Primary Health Care for Vulnerable Population

의료-사회적 취약대상자는 보건의료에 대한 수요는 높으나 이에 대한 지원이 부족하여 미충족된 보건의료 수요가있는 집단이라고 볼 수 있다. 암생존자, 말기환자, 간병가족,탈북자 및 다문화가정 등은 보건의료적인 수요는 매우 높으나 아직 이들을 위한 보건의료 지원체계가 정립되지 않으므로 의료-사회적 취약대상자이다. 장기간 생존하는 암환자들이 크게 증가하고, 암 치료 이후의 삶이 점차 중요한 이슈가 되면서, 암생존자를 위한 이차암 예방 · 검진 및 만성질환의 관리등 건강증진 프로그램에 대한 필요성이 증가하고 있다. 중증환자의 간병 부담은 간병가족의 삶의 질 저하 뿐 아니라 사망률 및 심혈관계 질환 발생률을 높이는 것으로 알려져 있다. 환자의 치료 뿐 아니라 간병가족을 위한 건강 증진 프로그램을제공하면, 가족 전체의 건강을 관리하는 가정의학의 기본 원칙에 충실한 독창적인 보건의료 서비스가 될 것이다. 최근 호스피스 수가 개발 및 적용에 대한 논의가 활발해 지면서 호스피스 · 완화의료와 가정방문진료서비스를 제공할 가정의학과의료진에 대한 수요도 증가할 것이다. 따라서 가정의학과 수련 교육과정뿐 아니라 진료의 현장에서도 지역 사회의 말기환자를 돌볼 수 있는 양질의 의료진을 양성할 수 있도록 노력해야 한다. 최근 우리 사회는 이민, 국제결혼, 탈북자의 국내 입국 등으로 인해 빠르게 다문화사회로 진입하고 있다. 이러한다양한 배경의 대상자들이 가지는 특성들을 이해하고 그들에게 적합한 설명 모델을 개발하며, 지속적인 건강관리를 수행할 수 있는 일차의료인을 양성하는 것이 필요하다. 우리나라는 최근의 빠른 변화에 대응할 수 있는 보건의료 사회 안전망이 탄탄하지 않다. 이러한 변화에 발맞추어 일차의료의 역할을 새롭게 정의하고, 선제적이며 적극적인 대응책을 준비하는 것이 가정의학이 담당해야 할 중요한 과제라고 생각된다.Although vulnerable population such as cancer survivors, terminal patients, caregivers and immigrants have greater health needs, they don't receive enough health care services in our health care system. Continuous advances in cancer treatment have led to a marked improvement in cure rates and thus, an increased population of long-term cancer survivors. Due to both original and treatment-related risk factors, survivors are at increased risk for second primary cancers. In addition, pre-diagnosis smoking, alcohol, obesity and insulin resistance, which are well-known risk factors for cancer development, also appear to affect cancer outcome. To improve the health promotion of cancer survivors, developing shared care model between oncologist and primary care physician is needed. Chronic disease has not only a great effect on the affected patients but also on their caregivers. Caregiving burden was associated with impaired physical function and increased emotional distress. Caregiving burden also increase the risk of cardiovascular disease incidence among caregivers. More attention should be focused on these caregivers to improve their health. Recently, as increasing social needs to develop the health care system for terminal patients, Korean Government began to support palliative care units with implementing the National Cancer Control Program for Terminal Cancer Care. With these social movements, the needs for human resources in the area of palliative care are continuosly increasing, and active participation of primary care physician is needed. Due to rapid changes of population structure in South Korea, the number of multi-cultures family has continuously increased. Especially, more than 15,000 North Korean defectors settled in South Korea in 2008. North Korean defectors are more likely to have unhealthy behaviors, poor quality of life and comorbidities, while they have poor primary care accessibility. Good primary health requires a population perspective, and there has been great change of population structure in South Korea. As prevalence of vulnerable population is seemed to continuously increasing, the planning and development of tailored primary care program for this population to reflect their actual unmet needs is essentially required.OAIID:oai:osos.snu.ac.kr:snu2009-01/102/0000052039/7SEQ:7PERF_CD:SNU2009-01EVAL_ITEM_CD:102USER_ID:0000052039ADJUST_YN:YEMP_ID:A077862DEPT_CD:801CITE_RATE:0FILENAME:의료사회적 취약대상자를 위한 일차의료.pdfDEPT_NM:의학과EMAIL:[email protected]_YN:NCONFIRM:

Direct Visualization of Plasmonic Hotspots of Silver Nanowire Dimers using SERS

학위논문 (석사)-- 서울대학교 대학원 : 자연과학대학 화학부, 2018. 2. 김지환.Visualization of surface plasmon polaritons (SPP) is essential for characterization of plasmonic waveguides which are building blocks for photonic circuits with subwavelength scale. Currently, well-established techniques such as fluorescence- or tip-based microscopy usually improper for being applied to narrow-gap plasmonic structures. In this case, surface-enhanced Raman scattering (SERS) microscopy can be an alternative tool for visualizing highly localized electric field of gap plasmon waveguides. In this work, we report on SERS imaging of chemically synthesized silver nanowire (AgNW) dimers, which shows spatial modulation of intensity patterns along NW-axis. We interpret that such unusual SERS patterns arise from mode beating between two distinct SPP eigenmodes of NW-dimers, generating oscillating intensity distributions. Also, we discuss the validity of the concept that SERS intensity at far-field region directly represents the intensity of local electric field generated from plasmon excitation process, contrary to usual nanoparticle dimers cases.1. Introduction 1 1.1. Plasmon 1 1.1.1. Localized Surface Plasmon 2 1.1.2. Surface Plasmon Polariton 2 1.2. SPP Propagation in Metal Waveguide 3 1.2.1. Eigenmodes of Waveguide 4 1.2.2. Effective Indices of Eigenmodes 5 1.2.3. Visualization of SPPs in Metal Waveguides 7 1.2.3.1. Fluorescence-based Technique 7 1.2.3.2. Tip-based Technique 8 1.3. Surface-enhanced Raman Scattering 9 1.3.1. Raman Effect 9 1.3.2. Surface-enhanced Raman Scattering 10 1.3.3. Electromagnetic Enhancement 11 1.4. Goal of the Project 13 2. Experimental Setup 14 2.1. Confocal Raman Microscope System 14 3. Wide-field SERS Imaging for Silver Nanowire (AgNW) Dimers 16 3.1. Sample Preparation 16 3.1.1. Polyol Synthesis of AgNWs 16 3.1.2. Surface Modification of AgNWs 17 3.2. Wide-field SERS imaging for AgNW dimers 19 3.3. Finite Difference Time Domain Simulation 24 3.3.1. Near-field Simulation 24 3.3.2. Far-field Simulation 36 3.4. Conclusions and Outlook 46 References 47 Abstract (in Korean) 52Maste

서울시 노인을 대상으로

학위논문 (석사) -- 서울대학교 대학원 : 행정대학원 공기업정책학과, 2020. 8. 정광호.본 연구는 평균수명의 증가와 출산율의 급감으로 인한 노인인구비율의 확대라는 환경 변화 속에서 노인의 주거환경 관련 특성과 삶의 만족도의 관계에 대한 의문에서 시작하였다. 노인의 주거환경 관련 특성과 삶의 만족도의 관계를 실증적으로 분석하고자 「서울서베이 도시정책지표조사」를 활용하였다. 주거환경 관련 특성을 주거점유형태, 주택형태, 거주기간, 가구원수로, 노인을 전기노인과 후기노인으로 구분하여 각각의 삶의 만족도를 분석하였고 나아가 노인층을 중장년층과 비교・분석해보고자 하였다. 주요 결과는 다음과 같다. 첫째, 노인은 자가 일수록(+), 아파트 일수록(+), 거주기간이 길수록(+), 가구원수가 적을수록(-) 삶의 만족도가 높게 나타났다. 둘째, 전기노인보다 후기노인의 경우 위 주거환경 관련 특성이 미치는 영향력이 더 강한 것으로 나타났다. 셋째, 주거환경 관련 특성이 삶의 만족도에 미치는 영향력은 중장년층보다 노인층에서 강하게 나타났다. 이러한 연구결과를 바탕으로 정책적 시사점을 도출해 보면 아래와 같다. 첫째, 노인들은 단독주택을 더 선호한다고 알려져 있지만 현실적으로 일반주택의 주거환경은 노인의 삶의 만족감을 충분히 지원해 주지 못하고 있는 것으로 나타났다. 대규모 단지로 개발되는 아파트의 주거환경 개선에 버금가는 일반주택의 노인친화형 주거환경 조성 노력이 필요한 것이다. 자가를 선호하고 한 장소에서의 거주기간이 길어질수록 삶의 만족도가 높아지므로 영구임대 주택 등의 노인공급확대를 통해 여생동안 이사를 가지 않고 자가와 같은 수준의 안정적인 주거가 가능하도록 제도를 정비할 필요가 있다. 둘째, 노인의 삶의 만족도를 결정하는 주거환경 관련 특성은 후기노인으로 갈수록 더 많은 영향을 미치는 것으로 나타났다. 따라서 주거·의료·여가 등 다양한 노인복지시설 제공 및 지역사회 자원을 활용한 사회복지 서비스의 연계를 통한 노인의 삶의 질을 향상시킬 수 있는 방안을 강구하되 노인의 연령대를 구분하여 차별화된 정책을 제시해야 할 필요성이 있다.This study began with a question about the relationship between residential environment-related characteristics of the elderly and life satisfaction amid environmental changes such as an increase in the average life expectancy and an increase in the proportion of the elderly population due to a sharp drop in the birth rate. The Seoul Survey of Urban Policy Indicators was used to empirically analyze the relationship between residential environment-related characteristics and life satisfaction of the elderly. The characteristics related to the residential environment were divided into housing occupancy type, housing type, period of residence, number of households, and senior citizens, and the satisfaction level of each life was analyzed. Furthermore, the elderly were compared and analyzed with the middle-aged. The main results are as follows: First, the older the elderly were found to be more satisfied with their lives (+), the more apartments (+), the longer the residence period (+), and the less the number of households (-). Second, it was found that the influence of the above residential environment-related characteristics was stronger for the old-old than for the young-old. Third, the influence of residential environment-related characteristics on life satisfaction was stronger in the elderly than in the middle-aged. Based on these findings, policy implications are shown below. First, the elderly are known to prefer detached houses, but in reality, the residential environment of ordinary houses does not fully support the satisfaction of the elderly's life. Efforts should be made to create an elderly-friendly residential environment for general housing, which is comparable to improving the residential environment of apartments developed into large-scale complexes. The system needs to be overhauled to ensure stable housing at the same level as the owner's house for the rest of his life without moving for the rest of his life, as the longer he lives in one place, and the higher the satisfaction of living in one place, such as permanent rental housing, increases the supply of senior citizens. Second, the residential environment-related characteristics that determine the satisfaction level of the elderly's life have been shown to have more and more influence on the old-old. Therefore, it is necessary to devise measures to improve the quality of life of senior citizens by providing various welfare facilities for them, such as housing, medical care, and leisure, and linking social welfare services using community resources, while presenting differentiated policies by dividing the age groups of senior citizens.제 1 장 서 론 1 제 1 절 연구의 배경 및 목적 1 제 2 절 연구의 범위 및 방법 4 1. 연구의 범위 4 2. 연구의 방법 4 제 2 장 이론적 논의 및 선행연구 검토 6 제 1 절 노인의 주거환경에 관한 논의 6 1. 노인의 특징 및 구분 6 2. 주거선택 및 주거만족에 관한 논의 7 3. 노인의 주거환경과 주거만족에 관한 논의 14 제 2 절 노인의 주거환경과 삶의 만족에 관한 논의 18 1. 삶의 만족에 관한 논의 18 2. 노인가구의 주거환경과 행복에 관한 논의 21 제 3 절 선행연구의 종합 및 본 연구의 차별성 24 1. 선행연구의 종합 24 2. 선행연구와의 차별성 25 제 3 장 연구모형 및 방법 26 제 1 절 연구모형과 연구가설 26 1. 연구모형 26 2. 연구가설 27 제 2 절 분석자료 및 변수의 정의 29 1. 조사대상과 분석자료 29 2. 변수의 정의 및 측정 30 제 4 장 분석결과 및 해석 33 제 1 절 응답자의 특성과 주요 변수의 기술통계량 33 1. 응답자의 특성과 주요 변수릐 기술통계량 33 2. 주요 변수의 응답자 유형별 측정결과 38 제 2 절 분석 결과 44 1. 상관관계 분석결과 44 2. 회귀분석 결과 45 제 5 장 연구의 함의 및 한계 62 제 1 절 연구의 의의 및 정책적 함의 62 제 2 절 연구의 한계 63 참고문헌 64 부 록 70 Abstract 79Maste

Evaluation of Fracture Energy and Structural Performance of Concrete with Accumulated Layers Formed by 3D Printing Technology

With the recent development of 3D printing technology, concrete materials are sometimes used in 3D printing. Concrete structures based on 3D printing have been characterized to have the form of multiple layer build-up. Unlike general concrete structures, therefore, the 3D-printed concrete can be regarded as an orthotropic material. The material property of the 3D-printed concrete's interface between layers is expected to be far different from that of general concrete bodies since there are no aggregate interlocks and weak chemical bonding. Such a difference finally affects the structural performance of concrete structures even though the interfaces are formed before initial setting of the concrete. Furthermore, it was confirmed that superimposed load from the accumulated layers increase the fracture energy of interface between two layers. The current study mainly reviewed the changes in fracture energy (toughness) with respect to various environmental conditions of such interface. Changes in fracture energies of interfaces between concrete layers were measured using low-speed Crack Mouth Opening Displacement (CMOD) closed loop concrete fracture test. The experimental results indicated reduction in fracture energy as well as tensile strengths. In order to improve the tensile strength of interfaces, use of bridging materials are suggested. Since it was assumed that reduction in fracture energy could be a cause of shear strength, in order to evaluate the reduced structural performance of concrete structure constructed with multiple interfaces by 3D printing technology, shear strength of RC beam by 3D printing technology was predicted and compared with plain RC beam. Based on the fracture energy measured in this study, MCFT theory-applied Vector 2 program was employed to predict the degree of reduction in shear strength without considering stirrups. Reduction factors were presented based on the obtained results to predict the reduction in shear strength due to interfaces before initial setting of the concrete.목 차 Abstract ⅰ List of Tables ⅲ List of Figures ⅳ 제 1 장 서 론 1 1.1 연구 배경 1 1.2 연구 목표 및 중요성 3 1.3 연구 내용 및 방법 5 제 2 장 파괴에너지 측정 실험 이론 및 분석 7 2.1 시험체 형상 및 실험 조건 7 2.2 파괴에너지 측정을 위한 실험 이론 10 2.3 파괴에너지 측정을 위한 실험계획 및 장비 16 2.3.1 자중에 대한 실험계획 및 장비 16 2.3.2 적층 소요시간에 따른 실험계획 및 장비 18 2.3.3 브릿징(Bridging) 재료의 적용 22 2.4 쪼갬인장시험 결과 (ASTM C496) 23 2.5 파괴에너지 측정시험 결과 및 분석 27 2.5.1 자중 조건과 적층 소요시간 조건이 적용된 시편의 파괴에너지 측정 시험 결과 27 2.5.2 브릿징(Bridging) 재료를 활용한 시편의 파괴에너지 측정 시험 결과 37 제 3 장 전단강도의 저감 예측 및 분석 41 3.1 접합면 형성에 의한 전단강도의 저감 추정 이론 41 3.2 접촉면의 요소에 대한 전단 응력 - 슬립 관계 44 3.3 전단강도 모델 검증 47 3.4 전단강도 저감에 따른 결과 및 분석 53 3.5 접합면을 갖는 RC 보에 대한 전단 감소 계수의 제안 59 제 4 장 결론 및 향후 과제 61 참고문헌 64 감사의 글 70Maste

Feasible economic strategies to improve screening compliance for colorectal cancer in Korea

Aim: While colorectal cancer (CRC) is an ideal target for population screening, physician and patient attitudes contribute to low levels of screening uptake. This study was carried out to find feasible economic strategies to improve the CRC screening compliance in Korea. Methods: The natural history of a simulated cohort of 50-year-old Korean in the general population was modeled with CRC screening until the age of 80 years. Cases of positive results were worked up with colonoscopy. After polypectomy, colonoscopy was repeated every 3 years. Baseline screening compliance without insurance coverage by the national health insurance (NHI) was assumed to be 30%. If NHI covered the CRC screening or the reimbursement of screening to physicians increased, the compliance was assumed to increase. We evaluated 16 different CRC screening strategies based on Markov model. Results: When the NHI did not cover the screening and compliance was 30%, non-dominated strategies were colonoscopy every 5 years (COL5) and colonoscopy every 3 years (COL3). In all scenarios of various compliance rates with raised coverage of the NHI and increased reimbursement of colonoscopy, COL10, COL5 and COL3 were non-dominated strategies, and COL10 had lower or minimal incremental medical cost and financial burden on the NHI than the strategy of no screening. These results were stable with sensitivity analyses. Conclusion: Economic strategies for promoting screening compliance can be accompanied by expanding insurance coverage by the NHI and by increasing reimbursement for CRC screening to providers. COL10 was a cost-effective and cost saving screening strategy for CRC in Korea. ？ 2005 The WJG Press and Elsevier Inc. All rights reserved.http://www.wjgnet.com/1007-9327/11/1587.aspOAIID:oai:osos.snu.ac.kr:snu2005-01/102/0000052039/4SEQ:4PERF_CD:SNU2005-01EVAL_ITEM_CD:102USER_ID:0000052039ADJUST_YN:YEMP_ID:A077862DEPT_CD:801CITE_RATE:0FILENAME:3_Feasible economic strategies to improve screening compliance for colorectal cancer in Korea.pdfDEPT_NM:의학과EMAIL:[email protected]:

Factors Associated with the Use of Uterine Cervical Cancer Screening Services in Korean Elderly Women

Background: The Papanicolaou (Pap) smear test is an effective screening test for the early detection of uterine cervicalcancer. The Pap test still plays an important role in Korean elderly women, as uterine cervical cancer remains a frequentform of cancer and an important cause of death. However, the participation rate and other factors related to the Pap testin Korean elderly women have been studied insufficiently.Methods: This study included 654 individuals aged 65 and over who completed a cervical cancer screening questionnairefrom the Third Korean National Health and Nutrition Examination Survey 2005. Using multiple logistic regression, oddsratios and confidence intervals for the association between attendance of the Pap test and sociodemographic or healthrelatedfactors were calculated.Results: One hundred and eleven individuals (17.0%) of the study population showed compliance with Pap testingwithin the previous 2 years. We recognized that the most elderly women (75 years and over) or those with lower levels ofeducation were less likely to have had the test.Conclusion: Primary health care providers need to make efforts to improve attendance rates of Pap smear screening inKorean elderly women, individually taking into account previous Pap results, life expectancy, risk factors for cervicalcancer, and preferences. More attention will especially be needed among the eldest elderly or less educated elderlywomen.OAIID:oai:osos.snu.ac.kr:snu2012-01/102/0000052039/9SEQ:9PERF_CD:SNU2012-01EVAL_ITEM_CD:102USER_ID:0000052039ADJUST_YN:YEMP_ID:A077862DEPT_CD:801CITE_RATE:0FILENAME:25_Factors associated with use of gastric cancer screening services in Korea.pdfDEPT_NM:의학과EMAIL:[email protected]_YN:NCONFIRM:

Bisphosphonate use and gastrointestinal tract cancer risk: Meta-analysis of observational studies

AIM: To perform a meta-analysis of observational studies to further elucidate the relationship between oral bisphosphonate use and gastrointestinal cancer risk.METHODS: Systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane Library to identify studies through January 2011. Search terms wereOAIID:oai:osos.snu.ac.kr:snu2012-01/102/0000052039/11SEQ:11PERF_CD:SNU2012-01EVAL_ITEM_CD:102USER_ID:0000052039ADJUST_YN:YEMP_ID:A077862DEPT_CD:801CITE_RATE:2.471FILENAME:63_Bisphosphonate use and gastrointestinal tract.pdfDEPT_NM:의학과EMAIL:[email protected]_YN:YCONFIRM:

Still life with less: North Korean young adult defectors in South Korea show continued poor nutrition and physique

North Korean defectors who settle in South Korea have experienced severe food shortage and transition of food environment which could affect their health status. However, little is known about their anthropometric measurements and dietary intake after settlement in South Korea. The purpose of this study is to compare anthropometric measurements and dietary intake between North Korean young adults who defected to South Korea and those of South Koreans. We hypothesized that North Korean young adults' physiques and dietary intake would be poorer than that of South Koreans. We compared anthropometric measurements and dietary intake from 3-day food records in a cross-sectional study of 103 North Korean young adult defectors, aged 12 to 24 and 309 South Korean subjects. North Korean subjects were significantly shorter #4.9 to 10.8 cm# and lighter #6.0 to 12.5 kg# than the control group. Body mass index were significantly different between North and South Korean groups only in men. North Korean young adult defectors had lower mean daily intakes of energy and most nutrients and food groups compared to the control group, while North Korean subjects had higher nutrient density diet than that of South Koreans. The proportion of subjects who had dietary intakes of nutrients of less than the Estimated Average Requirement was higher in North Korean subjects than in controls except for in the cases of vitamin A and vitamin C. In conclusion, we recommend providing nutrition support programs for North Korean young adult defectors to secure adequate nutrient intake.OAIID:oai:osos.snu.ac.kr:snu2010-01/102/0000052039/2SEQ:2PERF_CD:SNU2010-01EVAL_ITEM_CD:102USER_ID:0000052039ADJUST_YN:YEMP_ID:A077862DEPT_CD:801FILENAME:36_Still life with less_ North Korean young adult.pdfDEPT_NM:의학과EMAIL:[email protected]_YN:NCONFIRM:

Depressive symptoms, chronic medical illness, and health care utilization: findings from the Korean Longitudinal Study of Ageing (KLoSA)

Background: This population-based study examined the relative and combined relationships of chronic medical illness (CMI) and depressive symptoms with health care utilization among older adults in South Korea.Methods: A nationally representative sample of 3224 older adults participating in the Korean Longitudinal Study of Ageing (KLoSA) were categorized into four groups based on clinical characteristics: CMI only; depressive symptoms only; CMI and depressive symptoms; and neither CMI nor depressive symptoms. We estimated the use of various health care services by the groups while adjusting for clinical and sociodemographic characteristics.Results: Depressive symptoms, as measured by the short-form Center for Epidemiological Studies-Depression scale (CES-D10), were prevalent, often occurring together with CMI in community-dwelling older adults in South Korea. Having depressive symptoms was positively associated with the use of inpatient services, outpatient physician services, and public health centers. The odds of using health care services were larger among older people with both depressive symptoms and CMI than depressive symptoms only.Conclusions: Self-reported depressive symptoms and self-reported CMI are prevalent among older adults in South Korea, often occurring together and possibly increasing health care utilization. These findings imply a need for chronic disease management targeting older people with complex mental and medical conditions and evaluation of its effects on health outcomes and service use.OAIID:oai:osos.snu.ac.kr:snu2011-01/102/0000052039/1SEQ:1PERF_CD:SNU2011-01EVAL_ITEM_CD:102USER_ID:0000052039ADJUST_YN:YEMP_ID:A077862DEPT_CD:801CITE_RATE:2.24FILENAME:40_Depressive symptoms, chronic medical illness, and health care utilization_KLoSA.pdfDEPT_NM:의학과EMAIL:[email protected]_YN:YCONFIRM: