간호 대학생의 스트레스와 건강통제위

차남현 ( Nam Hyun Cha ) 경희대학교 동서의학연구소 2013 동서간호학연구지 Vol.19 No.2

본 연구는 간호 대학생을 대상으로 이들이 경험하는 스트레스 정도가 어느 정도인지 알고 스트레스가 건강통제위 유형과 유의한 관계를 가지고 있는지 파악하여 스트레스에 영향을 미치는 요인을 확인하기 위하여 시도되었다.간호대학생의 스트레스와 건강통제위 정도를 확인한 결과, 스트레스는 중간점수 이하였고, 건강통제위 점수는 내적 통제위, 타인의존통제위, 우연통제위 순으로 나타났다. 간호대학생의 건강통제위를 연구한 선행논문과 비교하면(Kim & Park, 2006; Lee, 2013), 본 연구대상자의 건강통제위는 Kim과 Park (2006)의 연구에서 제시한 건강통제위 유형별 순위는 같게 나타나 선행연구를 지지하였으나 각 유형별 점수는 더 높게 나타났다. 또한, 본 연구 대상자의 스트레스 정도는 평균 점수 이하로 낮았는데, 적응행동과 정적으로 연관 있는 내적 통제위 성향 점수는 가장 높게 나타났고 다음으로 타인의존통제위, 우연통제위 순인 것으로 나타났다. 그리고 평균 점수가 높은 문항은 “내 건강관리의 직접적 책임은 본인에게 있다” 등 대부분이 내적 통제위 문항이었고, 평균 점수가 가장 낮은 문항은 “내가 건강을 유지한다면 그것은 운이 좋기 때문이다” 등 대부분이 우연통제위 항목이었다. 타 전공 대학생에게 적용한 건강통제위 선행연구가 없어 비교하기 어렵지만, 본 결과로 볼 때 본 연구 대상자는 간호 대학생인 만큼 건강에 대한 지식을 어느 정도 갖추고 있고 관리하는 방법도 아는 만큼, 대부분 내적 통제위 성향 점수가 높고 우연통제위 점수가 낮게 나타나지 않았나 생각된다. 따라서, 자신이 처한 환경을 잘 통제하고 극복할 수 있으며 적극적인 경향을 가지는 내적 통제위 성향을 유도하기 위해서는 본인 스스로 건강에 대한 지식도 갖추고 있어야 하며, 간호대학생뿐 아니라 일반 대학생들도 내적 통제위 성향으로 지도할 수 있다면 스트레스 상황을 극복하고 학교생활에 적응할 수 있게 하는 데 도움이 될 수 있을 것으로 생각한다.간호대학생의 일반적 특성에 따른 스트레스와 건강통제위와의 차이를 검증한 결과, 스트레스는 여학생, 3학년, 하위 성적일수록 유의하게 높은 것으로 나타났으며, 스트레스 해소방법은 수다가 스트레스 정도를 감소시키는 것으로 나타났다. 이는 여학생과 고학년으로 갈수록 스트레스 경험 빈도가 높다는 연구(Im, 2007), 저학년, 하위성적일수록 스트레스가 높았다는 연구(Kim, 2011)를 지지하는 결과이나, 저학년이 고학년보다 스트레스 정도가 높았다는 연구와는(Jang, Park, & Choj, 2006) 반대되는 결과이다. 학년에 따른 차이의 결과는 Jang 등(2006)의 연구에서는 대상자가 취업과 관련된 진로결정 스트레스를 많이 받고 있는 일반 대학생이기 때문에(Ko & Nam, 2012) 고학년일수록 스트레스가 높아진 것으로 생각되나, 본 간호대학생은 취업에의 어려움보다는 학업과 실습 부담감과 관련된 스트레스 정도가 더 높아서 나온 결과로 생각된다.내적 통제위에 유의한 변수는 남학생, 저학년, 천주교, 중위권 성적, 유복한 학생, 과거 흡연자일수록 내적 통제위 수준이 높았다. 본 연구에서 종교는 Byun (2003)은 기독교와 천주교 집단이 불교집단에 비해 내적 건강통제위 수준이 높았다고 하여 본 연구를 일부 지지하였다. 종교적 영향이 내적 통제위에 영향을 미친다는 연구결과는 믿는 사람이 신과의 교감을 통해 자신의 삶에 만족하려 노력하면서 긍정적 정서경험을 많이 하여 심리적 안녕감을 가지려 하기 때문과 관련된 것으로 생각한다. 즉, 심리적 안정은 자신을 긍정적으로 느끼려 하고 온정적이고 신뢰로운 대인관계를 맺고 유지하고자 하기에 종교가 내적 통제위에 유의한 변수로 의미를 가지는 것으로 생각된다. 따라서, 간호대학생의 스트레스를 완화하고 긍정적인 내적 통제위로 자신의 건강을 조절하게 하기 위해서는 종교를 이용한 심리적 안정을 꾀하는 것도 한 방법이 될 수 있다. 저학년이 내적 통제위에 유의하게 나온 반면, Byun (2003)의 연구에서는 타인의존통제위가 높게 나와 상반된 결과를 보였다. 이는 저학년일수록 의미있는 타인(가족, 의료진 등)에 의존할 발달상태인데도 불구하고 본 연구에서 저학년의 내적 통제위 수준이 높은 것은 본 연구대상자의 발달 성숙도가 높기 때문이 아닌가 생각된다. 또한, 남학생이 여학생보다 내적 통제위에 유의한 것으로 나온 것은 비교할 만한 타 선행연구가 없어 비교하기 어렵지만, 남학생이 여학생보다 적극적이고 모든 일을 해결하려고 앞장서는 성격특성으로 대인관계가 좋고(Byun, 2003) 건강증진행위를 잘하는 것과(Paek, 2003) 관련된 것으로 생각된다. 유복한 학생이 내적 통제위가 높게 나타난 것 역시 경제상태가 좋을수록 건강증진 행위 수행 정도가 높고(Kim & Park, 2006), 이는 내적 통제위 형성에 긍정적인 바탕이 되었을 것으로 생각되며, 과거 흡연자가 내적 통제위가 높은 것은 과거에 흡연하다가 금연을 하였기에 금연성공경험이 내적 통제위로 작용했을 수 있을 것으로 생각된다. 성적 중위권의 내적 통제위가 높은 것 비교할 만한 선행연구가 없어 연관성을 추측하기 어렵고 추후 반복연구를 통해서 의미의 정확성을 파악해야 할 것이다.우연통제위에 통계적으로 유의한 변수는 형제순위 중 막내였다. 이는 선행연구가 없고 비교할 수 없으나 막내는 형제순위상 마지막이라 부모님의 사랑과 보살핌을 다른 형제보다 많이 받다 보니 의존적인 성향을 가질 수 있는데 건강도 우연에 의해 결정된다는 막내의 성향이 그대로 반영된 결과라 볼 수 있다.스트레스는 내적 통제위와 타인의존통제위와는 음의 상관관계가 있었으나 우연통제위와는 양의 상관관계가 있었으며, 내적 통제위와 우연통제위는 타인의존통제위와 양의 상관관계가 있는 것으로 나타났다. 즉, 스트레스가 많을수록 적극적인 건강행위나 타인의 지시이행을 잘 못하고 우연에 몸을 맡기는 부적응행동을 할 가능성은 높아짐을 의미한다. 또한, 자신의 행위에 의해 보상이 주어진다고 믿는 내적 건강통제위일수록 중요한 타인에게도 의존하는 경향이 있으며, 우연 등 통제할 수 없는 요소에 의해 자신의 건강이 결정된다고 믿을수록 중요한 타인에게 의존하는 경향이 높음을 의미한다. 따라서, 스트레스를 낮추기 위해서는 본인 스스로의 적극적인 건강관리뿐 아니라, 건강전문인, 부모, 친구와 같은 중요한 사람들의 개입도 필요함을 알 수 있다. 본 연구 결과는 대상자가 몸은 성인이지만 아직도 부모의 관리하에서 경제적인 것은 물론, 전반적인 면에서 의지하고 상담하는 비독립적인 상황과 관련되어 나타난 결과로 생각된다. 본 연구결과는 내적 통제위, 타인의존통제위, 우연통제위 모두가 스트레스 관리에 유의한 양의 상관관계가 있다는 Kim과 Park (2006)의 연구를 일부 지지하는 결과이다. 또한, 내적 통제위 및 우연통제위와 타인관계통제위의 상관관계 역시 선행연구 마다 상이한 결과를(Kim & Park, 2006) 내고 있어, 스트레스와 건강통제위 간의 관계에 대해서는 추후연구가 필요함을 제기한다. 그러나, 내적 통제위가 스트레스를 관리하고 정적 상관관계를 보이며 건강증진에 유의한 영향요인임을 대부분의 선행연구(Kim & Park, 2006; Shim, 2000)가 제시하고 있으므로 본 연구 결과를 고려한 제안으로 간호대학생의 스트레스를 완화시키기 위해서는 개인의 내적 통제위 성향을 강화시키되, 부모 및 의미있는 타인의 영향력도 고려한 건강증진 프로그램 개발과 적용이 필요하다.앞에서 시행한 통계에서 유의하게 나온 변수를 가지고 회귀분석한 결과, 간호대학생의 스트레스에 가장 큰 영향을 미치는 요인은 건강통제위 중 타인의존 건강통제위였으며, 다음으로 우연통제위, 학년 순으로 영향을 미치는 것으로 나타났고 모형의 설명력은 15.6%이었다. 스트레스라는 부정적 상황에 영향을 크게 미치는 건강통제위가 타인의존통제위와 우연통제위라는 결과는 연구 대상과 연구 개념이 좀 다르기는 하지만 Cha와 Seok (2013)의 연구에서 월경곤란증이라는 여중생의 부정적 상황에 영향을 미치는 통제위가 우연통제위와 타인의존통제위였다는 보고와 비교할 때 우연통제위과 타인통제위는 긍정적 상황보다는 부정적 상황에 유의하게 영향을 미치는 변수임을 알 수 있다. 이는 건강통제위 중 외적 통제위 성향을 가진 간호 대학생일수록 스트레스 상황이 더욱 부각될 수 있음을 의미한다. 따라서, 스트레스가 높을수록 극복력은 낮아지므로(Park, 2011) 스트레스 상황을 낮추어 주는 환경적 여건 마련 노력이 필요하다. 간호대학생의 스트레스 완화를 위해서는 학년을 고려한 외적 통제위 성향을 극복할 수 있는 환경적 여건 마련 및 교육적 훈련이 중요하다. 즉, 간호대학생이 강의와 실습을 병행하는 스트레스 상황 속에서도 스트레스를 극복할 수 있는 요인인 전공만족도를(Park, 2011) 높일 수 있도록 재미있고 생동감 넘치는 강의 교육, 실습을 통한 기술획득과 현장에서의 이론 및 기술 적용에 흥미 상승, 미래 직업을 잡는 데 어려움이 없다는 장점을 부각시키고, 현재의 부담감이 좋은 직업과 미래 형성에 도움이 많이 된다는 점을 부각시킨다면 간호대학생이 느끼는 스트레스 수준을 완화시킬 수 있을 것으로 생각된다. 또한, 스트레스를 완화하고 건강관리나 건강행위 이행을 바람직하게 하기 위해서는 대상자가 자신의 건강에 대해 올바르게 인식을 하고 책임감을 가지며 자신의 문제해결에 관심을 갖도록 잘못된 행동과 감정을 변화시킬 수 있는 생각의 변화에 가장 효율적인 인지행동적 접근방식(Lee, Jung, & Cho, 2008)으로 학생들을 지도하는 이 필요하며, 간호 대학생의 비독립적 특성도 고려한 스트레스 완화 프로그램을 개발, 적용할 것을 권고한다. This study was to identify the relations between stress and health locus of control in nursing college students. Methods: A total of 243 subjects aged between 17 and 27 were selected through convenient sampling. Data were collected with a self reported questionnaire from March 2 to 25, 2013. Collected data were analyzed with SPSS/PC Win 15.0. Results: Differences in stress and health locus of control according to general characteristics were as follows. Stress were significantly different according to gender (t=-2.51, p<.05), grade (F=5.40,p<.01), school record (F=5.72, p<.01), stress solving methods (F=2.62, p<.05). Internal health locus of control was significantly different according to gender (t=2.30, p<.05), grade (F=14.73, p<.001), religion (F=4.63, p<.01), school record (F=5.29, p<.01), economic state (F=5.50, p<.001) and smoking (F=4.17, p<.05). Chance health locus of control was significantly different according to sibling rank (F=2.86, p<.05). Except chance health locus of control, internal heath locus of control and dependence health locus of control have a negative correlation with stress. 15.6% of variance in stress was explained by dependence health locus of control, chance health locus of control, and grade. Conclusion: The findings of this study may be useful in understanding the stress expression of nursing college students and developing more specific programs on personality and self-control.

만성두통 환자의 성격유형 A 행태, 스트레스, 우울 및 두통영향정도의 관계 연구

차남현,임사비나,정인태,김수영,안경애,김건식,이재동,이상훈,최도영,이윤호,이두익 EAST-WEST MEDICAL RESEARCH INSTITUTE KYUNG HEE UNI 2005 東西醫學硏究所 論文集 Vol.2005 No.-

To examine an estimate factor and grasp the relation of difference for Ype A Behavior Pattern(TABP), Perceived Stress Questionnaire. Depression and HIT-6 in the Chronic headache client. Method: Data collected by self-reported questionnaires from 38 client in S city who were selected by criteria of IHS, from the 19^(th) of October to 10^(th) of December, 2004. Result: 1) Differences between biographical data by TABP was significant by SaSang constitutions, by Stress was significantly influenced by age, and by Depression were significantly influenced health status and SaSang constitutions. 2) Correlations Coefficients among Study Variables were Stress and Depression(r=.494, p=.002) and Depression and HIT-6(r=.432, p=.010). 3) In regression analysis, HIT-6 were significantly influenced by Depression and Type A Behavior Pattern(TABP). These variables explained 38% and 34% respectively. Conclusion: The result suggest that chronic headache management with psychological aspect, as well as physical aspect should be a focus to enhance the quality of life.

대학생의 노인복지에 대한 인식도

차병준,김무룡,김기열,차경미,김귀희,김현실,서인선,임상규,이순자,위광복,남철현 慶山大學校 保健福祉硏究所 1999 保健福祉硏究 Vol.2 No.-

The purpose of this study is to grasp the change of consciousness of young people in order to seek new approach of policy for aged era. 1,200 students attending collages and universities in three small or medium sized cities were inquired for 2 months, from October 1 to November 30, 1996. The result is as follows. 1. The characteristic of the respondents of this survey is that they include 72.1% of women, 40.4% of people aged between 20 to 21, and 49.1% of people who do not have any religion. Those who are from big cities and those who are form farming villages or fishing village occupy equally 40.2%, those who reside in that cities for a long period 49.0%, and those who live with their family 60.9%. 2. The family feature of the subject is that 31.5% of them are those whose father is the age of 55 and more than 55, 10% of them are those whose mothers age is so, 33.1% of them have 5 family members, 29.5% of them have the family income of 1,000,000 to 1,490,000 won, 83.9% of them are from middle class, 47.7% of them are the people whose grand parents have passed away, 70.4% of them live apart from their grand parents, and 60.9% of them are second child. 3. 64.0% of males, 70% of respondents who are aged over 24, 58.1% of respondents who are from rural communities, 62.4% of respondents who live in rural area, and 58.3% of respondents who live alone, prefer to live with grand parents, marked higher rate than other groups. The groups whose father and mother are the age of more than 55 marked higher rate of 55.9% and 58% each than any other groups(p<0.05). The groups whose family member is less than three, whose grand parents both have passed away in middle class, who live with their grand parents, and who are second children, give more positive answers than any other groups. 4. Those who are older, who are buddhists, who are from rural area or live in rural area, whose family is small, whose family income is small, who are from lower class and whose grand parents are still alive, shows preference to support their parents after marriage. 5. Females(89.4%), those who are from small or medium sized cities(89%), who live with their family(85.6%), whose father is the age of 55 and more than 55, whose mother is the age of 54 and less than 54, whose family member is 6, who are from middle class, whose grandparents are still alive and who are the eldest child in their family, give more response that they prefer to live apart from their children in their old age than any other groups. 6. What elderly people need most right now is past time(42.3%), and the respondents whose age is 20 to 21, who are buddhists, who are from middle sized cities and live alone, whose parents are the age of more than 55, who have small family income, who live with their grand parents and who are second children show higher level than any other groups. 7. 76.8% of respondents answer that they do not need their parent's fortune, marked still higher rate than the opposite answer. Those who are older, who are buddhists, who are from big cities, who reside in rural area, who live alone and have smaller family, who are in bad family economic conditions and who live with grand parents present higher rate of positive response. 8. 59.3% of respondents reply that they think about death from time to time, and those who are female, who are in the age of 20 to 21, who are christian, who live with their family, whose siblings or other family members offer their education expenses show higher rate than any other groups. 9. 92.3% of respondents answer that the budget for welfare facility for elderly people is very small. The younger the respondents are and the worse economic condition they have among those who live in big cities, the more answered that. 10. 50% of respondents think social security should provide for their old age, and 42.8% of them believe they themselves provide against it. The respondence that social security ought provide for it appeared more among those whose age are over 24, who are female, who reside in rural area, who are christian, who are in bad economic condition, and who ever used medical institutions in recent one month, marked higher level than other groups. 11. The adequate time of retirement is 59.97±5.60 for public officers, the highest and 59.28±6.35 for teachers, the next. 12. 35.2% of respondents reply that the adequate budget for the old age after their retirement at the age of 60 is 220 million won, showed the highest level of respondence. 13. The factors which affect on the old people in the charged welfare facilities are sex(p<0.01), the type of housing(p<0.05) and whole family income(p<0.05). 14. The factors which affect on remarriage are sex(p<0.05) and religion(p<0.05). For varying old population and expanded welfare service for them, government and relevant authority should give more attention to secure the budget, establish effective plans to expand various program and the facilities for elderly people in order that elderly people spend the rest of life time more happily and more fruitfully. To do that, each college and university should open Health courses, and educate and inform about health and welfare.

장기간 환기역치 운동이 심부전증 환자치료에 미치는 효과에 관한 연구

여남회,김종현,차혜리,김상수 대한스포츠의학회 2000 대한스포츠의학회지 Vol.18 No.2

The purpose of this study was to assess the feasibility and the effect of a long-term ventilatory threshold exercise training program on heart failure patients. The subjects were 20 patients who were divided into control and exercise group. They are mean aged from 61.5yr to 53.3yr. mean New York heart association (HYHA) class fromⅠto Ⅱ, mean left ventrical end-diastolic volume(LVED) from 123 to 123ml, mean ejection fraction (EF) from 39.9% to 38.4%, and mean V˙O_2max from 25.6ml/kg/min respectively. The underwent 6 weeks ventilatory threshold exercise training program which consisted of the workload was V˙O_2 at ventilatory threshold for 30 minutes as day at 3 times per week. Before and after exercise training program, V˙O_2, V˙CO_2 LVED volume and length, left ventrical end-systolic(LVES) volume and length, and ejection fraction were measured. Statistical analysis were performed using analysis of variance T-test and paired t-test. The results of this study are followings. After exercise training program, there were significantly differences in submaximal and maximal exercise performance, V˙O_2 at ventilatory threshold, V˙O_2max, and V˙Emax between control and exercise group respectively (p<0.05). Significantly differences between two groups were also found in left ventrical end-diastolic volum(LVESV) and ejection fraction (EF)(p<0.01). NYHA class also improved form a mean or 2.5 to 1.5(p<0.01). In conclusion, this study showed that the venilatory threshold exercise training program is useful method of clinical application for chronic heart failure.

만성두통환자에게 적용한 비약물적 치료가 통증행동에 미치는 영향

최도영,임사비나,차남현,김건식,이재동,김수영,이윤호,이두익 EAST-WEST MEDICAL RESEARCH INSTITUTE KYUNG HEE UNI 2005 東西醫學硏究所 論文集 Vol.2005 No.-

Objectives : This study is a random-controlled post-design for confirmation of headache degree, quality of life, and satisfaction to therapeutical effect on chronic headache adults after management of non-medicinal treatment (acupuncture therapy and stellate ganglion block therapy). Methods : 51 clinical experiment participants were gathered and through a questionnaire patients who experienced headache for more than 4 hours a day and more than 15 days per month were qualified as chronic headache patients. The qualified patients were classified in to two groups, acupuncture group (AT group, n=28) and stellate ganglion block group (SGB group, n=23). Treatment was applied 2 times a weeks for 4 weeks. The effects of both groups were analyzed using VAS scores, BPI (Brief Pain Inventory) and the satisfaction degree to the therapy. Results : 1. The recognized score of the headache of AT group and SGB group was reduced indicating the degree of the headache was released. 2. The recognition at damage to the quality of life was reduced post therapy of AT group and SGB group, in which general activity, mood, enjoyment of life, personal relationship, and sleeping showed significant improvement of life quality. 3. The satisfaction degree to the therapy showed lower score than expectation to it in AT group and SGB group, however, it was not significant. Conclusions : The results showed that the four-week non-medicinal treatment (AT and SGB) in chronic headache patients was effective for reducing headache and releasing its damage in daily life, however, no difference in superiority was found. Therefore, non-medicinal treatment (AT therapy and SGB) could be utilized in chronic headache patients.

파트너십에 의한 지하철 입구 공간의 쌈지공원 설계 및 시공

김승환,강현우,손용욱,박승범,남정칠,이기철,차민준 東亞大學校 建設技術硏究所 2009 硏究論文集 Vol.32 No.2

A pocket park is valued in securing green space in downtown and improving urban view in the aspect of natural and environmental values, and it signifies a lot as the center of local residents’ community and harmony as well. Since subway exits and surroundings that have high portions in taking up street space due to lack of green space in downtown aren't made full use of, valuable pocket park place. Dangni Pocket Park of subway exits is a park completed with cooperative works and partnership by students, specialists, administrative organizations, businesses and civilian organizations, etc. without support of special budget. The study site was finally chosen to the space between exit No.1 of Dangni subway station, after analyzing the surrounding circumstances, availability and accessibility of the space among the several subway station exits of Saha, Dangni, and Hadan Station in Busan Metropolitan city. For the designing process, The Citizens organization for Million Amenity Park performed the planning and project proceeding, and 19 design drafts were proposed during the class of landscape architecture in Dong-a University. Design review panel members discussed to select the best draft in practical and authentical, and the related experts reviewed and revised to present the final design plan. The construction was conducted was performed under the cooperation between the civil, authorities, and industrial organizations, among which Saha District office managed for the waste treatment and maintenance matters. The graduates of landscape architecture department of Dong-a University and related industrial enterprises supplied landscape materials and related labors, were supported by 20 members of GPM, one of clubs of Dong-a University volunteered durig the most of construction progress, completing the Pocket Park of subway exits through partnership.

만성두통환자에 대한 동서협진의 임상적 연구

정인태,이상훈,김수영,차남현,김건식,이두익,이재동,임사비나,이윤호,최도영 EAST-WEST MEDICAL RESEARCH INSTITUTE KYUNG HEE UNI 2005 東西醫學硏究所 論文集 Vol.2005 No.-

Objective : Because the cause and etiology of chronic headache are not yet fully explained, the treatment of this symptom is not simple. In order to study the effectiveness East-West pain treatment on chronic headache, we evaluated its effect of pain alleviation and quality of life improvement on chronic headache patients who were treated with nerve block and acupuncture, and only acupuncture for eight weeks. Methods : 92 clinical experiment participants were gathered and through a questionnaire patients who experienced headache for more than 4 hours a day and more than 15 days per month were qualified as chronic headache patients. The qualified patients were classified into two groups, nerve block and acupuncture group(EW group, n=49) and acupuncture group(E group, n=43). Treatment was applied 2 times a weeks for 8 weeks. The acupoints, GV20, HN23, ST8, HN46, TE17, GB20, LI20, LI11, LI14, ST36, and LR3 were stimulated for 20 minutes. The effects of two groups were analyzed using VAS scores and BPI(Brief Pain Inventory). Results : The VAS and BPI after four weeks of treatment showed significant improvement among two but differences between the three groups was statistically insignificant. The VAS and BPI of the EW group after eight weeks of treatment showed statistically significant improvement compared to the other two groups. Conclusion : The pain treatment for chronic headache might be contributed to improvement of quality of life as well as alleviation of pain of chronic headache patients. It was suggested that the West pain treatment in combination with East pain treatment might be an useful modality to improve the pain and quality of life in chronic headache patients.

만성두통환자에 대한 침치료가 심박변이도에 미치는 영향

정인태,이상훈,김수영,차남현,김건식,이두익,이재동,임사비나,이윤호,최도영 EAST-WEST MEDICAL RESEARCH INSTITUTE KYUNG HEE UNI 2005 東西醫學硏究所 論文集 Vol.2005 No.-

Objective : The purpose of this study was to assess the effect of acupuncture treatment for chronic headache patients using power spectrum analysis of the heart rate variability(HRV). Methods : 15 clinical experiment participants were gathered and through a questionnaire patients who experienced headache for more than 4 hours a day and more than 15 days per month were qualified as Chronic Headache patients. Treatment was applied 2 times a weeks for 8 weeks. The acupoints, GV20, HN23, ST8, HN46, TE17, GB20, LI20, LI11, LI14, ST36, and LR3 were stimulated for 20 minutes. The effects of acupuncture treatment were analyzed using power spectrum analysis of the HRV, HRV was recorded before and after acupuncture treatment. Results : HRV before and after treatment was compared after 8 weeks of acupuncture treatment. Increase in mean values of SDNN and RMSSD were observed but the increases were not statistically significants. Increase in mean values of TP, LF and HF were observed but, the increase was significant(p<0.05) only in TP. Conclusions : The results suggest that acupuncture treatment on chronic headache patients can increase the activity of autonomic nervous system. Further use of HRV for quantitative analysis of acupuncture treatment on autonomic nervous system related symptoms is suggested.

당뇨병 환자에서 혈장 Thrombin-Antithrombin Ⅲ 및 Plasmin-α_2-Plasmin Inhibitor 복합체의 임상적 의의

김경욱,김은숙,정상수,윤수지,박우일,이준희,남수연,안철우,문병수,김경래,차봉수,송영득,임승길,이현철,허갑범 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.25 No.5

연구배경:당뇨병 환자에서 혈액응고 및 섬유소용해 체계의 이상경향이 있어 그 결과로 여러 혈관합병증의 발생위험이 높다는 사실은 널리 알려져 있다. 그 기전은 아직 확실히 밝혀지지 않았으나, 고혈당으로 인한 혈장 단백질들의 비효소성 당화작용이나 산화성 스트레스로 인한 유리 라티칼 작용으로 응고항진이나 섬유소용해 활성의 저하를 유발하는 것으로 생각되고 있다. 최근 응고 및 용해인자와 그 억제자의 복합체들의 증가가 이 상태를 비교적 예민하게 반영한다고 알려져 있다. 방법:본 연구에서는 당뇨병 환자 101명과 정상 대조군 20명에서 혈장내 thrombin­antithrombin complex(TAT)와 plasmin­α₂­plasmin inhibitor complex(PIC)를 측정하여 비교하고, 당뇨병 환자에서 미세혈관 합병증과 대혈관합병증의 유무에 따른 차이와, 이미 혈관 질환의 위험인자로 알려져 있는 인자들간의 상관성을 알아보고자 하였다. 결과:1. 환자의 분포를 살펴보면 혈관합병증이 있는 군은 85명, 혈관합병증이 없는 군은 16명이었고, 평균연령은 각각 57.9±14.1세, 49.9±16.6세로 혈관 합병증이 있는 군에서 더 나이가 많았고, 체질량지수는 23.2±3.4㎏/㎡, 24.1±3.4㎏/㎡로 두 군간 유의한 차이는 없었다. 또 두 군간의 혈압 및 HbA1c, 공복혈당 및 인슐린과 C­peptide, 총 콜레스테롤, 중성지방, HDL­콜레스테롤, Lp⒜는 유의한 차이가 없었고, 미세혈관합병증이 있는 군에서 당뇨병의 유병기간이 길었다. 2. TAT 및 PIC의 농도는 정상 대조군에서는 2.8±1.2 ng/mL, 240.4±69.7 ng/mL이었고, 당뇨병 환자군에서는 9.5±22.6 ng/mL, 472.2±258.7 ng/mL이었다. TAT와 PIC 모두 당뇨병 환자군에서 정상 대조군에 비해 유의하게 증가되어 있었고(p<0.001), TAT/PIC ratio는 두 군간 차이가 없었다. 3. 당뇨병 환자의 혈관합병증에 따른 TAT 및 PIC, fibrinogen 농도는 합병증이 없는 군은 각각 4.1±2.4ng/mL, 362.2±272.0ng/mL, 322.7±102.4mg/mL으로 PIC와 fibrinogen의 증가를 보였으나, 연령을 보정한 후에는 통계학적 유의성은 없었다. 또 대혈관 합병증군에서는 각각 6.0±4.9 ng/mL, 507.4±321.6 ng/mL, 427.1±194.7 mg/dL이었으며 미세·대혈관 합병증군에서는 10.4±6.4 ng/mL, 484.8±269.7 ng/mL, 388.4±132.4 mg/dL으로 TAT의 증가를 보였으나 역시 연령을 보정한 후에는 통계학적 유의성은 없었다. 4. 미세혈관합병증군에서 HbA1c(>8%)가 높은 군의 PIC 농도가 유의하게 높았고(p=0.049), 대혈관합병증군에서 HbA1c(>8%)가 높은 군의 총 콜레스테롤 농도가 유의하게 높았다(p=0.042). 5. 총 당뇨병 환자군에서 PIC는 fibrinogen과 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며(r=0.47, 0.31,-0.25), 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다(r=0.67). 결론:이상의 결과에서 혈장 TAT 및 PIC 농도는 당뇨병 환자에서 정상 대조군에 비해 의미있게 증가되어 있었고, 당뇨병 환자군에서는 연령의 증가와 유병기간이 혈액응고항진 및 용해의 장애에 큰 역할을 함을 알 수 있었으며, 총 당뇨병 환자군에 PIC와 HbA1c와 양의 상관관계를, BMI와 음의 상관관계를 보였으며 혈관 합병증이 없는 당뇨병 환자군에서만 TAT는 HbA1c와 양의 상관관계를 보였다. 따라서 당뇨병 환자에서 혈액응고 및 용해의 장애가 동반되어 있다고 볼 수 있으며, 혈장 TAT 및 PIC는 혈관합병증으로의 진행을 예측하는 지표로서 유용하리라 생각된다. 또 혈당조절정도와 상관성이 있으므로 혈당조절후에 추적검사를 시행하여 합병증의 예방이 가능한지 추후 연구가 필요하리라 생각된다. Background : Abnormality of coagulation and fibrinolystic system is known as a predisposing factor of vascular complication in diabetes. Although the pathogenesis is not well known, non-enzymatic glycation reaction and the increase in production of free radicals due to an increased oxidative stress may be linked to the hypercoagulibility and hypofibrinolytic activity. As indices of abnormality in coagulation and firinolysis in peripheral blood, plasma thrombin-antithrombin Ⅲ complex (TAT) and plasmin-α_2-plasmin inhibitor complex (PIC) were measured. The purpose of this study was to clarify whether hypercoagulability exists in diabetic patients with or without vascular complication. Methods : In our study, we measured plasma thrombin-antithrombin Ⅲ compelx (TAT) and plasmin-α_2-plasmin inhibit or complex (PIC) in 101 diabetic subjects and 20 controls. Comparing TAT and PIC levels in diabetic microvascular complication group, diabetic macrovascular complication group and controls, we examined correlation between risk factors associated with diabetic vascular complication. Results : 1. The group with diabetic vascular complication was older than group without complication. There was no significant difference in BMI, blood pressure, HbA_ic, blood sugar level, insulin, C-peptide, serum creatinine, total cholesterol, triglyceride, HDL-cholesterol, Lp (a) between two groups. The group with diabetic microvascular complication had longer duration of diabetes. 2. Concentration of TAT and PIC were 2.8±1.2 ng/ mL, 240.4±69.7 ng/ mL in controls and 9.5±22.6 ng/ mL, 472.2±258.7 ng/ mL in diabetic patients, respectively. TAT and PIC were significantly higher in diabetic patients than in control (p<0.001). But TAT/PIC ratio was no significant difference between two groups. 3. In diabetic patients, concentration of TAT and PIC and fibrinogen were respectively 4.1±2.4 ng/ mL, 362.2±272.0 ng/ mL, 322.7±102.4 mg/ dL in group without vascular complication and 5.3±4.1 ng/ mL, 529.5±258.7 ng/ mL, 374.9±106.2 mg/ dL in group with microvascular complication, which group had increase in PIC and Fibrinogen but no significance after correction of age. Concentration of TAT and PIC and Fibrinogen were 60.±4.9 ng/ mL, 507.4±321.6 ng/ mL, 427.1±194.7 mg/ dL in macrovascular complication, and 10.4±6.7 mg/ mL, 484.8±269.7 ng/ mL, 388.4±132.4 mg/ dL in combined vascular complication which group showed increase of TAT but also had no significant increase after correction of age. 4. In diabetic microvascular complication patients, group of high HbA_1c (>8%) (p=0.049) had significant high PIC concentration. In diabetic macrovascular complication patients, group of high HbA_1c (>8%) (p=0.042) had significant high total cholesterol concentration. 5. In all diabetic patients, PIC was positively correlated with fibrinogen and HbA_1c and negatively correlated BMI (r=0.47, 0.31, -0.25). Only in daibetic patients without angiopathy, TAT was positively correlated with HbA_1c (r=0.67). Conclusion : In this study, plasma TAT and PIC concentration significantly increased in diabetic patients compared with controls, and PIC was increased in group with microvascular complication, TAT were increased in group with combined micro macrovascular complication. However, there was no significance relationship existed when correctinf for age. PIC was correlated with HbA_1c. TAT was correlated with HbA_1c only in the group without angiopathy. Abnormality of coagulation and fibrinolysis were combined in diabetes, plasma TAT and PIC can be used as an index of vascular complication. Also we found the correlation with the degree of the blood glucose control. Therefore we need follow up study for the possibility of prevention of vascular complication after controlling the blood glucose to age-matched patients (J Kor Diaabetes Asso 25:354~363, 2001).

한방자조관리 프로그램이 독거노인의 관절범위와 건강상태에 미치는 영향

Cha, Nam-Hyun 가야대학교 2007 가야대학교 논문집 Vol.16 No.-

Purpose: The purpose of this study was to evaluate the effect of an Oriental self help group program on living alone elders. Method: A one group pretest post test design was used. The subjects of the experimental group participated in the oriental self help program, health education, foot bathing in hot water, cupping therapy, and foot reflexology. The obtained data were analyzed using the Wilcoxon signed rank test of SPSS. Results: 1) The level of range of motion increased significantly in the experimental group. 2) The scores of health status partially increased significantly in the experimental group. Conclusion: Considering the results of this research, the program is effective in improving the range of motion and health status partially. Therefore, this program can be implemented as a community based self help group program for living alone elders.