노인장기요양서비스 이용과 의료이용의 관계

이주향 ( Juhyang Lee ) 한국보건경제정책학회 2022 보건경제와 정책연구 Vol.28 No.2

본 연구에서는 65세 이상 노인장기요양보험 인정자를 대상으로 장기요양서비스 이용 양상과 의료이용의 관계에 대해 실증적으로 분석하였다. 이를 위해 장기요양서비스를 재가서비스와 시설서비스로 구분하여 해당 서비스 이용자의 의료이용 경험 및 의료비용에 미치는 영향을 Two-part model을 사용하여 분석하였다. 특히 의료이용의 경우 급성기 병원 입원, 요양병원입원, 그리고 외래 이용으로 세분화하여 장기요양서비스 이용이 각각의 의료이용에 있어서 대체재 및 보완재의 역할을 하고 있는지를 파악하고자 하였다. 분석 결과, 요양병원 이용의 경우 시설서비스 이용군과 재가서비스 이용군 모두 요양병원 이용 경험에는 음(-)의 효과를 나타내었으며 요양병원 입원비용 및 입원일수 측면에서도 상당한 감소 효과를 보였다. 특히 시설서비스 이용군에서의 감소효과가 재가서비스 이용군보다 상대적으로 크게 나타나 요양병원과 요양시설 간의 대체효과가 더욱 명확하게 확인되었다. 급성기 병원 이용과 관련해서는 재가서비스 이용군과 시설서비스 이용군 모두 급성기 병원 이용 경험과 양(+)의 관계를 보였으나 입원 비용 및 입원일수의 감소 효과는 큰 것으로 나타났다. 이러한 결과는 장기요양서비스 이용이 의료이용의 대체재 또는 보완재 역할로서 의료비와 의료접근성에 영향을 미친다는 것을 시사한다. The purpose of this study is to empirically analyze the relationship between long-term care service use types and medical utilization for those who are certificated as long-term care insurance for the elderly over 65 years of age. We analyzed using the two-part model, and divided the long-term care service users into the home service use group, the facility service use group, and the non-use group, and examined their medical experience and medical use. As a result of the analysis, both the facility service use group and the home service use group showed negative(-) effects on the use of geriatric hospitals, and showed significant reduction in hospitalization costs and number of days in the geriatric hospitals. In particular, the reduction effect in the facility service use group was relatively greater than that of the home service use group, proving the substitution effect between geriatric hospitals and nursing facilities more clearly. Also, both the home service use group and the facility service use group showed a positive(+) relationship with acute hospital utilization, however, in both groups, the cost of hospitalization and the number of days of hospitalization showed a reduction effects. These results suggest that medical utilization and long-term care service affect medical expenses and medical accessibility, as substitutes or supplements to each other. Therefore, it is necessary to review the elderly health policy considering the cost of social insurance, including both health insurance and long-term care insurance, and health results for the elderly who have a desire for medical care and long term care services.

Multilevel Analysis of the Relationship Between Prescribing Institutions and Medication Adherence Among Patients With Hypertension and Diabetes in Korea

강하렴,Lee Juhyang 대한예방의학회 2023 예방의학회지 Vol.56 No.6

Objectives: This study investigated the relationship between prescribing institutions and medication adherence among patients newly diagnosed with hypertension and diabetes.Methods: This study investigated patients with new prescriptions for hypertension and diabetes in Korea in 2019 with using data collected from general health screenings. A multilevel logistic regression model was applied to explore the relationship between patients’ first prescribing institution and their medication adherence, defined as a medication possession ratio (MPR) over 80%.Results: The overall adherence rates were 53.7% and 56.0% among patients with hypertension and diabetes, respectively. The intraclass correlation coefficients were 13.2% for hypertension and 13.8% for diabetes (<i>p</i><0.001), implying that the first prescribing institution had a significant role in medication adherence. With clinics as the reference group, all other types of hospitals showed an odds ratio (OR) less than 1.00, with the lowest for tertiary hospitals (OR, 0.30 for hypertension; 0.45 for diabetes), and the next lowest in health screening specialized clinics (OR, 0.51 for hypertension; 0.46 for diabetes). Among individual-level variables, female sex, older age, higher insurance premium level, and residing in cities were positively associated with adherence in both the hypertension and diabetes samples.Conclusions: This study showed that the prescribing institution had a significant relationship with medication adherence. When the first prescribing institution was a clinic, newly diagnosed patients were more likely to adhere to their medication. These results highlight the important role played by primary care institutions in managing mild chronic diseases.

Factors Associated with Technology Acceptance among Middle- and Oldagedpeople in South Korea: A Systematic Review

Yuling Liang,Juhyang LEE,Eunjee Kim,Woosung Kwak,Siwan Kim,Hongsoo Kim 한국간호과학회 2019 한국간호과학회 학술대회 Vol.2019 No.10

야간경관계획에서 건축물 경관조명 디자인가이드라인에 관한 연구

김규진(Kim, Kyujin),이주향(Lee, Juhyang) 한국디자인지식학회 2013 디자인지식저널 Vol.26 No.-

야간경관계획은 도시를 구성하는 다양한 빛의 관계성을 경관형성에 주안점을 두고 체계화하여, 쾌적한 빛 환경을 조성하는 것이다. 조명기술의 발달과 야간 공간연출에 관한 관심의 증대는 도시계획, 야경계획, 야간경관조명계획등 국가, 지자체 차원에서의 경관조명 사업을 촉진시켰다. 도시계획에서의 조명은 크게 기능적인 목적의 생활조명과 연출적인 목적의 경관조명으로 구분할 수 있다. 그리고 경관조명은 공공시설물이나 도시기반 시설 등 공공사업차원의 경관조명과, 설치 및 운영 주체의 대다수가 민간주도적인 건축물 경관조명으로 구성된다. 공공사업 차원은 마스터플랜 구축, 유지 등이 비교적 체계적으로 관리가 가능하지만, 민간주도 차원의 건축물 경관조명은 자율성은 높은 반면 공공시설물과의 조화나 야간경관조명을 이루는 기능적 빛의 특성과 유기적인 조화를 이루는 데에는 어려움이 있다. 이의 대응방안으로 자치단체에서는 공공사업 차원에서 마스터플랜을 구축하고 이에 따르는 건축물 경관조명 가이드라인을 제시하고 있다. 본 연구에서는 각 지자체의 야간경관계획 사례를 조사·분석하여 공통적으로 활용 가능한 쾌적성, 공공성, 친환경성, 조화성의 4개 요소를 추출하였다. 즉 광공해를 유발하는 요소 제거, 도로안전의 확보, 에너지 오남용의 방지, 주야 도시경관의 조화의 내용 등을 주축으로 한 건축물 경관조명 디자인가이드라인을 제시하고자 한다. Nightscape Lighting is to create a pleasant lighting environment by focusing on the formation of landscape with ‘lights’ and systematizing the relations of various lights that consist city. As the additional functions of lighting space design has become important, the landscape lighting projects: urban planning, nightscape planning and nightscape lighting planning have been increasingly expanded by the government and the local governments. The purpose of urban lighting may be divided into a functional purpose of living lighting and an aesthetic purpose of landscape lighting. The landscape lighting from public facilities or urban infrastructures is relatively possible to manage systematically. But since the architectural lighting is installed and managed usually by private companies, it has difficulties in making an organic harmony with public facilities and functional light"s characteristic that create the nightscape lighting. Therefore, each local government establishes the master plan as a public service and offers architectural landscape lighting guidelines accordingly. Accordingly, the contents are classified into 4 factors: light pollution prevention, publicness, environment-friendly lighting and building aesthetics maintenance, and the relevant details are provided.

확장된 디자인 개념 기반의 디자인 윤리 모형 연구

유보현(Yoo, Bohyeon),이주향(Lee, Juhyang) 한국디자인지식학회 2014 디자인지식저널 Vol.30 No.-

디자인을 하는 역할로 진화되면서, 전문가의 디자인 과정에서부터 사용자의 사용 과정 및 사용자에 의해 재창조된 개인화된 디자인물에 까지 디자인 개념이 확장된다. 확장된 디자인 개념은 디자인 과정에 국한되어 다루어졌던 기존의 디자인 윤리에, 사용자의 사용 과정에 나타나는 여러 가지 윤리적 문제를 포함하게 한다. 이것은 디자이너의 디자인 과정에서 발생할 수 있는 디자인 및 디자이너의 위상 관련 윤리, 디자인 과제 관련 윤리, 사용자의 사용 과정에서 발생할 수 있는 사용자 욕구 관련 윤리 및 사용자의 위상 관련 윤리이다. 디자이너의 위상은 디자인 과제에 영향을 주며, 디자인 과제의 내용은 사용 과정의 사용 내용으로 그 내용은 다시 사용자 권익의 범주를 정하게 된다. 즉 이들은 각각에 대해 선행적으로, 한 영역에서만 국한하여 고민되어져서는 그 실효를 기대하기가 어렵다. 디자인 초기부터 사용자의 정서 및 개인적 욕구를 디자인 문제로 연계한 디자인은, 연장된 디자인 프로세스의 주체적 사용자를 배려한 윤리적 디자인으로 사회적 역할 및 책임 변화에 따른 새로운 대안이 될 수 있을 것이다. Nowadays the concept of design tends to be extended from professional design process to user process as a user and re-created outcome by personal end-user as the meaning of user is evolved as not only consumption and use but also creation and designing. The extended design concept includes existing design ethic within design process and several ethical problems which appears under the user process. That means the design ethic which involves status of designer, design project, status of user, and desire of user under the user environment. The status of designer would be effected by design project, the contents of design as contents of user process confine the user categories. That means we can’t expect actual effects because each of that confines one category. From the beginning of designing, the proposed alternative of design would be the ethical design that is considerate of subject user as extended design process.

리바운드 안압계, 비접촉 안압계, 골드만 압평안압계의 비교 및 중심각막두께와의 상관성

이주향,성민철,강민호,조희윤,이윤정,Juhyang Lee,Mincheol Seong,Minho Kang,Heeyoon Cho,Yoonjung Lee 대한안과학회 2012 대한안과학회지 Vol.53 No.7

Purpose: To compare the level of accuracy of intraocular pressure (IOP) measurements of a rebound tonometer (RT) Icare?, and non-contact tonometer (NCT), using Goldmann Applanation tonometer (GAT) as a reference to evaluate the influence of central corneal thickness (CCT) on IOP readings in the Korean population. Methods: In a prospective study of 273 eyes, IOP was measured with RT, GAT, and NCT and compared to CCT measurements. Patients were assigned to one of 3 groups based on IOP measurements of GAT and 1 of 2 groups based on CCT. The comparison of the IOP values of RT, GAT, and NCT was performed between the IOP and CCT groups, and the differences among tonometers were evaluated. Results: The RT showed statistically significant correlation with the GAT compared to the NCT. The CCT was related to RT measurements. The RT values compared to the GAT was underestimated in thin corneas and overestimated in thick corneas. Conclusions: There was a significant correlation between the RT and the GAT measurements compared with the NCT. However, RT is influenced by CCT and correlates less with GAT in low IOP ranges, suggesting that corneal thickness should be taken into consideration during such measurements. J Korean Ophthalmol Soc 2012;53(7):988-995

Vaginal leiomyoma in an adolescent woman

( Hyojin Kim ),( Taewon Jeong ),( Gyeongjin Kim ),( Yeongho Lee ),( Gyeonga Kim ),( Sanggi Hong ),( Sukyeong Beak ),( Jeongbeom Moon ),( Juhyang Lee ) 대한산부인과학회 2016 대한산부인과학회 학술대회 Vol.102 No.-

We report a case of vaginal wall leiomyoma in a young lady. Vaginal wall is a rare area that leiomyoma occurs which has reported approximately 300cases until now whose average age is 35~50years old. But, the patient we report is 18 years old adolescent women with sexually virgin. She presented first at local gynecology clinic with frequent(every two weeks) menstruation and for excluding organic causes rectal ultrasonography was done. Through ultrasonography, 3.5 cm sized vaginal wall mass was observed. The patient was referred to Jesus hospital gynecology clinic. Digital rectal examination was done and it is confirmed that there was no rectal mucosal invasion and there is no tenderness. To know the character of the mass and relationship with surrounding organs, MRI was done. The mass was probably seen leiomyoma and located in rectovaginal septum. The surgery was planned for the pathologic diagnosis and, because the patient was sexually virgin, the mass removal was done by rectovaginal approach. The patient was recovered without complications and final pathologic diagnosis was vaginal wall leiomyoma.

스펙트럼영역과 시간영역 빛간섭단층촬영기로 측정한 망막신경섬유층 두께 비교

이주향,송인석,김유정,차용재,엄기방,Juhyang Lee,MD,In Seok Song,MD,Yu-Jeong Kim,MD,Yong Jae Cha,MD,Ki Bang Uhm,MD,PhD 대한안과학회 2012 대한안과학회지 Vol.53 No.1

Purpose: To compare retinal nerve fiber layer (RNFL) thickness measured by time domain (Stratus) and spectral domain (3D) optical coherence tomography (OCT). Methods: Sixty-nine normal subjects and 92 glaucoma patients were included in the present study. Peripapillary RNFL thickness was measured with Stratus fast RNFL scan and 3D optic disc cube scan on the same day. The relationship between RNFL thickness measurements of the two OCTs were evaluated using a Pearson’s correlation analysis. A Bland-Altman plot was used for the comparison of Stratus-OCT and 3D-OCT. Results: In all subjects, average, superior, and inferior quadrant RNFL thicknesses measured by Stratus-OCT were thicker than those measured by 3D-OCT. In contrast, temporal and nasal quadrant RNFL thicknesses measured by 3D-OCT were thicker than those measured by Stratus-OCT. Although there were absolute value differences in RNFL thicknesses, high correlation was observed between Stratus-OCT and 3D-OCT (average: r = 0.897, temporal quadrant: r = 0.728, superior quadrant: r = 0.811, nasal quadrant: r = 0.678, and inferior quadrant: r = 0.905). Bland-Altman plots showed that Stratus-OCT values were greater than 3D-OCT values with relatively high RNFL thickness and the opposite with low RNFL thickness. Conclusions: For thicker RNFL, Stratus-OCT measurements tend to be greater than 3D-OCT, while for thinner RNFL, 3D-OCT measurements tend to be greater than Stratus-OCT. This difference must be taken into account if comparing measurements made with a Stratus-OCT to the measurements of a 3D-OCT. J Korean Ophthalmol Soc 2012;53(1):103-110

한국과 일본 대학교 구성원의 그린캠퍼스 인식 비교 연구

구자건(Jakon Koo),조용일(Yongil Cho),이승용(Seungyong Lee),김주향(Juhyang Kim),정종철(Jong Chul Jeong),김용범(Yong-Bum Kim) 한국환경교육학회 2012 環境 敎育 Vol.25 No.2

Green campus means the environmentally-conscious universities that are trying to increase campus sustainability by reducing carbon emissions, expanding eco-friendly activities. This study was carried out to compare the recognition level on green campus between Korea and Japan universities. For investigating the recognition level of students and faculties on green campus, the questionnaire surveys were conducted by personal interviews in Korea and Japan, separately. The 40% and 68% respondents in Korean A and B universities, respectively, pointed out the energy issue as one of the serious environmental problems while the corresponding ratio among Japanese respondents was 44% and 34%. The participation intention for green campus movement in Japanese universities was higher than Korean universities. The 70% or 52% of Korean students in A and B universities, respectively, replied that they did not participate the green campus movement. It is needed to strengthen the educational program to achieve the sustainability of campus in Korea.