• Health Policy and Management
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• v.34 no.3
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• pp.293-308
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• 2024

Background: Assessing the change in mental health status of quarantined patients in community treatment centers at the time of admission and discharge, and inferring the influencing factors. Methods: The study was conducted on a sample of 1,941 quarantined patients from three community treatment centers. Changes in anxiety, psychological distress, post-traumatic stress, depression, and self-harm ideation between admission and discharge were categorized as either "improved" or "worsened." Inference was performed to determine the probability of worsening in mental health status. Results: The mental health status of quarantined patients, such as anxiety and depression, was relatively higher than that of the general population. Anxiety (84.3% improved) and psychological distress (79.0% improved) were reduced during quarantine treatment. However, some patients continued to experience moderate to severe levels of anxiety (11.2%) and psychological distress (11.0%) at discharge. As for depression, the depression of moderate or higher level was increased at the time of discharge (28.7%→36.7%) compared to admission. The deterioration of anxiety and psychological distress was found to be the most significant factor influencing the worsening of depression at discharge (odds ratio [OR] for anxiety deterioration, 2.04; OR for psychological distress deterioration, 3.56). These effects were also observed similarly in post-traumatic stress and self-injury ideation. Conclusion: Improving anxiety and psychological distress among quarantined patients in community treatment centers can reduce the worsening of post-traumatic stress, depression, and self-injury ideation at the time of discharge. These findings provide evidence for the need for active mental health management from the initial stages of quarantine treatment.

• Journal of agricultural medicine and community health
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• v.19 no.2
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• pp.141-158
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• 1994

To provide better health care services to the rural population, the government has made the Community Health Practitioner(CHP) a regular government official from April 1, 1992. This study was carried out to study the impact of officialization of CHP on the activities and management system of Primary Health Post(PHP). Fifty PHPs were selected by two stage sampling, cluster and simple random, from 595 PHPs in Kyungnam and Kyungpook provinces. Data were collected by a personal interview with CHPs and review of records and reports kept in the PHPs. The study was done for the periods of January 1-March 31, 1992 (before officialization) and January 1-March 31, 1993 (after officialization). Ninety-six percent of the CHPs wanted to become a regular government official in the hope of better job security and higher salary. The proportion of CHPs who were proud of their iob was increased from 24% to 46% after officialization. Those CHPs who felt insecure for their job decreased from 30% to 10%. Monthly salary was increased by 34% from 802,600 Won to 1,076,000 Won and 90% of the CHPs were satisfied with their salary, also more CHPs responded that they have autonomy in their work planning, implementation of plan, management of the post, and evaluation of their activity. There were no appreciable changes in such CHPs' activities as assessment of local health resources, drawing map for the catchment area, utilization of community organization, grasping the current population structure in the catchment area, keeping the family health records, individual and group health education, and school health service. However, the number of home visits was increased from 13.6 times on the average per month per CHP to 27.5 times. More mothers and children were referred to other medical facilities for the immunization and family planning services. Average number of patients of hypertension, cancer, and diabetes in three months period was decreased from 12.7 to 11.6, from 1.5 to 1.2, and 4.3 to 3.4, respectively. Records for the patient care, drug management, and equipment were well kept but not for other records. The level of record keeping was not changed after officialization. The proportion of PHPs which had support from the health center was increased for drug supply from 14.0% to 30.0%, for consumable commodities from 22.0% to 52.0%, for maintenance of PHP from 54.0% to 68.0%, for supply of health education materials from 34.0% to 44.0%, and supply of equipment from 54.0% to 58.0%. Total monthly revenue of a PHP was increased by about 50,000 Won; increased by 22,000 Won in patient care and 34,700 Won in the government subsidy but decreased in the membership due and donation. However, there was no remarkable changes in the expenditure. The proportion of PHPs which had received official notes from the health center for the purpose of guidance and supervision of the CHPs was increased from 20% to 38% during three months period and the average number of telephone call for supervision from the health center per PHP was increased from 1.8 to 2.1 times(p<0.01). However, the proportion of PHPs that had supervisory visit and conference was reduced from 79% to 62%, and from 88% to 74%, respectively. The proportion of CHPs who maintained a cooperative relationship with Myun Health Workers was reduced from 42% to 36%, that with the director of health center from 46% to 24%, that with the chief of public health administration section from 56% to 36%, and that with the chairman of PHP management council from 62% to 38%. Most of the CHPs (92% before and 82% after officialization) stated that the PHP management council is not helpful for the PHP. CHPs who considered the PHP management council unnecessary increased from 4% to 16%(p<0.05). Suggestions made by the CHPs for the improvement of CHP program included emphasis on health education, assurance of autonomy for PHP management, increase of the kind of drugs that can be dispensed by CHPs, and appointment of an experienced CHP in the health center as the supervisor of CHPs. The results of this study revealed that the role and function of CHPs as reflected in their activities have not been changed after officialization. However, satisfaction in job security and salary was improved as well as the autonomy. Support of health center to the PHP was improved but more official notes were sent to the PHPs which required the CHPs more paper works. Number of telephone calls for supervision was increased but there was little administrative and technical guidance for the CHP activities.

• Proceedings of the KSEEG Conference
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• 2001.05b
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• pp.42-63
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• 2001

The detail survey on the Songsanri tomb site including the Muryong royal tomb was carried out during the period from May 1 , 1996 to April 30, 1997. A quantitative analysis was tried to find changes of tomb itself since the excavation. Main subjects of the survey are to find out the cause of infiltration of rain water and groundwater into the tomb and the tomb site, monitoring of the movement of tomb structure and safety, removal method of the algae inside the tomb, and air controlling system to solve high humidity condition and dew inside the tomb. For these purposes, detail survery inside and outside the tombs using a electronic distance meter and small airplane, monitoring of temperature and humidity, geophysical exploration including electrical resistivity, geomagnetic, gravity and georadar methods, drilling, measurement of physical and chemical properties of drill core and measurement of groundwater permeability were conducted. We found that the center of the subsurface tomb and the center of soil mound on ground are different 4.5 meter and 5 meter for the 5th tomb and 7th tomb, respectively. The fact has caused unequal stress on the tomb structure. In the 7th tomb (the Muryong royal tomb), 435 bricks were broken out of 6025 bricks in 1972, but 1072 bricks are broken in 1996. The break rate has been increased about 250% for just 24 years. The break rate increased about 290% in the 6th tomb. The situation in 1996 is the result for just 24 years while the situation in 1972 was the result for about 1450 years. Status of breaking of bircks represents that a severe problem is undergoing. The eastern wall of the Muryong royal tomb is moving toward inside the tomb with the rate of 2.95 mm/myr in rainy season and 1.52 mm/myr in dry season. The frontal wall shows biggest movement in the 7th tomb having a rate of 2.05 mm/myr toward the passage way. The 6th tomb shows biggest movement among the three tombs having the rate of 7.44mm/myr and 3.61mm/myr toward east for the high break rate of bricks in the 6th tomb. Georadar section of the shallow soil layer represents several faults in the top soil layer of the 5th tomb and 7th tomb. Raninwater flew through faults tnto the tomb and nearby ground and high water content in nearby ground resulted in low resistance and high humidity inside tombs. High humidity inside tomb made a good condition for algae living with high temperature and moderate light source. The 6th tomb is most severe situation and the 7th tomb is the second in terms of algae living. Artificial change of the tomb environment since the excavation, infiltration of rain water and groundwater into the tombsite and bad drainage system had resulted in dangerous status for the tomb structure. Main cause for many problems including breaking of bricks, movement of tomb walls and algae living is infiltration of rainwater and groundwater into the tomb site. Therefore, protection of the tomb site from high water content should be carried out at first. Waterproofing method includes a cover system over the tomvsith using geotextile, clay layer and geomembrane and a deep trench which is 2 meter down to the base of the 5th tomb at the north of the tomv site. Decrease and balancing of soil weight above the tomb are also needed for the sfety of tomb structures. For the algae living inside tombs, we recommend to spray K101 which developed in this study on the surface of wall and then, exposure to ultraviolet light sources for 24 hours. Air controlling system should be changed to a constant temperature and humidity system for the 6th tomb and the 7th tomb. It seems to much better to place the system at frontal room and to ciculate cold air inside tombs to solve dew problem. Above mentioned preservation methods are suggested to give least changes to tomb site and to solve the most fundmental problems. Repairing should be planned in order and some special cares are needed for the safety of tombs in reparing work. Finally, a monitoring system measuring tilting of tomb walls, water content, groundwater level, temperature and humidity is required to monitor and to evaluate the repairing work.

• Journal of Nutrition and Health
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• v.49 no.3
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• pp.189-200
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• 2016

Purpose: This study analyzed job importance, job performance, and job satisfaction in 38 dietitians working at geriatric hospitals and elderly healthcare facilities in Jeju surveyed from September 15-24, 2014 with the aim of providing basic data for improving the quality of meals and nutrition management for elderly patients. Methods: Data were analyzed using descriptive analysis, ${\chi}^2$-test, t-test, ANOVA, and Pearson's correlation coefficients using the SPSS Win program (version 12.0). Results: Regarding job importance, the average score was 4.29 (out of 5), indicating that hygiene and safety management scored the highest at 4.77 (out of 5), and nutrition management scored the lowest at3.86. In terms of job performance of subjects, the average score was 2.87 (out of 5), indicating that cooking operation management scored the highest at 4.42 (out of 5). Regarding the Importance-Performance Analysis (IPA) of job importance and job performance, hygiene and safety management and cooking operation management scored high for importance and performance (B quadrant) menu management, human resource management, and nutrition management scored low for importance and performance (C quadrant) and purchasing management and financial management were included inD quadrant and A quadrant, respectively. For the level of job satisfaction of subjects, the average score was 3.37 (out of 5), indicating that relationships with colleagues scored the highest at 3.72, and improving professionalism scored the lowest at 2.95. Additionally, job importance and performance of subjects were positively correlated withjob satisfaction (r = 0.395, r = 0.386, both p < 0.05). Conclusion: In conclusion, scores for job importance and job performance of nutrition management were low, and job satisfaction of improving professionalism scored low. Therefore, continuous training and education programs of nutrition management should be provided to improve professionalism of dietitians at geriatric hospitals and elderly healthcare facilities.

• Korean Journal of Soil Science and Fertilizer
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• v.45 no.2
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• pp.272-279
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• 2012

In order to effectively treat livestock wastewater in constructed wetlands by natural purification method, removal velocities of pollutants under different injection methods in constructed wetlands were investigated. The removal velocities of chemical oxygen demand (COD), suspended solid (SS), T-N and T-P by continuous injection method were slightly rapid than those by intermittent injection method in full-scale livestock wastewater treatment plant. The removal velocity (K; $day^{-1}$) of COD by continuous injection method was $0.38\;d^{-1}$ for $1^{st}$ bed, $0.13\;d^{-1}$ for $2^{nd}$ bed, $0.17\;d^{-1}$ for $3^{rd}$ bed, $0.05\;d^{-1}$ for $4^{th}$ bed and $0.17\;d^{-1}$ for $5^{th}$ bed. The removal velocities (K; $day^{-1}$) of COD in $1^{st}$, $2^{nd}$, $3^{rd}$, $4^{th}$ and $5^{th}$ beds by intermittent injection method were $0.210\;d^{-1}$, $0.086\;d^{-1}$, $0.222\;d^{-1}$, $0.053\;d^{-1}$ and $0.137\;d^{-1}$, respectively. The removal velocity (K; $day^{-1}$) of SS by continuous injection method was $0.750\;d^{-1}$ for $1^{st}$ bed, $0.108\;d^{-1}$ for $2^{nd}$ bed, $0.120\;d^{-1}$ for $3^{rd}$ bed, $0.086\;d^{-1}$ for $4^{th}$ bed and $0.292\;d^{-1}$ for $5^{th}$ bed. The removal velocities (K; $day^{-1}$) of SS in $1^{st}$, $2^{nd}$, $3^{rd}$, $4^{th}$ and $5^{th}$ beds by intermittent injection method were $0.485\;d^{-1}$, $0.056\;d^{-1}$, $0.174\;d^{-1}$, $0.081\;d^{-1}$ and $0.227\;d^{-1}$, respectively. The removal velocity (K; $day^{-1}$) of T-N by continuous injection method was $0.361\;d^{-1}$ for $1^{st}$ bed, $0.121\;d^{-1}$ for $2^{nd}$ bed, $109\;d^{-1}$ for $3^{rd}$ bed, $0.047\;d^{-1}$ for $4^{th}$ bed and $0.155\;d^{-1}$ for $5^{th}$ bed. The removal velocities (K; $day^{-1}$) of T-N in $1^{st}$, $2^{nd}$, $3^{rd}$, $4^{th}$ and $5^{th}$ beds by intermittent injection method were $0.235\;d^{-1}$, $0.071\;d^{-1}$, $0.171\;d^{-1}$, $0.058\;d^{-1}$ and $0.126\;d^{-1}$, respectively. The removal velocity (K; $day^{-1}$) of T-P by continuous injection method was $0.803\;d^{-1}$ for $1^{st}$ bed, $0.084\;d^{-1}$ for $2^{nd}$ bed, $0.076\;d^{-1}$ for $3^{rd}$ bed, $0.118\;d^{-1}$ for $4^{th}$ bed and $0.301\;d^{-1}$ for $5^{th}$ bed. The removal velocities (K; $day^{-1}$) of T-P in $1^{st}$, $2^{nd}$, $3^{rd}$, $4^{th}$ and $5^{th}$ beds by intermittent injection method were $0.572\;d^{-1}$, $0.049\;d^{-1}$, $0.090\;d^{-1}$, $0.112\;d^{-1}$ and $0.222\;d^{-1}$, respectively.

• The Korean Journal of Nuclear Medicine Technology
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• v.20 no.2
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• pp.54-61
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• 2016

Purpose Precocious Puberty is defined as the development of secondary sexual characteristics in girls younger than 8 years, and boys 9 years. Cause premature closure of the epiphysis is a disease that eventually decreases the final adult height. In this study, we retrospectively analyzed to evaluate the diagnostic difference the GnRH (Gonado-tropin-releasing Hormone) stimulation test results with medical records of precocious puberty in girls. Materials and Methods From February 2015 to December 2015 it was enrolled in the girls 118 people who visited the Seoul National University Bundang Hospital, Pediatrics, Endocrinology Internal Medicine. True precocious puberty group (n=57), early puberty group (n=39), were divided into Premature thelarche (n=22) group. A Tanner stage, chronological age, bone age, height, body weight for each group was determined by examining the mean${\pm}$standard deviation. GnRH test result was compared LH (Basal, 30 min, 45 min, 60 min), FSH (Basal, 30 min, 60 min) for each group, Each group LH, FSH Peak value distribution, the mean${\pm}$standard deviation was calculated for the peak LH/LH basal ratio, peak LH/Peak FSH ratio. The significance probability (P-value) between the value of each third group was determined. Results The average height of the true precocious puberty group $131{\pm}14.85$, the mean weight was $28.80{\pm}4.93$, the average chronological age $7.1{\pm}0.81$, the mean bone age was $9.9{\pm}0.9$, The average height of early puberty group was $134{\pm}5.10$, the average weight $28.50{\pm}4.43$, the average chronological age $8.05{\pm}0.03$, the mean bone age was $10.0{\pm}0.62$, The average height of Premature thelarche $129{\pm}6,01$, the average weight was $28.65{\pm}5.98$, the average chronological age $7.02{\pm}0.58$, the mean bone age was $8.04{\pm}1.29$. There was no significant difference when compared to the height and weight. There was a significant difference between the groups in the chronologic age and bone age difference (P <0.0002) True precocious puberty group showed peak LH levels at 30'(82.5%), 45'(12.3%), 60'(5.3%), in Peak FSH 30'(8.8%), 60'(91.2%). Early Puberty group showed high values in Peak LH at 30'(79.5%), 45'(17.9%), 60'(2.6%), in peak FSH levels at 30'(7.7%), 60'(92.32%). In Premature thelarche Group it showed the Peak LH levels at 30'(30%), 45'(59%), 60'(9.09%), Peak FSH levels at 30'(0%) 60'(100%). When compared with the The Peak LH/basal LH ratio, True precocious puberty group was $19.09{\pm}17.15$, early puberty group was $15.23{\pm}10.88$, Premature thelarche group showed significant differences between the three groups as $4.93{\pm}4.36$.(P <0.0001) LH Peak/FSH Peak ratio, true precocious puberty group was $1.222{\pm}0.77$, early puberty group was $1.34{\pm}1.23$, Premature thelarche group showed significant differences between the three groups as $0.3{\pm}0.09$(P <0.0001) Conclusion In order to diagnose the true precocious puberty have a diagnostic value when the LH peak after GnRH stimulation is increased by more than two to three times compared to baseline or a predetermined level or more than 5~10 IU/L increases. GnRH Test is a test for a long time and the patient discomfort due to repeated blood sampling, but the hypothalamus-pituitary gland- gonad axis activity evaluate and is the most basic accurate test in the differential diagnosis of precocious puberty disorders.

• Korean Journal of Soil Science and Fertilizer
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• v.43 no.3
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• pp.363-373
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• 2010

"Curve number" (CN) indicates the runoff potential of an area. The US Soil Conservation Service (SCS)'s CN method is a simple, widely used, and efficient method for estimating the runoff from a rainfall event in a particular area, especially in ungauged basins. The use of soil maps requested from end-users was dominant up to about 80% of total use for estimating CN based rainfall-runoff. This study introduce the use of soil maps with respect to hydrologic and watershed management focused on hydrologic soil group and a case study resulted in assessing effective rainfall and runoff hydrograph based on SCS-CN method in a small watershed. The ratio of distribution areas for hydrologic soil group based on detailed soil map (1:25,000) of Korea were 42.2% (A), 29.4% (B), 18.5% (C), and 9.9% (D) for HSG 1995, and 35.1% (A), 15.7% (B), 5.5% (C), and 43.7% (D) for HSG 2006, respectively. The ratio of D group in HSG 2006 accounted for 43.7% of the total and 34.1% reclassified from A, B, and C groups of HSG 1995. Similarity between HSG 1995 and 2006 was about 55%. Our study area was located in Sosu-myeon, Goesan-gun including an approx. 44 $km^2$-catchment, Chungchungbuk-do. We used a digital elevation model (DEM) to delineate the catchments. The soils were classified into 4 hydrologic soil groups on the basis of measured infiltration rate and a model of the representative soils of the study area reported by Jung et al. 2006. Digital soil maps (1:5,000) were used for classifying hydrologic soil groups on the basis of soil series unit. Using high resolution satellite images, we delineated the boundary of each field or other parcel on computer screen, then surveyed the land use and cover in each. We calculated CN for each and used those data and a land use and cover map and a hydrologic soil map to estimate runoff. CN values, which are ranged from 0 (no runoff) to 100 (all precipitation runs off), of the catchment were 73 by HSG 1995 and 79 by HSG 2006, respectively. Each runoff response, peak runoff and time-to-peak, was examined using the SCS triangular synthetic unit hydrograph, and the results of HSG 2006 showed better agreement with the field observed data than those with use of HSG 1995.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.2
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• pp.101-108
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• 2017

Purpose: The proton used in proton therapy has a characteristic of giving a small dose to the normal tissue in front of the tumor site while forming a Bragg peak at the cancer tissue site and giving up the maximum dose and disappearing immediately. It is very important to verify the proton arrival position. In this study, we used the off-line PET CT method to measure the distribution of positron emitted from nucleons such as 11C (half-life = 20 min), 150 (half-life = 2 min) and 13N The range and distal falloff point of the proton were verified by measurement. Materials and Methods: In the IEC 2001 Body Phantom, 37 mm, 28 mm, and 22 mm spheres were inserted. The phantom was filled with water to obtain a CT image for each sphere size. To verify the proton range and distal falloff points, As a treatment planning system, SOBP were set at 46 mm on 37 mm sphere, 37 mm on 28 mm, and 33 mm on 22 mm sphere for each sphere size. The proton was scanned in the same center with a single beam of Gantry 0 degree by the scanning method. The phantom was scanned using PET-CT equipment. In the PET-CT image acquisition method, 50 images were acquired per minute, four ROIs including the spheres in the phantom were set, and 10 images were reconstructed. The activity profile according to the depth was compared to the dose profile according to the sphere size established in the treatment plan Results: The PET-CT activity profile decreased rapidly at the distal falloff position in the 37 mm, 28 mm, and 22 mm spheres as well as the dose profile. However, in the SOBP section, which is a range for evaluating the range, the results in the proximal part of the activity profile are different from those of the dose profile, and the distal falloff position is compared with the proton therapy plan and PET-CT As a result, the maximum difference of 1.4 mm at the 50 % point of the Max dose, 1.1 mm at the 45 % point at the 28 mm sphere, and the difference at the 22 mm sphere at the maximum point of 1.2 mm were all less than 1.5 mm in the 37 mm sphere. Conclusion: To maximize the advantages of proton therapy, it is very important to verify the range of the proton beam. In this study, the proton range was confirmed by the SOBP and the distal falloff position of the proton beam using PET-CT. As a result, the difference of the distally falloff position between the activity distribution measured by PET-CT and the proton therapy plan was 1.4 mm, respectively. This may be used as a reference for the dose margin applied in the proton therapy plan.

• Radiation Oncology Journal
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• v.19 no.2
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• pp.127-135
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• 2001

Purpose : This study is a prospective randomized clinical trial comparing the efficacy and complication of anti-emetic drugs for prevention of nausea and vomiting after radiotherapy which has moderate emetogenic potential. The aim of this study was to investigate whether the anti-emetic efficacy of ondansetron $(Zofran^{\circledR})$ 8 mg bid dose (Group O) is better than the efficacy of metoclopramide 5 mg lid dose (Group M) in patients undergoing fractionated radiotherapy to the abdominal region. Materials and Methods : Study entry was restricted to those patients who met the following eligibility criteria: histologically confirmed malignant disease; no distant metastasis; performance status of not more than ECOG grade 2; no previous chemotherapy and radiotherapy. Between March 1997 and February 1998, 60 patients enrolled in this study. All patients signed a written statement of informed consent prior to enrollment. Blinding was maintained by dosing identical number of tablets including one dose of matching placebo for Group O. The extent of nausea, appetite loss, and the number of emetic episodes were recorded everyday using diary card. The mean score of nausea, appetite loss and the mean number of emetic episodes were obtained in a weekly interval. Results : Prescription error occurred in one patient. And diary cards have not returned in 3 patients due to premature refusal of treatment. Card from one patient was excluded from the analysis because she had a history of treatment for neurosis. As a result, the analysis consisted of 55 patients. Patient characteristics and radiotherapy characteristics were similar except mean age was $52.9{\pm}11.2$ in group M, $46.5{\pm}9.5$ in group O. The difference of age was statistically significant. The mean score of nausea, appetite loss and emetic episodes in a weekly interval was higher in group M than O. In group M, the symptoms were most significant at 5th week. In a panel data analysis using mixed procedure, treatment group was only significant factor detecting the difference of weekly score for all three symptoms. Ondansetron $(Zofran^{\circledR})$ 8 mg bid dose and metoclopramide 5 mg lid dose were well tolerated without significant side effects. There were no clinically important changes In vital signs or clinical laboratory parameters with either drug. Conclusion : Concerning the fact that patients with younger age have higher emetogenic potential, there are possibilities that age difference between two treatment groups lowered the statistical power of analysis. There were significant difference favoring ondansetron group with respect to the severity of nausea, vomiting and loss of appetite. We concluded that ondansetron is more effective anti-emetic agents in the control of radiotherapy-induced nausea, vomiting, loss of appetite without significant toxicity, compared with commonly used drug, i.e., metoclopramide. However, there were patients suffering emesis despite the administration of ondansetron. The possible strategies to improve the prevention and the treatment of radiotherapy-induced emesis must be further studied.

• Journal of Korean Academy of Nursing
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• v.4 no.3
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• pp.33-56
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• 1974

간호를 장래의 전문직으로 택하려고 공부하는 간호학생들은 완전한 성인으로서의 발달 과정중 후기 성년기에 속한다. 이시기는 자아를 발견하고 인간이 무엇을 믿으며 인간의 가치가 무엇인가를 추구하는 중요한 시기이다. 다시 말해서 어른과 어린이의 과도기에 서서 자신의 이상적 가치와 기성사회의 기존 가치를 잘 융화시켜 독립된 인간으로서 성숙하려는 노력의 시기이다. 그러므로 성년기의 갈등은 인생의 어느 시기보다도 그 정도가 심하게 나타난다. 간호학생들은 이상의 일반적인 성년기 발달의 요구 외에도 간호대학이라는 특수한 배움의 여건 때문에 좀 더 심각한 문제에 대두된다. 특히 소아과 간호대학이라는 실습환경은 여러 가지 복잡한 병실 사정으로 많은 긴장감을 주는 학습경험이다. 어린이의 간호에는 그들의 발달과정에 따른 다양한 역활이 요구된다. 또한 병원이라는 낯선 환경과 어머니를 떨어져야하는 두려움으로 불안한 어린이와 그 어린이의 불안과 두려움으로 인해 우울과 죄의식에 있는 어머니의 간호는 여러 면에서 성년기 학생들에게 긴장감을 일으키게 하는 요인이 된다. 본 연구의 문헌조사는 주로 미국 문헌에 나타난 간호 대학생들의 성년기 성숙을 위한 발달의 요구와, 소아병실의 복잡한 여건으로 발생되는 긴장감을 다루고 있다. 문헌을 기초로 하여 저자는 긴장감을 주는 간호활동을 크게 다섯 부군으로 묶었다. 1. 어린이 환자의 신체적 간호, 2. 어린이 환자나 부모와의 원만한 대화와 상호관계를 위한 간호활동 3. 소아병실에서 요구되는 다양한 간호원의 역활 4. 어린이나 부모의 간호에 대한 의뢰심 5. 간호의 가치나 이상적 간호. 연구방법으로는 49개의 폐쇄식 질문 항목을 가진 질문지를 사용하였다. 질문 항목들은 문헌연구에서 소아과 간호학 실습시 학생들이 긴장감을 느낀다고 밝혀진 내용들이 다. 학생들은 자신의 경험을 "긴장감이 없었다. ""긴장감이 있었다. ""심한 긴장감이 있었다. ""실습 중 경험이 없었다. "의 사항 중 택일을 하게 되어 있다. 연구대상으로는 모 대학교 간호대학 학생으로 산부인과 간호학 실습을 마친 후 소아과 간호학 실습 8주를 완료한 4학년 학생 42명이었다. 자료분석의 결과는 대부분의 학생들에게 소아과 간호학 실습은 긴장감을 주는 경험이 있다고 나타났다. 다음은 연구결과 주목할만한 몇 가지 사항들이다. 1. 어린이 환자의 신체적 간호는 성년기 학생들에게 긴장감을 주는 실습 경험이었다. 특별히 심하게 긴장감을 주었던 간호활동은 어린이환자의 상태가 중한 경우로, 장기간 앓는 아이, 선천성 기형이 있는 아이, 회복이 불가능하여 죽게될 아이나 사망하는 경우의 어린이 간호였다. 이 결과는 간호학의 기본과정 즉, 기초간호학이나 내 외과 간호학 실습만으로 소아과 간호학 실습을 위한 충분한 준비가 되지 못한다는 것을 뜻 할 수도 있다. 한편, 문헌연구에서 밝힌바와 같이 어리고 연약해 보이는 어린이들의 신체조건이 학생들의 간호활동을 어렵게 하는 경우도 될 수 있겠다. 2. 간호학생들의 어린이 환자와의 대화나 원만한 인간관계에서의 긴장감은 이 연구결과로 평가나 제언이 힘들다. 조사결과에서 학생들은 주로 어린이의 상태가 좋지 않은 경우에 심한 긴장감을 가졌고 일반적인 간호의 경우에는 별로 긴장감이 없었다. 이것은 질병의 상태나 화제, 이야기 할 때의 상황에 따라 긴장감의 여부가 달라질 수 있다는 결론이 되겠다. 3. 소아병실에서의 다양한 역활을 수행하는 것은 비교적 긴장감이 많이 생기는 간호활동으로 나타났다. 그러나 재미있는 사실은 학생들이 간호원으로서의 전문가적인 입장에서, 환자나 보호자를 가르칠때는 별로 문제가 없었으나 어린이 기르는 방법이나 어린이 이해면에서 좀 더 잘 안다고 생각되는 어머니가 지켜 볼때의 어린이 간호에는 긴장감을 가진다는 사실이다. 이것은 Jewett의 연구에서 밝힌바와는 상반되는 결과다. 그의 연구에서 학설들은 부모나 어머니들에 의해 전문가로서 인정받고 기대되는 경우가 제일 어려운 경험이 있다고 밝혔다. 4. 어린이 환자나 그들 부모의 간호에 대한 의뢰심은 학생들에게 심한 긴장감을 주는 경험이 있다. 특히 신체적 간호에 대해 의뢰하는 경우에는 더 심한 긴장감을 준다고 표현한다. 일반적으로 부모가 병실에 상주하는 경우에는 그들의 의뢰심이 심하며 이것은 학생들에게 감당하기 힘든 긴장과 어려움을 주게된다. 왜냐하면 성년기의 학생들은 그들 자신이 먼저 타인에게서 이해받기를 원하며 또 관용을 베풀어주기를 원하는데 그것을 남에게 주어야 하는 입장은 학생들을 긴장되게 하는 실습활동인 것이다. 5. 학생들은 그들이 배운 간호의 이상이나 가치가 실습지에서의 여러 경우와 맞지 않는 것을 보았을 때 극심한 긴장감을 갖는다고 밝혔다. 의사나 병원 행정의 사실이 자신의 이상과 맞지 않는다는 것보다는 간호원의 간호업무의 차이에서 더 비판적인 반응을 보였다. 대부분의 성년기 학생들은 그들의 이상적인 간호원상을 그들의 선배나 실무 간호원 중에서 찾으려는 시기에 그들의 간호활동이 이론과 다른 점이나 학생 자신의 소아과 간호의 가치와 다른 것을 보았을 때는 심한 반감과 긴장감을 갖게된다. 이 문제는 어린 사람이 윗 어른과 함께 동료의식을 갖고 일하기 어려운 한국적 사회구조 때문에 더 심하게 긴장감을 주는 경험인지도 모른다. 선배 간호원의 전문인으로서의 권위와 어린이 환자 보호자의 어른으로서의 권위 사이에서 자신의 이상과 가치의 추구는 용이하지 않으며 내적 갈등은 어쩔수 없는 일 일 것이다. 6. 대부분 높은 백분율의 긴장 반응은 죽음이나 환자의 사망에 관련된 간호활동 항목에서 나타났다. 이 연구의 대상 학생들은 2, 3학년에서 죽음에 대한 강의를 들었지만 이 연구 결과에 의하면 충분한 학습 경험이 주어진 것 같지 않다. 어떠한 경우의 죽음에라도 어린이 환자나 그 보호자들의 심리를 잘 이해하고 반응을 잘 관찰해서 적절한 간호를 해 줄 수 있는 다양한 방법의 학습 경험이 필요하다고 보겠다. 7. 학생들의 긴장도가 어린이 간호에 더 심한가, 보호자 간호에 더 심한가를 알기 위한 비교 결과는 비교적 비슷한 정도로 나타났다. 8. 학생들의 소아과 간호학 실습시의 긴장도는 과거의 병실 실습기간의 장, 단이나 가정에서의 어린인 간호의 경험과는 별 연관성이 없었다. 연구의 대상자가 적기 때문에 단정을 하기는 힘이 들지만 소아과 간호학 실습이 다른 병실의 실습과는 분리되어서 완전히 다르게 다루어 져야만 하며 간호교육자들의 주의 깊은 관심과 노력이 필요한 실습교육이 라 하겠다. 이상의 전반적인 고찰에 의하면 한국 성년기 간호학생들의 소아과 간호학 실습은 미국의 경우와 마찬가지로 긴장감을 주는 경험이다. 문화배경의 다른 점은 무시하고라도 Davis와 Oleson이 결론한 바와 같이 "간호대 학생은 어디를 막론하고 다 같은 성격과 문제를 가지고 있다. " 앞으로 보다 효과적인 학생들의 소아과 간호학 실습을 위한 연구를 위해 다음의 몇 가지를 본 연구의 결과를 가지고 제언한다. 1. 보다 여러 지역에서 다양한 교육 방법을 가진 학교의 학생을 대상으로 한 연구의 필요성. 2. 학생들이 실습 전 선입견이나 이미 들어서 생긴 긴장감의 개입 여부를 밝힐 수 있는 연구. 3. 학생 개인의 과거 경침이 긴장감 유발에 미치는 영향을 위한 연구 4. 이 연구의 결과를 입증할 수 있는 종단적 연구. 5. 이 연구에서 나타난 긴장감이 학습 행위에 미치는 영향을 알기 위한 관찰적 연구. 이 연구를 위해 많은 도움을 주셨던 보스턴대학의 Dr. Kennedy와 연세대학의 여러 선생님께 심심한 감사를 드립니다.