전립선비대증의 진료지침 개발

유승흠,채수응,김춘배,강명근,송재만,이은식,이정구,이춘용,홍성준,Yu, Seung-Hum,Chai, Soo Eung,Kim, Chun-Bae,Kang, Myung Geun,Song, Jae Mann,Lee, Eun Sik,Lee, Jung Gu,Lee, Tchun Yong,Hong, Sung Joon 한국의료질향상학회 1997 한국의료질향상학회지 Vol.3 No.2

Background : Clinical practice guidelines define "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" and help to improve patient care. The purpose of this study is to develop a clinical practice guideline for the most effective diagnoses and treatments of benign prostatic hyperplasia based on patient preference and clinical need. Methods : For this research project, extensive literature searches (208 articles) were conducted. As well, critical reviews and syntheses (meta-analysis) were used to evaluate empirical evidence and significant outcomes of the BPH literature. Questionnaires about clinical practice for BPH patients were distributed and consensus meetings were undertaken to grasp variations in clinical practice and to reach agreement on the guideline's development. The guideline was promoted under the sponsorship of the Korean Medical Association and the Korean urological Cancer. Society. For the task, the Benign Prostatic Hyperplasia Guideline Panel was composed of multidisciplinary experts in the field. Results : BPH is a disease that affects a patient's quality of life. This Clinical Practice Guideline was developed for the typical man over age 50 with symptoms of prostatism, but with no significant medical morbidities such as diabetes or other known causes of voiding dysfunction, such as urethral stricture or neurogenic bladder. The guidelines detail the relative benefits and obstacles associated with all diagnostic and treatment approaches, including watchful waiting. Conclusion : This guideline provides a cornerstone for our medical association. It represents the most current scientific knowledge regarding the development, diagnosis, and treatment of BPH. It will be revised and updated as needed.

도서지역주민의 의료이용양상과 그 결정요인

유승흠,조우현,박종연,이명근,Yu, Seung-Hum,Cho, Woo-Hyun,Park, Chong-Yon,Lee, Myung-Keun 대한예방의학회 1987 Journal of Preventive Medicine and Public Health Vol.20 No.2

Island regions suffer from a shortage of health care in part because they are less developed, they cover a widespread area relative to the population, and due to transportation barriers. The purpose of this study was to assess the level of illness and the magnitude of medical care utilization, and to investigate the determinants of utilization in these area. The data were collected by means of a household survey conducted from February 16 to 25, 1987 on S islands which were selected in consideration of the size of the population, the distance from the main land, and the distribution of health care facilities. The household response rate was 89.1% (491 of 551 households), and 1971 persons were surveyed. The major findings of this study are as follows: 1) The morbidity rate of the island inhabitants was 27.7% during the two weeks, and 25.5 chronic illnesses and 9.1 acute illnesses per 100 persons, were noted. Differences in the magnitude of illness were statistically significant by sex, age, education, and family size. 2) The magnitude of total ambulatory carl utilization was 16.8 visits per 100 persons during the two weeks, which was less than that of other regions; and differences in the magnitude of total ambulatory care were statistically significant by sex, age, education, occupation, and family size. 3) Unmet needs were classified as 56.0% in chronic illnesses and 19.6% in acute illnesses; and differences in unmet needs were statistically significant by sex, age, education, occupation, income, and family size. 4) Statistically significant determinants in medical care utilization included the frequency of acute illness and chronic illness, and income in total utilization; the frequency of chronic illness and acute illness, and medical care insurance in physician visits. 5) According to the results of the path analysis, need factors had the greatest effect on utilization, and predisposing factors had more indirect effects through enabling or need factors than direct effects.

지역의료보험 가입자의 외래 의료이용 변화

유승흠,조우현,손명세,박종연,Yu, Seung-Hum,Cho, Woo-Hyun,Sohn, Myong-Sei,Park, Chong-Yon 대한예방의학회 1988 Journal of Preventive Medicine and Public Health Vol.21 No.2

This study was performed in a rural community, Kanghwa county which was introduced to a regional medical insurance pilot program in 1982. The purposes of this study were, firstly, to observe the changes in ambulatory care utilization in the three years 1982, 1983 and 1987 : secondly, to analyse factors which convert perceived medical care needs to effective medical care demand. During the three periods, a serial interview survey was performed to determine the changes in medical utilization before and after the regional medical insurance program implementation. The number of subjects was 3,356 persons in the year 1982, 3,705 in 1983 and 2,745 in 1987. The results of the study were as follows : 1. Total ambulatory care utilization rates per 100 persons during a 2-week period were 23.6 in the year 1982, 21.8 in 1983, and 29.3 in 1987; and physician visit rates were 6.1 in 1982, 11.7 in 1983, and 14.9 in 1987. Thus, compared to the total utilization rate there was a definite increase in physician visit, and during the study periods there was a decrease in drug store visits whereas an increase in hospital or clinic visits was noticed. 2. The rates of effective demand for medical care need were 70.7% in 1982, 70.5% in 1983 and 75.9% in 1987 : and the rates of patients who visited physicians were 20.2% in 1982, 42.8% in 1983 and 35.6% in 1987. Thus, physician visits increased sharply by introducing the medical insurance program, but after the latent medical care demands were fulfilled, there was a slight decrease in the physician visits. 3. The number of acute symptoms and the number of chronic symptoms were common determinants of total ambulatory care utilization and physician visits. Besides the medical care need factors, age in 1982, sex and accessibility in 1983, and accessibility in 1987 were statistically significant determinants of the total utilization ; sex and accessibility in 1983, and education in 1987 were also statistically significant determinants of the physician visit. 4. For persons with perceived acute symptoms during the 2-week periods, accessibility in total utilization and age in physician visits were common discriminating factors of ambulatory care utilization in the three years, and education and income were also statistically significant variables. For persons with perceived chronic symptoms, occupation and income were statistically significant discriminating variables commonly observed in total utilization and physician visits.

연세지역 아파트 주민의 모자보건에 관한 실태조사

유승흠,정영숙,이경자,김광종,Yu, Seung-Hum,Chung, Young-Sook,Lee, Kyung-Ja,Kim, Kwang-Jong 대한예방의학회 1971 Journal of Preventive Medicine and Public Health Vol.4 No.1

연세지역 아파트 주민의 모자보건과 가족계획에 대한 지식, 태도와 실천을 파악하기 위하여 1970년 11 월24일부터 12월 30일까지 305명의 유배우가임부인을 대상으로 조사 하였다. 본 연구를 통해 얻어진 결과를 요약하면 다음과 같다. A. 임신과 출산 1. 현 임신율 16.4% 2. 분만장소 출산경험이 있는 281명에 대한 최종아의 분만중 48.0%가 의사 또는 조사원이 개조 하였고 그 나머지 52.0%는 가정분만이었다. 교육정도, 매스메디아 접촉정도가 높을수록, 그리고 도시출생성장일수록 병원 또는 조산원 분만이 높았다. 9. 분만시 방포 사용 종류 가정분만 141예중 세멘트 포대와 비닐을 깐 경우가 합해서 50%이었고 아무것도 깔지 않고 분만한 경우도 4예가 있었다. 4. 제대 절단 용구와 소독 가정 분만 141예중 70.2%가 가위를 사용했고, 소독해서 사용한 예는 불과 24.1%이었다. 5. 산후 휴식기간 산후 1달 혹은 1달이상 휴식한 예가 47.3%이었고 교육정도가 높아짐에 따라 길어지고 있다. 6. 초유처리 초유를 애기에게 먹인 예가 52.4%이있고 교육정도에 따라 유의한 차이가 없었다. 7. 산전 산후의 금기 음식 42.9%가 산전 산후에 먹어서는 안될 음식이 있다는 그릇된 지식을 갖고 있다. B. 아동 보건 1. 예방접종에 관한 지식과 실천 어린이 예방접종 6가지 모두 알고있는 부인은 20.3%이며 93.2%가 1가지 이상 알고있었다. 1가지 이상 실시한 경우는 85.2%이었고 교육정도별 유의한 차이는 없었다. 2. 최종아의 이환과 치료 48.1%가 아픈 일이 있었으며 그중 병원 이용은 41.5%이었다. 3. 육아 상담 76.5%가 상담한 일이 없었으며 세브란스 병원 육아 지도회 이용율은 13.2%의 저율을 보였고 앞으로의 육아지도회 이용할 생각은 54.1%가 생각 없다고 하였다. 4. 수 유 최종아의 이유기간은 6개월${\sim}$1년미만이 33.9%로 수위이며 젖뗀 이유는 모자 보건을 위해서가 수위였다. 5. 출생 및 사망신고장소에 대한 지식과 실천구청으로 답한 옳은 답은 64.6%였고 14일 이내 출생 신고한 비율은 29.2%에 한 하였다. C. 가족계획에 대한 지식, 태도, 실천정도 가족계획 찬성율은 95.0%의 고율을 보이고 있고, 97.7%가 1가지 이상의 방법을 알고 있었으나 가족계획 실천율은 35.4%이었다. 첫아이갖는 이상적인 연령은 $24{\sim}25$세가 수위였다. D. 자녀수 이상적인 평균 자녀수는 3.1명이며 인공유산 경험자는 31.1%이다. 본 논문을 완성함에 있어서 간곡하신 지도와 교열의 수고를 베풀어 주신 연세의대 예방의학교실 김일순 선생님과 연세간호대학 김모임 선생님께 충심으로 감사를 드린다. A study of the knowledge, attitude and practices about the maternal and child health of 305 married women residing in apartments at the Yonsei Community Health area was conducted during the period from November to December 1970 using designed questionnaire with well trained interviewers. The results and findings obtained from the study are summarized as follows: A. Pregnancy and Birth Questions were asked about their last child. 1. 16.4% of the women were pregnant. 2. Among 281 women who had experienced delivery, 48.0% were assisted by doctor or midwisves for their last delivery, while the rest of women delivered their last baby at home without any professional's assistance. The higher the level of education or the greater exposure to mass communication, the more the deliveries were assisted by doctors or midwives. Those women who were born and raised in cities had more deliveries assisted by doctors and midwives than those who were not. 3. Kinds of delivery sheets used. Among 141 cases of home delivery 68% used cement bag paper or vinyl sheets. Three% used nothing and remained used unsterile materials. 4. Among 141 cases of home delivery, 70.2% used scissors. The rest of them used other methods. 5. 47.3% of the women had a rest for one month or more after birth. The higher the level of education, the longer the period of rest was observed. 6. 52.4% of the women fed the colostrum to their babies. This was not related to the mother's education. 7 About half(42.9%) of the women had poor knowledge about a proper diet for the pre and post natal period. B. Child Health 1. Knowledge and practice regarding to the immunization for their children: Most of the women (93.2%) could name at least one kind of immunization. 20.3% could name 6 kinds of immunization. Mothers education level did not influence their ability to name immunizations. 85.2% of children had been immunized at least once. 2. Morbidity of last born children: 48.1% of their last born children were found to have been sick during the last year. Less than half(41.5%) of the sick children were seen by doctor. 3. Counselling at well baby clinic: Most of the women(76.5%) had no counselling for their children. Registration rate at the well baby clinic at the Severance Hospital was 13.2%. 45.9% wanted to visit to the well baby clinic at the Severance Hospital. 4. Weaning Period: 44.6% said that the beginning of the weaning for their last born children was from 6 months to twelve months of age. The most important reason of weaning was the health of both mothers and children. 5. Knowledge and Practice regarding birth and death Registration: 64.6% of the women could name correctly the Ku-office as the place for the registration. Only 29.2% registered the birth of their last born children within 14 days. C. Knowledge, Attitude and Practice regarding to family planning Most: of the women accepted the idea of family planning. 97.7% could name at least one contraceptive method. 35.4% were found to be current users of contraceptive methods. The ideal number of children was 3.1 in average.

의료보험환자(醫療保險患者)와 비보험환자(非保險患者)의 의료(醫療)서비스 내용(內容) 비교(比較) -한 종합병원(綜合病院)의 제왕절개(帝王切開) 수술환자(手術患者)를 대상(對象)으로-

유승흠,조우현,오대규,Yu, Seung-Hum,Cho, Woo-Hyun,Oh, Dai-Kyu 대한예방의학회 1981 예방의학회지 Vol.14 No.1

In order to discover differences that may exist in quantity of medical care services, length of stay and hospital charges between insured and non-insured patients, records for primary Cesarean section patients discharged between July 1978 and June 1980 from a university hospital were examined. In addition, Cesarean section rates among the total deliveries for a two-year period between the two groups were studied. The results shelved that volume of services was greater and length of stay was longer among the insured, however, charges were higher among the non-insured. Cesarean section rates were statistically significantly different between insured and non-insured patients for every age group except the group of 35 or more.

건강진단 대상질환 선정 및 건강진단의 정확성 평가

유승흠,노재훈,이해종,정상혁,Yu, Seung-Hum,Roh, Jae-Hoon,Lee, Hee-Jong,Jung, Sang-Hyuk 대한예방의학회 1989 Journal of Preventive Medicine and Public Health Vol.22 No.1

The purpose of this study was to select the manageable diseases which are prevalent in Korea for periodic health examinations and to evaluate the sensitivity and specificity of periodic health examination in detecting these diseases. The data was derived from reimbursement data of the Korea Medical Insurance Corporation over a two year period (April 15, 1986 to April 14,1988) and interviews with Yonsei Medical School professors. This study demonstrated that: 1. The manageable diseases which were selected for periodic health examinations are pulmonary tuberculosis, viral hepatitis, diabetes mellitus, syphilis groups, essential hypertension, renal disease groups, and iron deficiency anemia. 2. The sensitivity of the health screening for each disease was as follows: pulmonary tuberculosis 51.5%, viral hepatitis 60.3%, diabetes mellitus 64.7%, syphilis groups 63.3%, essential hypertension 49.9%, renal disease groups 44.0%, and iron deficiency anemia 80.9%. We conclude that peiodic health esaminations should focus on the manageable diseases that we have defined. The number of items in periodic health screening tests and hospital quality control should be increased for the diseases with a demonstrated low sensitivity.

의사인력 배출의 사회적 관련요인

유승흠,박종연,Yu, Seung-Hum,Park, Chong-Yon 대한예방의학회 1990 Journal of Preventive Medicine and Public Health Vol.23 No.4

This study was designed to investigate whether recruitment of physicians and dentists has been restricted to a social network, such as familial or kinship groups. The data was collected through a self-administered questionnaire survey distributed to a sampling of general physicians, specialists (internists, surgeons, other specialists), and dentists in August 1990. The major findings are as follows : 1) Total number of respondents was 405 ; of these, general physicians made up 48.9%, internists 10.4%, surgeons 15.8%, other specialists 4.9%, and dentists 20.0%. 2) 38.5% of the respondents had physicians or dentists in their immediate family or were related in some way to one. Those from urban areas, whose parents were highly educated, and whose father was a professional had more physicians or dentists in their family or kinship. 3) Parents of 7.1% of the respondents, brothers or sisters of 10.1%, grand parents of 1.7%, uncles or aunts of 7.9%, and cousins of 22.0% were physicians or dentists. 4) The majority of physicians or dentists in familial or kinship network specialized n surge, 32.3%, followed by internal medicine ; current worksites were noted as clinics by 30.8%, followed by general hospital, university hospital, and so on. The respondent's ma discipline tended to follow familial or kinship example. Consequently, it was concluded that physicians and dentists have been recruited within restricted familial or kinship network.

보건의료제도 변화에 대한 지역주민의 수용태도 분석

유승흠,손명세,박종연,Yu, Seung-Hum,Sohn, Myong-Sei,Park, Jong-Yeon 대한예방의학회 1989 Journal of Preventive Medicine and Public Health Vol.22 No.1

This study was conducted to analyse attitudes to a new health care system in a rural community. The specific purpose of this thesis was to classify attitudes to the patient referral system in Kangwha county, and to identify factors affecting the attitudes. Sampling was done by a multi-stage stratified cluster sampling method from the population. The data were collected in Kangwha county through a structured interview survey for two weeks in June, 1957. Attitudes to the patient referral system were classified into four types based upon answers to questions about awareness of the system, the recognition for the necessity of the system, and opinions on the improvement of the system. The four types of attitudes were active acceptance(10.2%), partial acceptance (27.2%), refusal(35.8%), and indifference(26.7%). The respondent's age, educational level, age of head of household, medical insurance fee, the number of ill family members, and the percentage of medical utilization by the family were the variables which affected the attitudes. The medical insurance fee, respondent's age, age of head of household, and the percentage of medical utilization by the family were the statistically significant discriminant factors of the four types of attitudes.

의과대학 예방의학 성적의 비교 분석

유승흠,노재훈,정상혁,남정모,Yu, Seung-Hum,Roh, Jae-Hoon,Jung, Sang-Hyuk,Nam, Chung-Mo 대한예방의학회 1989 Journal of Preventive Medicine and Public Health Vol.22 No.2

The purpose of this study was to find a better evaluation methody by comparison and analysis of the subdivision-score for preventive medicine with other subjects and the total score. Among the 475 students who were second grade in 1983, 1984 and 1985, we analyzed the stores for all subjects at Yonsei University College of Medicine obtained by 443 students, with the exception of 32 students who had had a temporary absence from school, failed or had been expelled. And we analyzed the score for preventive medicine of 162 students who were second grade in 1987 and 179 students who were second grade in 1988. Statistical analysis of the above data was done using the correlation analysis, chi-square test and discriminating index. The results were as fellows: 1. The correlations of the subdivision of preventive medicine in 1984, 1987 and 1988 were statisticall significantly high(r=0.36-0.56). 2. The grades obtained for preventive medicine and for other subjects except pediatrics (clerkship) were not independent. 3. The discriminating indices that determined whether or not a pertinent evaluation was made were 0.42 in 1983, 0.52 in 1984 and 0.54 in 1985. These results were classified as excellent. These results suggest that the score of a subject is determined not by the characteristics of the subject, but by the amount of personal study.

결정론적 모형에 의한 노인진료비 상승요인 분석

유승흠,손명세,박은철,Yu, Seung-Hum,Sohn, Myong-Sei,Park, Eun-Cheol 대한예방의학회 1994 예방의학회지 Vol.27 No.1

The purpose of this study compares determinants of eldery medical cost inflation with those of other age groups by analysing aggregated data with a deterministic model. The deterministic model of per capita medical cost inflation consists of increases in price, intensity of services, and medical utilization. We used a time series data($1985{\sim}1991$) from National Medical Insurance and analyzed by age groups. In total population, the average increase rates of inpatient and outpatient medical costs were respectively 9.5% and 8.8% during 6 years and the major cause of inflation was the increase in service intensity in both of inpatient and outpatient cases. But in the population of 65 years old and over, the average increase rates of inpatient and outpatient medical costs were respectively 13.8% and 14.8% and the major cause of inflation was the increase in per-capita medical utilization in both of inpatient and outpatient cases. Also, the increase in service intensity of 65 years old and over was the highest of other age groups. This pattern was similar during study periods. We concluded that the level of medical cost-inflation and the determinants in eldery was the highest-especially in per capita medical utilization, therfore, the inflation of medical costs in eldery will be higher than other age groups for the furture in Korea.