의과대학 개설 교과목의 변화 양상에 대한 고찰

최보율(Bo Yul Choi),최삼섭(Sam Sup Choi),나중열(Joong Yol Na),정명현(Myung Hyun Chung) 한국의학교육학회 1994 Korean journal of medical education Vol.5 No.2

We looked for and discussed the changes of curricula of medical course of 31 medical schools during the period of 1984 and 1993. The data used in this study were Educational State Report of Korean Med ical Schools published from Dean Association of Korean Medical Schools in 1984 and 1992-1993. The significant findings were as follows. 1. There were great variability in number of subjects and in time for lecture and exercise in each subject among 31 medical schools. 2. There were a great deal of changes during the period of 1984 and 1993. There were increased tendency in number of subjects and especially block lectures. Schools which had 1-4 subjects vanished in curriculum were most frequent among 22 schools during 9 years. Name of most frequent subjects in block lecture were clinico-patholo gical conference, reproductive medicine, hematology, oncology and cardiology in 1993. 3. Subjects which were transferred to pre-medical program were classified to two groups. One group was traditional basic medical subjects such anatomy, physiology and biochemistry, the other group was newly introduced subjects such as molecular biology and cell biology as basic medical subjects. 4. The data were suggested that long time was needed to stabilized in newly introduced subjects of clinical medicine such as neurology and plastic surgery. Time for lecture and exercise of these subjects shows increasing tendency in schools established before 1978, but decreasing tendency in schools established after 1978.

21세기 건강증진과 질병예방 교육과정 개발 - 제5차 대한예방의학회 예방의학 학습목표 개정 방향 -

천병철,조수헌,최보율,Chun, Byung-Chul,Cho, Soo-Hun,Choi, Bo-Yul 대한예방의학회 2006 예방의학회지 Vol.39 No.4

The preventive medicine learning objectives, first developed in 1977 and subsequently supplemented, underwent necessary revision of the contents for the fourth time to create the fifth revision. However, the required educational contents of health promotion and disease prevention have been changed by the new trends of medical education such as PBL and integrated curriculum, the rapid change of the health and medical environment and the globalization of medicine. The Korean Society of Preventive Medicine formed a task force, led by the Undergraduate Education Committee in 2003, which surveyed all the medical colleges to describe the state of preventive medicine education in Korea, analyzed the changing education demand according to the change of health environment and quantitatively measured the validity and usefulness of each learning objective in the previous curriculum. Based on these data, some temporary objectives were formed and promulgated to all the medical schools. After multiple revisions, an almost completely new series of learning objectives for preventive medicine was created. The objectives comprised 4 classifications and 1 supplement: 1) health and disease, 2) epidemiology and its application, 3) environment and health, 4) patient-doctor-society, and supplementary clinical occupational health. The total number of learning objectives, contained within 13 sub-classifications, was 221 (including 35 of supplementary clinical occupational health). Future studies of the learning process and ongoing development of teaching materials according to the new learning objectives should be undertaken with persistence in order to ensure the progress of preventive medicine education.

일본뇌염 예방접종 후 면역원성 및 중화항체 지속률에 관한 조사: 전향적 다기관 코호트 연구

김동현,홍영진,이훈재,최보율,김창휘,박재옥,강진한,최병준,김종현,안영민,주영란,정영의,한명국,Kim, Dong Hyun,Hong, Young-Jin,Lee, Hoon-Jai,Choi, Bo-Yul,Kim, Chang Hwi,Park, Jae Ock,Kang, Jin Han,Choi, Byung Joon,Kim, Jong Hyun,Ahn, Young Min 대한소아감염학회 2013 Pediatric Infection and Vaccine Vol.20 No.3

목적: 일본뇌염 백신의 면역원성 및 중화항체 지속률을 평가하여 일본뇌염 예방 사업을 위한 토대를 제공하고자 하였다. 방법: 국내 6개 대학병원에 입원한 2-6세의 어린이 중 기초접종력이 확인된 170명을 대상으로 기초접종 완료 경과 기간에 따른 중화항체가를 조사하였다. 결과: 총 170명 중 불활성화 백신 접종군 103명, 생백신 접종군 64명, 교차접종군 3명이었다. 항체검사까지의 기간은 불활성화 백신 17.5개월, 생백신 21.0개월이었고 모두 일본뇌염 방어가 가능한 항체가를 보여 불활성화 백신 322, 생백신 266이었다. 추가접종 후 항체역가 변화는 1-4개월에 가장 높았고 이후 서서히 떨어지는 경향을 보였다. 결론: 불활성화 백신과 생백신의 면역원성과 중화항체 지속률에는 차이가 없고 두 백신 모두 일본뇌염 예방을 위한 적절한 수준의 면역원성을 갖고 있었다. 향후 대규모 표본을 대상으로 더 많은 연구가 필요하다. Purpose: This study aimed to study the antibody response of Japanese encephalitis vaccination in children using different kinds of vaccines (inactivated vaccine, live attenuated vaccine or interchanged) and evaluate the effectiveness of the vaccines to provide the basis of efficient immunization schedule of Japanese encephalitis. Methods: Measurement of the neutralization antibody (NTAb) titers following Japanese encephalitis vaccination using different vaccines for 170 children, 2-6 year of age, who visited six university hospitals and are confirmed by immunization records. Results: Among 170 children who were given primary immunization on Japanese encephalitis, 103 children were given inactivated vaccine, 64 children were given live attenuated vaccine and 3 children were given interchangeably. NTAb titers were more than 1:10 in all children of three groups. The geographic mean antibody titer was 322 in inactivated vaccine group and 266 in live attenuated vaccine group. However, there was no significant difference between two groups. In both groups, the NTAb titer showed the peak at 1-4 months after the third immunization and declined. The NTAb titers of three children who were given two kinds of vaccines alternately were 1:135, 1:632, and 1:2511, respectively. Conclusion: According to the results of this study in children younger than 6 years old, there is no significant difference in effectiveness between inactivated and live attenuated vaccines. However, further studies for the changes of antibody titers for a longer period of time on larger population are required.

영양보충제 복용에 영향을 미치는 인자에 관한 연구 : 서울 지역 성인을 대상으로

김미경(Kim Mi-Kyung),최보율(Choi Bo-Yul),이상선(Lee Sang-Sun) 韓國營養學會 1992 Journal of Nutrition and Health Vol.25 No.3

의과대학 학생현황에 대한 고찰

나중열(Joong Yol Na),최삼섭(Sam Sup Choi),최보율(Bo Yul Choi),정명현(Myung Hyun Chung) 한국의학교육학회 1994 Korean journal of medical education Vol.5 No.2

일본뇌염 사백신 중화항체 지속률과 부작용에 대한 연구

손영모,박지호,이진수,노혜옥,기모란,최보율,김영호,Sohn, Young Mo,Park, Ji Ho,Lee, Jin Soo,Roh, Hye Ok,Ki, Moran,Choi, Bo Yul,Kim, Young Ho 대한소아감염학회 2001 Pediatric Infection and Vaccine Vol.8 No.2

목 적 : 현재 사용하고 있는 마우스 뇌조직 유래 Nakayama주 사백신 접종 방법의 의학적 타당성을 알아보고자 접종 실태와 부작용 발생 양상과 빈도를 조사하고 추가 접종 방법의 타당성을 확인하기 위하여 중화항체 지속률을 조사하였다. 방 법 : 15,487명의 접종아를 대상으로 이상반응 발생 여부를 조사하였고 초등학교 학생 2,277명을 대상으로 건강기록부와 설문지조사를 통하여 접종실태와 이상반응 발생 빈도를 확인하였으며 접종기록이 일치하는 311명의 학생을 대상으로 중화항체 검사를 시행하였다. 검사는 United States Armed Forces Research Institute of Medical Science/Department of Virology, Bangkok(USAMC-AFRIMS)에서 시행되었고 50% 플라크 감소를 기준으로 1 : 10 이상을 양성으로 하였다. 결 과 : 건강기록부에 의한 초등학생 2,277명의 접종률은 47.5%였으나 설문지 조사에서는 접종률이 93.5%로 큰 차이가 있었다. 건강기록부에 나타난 취학 전 접종률은 남자 48.5%, 여자 46.4%로 차이가 없었다. 연령이 증가함에 따라 일본뇌염의 접종 횟수도 증가하는 양상을 보였다. 예방접종 여부가 건강기록부와 설문지 조사 결과가 일치하는 경우는 95년과 96년에 모두 접종 받았다고 응답한 경우만 75.6%로 높았고 그 외에는 일치도가 낮았다. 일본뇌염 예방접종 장소는 학교가 60.1%로 가장 많았고 그 외 보건소가 25.1%, 병 의원 14.1% 순이었다. 1995년 5~6월 사이 서울 소재 보건소에서 15,487명을 대상으로 일본뇌염 사백신을 접종한 후 0.13%에서 이상반응이 발생하여 의료 기관을 방문하였으며 이 중 57%는 고열 때문이었고 1례에서 접종 후 3분만에 실신 발작이 있었다. 전체 접종자의 0.02%에서 심한 두드러기 반응으로 의료기관을 방문하였으며 0.03%에서 두통 및 구토 등으로 의료 기관을 다시 찾았다. 1996년 봄에 초등학생을 대상으로 시행한 이상반응 설문지 조사에 의하면 주사 부위 발적이 17.4%, 주사 부위 동통이 14.8%, 발열 4.3%였고 그 외에 두통, 구토, 반점 등이 관찰되었다. 초등학생 311명 중 일본뇌염 접종력 조사에서 마지막 접종 후 6개월이 경과한 경우(1군)가 155명, 접종 후 18개월이 경과한 경우(2군) 104명, 30개월이 경과한 경우(3군)이 45명, 42개월이 경과한 경우(4군)가 7명이었다. 이들의 항체 양성률은 1군이 98.1%(152/155), 2군이 99.0%(103/104), 3군이 95.6%(43/45), 4군이 71.4%(5/7)로 양성률에 있어서 각 군간의 차이는 없는 것으로 나타났다. 결 론 : 현재 격년으로 시행하고있는 일본뇌염 사백신 추가 접종은 시기를 늘려 시행하여도 항체 지속률을 유지할 수 있을 것으로 추정된다. Purpose : We need to reconsider booster vaccination schedule of Japanese encephalitis vaccination. To do that we evaluate the long-term immunogenicity and the incidence of adverse events with inactivated mouse brain derived Nakayama Japanese encephalitis vaccine. Methods : We tested neutalizing antibody for 311 elementary school students by plaque reduction neutralizing test(PRNT) at USAMC-AFRIMS(United States Armed Forces Research Institute of Medical Science/Department of Virology). We evaluated vaccine related adverse events by spontaneous reporting prospectively among 15,487 vaccinees who were vaccinated at public health center and 2,277 elementary school students who were immunized previously by a questionnaire and school health record. Results : According to the time interval from the last booster injection of 311 children, PRNT antibody titers gradually decreased as the interval increased; 239 mIU/mL, 188 mIU/mL, 134 mIU/mL, 49 mIU/mL each at 6, 18, 30, 42 months after the last booster injection. The seropositivity rates were 98%, 99%, 95.6%, 71.4% each at 6, 18, 30, 42 months after the last booster injection. There were 21(0.13%) cases with systemic reactions among 15,487 vaccinees who had visited the hospital by prospective passive reporting system at public health center. According to the questionnaires and school health records in elementary school students, local induration and pain were 17.4% and 14.8%, respectively. Systemic reactions including fever, vomiting, rash were reported in few cases. Conclusion : Biannual booster vaccination that has been recommended so far should not be necessary. Surveillance for adverse events with inactivated mouse brain derived Nakayama vaccine should be strengthened to better assess the number of cases and reactions associated with immunization.

일 농촌지역 주민에서 우울증상과 심박변이도의 관계

안정우(Jung Woo Ahn),한창우(Chang Woo Han),최보율(Bo Yul Choi),김유미(Yu Mi Kim),남정현(Jung Hyun Nam),최준호(Joonho Choi),김석현(Seok Hyeon Kim) 대한스트레스학회 2008 스트레스硏究 Vol.16 No.3

목적: 이 연구의 목적은 우울증 진단을 받지 않은 일반 인구 집단에서 심박변이도(heart rate variability, HRV)와 우울증과의 연관성을 조사하여 우울증상에 따른 일반 인구 집단에서도 HRV의 변화가 있는지를 알아보는데 있다. 방법:경기도 소재 ○○군의 주민 중 건강증진 프로그램에 참가한 155명을 대상으로 하였다. 이중 HRV에 영향을 줄 수 있는 신체 질환을 가진 58명과 Beck’s depression inventory (BDI) 작성을 못한 2명을 배제한 95명의 short term electrode HRV를 측정하였고 BDI를 이용하여 우울증상을 조사하였다. 이들을 대상으로 HRV와 BDI 간의 연관성을 통계적으로 분석하였다. 결과: BDI와 HRV의 지표들 중 SDNN (standard deviation of the normal to normal interval), TP (total power), HF (high frequency), LF (low frequency), VLF (very low frequency), pNN50 (전체 normal to normal interval들 중 연속된 Normal to Normal Interval들의 변이가 50 ms 이상인 간격들의 비)이 유의하게 음의 상관관계를 가진 것으로 나타났으며 이 중 LF, HF, RMSSD (the square root of the mean squared differences of successive normal to normal intervals)는 BDI값을 이용하여 우울증을 중증 정도로 구분했을 때 유의하게 차이가 있었다. 결론: HRV의 일부 지표는 일반 인구에서 잠재성의 우울 증상의 정도를 측정할 수 있었다. Purpose: The purpose of this study is to investigate relationship between HRV (heart rate variability) and depressive symptoms in general population. This study was designed to examine the correlation of HRV and depressive symptom in general rural population. Methods: In 155 participants lived in the anonymous rural area of Gyeonggi-do, Korea, they participated in health promotion program with short term electrode HRV test and BDI (Beck’s depression inventory) self-report. Two participants were excluded due to fail to make out BDI and 58 participants were excluded because of some kinds of heart problems which were found after electrocardiogram and echocardiography exam of the health promotion program. We analyze HRV and BDI of remaining 95 subjects. Results: Our results showed that SDNN (standard deviation of the normal to normal interval), total power (TP), low frequency (LF), high frequency (HF) had negative correlation with BDI score, but only pNN50 (the proportion derived by dividing the number of interval differences of successive normal to normal intervals greater than 50 ms by the total number of normal to normal intervals) had positive correlation with BDI score. Also HF, LF and RMSSD (the square root of the mean squared differences of successive normal to normal intervals) are decreased by BDI severity grades increasing. Conclusion: In this findings of our study, some HRV variables seem to reflect subclinical depressive symptom severity in general rural population.

중년성인의 C-반응성 단백질과 상대악력 간의 연관성

박두용 ( Doo Yong Park ),강명성 ( Myung Sung Kang ),박재영 ( Jae Young Park ),김미경 ( Mi Kyung Kim ),최보율 ( Bo Yul Choi ),김연수 ( Yeon Soo Kim ) 대한스포츠의학회 2020 대한스포츠의학회지 Vol.38 No.3

Purpose: The purpose of this study was to investigate whether obesity indicators are mediated in the association between muscle strength and inflammation levels, and further confirm the association between muscle strength level by sex and age and inflammatory levels. Methods: In this study, 3,234 adults living in rural areas were surveyed from 2007 to 2015 and the data was finally analyzed on 2,149 adults. To identify that obesity indicators are mediated in relation to the association between relative grip strength and C-reactive protein (CRP) level, odds ratio (OR) and 95% confidence interval (CI) were calculated using logistic regression analysis (p<0.05). Results: As confounding variables were adjusted, the odds ratio for high inflammatory conditions was lower at a high (OR, 0.58; 95% CI, 0.40-0.85) or medium (OR, 0.64; 95% CI, 0.46-0.90) level of relative grip strength than a low level of relative grip strength. However, there were no significant results if the body fat percentage was added for the confounding variable. When the association between relative grip strength and inflammatory conditions was divided by sex, for women, the odds ratio about high inflammatory conditions was gradually decreased as the relative grip level increased (medium level: OR, 0.55; 95% CI, 0.35-0.87; high level: OR, 0.49; 95% CI, 0.30-0.82). The association of relative grip strength with inflammatory conditions was shown differently in age groups. Conclusion: In conclusion, improvement of muscle strength is a factor that can lower the level of inflammation, and it is important to lower the level of inflammation that can cause cardiovascular disease through resistance exercise differentiated by age and sex.

일 농촌지역 주민에서 스트레스 수준과 심박 변이도의 관계

변지상(Ji Sang Byun),신유섭(Yoo Shup Shin),김석현(Seok Hyeon Kim),신진호(Jin Ho Shin),최보율(Bo Yul Choi),남정현(Jung Hyun Nam),오동훈(Dong Hoon Oh) 대한사회정신의학회 2012 사회정신의학 Vol.17 No.2

연구목적 : 본 연구 목적은 지역사회 성인 거주민을 대상으로 자가보고식 척도를 통해 측정된 스트레스 수준과 최근 정신건강의학 영역에서 스트레스 관련 신경생리학적 지표로 사용되는 Heart rate variability(HRV)와의 관계를 알아보고자 하였다. 방 법 : 국내 일 농촌지역에서 실시된 건강검진 프로그램에 참여한 40세 이상 주민 1303명(남자 507명, 여자 796명)을 연구대상으로 하였다. 이들을 대상으로 HRV와 Psychosocial Wellbeing Index-Short Form(PWI-SF)를 측정하였으며, 통계분석으로는 독립표본 t-검정, 상관 및 회귀 분석을 시행하였다. 결 과 : 고위험군(PWI-SF score≥27, n=331)은 건강 및 잠재군(0<PWI-SF score≤26,n=972)에 비해 pNN50(the percentage of differences between adjacent normal RR intervals >50ms)이 유의하게 저하된 소견을 보였다(p=0.018). 그러나 전체 대상군에서 pNN50 과 PWI-SF 점수 사이에 상관관계를 보았을 때, 그 상관 계수가 낮았다(r=-0.055, p=0.049). 회귀분석 결과는 pNN50 값이 PWI-SF 점수를 2.0%로 설명할 수 있음을 보여주었다(F= 4.859, p=0.032). 결 론 : 스트레스 수준이 높은 고위험군에서 pNN50이 저하된 소견을 보였다. 그러나 전체 대상군에서의 스트레스 수준과 pNN50의 상관 관계는 뚜렷하지 않으며, HRV가 스트레스 평가에 확정적 도구로 사용되기에는 한계가 있다는 사실을 알 수 있었다. Objectives : The aim of this study was to investigate the relationship between the levels of psychosocial stress measured by selfreport questionnaire and the heart rate variability (HRV) which is currently used for the noninvasive assessment of stressrelated autonomic function in psychiatry. Methods : We analyzed cross-sectional data collected from 1303 community dwelling adults aged 40 year and above. The Psychosocial Wellbeing Index-Short Form (PWI-SF) was used as the measurement tool for subjective stress level. The analysis of HRV was performed evaluate their autonomic function. Associations between psychosocial stressor levels and HRV measures were assessed by means of the independent t-test, correlations and multiple linear regression analysis. Results : Comparing the indices related to the HRV, the high risk group (PWI-SF score ≥27, n=331) had lower pNN50 (the percentage of differences between adjacent normal RR intervals >50 ms) than the healthy and potential group (0<PWI-SF score≤26, n=972) (p=0.018). But in the entire group, pNN50 and PWI-SF scores were not significantly correlated (r= -0.055, p<0.05). A regression analysis of pNN50 and PWI-SF scores showed an R-value of 2.0% (F=4.859, p=0.032). Conclusion : There was no distinct relationship between psychosocial stress level and HRV. It can be concluded that there is a limit for HRV to be used as a tool in stress assessment.

건강진단 후 건강관련형태의 변화

오미경,천경수,신영전,최보율 대한가정의학회 1999 Korean Journal of Family Medicine Vol.20 No.8