복강경 조절형 위밴드 삽입술 시행 후 미란에 의한 패혈성 혈전문맥염과 간농양이 발생한 1예

차선아,김경훈,이종민,김현선,김지혜,박성균,김석찬 대한비만학회 2014 The Korean journal of obesity Vol.23 No.2

복강경 조절형 위밴드 삽입술은 고도 비만 환자의 체중 감량과 비만 관련 질환의 효율적인 치료 방법으로 알려져 있다. 수술 후 혈전 문맥염과 간농양의 발생이 보고된 예는 거의 없다. 저자들은 복강경 조절형 위밴드 삽입술 시행 후 위미란 및 복강내 농양이 발생하였으나진단이 지연되어 혈전 문맥염과 다발성 간농양, 이어 패혈증이 발생한 예를 경험하여 문헌 고찰과 함께 보고하는 바이다.

Severe Hypoglycemia and Cardiovascular or All-Cause Mortality in Patients with Type 2 Diabetes

차선아,윤재승,임태석,황세원,임은정,송기호,유기동,박용문,안유배,고승현 대한당뇨병학회 2016 Diabetes and Metabolism Journal Vol.40 No.3

Background: We investigated the association between severe hypoglycemia (SH) and the risk of cardiovascular (CV) or allcause mortality in patients with type 2 diabetes. Methods: The study included 1,260 patients aged 25 to 75 years with type 2 diabetes from the Vincent Type 2 Diabetes Resgistry (VDR), who consecutively enrolled (n=1,260) from January 2000 to December 2010 and were followed up until May 2015 with a median follow-up time of 10.4 years. Primary outcomes were death from any cause or CV death. We investigated the association between the CV or all-cause mortality and various covariates using Cox proportional hazards regression analysis. Results: Among the 906 participants (71.9%) who completed follow-up, 85 patients (9.4%) had at least one episode of SH, and 86 patients (9.5%) died (9.1 per 1,000 patient-years). Patients who had died were older, had a longer duration of diabetes and hypertension, received more insulin, and had more diabetic microvascular complications at baseline, as compared with surviving patients. The experience of SH was significantly associated with an increased risk of all-cause mortality (hazard ratio [HR], 2.64; 95% confidence interval [CI], 1.39 to 5.02; P=0.003) and CV mortality (HR, 6.34; 95% CI, 2.02 to 19.87; P=0.002) after adjusting for sex, age, diabetic duration, hypertension, mean glycosylated hemoglobin levels, diabetic nephropathy, lipid profiles, and insulin use. Conclusions: We found a strong association between SH and increased risk of all-cause and CV mortality in patients with type 2 diabetes.

노인의 인지기능과 삶의 만족도 관계에서 구강건강관련 요인의 매개효과

차선아,홍익표 대한작업치료학회 2023 대한작업치료학회지 Vol.31 No.3

Objective: This study was conducted to analyze the mediating effect of oral health factors in the relationship between cognitive function and life satisfaction in the elderly. Methods: This study analyzed 6,169 elderly people aged 60 years or older described in the 8th Korean Longitudinal Study on Aging (2020). The oral health factors of the elderly were divided into "functional dimension factors," "psychosocial dimension factors," and "pain or discomfort factors" of the Geriatric Oral Health Assessment Index (GOHAI). To determine the mediating effect of each factor, a path analysis was conducted using Mplus 8.4. Results: Between cognitive function and life satisfaction, among the oral health factors in the elderly, the functional dimension factor showed the largest partial mediating effect at 23% (β = 0.207, 95% confidence interval; CI = 0.169, 0.207). The psychosocial dimension factor was 22% (β = 0.202, 95% CI = 0.171, 0.236), and the pain and discomfort factor was 16% (β = 0.146, 95% CI = 0.119, 0.175), showing a partial mediating effect. Conclusions: The influence of three oral health-related factors on cognitive function and life satisfaction was confirmed. Therefore, it is necessary to consider the cognitive level of the elderly and identify oral health factors in detail. Accordingly, it is necessary to establish a personalized rehabilitation treatment access strategy and increase the life satisfaction of the elderly.

Baseline-Corrected QT (QTc) Interval Is Associated with Prolongation of QTc during Severe Hypoglycemia in Patients with Type 2 Diabetes Mellitus

차선아,윤재승,임태석,강윤구,이강민,송기호,유기동,박용문,고승현,안유배 대한당뇨병학회 2016 Diabetes and Metabolism Journal Vol.40 No.6

Background: We investigated an association between baseline heart rate-corrected QT (QTc) interval before severe hypoglycemia (SH) and prolongation of QTc interval during SH in patients with type 2 diabetes mellitus (T2DM). Methods: Between January 2004 and June 2014, 208 patients with T2DM, who visited the emergency department because of SH and underwent standard 12-lead electrocardiography within the 6-month period before SH were consecutively enrolled. The QTc interval was analyzed during the incidence of SH, and 6 months before and after SH. QTc intervals of 450 ms or longer in men and 460 ms or longer in women were considered abnormally prolonged. Results: The mean age and diabetes duration were 68.1±12.1 and 14.1±10.1 years, respectively. The mean QTc intervals at baseline and SH episodes were 433±33 and 460±33 ms, respectively (P<0.001). One hundred and fourteen patients (54.8%) had a prolonged QTc interval during SH. There was a significant decrease in the prolonged QTc interval within 6 months after SH (QTc interval prolongation during SH vs. after recovery, 54.8% vs. 33.8%, P<0.001). The prolonged QTc interval was significantly associated with baseline QTc interval prolongation (odds ratio, 2.92; 95% confidence interval, 1.22 to 6.96; P=0.016) after adjusting for multiple confounders. Conclusion: A prolonged QTc interval at baseline was significantly associated with prolongation of the QTc interval during SH in patients with T2DM, suggesting the necessity of QTc interval monitoring and attention to those with a prolonged QTc interval to prevent SH.

피담보채권액을 초과한 과잉담보설정 문제 : 독일의 판례를 중심으로

차선자(車善子) 한국민사법학회 2003 民事法學 Vol.23 No.-

인지기능과 구강건강관련 삶의 질의 연관성에 대한 연구: 성향점수 분석과 회귀모델을 중심으로

차선아,배수영,남상훈,홍익표 대한신경계작업치료학회 2023 재활치료과학 Vol.12 No.3

Objective : This study analyzed the correlation between cognitive function and oral health-related quality of life (OHQoL). Methods : Demographic and clinical characteristics were extracted and utilized for subjects aged 45 years or older who participated in the 8th Korean Longitudinal Study on Aging in 2020. The dependent variable was the Geriatric Oral Health Assessment Index, and the independent variable was the level of cognitive function classified by the Mini-Mental State Examination scores. The analysis method used inverse probability of treatment weighting (IPTW). Then, the association between cognitive function and OHQoL was analyzed by multiple regression analysis. Results : Among the participants, 4,367 (71.40%) had normal cognition, 1,155 (18.89%) had moderate cognitive impairment, and 594 (9.71%) had severe cognitive impairment. As a result of analysis by applying IPTW, there was a negative correlation between the cognitive function group and OHQoL (normal vs. moderate: β = -2.534, p < .0001; normal vs. severe: β = -2.452, p < .0001). Conclusion : After propensity score matching, mild cognitive impairment showed a more negative association than severe cognitive impairment. Therefore, patients with cognitive impairment require oral health management education to improve OHQoL regardless of the level of cognitive impairment. 목적 : 본 연구는 노인들의 인지기능과 구강건강관련 삶의 질 사이의 연관성을 분석하기 위해 수행되었다. 연구방법 : 2020년에 수집된 제8차 고령화연구패널조사에 참여한 지역에 거주하는 45세 이상의 중고령자를 대상으로 인구통계학적 및 임상적 특성을 추출하여 활용하였다. 독립변수는 한국형 간이정신상태검사 점수를 기준으로 분류한 인지기능, 종속변수는 구강건강관련 삶의 질을 측정하기 위한 노인구강건강 평가지수이다. 인지기능 그룹 간 공변량의 차이를 보정하기 위해 성향점수 활용법 중 역확률가중치를적용 후 인지기능과 구강건강관련 삶의 질의 연관성을 분석하기 위해 역확률가중치 적용 전의 다중회귀분석과 적용 후의 다중회귀분석 결과에 차이가 있는지 결과를 비교하였다. 결과 : 연구 대상자는 총 6,116명으로 인지정상군 4,367명, 경도 인지손상군 1,155명, 중증 인지손상군 594명으로 구성되었다. 성향점수 역확률가중치 적용 결과로 표준화된 평균 차이(standardized mean difference)를 확인하여 0.2 이상인 변수를 다시 통제하고 분석한 다중회귀모델에서 인지기능 그룹과 구강건강관련 삶의 질 간의 부정적인 연관성이 있었다(정상 vs. 경도: β = -2.534, p < .0001; 정상 vs. 중증: β = -2.452, p < .0001). 결론 : 본 연구 결과에서 인지손상과 구강건강관련 삶의 질은 음의 연관성을 나타내었다. 성향점수 활용 후 중증 인지손상보다 경도 인지손상에서 더 부정적인 연관성을 나타낸 결과는 인지손상은 저하된 정도와 관계없이 구강건강관련 삶의 질에 부정적인 영향을 미치는 것을 의미한다. 따라서 인지기능의 감퇴가 나타난 모든 환자들은 구강관리의 중요성과 교육이 필요하다는 것을 시사한다.

Invasive Primary Colonic Aspergillosis in the Immunocompetent Host without Classical Risk Factors

차선아,박훈석,김미희,임태석,김현호,장경윤,김형욱,위성헌,진동찬 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.5

Invasive aspergillosis (IA), generally considered an opportunistic infection in immunocompromised hosts, is associated with high morbidity and mortality. IA commonly occurs in the respiratory tract with isolated reports of aspergillosis infection in the nasal sinuses, central nervous system, skin, liver, and urinary tract. Extra-pulmonary aspergillosis is usually observed in disseminateddisease. To date, there are a few studies regarding primary and disseminated gastrointestinal (GI) aspergillosis in immunocompromisedhosts. Only a few cases of primary GI aspergillosis in non-immunocompromised hosts have been reported; of these, almost all of them involved the upper GI tract. We describe a very rare case of IA involving the lower GI tract in the patient without classical risk factors that presented as multiple colon perforations and was successfully treated by surgery and antifungal treatment. We also review related literature and discuss the characteristics and risk factors of IA in the immunocompetent hosts without classical risk factors. This case that shows IA should be considered in critically ill patients, and that primary lower GI aspergillosismay also occur in the immunocompetent hosts without classical risk factors.

한국 노동시장 불안정성과 미충족 치과의료의 관련성: 고용과 소득 불안정성을 중심으로

차선화 ( Xianhua Che ),박희정 ( Hee-jung Park ) 대한예방치과·구강보건학회 2018 大韓口腔保健學會誌 Vol.42 No.4

Objectives: The aim of this study was to analyze the accessibility of dental care services among individuals with precarious employment in South Korea. Methods: We used the 9th wave of the Korean Health Panel data (2015) and included 7,736 wage and non-wage earners in our study. We determined precariousness in the labor market as a combination of employment relationship and job income, and categorized individuals based on this into the following four groups: Group A comprising those who report job and income security, Group B comprising those who experience job insecurity alone, Group C comprising those who report a stable job but low income, and Group D comprising those who experience both job and income insecurity. Accessibility to dental care services was determined by experience of unmet dental care needs and unmet dental care needs caused primarily by financial burden. Logistic regression analyses were used to assess the effect of precarious work on access to dental care services. Results: Individuals with job insecurity (Group B; OR=1.445; 95% CI=1.22-1.70) and both job and income insecurity (Group D; OR=1.899; 95% CI=1.61-2.24) were more likely to have unmet needs than the comparison group. Both groups B and D were also 2.048 (95% CI=1.57-2.66) times and 4.435 (95% CI =3.46-5.68) times more likely, respectively, to have unmet dental care needs caused by financial burden. Education status, health insurance, and health status were all also effective factors influencing unmet dental care needs. Conclusions: Unstable employment and low income resulted in diminished access to dental care services. Therefore, governments should consider health policy solutions to reduce barriers preventing individuals with employment and income instability from accessing adequate dental care.

[발표 1] 변화하는 가족관계에 따른 친자법의 과제

차선자 한국여성정책연구원(구 한국여성개발원) 2019 한국여성정책연구원 세미나자료 Vol.2019 No.12

양육비 이행강화를 위한 제도적 지원 - 한국과 독일법의 비교를 중심으로 -

차선자 ( Cha Seon-ja ) 제주대학교 법과정책연구원 2021 法과 政策 Vol.27 No.1

양육비는 아동의 기본적인 의식주, 양육 및 교육과 같은 것을 실현하기 위한 필수적인 것이다. 때문에 세계 각국은 양육비 이행을 강화하기 위하여 다양한 노력을 하고 있다. 궁극적으로 이러한 노력이 추구하는 것은 아동의 관점에서 양육비의 공백을 최소화하는 것이다. 예를 들어, 독일은 양육비채무자의 지불능력을 평가해서 자신의 생계를 유지할 정도 이외의 소득이 없거나, 그의 주소와 소득을 양육비 채권자가 알지 못하면 일단 국가가 양육비를 최장 18세까지 선급할 수 있도록 하고 있다. 또한 미성년 자녀는 양육비 채무자의 이행능력을 증명할 필요 없이 재산과 소득에 대한 고지를 요구하였다는 사실과 부양 의무를 이행하지 않았음을 표시하여 미성년 자녀의 거주 지역 법원에 간소화된 절차로 소송절차 없이 양육비를 청구할 수 있도록 하고 있다. 나아가 이러한 절차적 지원에서도 양육비가 이행되지 않아 미성년자녀의 생활이 위태롭게 되는 경우 형사적인 제재도 가능하다. 이처럼 독일은 자녀 양육비의 공백을 축소하기 위하여 3가지 방법의 지원을 제도화 하고 있다. 그러나 우리나라는 독일과 비교하여 국가의 양육비 선급이 기간과 액수에서 매우 제한적으로 지급될 뿐이다. 따라서 사적부양에 의한 양육비 지원이 최대한 가능하도록 법적 제도적 지원이 이루어져야 한다. 이를 위해 첫째, 양육비를 청구할 수 있는 대상자의 범위를 확장해야 한다. 구체적으로 미성년 자녀의 부모가 양육비를 지불할 자력이 부족하다면 조부모에게도 청구가 가능함을 명확히 해야 한다. 둘째, 절차적인 수월성과 신속성이 보장되도록 개정되어야 한다. 즉 가사소송절차를 신속하게 진행하기 위하여 양육비채무자 주소파악을 위한 수월성을 강화해야 한다. 또한 성년 이후의 교육비를 양육비로 합의한 경우 이를 존중하여 양육비 부담조서에 포함시켜 집행권원을 인정해야 한다. 그리고 재산명시명령을 양육비 심판청구의 시작시점에 동시에 진행하도록 제도를 안착시켜야 한다. 마지막으로, 이행을 강제할 수 있는 강력한 제재수단이 마련되어야 한다. 이를 위해서 이행강화를 위한 「가사소송법」상의 사전처분 등에 집행력이 부여될 필요가 있으며 양육비 채권을 집행할 때에는 압류금지최저금액에 대한 예외를 인정해야 할 것이다. 「아동복지법」과 「아동학대처벌법」에 규정을 근거로 양육비 미이행 행위를 아동방임으로 처벌할 수 있도록 관련규정을 개정할 필요가 있을 것으로 본다. Child support is the essential part for realizing minor’s necessities of life, nurture and education etc. For this reason, countries in the world give effort to strengthen implementation of child support. Ultimately, the effort aims at minimizing its vacuum. For instance, German government pays child support until 18 year’s old, if its debtor only has enough income to make a living or its creditor does not know his address and income. Furthermore, minors can claim support expenses by the simplified proceedings without law suit, if despite of their requestion of notice about debitor`s income and property it is not performed. Lastly, criminal sanctions could be applied, if child support is not paid in spite of carrying out the simplified proceedings and consequently minors’s physical or mental development is endangered. In this way Germany utilizes three different legal systems like civil procedure, social security, and criminal sanction in order to minimize the gap of child’s sustention. Compared with Germany, child maintenance by the social security system in Korea is paid only within the restricted amount and duration. Therefore, the importance of legalization and institutionalization by private support system to secure child maintenance should be much more stressed. To realize it, firstly a scope of requested person who is asked to pay child support should be extended. Concretely it has to be clarified that minors can also claim support from their grand parents, if their parents do not have sufficient income and property. Secondly, civil procedure to sue for child support should be revised to guarantee easiness and rapidity. Above all, obligator`s address ought to be easily accessed for rapid progression of litigation. In addition, parties’ agreement paying educational expense after reaching majority should be included as a part of the protocol about covering child support and executive power is granted to it. And order to specify property should be granted at the same time with beginning of procedure for requesting child support. Lastly, strong sanctions forcing the obligator of child support should be introduced. For the sake of it, executive power has to be afforded to advance decision. Child maintenance has to be dealt as an exception of minimum amount prohibiting seizure and it should be able to be executed, when parties agree to pay child support with minimum amount prohibiting seizure. Furthermore, by revising the provision of Child Welfare Act and Act on Special Cases Concerning the Punishment, etc. of Child Abuse Crimes non-custodial parents who do not pay child support have to be able to be punished because of neglect.