• Asian Pacific Journal of Cancer Prevention
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• 제15권17호
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• pp.7105-7112
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• 2014

In this study, we investigated oxidative stress and tumor marker levels of polycyclic aromatic hydrocarbons (PAHs) in 136 coke oven workers and in 60 control subjects, and evaluated the correlation between oxidative stress and tumor marker levels. Questionnaires on basic demographic information were also administered. Significant differences in employment time and percentages of alcohol drinkers were observed between the control and exposed groups. PAH exposure was assessed using urinary 1-hydroxy-pyrene (1-OHP) levels and was found to be significantly higher in workers than in the controls. Significant differences (P<0.001) of MDA, GST, LDH, NSE, Cyfra21-1, and of SCC and TNF-a (P<0.0001 and P<0.05, P<0.001, respectively) levels were observed among controls and coke-oven workers, except for bottom coke oven workers. Associations between age and risk of increased TNF-a, smoking and increased GST activities, and drinking with increased MDA concentrations, were marginal (P=0.055, P=0.048, P=0.057, respectively). The association between smoking with MDA (P=0.004), NSE (P=0.005), SCC (P=0.004) andTNF-a (P<0.001), and drinking with TNF-a levels was significant (P=0.012). In addition, a significant positive correlation between oxidative stress and tumor markers was found in the present study. These results suggest that a synergistic increase of oxidative stress and tumor markers induced by PAHs may play a role in toxic responses for PAHs in coke oven workers.

• 대한수의학회지
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• 제34권4호
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• pp.873-880
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• 1994

Progesterone catabolizing enzyme, the enzyme $20{\alpha}$-hydroxysteroid deltydrgenase($20{\alpha}$-HSD) is pivotal in the regulation of ovarian function in rodents, which catabolizes progesterone into biologically inactive $20{\alpha}$ hydroxypregn-4-en-3-one($20{\alpha}$-OHP). In this study was carried out the influence of $20{\alpha}$-HSD activity to ovarian function and regulation such as ovulation, formation of corpus luteum, maintenance of estrous cycles and pregnancy, we investigated changes in activities of the splenic macrophages and ovarian histological findings in rat. During the estrous cycles, the ratious of phagocytotic macrophage in splenic adherent cells were highest on the proestrous, but they were lowest on metestrous. During the pregnancy, the ratious of phagocytotic macrophages in splenic adhrent cells were lowest by 1 day and then significantly increased toward the pregnancy, which were highest pregnancy on day 12. On histological findings in rat ovary, the mean number of growing, antral and mature follicles were 15.9(72.9%), 3.4(15.9%), and 2.4(11.2%), respectively. Growing follicles reached to lowest number at diestrus and mature follicle reached to lowest number at metestrus. The numbers of corpus luteums per tissue section of the ovary were 14.4 and the number of normal and atretic follicles were 11.0(76.4%) and 3.4(23.6%), respectively. The number of corpus luteum with vacolated cell were 1.7(11.8%). In this study suggests splenic macrophages are as a source of the substance which maintainer progesterone secretion from luteal cells, and are recognized pass the vessels and reside in the fresh corpora lutea soon after ovulation via inflammatory reactions, and these macrophages are felt to have a stimulatory effect on the formation of cropora lutea. In view of the results include previous report, ovarian $20{\alpha}$-hydroxysteroid dehydrogenase enzyme and splenic macrophages consider play central role in the control and maintenance of estrous cycles and pregnancy, and also applicable to both clinical and research in a wide variety such as control of reproductive system.

• Child Health Nursing Research
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• 제6권3호
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• pp.372-386
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• 2000

The purpose of this study was to provide basic data on preschool children for accident prevention and improve their health through sound, safe living environment with safety education established through more systematic method. Data were collected from 300 preschoolers(150 preschooler are assigned to experimental group and 150 preschoolers are assigned to control group) from 4 to 6 years old using APP paper test which consists of questions and drawings. To experimental group, safety education were done 4 times within the time of 30 minutes per 1 time using education books, video, OHP, slide. The findings of this study are as follows: 1. There were significant difference in behavioral character between experimental group and control group(χ2=11.690, p= 0.003). So, safety education have effect on the behavioral character of preschooler. 2. In the accident proneness on preschooler between experimental group and control group according to general characteristics, it proved significant difference in the case of accident prevention education were done, movement stability(χ2=8.844, p=0.012) and behavioral character(χ2=6.699, p=0.035), in the case of housing pattern is mixed-type, behavioral character(χ2=10.37, p=0.006), in the case of subjects' age is 4 years old, watchfulness(χ2=9.525, p=0.009), in the case of subjects' age is 5 years old, behavioral character(χ2=7.324, p=0.026), in the case of children's order is second, behavioral character(χ2=14.31, p=0.001), in the case of children's sex is boy, living safety(χ2=7.981, p=0.018), movement speed (χ2=6.661, p=0.036), bihavioral character(χ2=8.837, p=0.012), in the case of children's sex is girl, reasoning power(χ2 =9.78, p=0.008), in the case of childrens have no past accidental experience, behavioral character(χ2=9.862, p=0.007), in the case of nuclear family, movement speed(χ2=6.341, p=0.042) and behavioral character(χ2=9.326, p=0.009), in the case of mothers' age is under thirty behavioral character(χ2=16.40, p=0.000), in the case of mothers' school career is under high school graduate, behavioral character(χ2 =8.375, p=0.015), in the case of mothers' school career is beyond college graduate, reasoning power(χ2=9.803, p=0.007) and behavioral character(χ2=6.205, p=0.045), in the case of mothers' job is part time, movement speed(χ2=10.99, p=0.004), in the case of mothers have no job, movement stability(χ2=8.490, p=0.014) and behavioral character(χ2=10.11, p=0.006). The difference of accident proneness between experimental group and control group according to general characteristics, it also showed that there were significant difference in behavioral character compared to other area.. From this findings, we can guess that safety education change and guide preschoolers' behavioral character to desirable direction.

• 한국간호교육학회지
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• 제4권2호
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• pp.204-219
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• 1998

The use of instructional media in nursing education was investigated using a descriptive research methodology. Data were collected from 199 professors teaching in the areas of Fundamental Nursing (48 subjects), Adult Nursing(56 subjects), Pediatric Nursing(49 subjects), and Community Health Nursing(46 subjects). 120 professors were from 3-year college of nursing and 79 professors were from 4-year college of nursing, Data were analyzed using descriptive statistics (mean, standard deviation), and ANOVA with SPSS $PC^+$ program. The results are as follows. 1) The general attitude of the subjects toward the use of instructional media was positive(mean : 3.75). However, from the ANOVA result the subjects from 4-year college of nursing had more positive attitudes in the areas of media utilization and supply system. Most subjects had high interest in the areas of effectiveness of the media, and media literacy in using instructional media. 2) OHP(mean was 3.76) and VTR(mean was 3.36) were the most used instructional media in nursing education. These media were efficiently supplied by the school. However, other media like CD-ROM, Opaque Projector, and LCD or beam Projector were not sufficiently provided by the school. 3) The main reasons to use instructional media were that the use of media is effective to raise students' attention and learning motivation. 4) Insufficiency of the media and environment to use media were the causes of the lack of using instructional media. 5) The use of PC communication of internet, LCD or beam Projector, and Computer Graphics was low. The reasons were that the subjects did not have enough knowledge and skills to use these media, and there was lack of media or environment. 6) In general, environment to use media of the 3-year college of nursing was worse than that of 4-year college of nursing. However, there was no significant differences between the two groups in the use of media related to their position, and subject. On the basis of the study results professors teaching nursing have positive attitudes to use instructional media but the lack of media supply or facility to use media limited the use of instructional media.

• 한국간호교육학회지
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• 제3권2호
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• pp.255-275
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• 1997

This study was conducted to find out the effect of sexual education for knowledge and attitude toward sex are elementary school students. Therefore, the present study aims to understand the changes of the knowledge are the attitude toward sex before and after the sex education, in elementary school students and then finally to provide some basic data to suggest directions for sex education. The subjects were 500 male and female elementary students from the fifth and sixth grades of 4 public elementary schools in Pusan. The subjects were assigned to a experimental (250) and a control (250) group. The research tools were sex education program and consists of physiology(menache, ejaculation), psycological(pleasure of growth), sociological(hetero sexual relationship) are about set The sex education program was given to experimental group for 6 hours by the trained school nurse's lecture using slide film and OHP film. The data were obtained before and after the sex education. Data collection was done during the period betwen Feb. 3. 1997. to Feb. 20. 1997. The collected data were analyed using frequency, percentages, $X^2$-test, means, standard deviation, t-test, ANOVA, MANCOVA with SPSS program. The results were obtained as follows : 1. The first hypotheses attained that the experimental group(19.72) is higher than the control group(12.12) on the knowledge toward sex(F=467.30, P=.000). At the physical area, the experimental group(8.84) is higher than the control group(3.96) (F=687.39, P=.000). At the psychological area the experimental group (5.18) is higher than the control group(2.63) (F=411.66, P=.000). At the social area, the experimental group (5.70) is higher than the control group (5.54), this is not significant difference (F=.67, P=.413). 2. The second hypotheses attained that the experimental group(60.42) is higher than the control group(52.48) on the attitude toward sex(F=215.70, P=.000). At the physical area, the experimental group(23.10) is higher than the control group(20.68) (F=128.68, P=.000), At the psychological area, the experimental group(20.11) is higher than the control group(16.40) (F=108.64, P=.000). At the social area, the experimental group(17.22) is higher than the control group(16.00), this is area are significant differences (F=70.37, P=.000). 3. Knowledge toward sex according to sex, religon, atmosphere of family, mother age and educational background are significant differance (P<0.05). Attitude toward sex according to sex is significant differance (P<0.05).

• Clinical and Experimental Reproductive Medicine
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• 제40권3호
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• pp.135-140
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• 2013

Objective: To evaluate correlations between serum anti-M${\ddot{u}}$llerian hormone (AMH) levels, phenotypes of polycystic ovary syndrome (PCOS), obesity, and metabolic parameters in patients with PCOS. Methods: A total of 175 patients with PCOS were diagnosed according to the Rotterdam Consensus were included. Exclusion criteria were age over 40, FSH>25 mIU/mL, and 17a-OHP>1.5 ng/mL. The Phenotypes of PCOS were divided into a severe form (oligo-anovulation, ANOV/hyperandrogenism/polycystic ovary morphology [PCOM]; n=59) and a mild form without HA (ANOV/PCOM, n=105). The serum AMH levels were classified into 3 groups (<5 vs. 5-10 vs. >10 ng/mL). Obesity was defined as body mass index (BMI) ${\geq}25kg/m^2$ (n=34). Results: The mean age was $25.9{\pm}5.7$ year and mean AMH level was $10.1{\pm}5.4$ ng/mL. The BMI ($kg/m^2$) was higher in group 1 ($24.2{\pm}6.3$) than in group 2 ($21.9{\pm}4.3$, p=0.046) or group 3 ($21.6{\pm}3.3$, p=0.019). There was no difference among the three groups in age, menstrual interval, antral follicle counts, androgens, or other metabolic parameters. The obesity group showed significantly lower AMH ($7.7{\pm}3.9$ ng/mL vs. $10.7{\pm}5.6$ ng/mL), p=0.004) and low-density lipoprotein levels ($93.1{\pm}21.2$ mg/dL vs. $107.5{\pm}39.3$ mg/dL, p=0.031), and showed higher total T ($0.74{\pm}0.59$ L vs. $0.47{\pm}0.36$ ng/mL, p=0.001), free T ($2.01{\pm}1.9$ vs. $1.04{\pm}0.8$ pg/mL, p=0.0001), and free androgen index ($6.2{\pm}7.9$ vs. $3.5{\pm}3.0$, p=0.003). After controlling for age factors and BMI, the serum AMH levles did not show any significant correlations with other hormonal or metabolic parmeters. Conclusion: For PCOS patients under the age 40, serum AMH is not negatively correlated with age. High serum AMH levels can not predict the phenotype of PCOS and metabolic disturbances in PCOS patients in the non-obese group. Further study might be needed to define the relation more clearly.

• 핵의학기술
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• 제13권3호
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• pp.159-164
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• 2009

목적 : 본원에서 시행하고 있는 혈액 검사 경고치 자동통보 시스템의 목적은 환자의 혈액 검사 결과에 따라 신속한 치료를 받아야 할 상황이 발생되면 구축된 자동통보 시스템을 통해 즉시 환자 주치의에게 결과를 알려주고, 이에 따른 적절한 처치가 시행되어 환자에게 발생될 수 있는 치명적 영향을 줄이기 위함이다. 최근 핵의학과 혈액 검사실에서도 TSH, FT4, $17{\alpha}$-OHPGR 3종목에 대해 혈액 검사 경고치 자동통보 시스템을 실시함에 따라 운영현황을 소개 하고자 한다. 실험재료 및 방법 : 대상은 2009년 2월 19일부터 5월 11일까지 신생아과로부터 의뢰된 TSH, FT4, $17{\alpha}$-OH-PGR 처방환자 중 다음 기준에 해당하는 환자들로 하였다. N2340 Thyroid-Stimulating Hormone: >$10{\mu}IU/mL$(참고치: 0.4~5.0) N2360 Free-Thyroxine: <$0.8{\mu}g/dL$(참고치: 0.8~1.9), N2444 $17{\alpha}$-OH-Progesterone: >$30{\mu}g/dL$(참고치: 남성(0.6~3.42), 여성 난포기(0.19~1.8)) 방법은 OCS Program에 대상 검사 종목, 진료과, 경고치보고 기준 값을 입력해 놓은 후 확정된 결과가 입력된 조건에 해당하면 처방의 및 주치의의 PDA로 SMS를 전달하게 된다. 결과 : 경고치 자동통보 시스템으로 보고된 결과는 2009년 2월 19일부터 3월 31일까지 총15건이었고 2009년 4월 1일부터 5월 11일까지 총 18건으로 3건의 증가가 있었다.

• Child Health Nursing Research
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• 제7권1호
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• pp.118-140
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• 2001

The purpose of this study was to measure the effect of safety education program in preschool children for accident prevention and improve their health through more systematic method. Data were collected from 584 preschoolers(247 preschooler are assigned to experimental group and 337 preschoolers are assinged to control group) from 4 to 6 years old using APP paper test which consists of questions and drawings. To experimental group, safety education were done 4 times within the time of 30 minutes per 1 time using education books, drawings, OHP. The findings of this study are as follows: 1. There were significant difference in movement(χ²=18.732, p=.0000), behavioral character(χ²=27.785, p=.000), synthetic judgement(χ²=12.02, p=0.002). So, safety education program have effect on preschooler. 2. In the accident proneness on preschooler between experimental group and control group according to general characteristics, it proved significant difference in the case of accident prevention education were done, reasoning power(χ²=10.48, p=.005), movement speed(χ²=7.341, p=.025) and behavioral character(χ²=18.86, p=.000), in the case of housing pattern is private house(individual house, yard?), reasoning power(χ²=6.683, p=.035), movement speed(χ²=12.76, p= .002) and behavioral character(χ²=12.24, p=.002), in the case of housing pattern is mixed-type, movement speed(χ²=6.935, p= .031) and behavioral character(χ²=10.816, p=.004), in the case of housing pattern is over six stories, movement speed(χ²=7.543, p=.023), in the case of subjects' age is 4 years old, movement speed(χ²=16.5, p= .000) and behavioral character(χ²=12.18, p=.002), in the case of subjects' age is 5 years old, movement speed(χ²=7.519, p= .023), watchfulness(χ²=6.372, p=.041), behavioral character(χ²=14.74, p=0.001) and synthetic judgement(χ²=14.5, p=.001), in the case of subjects' sex is male, life safety(χ²=6.406, p=.041), movement speed(χ²=22.86, p= .000), behavioral character(χ²=13.72, p= .001) and synthetic judgement(χ²=13.82, p=.001), in the case of subjects' sex is female, reasoning power(χ²=12.57, p=.002) and behavioral character(χ²=13.16, p= .001), in the case of childrens have past accidental experience, traffic safety(χ²= 6.683, p=.035), in the case of childrens have no past accidental experience, reasoning power(χ²=8.384, p=.015), movement speed(χ²=20.6, p=.000), behavioral character(χ²=25.1, p=.000) and synthetic judgement(χ² =10.79, p=.005), in the case of children's order is first, reasoning power(χ²=11.15, p=.004), movement speed(χ²=11.92, p= .003) and behavioral character(χ²=7.003, p=.030), in the case of children's order is second, movement speed(χ²=6.694, p= .035), behavioral character(χ²=26.9, p= .000) and synthetic judgement(χ²=14.3, p= .001), in the case of nuclear family, reasoning power(χ²=8.777, p=.012), movement speed(χ²=19.0, p=.000), behavioral character (χ²=26.4, p=0.000) and synthetic judgement (χ²=9.999, p=.007), in the case of mothers' school career is under high school graduate, life safety(χ²=8.023, p=.018), movement speed(χ²=10.99, p=.004) and behavioral character(χ²=6.777, p=.034), in the case of mothers' school career is beyond college graduate, reasoning power(χ²=6.717, p= .035), movement speed(χ²=8.963, p=.011), behavioral character(χ²=25.03, p=.000) and synthetic judgement(χ²=15.19, p=.001), in the case of mothers' age ranged 31-34, movement speed(χ²=12.29, p=.002) and behavioral character(χ²=14.17, p=.001), in the case of mothers' age ranged 35-39, movement speed(χ²=9.859, p=.007), behavioral character(χ²=9.095, p=.011) and synthetic judgement(χ²=7.810, p=.020), in the case of mothers' age is over 40, life safety(χ² =5.593, p=.025), in the case of mothers' job is full-time, traffic safety(χ²=6.032, p=.049) and reasoning power(χ²=8.502, p= .014), in the case of mothers' job is part- time., movement speed(χ²=10.99, p=.004) and behavioral character(χ²=7.895, p= .019), in the case of mothers have no job, movement speed(χ²=6.410, p=.041), movement stability(χ²=6.879, p=.032), behavioral character(χ²=27.72, p=.000) and synthetic judgement(χ²=18.11, p=.000). The difference of accident proneness between experimental group and control group according to general characterists, it also showed that there were significant difference in behavioral character compared to other area.. From this findings, we can guess that safety education program change and guide preschoolers' behavioral character to desirable direction.

• 한국수산과학회지
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• 제30권2호
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• pp.282-290
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• 1997

Vitellogenin 합성 메카니즘을 밝히기 위한 연구의 일환으로써, 뱀장어의 간세포배양계를 이용하여 Vg합성에 대한 $E_2$ 및 뇌하수체호르몬들의 영향에 대해 조사하였다. 일반적으로 어류를 비롯한 난생 척추동물들의 Vg은 $E_2$의 자극에 의해 간장에서 합성분비되어 지나 뱀장어 Vg은 $E_2$으로는 충분한 합성은 이루어지지 않았다. 그러나 $E_2$와 GH 및 PRL을 함께 첨가하면 Vg합성이 활발하게 유도되어 지는 것이 관찰되었다. $E_2$ 만으로 Vg이 합성되어지지 않는다면 세포내에 Vg합성 및 $E_2$ 의 활성을 억제하는 내인성 요소들이 있을 것으로 생각되어 세포를 8일간 호르몬 첨가없이 preculture하여 시행하였으나, $E_2$만으로 Vg합성은 유도되어 지지 않고 GH 및 PRL의 도움이 필요했다. 또한 $E_2$ 만으로 10일간 배양하여 장기간 $E_2$ 로 노출시켜 Vg합성에 대한 영향을 조사한 바, 약 10일간의 $E_2$ 노출에 의해 Vg합성은 전기영동상의 확인에 의해 양적으로 다소 증가하는 것이 관찰되었으나 $E_{2}+GH$ 및 $E_{2}+PRL$의 첨가에 비해 현저한 차이를 나타내어 뱀장어의 Vg합성 유도에는 뇌하수체 호르몬들이 직접 관련되는 것으로 나타났다. 또한 $E_{2}+GH+PRL$을 함께 첨가하여 6일간 배양하여 Vg이 왕성하게 합성되어 질때에도 계속해서 GH 및 PRL들이 필요한가를 조사하였는데, 3일간 관찰한 결과 Vg의 합성 정도는 GH 및 PRL등의 첨가유무에 커다란 차이를 나타내지 않았다.는 초기균수 $3.4{\times}10^3\;CFU/g$ 및 $3.4{\times}10^4\;CFU/g$에서 각각 $2.8{\times}10^4\;CFU/g$와$9.8{\times}10^5\;CFU/g$로 $1\~1.5-log-unit$가 증가하였다.평가는 0.005였다.5IU/ml의 배지에서는 대조구의 배란율과 차이를 보이지 않았다. 이러한 결과로 $E_2$를 제외한 스테로이드와 HCG는 동자개의 난모세포 성숙과 배란을 in vitro에서 유도할 수 있으며, $17\alpha\;20\alpha\;OHP$와 HCG는 다른 스테로이드에 비해 높은 율의 난모세포 성숙과 배란을 유도하였다.체로 잘 일치하였다. 또한 진해만의 저서동물 군집의 전반적인 계절별 공간분포는 다양도 분석 결과에서도 분명하게 나타나고 있으며, 주로 퇴적물 내의 유기물 함량에 의해 영향을 받고 있음을 알 수 있었다., Chlorella sp., yeast를 rotifer에 먹이로 투여했을 때 $S\;\pi-I$에서 lysine이 가장 높았고, PSB, Chlorellaal sp. 순으로 분석되었다. yeast에서는 검출되지 않았다./TEX>, betaine류$(0.1\~0.9\%)$의 순이었다. 연어 엑스분중의 질소분포 특징은 모든 시료에서 공통적으로 anserine과 creatine이 중요한 함질소 성분으로서 엑스분 질소에 대한 양 성분질소의 비율은 anserine이 평균 $38\%$, creatine이 평균 $31\%$로서 이 두 성분만으로 엑스분질소의 $60.9\~76.5\%$에 달하였다. 분석된 성분에 의한

• 여성건강간호학회지
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• 제1권2호
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• pp.200-221
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• 1995

The confusion of the sense of value on sex is increasing because of the rapid change in social-cultural environment. Also due to a rise in the standard of living, the age of adolescence is getting lower, and so the second sexual marks appear to primary schoolers. At this time in the aspect of the education for the whole man, it's very important for primary schoolers to acquire right knowledge and desirable attitude on sex so that can overcome psychological instability caused by physical growth, be responsible for their behaviors and lead happy lives. This study was made to find out the effects of sex education for the primary schoolers' knowledge and attitude about sex. The study was designed as simulated control group pretest-posttest design, which only pretest was practiced to control group and after sex education only posttest was practiced to experimental group. The data was collected for 18 days from March 13, 1995 to March 31, 1995. The subjects of this study were 130 six-graders in a private primary school in seoul. The control group and experimental group were composed of 65 pupils, each. Sex education consisted of lecture and discussion and the materials were this researcher's own made, 'How do I grow? and related OHP film and video. This education was practiced 40 minutes at a time, at intervals of 2-4 days' six times during 3weeks. For sex knowledge tools, 20 item questionaries on the base of related reference books and contents of this study were used. For sex attitude tools, this researcher's own made 13 item questionaries were used which were revised and complemented and laying stress on the reference books. The data was analyzed through pc-SAS program. The homogeneity test in terms of the general characteristics of experimental and control group was analyzed through $x^2$-test and t-test. And the difference in the primary schoolers' score on knowledge and attitude about sex before and after the sex education was analyzed through t-test and ANCOVA. The results of this study are as follows : 1. The result of the homogeneity test in terms of the general characteristics of the experimental and control group showed that there were significant differences in economic standard($x^2$=2.92, P=0.052) and brotherly ties($x^2$=3.78, P=0.052). 2. Hypothesis 'After sex education, the score of primary schoolers' sex knowledge will be higher than before. 'showed statistically significant difference.(t=11.99, P=.0001) Sex education was practiced under control over subjective view of economic standard and brotherly ties which showed significant difference at the homogeneity test in terms of the general characteristics between the two groups. After this education, the results of comparing the score of primary schoolers' sex knowledge also showed significant difference between the two groups. So hypothesis I was supported since primary schoolers to have education showed noticeable results in the sex knowledge score. (F=16.52, P=.0001) 3. Hypothesis 'After sex education, primary schooler's sex attitude score will be higher than before' showed statistically significant(t=5.08, P=.0001) Sex education was practiced, too, under control over subjective view of economic standard and brotherly ties which showed significant difference at the homogeneity test in terms of the general characteristics between the two groups. Bat this time the results of comparing the primary schoolers' sex attitude showed no significant difference between the two groups. So hypothesis II was rejected since for primary schoolers to have sex education showed no noticeable results in sex attitude score. (F=3.52, P=.0628) These results of the study show that sex education gives affirmative change to the primary schooler's sex knowledge, bat short periods' sex education doesn't give any change to the sex attitude. For the establishment of the pupils' desirable sex attitude, systematic and concrete sex education fit for the pupils' developing stage should be practiced over a long period of time.