미국 보건부의 질 향상활동

김선민,김재선,박영희,안미라,김형호,은상준,박건희,Kim, Sun Mean,Kim, Jae Sun,Park, Younghee,Ahn, Mi Ra,Kim, Hyeong-Ho,Eun, Sang Jun,Park, Kunhee,Shin, Youngsoo 한국의료질향상학회 2007 한국의료질향상학회지 Vol.13 No.1

선천성대사이상검사 사업의 비용편익 분석

김선민,황나미,김창엽,Kim, Sun-Mean,Hwang, Na-Mi,Kim, Chang-Yup 대한예방의학회 1999 Journal of Preventive Medicine and Public Health Vol.32 No.3

Objectives: Since 1991, nationwide massive neonatal screening program for phenylketonuria (PKU) and congenital hypothyroidism have been performed in Korea. As in many other countries, efficiency of this program has not been definitely concluded. For the purpose of evaluation of this program, from the perspective of efficiency, a cost-benefit analysis was carried out. Methods: Costs of the detection and the treatment program were compared with the projected benefit(avoided costs) that results from the prevention of the mental retardation associated with the disorders due to PKU and hypothyroidism. Costs and benefits were discounted at an annual rate of 5%, and duration of life-long labor was assumed to be 30 years. Cost and benefit were estimated based on the detection rates of one case of PKU per 5,572 and one case of congenital hypothyroidism per 32,554 babies screened during 1991-1997. Results: The benefit-cost ratio was 0.418. The sensitivity analysis for the discount rates and labor durations showed that most cost-benefit ratios were lower than one(1.0) except when discount rate was changed to 3% and detection rate to two- or threefold and/or labor duration to 40 years. Conclusion: The result of this study suggested that present program of mass screening for PKU and congenital hypothyroidism could not be justified in terms of efficiency. It doesn't coincide with the results of previous studies in major developed countries, presumably because of difference in detection rates and welfare cost for the disabled.

우리 나라 전산화단층촬영기(CT)의 도입에 영향을 미치는 요인에 관한 연구

윤석준,김선민,강철환,김창엽,신영수,Yoon, Seok-Jun,Kim, Sun-Mean,Kang, Chul-Hwan,Kim, Chang-Yup,Shin, Young-Soo 대한예방의학회 1997 예방의학회지 Vol.30 No.1

High price equipment is one of the major factors that increases national health expenditure in developed countries. Computerized Tomography(CT), one of the important high price equipment, has been concerns of health service researchers and policy makers in many countries. In Korea, CT, first introduced in 1984, have spreaded nationwide with rapid speed. Though the Committee for Approving Import of High Price Medical Equipment, founded in 1981, tried to regulate the introduction of high price medical equipment including CT, the effort resulted in failure. The exact situation of diffusion of the high price equipment, however, was not yet investigated. We aimed at the description of the diffusion of CT in Korea and analysis of influencing factors on hospitals for the adoption of CT. We mainly used the database of CT, made in 1996 by the National Federation of Medical Insurance for the purpose of insurance payment for CT. Also characteristics of hospitals were gathered from yearbooks published by the central and local governments and by the Korean Hospital Association. We calculated the cumulative number of the CT per one million population year by year. In turn, multiple linear logistic regression was done to find out the contributing factors for the adoption of CT by each hospital. In the logistic regression model, it is regarded as dependent factor whether a hospital retained CT or not in 1988 and 1993. The major categories of the independent factors were hospital characteristics, environmental factors and competitive conditions of hospitals at the period of the adoption. The results are as follows: Number of CT scanners per one million persons in Korea marked more higher level compared with those of most OECD countries. Major influencing factors on the adoption of CT scanners were hospital characteristics, such as hospital referral level, and competitive condition of hospitals, such as number of CT scanners per 10,000 persons in each district where the hospital was located. In Korea, CT diffused with rather rapid speed, comparable with those of the United States and Japan. The major factors contributing on the adoption of CT for hospitals were competitive condition and hospital characteristics rather than regional health care need for CT. In conclusion, a kind of regulating mechanism would be necessary for the prevention of the indiscreet adoption and inefficient use of high price equipment including CT.

경기도 시화공단 지역주민의 악취오염과 관련된 건강영향 평가

조수헌,김선민,주영수,김재용,최성우,Cho, Soo-Hun,Kim, Sun-Mean,Kim, Young-Su,Kim, Jae-Yong,Choi, Seong-Woo 대한예방의학회 1999 예방의학회지 Vol.32 No.4

Objectives: In recent days, the problem of odor pollution in community near Sihwa Industrial complex, Kynuggi Province is becoming of significant public concern. We have investigated the health effects of the Sihwa residents from odor pollution comparing with other less polluted areas. Methods: The Ansan and Kuri Cities were selected as control areas. The parents of the elementary and middle school students in these three areas were surveyed with structured questionnaire twice, Nov 1997 and Jure 1998 each. As a exposure index, the ambient air concentrations of five major air pollutants(particulates, $O_3,\;SO_2,\;NO_2$, CO) and subjective odor perception were used. We have focused health outcomes such as the prevalence of nonspecific irritant symptoms, respiratory disease among family members and the score of qualify of life(QOL). Results: Although the mean concentrations of major air pollutants except particulates were similar or lower in Sihwa than other areas, the odor perception rate and the monthly odor perception days were significantly higher. It suggested that odor producing chemical compounds are the major source of environmental pollution problem. There were higher prevalence rates of nonspecific irritant symptoms and respiratory disease among family members in Sihwa than other control areas. The QOL score was also lower in Sihwa. The odor perception proved to be a most important factor in reporting adverse health effects and lowering the QOL score. Conclusion: The residents living near Sihwa industrial complex were suffering from more adverse health symptoms and poorer QOL status than control areas. And it may be due to environmental odor pollution from industrial complex. Therefore, further research will be needed for monitoring of the responsible chemicals emitted from industries.

의학교육에 대한 의과대학 교육자의 만족도 조사

김창엽(Chang Yup Kim),김선민(Sun mean Kim),서정돈(Jung Don Seo),엄융의(Yung E Earm),안윤옥(Yoon Ok Ahn),김성권(Suhng gwon Kim),채종일(Jong Yil Chai ),이순형(Soon Hyung Lee) 한국의학교육학회 1997 Korean journal of medical education Vol.9 No.1

OBJECTIVES: To evaluate undergraduate medical education in Korea, we investigated educators satisfaction. Also analysis of the factors affecting educator satisfaction was intended. SUBJECTS: Of the entire educators(4,683 persons) of all medical schools, 585 persons were sampled systematically, based on the published list of medical educators. Of the sampled target, 275 persons(47.5%) responded. METHODS: We developed the questionnaire, asking educators satisfaction on six categories of medical education in terms of educational input and process; educator, facilities and equipments, educational contents, educational method and skill, the evaluation of students, and the performance of students. The questionnaire were mailed to each educator and returned back for analysis. RESULTS: Overall satisfaction of educators was rather low. In particular, educators were more dissatisfied with avaliability of assistant personnel and general environment for education. As for the contents of medical education, they were more dissatisfied with the clinical training in bedside setting. Geographically, educators in the kangwon and chungcheong area had more discontent than others. Educators of private schools were more satisfied with the facilities than those of public ones. CONCLUSION: It is necessary to develop continuous program that evaluate and improve the quality of medical education. Among them the clerkship and general environment for education would be focused. Periodic assessment of educators satisfaction would be a tool to ensure more concern for quality of medical education.

경피적 관동맥 확장술의 시술량과 조기 시술결과의 관련성

김용익,김창엽,이영성,김선민,이진석,오병희,강영호,Kim, Yong-Ik,Kim, Chang-Yup,Lee, Young-Sung,Kim, Sun-Mean,Lee, Jin-Seok,Oh, Byung-Hee,Khang, Young-Ho 대한예방의학회 2001 Journal of Preventive Medicine and Public Health Vol.34 No.1

Objectives : To explore the relationship between Percutaneous Transluminal Coronary Angioplasty(PTCA) volume and the associated immediate outcome. Methods : A total of 1,379 PTCAs were peformed in 25 hospitals in Korea between October 8 and December 31 in 1997. Data from 1,317 PTCAs (95.5%) were collected through medical record abstraction. Inter-observer reliability of the data was examined using the Kappa statistic on a subsample of 110 PTCA procedures from five hospitals. Intra-observer reliability of the data was also examined. PTCA success and immediate adverse outcomes were selected as the outcome variables. A successful PTCA was defined as a case that shows less than 50% diameter stenosis and more than 20% reduction of diameter stenosis. Immediate adverse outcomes included deaths during the same hospitalization, emergency coronary artery bypass graft (CABG) within 24 hours after PTCA, and acute myocardial infarction within 24 hours after PTCA. The numbers of PTCAs performed in 1997 per hospital were used as the volume variables. Results : Without adjusting for patient risk factors that may affect outcomes, procedures at high volume hospitals ($\geq200$ cases per year) had a greater success rate (P=0.001) than low volume hospitals. There was a marginally significant difference (P=0.070) in major adverse outcome rates between high and low volume hospitals. After adjusting for risk factors, there were significant differences in procedural failure and major adverse outcome rates between high and low volume hospitals. Conclusions : After adjusting for patient clinical risk factors, the hospital volume of PTCA was associated with immediate outcomes. It is recommended that a PTCA volume per year be established in order to improve the immediate outcome of this procedure in Korea.

전문의 대상 설문조사를 이용한 보건의료 기술평가 대상 시술의 우선 순위 선정 -이비인후과와 흉부외과를 중심으로-

안형식 ( Hyeong Sik Ahn ),김선민 ( Sun Mean Kim ),신영수 ( Young Soo Shin ),김차엽 ( Chang Yup Kim ),김선미 ( Seon Mee Kim ),이순형 ( Soon Hyung Lee ) 한국보건행정학회 1997 보건행정학회지 Vol.7 No.2

도시지역 노인들의 치매유병률에 관한 단면조사연구

나덕렬,연병길,강연욱,민경복,이수현,이상숙,이미라,표옥정,박찬병,김선민,배상수,김동현,Na, Duk-L.,Yeon, Byeon-Gil,Kang, Yeon-Wook,Min, Kyung-Bok,Lee, Soo-Hyun,Lee, Sang-Suk,Lee, Mi-Ra,Pyo, Ok-Jung,Park, Chan-Byung,Kim, Sun-Mean,Bae, Sang-S 대한예방의학회 1999 예방의학회지 Vol.32 No.3

Objectives: In Korea, as in most countries, there will be a sharp increase in the number of dementia patients in the near future. However basic data on dementia prevalence, which is important in defining epidemiologic characteristics and in implementing preventive strategy, are limited. This study was conducted to estimate the prevalence rate of dementia in the urban elderly aged 65 or older in Kwangmyung, Korea. Methods: A two phase design was used for case finding and case identification. In phase I, a representative sample aged 65 or older was selected and interviewed by door-to-door survey with a Korean version of the Mini-Mental State Examination (K-MMSE). In phase II, Of the 946 subjects interviewed in phase 1,356 elderly were randomly selected disproportionately according to K-MMSE score. Of these elderly, 223 (61.5%) underwent standardized clinical evaluations, including psychiatric interview, neurological examination, and neuropsychological assessment. Dementia was diagnosed by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. The diagnosis of Alzheimer's disease (AD) was made by National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and feinted Disorders Association(NINCDS-ADRDA) criteria and vascular dementia (VD) by DSM-IV. Results: The overall weighted prevalence rate of all dementia among Kwangmyung residents aged 65 or older was 12,8%(age-adjusted rate: 13,0%, 95% Confidence Interval[CI]: 10.6-15.3%). Women had much higher prevalence rate than men even when age was controlled(15.9%[95% CI 12.6-19.2%] vs 7.5%[95% CI 4.0-10.4%]), The rates of dementia were 5.2%, 12.2%, 17.0%, and 34.3% for the age groups of 65-69, 70-74, 75-79 and 80 and over, respectively. The rate of AD appeared to be slightly higher than that of VD(5.2% vs 4.8%), though not statistically significant. Most of the cases(69%) were mild dementia according to CDR(<1) in these subjects. Conclusions : These results showed that the prevalence rate of dementia among urban elderly in Korea appears to be higher than those of other Asian countries.

CORI(Concept-Oriented Reading Instruction)가 내용영역의 교수·학습 성취에 미치는 효과

김선민 한국초등국어교육학회 2008 한국초등국어교육 Vol.37 No.-

이 연구는 내용영역의 교수·학습 성취에 효과적인 영향을 미치는 CORI에 대한 연구이다. CORI 모형은 메릴랜드 주립대학의 Guthrie가 구안하여 실행 연구하였다. 초등학교 2학년과 5학년을 대상을 과학 과목과 언어 과목의 통합 수업을 통하여 내용영역의 학습에 효과적인 영향을 주는 읽기 모형을 구안한 것이다. CORI 모형은 주로 내용영역 학습 태도와 동기 그리고 몰입에 관한 연구 이다. 태도와 동기 그리고 몰입은 주관적이며, 변인이 다양하기 때문에 객관적 측정에 어려움이 많다. 특히 우리나라의 교육여건에 비추어 CORI 모형을 그대로 적용하는 것은 어려움이 있다. 따라서 여기서는 Guthrie의 CORI 모형이 갖고 있는 장점 중에서 우리나라의 교육 여건에 적용이 가능한 부분을 선택적으로 수업에 투입하여 그 효과를 검증하였다. 일반적인 과학 수업에 기존의 읽기 수업을 추가한 집단과, CORI 모형을 추가로 처치한 집단을 비교하여 세 집단 간의 성취도 검사 결과를 분석하였다. 그 결과 CORI 모형을 추가로 처치한 집단의 성취도 평균 점수가 유의미한 상승을 보였다는 결론을 얻을 수 있었다. 초등학교 5학년의 과학 영역을 대상으로 한 실험이지만 수학이나,사회 등의 다른 영역을 대상으로 실험하였을 경우에도 유의미한 효과가 나올 수 있을 것이라는 추론이 가능하다. This study is the effect of Content Area Learning Achievement through CORI(Concept−Oriented Reading Instruction). The concept oriented reading process model is based on Guthrie's CORI (concept−oriented reading instruction) but some of Guthrie's CORI process, strategies and method are not suitable for the Korean educational context or real activities. Therefore the concept oriented reading process model is constructed for content area learning through Korean language education. The concept oriented reading instruction is constructed four stages. The four stages are constructed “Question”, “Search”, “Apply”, “Communicate”.Relationship between reading skills and concept oriented reading instruction has been examined by diagnosis evaluation in March, 2007. The content area reading for content area learning is influenced by the concept oriented reading instruction. The basic conclusion from this study is that the content area learning ability of fifth graders increased during their experience in the CORI reading process. Not only did teachers observe these increases in content area learning abilities through student assessments of learning achievement and classroom performance, but content area learning achievement test also documented statistically significant increases. Student's enhanced content areas learning abilities were evident in their work on tasks that reflected the merger of cognitive strategies−SQ3R, MIE, K−W−L, R−S−W, COLD− an effective method during CORI. This study documented the effect of content area learning abilities during CORI.