• 생물정신의학
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• 제19권4호
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• pp.205-210
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• 2012

Objectives The purpose of this study was to investigate clinical profile, efficacy, and safety of long-term treatment with selective serotonin reuptake inhibitors (SSRIs) in Korean autism spectrum disorders (ASDs) patients. Methods Effectiveness was assessed through a retrospective review of self-reported target symptom improvement at the last follow-up visit. Changes in illness severity and improvement were measured using the Clinical Global Impression-Severity (CGI-S) of illness and Clinical Global Impression-Improvement (CGI-I) Scales. Tolerability was assessed through a review of the reason for discontinuation of SSRI and documented adverse events. Results A total of 21 ASDs patients (aged 9 to 19 years) treated with SSRI during July 2010 to July 2011 in department of child and adolescent psychiatry of Seoul National Hospital were identified. The mean duration of SSRI treatment was 47.9 (standard deviation = 36.9) months (range 0.7-114.5), and the mean fluoxetine equivalent dosage of SSRIs was $27.1{\pm}10.8$ mg. Nineteen (90.5%) patients were using concomitant medication. We found that SSRIs were prescribed for symptoms of agitation, stereotyped behavior, aggression, depression, impulsivity and self-injury in ASDs. Ten patients (47.6%) reported improvement in their target symptom after SSRI treatment based on CGI-I scores (CGI-I ${\leq}$ 2). The side effects were reported in 5 patients (23.8%) ; vomiting (n = 2, 9.5%), excessive mood elevation (n = 1, 4.8%), insomnia (n = 1, 4.8%), somnolence (n = 1, 4.8%) and decreased appetite (n = 1, 4.8%). Self-injurious behavior was reported in one patient (4.8%). Conclusions The results of this study suggest that SSRIs may be used effectively in children and adolescents diagnosed with ASDs. However, safety issues need to be considered carefully when choosing SSRIs for treatment. Future controlled trials are needed to confirm these findings.

• 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.

• 한국학교보건학회지
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• 제6권1호
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• pp.9-44
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• 1993

An explorative and descriptive study in order to determine the effect of family structure and other socio-demographic variables on health behavior, belief, locus, and value and utilization of public health service was carried out. Data were collected from 1,653 subjects randomly sampled in three areas, Seoul, Kyunggi province, and Cheju province. From Seoul 849 subjects were selected, 397 subjects Kyunggi, and 407 subjects from Cheju, respectively. Self-reporting questionaires were administered during the period from March to June, 1992. The major findings were as follows: 1) The subjects visited herb-doctor's at irregular intervals mainly to have tonic medicine prepared. They preferred herb-doctor's rather than with doctors at clinics and hospitals. Statistically significant difference was found among the regions studied (p<0.05). 2) The reason for visiting hospitals was primarily for treatment of diseases. They preferred hospital because they felt that the hospitals offer much highly reliable treatment services as well as medical accessibility. For the purpose of hospital utilization, statistically significant differences existed among sex, educational level, family type and region. However, no significance was found among sex, educational level, and region (p<0.05). 3) The subjects utilized general hospitals mainly for diagnosis and treatment of diseases. They preferred general hospitals because of their much better facilities and reliability. Statistical significance was found among sex, educational level, and region (p<0.05). 4) The subjects visited dentist at irregular intervals basis. They visited once half a year or three to four months. their purpose of visit was mainly for diagnosis and treatment of diseases. Statistical significance differences were found among educational level, region and economic standard (p<0.05). 5) Whenever their illnesses were mild and the pharmacies was located in nearby they visited to pharmacies. They visited once a month and patient medicines. Statistically significant differences were found among sex, educational level and region (p<0.05). 6) The subjects believed that herb medicine was quite efficacious for treatment of some diseases, particularly by information handed down through time-honored tradition and experience. However, they recognized that the efficacy of folk medicine can vary with type and severity of diseases. Statistical significance was among sex, educational level, region and economic standard (p<0.05). 7) The reason why subjects believed that pray and superstition are effective for treatment of certain type of diseases, particularly in neuropathy, was the belief in God's almighty. Statistically significant differences were found among sex, educational level, regions and economic standard (p<0.05). 8) Most of subjects under same condition preferred western medicine because they believed that it is more scientific and prompts in showing therapeutic effect. Statistical significance was not found in the choice of type of public health service among, regions. But significant differences were found among sex, educational level and region (p<0.05). 9) The subjects looked for pharmacy if they thought the symptom was mild. However, they visited hospitals for chronic disease and general hospitals for emergency treatment. Statistical significances were found among educational level, region and economic standard (p<0.05). 10) Although most of students wanted to have a healthy life as for the component of health standard and value, they think that they are not healthy (p<0.05). As for the health behavior, significant difference was found in the proportion of smoking and drinking between educational level and region (p<0.05). The health locus was affected by educational level, and health behavior was influenced by region, sex and educational level. The utilization of type of public health service was influenced by family type and region, and health belief by region and educational level, and the health values by region and economic standard respectively, most of correlation showed statistical significance. Among them, the highest correlation was seen between locus of control and external/internal locus of control, which is quite obvious. The correlation between health belief and behavior was the next highest, but still low (0.343). All the other variables are low but significant except only a few of those. These findings indicate that health education should be incorporated into the curriculum so as to develop desirable health habit, and ability of self-control in accordance with their growth stages. A systematic and scientific understanding on the herb/folk medicine is needed, and greater reliability of the utilization of public health services are is still required. Health policy for equal distribution of health service throughout the country along the hierarchical health service system and complementary mutual assistance and cooperation among various health organizations are also required.

• Journal of Hospice and Palliative Care
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• 제19권2호
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• pp.145-153
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• 2016

목적: 본 연구는 독립형 호스피스기관의 가정호스피스 서비스에 등록한 말기환자의 특성과 가정호스피스 서비스 제공 실태를 파악하여 가정호스피스 서비스 모델 개발을 위한 기초자료를 제공하기 위하여 수행되었다. 방법: 일개 독립형 호스피스기관의 가정호스피스에 등록하여 방문서비스를 받고, 2014년 1월 1일부터 2014년 12월 31일 사이에 서비스가 종료된 말기환자의 의무기록지 75개를 후향적으로 분석하였다. 결과: 등록 환자의 54.7%가 자가 의뢰를 통하여 가정 호스피스를 이용하였다. 종료 후 25.3%가 가정에서 임종하였고, 50.7%는 호스피스병동, 22.6%는 대학병원이나 요양병원으로 입원하였다. 등록 당시 97.3%가 암성질환이었으며, 비암성질환으로 가정호스피스를 이용한 경우는 2.7%였다. 등록 환자의 58.7%가 임종기에 있었으며, 34.7%는 거의 완전한 와상 상태에 있어 전반적으로 낮은 활동수준을 보였다. 등록 당시 환자들이 가진 신체 증상은 통증(89.4%), 수면장애(71.2%), 배변문제(47.8%), 배뇨문제(35.8%) 순으로 나타났다. 전체 환자의 77.4%가 1개월 이내에 서비스가 종결되었다. 환자들에 대한 가정방문 횟수는 평균 3.25회로 전체 환자의 82.7%가 5회 미만의 가정방문을 받고 서비스가 종결되었으며, 전화상담 횟수는 평균 3.4회였다. 의사 방문 횟수는 평균 1.21회였으며, 이는 불안정기에 유의하게 증가하였다. 결론: 독립형 호스피스기관을 이용하는 환자의 특성과 서비스 제공 형태를 반영한 가정호스피스 서비스 모델 개발이 필요하다.

• Journal of Oral Medicine and Pain
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• 제38권3호
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• pp.235-246
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• 2013

법치의학적 연령 감정은 개인 식별에 있어 중요한 역할을 한다. 본 연구는 한국 연령 감정 대상자들의 사회적 특성을 분석하는 것을 목적으로 한다. 2012년 3월부터 2013년 3월까지 경북대학교 치과병원 구강내과에 연령 감정을 의뢰한 대상자들에게 설문조사를 실시하였다.결과는 다음과 같다: 1. 성별 분포에서, 남성(42.86%)보다 여성(57.14%)이 더 많았다. 50대와 60대 이상의 고령자가 대다수였으며(89.28%), 40대 아래로는 한 명의 의뢰인도 없었다. 의뢰인들의 대부분이 초등학교 졸업 이하의 학력을 가지고 있었다(69.64%). 2. 호적 상 연령과 의뢰인이 주장하는 연령 간의 차이가 나게 된 가장 큰 이유로는 가족 및 친척의 실수로 인한 것이 가장 많았다(80.36%). 연령 감정을 통해 얻고자 하는 목적은 사회 복지 혜택(62.50%), 사회적 인관 관계 문제(12.50%), 단지 바른 나이를 찾기 위해서(10.71%), 직업과 관련한 문제(8.93%) 순이었다. 3. 연령 감정을 하기 위해 치과(구강내과)를 찾게 된 경로로는 관공서의 비중이 높았으며(48.21%), 친구나 지인(21.43%), 대중매체(14.29%), 병의원(10.71%) 등을 통한 경로가 뒤를 이었다. 법치의학적 연령 감정에 대한 의뢰인들의 이해도는 10점 만점에 7.03점으로 높은 수준이었다. 절반 이상의 의뢰인들에게서 현재의 연령 감정 비용에 대해 만족하는 것으로 나타났다. 4. 법치의학적 연령 감정을 통해 감정된 연령과 의뢰인들이 주장하는 연령 간에는 57.14%의 근접도를 보였다. 1년 간 조사한 연령 감정 대상자들의 23.53%가 법적으로 연령 정정을 하게 되었다.

• Journal of Preventive Medicine and Public Health
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• 제27권1호
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• pp.117-134
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• 1994

대구직할시 남구 1 개동 주민을 대상으로 도시 지역의료보험 실시 전후(이하 실시 전후)의 의료 이용양상을 파악하기 위하여 실시 6개월 전인 1989년 1월에 1차조사를 하였고, 실시 1년 6개월 후인 1991년 1월에 2차조사를 하였다. 1차조사의 대상자는 1,230가구 4,939명이 었으나, 2차추적조사가 가능했던 인구는 519가구 2,277명 (추적률:46.1%)이었다. 2차조사까지 추적이 가능했던 2,277명 중 1차 조사시 보험에 가입되지 않았던 240가구 1,033명을 코호트 I군(이하 I군)으로 하였고, 1차조사시 보험에 가입되었던 279가구 1,244명을 코흐트 II군(이하 II군)으로 구분하여 조사자료를 분석하였다. 인구 1,000명당 급성이환으로 인한 의사방문율의 변화는 실시 후에 I군에서 16.5 증가한 반면, II에서는 2.4만 증가하였으며, 만성이환에서도 I군이 13.5 증가하였으나 II군은 7.2만 증가하였다. 이환 및 활동제한 의료필요 충족률도 I군에서 실시 후 뚜렷히 증가하였다. 월가구소득별 급성이환에 의한 의료필요충족률은 I군에서 40만원미만군이 1.6으로 $40{\sim}99$만원군의 4.0과 100만원이상군의 49.3에 비해 월등히 낮았다. 이러한 소견은 나머지 조사대상군과 만성이환에서도 동일하였다. 급성과 만성이환자의 병원이용 이유는 유용성, 의원의 경우는 지리적 접근성이 실시전후모두에서 가장 많았고 약국이용 이유 중 실시 전에는 접근성과 의료비지불성이 중요하였으나, 실시 후에는 의료비지불성의 중요성은 상대적으로 감소하였다. 최근 15일간 의사방문여부를 종속변수로한 multiple logistic regression analysis에서 급성이환(+), 만성이환(+) 그리고 월가구소득(+)이 실시전후 모두에서 유의한 변수였다. 실시 후 부과된 보험료에 대한 불만족률이 두군 모두 지역의료보험 가입자에서 각각 81.0%와 74.1%로 타 의료보험가입자에 비해 월등히 높았다. 실시 후 병원과 의원의 의료비와 서어비스에 불만족스럽다고 응답한 사람이 I군에 비해 II군에서 더 많았다. 이상의 소견으로 의료보험이 실시됨으로 미충족의료수요를 감소시키는 효과를 가져왔으나 실시 후에도 저소득층의 의료이용률이 고소득층에 비해 여전히 낮아 의료보험실시로 경제적 장애가 감소하였음에도 불구하고 본인부담금 등으로 인한 경제적 장애와 의료기관을 방문하는데 소요되는 시간, 대기시간 등 의료이용을 저해하는 요인이 남아있어 의료이용의 형평이 사회계층들간에 완전히 이루어지지는 않았다. 특히 만성이환의 경우, 불균형이 심하였다. 또한, 부과된보험료에 대한 불만족도가 높아 현행 보험료선정기준의 재평가 및 공정성을 향상시킬 필요성이 제기되었다.

• 한국조경학회지
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• 제41권2호
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• pp.69-82
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• 2013

본 연구는 북한산국립공원 둘레길의 정상정복형 수직 탐방객의 분산 효과를 진단하고, 둘레길 구간별 특성화 및 개선방향을 제공하는데 목적이 있다. 조사방법은 이용자 자기 기입식 조사 방법으로 현장조사를 통해 둘레길 전체 21개 구간에서 탐방객을 대상으로 이루어졌다. 둘레길 조성 후 북한산 탐방 횟수가 증가하였으며, 둘레길에 처음 방문한 만 18~29세의 젊은 연령층 비율이 높아, 둘레길로 인해서 새로운 계층의 탐방객이 유입된 것으로 판단된다. 북한산 정상탐방 이용빈도는 '감소하였다' 7.6%, '증가하였다' 46.2%로 정상정복형 수직 탐방객의 분산효과는 아직 없는 것으로 판단된다. 둘레길 만족도는 7개의 측면 중 여가장소적 측면이 3.74, 보행만족 측면이 3.61로 높았고, 역사문화 측면이 3.09로 가장 낮았다. 둘레길 구간별 특성과 탐방객의 방문동기, 만족도 결과를 통해 둘레길이 가벼운 운동, 산책 등의 건강증진을 위한 개념으로 인식되고 있음을 보여주었다. 그러나 저지대 길에서의 자연, 생태, 역사, 경관 등 국립공원 자원에 대한 다양한 시각의 이용문화가 창출되어 장기적으로 긍정적인 효과를 예상할 수 있었다. 또한 둘레길의 구간별 특성과 여건, 인프라 및 프로그램에 따라 차이가 있어 둘레길 구간별 특성을 고려한 인프라 및 프로그램이 보완된다면 장기적으로 정상탐방객의 저지대 탐방문화 유도 효과를 기대할 수 있을 것이다.

• 동의신경정신과학회지
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• 제20권4호
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• pp.185-196
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• 2009

통제적이고 강압적인 부모의 양육태도로 유발된 내면의 불안 및 갈등이 '항문의 이상 감각'이라는 신체화 증상으로 상징화되어 표출된, 전환장애로 의심되는 7세 여환아(女患兒)에게 한약(韓藥)치료와 더불어 지언고론요법(至言高論療法)을 적용하여 약 2개월간 치료하였다. 지언고론요법(至言高論療法)은 한의학 정신요법 중 하나로 현재 임상에서 행해지고 있는 지지적 정신치료 및 행동치료와 유사하다. 의료진은 이를 본 증례의 환아(患兒)에게 2개월간 적용하여 증상이 80%이상 소실되는 긍정적인 치료 결과를 얻을 수 있었다. 아동의 심리 발달과정에서 부모의 양육태도 등과 같은 중요한 심리 환경적 요인들이 부적절하여 아동의 내면에 갈등이 생기면 심인성의 신체증상이 유발되기도 한다. 이는 전환장애의 심리기제와 매우 흡사하다 할 수 있다. 그러므로 아동의 심인성 신체 증상을 치료하는 장면에서, 우선 성장 환경의 문제점 혹은 환아(患兒)의 성격 기질적 특성을 정확히 파악하고 그에 따라 지언고론요법(至言高論療法)등과 같은 한의학 정신요법을 이용해 적절한 치료적 개입을 한다면 이른 시간 안에 효과적인 치료가 가능할 것이다. 본 증례는 그 좋은 예라 사료된다.

• 대한간호학회지
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• 제7권1호
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• pp.30-38
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• 1977

Breast cancer is one of the most feared health problems in women ; Recent studies revealed that it had come up to be the second most in this country and high prevalent disease in the western countries among breast disease in women. However, early detection of the cancer mass is known to be easier than in many other malignancies. This study was performed to investigate the various characteristics of patients of breast cancer ; by the structural variables, menstrual, marital, and child bearing, and also their understandings and attitude towards the disease. A hundred any in- and out- patients of 51. Mary's Hospital and National Atomic Institute, Seoul were sampled. Data were gathered through direct interview by the researcher from February 1976 to January 1977 and the clinical records were used as references. Results are as follows ; 1. Breast cancer revealed to be most prevalent in the forties ; average age of 45.2 years. 2. The average age of menarche revealed to be 15.4 years ; the largest group were the 16-20 years (N=75, 68.2%). In 55 cases (50%) menstruation were normal, 38 (34.5%) postmenopausal and only in 17 (15.5%), menstruation revealed irregularity. 3. The average marital age revealed to be 22.3 years ; the largest group were 21-25 group (N=43, 39.1%). The average duration of marital life revealed to be 24.7 years ; 11-20 years group were the largest (M=34, 30.9%). 4. Most of the patients revealed to have pregnancy experiences(N=100, 90.9%) ; the average rate of experience were 5, 3 times the largest group were 3.4 times group(N= 32, 29.1%). 54 patients (49.1%) revealed to have had abortion experience ; the average were 3.4 times. 5. The largest group(N=77, 70%) had been breast feeding : followed by mixed feeding (N=12, 10.9%) and artificial feeding(N=10, 9.1%). 6. Personal health history revealed that in 20 patients (18.2%) revealed to have the past history of Purulent mastitis, 5 patients(4.5%) of breast cancer and 3 patients(2.7%) of uttering cancer family history. 7. In the one half (N=56, 50.9%, they had some information about breast cancer :27 (24.5%) by mass media, 12 (10.9%) through personal contacts and 17 (15.5%) were not able to classify the source of information. 8. In 55 cases (50%) the canoe, mass were discovered incidentally, in 39 cases (35.5%) by manual detection by self, in 10 cases (9%) by others and in 6 cases(5.5%) by observing subjective symptoms. 9. The average duration lapsed between the discovery of cancer mass and the visit to the hospital revealed to be 9.4 month. Chief reason for the delay revealed to be the non-chaplaincy due to the absence of pain(N=50, 45.5 %) followed by the administration of herb and commercial medication (N=19, 17.3%). 10. The left side breast was more affected than the right side breast, represent by 60 cases in the left and 39 cases in the right. The most frequent site of the breast cancer was the upper- outer quadrant in 53 cases (47.7%), and followed by the center in 20 cases(18 %), and the upper inner quadrant, in 19 cases (17.1%). There was / cases of bilateral carcinoma. The most prominent symptom was painless mass.

• 한국콘텐츠학회논문지
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• 제12권11호
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• pp.258-266
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• 2012

본 연구는 일부 대학생들의 흡연행태와 흡연자와 비흡연자 간의 흡연에 대한 인식과 구강건강관리행태를 알아보고자 경상북도, 대구광역시, 강원도에 위치한 4년제 대학교에 재학 중인 대학생 260명을 대상으로 흡연에 대한 인식과 구강건강관리행태에 대해 조사한 결과 다음과 같은 결론을 얻었다. 1. 흡연자의 하루 평균 흡연량은 반 갑 미만이, 흡연기간은 1년~3년 미만이 가장 높았으며, 흡연을 시작하게 된 동기는 호기심과 주변 권유가 가장 높았고, 흡연이유는 스트레스 해소, 습관적 순으로 나타났다. 2. 흡연유무에 따른 구강건강관리행태 중 1회 잇솔질 시간, 정기적 치과 내원, 최근 치과 내원시기, 치과 방문 목적, 스켈링 및 구강보건교육 경험에서 유의한 차이가 있었다. 3. 흡연유무에 따른 구강건강에 대한 인식 중 주관적 구강건강상태에서 유의한 차이가 있었다. 4. 흡연유무에 따른 흡연에 대한 인식 중 담배, 한 두 개피 정도의 담배, 식후의 담배 및 간접흡연이 건강에 미치는 영향에 대한 인식에서 유의한 차이가 있었다. 이상의 결과로 미루어 볼 때 흡연자는 비흡연자에 비해 구강건강관리행태 및 구강건강에 대한 인식, 흡연에 대한 인식이 부족하므로, 대학생들을 위한 금연교육과 구강보건교육 프로그램 개발의 활성화가 필요하다고 사료된다.