자아존중 정도도 참여 전 평균 3.31에 참여 후 3.48로 모두 유의하게 향상되었다. 이는 저소득 노인의 자아존중감이 낮다는 Shim (2005)의 연구결과와 일치했고, 월 사용 지출액에 따라 자아존중감이 차이가 있다는 Kim2003)의 연구 결과와 월수입이 많은 사람 즉 경제적으로 나은사람이 자아존중감이 높다는 Kim (2002)의 연구 결과 및 일자프로그램 참여를 여가활동으로 여겨 이에 참여하는 사람이참여하지 않는 경우보다 자아존중감이 높다고 한 Kim (2007)연구 결과와도 유사한 결과를 보였다. 노인에게 자아존중감은 정신건강을 결정짓는데 중요한 요소로, 자아존중감은 노인의 우울과 역상관관계가 있는데(Park,1993), 본 연구에서 노인들이 일자리에 참여하므로 자존감 향상에 긍정적인 영향을 미치는 것으로 나타난 바, 이는 노후에노인 대상자들에게 여가활동과 소정의 수익을 통해 용돈이나기초생활에 필요한 경비를 조달받게 된 것이 자아존중감을 높인 것으로 사료된다.그러므로, 본 연구에서도 일자리 참여 프로그램이 노인들의 자아존중감을 향상시키는 점을 볼 때, 노인의 일자리 참여는 자신들의 소득을 확보하려는 경제적인 측면뿐 아니라 사회참여의 욕구도 포함하고 있어 노인에게 일자리 참여는 매우 중요한 의미를 지니고 있고, 소일거리와 여가선용 차원에서도 노인에게 일자리 참여의 기회를 제공해주는 것은 노후의 경제적인 자립생활은 물론 사회적으로도 바람직한 방안이라 할 수 있어 일을 통해 보람도 얻고, 단체 활동을 통한 소속감을 가지고 경제활동도 할 수 있는 방안도 모색해야 할 것이다.일자리 참여 프로그램 전과 후의 생활만족도의 변화에서, 일자리 프로그램에 참여하기 전 평균 3.04점이었고, 일자리 프로그램에 참여한 후 평균 3.24점으로 유의하게 향상하였는데, 이는 일자리 참여자와 비참여자들을 비교 연구한 Kim (2007)과Seo (2007)의 연구 결과와 일치하였고, 시니어클럽에 참여하고 있는 노인이 참여하지 않고 있는 노인보다 생활만족도가 유의하게 높게 나타난 Bang (2005)의 연구 결과와도 일치하였다.노인들의 생활만족도에 관한 선행연구를 고찰한 결과 노인의 생활만족도는 배우자가 있는 경우, 주관적 건강상태가 좋을수록, 경제수준이 높을수록, 교육정도가 높을수록 생활만족도가 높다고 보고되고 있으며, 노인의 사회적 지지나 자아존중감이 높을수록 생활만족도가 높다고 하였다(Jang, 2006; Kim,2005; Park & Lee, 2006).노인들이 일자리 프로그램에 참여하므로 생활만족도에 긍정적인 영향을 미치는 것으로 나타난 바, 이는 노인대상자들에게일자리를 통해 심리적, 경제적 여건에 도움이 된 것으로 여겨지며, 이로 인해 생활만족 정도를 높인 것으로 사료된다. 노후의시간활용 방법에 대한 2004 전국 노인생활실태 및 복지욕구조사 결과에서 가장 선호되는 것이 소득창출 27.8%, 취미활동16.3%, 소일거리 14.5%, 자원봉상활동 3.1%, 자아계발 활동2.4%로 나타났다(Jung et al, 2005). 그러나 노인의 일자리 참여는 여러 가지 문제에 봉착하게 된다. 우선 노인시장에 유입되는 신규 노동력의 과잉과 기업의 인사정체, 그리고 노인취업에 대한 잘못된 인식으로서 기능주의적 사회격리이론은 인간의 노화를 기능주의적으로 이해하려는 사회적 편견인데 노인이 반드시 체계적, 생물학적으로 또는 정신적으로 결함이 있다는 편견으로 인해 노인인력 활용가능성을 근본적으로 저해하는 요인이 된다(Jung, 2007). 또한 본 연구 대상자들에게 연구일자리 프로그램 유형에 따른 생활만족도와 자아존중감 정도를 분석한 결과에서는 유의하지 않았는데 노인들에게 일자리 참여 자체가 생활만족과 자아존중감 정도에 영향을 주는 것이지 유형별로는 큰 의미가 있는 것은 아닌 것으로 보인다. 본 연구 결과를 종합하여 볼 때 어떤 형태이든 간의 노인의 일자리 참여는 고령화 사회에서 나타나는 심각한 노인문제를 해결하고 노후 생활에 대한 적응력을 높이며, 노년기의 역할변화에 따른 적절한 대응을 통해 역할상실에 대한 대비를 할 수 있을 뿐만 아니라 노인 스스로의 자아존중감과 생활만족도 향상을 위해 필요하다. Purpose: The effects of job participation on self-esteem and life satisfaction were investigated. Methods: Seventy residents of D welfare center located in G city who were >60 yr-of-age were selected for the study. The SERS research tool (Nugent and Thomas,1993; modified by Koh, 2002) was used to assess self-esteem before and after a job participation program. The Cronbach`s αvalue-based reliability of this tool was 0.923 and 0.920 before and after the job participation program, respectively. Cronbach`s αvalue-based life satisfaction as measured according to Choi (1986) was 0.932 and 0.933 before and after the job participation program, respectively. Results: The hypothesis that job participation program increases self esteem was supported by the results. The mean self esteem of subjects before and after the job program, 3.31 and 3.48, respectively, represented a significant increase. The hypothesis that the job participation program increases life satisfaction was supported by the results, The mean life satisfaction index of subjects before and after the program, 3.04 and 3.24, respectively, represents a significant increase. Conclusions: Increased job opportunities and income guarantee for adults, particularly the elderly, can increase self-esteem, life satisfaction, and emotional stability.

임신능이 확인된 가임 여성에서의 Deciduosis의 유병율

김미란,유영옥,노덕영,류순원,권동진,김장흡,김진홍,임용택,김은중,정재근,이진우,Kim, Mee-Ran,Lew, Young-Oak,Ro, Duck-Yeong,Ryu, Sun-Won,Kwan, Dong-Jin,Kim, Jang-Heub,Kim, Jin-Hong,Lim, Yong-Taik,Kim, Eun-Jung,Jung, Jae-Keun,Lee, Jin-Woo 대한생식의학회 2000 Clinical and Experimental Reproductive Medicine Vol.27 No.4

Objective: Extrauterine formation of decidua of stromal cells has been well described, particularly in the cervix and ovary. The apparent hormonal mechanisn of this phenomenon suggestes a relationship to endometriosis. Whether formation of ectopic decidua represents a marked progestational response of endometriosis or an independent peritoneal-stromal reaction to pregnancy is unclear. This study was designed to determine the prevalence of deciduosis in the patients whose fertility were proven. Design: Prospective study of patients who had undergone cesarean delivery without history of endometriosis. Materials and Methods: The study was performed in 179 full tenn pregnant women. During the cesarean section, the pelvic organs were thoroughly investigated and the biopsies were collected at the lesions suspicious endometriosis. And then microscopic examination of removed tissues were done. Results: Of the 179 patients who underwent cesarean delivery, 48 women (26.8%) had the lesions suspicious endometriosis such as adhesion, pigmented spots. The ovary was the most frequently ocurred site (79.2%). Microscopically, decidual cells were observed in 34 cases (70.8%) of 48 biopsed patients. Conclusion: Endometriosis has been known to be associated with subfertility. Our observations found the prevalence of deciduosis was 19.0% (34/179) in tenn pregnant women whose fertilites were proven. We suggests that the deciduosis maya manifestation of endometriosis during pregnancy. However, further follow up study should be done to confirm this clinicopathologic process.

난소기능평가를 위한 Gonadotropin Releasing Hormone Agonist Stimulation Test (GAST)의 효용성에 관한 연구

김미란,송인옥,연혜정,최범채,백은찬,궁미경,손일표,이진우,강인수,Kim, Mee-Ran,Song, In-Ok,Yeon, Hye-Jeong,Choi, Bum-Chae,Paik, Eun-Chan,Koong, Mi-Kyoung,Song, Il-Pyo,Lee, Jin-Woo,Kang, Inn-Soo 대한생식의학회 1999 Clinical and Experimental Reproductive Medicine Vol.26 No.2

Objectives: The aims of this study are 1) to determine if GAST is a better indicator in predicting ovarian response to COH compared with patient's age or basal FSH level and 2) to evaluate its role in detecting abnormal ovarian response. Design: Prospective study in 118 patients undergoing IVF-ET using GnRH-a short protocol during May-September 1995. Materials and Methods: After blood sampling for basal FSH and estradiol $(E_2)$ on cycle day two, 0.5ml (0.525mg) GnRH agonist ($Suprefact^{(r)}$, Hoechst) was injected subcutaneously. Serum $E_2$ was measured 24 hours later. Initial $E_2$ difference $({\Delta}E_2)$ was defined as the change in $E_2$ on day 3 over the baseline day 2 value. Sixteen patients with ovarian cyst or single ovary or incorrect blood collection time were excluded from the analysis. The patients were divided into three groups by ${\Delta}E_2$; group A (n=30):${\Delta}E_2$<40 pg/ml, group B (n=52): 40 pg/ml${\leq}{\Delta}E_2$<100 pg/ml, group C (n=20): ${\Delta}E_2{\leq}100$ pg/ml. COH was done by GnRH agonist/HMG/hCG and IVF-ET was followed. Ratio of $E_2$ on day of hCG injection over the number of ampules of gonadotropins used ($E_2hCGday$/Amp) was regarded as ovarian responsiveness. Poor ovarian response and overstimulation were defined as $E_2$ hCGday less than 600 pg/ml and greater than 5000 pg/ml, respectively. Results: Mean age $({\pm}SEM)$ in group A, B and C were $33.7{\pm}0.8^*,\;31.5{\pm}0.6\;and\;30.6{\pm}0.5^*$, respectively ($^*$: p<0.05). Mean basal FSH level of group $A(11.1{\pm}1.1mlU/ml)$ was significantly higher than those of $B(7.4{\pm}0.2mIU/ml)$ and C $(6.8{\pm}0.4mIU/ml)$ (p<0.001). Mean $E_2hCGday$ of group A was significantly lower than those of group B or C, i.e., $1402.1{\pm}187.7pg/ml,\;3153.2{\pm}240.0pg/ml,\;4078.8{\pm}306.4pg/ml$ respectively (p<0.0001). The number of ampules of gonadotropins used in group A was significantly greater than those in group B or C: $38.6{\pm}2.3,\;24.2{\pm}1.1\;and\;18.5{\pm}1.0$ (p<0.0001). The number of oocytes retrieved in group A was significantly smaller than those in group B or C: $6.4{\pm}1.1,\;15.5{\pm}1.1\;and\;18.6{\pm}1.6$, respectively (p<0.0001). By stepwise multiple regression, only ${\Delta}E_2$ showed a significant correlation (r=0.68, p<0.0001) with $E_2HCGday$/Amp, while age or basal FSH level were not significant. Likewise, only ${\Delta}E_2$ correlated significantly with the number of oocytes retrieved (r=0.57, p<0.001). All four patients whose COH was canceled due to poor ovarian response belonged to group A only (Fisher's exact test, p<0.01). Whereas none of 30 patients in group A (0%) had overstimulation, 14 patients among 72 patients (19.4%) in group B and C had overstimulation (Fisher's exact test, p<0.01). Conclusions: These data suggest that initial $E_2$ difference after GAST may be a better prognostic indicator of ovarian response to COH than age or basal FSH level. Since initial $E_2$ difference demonstrates significant association with abnormal ovarian response such as poor ovarian response necessitating cycle cancellation or overstimulation, GAST may be helpful in monitoring and consultation of patients during COH in IVF-ET cycle.

Scenedesmus quadricauda var. biornatus Kiss 의 형태변이

김미란,안선숙,장윤경 ( Mi Ran Kim,Seon Sook An,Yoon Kyung Chang ) 한국하천호수학회 1991 생태와 환경 Vol.24 No.2

6 strains of S. quddricauda var. biornatus Kiss which is new to Korea were isolated from 6 different localities in Seoul and Kyunggi-do area in order to examine their taxonomic identity. Morphological variations of the coenobia, percentage of coenobia formed and the ultrastructure of the cell wall were observed in both synchronized and stationary cultures. Three different coenobial types, i.e. abundans type, biornatus type and quadricauda type were produced in all isolates. The percentages of coenobial types produced in different strains varied depending on the culture period. The cell wall structure of all but one (st. QB-6) strain were identical and constant through out the culture period. The cell wall structure of S. quadricauda var. biornatus were unique in its smooth surface and the presence of 1 or 2 rosette, and could be easely distinguished from those of S. quadricauda, S. armatus, S. ellipsoideus and S. intermedius which produce biornatus type coenobia during early log phase of growth.

자궁내막증 환자의 자궁내막내 성호르몬 수용체, Integrins, Cyclooxygenase의 발현과 변이 양상

김미란,박동욱,권혁찬,황경주,주희재,조동제,김세광,오기석,Kim, Mi-Ran,Park, Dong-Wook,Kwon, Hyuek-Chan,Hwang, Kyoung-Joo,Joo, Hee-Jae,Cho, Dong-Jae,Kim, Sei-Kwaug,Oh, Kie-Suk 대한생식의학회 2000 Clinical and Experimental Reproductive Medicine Vol.27 No.2

Objectives: To develop a new immunohistochemical marker system for supplementation of the Noyes histological classification of the endometrium in women of child bearing age with regular menstrual cycles, and to employ this system to evaluate pathologic factors involved in endometriosis, and thus to ascertain if it is useful in diagnosis. Materials and Methods: Endometrial biopsies were sampled from the posterior fundus of 41 (24 proliferative phases, 17 secretory phases) women with regular menstrual cycles (28-32 days), and each sample was immunohistochemically stained according to Noyes et al (1975) for determination of expression for estrogen receptor (ER), progesterone receptor (PR), integrin ${\alpha}_1$, ${\alpha}_4$, ${\beta}_3$, COX-1 and COX-2. Then, the PR, integrin ${\beta}_3$ and COX-2 which were clearly expressed in the luteal phase was with endometrial samples were obtained from 20 cases of normal patients (group 1) and 25 cases with endometriosis (group 2) after confirming the day of ovulation by sex steroid level measurements 7-8 days after ovulation Results: In the regular menstruation group the expression of ER showed a tendency to be increased in the proliferative phase and decreased in the secretory phase, and was the highest in the proliferative phase. However, PR in the stromal cells showed no change in the entire menstrual cycle while in the epithelial cells, PR reached a peak in the late proliferative phase and was almost absent in the secretory phase. Integrin (${\alpha}_1$, ${\alpha}_4$, and ${\beta}_3$ expression in the epithelial cells was absent in the proliferative phase but ${\alpha}_1$ was strongly expressed starting from the early secretory phase into the entire secretory phase. ${\alpha}_4$ was expressed strongly in the early and mid secretory phases and disappeared in the late proliferative phase, while ${\beta}_3$ appeared after the mid secretory phase and continued to be expressed until the late secretory phase. Expression in the stromal cells was weak overall and did not show any cyclic pattern. COX-1 expression was shown as a cyclic pattern in the stromal and epithelial cells and was particularly strongly expressed in the mid secretory phase of epithelial cells, and in the mid secretory and menstruation phase of stromal cells. In the endometrial epithelial cells there was strong expression during the entire cycle with stronger expression in the secretory phase compared to the prolferative phase. COX-2 was clearly expressed in the late proliferative, early and mid secretory phases in the stromal cells. No expression was observed in the proliferative phase of the epithelial cells, but which began to appear in the early secretory phase reaching a significant pattern from the mid secretory phase onwards. There was almost no expression in the stromal cells. In the cases with endometriosis showing normal endometrial maturation according to the Noyes classification, PR expression was increased while Integrin-${\beta}_3$의 expression was significantly decreased compared to the normal group. Also, COX-2 expression was slightly decreased in the stromal cells of patients with endometriosis while it was significantly increased in the stromal cells. Conclusion: Immunohistochemical markers can supplement the original Noyes classification of histological endometrial dating and therefore ascertain existing pathologic conditions. Particularly for patients with endometriosis with normally mature endometrial cells, changes in COX-2 and integrin expression patterns may assist in elucidating pathophysiologic mechanisms and therefore aid in the diagnosis of abnormal implantation conditions, and consequently determine a treatment modality.

보조생식술에 있어서 황체기 보강요법

김미란,황경주,Kim, Mi-Ran,Hwang, Kyung-Joo 대한생식의학회 2007 Clinical and Experimental Reproductive Medicine Vol.34 No.1

간질환 환아에서의 항생제 사용

김미란,Kim, Mi-Ran 대한소아감염학회 1996 Pediatric Infection and Vaccine Vol.3 No.1

수두의 임상 및 유행 양상에 대한 연구

김미란,박정식,김덕하,이혜란,박종영,Kim, Mi Ran,Park, Jung Sik,Kim, Dug Ha,Lee, Hae Ran,Park, Chong Young 대한소아감염학회 1998 Pediatric Infection and Vaccine Vol.5 No.1

목 적 : 전염력이 강한 수두는 국내에서 계속 발생하고 있고, 예방접종률도 증가하는 추세이나 수두에 대한 임상적, 역학적 보고는 매우 부진하다. 이에 저자들은 수두의 발생 양상 및 임상적 특성을 규명하고 예방접종의 효과를 알아보고자 하였다. 방 법 : 1994년 3월부터 1996년 12월까지 한림대학교 한강성심병원 소아과에서 수두로 진단받은 환아를 대상으로 수두 발생 시기와 임상 양상, 예방접종력, 가족내 수두 전파에 대하여 전향적으로 조사하여 분석하였다. 연구 기간 종결 2개월 후 발병 당시 환아와 동거 중이던 건강한 형제의 백신력과 환아 발병 후 전염 여부를 전화로 조사하였다. 결 과 : 1) 연도별 수두 발생은 '94년 31례, '95년 20례, '96년 22례로 총 73례가 있었으며, 연구 기간 중 6~7월과 12~1월에 증가하였다. 2) 성별 분포는 남아 46명, 여아 27명으로 남아가 많았고, 연령은 3개월부터 15년 9개월까지 분포하여 평균 $46{\pm}37.2$개월이었으며, 1세 미만 16.4%, 1~6세 68.5%, 7세 이상이 15.1%이었다. 3) 40명(54.8%)에서 수두 환자와 접촉한 기왕력이 있었고 평균 $11.3{\pm}5.5$일 후 발병하였다. 4) 발열은 44명(60%)에서 발생하여 평균 $38.4{\pm}0.8^{\circ}C$로 $3{\pm}2.4$일간 지속되었으며, 기침은 38명(52.1%), 콧물 33명(45.2%), 인두 편도 발적이 31명(42.5%)에서 있었다. 18(25%)명이 평균 $4{\pm}2.1$일간 입원 치료를 받았고, 합병증은 9명(12.3%)에서 발생하여 폐렴 4례, 기관지염 2례, 세기관지염 1례 등으로 모두 회복되었다. 5) 수두 예방접종을 받았던 환아는 20명(27.8%)이었으며, 수포 수는 예방접종을 받은 환아에서 유의하게 적었으나, 입원 치료, 발열 빈도(P=0.1), 발열 기간 및 정도, 합병증 발생은 유의한 차이가 없었다. 6) 환아의 발병 당시 동거 중이던 건강한 형제 35명 중 27명(77.1%)에서 수두가 발생하였으며, 수두 예방접종에 따른 발병률의 차이는 없었다. 결 론 : 연구 기간 중 수두는 73례가 있었고 매년 6~7월과 12~1월에 증가하였으며, 84.9%가 6세 이하에서 발생하였다. 27.8%가 수두 예방접종 후 이환되었으며, 가족내 수두 전파는 예방접종력에 따른 차이가 없었으므로 지속적인 백신 효능 연구 및 역학 조사가 필요하다고 사료된다. Purpose : Varicella is a common contagious illness and vaccine against it has been used in healthy Korean children. We studied clinical and epidemiologic features of varicella and the effect of vaccination. Methods : We analyzed clinical and epidemiologic features of varicella and vaccination effect against it in children treated in Hangang Sacred Heart Hospital from March 1994 to December 1996. Results : 1) Total 73 cases of varicella, 46 male and 27 female patients were included. Annual incidence was 31, 20 and 22 cases from '94 to '96 respectively, with an increase during the period June to July and December to January. 2) Mean age was $46{\pm}37.2$ months and 84.9% of the patients were younger than 7 years old including 16.4% of infants. 3) Varicella occurred after a contact with varicella patients in 40(54.8%) patients. 4) Fever developed in 44(60%) patients with mean $38.4{\pm}0.8^{\circ}C$ and persisted for mean $3{\pm}2.4$ days. Nine(12.3%) patients had complications and eighteen(25%) patients were admitted for mean $4{\pm}2.1$ days but all recovered. 5) Twenty(27.8%) patients were affected despite preceding vaccination against varicella but the number of vesicles decreased significantly in vaccinees(P<0.01). 6) The rate of secondary cases in healthy siblings was 27 out of 35(77.1%) and was not affected by preceding vaccination. Conclusion : Varicella occurred mainly in children younger than 7 years old and showed seasonality. Because 27.8% of cases developed despite preceding vaccination and the rate of secondary cases was not affected by vaccination, further study for vaccine efficacy is necessary.

HCoV-IMDB: Database for the Analysis of Interactions between HCoV and Host Immune Proteins

김미란,이지혜,손현석,Hayeon Kim 한국인터넷방송통신학회 2019 Journal of Advanced Smart Convergence Vol.8 No.1

Coronaviruses are known respiratory pathogens. In the past, most human coronaviruses were thought to cause mild symptoms such as cold. However recently, as seen in the Severe Acute Respiratory Syndrome (SARS) and the Middle East Respiratory Syndrome (MERS), infectious diseases with severe pulmonary disease and respiratory symptoms are caused by coronaviruses, making research on coronaviruses become important. Considering previous studies, we constructed ‘HCoV-IMDB (Human Corona Virus Immune Database)’ to systematically provide genetic information on human coronavirus and host immune information, which can be used to analyze the interaction between human coronavirus and host immune proteins. The ‘HCoV-IMDB’ constructed in the study can be used to search for genetic information on human coronavirus and host immune protein and to download data. A BLAST search specific to the human coronavirus, one of the database functions, can be used to infer genetic information and evolutionary relationship about the query sequence.

초오 성분이 포함된 화풍단 복용 후 발생한 심실 부정맥 2례

김미란,Kim, Mi-Ran 대한임상독성학회 2006 대한임상독성학회지 Vol.4 No.2

The various species of aconitum contain diterpene (C-20) and norditerpene (C-19) forms of the natural alkaloid aconitine that cause neurologic, gastrointestinal, cardiovascular symptoms. In chinese medicine, these plants has been used as drugs to treat pain, dyspepsia, cerebrovascular disease, and so on. Because the therapeutic window is narrow, poisoning may occur from unintentional exposure, with a variety of toxic effects such as arrhythmia, hypotension, paresthesia, paralysis, nausea, vomiting, and abdominal pain. Aconitine-containing folk remedies are widely used in Korea. We encountered two cases of ventricular arrhythmia in patients who ingested tablets, known as 'Wha-Pung-Dan' made with aconitine extracts and were subsequently admitted to the ED. A 42 year-old man who took 35 tablets presented with ventricualr tarchycardia, and 40 year-old woman who took 40 tablets showed premature ventricular contractions. Both patients were discharged normally without any complications after three days.