32 research outputs found

    The identity of an Afro-American Woman in The Color purple

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    ํ‘์ธ ์—ฌ์„ฑ๋“ค์ด ์–ด๋–ป๊ฒŒ ์„ฑ๊ณผ ์ธ์ข…๊ณผ ๊ณ„์ธต์—์˜ํ•ด ์–ต์••๋ฐ›์•˜์œผ๋ฉฐ ๊ทธ๋Ÿฐ ์ƒํ™ฉ๋“ค์„ ๊ทน๋ณตํ•ด๋‚˜๊ฐ€๋Š”๊ฐ€๋ฅผ ๋‹ค๋ฃจ๊ณ ์žˆ๋‹ค. ์•จ๋ฆฌ์Šค์›Œ์ปค๋Š” ํ‘์ธ ํŽ˜๋ฏธ๋‹ˆ์ŠคํŠธ ๊ณ„ํ†ต์˜ ์ž‘๊ฐ€์ด๋‹ค. ๊ทธ๋…€๋Š” ์ž‘ํ’ˆ์—์„œ ์„ฑ, ์ธ์ข…, ๊ณ„์ธต์˜ ์–ต์••์„ ๊ทธ๋ฆฌ๊ณ ์žˆ๋‹ค.๊ทธ๋…€์˜ ์ž‘ํ’ˆ์€ ์„ฑ์˜์ „์Ÿ์— ์ด›์ ์ด ๋งž์ถ”์–ด์ ธ์žˆ๋‹ค.์ž‘ํ’ˆ์—์„œ ํ‘์ธ ์†Œ๋…€ ์”ฐ๋ฆฌ๋Š” ๋…ธ์˜ˆ๋กœ , ๋‚จ์ž๋“ค์˜ ํฌ์ƒ๋ฌผ๋กœ, ์ „ํ†ต์ ์ธ ์„ฑ ์—ญํ• ๊ณผ ์ธ์ข…์ฐจ๋ณ„๊ณผ ์ˆ˜ ๋งŽ์€ ์‚ฌํšŒ ๋ถ€์ •์˜์—์˜ํ•ด ๊ทธ๋…€์˜ ์‚ถ์€ ์‹œ์ž‘ ๋˜์—ˆ๋‹ค.์‚ฌ๋ž‘์€ ๊ทธ๋…€์˜ ๊ณ ํ†ต์„ ์น˜๋ฃŒํ•˜๊ณ  ์ž์‹ ๊ณผ ์ฃผ์œ„์˜ ์‚ฌ๋žŒ๋“ค์„ ์šฉ์„œํ•˜๊ณ  ์‚ฌ๋ž‘ํ•˜๋Š” ๊ทธ๋…€์˜ ์‚ถ์˜ ๊ณผ์ •์„ ๋ณด์—ฌ์ค€๋‹ค.This thesis aims to study how Afro-American women are repressed by class, race, and gender. Black feminists have argued that the Afro-American critical theories which emerged during the Black Arts Movement of the late sixties and seventies were overtly masculinist. There is an assumption that the black feminist critics will necessarily be black women because white and black men both view things from a male perspective. Alice Walker belongs to the tradition of black feminist writers. She depicts class, race, and gender oppression in her works. Her works are focussed on the war of gender. Her most famous work is The Color Purple(1982). She depicted racial and gender discrimination that she had experienced during her childhood in her family. Walker was born in rural Georgia in the South of the United States of America. She was the eighth and the youngest child of sharecropper. In The Color Purple Celie tells her story. Celie represents the black women of the South. She writes letters to God in which she tells about her life. Her roles as daughter, wife, sister, and mother. In the course of her story she meets a series of other black women who shape her life: Nettie(Celie's sister, who becomes a missionary teacher in Africa), Shug Avery(the blues singer her husband Mr.- is in love with), and who ironically becomes Celie's salvation. There is also sofia, the strong willed daughter-in-law whose strength and courage inspires Celie, and Squeak who goes through an awakening of her own. Throughout the story Celie is the center of the community of women, the one who knows how to survive. She is uneducated and she is writing exactly as she speaks and thinks. There is nothing artificial about her writing style. The most distinctive characteristic about Celie's letters are their naturalness. However, it will be a long time before she gains enough self-esteem. Celie began her life as a virtual slave, the victim of men, of traditional sexual roles, of racism, and of innumerable social injustises. She has struggled for many years, keeping alive the memory of Nettie, believing in Nettie, despite the fact that she had no proof that Nettie was still alive. This is testamony to Celie's courageous spirit. as is Celie's love for Nettie and for Shug, which finally allows her to forgive her husband, for all of his intentional cruelty. Love heals heartaches, and love leads Celie to forgiveness and reconciliation. When the novel ends, Celie is solid. Love has sustained her. She has learned how to love herself and to share love despite continually cruel pressures. She has endured and learned how to love herself and to share love despite continually cruel pressures. She has endured and learned to fight and she has won her battles. What Walker demonstrates most clearly in her novel is that one has to make his or her own world. She trusts one's potential ability to change and in her words to survive wholly.1. ์„œ๋ก  = 1 2. ๋ณธ๋ก  1). ํ‘์ธ ์—ฌ์„ฑ์˜ ์ •์ฒด์„ฑ = 5 2). ์ธ์ข…๊ณผ ์„ฑ์ฐจ = 25 3). ์ •์ฒด์„ฑ ํšŒ๋ณต = 37 3. ๊ฒฐ๋ก  = 50 ์ฐธ๊ณ  ๋ฌธํ—Œ = 5

    ๋™๋ฃŒํ‰๊ฐ€์˜ ์ •ํ™•์„ฑ ํ–ฅ์ƒ์„ ์œ„ํ•œ ํ•˜์œ„ ํ‰๊ฐ€์ž ์ œ์™ธ ๋ฐฉ์‹๋“ค์˜ ๋น„๊ต ์—ฐ๊ตฌ

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์‹ฌ๋ฆฌํ•™๊ณผ, 2017. 2. ๋ฐ•์ฃผ์šฉ.๊ต์œก ํ˜„์žฅ์—์„œ ํ•™์Šต์œผ๋กœ์„œ ํ‰๊ฐ€์˜ ๊ธฐ๋Šฅ์— ์ฃผ์•ˆ์ ์„ ๋‘” ํ˜•์„ฑํ‰๊ฐ€์— ๋Œ€ํ•œ ๊ด€์‹ฌ์ด ์ ์  ๋†’์•„์ง€๊ณ  ์žˆ๋‹ค. ํ˜•์„ฑํ‰๊ฐ€์˜ ์˜์˜๋ฅผ ํšจ๊ณผ์ ์œผ๋กœ ์‚ด๋ฆด ์ˆ˜ ์žˆ๋Š” ๋ฐฉ๋ฒ• ์ค‘์— ํ•˜๋‚˜๋Š” ๋™๋ฃŒํ‰๊ฐ€์ด๋‹ค. ๋™๋ฃŒํ‰๊ฐ€๋Š” ํ•™์ƒ๋“ค๋ผ๋ฆฌ ์„œ๋กœ์˜ ๊ณผ์ œ๋ฌผ์ด๋‚˜ ์ˆ˜ํ–‰ ๊ณผ์ •์— ๋Œ€ํ•ด ์ ์ˆ˜๋ฅผ ๋ถ€์—ฌํ•˜๊ฑฐ๋‚˜ ์˜๊ฒฌ์„ ์ œ์‹œํ•˜๋Š” ํ‰๊ฐ€ ํ™œ๋™์ด๋‹ค. ํŠนํžˆ ๊ธ€์“ฐ๊ธฐ ์ˆ˜์—…์—์„œ ๋™๋ฃŒํ‰๊ฐ€๋ฅผ ํ™œ์šฉํ•˜๋ฉด ํ•™์ƒ๋“ค์ด ์„œ๋กœ์˜ ๊ธ€์„ ๋น„๊ตยท๊ฒ€ํ† ํ•˜๋ฉด์„œ ๊ธ€์„ ํ‰๊ฐ€ํ•˜๋Š” ์•ˆ๋ชฉ์„ ๊ธฐ๋ฅผ ์ˆ˜ ์žˆ๊ณ , ์ž์‹ ์˜ ๊ธ€์— ๋Œ€ํ•ด์„œ ๋ฐ˜์„ฑ์ ์œผ๋กœ ์ ๊ฒ€ํ•ด๋ณผ ์ˆ˜ ์žˆ๋Š” ๊ธฐํšŒ๋ฅผ ์ œ๊ณตํ•œ๋‹ค. ๊ฒฐ๊ณผ์ ์œผ๋กœ ํ•™์ƒ๋“ค์€ ์ž์‹ ๋ฟ ์•„๋‹ˆ๋ผ ๋‹ค๋ฅธ ํ•™์ƒ์˜ ์‚ฌ๊ณ ๊ณผ์ •์„ ๋ฐ˜์ถ”ํ•˜๊ฒŒ ๋˜์–ด ๊ธ€์“ฐ๊ธฐ ๋Šฅ๋ ฅ์„ ๋ฐœ์ „์‹œํ‚ฌ ์ˆ˜ ์žˆ๋‹ค. ๋™๋ฃŒํ‰๊ฐ€๋Š” ๋˜ํ•œ ๊ต์ˆ˜์ž๋“ค์ด ๋‹ค์ˆ˜ ํ•™์ƒ๋“ค์˜ ๊ธ€์“ฐ๊ธฐ ๊ณผ์ œ๋ฅผ ํ‰๊ฐ€ํ•˜๋Š”๋ฐ ๋“œ๋Š” ์‹œ๊ฐ„๊ณผ ๋…ธ๋ ฅ์„ ๊ฒฝ๊ฐ์‹œ์ผœ ์ฃผ๋Š” ๋ถ€์ˆ˜์  ํšจ๊ณผ๋„ ์žˆ๋‹ค. ์›์น™์ ์œผ๋กœ ๊ต์ˆ˜์ž๋“ค์ด ํ•™์ƒ๋“ค์˜ ๊ณผ์ œ๋ฅผ ๋งค๋ฒˆ ํ‰๊ฐ€ํ•˜๊ณ  ํ”ผ๋“œ๋ฐฑ์„ ์ฃผ๋Š” ๊ฒƒ์ด ์ด์ƒ์ ์ด์ง€๋งŒ, ํ˜„์‹ค์ ์œผ๋กœ ์ƒ๋‹นํ•œ ๋ถ€๋‹ด์ด ๋  ์ˆ˜๋ฐ–์— ์—†๋‹ค. ์ตœ๊ทผ ๋™๋ฃŒํ‰๊ฐ€๋ฅผ ๋”์šฑ ํšจ์œจ์ ์œผ๋กœ ์‹œํ–‰ํ•˜๊ธฐ ์œ„ํ•ด ์›น ๊ธฐ๋ฐ˜ ๋™๋ฃŒํ‰๊ฐ€ ์‹œ์Šคํ…œ๋„ ๊ฐœ๋ฐœ๋˜๊ณ  ์žˆ์–ด ์•ž์œผ๋กœ ํ™œ์šฉ๋„๊ฐ€ ๋”์šฑ ๋†’์•„์งˆ ๊ฒƒ์œผ๋กœ ์˜ˆ์ƒ๋˜๊ณ  ์žˆ๋‹ค. ํ•˜์ง€๋งŒ ๋™๋ฃŒํ‰๊ฐ€ ๊ฒฐ๊ณผ๋ฅผ ์„ฑ์ ์— ๋ฐ˜์˜ํ•˜๋Š” ๋ฌธ์ œ์—๋Š” ๋…ผ๋ž€์˜ ์—ฌ์ง€๊ฐ€ ์žˆ๋‹ค. ์ „๋ฌธ๊ฐ€๊ฐ€ ์•„๋‹Œ ๋น„์ „๋ฌธ๊ฐ€ ํ•™์ƒ๋“ค์ด ์‹คํ–‰ํ•œ ๋™๋ฃŒํ‰๊ฐ€ ๊ฒฐ๊ณผ๋Š” ๊ณผ์—ฐ ์–ผ๋งˆ๋‚˜ ์ •ํ™•ํ• ๊นŒ? ๋งŒ์•ฝ ํ•™์ƒ๋“ค์˜ ๋™๋ฃŒํ‰๊ฐ€ ๊ฒฐ๊ณผ๊ฐ€ ์ •ํ™•ํ•˜๋‹ค๋ฉด ์ด๋ฅผ ์„ฑ์ ์— ๋ฐ˜์˜ํ•จ์œผ๋กœ์จ ๋”์šฑ ํšจ๊ณผ์ ์œผ๋กœ ์ด์šฉํ•  ์ˆ˜ ์žˆ๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ๋™๋ฃŒํ‰๊ฐ€์˜ ์ •ํ™•์„ฑ์„ ํ–ฅ์ƒ์‹œํ‚ค๋Š” ๋ฐฉ์•ˆ๋“ค์„ ๋ถ„์„ํ•˜์˜€๋‹ค. ํŠนํžˆ ๋™๋ฃŒํ‰๊ฐ€ ์‚ฌํ›„์— ํ†ต๊ณ„์  ์ ˆ์ฐจ์— ๋”ฐ๋ผ ๊ฒฐ๊ณผ์˜ ์ •ํ™•๋„๋ฅผ ๊ฐœ์„ ํ•˜๋Š” ๋ฐฉ๋ฒ•์— ์ฃผ๋ชฉํ•˜์˜€๋‹ค, ๊ตฌ์ฒด์ ์œผ๋กœ ์šฐ์ˆ˜ ํ‰๊ฐ€์ž์˜ ํ‰๊ท ์„ ์ ์šฉํ•˜๋Š” ๋ฐฉ์•ˆ(select-crowd strategy)์„ ์‘์šฉํ•˜์—ฌ ์ƒ๋Œ€์ ์œผ๋กœ ์ •ํ™•๋„๊ฐ€ ๋‚ฎ์€ ํ•˜์œ„ ํ‰๊ฐ€์ž๋“ค์„ ์ œ์™ธ์‹œ์ผœ ๋‚˜๊ฐ€๋Š” ๋ฐฉ์‹๋“ค์„ ์‹คํ–‰ํ•˜๊ณ  ๋น„๊ตํ•˜์˜€๋‹ค. ์ด๋ฅผ ํ†ตํ•ด ๋™๋ฃŒํ‰๊ฐ€ ๊ฒฐ๊ณผ์˜ ์ •ํ™•์„ฑ์ด ์–ด๋–ป๊ฒŒ ๊ฐœ์„ ๋˜๋Š”์ง€ ์‚ดํŽด๋ณด์•˜๋‹ค. ๋ถ„์„๋Œ€์ƒ์€ ํ•œ ํ•™๊ธฐ ๋™์•ˆ ์„œ์šธ๋Œ€ํ•™๊ต ์‹ฌ๋ฆฌํ•™๊ณผ ํ•™๋ถ€ ์ˆ˜์—… ์ค‘ ์ด๋ฃจ์–ด์ง„ ๋™๋ฃŒํ‰๊ฐ€๋ฅผ ๋Œ€์ƒ์œผ๋กœ ์‚ผ์•˜๋‹ค. ์ด ๋™๋ฃŒํ‰๊ฐ€๋Š” ํด๋ž˜์Šคํ”„๋ ™(ClassPrep) ์‹œ์Šคํ…œ์„ ํ™œ์šฉํ•˜์—ฌ ์ด๋ฃจ์–ด์กŒ๋‹ค. ์ด ์‹œ์Šคํ…œ์€ ์˜ˆ์Šต์„ ์œ„ํ•ด ๊ณ ์•ˆ๋œ ๊ฒƒ์ด๋‹ค. ํ•™์ƒ๋“ค์—๊ฒŒ ํ•œ ๊ฐ€์ง€ ์ฃผ์ œ์— ๋Œ€ํ•ด ํด๋ž˜์Šคํ”„๋ ™์—์„œ ์ œ์‹œ๋œ ์ž๋ฃŒ๋ฅผ ์ฝ๊ฒŒ ํ•œ ํ›„ ๊ฐ์ž ๊ทธ์— ๋Œ€ํ•œ ๊ธ€์„ ์“ฐ๋„๋ก ํ•œ ๋‹ค์Œ ๋‹ค๋ฅธ 4๋ช…์ด ์“ด ๊ธ€๋“ค์„ ํ‰๊ฐ€ํ•˜๋„๋ก ํ•˜์˜€๋‹ค. ๊ทธ๋Ÿฐ ๋’ค ์ค€์ „๋ฌธ๊ฐ€ 2๋ช…์ด ๋ชจ๋“  ํ•™์ƒ๋“ค์˜ ๊ธ€๋“ค์„ ๊ฐ๊ฐ ํ‰๊ฐ€ํ•˜๊ณ  ์ฑ„์ ํ•˜๊ฒŒ ํ•˜์—ฌ, ๋™๋ฃŒํ‰๊ฐ€์˜ ์ •ํ™•๋„๋ฅผ ๋น„๊ตํ•˜๋Š” ๊ธฐ์ค€์œผ๋กœ ์‚ผ์•˜๋‹ค. ์šฐ์„  ๋ณดํ†ต ํ†ต๊ณ„์—์„œ ๋งŽ์ด ์“ฐ์ด๋Š” ์ด์ƒ์น˜(outlier)๋ฅผ ์ œ์™ธํ•˜๋Š” ๋ฐฉ๋ฒ•์˜ ํ•˜๋‚˜๋กœ ์ตœ๊ณ ๊ฐ’๊ณผ ์ตœ์†Œ๊ฐ’์„ ์ œ๊ฑฐํ•œ ํ›„ ๋™๋ฃŒํ‰๊ฐ€ ์ ์ˆ˜๋ฅผ ์ค€์ „๋ฌธ๊ฐ€ ์ ์ˆ˜์™€ ๋น„๊ตํ•ด ๋ณด์•˜์œผ๋‚˜ ์œ ์˜๋ฏธํ•œ ๊ฒฐ๊ณผ๋ฅผ ์–ป์ง€ ๋ชปํ•˜์˜€๋‹ค. ๊ทธ ๋‹ค์Œ์œผ๋กœ ํ•˜์œ„ ํ‰๊ฐ€์ž ๊ทธ๋ฃน์„ ์ œ์™ธํ•œ ์ ์ˆ˜๋ฅผ ์ค€์ „๋ฌธ๊ฐ€ ์ ์ˆ˜์™€ ๋น„๊ตํ•˜์˜€๋‹ค. ์ด ๋•Œ ์ค€์ „๋ฌธ๊ฐ€์ฒ™๋„์™€์˜ ํŽธ์ฐจ, ์ค€์ „๋ฌธ๊ฐ€์ฒ™๋„์™€์˜ ์ƒ๊ด€๊ด€๊ณ„, ๋™๋ฃŒํ‰๊ฐ€ ์ ์ˆ˜ ํ‰๊ท ๊ณผ์˜ ํŽธ์ฐจ, ๋™๋ฃŒํ‰๊ฐ€ ์ ์ˆ˜ ํ‰๊ท ๊ณผ์˜ ์ƒ๊ด€๊ด€๊ณ„๋ฅผ ๋ณด๋Š” 4๊ฐ€์ง€ ๋ฐฉ๋ฒ•์œผ๋กœ ์ธก์ •ํ•˜์˜€์œผ๋ฉฐ, ๊ฐ๊ฐ ํ•˜์œ„ 25%, 50%๋ฅผ ์ˆœ์ฐจ์ ์œผ๋กœ ์ œ์™ธํ•˜๊ณ  ์–ป์–ด์ง„ ๋™๋ฃŒํ‰๊ฐ€์˜ ์ ์ˆ˜๋ฅผ ์ค€์ „๋ฌธ๊ฐ€ ์ ์ˆ˜์™€ ๋น„๊ตํ•˜์˜€๋‹ค. ์—ฐ๊ตฌ ๊ฒฐ๊ณผ ๊ฐ๊ฐ 25%, 50%์˜ ํ•˜์œ„ ํ‰๊ฐ€์ž ๊ทธ๋ฃน์„ ์ œ์™ธํ–ˆ์„ ๋•Œ ๋ชจ๋‘ ๋™๋ฃŒํ‰๊ฐ€์˜ ์ •ํ™•๋„๊ฐ€ ๊ฐœ์„ ๋˜์—ˆ๋‹ค. ๋‹จ์ˆœํžˆ ์ด์ƒ์น˜๋งŒ ์ œ๊ฑฐํ–ˆ์„ ๋•Œ ๋™๋ฃŒํ‰๊ฐ€์˜ ์ •ํ™•์„ฑ์€ ๊ฐœ์„ ๋˜์ง€ ์•Š์•˜์œผ๋‚˜, ํ•˜์œ„ ํ‰๊ฐ€์ž๋ฅผ ์ œ์™ธํ–ˆ์„ ๋•Œ ์ค€์ „๋ฌธ๊ฐ€์ฒ™๋„์™€ ๋น„๊ตํ•œ ๊ฒฝ์šฐ๋‚˜ ๋™๋ฃŒํ‰๊ฐ€ ๋‚ด๋ถ€์—์„œ ๋น„๊ตํ•œ ๊ฒฝ์šฐ ์ •ํ™•์„ฑ์ด ์œ ์˜๋ฏธํ•˜๊ฒŒ ํ–ฅ์ƒ๋˜์—ˆ๋‹ค. ์ด๋Ÿฌํ•œ ์—ฐ๊ตฌ ๊ฒฐ๊ณผ๋Š” ๋™๋ฃŒํ‰๊ฐ€์˜ ์‚ฌํ›„์  ํ†ต๊ณ„ ์ฒ˜์น˜ ๋ฐฉ๋ฒ•์— ๋”ฐ๋ผ ๋™๋ฃŒํ‰๊ฐ€ ๊ฒฐ๊ณผ์˜ ์ •ํ™•๋„๋ฅผ ํ–ฅ์ƒ์‹œํ‚ฌ ์ˆ˜ ์žˆ์Œ์„ ๋ณด์—ฌ์ค€๋‹ค. ํ›„์† ์—ฐ๊ตฌ๋ฅผ ํ†ตํ•ด ์ด ๋ฐฉ๋ฒ•์˜ ํšจ๊ณผ๊ฐ€ ๋ฐ˜๋ณต์ ์œผ๋กœ ํ™•์ธ๋œ๋‹ค๋ฉด, ์‹ค์ œ ์ˆ˜์—…์—์„œ ๋™๋ฃŒํ‰๊ฐ€๊ฐ€ ํ•™์ƒ๊ณผ ๊ต์ˆ˜์ž ๋ชจ๋‘์—๊ฒŒ ์œ ์šฉํ•œ ํ•™์Šต ๋„๊ตฌ๋กœ ํ™œ์šฉ๋  ์ˆ˜ ์žˆ๋Š” ๊ฐ€๋Šฅ์„ฑ์„ ๋†’์—ฌ์ค„ ์ˆ˜ ์žˆ์„ ๊ฒƒ์œผ๋กœ ๊ธฐ๋Œ€๋œ๋‹ค.1. ์„œ๋ก  1 2. ์ด๋ก ์  ๋ฐฐ๊ฒฝ 4 2.1 ํ˜•์„ฑํ‰๊ฐ€์˜ ๋„๊ตฌ๋กœ์„œ ๋™๋ฃŒํ‰๊ฐ€ 4 2.2 ๋™๋ฃŒํ‰๊ฐ€์˜ ๋ฌธ์ œ์ ๊ณผ ํ•œ๊ณ„ 9 2.3 ๋™๋ฃŒํ‰๊ฐ€์˜ ์ •ํ™•์„ฑ ํ–ฅ์ƒ ๋ฐฉ์•ˆ 12 3. ์—ฐ๊ตฌ 15 4. ์ข…ํ•ฉ ๋…ผ์˜ 26 ์ฐธ๊ณ ๋ฌธํ—Œ 31 Abstract 36Maste

    Higher rate of Epstein-Barr virus incorporation on decidualendometrial cells in pregnant women with preeclampsia

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์˜๊ณผ๋Œ€ํ•™ ์˜ํ•™๊ณผ, 2018. 2. ๋ฐ•์ค‘์‹ .Introduction: There are various theories regarding the pathogenesis and pathophysiology of preeclampsia, but the exact cause of preeclampsia is not yet clearly established. Previous investigators have suggested that preeclampsia may be associated with Epstein-Barr virus (EBV) infection in the B lymphocytes during pregnancy based on polymerase chain reaction or serological tests. The purpose of this study was to evaluate the prevalence of EBV-positivity in women diagnosed with and without preeclampsia using placental specimens. Materials and methods:This retrospective study included 85 pregnant women with preeclampsia and 65 pregnant women without preeclampsia. Placental specimens were assessed for the presence of acute and chronic inflammation. EBV-positivity was evaluated using in situ hybridization on EBV genes from tissue microarray slides. Clinicopathological characteristics were compared between women with and without preeclampsia and between EBV-positive and EBV-negative women. Results: Women with preeclampsia showed a higher occurrence of EBV-positive cells than those without preeclampsia (36.5% vs 20.0%, p = 0.028). When stratified into gestational age, the occurrence of EBV-positivecells were consistently higher in women with preeclampsia with preterm delivery (39.1% vs 20.0%, p = 0.042) but not in those with full-term (28.6% vs 20.0%, p = 0.497). Conclusion: We found increased EBV infected placenta of women with preeclampsia compared with those without preeclamplasia. Further study is needed to elucidate the etiological role of EBV infection during development of preeclampsia.Introduction 1 Materialsand Methods 3 Results 7 Discussion 16 References 21 ์ดˆ๋ก (๊ตญ๋ฌธ) 24Maste

    Plant-derived juvenile hormone III analogues from the stem bark of Cananga latifolia

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์•ฝํ•™๊ณผ, 2013. 2. ์„ฑ์ƒํ˜„.Juvenile hormone III (JH III) regulates important physiological development such as metamorphosis and reproduction in insect species. Since JH III was first to be isolated from the plant, Cyperus iria, the discovery of JH III has not been reported in other plants. In the present study, we succeeded in gaining a proof of the existence of JH III and its mimics from Cananga latifolia. From 80% MeOH extract of C.latifolia stem bark, six new compounds (4-5, 8-11) were isolated along with ten known compounds (1-3, 6-7, 12-16). Six compounds were determined as (2E, 6E, 10R)-11-butoxy-10-hydroxy-3, 7, 11-trimethyldodeca-2, 6-dienoic acid methyl ester (4), (2E, 6E)-3, 7, 11-trimethyl-10-oxododeca-2, 6-dienoic acid methyl ester (5), (2E)-3-methyl-5-[(1S, 2R, 6R)-1, 2, 6-trimethyl-3-oxocyclohexyl]-pent-2-enoic acid methyl ester (8), 1ฮฒ-hydroxy-3-oxo-4ฮฒ, 5ฮฑ, 7ฮฑ-H-eudesmane 11-O-ฮฑ-L-rhamnopyranoside (9), aubergenone 11-O-2โ€ฒ, 3โ€ฒ-di-O-acetyl-ฮฑ-L-rhamnopyranoside (10) and aubergenone 11-O-2โ€ฒ, 4โ€ฒ-di-O-acetyl-ฮฑ-L-rhamnopyranoside (11) by spectroscopy analysis.Three known compounds, methyl-10R-hydroxy-3, 7, 11-trimethyl-2E, 6E, 10E-dodecatrienoate (6), (2E, 6E, 10R)-10, 11-dihydroxy-3, 7, 11-trimethyldodeca-2, 6-dienoic acid (3) and (2E, 6S)-3-methyl-6-hydroxy-6-[(2R, 5R)-5-(2-hydroxypropan-2-yl)-2-methyltetrahydrofuran-2-yl]-hex-2-enoaic acid methyl ester (7), were also reported for the first time from the plants, not the insects or synthetic chemistry. By analysis of the chemical constituents of C. latifolia using an UPLC-QTOF/MS system, Juvenile Hormone โ…ข (1) and (2E, 6E, 10R)-10, 11-dihydroxy-3, 7, 11-trimethyldodeca-2, 6-dienoaic acid methyl ester (2) were predominantly present in the 80% MeOH extract of C.latifolia.List of Schemes iii List of Tables iii List of Figures iv List of Abbreviations vi Introduction ๏ผ‘ II. Materials and Methods ๏ผ” 1. Material ๏ผ” 1.1. Plant material ๏ผ” 1.2 Reagents for isolation and purification ๏ผ• 1.3 Equipments ๏ผ• 2. Methods ๏ผ– 2.1. Extraction and fractionation of C.latifolia ๏ผ– 2.2. Isolation of Juvenile Hormone โ…ข and its analogues ๏ผ— 2.3. General Acid Hydrolysis ๏ผ™ III. Results 24 1. Identification of chemical structure of compounds from the stem bark of C .latifolia 24 1.1 Compound 1 24 1.2 Compound 2 28 1.3 Compound 3 30 1.4 Compound 4 30 1.5 Compound 5 35 1.6 Compound 6 38 1.7 Compound 7 40 1.8 Compound 8 42 1.9 Compound 9 46 1.10 Compound 10 51 1.11 Compound 11 55 1.12 Compound 12 59 1.13 Compound 13 61 1.14 Compound 14 63 1.15 Compound 15 65 1.16 Compound 16 67 โ…ฃ. Discussion 70 โ…ค. Conclusion 75 โ…ฅ. References 76 ๊ตญ๋ฌธ ์ดˆ๋ก 81Maste

    ์œ ์ „์ž ์žฌ์กฐํ•ฉ์— ์˜ํ•œ ํ•ต๋‹ค๊ฐ์ฒด๋ณ‘ ๋ฐ”์ด๋Ÿฌ์Šค์˜ ์ˆ™์ฃผ ๋ฒ”์œ„ ํ™•๋Œ€์™€ ๋ถ„์ž์ƒ๋ฌผํ•™์  ํŠน์„ฑ

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    ํ•™์œ„๋…ผ๋ฌธ(์„์‚ฌ)--์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› :๋†์ƒ๋ฌผํ•™๊ณผ ๊ณค์ถฉํ•™์ „๊ณต,1997.Maste

    Cohort R&D of civil aviation employees and a pilot study on the relation between their sick leaves

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    ์—ญํ•™๊ฑด๊ฐ•์ฆ์ง„ํ•™๊ณผ/์„์‚ฌ[ํ•œ๊ธ€]์—ฐ๊ตฌ๋ชฉ์  : ์ด ์—ฐ๊ตฌ๋Š” ๊ตญ๋‚ด 1๊ฐœ ๋ฏผ๊ฐ„ํ•ญ๊ณต์‚ฌ ๊ฑด๊ฐ•๊ฒ€์ง„ ์ž๋ฃŒ๋ฅผ ์ด์šฉํ•˜์—ฌ ๊ทผ๋กœ์ž์˜ ์ฝ”ํ˜ธํŠธ ์ž๋ฃŒ๋ฅผ ๊ตฌ์ถ•ํ•จ์œผ๋กœ์จ ์งˆ๋ณ‘์กฐ๊ธฐ๋ฐœ๊ฒฌ์„ ์œ„ํ•œ ๊ฑด๊ฐ•๊ด€๋ฆฌ ์ค‘์š”์„ฑ์„ ์ธ์‹ํ•˜๊ณ  ์ด๋ฅผ ์‹ค๋ฌด์— ์ ์šฉํ•˜๊ธฐ ์œ„ํ•จ์ด๋ฉฐ, ์ด๋ฅผ ๊ทผ๊ฑฐ๋กœ ๋ณด๋‹ค ์ ๊ทน์ ์ธ ๊ฑด๊ฐ•์ฆ์ง„ ์‚ฌ์—…์„ ์ง„ํ–‰ํ•˜๋Š” ๊ณ„๊ธฐ๋ฅผ ๋งˆ๋ จํ•˜๊ณ ์ž ํ•˜์˜€๋‹ค. ์—ฐ๊ตฌ๋ฐฉ๋ฒ• : ์—ฐ๊ตฌ๋Œ€์ƒ์ž๋Š” 1980๋…„ 1์›” 1์ผ๋ถ€ํ„ฐ 2009๋…„ 12์›” 31์ผ๊นŒ์ง€ ๊ฑด๊ฐ•๊ฒ€์ง„์„ ๋ฐ›์€ ์ด 34,687๋ช…์„ ๋Œ€์ƒ์œผ๋กœ ํ•˜์˜€๋‹ค. ๋™ ๋Œ€์ƒ์ž์˜ ์ตœ์ดˆ ๊ฒ€์ง„์ผ๋ถ€ํ„ฐ 2009๋…„ 12์›” 31์ผ๊นŒ์ง€์˜ ์งˆ๋ณ‘์œผ๋กœ ์ธํ•œ ๋ณ‘๊ฐ€ ๊ฑด์ˆ˜, ๋ณ‘๊ฐ€ ์ผ์ˆ˜ ๋ฐ ๊ทผ๋กœ์ผ์ˆ˜๋ฅผ ๋ถ„์„ํ•˜๋Š” ์ฝ”ํ˜ธํŠธ ์—ฐ๊ตฌ๋กœ ์ง„ํ–‰ํ•˜์˜€๋‹ค. ๊ฑด๊ฐ•์ƒํƒœ์™€ ๋ณ‘๊ฐ€๊ฑด์ˆ˜ ๋ฐ ๋ณ‘๊ฐ€ ์ผ์ˆ˜, ๊ทผ๋ฌด๋…„์ˆ˜์™€์˜ ๋ถ„์„์€ ๋‹ค๋ณ€๋Ÿ‰ ํšŒ๊ท€๋ถ„์„์„ ํ†ตํ•ด ๋น„๊ตํ•˜์˜€๋‹ค. ๊ธฐ์ดˆ ์ฒด๋ ฅ ์ˆ˜์ค€์€ ๊ตญ๋ฏผ์ฒด์œก์ง„ํฅ๊ณต๋‹จ ์ฒด์œก ๊ณผํ•™ ์—ฐ๊ตฌ์›๊ณผ O2run์‚ฌ๊ฐ€ ๊ณต๋™ ๊ฐœ๋ฐœํ•œ ์ฒด๋ ฅ ์ธก์ • ์‹œ์Šคํ…œ(Helmas)์„ ์ด์šฉํ•˜์—ฌ ์ด 7๊ฐœ ํ•ญ๋ชฉ์— ๋Œ€ํ•ด ์ฒด๋ ฅ ์ˆ˜์ค€์„ ์ธก์ •ํ•˜์˜€๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” 2003๋…„๋ถ€ํ„ฐ 2009๋…„๊นŒ์ง€ ๋ฐ์ดํ„ฐ๋ฅผ ์ด์šฉํ•˜์˜€์œผ๋ฉฐ, ๊ธฐ์ดˆ ์ฒด๋ ฅ ์ˆ˜์ค€์€ 3๊ฐœ ๊ตฌ๊ฐ„(<70์ , 70~83์ , โ‰ฅ84์ )์œผ๋กœ ๋‚˜๋ˆ„์–ด ๋ถ„์„ํ•˜์˜€๋‹ค. ๊ธฐ์ดˆ ์ฒด๋ ฅ ์ˆ˜์ค€๊ณผ ๋ณ‘๊ฐ€ ๋ฐœ์ƒ๊ณผ์˜ ๊ด€๋ จ์„ฑ์€ Kaplan-Meier ์ƒ์กดํ•จ์ˆ˜๋ฅผ ์ถ”์ •ํ•˜๊ณ  ๋กœ๊ทธ-์ˆœ์œ„ ๊ฒ€์ •์„ ํ†ตํ•ด ๋น„๊ตํ•˜์˜€์œผ๋ฉฐ, ๊ด€๋ จ๋œ ํ˜ผ๋ž€๋ณ€์ˆ˜๋ฅผ ํ†ต์ œํ•œ Coxโ€™s Proportional Hazard Models๋ฅผ ์‚ฌ์šฉํ•˜์—ฌ hazard ratio์™€ 95%์‹ ๋ขฐ๊ตฌ๊ฐ„์„ ์ œ์‹œํ•˜์˜€๋‹ค. ์—ฐ๊ตฌ๊ฒฐ๊ณผ : ์—ฐ๊ตฌ์˜ ์ฃผ์š” ๊ฒฐ๊ณผ๋Š” ๋‹ค์Œ๊ณผ ๊ฐ™์•˜๋‹ค. ์ฒซ์งธ, ์ „์ฒด ๋Œ€์ƒ์ž์˜ 37.9%๊ฐ€ ๋ณ‘๊ฐ€ ๋ฐœ์ƒ์ด ์žˆ์—ˆ์œผ๋ฉฐ, ๋‚จ์„ฑ์€ 20.3%, ์—ฌ์„ฑ์—์„œ๋Š” 63.7%๊ฐ€ ๋ฐœ์ƒ๋˜์—ˆ๋‹ค. ๋‘˜์งธ, ์ด ๋ณ‘๊ฐ€ ๊ฑด์ˆ˜๋Š” ์ตœํ•˜ 1๊ฑด์—์„œ๋ถ€ํ„ฐ ์ตœ๋Œ€ 11๊ฑด๊นŒ์ง€์˜€์œผ๋ฉฐ ๋‚จ์„ฑ ์—ฌ์„ฑ์˜ ๊ฒฝ์šฐ ๋ชจ๋‘ 1๊ฑด ๋ฐœ์ƒ์ด ๊ฐ๊ฐ 47.6%, 27.0%๋กœ ๋†’์•˜๋‹ค. ๋ณ‘๊ฐ€ ์ผ์ˆ˜๋Š” 30์ผ ์ดํ•˜์ธ ๊ฒฝ์šฐ๊ฐ€ 88.6% ์ฐจ์ง€ํ•˜์˜€์œผ๋ฉฐ ๊ทธ ์ค‘ ์—ฌ์„ฑ์˜ ๊ฒฝ์šฐ 94.9%๊ฐ€ 30์ผ ์ดํ•˜์˜€๋‹ค. ์ด ๋ณ‘๊ฐ€๊ฑด์ˆ˜ ๋ฐ ์ด ๋ณ‘๊ฐ€์ผ์ˆ˜ ๋ชจ๋‘ ์„ฑ๋ณ„์— ๋”ฐ๋ผ ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋ณด์˜€๋‹ค(P๊ฐ’<.0001). ์งˆํ™˜๋ณ„๋กœ๋Š” ์™ธ๊ณผ, ํ˜ธํก๊ธฐ๋‚ด๊ณผ, ์†Œํ™”๊ธฐ๋‚ด๊ณผ, ์ •ํ˜•์™ธ๊ณผ, ์•ˆ๊ณผ ์ˆœ์œผ๋กœ ๋†’์•˜๋‹ค. ์…‹์งธ, ๊ฑด๊ฐ•์ƒํƒœ์™€ ๋ณ‘๊ฐ€๋ฐœ์ƒ๊ณผ์˜ ๊ด€๋ จ์„ฑ ๋ถ„์„์—์„œ๋Š” ๋‚จ์„ฑ์—์„œ๋Š” ์Œ์ฃผ๋ ฅ, ํก์—ฐ๋ ฅ,์ด์™„๊ธฐ ํ˜ˆ์••, GOT๊ฐ’์ด, ์—ฌ์„ฑ์—์„œ๋Š” ์Œ์ฃผ๋ ฅ, ํก์—ฐ๋ ฅ, ์šด๋™๋ ฅ, ๋น„๋งŒ๋„, ์ด์™„๊ธฐ ํ˜ˆ์••, GOT ๊ฐ’์ด ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋ณด์˜€๋‹ค. ๊ฑด๊ฐ•์ƒํƒœ์™€ ๋ณ‘๊ฐ€ ๊ฑด์ˆ˜ ๋ฐ ๋ณ‘๊ฐ€ ์ผ์ˆ˜์™€์˜ ๋‹ค๋ณ€๋Ÿ‰ ํšŒ๊ท€๋ถ„์„ ๊ฒฐ๊ณผ ๋‚จ/๋…€ ๋ชจ๋‘ ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋ณด์˜€๋‹ค(P๊ฐ’<.0001). ๊ฑด๊ฐ•์ƒํƒœ์™€ ๊ทผ๋ฌด๋…„์ˆ˜์™€์˜ ๊ด€๋ จ์„ฑ์—์„œ๋Š” ๋‚จ์„ฑ์—์„œ ๋น„๋งŒ๋„, ์ˆ˜์ถ•๊ธฐํ˜ˆ์••, ์‹์ „ํ˜ˆ๋‹น, GOT๊ฐ€ ๋‚ฎ์„์ˆ˜๋ก ๊ทผ๋ฌด๋…„์ˆ˜๊ฐ€ ๋†’์•˜์œผ๋ฉฐ, ์—ฌ์„ฑ์—์„œ๋Š” ์ˆ˜์ถ•๊ธฐํ˜ˆ์••, ์ด์™„๊ธฐํ˜ˆ์••, ์‹์ „ํ˜ˆ๋‹น, GOT, GGT๊ฐ€ ๋‚ฎ์„์ˆ˜๋ก ๊ทผ๋ฌด๋…„์ˆ˜๊ฐ€ ๋†’์•˜๋‹ค(P๊ฐ’<.0001).๋„ท์งธ, ๋…„๋„๋ณ„ ๊ธฐ์ดˆ ์ฒด๋ ฅ ์ˆ˜์ค€ ํ‰๊ท ๊ฐ’์€ ์œ ์˜ํ•œ ์ฐจ์ด๊ฐ€ ์žˆ์—ˆ์œผ๋ฉฐ, ํ•ญ๋ชฉ๋ณ„ ๋ถ„์„์—์„œ๋Š” 2003๋…„๋ถ€ํ„ฐ 2009๋…„๊นŒ์ง€ ๊ณ„์† ์ฆ๊ฐ€ ์ˆ˜์น˜๋ฅผ ๋ณด์ด๋Š” ํ•ญ๋ชฉ์€ ํ‰ํ˜•์„ฑ, ๋ฏผ์ฒฉ์„ฑ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ์œผ๋ฉฐ, ๊ทผ์ง€๊ตฌ๋ ฅ์€ ์ง€์†์ ์œผ๋กœ ๋†’์€ ์ˆ˜์ค€์„ ๋‚˜ํƒ€๋‚ด์—ˆ๋‹ค. ๋‹ค์„ฏ์งธ, ๊ธฐ์ดˆ ์ฒด๋ ฅ ์ˆ˜์ค€์— ๋”ฐ๋ผ ์—ฐ๋ น, BMI, ์ด ์ฝœ๋ ˆ์Šคํ…Œ๋กค, ์ค‘์„ฑ์ง€๋ฐฉ, GPT๊ฐ’์ด ๊ธฐ์ดˆ ์ฒด๋ ฅ ์ˆ˜์ค€์— ๋”ฐ๋ผ ์œ ์˜ํ•œ ์ฐจ์ด๊ฐ€ ์žˆ์—ˆ์œผ๋ฉฐ, ์ƒํ™œ์Šต๊ด€ ์š”์†Œ์ธ ํก์—ฐ๋ ฅ์ด ๊ธฐ์ดˆ ์ฒด๋ ฅ ์ˆ˜์ค€์— ๋”ฐ๋ผ ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋ณด์˜€๋‹ค. ์—ฌ์„ฏ์งธ, ๊ธฐ์ดˆ ์ฒด๋ ฅ ์ˆ˜์ค€๋ณ„ ๋ณ‘๊ฐ€ ๊ด€๋ จ ์ƒ์กดํ•จ์ˆ˜ ์ถ”์ • ๊ทธ๋ž˜ํ”„๋ฅผ ํ™•์ธํ•œ ๊ฒฐ๊ณผ, ๊ธฐ์ดˆ ์ฒด๋ ฅ์ˆ˜์ค€์ด ๋†’์€ ๊ทธ๋ฃน์ด ์ตœ์ดˆ ๋ณ‘๊ฐ€ ๋ฐœ์ƒ ์‹œ์ ๊นŒ์ง€์˜ ์ƒ์กด๋ฅ ์ด ๋†’์Œ์„ ์•Œ ์ˆ˜ ์žˆ์—ˆ์œผ๋ฉฐ, ๊ธฐ์ดˆ ์ฒด๋ ฅ ์ˆ˜์ค€์— ๋”ฐ๋ฅธ ํ–ฅํ›„ ๋ณ‘๊ฐ€ ๋ฐœ์ƒ ์œ„ํ—˜๋„ ํ‰๊ฐ€ ๊ฒฐ๊ณผ, ๊ธฐ์ดˆ ์ฒด๋ ฅ ์ ์ˆ˜๊ฐ€ 70์  ๋ฏธ๋งŒ ๊ทธ๋ฃน์— ๋น„ํ•ด 70~83์  ๊ทธ๋ฃน์€ 27%, 84์  ์ด์ƒ ๊ทธ๋ฃน์€ 58% ๋ณ‘๊ฐ€ ๋ฐœ์ƒ ์œ„ํ—˜๋„๊ฐ€ ๋‚ฎ์•˜์œผ๋ฉฐ, ๋ชจ๋‘ ์œ ์˜ํ•œ ์ˆ˜์ค€์ด์—ˆ๋‹ค.๊ฒฐ๋ก  : ์—ฐ๊ตฌ ๊ฒฐ๊ณผ๋ฅผ ์ข…ํ•ฉํ•ด ๋ณด๋ฉด, ๋ณ‘๊ฐ€ ๋ฐœ์ƒ์—๋Š” ๋‚จ์ž์—์„œ ์Œ์ฃผ๋ ฅ, ํก์—ฐ๋ ฅ, ์ด์™„๊ธฐ ํ˜ˆ์••, GOT๊ฐ’, ์—ฌ์„ฑ์—์„œ ์Œ์ฃผ๋ ฅ, ํก์—ฐ๋ ฅ, ์šด๋™๋ ฅ, ๋น„๋งŒ๋„, ์ด์™„๊ธฐ ํ˜ˆ์••, GOT๊ฐ’์ด, ๊ทผ๋ฌด๋…„์ˆ˜์—๋Š” ๋‚จ์„ฑ์—์„œ๋Š” ๋น„๋งŒ๋„, ์ˆ˜์ถ•๊ธฐํ˜ˆ์••, ์‹์ „ํ˜ˆ๋‹น, GOT๊ฐ’์ด, ์—ฌ์„ฑ์—์„œ๋Š” ์ˆ˜์ถ•๊ธฐํ˜ˆ์••, ์ด์™„๊ธฐํ˜ˆ์••, ์‹์ „ํ˜ˆ๋‹น, GOT, GGT๊ฐ’์ด ์œ ์˜ํ•œ ์ฐจ์ด๊ฐ€ ์žˆ์—ˆ๋‹ค.๊ธฐ์ดˆ ์ฒด๋ ฅ ์ˆ˜์ค€์€ ์—ฐ๋ น, BMI, ์ด ์ฝœ๋ ˆ์Šคํ…Œ๋กค, ์ค‘์„ฑ์ง€๋ฐฉ, GPT์ด ๊ธฐ์ดˆ ์ฒด๋ ฅ ์ˆ˜์ค€์— ๋”ฐ๋ผ ์œ ์˜ํ•œ ์ฐจ์ด๊ฐ€ ์žˆ์—ˆ์œผ๋ฉฐ, ์ƒํ™œ์Šต๊ด€ ์š”์†Œ์ธ ํก์—ฐ๋ ฅ์ด ๊ธฐ์ดˆ ์ฒด๋ ฅ ์ˆ˜์ค€์— ๋”ฐ๋ผ ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋ณด์˜€๋‹ค. ๋˜ํ•œ ๋ณ‘๊ฐ€ ์š”์ธ๊ณผ ์œ ์˜ํ•œ ๊ด€๋ จ์„ฑ์ด ์žˆ์œผ๋ฉฐ, ๊ธฐ์ดˆ ์ฒด๋ ฅ ์ˆ˜์ค€์ด ๋†’์„์ˆ˜๋ก ๋ณ‘๊ฐ€ ๊ฑด์ˆ˜, ๋ณ‘๊ฐ€ ์ผ์ˆ˜ ๋ฐ ๋ณ‘๊ฐ€ ๋ฐœ์ƒ ์œ„ํ—˜๋„๊ฐ€ ๊ฐ์†Œํ•œ๋‹ค๋Š” ๊ฒฐ๊ณผ๋ฅผ ๋ณด์˜€๋‹ค. ์ด๋Ÿฌํ•œ ์—ฐ๊ตฌ ๊ฒฐ๊ณผ๋Š” ๊ฐœ์ธ์˜ ๊ฑด๊ฐ•์ฆ์ง„๊ณผ ๊ธฐ์—…์˜ ์œ ํœด์ธ๋ ฅ ๋ฐœ์ƒ ๊ฐ์†Œ๋ฅผ ํ†ตํ•œ ์ƒ์‚ฐ์„ฑ ์ฆ๋Œ€๋ฅผ ๋ชฉ์ ์œผ๋กœ ์ ๊ทน์ ์ธ ์ž„์ง์› ๊ฑด๊ฐ•๊ด€๋ฆฌ๋ฅผ ์ œ์–ธํ•˜๊ณ , ์ •๊ธฐ๊ฒ€์ง„์„ ํ†ตํ•ด ์ž๊ฐ€ ๊ฑด๊ฐ•๊ด€๋ฆฌ์˜ ์ค‘์š”์„ฑ์— ๋Œ€ํ•ด ์–ธ๊ธ‰ํ•จ์œผ๋กœ์จ, ์‚ฌ์—…์žฅ ๊ทผ๋กœ์ž์˜ ๊ฑด๊ฐ•์ฆ์ง„์— ๊ธฐ์—ฌํ•  ๊ฒƒ์œผ๋กœ ์‚ฌ๋ฃŒ๋œ๋‹ค. ๋˜ํ•œ ๊ฐ์‹ค์Šน๋ฌด์›์˜ ๊ธฐ์ดˆ์ฒด๋ ฅ ์ €ํ•˜์ž๋ฅผ ๋Œ€์ƒ์œผ๋กœ ์ฒด๋ ฅ ๊ด€๋ฆฌ๋ฅผ ํ†ตํ•ด ๊ฑด๊ฐ•์ฆ์ง„ ํ”„๋กœ๊ทธ๋žจ ๊ตฌ์ถ•์— ๊ธฐ์—ฌํ•  ๊ฒƒ์œผ๋กœ ์‚ฌ๋ฃŒ๋œ๋‹ค. [์˜๋ฌธ]restrictio

    ์น˜๊ณผ์˜๋ฃŒ๊ธฐ๊ด€์˜ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ์ ์ •์„ฑ ๊ด€๋ฆฌ ๋ฐฉ์•ˆ

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    ํ•™์œ„๋…ผ๋ฌธ (๋ฐ•์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์น˜์˜ํ•™๋Œ€ํ•™์› ์น˜์˜๊ณผํ•™๊ณผ, 2018. 8. ๊น€ํ™๊ธฐ.์—ฐ๊ตฌ ๋ชฉ์  ์ธ๋ฅ˜ ๊ฑด๊ฐ•๊ณผ ์ง„๋ฃŒ์˜ ์งˆ ํ–ฅ์ƒ์„ ์œ„ํ•ด ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์„ ์ค„์ด๋ ค๋Š” ์—ฌ๋Ÿฌ ๋…ธ๋ ฅ์—๋„ ๋ถˆ๊ตฌํ•˜๊ณ  ์•„์ง๋„ ๋งŽ์€ ํ•ญ์ƒ์ œ๋“ค์ด ๋ถ€์ ์ ˆํ•˜๊ฒŒ ์ฒ˜๋ฐฉ๋˜๊ณ  ์žˆ๋‹ค. ์ ์ง„์ ์œผ๋กœ ์ „์ฒด์ ์ธ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์ด ์ค„์–ด๋“ค๊ณ  ์žˆ์Œ์—๋„ ๋ถˆ๊ตฌํ•˜๊ณ , ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ๋Ÿ‰์˜ 10% ๋‚ด์™ธ๋ฅผ ์ฐจ์ง€ํ•˜๋Š” ์น˜๊ณผ์—์„œ์˜ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์€ ์˜คํžˆ๋ ค ์ฆ๊ฐ€ํ•˜๊ณ  ์žˆ๋‹ค. ์ด์— ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์น˜๊ณผ์˜๋ฃŒ๊ธฐ๊ด€์— ๊ทผ๋ฌดํ•˜๋Š” ์น˜๊ณผ์˜์‚ฌ๋“ค์˜ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ํ–‰ํƒœ ๋ณ€ํ™”๋ฅผ ์ผ์œผํ‚ฌ ์ˆ˜ ์žˆ๋Š” ๊ด€๋ฆฌ ๊ฐœ์ž… ๋ฐฉ์•ˆ(intervention)์„ ์‹œํ–‰ํ•˜๊ณ , ๊ทธ ํšจ๊ณผ๋ฅผ ํ‰๊ฐ€ํ•จ์œผ๋กœ์จ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์„ ์ค„์ผ ์ˆ˜ ์žˆ๋Š” ๋ฐฉ์•ˆ๋งˆ๋ จ์— ๊ธฐ์ดˆ๊ฐ€ ๋˜๊ณ ์ž ํ•˜์˜€๋‹ค. ์—ฐ๊ตฌ ๋Œ€์ƒ ๋ฐ ๋ฐฉ๋ฒ• ๋ณธ ์—ฐ๊ตฌ๋ฅผ ์ˆ˜ํ–‰ํ•œ ์น˜๊ณผ๋ณ‘์›์€ ์—ฐ๊ฐ„ ์—ฐ์ธ์› 10๋งŒ ๋ช… ์ด์ƒ์˜ ํ™˜์ž๋ฅผ ์ง„๋ฃŒํ•˜๋Š” ์น˜๊ณผ๋ณ‘์›์œผ๋กœ์„œ, ๋ณธ ์—ฐ๊ตฌ๋ฅผ ์ˆ˜ํ–‰ํ•˜๊ธฐ์— ์ถฉ๋ถ„ํ•œ ๊ทœ๋ชจ์˜ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ๋ฐ์ดํ„ฐ๋ฅผ ์ œ๊ณตํ•  ์ˆ˜ ์žˆ๋Š” ๋ณ‘์›์œผ๋กœ ์‚ฌ๋ฃŒ๋˜์–ด ์—ฐ๊ตฌ๋Œ€์ƒ์œผ๋กœ ์„ ์ •ํ•˜์˜€๋‹ค. ์—ฐ๊ตฌ๋Œ€์ƒ ์น˜๊ณผ๋ณ‘์›์—์„œ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์— ๊ด€ํ•œ ๊ด€๋ฆฌ ๊ฐœ์ž… ๋ฐฉ์•ˆ์„ ์‹œํ–‰ํ•˜๊ธฐ ์ „๊ณผ ํ›„์˜ ๋ฐ์ดํ„ฐ๋ฅผ ์ถ”์ถœํ•˜์—ฌ ๊ด€๋ฆฌ ๊ฐœ์ž… ๋ฐฉ์•ˆ์˜ ํšจ๊ณผ ๋ฐ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ์˜ํ–ฅ์š”์ธ์„ ๋ถ„์„ํ•˜์˜€๋‹ค. ์ฒซ๋ฒˆ์งธ ๊ด€๋ฆฌ ๊ฐœ์ž… ๋ฐฉ์•ˆ(๊ฐœ์ž… 1)์€ ํ˜„์žฌ๊นŒ์ง€์˜ ๋ฌธํ—Œ์„ ์ฐธ์กฐํ•˜์—ฌ ๊ทผ๊ฑฐ์— ๊ธฐ๋ฐ˜ํ•œ(evidence based) ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ๊ฐ€์ด๋“œ๋ผ์ธ์„ ๋งŒ๋“ค๊ณ , ์ด ๊ฐ€์ด๋“œ๋ผ์ธ์„ ์น˜๊ณผ์˜์‚ฌ๋“ค์—๊ฒŒ ๊ต์œกํ•˜๋Š” ๊ฒƒ์ด์—ˆ๋‹ค. ๋‘ ๋ฒˆ์งธ ๊ด€๋ฆฌ ๊ฐœ์ž… ๋ฐฉ์•ˆ(๊ฐœ์ž… 2)์€ ์ด๋ฏธ ๊ต์œก ๋ฐฉ์•ˆ์ด ์‹œํ–‰๋œ ์น˜๊ณผ์˜์‚ฌ๋“ค์„ ๋Œ€์ƒ์œผ๋กœ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ํ–‰์œ„๋ฅผ ๋ณด๋‹ค ์–ด๋ ต๊ฒŒ ๋งŒ๋“ค๊ธฐ ์œ„ํ•ด ์ „์ž ์ฐจํŠธ(EMR, Electronic Medical Record)์— ํฌํ•จ๋œ ํ•ญ์ƒ์ œ ํฌํ•จ ๋ฌถ์Œ ์ฒ˜๋ฐฉ ๋ฒ„ํŠผ์„ ์‚ญ์ œํ•˜๋Š” ๋ฐฉ์•ˆ์ด์—ˆ๋‹ค. ์—ฐ๊ตฌ๋Œ€์ƒ ์น˜๊ณผ๋ณ‘์›์˜ 2015๋…„ 1์›”๋ถ€ํ„ฐ 3์›”์˜ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ๋ฐ์ดํ„ฐ๋ฅผ ๊ด€๋ฆฌ ๊ฐœ์ž… ๋ฐฉ์•ˆ ์‹œํ–‰ ์ „ ๋ฐ์ดํ„ฐ(๋Œ€์กฐ๊ตฐ)๋กœ ํ•˜๊ณ , ๊ฐœ์ž… 1์ด ์‹œํ–‰๋˜๊ณ  ๊ฐœ์ž… 2๊ฐ€ ์‹œํ–‰๋˜๊ธฐ ์ „ ๊ธฐ๊ฐ„์ธ 2016๋…„ 1์›” 1์ผ๋ถ€ํ„ฐ 2์›” 21์ผ๊นŒ์ง€ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ๋ฐ์ดํ„ฐ๋ฅผ ๊ฐœ์ž… 1 ์‹คํ—˜๊ตฐ์œผ๋กœ ํ•˜๋ฉฐ, ๊ทธ ์งํ›„๋ถ€ํ„ฐ ๊ฐœ์ž… 2๊นŒ์ง€ ์‹œํ–‰๋œ ์‹œ๊ธฐ์ธ 2016๋…„ 2์›” 22์ผ๋ถ€ํ„ฐ 3์›” 31์ผ๊นŒ์ง€์˜ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ๋ฐ์ดํ„ฐ๋ฅผ ๊ฐœ์ž… 2 ์‹คํ—˜๊ตฐ์œผ๋กœ ํ•˜์—ฌ ๋ฐ์ดํ„ฐ๋ฅผ ๋ถ„๋ฅ˜ ์ถ”์ถœํ•˜์˜€๋‹ค. ์„ธ ๋ฐ์ดํ„ฐ ๊ตฐ์˜ ์ด ์ง„๋ฃŒ ๊ธฐ๋ก์€ 22,098๊ฑด์ด์—ˆ๋‹ค. ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ๊ด€๋ฆฌ ๊ฐœ์ž… ๋ฐฉ์•ˆ์˜ ํšจ๊ณผ๋ฅผ ํ‰๊ฐ€ํ•˜๊ธฐ ์œ„ํ•˜์—ฌ ๊ฐœ์ž… ๋ฐฉ์•ˆ๋ณ„ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ๋ฅ  ๋ฐ ์ฒ˜๋ฐฉ์ผ์ˆ˜, ์ฒ˜๋ฐฉ๋˜๋Š” ํ•ญ์ƒ์ œ์˜ ์ข…๋ฅ˜๋ฅผ ๋น„๊ต ํ‰๊ฐ€ํ•˜์˜€๋‹ค. ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์˜ ์˜ํ–ฅ์š”์ธ์„ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•˜์—ฌ ์„ ํ–‰์—ฐ๊ตฌ์—์„œ ์œ ์˜๋ฏธํ•˜๊ฒŒ ๋ถ„์„๋˜์—ˆ๊ฑฐ๋‚˜ ๊ด€๋ จ์„ฑ์ด ์žˆ์„ ๊ฒƒ์œผ๋กœ ์ถ”์ •๋˜๋Š” ์š”์ธ๋“ค์„ ์„ ๋ณ„ํ•˜์—ฌ ๊ฐ ์š”์ธ์ด ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ์„ ๋ถ„์„ํ•˜์˜€๋‹ค. ๋˜ํ•œ, ์ „์ฒด ์ง„๋ฃŒ์˜์—ญ์„ 12๊ฐœ์˜ ์ฃผ์š” ์ง„๋ฃŒ๊ตฐ์œผ๋กœ ๋ถ„๋ฅ˜ํ•˜์—ฌ ์ง„๋ฃŒ๊ตฐ๋ณ„๋กœ ํ•˜์œ„ ์ง‘๋‹จ ๋ถ„์„๋„ ์‹œํ–‰ํ•˜์˜€๋‹ค. ์ผ๋ณ€๋Ÿ‰ ๋ถ„์„์„ ์œ„ํ•ด์„œ๋Š” ์นด์ด์ œ๊ณฑ ๊ฒ€์ •๊ณผ ์ผ์›๋ถ„์‚ฐ๋ถ„์„๋ฒ•์„ ์‹œํ–‰ํ•˜์˜€๊ณ , ๋‹ค๋ณ€๋Ÿ‰ ๋ถ„์„์„ ์œ„ํ•ด์„œ๋Š” ๋กœ์ง€์Šคํ‹ฑ ํšŒ๊ท€๋ถ„์„์„ ์‹œํ–‰ํ•˜์˜€๋‹ค. ๋˜ ์‚ฌํ›„ ๊ฒ€์‚ฌ(audit)๋ฅผ ํ†ตํ•ด ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์˜ ์ ์ •์„ฑ(appropriateness)์„ ํ‰๊ฐ€ํ•˜์˜€๋‹ค. ์—ฐ๊ตฌ ๊ฒฐ๊ณผ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ์ง€์นจ์„ ์ œ์ •ํ•˜๊ณ  ์ด๋ฅผ ์น˜๊ณผ์˜์‚ฌ๋“ค์—๊ฒŒ ๊ต์œกํ•˜๋Š” ๊ฒƒ์€, ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ๋ฅ ์„ ๋‚ฎ์ถ”๊ณ , ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ๊ธฐ๊ฐ„์„ ์ค„์˜€์œผ๋ฉฐ, ํŽ˜๋‹ˆ์‹ค๋ฆฐ ๊ณ„ํ†ต์˜ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์„ ๋Š˜๋ฆฌ๋Š” ํšจ๊ณผ๊ฐ€ ์žˆ์—ˆ๋‹ค. ์ „์ž ์ฐจํŠธ์—์„œ ๋ฌถ์Œ ์ฒ˜๋ฐฉ์„ ์—†์• ๋Š” ๊ฒƒ์€, ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ๋ฅ ์„ ์ถ”๊ฐ€๋กœ ๋‚ฎ์ถ”์–ด, ํ•ญ์ƒ์ œ ์‚ฌ์šฉ๋Ÿ‰ ๋˜ํ•œ ์ถ”๊ฐ€๋กœ ์ค„์˜€์œผ๋ฉฐ, ํŽ˜๋‹ˆ์‹ค๋ฆฐ ๊ณ„ํ†ต์˜ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ์—ญ์‹œ ์ถ”๊ฐ€๋กœ ๋Š˜๋ฆฌ๋Š” ํšจ๊ณผ๊ฐ€ ์žˆ์—ˆ๋‹ค. ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์— ์˜ํ–ฅ์„ ๋ฏธ์น˜๋Š” ์—ฌ๋Ÿฌ ์š”์ธ๋“ค์—์„œ, ์ง„๋ฃŒ ๋‚ด์šฉ์˜ ์ฐจ์ด๊ฐ€ ๊ฐ€์žฅ ํฌ๊ฒŒ ์˜ํ–ฅ์„ ๋ฏธ์ณ ์ž„ํ”Œ๋ž€ํŠธ ์ˆ˜์ˆ ์ด๋‚˜ ๊ตฌ๊ฐ•๋‚ด ์†Œ์ˆ˜์ˆ  ๋“ฑ์˜ ๊ด€ํ˜ˆ์  ์‹œ์ˆ  ์‹œ ํ•ญ์ƒ์ œ๊ฐ€ ๋งŽ์ด ์ฒ˜๋ฐฉ๋˜์—ˆ๋‹ค. ๋˜ ํ™˜์ž๊ฐ€ ๋‚จ์„ฑ์ผ ๋•Œ, ์น˜๊ณผ์˜์‚ฌ๊ฐ€ ๋‚จ์„ฑ์ผ ๋•Œ ๋” ๋งŽ์€ ํ•ญ์ƒ์ œ๊ฐ€ ์ฒ˜๋ฐฉ๋˜์—ˆ๋‹ค. ์น˜๊ณผ์˜์‚ฌ๋ฅผ ์ƒ๋Œ€๋กœ ํ•œ ์ง€์นจ์ด๋‚˜, ์ „์ž ์ฐจํŠธ๋ฅผ ์ˆ˜์ •ํ•˜๋Š” ๊ฐœ์ž…์— ๋”ฐ๋ผ์„œ๋„ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์ด ์ค„์–ด๋“ค์—ˆ๋‹ค. ์ ์ •์„ฑ ํ‰๊ฐ€์—์„œ ํ‰๊ฐ€ ์ง€ํ‘œ๋กœ ์žก์€ ์„ธ ๊ฐ€์ง€ ์ง€ํ‘œ ์ค‘, ์นจ์Šต์„ฑ์ด ๊ฐ•ํ•œ ์ง„๋ฃŒ๋‚˜ ์‚ฌ์ „์— ๋ช…ํ™•ํ•œ ๊ฐ์—ผ ์ฆ์ƒ์ด ์กด์žฌํ–ˆ๋‹ค๋Š” ๊ธฐ๋ก ์—†์ด ํ•ญ์ƒ์ œ๊ฐ€ ์ฒ˜๋ฐฉ๋œ ๊ฒฝ์šฐ๊ฐ€ 55.3%์— ์ด๋ฅด๋ €๋‹ค. 1์ฐจ ํ•ญ์ƒ์ œ๋กœ ๊ด‘๋ฒ”์œ„ ํ•ญ์ƒ์ œ๊ฐ€ ์„ ํƒ๋œ ๊ฒฝ์šฐ๋„ 27.1%์˜€๊ณ , ํ•ญ์ƒ์ œ์˜ ํšจ๊ณผ์— ๋Œ€ํ•œ ํ‰๊ฐ€ ์•ฝ์†์ด ์ด๋ฃจ์–ด์ง€์ง€ ์•Š์€ ๊ฒฝ์šฐ๋„ 21.8%์— ์ด๋ฅด๋ €๋‹ค. ์ ์ •์„ฑ(appropriateness) ์ง€ํ‘œ ๋ชจ๋‘์— ๋ถ€ํ•ฉํ•œ ์ฆ๋ก€๋Š” ํ‰๊ฐ€๋Œ€์ƒ 1,049๊ฑด ์ค‘ 239๊ฑด(22.78%)์— ๋ถˆ๊ณผํ–ˆ๋‹ค. ๊ฒฐ๋ก ์ ์œผ๋กœ ์น˜๊ณผ์˜์‚ฌ๋“ค์„ ๋Œ€์ƒ์œผ๋กœ ํ•œ ๊ด€๋ฆฌ ๊ฐœ์ž… ๋ฐฉ์•ˆ์€ ํ•ญ์ƒ์ œ์˜ ์ฒ˜๋ฐฉ๋Ÿ‰์„ ์ค„์ด๊ณ , ์งˆ์„ ์ผ์ • ์ •๋„ ๊ฐœ์„ ํ•˜๋Š” ํšจ๊ณผ๋ฅผ ๋ณด์˜€์œผ๋‚˜, ์•ž์œผ๋กœ๋„ ์ง€์†์ ์ธ ์ง€์นจ์˜ ๊ฐœ์„ ๊ณผ ๊ต์œก์„ ํ†ตํ•ด ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์˜ ์ ์ •์„ฑ์„ ๋†’์—ฌ๊ฐ€์•ผ ํ•  ๊ฒƒ์œผ๋กœ ๋ณด์ธ๋‹ค. ๊ฒฐ๋ก  ์น˜๊ณผ์—์„œ ์‚ฌ์šฉํ•  ์ˆ˜ ์žˆ๋Š” ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ์ง€์นจ์„ ํฌํ•จํ•œ ๊ด€๋ฆฌ ๊ฐœ์ž… ๋ฐฉ์•ˆ๋“ค์€ ์น˜๊ณผ์˜์‚ฌ๋“ค์˜ ํ–‰๋™ ๋ณ€ํ™”๋ฅผ ์ผ์œผ์ผฐ๊ณ , ์น˜๊ณผ๋ณ‘์›์—์„œ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ๋ฅ ๊ณผ ์ฒ˜๋ฐฉ์ผ์ˆ˜๋ฅผ ๊ฐ์†Œ์‹œ์ผฐ์œผ๋ฉฐ, ํŽ˜๋‹ˆ์‹ค๋ฆฐ ๊ณ„ ํ•ญ์ƒ์ œ์˜ ์ฒ˜๋ฐฉ๋ฅ ์„ ๋†’์˜€๋‹ค. ํ•˜์ง€๋งŒ, ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์˜ ์ ์ •์„ฑ์€ ๊ฐœ์ž… ํ›„์—๋„ ๊ฐœ์„ ์˜ ์—ฌ์ง€๊ฐ€ ๋งŽ์•˜๋‹ค. ์ถ”ํ›„ ์ง€์†์ ์ธ ๊ต์œก๊ณผ ์น˜๊ณผ์˜์‚ฌ์˜ ํ–‰๋™ ๋ณ€ํ™”๋ฅผ ์ผ์œผํ‚ฌ ์ˆ˜ ์žˆ๋Š” ์ •์ฑ…๋“ค์„ ํ†ตํ•ด ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์„ ๋‚ฎ์ถ”๊ณ , ์ ์ •์„ฑ์„ ๋†’์—ฌ ๊ฐ€์•ผ ํ•  ๊ฒƒ์œผ๋กœ ์‚ฌ๋ฃŒ๋œ๋‹ค. ์ฃผ์š”์–ด : ์น˜๊ณผ: ์˜๋ฃŒ์˜ ์งˆ: ์น˜๊ณผ์˜์‚ฌ: ํ•ญ์ƒ์ œ: ์ฒ˜๋ฐฉ๋ฅ : ์ ์ •์„ฑ: ํ•ญ์ƒ์ œ ๊ด€๋ฆฌํ”„๋กœ๊ทธ๋žจ ์ œ 1 ์žฅ ์„œ๋ก  11 ์ œ 2 ์žฅ ์—ฐ๊ตฌ๋ฐฉ๋ฒ• 24 ์ œ 1 ์ ˆ ์—ฐ๊ตฌ๋Œ€์ƒ๊ณผ ๊ณผ์ • 24 ์ œ 2 ์ ˆ ์ง„๋ฃŒ ์ •๋ณด์˜ ๋ถ„์„ 32 (1) ๋Œ€์กฐ๊ตฐ๊ณผ ์‹คํ—˜๊ตฐ์˜ ์„ค์ • 32 (2) ์ง„๋ฃŒ ๋‚ด์šฉ์˜ ๋ถ„๋ฅ˜์™€ ๊ด€๋ฆฌ๊ฐœ์ž…๋ฐฉ์•ˆ ์ „ํ›„ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ๋ฅ ์˜ ๋น„๊ต 32 (3) ํ•ญ์ƒ์ œ์˜ ๋ถ„๋ฅ˜์™€ ๊ด€๋ฆฌ๊ฐœ์ž…๋ฐฉ์•ˆ ์ „ํ›„์˜ ๋น„๊ต 33 (4) ๊ด€๋ฆฌ ๊ฐœ์ž… ๋ฐฉ์•ˆ์ด ์ ์šฉ๋˜๊ธฐ ์ „ ํ›„ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์ผ์ˆ˜ ๋น„๊ต 33 (5) ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ๊ณผ ๊ด€๋ จ๋œ ์š”์ธ 34 (6) 12๊ฐ€์ง€ ์ง„๋ฃŒ ๊ฐ๊ฐ์— ๋Œ€ํ•œ ์ค‘์žฌ1๊ณผ ์ค‘์žฌ2์˜ ๋ณด์ • ๊ต์ฐจ๋น„ 36 (7) ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ์ ์ •์„ฑ(appropriateness) ํ‰๊ฐ€ 37 ์ œ 3 ์žฅ ๊ฒฐ๊ณผ 40 (1) ์ง„๋ฃŒ์˜์—ญ๋ณ„ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ๋ฅ ์˜ ๋ณ€ํ™” 40 (2) ์ง„๋ฃŒ์˜์—ญ๋ณ„ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์ผ ์ˆ˜์˜ ๋ณ€ํ™” 42 (3) ํ•ญ์ƒ์ œ์˜ ๋ถ„๋ฅ˜์™€ ๊ด€๋ฆฌ๊ฐœ์ž… ์ „ํ›„์˜ ๋ณ€ํ™” 43 (4) ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์— ๋ฏธ์น˜๋Š” ์š”์ธ 44 (5) 12๊ฐ€์ง€ ์ง„๋ฃŒ ๊ฐ๊ฐ์— ๋Œ€ํ•œ ๊ด€๋ฆฌ ๊ฐœ์ž… ์ค‘์žฌ1๊ณผ ๊ด€๋ฆฌ ๊ฐœ์ž… ์ค‘์žฌ2์˜ ๋ณด์ • ๊ต์ฐจ๋น„ 47 (6) ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์˜ ์ ์ •์„ฑ ํ‰๊ฐ€ 50 ์ œ 4 ์žฅ ๊ณ ์ฐฐ 56 ์ œ 1 ์ ˆ ๋ณธ ์—ฐ๊ตฌ์˜ ๋ฐฐ๊ฒฝ- ์น˜๊ณผ์—์„œ ํ•ญ์ƒ์ œ ๋ฌธ์ œ์˜ ์‹œ๊ธ‰์„ฑ 56 ์ œ 2 ์ ˆ ์—ฐ๊ตฌ์˜ ๊ฐœ๊ด„ 60 ์ œ 3 ์ ˆ ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ์ง€์นจ๊ณผ ๊ด€๋ฆฌ ๊ฐœ์ž… 63 ์ œ 4 ์ ˆ ์—ฐ๊ตฌ ๊ฒฐ๊ณผ์— ๋Œ€ํ•œ ๊ณ ์ฐฐ 67 (1) ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ๋ฅ  67 (2) ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์ผ ์ˆ˜ 71 (3) ์ฒ˜๋ฐฉ๋˜๋Š” ํ•ญ์ƒ์ œ์˜ ์ข…๋ฅ˜ 75 (4) ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ์— ๋ฏธ์น˜๋Š” ์š”์ธ 77 (5) ์ ์ •์„ฑ(appropriateness) ํ‰๊ฐ€ 79 ์ œ 5 ์ ˆ ๋ณธ ์—ฐ๊ตฌ์˜ ํ•œ๊ณ„์™€ ์ถ”ํ›„ ๊ณผ์ œ 81 ์ œ 5 ์žฅ ๊ฒฐ๋ก  89 ์ œ 6 ์žฅ ์ฐธ๊ณ  ๋ฌธํ—Œ 92 ์ œ 7 ์žฅ ๋ถ€๋ก 101 ์ œ 1 ์ ˆ ์‚ฌ๊ณผ๋‚˜๋ฌด ์น˜๊ณผ๋ณ‘์› ํ•ญ์ƒ์ œ ์ฒ˜๋ฐฉ ์ง€์นจ 101 (1) ์ทจ์ง€(introduction) 101 (2) ๊ตฌ๊ฐ• ์•…์•ˆ๋ฉด ๊ฐ์—ผ์˜ ํŠน์ง•(characteristics) 102 (3) ํ•ญ์ƒ์ œ, ์“ธ ๊ฒƒ์ธ๊ฐ€ ๋ง ๊ฒƒ์ธ๊ฐ€(indication) 103 (4) ์–ด๋–ค ํ•ญ์ƒ์ œ๋ฅผ ์“ธ ๊ฒƒ์ธ๊ฐ€(choice of antibiotics) 106 (5) ํ•ญ์ƒ์ œ ํˆฌ์—ฌ ๋ฐฉ๋ฒ•, ํˆฌ์—ฌ๊ธฐ๊ฐ„ ๋ฐ ์šฉ๋Ÿ‰ 111 (6) ์ •๊ธฐ์ ์ธ ๋ชจ๋‹ˆํ„ฐ๋ง๊ณผ ๊ต์œก 114 (7) ๊ฒฐ๋ก ์— ๋Œ€์‹ ํ•˜์—ฌ 115 (8) ์ฐธ๊ณ  ์‚ฌ์ดํŠธ ๋ฐ ๋ฌธํ—Œ 117 ์ œ 2 ์ ˆ ํ™˜์ž๊ต์œก์ž๋ฃŒ (์˜๊ตญ NHS) 118 Abstract 119Docto

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