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뇌졸중 발생 예측모형을 위한 Cox와 Weibull 모형의 비교 평가
김윤남(Youn Nam Kim),조어린(Ur Rin Cho),남병호(Byung-Ho Nam),박일수(Il Soo Park),지선하(Sun Ha Jee) 한국역학회 2008 Epidemiology and Health Vol.30 No.1
Objective: The objective was to compare Cox proportional hazards model and Weibull model for predicting long-term probabilities for stroke risk in the Korean Cancer Prevention Study(KCPS).<BR> Methods: The subjects comprised of 385,279 Korean aged 55 to 64 years who received health insurance from the National Health Insurance Corporation and who had medical examinations in 1992 and 1995. 70% of the subjects were used for model building and the rest for model evaluation. The final prediction model for stroke includes age, systolic blood pressure, diabetes, total cholesterol and smoking. Subjects were follow-up for identification of incident stroke cases between 1993 and 2005. Comparisons included predicted coefficients of stroke risk factors, incidence probabilities over 10 years, and the area under a receiver operating characteristics (ROC) curve for both Cox"s proportional hazard model and Weibull model.<BR> Results: The average age of study population was 55.5 years in men and 56.3 years in women, respectively. Percentage of men and women in study population were 58.0% and 42.0%, respectively. The study findings satisfied proportionality according to the two models. There was no significant difference in coefficients between the two models of prediction models in men and in women. Moreover, there was no difference in incidence probabilities of stroke and c-statistics. C-statistics were 0.68 for men as same as for women.<BR> Conclusion: There was no difference for the prediction of the stroke risk in the Korean population using Cox"s proportional hazard model and Weibull model, thus the two models were found to be efficient for this purpose.
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말기암환자 정보시스템을 이용한 우리나라 암환자 완화의료기관의 이용현황
신동욱,최진영,남병호,서원석,김효영,황은주,강진아,김소희,김양혁,박은철,Shin, Dong-Wook,Choi, Jin-Young,Nam, Byung-Ho,Seo, Won-Seok,Kim, Hyo-Young,Hwang, Eun-Joo,Kang, Jina,Kim, So-Hee,Kim, Yang-Hyuck,Park, Eun-Cheol 한국호스피스완화의료학회 2010 한국호스피스.완화의료학회지 Vol.13 No.3
목적: 최근 보건의료 정책 결정은 근거에 기반하여 이루어지는 추세에 있으며, 말기암환자 정보시스템은 이러한 필요에 부응하기 위하여 개발되었다. 본 고에서는 말기암환자 정보시스템의 개발과정 및 6개월 데이터로부터의 통계 결과를 보고하고자 한다. 방법: 말기암환자 정보시스템의 입력항목은 실무 전문가들의 자문을 받아 개발되었으며, 이벨로스 임상연구관리시스템을 기반으로 구축하였다. 2009년 보건복지가족부에서 지정된 34개 암환자완화의료 기관에 2009년 1월 1일부터 6월 30일까지 등록된 환자들에 대한 정보가 수집되었다. 분석은 기술적 통계를 이용하였다. 결과: 총 2,940명의 전국적으로 대표성 있는 데이터로부터 아래와 같은 결과를 얻었다. 평균연령은 $64.8{\pm}12.9$ 세였고, 56.6%가 남자였다. 폐암(18.0%)이 가장 많았다. 2인 이상의 의사에 의하여 말기진단을 받은 경우는 50.3% 였으며, 입원 당시 말기라는 사실을 알고 있는 환자는 69.7%였고, 거의 절반에 가까운 환자가 특별한 의뢰 없이 입원하였다. 평균 통증 및 최고 통증은 입원 1주 후에 통계적으로 유의하게 감소하였다. 사망 퇴원한 환자가 73.4%였으며, 집으로 퇴원하는 경우는 13.3%에 불과했다. 1회당 평균 입원일수는 $20.2{\pm}21.2$일이었으며, 중위값은 13일이었다. 결론: 말기암환자 정보시스템의 운영을 통하여 완화의료 기관 이용 환자 및 가족의 특성, 서비스 제공에 관한 현황 등에 관한 전국적으로 대표성 있는 자료를 얻을 수 있었다. Purpose: Recently, health policy making is increasingly based on evidence. Therefore, Korean Terminal Cancer Patient Information System (KTCPIS) was developed to meet such need. We aimed to report its developmental process and statistics from 6 months data. Methods: Items for KTCPIS were developed through the consultation with practitioners. E-Velos web-based clinical trial management system was used as a technical platform. Data were collected for patients who were registered to 34 inpatient palliative care services, designated by Ministry of Health, Welfare, and Family Affairs, from $1^{st}$ of January to $30^{th}$ of June in 2009. Descriptive statistics were used for the analysis. Results: From the nationally representative set of 2,940 patients, we obtained the following results. Mean age was $64.8{\pm}12.9$ years, and 56.6% were male. Lung cancer (18.0%) was most common diagnosis. Only 50.3% of patients received the confirmation of terminal diagnosis by two or more physicians, and 69.7% had an insight of terminal diagnosis at the time of admission. About half of patients were admitted to the units on their own without any formal referral. Average and worst pain scores were significantly reduced after 1 week when compared to those at the time of admission. 73.4% faced death in the units, and home-discharge comprised only 13.3%. Mean length of stay per admission was $20.2{\pm}21.2$ days, with median value of 13. Conclusion: Nationally representative data on the characteristics of patients and their caregiver, and current practice of service delivery in palliative care units were obtained through the operation of KTCPIS.
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박세정 ( Sea Jong Park ),성봉주 ( Bong Ju Sung ),고병구 ( Byoung Goo Ko ),김양례 ( Yang Rae Kim ),남병호 ( Byung Ho Nam ),신정택 ( Jung Taek Shin ),오상우 ( Sang Woo Oh ),제갈윤석 ( Yoon Suk Jekal ),정은지 ( Eun Ji Jung ) 한국스포츠정책과학원(구 한국스포츠개발원) 2012 체육과학연구 Vol.23 No.3
이 연구의 목적은 국민체력인증제 시범사업에 참여한 건강한 성인남녀를 대상으로 건강체력 뿐 아니라 기능체력을 포함한 총체력과 심혈관계질환 위험도와의 관련성을 분석하고, 근력과 심폐지구력이 독립적으로 심혈관계질환에 미치는 영향을 조사하는데 있다. 국민체력인증제에 참여한 건강성인(n=150; 여자 49.3%)을 대상으로 혈액검사와 신체조성, 건강체력(악력, 윗몸일으키기, 20m 왕복오래달리기, 앉아윗몸앞으로굽히기) 및 기능체력(10m×4회 왕복달리기, 제자리멀리뛰기)을 측정한 후, 근력지수와 총체력 지수는 해당항목 점수를 표준점수화(z-score)하여 산출하였다. 심혈관계질환 위험도는 성별에 따라 혈압, 총콜레스테롤, 고밀도지단백콜레스테롤, 당뇨 및 흡연여부, 나이 등을 고려한 프래밍함 위험점수를 사용하여 추정하였다. 그 결과, 남자는 심폐지구력만이 프래밍함 위험점수의 독립적 위험요인(ß=-0.297, p<0.05)으로 나타났으나, 여자는 심폐지구력(ß=-0.314, p<0.05)과 근력(ß=-0.366, p<0.05) 모두 독립적 위험요인으로 나타났다. 남자는 심폐지구력(p<0.05) 및 총체력(p<0.01) 수준에 따라 프래밍함 위험점수에 차이가 나타났으며, 심폐지구력과 총체력 최저수준그룹에서 프래밍함 위험점수가 높았다. 반면, 여자는 심폐지구력(p<0.001)과 총체력(p<0.001)은 물론 근력(0.001)까지 각각의 수준에 따라 프래밍함 위험점수의 차이를 보였으며, 근력, 심폐지구력 및 총체력 최저수준그룹에서 프래밍함 위험점수가 높았다. 이상의 결과를 종합해 보면 여자는 심폐지구력 뿐만 아니라 근력 또한 심혈관계질환의 독립적 위험요인임을 알 수 있었다. 또한, 성별에 관계없이 건강한 성인에게 건강체력과 기능체력을 포괄한 총체력이 심혈관계질환 위험도와 관련이 있었으며, 이는 심혈관계질환 예방에 있어 총체력의 향상노력이 중요함을 시사한다. The purpose of this study was to examine the relationship between coronary heart disease (CHD) risk and fitness including both health-related and skill-related physical fitness in healthy adults. National Fitness Award participants performed a total physical fitness (TF) testing (hand-grip strength, sit-ups, 20m shuttle run, sit and reach, shuttle run and long jump). Among the National Fitness Award participants the ones (n=150; 49.3% women) were able to be identified CHD risks included in this study. The indexes of MF (sum of the z scores for relative grip strength and sit ups) and TF (sum of the z-scores for all fitness factors) was calculated. The CHD risk was assessed by the 10-year Framingham CHD risk score (FRS) for CHD. The results were following:In men CRF was an independent risk factors for CHD (ß=-0.297, p<0.05). In women, however, both CRF (ß=-0.314, p<0.05) and MF (ß=-0.366, p<0.01) were all independent factors for the CHD risk. Furthermore, significant differences were found in the CHD risks among the levels of CRF (p<0.05) and TF (p<0.01), respectively, but in MF in men. The lowest levels of CRF and TF presented higher CHD risk in men. In women, however, there were significant differences in the CHD not only among the levels of CRF (p<0.001) and TF (p<0.001) but also MF (p<0.001). The lowest levels of MF, CRF and TF presented higher CHD risk in women. In conclusion, muscle fitness as well as cardiorespiratory fitness was independently associated with the CHD risk in healthy women. total fitness which was including both health-and skill-related was associated with risks of CHD in men and women. These results support current physical activity for adults which include muscle strengthening exercise in addition to aerobic activities.
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