제20대 대선을 중심으로

학위논문(석사) -- 서울대학교대학원 : 사회과학대학 정치외교학부(정치학전공), 2023. 8. 강원택.본 연구는 제20대 대통령 선거에서 새롭게 대두된 청년 여성 민주당 지지, 청년 남성 보수당 지지와 같은 유권자 사이의 젠더갈등이 앞으로 우리나라 선거에서 정치적 균열로 대두될 수 있는가에 대한 질문에서 시작되었다. 질문에 대한 답을 찾아가는 과정에서 지금까지 한국에서의 정치균열로서의 젠더갈등에 대한 논의는 대부분 사회구조적인 접근법에 초점 맞추어 왔으며, 이는 최근에 등장한 현상을 충분히 설명하기 어렵다는 한계를 발견하였다. 기존 연구의 한계를 극복하고자 본 연구에서는 정치균열로서의 갈등의 문제를 사회구조적인 문제가 아닌 정치적인 요소로 설명하고, 이를 통해 젠더갈등이 과연 우리나라의 정치균열로까지 자리매김할 수 있는지에 대한 답을 내리고자 한다. 젠더갈등을 정치적 요인으로 분석해내기 위해 선택한 이론적 접근법은 정당동원론이다. 해당 접근법에서 정당은 단순히 정치적 균열의 영향을 받는 수동적인 존재가 아닌 유권자를 동원하는 능동적인 행위자로 간주된다. 즉, 정당은 선거에서 승리하기 위해 정치갈등을 적극적으로 활용하고, 유권자는 이에 반응하면서 상호관계를 형성하게 되는 것이다. 본 연구에서는 제20대 대통령 선거에서 정당과 유권자의 관계를 확인하기 위해 커뮤니티 담론 분석을 진행하였다. 유권자의 반응을 확인할 수 있는 다양한 분석적 틀 중에서 커뮤니티 담론 분석을 선택한 이유는 제20대 대통령 선거에서 정당 및 후보자가 20·30 청년세대 동원을 위한 방안으로 커뮤니티를 적극적으로 활용하였기 때문이다. 커뮤니티 담론 분석은 선거에서 청년 유권자들의 지지율 변화에 큰 영향을 미쳤다고 생각되는 몇 가지 쟁점을 중심으로 이루어졌다. 분석 결과 더불어민주당과 국민의 힘 모두 청년 세대를 동원하기 위해 많은 노력을 하고 있었으며, 정당의 정치적 요인에 따라 성별, 세대별 유권자들의 반응이 상이함을 확인할 수 있었다. 특히, 선거가 다가올수록 더불어민주당은 청년 여성 유권자, 국민의 힘은 청년 남성 유권자를 더 적극적으로 동원하고자 하였고, 정당의 동원 정책의 변화에 따라 유권자들의 반응 역시 달라짐을 확인하였다. 담론 분석 이후에는 청년세대의 반응이 선거의 후보자 선택까지 이어졌는지를 확인하기 위해서 여론조사와 대선패널조사의 데이터를 활용하여 여론조사 시기별 지지율의 변화 추이와 성별이 후보자 호감도에 미치는 영향을 분석하였다. 해당 분석 과정을 통해 20·30 청년 유권자의 지지율이 정당의 동원전략과 같은 방향으로 가고 있음을 알 수 있었다. 특히, 대선패널조사 결과를 활용한 회귀분석 결과에서 여론조사에서 볼 수 있었던 정당의 유권자 동원 과정과 비슷한 결과가 확인되면서, 제20대 대통령 선거에서 등장한 2030 청년세대의 젠더갈등은 정당의 유권자 동원을 목적으로 한 정치적 요인의 결과로 등장한 것임을 확인할 수 있었다. 이러한 결과는 앞으로의 선거에서 정당에 동원되는 사회 갈등과 유권자가 다양한 형태로 변할 수 있다는 가능성을 내포한다는 점에서 연구적 함의를 지닌다고 할 수 있다.This study began with the question: "Can the gender divide among voters, such as the emergence of young women's support for the Democratic Party and young men's support for the Conservative Party in the 20th presidential election, emerge as a political fissure in future elections in South Korea?" While seeking an answer to this question, we realized that most of the discussions on gender conflict as a political fissure in Korea have focused on socio-structural approaches, which have the limitation of not fully explaining this recently emerged phenomenon. In order to overcome the limitations of existing research, this study attempts to explain the problem of gender conflict as a political fissure as a political factor rather than a socio-structural problem and to answer whether gender conflict can be established as a political fissure in Korea. The chosen theoretical approach to analyze gender conflict as a political factor is 'party mobilization theory.' In this approach, political parties are viewed as active actors that mobilize voters, rather than passive entities that are simply affected by political fissures. In other words, political parties actively use political conflict to win elections, and voters react to it and form a mutual relationship. In this study, we conducted a community discourse analysis to examine the relationship between political parties and voters in the 20th presidential election. Among various analytical frameworks to examine voter responses, we chose community discourse analysis because political parties and candidates actively used community as a way to mobilize young people in their 20s and 30s in the 20th presidential election. The community discourse analysis focused on several issues that we believe had a significant impact on the change in support among young voters in the election. We found that both the Democratic Party and the Conservative Party were making great efforts to mobilize the younger generation, and that voters' responses varied by gender and generation depending on the political factors of the parties. In particular, as the election approached, the Democratic Party tried to mobilize young female voters, and the Conservative Party tried to mobilize young male voters more actively. We found that voters' responses varied as the parties' mobilization policies changed. After analyzing the discourse, we examined the changes in approval ratings over time and the impact of gender on candidate preferences using data from opinion polls and presidential panel surveys to determine whether young people's responses led to their choice of candidates. In particular, the regression analysis using the results of the presidential panel survey confirmed similar results to those seen in the opinion polls, suggesting that the gender conflict among the 2030s emerged in the 20th presidential election as a result of political factors aimed at mobilizing voters. These results have research implications as they suggest the possibility that social conflicts and voters mobilized by political parties in future elections may change in various ways.제 1 장 서론 1 제 1 절 정당과 유권자 3 제 2 절 새로운 유권자의 등장 5 제 2 장 기존 연구 검토 및 대안적 분석틀 7 제 1 절 기존 연구 검토 7 1. 정치균열 7 2. 정치균열로서의 젠더 10 제 2 절 대안적 분석틀 : 정치동원이론 13 제 3 장 한국 정치 지형의 변화 15 제 1 절 구조의 변화 16 1. 균열구조의 변화 16 2. 이념의 변화 19 제 2 절 정당의 유권자 동원 23 1. 새로운 세대의 등장 : 2030 청년세대 27 2. 새로운 이슈의 등장 : 젠더갈등 30 제 4 장 정당의 유권자 동원 과정 33 제 1 절 정당의 동원과 유권자 반응 35 1. 이재명 후보와 청년 여성 유권자 36 2. 윤석열 후보와 청년 남성 유권자 42 제 2 절 정당의 유권자 동원 결과 46 1. 여론조사를 통한 가설 검증 47 2. 대선패널조사를 통한 가설 검증 52 제 5 장 결론 55 참고문헌 58 Abstract 68석

Comparison of two different doses of single bolus steroid injection to prevent atrial fibrillation recurrence after radiofrequency catheter ablation

PURPOSE: Steroids may play a role in preventing the early recurrence of atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA). However, optimal doses and route of steroid delivery have not yet been determined. This study evaluated the effect of two different doses of a single bolus injection of steroids on AF recurrence after RFCA. MATERIALS AND METHODS: Of 448 consecutive AF patients who underwent RFCA, a single steroid bolus was injected into 291 patients. A low-dose steroid group (n=113) received 100 mg of hydrocortisone and a moderate-dose steroid group (n=174) received 125 mg of methylprednisolone. We used propensity-score matching to select patients as follows: control (n=95), low-dose (n=95), and moderate-dose steroid groups (n=97). RESULTS: Pericarditis developed in 1 (1.1%) control patient, 2 (2.1%) low-dose patients and 0 moderate-dose patients. Maximum body temperature and C-reactive protein were significantly decreased in the moderate-dose steroid group compared to the other groups (p<0.01). The number of patients of early AF recurrence (≤3 months) did not differ among three groups. Early recurrence was 24 (25%) in the control, 24 (25%) in the low-dose and 25 (26%) in the medium-dose groups (p=0.99). Compared with control group, low-dose or moderate-dose steroid treatment did not effectively decrease mid-term (3-12 months) AF recurrence [22 (23%) vs. 23 (24%) vs. 18 (19%); p=0.12]. CONCLUSION: A single injection of moderate-dose steroid decreased inflammation. However, single bolus injections of low-dose or moderate-dose steroids were not effective in preventing immediate, early or midterm AF recurrence after RFCA.ope

Predictors of Long-Term Outcomes of Percutaneous Mitral Valvuloplasty in Patients with Rheumatic Mitral Stenosis.

PURPOSE: We determined factors associated with long-term outcomes of patients who underwent successful percutaneous mitral balloon valvuloplasty (PMV). MATERIALS AND METHODS: Between August 1980 and May 2013, 1187 patients underwent PMV at Severance Hospital, Seoul, Korea. A total of 742 patients who underwent regular clinic visits for more than 10 years were retrospectively analyzed. The endpoints consisted of repeated PMV, mitral valve (MV) surgery, and cardiovascular-related death. RESULTS: The optimal result, defined as a post-PMV mitral valve area (MVA) >1.5 cm² and mitral regurgitation ≤Grade II, was obtained in 631 (85%) patients. Over a mean follow up duration of 214±50 months, 54 (7.3%) patients underwent repeat PMV, 4 (0.5%) underwent trido-PMV, and 248 (33.4%) underwent MV surgery. A total of 33 patients (4.4%) had stroke, and 35 (4.7%) patients died from cardiovascular-related reasons. In a multivariate analysis, echocardiographic score [p=0.003, hazard ratio=1.56, 95% confidence interval (CI): 1.01-2.41] and post-MVA cut-off (p<0.001, relative risk=0.39, 95% CI: 0.37-0.69) were the only significant predictors of long-term clinical outcomes after adjusting for confounding variables. A post-MVA cut-off value of 1.76 cm² showed satisfactory predictive power for poor long-term clinical outcomes. CONCLUSION: In this long-term follow up study (up to 20 years), an echocardiographic score >8 and post-MVA ≤1.76 cm² were independent predictors of poor long-term clinical outcomes after PMV, including MV reintervention, stroke, and cardiovascular-related deathope

Impact of Ambulatory Blood Pressure on Early Cardiac and Renal Dysfunction in Hypertensive Patients without Clinically Apparent Target Organ Damage

PURPOSE: Impaired left ventricular (LV) global longitudinal strain (GLS) and the presence of microalbuminuria indicate early cardiac and renal dysfunction. We aimed to determine the relationships among 24-h ambulatory blood pressure (BP) variables, LV GLS, and urine albumin creatinine ratio (UACR) in hypertensive patients. MATERIALS AND METHODS: A total of 130 hypertensive patients (mean age 53 years; 59 men) underwent 24-h ambulatory BP monitoring, measurements of peripheral and central BPs, and transthoracic echocardiography. Patients with apparent LV systolic dysfunction (LV ejection fraction <50%) or chronic kidney disease were not included. LV GLS was calculated using two-dimensional speckle tracking, and UACR was analyzed from spot urine samples. RESULTS: In simple correlation analysis, LV GLS showed the most significant correlation with mean daytime diastolic BP (DBP) (r=0.427, p<0.001) among the various BP variables analyzed. UACR revealed a significant correlation only with night-time mean systolic BP (SBP) (r=0.253, p=0.019). In multiple regression analysis, daytime mean DBP and night-time mean SBP were independent determinants for LV GLS (beta=0.35, p=0.028) and log UACR (beta=0.49, p=0.007), respectively, after controlling for confounding factors. Daytime mean DBP showed better diagnostic performance for impaired LV GLS than did peripheral or central DBPs, which were not diagnostic. Night-time mean SBP showed satisfactory diagnostic performance for microalbuminuria. CONCLUSION: There are different associations for daytime and night-time BP with early cardiac and renal dysfunction. Ambulatory BP monitoring provides more relevant BP parameters than do peripheral or central BPs regarding early cardiac and renal dysfunction in hypertensive patients.ope

Differences in left ventricular functional adaptation to arterial stiffness and neurohormonal activation in patients with hypertension: a study with two-dimensional layer-specific speckle tracking echocardiography

Background: Arterial stiffness increases pressure load to the left ventricle (LV), leading to LV hypertrophy and subendocardial ischemia. Neurohormones stimulate myocardial fibrosis and LV dysfunction. We aimed to explore the associations of arterial stiffness and plasma aldosterone with multi-directional, layer-specific LV, and left atrial (LA) mechanical function in hypertensive patients. Methods: Layer-specific LV global longitudinal strain (GLS-trans, GLS-endo, GLS-epi), global circumferential strain (GCS-trans, GCS-endo, GCS-epi), LV torsional parameters, and LA global longitudinal strain (LA GLS) were analyzed by two-dimensional speckle tracking echocardiography in 195 hypertensive patients (110 men, mean age 55 years). Pulse wave velocity (PWV) was analyzed as a measure of arterial stiffness, and plasma aldosterone was measured for evaluation of neurohormonal activation. Results: In a simple correlation, PWV significantly correlated with LV GLS-endo and LA GLS. Log aldosterone correlated with both LV GCS-endo and LV GCS-trans. Multiple regression analysis revealed that LV GLS-endo (β = 0.223, p = 0.031) and LA GLS (β = -0.311, p = 0.002) were independently correlated with PWV even after controlling for confounding factors. Conclusions: In hypertensive patients without clinically apparent target organ damage, LV GLS, especially endocardium, and LA GLS were more dominantly affected by arterial stiffness because, among the three myocardial layers, the endocardium is most susceptible to pressure overload. Two-dimensional layer-specific speckle-tracking echocardiography sensitively detects LV mechanical dysfunction and provides pathophysiologic insights into LV mechanical adaptations in hypertension.ope

Sinus node dysfunction after surgical atrial fibrillation ablation with concomitant mitral valve surgery: Determinants and clinical outcomes

OBJECTIVE: We sought to investigate determinants and prognosis of sinus node dysfunction (SND) after surgical ablation of atrial fibrillation (AF) with concomitant mitral valve (MV) surgery. A total of 202 patients who underwent surgical AF ablation with concomitant MV surgery were studied. STUDY DESIGN AND SETTING: SND was defined as electrocardiographic manifestations, such as junctional bradycardia, symptomatic sick sinus syndrome, or symptomatic sinus bradycardia, 7 days after surgery. Baseline clinical and echocardiographic characteristics, rhythm outcomes [AF recurrence or permanent pacemaker (PM) implantation] at 6 and 12 months, and clinical outcomes were compared between patients without SND (n = 165) and those with SND (n = 37) after surgery. RESULTS: Patients with SND showed a significantly larger left atrial volume index (LAVI) and a higher right ventricular systolic pressure than those without SND. In addition, there was a higher likelihood for AF recurrence and PM implantation in patients with SND than in those without SND. Although clinical outcomes did not differ between the two groups, patients with SND had a significantly longer length of hospital stay (p<0.001). In a multivariate analysis, preoperative LAVI was a structural risk factor for SND [hazard ratio (HR): 1.126 per 10 mL/m2; 95% confidence interval (CI): 1.0206-1.236; p = 0.001]. An LAVI cut-off value of 105 mL/m2 showed significant predictive power for SND [sensitivity: 62%; specificity: 64%; area under the curve (AUC): 0.678; p = 0.002]. CONCLUSIONS: In conclusion, preoperative LA size was a structural risk factor for SND after surgical AF ablation during MV surgery. SND was associated with an increased risk for AF recurrence and implantation of permanent PM in patients undergoing concomitant surgical ablation of AF with MV surgery.ope

Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery

This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13-30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all p<0.05). After multivariate adjustment, occurrence of cardiac tamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, p<0.001) and mechanical valve replacement (HR 2.69, p = 0.025). The mean hospital days in patients with cardiac tamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9-43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention.ope

Metallic foreign body in heart mimicking moderator band

A foreign body in heart is rare, but it is more frequently encountered than the past as iatrogenic causes are increasing. Clinicians should be aware that foreign body could be mistaken for normal structure of heart. In order for accurate diagnosis, multi-imaging modalities should be used for information of exact location, mobility and hemodynamic effects. A decision to intervene should be made based on potential harms harbored by foreign bodies. Endovascular retrieval should be considered as an option. However, when fatal complications occur or when foreign bodies are embedded deeply, a surgical removal should be attempted.ope

Prosthetic Mitral valve Leaflet Escape

Leaflet escape of prosthetic valve is rare but potentially life threatening. It is essential to make timely diagnosis in order to avoid mortality. Transesophageal echocardiography and cinefluoroscopy is usually diagnostic and the location of the missing leaflet can be identified by computed tomography (CT). Emergent surgical correction is mandatory. We report a case of fractured escape of Edward-Duromedics mitral valve 27 years after the surgery. The patient presented with symptoms of acute decompensated heart failure and cardiogenic shock. She was instantly intubated and mechanically ventilated. After prompt evaluation including transthoracic echocardiography and CT, the escape of the leaflet was confirmed. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. Eleven days after the surgery, the dislodged leaflet in iliac artery was removed safely and the patient recovered well.ope

Incremental Value of Left Atrial Global Longitudinal Strain for Prediction of Post Stroke Atrial Fibrillation in Patients with Acute Ischemic Stroke.

BACKGROUND: Atrial fibrillation (AF) is a well-established risk factor for stroke. Interestingly, ischemic stroke increases risk of incident AF in patients without prior diagnosed AF. For better risk stratification for post-stroke AF, we studied left atrial (LA) size and mechanical function using two-dimensional (2D) speckle tracking imaging in patients with acute ischemic stroke. METHODS: A total of 227 patients (132 males, age 67 ± 12) with acute ischemic stroke without a history of AF underwent 2D transthoracic echocardiography and speckle tracking imaging for the assessment of LA volume index and global LA longitudinal strain (LALS). From clinical variables, the CHA2DS2-VASc score and National Institute of Health Stroke Scale (NIHSS) were calculated in each patient. Post-stroke AF was defined as newly diagnosed AF during the course after ischemic stroke. RESULTS: Post-stroke AF occurred in 25 patients (11%). Patients with post-stroke AF were older and showed a higher tendency of CHA2DS2-VASc score, significantly higher log NIHSS, larger LA volume index and lower global LALS than those without. In multivariate analysis, global LALS was an independent predictor for post-stroke AF (hazard ratio 0.90, 95% confidence interval 0.83.0.97, p < 0.01) after controlling for confounding factors. Furthermore, global LALS provided incremental predictive value for post-stroke AF over the CHA2DS2-VASc score, NIHSS, and LA volume index. The global LALS < 14.5% better distinguished post-stroke AF (area under the curve 0.837, sensitivity 60%, specificity 95%, p < 0.01) than CHA2DS2-VASc score. CONCLUSION: Global LALS as a marker of LA mechanical function has incremental predictive value for post-stroke AF in patients with acute ischemic stroke.ope