Interaction of Body Mass Index and Diabetes as Modifiers of Cardiovascular Mortality in a Cohort Study

마승현,박보영,양재정,En-Joo Jung,Yohwan Yeo,황윤지,장성훈,신해림,강대희,유근영,박수경 대한예방의학회 2012 Journal of Preventive Medicine and Public Health Vol.45 No.6

Objectives: Diabetes and obesity each increases mortality, but recent papers have shown that lean Asian persons were at greater risk for mortality than were obese persons. The objective of this study is to determine whether an interaction exists between body mass index (BMI) and diabetes, which can modify the risk of death by cardiovascular disease (CVD). Methods: Subjects who were over 20 years of age, and who had information regarding BMI, past history of diabetes, and fasting blood glucose levels (n=16 048), were selected from the Korea Multi-center Cancer Cohort study participants. By 2008, a total of 1290 participants had died; 251 and 155 had died of CVD and stroke, respectively. The hazard for deaths was calculated with hazard ratio (HR) and 95% confidence interval (95% CI) by Cox proportional hazard model. Results: Compared with the normal population, patients with diabetes were at higher risk for CVD and stroke deaths (HR, 1.84; 95% CI, 1.33 to 2.56; HR, 1.82; 95% CI, 1.20 to 2.76; respectively). Relative to subjects with no diabetes and normal BMI (21 to 22.9 kg/m2), lean subjects with diabetes (BMI <21 kg/m2) had a greater risk for CVD and stroke deaths (HR, 2.83; 95% CI, 1.57 to 5.09; HR, 3.27; 95% CI, 1.58 to 6.76; respectively), while obese subjects with diabetes (BMI ≥25 kg/m2) had no increased death risk (p-interaction <0.05). This pattern was consistent in sub-populations with no incidence of hypertension. Conclusions: This study suggests that diabetes in lean people is more critical to CVD deaths than it is in obese people.

일부 지역사회 거주 노인들의 노쇠수준과 기능장애의 연관성 및 노쇠 관련요인

마승현,정기윤,유상호,김미영,윤종률,홍선형,심은영 대한가정의학회 2009 Korean Journal of Family Medicine Vol.30 No.8

Background: Frailty is a wasting syndrome that presents loss of physiological function by aging, lowering of reserve capacity, and disability of body system. It is currently being considered an important issue in geriatrics. This study examined frailty level of Korean elderly in community and whether frailty can be meaningful a predictive factor for functional disability. Methods: Demographic characteristics, the number of chronic diseases and medications, cardiovascular health study (CHS) frailty index, study of osteoporotic fractures (SOF) frailty index, activities of daily living, Instrumental activities of daily living, depression, mini-mental state examination (MMSE) and fall history were examined for 302 men and women over 65 years old who visited the three community seniors welfare centers from February 2008 to June 2008. Results: There were defi nite differences of frailty status by age, educational level, marital status, monthly income, body mass index, the number of chronic diseases, the number of medications, depression, MMSE and fall history (P < 0.05), except in gender (P < 0.432). In logistic regression analysis for functional disability with frailty status defi ned by SOF frailty index, odds ratio to dependency of instrumental activities of daily living (IADL) from the healthy to the prefrail stage increased 6.84 times while from the healthy to the frail stage increased 130.87 times. These effects still increased after covariate adjustment. Also, the CHS frailty index showed the same result although there was some difference in odds ratio. Conclusion: There were meaningful correlations of frailty with functional disability when dividing Korean elderly’s frailty levels into the healthy, the prefrail and the frail stages. 연구배경: 노쇠는 노화에 따른 생리적 기능감소, 예비능력 저 하 및 신체계통의 조절장애에 의한 증상을 보이는 소모성 증 후군으로 현재 노인의학에서 중요한 연구과제이다. 이에 이 번 연구는 우리나라 노인의 노쇠의 수준 및 노쇠가 노인의 기 능 장애에 있어 유의한 예측인자가 될 수 있는 지를 알아 보고 자 하였다. 방법: 2008년 2월부터 2008년 6월 사이 서울 및 경기 시내 의 복지관 세 곳에 방문하는 만 65세 이상의 남녀 302명을 대상으로 인구학적 특성, 만성질환 유무, 복용약물 개수, Cardiovascular Health Study (CHS) 노쇠지수, Study of Osteoporotic Fractures (SOF) 노쇠지수, 일상생활 수행능력, 도구적 인 일상생활 수행능력, 우울, 한국형 간이 정신상태 검사 및 낙 상력 등을 조사하였다. 결과: 연령, 교육수준, 결혼상태, 월수입, 체질량지수, 만성질 환 개수 및 복용약물 수, 우울감, 인지능력(MMSE), 낙상력 등 이 노쇠의 단계별로 차이를 보였다. 노쇠 지표간의 로지스틱 회귀분석에서는 SOF 노쇠 지표에 따라 건강한 단계에서 노쇠 전 단계로 갈수록 IADL이 의존을 보일 교차비가 7.92배(95% 신뢰구간, 2.07-30.19), 노쇠 단계에서는 69.58배(95% 신뢰구 간: 18.80-257.51) 증가하였고, 이는 단변량분석에서 기능장 애와 상관관계를 보인 다른 변수들을 보정한 후에도 여전히 증가하였고 CHS 노쇠 지표에서도 교차비의 차이는 있지만 같 은 결과를 보였다. 결론: 도시지역 복지관을 방문하는 우리나라 노인들의 노쇠 관련요인은 고령, 낮은 교육수준 및 경제수준, 많은 동반질환, 우울감, 저하된 인지능력, 많은 낙상력 등이었고, 노쇠를 건강, 노쇠 전 단계, 노쇠 단계로 구분시 노쇠단계로 갈수록 기능장 애와 유의한 상관관계를 보였다.

Correlation between Frailty Level and Adverse Health-related Outcomes of Community-Dwelling Elderly, One Year Retrospective Study

심은영,마승현,홍선형,이윤상,백우열,서덕성,유은영,김미영,윤종률 대한가정의학회 2011 Korean Journal of Family Medicine Vol.32 No.4

Background: Frailty is considered to be a clinical syndrome characterized by decreased physiological reserves associated with a greater risk of health-related problems, hospitalization, and death. The current study examined hospitalization,falls, cognitive decline and disability between robust, prefrail and frail elderly in one year. Methods: 110 participants aged 65 or more who visited two senior welfare centers in Seoul from February 2008 to June 2008were surveyed again from March 2009 to June 2009 with demographic characteristics, number of chronic diseases and medication, study of osteoporotic fractures (SOF) frailty index, instrumental activity of daily living (IADL), depression,mini-mental state examination-Korean version (MMSE-K), falling history and admission history within one year. These results were compared with participants' previous survey done one year ago. Results: Among total 110 subjects, 48 (44%) robust, 30 (27%) prefrail, and 32 (29%) frail subjects changed to 26 (24%), 54(49%), and 30 (27%) respectively over the year. There were statistical significances in age, number of chronic disease,depressive mood, MMSE, falls, hospitalization, IADL disability contributing to frailty (P < 0.05). Frailty defined by SOF frailty index was associated with greater risk of adverse outcomes. Frail subjects had a higher age-adjusted risk of cognitive function decline (odds ratio [OR], 3.57), disability (OR, 9.64), fall (OR, 5.42), and hospitalization (OR, 4.45; P <0.005). Conclusion: The frailty index like SOF frailty index might predict risk of falls, disability, hospitalization, and cognitive decline in the elderly, emphasizing special attention to the individuals showing frailty in outpatient examination.

A Prospective Cohort Study on the Relationship of Sleep Duration With All-cause and Disease-specific Mortality in the Korean Multi-center Cancer Cohort Study

여요환,마승현,박수경,장성훈,신해림,강대희,유근영 대한예방의학회 2013 예방의학회지 Vol.46 No.5

Objectives: Emerging evidence indicates that sleep duration is associated with health outcomes. However, the relationship of sleep duration with long-term health is unclear. This study was designed to determine the relationship of sleep duration with mortality as a parameter for long-term health in a large prospective cohort study in Korea. Methods: The study population included 13 164 participants aged over 20 years from the Korean Multi-center Cancer Cohort study. Information on sleep duration was obtained through a structured questionnaire interview. The hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality were estimated using a Cox regression model. The non-linear relationship between sleep duration and mortality was examined non-parametrically using restricted cubic splines. Results: The HRs for all-cause mortality showed a U-shape, with the lowest point at sleep duration of 7 to 8 hours. There was an increased risk of death among persons with sleep duration of ≤5 hours (HR, 1.21; 95% CI, 1.03 to 1.41) and of ≥10 hours (HR, 1.36; 95%CI, 1.07 to 1.72). In stratified analysis, this relationship of HR was seen in women and in participants aged ≥60 years. Risk of cardiovascular disease-specific mortality was associated with a sleep duration of ≤5 hours (HR, 1.40; 95% CI, 1.02 to 1.93). Risk of death from respiratory disease was associated with sleep duration at both extremes (≤5 and ≥10 hours). Conclusions: Sleep durations of 7 to 8 hours may be recommended to the public for a general healthy lifestyle in Korea.

The Effect of Breastfeeding Duration and Parity on the Risk of Epithelial Ovarian Cancer: A Systematic Review and Meta-analysis

성호경,마승현,최지엽,황윤지,안충현,김병기,김용만,김재원,강석범,김재훈,김태진,유근영,강대희,박수경 대한예방의학회 2016 예방의학회지 Vol.49 No.6

Objectives: We conducted a systematic review and meta-analysis to summarize current evidence regarding the association of parity and duration of breastfeeding with the risk of epithelial ovarian cancer (EOC). Methods: A systematic search of relevant studies published by December 31, 2015 was performed in PubMed and EMBASE. A random-effect model was used to obtain the summary relative risks (RRs) and 95% confidence intervals (CIs). Results: Thirty-two studies had parity categories of 1, 2, and ≥3. The summary RRs for EOC were 0.72 (95% CI, 0.65 to 0.79), 0.57 (95% CI, 0.49 to 0.65), and 0.46 (95% CI, 0.41 to 0.52), respectively. Small to moderate heterogeneity was observed for one birth (p<0.01; Q=59.46; I2=47.9%). Fifteen studies had breastfeeding categories of <6 months, 6-12 months, and >13 months. The summary RRs were 0.79 (95% CI, 0.72 to 0.87), 0.72 (95% CI, 0.64 to 0.81), and 0.67 (95% CI, 0.56 to 0.79), respectively. Only small heterogeneity was observed for <6 months of breastfeeding (p=0.17; Q=18.79, I2=25.5%). Compared to nulliparous women with no history of breastfeeding, the joint effects of two births and <6 months of breastfeeding resulted in a 0.5-fold reduced risk for EOC. Conclusions: The first birth and breastfeeding for <6 months were associated with significant reductions in EOC risk.

곤충을 활용한 심리치료 프로그램이 아동에 미치는 이점

전윤석,마승현,이종경,김성화,이옥지,권은숙,이시종,김옥진 한국동물매개심리치료학회 2017 한국동물매개심리치료학회지 Vol.6 No.2

We studied the beneficial effects of psychotherapy program using therapy bugs for children. This study examined the reactions of children before and after the introduction of psychotherapy program using therapy bugs. The participants in this study were 15 children among 3 grade classes from Gummorae elementary school in Siheung City. The experimental group was provided with 10 incidences of the developed psychotherapy program using therapy bugs. The pre and post-tests were analyzed with Wilcoxon matched-pairs signed-ranks test using SPSS/WIN 19.0. The study found that the psychotherapy program using therapy bugs produced some beneficial effects on the experiment group children; a better life-respect, emotion, character and personality (p<0.05). These findings indicate that the developed psychotherapy program using therapy bugs produced beneficial effects on the children.

입원 환자를 대상으로 한 체계적 금연 교육과 금연 성공률

정기윤,유상호,마승현,윤종률,김미영,홍선형,이윤상,심은영 대한가정의학회 2009 Korean Journal of Family Medicine Vol.30 No.7

Background: Inpatient smoking cessation programs have been known to be quite effective for smoking cessation, but it was rarely conducted among Koreans. This study was to investigate the effect of inpatient smoking cessation program among Korean smokers. Methods: From March 1 to April 30, 2008, we carried out a randomized controlled trial for inpatient smoking cessation program among 70 smokers who were 18 years of age or over and admitted to a university hospital in Seoul, Korea. For the intervention group, a trained doctor conducted the systematic educational program for smoking cessation of 30 minutes to an hour. For the control group, they were advised with a 3-minute explanation for smoking cessation. We assessed the abstinence rates of study participants at 1 week, 1 month, and 3 months after discharge. Results: In 3 months after the discharge, the abstinence rate for the intervention group was 37.1% while that of the control group was 14.3%. In simple logistic regression analysis, the smokers among the intervention group were 3.5 times more likely to abstain than those in the control group. After controlling for confounding factors, the smokers among the intervention group was 11.4 times more likely to abstain than those in the control group. Conclusion: For Korean smokers, the inpatient smoking cessation program showed a higher success rate of abstinence compared to simple advice and limited counselling. 연구배경: 흡연이 주요 질병과 사망의 원인으로 널리 알려져 있음에도 불구하고, 우리나라 성인 흡연율은 세계최고 수준 이다. 외국에는 입원 환자를 대상으로 한 체계적인 금연 교육 의 효과를 평가한 연구 결과가 다수 있으나, 국내에는 거의 없 다. 이에 본 연구에서는 입원 환자를 대상으로 한 체계적 금연 교육이 금연 성공에 미치는 효과를 알아보기 위해 권고 수준 의 최소 금연 교육과 비교해 보았다. 방법: 2008년 3월 1일부터 4월 30일까지 일개 대학 병원에 입 원하였던 18세 이상의 환자 중 흡연 중이며, 금연 교육이 가능 한 70명을 대상으로 설문과 교육을 포함하는 무작위 대조 연 구를 시행하였다. 금연 교육은 입원 중에 실시하는 1회의 대면 교육과 퇴원 후 3개월 동안 실시하는 총 3회의 전화 상담으로 구성되었다. 퇴원 후 1주, 1개월 및 3개월째 금연 성공을 전화 설문으로 평가하였다. 결과: 퇴원 후 3개월째 시험군인 체계적 금연 교육군의 금연 성공률(37.1%)은 대조군인 최소 금연 교육군의 금연 성공률 (14.3%)보다 유의하게 높았다(P=0.029). 단순 로지스틱 회귀 분석 결과, 시험군이 금연에 성공할 교차비는 대조군과 비교 하여 3.5배(95% CI, 1.10-11.41) 높았으며, 다중 로지스틱 회귀 분석 결과, 시험군이 금연에 성공할 교차비는 대조군과 비교 하여 11.4배(95% CI, 1.38-99.61) 높았다. 결론: 입원 환자를 대상으로 한 체계적 금연 교육은 권고 수준 의 최소 금연 교육과 비교하여 높은 금연 성공률을 보였다.

일개 노인복지관 방문 노인환자들의 다약제복용과 부적절한 약물처방 실태

이준석,이재은,정기윤,마승현,김미영,유상호,윤종률 대한가정의학회 2008 Korean Journal of Family Medicine Vol.29 No.12

Background: Due to rapidly growing elderly population, there are increasing numbers of older persons with multiple chronic disorders and geriatric problems arising from polypharmacy. In this study we tried to find out the state of polypharmacy and inappropriate drug prescription and their related factors in community-dwelling elderly by review of drugs taken by older persons visiting a day health center. Methods: From April 2007 to July 2007, 80 subjects of 65 year-old or over with chronic illness who visited a elderly-wellness and health care center were randomly sampled. All of them were surveyed by structured questionnaires, medical records review, pill counts about all medications they are taking and experience of adverse drug reactions. And all the prescribed medications were reviewed or their drug prescription's appropriateness for each elderly according to Beers criteria. Data results were evaluated by frequency and correlation analyses. Results: The average counts of drugs taken by elderly with chronic disorders were 7.23, minimum 1 to maximum 27 drugs a day. Patients experienced more adverse effects significantly when more prescribed medications were taken (P=0.005), and patients with lack of information about their drugs had taken increased number of medications (P<0.001). Referred to Beers criteria, inappropriate cases of prescription were observed in 26 persons. Those drugs were NSAIDs including aspirin in 17 subjects (21%), amitrityline in 3 (4%), short-acting benzodiazepines in 3 (4%), long acting benzodiazepines in 2 (3%), and anticholinergic antihistamine in 1 (1%). Conclusion: Polypharmacy is very common in community-dwelling elderly with chronic disorders. More medications were related to more adverse drug reactions and lack of information about their drugs related to increased number of drug taking. High proportion of inappropriate drug prescriptions was observed in the elderly, which may have resulted from poor education concerning geriatric care of the medical personnels. 연구배경: 노인 인구가 지속적으로 증가하고 있고 노인 인구의 만성질환 유병률이 증가함에 따라 노인들의 다약제 복용과 부적절한 약물복용에 따른 문제 발생 위험성이 증가하고 있다. 이 연구에서는 만성질환을 가지고 있는 일부 지역사회 거주노인들의 다약제 복용 현황과 부작용 및 약 지식의 관계를 알아보고 Beers Criteria에 적용 시 부적절한 처방 사례를 파악하고자 하였다. 방법: 2007년 4월부터 2007년 7월까지 진료실이 개설되어 있는 노인복지관에 방문 중인 만성질환을 가진 노인환자를 대상으로 설문 및 전화 등을 통해 총 80명의 환자를 대상으로 조사하였고 답변에 대해 빈도 분석, 상관관계 분석 및 Beers Criteria를 적용한 약물처방 적정성평가 연구를 수행하였다. 결과: 복용약물의 평균 개수는 7.23개였고 최고 27개의 약물 복용 노인 환자도 있었다. 복용약물의 수가 많은 노인일수록 약물 부작용의 경험이 많은 것을 확인할 수 있었고(P=0.005), 복용약물에 대한 지식 정도가 부족한 환자에게서 복용 약의 수가 증가하는 것을 확인할 수 있었다(P<0.001). Beers Criteria에 적용했을 때 부적절한 처방 사례는 전체 대상자 중 26명(33%)에서 나타났고 구체적인 약물로는 비스테로이드 소염제와 Aspirin이 17명(21%), Amitriptyline이 3명 (4%), Short-acting benzodiazepines가 3명(4%), Long-acting benzodiazepines가 2명(3%), Anticholinergic antihistamine은 1명(1%)으로 나타났다. 결론: 노인 환자에서 자신이 복용하는 약물에 대한 지식이 부족하거나 복용 후 부작용을 경험하는 경우에서 복용하고 있는 약물의 수가 더 많았다. 또한 노인약물처방지침에 근거해서 보았을 때, 부적절한 처방사례가 많았다. 이는 노인 약물처방에 대한 지침의 마련과 노인에 대한 약물관련 교육의 필요성을 시사한다.

1000MW 초초임계압 신보령화력 보일러계통 시뮬레이터 개발

강해수(Hea-Su Kang),마삼선(Sam-Sun Ma),박신열(Shin-Yeol Park),김종안(Jong-An Kim),전원식(Won-Sik Jeon),최인규(In-Kyu Choi),변승현(Seung-Hyun Byun),김병철(Byoung-Chul Kim),신만수(Man-Su Shin) 대한전기학회 2015 정보 및 제어 심포지엄 논문집 Vol.2015 No.10

시뮬레이터를 활용한 발전소 제어성능감시 시스템 개발

박신열(Shin-Yeol Park),마삼선(Sam-Sun Ma),변승현(Seung-Hyun Byun),강해수(Hae-Su Kang) 대한전자공학회 2015 대한전자공학회 학술대회 Vol.2015 No.6

The performance of a power plant is highly dependent on the performance of its control loops. So real-time performance monitoring to identify poorly or under-performing control loops has become an integral part of preventative maintenance of power plant. Korea Electric Power Corporation has developed control loop performance monitoring system which can interface with several DCS to have original technology. This paper introduces general CLPM technology and commercial solutions. And then describes basic functions of the CLPM which has been developed to monitor automatically and continuously the performance of control loops of power plant.