• Journal of Preventive Medicine and Public Health
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• 제7권1호
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• pp.29-94
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• 1974

Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.

• 핵의학기술
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• 제20권1호
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• pp.32-36
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• 2016

핵의학검사에서 $^{131}I$은 갑상선암 및 질환의 진단, 치료등 핵의학 검사에서 많이 사용되고 있다. $^{131}I$은 ${\gamma}$선과 ${\beta}^-$선을 방출하여 검사와 치료를 할 수 있고, 높은 집적율과 신장을 통한 빠른 배설이 용이 하지만, $^{131}I$(364 keV)은 $^{99m}Tc$(140 keV)보다 고에너지이기 때문에 작업을 수행 시 조작 및 투여 과정에서 $^{99m}Tc$보다 술자의 피폭을 줄이기 위해 외부피폭 방어의 3요소인 거리, 시간, 차폐 중에 차폐에 주안점을 두어 $^{131}I$ 조작 시 차 폐체 착용 전과 후의 피폭선량의 차이를 비교하고자 한다. Apron(보통 Pb 0.5 mm) 착용 시 $^{99m}Tc$은 90%이상이 차폐가 되지만, $^{131}I$은 고에너지이기 때문에 차폐효과가 비교적 낮고, 고용량의 경우 산란선(2차) 및 제동방사선의 영향으로 오히려 더 피폭을 받을 수 있다. 하지만 저용량(74 MBq) 고에너지의 경우 이에 대한 특별한 보고나 Guide Line이 마련되어 있지 않아, $^{131}I$ 조작 시 Apron 착용 유무에 따른 술자의 피폭선량을 정량적으로 분석하고자 한다. 본원 핵의학과에서 2014년 6월부터 2014년 12월까지 7개월 동안 갑상선암 치료 및 진단을 위한 저용량$^{131}I$을 투여하기 위해 방문한 갑상선암 환자를 대상으로 준비과정부터 투여 시까지 연구기간 동안 갑상선, 가슴, 고환 3곳에 Apron 안쪽과 바깥쪽 각각 1개씩 총 6개의 TLD를 부착한 뒤 $^{131}I$검사 과정부터 투여 시 까지의 방사선 피폭선량을 측정하였다. 총 작업시간은 설명시간 3분, 분배시간 1분, 투여시간 1분으로 각각 1인당 5분이내로 설정하였다. TLD 위치설정은 일반적으로 피폭선량을 측정하는 가슴과 방사선 감수성이 높은 갑상선 및 고환으로 설정하였다. 준비과정은 $^{131}I$을 $2m{\ell}$ 주사기를 이용해 74MBq을 분배한 뒤 생리식염수와 희석해 $2m{\ell}$의 용량을 만들어 분배한다. $^{131}I$을 분배 후 환자에게 투여 시 컵에 물을 $100m{\ell}$ 담고 분배한 $^{131}I$을 희석하여 환자 1 m 정도 거리를 두고, 경구투여 한다. 그리고 경구투여 한 $2m{\ell}$ 주사기와 컵을 폐기하는 과정을 Apron과 TLD를 착용한 상태에서 시행하였다. Apron과 TLD는 방사선 피폭이 미치지 않는 보관실에 따로 보관하였고, 서울방사선 서비스에 의뢰하여 피폭선량을 측정하였다. 연구기간 동안 저용량 $^{131}I$ 검사 시 갑상선, 가슴, 고환 부위에 Apron 안과 밖d[착용한 TLD의 매월 누적선량을 인원수로 나눈 결과를 가지고, SPSS Version. 12.0K를 이용해 Wilcoxon Signed Rank Test를 사용하여 통계를 시행하였다. 그 결과 갑상선(p = 0.345), 가슴(p = 0.686), 고환(p = 0.715)은 모두 p > 0.05으로 유의한 차이가 없음을 알 수 있었다. 그리고 연구기간 동안의 총 누적선량의 변화를 백분율로 환산하였을 때, 갑상선 -23.5%, 가슴 -8.3%, 고환 19.0%로 나타났다. Wilcoxon Signed Rank Test를 사용한 결과 통계적으로 유의한 차이가 없는 것으로 나타났다(p > 0.05). 또한 7개월간의 누적선량으로 차폐율을 계산 했을 때 에는 Apron 안쪽과 바깥쪽의 피폭선량의 변화가 불규칙적으로 나타나는 결과를 보였다. 이 결과는 백분율로 표현 시 변화폭이 커보이지만, 누적 피폭선량이 소수점 이하이므로 큰 변화라고 보기 어렵다. 그러므로 고에너지 저용량 $^{131}I$ 투여 시 Apron을 착용유무와 상관없이 일정한 거리를 두고 최대한 빠른 시간 내에 투여를 종료하는 것이 피폭선량을 줄이는 데 도움이 될 것이다. 본 연구는 $^{131}I$ 투여시간을 1인당 각 5분 이내로 투여 할 수 있도록 제한하고, 거리를 1 m로 일정하게 하여 작업 할 수 있도록 하였으나 통계 시 N수가 적어서 비모수적인 방법으로 통계를 시행함으로써 정확한 결과를 얻기에 부족한 부분이 있었다. 또한 저용량 $^{131}I$ 투여 시 각 1인당 피폭선량을 직독식 선량으로 측정하지 못하고, TLD를 이용한 누적선량으로 측정한 결과 값이므로 전자선량계 및 포켓선량계를 이용한 측정이 이루어진다면 더 효과적인 결과를 얻을 수 있을 것으로 사료된다.

• 한국조경학회지
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• 제48권5호
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• pp.80-88
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• 2020

2019년 3월 미세먼지 비상저감조치가 일주일 동안 발령되면서, 미세먼지로 인한 국민의 불안감은 점차 가중되고 있다. 본 연구는 공기정화식물이 적용된 바이오필터의 다중이용시설 내 적용성 평가를 위해 입자상 오염원의 실내 연속방출환경을 조성하여 오염원 저감효과에 대한 측정방법을 제안하고, 시스템의 실내공기질 개선 여부를 확인할 수 있는 기초연구를 진행하였다. 강의실을 대상으로 춘절기에 모니터링 1시간 전 모기향을 오염원으로 배경농도를 조성한 후, 스케줄에 따라 2시간 관수, 1시간 송풍하여 미세먼지의 저감능을 확인하였으며, 바이오필터 2m 전방에 PM₁₀, PM_2.5 및 온습도 센서를 설치하고, 3개 송풍구 중 중앙에 풍속 프로브를 설치하여 시계열 모니터링을 수행하였다. 바이오필터에 구비된 총 3개소의 송풍구 평균 면풍속은 0.38±0.16 m/s로 댐퍼 면적이 제외된 송풍구별 면적 0.29m×0.65m을 적용한 총 공조풍량이 776.89±320.16㎥/h로 산출되었다. 시스템 가동으로 평균온도 21.5~22.3℃, 평균상대습도 63.79~73.6%를 유지하여, 선행연구의 다양한 조건별 온습도 범위에 부합하는 것으로 판단된다. 시스템 공조부 구동을 통해 급격하게 상대습도를 상승시키는 효과를 효율적으로 운용할 경우, 계절에 따른 실내 미세먼지 저감과 적정한 상대습도 확보도 가능할 것으로 판단된다. 미세먼지 농도는 바이오필터 시스템 가동 전의 모든 주기에서 상승 현상이 동일하게 집계되었으며, 시스템 가동 후 1주기 송풍구간(B-1, β=-3.83, β=-2.45)에서 미세먼지(PM₁₀)는 최대 28.8% 수준인 560.3㎍/㎥, 초미세 먼지(PM_2.5)는 최대 28.0% 수준인 350.0㎍/㎥까지 저감되었다. 이후 미세먼지(PM₁₀, PM_2.5)의 농도는 2주기 송풍구간 감소(B-2, β=-5.50, β=-3.30)로 각각 최대 32.6% 수준인 647.0㎍/㎥, 32.4% 수준인 401.3㎍/㎥까지 저감되었고, 3주기 송풍구간감소(B-3, β=5.48, β=-3.51)로 최대 30.8% 수준인 732.7㎍/㎥, 31.0% 수준인 459.3㎍/㎥까지 저감된 것으로 확인되었다. 본 연구는 식생 바이오필터의 다중이용시설 내 설치와 유관한 관련 표준 및 규정을 참조하여, 객관적인 성능평가환경의 구축 방안을 제시할 수 있었다. 이를 통해 일반 강의실 환경 내에 보다 객관화된 모니터링 인프라를 조성하여, 상대적으로 신뢰성 있는 데이터 확보가 가능했던 것으로 판단된다.

• Journal of Chest Surgery
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• 제41권1호
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• pp.34-40
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• 2008

배경: 심폐바이패스 없는 관상동맥우회술의 개발은 심폐바이패스로 일어나는 부작용을 피함으로써 관상동맥우회술의 적용범위를 더 확대할 수 있게 하였다. 특히 심폐바이페스 없는 관상동맥우회술은 심근보호 폐 및 신기능의 보호, 혈액응고 장애 예방, 전신 염증 반응 및 인지기능의 예방 등에서 이점이 있는 것으로 알려져 있다. 저자들은 관상동맥우회수술을 좀 더 작대 적용할 수 있는지를 알기 위하여 심폐바이패스 없는 관상동맥우회술의 임상성적을 분석하였다. 대상 및 방법: 1999년 5월부터 2007년 8월까지 관상동맥우회술을 시행한 310예의 한자 중 심폐바이패스 없이 시행한 100명을 대상으로 하였다. 남자가 63명, 여자가 37명이었으며 평균연령은 $62{\pm}10$세($29{\sim}82$세)이었다. 수술 전 진단은 불안정성 협심증이 77예, 안정성 협심증이 16예이었으며 급성심근경색증인 경우가 7예이었다. 동반된 질병은 고혈압이 48예, 당뇨병 42예, 신부전증의 경우가 10예이었고 만성폐쇄성폐질환이 5예, 경동맥질환이 동반된 경우가 6예이었다. 수슬 전 평균 심박출률은 $56.7{\pm}11.6%$ ($26{\sim}74%$)였다. 관상동맥조영술에서 심혈관질환이 47예, 이혈관질환이 25예이었고 단일혈관질환이 24예였으며, 이 중 좌주관상동맥협착이 있는 경우가 23예이었다. 내흉동맥은 97예에서 경상이식편으로 획득하였고 요골동맥과 대복재정맥은 각각 70예, 45예이었으며 이 중 내시경을 사용한 혈관 확보는 각각 53예, 41예 이었다. 결과: 평균 $2.7{\pm}1.2$개의 문합을 하였다. 일측 내흉동맥은 95예(95%)에서 사용되었으며 요골동맥이 62예, 대복재정맥이 39예였고 양측 내흉동맥은 2예에서 시행되었으며, 100예 중 연속문합은 46예가 있었다. 각각의 관상동맥별 문합 수는 좌전하행지가 97개소, 둔각변연지가 63개소, 대각지가 53개소, 우관상동맥이 30개소, 중간분지가 11개소, 후하행동맥이 9개소, 그리고 후측방분지가 3개소였다. 수술 중 심폐바이패스로 전환한 경우는 4예 있었다. 전체 100예 중 72예에서 퇴원 전 관상동맥조영술 혹은 다중절편 컴퓨터 단층촬영술을 이용한 관상동맥영상술로 확인하였는데 198문합 중에 184문합(92.9%)에서 개통성이 유지되었다. 수술 후 1예에서 패혈증으로 사망하였으며, 뇌경색 1예와 창상 감염 1예가 있었고 술 후 부정맥과 심근경색증은 없었다. 수술 후 평균 인공호흡기보조시간은 $20{\pm}35$시간이었으며 중환자실 체류시간은 $68{\pm}47$시간이었다. 수술 중 평균 수혈양은 $4.0{\pm}2.6\;pack$이었다. 결론: 저자들은 100예의 심폐바이패스 없는 관상동맥우회술을 시행하여 좋은 성적을 얻었기에 관상동맥우회수술의 범위를 확대하기 위해 사용할 수 있는 수술이라 제시할 수 있겠다.

• The Korean Journal of Pain
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• 제1권1호
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• pp.34-46
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• 1988

Intractable pain from advanced carcinoma of the upper abdomen is difficult to manage. One method used to control pain associated with these malignancies is to block off the splanchnic nerve. In 1919 Kappis described a technique by which the splanchnic nerve of the upper abdomen could be anesthetized, using a percutaneous injection. This method has been used for the relief of upper abdominal pain due to hematoma and cancer of the pancreas, stomach, gall bladder, bile duct, and colon. During the Period from November 1968 to January 1986, this method was used in 208 cases of malignancy at Severance Hospital and clinically evaluated. Patients were retroactively grouped according to the stage of development of technique used. Twelve patients who received the treatment in the period from November 1968 to March 1977 were designate4i as group 1, 26 patients from April 1977 to April 1979 as group 2, and 170 from May 1979 to January 1986 as group 3. The results are as follows: 1) The number of patients receiving splanchnic nerve block has been increasing since 1977. 2) A total of 208 patients, including 133 males and 75 females, ranging in age from 18 to 84 and averaging 51. 3) The causes of pain were stomach cancer 90, pancreatic cancer 69, and miscellaneous cancer 49 cases respectively. 4) There were 57.7% who had surgery. and 3.7% of whom had chemotherapy before the splanchnic nerve block was done. 5) These blocks were carried out with the patient in the prone position as described by Dr. Moore. For group 2 and 3, C-arm image intensifier was used. In group 1, a 22 gauze loom long needle was inserted at the lower border of the 12th rib on each aide about 7\;cm from the midline. The average distance from the midline was $6.60{\pm}0.61\;cm$ on the left side and $6.60{\pm}0.83\;cm$ on the right side in group 2, and $5.46{\pm}0.76\;cm$ on the left side and $5.49{\pm}0.69\;cm$ on the right side in group 3. The average depth to which the needle was inserted was $8.60{\pm}0.52\;cm$ on the left side and $8.74{\pm}0.60\;cm$ on the right side in group 2, and $8.96{\pm}0.63\;cm$ on the left side and $9.18{\pm}0.57\;cm$ on the right side in group 3. 6) The points of the inserted needles were positioned in the upper quarter anteriorly, 51.8% on the left side and 54.4% n the right side of the L1 vertebra by lateral roentgenogram in group 3. The inserted needle points were located in the upper and anterolateral part, of the L1 vertebra 68.5% on the left side and 60.6won the right side, on the anteroposterior rentgenogram in group 3. The needle tip was not advanced beyond the anterior margin of the vertebral body. 7) In some case of group 3, contrast media was injected before the block was done. It shows, the spread upward along the anterior mal gin of the vertebral body. 8) The concentration and the average amount of drug used in each group was as follows: In group 1, $39.17{\pm}6.69\;ml$ of 0.5% -l% lidocaine or 0.25% bupivacaine were injected for the test block and one to three days after the test block $40.00{\pm}4.26\;ml$ of 50% alcohol was injected for the semipermanent block. In group 2, $13.75{\pm}4.88\;ml$ of 1% lidocaine were used as the test block and followed by $46.17{\pm}4.37\;ml$ of 50% alcohol was injected as the semipermanent block. In group 3, $15.63{\pm}1.19\;ml$ of 1% lidocaine for test block followed by $15.62{\pm}1.20\;ml$ of pure alcohol and $16.05{\pm}2.58\;ml$ of 50% alcohol for semipermanent block were injected. 9) The result of the test block was satisfactory in all cases. However the semipermanent block was 83.3 percent of the patients in group 1 who received relief from pain for at least 2 weeks after the block, 73.1% in group 2, and 91.8% in group 3. In these unsuccessful cases, 2 cases in group 1 were controlled by narcotics but 7 cases in group 2 and 14 cases in group 3 received the same splanchnic nerve block 1 or 2 times again within 2 weeks. But, in some cases it was 3 to i months before the 2nd block and in 1 cases even 7 years. 10) The most common complications of splanchnic nerve block were hypotensino(25.5%) occasional flushing of the face, nausea, vomiting, and chest discomfort. 11) For the patients in group 3, the supplemental block most commonly used was a continuous epidural block; it was used as a diagnostic block and to afford relief from pain before the splanchnic nerve block was done. 12) The interval between the receiving of the alcohol block and discharge was from 5 to 8 days in 61 cases(31.1%) and from 1 to 2 days in 48 cases(24.5%). From the above results, it can be concluded that the splanchnic nerve block done in the prone position with pure and 50% alcohol immediately after an effective test block with 1% lidocaine under C-arm fluoroscopic control is satisfactory and reliable. How to minimize the repeat block is still a problem to be solved.

• Tuberculosis and Respiratory Diseases
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• 제60권6호
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• pp.653-662
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• 2006

연구배경 : 흡입화상은 폐렴, 호흡부전 등의 폐합병증으로 인해 이환율 및 사망률 증가에 기인하는 것으로 알려져 있다. 화기 흡입에 의한 기도 손상이 폐기능에 영향을 줄 것으로 예상되나 이에 대한 연구는 빈약한 실정이다. 흡입화상으로 인한 폐기능 검사소견의 변화를 알아보고자 하였다. 방 법 : 2002년 8월부터 2005년 8월까지 기관지내시경검사에 의해 흡입 폐 손상이 확인된 환자들을 대상으로 급성기 및 회복기에 폐기능 검사를 시행하여 비교 및 분석하였다. 초기 폐기능 검사에서 FVC, FEV1, FEV25-75% 및 PEF의 정상 추정치는 흡입화상에 대한 내시경적 중증도와의 상관성을 알아보았다. 사망환자, 연기 흡입으로 뇌손상을 입은 환자 및 선행 만성 호흡기질환자는 제외하였다. 결 과 : 화상체표면적이 0-18%의 범위에 있는 총 37명(남 28, 여 9)의 환자를 대상으로 하였다. 내원 당시의 $PaO_2/FiO_2$ 비는 $286.4{\pm}129.6mmHg$, COHb은 $7.8{\pm}6.6%$ 였으며, 기관내 삽관은 9예(24.3%), 기계호흡은 3예(8.1%)에서 이루어졌다. 초기 방사선 소견에서 이상 소견을 보인 18예(48.6%) 중 15예(83.3%)는 정상화되었으나 3예(16.7%)는 잔흔을 남기고 치유되었다. 초기 폐기능 검사에서 19예(51.4%)가 정상 소견이었다. 폐쇄성 장애가 9예(24.3%) 있었으며 이 중 4예(44.4%)는 기관지 확장제에 양성반응을 보였다. 제한성 장애도 9예(24.3%) 관찰되었다. DLco를 시행한 23예 중 4예(17.4%)만이 감소된 소견을 보여 주었다. 추적 폐기능 검사에서 초기에 이상 폐기능 소견을 보인 대부분이 정상으로 회복되었으며, 폐쇄성 및 제한성 장애가 각각 1예(2.7%)씩 관찰되었다. DLco는 전부 정상화 되었다. 결 론 : 흡입화상 이후 생존한 환자를 대상으로 급성 호흡기 증상이 안정된 상태에서 시행한 초기 폐기능 검사상 정상, 폐쇄성 및 제한성 장애로 나타나 특이적인 환기장애 양상은 관찰되지 않았다. 또한 초기에 이상소견을 보여주었다 하더라도 추적검사에서 대부분 정상으로 회복되는 것을 관찰할 수 있었다. 그리고, 기관지확장제 양성을 보이는 일부 환자는 기관지 확장제 치료를 적극적으로 시도해 볼 수 있을 것으로 사료된다.

• 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)

• 해양환경안전학회지
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• 제27권7호
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• pp.924-942
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• 2021

여름철 장강 저염수의 확장은 북부 동중국해의 환경 및 식물플랑크톤 다양성과 군집구조에 영향을 미치는 주요 요인으로 알려져 있다. 2020년 하계는 장강 저염수의 방류량이 매우 높았던 시기로 환경 특성 변화에 따라 식물플랑크톤 다양성 및 군집구조에 미치는 동력을 이해하기 위해 현장관측을 수행하였다. 2020년 8월 16일~17일 이어도호 승선조사와 2020년 8월 15일~21일 이어도 해양과학기지(IORS)에서 체류조사를 실시하였다. 조사 정점들에서 CTD로 측정한 결과 조사 수역 남서쪽은 장강 저염수의 영향을 받아 염분이 낮고 엽록소 형광값이 높았으며, 대마난류의 영향을 받은 남동수역은 염분이 높고 엽록소 형광값이 낮았다. 12개 정점의 표층수 시료의 엽록소 a 농도는 미소형(20~3 ㎛) 및 소형(> 20 ㎛) 식물플랑크톤의 생체량이 우점함을 나타냈으며, 대마난류수의 영향을 받은 정점에서만 초미소 식물플랑크톤(< 3 ㎛) 생체량이 약 50%를 차지하였다. 이러한 표층수의 식물플랑크톤 크기 분포는 영양염류 공급과 관련되어 장강 저염수의 높은 질산염 공급을 받는 정점들은 소형 식물플랑크톤의 생체량 기여율이 높았다. 형태분류 결과 미소형 및 소형 식물플랑크톤은 총 45종이며, 이들 중 우점 분류군은 규조류인 Guinardia flaccida, Nitzschia spp.와 와편모조류인 Gonyaulax monacantha, Noctiluca scintillans, Gymnodinium spirale, Heterocapsa spp., Prorocentrum micans, Tripos furca 등이었다. 대마난류의 영향을 받으며 질산염 농도가 낮은 정점들은 광합성 초미소 진핵생물(PPE)의 개체수와 광합성 초미소 원핵생물(PPP)인 Synechococcus의 개체수가 높았다. 질산염/인산염 비는 대부분 정점에서 인산염 제한을 받고 있음을 나타냈다. 유세포 분석 결과 Synechococcus 개체수는 난류의 영향을 받는 빈영양 수역의 정점들에서 높은 개체수를 보였다. NGS 분석 결과 PPP 중 Synechococcus는 29개의 clades가 나타났고, 이 중 한 시료에서 한 번이라도 1% 이상의 우점율을 보인 clade는 11개로 나타났다. 표층수에선 clade II가 우점분류군이었으며 SCM 층에서 다양한 clades(I과 IV 등)가 차우점군들로 분포하였다. Prochlorococcus 속은 난류 수역에서 high light adapted 생태형이 출현하는 양상을 보였으며 북쪽 수역에선 출현하지 않았다. PPE는 총 163개의 높은 operational taxonomic units(OTUs) 다양성을 보였으며, 이 중 한 시료에서 한 번이라도 5% 이상의 우점률을 나타낸 OTU는 총 11개였다. 장강 저염수의 영향을 받는 정점의 표층수에선 Amphidinium testudo가 우점 분류군이었으며, SCM 층에서 녹조류가 최우점하였다. 대마난류의 영향을 받는 해역에서는 다양한 분류군의 착편모조류가 우점하였다. IORS에서의 관측 결과도 주변 정점들과 식물플랑크톤 생체량, 크기분포, 다양성에서 유사한 수준을 나타냈다. 이번 연구 결과는 장강 저염수의 영향에 따른 식물플랑크톤의 반응을 다양한 분야에서 확인할 수 있었다. 또한, IORS와 승선조사를 비교하여 IORS 관측이 장강 저염수의 식물플랑크톤 동적 역학 모니터링에 활용할 수 있음을 확인하였다. 향후 기후변화에 따라 나타날 동중국해 하계 환경 및 생태계의 변화에 대비하여 IORS의 효과적 이용 방안 수립이 필요할 것으로 판단된다.