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임주원,엄춘식,김소연,계소신,조비룡 대한노인병학회 2010 Annals of geriatric medicine and research Vol.14 No.1
Background: Pneumococcal vaccination among elderly is important for prevention of pneumonia and invasive pneumococcal disease(IPD). There are few studies of pneumococcal vaccination among elderly in South Korea. The aim of study is to examine the pneumococcal vaccination rate for people aged over 65 in South Korea and identify the proportion of the high risk group.Methods: We analyzed data from The Third Korea National Health and Nutrition Examination Survey(KNHANES Ⅲ) 2005. The subjects of this study include persons over 65 years. We used questionnaires about demographics, chronic diseases and individual health behavioral risk factors, which were needed to indentify the high risk group.Results: There were 1,097 persons of observation. The rate of pneumococcal vaccination among 65 years and over was 0.8%. The proportion of the men and women with one more risk factors was 77.3%, 62.8% respectively. Chronic cardio- vascular diseases and diabetes were major risk factors among targets recommended vaccination. In men, the proportion of smoke and chronic alcoholism(33.2%, 12.3%) was higher compare to 7.4%, 0.3% in women(p<0.001, p<0.001). The proportion of chronic cardiovascular diseases(48.0%) in women was higher than(38.7%) in men(p=0.012).Conclusion: The rate of pneumococcal vaccination among elderly in South Korea was seriously very low compared to that of influenza vaccination. That might be due to unawareness of the necessity to vaccinate. Clinicians should encourage the vaccination as well take a leading role in government health policy 연구배경: 노인에서의 폐구균 예방접종은 폐렴 및 침습적폐구균 질병의 예방에 중요하다. 그러나, 이에 대한 국내의연구는 미미한 실정이다. 본 연구는 폐구균 접종률을 확인하고, 폐구균 고위험군의 수준을 분석하는 데 있다. 방법: 국민건강영양조사 제3기의 자료를 이용하였으며,연구 대상은 65세 이상의 노인이었다. 인구학적 특성 변수와만성질환 유무, 개인 건강행태 변수 등 백신이 추천되는고위험군을 판별하는데 필요한 자료를 사용하였다. 결과: 연구 대상자 수는 1,097명이었으며, 65세 이상에서폐구균 예방접종률은 0.8%였다. 한개 이상의 위험인자를가진 남성의 비율은 77.3%, 여성이 62.8%로 나타났다. 남녀모두에서 폐구균 예방접종이 추천되는 위험인자 중 만성심혈관계 질환과 당뇨병이 주된 요인으로 나타났으며, 남성에서는 흡연과 만성 음주도 위험의 주요 인자로 나타났다. 남성에서는 흡연 및 만성음주의 위험요인의 비율이 33.2%와 12.3%로 여성의 7.4%와 0.3% 보다 통계적으로 유의하게높았으며(각각 p<0.001, p<0.001), 여성은 만성심혈관계 질환의 비율이 48.0%로 남성의 38.7%보다 유의하게 높았다(p=0.012). 결론: 우리나라의 노인에서 폐구균 예방 접종률은 심각하게 낮은 수준이었다. 높은 독감 예방 접종률에 비해 폐렴구균예방 접종률이 매우 저조한 것은 무엇보다도 정부나 의사가이에 대한 필요성을 깊이 인식하지 못하는 데 있다고 생각한다. 따라서, 의사 주도의 적극적인 진료와 정부 의료 정책에대한 변화가 필요할 것이다.
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宋省獻,嚴春植 弘益大學校 科學技術硏究所 2001 科學技術硏究論文集 Vol.12 No.-
One of the important components in designing logistics network is facility location problem. It is possible to solve the real world location problem using the mathematical model included in the package because of the growth of computer hardware technology. In this paper the package is developed to find the optimal network flows and the relevant transportation cost according to the location alternatives of distribution centers in the two stage logistics network. For the given logistics network there are two types of the distribution schema according to the service area constraint of demand points. The one is the minimum cost network flow problem that is solved by the network simplex method and another is the integer programming problem that is solved by the branch & bound method. And the package extracts the distance data that is needed in the optimal model from the geographical data of GIS. The optimal solution can be found using the package developed in this research and the result cab be displayed on GIS map. And also a numerical example is illustrated.
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임주원,조비룡,엄춘식,김계형,김선미 대한노인병학회 2009 Annals of geriatric medicine and research Vol.13 No.4
Background: Influenza vaccine coverage among the elderly is important for informed vaccination policies and programs. There are few studies that define influenza coverage in the elderly in South Korea. The aim of this study is to examine influenza vaccination coverage among those 65 years old and older in South Korea over the 2004-2005 influenza season and to identify the socioeconomic and clinical factors associated with vaccination. Methods: We analyzed data retrieved from The Third Korea National Health and Nutrition Examination Survey(KNHANES Ⅲ) 2005 conducted by the Korea Centers for Disease Control and Prevention. Subjects included in this study were older than 65 years. We used questionnaires to obtain information regarding demographics, chronic diseases, and individual health behavioral risk factors. Univariate analysis, logistic regression, and trend test were performed. Results: There were 1,097 persons included in this study. Influenza vaccination among those 65 years old and older was 77.2%. There was no difference of coverage by sex, education level, and income status. For elderly females, the more- unheal thy lifestyle(currently smoking, heavy alcohol use, and no exercise) that was practiced, the less likely they were- to be vaccinated(p for trend=0.007). Conclusion: The influenza vaccination coverage rate among the elderly in South Korea during the 2004-2005 flu season was relatively high compared to that of Europe(19.3-26.5%) during the same season. Nevertheless, the coverage rate in elderly women with unhealthy lifestyle was not satisfactory causing them to be more vulnerable to related illnesses than those who practiced a healthy lifestyle. To prevent influenza related illnesses, clinicians should, in particu- lar, encourage vaccination in those with an unhealthy lifestyle, as well as, lifestyle modification. 연구배경: 노인에서의 인플루엔자 접종률에 대한 추정은 정책과 프로그램에 중요한 자료이다. 그러나, 이에 대한 국내의 연구는 미미한 실정이다. 본 연구는 2004-2005년 시즌의 65이상 성인에서 인플루엔자 접종률을 알아보고, 이와 관련된 사회경제학적, 임상적 요인들을 알아내는데 있다. 방법: 국민건강영양조사 제3기의 자료를 이용하였으며, 연구 대상은 65세 이상의 성인이었다. 인구학적 특성 변수와 만성 질환 유무, 개인 건강 행태 요인 변수를 사용하였다. 단변량 분석과 다변량 분석, 추세 분석 등을 시행하였다. 결과: 연구 대상자 수는 1,097명이었으며, 65세 이상에서 인플루엔자 백신 접종률은 77.2%였다. 성별, 교육수준이나 수입에 따른 차이는 관찰되지 않았다. 노인 여성에서 건강하지 못한 생활습관(현재흡연, 과음, 비운동)을 많이 가진 군의 접종률이 유의하게 낮았다(p for trend=0.007). 결론: 우리나라의 노인에서 인플루엔자 백신 접종률은 2004-2005년 시즌의 경우 유럽의 국가들과 비교하여 높은 수준이었다. 그러나 건강하지 못한 생활습관을 가진 노인여성의 인플루엔자 백신 접종률은 만족스럽지 못하며, 이들은 인플루엔자에 더욱 취약할 것이다. 일차 의료현장에 서 이와 같은 실태를 감안한 백신 접종 전략이 필요하다.
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Use of Proton Pump Inhibitor and Risk of Colorectal Cancer: A Meta-analysis of Observational Studies
안정수,박상민,엄춘식,김사라,명승권 대한가정의학회 2012 Korean Journal of Family Medicine Vol.33 No.5
Background: Previous case-control studies have reported inconsistent findings regarding the association between proton pump inhibitor (PPI) use and colorectal cancer (CRC) risk. We investigated these associations using meta-analysis. Methods: We searched MEDLINE (PubMed), EMBASE, and the Cochrane Library in April 2011. Two evaluators independently reviewed and selected articles, based on pre-determined selection criteria. Results: Out of 737 articles meeting our initial criteria, 5 case-control studies, which involved 120,091 participants (9,514cases and 110,577 controls), were included in the final analyses. The overall use of PPI (used vs. never or rarely used) was not significantly associated with the risk of CRC in a fixed-effects model meta-analysis of all 5 case-control studies (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.96 to 1.20; I2 = 3.5%). Also, in sensitivity meta-analysis by cumulative duration of PPI use, there was no association between PPI use of 1 year or longer and the risk of colorectal cancer in a fixed-effects meta-analysis (OR, 1.09; 95% CI, 0.98 to 1.22; I2 = 0%). Conclusion: Although hypergastrinemia could be an important factor in the pathogenesis of some colorectal cancers,our study suggests that this does not lead to significant clinical risk for most PPI users. Further prospective studies or randomized controlled trials related to PPI use and colorectal cancer risk are needed to investigate this association.
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