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우종민,김경미,김성아 大韓産業醫學會 2003 대한직업환경의학회지 Vol.15 No.2
목적: 자동차 정비업무에서 관리책임자로 업무전환 후에 발생한 정신과적 질환(공황장애 및 적응장애)의 증례 보고. 방법: 기억기능검사, 심리검사 등 정신과적 검사와 면담, 직무스트레스 척도(K-OSI)를 이용한 직무 스트레스 평가. 결과: 과거력 상 특이한 소견이 없었으며, 기억검사, 심리검사 등의 정신과적 검사와 직무스트레스평가 결과, 업무전환에 따른 직무스트레스와 개인의 특성과 환경의 요구사이의 부조화가 주 원인인 공황장애 및 적응장애로 진단받았다. 증례의 역할은 자동차 단순정비 업무에서 사무관리직/서비스직의 역할로 변화하였는데, 고객과의 상호작용이 주된 업무가 되면서 감정노동(emotional labor)과 대인관계의 책임성에 대해 부적절감과 강한 직무스트레스를 경험했던 것으로 판단된다. 직무역할의 변화는 환자가 성격적으로 다소 취약한 부분인 정서적 측면을 오히려 더 강하게 요구하였으므로, 개인의 특성과 환경의 요구 사이에 부조화가 일어나 정신과적 상병이 발생한 것으로 평가되었다. 결론: 이 증례는 정신적 직무스트레스와 관련되어 발생한 정신과적 상병에 대해 작업관련성 질환임을 인정받은 첫 번째 사례로서 그 의의가 크다고 할 수 있으며, 향후 체계적 자료수집과 도구개발을 통해 유사한 사례에 대한 판단기준을 마련할 필요가 있다. Background: Recently, social concern about occupational stress and disputes, which are surrounded with judgements of work relatedness for various psychiatric sequels, in increasing. Objective: We present a case of work-related, illness judgement in which panic disorder and adjustment disorder with conversion symptoms were associated with work stress due to job reallocation. Methods: We performed psychiatric assessment including mental status examination and neuropsychological test batteries. We also assessed job stress profiles using the Korean version of the Occupational Stress Inventory(K-OSI). Results: The patient showed no specific psychological or physical problems and had previously demonstrated suitable coping skills. However, the patient, who was sensitive to emotional stress, suffered chronic stress symptoms after a role change from a car mechanic to office manager which required continuous interaction with customers and a strong emotional burden. Panic attack and conversion symptoms were judged to be associated with disharmony between individual characteristics and environmental needs. Conclusion: It is noteworthy that this is the first reported case considered as a psychiatric illness related with psychological work stress. A further study will be attempted to assign standards of judgment for similar cases through systematic source collection and tool development.
이경석,윤석만,권희,이호,김혜경,조미자,한규남,김명성 순천향의학연구소 2003 Journal of Soonchunhyang Medical Science Vol.9 No.1
Background: Recently the health insurance review agency tried to cut off the cost of unnecessary hospital stay. It is important to reduce the prolonged occupation of the hospital beds. However, there are some obstacles of the management for the prolonged bed occupation. We report our experiences and the problems of bed-control. Methods: To increase the rate of effective bed-usage, a task force was made. This team was consisted of 4 dctors, 2 nurses and 2 personnel of the administrative department. From December 20th 2001 to May 17th 2002, the task force analysed the rate, number and causes of the prolonged (more than 60 days, regardless of the disease entities) bed occupation. We announced and explained the necessity of bed-control and actively pressed to reduce the prolonged bed occupation. Results: The number of the prolonged bed occupation was 71 at the beginning of the management. It was reduced to 46 at best, then turned back to 65 at the end. It seems to be impossible to reduce the prolonged bed occupation until there are sufficient numbers of long-term care facilities. Aggressive bed control makes the sick patients to move every two or three months, it is never desirable. Conclusion: We cannot expect any Quality Improvements without improvement of the wrong system. Prior to the management for the prolonged bed occupation, it is necessary to build a sufficient number of long-term care facilities.
( Gyung-mee Kim ),( Gyun-ho Jeon ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.4
Objective To investigate whether serum 25-hydroxyvitamin D [25(OH)D] level is associated with ovarian reserve markers in secondary amenorrhea (SA) patients. Methods Sixty-three women diagnosed with SA were recruited during 12 months from the initiation of this prospective observational study. Serum 25(OH)D levels, serum anti-Mullerian hormone (AMH) levels and antral follicle count (AFC) were estimated in study participants and ovarian reserve markers were compared between participants with vitamin D deficiency and those with normal vitamin D levels. Results Of the 63 participants, 27 (42.9%) were vitamin D deficient (<20 ng/mL) and 36 (57.1%) had normal vitamin D levels. The mean AMH levels and AFC were 10.86±8.94 μ/L and 15.23±7.65 in the vitamin D deficient group, and 7.24±5.62 μ/L and 12.30±6.95 in the normal vitamin D group. Univariate and multivariate linear regression analysis of log10 transformed AMH and AFC with serum 25(OH)D adjusted for age and body mass index confirmed no association between vitamin D levels and AMH levels or AFC. There was also no correlation between serum 25(OH)D and AMH levels or AFC in all participants. However, participants with vitamin D deficiency had an increased chance of having polycystic ovarian syndrome (PCOS) as cause of SA than those with normal vitamin D levels (adjusted odds ratio, 7.559; 95% confidence interval, 1.28-44.65; P=0.026) after adjustment for clinical factors by logistic regression model. Conclusion There was no correlation between serum 25(OH)D levels and ovarian reserve markers in SA patients, but vitamin D deficiency may be linked to PCOS patients.
주의력결핍 과잉행동장애 증상을 동반한 발달장애에서의 약물치료
김경미(Gyung-Mee Kim),안동현(Dong-Hyun Ahn),신석호(Suk-Ho Shin),서동수(Dong-Su Suh),유희정(Hee-Jeong Yoo),김영기(Young-Ki Kim) 대한소아청소년정신의학회 2012 소아청소년정신의학 Vol.23 No.S
Developmental disorders such as mental retardation, autism spectrum disorders, and learning disorders are frequently associated with attention-deficit/hyperactivity disorder (ADHD) symptoms such as inattention, hyperactivity, and impulsivity. The existing data for the pharmacological treatment of ADHD symptoms with developmental disorders suggest that the agents used to treat ADHD in typically developing children appear to have some benefit. However, the risks of treatment including side effect in these population appear to be greater than in typically developing children. Therefore, when considering pharmacotherapy for developmental disorders with ADHD symptoms, a cautious approach of starting with a low dosage and close monitoring of side effect are recommended.
( Ji Yeon Kim ),( Gyung Ah Wie ),( Yeong Ah Cho ),( So Young Kim ),( Dae Kyung Sohn ),( Suk Kyoung Kim ),( Mee Duck Jun ) 한국임상영양학회 2018 Clinical Nutrition Research Vol.7 No.4
The enhanced recovery after surgery (ERAS) program aims to maximize the recovery of patients by minimizing pre- and postoperative complications and stress. The program recommends providing preoperative carbohydrate (CHO) supplements and starting an early postoperative diet to reduce the fasting duration. Based on these recommendations, we implemented preoperative CHO supplementation and initiated an early postoperative diet in patients undergoing laparoscopic colorectal resection. We observed 3 patients as follows: a non-ERAS case, preoperative ERAS case, and pre- and postoperative ERAS case. The preoperative well-being and compliance of patients improved after implementation of the ERAS program. Moreover, the length of hospital stay was reduced. Therefore, we consider that the ERAS program may be helpful for the recovery of patients undergoing laparoscopic colorectal resection.
기억성 경도인지장애 및 알츠하이머 치매 환자에서 해마, 편도체, 뇌들보, 내후각 피질과 혈중 지질, 호모시스테인, 엽산 농도와의 연관성
이상준,김태형,허량,최승은,이봉주,김경미,이정구,김홍대,문치웅,김영훈,Lee, Sang Jun,Kim, Tae Hyung,Huh, Lyang,Choi, Seung Eun,Lee, Bong Ju,Kim, Gyung Mee,Lee, Jung Goo,Kim, Hong Dae,Mun, Chi Woong,Kim, Young Hoon 대한생물정신의학회 2015 생물정신의학 Vol.22 No.4
Objectives In this study, the authors evaluated the correlation between levels of serum lipid, homocysteine, and folate with volumes of hippocampus, amygdala, corpus callosum, and in patients with amnestic mild cognitive impairment (aMCI) or Alzheimer's disease (AD) type. Methods The study recruited patients who visited the dementia clinic of Haeundae Paik Hospital in Korea between March 2010 and June 2014. Among those, patients who had taken the neurocognitive test, brain magnetic resonance imaing, tests for serum lipid, homocysteine, folate, and apolipoprotein E (APOE) genotyping and diagnosed with aMCI or AD were included for analysis. Bilateral hippocampus, entorhinal cortex, amygdala and corpus callosum were selected for region of interest (ROI). The cross-sectional relationships between serum lipid, homocysteine, folate and ROI were assessed by partial correlation analysis and multiple linear regression analysis. Results In patients with aMCI, old age (> 80) and APOE ${\varepsilon}4$ carrier were associated with AD [odds ration (OR) : 12.80 ; 95% confidence interval (CI) : 2.25-72.98 and OR : 4.48 ; 95% CI : 1.58-12.67, respectively]. In patients with aMCI or AD, volumes and thickness of ROI were inversely correlated with levels of serum lipid and homocysteine. In multiple linear regression analyses, higher total cholesterol level was related to lower left, right hippocampus volume and left amygdala volume ; higher low-density lipoprotein cholesterol was related to lower right entorhinal cortex thickness ; higher homocysteine level was related to lower corpus callosum volume. Conclusions Higher serum lipid and homocysteine levels are associated with decreased volume of hippocampus, amygdala, corpus callosum and entorhinal cortex thickness in patients with aMCI or AD. These findings suggest that serum lipid and homocysteine levels are associated with AD as a modifiable risk factor.