한국인 직무 스트레스 측정도구의 개발 및 표준화

장세진,고상백,강동묵,김성아,강명근,이철갑,정진주,조정진,손미아,채창호,김정원,김정일,김형수,노상철,박재범,우종민,김수영,김정연,하미나,박정선,이경용,김형렬,공정옥,김인아,김정수,박준호,현숙정,손동국 大韓産業醫學會 2005 대한직업환경의학회지 Vol.17 No.4

Background and Purposes: Over the past three decades, numerous studies performed in Korea have reported that job stress is a determinant risk factor for chronic diseases and work disability. Every society has its own culture and occupational climate particular to their organizations, and hence experiences different occupational stress. An occupational stress measurement tool therefore needs to be developed to estimate it objectively. The purpose of this study is to develop and standardize the Korean Occupational Stress Scale (KOSS) which is considered to be unique and specific occupational stressors in Korean employees. Subjects and Methods: Data were obtained from the National Study for Development and Standardization of Occupational Stress (NSDSOS Project: 2002-2004). A total of 12,631 employees from a nationwide sample proportional to the Korean Standard Industrial Classification and the Korean Standard Occupational Classification were administered. The KOSS was developed for 2 years (2002-2004). In the first year, we collected 255 items from the most popular job stress measurement tools such as JCQ, ERI, NIOSH and OSI, and 44 items derived from the a qualitative study (depth interview). Forty-three items of KOSS, in the second year, were retained for use in the final version of the KOSS by using Delphi and factor analysis. Items were scored using conventional 1-2-3-4 Likert scores for the response categories. Results: We developed eight subscales by using factor analysis and validation process: physical environment (3 items), job demand (8 items), insufficient job control (5 items), interpersonal conflict (4 items), job insecurity (6 items), organizational system (7 items), lack of reward (6 items), and occupational climate (4 items). Together they explained 50.0% of total variance. Internal consistency alpha scores were ranged from 0.51 to 0.82. Twenty-four items of the short form of the KOSS (KOSS-SF) were also developed to estimate job stress in the work setting. Because the levels of the subscales of occupational stress were gender dependent, gender-specific standard norms for both the 43-item full version and the 24-item short form using a quartile for the subscales of KOSS were presented. Conclusion: The results of this study suggest that KOSS might be an appropriate measurement scale to estimate occupational stress of Korean employees. Further and more detailed study needs to be conducted to improve the validity of this scale.

이갈이 환자의 다면적 인성검사의 특성

박병욱,이희철,장문정,심주철 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.3

연구목적 : 다면적 인성검사를 통해 이갈이군의 심리적 특성을 알아보고 이갈이 환자의 성별, 가족력, 발병기간, 이갈이 유형, 동반된 통증 유무에 따른 심리적 특성의 차이를 알아보고자 하였다. 방 법 : 1998년 1월부터 8월까지 개인 치과의원을 방문한 환자들 중 46명의 이갈이군, 41명의 대조군을 대상으로, 이갈이군과 대조군의 심리적 특성, 이갈이 환자의 성별, 가족력 유무, 이갈이 기간, 이갈이 유형, 통증과 같은 동반증상유무에 따른 심리적 특성의 차이를 알아보기 위해 다면적 인성검사를 실시하였다. 결 과 : 이갈이군이 대조군보다 모든 임상척도에서 높은 점수를 나타냈으나 남성특성-여성특성 척도점수를 제외하고는 통계적 유의성이 없었다. 가족력이 있는 이갈이군이 가족력이 없는 이갈이군보다 반사회성 척도가 높았다. 이갈이군에서 남자가 여자보다 교정척도(K) 점수가 높게 나타났으며 여자는 편집증 척도점수가 높게 나타났다. 발병기간에 따른 차이는 없었으며 이갈이 종류의 비교에서는 이악물기형이 다른형보다 내향성 척도가 유의하게 높았다. 저작근 통증, 경통, 두통과 같은 동반된 통증 유무에 따른 차이는 없었다. 결 론 : 다면적 인성검사상 일부 항목에서 높은 점수를 나타낸 것으로 이갈이 환자의 심리적 특성을 규정짓기는 어려우나 이갈이군이 대조군에 비해서 다면적 인성검사상 모든 척도가 상승되어 있고, 이갈이의 성별, 가족력, 이갈이의 종류에 따라 일부 척도의 점수가 상승되어 있는 것은 이들이 서로 다른 심리적 특성을 가질 가능성을 시사한 것이라고 판단되며, 이는 치료에 있어서도 좀 더 개별화된 접근이 필요함을 시사한다. Objectives : The aim of this study was to evaluate the psychological characteristics of the patients with bruxism by Minnesota Multiphase Personality Inventory (MMPI). Methods : MMPI was administered to 87 patients(46 bruxism group and 41 control group) who had visited a local dental clinic from January to August 1998. Results : The bruxism group had a higher score than control group in Masculinity-Femininity (Mf) scale. There were no differences between bruxism group and control group on the distribution of Depression(D), Psychopatic Deviate(Pd), Paranoia(Pa), Psychasthenia(Pt) scales. The bruxism group with the family history showed higher score than the bruxism group without family history in Pd scale. Male bruxism group had a higher score than female bruxism group in Defensiveness(K) scale and female bruxism group had higher score than male bruxism group in Pa scale. The bruxism group of clenching type had a higher score than the bruxism group of mixed type in Social Introversion(Si) scale. There were no differences in MMPI score between those who had and did not have symptoms such as masticatory muscle pain, neck pain, and headache. Conclusion : It is concluded that individualized approach may be effective to the evaluation of psychological disturbances which might be related to sex, family history and, type of bruxism, while we did not find significant differences in personality characteristics between the bruxism and control groups.

일반인의 장애인에 대한 의식도 조사 연구

박재성,신동철,김주혁 창원대학교 체육과학연구소 2000 경남 체육연구 Vol.5 No.1

일반인의 장애인에 대한 의식도를 파악, 분석해 봄으로써 장애인들이 보다 밝은 생을 영위해 나가는데 필요한 기초자료를 제공하고, Gottlieb와 Corman의 설문자료를 참조하여 의식도에 관계되는 문항을 우리나라 여건에맞게 수정·보완하였으며, 199년도 부산광역시에 거주하는 시민으로서남자 387명과 여자171명 총 558명을 무작위로 추출한 결과 다음과 같은 결론을 얻었다. 1. 일반인의 장애인에 대한 인성의 인식도에서는성별, 연령, 교육수준에 의해서는 차이가 없으나, 종교인과 생활수준이 높은사람일수록‘친하게 지낼 수 있다’라고 나타났다. 2. 일반인이 장애인과의 공동생활여부에 대해서는성별과 연령은 무관하나, 종교유무, 교육수준, 생활수준에 의해서는 공동생활여부가결정되는 것으로 나타났고, 결혼여부에서는 성별, 교육수준, 생활수준에 의해서 차이가 있는 것으로 나타났다. 3.일반인의 장애인에 대한 체육활동 필요여부에서는 성별, 연령, 종교유무, 생활수준에 의해 차이가 나타났으며, 장애인의 직장생활에대한 성공여부로서는 성별, 연령, 교육수준, 생활수준에 의해 차이가 있는 것으로 나타났다. 4.장애인이 지역사회의 체육활동과 클럽행사 참여여부에 대해서는 연령, 종교유무, 생활수준과는 차이가 없으나, 성별, 교육수준에 의해서는차이가 있는 것으로 나타났다. 현재 장애인에 대한 편견을 버리고, 인간으로삶의 질을 향상시키기 위해서는 모두가 관심을 가지고 시설 확충이나 장애인을 위한 다양한프로그램을 제공해 줄 수 있도록 관계기관에서는 보다 많은 재원확보와 관심을 기울여야 할 것으로 사료된다.

공초점레이저주사현미경을 이용한 심미수복재와 상아질의 접착계면에 관한 연구

박병철,조영곤,문주훈 대한치과보존학회 2000 Restorative Dentistry & Endodontics Vol.25 No.3

The purpose of this study was to evaluate on the interfacial morphology between dentin and restorative materials. In this in vitro study. the cavity wall reiterated with 3 different kinds of tooth colored restorative materials [resin-modified Glass monomer cement (Fuji Ⅱ LC) , composite resin (Z-100) , composer (Dyract)] . The thirty extracted human molar teeth without caries and/or restorations are used. The experimental teeth were randomly divided into three groups of ten teeth each. In each group, Wedge shaped cavities (width: 3mm. length: 2mm, depth: 1.5mm) were prepared at the cementoenamel junction on buccal and lingual surfaces. The adhesive of composite resin were mixed with rhodamine B. Primer of composite resin, Prime & Bond 2.1 of Dyract and liquid of Fuji Ⅱ LC were mixed with fluorescein. In group 1, the cavity wall was treatment with dentin conditioner, and then reiterated with Fuji Ⅱ LC. In group 2, the cavity wall was treatment with Prime & Bond 2.1 and then reiterated with Dyract. In group 3, the cavity wall was etching with 10% maleic acid, applied with primer and bonding agent and then reiterated with Z-100. The interface between dentin and restorative materials was observed by fluoresence imaging with a confocal laser scanning microscope. The results were as follows : 1.In Glass ionomer group, adaptation of resin modified Glass-ionomer restoration against cavity wall is tight, but the crack formed inside of restoration were observed. 2.In Dyract group, the penetration of resin tag is shorter and the width of hybrid layer is narrower than composite resin group. 3.In Z-100 group, primer penetrated deeply through dentinal tubule, Also bonding agent was penetrated along the primer, but the penetration length is shoater than primer part, and in 3-D image. the resin tag is conical shape and lateral branch is observed.

장시간 불가피한 공복(fasting)후 인체의 내분비 변화 : 삼풍백화점 붕괴 사고후 구조된 3인의 증례 THREE CASES IN COLLAPSE OF SAMPOONG DEPARTMENT STORE

박규남,황주일,박조현,오동렬,이원재,오승택,김세경,김인철 대한응급의학회 1995 대한응급의학회지 Vol.6 No.2

The interactions between nutrition and the endocrine system are more intimate and complex that previously thought. Nutrition modulates secretion and activity of many hormones, as part of the stress adaptation process. Fasting, in particular, produces a number of important changes in the endocrine system, with teleological purpose of helping the body tolerate the lack of food ingestion. These changes are therefore beneficial and protective, although at times they may not appear to be that way. The endocrine changes of fasting mediate the metabolic response. We must emphasize that these changes are completely reversible when appropriate nutrition is established. These changes are as followes: 1) decreased insulin and increased glucagon levels, 2) decreased thyroid effect, 3) decreased sympathetic activity, 4) hypothalamic hypogonadism, 5) decreased growth, 6) altered glucocorticoid secretion and metabolism, 7) impaired mineralocorticoid response, 8) decreased ADH secretion and effect. We experienced three cases of involuntary prolonged fasting after collapse of Sampoong department store. They were released from collapsed field after 11(case Ⅰ), 13(case Ⅱ), 17days(case Ⅲ) respectively. In each case, the endocrine changes of plasma levels were as followes: decrease of cortisol in case Ⅰ, increase of GH in case Ⅱ, decrease of free T3, T3, cortisol and increase of reverse T3, insulin in case Ⅲ. Each one did not show the same endocrine changes of plasma levels. But we think these changes of fasting are beneficial in metabolic response of human.

Pristinamycin(Pyostacine®)의 methicillin-resistant Staphylococcus aureus,Penicillin-resistant Streptococcus pneumoniae, Haemophilus influenzae 임상균주에 대한 시험관내 항균력

박정원,송준영,김철현,정희진,김우주,김민자,박승철 대한화학요법학회 2000 대한화학요법학회지 Vol.18 No.4

목적 : 국내 및 전세계적으로 methicillin-resistant Staphylococcus aureus (MRSA), penicillin-resistant Streptococcus pneumoniae(PRSP), β-lactamase 생성 H. influenzae 등의 항균제 내성 감염증이 증가되고, 이에 대한 효과적인 항생제 요법에 대한 필요성이 증가되고 있다. Streptogramin 계열의 경구 항생제인 pristinamycin의 임상검체에서 분리된 균주에 대한 시험관내 항균력을 검사함으로서 이러한 감염증에 대한 임상적 사용의 유용성여부를 알아보고자 하였다. 방법 : 1999년 8월1일부터 2000년 1월 1일까지 호흡기 감염, 피부 및 연조직 감염환자로부터 분리된 MRSA 60주, PRSP 50주, H. influenzae 40주를 대상으로 pristinamycin을 비롯한 8-9종 항생제의 시험관내 항균제 감수성을 측정하였다. 결과 : Pristinamycin은 MRSA에 대한 MIC 범위가 0.125-1㎎/L로서 100%의 감수성을, PRSP에 대한 MIC 범위가 0.125-1㎎/L로서 100%의 감수성을, β-lactamase를 생성하는 H. influenzae에 대해서도 MIC 범위가 0.25-2㎎/L, 96% 감수성으로서 다른 항생제들에 비하여 우수한 시험관내 항균력을 나타내었다. 결론 : 국내에서 문제가 되고 있는 MRSA, PRSP, β-lactamase 생성 H. influenzae에 대하여 pristinamycin은 우수한 시험관내 항균력을 나타내어, 이들 항생제 내성균들에 의한 감염증의 치료에 효과적으로 사용될 수 있을 것으로 생각된다. Background: Pristinamycin(Pyostacine®) is a natural antibacterial combination of compounds Produced by Streptomyces pristinaespiralis. It has been marketed in European countries over 30 years as an oral anti-stphyhcoocal agent. Because of the increasing prevalence microorganisms that are resistant to multiple antimicrobial agents in Korea. there are demand of noble antibiotics like pristinamycin against these resistant organissms. Methods The one-hundred and fifity bacterial strains which were collected from Korea University Guro hospital included sixty methicillin-resistant S. aurous (MRSA) , fifty penicillin-resistant S. pneumoniae (PRSP) and forty H. infuenzae clinical isolates. Using an microbroth dilution or agar dilution technique, we compared the antimicrobial activities of pristinamycin and other usual antibiotics against the studmicroorganisms. Results: All sixty MRSA strains were multiply resistant to other antimicrobial agents, but 100% of MRSA strains were susceptible to pristinamycin (MIC range: 0.125-1㎎/L). All of fifty PRSP strains were multiple resistant to other antimicrobial agents but 100% PRSP strains were susceptible to pristinamycin (MIC range: 0.125-1㎎/L). Twenty-seven strains of forty H. influenzae strains were β-lactamase positive, and 95% (38/40) of H. influenzae strains were susceptible to prisitinamycin (MICrange : 0.015-4㎎/L) . Conclusion : Pristinamycin demonstrated the highly active. in vitro antimicrobial activities against MRSA. PRSP. and H.influenzae isolated so it might be an effective oral therapeutic agent for treating patients with mild infection due to those organisms or on the outpatient setting.

학교조직의 구조 개선에 관한 연구

박병량,주철안,성병창 釜山大學校 敎育硏究所 1995 敎育硏究 Vol.5 No.1

The purpose of this study is to develop the restructuring options for the schools in Korea. The study draws basic directions for the school restructuring by reviewing the literature which cover school restructuring works. It also analyzes structural and managerial problems of Korean primary and secondary schools. Finally, it suggests restrcturing options for the improvement of the schools. The major findings from the study are as follows. 1) The educational reforms from the middle of the 1980s focus on the change of school organization. The main approaches of the reforms have been strengthening of central bureaucratic control, strengthening of community participation, school-site management, teacher empowerment, and restructuring centered on teaching-learning. Recent reform literature tend to emphasize the four approaches except strengthening of central bureaucatic control. 2) In general the recent literature on school restructuring, on school organization, and on educational reform policy of the central government seemed to recommend the following: the basic directions of school restructuring should be toward client-centered education, self-managing school management, democratic school management, professional school management, teaching & learning centered school management, school management relevant for the future in which information technology is important. 3) Schools in general consist of three structural parts: a teaching & learning organization, academic affairs management, and student management organization. The analysis of our primary and secondary school organization shows that schools are management affairs oriented rather than teaching & learning oriented. Therefore, the organizations should be restructured to have more flexible and organic teaching-learning organization. Academic affairs organization and management organization should be restructured to support teaching and learning more effectively. In conclusion, we recommend that our shcool organization be restructured to upgrade the effectiveness of teaching & learning, to raise the autonomy & professionalism of school management, and to respond to the educational needs of clients.

병원과 지역사회에서 메티실린 내성 황색 포도상구균(methicillin-resistant Staphylococcus aureus) 감염의 임상 분자역학 연구

박정원,이종섭,송준영,김철현,엄중식,정희진,김우주,박승철 대한화학요법학회 2002 대한화학요법학회지 Vol.20 No.2

목적 : 국내에서 1990년대 이후 중요한 병원균으로 대두되고 있는 methicillin-resistant S. ureus(MRSA)는 주로 입원환자에서만 분리되는 것으로 알려져 있으나, 최근들어 지역사회에서도 퍼져있는 것으로 알려지기 시작하였다. 이에 병원획득 및 지역사회획득 MRSA의 임상역학 및 분자역학적 연구를 통하여 획득요인, 병원과 지역사회 획득 균주간의 교류 양상등을 규명하고자 하였다. 방법 : 1998년 1월부터 12월까지 고려대 부속 구로병원에서 임상검체로부터 분리된 S. aureus 균주중에서 MRSA 균주의 빈도를 구하였고, 이중 1998년 10월 1개월 동안 분리되었던 42균주에 대하여 지역사회획득 균주와 병원획득 균주로 나누고, 임상역학적 조사를 하였다. 지역사회 획득 18주와 병원획득 22주에 대하여 PCR 방법으로 mecA 유전자를 확인하였고, PFGE를 시행하여 균주의 클론형(clonal type)을 결정하고 이 결과에 준하여 덴드로그램 분석을 시행하여 분자적 친밀도를 결정하였다. 결과 : 1998년 1년간 분리된 총 1,587주의 S. aeureus 균주중 73.8%(1,163주)가 MRSA 였다. 1998년 10월 1개월 동안 임상자료의 고찰이 가능하였던 MRSA 감염환자 42명 중 20명이 지역사회획득 환자였고, 병원획득 환자가 지역사회획득 환자보다 항생제사용 과거력(17 vs 5, p=0.001), 기저질환의 존재(18 vs 8, p=0.002) 등이 통계적으로 의미있게 높았다. 지역사회획득환자가 이루(7/20[35.0%] vs 2/22[9.1%] ; p=0.041)와 밀접한 관계가 있음도 확인하였다. 분자생물학적연구가 진행된 40주의 MRSA 균주는 모두 mecA 유전자 양성이었고, 18주의 지역사회획득 균주에서 총 8가지의 PFGE 클론형이 존재하였으며 A형이 가장 많았다(7/18, 38.8%). 22주의 병원획득균주에서는 6가지의 클론형이 존재하고 A형이 가장 많았으며(15/22, 68%), 15주의 지역사회획득 균주(83.3%)가 21주의 병원획득균주와 공통적인 클론형을 공유하고 있었다. 결론 : 지역사회 획득 MRSA는 주로 이루나 창상부위에서 많이 분리되는 반면 병원획득 MRSA는 객담에서 많이 분리되고 또한 당뇨병을 가진 환자에서 감염을 잘 일으키는 것으로 밝혀졌다. PFGE 분석 결과 원내감염은 단일균주에 의한 유행양상을 보였고, 지역사회에서도 같은 형의 균주에 의한 감염빈도가 가장 높음을 보여 MRSA 균주가 지역사회로 유입되어 지역사회내 MRSA 감염의 발생에 기여했을 것으로 사료된다. Background : Until recently, methicillin-resistant Staphylococcus aureus (MRSA) infection has been acquired primarily in hospital settings. During the late 1990s, the incidence of community-acquired MRSA infections has been increased in this university hospital. This retrospective study evaluated the clinical features and risk factors for community-acquired MRSA infection compared with hospital-acquired MRSA infection; and molecular relatedness of MRSA strains determined by pulsed-field gel electrophoresis(PFGE). Method: MRSA isolates collected from patients during October of 1998 were classified as community-acquired("community') or hospital-acquired("hospital") cases. MRSA infections were defined as hospital-acquired if organisms were isolated > 48 hours after admission to the hospital or isolated from patients with a history of admission to a hospital within the last 3 months. A comparative analysis of risk factors for community MRSA compared with hospital MRSA was performed. mecA gene PCR and PFGE of MRSA isolated was used as a tool of strain identification and molecular typing. Result : During one month, there were 42 patients with MRSA infection or colonization. Of 42 patients with MRSA isolates, 22(52%) were hospital cases and 20(48%) were community cases. Previous exposure to antibiotics(17 vs 5, p = 0.001) and presence of underlying diseases (18 vs 8, p = 0.002) were more common in hospital cases than in community cases. MRSA were more frequently isolated in otorrhea specimens from patients with otitis media in community cases compared with hospital cases. Of the 40 MRSA isolates subjected for PFGE typing, 18 were community isolates and 22 were hospital isolates. There were 8 distinct PFGE types among the 18 community isolates and type A was the most common clonal type (7/18, 38.8%). 22 hospital isolates were of 6 distinct PFGE types, and type A was dominant clonal type (15/22, 68%). PGFE subtyping indicated that 15(83.3%) of 18 community MRSA strains were clonally related with that of 21 hospital MRSA strains. Conclusion : Our results suggest that hospital MRSA strains may have disseminated in the community setting. PFGE subtyping support the finding that MRSA is circulating beyond nosocomial settings in the regional community.

혈뇨의 감별진단을 위한 이형적혈구의 형태학적 연구

윤철종,박정오,문희주,윤기은 韓國電子顯微鏡學會 1999 Applied microscopy Vol.29 No.3

전체 성인의 약 4%에서 정도 차이는 있지만 혈뇨가 있다고 볼 때 그 원인을 구명하는 일이 중요하다. 그 원인이 사구체성 신염인지 기타 그 외의 비사구체성 원인에 따른 질환인지를 쉽게 감별하는 일이 중요하다. 본 연구자들은 혈뇨를 동반한 소아과 환자중에서 신 생검 조직검사까지 한 5명의 환자에서 혈뇨를 표본 제작하여 먼저 위상차현미경적 표본제작법을 통하여 적혈구를 감별하였고 방법을 달리하여 주사형 전자현미경으로 요침사를 관찰하여 형태학적 고찰을 통하여 이형적혈구를 보다 명확한 3차원구조를 관찰할 수 있었다. 침생검을 통해 얻은 조직학적 소견으로는 사구체의 기저막을 통과한 혈구들의 요로를 통하여 배출과정을 광학현미경 및 투과형 전자현미경으로 확인할 수 있었다. 본 연구에서 육안적 혈뇨의 색은 유출되는 적혈구의 양과 상관관계가 있으며 용혈된 정도가 심한 경우에 콜라색 혈뇨가 있음을 알 수 있었다. 이들 결과에서 본 연구자들은 사구체성 질환을 동반한 유극적혈구 및 환형 적혈구 등과 같은 변형된 적혈구를 주사형 전자현미경으로 명확한 관찰을 함으로 사구체성 질환으로 인한 혈뇨의 감별에 주사형 전자현미경이 가장 유용한 검사 방법이라고 생각된다. Examination of the morphology of red blood cells in the urine has been shown to be a promising adjunct in determining whether hematuria represents glomerular or nonglomerular bleeding. This is due to distortion of RBCs as they pass across the basement membrane of the glomerular capillaries. It is concluded that is method can greatly help the clinician in distinguishing between glomerular and non glomerular bleeding in patients with hematuria and channeling such patients toward the most appropriate investigations. We have experimented dysmorphic red blood cells that 5 patients of the hematuria are distorted with irregular outlines and often have small blebs extruding from the red cell membrane. Tried urinary sediments were seen with phase contrast microscope and confirmed scanning electron microscope. There are seen acanthocytes, anulocytes, ghost cells and sphero-echinocytes in dysmorphic erythrocytes. Clinical diagnosis was referred from the result of the biopsy-proven. Scanning electron microscopic findings of the hematuria are good diagnostic tool that disclose in distorted red blood cells from patients with glomerular disorders.

갑상선 종양에서 thrombin receptor (PAR-1)의 발현 양상

박지영,목지오,김여주,박형규,김철희,변동원,서교일,유명희,조현득,오미혜,김상진 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.2

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