청주시 일부 지역의 수돗물불소화사업 비용-편익 분석

정희웅 ( Hee Ung Chung ),안형식 ( Hyeong Sik Ahn ),문혁수 ( Hyock Soo Moon ),조수헌 ( Soo Hun Cho ),박형근 ( Hyeoung Keun Park ),이희영 ( Hee Young Lee ),윤석준 ( Seok Jun Yoon ) 한국보건행정학회 2003 보건행정학회지 Vol.13 No.1

청주시 지북정수장에서 시행되어온 수돗물 불소화 사업에 대하여 1982년부터 2010년까지 8∼14세 인구 2,343명을 대상으로 조사된 불소화 사업의 효과를 기초로 하여 경제성 평가를 시행한 결과 1982년-2010년까지 수돗물 불소화사업으로 인하여 감소된 우식경험치아의 진료비 순편익은 12,895,135,801원이었고, 비용-편익비는 8.64인 것으로 나타났다. 연도별로 나누어 살펴보면 다음과 같다. 1. 1982년∼2010년 동안 수돗물 불소화사업에 투여되는 총비용은 경상가격기준으로 1,384,164,734원이었으며, 총편익은 15,057,426,621원이었다. 2. 2000년 현재가치로 환산한 총비용은 1,687,412,718원이었고, 총편익은 14,582,548,519원이었다. 3. 1982년부터 2010년까지의 편익을 현재가치로 환산한 순현재가치는 12,895,135,801원이었고, 비용-편익비는 8.64이었다. 4. 1982년-2000년까지의 기간에 실제 발생한 순 현재가치는 7,990,710,155원이었고, 비용-편익비는 7.47이었다. 5. 2001년부터 2010년까지 발생할 편익의 순 현재가치는 4,904,425,646원이었고, 비용-편익비는 11.85이었다. 1982년부터 청주시 지북정수장에서 시행되어온 수돗물 불소화사업에 대하여 경제성 평가를 시행한 결과 수돗물 불소화사업의 경제성은 우수한 것으로 평가되었다. This study was performed to evaluate economic effect of the water fluoridation program in Cheong-Ju city from 1982 to 2010. To study this economic effect, this study used cost-benefit analysis methodology from eight years old to fourteen years old in Cheong-Ju city. Major findings were as follows; First, total cost of fluoridation program in Cheong-Ju city was 1,384,164,734 Korean won and total benefit was 15,057,426,621 Korean won from 1982 to 2010. Second, total cost which was converted by present value 2000 year was 1,687,412,718 won and total benefit which was converted by present value 2000 year was 14,582,548,519 Korean won. Cost-benefit ratio was 8.64. Net present value which happened from 1982 to 2000 was 7,990,710,155 Korean won and cost benefit ratio was 7.47. In conclusion, by the above result, economic impact of the water fluoridation program was very effective for children in some area of Cheong-Ju city.

수은 고노출 지역 초등학생의 수은노출수준과 노출요인 연구

김대선,권영민,정희웅,남상훈,유승도,Kim, Dae Seon,Kwon, Young Min,Chung, Hee-Ung,Nam, Sang Hoon,Yu, Seung Do 한국환경보건학회 2015 한국환경보건학회지 Vol.41 No.4

Objectives: Blood mercury levels among adults living in certain areas of the Gyeongsang Provinces have been shown to be very high (Kunwee County $29.6{\mu}g/L$, Yeongcheon-city $26.7{\mu}g/L$). The purpose of this project was to determine mercury exposure levels in schoolchildren and factors related with their mercury levels in high mercury exposure areas identifyed by the 2007 Korea National Environmental Health Survey. Methods: From June to September 2010, 1,097 students from grades 3 to 6 at 19 elementary schools participated in this study, including 294 students from 10 elementary schools in Kunwee County, 529 students from Yeongcheon City, 122 students from two elementary schools in Pohang City, North Gyeongsang Province, and 152 students from two elementary schools in Ulsan Metropolitan City. Biological samples from schoolchildren, including whole blood, urine and hair, were collected to measure total mercury at the time of a health check up. Information about children was collected by questionnaire. Total mercury concentrations in blood were measured using the Direct Mercury Analyzer 80 with the gold-amalgam collection method. Results: The mean mercury levels were $2.70{\mu}g/L$ in 1,091 blood samples, $2.25{\mu}g/g-creat.$ in 820 urine samples and $1.03{\mu}g/g$ in 1,064 hair samples. Blood mercury levels in the schoolchildren was slightly higher than the result of $2.4{\mu}g/L$ from a 2006 survey of elementary school children on exposure and health effects of mercury by the National Institute of Environmental Research. However, 0.3% and 4.5% of participants exceeded the reference level of blood mercury by CHBMII ($15{\mu}g/L$) and the US EPA ($5.8{\mu}g/L$), respectively. The reference level of urine by CHBMII ($20{\mu}g/L$) was exceeded by 0.4% of participants. As factors, residence period in the study areas, residence type, father's education level and income all showed significant associations with mercury level in the biological samples. The number of dental amalgam sides showed an association with urine mercury. Fish intake preference and fish intake frequency were important factors in mercury levels. In particular, intake of shark meat and recent intake of shark meat were associated with higher mercury levels. In this regard, participation in the performance of an ancestral rite showed a relation with higher mercury levels. Conclusion: The intake of shark meat was very important factor to high mercury exposure level. It is recommended to monitor and manage students with high mercury exposures who exceeded CHBM II and EPA guidelines, and include blood mercury testing in the Children's Health check up for this province.

수은 고노출지역 주민의 수은노출요인과 노출량 변화에 관한 연구

김대선,권영민,정희웅,최경희,KIM, Dae Seon,Kwon, Young Min,Chung, Hee-Ung,CHOI, Kyunghee 한국환경보건학회 2015 한국환경보건학회지 Vol.41 No.5

Objectives: The 2007 Korea National Survey for Environmental Pollutants in the Human Body found the highest blood mercury levels nationwide among residents in Seoksan-ri, Goro-myeon, Gunwi-gun, Gyeonsangbuk-do. With the aim to reduce the blood mercury levels of residents in this region, we conducted this study to identify the association between mercury exposure levels and shark meat consumption. Methods: This survey was conducted with 118 participants in Seoksan-ri before the Chuseok festival and 113 residents were added afterwards. Information on participants was collected via questionnaires. Total mercury concentrations in biological samples were measured using a mercury analyzer with the gold-amalgam collection method. Results: To identify this, we conducted mercury exposure level analysis before and after the Chuseok festival and found that blood and urinary mercury levels after Chuseok (GM of $6.9{\mu}g/L$ in blood and $1.68{\mu}g/g$_cr in urine) were higher than those before (GM of $5.29{\mu}g/L$ in blood and $1.44{\mu}g/g$_cr in urine). This area maintains a custom of using shark meat as one of the ancestral rite foods, and the performance of such rites and shark meat consumption have been identified as main sources of mercury exposure. Other than this, smoking, dental amalgam treatment and residential period in the area also contributed to an increase in mercury exposure levels. On the other hand, recent consumption of oriental medicine and vaccination did not have a significant influence on mercury levels. Conclusion: The results were attributed to the local custom of consuming shark meat with high mercury concentrations during rituals taking place during the festival and ancestral rites. Given that the blood mercury levels in 23.2% of the residents exceeded the HBM II values recommended by the German Commission on Human Biological Monitoring, it is suggested that further appropriate actions and follow-up measures be taken to reduce the mercury exposure levels of the residents that exceeded the reference values.

수은 고노출 지역 초등학생의 수은노출관련 건강영향 연구

김대선,안승철,정희웅,권영민,최경희,Kim, Dae Seon,Ahn, Seung Chul,Chung, Hee-Ung,Kwon, Young Min,CHOI, Kyunghee 한국환경보건학회 2015 한국환경보건학회지 Vol.41 No.4

Objectives: According to the 2007 Korea National Environmental Health Survey (KNEHS), some areas in the Gyeongsang Provinces showed very high blood mercury levels in adults. We conducted this project to investigate any related health effects in children due to mercury levels in these areas. Methods: In total, 1,097 students between grades 3 and 6 at 19 elementary schools were recruited from four areas with high mercury exposure as identified by the KNEHS. Total mercury levels in biological samples were compared with health check-ups performed on the schoolchildren. Biological monitoring, supported by questionnaires, a computerized neurobehavioral test, a posturography test and a personality test, were applied. Results: Triglycerides showed a significant relation with mercury in blood, urine and hair. Total mercury concentrations were divided into two groups: upper and lower concentration groups based on the median value. In the computerized neurobehavioral test, the upper blood mercury group showed a greater reaction time for color-word vigilance (p<0.05). In the posturography test, the intensity value of the tremor test showd high significant relations with mercury levels (p<0.01). In the personality test, self-consciousness, misdeeds and family relationships showed significant differences between the upper and lower urine mercury groups (p<0.01), and specific reactions, ego resilience and hyperactivity also showed some differences (p<0.1). Conclusion: Some items in the neurobehavioral test, posturography test and personality test showed significant relations with biological mercury levels. Therefore, monitoring and appropriate management of students showing high mercury levels are recommended in order to reduce their mercury exposure.

3개 대학병원의 주 진단 코딩사례 평가

서순원,김광환,부유경,서진숙,서정돈,윤석준,이영성,이무식,정희웅 한국의료QA학회 2002 한국의료질향상학회지 Vol.9 No.1

Background : Coding of principal diagnosis is essential component for producing reliable health statistics. We performed this study to evaluate the current practice of principal diagnoses determination and coding, and to give some basic data to improve coding of principal diagnosis. Method : Nineteen medical record administrators(MRAs) of 3 university hospitals participated in coding principal Dx. From August 1, 2001 to August 31, 2001. From each hospital, 10 medical records of patients with high frequency disease were selected randomly. Each 10 medical records were grouped into three(A,B,C). Then, these 30 medical records were given to each MRAs for coding. At the same time questionnaire was given to each of them. Questions were to prove how they decide and code the principal diagnosis among many current diagnoses ; how they decide and code the principal diagnosis when day see irrelevant diagnosis recorded as the principal diagnosis in medical record, when only tentative diagnoses were recorded without final diagnosis, and when different diagnoses were recorded in different sheets of same record. Agreement of coding among 3 hospitals were compared and survey results were analysed with SAS 6.12. Results : Agreement of coding was found in medical records 5-6 of each 10 medical records. Causes of disagreement were as follows. Difference of clinician’s opinion from each hospital; mixed use of guideline from KCD-3 and guideline from DRG; difference in 4th digit classification according to the absence of pathology report in the medical record; difference of abbreviations among hospitals. 57.9% of decided principal diagnosis after consulting to KCD-3 guideline. When there were difficulties in determining the principal diagnosis, 42.1% of MRAs decided principal diagnosis after discussion with the physician, 26.3% after discussion with fellow MRAs. Conclusion : There were differences in coding among hospitals. To minimize the difference, we suggest the development of disease-specific guidelines for coding in addition to the current general guideline such as KCD-3. To do this, Coding Clinic which can produce guidelines is needed.