• Korea journal of population studies
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• v.27 no.2
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• pp.1-34
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• 2004

최근 한국사회에서는 출산율의 저하로 인한 사회경제적 영향을 우려하여 대책방안을 강구하여야 한다는 논의가 증대되고 있다. 그런데 국가정책을 개발${\cdot}$추진하기 이전에 반드시 요구되는 것은 저출산 현상의 올바른 인식과 철저한 원인규명이다. 따라서 본 연구에서는 출산율 변화의 원인을 다각적으로 살펴보고, 향후 변화방향을 전망해 보고자 한다. 먼저 자녀출산의 변화를 결혼상태 변화와 유배우부인의 출산율 변화 부분으로 나누어 살펴본 결과, 과거와는 달리 최근의 출산율 저하는 유배우 부인에 의해서가 아니라 미혼자의 결혼연장 또는 독신생활에서 기인되는 것으로 나타났다. 이들 두 요인에 영향을 주는 변수로는 경기침체 및 직장불안정, 결혼가치관의 변화와 초혼연령의 상승, 자녀양육 관심증대, 자녀양육비 부담, 가정과 직장의 양립을 위한 사회적 인프라 부족, 여성의 자아욕구 및 사회참여 증대, 자녀효용가치 감소, 이혼 등 가족해체의 증대, 그리고 불임부부의 증대 등인 것으로 판단된다. 향후 출산율 변화를 전망해 보면, 저출산을 일찍 경험한 서구 선진국의 경우와는 달리 정책의 추진에 한계가 있어 선진국보다 더 낮은 출산율을 회복하는 데는 많은 어려움이 있을 것이라는 판단이다. 더군다나 젊은 미혼남녀의 가치관이 개인주의화 되는 경향이 있다는 점을 감안한다면 출산율 회복정책을 추진한다 하더라도 한계가 있을 수밖에 없을 것이다. 수년간 실시된 각종 실태조사를 분석한 결과에 의하면 현재의 경기침체가 회복될 경우 약 20%의 출산율 상승 가능성이 있으며, 이 때의 합계출산율은 약 1.43명 수준이 될 수 있을 것으로 예견된다. 또한 종합적 체계적 출산회복정책을 효과적${\cdot}$효율적으로 추진한다면 약 10년 후에는 합계출산율이 약 1.6 수준으로 회복될 것이라는 낙관적 견해를 가져본다. 그렇지만 정책의 강도에 따라서 회복수준은 현저하게 상이할 것이다.를 진단, 치료함에 있어 진행성 신질환의 가능성을 시사하는 예후인자가 없다면 신생검보다는 지속적이고 정기적인 추적관찰만으로도 충분할 것으로 생각된다도 등은 양군 사이에 유의한 차이가 관찰되지 않았다. 발견 당시 혈청 $C_3$치의 감소는 모두 11명(61.1%)에서 관찰되었는데, 증상군에서는 7명(87.5%), 집단뇨검사군에서는 4명(40%)으로 증상군에서 혈청 $C_3$치의 감소가 보다 현저하였다. 그러나 추적관찰 기간 동안 증상군에서는 7명 중 4명, 집단뇨검사군에서는 4명 중 1명에서 혈청 $C_3$치는 정상범위로 증가하여 최종 관찰시점에서는 6명 (33.3%)에서만 혈청 $C_3$치의 감소가 지속되고 있다. 혈청 $C_3$치의 감소를 보인 경우를 다시 병리조직학적 분류에 의해 세분하여보면 발병당시에는 I형 8명(61.5%), II형에 1명(100%), III형 2명(50%)에서 관찰되었는데, 최종 시점에서는 I형 4명(30.8%), II형 1명(100%), III형 1명(33.3%)이었다. 또한 증상군에서 세포성 반월체형성과 세뇨관위축의 빈도가 높았으며, 사구체 혈관벽 비후와 사구체 간질의 증가의 정도가 집단뇨검사군에 비해 통계적으로 유의하게 높았다. 결론: 무증상성 요이상을 가진 환자에서 신장조직검사 실시 후 MPGN으로 진단되는 증례가 증가하고 있고, 오히려 증상을 동반하는 경우보다 빈도가 증가한다는 사실은 집단뇨 검사에서 소변의 이상소견이 발견되어 신장 조직검사를 실시할 경우 혈청 $C_3$치의 감소 여부에 관계없이 MPGN도 진단적 고려 대상이 되어야 한다고 생각한다.신장 조직검사를 시행한 결과 진행성 경과를 취할 수 있는 막 증식성 사구체 신염과 매우 희귀한 증례인 신유전분증 등으로 진단됨으로써 지속성 단백뇨의 경우 정확 진단적 접근이 필수적임을 알 수

• Clinical and Experimental Pediatrics
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• v.52 no.11
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• pp.1260-1266
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• 2009

Purpose : Idiopathic nephrotic syndrome (NS) can be clinically classified as steroid-sensitive and steroid-resistant. The detailed mechanism of glucocorticoid action in NS is currently unknown. Methods : In this study, we investigated 3 known single nucleotide polymorphisms (SNPs) (ER22/23EK, N363S, and BclI) of the glucocorticoid receptor gene (the NR3C1 gene) in 190 children with NS using polymerase chain reaction-restriction fragment length polymorphism and analyzed the correlation between the genotypes and clinicopathologic features of the patients. Results : Eighty patients (42.1%) were initial steroid nonresponders, of which 31 (16.3% of the total) developed end-stage renal disease during follow-up. Renal biopsy findings of 133 patients were available, of which 36 (31.9%) showed minimal changes in NS and 77 (68.1%) had focal segmental glomerulosclerosis. The distribution of the BclI genotypes was comparable between the patient and control groups, and the G allele frequencies in both the groups were almost the same. The ER22/23EK and N363S genotypes were homogenous as ER/ER and NN, respectively, in all the patients and in 100 control subjects. The BclI genotype showed no correlation with the NS onset age, initial steroid responsiveness, renal pathologic findings, or progression to end-stage renal disease. Conclusion : These data suggested that the ER22/23EK, N363S, and BclI SNPs in the NR3C1 gene do not affect the development of NS, initial steroid responsiveness, renal pathologic lesion, and progression to end-stage renal disease in Korean children with NS.

• Parasites, Hosts and Diseases
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• v.28 no.1
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• pp.45-52
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• 1990

Intestinal histopathological changes due to infection with Echinostcma hortense (Trematoda) were studied in rats after experimental infection with the metacercariae. The metacercariae were obtained from the tadpoles of Rana nigrcmaculata, a second intermediate host infected in the laboratory. Total 18 albino rats(Sprague-Dawley) were given 200 matacercariae each and sacrificed on the day 1, 3, 7, 11, 22 or 44 post-infection(PI) Segments of- the small intestine at 1, 3, 5, 8 and 30 cm posterior to the pylorus(PTP) were rejected and studied histopathologically. 1. The flukes were seen to have intruded into the intervillous space in the upper small intestine at early stages(1∼3 days PI), however, they were located mainly in the intestinal lumen at later stages(7∼44 days PI) . The flukes were sucking and destroying the epithelial layers of villi with their oral and ventral suckers. 2. Histopathological changes of the intestine were recognizable in as early as 1∼3 days after infection, and the changes became severer as the infection progressed. 3. The intestinal mucosa was histopathologically characterized by villous atrophy and crypt hyperplasia throughout the infection period. Major villous changes were blunting, fusion, severe destruction and loss of epithelial layers of villi. Villous/crypt(V/C) height ratio was remarkably reduced from 3 : 1 in controls to 1 : 1 in severely infected animals. In the stroma of villi, inaamma- tory cell infiltrations, vascular congestion, edema, and/or fibrosis were recognized. The goblet cells were increased in number after 11 days PI. It was revealed in the present study that the pathological changes in the intestine of rats infected with E. hortense were chieay confined to the mucosal layer of the upper small intestine, however, the changes were very severe accompanying remarkable destruction of villi and loss of mucosal integrity, and persistent until 44 days PI.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.122-129
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• 2005

Purpose: Eosinophilic colitis is a disease characterized by gastrointestinal symptoms, peripheral eosinophilia, eosinophilic infiltration of the colonic wall. The etiology and pathogenesis of this disease is not clear and it is considered to be idiopathic. This study aimed to ascertain the clinical features, treatment and prognosis of eosinophilic colitis in early infancy. Methods: We reviewed 6 infants retrospectively, presented with bloody stool in early infancy, who were diagnosed with eosinophilic colitis in Pusan National University Hospital between August 2002 and February 2004. Results: Five males and one female were included. The mean age when bloody stool was identified was $79.2{\pm}56.1$ days (10~145 days). All but one infant with atopic dermatitis did not have other allergic diseases. Nobody had a family history of allergic disease. No specific dietary history in infants and their mothers related to food allergy was identified. Peripheral eosinophilia (total WBC count $11,763{\pm}3,498/mm^3$, eosinophils $17.0{\pm}4.3%$, absolute eosinophil count $2,044{\pm}996/mm^3$) was observed in all infants. Colonoscopy in six infants revealed diffuse erythema, congestion and granulation pattern of mucosa in the rectosigmoid colon. Histopathologic findings of colononic biopsies showed chronic inflammation with severe eosinophilic infiltration in the mucosa. Two infants were treated with hydrolyzed casein-based formula and four infants with prednisolone. Gastrointestinal symptoms and peripheral eosinophilia resolved completely with prednisolone and partially with a hydrolyzed casein-based formula. Relapse was not observed during the follow-up period. Conclusion: Our study demonstrated that there is no evidence of a definite relationship between eosinophilic colitis and food-allergic disorders. Clinical course and prognosis of infantile form of eosinophilic colitis is very favorable and treatment with prednisone was effective.

• Research in Plant Disease
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• v.10 no.3
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• pp.188-193
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• 2004

The symptom expressions such as yellowish and mosaic spots in overwintering barley have been considered to be a damage by cold or water. However, it had revealed that the symptom expressions were caused by viruses throughout three year nationwide surveys. Barley yellow mosaic virus (BaYMV), Barley mild mosaic virus (BaMMV), and Soil-borne wheat mosaic virus (SBWMV) was detected in 2001-2003 and Barley yellow dwarf virus-MA V (BYDV -MA V) from field samples collected on March in 2003. The results of investigation showed that the incidence of BaYMV was more than 70％ and that of BaMMV and SBWMV was 15.7-37.4％ and 0.7-10.1 ％ in three year surveys, respectively. The incidence of BYDV-MAV was approximately 1 ％ in 2003 only. The distribution of BaYMV was relatively uniform throughout barley fields in Korea, but the incidence of the virus in Gyunggi Province was as low as 19％ compared to 65-85％ in the rest of regions. On the other hand, 70％ of BaMMV was found to be in the west south regions of Korea, Jeonbuk and Jeonnam Provinces. Taken together, both BaYMV and BaMMV were thought to be dominant casual agents in overwintering barley by either single or mixed infections. Previous survey data for BaYMV from 1994 to 1996 indicated that the incidence of the virus was approximately 40％ in Jeonbuk, Jeonnam, and Gyungnam Provinces. Thus, comparing with the results from the recent nationwide survey, the incidence of BaYMV had been rapidly increasing in overwintering barley fields in the southern part of Korea.

• Journal of Life Science
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• v.30 no.8
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• pp.672-679
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• 2020

Distal myopathy is a clinically and genetically heterogeneous group of degenerative diseases of the distal muscle. Glycogen storage disease type IXD (GSD9D) is a metabolic distal myopathy characterized by muscle deficiency of phosphorylase kinase, a key regulatory enzyme in glycogen metabolism. Affected individuals may develop muscle weakness, degeneration, and cramps, as well as abnormal muscle pain and stiffness after exercise. It has been reported that mutations in the PHKA1 gene which encodes the alpha subunit of muscle phosphorylase kinase cause GSD9D. In this study, we examined a Korean GSD9D family with a c.3314T>C (p.I1105T) mutation in the PHKA1 gene. This mutation has not been previously reported in any mutation database nor was it found in 500 healthy controls. The mutation region is well conserved in various other species, and in silico analysis predicts that it is likely to be pathogenic. To date, only seven mutations in the PHKA1 gene have been documented, and this is the first report of Korean GSD9D patients. This study also describes and compares the clinical symptoms and pathological conditions of previously reported cases and these Korean patients. We believe that our findings will be useful for the molecular diagnosis of GSD9D.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.7 no.1
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• pp.34-43
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• 1996

In adolescence, the symptoms of depression are more various and different from those of adult. Conduct behaviours are frequently represented in adolescent's depression. The patients who have the depression and conduct disorder are defined as depressive condor disorder in ICD-10. We hypothesized that there might be different parental rearing patterns between the patients with depression alone and the depressive conduct disorder. We applied children's depression inventory (CDI), parental rating form for conduct disorder based on DSM-III-R, and parental bonding instrument (PBI) to patients and normal control adolescent group. The results were as follows : 1) There were no significant differences in severity of depressive symptoms, maternal care, maternal overprotection, and paternal care. 2) Paternal overprotection showed significant higher scores in depressive conduct disorder group than depression group and normal control group. 3) There were positive correlations in the severity of depressive symptoms and behavior problems in all subjects. 4) There were no correlations in maternal care and overprotecion with conduct problems, but with depressive symptoms in all subject. 4) There were no correlations in paternal care with conduct problems and depressive symptoms in all subjects. 5) There were significant correlations in patienral overprotective, intrusive attitudes with conduct problems, not with depressive symptoms in all subjects.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.8 no.2
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• pp.266-272
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• 1997

We examine the clinical efficacies of fluoxetine in treating the children with selective mutism. In an 8-week open-label clinical study, 17 children with selective mutism are received 20-60mg/day of fluoxetine. Our results reveal that 13 subjects(76%) of 17 subjects improve statistically in within subjects comparison of pre- and post-treatment changes in the scores of Clinical Global Impression scale for mutism, Children’s Depression Inventory scale, and Revised Children’s Manifest Anxiety Scale. These data suggest that selective serotonergic antidepressants may be effective in treating selective mutism in children and adolescents.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.6 no.1
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• pp.74-89
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• 1995

Selective mutism is a childhood condition defined by persisten failure to speak in specific social situation when speaking is expected, dispite preserved ability to comprehend spoken language and speak. Present study is to investigate clinical characteristics, treatment method and outcome of 23 children who were diagnosed as selective mutism by DSM-IV criteria at the child psychiatry ouptatient department of SNUH. The results were as follows : 1) The Sex ratio was 1: 4.8, female dominant Mear age of onset was 33 years old and mean age of first referral was 7.7 years old. 2) 22% of subjects had perinatal problem such as low birth weight, preterm birth, 26% of the subjects have history of delayed language development. There are subjects who had been separated with mam caretaker before 3 years old(26%) and who experienced physical or psychological trauma before 3 years old(26%). A few subjects had enurests(30%) and encoprests(4%). 3) Many subjects(65%) had symbiotic relationship with their mother. These families consist of dominant, verbally aggressive mother and passive father. Parents of 39% of all subjects were judged to have definite psychopathology(social phobic, depression, hysterical trait or alcohol problem) 26% of all subject, were reported physically abused. 4) The personality trait of the subjects were frequently described as follows(in order of frequency) ; Shy(100%), anxious(83%), stubborn(83%)m rigid and tense posture(78%), immature(65%) overdependent(65%), irritable(52%), manipulative(39%), depressive(39%). 5) The mean performance IQ of 16 subjects by KEDI-WISC was 88.3 Among them, the subjects with IQ below 69 were seven and those with IQ above 70 were nine. When comparing these two group(Mental retardation group vs Normal IQ group), we could find some difference in language development, personality trait, family dynamics and treatment outcome. 6) Among several treatment methods for selective mutism, play therapy was the most frequently used method(65%). Other commonly used treatment methods were pharmacotherapy(21%), behavioral therapy(8%), combined therapy(play therapy+pharmacotherapy+family therapy+behavioral therapy)(12%), 7) Regarding the outcome of treatment 8.6% was evaluated as Excellent, 30.4% as Good, 52% as Fair, 8.7% as Poor at the tinic of treatment. At follow up interview 21.7% was evaluated Excellent, 13% as Good, 21.7% as Fair, 34.8% as Poor. 8) We classified all subjects by Havden's 4 subtype. Symbiotic mutism was most common(65%) and other subtypes are Speech phobic mutism(8.6), Reactive mutism(13%) and Passive-aggressive mutism(30%).

• Childhood Kidney Diseases
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• v.5 no.2
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• pp.164-175
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• 2001

Purpose : Alport syndrome is a hereditary nephrotic disease characterized by progressive nephrotic symptom, sensorineural hearing loss, ophthalmic abnormality, typical microscopic findings, and familial occurrence. In this study, we tried to find the risk factors related with its prognosis by taking a close observation on clinical symptoms of children with Alport syndrome reviewing retrospectively. Materials & methods : We chose children diagnosed as Alport syndrome in renal biopsy during 20 years(from 1980, Jan. until 1999, Dec.) who could receive follow up studies in tile department of pediatrics. They were divided into two groups by comparing renal function at the time of diagnosis and at current status. We compared several clinical aspects in them, and applied nonparametric test for statistical analysis. Results : The sex ratio(male:female) of 24 children was 3:1. The most common clinical symptom presented at their first visit was gross hematuria. Among those 24 children, 11 cases($46\%$) of progressing into chronic renal failure(Group II) were observed. Hypertension, proteinuria and edema were seen much frequently in group II. The level of serum protein, albumin, and creatinine clearance were decreased while BUN, creatinine were relatively increased. All the results were statistically significant. Conclusion Clinically significant risk factors related to prognosis in Alport syndrome were the presence of hypertension, edema, and proteinuria at the time of diagnosis. Also, the level of serum protein, albumin, BUN, creatinine, and glomerular filtration rate were proved to be important factors in predicting prognosis. We believe that studies on these possible risk factors would be of great help in treating and predicting prognosis of children suffering with Alport syndrome. (J Korean Soc Pediatr Nephrol 2001;5 : 164-75)