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변형된 복약확인 치료(mDOT) 수행 후의 균음전율에 대한 연구 부제: 보건소 균양성 폐결핵 환자를 대상으로 (Sputum Smear Conversion During mDOT (Modified Directly Observed Treatment))

  • 황택근;김순덕;유세화;신유철
    • Tuberculosis and Respiratory Diseases
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    • 제56권5호
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    • pp.485-494
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    • 2004
  • 연구배경 : DOT를 보건소에서 현실적으로 실행 가능하게 변형시킨 mDOT는, 환자가 꾸준하게 약을 복용하도록 하기 위해 집중치료기간(투약 후 2개월)동안 1주에 1회씩 환자와 의료인 또는 의료보조요원이 면담하여 투약 및 복약감독, 상담 등을 수행하는 일주일 간격의 복약확인 치료법을 의미한다. 이를 균양성 폐결핵 환자들에게 적용시킨 후, 이 mDOT군의 균음전율(sputum smear conversion)을 self군의 그것과 비교하여, mDOT의 수행이 균양성 폐결핵 환자에서의 균음전율에 미치는 효과를 알아보기 위함이다. 방 법 : 서울시 S보건소에서 2001년 10월 8일부터 2002년 4월 23일까지 등록된 균양성환자 52명중에서 24명은 mDOT군, 28명은 자가복용(self)군으로 분류하였다. 24명의 mDOT군중 조절 안 되는 당뇨 동반환자 2명, 외국인 1명, 기타 1명을 제외된 20명의 mDOT군을 선정한 후, 성별, 폐결핵의 범위, 재발유무, 연령을 짝짓기 변수로 해서 일대일 1:1 짝짓기를 실시한 20명의 self군을 선정하여 균음전율을 비교연구 하였다. 본 연구의 경우 mDOT라는 중재만이 있고 무작위추출과 이중맹검이 없기 때문에 일종의 quasi-experimental study라고 할 수 있다. 분석방법은 SAS version 8.1을 이용해 짝지어진 자료에 대한 McNemar test를 사용하였다. 결 과 : 치료 2주 후, 균음전율은 self군에서 50%, mDOT군에서 78.57%로 mDOT군이 self군에서보다 약간 높았으나 통계적으로 유의한 차이는 없었다(p-value=0.289). 치료 1개월에는 mDOT군의 음전율이 self군보다 높게 나타났으나 통계적으로 유의하지는 않았다(83.33% vs 50%, p-value=0.125). 2개월의 균음전율 역시 self군보다 mDOT군에서 비교적 높은 균음전율을 나타냈으나 표본수가 적어 통계적으로 유의하지는 않았다(Table 5, p-value=0.219). 결 론 : 이번 연구에서 집중치료기간 중에 변형된 복약확인 치료를 mDOT군의 20명 모든 환자에게 수행했으며, 앞으로 sample size가 충분히 모아진 연구가 이뤄지면 mDOT가 균양성 폐결핵 환자의 전염성기간(배균기간)을 통계적으로 유의하게 단축시킬 수 있다는 방향성을 제시한데에 의미가 있다. 우리나라에서 복약확인치료(DOT)는 폐결핵 환자의 치료에 효과적일 수 있고, 어떤 고위험군에서 유용하리라 생각된다. 앞으로 좀 더 큰 규모의 전향적(prospective) 연구가 필요한 것으로 사료된다.

간호센타 개발을 위한 건강증진 프로그램 요구사정 연구-유방자가검진 프로그램을 중심으로- (A Study on Need Assessment in Health Promotion Programs for Developing Nursing Centers - Breast Self Examination-)

  • 박인혜;강혜영;이정희;류현숙
    • 지역사회간호학회지
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    • 제11권1호
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    • pp.21-36
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    • 2000
  • The purpose of this study was to assess the needs of breast self examination education (BSEE) programs for developing nursing centers. A first, we reviewed the literature of activity and management-related factors of nursing centers: and, second. we used a questionnaire to discover the degree of knowledge, attitude, and practice on breast cancer, as well as an individual's intention to participate BSEE program. 1. Reviewing the literatures of nursing center activities. Nursing centers which were administered by a professional nurse are an ideal site for faculty and student practices. With the use of nursing models of health. professional nurses in nursing centers diagnose and treat human responses to potential and actual health problems and offer holistic, client-centered health service. In nursing centers professional nursing services include health education, health promotion, and health-related research. A nursing center is comprised of the advisory and exacutive commitee; the advisory commitee serves consultants and links community needs to the nursing center, while the director of the exacutive commitee identifies the potential resources to generate funds, support, and facilitate the activities of staffs in a nursing center. Nursing centers mobilize various financal resources for reimbursement of services from college and insurance companies, collect minimum service fees from the client, and further collect fees for providing programs to community groups, this also includes membership fees, and donations. The services provided by nursing centers focus on services related to primary prevention, health maintenance & health promotion, direct nursing care for acute & chronic diseases, and holistic care for actual and potential health problems. The client satisfaction for the services was high. Students also showed positive reponses for their clinical experiences and independent working conditions. 2. The degree of knowledge, attitudes, and practices for breast cancer. and an individual's intention to participate in the BSEE program. The subjects of this study were 308 females in K-city in the Republic of Korea. Data were collected using a self-administered questionnaire. The mean age of the respondents was 35.0 years old. Those who already participated in the BSEE were 64.9%, and those who had support and encouragement to practice BSE from significant others were 25.1 %. Clients intent to participate in the BSEE were 37.0%. The mean score of knowledge(2.4 out of 5 points) and practices(1.8 out of 5 points) for breast cancer were quite low, but the mean score of attitudes was relatively positive04.5 out of 20 point) for breast cancer. Those who already had BSEE showed significantly high scores in knowledge(t=6.48, p<0.01), attitudes (t=10.54, p<0.01). and practices(t=57.07, p<0.001) for breast cancer than those who had not participated in the BSEE. In all age groups no intention to participate in the BSEE was higher than who the intention to participate. These findings suggest some strategies should be developed to increase the awareness of breast cancer's early detection.

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한국에서 방사선 관련 종사자들의 개인피폭선량 실태에 관한 연구 (Radiation Exposure Dose on Persons Engaged in Radiation-related Industries in Korea)

  • 임봉식
    • 대한방사선기술학회지:방사선기술과학
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    • 제29권3호
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    • pp.185-195
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    • 2006
  • 목 적: 방사선 관련종사자들의 1995년 1월 6일 "진단용 방사선 발생장치의 안전관리에 관한 규칙"을 제정한 이후 방사선 노출로 인한 개인피폭선량의 실태를 조사 분석하여, 해당 의료기관과 방사선 관련종사자들에게 방사선피폭에 대한 경각심을 고취시키고, 안전관리에 도움을 주고자 한다. 조사대상 및 방법: 2000년 1월 1일부터 2004년 12월 31일까지 5년 동안 전국에 있는 검사기관, 교육기관, 군부대, 병원, 보건소, 산업체, 연구기관, 의원에서 근무하였거나 근무하고 있는 방사선종사자들의 개인 피폭선량 측정결과 판독기관에 등재(登載)된 대상자 57,136명에 대한 분기별 피폭선량 자료 149,205건을 대상으로 하여 판독수행기관에 직접 방문 하거나, 전화를 통하여 책임자에게 연구의 목적을 설명하고 긴밀한 협조를 얻어 수집하였다. 자료를 분석하는데 있어 SPSS ver 12.0을 이용하였으며, 분석방법으로는 연도별 분기별 성별 연령별 직종별 근무부서별 업종별로 심부선량과 표면선량으로 나누어 분석하였다. 빈도분석 one-way ANOVA two-way ANOVA를 시행하였다. 결 과: 5년간의 평균 피폭선량에서 심부선량과 표면선량의 평균값이 해마다 낮아지는 것으로 조사되었고, 성별 평균 피폭선량은 심부선량과 표면선량에서 남자가 여자보다 높게 나타났으며 연령별 평균 피폭선량에서 심부선량과 표면선량은 높은 연령군보다 낮은 연령군에서 높게 나타났고, 직종별 평균 피폭선량은 심부선량과 표면선량 모두에서 방사선사가 가장 높게 나타났으며 근무 부서별 평균 피폭선량은 심부선량과 표면선량에서 핵의학과가 가장 높게 나타났고, 업종별 평균 피폭선량은 심부선량과 표면선량에서 병 의원이 높게 나타난 것으로 조사되었다. 결 론: 이상의 결과에서 볼 때 최근 5년간 전국 지역에 있는 병원 의원 기타 등에서 근무하는 방사선 종사자들의 방사선 평균 피폭선량은 국제방사선방어위원회(ICRP)에서 권고하는 허용선량 기준치(20 mSv/년)를 초과하지 않는 범위의 피폭을 받고 있는 것으로 나타났다. 그러나 그것은 평균적인 수치이지 개인적으로 피폭선량에 있어 그 범위의 피폭을 초과하는 종사자들이 있는 것으로 나타나 상당히 우려가 되고 있는 실정이다. 따라서 방사선 관련종사자들이 각자가 개인별 관리에 더욱더 철저를 기하고 방사선으로 인한 피폭을 최소화 시키는데 있어 체계적인 교육 및 안전 불감증에 대한 지도가 지속적으로 유지되어야 할 것이다.

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대학병원 간호사들의 직무스트레스와 이직의도와의 관련성 (Relationship Between Job Stress and Turnover Intention Among Nurses in University Hospitals)

  • 신현란;조영채
    • 한국산학기술학회논문지
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    • 제14권8호
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    • pp.3958-3970
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    • 2013
  • 본 연구는 종합 병원 간호사들의 인구사회학적특성, 건강관련행위 특성 및 직업관련 특성에 따른 직무 스트레스와 이직의도를 파악하고, 특히 직무 스트레스와 이직의도와의 관련성을 규명하고자 실시하였다. 조사대상은 대전광역시의 3개 대학병원에 근무하고 있는 간호사 355명을 대상으로 하였으며, 자료 수집은 2012년 4월 1일부터 5월 31일까지의 기간 동안에 구조화된 자기기입식 설문조사에 의하였다. 연구결과, 조사대상 간호사들의 직무스트레스 요인별 이직의도 평균점수는 상사의 지지도가 높은 군보다 낮은 군에서, 동료의 지지도가 높은 군보다 낮은 군에서 유의하게 높았다. 이직의도 점수와 직무 스트레스 요인들 간의 상관관계를 보면, 이직 의도는 상사의 지지도 및 동료의 지지도와 유의한 음의 상관관계를 보였으나, 업무의 요구도와 업무의 자율성과는 유의한 관련성이 없었다. 위계적 다중회귀분석 결과 조사대상 간호사들의 이직의도에 영향을 미치는 관련 변수로는 연령, 커피음용여부, 근무부서, 업무에 대한 만족도, 상사의 지지도 및 동료의 지지도가 유의한 변수로 선정되었으며 이들 변수의 설명력은 29.4%이었다. 이상과 같은 결과를 볼 때, 조사대상 간호사들의 직무스트레스와 이직 의도는 인구사회학적특성, 건강관련행위특성 및 직업관련 특성의 여러 변수들과 유의한 관련성이 있음을 시사한다. 또한 직무스트레스 요인과 이직의도 간에는 유의한 양의 상관관계를 보이고 있었으며, 직무스트레스 요인 중 상사나 동료의 지지도는 이직의도에 영향을 미치는 요인으로 나타났다. 따라서 간호사의 직무 스트레스를 최소화하는 동시에 이직을 예방하기 위한 구체적인 방안을 강구할 필요가 있다고 생각된다.

기관내 흡인 실시 후의 동맥혈 산소 분압 변화와 심부정맥 발현에 관한 연구 (Changes in Arterial Oxygen Tension($PaO_2$) and Cardiac Arrhvthmias after Endotracheal Suction)

  • 김선화;신정숙;최영희
    • 대한간호
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    • 제33권4호
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    • pp.62-85
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    • 1994
  • The data were analyzed by using an S. P. S. S. computerized program for mean, standard deviation, percentage and paired t-test. The results of this study were as follows: 1. The increase in $PaO_2$ after hyperoxygenation and hyperinflation was highly statistically significant(p=0.041), and the increase in $PaO_2$ immediately after suctioning was not significant (p=0.752). The time of lowest $PaO_2$ was 30 seconds after the endotracheal suction. 2. The occurrance of cardiac arrhythmia after the endotracheal suction included sinus tachycardia, sinus arrhythmia, sinus bradycardia, premature atrial contraction (PAC), and premature ventricular contraction (PVC). The most frequent cardiac arrhythmia was sinus tachycardia (a subjects). Sinus arrhythmia was observed in 5 subjects and continued till 10 minutes after suctioning in two of these. Sinus bradycardia occurred in only 3 subjects and among them, 1 subjects shows sinus arrythmia till 10 minutes after suctioning along. PAC was observed in only one subject and continued till five minutes after suctining along with sinus arrhythmia. PVC was observed in three subjects: it lasted for only 30 seconds after suctioning in two subjects. but continued for 10 minutes after suctioning in the third. 6 subjects manifested two kinds of Cardiac arrhythmia Three of them showed sinus tachycardia with PVC, another 2 showed sinus bradycardia with sinus arrhythmia, and the other subject showed sinus arrhythmia with PAC. 3. The increases in heart rate during the endotracheal suction immediately after and at 30 seconds after suctioning were statistically significant (p=0.005). The increase in heart rate at one minute after suctioning was also significant (p=0.023). The increase in heart rate continued until 10 minutes after the endotracheal suction, but was not statistically significant In this study, endotracheal suctioning with hyperoxygenation and hyperinflation was effective in preventing a decrease in $PaO_2$ after suctioning, but not in preventing cardiac arrhythmias. Nurses should be aware of the complications of endotracheal suctioning and do effective hyperoxygenation and hyperinflation before and after suctioning. Further research is needed to develop a efficient endotracheal suction method which will minimize complications. This study needs to be replicated with different population of patients intubatted or having a tracheostomy, specifically, patients who cardiac or pulmonary desease. The data were analyzed by using an S. P. S. S. computerized program for mean, standard deviation, percentage and paired t-test. The results of this study were as follows: 1. The increase in $PaO_2$ after hyperoxygenation and hyperinflation was highly statistically significant(p=0.041), and the increase in $PaO_2$ immediately after suctioning was not significant (p=0.752). The time of lowest $PaO_2$ was 30 seconds after the endotracheal suction. 2. The occurrance of cardiac arrhythmia after the endotracheal suction included sinus tachycardia, sinus arrhythmia, sinus bradycardia, premature atrial contraction (PAC), and premature ventricular contraction (PVC). The most frequent cardiac arrhythmia was sinus tachycardia (a subjects). Sinus arrhythmia was observed in 5 subjects and continued till 10 minutes after suctioning in two of these. Sinus bradycardia occurred in only 3 subjects and among them, 1 subjects shows sinus arrythmia till 10 minutes after suctioning along. PAC was observed in only one subject and continued till five minutes after suctining along with sinus arrhythmia. PVC was observed in three subjects: it lasted for only 30 seconds after suctioning in two subjects. but continued for 10 minutes after suctioning in the third. 6 subjects manifested two kinds of Cardiac arrhythmia Three of them showed sinus tachycardia with PVC, another 2 showed sinus bradycardia with sinus arrhythmia, and the other subject showed sinus arrhythmia with PAC. 3. The increases in heart rate during the endotracheal suction immediately after and at 30 seconds after suctioning were statistically significant (p=0.005). The increase in heart rate at one minute after suctioning was also significant (p=0.023). The increase in heart rate continued until 10 minutes after the endotracheal suction, but was not statistically significant In this study, endotracheal suctioning with hyperoxygenation and hyperinflation was effective in preventing a decrease in $PaO_2$ after suctioning, but not in preventing cardiac arrhythmias. Nurses should be aware of the complications of endotracheal suctioning and do effective hyperoxygenation and hyperinflation before and after suctioning. Further research is needed to develop a efficient endotracheal suction method which will minimize complications. This study needs to be replicated with different population of patients intubatted or having a tracheostomy, specifically, patients who cardiac or pulmonary desease.

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임부교실 운영효과 분석을 위한 일 연구 (A study on analyzing effectiveness of childbirth education)

  • 김혜숙;최연순;장순복;정재원
    • 대한간호
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    • 제34권3호
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    • pp.85-98
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    • 1995
  • The purpose of this study is to provide basic data regarding effective learning opportunities in childbirth education classes. Also analysis of the data indicates the optimum conditions for the welfare and improvements in the promotion of health in childbearing mothers. The results of this study are as follows; 1) The average age of the subjects in this study was 30.6 years and the total number of subjects was 58 pregnant women. The average number of children was one and 84.5% of the subjects were unemployed even though 63.8% of them held over bachelor's degrees. It was found that 22.4% of the subjects were living in an extended family. Also 61.5% of them were living with parents-in-law. The number of pregnancies were calssified as one, two, or three to nine times with the percentages of 58.7%, 22.4% and 18.9%, respectively. Further, 72.4% of the subjects had no abortion experience and 15.5% had one aborion experience. While 89.7% of the subjects planned to feed their babies with breastmilk, mixed feeding were used by only 22.4% of the sample. These data were collected at about 6 months after delivery. Thus one can see that a low rate of breastfeeding was common. 2) The length of one period of childbirth education is four weeks. It was found that 36.2% of the subjects participated in childbirth education only once, where as 13.8% participated four times and 19% of the subjects participated in this class more than four times. pregnant at least once. Further, 75.9% of the participants were participated in this education through their own will. Their motivation for participation developed through information, advertisement and posters which contained information on childbirth education. Those with unplanned pregnancies 92.9% participated after a suggestion by the nurses. The number of participants in terms of percentage according to the childbirth education contents can be classified as following. The most active participation was shown in preparation of delivery(77.6%), postpartrm management(56.9%) fetal development(37.6%) and physiology of pregnancy(17.2%). It was found that 75.9% of the subjects were willing to participate again if they were given a chance. The reason can be summarized as following: The content of the education is very helpful(47.7%). Scientific knowledge can be obtained through this program(20.5%). Participation helps in achieving psychological stability(9.1%). Participation enables one to establish a friendly relationship with other participants(6.8%) of the sample. 24.1% of the participants did not want to participate again. The reasons can be as following: They do not want another baby(42.9%). The first paricipation in childbirth education gave enough knowledge about childbirth(21.4%). Another reason for not want to participate again was because they had a cesarean birth(14.3%). Only 7.1% of them responded with a negative view. A response that they do not need childbirth education after their operation can be traced back to the general belief that childbirth education is the place where one prepares for natural birth through the Lamaze breathing technique. Of the subjects, 91.4% suggested that this program could be recommended to other childbearing mothers, because this program gave educational content along with psychological stability for childbearing women. Of the subjects 41.4% did not see any efforts towards the welfare of the baby, where as 88.2% did. Among the subjects 58.6% made some effort to eliminate the discomfort of labor by breathing and imagination and breathing and walking. Further 41.7% of the 24 subjects did not do anything toward the welfare of the baby, because they did have a cesarean section so that they didn't have a chance even though they had been educated about childbirth. Also 33.3% of the subjects did not do anything toward the welfare of the baby, because they lacked a willingness. After leaving the hospital, only 75.9% of the subjects did some exercises. The subjects who tried participate this program with their husband accounted for 20.7% of the sample. Interviewing with the subjects solved some of the uneasiness and. fear of delivery, increased self-confidence in parenting and active coping in the delivery process.

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간호사의 복장 형태에 따른 간호사 이미지에 대한 조사 연구 (A Survey of the Image Conveyed by Different Types of Nurses따 Uniforms)

  • 김조자;이원희;허혜경;김창희;홍성경
    • 대한간호학회지
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    • 제23권4호
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    • pp.631-648
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    • 1993
  • This study is a descriptive study to provide basic data related to types of uniforms worn by nurses. Nurses, other medical center personnel, patients and their famillies were asked for their opinion on changing nurses’ uniforms and how the image of nurses is 1 elated to the type of uniform worn by the nurses. The data for this study were collected during the period from Feb. 25, 1993 to Mar. 26, 1993 at Y-University Medical Center from 132 nurses, 137 other medical center personnel, 117 patients and their families. The instruments used for this study were the Nurses’ Image Scale(NIS) developed by Bown(1986), and an instrument to measure opinions of uniform and cap using photographs of nurses’ uniforms that was developed by the researcher through a literture review. Data were analyzed using the SPPS / PC package, Statistics used for analysis were frequencies, percentages, paired t -test, and oneway ANOVA The results of this study are summarized as follows ; 1. Of the nurses, 84.3%, along with, 51.5% of the medical center personnel, 39.1% of the patients and their families agreed to a change in the color of nurses uniforms. 2. Similarly, 87.4% of the nurses,27.7% of the medical center personnel, 19.3% of the patients and their families were in favor of nurses not wearing caps. 3. Only 11.8% of nurses answered that a white uniform was important to the professional image of nursing. Only 2.4% of the nurses answered that a cap was very important to the professional image of nursing. 4. Only 1.6% of the nurses answered that a white uniform and cap were important to show the role of nurses in the twenty first century. 5. About 1/3, 36.5%, of the medical center personnel, the patient and their families answered that changing the color of the nurses' uniform will make a change in the image of nurses. 6. A White uniform and cap were seen as being im-portant in distinguishing nurses from other medical personnel in the hospital by 76.5% of the medical personnel, the patients and their families. 7. Nurses gave high marks to the idea of no cap regardless of the color of the uniform which would still portray the symbol of the nurses’ role, identity and would differentiate the role from other jobs. The patients and their families gave high marks to a white uniform with cap. 8. Generally, nurses, medical center personnel and patients and their families thought that a colored uniform with cap presented a good image of nurses. 9. There was a significant difference in the response among the three groups(F=24.65, P〈.001) to the figure in a white uniform with a cap, and the patients and their families thought it was the best portrayal of the image of nurses. There was a significant difference among the three groups(F=9.03, P〈.001) to the figure in a white uniform with no cap and the nurses indicated that it was the beat portrayed of the image of nurses. There was no significant difference among the three groups to the figure in a colored uniform with cap. There was a significant difference(F=17.50, P〈. 001) to the figure in a colored uniform with no cap, and the nurses indicated that it was the best portrayal of the image of nurses. In summary, the nurses wanted to change the color of uniform and not to wear a cap. But many of the medical center personnel, patients and their families indicated they did not agree with this idea. Therefore, changing the type of uniform worn by nurses should be done only after consideration has been given to the relation of the change to the professional role of nurses and the image of nurses held people in general. Suggestions arising from this study are as follows : 1. The relation between the role of nurses and their uniform was surveyed, and these results can be used as data when considering a change in uniforms. 2. A change in uniforms should be tried based on the norm established about uniforms. 3. The nurses did not want to wear a cap, but before a decision is definitely made it is necessary to study the philosophy related to the symbol of the cap because the figure of a nurse with a cap portrayed a positive image of the nurses. If the cap is kept, the symbol of the cap should be redefined. 4. In this study, only the image related to the uniform was examined, but in future studies it will be necessary to examine the practicality of various types of uniforms.

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일부 농촌지역 노인들의 요실금 유병률과 관련요인 (Prevalence of Urinary Incontinence and Its Related Factors among the Rural Residing Elderlies)

  • 윤현숙;권인선;배남규;조영채
    • 농촌의학ㆍ지역보건
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    • 제34권1호
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    • pp.76-86
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    • 2009
  • 본 연구는 농촌지역 노인을 대상으로 요실금의 출현빈도를 조사하고 요실금과 관련된 요인을 검토하고자, 2007년 10월 1일부터 12월 31일까지의 기간에 충청남도의 농촌지역에 거주하고 있는 65세 이상 노인 464명을 대상으로 면접조사를 실시하였다. 그 결과 조사대상자의 요실금 경험률을 보면 「매일 실금」이 9.5%, 「가끔 실금」이 35.5% 로 요실금을 경험하고 있는 노인이 45.0%이었다. 성별로는 남자(29.8%)보다 여자(58.5%)에서, 연령이 낮은 군보다 높은 군에서, 교육수준이 높은 군보다 낮은 군에서, 월수입이 높은 군보다 낮은 군에서 요실금 경험률이 높았다. 일상생활습관별 요실금 경험률은 비흡연군보다 흡연군에서, 음주군보다 비음주군에서 유의하게 높았으며, 주관적 건강상태에 따른 요실금 경험률은 건강하다는 군보다 건강하지 않다는 군에서, 건강에 대한 걱정을 하지 않는다는 군보다 한다는 군에서, 신체부자유가 없다는 군보다 있다는 군에서, 건망증이 없다는 군보다 있다는 군에서, ADL과 IADL별로는 도움이 필요 없다는 군보다 도움이 필요하다는 군에서 유의하게 높은 비율이었다. 다변량 로지스틱회귀분석 결과 요실금발생에 영향을 미치는 관련요인으로 성별, 연령, 흡연습관, 건강에 대한 걱정유무, 신체부자유 유무, 건망증 유무, IADL이 유의한 변수로 선정되었다. 이상의 결과를 보면 농촌지역 노인들의 요실금 출현빈도는 남자보다 여자에서, 고연령일수록 높아지는 것을 알 수 있으며, 일상생활습관이나 주관적 및 신체적인 건강상태가 양호하지 않을수록 요실금 출현율이 높게 나타나고 있으므로 이에 따른 노인들의 적절한 건강관리 대책이 요구된다.

Molecular Epidemiologic Study of a Methicillin-resistant Staphylococcus aureus Outbreak at a Newborn Nursery and Neonatal Intensive Care Unit

  • Kang, Hyun Mi;Park, Ki Cheol;Lee, Kyung-Yil;Park, Joonhong;Park, Sun Hee;Lee, Dong-Gun;Kim, Jong-Hyun
    • Pediatric Infection and Vaccine
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    • 제26권3호
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    • pp.148-160
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    • 2019
  • 목적: 본 연구에서는 신생아실과 신생아 중환자실에서 발생한 methicillin-resistant Staphylococcus aureus (MRSA) 유행에서 환자와 보균자에서 분리된 MRSA의 분자역학적 연관성을 조사하여 유행의 감염원과 전파경로를 파악하고자 하였다. 방법: MRSA 유행기간인 2017년 8월부터 9월까지 피부감염 및 패혈증 환자들과 보균자로부터 분리된 MRSA 균주를 대상으로 유전형 및 병원성 인자를 분석하고 항생제 감수성 결과를 수집하였다. 결과: 연구기간 동안 신생아실(n=27)과 신생아 중환자실(n=14)에 총 41명의 신생아들이 입원하였다. 그 중, 7명(피부감염[n=6], 패혈증[n=1])에서 MRSA 감염이 확진되었고, 보균자 4명이 발견되었다. 신생아와 접촉이 있는 의료진 32명 중 3명이 MRSA를 비강에 보균하였다. 피부감염 유행 원인 균주는 Staphylococcal chromosomal cassette mec (SCCmec) type II, sequence type (ST) 89, spa type t375였고, 뮤피로신 저농도 내성을 포함하여 항생제 다제내성을 보였다. 패혈증을 일으킨 균주는 SCCmec type IVa, ST 72, 새로운 spa type인 t17879였다. 신생아 4명에게 집락된 MRSA 균주들은 다양하였으나 SCCmec type IVa, ST 72, spa type t664가 의료진과 신생아 2명에서 공통적으로 분리되었다. Panton-Valentine leukocidin (PVL) toxin 유전자가 신생아에게 집락된 모든 균주에서 발견되었다. 결론: 피부감염 유행을 일으킨 MRSA 균주는 항생제 다제내성을 보이는 균주였다. 신생아 MRSA 보균자에게서 분리된 균주는 모두 PVL 독소 유전자를 보유하였다. 유행기간 동안 다양한 MRSA 균주가 신생아들에게서 분리되기 때문에, 효과적인 감염 관리 및 추가 환자발생의 차단을 위하여 분자역학조사를 통하여 원인균을 확인하고 전파경로를 파악하는 것이 중요하다.

남자중학교 학생의 학교사고 발생률과 사고원인에 관한 코호트 연구 (A Cohort Study of Incidence Rate and Causes of School Accidents in a Boys' Middle School in Taegu)

  • 박정한;박미화
    • Journal of Preventive Medicine and Public Health
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    • 제20권2호
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    • pp.331-340
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    • 1987
  • 남자 중학생의 학교 사고발생 및 관련요인을 알아보고자 대구시내 일개 남자중학교 학생전원 2,324명을 대상으로 1986년 3월 3일부터 1987년 2월 23일까지 한 학년도에 발생된 교내사고에 대해 전향적 방법으로 조사하였다. 사고에 대한 자료는 양호실을 찾아오는 학생을 연구자가 직접 처치후 면담조사하였고 학교행사에 관한 자료는 학교일지에서 얻었다. 한 학년도의 사고발생 건수는 총 1,126건이며 사고자수는 총 603명으로 사고발생자의 1인당 평균 사고회수는 1.9회였다. 일일 사고발생건수는 5.1건이며, 사고발생률은 1,000학생일당 2.2회였다. 반별 사고빈도는 연간 평균 약 30회 정도이나 체육특기생이 한 반에 많이 배치되었거나 담임교사가 장기간 부재한 학반에서 54건 및 58건으로 사고발생이 더 많았다. 월별 사고발생율은 6월이 1,000학생일당 3.4건으로 가장 높고 12월과 2월에는 각각 1.5 및 0.7건으로 가장 낮으며 요일별로 별 차이가 없었다. 사고 원인의 62.2%가 장난과 부주의였고, 부적합한 교구 및 시설물이 18.6%였다. 부적합한 교구 및 시설물의 49.3%가 노후된 책걸상으로 인한 사고였다. 병.의원 후송률은 맑은 날에 비해 흐린 날이 3배, 비오는 날이 5배나 되었다. 시험기간 중에는 사고가 거의 없다가 시험이 끝난 후에는 증가하는 경향이었다. 이와 같은 사고발생 양상을 볼 때 사고 예방을 위해 반 편성시 체육특기생은 분산시키고, 담임교사의 장기간 부재시는 그 학반과 가장 친숙한 임시담임교사로 대치하여 기강이 흐트러지지 않게 하며, 노후한 교구 및 시설물을 정비 또는 대체하고, 흐린 날이나 비오는 날, 그리고 시험 후에는 사고 발생 가능성이 많으므로 방송, 훈화, 체조 등을 통한 분위기 조절에 힘써야 할 것이다.

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