• Journal of Preventive Medicine and Public Health
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• 제56권2호
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• pp.180-189
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• 2023

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has led to a global shortage of medical resources; therefore, we investigated whether COVID-19 impacted the quality of non-COVID-19 hospital care in Korea by comparing hospital standardized mortality rates (HSMRs) before and during the pandemic. Methods: This retrospective cohort study analyzed Korean National Health Insurance discharge claim data obtained from January to June in 2017, 2018, 2019, and 2020. Patients' in-hospital deaths were classified according to the most responsible diagnosis categories. The HSMR is calculated as the ratio of expected deaths to actual deaths. The time trend in the overall HSMR was analyzed by region and hospital type. Results: The final analysis included 2 252 824 patients. In 2020, the HSMR increased nationwide (HSMR, 99.3; 95% confidence interval [CI], 97.7 to 101.0) in comparison to 2019 (HSMR, 97.3; 95% CI, 95.8 to 98.8). In the COVID-19 pandemic zone, the HSMR increased significantly in 2020 (HSMR, 112.7; 95% CI, 107.0 to 118.7) compared to 2019 (HSMR, 101.7; 95% CI, 96.9 to 106.6). The HSMR in all general hospitals increased significantly in 2020 (HSMR, 106.4; 95% CI, 104.3 to 108.5) compared to 2019 (HSMR, 100.3; 95% CI, 98.4 to 102.2). Hospitals participating in the COVID-19 response had a lower HSMR (HSMR, 95.6; 95% CI, 93.9 to 97.4) than hospitals not participating in the COVID-19 response (HSMR, 124.3; 95% CI, 119.3 to 129.4). Conclusions: This study suggests that the COVID-19 pandemic may have negatively impacted the quality of care in hospitals, especially general hospitals with relatively few beds. In light of the COVID-19 pandemic, it is necessary to prevent excessive workloads in hospitals and to properly employ and coordinate the workforce.

• 한국방재안전학회논문집
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• 제16권4호
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• pp.137-145
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• 2023

어린이보호구역 일명 스쿨존에서 어린이와 보행자 사망사고가 지속적으로 발생하고 있다. 2019부터 2021년까지 3년 동안 전국 스쿨존 내 어린이사망사고는 11건이나 발생했으며, 2022년 12월에도 서울특별시 강남구 초등학교 인근 스쿨존에서 초등학생 사망사고가 발생했고, 2023년 4월에도 대전광역시 서구 중학교 인근 스쿨존과 부산광역시 영도구 초등학교 인근 스쿨존에서 각각 초등학생이 사망하는 사고가 발생하는 등 최근까지도 어린이보호구역 내 보도에서 어린이 사망사고가 지속적으로 발생하고 있어, 스쿨존 내 설치된 안전시설 현황과 관련 규정에 대한 면밀한 검토가 필요한 시점이다. 국내 어린이보호구역 보도에 설치된 안전시설 현황과 관련 규정을 조사 ‧ 분석하고, 어린이보호구역 보도용 안전시설에 대한 제도개선 필요사항을 도출하였다.

• Tuberculosis and Respiratory Diseases
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• 제61권4호
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• pp.366-373
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• 2006

연구배경 : Paraquat는 P-450 reductase에 의해 반응성 산소유리기(ROS)를 발생시켜 세포막, 단백질, 핵산 등과 반응함으로써 세포손상을 유도하며 급성 폐 손상을 일으킨다. 최근 급성 폐 손상 및 급성 호흡곤란 증후군에 있어서 폐상피세포의 아포프토시스가 중요한 역할을 한다고 알려지기 시작하였다. 이에 반응성 산소유리기에 의한 폐 손상의 대표적 물질인 paraquat로 인한 폐상피세포의 세포죽음이 아포프토시스인지 확인하고 dexamethasone, N-acetylcysteine, 그리고 bcl-2가 paraquat로 인한 폐상피 세포죽음에 어떠한 영향을 미치는지 등을 연구하였다. 방법 : 폐상피세포주인 A549와 BEAS-2B 세포주, 그리고 bcl-2 construct를 유전자 주입한 A549 pcDNA3-bcl-2 세포주를 이용하였다. 아포프토시스는 Annexin V assay를 이용하여서 판정하였으며 세포독성 검사는 MTT assay를 이용하였다. Paraquat는 0, $1{\mu}M$, $10{\mu}M$, $100{\mu}$M, 1 mM, 10 mM의 농도로 사용하였다. Dexamethasone은 $1{\mu}M$의 농도로 paraquat 투여 12시간 전에 전처치하였고, N-acetylcysteine은 1 mM의 농도로 paraquat 투여 1시간 전에 전처치하였다. 결과 : 양 세포주 모두에서 paraquat는 농도와 시간 경과에 따라서 세포죽음을 증가시켰고, 이러한 세포죽음은 아포프토시스였다. N-acetylcysteine과 dexamethasone은 시간과 농도에 따라 약간의 차이가 있으나 전반적으로 10~30%의 방어효과가 있었다. Bcl-2를 과발현시킨 A549-bcl-2 세포주에서 A549-neo 세포주에 비해 paraquat에 의한 세포독성이 약 20~30% 정도 차단되었다. 결론 : Paraquat는 폐상피세포에서 아포프토시스를 유도하며, paraquat에 의한 아포프토시스는 마이토콘드리아 경로에 의해 일어날 것으로 추정된다.

• 한국화재소방학회논문지
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• 제19권1호
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• pp.1-19
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• 2005

한국$\cdot$일본$\cdot$미국 3국의 화재로 인한 사상자 분석을 통해 다음과 같은 사항을 확인하였다. 1) 우리나라의 화재로 인한 사상자에 대한 통계자료는 가장 구체적이지 않으므로 사상자통계자료를 보다 구체화할 필요가 있다. 2) 인구 백만명당 화재로 인한 사망자 수는 우리나라는 10-11명으로 가장 낮으며, 일본은 15-17명,미국은 1/4세기만에 사망자수를 2/3정도 줄여 12명 수준이다. 3) 화재 100건당 사망자 수는 우리나라는 점점 낮아져 1.5명 정도이고, 일본은 3.5명 정도, 미국은 0.2-0.3명이다. 화재 100건당 부상자 수는 우리나라는 점점 낮아져 1977년 14.9에서 2001년 5.1, 2002년 5.3이었으며, 미국은 1.0-1.6이나 1994년도 이후는 1.2전후이고, 일본은 2.6-3.5로 약간 증가 경향이다. 따라서 화재가 발생했을 때 화재로 인해 사망할 확률은 일본이 가장 높으며 미국에 비해 약 15배정도 높고, 부상을 당할 확률은 우리나라가 가장 높으며 미국에 비해 깨 정도 높다. 4) 화재로 인한 전체사망자 중 주택(아파트포함) 화재로 인한 사망자가 차지하는 비율은 미국 쪽이 가장 높고 $80\%$ 전후이며, 일본은 감소경향에 있으며 $55\%$ 정도이고, 우리나라는 최근에는 일본과 비슷한 수준이다. 5) 우리나라는 2000년 65세 이상의 고령자가 7%를 초과하여 고령화사회에 진입하였으므로 화재로 인한 고령사망자를 줄이기 위한 정책을 검토 시행할 시기가 되었다. 전체인구 중 65세 이상이 $20\%$를 넘는 초고령사회를 앞둔 일본에서는 화재로 인해 고령자가 많이 희생되고 있고, 고령사망자를 줄이기 위한 정책을 10년 이상 전부터 시행해오고 있는 만큼 일본의 정책을 심도 있게 연구하여 도입을 검토하는 하는 젓은 좋은 대안일 것이다.

• Journal of Preventive Medicine and Public Health
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• 제31권4호
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• pp.604-615
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• 1998

Although previous studies revealed the association of physical activity with mortality rate, it is unclear whether there is a linear trend between physical activity and mortality rate. In this study, the association of physical activity with the risk of all-cause mortality was analysed using Cox's proportional hazard model for a cohort of 14,204 healthy Korean men aged 40-59 years followed up for 4 years(Jan. 1993-Dec. 1996). Physical activity and other life style were surveyed by a postal questionnaire in December 1992. Total of 14,204 subjects were grouped into quartiles by physical activity. Using death certificate data, 123 deaths were identified. The second most active quartile had a lowest mortality .ate with relative risk of 0.44(95% C.I. : 0.23-0.84) compared with most sedentary quartile, showing a J-shape pattern of physical activity-mortality curve. By examining the difference in proportion of cause of the death between most active quartile and the other quartiles, there was no significant difference of proportional mortality from cardiovascular deaths, cerebrovascular deaths or deaths from trauma. The covariates were stratified into two group between which the trend of RR was compared to test the effect modification. There was no remarkable effect modification by alcohol intake, smoking, body mass index, calorie consumption, percent fat consumption. In conclusion, moderate activity was found to have more protective effect on all-cause mortality than vigorous activity and that the J-shape pattern of physical activity-mortality curve was not due to the difference of mortality pattern or effect modification by alcohol intake, smoking, body mass index, calorie consumption and percent fat consumption.

• Asian Pacific Journal of Cancer Prevention
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• 제14권12호
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• pp.7251-7256
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• 2013

Objectives: To estimate the proportion of liver cancer cases and deaths due to infection with hepatitis B virus (HBV), hepatitis C virus (HCV), aflatoxin exposure, alcohol drinking and smoking in China in 2005. Study design: Systemic assessment of the burden of five modifiable risk factors on the occurrence of liver cancer in China using the population attributable fraction. Methods: We estimated the population attributable fraction of liver cancer caused by five modifiable risk factors using the prevalence data around 1990 and data on relative risks from meta-analyses, and large-scale observational studies. Liver cancer mortality data were from the 3rd National Death Causes Survey, and data on liver cancer incidence were estimated from the mortality data from cancer registries in China and a mortality/incidence ratio calculated. Results: We estimated that HBV infection was responsible for 65.9% of liver cancer deaths in men and 58.4% in women, while HCV was responsible for 27.3% and 28.6% respectively. The fraction of liver cancer deaths attributable to aflatoxin was estimated to be 25.0% for both men and women. Alcohol drinking was responsible for 23.4% of liver cancer deaths in men and 2.2% in women. Smoking was responsible for 18.7% and 1.0%. Overall, 86% of liver cancer mortality and incidence (88% in men and 78% in women) was attributable to these five modifiable risk factors. Conclusions: HBV, HCV, aflatoxin, alcohol drinking and tobacco smoking were responsible for 86% of liver cancer mortality and incidence in China in 2005. Our findings provide useful data for developing guidelines for liver cancer prevention and control in China and other developing countries.

• 한국대기환경학회지
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• 제26권1호
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• pp.10-20
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• 2010

In recent studies, $PM_{2.5}$ has been reported to be more harmful to human health than $PM_{10}$ because it penetrates more deeply into the lung. We estimated $PM_{2.5}$ related health benefits in Seoul from implementing the World Health Organization (WHO)'s guidelines (annual average $10{\mu}g/m^3$, 24-hour average $25{\mu}g/m^3$) and U.S. Environmental Protection Agency (EPA)'s National Ambient Air Quality Standard (annual average $15{\mu}g/m^3$, 24-hour average $35{\mu}g/m^3$). U.S. EPA's Environmental Benefits Mapping and Analysis Program was utilized for the analysis. It was predicted that the attainment of the WHO annual guideline and U.S. EPA's annual standard, relative to the concentration in 2006, would result in reduction of 2,333~2,895 premature deaths and 1,703~2,121 premature deaths, respectively. If the WHO and EPA's daily standard for $PM_{2.5}$ are attained, 1,211~1,394 and 1,012~1,165 premature deaths could be avoided, respectively. Sensitivity analyses indicated that the estimates were robust regardless of air quality simulation methods for attaining the $PM_{2.5}$ goals. This study provides a quantitative approach to evaluate health risks from air pollution as well as to assess the potential health benefits of improving atmospheric $PM_{2.5}$ concentration. Even considering the intrinsic limitations and uncertainties of the analysis, it is an important information to rationalize the enforcement of $PM_{2.5}$ management policies and measures in Seoul, Korea.

• 한국인구학
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• 제24권1호
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• pp.67-90
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• 2001

통계청에서는 출생 및 사망 신고가 동시에 누락되는 영아사망 미신고분을 감안하여 기간 출생률 및 사망률, 생명표상의 기간 영아사망확률을 추정하여 왔다. 보건복지부의 93년 및 96년 출생 코호트 영아사망조사 결과가 발표됨에 따라 통계청이 1971년-1997년 영아사망확률을 재추정하였다. 자료원은 사망신고 자료, 보건복지부 조사. 선진국의 사망신고 자료, 모델생명표 및 일본생명표이었으며, 17가지 방법으로 시산하였다. 최종 방법은 1993년 보건복지부 조사의 사망확률과 사망신고 자료의 1∼4세 사망 확률 관계에 의존하여 1971-1991년 영아사망확률을 추정하였고, 93년은 93년 보건 복지부 조사의 영아사망확률을 사용하였으며, 95년과 97년에 대해서는 93년과 96년 보건복지부 조사에 나타난 영아사망확률 감소율을 적용하였다. 영아사망확률은 Coale-Demeny North Model 을 활용하여 영아사망률로 전환하였다. 통계청이 수집한 98년 화장장 자료로 영아사망 미신고를 보완하여 영아사망률을 추정해 본 결과 화장장 자료는 영아사망수준 추정을 위한 중요한 자료원이 될 뿐만 아니라 신생아사망을 크게 보완하고, 태아사망 및 주산기사망 통계 생산도 가능한 것으로 나타났다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권4호
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• pp.1567-1574
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• 2014

The incidence and mortality rates of liver and nasopharyngeal cancer in Guangxi province of China have always been among the highest in the world, and cancer is one of the major diseases that pose a threat to the health of residents in Guangxi. However, no systematic study has been performed to evaluate the time trends in the structure of cancer-related deaths and cancer mortality. In this study, we reveal sex, age and geography differences of cancers mortality between three death surveys (1971 to 1973, 1990 to 1992, and 2004 to 2005). The results show that the standardized mortality rate of cancer in Guangxi residents has risen from 43.3/100,000 to 84.2/100,000, the share of cancer deaths in all-cause deaths has increased from 13.3% to 20.7%, and cancer has become the second most common cause of death. The five major cancers, liver cancer, lung cancer, gastric cancer, nasopharyngeal cancer and colorectal cancer, account for 60% of all the cancer deaths. Cancers with growing mortality rates over the past 30 years include lung cancer, colorectal cancer, liver cancer and female breast cancer, of which lung cancer is associated with the sharpest rise in mortality, with a more than 600% rise in both men and women. Cancer death in Guangxi residents occurs mainly in the elderly population above 45 years of age, especially in people over the age of 65. The areas with the highest mortality rates for liver cancer and nasopharyngeal cancer, which feature regional high incidences, include Chongzuo and Wuzhou. Therefore, for major cancers such as liver cancer, lung cancer, gastric cancer, nasopharyngeal cancer and female breast cancer in Guangxi, we can select high-risk age groups as the target population for cancer prevention and control efforts in high-prevalence areas in a bid to achieve the ultimate goal of lowering cancer mortality in Guangxi.

• Asian Pacific Journal of Cancer Prevention
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• 제13권5호
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• pp.1895-1899
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• 2012

Background and Aims: Liver cancer is a major health problem in low-resource countries. Approximately 55% of all liver cancer occurs in China. Hebei Province is one of the important covering nearly 6% of the population of China. The aim of this paper was to explore liver cancer mortality trends during past 30 years, and provide basic information on prevention strategies. Methods: Hebei was covered covered all the three national surveys during 1973-1975, 1990-1992, and 2004-2005 and one provincial survey during 1984-1986. Subjects included all cases dying from liver cancer in Hebei Province. Liver cancer mortality trend and geographic differences across cities and counties were analyzed. Results: There were 82,878 deaths in Hebei Province during 2004-2005 with an average mortality rate was 600.9/10,000, and an age-adjusted rate of 552.3/10,000. Those dying of cancer were 18,424 cases, accounting for 22.2% of all deaths, second only to cerebrovascular disease as a cause of death. Cancer mortality was 133.6/100,000 (age-adjusted rate was 119.2/100,000). Liver cancer ranked fourth in this survey with a mortality rate of 21.0/100,000, 28.4/100,000 in males and 13.35/10,000 in females, accounting for 15.7%, 17.1% and 13.4% of the total number of cancer deaths and in males and females, respectively. The sex ratio was 2.13. Since the 1970s, liver cancer deaths of Hebei province have been increasing slightly. The crude mortality rates in the four surveys were 11.3, 16.0, 17.4, 21.0 per 100,000, respectively, with age-adjusted rates fluctuating during the past 30 years, but the trend also being upwards. There is a tendency for the mortality rates to be higher in coastal than mountain areas, and is relative lower in the plain area, with crude mortality rates of 25.3, 22.1, and 19.1 per 100,000, respectively. There were no notable differences in cride data between urban and rural, but the age-adjusted mortality rate in rural was much higher. Conclusion: Our study indicated that the mortality of liver cancer in Hebei Province is lower than the national average level. There is a slightly increase trend, especially in some counties. Liver cancer is a major health problem and it is necessary to further promote prevention strategies in Hebei province.