• Asian Pacific Journal of Cancer Prevention
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• 제16권7호
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• pp.2915-2921
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• 2015

Background: Some recent clinical trials have been conducted to evaluate a combination of EGFR- TKI with chemotherapy for advanced NSCLC patients as second-line therapy, but the results on the efficacy of such trials are inconsistent. The aim of this meta-analysis was to evaluate the efficacy and safety of combination of EGFR-TKI and chemotherapy for patients with advanced NSCLC who failed first-line treatment. Materials and Methods: We searched relative trials from PubMed, EMBASE, ASCO Abstracts, ESMO Abstracts, Cochrane Library and Clinical Trials.gov. Outcomes analyzed were overall response rate (ORR), progression- free survival (PFS), overall survival (OS) and major toxicity. Results: Seven trails eventually were included in this meta-analysis, covering 1,168 patients. The results showed that the combined regimen arm had a significant higher ORR (RR 1.76 [1.16, 2.66], p=0.007) and longer PFS (HR 0.75 [0.66-0.85], p<0.00001), but failed to show effects on OS (HR 0.88 [0.68-1.15], p=0.36). In terms of subgroup results, continuation of EGFR-TKI in addition to chemotherapy after first-line EGFR-TKI resistance confered no improvement in ORR (RR 0.95 [0.68, 1.33], p=0.75) and PFS (HR 0.89[0.69, 1.15], p=0.38), and OS was even shorter (HR1.52 [1.05-2.21], p=0.03). However, combination therapy with EGFR-TKI and chemotherapy after failure of first-line chemotherapy significantly improved the ORR (RR 2.06 [1.42, 2.99], p=0.0002), PFS (HR 0.71 [0.61, 0.82], p<0.00001) and OS (HR 0.74 [0.62-0.88], p=0.0008), clinical benefit being restricted to combining EGFR-TKI with pemetrexed, but not docetaxel. Grade 3-4 toxicity was found at significantly higher incidence in the combined regimen arm. Conclusions: Continuation of EGFR-TKI in addition to chemotherapy after first-line EGFR-TKI resistance should be avoided. Combination therapy of EGFR-TKI and pemetrexed for advanced NSCLC should be further investigated for prognostic and predictive factors to find the group with the highest benefit of the combination strategy.

• KDI Journal of Economic Policy
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• 제12권4호
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• pp.113-126
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• 1990

국민연금(國民年金)의 도입(導入)과 더불어 4개(個) 공적연금(公的年金)(국민연금(國民年金), 공무원연금(公務員年金), 사립학교교직원연금(私立學校敎職員年金), 군인연금(軍人年金))간의 효율적(效率的) 연계방안(連繫方案)에 대한 논의(論議)가 있어 왔는데 연계(連繫)의 기본적(基本的) 방향(方向)이 누진적(累進的)인 제도(制度)로의 통합(統合)과 소득비례적(所得比例的)인 제도(制度)로의 통합(統合) 중 어느 것이 될 것이냐가 논의(論議)의 중심(中心)이 되어 왔다. 기존(旣存)의 소득세연구(所得稅硏究)에서는 노동시장(勞動市場) 완전하다는 전제하에 노동공급(勞動供給)에 있어 유인(誘因)의 문제가 있을 때는 가장 생산력(生産力)이 높은, 즉 최상위소득계층의 한계세율이 영(零) 역진적(逆進的)인 세제(稅制)가 가장 효율적인 (Pareto efficient) 제도임이 입증(立證)되어 왔다. 본(本) 연구(硏究)는 미래(未來)의 소득기회에 대한 불확실성(不確實性) 가정하(假定下)에 선형급여구조(線型給與構造)를 가지는 사회보장제도(社會保障制度)가 도입된 "라이프사이클"모형을 고찰하였다. 이 연구(硏究)에서는 비례적(比例的)인 사회보장세(社會保障稅) 의해 재원이 조달되는 사회보장제도(社會保障制度)는 급여에 있어 누진적(累進的) 구조(構造)를 가지는 것이 공리주의적(公利主義的) 사회후생함수(社會厚生函數)를 극대하는 차선적정해(次善適正解)임을 증명(證明)하고 있다. 이러한 이론적(理論的) 결과(結果)의 정책적(政策的) 함의(含意)는 앞으로 공적연금간(公的年金間)의 연계(連繫)에 있어 누진적(累進的)인 제도(制度)로의 통합(統合)이 형평의 차원에서뿐 아니라 효율성의 차원에서도 바람직하다는 것이다.

• 문화기술의 융합
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• 제3권2호
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• pp.21-30
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• 2017

본 연구는 뇌혈관질환자의 년간 총직접비용에 대하여 조사하였다. 본 연구를 위하여 2012년 한국의료패널 조사자 중 2012년 한 해 동안 뇌혈관질환으로 응급, 입원, 외래서비스를 1건 이상 이용하였다고 응답한 265명을 대상으로 하였다. 뇌혈관질환자 일반사항은 2012년에 한국의료패널 응답자 중 뇌혈관질환으로 응급, 입원, 외래서비스를 이용한 응답자의 비율이다. 연구방법은 응급, 입원, 외래서비스의 평균의료비와 가중평균을 적용하여 직접비용을 산출한 후 년간 총직접비용을 산출하였다. 연구결과는 뇌혈관질환자가 1인당 연 평균 본인부담 의료비 지출액은 약 561,934원이고, 남성은 669,557원, 여성은 448,696원이다. 건강보험 가입자의 경우 뇌혈관질환으로 인한 1인당 본인부담액은 평균 634,459원이고 의료급여 수급자는 160,236원이었다. 뇌혈관질환자가 265명의 연 평균 총직접비용은 약 162,165,690이고, 남성은 193,223,955원, 여성은 129,486,685이다. 건강보험가입자의 경우 뇌혈관질환으로 인한 1인당 총직접비용은 평균 183,095,125원이고 의료급여 수급자는 46,241,705원이었다. 가구소득별로 보면, 가구 소득 3분위에 속한 환자는 672,268원으로 가장 높게 나타났으며, 5분위에 속한 환자는 108,970,650원 으로 뇌혈관질환자의 총직접비용이 가장 낮았다.

• 한국작물학회:학술대회논문집
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• 한국작물학회 2017년도 9th Asian Crop Science Association conference
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• pp.351-351
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• 2017

Arbuscular mycorrhizal fungi (AMF) are particular soil fungi that benefit many crops and require a symbiosis with plant roots to survive. In our previous study, there was a positive correlation between AMF root colonization and soybean grain yield in a four-year consecutive winter cover crop-soybean rotational system without phosphorus fertilizer. It is suggested that higher AMF root colonization can be a better solution for improving soybean growth and grain yield in P-limited soil. Our purpose in this study was to test the hypothesis that a P application is the main factor improving soybean growth, P nutrition and grain yield, and the benefit from AMF to soybean P uptake and growth in a P-limited soil. Impact of a P application on AMF root colonization and communities in soybean roots and their potential contribution to soybean growth and P nutrition under a five-year P-unfertilized crop rotational system were investigated over two-years. In this study, four cover crop treatments included 1) wheat (Triticum aestivum); 2) red clover (Trifolium pratense); 3) rapeseed (Brassica napus); and 4) fallow in the crop rotation. The amount of triple superphosphate as a P fertilizer applied rate after cultivation of cover crops was 120 and $360k\;ha^{-1}$ in 2014 and 2015, respectively. Soybean roots were sampled at full-flowering and analyzed for AMF communities using polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) and quantitative real-time PCR (qPCR) techniques. The AMF root colonization in the soybean roots at full bloom stage was significantly influenced by cover crop and P application throughout the two-year rotation. The two-year rotation of different cover crops or fallow impacted the molecular diversity of AMF communities colonizing roots of soybean. Redundancy analysis (RDA) indicated that AMF communities colonizing roots of soybean were significantly different among cover crop rotations. The AMF communities colonizing roots of soybean were clearly influenced by a P application in the two-year trial. Moreover, a P application may have positively impacts on the AMF communities under P-deficit soil due to the continuous cover crop-soybean rotational system without a P fertilizer.

• 한국학교보건학회지
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• 제12권2호
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• pp.305-319
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• 1999

The objective of this study were to evaluate the relation between post-examination management states of dental caries in elementary school students and a mother's dental health beliefs. We systematically chose 10 elementary school in urban and rural areas of Chungnam Province and determined the first class students of 5 and 6 grade in each school as study subjects. Among 837 participants, 669 students were diagnosed with dental caries after a 1998 periodic dental health examination was answered completely and analysed. The contents of the questionnaire for students were general characteristics, dental health behaviors, notification factors, treatment factors. Their mothers were surveyed by another questionnaire. The contents of the questionnaire for mothers were also general characteristics, dental health behaviors, and dental health beliefs. The result of this study were as follows 1. The prevalence of dental caries was 65.0% and there was no significant difference between urban and rural areas. 2. Meanwhile, 63.8% of students in urban areas knew the examination result through a doctor's explanation, 52.4% of students in rural areas learned through a school notification letter, 82.9% of all the students let their parents know of their dental caries. 3. Among the dental caries group, 36.3% of the students were treated as for treatment, most students in urban areas visited a dental clinic, but those in rural areas visited the dental dept of a public health center as for the treatment time, 35.9% of the students were treated immediately after the examination. 4. 44.9% of those treated answered that they felt they needed treatment; 67.2% of those not treated answered that they considered the treatment as a bother and unnecessary due to no pain. 5. Overall, the scores in the dental health beliefs in mothers were low. Especially among the 5 items of susceptibility and seriousness, the scored were very low but the benefit was high. Logistic regression analysis showed that the treatment of a child's dental caries was significantly associated with low scores of benefit in those untreated and high scores among those treated. Considering these results, health education to stimalate a mother's susceptibility and seriousness in health beliefs and for students to learn the need for treatment, including a more detailed post exam management system at the school level should be considered for a higher treatment rate.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8993-9004
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• 2014

Background: The incidence rate and the treatment costs of hepatocellular carcinoma (HCC) are high, especially in Thailand. Previous studies indicated that early detection by a surveillance program could help by down-staging. This study aimed to compare the costs and health outcomes associated with the introduction of a HCC surveillance program with no program and to estimate the budget impact if the HCC surveillance program were implemented. Materials and Methods: A cost utility analysis using a decision tree and Markov models was used to compare costs and outcomes during the lifetime period based on a societal perspective between alternative HCC surveillance strategies with no program. Costs included direct medical, direct non-medical, and indirect costs. Health outcomes were measured as life years (LYs), and quality adjusted life years (QALYs). The results were presented in terms of the incremental cost-effectiveness ratio (ICER) in Thai THB per QALY gained. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Budget impact analysis (BIA) was performed based on the governmental perspective. Results: Semi-annual ultrasonography (US) and semi-annual ultrasonography plus alpha-fetoprotein (US plus AFP) as the first screening for HCC surveillance would be cost-effective options at the willingness to pay (WTP) threshold of 160,000 THB per QALY gained compared with no surveillance program (ICER=118,796 and ICER=123,451 THB/QALY), respectively. The semi-annual US plus AFP yielded more net monetary benefit, but caused a substantially higher budget (237 to 502 million THB) than semi-annual US (81 to 201 million THB) during the next ten fiscal years. Conclusions: Our results suggested that a semi-annual US program should be used as the first screening for HCC surveillance and included in the benefit package of Thai health insurance schemes for both chronic hepatitis B males and females aged between 40-50 years. In addition, policy makers considered the program could be feasible, but additional evidence is needed to support the whole prevention system before the implementation of a strategic plan.

• Asian Pacific Journal of Cancer Prevention
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• 제15권14호
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• pp.5557-5563
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• 2014

Background: This study investigated the survival benefit of radiotherapy (RT) of the supra- and infraclavicular lymphatic drainage area in Chinese women with T1-2N1M0 breast cancer receiving mastectomy. Methods: A total of 593 cases were retrospectively reviewed from 1998 to 2007. The relationship between supra- or infraclavicular fossa relapse (SCFR) and post-operative RT at the supra-/infraclavicular lymphatic drainage area was evaluated. Results: The majority of patients (532/593; 89. 8%) received no RT while 61 patients received RT. The median follow-up was 85 months. Among patients without RT, 54 (10. 2%) developed recurrence in the chest wall or ipsilateral SCFR. However, none of the 61 patients who underwent RT demonstrated SCFR. One patient who received RT (1. 6%) experienced recurrence in the chest wall. Univariate analysis revealed that age and molecular subtype (both P < 0. 05) were two prognostic factors related to supraclavicular and infraclavicular fossa relapse-free survival (SFRFS). Multivariate analysis revealed that only Her-2 positive status (P = 0. 011) was an independent predictor of SFRFS. RT had no influence on distant metastasis (P = 0. 328) or overall survival (P = 0. 541). SCFR significantly affected probability of distant metastasis (P < 0. 001) and overall survival (P < 0. 001). Conclusion: Although RT was not significantly associated with SFRFS, postoperative RT was significantly associated with a lower locoregional (i. e., supraclavicular/infraclavicular and chest wall) recurrence rate. SCFR significantly influenced distant metastasis-free survival, which significantly influenced the overall survival of T1-2N1M0 breast cancer patients after mastectomy. Thus, prophylactic RT is recommended in T1-2N1M0 breast cancer patients, especially those who have Her-2 positive lesions.

• 한국도로학회논문집
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• 제14권3호
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• pp.131-140
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• 2012

노면표시에 도포된 굴절률 1.5 유리알은 야간 우천 시 효과적인 재귀반사를 수행하지 못하여 교통안전에 심각한 문제를 초래하고 있다. 이를 극복하기 위해 습윤상태에서 효과적 재귀반사를 수행하는 굴절률 2.4인 우천형 bead와 건조 시 최적의 재귀반사를 수행해 내는 굴절률 1.9 bead를 혼합한다. 그러나 고성능의 굴절률 1.9와 2.4 bead는 기존 1.5 유리알에 비해 상당한 고가이므로 전량 사용하기에는 상당한 비용이 소요된다. 따라서 현장 설치 시에는 서로 혼합하여 사용하는 것이 바람직하며, 최적 성능과 소요 비용을 고려한 적정 배합비율을 찾아내는 것이 중요하다. 본 연구에서는 다양한 비율로 혼합된 bead를 국내 고속도로의 길가장자리선에 설치하였을 때 발생되는 각각의 비용 및 편익에 따른 경제성 분석을 수행하였다. 분석 수행결과, 다양한 강수량 변화에도 높은 시인성을 유지하는 대안은 굴절률 2.4가 100% 구성된 차선으로 나타났으며, 경제성이 가장 높게 확보되는 대안은 굴절률 1.5가 80%, 2.4가 20%로 구성된 차선으로 B/C는 약 1.92 수준으로 도출되어 국내 고속도로 길가장자리선의 적용 시 가장 효과적인 대안인 것으로 확인되었다. 아울러 연구의 한계와 몇몇 장래 연구과제가 토의되었다.

• 터널과지하공간
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• 제23권1호
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• pp.1-12
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• 2013

본 고에서는 $CO_2$ 지중저장과 연계한 원유회수증진 기술을 소개하였다. 원유회수증진을 목적으로 $CO_2$를 저류층 내에 주입하는 $CO_2$ EOR 기술은 장기적인 관점에서 $CO_2$를 지하 심부 암반에 저장하는 CCS 기술로 전환할 수 있다. CCS와 연계한 $CO_2$ EOR 기술은 EOR에 필요한 대규모 $CO_2$ 공급원을 확보할 수 있는 장점이 있으며 원유 회수율 증진에 따른 편익 발생으로 CCS를 위한 일련의 프로세스 중, 특히 포집 분야에 경제성을 부가할 수 있는 장점이 있다. 이러한 CCS와 연계한 $CO_2$ EOR 기술의 특징 및 시장 전망을 살펴보고 국외의 대표사례로 Weyburn $CO_2$ EOR 프로젝트를 소개하였다. 또한, 안정적이고 경제적인 $CO_2$ EOR 실시에 필요한 제반 기술 요소를 분석하고 $CO_2$ 주입중 및 주입후 장기운영과정에서의 미소진동 계측, $CO_2$의 최소혼화압력 및 최대주입압력의 사전설계 등의 암반공학적 쟁점들을 소개하였다.

• 치위생과학회지
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• 제13권3호
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• pp.314-320
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• 2013

본 연구는 한림대학교 성심병원과 충남대학교 병원 심혈관센터를 방문한 환자 중 본 연구에 대해 자발적으로 동의한 40대 이상 300명을 대상으로 하여 흡연 여부와 관련된 동기요소를 파악하고자 설문조사를 실시하고 분석하였다. 1. 흡연자율은 성별, 최종학력, 월수입에 따라 유의한 차이가 있었으며, 남자, 고등학교 졸업자, 월수입 200만원대인 대상자의 흡연율이 높았다. 2. 흡연군은 비흡연군이나 금연군에 비해 건강행위에 대한 지각된 유익성은 유의하게 낮고(p=0.021) 지각된 장애성은 더 높았다(p<0.001). 흡연군은 건강행위에 있어서는 생활방식, 건강습관 등을 실천하지 않으며(p<0.001), 변화단계에서는 비흡연군과 금연군이 행동단계 이상이나 흡연군은 준비단계에 위치하였다(p<0.001). 3. 흡연 여부에 따라 주관적 구강건강인식, 치은출혈 여부, 1일 잇솔질 횟수, 치과방문은 차이가 나지 않았다. 4. 건강행위에 대한 지각된 장애가 평균 미만인 군이 OR이 0.378 (p=0.039)이고 변화단계가 평균 미만인 군은 OR이 4.746 (p=0.002)이었다. 남성이 흡연할 OR은 12.743 (p<0.001)이었고, 경제상태에서는 월수입이 200만원대인 군이 300만원 이상인 군에 비해 OR이 3.271 (p=0.045)이었다. 따라서, 금연에 대한 동기요소를 변화시키기 위해 건강행위에 대한 유익성, 장애성, 실천 등을 변화시킬 수 있는 금연교육프로그램이 필요하며 구강보건관련인력도 흡연과 연관된 구강건강 관리뿐 아니라 동기요소를 변화시킬 수 있는 금연 유도 프로그램을 개발하고 이용해야 할 것이다.