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    ๊ณต๊ตฐ ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์ง€์›์ œ๋„์— ๊ด€ํ•œ ์—ฐ๊ตฌ

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ํ–‰์ •๋Œ€ํ•™์› : ํ–‰์ •ํ•™๊ณผ(ํ–‰์ •ํ•™์ „๊ณต), 2013. 2. ์ด์ˆ˜์˜.๊ณต๊ตฐ์—์„œ๋Š” ์‚ฌ๊ณ  ๋ฐฉ์ง€๋ฅผ ์œ„ํ•ด ์ด๋ ฅ์„ ๊ธฐ์šธ์ด๊ณ  ์žˆ์œผ๋‚˜ ๋น„ํ–‰ ์ค‘(้‡)์‚ฌ๊ณ ๋Š” ๊ฑฐ์˜ ๋งค๋…„ ์ผ์–ด๋‚˜๊ณ  ์žˆ๋‹ค. ์ง์ ‘์ ์œผ๋กœ ๋น„ํ–‰์‚ฌ๊ณ ๋ฅผ ๊ฒฝํ—˜ํ•˜๋Š” ๊ฒฝ์šฐ๋Š” ๋ฌผ๋ก ์ด๊ณ , ๋™๋ฃŒ์˜ ์ฃฝ์Œ์„ ๊ฒฝํ—˜ํ•˜๋Š” ๊ฐ„์ ‘์  ๋น„ํ–‰์‚ฌ๊ณ ๊ฒฝํ—˜์ด ์กฐ์ข…์‚ฌ์—๊ฒŒ ์ฃผ๋Š” ์‹ฌ๋ฆฌ์  ์••๋ฐ•๊ณผ ํ—ˆํƒˆ๊ฐ ๋“ฑ์€ ์ด๋ฃจ ๋งํ•  ์ˆ˜ ์—†์œผ๋ฉฐ, ์ฃผ๊ด€์  ์ˆ˜์šฉ์˜ ์ •๋„๋Š” ๋‹ค๋ฅด๊ฒ ์ง€๋งŒ ์‹ฌ๋ฆฌ์  ์™ธ์ƒ์œผ๋กœ ๋‚จ๊ฒŒ ๋œ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ์ด๋Ÿฌํ•œ ์กฐ์ข…์‚ฌ๋“ค์˜ ์‹ฌ๋ฆฌ์— ๋Œ€ํ•œ ๊ด€๋ฆฌ์˜ ํ•„์š”์„ฑ์— ๋Œ€ํ•ด ์ƒ๋ถ€์—์„œ๋Š” ์ œ๋Œ€๋กœ ์ธ์‹ํ•˜์ง€ ๋ชปํ•˜๊ณ  ์žˆ๊ณ  ์ด์— ๋”ฐ๋ผ ์กฐ์ข…์‚ฌ๋“ค์˜ ์‹ฌ๋ฆฌ์— ๋Œ€ํ•œ ์ฒด๊ณ„์ ์ธ ์ง€์› ์‹œ์Šคํ…œ์ด ๊ตฌ์ถ•๋˜์–ด ์žˆ์ง€ ์•Š์€ ์ƒํƒœ์ด๋‹ค. ๋”ฐ๋ผ์„œ ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ์กฐ์ข…์‚ฌ์— ๋Œ€ํ•œ ์‹ฌ๋ฆฌ์ง€์›์ด ์กฐ์ข…์‚ฌ์˜ ์‹ฌ๋ฆฌ์  ์•ˆ์ •๊ณผ PTSD(Post Traumatic Stress Disorder: ์™ธ์ƒ ํ›„ ์ŠคํŠธ๋ ˆ์Šค)์˜ ๊ฐ์†Œ, ์กฐ์งํ›„์›์ธ์‹ ๋ฐ ์ง๋ฌด๋งŒ์กฑ๊ณผ ์กฐ์ง๋ชฐ์ž…์„ ํฌํ•จํ•˜๋Š” ์ง๋ฌดํƒœ๋„์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ์„ ๋ถ„์„ํ•˜์—ฌ ๊ทธ ํšจ๊ณผ๋ฅผ ๊ฒ€์ฆํ•˜๊ณ , ๊ทธ์— ๋”ฐ๋ฅธ ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์ง€์›์— ๋Œ€ํ•œ ๊ตฌ์ฒด์  ์ฒด๊ณ„์˜ ํ•„์š”์„ฑ์„ ์—ญ์„คํ•˜๋ฉฐ ๋ฐœ์ „๋ฐฉํ–ฅ์„ ๋ชจ์ƒ‰ํ•˜๋Š” ๊ฒƒ์„ ๋ชฉ์ ์œผ๋กœ ์—ฐ๊ตฌ๋ฅผ ์ง„ํ–‰ํ•˜์˜€๋‹ค. 2010๋…„ ๊ฐ•๋ฆ‰๊ธฐ์ง€์—์„œ๋Š” 3์›”๊ณผ 6์›” ๋‘ ์ฐจ๋ก€์— ๊ฑธ์นœ ๋น„ํ–‰์‚ฌ๊ณ ๋กœ ํ•œ ๋Œ€๋Œ€์˜ ์กฐ์ข…์‚ฌ 5๋ช…์ด ์ˆœ์งํ•˜์˜€๋‹ค. ์ž‡๋”ฐ๋ฅธ ์‚ฌ๊ณ ๋กœ ์ธํ•ด ์‚ฌ๊ณ  ๋Œ€๋Œ€ ์กฐ์ข…์‚ฌ๋“ค์˜ ์‹ฌ๋ฆฌ์ƒํƒœ๋Š” ๋งค์šฐ ๋ถˆ์•ˆ์ •ํ•˜์˜€๊ณ , ์‹ฌ๋ฆฌ๊ด€๋ฆฌ์˜ ํ•„์š”์„ฑ์ด ์ œ๊ธฐ๋˜๋ฉด์„œ ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์•ˆ์ •ํ”„๋กœ๊ทธ๋žจ์ด ์ตœ์ดˆ๋กœ ์‹œํ–‰๋˜์—ˆ๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ๋‹น์‹œ ๊ฐ•๋ฆ‰๊ธฐ์ง€์—์„œ ์‹œํ–‰๋œ ์‹ฌ๋ฆฌ์•ˆ์ •ํ”„๋กœ๊ทธ๋žจ์„ ๋‹จ์ผ์‚ฌ๋ก€๋กœ ์„ ์ •ํ•˜์—ฌ ๋ถ„์„ํ•˜์˜€๋‹ค. ๋ถ„์„๋ฐฉ๋ฒ•์€ ๊ฐ•๋ฆ‰๊ธฐ์ง€์˜ ์‚ฌ๊ณ ๋ฐœ์ƒ๋ถ€ํ„ฐ ์‹ฌ๋ฆฌ์•ˆ์ •ํ”„๋กœ๊ทธ๋žจ์˜ ์‹ค์‹œ ์ดํ›„๊นŒ์ง€์˜ ๊ณผ์ •์„ ์‚ดํŽด๋ณด๊ณ  ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์— ์ฐธ์—ฌํ•œ ์‚ฌ๊ณ ๋Œ€๋Œ€ ์กฐ์ข…์‚ฌ, ์‹ค๋ฌด์ž๋ฅผ ๋Œ€์ƒ์œผ๋กœ ํ•œ ์ธํ„ฐ๋ทฐ๋ฅผ ํ†ตํ•ด ์‹ฌ๋ฆฌ์•ˆ์ •ํ”„๋กœ๊ทธ๋žจ์˜ ์‹œํ–‰๊ณผ์ •๊ณผ ํšจ๊ณผ, ๋ฌธ์ œ์ , ๋ณด์™„๋ฐฉ์•ˆ ๋“ฑ์— ๋Œ€ํ•ด ์‹ฌ์ธต์ ์œผ๋กœ ํŒŒ์•…ํ•˜์˜€๋‹ค. ์ถ”๊ฐ€๋กœ ์‹ฌ๋ฆฌ์•ˆ์ •ํ”„๋กœ๊ทธ๋žจ์„ ๋ฐ›์€ ์กฐ์ข…์‚ฌ์™€ ๊ทธ๋ ‡์ง€ ๋ชปํ•œ ์กฐ์ข…์‚ฌ๋“ค์„ ๋น„๊ตํ•˜๊ธฐ ์œ„ํ•ด ๋น„ํ–‰์‚ฌ๊ณ ๋ฅผ ๊ฒฝํ—˜ํ•˜๊ณ  ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์„ ๋ฐ›์ง€ ๋ชปํ•œ ์กฐ์ข…์‚ฌ๋“ค์— ๋Œ€ํ•œ ์ธํ„ฐ๋ทฐ๋„ ์ง„ํ–‰ํ•˜์˜€๋‹ค. ๊ทธ๋ฆฌ๊ณ  ๋ฐœ์ „๋œ ์‹ฌ๋ฆฌ์ง€์›์ฒด๊ณ„์™€์˜ ๋น„๊ต๋ฅผ ์œ„ํ•ด ๋ฌธํ—Œ๊ณผ ์ธํ„ฐ๋„ท ์กฐ์‚ฌ๋ฅผ ํ†ตํ•ด ๋ฏธ ๊ณต๊ตฐ์˜ ์‹ฌ๋ฆฌ์ง€์›์ฒด๊ณ„์™€ ์šฐ๋ฆฌ๋‚˜๋ผ ์†Œ๋ฐฉ๋ฐฉ์žฌ์ฒญ์˜ ์žฌ๋‚œ์‹ฌ๋ฆฌ์ง€์›์ฒด๊ณ„์— ๋Œ€ํ•œ ๋ถ„์„์„ ์‹ค์‹œํ•˜์˜€๊ณ , ์ด๋Ÿฌํ•œ ๊ณผ์ •์„ ๋ฐ”ํƒ•์œผ๋กœ ๋งˆ์ง€๋ง‰์œผ๋กœ ์šฐ๋ฆฌ๋‚˜๋ผ ๊ณต๊ตฐ ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์ง€์›์ฒด๊ณ„์˜ ๋ณด์™„ ๋ฐ ๋ฐœ์ „๋ฐฉ์•ˆ์„ ์ œ์‹œํ•˜์˜€๋‹ค. ์—ฐ๊ตฌ์˜ ๊ฒฐ๊ณผ๋Š” ๋‹ค์Œ๊ณผ ๊ฐ™๋‹ค. ์ฒซ์งธ, ๊ฐ•๋ฆ‰๊ธฐ์ง€ ์‚ฌ๊ณ ๋ฅผ ๊ฒช์€ ํ›„ ์‚ฌ๊ณ  ๋Œ€๋Œ€์˜ ์กฐ์ข…์‚ฌ๋“ค์˜ ์‹ฌ๋ฆฌ์ƒํƒœ๊ฐ€ ๋งค์šฐ ๋ถˆ์•ˆํ•˜์˜€์Œ์„ ์•Œ ์ˆ˜ ์žˆ์—ˆ๋‹ค. ์กฐ์ข…์‚ฌ๋“ค์€ ์žฌ๊ฒฝํ—˜, ํšŒํ”ผ, ๊ณผ๊ฐ์„ฑ ๋“ฑ์˜ ๋ฐ˜์‘์„ ๊ณจ๊ณ ๋ฃจ ๋‚˜ํƒ€๋ƒˆ๊ณ , ์ง€์† ์‹œ๊ธฐ์— ๋”ฐ๋ผ ๊ธ‰์„ฑ ์ŠคํŠธ๋ ˆ์Šค ๋ฐ˜์‘์—์„œ PTSD ์ฆ์ƒ์— ์ด๋ฅด๊ธฐ๊นŒ์ง€ ํ•œ ๊ฒƒ์œผ๋กœ ๋ณด์ธ๋‹ค. ๋‘˜์งธ, ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ ์‹ค์‹œ ํ›„ ์กฐ์ข…์‚ฌ๋“ค์˜ ์กฐ์งํ›„์›์ธ์‹์€ ๋Œ€์ฒด๋กœ ์ฆ๊ฐ€ํ•œ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ์ด๋Š” ํ†ต์ œ์ง‘๋‹จ ์กฐ์ข…์‚ฌ๋“ค๊ณผ์˜ ๋น„๊ต๋ฅผ ํ†ตํ•ด ๋”์šฑ ํ™•์—ฐํ•˜๊ฒŒ ๋“œ๋Ÿฌ๋‚ฌ๋Š”๋ฐ ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์˜ ํ˜œํƒ์„ ๋ฐ›์€ ์กฐ์ข…์‚ฌ๋“ค์€ ์กฐ์ง์—์„œ ์กฐ์ข…์‚ฌ๋“ค์˜ ์‹ฌ๋ฆฌ์ƒํƒœ์— ๊ด€์‹ฌ์„ ๊ฐ–๊ณ  ์‹ ๊ฒฝ์„ ์จ์ค€๋‹ค๋Š” ์ธ์‹์ด ์กฐ์งํ›„์›์ธ์‹์œผ๋กœ ์ด์–ด์กŒ์ง€๋งŒ ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์„ ๋ฐ›์ง€ ๋ชปํ•œ ์กฐ์ข…์‚ฌ๋“ค์€ ์‚ฌ๊ณ  ์กฐ์‚ฌ ๊ณผ์ •์„ ๋น„๋กฏํ•œ ์‚ฌํ›„ ์กฐ์น˜ ๊ณผ์ •์—์„œ ๊ตฌ์„ฑ์›์— ๋Œ€ํ•œ ๋ฐฐ๋ ค๋‚˜ ๋ณต์ง€์— ๋Œ€ํ•œ ๊ด€์‹ฌ๋ณด๋‹ค๋Š” ์‹ ์†ํ•œ ์‚ฌ๊ณ  ์ฒ˜๋ฆฌ์— ๋”์šฑ ์ค‘์ ์„ ๋‘”๋‹ค๋Š” ์ธ์ƒ์„ ๊ฐ•ํ•˜๊ฒŒ ๋ฐ›์•„ ์กฐ์งํ›„์›์ธ์‹์˜ ๊ฐ์†Œ๋ฅผ ๊ฒฝํ—˜ํ•˜์˜€๋‹ค. ์…‹์งธ, ์‚ฌ๊ณ  ๋ฐœ์ƒ ์ดํ›„ ์‹ฌ๊ฐํ•œ ์ƒํƒœ๋กœ๊นŒ์ง€ ์ง„์ „๋˜์—ˆ๋˜ ์กฐ์ข…์‚ฌ๋“ค์˜ ๋ถˆ์•ˆ์ •ํ•œ ์‹ฌ๋ฆฌ ์ƒํƒœ๊ฐ€ ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์„ ํ†ตํ•ด ์–ด๋Š ์ •๋„ ํšŒ๋ณต๋˜์—ˆ๋˜ ๊ฒƒ์œผ๋กœ ํŒŒ์•…๋˜์—ˆ๋‹ค. ์‚ฌ๊ณ ๋กœ ์ธํ•œ ์‹ฌ๋ฆฌ์  ๋ถˆ์•ˆ์ •๋ฟ๋งŒ ์•„๋‹ˆ๋ผ ๋ณธ์ธ๋„ ์•Œ์ง€ ๋ชปํ–ˆ๋˜ ๊ฐœ์ธ์  ๊ณ ๋ฏผ์ด๋‚˜ ์กฐ์ง์ด ๊ฐ€์ง€๊ณ  ์žˆ๋˜ ๋ฌธ์ œ๋“ค์ด ๋“œ๋Ÿฌ๋‚˜๋ฉด์„œ ์–ด๋Š ์ •๋„ ์ข‹์•„์กŒ๊ณ  ์„œ๋กœ์˜ ๋ฌธ์ œ์ ์˜ ๊ณต์œ ๋ฅผ ํ†ตํ•ด ์กฐ์ง ๊ตฌ์„ฑ์› ๊ฐ„์˜ ์‹ ๋ขฐ์™€ ์ดํ•ด ์ฆ์ง„์— ๋„์›€์ด ๋˜์—ˆ๋‹ค๋Š” ๋ฐ˜์‘์ด์—ˆ๋‹ค. ๋„ท์งธ, ์กฐ์งํ›„์›์ธ์‹๊ณผ ์‹ฌ๋ฆฌ์  ์•ˆ์ •์˜ ํ–ฅ์ƒ์—๋Š” ๋„์›€์ด ๋˜์—ˆ์œผ๋‚˜ ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์˜ ํšจ๊ณผ๊ฐ€ ์กฐ์ข…์‚ฌ๋“ค์˜ ๊ธ์ •์ ์ธ ์ง๋ฌดํƒœ๋„ ๋ณ€ํ™”๊นŒ์ง€ ๊ฐ€์ ธ์˜ค์ง€๋Š” ๋ชปํ•œ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๋Œ€๋ถ€๋ถ„์˜ ์กฐ์ข…์‚ฌ๋“ค์ด ์‚ฌ๊ณ  ํ›„ ๋‚ฎ์•„์กŒ๋˜ ์ง๋ฌด๋งŒ์กฑ๊ณผ ์กฐ์ง๋ชฐ์ž…์ด ์‹œ๊ฐ„์ด ์ง€๋‚˜๋ฉด์„œ ์–ด๋Š ์ •๋„ ํšŒ๋ณต๋˜์—ˆ์ง€๋งŒ, ๊ทธ๊ฒƒ์ด ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์˜ ํšจ๊ณผ๋กœ ์ธํ•œ ๊ฒƒ์ด๋ผ๊ณ  ๋งํ•˜๊ธฐ๋Š” ์–ด๋ ต๋‹ค๋Š” ๋ฐ˜์‘์ด์—ˆ๋‹ค. ๋ฉด์ ‘์„ ํ†ตํ•ด ๋“œ๋Ÿฌ๋‚œ ๊ฐ•๋ฆ‰๊ธฐ์ง€ ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์˜ ๋ฌธ์ œ์ ์€ ๋‹ค์Œ๊ณผ ๊ฐ™๋‹ค. ๊ณ ์œ„ํ—˜๊ตฐ์œผ๋กœ ๋ถ„๋ฅ˜๋œ ์กฐ์ข…์‚ฌ๋“ค์˜ ๊ด€๋ฆฌ ๋ฌธ์ œ์™€ ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ ๋ฌธ์ œ์— ๋Œ€ํ•œ ์ƒ๋ถ€์˜ ์ธ์‹ ๋ถ€์กฑ, ์กฐ์ข…์‚ฌ๋“ค์˜ ์‹ฌ๋ฆฌ์  ๋ถˆ์•ˆ์ •์— ๋Œ€ํ•œ ์ธ์‹๋ถ€์กฑ ๋ฐ ์‹ฌ๋ฆฌ์ƒ๋‹ด์— ๋Œ€ํ•œ ๊ฑฐ๋ถ€๊ฐ, ๋น„ํ–‰์‚ฌ๊ณ  ํ›„ ์‚ฌ๊ณ ๋กœ ์ธํ•œ ์‹ฌ๋ฆฌ์  ํ”ผํ•ด์ž๋“ค์— ๋Œ€ํ•œ ์ฃผ์œ„ ์‚ฌ๋žŒ๋“ค์˜ ์ธ์‹๋ถ€์กฑ ๋“ฑ ์„ธ ๊ฐ€์ง€ ์ธก๋ฉด์˜ ์ธ์‹ ๋ฌธ์ œ, ๊ทธ๋ฆฌ๊ณ  ์‹ฌ๋ฆฌ์ง€์›์— ๋Œ€ํ•œ ์ฃผ๊ด€๋ถ€์„œ ๋ฐ ํ†ตํ•ฉ์ฒด๊ณ„์˜ ๋ถ€์žฌ์™€ ํ”„๋กœ๊ทธ๋žจ์˜ ๋‚ด์šฉ๊ณผ ๊ด€๋ จ ์˜ˆ์‚ฐ, ์‹œ๊ฐ„ ๋“ฑ์˜ ์ž์› ๋ถ€์กฑ ๋ฌธ์ œ, ๋งˆ์ง€๋ง‰์œผ๋กœ ์‚ฌ๊ณ  ์ง€์›์š”์›์— ๋Œ€ํ•œ ๊ด€๋ฆฌ ๋ฐฉ์•ˆ ๋ถ€์žฌ ๋“ฑ์ด์—ˆ๋‹ค. ์ธํ„ฐ๋ทฐ๋ฅผ ์ง„ํ–‰ํ•œ ๋Œ€๋ถ€๋ถ„์˜ ์กฐ์ข…์‚ฌ๋“ค์ด ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์˜ ์‹œํ–‰ ์ž์ฒด์— ๋Œ€ํ•ด์„œ๋Š” ๊ธ์ •์ ์ธ ๋ฐ˜์‘์„ ๋ณด์—ฌ ์กฐ์ข…์‚ฌ๋“ค์˜ ์‹ฌ๋ฆฌ ๊ด€๋ฆฌ ๋ฐ ์ง€์›์— ๋Œ€ํ•ด์„œ๋Š” ํ•„์š”์„ฑ์„ ์ธ์‹ํ•˜๊ณ  ์žˆ์—ˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ๊ฐ•๋ฆ‰๊ธฐ์ง€ ์‚ฌ๊ณ  ๋ฐœ์ƒ ๋‹น์‹œ ์ˆ˜๋ฆฝ๋˜์–ด ํ˜„์žฌ๊นŒ์ง€ ์ง„ํ–‰๋˜๊ณ  ์žˆ๋Š” ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์—์„œ๋Š” ๋งŽ์€ ๋ฌธ์ œ์ ๊ณผ ๋ถ€์กฑํ•จ์ด ์žˆ๋‹ค๋Š” ๊ฒƒ์„ ์กฐ์ข…์‚ฌ์™€ ์‹ค๋ฌด์ž ๊ณตํžˆ ์ธ์‹ํ•˜๊ณ  ์žˆ์—ˆ์œผ๋ฉฐ, ์ด์— ๋Œ€ํ•œ ๋ณด์™„์ด ์ ˆ์‹คํ•˜๋‹ค๋Š” ๊ฒƒ์„ ์•Œ ์ˆ˜ ์žˆ์—ˆ๋‹ค. ๋”ฐ๋ผ์„œ ํ˜„์žฌ์˜ ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์„ ์œ„ํ•ด์„œ๋Š” ์šฐ์„ ์ ์œผ๋กœ ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์ง€์›์„ ๋‹ด๋‹นํ•˜๋Š” ์ฃผ๊ด€๋ถ€์„œ๊ฐ€ ์„ค์ •๋˜์–ด ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์ง€์›์— ๋Œ€ํ•ด ์ฑ…์ž„ ์žˆ๊ณ  ์ฒ ์ €ํ•œ ์ •์ฑ… ์‹œํ–‰์ด ๋˜์–ด์•ผ ํ•˜๋ฉฐ ์‹ฌ๋ฆฌ์ง€์›๊ณผ ์ƒ๋‹ด ๊ด€๋ จ ๊ณต๊ตฐ์˜ ์ผ์›์ ์ธ ์ฒด๊ณ„๊ฐ€ ๊ฐ–์ถ”์–ด์ ธ์•ผ ํ•œ๋‹ค. ๊ทธ๋ฆฌ๊ณ  ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์ง€์› ํŒ€์ด ์ƒ์„ค ์กฐ์ง์œผ๋กœ ์‹ ์„ค๋˜์–ด ์˜๋ฌด, ๊ต์œก ๋“ฑ ๊ฐ ์‹ค๋ฌด์ž๋“ค์ด ์œ ๊ธฐ์ ์œผ๋กœ ํ”„๋กœ๊ทธ๋žจ์„ ์ง„ํ–‰ํ•  ์ˆ˜ ์žˆ์–ด์•ผ ํ•œ๋‹ค. ๋‚˜์•„๊ฐ€ ํ‰์†Œ์—๋„ ๊ฐ ๋ถ€๋Œ€์—์„œ ์กฐ์ข…์‚ฌ๋“ค์˜ ์‹ฌ๋ฆฌ ์ƒํƒœ๋ฅผ ๊ด€๋ฆฌํ•  ์ˆ˜ ์žˆ๋Š” ์‹œ์Šคํ…œ์ด ๊ฐ–์ถ”์–ด์ง€๋Š” ๋ฐฉํ–ฅ์œผ๋กœ ๋‚˜์•„๊ฐ€๋Š” ๊ฒƒ์ด ๋ฐ”๋žŒ์งํ•˜๋‹ค. ๋˜ํ•œ ํ”„๋กœ๊ทธ๋žจ์˜ ์ƒ๋‹ดํšŸ์ˆ˜ ์ฆ๊ฐ€, ์ ์ ˆํ•œ follow up, ๊ณ ์œ„ํ—˜๊ตฐ ๊ด€๋ฆฌ์— ๋Œ€ํ•œ ๋ช…ํ™•ํ•œ ์ง€์นจ ์„ค์ •, ์กฐ์ข…์‚ฌ ๊ฐ€์กฑ์— ๋Œ€ํ•œ ์‹ฌ๋ฆฌ์ง€์› ๋ณด์žฅ, ์‚ฌ๊ณ  ์ง€์›์š”์› ๊ด€๋ฆฌ๋ฐฉ์•ˆ ์ˆ˜๋ฆฝ, ์‹ฌ๋ฆฌ์ง€์› ์‹ค๋ฌด์ž์— ๋Œ€ํ•œ ๊ถŒํ•œ ์„ค์ • ๋“ฑ ๋‚ด์‹ค ์žˆ๋Š” ํ”„๋กœ๊ทธ๋žจ์˜ ์‹œํ–‰์„ ์œ„ํ•œ ๋‚ด์šฉ ๋ณด์™„์ด ํ•„์š”ํ•˜๋ฉฐ ์ด๋Ÿฌํ•œ ์ œ๋ฐ˜ ์‚ฌํ•ญ๋“ค์„ ๋น„๋กฏํ•ด ๊ฐ ๋‹จ๊ณ„๋ณ„, ์กฐ์ข…์‚ฌ์˜ ์ƒํƒœ๋ณ„ ๋Œ€์‘ ์ง€์นจ ๋“ฑ์„ ์ˆ˜๋กํ•œ ์‹ฌ๋ฆฌ์ง€์› ๋งค๋‰ด์–ผ์ด ์ž‘์„ฑ๋˜์–ด์•ผ ํ•œ๋‹ค. ๋‘ ๋ฒˆ์งธ๋กœ, ์ •์‹ ๊ณผ ๊ตฐ์˜๊ด€, ์ •์‹ ๊ฑด๊ฐ• ์ „๋ฌธ ๊ฐ„ํ˜ธ ์žฅ๊ต, ์ƒ๋‹ด์‚ฌ ๋“ฑ์˜ ๊ตฐ ๋‚ด ์ธ๋ ฅ๋ณด์ถฉ์„ ์œ„ํ•œ ์ „๋ฌธ๊ฐ€ ์œก์„ฑ ๋ฐฉ์•ˆ ์ˆ˜๋ฆฝ, ์•„์›ƒ์†Œ์‹ฑ์„ ํ†ตํ•œ ์ธ๋ ฅ ํ™•๋ณด์™€ ํ•ด๋‹น ์ธ์›๋“ค์— ๋Œ€ํ•œ ์‚ฌ์ „ ๊ต์œก์„ ํ†ตํ•ด ์–ด๋–ค ์ƒํ™ฉ์ด ๋ถˆ์‹œ์— ๋ฐœ์ƒํ•˜๋”๋ผ๋„ ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ ์ง€์›์— ํ™œ์šฉ ๊ฐ€๋Šฅํ•œ ์ธ๋ ฅ ํ’€ ๊ตฌ์ถ• ๋ฐฉ์•ˆ์„ ์ˆ˜๋ฆฝํ•ด์•ผ ํ•œ๋‹ค. ์„ธ ๋ฒˆ์งธ๋กœ ์‹ฌ๋ฆฌ์ง€์›์— ๊ด€ํ•œ ๊ต์œก์ด ํ•„์š”ํ•˜๋‹ค. ์ง€ํœ˜๊ด€, ์กฐ์ข…์‚ฌ ๊ทธ๋ฆฌ๊ณ  ์ „ ์žฅ๋ณ‘์„ ๋Œ€์ƒ์œผ๋กœ ์•ž์„œ ๋ฌธ์ œ์ ์œผ๋กœ ์ง€์ ๋˜์—ˆ๋˜ ์ธ์‹์˜ ๋ฌธ์ œ๋ฅผ ๊ฐœ์„ ํ•˜๊ธฐ ์œ„ํ•ด ๊ฐ ๋Œ€์ƒ์ž๋ณ„๋กœ ๊ต์œก๊ณ„ํš์ด ์ˆ˜๋ฆฝ๋˜์–ด์•ผ ํ•œ๋‹ค. ๊ทธ๋ฆฌ๊ณ  ์‹ฌ๋ฆฌ์ง€์› ์‹ค๋ฌด์ž๋“ค์— ๋Œ€ํ•œ ๊ต์œก์ด ์‚ฌ์ „์— ๋ฏธ๋ฆฌ ์‹ค์‹œ๋˜์–ด ํšจ๊ณผ์ ์ธ ํ”„๋กœ๊ทธ๋žจ ์ œ๊ณต์„ ํ•  ์ˆ˜ ์žˆ์–ด์•ผ ํ•œ๋‹ค. ๋˜ํ•œ ์‹ฌ๋ฆฌ์ง€์› ๋ฐ ์ƒ๋‹ด ๊ด€๋ จํ•œ ์ •๋ณด๋ฅผ ์‰ฝ๊ฒŒ ์Šต๋“ํ•˜๊ณ  ์ ‘๊ทผ์ด ์šฉ์ดํ•˜๋„๋ก ์ ๊ทน์ ์ธ ํ™๋ณด๊ฐ€ ํ•„์š”ํ•˜๋‹ค. ๋งˆ์ง€๋ง‰์œผ๋กœ ๋ฏผ๊ฐ„ ์—ฐ๊ตฌ๊ธฐ๊ด€, ํ•™ํšŒ, ์˜๋ฃŒ๊ธฐ๊ด€ ๋“ฑ๊ณผ ๋ฏผยท๊ตฐ ํ˜‘๋ ฅ์ฒด๊ณ„๋ฅผ ๊ตฌ์ถ•ํ•จ์œผ๋กœ์จ ๊ตฐ ์ •์‹ ๊ฑด๊ฐ•์— ๋Œ€ํ•œ ์ „๋ฌธ์  ์ง€์‹ ํ™•๋ฆฝ๊ณผ ๋Œ€์ฒ˜๋ฐฉ์•ˆ ์ˆ˜๋ฆฝ์— ํž˜์จ์•ผ ํ•œ๋‹ค. ๊ทธ๋ฆฌ๊ณ  ์ƒ๋‹ด ์ง€์›์ด ๊ฐ€๋Šฅํ•œ ๊ฐ ์ง€์ž์ฒด ๋ฐ ํ˜‘ํšŒ ๋“ฑ๊ณผ์˜ ์—ฐ๊ณ„๋ฅผ ํ†ตํ•ด ์‹ฌ๋ฆฌ์ง€์› ๋…ธํ•˜์šฐ๋ฅผ ์Šต๋“ํ•˜๊ณ  ์ธ๋ ฅ๋ฌธ์ œ๋ฅผ ํ•ด๊ฒฐํ•ด์•ผ ํ•œ๋‹ค. ์šฐ๋ฆฌ๋‚˜๋ผ์—์„œ๋Š” ์•„์ง ๋ฏผ๊ฐ„์—์„œ๋„ ์ƒ๋‹ด๋ถ„์•ผ๊ฐ€ ๊ทธ๋ ‡๊ฒŒ ๋ฐœ์ „ํ•˜์ง€ ์•Š์•˜๊ณ , ์‹ฌ๋ฆฌ ์ƒ๋‹ด ๊ด€๋ จ ๋ถ„์•ผ์— ๋Œ€ํ•œ ์‚ฌ๋žŒ๋“ค์˜ ์ธ์‹์ด ๋งค์šฐ ๋‚ฎ์€ ํŽธ์ด๋‹ค. ๋ณด์ˆ˜์  ์„ฑํ–ฅ์„ ๊ฐ€์ง„ ๊ตฐ์—์„œ๋Š” ๋”์šฑ ๊ทธ๋ ‡๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ๊ตฐ์˜ ์‚ฌ๊ธฐ ์•™์–‘์ด๋‚˜ ์ „ํˆฌ๋ ฅ ํ–ฅ์ƒ์— ์žˆ์–ด์„œ ์ •์‹ ์ ์ธ ๋ฌด์žฅ์€ ์ฒจ๋‹จ ๋ฌด๊ธฐ์˜ ๋ฐฐ์น˜ ๋“ฑ ์™ธํ˜•์ ์ธ ์ „ํˆฌ๋ ฅ๋ณด๋‹ค ๋”์šฑ ์ค‘์š”ํ•œ ์ธก๋ฉด์ด๋‹ค. ์šฐ๋ฆฌ ๊ตฐ์—์„œ๋„ ์ด๋Ÿฌํ•œ ์ •์‹ ์ „๋ ฅ์˜ ์ค‘์š”์„ฑ์„ ๊นจ๋‹ซ๊ณ  ์ด์™€ ๊ด€๋ จํ•œ ์ฒด๊ณ„๋ฅผ ๋ฐœ์ „์‹œ์ผœ๋‚˜๊ฐ€์•ผ ํ•˜๋ฉฐ, ํŠนํžˆ ๊ตญ๋ฐฉ๋ ฅ์— ์žˆ์–ด ํ•ต์‹ฌ์š”์†Œ์ธ ์กฐ์ข…์‚ฌ๋“ค์˜ ์‹ฌ๋ฆฌ์ง€์›์— ๋Œ€ํ•œ ํ•„์š”์„ฑ์„ ์ธ์‹ํ•˜๊ณ  ์ด๋ฅผ ์œ„ํ•œ ์ •์ฑ…์„ ์ˆ˜๋ฆฝํ•˜๊ณ  ์ฒด๊ณ„๋ฅผ ๋ณด์™„ํ•˜๋Š” ๊ฒƒ์ด ์‹œ๊ธ‰ํ•˜๋‹ค. ๊ฐ•๋ฆ‰๊ธฐ์ง€์—์„œ ์ ์šฉ๋œ ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์€ ๊ณต๊ตฐ์—์„œ ์ฒ˜์Œ์œผ๋กœ ์‹œ๋„๋œ ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์ง€์› ํ”„๋กœ๊ทธ๋žจ์œผ๋กœ, ๋ณธ ์—ฐ๊ตฌ์—์„œ ํ•ด๋‹น ์‹ฌ๋ฆฌ์ง€์› ํ”„๋กœ๊ทธ๋žจ์— ๋Œ€ํ•ด ๋ถ„์„ํ•จ์œผ๋กœ์จ ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์ง€์›์˜ ํšจ๊ณผ์„ฑ์„ ๋ถ„์„ํ•œ ์ฒซ ์‹œ๋„์˜€๋‹ค๋Š” ์ ๊ณผ ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ ์‹œํ–‰๊ณผ์ •์—์„œ ๋‚˜ํƒ€๋‚œ ๋ฌธ์ œ์ ์„ ํŒŒ์•…ํ•˜๊ณ  ๋ฏธ ๊ณต๊ตฐ์˜ ๋ฐœ๋‹ฌ๋œ ์‹ฌ๋ฆฌ์ง€์› ์ฒด๊ณ„์— ๋Œ€ํ•œ ๋ถ„์„ ๋“ฑ์„ ํ†ตํ•ด ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์ง€์› ์ฒด๊ณ„์˜ ๋ฐœ์ „ ๋ฐฉํ–ฅ์„ ์ œ์‹œํ–ˆ๋‹ค๋Š” ๋ฐ์— ์˜์˜๊ฐ€ ์žˆ๋‹ค๊ณ  ๋ณธ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ๊ฐ•๋ฆ‰๊ธฐ์ง€ ์‚ฌ๊ณ  ์ดํ›„์—๋„ ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์ด ์„ธ ์ฐจ๋ก€ ์‹ค์‹œ๋˜์—ˆ์œผ๋‚˜ ๊ฐ•๋ฆ‰๊ธฐ์ง€ ์‚ฌ๋ก€์— ๋Œ€ํ•œ ๋‹จ์ผ ๋ถ„์„์„ ์‹ค์‹œํ•˜์—ฌ ํ†ตํ•ฉ์ ์ธ ๋ถ„์„์„ ์ œ์‹œํ•˜์ง€ ๋ชปํ–ˆ๋‹ค๋Š” ํ•œ๊ณ„๊ฐ€ ์žˆ๋‹ค. 2011๋…„ ์‹œํ–‰๋œ ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์€ ๋ฏผ๊ฐ„ ์ƒ๋‹ด์‚ฌ๊ฐ€ ํŒŒ๊ฒฌ๋˜์ง€ ์•Š๋Š” ๋“ฑ ํ”„๋กœ๊ทธ๋žจ์˜ ๋‚ด์šฉ์ด ๋”์šฑ ์ถ•์†Œ๋˜์–ด ์‹ฌ๋ฆฌ์•ˆ์ • ํ”„๋กœ๊ทธ๋žจ์˜ ํšจ๊ณผ๋‚˜ ์กฐ์ข…์‚ฌ๋“ค์˜ ์ธ์‹์ด ๋‹ฌ๋ž์„ ๊ฒƒ์ด๊ณ , ๊ฐ ์‚ฌ๊ณ ๋ณ„๋กœ ํŠน์„ฑ์ด ๋‹ค๋ฅด๊ธฐ ๋•Œ๋ฌธ์— ๊ฐ•๋ฆ‰๊ธฐ์ง€์—์„œ ๋“œ๋Ÿฌ๋‚˜์ง€ ์•Š์€ ๋ฌธ์ œ์ ๋“ค์ด ์กด์žฌํ•  ๊ฐ€๋Šฅ์„ฑ์ด ์žˆ์œผ๋‚˜ ์ด๋Ÿฐ ๊ฒƒ๋“ค์— ๋Œ€ํ•ด ์‚ดํŽด๋ณด์ง€ ๋ชปํ•˜์˜€๋‹ค. ๋˜ํ•œ ๋ฉด์ ‘๊ณผ์ •์—์„œ๋„ ์—ฌ๋Ÿฌ ์ฐจ๋ก€ ์–ธ๊ธ‰๋˜์—ˆ๋“ฏ์ด ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ๊ด€๋ฆฌ์— ์žˆ์–ด ์กฐ์ข…์‚ฌ์˜ ๊ฐ€์กฑ๋“ค์ด ์ฐจ์ง€ํ•˜๋Š” ๋น„์ค‘์ด ๋†’์Œ์—๋„ ๋ถˆ๊ตฌํ•˜๊ณ  ๋ฉด์ ‘๋Œ€์ƒ์— ๊ฐ€์กฑ๋“ค์„ ํฌํ•จ์‹œํ‚ค์ง€ ๋ชปํ•˜์˜€๋‹ค. ์ดํ›„์— ์ง„ํ–‰๋˜๋Š” ์—ฐ๊ตฌ์—์„œ๋Š” ๊ฐ€์กฑ๋“ค์— ๋Œ€ํ•œ ๋ถ„์„๋„ ํฌํ•จํ•˜์—ฌ ๋”์šฑ ๋„“์€ ๋ฒ”์œ„์—์„œ ํ†ต์ฐฐํ•  ์ˆ˜ ์žˆ๋„๋ก ํ•˜์—ฌ์•ผ ํ•  ๊ฒƒ์ด๋‹ค. ๋งˆ์ง€๋ง‰์œผ๋กœ ํšจ๊ณผ๋ถ„์„์— ์žˆ์–ด์„œ ์ธํ„ฐ๋ทฐ ์œ„์ฃผ์˜ ๋ถ„์„์„ ์‹ค์‹œํ•จ์œผ๋กœ์จ ๊ฐ๊ด€์ ์ธ ํ‰๊ฐ€๊ฐ€ ๋ถ€์กฑํ–ˆ์„ ๊ฐ€๋Šฅ์„ฑ์ด ์žˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ํ”„๋กœ๊ทธ๋žจ์˜ ๋ฌธ์ œ์ ์ด๋‚˜ ๋ณด์™„๋ฐฉ์•ˆ์— ๋Œ€ํ•œ ์‹ฌ์ธต์ ์ธ ํŒŒ์•…์„ ์œ„ํ•ด์„œ๋Š” ๋ฉด์ ‘์ด ๊ฐ€์žฅ ํšจ๊ณผ์ ์ธ ๋ฐฉ๋ฒ•์œผ๋กœ ํŒ๋‹จ๋˜์—ˆ๊ณ , ์‹ฌ๋ฆฌ์ง€์›์ œ๋„์˜ ํŠน์„ฑ์ƒ ๊ฐ๊ด€์  ์ž๋ฃŒ์˜ ์ˆ˜์ง‘์ด ๋ถˆ๊ฐ€๋Šฅํ–ˆ๋‹ค๋Š” ์ ์—์„œ ์ตœ์„ ์˜ ์„ ํƒ์ด์—ˆ๋˜ ๊ฒƒ์œผ๋กœ ์ƒ๊ฐ๋œ๋‹ค.์ œ1์žฅ ์„œ ๋ก  1 ์ œ1์ ˆ ์—ฐ๊ตฌ์˜ ๋ชฉ์ ๊ณผ ํ•„์š”์„ฑ 1 ์ œ2์ ˆ ์—ฐ๊ตฌ์˜ ๋Œ€์ƒ๊ณผ ๋ฐฉ๋ฒ• 4 1. ์—ฐ๊ตฌ์˜ ๋Œ€์ƒ 4 2. ์—ฐ๊ตฌ์˜ ๋ฐฉ๋ฒ• 5 ์ œ2์žฅ ์ด๋ก ์  ๋…ผ์˜์™€ ์„ ํ–‰์—ฐ๊ตฌ ๊ฒ€ํ†  6 ์ œ1์ ˆ ์™ธ์ƒ๊ณผ ์™ธ์ƒ ํ›„ ์ŠคํŠธ๋ ˆ์Šค ์žฅ์•  6 ์ œ2์ ˆ ์กฐ์งํ›„์›์ธ์‹ 9 ์ œ3์ ˆ ์ง๋ฌดํƒœ๋„ 11 ์ œ4์ ˆ ์„ ํ–‰์—ฐ๊ตฌ ๊ฒ€ํ†  11 1. PTSD์— ๊ด€ํ•œ ์„ ํ–‰์—ฐ๊ตฌ ๊ฒ€ํ†  11 1) ์™ธ์ƒ์„ฑ ์‚ฌ๊ฑด์ด PTSD์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ 11 2) ์™ธ์ƒ์„ฑ ์‚ฌ๊ฑด์— ๋Œ€ํ•œ ์ธ์‹์— ๊ด€ํ•œ ์—ฐ๊ตฌ 12 3) PTSD๊ฐ€ ์ง๋ฌดํƒœ๋„์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ 12 2. ์‹ฌ๋ฆฌ์ง€์› ์ œ๋„์— ๊ด€ํ•œ ์„ ํ–‰์—ฐ๊ตฌ ๊ฒ€ํ†  13 3. ์‚ฌํšŒ์ ์ง€์ง€, PTSD, ๊ทธ๋ฆฌ๊ณ  ์ง๋ฌดํƒœ๋„ 15 4. ์กฐ์งํ›„์›์ธ์‹๊ณผ ์ง๋ฌดํƒœ๋„ 17 ์ œ3์žฅ ์—ฐ๊ตฌ๋ฐฉ๋ฒ•๋ก  20 ์ œ1์ ˆ ์—ฐ๊ตฌ์˜ ๊ฐ€์„ค๊ณผ ๋ถ„์„ํ‹€ 20 ์ œ2์ ˆ ๋ณ€์ˆ˜์˜ ์ธก์ • 22 1. ์‹ฌ๋ฆฌ์  ์•ˆ์ •(PTSD ๊ฐ์†Œ) 22 2. ์ง๋ฌดํƒœ๋„(์ง๋ฌด๋งŒ์กฑ๊ณผ ์กฐ์ง๋ชฐ์ž…) 23 3. ์กฐ์งํ›„์›์ธ์‹ 23 ์ œ3์ ˆ ์‚ฌ๋ก€์—ฐ๊ตฌ 24 ์ œ4์ ˆ ๋ฉด์ ‘์กฐ์‚ฌ 26 ์ œ5์ ˆ ๋น„๊ต์‚ฌ๋ก€์—ฐ๊ตฌ 27 ์ œ4์žฅ ์—ฐ๊ตฌ์˜ ๊ฒฐ๊ณผ 28 ์ œ1์ ˆ ๊ฐ•๋ฆ‰๊ธฐ์ง€ ์‚ฌ๋ก€์˜ ๊ฐœ๊ด€ 28 1. ๊ฐ•๋ฆ‰๊ธฐ์ง€ ์†Œ๊ฐœ 28 2. 2010๋…„ ๊ฐ•๋ฆ‰๊ธฐ์ง€ ์‚ฌ๊ณ  ๋ฐœ์ƒ ๊ฒฝ๊ณผ 28 3. ๊ฐ•๋ฆ‰๊ธฐ์ง€ ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์•ˆ์ •ํ”„๋กœ๊ทธ๋žจ์˜ ๋„์ž… ๋ฐ ์‹œํ–‰ 30 4. ๋น„ํ–‰์‚ฌ๊ณ  ํ›„ ์‹ฌ๋ฆฌ์•ˆ์ •ํ”„๋กœ๊ทธ๋žจ ์‹œํ–‰ ์ ˆ์ฐจ ์ˆ˜๋ฆฝ 31 ์ œ2์ ˆ ๋ฉด์ ‘๊ฒฐ๊ณผ ๋ถ„์„ 34 1. ์‚ฌ๊ณ  ๋ฐœ์ƒ ํ›„ ๊ฐœ์ธ์˜ ๊ฐ์ • ๋ฐ ์ง‘๋‹จ ์ƒํƒœ 36 2. ์‹ฌ๋ฆฌ์ง€์›์ œ๋„์™€ ์กฐ์งํ›„์›์ธ์‹ 37 3. ์‹ฌ๋ฆฌ์ง€์›์ œ๋„์™€ PTSD 39 4. ์‹ฌ๋ฆฌ์ง€์›์ œ๋„์™€ ์ง๋ฌดํƒœ๋„ 42 5. ๊ฐ•๋ฆ‰๊ธฐ์ง€ ์‹ฌ๋ฆฌ์•ˆ์ •ํ”„๋กœ๊ทธ๋žจ์—์„œ ๋„์ถœ๋œ ๋ฌธ์ œ์  44 1) ๊ณ ์œ„ํ—˜๊ตฐ ๊ด€๋ฆฌ 44 2) ์ธ์‹์˜ ๋ฌธ์ œ 46 3) ์ฃผ๊ด€๋ถ€์„œ ๋ฐ ํ†ตํ•ฉ์ฒด๊ณ„์˜ ๋ถ€์žฌ 48 4) ํ”„๋กœ๊ทธ๋žจ ๋‚ด์šฉ ๋ฐ ๊ด€๋ จ ์˜ˆ์‚ฐ, ์‹œ๊ฐ„ ๋“ฑ ์ž์›์˜ ๋ถ€์กฑ 48 5) ์‚ฌ๊ณ  ์ง€์›์š”์› ๊ด€๋ฆฌ 50 ์ œ3์ ˆ ๋น„๊ต์‚ฌ๋ก€ ๋ถ„์„ 52 1. ๋ฏธ๊ตฐ์˜ ์‹ฌ๋ฆฌ์ง€์›์ฒด๊ณ„ 52 1) ๋ฏธ ๊ณต๊ตฐ์˜ ์‹ฌ๋ฆฌ์ง€์›์ฒด๊ณ„ 54 2) ๋ฏธ ๋ณดํ›ˆ๋ถ€ ๋ฐ ๊ตญ๋ฐฉ๋ถ€์˜ ์™ธ์ƒ ํ›„ ์ŠคํŠธ๋ ˆ์Šค ์น˜๋ฃŒ ๊ฐ€์ด๋“œ๋ผ์ธ 58 2. ์†Œ๋ฐฉ๋ฐฉ์žฌ์ฒญ ์žฌ๋‚œ์‹ฌ๋ฆฌ์ง€์›์ฒด๊ณ„ 66 1) ์žฌ๋‚œ์‹ฌ๋ฆฌ์ง€์› ์ถ”์ง„์ฒด๊ณ„ 68 2) ์žฌ๋‚œ ๋‹จ๊ณ„๋ณ„ ๊ธฐ๊ด€๋ณ„ ์กฐ์น˜์‚ฌํ•ญ 69 ์ œ4์ ˆ ๊ณต๊ตฐ ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์ง€์›์ œ๋„์˜ ๋ณด์™„ ๋ฐ ๋ฐœ์ „๋ฐฉํ–ฅ 72 1. ์‹ฌ๋ฆฌ์ง€์›์ฒด๊ณ„ ์ˆ˜๋ฆฝ 72 1) ์กฐ์ง, ์ฒด๊ณ„, ์ œ๋„ ์ •๋น„ 72 2) ์‹ฌ๋ฆฌ์ง€์› ํ”„๋กœ๊ทธ๋žจ ๋ณด์™„: ๊ณ ์œ„ํ—˜๊ตฐ ๊ด€๋ฆฌ์™€ ํ”„๋กœ๊ทธ๋žจ์˜ ๋‚ด์‹คํ™” 76 3) ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์ง€์› ๋งค๋‰ด์–ผ ์ž‘์„ฑ 78 4) ํ”„๋กœ๊ทธ๋žจ ์‹ค๋ฌด์ž์˜ ๊ถŒํ•œ ์„ค์ • 78 2. ์‹ฌ๋ฆฌ์ง€์› ์ธ๋ ฅ ๊ด€๋ฆฌ 79 3. ์™ธ์ƒ ํ›„ ์ŠคํŠธ๋ ˆ์Šค๋ฅผ ๋น„๋กฏํ•œ ์‹ฌ๋ฆฌ์ง€์›์— ๊ด€ํ•œ ๊ต์œก 80 1) ์ธ์‹์˜ ์ „ํ™˜์„ ์œ„ํ•œ ๊ต์œก 80 2) ์‹ฌ๋ฆฌ์ง€์› ๋ฐ ์ƒ๋‹ด์— ๋Œ€ํ•œ ํ™๋ณด 81 3) ์‹ฌ๋ฆฌ์ง€์› ์‹ค๋ฌด์ž ๊ต์œก 81 4. ๋„คํŠธ์›Œํฌ ๊ตฌ์ถ• 82 1) ๋ฏผ๊ฐ„ ๊ธฐ๊ด€๊ณผ์˜ ์—ฐ๊ณ„ ๋ฐ ๊ต๋ฅ˜ 82 2) ์ƒ๋‹ด ์ง€์› ๊ฐ€๋Šฅํ•œ ์กฐ์ง๊ณผ์˜ ์—ฐ๊ณ„ 83 ์ œ5์žฅ ๊ฒฐ ๋ก  85 ์ œ1์ ˆ ์—ฐ๊ตฌ์˜ ์š”์•ฝ 85 ์ œ2์ ˆ ์—ฐ๊ตฌ์˜ ์ •์ฑ…์  ํ•จ์˜ 87 ์ œ3์ ˆ ์—ฐ๊ตฌ์˜ ์˜์˜ ๋ฐ ํ•œ๊ณ„ 89 ใ€ํ‘œ ๋ชฉ ์ฐจใ€‘ ์กฐ์ง๋ชฐ์ž…์˜ ์ •์˜ 12 ๋ฉด์ ‘๋Œ€์ƒ์ž ๋ฐ ๋ฉด์ ‘๋ฐฉ๋ฒ•, ์ผ์‹œ 27 ๊ณต๊ตฐ ์กฐ์ข…์‚ฌ ์‹ฌ๋ฆฌ์•ˆ์ •ํ”„๋กœ๊ทธ๋žจ ๋ชจ์‹๋„ 34 ๊ฐ•๋ฆ‰๊ธฐ์ง€ ์‚ฌ๊ณ  ๊ด€๋ จ, ์‚ฌ๊ฑด ๋ฐœ์ƒ ๋ฐ ์‹ฌ๋ฆฌ์•ˆ์ •ํ”„๋กœ๊ทธ๋žจ ์ง„ํ–‰ ๊ฐœ์š” 35 ์†Œ๋ฐฉ๋ฐฉ์žฌ์ฒญ ์žฌ๋‚œ์‹ฌ๋ฆฌ์ง€์› ์ถ”์ง„์ฒด๊ณ„ 70 ๊ณต๊ตฐ ์‹ฌ๋ฆฌ์ƒ๋‹ด ํ†ตํ•ฉ ์ง€์›์ฒด๊ณ„ 74 ๊ณต๊ตฐ ํ†ตํ•ฉ์ƒ๋‹ด์ง€์›์„ผํ„ฐ ๊ธฐ๋Šฅ ๋ฐ ์กฐ์ง ์‹ ์„ค ์•ˆ 75 ์ •์‹ ๊ณผ ๊ตฐ์˜๊ด€ ํ˜„ํ™ฉ 76 ใ€๊ทธ ๋ฆผ ๋ชฉ ์ฐจใ€‘ ์ŠคํŠธ๋ ˆ์Šค ๋ฐ˜์‘์˜ ๊ฒฝ๋กœ 16 ์—ฐ๊ตฌ์˜ ๋ถ„์„ํ‹€ 21 ์ฆ์ƒ์˜ ์‹œ๊ธฐ์— ๋”ฐ๋ฅธ ์™ธ์ƒ์ŠคํŠธ๋ ˆ์Šค์˜ ๋ถ„๋ฅ˜ ๋ฐ CPG Module ์ ์šฉ์‹œ๊ธฐ 60 CPG์˜ Core Algorithm 61 CPG์˜ Algorithm A 62 CPG์˜ Algorithm B-1 64 CPG์˜ Algorithm B-2 65Maste

    Analysis of Lyrics on Songs about the Environment in Korean Music Curriculum

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ) -- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ์‚ฌ๋ฒ”๋Œ€ํ•™ ํ˜‘๋™๊ณผ์ • ํ™˜๊ฒฝ๊ต์œก์ „๊ณต, 2021. 2. ์ด์€์ฃผ.In the current Music Curriculum for elementary and secondary schools in Korea, Environmental education is being conducted through singing songs about the environment. While other subjects, such as social studies and science, aim for doing various activities related to the Environmental education, such as learning about the environment and recognizing problems, information exploring, and problem solving, Environmental education in the music curriculum unilaterally conveys environmental texts created by lyricists to audience without any interaction activities. In this regard, this study applied qualitative content analysis methods to analyze lyrics of songs about the environment, which is a form of messages in environmental communication. Analysis is based on two criteria. One is the theme of song and another is writing style of the song. Analyzing theme is to find out what content the message has and analyzing writing style is to find out how the message is being processed. Considering that the dictionary definition of the word โ€˜Environmentโ€™; natural conditions or social situations that directly/ indirectly affect oneโ€™s life, the definition of Songs about the Environment in this study was limited to songs that contain the content about relationship between nature and humans or given challenging situations that might cause issues related to the environment. Based on this definition, the subjects of this study were selected as a total of 11 environmental songs that were included at least more than once during the period 2001-2020 in Korean music curriculum. Prior to the analysis, a frame was developed for analyzing one environmental song based on the specific criteria of this study. Developed frame can be use to analyze the lyrics of song about the environment on two criteria. One criteria includes nine themes such as Environmental Perspective and Environmental Ethics, Composition of Environment, Environmental Issues, Human Activity and Environment, Sustainable Development, Exploration of Environmental Phenomena, Environmental Sensitivity and Consideration, Environmental Problem Solving, and Environmental Conservation Practice. Another criteria includes four writing styles such as a Declarative sentence, Interrogative sentence, Imperative sentence and Request sentence. As a result of the analysis on the theme, a total of 11 environmental songs were presented by three themes on average. The most frequently presented theme was Environmental Conservation Practices, followed by Composition of Environment. Environmental Perspective and Environmental Ethics, Environmental Issues, Environmental Sensitivity and Consideration themes were presented at the same frequency being followed next. And then followed by Human Activity and Environment, Environmental Problem Solving themes in order. Themes of Sustainable Development and Exploration of environmental phenomena were not analyzed on any songs. As a result of analysis on the writing style standard, it was found that each song has one or two writing styles. In the case of environmental songs analyzed in two writing styles, only one main writing style of the sentence was brought into the statistics. The most frequently analyzed writing style was Request sentence, which is found in a total of six songs, followed three Declarative sentence, two Interrogative sentence, and zero Imperative sentence. Environmental songs presenting Environmental Issues and Environmental Conservation Practices were mainly analyzed using Request sentence style, which shows that the messages are processed to make audience not only recognize environmental problems but also do something to solve the problem. Themes of Environmental Perspective and Environmental Ethics, Composition of Environment were mainly analyzed in Declarative sentence style, which shows that the messages are processed to make audience recognize or understand on those contents. The reason why there was no environmental song analyzed under themes of Sustainable Development and Exploration of Environmental Phenomena can be found in the complexity of the theme. And the reason why there was no environmental song analyzed by the Imperative sentence style is to avoid oppressive expression that can be over stimulate the audiences who are students. Although it has been more than 20 years since the song about the Environment began to be included in the music textbooks, environmental education in korean music curriculum is rarely being conducted, given that only a total of 11 environmental songs included among 20 years. However, nine songs out of 11 songs are included in the middle school-level textbook, so the possibility of environmental education in the middle school level is highly anticipated in the future strategy of strengthening environmental education. Since most of the environmental songs analyzed in this study were made from some old poems, it is also necessary to check whether songs about the Environment are included in other subject, such as language and Literature, liberal arts. For environmental communication research, text analysis is essential for analyzing message effects. However, it is also necessary to study whether the theoretically analyzed factors actually apply to the audience. Therefore, research should be conducted on the perspective of the audience so that can check the theoretically analyzed factors actually apply to them or not.ํ˜„ํ–‰ ํ•œ๊ตญ ์ดˆโ€ง์ค‘๋“ฑ ์Œ์•…๊ต์œก๊ณผ์ •์—์„œ ํ™˜๊ฒฝ๊ต์œก์€ ํ™˜๊ฒฝ์„ ์ฃผ์ œ๋กœ ํ•œ ๋…ธ๋ž˜ ๋ถ€๋ฅด๊ธฐ๋ฅผ ํ†ตํ•ด ์ด๋ฃจ์–ด์ง€๊ณ  ์žˆ๋‹ค. ์‚ฌํšŒ๊ณผ, ๊ณผํ•™๊ณผ ๋“ฑ์˜ ํƒ€ ๊ต๊ณผ์—์„œ๋Š” ํ™˜๊ฒฝ์— ๋Œ€ํ•œ ํ•™์Šต๊ณผ ๋ฌธ์ œ์ธ์‹, ์ •๋ณดํƒ์ƒ‰, ๋ฌธ์ œํ•ด๊ฒฐ ๋“ฑ ํ™˜๊ฒฝ๊ต์œก๊ณผ ๊ด€๋ จ๋œ ๋‹ค์–‘ํ•œ ํ™œ๋™์„ ํ†ตํ•ด ํ™˜๊ฒฝ ๋ฐ ํ™˜๊ฒฝ๋ฌธ์ œ์— ๋Œ€ํ•œ ์˜์‚ฌ์†Œํ†ต์„ ๊ฐ€๋Šฅํ•˜๊ฒŒ ํ•˜๋Š” ๋ฐ˜๋ฉด, ์Œ์•…๊ณผ์—์„œ์˜ ํ™˜๊ฒฝ๊ต์œก์€ ์ž‘์‚ฌ๊ฐ€์— ์˜ํ•ด ๋งŒ๋“ค์–ด์ง„ ํ™˜๊ฒฝํ…์ŠคํŠธ๋ฅผ ์ˆ˜์šฉ์ž์—๊ฒŒ ์ผ๋ฐฉ์ ์œผ๋กœ ์ „๋‹ฌํ•œ๋‹ค. ๋ณธ ์—ฐ๊ตฌ๋Š” ์ด๋Ÿฌํ•œ ์ ์— ์ฃผ๋ชฉํ•˜์—ฌ ํ™˜๊ฒฝ๋…ธ๋ž˜๋ฅผ ํ™˜๊ฒฝ์ปค๋ฎค๋‹ˆ์ผ€์ด์…˜์—์„œ ์‚ฌ์šฉ๋˜๋Š” ํ™˜๊ฒฝํ…์ŠคํŠธ, ์ฆ‰ ํ™˜๊ฒฝ๋ฉ”์‹œ์ง€์˜ ํ•œ ํ˜•ํƒœ๋กœ ๋ณด๊ณ  ํ™˜๊ฒฝ๋…ธ๋ž˜๊ฐ€ ์–ด๋– ํ•œ ์ฃผ์ œ๋ฅผ, ์–ด๋– ํ•œ ์ฒ˜๋ฆฌ ๋ฐฉ์‹์„ ํ†ตํ•ด ์ˆ˜์šฉ์ž์—๊ฒŒ ์ „๋‹ฌํ•˜๊ณ  ์žˆ๋Š”์ง€์— ๋Œ€ํ•ด ์‚ดํŽด๋ณด๊ณ ์ž ์งˆ์  ๋‚ด์šฉ ๋ถ„์„ ๋ฐฉ๋ฒ•์„ ์ ์šฉํ•˜์˜€๋‹ค. ํ™˜๊ฒฝ๋…ธ๋ž˜์˜ ์ •์˜๋Š” ํ™˜๊ฒฝ์ด๋ผ๋Š” ๋‹จ์–ด์˜ ์‚ฌ์ „์  ์ •์˜๊ฐ€ โ€˜์ƒ๋ฌผ์—๊ฒŒ ์ง์ ‘ยท๊ฐ„์ ‘์ ์œผ๋กœ ์˜ํ–ฅ์„ ์ฃผ๋Š” ์ž์—ฐ์  ์กฐ๊ฑด์ด๋‚˜ ์‚ฌํšŒ์  ์ƒํ™ฉโ€™์ž„์„ ๊ณ ๋ คํ•˜์—ฌ ์ž์—ฐ๊ณผ ์ธ๊ฐ„์˜ ๊ด€๊ณ„์— ๋Œ€ํ•œ ๋‚ด์šฉ์„ ๋‹ด๊ณ  ์žˆ๊ฑฐ๋‚˜ ํ™˜๊ฒฝ๊ณผ ๊ด€๋ จํ•˜์—ฌ ์Ÿ์ ์ด ์•ผ๊ธฐ๋ ๋งŒํ•œ ๋ฌธ์ œ์  ํ˜น์€ ๋„์ „์  ์ƒํ™ฉ์ด ์ฃผ์–ด์ง„ ๋…ธ๋ž˜๋กœ ํ•œ์ •ํ•˜์˜€๋‹ค. ์ด๋Ÿฌํ•œ ์ •์˜์— ์ž…๊ฐํ•˜์—ฌ ๋ณธ ์—ฐ๊ตฌ์˜ ์—ฐ๊ตฌ๋Œ€์ƒ์„ 2001๋…„๋ถ€ํ„ฐ 2020๋…„๊นŒ์ง€์˜ ๊ธฐ๊ฐ„ ๋™์•ˆ ์Œ์•…๊ณผ ๊ต์œก๊ณผ์ •์— 1ํšŒ ์ด์ƒ ์ˆ˜๋ก๋œ ํ™˜๊ฒฝ๋…ธ๋ž˜ ์ด 11๊ณก์œผ๋กœ ์„ ์ •ํ•˜์˜€๋‹ค. ๋ถ„์„์„ ์ง„ํ–‰ํ•˜๊ธฐ์— ์•ž์„œ ํ™˜๊ฒฝ๋ฉ”์‹œ์ง€์ธ ํ™˜๊ฒฝ๋…ธ๋ž˜์˜ ๋‚ด์šฉ๊ณผ ์ฒ˜๋ฆฌ ๋ฐฉ๋ฒ•์„ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•ด ์„ ํ–‰์—ฐ๊ตฌ๋ฅผ ๋ฐ”ํƒ•์œผ๋กœ ๊ฐ๊ฐ ์ฃผ์ œ(theme), ๋ฌธ์ฒด(style) ์ˆ˜์ค€์—์„œ ๋ถ„์„ํ•  ์ˆ˜ ์žˆ๋Š” ๊ธฐ์ค€์„ ์ •ํ•˜๊ณ , ์ •ํ•ด์ง„ ๊ธฐ์ค€์„ ํ† ๋Œ€๋กœ ํ™˜๊ฒฝ๋…ธ๋ž˜ 1๊ณก์„ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•œ ํ‹€์„ ๊ฐœ๋ฐœํ•˜์˜€๋‹ค. ๋ฉ”์‹œ์ง€ ๋‚ด์šฉ๊ณผ ๊ด€๋ จํ•œ ์ฃผ์ œ ๊ธฐ์ค€์œผ๋กœ๋Š” ํ™˜๊ฒฝ๊ด€๊ณผ ํ™˜๊ฒฝ์œค๋ฆฌ, ํ™˜๊ฒฝ์˜ ๊ตฌ์„ฑ, ํ™˜๊ฒฝ๋ฌธ์ œ, ์ธ๊ฐ„ ํ™œ๋™๊ณผ ํ™˜๊ฒฝ, ์ง€์†๊ฐ€๋Šฅ๋ฐœ์ „, ํ™˜๊ฒฝ ํ˜„์ƒ์˜ ํƒ๊ตฌ, ํ™˜๊ฒฝ๊ฐ์ˆ˜์„ฑ๊ณผ ๋ฐฐ๋ ค, ํ™˜๊ฒฝ๋ฌธ์ œํ•ด๊ฒฐ, ํ™˜๊ฒฝ๋ณด์ „์‹ค์ฒœ์˜ 9๊ฐ€์ง€๋ฅผ ์ œ์‹œํ•˜์˜€์œผ๋ฉฐ, ๋ฉ”์‹œ์ง€ ์ฒ˜๋ฆฌ๋ฐฉ๋ฒ•๊ณผ ๊ด€๋ จํ•˜์—ฌ ๋ฌธ์ฒด ๊ธฐ์ค€์œผ๋กœ๋Š” ์„œ์ˆ ๋ฒ•, ์˜๋ฌธ๋ฒ•, ๋ช…๋ น๋ฒ•, ์ฒญ์œ ๋ฒ•์˜ 4๊ฐ€์ง€ ๊ธฐ์ค€์„ ์ œ์‹œํ•˜์˜€๋‹ค. ์ฃผ์ œ ๊ธฐ์ค€ ๋ถ„์„ ๊ฒฐ๊ณผ, ์ด 11๊ณก์˜ ๊ฐ ํ™˜๊ฒฝ๋…ธ๋ž˜๋Š” ํ‰๊ท ์ ์œผ๋กœ 3๊ฐ€์ง€์˜ ์ฃผ์ œ๋ฅผ ์ œ์‹œํ•˜๊ณ  ์žˆ์—ˆ๋‹ค. ๊ฐ€์žฅ ๋งŽ์€ ๋นˆ๋„๋กœ ์ œ์‹œ๋œ ์ฃผ์ œ๋Š” ํ™˜๊ฒฝ๋ณด์ „ ์‹ค์ฒœ์ด์—ˆ์œผ๋ฉฐ ๋‹ค์Œ์œผ๋กœ๋Š” ํ™˜๊ฒฝ์˜ ๊ตฌ์„ฑ ์ฃผ์ œ๊ฐ€ ๋งŽ์ด ์ œ์‹œ๋˜์—ˆ๋‹ค. ๋‹ค์Œ์œผ๋กœ๋Š” ํ™˜๊ฒฝ๊ด€๊ณผ ํ™˜๊ฒฝ์œค๋ฆฌ, ํ™˜๊ฒฝ๋ฌธ์ œ, ํ™˜๊ฒฝ๊ฐ์ˆ˜์„ฑ๊ณผ ๋ฐฐ๋ ค ์ฃผ์ œ๊ฐ€ ๋™์ผํ•œ ๋นˆ๋„๋กœ ์ œ์‹œ๋˜์—ˆ์œผ๋ฉฐ ๋‹ค์Œ์œผ๋กœ๋Š” ์ธ๊ฐ„ ํ™œ๋™๊ณผ ํ™˜๊ฒฝ์ด, ๊ทธ๋ฆฌ๊ณ  ํ™˜๊ฒฝ๋ฌธ์ œ ํ•ด๊ฒฐ์ด ๊ฐ€์žฅ ์ ์€ ๋นˆ๋„๋กœ ๋ถ„์„๋˜์—ˆ๋‹ค. ๋˜ํ•œ ์ง€์†๊ฐ€๋Šฅ๋ฐœ์ „๊ณผ ํ™˜๊ฒฝํ˜„์ƒ์˜ ํƒ๊ตฌ ์ฃผ์ œ๋Š” ๋ถ„์„๋˜์ง€ ์•Š์•˜๋‹ค. ๋ฌธ์ฒด ๊ธฐ์ค€ ๋ถ„์„๊ฒฐ๊ณผ, ์ด 11๊ณก์˜ ๊ฐ ํ™˜๊ฒฝ๋…ธ๋ž˜๋Š” ์ตœ์†Œ 1๊ฐ€์ง€์—์„œ 2๊ฐ€์ง€์˜ ๋ฌธ์ฒด๋กœ ๋ถ„์„๋˜์—ˆ๋‹ค. 2๊ฐ€์ง€ ๋ฌธ์ฒด๋กœ ๋ถ„์„๋œ ํ™˜๊ฒฝ๋…ธ๋ž˜์˜ ๊ฒฝ์šฐ์—๋Š” ๋Œ€๋ถ€๋ถ„ ํ˜„์ƒ์„œ์ˆ  ํ›„ ์ด๋ฅผ ๋ฐ”ํƒ•์œผ๋กœ ํŠน์ •ํ•œ ๋ฌธ์ฒด๋ฅผ ์‚ฌ์šฉํ•˜์—ฌ ์ฃผ์žฅ์„ ์ œ์‹œํ•˜๋Š” ํ˜•์‹์„ ๋„๊ณ  ์žˆ์—ˆ์œผ๋ฏ€๋กœ ์ฃผ์žฅ์„ ๋‚˜ํƒ€๋‚ด๋Š” ๋ฌธ์žฅ์˜ ๋ฌธ์ฒด 1๊ฐ€์ง€๋งŒ์„ ํ†ต๊ณ„์— ๋ฐ˜์ž…ํ•˜์˜€๋‹ค. ๊ฐ€์žฅ ๋งŽ์ด ๋ถ„์„๋œ ๋ฌธ์ฒด๋ฒ•์€ ์ฒญ์œ ๋ฒ•์œผ๋กœ ์ด 6๊ฐœ์˜ ๊ณก์œผ๋กœ ๋ถ„์„๋˜์—ˆ์œผ๋ฉฐ, ์„œ์ˆ ๋ฒ•์€ 3๊ณก, ์˜๋ฌธ๋ฒ•์€ 2๊ณก, ๋ช…๋ น๋ฒ•์œผ๋กœ ๋ถ„์„๋œ ๊ณก์€ ์—†์—ˆ๋‹ค. ํ™˜๊ฒฝ๋ฌธ์ œ ๋ฐ ํ™˜๊ฒฝ๋ณด์ „์‹ค์ฒœ ์ฃผ์ œ๋ฅผ ์ œ์‹œํ•˜๋Š” ํ™˜๊ฒฝ๋…ธ๋ž˜๋Š” ์ฃผ๋กœ ์ฒญ์œ ํ˜•์œผ๋กœ ๋ถ„์„๋˜์—ˆ๋Š”๋ฐ, ์ด๋Š” ํ™˜๊ฒฝ๋…ธ๋ž˜๊ฐ€ ํ™˜๊ฒฝ๋ฌธ์ œ์˜ ์ธ์‹๊ณผ ๋”๋ถˆ์–ด ๋ฌธ์ฒดํ•ด๊ฒฐ ์‹ค์ฒœ๊นŒ์ง€ ๋ชฉํ‘œ๋กœ ํ•˜๋Š” ๋ฉ”์‹œ์ง€์ž„์„ ๋‚˜ํƒ€๋‚ธ๋‹ค. ๊ทธ๋ฆฌ๊ณ  ํ™˜๊ฒฝ๊ด€๊ณผ ํ™˜๊ฒฝ์œค๋ฆฌ ๋ฐ ํ™˜๊ฒฝ์˜ ๊ตฌ์„ฑ์— ๊ด€ํ•œ ์ฃผ์ œ๋Š” ์ฃผ๋กœ ์„œ์ˆ ํ˜•์œผ๋กœ ๋ถ„์„๋˜์—ˆ๋Š”๋ฐ, ์ด๋Š” ํ™˜๊ฒฝ๋…ธ๋ž˜๊ฐ€ ํ™˜๊ฒฝ๊ด€ ๋ฐ ํ™˜๊ฒฝ์œค๋ฆฌ์— ๋Œ€ํ•œ ์ธ์‹์ด๋‚˜ ์ดํ•ด๋ฅผ ๋ชฉํ‘œ๋กœ ํ•˜๋Š” ๋ฉ”์‹œ์ง€์ž„์„ ๋‚˜ํƒ€๋‚ธ๋‹ค. ์ง€์†๊ฐ€๋Šฅ๋ฐœ์ „ ๋ฐ ํ™˜๊ฒฝํ˜„์ƒ์˜ ํƒ๊ตฌ ์ฃผ์ œ๋กœ ๋ถ„์„๋œ ํ™˜๊ฒฝ๋…ธ๋ž˜๊ฐ€ ์—†์—ˆ๋˜ ์ด์œ ๋Š” ์ฃผ์ œ์˜ ๋ณต์žก์„ฑ์—์„œ ์ฐพ์„ ์ˆ˜ ์žˆ์œผ๋ฉฐ, ๋ช…๋ น๋ฒ•์œผ๋กœ ๋ถ„์„๋œ ํ™˜๊ฒฝ๋…ธ๋ž˜๊ฐ€ ์—†์—ˆ๋˜ ์ด์œ ๋Š” ๊ฐ•์••์ ์ด๊ณ  ์ผ๋ฐฉ์ ์ธ ๋ฌธ์ฒด๋ฒ•๋ณด๋‹ค ์ฒญ์œ ๋ฒ•์„ ์‚ฌ์šฉํ•จ์œผ๋กœ์จ ๋ณด๋‹ค ์ž๋ฐœ์ ์ธ ์ฐธ์—ฌ๋ฅผ ์œ ๋„ํ•˜๊ธฐ ์œ„ํ•จ์œผ๋กœ ํ•ด์„๋œ๋‹ค. ํ™˜๊ฒฝ๋…ธ๋ž˜๊ฐ€ ๊ต๊ณผ์šฉ ๋„์„œ์— ์ˆ˜๋ก๋˜๊ธฐ ์‹œ์ž‘ํ•œ์ง€ 20์—ฌ๋…„์ด ์ง€๋‚ฌ์Œ์—๋„ ๋ถˆ๊ตฌํ•˜๊ณ  ๊ทธ๋™์•ˆ ์ˆ˜๋ก๋œ ํ™˜๊ฒฝ๋…ธ๋ž˜๊ฐ€ 11๊ณก์— ์ง€๋‚˜์ง€ ์•Š๋Š”๋‹ค๋Š” ์ ์—์„œ ์Œ์•…๊ณผ์—์„œ ํ™˜๊ฒฝ๊ต์œก์€ ๊ฑฐ์˜ ์ด๋ฃจ์–ด์ง€์ง€ ์•Š๊ณ  ์žˆ๋‹ค๊ณ  ๋ณผ ์ˆ˜ ์žˆ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ 11๊ฐœ ๊ณก ์ค‘ ์ค‘ํ•™๊ต๊ธ‰ ๊ต๊ณผ์šฉ ๋„์„œ์— 9๊ฐœ ๊ณก์ด ์ˆ˜๋ก ๋œ ๊ฒƒ์œผ๋กœ ๋ณด์•„ ์•ž์œผ๋กœ์˜ ํ™˜๊ฒฝ๊ต์œก ๊ฐ•ํ™”์ „๋žต์— ์žˆ์–ด ์ค‘ํ•™๊ต๊ธ‰์—์„œ์˜ ํ™˜๊ฒฝ๊ต์œก ๊ฐ€๋Šฅ์„ฑ์ด ๋งค์šฐ ๊ธฐ๋Œ€๋œ๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ ๋ถ„์„ํ•œ ํ™˜๊ฒฝ๋…ธ๋ž˜๊ฐ€ ๋Œ€๋ถ€๋ถ„ ์‹œ์—์„œ ๋…ธ๋ž˜๋กœ ๋งŒ๋“ค์–ด์ง„ ๋งŒํผ ์Œ์•…๊ณผ ์™ธ์˜ ์–ด๋ฌธ๊ณผ๋ชฉ, ๊ต์–‘๊ณผ๋ชฉ์—์„œ์˜ ํ™˜๊ฒฝ๋…ธ๋ž˜ ์ˆ˜๋ก์—ฌ๋ถ€๋„ ํ™•์ธํ•  ํ•„์š”๊ฐ€ ์žˆ๋‹ค. ๋˜ํ•œ ๋ณธ ์—ฐ๊ตฌ์—์„œ ๋ถ„์„ํ•œ ์ฃผ์ œ ๊ธฐ์ค€์€ ํ™˜๊ฒฝ๋ถ€์—์„œ ์ œ์‹œํ•œ ํ™˜๊ฒฝ๊ต์œก ๋‚ด์šฉ์ฒด๊ณ„๋กœ ํ˜„ํ–‰ ํ•™๊ต๊ต์œก๊ณผ์ •์— ์ ์šฉ๋˜๊ณ  ์žˆ์ง€๋Š” ์•Š๊ธฐ์— ์‹ค์ œ๋กœ ๊ตญ๊ฐ€ ์ˆ˜์ค€์˜ ํ™˜๊ฒฝ๊ต์œก ๊ธฐ์ค€์ด ์‹œํ–‰๋  ๋•Œ, ๊ทธ ๊ธฐ์ค€์„ ๋‹ค์‹œ ์‚ดํŽด ์ ์šฉํ•  ํ•„์š”๊ฐ€ ์žˆ๋‹ค. ํ™˜๊ฒฝ์ปค๋ฎค๋‹ˆ์ผ€์ด์…˜์— ์žˆ์–ด ํ…์ŠคํŠธ ๋ถ„์„ ์—ฐ๊ตฌ๋Š” ๋ฉ”์‹œ์ง€ ํšจ๊ณผ๋ฅผ ๋ถ„์„ํ•˜๊ธฐ ์œ„ํ•ด ํ•„์ˆ˜์ ์ด๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ์ด๋ก ์ ์œผ๋กœ ๋ถ„์„ํ•œ ์š”์†Œ๋“ค์ด ์‹ค์ œ๋กœ ์ˆ˜์šฉ์ž๋“ค์—๊ฒŒ๋„ ์ ์šฉ๋˜๋Š”์ง€ ๋˜ํ•œ ์ค‘์š”ํ•œ ์—ฐ๊ตฌ์ž„์ด ๋ถ„๋ช…ํ•˜๋‹ค. ๋”ฐ๋ผ์„œ ๋ณธ ์—ฐ๊ตฌ์—์„œ ํ™•์ธํ•œ ํ™˜๊ฒฝ๋…ธ๋ž˜์™€ ๋ฌธ์ฒด์˜ ๊ด€๊ณ„๊ฐ€ ์ˆ˜์šฉ์ž์˜ ์ž…์žฅ์—์„œ๋Š” ์–ด๋–ป๊ฒŒ ๋Š๊ปด์ง€๋Š”์ง€์— ๋Œ€ํ•œ ์—ฐ๊ตฌ๊ฐ€ ํ›„ํ–‰๋˜์–ด์•ผ ํ•  ๊ฒƒ์ด๋‹ค.์ œ 1 ์žฅ ์„œ๋ก  1 ์ œ 1 ์ ˆ ์—ฐ๊ตฌ์˜ ํ•„์š”์„ฑ๊ณผ ๋ฐ ๋ชฉ์  1 ์ œ 2 ์ ˆ ์—ฐ๊ตฌ๋ฌธ์ œ 5 ์ œ 3 ์ ˆ ์šฉ์–ด์˜ ๊ฐœ๋… ๋ฐ ์ •์˜ 5 ์ œ 2 ์žฅ ์ด๋ก ์  ๋ฐฐ๊ฒฝ 7 ์ œ 1 ์ ˆ ํ™˜๊ฒฝ์ปค๋ฎค๋‹ˆ์ผ€์ด์…˜ 7 1. ํ™˜๊ฒฝ์ปค๋ฎค๋‹ˆ์ผ€์ด์…˜์˜ ์ •์˜์™€ ํ•„์š”์„ฑ 7 2. ํ™˜๊ฒฝ์ปค๋ฎค๋‹ˆ์ผ€์ด์…˜ ์—ฐ๊ตฌ 9 3. ํ™˜๊ฒฝ ์ˆ˜์‚ฌํ•™๊ณผ ๋‹ด๋ก  11 4. ์„ค๋“ ๋ฉ”์‹œ์ง€ 13 ์ œ 2 ์ ˆ ์ˆ˜์‚ฌํ•™์  ๋ฌธ์ฒด ์—ฐ๊ตฌ 14 ์ œ 3 ์ ˆ ํ™˜๊ฒฝ๋…ธ๋ž˜์™€ ๋…ธ๋ž˜ ๊ฐ€์‚ฌ ์—ฐ๊ตฌ 18 ์ œ 4 ์ ˆ ๊ตญ๊ฐ€ ์ˆ˜์ค€ ํ™˜๊ฒฝ๊ต์œก ๊ธฐ์ค€ 20 ์ œ 3 ์žฅ ์—ฐ๊ตฌ ๋ฐฉ๋ฒ• 22 ์ œ 1 ์ ˆ ์—ฐ๊ตฌ ๋ฐฉ๋ฒ• ๋ฐ ์—ฐ๊ตฌ ๋Œ€์ƒ 22 1. ์—ฐ๊ตฌ ๋ฐฉ๋ฒ• 22 2. ์—ฐ๊ตฌ ๋Œ€์ƒ 24 ์ œ 2 ์ ˆ ๋ถ„์„ ๋‹จ์œ„์™€ ๋ถ„์„ ๊ธฐ์ค€์˜ ์„ค์ • 26 ์ œ 3 ์ ˆ ๋ถ„์„ํ‹€ ๊ฐœ๋ฐœ 31 1. ๋ถ„์„ํ‹€ ๊ฐœ๋ฐœ 31 2. ๋ถ„์„๊ธฐ์ค€์— ๋Œ€ํ•œ ํƒ€๋‹น๋„ 32 3. ๋ถ„์„์— ๋Œ€ํ•œ ์‹ ๋ขฐ๋„ 34 ์ œ 4 ์žฅ ์—ฐ๊ตฌ ๊ฒฐ๊ณผ ๋ฐ ๋…ผ์˜ 35 ์ œ 1 ์ ˆ ํ™˜๊ฒฝ๋…ธ๋ž˜ ๊ฐ€์‚ฌ์˜ ์ฃผ์ œ ๋ถ„์„ 35 ์ œ 2 ์ ˆ ํ™˜๊ฒฝ๋…ธ๋ž˜ ๊ฐ€์‚ฌ์˜ ๋ฌธ์ฒด ๋ถ„์„ 44 ์ œ 3 ์ ˆ ํ™˜๊ฒฝ๋…ธ๋ž˜ ๊ฐ€์‚ฌ์˜ ์ฃผ์ œ์™€ ๋ฌธ์ฒด์˜ ๊ด€๊ณ„ 48 1. ํ™˜๊ฒฝ๊ด€๊ณผ ํ™˜๊ฒฝ์œค๋ฆฌ ์ฃผ์ œ์™€ ๋ฌธ์ฒด 49 2. ํ™˜๊ฒฝ์˜ ๊ตฌ์„ฑ ์ฃผ์ œ์™€ ๋ฌธ์ฒด 50 3. ํ™˜๊ฒฝ ๊ฐ์ˆ˜์„ฑ๊ณผ ๋ฐฐ๋ ค ์ฃผ์ œ์™€ ๋ฌธ์ฒด 51 4. ํ™˜๊ฒฝ๋ฌธ์ œ ์ฃผ์ œ์™€ ๋ฌธ์ฒด 52 5. ์ธ๊ฐ„ํ™œ๋™๊ณผ ํ™˜๊ฒฝ ์ฃผ์ œ์™€ ๋ฌธ์ฒด 53 6. ํ™˜๊ฒฝ๋ณด์ „์‹ค์ฒœ ์ฃผ์ œ์™€ ๋ฌธ์ฒด 54 ์ œ 4 ์ ˆ ์ข…ํ•ฉ ๋…ผ์˜ 56 ์ œ 5 ์žฅ ๊ฒฐ๋ก  ๋ฐ ์ œ์–ธ 60 ์ œ 1 ์ ˆ ์—ฐ๊ตฌ ์š”์•ฝ ๋ฐ ๊ฒฐ๋ก  60 ์ œ 2 ์ ˆ ์—ฐ๊ตฌ์˜ ํ•œ๊ณ„์™€ ์ œ์–ธ 61 ์ฐธ๊ณ ๋ฌธํ—Œ 63 ๋ถ€๋ก 69 Abstract 80Maste

    ์กฐํ˜ˆ๋ชจ์„ธํฌ ์ด์‹ ํ™˜์•„์™€ ๋ถ€๋ชจ๊ฐ€ ์ง€๊ฐํ•˜๋Š” ํ™˜์•„์˜ ํ†ต์ฆ ์ฐจ์ด์™€ ๊ด€๋ จ ์š”์ธ

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ๊ฐ„ํ˜ธํ•™๊ณผ ๊ฐ„ํ˜ธํ•™ ์ „๊ณต, 2016. 8. ์„œ์€์˜.๊ตญ๋ฌธ์ดˆ๋ก ์†Œ์•„์•”์€ ์•„๋™ ์งˆ๋ณ‘ ์‚ฌ๋ง์›์ธ 1์œ„์ด๋ฉฐ ๋งค๋…„ 1์ฒœ๋ช… ์ด์ƒ์˜ ์†Œ์•„๊ฐ€ ์ƒˆ๋กญ๊ฒŒ ์ง„๋‹จ์„ ๋ฐ›๊ณ  ์žˆ๋‹ค. ์†Œ์•„์•” ํ™˜์ž ์ค‘ ์ผ๋ฐ˜ ํ•ญ์•” ์น˜๋ฃŒ๋กœ ์™„์น˜๊ฐ€ ์–ด๋ ค์šด ๊ฒฝ์šฐ ์กฐํ˜ˆ๋ชจ์„ธํฌ ์ด์‹์„ ๋ฐ›๊ฒŒ ๋œ๋‹ค. ์กฐํ˜ˆ๋ชจ์„ธํฌ ์ด์‹ ๊ณผ์ • ์ค‘ ๋ฐ›๊ฒŒ ๋˜๋Š” ๊ณ ๊ฐ•๋„์˜ ์ „ ์ฒ˜์น˜ ์š”๋ฒ•์€ ์ด์‹ ํ™˜์ž์˜ ๋Œ€๋ถ€๋ถ„์—์„œ ๊ทน์‹ฌํ•œ ํ†ต์ฆ์„ ์œ ๋ฐœํ•œ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ํšจ๊ณผ์ ์ธ ํ†ต์ฆ ์กฐ์ ˆ์„ ์ €ํ•ดํ•˜๋Š” ์—ฌ๋Ÿฌ ์š”์ธ๋“ค๋กœ ์ธํ•ด ์•„๋™์˜ ํ†ต์ฆ ๊ด€๋ฆฌ๋Š” ์ ์ ˆํžˆ ์ด๋ฃจ์–ด์ง€์ง€ ๋ชปํ•˜๊ณ  ์žˆ๋Š” ์‹ค์ •์ด๋‹ค. ๊ทธ ์ค‘ ํ•˜๋‚˜๋กœ ์˜๋ฃŒ์ง„์ด ์•„๋™์˜ ์ง์ ‘๋ณด๊ณ  ๋ณด๋‹ค๋Š” ๋ถ€๋ชจ์˜ ๋ณด๊ณ ์—๋งŒ ์˜์กดํ•˜์—ฌ ํ†ต์ฆ์„ ์‚ฌ์ •ํ•˜์˜€๋‹ค๋Š” ์ ์„ ๋“ค ์ˆ˜ ์žˆ๋‹ค. ์กฐํ˜ˆ๋ชจ์„ธํฌ ์ด์‹ ํ™˜์•„์˜ ํ†ต์ฆ ์กฐ์ ˆ์— ๋ถ€๋ชจ์˜ ํ†ต์ฆ ์ธ์‹์ด๋‚˜ ์˜์‚ฌ๊ฒฐ์ • ์—ฌ๋ถ€๋ฅผ ์กฐ์‚ฌํ•œ ์—ฐ๊ตฌ๋Š” ๊ตญ๋‚ด์—์„œ ์ด๋ฃจ์–ด์ง€์ง€ ์•Š์•˜๋‹ค. ๋ณธ ์—ฐ๊ตฌ์˜ ๋ชฉ์ ์€ ์กฐํ˜ˆ๋ชจ์„ธํฌ ์ด์‹ ํ™˜์•„์˜ ํ†ต์ฆ ๊ฐ•๋„์— ๋Œ€ํ•ด ํ™˜์•„์™€ ๋ถ€๋ชจ๊ฐ€ ๊ฐ๊ฐ ๋ณด๊ณ ํ•œ ์ ์ˆ˜์˜ ์ฐจ์ด๋ฅผ ๋น„๊ตํ•˜๊ณ , ํ™˜์•„์™€ ๋ถ€๋ชจ ๊ฐ„ ํ†ต์ฆ ์ง€๊ฐ ์ฐจ์ด์— ์˜ํ–ฅ์„ ์ฃผ๋Š” ํŠน์„ฑ๋“ค์„ ๊ทœ๋ช…ํ•˜๋Š” ๊ฒƒ์ด๋‹ค. ๋ณธ ์—ฐ๊ตฌ๋Š” ์„œ์ˆ ์  ์กฐ์‚ฌ์—ฐ๊ตฌ๋กœ ์„ค๊ณ„๋˜์—ˆ์œผ๋ฉฐ ์กฐํ˜ˆ๋ชจ์„ธํฌ ์ด์‹์„ ๋ฐ›๊ธฐ ์œ„ํ•ด ์„œ์šธ ์‹œ๋‚ด ์ผ๊ฐœ ์ข…ํ•ฉ๋ณ‘์›์˜ ์กฐํ˜ˆ๋ชจ์„ธํฌ ์ด์‹์‹ค์— ์ž…์›ํ•œ ํ™˜์•„ 33๋ช…๊ณผ ๊ทธ ๋ถ€๋ชจ 33๋ช…์„ ๋Œ€์ƒ์œผ๋กœ ํ•˜์˜€๋‹ค. ๋Œ€์ƒ์ž ์ค‘ ํ™˜์•„๋Š” ์—ฐ๋ น์— ๋”ฐ๋ผ ์„ธ ์ง‘๋‹จ์œผ๋กœ ๋‚˜๋ˆ„์–ด ๊ตฌํš์„ค์ • ํ•˜์˜€๋‹ค. ์ž๋ฃŒ ์ˆ˜์ง‘์€ 2015๋…„ 5์›”๋ถ€ํ„ฐ 2016๋…„ 2์›”๊นŒ์ง€ ์ด๋ฃจ์–ด์กŒ๋‹ค. ํ†ต์ฆ ๊ฐ•๋„ ์ธก์ •์„ ์œ„ํ•œ ์—ฐ๊ตฌ ๋„๊ตฌ๋Š” ๋งŒ 4~6์„ธ์˜ ๊ฒฝ์šฐ Wong๊ณผ Baker๊ฐ€ ๊ฐœ๋ฐœํ•œ FPS (Faces pain rating scale), ๋งŒ 7์„ธ ์ด์ƒ์˜ ํ™˜์•„์™€ ๋ถ€๋ชจ๋Š” NRS (Numeric rating scale)์„ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ์ž๋ฃŒ๋Š” SPSS 18.0์„ ์ด์šฉํ•˜์—ฌ ๊ธฐ์ˆ ํ†ต๊ณ„, independent t test, Mann-Whitney test, One-way ANOVA, Repeated measure ANOVA ๋ฐฉ๋ฒ•์„ ํ†ตํ•˜์—ฌ ๋ถ„์„ํ•˜์˜€๋‹ค. ๋ณธ ์—ฐ๊ตฌ๋ฅผ ํ†ตํ•˜์—ฌ ์–ป์€ ๊ฒฐ๊ณผ๋Š” ๋‹ค์Œ๊ณผ ๊ฐ™๋‹ค. 1. ํ™˜์•„๊ฐ€ ๋ณด๊ณ ํ•œ ํ†ต์ฆ ์ ์ˆ˜์˜ ํ‰๊ท ์€ 5.4์ ์œผ๋กœ ๋ถ€๋ชจ๊ฐ€ ๋ณด๊ณ ํ•œ ํ†ต์ฆ ์ ์ˆ˜์˜ ํ‰๊ท  3.5๋ณด๋‹ค ์œ ์˜ํ•˜๊ฒŒ ๋†’์•˜์œผ๋ฉฐ(pโ‰ค.001), ์ธก์ • ์‹œ๊ธฐ๊ฐ€ ๊ฑฐ๋“ญ๋ ์ˆ˜๋ก ํ†ต์ฆ ๊ฐ•๋„๊ฐ€ ์ฆ๊ฐ€ํ•˜๋Š” ์–‘์ƒ์„ ๋ณด์˜€๋‹ค(pโ‰ค.001). 2. 4์„ธ์—์„œ 6์„ธ, 7์„ธ์—์„œ 11์„ธ ์‚ฌ์ด์˜ ์—ฐ๋ น ๊ตฐ์—์„œ๋Š” ํ™˜์•„์™€ ๋ถ€๋ชจ์˜ ํ†ต์ฆ ๋ณด๊ณ  ์ ์ˆ˜๊ฐ€ ํ†ต๊ณ„์ ์œผ๋กœ ์œ ์˜ํ•œ ์ฐจ์ด๋ฅผ ๋ณด์˜€๋‹ค(p=.011p=.019). 3. ์ด์‹ ํ›„ 2์ผ์—์„œ 10์ผ ์‚ฌ์ด์—๋Š” ํ™˜์•„์™€ ๋ถ€๋ชจ์˜ ํ†ต์ฆ ๊ฐ•๋„์˜ ์ฐจ์ด์˜ ์ •๋„๊ฐ€ ์‹œ๊ฐ„์ด ์ง€๋‚˜๋„ ์œ ์˜ํ•œ ๋ณ€ํ™”๊ฐ€ ์—†์—ˆ๋‹ค(F=1.020, p=.373). 4. ํ™˜์•„์™€ ๋ถ€๋ชจ์˜ ํ†ต์ฆ ์ง€๊ฐ ์ฐจ์ด์— ์˜ํ–ฅ์„ ์ฃผ๋Š” ์š”์ธ์€ ํ™˜์•„์˜ ์—ฐ๋ น(p=.011), ๋งˆ์•ฝ์„ฑ ์ง„ํ†ต์ œ ์‚ฌ์šฉ์— ๋Œ€ํ•œ ์˜๋ฃŒ์ง„์˜ ๊ต์œก ์—ฌ๋ถ€(pโ‰ค.001), ๊ทธ๋ฆฌ๊ณ  ์ง„ํ†ต์ œ ํˆฌ์—ฌ๊ธฐ๊ฐ„(pโ‰ค.001)์ธ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๊ฒฐ๋ก ์ ์œผ๋กœ, ์†Œ์•„ ์กฐํ˜ˆ๋ชจ์„ธํฌ ํ™˜์•„์˜ ํ†ต์ฆ์— ๋Œ€ํ•ด ๋ถ€๋ชจ๋Š” ํ™˜์•„๋ณด๋‹ค ๋” ๋‚ฎ๊ฒŒ ์ง€๊ฐํ•˜๊ณ  ์žˆ์œผ๋ฉฐ ํ™˜์•„์˜ ์—ฐ๋ น์ด ์–ด๋ฆด์ˆ˜๋ก, ์ด์ „ ๋งˆ์•ฝ์„ฑ ์ง„ํ†ต์ œ ์‚ฌ์šฉ์— ๋Œ€ํ•œ ๊ฒฝํ—˜์ด ์—†๋Š” ๊ฒฝ์šฐ, ๊ทธ๋ฆฌ๊ณ  ์ด ์ง„ํ†ต์ œ ํˆฌ์•ฝ ์ผ์ˆ˜๊ฐ€ ์งง์„์ˆ˜๋ก ํ™˜์•„์™€ ๋ถ€๋ชจ ๊ฐ„ ํ†ต์ฆ ์ง€๊ฐ ์ฐจ์ด๊ฐ€ ์œ ์˜ํ•˜๊ฒŒ ํฐ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๋”ฐ๋ผ์„œ ์กฐํ˜ˆ๋ชจ์„ธํฌ ์ด์‹์„ ๋ฐ›๋Š” ํ™˜์•„์˜ ํ†ต์ฆ ๊ด€๋ฆฌ๊ฐ€ ์ ์ ˆํžˆ ์ด๋ฃจ์–ด์ง€๊ธฐ ์œ„ํ•ด์„œ๋Š” ํ†ต์ฆ ์‚ฌ์ • ์‹œ ์ž„์ƒ ๊ฐ„ํ˜ธ์‚ฌ๊ฐ€ ํ™˜์•„์˜ ์ž๊ฐ€ ๋ณด๊ณ ๋ฅผ ๊ทผ๊ฐ„์œผ๋กœ ์ด์— ์˜ํ–ฅ์„ ์ค„ ์ˆ˜ ์žˆ๋Š” ์š”์†Œ๋“ค์„ ๊ณ ๋ คํ•˜์—ฌ์•ผ ํ•œ๋‹ค. ๋˜ํ•œ ์†Œ์•„ ํ™˜์ž์— ๋Œ€ํ•œ ํ†ต์ฆ ์‚ฌ์ • ๋ฐฉ๋ฒ•๊ณผ ์ˆ ๊ธฐ์— ๋Œ€ํ•œ ์ฒด๊ณ„์ ์ธ ๊ต์œก ๊ณผ์ • ๋งˆ๋ จ์ด ์ด๋ฃจ์–ด์ ธ์•ผ ํ•˜๋ฉฐ, ํ†ต์ฆ ์ž๊ฐ€๋ณด๊ณ ์˜ ์ค‘์š”์„ฑ์„ ๊ฐ•์กฐํ•˜๋Š” ๋‚ด์šฉ์„ ๊ฐ„ํ˜ธํ•™ ๊ต์œก ๊ณผ์ •์— ํฌํ•จํ•˜๋Š” ๊ฒƒ์ด ํ•„์š”ํ•˜๋‹ค. ์ฃผ์š”์–ด : ์กฐํ˜ˆ๋ชจ์„ธํฌ์ด์‹, ํ†ต์ฆ, ์†Œ์•„, ๋ถ€๋ชจ ํ•™ ๋ฒˆ : 2013-20422I. ์„œ๋ก  1 1. ์—ฐ๊ตฌ์˜ ํ•„์š”์„ฑ 1 2. ์—ฐ๊ตฌ ๋ชฉ์  4 3. ์šฉ์–ด์˜ ์ •์˜ 5 II. ๋ฌธํ—Œ๊ณ ์ฐฐ 6 1. ์กฐํ˜ˆ๋ชจ์„ธํฌ ์ด์‹ ํ™˜์•„์˜ ํ†ต์ฆ 6 2. ์†Œ์•„์˜ ํ†ต์ฆ ์‚ฌ์ • 7 3. ์†Œ์•„์˜ ํ†ต์ฆ์— ๋Œ€ํ•œ ์ž๊ฐ€๋ณด๊ณ , ๋Œ๋ด„ ์ œ๊ณต์ž๊ฐ€ ์‚ฌ์ •ํ•œ ์ ์ˆ˜์™€์˜ ๊ด€๋ จ์„ฑ 9 III. ์ด๋ก ์  ๊ธฐํ‹€ 13 IV. ์—ฐ๊ตฌ๋ฐฉ๋ฒ• 16 1. ์—ฐ๊ตฌ ์„ค๊ณ„ 16 2. ์—ฐ๊ตฌ ๋Œ€์ƒ 16 3. ์—ฐ๊ตฌ ๋„๊ตฌ 17 4. ์ž๋ฃŒ ์ˆ˜์ง‘ ๋ฐฉ๋ฒ• ๋ฐ ์ ˆ์ฐจ 19 5. ์ž๋ฃŒ ๋ถ„์„ ๋ฐฉ๋ฒ• 20 6. ์œค๋ฆฌ์  ๊ณ ๋ ค 20 V. ๊ฒฐ๊ณผ 22 1. ๋Œ€์ƒ์ž์˜ ์ผ๋ฐ˜์  ํŠน์„ฑ ๋ฐ ์งˆ๋ณ‘ ๊ด€๋ จ ํŠน์„ฑ 22 2. ๋Œ€์ƒ์ž์˜ ํ†ต์ฆ ๊ด€๋ จ ํŠน์„ฑ, ์ธก์ • ์‹œ์  ๋ณ„ ํ†ต์ฆ ์ ์ˆ˜ 24 3. ํ™˜์•„์™€ ๋ถ€๋ชจ ๊ฐ„ ํ†ต์ฆ ๊ฐ•๋„ ์ฐจ์ด 29 VI. ๋…ผ์˜ 34 1. ์กฐํ˜ˆ๋ชจ์„ธํฌ ์ด์‹ ํ™˜์•„์˜ ํ†ต์ฆ ์–‘์ƒ๊ณผ ํ™˜์•„์™€ ๋ถ€๋ชจ ๊ฐ„ ํ†ต์ฆ ์ง€๊ฐ ์ฐจ์ด 34 2. ์ผ๋ฐ˜์  ํŠน์„ฑ์— ๋”ฐ๋ฅธ ํ™˜์•„์™€ ๋ถ€๋ชจ์˜ ํ†ต์ฆ ์ง€๊ฐ ์ฐจ์ด 37 3. ๊ฐ„ํ˜ธ ์—ฐ๊ตฌ, ์ž„์ƒ, ๊ต์œก์  ์˜์˜ 38 VII. ๊ฒฐ๋ก  ๋ฐ ์ œ์–ธ 40 ์ฐธ๊ณ  ๋ฌธํ—Œ 42 ๋ถ€๋ก 49 Abstract 64Maste

    ์˜จ๋ผ์ธ ์˜คํ”ผ๋‹ˆ์–ธ ๋ฆฌ๋”์˜ ๋‹ด๋ก  ์œ ํ˜• ํƒ๊ตฌ - ์„ธ์ข…์‹œ ๊ด€๋ จ ์ธํ„ฐ๋„ท ํ† ๋ก ๋ฐฉ ๋‹ค์Œ ์•„๊ณ ๋ผ ์„ ๋„์˜๊ฒฌ์„ ์ค‘์‹ฌ์œผ๋กœ

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    ์ด ๋…ผ๋ฌธ์€ ๋ฐ•๋ฏผ๊ฒฝ์˜ ์„์‚ฌํ•™์œ„๋…ผ๋ฌธ(2009)์„ ์žฌ๊ตฌ์„ฑํ•˜๊ณ  ์ˆ˜์ •ยท๋ณด์™„ํ•œ ๊ฒƒ์ž„์„ ๋ฐํž™๋‹ˆ๋‹ค.๋ณธ ์—ฐ๊ตฌ ๋Š” 2009๋…„๊ณผ 2010๋…„ ๋œจ๊ฑฐ์šด ์ด์Šˆ์˜€๋˜ ์„ธ์ข…์‹œ ๋ฌธ์ œ์™€ ๊ด€๋ จ, ์ธํ„ฐ๋„ท ํฌํ„ธ ๋‹ค์Œ(Daum)์˜ ํ† ๋ก ๋ฐฉ ์•„๊ณ ๋ผ์—์„œ ํ™œ๋™ํ•œ ์˜จ๋ผ์ธ ์˜คํ”ผ๋‹ˆ์–ธ ๋ฆฌ๋”๋“ค์˜ ๊ฒŒ์‹œ๊ธ€ ๋‹ด๋ก ์„ ๋ถ„์„ํ–ˆ๋‹ค. ์—”ํŠธ๋งŒ์˜ 4๊ฐ€์ง€ ํ”„๋ ˆ์ž„ ์œ ํ˜•๊ณผ ์„ ์ „๋ถ„์„์—ฐ๊ตฌ์†Œ์˜ 7๊ฐ€์ง€ ์„ ์ „ ๊ธฐ๋ฒ•์„ ๋Œ€์ž…ํ•ด ํƒ๊ตฌํ•œ ๊ฒฐ๊ณผ, ์„ ๋„์˜๊ฒฌ(Leading Opinion)๋“ค์€ ํ”„๋ ˆ์ž„ ์œ ํ˜• ์ค‘ ๋ฌธ์ œ ์ •์˜๋ฅผ ๊ฐ€์žฅ ๋งŽ์ด ํ™œ์šฉํ–ˆ์œผ๋ฉฐ, ์„ ์ „ ๊ธฐ๋ฒ• ์ค‘์—์„œ๋Š” ๋งค๋„ํ•˜๊ธฐ๋ฅผ ์ œ์ผ ๋งŽ์ด ์‚ฌ์šฉํ–ˆ๋‹ค. ํ”„๋ ˆ์ž„ ๊ฐ„ ์ค‘๋ณต ์ฝ”๋”ฉ์„ ํ†ตํ•ด ์‚ดํŽด๋ณธ ๋ฐ”์— ๋”ฐ๋ฅด๋ฉด, ๋ฌธ์ œ์ •์˜ ์—†์ด ์ธ๊ณผ์  ํ•ด์„,๋„๋•์  ํ‰๊ฐ€, ํ•ด๊ฒฐ์ฑ… ์ œ์‹œ ํ”„๋ ˆ์ž„์ด ๋“ฑ์žฅํ•œ ๊ฒฝ์šฐ๊ฐ€ ๋ฐœ๊ฒฌ๋ผ ์˜จ๋ผ์ธ์ƒ์˜ ์„ ๋„์˜๊ฒฌ์€ ์ƒํ™ฉ์— ๋Œ€ํ•œ ์ •ํ™•ํ•œ ์ •๋ณด ์—†์ด๋„ ์ธ๊ณผ๊ด€๊ณ„๋ฅผ ์ „๋‹ฌํ•˜๊ฑฐ๋‚˜, ๊ฐ์ •์  ํŒ๋‹จ์„ ๋‚ด๋ฆฌ๊ณ , ์ •์ฑ… ๋Œ€์•ˆ์„ ์ œ๊ธฐํ•˜๋Š” ๋“ฑ ๋…ผ๋ฆฌ ์ „๊ฐœ์— ๋น„์•ฝ์ด ์žˆ๋‹ค๋Š” ํ•ด์„์ด ๊ฐ€๋Šฅํ–ˆ๋‹ค. ํ•œํŽธ ์„ ์ „ ๊ธฐ๋ฒ• ์ค‘์—์„œ๋Š” ๋งค๋„ํ•˜๊ธฐ, ์ฆ์–ธ, ๋ถ€ํ™”๋‡Œ๋™, ์นด๋“œ ์†์ž„์ˆ˜ ๋“ฑ 4๊ฐ€์ง€ ๊ธฐ๋ฒ•์ด ๊ฐ๊ฐ 2๊ฐœ ์ด์ƒ์˜ ๋‹ค๋ฅธ ๊ธฐ๋ฒ•๋“ค๊ณผ ์ค‘๋ณต ์‚ฌ์šฉ๋๋‹ค. ์„ ๋„์˜๊ฒฌ๋“ค์€ ์ž์‹ ๋“ค์˜ ์ฃผ์žฅ์„ ๊ฐ•์กฐํ•˜๊ธฐ ์œ„ํ•ด ๋‹ค๋ฅธ ์ž…์žฅ์„ ํ„ํ•˜ํ•˜๊ฑฐ๋‚˜, ํŽธํ–ฅ์„ฑ์„ ๊ฐ€์ง„ ์ •์น˜์ธ์˜ ๋ฐœ์–ธ ๋˜๋Š” ํŠน์ • ํ†ต๊ณ„ ๋“ฑ์„ ๋ณตํ•ฉ์ ์œผ๋กœ ํ™œ์šฉํ•œ ๊ฒƒ์ด๋‹ค. ์—ฐ๊ตฌ์ง„์€ ํƒ๊ตฌ ๊ฒฐ๊ณผ๋ฅผ ๋ฐ”ํƒ•์œผ๋กœ, ํ”„๋ ˆ์ž„ ์œ ํ˜•๊ณผ ์„ ์ „๋ถ„์„ ๊ธฐ๋ฒ•์˜ ์ƒํ˜ธ ์—ฐ๊ด€์„ฑ์— ๋Œ€ํ•œ ํ›„์† ์—ฐ๊ตฌ๋ฅผ ์ด‰๊ตฌํ–ˆ๋‹ค

    Cantharidin induces apoptosis and suppresses cell migration and invasion of MDA-MB-231 human breast cancer cells through inhibition of EGFR-STAT3 signaling

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› ์•ฝํ•™๋Œ€ํ•™ ์•ฝํ•™๊ณผ, 2017. 8. ๊น€์˜์‹.Breast cancer is the most frequently diagnosed life-threatening cancer in women. Common chemotherapeutic agents target three receptors: estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2). Breast cancer cells that lack ER, PR and HER2 are referred to as triple negative breast cancer (TNBC). TNBC occurs in about 15~20 % of diagnosed breast cancer. TNBC is known to increase recurrence and mortality rate within 5 years of cancer detection and is thus considered to have poorer prognosis. Recently, the signal transducer and activator of transcription 3 (STAT3) is reported as a key factor in TNBC treatment, due to high levels of STAT3 expression in TNBC. Bioassay-guided fractionation and purification were performed to isolate the cytotoxic compound from cantharides. The dried cantharides were crushed and extracted with acetonitrile and then separated into methylene chloride, acetonitrile, n-hexane and water layers. Methylene chloride and acetonitrile layerwhich had strong activity were further separated and purificated using various chromatographic techniques. The extract was fractionated into 4 fractions by Prep-LC, and the third fraction showing cytotoxic activity was separated using CCC (Counter-Current Chromatography). Separated fraction was structurally determined and identified as cantharidin by comparing NMR and HRMSdata with literature value. Cantharidin is an active constituent of the blister beetles, belonging to Meloidae family, which is traditionally used to treat wart and relieve blood stasis. Moreover, numerous studies have revealed that cantharidin has a cytotoxic effect on cancer cells. However, there have been no reports on cantharidins effect on inhibiting cell growth of TNBC. Herein, we demonstrated that cantharidin induced cell death in one of TNBC cells, MDA-MB-231, by suppressing STAT3 activation. The result showed that cantharidin reduced STAT3 tyrosine-705 in MDA-MB-231 cells.Cantharidinsignificantly inhibited activation of EGFR, Src, and STAT3, not affecting JAK-STAT3 signaling.Moreover, cantharidin inhibits cell proliferation and induces apoptosis by regulating a transcription of STAT3 target genes such as cox-2, cyclin D1, bcl-2, caspase-3 and parp1. Taken together, this study provides that cantharidin may be used as a potential therapeutic agent against TNBC, especially MDA-MB-231 cells, by reducing EGFR-STAT3 signaling.I. INTRODUCTION 1 1. Triple negative breast cancer (TNBC). 1 2. Signal transducer and activator of transcription 3 (STAT3) 2 3. EGFR (Epidermal growth factor receptor) 5 4. EGFR-STAT3 pathway. 6 5. Cantharides 7 II. MATERIALS AND METHODS 8 1. MATERIALS 8 1.1. Insect materials. 8 1.2. Chemicals and reagents. 8 1.3. Instruments.. 9 1.4. Antibodies 10 2. METHODS 11 2.1. Cell culture. 11 2.2. Cell viability assay 11 2.3. Preparation of nuclear and cytosolic fractions. 12 2.4. Luciferase reporter assay 12 2.5. Western blot analysis 13 2.6. Wound-healing assay 14 2.7. Annexin V & PI analysis 15 2.8. Invasion assay. 15 2.9. Extraction 16 2.10. Preparative HPLC separation 17 2.11. Measurement of the partition coeffient (K) 17 2.12. HPCCC separation. 18 2.13. Identification of isolated compound. 19 2.14. Statistical analysis. 19 III. RESULTS 20 1. Extraction and solvent partition 20 2. Separation of methylene chloride and acetonitrile fraction by preparative HPLC and the cell viability of obtained four fractions. 22 3. Separation of MA3 fraction by HPCCC and the cell viability of separated fractions 25 4. Identification of compound 28 5. Effect of cantharidin on the cell viability in MDA-MB-231 cells. 33 6. Inhibitory effect of cantharidin on STAT3 activation 35 7. Effect of cantharidin on STAT3 upstream signaling pathways. 38 8. Effect of cantharidin on STAT3 associated proteins. 41 9. Effect of cantharidin on expression of STAT3 downstream genes. 43 10. Induction of caspase-mediated apoptosis by cantharidin. 45 11. Effect of cantharidin on changes in cell morphology and apoptosis. 47 12. Effect of cantharidin on cell migration. 51 13. Effect of cantharidin on cell invasion. 53 IV. DISCUSSION. 55 V. CONCLUSION. 60 REFERENCES. 61 ABSTARCT IN KOREAN. 68Maste

    ่ฒฟๆ˜“่‡ช็”ฑๅŒ–๊ฐ€ ๅค–ๅœ‹ไบบ็›ดๆŽฅๆŠ•่ณ‡่ช˜่‡ด์— ๋ฏธ์น˜๋Š” ๅฝฑ้Ÿฟ ๅˆ†ๆž: ไธญๅ—็พŽ ไบ‹ไพ‹๋ฅผ ไธญๅฟƒ์œผ๋กœ

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    ํ•™์œ„๋…ผ๋ฌธ (์„์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๊ตญ์ œ๋Œ€ํ•™์› : ๊ตญ์ œํ•™๊ณผ(๊ตญ์ œ์ง€์—ญํ•™์ „๊ณต), 2013. 8. ๊น€์ข…์„ญ.์™ธ๊ตญ์ธ์ง์ ‘ํˆฌ์ž(์ดํ•˜ FDI)๋Š” ๊ฒฝ์ œํ™œ์„ฑํ™”์˜ ํ•œ ๋ฐฉํŽธ์œผ๋กœ ์—ฌ๊ฒจ์ง€๊ณ  ์žˆ์œผ๋ฉฐ, ํŠนํžˆ ๋งŽ์€ ์ค‘๋‚จ๋ฏธ๊ตญ๊ฐ€๋“ค์€ ์™ธ๊ตญ์ธ ํˆฌ์ž ์œ ์น˜๋ฅผ ์ •๋ถ€์ฐจ์›์—์„œ ์žฅ๋ คํ•˜๊ณ ์ž ํ•œ๋‹ค. ์ตœ๊ทผ 20๋…„ ๊ฐ„ ์ค‘๋‚จ๋ฏธ์— FDI ๋น„์œจ์€ ์ƒ๋‹นํžˆ ์ฆ๊ฐ€ํ–ˆ์œผ๋ฉฐ ์ด๋Š” ๋ฌด์—ญ์ž์œ ํ™”๊ฐ€ ์‹œ์ž‘๋œ ์‹œ๊ธฐ์™€ ์ผ์น˜ํ•œ๋‹ค. ๋ณธ ๋…ผ๋ฌธ์€ ์ค‘๋‚จ๋ฏธ์˜ ๋ฌด์—ญ์ž์œ ํ™”์™€ FDI์˜ ๊ด€๊ณ„๋ฅผ ์ง„๋‹จํ•˜๊ณ  ๋™ ์ง€์—ญ FDI์˜ ํ˜•ํƒœ๋ฅผ ํŒŒ์•…ํ•˜๊ณ ์ž ํ–ˆ๋‹ค. ๋ณธ ๋ถ„์„์—๋Š” ํŒจ๋„๋ฐ์ดํ„ฐ๋ฅผ ํ™œ์šฉํ•จ์œผ๋กœ์จ ๋”์šฑ ๊ตฌ์ฒด์  ๊ฒฐ๊ณผ๋ฅผ ์–ป๊ธฐ ์œ„ํ•ด ๋…ธ๋ ฅํ•˜์˜€๋‹ค. ํŒจ๋„๋ฐ์ดํ„ฐ๋ฅผ ์ด์šฉํ•œ ํšŒ๊ธฐ ๋ถ„์„ ๊ฒฐ๊ณผ๋ฅผ ํ†ตํ•ด ์ค‘๋‚จ๋ฏธ์—์„œ ์‹œ์žฅ์˜ ํฌ๊ธฐ์™€ ๋ฌด์—ญ๊ฐœ๋ฐฉ๋„ ๋ฐ ๊ด€์„ธ๊ฐ€ FDI ์œ ์น˜์— ์ƒ๋‹นํ•œ ์—ญํ• ์„ ํ•˜๊ณ  ์žˆ๋‹ค๋Š” ์‚ฌ์‹ค์„ ๋„์ถœํ•ด๋ƒˆ์œผ๋ฉฐ, ์ด๋ฅผ ํ†ตํ•ด ๊ธฐ์กด์— ์ค‘๋‚จ๋ฏธ ์ง€์—ญ์„ ๊ทœ์ •ํ•˜๊ณ  ์žˆ๋˜ ๊ด€์„ธํšŒํ”ผ(tariff-jumping)FDI์ด ์„ค๋“๋ ฅ์ด ์•ฝํ•ด์ง์„ ์•Œ ์ˆ˜ ์žˆ์—ˆ๋‹ค. ๋˜ํ•œ ๋ณธ ๋…ผ๋ฌธ์—์„œ๋Š” ๊ฐ€์„ค๊ณผ๋Š” ๋‹ฌ๋ฆฌ ์ „์ฒด์ ์œผ๋กœ ๋ดค์„ ๋•Œ ์ฒœ์—ฐ์ž์›์ด FDI์œ ์น˜์— ๋ฏธ์น˜๋Š” ์˜ํ–ฅ๋ ฅ์ด ํฌ๊ฒŒ ๋„์ถœ๋˜์ง€ ์•Š์€ ๊ฒƒ์œผ๋กœ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๋ณธ ๋…ผ๋ฌธ์„ ํ†ตํ•ด ์ค‘๋‚จ๋ฏธ์ง€์—ญ์—์„œ๋„ ์‹œ์žฅํ™•๋ณด(market-seeking)์™€ ํšจ์œจ์„ฑ(efficiency-seeking) ์ถ”๊ตฌํ˜• ํˆฌ์žํ˜•ํƒœ๊ฐ€ ๊ณต์กดํ•˜๊ณ  ์žˆ์Œ์„ ๋„์ถœํ•˜์˜€์œผ๋ฉฐ ๋ฌด์—ญ์ž์œ ํ™”์™€ ๋”๋ถˆ์–ด ์‹œ์žฅ์˜ ํฌ๊ธฐ์™€ ๊ฒฝ์ œ์ ์ •์น˜์  ์•ˆ์ •์„ฑ์ด ์ฃผ์š” ์š”์ธ์ž„์„ ๋ฐํ˜”๋‹ค. ์ด์— ์ตœ๊ทผ ํฌ๊ฒŒ ์ฆ๊ฐ€ํ•œ ์ค‘๋‚จ๋ฏธ ์ง€์—ญํ†ตํ•ฉ์ฒด์™€ ๊ฐœ๋ณ„ FTA๊ฐ€ ์ƒˆ๋กœ์šด ๊ธฐํšŒ๊ฐ€ ๋  ์ˆ˜ ์žˆ์„ ๊ฒƒ์œผ๋กœ ์‚ฌ๋ฃŒ๋œ๋‹ค.There has been dramatic increase of Foreign Direct Investment Latin America region, which coincides with the period of trade liberalization. The main objectives of this paper are, to examine the relationship with various factors with respect to trade liberalization in attracting FDIs in LAC and secondly, to explore the pattern of FDIs in the region. The analysis in this paper uses a panel data that allows panel data regression, which would give a more concrete result. The panel data regression results indicate that both market size and openness to trade and tariff has significant influence in FDIs in the region which weakens the tariff jumping argument. Moreover, natural resource did not have significant impact different from what expected. This paper suggests that market-seeking and efficiency seeking FDIs coexist in Latin America and the size and stability of the market as well as the trade liberalization contribute to attract more investment. In that sense, the regional integration and FTAs could be an opportunity for the region.CHAPTER I. INTRODUCTION 1.1 Recent Trend 1.2 Evolution of FDI in Latin America CHAPTER II. LITERATURE REVIEW 2.1 Motives for Foreign Direct Investment 2.2 Vertical FDI 2.3 Horizontal FDI CHAPTER III. TRADE LIBERALIZATION IN LATIN AMERICA CHAPTER IV. METHODOLOGY AND HYPOTHESIS 4.1 Methodology 4.1.1 Basic Regression Equation 4.1.2 Trade liberalization indicators 4.1.3 Overall Variables 4.2 Hypothesis CHAPTER V. EMPIRICAL ANALYSIS RESULTS 5.1 Basic Model 5.2 Trade liberalization variables CHAPTER VI. CONCLUSION AND FURTHER STUDIES BIBLIOGRAPHYMaste

    (A)Study on the change of management by objectives

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    ํ•™์œ„๋…ผ๋ฌธ(์„์‚ฌ)--์„œ์šธ๋Œ€ํ•™๊ต ํ–‰์ •๋Œ€ํ•™์› :ํ–‰์ •ํ•™๊ณผ ํ–‰์ •ํ•™์ „๊ณต,2007.Maste

    ์ œ7์ฐจ ๊ต์œก๊ณผ์ • ์ค‘ํ•™๊ต ๊ธฐ์ˆ ยท๊ฐ€์ •๊ต๊ณผ์˜ ์‹์ƒํ™œ ๋‹จ์› ๋‚ด์šฉ๋ถ„์„ ๋ฐ ๊ต์œก์˜ ํšจ๊ณผ์—ฐ๊ตฌ

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    ํ•™์œ„๋…ผ๋ฌธ(์„์‚ฌ)--์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› :ํ˜‘๋™๊ณผ์ • ๊ฐ€์ •๊ต์œก์ „๊ณต,2002.Maste

    ๊ด‘๊ณ  ํ”„๋ผ์ด๋ฒ„์‹œ๋ฅผ ์œ„ํ•œ ์ •๋ณด ํ๋ฆ„ ์ œ์–ด ๊ธฐ๋ฒ•

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    ํ•™์œ„๋…ผ๋ฌธ(๋ฐ•์‚ฌ) -- ์„œ์šธ๋Œ€ํ•™๊ต๋Œ€ํ•™์› : ๊ณต๊ณผ๋Œ€ํ•™ ์ปดํ“จํ„ฐ๊ณตํ•™๋ถ€, 2022. 8. ๊ถŒํƒœ๊ฒฝ.In online advertising, cross-site tracking enables advertisers to target potential customers by profiling their online behaviors. However, such practice raises privacy concerns because of the sensitivity of the collected user data. To address this issue, there have been proposals for privacy-preserving advertising. However, they allow ad companies to protect user privacy only by sacrificing the utility of the advertising. In this paper, I present a privacy-preserving advertising framework, PAVE, which allows ad companies to sustain the utility and current advertising mechanisms. PAVE provides an arbitrary ad program with an isolated execution environment equipped with a blackbox monitor, called a PAVEBOX, inspired by Secure Multi-Execution (SME). The PAVEBOX intercepts every data flow from the ad program and disallows any data flow that may explicitly or implicitly leak the user data. As the PAVEBOX is built on top of Intel SGX, its integrity can be remotely attested. I carry out the quantitative analysis with prototype-based experiments to show its feasibility.์˜จ๋ผ์ธ ๊ด‘๊ณ ์—์„œ๋Š” ์‚ฌ์šฉ์ž๋ณ„๋กœ ๋งž์ถคํ™”๋œ ๊ด‘๊ณ ๋ฅผ ์ œ๊ณตํ•˜๊ธฐ ์œ„ํ•ด ๊ต์ฐจ ์‚ฌ์ดํŠธ ์ถ”์  ๊ธฐ๋ฒ•์„ ์ด์šฉํ•œ๋‹ค. ๊ต์ฐจ ์‚ฌ์ดํŠธ ์ถ”์ ์€ ์‚ฌ์šฉ์ž์˜ ์ธํ„ฐ๋„ท ํ™œ๋™ ๊ธฐ๋ก์„ ์ถ”์ ํ•˜๋Š” ๋ฐฉ์‹์œผ๋กœ, ์ด๋ฅผ ํ†ตํ•ด ์‚ฌ์šฉ์ž์˜ ๊ด€์‹ฌ์‚ฌ๋ฅผ ์•Œ์•„๋‚ธ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ ์ด๋Ÿฌํ•œ ๋ฐฉ์‹์œผ๋กœ ์ˆ˜์ง‘๋œ ๋ฐ์ดํ„ฐ๋Š” ์‚ฌ์šฉ์ž์˜ ๋ฏผ๊ฐ ์ •๋ณด๋ฅผ ๋ณ„๋„์˜ ํ—ˆ๊ฐ€์—†์ด ์ˆ˜์ง‘ํ•˜๊ธฐ ๋•Œ๋ฌธ์— ํ”„๋ผ์ด๋ฒ„์‹œ ์นจํ•ด์˜ ์—ฌ์ง€๊ฐ€ ์žˆ๋‹ค. ์ด ๋ฌธ์ œ๋ฅผ ํ•ด๊ฒฐํ•˜๊ธฐ ์œ„ํ•ด ํ”„๋ผ์ด๋ฒ„์‹œ๋ฅผ ๋ณดํ˜ธํ•˜๋Š” ๊ด‘๊ณ  ์‹œ์Šคํ…œ๋“ค์ด ์ œ๊ธฐ๋˜์–ด ์™”๋‹ค. ๊ทธ๋Ÿฌ๋‚˜, ๊ธฐ์กด ์—ฐ๊ตฌ์—์„œ๋Š” ์‚ฌ์šฉ์ž์˜ ํ”„๋ผ์ด๋ฒ„์‹œ๋ฅผ ๋ณดํ˜ธํ•˜๊ธฐ ์œ„ํ•ด ๊ด‘๊ณ ์˜ ์œ ํ‹ธ๋ฆฌํ‹ฐ๋ฅผ ์ €ํ•ด์‹œํ‚จ๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š”, ํ”„๋ผ์ด๋ฒ„์‹œ๋ฅผ ๋ณดํ˜ธํ•˜๋Š” ๊ด‘๊ณ  ํ”„๋ ˆ์ž„์›Œํฌ์ธ PAVE๋ฅผ ์ œ์•ˆํ•œ๋‹ค. PAVE๋Š” ๊ด‘๊ณ  ํšŒ์‚ฌ๋“ค์ด ํ˜„์žฌ ๊ด‘๊ณ ์˜ ์œ ํ‹ธ๋ฆฌํ‹ฐ๋ฅผ ์œ ์ง€ํ•  ์ˆ˜ ์žˆ๊ณ , Real-Time Bidding(RTB)๊ณผ ๊ฐ™์€ ํ˜„์žฌ ๊ด‘๊ณ  ํ”„๋กœํ† ์ฝœ์„ ์ง€์›ํ•œ๋‹ค. PAVE๋Š” ์ž„์˜์˜ ๊ด‘๊ณ  ํ”„๋กœ๊ทธ๋žจ์—๊ฒŒ PAVEBOX๋ผ๋Š” ์‹ค์‹œ๊ฐ„ ๋ชจ๋‹ˆํ„ฐ๊ฐ€ ์กด์žฌํ•˜๋Š” ๊ฒฉ๋ฆฌ๋œ ์‹คํ–‰ ๊ณต๊ฐ„์„ ์ œ๊ณตํ•œ๋‹ค. Secure Multi-Execution(SME)์œผ๋กœ๋ถ€ํ„ฐ ์˜๊ฐ์„ ๋ฐ›์€ PAVEBOX๋Š” ๋ชจ๋“  ๋ฐ์ดํ„ฐ ํ๋ฆ„์„ ๊ฐ€๋กœ์ฑ„๊ณ  ์–ด๋–ค ๋ฐ์ดํ„ฐ ํ๋ฆ„์ด ์‚ฌ์šฉ์ž ๋ฐ์ดํ„ฐ๋ฅผ ์œ ์ถœ์‹œํ‚ฌ ์—ฌ์ง€๊ฐ€ ์žˆ๋‹ค๋ฉด ์ด๋ฅผ ๊ธˆ์ง€์‹œํ‚จ๋‹ค. PAVEBOX๋Š” Intel SGX๋กœ๋ถ€ํ„ฐ ๋ณดํ˜ธ๋ฐ›๊ธฐ ๋•Œ๋ฌธ์— ํ”„๋กœ๊ทธ๋žจ์˜ ๋ฌด๊ฒฐ์„ฑ์„ ์›๊ฒฉ์—์„œ ๊ฒ€์ฆํ•  ์ˆ˜ ์žˆ๋‹ค. ๋ณธ ์—ฐ๊ตฌ์—์„œ๋Š” ํ˜•์‹ํ™”๋œ ๋ณด์•ˆ ๋ชจ๋ธ์„ ์ˆ˜๋ฆฝํ•˜๊ณ , ์ด๋ฅผ ํ†ตํ•ด ํ”„๋ผ์ด๋ฒ„์‹œ๋ฅผ ํ˜•์‹์ ์œผ๋กœ ์ฆ๋ช…ํ•œ๋‹ค. ๋˜ํ•œ ํ”„๋กœํ† ํƒ€์ž…์„ ๊ฐœ๋ฐœํ•˜์—ฌ ์‹คํ—˜์„ ํ†ตํ•ด ๋ชจ๋ธ์˜ ์„ฑ๋Šฅ์  ํƒ€๋‹น์„ฑ์„ ๋ณด์—ฌ์ค€๋‹ค.Chapter 1 Introduction 1 Chapter 2 Background 6 2.1 Current Advertising Ecosystem 6 2.2 Intel SGX 8 2.3 Secure Multi-Execution (SME) 9 Chapter 3 Overview 12 3.1 Threat Model 12 3.2 System Goals 13 Chapter 4 Pave Design 17 4.1 Local Profiling 17 4.2 Shadow Execution 18 4.3 Faceted Session 19 4.4 Chained Attestation 22 Chapter 5 Pave Implementation 23 5.1 Sandbox 23 5.2 Syscall and FS Interfaces 25 5.3 Synchronization 26 5.4 Selective Remote Attestation (RA) 27 5.5 Lazy Execution 28 Chapter 6 Formal Analysis 30 6.1 Model Language 30 6.2 Standard Semantics 31 6.3 PaveBox Semantics 32 6.4 Security Properties 34 6.5 Proof of Security Properties 35 6.5.1 Proof of Non-Interference 35 6.5.2 Proof of Functionality Preservation 38 Chapter 7 Discussion 44 7.1 Side-channel Attacks 44 7.2 After AD Selections 46 Chapter 8 Evaluation 47 8.1 Experiment Setup 47 8.2 PaveBox Initialization Overhead 49 8.3 User Latency 49 8.4 Execution Time 53 Chapter 9 Related Work 55 9.1 Privacy-preserving Ad Systems 55 9.2 Information Flow Control 57 Chapter 10 Conculsion 59 ๊ตญ๋ฌธ์ดˆ๋ก 73๋ฐ•
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