• 보건행정학회지
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• 제16권2호
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• pp.49-76
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• 2006

The aim of this study was to explore the effects of a computerized review program which was introduced in August 1, 2003, using claims data for acute respiratory infection related diseases. National Health Insurance (NHI) claims data on respiratory infection related diseases before and after the introduction, with six month intervals respectively, were used for the analysis. Clinic was the unit of observation, and clinics with only one physician whose specialty was internal medicine, pediatrics, otorhinolaryngology and family medicine and clinics with a general practitioner were selected. The final sample had 7,637 clinics in total. Indices used to measure practice pattern was prescription rates of antibiotics, prescription rates of injection drug per visit, treatment costs per claim, and total costs per claim. Changes in the number of claims for major disease categories and upcoding index for disease categories were used to measure claiming behavior. Data were analysed using descriptive analysis, t-test for indices changes before and after the introduction, analysis of variance (ANOVA) for practice pattern change for major disease categories, and multiple regression analysis to identify whether new system influenced on provider' practice patterns or not. Prescription of antibiotics, prescription rates of injection drug, treatment costs per claim, and total costs per claim decreased significantly. Results from multiple regression analysis showed that a computerized review system had effects on all the indices measuring behavior. Introduction of the new system had the spillover effects on the provider's behavior in the related disease categories in addition to the effects in the target diseases, but the magnitude of the effects were bigger among the target diseases. Rates of claims for computerized review over total claims for respiratory diseases significantly decreased after the introduction of a computerized review system and rates of claims for non target diseases increased, which was also statistically significant. Distribution of the number of claims by disease categories after the introduction of a computerized review system changed so as to increase the costs per claims. Analysis of upcoding index showed index for 'other acute lower respiratory infection (J20-22)', which was included in the review target, decreased and 'otitis media (H65, H66)', which was not included in the review target, increase. Factors affecting provider's practice patterns should be taken into consideration when policies on claims review method and behavior changes. It is critical to include strategies to decrease the variations among providers.

• 대한한의학회지
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• 제28권4호
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• pp.74-85
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• 2007

Objective : In this study we wanted to confirm if proper stimulation and de-Qi of traditional Korean medical acupuncture could increase hot flash relief efficacy. Design : A randomized controlled, single blind study. We used two modalities of acupuncture, one with optimal stimulation [Study group; Korean medical acupuncture (TKMA)] and one with minimal stimulation [Control group; Minimal acupuncture (MA)]. Same acupoints [PC6(內關), HT8(少府), HT7(神門), LI4(合谷), ST36(足三里), SP6(三陰交), Ren4(關元)] were used in both groups. Fifty-two patients were treated twice a week for 8 weeks, and follow up was done after 4 weeks from the last treatment. Patients were checked hot flash VAS (visual analog scale), frequency and duration every time they visited. Results : Hot flash relief efficacy by 100mm hot flash VAS was obvious in both groups. Hot flash VAS scores of study group were smaller than the scores of control group at the early stage (3rd, $4^{th}$ and $8^{th}$ visit), but there wasn't a remarkable difference between study and control group at the end of the trial. Besides, diminution of hot flash VAS was faster and more even in the study group than control group by visualization using 'Box plot'. We compared frequency and duration of hot flash, 100mm sweating, palpitation, sleep disturbance VAS, and Kupperman Index, MENQOL, Patient's global assessment score. Both groups showed definite decrease from the baseline, but the difference was not statistically significant. There wasn't any adverse event. Hot flash relief efficacy was kept in most patients after 4 weeks' follow-up. Conclusion : Acupoint combination by Traditional Korean medical theory is effective on hot flashes and hot flash relief efficacy was faster and more even in optimal stimulation than minimal stimulation.

• 한국방사선학회논문지
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• 제1권3호
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• pp.23-34
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• 2007

한 대학병원 응급실에 방문한 응급환자들이 방사선에 얼마나 피폭되는지를 알아보고자, 2006년 3월 16일 부터 31일까지 15일 동안 방문환자 200명을 임의 추출하여 방사선 피폭선량을 측정한 결과는 다음과 같다. 1. 연구대상자의 분포는 타병원전원환자 50명(25.0%), 교통사고환자 24명(8.3%), 기타사고환자 50명(25.0%), 일반환자 76명(38.0%)이었다. 2. 환자의 방사선 촬영횟수를 보면 환자 1인당 타병원, 전원환자 6.4회, 교통사고환자 14.5회, 사고환자 2.6회, 일반환자 2.4회로 교통사고환자들이 타환자군에 비해 방사선촬영 건수가 3~4배 많았다. 3. 환자의 방사선촬영종류별 피폭선량을 보면 일반촬영 28.9mGy, CT촬영 84.2 mGy, 특수촬영 1.02mGy로 CT촬영피폭이 일반촬영 비해 10배 정도 많았다. 4. 환자의 평균 방사선 피폭선량을 보면 타병원 전원환자는 24.6mGy, 교통사고환자는 55.2 mGy, 사고환자는 17.1mGy 일반환자는 17.0mGy로 타병원 전원환자와 교통사고환자가 상대적으로 피폭이 많았다. 5. 방사선촬영 부위별로 보면 일반촬영에서는 두부피폭 1.7mGy로 사고환자에서 피폭이 많았고, 흉부 2.0mGy, 복부 1.6mGy는 일반환자에게 많았으며, 척추 3.4mGy, 골반부 1.8mGy, 상지부 0.5mGy, 하지부 0.6mGy는 교통사고 환자에게 피폭이 많았으며, 통계적으로 유의한 차이를 보였다(P<0.001). 6. CT촬영에서는 타병원 및 전원환자가 두부 10.9mGy으로 많았고, 흉부와 복부는 각각 2.9mGy, 3.6mGy로 일반환자에게 많았고, 척추, 골반부 1,9mGy 2.7mGy는 교통사고환자에게 많았다. 특히 복부피폭은 통계적으로 유의한 차이를 보였다.(P<0.05) 결론적으로 한 대학병원 방문한 응급환자 특히 교통사고환자의 방사선 검사시 일반 외래 환자들의 촬영보다는 과다한 검사와 피폭이 노출선량한도가 2배 이상 증가하는 실정이다. 따라서 병원 관리자 및 방사선취급자는 환자 방사선 촬영시 노출을 최소한으로 제한하고, 방사선피폭감소를 위해 병원의 종사자인 방사선사의 기술적인 연구와 및 보조연구자 및 의료인 등 모두가 예방할 수 있는 대책이 필요할 것으로 생각한다.

• 정보처리학회논문지D
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• 제12D권3호
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• pp.461-470
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• 2005

본 논문에서는 마케팅에서 주로 적용되는 CRM(Customer Relationship Management)의 군집분석 방법을 활용하여 콘텐츠 서비스를 이용하는 고객들을 서비스 패턴에 따라 세분화(Segmentation)하고, 군집별로 미디어 서버의 자원을 차별적으로 할당하여, 기업의 수익성을 높이기 위한 새로운 정책을 제시하였다. 새로운 서비스 정책의 구현을 위해 첫째, 고객 데이터에 대해 군집분석 중에서 K Means Method를 적용하여 고객들의 서비스 패턴 (총 사이트 방문 횟수, 서비스 종류, 서비스 이용 기간, 지불금액, 평균 서비스 시간, 사이트 방문 당 서비스 요금)과 수익에 대한 기석도 둥을 분석하였다. 고객들은 수익에 대한 기여도에 따라 4개의 군집으로 분류되었다. 둘째, 군집별로 미디어 서버 자원을 할당하는 알고리즘인 CRFA(Client Request Filtering Algorithm)를 제시하였다. CRFA 는 고객이 속한 군집의 자원 한도 내에서 승인제어를 실시하는 기능을 수행하였다. 분석된 결과에 의하면 CRFA를 적용하였을 때 기업의 네트워크 비용은 감소하고 기업의 수익에 기여도가 높은 군집에 속한 고객들의 수락률이 높아졌음을 알 수 있었다.

• Journal of Oral Medicine and Pain
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• 제33권1호
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• pp.67-73
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• 2008

구강건조증 환자의 미각기능과 치료에 따른 미각 기능의 변화를 알아보고자, 2006년 9월부터 2007년 7월까지 부산대학교 병원 구강내과에 내원한 환자 중에 구강검사를 통하여 구강건조증으로 진단된 환자를 실험군으로 선택하고, 2007년 9월부터 12월까지 부산대학교 병원 구강내과에 내원한 환자중에 구강검사와 설문지를 사용하여, 미각에 영향을 미칠 수 있는 전신질환, 약물복용, 구강내 연조직 질환을 가지고 있지 않은 환자를 대조군으로 선택하여 전기미각역치를 측정한 후 다음과 같은 결과를 얻었다. 1. 구강건조증 환자군과 대조군의 미각역치 비교에서 혀의 측면, 혀끝, 유곽유두에서 차이를 보였다. 2. 남성에서 구강건조증 환자군과 대조군의 미각역치 비교에서는 차이가 없었다. 3. 여성에서 구강건조증 환자군과 대조군의 미각역치 비교에서는 연구개를 제외한 모든 부위에서 환자군이 낮은 경향을 보였다. 4. 구강건조증 환자군의 치료에 따른 미각역치 비교에서는 초진 시와 1차 치료 후에서 차이를 보이지 않았으나 유곽유두에서는 차이를 보이는 경향이 있었다.

• 대한소아치과학회지
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• 제47권3호
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• pp.248-256
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• 2020

이 연구의 목적은 영유아구강검진의 효과를 치아우식 예방, 우식 치료행위, 치과진료비용이라는 다각적 관점에서 분석, 평가하는 것이다. 국민건강보험공단에서 제공하는 영유아검진코호트 데이터베이스를 활용하였고, 2008 - 2015년에 시행된 구강검진 1차 32,937건, 2차 22,608건, 3차 13,708건 및 2008년생과 2009년생 27,944명의 치과 진료 241,043건을 분석하였다. 2차와 3차 구강검진 결과를 통해 산출한 우식경험유치지수와 유치우식경험자율은 각각의 선행 구강검진 수검 횟수가 증가함에 따라 감소하였다. 유치의 급여 수복치료 및 치수치료, 유견치와 유구치의 조기 발치 시행 횟수는 구강검진 수검 횟수가 증가함에 따라 감소하였고, 전체 급여 치과진료비용 또한 수검 횟수가 증가함에 따라 감소하였다. 영유아구강검진은 치아우식을 예방하여 치아우식 관련 치료의 가능성을 줄이고, 따라서 치과진료비를 절감하는 효율적이고 경제적인 구강 건강 관리 방법이다.

• 보건교육건강증진학회지
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• 제20권1호
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• pp.91-109
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• 2003

The importance of repeat screening for stomach cancer is well known to decrease deaths from stomach cancer. This study was aimed at assessing practice behaviors and to identify related factors in the aspects of demographic factors, health status and cancer risk recognition, attitude to cancer screening, health behaviors, and inhibiting or facilitating factors to stomach cancer screening in an urban area. Data was collected through self-administered questionnaires from 403 people aged 40 to 69 years from April 23th to May 15th, 2002. Practice behaviors were classified as : "ever" or "never", and "repeat" or "not repeat" grouped based on a recent 5 year screening history. The results were as follows: 1. Among the 403 subjects: "the ever group" was 23.8% and "the repeat group" was 4.0%, The rates of screening were 20.5% for men, 27.8% for those women, and 27.3% for aged 40-49, 24.5% for those aged 50-59, 19.0% for those aged 60-69. The rates of repeat screening were 4.0% for men, 4.1% for women, and 2.9% for those aged 40-49, 6.3% for aged 50-59, 2.5% for those aged 60-69. 2. The main factors associated with adherence to gastric cancer screening were education(post high school vs below : OR=2.44), previous cancer screening(yes vs no : OR=2.61), belief in personal health(no vs yes : OR=2.72), health status(unhealthy vs healthy : OR=3.40), possibility of cancer compared to others(low vs not low : OR=2.56), and regular exercise(yes vs no : OR=2.94). The main factor associated with adherence to gastric cancer repeat screening was other cancer screening(yes vs no : OR=6.33). Consequently, there is a need to change the recognition of the importance and necessity of stomach cancer screening in healthy conditions through health education, and to perform multiple screening tests each visit.

• Annals of Geriatric Medicine and Research
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• 제22권4호
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• pp.176-183
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• 2018

Background: Although the frequency and intensity of headaches decrease in older adults, headaches in this population are still an important neurological disorder. The purpose of this study was to investigate the associations of headache characteristics in older adults with the development of cardiovascular disease and cognitive dysfunction. Methods: We prospectively enrolled 125 older (${\geq}65$ years old) patients with headache who were making their first visit to outpatient clinics and who had no prior history of cognitive dysfunction from 11 hospitals in Korea between August 2014 and February 2015. We investigated the occurrence of newly developed/or recurrent headache, cardiovascular disease, cognitive dysfunction, and poor functional outcomes. Results: The mean age of all included patients was 72.6 years, 68.8% were women, and 43 (34.4%) had newly developed/or recurrent headache during follow-up. During a median follow-up of 31 months (interquartile range, 28-34 months), 21 participants (16.8%) experienced cardiovascular disease, and 26 (20.8%) developed cognitive dysfunction. Upon multivariate analysis and after adjusting for sex, age, and other factors, presence of newly developed/or recurrent headache was found to be associated with cardiovascular disease (hazard ratio [HR], 4.03; 95% confidence interval [CI], 1.28-12.61; p=0.017) and frequency of headache for the recent 3 months was related with cognitive dysfunction (HR, 1.05; 95% CI, 1.00-1.09; p=0.017) and poor functional outcomes (HR, 1.06; 95% CI, 1.01-1.11; p=0.011). Conclusion: Our study demonstrated that there is an increased risk of cardiovascular disease, cognitive dysfunction, and poor functional outcomes in older patients with frequent, newly developed, or recurrent headache.

• 한국산림과학회지
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• 제104권1호
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• pp.140-149
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• 2015

본 연구는 산림 내 호수 주변에서의 산책과 경관감상이 인체에 미치는 생리적, 심리적 영향을 과학적으로 밝혀내고자 수행되었다. 실험지는 일본 아오모리현에 위치한 주니코(十二湖)주변의 산림으로 하였으며, 대조실험은 역 주변의 도시부에서 실시하였다. 실험 대상은 일본인 남자 대학생 11명($22.0{\pm}1.2$세)으로 하였다. 생리평가의 측정지표로 심박변이도, 심장박동수, 혈압, 맥박수 및 타액 중 코티솔 농도를 사용하였으며, 심리평가의 측정지표로 간이형 SD법, 스트레스-리프레쉬감 조사, POMS 및 STAI 상태불안을 사용하였다. 피험자는 산림과 도시에서 각각 1회씩 15분 동안 보행 및 경관감상을 실시하였다. 그 결과, 산림 내 호수 주변에서의 보행 및 경관감상은 도시와 비교하여, 부교감신경활동의 활성, 교감신경활동의 억제, 심장박동수, 혈압, 맥박수의 저하, 타액 중 코티솔 농도의 저하를 유발시키는 것을 알 수 있었다. 심리평가 결과, 쾌적감, 진정감, 자연감 및 리프레쉬감의 상승, 기분상태의 개선, 그리고 불안감의 저하를 보였다. 결론적으로, 산림 내 호수 주변에서의 산책 및 경관감상은 생리적, 심리적 안정 효과를 유발시킨다는 것을 알 수 있었다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제25권2호
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• pp.65-72
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• 2014

Objectives : The objective of this study was to evaluate the treatment duration and adherence of osmotic-controlled release oral delivery system (OROS) methylphenidate for treatment of attention-deficit hyperactivity disorder (ADHD). Methods : A total of 843 children with ADHD were recruited : 213 children (25.3%) who had previously taken medications for ADHD and 630 drug-na$\ddot{i}$ve children (74.7%) were recruited. The dosage was adjusted according to the clinician's judgment. The primary efficacy endpoint of this study was treatment retention rate, which was estimated at Week 12 and Week 20 using the Kaplan-Meier curve. The Swanson, Nolan and Pelham-IV (SNAP-IV), Clinical Global Impression-Severity (CGI-S), Clinical Global Impression-Improvement, and the side effect rating scale were measured at every visit. Remission rates were presented based on SNAP-IV and CGI-S, respectively. Results : The treatment retention rate at 12 weeks and at 20 weeks was 76.2% and 66.8%, respectively. Divided according to 6-8, 9-11, 12-14 and 15-18 years of age, younger children tended to show a statistically higher treatment retention rate (p=.02). Based on SNAP-IV and CGI scores, children with better response to medication showed tendencies of statistically higher treatment retention rate. The most common adverse events included loss of appetite (7.1%) and insomnia (3.3%). There was no serious adverse event related to the treatment, such as death. Conclusion : The use of OROS methylphenidate for treatment of ADHD was safe and tolerable for children. In this study, lower age and better treatment response showed a statistically significant relationship with higher treatment adherence. Boys showed a trend of high treatment adherence. The treatment adherence at 20 weeks was satisfactory, however, the treatment adherence after 20 weeks showed a sharp decrease. Therefore, treatment persistence for six months after the beginning of ADHD treatment is important. In addition, the positive role of psycho-education for children and parents is necessary for increasing treatment adherence.