Earticle

우리나라의 경제성장과 함께 의료서비스의 공급도 급속도로 상승하여 입원시설인 병동부의 병상수도 급 속도로 성장 발전하였다. 본 연구에서는 의료원 병동부의 성장변화 과정에서 병동과 병실 계획의 변화를 조사 분 석하여, 의료원의 건축계획적 자료를 제시를 목적으로 한다. 조사대상으로는 [AD]의료원과 [SS]의료원의 병동을 조사분석하였다. 결과로 첫째, 1980년대 후반에 본관이 건립된 이후 3배와 7배 이상 병상수가 증가하였다. 둘째, 수직증축과 수평증축하였으며, 수직증축은 기존시설을 그대로 반영하고 있다. 셋째, 간호단위당 병상수는 80병상에 서 최근에는 40병상대로 줄어들었다. 넷째 다인실은 6인실에서 최근에는 5인실과 4인실 위주이다.

With Korea's rapid economic growth, the supply of medical services has also expanded significantly, leading to a substantial increase in the number of hospital beds in inpatient facilities. This study aims to investigate and analyze changes in ward and patient room planning during the growth and transformation of medical center wards, providing architectural planning data for medical centers. The study focuses on analyzing the wards of [AD] Medical Center and [SS] Medical Center. The findings are as follows: First, since the construction of the main building in the late 1980s, the number of hospital beds has increased more than threefold and sevenfold, respectively. Second, both vertical and horizontal expansions were carried out, with vertical expansions incorporating the design of the existing facilities. Third, the number of beds per nursing unit has decreased from 80 to approximately 40 in recent years. Lastly, multi-patient rooms have transitioned from six-person rooms to primarily five-person and four-person rooms in recent years.

본 연구는 일개 대학생의 우울수준(CES-D: Center for Epidemiologic Studies Depression scale)과 관련된 스트레스 요인들의 융복합적 관련성을 조사하였다. 설문조사는 2018년 11월 12일부터 2018년 12월 14일까지 임의로 선정된 J지역 대 학의 재학생 304명에 대하여 무기명 자기기입식 설문지를 사용하였다. 위계적 다중회귀분석 결과, 취업스트레스(CMI: Conell Medical Index)가 높은 군에서, 학업소진(MBI-SS: Maslach Burnout Inventory-Student Survey)이 높은 군에서, 불 안(BAI: Beck Anxiety Inventory)이 높은 군에서 우울수준이 높았으며 이들의 설명력은 60.7%이었다. 이상의 연구결과를 볼 때, 대학생의 우울수준을 낮추기 위해서는 취업스트레스를 낮추고, 학업소진을 낮추고, 불안을 낮추는 노력이 필요하다. 이러한 결과는 대학생의 우울수준을 낮추는 학업 상담 및 지도, 취업상담, 및 심리 및 정서적 안정을 위한 다양한 중재 노력 에 활용될 수 있다. 추후연구에서는 대학생의 우울수준에 영향을 미치는 융복합적 요인들에 대한 구조모형의 제시 및 분석이 필요하다.

This study examined the convergent relationship of stress factors related to the depression level(CES-D) of a college student. The questionnaire was used using an unregistered self-administered questionnaire for 304 students from a college located in J area from Nov. 12, 2018 to Dec. 14, 2018. The hierarchical multiple regression analysis results are as follows: The depression level of respondents turned out to be significantly higher in following groups: a group in which job seeking stress(CMI) is higher, a group in which academic burnout(MBI-SS) is higher, a group in which anxiety(BAI) are higher. The results show explanatory power of 60.7%. The results of the study indicate that the efforts, to decrease job seeking stress, to decrease academic burnout and, to decrease anxiety, are required to decrease the depression level among college students. These results can be utilized in various interventional efforts for academic counseling and guidance, job counseling, and psychological and emotional stability that lowers the depression level in college students. Following studies requires the presentation and analysis of structural models for the structural model that effects the depression levels of college students.

Objective: To evaluate the relationship between depression and cognitive-behavioral characteristics of caregivers using social problem solving inventory (SPSI), social support or conflict scale (SSS or SCS) and somatic symptoms (SS). Method: Fifty five couples of brain-injured patients and caregivers participated in this study. We conducted a questionnaire survey of caregivers with Beck depression index (BDI), SPSI, SSS, SCS and SS for cognitive-behavioral characteristics. And also we studied demographic factors of patients and caregivers, clinical features of brain-injured patients, care- giving duration and time per day through interview and review of medical records. The statistical analyses were performed by independent t-test, one-way ANOVA, Pearson correlation test and linear regression analysis-stepwise method. Results: BDI of the caregivers showed a negative correlation with SPSI, SSS, patients’ MMSE and caregivers’ education level, also a positive correlation with SCS, SS and patients’ GDS (p＜0.05). And married caregivers showed more depressive mood (p＜0.05). Of these factors, the most influencing factors on BDI were GDS and SCS through linear regression analysis (p＜0.01). Conclusion: MMSE, GDS and education level as cognitive- mental factors rather than physical and economic strain had a statistical correlation with depression of caregivers. Especially, SPSI, SSS and SCS as cognitive-behavioral characteristics should be considered on evaluation of depression of caregivers and will be helpful for successful rehabilitation for patients and caregivers.

본 연구는 국내 치매노인 부양자들의 심리적 부양부담을 경감시키기 위한 인지행동적 집단프로그램을 개발하고자 하였다. 연구 참여자는 경기도 소재 대학병원 및 지역사회 정신건강센터에서 치매로 진단받은 환자들을 부양하는 가족부양자들이었으며, 개입 효과를 검증하기 위하여 사전, 사후, 추후평가를 하였다. 프로그램에 참여한 19명이 사전 설문지를 작성하였고, 프로그램 4회기를 종결한 후 사후 설문지를 작성한 참여자는 15명, 2개월 후 추후 회기를 마치고 추후 설문지를 작성한 참여자는 10명이었다. 참여자들에게는 단축형 자릿 부양부담평가척도(S-ZBI), Beck 우울 질문지(BDI), 상태불안질문지(STAI-Y), 부양행동척도(MCTS), 치매태도척도(DAS), 사회적 지지도 척도(MOS-SSS) 및 단축형 대처기술 설문(Brief COPE)을 사용하였고, 프로그램 개입 전, 후, 추후 효과를 검증하기 위해 반복측정 ANOVA와 대응표본 t-검정을 사용하였다. 연구 결과, 프로그램을 실시하기 전에 비해 부양부담의 하위 척도인 개인적 부담은 프로그램 종료 직후와 2개월 후에도 감소된 상태를 유지하였다. 그러나 부양부담, 우울수준 및 치매노인에 대한 잠재적 학대행동은 프로그램 종료 직후에만 유의하게 감소하였고, 스트레스에 대한 대처기술은 프로그램 종료 직후에만 유의하게 증가하였으며, 2개월 후까지 효과가 지속되지는 못하였다. 불안수준, 치매에 대한 태도, 사회적 지지에서는 사전, 사후, 추후 간에 유의한 변화가 관찰되지 않았다. 끝으로 본 연구의 의의와 제한점 및 추후 연구를 위한 제언을 논의하였다.

This study developed a preliminary cognitive-behavioral group program for the family care-givers of dementia patients, and explored its therapeutic effects on their care-giving burdens, coping skills, and psychological distress. Primary care-givers of dementia patients were recruited from a university hospital in Gyeonggi Province, Korea and a community mental health care center (N=19). The program took place weekly for 90 minutes, lasting for four weeks (four therapy sessions). A booster session was provided after two months. Treatment effect was measured by asking the participants to complete pre-, post-, and follow-up evaluation: the Short Zarit Burden Inventory (S-ZBI), Modified Conflict Tactics Scale (MCTS), Dementia Attitudes Scale (DAS), Medical Outcome Study Social Support Survey (MOS-SS), Brief COPE (B-COP), Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI). Repeated measures ANOVA, and paired t-test were conducted to assess the therapeutic effect of the group program. The decrease in personal strain (S-ZBI's subscale) was maintained at two-month follow-up. The level of depression and aggressive attitude/behaviors toward dementia patients were temporarily reduced after intervention, and the use of coping skill was temporarily increased after the intervention. However, there was no significant change in the level of anxiety, attitude towards dementia, and social support. The implication and limitation of this study and suggestions for future study are discussed.

Purpose: The purpose of this study was to compare patients who had undergone spine surgery (SS) and hip arthroplasty surgery (HAS) and to analyze how medical policies drawn from “The Evaluation of the Appropriate Use of Prophylactic Antibiotics” have affected length of hospital stay (LOS), direct medical costs (DMC), and the duration of antibiotics use in Korea. Materials and Methods: This retrospective nationwide study identified subjects from the Korean National Health Insurance Re view and Assessment Service database from January, 2011 to December, 2018. Evaluation of HAS (control group) was implement ed in 2007, and that for SS (case group) was conducted for the first time in 2014 (intervention time). In our comparative interrupt ed time series analysis, we compared DMC, LOS, and use of antibiotics between both groups. Results: 177468 patients who underwent SS and 89372 patients who underwent HAS were included in the study. In 2016, DMC increased for HAS, compared to SS, by 1.03 times (p=0.041). However, cost changes during other observational periods for SS were not higher than those for HAS (p>0.05). SS incurred a reduced LOS of 3% in the first 2 years (p<0.05). Thereafter, LOS chang es in SS were not smaller than those in HAS. A decrease in the usage of total antibiotics and broad spectrum antibiotics was ob served for 5 years. Conclusion: This medical policy was effective in terms of reducing usage and duration of antibiotics use, especially in the first 2 years after the implementation of the policy.

The purpose of this study was to evaluate the Osstem?? implants (US II/SS II implants) through the retrospective study for the clinical success rate during the installation of the Osstem?? implants (US II/SS II implants) by using of the procedures of maxillary sinus floor elevation. Materials and methods: The current study was researched in the 6 medical institutions: Chonnam National University, Chosun University, Pusan DaeDong Hospital, Bundang Seoul National University Hospital, Ap-Seon Clinic, and All Clinic. Based on the total number of 116 patients whose treatment was the installation of the US II/SS II implants with the procedures of the maxillary sinus floor elevation, they were conferred on the dental records of the patients under the joint consultation of the 6 medical institutions. On the dental recording charts, there were included in as the following; the name of the institutions, gender, age, with or without smoking or drinking, with or without the generalized diseases, the height of the alveolar bone on the operational sites, elapsed edentulous state period, the state of the opposed or adjacent teeth, the methods of the maxillary sinus floor elevation, secondary time period for surgery, the lengths, types, and diameters of implants, with or without bone transplantation or the types of bone, postoperative current bone height, current adjacent soft tissue state of the implants, with or without the success of the installations of the implants. We have done our survey with the clinical and radiolographical examinations and dental questionaries. The success and survival rate of the implants was evaluated. Results 1. Total number of the patients with the installation of the US II implants were 62. The 252 numbers of US II implants were installed on the 89 maxillary sinuses. The patient's mean age was 54.1 years old and there were 36 men and 27 women. 2. Total number of patients with the installation of SS II implant were 57. The 165 numbers of SS II implants were planted on the 80 maxillary sinuses. Their mean age was 48.7 years old and there were 37 men and 20 women. 3. The follow-up period was 30.7 months(21-49 mon) on average. The vertical bone loss of installed implants after the procedures of the maxillary sinus elevation was 1.1 mm on average in SS II and 1.3 mm on average in US II. There existed no statistical significance on each group. The mean enlarged bone height after the maxillary sinus floor elevation was 8.2 mm. 4. For the procedures of the maxillary sinus elevation, the Lateral approach technique occupied 87.1%, which was the most used one. In addition, the most frequently used transplanted bone was autogenous bone only which was 72.7% during the maxillary sinus floor elevation. 5. The complication of maxillary sinus floor elevation were perforation of sinus membrane, disesthesia on doner site, exposure of cover screw and exposure of maxillar bone. 6. The survival rate of US II and SS II after maxillary sinus floor elevation was 99.2% and 95.8%, respectively. And the success rate of US II and SS II after maxillary sinus floor elevation was 97.6% and 89.7%, respectively. Conclusion : On the evaluation of the analysis of our study, both US II and SS II implants showed the excellent clinical results by use of the procedures of maxillary sinus floor elevation.

Purpose: The purpose of this study was to evaluate the $Osstem^{(R)}$ implants (US II/SS II implants) through the retrospective study for the clinical success rate during the installation of the $Osstem^{(R)}$ implants (US II/SS II implants) by using of the procedures of maxillary sinus floor elevation. Materials and methods: The current study was researched in the 6 medical institutions: Chonnam National University, Chosun University, Pusan DaeDong Hospital, Bundang Seoul National University Hospital, Ap-Seon Clinic, and All Clinic. Based on the total number of 116 patients whose treatment was the installation of the US II/SS II implants with the procedures of the maxillary sinus floor elevation, they were conferred on the dental records of the patients under the joint consultation of the 6 medical institutions. On the dental recording charts, there were included in as the following; the name of the institutions, gender, age, with or without smoking or drinking, with or without the generalized diseases, the height of the alveolar bone on the operational sites, elapsed edentulous state period, the state of the opposed or adjacent teeth, the methods of the maxillary sinus floor elevation, secondary time period for surgery, the lengths, types, and diameters of implants, with or without bone transplantation or the types of bone, postoperative current bone height, current adjacent soft tissue state of the implants, with or without the success of the installations of the implants. We have done our survey with the clinical and radiolographical examinations and dental questionaries. The success and survival rate of the implants was evaluated. Results 1. Total number of the patients with the installation of the US II implants were 62. The 252 numbers of US II implants were installed on the 89 maxillary sinuses. The patient's mean age was 54.1 years old and there were 36 men and 27 women. 2. Total number of patients with the installation of SS II implant were 57. The 165 numbers of SS II implants were planted on the 80 maxillary sinuses. Their mean age was 48.7 years old and there were 37 men and 20 women. 3. The follow-up period was 30.7 months(21-49 mon) on average. The vertical bone loss of installed implants after the procedures of the maxillary sinus elevation was 1.1 mm on average in SS II and 1.3 mm on average in US II. There existed no statistical significance on each group. The mean enlarged bone height after the maxillary sinus floor elevation was 8.2 mm. 4. For the procedures of the maxillary sinus elevation, the Lateral approach technique occupied 87.1%, which was the most used one. In addition, the most frequently used transplanted bone was autogenous bone only which was 72.7% during the maxillary sinus floor elevation. 5. The complication of maxillary sinus floor elevation were perforation of sinus membrane, disesthesia on doner site, exposure of cover screw and exposure of maxillar bone. 6. The survival rate of US II and SS II after maxillary sinus floor elevation was 99.2% and 95.8%, respectively. And the success rate of US II and SS II after maxillary sinus floor elevation was 97.6% and 89.7%, respectively. Conclusion : On the evaluation of the analysis of our study, both US II and SS II implants showed the excellent clinical results by use of the procedures of maxillary sinus floor elevation.

This research explores the case of the 1903 smallpox outbreak on the SS Korea, a transpacific carrier making runs between Southeast Asia, East Asia, Hawaii, and the United States. These regions were connected to a degree that no one had ever imagined through the SS Korea. Honolulu, Hawaii, was one of the most important territories in US maritime history and served as a waypoint from Asia to San Francisco on the mainland. As increasing numbers of people traveled by sea, various microbes were communicated across the Pacific. International tourists traveling across the ocean to Hawaii and the United States were alerted infectious disease, one of the most significant being smallpox. The story of the SS Korea serves as an important lens through which to explore the early twentieth century transpacific world connected through Honolulu. Focusing on the spread of smallpox via international travelers, this research studies aspects of the public health system that were developed to contain smallpox infection on international ships and the application of smallpox vaccination as a method for infectious disease control. More importantly, in bringing attention to the uncertainty surrounding the diagnosis of smallpox, this research argues for the necessity of historians to build a more comprehensive medical historical context for disease control systems that includes the limits of medical science in making diagnoses of infectious diseases, the uncertainties arising from a lack of this component, and the implementation of health policies and preventative medical technologies.

치과 교정치료를 위하여 스테인리스 선재가 널리 사용되고 있다. 그러나 내식성이 우수한 스테인리스강 선재가 복합적인 구강환경에서 부식되어 구강조직에 과민반응 또는 이상반응이 발생되고 있다. 이러한 문제를 보완하기 위하여 본 연구에서는 초내식성의 듀플렉스 스테인리스 선재를 교정용 선재로 제시하고 자 한다. DSS선재의 교정용 선재로 제시하기 위하여 기계적 강도와 생물학적 안정성을 평가하였다. 기계적 강도는 상용 교정용 SS선재와 6종의 열처리(실온($28^{\circ}C$), $500^{\circ}C$, $600^{\circ}C$, $700^{\circ}C$, $800^{\circ}C$, $900^{\circ}C$)를 실시한 DSS선재를 이용하여 인장강도시험을 실시하였다. 그리고 최적의 강도를 가지는 열처리 조건에서 제작된 DSS선재를 이용하여 굽힘 모멘트 시험을 실시하여 최대 응력과 탄성계수를 산출하였다. 그리고 생물학적 안정성 평가를 위하여 세포성장률 시험을 실시하였다. 선재를 이용하여 금속용출배지를 만들어 세포를 배양 후 세포성장률을 관찰하였다. 기계적 강도 평가 결과 SS선재($8.17\times10^4\;N/mm^2$)와 DSS500($8.05\times10^4\;N/mm^2$)선재가 유사한 기계적 강도를 가졌다(p=0.05). 생물학적 안전성 평가 결과 세포 독성이 없는 것으로 나타났다(p=0.05). 따라서 본 연구에 제시한 초내식성의 듀플렉스 스테인리스 선재가 교정용 선재로 사용이 가능한 것으로 판단된다.

The stainless steel wire is extensively used for the orthodontic treatment. But, the stainless steel wire that has commonly superior corrosion resistance has caused hypersensitive reaction or allergy as side effects because of corrosion in the oral environment. For improving the problem of corrosion, we was evaluated the suitability of the duplex stainless steel(DSS) as orthodontic wire through this study. The DSS wire was evaluated the mechanical strength and bio-stability for suitability and bio-compatibility as orthodontic wire. In this work, the DSS and stainless steel(SS) as common use of medical grade were prepared for the tensile strength test. The DSS wire were treated by heat. and Temperature conditions of the heat treatment were $28^{\circ}C$, $500^{\circ}C$, $600^{\circ}C$, $700^{\circ}C$, $800^{\circ}C$, $900^{\circ}C$, respectively. And the DSS wires that treated by heat on the optimum temperature condition were conducted the bending moment test and calculated the S-Max value and the modulus of elasticity. For evaluating the bio stability, each materials were conducted in vitro test for measuring the cell survival rate. The most interesting results was that the tensile strength test of SS wire($8.17\times10^4\;N/mm^2$) and DSS wire($8.05\times10^4\;N/mm^2$) that treated at $500^{\circ}C$ by heat were similar in mechanical strength. In the bio-stability study, the DSS has no cytotoxicity (p=0.05) Thus, we could make a conclusion that the duplex stainless steel wire has vastly superior corrosion resistance was suitable as orthodontic wire.

이 글은 최창학(崔昌學, 1941~2020)의 원폭문학 「해변의 묘지」(1981)를 고찰하고자 한다. 최창학이 작품을 구상하던 1970년대 후반은 데탕트가 끝나고 미·소가 신무기를 바탕으로 핵군비 경쟁을 가속화하던 시점이었다. 그는 소련의 SS-20 배치와아프가니스탄 공습, 레이건의 등장 등을 목도하면서 ‘제2차 세계대전의 원자폭탄’으로시선을 향했다. 그 무렵 한국의 원폭 피해자에게도 변화가 시작되고 있었다. 1980년10월 8일 한·일 양 정부는 피폭자의 도일치료를 결정했다. 작가는 1970년대 합천원폭피해자진료소 개원, 손진두 소송의 승소, 도일치료 등을 접하면서 작품을 구상했다. 요컨대 ‘손진두 소송’으로 피폭자건강수첩을 교부받고 도일치료를 할 수 있는 길이 제한적으로 열린 시점에서 최창학은 한국인 원폭 피해자의 어떤 점에 주목하고 무엇을대변하여 독자에게 전달하고자 했을까. 전쟁과 피해자의 역사를 서사의 대상으로 삼은 전달자는 무엇을 어떻게 쓸 것인지 고심하지 않을 수 없다. 「해변의 묘지」는 이런고민의 산물이기에 이 소설이 지닌 문학적 전략과 효과는 구명(究明)되어야 할 과제라고 할 수 있다.

This study discusses Cemetery on the Beach, an atomic bomb novel written in 1981 by Choi Chang-hak (1941-2020). The late 1970s, when Choi envisioned this novel, was a period when the end of the detente opened an accelerating nuclear arms race between the United States (US) and the Soviet Union. Witnessing the the Soviet Union’s SS-20 deployment, the air strikes on Afghanistan, and US President Reagan’s intervension, Choi turned his eyes to the atomic bombs of World War II. At the time, the Korean victims of the Hiroshima atomic bombs were also experiencing changes. On October 8, 1980, the two governments of Korea and Japan decided to take the Korean victims to Japan for medical treatment. Choi put together his ideas for the novel in the 1970s amid the news of the new Hapcheon Atomic Bomb Victims Medical Center, the court’s ruling in favor of Son Jin-doo, a victim of the Hiroshima atomic bombs, and the medical treatment for Korean atomic bomb survivors in Japan. At a time when the Son Jin-doo lawsuit opened a small window for Korean atomic bomb survivors to obtain the Japanese Hibakusha Techo (booklet certifying atomic bomb victims) and go to Japan for medical treatment, what of the Korean atomic bomb victims attracted Choi’s attention and what did Choi seek to deliver to the readers on their behalf? A messenger narrating the history of war and its victims is compelled to worry over what to write and how. Since Cemetery on the Beach is a product of such worries, it is necessary to uncover the novel’s literary strategy and effects.

목적: 본 연구의 목적은 탄성력이 높게 개발된 레진의 굽힘 강도를 평가하고, resin wire splint (RWS)와 유연성을 비교 평가하는 것이다. 재료 및 방법: 세가지 레진 G-aenial flo (GA, GC), Superbond (SB, Sun medical), G-fix (GF, GC)의 세 점 굽힘 강도는 ISO4049/2000에 따라 진행하였다. GA, SB, GF를 이용한 세개의 RS군과 GA와 교정용 016" SS wire를 이용한 RWS군간의 치아 동요도 비교는 영구치 모형을 이용하였다. 상악좌측중절치에 3도의 동요를 부여하고, 치아의 수평적인 동요도를 splint 전후에 각 3회씩 periotest vale로 평가하였다. Splint 전후 periotest value는 splinting 효과로 환산하여 평가하였다. 통계적인 평가는 one-way ANOVA와 turkey HDS test를 이용하였다(${\alpha}=.05$). 결과: SB와 GF가 GA에 비해 낮은 굴곡강도를 보였으나, 세가지 RS군은 RWS에 비해 높은 splinting 효과를 나타내었다 (P < .05). 결론: 제한된 본 연구에서 사용된 재료와 상관없이 RS는 RWS에 비해 높은 견고성을 보였으며, 이는 탈구치아 치료를 위한 flexible splint에 부적합한 것으로 보인다.

Purpose: The aim of this study is to evaluate the flexural strength of flexible resins and the flexibility of different resin splint (RS) systems in comparison with resin wire splint (RWS) system. Materials and methods: Three different resin materials (G-aenial flo, GA, GC; Superbond, SB, Sun medical; G-fix, GF, GC) were tested flexural strength test in accordance with ISO-4049:2000. For the flexibility test of splint systems, a artificial model with resin teeth was used to evaluate three types of resin splint systems (GA, SB, and GF) and one resin wire splint system. The left central incisor was simulated 'injured teeth' with third degree mobility. Three consecutively repeated measurements of periotest value were taken in horizontal direction, before and after splinting to access tooth mobility. The splinting effect was calculated through the periotest value. Differences were evaluated through One-way Anova and Tukey HDS post-hoc tests for pair-wise comparison (${\alpha}=.05$). Results: Although GA group showed significant higher flexural strength than SB and GF groups, all of three different resin splint systems produced a significantly higher and rigid splinting effect compared with 016" resin-wire splint system (P < .05). Conclusion: Within the limits of an in vitro study, it can be stated that resin splint systems are too rigid and may not be acceptable to treat tooth avulsion.

본 연구는 유방암 환자의 외상 후 성장에 영향을 미치는 요인을 조사하고자 진행되었으며 자료수집은 인천광역시 내 대학병원 외래를 내원하여 유방암 진단을 받고 치료과정 중에 있는 유방암 환자 100명을 대상으로 하였다. 연구도구는 한국어판 외상 후 성장 척도(K-PTGI), 사회적지지(mMOS-SS), 유방암 자가관리에 대한 자기효능감 척도(SESSM-B)와 대처행동(CCQ) 도구를 사용하였다. 자료의 분석은 t-검정, ANOVA, Pearson 상관분석, 단계적 다중회귀분석을 하였다. 연구결과 외상 후 성장 정도는 5점만점에 평균 3.4(${\pm}0.9$)점이었다. 외상 후 성장은 사회적 지지, 유방암 자가관리에 대한 자기효능감, 대처행동과 통계적으로 유의한 양의 상관관계를 보였다. 단계적 다중회귀분석에서, 치료이행 자기효능감과 긍정적 재구조화 대처행동이 유방암환자의 외상 후 성장 영향 요인으로 나타났고, 이들 변수들의 설명력은 29%였다. 본 연구 결과를 바탕으로 유방암환자의 외상 후 성장을 향상시킬 수 있는 간호 중재 개발을 고려할 필요가 있겠다.

This study was undertaken to investigate the factors that influence post-traumatic growth in patients with breast cancer. The study subjects were 100 outpatients with breast cancer who visited the outpatient clinic of a university hospital. The instruments used for this study were Korean Post-traumatic Inventory (K-PTGI), Modified Medical Outcomes Study Social Support Survey (mMOS-SS), Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B) and Cancer Coping Questionnaire (CCQ). The data were analyzed by t-test, ANOVA, Pearson-correlation coefficient, and stepwise multiple regression using SPSS/WIN 21.0. The mean score of post-traumatic growth was $3.4{\pm}0.9$ out of 5. Post traumatic growth had statistically significant correlation with social support, breast cancer self-management self-efficacy, and coping behavior. In stepwise multiple regression analysis, post-traumatic growth was significantly influenced by therapeutic compliance related self-efficacy and positive reframing coping behavior and it was account for 29% of the total variance. These results suggest that these influencing factors should be considered in developing the nursing intervention to improve the post-traumatic growth in patient with breast cancer.

목적: TNM 분류법의 임상적 분류법과 병리학적 분류법은 항상 일치하지는 않는다. 진행성 위암의 육안적 침윤정도 특히 육안적 장막침윤의 의의를 파악하고, 육안적 침윤정도와 병리학적 침윤정도의 일치율을 높일 수 있는 방안을 모색하고자 하였다. 대상 및 방법: 1995년부터 1999년까지 경북대학교병원 외과에서 진행성 위암으로 수술 받은 789명의 환자를 대상으로 하였다. 육안적 및 병리학적 장막침윤 여부에 따른 환자의 예후와 재발양상을 분석하고 육안적 장막침윤과 병리학적 장막침윤이 일치하지 않는 경우는 이에 영향을 주는 인자를 찾았다. 결과: 병리학적 장막침윤에 따른 예후뿐 아니라 육안적 장막침윤에 따른 예후도 유의한 차이를 나타내었다. 육안적 장막침윤이 있는 경우의 42.2%와 병리학적 장막침윤이 있는 경우의 41.4%에서 재발하였으며, 복막재발의 빈도는 19.8% 및 21.9%로 비슷하였다. 육안적 장막침윤 판정의 민감도는 70.3%, 특이도는 77.0%, 양성예측도는 56,4%, 음성 예측도는 86.5%이었다 cT3/ss cancer와 cT3/se cancer와의 비교에서 원격전이 유무 및 육안적 형태에 따라서 유의한 차이를 나타내었고, 다변량 분석에서 두 변수 모두 cT3 cancer가 병리학적으로 ss cancer로 판정될 위험 인자이었다. 결론: 종양이 Borrmann I형이나 II형인 경우와 원격 전이가 없는 경우에는 육안적으로 장막침윤이 있더라도 병리학적으로는 장막침윤이 없을 가능성이 있기 때문에 주의를 요하지만, 위암의 육안적 장막침윤 여부는 환자의 생존율과 근치적 수술 후의 재발양상을 잘 반영하기 때문에 종양학적 가치가 충분하다.

Purpose: The macroscopic findings of tumors are not always identical with the microscopic findings. This study investigated the oncologic implications of macroscopic serosal invasion in advanced gastric cancer to find out how to improve the accuracy for the depth of invasion assessed by the surgeon during an operation. Materials and Methods: The medical records of 789 patients with advanced gastric cancer who underwent a gastrectomy at Kyungpook National University Hospital between 1995 and 1999 were reviewed. The prognoses and the recurrence patterns were analyzed according to macroscopic serosal invasion and microscopic serosal invasion, and the clinico-pathological factors of cT3/ss cancers were compared with those of cT3/se cancers. Results: Difference of survival rates according to macroscopic serosal invasion and microscopic serosal invasion revealed statistically significant. Recurrence rates were similar in patients with macroscopic and microscopic serosal invasion (42.2% and 41.4%, respectively). Peritoneal recurrence rates were also similar (19.8% and 21.9%, respectively). The sensitivity and the specificity of macroscopic assessment of serosal invasion were 70.3% and 77.8%, respectively, On univariate and multivariate analyses, Borrmann type I/II cancers and the absence of distant metastases revealed the risk factors for overestimating of serosal invasion. Conclusion: Macroscopic serosal invasion assessed by a surgeon intraoperatively can be used to give a prognosis and to predict the recurrence pattern precisely, although there is a risk for overestimation when the tumor is a Borrmann type I/II cancer or the tumor has no distant metastases. (J Korean Gastric Cancer Assoc 2006;6:84-90)

목적: 선천소안구증 환자에서 비수술적 치료로 의안 착용을 하였을 때의 임상 경과를 보고하고자 한다. 대상과 방법: 소안구증으로 진단받고 수술 없이 의안을 착용하고 있는 환자 20명의 임상 경과를 후향적으로 조사하였다. 결과: 총 20명의 환자 중 남자 12명, 여자 8명이며 소안구증 진단 당시 평균 나이는 생후 4개월이었다. 소안구증과 동반된 안과 질환으로는 선천성 백내장 2명, 후태 생환(posterior embryotoxon) 1명, 각막홍채 선조(corneo iris strand) 1명, 홍채 결손(iris coloboma) 4명, 중심부 각막혼탁 5명, 피터 이상(Peter’s anomaly) 1명, 구후낭(retrobulbar cyst) 1명이 있었다. 다른 신체 기형으로는 가쪽뇌실의 위축, 뇌량 위축, 동맥관개존증, 심방중격결손, 언어발달장애가 있으며, anti SS-A Ab과 anti nuclear antibody (ANA) 양성, next generation sequencing 검사상 PAX6 mutation이 1명에서 확인되었다. 가족력과 임신 시 특이 사항은 모든 환자에서 없었다. 평균추적 기간은 5.94년(1개월-18년), 초진 시 각막 수평직경은 평균 4.6 mm, 안구 길이는 평균 17.44 mm, 의안의 첫 착용 시기는 평균5.96살(7개월-19살)이었고, 의안의 교체 시기 간격은 평균 22개월(4개월-5년 8개월)이었다. 결론: 저자들은 선천소안구증 환자 20명에서 의안을 일정한 간격을 두고 교체하는 방법으로 안와를 점진적으로 확장시켜 수술 없이의안 착용만으로 심각한 합병증 없이 미용개선 효과를 얻을 수 있었다.

Purpose: To report the long-term clinical outcomes of non-surgical treatment involving prosthetic eye wear in patients diagnosed with congenital microphthalmos. Methods: A retrospective review of the medical records of 20 patients was conducted. In total, 21 eyes were diagnosed with congenital microphthalmos between May 2008 and December 2022 at Seoul St. Mary’s Hospital in Korea. Results: This study included 20 patients (12 males and 8 females) with an average age of 4 months at diagnosis. The observed ophthalmic anomalies included two cases of congenital cataract, one of posterior embryotoxon, one of corneo-iris strand, four of iris coloboma, five of central corneal opacity, one of Peter's anomaly, and one of retrobulbar cyst. Accompanying systemic abnormalities were noted, such as lateral ventricle atrophy, corpus callosum atrophy, patent ductus arteriosus, atrial septal defect, and developmental language disorder. Genetic anomalies included anti SS-A/Ro antibody positivity, a 1:100 titer of anti-nuclear antibody, and a PAX6 mutation identified through next-generation sequencing. No specific family histories or pregnancy-related factors were noted. The average follow-up duration was 5.94 years (range: 1 month to 18 years), the average corneal diameter was 4.6 mm, the average axial length was 17.44 mm, the average age for first artificial eye trial was 5.96 years (range: 7 months to 19 years), and the average interval for artificial eye replacement was 22 months (range: 4 months to 5 years and 8 months). Conclusions: Twenty patients with congenital microphthalmos underwent gradual expansion of their prosthetic eyes by regular replacement and size increase without severe complications. This approach led to aesthetically and emotionally positive outcomes for the patients.

목적: 원발쇼그렌증후군 환자에서 눈물 오스몰 농도와 눈 및 전신질환과 관련된 인자들의 관련성에 대하여 알아보고자 하였다. 대상과 방법: 원발쇼그렌증후군으로 진단받은 환자 중 3개월 이상 경과관찰한 총 53명을 대상으로 의무기록을 후향적으로 분석하였다. TearLabⓇ (TearLab™ Corp., San Diego, CA, USA) 오스몰 농도 측정기를 이용한 눈물 오스몰 농도와, 각결막표면염색 검사, 안구표면장애 측정표(ocular surface disease index, OSDI) 및 시각통증척도(visual analogue scale, VAS)를 통한 증상점수, 눈물막파괴시간, 쉬르머검사, 그리고 자가항체 등에 대하여 확인하였다. 결과: 53명의 환자는 여성의 비율이 96.23%였으며, 28.3%의 환자에서 중증 쇼그렌증후군에 대하여 류마티스 내과에서 전신적인 약제를 처방 받아 복용 중이었다. 쇼그렌증후군 환자에서 눈물 오스몰 농도는 평균 307 ± 13.6 mOsm/L였다. 눈물 오스몰 농도가 높은 것은 눈물막 파괴시간과 음의 상관관계를 보였으나 통계적으로 유의하지 않았으며, 높은 각결막표면염색 검사 점수와 연관이 있었다. 눈물 오스몰 농도는 쉬르머검사 결과와 연관성이 없었으며 높은 눈물 오스몰 농도는 역설적으로 낮은 VAS 점수와 낮은 OSDI 점수와 관련성이 있었다. 눈물 오스몰 농도는 항 Ro (SS-A)와 항 La (SS-B) 항체 수치와는 연관성이 없었지만, 혈청 면역글로불린 G (immunoglobulin G, IgG) 수치(ρ=0.347, p=0.003)와 혈청 적혈구침강속도(erythrocyte sedimentation rate, ESR) 수치(ρ=0.277, p=0.010) 와 양의 상관 관계를 보였다. 결론: 눈물 오스몰 농도는 안구건조증의 중증도와 양의 상관 관계가 있으며, 낮은 증상 지표와 연관이 있다. 높은 눈물 오스몰 농도와 IgG, ESR 수치가 연관 있는 것은 자가항체 발현 정도와 전신적인 염증 정도와 연관 있을 것으로 생각된다.

Purpose: To investigate the relationships between tear osmolarity and various parameters for ocular and systemic disease in primary Sjogren's syndrome. Methods: The medical records of 53 patients with primary Sjogren's syndrome were reviewed. Tear osmolarity using a TearLab® (TearLab™ Corp., San Diego, CA, USA) osmometer as well as other dry eye parameters such as tear break-up time, ocular staining score (Sjogren's International Collaboration Clinical Alliance [SICCA] ocular staining score, SICCA score), Schirmer-I score, symptoms with Ocular Surface Disease Index (OSDI), and Visual Analog Scale (VAS) were obtained. Systemic laboratory data and medication history were also collected. The correlations between the parameters were analyzed using the Spearman's rank correlation test. Results: 53 patients with a mean age of 54.1 ± 13.2 years and female predominance (96.23%) were enrolled. The majority of patients (28.3%) were receiving systemic therapy for severe Sjogren's syndrome. The tear osmolarity in Sjogren's syndrome patients was 307 ± 13.6 (mOsm/L). Higher tear osmolarity was associated with lower tear film break-up time (BUT) scores and with higher SICCA scores. Tear osmolarity and the Schirmer test results were not significantly related. Higher tear osmolarity was paradoxically associated with lower VAS scores and lower OSDI scores. Neither current medication nor the salivary gland focus score showed significant associations with tear osmolarity. Although tear osmolarity was not associated with the SSA-Ro or SSA-LA titer, serum immunoglobulin G (IgG) level and serum erythrocyte sedimentation rate (ESR) level showed positive correlations with tear osmolarity. Conclusions: Tear osmolarity is positively correlated with the severity of dry eye and was associated with lower symptom severity. The significant associations of tear osmolarity with IgG and ESR suggest that high tear osmolarity may be correlated with autoantibody load and the systemic inflammatory state.

연구목적: 본 연구는 작업치료사의 심리적 안녕감의 정도를 알아보고 일반적 특성 및 업무관련 특성과 심리적 안녕감과의 상관관계를 알아보고자 한다. 연구방법:2011년 6월 1일에서 6월 30일까지 현재 국내 대학병원, 종합병원, 복지관, 재활 관련 기관 등에서 근무경력이 6개월 이상인 작업치료사를 대상으로 우편, 온라인 등을 통한 설문지 94부를 수집 및 분석하였다. 실시하였다. MAL과 SS-QOL의 점수 간의 상관관계를 분석하기 위해 Pearson 상관분석을 하였다. 연구결과:작업치료사의 심리적 안녕감은 192.5±28.5점이었고 작업치료사의 심리적 안녕감의 6가지 차원은 개인적 성장, 긍정적 대인관계, 자아수용, 환경통제력, 삶의 목적, 자율성 순으로 점수가 높았다. 작업치료사의 일반적 특성과 심리적 안녕감에 관한 분석 결과, 유의미한 관련성이 없었고 작업치료사의 업무 특성과 심리적 안녕감에 관한 분석 결과, 동료 수는 심리적 안녕감과 심리적 안녕감의 6가지 차원 중 자아수용, 긍정적 대인관계에 유의미한 차이를 보였으며 특히, 환경통제력은 매우 유의미한 차이를 보여주었다. 치료대상은 심리적 안녕감의 6가지 차원 중, 삶의 목적에만 유의미한 차이를 보였고 근무 중 휴식시간은 심리적 안녕감의 6가지 차원 중 개인적 성장과 유의미한 차이를 보였다. 결론:심리적 안녕감은 동료수와 유의미한 관련이 있었으며 작업치료사의 심리적 안녕감에 대한 체계적인 연구 및 심리적 안녕감을 증진시킬 수 있는 프로그램의 개발 및 실시를 통한 질적인 의료서비스 제공이 이루어져야 할 것이다.

Purpose : The aim of this study was conducted to investigate the level of psychological well-being of occupational therapists, and look into psychological well-being according to general characteristic and work characteristic for the occupational therapist. Methods : The Structured questionnaires were distributed to occupational therapists with more than 6 months of experience in occupational therapy at the places like university hospitals, general hospitals, welfare houses and rehabilitation facilities through on-line and mail service from June 1, 2011 to June 30, 2011. The 94 questionnaires were collected and analyzed. Results : The average score of occupational therapists' psychological well-being was 192.5±28.5 and the personal growth showed highest score followed by positive relations, self-acceptance, environmental mastery, purpose in life, autonomy of psychological well-being. There were no significant differences between general characteristic and psychological well-being. The study showed statistically significant differences in the correlation between company number and psychological well-being, self-acceptance, positive relations, environmental mastery. There were significant differences between subject of investigation and purpose in life. The break time made a significant difference in the personal growth. Conclusion : There were statistically significant differences in the correlation between company number and psychological well-being. It would provide better medical service through implementation of the developed program to improve the psychological well-being of occupational therapists.

Purpose: This study was conducted to examine the relationship between the prevalence of burnout and its related factors in medical students in Korea. Methods: All available medical students in the metropolitan city of Daejeon, Korea, were asked to answer self-administered questionnaires from July 1 to July 26 in 2013. A total of 534 medical students participated. The Maslach Burnout Inventory-Student Survey (MBI-SS) and structured questionnaires on related factors were used. Confirmatory factor analysis and Cronbach’s α were used to verify the applicability of the MBI-SS to medical students in Korea. We also performed chi-square test and logistic regression analysis to identify the factors that were associated with burnout. Results: The MBI-SS was reliable and valid in measuring burnout in Korean medical students. Our confirmatory factor analysis approved and explained the appropriateness of the model fit. The prevalence of burnout among medical students was 26.4% (n=141). Such rates were higher in students who were female, experienced greater levels of depression, had poor academic performance, feared dropping out, and were stressed by the poor quality of the class facilities. Conclusion: The MBI-SS is a valid instrument to measure academic burnout in Korean medical students. Further studies should be performed, because improvements in the mental health of medical students will benefit these doctors-to-be and their future patients.

Objectives: Medical students suffer from mental health and academic problems due to academic stress. We investigated academic stress and exhaustion along with psychological issues caused by medical education during the years in the School of Korean Medicine. Methods: Two hundred fifty-one university students from the School of Korean Medicine, Pusan National University, were asked to complete the Medical Stress Scale (MSS), Maslach Burnout Inventory-Student Survey (MBI-SS), Positive Affect and Negative Affect Schedule (PANAS), and State-Trait Anxiety Inventory (STAI) three times during each semester for two years from 2013 onwards. We analyzed the influence of school term and vacation on educational stress and negative affect with the T-test. The Pearson's correlation analysis and regression analysis were used to predict changes during the first semester or first years of study in the School of Korean Medicine. Results: Academic stress and burnout increased steadily until the first semester of third grade, which was measured with MSS and MBI-SS. The anxiety level was highest when the students started the first grade and it decreased significantly after the first semester. Negative affect repeatedly increased significantly after each school term; however, it reduced after each vacation. In the first grade, 19.5% of the last measure of MSS can be explained with the first measure of MSS. Discussion: This study extensively reviewed the trends and characteristics of four years of academic stress and its related psychological influence, and discussed its importance for developing a more efficient academic curriculum for traditional Korean Medicine.

Objectives: The purpose of this study was to research the correlation between academic achievement, lifestyle, and the psychological characteristics of Korean medical students. Methods: The grade point averages of 73 Korean medical students were collected. Surveys including lifestyle and psychological properties of Korean medical students were conducted. Results: In the MBI-SS (Maslach Burnout Inventory-Student Survey) survey, the scores of the top, medium, and bottom groups showed statistically significant difference in at least one group, and the score of the bottom group was higher than that of the top group. In the SES (Self-Esteem Scale) survey, the scores of the top, middle, and bottom groups showed statistically significant differences in at least one group, and the scores of the top group were higher than those of the medium and bottom groups. Conclusions: Some lifestyle and psychological characteristics of Korean medical students were correlated with academic achievement. Thus, the results could be used as a valuable resource for improving academic achievements of Korean medical students.