• 응용통계연구
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• 제20권3호
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• pp.597-604
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• 2007

현대 사회에서 건강관리와 공중보건 분야의 이상원인 탐지와 감시를 위하여 관리도 기법을 많이 사용하고 있다 예를 들어, 외과의사의 수술 수행성과의 변화나 만성병과 전염병 등의 비율 변화를 탐지하는데 관리도를 사용할 수 있다. 이 논문에서는 건강관리와 공중보건 분야에서 많이 사용하는 VLAD (variable life-adjusted display) 관리도를 소개하고, 이 관리도에서 관리한계선을 설정하는 방법을 제안하였다.

• 대한간호학회지
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• 제43권5호
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• pp.595-604
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• 2013

Purpose: The purpose of this study was to identify risk factors for pediatric inpatients falls. Methods: The study was a matched case-control design. The participants were 279 patients under the age of 6 who were admitted between January 1, 2004 and December 31, 2009. Through chart reviews, 93 pediatric patients who fell and 186 ones who did not fall were paired by gender, age, diagnosis, and length of stay. Five experts evaluated the 38 fall risk factors selected by the researchers. Results: In a general hospital, pediatric patients with secondary diagnosis, tests that need the patient to be moved, intravenous lines, hyperactivity, anxiolytics, sedatives and hypnotics, and general anesthetics showed significance for falls on adjusted-odds ratios. Conditional logistic regression analysis was performed to elucidate the factors that influence pediatric inpatient falls. The probability of falls increased with hyperactivity and general weakness. Patients who didn't have tests that required them to be moved and intravenous line had a higher risk of falls. Conclusion: These findings provide information that is relevant in developing fall risk assessment tools and prevention programs for pediatric inpatient falls.

• Journal of Preventive Medicine and Public Health
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• 제32권4호
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• pp.513-525
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• 1999

Objectives : High-normal blood pressure' is a factor influencing decision to initiate targeted intensive intervention strategy in westernized populations. JNC-VI offered the vigorous lifestyle modification for persons with 'high-normal blood pressure', who could be early detected. As a hypertension seems to be the result of multiple genetic factors operating in concert with associated environmental factors, it will be necessary to identify the high-normal blood pressure as a risk factor of hypertension for applying primary prevention strategy in Korean people. Methods : Although cohort study design might be adequate to recruit incidence cases, to keep time sequence of events, and to prevent information bias, nested case-control study was chosen for avoiding measurement errors because hypertension is a benign disease. Source population was the 'Seoul Cohort' participants and follow-up was done by using Korea Medical Insurance Corporation's database on the utilization of health services from 1 Jan93 to 30Jun97. Incidence cases were ascertained through the chart review, telephone contacts, and direct blood pressure measurements. Controls included the pairing of 4 individuals to each case on the basis of age. Results : As 75% of 247 incident cases had high-normal blood pressure, the crude odds ratio for hypertension was 2.04 (95% CI 1.47-2.83). Another statistically significant risk factors of hypertension were body mass index, dietary fiber, alcohol consumption, weekly activity and history of quitting smoking. The multivariate odds ratio of high-normal blood pressure adjusted for all risk factors was 1.84 (95% CI 1.31-2.56). Among high-normal blood pressure group, body mass index, weekly ethanol amounts, weekly physical activity, and dietary fiber except history of quitting smoking were still risk factors of hypertension. Conclusion : 'High-normal blood pressure' is a risk factor for hypertension in Korean middle-aged men, which represents that the vigorous lifestyle modification for persons with 'high-normal blood pressure' is need.

• 대한응급의학회지
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• 제29권5호
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• pp.408-414
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• 2018

Objective: Patients with low acuity who need hospitalization may be at risk if they do not receive proper treatment in overcrowded emergency rooms. This study was conducted to investigate factors affecting the hospitalization of patients with low acuity of Korean Triage and Acuity Scale (KTAS). Methods: This study was a retrospective chart review analysis of patients aged 15 years or older who had triaged as KTAS 4 and 5 grades when visiting a local emergency medical center from January 1, 2016 to December 31, 2017. Multivariate logistic analysis was performed to analyze the effects of age, sex, reasons for visiting, visiting route, ambulance utilization, KTAS grade and major category on patient admission. Results: A total of 10,540 patients were enrolled and the odds ratio (OR) increased with age from those aged over 34 years (P<0.001). Patients that triaged as KTAS grade 5 (adjusted OR, 1.57; 95% confidence interval [CI], 1.36-1.82), had a condition caused by disease (adjusted OR, 2.31; 95% CI, 2.00-2.68), and visited by using an ambulance (public: adjusted OR, 1.05; 95% CI, 0.91-1.22; private: adjusted OR, 4.60; 95% CI, 3.85-5.49) were more likely to be hospitalized. Individuals in the "general" major category were more likely to be hospitalized than those falling into other major categories (P<0.001). Conclusion: The factors influencing the hospitalization of patients with low acuity were age, reasons for visiting, visiting route, ambulance utilization, KTAS grade and major category on patient admission.

• Journal of Preventive Medicine and Public Health
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• 제51권4호
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• pp.205-212
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• 2018

Objectives: The main purpose of this study was to quantify the risk of mortality linked to various regimens of hypertonic peritoneal dialysis (PD) solution. Methods: A retrospective cohort study of patients using home-based PD was carried out. The prescribed regimen of glucose-based PD solution for all patients, determined on the basis of their individual conditions, was extracted from their medical chart records. The primary outcome was death. The treatment regimens were categorized into 3 groups according to the type of PD solution used: original PD (1.5% glucose), shuffle PD (1.5 and 2.5% glucose), and serialized PD (2.5 and 4.5% glucose). Multivariate analysis (using the Weibull model) was applied to comprehensively examine survival probabilities related to the explanatory variable, while adjusting for other potential confounders. Results: Of 300 consecutive patients, 38% died over a median follow-up time of 30 months (interquartile range: 15-46 months). Multivariate analysis showed that a treatment regimen with continued higher-strength PD solution (serialized PD) resulted in a lower survival rate than when the conventional strength solution was used (adjusted hazard ratio, 2.6; 95% confidence interval, 1.6 to 4.6, p<0.01). Five interrelated risk factors (age, length of time on PD, hemoglobin levels, albumin levels, and oliguria) were significant predictors contributing to the outcome. Conclusions: Frequent exposure to high levels of glucose PD solution significantly contributed to a 2-fold higher rate of death, especially when hypertonic glucose was prescribed continuously.

• Journal of Preventive Medicine and Public Health
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• 제32권4호
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• pp.526-537
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• 1999

Objectives : It is known that the prevalence of diabetes mellitus(DM) appears to be rapidly increasing in recent times in Korea, presumably due to a westernized diet and change of life style followed by rapid economic growth. Based on the Seoul male cohort which was constructed in 1993, this study was conducted to estimate the annual incidence rates of DM through 4 years' follow up and to determine which factors are associated with DM risk in Korean middle-aged men. Methods : Among 14,533 men recruited at baseline, 559 were excluded because they reported a history of diabetes or were found to be diabetes at 1992 routine health examination. During 4 years' follow-up, 237 incident DM cases were ascertained through chart reviews and telephone contacts for those who have ever visited hospitals or clinics under suspicion of DM during 1993-1996 and the biennial routine health examinations in 1994 and 1996. Results : In this study the annual incidence of DM among the study population was estimated to be 0.5 per 100. This study showed that fasting glucose level at initial baseline examination was a powerful predictor of risk for diabetes several years later(fasting blood glucose of $\geq$ 110 mg/dl compared with $\leq$ 80 mg/dl, Hazard Ratio[HR]:15.6, 95% Confidence interval[CI]=9.1-26.6) after considering potential covariates such as age, family history, smoking and alcohol history, body mass index, physical activity, total energy intake, and total fiber intake. Adjusted hazard ratios of family history of diabetes was 1.95(95% CI=1.38-2.75); of obesity as measured by BMI(BMI $\geq$ 25.3 compared with $\leq$ 21.3) was 7.19(95% CI=3,75-13.8); of weight change during middle life(>10kg compared with $\leq$ 5) was 1.77(95% CI=1.16-2.69); of smoking(current vs none) was 1.93(95% CI=1.06-3.51); and fat intake(upper fertile compared with lower fertile) was 1.88(95% CI=1.01-3.49), while fiber intake was associated with the reduced risk(HR=0.36, 95% CI=0.19-0.67). Conclusion : The factors identified in this study indicate that the greatest reduction in risk of diabetes might be achieved through population-based efforts that promote fiber intake and reduce obesity, smoking, and fat intake.

• 한방비만학회지
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• 제14권2호
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• pp.63-71
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• 2014

목적: 본 연구는 사상체질과 이상지질혈증의 상관관계 및 사상체질이 이상지질혈증의 위험요인이 될 수 있는가를 탐색하는 데 목적이 있다. 방법: 본 연구는 의무기록을 바탕으로 한 후향적 단면조사연구로, 2007년 5월부터 2010년 6월까지 서울 소재 경희의료원 건강증진센터에 내원한 건강검진 수진자 17,069명의 의무기록을 조사하여 사상체질진단검사 결과 및 생화학검사 결과 등이 확인된 15,250명을 대상으로 사상체질과 이상지질혈증 간의 상관관계를 조사하였다. 결과: 총 콜레스테롤과 중성지방은 체질량지수(body mass index, BMI)를 보정한 상태에서 태음인, 소양인, 소음인 등의 순서로 높았고, 고밀도 콜레스테롤은 소음인, 소양인, 태음인 순서로 높았다. 연령, 성별, BMI 등을 보정한 상태에서 '높은 중성지방'에 대한 odds ratio는 소음인에 비해 소양인이 1.716 (1.411~2.087), 태음인이 2.021 (1.650~2.475)이었으며, '높은 저밀도콜레스테롤'에 대한 odds ratio는 소음인에 비해 소양인이 1.229 (1.006~1.501)였고, '낮은 고밀도 콜레스테롤'에 대한 odds ratio는 소음인에 비해 소양인이 1.195 (1.033~1.381), 태음인이 1.414 (1.212~1.649)였다. 결론: 사상체질에 따라 일부 이상지혈증의 분포 및 odds ratio에 유의한 차이가 있었고, 이에 따라 사상체질이 이상지질혈증의 위험요인이 될 수 있는 가능성을 찾을 수 있었다.

• Journal of Chest Surgery
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• 제38권11호
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• pp.761-772
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• 2005

배경: 인공심장판막 시술 후에 혈전색전증의 위험성을 감소시키기 위래서 치료범위의 INR을 유지하는 것이 중요하다. 이 연구의 목적은 약사에 의해서 운영되는 anticoagulation service (ACS)을 받는 한국 인공심장판막 외래환자에서 실제적인 용량 가이드라인을 제시하고자 하였다. 대상 및 방법: 1997년 3월에서 2000년 9월까지 서울대학교병원에서 ACS를 방문한 모든 환자의 의무기록을 후향적으로 검토하였다. 수술 후 6개월이 경과된 환자로 INR 2.0미만과 INR 3.0초과가 한 번 이상 있는 환자의 자료를 대상으로 하였으며 이전의 INR이 안정화되었고, 복약순응도가 확인되고, warfarin과 알려진 약물 또는 상호작용이 없는 경우로 목표 INR에 도달하기 위해서 용량 조절을 필요로 한 증례(총 688명, 1,782회 방문)를 분석하였다. Warfarin용량 조절 가이드라인을 제시하기 위해서 대동맥 판막치환술과 승모판 또는 이중판막 치환술을 받은 환자를 구별하여 각각 용량 조절 전의 INR, 평균 조절된 용량, 조절 후의 INR을 조사하였다. 결과: 이 연구에서는 1주일 총 투여량의 변화량(mg)에 근거한 warfarin 용량 조절(가이드라인 I)과 비율에 근거한 1주일 총 투여량 조절 가이드라인(가이드라인 II)을 제시하였고 가이드라인 I과 가이드라인 II의 유효성도 평가하였다. 모든 환자 군에서 가이드라인 I이 가이드라인 II보다 우수하였지만 가장 흔히 사용되는 중등도의 용량(1주 총 투여량$23\~47mg$)을 투여 받는 환자에서는 두 가이드라인 사이에 유의한 차이가 없었다 결론: 이 연구에서 제시된 가이드 라인은 심장판막수술을 받은 외래 환자에서의 warfarin 용량 조절에 유용할 것으로 생각된다.대한 치료 순응도가 높아졌다. 후 동율동 전환율이나 좌심방 수축능 회복에 좋은 결과를 보여주었다 그러나 향후 대상환자들에 대한 중장기적인 추적 관찰이 필요하리라 생각한다.pm1.6$일째에 관상동맥조영술을 시행하여 모든 도관의 개존율$(100\%=57/57)$을 확인하였다 수술 전 중재 술을 시행한 1개소에서는 중재술 부위의 재협착소견이 보여 수술 후 조영술시 재풍선확장술로 치료하였다. 수술 후 추적관찰(평균 $25\pm26$개월)동안 1예에서 심부전으로 사망하였다. 생존한 환자 24예에서 술 후 평균 $9.6\pm3$개월째에 관상동맥조영술을 시행하였고 이식도관이 string 징후를 보인 1예를 제외하고 모두 개존(56/57)되어 있었으며, 약물용출형 스탠트를 시행하기 이전의 12예의 중재술 중 2예에서 $50\%$ 이상의 스텐트 협착이 있었으나 흉통의 재발은 없었다. 결론: 하이브리드 관상동맥 우회 술은 수술위험도를 낮추기 위하여 최소절개 관상동맥우회술과 병합하여 시도될 수 있을 뿐 아니라, 선택적 환자들에서는 정중 흉골절개 관상동맥우회술과 병합하여 수술관련 유병률을 낮추고 심근의 완전 재관류화를 도모할 수 있었다.호도에서 가장 적절한 방법으로 사료된다.비위생 점수가 유의적으로 높은 점수를 나타내었다. 조리종사자의 위생지식 점수와 위생관리 수행수준의 상관관계를 조사한 결과, 위생지식의 기기설비위생은 위생관리 수행수준의 합계(p<0.01)에서 유의적인 상관관계(p<0.01)를 나타내었으며, 위생지식의 식중독 및 미생물은 위생관리 수행수준의 개인위생(p<0.01)과 유의적인 상관관계가 있는 것으로 나타났다 위생지식의 점수합계는 개인위생(p<0.05)과 식중독 및 미생물(p<0.