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.

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

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.

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

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.

우리나라 병원의 경영전략 실태

문옥륜(Ok Ryun Moon),이기효(Key Hyo Lee) 한국병원경영학회 1996 병원경영학회지 Vol.1 No.1

This paper investigates the current feature of management strategy of hospitals in Korea, and examines the relationships between adoption of a particular strategic orientation and the hospitals environmental and organizational characteristics, strategic behaviors and management improvement activities, and financial performance. Data were collected from CEOs of 88 hospitals among 650 hospitals for a 13.5% response rate using the self-administered questionnaire by mail survey. The major findings that obtained are as follows : 1. Only 37.2% of response hospitals carried out strategic planning. Most of these hospitals established the first strategic planning in 1991(81.3%) and renovated strategic planning by 4 or 5 years(56.3%), and modified strategic planning with flexibility(59.4%). Most strategic plans were documented, but informalized(68.8%). And only 29.0% of these hospitals had independent planning division. 2. Hospital services that CEOs assessed rank ordered for their impact on profitability are as follows : i ) diagnostic ultrasound facility, computerized tomography scanner, obstetric inpatient unit, therapeutic X-ray, and physical therapy at present. ii ) diagnostic ultrasound facility, physical therapy, computerized tomography scanner, emergency department, and health screening at future. And the services rank ordered that CEOs hoped to introduce are as follows : emergency department, physical therapy, health screening, volunteer services, and computerized tomography scanner. Using a typology developed by Miles and Snow(1978), the strategic orientation of response hospitals are shifting significantly from defenders in the past to analyzers in the present, and to prospectors in the future(p<.01). 4. With regard to hospital environmental and organizational characteristics such as ownership, physician training, location, bed size, and hospital management training career and specialty of CEOs, the four strategic orientation archetypes varied not significantly. But, hospitals with a analyser orientation in the present and a reactor orientation in the future perceived competition significantly higher than the other three archetypes(p<.05). 5. The four archetypes rank ordered in terms of appling strategic behaviors and management improvement activities are as follows : prospector, analyzer, reactor, and defender. 6. The four archetypes differed significantly in terms of their financial performance using revenue per bed(p<.05). Reactors and prospectors in terms of total revenue per bed, prospectors in terms of outpatient revenue per bed, and reactors and prospectors in terms of inpatient revenue per bed had the best performance.

동일 질환에 대한 상병분류기호의 의료기관별 변이에 관한 연구

문옥륜 ( Ok Ryun Moon ),김창엽 ( Chang Yup Kim ),김명기 ( Myung Kee Kim ) 한국보건행정학회 1992 보건행정학회지 Vol.2 No.1

동북아시아 4개국의 양,한방 의료협진체계 비교

문옥륜 ( Ok Ryun Moon ),김은영 ( Hae Young Kim ),신은영 ( Eun Young Shin ),김혜영 ( Eun Young Kim ),천희란 ( Hee Ran Chun ) 한국보건행정학회 2003 보건행정학회지 Vol.13 No.2

Since 1990s, the use of Complementary and Alternative Medicine(CAM) has been rising rapidly all of the world. In 1983, WHO recommended that the traditional medicine actively be utilized. At the end of 20th century, as chronic and intractable diseases increased in western countries, traditional medicine has attracted considerable attention. COWM shows possibilities of new approaches for these intractable diseases. Thus, we try to show our proper approach of COWM through the international comparative study. In order to fulfill the objectives, we applied the following methodology: 1) Literature review on previous study, 2) Local survey using self-administered questionnaire, and 3) FGI(Focus Group Interview) with local experts. The results were as follows ; Three Asian countries, China, Korea and Taiwan, are very active in implementing COWM policy. Japan, however, has independent system of unified medicine. In regards to the combined care policy and system, China has the most advanced COWM system among four countries. In respect to combined care education, it is needed to increase the COWM education contents and the amount of cross educational curriculum. Based on the current COWM system, Chinese, Japanese and Taiwanese doctors can prescribe both oriental and western drugs. But, Korean medical law prohibits western doctors and oriental doctors from prescribing the counterpart`s medicine. So, the revision of current medical law is urgent for COWM in Korea. And when it comes to patient satisfaction, more than fifty percent responded positively in China, Korea and Taiwan. To achieve the goal of COWM; 1) mutual understanding and recognition of COWM is essential. 2) institutional and legal support system for COWM is desperately urgent. 3) possible international collaboration and cooperation should be sought to untangle these complex cultural dilemmas.

의료사고피해 구제제도의 제 모형

문옥륜 ( Ok Ryun Moon ),이기효 ( Key Hyo Lee ) 한국보건행정학회 1992 보건행정학회지 Vol.2 No.1