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주의력결핍/과잉운동장애(ADHD) 아동의 진단도구로서 부모용 행동 평가지의 타당도 연구 : 한국아동인성검사와 아동ㆍ청소년 행동평가척도를 중심으로
김지혜,소유경,정유숙,이임순,홍성도 대한소아청소년정신의학회 2000 소아청소년정신의학 Vol.11 No.2
본 연구에서는 현재 주의력-결핍 및 과잉운동장애(Attention Deficit/Hyperactivity Disorder, 이하 ADHD)의 주요한 평가척도 중의 하나로서 이용되고 있는 한국아동인성검사(Korean Personality Inventory for Children, K-PIC)와 아동ㆍ청소년 행동평가척도(Korean Child Behavior Checklist K-CBCL)의 임상적 타당도에 대해 살펴보고자 하였다. 피검자들은 ADHD의 하위 유형 중 주의력-결핍 우세형(ADHD-I)으로 진단된 환아 11명과 과잉 행동-충동 우세형 및 복합형(ADHD-H)로 진단된 환아 23명, 우울, 불안 등 정서적 문제로 진단(신경증 집단 ; N) 받은 정신과 외래 환아 16명, 정상아동 15명 등 총 65명이었다. 먼저 각 집단별로 분산분석을 실시하였고, 각각 행동 평정 척도의 변별력을 측정하기 위하여 판별분석을 실시하였다. 이 집단들의 K-PIC와 K-CBCL 결과들에 대한 전체(omnibus) F-검증 결과, K-PIC의 과잉행동(HPR) 척도와 K-CBCL의 주의집중문제(Attention Problems, 이하 AP) 척도들은 분산분석결과 유의한 차이를 보였다. 하지만 사후검증 결과, ADHD-I 집단과 ADHD-H 집단 그리고 신경증 집단 사이에 유의한 차이를 보이지 않는 반면, 그 세 집단은 모두 정상집단과 .05 유의도 수준 하에서 유의한 차이를 나타내었다. 이러한 결과는 K-PIC의 과잉행동(HPR) 척도와 K-CBCL의 주의집중문제(Attention Problems) 척도의 경우, 기본적으로 임상군과 정상군을 구별하는데는 유용하지만 임상군내에서의 세부 진단을 위해 사용하는 데는 한계가 있음을 시사해준다. 또한 본 연구 결과 상대적으로 HPR 척도는 ADHD-H type을 감별하는 데 더 유용한 반면, K-CBCL의 AP 척도는 ADHD-I type을 감별하는 데 더 큰 강점을 갖는 것으로 보이나, HPR 척도와 AP 척도 중 어느 하나만을 사용하는 것보다는 병행하여 사용하는 것이 더 바람직한 것으로 보인다. 특히 cut-off score면에서 두 척도 중 어느 하나에서 T점수 65점 이상 상승할 때 ADHD로 진단내리는 경우, 가장 효과적으로 정분류율(true positive rate : sensitivity)과 정배제율(true negative rate : specificity)을 조화시킬 수 있는 결정규칙이 되는 것으로 나타났다. 중심 단어 : 주의력결핍/과잉운동장애 한국아동인성검사ㆍ아동ㆍ청소년 행동평가척도. This study was designed to examine the validity of HPR subscale in Korean Personality Inventory for Children(KPI-C) and Attention Problems subscale in Korean Child Behavior Checklist(K-CBCL) as diagnostic tool for Attention-Deficit/Hyperactivity Disorder(ADHD). Nineteen ADHD-1 type, twenty-three ADHD-H type, sixteen Neurosis, and fifteen normal children with the age from 6 to12 were selected based on DSM-IV, and their responses of the KPI-C and CBCL were analyzed. Omnibus F-test results showed that there were significant differences in the F scores of HPR and Attention Problems T scores(p<.05). But in Post-hoc analysis, the HPR and AP scores in three clinical groups were significantly higher than in normal group, but there was no group difference among three clinical groups(p<.05). These results shows that HPR subscale and Attention Problems subscale may be useful tools for screening clinical groups(vs normal group) but there was a limit to the clinical validity of two subscales as diagnostic tools for the subtypes of ADHD. KEY WORDS : ADHDㆍKPI-CㆍK-CBCLㆍHPRㆍAttention problems.
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김정민,권영준,주영수,임형준,이태경,강혜련,백도명 大韓産業醫學會 2008 대한직업환경의학회지 Vol.20 No.3
목적: 일개 제빵회사에서 제빵공 천식 유병률을 조사하여 제빵공 천식으로 인한 국내 질병부담을 파악하는데 기초자료를 제공하고자 하였다. 방법: 일개 제빵회사의 생산관련 근로자 596명에서 수습기간(3개월) 중이거나 참여를 거부한 216명을 제외하고,380명을 연구대상으로 하였다. 밀가루분진 노출형태에 따라 직접노출군과 간접노출군으로 직무 카테고리를 분류하고,설문조사는 ISAAC 설문항목에 직업력 등을 추가한 설문지를 사용하였다. 설문조사에서 천식이나 알레르기병과 관련된 증상이나 병력이 전혀 없는 간접노출군은 임상검사대상에서 제외하였다. 임상검사대상 233명에게 피부단자검사,혈청 특이 IgE 항체검사,산업의학 전문의와의 면담을 시행하였고,면담에서 천식이나 알레르기비염과 관련된 증상이나 병력이 확인된 31명을 연속적 PEFR 측정대상으로 하였다. PEFR 변동률로써 메타콜린 기관지유발검사대상을 선정하였고,메타콜린 기관 지유발검사에서 기관지과민성이 확인된 경우에 특이 기관지유발검사를 시행하였다. 제빵공 천식은 특이 기관지유 발검사에서 천식반응이 확인된 경우로 정의하였다. 결과: 연구대상의 밀가루 민감화율은 21.0%(직접노출군 25.9%,간접노출군 13.3%), 제빵공 천식 유병률은 3.2%(직접노출군 5.1%,간접노출군 1.8%)였다. 직접 노출군이 간접노출군에 비해 밀가루에 민감화될 위험이 높았으며(OR 2.15,95% CI=1.03∼4.51), 제빵공 천식에 이환될 위험은 통계적으로 유의하지 않았다(PR 2.52,95% CI=O.78∼8.18). 밀가루에 민감화된 군이 그렇지 않은 군에 비해 제빵공 천식에 이환될 위험이 매우 높았다(PR 38.63, 95% CI=6.14∼243.22). 결론: 이번 연구결과는 직업적으로 밀가루에 노출되는 국내 근로자에서 제빵공 천식이 적지 않을 것임을 시사하고 있다. 향후 제빵공 천식으로 인한 질병부담을 보다 정확히 파악하기 위해서는 국내에서 연구된 바 없는 밀가루 취급 사업장(제분회사 등)에 대한 연구가 필요하며,근로자의 건강과 사회경제적 위치를 보호하기 위한 체계적인 연구도 요구된다. Objectives: To determine the prevalence of baker's asthma due to flour dust in an industrial bakery in Korea. Methods: Of the 596 active workers, 380 were allocated to a category of either direct exposure (DE) or indirect exposure (IE) to flour dust and completed a modified ISAAC questionnaire. Of the 380 participants, 233 were screened by an occupational physician interview, a skin prick test, and an ELISA for serum-specific IgE antibodies to wheat flour extracts. Selected workers received serial monitoring of peak expiratory flow rate (PEFR), and positive PEFR respondents received a methacholine challenge test. The diagnosis of baker's asthma was confirmed by a specific inhalation challenge with wheat flour extracts. Results: The prevalence of sensitization to wheat flour and baker's asthma was 21.0% (25.9% DE, 13.3% IE) and 3.2% (5.1 % DE, 1.8% IE), respectively. DE had an increased risk of sensitization to wheat flour (OR 2.15, 95% CI = 1.03∼4.51). Sensitization to wheat flour and the prevalence of baker's asthma correlated significantly (PR 38.63, 95% CI = 6.14∼243.22). Conclusions: These findings indicate a considerable prevalence of baker's asthma among flour-exposed workers in Korea. Future studies will be required to survey the situation in flour mill companies and seek ways to protect the health and socioeconomic position of flour industry workers.
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( Do Youn Oh ),( Yu Jung Kim ),( Yung Jue Bang ),( Jee Hyun Kim ),( In Sil Choi ),( Sae Won Han ),( Seock Ah Im ),( Kyung Hun Lee ),( Tae You Kim ),( Keun Wook Lee ),( Tae Yong Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: To investigate the effi cacy of gemcitabine plus UFT (uracil-tegafur) combination chemotherapy as a salvage treatment in patients with metastatic colorectal cancer (MCRC) Methods: This single-arm phase 2 study was conducted at 3 institutions in Korea. Patients with MCRC refractory to fiuoropyrimidine, oxaliplatin and irinotecan were enrolled. Gemcitabine 800 mg/m2 was administered intravenously on days 1, 8 and 15.UFT 200 mg/m2/day was taken orally in 3 divided doses on days 1-21. Cycles were repeated every 4 weeks and tumor evaluation was carried out every 8 weeks. The primary endpoint of this study was 8-week progression-free survival (PFS) rate. Results: Forty-one patients were enrolled. Fourteen patients received gemcitabine/UFT as a third-line treatment and 37 patients as a 4th-line or later-line therapy. Toxicities were easily manageable and non-hematologic toxicities of = grade 3 were rare. The most common toxicity of = grade 3 was neutropenia (20.0%). One patient showed partial response (response rate, 2.4%) and 14 (34.1%) showed stable disease. The 8-week PFS rate was 42.3%. The median PFS was 1.7 months [95% confi dence interval (CI), 1.6-1.8 months] and the median OS was 9.2 months (95% CI, 5.8-12.6 months). Conclusions: Overall effi cacy of gemcitabine/UFT in refractory MCRC was unsatisfactory. However, we could found a minor proportion of patients who showed prolonged tumor stabilization to gemcitabine/UFT. Further studies are warranted to identify a patient subgroup that might have benefi ts from gemcitabine/UFT therapy.
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( Do Hwa Im ),( Jung Mi Byun ),( Young Nam Kim ),( Eun Jeong Jeong ),( Hye Mi Eom ),( Mi Jeong Kim ),( En Bee Cho ),( Dae Hoon Jeong ),( Byung Jin Min ),( Kyung Bok Lee ),( Moon Su Sung ),( Ki Tae Kim 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-
목적: To describe the incidence of placenta previa in nulliparous women and to assess risk factors between nulliparous and multiparous women with placenta previa after adjustment for pervious dilatation and curettage, in vitro fertilization (IVF), smoking, previous cesarean section and maternal age. 방법: A retrospective study was conducted based on the descriptive and statistical analysis risk factors of placenta previa and maternal and fetal prognosis of 221 patients who underwent cesarean section for placenta previa between January 2010 and December 2015 in Busan Paik hospital. We divided the patients into two groups, nulliparous women and multiparous women, and compared with cause of previa and prognosis. 결과: 106 patients (48.0%) was nulliparous women and 115 patients(52.0%) was mutiparous women. Placenta previa totalis was the most common type of previa but there was no significant difference between nulliparous women and multiparous women(43.9% vs 56.1%). Nulliparous women were younger than multiparous women(32.6±3.4 years old vs 34.5±4.5 years old, p=0.0005). Placental previa with risk factors was occurred in 141 patients( 63.8%) and the others, 80 patients(36.2%) showed placenta previa without risk factors. It was presented that no risk factor in nulliparous women was significantly many compared with multiparous women(61.2% vs 38.8%, p=0.0045). In the multiple logistic regression analysis the strongest independent risk factor of placenta previa was IVF between nulliparous and multiparous women(78.1% vs 21.9%, p=0.0003). There was no significant difference in the incidence of postpartum hemorrhage(PPH) but was significantly different in management. Cesarean hysterectomy for PPH was significantly increased in multiparous women(80.0% vs 20.0%, p=0.0352). 결론: Increasing maternal age and in vitro fertilization(IVF) treatment are all risk factors for placenta previa in nulliparous women in this study. Therefore the strategies to prevent placental previa in nulliparous women undergoing IVF are needed.
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Vulvodynia as a referred Pain: clinical experience of surgical treatment
( Kyung Bok Lee ),( Dae Hoon Jeong ),( Moon Su Sung ),( Young Nam Kim ),( Da Hyun Kim ),( Do Hwa Im ),( Ye Seul Kim ) 대한산부인과학회 2022 대한산부인과학회 학술대회 Vol.108 No.-
Objective: 3. Demonstrate a new instrument, technique or procedure Target: 2. Adanced practicioners Methods: Vulvodynia is chronic pain or discomfort around the opening of with vagina (vulva) for which there's no identifiable cause. Among the causes that can cause vulvodynia, we consider pelvic congestion syndrome, which is due to the enlarged and changed shape of veins in pelvic area, including around the ovarian veins. And we focused that vulvodynia may be a result of viscerosomatic referred pain. According to the integral theory, chronic pelvic pain may be caused by uterosacral ligament laxity, which can stimulate or irritate interior hypogastric plexus. For the last three years (from 2020 to 2022), we have performed about 30 laparoscopic operations (ovarian vein ligation with or without pectopexy and uterosacral ligament plication) for patients who suspected referred vulvodynia by pelvic congestion syndrome with or without lax uterosacral ligament. Results: Laparoscopic ovarian vein ligation and utero-sacral ligament plication operation was performed on these patients with such pelvic pain, and it was confirmed that vulvodynia was great relieved and improved through the pain assessment test performed at the outpatient clinic after the operation. Conclusion: In conclusion, when we manage patients suffering from vulvodynia we must first rule out specific identifiable cause of vulva pain, as well as the above two conditions, which may be cured with surgical treatment before nonspecific medical treatment from pain clinic or psychiatric department.
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