• 한국사회정책
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• 제24권2호
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• pp.31-60
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• 2017

이 논문은 독일에서 진행 중인 사회보험 개혁론의 배경과 쟁점을 드러내고 시사점을 제시한다. 사회보험 개혁론의 배경에는 사회보험이 근간으로 삼았던 산업사회 표준성의 위기가 자리 잡고 있다. 표준성의 위기는 재정과 이중화라는 이중적 위기로 표출되고 있다. 사회보험 개혁론은 개별 사회보험 영역에서 서로 다른 형태로 표출되는 표준성의 위기에 대한 대응으로서, 건강보험은 시민보험으로, 연금보험은 취업자 보험을 비롯한 다양한 대안적 제도로, 실업보험은 일자리 보험으로 재편을 모색하고 있다. 사회보험이 전통적으로 가정했던 표준성을 재구성하려는 사회보험 개혁론의 공통점 중 하나는 자신의 선조인 비스마르크로부터 벗어나려는 것이다. 그러나 경제 상황의 호전, 사회보험 개선의 역사적 경험, 높은 만족도 등으로 전통적인 사회보험에서 급진적으로 전환하기 보다는 점진적 개선으로 가닥을 잡을 것으로 전망된다. 사회보험의 성숙도가 낮은 한국의 경우 독일 사회보험이 직면한 위기를 반면교사로 새길 필요가 있다. 우리는 사회정책의 기본으로 돌아가 표준성과 보편성의 재구성이라는 관점에서 다양한 구상들을 열어 놓고 사회정책의 설계도를 다시 그려볼 필요가 있다.

• Clinical and Experimental Emergency Medicine
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• 제5권4호
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• pp.240-248
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• 2018

Objective Determine differences between faculty, residents, and nurses regarding night shift preparation, performance, recovery, and perception of emotional and physical health effects. Methods Survey study performed at an urban university medical center emergency department with an accredited residency program in emergency medicine. Results Forty-seven faculty, 37 residents, and 90 nurses completed the survey. There was no difference in use of physical sleep aids between groups, except nurses utilized blackout curtains more (69%) than residents (60%) and faculty (45%). Bedroom temperature preference was similar. The routine use of pharmacologic sleep aids differed: nurses and residents (both 38%) compared to faculty (13%). Residents routinely used melatonin more (79%) than did faculty (33%) and nurses (38%). Faculty preferred not to eat (45%), whereas residents (24%) preferred a full meal. The majority (>72%) in all groups drank coffee before their night shift and reported feeling tired despite their routine, with 4:00 a.m. as median nadir. Faculty reported a higher rate (41%) of falling asleep while driving compared to residents (14%) and nurses (32%), but the accident rate (3% to 6%) did not differ significantly. All had similar opinions regarding night shift-associated health effects. However, faculty reported lower level of satisfaction working night shifts, whereas nurses agreed less than the other groups regarding increased risk of drug and alcohol dependence. Conclusion Faculty, residents, and nurses shared many characteristics. Faculty tended to not use pharmacologic sleep aids, not eat before their shift, fall asleep at a higher rate while driving home, and enjoy night shift work less.

• Medical Lasers
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• 제9권1호
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• pp.39-43
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• 2020

Background and Objectives Breast reconstruction has the advantage of reducing the loss of the body image of patients after mastectomy surgery, and also improving the quality of the social and sexual life of breast cancer patients. However, in surprising and unfortunate number of patients, acute postoperative pain persists beyond the normal course of postsurgical recovery. We set out to investigate the effect of local dynamical micro-massage (LDM) treatment for achieving pain relief and reducing other postoperative complications. Materials and Methods We performed a retrospective analysis on 58 patients who underwent LDM treatment for postoperative pain management at Soonchunhyang University Bucheon Hospital between February 2017 and June 2019. Those patients who complained of persistent postoperative pain, which was uncontrollable with medication, were treated with LDM. The degree of pain and discomfort with contracture were recorded using numerical rating scale (NRS) scoring system with numbers from 0 to 10 ('none' to 'worst'). Results The median NRS score of pain was reduced by 62.3% from the start to the end of LDM treatment (p<0.001). Further, the NRS score of discomfort with contracture was reduced 66.0% (p<0.001). There was no complication related to the LDM treatment. Conclusion Dual-frequency ultrasound LDM can be an effective therapeutic option for persisting pain after breast reconstruction surgery. It was also effective in improvement of discomfort with contracture and erythema of the surgical wound.

• 대한안전경영과학회지
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• 제24권4호
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• pp.85-93
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• 2022

Today's customer service providers, who have the greatest impact on customer satisfaction, are experiencing severe stress and job burnout due to various causes. Unlike general companies, the corporation has a relatively high level of dissatisfaction with customer service since there is a large conflict between the provision of kindness and the reasonable handling of civil complaints according to laws and regulations. In order to analyze the environment of the NPS' customer service providers, 5.583 branch employees working at the National Pension Service and 407 call center employees were surveyed online using the questionnaire function of the Enterprise resource planning system. The contents of the survey consisted of a survey on customer-facing employees, the level of awareness of customer-facing workers protection measures, and opinions on improvement and supplementation related to customer-facing workers protection measures. As a result of the survey, 72.8% of the total respondents experienced grievance complaints, and the proportion of call center employees was even higher at 89.0%. In addition, both the branch and the call center had the largest share of complaints about obstruction of business, unreasonable demands, abusive language, and verbal abuse. More than 40% of call center employees in their 20s and 30s experienced the highest frequency of complaints 13 or more times a year. The most difficult thing in the process of responding to complaints was that both branch offices and call centers had insufficient psychological recovery time, lack of space, and lack of help from colleagues and superiors. Based on the survey analysis, it is suggested to establish a countermeasure through case analysis rather than the right to suspend work for civil complaints that cannot be handled, such as customized manuals and action strategies for the age group with high grievance complaints.

• Clinics in Shoulder and Elbow
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• 제24권3호
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• pp.172-177
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• 2021

Background: This study aimed to evaluate the response rate to arthroscopic release treatment in adhesive capsulitis of the shoulder (ACS) for patients with refractory to conservative treatment. Methods: In this retrospective study, 51 patients (age mean, 49.1±5.6 years) with unilateral adherent capsule underwent arthroscopic releasing surgery for the shoulder capsule. Etiologies of the ACS in 30 patients were idiopathic: 10 patients were affected after surgery and 11 patients following trauma. The patients were evaluated in terms of shoulder function, satisfaction rate, pain intensity, and joint range of motion (ROM) based on a Constant score, a Simple Shoulder Test, the visual analog scale, and four movements, respectively. Results: The mean Constant score before surgery was 48.2±3.5 and reached 74.4±6 and 77.0±6.3 at 6 months and the final follow-up, respectively (p<0.001). The mean scores of pain intensity, a Simple Shoulder Test, and ROM showed significant improvement at all follow-ups (p<0.001). Sex, age, and diabetes did not have any significant effect on patient recovery. However, patients who experienced ACS after surgery had poorer results than others at all follow-up points. Conclusions: Arthroscopic releasing surgery of the shoulder in patients with ACS refractory to conservative treatment produces rare complications and an effective injury response. It seems that patients suffering ACS following surgery have a weaker response to the treatment.

• Medical Lasers
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• 제8권2호
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• pp.59-63
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• 2019

Background and Objectives High-intensity focused ultrasound (HIFU) has been developed as an effective, non-invasive, skin-tightening method in response to the increasing demand for improvements in skin laxity and tightening with minimal risk and recovery time. This study evaluated the efficacy and safety of HIFU for non-invasive skin tightening of crow's feet wrinkles, with the aim of determining how long the tightening can be maintained. Materials and Methods Between January and March 2019, 21 female patients with crow's feet wrinkles were treated with HIFU. The treatment involved 200 shots, three times every 2 weeks. Three blinded, experienced plastic surgeons and patients evaluated satisfaction at 2 weeks after the first procedure, 2 weeks after the second procedure, 2 weeks after the third procedure, and 6 weeks after the first procedure based on photographs according to the Global Aesthetic Improvement Scale (GAIS). The Friedman test was used to compare data. Results Of the 21 patients treated using HIFU, one was lost to follow-up for nonstudy-related reasons. Therefore, 20 patients were evaluated and ranged in age from 28 to 48 years. Plastic surgeons' GAIS scores were 2.6, 2.3, 1.7, and 1.3 and patients' GAIS scores were 2.6, 2.2, 1.8, and 1.4 at 2 weeks after the first procedure, 2 weeks after the second procedure, 2 weeks after the third procedure, and 6 weeks after the third procedure. No serious adverse effects were observed. Conclusion The aging face with crow's feet wrinkles can be improved by using HIFU, while minimizing epidermal and dermal injury.

• 한국정보처리학회:학술대회논문집
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• 한국정보처리학회 2008년도 추계학술발표대회
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• pp.1387-1390
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• 2008

In a wireless network, handover latency is very important in supporting user mobility with the required quality of service (QoS). In view of this many schemes have been developed which aim to reduce the handover latency. The Hierarchical Mobile IPv6 (HMIPv6) approach is one such scheme which reduces the high handover latency that arises when mobile nodes perform frequent handover in Mobile IPv6 wireless networks. Although HMIPv6 reduces handoff latency, failures in the mobility anchor point (MAP) results in severe disruption or total disconnection that can seriously affect user satisfaction in ongoing sessions between the mobile and its correspondent nodes. HMIPv6 can avoid this situation by using more than one mobility anchor point for each link. In [3], an improved Robust Hierarchical Mobile IPv6 (RH-MIPv6) scheme is presented which enhances the HMIPv6 method by providing a fault-tolerant mobile service using two different MAPs (Primary and Secondary). It has been shown that the RH-MIPv6 scheme can achieve approximately 60% faster recovery times compared with the standard HMIPv6 approach. However, if mobile nodes perform frequent handover in RH-MIPv6, these changes incur a high communication overhead which is configured by two local binding update units (LBUs) as to two MAPs. To reduce this communication overhead, a new cost-reduced binding update scheme is proposed here, which reduces the communication overhead compared to previous schemes, by using an increased number of MAP switches. Using this new proposed method, it is shown that there is a 19.6% performance improvement in terms of the total handover latency.

• Clinics in Shoulder and Elbow
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• 제26권3호
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• pp.296-301
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• 2023

Background: A supervised physiotherapy program (SPP) is a standard regimen after surgical rotator cuff repair (RCR); however, the effect of a home-based exercise program (HEP), as an alternative, on postoperative functional recovery remains unclear. Therefore, the purpose of this meta-analysis was to compare the functional effects of SPP and HEP after RCR. Methods: We searched electronic databases including Central, Medline, and Embase in April 2022. The primary outcomes included the Constant score, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, and pain score. Secondary outcomes included range of motion, muscle strength, retear rate, and patient satisfaction rate. A meta-analysis using random-effects models was performed on the pooled results to determine the significance. Results: The initial database search yielded 848 records, five of which met our criteria. Variables at 3 months after surgery were successfully analyzed, including the Constant score (mean difference, -8.51 points; 95% confidence interval [CI], -32.72 to 15.69; P=0.49) and pain score (mean difference, 0.02 cm; 95% CI, -2.29 to 2.33; P=0.99). There were no significant differences between the SPP and HEP. Other variables were not analyzed owing to the lack of data. Conclusions: Our data showed no significant differences between SSP and HEP with regard to the Constant and pain scores at 3 months after RCR. These results suggest that HEP may be an alternative regimen after RCR. Level of evidence: I.

• Clinical and Experimental Pediatrics
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• 제49권7호
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• pp.726-731
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• 2006

목 적 : 소아의 통증을 수반하는 술기의 시술시에 진통, 진정을 위해 ketamine을 사용하는데, midazolam을 병용 투여 할 필요가 있는가에 대한 논의가 활발하게 진행되고 있다. ketamine의 근육주사의 적정용량은 국내에서 연구된 바가 없으며 저자들은 이전 연구에서 ketamine 3 mg/kg가 부족하다는 결론을 얻어 용량을 4 mg/kg로 증량하여 KMA(ketamine+midazolam+atropine)와 KA(ketamine+atropine)의 진정 및 부작용 발생여부의 차이를 알아보고자 하였다. 방 법 : 2005년 1월부터 2005년 7월까지 열상처치 시 진정이 필요한 생후 3개월에서 7세까지의 60명의 소아를 대상으로 KMA군(IM ketamine 4 mg/kg+atropine 0.01 mg/kg+intramuscular midazolam 0.05 mg/kg) 혹은 KA 군(without midazolam)을 무작위로 선택하여 anxiety/tolerance scores, 합병증, 진정정도, 진정유도시간, 진정회복시간, 총 진정시간, 시술자의 만족도를 기록하였다. 결 과 : 두 군간에 성비, 체중, 연령, 상처 부위에는 통계학적으로 유의한 차이가 없었으며anxiety/tolerance score, 진정유도시간, 진정회복시간, 총 진정시간에는 두 군간에 통계적으로 유의한 차이가 없었다. 효과적 진정을 보인 경우가 KA군은 66.7%, KMA군은 90.9%로 KMA군이 진정에 보다 효과적이었으며(P=0.02), 시술자의 만족도는 KA군은 55.6%, KMA군은 90.9%로 만족, 매우 만족 이상으로 유의한 차이를 보였다. 의미 있는 부작용의 발생은 KA군은 37.0%, KMA군은 0.0%였다. 결 론 : 소아의 피부 열상 봉합 시 진정을 위해 근육주사를 통한 ketamine 4 mg/kg과 midazolam 및 atropine의 병용 투여는 ketamine과 atropine만을 투여하는 것보다 안전하고 효과적으로 진정을 유도할 뿐 아니라 시술자의 만족도를 높일 수 있다.

• 대한치과보철학회지
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• 제47권2호
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• pp.215-221
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• 2009

연구목적: 임플란트 시술을 받는 환자가 크게 증가하는 시점에 임플란트 시술환자를 시술 전후로 추적 조사하여 시술 전후의 저작능력을 평가하고, 시술 전후의 환자 만족도와 삶의 질의 변화를 비교하기 위하여 연구를 수행하였다. 연구 재료 및 방법: 대구광역시와 울산광역시에 있는 6개의 치과 의원에서 2006년 12월부터 2007년 10월까지 임플란트 시술을 받은 20세 이상의 성인 환자 109명을 대상으로 임플란트 시술 전후에 설문조사를 실시하여 임플란트 치료선택동기, 저작능력, 환자만족도, 권유의향, 삶의 질을 비교분석하였다. 결과: 임플란트 선택 동기는 '치아기능의 회복을 위하여'가 45.9%로 가장 많았고, 치료 시 가장 걱정되는 것은 '치료실패와 부작용'이 38.5%로 가장 많았다. 임플란트 시술에 대한 만족도는 시술 전 30.37점에서 시술 후 45.01점으로 시술 전후의 만족도 점수가 유의한 차이가 있었으며(P<.001), 치료에 대한 만족도는 '만족한다'라고 답한 사람이 91.8%였으며, 연구대상자의 89%가 가족이나 주위에 임플란트를 '권유할 의향이 있다'라고 응답했다. 섭취가능 식품에 대한 설문을 이용하여 측정한 저작능력 점수는 임플란트 시술 전 15.24점에서 임플란트 시술 후 19.11점으로 시술 전후의 저작능력 점수가 유의한 차이가 있었으며(P<.001), 삶의 질 점수도 임플란트 시술 전 9.99점에서 시술 후 11.17점으로 시술 전후 유의한 차이가 있었다(P<.001). 결론: 이 연구 결과를 통해 치아 질환, 치아상실로 인하여 저하된 저작 능력이 임플란트를 통하여 유의하게 개선됨을 확인할 수 있었다. 향후 임플란트를 시술한 상실치아 수나 상실 부위에 따른 임플란트 시술환자의 만족도에 대한 연구가 필요하며, 시술 후 장기간의 경과 후 평가 및 연구대상자 확대를 통한 연구를 시행할 필요가 있다고 생각한다.