커뮤니티 케어를 위한 보건⋅복지⋅돌봄 협업사례관리 경험에 관한 연구

정재연,남석인 한국노인복지학회 2024 노인복지연구 Vol.79 No.1

본 연구는 초고령사회 대응 정책인 커뮤니티 케어의 성공적 정착을 위해 보건⋅복지⋅돌봄 전문가들의 협업사례관리 경험을 심층적으로 분석한 질적 연구이다. 공공 또는 민간기관에 소속되어 사례관리와 협력을 경험한 보건⋅복지⋅돌봄 영역의 실천 전문가 13명을 대상으로 진행하였다. 사전 질문지와 초점집단면접 및 개별 면접으로 자료를 수집하였고, 수집된 자료는 ATLAS.ti 24 프로그램을 활용하여 Strauss와 Corbin의 근거이론 방법으로 분석하였다. 개방코딩을 진행하여 78개의 개념, 33개의 하위범주, 18개의 범주를 도출하였다. 축코딩, 선택코딩을 진행하여 중심현상 ‘과도기를 걷고 있는 다 영역 전문가의 협업사례관리’를도출하였으며, 협력의 형태와 협업사례관리의 유형을 도출하였다. 연구의 결과를 기반으로커뮤니티 케어를 위한 실천적, 정책적 방안을 제시하였다. This study is a qualitative investigation that deeply analyzes the collaborative management experiences of health, welfare, and care professionals to successfully establish community care policies in response to an aging society. Thirteen practitioners with expertise in the fields of health, welfare, and care who were affiliated with public or private institutions and had experience in case management or collaboration were selected for the study. Data were collected through pre-questionnaires, focus group interviews, and individual interviews. The collected data were analyzed using the ATLAS.ti 24 program based on Strauss and Corbin’s grounded theory method. Through open coding, axial coding, and selective coding, the central phenomenon of ‘Collaborative Case Management by Experts in Various Fields at the Transition Stage’ was identified. The study derived forms of collaboration, types of collaborative case management, and specific practical approaches to health, welfare, and care collaborative case management for the success of community care. Based on the research findings, practical and policy-oriented approaches for community care were proposed.

노인의 의미 있는 사회활동 참여 유형과 삶의 의미의 관계

정재연,고수빈,남석인 한국노년학회 2022 한국노년학 Vol.42 No.4

This study aims to identify the types of meaningful social activity of older adults and analyze how each type influences their meaning in life. A survey of 875 older adults aged 65 and over who utilized day-care centers and welfare centers in South Korea was undertaken for this aim. Latent class analysis, multinomial logistic regression analysis, and multiple regression analysis were performed on the collected data. The following are the major findings: First, multidimensional activity type, self-development-oriented type, social contribution-oriented type, and passive activity type were derived as the types of meaningful social activity for the aged. Second, demographic and social characteristics, such as gender, age, and education, were identified as influential factors for each type. Finally, when considering the impact of meaningful social activity type on meaning in life, passive and self-development-oriented activity type had lower mean in g in life than multidimensional activity type. On the other hand, the impacts of the multidimensional activity type and the social contribution-oriented type on meaning in life were not significantly different. Based on these findings, this study suggests practical and policy interventions to promote older individuals' engagement in social activities and improve their meaning in life. 본 연구의 목적은 노인의 의미 있는 사회활동 유형과 영향요인을 탐색하고, 각 유형이 삶의 의미에 어떠한 영향을 미치는지분석하는 것이다. 이를 위해 전국의 노인종합복지관과 주간보호시설을 이용하는 만 65세 이상 노인 875명을 대상으로 8가지 사회활동에대한 지속적 참여 유무를 기준으로 잠재계층분석을 실시하였다. 도출된 유형으로 영향요인과 삶의 의미에 미치는 영향을 확인하고자다항 로지스틱 회귀분석과 다중회귀분석을 실시하였다. 연구 결과는 다음과 같다. 첫째, 노인의 의미 있는 사회활동 유형은 다차원적활동형, 자기계발 중심형, 사회기여 중심형, 소극적 활동형의 4가지로 도출되었다. 둘째, 성별, 연령, 최종학력 등 노인의 인구사회학적변수가 각 유형의 영향요인으로 확인되었다. 셋째, 사회활동 유형이 삶의 의미에 미치는 영향을 살펴보면 다차원적 활동형에 비해소극적 활동형과 자기계발 중심형의 삶의 의미가 낮게 나타났으며, 다차원적 활동형과 사회기여 중심형이 삶의 의미에 미치는 영향은유의미한 차이가 도출되지 않았다. 연구결과를 기반으로 노인의 사회활동 참여를 높이고, 삶의 의미 증진을 위한 구체적인 실천방안을제시하였다.

노인의 주거환경 만족 유형과 이웃관계에 대한 연구

정재연(Jung, Jae Yeon),김은표(Kim, Eun Pyo),남석인(Nam, Seok In) 한국노인복지학회 2021 노인복지연구 Vol.76 No.4

최근 국내외적으로 노인의 주거와 관련하여 지역사회계속거주(AIP)와 커뮤니티케어 정책이 중요시되고 있다. 본 연구는 노년기 지역사회계속거주의 주요한 요인을 주거환경과 이웃 관계의 건강함에 주목하였다. 이를 위해 ‘2019년 주거실태조사’를 활용하여 잠재프로파일분석을 실시하였다. 노인의 삶에 영향을 주는 주거환경 만족 유형으로 시설 · 서비스 불만족, 시설 불만족 · 서비스 만족, 시설 만족 · 서비스 불만족, 시설 · 서비스 높은 만족의 4가지 유형을 도출하였다. 도출된 유형으로 다항 로지스틱 회귀분석과 다중회귀분석을 실시하여 유형의 특성 및 영역 간의 상호 연관성, 유형별 이웃관계에 대한 영향을 확인하였다. 주거환경의 시설 또는 서비스 영역 중 하나라도 만족하면 이웃관계에 긍정적인 영향을 주는 것으로 나타났다. 이러한 연구결과를 바탕으로 지역사회계속거주를 위한 커뮤니티케어 기반 주거환경 개선과 노인의 건강한 이웃관계에 대한 정책적 · 실천적 방안을 제시하였다. Recently, Aging In Place(AIP) and Community care policies have become important concerning the housing of older people. This study focused on the residential environment and neighborhood relationships as the main factors of Aging In Place(AIP) in old age. We conducted a latent profile analysis using the ‘2019 Korea Housing Survey to analyze the types of residential environment satisfaction. Four types of residential environment satisfaction were derived: the ‘facility and service dissatisfaction’, the ‘facility dissatisfaction and service satisfaction’, the ‘facility satisfaction and service dissatisfaction’, and the ‘facility and service high satisfaction’. In addition, Multinomial logistic regression analysis and multiple regression analysis were conducted with the derived types to confirm the characteristics of the type and the effect on neighborhood relationships by type. It was found that if any one of the facilities or service areas of the residential environment was satisfied, it had a positive effect on neighborhood relationships. Based on these results, we propose policy and practical intervention strategies for the improvement of the residential environment based on community care and the healthy neighborhood relationships of older people.

류마티스 관절염 환자에서 약사의 교육 전후에 따른 약물인지도변화

이소영,남재연,이주연,박경호,손인자,이은봉 한국병원약사회 2009 병원약사회지 Vol.26 No.3

Abstract: Rheumatoid arthritis is a systemic inflammatory disease, causing chronic inflamma-tion of the joints and multiple organs of the body. Long-term use of antirheumatic drugs is important for patients with rheumatoid arthritis. But in spite of long-term use of drugs, patients have little medication knowledge. Medication knowledge may increase the awareness about bene-fits and risks of the medicine and may improve adherence. Therefore, the purpose of this study was to examine the medication knowledge in patients with rheumatoid arthritis and to evaluate the change of drug awareness before and after education program by pharmacists and to identify the factors that influence medication knowledge. A total of 101 Korean patients with rheumatoid arthritis were enrolled from the Rheumatologic Clinic of Seoul National University Hospital. The patients' medication knowledges were assessed before education and again at next visit. Medication knowledge was calculated by (the number of drugs recognized)/(the number of drugs prescribed) ×100%. For identifying the factors that influence medication knowledge, we collected information about the participants. At first estimation before education, patients' medication knowledges about drug names, purpose of use, dosage, major adverse reaction were 36.6(±39.3)%, 37.6(±34.7)%, 96.0(±9.7)%, and 10.2(±24.8)%, respectively. At second estimation, all items improved to 53.1(±40.8)%, 69.8(±32.0)%, 98.0(±7.0)%, and 43.9(±37.8)%, respectively. The mean medication knowledge of 4 items increased from 45.1(±19.6)% to 66.2(±22.9)% (p<0.001). Age, the number of drugs prescribed, dosing frequency, education level and employment status were significantly related to medication knowledge. In this study, we confirmed that the medica-tion knowledge can be improved by education program of pharmacists.

Plasma MicroRNA-21, 26a, and 29a-3p as Predictive Markers for Treatment Response Following Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma

김순선,조효정,남지선,김현지,강대룡,원지환,김진우,김재근,이제희,김보현,이미영,조성원,정재연 대한의학회 2018 Journal of Korean medical science Vol.33 No.1

Background: We investigated an association between the levels of plasma microRNA (miRNA)-21, -26a, and -29a-3p and treatment outcomes following transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). Methods: A total of 198 patients with TACE-treated HCC were followed up for TACE refractoriness and liver transplantation (LT)-free survival. Pretreatment plasma miRNA-21, -26a, and -29a-3p levels were measured using quantitative real-time polymerase chain reaction. Results: During the mean follow-up of 22.3 (range, 0.7–79) months, 118 (59.6%) patients exhibited TACE refractoriness. Multivariate analyses showed that expression of a specific combination of miRNAs (miRNA-21 ≥ 2.5, miRNA-26a ≥ 1.5, and miRNA-29a-3p < 0.4) was associated with early TACE refractoriness (within 1 year; hazard ratio [HR], 2.32; 95% confidence interval [CI], 1.08–4.99; P = 0.031) together with tumor size (HR, 4.62; 95% CI, 1.50–14.21; P = 0.008), and macrovascular invasion (HR, 3.80; 95% CI, 1.19–12.20; P = 0.025). However, miRNA-21, -26a, and -29a-3p levels were not significantly associated with overall TACE refractoriness or LT-free survival. Additionally, large tumor size and macrovascular invasion were common predictive factor of overall TACE refractoriness and survival. Conclusion: Combination of plasma miRNA-21, -26a, and -29a-3p expression could predict early TACE refractoriness in patients with TACE-treated HCC.

수소동위원소 공정 안전해석

정흥석,강헌구,장민호,조승연,김원국,남재연,김덕진,송규민,백승우,구대서,정동유,이정민,김창석,정기정,윤세훈 한국수소및신에너지학회 2012 한국수소 및 신에너지학회논문집 Vol.23 No.3

A nuclear fusion fuel cycle plant is composed of various subsystems such as a hydrogen isotope storage and delivery system, a tokamak exhaust processing system, and a hydrogen isotope separation system. Korea shares in the construction of the International Thermonuclear Experimental Reactor fuel cycle plant with the EU,Japan and US, and is responsible for the development and supply of the storage and delivery system. We thus present details on the hydrogen isotope process safety. The main safety analysis procedure is to use a hazard and operability study. Nine segments were studied how the plant might deviate from its design purpose. We present a detailed description of the process, examine every part of it to determine how deviations from the design intent can occur and decide whether these deviations can give rise to hazards. We determine possible causes and note protective systems, evaluate the consequences of the deviation, and recommend actions to achieve our safety goal.

Clinical Significance and Characteristics of Newly Detected Lesions on Breast MRI During Neoadjuvant Chemotherapy

Kyeyoung Lee,Kyung Jin Nam,추기석,남수봉,김현열,Youn Joo Jung,Jae-Joon Kim,주지현,김진유,이지원,황재연,Chankue Park 대한자기공명의과학회 2022 Investigative Magnetic Resonance Imaging Vol.26 No.4

Purpose: This study aimed to evaluate clinical significance and imaging findings of newly detected lesions on breast MRI while monitoring patients’ response to neoadjuvant chemotherapy (NAC). Materials and Methods: We identified 291 patients with newly diagnosed breast cancer who underwent breast MRI to assess their response to NAC between January 2017 and August 2021. We evaluated 26 new lesions in 24 women (mean age, 49.8 years; range, 35–63 years) who were included in this study. Two radiologists assessed imaging findings of new lesions according to Breast Imaging Reporting and Data System (BI-RADS) lexicon 5th edition and evaluated follow-up MRI during NAC. Outcomes of new lesions were determined based on pathologic examination or imaging follow-up after surgery. Results: All 26 new lesions were found on the first follow-up imaging. They disappeared or decreased in size on the second follow-up imaging. Lesion types included mass (n = 22, 84.6%) and non-mass enhancement (n = 4, 15.4%). The majority of the mass types showed oval to round shapes (22/22, 100%), circumscribed margins (21/22, 95.5%), and rim enhancement (18/22, 81.8%). Seven (26.9%) new lesions were ipsilateral to the index cancer, 7 (26.9%) were contralateral, and 12 (46.2%) were bilateral. None of these new lesions were malignant. Conclusion: New lesions were detected in 4.7% of breast MRI during NAC. Most new lesions tended to be oval, circumscribed, or rim-enhancing masses. None of these new lesions were malignant.

환경자료를 이용한 간척지 하부 해안유출지하수 탐사

이병선(Lee Byung Sun),송성호(Song Sung Ho),엄재연(Um Jae Yeon),김양빈(Kim Yang Bin),남택우(Nam Taekwoo),남경필(Nam Kyoungphile) 대한토목학회 2009 대한토목학회 학술대회 Vol.2009 No.10