응급의료센터를 보유한 의료기관 입원 중 응급실경유입원 관련 요인

나백주 ( Baeg Ju Na ),정설희 ( Seol Hee Chung ),이선경 ( Sun Kyung Lee ),오경희 ( Kyung Hee Oh ),김건엽 ( Keon Yeop Kim ) 한국보건행정학회 2009 보건행정학회지 Vol.19 No.2

Objectives: The purpose of this study is to analyze the proportion of admission via the emergency room(the rest is ER) in an emergency medical center and to examine the factors related to admission. Methods: This study used 2005 National Health Insurance claims data for admitted patients of 112 hospitals having emergency medical centers in Korea. The study sample had 2,335,610 patients. The data was classified into emergency admission and non-emergency admission. To investigate the factors affecting the type of admission, the following were included as independent variables: type of health assurance_(national health insurance beneficiaries or medical aid beneficiaries), demographic characteristics_ (sex, age), cause of admission_ (disease or injury), whether an operation was performed or not, DRG severity level, the number of beds, and the location of the hospital. Data were analyzed using the Chi?square test for the differences in emergency admission rates for each variables, and multiple logistic regression analysis was used for identifying the factors affecting admission type. Results: The proportion of admission via the ER accounted for 40.6% of the total admission among hospitals having emergency medical centers. The risk of admission via ER was relatively high for patients who were male, the aged, the injured, the surgical patients, the patients having more severe symptoms, and the patients admitted the hospitals located in metropolitan areas, and the patients admitted the hospitals having 300?699 beds. Medical aid patients were more likely admitted through the emergency room than health insurance patients after other variables ware adjusted. Conclusions and Discussion: We analyzed the proportion of admission via the ER for the total admission rate of hospitals having an emergency medical center in Korea. And we explored the factors related to admission via the ER. This proportion may be used as an indicator of the adequacy of medical utilization or low accessibility to hospitals of patients with low socioeconomic status.

의료보장유형에 따른 연령표준화 결핵 사망률비와 관련 요인

나백주(Baeg-Ju Na),강문영(Moon-Young Kang),홍지영(Jee-Young Hong),김은영(Eun-Young Kim),김건엽(Keon-Yeop Kim),이무식(Moo-Sik Lee),양상규(Sang Kyu Yang) 한국농촌의학 지역보건학회 2006 농촌의학·지역보건 Vol.31 No.1

보건소 금연사업 담당자의 직무분석

나백주(Baeg Ju Na),이무식(Moo Sik Lee),김건엽(Keon Yeop Kim),김은영(Eun Young Kim),배경희(Kyung Hee Bae),이주열(Ju Yul Lee),오경희(Kyung Hee Oh),오종두(Jong Doo Oh) 한국보건교육건강증진학회 2006 보건교육건강증진학회지 Vol.23 No.4

일부 농촌지역주민에서 Bioelectric Impedance로 측정한 체지방비율에 대한 고찰

나백주,박요섭,선병환,남해성,신준호,손석준,최진수,Na, Baeg-Ju,Park, Yo-Sub,Sun, Byung-Hwan,Nam, Hae-Sung,Shin, Jun-Ho,Sohn, Seok-Joon,Choi, Jin-Su 대한예방의학회 1997 예방의학회지 Vol.30 No.1

Obesity usually is defined as the presence of and abnormally amount of adipose tissue. In many epidemiologic study, obesity as a health risk factor has been estimated by Body Mass Index(BMI) in general. This study was conducted to review of body fat percent measured by Bioelectric impedance analyzer as a estimator of obesity in a rural adult population. The study subjects were 421 men and 664 women who reside in the area on the Juam lake. They were sampled by multistage cluster sampling. Their mean age was 59 years old. Body fat percent increased with age, but BMI decreased with age in this study. Body fat percent was more larger at female and elder on the same BMI. The correlation coefficient between with body fat percent and body mass index was low (r=0.4737). Body fat percent was explained by not only BMI but also sex and age $(r^2=0.63)$. The result suggested that it is inadequate for BMI only to estimate obesity about elderly person who reside in the rural community. The relation of body fat percent and body mass index of this study agreed with the preceding know-ledges and studies in general.

범이론적 모형에 근거한 고등학생의 흡연시작 관련요인

홍지영,나백주,김건엽,이무식,Hong, Jee-Young,Na, Baeg-Ju,Kim, Keon-Yeop,Lee, Moo-Sik 대한예방의학회 2006 예방의학회지 Vol.39 No.1

Objective: This study was conducted to investigate the relationship between the intention of smoking and its related factors in high school students. Methods: Our study subjects were 1,203 high school students who resided in one city and in one county region. We conducted a self-administered questionnaire survey from June 7 to June 19, 2004. Both the decisional balance and temptation inventory showed high reliability estimates. We provided good fit for the 12-item decisional balance inventory and the 10-item temptation inventory by using a confirmatory factor analysis. We also used multiple logistic regression analysis to identify the major contributing factors for the intention to start smoking. Results: On the univariate analysis, the subjects who were female, the 2nd and 3rd grade students, the students in vocational high school, the ex-drinkers or current drinkers, and ex-smokers were found to be significantly more distributed in the groups with intention to start smoking. Except for the concept of the cons, the group with intention to start smoking showed significantly higher standardized T scores for the 7 concepts of decisional balance and temptations. On the multiple logistic regression analysis, the females, the 2nd and 3rd grade students, the students in vocational high school, the experience of cigarette smoking and low T score of the cons were significantly related to the intention to start smoking. Conclusions: The intention to start smoking in high school students was affected by various factors such as gender, the school grade and the experience of smoking. Therefore, further research should be conducted for providing the essential data for developing a brief instrument for selecting the groups with intention of starting smoking among adolescents.

농촌지역 노인들의 인지기능 장애와 사망과의 관련성

선병환,박경수,나백주,박요섭,남해성,신준호,손석준,이정애,Sun, Byeong-Hwan,Park, Kyeong-Soo,Na, Baeg-Ju,Park, Yo-Seop,Nam, Hae-Sung,Shin, Jun-Ho,Sohn, Seok-Joon,Rhee, Jung-Ae 대한예방의학회 1997 예방의학회지 Vol.30 No.3

60세이상 노인인구를 대상으로 '농촌지역 노인들의 우울 및 인지기능 장애에 관한 연구'를 한 이정애와 정향균의 연구대상 558명에 대해 농촌지역 노인들의 인지기능 장애와 사망과의 관련성을 살펴본 결과는 다음과 같다. 1) 3년동안 동안 전체 대상자의 사망률은 558명중 57명인 10.2%이었으며 353명의 정상 인지기능군 중 사망자는 30명으로 사망률 8.5%, 126명 의 경도 인지장애군중 사망자는 14명으로 사망률 11.1%, 79명의 중증 인지장애군중 사망자는 13명으로 사망률 16.5% 이었다(표 3). 2) 3년동안 전체 연구 대상자의 생존율은 0.91이었으며 정상, 경도, 중증 인지기능 장애군의 3년 생존율은 각각 0.92, 0.90, 0.86이었다. 로그 순위 검정법으로 인지기능 정상군과 경도 및 중증의 각 인지기능 장애군의 생존곡선을 비교한 결과 통계적으로 유의하지 않았다. 또한 인지기능 정상군과 경도 이상의 인지기능 장애군간 생존곡선을 비교한 결과도 유의한 차이는 없었다. 3) 혼란변인을 보정하지 않는 Cox의 비례위험 회귀 모형의 단변량분석의 결과 95% 신뢰구간(C.I. : Confidence Interval)에서 사망위험도가 유의한 변인은 연령, 월수입, 흡연습관, 신체장애 등이었으며, 인지기능 장애정도를 정상 그리고 경도 및 중증으로 분류한 분석에서는 정상군에 비해 경도 및 중증의 사망위험도가 유의하게 높지 않았으나, 인지기능 점수(MMSEK score)의 증가에 따른 분석 결과 사망위험도가 0.94로 유의하게 낮게 나타났다(표 4). 4) 잠재적 혼란변인들의 영향을 보정한 Cox의 비례위험 회귀모형의 다변량 분석의 결과 인지기능 장애정도 및 MMSEK 점수증가에 따른 사망위험도는 어느 모형에서도 인지기능 장애정도가 사망에 미치는 위험도는 통계적으로 유의하지 않았다(표 5). 5) 남녀별로 각각 인지기능 장애와 사망위험도와의 관계를 알아보기 위해 다변량 분석을 시행한 결과 인지기능 장애정도 및 MMSEK 점수 증가에 따른 사망위험도는 어느 모형에서도 인지기능 장애정도가 사망에 미치는 위험도는 통계적으로 유의하지 않았다(표 6, 표 7). 이상 본 연구는 농촌지역 노인들에서 인지기능 장애정도가 사망에 미치는 영향을 알아보고자 하였지만, 인지기능 장애정도가 사망에 미치는 영향을 통계적으로 유의하게 고찰하지 못하였다. The purpose of this study was to examine the mortality risk associated with cognitive impairment among the rural elderly. The subjective of study was 558 of 'A Study on the Depression and Cognitive Impairment in the Rural Elderly' of Jung Ae Rhee and Hyang Gyun Jung's study(1993). Cognitive impairment and other social and health factors were assessed in 558 elderly rural community residents. For this study, a Korean version of the Mini-Mental State Examination(MMSEK) was used as a global indicator of cognitive functioning. And mortality risk factors for each cognitive impairment subgroup were identified by univariate and multivariate Cox regression analysis. At baseline 22.6% of the sample were mildly impaired and 14.2% were severely impaired. As the age increased, the cognitive function was more impaired. Sexual difference was existed in the cognitive function level. Also the variables such as smoking habits, physical disorders had the significant relationship with cognitive function impairment. Across a 3-year observation period the mortality rate was 8.5% for the cognitively unimpaired, 11.1% for the mildly impaired, and 16.5% for the severly impaired respendents. And the survival probability was .92 for the cognitively unimpaired, .90 for the mildly impaired, and .86 for the severly impaired respondents. Compared to survival curve for the cognitively unimpaired group, each survival curve for the mildly and the severely impaired group was not significantly different. When adjustments models were not made for the effects of other health and social covariates, each hazard ratio of death of mildly and severely impaired persons was not significantly different as compared with the cognitively unimpaired. But, as MMSEK score increased, significantly hazard ratio of death decreased. Employing Cox univariate proportional hazards model, statistically other significant variables were age, monthly income, smoking habits, physical disorders. Also when adjustments were made for the effects of other health and social covariates, there was no difference in hazard ratio of death between those with severe or mild impairment and unimpaired persons. And as MMSEK score increased, significantly hazard ratio of death did not decrease. Employing Cox multivariate proportional hazards model, statistically other significant variables were age, monthly income, physical disorders. Employing Cox multivariate proportional hazards model by sex, at men and women statistically significant variable was only age. For both men and women, also cognitive impairment was not a significant risk factor. Other investigators have found that cognitive impairment is a significant predictor of mortality. But we didn't find that it is a significant predictor of mortality. Even though the conclusions of our study were not related to cognitive impairment and mortality, early detection of impaired cognition and attention to associated health problems could improve the quality of life of these older adults and perhaps extend their survival.

일부 농촌지역 주민의 불안과 혈중 콜레스테롤의 관련성

박요섭,박경수,나백주,남해성,신준호,손석준,최진수,김병우,Park, Yo-Seop,Park, Kyeong-Soo,Na, Baeg-Ju,Nam, Hae-Sung,Shin, Jun-Ho,Shon, Seok-Joon,Choi, Jin-Su,Kim, Byong-Woo 대한예방의학회 1997 Journal of Preventive Medicine and Public Health Vol.30 No.3

In other to study relationship of anxiety and serum cholesterol in general population, we performed the interview survey and screening test for the Ju-am cohort and residents in controlling area at 1995. Among them, 622 people are selected for this analysis. The results were summarized as follows. 1. Anxiety and total serum cholesterol related each other in the group of anxiety. Correlation coefficient was 0.39(p<0.01). 2. According to the result of multiple regression that the total serum cholesterol regarded as the dependent variable, anxiety and total serum cholesterol were related each other positively in the group of anxiety(p<0.05). 3. As the symptoms of anxiety was dichotomized affective and somatic symptom. There was no relationship of 2 symptoms and total serum cholesterol in all subjects, but there was more relationship on the affective symptom than on the somatic symptom in the group of anxiety(p<0.05). The above results show that anxiety and total serum cholesterol related each other significantly in the anxiety group. And the relationship of psychological factors and serum cholesterol could be applied significantly in general population as well as in the special group.

농촌 보건기관의 신축이 고혈압 환자 혈압 조절에 미치는 영향

천성아(Sung-A Chun),나백주(Baeg-Ju Na),김철웅(Chul-Woung Kim),이무식(Moo-Sik Lee) 한국농촌의학 지역보건학회 2008 농촌의학·지역보건 Vol.33 No.1

본 연구는 시설 신축 여부에 따른 환경요인이 고혈압 조절에 미치는 영향을 미치는 지 여부를 파악하기 위해 1994년부터 약 10여년 동안 시행되어 온 농촌의료서비스 개선사업에 의한 보건기관 신축 여부와 인구학적 개인 요인, 전문의 여부 등 의사 요인의 영향을 함께 고려하여 분석한 연구이다. 고혈압 조절에 영향을 미치는 요인에 관한 연구는 주로 개인 특성에 대한 연구가 이미 수행되었지만 의사의 특성 요인 및 의료 조직 및 시설의 위치 등 환경 요인에 대한 분석은 미흡하였다. 조사는 충청도 일부 지역 6개 시,군으로 농어촌의료서비스 개선사업 대상지역이다. 해당 지역의 6개 보건소 및 산하 59개 보건지소에 2005년 7월 1일부터 2006년 6월 30일까지 한번이라도 고혈압 진료를 위해 환자가 내원하거나 보건소 직원이 직접 방문하여 투약 혹은 상담을 한 내용이 기록된 자료 가운데 분석에 적합한 약 2만5천건의 고혈압 환자 진료 자료를 분석하였다. 연구결과 전체적인 보건기관에 혈압수치 조절율은 53.9%이었으며 여성이 남성보다 혈압이 잘 조절되었으면 60대와 70대의 혈압 조절율이 유의하게 높았다(p<0.01). 또한 개선지역이 미개선 지역에 비해 혈압조절율이 유의하게 높았다(p<0.01). 전문의 기준으로 일반의에서 혈압조절율이 다변량 분석에서 유의하게 낮았다(p<0.01). 이 연구는 진료에 적합한 시설이 환자진료 과정에서 의료진의 만족도와 환자의 안정감을 향상시키고 이는 결국 환자관리의 순응도 등을 높이는데 기여하여 진료결과의 질적 향상에도 영향을 미칠 수 있음을 실증적으로 확인하였다. 이는 향후 농어촌의료서비스개선사업이 지역사회 건강결과 향상에 미치는 효과를 계량화 하는 기초 자료가 될 수 있을 것으로 판단한다. Objectives: The purpose of this study was to determine the effect of public health facilities rebuilding on the hypertension control in the rural area. Method: 6 health centers and 59 health subcenters in some Chung-chung province was surveyed. And 29,503 patients were finally selected who had records of prescription about hypertension at list once in those -health facilities from July 1th, 2005 to June 30th, 2006. Demographic variable of patients and whether medical doctor was a medical specialist or not, and whether the facilities were recently rebuilded or not was measured. Results: The Overall control rate was 53.9%. Women had higher hypertension control rate than men. And 60s and 70s years old are had higher hypertension control rate than 40s and 80s years old. Patients who had been treated from medical specialist had higher hypertension control rate than general doctor. And patient who treated in rebuilded public health facilities had higher hypertension control rate. Conclusions: Rebuilding of public health facilities were related to increasing control rate of hypertensive patients.

유두상 갑상선암에서 VEGF, HIF-1α, E-cadherin, p53의 발현과 병기의 관련성 연구

김종삼(Kim, Jong-Sam),나백주(Na, Baeg-Ju),이무식(Lee, Moo-Sik),김철웅(Kim, Chul-Woung),정계림(Jeong, Gye-Rim) 한국산학기술학회 2010 한국산학기술학회논문지 Vol.11 No.3

이 연구는 갑상샘 유두암 환자에서 VEGF, HIF-1α, E-cadherin, p53의 발현 정도와 병기와의 상관관계를 알 아보고자 하였다. 2000년부터 2007년까지 갑상샘 절제술을 시행받은 101명의 환자의 의무기록을 후향적으로 검토하 였다. VEGF, HIF-1α, E-cadherin, p53의 발현은 면역학적으로 조사되었다. 갑상샘 유두암으로 진단된 45세 이상의 환 자 중 54명을 대상으로 하여 VEGF, HIF-1α, E-cadherin, p53의 발현이 분석되었다. E-cadherin의 발현소실과 병기 사 이에는 유의한 상관관계가 있었다. VEGF의 발현과 HIF-1α의 과발현 사이에는 유의한 관련성이 관찰되었다(p<0.05). E-cadherin의 발현소실은 통계적인 유의성은 없었다. HIF-1α의 높은 발현이 HIF-VEGF 경로를 통해 종양간 맥관형성 과 관련된 것으로 여겨진다. The purpose of our study was to evaluate the correlation between expression of VEGF, HIF-1α, E-cadherin, and p53 and pathologic stage. We retrospectively reviewed the medical records of the 101 patients who underwent surgery of thyroid nodules from 2000 to 2007. Expression of VEGF, HIF-1α, E-cadherin, and p53 were examinated immunohistochemically. Papillary thyroid carcinoma in this study included 54 cases of more than 45 years old. Each expression of VEGF, HIF-1α, E-cadherin, and p53 was analysed. Only expression loss of E-cadherin was associated with the stage. High HIF-1 expression was significantly associated with VEGF immunoreactivity (p<0.05). Expression loss of E-cadherin was independent unfavorable factors. It is suggested that high HIF-1α expression may be associated with intratumoral neovascularization possibly through HIF-VEGF pathway.

소득계층에 따른 건강생활실천 관련 요인의 영향 차이

이민행(Lee, Min-Haeng),나백주(Na, Baeg-Ju),이무식(Lee, Moo-Sik),천성아(Chun, Sung-A) 한국산학기술학회 2010 한국산학기술학회논문지 Vol.11 No.2

본 연구는 어느 중소도시의 주민을 대상으로 무작위 표본 추출하여 전화로 건강생활실천 행태를 소득계층 별로 파악하고 관련요인을 분석하였다. 특히 보건소의 건강증진사업에 대한 긍정적인 인식도와 건강생활실천 행태와 의 관련성을 분석하고자 하였다. 한국갤럽(주)을 통해 2006년 10월 11일에서 13일까지 3일간 일개시 19세에서 69세 까지의 809명의 주민을 표본추출하여 이들을 대상으로 전화설문조사를 시행하여 자료를 분석하였다. 분석결과 소득 계층이 낮은 사람들은 보건소의 건강증진사업에 대해 긍정적인 인식을 갖는 것과 건강생활실천의 관련성이 낮았으나 소득계층이 높은 사람들은 관련성이 높게 나타났다. 이는 소득계층에 따라 보건소의 건강증진사업이 미치는 영향이 다름을 시사한다. This research have aimed for analyzing the effect of relative factors on healthy life styles by the income level in a medium-sized city. Especially, the research tried to figure out whether the public health center's health-promotion-activity had different effects on healthy life styles by the income level. The random sampled data of 809 citizens aged between 19 and 69 were analyzed through phone survey by the Korea Gallop inc(surveyed from 2006.10.11 to 10.13). In the low socioeconomic status, the relation between people's positive conception about public health center's health-promoting-program and healthy behavior tendency is low. But in the high socioeconomic status, the relation is high. This result suggest that the effect of public health center's health promotion programs on healthy life styles is different by income level.