정신보건관련시설 입원(소)자의 주요 정신장애 유병률 : 전국 20개 시설의 입원(소)자를 대상으로

조성진,조맹제,서동우,함봉진,홍진표,배재남,이준영,이동우,박종익,전홍진,김성주,김용익 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.6

Objectives : One of the objectives of this study is to estimate the prevalence rates of psychiatric diagnoses in the combined populations of psychiatric hospitals, psychiatric nursing facilities and homeless asylums using the Korean version of the Composite International Diagnostic Interview (K-CIDI), which is a comprehensive and fully standardized interview schedule to assess psychiatric disorders for diagnosis. The Other objective is to compare with previously studied prevalence rates of Psy-chiatric diagnoses using the results of this study. Methods : The study subjects, aged from 181o 64 years, were randomly selected from 64,582 institutionalized population of psychiatric hospitals, Psychiatric nursing facilities and homeless asylums as of 30, June, 2001. Twelve trained interviewers administered the K-CIDI to the selected respondents. A total of 1,875 respondents (male 1,194, female 681) completed the interview. Results : The lifetime and one year prevalences of any diagnosis excluding nicotine dependence · withdrawal, anxiety disorder, eating disorder, somatoform disorder were 88.2% (male 88.1%, female 88.3%), and 65.8% (male 62.7%, female 73.7%), respectively. The lifetime and one year prevalences of schizophrenia and other psychotic disorders were 78.5% (male 75.3%, female 83.7%), and 56.8% (male 51.9%, female 64.8%), respectively. The lifetime and one year prevalences of alcohol use disorder (dependence/abuse) were 26.7% (male 37.9%, female 8.3%), and 8.7% (male 12.8%, female 2.1%), respectively. The lifetime and one year prevalences of mood disorder were 18.1% (male 13.5%, female 25.8%), and 10.4% (male 7.2%,female 16.9%), respectively. The lifetime and one year prevalences of schizophrenia and other psychotic disorders were comparable with the 2001 community survey by 1.19% to 1.32%, and 0.51% to 0.61%, respectively. The lifetime and one year prevalences of schizophrenia were also comparable by 0.16% to 0.28%, and 0.16% to 0.25%, respectively. There were no significant changes of prevalence rates when correction were applied to other psychiatric diagnosis. Conclusion : The results of this study could be used for evaluating the distribution of psychiatric diagnoses in mental health related facilities and for planning mental health policies.

한국어판 Composite International Dianostic Interview(K-CIDI)의 개발

조맹제,함봉진,서동우,홍진표,배재남,김장규,이동우,조성진 大韓神經精神醫學會 2002 신경정신의학 Vol.41 No.1

연구목적 : 본 연구는 국제적인 정신장애 진단도구인 Composite International Diagnostic Interview(CIDI)를 한국의 사회문화적 상황에 적합하게 번역하고 신뢰도 및 타당도를 평가하여 한국어판으로 개발하기 위한 것이다. 방 법 : CIDI는 정신장애를 평가하고 진단할 수 있는 포괄적이고, 완전히 표준화된 진단도구로 훈련받은 일반인들이 적용할 수 있기 때문에 대규모 역학조사에 적합하다. 세계보건기구에서 제공하는 CIDI 번역 지침에 따라 한국어판 CIDI(K-CIDI)를 제작하였다. 영어권과 한국의 언어 및 사회문화적 차이를 고려하여 번역 및 개정을 하였고 역번역을 통하여 원본의 의미와 일치하는지를 확인하였다. 임상환자를 135명과 일반인 5명을 대상으로 신뢰도와 타당도 검사를 실시하였다. 두 명의 평가자가 K-CIDI를 이용하여 동일한 대상자를 동시에 면담하고 일주일 뒤에 재검사를 실시하였다. K-CIDI로 검사를 받은 대상자들을 정신과 전공의와 임상심리사가 한국어판 Structured Clinical Interview for DSM-Ⅳ를 이용하여 진단을 내렸다. 두 가지 진단의 일치도에 대한 kappa값을 산출하였다. 결 과 : CIDI의 번역에서 한국어 표현이 복잡하고 긴 문항은 두 개의 문장으로 분리하였고, 성과 관련된 표현과 의료체계 및 의료추구행태에서 사회문화적 차이를 반영하였다. 공포장애의 대상과 알코올 및 물질의 종류도 한국의 실정에 맞게 조정하였다. 현장 검사와 역번역 과정에서 K-CIDI가 적절하게 제작된 것으로 평가되었다. K-CIDI의 평가자간 신뢰도 검사는 140명에 대하여 이루어졌고 kappa값은 진단에 따라 0.86∼1.00범위였다. 검사/재검사 신뢰도 검사는 47명에 대해 이루어졌고 kappa값은 진단에 따라 0.42∼0.89였다. K-CIDI의 타당도 검사는 50명에 대해 이루어졌고 kappa값이 진단에 따라 0.50∼1.00의 범위였다. 결 론 : K-CIDI는 한국의 사회 문화적 배경에 적합하게 제작되었고 신뢰도 및 타당도 검사에서 역학연구에 적절한 진단도구로 평가되었다. Objectives : This study aims to develop a Korean version of the Composite International Diagnostic Interview(K-CIDI). Methods : The Composite International Diagnostic Interview(CIDI) is a comprehensive, fully standardized interview that can be used to assess psychiatric disorders and provide diagnoses. The K-CIDI was developed according to the guidelines provided by the WHO. The reliability and validity of the K-CIDI was evaluated by examining 135 psychiatric patients and five community residents. Subjects were jointly interviewed twice with a one-week interval. A psychiatric resident and clinical psychologist jointly determined clinical diagnoses using the Structured Clinical Interview for DSM-Ⅳ. Results : Notable modifications were done on sex-related expression, health system and help seeking behavior, subjects for phobic disorder, and kinds of alcohol and substance. Long and complex questions were divided into two or more questions. Field test and back-translation of the K-CIDI confirmed the appropriateness of the translation of the CIDI. The inter-rater reliability, test/retest reliability, and validity of the K-CIDI indicated kappa values ranging from 0.86-1.00, 0.42-0.89, and 0.50-1.00, respectively. Conclusion : The K-CIDI was deemed to be appropriate for the sociocultural background of Koreans. The reliability and validity of the K-CIDI were judged to be exceptionally acceptable.

한국 정신장애의 역학 조사 연구[I] : 각 정신장애의 유병률

조맹제,함봉진,김장규,박강규,정은기,서동우,김선욱,조성진,이준영,홍진표,최용성,박종익,이동우,이기철,배재남,신정호,정인원,박종한,배안,이충경 大韓神經精神醫學會 2004 신경정신의학 Vol.43 No.4

Objectives : This study aims to estimate the prevalence of the DSM-IV psychiatric disorders in Korean population using the Korean version of Composite International Diagnostic Interview (K-CIDI). Methods : Subjects were selected by taking multi-stage, cluster samples of 7,867 adult household residents, 18 to 64 years of age, in ten catchment areas. Total 78 trained interviewers administered the K-CIDI to the selected respondents, from June 1 to November30,2001. Results : Total 6,275 respondents completed the interview. Some 33.5% of respondents reported at least one lifetime disorder, 20.6% reported at least one-year disorder, and 16.7% reported at least one-month disorder. The most common lifetime disorders were alcohol abuse/dependence (17.24%), nicotine dependence/withdrawal (11.19%), specific phobia (5.16%), and major de-pressive disorder (4.25%). The lifetime prevalence of substance abuse/dependence (0.25%) and schizophrenia (0.16%) was very low. Nicotine and alcohol use disorder showed very high male/female ratio. Mood disorder and anxiety disorder were more prevalent among female than male. Conclusion : The prevalence of psychiatric disorders was high. In comparison with other studies, remarkable differences in distributions of psychiatric disorders across the areas and times were observed.

한국어 판 구조화 임상면담도구 개발 : 신뢰도 연구

한오수,안준호,송선희,조맹제,김장규,배재남,조성진,정범수,서동우,함봉진,이동우,박종익,홍진표 대한신경정신의학회 2000 신경정신의학 Vol.39 No.2

연구목적: 정신장애의 정확한 진단과 평가는 임상에서뿐만 아니라 신뢰성 있는 연구를 위해서도 매우 중요하다. Structured Clinical Interview for DSM-IV(SCID)는 임상전문가들이 사용하는 진단도구로서, 비교적 짧은 시간에 정확한 진단을 내릴 수 있다. 본 연구는 한국어판SCID를 개발하고 그 신뢰도를 평가하기 위해 수행되었다. 방법: 국문학자가 포함된 번역위원회를 통하여 연구용판 SCID를 번역한 후, 정신과 의사 2인과 임상심리학자 1인에게 한국어판SCID 실시방법을 교육시킨 뒤 한국어판SCID를 이용한 면담의 평가자간 신뢰도 (interrater reliability)를 검증하였다. 면담 대상은 1999년 2월에서 3월까지 2개 병원 정신과에 치료중인 환자 90명(남:41명, 여:29명)이었다. 결과: 현재 장애(current disorder) 평가에서 주요 우울장애, 기분부전장애, 정신분열병, 알코올 남용 및 의존, 기타 물질 남용 또는 의존, 여러 불안장애들 및 섭식장애 등과 같은 대부분 장애의 kappa값은 .70이상으로 매우 높았다. 그 이외의 양극성 장애, 망상장애, 광장공포증, 감별 불능 신체화 장애 및 건강염려증의 kappa값도 .69에서 .40사이로 수용할 수 있는 정도였다. 평생 장애(lifetime disorder)에서는 양극성 장애(k=.69)와 감별 불능 신체화장애(k=.59)를 제외한 다른 모든 장애의 kappa값이 .70이상이었다. K-SCID 면담시 Ⅰ축 질환에 대하여 흔하게 다중 진단이 내려졌으며, 평균 진단 수는 1.5∼1.7개로 나타났다. 결론: 한국어판 SCID는 신뢰도가 높은 진단도구로 생각되며, 향후 정신질환의 정확한 진단과 임상연구에 유용하게 사용될 수 있다. Objectives: Accurate diagnosis and assessment for psychiatric disorders is crucial for research, as well as for clinical practice. Structured Clinical Interview for DSM-Ⅳ(SCID-RV) is a less time-consumimg and more accurate structured diagnostic interview form. It can be used by clinical professions and is known for a reliable diagnostic tool. Present study was conducted to develop Korean version of SCID-RV and to test the inter-rater reliability. Methods: The authors have translated original SCID-RV into Korean, and revised in parallel with sociocultural background of Korea. Ninety patients from two psychiatric hospitals, both outpatient and inpatient, were interviewed and rated independently by three raters. Results: The kappa coefficients for most of illnesses, such as major depressive disorder, dysthymia, schizophrenia, alcohol abuse and dependency, anxiety disorder and eating disorder were excellent(>0.70) in the evaluation of current disorders. And the kappa coefficients for bipolar disorder, delusional disorder, agoraphobia, undifferentiated somatoform disorder, and hypochondriasis were acceptable(>0.40) in the evaluation of current disorders. In the evalua-tion of lifetime disorders, the concordant rates of all the diagnoses except bipolar disorder and undifferentiated somatoform disorder were excellent. Lack of hierarchy in DSM-Ⅳ allows for multiple Axis I diagnoses. Mean numbers of Axis I diagnoses per subject assigned by the three raters were 1.5-1.7. Conclusions: Our findings confirm that SCID-RV yields highly reliable diagnoses. SCID-RV is recommended for accurate diagnosis in clinical practice and research on psychiatric disorders.

非結石性 膽囊炎에 關한 臨床的 硏究

裵振善,睦愚均 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.2

A clinical study was undertaken on the 35 cases of acalculous cholecystitis among 392 cases operated for the biliary disease during the period from. January 1980 through June 1987 admitted in the department of surgery Chungnam National University Hospital. The results obtained were as followings; 1. The incidence of acalculous cholecystitis was 8.9% and extragallbladder biliary stone 3.1% among all cholecystitis. 2. The incidence of acalculous cholecystitis was slight more prevalent in female in contrast to many reports, i. e. the ratio of male to female was 1 : 1.2. 3. In regard of the age distribution, 5th decade was most prevalent, followed by 7th, 4th, & 6th decade in order of frequency; 91.4% of all patients were older than 30 years. 4. Right upper quadrant pain (74%) was most frequent clinical symptom, followed by nausea and vomiting (57%), fever & chillness (54%), & epigastric pain (37%) in order of frequency. 5. 37% of patiients was within one week of duration of symptoms, 14% between 1∼2 weeks, & 63% of patients within 4 weeks, 6. Right upper quadrant tenderness (77%) was most frequent positive physical finding, followed by jaundice (26%), & right upper quadrant mass (20%). 7. The elevated SGPT(74%) was most frequent positive laboratory finding, followed by elevated SGOT (69%), elevated serum bilirubin above 1. 5mg% (66%), above 3.0mg% (40%), leukocytosis (37%) & elevated alkaline phosphatase (37%). 8. Ileus on simple abdomen (60%) was most frequent finding as diagnostic measures, nonvisualisation of gallbladder in oral cholecystography or cholescintigraphy (17%) ; in most cases, the findings were nonspecific, therefore it can be said that clinical findings were most important in the diagnosis of acalculous cholecystitis. 9. Preoperatively, it was diagnosed as chronic cholecystitis (37%), empyema gallbladder (11%), gallbladder stone (11%), choledocholithiasis (9%), & acalculous cholecystitis (6%). i. e. the preoperative diagnostic accuracy was very low. 10. The most frequent operation underwent was cholecystectomy with or without T-tube drainage (86%), followed by cholecytostomy (9%), & choledochojejunostomy (5. 7%). 11. Bile culture was performed in 14 cases, 79% being positive, among them E. coli was most frequent (29%), followed by Klebsiella (21%), Proteus mirabilis, Streptococcus intermidius, & Streptococcus epidermidis. 12. Regarding etiologic and predisposing factors, ascaris was found in 14% of cases, Clonorchis sinensis (9%), & common bile duct cancer (9%), gallblader cancer (9%), pancreas head cancer (6%), & unclear(37%). 13. Postoperative complications were developed in 8 cases (23%), among them wound infections were most frequent (4 cases), followed by wound dehiscence (1 case), intraabdominal abscess (1 ,case), biliary fistula (1 case), & cholangitis (1 case).

뇌졸중 환자의 상지운동 패턴의 운동학적 분석

우상연,이진희,배성수 한국특수체육학회 2003 한국특수체육학회지 Vol.11 No.2

The purpose of this study was to analyze the abnormal movement patterns in upper limb after stroke, and to identify the effects of a 4 week task-oriented movement therapy on upper motor patterns. The Kwon 3D motion analysis system was used to measure voluntary reaching in the impaired and unimpaired arms of 9 subjects with stroke history. Following the 4 weeks period of TOMT, which is task-specific practice, patients exhibited a significant improvement in upper motor patterns and function as shown in the results of movement kinematic analysis. Motor performance changed through TOMT from initially slow, inaccurate, and uncoordinated movement to fast, accurate, and coordinated movement in group 1 and group 2.

무리말뚝의 수평하중분담에 관한 실험적 연구

裵鍾淳,金成浩,崔震宇,姜秉卓 경상대학교 생산기술연구소 2000 生産技術硏究所論文集 Vol.16 No.-

Load distribution in group piles is an important matter of consequence for the safe design and the economical design. In the group piles, the model tests were to investigate the effects on spacing-to-diameter ratio of pile, number of piles and arrangement of the pile. The tops of pile were all set to rotate freely. This paper considered the load distribution by the location of the pile as compared the behavior of group piles with single pile. For a three row pile group at 3D spacing, the measured individual row distributions were 35~38%(lead), 32∼34%(middle) and 27∼30%(tail). This results were compared very favorably to those by McVay et al(1995). The shadowing effect for the parallel direction of lateral loading appears to be more significant than the one for the perpendicular direction of lateral loading.

분편 인플루엔자백신(split influenza vaccine)의 임상효과 및 면역원성에 관한 연구

우흥정,김동림,정희진,천병철,이주연,안정배,김지희,박찬,신영규,김우주,김민자,박승철 대한화학요법학회 1999 대한화학요법학회지 Vol.17 No.1

목적 : 아단위 인플루엔자 백신 접종 후 백신의 인플루엔자 예방효과, 인플루엔자 방어 항체형성, 인플루엔자 백신의 안전성을 조사하고자 하였다. 방법 : 총 571명을 대상으로 인플루엔자 백신 접종을 하였고, 이들 접종자에서 인플루엔자 양질환의 이환을 조사하여 인플루엔자 백신의 인플루엔자예방효과를 알아보았고, 백신의 접종 전 및 접종 4주 후 혈청에서 혈구응집억제물(Hemagglutination Inhibition : HAI) 항체 검사를 실시하여 백신의 방어항체생성을 조사하였고, 백신의 안전성을 알아보기 위해 백신접종 후 1주일 이내의 부작용을 조사하였다. 결과 :백신 접종군과 백신 비접종군에서 인플루엔자 양 질환의 이환을 조사한 결과 접종군 28.35%, 비접종군 35.88%으로 나왔으며, p 값이 0.001로 통계적으로 접종군에서 유의하게 낮았고, 인플루엔자 양 질환의 예방 효과는 20.97%를 보였다. 백신의 방어항체 형성의 평가를 위해 유럽의 인플루엔자 백신 허가 기준을 조사하였는데 B/Guangdong/5/94균주의 백신접종 후 항체가 40이상의 비율을 제외한 다른 기준은 모두 만족 시켰다. 부작용은 전체 조사자 521명중 149명(29%)으로 주로 접종 부위의 국소 부작용을 호소했고, 전신 부작용은 2% 내외였으며 특별히 심각한 부작용은 발견되지 않았다. 결론 : 분편 인플루엔자 백신은 인플루엔자양질환의 예방과 방어항체생성에 효과 있으며 안전한 것으로 사료된다. Background : The safety and effectiveness of influenza vaccine are well known in developed country. The influenza vaccination has been recommended as one of the tentative immunization schedule for indicated persons since 1997 in Korea. But there are still no available data about them, even though nearly 5 million doses of influenza vaccine were used in 1997-1998 season. So it is immediately needed to investigate the safety. efficacy and immunogenicity of influenza vaccine among Korean. Methods : We studied the clinical efficacy of influenza vaccine by monitoring Occurrence of influenza-like illness in influenza risk group(vaccination ; 300, non-vaccination; 215) from December in 1997 to March in 1998. We used the split quadrivalent influenza vaccine containing 15 microgram of hemagglutinin of A/Beijing/262/95(HlNl), A/Wuhan/359/95(H3N2), B/Mie/1/93 and B/Guangdong/5/94. Hemagglutination inhibition(HA1) antibody titers were determined before immunization and 1 months after vaccination And we evaluated adverse effect of influenza vaccination at 7 days after vaccination. Results : Influenza vaccination was associated with si@icant reductions in influenza-like spptoms(vaccination group; 28.35%, non-vaccination group, 35.88%, p=0.001). The preventive effect of influenza-like i3lne.s among influenza risk goup was 20.97%. And immunogenicity of influenza A and B exceeded all of the European licensure criteria for immunogenicity except postvaccination proportion of titers 240 of B/Guangdong/5/94 strain. And the adverse effects were mainly local injection site problem and no serious adverse effect was noted. Conclusion : Split influenza vaccine is safe, inmunogenic and eff'tive in influenza risk group in Korea.

사이버 윤리지표 개발에 관한 실증연구 : 한국, 미국, 인도의 차이를 중심으로

백승익,조남재,이인,강진우,김봉준 한국정보사회진흥원 2007 정보화정책 Vol.14 No.1

정보화 시대에서 인터넷이 주는 여러 장점이 존재하기는 하지만 그에 따른 비윤리적 행위에 대한 폐해도 점차 심각해지고 있기 때문에 사이버 상에서의 윤리지표가 필요한 시점이라 생각한다. 본 연구에서는 다음과 같은 두 가지 목적을 가지고 있다. 첫째, 사이버 공간에서 발생되는 범죄행위에 대한 문제인식을 바탕으로 본 연구에서 제시된 인터넷 사용자들의 윤리의식 지수(Self-Evaluation)를 스스로 측정해 볼 수 있는 표준화된 사이버 윤리 프레임워크를 개발하는 것이다. 둘째, 제시된 프레임워크의 타당성을 검증하기 위해 3개국(한국, 미국, 인도) 인터넷 사용자들을 대상으로 실증분석을 함으로써 각기 문화권이 다른 한국, 미국, 인도의 인터넷 사용자들의 윤리지수 차이를 문화적 관점에서 국가간 어떤 차이를 보이는지를 규명하는데 그 목적이 있다. 연구의 시사점으로는 국가별 전통문화의 차이 규명과 함께 행동의도를 분석하였다는 점과 인터넷 공간에서 사용자들이 윤리적인 부분에 있어 불안감이나 민감하게 느끼는 요인들을 분석하였다는 점에서 연구의 의의를 찾아볼 수 있다. The Internet-assisted communication transforms conventional information systems into vast human interactive networks, and offers people opportunities to experience new forms of social contacts, without any real social presence. Because of this anonymity of Internet users, they have a strong tendency to behave in an unrestricted manner. This experience is do stimulating, rewarding and reinforcing that ome user find it hard to know when to stop. These behaviors frequently go over the fun, and are developed into the crimes. To reduce these side-effects, various computer security solution and laws have been introduced. However, the most important factor in reducing the Internet side-effects is individual user’s ethics. This research proposes a Cyber Ethics Evaluation Model to measure the ethics of Internet users and compares cyber ethics of South Korea, U.S.A, and India by using the model. It conduct Confirmatory Factor Analysis (CFA) to test the validation of the model.

건국대학교 의과대학에서의 임상연구를 위한 기반 조성에 관하여 : 연구윤리심의위원회(의학윤리위원회)의 설치 및 운영 Establishment and Operation of Institutional Review Board (Medical Ethics Committee)

배진우 건국대학교 의과학연구소 2003 건국의과학학술지 Vol.13 No.-

Clinical study is undoubtedly essential in the development of medical science. All proposals for clinical study should be submitted to the Institutional Review Board (IRB) for scientific and ethical review. IRB is the fulfillment of the governments obligation to establish an institution of clinical study. Thus, some important factors for the establishment and operation of IRB were introduced in this manuscript to reiterate the importance of IRB among faculty members. While each hospital usually establishes its own IRB, it will probably be better to establish one IRB at Konkuk University Clinic to do away with manpower and financial burdens. IRB should consist of more than five persons including a physician, a statistician, a scientist, a lawyer, and a non-medical expert. Likewise, there should also be at least one female member. In addition, IRB should prepare several forms including standard operating procedures(SOP), application forms, informed consent, and their exemplar. The SOP of IRB should consider the regulations of IRB particularly on membership, conference, finance, review procedures, etc. IRB should determine whether the clinical study is scientific and ethical, given that unscientific study is also unethical. The quality of investigator and facilities, control group, informed consent, and recruitment of subjects should also be reviewed. In particular, informed consent is very important in the review of ethicality. It should be comprehensible; subjects should be well informed of the risks and benefits. Participation in and withdrawal from the study should also be unrestrictive and also do not influent to the relationship between medical doctor and patient