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Priming Effect of Endotoxin in Human Alveolar Macrophage (사람 폐포대식세포에서 내독소의 Priming 효과)

  • Chung, Man-Pyo;Yoo, Chul-Gyu;Kim, Young-Whan;Han, Sung-Koo;Shim, Young-Soo;Han, Yong-Chol
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.1
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    • pp.46-53
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    • 1996
  • Background: Endotoxin or lipopolysaccharide(LPS) can prime phagocytic cells such as polymorphonuclear leukocytes, monocytes or animal peritoneal macrophages to generate increased amounts of secretory products such as oxygen free radicals and tumor necrosis factor, which play an important role in developing adult respiratory distress syndrome in gram negative sepsis. Human alveolar macrophages(HAM) are continuously exposed to various stimuli inhaled into the alveoli, and the response to LPS might be different in HAM. Therefore, we investigated the effect of LPS pre-exposure on HAM adhered to plastic surface and A549 cell(type II human alveolar epithelial cell line) monolayer. Methods: HAM were isolated from bronchoalveolar lavage fluid from normal lung of the patients with localized lung cancer and esophageal cancer. LPS was exposed to HAM for 2hrs before or after adherence to plastic surface of 24-well Linbro plate and A549 cell monolayer. And then HAM was stimulated with PMA(phorbol myristate acetate) or fMLP(N-formyl-methionylleucyl-phenylalanine). The amount of hydrogen peroxide($H_2O_2$) production in the supernatant was measured on the principle of peroxidase-dependent oxidation of phenol red by hydrogen peroxide. Results: LPS pre-exposure could not enhance $H_2O_2$ production in neither HAM adhered to plastic surface nor one to A549 cell monolayer. But LPS even in the absence of PMA or fMLP stimulation directly increased $H_2O_2$ release in HAM if added after the adherence to A549 cell monolayer. Conclusion: Endotoxin does not prime HAM, but may directly activate HAM adhered to alveolar epithelial cells. Further investagation will be necessary.

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The Effects of Leader's Attitude and Job Characteristics on Subordinate's Creative Performance (상사의 태도와 직무 특성이 창의적 성과를 일으키는 과정에 관한 연구)

  • Ryu, Jeong-Ran
    • Management & Information Systems Review
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    • v.33 no.3
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    • pp.129-154
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    • 2014
  • We are making products and services that we didn't easily think or even imagine when young and living using them. Consumer needs become more diversified, markets and technologies are being constantly changed, and corporate global competitiveness is getting intensified. Now, companies that don't change nor create new values cannot survive. The cycle of new products is faster, and therefore corporations should improve previous products continuously or create new values according to such a trend. This era requires 'creativity' for companies to overcome uncertainty and survive. Corporate creativity is not easily activated as financial and physical compensation unlike the work ability or performance. When there is an environment that people with various abilities, experiences and backgrounds can express their opinions freely, it becomes possible. Despite the importance, the studies have focused on creativity education so far instead of the viewpoint of corporate business administration. In addition, most studies have dealt with job characteristics and employees' personality factors rather than the process that is connected to actual performance. In other words, the studies on environmental factors that can lead motivation as situational characteristics of the employee's company in a current non-monetary and non-physical way are very insufficient. Therefore, this study aims to comprehensively examine the process of creating creative performance in the environment inside the company that the employee could approach most closely from the corporate deinstitutional perspective. As the major variables, job characteristics and supervisor's ethical leadership were selected, and the process that is connected to the creative performance was explained by means of motivation necessary to understand creativity of the organization and creative process engagement(CPE). The summary of the verification results is following. First, job characteristics and supervisor's attitude(ethical leadership) had positive effects on intrinsic motivation and creativity process engagement. Second, intrinsic motivation and creativity process engagement had positive effects on creative performance. Third, intrinsic motivation and creativity process engagement had mediated the relationship between job characteristics, supervisor's attitude and intrinsic motivation, creativity process engagement

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Effects of Dietary Supplementation of Mixed Probiotics on Production Performance and Intestinal Environment in Broiler Chicken (혼합 생균제의 사료 내 첨가 급여가 육계의 생산성과 장내 환경에 미치는 영향)

  • Oh, Seong Taek;Kang, Chang Won;Kim, Eun Jib
    • Korean Journal of Poultry Science
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    • v.41 no.2
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    • pp.143-149
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    • 2014
  • This study was conducted to investigate the effects of dietary supplementation of the mixture of probiotics (MP) on growth performance, size of small intestine, cecal microflora and ammonia concentrations in broiler chicks. A total of 700, one-day-old male broiler chicks were randomly allotted to four treatments with seven replications having 25 birds per pen. The birds were fed one of the four experimental diets; containing no antibiotics nor MP (negative control, NC), containing antibiotics without MP(positive control, PC), negative control with MP 0.1% and negative control with MP 0.2% for 5 weeks. During overall experiment, birds in PC and MP treatments had higher final BW and daily BW gains than birds in NC treatments; however, the significance was not identified. The feed conversion ratio of the chicks fed the diet containing MP was significantly improved as compared to those fed the NC diets. The weights of jejunum were increased by the MP (p<0.05), but weights of duodenum, ileum and length of small intestine were similar among the groups. Birds in PC treatment showed lower populations of total microbes and lactic acid bacteria than other groups (p<0.05), cecal ammonia concentrations of the chicks fed the diet containing MP were significantly decreased as compared to those of NC and PC (p<0.01). In conclusion, MP added to the broiler diets improved the feed conversion rate and reduced cecal ammonia concentration.

A Study on the Impact of Employee's Person-Environment Fit and Information Systems Acceptance Factors on Performance: The Mediating Role of Social Capital (조직구성원의 개인-환경적합성과 정보시스템 수용요인이 성과에 미치는 영향에 관한 연구: 사회자본의 매개역할)

  • Heo, Myung-Sook;Cheon, Myun-Joong
    • Asia pacific journal of information systems
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    • v.19 no.2
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    • pp.1-42
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    • 2009
  • In a knowledge-based society, a firm's intellectual capital represents the wealth of ideas and ability to innovate, which are indispensable elements for the future growth. Therefore, the intellectual capital is evidently recognized as the most valuable asset in the organization. Considered as intangible asset, intellectual capital is the basis based on which firms can foster their sustainable competitive advantage. One of the essential components of the intellectual capital is a social capital, indicating the firm's individual members' ability to build a firm's social networks. As such, social capital is a powerful concept necessary for understanding the emergence, growth, and functioning of network linkages. The more social capital a firm is equipped with, the more successfully it can establish new social networks. By providing a shared context for social interactions, social capital facilitates the creation of new linkages in the organizational setting. This concept of "person-environment fit" has long been prevalent in the management literature. The fit is grounded in the interaction theory of behavior. The interaction perspective has a fairly long theoretical tradition, beginning with proposition that behavior is a function of the person and environment. This view asserts that neither personal characteristics nor the situation alone adequately explains the variance in behavioral and attitudinal variables. Instead, the interaction of personal and situational variables accounts for the greatest variance. Accordingly, the person-environment fit is defined as the degree of congruence or match between personal and situational variables in producing significant selected outcomes. In addition, information systems acceptance factors enable organizations to build large electronic communities with huge knowledge resources. For example, the Intranet helps to build knowledge-based communities, which in turn increases employee communication and collaboration. It is vital since through active communication and collaborative efforts can employees build common basis for shared understandings that evolve into stronger relationships embedded with trust. To this aim, the electronic communication network allows the formation of social network to be more viable to rapid mobilization and assimilation of knowledge assets in the organizations. The purpose of this study is to investigate: (1) the impact of person-environment fit(person-job fit, person-person fit, person-group fit, person-organization fit) on social capital(network ties, trust, norm, shared language); (2) the impact of information systems acceptance factors(availability, perceived usefulness, perceived ease of use) on social capital; (3) the impact of social capital on personal performance(work performance, work satisfaction); and (4) the mediating role of social capital between person-environment fit and personal performance. In general, social capital is defined as the aggregated actual or collective potential resources which lead to the possession of a durable network. The concept of social capital was originally developed by sociologists for their analysis in social context. Recently, it has become an increasingly popular jargon used in the management literature in describing organizational phenomena outside the realm of transaction costs. Since both environmental factors and information systems acceptance factors affect the network of employee's relationships, this study proposes that these two factors have significant influence on the social capital of employees. The person-environment fit basically refers to the alignment between characteristics of people and their environments, thereby resulting in positive outcomes for both individuals and organizations. In addition, the information systems acceptance factors have rather direct influences on the social network of employees. Based on such theoretical framework, namely person-environment fit and social capital theory, we develop our research model and hypotheses. The results of data analysis, based on 458 employee cases are as follow: Firstly, both person-environment fit(person-job fit, person-person fit, person-group fit, person-organization fit) and information systems acceptance factors(availability perceived usefulness, perceived ease of use) significantly influence social capital(network ties, norm, shared language). In addition, person-environment fit is a stronger factor influencing social capital than information systems acceptance factors. Secondly, social capital is a significant factor in both work satisfaction and work performance. Finally, social capital partly plays a mediating role between person-environment fit and personal performance. Our findings suggest that it is vital for firms to understand the importance of environmental factors affecting social capital of employees and accordingly identify the importance of information systems acceptance factors in building formal and informal relationships of employees. Firms also need to reflect their recognition of the importance of social capital's mediating role in boosting personal performance. Some limitations arisen in the course of the research and suggestions for future research directions are also discussed.

Transforming growth factor-β promoted vascular endothelial growth factor release by human lung fibroblasts (인간 폐섬유아세포에서 TGF-β 자극에 의한 VEGF 분비)

  • Park, Sang-Uk;Shin, Joo-Hwa;Shim, Jae-Won;Kim, Deok-Soo;Jung, Hye-Lim;Park, Moon-Soo;Shim, Jung-Yeon
    • Clinical and Experimental Pediatrics
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    • v.51 no.8
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    • pp.879-885
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    • 2008
  • Purpose : The human lung fibroblast may act as an immunomodulatory cell by providing pro-inflammatory cytokines and chemokines, which are important in airway remodeling. Vascular endothelial growth factor (VEGF) induces mucosal edema and angiogenesis. Thymus and activation regulated chemokine (TARC) induces selective migration of T helper 2 cells. We investigated whether human lung fibroblasts produced VEGF and TARC, and the effects were augmented with the co-culture of fibroblasts and human bronchial smooth muscle cells (HBSMC), and whether dexamethasone can inhibit the proliferation and the release of VEGF in lung fibroblasts. Methods : Human lung fibroblasts were cultured with and without HBSMC, growth-arrested in serum-deprived medium, and pretreated with dexamethasone for 16 hours. After 24-hour stimulation with platelet derived growth factor-BB (PDGF-BB) and/or transforming growth factor-${\beta}$ (TGF-${\beta}$), culture supernatant was harvested for assays of VEGF and TARC. Cell proliferation was assayed using BrdU cell proliferation ELISA kit. Results : 1) The release of VEGF was significantly increased after stimulation with TGF-${\beta}$, and its release was augmented when co-stimulated with PDGF and TGF-${\beta}$. 2) VEGF release induced by PDGF or TGF-${\beta}$ was inhibited by dexamethasone. 3) There was no synergistic effect on the release of VEGF when human lung fibroblasts were co-cultured with HBSMC. 4) Dexamethasone did not suppress human lung fibroblasts proliferations. 5) Neither TGF-${\beta}$ nor PDGF induced TARC release from lung fibroblasts. Conclusion : Human lung fibroblasts may modulate airway remodeling by release of VEGF, but they have no synergistic effects when co-cultured with HBSMC. Dexamethasone suppresses VEGF release, not proliferation of lung fibroblast.

Effect of Dietary Betaine and Energy Levels on Liver Fats and Cholesterol in Laying Hens (사료내 비태인과 에너지 수준이 산란계의 간지방과 콜레스테롤에 미치는 영향)

  • Park J. H.;Park S. Y.;Ryu K. S.
    • Korean Journal of Poultry Science
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    • v.32 no.3
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    • pp.149-156
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    • 2005
  • Two experiments were conducted to examine the effects of betaine intake on blood and yolk cholesterol, abdominal fat, liver fat, tissue triglyceride(TG) and liver HMG-CoA reductase In laying hens. In Expt. 1, a total of 72 ISA-brown laying hens were individually assigned into four treatments from 18 to 21 weeks old. Com-soybean meal based diet were fed with the addition of 0, 300, 600 and 1,200ppm. In Expt. 2, 72 ISA-brown laying hens were housed into individual cage to evaluate the effect of dietary betaine(0, 600ppm) and energy(ME, 2,800, 2,900kca/kg) from 70 to 74 weeks. Serum total cholesterol, LDL and HDL-cholesterol and TG concentration in blood of hens fed betaine tended to increase compared to those of the control, but were not significantly different. However, betaine supplementation showed a statistically significant decrease in yolk cholesterol(P<0.05). There was no significant difference in abdominal fat among the treatments. Liver fats and 7c of birds 130 betaine was decreased compared with control. Serum total cholesterol, LDL-cholesterol and triglyceride concentration were significantly inc.eased by ffeding a diet containing 600ppm betaine in Expt. 2(P<0.05), but were not influenced by the dietary energy levels. Yolk cholesterol, abdominal fat and HMG-CoA reductase activity were affected neither by dietary energy nor betaine level.

Constructing Geological Cross-sections at Depth and Interpreting Faults Based on Limited Shallow Depth Data Analysis and Core Logging: Southern Section of the Yangsan Fault System, SE Korea (제한된 천부자료와 시추코어분석을 통한 심부지질단면도 작성과 단층 인지법: 한반도 남동부 양산단층대 주변에서의 적용)

  • Kim, Taehyung;Kim, Young-Seog;Lee, Youngmin;Choi, Jin-Hyuck
    • The Journal of Engineering Geology
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    • v.26 no.2
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    • pp.277-290
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    • 2016
  • Deep geological cross-sectional data is generally not common nor easy to construct, because it is expensive and requires a great deal of time. As a result, geological interpretations at depth are limited. Many scientists attempt to construct geological cross-sections at depth using geological surface data and geophysical data. In this paper, we suggest a method for constructing cross-sections from limited geological surface data in a target area. The reason for this study is to construct and interpret geological cros-sections at depth to evaluate heat flow anomaly along the Yangsan fault. The Yangsan Fault passes through the south-eastern part of the Korean Peninsula. The cross-section is constructed from Sangbukmyeon to Unchonmyeon passing perpendicularly through the Yangsan Fault System trending NW-SE direction. The geological cross-section is constructed using the following data: (1) Lithologic distributions and main structural elements. (2) Extensity of sedimentary rock and igneous rock, from field mapping. (3) Fault dimension calculated based on geometry of exposed surface rupture, and (4) Seismic and core logging data. The Yangsan Fault System is composed of the Jain fault, Milyang fault, Moryang fault, Yangsan fault, Dongnae fault, and Ingwang fault which strike NNE-SSW. According to field observation, the western section of the Yangsan fault bounded by igneous rocks and in the eastern section sedimentary rocks are dominant. Using surface fault length we infer that the Yangsan Fault System has developed to a depth of kilometers beneath the surface. According to seismic data, sedimentary rocks that are adjacent to the Yangsan fault are thin and getting thicker towards the east of the section. In this study we also suggest a new method to recognize faults using core loggings. This analysis could be used to estimate fault locations at different scales.

Stress and Coping for Patients with Hemiplegia during the Rehabilitation Process (편마비 환자의 재활과정에 따른 스트레스와 대처의 변화양상)

  • 강현숙
    • Journal of Korean Academy of Nursing
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    • v.24 no.1
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    • pp.18-32
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    • 1994
  • It is important to understand that patients with hemiplegia are under stress during the rehabilitation process. This study was designed to determine what changes occur in the stress perceived by these patients during the rehabilitation process. and what changes occur in the ways they coped with stress. A decriptive study with a longitudinal design was conducted. A total of 57 patients with hemiplegia who were admitted to one general hospital made up the sample for this study. A questionnaire, observations and interviews were used for the data collection which was done in three phases(within one week after admission : within one week before discharge ; within one month after discharge ). Data were analyzed using t-test, ANOVA repeated measures of ANOVA, and post hoc paired t -test, Bonferroni correction. The results of this study are : 1. Changes in the perception of stress during the rehabilitation process : There was a statistically significant differencs in the perception of stress among these patients during the rehabilitation process. On the post-hoc test. the perception of stress showed a statistically significant decrease from admission to discharge. The perception of psychological stress was high during the rehabilitation process as compared with the perception of physical and social stress. 2. Changes in the way the patients coped during the rehabilitation process : On admission passive coping was used by most of the subjects(91.2%). Passive coping showed an decrease from admission to discharge, but an increase from discharge to follow-up at one month post discharge. There was, however, no statistically significant changes in the way the patients coped during the rehabilitation process. 3. Changes in perception of stress during the rehabilitation process according to variables. Perception of stress among patients classified as So-Um was higher during the rehabilitation process, when compared with patients classified as So- Yang and Tae-Um. There was, however, no statistically significant difference in perception of stress over time. The patients with right sided paralysis perceived higher stress than those with left sided paralysis. There was, however, no statistically significant difference in perception of stress over time. Hence, stress was not influenced by which side was paralyzed th frequency of the relapse of the disease, or the time in the rehabilitation process. 4. Changes in coping during the rehabilitation process according to variables. There was a statistically significant difference in the way the patients coped at follow- up according to the three different kinds of the constitution groups. In other words, coping was not used by patients classified as Tae-Um but was used by those classified as So-Um. On the repeated measures of ANOVA, there was a statstically significant difference in stress over time, and an interaction between constitution and time. But the way of coping during the rehabilitation process was not influenced by which side was paralyzed nor by the frequency of the relapse of the disease. In conclusion, perception of psychological stress was high during the rehabilitation process, as compared to perception of physical and social stress. There was a statistcally significant difference in the perception of stress over time, Perception of stress showed a gradual decrease from over admission to follow-up period. There was. however, no statistically significant difference in the way of coping over time. Passive coping was used by most of patients. In the study, these findings suggest a need for nursing care related to the psychological support for patients with hemiplegia both in the hospital as well as at home, and the need for education and counseling on independent self-care to help the hemiplegic patients adapt to stress using active coping.

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A Prospective Study on Attitude of Professional Student toward Population Related Issues in Korea (대학전공별(大學專攻別) 전문직학생(專門職學生)들의 인구관련문제(人口關聯問題)에 대한 연차적(年次的) 변화(變化) 연구(硏究))

  • Lee, Kyung-Sik;Kim, Hwa-Joong
    • Journal of Preventive Medicine and Public Health
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    • v.9 no.1
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    • pp.11-24
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    • 1976
  • This study was a part of large scale of a prospective study on attitudes of professional students in medicine, nursing and teaching toward population related issues in Korea. The study was first conducted in May 1974 and then in May 1975 for the 1974 class cohot using a questionaire consisted of attitude scales and other items developed by Lee. The purpose of stuay was twohold, namely, to determine the difference in students among specializations on one hand and between the first and second years in the 1974 class cohot regarding tile subject matter. A one-way analysis of variance was used for attitude scale, and absolute and relative frequency were computed for the analysis of non-attitude scale items by employing Fishers' Ratio and Duncan's multiple range test at 5% level and chi square test at 5% level as significance tests. The hypothesis 'students in health profession are more likely to have positive attitudes toward population related issues progressively as class year advances than students in teaching profession' was tested and the following results were obtained: 1) Nursing students were more likely to display favarable attitudes toward family planning than medical or teaching students although the class cohot showed slightly negative improvement in the second year. Medical and teaching students apperaed to have slightly improved attitudes in the second year. 2) Respondents in general perceived national family planning program as a means of population control and this tendency was more true among nursing students as the class year advances than two other professional groups of students. Students in teaching profession appeared to perceive it more as a means to improve individual family welfare while health students were likely to see as to improve maternal and child health. This tendency was progressively improved as the class year advanced. 3) The majority of students regardless of their respective specializations believed that family planning program should be directed toward the improvement of individual family welfare. No progressive changes in the class cohot were observed. 4) About the plan to use contraceptives in future, no singnificant differences were observes among different specializations nor in different class years. However, the majority was confirmed to have a plan to use contracepives in future. An increasing proportion of the undecided category was observed, as class year advanced among health students. 5) Students in health profession were found to be more favorable about 'more leisure opportunities' as motive for limiting number of children whereas education students indicated the reasons as 'facilitate ambitions' and 'economic base' The progressive changes toward positive direction in both groups were observed as the class years advanced. 6) Attitudes toward induced abortions of the health students were observed to be positively related to class years while an inverse relationship was found in teaching students who showed much less favor in the subject matter than health students. This phenomenon may be due to the different exposure to learning environments unique to respective specializations. 7) Health students were found to have more favorable attitudes toward population education in general than the teaching students. The teaching students appeared to have changed more to the negative direction when they became the second year while no such development was observed in health students. The teaching students seemed to hold a very conservative position with regard to sex education in schools. 8) About the equality of sexes, the nursing group was found to be most favorable while the reverse was true in the teaching group. A change in the negative direction as the class year advanced was found in the teaching group. 9) About questions related to fertility values-the 10 percent of respondents regardless of specialization indicated that they would maintain their single status in future, however no change was observed in the second year. The desired number of children was found to be two by the majority of students in nursing, medicine and teaching in order of high proportion. No changes in a different class year were observed. The childless marriage was seen by nursing students as a problem more than other students, but a slight change in positive direction was found when the nursing students became the second year. In summing, as data supported in the above, students in health profession demonstrated more favorable attitudes toward population related issues than the teaching students and this tendency became more apparent in the second year. It was noticed that health students were more conscious about the health aspect of population and family planning program while the teaching students gave more attention to the socioeconomic aspect. The sex variable seemed to have operated in the item related to the equality of sexes. In conclusion, as data presented in the above, the hypothesis of this study was accepted except in the few items. It should be noted that the limitation of this study is the short duration of the observation in measuring the possible attitude changes. It should include curriculum analysis for the respective specializations in order to indentify the area of curriculum impact on students in future study.

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Chronic pain control in patients with rheumatoid arthritis (만성통증 환자의 통증 조절)

  • Eun, Young
    • Journal of muscle and joint health
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    • v.2 no.1
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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.

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