• 대한방사선기술학회지:방사선기술과학
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• 제31권1호
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• pp.17-23
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• 2008

목적 : 골밀도검사의 중요한 부분을 차지하고 있는 검사장비 및 검사자의 정밀도와 정확도는 환경에 따라 차이가 있기 때문에 질 관리가 체계적으로 이루어져야 한다. 골밀도 검사장비의 노화 및 잦은 고장에 의하여 장비의 교체 및 추가 구입으로 인하여, 추적검사를 하는 환자들의 호환성에 문제가 있다. 따라서 장비 교체 및 증설 후 동일한 장비처럼 호환하여 시용해도 환자의 임상적인 골밀도 변화를 정확하고 정밀하게 반영할수 있는지 알아보고자 한다. 재료 및 방법 : 장비 정밀도는 GE Lunar Prodigy Advance 2 대의 장비 (P1, P2)와 HOLOGIC Spine Phantom(HSP)을 이용하여 각 장비에서 20 번씩 스캔하여 팬텀을 이용한 정밀도 데이터를 획득하였고 (Group 1), 여성 120명 (평균나이 48.78, $20{\sim}60$세)을 대상으로 각 장비에서 15명씩, 같은 환자가 두 번 촬영을 하여 각 검사자의 정밀도를 측정했다(Group 2), 또한 검사자의 정밀도는 팬텀(ASP)을 이용하여 매일 아침마다 질 관리 시행후 얻은은 데이터를 기준으로, 각각의 장비에서 HSP를 이용하여 각 장비에서 20번씩 스캔 후 데�歷� 획득하여 검사자정밀도 및교차 보정 데이터를 산출하였고(Group 3), 여성 120명(평균나이 48.78, $20{\sim}60$세)의 동일 환자를 대상으로 한 장비에서 한 번씩 교차로 측정하여 검사자 정밀도 및 교차보정 데이터를 산추라였다(Group 4). 결과 : Daily Q.C Data는 $0.996\;g/cm^2$, 변동계수(%CV) 0.08로 안정된 장비로서 Group 1에서 Mean${\pm}$SD 및 %CV값은 ALP(P1: $1.064{\pm}0.002\;g/cm^2$, $%CV=0.190\;g/cm^2$, P2: $1.061{\pm}0.003\;g/cm^2$, %CV=0.192). Group 2에서 Mean${\pm}$SD 및 %CV값은 P1: $1.187{\pm}0.002\;g/cm^2$, $%CV=0.164\;g/cm^2$, P2: $1.198{\pm}0.002\;g/cm^2$, %CV=0.163, Group 3에서의 Mean${\pm}$2SD 및 %CV는 P1 - (spine: $0.001{\pm}0.03\;g/cm^2$, %CV=0.94, Femur: $0.001{\pm}0.019\;g/cm^2$, %CV=0.96), P2 - (spine: $0.002{\pm}0.018\;g/cm^2$, %CV=0.55, Femur: $0.001{\pm}0.013\;g/cm^2$, %CV=0.48), Group 4에서 Mean${\pm}$2SD 및 %CV는, r값은 spine: $0.006{\pm}0.024\;g/cm^2$, %CV=0.86, r=0.995, Femur: $0{\pm}0.014\;g/cm^2$, %CV=0.54, r=0.998이였다. 결론 : HOLOGIC Spine Phantom과 LUNAR ASP %CV는 ISCD에서 규정한 정상오차 범위인 ${\pm}2%$안에 모두 포함되었고 BMD가 비교적 일정한 값을 유지하면 측정되어 뛰어난 재현성을 보였다. 하지만 Phantom은 환자의 체중이나 체지방 조성의 변화 등 임상적인 부분을 반영하는 데는 한계성을 갖고 있어 mis-calibration을 check하는데 유용할 것으로 판단된다. Group 3과 Group 4의 결과에서 환자를 하나의 장비로 두 번 측정한 값을 보았을 때와 두 대의 장비를 교차하여 측정한 값 모두 2SD값 이내에 포함되었고 선형회귀분석(Regression Analysis) r값이 0.99 이상으로 높은 정밀도와 상관도를 나타냄으로써 두 장비를 호환하여 추적검사를 시행하여도 영향이 없었다. 신뢰있는 BMD 산출을 위해서는 정기적으로 장비 및 검사자의 기능테스트와 이에 대한 적절한 교정행위가 이루어져야 할 것이다.

• Clinical and Experimental Reproductive Medicine
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• 제2권2호
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• pp.27-36
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• 1975

The success of the family planning program in Korea is reflected in the decrease in the growth rate from 3.0% in 1962 to 2.0% in 1971, and in the decrease in the fertility rate from 43/1,000 in 1960 to 29/1,000 in 1970. However, it would be erroneous to attribute these reductions entirely to the family planning program. Other socio-economic factors, such as the increasing age at marriage and the increasing use of induced abortions, definitely had an impact on the lowered growth and fertility rate. Despite the relative success of the program to data in meeting its goals, there is no room for complacency. Meeting the goal of a further reduction in the population growth rate to 1.3% by 1981 is a much more difficult task than any one faced in the past. Not only must fertility be lowered further, but the size of the target population itself will expand tremendously in the late seventies; due to the post-war baby boom of the 1950's reaching reproductive ages. Furthermore, it is doubtful that the age at marriage will continue to rise as in the past or that the incidence of induced abortion will continue to increase. Consequently, future reductions in fertility will be more dependent on the performance of the national family planning program, with less assistance from these non-program factors. This paper will describe various approaches to help to the solution of these current problems. 1. PRACTICE RATE IN FAMILY PLANNING In 1973, the attitude (approval) and knowledge rates were quite high; 94% and 98% respectively. But a large gap exists between that and the actual practice rate, which is only 3695. Two factors must be considered in attempting to close the KAP-gap. The first is to change social norms, which still favor a larger family, increasing the practice rate cannot be done very quickly. The second point to consider is that the family planning program has not yet reached all the eligible women. A 1973 study determineded that a large portion, 3096 in fact, of all eligible women do not want more children, but are not practicing family planning. Thus, future efforts to help close the KAP-gap must focus attention and services on this important large group of potential acceptors. 2. CONTINUATION RATES Dissatisfaction with the loop and pill has resulted in high discontinuation rates. For example, a 1973 survey revealed that within the first six months initial loop acceptance. nearly 50% were dropouts, and that within the first four months of inital pill acceptance. nearly 50% were dropouts. These discontinuation rates have risen over the past few years. The high rate of discontinuance obviously decreases the contraceptive effectiveness. and has resulted in many unwanted births which is directly related to the increase of induced abortions. In the future, the family planning program must emphasize the improved quality of initial and follow-up services. rather than more quantity, in order to insure higher continuation rates and thus more effective contraceptive protection. 3. INDUCED ABORTION As noted earlier. the use of induced abortions has been increase yearly. For example, in 1960, the average number of abortions was 0.6 abortions per women in the 15-44 age range. By 1970. that had increased to 2 abortions per women. In 1966. 13% of all women between 15-44 had experienced at least one abortion. By 1971, that figure jumped to 28%. In 1973 alone, the total number of abortions was 400,000. Besides the ever incre.sing number of induced abortions, another change has that those who use abortions have shifted since 1965 to include- not. only the middle class, but also rural and low-income women. In the future. in response to the demand for abortion services among rural and low-income w~men, the government must provide and support abortion services for these women as a part of the national family planning program. 4. TARGET SYSTIi:M Since 1962, the nationwide target system has been used to set a target for each method, and the target number of acceptors is then apportioned out to various sub-areas according to the number of eligible couples in each area. Because these targets are set without consideration for demographic factors, particular tastes, prejudices, and previous patterns of acceptance in the area, a high discontinuation rate for all methods and a high wastage rate for the oral pill and condom results. In the future. to alleviate these problems of the methodbased target system. an alternative. such as the weighted-credit system, should be adopted on a nation wide basis. In this system. each contraceptive method is. assigned a specific number of points based upon the couple-years of protection (CYP) provided by the method. and no specific targets for each method are given. 5. INCREASE OF STERILIZA.TION TARGET Two special projects. the hospital-based family planning program and the armed forces program, has greatly contributed to the increasing acceptance in female and male sterilization respectively. From January-September 1974, 28,773 sterilizations were performed. During the same time in 1975, 46,894 were performed; a 63% increase. If this trend continues, by the end of 1975. approximately 70,000 sterilizations will have been performed. Sterilization is a much better method than both the loop and pill, in terms of more effective contraceptive protection and the almost zero dropout rate. In the future, the. family planning program should continue to stress the special programs which make more sterilizations possible. In particular, it should seek to add the laparoscope techniques to facilitate female sterilization acceptance rates. 6. INCREASE NUMBER OF PRIVATE ACCEPTORS Among the current family planning users, approximately 1/3 are in the private sector and thus do not- require government subsidy. The number of private acceptors increases with increasing urbanization and economic growth. To speed this process, the government initiated the special hospital based family planning program which is utilized mostly by the private sector. However, in the future, to further hasten the increase of private acceptors, the government should encourage doctors in private practice to provide family planning services, and provide the contraceptive supplies. This way, those do utilize the private medical system will also be able to receive family planning services and pay for it. Another means of increasing the number of private acceptors, IS to greatly expand the commercial outlets for pills and condoms beyond the existing service points of drugstores, hospitals, and health centers. 7. IE&C PROGRAM The current preferred family size is nearly twice as high as needed to achieve a stable poplation. Also, a strong boy preference hinders a small family size as nearly all couples fuel they must have at least one or more sons. The IE&C program must, in the future, strive to emphasize the values of the small family and equality of the sexes. A second problem for the IE&C program to work. with in the: future is the large group of people who approves family planning, want no more children, but do not practice. The IE&C program must work to motivate these people to accept family planning And finally, for those who already practice, an IE&C program in the future must stress continuation of use. The IE&C campaign, to insure highest effectiveness, should be based on a detailed factor analysis of contraceptive discontinuance. In conclusion, Korea faces a serious unfavorable sociodemographic situation- in the future unless the population growth rate can be curtailed. And in the future, the decrease in fertility will depend solely on the family planning program, as the effect of other socio-economic factors has already been maximumally felt. A second serious factor to consider is the increasing number of eligible women due to the 1950's baby boom. Thus, to meet these challenges, the program target must be increased and the program must improve the effectiveness of its current activities and develop new programs.

• 대한간호학회지
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• 제22권1호
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• pp.81-115
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• 1992

The problem addressed by this study was to determine the effect of nurse - patient agreement on the means to achieve nursing goals in the early postpartum period of primiparous mothers. It was hypothesized that the experimental treatment would result in hegher self-confidence and satisfaction in maternal role performance. This purpose was to contribute to the planning of nursing care to enhance self- confidence and satisfaction in maternal role performance and to the development of relevant nursing theory. Especially, the early postpartum period is crucial toward in recovery from childbirth and attainment of the maternal role. Maternal role attaintment is a complex social and cognitive process of stimulus -response accomplished by learning. Most women attain the maternal role sucessfully. But, some primiparous mothers experience difficultites in attainment of the maternal role due to lack of experience and knowledge. Self-confidence and satisfaction in maternal role performance are important factors in attainment and adjustment to the maternal role (Mercer, 1981a, 1981b ; Lederman, Weigarten, and Lederman, 1981 :Bobak and Jensen, 1985). Nursing is defined as behaviors of nurses add patients that attain nursing goals through action, reaction, interaction, and transaction. For attainment of nursing goals, active participating transactions must occur by agreement on the means to achieve those goals through nurse -patient mutual goal setting and establishment of their active relationships(King, 1981, Ha, 1977). Based on King's theory of goal attainment (1981), this stuy was planned as a non-equivalent control group, non -synchronized quasi -experimental design using agreement on the means to achieve nursing goals in early postpartum as the experimental treatment. The data were collected from July 20 to Sep. 1, 1991 by questionnaires with 60 primiparous mothers planing to breast feed after normal deliveries at W hospital in Pusan, Korea. The subjects were divided into a control group(conventional group) -those admitted from July 20 to Aug. 12, and an experimental group(agreement group) - those admitted from Aug. 13 to Sep. 1. The instument for agreement on the means to nursing goals in the early postpartum period included five steps - identification of disturbances of problems through action, reaction, and interaction with primiparous mothers : mutual early postpartal nursing goal setting : exploration of the means to achieve goals ; agreement on the means (self- care, ealry maternal -infant contact, performance of mothering behavior, and communicating about the infant's behavior and health condition) : implementation of the means. This instrument was developed on the basis of King's elements that lead to transactions in nurse-patient interactions. Lederman et al's (1981) scale for Confidence in ability to cope with tasks of motherhood and Lederman et al's(1981) scale for Mother's satisfaction with motherhood and infant care were used to measure self-confidence and satisfaction in maternal role performance ·with the subjects immediately after admission and on the day of discharge. Self-care performance in the experimental group was measured by self -evaluation tool developed by the investigator from the literature concerned. The tools to measure Pelf-confidence and satisfaction in maternal role performance, and the tool to measure self-evaluation of self-care performance were tested for internal reliability. Cronbach's Alphas were 0.94, 0.94, and 0.63. The data were analysed by using in S.P.S.S. computerized program and included percentage, x²-test, t-test, ANOVA, and Pearson Correlation Coefficient. The conclusions obtained from this study are summerized as follows : 1. The degree of self-confidence in maternal role performance of the total subjects group measured before the experimental treatment was above average with a mean score of 2.77(range 2.14-3.64). Out of 14 items, those with relatively high mean scores were ‘I would like to be a better mother than I am’(3.95), and ‘I have my doubts about whether I am a good mother’(2.87). Those with low mean scores were ‘I know that my baby wants most of the times’(2.28), ‘When the baby cries, I can tell what she /he wants’(2.37), and ‘I have confidence in my ability to care for the baby’(2;50). That is, the self - confidence of Primiparous mothers was considerably high in mothering, but rather low in activities concerning the infant care and understanding of the infant behavior. The degree of satisfaction in maternal role performance of the total subjects group measured before the experimental treatment was high with a mean score of 3.18(range 1.92-3.92). Out of 13 items, those with relatively high mean scores were ‘I am glad 1 had this baby now’(3.75), ‘I play with the baby between feedings when s/he is awake and quiet’(3.67), and ‘I enjoy being a mother’(3.27). Those with low mean scores were ‘I am upset about having too many responsibilities as a mother’(2.78), ‘It bothers me to get up for the baby at night’(2.82), and ‘I get annoyed if the baby frequently interrupts my activities’.(2.82), That is, the satisfaction of primiparous mothers was considerably high in mothering and infant care, but rather low in restraints in time or on the mother's self accomplishment and development. 2. Agreement on the means to achieve nursing goals in the early postpartum period included process of mutual goal setting, exploration of the means to achieve goals, and ahreement in concert means to achieve goals based on the mothers' condition, concerns, self-perception of the nurse - patient interactions. In the process of agreement, there was agreement that the means to achieve goals should be through trust and establishment of active relationships with the nurse through identification of problems according to planned nursing goals and active interaction, such as explanations, teaching, changing of opinions, acceptance or rejection of explanations, and proposing of questions. Therefore agreement on the means to achieve nursing goals in the early postpartum period appears to be an effective nursing intervention for primiparous mothers. 3. The degree of self- confidence in maternal role performance of the exprimental group was higher than that of the control group(t＝3.95, p＜0.01). Out of 14 items, those with higher score in the experimental group were ‘I would like to be a better mother than I am’(t＝1.93, p＜0.05), ‘I know that my baby wants most of the times’(t＝2.75, p＜0.01), ‘When the baby cries, 1 can tell what she/he wants’(t＝2.10, p＜0.05), ‘I have confidence in my ability to care for the baby’(t＝3.72, p＜0.01), ‘I trust my own judement in deciding how to care for the baby’(t＝1.96, p＜0.05), ‘I feel that I know my baby and what to do for him /her’(t＝2.44, p＜0.01), ‘I am concerned about being able to meet the baby's needs’(t＝2.87, p＜0.01), ‘I know what my baby likes and dislikes’(t＝3.26, p＜0.01), ‘I don't know to care for the baby as well as I should’(t＝2.07, p＜0.05), and ‘I am unsure about whether I give enough attention to the baby’(t＝3.04, p＜0.01), That is, the degree of self-confidence in mothering, activities concerning infant care, and understanding of infant behavior of the experimental group was higher than that of the control group. Therefore, the first hypothesis, that the degree of self-confidence in maternal role performance of the experimental group would be higher than that of the control group, was supported(t＝3.95, p＜0.01). 4. The degree of satisfaction in the maternal role performance of the exprimental group was higer than that or the control group(t＝2.31, p＜0.05). Out of 13 items, those with higher score in the experimental group were ‘I am glad I had this baby now’(t＝2.29, p＜0.05), ‘I enjoy taking care of the baby’(t＝2.4g, p＜0.01), ‘It is boring for me to care for the baby and do the same thing over and over’(t＝2.87, P＜0.01), ‘I am unhappy with the amount of time I have for activities other than childcare’(t＝2.51, p＜0.01), and ‘When bathing and diapering the baby, I would like to be doing something else’(t＝2.43, p＜0.01). That is, the degree of satisfaction in mothering, infant care, and restraints in time of on the mother's self accomplishment and development in the experimental group was higher than that of the control group. Therefore, the second hypothesis, that the degree of satisfaction in maternal role performance of the experimental group would be higher than that of the control group, was supported(t＝2.31, p＜0.05). 5. The third hypothesis, that the higher the degree of satisfaction in materenal role performance, the higher the degree of self-confidence in materenal role performance in the experimental group, was supported (r＝0.57, p＜0.01)

• 농업과학연구
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• 제2권1호
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• pp.199-231
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• 1975

우유내(牛乳內)에 잔류(殘留)하는 항생물질(抗生物質)은 starter의 발육(發育)을 억제(抑制)함으로써 산소유제품(酸素乳製品)의 제조(製造)에 막대(莫大) 한 손실(損失)을 가져올 뿐만 아 니라 유우(乳牛)를 음용(飮用)하는데 인류(人類)에 과민병(過敏病)을 비롯한 각종(各種) 질병(疾病)을 일으킬 수 있다는 것은 주지(周知)의 사실(事實)이다. 그러나 기타(其他) 가축(家畜)에 있어서도 모유내(母乳內)에 항생물질(抗生物質)이 출현(出現)할때는 이것을 포유(哺乳)하는 자축(仔畜)에게도 인류(人類)에서와 같은 장애(障碍)를 초래(招來)할 수 있다는 점(点)도 간과(看過)할수 없는 일이다. 이러한 관점(觀點)에서 본연구(本硏究)에서는 유우(乳牛), 산양(山羊) 및 견(犬)에 penicillin, streptomycin 및 oxytetracycline을 근육(筋肉) 또는 정맥내(靜脈內)에 주사(注射)하고 유방내(乳房內)에 주입(注入)할 경우(境遇) 유즙내(乳汁內)에 이해(移行) 또는 잔류(殘留)하는 농도(濃度)와 지속시간(持續時間)을 cylinder-plate법(法)으로 실험(實驗)한바 그 결과(結果)를 요약(要約)하면 다음과 같다. 1) penicillin을 근육주사(筋肉注射)한 후 유즙내(乳汁內)에서 검출(檢出)할 수 있는 penicillin의 최고농도(最高濃度)는 유우(乳牛)가 12시간(時間)에 0.093~0.214(평균(平均) 0.136)I.U./ml, 산양(山羊)이 6시간(時間)에 0.58~0.974(평균(平均) 0.773)I.U./ml, 견(犬)이 3시간(時間)에 0.823~1.482(평균(平均) 1.192)I.U./ml였으며 유즙내(乳汁內) 잔류지속시간(殘留持續時間)은 각각(各各) 60~72시간(時間), 36~48(時間) 및 48~60시간(時間)이었다. 2) streptomycin을 근육주사(筋肉注射)한 후 유즙내(乳汁內)에서 검출(檢出)된 streptomycin 최고농도(最高濃度)는 유우(乳牛)가 6시간(時間)에 0.09~0.47(평균(平均) 0.26)${\mu}g/ml$, 산양(山羊)이 3시간(時間)에 0.17~0.64(평균(平均) 0.45)${\mu}g/ml$, 견(犬)이 3시간(時間)에 0.32~0.96(평균(平均) 0.63)${\mu}g/ml$였으며 유즙내(乳汁內)의 잔류지속시간(殘留持續時間)은 각각(各各) 6~36시간(時間), 12~36(時間) 및 12~24시간(時間)이었다. 3) oxytetracycline을 정맥주사(靜脈注射)한 후 유즙내(乳汁內)에서 검출(檢出)된 oxytetracycline의 최고농도(最高濃度) 유우(乳牛)가 6시간(時間)에 1.5~3.2(평균(平均) 2.4)${\mu}g/ml$, 견(犬)이 6시간(時間)에 1.5~2.4(평균(平均) 2.0)${\mu}g/ml$였으며 잔류지속시간(殘留持續時間)은 유우(乳牛)가 24~48시간(時間), 산양(山羊)및 견(犬)이 36~48시간(時間)이었다. 4) penicillin을 유방내(乳房內) 주입(注入)한 경우 주입방(注入房) 유즙(乳汁)에 잔류(殘溜)하는 시간(時間)은 유우(乳牛)가 48~72시간(時間)이었으며 산양(山羊) 및 견(犬)은 72~84시간(時間)이었다. 5) streptomycin을 유방내(乳房內) 주입(注入)할 경우 주입방(注入房) 유즙내(乳汁內)에 잔류(殘溜)하는 지속시간(持續時間)은 유우(乳牛) 및 산양(山羊)이 48~72시간(時間)이었으며 견(犬)은 48~60시간(時間)이었다. 6) oxytetracycline을 유방내(乳房內) 주입(注入)한 경우 주입방(注入房) 유즙(乳汁)에 잔류(殘溜)하는 시간(時間)은 유우(乳牛)가 48~72시간(時間), 산양(山羊) 36~60시간(時間)이었으며 견(犬)은 48~60시간(時間)이었다. 7) penicillin, streptomycin 및 oxytetracycline을 유방내(乳房內) 주입(注入)한후 주입방내(注入房內) 잔류항생물질(殘留抗生物質)의 농도(濃度)와 지속시간(持續時間)을 검토(檢討)한 결과 유우(乳牛) 및 산양(山羊)에 있어서는 필유량(泌乳量)과의 관계(關係)가 인정(認定)되었고 고생산성(高生産性) 유우(乳牛)나 산양(山羊)에 비(比)하여 저생산성(低生産性) 유유(乳牛)와 산양(山羊)에서 농도(濃度)가 높고 잔류지속시간(殘溜持續時間)도 긴 경향(傾向)을 나타내었다. 8) 유우(乳牛)와 산양(山羊)에 penicillin을 각각(各各) 100,000 I.U., 20,000 I.U., streptomycin은 각각(各各) 500mg, 100mg를, oxytetracycline은 각각(各各) 500mg, 100mg를 유방내(乳房內) 주입(注入)한 결과 비주입방(非注入房) 유즙(乳汁)에서는 항생물질(抗生物質)을 검출(檢出)하지 못하였으나 견(犬)에 있어서는 penicillin 10,000 I.U., streptomycin 20mg, oxytetracycline 25mg를 유방내(乳房內) 주입(注入)할때 비주입방(比注入房) 유즙(乳汁)으로부터 항생물질(抗生物質)을 검출(檢出)할 수 있었다. 검출농도(檢出濃度)는 언제나 혈청내(血淸內)가 유즙내(乳汁內) 보다 더 높았으나 비주입방간(非注入房間)의 차이(差異)는 인정(認定)되지 않았다. 9) 견(犬)에 있어서 비주입방(比注入房)으로의 이행가능(移行可能) 최소(最少) 주입량(注入量)은 penicillin이 2,500 I.U., streptomycin은 5mg, oxytetracycline은 5mg이었다.