• 제목/요약/키워드: Internal Control System

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웹 기반 한국판 섭식장애진단척도 DSM-5의 개발 및 타당화 연구 (A Development and Validation Study of the Web-based Korean Version of the Eating Disorder Diagnostic Scale DSM-5)

  • 이혜린;곽경화;이유경;한수완;김율리
    • 정신신체의학
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    • 제28권2호
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    • pp.185-193
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    • 2020
  • 연구목적 본 연구의 목적은 한국판 섭식장애 진단척도 DSM-5 (Korean version Eating Disorder Diagnostic Scale, K-EDDS)를 웹 기반 진단 시스템으로 개발하고 타당도를 검증하는 데 있다. 방 법 본 연구는 섭식장애 환자(38명)와 대학생(81명)을 포함하여 총 119명이 참여하였다. 모든 참가자는 지필 섭식장애 스크리닝 검사인 Sick, Control, One, Fat, Food (SCOFF) 후 별도의 사이트에서 웹 기반 K-EDDS, 섭식장애검사(Eating Disorder Examination-Questionnaire, EDE-Q), 임상손상평가(Clinical Impairment Assessment Questionnaire, CIA)를 작성했다. SCOFF 점수가 2점 이상인 사람을 대상으로 EDE (Eating Disorder Examination Interview) 면담을 진행하였다. 검사 후 2주 이내에 웹 기반 K-EDDS, EDE-Q, CIA를 재실시하였다. 결 과 탐색적 요인분석 결과, 신체불만족, 폭식행동, 폭식빈도, 보상행동의 4가지 요인이 추출되어 총 분산의 82.4%를 설명하였다. 웹 기반 K-EDDS의 4개 하위요인은 EDE-Q의 4개 하위요인과 각각 유의미한 상관관계가 있었으며, 우수한 내적 일치도를 보였다(Cronbach's alpha=0.93). 웹 기반 K-EDDS와 EDE의 진단 일치도는 96.83%, 웹 기반 K-EDDS의 검사-재검사 진단 일치도는 92.86%로 우수하였다. 웹 기반 K-EDDS와 CIA에서 환자군과 정상군 간 차이가 유의하게 나타나, 본 척도의 판별 타당도를 검증하였다. 결 론 본 연구를 통해 웹 기반 K-EDDS는 임상 및 연구 현장에서 DSM-5를 기반으로 한 섭식장애 진단에 유용하게 사용할 수 있는 타당한 도구임을 확인하였다.

고령환자에서 발생한 불안정성 대퇴골 전자간부 골절(AO/OTA 31-A2)의 치료 시 골수강내 금속정의 길이에 따른 추시 결과 (The Difference between Short and Long Intramedullary Nailing as the Treatment for Unstable Intertrochanteric Femoral Fracture (AO/OTA 31-A2) in Elderly Patients)

  • 신원철;이은성;서근택
    • 대한정형외과학회지
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    • 제52권1호
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    • pp.25-32
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    • 2017
  • 목적: 고령 환자에서 발생한 불안정성 대퇴골 전자간부 골절의 치료 시 골수강내 금속정의 길이에 따른 방사선적, 임상적 치료 결과를 비교 분석하고자 한다. 대상 및 방법: 2009년 8월부터 2014년 12월까지 방사선 영상상 AO/OTA 분류 31-A2 대퇴골 전자간부 골절로 진단되어 골수강 내 금속정을 이용한 내고정을 시행한 뒤 최소 1년 이상 추시가 가능하였던 65세 이상의 환자 139예를 대상으로 후향적 대조군 연구를 시행하였다. 대상군을 짧은 골수정(I군)과 긴 골수정(II군)을 사용한 군으로 분류하였으며 각각 106예, 33예로 조사되었다. 방사선적인 평가로 골절의 정복 정도, 골유합까지의 기간, 합병증 발생을 조사하였으며 수술 전 혈색소, 수술 시간, 수술 중 출혈량, 수혈 유무, 입원 기간 및 최종 추시 시 Charnley 고관절 점수를 통한 임상적 평가를 시행하였다. 결과: 수술 후 단순 방사선 검사상 전 예에서 good 또는 acceptable한 정복 상태를 얻었다. 골유합까지 평균 4.8개월이 걸렸으며 두 군 간의 차이는 없었다. II군(57.87분)이 I군(45.65분)보다 수술 시간이 길었던 것으로 확인되었다(p=0.003). 수술 중 출혈량의 경우 II군(288.78 ml)이 I군(209.90 ml)보다 많은 것으로 확인되었다(p=0.046). 최종 추시 시 임상적 결과는 두 군 모두 만족스러웠다. 결론: 고령의 환자에서 발생한 후내측 골편을 동반한 불안정성 대퇴골 전자간부 골절의 치료 시 골절 부위의 정복을 잘 시행한 경우 긴 골수정과 짧은 골수정 모두 만족스러운 방사선적, 임상적 결과를 보였다.

일본적인 것, 혹은 금지된 '소리'의 계보 -한일국교정상화 성립기 '왜색(倭色)' 비판담론과 양의성의 정치미학 (The Genealogy of Forbidden Sound -Political Aesthetics of Ambiguity in the Criticism of Japanese Style in Korean Society of the 1960s)

  • 정창훈
    • 대중서사연구
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    • 제25권1호
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    • pp.349-392
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    • 2019
  • 한일국교정상화를 전후하여 '일본이 또 다시 한반도로 온다'라는 막연한 불안과 공포의 정조가 조성되었으며, 그에 대한 반작용으로 '왜색' 비판담론이 강력하게 대두되었다. 다만 기존의 '왜색' 비판담론이 미처 처분하지 못한 식민지 잔재에 대한 민족적 반감을 표명하는 것이었다면, 1960년대 비판담론은 대중문화 속에서 새롭게 생성되고 있던 '왜색'에 신경을 곤두세우고 있었으며 그것을 한국에 대한 '일본의 변함없는 악의'가 징후적으로 드러나는 현상으로서 파악하고자 했던 것이다. 이처럼 국교정상화를 전후하여 대두된 '왜색' 비판담론은 기존 비판담론과는 질적인 차이를 지녔다. 이 새로운 '왜색' 비판의 논리는 "국경을 넘는 문화적 현대성의 매개", 즉 냉전체제하 지정학적 질서 속에서 유동하고 연쇄되었던 서구(미국)발 탈민족적·탈국가적 '대중문화'와 그것의 소비주체로서 성장한 '대중'에 대한 경계와 검열의 의지를 동반하고 있었던 것이다. 따라서 1960년대 한국에서 '대중적인 것=왜색적인 것=소비적인 것'의 위상학은 그 사회 내부에 존재했던 "도덕적 요구의 역설"을 드러내 보인다. 이는 일본이라는 타자와의 직접적 접촉을 회피하도록 하면서도 동시에 그것에 한없이 이끌리며 가까이 다가가도록 만드는 분열적 순환구조를 고착화하는 계기가 된다. 그것은 자타를 엄밀하게 가르는 도덕적 절단을 통해 대상을 저편으로 밀어내면서도 한편으로는 그 대상에 매료되어 다시 이편으로 끌어들이는 반복강박을 내포하는 것이다. 이 글은 그것이 구조화된 궤적을 더듬어보고 그에서 반복되어 나타난 불협화음의 의의를 정치미학적 차원에서 해명하고자 당대에 발생된 상이한 소리들에 귀를 기울여 볼 작정이다. 그것은 곧 한국사회의 내적 통제원리를 구축하려는 권력이 강력하게 발동하면 할수록, 혹은 그 권력이 지닌 억압적이고도 폭력적인 이면을 감추기 위해서라도 되풀이하여 끌어들어야만 했던 '일본(적인 것)'이라는 대타성, 즉 완전히 자신의 일부로 받아들일 수도 없고 소멸시켜 버릴 수도 없는 역설에 대한 고찰이 될 것이다.

『숙천제아도(宿踐諸衙圖)』를 통해 본 조선시대 읍치(邑治)의 공간구조와 관아(官衙) 조경 - 평안도 영유현과 황해도 신천군을 중심으로 - (A Study on the Spatial Structure of Eupchi(邑治) and Landscape Architecture of Provincial Government Office(地方官衙) in the Late Joseon Dynasty through 'Sukchunjeahdo(宿踐諸衙圖)' - Focused on the Youngyuhyun Pyeongan Province and Sincheongun Hwanghae Province -)

  • 신상섭;이승연
    • 헤리티지:역사와 과학
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    • 제49권2호
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    • pp.86-103
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    • 2016
  • 조선후기 문신 한필교(1807~1878년)가 관직을 역임했던 읍치를 대상으로 제작한 "숙천제아도(宿踐諸衙圖)" 화첩의 평안도 영유현과 황해도 신천군 읍치를 분석 자료로 활용하여 실증사료로서의 가치추적, 공간구조 등의 전형성 정립, 관아조경 및 문화경관 특성 도출 등을 시도한 연구결과는 다음과 같다. '풍수형국도' 성격을 겸하며 사방전도묘법으로 그려진 "숙천제아도"의 읍치도는 조선시대 지방고을의 터잡기와 공간구조는 물론 환경설계원칙 등을 파악할 수 있는 사료적 가치를 지닌다. 고을 치소(邑治)는 남북 중심축선에 위계를 설정한 배산임수 체계이며, 전조후침(前朝後寢)의 관아시설, 그리고 3단1묘의 제례처 등 도성에 준한 토지이용과 배치규범을 적용하고 있다. 교통요충지에 자리한 고을 치소는 어귀 장터마당을 결절점으로 안길을 따라 북쪽으로 향하면 관아 문루에 다다르는 노단경이 형성되고, 고갯길 또는 물길을 따라 외부 바깥길로 이어지는 체계를 갖는다. 즉, 동선체계는 바깥길-고갯길-어귀길-장터마당-안길-또는 샛길로 수용력과 위계에 따라 분절되며 3거리 길로 접합되는 양상이다. 지방관아의 토지이용은 3조(三朝)의 개념(외조, 치조, 연조)을 반영한 위계적 구성인데, 동헌의 후원과 객사의 별원을 포함하여 3문3조2원(三門三朝二園)의 공간체계를 보여준다. 고을의 뒷동산 소나무 숲, 명당수인 남천, 안산(案山)에 해당하는 조산(造山), 비보숲 읍수(邑藪) 등 풍수적 경관짜임이 작용되었는데, 겨울철 북서풍 차단과 여름철 상승기류 형성 등 에너지 보존, 색체 항상성, 자연재해 방지와 심리적 안정성 등 쾌적성 조건에 부합되는 환경지속성이 추출된다. 한적한 곳에 자리한 향교는 별도의 원림을 가꾸지 않았으며, 누정은 심신수양, 안분지족, 자연회귀 같은 상징적 가치, 정치적 행사와 윤리관 반영, 유흥상경 등 문화경관 양상이 다양하게 표출되는데, 객사에는 기와를 얹은 와정(瓦亭)이, 동헌과 내아에는 네모꼴 연못을 두고 소박한 모정(茅亭)이 도입되는 차별성을 보여준다. 관아에 지표경관으로 문루가 자리하고, 군사훈련 및 심신수양을 겸한 사정(射亭)이 필수시설로 도입되었다. 아사의 앞뜰은 네모꼴 마당(庭)으로 조경처리를 하지 않은 반면, 정청의 뒤뜰(後園)과 객사의 별원(別園) 등은 장식적으로 가꾸었다. 이러한 관아조경은 공간 성격 및 위계를 반영하되 기능적 지속성(차폐와 방화, 미기후조절 등)과 심리적 건전성, 상징성 등을 복합적으로 고려한 경관미학이라 하겠다. 한편, 소나무, 느티나무, 배나무, 버드나무, 향나무(또는 노송), 연(蓮), 화목(花木) 등이 조경식물로 활용되었는데, 환경심리적 가치가 부가된 배후숲, 조산숲과 비보숲 등과 함께 건전한 문화경관 요소로 자리매김하고 있다. 이러한 분석결과를 일반화 시킬 수 있느냐 하는 문제는 조선시대 읍치의 공간구조 및 환경설계 원칙이 제도적 틀 안에서 정형성으로 작용되고 있어 연구의 한계를 극복할 수 있으리라 판단된다.

농촌(農村) 주민(住民)들의 의료필요도(醫療必要度)에 관(關)한 연구(硏究) (A Study Concerning Health Needs in Rural Korea)

  • 이성관;김두희;정종학;정극수;박상빈;최정헌;홍순호;라진훈
    • Journal of Preventive Medicine and Public Health
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    • 제7권1호
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    • pp.29-94
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    • 1974
  • Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.

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