의학교과서를 통해 본 북한예방의학 내용분석에 관한 연구

문옥륜,이신재,김정철,문용,박송림,이상구,Moon, Ok-Ryun,Lee, Sin-Jae,Kim, Jung-Chul,Wen, Yong,Piao, Song-Lin,Yi, Sang-Gu 대한예방의학회 2000 Journal of Preventive Medicine and Public Health Vol.33 No.3

Objectives : The most frequently cited health related slogan in North Korea is that socialistic medicine is preventive medicine. It implies that North Korea puts preventive medicine at the operational center of its national health care system. This study aimed at examining and comparing preventive medicine practices in North Korea with those of South Korea. Methods : Efforts have been made to obtain a textbook for analysis its contents. Many people have iassisted in the study by joining the interview. Some of these people are as follows : a former professor of PyongYang Medical School, NK physicians living in South Korea, WHO staffs, diplomatic officials, etc. The major items of analysis consisted of industrial medicine and hygiene, nutrition, school health, epidemiology, health statistics and heath policy & management. Results : Public health philosophy is finely noted and well integrated in the operation of the North Korean national health care system, particularly in the area of industrial medicine and hygiene. Preventive medicine with a strong health surveillance system spanning a number of broad social organizations is a major tool to improve the health of the people in North Korea. The emphasis on preventive medicine has a close relationship with the 'Juche Philosophy' and the shortage of pharmaceuticals and medical equipment. To cope with the shortage problem, North Korean health workers are encouraged to grow medicinal herbs. We have found that they put little effort into teaching newly emerging diseases, such as AIDS, VDT syndrome, hazards of EMF, and agricultural chemical poisonings. Of the subjects of the preventive medicine text, 78.9% coincide with those of South Korean industrial health manuals and 34.2% with South Korean epidemiology texts. However, an absolute difference was found to exist between the health policies and management systems. Conclusion : In North Korea, the concept of preventive medicine functions as the basic philosophic strategy of the national health care system. It differs greatly from the South Korean system in both practice and educational content. Its contribution to society is simply incomparable to that of South Korea. More communication and further study is called for in order to improve the preventive medicine practices in the future.

한국인 성인 비만의 사회경제적 비용

문옥륜,김남순,강재헌,윤태호,이상이,이신재,정백근,Moon, Ok-Ryun,Kim, Nam-Soon,Kang, Jae-Heon,Yoon, Tae-Ho,Lee, Sang-Yi,Lee, Sin-Jae,Jeong, Baek-Geun 대한예방의학회 2002 예방의학회지 Vol.35 No.1

Objective : To estimate the socioeconomic costs of obesity in Korea,1998. Methods : The 1998 National Health and Nutrition Examination Survey(1998 NHNES) data was used and 10,880 persons who had taken health examinations were selected for study. Essential hypertension, NIDDM(non insulin-dependent diabetes mellitus), dyslipidemia, osteoarthritis, coronary heart disease, stroke were included as obesity related disease. The data of direct costs of obesity was obtained from the National Federation of Medical Insurance. The category of indirect costs was the loss of productivity caused by premature death and admission, time costs, traffic costs, nursing fees due to obesity. Multiple logistic regression model was developed to estimate prevalence odds ratio by obesity class adjusted demographic and socio-ecnomic factors and calculate PAF(Population Attributable Fraction) of obesity on obesity related disease. And we finally calculated the socioeconomic costs of obesity in relation to BMI with PAF. Results : The direct costs of obesity were 2,126 billion${\sim}965$ billion Won in considering out of pocket payment to uninsured services, and the indirect costs of obesity were 2,099 billion${\sim}1,086$ billion Won. Consequently, in considering out of pocket payment to uninsured services, the socioeconomic costs of obesity were 4.225 billion${\sim}2,050$ billion Won, which corresponded to about $0.094%{\sim}0.046%$ of GDP and $1.88%{\sim}0.91$ of total health care costs in Korea. Conclusions : Obesity represents a major health problem with significant economic implications for the society. This results are conservative estimates as far as all obesity related disease and all health care and indirect costs were not included due to missing information. further studies are needed to caculate socioeconomic costs of obesity more exactly.

우리나라의 사회계층별 건강행태의 차이

문옥륜,이상이,정백근,이신재,김남순,장원기,윤태호,Moon, Ok-Ryun,Lee, Sang-Yi,Jeong, Baek-Geun,Lee, Sin-Jae,Kim, Nam-Sun,Jhang, Won-Ki,Yoon, Tae-Ho 대한예방의학회 2000 예방의학회지 Vol.33 No.4

Objectives : To analyze differences in health behaviors among the social strata in Korea by using the 1995 National Health and Health Behavior Survey Data. Methods : Study Participants numbered 2,352 men and 1,016 women aged between 15-64 years old, with housewives, students and non-waged family workers excluded. Health behaviors in this study were defined according to the recommendations of the Alameda 7 study. The measure of health behaviors was based on the Health Practices Index(HPI; 0-5 range, with the exclusion of snacking between meals and regularly eating breakfast) developed by the Alameda County research. The significance of the relationship between social strata and HPI was assessed by considering the adjusted means from the multi-variate model. Results : For men, incidence rates of never having smoked, no/moderate use of alcohol, regular exercise, and regular 7-8 hours sleep per night were higher in the upper social strate. Meanwhile, for women, incidence rates of never having smoked, no/moderate use of alcohol, appropriate weight, regular exercise, and regular 7-8 hours sleep per night were higher in the upper strata. HPI varied significantly among social strata in both sexes (p<0.001), a result which held true when adjusted for age, education, income, social insurance type, marital status and region. Conclusions : Health behaviors assessed by Health Practices Index(HPI) varied significantly among social strata for both sexes. Therefore, the existing gap in health behaviors among social strata can be corrected more effectively by target oriented health promotional activities.

보건소(保健所) 행정(行政)의 기선을 위(爲)한 연구(硏究)

문옥륜,Moon, Ok-Ryun 대한예방의학회 1970 Journal of Preventive Medicine and Public Health Vol.3 No.1

This survey was conducted to evaluate not only the present status of health center directors-their personal histories, their will to private practice in the future, their responses to governmental policies, -but also the distribution of doctorless myons, budget and subsidy, and director's opinions to the enhancement of health center activities. This survey questioned 116 health center directors and 16 health personnel from August to October of 1970 and obtained the following results; 1) The average ages of directors of kun, city, and total health centers were $43.2{\pm}7.8,\;42.1{\pm}7.7,\;and\;42.9{\pm}10.3$ respectively. 2) The average family sizes of directors of kun, city, and total health centers were $5.6{\pm}2.7,\;5.6{\pm}2.1,\;and\;5.6{\pm}2.6$ respectively. 3) Directors holding M. D. degrees were 79.3%, those holding qualified M. D. degrees ('approved director') were 20.7%. 4) M. P. H., M. S., and Ph. D. holders were 6.0%, 6.1%, and 4.3% respectively. 5) The average duration of present directorship in kun and city were 30.2 months and 20.4 months respectively. 6) The majority of directors had been employed in related fields before assuming current position : directorship at other health center 26.7%, army 22.4%, health subcenter 21.6%, private practice 19.0%. 7) Average length of directorship is 41.8 months. Average length of public health career, including health subcenter and present position, is 56.5 months. 8) Both rural and urban experience in health centers for regular directors is 16.3% and for approved directors, 12,5%. A total of 15.5% of all survey directors had experience in both rural and urban health center. 9) A total of 70.7% of health center directorships were staffed by local doctors. 10) Nearly 40% wanted to quit the directorships within 3 years and 60.3% had already experienced private practice. 11) Of the regular directors 17.4% felt strongly about devoting their lives to public health fields, but only 4.1% of the approved approved directors felt so. 12) There wire 432 doctorless myons among 996 respondent myons and 4.5 doctorless myons per kun. 13) The percentage of doctorless myon by Province are as follows, Cholla buk-do 57.2%, Cholla nam-de 55.0%, Kyungsang nam-do 52.0%, Kyungsang buk-do 49.7%, Chungchong but-do 42.4%, Kyonggi-do 32.9%. Cheju-do 30.8%, Kangwon-do 25.8%. 14) Two thirds of health critters have experienced the abscence of the director for a certain period since 1966 and the average span of the abscence was 18.2 months. 15) The percentage of doctorless myons increased proportionally with the span of the director's abscence. 16) The average budgets of health centers, kun, city and ku, were $W15.03\;million{\pm}W4.5\;million,\;W22.03\;million{\pm}W17.80\;million,\;W13.10\;million{\pm}W7.9\;million$ respectively. 17) Chunju city had the highest health budget per capita(W344) while Pusan Seo ku had the lowest(W19). 18) Director's medical subsidies are W30,000-50,000 in kun, and roughly W20,000 in city. 19) The older of priority in health center activities is T.B. control(31.1%), Family Planning and M. C. H.(28.0%), prevention of acute communicable disease and endemic disease (18.2%) and clinical care of patients(14.3%). 20) Nearly 32% opposed in principle the governmental policy of prohibiting medical doctors from going abroad. 21) Suggestions for immediate enhancing the position of director of health centers and subcenters: (1) Raise the base subsidy (48.2%), (2) Provide more opportunities for promotion (20.7%), (3) Exemption from army services(12.1%), (4) Full scholarship to medical students for this purpose only (7.8%). 22) A newly established medical school was opposed by 56.9% of the directors, however 33.6% of them approved. 23) Pertaining to the division of labor in Medicine and Pharmacy, the largest portion (31.9%) urged the immediate partial division of antibiotics and some addictive drugs to be given only by prescription. 24) More than half wa

Exploring H.M.O. Feasibility in the Korean Health Care Delivery Settings

문옥륜,Moon, Ok-Ryun The Korean Society for Preventive Medicine 1977 Journal of Preventive Medicine and Public Health Vol.10 No.1

한국인의 비만도에 따른 비만관련질환의 유병률 증가

문옥륜,강재헌,이상이,정백근,이신재,윤태호,황경화,김남순,Moon, Ok-Ryun,Kang, Jae-Heon,Lee, Sang-Yi,Jeong, Baek-Geun,Lee, Sin-Jae,Yoon, Tae-Ho,Hwang, Kyung-Hwa,Kim, Nam-Soon 대한예방의학회 2001 예방의학회지 Vol.34 No.4

Objective : To develop a boner understanding of the relationship between weight status and the prevalence of obesity related diseases in the Korean population. Methods : The 1998 Korean National Health and Nutrition Survey was used and 10,880 persons who had previously taken health examinations were selected for study. The Korean Society for the Study of Obesity's classification of weight status was used. Hypertension, diabetes mellitus, dyslipidemia, osteoarthritis, chronic heart disease, stroke were included as obesity related disease. A logistic regression model was developed to estimate the prevalence odds ratio by obesity class adjusted for demographic and socioeconomic factors and we converted the odds ratio to a prevalence ratio using the base line prevalence of disease to aid in the interpretation of the ratios. Results : The prevalence of obesity was 26.3% based on the KSSO classification $(BMI\geq25)$. A graded increase in the prevalence ratio was observed with increasing severity of overweight and obesity for all health outcomes with the exception of chronic heart disease in men and stroke in both men and women. With normal weight individuals as the reference, for men who were younger than 50 years, the prevalence ratios were highest for hypertension BMI<23-25: 1.70(95% CI=1.41-2.05), 25<BMI<30: 2.63(95% CI=2.25-3.05), $BMI\geq30$: 4.83(95% CI=3.70-5.84). The prevalence ratios for dyslipidemia were as high as hypertension, but were lower than hypertension for diabetes mellitus and osteoarthritis. Prevalence ratios generally were greater in younger adults. The prevalence of having 2 or more obesity related diseases increased with weight status category, except in people who were older than 50 years. Conclusions : Based on results, obesity is an increasingly important health problem in Korea and the disease burden increases according to weight status. For Korean adults, the strongest relationship was seen between weight status and hypertension and dyslipidemia. In older people the impact of excess weight and obesity is stronger than that seen in younger people. Increased efforts in the study of obesity and prevention and treatment of obesity and obesity related disease are required.

병원급 의료기관의 진료권별 병상소요 추계

문옥륜 ( Ok Ryun Moon ),이기효 ( Key Hyo Lee ),장동민 ( Dong Min Lang ) 한국보건사회연구원 1992 保健社會硏究 Vol.12 No.1

병상확충은 자원투입을 가장 많이 요구하기 때문에 병원급 의료기관 병상소요에 관한 분석은 보건의료자원의 합리적인 배분에 필수적인 요소이다. 이에 따라 본 논문은 효과적인 보건의료자원의 배분을 위한 기초자료를 제공하고자 전국 1407ß 의료보험 중진료권을 대상으로 병상소요를 추계하였다. 연구의 방법으로는 첫째, 인구 천명당 병상수, 둘째, 연간 병상공급 증가율, 셋째, 친화율 (RI), 넷째, 병상공급 과부족, 다섯째, 친화율을 이용하여 중진료권을 확대개편한 후 위 네가지 방법을 적용하는 방법을 사용하였다. 이러한 5가지 방법의 장단점이 검토되었으며, 각 방법을 사용한 진료권별 병상소요추계가 시도되었다. 그리고 이를 바탕으로 병상건립의 필요도가 큰 지역이 검토되었다. 본 연구의 결과는 미래의 의료이용에 관한 수요와 의료공급자의 행태변화를 반영하지 못하였기 때문에 이틀을 고려한 추후의 보다 심도깊은 연구가 수행되어야 할 것으로 보인다. Analysis of the hospital bed requirement is critical for the rational distribution of health resources, because this is the most expensive item in health services, so no effective health resource allocation is conceivable without considering it. This paper has applied five different indicators for measuring demand for hospital beds and discussed their advantages / disadvantages and limitations. The unit of analysis is the 1st level health service region, of which there are 140. The indicators employed in this analysis are : 1) the number of hospital beds for 1,000 population, 2) an- increase rate of hospital bed supply, 3) the percent of an age of residents taken care of by hospitals within a given region(Relevance lndexes ; RI), 4) the size of the gap between hospital supply and actual use, and 5) using the above fourth indicator by changing a health service region to a bigger region. The measure of relevance indexes(RI) was used extensively. The fact that this study has not considered future medical care demand and changing of provider behavior patterns calls for further comprehensive studies which would include the elements not dealt with in this analysis.

학교 구강보건사업에 관한 고찰

文玉綸(Ok Ryun Moon),申相完(Sang Wan Shin) 대한치과의사협회 1983 대한치과의사협회지 Vol.21 No.6

농촌의료보험의 당면과제와 개선방향

문옥륜(Moon Ok-Ryun) 한국농촌의학 지역보건학회 1991 농촌의학·지역보건 Vol.16 No.2

산업보건서비스체계의 효율적 관리방안에 관한 연구

문옥륜 ( Ok Ryun Moon ),한동운 ( Dong Woon Han ),최병순 ( Byung Soon Choi ),최재욱 ( Jae Wook Choi ),하은희 ( Eun Hee Ha ),이기효 ( Key Hyo Lee ),장동민 ( Dong Min Chang ) 한국보건행정학회 1994 보건행정학회지 Vol.4 No.1