대구광역시 5년간 연평균 암 발생률과 연간 암 발생률 추이, 1997~2001

천병렬(Byung-Yeol Chun),양진훈(Jin-Hoon Yang),송정흡(Jung-Hup Song),임지선(Ji-Seun Lim) 한국역학회 2007 Epidemiology and Health Vol.29 No.1

  Purpose: This study is conducted to identify the annual average cancer incidence and the trend of cancer incidence in Daegu during the 5-year period from 1997 to 2001.   Method: Data on newly diagnosed cancer patients from 1997 to 2001 were collected with a standard registration form. Medical record reviewers visited hospitals if necessary, to detect missing cancer patients.   Results: The annual average overall number of cancer patient was 4,606 (male 2,529 and female 2,077). The crude average annual incidence of cancer in male were 211.8 (ASR 251.4) and 169.8 (ASR 151.3) in female. Five major cancers in male were stomach (ASR 60.3), bronchus and lung (ASR 44.8), liver and intrahepatic bile ducts (ASR 40.7), rectum (ASR 11.2), and colon (ASR 10.8). However, in women, those were stomach (ASR 25.3), breast (ASR 19.8), cervix (ASR 14.9), bronchus and lung (ASR 12.7), liver and intrahepatic bile ducts (ASR 11.1). Increases in incidence were found for colon cancer for both sexes, rectal cancer for males, and lung and breast cancer for females. Decreaseswere shown for liver cancer for both sexes and stomach and cervical cancer for females.   Conclusions: Primary prevention of cancer based on results of this study remains important.

일부 농촌지역 여성 골다공증 환자의 칼슘보조제 치료순응도와 결정요인

천병렬(Byung-Yeol Chun),감신(Sin Kam),이영자(Young-Ja Lee),이상원(Sang-Won Lee),이경은(Kyung-Eun Lee),이영석(Young-Seok Lee),김봉기(Bong-Kee Kim) 한국농촌의학 지역보건학회 2001 농촌의학·지역보건 Vol.26 No.2

순환기질환 감시체계

천병렬,Chun, Byung-Yeol 대한예방의학회 2007 예방의학회지 Vol.40 No.4

The purpose of establishing the circulatory disease surveillance system in Korea is to ensure that the problems of circulatory disease importance are being monitored efficiently and effectively. The goals of circulatory disease surveillance system are to monitor the epidemiological trends of circulatory disease and to evaluate the outcome of health activity for controlling circulatory diseases. Surveillance system are being updated to achieve the needs for the integration of the surveillance and information system, the establishment of data standards, the electronic exchange of data, and changes in the goals of circulatory disease surveillance system to facilitate the response of this system to manage the national health problem effectively. This article provides the target diseases and determinant indicators to be monitored, structure of circulatory disease surveillance system, and many tasks and related activities that should be applied to this system.

고혈압 환자의 연간 내원일수, 처방일수 그리고 진료비

천병렬,감신,임정수,박순우,박정한,임부돌,Chun, Byung-Yeol,Kam, Sin,Im, Jeong-Soo,Park, Soon-Woo,Park, Jung-Han,Lim, Bu-Dol 대한예방의학회 2002 Journal of Preventive Medicine and Public Health Vol.35 No.4

Objectives : To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. Methods : The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. Results : The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I, IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses,453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). Conclusions : The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.

장애인의 건강관심도, 건강실천행위 그리고 건강수준간의 구조분석

천병렬,감신,예민해,강윤식,김건엽,손재희,이영숙,박기수,Chun, Byung-Yeol,Kam, Sin,Yeh, Min-Hae,Kang, Yun-Sik,Kim, Keon-Yeop,Son, Jae-Hee,Lee, Young-Suk,Park, Ki-Soo 대한예방의학회 1999 예방의학회지 Vol.32 No.3

Objectives: This study was performed to determine the relationships among health concern, health practice and health status of the disabled. Methods: A self-administered questionnaire survey was carried out for 1,662 disabled persons in Taegu city from April to July, 1997. Results: Health concern had a significant and positive relationship with health practice(p<0.05) and health practice also had a significant and positive relationship with self-rated health status(p<0.05) in men and women. To determine the structural model of the Health concern, health practice, health status and sociodemographic variables, the covariance structural analysis was used. In men, age, economic status, medical security type, educational level and type of disability had significant direct effects on Health concern(T>2.0). Educational level and type of disability had significant direct effects on health practice(T>2.0). And Economic status, medical security type and job status had significant direct effects on health status(T>2.0). In women, economic status and educational level had significant direct effects on Health concern(T>2.0). However there was no variable which had a significant direct effect on health practice. Job status had a significant direct effect or health status(T>2.0). In men and women, health practice was significantly increased with increasing health concern and the more health practice, the higher health status(T>2.0). Conclusions: It is recommended that the institutional approach which improve the economic status of the disabled with understanding their behavior and attitude should be established to increase health status, in addition, the health policy for encouraging the disabled, such as health education, consulting and health promotion program, should be done.

도시지역의 관상동맥질환 발생률 조사

천병렬,김권배,김기식,김영조,김윤년,김창윤,박의현,신동구,심봉섭,이종주,이충원,장성국,전재은,Chun, Byung-Yeol,Kim, Kwon-Bae,Kim, Kee-Sik,Kim, Young-Jo,Kim, Yoon-Nyun,Kim, Chang-Yoon,Park, Wee-Hyun,Shin, Dong-Gu,Shim, Bong-Sub,Lee, Jong-Joo,L 대한예방의학회 1998 Journal of Preventive Medicine and Public Health Vol.31 No.3

To estimate the incidence rate of coronary heart disease in Korea, of all residents in Taegu city aged 25 or above, those who had an acute MI or a fatal coronary event between 1 July 1996 and 30 June 1997 were registered. Seven hundreds and eight patients were registered during the study period(685 were identified at hospital and 23 were autopsy cases). Age-standardized annual incidence rate of men in city area was 93 per 100,000(95% CI; 61-142) and 35% CI; 16-67) in women(100 in men and 20 in women aged 35-64). The incidence was rapidly increased after age 40 in men, however, in women after age 60. Twenty-eight-days case fatality rate was 45% in men and 47% in women. However, in the age group of 45-59 case fatality rate in women was two times higher than that in men. In conclusion, crude annual incidence rate of CHD in city area was 73 per 100,000 in men and 33 in women. The age-standardized annual incidence of CHD in men(93 per 100,000) was 2 times higher than that in women (33 per 100,000) in Korea.

보건지소 공중보건 일반의사의 업무수행정도와 수련개선방안

박정한,천병렬,우극현,Park, Jung-Han,Chun, Byung-Yeol,Woo, Kuck-Hyeun 대한예방의학회 1986 예방의학회지 Vol.19 No.2

공중보건 일반의사들의 업무수행 정도와 진료, 예방 및 보건증진 사업 수행에 필요한 기본적인 수기의 수행능력을 평가하고 그들의 업무 수행능력을 향상시키기 위한 교육 개선 방안을 마련하기 위하여 1982년과 1983년에 배치된 공중보건 일반의사들 가운데 남부 4개도(경북, 경남, 전북, 전남)에서 출신학교별로 비슷한 비율로 120명을 무작위로 뽑아 1984년 1월 9일에서 2월 10일 사이에 설문지를 이용한 집단면담을 하였다. 면담에 응한 97명 가운데 본 조사에 필요한 자료를 제시할 수 있었는 86명으로 부터 얻은 자료를 분석하였다. 보건지소의 진료실적은 2종 보험실시 지역이 1일 평균 $30{\sim}40$명으로 환자가 많으나 그외 지역은 $3{\sim}4$명으로 매우 저조하였다. 또한 예방 및 보건증진사업을 적극적으로 추진한다고 답한 사람은 조사대상자의 2%에 불과했다. 63가지 기본적인 임상수기 가운데서 자신있게 할 수 있다고 한 사람이 50%이상인 것은 근육주사, 정맥주사, 외상치료와 같이 간단한 것으로 12가지에 불과했고 임산부관리, 응급환자처치, 예방 및 보건증진 사업등에 필요한 수기에 자신이 있는 사람은 10%도 못 되었다. 국립보건원에서 실시하고 있는 공중보건 일반의사들의 실무교육이 현지 사정과 맞지 않는것이 많아 실무에 큰 도움이 안 된다고 했으며, 도립병원이나 지방 종합병원에서 받은 임상수련이 실무에 많은 도움이 된다고 한 사람은 38.8%였으며, 별도움이 안된 이유 가운데 전문의가 없거나 있어도 무관심하여 수련지도가 부족한 탓이라고 한 사람이 48.4%로 가장 많았다. 공중보건일반의 실무교육은 교육내용을 실무종사자들의 의견을 수렴하여 현지 사정에 맞도록 개선해야할 것이며, 실무종사자들 가운데 유능한 사람을 강사로 활용하고, 국립보건원에 모아 교육시키는 것보다 전국을 몇개의 지역으로 나누어 지방에서 교육을 시키는것이 효과적일 것이다. 임상실습은 4개월이 적당할 것으로 생각되며, 수련기간 동안에 필수적으로 익혀야 할 수기를 수첩으로 만들어 실습사실을 지도전문의에게 확인 받게하며, 보건사회부에서는 수련지도에 관한 지침을 마련하여 수련병원에 배부하고 수련상황을 평가하도록 한다. 최소한 기본 4과에 전문의를 갖춘 병원을 수련병원으로 선정하여야 할 것이다. 공중보건 일반의사들이 현지에서 당면하는 문제해결을 도우고 사업추진을 위한 동기를 유발하기 위해 보수교육이 필요하며 이를 위해 보건사회부는 재정 및 행정적 지원을 하는 것이 좋겠다. 도를 몇개지역으로 나누어 지역마다 지도위원회를 구성하여 공중보건 일반의사들을 순회지도 하고 자문에 응하도록 하는 것이 좋을 것으로 생각된다. The activities of general physicians (GPs) in health subcenters and their competency for clinical skills were assessed to develop a scheme to improve the training program. One hundred-twenty GPs in southern four provinces (Kyungpook, Kyungnam, Chunpook, Chunnam) were randomly selected and 97 were interviewed between January 9 and February 10, 1984. Of the 97 GPs, 86 provided all the information we requested. Average number of patient visits per health subcenter in a day was 30-40 in the demonstration project area for the class II medical insurance whereas it was 3-4 visits in other area. The interviewees were asked to rate their competency in 63 clinical skills. The skills in which over 50% of the interviewees rated themselves competent were only 12 items including IM injection, IV injection, wound dressing, etc. Less than 10% of the interviewees rated themselves competent in such skills as maternal health care, emergency medical care, preventive and promotive health services. Most part of the training program of the NIH for the GPs were not applicable to their field work as the training contents were unrealistic. Clinical training at a local general hospital was of great help in 38.8% and the rest of training was not much helpful as the training was inadequate due to lack of trainer or indifference of the trainer. For more effective training of the GPs, the training program of the NIH should be modified to be more realistic and utilize competent field workers as the instructors. It may be more effective if the training is carried out at several local centers. Ideal length of the clinical training for the GPs is 4 months. A pocketbook should be developed that includes specific skills to master during the clinical training and require the trainer to confirm the achievement. The Ministry of Health and Social Affairs should provide the training hospitals with a training guideline and evaluate the training activities and make sure that the training hospital has specialist for each of the 4 major clinical departments. The Ministry of Health and Social Affairs should provide the GPs with a continuing education to assist the problem solving in the field and motivate them to actively carry out the health program. A province may be divided into several regions and a supervisory committee may be organized with specialists in each region. The committee may hold a meeting for the GPs periodically and respond to the specific questions of the GPs by mail.

농촌지역 주민의 고혈압 치료순응도와 관련요인

이상원,천병렬,예민해,강윤식,김건엽,이영숙,박기수,손재희,오희숙,안문영,임부돌,감신,Lee, Sang-Won,Chun, Byung-Yeol,Yeh, Min-Hae,Kang, Yun-Sik,Kim, Keon-Yeop,Lee, Young-Sook,Park, Ki-Soo,Son, Jae-Hee,Oh, Hee-Sook,Ahn, Moon-Young,Lim, Pu-D 대한예방의학회 2000 예방의학회지 Vol.33 No.2

Objective : The purpose of this study was to examine the therapeutic compliance and its related factors in the rural hypertensives. Method : A questionnaire survey and blood pressure measurement were performed to 3,876 residents of a rural area, and 660 hypertensives were selected as subjects of study. The study employed a hypothetical model which was composed of constructs from the health belief model and KAP model. The analysis techniques employed included contingency table analysis and structural equation modeling. Result : The proportion of those who were compliant to the treatment of hypertension was 44.2% of subjects. As the result of structural equation modeling, when patients had more favorable attitude toward treatment, higher perceived benefit, or lower perceived barriers to treatment, the therapeutic compliance was significantly higher(T>2.0). When patients had more knowledge about hypertension, or higher perceived severity of hypertension, the attitude toward the treatment of hypertension was more favorable significantly(T>2.0). And when patients had the support for treatment from family or neighbor, the attitude toward treatment was more favorable(T>2.0). When patients had experience of health education, they had more knowledge, higher perceived susceptibility of complication, perceived severity for hypertension, and perceived benefit of treatment, compare to patients without health education(T>2.0). Conclusion : In consideration of above findings, in order to improve the therapeutic compliance in the rural hypertensives, it would be necessary to change attitude, perception, knowledge about hypertension and its treatment, by various methods such as effective health education and programs for maintaining the supportive environment for hypertension treatment.

대구지역 암등록사업의 효율적 수행방안

진대구,천병렬,안순기,김종연,감신,Jin, Dae-Gu,Chun, Byung-Yeol,Ahn, Soon-Ki,Kim, Jong-Yeon,Kam, Sin 대한예방의학회 2002 예방의학회지 Vol.35 No.4

Objective: This study was conducted to automatically improve the completeness and validity of the Daegu Cancer Registry, using cross record linkage of many data sources, and to develop a computerized patient enrollment system for efficient communication among cancer researchers via the internet. Method: We analyzed 10,229 cancer patients who were reported in the National Cancer Registry, and from pathological reports, health insurance cancer claims lists, cancer patient records at hospital information centers and death certificates from the Korea National Statistical Office. Result: We confirmed 4,624 cancer patients and found 897 of new cases from a review of medical chart. The new cases were detected efficiently using cross record linkage. We developed a computerized patient enrollment system, based on a client-sewer model, for the input of cancer patients, and then developed a web-based reporting homepage and patient enrollment system for the internet. Conclusion: This system could manage cancer databases systematically, and could be given to other researchers as a basic database.

성인 남성 근로자에서 비만 지표의 변화와 혈청지질치 변화와의 관련성

하영애,천병렬,감신,이성국,예민해,Ha, Young-Ae,Chun, Byung-Yeol,Kam, Sin,Lee, Sung-Kook,Yeh, Min-Hae 대한예방의학회 1996 예방의학회지 Vol.29 No.3

성인 남성 근로자들에 있어서 비만지표의 변화와 혈청지질치 변화와의 관련성을 평가하기 위하여, 대구시에 소재한 1개 회사의 남성 근로자 208명을 연구 대상자로 선정하였다. 1995년 7월에 신장, 체중, 허리둘레, 엉덩이둘레를 재고 혈압을 측정하였으며, 혈청 총 콜레스테롤, 중성지방, HDL-콜레스테롤 등을 검사하고 LDL-콜레스테롤, 심근경색지수를 계산하였다. 이를 1991년도에 검사된 기초 자료들과 비교하였다. 1. 4년간 체중이 1.63kg, 허리둘레가 3.61cm, 엉덩이둘레가 4.23cm, BMI가 $0.52kg/m^2$, Katsura 지수는 0.02만큼 유의하게 증가했지만, 허리 엉덩이둘레비는 0.021만큼 유의한 감소가 있었다(p<0.01). 총 콜레스테롤은 15.09mg/이, 중성지방 20.43mg/dl, HDL-콜레스테롤 9.40mg/dl, 그리고 심근경색지수는 2.87mg/dl 만큼 유의하게 증가하였다. (p<0.01). LDL-콜레스테롤은 3.50mg/dl 만큼 증가하였으나 유의하지는 않았다. 2. BMI 변화 및 Katsura 지수의 변화와 총 콜레스테롤의 변화(r=0.174, p<0.05), BMI 변화와 중성지방의 변화(r=0.374, p<0.01), 그리고 체중의 변화와 심근경색지수의 변화(r=-0.173, p<0.05)가 상대적으로 강한 상관성을 보였다. 허리 엉덩이둘레비 변화는 총 콜레스테롤 변화량과 양의 상관관계(r=0.162, p<0.05)를 보였지만 다른 혈청지질치들과는 유의한 관련성이 없었다. 3. 생활습관의 변화를 보정하고도 중성지방은 체중 (r=0.262, p<0.01), BMI(r=0.267, p<0.01) Katsura 지수(r=0.258, p<0.01)와 유의한 관련성이 있었다. 심근경색지수의 변화는 체중(r=-0.143, p<0.05), BMI(r=-0.158, p<0.05), Katsura 지수(r=-0.144, p<0.05)와 유의한 음의 관련성이 있었다. 이 중 BMI가 가장 큰 상관계수 값을 보였다. 4. 1991년의 허리 엉덩이둘레비로 분류한 경우, 상체형 비만군이 그렇지 않은 군에 비해 HDL-콜레스테롤과 심근경색지수의 증가폭이 유의하게 더 낮았다(p<0.05). Katsura 지수의 경우도 유사한 결과를 보였다. BMI로 분류한 경우에도 역시 비만군이 그렇지 않은 군에 비해 HDL-콜레스테롤, 심근경색지수 값들의 증가폭이 유의하게 낮았다(p<0.05 또는 p<0.01). 중성지방은 BMI로 분류한 경우 비만한 군의 증가폭이 유의하게 높았다(p<0.05). 이상의 결과로 보아, 성인 남성 근로자들에서 혈청 지질치 변화에 대한 비만도의 지표로는 BMI가 허리 엉덩이둘레비나 Katsura 지수보다 더 적절할 것으로 생각된다. This study was conducted to evaluate the relationship between change in obesity indices and change in serum lipids in adult male workers. Two-hundred-eight adult male workers of an industry in Taegu city were followed-up from 1991 to 1995. Height, weight, circumferences of hip and waist, blood pressure were measured and serum lipids were analysed. Data on life style were obtained using self-administered questionnaires. Mean differences of anthropometric measurements between 1991 and 1995 were as follows: 1.63kg in weight, 3.61cm in waist circumferences, 4.23cm in hip circumferences, $0.52kg/m^2$ in BMI and -0.021 in WHR. Those of lipids were as follows; 15.09mg/dl in total cholesterol, 20.43mg/dl in triglyceride, 9.40mg/dl in HDL-cholesterol, 2.87 in MI - index (p<0.01) and 350mg/dl in LDL-cholesterol. The changed value of BMI and Katsura index were strongly correlated with that of total cholesterol(r=0.174, p<0.05), the changed value of BMI correlated with that of triglyceride(r=0.374, p<0.01) and the changed value of weight correlated with that of MI index(r=-0.173, p<0.05). The changed value of WHR was signifiantly correlated with that of total cholesterol(r=0.162, p<0.05), however, was not significantly correlated with HDL-cholesterol, LDL-cholesterol, triglyceride and MI index. The changed value of weight, BMI and Katsura index were correlated with that of triglyceride (r=0.262, p<0.01; r=0.267, p<0.01; r=0.258, p<0.01) and the changed value of MI index(r=0.143, p<0.05; r=-0.158; r=-0.144, p<0.01), adjusting the pattern of change in life style. The changed values of HDL - cholesterol and MI index between 1991 and 1995 in low WHR group were significantly higher than those in high WHR group(p<0.05, p<0.01), adjusting the baseline value of them. Similar pattern was observed when considering Katsura index. When stratifying by BMI value of 1991, in low BMI group, the changed value of HDL - cholesterol and MI index showed the same pattern as above, however that of triglyceride was statistically higher in obese group than in non obese group(p<0.05). In conclusion BMI might be a better indicator to predict serum lipids change than other obesity indices.