유전상담과 전문 유전상담사 수요에 대한 전국적인 조사

정윤석(Yoon-Sok Chung),김숙령(Sook Ryung Kim),최지영(Jiyoung Choi),김현주(Hyon J. Kim) 대한의학유전학회 2007 대한의학유전학회지 Vol.4 No.2

목적 : 최근 들어서 국내 의료계에서도 Non-MD 전문 유전상담사의 필요성이 대두되고 있으며, 유전상담과 전문유전상담자 수요에 대한 전국적 기초조사를 수행함으로서, 향후 중장기 계획 Master plan을 가지고 유전상담교육 및 상담사 배출을 체계적으로 할 수 있게 될 것이다 방법 : 2007년 9월 3일부터 2007년 10월 4일까지 1개월 동안 이메일, 전화, 팩스, 직접수령의 방법으로 의료기관, 유전자 검사평가원에 등록된 비 의료기관, 정책연구기관, 자조회 등을 통하여 주임연구원, 교수 등을 대상으로 총 16문항의 설문을 하였다. 결과 : 설문 내용의 분석 결과 “유전상담의 필요성을 느끼고 있는지”에 대하여 응답자의 90명(88%)에서 유전상담의 필요성을 느끼고 있었으며, 그 중 “매우 필요하다”는 답변은 31명(34%)으로 나타났다. 또 “응답자 또는 응답자가 근무하는 기관에서는 의학유전학 석사학위 이상의 교육을 받은 전문직 유전상담사의 필요성을 느끼고 있는지”에 대한 문항에서는 필요하다는 의견이 68명(77%)을 차지하였고, 그 중 “매우 필요하다”는 의견은 16명(23%)의 결과를 보였다. 전문 유전상담에 대한 수가 책정이 건강보험급여로 인정되어야 한다고 생각하는 응답자가 78명(77%)으로 나타났으며, 그 중 23명(29%)이 매우 필요하다고 응답하였다. 이에 전문 유전상담사를 채용할 계획이 있다고 응답한 57명의 답변으로, 5년 이내 채용계획이 있다는 의견이 41명(71%)이었고, 채용 시 기대하는 담당 업무는 “유전 카운슬링” 34명(60%), “학술담당” 24명(42%), “교육담당” 10명(18%), “임상검사담당” 11명(19%)으로 나타났다. 결론 : 이번 조사에는 대상자 650명 중에 총 102명이 설문에 응하였고, 국내 유전상담과 전문 유전상담사 수요에 대한 전국적 기초조사 결과를 토대로, 향후 5-10년 중장기계획을 가지고 유전상담교육, 유전 상담의 의료보험 적용과 전문 유전상담사 배출을 체계적으로 하는데 있었으며 이에 효율적인 유전질환 관리와 국가차원의 시스템 구축 및 유전질환 환자에 대한 양질의 의료서비스를 제공할 수 있을 것으로 기대된다. Purpose: The necessity of professional non-MD genetic counselor has been recently emphasized in a medical field. By conducting a national survey on the demands for generic counseling and professional non-MD generic counselor, we can make a long-term master plan to execute the educational program for professional genetic counselors and indeed promote genetic counseling in Korean health care service in a systemic manner. Methods: The survey has been conducted from September 3rd to October 4th of 2007 in a way of e-mail, telephone interview, fax, and direct contacts. It's targets were senior researchers and professors in medical and non-medical institutions, policy makers, research institutions or foundations. The survey questions consist of 16 questionnaires. Results: As a result of survey, 102 of 650 people responded, 80 % of respondents indicated that genetic counseling is needed as a health care service and 34% among them considered it as "the most needed". In addition, 77% of the respondents showed that, it is necessary to have a professional non-MD genetic counselor with a master degree or higher in the field of medical genetics and among them 29% thought it as "the most necessary". A 77% of respondents considered that the cost of genetic counseling should be covered by health insurance and among them. 29% answered "strongly agreed". A 56% of respondents chose the answer of "They have a plan to hire the professional non-MD genetic counselor or" in their institution, and among them 71% selected "within 5 years" in terms of when to hire. Also, they tend to expect the role of the professional non-MD genetic counselor to be not only "genetic counselor" (60%), but also "researcher" (42%), "educator" (18%) and "clinical laboratory coordinator" (19%). Conclusion: The 102 of 650 people responded to the survey. Based upon the nationwide survey over the needs on genetic counseling in health care service and demands on the professional non-MD genetic counselor, systematic educational program for the genetic counseling, with reimbursement coverage for counseling service by health insurance should be emphasized in development of a master plan.

한국인 정상 성인에서 성장호르몬의 분비능

정윤석(Yoon Sok Chung),김현만(Hyeon Man Kim),이은직(Eun Jig Lee),정재희(Jae Hee Chung),이경미(Kyung Mi Lee),박석원(Seog Won Park),조홍근(Hong Keun Cho),이현철(Hyun Chul Lee),허갑범(Kap Bum Huh),박유경(Yoo Kyoung Park),김희선(Hee Son 대한내과학회 1994 대한내과학회지 Vol.47 No.3

N/A Objectives: Growth hormone secretory capacity of adults decrease with aging, Growth hormone secretory capacity and prevalence of growth hormone deficiency in Korean adults were studied. Methods: History, physical examination, and routine blood tests were performed to roule out ill patients among ordinary subjects. Anthropometry, nutritional history, serum insulin-like growth factor-1 (IGF-1) levels, L-dopa stimulation tests, and urinary growth hormone levels were measured in 309 Korean adults, ages 20-87 years. Results: The mean serum IGF-1 levels were 258,2+6. 8 ng/ml. The mean serum IGF-1 levels of adult males were significantly higher than those of the females. The serum IGF-1 levels decreased with aging. The prevalence of growth hormone deficiency defined by serum IGF-1 levels (< 150 ng/ml) were 0.0% in the 3rd decade, 5.5% in the 4th decade, 12.2% in the 5th decade, 10.0% in the 6th decade, 32.1% in the 7th decade, 48.1% in the 8th decade, respectively. The serum IGF-1 levels were positively correlated with total energy expenditure, but negatively correlated with body fat mass. The peak serum growth hormone levels after L-dopa stimulation and urinary growth hormone levels of the younger subjects were significantly higher than those of the older subjects, There were goad correlations among serum IGF-1 levels, peak growth hormone levels after L-dopa stimulation, and urinary growth hormone levels. Conclusion: Growth hormone secretory capacity decreased significantly with aging, and growth hormone deficiency was found in about 1/3 of subjects aged over 60 years.

골다공증의 최신 치료

정윤석 ( Yoon Sok Chung ) 대한류마티스학회 2012 대한류마티스학회지 Vol.19 No.1

Osteoporosis is a common senile disease that results in fragility fractures. With an ageing population, the medical and socioeconomic effect of osteoporosis, particularly postmenopausal osteoporosis, will increase further. Currently, good anti-fracture data supports many available anti-resorptive and anabolic drugs including bisphosphonates, selective estrogen receptor modulators, and recombinant human parathyroid hormones. Calcium and vitamin D are also essential treatments for the prevention and treatment of osteoporosis. Although, bisphosphonate is the cornerstone of osteoporosis treatment and is considered as the first line of therapy, their duration of therapy and long- term safety is under question. Novel agents, particularly denosumab, inhibitors of cathepsin K, andanabolic agents that act on Wnt signaling, will increase the therapeutic options for clinicians in the coming years.

성장호르몬이 결핍된 성인에서 성장호르몬의 치료 효과

정윤석(Yoon Sok Chung),이현철(Hyun Chul Lee),안광진(Kwang Jin Ahn),이은직(Eun Jig Lee),임승길(Sung Kil Lim),김경래(Kyung Rae Kim),허갑범(Kap Bum Huh),황수관(Soo Kwan Hwang),백인경(In Kyoung Park),이종호(Jong Ho Lee),이영해(Young Hae 대한내과학회 1992 대한내과학회지 Vol.43 No.6

N/A Background: The growth hormone deficient adults have reduced lean body mass and increased fat mass. And growth hormone deficiency leads to other endocrinologic and metabolic alterations. In recent studies, growth hormone replacement therapy improved these endocrinologic and metabolic alterations. Methods: In a placebo controlled trial, we studied the effects of six months treatment of recombinant human growth hormone (rhGH) in 28 adults with GH deficiency, The patients had acquired GH deficiency due to pituitary tumors (13 cases), Sheehan`s syndrome (13 cases), and head trauma (2 cases). They were randomly divided into three groups. The group 1 (10 cases, M:F= 5:5) received 0.06 U of rhGH per kilogram of body weight subcutaneously three times a week at bed time, the group 2 (9 cases, M:F=4:5) received same amout of rhGH daily, and the group 3 (9 cases, M:F=4:5) received placebo. Results; In all three groups the total body weight did not change, whereas lean body mass significantly increased and adipose tissue mass decreased in rhGH treatment groups. The plasma glucose and glycated hemoglobin levels were not increased during rhGH treatment. The bone mineral densities of spines and femurs were not changed. According to computed tomography on two levels (umbilicus and mid-thigh), the mean mid-thigh muscle mass was significantly increased in group 1, while visceral fat mass significantly decreased in group 2. In groups 1 and 2, rhGH slightly increased exercise maximum oxygen uptake, significantly increased exercise rate-pressure product, hand grip strength and back lift strength after rhGH treatment, but the placebo group had not any change. Conclusion: These results suggest that rhGH has various potentially beneficial effects in GH-deficient adults, especially in changing body composition and increasing exercise capacity.

의학강좌 : 개원의를 위한 모범처방 ; 골다공증의 치료

정윤석 ( Yoon Sok Chung ) 대한내과학회 2010 대한내과학회지 Vol.79 No.3

심포지움 : 골세포의 자멸과 비스포스포네이트

정윤석 ( Yoon Sok Chung ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

한국인에게서 당뇨병성 말초 신경병증을 선별하기 위한 문진표의 유용성

정윤석(Yoon Sok Chung),채봉남(Bong Nam Chae),홍은경(Eun Gyoung Hong),이성규(Seong Kyu Lee),노혜림(Hae Lim Noh),김윤정(Yoon Jung Kim),신영구(Young Goo Shin),이관우(Kawn Woo Lee),김현만(Hyeon Man Kim) 대한내과학회 1999 대한내과학회지 Vol.57 No.1

N/A Discrepancies exist in the currently available data on the prevalence of diabetic neuropathy. Variations in the prevalence of diabetic neuropathy have reflected the different criteria used to form its diagnosis. The majority of diagnostic criteria are less practical in many routine clinical settings where there is a need for a simple assessment using widely available techniques to rapidly screen large numbers of patients. We already reported that the questionnaire of Feldman's two-step assessment was less useful in Koreans, because of the different expression of neuropathic symptoms. We proposed a representative questionnaire which was based on patients' own complaints, and assessed its clinical availability. Methods : Ninety diabetic patients(45 cases with diabetic neuropathy, 45 cases without neuropathy) were included in this study. Diabetic neuropathy was diagnosed by neurologic examination and nerve conduction velocity. The questionnaire consisted of 7 questions on foot sensation (prickling, lancinating, burning, numb), which are frequent complaints of diabetic patients. All subjects were assessed with the questionnaire. Results : 1. The most sensitive symptom was tingling sensation (75.6%) and the least sensitive one was numbness(28.9%). 2. The most specific symptom was numbness(82.2%) and the least specific one was tingling sensation(33.3%). 3. If we would assume that three or more of symptoms were diagnostic, the sensitivity and specificity were 66.7% and 53.3%, respectively. Conclusion : Our new questionnaire can be used as a screening test or a follow-up tool for the diagnosis of diabetic peripheral neuropathy in Koreans.

관상동맥죽상경화증 환자에서 식생활요법 후 관상동맥경화증의 변화

정윤석(Yoon Sok Chung),김현만(Hyeon Man Kim),김한수(Han Su Kim),탁승제(Seung Jea Tahk),이웅구(Woong Ku Lee),정익모(Ick Mo Chung),조홍근(Hong Keun Cho),조승연(Seung Yun Cho),이현철(Hyun Chul Lee),허갑범(Kap Bum Huh),백인경(In Kyung Pa 대한내과학회 1995 대한내과학회지 Vol.48 No.2

N/A Objectives: Coronary atherosclerosis is a life-style disease. Recently, Ornish et al. reported regression of coronary atherosclerosis in subjects with coronary artery disease who participated in a strict life-style modification program. We studied the effects of a life-style modification program on Korean patients with coronary atherosclerosis. Methods: Fourteen patients with angiographically documented coronary artery narrowing of over 50% in at least one vessel were studied prospectively. Subjects were divided into two groups. Subjects of group 1 (n=8) had a strict diet program composed of daily intake of less than 15% of fat and less than 100㎎ cholesterol; subjects of group 2 (n=6) had a usual diet program (American Heart Association step 1 diet) with daily intake of less than 30% fat and less than 300㎎ of cholesterol. All subjects were recommended with 200kcal per day exercise and instructed to stop cigarette smoking. Diet, anthropometric parameter, blood pressure measurements, serum lipid levels, and coronary angiography were recorded before and after the life-style modification program. Results: In group 1 (strict program) subjects, whose dietary intake of cholesterol and saturated fatty acid decreased, waist to hip circumference ratio and body fat decreased after the program. In contrast, there was no significant change in waist to hip circumference ratio and body fat of group 2 (usual program) subjects, whose dietary intake of cholesterol and saturated fatty acid did not decrease. In group 1, systolic blood pressure, serum total cholesterol and low density lipoprotein cholesterol levels decreased. There was no significant change in systolic blood pressure, serum total cholesterol, and low density lipoprotein cholesterol levels in group 2. Diameter stenosis of coronary artery regressed from 63.2±3.9% to 56.8±3.6% in group 1. There was no significant change (65.8±4.5% to 66.6±7.7%) in group 2. Conclusion: Coronary atherosclerosis significantly regressed in subjects who followed a strict life-style modification program, but not in subjects who continued their usual life-style program. Therefore, strict life-style change should be advised for coronary atherosclerotic patients.

한국인 임신성 당뇨병의 임상적 특성

안광진(Kwang Jin Ahn),정윤석(Yoon Sok Chung),이현철(Hyun Chul Lee),허갑범(Kap Bum Huh),김유리(Yoo Lee Kim),안명옥(Myong Ock Ahn),김문종(Moon Jong Kim),차경섭(Kyung Sub Cha),정춘희(Choon Hee Chung),곽인평(In Pyung Kwak) 대한내과학회 1992 대한내과학회지 Vol.43 No.6

N/A Background: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy irrespective of whether or not insulin is used for treatment or the condition persist after delivery. Little has been known of the clinical characteristics of GDM in Korean wiomen. This study was done to investigate the clinical features of GDM of Korean women. Methods: Screening test was performed on pregnant women between 24th and the 28th week of gestational age or when showing glycosuria. Venous plasma glucose was measured 1 hour after 50 gm oral glucose load, A value of 130 mg/dl or above was indicated for 100 gm 3-hour oral glucose tolerance test after standard preparation. According to O`Sullivan and Mahan`s criteria, 45 women were diagnosed as having GDM. Results: Maternal age and parity of GDM patients (31.7±4.5, 0,66±0,65) was significantly higher than those in controls (28.6±3.4, 0.21±0,07). Pregnant body weight of GDM patients (109.3±16.0%) was significantly higher than that of controls (92.6±27.04). The incidence of macrosomic infant (≥ 4kg) was 26,8% in GDM patients and 6. 5% in controls. Among 35 GDM patients 7 showed impaired glucose tolerance and 6 showed overt diabetes mellitus 6 weeks after delivery. The fasting blood sugar at diagnosis of GDM were higher in those patients whose glucose intolerance persist than in the patients whose glucose intolerance recovered to normal 6 weeks after delivery (126.8±70. 0 vs 79.9+±7,7). Conclusion: Screening test for GDM is needed to all pregnant women and to investigate clinical course of GDM, further follow up study is needed.

인슐린 비의존형 당뇨병 환자에서 어유 투여량이 혈청 지질에 미치는 영향

백인경(Paik In Kyung),윤지영(Yoon Jee Young),정윤석(Chung Yoon Sok),장현정(Chang Hyun Jung),이종호(Lee Jong Ho),이은직(Lee Eun Jik),이현철(Lee Hyun Chul),허갑범(Huh Kap Bum) 韓國營養學會 1993 Journal of Nutrition and Health Vol.26 No.6