정신분열병에 대한 리스페리돈의 효과 및 안정성

이민수,김용구,김영훈,연병길,오병훈,윤도준,윤진상,이철,정희연,강병조,김광수,김동언,김명정,김상훈,김희철,나철,노승호,민경준,박기창,박두병,백기청,백인호,손봉기,손진욱,양병환,양창국,우행원,이정호,이종범,이홍식,임기영,전태연,정영조,정영철,정인과,정인원,지익성,채정호,한상익,한선호,한진희,서광윤 大韓神經精神醫學會 1998 신경정신의학 Vol.37 No.1

연구목적 : 본 시험의 목적은 임상시험 시작전에 연구자들을 대상으로 PANSS Workshop을 통하여 PANSS, ESRS에 대한 국내에서의 표준화 작업을 구축하고 새로운 정신병 치료제인 리스페리돈의 효과와 안정성을 재확인하여 리스페리돈 사용에 대한 적정화를 이루는데 있다. 연구방법 : 1996년 4월부터 1996년 9월까지 국내 39개 대학병원 정신과에 입원중인 혹은 증상이 악화되어 입원하는 정신분열병 환자 377명을 대상으로 다시설 개방 연구를 시행하였다. 1주일간의 약물 배설기간을 가진후, 리스페리돈을 8주간 투여하였고, 기준점, 1주, 2주, 4주, 그리고 8주후에 평가되었다. 용량은 제1일에는 리스페리돈 1mg씩 1일 2회, 제2일에는 2mg씩 1일 2회, 제3∼7일에는 3mg씩 1일 2회 투여하였다. 이후 환자의 임상상태에 따라 임의로 증량할 수 있으며, 최대 일일 16mg을 초과하지 않도록 하였다. 추체외로 증상을 조절하기 위한 투약을 허용하였다. 임상증상 및 부작용의 평가는 PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) 그리고 ESRS(Extrapyramidal Symptom Rating Scale)을 사용하였다. 연구결과 : 377명중 343명(91%)이 8주간의 연구를 완결하였다. 치료 종결시점인 8주후 PANSS 총점수가 20% 이상 호전된 경우를 약물 반응군으로 정의할때, 약물반응군은 81.3%였다. 리스페리돈에 반응하는 예측인자로는 발병연령, 이전의 입원 횟수, 유병기간이 관련 있었다. 리스페리돈은 1주후부터 PANSS양성, 음성, 및 일반정신병리 점수상에 유의한 호전을 보여 효과가 빨랐다. CGI의 경우도 기준점에 비해 1주후부터 유의한 감소를 나타내었다. ESRS의 경우, 파킨슨 평가점수는 기준점과 비교해 투여 1주, 2주, 4주후 유의하게 증가되었다가 8주후 기준점과 차이가 없었다. Dystonia 평가점수는 1주후만 유의한 증가를 보였으며, dyskinesia 평가점수는 유의한 차이가 없었다. 혈압, 맥박수의 생명징후 및 일반 혈액학 검사, 생화학적 검사, 심전도 검사에서 유의한 변화는 없었다. 결 론 : 이상의 다시설 개방 임상 연구를 통해 리스페리돈은 정신분열병 환자에서 양성증상뿐만 아니라 음성증상 및 전반적인 증상에도 효과적인 것으로 사료된다. 보다 명확한 평가를 위해서는 다른 항정신병약물과의 이중맹검 연구가 필요할 것으로 생각되며, 또한 장기적 치료에 대한 평가도 함께 이루어져야 하겠다. Objective : The purpose of this study was to investigate the efficacy and safety of risperidone in the treatment of Korean schizophrenic patients. Method : This multicenter open study included 377 schizophrenic patients drawn from 39 university hospitals. After a wash-out period of 1 week, the schizophrenic patients were treated with risperidone for 8 weeks and evaluated at 5 points ; at baseline, and 1, 2, 4 and 8 weeks of treatment. The dose was increased from 2mg/day(1mg twice daily) to 6mg/day(3mg twice daily) during the first week and adjusted to a maximum of 16mg/day over the next 7 weeks according to the patient's clinical response. Medication to control extrapyramidal symptoms was permitted. The psychiatric and neurological status of the patients was assessed by PANSS, CGI, and ESRS scales. Results : 343(91%) of 377 patients completed the 8-week trial period. Clinical improvement, as defined by a 20% or more reduction in total PANSS score at end point, was shown by 81.3% of patients. The predictors of response to risperidone were associated older age, shorter duration of illness, fewer previous hospitalization. Risperidone had rapid onset of action ; a significant decrease of the total PANSS and three PANSS factor(positive, negative, general), and CGI was already noticed at the end of first week. For the ESRS, parkinsonism rating scores were significantly increased until week 4 comparing with baseline. Dystonia rating scores were significantly increased until week 1, and dyskinesia rating scores were not significantly changed during the study. Laboratory parameters including vital sign, EKG, hematological, and biochemical values showed no significant changes during the trial. Conclusions : This study suggests that risperidone is generally safe and effective against both the positive and negative symptoms in our group of patients.

Coating을 시행한 뇌동맥류 파열환자의 예후

박종혁,석종식,목진호,박관,김영백,민병국,황성남,최덕영 대한신경외과학회 1995 Journal of Korean neurosurgical society Vol.24 No.6

In rare occasions in which aneurysmal neck clipping is nearly impossible, coating is employed. During the period from 1985 to 1992, 312 patients with aneurysm underwent surgery ; aneurysmal neck clipping were performed in 284 cases while coating only in 28. The reasons that coating was required were ; wide and broad neck in 13, perforators arising from the neck in 4, neck tearing during dissection in 3, very friable neck in 2, severe adhesion with surrounding structures in 3, and small aneurysm without enough room for clipping in 3. In twenty-three cases, cotton wisp and bioglue were used as coating materials. In another five cases, the aneurysmal wall was reinforced using Surgicel or Gelfoam. Patients were followed for 24 months on average of all the patients. Four had last contact Six died(4 due to rebleeding and 2 due to pneumonia). Fourteen were good and 4 were moderately disabled. There were no rebleeding incidences during first three months' follow-up after coating. We thus concluded that coating an aneurysm offers some protection from rebleeding, particularly when the rebleeding risk period is over.

아크 용접작업에서의 방진마스크 포집효율에 관한 조사

박동기,안규동,이병국 순천향대학교 산업의학연구소 1997 순천향산업의학 Vol.3 No.1

The results of survey on filtering efficiency of tight fitting respirators and disposable dust respirators which are mostly used at arc-welding works are as follows; 1. The mean efficiency of two tight fitting respirators(made by "M" and "MA") marked with "Dust-mist" for 10, 30 and 60 minutes is 60.6% and that of three disposable dust respirators(one piece of "M" maker's and two pieces of "W" maker's) with same mark is 65.7% much less than 97.1% of "M" maker's one disposable dust respirator marked with "Dust-mist-fume". 2. The mean efficiency of four tight fitting respirators for 10 minutes is 40.8-88.35% and thant of eight disposable dust respirators mean 52.7-97.2%. 3. The efficiency of both types marked with "Dust-mist" for 10 minutes is lower than that for 60 minutes but higher than that for 30 minutes whereas that of respirator made with "Dust-mist-fume" is almost constant. One the other hand, the efficiency of disposable dust respirators marked with "Dust-mist" is 5.1% higher than that of tight fitting respirators with same mark. 4. They are investigated after years that it is the efficiency of dispoasble dust respirators marked with "Dust-Mist" 5.1% higher than of tight fitting respirators with same mark and that the efficiency of both types marked with "Dust-Mist" for 10 minutes is lower than that for 60 minutes but higher than thant for 30 minutes, respectively. According to the results, it should be recommended that are welding workers must wear the respirator for fume. Furthermore the testing methods for mineral dust (SiO_(2) : Concentration, Particle size, etc.) should not be applied to all types of dust masks, but testing standards in accordance with the size of fume and mist should be established, which the developed countries have.

일부 간호사들의 스트레스와 직무만족도 연구

박종희,이성수,이병국 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

There are high chances of getting stress among nurses compared to other occupation because nurses provided with not only nursing service toward patient but also teamwork between different, professional other type of occupation and large amount of work administratively. The purpose of this study is to examine job satisfaction and a degree of stress of clinical nurses to identify the main source of stress and analyse it in order to prevent, decrease, and draw up plan for better way of coping with stress. The subject were 304 nurses who were working in a university hospital in Cheon-An city and data was collected from April 10 to April 30, 2004 using the degree of job satisfaction, which was developed by Slavitt (1978) and corrected by Jung-hee Kim (1996). To measure the degree of stress, Psychosocial Well-being Index (PWI) was used. The statistical analysis, such as frequency, mean, percentage, t-test, Chi-square test, multiple regression, Pearson's correlation, was performed. The results collected were as follows; The age of nurses were distributed diversely 21-43 years, among them was mainly 24-27 years (32.5%). The most nurses have over 1-5 years clinical career (40.8%), and unmarried (68.4%). In case of position of work, acting marked the highest score (35.5%). The most nurses do night shift (74.3%), and shift work (83.9%). About eating breakfast, eat occasionally got the highest score. About the duration of sleep, take 7-8 hours a day marked the highest score. In case of no hobby marked 66.1 %. In case of accommodation, live with family marked the same score as live with friend (43.8%) and overtime work, less then one hour marked the highest score. The degree of job satisfaction of nurse, the professional status (2.42±0.43) was the highest among the factors of job satisfaction and then Interaction (2.26±0.4), autonomy (2.22±0.42), the relationship between nurse and doctor (1.89±0.52), the demand of organization (1.64±0.36), pay (1.54+0.45), and the demand of work (1.4±0.46) were followed. The mean of job satisfaction was 1.90±0.27. The degree of stress of nurse was normal(PWI ≤ 22 scores) 9 persons, low stress level (PWI = 22-62 scores) 219 persons, high stress level (PWI ≥ 63 scores) 76 persons. The mean stress level was 52.50± 16.67. In order to identify the factors that have influence on stress, multiple regression analysis was used. The most influential predictors of the stress scores was interaction (19.8%) among the degree of job satisfaction, and then the statue of profession (7.7%), the demand of work (5.6%), hobby (1.6%), autonomy (1.5%), age (1.4%), position (1.3%), body mass index (0.8%) were followed. Total determinant of coefficients of these 8 independent variables for the stress was 40.9%. This study shows that the job satisfaction was the most influential factor for predicting stress of clinical nurses.

의료기사의 누적 외상성 증후군 증상에 관한 조사

박찬호,리갑수,이성수,안규동,이병국 순천향대학교 산업의학연구소 2001 순천향산업의학 Vol.7 No.1

The cumulative trauma disorder is a disease group of musculoskeletal systems developed by repeated work, which became greate concern in occupational health problem in Korea recently. Many paramedicals working in the department of Laboratory, Radiology, and Rehabilitation of the hospital have been engaged in the simple repetitive hard works causing cumulative trauma disorder. This is the study on the cumulative trauma disorder in those medical technicians. Total 285 (180 male, 105 female) medical technicians and office workers working in the hospital were surveyed with the self-administered questionnaires. They included the questions such as age, sex, marital status, education, height, weight, smoking and drinking history as a general characteristics and work department, kind of work, work duration, work conditions as a work characteristics. And also subjective symptoms related with the work in each region of body area were questioned. Among the work conditions, there were significant differences between medical technicians and office workers (e.g., high in medical technicians) in daily works lifting patients or heavy equipments, works moving continuously and rapidly, works with uncomfortable position, works keeping neck and upper arms in uneasy position. Complained rate of subjective symptoms was significantly higher in physical therapist and in the group of work duration over 10 years. The significant symptoms were pain, abnormal sensation, burning sensation. The significant factors affecting the subjective symptoms were female and work duration over 10 years for wrist area, female and current smoking for knee or ankle area, physical therapist, work duration between 6 and 9 years for lumbar area, female and radiologic technicians and work duration over 6 years for shoulder area. None was significant for neck area.

청력 보호구 착용에 대한 점검이 보호구 착용율에 미치는 영향

박상일,이용진,김화성,안규동,이병국 순천향대학교 산업의학연구소 2001 순천향산업의학 Vol.7 No.1

This study was carried out to investigate the effects on wearing hearing protector by checking hearing protector. Research subjects were 333 workers in 5 fiber industries and which were noise exposed above 90dB(A). The frequency of checking and wearing rate of hearing protector by sex, age, work duration and grade of health administration personnel were obtained by self-administered questionnaire and check list. The results were as followed. 1. The wearing rates of hearing protector by checking hearing protector were 50.2%, 51.4%, 61.3%, and 64.3%, respectively and those were significant increasing trends(p<0.05). 2. The wearing rate of hearing protector was significantly increased with increasing frequency of checking hearing protector regardless of sex(p<0.O5). 3. The wearing rate of hearing protector was increased with increasing frequency of checking hearing protector regardless of age. Aged above 20 years or below 50 years were significantly increased(p<0.O5), whereas aged below 20 years and above 50 years were not significantly increased. 4. The wearing rate of hearing protector was increased with increasing frequency of checking hearing protector regardless of work duration. Work durations below 10 years were significantly increased (p<0.O5), whereas work durations above 10 years were not significantly increased. 5. The wearing rate of hearing protector was increased with increasing frequency of checking hearing protector regardless of grade of health administration personnel. Grade above chief was significantly increased(p<0.05), whereas grade below chief was not significantly increased. As the result of this study, it was suggested that the wearing rate of hearing protector was related to frequency of checking hearing protector. The continuous check up of hearing protector was recommended for the effective health management.

중증 근무력증 52례에 대한 임상적 고찰

박건주,하정상,이준,도현철,박승권,서상덕,기병수,김진국 영남대학교 의과대학 1996 Yeungnam University Journal of Medicine Vol.13 No.1

1985년 8월부터 1996년 1월까지 중증근무력증으로 진단받은 환자 52례에 대한 임상적 고찰을 통하여 다음과 같은 결론을 얻었다. 1. 전체 환자 중 남자가 19례(35.8%), 여자가 33례(64.2%)이넜고 11세에서 20세 사이가 12례(23%)로 가장 높은 빈도를 보였다. 2. 환자의 초기증상으로는 안검하수, 복시 등의 안구증상이 37례(71.2%)로 가장 많았고 modified Osserman의 분류에 따라서도 가장 증상이 가볍고 약물치료에 잘 반응하는 1군이 36례(69.3%)로 가장 많았다. 3. 환자가 호소하는 증상의 비특이성과 회복과 재발을 거듭하는 질병의 특성으로 인해 발병이후 진단될 때까지의 시간은 비교적 오래 걸렸고 1년이상 경과하며 진단된 경우도 16례(30.8%)나 되었다. 4. 자가면역질환이 7.6%에서 동반되었는데 갑상선기능 항진증이 2례(3.8), 인슐린의존형 당뇨 2례(3.8%)였고 종격동 전산화 단층촬영소견에서 흉선의 비대가 의심되었던 환자는 6례(11.5%), 흉선종이 발견 되었던 경우는 3례였다. 5. 환자의 치료는 대부분 항콜린에스테라제나 부신피질호르몬을 병용하는 내과적 치료를 하였으며 약물의 치료에 반응이 미비하거나 악화되는 경우 혹은 종격동 전산화 단층촬영상에서 흉선의 이상 소견이 보인 경우에 2례(3.9%)에서는 흉선절제술이, 1례(1.9%)에서는 혈장여과요법이 추가 되었고 흉선절제술과 혈장여과요법이 같이 병합 치료된 경우도 3례(5.9%)있었다. 6. 전체 환자중 2명에서 자연치유의 경과를 보였으며 이들은 모두 1군이였다. 그리고 흉선절제술과 부신피질 호르몬 투여로 완치된 예가 1례있었다. The authors experienced 52 patients with myasthenia gravis who were diagnosed at the Department of Neurology, Yeungnam University Hospital from August 1985 to January 1996. The following results were obtained through diagnostic evaluation and treatment. 1. The ratio of male to female was 1:1.7 and the most prevalent age group was second decade. 2. The most common initial presentation symptom was ocular(71.2%) and the peak incidence group was stage I(69.3%) according to the modified Osserman's classification. 3. In 16 patients(30.8%), it took more than a year to diagnose due to symptoms which were relapsed and remitting. 4. Of 52 patients, 2 cases were associated with thyroid disease(3.8%) and 2 with insulin-dependent diabetes mellitus(3.8%). 5. All of those who received anticholinesterase and corticosteroid therapy were improved with the exception of 5 cases which were improved after thymectomy and/or plasmapheresis. 6. Spontaneous remission was occured in 2 cases(3.8%) of ocular myasthenia gravis. And 1 case of group II was cured through thymectomy and long-term corticosteroid therapy.

보건관리 대행사업 이후 작업환경 수준의 변화

박복현,김화성,이용진,안규동,이병국 순천향대학교 산업의학연구소 1999 순천향산업의학 Vol.5 No.1

This study was performed to evaluate the threshold limit values(TLVs) exceeding rates and periodical changes based on the results from work environmental measurement for 40 factories applied health service program, located in Cheonnan area, from 1995 to 1997. The obtained results were as follows; 1. The hazaed frequency in environmental monitoring were noise(865, 34.4%), illumination(804, 31.9%), dust(205, 8.1%), organic solvent(371, 14.7%), lead(114, 4.5%), and specific chemicals(31, 1.2%), heavy metal(127, 5.0%) in order. 2. The order of TLVs exceeding rate of hazardous agents by type of industries were cement-related manufacture(42.3%), fiber industry(40.0%), food stuff industry(24.3%), metal work industry(21.8%), electronics manufacture (9.9%), other industries(10.2%), chemical industry(7.9%). 3. The mean exceeding rates of hazard by type of industry were 29.5% in noise, 27.3% in dust, 25.8% in specific chemicals, 10.2% in solvent and 7.9% in lead, but none in heavy metal. 4. The average of standardized values of noise divided by TLV were decreased in food stuff industries and chemical industries, but not changed in fiber and cement-related industries. While, the average of standardized values of organic solvents divided by TLVs were decreased in electronic manufacturing industries and other industries.

Interleukin-2와 결핵균 30 kDa 항원이 구개편도 및 말초혈액 T 세포 증식에 미치는 상승효과

박정규,박찬권,조은경,김화중,백태현,고필준,김병국,남부현,나기상,박찬일 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.1

Widespread use of BCG has not controlled tuberculosis, and more effective vaccines are clearly needed. Although chemotherapy will remain the mainstay of antituberculosis treatment, the use of adjunctive immunotherapeutic modalitites is attractive, particularly in persons with drug-resistant tuberculosis. Administration of IL-2 or IFN-γto tuberculosis patients enhance bacillary elimination. Cell-mediated immunity is the critical protective immune response in tuberculosis. Mycobacterial antigens are recognized by T cells and that elicit production of protective cytokines are potentially important vaccine antigens. The 30 kDa antigen is secreted in large quantities by growing mycobacteria. That antigen elicits greater proliferation in lymphocytes from healthy tuberculin reactors than healthy tuberculin nonreactors. In this study, the T lymphocyte proliferative responses to 30 kDa antigen from Mycobactrium tuberculosis H37Rv were examined by using tonsilar and peripheral blood lymphocytes from PPD(+) and PPD(-) tonsilectomized persons. When cultured with 30 kD antigen, tonsilar mononuclear leukocytes and T cells of PPD(+) demonstrated more ^3H-thymidine incorporation than PPD(-) persons (stimulation index was 2.5 and 1.9, 0.8 and 1.0, repectively). Peripheral blood mononuclear cells (PBMC) and peripheral blood T lymphocytes were shown the similar responses to this antigen. The combination of IL-2 and 30 kDa antigen elicited a significant proliferative responsiveness in tonsilar mononuclear leukocytes and T cells of PPD(+) persons (SI was 20 and 14.1). PBMC and peripheral blood T cells of PPD(+) persons were also shown a significant responsiveness, but PPD(-) persons did not show. These results demonstrate that the 30 kDa antigen and IL-2 have a synergistic stimulatory property in mycobacteria sensitizing lymphocytes.

정보화근로사업으로 인한 관련산업의 고용유발효과 분석 : 산업연관분석 (Input-Output Analysis)기법의 적용 An Application of the Input-Output Analysis

박광국,주효진,최병기 한국정책학회 2002 韓國政策學會報 Vol.11 No.3

본 연구는 정보화근로사업으로 인한 관련산업의 고용유발효과가 어느 정도인가를 알아보기 위해 산업연관분석(I/O) 기법을 적용하여 그 효과를 추정하였다. 이를 위해 1998년부터 2000년까지 한국전산원에 정보화근로사업 예산지출내역서를 보고한 7개 중앙행정기관(행정자치부. 외교통상부, 건설교통부, 보건복지부. 법제처, 대검찰청, 기상청)을 대상으로 하였으며, 정확한 추정을 위해 한국은행에서 1998년을 기준으로 작성하여 2001년 7월에 발간한 산업연관표(인장표)를 이용하였다. 산업연관분석을 위해 먼저 정보화근로사업의 예산지출내역을 정보화기반조성 예산지출부분과 인건비 지출부분으로 구분한 다음 각 부문별 예산지출내역을 산업연관표의 분류기준에 맞추어 재분류하였다. 또한 산업연관분석에 필요한 산업부문별 생산유발계수와 고용유발계수를 도출하였다. 분석결과, 정보화기반조성 예산지출로 인해 45,999명의 고용유발효과가 있었으며. 인건비 예산지출로 인해 2,020명의 고용유발효과가 있는 것으로 나타났다. 따라서 전체적으로 정보화근로사업으로 1998년부터 2000년까지 약 307억원의 예산지출을 통해 약 48.019명의 고용유발효과가 관련산업에서 발생한 것으로 추정되었다. The purpose of this study is to estimate employment induced effects produced by the IT New Deal by introducing the method of the input-output analysis. The seven central governmental agencies were sampled because they reported the whole budget data related to the IT New Deal from 1998 to 2000. For the elaborate estimate, the 「1998 Input-Output Table: Extended Version」 released by the Bank of Korea on July, 2001 was used. The analysis was conducted according to the following steps. First, the budget outlays of the IT New Deal Program were reconstructed based on the classification system of the input-output table. Second, the coefficients of production and employment induced by the industrial sector were drawn in order to estimate the whole effects resulting from the IT New Deal. The analytic results showed that employment induced effect of 45,999 persons was estimated with the budget expenditure invested in purchasing infrastructure equipments and employment induced effect of 2,020 persons was produced with the budget expenditure used in hiring manpower for the IT New Deal.