In December 2019, a novel coronavirus, which is now designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified as the etiology of pneumonia of unknown cause in patients from Wuhan of central China. Since the first report of coronavirus disease 2019 (COVID-19), the disease became pandemic causing the large-scale outbreak all over the world. In this review, we discuss the clinical and epidemiological characteristics of COVID-19 in the early stage of outbreak based on recent reports from China. (Korean J Med 2020;95:67-73)

최근 20여년간 신종 및 재출현 감염병에 의한 유행이 세계적으로 인류에게 직접적인 보건의 위해를 끼침과 동시에 막대한 사회, 경제 피해를 초래하는 경우가 점차 빈발하고 있다. 신종감염병의 약 75%는 인수공통 또는 매개체 관련 감염병이 차지할 정도로 인수공통전염병이 주요 원인이 되고 있다. 인수공통전염병은 사람 감염병의 약 60%를 차지하기도 하며, 특히 최근 문제가 되고 있는 신종감염병의 거의 대부분이 야생동물로부터 유래된 바이러스가 원인이다. 대표적인 신종감염병인 1997년 H5N1 조류인플루엔자바이러스, 2003년 사스코로나바이러스, 2009년 H1N1 신종인플루엔자바이러스, 2012년 중동호흡기증후군(MERS) 코로나바이러스 등은 각각 야생 철새, 사향고양이, 돼지 및 낙타등이 자연계 병원소 또는 중간 증폭 숙주로 작용하여 사람감염을 초래하였다. 신종인수공통감염병의 대두는 병원균, 사람 및 환경적 요인들의 변화에서 비롯되고 있다. 병원균은 유전적 적응변화를 통하여 사람 감염 및 확산 전파능력을 획득하고 있으며, 사람의 요인으로는 인구학적 변화(노령화, 면역저하환자 증가 등), 행동의 변화, 국제교역 및 여행 증가, 생물테러, 항생제의 남용 등이 원인이 되고 있다. 환경요인으로는 기후 및 날씨변화(온난화 등), 생태계의 변화, 경제개발과 밀림 파괴, 가난과 사회 불평등, 도시집중화, 공중보건체계의 미비, 전쟁, 정치적 의지의 부재 등이 기여하고 있다. 특히 밀림에 있는 야생동물로부터 가축으로 신종병원균의 전파, 그리고 종간벽을 넘어서 사람이 감염되고, 종래에 사람-사람간 전파가 지속되어 세계적인 유행으로 치닫는 것이 전형적인 인수공통신종전염병의 출현 기전이다. 대표적으로 1981년에 시작된 HIV, 2003의 SARS-CoV 대유행이 좋은 본보기이다. 또한 모기, 진드기 등 매개체(vector) 관련 감염병이 지구 온난화, 국제교역 및 여행증가, 도시집중화 등 요인에 의하여 더욱 빈발해지고 광범위한 지역으로 확산되는 추세이다. 대표적으로 웨스트나일, 뎅기, 치쿤군야 및 지카바이러스 등의 출현 및 확산이 문제되고 있다. 신종인수공통감염병의 대두에 대한 대응전략으로는 사람-동물 접점에서의 감시체계를 통한 조기 발견, 신속 대응이 필수적인데 특히 신종감염병의 출현 빈도가 높은지역(hot-spot)을 겨냥한 집중감시가 필요하다. 인수공통감염병의 대응에는 임상, 동물 및 생태학 등 다양한 전문영역의 다학제 협력이 필수적이다. 정부도 보건부, 농림부, 환경부, 과학부 등 여러부처 기관들의 협업이 신종인수공통전염병의 통제 및 피해 죄소화에 중요하다. 또는 WHO, OIE 등 국제 보건기구와의 정보교환 및 공조를 통하여 세계적인 인수공통전염병의 발생을 파악하고, 예방 및 관리에 노력을 기울여야 한다. 신종인수공통전염병의 출현, 사람에의 전파 및 확산, 그리고 대유행에 이르기 까지 매우 복잡, 다단한 요인들이 개재되기 때문에 “One Health”라는 거시적, 포괄적 안목에서 사람, 동물 및 환경의 생태, 진화적관계에서 예방 및 관리 대비·대응 전략이 필요하다. 본 강의에서는 신종인수공통전염병의 발생현황, 대두요인, 영향 및 발생기전을 살펴보고, 국가적인 대비·대응 전략을 논의하고자 한다.

2019년 12월에 중국 후베이성 우한시에서 원인 미상 폐렴이 무리 지어 발생하기 시작하였다. 환자의 하기도에서 이전에 알려지지 않은 새로운 코로나바이러스가 분리되었으며 severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)로 명명되었다. 세계보건기구는 SARS-CoV-2에 의한 질병을 코로나바이러스감염증-19(coronavirus disease 2019, COVID-19)로 명명하였다. 2020년 3월 11일에 COVID-19는 전세계 최소 114국으로 퍼졌으며 약 4,000명이 사망하여 세계보건기구는 COVID-19가 세계적 대유행임을 선언하였다. 지난 20년 동안 새로운 코로나바이러스에 의한 두 번의 유행이 있었다. 2002-2003년 중증급성호흡기증후군(severe acute respiratory syndrome, SARS) 유행 시에는 8,098명의 확진 환자와 774명의 사망자가 발생하였으며, 2012년에 사우디 아라비아에서 시작되어 현재까지 주로 아라비아 반도에서 발생하고 있는 중동호흡기증후군(Middle East respiratory syndrome, MERS)는 2019년까지 총 2,499명의 환자와 858명의 사망자를 발생시켰다. 본 종설의 목적은 2020년 3월 12일까지 알려진 SARS-CoV-2의 특징과 전파 양상 및 COVID-19의 임상 증상을 알아보고 SARS와 MERS와의 유사점 및 차이점에 대하여 간략하게 소개하는 것이다.

A cluster of severe pneumonia of unknown etiology in Wuhan City, Hubei province in China emerged in December 2019. A novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was isolated from lower respiratory tract sample as the causative agent. The current outbreak of infections with SARS-CoV-2 is termed coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO). COVID-19 rapidly spread into at least 114 countries and killed more than 4,000 people by March 11, 2020. WHO officially declared COVID-19 a pandemic on March 11, 2020. There have been 2 novel coronavirus outbreaks in the past 2 decades. The outbreak of severe acute respiratory syndrome (SARS) in 2002-2003 caused by SARS-CoV had a case fatality rate of around 10% (8,098 confirmed cases and 774 deaths), while Middle East respiratory syndrome (MERS) caused by MERS-CoV killed 858 people out of a total 2,499 confirmed cases between 2012 and 2019. The purpose of this review is to summarize known-to-date information about SARS-CoV-2, transmission of SARS-CoV-2, and clinical features of COVID-19.

Purpose: The purpose of this study was to evaluate the effect of abdominal massage on alleviating pain caused by the injection of recombinant gonadotropin for In Vitro Fertilization (IVF) among infertile women. Methods: This study employed a nonequivalent control group non-synchronized design. A total sample of 149 infertile women who never experienced in vitro fertilization was recruited at C fertility center. Seventy women were assigned into experimental group and 79 into controls. The experimental group had been informed to do abdominal massage prior to the injection and to record their subjective pain using visual analogue scale. The control group had been informed to record their subjective pain in the same way just after the injection. Results: Compared to the pre-tested pain scores, the pain scores in experimental group were significantly reduced by 0.7 points, whereas the control group increased by 0.9 points (t=-4.55, p=.001). Conclusion: This study confirms that the use of abdominal massage prior to the injection is an effective way to alleviate pain on injection site. This massage may be a useful intervention for infertile women about pain alleviation.

Roy의 Adaptation Model은 University of California에서 석사학위 과정 중에 기초가 만들어졌다. 적응모형의 과학적 기초는 System theroy와 Ddaptation level이론에서 나온 가설에 근거한다. 로이는 Dorothy E. Johnson의 영향을 많이 받았으며, 인문학, 자연과학, 사회과학의 연구로부터 많은 영향을 받았다. 또한 소아과 간호사로 근무하면서 아동간호학에 대한 임상실무에서 많은 경험을 얻었다. 1970년 로이 적응모형의 첫 출판물이 간행되었는데, 그 당시 로이는 인문대학의 간호학부 교수로 있을 때였으며, 그때 간호교육과정에 적응이론을 적용할 기회가 있었다. 그 후 10년 동안 Mount St. Mary`s College에서 로이 간호적응모형의 기본개념을 개발하고, 정련화하고 구체화하는 작업이 이루어졌다.

Roy adaptation model is based on general system theory and adaptation level theory. The scientific assumptions reflect the Von Bertalantfy general system theory and Helson`s adaptation-level theory. The philosophic assumptions on which the model is based are associated with humanism and veritivity. Roy describes the recipient of nursing care in terms of a holistic adaptive system(Roy, 1984). In her description of the person, inputs have been termed stimuli and may come externally from the environment (external stimuli) and internally from the self (internal stimuli). Certain stimuli pool to make up a specific input, the person`s adaptation level. The person`s response (output) is thus a function of the input stimuli and the person`s individual adaptation level. The Roy Adaptation Model for Nursing describes three classes of stimuli that form the person`s environment. It is the focal stimuli, the contextual stimuli and the residual stimuli. The focal, contextual, and residual stimuli pool to make up the person`s adaptation level. Adaptation level is the name given to the changing point that represents the person`s ability to respond positively in a situation. Roy has developed 4 adaptative mode, the physiological, the self-concept the role function and the inter dependence modes. The reponses may be either adaptive and thus promoting the integrity or wholeness of the person. The second major concept of a nursing model, environment is describe as the world within and around the person. According to Roy, environment includes all conditions, circumstances, and influences that surround and affect the development and behavior of the person. These influencing factors are categorized as focal, contextual, and residual stimuli. Health is a state and a process of being and becoming an integrated and whole person. It is a reflection of adaptation, that is, the interaction of the person and the environment. Nursing acts to promote this adaptation. The goal of nursing is stated as the promotion of adaptation in each of the four modes. In promoting adaptation, the nurse contributes to the person`s health, quality of life, and dying with dignity.

Purpose: The purpose of this study was to investigate the effects of thermotherapy on gas pain, post-operative resilience, and body temperature discomfort among patients who received laparoscopic myomectomies.
Methods: The experimental group consisted of 62 patients with thermotherapy and the control group consisted of 60 patients. Thermotherapy was applied individually to the experimental group four hours after surgery. The collected data was analyzed using descriptive statistics, t-tests, χ2-tests, and repeated measures of analysis of variance, using IBM SPSS Statistics version 18.
Results: The results showed no significant interaction effect between the group and time of measurement in gas-related pain in the experimental group. For gas-related pain, there was significant difference in right shoulder pain at 24 hours (t=-4.222, p=.000), 48 hours (t=-3.688, p=.000), 72 hours (t=-2.250, p=.028), and left at 24 hours (t=-3.727, p=.000), 48 hours (t=-4.150, p=.000), and 72 hours (t=-2.482, p=.016) and both shoulders at 24 hours (t=-2.722, p=.009) and 48 hours (t=-2.525, p=.014). There was no significant difference in epigastric pain, excluding both epigastric pain at 48 hours (t=2.908, p=.005), 72 hours (t=3.010, p=.004), but there was a significant difference in objective body temperature discomfort (t=2.895, p=.008)
Conclusion: Thermotherapy relieved shoulder gas-related pain and objective body temperature discomfort. It needs to be developed and applied to improve post-operative discomfort in patients with laparoscopic hysterectomies.

Purpose: This study aimed to compare the knowledge, attitude, and practice related to handwashing among undergraduate students majoring and not majoring in health science. Methods: This descriptive study included 188 undergraduate students with 100 majoring and 88 not majoring in health science. Data were collected using a structured questionnaire and they were analyzed with the IBM SPSS 24.0 program using descriptive statistics, t-tests, Pearson’s correlation coefficients and a multiple regression. Results: Mean scores on knowledge and attitude toward handwashing were 13.86±1.56 and 21.05±2.34 respectively in students majoring health science, whereas the same were 13.22±1.73 and 19.76±2.24 in students not majoring health science respectively. In both groups, there was significant correlations between knowledge and attitude (r=.32, p<.001; r=.33, p=.002), and between attitude and practice (r=.27, p=.006; r=.40, p<.001) respectively. Attitude toward handwashing (β=0.20, p=.028), experience of education about handwashing (β=0.33, p<.001) and perception about health status (β=-0.23, p=.014) were significant predictors of handwashing practice in students majoring health science. On the other hand, only attitude toward handwashing (β=0.37, p<.001) was a significant predictor of handwashing practice in students not majoring health science. Conclusion: The present results reveal the importance continuing various educational programs on handwashing and the need to identify their longitudinal effects to improve handwashing practice among students majoring in health science. Additionally, when developing strategies to improve handwashing habits, we need to consider factors that could help change attitudes toward handwashing.

Purpose: The objective of this study was to investigate the prevalence of antenatal depression in pregnant women and its influencing factors.
Methods: With a cross-sectional survey design, a total of 396 pregnant women were recruited from a local obstetrics and gynecology clinic. Measurements included antenatal depression, perceived stress, predictors of depression during pregnancy, and demographic and obstetric characteristics.
Results: Mean antenatal depression score was 8.20 (standard deviation=4.95) out of 30, falling into its normal range. However, the prevalence of antenatal depression was 35.9% when cut-point of 9/10 was used. The prevalence of antenatal depression among women in the first trimester was 31.4%. It was slightly increased to 34.9% in the second trimester but significantly increased to 40.5% in the third trimester. In multiple logistic regression analysis, experiencing prenatal anxiety (odds ratio [OR], 4.16), having no job (OR, 2.90), lower self-esteem (OR, 1.62), and higher perceived stress (OR, 1.32) were significant factors influencing antenatal depression.
Conclusion: Negative feeling such as feeling anxious, lower self-esteem, and higher perceived stress during pregnancy are key factors affecting antenatal depression. Thus, antenatal nursing intervention focusing on pregnant women's feeling upon their job status is necessary to improve their antenatal psychological well-being.