외래환자에서 금연 성공의 결정요인

강윤식,장정순,황영실,홍대용,김장락,Kang, Yune-Sik,Jang, Joung-Soon,Hwang, Young-Sil,Hong, Dae-Yong,Kim, Jang-Rak 대한예방의학회 2003 Journal of Preventive Medicine and Public Health Vol.36 No.3

Objective : This study was conducted in order to investigate predictors of smoking cessation in outpatients. Method : Subjects were 40f adult smoking patients who saw their doctors in the outpatient setting at a university hospital, regardless of their willingness of otherwise in smoking cessation. Physicians delivered a brief, stop smoking prompt to all patients who smoked one or more cigarettes a day. Then they referred to on-site counselors who provided a brief, nurse assisted intervention with a survey to a randomly assigned intervention group (200 smoking patients), whom the counselors telephoned later to prevent relapse or promote the motivation to quit, or gave only a survey to a control group (201 smoking patients). After at least 5 months, self-reported current smoking cessation was confirmed later using cut-off values of 7 ppm or less in expired alveolar air after breath holding portable CO analyzer. Results : After 5 months, subjects in the intervention group were 1.56 times (95% C.I. 0.89-2.73) more likely to quit smoking than those in the non-intervention group (14.0% vs. 9.0%). Willingness to quit smoking in a month, scheduled admission in a month, self efficacy score and FTND (Fagerstrom Test for Nicotine Dependence) score were all significantly related with smoking cessation. In stepwise multiple logistic regression, previous attempts to quit smoking were significant instead of self efficacy score. In the intervention group who had willingness to quit smoking in a month (132 smoking patients), FTND score, whether quit date was today, and whether quit promise paper was submitting were all significantly related with smoking cessation. In stepwise multiple logistic regression, scheduled admission in a month and whether quit date was today were significant predictor variables, Smoking cessation treatment should be tailored to individual smoking patients considering these predictors.

전공의들의 전문직인식이 직업만족도에 미치는 영향

강윤식,감신,예민해,Kang, Yune-Sik,Kam, Sin,Yeh, Min-Hae 대한예방의학회 1997 예방의학회지 Vol.30 No.1

In ordo to investigate the professional job perception and job satisfaction of interns and residents and its related factors, the author conducted survey using self administered questionnaire for 2 months(August and September, 1996). The study subjects were 562 interns and residents who worked at one university hospital(tertiary hospital) and two general hospitals(secondary hospital) in Taegu, Korea. Among them, 297 (52.8%) responded completely. The results were as follows ; Respondents thought that people component was most important, science and status components were next among professional value scales which meant the desirable attitudes required to conduct professional works. But, the score of professional value scales was generally high and not affected by other variables in multiple linear regression analysis. They seemed to have very normative and ideal perceptions about professional values. The score of professionalism scales, which were attitudinal and behavioral traits about professional job, of high grade residents was significantly higher than that of interns and lower grade residents. The score of reference to professional organization and autonomy factor were increasing significantly as the grade increased. Working conditions and perception for socioeconomic status of doctors influenced the score of professionalism scale significantly. It seemed that professional socialization was made during the training periods of interns and residents. Most of respondents answered that current socioeconomic status of doctors were middle and high strata but they responded that the socioeconomic status of doctors would fall in the future. They seemed to have a pessimistic thought about doctor's status. Generally the respondents thought that they were satisfied with doctor job and fit to the job, but 51.9% answered that if possible they would get other jobs. It seemed to reflect their critical thinking on doctors' status. Perceptions about socioeconomic status of doctors, professional value and professionalism influenced job satisfaction significantly. The interns and residents had high sense of calling to doctors and thought that doctors were socially important job. Generally they were satisfied with their job. Interns and residents had normative thoughts about the trait which compentent doctors must have. During the training period, they seemed to have attitude and perception as a professional and to make professional socializations.

예방의학 영역에서 심신의학적 접근의 적용 가능성: 스트레스 관리를 위한 이완과 명상 기법을 중심으로

강윤식,Kang, Yune-Sik 대한예방의학회 2010 예방의학회지 Vol.43 No.5

Objectives: Emotional support and a stress management program should be simultaneously provided to clients as effective preventive services for healthy behavioral change. This study was conducted to review various relaxation and meditation intervention methods and their applicability for a preventive service program. Methods and results: The author of this paper tried to find various relaxation and meditation programs through a literature review and program searching and to introduce them. The 'Relaxation Response' and 'Mindfulness Based Stress Reduction (MBSR)' are the most the widely used meditative programs in mainstream medical systems. Abdominal breathing, Progressive Musclular Relaxation (PMR), Relaxative Imagery, Autogenic Training (AT) and Biofeedback are other well-known techniques for relaxation and stress management. I have developed and implemented some programs using these methods. Relaxation and meditation classes for cancer patients and a meditation based stress coping workshop are examples of this program. Conclusions: Relaxation and meditation seem to be good and effective methods for primary, secondary and tertiary preventive service programs. Program development and standardization and further study are needed for more and wider use of the mindbody approach in the preventive service area of medicine.

한국에서 의료전문직의 개념과 논의

강윤식 ( Yune Sik Kang ) 한국의료윤리학회 2010 한국의료윤리학회지 Vol.13 No.3

Many Korean physicians are dissatisfied with their socioeconomic status. While they report high levels of pride in their chosen profession, Korean physicians tend to have a poor understanding of ethical issues, weak social skills, confusion about their job identity, and high levels of anxiety toward the future. These problems are partly addressed by current medical school curricula, most of which provide students with at least some basic training in medical ethics. However, this article argues that in order to resolve the aforementioned problems fully, greater awareness is needed of the concept of medical professionalism. Awareness of the requirements of medical professionalism would not only assist physicians in their practice of medicine, but would also help physicians gain greater levels public trust and thereby improve their standing in society.

개원의사와 개원한의사의 전문직업성, 직무스트레스 및 직업만족도

김종연,강윤식,조용기,이상원,진대구,안순기,천병렬,예민해,감신,Kim, Jong-Yeon,Kang, Yune-Sik,Cho, Yong-Kee,Lee, Sang-Won,Jin, Dae-Gu,Ahn, Soon-Gi,Chun, Byung-Yeol,Yeh, Min-Hae,Kam, Sin 대한예방의학회 2004 예방의학회지 Vol.37 No.1

Objectives : This study was conducted in order to investigate the professionalism, job stress and job satisfaction in western and oriental doctors in Korea. Methods : The authors conducted a survey using a self-administered questionnaire, conducted between August and September, 2001. The study subjects were 457 western doctors and 161 oriental doctors practicing at local clinics in Daegu City. Results : For the professionalism scale, the score for belief in service to the public of western doctors was significantly higher than that of oriental doctors (p<0.05) whereas the scores for sense of calling to the field and feeling of autonomy were higher in oriental doctors (p<0.01). For the job stress scale, the scores for work factor, and clinical responsibility/decision factor of western doctors were significantly higher than those of oriental doctors (p<0.01). Of the western doctors, 59.7% expressed satisfaction with their job as a doctor, 69.5% responded that the role of a doctor was appropriate to their aptitude, and 61.8% answered that they wouldn't consider other kinds of job even if offered. In case of oriental doctors, these responses were 83.1%, 82.5%, and 82.3%, respectively. Conclusions : The job stress scores of western doctors were higher than those of oriental doctors, but the job satisfaction was lower. The reasons for the above results are not clear. Further studies are required to understand the characteristics of job stress and job satisfaction in doctors.

네팔 돌카지역의 임신분만 환경

안영우,강윤식,감신,이종영,Ahn, Young-Woo,Kang, Yune-Sik,Kam, Sin,Lee, Jong-Young 대한예방의학회 1996 예방의학회지 Vol.29 No.4

생활수준과 교육수준이 매우 낮은 저개발국가에서의 임신분만 환경을 알아보고 건강관련 행위 실천(산전진찰, 시설분만, 제대기구소독)과 지식과 태도와의 관계를 알아보기 위하여 네팔 돌카 마을에서 지난 1년간(1994년 4월 13일$\sim$1995년 4월 12일)출산한 경험이 있는 산모를 대상으로 일반적 특성, 임신과 분만에 관련된 지식, 태도, 산전진찰률, 분만환경 등을 조사하였다. 이 지역의 임신과 분만에 관련된 지식수준은 낮은 편으로 대상자의 87.5%가 보건교육을 받은 경험이 없었다. 대상자의 29.6%는 임신시 흡연이 태아에 해가 없다고 하였으며, 42.8%는 임신시 음주와 약의 복용이 태아에 해가 없다고 답하였고, 17.1%가 제대절단시 소독하지 않은 기구를 사용해도 유해하지 않다고 응답하였는데, 교육을 받은 적이 없는 경우, 보건교육을 받은 경험이 없는 경우, 그리고 보건기관까지의 거리가 멀 수록 올바르지 못한 지식을 가지고 있었다. 응답자의 56.6%가 산전진찰이 필요없다는 태도를 보였고, 42.8%가 질출혈시 병원을 방문할 필요가 없다는 태도를 보였는데, 교육을 받은 적이 없는 경우, 보건 교육을 받은 경험이 없는 경우, 그리고 보건기관까지의 거리가 멀수록 바람직하지 못한 태도를 가지고 있었다. 또한 82.9%가 분만과정 자체가 불결한 것이라고 여기고 있었다. 한번이라도 산전진찰을 받은 경험이 있는 산전진찰 경험률은 28.3%였는데 교육을 받은 적이 없는 경우, 보건교육을 받은 경험이 없는 경우에 산전진찰 미경험률이 높았다. 시설분만율은 5.3%로 매우 저조하였고, 시설 외 분만인 경우 82.6%가 제대절단기구를 소독하지 않고 사용하고 있었는데 교육을 받은 적이 없는 경우, 보건교육을 받은 경험이 없는 경우, 그리고 보건기관까지의 거리가 멀수록 소독을 하지 않고 사용하고 있었다. 지식과 태도와의 관계에 있어서는 지식이 많은 군이 산전진찰의 필요성을 더 느끼며 질출혈시 병원방문의 필요성을 더 느끼고 있어, 임신과 분만에 관련하여 더 바람직한 태도를 가지고 있었다. 태도와 실천과의 관계에 있어서는 바람직한 태도를 가진 산모군이 산전진찰 경험률이 높았으며, 시설분만이 많아 실천율이 높았다. 다변량 분석에서도 지식이 태도에 양(陽)의 영향을 미치는 변수였으며, 태도는 실천에 영향을 미치는 유의한 양(陽)의 변수여서 실천을 위해서는 긍정적인 태도가 선행되어야 하고, 그러기 위하여는 먼저 올바른 지식을 가지고 있어야 함을 알 수 있었다. 이상의 연구결과로 볼 때, 저개발국가에서의 분만환경은 매우 열악한 편으로 모자의 건강수준 향상을 위해서는 예방적 기능으로서 보건교육 활동이 더욱 중요 성을 가지게 된다. 효율적 보건교육활동을 위해서는 보건교육을 보다 긴요하게 요하는 인구군이 어떤 계층이냐 하는 대상파악에 특별히 유념하여야 하는데 주로 교육수준이 낮고 생활이 어려운 인구층, 그리고 보건기관으로부터 멀리 떨어져 있는 사람들에게 중점적으로 교육을 시도하여야 하겠는데 이들 나라는 대부분의 국민이 교육수준이 낮고 생활수준이 낮은 편으로 보건교육시 단순한 지식의 전달에 그칠 것이 아니라 동기 유발을 가져와 행위변화를 할 수 있도록 보다 세밀한 연구노력이 필요하다. 또한 순회진료와 보건교육을 하는 의료캠프가 활성화되어야 하겠다. 향후 저개발국에 의료단을 파견하여 그 지 역의 보건문제 해결에 도움을 주기 위하여는 이와 This study was conducted to investigate the status of pregnancy and delivery and relationship among knowledge, attitude and practice about pregnancy and delivery in poor country, Nepal. A questionnaire survey by interviewer was conducted to examine the general characteristics, knowledge about pregnancy and delivery, attitude about pregnancy and delivery, the rate of prenatal care and delivery condition of women who had an experience of delivery during last year$(1994.4.13\sim1995.4.12)$ at a rural area, nepal(Dolakha Bazar Area). The major findings are as follows ; Among respondents, 87.5 percentage never had health education and the degree of knowledge about pregnancy and delivery was low. Among respondents, 56.6 percentage had the attitude that they didn't want antenatal care, 42.8 % of respondents answered that they wouldn't visit hospital or health center when vaginal bleeding occurred and 82.9% thought that the delivery itself was dirty. The proportion of women who experienced antenatal care was 28.3%, the proportion of health facilities delivery was 5.3%, which was very low and 82.6% of home delivery case didn't sanitate the tool to cut the umbilical cord. The women who had positive attitude about antenatal care and health facility utilization experienced more antenatal care and health facilities delivery. On consideration of above findings, health education for pregnancy and delivery is required to improve mother-child health status in poor country. To make efficient health education, the target population group, such as the uneducated, inhabitants far from health center or medical facility, must be chosen. To help the poor countries in medical field, the study on health status and its related factors on these countries like this article would be required.

개원의사들의 전문직업성과 직무스트레스가 직업만족도에 미치는 영향

진대구,강윤식,조용기,이상원,김종연,안순기,천병렬,예민해,감신,Jin, Dae-Gu,Kang, Yune-Sik,Cho, Yong-Kee,Lee, Sang-Won,Kim, Jong-Yeon,Ahn, Soon-Gi,Chun, Byung-Yeol,Yeh, Min-Hae,Kam, Sin 대한예방의학회 2003 예방의학회지 Vol.36 No.2

Objective : This study was conducted in order to investigate professional job perception, job stress and job satisfaction in doctors. Method : The authors conducted a survey using a self-administered questionnaire, conducted between August and September,2001. The study subjects were 457 doctors practicing at local clinics in Daegu City. Results : For the professionalism scale, the score for 'sense of calling to field' and 'feeling of autonomy' were relatively high, Age, working hours per day, and perception of socioeconomic status significantly influenced the professionalism scale scores (p<0.01). For the job stress scale, the scores for 'clinical responsibility/decision' factor were the highest of all the surveyed factors. Working hours per day significantly influenced the job stress scores (p<0.01). To investigate the overall relationship between the variables, the authors conducted a linear structural equation model analysis. The equation was statistically appropriate and a good fit. The job stress, and the professionalism factors, respectively influenced job satisfaction negatively and positively (T>2.0). The working hours per day and status perception also influenced their job satisfaction (T>2.0). Conclusion : To promote the iob satisfaction of doctors, the development of coping tools and other intervention methods are needed to increase doctor's professional job perception and reduce their job stress. Further studies are required to understand the characteristics of job satisfaction and for its promotion with doctors.

남성 근로자의 재흡연에 관련된 요인

양진훈,하희숙,임지선,강윤식,이덕희,천병렬,감신,Yang, Jin-Hoon,Ha, Hee-Sook,Lim, Ji-Seun,Kang, Yune-Sik,Lee, Duk-Hee,Chun, Byung-Yeol,Kam, Sin 대한예방의학회 2005 예방의학회지 Vol.38 No.2

Objectives: This study was performed to examine the factors affecting re-smoking in male workers. Methods: A self-administrated questionnaire survey was conducted during April 2003 to examine the smoking state of 1,154 employees of a company that launched a smoking cessation campaign in1998. Five hundred and eighty seven persons, who had stopped smoking for at least one week, were selected as the final study subjects. This study collected data on smoking cessation success or failure for 6 months, and looked at the factors having an effect on re-smoking within this period. This study employed the Health Belief Model as its theoretical basis. Results: The re-smoking rate of the 587 study subjects who had stopped smoking for at least one week was 44.8% within the 6 month period. In a simple analysis, the re-smoking rates were higher in workers with a low age, on day and night shifts, blue collar, of a low rank, where this was their second attempt at smoking cessation and for those with a shorter job duration (p<0.05). Of the cues to action variables in the Heath Belief Model, re-smoking was significantly related with the perceived susceptibility factor, economic advantages of smoking cessation among the perceived benefits factor, the degree of cessation trial's barrier of the perceived barriers factor, smoking symptom experience, recognition of the degree of harmfulness of environmental tobacco smoke and the existence of chronic disease due to smoking (p<0.05). In the multiple logistic regression analysis for re-smoking, the significant variables were age, perceived susceptibility for disease, economic advantages due to smoking cessation, the perceived barrier for smoking cessation, recognition on the degree of harmfulness of environmental tobacco smoke, the existence of chronic disease due to smoking and the number of attempts at smoking cessation (p<0.05). Conclusion: From the result of this study, for an effective smoking ban policy within the work place, health education that improves the knowledge of the adverse health effects of smoking and the harmfulness of environmental tobacco smoke will be required, as well as counter plans to reduce the barriers for smoking cessation.

성인 남성에서 흡연이 기도청력역치에 미치는 영향

김진석,예민해,천병렬,우극현,강윤식,김건엽,이영숙,Kim, Jin-Seok,Yeh, Min-Hae,Chun, Byung-Yeol,Woo, Kuck-Hyeun,Kang, Yune-Sik,Kim, Keon-Yeop,Lee, Young-Sook 대한예방의학회 1998 예방의학회지 Vol.31 No.2

흡연과 기도청력역치와의 연관성을 알아보기 위하여 1996년 1월 1일에서 1997년 7월 31일 사이에 종합 건강진단을 받기 위하여 내원한 성인 남성 1,887명을 연구대상으로 선정하였다. 주파수대별 순음기도청력 검사, 이완기 혈압, 총콜레스테롤, 공복혈당, 혈구용적치 그리고 비만도를 검사하였다. 설문지를 이용하여 연령, 직업, 흡연상태를 조사하였다. 흡연군이 비흡연군에 비하여 250 Hz, 500 Hz, 1000 Hz 그리고 4000 Hz 주파수에서 기도청력역치가 유의하게 높았다(p<0.05). 저주파수영역 평균청력 중간주파수영역 평균청력, 고주파수영역 평균청력에서 흡연군이 유의하게 기도청력역치가 높았다(p<0.05). 다중회귀분석 결과, 흡연상태는 연령, 직업, 이완기 혈압, 공복혈당, 총콜레스테롤, 혈구용적치, 비만도의 영향을 조정 한 후에도 유의한 변수였으며(p<0.05), 연령이 많고, 생산직이고, 혈구용적치가 높고 비만할수록 유의한 청력저하가 관찰되었다(p<0.05). 그러나 이완기혈압, 총콜레스테롤 그리고 공복혈당은 청력저하와 유의한 관련성이 없었다. 이상의 결과를 볼 때, 흡연은 성인 남성의 청력저하와 연관성이 있었다. To investigate the effect of smoking on the hearing threshold, 1,887 adult male workers who visited health care center during the period 1 January 1996 - 31 July 1997 were selected. Air-conduction hearing threshold level, diastolic blood pressure(DBP), total cholesterol, fasting blood sugar(FBS), hematocrit and obesity were measured. The data on age, occupation, and smoking were collected. Air-conduction hearing threshold in smoker was significantly higher than non-smoker in categories of 250, 500, 1000 and 4000 Hz(p<0.05). Mean values of PTA-low, PTA-mid, and PTA-high in smoker were also significantly higher than non-smoker(p<0.05). In multiple regression analysis, smoking is likely to play a significant role after controlling age, occupation, DBP, FBS, total cholesterol, hematocrit, and obesity(p<0.05). The hearing threshold was significantly increased with increasing age(p<0.05), the manufacturing worker may have higher hearing threshold(p<0.05). The higher hematocrit and the more obese, the higher hearing threshold(p<0.05). However, DBP, total cholesterol and FBS were not significantly related with hearing threshold level. In conclusion, smoking was significantly related with the hearing threshold level in adult men.

의과대학생들의 흡연 실태 및 다른 건강 행태와의 관련성

박정한,이상원,임현술,이종태,강윤식,박순우,Park, Jung-Han,Lee, Sang-Won,Lim, Hyun-Sul,Lee, Jong-Tae,Kang, Yune-Sik,Park, Soon-Woo 대한예방의학회 2004 예방의학회지 Vol.37 No.3

Objectives : This study was conducted to examine the smoking behaviors and the relationship between smoking and other health behaviors among medical students. Methods : A self-administrated questionnaire was administered to a sample of 1,775 students from four medical schools between April and May 2003. Due to the small number of female smokers, the characteristics of smoking behaviors were analyzed only for males. Results : A total of 1,367 students (920 males and 447 females) completed the questionnaires, with an overall response rate of 77.7%. The smoking rates for males and females were 31.5, and 2.2%, respectively. Among the male smokers, 70.7% smoked daily, and 39.0% smoked one pack or more per day. Male students on medical course were more likely to smoke daily, and one pack or more per day, than those on premedical course. Male daily smokers desired to quit smoking less than occasional smokers, and 65.0% of male daily smokers were not ready to quit compared with 37.8% of the occasional smokers. Among the male daily smokers, 29.6% were severely nicotine dependent. The most common reason for not to quit smoking among male smokers was 'no alternative stress coping method' (44.4%), followed by 'lack of will power' (25.4%), and 'no need to quit' (19.4%). Compared with male non-smokers, male smokers were more likely to drink alcohol more often and in larger amounts, take coffee more often, eat breakfast less regularly, and be overweight or obese. Conclusions : The results of this study suggest that many male medical students were serious smokers, especially those on medical course. It is necessary to install a smoking prevention program for pre-medical students, provide effective smoking cessation methods for smokers, teach positive stress coping methods, and make the school environment suitable for coping with stress.