2009년 인플루엔자 대유행 중 인플루엔자 진료소 방문자의 연령 분포 변화

김백남,곽이경,문치숙,김연숙,김의석,배인규,염준섭,이창섭,허지안 대한감염학회 2010 감염과 화학요법 Vol.42 No.2

The pandemic influenza (H1N1 2009) virus, after being introduced in Korea in April, 2009, spread rapidly nationwide in mid-2009. This study was conducted to characterize trend in age distribution of visitors to Flu-clinics during the pandemic. Demographic, clinical and laboratory data of visitors to flu clinic from Week 36 to 52 (August 30 to December 26) of 2009 were retrieved and collected from electronic databases at 9 hospitals. Visitors 0-6, 7-12, 13-18, 19-29, 30-64, and 65 years or more of age were classified into group I to VI, respectively. A total of 107,467 visitors were seen at Flu-clinics for a 17-week study period. Of those, 32,485 were laboratory-confirmed. Antivirals were prescribed for 62,533 visitors. Numbers of visits, prescriptions of antivirals, and laboratory-confirmed cases of the pandemic influenza (H1N1 2009) peaked at Week 44. A large number of visits by group II and III were followed by those of group I and V, especially around the peak. Numbers of visits by group VI were lowest in all hospitals. In some hospitals, higher number of visits lasted longer in children than in adults while vice versa in other hospitals depending on the location. In summary, the pandemic influenza (H1N1 2009) was presumed to peak in late October and involved majorly children and students in Korea. Unique age distribution of visitors to flu clinic was observed in some hospitals.

부산지역 수돗물과 지하수의 중금속 농도

김준연,손지언,김형수,김두희,원미숙,김인식,이혜령 동아대학교 산업의학연구소 2000 산업의학연구소 논총 Vol.- No.5

This study investigated mean airborne CO concention of 15 workplaces, suspected of CO exposure and conducted self-reported questionnaire completion and indirect COHb concentration measure using Micro II Smokerlyzer to healthy 702 adult subjects from 1999 May to 1999 September in order to find a relation of CO exposure and occupational factors, socioeconomic factors, and health related behaviors and confirm the related conditions in the screening test for CO exposure. The results of this study were summarized as follows : 1. In the CO exposed and non exposed group, COHb concentrations of the smokers were 2.55±0.96% and 2.21±0.97% and that got a statistically significant difference, There were not statistically significant differences in the age and total smoking index. Passed times after the last smoking, Working time/day, and working duration were statistically significant difference (p〈0.05). 2. In the CO exposed and non exposed group, COHb concentrations of non-smoking group were 0.94±0.35% and 0.68±0.47% and that got a statistically significant difference. There were not statistically significant differences in the age and working duration but Working time/day was a statistically significant difference(p〈0.05). 3. In the CO exposed group, r-square of multiple regression of the smokers was 38.5 % and passed time after the last smoking, working time/day, and job category were statistically significant differences (p〈0.05). And r-square in the CO non-exposed group was 38.3 % and age, passed time after the last smoking, and total smoking index were statistically significant difference. 4. In the CO exposed group, r-square of multiple repression of the non-smokers was 66.3% and job category and airborne CO concentration were statistically significant differences(p〈0.05). But r-square of non-smokers in the CO non-exposed group was 1.0% and there was not a statistically significant difference(p〈0.05). 5. In the smokers of CO exposed and non exposed groups, relation of COHb concentration and passed time after the last smoking was expressed as exponential function, Y = 2.9182e-0.0083x and r-square of this function was 37.4%. Therefore it was more than 150 minutes that passed time after the last smoking was when COHb concentrations were measured as less than 1%. In conclusion, variable, that was statistically significant to COHb concentraion in the both CO exposed and non-exposed smokers, was a passed time after the last smoking. We suggest that you have to restrict the smoking of smokers at least 150 minutes in the exposed and non exposed group before COHb concentration measure in order to exclude smoking effects

불안과 뇌파와의 관계에 관한 연구

김홍석,김인선 경희대학교 사회체육연구소 1996 體育科學論叢 Vol.- No.9

This study was interested in how different the type pf EEG(Electroencephalograph) is according to the levels of trait and/or state anxiety. Particularly, & respinse of EEG In each anxiety level (high - and low level) was mesaured, and each anxiety level was compared in terms of the ratio of the & wave to the total wave. Two hypotheses were postulated as follows: Ⅰ. & respponse would be different according to trait anxiety level. The ratio of & response to the wave of high anxiety group would be higher than that of low anxiety group in resting situation. Ⅱ. & response would be different according to anxiety level in stressful situation. Junior high school students (48 girls) with the age range of 15 to 16 years were given by questoinnaire to measure the anxiety level. Some items were selected from PIC (the Personality Inventory for Children)and revised for the young students. The upper 10% of the score was selected as high anxiety group (5 girls) and the lower 10% as low anxiety group (5 girls). In both resting - and stressful sityation, EEG was recorded and compaired to both high anxiety - and low anxiety group. The results were that 1) in resting situation, the & response to the total wave on Cz and T3 in high anxiety group was higher than tnat in low anxiety group 2) in stressful situation, & response Cz and T3 in low anxiety group was not any significant change although & response in high anxiety group was increased, and 3)there was not significant difference in & response on O1, known as a part that & response is frequently recorded, in terms of anxiety and experimental condition, These results supported both hypotesis Ⅰ and Ⅱ, and were consistent with the prvious data of Siciliani(1975) and Nowak(1981). The study, as first study to examine the realtionship between anxiety and physiological data, showed that physiological index could be useful in testing of the problems of young students in school.

The Effect of Rosiglitazone on the Cell Proliferation and the Expressions of p27 and Skp2 in<i>Helicobacter pylori</i>Infected Human Gastric Epithelial Cells

Kim, Sung-Soo,Cho, Young-Seok,Kim, Hyung-Keun,Shin, Ok-Ran,Chae, Hiun-Suk,Choi, Myung-Gyu,Chung, In-Sik The Korean Society of Gastroenterology 2010 대한소화기학회지 Vol.55 No.4

<P>Background/Aims: Ligands for peroxisome proliferator-activated receptorgamma (PPARgamma), a member of the ligand-activated nuclear receptor superfamily, exhibit anti-tumoral effects and are associated with de novo synthesis of proteins involved in regulating the cell cycle and cell survival/death. Helicobacter pylori (H. pylori) is an etiologic agent for gastric adenocarcinoma, and raises the cell turnover of gastric epithelium. The aim of this study was to investigate the effect of PPARgamma ligand rosiglitazone on the cell proliferation and the expressions of p27 and Skp2 protein in H. pylori infected gastric epithelial cells. Methods: We examined the expression of PPARgamma by Western blot in H. pylori infected AGS human gastric epithelial cells. The effect of rosiglitazone on the survival of H. pylori infected AGS cells was assessed by cell viability assay. After the treatment of rosiglitazone in H. pylori infected AGS cells, the expressions of p27 and Skp2 were assessed by Western blot. Results: The expression of PPARgamma protein was increased in H. pylori infected AGS cells. Cell growth was inhibited and decreased in dose- and time- dependent manner in H. pylori infected AGS cells treated with rosiglitazone. A decrease in Skp2 expression and a reciprocal increase in p27 expression were found in dose- and time-dependent manner in H. pylori infected AGS cells treated with rosiglitazone. Conclusions: Rosiglitazone inhibited the growth of H. pylori infected AGS cells. Rosiglitazone attenuated Skp2 expression, thereby promoting p27 accumulation in H. pylori infected human gastric epithelial cells. Further studies will be needed to find the effects of accumulation on cell turnover in H. pylori infection and the role in the H. pylori-associated gastric carcinogenesis.</P>

Condylar positioning changes following unilateral sagittal split ramus osteotomy in patients with mandibular prognathism

Kim, Myung-In,Kim, Jun-Hwa,Jung, Seunggon,Park, Hong-Ju,Oh, Hee-Kyun,Ryu, Sun-Youl,Kook, Min-Suk Korean Association of Maxillofacial Plastic and Re 2015 Maxillofacial Plastic Reconstructive Surgery Vol.37 No.-

Background: This study was performed to evaluate three-dimensional positional change of the condyle using three-dimensional computed tomography (3D-CT) following unilateral sagittal split ramus osteotomy (USSRO) in patients with mandibular prognathism. Methods: This study examined two patients exhibiting skeletal class III malocclusion with facial asymmetry who underwent USSRO for a mandibular setback. 3D-CT was performed before surgery, immediately after surgery, and 6 months postoperatively. After creating 3D-CT images by using the In-vivo $5^{TM}$ program, the axial plane, coronal plane, and sagittal plane were configured. Three-dimensional positional changes from each plane to the condyle, axial condylar head axis angle (AHA), axial condylar head position (AHP), frontal condylar head axis angle (FHA), frontal condylar head position (FHP), sagittal condylar head axis angle (SHA), and sagittal condylar head position (SHP) of the two patients were measured before surgery, immediately after surgery, and 6 months postoperatively. Results: In the first patient, medial rotation of the operated condyle in AHA and anterior rotation in SHA were observed. There were no significant changes after surgery in AHP, FHP, and SHP after surgery. In the second patient, medial rotation of the operated condyle in AHA and lateral rotation of the operated condyle in FHA were observed. There were no significant changes in AHP, FHP, and SHP postoperatively. This indicates that in USSRO, postoperative movement of the condylar head is insignificant; however, medial rotation of the condylar head is possible. Although three-dimensional changes were observed, these were not clinically significant. Conclusions: The results of this study suggest that although three-dimensional changes in condylar head position are observed in patients post SSRO, there are no significant changes that would clinically affect the patient.

Adult invasive pneumococcal disease in the Republic of Korea: Risk medical conditions and mortality stratified by age group

Kim, Jong Hun,Baik, Seung Hee,Chun, Byung Chul,Song, Joon Young,Bae, In-Gyu,Kim, Hyo Youl,Kim, Dong-Min,Choi, Young Hwa,Choi, Won Suk,Jo, Yu Mi,Kwon, Hyun Hee,Jeong, Hye Won,Kim, Yeon-Sook,Kim, Jeong Elsevier 2018 INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES Vol.74 No.-

<P><B>Abstract</B></P> <P><B>Objectives</B></P> <P>This study aimed to characterize the risk factors for mortality in adult patients with invasive pneumococcal disease (IPD) stratified by age groups, after implementation of the national immunization program of 23-valent polysaccharide vaccine (PPSV23) for those aged ≥65 years in the Republic of Korea (ROK).</P> <P><B>Methods</B></P> <P>Clinical data and pneumococcal isolates from adult patients with IPD (≥18 years of age) were collected prospectively from 20 hospitals through the nationwide surveillance program from March 2013 to October 2015.</P> <P><B>Results</B></P> <P>A total of 319 patients with IPD were enrolled. Median age was 69 years. Overall in-hospital mortality was 34.2%: 17.1% in those aged 18–49 years, 23.7% in those aged 50–64 years, 33.0% in those aged 65–74 years, and 51.0% in those aged ≥75 years (<I>p<</I> 0.001). In particular, early death within 7days of hospitalization accounted for 60.6% (66/109). While old age (≥65 years), higher Pitt bacteremia score (≥4), and bacteremic pneumonia were independently associated with IPD mortality in all age groups, an additional mortality risk factor of immunocompromised status was identified for patients aged 50–64 years. PPSV23 serotypes accounted for 64.4% (122/189) of the pneumococcal isolates serotyped.</P> <P><B>Conclusions</B></P> <P>This study suggests that vaccine-type IPD continues to place a substantial burden on older adults in the ROK, necessitating an effective vaccination strategy for those at higher risk.</P> <P><B>Highlights</B></P> <P> <UL> <LI> National immunization of the elderly with the 23-valent polysaccharide vaccine (PPSV23) was implemented in Korea in 2013. </LI> <LI> Overall in-hospital mortality was 34.2% for adult invasive pneumococcal disease (IPD) and 51.0% for patients ≥75 years of age. </LI> <LI> Mortality risks were older age, higher bacteremia score, and immunocompromised status. </LI> <LI> An effective vaccination strategy for those at higher risk of IPD is needed. </LI> </UL> </P>

장애인 평생교육 실태 및 개선방안 연구

정인숙,김현진,김형일,정동영,정희섭 국립특수교육원 2005 연구보고서 Vol.- No.9

본 연구는 장애인의 삶의 질을 제고하는데 필요한 장애인 평생교육의 실태를 조사하고 지원대책을 마련하는데 목적을 두고, 장애인 평생교육의 개념과 특성, 장애인 평생교육의 지원체제, 외국의 장애인 평생교육 실태 등을 탐색하여 이론적 토대로 삼고, 2005년 6월 21일부터 8월 13일까지 전국의 18세 이상 장애인 2,922명을 대상으로 설문조사와 71명을 대상으로 면담조사를 통해 평생교육 실태와 지원요구를 조사하였다. 또한 전국의 평생학습관 239개, 지역평생교육정보센터 26개 등 일반인 평생교육기관 265개와 장애인 평생교육 관련기관 464개를 대상으로 설문조사와 일반평생교육기관 46개 및 장애인 평생교육기관 67개를 대상으로 면담조사를 통해 운영실태와 지원요구를 조사하였다. 본 연구를 통해 나타난 장애인 평생교육 실태와 지원요구 및 평생교육기관 운영실태와 지원요구는 다음과 같다. 첫째, 장애인 평생교육 실태조사 결과, 장애인들은 학교 졸업 이후 교육을 1회도 받지 않은 경우 34.8%, 1회 받은 경우 19.6%, 2회 받은 경우 14.9%순으로 나타났다. 장애유형별로 교육을 1회도 받지 않은 경우는 청각장애 47.2%, 지체장애 36.9%, 언어장애 33.3%, 발달장애 32.7%, 뇌병변장애 31.8%, 시각장애 31.5% 중복장애 29.2%, 정신지체 28.8%순으로 나타났고, 교육을 받은 경우를 살펴보면 지체장애, 뇌병변장애, 시각장애, 청각장애, 언어장애, 중복장애는 1회만 받은 경우가 많고, 정신지체와 발달장애는 4회 이상 받은 경우도 있는 것으로 나타났다. 장애인들이 학교 졸업 이후 받은 교육 프로그램의 내용은 정보화교육 46.0%, 직업교육 33.8%, 여가교육 22.6%, 교양교육 20.7%, 문해교육 15.4%순으로 나타났다. 장애유형별로 살펴보면 지체장애 52.2%, 시각장애 50.2%, 뇌병변 장애 46.9%, 발달장애 45.9%, 중복장애 45.7% 순으로 정보화교육을 가장 많이 받았고, 발달장애 51.4%는 여가교육을, 정신지체 47.4%, 언어장애 36.4%는 직업교육을 받은 것으로 나타났다. 또한 연령별로 20세미만은 직업교육을, 20대에는 직업교육과 정보화교육을, 30대 이후에는 정보화교육을 많이 받는 것으로 나타났다. 장애인들이 학교 졸업 이후 교육을 받은 경우 중에서 교육을 받은 기관은 장애인복지관 34.0%, 장애인단체 23.6%, 장애인평생교육기관 11.1%, 일반인 평생교육기관 10.9%, 사회복지관 9.8%, 장애인 직업 전문학교 8.2%순으로 나타났다. 전체적으로 장애인 기관에서 교육을 받은 경우는 80.3%, 일반인 평생교육기관에서 교육을 받은 경우는 32.0%로 나타났다. 장애유형별로 지체장애 26%와 청각장애 25.0%는 장애인단체에서, 뇌병변장애 43.6%, 시각장애 44.0%, 정신지체 41.0%, 발달장애 64.1%, 중복장애 31.9%는 장애인복지관에서 언어장애 40.0%는 장애인 평생교육기관에서 교육을 받은 것으로 나타났으며, 일반인 평생교육기관에서 교육을 받은 경우는 지체장애 52.9%, 중복장애 39.1%, 청각장애 33.0%, 시각장애 25.9%, 뇌병변장애 22.4%, 정신지체 22.1%, 언어장애 15.0%, 발달장애 18.0%순으로 나타났다. 장애인들의 평생교육비는 본인이 부담하지 않은 경우가 39.9%로 나타났으며, 부담한 경우 1인당 월 10만원 미만이 37.5%, 월 10만원 이상에서 월 20만원 미만이 14.2%, 월 20만원 이상이 8.8%순으로 나타났다. 장애유형별로 모든 장애영역에서 월 10만원 미만이 30%~50%정도로 나타났으며, 월 10만원 이상을 부담하는 경우는 발달장애 41.1%, 언어장애 35%, 정신지체 28.9%, 지체장애 27.7%, 청각장애 25.7%, 시각장애 15.3%, 뇌병변장애 13.9%순으로 나타났다. 둘째, 장애인들의 평생교육 요구를 조사한 결과, 가장 받고 싶어 하는 성인교육 프로그램의 내용은 직업교육 31.0%, 정보화교육 30.4%, 여가교육 18.2% 교양교육 14.8%, 문해교육 8.8%순으로 나타났다. 장애유형별로는 언어장애 41.9%, 뇌병변장애 39.9%, 지체장애 39.0%, 청각장애 33.1%, 시각장애 31.8%가 정보화교육을 가장 원하고 있는 것으로 나타났고, 발달장애 58.8%, 정신지체 41.0%, 중복장애 32.4%는 직업교육을 가장 원하고 있는 것으로 나타났다. 연령별로 20대는 직업교육, 30대는 직업교육(34.6%)과 정보화교육(32.8%), 40대와 50대는 정보화교육, 60대에는 여가교육을 가장 요구하고 있는 것으로 나타났다. 성인교육을 받고 싶은 기관은 장애인평생교육기관 23.8%, 장애인복지관 22.6%, 일반인 평생교육기관 22.2%, 사회복지관 8.9%, 대학 일반성인 프로그램 6.2%, 장애성인학원 5.5%, 대학 장애성인 프로그램 5.2%, 일반성인 학원 2.7%순으로 나타났다. 장애유형별로 지체장애 36.4%, 뇌병변장애 34.0%는 일반인 평생교육기관을 선호하였고, 정신지체 33.7%, 중복장애 34.0%, 청각장애 27.8%는 장애인 평생교육기관을 선호하였으며, 또한 시각장애 30.4%, 발달장애 31.6%는 장애인복지관을 선호하였고, 언어장애는 대학 장애성인 프로그램과 사회복지관을 선호하는 것으로 나타났다. 연령별로 20대와 40대는 장애인 평생교육기관, 30대는 일반인 평생교육기관, 50대와 60대는 장애인 복지관을 선호하는 것으로 나타났다. 셋째, 평생교육기관의 운영실태를 조사한 결과, 일반인 평생교육기관의 이용대상 연령대는 30~39세 60%, 40~49세 48%, 50~59세 31%이었고, 장애인 평생교육기관은 20~29세 64.8%, 40~49세 38.6%, 30~39세 31.1%, 50~59세 26.1%로 나타났다. 평생교육기관의 규모는 일반인 평생교육기관은 101명 이상의 규모가 36.6%, 20~40명의 규모 23.8%, 81~100명의 규모 15.8%순으로 나타났고, 장애인 평생교육기관은 20~40명의 규모 40.2%, 20명 미만의 규모 28.7%, 101명 이상의 규모 12.6%로 일반인 평생교육기관은 80명이상 규모가 52.4%인 반면, 장애인 평생교육기관은 80명 이상의 규모가 18.3%에 불과한 것으로 나타났다. 장애인 편의시설 설치 현황을 살펴보면 일반인 평생교육기관은 장애인 주차장 82.7%, 장애인용 대소변기 77.6%, 승강기와 경사로 67.3%, 출입구 높이차이 제거, 출입구 출입문, 복도 손잡이 설치는 각각 약 30%인 것으로 나타났고, 장애인 평생교육기관은 장애인용 대소변기, 승강기 경사로 78%, 장애인주차장 76.8%, 복도 손잡이 68.3%로 나타났다. 평생교육 프로그램 운영기간은 일반인 평생교육기관은 3개월 이상 6개월 미만이 48.0%, 6개월 이상 1년 미만이 25.5%, 3개월 미만이 20.6%, 1년 이상이 5.9%순으로 나타났고, 장애인 평생교육기관은 1년 이상이 38.4%, 6개월 이상 1년 미만이 32.6%, 3개월 이상 6개월 미만이 12.8%, 3개월 미만이 9.3%순으로 나타났다. 그리고 1일 평생교육 프로그램 운영시간은 일반인 평생교육기관은 2시간이 71.3%로 나타났고, 장애인 평생교육기관은 2시간이 19.5%이며 6시간, 8시간, 4시간 순으로 다양하게 나타났다. 평생교육 프로그램의 주요 내용은 일반인 평생교육기관의 경우 교양교육 77.5%, 여가교육이 62.7%순으로 나타났고, 장애인 평생교육기관은 직업교육 71.6%, 여가교육과 교양교육 각각 30%로 나타났다. 그리고 수강생 1인이 부담하는 교육비는 일반인 평생교육기관의 경우 수강료가 없는 기관이 73.5%, 월 10만원 미만이 22.5%로 나타났고, 장애인 평생교육기관의 경우 수강료가 없는 기관이 77.3%, 월 10만원 미만이 17%로 나타났다. 평생교육 프로그램의 담당인력은 일반인 평생교육기관의 경우 5명 미만이 40.6%, 5~10명이 23.8%로 나타났고, 장애인 평생교육기관은 5명 미만이 64.4%, 5~10명이 20.7%로 나타났다. 그리고 평생교육 담당인력의 자격증은 일반인 평생교육기관의 경우 기능사?기술사 34.7%, 일반학교 교사 33.7%, 평생교육사 17.9%로 나타났고, 장애인 평생교육기관의 경우 사회복지사 66.3%, 기능사?기술사 24.4%, 특수학교 교사 23.3%로 나타났다. 넷째, 평생교육기관의 지원요구를 조사한 결과, 장애인의 평생교육 프로그램을 운영하는 시설로 가장 적절한 형태에 대해서는 일반인 평생교육기관 관계자의 경우 일반인 독립 평생교육시설 36.7%, 사회복지관 26.5%, 장애인 독립 평생교육시설 24.5%순으로 응답하였고, 장애인 평생교육기관 관계자는 장애인복지관 36.9%, 장애인 평생교육시설 26.2%, 장애인직업훈련학교 23.8%순으로 응답하였다. 장애인 평생교육 프로그램의 적절한 운영기간에 대해서는 일반인 평생교육기관 관계자는 3개월~6개월 미만 47.0%, 6개월~1년 미만 25%, 3개월 미만 22%, 1년 이상은 5%순으로 응답하였고, 장애인 평생교육기관 관계자는 6개월~1년 미만 42.5%, 1년 이상 29.9%, 3개월~6개월 미만 20.7%순으로 응답하였다. 장애인 평생교육 프로그램의 1일 운영시간에 대해서는 일반인 평생교육기관 관계자의 경우 2시간 76%, 4시간 9%, 3시간 7%, 6시간 4%순으로 응답하였고, 장애인 평생교육기관 관계자의 경우 2시간 24.1%, 6시간 20.7%, 4시간 16.1%, 3시간 13.8%순으로 응답하였다. 그리고 장애인 평생교육 프로그램의 내용에 대해서는 일반인 평생교육기관 관계자의 경우 직업교육 65%, 교양교육과 정보화교육 21%, 여가교육 17%순으로 응답하였고, 장애인 평생교육기관 관계자의 경우 직업교육 70.9%, 여가교육 23.3%, 정보화교육 20.9%, 교양교육 10.5%순으로 응답하였다. 장애인이 부담해야 할 적절한 평생교육비에 대해서 일반인 평생교육기관 관계자는 월 10만원 미만 68.4%, 월 10만원~20만원 미만 4.1%순으로 응답하였고, 장애인 평생교육기관관계자는 월 10만원 미만 75.0%,월 10만원~20만원 미만 7.1%순으로 응답하였다. 그리고 평생교육기관의 운영경비 지원기관으로 적절한 기관에 대해서 일반인 평생교육기관 관계자는 국가 75%, 지방자치 단체 43%순으로 응답하였고, 장애인 평생교육기관 관계자는 국가 81.4%, 지방자치 단체 32.6%순으로 응답하였다. 또한 장애인 평생교육 담당인력으로 가장 적절한 자격에 대해서는 일반인 평생교육기관 관계자는 특수학교 교사 49.5%, 사회복지사 33.3%, 평생교육사 21.2%, 기능사?기술사 17.2%순으로 응답하였고, 장애인 평생교육기관 관계자는 사회복지사 50.0%, 특수학교 교사 29.8%, 기능사?기술사 23.8%순으로 응답하였다. 그리고 장애인을 위한 개선사항으로 일반인 평생교육기관 관계자는 장애인 편의시설 설치 36.6%, 교육 프로그램 개발 27.7%, 이동문제 편의시설 25.7%, 일반성인의 장애인 이해 24.8%, 재정적 지원 14.9%, 기관 운영자의 장애인 이해 12.9%순으로 응답하였고, 장애인 평생교육기관 관계자들은 교육 프로그램 개발 36.1%, 재정적 지원 34.9%, 일반성인의 장애인 이해 22.9%, 이동문제 및 편의시설 19.3%, 장애인 편의시설 설치 10.8%순으로 응답하였다. 이와 같은 장애인 평생교육 실태와 지원요구 및 평생교육기관의 실태와 지원요구 면담자료 등을 토대로 본 연구는 모든 장애인의 평생교육 권리를 보장하고, 장애인의 지역사회 중심 교육체제를 구축할 뿐 아니라, 장애인의 통합교육 기회를 확대하고, 장애인 평생교육 지원을 확대하기 위해서는 다음과 같은 대책을 우선적으로 마련해야 한다고 결론을 내렸다. 첫째, 장애인도 동등하게 평생 교육을 받을 수 있는 권리를 보장 받을 수 있도록 하기 위해서는 장애인들의 평생교육 기회 확대가 필요하며, 이러한 기회를 확대하기 위해서는 일반인 평생교육기관에서 일정비율의 장애인 참여를 규정하는 장애인 의무 평생교육 제도를 시행해야 하며, 일반인 평생교육기관에서 운영하는 프로그램에 특화된 장애인 프로그램의 운영을 규정하는 장애인 평생교육 프로그램 운영 의무 제도를 시행해야 한다. 그리고 장애인 평생교육 기회 확대를 위해 장애인 교육시설의 프로그램 운영내용과 방법을 개선해야 하며, 장애학생의 교육을 담당하는 특수교육기관의 운영내용과 방법을 개선해야 한다. 둘째, 장애인이 지역사회 평생교육 프로그램에 접근하고 참여할 수 있는 문화의 창조를 위해서는 평생교육기관 및 시설에 장애인 지원 매뉴얼을 제작?배부하며, 평생교육기관과 시설에 장애인 편의시설을 설치해야 한다. 그리고 장애인의 평생교육을 위해 장애인을 대상으로 교육 프로그램을 제공하는 지역사회 기관과 시설의 네트워크를 구축해야 하며, 장애인의 평생학습기관과 시설을 지원하는 기관을 설립?운영해야 한다. 셋째, 장애인 평생교육의 질 제고를 위해 장애인 교육 프로그램의 연구?개발을 확대해야 하며, 정기적으로 장애인 평생교육 프로그램의 내용과 운영실태를 평가해야 한다. 그리고 장애인 평생교육 담당인력의 전문성 제고를 위해 평생교육사의 양성 및 현직 교육과정에 장애인 평생교육 과목을 필수과목으로 편성해야 하며, 장애인 평생교육 전문인력으로 장애인평생교육사를 양성?배치해야 한다. 넷째, 장애인 평생교육 행정 지원 확대를 위해 교육인적자원부, 시?도교육청 및 시?군?구교육청의 장애학생 교육 담당조직에 장애인 평생교육 업무를 부과하며, 교육인적자원부, 시?도교육청 및 시?군?구교육청의 장애학생 교육 담당조직에 장애인 평생교육 장학기능을 부과하고, 교육인적자원부, 시?도교육청 및 시?군?구교육청의 장애학생 교육 담당조직에 장애인 평생교육 전담인력을 배치해야 한다. 그리고 장애인 평생교육 재정 지원 확대를 위해 장애로 인하여 평생교육의 기회를 제대로 제공받지 못하고 있는 장애인들을 대상으로 평생교육을 무상으로 제공해야 하며, 장애인이 평생교육을 원할 때, 적절한 평생교육을 제공하기 위해 장애인 평생교육 욕구를 조사?분석하는 장애인 평생교육 실태조사를 정기적으로 실시해야 하며, 장애인 교육기관과 시설 운영의 공평성과 투명성을 확보하고, 장애영역별, 장애정도별로 적절한 교육공학적 지원을 확대해야 한다. The purpose of This study is to investigate the current status of lifelong education for individuals with disabilities which is necessary to protect the quality of life for individuals with disabilities, and to make the desirable the policy. Based on concept, characteristics, support system, abroad situation of lifelong education for individuals with disabilities, we surveyed the status and support need through questionnaire and interview with 2,922 persons from age 18 from 21th June 2005 to 13th August. In addition to we survey the status of the management support need of 239 lifelong learning centers in the nation, 26 information centers for local lifelong education, 265 lifelong education institutes for ordinary people, 88 lifelong education institutes for individuals with disabilities. The survey results are as follows. First, the status survey results of lifelong education for individuals with disabilities show that 34.8% of individuals with disabilities doesn't have education opportunity at all, 19.6% of them has it once, 14.9% of them has it twice. Clarified by categories of disabilities, people has no opportunity as follows ; hearing impairments 47.2%, physical impairment 36.9%, developmental disabilities 32.7%, brain stroke 31.8%, visual impairments 31.5%, multiple impairments 29.2%, mental retardation 28.8%.. and people has opportunity once as follows ; physical impairments, brain stroke, visual impairments, language impairments, multiple impairments. Development impairments has above four opportunities. After graduation school, individuals with disabilities have program as follows: information education 46%, vocational education 33.8%, leisure education 22.6%, literacy education 15.4%. Clarified by categories of disabilities, they have information education program as follows: physical impairments 52.2%, visual impairments 50.2%, brain stroke 46.9%, developmental impairments 45.9%, multiple impairments 45.7%, developmental impairment 51.4% has leisure education, mental retardation 47.4% and language impairment 36.4% has vocational education. Also, by aging, people who are below age 20 has vocational education, people above aged 30 has information education. Institutes which individuals with disabilities have education after graduation school are as follows. Welfare Center for individuals with disabilities 34%, Organization for individuals with disabilities 23.6%, lifelong education institute for individuals with disabilities 11.1%, lifelong education institute for ordinary people 10.9%, social welfare center 9.8%, vocational special school for disabled people 8.2%. Clarified by categories of disabilities, they have education program as follows : physical impairments 26%, hearing impairments 25% have education in the organization for individuals with disabilities and brain stroke 43.6%, visual impairments 44.0%, mental retardation 41.0%, developmental impairment 64.1%, multiple impairment 31.9% have welfare center for individuals with disabilities and language impairment 40.0% have lifelong education center for individuals with disabilities. Also, in lifelong education institute for ordinary people, they have education as follows. Physical impairments 52.9%, multiple impairment 39.1%, hearing impairments 33%, visual impairments 25.9%, brain stroke 22.4%, mental retardation 22.1%, language impairment 15.0%, developmental impairment 18.0%. Lifelong education for individuals with disabilities tuition fee is as follow. 39.9% of individuals with disabilities doesn't pay tuition fe. 37.5% of them pays tuition fee below 100,000 won a month, 14.2% from 100,000 won to 200,000 won a month, 8.8% above 200,000 won a month. Clarified by categories of disabilities, 30%-50% of all disability categories pay tuition fee below 100,000 won a month. And case of paying tuition fee above 100,000 won a month is as follow. developmental impairment 41.1%, language impairment 35%, mental retardation 28.9%, physical impairment 27.7%, hearing impairment 25.7%, visual impairment 15.3%, brain stroke 13.9%. Second, lifelong education for individuals with disabilities needs survey results show that the favorite adult education programs are as follows. vocational education 31.0%, information education 30.4%, leisure program 18.2%, general education coruse 14.8%, literature education 8.8%. Clarified by categories of disabilities, language impairment 41.9%, brain stroke 39.9%, physical impairment 39.0%, hearing impairment 33.1%, visual impairment 31.8% wanted information education, developmental impairment 58.8%, mental retardation 41.0%, multiple impairment 32.4% wanted vocational education. Clarified by age, they wanted vocational education in 20 age, vocational education and information education in 3 age information education in 40, 50 age, leisure program in 60 age. The places where they wanted are as follows. lifelong education center for individuals with disabilities 23.8%, welfare center for individuals with disabilities 22.6%, lifelong education institution for ordinary people 22.2%, social welfare center 8.9%, adult program in college 6.2%, institution for adult individuals with disabilities 5.5%, adult with disabilities program in college 5.2%, institution for adult 2.7%. Clarified by categories of disabilities, physical impairment 36.4%, brain stroke 34.0% wanted general lifelong education institution and mental retardation 33.7%, multiple impairment 34.0%, hearing impairment 27.8% wanted lifelong education institution for individuals with disabilities and visual impairment 30.4%, developmental impairment 31.6% wanted welfare center for disabled people, language impairment wanted the adult with disabilities program in college and socila welfare center. Third, lifelong education institution status of the management survey results show that use age of general lifelong education institution is as follows. 60% of it is from age 30 to 39, 48% is from age 40 to 49, 31% from age 50 to 59. And use age of lifelong education for individuals with disabilities is as follows. 64.8% of it is from age 20 to 29, 38.6% from age 40 to 49, 38.6% from age 30 to 39, 26.1% from age 50 to 59. The scale of institutions is as follows. 40.2% of them cover from 20 person to 40, 28.7% of them cover below 20 person. 18.3% cover above 80 person. Status of facilities for individuals with disabilities shows that 78% of lifelong education institution for individuals with disabilities has restroom, elevators, slope for the disabled, and 76.8% of them has parking lot for the disabled, 68.3% has hallway handle. Period of program management shows that 38.4% of lifelong education institutions for individuals with disabilities is above 1 year, 32.6% of them is from 6 month to 1 year. 12.8% of them is from 3 month to 6 month, 9.3% of them is below 3 month. Time of program management shows that 19.5% of lifelong education institutions for individuals with disabilities is 2 hours, others is 6 hours, 8 hours, 4 hours. Program contents is that 71.6% of them has vocational education, 30% of them has leisure and general education course. The tuition fee shows that 22.5% of them is below 100,000 won a month. 77.3% of them has no fee, 17% of them has below 100,000 won a month. The number of staffs shows that 64.4% has below 5 person, 20.7% has from 5 to 10 person. 66.3% has social welfare certificate, 23.3% has special education teacher, 24.4% has special engineer and 31.4% has other things. Fourth, we survey the support needs of institution. The results are as follows. 36.9% of staffs in lifelong education institution for individuals with disabilities thought that the proper facilities is welfare center for individuals with disabilities and 26.2% of them thought that it is lifelong education facilities for the disabled, next to vocational training center for the disabled as 23.5%. 24.1% of them thought proper management time is 2 hours, 20.7% 6 hours, 16.1% 4 hours, 13.8% 3 hours. They respond about program 70.9% of them wanted vocational program, leisure 23.3%, information education 20.9%, general education program 10.5%. Lifelong education for individuals with disabilities tuition fee is as follow. 75.0% of staffs in lifelong education institution for the disabled respond that under 100,000 won is the proper a month, 7.1% of them does over 100,000 won to 200,000 won is proper. And 81.4% of respondent thought it is reasonable for Nation supply the budget, and 32% of them thought that it is local self-government staffs who are related in individuals with disabilities don't pay tuition fee. 37.5% of them pays tuition fee below 100,000 won a month, 14.2% from 100,000 won to 200,000 won a month, 8.8% above 200,000 won a month. Clarified by categories of disabilities, 30%-50% of all disability categories pay tuition fee below 100,000 won a month. And case of paying tuition fee above 100,000 won a month is as follow. developmental impairment 41.1%, language impairment 35%, mental retardation 28.9%, physical impairment 27.7%, hearing impairment 25.7%, visual impairment 15.3%, brain stroke 13.9%.. About staffs certificate, 50.0% of lifelong education institution staffs with disabilities want the social welfare people, 29.8% of them want special education teacher, 23.8% does engineers. What they want to change for the disabled are as follows. Education program development 36.1%, financial support 34.9%, general adult's understanding of the disabled 22.9%, moving problem and easy facilities 19.3%, establish facilities for the disabled 10.8%. Based on lifelong education status and support need of the disabled and lifelong education institution, to protect lifelong education's right of the disabled, to establish education system based on community of the disabled, we have to make the policy as follows. First, it is needed to expand the opportunity of lifelong education for individuals with disabilities in order to protect the right of which the disabled can receive education equally. In order to expand the opportunity, it is needed to make the policy which it is compulsory for individuals with disabilities to participate in general lifelong education institution as part. In general lifelong education program, we have to make the program for the disabled. Also, to expand the opportunity of the lifelong education opportunity for the disabled, we have to change the program contents and method in education institution for the disabled. Second, for the establishment of the culture in which individuals with disabilities can take part in the lifelong education program of the community, we have to distribute the manual which the staffs can use for the disabled in lifelong education institution and facilities, to make the facilities for the disabled. Also, we have to make the network of community institute and facilities which supply lifelong education program for the disabled and to establish and manage the institute which support the lifelong education institutes and facilities for the disabled. Third, we must extend the study and development of education program for the quality of lifelong education for individuals with disabilities, estimate the lifelong education program and management's status of the disabled. And the lifelong education for individuals with disabilities course has to be the compulsory subject in the training course and in-service training course of the lifelong education person, and lifelong education person for the disabled has to be trained, placed as the specialist of the disabilities' lifelong education. Fourth, to extend administration support of lifelong education for individuals with disabilities, it is needed to give the affairs, staffs, and functions that are related to lifelong education of the disabled to the division of education for the disabled in the Ministry of Education and Human Resources Development, Metropolitan Office of Education, Provincial Office of Education, and District Office of Education. We must give lifelong education of individuals with disabilities who are not received the opportunities of lifelong education because of handicap for free. And to give the proper lifelong education, we have to survey and analyzed the needs and status periodically. Also, we have to ensure the equatability and transparency about education institution's management, to increase proper educational and engineering supports depending on level of disability.

원발성 유방암에서 Sodium Iodide Symporter의 발현과 ^(99m)Tc-MIBI 유방스캔의 관계

석주원,김성장,곽희숙,이창훈,김인주,김용기,배영태,김동수 대한핵의학회 2002 핵의학 분자영상 Vol.36 No.6

목적: hNIS는 갑상선 조직 외에 다른 조직들에서도 발현된다고 알려져 있다. 유방암 세포는 그런 조직들 중에 하나이며, 그에 의한 유방암의 방사성옥소치료의 가능성이 제시되고 있다. 본 연구에서는 유방암 조직에서 hNIS의 발현정도를 알아보고, ^99mTc-MIBI 유방스캔과 hNIS의 발현 정도와의 관계를 조사하여 보았다. 대상 및 방법: 본 연구에서는 유방암으로 수술을 시행했던 56명의 환자를 대상으로 하였다. hNIS의 발현은 면역조직화학염색에 의해서 평가되었으며, 그 결과를 ^99mTc-MIBI 유방스캔의 판정 결과와 비교하였다. 결과: 전체 56명의 환자에서 hNIS의 발현율은 41.1%였다. 병리학적 진단에 의해 침윤성관상피암종이었던 49명에서의 발현율은 42.9%, 관상피내암종이었던 7명에서의 발현율은 28.6%였다. ^99mTc-MIBI 유방스캔에서 국소섭취 소견이 관찰되었던 41명에서의 hNIS의 발현율은 31.7%였다. 비정상적인 섭취 소견이 관찰되지 않았던 15명의 환자에서의 hNIS의 발현율이 의미있게 높게 관찰되었다(66.7%, p>0.05). 결론: 유방암 환자에서의 hNIS의 발현율은 그다지 높지 않았다. ^99mTc-MIBI 유방스캔에서 섭취증가 소견이 없을 때 hNIS의 발현율이 더 높았다. Purpose: Human Na^+/I- symporter (hNIS) is known to be expressed in many tissues other than thyroid gland. The breast cancer cells are one of them and the possibility of radioiodine therapy in treatment of the breast cancer may be suggested. We investigated the expression rate of hNIS and the relationship between the expression of hNIS and the finding of 99mTc-MIBI scintimammography in the breast cancer. Materials and Methods: Surgically proved 56 patients with breast cancer were the subjects of this study. The expression of hNIS were evaluated by immunohistochemistry and the results were compared to the findings of 99mTc-MIBI scintimammography. Results: Overall expression rate of hNIS was 41.1% in 56 patients. According to the pathologic diagnosis, it was 42.9% in 49 patients with invasive ductal carcinoma and 28.6% in the 7 patients with ductal carcinoma in situ. The expression rate of hNIS in the 41 cases with a focal increased uptake at he breast lesion on 99mTc-MIBI scintimammogram was 31.7%. That in the 15 cases without any abnormal uptake on the scan was significantly higher(66.7%, p<0.05). Conclusion: The expression rate of hNIS in the patients with breast cancer was not so high. The rate was higher in the patients with no increased uptake at the breast lesion on 99mTc-MIBI scintimammography. (Korean J Nucl Med 2002;36;325-32)

Developing Core Elements and Checklist Items for Implementing Antimicrobial Stewardship Programs in Korean General Hospitals: A Modified Delphi Survey

Cheong Hae Suk,Park Kyung-Hwa,Kim Bongyoung,Eun Byung Wook,Kim Hyung-Sook,Kim Yong Chan,Lee Hyukmin,Jeong Su Jin,Moon Chisook,Kim Shin-Woo,Yoon Young Kyung,Hwang In Sun,Park Choon-Seon,Lee Mi Suk,Kim 대한감염학회 2023 Infection and Chemotherapy Vol.55 No.1

Background: Antimicrobial stewardship programs (ASPs) aim to optimize antimicrobial use by minimizing the spread of antimicrobial resistance. The core elements for implementing ASPs in healthcare facilities have been developed by the World Health Organization, international research group and government agencies of various countries. However, to date, there is no documented core elements for implementation of ASP in Korea. This survey aimed to establish a national consensus on a set of core elements and their related checklist items for the implementation of ASPs in Korean general hospitals. Materials and Methods: The survey was conducted from July 2022 to August 2022 by the Korean Society for Antimicrobial Therapy with support from the Korea Disease Control and Prevention Agency. A literature review was conducted by searching Medline and relevant websites to retrieve a list of core elements and checklist items. These core elements and checklist items were evaluated by a multidisciplinary panel of experts using a structured modified Delphi consensus procedure, using two-step survey included online in-depth questionnaires and in-person meeting. Results: The literature review identified 6 core elements (Leadership commitment, Operating system, Action, Tracking, Reporting, and Education) and 37 related checklist items. Fifteen experts participated in the consensus procedures. Ultimately, all 6 core elements were retained, and 28 checklist items were proposed, all with ≥80% agreement; in addition 9 items were merged into 2 items, 2 items were deleted, and 15 items were rephrased. Conclusion: This Delphi survey provides useful indicators for the implementation of ASP in Korea and suggests national policy improvement about the barriers (e.g., shortage of staffing and financial support) existing in Korea for optimal implementation of ASPs.

특수학교(급)고등부 졸업생의 진로실태 및 진로 지원체제 구축방안 : Future Directions and Practices for Developing a Comprehensive Career Support System in Special Education School

정희섭,김현진,김형일,정동영,정인숙 국립특수교육원 2005 연구보고서 Vol.- No.11

이 연구는 장애인 삶의 질을 보다 확충하는 차원에서 특수학교(급) 고등부 졸업생의 진로 실태를 분석하고, 그 결과를 기반으로 현실여건에서 최상의 진로 지원체제 구축방안을 마련 하는데 목적을 두고 수행되었다. 이 연구는 목적의 달성을 위해 문헌고찰을 통해서 진로실태 분석모형을 개발하고 진로 지원체제 구축을 위한 요인을 발굴한 이후, 최근 5년간 전국 특수학교(급) 고등부 졸업생을 대상으로 전반의 진로실태를 조사?분석하고, 문헌분석 및 실태조사를 통해서 도출된 결과를 중심으로 학교와 지역이 연계된 진로 지원체제 구축 방안을 제시하였다. 먼저, 특수학교(급) 고등부 졸업생의 진로 실태에 대한 조사 결과를 제시하면 다음과 같다. 특수학교(급) 고등부 졸업생 진로실태 조사는 전국 120개 특수학교(고등부 과정 설치 특수학교), 161개 고등부 특수학급 총281개 학교의 2001년도부터 2005년도까지 5년간 졸업생 1,334명을 조사대상으로 하였다. 이들 조사대상 1,334명은 행정공문으로 각 학교별 졸업생 명부를 통하여 추출된 것으로, 실제 5년간 특수학교(급) 고등부 졸업생의 11.1%에 해당된다. 실태조사는 1차로 우편을 통한 설문지 발송과 회수를 통해서 이루어졌고, 2차로 본원의 현장연구위원 교사 176명이 소속 지역교육청의 졸업생을 직접 방문하여 설문 및 면담 조사실시하는 방법을 통해 이루어졌다. 조사결과에 의하면, 특수학교(급) 고등부 졸업생의 35.2%가 직장을 가진 취업자이고, 64.8%가 직장을 가지지 않은 미취업자(가정거주, 시설거주, 자영업, 대학진학포함)로 조사되었다. 장애영역별 학교 졸업생의 진로 실태를 취업률 중심으로 제시하면, 시각장애학교 졸업생 36.8%, 청각장애학교 졸업생 45.4%, 지체부자유학교 졸업생 35.1%, 정신지체 및 정서장애학교 졸업생 31.7%, 특수학급 졸업생 39.5%로 나타났다. 한편, 졸업생의 연도별 추이를 취업률 중심으로 제시하면, 2001년도 졸업생 45.3%, 2002년도 졸업생 32.8%, 2003년도 졸업생 32.2%, 2004년도 졸업생 31.3%, 2005년도 졸업생 33.8%로 나타났다. 최근 5년간 특수학교(급) 고등부 졸업생의 진로실태 전반에서, 미취업자는 가족과 함께 생활하지 않은 장애성인이 많고, 학교 졸업이후 무직상태가 지속되고, 직장생활을 원하지만 특별한 지원을 받지 못하고 있으며, 전반적인 생활만족도가 낮은 것으로 나타나고 있다. 한편, 취업자의 경우, 직장생활을 하고 있는 그 자체의 만족도를 제외하고는 고용상황 전반이 열악하고, 직장의 직무수행에 다소의 어려움을 느끼고 있고, 직장의 이직률이 높지만 적절한 지원을 받고 있지 못하며, 직장의 적응 · 유지를 위한 직업훈련을 받지 못한 경우가 많고, 현 수준보다 높은 임금을 지급하는 안정된 직장에 대한 요구가 많은 것으로 나타나고 있다. 또한 직장 생활의 직무수행 효율화를 위하여 장애인식 개선 혹은 장애인편의시설 확충에 대한 요구가 많은 것으로 나타나고 있다. 이와 같은 연구의 결과를 토대로 진로 지원체제 구축을 방안을 제시하면 다음과 같다. 특수학교(급) 고등부 졸업생의 진로 지원체제 구축 방안은 진로교육 대상자의 ‘개별성’과 진로발달 단계의 ‘연속성’을 보장하고, 진로 관련 기관간의 ‘협력성’을 강조하는 진로 지원체제의 구축이 필요하다는 방향성을 설정하고, 다음과 같은 구체적인 방안이 필요하다고 보았다. 첫째, 학령기 특수교육 대상학생의 직업 · 진로교육 실시를 위한 기반을 조성하여야 한다. 특수교육 진로관련 다양한 용어들을 정비하고, 직업 · 진로 관련 법규의 수정 및 보완이 이루어져야 하며, 개별화교육계획(IEP)에 개별화전환계획(ITP)이 포함되도록 하는 법규의 재정이 필요하다. 이를 통해서 단위 특수학교(급)에서 진로교육이 시스템적으로 실천되도록 하는 토대를 마련하여야 한다. 둘째, 현행 특수교육 직업 및 진로 관련 교육과정의 현실화가 이루어져야 한다. 현행 제7차 특수학교 교육과정 기본교육과정의 ‘직업교과’ 교육실시 시기를 앞당기고, 선택중심 교육과정 ‘전문선택’의 이수 범위를 확대할 필요가 있으며, 이를 통해서 현실성 있고 실제적인 단위 학교의 직업 및 진로교육 교육과정 운영이 이루어지도록 해야 한다. 한편, 특수학급 재학생들의 직업 및 진로교육을 효율적으로 실천하기 위한 근거를 국가수준 교육과정 문서에 마련하고, 다양한 교과에 산재된 진로관련 내용을 지도할 수 있도록 교사용 지도서를 제작 · 배부하여 활용토록 해야 한다. 셋째, 특수교육 대상학생을 위한 진로교육 방법의 개선이 이루어져야 하다. 직업 · 진로교육을 위한 일관성 있는 모형을 마련하여 적용하여야 하며, 진로교육의 효율적인 실시를 위하여 평가체제 및 평가주체를 명확히 확립하고, 직업 · 진로교육의 효율적인 실시를 위하여 전문 인력을 양성하여 배치하여야 한다. 또한, 특수교육 대상학생을 위한 직업 및 진로교육은 현장친화적인 교수-학습이 이루어지도록 하는 방법상의 변화를 모색해야 하며, 현장을 중심으로 하는 다양한 진로교육 모델을 개발하여 개별학생들의 요구와 필요가 충족되도록 하여야 한다. 넷째, 특수교육 대상학생의 졸업 시 진로선택의 역량 및 지원의 강화가 이루어져야 한다. 특수교육 대상학생의 자기결정 능력을 지속적으로 향상시키고, 이를 통해서 자신의 진로를 선택하고, 선택한 진로를 유지 · 발전시킬 수 있도록 그 역량을 강화해야 한다. 또한 특수교육 대상학생의 가족이 학교의 진로교육, 지역의 진로지원을 위한 프로그램의 계획 · 실행 · 평가 전반의 과정에 효율적인 참여가 이루어지도록 지원해야 한다. 한편, 학교와 지역의 직업 · 진로관련 기관 및 인사 간을 연계하는 가칭 ‘연계 및 협력 조력자’를 양성하여 활용토록 해야 한다. 다섯째, 장애성인의 지역사회에서의 효율적인 진로 지원을 위하여 다양한 지원 프로그램이 마련되어야 한다. 특수학교(급) 고등부를 졸업한 대학진학자와 미취업자는 항시 취업대기자이기 때문에 이들을 위한 대학 당국과 평생교육기관에서의 진로 지원을 위한 다양한 프로그램을 마련하여야 한다. 또한 특수학교(급) 고등부를 졸업한 취업자를 위해서는 직업 적응 및 유지, 직업 이동을 위한 준비 프로그램, 인턴 프로그램, 사후관리 프로그램을 마련하여 지원이 이루어지도록 해야 한다. 또한 국가는 범정부 차원의 특수교육 대상학생 직업 및 진로 촉진을 위한 추진 기구를 구성하여 운영하고, 장애학생 및 장애성인의 취업활성화를 위한 정책적 지원 기구와 방안을 강구하여야 한다. 이상에서와 같이, 특수교육 대상학생의 진로교육 및 진로지원은 그들의 삶의 질 향상에 목표를 두고, 진로 대상자의 개별성과 진로발달 단계의 연속성, 관련 기관간의 연계성을 기반으로 하는 학령기, 졸업시점, 학령기 이후가 통합된 적절한 지원체제를 마련해야 한다. 이와 같은 진로 지원체제가 현실성을 가지고 효율적으로 작동하게 된다면, 대부분의 일반인이 그렇듯 장애인도 직업을 가지고, 일과 노동의 댓가로 보수를 받으며, 받은 보수로서 세금을 납부 하면서 국가와 사회에 기여하고, 가정을 유지하면서 자신의 만족감을 가지며 살아가는 데 기여하게 될 것이다. The purpose of this study was to suggest the future directions and practices for developing a comprehensive career support system in special education school, based on the analysis of the actual career status of the high school graduates with disabilities in Korea. The research was conducted in several ways. First, by reviewing the related research and the literature, the analytical frame for the actual career status was developed and the considerable factors for the development of a comprehensive career support system were identified. Second, the nation-wide survey was conducted to overview and to analyze the actual career status of the students who graduated special education high schools over the last 5 years. Third, based on the literature review and the results of the survey analysis, the future directions and best practices for the comprehensive career support system were suggested. First, the nation-wide survey was conducted in the following. The subjects were 1,334 high school graduates from both 120 nation-wide special education schools (these schools include the course of high school) and 161 special education classes among 281 general education high schools from 2001 to 2005. The subjects were identified through the school graduate lists. And they were 11.1% of the total graduates both from special education schools and special education classes over the last 5 years. The first preliminary survey was conducted by mailing the questionnaires in returning envelops. The second survey was conducted by the 176 teachers who served as research committee members of the KISE. The teachers conducted in-depth surveys and interviews by calling on the graduates who belonged to their local school districts. The survey results showed that 35.2% of the graduates were employed and 64.8% were unemployed (staying at home, living in the facilities for people with disabilities, self-employed, and attending college or universities). The survey results according to the schools classified by the disabilities indicated the following employment rate; 36.8% of the graduates from the school for the visual impairments, 45.4% of the graduates from the school for the hearing impairments, 35.1% of the graduates from the school for the physical disabilities, 31.7% of the graduates from the school for the mental retardation and emotional disorders, and 39.5% of the graduates from the special education classes. On the other hand, the employment rate were different by the year; 45.3% of the graduates in 2001, 32.8% in 2002, 32.2% in 2003, 31.3% in 2004, and 33.8% in 2005. In general, the actual career status of the high school graduates with disabilities over the last 5 years were identified for the unemployed graduates; a) many unemployed graduates did not live with their family; b) the status of unemployment went on after high school graduation; c) most unemployed graduates wanted to have occupations, but there were little support for employment, such as vocational education programs; and d) their overall level of satisfaction in life was low. Meanwhile, the employed graduates also indicated that their employment condition was poor, except the fact that they had some satisfaction for them to have jobs. The actual career status for the employed graduates were identified in the following; a) their overall employment condition was poor; b) they felt some difficulties for carrying out their jobs; c) a change of occupation rates were high without proper support, d) there were little job training for adapting a new workplace and for maintaining their current jobs; d) there were high expectations for stable jobs with better wages than their current jobs; and e) they also requested for improving the convenient facilities for the people with disabilities and for increasing the understanding and the awareness of people with disabilities for their work efficiency. Based on these findings of the high school graduates with disabilities, the future directions and practices for developing a comprehensive career support system in special education school are suggested; a) the individualities of each student with disabilities and the continuity of career development are ensured, and b) the collaboration among schools, the community resources, and the employment agencies are emphasized. Therefore, it is necessary to draw a concrete plan in the following. First, the foundation of vocational education and career services should be established firmly for the students with disabilities in school. It is necessary to compile the glossary for the vocational education, career services, and transition in special education. It is also required to amend and make laws related to vocational education and career services, and to mandate the TP(Individual Transition Plan) to be included in the IEP(Individualized Education Program). Through these laws and policies, a firm basis for the systematic vocational education should be implemented. Second, the present vocational education and career related curriculum should be actualized. The 'vocational course' of the 7th Special Education Curriculum should be taught earlier, the 'specific elective courses' from the choice-based basic curriculum should be expanded in order to implement the school-based vocational career education curriculum practically and realistically. At the same time, these suggestions should be mandated by the national curriculum. And the teacher's manual should be prepared and distributed for teachers to effectively guide students for their vocation and career preparation. Third, the vocational education teaching strategies for students with disabilities should be improved. The consistent model for the vocational and career education as well as the effective assessment system should be developed and implemented. And for the effective implementation of the vocational and career education, the professionals should be trained and be placed in school. Moreover, the model for the vocational and career education for students with disabilities should utilize the field-based teaching and learning strategies. Especially, the field-based model needs to be diverse in order to meet the individual students' needs. Fourth, it is essential to strengthen the ability and to support the career choices of students at the time of graduation. It is necessary to continually make better for their self-decision ability. Through their self-decision ability, they can make their career choices and strengthen the ability to keep and develop their chosen careers. In addition, the families of students with disability should be supported in order to participate effectively in vocational and career education in schools and the whole process of planning, implementation, and the assessment for the career support within the community. Therefore, the 'transition coordinator', who can make connections and cooperations among schools, community resources, and the employment agencies, should be trained and utilized. Fifth, a variety of supportive programs for adults with disabilities must be provided in order to ensure the effective career supports in the communities. Since the students who went to college or universities after graduating special education high schools(classes) and the unemployed high school graduates are potential employees, the university authorities and the continuing education agencies must have a variety of supportive programs for them. Besides, it is essential to have specific programs for a job adaptation and sustainment, job preparation program for a career change, various internship programs, and the follow-up programs. In addition, the government should have the special organization for promoting the employment of the students with disabilities and adults with disabilities as well. In conclusion, the purpose of the vocational and career education for the students with disabilities should be the improvement of their quality of life. Therefore, based on the individuality of each student with disabilities, the continuity of career development stages, and the inter-agency collaboration, the comprehensive career support system should be integrated throughout the schools years, at the time of graduation, and after the graduation. If the suggested comprehensive career support system are to be implemented effectively within each school and each classroom, the people with disabilities will have occupations, get paid for the work they do, pay the taxes, have families, and contribute to the community and the nation with a feeling of great satisfaction, just as the most people without disabilities do.