간 이식 소아에서 발생한 이식 후 림프 증식 질환: 단일 기관에서의 21년 경험

이정화,고재성,서정기,이남준,서경석,이건욱,강경훈,Lee, Jung-Hwa,Ko, Jae-Sung,Seo, Jeong-Kee,Yi, Nam-Joon,Suh, Kyung-Suk,Lee, Kuhn-Uk,Kang, Gyeong-Hoon 대한소아소화기영양학회 2009 Pediatric gastroenterology, hepatology & nutrition Vol.12 No.2

Purpose: To analyze the clinical spectrum of posttransplantation lymphoproliferative disorder (PTLD) after liver transplantation in children. Methods: From January 1988 to June 2009, we retrospectively reviewed the medical records of 8 PTLD cases among 148 pediatric patients underwent liver transplantation. The age at transplantation, time of presentation after transplantation, clinical manifestations, histologic diagnosis, results of EBV (Epstein-Barr virus) assessments, managements and outcomes of PTLD were investigated. Results: The prevalence of PTLD in liver transplant pediatric recipients was 5.4% (8 of 148). The mean age of patients was 25.4${\pm}$21.3 months (range 10 to 67 months). Seven of 8 patients (87.5%) underwent liver transplantation before 1 year of age. The common clinical presentations were persistent fever (8 of 8, 100%) and bloody diarrhea (6 of 8, 75%). PTLD was diagnosed with gastrointestinal endoscopic biopsies in five patients and surgical biopsies in three. Histologic findings showed early lesion in three patients, polymorphic in two, and monomorphic in three. Burkitt lymphoma and lymphoblastic lymphoma were found in two of 3 monomorphic patients. Seven of 8 patients were found with EBV-positive. Eight patients were treated with dose reduction of immunosuppressants and infusion of ganciclovir. Rituximab was added to four patients. PTLD were successfully managed in all patients except one who died of sepsis during chemotherapy. Conclusion: Major risk factor of PTLD was to undergo liver transplantation before 1 year of age. Continuous monitoring for EBV viral load and gastrointestinal endoscopic biopsy may be useful to early detection of PTLD. 목 적: 간 이식 소아에서 발생한 PTLD의 경험을 통해 발현 양상, 발병 위험 인자, 진단 방법, 치료 및 예후에 영향을 줄 수 있는 요인들을 알아보았다. 방 법: 1988년 1월부터 2009년 6월까지 서울대학교 어린이병원에서 간 이식을 받은 소아 148명 중 PTLD로 진단된 8명의 환아들을 대상으로 후향적 분석을 하였다. 이식당시 나이, 이식 후 PTLD 증상이 나타날 때 까지의 기간, 임상적 증상, 조직학적 소견, EBV 검사 결과, 치료 및 경과에 대해 조사하였다. 결 과: 간 이식 후 PTLD의 유병률은 5.4%였고, 발생시기는 조기 PTLD가 6명(75%), 후기 PTLD가 2명(25%)이었다. 대상 환아의 간 이식 당시 나이는 평균8.1${\pm}$4.4개월로, 12개월 미만이 7명(87.5%), 12개월 이후가 1명(12.5%)이었다. PTLD 진단 시 주증상은 발열, 설사, 혈변이었고 모두 장이나 장간막 림프절 침범이 있었다. 3명은 개복 수술로 5명은 상부 위장관 내시경이나 대장 내시경을 통한 조직 검사로 진단되었다. 조직학적 진단은 early lesion이 3명, polymorphic PTLD 2명, monomorphic PTLD 1명, Burkitt 림프종 1명, B 세포 림프종이 1명이었다. EBV는 7명에서 양성을 보였다. 치료는 전례에서 1차 치료로 면역억제제를 중지하고 항바이러스제(ganciclovir)를 투여 하였다. 4명의 환아들에서 rituximab을 추가하였고 Burkitt 림프종과 B 세포림프종으로 진단된 환아들은 각각 항암 치료를 병행하였다. B 세포 림프종으로 진단되어 치료 중에 패혈증으로 1명이 사망하였으며 나머지 7명은 호전되었다. 결 론: 1세 미만에 간 이식을 받은 경우가 PTLD 발생의 주요한 위험 인자였으며, EBV viral load의 지속적인 감시와 위장관 내시경을 통한 조직 검사가 PTLD 조기진단에 유용할 것으로 생각한다.

서울형 주거복지 프로그램 운영 개선방안

박은철 ( Eun Cheol Park ),이주헌 ( Joo Hun Lee ),김정욱 ( Jung Wook Kim ),이정화 ( Jung Hwa Yi ) 서울시정개발연구원 2009 연구보고서 Vol.2009 No.38

Seoul Metropolitan Government has been operating the monthly rent aid and the lease deposit loan program through the housing assistance account of social welfare fund from 2002, and has been conducting S-Habitat project from 2009. This study aims to improve the operation of housing welfare program through an analysis of the actual housing condition of low-income households and the operation and delivery system of Seoul-type housing welfare program. The results of examining the status quo of the Seoul-type housing welfare program indicate that there are several problems as follows: First, the beneficiaries of the monthly rent aid may overlap with those of housing voucher, which is planned to be introduced by national government. In addition, the monthly rent aid is not equally distributed in proportion to the size of households, thus the problem of inequality among beneficiaries might be happened. Second, the lease deposit loan is provided to public housing renters, thus, the problem of double benefit and equity with private housing renters has been raised. Third, S-Habitat project has implemented by change of wallpaper, linoleum, and removable furniture rather than supplementation of function of the houses or improvement of energy efficiency. The results of survey for 282 beneficiaries of Seoul-type housing welfare program and 215 general low-income renters suggest policy implications like the ones below: First, it is needed to expand the rent aid program for the low-income households. Second, it is necessary that the beneficiaries of the monthly rent aid program may not overlap with those of housing voucher, which is planned to be introduced by national government. Third, it is needed to expand the target of the lease deposit loan program to private housing renters. Fourth, S-Habitat project should mainly be implemented not only by improvement of the function of houses that low-income households live in, but also by some projects such as insulation and improvement of windows and doors, which might be effective to decrease the consumption of fossil fuel and the emission of CO2. Fifth, it is required to reinforce public relations exercise of Seoul-type housing welfare program, and to improve the program`s effectiveness by finding and supporting the households that need housing welfare. In the long term, the Seoul-type housing welfare program needs to be improved as follows: The monthly rent aid program needs to expand the target of the program to the households that their certificated amount of income is below 150% of the minimum cost of living. However, the people who receive a residential salary or a housing voucher according to the National Basic Living Security Act have to be excluded from the beneficiaries. The amount of the monthly rent aid has to be distributed equally according to the size of households, and to be increased by 53 thousands won for 1-2 person households, 84 thousands won for 3-4 person households, and 115 thousands won for over 5 person households on the basis of the criteria of 20% RIR. In the case of the lease deposit loan program, it is required to reduce the amount of loan for public housing renters, and to increase loans for low-income households among the private housing renters. The amount of loan is better to be 50% of the standard lease deposit for public housing renters and one third of deposit for guaranteed monthly renters. S-Habitat projects need to be implemented for socially vulnerable classes and households below the minimum living standard among the low-income households. The housing renovation should be conducted in the aspects of the stock management and house function reinforcement in terms of housing policy and the improvement of efficiency in terms of energy policy. For this, the cost of project per household should be fixed at least 1.7 million won. In addition, it is needed to establish a strategic fit housing welfare service delivery system through a strategic collaboration. In the short term, it is better to combine delivery systems of the monthly rent aid and the lease deposit loan program, and to reorganize S-Habitat as a system mainly focused on the non-profit organizations. In the long term, it is needed to combine those programs with local welfare service delivery systems. All social welfare service including housing welfare service should be delivered through the network that is composed of a variety of organizations from consumer searching to final delivery step.

경남 지역 다문화가정 이주여성의 구강건강 관련 특성

조우순 ( Woo Sun Cho ),전진호 ( Jin Ho Chun ),최미숙 ( Mi Sook Choi ),이정화 ( Jung Hwa Lee ),이혜민 ( Hye Min Lee ),이지희 ( Ji Hi Yi ),손혜숙 ( Hae Sook Sohn ),조영하 ( Young Ha Jo ) 대한예방치과·구강보건학회 2011 大韓口腔保健學會誌 Vol.35 No.4

Objectives. To figure out and establish the basic data that can help to improve the cognition and management of oral healthcare in international marriage migrant women (IMMW). Methods. Subjects were 200 IMMW living in Changwon, Hananm Sancheong area, Gyungsangnam-do. Questionnaire survey was performed from January to March, 2011 in each translated languages (Vietnamese, Chinese, Japanese, Filipino and English). Oral health examination was conducted on 63 voluntary participants. Data analysis was performed using SPSS (ver. 18.0, Chicago, Illinois, USA) and MedCalc (ver 11.5, Mariakerke, Belgium). Proportion and means of the major characteristics were compared with chi-square test and t-test, and, the rate of over three minutes toothbrushing by the subjects` characteristics were presented with odds ratio (OR). Results. Their nationality was Vietnam 43.5%, China 20.5%, Cambodia 11.5%, Philippines 9.0% and Japan 7.5% and their years of living in Korea was 1∼3 years for 28.5%, 3∼5 years for 23.5% or lesser than 1 year for 22.0%. Mean age was about 29.1 years, and 66.5% of them had no job. 67.0% of them had experienced a visit to dental clinics, and 88% were satisfied with the offered services. Their recognition for the need of dental care and dissatisfaction of dental care were relatively high as 73.5% and 50.5% respectively. The reason for the dissatisfaction of dental care was fear for pain for 35.0%, financial burden was for 34.0%. Difficulty in communication and worry about ignorance were rather low. Mean time for toothbrushing was about 3.2, and brushing after meal was relatively good. However brushing at the rate of over three minutes was as low as 36.5%. On oral examination, they had a lot of oral health problems; periodontal disease was about 74.6%, caries were 71.4%, missing teeth was about 52.4% etc. The rate of prosthesis and filling treatment was as low as 36.5% and 38.1%, respectively. Experiences to visit dental clinics and oral heal education; the rate of dissatisfaction for dental care had no significant differences according to the number of years of stay in Korea, school, job and income level. OR (95% CI) of the desirable toothbrushing rate was higher in the over college educated group [2.20 (1.10∼4.41)], but, rather lower in the ever visited group [0.39 (0.21∼0.71)]. Conclusions. Though they were relatively young, most of them had a lot of oral health problems due to poor oral care. Their major difficulties to access dental care were identified to be due to the fear for pain and economic problems rather than problem of communication and ignorance. In order to assist their oral health improvement, considerations on their economic and language barriers are needed. Enhancing the interest and motivation for their own oral health management is also needed. Community based efforts to support their cultural adaptation and self care would be strengthened through practical education programs and by participating in various activities.

서울형 주거복지 프로그램 운영 개선방안

박은철(Eun-Cheol Park),이주헌(Joo-Hun Lee),김정욱(Jung Wook Kim),이정화(Jung Hwa Yi) 서울연구원 2009 서울연구원 정책과제연구보고서 Vol.- No.-

서울시 평생교육 운영 개선 방안 연구

이혜숙 ( Hye Sook Lee ),박은철 ( Eun Cheol Park ),이정화 ( Jung Hwa Yi ) 서울시정개발연구원 2009 연구보고서 Vol.2009 No.12

Increasing the importance in lifelong education with the change towards the knowledge-based society, local governments` interest in lifelong education has increased. Moreover, as a result of amendment in Lifelong Education Law in December 2007, Seoul Metropolitan Government (below SMG) was given the responsibility and authority to improve this. Therefore, this research is aimed for the proposal of the operation improvement plan for the sake of developing lifelong education. This study analyzed the current operational circumstances and the actual condition of lifelong education in SMG and the local governments (Jachigu), to provide an operational improvement plan. Also, experts are taking into account of these points, which will be reflected into the improvement plans. In this research, the interview method was used to analyze the current lifelong education`s operational circumstances. The interviewee was the people in charge of lifelong in 13 local governments. We also used the Delphi technique to experts, and the survey method to ask the people in charge of lifelong education about the improvement demands. On the basis of those results, we suggest the operational improvement plan to SMG. First of all, they should empower the functional operations of the lifelong education division. The current director of lifelong education should have a duty to manage the whole work of other departments` related work in lifelong education. Secondly, this research recommends that SMG should build the Lifelong Educational Agency (SMG Peongsanggyoyook Ginheungwon) as a main system to pursue the lifelong education. Thirdly, they should construct the lifelong educational network. This network connects the lifelong education division and other related departments in SMG including other local governments. In this case, Lifelong Educational Agency in SMG, as a main center, will build the network. Also, SMG should arrange information system to enhance communications between SMG and people. Besides these points, this research suggests that SMG should promote the integration of lifelong education and human resource development (HRD). Also SMG should reduce the disparities between the local governments in SMG.