부모의 놀이신념과 놀이참여태도가 유아의 자아탄력성에 미치는 영향

곽경화,최진숙,백승선 한국영유아교원교육학회 2020 유아교육학논집 Vol.24 No.5

The objective of this study was to examine the relationship between parent's play beliefs and play participation attitudes alongside children’s ego-resiliency, and then look into the effects of parent's play beliefs and play participation attitudes on children’s ego-resiliency. Data was collected from 250 children of 3-5 years of age who were attending kindergartens and child-care centers in Jeollabuk-do and also from 250 parents. The study’s findings are as follows: First, a parent's support for play, a sub-variable of a parent's play beliefs, and a parent's play participation attitude itself and its sub-factors such as playing sensitively, playing responsively, and playing merrily had positive effects on children's ego-resiliency. Second, step-wise regression analysis presented the fact that variables that had effects on children’s ego-resiliency were support for play, a sub-variable of parent's play beliefs, and playing merrily, a sub-variable of a parent's play participation attitude. Study findings show the fact that support for play, a sub-variable of a parent's play beliefs, and the parent's play participation attitude have a correlated effect on children’s ego-resiliency. Therefore, in order to increase children’s ego-resiliency, it is necessary for parents to improve their play beliefs and play participation attitudes. 본 연구는 부모의 놀이신념과 놀이참여태도 및 유아의 자아탄력성과의 상관관계를 알아보고, 부모의 놀이신념과 놀이참여태도가 유아의 자아탄력성에 미치는 영향력을 살펴보기 위한것이다. J도에 위치한 어린이집과 유치원에 다니는 만 3~5세 유아와 부모 각각 250명을 대상으로 자료를 수집하고 분석하였다. 분석 결과 첫째, 부모의 놀이신념 중 놀이지지와 부모의놀이참여태도 전체 및 하위변인인 민감하게 놀기, 반응적으로 놀기, 즐겁게 놀기는 유아의 자아탄력성에 정적 상관관계가 있었다. 둘째, 단계적 회귀분석 결과 유아의 자아탄력성에 영향을 미치는 변인은 부모의 놀이신념의 하위변인 중 놀이지지와 부모의 놀이참여태도의 하위요인 중 즐겁게 놀기와 반응적으로 놀기로 나타났다. 본 연구를 통해 부모의 놀이신념 중 놀이지지와 놀이참여태도가 유아의 자아탄력성에 영향을 미치는 것을 알 수 있고, 유아의 자아탄력성을 높이기 위해서는 부모의 놀이신념과 놀이참여태도 증진을 위한 노력이 필요함을 시사한다.

준고령층의 소득계층에 따른 건강 및 의료비 지출 차이에 대한 종단연구

곽경화 한국보건사회학회 2017 보건과 사회과학 Vol.0 No.46

본 연구는 준고령층의 소득 계층의 변화 과정의 특성을 공유하는 하위집단, 즉 잠재계층들을 구분하고, 소득 계층의 변화유형에 따른 건강 및 의료 이용의 불평등을 알아보기 위하여 각 소득 변화의하위 집단별 만성질환 수와 주관적 건강상태 및 의료비 지출의 변화 궤적을 살펴보았다. 본 연구는2008년부터 2013년까지 이루어진 한국의료패널 자료를 사용하였으며, 2008년을 기준으로 55세~64 세에 해당하는 준고령층 2,340명을 대상으로 분석하였다. 연구문제를 해결하기 위해, 잠재계층성장분석과 잠재성장곡선분석을 실시하였다. 준고령층의 소득 계층 변화궤적은 4개의 하위집단으로 분류되었으며, 각각 하위계층 감소집단, 중하위계층 감소집단, 중상위계층 유지집단, 상위계층 유지집단으로구분하였다. 이러한 4개의 하위집단 중, 하위계층 감소집단과 중하위계층 감소집단이 중상위계층 유지집단과 상위계층 유지집단에 비해서 객관적 건강 및 주관적 건강 모두 초기 수준에서 차이가 나며, 시간이 지날수록 건강이 악화되는 것으로 나타났다. 이는 소득 계층별 건강불평등을 종단적으로 입증하는 결과이다. 또한, 이러한 4개의 하위집단별 개인의료비 지출에서는 큰 차이가 없는 것으로 나타났으며, 이는 하위계층 감소집단의 소득대비 의료비 과부담을 입증하는 것이다. 하지만, 앞서 하위집단별 건강의 차이가 있다는 결과와 함께 고려해 보건데 소득 계층별 의료비 지출상의 불평등을 입증하는 결과라고 할 수 있다. 즉, 소득 계층별 건강불평등이나 의료 이용의 불평등을 해소하기 위한 보건정책을 필요로 한다. The purpose of this study was to identify the latent classes of income status over time and to investigate socioeconomic disparities in trajectories of health and medical expenditure among adults aged 55 to 64 years. The data for this study came from the Korea Health Panel, collected from 2008 to 2013. To verify the purpose of this study, we performed latent class growth analyses and latent growth curve analyses. Trajectories of income status were categorized into four latent classes, low-decreasing, mid-low-decreasing, mid-high-stable, and high-stable groups. There were chronic diseases and subjective health status were different over time depending on latent classes of income status, supporting health disparities. Although there were no socioeconomic differences of trajectories in medical expenditure, individuals in low income status may have disadvantages in medical expenditure with the consideration of their health status. As a result, findings from the study highlight the importance of more sophisticated public policy to reduce the gap of trajectories in health and medical expenditure across socioeconomic status.

경요도 전립선절제술에서 척추마취 시 소용량 Bupivacaine-Fentanyl의 병용투여와 상용용량 Bupivacaine의 임상 효과 비교

곽경화,이수현,전영훈,문철원,백운이 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.4

Background: The combination of local anesthetics and opioids in the spinal anesthesia has a synergic analgesic effect, Therefore, we compated intraoperative conditions and clinical effects of low dose (5 mg) bupivacaine added with fentanyl versus a conventional dose(10 mg) of bupivacaine in spinal anesthesia for a transurethral resection of the prostate (TURP). Methods: Forty five ASA class 1 and 2 patients scheduled for a TURP were randomly divided into three groups. Group B (n = 15) received bupivacaine 10 mg, group BF (n = 15) received bupivacaine 5 mg added with fentanyl 20 ㎍, and group BFE received bupivacaine 5 mg added with fentanyl 20 ㎍ and 0.2 mg epinephrine. Blood pressure and heart rate were recorded every 5 minutes before and after spinal anesthesia. Sensory blockade was measured by a pin-prick test and motor blockade was evaluated by the Bromage motor scale. Side effects including pruritus, nausea, vomiting, respiratory depression, and intraoperative pain were observed. Results: The duration of sensory and motor blockade in group BF was significantly shorter than in group B and group BFE (P < 0.05). Without statistical significance, hypotension (6.7%) and bradycardia (13.3%) were observed in group B and pruritus (26.7%) and nausea (13.3%) occurred in all patients who received fentanyl. Conclusions: The addition of fentanyl 20 ㎍ to low dose bupivacaine 5 mg resulted in short lasting motor and sensory block, compared with conventional dose bupivacaine 10 mg. Therefore, we concluded that the clinical application of this method could provide adequate analgesia with early discharge and no serious side effects for TURP patients. (Korean J Anesthesiol 2002; 43: 418~423)

경북대학교병원 외래환자수술실의 현황

곽경화,문철원,박성식,임동건,박진웅 대한정맥마취학회 2001 정맥마취 Vol.5 No.4

Background: Outpatient surgery has been continuously expanded around the world because of its cost-effectiveness and benefits for patients. Additionally, advances in anesthesia and surgical procedure have facilitated the rapid growth in day surgery. The purpose of this article is to analyze our 2 years' experience in day surgery center and therefore, to improve the management and effectiveness of day surgery center. Methods: We retrospectively analyzed 1,160 patients who were monitored and maintained by anesthesiologist except 6,549 patients who were done under local anesthetics during 2 years from Feb. 1998 to Jan. 2000. Patients were evaluated for ratio of outpatients to total surgery patients, male to female ratio, age distribution, ASA classification, participating departments, anesthetic techniques and aesthesia time. Results: The mean ratio of outpatients to total surgery patients was 4.6%. The sex ratio of outpatient surgery was similar and the age of patients was distributed 34.6 of under 20 years of age, 63.7 of 20-59 years of age and 12% of over 60 years of age. ASA physical status 1 and 2 occupied most of proportion of patients by 77.4 and 21.7% respectively. In our outpatient surgery center, all case was dane under general anesthesia and otolaryngologic surgery (47.5), orthopedic surgery (10.6), cardiac surgery (10.3), gynecologic sugery (10.1) and general surgery (10.0%) in ascending order. General anesthesia using propofol (88.2%) was commonly used and the airway has been kept with endotracheal tube (61.0), mask or manual (22.6), LMA (14.0) and COPA (2.4%). Anesthesia time less than 30 minutes was most common (42.2%), and most of the cases were done in less than 60 minutes (71.2%). Conclusions: The rate of outpatient surgery was very low compared to other countries but continuously has been increased. In this period, I think that the role of anesthesiologist is very important for faclitating outpatient surgery and improving both quantity and quality of outpatient surgery center.

과학교사 전문성 기준 : 포스터 발표 ; 논의 과정을 이용한 과학 교수,학습 전략이 중학생들의 인지발달 및 과학 학습에 미치는 영향

곽경화,강순민,남정희 한국과학교육학회 2004 한국과학교육학회 학술발표 및 세미나집 Vol.- No.-

Need for an optimal regimen of programmed intermittent epidural bolus administration for maintenance of labor analgesia

곽경화 대한마취통증의학회 2019 Korean Journal of Anesthesiology Vol.72 No.5

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PONV prevention: still not enough

곽경화 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.5

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Postdural puncture headache

곽경화 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.2

Postdural puncture headache (PDPH) is a common complication after inadvertent dural puncture. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design, and the technique used also affect the risk. Because PDPH can be incapacitating, prompt diagnosis and treatment are mandatory. A diagnostic hallmark of PDPH is a postural headache that worsens with sitting or standing, and improves with lying down. Conservative therapies such as bed rest, hydration, and caffeine are commonly used as prophylaxis and treatment for this condition; however, no substantial evidence supports routine bed rest and aggressive hydration. An epidural blood patch is the most effective treatment option for patients with unsuccessful conservative management. Various other prophylactic and treatment interventions have been suggested. However, due to a lack of conclusive evidence supporting their use, the potential benefits of such interventions should be weighed carefully against the risks. This article reviews the current literature on the diagnosis, risk factors, pathophysiology, prevention, and treatment of PDPH.

노인 수술환자의 부위마취관리

곽경화,박성식 대한의사협회 2017 대한의사협회지 Vol.60 No.5

Small Dose of Midazolam Added to Fentanyl-Ropivacaine for Patient Controlled Epidural Analgesia after Subtotal Gastrectomy

곽경화 대한마취통증의학회 2008 Anesthesia and pain medicine Vol.3 No.1

Background: Midazolam has been reported to have a spinally mediated antinociceptive effect. In this randomized, double-blind study, we evaluated whether a small dose of midazolam added to fentanyl-ropivacaine mixture for PCEA (patient controlled epidural analgesia) improves epidural analgesia in patients underwent elective subtotal gastrectomy. Methods: Forty five patients, ASA physical status I and II, undergoing subtotal gastrectomy were randomly allocated to receive 0.2% ropivacaine mixed with fentanyl 4μg/ml or 0.2% ropivacaine mixed with fentanyl 4μg/ml and midazolam 0.2 mg/ml. The infusion rate was set to deliver 4 ml/hr of the study solution, with a bolus of 2 ml per demand and a 20 minutes lockout time. Results: Infused volume (P < 0.05) and VAS scores (P < 0.05) was significantly lower in the patients receiving midazolam. However, there were no differences in requiring rescue analgesics, PONV (postoperative nausea and vomiting), sedation scores, urinary retention, and pruritus between groups. Conclusions: Small dose of midazolam could augment analgesia without adverse effects when added to thoracic epidural infusion of fentanyl and ropivacaine.