검사법 평가: 검사법 비교와 신뢰도 평가

공경애 이화여자대학교 의과학연구소 2017 EMJ (Ewha medical journal) Vol.40 No.1

The reliability of clinical measurements is critical to medical research and clinical practice. Newly proposed methods are assessed in terms of their reliability, which includes their repeatability, intra- and interobserver reproducibility. In general, new methods that provide repeatable and reproducible results are compared with established methods used clinically. This paper describes common statistical methods for assessing reliability and agreement between methods, including the intraclass correlation coefficient, coefficient of variation, Bland-Altman plot, limits of agreement, percent agreement, and the kappa statistic. These methods are more appropriate for estimating reliability than hypothesis testing or simple correlation methods. However, some methods of reliability, especially unscaled ones, do not clearly define the acceptable level of error in real size and unit. The Bland-Altman plot is more useful for method comparison studies as it assesses the relationship between the differences and the magnitude of paired measurements, bias (as mean difference), and degree of agreement (as limits of agreement) between two methods or conditions (e.g., observers). Caution should be used when handling heteroscedasticity of difference between two measurements, employing the means of repeated measurements by method in methods comparison studies, and comparing reliability between different studies. Additionally, independence in the measuring processes, the combined use of different forms of estimating, clear descriptions of the calculations used to produce indices, and clinical acceptability should be emphasized when assessing reliability and method comparison studies.

Public Acceptance and Willingness to Hepatitis A Vaccination in Children Aged 7-18 Years in Republic of Korea

공경애,윤서희,조수진,김한울,김경효 대한의학회 2014 Journal of Korean medical science Vol.29 No.11

Hepatitis A can cause serious illness among adolescents and adults with low vaccinationcoverage. Even though hepatitis A vaccine is one of the strong candidates for Koreannational immunization program, adolescents aged older than 12 yr would not benefit. Ourpurpose was to assess the willingness and analyze the correlates of Korean mothers forhepatitis A (HepA) vaccination to develop strategies for HepA vaccination. A nationaltelephone survey on 800 mothers with children aged 7-18 yr was conducted with randomdigitdialing method. Sixty-two percent and 92% of the mothers reported that they werewilling to HepA vaccination at current cost and at half of the current cost, respectively. However, at current cost, only 79% wished to vaccinate their child in an epidemic and32% wished to vaccinate promptly. Having two or more children, not having future plansto send the child overseas, and low family income were significantly associated with notwilling to HepA vaccination. Low perception of the susceptibility for hepatitis A andperception of the current cost as barrier increased the odds of unwillingness to vaccinationat current cost and to prompt vaccination. The mothers’ willingness to HepA vaccinationfor the children aged 7-18 yr in Korea was not very high at current cost and associatedsocioeconomic status and health-belief. Targeted intervention or strategies are needed toincrease the HepA vaccination rate among children in Korea.

서울의 한 의원에서 시행한 방문 진료

공경애,이상화,이홍수,백인미,정유지 대한가정의학회 2003 Korean Journal of Family Medicine Vol.24 No.6

Home Visits in an Office Practice in SeoulKyoung Ae Kong, M.D., In Mee Baik, M.D.*, You Ji Chung, M.D., Sang Hwa Lee, M.D., Hong Soo Lee, M.D.

초등학교 저학년 어린이에서의 대사위험요인 군집의 분포와 관련 위험요인

공경애,박보현,민정원,홍주희,홍영선,이보은,장남수,이선화,하은희,박혜숙,Kong, Kyoung-Ae,Park, Bo-Hyun,Min, Jung-Won,Hong, Ju-Hee,Hong, Young-Sun,Lee, Bo-Eun,Chang, Nam-Soo,Lee, Sun-Hwa,Ha, Eun-Hee,Park, Hye-Sook 대한예방의학회 2006 예방의학회지 Vol.39 No.3

Objectives: We wanted to determine the distribution of the clustering of the metabolic risk factors and we wanted to evaluate the related factors in young schoolchildren. Methods: A cross-sectional study of metabolic syndrome was conducted in an elementary school in Seoul, Korea. We evaluated fasting glucose, triglyceride, HDL cholesterol, blood pressures and the body mass index, and we used parent-reported questionnaires to assess the potential risk factors in 261 children (136 boys, 125 girls). We defined the metabolic risk factors as obesity or at risk for obesity ($\geqq$ 85th percentile for age and gender), a systolic or diastolic blood pressure at $\geqq90th$ percentile for age and gender, fasting glucose at $\geqq110mg/dl$, triglyceride at $\geqq110mg/dl$ and HDL cholesterol at $\leqq40mg/dl$. Results: There were 15.7% of the subjects who showed clustering of two or more metabolic risk factors, 2.3% of the subjects who showed clustering for three or more risk factors, and 0.8% of the subjects who showed clustering for four or more risk factors. A multivariate analysis revealed that a father smoking more than 20 cigarettes per day, a mother with a body mass index of = $25kg/m^2$, and the child eating precooked or frozen food more than once per day were associated with clustering of two or more components, with the odds ratios of 3.61 (95% CI=1.24-10.48), 5.50 (95% CI=1.39-21.73) and 8.04 (95% CI=1.67-38.81), respectively. Conclusions: This study shows that clustering of the metabolic risk factors is present in young schoolchildren in Korea, with the clustering being associated with parental smoking and obesity as well as the child's eating behavior. These results suggest that evaluation of metabolic risk factors and intervention for lifestyle factors may be needed in both young Korean children and their parents.

내관혈 자극이 수술 후 오심과 구토에 미치는 효과에 대한 체계적 고찰

공경애(Kong, Kyung Ai) 대한여성건강학회 2012 여성건강 Vol.13 No.1

지역사회 성인남성에서의 하부요로증상 및 전립선비대증 의료이용과 사회경제적 요인의 관련성

김한해,공경애,이훈재,윤하나,이보은,문옥륜,박혜숙,Kim, Han-Hae,Kong, Kyoung-Ae,Lee, Hun-Jae,Yoon, Ha-Na,Lee, Bo-Eun,Moon, Ok-Ryun,Park, Hye-Sook 대한예방의학회 2006 예방의학회지 Vol.39 No.2

Objectives : We wanted to evaluate the medical underutilization for benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) among Korean elderly men and we wanted to determine their associated factors. Methods : This study was conducted on 239 men with LUTS and 116 men with BPH who were compatible with the diagnostic criteria from a total of 641 participants. These participants were over 50 years old and they were randomly chosen in a community-based study for estimating the prevalence of BPH. Using a self-reported questionnaire, we surveyed the sociodemographics, health status, quality of life, lower urinary tract symptoms, medical utilization and reasons for not seeking treatment. Results : Only 27.6% of the men with LUTS and 31.0% of the men with BPH reported having visited a doctor for urinary symptoms. The reasons for not visiting a doctor were, in order of responses from the group with LUTS: 'considered the symptoms as a part of the normal ageing process', 'not enough time to visit a doctor', 'financial difficulty' and 'the symptoms were not severe or bothersome'. Regarding BPH, the responses were the same as those of the group with LUTS however, 'financial difficulty' placed second. Among the men with experience of visiting a doctor for urinary symptoms, 33.3% of those with LUTS and 28.1% of those with BPH were not treated. The most common reason in both groups was 'the symptoms were not severe to be treated'. On a multiple logistic regression analysis, the larger size household (odds ratio (OR) 3.03, 95% confidence interval (CI)=1.40-6.54) and an unsatisfactory quality of life related with urinary symptoms (OR 2.98, 95% CI=1.23-7.21) were associated with medical utilization in the group of LUTS. For BPH, the current employment status was related with the medical utilization (OR 2.80, 95% CI=1.10-7.11), in addition to the larger size household (OR 3.24, 95% CI=1.14-9.21). Conclusions : Many men with urinary symptoms do not visit a doctor. This medical underutilization for people with LUTS and BPH may be associated with economic status in Korea.

정신과 입원환자의 공격행위와 간호에 관한 문헌고찰

강선정,공경애,곽민정,권유경,김선영,김진영,신희연,이원경 이화여자대학교 간호과학대학 1997 이화간호학회지 Vol.- No.30

Childhood Cancer Mortality and Birth Characteristics in Korea: A National Population-based Birth Cohort Study

차은실,공경애,문은경,강영호,이원진 대한의학회 2011 Journal of Korean medical science Vol.26 No.3

To examine the relationship between birth characteristics and childhood cancer mortality,a retrospective cohort study of Korean children was conducted using data collected by the national birth register between 1995 and 2006, which were then individually linked to death data. A cohort of 6,479,406 children was followed from birth until their death or until December 31, 2006. Poisson regression analyses were used to calculate rate ratios of childhood cancer deaths according to birth characteristics. A total of 1,469 cancer deaths were noted and the childhood cancer mortality rate was found to be 3.43 per 100,000person-years in Korea during the period of 1995-2006. The birth characteristics examined in this study (i.e. , birth weight, gestational age, multiple births, parental ages, and number of siblings) were generally found to be not significantly associated with childhood cancer mortality, and the associations did not vary meaningfully with gender nor with cancer sites. However, among children aged 5-11 yr, higher birth weight was associated with elevated childhood cancer mortality (rate ratio = 1.28, 95% confidence interval 1.04-1.58). Our results offer no overall associations between childhood cancer mortality and birth characteristics, but suggest that the association may be specific to age group.

Validation and proposal for cut-off values of an abbreviated version of the Alcohol Use Disorder Identification Test using the Korean National Health and Nutrition Examination Survey

이재희,공경애,이덕희,최윤희,정구영 대한응급의학회 2018 Clinical and Experimental Emergency Medicine Vol.5 No.2

Objective Several abbreviated versions of the Alcohol Use Disorder Identification Test (AUDIT) have been developed and are widely used in clinical settings. In this study, we provide evidence supporting the use of abbreviated versions of AUDIT by comparing the utility of various abbreviated versions and determining cut-off values for the population of South Korea. Methods Data were obtained from the 4th to 6th Korean National Health and Nutrition Examination Surveys. After calculating the whole AUDIT score, we applied the cut-off value of at-risk drinking proposed by the World Health Organization and divided the study sample into normal and at-risk drinking groups. Receiver operating characteristic curves were drawn for AUDIT-3rd question (Q3) alone, AUDIT-quantity and frequency (QF), AUDIT-consumption (C), AUDIT-4, and AUDIT-primary clinic (PC), and optimal cut-off values were obtained for each group. Results A total of 46,450 subjects were analyzed. The at-risk drinking group comprised 29.2% of all subjects. The area under receiver operating characteristic curve (AUROC) of the abbreviated versions of AUDIT increased from 0.954 to 0.991 as the number of questions increased from one to four. The differences in AUROC between the abbreviated versions of AUDIT were statistically significant. The most appropriate cut-off values for AUDIT-Q3 alone, AUDIT-QF, AUDIT-C, AUDIT-4, and AUDIT-PC for adults over age 19 were 2, 4, 5, 6, and 4 points, respectively. Conclusion As the number of items analyzed increased from one to four items, the AUROC increased to a statistically significant level. Cut-off values for abbreviated versions of AUDIT are similar in South Korea to other countries.

Validation of abbreviated version of AUDIT

이재희,공경애,이덕희,최윤희,정구영 대한응급의학회 2018 大韓應急醫學會誌 Vol.29 No.3

Objective: Several abbreviated versions of the Alcohol Use Disorder Identification Test (AUDIT) have been developed and used widely in clinical settings. This paper provides evidence supporting the use of abbreviated versions of AUDIT by comparing the utility of various abbreviated versions and determining the cut-off values for the population of South Korea. Methods: Data were obtained from the 4th to 6th Korean National Health and Nutrition Examination Surveys. After calculating the whole AUDIT score, the cut-off value of at-risk drinking proposed by the World Health Organization was applied and the study sample was divided into normal and at-risk drinking groups. Receiver operating characteristic curves were drawn for the AUDIT-3rd question (Q3) alone, AUDIT-quantity and frequency (QF), AUDIT-consumption (C), AUDIT-4, and AUDIT-primary clinic (PC), and the optimal cut-off values were obtained for each group. Results: A total of 46,450 subjects were analyzed. The at-risk drinking group comprised 29.2% of all subjects. The area under the receiver operating characteristic curve (AUROC) of the abbreviated versions of AUDIT increased from 0.954 to 0.991 as the number of questions was increased from one to four. The differences in the AUROC between the abbreviated versions of AUDIT were statistically significant. The most appropriate cut-off values for AUDIT-Q3 alone, AUDIT-QF, AUDIT-C, AUDIT-4, and AUDIT-PC for adults over age 19 were 2, 4, 5, 6, and 4 points, respectively. Conclusion: As the number of items analyzed increased from one to four, the AUROC increased to a statistically significant level. The cut-off values for the abbreviated versions of AUDIT were similar in South Korea to other countries.