소아 무균성 뇌막염의 역학적 연구를 위한 건강보험자료원의 유용성 평가

박수경,기모란,손영모,김호,정해관,Park, Sue-Kyung,Ki, Mo-Ran,Son, Young-Mo,Kim, Ho,Cheong, Hae-Kwan 대한예방의학회 2003 Journal of Preventive Medicine and Public Health Vol.36 No.4

Objectives : Aseptic meningitis is a major cause of Korean childhood morbidity late spring and early summer. However, the nationwide incidences of the disease have not been reported. This study was conducted to evaluate the availability of National Health Insurance data (NHID) for the study of an epidemiological trend in the surveillance of aseptic meningitis in children. Methods : All the claims, under A87, A87.8, and A87.9 by ICD-10, among children below 15 years of age, to the National Health Insurance Corporation, between January and December 1998, were extracted. A survey of the medical record of 3,874 cases from 136 general hospitals was peformed. The availability of the NHID was evaluated by the three following methods: 1) The diagnostic accuracy (the positive Predictive value : proportion of the confirmed aseptic meningitis among the subjects registered as above disease-codes in NHID) was evaluated through a chart review, and according to age, gender, month and region of disease-occurrence. 2) The distribution of confirmed cases was compared with the distribution of total subjects from the NHID, for subjects in General hospitals, or the subjects surveyed. 3) The proportion of confirmed CSF test was confirmed, and the relating factor, which was the difference in CSF-test rate, analyzed. Results : Among 3,874 cases, CSF examinations were peformed on 1,845 (47.6%), and the CSF-test rates were different according to the medical utility (admission vs. OPD visit) and the severity of the symptoms and signs. The diagnostic accuracy for aseptic meningitis, and during the epidemic (May-Aug) and sporadic (Sept-Apr) periods, were 85.0 (1,568/1,845), 86.0 (1,239/l,440) and 81.2% (329/405), respectively. The distributions by age, sex, month or period (epidemic/sporadic) and region, in the confirmed cases, were similar to those in the NHID, in both the subjects at General hospitals and in those surveyed, to within ${\pm}7%$. Conclusions : In this paper, the NHID for the subjects registered with an aseptic meningitis disease-code might be available for an epidemiological study on the incidence-estimation of childhood aseptic meningitis, as the NHID could include both the probable and definite cases. On the basis of this result, further studies of time-series and secular trend analyses, using the NHID, will be peformed.

일부 농촌 성인의 당뇨병 유병률 추정

박수경,김정순,Park, Sue-Kyung,Kim, Joung-Soon 대한예방의학회 1996 Journal of Preventive Medicine and Public Health Vol.29 No.3

The objectives of this study are to estimate the prevalence of diabetes mellitus (DM) and to identify risk factors associated with fasting blood sugar in a rural adult population. We carried out a cross - sectional study on the residents over 30-year old. Among the 1077 eligible subjects, 725 persons responded to the study;the study consisted of interview on family and past history of DM, anthropometry, blood pressure, and blood sugar level in each subjects. Only 707 subjects of 725 participants had fasting blood sugar(FBS) examined and the rest, 18 subjects were had casual blood sugar examined due to failure of fasting over 8 - hour. When subjects had $FBS\geq140mg/dl$, 2 hours postprandial blood sugar level was checked after 75g oral glucose loading. The prevalence of DM was 8.9%, and age standarized prevalence rate adjusted to Korean population of 1995 was 5.8%. Mean and SD of fasting blood sugar in men was $99.8{\pm}22.6$, and in women was $111.5{\pm}29.9$. Mean levels of fasting blood sugar were significantly higher in women than in man and as their ages advanced the prevalences increased in both sexes. PP2 blood sugar levels were significantly higher in elder age and in persons with higher FBS levels than others. The risk factors associated with FBS were past history of diabetes, sex, socioeconomic status and waist - to - hip circumference ratio;the risk of diabetes was increased in female, people with past DM history, central obesity and low socioeconomic state. The low socioeconomic status associated with DM in this study, which is different from other study results, should be pursued in further studies.

2000년 영덕군 홍역 유행시 유행 차이에 따른 2개 초등학교 일부 학생에 대한 역학 조사

박수경,김지희,이주연,나병국,김우주,정해관,Park, Sue-Kyung,Kim, Jee-Hee,Lee, Joo-Yeon,Na, Byoung-Kuk,Kim, Woo-Joo,Cheong, Hae-Kwan 대한예방의학회 2001 Journal of Preventive Medicine and Public Health Vol.34 No.2

Objectives : During March-May, 2000, a measles outbreak occurred at Youngduk, Korea. This county is divided into two areas with different historical and socioeconomic background. The outbreak occurred in one of these areas. We conducted a comparative epidemiologic study on the two areas in order to evaluate the factors related to the epidemic. Materials and Methods : We selected two groups, grades 3 and 5 in a primary schools in each area. We investigated outbreak-related factors using parent-questionnaires, the vaccination history from the student's health record and the records concerning the recent measles-outbreak from the local health center. Serologic test on measles-IgG and -IgM antibody was done. Results : The infection rate was 31.5% for the epidemic area and 3.7% for non-the epidemic area according to clinical or serological criteria (p<0.001). No difference was seen in the measles vaccination rate, residence at the time of vaccination or past measles infection history between the two areas. In the epidemic area, the attack rate for the 4-6 year-old MMR booster group(20.5%) was higher than the non-booster group(32.4%), but was not found significantly. Vaccine efficacy was 29.6% in the epidemic area and 87.0% in the non-epidemic area (p<0.001). The IgG level and positive rate were significantly different between the two areas (median 10727 IU/ml, 98.9% in epidemic area; median 346 IU/ml, 85.9% in the non-epidemic area, p<0.001). However, the IgG level and positive rate between the measles-cases and non-cases were not significantly different. Conclusions : This outbreak took place in mostly vaccinated children. These results suggest that a reduction of herd immunity for immunity failure after vaccination may be one of the feasible factors related to the outbreak pattern in the two areas. The results of the IgG level and positive rate suggest that re-establishment of a normal value for IgG level and of a qualitative method for IgG are needed.

혼합 액상 폐기물 취급 사업장의 집단 피부 질환 증례보고

박수경(Sue Kyung Park),임현술(Hyun-Sul Lim) 대한직업환경의학회 2004 대한직업환경의학회지 Vol.16 No.3

열공성 뇌경색 환자-대조군에서 신경행동검사의 수행 평가

김함겸,박수경,이건세,김형수,김화선,장성훈,Kim, Ham-Gyum,Park, Sue-Kyung,Lee, Kun-Sei,Kim, Hyeoug-Su,Kim, Wha-Sun,Chang, Soung-Hoon 대한예방의학회 2003 예방의학회지 Vol.36 No.3

전체 뇌졸중의 $15{\sim}20%$를 차지하고 있는 열공성 뇌경색(lacunar infarction)은 최근 뇌경색형 뇌졸중의 증가와 더불어 그 중요성이 점차 증가하고 있는데, 1년 이내 뇌경색이 재발되거나 노인, 고혈압 및 초기 신경학적 이상과 같은 감수성 인자가 있는 경우 뇌경색 재발과 혈관성 치매 발생 위험이 있어 삼차예방적 측면에서의 적절한 처치가 필요한 질병이다. 그렇지만 열공성 뇌경색은 증상이 없거나 경미한 경우가 상당히 많아 환자 자신이 치료의 중요성을 느끼지 못할 뿐 아니라 의사들도 환자의 경미한 신경학적 이상을 인지하지 못하여 처치의 당위성에 대해 설득력있는 근거를 제시할 수 없어 적절한 처치가 미비한 상황이다. 본 연구는 신경학적 자각 증상은 없지만 MRI상 열공성 뇌경색으로만 진단된 환자군이 MRI상 이상소견이 관찰되지 않는 대조군에 비하여 신경행동 검사상 차이가 관찰될 것이라는 가설을 구명하고자 하였다. 따라서 뇌졸중의 증상 및 증후 없이 두개골 외상 혹은 두통, 경부강직 등과 같은 신경학적 이상으로 MRI를 촬영한 대상자 중에서 다른 이상 없이 열공성 뇌경색으로만 진단될 환자군과 특별한 이상 소견이 없는 것으로 진단된 대조군에서 WHO의 NCTB(neurobehavioral core test battery)검사의 일부와 Perdue pegboard score검사를 시행하였고, 그 결과 대조군에 비해 환자군의 신경행동 이상이 평균 및 가장 빠른 단순반응시간 검사를 제외한 5개 검사에서 관찰되었다. 본 검사의 결과는 자각 증상이 없거나 경미한 증상을 호소하는 열공성 뇌경색 환자들의 차후 필요한 검사의 선별과 삼차 예방적 측면에서 처치의 근거로서 활용될 수 있을 것이다. 또한 자각 증상이 없거나 경미한 증상이 있지만 진찰상 신경학적 이상 증후를 거의 찾을 수 없는 대상자에서 MRI검사 필요성의 근거를 확인하고자 하는 대상자에게 이용될 수 있을 것으로 사료된다. Objectives : We carried out tests for neurobehavior by using WHO-NCTB (neurobehavioral core test battery) and Perdue pegboard score test to identify differences between lacunar infarction cases and controls. Methods : Among the subjects who underwent MRI between February 2001 and March 2002 in a university hospital located in Seoul and who were diagnosed only as lacunar infarction without any intracranial disease, 46 patients were selected as cases (male: 21, female: 25). Controls were selected who had no cerebrovascular disease on MRI by matching age (5 years), gender, and education (2 years) in a ratio of 1:1 , Among WHO-NCTB, the following 5 tests and Perdue pegboard score test were used to categorize the study subjects: digit and symbol matching, simple reaction time, Benton visual retention, digit span, and Pursuit aiming test, Results : Among the above 6 tests of neurobehavior, lacunar infarction cases showed lower score than controls except for the simple reaction time test. As the controlling variables of multivariate analysis in the stepwise regression analysis, the followings were selected due to their significant association: age, education, BMI, gender, drinking, exercise, add systolic blood pressure. From multivariate regression analysis, there was significant difference (p<0.05) between lacunar infarction cases and controls in digit and symbol matching, Benton visual retention, digit span, pursuit aiming, and Perdue pegboard score test, but not in the score of simple reaction time test. Conclusions : We suggest that the above 5 tests for neurobehavior, with the exception of the simple reaction time test, might be used as the basis for recommendation of further treatment and other neurological tests by the earlier defection for neurological abnormality in lacunar infarction.

여성의 출산력과 초경 및 폐경 연령에 대한 설문지의 신뢰도

고광필,박수경,김연주,배지숙,전재관,곽진,유근영,Ko, Kwang-Pil,Park, Sue-Kyung,Kim, Yeon-Ju,Bae, Ji-Suk,Jun, Jae-Kwan,Gwack, Jin,Yoo, Keun-Young 대한예방의학회 2008 예방의학회지 Vol.41 No.3

Objectives : This study was performed to evaluate the reproducibility of a questionnaire concerned with reproductive history and to ascertain which characteristics of the subjects (age, the visit-revisit intervals, education and chronic disease) are associated with good reliability in the Korean Multi-Center Cancer Cohort (KMCC) study. Materials and Methods: A total of 19,688 participants were enrolled between 1993 and 2004. Among them, we selected 386 participants who were aged 40 or more and who re-visited within 8 years after the first visit. Reliability was measured by the percent agreement according to error range for the continuous variables and the percent agreement and kappa statistics for the categorical variables. Results : The pregnancy histories were reliable (kappa=0.67) and the reasons for being menopausal among the postmenopausal women were also reliable (kappa=0.92). The percent agreement of the breast-feeding history was high (96.1%), although the kappa statistic was low. For the continuous variables, when the error range of one variable was considered to be reliable, the percent agreement of the age at menarche and the age at the first full term pregnancy was good (69.4% and 83.6%), whereas that of the age at menopause was low (51.5%). The factors associated with high reliability were a younger age, the presence of chronic disease and a short visit-revisit time interval. Conclusions : The agreements for parity, the reasons for menopause, and the breastfeeding history in the reproductive history questionnaire used in the KMCC were relatively good. The questionnaire for the menarche age and the menopausal age might have lower reliability due to the difference between Korean age and American age. To obtain reliable information, more attention should be given to the items in questionnaire-based surveys, and especially for surveying old-aged women.

한국인 여성 유방암 발생률 추정에 관한 역학적 연구 -충북지역을 대상으로-

유근영,박수경,성주헌,노동영,최국진,Yoo, Keun-Young,Park, Sue-Kyung,Sung, Joo-Hun,Noh, Dong-Young,Choe, Kuk-Jin 대한예방의학회 1998 예방의학회지 Vol.31 No.4

This study was conducted to estimate incidence rate of female breast cancer in a defined area of Chungchongbuk-do in Korea. The presumptive breast cancer cases were selected from two different sources, i.e., medical utilization database of the National Health Insurance Corporation and the database from the National Cancer Registry. Medical students visited each hospital where the presumptive cases had been treated as a breast cancer patient, and made a dictation of medical record of each patient based on the claims stored in the Insurance Corporation from January to December 1995. The diagnoses in the claims included one of the following diagnostic codes; ICD-9 174-175(malignant neoplasms of the breast), 233(carcinoma in situ of the breast and genito-urinary system)or ICD-10 C50(malignant neoplasms of the breast), D05(carcinoma in situ of the breast and genito-urinary system). Each case has been confirmed as having a breast cancer by a breast surgeon through a medical record review. Age-standardized incidence rate of female breast cancer to the Korean population was estimated to be 10.5(95%confidence interval : 8.1-12.9)per 100,000 persons in 1995. Age-standardized rate to the world population was 9.8 per 100,000 persons, and the truncated rate for ages 35-64 was 27.2 per 100,000 persons. Validity of these estimates is discussing in comparison with previous methods of incidence estimation in Korea.

지역사회 유행을 통하여 평가한 홍역 예방접종의 효과

박병찬,박수경,정해관,Park, Byung-Chan,Park, Sue-Kyung,Cheong, Hae-Kwan 대한예방의학회 2002 예방의학회지 Vol.35 No.1

Objective : From an analysis of a community outbreak of measles in Youngju, Gyeongbuk, in March 2000, the authors evaluated the effectiveness of the measles vaccination and its determinants to Provide an epidemiologic basis for the establishment of a vaccination policy. Methods : Information was collected regarding the vaccinations from the health records of four primary schools and through a questionnaire surrey of the parents of students in two middle and two high schools (N=4638). Measles cases were surveyed from the patient list of each school and from case reports in the public health center. The attack rate and vaccine effectiveness of measles was evaluated by school; grade; frequency, region, and institution of vaccination. Results : The attack rate cf measles, 6.3% among the total subjects, was higher in middle school students (15.8%) than in primary (2.0%, p<0.05) and high school students (8.9%, p<0.05). The attack rate of the unvaccinated group was 4.6-fold higher than the vaccinated group in primary schools (p<0.05). Vaccine effectiveness was 83.2% among lower graders of primary schools, 34.0% among higher graders of primary schools,26.1% in middle schools, and -7.0% in high schools. In multiple logistic regression analysis, grade in school (odds ratio, 0.77; 95% CI=0.67-0.87) and frequency of vaccination (odds ratio, 0.57: 95% CI=0.37-0.58) were significant predictors of the outcome. Conclusions : We concluded that the explosive outbreak of measles in this area resulted from both inadequate vaccination coverage and secondary failure of vaccination. There was no evidence of any effect of the cold chain system on the vaccine failure.

공복 혈당과 위암 발생 위험에 관한 코호트 내 환자-대조군 연구

전재관,곽진,박수경,최윤희,김연주,신애선,장성훈,신해림,유근영,Jun, Jae-Kwan,Gwack, Jin,Park, Sue-Kyung,Choi, Yun-Hee,Kim, Yeon-Ju,Shin, Ae-Sun,Chang, Soung-Hoon,Shin, Hai-Rim,Yoo, Keun-Young 대한예방의학회 2006 예방의학회지 Vol.39 No.6

Objectives : Diabetes has been reported as a risk factor for several cancers. However, the association between diabetes and gastric cancer has been inconsistent. The aim of this study was to evaluate the association between the fasting serum glucose level and gastric cancer risk in Korea. Methods : Among the members of the Korean Multi-Center Cancer Cohort (KMCC) from 1993 to 2004, a total of 100 incident gastric cancer cases were ascertained until December 31, 2002 and 400 controls were matched according to age, sex, and year and area of enrollment. Of the eligible subjects, those without fasting serum glucose level information were excluded, with a total of 64 cases and 236 controls finally selected. On enrollment, all subjects completed a baseline demographic and lifestyle characteristics questionnaire, and had their fasting serum glucose level measured. The Helicobacter pylori infection status was determined by an immunoblot assay using long-term stored serum. The odds ratios (ORs) were estimated using conditional and unconditional logistic regression models adjusted for the H. pylori infection status, smoking, drinking, education, follow-up period and matching variables. Results : The ORs for risk of gastric cancer according to the serum glucose level were 1.33 [95% CI=0.50-3.53] and 1.66 [95% CI=0.55-5.02] for the categories of 100-125 and 126 mg/dL or greater, respectively, compared to the category of less than 100 mg/dL. No increased risk of gastric cancer according to the serum glucose level was found (p-trend=0.337). Conclusions : This study provides no evidence for an association of the serum glucose level with gastric cancer.

정신질환에 대한 일반인의 사회적 거리감에 영향을 미치는 요인

문상준,이진석,박수경,이선영,김윤,김용익,신영수,Moon, Sang-Jun,Lee, Jin-Seok,Park, Sue-Kyung,Lee, Sun-Young,Kim, Yoon,Kim, Yong-Ik,Shin, Young-Soo 대한예방의학회 2008 예방의학회지 Vol.41 No.6

Objective: The purpose of this study was to investigate impact of knowledge familiarity, and prejudice about mental illness as well as demographic factors on the social distance from mentally ill people, which is a proxy measure of discrimination. Method: To assess the impact of knowledge and familiarity, prejudice about mental illness and demographic factors on the social distance from mental illness, we conducted a telephone survey in South Korea with the responders being nationally representative people who were 18 years old or over (n=1040). Independent samples T-tests, one way ANOVA and linear regression analysis were performed to analyze the results of the survey. Result: The social distance from mental illness decreased as the knowledge and familiarity increased, but the social distance was increased as prejudice was increased. Prejudice had a greater impact on social distance than familiarity and knowledge. Females showed greater social distance than did males. A higher education level had a negative effect on social distance. Conclusion: to reduce the social distance from mentally ill people, efforts to increase the familiarity about mental illness as well as efforts to educate people about mental illness are important.