병원건강증진서비스에 대한 의료소비자의 이용의도

함명일,강명근,박춘선,조우현,Hahm, Myung-Il,Kang, Myung-Geun,Park, Choon-Sun,Cho, Woo-Hyun 대한예방의학회 2003 예방의학회지 Vol.36 No.2

Objective : To determine the relationships between customer's attitude, the subjective norm and the intention to use hospital-based health promotion services. Methods : This study was based on the theory of reasoned action, suggested by Fishbein and Ajzen. The subjects of this study were 501 residents of Seoul, Bun-dang, Il-san and Pyung-chon city, under 65 years, who were stratified by sex and age. A covariance structural analysis was used to identify the structural relationships between attitude towards health promotion programs or services, their subjective norm and their intention to use the aforementioned services. Results : The subjective norm for using the health promotion programs or services provided by hospitals was a significant predictor of the intention to use, but the attitude towards the services was not significant Conclusions : Our results suggest that a customer's reference group affects their use of the hospital-based health promotion services. Because the subjects of this study were restricted to specific urban areas, there are limitations to generalizing the study results. Despite the limitations of these results, they can serve as baseline information for the understanding of consumers behavior toward hospital-based health promotion services.

전립선비대증의 진료지침 개발을 위한 한국문헌의 메타분석

유승흠,김춘배,강명근,송재만,Yu, Seung-Hum,Kim, Chun-Bae,Kang, Myung-Geun,Song, Jae-Mann 대한예방의학회 1997 Journal of Preventive Medicine and Public Health Vol.30 No.3

This study is to provide evidence-based recommendations for the most-effective treatments of benign prostatic hyperplasia based on patient preference or clinical need, and to meta-analyze the Korean literatures for the development of BPH treatment guidelines. For these analyses, extensive literature searches (208 articles), with priority given to the Korean Journal of Urology, were conducted from 1960 to August, 1996. Meta-analysis, like all statistical analysis, has two main functions: data summarization (qualitative meta-analysis) and smoothing o. pattern recognition (quantitative meta-analysis). As well, critical reviews and syntheses with the mean and 90-percent confidence intervals for the likelihood were used to evaluate empirical evidence and significant outcomes of the BPH treatment literatures (106 articles). For this task, the Methodologic Panel for BPH Guidelines was composed of multidisciplinary experts in the field. The results of the study were summarized as follows: For all that watchful waiting is an appropriate treatment strategy for the majority of patients with prostatism, we couldn't find the Korean literatures which carried this article. The literatures on alpha-1-adrenergic receptor blockers provide no evidence to suggest that any one alpha blocker is more effective than another. The finasteride reduces the size of the prostate, on average, and leads to a small yet perceptible reduction in sysptoms. Of all treatment options, prostate surgery with transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), and so on, offers the best chance for symptom improvement. However, surgery also has the highest rates of significant complications. Therefore, surgery need not always be a treatment of last resort. Balloon dilation of the prostatic urethra is clearly less effective than surgery in relieving symptoms, but it is associated with fewer complications. Emerging technologies for treating BPH include lasers, coils, stents, thermal therapy and hyperthermia. Established technologies will also be reanalyzed as results of new trials are reported. Although this study has some limitations due to lacking for good quality literatures, ' it provides a cornerstone for our medical research. It represents the most current scientific knowledge regarding the clinical epidemiology including treatment of BPH. It will be revised and updated as needed.

직업적 특성과 사회심리적 스트레스간의 관련성

장세진,차봉석,고상백,강명근,고상열,박종구,Chang, Sei-Jin,Cha, Bong-Suk,Koh, Sang-Baek,Kang, Myung-Geun,Koh, Sang-Ryul,Park, Jong-Ku 대한예방의학회 1997 예방의학회지 Vol.30 No.1

This study was carried out to assess the relationship between job characteristics(job strain) and psychosocial distress, and to find out the effect of social support on psychosocial distress. The study design was cross-sectional, and included 1,211 industrial workers in middle-sized city. A self-administered questionnaire measured job characteristics(jod demand, job control), and social support(coworker support, supervisor support) at work. Psychosocial distress was measured using PWI(Psychosocial Well-being Index), a 45-item self-administered instrument. Among the 1,211 respondents, the prevalence of psychosocial distress was 24.8% High job stram (high job demand + low job control) was present in 8% of the subjects. The crude odds ratio of high job strain was 4.76 (95% CI : 2.60-8.74), and those of active group and passive group were 3.81(95% CI : 1.82-3.95) and 2.64(95% CI : 1.77-3.94), respectively. The odds ratios of each group adjusted for sex, age, support, and religion were still significant. Our results supported the association between job strain and psychosocial distress. Social support at work, although significantly associated with psychosocial distress, did not modify the association between job strain and psychosocial distress.

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.

민영의료보험 가입이 일부 경ㆍ요추부 염좌 환자의 입원에 미치는 영향

장동렬(Dong-ryul Jang),강명근(Myung-geun Kang) 한국농촌의학 지역보건학회 2012 농촌의학·지역보건 Vol.37 No.2

이 연구는 2008년 6월 1일부터 2008년 8월 31일까지 광주ㆍ전남지역에 소재하고 있는 20개 의료기관(병원 3, 의원 17)에서 신경학적 증상이 없는 단순 경ㆍ요추부 염좌 진단을 받고 입원 및 외래치료를 받은 환자 449명(입원=384명, 외래=85명)을 대상으로 민영의료보험 가입이 입원에 미치는 영향을 규명하기 위해 시행되었다. 구조화된 설문지를 이용하여 조사한 응답 결과에 대해 단일변량분석을 시행하고 입원여부와 유의한 관련성이 있는 변수를 독립변수로 하여 다단계 로지스틱회귀분석을 실시한 결과와 그 함의는 다음과 같았다. 관련된 요인을 통제한 후에도 민영의료보험 가입여부의 입원에 대한 비차비는 3.31(95%CI 1.41-9.58)로서 민영의료보험 가입은 입원여부에 독립적으로 유의한 영향을 미치는 요인임이 확인되었다. 그 밖에 조사대상 환자군의 입원에 영향을 미치는 요인들을 변수군별로 보면 환자의 사회인구학적 요인 변수군의 결정계수(R²)가 0.226로 가장 컸고 다음으로 의료기관 및 의료인 특성 변수군의 R²=0.122, 질병 특성 변수군의 R²=0.108 등이었으며 민영의료보험의 가입여부의 R²=0.013으로 결정계수 값이 크지는 않았다. 이 연구는 경증질환 진단을 받은 환자를 대상으로 현재 중소규모 의료기관에서 진료중인 환자를 대상으로 민영의료보험 가입여부와 입원여부의 관련성을 구명한 국내 최초의 실증연구로서 민영의료보험의 가입이 초래하는 도덕적 해이의 존재와 정도를 일정부분 규명하였다는 점에서 그 의의를 찾아 볼 수 있다. 전 국민 의료보험제도 하에서 이는 민영의료보험 자체 뿐 아니라 건강보험에 대한 외부효과도 존재할 수 있음을 시사하는 결과로서 이를 내부화하기 위한 적절한 조치의 마련이 필요할 것으로 판단된다. Background: In Korea, private health insurance has neglected to induce externality on national health insurance by moral hazard. Therefore, we conducted this study in order to explore the influence of private health insurance on unnecessary medical utilization among patients with cervical or lumbar sprain. Method: The study examined a population of 449 patients (admission, 384; out-patient; 85) diagnosed with simple cervical or lumbar sprain without neurological symptoms at 20 small hospitals or clinics in Gwangju and Jeollanam provinces from Jul. 1 to Aug. 31 2008. The data were collected using structured, self-administrated questionnaire which collected information such as whether or not the patient was admitted (as a dependent variable), whether or not they had private health insurance (as a independent variable), and covariates such as socio-demographic characteristics, the factors related to the sprain, and characteristics of the insurance provider. Results: From hierarchical multiple logistic regression analysis, it was found that the admission rate of patient with private health insurance was higher than that those without it (Odds ratio=3.31, 95% Confidence interval; 1.14-9.58), meaning that private health insurance was an independent factor influencing the admission of patients with these conditions. Other determinants of admission were patient age and physician referral. Conclusions: This study is the first empirical study to explore the influence of private health insurance on inducing moral hazard in admission services, specifically among patients with cervical or lumbar sprain. Regulation of benefits provided by private health insurance may be necessary, as the effect of this moral hazard may mean existence of externality.

일부 농촌지역 성인에서 EQ-5D를 이용한 건강관련 삶의 질

한미아,류소연,박종,강명근,박종구,김기순,Han, Mi-Ah,Ryu, So-Yeon,Park, Jong,Kang, Myung-Geun,Park, Jong-Ku,Kim, Ki-Soon 대한예방의학회 2008 예방의학회지 Vol.41 No.3

Objectives : The purposes of this study were to examine the health-related quality of life(HRQoL) and to identify its related factors for a group of rural adults. Methods : The study subjects were 1,901 adults who were aged 40-70 years and who were living in Naju City, Jeollanamdo. The sociodemographic characteristics, health-related behavior, health status and global self-rated health were collected for statistical analysis. The health-related quality of life was measured by the Euroqol EQ-5D instrument. The differences on the EQ-5D index between the groups were assessed with t-test, ANOVA and hierarchical multiple regression analysis. Results : Overall, the mean value of the EQ-5D index was $0.884{\pm}0.140$ and this score was significantly different according to the socioeconomic characteristics, the health-related behavior, the health status and the global self-rated health. According to the results from the hierarchical multiple regression analysis, the HRQoL was significantly reduced for females, older subjects, and other subjects with no spouse and the subjects with osteoporosis, obesity, mental distress or poorer global self-rated health. Conclusions : The HRQoL for rural adults was related to the socioeconomic characteristics, the health status and the global self-rated health, A better understanding of the factors related to the HRQoL would help to improve the rural adults' quality of life.

대사증후군과 알라닌 아미노전이효소와의 관련성 - 국민건강영양조사 제3기(2005년)

한미아(Mi Ah Han),류소연(So Yeon Ryu),박종(Jong Park),강명근(Myung Geun Kang),김기순(Ki Soon Kim) 한국역학회 2008 Epidemiology and Health Vol.30 No.1

  Purpose: The aim of this study was to investigate the association between the metabolic syndrome and alanine aminotransferase(SGPT) levels in Korean adults.   Methods: The study subjects were 4,325 adults aged ≥ 19 years without an apparent cause of liver disease from the Third Korea National Health and Nutrition Examination Survey(2005). The metabolic syndrome was defined using criteria established by the NCEP/ATP Ⅲ, while abdominal obesity was assessed based on the Asia-Pacific guidelines. Subjects with SGPT ≥ 40 IU/L were considered to have elevated SGPT levels. Demographic characteristics, waist circumference, blood pressure, triglyceride, HDL cholesterol, fasting blood sugar were recorded for statistical analysis.   Results: The prevalence of elevated SGPT levels was significantly increase with the presence of the metabolic syndrome and its components. In multiple logistic regression analyses, odds ratio for the elevated SGPT levels was significantly high in the subjects with the metabolic syndrome compared to the subjects without metabolic syndrome after adjusted for socio-demographic characteristics and health-related behavior.   Conclusions: The metabolic syndrome was independently associated with SGPT levels in Korean adults.

일부 응급구조사들의 응급처치 시행내용과 관련 요인

정상길(Sang Gil Jeong),김기순(Ki Soon Kim),조수형(Soo Hyung Cho),강명근(Myung Geun Kang),한미아(Mi Ah Han) 한국농촌의학 지역보건학회 2009 농촌의학·지역보건 Vol.34 No.3

우리나라 여러 기관에 근무하는 응급구조사들의 응급처치 시행내용과 관련요인을 파악코자 2008년 6월 대한응급구조사협회에서 주최하는 보수교육에 참여한 자중 80명과 특정지역 119 구급대 소속 53명, 총 133명에게 설문조사를 시행하였다. 본 연구 결과 조사대상 응급구조사들의 응급처치 내용별 빈도를 보면 생체징후감시가 가장 많았고 그다음이 산소포화도 측정, 산소투여, 지혈 및 창상처치, 심전도 감시 순으로 많았다. 응급처치 23개 전체항목 시행횟수에 통계적으로 유의한 관련요인은 거주지 구분과 자격종류이었으며 단일 응급처치항목으로서 정맥로 연결시행횟수의 유의한 관련요인은 대상자의 성별, 정맥로 연결에 대한 중요성 인식도이었고 근무 기관의 종류도 경계역에서 유의한 관련요인으로 선정되었다. 심전도 감시 시행횟수의 유의한 관련요인은 대상자의 성별로 남성보다 여성이 시행 횟수가 많았다. 따라서 응급구조사들의 응급처치 시행횟수를 상황에 따라 적절하게 유지케 하기 위해서는 응급구조사들의 응급처치에 대한 중요성 인식도, 응급처치에 대한 자신감 등을 향상 시킬 수 있는 노력이 이루어져야 하며 특히 남성 응급구조사, 2급 응급구조사, 중소도시에 거주하는 응급구조사들에 대한 관리 노력이 이루어져야 할 것으로 사료된다. 또한 응급구조사들의 응급처치 시행에 대한 적절성 평가와 더불어 응급구조사 역할 발전에 대한 지속적인 연구가 이루어져야 한다고 사료된다. Objectives: A study was conducted by analysing the contents and frequency of emergency treatment practiced by emergency medical technicians(EMTs) in emergency situations and contains related factors. Methods: The study subjects included 80 EMTs who participated in ongoing education classes during the period from June 25th to June 26th, 2008. the survey included 53 EMTs employed within 119 first aid teams in fire stations in both a metropolitan city and a medium-sized city. From the survey results relation between frequency of emergency treatment and subjects characteristics explored statistically including t-test, X2 test, Pearson correlation and finally stepwise multiple regression. Results: The most frequent procedure by EMTs checking vital signs. The statistically significant related factors overall of the 23 items of emergency treatment frequency was the working area and the grading of EMT certification. In contrast, significant related factors with frequency of IV linkage were found to be the subjects gender, institution employed and the importance of recognizing the item. The statistically significant related factors of that of ECG monitoring was the gender of respondents. Conclusions: To keep the appropriate frequency of emergency treatment by EMT, active efforts to promote their individual importance and confidence cognition are necessary, especially towards males and persons who have 2<SUP>nd</SUP> class certification. Moreover, EMTs who work in small cities must be supported.

원저 : 공중구강보건학 분야 ; 초등학교 불소용액양치사업의 비용-편익 분석

정세환 ( Se Hwan Jung ),박웅섭 ( Woong Sub Park ),류다영 ( Da Young Ryu ),강명근 ( Myung Geun Kang ) 대한구강보건학회 2008 大韓口腔保健學會誌 Vol.32 No.2

범이론적 모형에 근거한 일부 초등학교 고학년 아동의 운동행위 변화단계 관련요인

박일순(Il Soon Park),박종(Jong Park),류소연(So Yeon Ryu),강명근(Myung Geun Kang) 한국보건교육건강증진학회 2011 보건교육건강증진학회지 Vol.28 No.3