노인과 중년 당뇨병 환자의 골절의 발생 빈도 위험과 혈당조절의 관계

신혜연,Sin, Hye Yeon Korean College Of Clinical Pharmacy 2018 한국임상약학회지 Vol.28 No.3

Background: Bone fractures are high in elderly patients with type 2 diabetes mellitus (T2DM). Hyperglycemia and chronic kidney disease may increase the risk of fracture prevalence via altered bone metabolism, but whether glycemic control and kidney function are associated with the risk of fracture prevalence remains unclear. This study evaluated the relationship between glycemic control and baseline estimated glomerular filtration rate (eGFR) and risk of fracture prevalence in older and middle-aged patients with T2DM. Methods: Patients who underwent a general medical check-up between 2009 and 2013 were selected from the Korean National Health Insurance Sharing Service records. Chi-square test and multiple logistic regression analysis were used to assess the relationship between glycemic control and eGFR and risk of fracture prevalence. Results: Cumulative fracture prevalence were higher in patients with T2DM, irrespective of whether they had tight or less stringent glycemic control (fasting blood glucose [FBG] ${\geq}110mg/dL$). After adjustment for baseline age and FBG, tight and less stringent glycemic control was significantly associated with increased adjusted risk of fracture prevalence in middle-aged patients with T2DM (OR=1.13, 95% CI, 1.05-1.21, p=0.0005 vs OR=1.13, 95% CI, 1.06-1.20, p=0.0001), but not in older patients. Baseline eGFR was not significantly related to fracture prevalence in either older or middle-aged patients. Conclusion: Less stringent glycemic control significantly increased the adjusted risk of fracture prevalence in middle-aged patients with T2DM. Further studies are needed to confirm the effect of tight glycemic control on fracture prevalence.

SNS 상의 가나표기 한국어의 특징과 인식-ハムニダ․イムニダ를 중심으로-

신혜연,이길용 중앙대학교 일본연구소 2018 日本 硏究 Vol.0 No.48

This study analyzed the sociolinguistic characteristics of katakana Korean in social networking services(SNSs). Data for the analysis were obtained from Twitter. This study analyzed the forms of structural combination and images by extracting the cases where nida was used on Internet community sites with katakana Korean and compared them with the cases where only hamunida and imunida were not used on Internet community sites. The results of the analysis are summarized as follows. (1) Regarding the overall usage aspect of katakana Korean, hamunida is attached to verbs, and imunida to nouns. It seems that the use varies according to the structural characteristics and grammar rules concerning hamunida and imunida in Korean language. (2) “Hamnida” is equivalent to “(shi)masu” in Japanese, and “ imnida” to “desu”. The possibility of replacement of one for another in the collected data was examined. As a result, it was found that the users tend to apply the structural rules of the Korean language to both elements when using “hamunida” and “imunida”, showing awareness of their difference. (3) There were many cases in which the “い” of Japanese adjectives was combined with “imunida”. In these cases, it is supposed that “い” was dropped due to its fusion with “i” of “imunida”. (4) The analysis on the usage statuses of “nida”, “hamunida”, “imunida”, and “emojis” revealed a substantial number of cases in which an emoji was used to convey a more negative meaning in “nida” compared with hamunida and imunida. Therefore, users of “hamunida” and “imunida” seem to have a more positive image of Korea or the Korean language compared with users of “nida”. It is believed that he users of “hamunida” and “imunida” have some knowledge of Korean language. They use this knowledge in their SNS messages, showing a positive attitude toward Korea.

조현병 및 조현정동장애 환자에서 항정신병약물에 의한 체중증가에 미치는 메트포르민의 영향: 체계적 문헌고찰 및 메타분석

신혜연,천부순,Sin, Hye Yeon,Chun, Pusoon 한국임상약학회 2018 한국임상약학회지 Vol.28 No.3

Background: In this systematic review and meta-analysis, the effect of metformin on weight loss was assessed to determine whether metformin should be recommended for the prevention or treatment of weight gain in patients receiving antipsychotic medication for the treatment of schizophrenia or schizoaffective disorder. Methods: The PubMed, Embase, and Cochrane Library databases were searched for all published randomized controlled trials (RCTs) from inception to June 2018. In addition, the references of relevant articles were also examined. Using Review Manager 5, the pooled estimates of the weighted mean difference (WMD) of the changes in body weight and body mass index (BMI) and the corresponding 95 % confidence intervals (CIs) were calculated. Results: The meta-analysis included 15 RCTs. The pooled analysis showed that compared with placebo, metformin led to significant reductions in body weight (WMD: -2.09, 95% CI: -2.59, -1.60; p<0.00001) and BMI (WMD: -0.90, 95% CI: -1.08, -0.72; p<0.00001). The effect of metformin on weight loss was greater in patients receiving olanzapine than in patients receiving clozapine (body weight, WMD: -2.39, 95% CI: -3.76, -1.02; p=0.0006 for olanzapine; -1.99, 95% C: -3.47, -0.51; p=0.009 for clozapine; BMI, WMD: -1.15, 95% CI: -1.74, -0.57, p=0.0001 for olanzapine; WMD: 0.76, 95% CI: -1.23, -0.28; p=0.002 for clozapine). Conclusion: Metformin can be recommended to manage olanzapine-induced weight gain in patients with schizophrenia or schizoaffective disorder. The magnitude of the reductionss in body weight and BMI implieds that the use of metformin to attenuate olanzapine-induced weight gain can minimize the risk of coronary heart disease.

Hyperglycemia and survival rate in Asian patients with Acute Coronary Syndrome

신혜연 대한약학회 2014 Archives of Pharmacal Research Vol.37 No.6

Current studies are debating on the association ofhigher admission blood glucose (BG) and increased mortalityof acute coronary syndrome (ACS). This study evaluatedassociation of mortality between admission BG and BGcontrol in 222 patients with ACS who received coronaryintervention in the intensive care unit. This study observedmedical records through electronic medical record retrospectivelyand evaluated all patients who were admitted forthe first attack of ST-segment elevation MI (STEMI), non-STEMI, and unstable angina pectoris. Admission BG higherthan 220 mg/dl was statistically significantly associated withlower survival in patients; the association was stronger thanin patients with admission BG higher than 140 mg/dl to lessthan 220 mg/dl and patients with admission BG less than140 mg/dl (Wilcoxon test, p = 0.002). Survival time afteradmission was also associated with the history of diabetesmellitus (DM). Patients with diabetes had significantly lowersurvival than those without diabetes (Wilcoxon test,p = 0.028). Survival after ACS was not consistent with eachinsulin intervention of on admission to 6, 24, and 48 h afteradmission. There is a statistically significant associationbetween admission BG higher than 220 mg/dl and low survivalbut each intervention of post admission BG levels werenot consistently associated with the mortality. Additionally,history of DM is associated with lower survival in patientswith ACS on admission.

아동병동 간호사의 병원감염 표준주의에 대한 인지도와 이행도

신혜연,김경희,김기숙 한국아동간호학회 2011 Child Health Nursing Research Vol.17 No.4

Purpose: The purpose of this study was to identify pediatric nurses’ attitudes to, and compliance with, standard precautions in the prevention of hospital infections by enhancing their practice of standard precautions. Methods: The participants were 206 nurses who worked in pediatric nursing departments of a general medical institution in Seoul. The questionnaire was a modification of Kim (2008) and consisted of 18 questions about hand washing, personal protective equipment, sharps, linen and patient care equipment. Collected data were processed using SPSS 15.0 WIN. Results: Mean scores for attitudes to standard precautions and for compliance with standard precautions were 4.43 (±0.83) and 4.22 (±0.44) respectively. This difference was statistically significant (t=3.368, p=.001). The nurses’ compliance with standard precautions differed significantly according to the general characteristics of age (F=8.705, p<.001), total clinical experience (F=9.426, p<.001), current department experience (F=6.555, p<.001), and education experience (t=0.616, p<.043). There was a positive correlation between attitudes to, and compliance with, standard precautions (r=.156, p=.025). Conclusion: The results of this study indicate that educational programs and policy on infection control and standard precautions for pediatric nurses are needed. Also these results should contribute to baseline data for establishing appropriate clinical policy on infection control.

만성신부전 환자의 혈관 석회화와 사망률에 미치는 인결합제의 영향

신혜연 한국임상약학회 2014 한국임상약학회지 Vol.24 No.3

Objectives: Current studies are debating on the association of vascular calcification and the benefit of treatment to lower serum phosphorus level in patients with chronic kidney disease. The aim of this study was to evaluate the association of mortality and risk of vascular calcification in patients with CKD who were taking phosphate binders. Methods: This study was conducted through retrospective medical chart review for 420 patients aged 18 years and older who were admitted for chronic kidney disease. Results: Vascular calcification was not statistically significantly associated with increased mortality in patients with CKD [16.7% vs. 19.2%; 95% CI; 0.388 to 1.818 (p=0.656)]. Intervention of calcium-based phosphate binders was not significantly associated with vascular calcification in patients with CKD [9.1% vs. 12.5%; 95% CI; 0.364 to 1.358 (p=0.292)]. Ca x P product ≥ 55 mg2/dL2 was not significantly associated with increased 1 year mortality in patients with CKD [25.4% vs. 17.5%; 95% CI; 0.851 to 3.013 (p=0.142)]. Intervention of sevelamer was significantly associated with reduced 1 year mortality in patients with CKD than that of patients who did not take sevelamer [6.3% vs. 25.3%; 95% CI; 0.044 to 0.880 (p=0.020)]. Conclusion: There was not a statistically significant association between vascular calcification and phosphate binder’s use. But phosphate binder use was significantly associated with decreased mortality in patients with CKD.

고등학생의 교육성과 잠재계층 분류 및 방과 후 활용시간 영향 요인 탐색

신혜연,김재철 학습자중심교과교육학회 2023 학습자중심교과교육연구 Vol.23 No.24

Objectives This study classified the potential class according to school satisfaction, self-esteem, academic achievement, and career maturity, which are the educational performance of high school students' school education, and explored the factors of the use of after-school time that affect the potential class. Methods Latent Profile Analysis(LPA) and Logistic Regression Analysis were conducted to analyze the classification and influencing factors of the latent class using the 5th data(2021) of the a middle school student panel of the Daegu Education Longitudinal Study(DELS). Results As a result of the analysis, the four latent profiles classified according to high school students' educational performance were as follows: ‘low performance type(24.2%)’, ‘high achievement type(7.6%)’, ‘medium performance type (38.9%)’, ‘satisfaction type (29.3%)’ and the factors of the use of after-school time affecting the potential class were identified as learning time, reading time, physical activity time, and electronic device learning time. Conclusions This study is meaningful in identifying potential classes according to school satisfaction, self-esteem, academic achievement, and career maturity, which are the educational performance of school education, and to find out the differences in factors influencing the use of after-school time.

다면적 인성검사 II 재구성판(MMPI-2-RF)으로 살펴본 외상성 뇌손상 환자와 외상후스트레스 장애 환자의 임상적 특성 비교

신혜연,최지영 한국건강심리학회 2016 한국심리학회지 건강 Vol.21 No.4

The purpose of this study was to investigate the clinical characteristics of Traumatic Brain Injury (TBI) and Posttraumatic Stress Disorder (PTSD) using the Minnesota Multiphasic Personality Inventory-2 Restructured Form. The participants were 34 TBI patients and 53 PTSD patients. The results showed that scores on Thought Dysfunction (THD), Behavioral/Externalizing Dysfunction (BXD), Ideas of Persecution (RC6), Aberrant Experiences (RC8), Neurological Complaints (NUC), Inefficacy (NFC), Substance Abuse (SUB), and Psychoticism-Revised (PSYC-r) scales were significantly higher in the TBI group compared to the PTSD group. However, the PTSD group scored significantly higher than the TBI group on the Multiple Specific Fears (MSF) scale. Moreover, in a logistic regression analysis, Thought Dysfunction (THD), Inefficacy (NFC), Activation (ACT), and Psychoticism-Revised (PSYC-r) scales were identified to be significant predictors distinguishing the PTSD group from the TBI group, after controlling for demographic variables and depression levels. Implications, limitations, and directions for future research are discussed. 외상성 뇌손상과 외상후스트레스 장애는 병인론에서 명백히 구분되는 증후군임에도 불구하고, 유사한 증상 양상들이 보고되기 때문에 이를 비교 및 변별하고자 하는 연구와 논의가 지속적으로 이루어져왔다. 본 연구에서는 외상성 뇌손상과 외상후스트레스 장애의 임상적 특성을 확인하기 위하여, 34명의 외상성 뇌손상 집단과 53명의 외상후스트레스 장애 집단을 대상으로 다면적 인성검사II 재구성판(MMPI-2-RF)을 실시한 후, 그 결과를 비교 분석하였다. 집단 간 차이 검증 결과, 증상차원에서 외상성 뇌손상 집단은 사고 문제(THD), 행동적/외현화 문제(BXD), 피해의식(RC6), 기태적 경험(RC8), 신경학적 증상 호소(NUC), 효능감 결여(NFC), 약물 남용(SUB), 정신증(PSYC-r) 척도에서 유의미하게 높은 T점수를 보였다. 반면, 외상후스트레스 장애 집단은 다중 특정 공포(MSF) 척도에서 유의미하게 높은 T점수를 보였다. 아울러, 두 집단을 변별하는 변인을 살펴보기위해 로지스틱 회귀 분석을 시행한 결과, 사고 문제(THD), 효능감 결여(NFC), 흥분 성향(ACT), 정신증(PSYC-r) 척도가 인구통계학적 변인과 우울 정도를 통제한 이후에도 두 집단을 유의미하게변별해주는 것으로 확인되었다. 즉, 외상성 뇌손상 집단은 외상후스트레스 집단에 비하여 사고 관련 문제, 신경학적 증상, 낮은 효능감, 행동통제의 어려움 및 약물과 관련된 문제를 보일 가능성이시사된 반면, 외상후스트레스 장애 환자의 경우에는 다양한 공포 및 회피 반응이 두드러지는 것으로 나타났다. 이러한 결과를 중심으로 본 연구의 의의와 제한점에 대해 논의하였다.

The Effectiveness of Team-based Case-based Learning Approach on the Learning Outcome: A Single Course Level in a University Setting

신혜연 한국임상약학회 2022 한국임상약학회지 Vol.32 No.4

Background: Case-based learning (CBL) is becoming an important approach for improving interprofessional collaborationeducation. Previous studies have examined learners’ satisfaction with interprofessional education (IPE) in medical institutions. However, there are few studies on the implementation of university-led CBL interventions and their direct effects on learningoutcomes. The aim of this study was to evaluate the effectiveness of CBL interventions on changes in the participants’ perceptionand knowledge acquisition ability. Methods: The CBL approach consisted of team-based case-based learning, self-directed learning,and post-feedback. It was conducted as a single course for pharmacy students in their 5th year in a university setting. Changes in theparticipants’ perceptions and self-assessments of competence levels were evaluated using survey responses. The effect of the CBLintervention on knowledge acquisition ability was directly evaluated using the exam score. Results: The majority agreed or stronglyagreed that team-based case-based learning, and self-directed learning helped them to improve their knowledge and skills to a higherlevel and to increase the self-assessment of competency level. The average score of knowledge acquisition ability (average score of75.0, p=0.0098) was significantly higher in the CBL intervention group than the lecture-based learning intervention group (averagescore of 52.0). Conclusion: The participants positively perceived that CBL intervention helped them to effectively improve theirknowledge and the self-assessment of competency level. It also enhanced knowledge acquisition ability. These data, based on thesurvey responses, suggest that it is necessary to implement CBL interventions in a university-led single professional education.

‘유형원의 실리론’ 분석 - 실리의 강조는 ‘주리’적 사유로의 轉回인가 -

신혜연 한국동양철학회 2022 동양철학 Vol.- No.57

The Neo-Confucian writings of Bangye Yu Hyeong-won, the pioneer of Shilhak, did not remain, and he himself confessed his conversion from a ‘Qi centered view’ to 'Shilli theory', resulting in a variety of interpretations, making the whole aspect of his Neo-Confucian philosophy difficult to figure out. From that time on, as interpreted in his conversion from ‘anti Zhuzi Studies’ to ‘Zhuzi Studies’, he has been recognized as a Juri-theorist with a Li-centered thinking. Nevertheless, many scholars who paid attention to Yu's 'The Theory of Governing Society' evaluated him as a reality-oriented Qi-theorist and experientialist. In this article, through analyzing the content and character of his Shilli theory expressed by Yu himself, and exploring the content, inclination degree, motive and purpose of the conversion he confessed at the age of 37, I examine whether his confession really meant a turn to Juri. I point out that even if he recognized Li's substance and developed Shilli theory, which emphasized Li’s independence and Superintendence Character, he still did not give up 'Qiwaiwuli' and 'Qizhili' and maintained a reality-oriented perspective that focuses on things and practice. I also point out that his Shilli theory has a light inclination that just adds reinforcement of the essential nature to the existence that is already firmly established in his philosophy. The trigger or purpose of the turn to Shilli theory was to secure absolute moral standards that could not be solved by Qi-centered theory, and to lay the cornerstone of his lifelong work, Bangyesurok, on the absolute principle of Tianli. Through this, I develop the argument that his Shilli theory was not a conversion to Juri. 실학의 선구자 반계 유형원의 성리 철학은 그의 성리 저술들이 남아있지 않은 데다가 일찍이 그 자신이 스스로 기 중심적 견해로부터 실리론으로의 전회를 고백하는 바람에 다양한 해석들이 산출되어 그 전모를 명확하게 파악하기 어려웠다. 그때를 기점으로 반주자학적 경향에서 주자학으로 돌아섰다고 해석된 그는 리 중심적 사유를 하는 ‘주리론’자로 평가되었지만, 그럼에도 유형원의 경세론에 주목했던 학자들의 현실 중심의 기론ㆍ경험론자로서의 평가도 상당하였다. 이글에서는 유형원 자신이 피력한 그의 실리론의 내용과 성격을 분석해 보고 37세 때의 전향 고백의 내용과 정도, 전향의 계기나 목적 등의 탐색을 통해 그의 고백이 과연 주리로의 전회를 의미하는지 살펴보았다. 논자는 그가 리의 실체를 인정하고 독립성과 주재성을 강조하는 실리론을 전개했다 하더라도 그는 여전히 기외무리와 기지리를 포기하지 않았으며 물과 사 차원의 현실 중심적 시각을 고수하였다는 점, 그의 실리는 물지리였기 때문에 그의 실리론은 자신의 철학에서 이미 확고히 자리매김한 실제성에 본원성 강화를 덧입히는 정도의 경도를 가진다는 점, 그 계기나 목적은 기 중심으로는 해결할 수 없는 절대적 도덕기준의 확보와 더불어 자신의 필생의 작업이었던 『반계수록』을 ‘천리’라는 절대 원리에 정초시키기 위해서였다는 점을 지적하고, 따라서 그의 실리론은 주리로의 전회가 아니라는 주장을 전개하였다.