• 대한임상독성학회지
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• 제16권2호
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• pp.116-123
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• 2018

Purpose: The social environment of easy access to medicines and arbitrary personal decisions leading to overdose aggravate unintentional medicine poisoning. This study aimed to investigate the characteristics of patients who visited emergency departments with unintentional medicine poisoning and reasons for poisoning based on age group. Methods: We retrospectively collected patients who experienced unintentional medicine poisoning based on data from the national injury surveillance system between 2013 and 2016. Subjects were classified into three groups based on age (0-14 years, 15-64 years, and ${\geq}65\;years$). We identified sex, insurance, time of poisoning, place, alcohol co-ingestion, hospitalization, death, and reason for poisoning in each age group. Results: A total of 27,472 patients visited an emergency department with poisoning during the study period; 1,958 patients who experienced unintentional poisoning were enrolled in this study. Respiratory medicine was the most frequent medicine in those younger than 15 years of age, and sedatives and antipsychotic drugs were the most common in patients older than 15 years of age. In total, 35.1% of patients older than 65 years were hospitalized. The most common reasons for poisoning were careless storage of medicine in those younger than 15 years of age and overdose due to arbitrary decisions in those older than 15 years of age. Conclusion: Unintentional medicine poisoning has distinct characteristics based on age group, and strategies to prevent poisoning should be approached differently based on age.

• 대한예방한의학회지
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• 제26권2호
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• pp.1-9
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• 2022

Objectives : The purpose of this study is to identify priorities for the 4th Comprehensive Plan for Korean Medicine Development using Delphi and AHP techniques. Methods : This study uses Delphi-AHP method to first, select the target priority policy based on the policy content of the 4th Comprehensive Plan. In addition, two surveys on the priorities were conducted to reach consensus between experts. The main results of the first survey were also provided to experts participating in the second survey to help form expert consensus. Finally, the final policy priority was chosen based on the second survey result. Results : Survey results showed that of the 39 policies in the 4th Comprehensive Plan, "improve the accessibility of Korean medicines," was the most important goal. This was followed by "support for Korean medicine R&D from clinical research to industrialization," "provide foundation for a pilot project that provides customized medical services" and "strengthen the public medicine function of Korean medicine by expanding the its infrastructure in national and public hospitals." Conclusion : The results showed that capacity building of Korean medicine in primary care, improvement of the health insurance system, and research centered on industrialization are relatively more important goals, while the need to enhance global competitiveness was much less important. These key points can serve as a reference when formulating the 5th Comprehensive Plan for Korean Medicine Development in the future.

• 대한한의학방제학회지
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• 제31권2호
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• pp.99-109
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• 2023

Objectives : Sihosogan-tang (SST) is one of the traditional herbal formula and also one of the Korean medical insurance medicines. It commonly used in the treatment of hepatitis, chronic gastritis, intercostal neuralgia, pleurisy, and depression in East Asia. In the present study, we have demonstrated the anti-inflammatory effects of SST in macrophage cell line. Methods : To investigate mechanism of the anti-inflammatory effect of SST, we examined the productions of nitric oxide (NO) and pro-inflammatory cytokines, and the expressions of inducible NO synthase (iNOS), nuclear factor-κ B (NF-κB) and mitogen-activated protein kinase (MAPK) on RAW 264.7 cells activated by LPS. Results : SST significantly inhibited the expression of iNOS increased by LPS, and also significantly inhibited the production of NO. In addition, SST significantly inhibited pro-inflammatory cytokines such as TNF- α and interleukines. SST inhibited the expression of NF-κB and MAPK activation. Conclusions : These results suggest that SST ameliorates inflammatory response in LPS-activated RAW 264.7 cells through the inhibition of the NF-κB and MAPK pathway. Therefore, this study supplies objective evidence for the anti-inflammatory effect of SST.

• 보건행정학회지
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• 제12권4호
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• pp.91-113
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• 2002

본 논문은 의약분업의 실시와 이에 따른 의료인의 대규모 파업을 연구 대상으로 하였다. 협상 (bargaining)에 관한 게임이론 (game-theory) 모형을 활용하여 의료인들과 정부의 협상과 정과 결과를 분석하고자 하였다. 특히 제도 변화의 과정에 있어 사회적 행위자들 사이의 분배적 갈등의 역할에 초점을 맞추고 있다 정부에 의한 의약분업의 시행은 의료인들로 하여금 심각한 분배적 결과를 초래할 수 있다는 것이며, 이는 다양한 배경의 의료인들로 하여금 정치적 연합의 가능성을 강화시켰다. 의료인들에 의한 분배적 결과의 인식은 파업과 같은 집합행동의 조직화로 나타나고 정부와의 협상 관계에 있어서도 줄곧 협상력의 우위를 견지하는 모습을 보여주었다. 결과적으로 의료인들은 그들이 원하는 결과를 확보하는데 성공한듯이 보인다. 협상은 제도의 형성과 변화에 있어 행위자들 간 상호작용의 중요한 형태라 할 수 있다. 이 경우 한 행위자의 목적은 그들에 유리하게 어떻게 제도적 규칙을 형성해 나가느냐 이다. 행위자들간 이해관계에 따른 갈등의 분석에 있어 주요한 변수는 당사자들 간 협상력의 차이라 할 수 있다. 힘의 비대칭 (asymmetry of power)현상은 제도 형성의 중요한 요소가 될 수 있다. 본 논문은 비협조 게임 모형 (the battle of sexes game)을 이용하여 협상력의 차이에 따른 균형해(equilibrium outcome)의 차이를 분석하고자 하였다. 특히 정부와 의료인의 협상에 있어 선호의 강도(intensity of preference)와 협상의 결렬시 지불해야 하는 비용 (breakdown cost) 의 차이는 협상력의 차이로 이어지고, 결과적으로 제도 변화의 결과를 가늠케 하는 척도로 작용하고 있음을 알 수 있다.

• KDI Journal of Economic Policy
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• 제30권2호
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• pp.129-155
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• 2008

급성상기도감염증에 대한 항생제 처방률은 의료기관의 유형, 표시과목, 의료기관이 위치한 지역 등 여러 요인에 따라 차이를 보인다. 본 연구는 1차 의료기관인 의원들 중 내과, 소아과, 이비인후과 의원의 급성상기도감염증에 대한 항생제 처방률에 환자의 특성과 같은 의학적 요인이 아닌 의원의 수입과 밀접한 관계가 있는 의원 수의 변화(경쟁 정도의 변화)와 같은 경제적 요인이 미치는 영향을 실증 분석하였다. 2006년 건강보험심사평가원에서 발표한 전국 각 의료기관의 급성상기도감염증에 대한 항생제 처방률을 주 자료원으로 하여, 경쟁지수를 두 가지 형태로 정의하고 수요 측면을 나타내는 변수와 공급 측면을 나타내는 변수를 통제변수로 선정하여 회귀분석을 실시한 결과 경쟁지수를 어떤 형태로 정의하든, 의원이 위치한 지역의 경쟁정도는 의사들의 항생제 처방률에 통계적으로 유의한 영향을 미친 것으로 분석되었다. 이러한 결과는 시장지역 내 경쟁 정도의 변화와 같은 경제적 요인이 의사들의 처방행태에 영향을 미치는 요인 중 하나라고 해석할 수 있다. 아울러 인과관계의 방향과 관련하여, 의사가 진료하는 지역의 경쟁 정도가 높아질수록 항생제 처방률이 통계적으로 유의하게 높아지는 것으로 나타났다. 이러한 결과는 의사의 진료수입 감소를 초래할 것으로 예상되는 시장환경의 변화에 대해 자신의 진료수입을 예전상태로 보전하기 위해 불필요한 의료서비스 소비를 유도해서 얻는 편익(소득효과)이 이를 위해 자신이 지불해야 할 비용(대체효과)보다 크기 때문에 항생제 처방률을 증가시킨 것으로 해석할 수 있으며, 또한 경제적 유인체계의 변화에 대하여 의사의 진료행태가 영향을 받을 수 있음을 실증적으로 뒷받침하는 것으로 이해할 수 있을 것이다.

• 의료법학
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• 제13권1호
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• pp.199-247
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• 2012

According to the review and analysis of medical cases that are assigned to the Supreme Court and all local High Court in 2011 and that are presented in the media, it was found that the following categories were taken seriously, medical and pharmaceutical product liability, the third principle of trust between medical institutions, negligence and causation estimation, responsibility limit, the meaning of medical records and related judgment of disturbed substantiation, Oriental doctors' duties to explain the procedures, IMS events, whether one can claim for each medical care operated by non-physician health care institutions to the nonmedical domain in the National Health Insurance Corporation, and the basis of norms for each claim. In the cases related to medical pharmaceutical product liability, Supreme Court alleviated burden of proof for accidents with medical and pharmaceutical products prior to the practice of Product Liability Law and onset the point of negative prescription as the time of damage strikes to condition feasibility of the specific situation. In the cases related to the 3rd principle of trust between medical institutions, the Supreme Court refused to sentence the doctor who has trusted the judgment of the same third-party doctors the violations of the care duty. With respect to proof of a causal relationship and damages in a medical negligence case, the Supreme Court decided that it is unjust to deny negligence by the materials of causal relationship rejecting the original verdict and clarified that the causal relationship shall not deny the reasons to limit doctors' responsibilities. In order not put burden on patients with disadvantages in which medical records and the description of the practice or the most fundamental and important evidence to prove negligence and causation are being neglected, the Supreme Court admitted in the hospital's responsibility for the case of the neonate death of suffocation without properly listed fetal heart rate and uterine contraction monitor. On the other hand, the Seoul Western District Court has admitted alimony for altering and forging medical records. With respect to doctors' obligations to description, the Supreme Court decided that it is necessary to explain the foreseen risks by the combination of oriental and western medicines emphasizing the right of patient's self-determination. However, questions have arisen whether it is realistically feasible or not. In a case of an unlicensed doctor performing intramuscular stimulation treatment (IMS), the Supreme Court put off its decision if it was an unlicensed medical practice as to put limitation of eastern and western medical practices, but it declared that IMS practice was an acupuncture treatment therefore the plaintiff's conduct being an illegal act. In the future, clear judgment on this matter should be made. With respect to the claim of bills from non-physical health care institutions, the Supreme Court decided to void it for the implementation of the arrangement is contrary to the commitments made in the medical law and therefore, it is invalid to claim. In addition, contrast to the private healthcare professionals, who are subject to redemption according to the National Healthcare Insurance Law, the Seoul High Court explicitly confirmed that the non-professionals who receive the tort operating profit must return the unjust enrichment and have the liability for damages. As mentioned above, a relatively wide range of topics were discussed in medical field of 2011. In Korea's health care environment undergoing complex changes day by day, it is expected to see more diverse and in-depth discussions striding out to the development in the field of health care.