(An) evaluative study for the alcoholics anonymous(A.A.) in Korea

보건학과/박사[한글] 본 연구는 우리나라에서 운영되고 있는 자활단주프로그램의 효과를 단면 연구의 틀로 평가하였다. 이 연구에서 평가하고자 한 효과는 단주, 사회병리, 비용, 의료이용, 그리고 본인이 느끼는 A.A. 프로그램의 효과의 5가지 측면으로 되어 있고, 각각을 3단계로 나누어서 평가하였다. 첫 단계로 A.A.가입 전과 후를 비교하였고, 다음단계로 A.A. 가입 후 A.A.모임에의 참여정도 및 A.A.프로그램(12단계)의 실천정도에 따른 차이를 비교해 보았고, 마지막으로 A.A.참여변수들의 단주측면에 대한 영향을 분석하였다. 연구대상은 1998년 5월말 현재 총 30개 익명의 알콜중독자 모임(A.A.)에 참여하고 있는 사람들을 대상으로 하였다. 본 연구를 위하여 구조화된 자기기입식 조사표를 만들어 사용하였다. 조사당시 A.A.모임에 참석했던 300명을 전수조사하였다. 방문과 우편을 통하여 조사표를 회수하였으며, 조사표 회수율은 70.0%였다. 단주 측면은 단주지속기간과 재발경험으로, 비용 측면은 의료비와 술값으로 평가하였다. 사회병리적 행태는 비정상적인 행동 16항목의 총 횟수로, 의료이용 측면은 의료이용횟수 및 기간으로 평가하였다. 본인이 느끼는 A.A.프로그램의 효과는 신체적 측면 7항목, 사회적 측면 6항목, 정신적 측면 19항목으로 평가하였고, 효과여부는 5점 척도로 조사한 후 분석시에 점수화 하였다. 분석으로는 단주지속기간과 재발경험을 각각 종속변수로 하여 다중선형 회귀분석과 로지스틱 회귀분석을 실시하였다. 이때 일반적 특성변수(결혼상태, 성장여건)와 A.A.참여변수(A.A.참여년수, 월평균 A.A.모임 참여횟수,A.A.모임에 한달 이상 빠진 경험, 기도와 명상 실천 여부, 메시지 전달 후 인도한 사람수, 후원자 유무)를 독립 변수로 사용하였다. 연구결과는 다음과 같다. 첫째, A.A.프로그램에의 참여는 음주로 인한 비정상적인 행동의 발생을 최고 32회 낮추는 효과가 있었다. 둘째, A.A.모임 참여 후에 월 평균 약값은 13,140원, 월 평균 병원비는 15,555원, 평균 입원비는 250,338원 감소했으며, A.A.모임에 참여하여 단주함으로써 절감된 술값은 월평균 299,504원이었다. 셋째, A.A.모임 참여 후에 월 평균 약국 방문횟수는 2.88회, 월 평균 병 ·의원 외래이용횟수는 0.17회, 내과 입원 총 횟수는 1.10회, 정신과 입원 총 횟수는 1.33회 감소했으며, 평균 내과 입원기간은 19.92일, 평균 정신과 입원기간은 79.45일 감소했다. 넷째, A.A.모임 참여정도 및 A.A.프로그램 내용의 실천정도에 따른 프로그램의 효과를 비교해 본 결과 현재 단주지속기간은 A.A.참여기간이 3년 이상인 경우에 34.4개월, 메시지 전달 후 알콜중독자를 인도한 경험이 있는 경우에 15.7개월 통계학적으로 유의하게 더 길었다. 재발횟수는 월 평균 A.A.모임 참여횟수가 11회 이상인 경우에 5.8회, A.A.모임에 한달 이상 빠진 경험이 없는 경우에 4.7회 통계학적으로 유의하게 낮았다. 다섯째, A.A.모임 참여정도 및 A.A.프로그램 내용의 실천정도에 따른 본인이 느끼는 A.A.프로그램의 효과를 비교해 본 결과 A.A.참여기간이 7년 이상인 경우에 신체적 측면, 사회적 측면, 정신적 측면 모두에서 보다 긍정적인 효과가 있었다고 응답하였다. 기도와 명 상을 실천하는 경우에는 정신적측면에서, 메시지 전달 후 알콜중독자를 인도한 경험이 있는 경우에는 사회적 측면 및 정신적 측면에서 보다 긍정적인 효과가 있었다고 응답하였고, 모두 통계학적으로 유의하였다. 여섯째, 모형내에 포함된 다른 변수의 영향을 통제한 후 독립변수 각각의 단주지속기간에 대한 영향력의 크기와 방향을 검증하기 위하여 다중선형 회귀분석을 실시한 결과 개인속성요인만을 통제한 축소모형 I에서는 결혼상태(결혼)가 단주지속기간에 유의하게 영향을 미치는 요인이었으며, 이 요인의 회귀계수 방향은 예측했던 것과 일치하였다. 선정된 3개 변수에 의하여 단주지속기간은 9%를 설명할 수 있었다. 개인속성요인에 A.A.참여요인을 추가로 통제한 모형 Ⅱ에서는 기도와 명상 실천여부와 메시지 전달 후 인도한 사람수가 단주지속기간에 유의하게 영향을 미치는 요인이었으며, 이 요인의 회귀계수 방향은 예 측했던 것과 일치하였다. 선정된 9개 변수에 의하여 단주지속기간은 54%를 설명할 수 있었으므로, 개인속성요인에 A.A.참여요인이 추가됨으로써 설명력이 45% 증가하였다. 일곱째, 모형내의 나머지 독립변수들에 의한 영향을 통제한 후 재발경험 유무에 영향을 미치는 요인을 분석하고, 비차비를 산출하기 위하여 로지스틱 회귀분석을 실시한 결과 A.A.모임에 한달 이상 빠진 경험이 있는 경우에 비차비가 4.68배로서 재발경험이 유의하게 높았으며, 메시지 전달 후 인도한 사람수가 많을수록 비차비가 0.78배로서 재발경험이 유의하게 낮았다. 이 요인들의 회귀계수 방향은 예측했던 것과 일치하였으며, 구축된 연구모형은 모수의 적합도 검정 결과 유의하였다. 이상의 연추결과에 의하면 A.A.프로그램에 참여함으로써 음주로 인한 비정상적인 행동이 교정될 뿐만 아니라 의료비 및 술값에서 비용절감의 효과가 있었으며, 의료이용횟수 및 기간이 감소함으로써 의료이용 측면에서도 효과가 있음을 알 수 있었다. 또한 A.A.에 가입한 후에는 A.A.모임 참여정도 및 A.A.프로그램 내용(12단계)의 실천정도에 따라서 프로그램의 효과가 차이가 있었는데, 특히 A.A.프로그램의 실천 12단계 중에서 제11단계인 기도와 명상을 실천하는 것과 메시지 전달 후 알콜중독자를 A.A.모임에 인도하는 제12단계를 실천하는 것이 단주를 지속하는데 중요한 요인이라는 결론을 얻었다. 따라서 이와 같은 요인들에 대한 적절하고 효율적인 관리와 통제를 통하여 오랫동안 재발없이 단주상태를 유지할 수 있을 것으로 생각된다. 본 연구는 단면연구의 틀로 A.A.가입 전과 후의 효과를 평가하였는데, 앞으로 A.A.프로그램에 참여하지 않고 있는 알콜중독자를 대상으로 전향적연구설계 하에서 A.A.가입 전과 후의 프로그램의 효과를 정확하게 평가하여 실증적인 자료를 제시함으로써 알콜중독인 사람들이 자활단주프로그램에 보다 많이 참여하여 단주를 실천하고, 삶의 질을 향상시킬 수 있도록 기본여건을 마련하는 일이 중요하므로 이를 위한 노력이 요구된다. [영문] In this study, we have evaluated the effect of Self Help Sobriety(A.A.)Program in Korea. This study investigates the efficacy of the A.A. Program on sobriety, socio-pathological behaviors, alcohol consumption expense, health care expense and includes the members' own evaluations of the A.A. Program. This five aspects were studied in 3 different steps, firstly, the comparison before and after the entry to the program, secondly, after the entry to the program, the comparison of the differences by their participation and practice of the program and finally we compared the effects of the variables of their A.A. participation on the sobriety aspects. The study group was the members of the 30 different A.A. group in Korea. We made the organized self-writing questionnares for this study. We studied the whole 300 members through visiting and mail system. The return was about 70%. The sobriety aspects were the longevity of the sobriety and relapse rate, the expense aspects were health expense and alcohol consumption expense. The socio-pathological behaviors include 16 abnormal behaviors and its tonal numbers and the health care aspects were examined in the number of visits to the health care facilities and the duration of the hospital stays. The self-evaluation of the A.A. Program includes 7 items on physical aspects, 6 on social, 19 on the mental aspects. The desgree of the effects were 5 points system. 1. A socio-pathological study of sixteen different abnormal behaviors. caused by alcohol abuse, such as the experience(s) of police arrest and detention; hostile arguments with passers-by in public; physical abuse against family members; sleeping in public streets; and black-outs showed a substantial decrease in these incidents after their entrance into the program by an average of 5 incidents and a maximum decrease of 32 incidents in one individual. 2. A comparison of drinking and medical expenses revealed statistically significant differences in monthly medication expenses, average hospital admission expenses, and monthly alcohol consumption expenses. It was estimated that the average decrease in medical and drinking expenses was 578,537 won per year following entrance into the program. 3. A comparison in the frequency of visits to health care facilities including monthly visits to the pharmacy, admissions to the internal medicine ward, admissions to the psychiatric ward, and the length of stay for both types of in-patient admissions showed statistically significant differences. Subsequent to entry into the A.A. program, there were substantial decreases in monthly pharmaceutical visits (2.88), out-patient visits (0.17), in-patient internal medicine ward admissions (1.10), and in-patient psychiatric ward admissions (1.33). The number of days hospitalized in the in-patient internal medicine ward and the in-patient psychiatric ward was also decreased by 19.92 days and 79.45 days respectively. The program was effective in shortening overall in-patient hospitalization duration. 4. A comparison of the program attendance rates and the practice of the A.A. program's 12 Steps in relation to the effectiveness of the Program were examined, The comparison revealed that the unbroken sobriety period was 77.4 months longer for the A.A. members who had been involved in the program for more than 3 years; 15.7 months longer for members who had experienced delivering the A.A. message to others (12th Step); and 12.7months longer for the members who had never experienced the occurrence of relapse. The frequency of relapse was significantly lower in the group of members who did not miss meetings at a rate of more than 11 meeting per month (5.8) and in the group of members who did not miss meetings for longer than one month(4.8). The total number of abnormal behavior incidents was significantly lower in the group who attended more than 10 meetings per month (6.44); 7.30 incidents lower in the group who did not miss A.A. meetings for more than one month; and 7.62 lower in the no relapse group, In this no relapse group, the monthly expense was significantly lower in the area of drug cost (3,491 won), out-patient cost (23,342 won) and hospital admissions cost (87,047 won). The number of out-patient visits was significantly lower in the group with no relapse by a rate of0.41 per month, and the total number of psychiatric admissions was 1.33 lower in the group with a meeting attendance rate of11 or more per month and 2.08 lower in the group who did not miss meetings for more than one month, and 2.18 lower in the no relapse group, The number of days of psychiatric in-patient admissions was 41.44 days shorter in the group who did not miss meetings for more than one month and 43.28 days shorter in the no relapse group. 5. The self-evaluation that self-evaluation during the attendance period and the practice of the 11th and 12th steps had the greatest potential in regards 7o the effectiveness of the program. The group with 3 or more years in the program responded with positive improvement in physical, social, and mental aspects. The group who practiced the 11th step of prayer and meditation regularly indicated positive improvement in the mental aspects of their lives and those who practiced the 12th step indicated positive improvement in both social and mental aspects of their lives. 6. following the control of the other variables in this model, we have studied a linear multiple regression analysis to find the size of the influence and direction of the independent variables over the sobriety period. Following the control of individual characteristic factor, the marital status affected significantly over the sobriety period in the reduced Model 1. The direction of regression coefficient was consistent with the prediction. The constructed reduced Model I was significant and we could explain the 9% of the continuous sobriety period in terms of the three selected variables. In the Model Ⅱ, where A.A. related factors were added into the individual characteristic factors, the practice of the 11th step of prayer and meditation significantly affected the continuous sobriety period and the direction of regression coefficient was consistent with the prediction. The constructed Model Ⅱ was statistically significant and 54% of the sobriety period could be explained in terms of the selected 9 variables, Therefore, by the addition of A.A. related factors to the individual characteristic factors, the explicability was increased by 45%. 7. We have analyzed the factor(s) which influence relapse after control of the influence of the other independent variables, and performed logistic regression analysis to calculate the odds ratio. There was a significant increase in relapse of 4.68 times in the group who missed meetings for over a one month period and a 0.78 times relapse rate was noted in the group who practiced the12th step more. The direction of the regression coefficient was consistent with prediction and the constructed study model was significant after the assessment of the fitness of the parameter. In summary, participation in the A.A. program reduced abnormal behaviors induced by alcohol abase, and decreased medication and alcohol consumption expenses; frequency of health care facility visits; and length of in-patient health care facility admissions. Consequently, there was an overall positive effect in terms of health care. furthermore, the study reveals that subsequent to the members entrance into the program, frequency of meeting attendance and the practice of the 12 steps were the primary factors which gave rise to the positive differences. In particular, the practice of the 11th step of prayer and meditation proved to be a most effective and important factor in the maintenance of sobriety. It is our conclusion, therefore, that the adequate and effective management and control of such factor(s) will maintain long term sobriety without relapse. As across-sectional study, this comparison survey evaluated several aspects of the member's lives before and after entry into the A.A. program. It is necessary to survey alcoholics who did not ender the program and to compare the two groups in different models and review the differences between the two groups to present accurate and realistic data. This data may prove that the self-help program (A.A.) can help to maintain long term sobriety and improve the quality of life of its members. To accomplish this, further study is required.restrictio

Synthesis and Characterization of Cyclic polymer by using HPLC and its Intrinsic viscosity property

DoctorCyclic polymers exhibit unique topological effects on physical properties such as chain dimensions, viscoelastic properties and chain dynamics. Various properties of cyclic polymers have been predicted by theoretical studies and computer simulations and examined by experimental studies. Typically, cyclic polymers are prepared by end-linking telechelic linear precursors, but contamination with linear polymers due to incomplete ring-closure reactions or side reactions to the targeted cyclic polymer is usually unavoidable. The purity of the cyclic polymers strongly affects their physical properties, but the effect of the purity of the polymers on their physical properties is not understood well due to the difficulty in obtaining highly pure cyclic polymers. Since direct synthesis of pure cyclic polymers is difficult, to obtain cyclic polymers with high purity, post-synthesis purification is necessary. To fractionate cyclic polymers from a ring-closure reaction mixture, two methods have been employed most often: fractional precipitation and Size Exclusion Chromatography (SEC) fractionation. None of the methods has been fully successful in separating the cyclic polymers from the side products. The SEC retention times of a cyclic polymer and its linear precursor are not sufficiently different to provide complete resolution of the elution peaks that also suffers from serious band broadening of SEC. Ultracentrifugation sedimentation can be more successful than SEC in separating cyclic polymers from the linear precursor, but it is impractical even for a lab scale fractionation. In this thesis research, cyclic polystyrenes were prepared by end-linking telechelic linear precursors with wide range of molecular weights. All as-synthesized cyclic polymers were characterized and fractionated by HPLC (High Performance Liquid Chromatography) methods. Using the cyclic polymers of high purity, we compared the HPLC retention behaviors of cyclic vs. linear polymer and characterized the intrinsic viscosity of cyclic polymer in good solvent. In chapter 1, various methods to synthesize cyclic polymers are described and methods to characterize cyclic polymers are briefly reviewed. In chapter 2, the synthesis method and basic principle of the characterization methods used in this thesis are described in detail. In chapter 3, HPLC elution behaviors of cyclic and linear polymer are investigated by using a series of polystyrene precursors with Mw = 16.4 kg/mol, 33.1 kg/mol, 64.6 kg/mol, and 92.2 kg/mol. Their retention behavior in reversed phase liquid chromatography (RPLC) at the critical absorption point (CAP) was investigated using a C18-bonded silica stationary phase and a mixed solvent of CH2Cl2 and CH3CN. The CAP of cyclic PSs (C-PS) occurred at a higher temperature (TCAP) than linear PSs (L-PS). At TCAP of linear PSs, cyclic polymers elute later than their counterpart linear PS in the increasing order of MW like the elution sequence in interaction chromatography (IC) mode. At the TCAP of cyclic PSs, linear polymers elute earlier than cyclic polymers in the decreasing order as in SEC mode. The experiment results concur well with computer simulation results using the Random Walk (RW) model. In addition, the normal phase LC (NPLC) retention behavior at the CAP of each polymer was investigated using a bare silica stationary phase and a mixed solvent of THF and Hexane. While C-PS eluted later than L-PSs at the CAP of each polymer as in RPLC, the TCAP of C-PS was lower than that of L-PS in contrast to the RPLC result. Therefore the L-PSs eluted in the increasing order of Mw as in IC mode at the CAP of C-PS and C-PSs eluted in SEC mode at the CAP of L-PS. The inversion of TCAP of C-PS and L-PS in NPLC is not predicted in the computer simulation result and it is seemingly due to the contribution of the end-funtionality that is not reflected in the computer simulation. In chapter 4, each part of cyclic PS and linear PS (L-PSs) containing dimeric and high Mw PSs were fractionated using liquid chromatography at the critical condition (LCCC). Fractionated C-PSs with purity > 99% was used to measure intrinsic viscosities of C-PSs and L-PSs (from 16k to 370k) in tetrahydrofuran (THF), a good solvent for PS. Exponent of the Mark-Houwink-Sakurada (MHS) relationship was 0.67 for C-PSs and 0.70 for the L-PS. Therefore, the ratio of the intrinsic viscosity (g’-factor) of C-PS to L-PS in THF is a function of Mw (0.622 ≥ [η]C/[η]L ≥ 0.572). In chapter 5, we synthesized telechelic ABA triblock copolymer of polystyrene and polyisoprene as A and B block, respectively. The synthesis of AB cyclic copolymer is accomplished by coupling reaction of chain ends of the telechelic ABA triblock copolymer. HPLC was employed for the separation and characterization of as-synthesized cyclic AB diblock copolymer. And, we compared the morphology of linear triblock copolymer and cyclic diblock copolymer by T-SAXS experiment

preparation and characterization of complex cyclic polymers by high performance liquid chromatography

1

HPLC Retention behavior of Linear vs. Cyclic Polymer

2

Characterization of Synthesized Cyclic Poly(ethylene Oxide) by Liquid Chromatography at the Critical Condition

2

Study on harmful effects of exogenous 8-hydroxydeoxyguanosine in KG-1 cells with impaired function of OGG1, a repair enzyme for 8-hydroxyguanine in DNA

학위논문(박사)--서울대학교 대학원 :의학과 약리학전공,2001.Docto

디지탈 거리 영상화 센서 및 방향 탐지 센서에 관한연구

Maste

HPLC Retention behavior of Linear and Cyclic Polymer

2