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Biomedicus pump를 이용한 개심술후 심실보조 (Postcardiotomy Ventricular Support with Biomedicus Pump)

  • 김원곤;이창하;김기봉;안혁;노준량
    • Journal of Chest Surgery
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    • 제29권11호
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    • pp.1218-1222
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    • 1996
  • 근래에 와서 심장수술 기법 및 심근보호법의 현저한 향상에도 불구하고 심장수술 환자들의 약 0.1~0.8 % 에서는 여전히 심장수술후 약물 치료나 대동맥 풍선펌프 등의 전통적인 치료법에 반응하지 않는 급성 심부전증이 발생하고 있다. 이런 환자들에서는 보다 적극적인 순환보조법으로 심실보조를 시행할 필요가 있는데, 현재 이런 목적으로 원심성 펌프가 비용이 비교적 저렴하고 사용하기 편리하다는 점에서 세계적으로 가장 많이 사용되고 있다. 그러나 아직 국내에서는 이러한 심실보조장치로서의 원심성펌프의 사용에 관한 문헌 보고가 매우 드문 실정이다. 1992년 1월 부터 1996년 1월 까지 서울대학병원에서는 총 2986례의 개심술이 시행되었는데, 이들 환자 중 모두 10명에서 심장수술후 전통적인 치료법에 반응하지 않는 심부전증이 발생하여 Biomedicus 원심성 펌프를 이용한 심실보조를 시행하였다. 10명의 환자중 남자가 8명 여자는 2명이였으며 평균 연령은 50$\pm$20세였다(범위; 9세~77세). 환자들이 받은 수술로는 6명의 환자가 관상동맥우회수술을 받았으며 이중2명의 환자는 관상동맥우회수술과 함께 대동맥판막치환수술을 시행받았다. 그밖에 대동맥박리증 수술 2례, 그리고 폐색전제거술 및 심장이식수술이 각각 1례씩 있었다. 심실보조 형태로는 전체 환자 중 5명의 환자에서 좌심실 보조를 시행하였으며 1명에서 우심실보조 그리고 4명에서 양심실보조를 시행하였다. 심실보조 기간은 평균 76$\pm$51시간이였다(범위; 24시간~175 시간). 10명중 7명에서 심실보조 장치 이탈이 가능하였고 이중4명이 생존하여 퇴원하였다. 사망 환자들의 사망 원인으로는 진행성 심부전증 2례, 그리고 다장기 부전증, 심실세동, 비가역적 뇌손상, 기계적 문제가 각각 1례씩이였다. 사망환자와 생존 퇴원환자간의 심폐바이패스시간, 대동맥차단시간, 심실보조시간에서 통계학적인 차이는 없었다. 원심성 심실보조장치 삽입에 연관된 주된 합병증으로는 출혈(7), 급성 신부전증(6), 감염(3), 그리고 신경학적 합병증(2)등이 관찰되었다. 결론적으로 원심성 펌프는 단기 순환보조용으로 비교적 만족한 결과로 사용될 수 있었다.

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도심지 급경사지에서 토석류 범람 특성 및 사방댐 기능 (Debris flow characteristics and sabo dam function in urban steep slopes)

  • 김연중;김태우;김동겸;윤종성
    • 한국수자원학회논문집
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    • 제53권8호
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    • pp.627-636
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    • 2020
  • 과거의 토석류 재해는 도시로부터 멀리 떨어진 산지지형에서 주로 발생하여 다른 자연재해 보다 비교적 피해가 적은 재해로 저평가 되었다. 하지만 도시화가 진행됨에 따라 도심속 산지지형에 많은 주거지 및 주요 시설물 등이 건설되면서 많은 환경적 변화와 기후변화에 따른 강우량의 증가로 토사재해의 발생 빈도가 꾸준히 증가 하고 있어 토석류에 대한 위험 리스크가 고조되고 있다. 특히 급경사지로 지정된 지역에서 토석류 범람 특성 및 저감대책에 관한 연구는 아직 미비하다. 따라서 우리나라 환경에 적합한 독자적인 방재 기술을 확보하기 위한 연구와 여러 방재 정보의 업데이트 및 개량이 요구되며 우리나라 지형 특성을 고려할 수 있는 독자적인 기술이 필요하다. 본 연구에서는 우리나라 급경사지로 지정된 지역을 대상으로 방재성능목표에 따른 토사 유출량을 산정하고 그에 따른 독자적인 모델을 개발하여 토석류 영향평가와 피해저감에 탁월한 사방댐의 기능 평가를 목적으로 한다. 사방댐 평가를 위해 개발한 2차원 토석류 모델의 신뢰성 확보를 위해 수리모형실험과의 비교 검증 결과 잘 일치하는 것으로 나타났으며 이 결과로부터 모델의 신뢰성을 확인하였다. 또한, 급경사지 주변의 지역적 특징을 고려하기 위해 평면 2차원 토석류 모델을 구축하여 직접 피해지역에 도달하는 토석류의 흐름 특성을 분석하였고, 피해저감을 위해 설치한 사방댐의 제원(높이) 및 설치장소에 따라 토석류가 하류로 전달되는 흐름 특성을 분석하였다. 특히 사방댐 설치장소가 토석류의 흐름이 발생하는 약 20° 이상의 지역에서는 사방댐의 기능이 현저히 떨어지는 것을 확인하였다.

Pasteurella multocida에 대(對)한 간이적혈구(簡易赤血球) 응집반응(凝集反應)과 적혈구(赤血球)의 안정화(安定化)에 관(關)한 연구(硏究) (Studies on the Simplified Hemagglutination Reaction to Pasteurella multocida and the Stabilization of Erythrocytes)

  • 이학철;정영건;김교준
    • 대한수의학회지
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    • 제10권1호
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    • pp.11-23
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    • 1970
  • Recently Carter(1952) reported the capsule antigens of Pasteurella multocida could be divided into four serological types A,B,C and D by means of precipitation tests. Subsequently he showed that the most sensitive for identification of these types involved the use of capsule substance adsorbed by erythrocytes in hemagglutination test. It may be somewhat difficult to conduct the hemagglutination test in small laboratory, because relatively large amounts of antisera and erythrocytes of the human O type are required for the test. A simple method for serological typing of P. multocida was the slide agglutination test employed by Little et al. (1943) and Namioka et al. (1962), but this method is still in controversy. The author tried adapting Carter's hemagglutination method to the slide method so called "micromethod technique", and studied on the stabilization of erythrocytes for use of slide hemagglutination to P. multocida although many invesigators reported the stabilization of erythrocytes. The results obtained are summarized as follows: 1. A simplified method (slide method) for capsule typing of the organism was developed by adapting Carter's hemagglutination reaction(tube method). Antibody-containing serum can be diluted serially on Boerner's microtest slide with capillary or serological pipetts with a considerable accuracy. The slide reaction can be carried out with case on the slide by adding $0.05m{\ell}$ of antigen-sensitized erythrocytes suspension diluted to one percent on $0.05m{\ell}$ of serially diluted antibody-containing sera, and the final result can be read after 60 minutes at the room temperature ($15^{\circ}C$). 2. It is difficult to determine superiority of inferiority between the slide method and the tube method on the pattern of the reaction of hemagglutination. 3. The pH range of 6.6 to 8.3 is optimal for the slide hemagglutination reaction. 4. The antigen-sensitization against erythrocytes at $37^{\circ}C$ is optimal for the slide hemagglutination. 5. Both the doses and concentration of antigen do not influence the antigen-adsorbing capacity of erythrocytes. 6. The reduction of antigen-sensitizing hours does not influence the antigen-adsorbing capacity of erythrocytes even 30 minutes. 7. The tannic acid treatment against formalinized and non-formalinized erythrocytes showed no effect on the reaction of hemagglutination. 8. The erythrocytes preserved at $4^{\circ}C$ in the ACD solution do not decrease the reactivity on the reaction of hemagglutination for 60 days, while they begin slight hemolysis 30 days after preserving. 9. The stable preparation of erythrocytes can be obtained by treating the cells at $37^{\circ}C$ for 20 hours with from 4 to 8 percent of formalin in saline or buffer. These cells can be preserved at $4^{\circ}C$ for more than 8 months experimented without hemolysis. With low concentration of formalin, the cells were not sufficiently stabilized resulting in the hemolysis after short period of preservation at $4^{\circ}C$. 10. The erythrocytes treated with 16 percent of formalin remain constantly or increase the reactivity for the reaction of hemagglutination. On the contrary, the cells treated with I to 8 percent of formalin decrease the reactivity. 11. There is no difference between nontreated fresh erythrocytes and the erythrocytes preserved in the ACD solution on the reactivity against the hemagglutination, and the erythrocytes treated with 16 percent of formalin showed the reactivity of higher level than that of the above two kinds of erythrocytes. 12. There is no difference between the saline and the isotonic buffer solution on the reaction of hemagglutination.

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수도(水稻) 재배유형별(栽培類型別) 잡초발생양상(雜草發生樣相)과 경합특성(競合特性) - 제(第) 2 보(報). 군락공간(群落空間)에 대한 벼와 잡초(雜草)의 경합(競合) (Weed Occurrence and Competitive Characteristic under Different Cultivation Types of Rice(Oyriza sativa L.) - 2. Competition for Community Space of Rice and Weed)

  • 임일빈;구자옥;이선용
    • 한국잡초학회지
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    • 제13권1호
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    • pp.36-43
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    • 1993
  • 1. 벼의 생장율(生長率) 중묘(中苗)보다는 어린모를 이앙(移秧)할 경우(境遇)에 잡초(雜草)와의 경합해(競合害)가 컸으며, 이보다 직파(直播)에서는 더욱 치명적(致命的)이었으나, 담수(湛水) 및 건답직파재배간(乾畓直播我培間)에는 차이(差異)가 크지 않았다. 잡초경합(雜草競合)의 영향(影響)이 가장 컸던 시기(時期)는 이앙재배(移秧栽培)에서는 이앙후(移秧後) 10-11주(週), 담수직파(湛水直播)에서는 파종후(播種後) 11주(週), 건답직파(乾畓直播)에서는 파종후(播種後) 12주(週)에 해당하였다. 2. 벼와 잡초(雜草)의 군락구조(群落構造) : 관행이앙(慣行移秧)과 잡초(雜草) 기계이앙(機械移快)에서는 잡초(雜草)의 군락(群落) 점유율(占有率)이 늦어서 80cm이하(以下) 부위(部位)에서의 벼 공간점유율(空間占有率)이 특히 떨어지는 경향(傾向)이었으며 담수(湛水) 및 건답직파재배(乾畓直播我培)에서는 상하위(上下位)의 군락공간(群落空間)을 전체적(全體的)으로 잡초(雜草)가 점유(占有)하였다. 3. 벼와 잡초(雜草)의 초장신장(草長伸長) : 관행이앙재배(慣行移秧栽培)에서는 출수기(出穗期) 이전(以前)까지 벼의 초장(草長)이 상위(上位)에 있었으나 그 이후(以後)부터는 피와 올방개가 상위(上位)를 점하였으며, 중묘(中苗) 및 어린모 기계이앙재배(機械移秧栽培)에서는 출수기(出穗期)까지 벼와 잡초간(雜草間)에 상호경합적(且互競合的)인 관계(關係)에 있다가 이후(以後)에는 잡초(雜草)가 상위(上位)를 점하였다. 반면에 담수직파재배(湛水直播栽培)에서는 출수기(出穗期) 5주(週)까지 벼와 잡초간(雜草間)에 상호(相互) 경합적(競合的)이다가 6주이후(週以後)에는 피와 너도방동사니, 9주(週) 이후(以後)에는 올방개, 10주(週) 이후(以後)에는 알방동사니가 차례로 우위(優位)를 차지하였으며, 건답직파(乾畓直播)에서는 피가 생육(生育) 전기간(全期間)을 통하여 상위(上位)를 점하는 경향(傾向)이었다.

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$SnO_2$ 박막을 이용한 ${Ta_2}{O_5}$박막 커패시터의유전특성 (Dielectric properties of ${Ta_2}{O_5}$ thin film capacitor with $SnO_2$ thin film underlayer)

  • 김진석;정강민;이문희
    • 한국재료학회지
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    • 제4권7호
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    • pp.759-766
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    • 1994
  • 본 연구에서는 Ta 박막 밑에 $SnO_{2}$박막층을 입혀서 $Ta/SnO_2$이중박막이 산화될 때 산소의 공급원을 2원화 함으로써 $Ta_2O_5$의 stoichiomitry를 향상시켜 $Ta_2O_5$박막 커패시터의 주설전류를 줄이고자 하였다. Tantalum을 실리콘 웨이퍼 위에 기판온도를 변화시켜 가면서 전자빔증착이나 스퍼터링 방밥으로 입히고 $500^{\circ}C$~$900^{\circ}C$에서 산화시켜 Al/$Ta_2O_5$p-Si/Al또는Al/$Ta_2O_5$/p-Si/Al과 같은 MIS형 커패시터를 만들어 유전상수 및 누설전류를 측정하였으며 XRD, AES, ESCA등을 이용하여 박막의 결정성 및 특성을 분석하였다. $SnO_{2}$박막층을 입힌 커패시터는$SnO_{2}$층을 입히지 않은 커패시터보다 10배 이상 큰 200정도의 유전상수 값을 나타내었다. 그리고 산화온도가 높으면 박막의 결정화로 인하여 유전상수는 증가하지아는 누설전류도 약간 증가하는 것이 확인되었다. 또한 높은 증착온도는 일반적으로 누설전류를 낮추는 것으로 나타났다. 특히 $SnO_{2}$층을 입힌 경우에 기판온도를 $200^{\circ}C$로 하고 $800^{\circ}C$에서 산화시켜 만든 커패스터의 경우에 $4 \times 10^{5}$V/cm의 전장강도에서 $10^{-7}A/\textrm{cm}^2$의 낮은 누설전류 값을 나타내었다. $Ta_2O_5$박막은 $700^{\circ}C$ 이상에서 박막이 결정되고, Ta /$SnO_{2}$ 이중박막을 산화시키면 처음에는 Ta박막과 $SnO_{2}$박막 계면에서 $SnO_{2}$로부터 Ta박막에 산소가 공급되지마는 점차 Sn이 Ta박막쪽으로 확산되어 결국에는 Ta-Sn-O계의 새로운 ternary oxide가 생성되는 것으로 나타났다.

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펜톤산화 및 생물학적 연속처리를 통한 유류오염토양의 효율적 처리 (Efficient Remediation of Petroleum Hydrocarbon-Contaminated Soils through Sequential Fenton Oxidation and Biological Treatment Processes)

  • 배재상;김종향;최정혜;칼루 이베 엑페게어;김수곤;고성철
    • 미생물학회지
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    • 제47권4호
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    • pp.356-363
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    • 2011
  • 유류의 유출로 인한 총석유계탄화수소(total petroleum hydrocarbons: TPH)는 종종 토양과 지하수의 오염을 초래하고 있다. TPH는 환경에 노출이 될 경우 물리화학적 과정을 거쳐 분해가 되나 그 반응은 상대적으로 느리다. 본 연구에서는 TPH로 오염된 토양의 환경친화적인 처리기법을 궁극적으로 개발하기 위해서 화학적 및 생물학적 통합기술을 도입하고자 시도하였다. 여기서 펜톤유사반응을 전처리단계로 도입하고 이후 디젤분해 혼합균을 처리하여(생물증강법) 오염유류를 처리하고자 하였다. 계면활성제 OP-10S (0.05%)과 산화제($FeSO_4$ 4%, 및 $H_2O_2$ 5%)를 사용할 경우 토양으로부터 효율적으로 TPH를 처리, 제거할 수 있는 것으로 나타났다. 디젤분해 혼합균을 토양슬러리에 접종할 경우 100배 이상 분해균의 밀도상승이 관찰되었는데 이는 접종된 분해균이 오염된 토양에서 성공적으로 존재할 수 있음을 의미한다($10^8-10^9$ CFU/g slurry). Fenton으로 처리된 토양에서의 TPH 제거 효율은 분해균으로 생물증강을 실시할 경우 최소한 57% 정도 상승되는 것으로 나타났다. 그러나 화학적, 생물학적 연속처리를 실시할 경우 대조구(무처리; 재거효율 95%)에 비해 상대적으로 낮은 처리효율(79-83%)을 나타내었는데, 이는 화학처리 중에 발생하는 자유기(free radicals) 함유 산화물질이 분해를 억제한 것에 기인하는 것으로 보인다. 본 연구에서의 얻어진 결과는 환경에 있어서 TPH로 오염된 토양과 저질을 효율적으로 정화하고 토양생태계의 신속한 회복에 활용할 수 있을 것으로 판단된다.

소형 사업장 근로자들의 건강증진 생활양식에 영향을 미치는 요인 (A Study on the Factors Affecting Health Promoting Lifestyles of Workers in the Small Scale Industries)

  • 장용남;이은경;정명수;전선영;김상덕;정재열;장두섭;송용선;이기남
    • 대한예방한의학회지
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    • 제5권1호
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    • pp.10-30
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    • 2001
  • Oriental medicine needs to be armed with theories on health-improvement concept under it and basic data matching its views, in order to participate in the health-improvement service in industrial work places. The Orient medicine health-improvement program defines factors that determine individuals' lifestyle, and provides information and technologies for workers to practice in life. To that end, this research compares and analyzes health-improvement concept and health care, defines relations between individuals' health state and their lifestyle as the basic data needed to perform health-improvement business for workers. 1. The subjects employed for this research is categorized into; by gender, males 52.1% and females 47.9% with no big difference between them; and by age, 20s, 6.1%, 30s. 33.9%, 40s, 34.1%, and 50s, 24.8% with 30-50 accounting for most of it. By marriage status, unmarried represents 7.1%, and married 79.1% with most of them married; by revenue, under one million won represents 3.0%, 1-2 million won 26.4%, 2-2.49 million won 11.2%, above 2.5 million won 11.2%, and 1-2.5 million won a majority. By living location, owned houses represents 65.4%, rented houses 14.7%, monthly-rented 9.5%; and by education, elementary and middle school represent 16.9%, high school and its dropouts 22.6%, and junior college and higher 51.6%, with high school and higher occupying most of the group. 2. By job, office workers and managerial workers represent 12.3%, part-timers 21.0%, manual workers 11.4%, jobless 0.6%, professionals 35.6%, service 0.6%, housewives 8.4%, and equipment/machinery operation/assemblers 10.1%. Of this, jobless and part-timers, totaling three, are dropped from this research. By years worked, 0-3.9 years represents 9.7%, 4-7.9 years 6.7%, 8-14.9 years 18.4%, above 15 years 28.7%, and no respondents 36.5%. 3. The degree of the subjects practicing life-improvement lifestyle, on a scale of 1 to 4, is an average of 2.69, personal relations 3.04, self-realization 2.92, stress management 2.76, nutritional state 2.73, responsibility for health 2.47, and athletic activities 2.18, with personal relations earning the highest points and athletic activities the lowest. As for factors influencing health-improvement lifestyle, there is no significant difference between gender, age, and marriage status. Meanwhile, there is significant difference between revenue, dwelling pattern, education level, etc. That is, higher income-bracket, owned houses, rented houses, monthly-rented houses, and higher-educated, in this order, show higher average in health-enhancement lifestyle. By job, housewives, manual workers, office workers, professionals, equipment/ machinery operation/ assemblers, and part-timers, in this order show higher points, while there is no difference with significance by years worked. 4. Factors that affect health-improvement lifestyle are shown below. Self-realization is influenced by age, marriage status, type of dwellings, and level of education; responsibility for health by type of dwellings; athletic activities by gender and age; nutrition by age, marriage status and type of dwellings; personal relations by marriage status; and stress management by type of dwellings. 5. Areas with high points by job show this: in self-realization, office workers, manual workers, housewives, professionals, equipment/ machinery operation/ assemblers, in this order, show difference with significance; in the area of responsibility for health, manual workers, housewives, equipment/ machinery operation/ assemblers, professionals, office workers and part-timers, in this order, do. In athletic activities, manual workers, housewives, office workers, professionals, equipment/ machinery operation/ assemblers, and part-timers, in this order, show difference with significance; in nutrition, housewives, office workers, manual workers, professionals, equipment/ machinery operation/ assemblers, and part-timers, in this order do; and in stress, housewives, office workers, manual workers, professionals, equipment/ machinery operation/ assemblers, part-timers, in this order do. By years worked, more years showed higher points in the area of responsibility for health and nutrition; in the area of athletic activities, above 15 years, 4-8 years, below 4 years and 8-14 years, in this order, show higher points; and no difference shows in realization, personal relation, and stress area. 6. To look at correlation between overall and divisional health-improvement practice degree, this researcher has analyzed it using Person's correlation coefficient. Self-realization, responsibility for health, athletic activities, nutrition, support for personal relations, and stress management show significant correlation with the sub-divisions, while all health-improvement lifestyle shows significant correlation with the six sub-divisions.

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가족계획(家族計劃) 및 모자보건사업(母子保健事業)의 효율적 통합방안(統合方案)에 관한 연구(硏究)(서산군(瑞山郡)) -기초조사보고(基礎調査報告)- (The Seosan County Family Planning/Maternal & Child Health Service Research Project, Korea -Project Design and Findings of the Baseline Survey-)

  • 방숙;조태호;이상주;한성현;임경주;안문영
    • Journal of Preventive Medicine and Public Health
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    • 제16권1호
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    • pp.163-192
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    • 1983
  • In order to facilitate the Korean government's efforts in integrating family planning and maternal & child health at the primary health care level (or township level), the Soon Chun Hyang College of Medicine, with the financial and technical assistance of WHO, has under-taken a service research project. The project has employed a quasi-experimental study design introducing interventions tat provide crucial factors lacking in the ongoing government programs such as midwives and qualified referral physicians. The study is being conducted in three locations, one control area and two study areas. Before introducing trained Nurse/Midewives into the study areas, a baseline prevalence survey was undertaken from 15 July 1981 to 10 August 1981 in selelcted townships of Seosan County. In this sample survey of bath the study and control areas, 2,484 eligible women (97% reponse rate) were interviewed to obtain benchmark data on basic evaluation indicators related to family planning and maternal and child health. The salients results were summarized as follows.: 1. CONTACT RATES WITH HEALTH WORKERS; During the year preceding the survey, 12% of women were visited by government health workers. The primary reason for such visits by health workers was family planning (45% of the visits). About 34% of the women visited the health centers during the year. The primary reason for visiting health centers was immunizations for their children (45% of the visits). 3. FAMILY PLANNING USE RATE; The baseline data showed little difference between women in the study area and the control area on contraceptive use. Approximately 59% were currently using some methods. However, among those current users, almost half were practicing less effective methods of birth control such as rhythm or withdrawal. Among other methods, the tubectomy was the most popular (16%), while use of the IUD, oral pill and condom together reached only 14%. 3. PRENATAL CARE RATE; About 75% of the women reported no prenatal care for their last births (the youngest child of each women), Additionally, among women received prenatal care, over half had only one visit. 4. ATTENDANCE AT DELIVERY; Most of the women surveyed (over 80%) were attended by a non-medical person during their last delivery. These figures are somewhat comparable to the national figure of 84% for remote areas. 5. POSTNATAL CARE; The proportion of women reporting postnatal care was only 4.5%, and postnatal care was not received by the majority of women surveyed. 6. CHILD HEALTH CARE: In contrast to the low rate of maternity care for women themselves, most women reported obtaining immunization care for their children. About 75% of the women obtained Polio and/or DPT, 58% BCG, and 44% Measles vaccine for their children. However, in terms of illness care, while 35% of the women stated that their youngest child had been sick during the month preceding the survey, only 28% of these women took their child to the clinic for treatment. 7. COMPLICATIONS OF PREGNANCY AND DELIVERY AND ABNORMALITIES IN THE NEWBORN; Among all last deliveries, 18% of the women had pregnancy complications and 9% of the women had complications during delivery About 5% of the women reported abnormality in their most recent newborn. 8. REPRODUCTION EFFICIENCY; PERINATAL MORTALITY AND INFANT MORTALITY Based on data from the pregnancy history in this survey, reproduction efficiency was estimated. Out of the 11,154 pregnancies reported by all women surveyed, foetal loss was 21% (almost 16% were induced abortions) and infant deaths before reaching one year old were 3.1%. The reproduction efficiency was, therefore, reduced to 76%. In terms of perinatal and infant mortality rates, the former was 40.2 per 1,000 total births and the latter was 39.3 per 1,000 live births. Both rates described J shaped relationships with age of mothers and parity, and they were also correlated with birth interval and mother's education. In summary, this baseline survey data indicated a need for (1) improving contraceptive practices with more effective methods to prevent unwanted pregnancies and (2) providing better services for maternal and child care to protect wanted pregancies. In the Korean rural setting. the author believes that the latter is more important as the value of each child has increased as a result of the family planning campaign for the past two decades. This calls for more effective integration of Family Planning and MCH programmes to meet the needs of the family in each stage of the child bearing and rearing period with deploying more qualified personnel than the current government program personnel.

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추적조사된 대구시내 일부 병원분만 산모에서 모유수유중단 예측변수 (Predictors of breast-feeding discontinuation in some followed-up hospital-delivered mothers)

  • 이충원;이무식;박종원;이미영;강미정;신동훈;이세엽
    • Journal of Preventive Medicine and Public Health
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    • 제28권4호
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    • pp.845-862
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    • 1995
  • 모유수유를 시작하지 않는 산모의 특성과 모유수유 중단을 예측해주는 특성을 찾아내기 위하여 1년간 매달 전화면담으로 추적조사를 실시하였다. 등록대상자는 대구시의 대학병원 산부인과와 개업산부인과 각각 1개소에서 1991년 9월부터 11월까지 분만한 산모로서 최종분석에 이용된 자는 대학병원에서 166명, 개업산부인과에서 316명으로 총 482명이었다. 모유수유 중단은 고형식 유무에 관계없이 100% 인공수유로 전환하여 1주일 이상 지속하는 것으로 정의하였다. 대상자의 평균연령은 27.3세(표준편차 3.2)였다. 모유수유를 중단한 산모와 지속한 산모간의 특성차이는 다중지수회귀분석시 출신지, 직업, 출산방법, 모성의 건강을 위해 좋다고 생각되는 수유방법 등이었다. 한 달 이상 모유수유를 지속한 242명의 산모를 추적조사시에 모유수유 중단의 중앙값은 5개월이었으며 추적 대상자의 25%, 75%가 각각 3개월, 9개월에 모유수유를 중단하였다. Cox's proportional hazard model로 분석시 9년이하의 교육수준인 산모에 비하여 $10\sim12$년을 교육받은 산모는 2.63배(95% 신뢰구간 $1.50\sim4.60$), 13년 이상의 교육을 받은 산모는 3.55배(95% 신뢰구간 $1.99\sim6.33$)나 모유수유 중단을 할 가능성이 더 높았다. 전업 주부에 비하여 시간제 근무를 하는 주부는 1.99배(95% 신뢰구간 $0.86\sim4.57$) 모유수유 중단의 가능성이 더 높았고 취업 주부는 1.55배(95% 신뢰구간 $0.96\sim2.51$) 더 높았다. 이러한 결과는 모유수유를 시작하지 않는 것과 관련된 변수와 모유수유 중단과 관련된 변수들이 다를 수 있다는 사실을 시사해주며 모유수유 증진을 위한 전략 역시 출산 후 시기에 따라 달라져야 한다는 것을 시사해준다.

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국내 MIS 연구에서 구조방정식모형 활용에 관한 메타분석 (A Meta Analysis of Using Structural Equation Model on the Korean MIS Research)

  • 김종기;전진환
    • Asia pacific journal of information systems
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    • 제19권4호
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    • pp.47-75
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    • 2009
  • Recently, researches on Management Information Systems (MIS) have laid out theoretical foundation and academic paradigms by introducing diverse theories, themes, and methodologies. Especially, academic paradigms of MIS encourage a user-friendly approach by developing the technologies from the users' perspectives, which reflects the existence of strong causal relationships between information systems and user's behavior. As in other areas in social science the use of structural equation modeling (SEM) has rapidly increased in recent years especially in the MIS area. The SEM technique is important because it provides powerful ways to address key IS research problems. It also has a unique ability to simultaneously examine a series of casual relationships while analyzing multiple independent and dependent variables all at the same time. In spite of providing many benefits to the MIS researchers, there are some potential pitfalls with the analytical technique. The research objective of this study is to provide some guidelines for an appropriate use of SEM based on the assessment of current practice of using SEM in the MIS research. This study focuses on several statistical issues related to the use of SEM in the MIS research. Selected articles are assessed in three parts through the meta analysis. The first part is related to the initial specification of theoretical model of interest. The second is about data screening prior to model estimation and testing. And the last part concerns estimation and testing of theoretical models based on empirical data. This study reviewed the use of SEM in 164 empirical research articles published in four major MIS journals in Korea (APJIS, ISR, JIS and JITAM) from 1991 to 2007. APJIS, ISR, JIS and JITAM accounted for 73, 17, 58, and 16 of the total number of applications, respectively. The number of published applications has been increased over time. LISREL was the most frequently used SEM software among MIS researchers (97 studies (59.15%)), followed by AMOS (45 studies (27.44%)). In the first part, regarding issues related to the initial specification of theoretical model of interest, all of the studies have used cross-sectional data. The studies that use cross-sectional data may be able to better explain their structural model as a set of relationships. Most of SEM studies, meanwhile, have employed. confirmatory-type analysis (146 articles (89%)). For the model specification issue about model formulation, 159 (96.9%) of the studies were the full structural equation model. For only 5 researches, SEM was used for the measurement model with a set of observed variables. The average sample size for all models was 365.41, with some models retaining a sample as small as 50 and as large as 500. The second part of the issue is related to data screening prior to model estimation and testing. Data screening is important for researchers particularly in defining how they deal with missing values. Overall, discussion of data screening was reported in 118 (71.95%) of the studies while there was no study discussing evidence of multivariate normality for the models. On the third part, issues related to the estimation and testing of theoretical models on empirical data, assessing model fit is one of most important issues because it provides adequate statistical power for research models. There were multiple fit indices used in the SEM applications. The test was reported in the most of studies (146 (89%)), whereas normed-test was reported less frequently (65 studies (39.64%)). It is important that normed- of 3 or lower is required for adequate model fit. The most popular model fit indices were GFI (109 (66.46%)), AGFI (84 (51.22%)), NFI (44 (47.56%)), RMR (42 (25.61%)), CFI (59 (35.98%)), RMSEA (62 (37.80)), and NNFI (48 (29.27%)). Regarding the test of construct validity, convergent validity has been examined in 109 studies (66.46%) and discriminant validity in 98 (59.76%). 81 studies (49.39%) have reported the average variance extracted (AVE). However, there was little discussion of direct (47 (28.66%)), indirect, and total effect in the SEM models. Based on these findings, we suggest general guidelines for the use of SEM and propose some recommendations on concerning issues of latent variables models, raw data, sample size, data screening, reporting parameter estimated, model fit statistics, multivariate normality, confirmatory factor analysis, reliabilities and the decomposition of effects.