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.

의료보험하에서의 의료수요의 가격탄력성에 관한 실증분석

김춘배,이도성,김한중,손명세,Kim, Chun-Bae,Lee, Do-Sung,Kim, Han-Joong,Sohn, Myong-Sei 대한예방의학회 1995 예방의학회지 Vol.28 No.2

This paper tested by using Micro TSP, an empirical econometric analysis to approve officially a hypothesis of price elasticity of the demand for medical care services in Korean national medical insurance and the economic effect of health care delivery system with time-series datas of Medical Insurance Statistical Yearbook$(1981\sim1993)$. The results suggest that the Korean medical insurance system shows moral hazard due to the change of coinsurance and the economic effect according to intervention of the health care delivery system, but it is different by insurers regardless of the same structure of the medical insurance scheme.

작품노트 - 백범 기념관

김춘배,Kim, Chun-Bae 대한건축사협회 2000 建築士 Vol.2000 No.12

우리 나라에서의 임상지료지침 개발과 적용 방안

김춘배,Kim, Chun-Bae 한국의료질향상학회 2001 한국의료질향상학회지 Vol.8 No.2

메타분석 방법을 적용한 서울시 대기오염과 조기사망의 상관성 연구 (1991년$\sim$1995년)

김춘배,지선하,정용,이종태,Kim, Chun-Bae,Jee, Sun-Ha,Chung, Yong,Lee, Jong-Tae 대한예방의학회 1999 예방의학회지 Vol.32 No.2

유럽과 미국을 비롯한 선진 산업국가에서 1930년에서 1950대 사이에 발생하였던 일련의 대기오염사건을 경험한 이후, 대기오염과 인체건강영향과의 상관성을 평가하려는 체계적인 연구수행이 있어왔다. 국내에서도 최근 2-3년 동안 단면적 연구 설계에서 벗어나 시계열적 분석방법을 적용한 연구결과들이 발표되었으며, 외국에서의 결과와 유사하게 현재 수준의 대기오염도에서도 인체건강영향 특히 조기사망발생과 유의한 상관성이 있음이 제시되었다. 특히 서울시를 대상으로 한 일련의 연구결과가 대기오염도와 일별사망과에 유의한 상관관계가 있음을 보이고 있어 이에 대한 보다 정밀한 연구수행 필요성이 제기되었다. 따라서 본 연구는 메타분석적 방법론을 적용하여 서울시내의 구별분석 결과를 통합하여 기존의 연구결과와 비교함으로써 대기오염과 인체건강영향의 원인적 상관성을 규명하는 보조적 자료를 제공하기 위하여 수행되었다. 대기오염 자동측정기가 설치된 서울시 내 총 18개 구를 대상으로 대기오염도와 사망과의 상관관계를 추정하는 구별 예측치를 산출하였다. 이렇게 산출된 각 개별 예측치는 전체로서 총괄되는 가중평균 예측치를 계산하기 위하여 사용되었으며 이 때 모수효과 모형 또는 랜덤효과 모형을 적용하여 가중평균 예측치를 산출하였다. 지역별 또는 구별 예측치간의 변이차를 검정하는 동질성 검정의 결과 세 오염물질의 경우 모두 지역간 변이가 큰 것으로 평가되었으며 따라서 랜덤효과 모형의 결과를 최종결과로 선정하여 제시하였다. 랜덤효과 모형의 결과를 보면 총부유분진과 아황산가스의 경우 일별사망과 유의한 상관관계가 있는 것으로 평가되었으나 오존의 경우는 그렇지 않았다. 또한 메타분석 결과가 기존의 연구결과와 비교할 때 유사하게 평가된 점으로 미루어 현재 수준의 대기오염도와 일별사망 또는 인체건강영향과 밀접한 상관관계가 있음을 알 수 있다. 메타분석 방법을 적용하였어도 직접적 개인노출평가가 이루어지지 않았다는 점에서 정보편견의 가능성을 제외할 수 없다. 그러나 이러한 메타분석 방법이 기존의 연구(서울시 전체를 대상으로 하는)에 비하여 정보편견을 어느정도 줄여줄 수 있을 것으로 기대되었으며, 분석결과 기존 연구에서 제시하는 것과 매우 유사함을 알 수 있다. 결론적으로 대기오염 역학 연구에 있어서 이와 같은 메타분석적 방법이 유용하며, 본 연구결과도 기존의 연구에서와 같이 현재 수준의 대기오염도가 인체 건강에 위해한 영향을 미칠 수 있음을 보여 준다는 점에서 향후 보다 강화된 대기오염관리 방안 마련의 필요성을 제기한다고 하겠다. 이를 위하여 대기 오염기준치의 강화뿐 아니라 대기오염에 민감한 인구집단, 즉 어린이나 노약자 등에 대한 각별한 감시와 연구수행이 필요시 된다. Objectives: To reexamine the association between air pollution and daily mortality in Seoul, Korea using a method of meta-analysis with the data filed for 1991 through 1995. Methods: A separate Poisson regression analysis on each district within the metropolitan area of Seoul was conducted to regress daily death counts on levels of each ambient air pollutant, such as total suspended particulates (TSP), sulfur dioxide $(SO_2)$, and ozone $(O_3)$, controlling for variability in the weather condition. We calculated a weighted mean as a meta-analysis summary of the estimates and its standard error. Results: We found that the p value from each pollutant model to test the homogeneity assumption was small (p<0.01) because of the large disparity among district-specific estimates. Therefore, all results reported here were estimated from the random effect model. Using the weighted mean that we calculated, the mortality at a $100{\mu}g/m^3$ increment in a 3-day moving average of TSP levels was 1.034 (95% Cl 1.009-1.059). The mortality was estimated to increase 6% (95% Cl 3-10%) and 3% (95% Cl 0-6%) with each 50 ppb increase for 9-day moving average of SO2 and 1-hr maximum O3, respectively. Conclusions: Like most of air pollution epidemiologic studies, this meta-analysis cannot avoid fleeing from measurement misclassification since no personal measurement was taken. However, we can expect that a measurement bias be reduced in a district-specific estimate since a monitoring station is hefter representative cf air quality of the matched district. The similar results to those from the previous studios indicated existence of health effect of air pollution at current levels in many industrialized countries, including Korea.

한 종합병원의 장기입원환자 흐름의 효율적 관리에 관한 연구 - 장기입원환자정상 운용개선방안을 중심으로 -

김춘배,채영문,유승흠,오희철,Kim, Chun-Bae,Chae, Young-Moon,Yu, Seung-Hum,O, Hee-Chul 대한예방의학회 1990 예방의학회지 Vol.23 No.1

This study refers to the problem of long-term inpatient flow in a general hospital. In this study, a queueing simulation model was developed for the two departments in the hospital with a homogeneous case mix and relatively many long-term inpatients in order to increase the turnover rate and hospital charges. Before the simulation n, the model was verified by the Kolmogorov-Smirnov test. The following results were generated by three alternative models of the special bed policies. 1. Alternative I : When long term inpatients were admitted to the wards belonging to departments A and B without transfer to other departments and special beds, the average turn-over rate decreased by 2-4% and the average hospital charges decreased by 70 million won. 2. Alternative II : When long-term inpatients were transferred to department C but the transfer of wards was determined by department C in order of clinical need, the average turnover rate increased by 4-13% but the average hospital charges decreased by 30 million won. This result was not greatly different from the present state. 3. Alternative III : When long-term inpatients were transferred to the special wards and department C simultaneously, the increase in the average turnover rate and hospital charges was equivalent to the increase of two beds in the special wards. When the special wards were allocated 16 beds, the average turnover rate of departments A and B increased by about 55% and 20% respectively. Also, the hospital charges increased by about 0.44 billion won. As a result, transfer to department C and the use of 16 beds in the special wards for long-term inpatients of departments A and B is expected to maximize the hospital revenue. However, as the above special bed policy can not increase the turnover rate above 60%, there is a need for a more comprehensive policy to further increase the rate. The development of an elaborate model should include the number of long-term inpatients in all clinical departments, the special wards system or an increase of hospital beds to handle admission needs, and the resources of the hospital by department. When the alternatives are evaluated, a cost-benefit analysis in addition to the turnover rate and the hospital charges should be considered.

결과연구의 방법론

김춘배,Kim, Chun Bae 한국의료질향상학회 2007 한국의료질향상학회지 Vol.13 No.1

중피종 환자에 대한 생존분석 - 한 종합병원의 입원환자를 중심으로 -

김춘배,정상혁,이경종,강종두,Kim, Chun-Bae,Jung, Sang-Hyuk,Lee, Kyung-Jong,Kang, Jong-Doo 대한예방의학회 1990 Journal of Preventive Medicine and Public Health Vol.23 No.1

Between 1977 and 1987, 20 patients with mesothelioma were treated at Severance Hospital. Data was gathered from medical charts at the time of hospitalization of mesothelioma patients and from a follow-up questionnaire by mail or telephone. The results acquired were as follows : 1. Among the 20 patients, 11 men and 9 women with mesothelioma were identified. The mean age at hospitalization was 47 years and 11 mesothelioma patients were known or presumed to be dead during the different observation periods. 2. Only one mesothelioma patient had a definite history of occupational asbestos exposure. 3. The sites of origin of mesothelioma were the pleura(13), peritoneum(2), pericardium(2), mediastinum (2), and pelvis(1). Common symptoms included dyspnea, chest pain, abdominal distension, etc. 4. Pathologically, mesotheliomas were divided into 14 malignant types and 6 benign types ; and histologically, 8 fibrous mesotheliomas and 3 epithelial mesotheliomas were shown. 5. There was a statistically significant difference in survival rate according to pathologic type and smoking status. In the groups with malignant mesothelioma, 50% survival time from first symptoms was 18 months and that from diagnosis was 11 months. Also, 75% survival time from diagnosis was 6 months in the smoking groups and 19 months in the non-smoking groups.

강원도내 일부 초,중,고등학교의 금연에 대한 건강증진정책의 조사연구

김춘배 ( Chun Bae Kim ),박준호 ( Jun Ho Park ),안정숙 ( Joung Sook Ahn ),허혜경 ( Hea Kung Hur ),박은정 ( Eun Jung Park ),전은표 ( Eun Po Jeon ),지역보건연구회 ( Community Health Service Research Group ) 한국보건행정학회 2003 보건행정학회지 Vol.13 No.3

The purpose of this study was to investigate the current status of health promotion policies about antismoking, and the relationship between policy status, enforcement of smoking restrictions and perceptions of smoking behaviour among teachers. A representative sample of 173 teachers·school inspectors from 150 elementary·middle·high schools in Gangwon-do was surveyed during Gangwon-do Office of Education`s antismoking and temperance training course in 2002 (response rate 60.7%). One staff member from each school was also analyzed regarding school antismoking polices for students and teachers in several locations within and outside the school building. The results showed that 118 elementary·middle·high schools (78.7%) had an antismoking policy and more schools had a written policy on student antismoking than on teacher antismoking. Most schools (92.4%) in the sample banned smoking by students, but 52 schools (44.1%) allowed smoking by teachers in restricted areas. However, teachers reported seeing smoking sometimes in the toilets (42.7%) or the playground (40.0%) among students and sometimes in the staff room (31.3%) or about every day on school premises (52.7%) among teachers. Irrespective of the type of policy or restrictions on smoking, the association between having a ban on student/teacher smoking and teachers` perceptions of student/teacher smoking in school was not significant. In conclusion, we suggest that most schools must have explicitly an antismoking policy on both students & teachers and enforce consistently a ban in promoting a healthy school environment (smoke-free schools).

국가필수예방접종 보장범위 확대 시범사업의 정책 내용분석 -국가필수예방접종 공급방식을 중심으로-

김춘배 ( Chun Bae Kim ),안양희 ( Yang Heui Ahn ),차병호 ( Byung Ho Cha ),김효열 ( Hyo Youl Kim ),이석구 ( Sok Goo Lee ),이중정 ( Jung Jeung Lee ),박혜숙 ( Hye Sook Park ),신택수 ( Taek Soo Shin ),현숙정 ( Sook Jung Hyun ),고운영 ( 한국보건행정학회 2008 보건행정학회지 Vol.18 No.3

The purpose of this study was to evaluate comparatively the content of the Expanded National Immunization Program according to the provision method between 2005 and 2006 in Korea. We assessed the impact of the mutually exclusive vaccination policy using the result reports of the 2005 and 2006 Demonstration Project and the related references by the content analysis. The public health centers paid vaccination fees to the private clinic and hospital in the 2005 Demonstration Project in Daegu metropolitan city and Gunpo city. But, the public health centers directly supplied free vaccination services to the children in the 2006 Demonstration Project in Gangneung city, Yangsan city, and Yeongi-gun. The total budgets of 2005 and 2006 Demonstration Project were 6.57 billion won and 0.65 billion won, respectively. The computerized registration rates and timeliness rates of administration of each vaccination had improved all in the 5 Demonstration Project regions. However, the computerized registration rates of most vaccination in Gunpo city were higher than those in the 2006 Demonstration Project regions except hepatitis B. Especially, the computerized registration rate of BCG was 48.3%, but the BCG coverage rate by the follow-up telephone survey was 99.8% in Daegu metropolitan city. The community parents in all the regions were satisfied because of expanding financial and geographical access to immunization coverage. In conclusions, from the aspect of the main outcomes, the implementation of two different financial immunization aids appears to be widely accepted among these parents and to have had an impact on vaccination coverage. In the future, the government must try to enact that the national immunization policy including under-immunised or incompletely immunised groups would be achieved by the affordable method of the public-private dynamics.