A Study on Enhancement for the Medical Response System of the Korea Coast Guard in order to Improve Stability on Duty

The purpose of this study is to improve the stability of the KCG Injured officer on duty. Therefore, it is necessary to reveal the actual conditions and problems of the field Emergency Medical Response System for KCG Injured officer, and to suggest ways to improve the Medical Response System such as cooperation and training with related organizations, rehabilitation program for injured officer. In this study, we classify the marital characteristics of the KCG Injured officer by carrying out dangerous duties in the barren oceans to confirm the importance of the Medical Response System for injured persons, in order to understand the actual condition, we analyzed the actual condition of KCG, and analyzed the problems by analyzing the effect of post - traumatic stress disorder on KCG. In Korea, Medical Response System in the Pre-hospital stage are investigated in Korea, and there is a high frequency and risk of being injured officer on duty such as KCG. Emergency Medical Response System of the injured officer of the military, those of neighboring Japan Coast Guard, which has high geographical and cultural similarity with us and performs their duties, was investigated and compared. The analysis of the KCG Injured officer medical response survey, the comparison of the Emergency Medical Response System of similar organizations, and the analysis of related research data, suggests the improvement direction of the Medical Response System in terms of structure side. This study is a study on KCG officers' surveys on maritime emergency medical response, suggesting a comprehensive Medical Response System for injured officers such as rehabilitation and rehabilitation after disaster treatment and disaster prevention policy There is great significance.|본 연구는 그동안 발생해왔던 해양경찰관의 직무 수행 중 부상자에 대한 안정성 향상을 위한 것이 목적이다. 따라서 부상자에 대한 현장 응급의료의 실태와 문제점을 도출하고, 유관기관과의 협력 및 훈련, 부상자에 대한 재활 및 사회 복귀프로그램 등 의료대응체계의 개선방향을 제시하고자한다. 따라서 금번 연구에서는 척박한 해양 속에서 위험한 직무를 수행하다 부상을 당하는 해양경찰의 직무적 특성을 분류하여 부상자에 대한 의료 대응체계의 중요성을 확인하고, 해양경찰 부상자 발생 시 현재의 응급의료 대응체계의 정확한 실태를 파악하기 위해 해양경찰 응급의료 대응관리체계 실태조사 및 분석, 해양경찰특공대 외상후 스트레스 장애영향 조사 분석을 통해 문제점을 분석하였다. 우리나라의 응급환자에 대한 병원전 단계에서의 응급의료 대응체계 및 소방중심의 응급의료 대응체계를 알아보고, 해양경찰과 같이 현장 공무 수행 중 부상을 당하는 빈도나 위험성이 높아 자체 응급의료 대응체계를 운영 중인 군의 부상자 응급의료 대응체계, 우리와 지리적·문화적 유사성이 높고 해양경찰의 직무를 수행하고 있는 이웃 일본 해상보안청의 응급의료 대응체계를 조사하여 비교 분석하였다. 이러한 해양경찰 부상자 의료대응 실태 조사 분석, 유사기관의 응급의료 대응체계 비교 및 관련 연구 자료 등의 분석을 통해 해양경찰 부상자에 대한 구조 측면, 과정 측면 및 결과 측면에서의 의료대응체계에 대한 개선 방향을 제시하였다. 이번 연구는 해양경찰관들을 대상으로 해상 응급의료 대응에 관한 실태 조사에 대한 연구이자, 부상자 치료 이후의 재활 및 사회복귀, 재해예방정책 분야 등 부상자에 대한 종합적인 의료대응 체계에 관한 방안을 제시하였다는데 큰 의의가 있다.제1장 서론 1 1.1 연구의 배경과 필요성 1 1.2 연구의 목적 4 1.3 연구 범위와 방법 4 1.3.1 연구의 범위 4 1.3.2 연구의 방법 5 제2장 해양경찰의 직무적 특성 6 2.1 직무 영역의 광역성 7 2.2 해양의 다양한 우발적 상황변화에 대한 취약성 8 2.3 일반사회와의 격리성 및 관심에서의 소외성 9 2.4 전문성과 직무유형의 다양성 10 2.5 척박한 해양에서 해양경찰 직무수행의 위험성 11 2.5.1 해양경찰관 직무 중 부상자 대응 사례 11 2.5.2 해양경찰관 사고 사례 14 제3장 해양경찰 부상자 의료 대응체계 실태 21 3.1 해양경찰 응급의료 대응 관리체계 실태 조사 21 3.1.1 부상자 응급의료 대응 관리 체계 개요 23 3.1.2 해양경찰 부상자 의료 대응 설문 조사 결과 38 3.1.3 부상자 의료 대응관리 체계 문제점 64 3.2 해양경찰특공대 외상후 스트레스 장애 영향 조사 70 3.2.1 외상후 스트레스 장애 영향 조사 개요 71 3.2.2 외상후 스트레스 장애 영향 조사 분석 결과 74 3.2.3 외상후 스트레스 장애 영향 문제점 및 요약 78 3.3 소결 81 3.3.1 결과 요약 81 3.3.2 요인 분석 83 제4장 유사기관의 응급의료 대응체계 비교 97 4.1 우리나라 응급의료 대응체계 97 4.1.1 응급의료의 개념과 역사 97 4.1.2 응급의료체계의 구성요소 105 4.2 소방(119 구급대) 응급의료 대응체계 116 4.2.1 소방조직 및 인력 116 4.2.2 119 구급대 현황 118 4.2.3 119 구급대 운영 체계 119 4.3 군 부상자 응급의료 대응체계 120 4.3.1 관련 근거 121 4.3.2 군 부상자 대응관리체계 121 4.4 일본 해상보안청 응급의료 대응체계 126 4.4.1 해상보안청의 응급의료 대응체계 126 4.4.2 해상보안청 해상 환자에 대한 응급의료 대응체계의 변화 127 제5장 해양경찰 부상자 의료대응체계 발전 방향 130 5.1 응급대응 구조 측면 130 5.1.1 해양경찰관 부상자 응급의료체계 130 5.1.2 부상자 응급 대응 조직 신설 및 인력 확보 133 5.1.3 응급 대응 장비의 확충 136 5.1.4 응급대응 체계의 법적 규정 보완 137 5.2 응급대응 과정 측면 138 5.2.1 대응 합동 훈련 강화 및 대응 자산 공유 활성화 138 5.2.2 직무 수행 전 예방 교육 및 응급대응 지침 마련 140 5.3 응급대응 결과 측면 141 5.3.1 부상자 재활 프로그램 수립 141 5.3.2 산업안전보건에 준하는 재해 예방 정책 적용 143 제6장 결론 147Docto

Porphyromonas gingivalis, Treponema denticola,

Dept. of Dentistry/석사[한글] 치주염은 치조골의 흡수를 동반하는 염증성 질환으로 치은연하 치태내의 여러 종류의 미생물이 치조골 흡수에 영향을 준다. 이러한 여러 종류의 치주병인체로 인하여 발생하는 여러 파골세포형성 인자 중에서 공통된 인자를 찾기 위해, 마우스 두개골 기원의 조골세포와 골수 세포의 혼합배양에서 세 종류의 치주병인체, 즉, Porphyromonas gingivalis, Treponema denticola 및 Treponema socranskii에 의한 파골세포형성 기전을 관찰하였다. 조골세포의 interleukin (IL)-1b, tumor necrosis factor (TNF)-a, receptor activator of NF-kB ligand (RANKL) 및 prostaglandin E2 (PGE2)의 발현은 reverse transcriptase polymerase chain reaction (RT-PCR) 및 면역분석법을 통하여 관찰하였다. 세 종의 세균 분쇄액은 혼합배양에서 파골세포형성을 촉진하였고, 조골세포의 RANKL, IL-1b 및 TNF-a의 mRNA 발현 그리고 PGE2 의 생성을 증가시켰다. RANKL의 억제 인자인 osteopotegerin (OPG)는 각 세균 분쇄액에 의한 파골세포형성을 완전히 억제하였다. 또한 PGE2 형성 억제 인자인 indomethacin, anti-IL-1b antibody (Ab), 및 anti-TNF-a Ab가 더해졌을 때 각각의 미세균 분쇄액의 파골세포 형성능이 저하되었다. 또한, indomethacin, anti-IL-1b Ab, 또는 anti-TNF-a Ab는 P. gingivalis, T. denticola, 및 T. socranskii 분쇄액 으로 처리된 조골 세포내에서 RANKL 발현을 저하시켰다. 이는 P. gingivalis, T. denticola, 및 T. socranskii가 조골세포의 RANKL의 발현을 증가시켜 파골세포 형성을 촉진하며, 이러한 세 종의 미생물에 의한 RANKL 발현에 IL-1b, TNF-a 및 PGE2 가 중간 매개체로 작용한다는 것을 보여주고 있다. [영문] Periodontitis is an inflammatory disease that often leads to destruction of alveolar bone. Multiple species of bacteria in subgingival plaque are associated with bone destruction in periodontitis. In this kind of bone destruction, the osteoclast is known to play a key role. To determine the mediators which are involved in osteoclastogenesis by periodontopathogens, we studied the effect of three periodontopathogens, Porphyromonas gingivalis, Treponema denticola, and Treponema socranskii on osteoclastogenesis in coculture system of mouse calvaria derived osteoblastic cells and bone marrow cells. The expression of interleukin (IL)-1b, tumor necrosis factor (TNF)-a, receptor activator of NF-kB ligand (RANKL) and prostaglandin E2 (PGE2) in mouse calvaria cells was determined by reverse transcriptase-polymerase chain reaction (RT-PCR) or immunoassay. Sonicates of three bacteria induced osteoclast formation in coculture systems and the mRNA expression of IL-1b, TNF-a, and RANKL in osteoblastic cells. The production of PGE2 was increased by three bacteria sonicates. Addition of osteoprotegerin (OPG), which is an inhibitor of RANKL, in the cocultures resulted in the complete suppression of the induction of the osteoclast formation. Anti-IL-1b antibody (Ab), anti-TNF-a Ab and indomethacin, which is an inhibitor of PGE2, partially inhibited the induction of the osteoclast formation by each bacteria. In addition, indomethacin, anti-IL-1b Ab, or anti-TNF-a Ab decreased RANKL expression of osteoblastic cells treated with bacterial sonicates of P. gingivalis, T. denticola, and T. socranskii. These findings suggest that increased RANKL expression of osteoblastic cells may play an important role in the osteoclast formation induced by P. gingivalis, T. denticola, and T. socranskii and that PGE2, IL-1b, and TNF-a are mediators for the induction of RANKL expression by these bacteria.ope

Current Analysis of Acintobacter baumannii Infection among Pediatric Patients in a Single-centered Study

Purpose : Acinetobacter baumannii is an aerobic, gram negative coccobacillus. Due to its pathogenicity and ability to accumulate diverse mechanisms of resistance, the importance of this organism is increasing. Many reports have targeted adults, and studies of pediatric patients are limited. This study aims to investigate the current status of A. baumannii infection in children. Methods : From January 2001 to December 2008, 505 patients hospitalized with A. baumannii infection were enrolled. Admission records for underlying disease, duration of hospitalization, previous antibiotic use, location of admission, presence of ventilator care, and resistance to antibiotics were retrospectively reviewed and analyzed. Results : Hemato-oncological disease and neurological disease were 30.6% and 24.3% of all cases; therefore, these were the most common underlying diseases of patients with A. baumannii infection. Prevalence of A. baumannii infection was 78.1% in patients with previous antibiotic use, which was higher than that of the group not using previous antibiotic. And prevalence of multi-drug resistant and pan-drug resistant A. baumannii infection was 76.4% and 38.3% in patients with ICU care, 76.8% and 38.9% with ventilator care, and these were higher than the others. Rate of resistance to all groups of antibiotics showed a gradual increase to over 50% in 2008. Multi-drug resistant A. baumannii was 63.5% and pan-drug resistant A. baumannii was 48.2% of all cases. Conclusion : Prevalence of A. baumannii infection and resistance to antibacterial agents of A. baumannii is increasing. Adequate use of antibiotics and infection control should be emphasized in pediatric patientsope

Risk Factors for Neurologic Complications of Hand, Foot and Mouth Disease in the Republic of Korea, 2009

In 2009, the first outbreak of hand, foot and mouth disease (HFMD) or herpangina (HP) caused by enterovirus 71 occurred in the Republic of Korea. This study inquired into risk factors associated with complications of HFMD or HP. A retrospective medical records review was conducted on HFMD or HP patients for whom etiologic viruses had been verified in 2009. One hundred sixty-eight patients were examined for this investigation. Eighty patients were without complications while 88 were accompanied by complications, and 2 had expired. Enterovirus 71 subgenotype C4a was the most prevalent in number with 67 cases (54.9%). In the univariate analysis, the disease patterns of HFMD rather than HP, fever longer than 4 days, peak body temperature over 39℃, vomiting, headache, neurologic signs, serum glucose over 100 mg/dL, and having an enterovirus 71 as a causative virus were significant risk factors of the complications. After multiple logistic analysis, headache (Odds ratio [OR], 10.75; P < 0.001) and neurologic signs (OR, 42.76; P < 0.001) were found to be the most significant factors. Early detection and proper management of patients with aforementioned risk factors would be necessary in order to attain a better clinical outcome.ope

Clinical Features of Brain Abscesses in Neonates and Children : A Single Center Experience from 1997 to 2006

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Identification of Viral Pathogens for Lower Respiratory Tract Infection in Children at Seoul During Autumn and Winter Seasons of the Year of 2008-2009

Purpose: The Purposes of this study are to identify the circulating etiologic viruses of acute lower respiratory tract infection in children and to understand the relation with clinical diagnosis. Methods: We obtained a total of 418 nasopharyngeal aspirates from children admitted for their acute lower respiratory tract infections at three tertiary hospitals in Seoul from September 2008 to March 2009. We performed multiplex RT-PCR to identify 14 etiologic viruses and analyzed their emerging patterns and clinical features. Results: Average age of patients was 16.4 months old and the ratio of male to female was 1.36. Viruses were detected in 56.2% of a total of 418 samples. Respiratory syncytial virus (35%) was the most frequently detected and followed by human rhinovirus (22%), human bocavirus, adenovirus, human metapneumovirus, parainfluenza virus, influenza virus and human coronavirus. Co-infection reached 21.9 % of positive patients. Conclusion: When we manage the patients with acute lower respiratory infectious diseases, we should remind the role of various viral pathogens, which might be circulating by seasons and by local areasope

Identification of Recombinant Human Rhinovirus A and C in Circulating Strains from Upper and Lower Respiratory Infections

Human rhinoviruses (HRVs), in the Enterovirus genus within the family Picornaviridae, are a highly prevalent cause of acute respiratory infection (ARI). Enteroviruses are genetically highly variable, and recombination between serotypes is known to be a major contribution to their diversity. Recently it was reported that recombination events in HRVs cause the diversity of HRV-C. This study analyzed parts of the viral genes spanning the 5′ non- coding region (NCR) through to the viral protein (VP) encoding sequences of 105 HRV field isolates from 51 outpatient cases of Acute Respiratory Infectious Network (ARINET) and 54 inpatient cases of severe lower respiratory infection (SLRI) surveillance, in order to identify recombination in field samples. When analyzing parts of the 5′NCR and VP4/VP2 encoding sequences, we found intra- and interspecies recombinants in field strains of HRV-A and -C. Nineteen cases of recombination events (18.1%) were found among 105 field strains. For HRV-A, there were five cases (4.8%) of intraspecies recombination events and three cases (2.8%) of interspecies recombination events. For HRV-C, there were four cases (3.8%) of intraspecies recombination events and seven cases (6.7%) of interspecies recombination events. Recombination events were significantly more frequently observed in the ARINET samples (18 cases) than in the SLRI samples (1 case; P< 0.0001). The recombination breakpoints were located in nucleotides (nt) 472–554, which comprise stem-loop 5 in the internal ribosomal entry site (IRES), based on the HRV-B 35 sequence (accession no. FJ445187). Our findings regarding genomic recombination in circulating HRV-A and -C strains suggest that recombination might play a role in HRV fitness and could be a possible determinant of disease severity caused by various HRV infections in patients with ARI.ope

Clinical Characteristic of Respiratory Tract Infections in Children during Pandemic Influenza (H1N1 2009) in Korea

BACKGROUND: Since initial emergence on pandemic influenza (H1N1 2009) in Mexico on March 2009, the first case of pandemic influenza (H1N1 2009) occured on 2 May 2009 in Korea. We describe the clinical characteristics of childhood patients from pandemic influenza (H1N1 2009) and other concurrent respiratory pathogens during early phase of the pandemic influenza in Korea. MATERIALS AND METHODS: We have retrospectively studied 959 patients under age of 15 years who have visited Department of Emergency Medicine for a diagnostic test of pandemic influenza (H1N1 2009) or treatment of flu-like illness between May and September of 2009. The pandemic influenza (H1N1 2009) was detected via real-time RT-PCR and other respiratory viruses were detected via multiplex RT-PCR. RESULTS: A total of 959 patients visited Department of Emergency Medicine at Severance Hospital. Of them, 562 were tested; 124 (12.7%) were positive for pandemic influenza (H1N1 2009). Confirmed patients of pandemic influenza (H1N1 2009) were relatively older than non-H1N1 patients (7.5 years of age vs 4.6 years, P<0.001). Among histories or symptoms of patients with flu-like illness, contact history (80%) with another patient with pandemic influenza (H1N1 2009) was an important clue of the infection in early phase of pandemic. Comparing with hospitalized patients with respiratory tract infections due to other causes, lower ESR (32.9+/-23.5 mm/hour vs 11.5+/-9.2 mm/hour), hyperkalemia (4.2+/-0.3 mmol/L vs 5.2+/-3 mmol/L) and hyponatremia (137.2+/-2.5 mmol/L vs 124+/-40.5 mmol/L) were significant laboratory finding and higher cholesterol and GTP were noticed in pandemic influenza (H1N1 2009). Ten confirmed patients with pandemic influenza (H1N1 2009) were hospitalized due to pneumonia and all of them were resolved without any complication. CONCLUSIONS: Respiratory tract infections were caused not only by pandemic influenza (H1N1 2009) virus but also various respiratory viruses. Hospitalized patients, confirmed as pandemic influenza (H1N1 2009), showed a good prognosis. Age and contact history were distinct features and could be an important clue to differentiate causes in patients with febrile respiratory symptoms.ope

Juvenile idiopathic arthritis: Diagnosis and differential diagnosis

Juvenile idiopathic arthritis (JIA) is comprised of a heterogeneous group of several disease subtypes that are characterized by the onset of arthritis before the age of 16 years and has symptoms lasting at least 6 weeks. The previous classification of JIA included seven different categories, whereas its current classification was compiled by the International League of the Association for Rheumatology, and replaced the previous terms of "juvenile chronic arthritis" and "juvenile rheumatoid arthritis," which were used in Europe or North America, respectively, with the single nomenclature of JIA. As mentioned above, JIA is defined as arthritis of unknown etiology that manifests itself before the age of 16 years and persists for at least 6 weeks, while excluding other known conditions. The clinical symptoms of JIA can be quite variable. Several symptoms that are characteristic of arthritis are not necessarily diagnostic of JIA and may have multiple etiologies that can be differentiated with careful examination of patient history. The disease may develop over days or sometimes weeks, thereby making the diagnosis difficult at the time of presentation. To make a clinical diagnosis of JIA, the first step is to exclude arthritis with known etiologies. Of note, late treatment due to excessive delay of diagnosis can cause severe damage to joints and other organs and impair skeletal maturation. Therefore, early detection of JIA is critical to ensure prompt treatment and to prevent long-term complications including the likelihood of disability in childhoodope

Serotype Distribution of Pneumococcus Isolated from the Ear Discharge in Children with Otitis Media in 2001-2006

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