Study on the effect of environmental improvement of urban open space on the housing price

학위논문 (석사)-- 서울대학교 대학원 : 환경계획학과, 2011.8. 최막중.Maste

Stages of Adoption for Fecal Occult Blood Test and Colonoscopy Tests for Colorectal Cancer Screening in Korea

PurposeWhile colorectal cancer (CRC) is common in Asian countries, screening for CRC is not. Moreover, CRC screening behaviors in Asian populations remain largely unknown. The present study aimed to investigate the stages of adopting CRC screening in Korea according to screening modality.Materials and MethodsData were obtained from the 2014 Korean National Cancer Screening Survey, a cross-sectional survey that utilized nationally representative random sampling to investigate cancer screening rates. A total of 2,066 participants aged 50-74 years were included in this study. Chi-square test and multinomial logistic regression were applied to determine stages of adoption for fecal occult blood test (FOBT) and colonoscopy and factors associated with each stage.ResultsOf 1,593 participants included in an analysis of stage of adoption for FOBT, 36% were in action/maintenance stages, while 18%, 40%, and 6% were in precontemplation, contemplation, and relapse/relapse risk stages, respectively. Of 1,371 subjects included in an analysis of stage of adoption for colonoscopy, 48% were in action/maintenance stages, with 21% in precontemplation, 21% in contemplation, and 11% in relapse/relapse risk stages. Multinomial logistic regression highlighted sex, household income, place of residency, family history of cancer, having private cancer insurance, smoking status, alcohol use, and regular exercise as being associated with stages of adoption for FOBT and colonoscopy.ConclusionThis study outlines the distributions of stages of adoption for CRC screening by screening modality. Interventions to improve screening rates should be tailored to individuals in particular stages of adoption for CRC screening by modality.This study was supported by a Grant-in-Aid for Cancer Research and Control from the National Cancer Center of Korea (# 1310232)

Socioeconomic Inequalities in Colorectal Cancer Screening in Korea, 2005-2015: After the Introduction of the National Cancer Screening Program

Purpose: This study aimed to investigate inequalities in colorectal cancer (CRC) screening rates in Korea and trends therein using the slope index of inequality (SII) and relative index of inequality (RII) across income and education groups.Materials and Methods: Data from the Korean National Cancer Screening Survey, an annually conducted, nationwide cross-sectional survey, were utilized. A total of 17174 men and women aged 50 to 74 years were included for analysis. Prior experience with CRC screening was defined as having either a fecal occult blood test within the past year or a lifetime colonoscopy. CRC screening rates and annual percentage changes (APCs) were evaluated. Then, SII and RII were calculated to assess inequality in CRC screening for each survey year.Results: CRC screening rates increased from 23.4% in 2005 to 50.9% in 2015 (APC, 7.8%; 95% CI, 6.0 to 9.6). Upward trends in CRC screening rates were observed for all age, education, and household income groups. Education inequalities were noted in 2009, 2014, and overall pooled estimates in both indices. Income inequalities were inconsistent among survey years, and overall estimates did not reach statistical significance.Conclusion: Education inequalities in CRC screening among men and women aged 50 to 74 years were observed in Korea. No apparent pattern, however, was found for income inequalities. Further studies are needed to thoroughly outline socio-economic inequalities in CRC screening.This study was supported by a Grant-in-Aid for Cancer Research and Control from the National Cancer Center of Korea (#1610401). Three authors, Tran Thi Xuan Mai, Eunji Choi, and Eun Young Lee received funding from the "International Cooperation & Education Program (#NCCRI.NCCI 52210-52211, 2018)" of National Cancer Center, Korea

Socioeconomic Inequalities in Cervical and Breast Cancer Screening among Women in Korea, 2005-2015

Purpose: Consistent evidence indicates that cervical and breast cancer screening rates are low among socioeconomically deprived women. This study aimed to assess trends in cervical and breast cancer screening rates and to analyze socioeconomic inequalities among Korean women from 2005 to 2015.Materials and Methods: Data from the Korean National Cancer Screening Survey, an annual nationwide cross-sectional survey, were utilized. A total of 19910 women were finally included for analysis. Inequalities in education and household income status were estimated by slope index of inequality (SII) and relative index of inequality (RII), along with calculation of annual percent changes (APCs), to show trends in cancer screening rates.Results: Cervical and breast cancer screening rates increased from 54.8% in 2005 to 65.6% in 2015 and from 37.6% in 2005 to 61.2% in 2015, respectively. APCs in breast cancer screening rates were significant among women with higher levels of household income and education status. Inequalities by household income in cervical cancer screening uptake were observed with a pooled SII estimate of 10.6% (95% CI: 8.1 to 13.2) and RII of 1.4 (95% CI: 1.3 to 1.6). Income inequalities in breast cancer screening were shown to gradually increase over time with a pooled SII of 5.9% (95% CI: 2.9 to 9.0) and RII of 1.2 (95% CI: 0.9 to 1.3). Educational inequalities appeared to diminish over the study period for both cervical and breast cancer screening.Conclusion: Our study identified significant inequalities among socioeconomically deprived women in cervical and breast cancer screening in Korea. Especially, income-related inequalities were greater than education-related inequalities, and these were constant from 2005 to 2015 for both cervical and breast cancer screening.This study was supported by a Grant-in-Aid for Cancer Research and Control from the National Cancer Center of Korea (#1610401). Three authors, Eunji Choi, Mai Tran, and Eun Young Lee received funding from the "International Cooperation & Education Program (#NCCRI.NCCI 52210-52211, 2017).&quot

A Study on the Joint Part of the Lower story and the Upper Story in the Multi-Study Buildings in the Joseon Dynasty

학위논문 (석사)-- 서울대학교 대학원 : 건축학과, 2016. 2. 전봉희.이 연구는 중층목조건축물에서, 하층의 처마지붕구조와 상층평주가 만나는 부분에 대한 연구이다. 중층목조건축은 대형건물을 구성하기 위한 건축방식으로 단층목조건축물과는 다른 구조적, 의장적 특징이 나타난다. 그 특징이 가장 두드러지게 나타나는 부분이 바로 하층지붕구조와 상층평주가 만나는 접합부이다. 이 연구를 통해 접합부 구성상의 유형을 분류하고 각각의 유형이 갖는 구조·공간·의장적 의미를 찾아보려 하였다. 이를 위해, 한반도에 현존하는 40동의 중층목조건물 가운데 치수 자료를 구할 수 있는 23동를 연구대상으로 하였다. 그 외 나머지는 그림 자료 등을 구하여 참고 하였다. 20세기에 지어진 중층목조건물 가운데 재건을 제외한 보수·복원한 대상을 포함하였다. 상층평주의 하중 전달방식과 그에 따른 하층 처마지붕구조의 구성방식이 접합부 분류기준으로 작용하였다. 상하층 접합부의 구성 유형은 크게 3가지로 나눌 수 있었고 각각의 접합부 유형을 고주별립형, 퇴량매개형, 포작직결형으로 명명하였다. 고주별립형은 상하층 지붕의 하중이 각각 독립적으로 지반으로 전달된다. 상층지붕의 하중은 내진고주가 담당하고 하층지붕의 하중은 하층 평주가 담당한다. 퇴량매개형은 상층지붕을 지지하는 상층평주가 하층 퇴량의 중간지점에 위치한다. 상층지붕의 하중은 하층퇴량을 거쳐 하층의 외벽 포작부와 몸체부에 전달되어 지반으로 전달된다. 포작직결형은 상층평주를 하층 퇴량의 상부 및 하층포작부의 최내출목선과 동일한 위치에 세운다. 상층지붕의 하중은 상층의 외벽 몸체부를 통해 하층의 가구부와 포작부 및 몸체부에 동시에 전달되어 지반으로 전달된다. 접합부의 하층지붕구조는 공포형식 또는 내목도리의 유무에 따라 재분류하였다. 이들 유형이 적용된 대상건축물을 그 용도에 따른 실내공간의 사용, 구조적인 필요성 등으로 검토해 본 결과, 실내공간의 사용상의 필요가 구조적인 목적보다 우선적으로 고려되었음을 알 수 있었다. 또한 접합부는 중층목조건축물의 구조와 외관은 물론, 내부공간의 의장과도 밀접한 관련이 있음을 확인 할 수 있었다. 상하층 접합부는 시기적 선호가 있지는 않았지만 각각의 접합부는 건물 내부사용방식의 요구에 따라 구조와 의장을 보완하였다. 구조적으로는 안정적으로 변하였고 의장적으로는 세련되어졌다. 구조성능을 향상시키기 위해, 하층지붕구조의 결구방식을 조절하였으며 의장성을 꾀하기 위해 주요입면을 보완하는 등 새로운 기법이 등장하였다. 이 연구를 통해 접합부의 의장·구조·기능의 의미를 분별함으로써, 한국건축에서 접합부가 중층목조건물의 계획 기준으로서의 효용성을 가지고 있음을 알 수 있었다.1장 서론 1 1.1 연구의 배경과 목적 01 1.2 연구의 대상 04 1.3 기존연구의 검토 06 1.4 연구의 방법 13 2장 중층목조건물 접합부에 대한 예비고찰 15 2.1 중층목조건물 접합부 발생에 대한 고찰 15 2.1.1 상하층실내통층확보를 위한 접합부 발생 17 2.1.2 상하층 분리를 위한 접합부 발생 24 2.2 중층목조건물 접합부 구조에 대한 고찰 29 2.2.1 단층목조건물 구성방식의 이해 29 2.2.2 상하층접합부 구성방식의 이해 34 3장 상하층 접합부의 유형 별 특성 39 3.1 상하층 접합부 유형 분류기준 39 3.1.1 상층평주위치에 따른 하중전달방식 40 3.1.2 상층평주위치에 따른 하층지붕구조 46 3.2 접합부 유형 별 공간 및 구조적 특성 49 3.2.1 고주별립형 49 3.2.2 퇴량매개형 56 3.2.3 포작직결형 63 3.3 접합부 유형 별 분포적 특성 68 3.4 소결 74 4장 접합부 유형의 선택과 조절 77 4.1 내부공간구성과 접합부 유형의 선택 77 4.1.1 상충퇴칸구성에 따른 접합부 유형의 대응 78 4.1.2 실내천장공간구성과 기법의 선택 81 4.1.3 실내상하층분리와 기법의 선택 88 4.2 구조성능향상과 접합부 결구방식의 조절 91 4.2.1 하층지붕구조에 따른 접합부 유형의 대응 91 4.2.2 상층퇴칸확보를 위한 구조의 보강 94 4.2.3 실내·외입면구성에 의한 구조의 조절 101 4.2.4 상층우주위치에 따른 구조의 변화 106 4.3 의장적 고려와 접합부 입면의 보완 112 4.3.1 실내입면구성에 따른 접합부 유형의 대응 112 4.3.2 하층서까래 하부면 처리 기법의 등장 114 4.3.3 하층서까래 뒤초리 처리 기법의 등장 120 4.4 소결 125 5장 결론 129 참고문헌 135 Abstract 137Maste

Effect of mammography screening on stage at breast cancer diagnosis: results from the Korea National Cancer Screening Program

In Asian countries, breast densities and the proportion of younger women with breast cancer are higher than those in Western countries. This study was designed to determine differences in stage at diagnosis of breast cancer among Korean women according to screening history. The study population was derived from the Korea National Cancer Screening Program (KNCSP). The study cohort comprised 17,689 women who were newly diagnosed with breast cancer in 2011 and were invited to undergo breast cancer screening via the KNCSP between 2002 and 2011. Ductal carcinoma in situ (DCIS) and localized breast cancer were most frequent in both ever-screened and never-screened patients. Late stage cancer was significantly more frequent in never-screened patients, compared with ever-screened patients. Compared to never-screened women, the odds ratio (OR) for being diagnosed with early stage breast cancer among screened women was 1.41 (95% Confidence Interval [CI] = 1.28-1.55). The OR for being diagnosed with early stage breast cancer was highest among patients who underwent screening three times or more (aOR = 1.89, 95% CI = 1.57-2.29). Screening by mammography was associated with diagnosis of early stage breast cancer in Korean women. However, significant increases in the diagnosis of DCIS and localized breast cancers among ever-screened patients suggest the possibility of overdiagnosis due to screening.The authors would like to thank the staff of the National Health Insurance Service. This study was supported by a Grant-in-Aid for Cancer Research and Control from the National Cancer Center of Korea (#1310232 and #1610401)

Risk reduction of breast cancer by childbirth, breastfeeding, and their interaction in Korean women: Heterogeneous effects across menopausal status, hormone receptor status, and pathological subtypes

Objectives: The purpose of this study was to examine the associations of childbirth, breastfeeding, and their interaction with breast cancer (BC) risk reduction, and to evaluate the heterogeneity in the BC risk reduction effects of these factors by menopause, hormone receptor (HR) status, and pathological subtype.Methods: BC patients aged 40+ from the Korean Breast Cancer Registry in 2004-2012 and controls from the Health Examinee cohort participants were included in this study after 1:1 matching (12 889 pairs) by age and enrollment year. BC risk according to childbirth, breastfeeding, and their interaction was calculated in logistic regression models using odds ratios (ORs) and 95% confidence intervals (CIs).Results: BC risk decreased with childbirth (3+ childbirths relative to 1 childbirth: OR, 0.66; 95% CI, 0.56 to 0.78 and OR, 0.80; 95% CI, 0.68 to 0.95 in postmenopausal and premenopausal women, respectively); and the degree of risk reduction by the number of children was heterogeneous according to menopausal status (p-heterogeneity=0.04), HR status (p-heterogeneity<0.001), and pathological subtype (p-heterogeneity<0.001); whereas breastfeeding for 1-12 months showed a heterogeneous association with BC risk according to menopausal status, with risk reduction only in premenopausal women (p-heterogeneity<0.05). The combination of 2 more childbirths and breastfeeding for ≥13 months had a much stronger BC risk reduction of 49% (OR, 0.51; 95% CI, 0.45 to 0.58).Conclusions: This study suggests that the combination of longer breastfeeding and more childbirths reduces BC risk more strongly, and that women who experience both 2 or more childbirths and breastfeed for ≥13 months can reduce their BC risk by about 50%

한국 여성에서의 산발성 및 유전성 유방암 발생위험도 평가모델 개발

연구 목적: 한국에서 유방암 발생 증가 속도를 고려하였을 때 유방암 발생위험도에 대한 선별검사를 시행하여 고위험군을 선정하고, 이들을 대상으로 조기에 위험인자 교정, 진단검사 등의 개입을 시행하여 유방암의 발생과 유방암으로 인한 사망을 줄이는 것은 중요하다. 이에 본 연구는 한국 여성에서 유방암 발생위험도 평가모델을 개발하고자 한다. 연구 방법: 산발성 유방암 발생위험도 평가모델은 유방암 환자-대조군 연구의 참여자 중 연령과 입적년도를 매칭한 사람을 대상으로 다변량 로짓 회귀분석을 통해 주요 위험인자를 선정하고, 2009년 사망자료에서의 유방암 및 유방암 이외 원인에 의한 연령별 사망확률, 2008년 유방암 발생률 자료를 이용하여 절대위험도를 근사적으로 추정하였다. 예측 모델의 검정을 위해 한국인다기관암코호트, 국립암센터 검진자코호트의 여성 대상자 중 추적기간 동안 유방암이 발생한 사람, 유방암 학회 등록자료의 여성 환자와 한국인 유전체 역학조사사업의 여성 참여자를 대상으로 하여 환자군과 대조군에서의 유방암 발생위험도 및 발생 관찰 수와 예측 관찰 수를 비교하였다. 고위험군을 선정하는 cut-off 값을 정하기 위해 다양한 cut-off 값에 따른 민감도, 특이도, AUC (area under curve)를 비교하였다. 또한 산발성 유방암 발생위험도 평가모델에 유전자를 포함하여 그 AUC의 증가를 확인하였다. 유전성 유방암 발생위험도 평가모델은 한국인유전성유방암 연구의 대상자를 이용하여 Kin-cohort 법과 누적위험도 방식으로 침투율을 계산하여 비교하고, kin-cohort법에서 산출한 침투율과 한국인에서 BRCA유전자 돌연변이의 유병률을 BRCAPRO 모델에 대입하여 구축하였다. 암 발생 상태에 따른 관찰 발생 수와 예측 발생 수를 비교하였다. 연구 결과: 산발성 유방암 발생위험도 평가모델에 선정된 위험인자는 가족력, 초경연령, 첫 출산 연령, 자녀 수, 정기적인 운동, 폐경 여부 및 폐경 연령, 체질량지수 였다. 이들의 조합으로 구축한 모델의 AUC는 50세 미만에서 0.59, 50세 이상에서 0.64였다. 이를 한국인다기관암코호트와 국립암센터 검진자코호트의 여성 대상자에게 적용하였을 때 환자군에서의 위험도가 대조군에 비해 유의하게 높았고 추적기간에 따른 관찰 발생 수와 예측 발생 수에서 유의한 차이가 없었다. 유방암 학회 등록자료의 여성 환자와 한국인 유전체 역학조사사업의 여성 참여자의 위험도를 비교하였을 때 두 군에서 유의한 차이가 관찰되었다. 산발성 유방암 발생위험도 평가모델에 8개 유전자를 추가하였을 때 예측타당도 값은 50세 미만에서 0.65, 50세 이상에서 0.67로 증가하였으나 증가 정도는 3~6%로 크지 않았다. 한국인에서 BRCA1 유전자 돌연변이의 80세까지 유방암 침투율은 Kin-cohort법으로 구했을 때44.9%, 누적위험도법으로 구했을 때 42.1%였고, BRCA2유전자 돌연변이의 80세까지 유방암 침투율은 kin-cohort법으로 구했을 때26.7%, 누적위험도법으로 구했을 때 26.3%였다. 이를 이용하여 유전성 유방암 발생위험도 평가모델을 구축하였을 때, 유방암 환자와 암이 발생하지 않은 사람에서BRCA1/2 유전자 돌연변이 보인자 확률의 관찰값과 예측값은 유사하였으나, 양측성 유방암 환자에서는 BRCA1/2 유전자 돌연변이 보인자 확률을 과대추정하고 있었다. 결론: 본 연구에서 개발된 유방암 발생위험도 평가모델은 한국 여성에서 향후 유방암 발생위험도, BRCA1/2 돌연변이 보인자 확률을 예측하고, 이에 따라 조기 검진 및 예방적 시도를 수행할 수 있는 중요한 도구이다. 그러나 고위험군을 선정하여 이들에 대한 중재를 시도하기 위한 cut-off 값을 결정하기 위해서는 향후 다양한 cut-off 값에 따른 중재연구를 시도하여 예방적 시도에 따른 유방암의 발생 및 유방암으로 인한 사망의 감소를 확인해야 할 것이다. 추후 충분한 유방암 발생이 있는 대규모 코호트에서 모델의 검정력 및 예측타당도를 높이는 연구 및 유전성 유방암 발생위험도 평가모델의 타당도 검정이 이루어져야 할 것이다.Objective: Considering the rapid increase of breast cancer incidence in Korea, predicting high risk group of breast cancer and conducting preventive strategy such as modification of risk factors, screening assessment for early detection are important to reduce mortality. This study was conducted to develop sporadic and hereditary breast cancer assessment model in Korean female population. Methods: In the development process of sporadic hereditary breast cancer assessment model, risk factors were selected by multiple logistic regression analysis of breast cancer case-control study. National mortality data in 2009 for breast cancer mortality and mortality other than breast cancer and national cancer registry data in 2008 were applied to estimate the absolute probability of developing breast cancer. The external validity was examined using female participants data from Korean Multi-Center Cohort, National Cancer Center Cohort, Breast Cancer Registry data, and Korean Genome and Epidemiology Study data. Eight genes were added in the sporadic breast cancer risk assessment model to investigate t.he increment of discrimination power by comparing area under curve. Data from Korean Hereditary Breast Cancer Study Korean was used to calculate penetrance using Kin-cohort method and cumulative incidence method. The penetrance results and BRCA mutation prevalence in Korean population was applied to BRCAPRO model to develop the Korean hereditary breast cancer assessment model. Results: The risk factors included in sporadic breast cancer risk assessment model were family history of breast cancer, age at menarche, age at first full term pregnancy, number of children, regular exercise, age at menopause and body mass index. The discrimination power was 0.59 under the age 50 and 0.64 over the age 50. When this model applied to female participants of Korean Multi-Center Cohort and National Cancer Center Cohort, the risk of breast cancer patients was significantly higher than matched controls and there were no significant differences between observed and predicted incidence. Compared to the controls from Korean Genome and Epidemiology Study data, the risk of cases from Breast Cancer Registry data was higher. The discrimination power of this model increased to 0.65 under age 50 and 0.67 over the age 50 with eight genes. The penetrance of BRCA1 mutation for breast cancer until the age 80 was 44.9% from kin-cohort method and 42.1% for cumulative incidence method. The penetrance of BRCA2 mutation for breast cancer until the age 80 was 26.7% from kin-cohort method and 26.3% for cumulative incidence method. Using these penetrance estimates and prevalence of BRCA mutation carrier, Korean hereditary breast cancer assessment model was developed and it estimated the risk of BRCA mutation carrier well in unaffected people and breast cancer patients but overestimated BRCA mutation carrier in bilateral breast cancer patients. Conclusions: The sporadic and hereditary breast cancer assessment model developed in this study were important tool for estimating the risk, early detection and preventive options for risk reduction in Korean female population. Further studies to increase the discrimination power and validity study for hereditary breast cancer risk assessment model are necessary.Docto

Incidence of bacteremia and antimicrobial resistance, and associated factors among patients transferred from long-term care hospital

Objective: To evaluate the prevalence of bacteremia and antimicrobial resistance, and associated factors among infectious patients transferred from long-term care hospitals (LTCHs).Methods: Consecutive adult patients who were transferred for suspected infection from affiliated LTCH's to study hospital emergency department (ED) over a 12 month period from January to December 2016 were included retrospectively. Patients with positive blood cultures (excluding contaminants as clinically determined) were defined as primary measure and subjected to further analysis according to antimicrobial resistance pattern. The latter was categorized into 4 subgroups based on groups of antimicrobial choices for empiric choices of suspected bloodstream infections. R-Group 0: bacteria susceptible to penicillin and amoxicillin; R-Group 1: bacteria resistant to penicillin/amoxicillin, first, second, or third generation cephalosporins. R-Group 2: ESBL-producing bacteria or bacteria resistant methicillin, fourth generation cephalosporin, or fluoroquinolone. R-Group 3: highly resistant pathogens including vancomycin resistant enterococci, carbapenem or colistin resistant Gram negatives. Blood culture isolate could therefore be included in >1 group.Results: Among 756 patients who were transferred from LTCHs, we excluded 278 patients who were not suspicious of infection and 65 patients who were not checked blood culture at ED. In total, 422 patients were enrolled. The incidence of bacteremia was 20.4% (n = 86). The most frequent pathogen was E. coli (n = 25) followed by S. aureus (n = 10), S. epidermidis (n = 8), and K. pneumonia (n = 6). The incidences of the R-Group 1, 2, and 3 groups were 16.8% (n = 71), 14.4% (n = 61), and 1.4% (n = 6), respectively. Of the Gram-positive pathogens (n = 44), the R-Group 1, 2, and 3 groups were 84.1% (n = 37), 75.0% (n = 33), and 9.1% (n = 4), respectively. Of the Gram-negative pathogens (n = 46), the R-Group 1, 2, and 3 groups were 82.6% (n = 38), 69.6% (n = 32), and 4.3% (n = 2), respectively. Among tested variables, initial serum procalcitonin level was significantly associated with the presence of bacteremia (AOR 1.03, 95% confidence interval 1.00-1.05), R-Group 1 (1.04, 1.01-1.07) and the R-Group 2 (1.04, 1.00-1.06).Conclusions: The prevalence of bloodstream infections in patients admitted from LTCH was high (20.4%) with majority of these infections from resistant bacteria. Procalcitonin levels were significantly higher in bacteremic patients with an increasing trend towards bacteria in the antimicrobial resistant groups. (C) 2018 Elsevier Inc. All rights reserved

Method for estimation of nationwide mandatory vaccination coverage rate and the result of pilot study

학위논문(석사) --서울대학교 대학원 :의학과(예방의학전공),2010.2.Maste