사회경제적 요인이 의료기관 선택 시 사용한 정보원에 미치는 영향

탁양주(Tak, Yang-Ju) 한국산학기술학회 2011 한국산학기술학회논문지 Vol.12 No.11

본 연구는 의료소비자들이 의료기관을 선택할 때 이용하는 의료정보원에 성별, 연령, 직업, 소득수준, 의료보 장의 형태, 주거지역 등 사회경제적 요인이 어떤 영향을 미치는지 알아보기 위한 면접조사이다. 2008년 지역사회 건 강조사의 일환으로 충북 지역 거주자들을 대상으로 표준화된 설문지를 이용한 면접을 통하여 의료정보원과 관련된 자료를 수집하였고, SPSS version 12.0을 이용하여 분석하였다. 의료기관 선택 시 가장 많이 이용한 정보원은 입원, 외래 모두 개인적 정보원(41.9%, 33.5%)이었으며 가정 적게 이용한 정보원은 경험적 정보원(3.0%, 4.3%)이었다. 개인 적 정보원에는 입원, 외래 모두 성별의 차이가 존재하였으며, 외래이용에서 교육수준과 거주지역의 차이가 존재하였 다(p<0.001). 공공적 정보원은 입원 시는 연령, 교육수준, 월 가구 소득 간의 차이를 보였고 외래이용 시는 거주지역 만 차이를 보였다(p<0.001). 경험적 정보원은 거주지역의 차이만 보였으며, 전문가 정보원은 입원 시는 남자가 외래이 용 시는 여자가 더 많이 이용하는 결과를 보였다. 결론적으로 의료기관 선택 시 사용한 정보원은 의료이용자의 사회 경제적 요인과 관련성을 가지고 있으며 이는 의료기관 이용형태(입원, 외래)에 따라 서로 다른 양상을 보였다. The purpose of this study was to investigate the effects of Socioeconomic factors on medical information resources when medical consumer choose inpatient or outpatient services. The target population was 12,249 people aged above 19 in Chungcheongbuk-do. The sample was accrued for the period of 3 months in 2008 by face to face interview of direct visiting from systematic sampling method. There was a significant difference in the use of personal informer and public informer by sex(p<0.001). There was a significant difference in the use of experimental and professional informer by living area(p<0.001). In conclusion, the results suggest that there is relationship between medical information resource and socioeconomic factors of medical consumer.

일반 후두경과 비디오 후두경을 이용한 기관내 삽관의 심박수 및 혈압 상승 효과의 비교

탁양주 ( Yang Ju Tak ),김선중 ( Seon Jng Kim ),김상태 ( Sang Tae Kim ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.54 No.5

노인 환자에서 Propofol로 마취유도 시 기관내삽관에 따른 심혈관계변화를 최소화하기 위한 Remifentanil의 적정 효과처 농도는?

탁양주 ( Yang Ju Tak ),신현정 ( Hyun Jung Shin ),김은석 ( Eun Seok Kim ),구본욱 ( Bon Wook Koo ),신영덕 ( Young Duck Shin ),김상태 ( Sang Tae Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4

Background: The addition of remifentanil during propofol TCI (target controlled infusion) attenuates the hemodynamic changes induced by endotracheal intubation. This study examined the optimal effect-site concentration of remifentanil to minimize the cardiovascular changes to endotracheal intubation in elderly patients. Methods: Fifty ASA 1 or 2 elderly patients scheduled for elective surgery under general anesthesia were assigned randomly to one of two groups according to the effect-site concentration of remifentanil. Each group was administered 4 μg/ml of propofol TCI with 1 ng/ml (group R1) or 3 ng/ml (group R3) of remifentanil. The heart rate (HR), systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP) were measured at pre-induction, before and after endotracheal intubation. Results: After intubation, the HR, SAP, MAP and DAP increased significantly in the two groups compared with the pre-intubation values. However, the HR, SAP, MAP and DAP for group R3 were lower than group R1 for 5 min after intubation. Conclusions: In elderly patients administered 4 μg/ml of propofol TCI, we suggest that the optimal effect-site concentration of remifentanil to minimize the cardiovascular changes to endotracheal intubation is 3 ng/ml rather than 1 ng/ml. (Korean J Anesthesiol 2009;56:392~7)

Propofol 정주 통증에 대한 서로 다른 두 농도의 Remifentanil 전처치 효과

탁양주 ( Yang Ju Tak ),박상희 ( Sang Hi Park ),김상태 ( Sang Tae Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.2

Background: Propofol produces anesthesia with rapid recovery but also causes pain on injection. This study was designed to evaluate the effects of two different concentrations of remifentanil for minimizing the pain caused by propofol and to compare the hemodynamic changes during propofol-remifentanil infusion. Methods: In a randomized, double-blind study of 80 patients, we compared the severity of the injection pain of propofol between two groups of patients. The initial effect-site target concentration of remifentanil was set at 4 ng/ml (the R4 group, n=40) or 8 ng/ml (the R8 group, n=40). After the effect-site concentration of remifentanil was achieved, the infusion of propofol was started with the concentration of 4 μg/ml. The remifentanil-related complications were evaluated and the severity of the pain caused by propofol was compared by using a four-point scale during the propofol infusion. The heart rate and arterial blood pressure were measured at pre-induction, just before intubation and at 1 minute after intubation. Results: The severity of injection pain of propofol was significantly lower in the R8 group than in the R4. There was no significant difference in the incidence of remifentanil-related complications between the two groups. Compared with the pre-induction values, the heart rate and arterial blood pressure were significantly lower at pre-intubation and at 1 minute after intubation in the R4 and R8 groups. Conclusions: Pretreatment with an effect-site concentration of 8 ng/ml remifentanil may be useful for minimizing the propofol injection pain compared with 4 ng/ml remifentanil. (Korean J Anesthesiol 2009;57:155∼60)

종설 : 최근 국내 비만 연구의 경향: 1984년부터 2002년까지

탁양주 ( Yang Ju Tak ),이영성 ( Young Sung Lee ),이진석 ( Jin Seok Lee ),강재헌 ( Jae Heun Kang ) 대한비만학회 2004 The Korean journal of obesity Vol.13 No.1

연구배경: 1990년대 이후 비만이 중요한 건강문제로 대두되면서 국내에서도 비만에 관한 많은 연구가 진행되고 있으나, 대부분 소규모 산발적으로 진행되고 있어 국가차원의 대책 마련을 위한 자료로 사용하기에 불충분한 경우가 많았다. 이에 저자는 1984년부터 2002년까지 국내에서 발표된 비만에 관련된 논문들의 연구 방법과 연구의 내용 등 연구경향을 분석함으로써 앞으로 국내 비만에 관련된 연구의 기본적인 방향을 정하는데 필요한 기초 자료로 삼고자 하였다. Background: Rescently from 1990`s, the researches related to obesity were increasing significantly. But most of researches were done individually and separately, so that datas were not sufficient to establise nation-wide strategies against obesity. The ai

신생아-학령전기 대상자의 맞춤형 방문건강관리 기록지 및 모형 개발

김희자 ( Hee Ja Kim ),유재순 ( Jae Soon Yoo ),김현숙 ( Hyun Sook Kim ),탁양주 ( Yang Ju Tak ),방경숙 ( Kyung Sook Bang ),허보윤 ( Bo Yun Huh ) 부모자녀건강학회 2010 부모자녀건강학회지 Vol.13 No.2

Purpose: The purpose of this study was to develop child`s health assessment tools and tailored home visiting nursing service model in a community. Methods: Based on the literature review and several types of workshops participated with the child health nursing professors and visiting nurses in public health centers from May to December 2009, the standards of child health assessment tools, service model and education materials for visiting nurses were developed. Results: Some record forms were newly developed, including neonatal assessment, breast feeding, mother-infant interaction, oral care, vaccination and safety, and appropriate developmental screening tests in the community were selected. For systematic health care management in the community, problem list, problem criteria, health care plan, outcome criteria were also developed. Conclusion: On the demand of growing need for health promotion and early intervention for children and their association with parenting and socioeconomic status, assessment and control measures are indispensable to the promotion of child health for vulnerable population. Children`s health and developmental problems, and safe circumstances can be assessed using this assessment tools, and can be used for tailored home visiting nursing care for children.

투석환자의 진료권 이동에 영향을 미치는 요인

김민경 ( Min Kyoung Kim ),권순길 ( Soon Kil Kwon ),최웅 ( Woong Choi ),탁양주 ( Yang Ju Tak ),박종혁 ( Jong-hyock Park ),강길원 ( Kil Won Kang ) 한국보건경제정책학회(구 한국보건경제학회) 2020 보건경제와 정책연구 Vol.26 No.4

본 연구는 대표성 있는 자료를 활용한 투석환자의 진료권 이동 현황 및 이에 미치는 영향 요인 분석을 바탕으로 향후 투석 환자의 효율적인 의료이용을 위한 관리 정책에 참고자료가 될 수 있는 정보를 제공하고자 한다. 이를 위해 2003년~2015년까지 건강보험수급자의 자격 및 청구자료, 의료기관자료, 대한신장학회자료, 통계청자료를 활용하여 데이터베이스를 구축하고 분석에 활용하였으며, 개인, 의료기관, 지역사회특성에 따라 투석환자의 진료권 이동에 영향을 미치는 요인을 파악하기 위하여 다수준로지스틱 회귀분석을 하였다. 투석환자의 특성요인으로 남자, 29세 이하의 연령, 소득 9~10분위, 복막투석을 하는 경우 거주지역과 투석지역이 불일치하였고, 동반상병지표가 낮을수록, 입내원일수가 짧을수록 거주지역과 투석지역이 일치하였다. 의료기관요인으로 요양병원을 이용하는 경우 거주지역과 투석지역이 불일치하였고, 병상수가 적을수록 거주지역과 투석지역이 일치하였다. 지역사회요인으로 지역투석기수가 많을수록, 재정자주도가 높을수록, 고령인구비율이 높을수록, 인구밀도가 높을수록 거주지역과 투석지역이 일치하였다. 따라서 투석환자는 대진료권보다 중진료권 위주의 자원 배분과 지리적 인접성을 높이기 위해 진료권을 재편성함으로써 진료권간 연계를 통하여 의료이용의 지역적 불균형 문제를 해결할 수 있도록 정책적인 지원이 필요하다. This study attempts to fill this gap by analyzing the migration of dialysis patients between medical service regions and the underlying factors influencing the migration, thereby providing a reference data for future medical services management policy of dialysis patients. The database for the analysis was established by using the qualification and insurance claim data of health insurance recipients, medical institution data, Korean Society of Nephrology data and national statistical office data, from 2003 to 2015. The effect of the Migration of Dialysis Patients between Medical Service Regions on individual, medical institutions and community characteristics were analyzed by multilevel logistic regression analysis. There is greater inconsistency between the residential and medical service regions for dialysis patients who are male, under 29 years old, belong in the 9th-10th income quintile, and are performing peritoneal dialysis, while there is greater consistency if the co-morbidity index is lower and periods of staying in or visiting hospitals are shorter. In terms of medical institution factors, greater inconsistency is exhibited if patients use care hospitals, and greater consistency with lower number of beds. For the local social factors, consistency increases with a higher number of dialyzers and higher financial independence, a greater ratio of aging population and population density. To conclude, political support is required to resolve the imbalance in medical services by reorganizing the medical service boundaries and enhancing the geographical proximity and resource distribution to patients around medium-sized medical service regions rather than large ones.

자동차 탑승자 사고에서 외상계수를 이용한 구급대원의 중증도 분류 평가

김상철 ( Sang Chul Kim ),김병우 ( Byung Woo Kim ),탁양주 ( Yang Ju Tak ),이상희 ( Sang Hee Lee1 ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.3

Purpose: The assessment of trauma patients in the prehospital setting is difficult, but appropriate field triage is critical to the prognosis of trauma patients. We sought to evaluate the triage given by the emergency medical technicians (EMTs) using the trauma score to patients injured in motor vehicle collisions (MVCs). Methods: From June 2012 to July 2012, questionnaires were distributed to EMTs, who had transported injured patients to the study hospital. Scene records, photos of the damaged vehicle, and ambulance run sheets were used to provide physiologic, physical, and mechanistic information about the MVC. To evaluate the appropriateness of the injury assessment by EMTs, we compared their impressions with the hospital`s final diagnosis within a 3 level triage system comprising both the maximum abbreviated injury scale (MAIS) and the injury severity score (ISS). Kappa (k) was calculated to evaluate the agreement between the triage by EMTs and the triage based on hospital`s final diagnosis. Results: A total of 91 patients were analyzed by 31 EMTs. The percentage of males was 57.1%, the mean age was 44.5, and the mean MAIS and ISS were 2.7 and 16.6 respectively. While EMTs correctly diagnosed patient injuries to the extremities in 35.7%, and to the neck in 32.1%, pelvic injuries were missed in 80.0%. The agreement between the triage by the EMTs and the triage based on the hospital`s final diagnosis was 62.6%(k=0.366) by the MAIS and 50.5%(k=0.234) by the ISS. The kappa value was higher in EMT-I than in EMT-II. Conclusion: In MVC, the assessment of injured patients by EMT-I was more appropriate, and the 3-level triage method based on the MAIS could contribute to a more accurate triage. Prospective studies to search for appropriate methods of field triage are required for programming practical education for EMTs.

2008년 지역사회건강조사 질관리정도 평가

김종희 ( Jong Hee Kim ),박해용 ( Hye Yong Park ),김윤아 ( Yun A Ki ),강양화 ( Yang Hwa Gang ),김정숙 ( Jung Suk Kim ),임도상 ( Do Sang Im ),탁양주 ( Yang Ju Tak ),임현술 ( Hyun Sul Im ),김호 ( Ho Kim ) 한국보건정보통계학회(구 한국보건통계학회) 2010 한국보건정보통계학회지 Vol.35 No.2

Objective: 2008 Community health survey is an survey to produce health statistics of 253 communities. This study aims to develope quality management`s system and assess the quality of [2008 Community Health Survey]. Method: We reviewed literatures related to health interview survey in and out countries and visited the survey site to get information. We set up 3-step system for managing quality of [2008 Community health survey], which consists of community health center, college and KCDC. We also developed a survey manuals, a quality management system and a quality index. Using quality-evaluation index, we assessed quality of [2008 Community Health Survey]. Result: Out of 231,355 participants which were 101,307 male, 118,941 female, 220,248(95.2%) completed the questionnaire. Spot-replacement, Household-replacement was 0.6%, 7.2%, respectively. Kappa index of answer-concordance was 0.68 which means a good concordance. According to results of survey site evaluation, quality poor items were Questioning order(Insufficiency 45.6%), Question completion(Insufficiency 36.8%), Explanation of survey goal(Insufficiency 31.6%), Probing(Insufficiency 28.1%) orderly. Conclusion: The quality of [2008 Community Health Survey] was fine, but more efforts to improve health-survey quality need in the future.

혈청 총 콜레스테롤과 관련된 인자들

탁양주,유선미,조비룡,송윤미,유태우,허봉렬 대한가정의학회 1992 Korean Journal of Family Medicine Vol.13 No.12