의학교과서를 통해 본 북한예방의학 내용분석에 관한 연구

문옥륜,이신재,김정철,문용,박송림,이상구,Moon, Ok-Ryun,Lee, Sin-Jae,Kim, Jung-Chul,Wen, Yong,Piao, Song-Lin,Yi, Sang-Gu 대한예방의학회 2000 Journal of Preventive Medicine and Public Health Vol.33 No.3

Objectives : The most frequently cited health related slogan in North Korea is that socialistic medicine is preventive medicine. It implies that North Korea puts preventive medicine at the operational center of its national health care system. This study aimed at examining and comparing preventive medicine practices in North Korea with those of South Korea. Methods : Efforts have been made to obtain a textbook for analysis its contents. Many people have iassisted in the study by joining the interview. Some of these people are as follows : a former professor of PyongYang Medical School, NK physicians living in South Korea, WHO staffs, diplomatic officials, etc. The major items of analysis consisted of industrial medicine and hygiene, nutrition, school health, epidemiology, health statistics and heath policy & management. Results : Public health philosophy is finely noted and well integrated in the operation of the North Korean national health care system, particularly in the area of industrial medicine and hygiene. Preventive medicine with a strong health surveillance system spanning a number of broad social organizations is a major tool to improve the health of the people in North Korea. The emphasis on preventive medicine has a close relationship with the 'Juche Philosophy' and the shortage of pharmaceuticals and medical equipment. To cope with the shortage problem, North Korean health workers are encouraged to grow medicinal herbs. We have found that they put little effort into teaching newly emerging diseases, such as AIDS, VDT syndrome, hazards of EMF, and agricultural chemical poisonings. Of the subjects of the preventive medicine text, 78.9% coincide with those of South Korean industrial health manuals and 34.2% with South Korean epidemiology texts. However, an absolute difference was found to exist between the health policies and management systems. Conclusion : In North Korea, the concept of preventive medicine functions as the basic philosophic strategy of the national health care system. It differs greatly from the South Korean system in both practice and educational content. Its contribution to society is simply incomparable to that of South Korea. More communication and further study is called for in order to improve the preventive medicine practices in the future.

보건소(保健所) 행정(行政)의 기선을 위(爲)한 연구(硏究)

문옥륜,Moon, Ok-Ryun 대한예방의학회 1970 Journal of Preventive Medicine and Public Health Vol.3 No.1

This survey was conducted to evaluate not only the present status of health center directors-their personal histories, their will to private practice in the future, their responses to governmental policies, -but also the distribution of doctorless myons, budget and subsidy, and director's opinions to the enhancement of health center activities. This survey questioned 116 health center directors and 16 health personnel from August to October of 1970 and obtained the following results; 1) The average ages of directors of kun, city, and total health centers were $43.2{\pm}7.8,\;42.1{\pm}7.7,\;and\;42.9{\pm}10.3$ respectively. 2) The average family sizes of directors of kun, city, and total health centers were $5.6{\pm}2.7,\;5.6{\pm}2.1,\;and\;5.6{\pm}2.6$ respectively. 3) Directors holding M. D. degrees were 79.3%, those holding qualified M. D. degrees ('approved director') were 20.7%. 4) M. P. H., M. S., and Ph. D. holders were 6.0%, 6.1%, and 4.3% respectively. 5) The average duration of present directorship in kun and city were 30.2 months and 20.4 months respectively. 6) The majority of directors had been employed in related fields before assuming current position : directorship at other health center 26.7%, army 22.4%, health subcenter 21.6%, private practice 19.0%. 7) Average length of directorship is 41.8 months. Average length of public health career, including health subcenter and present position, is 56.5 months. 8) Both rural and urban experience in health centers for regular directors is 16.3% and for approved directors, 12,5%. A total of 15.5% of all survey directors had experience in both rural and urban health center. 9) A total of 70.7% of health center directorships were staffed by local doctors. 10) Nearly 40% wanted to quit the directorships within 3 years and 60.3% had already experienced private practice. 11) Of the regular directors 17.4% felt strongly about devoting their lives to public health fields, but only 4.1% of the approved approved directors felt so. 12) There wire 432 doctorless myons among 996 respondent myons and 4.5 doctorless myons per kun. 13) The percentage of doctorless myon by Province are as follows, Cholla buk-do 57.2%, Cholla nam-de 55.0%, Kyungsang nam-do 52.0%, Kyungsang buk-do 49.7%, Chungchong but-do 42.4%, Kyonggi-do 32.9%. Cheju-do 30.8%, Kangwon-do 25.8%. 14) Two thirds of health critters have experienced the abscence of the director for a certain period since 1966 and the average span of the abscence was 18.2 months. 15) The percentage of doctorless myons increased proportionally with the span of the director's abscence. 16) The average budgets of health centers, kun, city and ku, were $W15.03\;million{\pm}W4.5\;million,\;W22.03\;million{\pm}W17.80\;million,\;W13.10\;million{\pm}W7.9\;million$ respectively. 17) Chunju city had the highest health budget per capita(W344) while Pusan Seo ku had the lowest(W19). 18) Director's medical subsidies are W30,000-50,000 in kun, and roughly W20,000 in city. 19) The older of priority in health center activities is T.B. control(31.1%), Family Planning and M. C. H.(28.0%), prevention of acute communicable disease and endemic disease (18.2%) and clinical care of patients(14.3%). 20) Nearly 32% opposed in principle the governmental policy of prohibiting medical doctors from going abroad. 21) Suggestions for immediate enhancing the position of director of health centers and subcenters: (1) Raise the base subsidy (48.2%), (2) Provide more opportunities for promotion (20.7%), (3) Exemption from army services(12.1%), (4) Full scholarship to medical students for this purpose only (7.8%). 22) A newly established medical school was opposed by 56.9% of the directors, however 33.6% of them approved. 23) Pertaining to the division of labor in Medicine and Pharmacy, the largest portion (31.9%) urged the immediate partial division of antibiotics and some addictive drugs to be given only by prescription. 24) More than half wa

한국인 성인 비만의 사회경제적 비용

문옥륜,김남순,강재헌,윤태호,이상이,이신재,정백근,Moon, Ok-Ryun,Kim, Nam-Soon,Kang, Jae-Heon,Yoon, Tae-Ho,Lee, Sang-Yi,Lee, Sin-Jae,Jeong, Baek-Geun 대한예방의학회 2002 예방의학회지 Vol.35 No.1

Objective : To estimate the socioeconomic costs of obesity in Korea,1998. Methods : The 1998 National Health and Nutrition Examination Survey(1998 NHNES) data was used and 10,880 persons who had taken health examinations were selected for study. Essential hypertension, NIDDM(non insulin-dependent diabetes mellitus), dyslipidemia, osteoarthritis, coronary heart disease, stroke were included as obesity related disease. The data of direct costs of obesity was obtained from the National Federation of Medical Insurance. The category of indirect costs was the loss of productivity caused by premature death and admission, time costs, traffic costs, nursing fees due to obesity. Multiple logistic regression model was developed to estimate prevalence odds ratio by obesity class adjusted demographic and socio-ecnomic factors and calculate PAF(Population Attributable Fraction) of obesity on obesity related disease. And we finally calculated the socioeconomic costs of obesity in relation to BMI with PAF. Results : The direct costs of obesity were 2,126 billion${\sim}965$ billion Won in considering out of pocket payment to uninsured services, and the indirect costs of obesity were 2,099 billion${\sim}1,086$ billion Won. Consequently, in considering out of pocket payment to uninsured services, the socioeconomic costs of obesity were 4.225 billion${\sim}2,050$ billion Won, which corresponded to about $0.094%{\sim}0.046%$ of GDP and $1.88%{\sim}0.91$ of total health care costs in Korea. Conclusions : Obesity represents a major health problem with significant economic implications for the society. This results are conservative estimates as far as all obesity related disease and all health care and indirect costs were not included due to missing information. further studies are needed to caculate socioeconomic costs of obesity more exactly.

Exploring H.M.O. Feasibility in the Korean Health Care Delivery Settings

문옥륜,Moon, Ok-Ryun The Korean Society for Preventive Medicine 1977 Journal of Preventive Medicine and Public Health Vol.10 No.1

한국인의 비만도에 따른 비만관련질환의 유병률 증가

문옥륜,강재헌,이상이,정백근,이신재,윤태호,황경화,김남순,Moon, Ok-Ryun,Kang, Jae-Heon,Lee, Sang-Yi,Jeong, Baek-Geun,Lee, Sin-Jae,Yoon, Tae-Ho,Hwang, Kyung-Hwa,Kim, Nam-Soon 대한예방의학회 2001 예방의학회지 Vol.34 No.4

Objective : To develop a boner understanding of the relationship between weight status and the prevalence of obesity related diseases in the Korean population. Methods : The 1998 Korean National Health and Nutrition Survey was used and 10,880 persons who had previously taken health examinations were selected for study. The Korean Society for the Study of Obesity's classification of weight status was used. Hypertension, diabetes mellitus, dyslipidemia, osteoarthritis, chronic heart disease, stroke were included as obesity related disease. A logistic regression model was developed to estimate the prevalence odds ratio by obesity class adjusted for demographic and socioeconomic factors and we converted the odds ratio to a prevalence ratio using the base line prevalence of disease to aid in the interpretation of the ratios. Results : The prevalence of obesity was 26.3% based on the KSSO classification $(BMI\geq25)$. A graded increase in the prevalence ratio was observed with increasing severity of overweight and obesity for all health outcomes with the exception of chronic heart disease in men and stroke in both men and women. With normal weight individuals as the reference, for men who were younger than 50 years, the prevalence ratios were highest for hypertension BMI<23-25: 1.70(95% CI=1.41-2.05), 25<BMI<30: 2.63(95% CI=2.25-3.05), $BMI\geq30$: 4.83(95% CI=3.70-5.84). The prevalence ratios for dyslipidemia were as high as hypertension, but were lower than hypertension for diabetes mellitus and osteoarthritis. Prevalence ratios generally were greater in younger adults. The prevalence of having 2 or more obesity related diseases increased with weight status category, except in people who were older than 50 years. Conclusions : Based on results, obesity is an increasingly important health problem in Korea and the disease burden increases according to weight status. For Korean adults, the strongest relationship was seen between weight status and hypertension and dyslipidemia. In older people the impact of excess weight and obesity is stronger than that seen in younger people. Increased efforts in the study of obesity and prevention and treatment of obesity and obesity related disease are required.

우리나라의 사회계층별 건강행태의 차이

문옥륜,이상이,정백근,이신재,김남순,장원기,윤태호,Moon, Ok-Ryun,Lee, Sang-Yi,Jeong, Baek-Geun,Lee, Sin-Jae,Kim, Nam-Sun,Jhang, Won-Ki,Yoon, Tae-Ho 대한예방의학회 2000 예방의학회지 Vol.33 No.4

Objectives : To analyze differences in health behaviors among the social strata in Korea by using the 1995 National Health and Health Behavior Survey Data. Methods : Study Participants numbered 2,352 men and 1,016 women aged between 15-64 years old, with housewives, students and non-waged family workers excluded. Health behaviors in this study were defined according to the recommendations of the Alameda 7 study. The measure of health behaviors was based on the Health Practices Index(HPI; 0-5 range, with the exclusion of snacking between meals and regularly eating breakfast) developed by the Alameda County research. The significance of the relationship between social strata and HPI was assessed by considering the adjusted means from the multi-variate model. Results : For men, incidence rates of never having smoked, no/moderate use of alcohol, regular exercise, and regular 7-8 hours sleep per night were higher in the upper social strate. Meanwhile, for women, incidence rates of never having smoked, no/moderate use of alcohol, appropriate weight, regular exercise, and regular 7-8 hours sleep per night were higher in the upper strata. HPI varied significantly among social strata in both sexes (p<0.001), a result which held true when adjusted for age, education, income, social insurance type, marital status and region. Conclusions : Health behaviors assessed by Health Practices Index(HPI) varied significantly among social strata for both sexes. Therefore, the existing gap in health behaviors among social strata can be corrected more effectively by target oriented health promotional activities.

Health Maintenance Organization의 導入可能性에 關한 硏究

文玉綸(Ok Ryun Moon) 서울대학교 보건환경연구소 1978 보건학논집 Vol.15 No.1

노인인구의 의료수요에 따른 필요의료인구의 추계

문옥륜(Ok Ryun Moon),조유향(Yoo Hyang Cho),이석구(Seok Goo Lee) 한국노년학회 1991 한국노년학 Vol.11 No.1

Korea has experienced a rather rapid population aging process. The number of the elderly has increased from 1 million in 1970 to 2 million in 1990. however, the elderly will number as many as 3 million in 2000, and 5.8 million in 2020. Thus, it will take only 25 years for the number of the elderly to reach 14% of the total population from 7% in 2005. Yet, no information is available for health manpower requirement for the care of the elderly in Korea. The objective of this study is to analyze health manpower needs with respect to the care of elderlies. This paper is specifically addressed to the projection of physicians and nurses requirement by the year 2010. Ⅱ. METHODS Korea has achieved its universal health insurance program in July 1999. A population component method was applied to this analysis by breaking down its population into the following four categories : those members under the employees' health insurance, public officials and private school teachers' health insurance, regional self-employed health insurance and those under the medical assiance program. Based upon the existing data on the utilization rate and the number of days per in -and out-patient case, this study has made estimates of the daily number of elderlies-patients that will use medical care facilities of all kinds for the coming years up to 2010. Aprojection has been made on the health manpower requirement by using the optimum physician productivity per day and other criteria defined legally and customarily. Ⅲ. RESULTS In general, the medical care utilization rate for elderlies has increased much faster than is that for general population. This is particularly the case for inpatient. Average length of hospital stay for the aged is longer than that for the total population by 2.5 days per case. However, the difference is not remarkable for outpatient visits. The daily number of elderlies who will use medical facilities is estimated at 346,640 in the year 2010. This is equivalent to 8.1% of the aged at 65 and over. In other words, 51.335 beds will be occupied and 295,305 physician visits will be made nearly everyday by elderlies. Three indicators for measuring physician productivity and two indicators for nurses requirement are chosen for the purpose of projection of this study. The proportion of physicians caring for elderlies will increase from 8.7% in 1992 to 21.3% in 2010, or from 8.1% to 17.2% the same period. This difference mainly originates from variations on the medical care utilization rates of the regional self-employed health insurance program which extended to the entire target population only two years ago. Similar findings are noted for nurses. According to the projection, the proportion of nurses caring for elderlies will be doubled during the same period. Despite the fact that the current population structure is relatively young, this study shows that the Repulic of Korea will undergo a rapid change of aging in early 2000s. As a Preparatory measure, this study tries to project health manpower requirement for the coming 20 years.

MRI 분포와 관행수가 현황 및 촬영실적 분석

문옥륜 ( Ok Ryun Moon ),장원기 ( Won Gi Jhang ),이상이 ( Shang Yi Lee ),김철웅 ( Chul Woung Kim ),최경혜 ( Kyung Hye Choi ) 한국보건행정학회 1998 보건행정학회지 Vol.8 No.1

학교 구강보건사업에 관한 고찰

文玉綸(Ok Ryun Moon),申相完(Sang Wan Shin) 대한치과의사협회 1983 대한치과의사협회지 Vol.21 No.6