만성적 소음노출과 혈압의 상관성에 관한 메타분석

김춘배,김재용,차봉석,최홍렬,이종태,남정모,이상윤,왕승준,박기호,김대열,고상백,Kim, Chun-Bae,Kim, Jai-Young,Cha, Bong-Suk,Choi, Hong-Ryul,Lee, Jong-Tae,Nam, Chung-Mo,Lee, Sang-Yun,Wang, Seung-Jun,Park, Kee-Ho,Kim, Dae-Youl,Koh, Sang-Ba 대한예방의학회 2000 예방의학회지 Vol.33 No.3

Objectives : This study was conducted to integrate the results of studies assessing the association between chronic noise exposure and blood pressure. Methods : Using a MEDLINE search with noise exposure, blood pressure and hypertension as key words, we retrieved articles from the literature that were published from 1980 to December 1999. The criteria for quality evaluation were as follows: 1) the study subjects must have been workers employed at a high noise level area 2) The paper should use average and cumulative noise exposure as method for exposure evaluation. 3) Blood pressure in each article should be reported in a continuous scale Among the 77 retrieved articles, six studies were selected for quantitative meta-analysis. Before the integration of the regression coefficients for the association between blood pressure and noise level, homogeneity tests were conducted. Results : All studies were a cross-sectional design and the study subjects were industrial workers. Five papers used a time-weighted average for noise exposure and only one paper calculated the cumulative noise exposure level. The measurement of blood pressure in the majority of studios were accomplished in a resting stale, and used an average of two or more readings. The homogeneity of studies was rejected in a fixed effect model, so we used the results in a random effect model. The results of the quantitative meta-analysis, the weighted regression coefficient of noise associated with systolic blood pressure and diastolic blood pressure were 0.05 (95% confidence interval [CI]: -0.03, 0.13) and 0.06 (95% CI: -0.01, 0.13), respectively. Conclusions : Our results suggested that chronic exposure to industrial noise does not cause elevated blood pressure.

우리나라 당뇨병의 역학적 규모와 당뇨병 관리현황 파악을 위한 표본설계의 평가

이지성,김재용,백세현,박이병,이준영,Lee, Ji-Sung,Kim, Jai-Yong,Baik, Sei-Hyun,Park, Ie-Byung,Lee, June-Young 대한예방의학회 2009 예방의학회지 Vol.42 No.2

Objectives : An appropriate sampling strategy for estimating an epidemiologic volume of diabetes has been evaluated through a simulation. Methods : We analyzed about 250 million medical insurance claims data submitted to the Health Insurance Review & Assessment Service with diabetes as principal or subsequent diagnoses, more than or equal to once per year, in 2003. The database was re-constructed to a 'patient-hospital profile' that had 3,676,164 cases, and then to a 'patient profile' that consisted of 2,412,082 observations. The patient profile data was then used to test the validity of a proposed sampling frame and methods of sampling to develop diabetic-related epidemiologic indices. Results : Simulation study showed that a use of a stratified two-stage cluster sampling design with a total sample size of 4,000 will provide an estimate of 57.04%(95% prediction range, 49.83 - 64.24%) for a treatment prescription rate of diabetes. The proposed sampling design consists, at first, stratifying the area of the nation into "metropolitan/city/county" and the types of hospital into "tertiary/secondary/primary/clinic" with a proportion of 5:10:10:75. Hospitals were then randomly selected within the strata as a primary sampling unit, followed by a random selection of patients within the hospitals as a secondly sampling unit. The difference between the estimate and the parameter value was projected to be less than 0.3%. Conclusions : The sampling scheme proposed will be applied to a subsequent nationwide field survey not only for estimating the epidemiologic volume of diabetes but also for assessing the present status of nationwide diabetes control.

서울지역 대기오염이 천식에 미치는 급성영향: 연구대상의 특성에 따른 비교

김선영,김재용,김호,Kim, Sun-Young,Kim, Jai-Yong,Kim, Ho 대한예방의학회 2006 예방의학회지 Vol.39 No.4

Objectives: Korean epidemiological studies have used reduced samples according to the subject's characteristics, such as the health services provided, the historical note with asthma, and age, to examine the acute effect of air pollution on asthma using the Korean National Health Insurance records. However, there have been few studies on whether the effects shown in these reduced samples are different from those of all samples. This study compared the effects of air pollution on asthma attacks in three reduced samples with those of entire samples. Methods: The air pollution data for $PM_{10},\;CO,\;SO_2,\;NO_2,\;and\;O_3$, and weather conditions including temperature, relative humidity, and air pressure in Seoul, 2002, were obtained from outdoor monitoring stations in Seoul. The emergency hospital visits with an asthma attack in Seoul, 2002 were extracted from the Korean National Health Insurance records. From these, the reduced samples were created by health service, historical notes with asthma, and age. A case-crossover design was adopted and the acute effects of air pollution on asthma were estimated after adjusting for weather, time trend, and seasonality. The model was applied to each reduced sample and the entire sample. Results: With respect to the health service, the effects on outpatients were similar to those for the total sample but were different for inpatients. These similar effect sizes were also observed in the reduced samples according to the historical note with asthma and age. The relative risks of $PM_{10},\;CO,\;SO_2,\;NO_2,\;and\;O_3$, among the reduced and entire samples were 1.03, 1.04-1.05, 1.02-1.03, 1.04-1.06, and 1.10-1.17, respectively. Conclusions: There was no clear evidence to show a difference between the reduced samples and the entire samples.

수돗물 불소화와 노령 인구의 고관절 골절에 대한 생태학적 연구

박은영,황승식,김재용,조수헌,Park, Eun-Young,Hwang, Seung-Sik,Kim, Jai-Yong,Cho, Soo-Hun 대한예방의학회 2008 예방의학회지 Vol.41 No.3

Objectives : Fluoridation of drinking water is known to decrease dental caries, particularly in children. However, the effects of fluoridated water on bone over several decades are still in controversy. To assess the risk of hip fracture related to water fluoridation, we evaluated the hip fracture-related hospitalizations of the elderly between a fluoridated city and non-fluoridated cities in Korea. Methods : Cheongju as a fluoridated area and Chungju, Chuncheon, Suwon, Wonju as non-fluoridated areas were chosen for the study. We established a database of hip fracture hospitalization episode based on the claims data submitted to the Health Insurance Review Agency from January 1995 to December 2002. The hip fracture hospitalization episodes that satisfied the conditions were those that occurred in patients over 65 years old, the injuries had a hip fracture code (ICD-9 820, ICD-10 S72) and the patients were hospitalized for at least 7days. A total of 80,558 cases of hip fracture hospitalization episodes were analyzed. Results : The admission rates for hip fracture increased with the age of the men and women in both a fluoridated city and the non-fluoridated cities (p<0.01). The relative risk of hip fracture increased significantly both for men and women as their age increased. However, any difference in the hip fracture admission rates was not consistently observed between the fluoridated city and the non-fluoridated cities. Conclusions : We cannot conclude that fluoridation of drinking water increases the risk of hip fracture in the elderly.

당뇨병 환자의 인플루엔자 예방접종률과 관련 요인

변경향 ( Kyeong Hyang Byeon ),김재용 ( Jai Yong Kim ),최보영 ( Bo Young Choi ),최보율 ( Bo Youl Choi ) 한국보건행정학회 2018 보건행정학회지 Vol.28 No.2

Background: The purpose of this study was to investigate the estimated proportion for influenza vaccination and to identify factors associated with influenza vaccination in Korean diabetic patients. Methods: Data from the fourth, fifth, and sixth (except for 2013) Korea National Health and Nutrition Examination Survey (n=3,726) was used. A chi-square test was performed to investigate the estimated proportion for influenza vaccination, and a multiple logistic regression analysis was used to identify the factors associated with self-reported influenza vaccination. Results: In men, 28.8% of diabetes patients 30-64 years of age, and 76.1% of elderly (over 65 years of age) diabetes patients received influenza vaccination. In women, 37.7% of diabetes patients 30-64 years of age, and 78.4% of elderly diabetes patients received influenza vaccination (p<0.0001). The determinants of influenza vaccination were marriage, hypertension (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.07-2.24), residence within a mega city, unemployment (OR, 3.94; 95% CI, 1.24-12.54), and exercise via (weekly) walking for diabetic men; and hypertension (OR, 1.71; 95% CI, 1.16-2.52), chronic disease (OR, 1.81; 95% CI, 1.08-3.02), and exercise via walking (OR, 2.65; 95% CI, 1.49-4.73) for diabetic women. Conclusion: Influenza vaccination remains relatively low in young diabetic patients. It is necessary to recommend vaccination to young diabetic patients, and to devise other strategies to improve vaccination.

작업장 누적소음 노출과 혈압과의 관련성

이상윤(Sang-Yun Lee),김재용(Jai-Young Kim),임형준(Hyoungjune Im),윤기정(Kijung Yoon),최홍렬(Hongryul Choi),고상백(Sangbaek Koh),강대희(Daehee Kang),조수헌(Soo-Hun Cho) 대한직업환경의학회 2001 대한직업환경의학회지 Vol.13 No.2

과지압 하에 있는 대규모 지하공동의 지보 시스템에 관한 연구

박연준(Yeonjun park),유광호(Kwangho You),최영태(Young Tae Choi),김재용(Jai Yong Kim) 한국암반공학회 2004 터널과지하공간 Vol.14 No.2

본 연구에서는 측압이 매우 큰 암반에 대규모 유류저장공동을 병렬로 굴착할 경우, 공동 및 지보재의 역학적 안정성을 평가하였다. 수치해석적인 방법을 동원하여 공동 주변 암반의 거동을 분석하고 주된 지보재인 rockbolt와 숏크리트의 역할을 분석하였으며, 각 지보재의 안정성을 평가하였다. 적정한 지보시스템 구축을 위하여 지보재 모델링 기법, 공동 단면 형상, 지보재의 규격 등이 공동의 안정성에 미치는 영향을 파악하였다. 해석결과 지보재의 타설시기와 다단계 굴착에 따른 공동 형상의 변화가 지보재에 발생하는 응력에 큰 영향이 있음을 알 수 있었으며, 강섬유보강 숏크리트의 변형 및 파괴 특성을 고려한 해석기법 개발의 필요성을 확인하였다. A numerical stability analysis was conducted on the large oil storage caverns excavated in a rock mass under high initial horizontal stress. The behaviors of the surrounding rock mass, rockbolts, and shotcrete were analyzed and stability of the support members were assessed. For a proper support system design, the effect of the modelling technique, cavern shape and rockbolt length on the stability of the cavern was investigated. Results show that installation timing of supports and the change in cavern shape due to step-wise excavation affect the stress induced in support members. Also found was desperate need for a numerical technique which can properly reflect the behavior of the steel fiber reinforced shotcrete.

Receiver Operating Characteristic 분석법을 이용한 업무관련성 근골격계질환 설문지 개발

권호장,주영수,조수헌,강대희,성주헌,최성우,최재욱,김재영,김돈규,김재용,Kwon, Ho-Jang,Ju, Yeong-Su,Cho, Soo-Hun,Kang, Dae-Hee,Sung, Joo-Hon,Choi, Seong-Woo,Choi, Jae-Wook,Kim, Jae-Young,Kim, Don-Gyu,Kim, Jai-Yong 대한예방의학회 1999 예방의학회지 Vol.32 No.3

ROC곡선의 AUC는 측전도구의 기준 타당도를 나타내는 가장 일반화된 지표다. 본 연구는 ROC분석법을 이용하여 현행의 근로자건강진단에서 업무관련성 근골격계 질환의 고위험군을 변별하는 표준 설문지를 개발하고자 하였다. 컴퓨터를 이용하는 선박 설계업 종사자 89명, 전화번호 안내원 113명, 일반 직업 여성 79명, 주부 89명 등 총 370명의 일차 연구대상군에 대한 재활의 학과 전문의의 최종 진단결과를 기준으로 1996년에 개발된 '근로자의 신체 증상에 관한 설문지'의 응답결과를 비교하였다. 근골격계 질환과의 관련성이 높은 문항조합을 선정하고 문항별 가중치를 산출하기 위해 로짓회귀분석, 상관분석 등을 실시하였으며, 문항조합 및 가중치 산출방법이 서로 다른 4가지 설문모형에 따른 AUC를 비교 하였다. 또한, 국내 모 자동차조립공장 근로자 225명의 설문결과와 산업의학 전문의의 진단결과 자료를 이용하여 4가지 설문모형의 AUC 재현도를 확인하였다. 분석 결과, 통계적으로 유의 한 차이는 없었으나 문항수를 줄여도 문항별 응답수준별 가중치를 부여하면 AUC가 일관되게 증가함을 확인하였다. 증상문항 4개와 신체부위문항 7개를 통합한 11개 문항에 가중치를 부여하는 모형이 변별력, 재현도, 편의성 측면에서 우수한 것으로 나타나, 이를 기준으로 새로운 업무관련성 근골격계 질환 설문지를 설계할 수 있었다. 문항수가 적으면서도 타당도는 높은 설문지를 개발하고, 상대적인 비교평가에 쓰일 수 있는 정량적 가중치를 제시한 것이 본 연구의 주요성과라 할 수 있다. 본 연구는 전문의 사이의 진단기준 차이를 고려하지 못한 점, 다양한 인구집단에 적용할만한 절대적인 참고치를 제시하지 못한 점 등에서 한계가 있다. 그러나, '측정 도구의 정량적 타당도 검증을 통한 질병 감시용 도구 개발'이라는 본 연구의 기본 취지 및 접근방법은 향후 조직적인 질병 예방활동에 활용될 여지가 있을 것이다. Objectives: Receive Operating Characteristic(ROC) curve with the area under the ROC curve(AUC) is one of the most popular indicator to evaluate the criterion validity of the measurement tool. This study was conducted to develop a standardized questionnaire to discriminate workers at high-risk of work-related musculoskeletal disorders using ROC analysis. Methods: The diagnostic results determined by rehabilitation medicine specialists in 370 persons(89 shipyard CAD workers, 113 telephone directory assistant operators, 79 women with occupation, and 89 housewives) were compared with participant's own replies to 'the questionnair on the worker's subjective physical symptoms'(Kwon, 1996). The AUC's from four models with different methods in item selection and weighting were compared with each other. These 4 models were applied to 225 persons, working in an assembly line of motor vehicle, for the purpose of AUC reliability test. Results: In a weighted model with 11 items, the AUC was 0.8155 in the primary study population, and 0.8026 in the secondary study population(p=0.3780). It was superior in the aspects of discriminability, reliability and convenience. A new questionnaire of musculoskeletal disorder could be constructed by this model. Conclusion: A more valid questionnaire with a small number of items and the quantitative weight scores useful for the relative comparisons are the main results of this study. While the absolute reference value applicable to the wide range of populations was not estimated, the basic intent of this study, developing a surveillance fool through quantitative validation of the measures, would serve for the systematic disease prevention activities.

첫 뇌경색증 발병후의 사망율과 재발에 영향을 미치는 위험요인들

김재용,황지환,최진영,조동영,유병연 대한가정의학회 2001 Korean Journal of Family Medicine Vol.22 No.6

작업장 누적소음 노출과 혈압과의 관련성

이상윤, 김재용*, 임형준, 윤기정, 최홍렬*, 고상백**, 강대희, 조수헌 대한산업의학회 2001 대한직업환경의학회지 Vol.13 No.2

목적 : 작업장에서의 누적소음노출값과 혈압의 변화 사이의 관계를 관찰하기 위한 단면 연구를 시행하였다. 방법 : 소음발생 제조업체의 남성근로자 중 건강진단 자료, 설문지 자료, 인사기록이 모두 갖추어진 852명을 연구대상으로 하였다. 작업장 소음측정값은 34개 지점에서 측정된 작업환경 측정 보고서 값을 사용하였고, 혈압은 건강진단시 측정한 수축기 혈압과 이완기 혈압 각각의 평균을 이용하였다. 가능한 교란변수들을 건강진단시 설문조사를 통하여 조사하였다. 근로자의 근무기간과 근무했던 작업부서의 소음노출값을 이용하여 누적소음노출값을 추정하였고, 이에 따라 전체 연구대상 근로자를 저소음노출군, 중등도소음노출군, 고소음노출군, 과다소음노출군으로 구분하였다. 누적소음노출값으로 구분한 소음노출군 사이에 평균 수축기 혈압 및 이완기 혈압의 차이가 있는 지를 나이, 비만도지수, 혈중 콜레스테롤값, 고혈압의 가족력, 흡연력, 음주력 등의 가능한 교란변수들의 영향을 통제한 상태에서 비교하였다. 결과 : 가능한 교란변수들을 보정한 상태에서 저소음노출군에서 과다소음노출군으로 갈수록 수축기 혈압 및 이완기 혈압의 증가가 있는지를 관찰하기 위해 일반선형모델을 이용하여 분석하였을 때, 수축기 혈압 및 이완기 혈압 모두 소음노출군이 혈압 변화의 유의한 설명변수였고, 수축기 혈압 및 이완기 혈압 모두 저소음노출군에 비해 과다소음노출군이 각각 2.1 mmHg, 2.7 mmHg 만큼 높았다. 결론 : 이는 만성적으로 누적된 고소음에의 노출로 인하여 혈압 상승의 가능성이 있음을 시사한다. Objectives : The association of workplace cumulative noise exposure and blood pressure was investigated in this study using cross-sectional design. Methods : The study population comprised 852 manufacturing male workers of whom occupational health examination data, questionnaire and personnel records were available. Workplace ambient noise monitoring data was used for calculating individual cumulative noise exposure level. Mean of each systolic and diastolic blood pressure of occupational health examination data was used for individual systolic and diastolic blood pressure level. Possible confounding variables including family history of hypertension, smoking habit, alcohol drinking habit were collected by questionnaire. On the basis of job location and duration of work at the location, a cumulatlve time-weighted average noise level was calculated for each workers. According to this cumulative noise exposure level, each study subject was categorized as low noise exposure group, moderate noise exposure group, high noise exposure group, very high noise exposure group. Among noise exposure groups, mean of systolic and diastolic blood pressure was compared after adjusting possible confounding variables such as age, body mass index, serum cholesterol level, family history of hypertension, smoking history, alcohol drinking habit. Results : After adjusting possible confounding variables, noise exposure group was signnificant explanatory variables for both systolic and diastolic blood pressure, and mean of both systolic and diastolic blood pressure of very high exposure group was higher than that of low exposure group. Conclusions : These findings suggested that the high cumulative noise exposure might elevate the blood pressure.