Receiver Operating Characteristic 분석법을 이용한 업무관련성 근골격계질환 설문지 개발

권호장,주영수,조수헌,강대희,성주헌,최성우,최재욱,김재영,김돈규,김재용,Kwon, Ho-Jang,Ju, Yeong-Su,Cho, Soo-Hun,Kang, Dae-Hee,Sung, Joo-Hon,Choi, Seong-Woo,Choi, Jae-Wook,Kim, Jae-Young,Kim, Don-Gyu,Kim, Jai-Yong 대한예방의학회 1999 예방의학회지 Vol.32 No.3

ROC곡선의 AUC는 측전도구의 기준 타당도를 나타내는 가장 일반화된 지표다. 본 연구는 ROC분석법을 이용하여 현행의 근로자건강진단에서 업무관련성 근골격계 질환의 고위험군을 변별하는 표준 설문지를 개발하고자 하였다. 컴퓨터를 이용하는 선박 설계업 종사자 89명, 전화번호 안내원 113명, 일반 직업 여성 79명, 주부 89명 등 총 370명의 일차 연구대상군에 대한 재활의 학과 전문의의 최종 진단결과를 기준으로 1996년에 개발된 '근로자의 신체 증상에 관한 설문지'의 응답결과를 비교하였다. 근골격계 질환과의 관련성이 높은 문항조합을 선정하고 문항별 가중치를 산출하기 위해 로짓회귀분석, 상관분석 등을 실시하였으며, 문항조합 및 가중치 산출방법이 서로 다른 4가지 설문모형에 따른 AUC를 비교 하였다. 또한, 국내 모 자동차조립공장 근로자 225명의 설문결과와 산업의학 전문의의 진단결과 자료를 이용하여 4가지 설문모형의 AUC 재현도를 확인하였다. 분석 결과, 통계적으로 유의 한 차이는 없었으나 문항수를 줄여도 문항별 응답수준별 가중치를 부여하면 AUC가 일관되게 증가함을 확인하였다. 증상문항 4개와 신체부위문항 7개를 통합한 11개 문항에 가중치를 부여하는 모형이 변별력, 재현도, 편의성 측면에서 우수한 것으로 나타나, 이를 기준으로 새로운 업무관련성 근골격계 질환 설문지를 설계할 수 있었다. 문항수가 적으면서도 타당도는 높은 설문지를 개발하고, 상대적인 비교평가에 쓰일 수 있는 정량적 가중치를 제시한 것이 본 연구의 주요성과라 할 수 있다. 본 연구는 전문의 사이의 진단기준 차이를 고려하지 못한 점, 다양한 인구집단에 적용할만한 절대적인 참고치를 제시하지 못한 점 등에서 한계가 있다. 그러나, '측정 도구의 정량적 타당도 검증을 통한 질병 감시용 도구 개발'이라는 본 연구의 기본 취지 및 접근방법은 향후 조직적인 질병 예방활동에 활용될 여지가 있을 것이다. Objectives: Receive Operating Characteristic(ROC) curve with the area under the ROC curve(AUC) is one of the most popular indicator to evaluate the criterion validity of the measurement tool. This study was conducted to develop a standardized questionnaire to discriminate workers at high-risk of work-related musculoskeletal disorders using ROC analysis. Methods: The diagnostic results determined by rehabilitation medicine specialists in 370 persons(89 shipyard CAD workers, 113 telephone directory assistant operators, 79 women with occupation, and 89 housewives) were compared with participant's own replies to 'the questionnair on the worker's subjective physical symptoms'(Kwon, 1996). The AUC's from four models with different methods in item selection and weighting were compared with each other. These 4 models were applied to 225 persons, working in an assembly line of motor vehicle, for the purpose of AUC reliability test. Results: In a weighted model with 11 items, the AUC was 0.8155 in the primary study population, and 0.8026 in the secondary study population(p=0.3780). It was superior in the aspects of discriminability, reliability and convenience. A new questionnaire of musculoskeletal disorder could be constructed by this model. Conclusion: A more valid questionnaire with a small number of items and the quantitative weight scores useful for the relative comparisons are the main results of this study. While the absolute reference value applicable to the wide range of populations was not estimated, the basic intent of this study, developing a surveillance fool through quantitative validation of the measures, would serve for the systematic disease prevention activities.

일부 재해성 요부손상 환자의 심리적 특성

하미나,조수헌,권호장,한상환,주영수,박남종,Ha, Mi-Na,Cho, Soo-Hun,Kweon, Ho-Jang,Han, Sang-Hwan,Joo, Young-Soo,Pack, Nam-Jong 대한예방의학회 1995 Journal of Preventive Medicine and Public Health Vol.28 No.3

This study was done for identifying the factors which affect psychologic symptoms of low back(LBP) patients. The study subjects were 43 work-related low back pain patients, 28 work-related non-low back pain patients and 47 general low back injury patients. The study materialis SCL 90-R for checking psychologic symptoms and questionnaire for obtaining general information about the subjects. The data were analyzed by model of analysis of covariance adjusted by several variables such as gender, age, education and marital status and then compared the least square means of symptom score between groups. To identify the factors that affect psychologic symptom, duration of suspension, return to work and interaction factor of these two variables were analyzed by multivariate model and we calcuated partial correlation coefficient of these variables. As a result, work-related LBP patients showed higher score of symptoms in somatization, depression and psychosis than work-related non-LBP and non-work-related LBP. Duration of suspension and return to work were significant explanatory variables for psychologic symptom score of work-related LBP. Then, we may conclude that the treatment and rehabilitation programe for work-related LBP should cover the strategy of early return to work. 산업재해성 요부손상 환자의 심리적 증상은 산업재해성 비요추 환자에 비하여 신체화 증상, 우울, 공포증, 정신증의 항목에서 통계학적으로 유의하게 높은 점수를 나타냈고, 직업과 관련없이 발생되어 의료보험으로 치료를 받는 비산업재해성 요부손상 환자에 비하여 신체화 증상, 우울, 불안, 편집증, 정신증의 항목에서 통계학적으로 유의하게 높은 점수를 나타냈다. 산업재해성 요부손상 환자의 심리적 증상은 휴직 기간과, 작업복귀 여부, 그리고 이 둘의 교호 작용이 유의한 설명력을 가지는데, 휴직 기간이 길수록 또 현재 작업에 복귀하고 있지 않았을 경우에 심리적 증상은 더 높은 점수를 나타내었다. 산업재해성 요부손상 환자에서 사회심리적 증상은 질병의 발생과 그것의 만성화에 따라 심화되며, 조기 작업복귀를 포함한 다차원적이고 포괄적인 재활 치료가 산업재해성 요부손상 환자의 관리에 성공적일 수 있을 것으로 생각된다.

연구논문 : 인터넷 여론조사의 정확도 관련요인

조성겸 ( Sung Kyum Cho ),주영수 ( Young Soo Joo ),조은희 ( Eun Hee Cho ) 한국조사연구학회 2005 조사연구 Vol.6 No.2

크롬 폭로가 자매염색분체교환 빈도 및 8-hydroxydeoxyguanosine 농도에 미치는 영향

한상환,조수헌,김헌,하미나,주영수,박수민,권호장,김용대,정명희,Han, Sang-Hwan,Cho, Soo-Hun,Kim, Heon,Ha, Mi-Na,Joo, Young-Soo,Park, Soo-Min,Kwon, Ho-Jang,Kim, Yong-Dae,Chung, Myung-Hee 대한예방의학회 1995 예방의학회지 Vol.28 No.2

크롬염 안료제조공장 근로자를 대상으로 크롬 폭로와 말초혈액 림프구의 8-OH-dG 농도의 상관성을 직접 관찰함으로써 크롬의 암 발생기전에 산소유리기(oxygen free radical)가 관여하는지 여부와 크롬폭로에 따라 자매염색분체교환 빈도가 증가하는지를 밝힐 목적으로 본 연구를 수행하였다. 안료공장에 1년 이상 근무한 근로자 38명을 대상으로 설문지를 통하여 근무기간, 연령, 성, 크롬 폭로와 관련된 자각적 증상 등을 조사하였으며, 이들의 크롬 폭로 수준을 평가할 수 있는 생물학적 지표로서 혈중 및 크레아티닌 보정 요중 크롬 농도를 측정하였다. 크롬에 의한 생물학적 영향지표로서 말초혈액 림프구로 부터 dG에 대한 8-OH-dG의 몰 농도비를 측정하였으며, 분열 중기의 세포 30개를 관찰하여 세포당 자매염색분체교환 빈도를 계수하여 염색체 46개당 평균 자매 염색분체교환 빈도로 환산하였다. 분석결과 현재 크롬 폭로 수준을 판단하는 생물학적지표로 가장 많이 사용되는 크레아티닌 보정 요중 크롬 농도와 림프구에서의 dG에 대한 8-OH-dG의 물 농도비는 유의한 상관관계(r=0.47, p<0.01)를 보이는 것으로 분석되었으며, 현재의 흡연수준을 보정하고 분석한 결과에서는 상관계수가 증가하는 결과(r=0.62, p<0.05)를 나타내었다. 한편 자매염색분체교환 빈도와 크롬 폭로수준간에는 유의한 상관관계가 관찰되지 않았다. 이러한 결과는 크롬의 발암성에 DNA 부가체(adduct)의 형성이 중요한 기전일 수 있다는 기존의 연구결과와 일치하며, 따라서 8-OH-dG는 크롬에 의한 발암성을 예측할 수 있는 생물학적 영향지표로서 활용될 수 있음을 시사한다고 할 수 있다. To elucidate some DNA adducts as a biological marker for workers of chromate pigment, the effects of chromium exposure on the formation of 8-hydroxydeoxyguanosine(8-OH-dG) and sister chromatid exchanges(SCEs) frequency in 38 workers of a pigment plant in Bucheon which utilized lead chromates, were examined. The chromium contents of venous blood and urine were measured as working environmental exposure level. The concentrations of 8-OH-dG in DNA isolated from lymphocytes were determined with high performance liquid chromatography and electrochemical detector and denoted as a molar ratio of 8-OH-dG to deoxyguanosine(dG). The SCEs frequency were analyzed in DNA isolated from lymphocytes. A significant correlation was found between creatinine adjusted urine chromium concentration and the molar ratio of 8-OH-dG to dG(r=0.47, p<0.01). After adjusting the current smoking habit, the correlation coefficient was increased(r=0.62, p<0.05). However, there was no significant correlation between the SCE frequency and chromium exposure. This significant results between molar ratio of 8-OH-dG to dG and chromium exposure are in good agreement with in vitro studies that support the importance of DNA adduct formation for the carcinogenic effect of chromium.

한국 여성에서의 자궁경부암 발생률

박병주,이무송,안윤옥,최영민,주영수,유근영,김헌,유하성,박태수,Park, Byung-Joo,Lee, Moo-Song,Ahn, Yoon-Ok,Choi, Young-Min,Ju, Yeong-Su,Yoo, Keun-Young,Kim, Hun,Yew, Ha-Seung,Park, Tae-Soo 대한예방의학회 1996 Journal of Preventive Medicine and Public Health Vol.29 No.4

To estimate the incidence of uterine cervix cancer among Korean women, we have conducted a study using the claim data on the beneficiaries of Korea Medical Insurance Corporation (KMIC). All medical records of the potential cases with diagnosis of ICD-9 180, 181, 182, 199, 219, 233 in the claims sent by medical care institutions in the whole country to the KMIC from January 1988 to December 1989, were abstracted and Gynecology specialist reviewed the records to identify the new cases of uterine cervix cancer among the potential cases during the corresponding period. Using these data, the incidence of uterine cervix cancer among Korean women was estimated as of July 1, 1988 to June 30, 1989. The crude rate was estimated to be 17.34(95% CI: $16.76\sim17.92$) per 100,000 and the cumulative rates for the ages $0\sim64\;and\;0\sim74$ were 1.7% and 2.2%, respectively. The age-adjusted rate for the world population was 19.93 per 100,000 which was higher than those of other Asian countries including China and Japan in $1983\sim1987$. The truncated rate for ages $35\sim64$ was 52.05 per 100,000 which was one of the highest in the world. With increasing age, the incidence rate increased to 78.11 per 100,000 in women aged $55\sim59$ years, then it decreased in the older groups. This finding suggests that detecting rate of uterine cervix cancer may decrease in women aged 60 years or older due to inadequate medical care seeking behavior. In the geographical area, the SIR of Jeju province was significantly low but it might be due to statistical unstability by small case numbers.

알레르기 ; 단일기관에서 전산을 통해 수집된 자발적 약물유해반응 보고사례들의 분석

김민강 ( Min Gang Kim ),강혜련 ( Hye Ryun Kang ),김주희 ( Joo Hee Kim ),주영수 ( Young Soo Ju ),박성훈 ( Sung Hoon Park ),황용일 ( Yong Il Hwang ),장승훈 ( Seung Hun Jang ),김동규 ( Dong Gyu Kim ),정기석 ( Ki Suck Jung ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5

저자는 2007년 9월부터 2008년 10월까지 한림대 성심병원에서 보고된 약물유해반응 사례들의 원인약물과 임상양상을 분석하였다. 전산화 시스템을 도입한 이래 보다 효율적으로 약물유해반응을 수집할 수 있었으며, 병동별 약물유해반응 담당자를 정함으로써 안정적인 약물감시체계를 정착시킬 수 있었다. 보고된 1,112건 중 인과성이 있다고 평가된 사례는 980건이었으며, 이 중 원인 약물로 의심되는 약제는 항생제, tramadol, 조영제, 아편계 진통제 순이었다. 보고사례들 나이가 많을수록 증상이 심한 사례의 비율이 높았으며, 성별에 따라서는 여자들의 평균 연령이 남자들보다 높았다. Tramadol, NSAIDs로 인한 약물 유해반응 보고사례에서는 여자가 차지하는 비율이 높았다. 가장 흔한 임상양상은 피부 발진과 두드러기 등의 피부 이상반응이었고, 오심, 구토 등의 소화기계반응이 그 뒤를 이었다. Background/Aims: The recent introduction of computerized surveillance systems has promoted the monitoring of adverse drug reactions (ADRs), a feature that facilitates voluntary reports and enables prompt feedback. To investigate the causative agents and severity of ADRs that occurred in a single hospital, we analyzed the features of 980 ADRs that occurred over 14 months after developing a computerized ADR reporting system in Hallym Sacred Heart Hospital. Methods: ADR data collected prospectively from September 2007 to October 2008 by a computerized reporting system were analyzed. The World Health Organization-Uppsala Monitoring Center (WHO-UMC) criteria were used to determinate causality for each ADR. Results: The number of ADR cases reported voluntarily increased rapidly since the introduction of the computerized ADR reporting system. Of the 980 cases, antibiotics (34.5%) were the most common causative drugs, followed by analgesics such as tramadol and its compound (15.2%), radiocontrast media (7.0%), narcotics (5.9%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (5.5%). Fifty-nine (6.0%) and 206 (21.0%) cases were classified as severe and moderate reactions, respectively. The mean age was older in patients with severe ADRs than in patients with non-severe ADRs. The most common clinical features were skin manifestations, such as pruritus, skin eruptions, and urticaria. Gastrointestinal symptoms including nausea, vomiting, and diarrhea were the second most frequently reported ADRs. Among antibiotics, first-generation cephalosporins were the most frequently reported causative drugs, followed by second-generation cephalosporins, penicillin/β-lactamase inhibitors, and third-generation cephalosporins. While 11.6% of ADRs related to penicillin/β-lactamase inhibitors were classified as severe, there was only one severe ADR (1.1%) for first-generation cephalosporins. Most ADRs were reported equally in men and women, although female cases constituted about two thirds of ADRs associated with tramadol and NSAIDs. Conclusions: We believe that a computerized reporting and replying system promoted the monitoring of ADRs. Antibiotics were reported most frequently as the causative agent of ADRs. Elderly patients seemed to be more susceptible to severe ADRs. With the voluntary reporting system, skin manifestations and gastrointestinal symptoms were detected successfully, while laboratory abnormalities without prominent symptoms seemed to be overlooked. Further efforts to screen for automated ADR signals are required. (Korean J Med 77:601-609, 2009)

사업장 소음 폭로에 의한 일과성 역치 상승과 회복

조수헌,하미나,한상환,주영수,성주헌,강종원,윤덕로,송동빈,이명학,김선태 大韓産業醫學會 1996 대한직업환경의학회지 Vol.8 No.2

To determine the recovery time from noise-induced temporary threshold shift(TTS), a prospective field study was conducted at three worksites where workers are known to be exposed high level of noise. Subjects were selected according to answers on a questionnaire which inquired about otological history and previous noise exposure, including avocational, military and occupational exposures. After excluding employee with past otologic problems, recent exposure to high level noise, and under medications, total 92 employees participated in the study. Among 92 participants, complete consecutive audiometric examinations were carried out at 0∼2 hours, 5∼7 hours, 14∼16 hours after worktime noise exposure on 26 participants wearing hearing protectors and 22 participants wearing no protective devices. The difference between the hearing level 0∼2 hours after noise exposure and 5∼7 hours is statistically significant by paired t-test(p<0.01). The median recovery times calculated from the data of 22 participants wearing no protective hearing devices are 15.6 hours at 4000Hz, and 7.7 hours, 10.3 hours, 8.4 hours at 1000Hz, 2000Hz and 8000Hz respectively. These data suggest that when measuring the pure tone audiometry for noise exposed workers, at least 16 hours noise-free interval is required.

일부 간호사들에서 교대근무가 수면에 미치는 영향

윤덕로,강대희,이승준,주영수,박진구,황호영,황필규,황은주,황예원,성주헌,홍순범,황승식,황재욱,조수헌 大韓産業醫學會 1998 대한직업환경의학회지 Vol.10 No.1

Industrialization has introduced various working systems into the modern society. Shift work is a good representative among those. So far various adverse health effects, possibly caused by this shift work, have mainly been reported in the fields of manufacturing industry by many other researchers ; sleep disorders, gastrointestinal disorders and cardiovascular disorders and so on, These health effects were thought to be caused by the changes of circadian rhythm on shift working. This study was especially planned to evaluate effects of shift work on sleep disorders among shift-working medical manpower like hospital nurses, important persons dealings with lives, and ultimately to provide them with basic evidence for improving work environment. The study subjects were arbitrarily selected among shift-working female nurses and day-working female pharmacists in one university hospital in Seoul, and finally 79 nurses and 58 pharmacists were enrolled. The research was conducted by using self-administered questionnaire, consisting of items about socio-behavioral factors including demographic factors which can affect sleep patterns and questions which make it possible to evaluate sleep disorders(e.g. sleeping duration, sleep latency, re-sleep latency, days of insomnia per week, drug use for sleep, and subjective symptoms). The result showed that the shift workers had significantly longer sleep and re-sleep latency, more days of insomnia, and a stronger likelihood of using drugs when they had sleep difficulty than day-working pharmacists. And the number of night shift duties per month was discovered as the only significant predictor of sleep latency. Additionally, the subjective symptoms related to sleep disorders when awake and at work, showed negligible differences between the shift workers and dayworkers. In conclusion, we found shift-work was risk factor for sleep disorders.