학생들이 강의에 집중하고 싶도록 만드는 팁

이상엽(Sang Yeoup Lee) 한국의학교육학회 2008 Korean journal of medical education Vol.20 No.3

일상적인 이동 전화의 사용과 혈압, 체질량지수 및 혈색소와의 관련성

이상엽(Sang-Yeoup Lee),김윤진(Yun-Jin Kim) 한국항공우주의학협회 2000 항공우주의학회지 Vol.10 No.1

종설 : 한국인의 복부비만 기준을 위한 허리둘레 분별점

이상엽 ( Sang Yeoup Lee ),박혜순 ( Hye Soon Park ),김선미 ( Sun Mee Kim ),권혁상 ( Hyuk Sang Kwon ),김대영 ( Dae Young Kim ),김대중 ( Dae Joong Kim ),조금주 ( Guem Joo Cho ),한지혜 ( Jee Hye Han ),김성래 ( Sung Rae Kim ),박철영 ( 대한비만학회 2006 The Korean journal of obesity Vol.15 No.1

연구배경: 최근 국제당뇨병연맹 (International Diabetes Federation, 이하 IDF)에서는 민족적 특성을 고려한 복부비만을 대사증후군의 필수 진단항목으로 설정하였다. 이에 비만학회에서는 한국인에서 복부비만 기준을 위한 허리둘레 분별점 설정 사업을 시행하였다. 방법: 체계적인 문헌 고찰 및 전문가 토론 과정을 거쳐 가장 적절한 도구로 분석 방법을 선정하였다. 분석자료로는 한국인을 대표할 수 있는 1998년도 국민건강영양조사 자료 (총 6,562명)를 이용하였으며, 분별점의 기준 지표로는 가장 최근에 제시된 IDF의 대사증후군 진단기준을 택하였다. Receiver Operating Characteristics (이하 ROC) curve를 통해 가장 적절한 분별점을 살펴보았으며, 교차비를 통해 대사 항목 2개 이상의 존재를 가장 잘 예측할 수 있는 수치를 구하였고, 얻어진 수치별로 복부비만의 유병률을 구하여 현재 국내의 실정에 가장 타당하다고 여겨지는 분별점을 정하였다. 결과: ROC 분석 결과, 높은 중성지방, 낮은 HDL-콜레스테롤, 높은 혈압, 높은 혈당 및 이러한 4가지 대사 이상을 예측하는 적정 허리둘레의 분별점은 대사 항목에 따라 남자에서는 82~84㎝, 여자에서는 79~82㎝의 범위를 보였다. 허리둘레 70㎝ 미만을 기준으로 교차비를 구한 결과, 허리둘레가 5㎝ 단위로 증가함에 따라 각각의 대사 항목 및 2개 이상 집합체의 교차비가 증가하는 경향을 나타내었다. 특히 대사 항목 2개 이상 집합체의 교차비가 5일 때의 허리둘레가 남자는 약 90㎝, 여자는 약 85㎝이었으며, 80백분위수에 해당하는 허리둘레는 남, 녀 각각 90.0㎝, 86.5㎝로 나타났다. 결론: 현재의 시점에서 사용 가능한 자료를 이용하여 분석, 고찰한 결과 한국인에서 복부비만의 기준을 위한 허리둘레 분별점은 남자에서 90㎝, 여자에서 85㎝로 나타났다. 따라서 남자에서 90㎝ 이상, 여자에서 85㎝ 이상일 때 복부비만으로 정의하는 것이 가장 적절할 것으로 보인다. Background: Recently, the International Diabetes Federation (IDF) consensus proposed a new definition for diagnosing metabolic syndrome. Ethnic-specific waist circumference (WC) cut-off points have been incorporated into the definition. Therefore, the study of the WC cut-off points for defining abdominal obesity in Koreans was performed by the Korean Society of the Study of Obesity. Methods: The data used for analysis was from the Korean National Health and Nutritional Examination Survey (KNHANES) performed in 1998 (involved 6562 participants), which is representative of nutritional health research in Korea. The 2005 International Diabetes Federation definition of the metabolic syndrome was applied. The reasonable cut-off points of WC for abdominal obesity in Koreans were set based on Receiver Operating Characteristics (ROC) curve, odds ratio and prevalence of abdominal obesity in the study population. Results: Using ROC analysis, the optimal WC to predict the risk factors of metabolic syndrome, such as high triglyceride levels, low levels of HDL-cholesterol, hypertension, and high glucose levels in Koreans, was 82~84㎝ for men, and 79~82㎝ for women. The odds ratio of having more than 2 metabolic abnormalities was about 5 in men with WC>90㎝ and in women with WC>80㎝. WC in the 80th percentile in the Korean population is 90㎝ and 86.5㎝ for men and women, respectively. Conclusions: The cut-off points of WC for abdominal obesity in Koreans are 90㎝ for men and 85㎝ for women, respectively. The cut-off points of waist circumference for defining abdominal obesity should be followed up by future additional studies and updated when new data becomes available.

흡연, 비만 및 대사증후군

이상엽 ( Sang Yeoup Lee ) 대한비만학회 2014 The Korean journal of obesity Vol.23 No.3

가정의학과 임상실습학생들의 논문작성법 교육에 적용한 간이 조사 시행 경험

이상엽(Sang-Yeoup Lee),김영주(Young-Joo Kim),최상한(Sang-Han Choi),이해균(Hae-Gyun Lee),안성률(Seong-Yul Ahn),김윤진(Yun-Jin Kim) 한국의학교육학회 2002 Korean journal of medical education Vol.14 No.1

Purpose: This study was to report our experience of the brief survey for teaching journal writing by medical students in a clinical curriculum of family medicine. Methods: Brief surveys performed by medical students in clinical clerkship of department of family medicine from 1998 to 2000. Medical students determined theme without rein for brief surveys. Lecture about meaning and process of survey was given for sufficient understanding of students, and then surveys were conducted. The subjects of survey were outpatients, nursing person, medical students, nursing students, and other general persons. The subjects of theme were classified to 17 chapters 7 components by international classification of primary care (ICPC). Results: In analysis of brief surveys according to ICPC, the reasons for surveys by components were diagnostic, screening prevention (89.0%), treatment, procedures, medication (5.7%), symptoms, complaints (5.3%). By chapters, there were social (64.6%), psychological (12.6%), metabolic and endocrine (6.5%). Among social problems, there were other social problem (35.4%), health care system/access (20.9%), problem with education (13.9%), relation problems partner (12.7%). Majority of medical students had affirmative response for survey conduction. In conclusion, our finding suggest that teaching journal writing as brief survey seems to be useful in understanding of journal writing of medical students.

식사시간에 따른 Ghrelin과 PYY3-36 농도 변화

최상한 ( Sang Han Choi ),이상엽 ( Sang Yeoup Lee ),김형회 ( Hyoung Hoi Kim ),전태용 ( Tae Yong Jeon ),김현준 ( Hyun Jun Kim ) 대한비만학회 2007 The Korean journal of obesity Vol.16 No.1

연구배경: 그렐린과 펩티드 YYJ3-36은 에너지 항상성과 연관된 위장관 호르몬이다. 저자 등은 식후 그렐린과 펩티드 YY3-36의 시간별 변화를 동시에 조사하였다. 방법: 연구를 시작하기 2주 전부터 아침식사시간을 엄격히 고정한 9명의 건강한 자원자를 대상으로 하였다. 채혈은 식전 1시간부터 11시 30분까지 매 시간 실시되었다. 혈장 그렐란, 펩티드 YY3-36, 렙틴 및 인슐린을 방사선면 역법으로 측정하였다. 결과: 혈장 그렐린 농도는 식전에는 588.0±204.4 pg/mL이었고 식후 1시간째는 394.22±145.25 pg/mL으로 감소하였다. 반면에 펩티드 YY3-36는 식전에는 29.9±13.7 pmol/L이었고 식후 1시간째에는 44.2±12.1 pmol/L로 증가하였다. 렙틴은 식전에는7.4±2.7 ng/mL이었고, 식후 1시간째에는 7.1±2.9ng/mL이었다. 반면에 인슐린은 식전에는 129.8±50.0 pmol/mL이었고, 식후 1시간째에는 658.8±332.3 pmol/L로 증가하였다. 혈장 그렐린은 식후 1시간째 최저 농도이었고, 펩티드 YY3-36는 식후 1시간째 최고 농도이었다. 결론 혈장 그렐린은 식후 1시간째 최저인 반면에 펩티드 YY3-36는 식후 l시간째 최고 농도이었다. 이는 혈장 그렐린과 펩티드 YY3-36가 식사에 띠라 같은 속도로 반대방향으로 반응한다는 것을 시사하는 소견이다. Background: Ghrelin and Peptide YY3-36 are gastrointestinal hormones related energy homeostasis. We investigated the changes in post-meal plasma ghrelin and PYY3-36 levels in people after meal, simultaneously. Methods: Nine healthy volunteers adhered to strict meal rimes starting two weeks before the study. Blood was drawn hourly for 4 hours. Plasma ghrelin, PYY3-36, leptin, and insulin levels were measured by radioimmunoassay. (RIA). Results: The mean plasma ghrelin level in subjects consuming the meal was 588.0±204.4 pg/mL just before breakfast and 394.22±145.25 pg/mL 1 h after meal, with the mean plasma PYY3-36 levels of 29.9±13.7 pmol/L and 44.2±12.1 pmol/L, respectively. The mean plasma leptin level in subjects consuming the meal was 7.4±2.7 ng/mL before the meal and 7.1±2.9 ng/mL 1 h after meal, with insulin levels of 129.8±50.0 pmol/L and 658.8±332.3 pmol/L, respectively. Plasma ghrelin levels were lowest 1 h after the meal. although PYY 3-36 levels were highest 1 h after the meal. Conclusion: While plasma ghrelin levels were lowest 1 h, PYY 3-36 levels were highest 1 h after the meal. These findings suggest that Plasma ghrelin and peptide YY3-36 levels change in opposite ways at the same speed.

Corrigendum: Correction of Acknowledgments

박은주,이상엽,임선주,윤소정,감비성,백선용,김윤진,우재석,이정규,정동욱,조영혜,이유현,탁영진,Park, Eun Ju,Lee, Sang Yeoup,Im, Sun Ju,Yune, So Jung,Kam, Beesung,Baek, Sun Yong,Kim, Yun-Jin,Woo, Jae Seok,Lee, Jeong-Gyu,Jeong, Dong-Wook,Cho, Yo 연세대학교 의과대학 2017 의학교육논단 Vol.19 No.2

정보기술을 활용한 의학교육시스템의 설계와 개발: 부산대학교 의학전문대학원 사례

임선주,이상엽,백선용,우재석,감비성,Im, Sun Ju,Lee, Sang Yeoup,Baek, Sun Yong,Woo, Jae Seok,Kam, Beesung 연세대학교 의과대학 2014 의학교육논단 Vol.16 No.1

The development of information technology (IT) has led to changes in medical education. IT has been used for e-learning and e-teaching, e-assessment, e-logistics, and e-administration. Pusan National University School of Medicine has developed its own educational information system using IT to support students' learning and assessment and to manage curricular activities. Based on our experience, we propose six suggestions for designing new software, specifically regarding simplifying the design for users, communication with the programmer, a rapid cycle from design to implementation, orientation support for users, backup and security support, and obtaining patents. Collaborating with the Department of Medical Informatics within the School of Medicine has advantages, and an alliance among medical schools can simplify the development of software. In any case, curricular innovation should precede the introduction of technology because all technologies should support curricular goals.

가정의학 임상실습과정에 대한 구조화된 평가

박은주,이상엽,임선주,윤소정,감비성,백선용,김윤진,우재석,이정규,정동욱,조영혜,이유현,탁영진,Park, Eun Ju,Lee, Sang Yeoup,Im, Sun Ju,Yune, So Jung,Kam, Beesung,Baek, Sun Yong,Kim, Yun-Jin,Woo, Jae Seok,Lee, Jeong-Gyu,Jeong, Dong-Wook,Cho, Yo 연세대학교 의과대학 2017 의학교육논단 Vol.19 No.1

This study was conducted to analyze the strengths and weaknesses of a 3-week family medicine clerkship program based on the results of an online survey taken by the students (N=127) and a structured interview with a focus group (n=10), aimed to improve the quality of the clerkship program. The online survey contained questions pertaining to goals, schedule, contents, arrangement, atmosphere, environment, evaluation, and satisfaction regarding the clerkship. The focus group interview addressed the schedule and achievements of the program. Scores were reported on a 5-point Likert scale. Most students were highly satisfied with the overall quality of the clerkship. The structured interview results showed that 97.6% of the clerkship program was executed according to the schedule. The focus group reported a perfect score of 5 points on several measures including: accomplishment of the educational goals of the family medicine clerkship, providing many chances to obtain medical histories and perform physical examinations on real patients, experience with various symptoms and diseases, positive attitudes of faculty members when teaching, notification of the guidelines for evaluation beforehand, well-constructed and effective clerkship schedule, and reflection of student feedback. However, the focus group gave low scores on: support for health accidents of students, access to patient information, enough opportunities to practice clinical skills, appropriate rest facilities for students, and fairness of clerkship evaluation process. In conclusion, the structured evaluation performed after the 3-week clerkship program motivated students and helped them ensure an efficient clerkship. This structured evaluation also suggested basic data to make the professor who is subject of the assessment. This study shows that structured assessment is an effective method which can be used to improve the quality of clerkships.

C형 간염 바이러스 RNA 유무에 따른 지질, 인슐린저항성 및 대사증후군 지표 수준의 차이

조성환(Sung-Hwan Cho),김윤진(Yun-Jin Kim),이상엽(Sang-Yeoup Lee),조병만(Byung-Mann Cho),황혜림(Hye-Lim Hwang),이유현(Yu-Hyeon Yi),조영혜(Young-Hye Cho),탁영진(Young-Jin Tak),정동욱(Dong-Wook Jeong),이승훈(Seung-Hun Lee),이정규(Jeong- 한국농촌의학 지역보건학회 2016 농촌의학·지역보건 Vol.41 No.4

본 연구에서는 한국인 성인에서 ant-HCV 양성인 군에서 HCV RNA 유무에 따른 지질, 인슐린저항성 및 대사증후군의 지표 수준의 차이를 알아보고자 하였다. 2004년 1월 1일부터 2010년 12월 31일까지 부산의 일개 대학병원 건강증진센터를 방문하여 검사한 효소면역측정법에서 anti-HCV 양성인 수진자 중 RT-PCR을 시행한 성인 222명을 대상으로 하였다. 이 중 HCV RNA가 양성인 사람이 85명, HCV RNA가 음성인 사람이 115명, HCV RNA의 음전이 확인된 사람이 22명이었다. 허리둘레, 체질량지수, 혈압과 총콜레스테롤, LDL 콜레스테롤, HDL 콜레스테롤, 중성지방, 인슐린저항성의 상관관계를 분석하고, 나이, 성별을 보정한 후 세 군간의 콜레스테롤, 대사적 지표, 인슐린저항성의 차이를 알아보았다. HCV RNA 양성군에서 음성군 및 음전군과 비교하여 허리둘레, 체질량지수, 혈압, 중성지방, HDL 콜레스테롤, 인슐린저항성 등에 통계적으로 유의한 차이는 없었다. HCV RNA 양성군에서 음성군에 비해 총콜레스테롤과 LDL 콜레스테롤이 통계적으로 유의하게 낮았다(186.24±37.63 vs 197.22±37.23 mg/dl (mean±SD), p=0.041, 111.66±34.06 vs 121.38±35.50 mg/dl (mean±SD), p=0.042). 나이, 성별을 보정한 뒤, HCV RNA 양성군과 음성군 간에 고콜레스테롤혈증과 LDL 콜레스테롤혈증의 교차비는 0.51(95% 신뢰구간 0.28-0.94, p=0.03), 0.46(95% 신뢰구간 0.24~0.87, p=0.02)이다. HCV RNA 양성군에서 음성군에 비해 고콜레스테롤혈증, LDL 콜레스테롤혈증의 유병률이 통계학적으로 유의하게 낮았으나, HCV RNA 음전군은 양성군에 비하여 통계학적으로 유의한 차이가 없었다. C형 간염과 대사증후군의 관계를 보다 정확히 규명하기 위해서는 향후 보다 대규모 집단에서 전향적인 코호트 연구가 필요할 것으로 생각된다. Objectives: We compared the difference of lipid, insulin resistance and metabolic markers based on HCV RNA in Korean adults. Methods: This was a cross-sectional study of 222 subjects visited the health promotion center of Pusan national university hospital from 2004 to 2007. Subjects were anti-HCV antibody positive and were performed RT-PCR for HCV RNA. The HCV RNA (+) group were 85 subjects, HCV RNA (-) control group were 115 subjects, and the HCV RNA (-) but past positive group were 22 subjects. We performed anthropometry, anti-HCV, RT-PCR, plasma concentrations of insulin, total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglyceride. Results: BMI, waist circumference, blood pressure, fasting plasma glucose, triglyceride, HDL cholesterol, insulin resistance such as HOMA-IR and QUICKI were not significantly different between HCV RNA positive and negative groups. The serum total cholesterol and LDL cholesterol level were significantly lower in the HCV RNA positive group than in the negative group (186.24±37.63 vs 197.22±37.23 mg/dl, p=0.041, 111.66±34.06 vs 121.38±35.50 mg/dl, p=0.042). After adjusting age and sex, high total cholesterol (≥ 200mg/dl) (adjusted OR=0.51, 95%CI 0.28-0.94, p=0.03) and high LDL cholesterol (≥ 130mg/dl) (adjusted OR=0.46, 95%CI 0.24~0.87, p=0.02) were inversely associated with being HCV RNA positive (p<0.05). Conclusion: The serum total cholesterol and LDL-cholesterol level were significantly lower in HCV RNA (+) group than in HCV RNA (-) group, but not in HCV RNA (-) but past positive group. Prospective cohort studies are needed to clarify the relationship between HCV RNA and metabolic markers.