한국인 여성에서 자궁경부암의 위험요인에 관한 환자-대조군 연구

구혜원,유근영,김동현,송용상,박노현,강순범,이효표,안윤옥,이채언,Koo, Hye-Won,Yoo, Keun-Young,Kim, Dong-Hyun,Song, Yong-Sang,Park, No-Hyun,Kang, Soon-Beom,Lee, Hyo-Pyo,Ahn, Yoon-Ok,Lee, Chae-Un 대한예방의학회 1996 예방의학회지 Vol.29 No.2

A hospital-based case-control study was carried out to investigate the risk factors of uterine cervical cancer in Korea. Information on a wide-range of life-styles, which might be related with uterine cervix cancer, has been routinely collected through a dual application of the self-administered questionnaire and the direct interview by a well-trained nurse at the Department of Gynecology, Seoul National University Hosiptal since 1992. The number of cervical cancer cases, histologically confirmed at the hospital, were 284. Included were 939 women as controls, who were free of past history of any malignancies. Adjusted odds ratio and 95% confidence limits were based on the unconditional logistic regression model. The multivariate logistic model was constructed under the consideration of biologic characteristics on the natural history of the malignancy. In the multivariate results, the uterine cervical cancer risk was higher in women of shorter height$(P_{trend}<0.05)$, less educated spouse$(P_{trend}<0.001)$(0.001), multiple marriages(adjusted OR=2,70, 95% C.I. $1.64\sim4.47$), ever had a family history (adjusted OR=2.14., 95% C.I. $1.18\sim3.89$), multiparity$(P_{trend}<0.001)$, and early age at first $(P_{trend}<0.001)$. These results strongly suggest that the uterine cervix cancer might be related to the reproductive factors, and probably with sexual behaviour of both women and men in Korea.

지역사회 임상시험시 개인별 무작위배정과 군집 무작위배정의 효율성 비교

구혜원,곽민정,이영조,박병주,Koo, Hye-Won,Kwak, Min-Jeong,Lee, Young-Jo,Park, Byung-Joo 대한예방의학회 2000 Journal of Preventive Medicine and Public Health Vol.33 No.1

Objectives . In large-scale field trials, randomization by cluster is frequently used because of the administrative convenience, a desire to reduce the effect of treatment contamination, and the need to avoid ethical issues that might of otherwise arise. Cluster randomization trials are experiments in which intact social unit, e.g., families, schools, cities, rather than independent individuals are randomly allocated to intervention groups. The positive correlation among responses of subjects from the same cluster is in matter in cluster randomization. This thesis is to compare the results of three randomization methods by standard error of estimator of treatment effect. Methods : We simulated cholesterol data varing the size of the cluster and the level of the correlation in clusters and analyzed the effect of cholesterol-lowering agent. Results : In intra-cluster randomization the standard error of the estimator of treatment effect is smallest relative to that in inter-cluster randomization and that in individual randomization. Conclusions : Infra-cluster randomization is the most efficient in its standard error of estimator of treatment effect but other factor should be considered when selecting a specific randomization method.

일부 농촌 지역 여성의 자궁경부암 조기검진에 영향을 미치는 요인

구혜원,이원진,장성훈,유근영,이건세,Koo, Hye-Won,Lee, Won-Jin,Chang, Soung-Hoon,Yoo, Keun-Young,Lee, Kun-Sei 대한예방의학회 1999 Journal of Preventive Medicine and Public Health Vol.32 No.2

Objectives: To construct basic data to develop strategies for achieving higher Pap test coverage rate by evaluating factors associated with the use of Pap test through population-based survey. Methods: 16.4%(671) of the 4,090 women, who were eligible population for this study, in 3 Myens of Chung-ju City participated in this study voluntarily from July 21 to 26, 1997. After basic physical examination by trained doctors, they were interviewed with structured questionnaire by well-educated interviewers. Results: It shows that only 54.3% of study participants experienced Pap test. The strongest factor which is related with the use of Pap test was the history of having breast screening tests(aOR=8.71, 95% CI=4.25-17.84). Probability of ever having Pap test was also higher in married women(aOR of single=0.46, 95% CI=0.29-0.72), younger(Ptrend<0,051, more educated (Ptrend<0.001), non-smoker (aOR of smoker=0.25, 95% CI=0.12-0.55), women of ever having Hepatitis test(aOR=2.60, 95% CI=1.73-3.88) in multiple lineal logistic analysis. Conclusions : This study suggests that several factors significantly associated with the use of Pap test, and especially, high-risk population for cervical cancer such as women of older ages, less educated, living alone are less likely to have the Pap test. We should concentrate on encouraging high-risk women in the use of Pap test to improve Pap test coverage rate.

공공환경물의 외관이미지 요인 중 진보성에 영향을 미치는 물리적 요소에 관한 연구

구혜원(Koo Hye-Won),이영창(Lee Young-Chang),한정완(Han Jung-Wan) 한국디자인학회 2006 한국디자인학회 학술발표대회 논문집 Vol.- No.-

한, 일 인공환경물의 인지심리에 관한 비교

구혜원(Koo Hye-Won),이영창(Lee Young-chang),한정완(Han Jung-Wan) 한국디자인학회 2003 한국디자인학회 학술발표대회 논문집 Vol.- No.-

서울시 중년남성에서 육체적 활동량이 총 사망률에 미치는 영향에 관한 코호트 연구

김대성,구혜원,김동현,배종면,신명희,이무송,이충민,안윤옥,Kim, Dae-Sung,Koo, Hye-Won,Kim, Dong-Hyon,Bae, Jong-Myon,Shin, Myung-Hee,Lee, Moo-Song,Lee, Chung-Min,Ahn, Yoon-Ok 대한예방의학회 1998 예방의학회지 Vol.31 No.4

Although previous studies revealed the association of physical activity with mortality rate, it is unclear whether there is a linear trend between physical activity and mortality rate. In this study, the association of physical activity with the risk of all-cause mortality was analysed using Cox's proportional hazard model for a cohort of 14,204 healthy Korean men aged 40-59 years followed up for 4 years(Jan. 1993-Dec. 1996). Physical activity and other life style were surveyed by a postal questionnaire in December 1992. Total of 14,204 subjects were grouped into quartiles by physical activity. Using death certificate data, 123 deaths were identified. The second most active quartile had a lowest mortality .ate with relative risk of 0.44(95% C.I. : 0.23-0.84) compared with most sedentary quartile, showing a J-shape pattern of physical activity-mortality curve. By examining the difference in proportion of cause of the death between most active quartile and the other quartiles, there was no significant difference of proportional mortality from cardiovascular deaths, cerebrovascular deaths or deaths from trauma. The covariates were stratified into two group between which the trend of RR was compared to test the effect modification. There was no remarkable effect modification by alcohol intake, smoking, body mass index, calorie consumption, percent fat consumption. In conclusion, moderate activity was found to have more protective effect on all-cause mortality than vigorous activity and that the J-shape pattern of physical activity-mortality curve was not due to the difference of mortality pattern or effect modification by alcohol intake, smoking, body mass index, calorie consumption and percent fat consumption.

부산지역의 암 사망에 관한 역학적 연구

김휘동,구혜원,곽문석,김종렬,손병철,문덕환,이종태,조규일,엄상화,정귀옥,전진호,이채언,Kim, Hwi-Dong,Koo, Hye-Won,Kwak, Moon-Suk,Kim, Jong-Ryul,Son, Byung-Chul,Moon, Deog-Hwan,Lee, Jong-Tae,Cho, Kyu-Il,Ohm, Sang-Hwa,Jung, Kui-Oak,Chun, Jin 대한예방의학회 1996 Journal of Preventive Medicine and Public Health Vol.29 No.4

This study surveyed and measured the level and structure of cancer deaths and their trends over time for offering the fundamental data of e cancer prevention and control in Pusan city in the future. Authors conducted the study of descriptive epidemiology using materials derived from the computerized data of total 3,722 certified cancer deaths in Pusan city from January 1 to December 31, 1993 registered on the National Statistical Once, the Republic of Korea. The obtained results were as follows: 1. According to the total registered cases of deaths(16,331 cases) in Pusan city during 1993, cancer(3,722 cases) and cerebrovascular disease(2,118 cases) were the first and second cause of deaths as 23.1% and 16.9%, respectively. These pattern showed the change between cancer (14.7%) and cerebrovascular disease(18.5%) in order of frequency in comparison to 1982. Also, the total number of cancer deaths was increased in comparison to 1982. The rate of death certification by physicians was 87.1% of all registered deaths, which was increased to 6.8% in comparison to 1982(80.3%). 2. Crude death rate and cancer specific death rate was 4.06 per 1,000 populations and 93.8 per 100,000 populations(male:117.8, female:70.0), respectively. The former was similar to that of 1982, but the latter was increased to 1.6 times as that of 1982. 3. Age-adjusted cancer specific death rate by standardization with whole country population was 111.9(male:141.5, female:106.7) per 100,000 populations, higher than not age-adjusted cancer specific death rate(93.8), and the sex difference was statistically significant with male predominance (p<0.05). 4. Cancer specific death rate by age was generally increased with age and most of cancer deaths(male:91.8%, female:88.5%) occurred since 40 years old. 5. The major cancer(cancer specific death rate per 100,000 populations) in male was liver(30.6) followed by stomach(25.6), lung(21.9), and GB and EHBD(5.7), in female stomach(15.7), liver(9.9), lung(7.3), and uterus(6.9). The relative frequency of the leading three cancer among total cancer deaths marked 66.3% in male and 47.l% in female, and decreased in comparison to 1982(male:72.2%, female:54.5%). 6. The total ratio of male to female cancer specific death rate showed 1.68 to 1 with male predominance. And the ratio was above 2.0 in larynx, oral cavity & pharynx, esophagus, liver, lung, bladder cancer and the ratio was $1.0\sim1.9$ in stomach, pancreas, gall bladder and EHBD, brain, rectum and anus cancer, leukemia, but the ratio was reversed in thyroid and colon cancer. In conclusion, cancer was the first cause of deaths. The proportion of lung cancer was increased, that of stomach & uterine cancer was decreased relatively, and liver cancer was constantly higher proportion. In the future, it is necessary to conduct the further investigations on the cancer risk factors considering areal specificity.

노인 입원환자에 대한 부신 피질 스테로이드 처방평가

김석우,구혜원,박병주,Kim, Seok-Woo,Koo, Hye-Won,Park, Byung-Joo 대한임상약리학회 1999 臨床藥理學會誌 Vol.7 No.1

연구배경 : 제약기술의 발전으로 인한 활발한 신약 개발은 다양한 형태의 약물요법을 가능케 하였으나, 동시에 부적절한 약물 처방의 가능성도 증대시켜 왔다. 최근 약물요법의 수준을 향상시키기 위하여 DUR의 필요성이 커지고 있고, 선진국에서는 각 국가나 사회가 처한 상황에 맞는 프로그램을 개발하여 적용하고 있다. 아직 이러한 개념과 방법론이 도입되지 않은 한국에서 우선적인 DUR 적용대상으로 스테로이드제를 선택하였다. 방 법 : 의료보험관리공단의 피보험자 및 피부양자로서 1993-1994년의 2년간에 걸쳐서 부산광역시에 거주하는 65세 이상의 노인 23,649명에 대한 약물역학연구를 실시하였다. 연구대상은 연구기간 중에 1회 이상 입원치료를 받은 적이 있는 남녀노인들이었다. 분석대상자료는 의료보험관리공단에 청구된 진료명세서에 기록되어 있는 약물처방정보를 직접 입력하여 구축한 데이터베이스와 공단에 전산입력되어 있는 병명코드를 이용하였다. 연구대상약제는 경구용 스테로이드 5종과 주사용 스테로이드 7종이었다. 결 과 : 연구기간 동안에 입원 환자는 총 3,642명이었으며, 이들 중에서 1,168명(32.1%)이 스테로이드제를 처방받았다. 병원의 등급간 비교에서는 2차 병원에서는 3차 병원들보다 경구용 약제에서는 triamcinolone, 주사용 약제에서는 dexamethasone이 더 빈번히 처방되었음을 알 수 있었다. 환자의 연령에 따른 스테로이드약물 처방률은 유의한 차이가 없었으며, 질환군에의한 분류에서 신경계 질환에서는 90.5%의 스테로이드 처방률을 보여서 가장 높았고, 감염, 종양, 내분비계, 신경계, 순환기, 호흡기, 소화기, 비뇨생식기, 근골격계 및 기타의 다른 9개 질환군에서는 14.2-36.0%의 처방률을 보였다. 종양성 질환에서는 주사용 제제, 감염성 질환에서는 경구용 제제가 각각 더 많이 처방되어 질환의 특성에 따라 약물의 사용 양상이 영향을 받는 모습을 관찰할 수 있었다. 결 론 : 본 연구를 통하여 병원의 규모와 기능에 따라 스테로이드계의 처방양상이 유의하게 차이가 있음을 확인하였고, 질환별로는 신경계 질환에서 가장 빈번하게 스테로이드 처방이 시행되고 있음을 확인하였다. 향후 노인환자를 대상으로 한 스테로이드제의 표준처방의 개발을 위한 연구가 수행되어야 할 것으로 사료된다. This study was designed for conducting the drug utilization review(DUR) for the geriatric in-patients aged 65 or more living in Pusan, Korea. Computerized database on steroidal drug use has been constructed by directly inputting the prescription information of the steroids on the claims data submitted to the Korea Medical Insurance Corporation for reimbursement from the health care institutions. The database included personal identifier, age, sex, diagnosis, the name of drug, dosage, the date of prescription and the code number of medical institution where the patients were admitted. The target drugs were 7 steroidal agents of oral or parenteral preparations. The total number of patients prescribed steroids from January 1993 to December 1994 were 1,168, of whom 703(60.2%) were female and 465(39.8%) were male. The oral triamcinolone and parenteral dexamethasone were prescribed more frequently in the secondary hospitals than in the tertiary hospitals. There was no difference in prescription rate of steroids according to the age groups in the elderly patients. Patients with neurologic disease was the most frequently prescribed group with steroids(90.5%). To construct the drug prescription database on the elderly cohort is very important in Korea. We can improve the level of medical practice through DUR program with these data, which should result in enhancing the level of 'Quality of Life' for the elderly patients in Korea through preventing drug misuse and abuse.

노인 입원환자에 대한 항궤양약물 처방양상 분석

이원식,이승미,구혜원,박병주,Lee, Won-Sik,Lee, Seung-Mi,Koo, Hye-Won,Park, Byung-Joo 대한예방의학회 2002 Journal of Preventive Medicine and Public Health Vol.35 No.1

Objectives : To review the drug prescription pattern of antiulcerative agents for elderly inpatients, Methods : The study population comprised inpatients of community hospitals who were members of the Korean Elderly Pharmacoepidemiologic Cohort (KEPEC), aged 65 years or over, beneficiaries of the Korea Medical Insurance Corporation (KMIC) and residing in Busan city in 1993. The drug prescription information was collected from the claims data of hospitals where the cohort members received medical care between January 1993 and December 1594. The information included personal identification, age, gender, diagnosis, drug dosage, date of hospital admission and name of medical institutions where the study subjects received drug prescriptions. The data analysis produced outcomes in terms of distribution of antiulcerative agents by class and by medical institution and trend of relative prescription, Analysis was also performed in terms of combined prescriptions of antiulceratives and drugs that could induce risk from drug interaction with antiulceratives. Results : The number of patients prescribed antiulcerative agents was 1,059 (64,9%) male and 1,724 (65.5%) female among the total inpatients. An antacid and composite agent was the most frequently prescribed antiulcerative agent (70.8%), followed by $H_2$ antagonist (16.0%), Among the potential drugs that could induce risk from drug interaction with the antiulcerative agents, diazepam was the most frequently prescribed. The proportion of diazepam co-prescription was 22.5% of the total cimetidine prescriptions and 14.5% of the fetal omeprazole prescriptions. Conclusions : Antiulcerative drugs were frequently prescribed in the elderly inpatients. The adverse drug reaction could possibly be due to drug interaction. The study results could be used as fundamental data for further drug utilization review of antiulceratiye agents.

노인 생활습관 설문서의 신뢰도 및 타당도 평가 연구

박병주,김대성,구혜원,배종면,Park, Byung-Joo,Kim, Dae-Sung,Koo, Hye-Won,Bae, Jong-Myon 대한예방의학회 1998 예방의학회지 Vol.31 No.1

부산지역의 공무원 및 사립학교 교직원 의료보험관리공단의 피부양자중 65세 이상인 16,524명에 대하여 생활습관에 대한 설문서를 발송하여 이중 9,139명으로부터 설문서를 회수하였다. 본 연구는 여기에 사용된 설문서의 신뢰도를 평가하기 위하여 이중 200명을 단순 무작위 표본추출하여 다시 설문서를 발송하였으며 회수된 설문서 110건에 대하여 항목별, 응답자별 신뢰도를 평가하였다. 1) 본인이 두 번 모두 응답한 경우에 있어서 대부분의 항목이 0.6이상의 신뢰도 계수를 가졌으나, '산보', '정원일', '맨손체조', '활동상태'와 같은 육체적 활동과 관계 있는 항목의 일부에 있어서는 낮은 신뢰도를 보였다. 반면 현재의 '현재까지의 흡연여부', '현재까지의 흡연량', '3년전의 흡연여부', '지난 1년간의 음주량', '3년전의 음주량' 등의 흡연 및 음주와 관련있는 항목과 '키', '몸무게', '체격그림'과 같은 체격과 관련 있는 항목, '폐경나이', '낳은 아이의 수'와 같은 산부인과력의 일부항목 등에서는 높은 신뢰도를 보였다. 2) 한번은 본인이 다른 한번은 대리응답자가 응답을 한 32건에 대하여 신뢰도 계수를 계산하였다. 두 번 다 본인이 응답한 경우에 비하여 신뢰도 계수가 크게 하락한 항목은 '청소', '주관적 건강상태', '첫아이를 낳은 나이', '폐경나이', '맵게 먹는 정도', '육식선호정도', '야간수면시간' 등이었으며 본인이 두 번 응답한 경우에 비하여 본인-대리응답에서 신뢰도계수가 더 높게 나타난 항목은 '3년전의 음주여부', '3년전의 홉연량', '산보', '정원일', '활동상태' 등이었다. 3) 응답자의 성별 타당도 분석결과 식생활과 관련된 항목에서는 여자보다 남자에서 타당도가 높았고, '약수터 가기', '정원일', '산보' 등의 일일 활동과 관련된 항목과 음주, 흡연 등의 항목에서는 여자에서 타당도가 높았다. 4) 대리응답자가 가질 수 있는 비뚤림을 파악하기 위하여 쌍체분석을 실시하였다. 분석대상은 본인과 자녀가 번갈아 응답한 19건에 제한하였다. '청소'와 '부엌일'에서 본인의 응답이 자녀의 응답보다 빈도가 더 높은 것으로 나타났다. '키'항목에서는 자녀보다 본인의 응답이 키가 더 작은 것으로 나타났다. The study was done to determine the reliability and validity of a life style questionnaire for the elderly. The questionnaires were sent to 16,524 elderly people who were beneficiaries of Korean Medical Insurance Corporation in Pusan. Among the completed 9,139 questionnaires, 200 were randomly sampled and retested. finally, 110 duplicates were collected. Weighted kappa-value and Pearson correlation coefficients were estimated to measure the reliability. Validity coefficient was estimated by using reliability coefficient. In self-self responses, reliability coefficients of the most of items were over 0.6 except some physical activity related item. Relatively high reliability was observed in smoking, alcohol related items and anthropometric items. In self-proxy responses, most of the physical activity related items were found to be less reliable than self-self responses. Smoking and alcohol related items were consistently reliable. Male showed higher validity in food related item than female. On the other hand, some of the physical activity related items and smoking and alcohol related items were less valid in male than female. With regard to bias of proxy respondents, offsprings tended to underestimate the frequency of house cleaning' and 'kitchen work' and overestimate the height of them. In conclusion, the life style questionnaire was found to be reliable in the most of items. But, some items related with physical activity were found to be somewhat less reliable. Sexual difference on the validity was identified in some items. With regard to bias of proxy respondents, offsprings tended to have bias in part of items of housework and anthropometry.