도시거주 노인의 건강에 관한 신체기능평가

정재웅,장호석 한국스포츠리서치 2004 한국 스포츠 리서치 Vol.15 No.6

The purpose of this study was to assess daily living and health-related determining physical function, using a elderly group. Ninety five Korean elderly volunteered for this study. Each participants signed and informed consent and completed a written questionnaire requesting information about theft health, functional status, and physical activity level. The physical Function items represent body composition(waist girth), cardiovascular endurance(800m walking), flexibility(sit and reach), muscular strength/endurance(arm curls, 3G minutes sit and down of chair), balance(balancing on one leg with eyes closed), and agility(agility course). The results of physical characteristics and physical function tests are expressed as mean values standard deviations. Each physical function tasks representing activity of daily living had to demonstrate a significant correlation with age. In order to reduce the all items to a singe score, the correlation matrix for the items including age was subjected to principal component analysis. The main idea of this analysis is to reduce the dimensionality of a data set, which consists of a large number of interrelated variables, while retaining as much as possible the variation present in the data set, The first principal component was used as the best single descriptor of total daily living-related physical function tasks. The first principal component scores were computed for each subject. Because the scores generated by the principal component analysis were expressed in dimensionless units, it was considered desirable to convert these scores to units of ages, The total physical function score was considered useful in assessing functional fitness of daily living in the Korean elderly.

스티렌 폭로 근로자들의 기중 및 혈중 스티렌과 요중 만델산의 관계 분석

정호근,강성규,양정선,김기웅,이종성,조영숙,박인정 大韓産業醫學會 1994 대한직업환경의학회지 Vol.6 No.1

The concentration of styrene in air in blood and mandelic acid in urine were checked for the 60 workers with normal liver function, exposed to styrene. Styrene in air were sampled with personal air sampler at least 4 hours and analyzed by gas chromatography. Blood and spot urine were collected at the end of shift with a vacuum tube and a polythylene bottle and analyzed by gas chromatography and high performance liquid chromatography. Means of air and blood styrene and urine mandelic acid were 8.16 ppm(geometric mean), 0.199 mg/L, and 0.519 g/g creatinine, respectively. The concentration of styrene in air and mandelic acid in urine were high in the FRP factories and low in polymerization factory. Styrene in blood showed large difference by the working process. Styrene in air showed a good correlation with mandelic acid in urine(r=0.6369) and styrene in blood(r=0.6371). The mandelic acid in urine and styrene in blood corresponded to exposure of 50 ppm styrene were 0.890 g/g creatinine and 0.434 mg/L. However, hippuric acid in urine did not show any correlation with styrene in air. Urine mandelic acid excretion expected ratio showed a tendency to decrease according to obesity index and to increase with alcohol consumption.

한국어판 병동매일행동척도 개발

임호섭,신경철,함웅,채정호,김한오,정찬호 大韓神經精神醫學會 1997 신경정신의학 Vol.36 No.2

Objectives : Patient's behavior features are important factors which influences the clinical judgement including diagnosis. However, most psychiatrists build up a picture of patients' behavior from an amalgamation of their own brief observations and nurses' reports, which often lack in the objectiveness. Several behavioral scales have been developed to alleviate this difficulty, but the poor efficiency and reliability of these scales have made them less useful. The recently developed Ward Daily Behavior Scale is an objective tool for evaluating all the daily noteworthy behaviors of patients, and is easily applicable to wide ranges of diagnoses and ages. This study tried to prove the reliability and validity of the Ward Daily Behavior Scale-Korean version. Methods : The 112 patients, 63 males and 49 females, at a chronic psychiatric inpatient ward were selected as subjects. Experienced and unexperienced nurses rated patients' behaviors independently with the Ward Daily Behavior Scale-Korean version, after observing behaviors of subjects for 8 hours during day duty time. And then we tested the inter-rater reliability, internal consistency, and concurrent validity of this scale. Results : The Ward Daily Behavior Scale-Korean version proved to be both reliable and valid for measuring of behaviors of psychiatric inpatients. Conclusions : The Ward Daily Behavior Scale-Korean version will be a valuable tool to observe and quantify patients' behavior in psychiatric wards.

한 정신병원에서의 강박 처치에 대한 입원 환자 및 병원 직원의 지각의 차이

채정호,차성조,함웅,이규항,이정균 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.5

한 정신병원에서 강박처치의 적응증, 합병증, 대체법, 감정적 영향, 적당한 처치 시간, 처치의 효능과 필요성등을 병원에 입원 중인 환자들과 직원들에게 설문조사를 하여 양 집단간에 차이가 있는 지를 알아봄으로써 환자들과 직원들간에 있는 강박처치에 대한 지각 차이를 조사하고 나아가 강박처치 시행의 규준을 확립하기 위한 기본 자를 제시하기 위하여 본 연구를 시행하였다. 강박처치의 적응증에 대해서 입원환자들은 대부분의 항목에 대해 부정적으로 보았고 단지 타환자에 대한 신체적 공격에 대해서만 다소 긍정적인 반응을 보인 반면 직원들의 경우 자해, 타환자에 대한 신체적 공격, 치료진에 대한 공격 등에 높은 응답율을 보였다. 강박처치의 부작용에 대한 지각은 입원환자의 경우 정신상태의 악화, 자해의 증가 등에 대해 보다 민감하게 반응 하였고, 실제로 경험한 부작용에 있어서는 직원들의 경우 피부박탈을 더 강조한 반면 환자군에서는 호흡곤란, 정신 상태의 악화 등을 강조하였다. 강제 처치에 대한 대체치료 방법으로는 환자군에서 면담을 중요시한 반면 직원군에서는 격리실의 이용을 강조하였다. 신체억제와 고용량의 정온화를 비교한 것은 환자군에서 신체억제가 더 효과적이라고 하였다. 신체억제 동안 느끼는 감정에 대한 지각에서 환자군은 슬픔을 가장 많이 보고하였고, 직원군은 적개심을 가장 많이 느낄 것으로 추정하였다. 신체억제의 시간에 대해서는 환자군이 긴 것으로 지각하고 있으며, 이상적인 신체억제의 시간은 환자군이 짧은 것이 좋다고 생각하고 있었다. 본 연구 결과 정신과 입원환자들과 병원직원들은 강박처치에 대하여 유의한 지각의 차이가 있다는 것을 알았으며 정신병원내에서 강제처치를 실시할 때에는 명확한 강박처치 시행에 대한 규준에 따라야 할 것임을 확인할 수 있었다. Objectives : The purpose of this study was to examine different perceptions of physical restraint and their nature between psychiatric inpatients and hospital staffs in a mental hospital and to provide baseline data for establishing the practicing standard of this therapeutic maneuver. Methods : Two hundred and two psychiatric inpatients who experienced physical restraint and 103 hospital staffs who frequently used this maneurer were surveyed with a questionnaire regarding indications, complications, alternative methods, emotional influences, duration of treatment and subjective effects of restraint. Results : Regarding indications of physical restraint, the inpatient group had negative viewpoint on the most items except "physical assault to other patients". Regarding the perception about possible complications of this treatment, the inpatient group had more concerns about "deterioration of mental status" and "increasing risk of self-injury". For experienced complications, staffs stressed "skin abrasion " while inpatients believed of "respiratory difficulties" and "deterioration of mental status" more frequently. As alternative methods of physical restraint, "increasing frequency of interview" was suggested by the inpatient group and "using seclusion room" was favored by the staff group. The inpatient group had an impression that physical restraint was more effective than high-dose neuroleptic tranquilization. For suspected emotion during this procedure, the inpatient group reported "sorrow" most frequently while the staff group presumed that "hostility" might be most frequent. Inpatients estimated that the average duration of physical restraint was longer than staffs did. Ideal duration of physical restraint was shorter in the inpatient group. Conclusion : These results suggest that there are definite differences in the perception of physical restraint between psychiatric inpatients and hospital staffs. Formal practing guideline for restraint should be set up with careful attention for these differences to maximize the therapeutic effect of this maneuver.

Hinman 증후군(비신경인성 신경인성 방광) 1예

이경욱,채정호,이승주,김세웅,박원명,전태연,김광수 大韓神經精神醫學會 2003 신경정신의학 Vol.42 No.3

Objectives : The Hinman Syndrome is a condition representing urinary voiding dysfunction in a neurologically intact child. This syndrome probably is an acquired behavioral and psychosocial disorders. We present a case presenting voiding dysfuntion with no neurologic etiology. Case : The departmcnt of urology consulted the department of psychiatry for a psychiatric evaluation of a 14-year-o1d girl with a history of recurrent urinary tract infections, enuresis, and urinary dribbling since early childhood. She visited the emergency room bccausc of severe abdominal pain and hematuria. She was admitted to the department of urology. Neurological tests showed no abnormality, but a retrograde cystogram showed free vesicoureteral reflux to the level of the dilated intrarenal collecting systems. Marked blunting and dilatation of the caliccs suggested longstanding urinary flow obstruction. She had a history of scparation anxiety disorder and was very competetive, perfectionistic, and nervous. She also had very poor relationships with her friends and had difficults in managing them. Afer admission, she had stent operation and cystostomy. Antidepressant and anxiolytic medications with supportive psychotherapy were administered to treat anxiety, tension and depression. Gradually, her depressive symptoms and voiding difficulties improved. Conclusions : Psychological factors such as a perfectionistic and obsessive personality, a history of severe separation anxiety, stressors from poor interpersonal relationships and Ihe failure of an entrance examination seem to have contributes to the development and exacerbation of the urinary dysfunction. Pharmacotherapy and supportive psycho-therapy may be efective in treating associated psychiatric problems of these patients with hinman syndrome.

정신분열병 입원 환자에서 단축형 증상관리 훈련의 효과:예비적 연구

최충식,채정호,우동원,최영희,함웅,이규항,장미화 대한신경정신의학회 2001 신경정신의학 Vol.40 No.1

연구목적: 정신분열병 환자에서의 재활치료는 개인의 극복 기술과 능력을 향상시키고 재발을 유발시킬 수 있는 스트레스의 부정적인 영향을 중화시킴으로써 질병의 만성화를 막고 사회기능을 호전시킬 수 있기에 점차 그 중요성이 대두되고 있다. 본 연구는 만성 정신분열병 입원 환자에서 재활치료의 하나인 단축형 증상관리 훈련이 정신장애에 대한 자기 인식에 미치는 효능을 알아보기 위하여 시행되었다. 방법: 정신분열병으로 진단받고 입원 중인 환자들에게 재발경고징후를 규명하는 것, 재발경고징후를 관리하는 것, 지속증상을 극복하는 것, 술과 불법 약물을 피하는 것 등으로 구성된 승인-UCLA 사회기술 및 독립적인 생활기술훈련 단위 중 증상관리단위를 기초로 한국실정에 맞게 축약한 증산관리 훈련을 주 1회, 60분씩, 4∼5주간 실시하였고 실시 전후에 전신장애 비인식 평가 척도(Scale to Assess Unawareness ofMental Disorder; 이하 SUMD)로 자신의 정신장애에 대한 인식을 평가하였으며 임상적 전반적 인상(Clinical Global Impression;이하 CGI)로 임상 상태를 조사하였고 각 인구학적 변인들을 조사하였다. 결과: 환자 30명이 훈련을 완수하였으며 이들의 평균 연령은 36.6±7.6세였고 남자가 14명(46.7%), 여자가16명(53.3%)이었다. SUMD 점수는 훈련 전 16.9±4.0점에서 훈련 후 12.9±4.2점으로 유의하게 줄어 정신장애에 대한 자기 인식 정도가 향상되었으며(p<0.01), CGI도 훈련전의 3.7±0.9점에서 훈련 후 2.8±0.8점으로 유의하게 호전되었다(p<0.01). 환자의 연령, 발병시 연령, 유병 기간, 입원 기간, 항정신병약물 사용 용량, 교육 정도, CGI로 평가한 임상 상태등은 정신장애의 자기 인식 정도와는 관련성이 없었다. 결론: 정신분열병 입원 환자에서 단축형 증상관리 훈련은 정신장애에 대한 자기 인식을 증가시킬 수 있는 방법이 될 가능성을 확인하였으며 이 방법이 정신분열병 재활치료의 중요한 요소가 될 수 있음을 알 수 있었다. Objectives : The purpose of this study was to examine whether Symptom Management Module-Korean Brief Version(SMM-B) is effective as a psychosocial treatment of the inpat-ients with chronic schizophrenia. We also questioned which of demographic and clinical characteristics could be predictors of differential treatment response. Methods : The subjects were composed of 30 inpatients with chronic schizophrenia, who were trained with weekly session of SMM-B for 5 weeks. Before and after the training, the level of psychopathology, knowledge about schizophrenia were assessed as dependent variables by using Clinical Global Impression(CGI) and Scale to Assess Unawareness of Mental Disorder(SUMD). Results : Overall, patients showed improvement over the treatment period on psychopath-ology as well as knowledge about psychosis. Total scores of SUMD were changed from 16.9±4.0 before training to 12.9±4.2 after training(p<0.01) and scores of CGI were improved from 3.7±0.9 to 2.8±0.8<p<0.01). Howver age, gender, years of education, age of onset, duration of illness, duration of admission, numbers of psychiatric admission, and clinical status evaluated by CGI were not correlated with unawareness of psychosis. Conclusion : These results suggest that SMM-B could be a reliable method to improve self-aw-areness of psychosis in patients whth chronic schizophrenia and one of important elements in rehabilitation.

구조화 전화추적 면담을 이용한 품행장애 입원 치료 환자의 예후

방양원,채정호,문석우,이은회,함웅 대한소아청소년정신의학회 2000 소아청소년정신의학 Vol.11 No.2

연구 목적 : 본 연구의 목적은 입원치료후 퇴원한 품행장애 환자들의 예후와 가족들의 정신과 입원치료의 효능에 대한 인식도를 알아보고 예후에 영향을 미칠 수 있는 요인을 알아보기 위한 것이다. 방법 : 품행장애의 진단 하에 7일 이상 입원치료를 받았으며 퇴원 후 6개월이 경과된 300명 중 전화 추적이 가능하였던 96명에서 퇴원 후 문제행동, 가족관계, 가족들의 인식도를 조사하였으며 이와 관련된 요인을 알아보았다. 결과 : 퇴원 후 문제행동의 양상은 입원전보다 호전된 경우가 90%이었으며 더 심해진 경우는 2%이었으며 8%는 변화가 없었다. 퇴원 후 가족관계는 보다 좋아진 경우가 70%, 나빠진 경우가 2%, 별 차이가 없는 경우가 28%이었다. 병원치료의 효율성에 대한 가족들의 인식도는 도움이 되었다는 경우가 57%, 해가 되었다는 경우가 6%, 그저 그렇다가 37%이었다. 퇴원 후 문제행동, 가족관계, 가족들의 입원치료에 대한 인식도 등 세 가지 항목이 모두 양호하다고 답변한 대상을 양호군으로 설정하고 그 외의 대상을 대조군으로 하여 양군의 특성의 차이를 비교하였을 때 양호군의 연령이 유의하게 낮았으며 가족 형태의 문제가 있었고 MMPI하위척도 중 남성성 -여성성 척도 점수가 유의하게 높았다. 결론 : 비록 본 연구는 여러 제한점이 내포되어 있음에도 불구하고, 정신과 입원치료를 받았던 청소년의 행동이 대부분은 호전된다는 것을 시사하여 품행장애에서의 정신과적 치료에 상당히 고무적인 결과를 나타내었으며 추후 대상자와 치료프로그램의 다양성을 통제한 연구를 지속하는 것이 필요할 것으로 생각되었다. 중심 단어 : 품행장애ㆍ청소년ㆍ예후ㆍ입원치료. Objectives : The major goal of this study was to investigate the treatment outcome of psychiatric treatment in inpatients with conduct disorder and to elucidate factors affecting its prognosis. Methods : We reviewed the medical records of 300 inpatients with conduct disorder who had been treated with a specialized adolescent treatment program. Follow-up structured telephone interview had been performed in 96 patients. Results : 1) At the point of follow-up, 90% of the patients were improved in behavioral patterns, 2% of the patients were worse, and 8% of the patients were unchanged. 2) Intrafamilial relationship was improved in 70% of the patients, worse in 2%, and unchanged in 28%, 3) Fiftyseven percent of families thought to be helped by psychiatric inpatient treatment, 6% replied to be harmed, and 37% thought not to be helpful. 4) Comparing the good prognosis group who were all better in behavioral patterns, intrafamilial relationship, and efficacy of treatment with the rest of subjects, the good prognosis group was significantly younger and had more history of problems in familial structure. Conclusion : Although the present study had some meterological limits, the promising positive results in the outcome of inpatients with conduct disorder encourages further more sophisticated investigations in this problematic psychiatric conditions. KEY WORDS : Conduct disorderㆍAdolescentㆍTreatment outcomeㆍInpatient treatment.

국내 카드뮴 취급 사업장의 카드뮴 폭로 실태 평가

강성규,홍정표,김기웅,장재연,정호근,정규철 大韓産業醫學會 1994 대한직업환경의학회지 Vol.6 No.2

Twenty-four factories registered at the Ministry of Labor as factories using or producing cadmium in 1991 were investigated to know the present state of occupational exposure to cadmium in 1992. Nine factories among 24 stopped using or changed to other substances and 1 factory didn't produce any more, but delivered it to other factories through imports. Therefore, only 14 factories were producing or using cadmium. But, alloying materials were supplied to about 20 and more factories, however, they couldn't be investigated because of limited information. Three factories had less than 50 workers were 3,6 had 50-300 and 5 had more than 300. About 167 workers were exposed to cadmium. According to the classification by process, there were 4 alloy processes, 2 refinary, 2 elctroplating, 2 dry cell making, 1 industrial battery making, 1 duplicator drum making, 1 recycling of battery and 1 copper refinary. 8 factories used metal cadmium, 3 cadmium oxide, 2 cadmium sulfide, and 1 cadmium hyroxide. One factory was importing cadmium stearates only and supplying them to the PVC making factories. The amount of metal cadmium producing in 2 refinary factories was about 50-65 ton per month. The other cadmium compounds were imported. According to exposure level of cadmium air of the 10 factories examined, each factory could be divided into high, moderate and low exposure groups. 1 battery recycling factory and 3 alloy factories were in the high exposure group and their mean air concentrations were 0.06679, 0.05481, 0.02492, and 0.003㎎/㎥, respectively. Refinary and industrial battery making factories were in the middle exposure group and their mean air concentrations were 0.00773 and 0.00613 ㎎/㎥, respectively. Finally, low exposure group were copper smelting, dry cell case making, duplicator drum making and electroplating factory and their mean air concentrations were 0.00096, 0.00071, 0.00057 and 0.00054 ㎎/㎥ respectively.

우리나라 카드뮴 폭로 근로자들의 혈중, 요중 카드뮴과 누적폭로 추정량에 따른 신장장해 평가

강성규,양정선,김기웅,장재연,정호근 大韓産業醫學會 1995 대한직업환경의학회지 Vol.7 No.1

88 workers exposed to cadmium were examined at the 12 factories using or producing cadmium in order to know the present state of cadmium exposure and renal dysfunction in 1992. Cadmium in blood and in urine were measured and compared by the 3 exposure level of cadmium in air. Cadmium in blood of low, moderate and high exposure group were 2.5, 3.8 and 7.6 ㎍/L, respectively. Cadmium in urine were 1.8(1.3), 3.8(2.6) and 7.9 ㎍/L(6.1 ㎍/g creatinine), respectively. However, there was no relationship between urinary cadmium and β₂-microglobulin. Cumulative exposure estimate(CEE) was calculated by multiplying the mean ambient cadmium level of the factory and working duration. CEE has a high correlation with cadmium in blood and urine, but no relation to β₂-microglobulin. Because working durations were relatively shorter than European workers', the highest CEE was just 300 ㎍·year/m³, which was not enough to induce renal tubular dysfunction. This study, however, suggested the possibility that renal tubular dysfunction caused by cadmium could be happened in Korea in the near future.

슬관절 골관절염 환자에서 근육내 자극요법의 치료 효과

박영규,우종웅,안승렬,김정아,윤도경,박승회,조경환,홍명호 대한노인병학회 2001 대한노인병학회지 Vol.5 No.4