• 대한간호학회지
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• 제22권1호
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• pp.81-115
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• 1992

The problem addressed by this study was to determine the effect of nurse - patient agreement on the means to achieve nursing goals in the early postpartum period of primiparous mothers. It was hypothesized that the experimental treatment would result in hegher self-confidence and satisfaction in maternal role performance. This purpose was to contribute to the planning of nursing care to enhance self- confidence and satisfaction in maternal role performance and to the development of relevant nursing theory. Especially, the early postpartum period is crucial toward in recovery from childbirth and attainment of the maternal role. Maternal role attaintment is a complex social and cognitive process of stimulus -response accomplished by learning. Most women attain the maternal role sucessfully. But, some primiparous mothers experience difficultites in attainment of the maternal role due to lack of experience and knowledge. Self-confidence and satisfaction in maternal role performance are important factors in attainment and adjustment to the maternal role (Mercer, 1981a, 1981b ; Lederman, Weigarten, and Lederman, 1981 :Bobak and Jensen, 1985). Nursing is defined as behaviors of nurses add patients that attain nursing goals through action, reaction, interaction, and transaction. For attainment of nursing goals, active participating transactions must occur by agreement on the means to achieve those goals through nurse -patient mutual goal setting and establishment of their active relationships(King, 1981, Ha, 1977). Based on King's theory of goal attainment (1981), this stuy was planned as a non-equivalent control group, non -synchronized quasi -experimental design using agreement on the means to achieve nursing goals in early postpartum as the experimental treatment. The data were collected from July 20 to Sep. 1, 1991 by questionnaires with 60 primiparous mothers planing to breast feed after normal deliveries at W hospital in Pusan, Korea. The subjects were divided into a control group(conventional group) -those admitted from July 20 to Aug. 12, and an experimental group(agreement group) - those admitted from Aug. 13 to Sep. 1. The instument for agreement on the means to nursing goals in the early postpartum period included five steps - identification of disturbances of problems through action, reaction, and interaction with primiparous mothers : mutual early postpartal nursing goal setting : exploration of the means to achieve goals ; agreement on the means (self- care, ealry maternal -infant contact, performance of mothering behavior, and communicating about the infant's behavior and health condition) : implementation of the means. This instrument was developed on the basis of King's elements that lead to transactions in nurse-patient interactions. Lederman et al's (1981) scale for Confidence in ability to cope with tasks of motherhood and Lederman et al's(1981) scale for Mother's satisfaction with motherhood and infant care were used to measure self-confidence and satisfaction in maternal role performance ·with the subjects immediately after admission and on the day of discharge. Self-care performance in the experimental group was measured by self -evaluation tool developed by the investigator from the literature concerned. The tools to measure Pelf-confidence and satisfaction in maternal role performance, and the tool to measure self-evaluation of self-care performance were tested for internal reliability. Cronbach's Alphas were 0.94, 0.94, and 0.63. The data were analysed by using in S.P.S.S. computerized program and included percentage, x²-test, t-test, ANOVA, and Pearson Correlation Coefficient. The conclusions obtained from this study are summerized as follows : 1. The degree of self-confidence in maternal role performance of the total subjects group measured before the experimental treatment was above average with a mean score of 2.77(range 2.14-3.64). Out of 14 items, those with relatively high mean scores were ‘I would like to be a better mother than I am’(3.95), and ‘I have my doubts about whether I am a good mother’(2.87). Those with low mean scores were ‘I know that my baby wants most of the times’(2.28), ‘When the baby cries, I can tell what she /he wants’(2.37), and ‘I have confidence in my ability to care for the baby’(2;50). That is, the self - confidence of Primiparous mothers was considerably high in mothering, but rather low in activities concerning the infant care and understanding of the infant behavior. The degree of satisfaction in maternal role performance of the total subjects group measured before the experimental treatment was high with a mean score of 3.18(range 1.92-3.92). Out of 13 items, those with relatively high mean scores were ‘I am glad 1 had this baby now’(3.75), ‘I play with the baby between feedings when s/he is awake and quiet’(3.67), and ‘I enjoy being a mother’(3.27). Those with low mean scores were ‘I am upset about having too many responsibilities as a mother’(2.78), ‘It bothers me to get up for the baby at night’(2.82), and ‘I get annoyed if the baby frequently interrupts my activities’.(2.82), That is, the satisfaction of primiparous mothers was considerably high in mothering and infant care, but rather low in restraints in time or on the mother's self accomplishment and development. 2. Agreement on the means to achieve nursing goals in the early postpartum period included process of mutual goal setting, exploration of the means to achieve goals, and ahreement in concert means to achieve goals based on the mothers' condition, concerns, self-perception of the nurse - patient interactions. In the process of agreement, there was agreement that the means to achieve goals should be through trust and establishment of active relationships with the nurse through identification of problems according to planned nursing goals and active interaction, such as explanations, teaching, changing of opinions, acceptance or rejection of explanations, and proposing of questions. Therefore agreement on the means to achieve nursing goals in the early postpartum period appears to be an effective nursing intervention for primiparous mothers. 3. The degree of self- confidence in maternal role performance of the exprimental group was higher than that of the control group(t＝3.95, p＜0.01). Out of 14 items, those with higher score in the experimental group were ‘I would like to be a better mother than I am’(t＝1.93, p＜0.05), ‘I know that my baby wants most of the times’(t＝2.75, p＜0.01), ‘When the baby cries, 1 can tell what she/he wants’(t＝2.10, p＜0.05), ‘I have confidence in my ability to care for the baby’(t＝3.72, p＜0.01), ‘I trust my own judement in deciding how to care for the baby’(t＝1.96, p＜0.05), ‘I feel that I know my baby and what to do for him /her’(t＝2.44, p＜0.01), ‘I am concerned about being able to meet the baby's needs’(t＝2.87, p＜0.01), ‘I know what my baby likes and dislikes’(t＝3.26, p＜0.01), ‘I don't know to care for the baby as well as I should’(t＝2.07, p＜0.05), and ‘I am unsure about whether I give enough attention to the baby’(t＝3.04, p＜0.01), That is, the degree of self-confidence in mothering, activities concerning infant care, and understanding of infant behavior of the experimental group was higher than that of the control group. Therefore, the first hypothesis, that the degree of self-confidence in maternal role performance of the experimental group would be higher than that of the control group, was supported(t＝3.95, p＜0.01). 4. The degree of satisfaction in the maternal role performance of the exprimental group was higer than that or the control group(t＝2.31, p＜0.05). Out of 13 items, those with higher score in the experimental group were ‘I am glad I had this baby now’(t＝2.29, p＜0.05), ‘I enjoy taking care of the baby’(t＝2.4g, p＜0.01), ‘It is boring for me to care for the baby and do the same thing over and over’(t＝2.87, P＜0.01), ‘I am unhappy with the amount of time I have for activities other than childcare’(t＝2.51, p＜0.01), and ‘When bathing and diapering the baby, I would like to be doing something else’(t＝2.43, p＜0.01). That is, the degree of satisfaction in mothering, infant care, and restraints in time of on the mother's self accomplishment and development in the experimental group was higher than that of the control group. Therefore, the second hypothesis, that the degree of satisfaction in maternal role performance of the experimental group would be higher than that of the control group, was supported(t＝2.31, p＜0.05). 5. The third hypothesis, that the higher the degree of satisfaction in materenal role performance, the higher the degree of self-confidence in materenal role performance in the experimental group, was supported (r＝0.57, p＜0.01)

• 대한예방한의학회지
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• 제7권1호
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• pp.17-28
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• 2003

We met results like the followings through the literatures and questionnaires about the tasks and solutions about the insurance fee of packed medical herbs. 1) It's turned out that 74.8% of herb doctors agrees to the insurance fee of packed medical herbs. However, in comparison with the same survey of the herb doctor association the percentage of general approval went somewhat lower, and especially the percentage of 'positive approval' became notably lower$(43.7%{\rightarrow}26.5%)$ and the percentage of 'active objection' raised about 2 times$(6.8%{\rightarrow}12.9%)$. Inquiring into the approval reasons on the insurance fee application of packed medical herbs some heads such as 'development toward treatment medical science' and 'decrease of publics burden' were higher than the one of 'management income and expenditure.' 2) As a result of the research, 36.0% of the patients and 42.8% of the residents recognized that the pay range of Chinese herb health insurance is narrow. They recognized that less people have the experiences of Chinese medical hospital use and internal application of the packed medical herbs as they are older, men rather than women. 85.4% of the patients and 74.9% of the residents agreed on the insurance pay of packed medical herbs. It's shown that they agree on the Chinese medical hospital use more as the economic standard is lower, on the insurance pay as they have ever taken the packed medical herbs. In the aspect of increase of insurance fee, 66.7% of the patients and 44.3% of the residents agreed on the insurance pay of packed medical herbs, and 18.1% and 36.1% disagreed on the insurance pay of packed medical herbs. The main objective reason why they disagree on the insurance pay of packed medical herbs was 'because the insurance fee goes up higher,' which answered 95.2% of the patients and 78.8% of the residents. 7.22% of the patients and 1.80% of the residents answered that they can pay more insurance fee in case of the insurance pay of packed medical herbs. However, in the priority order of the insurance pay, it hold the 5th position between 2 target research groups which was less than medical examination, charges for hospital accommodation and taking MRI. 3) According to the result of analysis about the cost of packed medical herbs, current practice price is 115,000 won and the average prime cost of a packed medical herb is 73,000 to 106,000 won. It's examined that the herb doctors regard that 95,000 won will be reasonable when the packed medical herb is payed in insurance. However, it was found out that the public generally thinks that the price would be appropriate on the level of 30,000 to 40,000 won and the percentage of the answers of 20,000 won to 30,000 was fairly high. 4) the central system of a prescription should be change into the central system of demonstration and the sick and wounded. 5) To solve this problem, the government should regulate it to pass by the circulation gradation of [importer, $peasantry{\rightarrow}manufacturer{\rightarrow}wholesaler{\rightarrow}distributor$(Chinese medical hospital, pharmacy dispensary of Chinese medicine)]And it should intervene into the quality and the circulation steps of Chinese medicine through 'the office or organization which is in charge of certification of Chinese medicine' and 'the office or organization which is in charge of the circulation of Chinese medicine.' And some actions such as simple severance, lavation, drying should be included into the conception of manufacture and the boundary between food and medical supplies should be made at a manufactory. And the regulation of standardized goods at one's own house should be improved so that, the peasantry can sell the materials of Chinese medicine only to the manufacturer. 6) In company with the insurance pay of packed medical herbs, the study about the separation of dispensary from medical practice in the Chinese medicine should be accomplished.

• 근관절건강학회지
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• 제2권1호
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• pp.17-40
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• 1995

Rheumatoid arthritis is the one of the chronic diseases, one of its major symptoms is a chronic pain. Despite developing medical treatment and surgical techniques, it is suggested that to control the pain is the goal of the treatment. But pain is an inner experience and even those closest to the patient cannot truly observe its progress or share in its suffering. The National Academy of Sciences Institute of Medicine's report on Pain and Disability concluded that there is no objective measure of pain-(exactly) no pain thermometer-nor can there ever be one, because the experience of pain is inseparable from personal perception and social influence such as culture. To explore chronic pain experience is to understand the process and property of the patient's perception of pain through the response to pain, the coping with pain, and the adaptation to pain. Therefore a qualitative study was conducted in order to gain an understanding of pain experience of patients with RA in korea. I used naturalistic inquiry as a research methodology, which had 5 axioms, the first is that realities are multiple, constructed, and holistic, the second is that knower and known are interactive, inseparable, the third is only time and context bound working hypotheses(idiographic statements) are possible, the forth is all entities are in a state of mutual simultaneous shaping, so that it is impossible to distinguish causes from effects and the last is that inquiry is value-bound. Purposive sampling was conducted as a sampling. 20 subjects who experienced pain over 10 years, lived in middle-sized city and big city in Korea, and 17 women and 3 men. The subject's age was from 32 to 62 (average 48.8), all were married, living with their spouse and children, except two-one divorced and the other widow before they became ill. I collected data using In depth structured interview. I had interviews two or three times with each subject, and the interviews were conducted at each subject's home. Each interview lasted about two hours an average. A recording was taken with the consent of the subject. I used inductive data analysis-such as unitizing and categorizing. unitizing is a process of coding, whereby raw data are systematically transformed and aggregated into units. Categorizing is a process wherby previously unitized data are organized into categories that provide descriptive or inferential information about the context or setting from which the units were derived. This process is used constant comparative method. The pain controlling process is composed of behavior of pain control. The behaviors of pain control are rearranging of ADL, hiddening role conflict, balancing treatment, and changing social relation. Rearranging of ADL includes diet management, sleep management, and the adjustment of daily life activities. The subjects try to rearrange their daily activities by modified style of motions, rearranging time span & range of activities, using auxillary facilities, and getting help in order to keep on the pace of daily life. Hiddening role conflict means to reduce conflicts between sick role and their role as a family member. In this process, the subjects use two modes, one is to control the pain complaints, and the other is to internalize the value which is to stay home is good for caring her children and being a good mother. To control pain complaints is done by 'enduring', 'understanding' the other family members, or making them undersood in order to reduce pain. Balancing treatment is composed of two aspects. One is to keep the pain within the endurable level, the other is to keep in touch with medical personnel in order to get the information of treatment and emotional support. Changing social relation is made by information seeking and sharing, formation of mutual support relation, and finally simplification of social relationships. The subjects simplify their social relationships by refraining from relations with someone who makes them physically and psychologically strained. In particular the subjects are apt to avoid contact with in-laws, and the change of relation to in-laws results in lessening the family boundary. In the course of this process, they confront the crisis of family confict result in family dissolution. This crisis is related to the threat of self-existence. Findings from this study contribute to understanding the chronic pain experience. To advance this study, we should compare this result with other cases in different cultural contexts. I think to interpret these results, korean cultural background should be considered. Especially the different family concept, more broader family members and kinship network, and the traditional medical knowledge influences patients' behavior.

• 한국식품과학회지
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• 제38권1호
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• pp.121-127
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• 2006

본 연구에서는 미생물 정량시험을 통해 광천 토굴새우젓의 미생물학적인 위해성을 평가하고 일반성분 및 영양성분 분석에 의한 영양적인 평가를 실시하였다. 광천 토굴새우젓의 총호기성균의 평균오염도는 3.48-5.42 $log_{10}CFU/g$이었으며 최고오염치는 추젓-1(5.42 $log_{10}CFU/g$)과 최소오염치는 추젓-2(3.48$log_{10}CFU/g$)에서 나타났다. 대장균군의 평균오염도는 2.22-2.95 $log_{10}CFU/g$의 분포이었으며 총균수와 같은 양상인 최대오염치와 최소오염치를 각각 추젓-1(2.95 $log_{10}CFU/g$)과 추젓-2(2.22 $log_{10}CFU/g$)에서 나타났다. 진균류는 추젓-1, 추젓-2 및 동백하젓에서는 검출되지 않았으며 오젓과 육젓에서 각각 1.99와 1.47 $log_{10}CFU/g$이었다. 식중독균인 S. aureus의 평균오염도는 0.58-2.51 $log_{10}CFU/g$이었으며 추젓-1(2.51 $log_{10}CFU/g$)에서 가장 높았고 추젓-2(0.58 $log_{10}CFU/g$)에서 가장 낮았다. 기타 식중독균인 B. cereus, L. monocytogenes, Vibrio spp.와 대장균은 검출되지 않았다. 일반성분 분석결과 열량과 수분 함량은 동백하젓이 가장 높았고 지방은 추젓-2와 동백하젓이 가장 높았다. 단백질, 아미노태 질소는 동백하젓이, 회분, 탄수화물은 육젓이 가장 높은 것으로 나타났다. 염도는 육젓과 오젓이 다른 종류의 새우젓보다 높았다. 다량무기질 함량은 모두 새우젓의 종류에 따라 유의적인 차이가 있었는데(p<0.05) 칼슘, 마그네슘, 칼륨의 함량은 모두 추젓-2에서 가장 높았다. 반면 나트륨은 추젓-2가 $297.97{\pm}1.13\;mg/100\;g$으로 가장 낮게 나타났고 육젓은 $908.12{\pm}9.20\;mg/100\;g$으로 가장 높게 나타났다. 미량 무기질 함량 중 철분은 동백하젓이, 구리와 망간 함량은 오젓이, 셀레늄 함량은 추젓-1이 유의적으로 높은 것으로 나타났다(p<0.05). 아미노산 분석결과 glutamic aicd의 함량이 가장 높게 분석되었고 지방산은 포화지방산 중 팔미트산, 불포화지방산 중 불포화도가 높은 eicosapentaenoic acid(EPA), docosahexaenoic acid(DHA)의 함량이 높게 나타났다. 결론적으로 광천토굴새우젓은 미생물학적으로 안전하며, 영양학적으로는 무기질 함량이 풍부하고 감칠맛을 내는 아미노산 성분이 함유되어 있으며 혈청지질 감소, 혈관 확장, 혈압강하, 두뇌성장발달에 관여하는 n-3계 지방산인 EPA, DHA의 함량이 높은 것으로 나타났다. 따라서 우리나라의 전통 식품이면서 지역특산물인 광천토굴새우젓은 그 이용가치가 높다는 것을 확인할 수 있었다.

• 한국사회정책
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• 제20권2호
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• pp.169-193
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• 2013

본 연구는 사회투자접근의 돌봄 체제의 국가 간 비교에 대한 분석학적 가능성과 유용성을 논의하고, 2000년대 스웨덴, 독일, 일본, 한국, 영국의 아동 돌봄 체제 변화에 대한 분석을 그 목적으로 한다. 이를 위해 노동시장 활성화, 양성 평등, 돌봄의 질, 그리고 정부의 개입 정도를 분석하였다. 휴직제도와 돌봄 서비스 이용 아동비율을 고려하여 노동시장 활성화를 측정하였다. 양성평등의 경우, 노동시장에서의 양성평등에 집중하였으며, 25-54세 여성의 노동시장 참여율, 종사상의 지위와 성별 임금 격차를 고려하였다. 돌봄의 질은 돌봄 서비스의 질로 선생님 1인당 아동 비율과 정부가 제공하는 돌봄 서비스를 이용하는 아동의 비율을 포함하였다. 마지막으로 정부의 개입정도는 가족에 대한 사회지출의 GDP 대비, 총 사회비출 대비률을 이용하여 측정하였다. 본 연구는 아동 돌봄에 대한 높은 사회투자관점은 스웨덴, 프랑스, 영국에서 발견한다. 이 국가들은, 높은 활성화 정도, 노동시장에서의 양성 평등도, 높은 돌봄 서비스의 질과 가족에 대한 사회지출이 상대적으로 높은 나라들이다. 반면, 독일, 한국, 일본은 낮은 사회투자적 돌봄 체제로서 상대적으로 낮은 활성화, 양성평등, 돌봄 서비스의 질 그리고 국가에 의한 개입을 보이고 있다. 또한, 영국은 스웨덴과 프랑스와 세부적인 성격을 달리하는데, 상대적으로 낮은 양성 평등과 돌봄 제공으로서 시장의 기능에 대한 높은 의존성이 두드러진다. 독일은 동아시아 국가들과 낮은 사회투자정도로 동일하나, 상대적으로 높은 정부의 가족에 대한 사회지출과 노동시장에서의 높은 양성평등 면에서 상이함을 발견한다. 영국, 독일, 한국 그리고 일본은 아동돌봄에 대한 기존의 패러다임에서, 정도의 상이함은 뚜렷하게 보이나, 정책적 발전에 있어 체제 전환을 보이고 있다는 점에서 동일하다. 사회투자 관점은 돌봄체제의 국가 비교 연구의 분석학적 틀로서 그 유용성이 두드러진다고 하겠다. 정책의 변화에 따른 여성의 사회권뿐만 아니라, 돌봄 수혜자인 아동의 사회권에 대한 중요성을 부각시키며, 또한 정부, 시장, 가족, 지역사회간의 새로운 책임 분배 체제를 구축할 수 있는 가능성을 가지고 있기 때문이다. 사회투자적 접근이 돌봄 체제의 나아갈 방향으로 적절한 것인가? 이는 무급가사노동의 양성 평등, 여성 유급노동의 질적 개선, 국가에 의해 관리되는 보편적 제공 등의 도전과제의 해결을 통해 가능할 것이다.

• 항공우주정책ㆍ법학회지
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• 제25권2호
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• pp.139-162
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• 2010

국제운송에 있어서 항공자유화 정책(open skies police)은 하늘의 자유 또는 하늘의 개방이란 의미를 내포하고 있다. 규범적으로 여러 형태의 운송권을 타 국가에 허용하는 개방 정책이나 국제 항공운송에 있어서 자유경쟁 정책이다. 미국의 경우, 1978년 항공규제완화 이후 경쟁력을 갖춘 대형 항공사들이 시장 기회가 많은 국제 항공시장에서 경쟁할 수 있도록 하기위해 네델란드와 항공자유화 협정을 체결한 것을 시작으로 많은 국가들이 항공자 유화 협정을 맺고 있으며, 우리나라의 경우는 20여개국과 항공자유화 협정을 체결하고 있는 상태이다. 상용고객우대제도(Frequent Flyer Program : FFP)는 미국 정부의 항공법 규제 완화 이후 항공 운임 전략의 일환으로 포괄적 마케팅 제휴의 한 부분이다. 자사 항공편을 이용하는 고객을 회원제로 관리하는 제도로서, 승객들의 탑승이나 기타 이용 실적에 따라 마일리지를 부여하여 누적된 마일리지가 일정한 기준에 도달하면 다양한 유형적 보상을 실시하는 개념이다. 상용고객 우대제도는 초창기에는 고객확보를 위한 마케팅 중심으로 형성되었으나, 항공사간의 치열한 경쟁으로 인해 경영이 점점 더 어려워지고 있는 상황에서 항공사들은 상용고객우대제도를 항공사 경영성과를 높이는 마케팅의 중요한 전략의 수단으로 활용하고 있다. 따라서 항공사들은 충성고객을 확보하기 위해 고객의 니즈를 효과적으로 파악할 필요가 있다고 판단한다. 항공사 상용고객우대제도에 따른 성과가 국제 경쟁에 미치는 영향은 다양하게 나타날 수 있다. 첫째, 노선망을 확대를 통해 항공 시장을 확보할 수 있다. 둘째, 운항빈도를 증대시킴에 따라 고객에게 항공 상품의 공급 능력을 증대시키게 될 수 있을 것이다. 셋째, 새로운 시장에 우선적으로 진입함으로써 경쟁 항공사를 견제하는 효과가 나타날 것 이라고 생각한다. 그럼에도 불구하고 항공사 상용고객우대제도에 대한 실증적 연구는 매우 미비하다. 따라서 본 연구에서는 상용고객우대제도의 전략적 제휴 유형을 검토한 후 이의 제휴 성과와 국제경쟁에 미치는 영향을 알아보고자 한다. 주요 국가들의 항공사 전략적 제휴는 항공자유화 정책상 세계적인 추세이다. 우리나라의 경우에도 국적 항공사들의 발전과 경쟁력 확보를 위해서는 보다 더 현실적인 항공자유화 협정이 진행되어야 할 것이다. 본 논문은 항공자유화 정책 상 항공사 상용고객우대제도의 제휴 성과와 국제경쟁에 관한 연구이다. 본 연구에서는 5개 글로벌 제휴 그룹(star, oneworld, wings, qualiflyer, skyteam)을 대상으로 선정하여 제휴 그룹의 항공사가 보유한 자원구조와 정보기술수준이 제휴 유형에 미치는 성과에 대한 실증 연구를 실시하고자 하였으며 가설 검정을 위해 일원분산분석과 회귀분석을 사용하였다. 규모가 큰 대형항공사 이거나 중소 규모의 지역 항공사일지라도 세계적인 네트워크 와 조직력을 갖춘 제휴 그룹에 참여하는 항공사는 높은 성과와 국제 경쟁력을 확보할 수 있다고 판단한다. 항공사 승객의 경우, 회원 가입항공사의 호텔과 렌트카, 면세점, 여행사 등의 제휴 네트워크를 활용하여 항공사 탑승 이외의 마일리지 획득하는 것외에도 관련된 서비스 혜택에 대한 관심과 선호도가 높으므로, 우리나라의 항공사들은 항공사간 제휴뿐 만 아니라 호텔 등 타 산업과의 다각적으로 제휴를 통해 공격적 마케팅을 실행해야 한다.

• Journal of Chest Surgery
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• 제30권5호
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• pp.471-478
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• 1997

토끼는 심폐바이패스(CPB) 실험동물로서 많은 장점을 가지고 있음에도 불구하고 토끼에서 CPB운용법의 확립은 기술적으로 대단히 어려운 것으로 알려져 있다. 한편 저체온 순환정지법은 심장수술에서 유용하게 사용되고 있으나 뇌 보호상의 문제점이 지적되고 있다. 스테로이드는 일반적으로 뇌부종 치료에 효과가 있는 것으로 알려져 있으나 순환정지시 뇌보호에 미치는 영향에 관해서는 아직 명확하게 규명되지 못하고 있다. 이런 관점에서 본 연구는 첫째 토끼에서 CPB운용법을 확립하고 둘째 이를 바탕으로 순환정지시 스테로이드에 의한 뇌보호 효과를 분석할 목적으로 시행하였다. 흰 토끼 15마리(평균 체중 3,5kg)를 3군의 실험군에 각각 5마리씩 사용하였다. 제 1실험군(대조군)은 순환 정지시 토끼를 수술대와 평행된 자세로 유지하였으며, 제 2실험군에서는 대조군과 다른 실험방법은 동일하나 순환정지시 토끼를 트렌델렌부르그 자세로 유지하였다. 제 3실험군에서는 트렌델렌부르그 자세와 함께 순환정지전 스테로이드(methylprednisolone 30 mg/kg)를 투여하였다. 실험방법은 토끼를 마취시킨후 정중흉골절 개술로 심장을 노출시키고 상행대동맥 및 \ulcorner심방부속지에 각각 3.3mm 동맥캐늘라 및 14 Fr 단일 정맥캐늘라를 삽관하였다. CPB 회로에는 롤러 펌프와 기포형 산화기를 사용하였다. 충전액은 토끼혈액 120-150cc를 포함하여 약 450cc를 사용하였다. 전체 실험시간은 70분으로 심폐바이패스 시작후 10일 동안 관류 및 표면냉각법으로 체온을 20도(직장)까지 감소시킨뒤 40분 동안 순환정지를 시켰다. 순환정지후 관류를 재개하여 20분 동안 재가온으로 체온을 정상화시키면서 심장 박동이 되돌아오는 것을 확인하였다. 관류 유속은 80~ 90mg/min 으로 시작하였고 체온 하강에 따라 유속을 조절하였다. 실험후 토끼를 희생시킨뒤 바로 부검을 시행하여 뇌, 척수, 신장, 십이지장, 폐, 심장, 간장, 비장, 췌장, 위장의 일부를 채취하여 수분함유량을 조사하였다. 각 실험군간의 수분양 비교는 Kruskal-Wallis 비모수 검정법에 의해 분석하였다. CPB 중 관류 유속 변화는 60~l00ml/kg/min 이었다. 동맥압은 대부분 35-55mmhg 사이에서 유지되었다. 재가온후 심장은 전례에서 박동을 재개하였다. 동맥혈가스분석 결과 심한 조직 허혈을 의미하는 정도의 대사 성 산증은 발견되지 않았다. 각 실험군별 조직수분양 측정 결\ulcorner 뇌를 포함한 각 장기들에서 실험군간체 유의 한 차이는 발견되지 않았다. 이러한 실험결과를 통하여 저자들은 (1) 적절한 기법하에서는 토끼에서도 정상 적인 심폐바이패스 운용이 가능하다는 것과, (2) 본 실험 범주에서는 저체온 순환정지시 트렌델렌부르그 자 세에 의한 뇌부종 발현에 대한 스테로이드의 예방효과를 검정할 수없다는 결론을 얻었다.

• 대한예방한의학회지
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• 제12권1호
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• pp.19-48
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• 2008

In order to verify the risk of onset of the illnesses based on gender, age, and monthly income 1,739 subjects from Hongcheon county, Gangwon province were selected. Questionnaire on demographic sociology, health condition, existence of illnesses(cancer, hypertension, stroke, diabetes, arthritis, cardiac disorders), and usage of public health services was surveyed from October 1, 2006 to October 20, 2006. Following conclusions were reached on the basis of the questionnaire : - For demographic sociological peculiarities, gender, age, occupation, and education level were evenly distributed. Most were under normal marriage(67.38%), health insurance(86.39%), 494(36.0%) individuals with less than monthly income of 1 million won, 494(36.0%) individuals with monthly income between 1 and 2 million won, 219(16.0%) with monthly income between 2 and 3 million won, and 164(12.0%) individuals with more than 3 million won, thus showing relatively low income. - For health status, 1,199(70.28%) individuals are non-smokers, 209(45.63%) individuals smoke $10{\sim}20$ cigarettes a day, 754(44.02%) individuals exercise less than twice a week are the major sector of the population. 1,518(88.10%) individuals have regular checkup more than once and 1,131(65.49%) stated their health condition less than average. - For comparison of existence of illnesses between genders, there was no statistical significance on cancer, stroke, and diabetes. But statistical significance was shown on hypertension(P value 0.025), arthritis(P value 0.000), and cardiac disorders(P value 0.016). Statistical significance was seen in the age comparison, and OR(confidence interval) drastically increased with increase in age. - There was no difference between the primary health clinic(P value 0.000), most visited clinic(P value 0.000), selection criteria(P value 0.000), and satisfaction on efficacy(P value 0.000). There was a tendency preferring hospital than public health center with increase in income. - For correlation between the existence of illnesses among different income levels, except for cancer(P value 0.172), statistical significance was seen in hypertension(P value 0.000), stroke(P value 0.003), diabetes (P value 0.001), arthritis(P value 0.000), and cardiac disorders(P value 0.000). The number of individuals suffering from illnesses and ratio all decreased for all illnesses with increase in income. - After adjusting confounding factors(gender, age, income, marriage, occupation, education) and male (1) as the standard, OR (confidence interval) of cancer, hypertension, stroke, diabetes, arthritis, cardiac disorders were 0.47(0.11${\sim}$2.05), 1.27(0.89${\sim}$1.81), 0.58(0.21${\sim}$1.59), 0.71(0.41${\sim}$1.23), 1.79(1.34${\sim}$2.39, P<0.01), and 1.46(0.72${\sim}$2.96), respectively. Risk of arthritis is significantly high in female and 20's (1) as the standard, OR(confidence interval) of cancer, hypertension, stroke, diabetes, arthritis, cardiac disorders were 1.01(0.96${\sim}$1.07), 1.06(1.04${\sim}$1.07, P<0.01), 1.05(1.01${\sim}$1.10, P<0.01), 1.06(1.03${\sim}$1.08, P<0.01), 1.05(1.03${\sim}$1.06, P<0.01), and 1.06(1.04${\sim}$1.09, P<0.01), respectively. Risk of onset for illnesses significantly increased with yearly aging except for cancer. - For comparison between monthly income after adjusting confounding factors(gender, age, income, marriage, occupation, education), with less than 1 million won (1) as the standard, OR(confidence interval) of cancer for 1 to 2 million won, 2 to 3 million won, and more than 3 million won were 0.23(0.03${\sim}$2.16), 2.53(0.41${\sim}$15.43), and 1.73(0.15${\sim}$19.50), respectively. OR(confidence interval) of hypertension were 1.12(0.76 ${\sim}$1.66), 0.68(0.34${\sim}$1.34), and 2.04(1.08${\sim}$3.86, P<0.01), respectively. OR(confidence interval) of stroke were 0.96(0.30${\sim}$3.08) for 1 to 2 million won, and 0.80(0.08${\sim}$8.46) for 2 to 3 million won. OR(confidence interval) of diabetes were 0.73(0.38${\sim}$1.38), 0.65(0.24${\sim}$1.71), and 0.69(0.24${\sim}$2.01), respectively. The values were 0.76(0.55${\sim}$1.03), 1.14(0.75${\sim}$1.73), and 0.90(0.56${\sim}$1.46), respectively for arthritis. OR(confidence interval) of cardiac disorders were 1.15(0.53${\sim}$2.48), 0.63(0.13${\sim}$3.12), and 1.20(0.28${\sim}$5.14), respectively. Risks of cancer, hypertension, stroke, diabetes, arthritis, and cardiac disorders were dependent of monthly income, and stroke and diabetes decreased with increase in income. Summarizing above data, arthritis was significantly higher in women and increase in age by each year brought significant increase in the chance of onset in hypertension, stroke, diabetes, arthritis, and cardiac disorders except for cancer. Stroke and diabetes decreased with increase in income. Above findings can be applied and reflected in public health policies at the national level, and it can also be applied at the personal level for individual health maintenance and prevention.

• 한국의학물리학회지:의학물리
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• 제20권4호
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• pp.235-243
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• 2009

다양한 간 질환에 Ferucarbotran (SPIO)과 Gd-EOB-DTPA (Primovist) 조영제를 사용하여 자기공명영상 상에서 비교하여 간 질환의 특성 및 검출 과 그 질환에 따른 조영제 흡수관계를 알아보고자 한다. 실험대상은 국소 간 병변을 가진 50명의 환자 중 남자 25명, 여자 25명으로 평균나이는 50세이었다. 사용된 장비와 코일은 3.0T (General Electric Medical System, Excite HD) 자기공명영상장치와 8채널 채부코일이었다. 질환과 조영제 흡수관계를 비교하기 위하여 사용된 펄스 시퀀스는 Liver aquisition with volume acceleration (LAVA)와 Multi-Gradient rapid Echo (MGRE)이었다. 모든 검사기법은 일정한 데이터를 획득하기 위하여 Ferucarbotran (SPIO) 및 Gd-EOB-DTPA (Primovist) 조영제를 주입 전 후에 같은 위치를 선정하여 검사를 시행했다(p<0.05). 검사 결과는 Ferucarbotran와 Gd-EOB-DTPA의 대조도대 잡음비는 간세포암(HCC, 16 cases)이 $3.08{\pm}0.12$과 $7.00{\pm}0.27$이었다. 과다형성결절(Hyperplastic Nodule, 7 cases) 질환은 $3.62{\pm}0.13$, $2.60{\pm}0.23$, 전이(Metastasis, 13 cases)는 $1.70{\pm}0.09$, $2.60{\pm}0.23$, 초점성 결절성 과증식(Focal Nodular Hyperplasia, 6 cases)질환은 $2.12{\pm}0.28$, $5.86{\pm}0.28$, 농양(Abscess, 8 cases)은 $4.45{\pm}0.28$, $1.73{\pm}0.02$이었다. 또한, 각 질환에 대한 진단적 수행을 위해 ANOVA 검증을 하였다(p<0.05). 결론적으로, 두 조영제 효과로 2개 검사기법 모두가 간질환의 특성 및 검출과 그 질환에 따른 조영제 특성을 잘 보여주었다.

• 핵의학기술
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• 제14권2호
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• pp.155-158
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• 2010

$^{99m}Tc$-macroaggregated albumin (MAA) 를 이용한 간동맥 관류스캔(hepatic arterial perfusion scintigraphy, HAPS)은 간종양의 경동맥 화학요법을 위해 종양의 관류 등을 평가하는데 매우 유용한 방법으로 알려져 있다. 본 연구는 간암환자(hepatocellular carcinoma, HCC)에서의 정상 간 조직에 대한 간세포암의 상대적인 혈류량을 평가하여 종양의 형태, 크기와 lung shunting, tumor to normal ratio (T/N ratio)를 측정하여 HAPS 의 유용성을 알아보고자 하였다. 2009년 6월부터 2009년 9월까지 본원에서 HCC 진단을 받은 환자 7명(평균 64세, 남자 6명, 여자 1명)을 대상으로 하였다. $^{99m}Tc$-MAA 5 mCi를 간 동맥 내에 위치된 카테타를 통하여 주입하고 20분경과 후 HAPS를 시행하였다. 환자의 흉부와 복부가 포함되게 시야를 잡고 anterior, posterior, both lateral 상을 얻고 SPECT를 시행하였다. liver, tumor, lung의 ROI를 그리고 각각의 count와 count/pixel (mean value) 를 구하여 lung shunting, T/N ratio를 구하였다. anterior, posterior 상에서 얻어진 ROI에서 얻어진 tumor size는 2.0~10.8 cm(평균 3.75 cm), liver size 는 8.8~18.5 cm(평균14.6 cm)였다. total tumor와 total normal의 mean value를 통해 얻은 T/N ratio의 범위는 2.41~5.76(평균 3.8)였다. total lung과 total liver의 counts를 통해 얻은 lung shunting의 범위는 3.14~13.92%(평균 6.77%)였다. $^{99m}Tc$-MAA를 이용한 HAPS 는 정상 간 조직에 비해 간세포암내에 강한 방사능 섭취를 보였으며 종양의 크기, 위치 및 T/N ratio를 통한 정량적 관류 평가를 할 수 있었다. 또한 폐 섭취 빈도는 종양 내 동정맥 단락을 추정할 수 있어 간동맥 동위원소 치료 전 단락 유무를 평가할 수 있다는 점이 유용하게 활용될 수 있을 것이다. 따라서 $^{99m}Tc$-MAA를 이용한 HAPS는 간암의 평가 및 치료를 결정 할 수 있는 유용한 검사법으로 이용될 수 있을 것으로 사료된다.