우리 나라 보건관리대행서비스 평가 연구

하은희,조수헌,김선민,주영수,한상환,하미나,권호장,홍윤철,김창엽 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.1

Group occupational health service programme started in 1990 is one of the measures to cope with limited human and financial resources in occupational health. The programme has expanded rapidly to include 52 institutions, private as well as public, all over the country. In spite of its potential impact on health of employees and practice of occupational health in small and medium sized industries, comprehensive evaluation in terms of quality has not been tried. This study has aims to develop the criteria to assess the quality of newly developed group occupational health service programme, and to investigate the quality of institutions, and finally to develop policies for the quality improvement. 1) Criteria development : By defining occupational health services, in particular for small and medium sized industries, as one of the primary health care, followings are included as core elements of qualitative occupational health programme; accessibility, continuity, comprehensiveness, technical quality, intersectoral collaboration, emphasis on preventive services, community participation, and adequacy. Again each element is divided into five major components of national health system infrastructure developed by the World Health Organization; development of health resources, organized arrangement of resources, delivery of health care, economic support, and management. In turn, each component is categorized into three aspects of quality assessment, structure, process and outcome. Expert panel selected several criteria for each category to evaluate the programme. Criteria were modified according to each group of interviewees, to produce two sets of questionnaire, one for chief operating officer and another for nurses in the institutions, and the chief operating officer and workers in the workplace. 2) Subject : Of all 52 institutions, 25 voluntarily participated in the survey. At individual institution, chief operating officer and practicing nurses were interviewed in depth. After intensive education for interviewees, every interviewees, every interview was performed with standardized guideline and questionnaire. The quality of the 'Group occupational health service programme' was found to be lower than expected. Especially in continuity, comprehensiveness, technical quality, community participation and adequacy, lower quality in structural aspect was commonly identified throughout all the institutions,. Quality in terms of accessibility and continuity highly varied among institutions., To improve quality of the programme, more comprehensive and systematic programme such as accreditation has to be introduced. In addition, human resources, governmental fund and information systems for individual workers are to be developed. As a long range plan, integration of occupational health services into the national health systems and pooling of financial resources and planned allocation should be considered.

치환된 프로탈로시아닌의 합성 방법 연구

河潤卿,金永寬,孫秉淸,申鉉萬,朴美敬 弘益大學校 科學技術硏究所 1996 科學技術硏究論文集 Vol.7 No.1

The octadodecanoxy derivative of the phthalocyanine which has such long hydrocarbon chains around the skeleton of the phthalocyanine was synthesized. First of all, ortho-catechol was treated with 2 moles of 1-bromododecane to yield ortho-didodecanoxybenzene(I). Second, bromination of I resulted in dibromo-didodecanoxy benzene(II) where the para positions to the dodecanoxy groups were brominated. Finally, reaction of II with an excess of CuCN under an N₂atmosphere gave the intermediate dicyano-didodecanoxy-benzene(III), in situ, and futher heating in dry DMF with more CuCN gave the final product, octadodecanoxy derivative of the phthalocyanine. The synthetic method developed herein provides a general way to synthesize the variety of the phthalocyanines which displays many different substituents such as long hydrocarbons around its skeleton and contains a various metal inside of the phthalocyanine.

Cotton xanthate-Mg(Ⅱ)-homosulfamin complex의 생성 및 성상

김영미,하능진,정연진,이정수 釜山大學校 新藥開發硏究所 1999 藥學硏究誌 Vol.33 No.1

Formation of Cotton xanthate-Mg(Ⅱ)-Homosulfamine complex was investigated varying reaction conditions. Release of homosulfamin from cotton xanthate-Mg(Ⅱ)-homosulfamin complex was studied by batch- and flow-method. Antimicrobial activities were tested against Staphylococcus aureus ATCC 12228, Bacillus subtillis TG-1 Pseudomonas aeruginosa ATCC 9027 and Escherichia coli (NA-1) by employing ditch plate method and compared to that of free Hs.

서낙동강에서 분리된 남조 Microcystis의 처리상태에 따른 세균의 성장 및 형태변화

박재림,하경,권윤미 한국환경과학회 2003 한국환경과학회지 Vol.12 No.9

To investigate the interaction of bacteria and Microcystis isolated from a hypertrophic reservoir(Seo-Nakdong River), the response of five bacteria in relation to the different treatment of Microcystis and microcystin production by addition of dominant bacteria Staphylococcus sciuri were examined. Five bacteria (S. sciuri. S. capitis, S. epidermis, Pseudomonas aeruginosa and Aeromonas almonicida) were identified from the reservoir. In the experiment of bacterial response, two types of bacterial growth pattern were observed. All bacteria showed active growth in heated Microcystis-added media. Especially, three species of bacteria (S. sciuri. S. capitis and P. aeruginosa) among them showed active growth in live Microcystis-added media. In Microcystis response, increase of microcystin production showed when dominant bacteria. S. sciuri was added.

VDT작업자에서 업무로 인한 정신사회적 스트레스에 대한 인지가 근골격계장애에 미치는 영향

백남종,하미나,조수헌,강대희,백도명,주영수,윤덕로,권호장 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.3

업무에 의한 정신사회적 스트레스가 근골격계 질환의 유병에 미치는 영향을 파악하기 위하여 전화안내원을 대상으로 단면적 조사연구를 수행하였다. 연구 결과 나이, 교육정도, 근무연한, 가사부담 등의 인구학적 변수는 근골격계질환의 유병에 영향을 미치지 않는 것으로 분석되었다. 정신사회적 스트레스 중 업무요구도가 높다고 느끼는 집단에서 그렇지 않은 집단에 비해 근골격계 질환의 유병률이 통계적으로 유의하게 높게 나타났으나 업무재량도나 사회적지지도는 근골격계질환과 유의한 상관관계를 발견할 수 없었다. 그러나 업무요구도는 높고 업무재량도는 낮다고 느끼는 '근무긴장도가 가장 높은 군'은 업무요구도는 낮고 업무재량도는 높다고 느끼는 '근무긴장도가 낮은 군'에 비해 근골격계 질환의 발생위험이 통계적으로 유의하게 높은 것으로 나타났다. 본 연구의 결과는 업무로 인한 정신사회적 스트레스에 대한 인지 정도에 따라 근골격계질환의 유병률이 달라짐을 시사하고 있다. 따라서 작업관련성 근골격계질환의 예방을 위해서는 기존의 인간공학적 접근 이외에 스트레스를 감소시키려는 노력이 동시에 진행되어야 할 것으로 생각한다. A cross-sectional study was conducted to assess the association between perceived occupational psychosocial stress at work and the work-related musculoskeletal disorder(WRMSD) among employees using video display terminals. The study included 111 female telecommunication employees from three companies at ChungBuk province. Cases of WRMSD were defined using symptom questionnaire and physical examination conducted by rehabilitation specialist. Information on demographics, individual factors, and perceived psychosocial stress, were obtained by self-administered questionnaire. For assessing perceived psychosocial stress, we used variables from 'job strain model' proposed by Karasek. Associations between perceived psychosocial stress and WRMSD were assessed by multiple logistic regression models. Forty nine(44% to the total) subjects met our operational definition for WRMSD. Age, seniority, housing load were not associated with WRMSD. Perceived psychosocial stress was associated with WRMSD[odds ratio=3.28, 95% confidence interval: 1.05-10.19]. This study suggests that perceived occupational psychosocial stress is related to the prevalence of WRMSD.

유기용제 사용 소규모사업장의 체계적 건강관리 프로그램 개발에 관한 연구1) : 신경행동학적 검사법의 적용 가능성 Application of Neurobehavioral Core Test Battery(NCTB)

한상환,하미나,권호장,윤덕로,조수헌 大韓産業醫學會 1995 대한직업환경의학회지 Vol.7 No.2

It is known that there appear some nonspecific and delicate changes in neuropsychiatric aspect on the workers when they are exposed for a long period to low concentrated organic solvents in the work places. Therefore, it gives rise to the necessity of developing a program for the health supervisor stationed in the work place to supervise these neurobehavioral health affection. In addition to the questionnaire posed to the workers exposed to organic solvents, the study team conducted NCTB(Neurobehavioral Core Test Battery) respectively on an exposed group and a non-exposed group to organic solvents. The study team compared the results and decided whether or not to apply the results to the evaluation program of health affection. The study team divided 132 workers in 6 car repairing factories and 2 textile printing factories into exposed group and non-exposed group, pairing them off into 66 research objects according to their age, sex, and job. Neurobehavioral test was conducted on 6 items, except the POMS test, of NCTB developed by the World Health Organization(WHO). The study team conducted examinations of working environment on the exposed and non-exposed groups of each work place. The analysis of the collected materials for examinations were conducted with GC-MS. The concentration of the mixture in the air, relative to their respective threshold limit values(TLV) was calculated according to the formula of the ACGIH and the Korean threshold limits. The results indicated that for two of eight factories samples the recommended concentration limits for mixtures was exceeded. Of the six tests, the 'digit span forward', 'digit span backward' and 'digit symbol' produced conspicuous statistical differences between the two groups(p<0.1) as a result of compairing the test values by means of paired t-test. The results of respective analysis of the car repairing factories and textile printing factories revealed that the textile printing factories had greater differences between the exposed and the non-exposed than in the car repairing factories. It is presumably because the textile printing workers are continuously exposed to the organic solvents during working hours, whereas the car repairing workers are exposed only when they are doing painting works, The NCTB is assessed very useful in examining the neurobehavioral health affection under the exposure to organic solvents, and, therefore, the study team expects that the NCTB will play an important part in the course of developing a health program for the workers exposed to organic solvents.

사업장 소음 폭로에 의한 일과성 역치 상승과 회복

조수헌,하미나,한상환,주영수,성주헌,강종원,윤덕로,송동빈,이명학,김선태 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.2

To determine the recovery time from noise-induced temporary threshold shift(TTS), a prospective field study was conducted at three worksites where workers are known to be exposed high level of noise. Subjects were selected according to answers on a questionnaire which inquired about otological history and previous noise exposure, including avocational, military and occupational exposures. After excluding employee with past otologic problems, recent exposure to high level noise, and under medications, total 92 employees participated in the study. Among 92 participants, complete consecutive audiometric examinations were carried out at 0∼2 hours, 5∼7 hours, 14∼16 hours after worktime noise exposure on 26 participants wearing hearing protectors and 22 participants wearing no protective devices. The difference between the hearing level 0∼2 hours after noise exposure and 5∼7 hours is statistically significant by paired t-test(p<0.01). The median recovery times calculated from the data of 22 participants wearing no protective hearing devices are 15.6 hours at 4000Hz, and 7.7 hours, 10.3 hours, 8.4 hours at 1000Hz, 2000Hz and 8000Hz respectively. These data suggest that when measuring the pure tone audiometry for noise exposed workers, at least 16 hours noise-free interval is required.

특수건강진단 자료를 이용한 소음성난청 판정기준의 비교

한상환,조수헌,주영수,하미나,윤덕로,권호장,강대희,성주헌 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.3

Although noise-induced hearing loss (NIHL) is the most prevalent occupational disease in Korea, only 10% of the diagnosed cases are compensated. Old (1989-94) and current diagnostic criteria, criteria for workers' compensation of NIHL in Korea, compensation formulas of American Medical Association/American association of Ophthalmology and Otolaryngology (AMA/AAOO), the Committee on Hearing, Bio-Acoustics, Biomechanics (CHABA), American Academy of Otolaryngology (AAO) recommendation were compared. Each criterion was applied on the audiomety data of 4044 workers (8023 ears), who had received the second line screening test of Special Periodic Health Examination Program for noise-exposed workers during 1991-2. First, the resulting proportions of NIHL cases by employing each criterion were compared and strength of agreement was measured using kappa value. Temporary Threshold Shift (TTS) was corrected by noise free interval, and the reduction ratio of NIHL cases was calculated. Theoretical progression model of NIHL was reconstructed from previous studies on the natural course of NIHL to evaluate the change of diagnosis result of each criterion in the model. The kappa value between old and current criteria was 0.19, 0.55 for current criteria and workers' com. criteria, ranging from 0.08 to 0.78, highest coincidence was observed between current criteria and CHABA formula. The current criteria produce most similar results with CHABA formula. If TTS is corrected for NFI, there is about 14% reduction of NIHL cases. The results of applying on NIHL progression model divided the formulas roughly into 3 groups, of which compensation criteria was the most, old criteria and AAO the least conservative. In conclusion, the result of 4 ㎑ audiometry should be excluded in evaluation of hearing level and a new hearing conservation program should be set out. Current diagnostic criteria has an ambiguity in that managerial concept for prevention and purpose of compensation is mixed up. The current diagnostic criteria and compensation criteria could be incorporated into a new formula which is based on the state of the art test for estimating everyday hearing disability.

비만을 동반한 위암 환자에서 두 병을 같이 수술 치료한 경험(증례)

최경현,윤기영,문형환,신연명,서경원,안수미,송윤미,석정희,정경연,이은하 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.3

Obesity is growing problem in Korea. We had a case of bariatric surgery during gastric cancer operation. Patient was 29 year old Korean lady with early gastric cancer located in the lesser curvature side of the middle 1/3 of the stomach. Her body weight was 89 kg, height 163 cm, and thus body mass index was 33.5 kg/m2. Preoperative blood pressure was 130/90 mmHg, hemoglobin 12.9 g/dL, total lymphocyte count 3,280/mL, serum albumin 4.3 g/dL, CEA 1.1 ng/mL, CA 19-9 9.1 ng/mL, and alpha fetoprotein 2 ng/mL. Another associated disease was right thyroid follicular neoplasm. The chest X-ray was normal. After IM injection of 2,500 units of heparin 30 minutes before the induction of general anesthesia, she received curative subtotal gastrectomy and Roux en Y gastrojejunostomy when a malabsorption loop of 120 cm jejunum was incorporated between the Treitz ligament and the end to side jejuno-jejunostmy site at May 29th 2006. Her postoperative course was uneventful except a minor wound seroma and the elevations of serum amylase(up to 4 folds) and lipase(up to 2 folds). She lost her body weight 9 kg in 5th, 21 kg in 7th, and 27 kg in 10th postoperative months to became 61.5 kg. On follow up exams in July 2008, she gained 4 kg to overcome her weakness and fatigue. From the above result, the incorporation of a malabsorption loop during reconstruction phase of gastric cancer operation was a good option for obese gastric cancer patients especially in cases of early gastric cancer.

전국 단위 감시체계의 현황과 전망

강성규,안연순,지영구,김형옥,하미나,권호장,백남종,김성아,홍윤철,김재용,강대희,정혜선,하은희 대한산업의학회 2001 대한직업환경의학회지 Vol.13 No.2