129 research outputs found
POSTN ๊ฒฐ์ฌ๋ก ์ธํ ์ท์ฅ ฮฒ-์ธํฌ ๊ธฐ๋ฅ์ฅ์ ๊ฐ์ ์ ๋ฐ๋ฅธ ๋น๋จ๋ณ ์ฝฉํฅ๋ณ ์ํ ํจ๊ณผ
ํ์๋
ผ๋ฌธ(์์ฌ) -- ์์ธ๋ํ๊ต๋ํ์ : ์๊ณผ๋ํ ์ํ๊ณผ, 2023. 2. ์ด์ ํ.์๋ก : ๋ง์ฑ ์ ์ฅ ์งํ์ ๊ฐ์ฅ ํํ ์์ธ์ธ ๋น๋จ๋ณ ์ฝฉํฅ๋ณ(DN)์ ์ ์ฅ ์ฌ์ ์ฆ๊ณผ ๊ด๋ จ์ด ์๋ค. ์ด์ ์ฐ๊ตฌ์์ periostin (POSTN)์ด ์ ์ฅ ์ฌ์ ์ฆ์์ ์ค์ํ ์ญํ ์ ํ๋ค๋ ๊ฒ์ ์
์ฆํ๋ค. ํด๋น ์ฐ๊ตฌ์์๋ ๋น๋จ๋ณ ์ฝฉํฅ๋ณ์์ POSTN์ ์ญํ ์ ์กฐ์ฌํ์๋ค.
๋ฐฉ๋ฒ: ๋น๋จ๋ณ ์ฝฉํฅ๋ณ ํ์์ ์๋ณ ์ํ์์ POSTN ๋ฐ tenascin C (TNC) ๋๋๋ฅผ ์ธก์ ํ๋ค. ๋ง์ฐ์ค์ ํธ์ธก ์ ์ฅ ์ ์ ์ (UNXSTZ)์ ์งํํ ํ 50mg/kg streptozotocin (STZ)์ 5์ผ ๋์ ํฌ์ฌํ์ฌ WT ๋ฐ Postn-null mice ๋ชจ๋์์ ๋น๋จ๋ณ ์ฝฉํฅ๋ณ ๋ชจ๋ธ์ ๊ตฌ์ถํ์๋ค. ์คํ๊ตฐ์ ์ด 4๊ฐ์ ์คํ ๊ทธ๋ฃน: wild-type sham (WT sham), wild-type UNXSTZ (WT STZ), Postn-null mice sham (KO sham), Postn-null mice UNXSTZ (KO STZ)์ผ๋ก ๊ตฌ์ฑ๋์ด ์๋ค. 20์ฃผ ํ, ์ฌ์ ํ ๊ด๋ จ ๋ง์ปค์ ๋ถ์ ๋ฐํ ๋ฐ ์กฐ์งํ์ ๋ณํ๋ฅผ ํ๊ฐํ์๋ค. ๋ํ ์คํ ๋ง์ฐ์ค์ ํ๋น ์์น์ ์๋ณ ์๋ถ๋ฏผ์ ์ฃผ๊ธฐ์ ์ผ๋ก ์ธก์ ํ์๋ค. ๋น๋จ๋ณ ์ฝฉํฅ๋ณ์ ์ธํฌ ๋ชจ๋ธ๋ก์ NRK 49F ์ธํฌ๋ฅผ TGF-ฮฒ ์ฒ๋ฆฌ ํ์ ๋ฐฐ์ํ์๊ณ , STZ์ผ๋ก INS-1 ์ธํฌ๋ฅผ ์๊ทนํ ๋ค cell viability๋ฅผ ์ธก์ ํ์๋ค.
๊ฒฐ๊ณผ: ์ธ์ฒด ์๋ฃ์์ ๋น๋จ๋ณ ์ฝฉํฅ๋ณ์ ์ค์ฆ๋์ ๋ฐ๋ผ POSTN ๋ฐ TNC์ ๋๋๊ฐ ์ฆ๊ฐํ์๋ค. WT STZ ๋ชจ๋ธ๊ณผ ๋น๊ตํ์ฌ KO STZ ๋ชจ๋ธ์ ์๋ณ ์๋ถ๋ฏผ ๋ฐฐ์ค์ด ๋ฎ๊ณ ์ฌ๊ตฌ์ฒด ๊ฒฝํ์ฆ ๋ฐ ๊ฐ์ง ์ฌ์ ์ฆ์ด ์ ์๋ค. ๋ํ KO STZ ๋ชจ๋ธ์ ์ฌ์ ์ฆ ๋ง์ปค ๋ฐํ ๋ฐ TNC์ ๋ฐํ์ด ๋ ๋ฎ์๋ค. KO STZ ๋ชจ๋ธ์ ํ๋น ์์ค์ WT STZ ๋ชจ๋ธ๊ณผ ๋น๊ตํ์ฌ ์ ์กฐ์ ๋์์ ๋ฟ๋ง ์๋๋ผ ์ท์ฅ์กฐ์ง์ ์์ ์ฑ ๋ฐ ์ธ์๋ฆฐ ๋ฐํ์ด ์ ์ํ๊ฒ ๋ ๋ง์ด ๋ณด์กด๋์๋ค. ์ธํฌ ๋ชจ๋ธ์์๋ NRK-49F ์ธํฌ๋ฅผ ์ด์ฉํ์ฌ TGF-ฮฒ์ rPOSTN์ ๋์์ ์ฒ๋ฆฌํจ์ผ๋ก์จ fibrosis ์งํ ์ ๋๋ฅผ ํ์ธํ์์ง๋ง TGF-ฮฒ๋จ๋
์ฒ๋ฆฌ์ ๋ณ๋ค๋ฅธ ์ฐจ์ด๊ฐ ์์๋ค. INS-1 ์ธํฌ์ STZ ์ฒ๋ฆฌ์ ํญ POSTN antibody๋ฅผ ์ฒ๋ฆฌํ ๊ฒฝ์ฐ STZ ๋จ๋
์ฒ๋ฆฌ๋ณด๋ค ๋ ๋์ cell viability๋ฅผ ๋ํ๋๋ค.
๊ฒฐ๋ก : POSTN์ ๊ฒฐ์ฌ๋ ๋น๋จ๋ณ ์ฝฉํฅ๋ณ์์ ์ท์ฅ ฮฒ ์ธํฌ ๊ธฐ๋ฅ ๊ฐ์ ์ ํตํ ์ ์ฅ ์ฌ์ ์ํ์์ ํ์์ ์ธ ์ญํ ์ ํ๋ค. POSTN ์ฐจ๋จ์ ๋น๋จ๋ณ ์ฝฉํฅ๋ณ์ ์๋ก์ด ์น๋ฃ๋ฒ์ด ๋ ๊ฐ๋ฅ์ฑ์ ๋ณด์ฌ์ค๋ค.Introduction: Diabetic nephropathy (DN), the most common cause of chronic kidney disease, is associated with kidney fibrosis. Previous study demonstrated that periostin (POSTN) plays an important role in kidney fibrosis. The purpose of this study was to investigate the role of POSTN in DN.
Method: POSTN and tenascin C (TNC) concentrations in urine samples from patients with DN were measured. Fifty milligrams/kilogram streptozotocin (STZ) was administered for 5 days after unilateral nephrectomy (UNXSTZ) to induce DN in both the wild-type and Postn-null mice. Four experimental groups were generated: wild-type sham (WT sham), wild-type UNXSTZ (WT STZ), Postn-null sham (KO sham), Postn-null UNXSTZ (KO STZ). After 20 weeks, the molecular expression of fibrosis markers and histological changes were evaluated. Blood glucose levels and urine albumin were periodically measured. As a cell model of DN, NRK 49F cells were cultured under TGF-ฮฒ treatment. We stimulated INS-1 cells with streptozotocin and evaluated cell viability in these cells.
Results: The concentrations of POSTN and TNC increased according to the severity of DN in human samples. In contrast to the WT STZ model, the KO STZ model showed lower urine albumin excretion and less glomerular sclerosis and interstitial fibrosis. The KO STZ model had lower expression of fibrosis markers and TNC. The glucose level of the KO STZ model was well regulated in comparison with that of the WT STZ model. In addition, in the KO STZ model, pancreatic islet integrity and insulin expression were significantly more preserved. In in vitro models using NRK 49F cells, the degree of fibrosis was not significantly different between groups treated with TGF-ฮฒ alone and TGF-ฮฒ and recombinant POSTN (rPOSTN) together. The anti-POSTN antibody treatment of INS-1 cells with streptozotocin resulted in a higher cell viability than treatment with streptozotocin alone.
Conclusion: The absence of POSTN in DN contributes to renal fibrosis alleviation by improving pancreatic ฮฒ-cell function. Blocking POSTN could be a new treatment target for DN. Additionally, there is an association between POSTN and TNC.Introduction 1
Materials and Methods 3
Results 11
Discussion 16
Figures 20
Reference 32
Abstract in Korean 36์
Usefulness of transparent mask for communication in emergency room
Background: It is important to communicate accurately in the emergency department. Due to COVID-19 pandemic, a mask is mandatory to protect medical staffs and patients from infectious diseases, and the mask is known to disturb speech intelligibility. The objective of this study is to find out if a transparent mask can affect communication.
Methods : We conducted a randomized pre- and post-test trial with 40 participants in a real emergency room environment. The reader puts on a mask and read aloud sentences which are frequently used between medical staffs and patients or among medical staffs. The type of mask was randomly assigned to the reader which was transparent or non-transparent. Frequently used 5 sentences between medical staffs and patients and 5 sentences among medical staffs from prepared 100 sentences were randomly selected and recited. Participants were told to write down the sentences they heard. Each sentence written down was graded 0 or 1. After writing down 10 sentences, reader puts on another type of mask and the same experiment was done. The order of transparent/non-transparent mask was randomly allocated to each participant.
Results : In frequently used sentences between medical staffs and patient, average score with a transparent mask was 4.88, and with a non-transparent mask was 4.50(p=0.001). In frequently used sentences among medical staffs, average score with a transparent was 4.77, and with a non-transparent mask was 4.05(p<0.001).
Conclusions: This study showed the transparent mask improves speech intelligibility when communicating in an emergency room.ope
Differences among Three Skeletal Muscle Mass Indices in Predicting Non-Alcoholic Fatty Liver Disease: Korean Nationwide Population-Based Study
Recent studies have investigated the relationship between sarcopenia and non-alcoholic fatty liver disease (NAFLD); however, there is no unified definition of sarcopenia. Thus, we aimed to investigate the differences among three skeletal muscle mass indices (SMI) in predicting NAFLD. This study included 8133 adults from the 2008โ2010 Korea National Health and Nutrition Survey. SMI was calculated as appendicular skeletal muscle mass divided by height-square (hSMI), weight (wSMI), or body mass index (bSMI). The presence of NAFLD was defined by using the NAFLD-liver fat score. On the receiver operating characteristic curve analysis, the predictive power of wSMI for NAFLD was significantly higher than those of hSMI and bSMI in men (wSMI vs. hSMI, p = 0.003; wSMI vs. bSMI, p < 0.001). In women, the predictive power of hSMI was only significantly higher than that of bSMI (p = 0.023), and other predictive powers were not significantly different. In addition, hSMI was correlated with insulin resistance and NAFLD-liver fat score in the opposite direction to wSMI and bSMI in both men and women. Among the three definitions of SMI, wSMI showed the highest diagnostic performance for predicting NAFLD in men, suggesting the importance of defining sarcopenia for its association with specific diseases.ope
Pre-Metabolic Syndrome and Incidence of Type 2 Diabetes and Hypertension: From the Korean Genome and Epidemiology Study
The aim of this study was to investigate the prevalence of premetabolic syndrome (pre-MetSyn) and its components and to longitudinally examine their association with new-onset type 2 diabetes (T2D) or hypertension. A total of 4037 men and 4400 women aged 40 to 69 years were selected from the Korean Genome and Epidemiology Study, observed from 2001 to 2014. Pre-MetSyn was defined as the presence of one or two components of MetSyn (B, elevated blood pressure; G, elevated glucose; H, low HDL-cholesterol; T, elevated triglycerides; W, increased waist circumference). The prevalence of pre-MetSyn was higher than that of non-MetSyn and MetSyn in both men and women. In multivariate Cox regression analyses, G, T, G+T, W+G, B+G, B+T, W+T, B+H, and H+T in men and G, T, G+H, B+T, and H+T in women were significantly associated with new-onset T2D. B, W, B+H, B+T, W+H, and W+T in men and B, B+T, B+H, B+W, and W+H in women were significantly associated with new-onset hypertension. The prevalence of pre-MetSyn components and their associations with new-onset T2D or hypertension differed according to sex and disease. Our results suggest that specific phenotypes of pre-MetSyn may be important factors for predicting and preventing the development of T2D and hypertension.ope
Relationship between Serum Alkaline Phosphatase and Low Muscle Mass Index Among Korean Adults: A Nationwide Population-Based Study
Sarcopenia has attracted interest due to its impact on various health problems. Chronic inflammation is an important contributor to sarcopenia. Thus, we aimed to investigate the association between serum alkaline phosphatase (ALP), which is a novel inflammatory marker, and muscle mass. This study included 15,579 adults from the 2008-2011 Korea National Health and Nutrition Survey. Low skeletal muscle mass index (LSMI) was defined as body mass index-adjusted appendicular skeletal muscle mass less than 0.789 for men and 0.512 for women. Multiple logistic regression revealed that the highest ALP tertile was significantly associated with LSMI compared with the lowest ALP tertile in both men [Odds ratio (OR): 1.41; 95% confidence interval (CI): 1.04-1.91] and women (OR: 1.45; 95% CI: 1.00-2.10) after adjusting for other confounders. On the receiver operating characteristic curve analysis, the predictive power was significantly higher for ALP levels than for white blood cell count in women (p < 0.001), whereas the difference was not significant in men (p = 0.515). Our findings suggest the potential use of serum ALP as an inflammatory marker and a predictor of sarcopenia.ope
์คํ์ ๊ธฐ๋ฐ ์ํ์ ์ฐฝ์์ฑ ๊ต์ก ์ฐ๊ตฌ
ํ์๋
ผ๋ฌธ (์์ฌ)-- ์์ธ๋ํ๊ต ๋ํ์ : ์ฌ๋ฒ๋ํ ์ํ๊ต์ก๊ณผ, 2018. 8. ์กฐํํ.๊ธฐ์กด์ ์ง์ ๊ธฐ๋ฐ ๊ต์ก์์ ๊ต์ก๊ณผ ์ถ์ ์ด์ฒด์ฑ์ ๋์ฑ ์ ์ค๋ช
ํ ์ ์๋ ์ญ๋ ์ค์ฌ ๊ต์ก์ผ๋ก ํ๊ต ๊ต์ก์ ๋ฐฉํฅ์ด ์ ํ๋๊ณ ์๋ค. ๋ค์ํ ์ญ๋ ์ค์์๋ 2015 ๊ฐ์ ๊ต์ก๊ณผ์ ์ ์ด๋ก ๊ณผ ์ํ๊ณผ ๊ต์ก๊ณผ์ ๊ณ ์๋ฌธ์๋ฅผ ์ดํด๋ณด๋ฉด ๊ณตํต์ ์ผ๋ก ์ฐฝ์์ฑ์ ์ธ๊ธํ๊ณ ์์ผ๋ฉฐ, ์ฐฝ์์ฑ์ ํ๋์ ๋ฏธ๋ ์ฌํ์์ ๊ฐ์ถ์ด์ผ ํ ์ญ๋์ ํ ๋ถ๋ถ์ผ๋ก์ ์ธ์๋๊ณ ์๋ค. ๋ณธ๊ณ ์์๋ ์ง๋ ๋ช ์ฐจ๋ก์ ๊ฐ์ ์์ ์ํ๊ณผ ๊ต์ก๊ณผ์ ์ด ๊ณตํต์ ์ผ๋ก ๊ฐ์กฐํด์จ ์ํ์ ์ฐฝ์์ฑ์ ๋ํด ๋
ผ์ํ๋ค. ์ํ์ ์ฐฝ์์ฑ๊ณผ ๊ด๋ จ๋ ์ฌ๋ฌ ์ฐ๊ตฌ๋ฅผ ๊ธฐ๋ฐ์ผ๋ก, ๋ณธ๊ณ ์์๋ ์ํํ ๊ณผ์ ์์ ์์ค ์์น์ ๋ฐ์์ํค๊ธฐ ์ํด ์ํ์ ์ฐฝ์์ฑ์ด ํ์ํ๋ค๋ ๋
ผ์ง๋ก๋ถํฐ ์ถ๋ฐํ์ฌ, ์ด๋ฅผ ์ํ ํ์ต ํ๊ฒฝ์ผ๋ก์ ์คํ์์ ์ ์ํ๋ค.
๋ฐ๋ผ์ ์คํ์๊ณผ ๊ทธ์ ๊ด๋ จ๋ ์ํ์ ์๋ฏธ, ์ํ์ ์ฐฝ์์ฑ, ์ํํ, ๊ทธ๋ฆฌ๊ณ ๋ณธ๊ณ ์์ ์ทจํ๊ณ ์ ํ๋ ๊ต์-ํ์ต ์ค๊ณ ๋ฐฉ๋ฒ์ธ e-PBL์ ์ค์ฌ์ธ ๊ตฌ์ฑ์ฃผ์์ ๋ํด ์ดํด๋ณด๊ณ , ์ด๋ฅผ ์ ๊ธฐ์ ์ผ๋ก ์ฐ๊ฒฐํ์ฌ ์ฐ๊ตฌ์ ๋น์์ฑ๊ณผ ๋ฐฉ๋ฒ๋ก ์ ๋ง๋ จํ์๋ค. ์ดํ ์คํ์ ๊ธฐ๋ฐ ํ์ต ํ๊ฒฝ์ ์ ํฉํ ๊ต์-ํ์ต ์ค๊ณ ๋ฐฉ๋ฒ์ ์ ์ํ๊ณ , ๊ฐ๋ฐ๋ ์ค๊ณ ๋ฐฉ๋ฒ์ ์ง์ ์ ์ฉํด๋ณด๊ธฐ ์ํด ๋์นญ์ฑ์ ํ์ฉํ ๋ค๋ฆฌ ๋ง๋ค๊ธฐ๋ฅผ ๋ฌธ์ ๋ก ์ผ์ ํ์ต์์ ์คํ์ ๋ฐ์ดํฐ๋ฅผ ๋น๋กฏํ ์ฐ์ถ๋ฌผ์ ๋ถ์ํ์๋ค. ํนํ, ์ํ์ ์ฐฝ์์ฑ๊ณผ ์คํ์์ ๋ชจ๋ ๋ฐ์ํ ๋ถ์ ๊ธฐ์ค์ ์ค์ ํ๊ธฐ ์ํด, ์ ๋ฌธ๊ฐ 3์ธ์ ๊ฒฌํด๋ฅผ ํ ๋๋ก ๊ฒฐ๊ณผ ๋ถ์์ ์งํํ์๋ค.
์ด์ ๊ฐ์ ๋ถ์์์ ๋ ๋์๊ฐ, ์ฐฝ์์ ์ธ ๊ฒฐ๊ณผ๋ฌผ์ ์ฐฝ์์ ์ธ ์ฌ๊ณ ๊ณผ์ ์ ์๋ฐํ๋ค๋ ๋
ผ์ง์ ์
๊ฐํด ํ์ต์์ ์ฌ๊ณ ๊ณผ์ ์ ๋ถ์ํ๊ธฐ ์ํด ํ์ต์๊ฐ ์ต์ข
์ ์ถํ ์คํ์๊ณผ ์ด์ ๊ณผ์ ์ ๋ํ ๊ณผ์ ๋ถ์์ ์ค์ํ์๋ค. ์ด๋ฅผ ํตํด, ํ์ต์๊ฐ ์ํ์ ์๋ฏธ๋ฅผ ์ถ๊ตฌํ๋ ๊ณผ์ ์์์ ์ํ์ ์ฐฝ์์ฑ์ด ๋ฐํ๋๋ ํ์์ ์์ฐ์ค๋ฝ๊ฒ ํฌ์ฐฉํ์๋ค. ์ฆ, ์ํ์ ๊ฒฐ๊ณผ๋ฌผ๋ค๋ก ๊ฐ๋ ์ฐฌ ์ต์ข
์ฐ์ถ๋ฌผ์ ํ์ต์๊ฐ ์ด๋ ํ ๋งฅ๋ฝ๋ค์ ์ฎ์ด ํ์ฑํ๋์ง์ ๊ทธ ๊ณผ์ ์ ์ค์ ์ ์ผ๋ก ๋
ผ์ํ๊ณ ์ ํ์๋ค.โ
. ์๋ก 1
โ
ก. ์คํ์ 6
1. ๋ฌธ์์ ๋์ 6
2. ์คํ์ 11
2.1 ์๊ธฐ๋๋ฌด 11
2.2 ์๊ธฐ๋๋ฌด ์คํ์ 13
2.3 ์คํ์๊ณผ ๋ฌธ์ ํ์ฉ 15
โ
ข. ์ํ์ ์ฐฝ์์ฑ๊ณผ ์ํํ 19
1. ์ฐฝ์์ฑ 19
2. ์ํ์ ์ฐฝ์์ฑ 22
2.1 ์ํ์ ์ฐฝ์์ฑ๊ณผ ๊ทธ ์์ธ 22
2.2 ์ํ์ ์ฐฝ์์ฑ ๊ต์ก 25
3. ์ํ์ ์ฐฝ์์ฑ๊ณผ ์ํํ 30
4. ๋
ผ์ 31
โ
ฃ. ๊ตฌ์ฑ์ฃผ์์ ๊ต์-ํ์ต ์ค๊ณ 34
1. ๊ตฌ์ฑ์ฃผ์ 34
1.1 ๊ตฌ์ฑ์ฃผ์ 34
1.2 ๊ตฌ์ฑ์ฃผ์์ ์ํํ 39
1.3 ๊ตฌ์ฑ์ฃผ์์ ์ํ์ ์ฐฝ์์ฑ 41
2. ๊ตฌ์ฑ์ฃผ์ ๊ต์-ํ์ต ์ค๊ณ 43
2.1 ๊ตฌ์ฑ์ฃผ์ ๊ต์-ํ์ต ์ค๊ณ์ ํน์ง 44
2.2 PBL๊ณผ e-PBL 46
โ
ค. ์ํ์ ์ฐฝ์์ฑ ํฅ์์ ์ํ ๊ต์-ํ์ต ์ค๊ณ์ ์ ์ฉ 53
1. ์ํ์ ์ฐฝ์์ฑ ํฅ์์ ์ํ ๊ต์-ํ์ต ์ค๊ณ 53
1.1 ๊ต์-ํ์ต ์ค๊ณ ๋ชจํ 53
1.2 ์ฐ๊ตฌ ๋ฌธ์ 56
2. ์ฌ๋ก ์ ์ฉ 61
2.1 ์ฐ๊ตฌ ์๋ฃ ์์ง 61
3. ์ฌ๋ก ๋ถ์ 63
3.1 ๋ถ์ ์ ์ฐจ ๋ฐ ๋ฐฉ๋ฒ 63
3.2 1 ~ 2๋จ๊ณ ๋ถ์ ๊ฒฐ๊ณผ 64
3.3 3 ~ 4๋จ๊ณ์ ๊ฒฐ๊ณผ ๋ถ์ 68
3.4 3 ~ 4๋จ๊ณ์ ๊ณผ์ ๋ถ์ 83
โ
ฅ. ๊ฒฐ๋ก 103
์ฐธ๊ณ ๋ฌธํ 106
๋ถ๋ก 114
Abstract 140Maste
์ฃผ๊ฑฐ์ด๋๋ฐฉํฅ์ ์กฐ์ ํจ๊ณผ๋ฅผ ์ค์ฌ์ผ๋ก
ํ์๋
ผ๋ฌธ(์์ฌ) -- ์์ธ๋ํ๊ต๋ํ์ : ํ์ ๋ํ์ ๊ณต๊ธฐ์
์ ์ฑ
ํ๊ณผ, 2022. 8. ๊น๋์ฑ.์ด ์ฐ๊ตฌ๋ ์๋๊ถ ์์ฐจ๊ฐ๊ตฌ์ ์ฃผ๊ฑฐ๋ถ์์ ์ฑ์ ๋ํ ์ฃผ๊ฑฐ์ด๋์์ธ์ ์ํฅ
๋ ฅ์ ํ์
ํ๊ณ , ์ด ๊ด๊ณ์์ ์ฃผ๊ฑฐ์ด๋๋ฐฉํฅ์ ์กฐ์ ํจ๊ณผ๋ฅผ ๊ท๋ช
ํ๋ ๊ฒ์
๋ชฉ์ ์ผ๋ก ํ์๋ค. ์ฃผ๊ฑฐ๋ถ์์ ์ฑ์ ์ํฅ์์ธ์ ์ฃผ๊ฑฐ์ด๋์ ๊ฒฝํํ ๊ฐ๊ตฌ์
์ฌ๋ฌดํน์ฑ(์์ฐ, ๋ถ์ฑ)๊ณผ ์ฃผํํน์ฑ(์ ์ ํํ, ์ฃผํ์ ํ, ์ฃผํ๋ง์กฑ๋) ์ด 5
๊ฐ์ ์์ธ์ผ๋ก ์ถ์ถํ์๋ค. ์ ์ ํํ๋ ์๋๊ถ์์ ์ฃผ๊ฑฐ์ด๋์ ๊ฒฝํํ
์์ฐจ๊ฐ๊ตฌ๊ฐ ์ง์ํ์ฌ ์์ฐจ๊ฐ๊ตฌ์ธ์ง, ์๋๋ฉด ์๊ฐ๊ฐ๊ตฌ์์ ์์ฐจ๊ฐ๊ตฌ๋ก ๋ณ
ํํ๋์ง๋ก ๊ตฌ๋ถํ์๋ค. ์ฃผํ์ ํ์ ํ์ฌ ๊ฑฐ์ฃผํ๋ ์ฃผํ์ด ์ํํธ์ธ์ง,
์๋๋ฉด ๋น์ํํธ์ธ์ง๋ฅผ ๊ตฌ๋ถํ์๋ค. ์กฐ์ ๋ณ์๋ Alonso์ ํจ์ฉ๊ทน๋ํ ์ด
๋ก ์ ๋ฐ๋ผ ์ฃผ๊ฑฐ๋น์ ์ฐจ์ด๊ฐ ์ฃผ๊ฑฐ์ด๋๋ฐฉํฅ์ ์ฐจ์ด์์ ๊ธฐ์ธํ๋ค๊ณ ๋ณด๊ณ
์์ธ โ ์์ธ, ๊ฒฝ์ธ โ ์์ธ, ์์ธ โ ๊ฒฝ์ธ, ๊ฒฝ์ธ โ ๊ฒฝ์ธ์ผ๋ก ๊ตฌ๋ถํ์
๋ค. ์ข
์๋ณ์๋ ์ฃผ๊ฑฐ๋ถ์์ ์ฑ์ผ๋ก์จ ์ฃผ๊ฑฐ๋น ์ง๋ถ๋ฅ๋ ฅ์ ์ค์ฌ์ผ๋ก ํ์
ํ
์ฌ RIR(Rent to Income Ratio : ์๋๋๋น ์ฃผ๊ฑฐ๋น ๋น์จ๋ฐฉ์)๊ณผ ์๋ฐ๋ฒ ์ง
์(์๋น์ง์ถ๋๋น ์ฃผ๊ฑฐ๋น ๋น์จ๋ฐฉ์)์ ํจ๊ป ์ธก์ ํ์๋ค. ๋ถ์์๋ฃ๋ก ๊ตญํ
๊ตํต๋ถ ใ2020๋
๋ ์ฃผ๊ฑฐ์คํ์กฐ์ฌใ๋ฅผ ํ์ฉํ์๋ค. ๊ทธ ๋ฐ์ ํต์ ๋ณ์๋ก๋
๊ฐ๊ตฌ์ ์, ๊ฐ๊ตฌ์ฃผ์ ๋์ด, ๊ฐ๊ตฌ์ฃผ์ ํ๋ ฅ์ ํฌํจํ์๋ค.
์ด ์ฐ๊ตฌ ๊ฒฐ๊ณผ์ ๋ํ ์์ฝ์ ๋ค์๊ณผ ๊ฐ๋ค.
์ฒซ์งธ, ๊ฒฝ์ธ์ง์ญ์์ ์์ธ๋ก์ ์ด๋์ ๊ฒฝ์ฐ ๋ถ๋ดํด์ผ ํ๋ ์๋๋ฃ ๋๋น
์์ฐ์ด ๋ ๋ง์ ๊ฒฝ์ฐ ์ฃผ๊ฑฐ๋ถ์์ ์ฑ์ด ๋ฎ์์ง๋ค. ๋ฐ๋ผ์ ๊ฒฝ์ ์ ์ผ๋ก ์ฌ์
๊ฐ ์๋ ์ฌ๋๋ค์ ์ฃผ๊ฑฐ์ํฅ์ด๋ ์ ์ฃผ๊ฑฐ๋ถ์์ ์ฑ์ ๊ฐ์ ํ ๋ฐฉ๋ฒ์ ๊ฐ๊ตฌ
ํด์ผํ๋ค. ์ด์ ์์ธ์์ LH๊ฐ ๊ณต๊ธํ๋ ๋ชจ๋ ์๋๊ถ ๊ณต๊ณต์๋์ฃผํ ์
ํ์ ์
์ฃผ์ ์์ฐ๊ธฐ์ค๋ ๋ง๋ จ๋์ด ์๋์ง ๊ฒํ ํ๊ณ , ์์ฐ ์ฐ๋ํ ์๋๋ฃ
์ฒด๊ณ๋ฅผ ๋์
ํ ํ์๊ฐ ์๋ค.
๋์งธ, ์ ์ธ์๊ธ๋์ถ ๋ฑ์ ๋ถ์ฑ์ฐจ์
์ ํ์ฉํ์ฌ ๋ณด์ฆ๊ธ์ ๋ง๋ จํ๋ฉด์ ์ฃผ
๊ฑฐ๋ถ์์ ์ฑ์ด ์ฌํ๋จ์ ์ ์ ์๋ค. ํนํ, ๊ฒฝ์ธ์ง์ญ์์ ์์ธ๋ก ์ด๋์
์ฃผ๊ฑฐ๋ถ์์ ์ฑ์ ์๊ทนํ๊ฐ ๋๋ ทํ๋ค๋ ๋ฐ์ ์ ์ฑ
์ ์ธ ํจ์๋ฅผ ๊ฐ๋๋ค. ์ด
์ ๋ํ ์ ์ฑ
๋ฐฉ์์ผ๋ก ์ฃผ๊ฑฐ์ํฅ์ ์๋ํ๋ ์์ฐจ๊ฐ๊ตฌ๋ค์ ์ฃผ๊ฑฐ๋ถ์์ ์ฑ
์ ๊ฐ์ ํ๊ธฐ ์ํด ์ ๊ธ๋ฆฌ๋ก ์ ์ธ๋ณด์ฆ๊ธ ๋์ถ์ด์๋ฅผ ์ง์ํ๊ฑฐ๋ ์ ์ธ์๊ธ
๋์ถ์ ์ฑ
๊ฐ์ ์ ์์ธ์ ์ ์
๊ฐ์ ๊ฐ์ํ์ฌ ์ง์ญ๋ณ ํ๋๋ฅผ ์ฐจ๋ฑํํ์ฌ ์ฌ
์ค์ ํ๋ ๋ฑ ๋์ถ์ ์ฑ
์ ์คํจ์ฑ์ ๋์ฌ์ผ ํ ํ์๊ฐ ์๋ค.
์
์งธ, ๊ฒฝ์ธ์ง์ญ์์ ๊ฒฝ์ธ์ผ๋ก ์ด๋์ ์ํํธ์ ๋น์ํํธ ๊ฐ ์ฃผ๊ฑฐ๋ถ์์
์ฑ์ ์๊ทนํ๊ฐ ๋ค์ ํด์๋์๋ค. ์ด๋ ๊ฒฝ์ธ์ง์ญ ๋ด์์ ์ด๋ํ๋ ๊ฐ๊ตฌ๋ค
์ ๊ณต๊ณต์๋ ์ํํธ์ ๊ฑฐ์ฃผํ ํ๋ฅ ์ด ํฌ๋ค๋ ๋ฐ์์ ๊ธฐ์ธํ๋ค. ์ฆ ์์ธ
์ ๋นํด ๊ฒฝ์ธ์ง์ญ์ ์์ง์ ์ฃผํ์ง ๊ฐ๋ฐ, ์ ๋์ ๊ฑด์ค์ ๋ฐ๋ฅธ ์ ๊ท์ฃผํ
๊ณต๊ธํ๋๊ฐ ์์ฐจ๊ฐ๊ตฌ์ ์ฃผ๊ฑฐ์์ ์ ๊ธฐ์ฌํ ๋ฐ๊ฐ ํฌ๋ฏ๋ก ์์ธ ์๊ฐ์ง ๋ด
๋ถ๋ด๊ฐ๋ฅํ ์์ง์ ์ฃผํ๊ณต๊ธ์ ์ฑ
์ ํ๋ํด์ผ ํ ํ์๊ฐ ์๋ค๊ณ ๋ณด์ฌ์ง๋ค.
๋ท์งธ, ๊ฒฝ์ธ์ง์ญ์์ ์์ธ๋ก ์ด๋ํ ๋ ์ฃผํ๋ง์กฑ๋๊ฐ ๋์ ์ฃผํ์ ๊ฑฐ์ฃผํ
์๋ก ์ฃผ๊ฑฐ๋ถ์์ ์ฑ์ ์๊ทนํ๊ฐ ๋๋ ทํ๋ค. ์ฃผํ๋ง์กฑ๋๊ฐ ๋์ ์ฃผํ์ผ๋ก์
์ด๋์ด ์ฃผ๊ฑฐ๋น์ ๋ถ๋ด์ด ์ ๋
๋์ ์ด์ ๋ ์์ธ์ ๊ทน์ฌํ ์ฃผํ ๋
ธํํ์
์ ๋น๋กฏ๋ ๊ฒ์ผ๋ก ๋ณด์ธ๋ค. ๋ฐ๋ผ์ ๋ฆฌ๋ชจ๋ธ๋งใป์ฌ๊ฐ๋ฐ ๋ฑ ์ฃผ๊ฑฐ์ ์ง์ ๋
ํ ์๊ตฌ์ ๋์ํ ์ ์๋ ์ ์ฑ
์ ๋ฐฉ์๋ ํ์ํ๋คThe purpose of this study was to understand the influence of housing
movement factors on housing instability of rental households in the
metropolitan area and to investigate the moderating effect of housing
movement direction in this relationship. The factors influencing
housing instability were extracted as a total of five factors: financial
characteristics(assets,liabilities) and housing characteristics (occupancy
type, housing type, and housing satisfaction) of households that
experienced housing movement. The type of occupancy was classified
into whether rental households that experienced residential movement
in the metropolitan area continued to be rental households or whether
their own households changed to rental households. The type of
housing was classified whether the current housing was an apartment
- 76 -
or a non-apartment. According to Alonso's utility maximization
theory, the moderating variable was divided into moving from Seoul
to Seoul, moving from Gyeonggi-do or Incheon to Seoul, moving
from Seoul to Gyeonggi-do or Incheon, and moving from
Gyeonggi-do or Incheon to Gyeonggi-do or Incheon. The dependent
variable was housing instability and the RIR (Rent to Income Ratio)
and Schwabe's Index(Housing Cost Ratio) were measured together by
focusing on housing cost payment ability. Data from the Ministry of
Land, Infrastructure and Transport's 2020 Housing Survey were used
as analysis data. Other control variables included the number of
household members, the age of the head of the household, and the
educational background of the head of the household.
A summary of the results of this study is as follows.
First, in the case of movement from Gyeonggi-do and Incheon to
Seoul, households with low assets tend to consume relatively less
housing, while households with high assets tend to consume relatively
more housing. However, if there are more assets than the rent to be
borne, housing instability is likely to decrease. Therefore, it is
necessary to devise a way to improve housing instability while
raising the housing of those who cannot afford it economically.
Accordingly, it is necessary to review whether all types of public
rental housing in the metropolitan area supplied by the Seoul
Metropolitan Government and LH Corporation also have resident asset
standards, and to introduce an asset-linked rent system.
Second, it can be seen that housing instability intensifies as deposits
are prepared using debts such as lease loans. In particular, the
movement from Gyeonggi-do and Incheon to Seoul clearly showed
polarization of housing instability. In addition, it has policy
implications in that the proportion of single-person youth households๋ชฉ ์ฐจ
์ 1์ฅ ์๋ก 1
์ 1์ ์ฐ๊ตฌ์ ๋ฐฐ๊ฒฝ ๋ฐ ๋ชฉ์ 1
์ 2์ ์ฐ๊ตฌ์ ๋ฒ์ ๋ฐ ๋ฐฉ๋ฒ 8
์ 2์ฅ ์ด๋ก ์ ๋
ผ์ ๋ฐ ์ ํ์ฐ๊ตฌ ๊ฒํ 14
์ 1์ ์ด๋ก ์ ๋
ผ์ 14
1. ์ฃผ๊ฑฐ์ด๋์ ๊ดํ ์ด๋ก ์ ๋
ผ์ 14
2. ์ฃผ๊ฑฐ์ด๋ ์ํฅ์์ธ๊ณผ ์ฃผ๊ฑฐ์ด๋๋ฐฉํฅ์ ๊ดํ ์ฐ๊ตฌ 17
3. ์ฃผ๊ฑฐ๋ถ์์ ์ฑ์ ๊ดํ ์ฐ๊ตฌ 21
4. ์ฃผ๊ฑฐ์ด๋๋ฐฉํฅ๊ณผ ์ฃผ๊ฑฐ๋ถ์์ ์ฑ์ ๊ด๊ณ์ ๊ดํ ์ฐ๊ตฌ 27
์ 2์ ์ ํ์ฐ๊ตฌ์์ ์ฐจ๋ณ์ฑ 30
์ 3์ฅ ์ฐ๊ตฌ๋ถ์ ๋ฐ ์ฐ๊ตฌ๋ฐฉ๋ฒ 32
์ 1์ ์ฐ๊ตฌ๋ชจํ ๋ฐ ์ฐ๊ตฌ๊ฐ์ค์ ์ค์ 32
1. ์ฐ๊ตฌ๋ชจํ 32
2. ์ฐ๊ตฌ๊ฐ์ค 34
์ 2์ ๋ณ์์ ์ ์ ๋ฐ ์กฐ์์ ์ ์ 35
1. ์ข
์๋ณ์ 35
2. ๋
๋ฆฝ๋ณ์ 37
3. ์กฐ์ ๋ณ์ 40
์ 3์ ์๋ฃ์์ง ๋ฐ ๋ถ์๋ฐฉ๋ฒ 42
1. ์๋ฃ์์ง 42
2. ๋ถ์๋ฐฉ๋ฒ 44
์ 4์ฅ ๋ถ์๊ฒฐ๊ณผ 47
1. ์๋ต๊ฐ๊ตฌ์ ์ผ๋ฐ์ ํน์ฑ 47
2. ์ฃผ๊ฑฐ๋ถ์์ ์ฑ ์ํฅ์์ธ์ ๋ฐ๋ฅธ RIR๊ณผ ์๋ฐ๋ฒ ์ง์
๋น๊ต๋ถ์ 53
3. ์ฃผ์ ๋ณ์ธ๊ฐ์ ์๊ด๊ด๊ณ 54
4. ์ฃผ๊ฑฐ์ด๋๋ฐฉํฅ์ ์กฐ์ ํจ๊ณผ 55
์ 5์ฅ ๊ฒฐ๋ก 67
์ 1์ ์ฐ๊ตฌ๊ฒฐ๊ณผ์ ์์ฝ 67
์ 2์ ์ฐ๊ตฌ์ ์ ์ฑ
์ ํจ์ 68
์ฐธ๊ณ ๋ฌธํ 71
Abstract 75์
FoxO3a represses lymphangiogenesis in gastric cancer
์๊ณผ๋ํ/์์ฌLymph node metastasis is the most important prognostic factor and is associated with about 60% of gastric cancer. For cancer cells to metastasize to lymph nodes, lymphangiogenesis is required. FoxO3a, a tumor suppressive transcription factor, is known to be a negative regulator of angiogenesis. Despite that lymphangiogenesis and angiogenesis in cancer are interrelated processes, the role of Foxo3a in lymphangiogenesis remains unknown. Thus, the goal of the study is to investigate the clinical significance and the role of FoxO3a in lymph node metastasis and lymphangiogenesis in gastric cancer. Foxo3a expression was analyzed across a large number of gastric cancer patient tissue samples with reverse phase protein microarray (RPPA). To study the biological function, FoxO3a was knocked down with RNA interference or overexpressed with an expression vector in gastric cancer cells. Tube formation and migration assays were carried out in human lymphatic endothelial cells (HLECs) with conditioned media of FoxO3a-silenced or overexpressed gastric cancer cells, respectively. To assess the DNA binding activity of FoxO3a, electrophoretic mobility shift assay (EMSA) was performed. RPPA analysis revealed that FoxO3a expression was inversely correlated with lymph node metastasis and high expression of phosphorylated FoxO3a was a poor prognostic factor in gastric cancer patients. Silencing of FoxO3a in gastric cancer cells profoundly induced VEGF-C expression and secretion, increased tube formation, and migration of HLECs treated with the conditioned media while overexpression of FoxO3a in gastric cancer cells showed the opposite effects. EMSA with supershift assay demonstrated that FoxO3a binds to the FHRE in the promoter region of VEGF-C. Treatment of LY294002, a PI3K pathway inhibitor, reversed the phosphorylation of FoxO3a and increased the nuclear localization of FoxO3a in gastric cancer cells. Collectively, our data clearly illustrate that FoxO3a binds to VEGF-C promoter and transcriptionally represses the expression of VEGF-C thereby inhibiting tumor lymphangiogenesis.ope
์ผ๊ฐ ์ ๋ฐฉ์ฌ๋จ์์ ๊ทผ๊ณจ๊ฒฉ๊ณ ์งํ์ ์ค์ฌ์ผ๋ก
ํ์๋
ผ๋ฌธ(์์ฌ) -- ์์ธ๋ํ๊ต๋ํ์ : ๋ณด๊ฑด๋ํ์ ๋ณด๊ฑดํ๊ณผ(๋ณด๊ฑด์ ์ฑ
๊ด๋ฆฌํ์ ๊ณต), 2023. 2. ์กฐ์๊ด.๊ตฐ ๋ณ์์ ๊ตฐ์ธ์ ์๋ฃ๊ถ ๋ณด์ฅ์ ํต์ฌ์ ์ธ ์ญํ ์ ์ํํ๋ค. ๋ํ ์ฅ๋ณ์ ๊ฑด๊ฐ ์ ์ง์ ์ง๋ณ ๋ฐ ์ฌ๊ณ ๋์์ ํตํด ๊ตฐ์ ์ ํฌ๋ ฅ์ ๋ณด์กดํ๋ ๊ตฐ์ ์ฃผ์ ์กฐ์ง์ด์ ํต์ฌ ์ธํ๋ผ์ด๋ฉฐ, ๊ตญ๊ฐ ์๋ณด๋ฅผ ์ํ ์ ๋ต ์์์ผ๋ก์ ์ค์์ฑ์ ์ง๋๋ค. ๊ทธ๋ฌ๋ ์ต๊ทผ ๊ตฐ ๋ณ์์ ํต์ฌ ์ด์ฉ ๊ณ์ธต์ธ ํ์ญ๋ณ๋ค์ ๊ตฐ ๋ณ์์ ๋ํ ์ ํธ๊ฐ ๋ฎ๊ฒ ํ๊ฐ๋๊ณ , ๊ตฐ ๋ณ์ ์ด์ฉ์ ๊พธ์คํ ๊ฐ์ํ๋ ์ถ์ธ์ด๋ค. ๋ฐ๋ฉด, ํ์ญ๋ณ๋ค์ ๋ฏผ๊ฐ๋ณ์์ ๋ํ ์ ํธ๋ ์๋์ ์ผ๋ก ๋์ผ๋ฉฐ, ๋ฏผ๊ฐ๋ณ์์ ์ฐพ๋ ํ์ญ๋ณ ์๋ ๋งค๋
10% ์ด์ ์ง์์ ์ผ๋ก ์ฆ๊ฐํ๊ณ ์๋ค.
๋ณธ ์ฐ๊ตฌ๋ ์ด์ ๊ฐ์ ์ํฉ์ธ์์ ๋ฐํ์ผ๋ก ๊ทผ๊ฑฐ์ด๋ก ๋ฐฉ๋ฒ๋ก ์ ํ์ฉํ์ฌ ์ค์ ํ์ญ๋ณ๋ค์ ์ง๋ณ ์ํฉ์์ ์ด๋ค ์๋ฃ๊ธฐ๊ด์ ์ ํํ๋์ง์ ๋ํ ๊ณผ์ ์ ์ดํผ๊ณ ์ ํ๋ค. ๊ตฌ์ฒด์ ์ผ๋ก๋ ๋ค์ํ ๊ฐ์ธ์ , ์ฌํ์ ์์ธ๊ณผ ์ด๋ค์ ์ํธ์์ฉ์ด ์ ํ ๊ณผ์ ์ ์ด๋ค ์ํฅ์ ๋ฏธ์น๋์ง ํ๊ตฌํ๊ณ ์ ํ์๋ค.
์ด๋ฅผ ์ํด ๊ตฐ ์ํ ์ค ๊ทผ๊ณจ๊ฒฉ๊ณ ๊ด๋ จ ์ง๋ณ ๋ฐ์์ผ๋ก ์
์ ๋ฐ ์์ ์น๋ฃ๋ฅผ ์ํ ์๋ฃ๊ธฐ๊ด ์ ํ ๊ฒฝํ์ด ์๋ ํ์ญ๋ณ 16๋ช
์ ๋์์ผ๋ก 1:1 ์ฌ์ธต๋ฉด์ ์กฐ์ฌ๋ฅผ ํตํด ์ง์ ์๋ฃ๋ฅผ ์์งํ์๊ณ , ๊ทผ๊ฑฐ์ด๋ก ์ ๋ถ์ ์ ์ฐจ์ ๋ฐ๋ผ ํ์ญ๋ณ์ ์๋ฃ๊ธฐ๊ด ์ ํ ๊ณผ์ ์ด ์ด๋ป๊ฒ ๊ฒฝํ๋๋์ง๋ฅผ ํ๊ตฌ ๋ฐ ๋ถ์ํ์๋ค.
Strauss์ Corbin(1990; 1998)์ ๊ทผ๊ฑฐ์ด๋ก ๋ถ์ ์ ์ฐจ์ ์ํด ๊ฐ๋ฐฉ ์ฝ๋ฉ์ ์ํํ ๊ฒฐ๊ณผ ์ด 65๊ฐ์ ๊ฐ๋
๊ณผ 14๊ฐ์ ํ์๋ฒ์ฃผ, 6๊ฐ์ ์์๋ฒ์ฃผ๋ฅผ ๋์ถํ์์ผ๋ฉฐ, ๋ฐ๋ณต์ ์ธ ์ถ ์ฝ๋ฉ๊ณผ ์ ํ ์ฝ๋ฉ ๊ฒฐ๊ณผ 6๊ฐ์ ํจ๋ฌ๋ค์ ์์์ ํต์ฌ๋ฒ์ฃผ๋ฅผ ๋ฐ๊ฒฌํ์๋ค.
๋ถ์ ๊ฒฐ๊ณผ ํต์ฌ๋ฒ์ฃผ๋ ํ์ญ๋ณ์ ์ง๋ณ ์ด๊ธฐ ์ง๋จ ๊ณผ์ ์์์ ๋ถ์ ์ ์ ๋ ๊ฒฝํ๊ณผ ๊ด๊ณ ๊ฒฝํ์ ๊ตฐ ์๋ฃ์ ๋ํ ๋ถ์ ์ ์ธ์ ๊ฐํ๋ฅผ ์ผ์ผ์ผ ํ์ญ๋ณ์ ๋ฏผ๊ฐ๋ณ์ ์ ํ ๊ฐ๋ฅ์ฑ์ ๋์์ผ๋ก ๋ํ๋ฌ๋ค. ์ธ๊ณผ์ ์กฐ๊ฑด์ ์ง๋ณ ์ํฉ์ด์์ผ๋ฉฐ, ๊ทธ์ ๋ฐ๋ฅธ ์ค์ฌ ํ์์ ์ด๊ธฐ ์ง๋จ ๊ฒฝํ์์์ ์ค๋ง๊ฐ์ผ๋ก ๋ํ๋ฌ๋ค. ์์ฉ-์ํธ์์ฉ ์ ๋ต์ ๊ตฐ/๋ฏผ๊ฐ๋ณ์ ํจ์ฉ์ฑ ํ๊ฐ๋ก ๋ํ๋ฌ์ผ๋ฉฐ, ๊ทธ์ ๋ฐ๋ผ ์๋ฃ๊ธฐ๊ด ์ ํ ๊ฒฐ๊ณผ๋ก ์ด์ด์ก๋ค. ๋งฅ๋ฝ์ ์กฐ๊ฑด๊ณผ ์ค์ฌ์ ์กฐ๊ฑด์ ๊ฐ๊ฐ ๊ตฐ ์๋ฃ์ ๋ฌ์ฒด๊ณ์ ๊ฐ์กฑ ์ง์ ๊ฐ๋ฅ์ฑ์ผ๋ก ๋์ถ๋์๋ค.
๋ถ์ ๊ฒฐ๊ณผ์ ๋ฐ๋ผ, ๊ตฐ ์๋ฃ์ ๋ฌ์ฒด๊ณ ํน์์ฑ์ ๋ํ ์ฌ๋ฐ๋ฅธ ์ดํด๋ฅผ ๋ฐํ์ผ๋ก ํ ํฉ๋ฆฌ์ ์ด๊ณ ํจ์จ์ ์ธ ๊ตฐ ์๋ฃ์ ๋ฌ์ฒด๊ณ์ ๊ตฌ์ถ, ๊ตฐ ์๋ฃ์ธ๋ ฅ์ ์ ๋ฌธ์ ์์ฌ์ํต ๋ฅ๋ ฅ ํฅ์ ๋ฐฉ์ ๋ง๋ จ, ๊ตฐ ์๋ฃ์ ๋ํ ๋์์ ์ดํด์ฆ์ง ๋
ธ๋ ฅ์ ์ ์ํ์๋ค.The military hospital plays a pivotal role in guaranteeing the medical rights of enlisted soldiers in South Korea. In addition, it serves as a strategic resource for national security as well as a key institution for preserving the combat power of the military. Nonetheless, in recent years, the preference for military hospitals by enlisted soldiers has declined; the number of patients at military hospitals has decreased. Instead, the number of enlisted soldiers who visit private hospitals has increased by at least 10% every year.
This study seeks to explore the process by which enlisted soldiers select a medical institution for professional medical treatment. Specifically, this study delves into the ways in which various personal and social factors, and their interactions, influence the selection process. For the study, I collected qualitative data by conducting in-depth interviews with 16 enlisted soldiers who had had surgical treatment for their musculoskeletal-related diseases during their service. I analyzed the data following the process that the grounded theory: I extracted 65 concepts, 14 subcategories, and 6 upper categories through open coding; also, I identified six paradigm elements and core categories through repetitive axis coding and selective coding.
The major findings of this study include: First, the soldiers negative interactions with medical institutions and staff in the early diagnosis stage serve as the confirmation of their negative perceptions about military medical care that they have held. Second, after going through the negative interactions in the early diagnosis stage, the soldiers actively engage in comparing the pros and cons of military and private medical institutions, which leads to their selection of medical institutions. In this process, the military medical delivery system and the mobilizability of family support influence their selections.
Based on the findings, this study offers three suggestions for the military medical policy in South Korea including establishing a reasonable and efficient military medical delivery system, improving the professional communication skills of military medical personnel, and promoting positive images of military medical care.โ
. ์๋ก 1
1. ์ฐ๊ตฌ์ ๋ฐฐ๊ฒฝ ๋ฐ ํ์์ฑ 1
2. ์ฐ๊ตฌ ๋ชฉ์ 3
โ
ก. ๋ณธ๋ก 4
1. ๊ตฐ ๋ณด๊ฑด์๋ฃ์ฒด๊ณ 4
๊ฐ. ๊ตฐ ๋ณด๊ฑด์๋ฃ๊ธฐ๊ด ๋ฐ ์๋ฃ์ ๋ฌ์ฒด๊ณ 5
๋. ๊ตฐ ์๋ฃ ์๋น์ค ์ด์ฉ ํํฉ 8
2. ์๋ฃ๊ธฐ๊ด ์ ํ 11
๊ฐ. ์๋ฃ๊ธฐ๊ด ์ ํ์์ธ์ ๊ดํ ์ด๋ก ๋ฐ ์ ํ์ฐ๊ตฌ 11
๋. ํ์ญ๋ณ์ ์๋ฃ๊ธฐ๊ด ์ ํ ๊ด๋ จ ์ ํ์ฐ๊ตฌ 16
โ
ข. ์ฐ๊ตฌ๋ฐฉ๋ฒ 21
1. ์ฐ๊ตฌ ์ค๊ณ 21
2. ์๋ฃ ์์ง 22
๊ฐ. ์ฐ๊ตฌ ์ฐธ์ฌ์์ ์ ์ 22
๋. ์๋ฃ ์์ง ์ ์ฐจ 25
3. ์๋ฃ ๋ถ์ 28
4. ์ฐ๊ตฌ์ ์ ๋ขฐ์ฑ ๋ฐ ํ๋น์ฑ 31
5. ์ฐ๊ตฌ์ค๋ฆฌ 31
โ
ฃ. ์ฐ๊ตฌ ๊ฒฐ๊ณผ 32
1. ํ์ญ๋ณ์ ์๋ฃ๊ธฐ๊ด ์ ํ ๊ณผ์ 32
๊ฐ. ๊ฐ๋ฐฉ ์ฝ๋ฉ 32
๋. ์ถ ์ฝ๋ฉ 36
๋ค. ์ ํ ์ฝ๋ฉ 56
โ
ค. ๋
ผ์ 62
1. ์ฐ๊ตฌ ๊ฒฐ๊ณผ์ ์์ฝ 62
2. ์ฐ๊ตฌ ๊ฒฐ๊ณผ์ ๋ํ ๋
ผ์ ๋ฐ ์ ์ฑ
์ ์ 66
3. ์ฐ๊ตฌ์ ์์ ๋ฐ ํ๊ณ 69
์ฐธ๊ณ ๋ฌธํ 71
Abstract 77์
Fat-to-Muscle Ratios and the Non-Achievement of LDL Cholesterol Targets: Analysis of the Korean Genome and Epidemiology Study
Maintaining optimal low-density lipoprotein (LDL) cholesterol levels is necessary to prevent cardiovascular disease (CVD). Excessive fat mass and decreased muscle mass are both associated with increased risks of developing dyslipidemia. Thus, we investigated the longitudinal relationship between the fat-to-muscle ratio (FMR) and the non-achievement of LDL cholesterol targets. We analyzed a total of 4386 participants aged 40โ69 years from the Korean Genome and Epidemiology Study. FMR was defined as the ratio of total fat mass to total muscle mass, measured by bioelectrical impedance. The non-achievement of an LDL cholesterol target was defined as an LDL cholesterol level higher than the established target level according to individual CVD risk. The adjusted hazard ratios and 95% confidence interval for the incidence of non-achievement of LDL cholesterol targets for the sex-specific middle and highest tertiles vs. the referent lowest tertile of FMR were 1.56 (1.29โ1.90) and 1.86 (1.47โ2.31) in men and 1.40 (1.18โ1.66) and 1.31 (1.06โ1.62) in women after adjusting confounders. Our findings suggest that FMR, a novel indicator of the combined effects of fat and muscle mass, is useful for predicting non-achievement of LDL cholesterol targets.ope
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